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Multiparametric ultrasound for the assessment of testicular lesions with negative tumoral markers

Asian Journal of Andrology 2023年第1期25卷 50-57页

作者： hui Liu Lin Dong Li-Hua Xiang Guang xu Jing Wan Yan Fang Shi-Si Ding Ye Jin Li-Ping Sun hui-xiong xu Department of Medical Ultrasound Center of Minimally Invasive Treatment for TumorShanghai Tenth People's HospitalSchool of MedicineTongji UniversityShanghai 200072China Ultrasound Research and Education Institute Clinical Research Center for Interventional MedicineSchool of MedicineTongji UniversityShanghai 200072China Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment Shanghai 200072China National Clinical Research Center for Interventional Medicine Shanghai 200072China Department of Ultrasound Zhongshan HospitalFudan UniversityInstitute of Ultrasound in Medicine and EngineeringShanghai 200032China

The purpose of this study was to evaluate the diagnostic performance of multiparametric ultrasound(mpUS;grayscale US,color Doppler US,strain elastography,and contrast-enhanced US)in the assessment of testicular lesions with negative tumoral markers.MpUS imaging data,patient age,serum tumor markers,scrotal pain,cryptorchidism,and related clinical information were retrospectively collected for patients who underwent mpUS examination between January 2013 and December 2019.Histologic results or follow-up examinations were used as the reference standard.In total,83 lesions from 79 patients were included in the analysis.Fifty-six patients were finally diagnosed with benign tumors,and 23 patients were ultimately diagnosed with malignant tumors.Chi-square tests or Fisher's exact tests were used to assess the difference between the two groups.Stepwise multivariate logistic regression analysis showed that lesion diameter(odds ratio[OR]=1.072,P=0.005),vascularization on color Doppler US(OR=4.066,P=0.001),and hyperenhancement during the early phase(OR=6.465,P=0.047)were significant independent risk factors for malignancy;however,when compared with neoplastic lesions,pain(OR=0.136,P<0.001),absence of vascularization on color Doppler US(OR=1.680,P=0.042),and nonenhancement during the late phase(OR=3.461,P=0.031)were strongly associated with nonneoplastic lesions.MpUS features are useful for differentiating testicular lesions with negative tumoral markers and improving the preoperative diagnosis,which may avoid inappropriate radical orchiectomy.

关键词： diagnosis histology testicular diseases ultrasound

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Transrectal ultrasound examination of prostate cancer guided by fusion imaging of multiparametric MRI and TRUS:avoiding unnecessary mpMRI-guided targeted biopsy

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Asian Journal of Andrology 2023年第3期25卷 410-415页

作者： Guang xu Jun-Heng Li Li-Hua Xiang Bin Yang Yun-Chao Chen Yi-Kang Sun Bing-hui Zhao Jian Wu Li-Ping Sun hui-xiong xu Department of Medical Ultrasound Center of Minimally Invasive Treatment for TumorShanghai Tenth People’s HospitalUltrasound Research and Education InstituteClinical Research Center for Interventional MedicineSchool of MedicineTongji UniversityShanghai 200072China Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment Shanghai 200072China Department of Radiology Shanghai Tenth People’s HospitalSchool of MedicineTongji UniversityShanghai 200072China Department of Urology Shanghai Tenth People’s HospitalSchool of MedicineTongji UniversityShanghai 200072China Department of Medical Ultrasound Xiang’an Hospital of Xiamen UniversityXiamen 361101China Department of Ultrasound Zhongshan HospitalInstitute of Ultrasound in Medicine and EngineeringFudan UniversityShanghai 200032China

