Enhanced Intensity Research Articles

The application of dynamic contrast-enhanced ultrasonography in immediate distinguishing residual tumour from benign periablational enhancement after hepatocellular carcinoma radiofrequency ablation.

This study set out to access the performance of quantitative analysis of contrast-enhanced ultrasound (CEUS) indistinguishing between benign periablational enhancement (BPE) and residual tumor (RT) following radiofrequency ablation(RFA). 165 tumors from 124 patients with hepatocellular carcinoma between 2021 and 2023underwent RFA, contrast-enhanced computed tomography (CECT), and CEUS in less than 24 hours. Analysis was done onthe quantitative parameters from RT and BPE found by CEUS. Complete ablation was obtained in 89.1% of lesions.When compared to BPE, RT had significantly greater peak intensity (PI), time to peak (TTP), area under the curve (AUC),ratio of PI and base intensity (PI/BI), and enhanced intensity (EI) values (all p<0.05). PI, TTP, AUC, PI/BI, and EI had largeareas under the receiver operating (ROC) curves. A binary logistic regression analysis, respectively, demonstrated that PI andPI/BI were independent favorable prognostic variables. Multiple parameters of quantitative analysis of CEUScan aid in distinguishing immediately between RT and BPE lesions. PI and PI/BI may be a more promising parameter. ImmediateCEUS evaluation following RFA may allow immediate retreatment of RT during the same operation time, which reducespatients' hospital stays and financial costs.

Detection of Subchondral Bone Microcirculatory Perfusion in Adults with Early Osteonecrosis of the Femoral Head Using Contrast-Enhanced Ultrasound: A Prospective Study.

The aim of this study was to quantitatively assess subchondral bone microcirculation perfusion in adults with early osteonecrosis of the femoral head (ONFH) using contrast-enhanced ultrasound (CEUS) and to evaluate its correlation with the Association Research Circulation Osseous (ARCO) stage. We investigated 97 adult patients with definite ONFH by imaging a total of 155 hips, performing CEUS, storing images of CEUS processes at different ARCO stages and generating CEUS time-intensity curves (TICs) to obtain perfusion parameters. Differences in CEUS parameters at different ARCO stages were analyzed, and correlations were explored. A logistic regression model was constructed by incorporating the meaningful CEUS indicators. The CEUS parameters time to peak (TTP), peak intensity (PI), enhanced intensity (EI), ascending slope (AS), descending slope (DS) and area under the receiver operating characteristic curve (AUC) were significantly different in ARCO stage Ⅰ compared with stage ⅢA, and the same results were obtained in stage Ⅱ compared with stage ⅢA. However, there were no significant differences between stages Ⅰ and Ⅱ. The MTT (mean transit time) assay was not significantly different between the different stages. The receiver operating characteristic curve analysis of TTP, PI, EI, AS, DS and AUC in stages Ⅰ and ⅢA had a certain diagnostic efficacy, similar to the results in stages Ⅱ and ⅢA. The diagnostic performance of DS was less accurate in stages Ⅰ and ⅢA, while the diagnostic performance of TTP was less accurate in stages Ⅱ and ⅢA. ARCO stage was independently and negatively correlated with TTP and DS and independently and positively correlated with PI, EI, AS and AUC. The MTT assay was not correlated with ARCO stage. Logistic regression models containing statistically significant TTP, EI and AUC values were constructed, and all three values were closely related to the ARCO stage. In patients with different ARCO stages of ONFH, CEUS can effectively assess subchondral bone perfusion of the femoral head and is expected to become an effective imaging method for the diagnosis of early ONFH.

Savitzky-Golay Filter Based Quantitative Dynamic Contrast-Enhanced Ultrasound on Assessing Therapeutic Response in Mice with Hepatocellular Carcinoma

