MEETING ABSTRACTS

CSUM 2019 ABSTRACTS

The Annual National Congress of the Chinese Society of Ultrasound in Medicine (CSUM) is one of the most prestigious and influential academic conferences in China, with the largest number of participants. The 19^th conference will be held in Hefei, Anhui from August 29 to September 1, 2019. The scientific program of the meeting received 3,441 proceeding papers which covers the latest developments and trends in basic and clinical ultrasound research, continuing education and promotion of ultrasound-related guidelines and consensus, clinical application of new technologies such as interventional ultrasound, elastography, real-time three-dimensional ultrasound, and contrast-enhanced ultrasound.

The conference will hold a Young English-Presentation Forum to provide a stage for early career doctors to display academic achievement and cultivate the international vision of young physicians. A total of 385 papers were submitted for this forum, including 30 on Ob/Gyn ultrasound, 85 on abdominal ultrasound, 60 on interventional ultrasound, 135 on superficial organs and vascular ultrasound, and 75 on echocardiography. Under the recommendation of the Academic Committee of the General Assembly, the journal of AUDT selected 32 abstracts from the oral presentation group and 23 abstracts from poster presentation group to be published online and in print. Following publication in AUDT, these abstracts can be cited as scientific publications and shared with the international community.

CSUM19-e43351

Ultrasound Guided Delineation of the Recurrent Laryngeal Nerve and the Presence of Tubercle of Zuckerkandl and Its Effect on RLN in Patients with Hoarse Voice

Homagni Sikha Roy

Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University

Objective: To present an initial attempt in patients with long standing hoarseness to utilize Ultrasound as a direct, non-invasive method for the delineation of the Recurrent Laryngeal Nerve (RLN) and the presence of Tubercle of Zuckerkandl (ToZ) and its effect on RLN. Hoarseness is an abnormal change in voice characterized by strained or harsh voice with slow changes in volume or pitch.

Methods: RLN from a Healthy control group of 50 people without any hoarseness and a Patient group of 50 people with symptoms of hoarseness were compared upon examining by Ultrasound. On both sides of the neck, RLN is identified and its distance is calculated from the skin, sternocleidomastoid muscle, mid line of the trachea and the carotid artery. Diameter of the Nerve is also calculated. The ToZ is searched for in all patients belonging to both study groups.

Results: Compared to the Healthy control group, The Patient group showed a minor change in the measurement of all the values including the distance of both left and Right RLN from the skin, sternocleidomastoid muscle, carotid artery and the midpoint of the trachea. A small decrease in the value of the diameter of RLN in both left and right side of the neck is noted in the patient group people presenting with hoarseness. Another interesting finding is the identification of the ToZ in few but not all patients in the posterolateral aspect of the thyroid lobe.

Conclusion: This method of RLN delineation and identification of the ToZ and its effect on RLN in patients with hoarse voice would be very beneficial not only in deducing the relationship between hoarseness and morphological changes of RLN but also in surgical practice both in the pre-operative and post-operatvie period. This might be an effective method for deducing the exact cause of hoarseness; its effect on RLN; relationship to the presence of Tubercle of Zuckerkandl and the other associated findings encountered due to hoarseness.

CSUM19-e49451

Effectiveness of Vascular Ultrasonography in The Diagnosis and Evaluation of Vertebral Artery Ostium Stenting

Jingzhi Li, Yang Hua, Ran Liu, Xiaojie Tian, Liqun Jiao Xuanwu Hospital, Capital Medical University

Objective: Vertebral artery ostium stenosis (VAOS) is commonly treated by stenting in clinical practice. However, the high incidence of in-stent restenosis (ISR) remains unresolved. In this study, the VAOS stenting follow-up was conducted by Color Doppler ultrasonography (CDUS), the hemodynamic parameters acquired by CDUS was analyzed to evaluate the effectiveness of imaging modality post-procedure, and the occurrence characteristics of ISR after the procedure was present as well.

Methods: Patients who underwent stenting of the VAOS in our center from January 2013 to December 2014 were enrolled consecutively. CDUS was used to conduct regular follow-up for patients, and peak systolic velocity (PSVos) and end diastolic velocity (EDVos) in the ostium segment of vertebral artery, peak systolic velocity (PSViv) and diastolic velocity (EDViv) in intervertebral segments (c4-5 or c3-4) were recorded. Survival analysis was applied to calculate the cumulative incidence of restenosis at different time points within 2 years after stenting.

Results: A total of 420 patients were recruited in this study for final analysis. The preoperative was 307±103cm/s, which significantly decreased to 109±31cm/s after the procedure (P <0.01). EDVos was decreased from 97±44cm/s before surgery to 31±8cm/s (P <0.01). Meanwhile, the hemodynamic parameters of the distal intervertebral segment of the target vessel were also significantly improved, which was manifested by significantly increased PSViv and EDViv (P < 0.01). ISR occurred in 120 patients (36.4%) and the median time of follow up period was 12 months (IQR 4, 15，range 2-24), 85.0% of these ISR occurred within 1 year after stenting. When ISR occurred, the diameter of vertebral artery decreased from 2.9±0.5mm to 1.6±0.6mm ( P <0.01), the PSVos increased from 110±26cm/s to 224±79cm/s ( P < 0.01), and the EDVos increased from 31±8cm/s to 68±29cm/s ( P < 0.01).There were statistically significant differences in hemodynamic parameters among different ISR degrees as well (P < 0.05).

Conclusion: This study indicated that 1 year after the VAOS stenting was a period of high ISR incidence, therefore the follow-up should be more aggressive within 1 year after the vertebral artery stenting, in order to achieve early detection and treatment to improve the prognosis of these patients. CDUS, as an effective and non-invasive imaging modality, should be widely used in the follow-up after VAOS stenting.

CSUM19-e49477

Assessment and Differentiation of Breast Cancer Metastatic and Reactive Sentinel Lymph Nodes with B7-H3-Targeted Ultrasound Molecular Imaging in Mouse Models: A Longitudinal Study

Fengyang Zheng b,c, A-MASAMY PAULMURUGAN Ra, Beijian Huangb, Pan Lid

^a Stanford University, California 94304, USA; ^b Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China; ^c Shanghai Institute of Medical Imaging, Shanghai 200032, China; ^d Department of Ultrasound, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China

Objective: To explore the potential of B7-H3-targeted ultrasound (US) molecular imaging for longitudinal assessment and differentiation of metastatic and reactive sentinel lymph nodes (SLNs) in breast cancer and inflammation mouse models.

Methods: Breast cancer (n=20) and inflammation (n=5) mouse models were built by inoculation of either 4T1 breast cancer cells or Complete Freund’s Adjuvant (CFA) to the 4th mammary fat pad in female BALB/c mice. At day 21, 28, and 35 after inoculation, US molecular imaging was performed for SLNs following intravenous injection of B7-H3-targeted microbubbles (MB_B7-H3) or IgG-control microbubbles (MB_control). After the last imaging session (day35), all examined SLNs were harvested after euthanizing all the mice and subjected to HE staining for evaluation of metastasis. Volume fraction of metastasis (VFM) was calculated and correlated with MB_B7-H3 signal.

Results: HE staining showed that nine of the 20 SLNs from tumor-bearing mice (T-SLNs) displayed metastasis. From day 21 to day 35, metastatic T-SLNs (MT-SLNs) showed a rising trend in MB_B7-H3 signal, with a steep increase at day 35 (213.5 ± 80.8 a.u.) as compared to day 28 (87.6 ± 77.2 a.u., P=0.002) and day 21 (55.7 ± 35.5 a.u., P<0.001). At day 35, MT-SLNs had significantly higher MB_B7- H3 signal than non-metastatic T-SLNs (NMT-SLNs) (101.9 ± 48.0 a.u., P=0.001) and C-SLNs (SLNs from CFA-injected mice) (38.5 ± 34.0 a.u., P=0.001); MB_B7-H3 signal was significantly higher than MB_control signal in MT-SLNs (98.0 ±35.2 a.u., P=0.001), but not in NMT-SLNs or C-SLNs (both P>0.05). A significant correlation was detected between MB_B7-H3 signal and VFM with a correlation coefficient of 0.76 (95% confidence interval: 0.59, 0.94; P=0.017). Area under the ROC curve of MB_B7-H3 signal for differentiating MT-SLNs from NMT-SLNs and C-SLNs was 0.91 (95% confidence interval: 0.77, 1.00; P=0.001).

Conclusion: B7-H3-targeted molecular US imaging is of great value for diagnosing metastatic SLNs and can evaluate the extent of metastatic involvement in SLNs.

CSUM19-e51819

Combined Use of Superb Microvascular Imaging and Strain Elastography with Greyscale Ultrasound according to the BI-RADS Classification for the Differentiation of Benign from Malignant Breast Masses

Ming Liang

Sun Yat-sen Memorial Hospital, Sun Yat-sen University

Objectives: To evaluate the combined use of superb microvascular imaging (SMI) and strain elastography (SE) with greyscale ultrasound (US) according to the Breast Imaging Reporting and Data System (BI-RADS) classification for the differentiation of benign from malignant breast masses.

Methods: In total, 166 patients with 177 breast masses categorized as BI-RADS 3-5 were included in the study between April 2016 to September 2017. US, SMI, and SE were performed to evaluate each mass. The following outcome measures were compared between US and the combination of US, SMI, and SE: area under the receiver operating characteristic curve (AUC), sensitivity, specificity. The pathologic results were the reference standards.

Results: The addition of SMI and SE to US increased the AUC from 0.816 to 0.948 (P< .001); and the specificity from 43.7 % to 80.8 % (P< .001), without a significant decrease in sensitivity. Meanwhile, 66.1 % (37 of 56) of the benign masses that were indicated for unnecessary biopsy were correctly changed to follow-up.

Conclusion: The addition SMI and SE to US could improve the diagnostic performance in differentiating benign from malignant breast masses compared to US alone. When US was combined with SMI and SE, the specificity was increased, thus significantly reducing unnecessary biopsies.

CSUM19-e47120

Nanosonosensitizers for Highly Efficient Sonodynamic Cancer Theranostics

Ju Huang

The Second Affiliated Hospital of Chongqing Medical University

Multifunctional nanoplatforms with diagnostic-imaging and targeted therapeutic functionality (theranostics) are of great interest in the field of precision nanomedicine. The emerging sonodynamic therapy (SDT) combined with sonosensitizers under the guidance of photoacoustic (PA) imaging is highly expected to accurately eliminate cancer cells/tissue. Unique core/shell-structured theranostic FA-HMME-MNPs-PLGA nanoparticles (FHMP NPs, FA: folate, HMME: hematoporphyrin monomethyl ether, MNPs: melanin nanoparticles, PLGA: poly (lactic-co-glycolic) acid) were constructed by the integration of MNPs (for PA imaging) in the core and HMME in the shell for enhanced PA imaging-guided SDT, which were further functionalized with a tumor-targeting ligand, FA. The PA imaging-guided SDT was systematically and successfully demonstrated both in vitro and in vivo. The high biosafety of FHMP NPs was also systematically evaluated.

CSUM19-e55476

Computer-aided Detection in Automated Breast Ultrasound: Comparison of The Performance of A New 3D CNN Algorithm System with A Commercial System

Hongping Song, Shanling Yang, Liwen Liu

The First Affiliated Hospital of Air Force Military Medicine University

Objectives: To develop an automated breast ultrasound (ABUS) computer-aided detection (CAD) system using 3D Convolutional Neural Networks (CNN), and compare the performance to a commercial ABUS CAD system on the detection of breast cancer.

Methods: We developed a new CAD system using 3D CNN for scenarios of clinical breast cancer screening, with a set of 1,400 ABUS examinations for training, including 632 malignant examinations. Then another 393 diagnostic and screening ABUS examinations were retrospectively and randomly selected from two institutions. Examinations included 293 women with 293 biopsy-proven cancers, and 100 with negative results with 1-year follow-up were evaluated by using a commercial CAD system (QView Medical Inc, Los Altos, CA) and the developing CAD system. For each woman, 2-4 acquisitions per breast were performed. CAD marks were considered positive if, on at least one acquisition, they correctly identified the corresponding lesion location. CAD performance was assessed as sensitivity and false-positive findings per volume in women with negative results. The McNemar test was used to determine statistical significance for the matched group sensitivity of two CAD systems.

Results: The overall sensitivity of the developing CAD system (96% [280/293]) was similar to that of the commercial CAD system (94% [274/293]) (P>.05). The developing CAD system and commercial CAD correctly marked 258 (96%), 254 (94%) of 270 lesions of invasive carcinoma, and 22 (96%), 20 (87%) of 23 lesions of noninvasive carcinoma, respectively (all P>.05). For the developing CAD system, with the lesion size increases, the sensitivity will be higher (P=.01). The average number of false-positive findings per volume was 0.29 (range,0-6) of the developing CAD system and 0.21 (range, 0-6) of the commercial CAD system.

Conclusion: The developing ABUS-CAD system has a similar performance compared to the commercial CAD system on the detection of breast cancer. Further research is warranted including larger training samples to improve CAD performance and in a multi-center prospective study to investigate the usefulness of 2 kinds of CAD systems in breast cancer screening with ABUS.

CSUM19-e56297

Malignant Risk Stratification of Cytological Indeterminate Thyroid Nodules Based on American College of Radiology Thyroid Imaging Reporting and Data System

Jingliang Ruan, Baoming Luo

Sun Yat-sen Memorial Hospital, Sun Yat-sen University

Objectives: Based on the reduction in thyroid nodule biopsies and improve accuracy with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS), we hypothesized that ACR-TIRADS should stratify the risk of malignancy of cytologically indeterminate thyroid nodules (ITNs).

Methods: Ultrasound images of 515 ITNs (62% atypia/follicular lesions of undetermined significance; 38% follicular neoplasms) with histological follow-up consecutively evaluated between July 2015 and December 2018 at the author’s academic hospital were independently evaluated by three observers and classified into one of the five levels proposed by the ACR-TIRADS. Differences in clinical and histological findings between the ACR-TIRADS levels were assessed. The prevalence of malignancy and odds ratio for malignancy were calculated for each ACR-TIRADS level (benign and not suspicious were collapsed for the analysis).

