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Emerging Applications of Contrast-enhanced Ultrasound in Trauma
Brenda E. Tester, BS, MS, Ji-Bin Liu, MD, John R. Eisenbrey, PhD, George Koenig, MD
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (2): 39-47.   DOI: 10.37015/AUDT.2022.220017
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The use of contrast-enhanced ultrasound (CEUS) has expanded over the past decade to include a variety of diagnostic and therapeutic applications. These include urgent clinical situations that require timely diagnosis and subsequent treatment. With the introduction of microbubble ultrasound contrast agents (UCAs), CEUS provides increased sensitivity and specificity over conventional ultrasound. Within the trauma setting, CEUS benefits include point of care imaging and an ability to monitor perfusion in real-time. Additionally, UCAs are non-nephrotoxic, and can be used when contrast enhanced CT is contraindicated. In this review, we discuss recent advancements of CEUS within trauma settings.

Follicular Thyroid Neoplasmon Conventional and Contrast-enhanced Ultrasound
Xuehong Diao, MD, Lin Chen, MD, Bo Yu, MS, Jiamei Jin, MS, Jia Zhan, MD, Yue Chen, BS
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (2): 48-57.   DOI: 10.37015/AUDT.2022.210026
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Objective: The aim of this study was to identify features of follicular thyroid neoplasm by conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) based on morphological and pathological correlations and make diagnostic strategy for predicting malignancy.

Methods: Conventional US and CEUS were performed in 21 follicular thyroid cancers (FTCs) and 35 follicular adenomas (FAs) that were pathologically approved. Sonographic features were retrospectively reviewed, and diagnostic performance were analyzed using pathology as reference standard.

Results: The most useful character in diagnosis of FTC by conventional US was round shape (OR=6.6), followed by absent of halo sign (Odds ratio, OR = 4.79) and calcification (OR = 3.875). Among all CEUS morphological and blow flow findings, incomplete rim enhancement pattern (OR = 19.2) and the presence of perfusion defects (OR = 5.454) were the most effective features to discriminate between FTC and FA. Based on the five discriminatory parameters, a diagnostic criterion was established to assess the risk of FTC. The sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and accuracy for predicting malignancy were 81.0 %, 80 %, 70.8 %, 87.5 % and 80.4%, respectively.

Conclusions: CEUS provided additional sonographic features which is helpful for predicting potentially malignancy of follicular thyroid neoplasm.

Ultrasonographic Features of Intrathyroidal Thymic Carcinoma: Review and Analysis of 10 Cases
Yanhai Wang, MD, Hua Yang, MD, Hanqing Liu, MD, Xiaoli Luo, MD, Luying Liu, BS, Pingting Zhou, BS
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (2): 58-63.   DOI: 10.37015/AUDT.2022.220013
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ObjectiveIntrathyroidal thymic carcinoma (ITTC) is a rare epithelial tumor of the thyroid gland. Since ITTC is rare, its imaging findings have not been well defined. In the present study, we studied the US appearance of ITTC by analyzing ten cases retrospectively.

Methods Patients were identified by searching the surgical pathology records at our hospital. There were three male and seven female patients ranging in age from 40 to 79 years. The ultrasound (US) features were evaluated, and the relevant clinical data were combined with the fine needle aspiration (FNA) results from previous publications.

Results The average length of the nodules was 48 mm. Of all ten nodules, half were located in the right lobe of the thyroid, and half were located in the left lobe, either immediately adjacent to the lower lobe or within the lower part of the thyroid lobe. All nodules manifested with a completely solid composition and heterogeneous hypoechoic echogenicity. Three nodules had striped hyperechogenicity within the nodule. All nodules had irregular margins. Seven had a horizontal shape, and three had a vertical shape. Four nodules manifested with mainly peripheral vascularity, two nodules showed mainly central vascularity, and three had mixed vascularity. The vascularity of one remaining nodule was unknown. Cervical lymph node metastasis was detected in two cases by US examination. According to previous literature, FNA cytology revealed atypical type of thyroid cancer, poorly differentiated carcinoma, or a high-grade malignant thyroid neoplasm without further definitive classification.

ConclusionA large cancer-like nodule located within the lower thyroid in middle-aged people, combined with an atypical type of thyroid cancer after FNA, indicated that ITTC should be considered.

Incidental Ultrasound Findings of a Giant Retroperitoneal Schwannoma: A Case Study
Jiaqi Zhao, MD, Weiqing Li, MD, Xiaolin Ma, MD, Rui Chen, MD, Lin Chen, MD
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (2): 64-67.   DOI: 10.37015/AUDT.2022.210010
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Schwannoma in retroperitoneal region is quite rare. In this report, we presented such a rare case of a large size schwannoma in a 23-year-old man admitted with a complaint of mild pain in his right lower abdomen. The abdominal ultrasonography detected a round-shaped heterogeneous hypoechoic mass with a few blood flow signals at the retroperitoneal area inferior to the right kidney. The contrast-enhanced ultrasound demonstrated a well-demarcated hypoechoic mass with minor vascularization. Computed tomography (CT) diagnosed the retroperitoneal mass as a malignant neoplasm. After surgical resection, histopathologic examination revealed that the mass was a benign cellular schwannoma. Besides the rare case of schwannoma in retroperitoneal region, we believe that multimodal sonographic patterns are conducive to the preoperative diagnosis of retroperitoneal neurilemmoma.

Diagnosis of Anomalous Origin of Left Main Coronary Artery from Right Sinus of the Valsalva Based on the “Seagull Sign” in Echocardiography: A Case Study
Yun Zheng, MM, Shiwen Fu, MM, Wei Miao, MM, Shanshan Qu, MM, Junhua Wang, MM, Liping Guo, MM, Xihe Sun, MM
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (2): 68-71.   DOI: 10.37015/AUDT.2022.210032
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The anomalous origin of the left main coronary artery from the right sinus of the Valsalva (ALCA) is rare, and varies significantly in congenital heart disease. Patients are usually asymptomatic, and in most cases, coronary abnormalities are discovered by chance at autopsy after coronary angiography or sudden cardiac death. As a routine physical examination procedure, echocardiography is particularly important for the rapid and sensitive diagnosis of ALCA. We report a case of ALCA using echocardiography. “Seagull sign” is a direct ALCA sign manifesting on the short axis section of the artery with two vessels coming from the right coronary sinus. Based on this case, we propose this specific ultrasound sign as a way to improve the diagnostic rate.

