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Objective To explore the clinical application value and feasibility of contrast-enhanced ultrasonography (CEUS) in rapid diagnosis for bleeding of hepatocellular carcinoma. Methods From January 2009 to December 2012, 58 patients from the 302nd Hospital of the People′s Liberation Army underwent CEUS and conventional ultrasound, who were suspicioused primary bleeding of liver cancer or secondary bleeding of liver cancer after percutaneous radiofrequency ablation (RFA). The change of effusion volume in front of liver and in abdominal cavity, the perfusion time, range and characteristics of contrast agent, tumor vessel and the characteristic manifestation of active bleeding within the tumor and subcapsular were evaluated. Theχ2 test was used to compare the show rates of lesion boundary and the bleeding point by conventional ultrasound and CEUS. The t test was used to compare the change of effusion in front of liver and in abdominal cavity from 0 min to 30 min after bleeding were diagnosis by CEUS. Results For 58 cases of suspicious rupture and bleeding of liver cancer, 34 cases were conifrmed by clinical and imaging ifndings. The bleeding points were detected by conventional ultrasound in 5 cases. The bleeding points in 30 cases (including 4 cases of rapid bleeding, 7 cases of medium bleeding and 19 cases of slow bleeding) were detected by CEUS. The detection rate of lesion boundary, tumor vessel and bleeding point of CEUS were higher than those of conventional ultrasound, and the differences were statistically significant (χ2=10.350, P=0.001; χ2=4.300, P=0.034;χ2=36.790, P=0.0007). CEUS showed that contrast agent continuously concentrated at the bleeding point of lesions, and different degrees of bleeding were shown as′jet-like′,′linear′or′intermittent′spillover. The volume of effusion in front of the liver and in abdominal cavity at 30 min was more than those at 0 min after bleeding were diagnosis by CEUS, and the differences were statistically significant (the volume of effusion in abdominal cavity:t=-3.467, P=0.026;t=-12.895, P=0.000;t=-3.055, P=0.007;the volume of effusion in front of the liver:t=-8.110, P=0.001;t=-5.642, P=0.002;t=-5.981, P=0.000). Conclusions CEUS can show direct signs of rupture and bleeding of liver cancer, and the degree of bleeding can be evaluated according to the extravasation characteristics of contrast medium and the changes of lfuid volume. Therefore, CEUS can provid an objective basis for rapid diagnosis of ruptured hepatocellular carcinoma in the emergency scene and bedside.
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Objective To explore imaging feature of muscle crush injury of extremity on contrast enhanced ultrasound (CEUS) by an animal experiment.Methods Twenty-eight New Zealand rabbits were anesthetized by intramuscular pentobarbital sodium (30 mg/kg).A special balloon cuff device was used to create left hind leg crush injury with a force of (18.6 kPa).23 of the 28 rabbits had crush injury of extremity and survived for 72 hours.CEUS evaluated infusion model and contrast intensity in crush region of hind leg at the 0.5,2,6,24 and 72 hour after the release of the crushing pressure.Peak intensity (PI) was analyzed by comparing with serum creatinekinase (CK) and myoglobin (MYO).Results Twenty-three rabbits presented that the area of crushed region in left hind leg was 60 cm2,accounting for 2.6％-3.0％ of body surface area.In different time after decompression,the crushed regions showed rapid enhancement and the intensity was higher than that of no-crushed region.The time-intensity curves of crushed regions all appeared as fast wash-in and slow wash-out.PIs of rushed regions were higher obviously than those of nocrushed regions (P ＜0.001).ROC curves were employed in diagnosis value of PI for crushed region.And PIs showed positive correlation with CK and MYO and the correlation coefficient was 0.833-0.996.Conclusions CEUS presents that the micro-circulation perfusion of the crushed muscle increased obviously after the release of the crush pressure.PIs evaluated quantitatively the micro-circulation perfusion changes.It suggests a potential alternative for evaluating micro-circulation abnormality and ischemia reperfusion injury of the muscle crush injury to extremities.
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Objective To quickly evaluate the traumatic degree of abdominal solid-organs using contrast-enhanced ultrasonography (CEUS) and analysis on related factors with clinical treatment.Methods 52 patients with abdominal traumatic were observed by CEUS,and the traumatic degree was judged according to American Association for the Surgery of Trauma (AAST).The change of peritoneal fluid was observed with ultrasonography,and active bleeding and involve adjacent vessels their branches were observed with CEUS.In this way,a method of quickly evaluate the traumatic degree was established,and the correlation between indifferent grade trauma and appropriate interventions that include surgical and conservative treatment was studied.Results 52 patients with 71 lesions,compound injuries accounted for 82.7％ (43/52).Among them,37 lesions were Ⅰ-Ⅲ grade trauma,34 lesions were severe trauma of Ⅳ-Ⅴ grade.The lesions complicated with active bleeding were 76.1％ (54/71).The amount of peritoneal fluid was increased significantly within 30 min (P ＜0.05) in traumatic lesions with rapid bleeding.Among of 50lesions associated with active bleeding,the surgical treatment was 24.0％ (12/50),the conservative treatment was 76.0％ (38/50).Among of trauma lesions involving the two following vessels,Ⅰ-Ⅲ grade was 97.3％ (36/37),Ⅳ-Ⅴ grade was 61.8％ (21/34).Trauma involvement above level 2 focal blood vessels,surgical treatment accounted for 23.1％ (12/52),conservative treatment accounted for 44.2％(23/52).Conclusions The severity of the trauma can not be a comprehensive response by AAST,becauce it is not only related to the scope of the traumatic lesions,vascular level,also involved with the trauma associated with active bleeding,bleeding speed and amount of peritoneal effusion and other factors.
