Hypoechoic Research Articles

Assessment of skin and associated soft tissue changes with ultrasonography in chronic venous disease.

Chronic venous disease (CVD) is accompanied by a spectrum of skin changes. The aim of this study was to assess skin changes in CVD in different classes of the classifications such as the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification using ultrasound (US). This study was conducted from July 2020 to July 2021 after obtaining approval from Institutional Ethical Committee. Patients with chronic venous insufficiency were enrolled after taking informed consent. Assessment of cutaneous layer (CL), subcutaneous layer (SCL), dermo-hypodermal junction (D-HJ), and other significant US findings were noted. Ninety-eight limbs were evaluated. Most common skin finding was dermal edema in 59 (60.2%) legs. Other findings included infiltrates, CL thickening, hyper echogenicity and thickening of SCL, anechoic lacunae, disappearance of D-HJ, and epidermal loss or change in thickness of epidermis. Notably, US detected dermal edema in 15 and infiltrates in five C2 legs (normal on inspection). US evaluation of skin changes adds insight to clinical assessment and may reveal skin changes in legs affected with CVD that may appear normal on clinical examination.

Relationship of The Characteristic Imaging Findings of Breast Cancer with Molecular Subtypes in Young Women.

The characteristic imaging findings of breast cancer in young women are not yet fully understood. It causes a delay in diagnosis by mixing with benign findings. To evaluate the relationship between the imaging and histopathological features of breast cancer in women aged under 40 years. In our center, 537 suspicious lesions were detected in a total of 15,223 adult female patients under 40 years who were evaluated by breast ultrasonography (US). As a result of the mammographic, histopathological, and immunohistochemical analysis, 101 lesions meeting the study criteria were included in the sample. The luminal subtypes of breast cancer mostly visualized as irregularly shaped spiculated lesions with calcification and architectural distortion mammography and presented as masses that were sometimes accompanied by increased echogenicity in the surrounding tissue on US. The human epidermal growth factor receptor 2 (HER2) enriched subtypes mostly had microlobulated or indistinct margins with heterogeneous echoes accompanied by high calcification on mammography. The triple-negative (TN) subtypes generally appeared as microlobulated lesions with angular or indistinct margins, hypo echogenicity, posterior enhancement or shadowing, and vascularization. Some radiological features of breast cancer in young women were found to be associated with molecular subtypes similar to other age groups in the literature. However, unlike other age groups, the incidences of the HER2-enriched subtype presenting with only calcification, TN subtypes presenting with circumscribed masses, and calcification were found to be low among the young women in our study.

ROLE OF SONOGRAPHY IN CHARACTERIZATION OF THYROID NODULES FOR DIFFERENTIATING BENIGN FROM MALIGNANT

Background: Thyroid nodules are a common entity found in about 4-8% of adults by palpation, 41% by ultrasound and 50% at autopsy according to studies done. A minority of these, less than 5% are malignant. Ultrasound has over the decades played an important role in the diagnostic evaluation of thyroid disease mainly because of the gland's supercial location, availability and cost effectiveness of the ultrasound examination. We aimed to use ultrasonographic criteria to differentiate benign and malignant thyroid nodules and correlate with ne-needle aspiration cytology (FNAC) ndings. It is a cross-sectional study carried out in 100 patient Settings and Design: s who had undergone USG for thyroid nodule during March 2021 to December 2021. For the purpose of establishing a diagnosis and validating the ultrasound results, these cases underwent FNAC. The nodules were surgically removed, and a specimen was sent for histological analysis to distinguish between follicular adenoma and follicular carcinoma, according to the FNAC diagnosis of follicular neoplasms. Six of the 100 nodules tested were cytopathologically determined to be maligna Results: nt. The malignant nodules had a solid or mostly solid composition (sensitivity 100%, specicity 49.5%), absence or thick incomplete halo (sensitivity 92%, specicity 72.9%), microcalcication (sensitivity 91.7%, specicity 66.7%), a markedly hypoechoic character (sensitivity 85%, specicity 83.7%), irregular or poorly dened margins (sensitivity 83.3%, specicity 92.5%) and anteroposterior diameter greater than transverse diameter (sensitivity 65%, specicity 93%). To differentiate Conclusions: between benign and malignant thyroid nodules, ultrasonography (USG) features are helpful. thyroid tumors It is clear from our study that the USG ndings of poorly dened margins, noticeable hypo echogenicity, and A taller-than-wider form, a thin or thick irregular peripheral halo, and microcalcications all have good diagnostic accuracy for recognizing thyroid nodules that are cancerous