Guidelines for Echocardiographic Diagnosis of Cardiomyopathy: Recommendations from Echocardiography Group of Ultrasound Medicine Branch in Chinese Medical Association, Echocardiography Committee of Cardiovascular Branch in Chinese Medical Association
Echocardiography Group of Ultrasound Medicine Branch in Chinese Medical Association, Echocardiography Committee of Cardiovascular Branch in Chinese Medical Association
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (2): 72-94.   DOI: 10.37015/AUDT.2022.210021
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Cover, Foreword and Content
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 0-0.  
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Micro/Nanobubbles Driven Multimodal Imaging and Theragnostics of Cancer
Xiaoting Zhang, BS, Zhifei Dai, PhD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 163-172.   DOI: 10.37015/AUDT.2021.200053
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Ultrasound imaging has attracted great interest of researchers due to their application in cancer diagnosis and treatment. Ultrasound contrast agents, microbubbles and nanobubbles are widely explored as a multifunctional platform, not only carrying other contrast agents for multimodal imaging to complement the disadvantages of each imaging modality, but also carrying drug/gene for cancer theragnostic. In this article, the characteristics and differences of microbubbles and nanobubbles are briefly introduced and reviewed. Besides, the microbubbles and nanobubbles driven multimodal imaging and theragnostic of cancer are summarized.

Targeted Delivery of Therapeutic Gas by Microbubbles
Lingling Xu, MM, Yihan Chen, MM, Qiaofeng Jin, PhD, Li Zhang, MD, Wenpei Fu, BS, Shan Lin, MM, Ling Lin, BS, Rui Wang, BS, Dandan Chen, MM, Zhengyang Han, MM, Mingxing Xie, MD, Yali Yang, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 173-182.   DOI: 10.37015/AUDT.2021.200059
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Gas therapy is a new therapeutic method that has been developed in recent years and shows great clinical prospects for the treatment of tumours and cardiovascular, nerve, and immune system diseases. Therapeutic gases, including oxygen, hydrogen, nitric oxide, hydrogen sulfide, xenon, and other bioactive gases are involved in modulating cell signaling pathways and have important physiological functions with substantial therapeutic potential. However, their precise delivery remains a major challenge. Recently, researchers began to use ultrasound to trigger microbubbles that have encapsulated these gases for intravenous administration. This not only enhances the contrast of ultrasound imaging, but also precisely releases gases in the targeted area using ultrasound-targeted microbubble destruction. This article reviews the latest advances in the use of microbubbles to load therapeutic gases for the treatment of diseases.

Characterization of Breast Lesions: Comparison between Three-dimensional Ultrasound and Automated Volume Breast Ultrasound
Wanru Jia, MD, Jingwen, Zhang, MD, Yijie Dong, MD, Ying Zhu, MD, Xiaohong Jia, MD, Weiwei Zhan, MD, Jianqiao Zhou, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 204-211.   DOI: 10.37015/AUDT.2021.210007
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Objective: This study aimed to compare the diagnostic performance of three-dimensional ultrasound (3D-US) and automated breast volume scanner (ABVS) for the characterization of benign and malignant breast lesions.
Methods: Ninety patients who underwent surgery and preoperative conventional ultrasound (US), 3D-US, and ABVS examinations were enrolled in this study. The image quality and adjacent structures of the lesions in the coronal plane were compared. The combination of US, 3D-US, and ABVS for retraction phenomenon of the lesion was compared and the diagnostic performance of each combination was analyzed.
Results: ABVS displayed better image quality and adjacent structures than 3D-US (P < 0.001). The area under the curve (AUC) was 0.913, 0.842, and 0.871 for US, 3D-US, and ABVS, respectively. The AUC of the retraction phenomenon of the lesion was 0.732 and 0.810 for 3D-US and ABVS, respectively. When they were combined, US+ABVS showed the highest AUC of 0.924. No significant difference of diagnostic performances was found among conventional US, US+3D-US, and US+ABVS(P > 0.05).
Conclusions: Compared with 3D-US, ABVS seems to be superior in showing the retraction phenomenon of breast lesions and in the characterization of breast lesions alone or in combination with conventional US. Although no significant difference was observed between them, both ABVS and 3D-US provided valuable information in the coronal plane and improved our confidence level in breast lesion characterization, especially when combined with the conventional US.

Point-of-Care Ultrasound: New Concepts and Future Trends
Yaoting Wang, MD, Huihui Chai, MD, Ruizhong Ye, MD, Jingzhi Li, MD, PhD, Ji-Bin Liu, MD, Chen Lin, Chengzhong Peng, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 268-276.   DOI: 10.37015/AUDT.2021.210023
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Ultrasound (US) technology, with major advances and new developments, has become an essential and first-line imaging modality for clinical diagnosis and interventional treatment. US imaging has evolved from one-dimensional, two-dimensional to three-dimensional display, and from static to real-time imaging, as well as from structural to functional imaging. Based on its portability and advanced digital imaging technique, US was first adopted by emergency medicine in the 1980s and gradually gained popularity among other specialists for clinical diagnosis and interventional treatment. Point-of-Care Ultrasound (POCUS) was then proposed as a new concept and developed for new uses, which greatly extended clinical US applications. Nowadays, artificial intelligence (AI), cloud computing, 5G network, robotics, and remote technologies are starting to be integrated into US equipment. US systems have gradually evolved to an intelligent terminal platform with powerful imaging and communication tools. In addition, specialized US machines tend to be more suitable and important to meet increasing demands and requirements by various clinical specialties and departments. In this article, we review current US technology and POCUS as new concepts and its future trends, as well as related technological developments and clinical applications.

Advances in Targeted Tumor Diagnosis and Therapy Based on Ultrasound-Responsive Nanodroplets
Yaqiong Li, PhD, Ruiqing Liu, MD, Shaobo Duan, MD, Lianzhong Zhang, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (4): 273-283.   DOI: 10.37015/AUDT.2020.200043
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The ultrasound contrast agents currently used in clinics are microbubbles with a large particle size and short circulation time, and their approved clinical applications are limited to endovascular diagnosis and therapy only. The development of ultrasound-responsive nanodroplets (NDs) provides a new approach for extravascular diagnosis and therapy, especially for molecular imaging and targeted therapy of tumors. The NDs with a nano-scaled particle size and a liquid core can maintain their shape and initial diameter during injection, enhancing their EPR effects and facilitating the accumulation of NDs at the tumor site. When exposed to ultrasound, NDs can vaporize and exhibit contrast enhancement at the sites of interest. In addition, the destruction of microbubbles can provide a driving force to facilitate the release of drugs or genes from the microbubbles into target cells, allowing the NDs to act as drug carriers. The development of ultrasound-responsive NDs has shown rapid progress in recent years, while a variety of NDs with excellent properties have been fabricated for targeted diagnosis and drug delivery. In this article, the development of ultrasound-responsive NDs was reviewed in terms of their structure, phase transition properties, and applications in targeted tumor diagnosis and therapy.

