Value of Conventional Ultrasonography with Contrast-Enhanced Ultrasonography in the Differential Diagnosis of Partial Cystic Thyroid Nodules

The value of contrast-enhanced ultrasonography (CEUS) in the diagnosis of malignant partial cystic thyroid nodules (PCTNs) remains unclear. Thus, in the present study, the data of patients with pathologically proven PCTNs who underwent CEUS in the Chinese PLA General Hospital from January 2016 to February 2019 were retrospectively reviewed, and the imaging characteristics of benign and malignant PCTNs were compared. A total of 177 PCTNs were enrolled in this study, including 58 (32.7%) malignant nodules and 119 (67.2%) benign nodules. Six characteristics significantly differed between malignant PCTNs and benign PCTNs in univariate comparison: position of the solid portion (χ² = 17.937, p < 0.001), microcalcifications (χ² = 81.382, p < 0.001), boundaries (χ² = 45.486, p < 0.001), echogenicity (χ² = 11.152, p = 0.004), intensity of enhancement (χ² = 40.656, p < 0.001) and uniformity of enhancement (χ² = 19.933, p < 0.001). Among these, microcalcifications, boundaries, position of the solid portion, and uniformity of enhancement were independent risk factors in the multivariate comparison. A logistic regression model for predicting benign and malignant PCTNs was established with a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 89.0% (95% confidence interval [CI]: 0.788–0.961), 91.0% (95% CI: 0.830–0.946), 81.0% (95% CI: 0.715–0.881), 95.0% (95% CI: 0.892–0.974) and 90.0% (95% CI: 0.844–0.938), respectively. The area under the receiver operating characteristic curve was 0.967 (95% CI: 0.944–0.990), which was significantly higher than that of conventional ultrasound only (0.747, 95% CI: 0.663–0.831, Z = 2.090, p = 0.0366). CEUS can be used in the diagnosis of PCTNs, and the four characteristics of malignant PCTNs proven by our study were microcalcifications, unclear boundaries, eccentric distributions of the solid parts and heterogeneous enhancement.     

厚壁型胆囊癌超声造影征象及诊断价值的研究

目的研究厚壁型胆囊癌的超声造影特征,并评价其对胆囊癌的诊断价值。 方法选取2014年7月至2017年10月在解放军总医院接受超声造影检查及手术切除的26例厚壁型胆囊癌及37例良性厚壁型病变患者的超声造影图像、临床资料及手术病理。观察不同超声造影征象诊断壁厚型胆囊癌的价值。厚壁型胆囊癌26例为恶性组,良性厚壁型占位37例为良性组,2组患者年龄、胆囊长度、宽度、胆囊壁厚度采用t检验,超声造影特征（胆囊壁增强强度、黏膜层形态、黏膜下低增强区）比较采用χ²检验。诊断性试验采用ROC曲线计算敏感度、特异度、阳性预测值、阴性预测值及准确性。 结果恶性组胆囊壁厚度、年龄均大于良性组[（1.63±0.68）cm vs（0.96±0.55）cm,（63.7±10.1）岁 vs（53.2±11.8）岁],差异均有统计学意义（t=3.70、4.32,P均<0.001）。恶性组超声造影表现为黏膜层形态不规则、胆囊壁高增强、黏膜下无低增强区,与良性组比较,差异均有统计学意义（χ²=48.7、42.9、23.8,OR=9.25、6.17、2.47,P均<0.001）。黏膜层形态不规则、胆囊壁高增强、黏膜下无低增强区诊断厚壁型胆囊癌的敏感度均为100.0%,准确性分别为93.7%、90.5%、76.2%。前2项联合诊断（同时出现黏膜形态不规则与胆囊壁高增强诊断厚壁型胆囊癌）准确性可进一步提高至98.4%。 结论超声造影有助于胆囊厚壁型病变的良恶性鉴别,具有较高的诊断价值。     