Clinical and neuroimaging study of patients with Parkinson’s disease using transcranial sonography and neuromelanin-sensitive magnetic resonance imaging

Background. Parkinson’s disease (PD) is one of the most common neurodegenerative diseases and aff ects 1% of the population above 60 years. The leading pathological features of PD include degeneration of neuromelanin (NM) containing dopaminergic neurons and iron deposition in the substantia nigra (SN) of the midbrain. Various neuroimaging methods sensitive to NM and iron can be clinically important for diagnosing and monitoring disease progression. Examples of such neuroimaging methods include transcranial sonography (TCS) and neuromelanin-sensitive magnetic resonance imaging (NM-MRI) fi rst and foremost.Aims. To compare the diagnostic signifi cance and eff ectiveness of TCS and NM-MRI in diff erentiating patients with PD from the norm and to elucidate the magnetic resonance- (MR-) morphological representation of the hyperechogenicity (HE) on midbrain during TCS by NM-MRI.Material and methods. 40 patients with PD were included in the main group, and 20 healthy volunteers of gender and age comparable with the main group were included in the control group. In the case of HE detection during TCS, this area was manually traced and automatic calculated. NM-MRI images were pre-processed using image processing program Image-J (USA) with subsequent automatic calculation of SN area. Based on the data obtained, clinical, demographic and neuroimaging correlations were estimated.Results. The sensitivity and specifi city of TCS in diff erentiating PD from the norm were 70 and 100% respectively, the sensitivity and specifi city of NM-MRI were 90.0 and 92.5% respectively. An analysis of the relationship between the HE area and the area of the SN according to NM-MRI data on the ipsilateral side showed a noticeable inverse correlation (for the right side: ρ = –0.606, p < 0.001; for the left side: ρ = –0.550; p < 0.001). Thus, in the case of an increase in the HE area, a decrease in the area of SN measured using NM-MRI is expected.Conclusion. TCS and NM-MRI are reliable biomarkers allowing highly eff ective diff erentiation of PD from normal. The pathophysiological and neuroimaging correlates of PD changes in neurodegenerative process remain not completely clear and require further clarifi cation in multicenter prospective studies.

Renal Ultrasonographic Abnormalities at Initial Presentation of Children Diagnosed with Acute Lymphoblastic Leukemia and Long-Term Renal Functions and Prognosis in Survivors.

ObjectivesThe kidney is a vulnerable organ for acute lymphoblastic leukemia (ALL), by the disease, and various associated clinical pictures. This retrospective study aims to document renal ultrasound abnormalities in children with newly diagnosed ALL as well as to investigate the correlation between renal findings and clinical/laboratory/survival data.MethodsAll children (age <18 years) with ALL were included in the study. An increase in size/nephromegaly (NM) or hyperechogenicity (HE) of the kidneys at first admission was accepted as a pathological renal abnormality. The clinical/laboratory findings, survival, and long-term renal functions were compared between patients with and without NM/HE.ResultsThe incidence of NM±HE was 12% in 163 patients. Enlargement of spleen, liver, or both and, hypercreatininemia was independently correlated with the presence of NM/HE. After the induction therapy, ultrasound findings were resolved in all patients, and NM/HE did not influence ALL prognosis. All survivors had normal renal functions in long term.ConclusionThe renal ultrasound abnormalities are not uncommon in children with leukemia at admission, without a negative impact on leukemia prognosis and on long-term renal functions.

