ObjectiveTo investigate the application value of contrast-enhanced ultrasound (CEUS) technique to assist the repair of oral and maxillofacial defects by superficial inferior epigastric artery perforator flap.MethodsSixteen oral cancer patients, 10 males and 6 females, who were to undergo superficial inferior epigastric artery perforator flap repair between June 2018 and February 2020, were selected, with an average age of 55.8 years (range, 24-77 years). There were 13 cases of squamous cell carcinoma, 2 cases of adenoid cystic carcinoma, and 1 case of mucinous epidermis-like carcinoma. The color Doppler ultrasound (CDUS) and CEUS were used to screen the superficial inferior epigastric artery, assisted in the design of the flap, and compared it with the actual intraoperative exploration. The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS and CDUS examinations were analyzed. Fourteen of 16 patients were repaired with superficial inferior epigastric artery perforator flap, and 2 patients were repaired with superficial iliac artery flap because the source artery was not found. After surgery, regular follow-up was performed to check for disease recurrence and metastasis and to evaluate the appearance of the patien’s donor area, the recovery of transoral feeding function, and the presence of complications.ResultsComparison of preoperative CDUS and CEUS findings and intraoperative exploration showed that CEUS had 100% sensitivity, specificity, positive predictive value, and negative predictive value for vascular exploration of the superficial inferior epigastric artery perforator flap, compared with 57%, 100%, 100%, and 25% for CDUS. The preoperative CDUS identified 25 penetrating vessels in 14 cases repaired with superficial inferior epigastric artery flaps. All vessel signals were enhanced by CEUS enhancement, and an additional 11 penetrating vessels were identified confirmed intraoperatively. The preoperative CEUS measurements of the initial diameter of superficial arteries in the abdominal wall were significantly higher than both CDUS and intraoperative measurements (P<0.05); the difference in peak systolic velocity between CEUS and CDUS measurements was significant (t=3.708, P=0.003). One case of superficial epigastric artery perforator flap developed venous embolism crisis at 48 hours after operation, the wound healing delayed. The other incisions in donor sites healed by first intention. All the patients were followed up 3-12 months, with an average of 8 months. No recurrence or metastasis appeared during the follow-up. There was no serious complications such as abdominal wall hernia, the location of abdominal scarring was hidden, and transoral feeding was resumed.ConclusionThe superficial inferior epigastric artery perforator flap with small injury in supply area and hidden scar location is a better choice for repairing oral and maxillofacial defects. The use of CEUS technique to assist the preoperative design of the superficial inferior epigastric artery perforator flap has good feasibility and high accuracy.
Chronic kidney disease (CKD) is now recognized as a worldwide public health challenge, and the incidence rate and hospitalization rate have significantly increased in recent years. Without prompt diagnoses and effective treatment in the early renal function damage of CKD, the symptoms will continue to worsen and eventually develop into end-stage renal disease. Functional imaging techniques such as single photon emission computed tomography (SPECT), contrast-enhanced ultrasound (CEUS), computerized tomography perfusion (CTP), and magnetic resonance perfusion weighted imaging (MR-PWI) could be used to quantitatively analyze renal perfusion and renal filtration function. Their diagnostic values are increasingly evident and have become the research hotspot in evaluating renal function. The aim of this review is to briefly evaluate the research and application advances in the early renal function damage assessment of CKD, so as to raise the efficiency of clinical applications.
ObjectiveTo systematically review the value of contrast-enhanced ultrasound in diagnosis of benign and malignant renal tumors. MethodsSuch databases as PubMed, EMbase, The Cochrane Library (Issue 9, 2013), CBM, CNKI, WanFang Data and VIP were searched by Sep 31st, 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using Meta-Disc 1.4 software. ResultsSeven studies involving 462 patients were finally included. ROC curve showed shoulder-arm shape. The results of Spearman suggested significance of the threshold effect. The results of meta-analysis showed that, the area under curve (AUC) was 0.98. ConclusionContrast-enhanced ultrasound can improve diagnostic accuracy, which is of important value in the diagnosis and differential diagnosis of benign and malignant renal tumors. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies.
Objective To approach the enhancing patterns of hepatic focal nodular hyperplasia (FNH) under contrast-enhanced ultrasound, and improve the recognition on diagnosis for FNH by contrast-enhanced ultrasound. Methods The clinical data of 12 patients with histologically proved FNHs having accepted contrast-enhanced ultrasound examination from May 2007 to February 2009 in West China Hospital of Sichuan University were retroptectively analyzed, and related literatures were reviewed. Results All FNHs were rapidly enhanced in arterial phase and spoke-wheel-like sign was detected in 9/12 lesions. Slightly hyper-enhancement or iso-enhancement were showed in 11/12 lesions, while 1/12 lesions showed hypo-enhancement in late phase. Conclusion Contrast-enhanced ultrasound can display the dynamic blood perfusion of FNH, especially spoke-wheel-like arterial flow in early arterial phase, which is of great value for the diagnosis of FNH.