Application of Ultrasonography in the Diagnosis and Management of Papillary Thyroid Microcarcinoma
Kun Huang, MD, Ji-Bin Liu, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (4): 284-290.   DOI: 10.37015/AUDT.2020.200001
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Thyroid carcinoma is the most common malignant tumor of the endocrine system. Nearly 90% of thyroid carcinomas are papillary type, of which many are thyroid papillary microcarcinoma (PTMC) with a maximum diameter≤1 cm. Highresolution ultrasound imaging plays an important role in evaluating PTMC and guiding biopsy for pathology as well as appropriate treatment. This review paper discusses the ultrasonography features of PTMC and explores the clinical value of ultrasonography with gene testing in the diagnosis and management of PTMC.

The Roles of Ultrasound-Based Radiomics In Precision Diagnosis and Treatment of Different Cancers: A Literature Review
Bing Mao, MD, Shaobo Duan, MD, Ruiqing Liu, MD, Na Li, PhD, Yaqiong Li, PhD, Lianzhong Zhang, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (4): 291-296.   DOI: 10.37015/AUDT.2020.200051
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The study aims to review literatures on ultrasound-based radiomics, including ultrasound modalities, and discusses basic methods, applications, and limitations of ultrasound-based radiomics. The search strategy was conducted in form of “Radiomics [Title/Abstract] and Ultrasound [Title/Abstract]”in PubMed. The retrieved articles were initially screened via abstracts. Then, the main objectives, methods, and achievements of selected articles were summarized. Finally, twenty articles focused on malignancies of different organs, such as liver, rectum, breast, and thyroid were included into this review. The multiparametric features exhibited a superior diagnostic performance compared with a single modality. Ultrasound-based radiomics can assist radiologists to improve the accuracy of diagnosis, and it may promote the development of precision diagnosis and treatment of various types of cancer.

Inter-ventricular Septum Ablation for the Treatment of Hypertrophic Obstructive Cardiomyopathy
Yuejin Wu, MS, Shaobo Duan, MD, Luwen Liu, MS, Shuaiyang Wang, MS, Shuang Xu, MS, Liuwei Hao, BS, Lianzhong Zhang, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (4): 297-302.   DOI: 10.37015/AUDT.2020.200048
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For symptomatic hypertrophic obstructive cardiomyopathy (HOCM), how to effectively relieve left ventricular outflow tract obstruction is of great significance. Relying on drugs and double-chamber pacing to reduce left ventricular outflow tract pressure gradient can alleviate symptoms. Methods to reduce the thickness of inter-ventricular septum include myocardial myectomy, percutaneous transluminal septal myocardial ablation, radiofrequency catheter ablation of ventricular tachycardia, and high-intensity focused ultrasound (HIFU) ablation of the ventricular septum that were performed on animal experiments to reduce inter-ventricular septal thickness, and showed significant therapeutic effects. Ultrasound-guided percutaneous intramyocardial septal ablation, as a less invasive and more effective treatment, exhibited great application prospects in reducing the pressure gradient of left ventricular outflow tract. This article reviews the research progress of several ventricular septal ablation techniques for the treatment of HOCM.

Development Status and Prospect of Remote Diagnosis and Treatment of Echocardiography Worldwide
Luwen Liu, MS, Shaobo Duan, MD, Yaqiong Li, PhD, Ruiqing Liu, MD, Yuejin Wu, MS, Lianzhong Zhang, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (4): 303-307.   DOI: 10.37015/AUDT.2020.200047
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Telemedicine refers to a discipline in which medical personnel use modern communication technology, electronic technology, and computer technology to realize the remote collection, storage, processing, transmission, and inquiry of various medical information, so as to cross the barriers of time and space and provide medical services to a wider range of people With the rapid development of Internet technology, telemedicine is being used more widely in case consultation, imaging, ECG and pathology. The demand for remote echocardiography is increasingly strong and its potential applications becoming more extensive, however, the development of remote ultrasound imaging, especially remote echocardiography, is lagging behind due to the limitation of dynamic image codec, immature multi-channel information synchronization technology, and slow network transmission speeds. This article reviews the development status and application prospects of remote diagnosis and treatment of echocardiography at home and abroad.

Focal Ablation Therapy for Prostate Cancer: A Literature Review
Ruiqing Liu, MD, Yaqiong Li, PhD, Bing Mao, MD, Na Li, PhD, Shaobo Duan, MD, Zhiyang Chang, MS, Ye Zhang, MS, Shuaiyang Wang, MS, Lianzhong Zhang, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (4): 308-314.   DOI: 10.37015/AUDT.2020.200045
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The incidence and mortality of prostate cancer (PCa) are gradually increasing. Traditional treatments for PCa may result numerous side effects and complications that affect patients’ quality of life. Furthermore, older patients frequently cannot tolerate conventional treatments, such as surgery, chemotherapy, and radiotherapy. Thus, minimally invasive and effective therapeutic approaches for PCa need to be developed for clinical practice. Focal ablation therapy, which uses high temperature to destroy tumors, holds promise as one such approach. It has been applied to PCa in several countries with gradual success and clinical practice This review briefly discusses the application of high-intensity focused ultrasound ablation (HIFU), cryoablation, laser ablation (LA), and radiofrequency and microwave ablation (RFA, MWA) for PCa, including the principles of treatment, clinical effects, and complications. The aim of this review is to provide a reliable reference for the application of focal ablation therapy to PCa.