Ultrasound Assessment for Thyroid Examination in Patients with Hypothyroidism

Patients with overt hypothyroidism show decreased echogenicity of the thyroid at ultrasonography . The purpose of the present study was to evaluate the effectiveness of ultrasonography for diagnosing the most common hypothyroidism and to guide patients to appropriate treatment show decreased echogenicity of the thyroid by ultrasonography. This study have been conducted on 80Patients, the age group between 20-70 years, in the period of January 2020 to October 2021. Thyroid ultrasonography was carried out by the type of ultrasound (US) machine used in the study is a sameness -X300 ultrasound device with 7.5MHz probe. The volume of the thyroid lobe noticed calculations according to the formula of the: width x length x thickness. The assessment of the 80 patients with hypothyroidism who were included in our study, (57) patients with decreased echogenicity, 23 patients had been with normal echogenicity, the lowest was found in patients homogenous enhancement 42.5%, non- homogenous 57.5%, thyroid the gland has a medium gray scale homogeneous echo pattern and the level of echogenicity is higher than Size of thyroid, The higher percentage of nodules (51.3%) of the size of the thyroid was normal. But the higher percentage of nodules type (40.0%) for the study group was solid compared to the lower percentage (2.5%) was solid and cystic. Ultrasound had high specificity and more accuracy to assess patients with hypothyroidism. An association between hypo echogenicity at thyroid US and high level of thyroid stimulation hormone (TSH suggesting decreased echogenicity at the ultrasonography diagnostic.

Vulvar lipoblastoma in the utero of a female fetus: A case report

Background: Lipoblastoma is one of the rare masses in childhood and its diagnosis is very uncommon in the perinatal period, so we reported a case with a diagnosis of this mass during pregnancy. Case Report: In a routine third-trimester ultrasound at 28 weeks, a hyperechoic mass in the size of 27*30 mm between both labia major was detected. However, no abnormal findings were found in perinatal care before this gestational age. Finally, after the birth, at 40weeks of gestation, the mass was resected and now the baby is in good condition and no recurrence has occurred. There was also an anorectal anomaly associated with this mass in our patient who underwent Anorectoplasty surgery. Conclusion: Due to the rarity of these tumors, it is important to diagnose them in the perinatal period and to investigate other associated anomalies.

THE FOLLOW UP OF 114 FETUSES AND NEWBORNS (WITHOUT CHROMOSOMAL ABERRATIONS) WITH ECHOGENIC INTRACARDIAC FOCUS DETECTED IN PRENATAL USG

THE FOLLOW UP OF 114 FETUSES AND NEWBORNS (WITHOUT CHROMOSOMAL ABERRATIONS) WITH ECHOGENIC INTRACARDIAC FOCUS DETECTED IN PRENATAL USG

Prevalence and Related Risk Factors of Non-Alcoholic Fatty Liver Disease In HIV/AIDS Patients

Objective: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of fatty liver without inflammatory infiltration, excessive alcohol consumption, viral hepatitis, and other liver diseases. NAFLD is a major health problem as it can lead to cirrhosis, liver cancer and mortality. In HIV-positive patients, the prevalence of NAFLD ranges from 28 to 48%. Currently, there is no information about the prevalence and related factors related to NAFLD in those with HIV infection in our country. In this study, we aimed to investigate the prevalence of NAFLD and the related factors in newly diagnosed HIV-infected patients. Methods: The demographic data and ultrasonography of 558 HIV-infected patients newly diagnosed between June 2015 and September 2019 were analyzed retrospectively. In hepatic echogenicity, fatty liver was diagnosed with hyper echogenicity of liver compared with renal cortex and diffusion. Uni- and multi-variate logistic regression analyses were applied to estimate factors associated with NAFLD. Results: Of 358 patients who met the study criteria, 118 (33%) were diagnosed as NAFLD. Obesity was found in 10.2% of the patients with NAFLD and in 3.1% of the patients without NAFLD (p=0.021). NAFLD rate was significantly higher in patients with diabetes mellitus and hypertension (p&lt;0.05). In the multivariate analysis, age, 1 mg/dl increase in glucose and triglyceride values and 1 unit increase in ALT/AST were associated with NAFLD. Conclusions: The results highlight the importance of early recognition and management of NAFLD and traditional factors associated with NAFLD in Turkish patients with HIV infection. Additionally, precautions and treatments should be a priority in the follow-up of patients in order to ensure the reduction of liver-related morbidity and mortality, which is one of the non-AIDS causes of these newly diagnosed HIV-infected patients.