ObjectiveTo evaluate the diagnostic value of contrast enhanced ultrasound (CEUS) to the sentinel lymph node (SLN) of breast cancer. MethodsSeventy-two operable breast cancer patients with clinically negative axillary lymph node were enrolled.Sulphur hexafluoride microbubbles for injection (SonoVue) was used alone as the tracer agent for the sentinel lymph node biopsy (SLNB), and axillary dissection was performed after the methylene blue location.All SLNs were examined pathologically with HE staining.The SLN diagnosis result of contrast enhanced ultrasound and postoperative pathological examination result were comparative analyzed. ResultsAfter the injection of SonoVue can obtain a clear image of the lymphatic vessels and SLN.The success rate of CEUS imaging was 84.72% (61/72) in this group of 72 patients, and the false negative rate was 12.12% (4/33).The sensitivity and specificity of diagnosis by CEUS was 92.50% (37/40) and 92.59% (50/54), respectively, the diagnostic odds ratio (DOR) was 154.17.By the pathology results as the gold standard, the internal consistency of these two methods was good (Kappa value=0.848, P < 0.01). ConclusionCEUS may be a useful orientation and determination method for SLNs.
Objective To investigate the application and clinical efficacy of orthotopic autologous renal transplantation combined with inferior vena cava (IVC) resection and reconstruction in retroperitoneal tumor. Methods The clinical data of a patient with complex retroperitoneal tumor was analyzed retrospectively. Abdominal CT examination showed that the tumor originated from IVC and invaded the retrohepatic IVC and bilateral renal vein trunks. Intraoperative ultrasound exploration revealed mechanized thrombosis in the IVC and bilateral renal vein trunks. After blocking the left renal vein, no significant hemodynamic changes were seen before and after intraoperative ultrasound exploration and contrast-enhanced ultrasound. Results After complete removal of the left renal vein and suture of the severed end, the right renal vein was successfully reconstructed with an orthotopic autologous right kidney graft combined with IVC resection after removal of the mechanized thrombus. The patient recovered well after surgery, and a repeat CT showed that the reconstructed artificial IVC was patent, and the color Doppler ultrasonography of both kidneys showed good perfusion and no obstruction of return. The patient was given oral rivaroxaban anticoagulant therapy after operation, and discharged at 19 days after operation. The postoperative pathological findings suggested inferior vena cava smooth muscle sarcoma. Conclusion Orthotopic autologous renal transplantation combined with IVC resection and reconstruction for complex retroperitoneal tumor is safe and feasible, and the left renal vein can be ligated and dissected intraoperatively, but a comprehensive evaluation with intraoperative ultrasound (imaging) is required.
ObjectiveTo systematically review the clinical value of the contrast-enhanced ultrasonic in the diagnosis of breast tumors. MethodsWe electronically and comprehensively searched the databases including The Cochrane Library (Issue 2, 2013), PubMed, CNKI, WanFang Data, Chaoxing medalink, VIP, and CBM for clinical research reports of diagnosing breast cancer with Contrast-enhance ultrasonic (all from foundation to May 2013). Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies according to the QUADAS items. The Meta-DiSc software (version 1.4) was used to conduct pooling on sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Heterogeneity test was performed and the summary receiver operating characteristic (SROC) curve was drawn for area under the curve (AUC). ResultsA total of 19 studies involving 1 161 participants were included. The results of meta-analysis showed that, specificity, the pooled sensitivity, positive likelihood ratio, negative likelihood ratio and DOR were 0.79 (95%CI 0.75 to 0.82), 0.86 (95%CI 0.83 to 0.89), 3.92 (95%CI 2.77 to 6.56), 0.18 (95%CI 0.13 to 0.26), and 25.86 (95%CI 13.77 to 48.55), respectively. The AUC of the SROC curve was 0.917 0. ConclusionThe current evidence shows that contrast-enhanced ultrasonic has high sensitivity and specificity in the diagnosis of preoperative benign and malignant breast mass, which indicates that it could be used as a good method to diagnosing breast tumors.
【摘要】 目的 讨论胃充盈超声造影在胃溃疡患者术后的应用价值。 方法 2002年6月-2009年6月对因胃溃疡行手术的72例患者采用饮水法充盈胃进行术后超声检查随访，观察术后胃的容量变化、术后近期并发症及远期并发症。 结果 所有胃术后的患者，近期胃容量较前减少60%～70%，随着时间的延长，容量逐渐恢复，最大恢复至术前的50%。吻合处胃壁僵直，蠕动波消失。十二指肠残端漏2例，近期吻合口狭窄5例，胃瘫综合症3例，吻合口反流40例，有临床症状的患者10例，无临床症状的患者30例，复发性溃疡1例，未发现残胃癌及远期吻合口梗阻。 结论 胃充盈超声造影是胃溃疡术后简单易行的随访方法，具有重要的临床应用价值。【Abstract】 Objective To evaluate the use of contrast-enhanced ultrasonography of gastric filling in gastric ulcer patients after the operation. Methods A total of 72 patients who underwent the operation due to gastric ulcer between June 2002 and June 2009 were selected. We used water-drinking method for filling stomach to perform the ultrasonic examination and the patients were followed up. The post-operation changes in the capacity of the stomach, postoperation complication and long-term complication were observed. Results The reduction of recent stomach capacity was 60%-70% in of the patients after the operation. As time goes on, the capacity gradually recovered, and the largest recovery was 50%. Anastomosis gastric wall was stiff, and peristaltic wave disappeared. Drain off residual duodenum was found in 2 patients, anastomotic stricture near was in 5, delayed gastric emptying was in 3, anastomotic reflux was in 40, clinical symptoms was in 10, no clinical symptoms was in 30, and recurrent ulcer was in 1. No gastric remnant cancer or long-term anastomtic obstruction was observed. Conclusion Contrast-enhanced ultrasonography of gastric filling is a simple and practicable ultrasound follow-up method after gastric ulcer.