Results: The distribution of size and cytological diagnosis was significantly different between ACR- TIRADS levels (P < 0.001). The overall rate of malignancy was 29%. The rate of malignancy for the benign, not suspicious, mildly suspicious, moderately suspicious and highly suspicious levels were 0%, 3%, 12%, 28%, and 69%. Compared to the benign/not suspicious level, the odds ratios for malignancy were 5.27 for the mildly suspicious level (P =0.011), 14.99 for the moderately suspicious level (P < 0.001) and 83.41 for the highly suspicious level (P < 0.001). Results were similar in both cytological categories and for each observer separately. ACR-TIRADS levels were associated with distinct histopathological profiles (P < 0.001).

Conclusion: ACR-TIRADS levels are associated with distinct clinical features and pathological outcomes, and effectively stratify the cancer risk in ITNs. Thus, the ACR-TIRADS should be used not only to set the size threshold for biopsy but also to personalize management after the biopsy.

CSUM19-e55934

Using VFM Technique to Evaluate the Clinical Value of Left Intraventricular Pressure Gradients in Patients with Heart Failure

Yao Xu, Mengmeng Li, Mingjun Xu, Mei Zhang

Qilu Hospital of Shandong University

Objective: Intra-ventricular pressure differences (IVPDs) & intra-ventricular pressure gradients (IVPGs) were not widely used in clinical practice due to their limitations in measurement. This study aims to evaluate the clinical value of IVPDs and IVPGs in patients with heart failure during each cardiac cycle by vector flow mapping (VFM).

Methods: Forty-nine patients with heart failure with LVEF lower than 0.50 and 43 age-matched controls were enrolled in this study. Clinical data and echocardiographic images were collected and the main conventional ultrasound parameters analyzed. We entered the VFM station in the apical 3-chamber view and identified each phase by combining the flow-time curve and ECG. A sampling line was set parallel from the level of mitral annulus to the apex to obtain the IVPDs and IVPGs.

Results: IVPDs and IVPGs in heart failure group were reduced compared with the control group especially in isovolumic relaxation phase (IVPD-IR 0.38±0.25 vs 1.44±1.02 mmHg, p<0.001; IVPG-IR 0.07±0.12 vs 0.27±0.23mmHg/mm, P<0.001). IVPDs and IVPGs in patients with reduced ejection fraction (HFrEF) were further reduced than those in heart failure middle range ejection fraction (HFmrEF). However, there was no significant difference in IVPDs and IVPGs in patients with different NYHA cardiac function grades. IVPDs & IVPGs in all phases were correlated with LVEF, GLS, EDVI, LAVI, E/e’. The cut-off value of IVPD-IR and IVPG-IR to detect patients with HF (LVEF<0.50) were<0.73 mmHg (AUC=0.915, P<0.001) and <0.103mmHg (AUC=0.932, P<0.001), and that to detect the patients with HFmrEF (LVEF 0.40-0.50) were <0.68mmHg (AUC=0.894, P<0.001) and <0.095mmHg (AUC=0.912, P<0.001).

Conclusion: The IVPDs and IVPGs in all phases of cardiac cycle are surrogate parameters that reflect LV systolic and diastolic function in patients with heart failure especially in isovolumic relaxation phase. Both IVPD-IR and IVPG-IR are useful to distinguish patients with HF.

CSUM19-e58223

A Study to Quantitative Assess of the Elasticity of the Common Carotid Artery in Chinese Adults

Yao Wei

Peking Union Medical College Hospital

Objective: A population-based study of ultrasound measurements of carotid elasticity by using quality arterial stiffness (QAS) to assess changes in relevant parameters in Chinese adults.

Methods: Cohort studies of carotid QAS in 636 Chinese adults (mean age 54.1 years) in the northern countryside between July 2013 and April 2016. Arterial stiffness parameters included pulse wave velocity (PWV), stiffness indices α and β and compliance coefficient (CC) calculated by QAS. Other clinical indicators included physical measurements and medical history.

Results: The overall mean PWV in the study was 9.3m/s (SD 2.4), which increased by approximately 1.08 m/s (SE 0.08) per 10 years of age. The overall mean α in the study was 7.54 (SD 5.06), which increased by approximately 1.338 (SE 0.163) per 10 years of age. The overall mean β in the study was 15.31 (SD 10.16), which increased by approximately 2.715 (SE 0.345) per 10 years of age. The overall mean CC in the study was 0.61mm2/kPa (SD 0.26), which decreased by approximately 0.074mm2/kPa (SE 0.008) per 10 years of age. The overall mean PWV increased with SBP by approximately 0.35m/s (SE 0.09) for every 10 mmHg increase in SBP. The overall mean α in the study was 7.54 (SD 5.06), which increased with SBP by approximately 0.132 (SE 0.031) for every 10mmHg increase in SBP. The overall mean β in the study was 15.31 (SD 10.16), which increased with SBP by approximately 0.147 (SE 0.100) for every 10mmHg increase in SBP. The overall mean CC in the study was 0.61mm2/kPa (SD 0.26), which decreased with SBP by approximately 0.017 mm2/kPa (SE 0.003) for every 10 mmHg increase in SBP. The results of the QAS analysis show that PWV was much higher in the participants with hypertension (P = 0.010). The PWV and the stiffness indices α and β were much higher in participants with diabetes (P = 0.004, P = 0.027, and P = 0.001, respectively).

Conclusion: The ultrasound automated QAS technique can be used to noninvasively and comprehensively assess local arterial elasticity. A total of 636 participants were enrolled in our present study at baseline. The present study provides important information regarding the association between arterial function and risk factors for CVD.

CSUM19-e58985

Intraoperative Identification and Guidance of Breast Cancer Microfoci Using Ultrasound and Near-Infrared Fluorescence Dual- Modality Imaging

Desheng Sun, Xiaona Lin, Xiao Zhang, Shumin Wang, Xiaolong Liang, Min Chen, Chuang Gao, Renfa Liu, Zhifei Dai

Peking University Shenzhen Hospital

The traditional method of labeling the nonpalpable breast cancer is placing a guidewire or metal marker guided by ultrasound or stereographic mammogram before surgery. However, the wire localization has a risk of displacement and could be an obstacle in the surgical course. To avoid these issues, we tried to combine the near-infrared (NIR) fluorescence dye dioctadecyltetramethyl indotricarbocyanine iodide (DiR) and microbubbles (MBs) to realize the dual-modality imaging for breast cancer microfoci intraoperative identification and guidance as a more efficient workflow. First, 24 mice were divided into three groups, injected with DiR nanoparticles (NPs), DiR MBs, and DiR MBs + ultrasound (US), and then, in vivo and ex vivo NIR fluorescence imaging was conducted, respectively. The distinction of fluorescence imaging intensity at the tumor site among the three groups was statistically significant (P < 0.001). Group 3 (DiR MBs + US) exhibited the highest fluorescence imaging intensity; the distinctions between group 3 and group 1 (DiR NPs) and group 3 and group 2 (DiR MBs) were both statistically significant (p = 0.001, p = 0.003), while the distinction between group 1 and group 2 was not statistically significant (p = 1.0). The results above validated the advantage of fluorescence imaging by using ultrasound-targeted MB destruction. Second, two kinds of subcutaneous breast cancer mice models [4T1-luc (n = 5)/MCF-7 (n= 3)] received tumor resection, and NIR fluorescence and bioluminescence images were obtained to detect tumor residuals. We found that the small residual tumor tissues, metastatic lymph nodes, and even the surrounding infiltrated tissue all can be indicated by the fluorescence imaging and verified with bioluminescence and histological examination. In addition, the residual tumor cells appeared as tumor recurrence 22 days post-operation and were confirmed with contrast-enhanced ultrasound (CEUS) in vivo. Thereby, ultrasound-targeted DiR MB destruction and then conversion into DiR NPs were feasible for intraoperative identification and guidance of nonpalpable breast cancer foci.

CSUM19-e48959

Clinical Research of Real-time Shear Wave Elastography in Differential Diagnosis of Hepatic Alveolar Echinococcosis and Hepatocellular Carcinoma

Qingyang Meng, Shumei Ma

QingHai University Affiliated Hospital

Objective: To evaluate the sonographic features of real-time shear wave elastography (SWE) in patients with hepatic alveolar echinococcosis (HAE) and hepatocellular carcinoma (HCC) and investigate the clinical application of SWE in the differential diagnosis of HAE and HCC.

Methods: There were 20 cases in the HAE group and 30 cases in the HCC group in the study. All the cases were performed SWE before surgery, the mean elasticity of Young’s modulus of all the cases was obtained. All the lesions were confirmed by pathologies as the gold standard. SWE results were compared with the pathologies to evaluate the accuracy and efficacy of using SWE to diagnose the HAE and HCC.

Results: The mean elasticity of Young’s modulus of the lesions was (34.57±10.76) kPa in the HAE group and (21.82±3.51) kPa in the HCC group. The mean elasticity of Young’s modulus of lesions had a significant difference between HAE and HCC groups (P<0.001). The critical point of the mean elasticity of Young’s modulus of the lesions between HAE and HCC was 27.43Kpa by ROC curve, the sensitivity was 80%, and the specificity was 97%. The area under the ROC curve was 86.9%.

Conclusion: SWE has an important value of clinical application in diagnosis between HAE and HCC.

CSUM19-e49984

Saline-contrast Ultrasound versus Upper Gastrointestinal Contrast Series for the Diagnosis of Upper Gastrointestinal Obstruction in Neonates and Infants: A Prospective Multicentric Study

Shuling Chen a, Luyao Zhou a, Juncheng Liu b, Xiaoyan Xie a

^a Department of Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University; ^b Department of Pediatrics Surgery, The First Affiliated Hospital of Sun Yat-sen University

Objective: Timely accurate diagnosis of upper gastrointestinal (UGI) obstruction is of great importance to make in-time treatment management to optimize outcomes for neonates and infants. We aimed to evaluate the diagnostic value of saline- contrast ultrasound in UGI obstruction for neonates and infants, and to compare it with UGI contrast series.

Methods: In this prospective multicentric study between Jun 2015 to Feb 2019, 275 pediatric patients with the clinical presentation of UGI obstruction who underwent saline-contrast ultrasound were included, with 209 of them also underwent UGI contrast series. Surgical finding or follow-up was taken as the reference standard of the diagnosis of UGI obstruction. The primary outcome was the diagnostic performance in the obstruction. The secondary outcomes were the diagnostic accuracy in the level, severity, and etiologies of obstruction. Comparisons between saline-contrast ultrasound and UGI contrast series were performed.

Results: A total of 152 patients were diagnosed with UGI obstruction. Saline-contrast US yielded a good performance in diagnosing UGI obstruction in both the entire cohort (n=275, AUC=90.1% (95% CI: 86.9%-94.0%)) and sub-cohort (n=209, AUC=91.4% (95% CI: 86.8%-94.8%)), with the sensitivity, specificity, PPV and NPV of 92.1%, 89.4%, 91.5%, 90.2%, and 93.8%, 89.1%, 95.1%, 86.4%, respectively. In the sub-cohort (n=209), the AUC of contrast UGI series in diagnosing UGI obstruction was 89.8% (95% CI: 84.9%-93.5%), which was comparable to that of saline-contrast US (P=0.571). In patients with UGI obstruction who underwent two imaging modalities (n=145), saline-contrast US was not significantly different to UGI contrast series in diagnosing the level of obstruction (73.7% vs. 67.2%, P=0.368), but was superior in diagnosing the severity of obstruction (76.6% vs 59.6%, P<0.001). Saline-contrast US showed moderate to high diagnostic accuracy in annular pancreas, duodenum septum and enteric atresia with AUC being 72.4%, 79.8% and 94.4%.

Conclusion: Saline-contrast US is effective in detecting UGI obstruction for pediatric patients, which was comparable to UGI contrast series in diagnostic accuracy. Saline-contrast US can provide informative data about obstructive level, severity, and etiologies.

CSUM19-e57960

Clinical Application of Intra-hepatic Arterial Contrast Enhanced Ultrasound in the Evaluation of the Characteristics of the Drainage Area of Hepatocellular Carcinoma: Comparing with Traditional Contrast Enhanced Ultrasound

Bo Jiang, Xiang Fei, Peng Han, Yukun Luo, Zhijun Wang

Chinese PLA general hospital

Objective: To evaluate the role of the Intra-hepatic arterial contrast enhanced ultrasound (IHA-CEUS) in showing blood drainage area Characteristics in hepatocellular carcinoma (HCC) during transarterial chemoembolization (TACE) by comparing with traditional contrast enhanced ultrasound (CEUS).

Methods: patients who were clinically diagnosed as HCC underwent TACE therapy during August 2018 - February 2019 in interventional radiology department of PLA general hospital (china) were enrolled in this study. IHA-CEUS and traditional CEUS were performed before TACE by means of injection of the contrast agent Sulphur hexafluoride (Sonovue). Corona enhancement of the drainage area was recorded and the thickness was compared in both imaging modalities. The relationship between the thickness of the enhancement ring and the size of the lesion was also analyzed.

Results: 55 HCC lesions in 44 Patients were enrolled in this study. The visualization rate of the drainage area in IHA-CEUS was 83.6% (46/55), respectively, 23.7% (13/55) for PV-CEUS (P＜0.001). The average thickness of the drainage area in PV-CEUS and IHA-CEUS was 0.60±0.34 and 1.03±0.69 (P=0.005). Compared with the PV-CEUS, the visualization rate in IHA-CEUS of the drainage area in HCC less than 3cm, 3-5cm and 5cm lesions was 78.1% (25/32), 91.7% (11/12) and 90.9% (10/11) vs 15.6% (5/32), 41.7% (5/12) and 27.3% (3/11), respectively, with statistically significant differences (P < 0.001, P=0.031, P=0.016). There was a positive linear correlation between tumor size and drainage area thickness (r=0.416, P=0.004).

Conclusion: Compared with conventional contrast enhancement ultrasound, intra-hepatic arterial contrast enhancement ultrasound can more effectively display the drainage area of HCC lesions and their ultrasonic characteristics, which may become a novel way to evaluate the drainage area of HCC.