A fast technique for hyper-echoic region separation from brain ultrasound images using patch based thresholding and cubic B-spline based contour smoothing

Ultrasound image guided brain surgery (UGBS) requires an automatic and fast image segmentation method. The level-set and active contour based algorithms have been found to be useful for obtaining topology-independent boundaries between different image regions. But slow convergence limits their use in online US image segmentation. The performance of these algorithms deteriorates on US images because of the intensity inhomogeneity. This paper proposes an effective region-driven method for the segmentation of hyper-echoic (HE) regions suppressing the hypo-echoic and anechoic regions in brain US images. An automatic threshold estimation scheme is developed with a modified Niblack’s approach. The separation of the hyper-echoic and non-hyper-echoic (NHE) regions is performed by successively applying patch based intensity thresholding and boundary smoothing. First, a patch based segmentation is performed, which separates roughly the two regions. The patch based approach in this process reduces the effect of intensity heterogeneity within an HE region. An iterative boundary correction step with reducing patch size improves further the regional topology and refines the boundary regions. For avoiding the slope and curvature discontinuities and obtaining distinct boundaries between HE and NHE regions, a cubic B-spline model of curve smoothing is applied. The proposed method is 50–100 times faster than the other level-set based image segmentation algorithms. The segmentation performance and the convergence speed of the proposed method are compared with four other competing level-set based algorithms. The computational results show that the proposed segmentation approach outperforms other level-set based techniques both subjectively and objectively.

Interpretation of Prostatic Biopsy at a tertiary care centre

Introduction: Worldwide prostatic carcinoma is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. Prostate-specific antigen (PSA), digital rectal examination, and transrectal ultrasound are the tools most commonly used to screen for prostate cancer. Prostatic biopsy is most often preceded by abnormalities found on digital rectal examination (DRE) or serum prostate specific antigen (S.PSA) elevation. This study was planned to know proportion of malignant and benign lesions in histopathologic examination for prostatic lesions in patient who attend OPD/IPD and to analyze the usefulness of serum PSA & ultrasound examination by histopathological confirmation. Methods: Patients visited to urology department with urinary incontinence and other complaints were evaluated which includes clinical history, signs and symptoms. Rectal examination of patients was done. Serum PSA level and prostatic biopsy were sent of those who were suspected for prostatic disease. Prostate biopsy was obtained by using any one of the following method 1.Transurethral resection biopsy 2. Transrectal biopsy Trucut biopsy. Results: Out of 300 cases of prostatic biopsy 265 (88.33%) are benign and 35 (11.66%) cases are malignant lesions. Out of 300 cases, 191 (63.66%) are pure benign prostatic hyperplasia, 48(16%) are BPH with chronic prostatitis and 11(3.66%) are BPH with severe prostatitis. Out of 35 cases of prostatic carcinoma 33 (94.28%) cases are adenocarcinoma and 2 cases (5.71%) are transitional cell carcinoma. Out of 262 cases with clinically benign lesions, 258 cases proved benign histopathologically but 4 cases (1.52%) are diagnose malignant. 151 patients have S.PSA less than 4 ng/ml, out of 151, 149 turned to be benign on histopathological examination. 52 patient have S.PSA above 10 ng/ml, out of these 52 cases, 29 have malignancy in HPE examination. Out of 278 cases diagnosed as benign isoechoic by ultra sonography 262 cases have benign lesion on histologic diagnosis and 16 have malignant lesion. Out of 22 cases diagnosed as malignant (hypoechoic asymmetrical) by ultrasonographicaly 19 proved malignant histologically. Conclusion: The results of this study indicate that transrectal ultrasound, serum prostate specific antigen and digital rectal examination were good tool to differentiate between malignant and benign lesions of prostate. Proportion of malignancies are quiet significant in prostatic lesions and increased with age. Key words: Prostae, Malignancy, Biopsy, PSA, DRE

Is there association between QRS-T angle, and hormonal and sonographic features in polycystic ovarian syndrome?

