The Liver Imaging Reporting and Data System (LI-RADS) was created to standardize liver imaging in patients at high risk for hepatocellular carcinoma (HCC), and it uses a diagnostic algorithm to assign categories that reflect the relative probability of HCC, non-HCC malignancies, or benign focal liver lesions. In addition to major imaging features, ancillary features (AFs) are used by radiologists to refine the categorization of liver nodules. In the present document, we discuss and explain the application of AFs currently defined within the LI-RADS guidelines. We also explore possible additional AFs visible on contrast-enhanced ultrasonography (CEUS). Finally, we summarize the management of CEUS LI-RADS features, including the role of current and potential future AFs.
In "What should be known prior to performing EUS exams, Part I," the authors discussed the need for clinical information and whether other imaging modalities are required before embarking EUS examinations.Herewith, we present part II which addresses some (technical) controversies how EUS is performed and discuss from different points of view providing the relevant evidence as available.(1) Does equipment design influence the complication rate?(2) Should we have a standardized screen orientation?(3) Radial EUS versus longitudinal (linear) EUS.(4) Should we search for incidental findings using EUS?
A salivary incidentaloma (SI) stands for any focal salivary lesion, independent of size, discovered by any imaging method including ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), multimodal positron emis-sion tomography (PET) combined with CT or MRI, or X-ray imaging, performed for another reason, in the absence of known salivary glands’ disease. The article presents a detailed analysis of salivary gland diseases with the emphasis on neoplasms. It describes frequency of SIs found on imaging, their prevalence, epidemiology and clinical significance. The probability of malignancy or malignant transformation of a SI, its imaging features, recommended treatment, management and follow-up, as well as ethical issues, psychological burden, informed decision making, economical consequences and costs are discussed. The general prevalence of SIs is low, but is dramatically increasing over time, and may rise significantly in selected groups of oncologic patients. SIs most frequently turn out to be benign primary neoplasms or pseudotumors, including intraparenchymal lymph nodes. SIs detected by other imaging methods should be subsequently assessed with US. Solid SIs demand ultrasound guided fine-needle aspiration cytology (US-FNAC). Neoplasms should undergo surgery. Post-operative US follow-up is man-datory for malignant tumors and recommended for benign neoplasms.
We present a report on ultrasound findings in extragenital endometriosis and a literature review accompanied by illustrations.Intestinal endometriosis should be considered in female patients of reproductive age who present with constipation, gastrointestinal bleeding, nausea, vomiting, cramp-like abdominal pain, diarrhoea and pelvic pain.Although definitive preoperative diagnosis of endometriosis is difficult, clinical suspicion and appropriate imaging might prevent extensive surgical procedures with higher morbidity.Contrast-enhanced ultrasound is an efficient non-invasive imaging method without any radiation exposure that supports the early diagnosis of intestinal endometriosis and may help assess the vascularization of endometriotic lesions within the distinct layers of the intestinal wall.
Hypothyroidism greatly affects the healthrelated quality of patients’ life, and microglia in brain have essential functions on neurodegeneration, but the underlying link between hypothyroidism and microglia function is largely ambiguous. Methods: Methimazole-induced mice was used to construct hypothyroidism model and explore the polarization of microglia. Lipopolysaccharide (LPS)-treated BV2 cells were used to investigate the effecting factors on microglia M1 polarization. Finally, global transcriptome sequencing (RNA-seq) was utilized to identify the underlying regulatory mechanisms. Results: The biomarkers of microglia M1 polarization and pro-inflammatory cytokines were significantly increased in hypothyroidism mice brain; hypothyroidism could also repress the expression of BDNF and TrkB, and the anti-inflammatory cytokine such as IL-10. In BV2 cells, LPS treatment decreased expression of BDNF, IL-10, and Arg1, while BDNF overexpression (BDNF-OE) significantly reversed the inflammation-induced by LPS by repressing iNOS and TNF-α, while increasing IL-10 and Arg1. RNA-seq analysis demonstrated that in LPS-treated BV2 cells, BDNF-OE significantly altered expression pattern of genes involved in PI3K-Akt signaling pathway, including the upregulated Thbs3, Myc, Gdnf, Thbs1, and Ccnd1, and the downregulated Gnb4, Fgf22, Pik3r3, Pgf, Cdkn1a, and Pdgfra. Myc, Gdnf, Thbs1, and Ccnd1 showed much higher expression levels than other genes in PI3K-Akt signaling pathway. Conclusions: Our study demonstrated a sound conclusion that hypothyroidism promotes microglia M1 polarization by inhibiting BDNF-activated PI3K-Akt signaling pathway in brain, which could serve as a promising therapeutic target for microglia-induced neurodegenerative or emotional disorders in future.
Objective
To investigate the efficacy and safety of telbivudine treatment for 52 weeks of HBeAg-positive chronic hepatitis B (CHB)children and adolescents.
Methods
A total of 41 HBeAg-positive CHB children and adolescents aged from 3 to 16 years were treated with telbivudine for 52 weeks. Biochemical responses, hepatitis B virus (HBV) markers and HBV DNA quantitation were detected, adverse events were also recorded.