CSUM19-e58738

Implementation of Two-dimensional Shear Wave Elastography and Acoustic Radiation Force Impulse Induced Strain Elastography in Combination with B-mode Ultrasound: A Method Avoids Unnecessary Biopsies of Breast Lesions

JiaWei Sun

Second Affiliated Hospital of Harbin Medical University

Objective: To investigate the diagnostic performance of two-dimensional shear wave elastography and acoustic radiation force impulse induced strain elastography for di?erentiation between benign from malignant breast lesions. And to explore whether their combination with B-mode ultrasound can reduce unnecessary biopsies of breast lesions.

Methods: One hundred fifty-nine benign breast lesions and one hundred eleven malignant breast lesions were retrospectively analyzed. Conventional ultrasound (CUS) features and virtual touch imaging (VTI) and virtual touch tissue imaging and quantification (VTIQ) parameters of lesions were performed on each lesion. The maximum shear wave speed (SWS-max) and VTI score were computed. The area under the receiver operating characteristic (AUC ROC) curve analysis was performed to evaluate the best cut-off value. We decreased the BI-RADS grade of the lesion form 4a to 3 when either one of the VTIQ or VTI was negative. The reference standard was histopathological and/or core-needle biopsy (CNB) results.

Results: The SWS-max and the VTI score of malignant lesions were significantly higher than those of benign lesions (p < 0.05). Among VTIQ parameters, SWS-max achieved the highest diagnostic performance with a cut-o? value of 4.46 m/s. The cut-off value of VTI score was 3. According to the SWS-max and VTI scores, there were 84.4% (27/ 32) BI-RADS 4a lesions on B- mode ultrasound degraded to 3 which avoided unnecessary biopsies.

Conclusion: Combination of VTIQ and VTI is a strong complement to B-mode ultrasound, which is a promising method in the differential diagnosis of the breast lesions as well as reduces unnecessary biopsies.

CSUM19-e54834

Diagnosis of Sacrococcygeal Pilonidal Sinus: The Value of Transcutaneous Sacrococcygeal/Perianal Combination with Transrectal Sonography

Guozhu Wu, Hua Hong, Fang Wang, Yumin Wang, Siqin Li

Inner Mongolia People's Hospital

Objective: Successful surgical management of Sacrococcygeal Pilonidal Sinus (SPS) is contingent upon accurate preoperative diagnosis, Objective of the study was to examine patients with Sacrococcygeal inflammatory disease preoperatively with ultrasound and then compare with operative finding, to evaluate the accuracy of ultrasound for the detection SPS and to describe the ultrasonography feature of SPS.

Methods: In the period from July 2008 to December 2016, 46 patients with Sacrococcygeal inflammatory disease were included in the study, All the cases were checked by ultrasound preoperative in the form of either transcutaneous sacrococcygeal/perianal (group I, n=20 patients) or transcutaneous sacrococcygeal/perianal combination with Transrectal sonography (group II, n=26 patients), All patients confirmed by surgery and approved by pathologic diagnosis. The study protocol was approved by the local institutional review board, and patient’s family member was giving full informed consent.

Results: 36 patients with Sacrococcygeal inflammatory disease were diagnosed exactly as SPS disease, the median age of patients with SPS was 22 (range 16-38) years, 6 patients with fistula in ano，3 patients with perianal abscess，1 patient with Hidradenitis suppurativa. Because of the low number of patients with fistula and abscess, statistical interpretations are not significant. The sensitivity of ultrasound in the detection of SPS disease was 93.3%, specificity 71.4%, accuracy 86.4%. The positive predictive value and negative predictive were 87.5% and 83.3% respectively.

Conclusion: The sacrococcygeal pilonidal sinus could be diagnosed exactly by transcutaneous sacrococcygeal/perianal combination with Transrectal sonography. The suggested technique is an attractive, safe, easily operated and can be reliably used as a diagnosis tool for SPS disease.

CSUM19-e48988

Transvaginal/transrectal Ultrasound-guided Aspiration Biopsy for Diagnosis of Pelvic/pelvic Floor Tumors in Females: A Retrospective Analysis

Chuanfen Gao, Ling Wang, Chaoxue Zhang

The First Affiliated Hospital of Medical University of Anhui

Ultrasound guidance for histological diagnosis is in real-time, convenient, and economical. The aim of this study was to determine whether transvaginal ultrasound (TVUS) - and transrectal ultrasound (TRUS) - guided aspiration biopsy allows detection of a malignant pathology of pelvic/pelvic masses. Data of 40 patients with pelvic and pelvic mass lesions by computed tomography or magnetic resonance imaging underwent TVUS- or TRUS-guided biopsy. Tissue samples obtained were assessed on suitability for histopathologic evaluation. The post-biopsy complication was monitored. All the specimens in the pelvic floor, vaginal stump, vaginal fornix, cervix, and posterior wall of the anal canal were adequate for histologic diagnosis. There were no post-biopsy complications. Transvaginal/transrectal ultrasound-guided aspiration biopsy is safe and simple. It can be used for the diagnosis and differential diagnosis of pelvic and pelvic floor lesions in women. Prospective studies are needed to test diagnostic performance across clinical scenarios.

CSUM19-e58913

Characteristics and Differential Diagnosis of Focal Pancreatic Lesions with Iso- to Hyper-enhancement in the Arterial Phase in CEUS

Xueqi Chen, Fengzhi Hao, Yang Gui, Jing Zhang, Li Tan, Mengsu Xiao, Qing Zhang, Ke Lv

Peking Union Medical College Hospital

Objective: Contrast-enhanced endoscopic ultrasound (CEUS) is a new method that allows enhanced characterization and differential diagnosis of focal pancreatic lesions. Masses visualized as hypovascular, hypoenhanced as compared to the rest of the pancreatic parenchyma can be correctly classified as pancreatic adenocarcinomas. Few researches describe the hyperenhanced lesions. This research is conducted to observe the characteristics of focal pancreatic lesions with iso- to hyper-enhancement in the arterial phase.

Methods: Picture archiving and communication system (PACS) of our institution were reviewed for patients who received CEUS for pancreatic lesions in Peking Union Medical College Hospital from April 2017 to April 2019 and 85 cases were identified as iso- to hyper-enhanced in the arterial phase. Pathological diagnosis was obtained in 49/85 cases, and clinical diagnosis was obtained in 9 cases. In total, 58 cases were retrospectively included in this study. Two radiologists evaluated the CEUS images and characterized their findings.

Results: 36 males and 22 females were included. The average age was 57.46±10.03 years old. 18 cases were diagnosed as benign and 40 cases malignant. 7 p-NET cases were included and 6/7 lesions were characterized as hypoenhancement in the venous phase. Hypoenhancement with rapid washout in venous phase was characterized in 20 malignant lesions and 3 benign lesions (p- NET G2, SPT, and inflammation with focal PanIN I-II, respectively), and has a sensitivity of 50.0% and a high specificity of 83.3% for determining malignancies. Homogeneous washout, synchronized and iso-enhanced with normal pancreas tissues was characterized in 9 benign lesions and 2 malignant lesions (both malignant p-NET), and has a sensitivity of 50.0% and a high specificity of 95.0% for determining benign lesions. Early and high hyperenhancement in arterial phase followed by slow washout and appearing hyperechoic compared with normal pancreas tissues in venous phase was characterized in 6 cases, of which 4 cases were diagnosed as metastases from renal cell carcinoma. This characteristic has a high specificity of 96.3% for determining metastases.

Conclusion: Quite a lot of focal pancreatic lesions with iso- to hyper-enhancement in the arterial phase are malignant. Hypoenhancement with rapid washout in venous phase is a reliable indicator of malignancy/ low malignant potential/precancerous lesions with high specificity. Homogeneous washout, synchronized and iso-enhanced with normal pancreas tissues is highly specified for determining benign lesions. Early and high hyperenhancement in arterial phase followed by slow and isoenhanced washout has a high specificity for determining metastases.

CSUM19-e58934

Protective Effects of Brown Fat-derived Exosomes on Obesity-related Cardiovascular Dysfunction as Revealed by Ultrasound Evaluation

Xueying Zhou, Lijun Yuan

Tangdu Hospital, Fourth Military Medical University

Objective: The ever-increasing incidence of obesity and its cardiovascular complications impose serious challenges on public health worldwide. Effective treatments for obesity and related complications are urgently needed. Brown adipose tissue (BAT) is a distinct kind of adipose tissue which does not store energy but consumes energy instead and has shown great potential in treating obesity. Exosomes are extracellular vesicles that play vital roles in intercellular communication and harbor the properties of their parental cells. In this study, we aimed to explore whether BAT exosomes might exert metabolic benefits on obesity and associated cardiovascular diseases.

Methods: Exosomes from brown adipose tissue and serum were harvested from young healthy mice and were identified using electron microscopy, particle size analysis as well as western blotting. 6-week-old male C57/BJ6 mice were fed with high fat diet for 16 weeks and were intravenously injected with indicated exosomes every week. Total body weights of mice were monitored weekly. After 6 weeks of exosome treatment, echocardiography was performed using Vevo2100 imaging system for evaluation of cardiovascular function of mice. Mice were then sacrificed after anesthesia. Major metabolic organs such as adipose tissue, liver, and heart were weighed and sectioned for further analyses. To figure out the major targets of BAT exosomes after intravenous injection, exosomes labeled with fluorescent dye DiI were injected into mice and in vivo and ex vivo imaging were done to show the organ distribution of injected exosomes. At the same time, the mass spectrum was done to assess the protein contents of BAT exosomes to interrogate the potential active molecules. Cell metabolism analysis was also performed using Seahorse XF analyzer to investigate the effect of BAT exosomes on metabolism in vitro.

Results: Mice injected with BAT exosomes exhibited obvious decreases in both body weights and blood glucose levels compared to mice that received no injections or mice injected with serum exosomes. Echocardiography analysis revealed that diastolic cardiac function in high-fat feeding mice was impaired and that treatment of BAT exosomes restored diastolic function of mice. The weights of liver and white adipose tissue were lower in BAT-Exos-treated mice compared to the other two groups of mice. According to HE staining, BAT-Exos treatment significantly alleviated lipid accumulation and inflammation in liver. Exosome tracking analysis indicated that exosomes injected intravenously were mostly taken up by liver. Protein profiling of exosomes revealed that exosomes derived from BAT were rich in mitochondria components, particularly components of respiration chain. Cell metabolism analysis showed that treatment with BAT-Exos can significantly promote oxygen consumption, thus increasing energy expenditure.

Conclusion: In this study, we proposed and verified the metabolic benefits of BAT-Exos from healthy young mice in treating obesity. The weekly treatment with BAT-Exos significantly reduced the body weight, lowered the blood glucose and restored cardiac function of high-fat-diet fed mice. Detailed elucidation of the reactive molecules and mechanism of action would provide new insights in combating obesity and obesity-related cardiovascular diseases.

CSUM19-e44576

Echocardiographic Investigation of Ventricular-ventricular Interactions in Patients with Repaired Tetralogy of Fallot

Jingya Li a, Ya Yang b, Ning Ma a

^a Beijing Children's Hospital; ^b Beijing Anzhen Hospital

Objective: To study the ventricular function of patients with repaired tetralogy of Fallot during the mid-term follow-up, and to compare the two groups of patients with right ventricular dysfunction and normal function, to investigate the difference in left ventricular function and the interaction between the ventricles. All patients were compared with the control group.

Methods: In the cross-sectional study, 46 patients with repaired tetralogy of Fallot were included in the study, 65% of them were male, with an average age of 4.72 ± 2.33 years, with an average follow-up of 3.78 ± 2.02 years. Twenty-four healthy children were included as a control group. Two-dimensional and three-dimensional ventricle images were acquired, and TomTec post-processing analysis software was used to obtain parameters. Ventricular diameters, volume, function and deformative parameters were compared between groups. The comparison of multiple groups of mean values was performed by ANOVA, and the comparison between groups was performed by the Games-Howell method.

Results: During the mid-term follow-up, 33% of the patients in this group had a decrease in right ventricular ejection fraction (40.8±3.8 vs 52.3±5.5 vs 59.0±4.4), and left ventricular ejection fraction (56.1±10.9 vs 59.4±6.7 vs 58.3±5.6) was in the normal range. In addition, left ventricular global longitudinal strain (-17.1 ± 7.8 vs -19.9 ± 5.3 vs -21.7 ± 3.8), global circumferential strain (-24.2 ± 7.1 vs - 26.5 ± 5.0 vs -25.1 ± 3.9) had no statistical difference between groups. In the segmental analysis, circumferential and radial strain of septum segments were reduced, but enhanced in the free wall of the left ventricle.

Conclusion: At the mid-term follow-up, some patients with rTOF experienced a decrease in right ventricular function and no overall reduction in left ventricular function. In the segmental analysis of the left ventricle, it was found that the ventricular septum strain decreased in the three directions of the long axis, the circumferential direction and the radial direction, while the partial segments of the left ventricular free wall increased in the circumferential and radial strain.

CSUM19-e57666

Percutaneous Microwave Ablation versus Open Surgical Resection for Colorectal Cancer Liver Metastasis.

Qinxian Zhao, Jianping Dou, Xiaoling Yu, Zhigang Cheng, Zhiyu Han, Fangyi Liu, Jie Yu, Ping Liang

Chinese PLA General Hospital

Objective: To compare the therapeutic outcome between open surgical resection（OSR）and percutaneous microwave ablation (PMWA) for colorectal liver metastasis (CRLM) ≤3cm

Methods: In this retrospective study, 200 consecutive patients with 306 liver metastases were reviewed from January 2009 to December 2017 who underwent either PMWA (n=135) or OSR (n=65) as the first line local treatment. Overall survival (OS), disease-free survival (DFS), local tumor progression (LTP), intrahepatic distant recurrence, extrahepatic metastasis was analyzed to compare the therapeutic efficacy by using the Kaplan-Meier method and log-rank test. Cox proportional hazards regression analysis was used to identify the prognostic factors for OS and DFS. Major complications and postoperative hospital stay were also assessed.