Polycystic ovary syndrome (PCOS) is a complex disorder comprising ovulatory dysfunction, hyperandrogenism, and polycystic ovaries (PCO). Several studies have used electrocardiography (ECG) to assess PCOS patients. We aimed to analyze the associations among QRS-T angle, hormonal parameters, and ovarian and thyroid sonography in PCOS. Adult females with PCOS, but without comorbid illness, were included in our study. Demographic and clinical features (body mass index, Ferriman-Gallwey score, phenotype) were analyzed, as well as laboratory test results. Based on standard 12-lead ECGs, frontal plane QRS-T angles were calculated, defined as the angle between the mean QRS and the mean T vector, and verified with automatic instrument measurements. Values within the range -46 to +59° were classified as "normal", and those out of this range as "abnormal". Patients were divided into groups according to the presence of thyroid nodules, echogenicity (normal/decreased), and vascularity (normal/increased) based on thyroid sonography, and by mean ovarian volume (MOV ≥ 10/< 10 mL) or apparent PCO based on ovarian sonography. The mean age of the 92 patients was 22.68 ± 4.58 years; 11 patients (11.9%) had abnormal QRS-T angles. Demographic, clinical, electrocardiographic, and laboratory parameters were similar between the normal and abnormal QRS-T angle groups, with the exception of MOV, which was higher in the latter group (p=0.032). Among all clinical and laboratory parameters, only MOV was a strong predictor of abnormal QRS-T angle (p=0.016). Our study is the first to analyze the association between the QRS-T angle and hormonal and sonographic features of patients with PCOS. A small percentage of patients had abnormal QRS-T angles, and a large MOV was a strong predictor of this abnormality.

Analysis of the diagnosis and missed diagnosis of intrauterine adhesions by three-dimensional transvaginal sonography Render and tomographic ultrasound imaging

Objective To investigate the value of three-dimensional transvaginal sonography(3D-TVS) in the diagnosis of intrauterine adhesions(IUA) and to analyze the causes of the missed diagnosis. Methods Forty-seven patients with IUA were examined by three-dimensional transvaginal sonography(3D-TVS), 3D volume imaging (Render imaging) and tomographic ultrasound imaging(TUI imaging) in the Union Hospital of Fujian Medical University from January 2017 to July 2019. The abnormal echo data of the endometrium were recorded and analyzed, and the ultrasound diagnosis and hysteroscopic diagnosis were compared. Results 3D-TVS correctly diagnosed IUA was accurate in the 39 cases whose ultrasound imaging showed an uneven thickness of endometrial echo with the uterine cavity line having different degrees of echo continuity interruption. The diagnostic accuracy rate was 83.0%(39/47). In the Render imaging, 7 cases showed endometrial echo with honeycomb change, 28 cases showed partial echo loss with irregular low echo zone or low echo, and 4 cases showed corneal disappearance of one side. In TUI imaging, the endometrium was partly thinned in varying degrees where echo continuity was interrupted with hypoechoic band-like changes in all 39 cases. Three of the 8 missed IUA cases showed slender endometrium with filiform or membranous adhesions, and the other 5 were patients with uterine endometrial polyps. Conclusions 3D-TVS, Render imaging and TUI imaging technology can display stereo images, which contributes to the better preoperative diagnosis and postoperative follow-up. Care should be taken to avoid missed diagnosis and to improve the diagnostic accuracy for IUA by the techniques. Key words: Ultrasonography, transvaginal, three-dimensional; Intrauterine adhesions

Predictive model for cervical lymph node metastasis of papillary thyroid carcinoma based on ultrasound and thyroglobulin infine-needle aspirate fluid detection

