Cerebral hyperperfusion syndrome (CHS) is a rare but serious complication following carotid endarterectomy (CEA). The aim of this study was to identify intraoperative transcranial Doppler (TCD) hemodynamic predictors of CHS after CEA.Between January 2013 and December 2018, intraoperative TCD monitoring was performed for 969 patients who underwent CEA. The percentage increase in the mean velocity of the middle cerebral artery (MCAV%) at 3 postdeclamping time points (immediately after declamping, 5 minutes after declamping, and after suturing the skin) over baseline was compared between CHS and non-CHS patients.CHS was diagnosed in 31 patients (3.2%), including 11 with intracranial hemorrhage. The MCAV% values at the 3 postdeclamping time points over baseline were 177% (81%-275%), 90% (41%-175%), and 107% (55%-191%) in the CHS group, significantly higher than those in the non-CHS group (40% [14%-75%], 15% [1%-36%], and 18% [3%-41%], respectively, all P < 0.001). Receiver operating characteristic curve analysis showed that the 3 intraoperative MCAV% parameters all had excellent accuracy in identifying CHS (areas under the curve: 0.854, 0.839, and 0.858, respectively, all P < 0.001). The predictive value of the model consisting only of preoperative parameters was significantly increased by adding the intraoperative TCD hemodynamic parameters (area under the curve: 0.747 vs. 0.858, P = 0.006). Multivariate analyses identified the intraoperative MCAV% immediately after declamping (odds ratio: 9.840, 95% confidence interval: 2.638-36.696, P < 0.001) as an independent predictor of CHS.Our results indicate that intraoperative TCD monitoring helps predict CHS after CEA at an early stage.
To investigate the relationship between calcification characteristics of carotid atherosclerotic plaque and lipid rich necrotic core (LRNC) and intraplaque hemorrhage (IPH).Patients with severe carotid stenosis undergoing carotid endarterectomy (CEA) were selected. Ultrasound and CT angiography (CTA) were performed to evaluate the calcification characteristics of the plaque before the surgery.A total of 142 patients were included and 142 pathological specimens of postoperative plaque were obtained accordingly. There were 78 plaques (54.9%) with LRNC and 41 (28.9%) with IPH. The plaque with LRNC had higher calcification rate (93.6%) compared with the plaque with IPH (87.8%). LRNC was often found in multiple calcification (P = 0.003) and mixed type calcification (P = 0.001). Multiple calcification was more likely to combine with IPH (P = 0.008), while simple basal calcification was not likely to combine IPH (P = 0.002). Smaller granular calcification was more likely to be associated with IPH (P < 0.05). In multivariate regression analysis of IPH and calcification characteristics, simple basal calcification was still a protective factor for IPH (OR, 0.25; 95% CI, 0.09-0.66; P = 0.005), while multiple calcification was closely related to the occurrence of IPH (OR, 3.58; 95% CI, 1.49-8.61; P = 0.004).Calcification characteristics of carotid atherosclerotic plaques are closely related to the vulnerability of plaques, especially multiple calcification and mixed type calcification.
Purpose: Intraplaque neovascularization, assessed using contrast-enhanced ultrasound (CEUS), is associated with ischemic stroke.It remains unclear whether detection of intraplaque neovascularization combined with color Doppler ultrasound (CDUS) provides additional value compared with CDUS alone in assessing ischemic stroke risk.Therefore, we investigated the clinical value of combined CEUS, CDUS, and clinical features for ischemic stroke risk stratification.Patients and Methods: We recruited 360 patients with ≥50% carotid stenosis between January 2019 and September 2022.Patients were examined using CDUS and CEUS.Covariates associated with ischemic stroke were identified using multivariate logistic regression analysis.The discrimination and calibration were verified using the C-statistic and Hosmer-Lemeshow test.The incremental value of intraplaque neovascularization in the assessment of ischemic stroke was analyzed using the Delong test.Results: We analyzed the data of 162 symptomatic and 159 asymptomatic patients who satisfied the inclusion and exclusion criteria, respectively.Based on multivariate logistic regression analysis, we constructed a nomogram using intraplaque neovascularization, degree of carotid stenosis, plaque hypoechoicity, and smoking status, with a C-statistic of 0.719 (95% confidence interval [CI]: 0.666-0.768)and a Hosmer-Lemeshow test p value of 0.261.The net reclassification index of the nomogram was 0.249 (95% CI: 0.138-0.359),and the integrated discrimination improvement was 0.053 (95% CI: 0.029-0.079).Adding intraplaque neovascularization to the combination of CDUS and clinical features (0.672; 95% CI: 0.617-0.723)increased the C-statistics (p=0.028).Conclusion: Further assessment of intraplaque neovascularization after CDUS may help more accurately identify patients at risk of ischemic stroke.Combining multiparametric carotid ultrasound and clinical features may help improve the risk stratification of patients with ischemic stroke with ≥50% carotid stenosis.Plain Language Summary: We studied whether using contrast-enhanced ultrasound (CEUS) to detect intraplaque neovascularization could help better determine the risk of ischemic stroke.We compared the combined use of color Doppler ultrasound (CDUS) and CEUS with CDUS alone in patients with more than 50% carotid narrowing.Our findings showed that combining clinical details, CDUS, and CEUS was more effective (0.719 vs 0.672).This means that CEUS provides extra insight when gauging ischemic stroke risk compared with CDUS alone.This could help in accurately identifying patients at high risk of stroke.However, more extensive studies are needed to fully understand the role of these tests in the evaluation of stroke risk.