超声造影鉴别诊断胆囊良恶性病变的价值

目的 探讨超声造影在鉴别诊断胆囊良恶性疾病中的价值.方法 回顾分析应用对比脉冲序列成像技术和SonoVue超声造影检查117例胆囊病变的特征,比较胆囊良恶性病变常规超声和超声造影的诊断符合率.结果 除胆泥无造影剂进入外,胆囊良恶性病灶在达峰时多表现为高增强、富血供;消退时胆囊癌为低增强,良性病灶多为等增强.对于胆囊癌,常规超声的诊断符合率为65.38%,超声造影为92.31%;胆囊良性病灶,常规超声的诊断符合率为82.41%,超声造影为93.41%.结论 超声造影可提高超声诊断胆囊疾病的准确率,可鉴别胆泥沉积与胆囊癌,了解胆囊癌侵犯胆囊壁的程度及肝内转移情况,但对于腺瘤和单发息肉以及直径小的胆囊癌鉴别较困难.     

Use of Endoscopic Ultrasound to Evaluate Large Gastric Folds: Features Predictive of Malignancy

The aim of this study was to investigate with endoscopic ultrasound (EUS) the features of the gastric wall that can be used to predict malignant disease in patients with large gastric folds. We retrospectively reviewed the EUS findings of 65 patients (26 with benign and 39 with malignant disease) with large gastric folds on endoscopy and EUS and analyzed the predictors of malignant disease (e.g., gastric wall thickness, preservation of five-layered structure, thickened layers). Gastric wall thickness (≥9.8 mm), thickened deep layer, thickened muscularis propria and non-preserved wall layer structures were significantly more prevalent in patients with malignant disease on EUS. Among them, gastric wall thickness (≥9.8 mm) (odds ratio = 6.72, 95% confidence interval = 1.23–36.73, p = 0.028) and thickened muscularis propria (odds ratio = 37.14, 95% confidence interval = 7.02–196.49, p < 0.001) were significantly associated with malignant disease. Our data indicate that EUS is a useful tool for assessing large gastric folds and that gastric wall thickness (≥9.8 mm) and thickened muscularis propria are significant features predictive of malignant disease on EUS.     

Role of Contrast-Enhanced Ultrasound in the Pre-operative Diagnosis of Cervical Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma

The objective of this study was to prospectively evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in differentiating between benign and metastatic cervical lymph nodes in patients with papillary thyroid cancer (PTC). Three hundred nineteen cervical lymph nodes (162 metastatic from PTC and 157 benign) were evaluated using conventional ultrasonography (US) and CEUS before biopsy or surgery. Metastatic lymph nodes more often manifested centripetal or asynchronous perfusion, hyper-enhancement, heterogeneous enhancement, perfusion defects and ring-enhancing margins than benign lymph nodes at pre-operative CEUS (all p values < 0.001). The area under the receiver operating characteristic curve (AUC) for the combination of conventional US and CEUS (0.983, 95% confidence interval [CI]: 0.971–0.994) was higher than that of conventional US alone (0.929, 95% CI: 0.899–0.958) and CEUS (0.911, 95% CI: 0.876–0.947). In conclusion, CEUS is a promising tool in conjunction with conventional US for the pre-operative prediction of metastatic cervical lymph nodes in patients with PTC.     

超声造影模式在胆囊癌诊断中的应用价值

目的探讨实时超声造影(CEUS)增强模式对胆囊癌的鉴别诊断价值。方法 20例胆囊癌和37例胆囊良性病变患者行常规超声及CEUS检查,重点观察病灶的造影增强模式。结果胆囊癌CEUS表现为病灶与胆囊壁同时显影,肝动脉期以增强明显为主,肝门静脉期以低增强为主。在CEUS增强早期呈高增强或等增强并在造影剂注射后35 s内变低增强者在胆囊癌中占95.0%(19/20);良性病变中占16.2%(6/37)(P=0.000)。病变表现为不均匀增强者在胆囊癌中占80.0%(16/20),良性病变中占23.3%(7/30)(P=0.000)。病变处胆囊壁完整性破坏者在胆囊癌中占85.0%(17/20),良性病变中占0.0%(0/37)(P=0.000)。超声检查诊断胆囊良恶性病灶的准确性92.98%、敏感性95.00%和特异性91.83%。结论 CEUS可提高超声诊断胆囊癌的准确率,能显著改善对胆囊疾病良恶性鉴别诊断能力,值得临床应用推广。     