Chinese Expert Consensus on Critical Care Ultrasound Applications at COVID-19 Pandemic
Faqin Lv, MD, Jinrui Wang, MD, Xing Yu, MD, Aiping Yang, MD, Ji-Bin Liu, MD, Linxue Qian, MD, Huixiong Xu, MD, Ligang Cui, MD, Mingxing Xie, MD, Xi Liu, MD, Chengzhong Peng, MD, Yi Huang, MD, Haiyan Kou, MD, Shengzheng Wu, MD, Xi Yang, MD, Bin Tu, MD, Huaping Jia, MD, Qingyi Meng, MD, Jie Liu, MD, Ruizhong Ye, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 27-42.   DOI: 10.37015/AUDT.2020.200029
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The spread of new coronavirus (SARS-Cov-2) follows a different pattern than previous respiratory viruses, posing a serious public health risk worldwide. World Health Organization (WHO) named the disease as COVID-19 and declared it a pandemic. COVID-19 is characterized by highly contagious nature, rapid transmission, swift clinical course, profound worldwide impact, and high mortality among critically ill patients. Chest X-ray, computerized tomography (CT), and ultrasound are commonly used imaging modalities. Among them, ultrasound, due to its portability and non-invasiveness, can be easily moved to the bedside for examination at any time. In addition, with use of 4G or 5G networks, remote ultrasound consultation can also be performed, which allows ultrasound to be used in isolated medial areas. Besides, the contact surface of ultrasound probe with patients is small and easy to be disinfected. Therefore, ultrasound has gotten lots of positive feedbacks from the frontline healthcare workers, and it has played an indispensable role in the course of COVID-19 diagnosis and follow up.

Critical Care Ultrasonography and Its Application for COVID-19
Xi Liu, MD, Yang Hai, MD, Bin Ma, MD, Weelic Chong, BA, Ji-Bin Liu, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 43-49.   DOI: 10.37015/AUDT.2020.200035
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Ultrasound has developed as an invaluable tool in diagnosis and proper management in the intensive care unit (ICU). Application of critical care ultrasonography is quite distinct from the routine comprehensive diagnostic ultrasound exam, because the urgent setting mandates a goal-directed approach. Performing accurate and efficient critical care ultrasound requires ultrasound providers to first understand the pathophysiology of the disease and related imaging findings, and then follow the protocols to perform a focused ultrasound exam. In the ongoing coronavirus disease 2019 (COVID-19) pandemic, ultrasound plays an essential role in diagnosing and monitoring critically ill COVID-19 patients in the ICU. Our review focuses on the basics and clinical application of critical care ultrasound in diagnosing common lung disease, COVID-19 pulmonary lesions, pediatric COVID-19, and cardiovascular dysfunction as well as its role in ECMO and interventional ultrasonography.

Teleultrasound for the COVID-19 Pandemic: A Statement from China
Xiaolong Li, MD, Lehang Guo, MD, Liping Sun, MD, PhD. Wenwen Yue, MD, Huixiong Xu, MD, PhD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 50-56.   DOI: 10.37015/AUDT.2020.200036
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The Coronavirus Disease 2019 (COVID-19) has spread rapidly throughout the world. COVID-19 is a highly contagious and potentially lethal infection, and as a result, individuals infected with it are treated in isolation units. Teleultrasound (TUS), particularly with the support of the fifth generation (5G) wireless transmission technology, can provide timely monitoring, fast clinical progress assessment, and help to guide interventional produces for patients with COVID-19 in isolation units. It can also reduce the risk of medical workers infection and save medical resources such as equipment and supplies. The purpose of this paper is to present an overview of operating procedures and ongoing planning with TUS for COVID-19 patients in China.

Lung Ultrasonography in Diagnosis and Management of Novel Coronavirus (COVID-19) Pneumonia: Pearls and Pitfalls
Heng Xue, MD, Yao Zhang, MD, Ligang Cui, MD, Jing Han, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 57-59.   DOI: 10.37015/AUDT.2020.200030
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The purpose of this article is to review the use of lung ultrasonography (US) in the workup of COVID-19 pneumonia. The scanning protocol, normal US appearance of lung, major US features of COVID-19 pneumonia, diagnostic performance of lung US and potential pitfalls when explaining US results are descripted and discussed. Lung US is increasingly accepted as a useful tool in the workup of COVID-19 pneumonia. Certain US imaging features allow to confirm or rule out the diagnosis for clinical management; on other hand, most US findings are nonspecific with technical limitations. Thus, it is important to recognize these drawbacks since the ignorance of potential pitfalls of lung US may lead to over diagnosis or missed diagnosis.

Bedside Ultrasound in Assessment of 510 Severe and Critical Patients with COVID-19 Pneumonia in Wuhan, China
Bin Wang, MD, Li Zhang, MD, Danqing Zhang, MD, Hongliang Yuan, MD, Chun Wu, MD, Yongxing Zhang, MD, Lin He, MD, Rui Wang, MD, Jing Wang, MD, Mingxing Xie, MD, PhD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 60-66.   DOI: 10.37015/AUDT.2020.200018
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Objective: To discuss the value of bedside ultrasound in the diagnosis and treatment of 2019 novel coronavirus diseases (COVID-19).
Methods: Retrospective analysis of the results of bedside ultrasound of 510 patients with COVID-19 in our hospital was done from January 31, 2020 to March 4, 2020.
Results: (1) Among the 510 patients who underwent bedside ultrasound examination, a total of 327 (64.1%) underwent echocardiography, 494 (96.9%) underwent bilateral venous ultrasound examination of lower limbs, 86 (16.9%) underwent bilateral artery ultrasound examination of lower limbs, 48 (9.4%) underwent ultrasound examination of liver, gallbladder, spleen and pancreas, 26 (5.1%) underwent ultrasound examination of kidney, ureter and bladder, and the numbers of patients who underwent ultrasound examination of pericardium, pleural effusion, and peritoneal effusion were 16 (3.1%), 21 (4.1%), and 5 (1%), respectively. (2) Among the 327 patients who underwent bedside ultrasound examination of the heart, 96 (29.4%) showed results of positive for other abnormalities or complications, in which 31 (9.5%) had abnormal left ventricular wall motion, 42 (12.8%) were with valvular heart disease, 3 (0.9%) showed coronary heart disease, 19 (5.8%) showed the enlargement of right heart with pulmonary hypertension (PAH), and 1 (0.3%) had congenital heart disease. In addition, 6 of the 327 echocardiography patients showed negative results (no other abnormalities or complications), accounting for 1.8%. (3) Among the 494 patients who underwent bilateral venous examination of lower limbs, 182 (36.8%) had phlebothrombosis. Eighty-six (86) patients underwent bilateral artery examination of lower limbs, and 63 (73%) of them had positive results, in which 5 patients showed arterial occlusion and the other 57 patients showed atherosclerosis. (4) Thirty-three (33) patients underwent ultrasound examination of liver, gallbladder, spleen, and pancreas, and 23 (70%) of them showed positive results. Among the 26 patients who underwent the urological examination, 7 (26.9%) showed positive results. Additionally, there are 2 positive findings in 21 patients who underwent the examination of pleural effusion (9.5%), and 1 positive case in 5 patients who underwent the examination of abdominal effusion (20%).
Conclusion: Bedside ultrasound is important in the diagnosis and treatment of COVID-19. We hope to make better use of bedside ultrasound to help clinicians get accurate diagnosis and treatment strategies.