As new drugs are developed in targeted therapy for advanced hepatocellular carcinoma (HCC), an accurate evaluation procedure for the therapeutic efficacy is needed. Current methods use MRI or CT based response evaluation criteria in solid tumors (RECIST) which is unsatisfactory for overlooking the functional response. We propose a new mice model of HCC for assessment of the early response to targeted therapy with contrast-enhanced ultrasound (CEUS). The major technical innovation is analysis of tumor functional characteristics using Savitzky-Golay filter (S-G filter) based CEUS quantification (SGCQ) software. In this study, mice were divided into three groups, including the control group (n1 = 18), sorafenib treatment group (n2 = 18) and lenvatinib treatment group (n3 = 18). SGCQ software specialized in data smoothing was used to quantify the time, enhanced intensity and blood volume related parameters at five different time points within 14 days of therapy. Promising experimental results were obtained. From the analysis, it could detect response as early as 4th day and perfusion time (PT), mean transit time (MTT), area under the curve of tumor/adjacent parenchyma (qAUC), wash-in slope a3, the average time of perfusion (T0) were early predictors. Then, tumors were excised with histopathology performed, CD31 H-score is in correlation with parameters peak intensity (PI), enhanced intensity (EI) and area under the curve of tumor/adjacent parenchyma (qAUC). Moreover, there was no significant difference in efficacy between sorafenib and lenvatinib in both CEUS parameters and histopathology. Finally, the finding of this study proves SGCQ software to be a valid, sensitive and repeatable method for therapeutic evaluation. Quantitative and comparative studies show that sorafenib and lenvatinib, as two first-line targeted drugs, ensure the therapeutic advantages of HCC.

Savitzky-Golay filter based contrast-enhanced ultrasound quantification in hepatic tumors: Methodology and its correlation with tumor angiogenesis.

Savitzky-Golay filter is a digital filter used in data smoothing, we introduced a contrast-enhanced ultrasound (CEUS) quantification software based on the filter (SGCQ). To explore the methodology of analyzing hepatic tumors hemodynamics applying SGCQ software and the correlation between SGCQ parameters and hepatocellular carcinoma (HCC) angiogenesis. Nighty-seven right-lobe located hepatic mass cases (15 females and 82 males, mean age 58±10y, mean lesion size: 39.9±11.6 mm) underwent CEUS scan preoperatively and had a final diagnosis of HCC (n = 52) or colorectal cancer metastatic liver tumors (MLT, n = 45) were included. CEUS was carried out using a 1-5 MHz convex probe. The CEUS clips were recorded and analyzed off-line to obtain the parameters. The parameters were analyzed by 3 observers separately to investigate inter-observer variability. Parameters were compared between tumor and adjacent liver and between different tumors. Immunohistochemistry was used to evaluate the microvessel density (MVD) of HCC, and the correlation between the parameters and MVD was analyzed. Intraclass correlation coefficient (ICC) of all parameters were greater than 0.75 except wash-in slope (a3) and time to peak (TTP) of adjacent liver. The parameters of a3, wash-out slope (a2), perfusion time (PT) and area under the curve (AUC) were significantly different between HCC and liver. The a2, a3, AUC, PT and enhanced intensity (EI) were significantly different between MLT and liver. AUC, a2, a3, da1 and dPI were significantly different between HCC and MLT. AUC, a2 and EI correlated with MVD. SGCQ software quantification have good consistency among three observers, the parameters of SGCQ can display the hemodynamics of HCC and MLT and the difference between them. AUC and EI can serve as useful biomarkers in tumor angiogenesis evaluation.

Role of Contrast-Enhanced Ultrasound Sonography in the Medical Diagnostics of the Disease Activity in Patients With Takayasu Arteritis

The accurate diagnosis of Takayasu arteritis (TA) and the evaluation of its activity can bring significant challenges. In this paper, we sought to investigate a correlation between clinical activity and the enhancement of vessel wall acquired by contrast-enhanced ultrasound sonography (CEUS) in patients with TA, and to evaluate whether CEUS can be used to assess the disease activity of TA. Twenty TA patients with their carotid arteries affected were enrolled and divided into the active group and the inactive group according to the NIH scoring method. The white blood cell counts, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were obtained. Conventional ultrasound was performed to acquire the external diameter of the artery (D), intima-media thickness of the arterial wall (IMT), percent area stenosis, peak systolic velocity, end diastolic velocity, and resistance index. CEUS was performed to acquire the enhanced intensity (EI), derived peak intensity (DPI), and time to peak. The analysis showed that compared with the inactive group, D and IMT were significantly higher in the active group ( $6.50~\pm ~1.80$ versus $9.20~\pm ~4.00$ mm, $1.80~\pm ~0.40$ versus $2.40~\pm ~0.70$ mm, $p ). EI and DPI were also significantly higher in the active group ( $38.20~\pm ~10.62$ versus $80.80~\pm ~23.60$ IU, $46.20~\pm ~10.20$ versus $90.30~\pm ~24.60$ IU, $p ). Meanwhile, EI and DPI showed good correlation with CRP and ESR. Therefore, our study demonstrated that CEUS can increase the effectiveness of conventional ultrasound in differentiating active and inactive TA.