Objective To establish a predictive model of lateral lymph node metastasis in patients with papillary thyroid carcinoma(PTC), and further to compare the diagnostic efficiency of this model with the suspected abnormal lymph node thyroglobulin in fine-needle aspirate fluid (FNA-Tg) for lateral lymph node metastasis. Methods The preoperative clinical and ultrasonographic data of 110 patients (257 lymph nodes) who underwent PTC cervical lymph node dissection were retrospectively analyzed. According to the postoperative pathological results, they were divided into lateral lymph node metastasis and non-metastasis group. Regression analysis was used to screen out independent risk factors affecting lateral lymph node metastasis and establish a predictive model. The ROC curve was used to evaluate the diagnostic efficacy and the best diagnostic cut-off point. Results Prediction model: Logit(P)=-2.987+ 2.189(S/L ratio of lymph nodes)+ 1.748(hilum absent)+ 2.030(hyperechoic)+ 1.849(vascular abnormalities). The sensitivity, specificity, accuracy and AUC of the prediction model in the diagnosis of lateral lymph node metastasis were 92.1%, 83.9%, 87.9% and 0.929, respectively. The Homser-Lemeshow goodness of fit test showed that the Logistic model has a good fitting effect. The sensitivity, specificity, accuracy, and AUC of FNA-Tg in the diagnosis of lateral lymph node metastasis were 87.4%, 95.4%, 90.3% and 0.968, respectively. The sensitivity, specificity, accuracy, and AUC of the combined diagnosis of the predictive model and FNA-Tg were 92.9%, 96.9%, 94.2% and 0.989, respectively. Conclusions The model has a good predictive value for PTC cervical lymph node metastasis. Combined with FNA-Tg, it can improve its diagnostic efficiency and provide more valuable information for the decision-making of clinical surgical procedures. Key words: Ultrasonography; Thyroid neoplasms; Lymphatic metastasis; Logistic models

Color Doppler ultrasound visualizes early post-traumatic heterotopic ossification in animal model

Objective To validate the role of color Doppler ultrasound in an animal model to detect early heterotopic ossification (HO) after brain-traumatic/burn/tenotomy. Methods Forty-four rats were randomly divided into two groups. Rats in experimental group (n=22) were operated to build brain-traumatic/burn/tenotomy model and others in control group (n=22) underwent only skin incision injury. Color Doppler ultrasound, X-ray film examination at 2, 3, 4, 6, 8 and 10 weeks post-injury were performed to follow up the progression of HO in both groups respectively. Histology was used to confirm bone formation. Results In the experimental group, disorder structure with a hypoechoiccore in treated Achilles tendon was visualized using color Doppler ultrasound in the 2nd week. Additional tiny hyperechoic foci were observed in the 3rd week, which increased in the fourth week and fused into a mineralized island in the sixth week. No obvious abnormality was found in control group at the aforementioned time point. X-ray could detect heterotopic bone tissue in the sixth week in the experimental group but not in the control group. X-ray and HE stainning had confirmed bone formation in the tenth week in the experimental group. Conclusions Color Doppler ultrasound can detect early HO and continuously follow up the progression of HO. Key words: Ultrasonography; Heterotopic ossification; Animal model; X-ray