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Objective To explore contrast-enhanced ultrasonography (CEUS) in diagnosis renal injuries complicated with active bleeding of different velocity,and analysis the related factors of renal traumatic degree.Methods Thirty-four Ⅰ - Ⅴ grade lesions of renal injury were made in 4 dogs and 6 New Zealand rabbits.Two and three dimensional CEUS were used to observe traumatic extension,and traumatic position,involving in vascular as well.Then the injury condition was classified and assessed synthetically.Results The range of lesions observed by using 2D and 3D ultrasound had consistency with those of the pathologic sample (length-diameter:F =0.4724,P =0.6252; transverse diameter:F =1.6174,P =0.20490),3D-CEUS can display the vascular that involved by renal injury.In the same traumatic extension condition,the time of animal becoming shocked and injury severity was related to not only traumatic extension but also different velocity of active bleeding and involving in vascular.Conclusions Contrastenhanced ultrasound can objectively reflect renal injury severity,and more information can be provided to clinical for management.
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ObjectiveToexplore the appearance ofmusclecrushinjuryatquantitative ultrasonographic elastography by supersonic shear imaging (SSI).MethodsThe animal experiment was done using a special balloon cuff device to create left hind leg crush injury with a force of 18.6 kPa.Twentythree New Zealand rabbits had crush injury of extremity and survived for 72 hours.SSI quantitative elastography was performed in crushed and no-crushed regions of each rabbit hind leg.Quantitative lesion elasticity was measured in terms of the Young modulus (in kilopascals) at 30 min,2 h,6 h,24 h and 72 h after the release of the crushing pressure.A receiver operating characteristic (ROC) curve analysis was used to assess diagnostic performance.ResultsThe area of crushed region in left hind leg accounted for 2.6％ -3.0％ of body surface area in 23 rabbits.The crushed regions exhibited maximum elasticity values of (19.51 ± 6.74)kPa,(21.47 ± 5.54) Pa,(11.36 ± 5.35)kPa,(15.09 ± 3.31)kPa and (13.72 ± 3.74) kPa,and mean elasticity values of (12.44 ± 3.77)kPa,(13.20 ± 3.60)kPa,(6.80±2.86)kPa,(10.04 ± 2.95)kPa and (6.94 ± 0.97)kPa at 30 min,2 h,6 h,24 h and 72 h after the release of the crushing pressure.Comparing with those of no-crushed regions,they were higher obviously (P＜0.001).ROC curves showed that extremity crush injury was diagnosed by using elasticity value,and the greater the elasticity value,the greater the diagnostic value.Conclusions SSI provides quantitative elasticity measurements,thus adding complementary information that potentially could help in crush injury characterization with conventional ultrasonography.
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<p><b>OBJECTIVE</b>To explore the efficacy of injectable gelatin matrix as a hemostatic agent for treatment of grade III-IV hepatic trauma to a canine model with contrast-enhanced ultrasound (CEUS) guidance.</p><p><b>METHODS</b>Twenty-seven healthy adult dogs underwent celiotomy in induce grade III-IV hepatic trauma in the left lateral lobe of the liver. The dogs were then randomized into 3 groups, namely the treatment group in which the injectable hemostat was percutaneously injected into the injury site under CEUS guidance, and the positive and negative control groups with thrombin solution and normal saline treatment, respectively. Intra-abdominal blood loss within 30 min postoperatively, and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 7 days postoperatively were compared among the groups. Follow-up CEUS was performed in each animal 7 days after the operation.</p><p><b>RESULTS</b>The mean blood loss was 47.69 ml in the treatment group, significantly less than that in the positive control group (81.77 ml, P/0.01) and negative control group (110.35 ml, P<0.01). The treatment group had also significantly lower ALT and AST levels than the two control groups (ALT: 49.37, 62.81, and 82.83 U/L, respectively, P<0.05; AST: 48.32, 67.16, and 82.54 U/L, respectively, P<0.05). In the treatment group, CEUS did not detect hepatic lesions or ascites as found in the two control groups, and the perfusion of the liver was homogeneous.</p><p><b>CONCLUSION</b>The injectable hemostat injected under the guidance of CEUS can effectively control grade III-IV hepatic hemorrhage in the canine model and show strong effects of stopping bleeding and promoting wound healing.</p>
Subject(s)
Animals , Dogs , Contrast Media , Gelatin , Therapeutic Uses , Hemostasis, Surgical , Liver , Wounds and Injuries , Ultrasonography, InterventionalABSTRACT
<p><b>OBJECTIVE</b>To investigate the relationship between hepatitis B and gallstones using epidemiological methods.</p><p><b>METHODS</b>The analysed data from 510 patients with hepatitis B and 359 patients with other diseases treated in our hospital from the period January 1998 to June 2001 were retrospectively analysed. The patients with hepatitis B were classified into groups. The incidence of gallstones was determined in each group. Queue study method was used to calculate RR in each group and statistical analysis was conducted to determine difference among different groups.</p><p><b>RESULTS</b>As compared the patients gallstone with the patients with other diseases RR in those with hepatitis B (including those with chronic hepatitis or liver cirrhosis) was significantly higher (P<0.01). The value of RR was not markedly increased in patients with acute hepatitis or cholestatic hepatitis. After long-term administration of Chinese herbal medicine, the incidence of gallstones in patients with hepatitis B was decreased.</p><p><b>CONCLUSIONS</b>Chronic pathological changes in patients with hepatitis B may be one of the causes for gallstones. This may provide epidemiological basis for prevention and treatment of gallstones.</p>