超声造影与增强CT在鉴别诊断胆囊良恶性病变中的应用价值

目的对比分析胆囊良恶性病变超声造影（CEUS）及增强CT（CECT）的图像特征,探讨二者在胆囊良恶性病变中的诊断价值。 方法选取2010年1月至2017年9月在陆军军医大学第一附属医院就诊的经病理证实的86例胆囊病变患者,术前CEUS与CECT的图像特征以及术前诊断结果进行对比分析。胆囊病变CEUS与CECT的增强模式比较以及单用CEUS或CECT与联合运用的诊断准确性的比较采用McNemer检验,CEUS胆囊良恶性病变由高增强转变为低增强的时间比较用t检验。 结果胆囊良恶性病变CEUS与CECT的增强模式类似。动脉期,良恶性病变CEUS与CECT均以高增强为主,其中,恶性病变分别为83.8%（57/68）、85.3%（58/68）,差异无统计学意义（P=1.000）,良性病变分别为100%（18/18）、94.4%%（17/18）。恶性病变CEUS与CECT在增强晚期或延迟期表现为低增强者分别为86.8%（59/68）、85.3%（58/68）,差异无统计学意义（P=0.500）,良性病变CEUS与CECT在增强晚期或延迟期表现为低增强者分别为83.3%（15/18）、77.8%（14/18）。良恶性病变CEUS转变为低增强的时间比较,差异有统计学意义[（53.9±10.0）s vs（35.50±6.72）s,t=6.729,P<0.001）]。单用CEUS其诊断胆囊恶性病变的敏感度、特异度及准确性分别为77.9%（53/68）、77.8%（14/18）、77.9%（67/86）;单用CECT其诊断敏感度、特异度及准确性分别为75%（51/68）、55.6%（10/18）、70.9%（61/86）;联合应用两种检查方法的敏感度、特异度及准确性分别为83.8%（57/68）、55.6%（10/18）、77.9%（67/86）;CEUS与CECT联合应用对胆囊恶性病变诊断准确性高于单用CECT。 结论CEUS与CECT结合有助于提高胆囊恶性病变诊断准确性,为胆囊良恶性病变的鉴别诊断提供更多有价值的信息。     

Characterization of Malignant Portal Vein Thrombosis with Contrast-Enhanced Ultrasonography

We prospectively evaluated the effectiveness of contrast-enhanced ultrasonography (CEUS) for differentiation of benign versus malignant portal vein thrombosis (PVT). We studied a total of 43 patients with chronic liver disease, hepatocellular carcinoma-suggestive nodules and confirmed PVT, in whom the nature of the PVT was confirmed by follow-up imaging (US, computed tomography and/or magnetic resonance imaging) performed up to 6 mo after CEUS. PVT was assessed by US, Doppler US and CEUS with respect to vessel wall disruption and/or invasion, color Doppler vascularization, pulsed Doppler vascularization pattern and CEUS enhancement and vascularization pattern, and thrombi were classified as benign or malignant based on these findings. Follow-up studies revealed malignant PVT in 22 of the 43 patients (51%) and benign PVT in 21 patients (49%). CEUS findings were consistent with follow-up studies in 41 of the 43 patients (95%), with κ?=?0.903 (p < 0.0001), sensitivity?=?91% and specificity?=?100%, indicating that CEUS can be confidently used to differentiate benign from malignant portal vein thrombosis in the setting of chronic liver disease.     