Evaluation of prediction of pathologic grade of regression to preoperative neoadjuvant chemotherapy in patients with resectable advanced gastric cancer using double contrast-enhanced ultrasound

Objective To discuss the value of double contrast-enhanced ultrasound(DCEUS) as a method to predict the pathologic grade of regression to preoperative neoadjuvant chemotherapy(NAC) in advanced gastric cancer(AGC) patients, the contrast parameters of gastric carcinoma were measured and its correlation with pathologic response degree was analyzed. Methods Fifty seven patients with endoscopic biopsy-proven AGC were considered for a complete resection of the lesion and had a DCEUS prior to and following XELOX pre-operative NAC therapy for 3 cycles. The arrival time (AT), time-to-peak (TTP), baseline intensity (BI) and peak intensity (PI) of the primary gastric tumor were measured.The enhanced intensity (EI) was defined as PI minus BI. The percentage of change of DCEUS parameters before and after NAC therapy and its correlation with phathologic grades of regression was calculated. Patients were divided into responder and nonreponder group according to different pathologic response grade. The differences of DCEUS parameters between two groups were compared. The diagnostic accuracy of DCEUS in prediction of benefit from preoperative NAC was represented by means of receive operating characteristic (ROC) curves. Results After NAC, the PI and EI values of local gastric cancer were significantly lower than before NAC. There were significant differences in PI and EI after NAC between the responder and nonresponder groups. Among the DCEUS parameters showed significant correlation with pathologic grade of regression, the correlation factor was highest in percentage of EI reduction of primary gastric tumor(ρ=-0.501, P=0.007). When the optimal cutoff value of EI reduction rate of gastric tumor determined was 27%, a sensitivity of 81.8% and specificity of 66.7% were achieved. Conclusions DCEUS might be a novel, noninvasive, liable and potential method to select the benefit responder from the preoperative NAC in AGC patient. Key words: Contrast-enhanced ultrasound; Microbubbles; Stomach neoplasms; Neoadjuvant chemotherapy

The experimental study of the inhibitory effect of self-made nanobubbles combined with cisplatin mediated by ultrasound on H22 neoplasms of mice

Objective To investigate the optimal ultrasound exposure parameter on H22 neoplasms of mice meditated by ultrasound exposure combined with self-made nanobubbles, and then observe their therapeutic effect combined with cisplatin and their possible mechanism of anti-tumor. Methods Thirty mice engrafts models with subcutaneous H22 neoplasms were established and divided into 6 groups randomly, which received ultrasound exposure at different intensity and exposure time. The contrast enhanced ultrasound imaging (CEUS ) was performed in every group at the four time points of before treatment and at 0 h, 24 h, 72 h after treatment. To obtain the optimal ultrasound parameters, the tumor inhibitory effect was assessed by enhanced intensity (EI) and microvascular density (MVD). The H22 tumor were treated by ultrasound exposure nanobubbles combined with cisplatin to observe their tumor growth inhibition rate, and the microvessels density and nuclear associated antigen Ki-67 proliferation index were measured by immunohistochemical staining. Results There was a statistically difference in enhanced intensity (EI) between the experimental groups and control group (P<0.05=. With the increasing of ultrasound intensity and exposure time, the tumor inhibitory effect was more obvious, with an increasing side reactions. Except the simple ultrasound group, there was a statistical difference in tumor inhibition, the mean MVD and the tumor cell proliferation index (KI-67) between control group and the other ultrasound therapy groups (P<0.05=. The tumor inhibitory rate was the highest (tumor inhibition rate 70.0%) and the mean MVD and KI-67 expression were the lowest (P<0.05= in the combination group comparing with the others. Conclusions The ideal ultrasound exposure parameter of tumor inhibition showed that exposure intensity chose 1 W/cm2 and exposure time chose 1 min or 3 min intermittence. The ultrasound exposure self-made nanobubbles combined with cisplatin could enhance the tumor inhibitory effect.Its mechanism may be related to the decrease of microvascular density, the inbition of tumor cell proliferation and the increase of tumor cell necrosis. Key words: Ultrasonography; Microbubbles; Liver neoplasms, experimental; Cisplatin

The therapeuatic effect of Endostar on soft carotid plaque neovascularization in patients with non-small cell lung cancer.