Objectives: The preoperative diagnosis between serous cystadenomas (SCAs) and mucinous cystadenomas (MCAs) in pancreas is significant due to their completely different biological behaviors. The purpose of our study was to examine and compare detailed contrast-enhanced ultrasonography (CEUS) images of SCAs and MCAs and to determine whether there are significant findings that can contribute to the discrimination between these two diseases. Methods: From April 2015 to June 2016, 61 patients (35 patients with SCAs and 26 patients with MCAs) were enrolled in this study. Forty-three cases were confirmed by surgical pathology and 18 by comprehensive clinical diagnoses. All of the CEUS characteristics of these lesions were recorded: size, location, echogenicity, shape, wall characteristics, septa characteristics, and the presence of a honeycomb pattern or nodules. CEUS examinations were performed by two ultrasound physicians. Results: Location ( P =0.003), shape ( P =0.000), thickness of the wall ( P =0.005), the number of septa ( P =0.001), and the honeycomb pattern ( P =0.001) were statistically significantly different. A head–neck location, a lobulated shape, an inner regular honeycomb pattern, and a thin wall (<3 mm thick) were significant in diagnosing patients with SCAs. When two of these four findings were combined, we could achieve a sensitivity of 71.4% and a specificity of 80.8% to diagnose SCA; when three of these four findings were combined, the specificity was 100%. A body–tail location, a round/oval shape, 0–2 septa, and a thick wall (≥3 mm thick) were most often detected in patients with MCAs. When two of these four findings were combined, we could achieve a sensitivity of 88.5% and a specificity of 65.7% to diagnose MCA; when three of these four findings were combined, the area under the curve (Az) was highest at 0.832, with a sensitivity of 80.8% and a specificity of 85.7%. Conclusions: The characteristics of tumor location, shape, thickness of the wall, the number of septa, and the honeycomb pattern by CEUS play an important role in the diagnosis of SCAs and MCAs. A combination of these findings can provide better diagnostic performance in the discrimination of SCAs from MCAs. Keywords: contrast-enhanced sonography, ultrasound, pancreatic cystic tumor, serous cystadenoma, mucinous cystadenoma, diagnosis
Objective
To evaluate the correlation between the degree of subclavian artery (SA) stenosis with vertebral artery (VA) stenosis and the type of subclavian artery steal (SAS) by color Doppler ultrasonography (CDU).
Methods
A total of 503 patients with SA stenosis≥ 50% or occlusion with varying degrees of VA stenosis were consecutively enrolled from January 2013 to October 2017. All patients underwent CDU screening and confirmed by CT angiography (CTA) or digital subtraction angiography (DSA). According to the flow waveform of the VA, SAS was divided into three types: I (latent type), II (partial type), and III (complete type). Based on the degree of SA stenosis, the patients were divided into two groups: patients with SA stenosis ≥ 50% to<70% (n=254) and those with SA stenosis ≥ 70% (n=249). Based on the degree of VA stenosis, the patients were also divided into two groups: patients with VA stenosis ≥ 50% to<70% (n=391) and those with VA stenosis ≥ 70% (n=112). The correlation between the degree of SA stenosis with VA stenosis and the type of SAS was analyzed.
Results
Among all 503 patients, type I SAS was the most common type, accounting for 50.3% (253/503), while types II and III accounted for 18.9% (95/503) and 26.0% (131/503), respectively; the percentage of patients with no SAS was 4.8% (24/503). There was a significant difference in the distribution of SAS types between patients with SA stenosis ≥ 50% to<70% and patients with SA stenosis ≥ 70% (P<0.01), with type I SAS being the most common type in patients with SA stenosis ≥ 50% to<70% (90.6%, 230/254) and type III being the predominant type in patients with SA stenosis ≥ 70%. In patients with SA stenosis ≥ 50% to<70%, there was no significant difference in the distribution of SAS types between patients with VA stenosis ≥ 50% to<70% and patients with VA stenosis ≥ 70% (P=0.184), with type I being the predominant SSA type in both groups. In patients with SA stenosis ≥ 70%, there was a significant difference in the distribution of SAS types between patients with VA stenosis ≥ 50% to<70% and patients with VA stenosis ≥ 70% (P<0.001); the percentage of patients with type III SAS was significantly higher in patients with VA stenosis≥50% to<70% than in patients with VA stenosis ≥70% (63.0% vs 2 5.0%, P<0.001), while he percentage of patients with type I SAS was significantly lower in patients with VA stenosis ≥50% to<70% than in patients with VA stenosis ≥ 70%.