Diagnostic Value of Contrast-Enhanced Ultrasound for Differential Diagnosis of Malignant and Benign Soft Tissue Masses: A Meta-Analysis

This meta-analysis was aimed at investigating the value of using contrast-enhanced ultrasound (CEUS) in the differential diagnosis of benign and malignant soft tissue masses (STMs). Relevant studies published before March 24, 2020 were identified through a comprehensive search of PubMed, Ovid, Cochrane and Web of Science. According to the inclusion criteria, five studies were selected comprising 746 patients. In the differential diagnosis of benign and malignant STMs, the pooled sensitivity and specificity of CEUS were 76% (95% confidence interval [CI]: 71%–81%; heterogeneity [I²] = 74.5%) and 67% (95% CI: 62%–71%; I² = 36.5%), respectively. The diagnostic odds ratio was 7.37 (95% CI: 3.78%–14.35; I² = 66.6%). The overall area under the curve was 0.77 (standard error: 0.0392). Subgroup analysis revealed that different index tests of CEUS resulted in different diagnostic performance. Importantly, CEUS is an effective method for the differential diagnosis between benign and malignant STMs.     

Prediction of Microvascular Invasion in Combined Hepatocellular-Cholangiocarcinoma Based on Pre-operative Clinical Data and Contrast-Enhanced Ultrasound Characteristics

The goal of the study described here was to define the predictive value of pre-operative clinical information and contrast-enhanced ultrasound (CEUS) imaging characteristics in combined hepatocellular-cholangiocarcinoma (CHC) patients with microvascular invasion (MVI). Seventy-six patients with pathologically confirmed CHC were enrolled in this study, comprising 18 patients with MVI-positive status and 58 with MVI-negative CHC nodules. The pre-operative clinical data and CEUS imaging features were retrospectively analyzed. Univariate and multivariate analyses were performed to identify the potential predictors of MVI in CHC. Recurrence-free survival (RFS) after hepatectomy was compared between patients with different MVI status using the log-rank test and Kaplan-Meier survival curves. Univariate analysis indicated that the following parameters of patients with CHC significantly differed between the MVI-positive and MVI-negative groups (p<0.05): tumor size, α-fetoprotein ≥400 ng/mL, enhancement patterns in arterial phase and marked washout during the portal venous phase on CEUS. On multivariate logistic regression analysis, only the CEUS characteristics of heterogeneous enhancement (odds ratio = 6.807; 95% confidence interval [CI]: 1.099, 42.147; p = 0.039) and marked washout (odds ratio = 4.380; 95% CI: 1.050,18.270; p = 0.043) were identified as independent predictors of MVI in CHC. The combination of the two risk factors in predicting MVI achieved a better diagnostic performance than each parameter alone, with an area under the receiver operating characteristic curve of 0.736 (0.622, 0.830). After hepatectomy, CHC patients with MVI exhibited earlier recurrence compared with those without MVI (hazard ratio = 1.859; 95% CI: 0.8699–3.9722, p = 0.046). The CEUS imaging features of heterogeneous enhancement in the arterial phase and marked washout during the portal venous phase were the potential predictors of MVI in CHC. Aside from that, CHC patients with MVI had an earlier recurrence rate than those without MVI after surgery.     

Combining the Arterial Phase of Contrast-Enhanced Ultrasonography,Gadoxetic Acid-Enhanced Magnetic Resonance Imaging and Diffusion-Weighted Imaging in the Diagnosis of Hepatic Nodules ≤20 mm in Patients with Cirrhosis

Contrast-enhanced ultrasonography (CEUS) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) were compared with respect to diagnostic efficacy in the detection of small hepatocellular carcinoma. A new diagnostic strategy that combines the arterial phase of CEUS, the hepatobiliary phase of EOB-MRI and diffusion-weighted MR imaging (DWI) is described. One hundred sixteen nodules were enrolled to validate the performance of the strategy. For lesions ≤20 mm in size, the areas under the receiver operating characteristic curves (Az) of CEUS and EOB-MRI were 0.930 (95% confidence interval [CI]: 0.867–0.969) and 0.920 (95% CI: 0.855–0.962) (p?=?0.796), respectively. The Az value of the new diagnostic strategy was 0.985 (95% CI: 0.942–0.999) (vs. CEUS, p?=?0.026; vs. EOB-MRI, p?=?0.014). The sensitivity, specificity and diagnostic accuracy of the new strategy were 95.5% (95% CI: 88.9%–98.8%), 96.3% (95% CI: 81.0%–99.9%) and 95.7% (95% CI: 91.9%–99.4%), respectively. The new diagnostic strategy based on the arterial phase of CEUS, hepatobiliary phase of EOB-MRI and DWI represents an appealing solution for distinguishing small hepatocellular carcinomas from benign lesions, especially when the nodules present atypical enhancement patterns.     