Result: The mean follow-up period was 35.1 months (range, 2.0-116.0 months) and the mean diameter of CRLM was 2.1cm (range, 0.7cm to 3.0cm). The OS rates of 1-, 3-, 5-year were 91.6%, 64.1%, and 46.3% respectively in PMWA group and 89.7%, 62.4% and 44.7% in OSR group (P=0.839). The 1-, 3-, 5-year DFS rate were 61.9%, 44.8%, and 41.3% respectively in PMWA group and 58.1%, 24.4%, and 18.3% respectively in OSR groups (P =0.066). Tumor number and preoperative chemotherapy were the independent prognostic factors for OS, and tumor number was the only independent prognostic factors for DFS. The two groups have comparable 5-year cumulative intrahepatic distant recurrence rate (P=0.627) and extrahepatic metastasis rate (P=0.884). The local tumor progression was lower in OSR group than that of PMWA group (P=0.023). The patients more than 60 years got more benefit from the treatment of PMWA than OSR. The major complications were higher in OSR group than that of PMWA group (P =0.025), and the length of hospital stay after treatment is shorter in PMWA group (P＜0.001).

Conclusion: There were no significant differences in OS and DFS between the two groups; PMWA was associated with higher LTP, fewer postoperative days and lower major complications.

CSUM19-e54879

The Effects of Liver Damage after Thermal Ablation on The Prognosis of HCC Patients and Its Prediction

Yan Zhou, Xiang Jing, Jianmin Ding

Tianjin Third Central Hospital

Objective: To investigate the influence of liver function damage in patients with hepatocellular carcinoma (HCC) after microwave ablation (MWA) on the prognosis and to establish an algorithm to predict potential liver function damage before the treatment

Methods: The liver function of HCC patients who underwent MWA in Tianjin third central hospital between August 2013 and October 2016 was retrospectively reviewed. A total of 745 patients were enrolled in this study and classified into the modeling group and the validation group. The liver function damage was defined as an increase of Child-Pugh score by two-three days after MWA. The progression free survival (PFS) and overall survival (OS) were analyzed using Kaplan–Meier and log-rank tests. The β-Coefficients derived from a logistic regression model predicting the presence of liver function damage were used to calculate the risk score. Diagnostic accuracy was assessed by the area under the curve (AUC).

Results: 69 of 498 patients in the modeling group suffered from liver function damage. The 1-, 2- and 3-year PFS were 70.2%, 51.9%, and 33% for patients without liver function damage and 70.3%, 50.7%, 29.1% for patients with liver function damage, respectively, with a median follow-up of 25 months (P=0.871). The 1-, 2- and 3-year OS were 93.7%, 88.0%, and 79.8% for patients without liver function damage and 89.2%, 79.6%, 57.8% for those with liver function damage (P=0.043), respectively. A total of five risk factors filtrated by logistic regression model, including Child-Pugh classification before treatment, tumor numbers, ablation volumes, relative position between the tumor and portal vein (PV) and APRI, were used to calculate the risk score for liver function damage. The AUC of the risk score for predicting liver function damage was 0.798 for the modeling group and 0.832 for the validation group. At a cut-off value of 24, the sensitivity and specificity of the risk score to identify liver function damage was 65.22%, 84.38% in the modeling group and 60.61%, 88.32% in the validation group, respectively.

Conclusion: Liver function damage after MWA is unfavorable the prognosis in patients with HCC. The prediction algorithm based on the Child-Pugh classification before treatment, tumor numbers, ablation volumes, the relative position between the tumor and portal vein (PV) and APRI is a robust model with significant specificity and can be used to predict possible liver function damage in patients with HCC after MWA.

CSUM19-e58799

Contrast-enhanced Ultrasound in Liver Assessment after Radiofrequency Ablation of Liver Focal Malignant Lesions

Mengna He

The First Affiliated Hospital,College of Medicine, Zhejiang University

Objective: To evaluate the value of contrast-enhanced ultrasound (CEUS) in the liver after radiofrequency ablation of focal malignant lesions.

Methods: A retrospective analysis of all the cases underwent radiofrequency ablation (RFA) for the focal liver malignant lesions in our hospital between January 2015 and December 2018, the cases had CEUS and CE-MRI results one –three month after RFA were selected, and among them 190 cases who had pathological or clinical diagnosis results were enrolled. According to the pathological or clinical diagnosis result, they were divided into four groups, group 1: negative group, group 2：Residual positive and new lesions group, group 3：simple residual group, and group 4：Simple new lesions group. We compared the value of CEUS and CE-MRI in the assessment of the liver situation.

Results: There are 111, 1, 12, 66 cases in the group 1~4, the rate of complete ablation was 93.2% (177/190). In group 1, CE-MRI showed 3 cases were residual positive, CEUS showed 6 cases were residual positive and 2 cases were new lesions positive, but no significant statistical difference was showed (P> 0.05), in group 4, 64 cases were detected by CE-MRI, 20 cases were detected by CEUS, the difference was obvious (P< 0.05), in group 3, 4 cases were missed diagnosed by CEUS and 1 were missed diagnosed by CE-MRI, no obvious difference were found (P＞0.05), the 1 case of residual with new lesions group, both CEUS and CE-MRI found the residual and new lesions.

Conclusion: The complete ablation rate was high in our center and CEUS has high accuracy in evaluation of the residual RFA liver lesions, but CEUS has low sensitivity in the evaluation of new liver lesions after RFA. For the liver evaluation after RFA of malignant liver lesions, CEUS should be combined with CE-MRI.

CSUM19-e48352

The VVI Ventricular Function Assessment in Second-third Trimester Fetus with Tricuspid Regurgitation

Liu Hong a,b, Haiyan Cao a,b, Li Zhang a,b, Qingchang Chen a,b, Mingxing Xie a,b

^a Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; ^b Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China

Objective: To evaluate the changes of ventricular function in second-third trimester fetus with tricuspid regurgitation by velocity vector imaging (VVI).

Methods: The fetus include in this study diagnosed as tricuspid regurgitation from January 2014 to August 2017 in the Union Hospital of HUST. They were divided in group A-mild tricuspid regurgitation, group B- severe tricuspid regurgitation. The control group included 36 normal fetuses in the same period. To evaluate the global ventricular motion of group A, B, and the control group by VVI. The following parameters of the left and right ventricular were obtain by manual tracing endocardial at the end of ventricular diastolic in four-chamber view: the global systolic longitudinal velocity (GLVs), the global diastolic longitudinal velocity (GLVd), the global systolic longitudinal strain rate (GLSRs), the global diastolic longitudinal strain rate (GLSRd) and the global longitudinal strain (GLS). The differences of baseline and parameters between groups A, B and the control group were analyzed.

Results: (1) Comparison of general data: There were no significant differences among group A, B and the control group (P > 0.05). (2) Comparison of right ventricular parameters: There were significant differences among group A, B and the control group in terms of the right ventricular GLVs, GLVd, GLS, GLSRs and GLSRd (P<0.01); there were significant differences between the group B and the control group in terms of the right ventricular GLVs, GLVd, GLS, GLSRs and GLSRd (P<0.01). (3) Left ventricle parameter comparison (ANOVA analysis): There were significant differences between group A and B in terms of the left ventricle GLVs, GLVd, GLS, GLSRs and GLSRd (p <0.01); There were significant differences between group B and the control group in terms of the GLVs, GLVd, GLS, GLSRs and GLSRd (P <0.01).

Conclusion: The ventricular function is significantly different among the fetus diagnosed as mild/severe tricuspid regurgitation and normal, the ventricular systolic and diastolic function is obviously impaired. There were no significant differences between the mild tricuspid regurgitation fetus and control in terms of the ventricular function index, which means mild tricuspid regurgitation did not cause fetal ventricular function damage. The qualitative and quantitative measurements of prenatal fetal tricuspid regurgitation are beneficial to evaluate the effects of cardiac structure, activity, and rhythm, which helps to predict the prognosis, guide clinical practices, and give recommendations of good birth and good care.

CSUM19-e52482

Ultrasound Technique in Assessing the Relationship between The Inter-rectus Distance and The Pelvic Floor Dysfunction in Early Postpartum Women

Jie Wang, Xinlu Wang, He Li, Jiaojiao Gu, Yifan Ning

Shengjing Hospital affiliated to China Medical University

Objective: The pelvic and abdominal muscle structure is holistic. At the same time, due to the changes of hormone levels, abdominal muscles and pelvic floor muscles during pregnancy, there is a correlation between two diseases. The aim of this study was to evaluate the application value of three/four dimensional ultrasound for inter-rectus distance (IRD) and Pelvic floor dysfunction (PFD) in early postpartum women, and to further assess the relationship between the contraction of levator ani muscle and IRD as well as to clarify the role of IRD in maintaining the female pelvic and abdominal organs in medical imaging.

Methods: Transperineal ultrasound was used in Seventy-nine parous women who underwent 6-8 weeks postpartum examination in Shengjing hospital affiliated to China medical university to diagnose PFD and IRD. The subjects were divided into two groups: (1) Group A: 42 subjects with PFD (2) Group B: 37 subjects without PFD. The area of levator ani muscle in the Valsalva state, the change of the area of the levator ani muscle in resting and in Valsalva state, IRD were compared in two groups. Correlation analysis was made between the contraction of levator ani muscle and IRD.

Results: (1) The changes of the area of levator ani muscle and the area of levator ani muscle in Valsalva in group A and group B were statistically significant (P<0.05). (2) The three levels of IRD in group A and group B (3cm on the umbilicus, umbilical level, and 3cm below the umbilicus) were statistically analyzed. The difference in umbilical level IRD was statistically significant (P<0.05); 3cm on the umbilicus, 3cm below the umbilicus IRD were not statistically significant (P>0.05). (3) There was a positive correlation between the changes in the area of the levator ani muscle area and IRD, the correlation coefficient is 0.512. There was a positive correlation between the area of the levator ani muscle in Valsalva and IRD, the correlation coefficient is 0.525.

Conclusion: Ultrasound technique can fully evaluate the pelvic floor function and IRD in postpartum women. It confirms the correlation between the pelvic floor function and IRD in postpartum women. It is important to examine the postpartum related muscle function and structure.

CSUM19-e58103

Value of 3D Transperineal Ultrasound in The Evaluation of Female Pelvic Support to Urethra

Wen Shui, Minzhi Zhou, Haiwen Du, Tao Ying

Shanghai Jiao Tong University Affiliated Sixth People's Hospital

Objective: To explore the feasibility of three-dimensional (3D) transperineal tomographic ultrasound in evaluating pelvic floor support to the urethra in women.

Methods: 3D transperineal ultrasound volume datasets of 25 normal volunteers and 50 women with stress urinary incontinence (SUI) were obtained for analysis. Pelvic floor support to urethra was evaluated by studying the relationship between urethra and vagina in vaginal cross section and quantified by estimating urethral depression (UD) rate. The extent of paravaginal support at level II was also evaluated in tomographic ultrasound imaging (TUI) mode in all participants. Two sample t-test was used for statistical analysis.

Results: The extent of paravaginal support at level II showed no difference between the two groups. The posterior depression of urethra into the anterior vaginal wall was increased in SUI (p<0.05). When the value of UD rate was 0.53 (CI 85%) combined with 3 continuous ‘abnormal slices’, the maximum Youden Index (sensitivity 0.82, specificity 0.88) was obtained to screen the dysfunctional support to urethra.

Conclusion: The pelvic floor support to the urethra can be evaluated indirectly by studying the relationship between urethra and anterior vaginal wall in the vaginal cross section by TUI. The obvious depression of the urethra sinking into the anterior vaginal wall could be an indirect evidence of support defect to the urethra.

CSUM19-e47718

Layer-specific Strain in Exercise Stress Echo: A New Tool for Analysis on Microvascular Ischemia in Patients with Primary Hypertension.

Qingfeng Zhang, Yi Wang, Hongmei Zhang, Geqi Ding, Wenhua Li, Qingguo Meng, Lixue Yin

Sichuan Academy of Medical Science and Sichuan Province People's Hospital

Objective: Exercise stress echocardiography has been routinely used for the early detection of patients with suspected ischemia, but the diagnosis of microvascular disease is still challenging, especially for patients with primary hypertension. The study was aimed to determine the diagnostic value of left ventricular layer-specific longitudinal and circumferential strain by speckle tracking during ESE, to study the suspected microvascular ischemia in patients with primary hypertension.

Methods: We enrolled 60 patients; all patients’ coronary angiography were normal. 20 patients of control group (group 1), 20 patients of primary well-controlled hypertension with no symptoms or ECG change (group 2). 20 patients of primary well-controlled hypertension with symptoms or abnormal ECG (group 3). Standard images were aquired by GE E95. The longitudinal strain (LS) and global circumferential strain (CS), and layer-specific strains of endocardium, mid-myocardium, epicardium (LSendo, LSmid, LSepi, CSendo, CSmid and CSepi) were measured at rest and peak stress. Exercise tolerance was assessed by metabolic equivalents (METs).

Results: Layer-specific strain showed decreasing gradient from the endocardium to epicardium in all three groups (P<0.01) both at rest and peak. However, LSendo and CSendo were lowest in group three (-18.7±3.3% and -31.3±2.6%), highest in control group (-24.3±2.7% and -37.3±3.3%, P<0.01). Similar results were obtained for LSmid, LSepi, CSmid and CSepi, but the most powerful difference was only observed between group1 and group3, especially for the global CSendo at peak.

Conclusion: Layer-specific strain combined with global circumferential strain can be a new effective tool for the echocardiographic diagnosis of microvascular ischemia in patients with primary well-controlled hypertension. It may be an indicator of the presence of microvascular ischemia. Exercise stress echocardiography can early detect myocardial impairment in patients with primary hypertension.

CSUM19-e48310

Prognostic Value of Right Ventricular Three-Dimensional Speckle-Tracking strain in Pulmonary Hypertension: Superiority of Longitudinal Strain over Circumferential and Radial Strain

Yuman Li a,b, Li Zhang a,b, Qing Lv a,b, Jing Wang a,b, Yali Yang a,b, Mingxing Xie a,b, Mengmei Li a,b

^a Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; ^b Hubei Province Key Laboratory of Molecular Imaging

Objective: Right ventricular (RV) dysfunction is a predictor of adverse outcomes in patients with pulmonary hypertension (PH). Three-dimensional speckle tracking echocardiography (3D-STE) has been increasingly used to quantify RV function, but we do not know which 3D-STE parameters provide the most important clinical information. The purpose of our study was to investigate whether RV longitudinal strain (LS) provided a better estimation of RV systolic performance and prognostic information.