Conclusion
The presence of VA stenosis ≥ 70% in patients with SA stenosis ≥70% can alter the distribution of SAS types. In patients with SA stenosis with different degrees of VA stenosis, there may be inconsistency between the degree of SA stenosis and the classification of SAS, which should be paid attention to in clinical ultrasound evaluation.
Key words:
Ultrasonography, Doppler, color; Subclavian steal syndrome; Vertebral artery; Stenosis
Thermal ablation has been considered as an alternative for local curative intent in patients with unresectable colorectal liver metastases. The influence of primary tumor location on the prognosis of colorectal liver metastases patients who have undergone microwave ablation has yet to be determined. We reviewed 295 patients who underwent microwave ablation for colorectal liver metastases at our institution between March 2006 and March 2016. Univariate and multivariate analyses were performed to identify predictors of overall and progression-free survival. Technical success was achieved in 96.6% of patients (n = 289), with a post-procedural complication rate of 2.0% (n = 6). After a median follow-up of 24 (range, 2-86) months, comparable overall survival rates (p = 0.583) were observed in patients with different primary tumor locations. Patients with colorectal liver metastases originating from left-sided primary colon cancer exhibited a better progression-free survival than patients whose colorectal liver metastases had originated from right-sided primary colon cancer (hazard ratio: 0.67, 95.0% confidence interval: 0.48-0.94; p = 0.012), which was further confirmed in a multivariate analysis after adjustment for other potential prognostic factors. Stratification based on primary tumor location should be taken into consideration in the assessment of disease progression in patients who intend to undergo microwave ablation for colorectal liver metastases.
Objective
To explore the clinical curative effect of the Taohong-Siwu decoction combined with manipulation in the treatment of the acute phase of lumbar disc herniation (LDH) and its effect on serum inflammatory factors.
Methods
According to the random number table method, 102 patients with the acute phase of LDH were divided into control group and research group from May 2014 to September 2016, 51 cases in each group. Patients in control group were treated by traction and non-steroidal anti-inflammatory drug for a month, while patients in research group were treated by manipulation combined with Taohong-Siwu decoction for a month. After treatment, the overall efficacy was observed. The Visual analogous scale (VAS) and JOA scores were recorded before and after the treatment. The IL-1β, IL-6 and TNF-α levels of inflammatory factors were detected by enzyme-linked immunosorbent assay.
Results
The total effective rate of patients in research roup was significantly higher than that of the control group [90.20% (46/51) vs. 43.14% (22/51), χ2=19.329, P=0.006]. After treatment, the VAS scores of patients in both groups were significantly decreased, and JOA score increased markedly, which the differences were statistically significant (Ps<0.05). After treatment, the VAS score of research group was significantly lower than the control group (4.26 ± 0.56 vs. 5.13 ± 0.87; t=4.843, P=0.027), and JOA score was significantly higher than the control group (18.42 ± 3.92 vs. 17.33 ± 4.21; t=5.127, P=0.022). After treatment, the IL-1β, IL-6 and TNF-α levels of of patients in the research group were significantly lower than those of the control group (0.57 ± 0.11 μg/L vs. 0.90 ± 0.13 μg/L, 112.26 ± 15.17 μg/L vs. 130.38 ± 18.29 μg/L, 2.01 ± 0.34 μg/L vs. 2.37 ± 0.51 μg/L; t=5.429, 6.317, 5.011, P<0.05).
Conclusions
The Taohong-Siwu decoction combined with manipulation on treatment of the acute phase of LDH was effective. The combined therapy can improve the VAS score and JOA score, and reduce the levels of inflammatory cytokines.