The purpose of this study was to investigate the effect of the angiogenesis inhibitor Endostar on carotid plaque neovascularization in patients with non-small cell lung cancer (NSCLC) using contrast-enhanced ultrasound (CEUS). Ninety-one patients who had NSCLC with soft carotid plaques were selected for treatment either with the NP regimen (vinorelbine + cisplatin) (43 patients) or with the ENP regimen (Endostar + NP) (48 patients). Plaque thickness and neovascularization of the plaque were assessed before and at 1 month after treatment using CEUS. Enhanced intensity (EI) of CEUS was used for quantification of plaque neovascularization. There was no significant changes in any group in thickness of plaque between recruitment and 1 month after treatment (P > 0.05 for all). There was no significant change in the EI of plaque in the controls or NP groups at 1 month after treatment (P > 0.05), while EI in the ENP group was significantly reduced at 1 month after treatment (P < 0.01) and significantly lower than that in the controls or NP group at 1 month after treatment (P < 0.001 both). This study indicates that carotid soft plaque neovascularization in patients with NSCLC can be reduced by anti-angiogenesis treatment.

Relationship between Enhanced Intensity of Contrast Enhanced Ultrasound and Microvessel Density of Aortic Atherosclerostic Plaque in Rabbit Model

The aim of this study was to evaluate the relationship between enhanced intensity of contrast enhanced ultrasound and microvessel density of aortic atherosclerotic plaque in rabbit model. The abdominal aortas of thirty-six male New Zealand rabbits were damaged by balloon expansion and the animals were then fed a high fat diet for 12 weeks. Twenty-seven plaques on the near aortic wall were detected using conventional ultrasound examination. The maximum thickness of each plaque was recorded. CEUS was performed on these 27 plaques and the time-intensity curves (TICs) were analyzed offline. Using the quantitative ACQ software, features such as the arrival time (AT), time to peak (TTP), baseline intensity (BI), peak intensity (PI) and enhanced intensity (EI) (EI = PI-BI) were assessed. Inter- and intra-observer agreement of EI were assessed using the Bland-Altman test. After CEUS examination, the rabbits were sacrificed for pathological examination and CD34 monoclonal antibody immunohistochemical detection. Microvessel density (MVD) was counted under the microscope. The relationship between indexes of CEUS and the level of MVD was analyzed. There was a good positive linear correlation between EI and MVD (γ = 0. 854, P<0. 001), the intraclass correlations for inter- and intra-observer agreement for EI were 0.73 and 0.82 respectively, suggesting that EI may be act as a useful index for plaque risk stratification in animal models.

Evaluation of the effect of endostar on neovascularization within rabbits of abdominal aortic atherosclerotic plaque using contrast-enhanced ultrasonography

Objective To evaluate the effect of endostar on neovascularization within rabbits of abdominal aortic atherosclerotic plaques using contrast-enhanced ultrasonography (CEUS).Methods Twenty six male New Zealand rabbits,damaged abdominal aorta by expanded balloon,high-fat feeding for consecutive twelve weeks,made plaque model successfully,were detected using conventional ultrasound examination and CEUS.Group A (eight rabbits) as pathology control group was killed immediately randomly after examination,then every abdominal aortic plaque were taken out for pathological examination and immunohistochemical detection.Survivals were divided into two groups randomly:Group B (nine as control group) fed common diet for another four weeks; Group C (nine as treatment group) injected endostar besides common diet.All survivals were detected using conventional ultrasound examination and CEUS once more in sixteen weeks,then killed immediately and all plaques were made for pathological examination.Results The value of maximum thickness,luminal stenosis rate,time to peak(TTP),peak intensity(PI) and enhanced intensity (EI) compared among three groups had no significant difference(P ＞0.05).After four weeks treatment,EI,microvessel density (MVD) and the rate of vulnerable plaques in group C were significantly less than group A and the same time group B,and the value of contrast between the two groups was significantly different (P ＜ 0.05).Others value compared with group A had no significant difference P ＞ 0.05).However,every value in group B compared with group A had no significant difference (P ＞ 0.05).Conclusions EI could accurately evaluate the effect of endostar on neovascularization within rabbits of abdominal aortic atherosclerotic plaques,at the same time showed endostar could suppress neovascularization of atherosclerotic plaques,which contributed to them become stable. Key words: Ultrasonography ; Microbubbles ; Aorta, abdominal; Plaques, atherosclerotic ; Endostains

Time-intensity curve parameters in rectal cancer measured using endorectal ultrasonography with sterile coupling gels filling the rectum: correlations with tumor angiogenesis and clinicopathological features.