Artificial Intelligence in Ultrasound Imaging: Current Research and Applications
Shuo Wang, BS, Ji-Bin Liu, MD, Ziyin Zhu, MD, John Eisenbrey, PhD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 53-61.   DOI: 10.37015/AUDT.2019.190811
Online available: 30 September 2019
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Artificial intelligence (AI) is an area of computer science that emphasizes the creation of intelligent software or system based on big data information, machine learning and deep learning technologies. The rapid development of science and technology as well as internet communication has enabled AI and big data to gradually apply to many fields of health care. The modern imaging medicine is one of the first areas where AI can play an important role and applications. As cross-sectional imaging, ultrasound (US) is well suitable for AI technology to standardize imaging protocols and improve diagnostic accuracy. This article reviews current AI technology and related clinical applications in the fields of thyroid, breast and liver US.

Applications in Molecular Ultrasound Imaging: Present and Future
Vishal Thumar, MD, Ji-Bin Liu, MD, John Eisenbrey, PhD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 62-75.   DOI: 10.37015/AUDT.2019.190812
Online available: 30 September 2019
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Molecular ultrasound imaging or targeted contrast-enhanced ultrasound (CEUS) is a relatively new technique that has varied applications to augment both diagnostics and therapeutics. Ultrasound contrast agents are conjugated to ligands that bind with specific biomarkers in the areas of interest which can then be quantified using ultrasound technology. This technique has numerous clinical applications including studying pathophysiology of disease, improving diagnostic sensitivity and specificity, and improving localized drug delivery. This technology, most notably, has proven useful in numerous oncologic and cardiovascular applications. Given ultrasound’s advantages over other radiographic studies including its low cost, lack of ionizing radiation, portability, ability to provide real-time imaging, and non-invasiveness, recent investigations have expanded the utility of molecular ultrasound. In this review, we briefly review targeted ultrasound contrast agents and explore the current applications of molecular ultrasound as well as future applications based on the currently published literature.

Coronary Heart Disease Concomitant with Atherosclerotic Cerebrovascular Disease
Yumei Liu, MD, Beibei Liu, MD, MS, Boyu Li, MD, PhD, Yang Hua, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 76-80.   DOI: 10.37015/AUDT.2019.190813
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Cardio-cerebrovascular disease has a high rate of disability and mortality and affects a large number of people worldwide. Early prevention, accurate diagnosis and effective treatment are of great significance. This article reviews the risk factors, multimodalities of imaging diagnosis, and operational options for the atherosclerotic cardio-cerebrovascular combined disease.

Improving Ultrasound Gene Transfection Efficiency in Vitro
Xianghong Luo, MD, Jianhui Zhang, MD, Sihui Shao, MD, Rong Wu, MD, Lianfang Du, MD, Jie Yuan, PhD, Zhaojun Li, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 81-86.   DOI: 10.37015/AUDT.2019.190814
Online available: 30 September 2019
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Objective: The purpose of this study was to optimize ultrasound-targeted microbubble destruction (UTMD) on RAGE plasmid transfection in human coronary artery endothelial cells (HCAECs) and improve gene transfection efficiency in vitro.

Methods: SonoVue microbubble suspension was prepared and mixed with HCAECs, while the cells were adherent and suspended, respectively. After RAGE plasmids being added, they were exposed to ultrasonic irradiation for 10, 20, and 30 s by a therapeutic US machine with 0.4W, respectively. The samples with adherent HCAECs (adherent group) were irradiated directly, while the samples with suspended HCAECs (suspended group) were irradiated via the water. The combined effect of ultrasound and microbubble on RAGE plasmid transfection in HCAECs was evaluated by detecting protein expression of RAGE by western blot. In addition, the viability of the HCAECs was analyzed by CCK8 in order to explore the optimal transfection condition.

Results: In suspension group, compared with control, the expression of RAGE was gradually increased from 5 to 20s, and decreased from 20 to 30s. The expression of RAGE peaked in 20s and indicated statistical significance. However, compared with the control, the expression of RAGE did not significantly increase with prolonged ultrasound irradiation in the adherent group. On the other hand, viability of the HCAECs did not decrease significantly with extended exposure time in both groups.

Conclusion: UTMD represents an efficient and safe method for the transfection of cells in suspension and optimal exposure.

Histological Reference for Shear Wave Elastography in Liver Fibrosis: Collagen Quantification and Scoring System
Yue Zhang, MD, Hong Ding, MD, Shengdi Wu, MD, Peili Fan, MD, Zheng Li, MD, Wenjiao Zeng, MD, Wenping Wang, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 87-96.   DOI: 10.37015/AUDT.2019.190815
Online available: 30 September 2019
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Objective: To investigate the significance and value of collagen quantification as an optimized histological standard to evaluate shear wave elastography (SWE) in assessing liver fibrosis.

Methods: Liver fibrosis models of rats were created by intraperitoneal injection of thioacetamide over 12 weeks. Liver stiffness was measured with SWE in 96 rats and 16 controls from week 5 to week 12. After removing, three liver specimens were processed for hematoxylin-eosin staining, reticular fiber staining, and picric-sirius red staining, respectively. Liver fibrosis stage (F0-F4) was assessed with the Scheuer scoring system. Collagen was quantified using collagen proportionate area (CPA) with computer-assisted digital image analysis. The Spearman’s rank correlation analysis was performed to determine the correlation between hepatic stiffness measured by SWE, traditional stages and CPA.