Gender distribution of editorial board members in critical care journals: Assessment of gender parity

PurposeTo reveal factors related to gender parity on editorial boards of critical care journals indexing in SCI-E.MethodsThe genders were defined according to data obtained from journals' websites between 01—30 September 2022. Publisher properties and journal metrics were analyzed by using Chi-square, Fisher exact, Mann–Whitney U tests, and Spearman's correlation coefficient. Logistic regression analysis was used to reveal independent factors.ResultsWomen's representation on editorial boards was 23.6%. The USA (OR, 0.04, 95% CI, 0.01–0.15, p < 0.001) and Netherlands (OR, 0.04, 95% CI, 0.01–0.16, p < 0.001) as publisher's countries, an IF >5 (OR, 0.25, 95% CI, 0.17–0.38, p < 0.001), publication duration <30 years (OR, 0.09, 95% CI, 0.06–0.12, p < 0.001), multidisciplinary perspective of editorial policy (OR, 0.46, 95% CI, 0.32–0.65, p < 0.001), journals categorized also in nursing (OR, 0.38, 95% CI, 0.22–0.66, p < 0.001), and being a section editor (OR, 0.49, 95% CI, 0.32–0.74, p = 0.001) were associated with gender parity. Europe as a journal continent (OR, 36.71, 95% CI, 8.39–160.53, p < 0.001) was related to gender disparity.ConclusionsFurther efforts are needed to expand diversity policies in critical care medicine.     

Prediction Model and Nomogram of Early Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation Based on Logistic Regression Analysis

The purpose of this study was to screen for high-risk factors leading to the early recurrence of hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) and to construct a prediction model and nomogram. This retrospective study included 108 patients with primary HCC who underwent RFA treatment at the Harbin Medical University Cancer Hospital between January 2018 and June 2019. Four risk factors were screened for using univariate and multivariate logistic regression analyses: number of tumors (hazard ratio [HR] = 14.684, 95% confidence interval [CI]: 1.099–196.215, p = 0.042), neutrophil-to-lymphocyte ratio (NLR) (HR = 2.178, 95% CI: 1.003–4.730, p = 0.049), contrast-enhanced ultrasound (CEUS) performance (HR = 6.482, 95% CI: 1.161–36.184, p = 0.033) and α-fetoprotein (AFP) level (HR = 1.001, 95% CI: 1.000–1.003, p = 0.040). We established a prediction model: Logit(p) = –3.096 + 2.827 × (number of tumors >1 = 1) + 1.851 × (CEUS revealing rapid enhancement of blood flow signal in the arterial phase and clearance in the portal phase = 1) + 1.941 × (NLR >1.55 = 1) + 0.257 × (AFP >32.545 = 1). Through clinical decision curve analysis, the model's threshold was 0.043–0.873, indicating a high clinical value. Patients with a high AFP level, typical CEUS enhancement pattern, multiple tumors and elevated NLR are more likely to relapse early.     

Gallbladder carcinoma and chronic cholecystitis: differentiation with two-phase spiral CT

The objective of the present study was to determine whether an analysis of two-phase spiral computed tomographic (CT) features provides a sound basis for the differential diagnosis between gallbladder carcinoma and chronic cholecystitis. Eighty-two patients, 35 with gallbladder carcinoma and 47 with chronic cholecystitis, underwent two-phase spiral CT. We reviewed the two-phase spiral CT features of thickness and enhancement pattern of the gallbladder wall seen during the arterial and venous phases. Mean wall thicknesses were 12.6 mm in the gallbladder carcinoma group and 6.9 mm in the chronic cholecystitis group. The common enhancement patterns seen in gallbladder carcinoma were (a) a highly enhanced thick inner wall layer during the arterial phase that showed isoattenuation with the adjacent hepatic parenchyma during the venous phase (16 of 35, 45.7%) and (b) a highly enhanced thick inner wall layer during both phases (eight of 35, 22.9%). The most common enhancement pattern of chronic cholecystitis was isoattenuation of the thin inner wall layer during both phases (42 of 47, 89.4%). In conclusion, awareness of the wall thickening and enhancement patterns in gallbladder carcinoma and chronic cholecystitis on two-phase spiral CT appears to be valuable in differentiating these two different disease entities.     

