ObjectiveTo explore the diagnostic value of sonography in thyroid imaging reporting and data system (TI-RADS) for thyroid nodules. MethodsA total of 292 patients (423 nodules) underwent thyroid examination with high frequency ultrasound. The results were retrospectively compared with histopathological diagnosis and TI-RADS lexicon. ResultsThe category 1-5 of 423 thyroid nodules were evaluated by using TI-RADS, and it’s frequency of being malignancy rate was 0(0/129), 6.3%(11/176), 33.3%(10/30), 86.8%(46/53), and 100% (35/35), respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for benign thyroid nodule of ultrasound in TI-RADS was 96.3%（309/321）, 83.3%（85/102）, 93.1%（394/423）, 94.8%（309/326）, and 87.6%（85/97）, respectively. Positive likelihood ratio, negative likelihood ratio, and Youden’ index was 5.77, 0.04, and 79.6%, respectively. The benign and malignancy nodule of TI-RADS category were statistically difference in shape, margin, echogenicity, echotexture, composition, and calcification inside the nodule (Plt;0.001). ConclusionsTI-RADS lexicon has an important guiding value for clinical diagnosis and treatment in ultrasound examination of thyroid nodule.
【摘要】 目的 评价彩色多普勒超声对肾动脉狭窄（ARAS）的诊断指标及准确性。 方法 1999年10月-2008年12月对患有高血压病的58例共113根肾动脉进行彩色多普勒超声检查。每例患者均测量肾动脉峰值流速（PSV）与肾内段动脉的阻力指数及肾脏长轴。在双盲条件下，以患者肾动脉造影、MRI血管造影及CT血管造影为标准，评价彩色多普勒超声诊断ARAS的诊断指标及准确性。 结果 彩色多普勒超声诊断肾动脉狭窄的敏感性为60%，特异性为83%，阳性预测值为83%，阴性预测值为61%。患侧肾长轴小于健侧肾长轴，患侧肾峰值流速高于健侧肾峰值流速，患侧肾阻力指数低于健侧肾阻力指数。 结论 肾动脉彩色多普勒超声对于肾动脉狭窄初筛诊断以及评价肾动脉狭窄介入治疗后的近、远期疗效，是一种简便可靠的无创检查手段。【Abstract】 Objective To evaluate the accuracy and index of color Doppler ultrasonography (CDU) diagnosing renal artery stenosis (RAS).〖WTHZ〗Methods〖WTBZ〗A total of 113 renal arteries of 58 patients with hypertension from October 1999 to December 2008 were examined by CDU. The peak systolic velocity (PSV) of the renal artery, resistant index of interior artery of kidney,and long axis of kidney of each patient were obtained. Under the double-blind condition, accuracy and diagnostic index of CDU for diagnosing RAS were evaluated according to the standard of renal arteriography, magnetic resonance angiography or computerized tomography angiography. Results The sensitivity of CDU for diagnosing RAS was 60%, specificity was 83%, positive predictive value was 83%, and negative predictive value was 61%. Long axis of kidney in patients with RAS was shorter than that in the healthy ones. The PSV in patients with RAS was higher than that in the healthy ones, and the resistant index of section artery of kidney in patients with RAS was lower than that in the healthy ones. Conclusion CDU is an easy and reliable non-invasive examination for early diagnosis and screening of RAS and for evaluating a short-or long-term therapeutic effect.
Objective To investigate the influence of preoperative assessment by transrectal ultrasound (TRUS) on the development of operative procedures for rectal cancer. Methods A total of 110 patients with pathologically proven rectal cancer and distance between tumor to dentate line ≤10 cm were enrolled and randomized into group A (n=55) and group B (n=55) according to a computer-generated random sequence. Both TRUS staging and Clinical Staging System (CS staging) were performed preoperatively in group A, while only CS staging was conducted in group B. Preoperative TRUS stage, CS stage, and proposed operative procedures were recorded to compare with the postoperative pathological stage and practical operative procedures. Results A total of 99 patients were assessed. They were randomized into group A (n=49) and B (n=50), and there were no significant differences in baseline characteristics between the two groups. The difference in staging accuracy was statistically significant (P=0.000) between group A (91.8%) and group B (48.0%). Statistically significant improvement (P=0.013) in the accuracy of proposing operative procedures for rectal cancer was observed in group A (93.9%) compared with group B (76.0%). Conclusion TRUS is evidently superior to CS staging in preoperative assessment for rectal cancer, and may remarkably enhance the accuracy of proposing operative procedures. Therefore, TRUS is valuable in preoperative assessment which may help to guide the selection of operative procedures for rectal cancer surgery.
Objective To investigate the effectiveness of high frequency color Doppler ultrasound for detecting perforators in the anterolateral thigh (ALT) flap surgery. Methods Between February 2011 and July 2012, 8 patients underwent high frequency color Doppler ultrasound to detect the perforator anatomy before ALT flap surgery. There were 5 males and 3 females, aged 21-46 years (mean, 34 years). Defects were caused by excision of squamous cell carcinoma in 2 cases, by scalp avulsion in 2 cases, by soft tissue necrosis after neck trauma in 1 case, by excision of groin fibrosarcoma in 1 case, by excision of groin melanoma in 1 case, and by malformation of the face in 1 case. The defect size varied from 12 cm × 7 cm to 22 cm × 18 cm. The perforator with wider caliber, faster flow speed, and shorter intramuscular trajectory was selected, and the flap was designed according to the observed results, which size varied from 14 cm × 9 cm to 25 cm × 20 cm. The donnor sites were repaired by free skin graft. Results Totally, 19 perforators in the flap area were detected by high frequency color Doppler ultrasound, and 18 were identified during operation, with an accuracy rate of 94.7%. The point going out muscle, the travel and direction of perforators observed during operation were basically in accordance with those detected by high frequency color Doppler ultrasound. The other flaps survived, and obtained healing by first intention except 1 flap which had partial fat necrosis with healing by second intention. The skin graft at donor site survived. All patients followed up 4-16 months (mean, 8 months). The flaps had good color and texture. Conclusion High frequency color Doppler ultrasound is a valuable imaging modality for the preoperative assessment of the vascular supply for ALT flap.