The primary aim of this study was to investigate the relationship between contrast-enhanced ultrasonography (CEUS) imaging parameters and clinicopathological features of rectal carcinoma and assess their potential as new radiological prognostic predictors. A total of 66 rectal carcinoma patients were analyzed with the time-intensity curve of CEUS. The parameter arrival time (AT), time to peak enhancement (TTP), wash-in time (WIT), enhanced intensity (EI), and ascending slope (AS) were measured. Microvessel density (MVD) was evaluated by immunohistochemical staining of surgical specimens. All findings were analysed prospectively and correlated with tumor staging, histological grading, and MVD. The mean values of AT, TTP, WIT, EI, and AS value of the rectal carcinoma were 10.84 ± 3.28 s, 20.61 ± 5.52 s, 9.78 ± 2.83 s, 28.68 ± 4.67 dB, and 3.20 ± 1.10, respectively. A positive linear correlation was found between the EI and MVD in rectal carcinoma (r = 0.295, P = 0.016), and there was a significant difference for EI among histological grading (r = −0.264, P = 0.007). EI decreased as T stage increased with a trend of association noted (P = 0.096). EI of contrast enhanced endorectal ultrasonography provides noninvasive biomarker of tumor angiogenesis in rectal cancer. CEUS data have the potential to predict patient prognosis.

Double contrast-enhanced two-dimensional and three-dimensional ultrasonography for evaluation of gastric lesions

To investigate the value of two-dimensional (2D) and three-dimensional (3D) double contrast-enhanced ultrasonography (DCUS) imaging for evaluation of gastric lesions. 2D and 3D DCUS imaging with both oral and intravenous administrations of contrast agents was used to assess gastroscopiclly-confirmed gastric lesions in 46 patients with benign and malignant diseases. Initially, liquid-based ultrasound contrast agent (Xinzhang®) was given orally at dose of 500-600 mL for conventional ultrasound examination of the gastric lesions, and then a microbubble-based contrast agent (SonoVue) was injected intravenously at dose of 1.2-2.4 mL in bolus fashion to assess the perfusion pattern of the lesions using contrast imaging modes. The parameters derived from time-intensity curves including the arrival time (AT), time to peak (TTP), peak intensity (PI) and enhanced intensity (EI) were measured on the 2D DCUS imaging. 3D DCUS of the lesions was acquired to demonstrate the value of this imaging mode. There were 22 cases with benign lesions including chronic gastritis (n = 5), gastric ulcer (n = 9), gastric polyps (n = 3), gastric stromal tumors (n = 5), and 24 cases with malignant lesions including gastric cancer (n = 20), gastric cardia carcinoma (n = 3) and post-operative recurrent gastric cancer (n = 1) in the study. The oral contrast-enhanced ultrasonography (CEUS) imaging of the stomach clearly demonstrated the anatomy of the stomach and morphologic features of gastric lesions. With optimal scanning window and imaging display under oral CEUS, intravenous CEUS clearly showed the perfusion of gastric lesions with various characteristic manifestations. Both 2D and 3D DCUS images clearly demonstrated normal gastric wall as a three-layer structure, from the inside out, hyperechoic mucosa, hypoechoic muscularis and hyperechoic serosa, respectively. There were statistical significant differences of AT (8.68 ± 2.06 vs 10.43 ± 2.75, P = 0.017), PI (34.64 ± 6.63 vs 29.58 ± 8.22, P = 0.023) and EI (29.72 ± 6.69 vs 22.66 ± 7.01, P = 0.001) between malignant lesions and normal gastric wall. However, no differences of AT, PI and EI between benign lesions and normal gastric wall tissue were found. 3D DCUS could intuitively display morphological features and vascularities of the lesions with multiplanar and volume views. 3D DCUS imaging provided comprehensive information complementary to 2D imaging. The crater or wellhead appearances and feeding vessels as well as distorted nourishing vasculature of gastric carcinoma were better seen with 3D imaging than 2D imaging. DCUS imaging can simultaneously display the anatomic and perfusion features of gastric lesions. 3D DCUS can provide additional information to 2D DCUS for evaluation of gastric lesions.