ОПЫТ ПРИМЕНЕНИЯ УЛЬТРАЗВУКОВОГО МЕТОДА В ДИАГНОСТИКЕ ПНЕВМОНИИ, ОБУСЛОВЛЕННОЙ SARS-CoV-2

Purpose To assess the possibilities of using the ultrasound method in detecting signs of pneumonia associated with COVID-19 Material and methods The experience of using ultrasound lungs examination of 75 patients hospitalized for COVID-19 Ultrasound studies were carried out on a portable device Mindray DC-6900 (China) using linear transducers at a frequency of 5 0-15 MHz and convex transducers at a frequency of 3 5-5 0 MHz The method of ultrasound examination of the chest organs provided for a sequential examination and assessment of twelve conventional scanning zones The presence of artifacts of the ultrasound image along the horizontal (A-line) and confluent vertical (B-lines) scanning lines was studied Results Ultrasound examination of the lungs of 75 patients with COVID-19 revealed vertical artifacts of the ultrasound image Focal or confluent B-lines (49,3% patients), as well as thickening and compaction of the pleural line (44% patients), subpleural consolidations in the form of hypoechoic areas under the pleural line (34,7% patients) Pleural effusions were found in 3 (4%) cases In 35 (46,7%) patients with a mild course of the disease and an asymptomatic form, according to the ultrasound examination, horizontal A-lines were identified, which indicated the preservation of the airiness of the lungs Discussion The main ultrasound diagnostic criteria for pneumonia caused by SARSCoV-2 is the absence of horizontal A-lines and the appearance of vertical B-lines Subpleural consolidations and changes in the pleural line served as additional ultrasound signs Ultrasound signs and the number of affected areas correlated with the severity of the disease False negative results were associated with deep-seated consolidations or shielding by scapulae and ribs Significant difficulties in imaging the chest organs have arisen in obese patients In these cases, the data of ultrasound studies in combination with X-ray and CT scan facilitated a more precise diagnosis of the course of the disease Conclusion Ultrasound examination is one of the available methods in the diagnosis and assessment of the severity of the disease and can be used more widely in clinical practice © 2020 Russian Electronic Journal of Radiology All rights reserved

Clinical features and treatment of ten patients with primary hepatic angiosarcoma

Objective To investigate the clinical characteristics, treatment and curative effect of primary hepatic angiosarcoma. Methods A retrospective study was conducted on 10 patients with primary hepatic angiosarcoma who were treated in the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Zhengzhou University from April 2012 to July 2018. There were 6 males and 4 females, with an average age of 55.1 (range 39.0 to 71.0) years. The clinical features, imaging findings, treatment methods and survival time of the patients were analyzed. Results The clinical manifestations of 10 patients with primary hepatic angiosarcoma were non-specific and all were confirmed by pathology. Three cases had diffuse liver echo changes on ultrasound, and 7 cases had hypoechoic lesions with blurred borders. Space occupying lesions were found in 10 cases by CT. A total of five patients underwent partial hepatectomy, 1 case received chemotherapy, 1 case received transcatheter arterial chemoembolization (TACE), 2 case received molecular targeted therapy, and 1 case was untreated. From diagnosis to the last follow-up, the survival time of the 5 patients receiving surgical resection were 9 months, 15 months, 19 months, 21 months and 26 months. The survival time of the patient receiving chemotherapy was 7 months. The survival time of the patient receiving TACE was 3 months. Two patients were targeted for treatment, one survived for 32 months, another had been targeted for 15 months, and treatment was continuing. One patient survived for 1 month without treatment. Conclusions Primary hepatic angiosarcoma has a high degree of malignancy and a poor prognosis. No specific clinical manifestations and imaging findings, confirmed by pathological examination. Patients with partial hepatectomy have a better survival. Targeted therapy may be the most effective treatment for primary hepatic angiosarcoma in the future. Key words: Hemangiosarcoma; Liver; Diagnosis; Treatment outcome

The anatomical structure of fused renal pyramid and its imaging findings in ultrasound and computed tomography

Objective To analyze the anatomical structure and distribution of the fused renal pyramid (FRP) in cadaveric kidney, and discuss its appearances by CT and ultrasonic examinations. Methods From June 2018 to September 2018, 108 cadaveric kidneys were proceeded for regional anatomy. The distribution and anatomical manifestations of FRP was recorded. The renal pyramid was sliced and HE stained to explore the vascular distribution in FRP. From October 2018 to January 2019, ultrasound imaging data of 112 patients with 224 kidneys were collected, including 60 males and 52 females, age (39.0±15.1), ranging from 16 to 73 years old. The renal imaging data of 89 patients and 178 patients with enhanced renal CT were collected, including 48 males and 41 females. Age (45.4±13.6), ranging from 23 to 69 years old. The imaging findings of FRP in ultrasound and enhanced CT was summarized. Results In cadaver kidneys, the proportion of FRP in upper and lower calyces was 68.6% (74/108) and 64.8% (70/108), respectively, higher than that in middle calyces 34.3% (37/108). In the middle group, the incidence of mild fusion was 39.0% (16/41) and severe fusion was 48.8% (20/41). The incidence of fusion of two renal pyramidal structures was 90.2% (37/41). HE staining showed that the boundary between the artery in FRP and the surrounding renal pyramidal was unclear, and the protection of connective tissue was lacking. In Ultrasound, the FRP presented as a large trapezoidal hypo-echoic area with red and blue color signals in doppler mode. In ultrasound, the incidence of FRP was 18.8% (42/224). In enhanced CT, the FRP presented as enhanced cord-like high density shade in large low density area in cortex phase. In enhanced CT, the incidence of FRP 27.5%(49/178). Conclusions The FRP is a common structure in human kidney. The arteries localize within the FRP and are absence of sufficient connective tissue protection which are different from normal arteries. Ultrasound and enhanced CT have recognition ability for FRP. Key words: Kidney diseases; Fused renal pyramid; Anatomical structure; Percutaneous nephrolithotomy; Ultrasound; Computed tomography