Methods: 60 patients with PH and 35 normal controls were enrolled in our study. RV LS, circumferential strain (CS), radial strain (RS) were calculated by 3D-STE. RV volumes and ejection fraction (EF) were obtained from cardiac magnetic resonance (CMR) imaging.

Results: Patients with moderate and severe PH had decreased RVEF compared with controls. Our findings revealed that LS showed a significant reduction in mild PH patients; whereas CS and RS were decreased in moderate and severe PH patients. Patients with severe PH exhibited reduced RV LS, RS and CS compared with patients with mild PH. RV LS had a better correlation with CMR-derived RVEF, and 6-min walking distance, pulmonary vascular resistance, and pulmonary artery systolic pressure than CS, and RS. Only LS improved 6 months after medical treatment. RV LS (hazard ratio [HR]: 1.186; 95% confidence interval [CI]: 1.017 to 1.383; P=0.029) and RVEF (HR: 0.878; 95% CI: 0.779 to 0.989; P=0.033) were independent predictors of unfavorable clinical outcomes.

Conclusions: Patients with PH show decreased RV strain. LS best correlates with CMR-derived RVEF, hemodynamic parameters and exercise capacity, and provides prognostic information.

CSUM19-e43693

Renal Carcinoma with Inferior Vena Cava Tumor Thrombus: Predictive Model of Resection Using Multimodal Imaging

Liwei Li, Zhuo Liu, Guoliang Wang, Wei He, Hua Zhang, Heng Xue, Huiyu Ge, Jie Jiang, Lulin Ma, Shumin Wang

Peking University Third Hospital

Objective: The resection of the inferior vena cava (IVC) is a risk factor for poor prognosis in renal cell carcinoma (RCC). However, it is key for surgery and preoperative imaging evaluation. We used a prediction method based on multimodal imaging to evaluate IVC resection probability.

Methods: We retrospectively analyzed the clinical data of 87 patients with RCC with level I-IV tumor thrombus who underwent radical nephrectomy and IVC thrombectomy between January 2014 and September 2018. We measured imaging parameters in magnetic resonance imaging/computed tomography (MRI/CT) and ultrasound, evaluated the uni- and multivariable associations of clinical and radiographic features with IVC resection by logistic regression, and established an image prediction model to assess the resection probability.

Results: Forty-two patients (48.3%) underwent IVC resection. The maximum coronal IVC diameter in MRI/CT and the absence of color flow signal in ultrasound image were significant risk factors in the univariate and multivariate analyses. We identified the residual IVC blood flow (OR 0.152; p = 0.002) and maximum coronal IVC diameter in mm (OR 1.291; P < 0.001) as independent risk factors for resection. We predicted the need for IVC resection if the probability was > 50%, as calculated by: Ln{pre/(1-pre)} =0.256×maximum coronal IVC diameter-1.885×residual IVC blood flow-7.602. The prediction for resection was consistent with the actual treatment in 85% (74/87). The false positive rate was 8% (7/87), and the false negative rate was 7% (6/87).

Conclusions: Our model of multimodal imaging associated with IVC vascular wall resection may be used for preoperative evaluation and prediction of need for partial resection or segmental IVC resection.

CSUM19-e51130

Functional Studies of Left Atrial in Patients with Paroxysmal Atrial Fibrillation and The Prediction of Recurrence after CPVA

Min Xu

The Third Affiliated Hospital of Soochow University

Objective: This study was aimed to observe the significance of the left atrium (LA) functional index combined with B- type natriuretic peptide (BNP) level in predicting recurrence in patients with paroxysmal atrial fibrillation (PAF) after circumferential pulmonary vein ablation (CPVA). Real-time three-dimensional echocardiography (RT-3DE) was used to observe the structural and functional changes of the LA in patients with PAF after CPVA. BNP is a hemodynamic indicator of LA wall stress increase in atrial fibrillation (AF) patients.

Methods: 209 patients with PAF who underwent CPVA were selected in the study, and the following clinical data of the patients were collected. (1) The blood BNP levels measured before and three months after CPVA. (2) The measurements of routine echocardiography before and three months after CPVA. RT-3DE was used to obtain the time-volume curve of LA. (3) Multivariate logistic regression analysis was used to analyze the factors affecting PAF recurrence after CPVA. (4) Obtain the ROC curve of PAF recurrence predicted by the independent risk factors.

Results: (1) A total of 201 AF patients underwent CPVA, 36 patients had AF recurrence (18%) during follow-up, and BNP in the recurrent group was higher than that in the non-recurrence group (P < 0.001). (2) The preoperative LA volume of the recurrent and non-recurrent group before CPVA, LAVImin, LAVIpre-a (left atrial volume index before contraction, LAVIpre) exhibited a significant statistical difference (P< 0.001). Also, the two sets of reservoir function (expansion index, diastolic emptying index), conduit function (passive emptying index, PEI), booster pumping function (active emptying index, AEI) showed statistically significant differences (P <0.001). (3) Multivariate logistic regression analysis showed that the preoperative BNP, Diastolic emptying index (DEI) and PAF history were independent predictors of PAF recurrence (p =0.016; p =0.001; P =0.002). (4) ROC curve showed that compared with LAVImax, the z statistics of the AUC of recurrence of CPVA in patients with PAF predicted by BNP, DEI and combined index predicting were 2.204 (95% CI: 0.014 to 0.246, P = 0.028), 4.425 (95% CI: 0.156 to 0.404, P < 0.001), and 5.149 (95% CI: 0.186 to 0.414, P < 0.001), respectively.

Conclusion: In patients with PAF treated with CPVA, the impaired LA reservoir function and increased BNP were independent predictors of PAF recurrence. The combination of the two can improve the diagnostic specificity.

CSUM19-e52887

Clinical Evaluation of Layer-specific Strain of Left Ventricular Regional Myocardial in Patients with Hypothyroidism

Xiao Ding

Henan Province People's Hospital

Objective: To investigate the clinical value of layer-specific strain in evaluating the changes of left ventricular 18-segment regional myocardial systolic function in patients with hypothyroidism.

Methods: 30 female patients with hypothyrodism (hypothyrodism group, HG) with normal left ventricular global systolic function (LVEF≥50%) and 30 healthy female volunteers (control group, CG) underwent two-dimensional echocardiography. After routine acquisition and analysis of images, peak circumferential strain (PCS) and longitudinal strain (PLS) were automatically obtained for left ventricular three layers myocardial in an 18-segment model by the off-line EchoPAC113 software.

Results: Layer-specific longitudinal strain in left ventricular 18 segments: PLS in the endo-myocardium (PLS-endo) of posterior wall in the middle LV segments in the hypothyroidism group was lower than those in the control group (P <0.05); PLS in the mid- and epi-myocardium (PLS-mid, PLS-epi) of posterior wall in the middle LV segments in the hypothyroidism group was lower than those in the control group, but the difference was no statistically significant (P > 0.05). PLS in other LV myocardial segments between the three groups were compared, there was no significant difference (P > 0.05). Layer-specific circumferential strain in left ventricular 18 segments: PCS in the mid- and epi-myocardium (PCS-mid, PCS-epi) of all wall in the apex LV segments in the hypothyroidism group were lower than those in the control group, the difference was statistically significant (P <0.05); PCS-epi of anterior septal wall, PCS-mid and PCS-epi of anterior wall, PCS-mid and PCS-epi of inferior wall, PCS-endo, PCS-mid and PCS-epi of lateral and posterior walls in the middle LV segments in the hypothyroidism group were lower than those in the control group (P <0.05); PCS-mid and PCS-epi of anterior wall, PCS- mid and PCS-epi of posterior wall, PCS-epi of inferior wall, PCS-endo, PCS-mid and PCS-epi of lateral wall in the basal LV segments in the hypothyroidism group were lower than those in the control group (P <0.05); PCS in other LV myocardial segments in the hypothyroidism group compared with the control group, the difference was no statistically significant (P > 0.05).

Conclusions: Circumferential strain (CS) in left ventricular was earlier affected by abnormal thyroid hormone than longitudinal strain (LS) in patients with hypothyroidism. In the assessment of left ventricular regional myocardial systolic function in patients with hypothyroidism, CS was more sensitive than LS.

CSUM19-e50302

Analysis of Misdiagnosis and Missed Diagnosis of Fetal Complex Heart Malformations by Fetal Echocardiography Combined with Cardiovascular Cast

Yu Wang

Department of Ultrasound, Xiangyang No.1 People’s Hospital Affiliated to Hubei University of Medicine, Xiangyang 441000, China

Objective: We compared fetal echocardiography with cardiovascular casts and analyzed the causes of missed diagnosis and missed diagnosis of fetal cardiac malformations.

Methods: We retrospectively identified patients with a fetal diagnosis of severe congenital heart defects referred to our Maternal-Fetal Medicine center from 2013 to 2018 and selected those who had post-natal confirmation of cardiovascular anatomy. Prenatal and postnatal medical records, including echocardiographic reports and cardiovascular casts, were reviewed and cardiac abnormalities were compared and analyzed.

Results: The fetal cardiovascular casts showed that all of thirty-five cases of induced labors were confirmed to have complex cardiac malformations. Ninety cardiovascular malformations were demonstrated on casts, sixty-nine cardiovascular malformations were found on prenatal echocardiography. Twenty-one fetal cardiovascular malformations were misdiagnosed and missed diagnosed by prenatal ultrasound. Among them, seven cardiovascular malformations were misdiagnosed and fourteen cardiovascular malformations were missed diagnosed.

Conclusion: Our study shows that fetal echocardiography may misdiagnose and missed diagnose of abnormal DA, vascular deformities and other complex cardiac malformations. The cast specimens of fetal hearts and great vessels can visually display fetal cardiac malformations and abnormalities of macrovascular and its branches. Prenatal understanding of such malformations may help to improve prenatal diagnosis.

CSUM19-e48321

Biventricular Myocardial Strain Correlates with Myocardial Fibrosis in Patients with End-stage Dilated Cardiomyopathy: A Study Using Three-dimensional Speckle Tracking Echocardiography

Mingxing Xie a,b, Yan Zhang a,b, Fangyan Tian a,b, Li Zhang a,b, Yali Yang a,b, Jing Wang a,b, Qing Lv a,b, Yuman Li a,b

^a Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; ^b Hubei Province Key Lab of Molecular Imaging

Objective: Previous results regarding the correlations of the myocardial strain with myocardial fibrosis were discordant. Therefore, our study aimed to evaluate the accuracy of biventricular strains by three-dimensional speckle tracking echocardiography (3D-STE) in predicting myocardial fibrosis in patients with end-stage dilated cardiomyopathy (DCM) undergoing heart transplantation.

Methods: We studied 35 patients with end-stage DCM using echocardiography before heart transplantation. Left ventricular (LV) global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and right ventricular (RV) free wall longitudinal strain (LS) were measured by 3D-STE. LV and RV ejection fraction (EF) were obtained from cardiac magnetic resonance (CMR) imaging. LV and RV tissue samples were obtained from all patients who underwent heart transplantation. The ratio of the fibrotic to the total sample area (collagen volume fraction, %) determined the extent of fibrosis.

Results: LV myocardial fibrosis correlated strongly with GLS (r = 0.74, P <0.001), modestly with GRS (r = -0.66, P <0.001 ), weakly with GCS (r = 0.44, P <0.01) , but not with CMR-derived LVEF; RV myocardial fibrosis was strongly associated with RV free wall LS (r =0.71; P < 0.001), but not with CMR-derived RVEF .Compared with patients with mild myocardial fibrosis, LV GLS, GCS and GRS, and RV LS decreased in patients with severe myocardial fibrosis. LV GLS and RV free wall LS had the highest diagnostic accuracy for detecting severe myocardial fibrosis (LV GLS: AUC =0.86; 95% CI: 0.73 to 0.99; RV LS: AUC =0.85; 95% CI: 0.70 to 0.99). Stepwise multivariate analysis showed that LV GLS (β=0.740, P < 0.001) and RV free wall LS (β= 0.60, P < 0.0001) were independent predictors of LV and RV fibrosis respectively.

Conclusion: Myocardial fibrosis leads to reduced systolic function in the end-stage DCM. LV GLS and RV free wall LS are the most accurate LV and RV global function measurements that correlate with the extent of myocardial fibrosis in patients with end-stage DCM.

CSUM19-e43374

Application of Hemocoagulase Combined with Low Intensity Ultrasound Induced Microbubble Cavitation Enhanced Nd: YAG Laser Ablation for Rabbit VX2 Liver Tumors

Qian Yang, Xiaodong Zhou

Xijing Hospital

Objective: In this study, we propose and investigate both safety and efficacy method for hemocoagulase combined with low intensity ultrasound induced microbubble cavitation enhanced ultrasound-guided percutaneous laser ablation (PLA) in rabbit VX2 liver tumors.

Methods: Fourteen days after rabbits were implanted single liver VX2 tumor, were randomly divided into 5 study groups: A, Control group; B, PLA group; C, HC+PLA group; D, MEUC+PLA group; E, MEUC+HC+PLA group. Nd: YAG laser was coupled to a quartz fibreoptic guide (600μm) with a flat tip. The fiber and a thermocouple were placed in the lumen of one Chiba needles (21-G) and these were inserted into the tumor under ultrasound-guidance. The laser was fired for 6 min at 5 W power. Contrast enhanced ultrasound (CEUS) was performed before treatment and 1h, 1-day, 7-day, 14-day post- treatment for the analysis of tumor size, enhancement, and necrosis range.

Results: Quantitative analysis time intensity curve (TIC) of the tumor blood perfusion and microvascular changes. Tumor ablated volume in MEUC+HC +PLA group grows significantly bigger than PLA group 1-day and 14-day (P<0.01). A substantial significant reduction of blood flow of the tumors as a result of the MEUC+HC+PLA treatments than PLA treatment of Peak, RBV and AUC parameters (P<0.01). Examination of treated tumors demonstrated necrosis in the ablated zones and increasing surrounding fibrous bands in both treatment groups. No damage was observed in the surrounding normal tissues.