Results: The mean CPAs in different stages of liver fibrosis were 0.221 ± 0.134, 0.425 ± 0.204, 0.775 ± 0.375, 1.293 ± 0.591, and 2.447 ± 0.891 for F0, F1, F2, F3, and F4, respectively. CPAs showed a strong positive correlation with the traditional scoring system (r = 0.819, P < 0.001). Liver stiffness represented by SWE values exhibited a slightly stronger positive correlation with CPA (r = 0.889, P < 0.001) than with traditional fibrosis staging system (r = 0.836, P < 0.001), with no statistic difference.

Conclusion: The accurate and scientific collagen quantification of CPA can be developed as one pathological reference to reliably reflect the diagnostic value of SWE in evaluating liver fibrosis progression.

The Role of Ultrasound Shear Wave Dispersion Imaging in Evaluating Carotid Viscoelasticity:A Preliminary Study
Xianghong Luo, MD, Jianhui Zhang, MD, Sihui Shao, MD, Min Yan, MD, Rong Wu, MD, Lianfang Du, MD, Zhaojun Li, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 97-102.   DOI: 10.37015/AUDT.2019.190816
Online available: 30 September 2019
Abstract371)   HTML25)    PDF 251

Objective: To evaluate the carotid viscoelasticity using ultrasound shear wave dispersion imaging (USWD) and determine its feasibility.

Methods: Forty-five volunteers were recruited and divided into the group1 (≥50 years old) and group 2 (<50 years old). The shear wave elastic modulus (SWE-AR and SWE-PR) and shear wave dispersion indexes (SWD-AR and SWD-PR), which located at the anterior and posterior walls of the common carotid artery (CCA), were obtained by USWD, and compared with pulse wave velocity (PWV). Pearson correlation analysis was applied to analyze the related factors of viscoelasticity.

Results: Before and after body mass index, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were adjusted, SWE-AR, SWE-PR, SWD-AR and SWD-PR were all higher in the group 2 than those of group 1 (all P < 0.05). In all subjects, SWE was negatively correlated with age, SBP, DBP and PWV, respectively (r = -0.282, -0.374, -0.321, -0.256 and all P < 0.05). The SWD was negatively correlated with PWV in the group 1, while positively correlated with SBP in the group 2 (r=-0.393 and r=0.366, all P < 0.05).

Conclusion: The viscoelasticity of arterial wall can be assessed by USWD. It provides a new way to describe arterial disease for clinical study.

The Significance of Heat Shock Protein 70 Expression in Benign Thyroid Nodules During Thermal Ablation
Lei Yan, MM, Jianquan Zhang, MD, Jianguo Sheng, MM, Hang Zhang, MM, Zongping Diao, MM, Jianming Zheng, PhD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 103-108.   DOI: 10.37015/AUDT.2019.190817
Online available: 30 September 2019
Abstract196)   HTML10)    PDF 375

Objective: To investigate the change of HSP70 expression after microwave ablation of benign thyroid nodules.

Method: Ultrasound-guided microwave ablation (MWA) was conducted for treating 60 benign solid thyroid nodules in 60 patients. Three different region of interest (ROI), named as central zone, marginal zone and transitional zone, were artificially set in each nodule for quantitative investigation of HSP70 expression by using the immunohistochemistry (IHC) method based on the US-guided core-needle biopsy (CNB) technique. As a longitudinal comparative study design, each ROI experienced twice histological sampling twice by using CNB before and after MWA. IHC semi-quantitative determination of HSP70 expression was compared among the specimen from the three ROIs in a same nodule before ablation and between the specimen from the same ROI before and after ablation respectively as well.

Results: Of the 60 solid thyroid nodules, either in the central zone or in the marginal zone, HSP70 expression did not experienced significant change (P > 0.05) from before ablation to after ablation, however, a significant upgrading of HSP70 expression developed in the transitional zone after ablation (P < 0.05). After ablation, the transitional zone had a higher level of HSP70 than that in both the central and marginal zones (P < 0.05) in a same nodule, while the level of HSP70 was not found significantly different between the central zone and marginal zone (P > 0.05).

Conclusion: Thermal coagulation by MWA stimulates the upgrading of HSP70 expression in the heated tissue of benign thyroid nodules, but in a way of regional discrepancies. The remarkable increased expression of HSP70 in the transitional zone tissue might originate from a slower and less intensive temperature rise along with the attenuation of microwave radiation, and it is postulated to protect normal glandular tissue against heat damage. Fast and intensive temperature rise within the nodule causes more intensive and massive thermal coagulation changes and weakens the adequate expression and proper protective function of HSP70 in those two areas.

Clinical Value of Contrast Enhanced Ultrasound in Differential Diagnosis of Early Hepatocellular Carcinoma and Dysplastic Nodules
Yanhua Zhen, MD, Xuefeng Lu, MD, Chenyu Wang, MD, Huixia Li, MD, Ji-Bin Liu, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 109-114.   DOI: 10.37015/AUDT.2019.190818
Online available: 30 September 2019
Abstract393)   HTML1)    PDF 224

Objective: To explore the clinical value of ultrasonography for early detection and monitoring of angular pregnancy during the first-trimester.

Methods: For this retrospective study, we enrolled 23 patients with asymptomatic angular pregnancy who were diagnosed by ultrasound at early pregnancy and who underwent ultrasound follow-up to determine its clinical outcome. An ultrasound unit E8 (GE Healthcare, Milwaukee, WI) associated with a 5-9 MHz convex array transvaginal probe was used to image the gestational sac by both two-dimensional and three-dimensional modes. Transvaginal sonographic observation included the location, size, and shape of the gestational sac, as well as the relationship between the gestational sac and the endometrium. When the gestational sac was located close to or at the corners of the uterus, the wall thickness of the corner was measured and documented for follow-up during the first-trimester.

Results: Angular pregnancy (n=23) was detected by first ultrasonography at 37-50 days of gestation. All patients then underwent dynamic sonographic monitoring and were closely followed every 5-10 days for 1-3 weeks. In 3 cases, ultrasound showed embryo demise at follow-up examination. Seven cases were converted to intrauterine pregnancies based on sonographic findings and carried to term. In 13 cases, ultrasonography showed the gestational sacs grew outward in the corner of the uterus where the wall was thinning and had asymmetrical corners. Based on the ultrasound results, thesepregnancies were terminated (by surgery [n=6] or medication [n=7]).

Conclusions: Sonography is a valuable clinical tool for early detection and monitoring of angular pregnancy. Follow-up ultrasound can provide useful information for observing the transformation of angular pregnancy to guide clinical management, including whether to continue or terminate pregnancy.