Key words:
Intervertebral disc displacement; Muscle-tendon relaxing reduction; Tao Hong Si Wu Tang; Interleukin-1β; Interleukin-1; Tumor necrosis factor alpha
Objective: To assess the clinical value of real-time shear wave elastography (SWE) in distinguishing between mild and severe cholecystitis. Methods: A total of 176 patients with cholecystitis who meet the criteria of Tokyo Guideline in Wuxi People's Hospital of Nanjing Medical University from January 2017 to March 2018 were recruited, 95 male, 81 female, age range of 23-88 years, average age (48±16)years, and divided into severe (91 cases) and mild (85 cases) groups according to disease severity. All patients underwent routine ultrasound and SWE examination to assess gallbladder morphology, hepatic flow signals and liver cirrhosis adjacent to the gallbladder. Two sonographers with different diagnostic experience independently reviewed ultrasound images alone and in combination with SWE, respectively, and compared the diagnostic consistency of two sonographers in assessing severe cholecystitis. Results: The SWE value of liver in the severe group of cholecystitis was significantly higher than that of mild group (t=10.34, P=0.01). The area under the ROC curve of SWE value for diagnosing severe cholecystitis was 0.809 with the optimal cut-off value of 7.2 kPa. The sensitivity, specificity was 78.0% and 83.5%, respectively. In distinguishing between mild and severe cholecystitis, the diagnostic sensitivity (84.6%, 95.6%) was high and the specificity (49.4%, 35.3%) was low in diagnosing gallbladder edema and sludge.The diagnostic sensitivity (14.3%, 26.4%) was low and the specificity (100%, 95.3%) was high in diagnosing pericholecystic fluid and blood flow signal of the gallbladder wall.Two sonographers reviewed ultrasound images independently for diagnosing severe cholecystitis in good agreement (κ =0.75). Combining SWE to conventional ultrasound, the diagnostic consistency of the two sonographers in diagnosing server cholecystitis was excellent (κ=0.86), and the difference was statistically significant (P=0.02), the diagnostic efficacy of which was higher than that of conventional ultrasound alone. Conclusions: Compared with conventional ultrasound alone, combining with SWE can improve the diagnostic efficacy of distinguishing between mild and severe cholecystitis, and the clinical experience of sonographers has less influence on the diagnostic accuracy.目的： 利用实时剪切波弹性成像(SWE)测量急性胆囊炎患者邻近胆囊旁肝脏硬度，探讨其在区分轻重度急性胆囊炎的临床价值。 方法： 选取2017年1月至2018年3月南京医科大学附属无锡人民医院急诊科收治后入院符合《东京指南》原则的急性胆囊炎患者176例，男95例、女81例，年龄23～88岁，平均(48±16)岁。根据临床病情分为重度组91例，轻度组85例。所有患者均行常规超声和SWE，评估胆囊形态学、胆囊旁肝脏血流信号和测量胆囊旁肝脏硬度。另选二位不同经验的超声医师分别独立回顾常规超声及常规超声联合SWE的声像图，比较二位医师对重度急性胆囊炎的诊断效能。 结果： 肝脏SWE值急性胆囊炎重度组显著高于轻度组(t＝10.34，P＝0.01)。SWE值诊断重度急性胆囊炎的ROC曲线下面积为0.809，截断值为7.2 kPa，敏感度、特异度分别为78.0%、83.5%。在区分轻、重度患者中，胆囊形态肿大和胆囊内碎屑回声诊断敏感度高(84.6%、95.6%)，特异度低(49.4%、35.3%)；胆囊周边积液和胆囊壁血流信号诊断敏感度低(14.3%、26.4%)，特异度高(100%、95.3%)。二位医师单独观察超声图像诊断重度的一致性良好(k＝0.75)，而联合运用SWE后，二者的一致性极佳(k＝0.86)，差异有统计学意义(P＝0.02)；二位医师运用SWE联合常规超声诊断重度急性胆囊炎的诊断效能优于单独常规超声诊断。 结论： 与常规超声检查比较，联合运用SWE测量胆囊旁肝脏硬度可以提高区分轻重度急性胆囊炎的诊断效能，且受临床经验影响小。.
Purpose: Previous studies have reported that parameters of dynamic contrast-enhanced ultrasound (DCE-US) could predict prognosis of hepatocellular carcinoma (HCC) patients after antiangiogenic therapies. In this study, we aimed to investigate the correlation of DCE-US parameters and the prognosis of HCC patients after microwave ablation (MWA).Materials and methods: Between June 2012 and January 2018, a total of 35 HCC patients who received MWA with a curative intent were enrolled. Pre-ablation DCE-US, liver biopsy, CD34 staining, and vascular endothelial growth factor (VEGF) staining were performed. DCE-US parameters were extracted from time-intensity curves using SonoLiver software. The correlation of DCE-US parameters with histopathology results and overall survival (OS) were investigated.Results: Quantitative analysis showed that IMAX, RT, TTP, and mTT of HCC were statistically different with that of reference liver parenchyma (all p < .001). Microvessel density was shown to be positively correlated with IMAX and negatively correlated with TTP (r = 0.755 and −0.647, both p < .01). Additionally, positive correlations were observed between IMAX and VEGF expression (r = 0.665, p < .01). After a median follow-up of 22 months (range 6–64 months), local recurrence was detected in three patients. Largest diameter and TTP were shown to help predict OS in univariate and multivariate analyses.Conclusion: DCE-US parameter may help predict the outcome of HCC patients after MWA, though further study is still needed.
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