Conclusion: Our study seems to offer the safely and efficiently technique of hemocoagulase combined with low intensity ultrasound induced microbubble cavitation enhances the efficiency of laser ablation therapy. Meanwhile, it would be well suited to the treatment of tumor were superficially located or near vital structures.

CSUM19-e43558

The Value of Contrast-enhanced Ultrasound with Quantitative Analysis in Differential Diagnosis of Solid Renal Mass

Jia Zhan

Huadong Hospital of Fudan University

Objective: To investigate the value of contrast-enhanced ultrasound (CEUS) with quantitative analysis in the differential diagnosis of solid renal mass.

Methods: Fifty-four solid renal masses in 54 patients were performed CEUS before nephrectomy, quantitative analysis parameters were compared between the benign renal mass group and malignant renal mass group.

Results: There was a significant difference in time to peak (TTP) between two groups (P<0.05). Among the parameter ratios, the greatest area under the ROC curve was 0.74 by PI ratio. Taking PI ratio≥1.42 as the cutoff, the sensitivity, specificity, and accuracy were 84.4%, 77.8%, 83.3%.

Conclusion: PI ratio of malignant renal mass and its adjacent cortex was valuable in the differential diagnosis between benign and malignant solid renal mass, which could improve the accuracy.

CSUM19-e43836

Study of Ultrasound Guided Celiac Plexus Neurolysis: Safety and Efficacy

Lu Wang, Man Lu

Sichuan cancer hospital

Objective: To evaluate the safety and efficacy of ultrasound guided celiac plexus neurolysis (US-guided CPN) in patients with upper abdominal cancer pain.

Methods: 15 patients with advanced upper abdominal cancer pain were subjected to US-guided CPN. Visual Analogue Scales (VAS) method was used to assess the extent of pain relief in patients and the score of pain was recorded Immediately before the CPN and Immediately post-procedure, 1 day, 1 week, 1month and 3 months after CPN, respectively. The differences in VAS scores of pains before and after CPN were analyzed with the paired samples t tests.

Results: 13 patients successfully achieved CPN. 2 of the 15 patients excluded for lacking safe puncture path. All the 13 patients who successfully achieved CPN showed a significant reduction of VAS score after CPN (P<0.001). No serious side effects or complications occurred.

Conclusion US-guided CPN is a visualization and minimally invasive method to treat upper abdominal cancer pain. It is safe and effective.

CSUM19-e44585

E/e’ is Better Than Myocardial Strain in Detecting Coronary Stenosis

Min Hu, Xilin Zhang, Suxia Wang, Shanshan Cheng

People's Hospital of Huangshan

Objective: To compare the values of mitral E/e’ ratio and left ventricular (LV) myocardial strain in detecting coronary stenosis.

Methods: Echocardiogram examination was performed in 65 inpatient patients who with chest pain and suspected CAD. Measured LV ejection fraction (LVEF) and mitral E/e′, estimated regional wall-motion abnormalities (WMA) visually. The Global longitudinal strain (GLS) was obtained by 2DSTE from 3 standard apical planes using an LV 17-segment model. The peak negative systolic strain (Spk) took the average value of the segments belonging to the left anterior descending (LAD) perfusion territory. If any these segments existed early systolic lengthening (ESL), peak positive early strain (PS) and duration of ESL (DESL) were recorded. A significance level of 0.05 was used.

Results: Patients were divided by the stenosis degree of proximal LAD into severe group (>70%), moderate group (50~70%) and control group (<50% or without coronary stenosis). Each group was 11 cases after excluding some with atrial fibrillation or without coronary angiography examination. Between the severe group, moderate group and control group, the male to female ratios were 9/2, 6/5 and 4/7 respectively, and the difference had no statistical significance. The severe group's age (70±11.7 years vs. 65±8.3 and 60±4.2 years, P=0.02) was older and incidence of WMA (8/11 vs. 2/11 and 3/11, p =0.02) was higher compared to that of the moderate group and control group. The E/e’ (14.2±2.7 vs. 10.0±2.1 and 10.9±2.4, P =0.001), GLS (-16.2±3.5% vs. -20.6±4.1% and -21.0±3.3%, P =0.007) and Spk (-17.3±7.6% vs. -21.5±8.3% and -21.8±7.8%, p =0.002) were significantly higher in severe group, compared with moderate and control group. The LVEF (56±13.8% vs. 66±8.7% and 68±5.9%, p =0.02) of the severe group was significantly lower than others. All above indices except age had no significant difference between moderate group and control group. The incidence of ESL segments (P =0.296), and the value of PS (P =0.888) and DESL (P =0.533) had no significant difference between the three groups. The E/e’, GLS, Spk, and LVEF showed significant accuracy in detecting severe coronary stenosis, with areas under the receiver operating characteristic curves of 0.85, 0.83, 0.81 and 0.75 respectively, while all parameters were a failure to divide moderate coronary stenosis from the control group. After adjusting the age, GLS, LVEF, and WMA by a multivariate Logistic regression model, the E/e’>11 and Spk>20%，which cutoff value derived from the ROC curve method, could significantly improve the accuracy of detecting severe coronary stenosis by echocardiography to 87.9%. The OR of E/e’ was 46.9 (95% CI: 2.7~820.9), Spk was 27.2 (95% CI: 2.1-345.4).

Conclusion: Rest echocardiographic indicators could not detect moderate and mild coronary stenosis. The mitral E/e’ and peak negative systolic strain value of perfusion territory could significantly improve the accuracy of predicting severe coronary stenosis by echocardiography. E/e’ is superior to left ventricular longitudinal strain parameters both in terms of technical accessibility and diagnostic value.

CSUM19-e44806

The Applicability and Normal Value of STE and STQ in Measuring Liver and Spleen Stiffness

Jian Zheng a, Rongqin Zheng ^b

^a Third hospital of Longgang, Shenzhen; ^b Third Affiliated Hospital of Sun Yat-Sen University

Objective: To assess the applicability of sound touch elastography (STE) and sound touch quantify (STQ) in measuring liver and spleen stiffness.

Methods: One hundred and eighteen healthy volunteers were included. The success rate, variability and reproducibility of STE, and STQ were analysist. The detect size and times of liver STQ were also analysist.

Results: The success rates, variability, reproducibility of STE and STQ in liver were 97.5% and 99.2%, 8.7% and 12.0%, 0.917 and 0.916, respectively; while with spleen were 76.3% and 66.9%, 12.4% and 16.4%, 0.847 and 0.706, respectively. The detect size of 15 × 10mm yield lower variability (8.5%) and detect 5 times was enough; in our study, the liver and spleen stiffness of STE were 5.75 kPa (95%CI: 5.60-5.91 kPa) and 15.58 kPa (95%CI: 14.99-16.16 kPa), respectively.

Conclusion: Both STE and STQ have a high success rate and low variability in measuring liver stiffness; however, STE is better than STQ in measuring spleen stiffness.

CSUM19-e45457

Gender Difference in Severity of Heart Failure in Patients with Hypertrophic Cardiomyopathy: Age, Menopause or Other Factors?

Liwei Huang, Lixue Yin, Yu Chen

Sichuan Academy of Medical Sciences and Sichuan People’s Hospital

Objective: Gender difference is an important clinical feature of hypertrophic cardiomyopathy (HCM). Female patients are older and have more serious symptoms of heart failure at diagnosis. It is considered that age and menopause affect the clinical presentation. The goal of this study was to assess the effect of age and menopause on the severity of heart failure in female patients with HCM.

Methods: We included 141 female patients with HCM (66 in premenopausal group, 75 in postmenopausal group) and 141 age-matched male controls. Furthermore, we selected 26 pairs of age-matched pre- and postmenopausal female subjects for subgroup analysis. All patients underwent an echocardiographic study to evaluate the structure of the heart. Blood samples were taken to test serum N-terminal pro-BNP (a biological surrogate of severity of heart failure).

Results: Both pre- and postmenopausal female patients had a significantly higher level of NT-proBNP than male controls (1971.41±1542.16 vs. 1087.81±698.20 fmol/ml, P<0.001；1491.93±1046.23 vs. 862.91±513 fmol/ml, P <0.001). The left ventricular end-diastolic volume index (LVEDVI) was lower in pre- and postmenopausal female patients than male subjects (40.36±10.10 vs. 47.61±9.64 ml/m 2, P <0.001; 55.42±8.16 vs. 58.31±7.29 ml/m 2, P <0.001). The concentration of NT-proBNP was higher in premenopausal women than that in postmenopausal women (1971.41±1542.16 vs. 1491.93±1046.23 fmol/ml, P =0.031). Age- matched pre- and postmenopausal female patients had a similar level of NT- proBNP (P =0.421). Age was negatively associated with the level of NT-proBNP in this cohort (r=-0.199, P=0 .001). There was also a negative correlation between LVEDVI and the concentration of NT-proBNP in HCM patients (r=-0.36, P <0 .001). Linear regression analysis revealed that only LVEDVI was independently related to the level of NT-proBNP (beta=-0.275, P <0.001).

Conclusion: Older age and menopause do not increase the burden of heart failure in female patients with HCM. Smaller left ventricular cavity in women may partly explain the gender difference in the severity of heart failure in HCM patients.

CSUM19-e45686

An Unusual Presentation of Repeated Lumps and Infection: Complication of Breast Augmentation

Mingxuan Zhang, Lilong Xu, Shiyan Li, Bowen Zhao, Xiaoyan Cai, Guanglan Wang

Sir Run Run Shaw Hospital, Zhejiang University College of Medicine

Objective: Polyacrylamide hydrogel (PAAG) injection was once prevalent in breast augmentation, and had been prohibited for augmentation mammaplasty in China since a great number of patients whose breasts were augmented with the PAAG injection have continued to seek medical advice as a result of its complications. Among all these complications, distant migration is relatively rare.

Methods: A 49-year-old female presented to the hospital with a one-year history of vulva lump. The lump sonography showed several subcutaneous fluid regions from the left vulva to the pubic symphysis, with multilocular and mobility, and the lump was considered as the possibility of fat liquefaction according to ultrasonography. An enhanced MRI of the pelvic cavity revealed a cystic area, which was considered as a benign lesion. After resection of vulva mass and closed drainage, the lump repeated from the left lower abdomen with infection signs a few weeks later. While the lump appeared again in bilateral hypochondria one month with infection after therapy. The sonography found that there was one hypoechoic area on each side, in the shape of bars. Both hypoechoic areas seemed continuous with the deep of breasts.

Results: Intraoperative observation showed that the mass didn’t have an obvious capsule and its boundaries were unclear, subcutaneous tissue presented as a cavity with some yellow materials like bean dregs came out. The culture of the drainage showed no bacterial contamination. Histopathology of the drainage revealed that the tissue was composed of foreign body granuloma. The patient informed that she had undergone PAAG injection breast augmentation surgery 20 years ago until she was repeatedly asked the history by ultrasound doctor. Finally, based on the history and the repeated lumps and infection, a diagnosis of distant migration of polyacrylamide hydrogel was made.

Conclusion: PAAG gel still has the possibility of migration and infection after a long term. Timely debridement surgery may be necessary even without symptoms. It is noteworthy that it took four months to make an accurate diagnosis for this patient, and reminds us to value the medical history and not to limit our diagnosis idea to where the symptom is.

CSUM19-e45705

Evaluation of Contrast-enhanced Ultrasound in the Treatment of Rheumatoid Arthritis Knee Synovial Lesions

Huaning Xu, Yiyun Wu, Wei Ji, Xuguang Song, Yuning He, Qin Zhang, Qian Lu, Hui Gao

Affiliated Hospital of Nanjing University of Chinese Medicine

Objective: In recent years, the microvascular imaging function provided by contrast-enhanced ultrasonography (CEUS) has provided a profound diagnostic basis for clinical practice. In the EFSUMB guide (European Federation of Societies for Ultrasound in Medicine and Biology), CEUS is recommended as a better method for assessing the degree of synovial vascularization in patients with rheumatoid arthritis (RA), which is conducive to the early detection of abnormalities. This study was designed to investigate the role of CEUS in evaluating the efficacy of RA knee synovial lesions.

Methods: The hospitalized patients with a clinical diagnosis of RA were selected. The clinical manifestations were swelling and pain of the knee joint. The clinical diagnostic criteria for RA are based on the 2010 American College of Rheumatology (ACR)/European Association Against Rheumatoid Arthritis (EUIAR) Classification of Rheumatoid Arthritis (RA). The results of 37 knee joints with gray scan ultrasonography (GSUS), power Doppler ultrasonography (PDUS) and CEUS were observed in 37 patients with RA, and 26 knees were reviewed after treatment. The observation indicators included the presence or absence of effusion in the suprapatellar capsule, measuring and recording the maximum depth of the effusion; the presence or absence of thickening of the synovial membrane of the suprapatellar, medial and lateral condyles and the blood flow in the thickened synovial membrane; synovial area, rise time, peak intensity, peak time, area under the curve, average transit time, half-down time, internal wash slope. Before and after treatment, the measurement data were expressed as mean±SD. The effect of joint effusion depth, synovial thickness, CEUS parameters and synovial area on CEUS parameters before and after treatment was analyzed by paired data t test, blood flow grading before and after treatment. Grade data comparisons were tested using the Wilcoxon symbol level. The difference was statistically significant at P <0.05.

Results: GSUS showed that the thickness of supracondylar synovium and the depth of suprapatellar bursa effusion in 37 knee joints before treatment were (0.47±0.26) cm, (0.31±0.15) cm, (0.36±0.21) cm, (0.72±0.42) cm, respectively; the thickness of supracondylar synovium and suprapatellar bursa effusion in 26 knee joints after treatment were (0.36±0.16) cm, (0.28±0.17) cm, (0.30±0.19) cm and (0.41±0.19) cm, respectively. There was statistical significance (P < 0.05). PDUS showed that there were significant differences in the blood flow grading of 26 knee joints before and after treatment (P < 0.05). CEUS showed that the peak intensity of synovial membrane decreased, the area under curve decreased, the half-fall time shortened, the slope of internal washing decreased, and the peak time prolonged after treatment. There were significant differences in the parameters before and after treatment (P < 0.05). Synovial area has some influence on CEUS parameters.