Objective To determine the influence of combinative assessment of transrectal ultrasound (TRUS) and serum amyloid A protein (SAA) on the assessment of preoperative staging selection of operative procedures in the middle and lower rectal cancer. Methods Prospectively enrolled 130 patients, who diagnosed definitely as middle and lower rectal cancer at West China Hospital of Sichuan University from June 2008 to February 2009 were randomly assigned into two groups with 65 participants, respectively. In one group named TRUS combined SAA group, both TRUS and SAA combinative assessment were made for the preoperative evaluation. In another group named TRUS group, only the preoperative TRUS was made. The preoperative staging and predicted operative procedures were compared with postoperative pathologic staging and practical operation program, respectively.Results Of 118 patients with rectal cancer were actually included into TRUS combined SAA group (n=59) and TRUS group (n=59). The baselines of characteristics of two groups were basically identical. For TRUS combined SAA group， the accuracies of preoperative T and N staging were 79.7% (47/59) and 77.8% (42/54) respectively; For TRUS group the corresponding rates were 86.4% (51/59) and 57.7% (30/52), respectively. There was no statistically significant difference of the accuracy of preoperative T staging （P=0.609） while preoperative N staging had statistical difference (P=0.027) between two groups. There was a statistically significant difference of the accuracy of prediction to operative procedures in two groups 〔96.6% (57/59) vs. 83.1% (49/59), P=0.015〕. The preoperative T staging was related to the selection of operative procedures (P=0.037) when analyzing the relationship between the operative procedures and the multiple clinicopathological factors in middle and lower rectal cancer. ConclusionCombinative assessment of TRUS and SAA could improve the accuracy of preoperative staging in middle and lower rectal cancer, thus provide higher predictive coincidence rate to operative procedures for surgeon.
Objective To determine the role of multimodal preoperative evaluation (MPE) system of transrectal ultrasound (TRUS), 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) in assessment of preoperative staging and selection of operative procedures of the lower and middle rectal cancer in multi-disciplinary team. Methods Prospectively enrolled 150 patients, who were diagnosed definitely as lower and middle rectal cancer (distance of tumor to the dentate line ≤10 cm) at West China Hospital of Sichuan University from November 2008 to March 2009, randomly assigned into two groups. In one group named MPE group, MPE consisting of TRUS, MSCT and SAA were made for the preoperative evaluation. In another group named MSCT+SAA group, both MSCT and SAA were made preoperatively. Then, the preoperative staging and predicted operative procedures were compared with postoperative pathologic staging and practical operative procedures, respectively. Furthermore, the pooled data were analyzed for the correlative relationship between the choice of surgery strategy and clinicopathological factors. Results According to the criteria, 146 patients with lower and middle rectal cancer were randomly assigned into MPE group (n=74) and MSCT+SAA group (n=72). The baselines characteristics of two groups were statistically identical. For MPE group the accuracy of preoperative staging T, N, M and TNM were 94.6% (70/74), 85.1% (63/74), 100% （74/74） and 82.4% (61/74), respectively; For MSCT+SAA group the corresponding rates were 77.8% (56/72), 84.7% (61/72), 100% （72/72） and 81.9% (59/72), respectively. The analysis showed a statistically difference in the accuracy of preoperative T staging between two groups (P=0.003) while there was no statistically significant difference of the accuracies of preoperative N, M and TNM staging between two groups (Pgt;0.05). There wasn’t a statistically significant increasing of the accuracy of prediction to operative procedures in MPE group compared with MSCT+SAA group 〔95.9% (71/74) vs.88.9% (64/72), P=0.106〕. When analyzing the relationship between multiple clinicopathologic factors and the operative procedures of lower and middle rectal cancer, there were statistical correlations between the pathological T staging (r=0.216， P=0.009), N staging (r=0.264， P=0.001), TNM staging (r=0.281， P=0.001), serum level of SAA before operation (r=0.252， P=0.002) or the distance of tumor to the dentate line (r=－0.261， P=0.001) and the operative procedures. Conclusion MPE system could display the accurate preoperative staging for lower and middle rectal cancer, on which the prediction of operative procedures can rest convincingly.
Objective To determine the role of multi-slice spiral computed tomography (MSCT) compared with transrectal ultrasound (TRUS) in preoperative staging of rectal cancer. Methods Patients with rectal cancer from January to May 2009 in Department of Anal-Colorectal Surgery of West China Hospital were enrolled. All patients were preoperatively examined by both MSCT and TRUS for T and N staging, which were compared with postoperative pathological findings. Results The study population consisted of 81 patients. Regarding depth of tumor invasion, the accuracy of TRUS (88.89%) was not significantly higher than that of MSCT (77.78%), P=0.168. Regarding lymph node metastasis, the result of MSCT was more accurate than that of TRUS (66.67% vs. 48.15%, P=0.034). Conclusions Although TRUS remains the advantages in evaluating local invasion, the gap between MSCT and TRUS are significantly diminished. MSCT is superior to TRUS in evaluation of lymph node metastasis, however, further improvement on the diagnostic accuracies would be warranted in both modalities.