Evaluation of the chemotherapy effect in advanced gastric carcinoma using double contrast-enhanced ultrasonography

Objective To explore the clinical value of double contrast-enhanced ultrasonography (DCUS) on evaluation of the chemotherapy effect in advanced gastric carcinoma. Methods A total of 21 patients with unresectable and received chemotherapy of advanced gastric carcinoma were examined using ultrasound after taking oral contrast agent and bolus injection of Sono Vue, and findings of DCUS of each patient before and after chemotherapy were compared. Results The thickness of lesions was slightly thinner than that after chemotherapy,but there was no significant difference ( P ＞0. 05). In addition, there was no significant difference in the basal intensity (BI), peak intensity (PI), arrive time (AT) and time to peak (TTP) of gastric carcinoma tissues after chemotherapy (P ＞0.05). While the enhanced intensity (EI) value of gastric carcinoma tissues after chemotherapy was significantly less than that before chemotherapy (P ＜0.05). Conclusions The EI value in gastric carcinoma tissues may be considered as a sensitive and effective index in assessing the therapeutic effect of the chemotherapy in patients with advanced gastric carcinoma. Key words: Ultrasonography; Microbubbles; Stomach neoplasms

Application of double contrast-enhanced ultrasonography to access the lymph nodes metastasis of gastric carcinoma

Objective To investigate the clinical value of double contrast-enhanced ultrasonography (DCUS) in diagnosing lymph nodes metastasis of gastric carcinoma.Methods One hundred and sixteen patients with gastric cancer diagnosed by gastroscope and confirmed by pathology after operation were examined by DCUS preoperatively.The enhanced characteristic of gastric carcinoma tissues was assessed by autotracking contrast quantification(ACQ) software.The baseline intensity(BI), peak intensity(PI), arrival time(AT) and time to peak(TTP) of gastric cancer was measured automatically,and the enhanced intensity (EI) and wash-in time(WIT) of gastric cancer was calculated manually (EI=PI-BI; WIT=TTP-AT).All of the subjects were divided into two groups according to their lymph nodes status postoperatively:group N1,sixty-nine patients with lymph nodes metastasis; and group N0, forty-seven patients without lymph nodes metastasis.The DCUS quantitative analysis and pathological results of these two groups were compared each other.The Kappa's test was used for inter-rater reliability.Results BI of group N1 in the gastric carcinoma tissues was lower than that of group N0 significantly [(1.41 ± 1.56)dB vs (3.92 ± 2.82)dB, t = - 4.81, P = 0.000].EI of group N1 in the gastric carcinoma tissues was higher than that of group N0 significantly [(20.67±3.71)dB vs (14.12±3.75)dB, t=7.31, P=0.000].Moreover, there was a significant difference of WIT in the gastric carcinoma tissues between these two groups[(9.12±2.99)s vs (10.88±3.05)s, t =-2.43, P=0.018].The WIT in patients with lymph nodes metastasis was shorter than that without it. A cut-off value ＞17.05 dB of EI in gastric cancer tissues for assessing the lymph nodes metastasis had a sensitivity of 80.50% and specificity of 76.70% respectively obtained by the area under the ROC curve. The Kappa value of this method was 0.88.Conclusions EI of gastric cancer tissues can be considered as a new potential index to evaluate the lymph nodes metastasis of gastric cancer. Key words: Ultrasonography; Microbubbles; Stomach neoplasms; Lymphatic metastasis

Pilot study of double contrast ultrasonography for pathological typing of advanced gastric cancer

Objective To explore the value of double contrast-enhanced ultrasonography(DCUS) in the evaluation of pathological typing of advanced gastric cancer. Methods Sixty one patients who had been diagnosed as gastric cancer by gastroscope and confirmed by pathology after operation were examined using DCUS. According to pathological typing, all cases were divided into mucoid gastric cancer (26 cases) and non-mucoid gastric cancer (35 cases). A comparison with final pathologic results was made after surgery. The correlation of initial enhanced features of the lesions was compared with pathological typing of gastric cancer. Results Among 26 cases of mucoid gastric cancer,21 cases of initial enhanced region were mainly focused on serosa surface or mucosa surface, which were disconnected as line-typed, and followed by lamellar signs (at least 3 seconds duration). As for 35 cases of non-mucoid gastric cancer,30 cases were presented as diffused distribution at initial enhanced region,and were enhanced thoroughly after 3 seconds. The sensitivity and specificity of initial enhanced features in diagnosing mucoid gastric cancer was 80.8% and 88.6% respectively,and the Youden's index was 0.69. In thirty five cases of non-mucoid gastric cancer, the peak intensity(PI) and enhanced intensity(EI) in poorly differentiated and undifferentiated group was higher than that in well and moderatel differentiated group significantly(P 0.05). The PI and EI in mucoid gastric cancer was lower than that in poorly differentiated and undifferentiated group of non-mucoid gastric cancer (P<0.05). Conclusions DCUS could initial estimate the pathological typing of advanced gastric caner before operation. Key words: Ultrasonography; Microbubbles; Stomach neoplasms