Conclusion: The advantage of CEUS and GSUS is that it can clearly distinguish the thickened synovial membrane from the joint effusion, and clearly show the thickened synovial membrane for observation and evaluation. CEUS uses its advantages of microvascular imaging to detect blood perfusion in early RA or chronic RA synovial lesions, and CEUS is more sensitive than PDUS. When CEUS found that the difference in the treatment of RA synovial lesions before and after treatment, the overall area of the synovial membrane is also a factor worthy of reference, which has a certain influence on the evaluation results, which can improve the reliability of judgment. CEUS is an objective method for evaluating the efficacy of RA and provides a reliable basis for clinical treatment of RA.

CSUM19-e45989

Prognosis Determined by Primary Tumour Location in Patients with Colorectal Cancer Liver Metastases Following Thermal Ablation

Daopeng Yang ^a, Bowen Zhuang ^a, Manxia Lin ^a, Ming Xu ^a, Mingde LV ^a, Ming Kuang ^b, Xiaoyan Xie ^a, Xiaohua Xie ^a

^a Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University; ^b Department of Hepatobiliary Surgery, The Affiliated Hospital of Sun Yat-Sen University

Objective: To determine the outcome of thermal ablations for colorectal cancer liver metastases (CRCLM) and to investigate the correlation between the location of primary cancer (rectum vs colon) and the prognosis.

Method: This retrospective study was approved by the institutional review board of the First Affiliated Hospital of Sun Yat-Sen University. The requirement for informed consent was obtained from all patients. Patients diagnosed with CRCLM from July 2011 to December 2016 entered into this retrospective study and were followed up until death or to December 2018. The study included 81 patients, consisting of 127 lesions, and all the patients had thermal ablation (radiofrequency ablation or microwave ablation) of CRCLM. The overall survival (OS) and progression free survival (PFS) were assessed with Kaplan Meier survival function estimate curves and Cox regression analysis between the two patient groups with rectum cancer liver metastases (RCLM) and colon cancer liver metastases (CCLM).

Results: Patients with RCLM exhibited a worse OS and PFS than those with CCLM. Median OS in RCLM group vs CCLM group was 36.0 vs 48.0 months, (p=0.002) and median PFS was 8.0 vs 23.5 months, (p=0.001). Multivariate analysis showed that OS and PFS were also significantly influenced by high carcino-embryonic antigen (CEA) and a multiple number of liver metastases.

Conclusion: Patients with CCLM had a better prognosis than those with RCLM following thermal ablation. When patients intend to undergo thermal ablation for CRCLM, the primary tumour location should be taken into consideration in the assessment of long-term curative effect.

CSUM19-e46141

Quantitative Evaluation of Three-dimensional Ultrasound in Patients with Ovarian Dysfunction (DOR)

Shuxia Mao, Ye Qiang

Department of Medical Ultrasound, Affiliated Hospital of Nanjing University of TCM

Objective: To explore the value of three-dimensional ultrasound quantitative indicators in evaluating the efficacy of ovarian reserve dysfunction (DOR) patients before and after treatment.

Methods: A retrospective analysis was made of 45 infertility patients treated with DOR in the Department of Reproductive Medicine, Jiangsu Hospital of Traditional Chinese Medicine from 2016 to 2018, and in the early follicular stage before and after treatment, three-dimensional ultrasound quantitative index were get respectively. Three-dimensional transvaginal ultrasound was used to monitor the quantitative indexes of ovary, including sinus follicle count (AFC), ovarian 3D volume (OV), ovarian stromal artery peak flow velocity (PSV), ovarian interstitial artery vascular index (VI), blood flow index (FI), and blood flow index (VFI) in the early follicular phase of the ovarian follicle, and the blood flow index was measured at the same time. Correlation analysis was made with anti-Mullerian hormone (AMH).

Results: There were significant differences in AFC, OV, PSV, VI, FI and VFI before and after treatment in patients with DOR. Pearson correlation analysis showed that AFC, OV, PSV, VI, FI, VFI were positively correlated with AMH, and AFC had the highest correlation.

Conclusion: Three-dimensional ultrasound quantitative indicators have certain clinical value in evaluating the therapeutic effect of DOR patients, and can also evaluate the unilateral ovarian function.

CSUM19-e46182

Combination Diagnosis with Strain Rate Ratio and Molecular Markers Effectively Improve the Diagnosis Rate of Small Breast Cancer and Lymph Node Metastasis

Yi Hao, Xia Guo

Shenzhen hospital of southern medical university

Objective: To evaluate the strain rate ratio (SR) combined with various molecular pathological and serum markers for the diagnosis of breast masses, SR and 7-point scale elasticity scores were used with real-time tissue elastography and 2-dimensional color-Doppler ultrasound to diagnose breast lesions in 311 hospitalized patients.

Methods: Immunohistochemical staining and enzyme linked immunosorbent assays (ELISAs) were used to examine pathological and serum tumor markers and discuss their correlations with SR findings.

Results: SR had a higher diagnostic value compared to the 7-point scale elasticity score, displaying an obvious low-to-high distribution from benign to malignant lesions with an optimal cutoff point at 3.88, which yielded an AUC of 0.896 with 89.1% sensitivity, 85.6% specificity and positive and negative predictive values of 91.0% and 82.8%, respectively. The differences of SR values between small (<1.5 cm), large (>3 cm) (P=0.010) and moderate (1.5~3cm) sizes (P=0.038) in distinguishing benign from malignant breast masses were statistically significant, with SR being most specific and sensitive for diagnosing small lesions. Expression of 3 molecular pathological indicators (p75NTR, p63, and CK5/6) and 5 serum mastocarcinoma markers (uPA, PAI-I, CA27-29, CEA and CA15-3) showed statistical significance (P<0.05) in distinguishing between benign and malignant breast lesions. Furthermore, SR combined with CA15-3 and CK5/6 positivity showed 94.2% sensitivity and 89.2% specificity as combined markers for triple-negative breast cancer, whereas SR combined with D2-40 and CK19 were good diagnostic markers for breast cancer lymph node metastasis.

Conclusion: SR together with molecular and serological marker may serve as an additional diagnostic tool for small breast cancer diagnosis.

CSUM19-e46185

SonoVue? in Hysterosalpingo-contrast Sonography (HyCoSy) for Fallopian Tubal Patency Assessment: A Systematic Review with Meta-Analysis

Enze QU

Third Affiliated Hospital of Sun Yat-sen University

Objective: To assess the diagnostic value of SonoVue? in Hysterosalpingo-contrast Sonography (HyCoSy) for detecting tubal patency in infertile females.

Methods: PubMed, Medline, Embase, Cochrane Collaboration, China National Knowledge Infrastructure and Wanfang database were searched for relevant trials published from June 1990 to December 2018. Index test was SonoVue? in HyCoSy for infertile females. The reference standard was laparoscopy with a dye test. The pooled results were calculated by diagnostic meta-analysis with bivariate mixed-effects binary regression. The heterogeneity test was done using the Cochran Q statistic and the I² statistic. Subgroup analyses and publication bias were further performed.

Results: 24 studies, including 1358 females with 2661 detected fallopian tubes, were identified. The pooled estimates of sensitivity and specificity were 0.93 [95% confidence interval (CI): 0.90-0.95, Cochran Q=47.56, p < 0.001, I²=51.64%] and 0.91 (95% CI: 0.87–0.92, Cochran Q= 40.68, p < 0.001, I²=43.46%), respectively. The area under the receiver-operating characteristic curve was 0.96 (95% CI: 0.94–0.98). No publication bias was observed. Subgroup analysis showed that the specificity of the four-dimensional (4D) HyCoSy group was higher than the 2D/3D HyCoSy group; the sensitivity decreased as the contrast agent dose increased.

Conclusion: SonoVue? in Hysterosalpingo-Contrast Sonography (HyCoSy) is an accurate test for diagnosing tubal patency in infertile females.

CSUM19-e46477

Cell Penetrating Peptide-modified Nanoparticles for Tumor Targeted Imaging and Synergistic Effect of Sonodynamic/HIFU Therapy

Yizhen Li ^a,b, Lan Hao ^c, Fengqiu Liu ^b,c, Lixue Yin ^a, Haitao Ran ^b,c, Yang Sun ^b,c

^a Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital; ^b The Second Affiliated Hospital of Chongqing Medical University; ^c Chongqing Key Laboratory of Ultrasound Molecular Imaging

Objective: Combination therapy has become an important strategy for minimizing side effects and enhancing the therapeutic outcomes of cancer treatment. Sonodynamic therapy (SDT) utilizing ultrasound combined with a sonosensitizer represents a novel noninvasive modality for cancer therapy. Different ultrasound frequencies have been used for SDT, nevertheless, whether the effect of SDT can enhance synergistic HIFU ablation remains to be investigated.

Methods: In this study, we prepared a nanosystem for codelivery of a sonosensitizer (methylene blue, MB) and a magnetic resonance contrast agent (gadodiamide, Gd-DTPA-BMA) based on hydrophilic biodegradable polymeric NPs composed of poly (lactic-co-glycolic acid) (PLGA). To enhance the accumulation and penetration of the NPs at the tumor site, the surface of PLGA NPs was decorated with a tumor-homing and penetrating peptide-F3 and polyethylene glycol (PEG). The physicochemical, imaging and therapeutic properties of F3-PLGA@MB/Gd and drug safety were thoroughly evaluated both in vitro and in vivo. F3-PLGA@MB/Gd was evaluated by photoacoustic and resonance imagings

Results: These NPs exhibited higher cellular association than non-targeted NPs and showed a more preferential enrichment at the tumor site. Furthermore, with good drug safety, the apoptosis triggered by ultrasound in the F3-PLGA@MB/Gd group was greater than that in the contrast group.

Conclusion: F3-PLGA@MB/Gd can work as a highly efficient theranostic agent, and the incorporation of targeted multimodal imaging and combined therapy could be an encouraging strategy for cancer treatment.

CSUM19-e46578

Research of Cavum Septi Pellucidi Variation by Ultrasonography in Normal and 18-Trisomy Fetuses

Xue Zhou

Guangzhou Women and Children’s Medical Center

Objective: To explore the variation of cavum septi pellucidi (CSP) width of normal fetuses throughout the whole pregnancy, and compare fetal CSP width between normal and 18-trisomy syndrome fetuses.

Methods: This study used 2D ultrasound to measure 691 normal fetuses CSP width and growth parameters to underwent regression analysis respectively, and established normal fetal CSP z-score data model. Medical record of 18-trisomy fetuses was reviewed to acquire the information about CSP width, gestational age and so on.

Results: Regression analysis showed normal fetal CSP width increased along with gestational age before 28w, kept a plateau during 28w-36w, decreased after 36w. 57 cases of 18-trisomy syndrome fetus were involved, after 18 weeks 69% (34/49) 18-trisomy fetal CSP width were higher than normal fetus over +2SD, and 18-trisomy fetal CSP z-score was larger than the normal (P < 0.001).

Conclusion: Fetal CSP width increased first, reached the peak after 28 weeks, and gradually decreased after full-term during the whole pregnancy. Fetal ultrasound screening of CSP widening may become a soft indicator of the prenatal diagnosis of 18-trisomy syndrome.

CSUM19-e46929

Sonographic and Histo-pathologic Features of the Tall Cell Variant of Papillary Thyroid Micro-carcinoma

Jing Ma

Peking University Third Hospital

Objective: To compare sonographic and histopathologic features of tall cell variant of papillary thyroid microcarcinoma (TCV-PTMC) and classic papillary thyroid microcarcinoma (PTMC).

Methods: We retrospectively reviewed the sonographic and histopathologic characteristics of 20 TCV-PTMC and 105 classic PTMC between 2014 and 2018.

Results: Patients with TCV-PTMC nodules had lower TI-RADS records. TCV-PTMC exhibited a more regular margin and less micro-calcification in sonography. Histopathologically much higher tumor epithelium rate can be seen in TCV-PTMC nodules (P<0.05).

Conclusion: 2017 TI-RADS and ATA failed to differentiate TCV-PTMC from classic PTMC. TCV- PTMC often appeared as well-defined and hypoechoic solid nodules with fewer micro-calcifications. TCV-PTMC neither has typical benign characteristic nor malignant features. Considering the worse prognosis of TCV-PTMC, even the suspicious nodule measures less than 1cm, FNA should be recommended.

CSUM19-e47142

Mitochondria-targeted Artificial Nano-RBCs for Amplified Synergistic Cancer Phototherapy by A Single NIR Irradiation

Liang Zhang

Chongqing Medical University

We report on amplifying the photo-therapeutic efficacy by constructing a NIR-responsive multifunctional nanoplatform for synergistic cancer photo-therapy by a single NIR irradiation, which can concurrently achieve mitochondria-targeting photo- therapy, synergistic PTT/PDT, self-sufficient oxygen-augmented PDT, and multiple-imaging guidance/monitoring. Perfluorooctyl bromide (PFOB) based nano-liposomes were constructed for oxygen delivery into the tumor, acting the functions of RBCs for oxygen delivery (Nano-RBCs nanosystem), which can alleviate the tumor hypoxia and enhance the PDT efficacy. IR780 as a heptamethine dye was further integrated into the lipid shell for concurrent PTT and PDT. The mitochondria-targeting performance for enhanced and synergistic PDT/PTT has been demonstrated as assisted by nano-liposomes, by which the tumor could be completely eradicated without obvious reoccurrence.

CSUM19-e47308

False-negative Results of Mammography Screening in Women with Dense Breasts: Analysis of Clinical and Ultrasonographic Characteristics

Huan Pu

Renmin Hospital of Wuhan University

Objective: To analyze the clinical and ultrasonographic characteristics associated with false-negative mammographic results in dense breasts.

Methods: The study involved 191 pathologically confirmed malignant breast lesions. Multivariate logistic regression analysis was performed to identify factors independently associated to false-negative results in mammographic screening.

Results: Younger age, lower histologic grade, smaller size, negative lymph node status, rougher margin, absence of calcification, softer lesion, and lower stiffness ratio were significantly associated with false-negative results. The rougher margin was the strongest independent factor associated with negative results.

Conclusion: In younger patients with high breast glandular density, lower stiffness ratio and absence of calcification easily lead to the misdiagnosis of breast cancer on mammography.