Results
After 52 weeks of telbivudine treatment, the rates of ALT normalization, HBeAgloss and HBeAgseroconversionwere 85.4% (35), 43.9% (18) and 24.4% (10), respectively. Mean HBVDNA load declined by (6.97 ± 0.96) log IU/ml (median, 7.3 logIU/ml), and 31 (75.6%) cases had HBV DNA undetectable. 2 cases had a decline of quantitative HBsAg<10 IU/ml. Patients who achieved HBV DNA undetectable at week 24 had higher rates of ALT normalization, HBV DNA undetectable, HBeAg loss and HBeAgseroconversion than those with HBV DNA detectable. Decline in HBV DNA levels correlated with prior treatment with interferon(IFN)(P=0.004), but did not correlate with a family history of hepatitis B (P=0.122). Mild and transient adverse events were observed, and no serious adverse events were found. No gene mutations were observed.
Conclusions
Telbivudine treatment for HBeAg-positive CHB children and adolescents showed good efficacy and safety.
Key words:
Children, adolescents; Chronic hepatitis B; Antiviral therapy; Telbivudine; Efficacy; Safety
Objective
To investigate the value of contrast enhanced ultrasonography(CEUS) in the diagnosis of hepatic epithelioid hemangioendothelioma(HEHE).
Methods
The images of CEUS had been retrospectively evaluated in 21 lesions of HEHE which were confirmed by pathology. The perfusion patterns and time of enhancement were observed,including time to begin enhancement,time to peak enhancement,the washout time and the appearance of internal structures.
Results
The mean time of begin enhancement,time to peak,time to isoechogenity and hypoechogenity were (17.4±5.2)s,(22.0±7.2) s,(23.9±4.6)s and (42.2±13.7)s,respectively. During the arterial phase,8 lesions showed diffuse enhancement,7 lesions showed rim-like enhancement and 6 lesions showed branch enhancement. The inner margin in 6 lesions showed speculate enhancement. The central portion of the tumors was not enhanced in part lesions of 8 cases. As to time of peak enhancement,compared to the normal hepatic parenchyma,hypoenhancement,isoenhancement and hyperenhancement were observed in 10 lesions,6 lesions and 5 lesions respectively. Synchronous enhancement was observed in 11 lesions on CEUS,rapid enhancement was observed in 8 lesions and slow enhancement was observed in 2 lesions. Twenty-one lesions manifested hypoechoic mass in portal phase and delayed phase. The boundary of lesions was unclear on conventional ultrasound and became distinct after contrast injection in 21 lesions.
Conclusions
CEUS is useful for the diagnosis of HEHE.
Key words:
Contrast-enhanced ultrasound; Liver neoplasms; Hemangioendothelioma,epithelioid
Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, realtime imaging, and lack of ionizing radiation and bedside availability. The lack of superficial adipose tissue and favourable acoustic windows in children makes US the first line of investigation for evaluation of pleural and chest wall abnormalities.In the first part of the topic the technical requirements were explained and the use of ultrasound in the lung and pleura in paediatric patients were discussed. In the second part lung parenchymal diseases with their subpleural consolidations are reflected. In the third part, the use of ultrasound for chest wall, mediastinum, diaphragmatic diseases, trachea, interventions and artifacts in paediatric patients are summarized.
The aim of this study is to explore the value of volume navigation image fusion-assisted contrast-enhanced ultrasound (CEUS) in detection for radiofrequency ablation guidance of hepatocellular carcinomas (HCCs), which were undetectable on conventional ultrasound.From May 2012 to May 2014, 41 patients with 49 HCCs were included in this study. All lesions were detected by dynamic magnetic resonance imaging (MRI) and planned for radiofrequency ablation but were undetectable on conventional ultrasound. After a bolus injection of 2.4 ml SonoVue® (Bracco, Italy), LOGIQ E9 ultrasound system with volume navigation system (version R1.0.5, GE Healthcare, Milwaukee, WI, USA) was used to fuse CEUS and MRI images. The fusion time, fusion success rate, lesion enhancement pattern, and detection rate were analyzed.Image fusions were conducted successfully in 49 HCCs, the technical success rate was 100%. The average fusion time was (9.2 ± 2.1) min (6-12 min). The mean diameter of HCCs was 25.2 ± 5.3 mm (mean ± SD), and mean depth was 41.8 ± 17.2 mm. The detection rate of HCCs using CEUS/MRI imaging fusion (95.9%, 47/49) was significantly higher than CEUS (42.9%, 21/49) (P < 0.05). For small HCCs (diameter, 1-2 cm), the detection rate using imaging fusion (96.9%, 32/33) was also significantly higher than CEUS (18.2%, 6/33) (P < 0.01). All HCCs displayed a rapid wash-in pattern in the arterial phase of CEUS.Imaging fusion combining CEUS and MRI is a promising technique to improve the detection, precise localization, and accurate diagnosis of undetectable HCCs on conventional ultrasound, especially small and atypical HCCs.
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