CMUT/CMOS-based Butterfly iQ - A Portable Personal Sonoscope
Joyce Y Liu, BA, Jiajun Xu, MD, Flemming Forsberg, PhD, Ji-Bin Liu. MD, FAIUM
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 115-118.   DOI: 10.37015/AUDT.2019.190819
Online available: 30 September 2019
Abstract1762)   HTML120)    PDF 2945

With the development of bioengineering technologies, medical ultrasound systems have evolved and advanced over the years, including the transition of ultrasound machines from analog devices to digital systems and improvements in transducer assembly from piezoelectric ceramics to single crystals. In the past several years, the further miniaturization of ultrasound units has become possible with the advancement of computer chip manufacturing and production. Most recently, a new handheld ultrasound system has been developed by the startup company Butterfly Network, using an innovative CMUT/CMOS-based probe technique. This paper will review the history, technology and features of this new device, as well as discuss its future potential as a personal sonoscope.

Review of Certification in Building a Successful Sonographer Program in China
Hannah Mason, MA, Karen Caruth, MBA, Qiang Lu, MD, Dale R. Cyr, MBA, CAE
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 119-122.   DOI: 10.37015/AUDT.2019.190820
Online available: 30 September 2019
Abstract232)   HTML1)    PDF 188

By working with local medical ultrasound experts, American Registry for Diagnostic Medical Sonography (ARDMS) of Inteleos, a non-profit certification organization, is striving to create global standards and international certifications in the field of diagnostic ultrasound that will improve clinical practice and patient safety. Through eligibility and application requirements, building a proper assessment, and determining continuing education requirements, standards are a critical part of Inteleos’ test development process. Since 2005, Inteleos/ARDMS has been working with Chinese physicians and professional societies to facilitate and promote certification and credentialing programs. Through the Registered Physician in Vascular Interpretation (RPVI-China) assessment, applicants can earn the internationally-recognized certificates in vascular ultrasound in China. Along with certification for Physicians, China’s growing population and the related burden on its healthcare system as well as the rapid increases in ultrasound use could contribute to the ideal situation for building a sonographer profession in China. Through a pilot education and certification program for Chinese sonographers, Inteleos will work with Chinese universities and collaborators to build and expand the sonographer profession in China in order to reduce workload on physicians, reduce wait times, decrease hospital costs, and provide consistently better care for their population.

Contrast-enhanced Ultrasonography: A New Strategy to Confirm Cervical Pregnancy
Qingyun Song, MD, Sha Hu, Hong Luo, MD, Taizhu Yang, Qianqian Gao, MD, Fan Yang, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 123-127.   DOI: 10.37015/AUDT.2019.190821
Online available: 30 September 2019
Abstract186)   HTML2)    PDF 263

Cervical pregnancy is a rare variety of ectopic pregnancy. The success of conservative treatment for cervical pregnancy depends on early and accurate diagnosis of ultrasound. We found Contrast-enhanced ultrasonography (CEUS) to be an accurate diagnosis approach for cervical pregnancy. In cervical pregnancy, CEUS showed rapid enhancement of the wall of the gestational sac during the early enhancement phase with the performance of hyper-enhanced. Enhancement sustained at a high level of intensity through the early enhancement phase, with the sign of doughnut-shaped in the wall of the gestational sac, and washed out slowly during the late enhancement phase. While the wall of the gestational sac showed no enhancement during the whole phase in aborting intrauterine pregnancy residing in the cervical canal.

A Rare Case of Spontaneous Gastrobiliary Fistula Diagnosed by Oral Contrast-enhanced Ultrasound
Wei Zhang, MS, Rongqin Zheng, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 128-131.   DOI: 10.37015/AUDT.2019.190822
Online available: 30 September 2019
Abstract239)   HTML4)    PDF 234

We report the case of a 55-year-old man with a spontaneous fistula between the intrahepatic bile duct and stomach. Oral contrast-enhanced ultrasound (CEUS) was used in this patient and made the diagnosis of fistula as observed during open surgery. We found that oral CEUS should be considered as a safe, simple and effective method to diagnose and evaluate gastrobiliary fistulas.

Fusion Image of Gd-EOB-DTPA MRI and Ultrasound Guiding Microwave Ablation of Hepatocellular Carcinoma Adjacent to Intrahepatic Bile Ducts: A Report of Two Cases
Huijuan Peng, MD, Wenzhao Liang, MD, Lei Liu, MD, Jing Jia, MD, Yingqiao Zhu, Dezhi Zhang, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 132-135.   DOI: 10.37015/AUDT.2019.190823
Online available: 30 September 2019
Abstract150)   HTML1)    PDF 176

Ultrasound (US) has been the most common imaging modality to guide ablation therapy. However, if the tumor is adjacent to intrahepatic bile ducts, only using US as guiding image may not be safe or effective. Gd-EOB-DTPA magnetic resonance imaging (MRI) enables improved liver lesion detection as well as a better illustration of the biliary system information [1-3]. We report two cases of microwave ablation (MWA) guided by a real-time image fusion of Gd-EOB-DTPA MRI and US for hepatocellular carcinoma (HCC) located adjacent to the intrahepatic bile ducts. The therapeutic effect was assessed by contrast enhanced ultrasound (CEUS) and MRI.

Microwave Ablation of An Autonomous Functioning Thyroid Nodule in A Pregnant Patient: A Case Report
Shengnan Huo, MD, Lin Yin, Lili Peng, MD, Zhao Wang, MD, Ming-an Yu, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 136-139.   DOI: 10.37015/AUDT.2019.190824
Online available: 30 September 2019
Abstract305)   HTML1)    PDF 307

An autonomous functioning thyroid nodule (AFTN) is a benign disease. It can autonomously secrete excessive thyroid hormones without the need for TSH stimulation. It is not subject to the hypothalamic-pituitary-thyroid axis and is rare during pregnancy. Here we report a case of a 36-year-old pregnant woman with hyperthyroidism detected in early pregnancy, According to ultrasound and laboratory results, she was diagnosed with an AFTN. Ultrasound-guided (US-guided) microwave ablation (MWA) was used to treat AFTN during the second trimester of pregnancy. Hyperthyroidism crisis and other complications did not occur due to MWA. Thyroid function was normal at 2, 3 and 4 months after MWA. The volume reduction rate (VRR) was 83.67% at 4 months after MWA. The patient gave birth normally at 40 weeks gestation. All indices of thyroid function were normal during postpartum and lactation. US-guided MWA is a feasible and safe method for the treatment of AFTN during pregnancy, specifically in the second trimester.