超声造影在肝肿瘤热消融术中评估胆囊损伤的应用

目的探讨超声造影在胆囊旁肝肿瘤的热消融术中评估胆囊损伤的价值。 方法选取2016年1月至2017年3月在中山大学附属第三医院接受射频或微波消融治疗的患者40例,共42个胆囊旁肝肿瘤。采用常规超声检查评估患者术前术后胆囊壁厚度变化情况的同时,消融术中即时行超声造影检查评估胆囊壁血流灌注情况,判断胆囊壁损伤情况,并进行后续处理。通过随访评估胆囊旁肝肿瘤消融治疗的有效性、安全性。术前、术中及术后胆囊壁厚度的比较采用配对符号秩和检验。 结果与消融术前比较,40例接受消融治疗患者的胆囊壁术中评估有8例患者胆囊壁明显增厚。术中超声造影检查除2例评估为胆囊壁血流灌注缺损外,其他患者胆囊壁灌注较好,这2例患者行腹腔镜胆囊切除术并病理证实胆囊壁热损伤坏死（其中1例出现胆囊穿孔）,另有4例患者因多发胆囊结石行切除胆囊。34例保留胆囊患者中有6例在术后3 d内复查仍有胆囊壁增厚,后续随访中4例恢复,2例保持胆囊壁增厚状态,但均未出现胆囊消融热损伤相关症状。患者术中、术后的胆囊壁厚度与术前比较,差异均有统计学意义[5.00 mm（4.00~6.25 mm） vs 3.50 mm（3.00~5.00 mm）,Z=-3.741,P<0.001;5.0 mm（3.0~8.0 mm） vs 3.5 mm（3.0~5.0 mm）,Z=-3.735,P<0.001]。术后1个月增强CT/MRI检查证实41个病灶消融完全,完全消融率为97.6%（41/42）,所有消融完全病灶至随访结束均未发生局部肿瘤进展。 结论在超声引导下胆囊旁肝肿瘤消融术中即时行超声造影检查能够通过反映胆囊壁血流灌注状态判断胆囊壁消融热损伤情况。     

Gallbladder wall thickening in dengue hemorrhagic fever: An ultrasonographic study

This study attempts to investigate whether gallbladder wall thickening (GBWT) measured by ultrasonography can be used in children as a reliable criterion to predict the onset of severe dengue hemorrhage fever (DHF). In this prospective study, we performed ultrasound examinations focusing on the gallbladder wall and the presence of intraperitoneal free fluid in 48 mild DHF cases (grades I–II) and 48 severe cases (grades III–IV). GBWT varied between 1 mm and 8 mm with a mean of 3.77 mm ± 2.04 mm. The mean value of DHF grades I and II (2.39 mm ± 1.48 mm) is significantly lower than that of grades III and IV (5.14 mm ± 1.54 mm), p < 0.001. GBWT exceeded 3 mm in only 16 of 48 (33.3%) grade I–II patients and in 45 of 48 (93.8%) grade III–IV patients. A significant positive correlation was apparent between GBWT and the severity of illness, p < 0.001. Patients with ascites have significantly thicker gallbladder walls than those without, p < 0.01. In clinically confirmed DHF cases, the sonographic finding of GBWT >3 mm to 5 mm, with 93.8% sensitivity, can be used as a criterion indicating the need for admission and monitoring. A GBWT of ?5 mm, with 91.7% specificity, is useful as a criterion for identifying DHF patients at high risk of developing hypovolemic shock. © 1995 John Wiley & Sons, Inc.     