CSUM19-e47451

Predicting Axillary Lymph Node Metastasis in Breast Invasive Ductal Carcinoma Patients: A Novel Risk Prediction Model based on Conventional ultrasound and Contrast-enhanced ultrasound

Anqi Zhu

Shanghai Tenth People's Hospital

Objective: To establish a novel risk prediction model for axillary lymph node metastasis (ALNM) in patients with breast invasive ductal carcinoma (IDCs) using conventional ultrasound (US) and contrasted-enhanced ultrasound (CEUS).

Methods: 156 breast IDCs lesions from 156 women were retrospectively included in this study. The features of conventional US, CEUS qualitative enhancement patterns and quantitative enhancement parameters were analyzed. Subsequently, a risk prediction model was created by multivariate logistic regression analysis.

Results: The results showed that 60 (38%) of 156 patients had ALNMs. Univariate analysis indicated that lesion size > 20 mm (odds ratio [OR]: 8.504), uncircumscribed margin (OR: 4.411), coarse or twist penetrating vessels (OR: 8.282), and PI > -47.75 (OR: 7.954) were independent risk factors for ALNM. The risk prediction model was obtained by multivariate logistic regression analysis and the risk score (RS) was de?ned as 1.75 * (if lesion size > 20 mm) + 1.93 * (if uncircumscribed margin) +1.77 * (if coarse or twist penetrating vessels), with an area under the receiver operating characteristic curve of 0.830 (95%CIs, 0.764–0.895).The rating system was divided into 4 stages. Stage I, RS <1.75; Stage II, RS = 1.75 to 1.93; Stage III, RS = 1.94 to 3.70; Stage IV, RS > 3.70. The risk rates of ALNM were 0% (0/9) in Stage I, 10.7% (5/46) in Stage II, 29.2% (14/48) in Stage III, and 77.4% (41/53) in Stage IV.

Conclusion: We concluded that lesion size > 20 mm, uncircumscribed margin, and the presence of coarse or twist penetrating vessels are risk factors for ALNM. The risk prediction model based on conventional ultrasound and CEUS developed in the present study can improve the prediction of ALNM.

CSUM19-e47763

Ultrasound Ultrafast imaging of the Carotid Artery Pulse Wave Velocity: Is the Surrogate of Regional Artery Stiffness?

Lingyun Fang ^a,b, Mingxing Xie ^a,b, Jing Wang ^a,b

^a Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; ^b Hubei Key Laboratory of Molecular Imaging

Objective: Cardiovascular diseases (CVDs) are the leading causes of death in the world and responsible for over 17.7 million deaths annually. Arterial stiffness could be the strongest predictor for coronary heart disease and stroke. Pulsed wave velocity (PWV) is “the most hallowed and still probably the best” measure of arterial stiffness and closely related to the processing of arteriosclerosis. Techniques to measure PWV present limitations. There are based on the mathematical model calculation, or need special instruments and required a fairly high level of technical expertise. A new ultrasound-based technique, Ultrasound Ultrafast imaging could noninvasive assessment of regional carotid artery stiffness. The imaging system has a very high frame rate over 2000 frames per second, and could quickly obtain the PWV propagate along the carotid artery. The objective is to detect the PWV in elder Humans’ carotid artery in vivo. Determine the feasibility and accuracy to assess artery stiffness by Ultrasound Ultrafast imaging. Confirm the relationship between the local carotid artery PWV and the stiffness of the systemic vessels.

Methods: Ultrasound Ultrafast imaging was performed and obtain the velocity propagate along the left common carotid arteries of fifty-nine (n = 59) healthy volunteers. Including the PWV at the beginning of the systole and the ending of the systole (BSPWV, ESPWV), the mean PWV (mPWV) were calculated. E-Tracking technology in measuring artery elasticity modulus (PWVβ) and cardio- ankle vascular index (CAVI) were calculated in all subjects. The correlation between parameters derived from Ultrasound Ultrafast imaging and elastic modulus were analyzed. Indicate artery elasticity and the impact of modifying factors such as BMI, age and hypertension.

Results: (1) The success rate of first obtained the BSPWV, ESPWV were 94.2% and 90.8%, which required a median overall duration of 73s. (2) mPWV were significant positively correlated with PWVβ and CAVI (r=0.68, P<0.01, r=0.48, P<0.05). BMI, age, and hypertension were also positively correlated with PWV. (3) The mPWV have good repeatability and conformity. Interobserver and intraobserver variabilities were 4.2% and 3.6 % respectively.

Conclusion: The elasticity of the carotid artery is an integral part of the global arterial elasticity. Ultrasound Ultrafast imaging is a reliable method to assess the regional carotid artery stiffness. The technique can directly and quickly measure PWV of local vessels, with high repeatability and provides a new method for clinical early assessment artery elasticity.

CSUM19-e48808

Multi-mode Blood Flow Imaging in Evaluation of Radiofrequency Ablation for Liver Metastases after Liver Transplant

Xiaoli Zou, Yuyang Liu, Hong Qu, Xiaojun Gao

Dalian Municipal Friendship Hospital

Objective: To evaluate the micro-visualisation of liver metastases after microwave ablation with multi-mode blood flow imaging.

Methods: The characteristics of Color Doppler Flow Imaging (CDFI), Superb Microvascular Imaging (SMI) and Contrast-enhanced Ultrasound (CEUS) in 6 patients with liver metastases after liver transplant were analyzed. The blood flow grading was performed by Adler's semi-quantitative method, and the differences among the three methods were analyzed.

Results: The grade 0, I, II and III of Adler's semi-quantitative method in 28 lesions in three kinds of blood flow imaging techniques were shown as followed:17 (60.72%), 9 (32.14%), 2 (7.14%) and 0 (0) in CDFI group;10 (35.71%) , 9 (32.14%) , 8 (28.58%) and 1(3.57%) in SMI group; and 10(35.71%), 11 (39.29%), 6 (21.43%) and 1 (3.57%) in CEUS group. The coincidence rate of blood flow grading in CDFI group and SMI group was 67.86% and 89.29% respectively (P < 0.05).

Discussion: Liver metastasis after liver transplant is the main problem for long-term survival. Microwave ablation has less trauma and complications, which is the best choice for effective control of the disease. After ablation, multi-mode blood flow imaging can be used for early detection of residual lesions and early remedial treatment to maintain the function of transplanted liver and prolong the life of patients. CDFI and SMI can observe the number, morphology, arrangement and distribution of the capillaries in the liver metastases after liver transplant after ablation. CDFI can show high-speed blood flow signals in the lesions, while low-speed blood flow signals can produce artifacts with low display rate. SMI can display the capillaries with low-speed blood flow signals and display the small branches of blood vessels simply and non-invasively. In this study, coagulative necrosis occurred in liver metastases after microwave ablation. CDFI could not clearly show the boundary of the lesions and the distribution of the capillaries, while SMI and CEUS could still accurately show microvascular morphology and arrangement in the lesions after microwave ablation. The coincidence rate of blood flow signals between SMI group and CEUS group was 89.29%, which was significantly higher than CDFI group (67.86%). It can be concluded that SMI has higher accuracy in evaluating the blood flow signals of liver metastases after microwave ablation. There is a significant difference in the classification of microvascular signals between CDFI and SMI in the lesions after ablation.

Conclusion: SMI is superior to CDFI in demonstrating low-speed capillaries in the liver metastases after liver transplant after microwave ablation, and can detect residual lesions early, which is better for the long-term survival.

CSUM19-e48841

A First Contrast Enhanced Ultrasonography (CEUS) Study on Hemophilia Arthropathy Showing More Sensitivity in Detecting Synovial Vascularity and Hypertrophy than Conventional Gray Scale Ultrasonography (CUS) and Color Doppler Flow Image (CDFI)

Fei Ma ^a, Xiaoqin Feng ^b, Jing Sun ^a, Yingjia Li ^a, K.H. LUKE ^b, Yaru Zhang ^a, Hao Liu ^a, Shiyu Zhang ^a, Liling Xiao ^a, Wanxian Luo ^a, Li Zhang ^a, Weizhen Wang ^a

^a Nanfang Hospital, Southern Medical University, Guangzhou, China; ^b Children Hospital of Eastern Ontario, Ottawa, Canada

Objective: CEUS showed more sensitive in detecting synovial vascularity and hypertrophy in Rheumatoid arthritis studies, but no study in Hemophilia. To conduct a first CEUS study on hemophilia comparing to CUS and CDFI.

Methods: Between August 1, 2016 to January 31, 2017 all severe Hemophilia A patients referred for ultrasound joint assessments were enrolled. A CUS and CDFI did at baseline. Patients showing synovial hypertrophy were requested for a CEUS same day. CUS and CDFI by Orhndorf S and CEUS (SenoVue) by Klauser AS (Ultrashall Med 2011 .32 suppl 2, E38-44 and E 31-37).

Results: 81 severe A patients enrolled. 68 showing synovial hypertrophy and 46 of them consented for CEUS same day. Paired CDFI and CEUS collected on 27knees, 9 ankles, and 10 elbows. CEUS showed blood flow signal in 45 joints (98%) vs 39(84%) by CDFI, significant higher vascular scores in 26 joints (Z 3.781 P< 0.001) and 51% higher total vascular scores on 46 joints 103 vs 67, besides, thicker synovial measurement mean 0.53 cm vs 0.39 cm by CUS and CDFI. No adverse effects reported.

Conclusion: CEUS is a safe more sensitive test in detecting synovial vascularity and hypertrophy for hemophilia joint assessments and clinical studies.

CSUM19-e48959

Clinical Research of Real-time Shear Wave Elastography in Differential Diagnosis of Hepatic Alveolar Echinococcosis and Hepatocellular Carcinoma

Qingyang Meng, Shumei Ma

QingHai University Affiliated Hospital

Objective: To evaluate the sonographic features of real-time shear wave elastography (SWE) in patients with hepatic alveolar echinococcosis (HAE) and hepatocellular carcinoma (HCC) and investigate the clinical application of SWE in the differential diagnosis of HAE and HCC.

Methods: There were 20 cases in the HAE group and 30 cases in the HCC group in the study. All the cases were performed SWE before surgery, the mean elasticity of Young’s modulus of all the cases was obtained. All the lesions were confirmed by pathologies as the gold standard. SWE results were compared with the pathologies to evaluate the accuracy and efficacy of using SWE to diagnose the HAE and HCC.

Results: The mean elasticity of Young’s modulus of the lesions was (34.57±10.76) Kpa in the HAE group and (21.82±3.51) Kpa in the HCC group. The mean elasticity of Young’s modulus of lesions had a significant difference between HAE and HCC groups (P<0.001). The critical point of the mean elasticity of Young’s modulus of the lesions between HAE and HCC was 27.43Kpa by ROC curve, the sensitivity was 80%, and the specificity was 97%. The area under the ROC curve was 86.9%.

Conclusion: SWE has an important value of clinical application in diagnosis between HAE and HCC.

CSUM19-e49107

Ultrasound-guided Removal of Breast Foreign Matter

Mengying Xu, Ying Huang

Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China

Although breast foreign matter has been reported, the origins of the foreign matter are almost of medical materials. This report describes a unique case of ultrasound-guided removal of mammary foreign matter, a horse’s bristle, that was used in the nonmedical treatment of milk stasis. No previous cases of ultrasound-guided breast foreign matter removal have been reported.

Case Report: A 30-year-old female, who gave birth to a baby 3 months previously, was evaluated for a mass in the lower outer quadrant of the right breast. The day before she came to the hospital, she was treated by a folk doctor, who is called in China a “galactagogue master,” to cure presumed milk stasis. Treatment conducted by the galactagogue master consisted in the cannulation of the breast duct with a horse’s bristle. Unfortunately, during treatment the bristle could not be retrieved and remained in the breast tissue. On examination the lower outer quadrant of right breast was erythematous. Palpation noted a well-defined hard mass with poor mobility. Ultrasonography revealed well-defined multiple high-echoic oval masses that were attributed to areas of milk agglutination. In addition, a strong echo band, 5 cm long, could be seen clearly with a low echo background. The patient decided to delay any treatment and after 1 week, the repeat ultrasonography noted that the location of the horse’s bristle had changed. The patient agreed to proceed with an interventional procedure to remove the horse bristle. A disposable coaxial biopsy needle (17 G ×17.8 cm; Becton, Dickinson and Company) was inserted into the milk stasis area under the guidance of ultrasound, and aimed at the stiffer end of the horse’s bristle. The needle core was pulled out and the 5 cm long bristle was sucked out by negative pressure. The overall process of the operation went smoothly and took minutes. Postoperatively the patient recovered well and did not need any further treatment.

Discussion: Foreign matter in the breast is rare and the most common is silicone from breast augmentation procedures. Besides silicone, other rare foreign matters found in the breast are residual such as Lipiodol is an ultra-fluid, which is used for galactography and could mimic microcalcifications or induce inflammatory reactions or metallic particles from surgical instruments. There is also a report in the Chinese langue literature of a patient using folk prescription, cinnabar, to cure her mastitis. As far as we know, no cases have ever been reported of a horse’s bristle in the breast that was successfully removed with the guidance of ultrasound. In China, a group of folk doctors who are strictly regulated and called galactagogue masters are skilled at curing postpartum hypogalactia, breast engorgement, milk stasis, and the like. But, as documented in this case, these procedures are not without risk.

A search of the Chinese databases revealed that three similar cases had been reported in the medical news. All three patients came to the breast surgery department and the animal bristle was removed with the help of mammary fiberoptic ductoscopy. The mammary duct–lobular system is complex, thus, finding the horse’s bristle is not easy in the tainted thick milk using this technique. Therefore, not surprisingly all three cases took about 2–4 hours.

Ultrasonography is the first line of breast disease examination. As a new technology, interventional ultrasound was applied to more and more fields. In the aspect of diagnosis, ultrasound-guided breast lesions biopsy is a mature technology. In the aspect of treatment, cryoablation and thermal ablation have been reported and might be considered as a primary treatment option for patients who reject open surgical excision. Ultrasound-guided breast abscess drainage and drug injection for treatment have been commonly used.

Conclusion: We report a case in which ultrasound facilitated the removal of breast foreign matter, that is, a horse’s bristle, in a relatively benign manner, demonstrating the potential therapeutic of interventional ultrasound. This case suggests that the future will present many new treatment opportunities.