Ultrasound-guided Catheter Decompression of Afferent Loop Obstruction after Pancreaticoduodenectomy: A Case Report
Zhanli Wei, MM, Jie Li, MM, Hua Wang, MD, Xiaopeng Li, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 140-143.   DOI: 10.37015/AUDT.2019.190825
Abstract198)   HTML3)    PDF 187

Ultrasound-guided percutaneous trans-hepatic intestinal drainage is a rare intervention operation at home and broad.We report this case of percutaneous trans-hepatic intestinal drainage because of its mechanic intestinal obstruction. A 61-year-old woman was admitted to our hospital for abdominal distension, stomachache, vomit. The symptoms could not be alleviated by routine fast and nasogastric tube. She had received pancreaticoduodenectomy as a result of carcinoma of pancreatic head three months before this hospital visit. T-tube angiography showed obvious afferent loop obstruction and ultrasonography demonstrated dilated proximal intestines. Considering her poor laboratory results, we put a pigtail into the patient’s dilated proximal intestines instead of administering laparotomy to alleviate intestinal pressure in a short time. Our case mainly stresses the feasibility of ultrasound-guided percutaneous trans-hepatic catheter intestinal decompression in special circumstances.

CT Perfusion Imaging: A Valuable and Feasible Resolution of Pulmonary Nodules
Mai-lin Chen, MD, Ying-shi Sun, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (2): 27-34.   DOI: 10.37015/AUDT.2019.190806
Abstract223)   HTML14)    PDF 267

CT perfusion imaging, a non-invasive functional imaging method, can accurately reflect the hemodynamic changes of pulmonary nodules. It plays an important role in the diagnosis, differential diagnosis, treatment effect assessment and prognosis prediction. This article reviews the hemodynamics of pulmonary nodules, the characteristics of the blood flow of CT perfusion imaging of the pulmonary nodules, the characteristics of the CT perfusion technique of the pulmonary nodules and the status of the clinical application in the characterization of pulmonary nodules.

Morphology and Hemodynamic Characteristics of Internal Jugular Vein Hypoplasia and Relation with Cerebral Venous Sinus Stenosis
Lingyun Jia, MD, Yang Hua, MD, Xunming Ji, MD, Kaiyuan Zhang, MD, Yu Tang, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (2): 35-40.   DOI: 10.37015/AUDT.2019.190807
Abstract202)   HTML3)    PDF 318

Objective: The characteristics of Internal jugular vein (IJV) morphology and hemodynamics of IJV hypoplasia have not been well illustrated.
Methods: Seventy-three cases with IJV hypoplasia diagnosed by MR and/or CT venous angiography and 126 healthy control were recruited. Ultrasound was performed to examine the J1-J3 segments of IJV. The diameter and mean flow volume (FVm) of bilateral IJV were compared. The linear regression of bilateral diameter ratio and FVm ratio were analyzed. The optimal cutoff values of diameter and flow volume of different segment of IJVs were determined by receiver operating characteristic (ROC) analysis. Furthermore, the correlation between the IJV hypoplasia and cerebral venous sinus stenosis were analyzed.
Results: There were 91.8% (67/73) cases with left IJV hypoplasia. The diameter and FVm of hypoplasia IJV were lower than the contralateral side (P<0.001). The bilateral J1 diameter ratio was linear correlation with the FVm ratio, with a coefficient 0.720. The optimal cut-off diameter ratio of J1-J3 hypoplasia/dominant side were 0.70, 0.80 and 0.75 respectively and the optimal cutoff FVm ratio of three segments were all 0.50. The side of IJV hypoplasia was highly correlated with the side of transverse sinus and/or sigmoid sinus stenosis with an overall coincidence rate of 68.5%.
Conclusion: The left IJV was vulnerable for hypoplasia. IJV hypoplasia was correlated with ipsilateral cerebral venous sinus stenosis. Ultrasound is a reliable modality for evaluating IJV hypoplasia.

Age-dependent D-dimer Cut-off Value Reduced Unnecessary Ultrasound Scans for Chinese Older Patients Suspected with Deep Vein Thrombosis
Shunxin Zhang, MD, Cui Liu, MD, Xin Zhao, MD, Danfei Song, MD, Junlai Li, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (2): 41-46.   DOI: 10.37015/AUDT.2019.190808
Abstract198)   HTML1)    PDF 193

Objective: To evaluate whether the age-dependent D-dimer cut-off value would help to effectively decrease proportion of older patients suspected with deep vein thrombosis (DVT) to take unnecessary ultrasound imaging tests.
Method: This prospective, single institution study was approved by the Institutional Ethics Committee of PLA General Hospital. The patients greater than 65 years with suspected DVT were enrolled in this study and underwent clinical estimations, D-dimer test and ultrasound scans of lower extremity. Clinical probability scores were graded as unlikely (score < 2 and likely (score≥2). Conventional cut-off value (500 μg/L) and age-dependent cut-off value (patient’s age × 10 μg/L) were applied for analyzing respectively. Evaluation and analysis include diagnostic accuracy (sensitivity and specificity), number of false negative results and 95% confidence intervals, and comparison of two cut-off values in different age groups.
Results: A total of 1024 consecutive patients (76.4±19.3 years old) met the inclusion criteria. DVT was present in 256 patients (prevalence 25.0%). In 543 patients (Wells score < 2), DVT could be excluded in 193 patients using conventional cut-off value, while in 277 patients using age-dependent cut-off value, 84 patients could avoid unnecessary ultrasound scans. False negative rates were 3 patients (0.55%, 95% confidence interval 0.11-1.61%) using conventional cut-off vs. 4 patients (0.74%, 95% confidence interval 0.20-1.88%) using age-dependent cut-off value. The absolute increase in patients which DVT could be ruled out using the age-dependent cut-off value was largest in patients > 85 years.
Conclusion: The age-dependent D-dimer cut-off value could help to exclude older patients with suspected DVT, to reduce unnecessary ultrasound scans, and to relieve the financial burden on patients, hospitals and society.

Open Access, Peer-reviewed

ISSN 2576-2516 (Online)

ISSN 2576-2508 (Print)

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