Anatomical Variation in Diaphragm Thickness Assessed with Ultrasound in Healthy Volunteers

Ultrasonography of the diaphragm in the zone of apposition has become increasingly popular to evaluate muscle thickness and thickening fraction. However, measurements in this anatomical location are frequently hindered by factors that constrain physical accessibility or that alter diaphragm position. Therefore, other anatomical positions at the chest wall for transducer placement are used, but the variability in diaphragm thickness across the dome has not been systematically studied. The aim of this study was to evaluate anatomical variation of diaphragm thickness in 46 healthy volunteers on three ventrodorsal lines and two craniocaudal positions on these three lines. The intraclass correlation coefficient (ICC) for diaphragm thickness in the craniocaudal direction on the mid-axillary line was significantly higher than those on the posterior axillary and midclavicular lines, suggesting it had the lowest variability (ICC_midaxillary = .89, 95% confidence interval [CI]: 0.83–0.93, ICC_{posterior axillary} = 0.74, 95% CI: 0.62–0.85, ICC_{midclavicular} = 0.62, 95% CI: 0.43–0.47, p < 0.05). Average diaphragm thickness was comparable on the posterior axillary and midaxillary lines and substantially larger on the midclavicular line (1.24 mm [1.06–1.47], 1.27 mm [1.10–1.42] and 2.32 [1.97–2.70], p < 0.01). We conclude that the normal diaphragm has a large variability in thickness, especially in the ventrodorsal direction. Variability in craniocaudal position is the lowest at the midaxillary line, which therefore appears to be the preferred site for diaphragm thickness measurement.     

胆囊癌的超声造影和增强螺旋CT对比分析

目的评价超声造影和增强螺旋CT对胆囊癌的诊断价值。方法对比分析26例经手术、病理证实的胆囊癌的超声造影和CT增强的影像表现。结果超声造影和CT增强具有相似的表现。26例中,厚壁型14例,肿块型7例,腔内结节型5例。超声造影确诊23例,CT增强确诊22例,两者结合确诊25例,误诊1例。结论超声造影和CT增强扫描对于胆囊癌的诊断均很敏感且价值很高,结合两者可提高该病的确诊率。     

胆囊腺瘤性病变的超声造影表现分析

增强.④恶变组增强模式为造影早期呈多支迂曲血管分布或快速不均质高增强.结论 胆囊良、恶性腺瘤超声造影表现不同,观察病灶增强模式和增强速度对鉴别良、恶性胆囊腺瘤有一定意义.     

Qualitative and Quantitative Contrast-Enhanced Ultrasound Combined with Conventional Ultrasound for Predicting the Malignancy of Soft Tissue Tumors

This study was aimed at evaluating the performance of perfusion patterns and the quantitative parameters of contrast-enhanced ultrasound (CEUS) in the detection of soft tissue tumors (STTs) and establishing a US workflow for STTs to improve patient management. Conventional ultrasound (US) and CEUS data were retrospectively collected from 156 soft tissue masses. Six perfusion patterns (P1–P6) were applied for CEUS qualitative analysis. Multivariate logistic regression was used to evaluate the performance of conventional US and qualitative and quantitative CEUS in distinguishing benign and malignant STTs. The malignancy rates of P1–P6 in STTs were 0%, 50.0%, 9.1%, 33.3%, 73.4% and 61.0%, respectively. For "non-P1" STTs, the predictive model combining quantitative CEUS parameters with conventional US features, including margin (odds ratio [OR] = 4.490, p = 0.000), vascular density (OR = 2.307, p = 0.013), 50% wash-out intensity (OR = 1.904, p = 0.032) and 50% wash-out time (OR = 1.031, p = 0.019), performed favorably in predicting malignancy, with an accuracy of 81.0% and an area under the receiver operating characteristic curve of 0.868. Furthermore, a US workflow for the detection of STTs based on conventional US and CEUS was established. CEUS with qualitative and quantitative analyses could be an effective tool for STT diagnosis. The US workflow in this study may improve the management of STT patients.