The application of neonate lung ultrasound in congenital pulmonary airway malformation

Objective To analyze the characteristics of lung ultrasound (LUS) in congenital pulmonary airway malformation (CPAM), and to compare the difference of image characteristics between LUS and chest X-ray(CXR) and evaluate the value of neonate LUS in CPAM. Methods From June 2017 to October 2018, the characteristics of LUS and CXR of 32 neonates who were diagnosed with CPAM by prenatal ultrasound and postnatal chest CT were analyzed retrospectively, and the difference of their direct signs and indirect signs were compared. Results Among 32 CPAM cases, 10 cases (31.25%) showed a single large cystic lesions and 3 cases with consolidation, 4 cases (12.5%) characterized by multiple hypoechoic lesions and 3 cases with consolidation, 16 cases (50%) showed consolidation with or without intensiveaerated bronchus sign or dendritic air-filled bronchi, 2 cases (6.25%) only characterized by dense B-line. The non-characteristic sonographic findings including pleural line was not smooth and not clear; A-line decreased or disappeared, dense B-lines were observed. The ability of LUS in measuring the size of CPAM was limited.Among 32 CPAM cases, 10 cases (31.25%) showed large cystic hypoechoic lesions and 22 cases (68.75%) showed small cystic hypoechoic lesions by CT scan. In this group, there were 11 cases(34.4%) with normal CXR. There was no significant differences of the direct signs (including single large cystic lesions and multiple hypoechoic lesions) between LUS and CXR (P=0.80), however the indirect signs of LUS were more obvious than CXR, with significant difference(P=0.001). Conclusions The neonatal LUS findings of CPAM is multiple, it can be used as a preliminary qualitative screening method.The diagnosis value of indirect sign of LUS is superior to CXR. Key words: Ultrasonography; Lungs; Congenital pulmonary airway malformation; Computed tomography; Chest X-ray

The ultrasonic appearances of primary testicular lymphoma

Objective To explore the sonographic features of primary testicular lymphoma(PLT). Methods The sonographic features of 16 PLT patients confirmed by surgery and pathology were retrospectively analyzed. Results Sixteen PLT patients were typed into 3 ultrasonic patterns: ①The diffuse homogeneous echo type: 2 cases, the ultrasonic features were homogeneous sieve-like hypoechoic echo, the blood flow signal was rich and radially distributed, with interstisial fibrosis inapparently under-microscope. ②The diffuse uneven homogeneous echo type: 9 cases, the ultrasonic features lobulated or map-like heterogeneous hypoechoic features, the blood flow signal was rich in linear distribution, and interstisial fibrosis proliferated to form fibrous septa under-microscope. ③The focal nodular pattern echo type: 5 cases, the ultrasonic features were homogeneous hypoechoic nodules, the blood flow signal was few, interstisial fibrosis hyperplasia surrounding the tumor under-microscope. Conclusions Ultrasonic appearances of primary testicular lymphoma are closely related to its pathologic characteristics, the recognization of their relations contributes to improve the diagnostic value of ultrasound. Key words: Ultrasonograghy; Lymphoma, testis, primary