The purpose of this study was to explore transrectal ultrasound(TRUS)findings of prostate cancer(PCa)guided by multiparametric magnetic resonance imaging(mpMRI)and to improve the Prostate Imaging Reporting and Data System(PI-RADS)system for avoiding unnecessary mpMRI-guided targeted biopsy(TB).From January 2018 to October 2019,fusion mpMRI and TRUS-guided biopsies were performed in 162 consecutive patients.The study included 188 suspicious lesions on mpMRI in 156 patients,all of whom underwent mpMRI-TRUS fusion imaging-guided TB and 12-core transperineal systematic biopsy(SB).Univariate analyses were performed to investigate the relationship between TRUS features and PCa.Then,logistic regression analysis with generalized estimating equations was performed to determine the independent predictors of PCa and obtain the fitted probability of PCa.The detection rates of PCa based on TB alone,SB alone,and combined SB and TB were 55.9%(105 of 188),52.6%(82 of 156),and 62.8%(98 of 156),respectively.The significant predictors of PCa on TRUS were hypoechogenicity(odds ratio[OR]:9.595,P=0.002),taller-than-wide shape(OR:3.539,P=0.022),asymmetric vascular structures(OR:3.728,P=0.031),close proximity to capsule(OR:3.473,P=0.040),and irregular margins(OR:3.843,P=0.041).We propose subgrouping PI-RADS score 3 into categories 3a,3b,3c,and 3d based on different numbers of TRUS predictors,as the creation of PI-RADS 3a(no suspicious ultrasound features)could avoid 16.7%of mpMRI-guided TBs.Risk stratification of PCa with mpMRI-TRUS fusion imaging-directed ultrasound features could avoid unnecessary mpMRI-TBs.

关键词： fusion biopsy multiparametric MRI prostate cancer transrectal ultrasound

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Added value of shear-wave elastography in the prediction of extracapsular extension and seminal vesicle invasion before radical prostatectomy

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Asian Journal of Andrology 2023年第2期25卷 259-264页

作者： Yi-Kang Sun Yang Yu Guang xu Jian Wu Yun-Yun Liu Shuai Wang Lin Dong Li-Hua Xiang hui-xiong xu Department of Medical Ultrasound Center of Minimally Invasive Treatment for TumorShanghai Tenth People’s HospitalUltrasound Research and Education InstituteClinical Research Center for Interventional MedicineSchool of MedicineTongji UniversityShanghai 200072China Department of Ultrasound Zhongshan HospitalInstitute of Ultrasound in Medicine and EngineeringFudan UniversityShanghai 200032China Department of Urology Shanghai Tenth People’s HospitalSchool of MedicineTongji UniversityShanghai 200072China

The purpose of this study was to analyze the value of transrectal shear-wave elastography(SWE)in combination with multivariable tools for predicting adverse pathological features before radical prostatectomy(RP).Preoperative clinicopathological variables,multiparametric magnetic resonance imaging(mp-MRI)manifestations,and the maximum elastic value of the prostate(Emax)on SWE were retrospectively collected.The accuracy of SWE for predicting adverse pathological features was evaluated based on postoperative pathology,and parameters with statistical significance were selected.The diagnostic performance of various models,including preoperative clinicopathological variables(model 1),preoperative clinicopathological variables+mp-MRI(model 2),and preoperative clinicopathological variables+mp-MRI+SWE(model 3),was evaluated with area under the receiver operator characteristic curve(AUC)analysis.Emax was significantly higher in prostate cancer with extracapsular extension(ECE)or seminal vesicle invasion(SVI)with both P<0.001.The optimal cutoff Emax values for ECE and SVI were 60.45 kPa and 81.55 kPa,respectively.Inclusion of mp-MRI and SWE improved discrimination by clinical models for ECE(model 2 vs model 1,P=0.031;model 3 vs model 1,P=0.002;model 3 vs model 2,P=0.018)and SVI(model 2 vs model 1,P=0.147;model 3 vs model 1,P=0.037;model 3 vs model 2,P=0.134).SWE is valuable for identifying patients at high risk of adverse pathology.

关键词： extracapsular extension prostate cancer seminal vesicle invasion shear-wave elastography transrectal ultrasound

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Uterine artery embolization combined with percutaneous microwave ablation for the treatment of prolapsed uterine submucosal leiomyoma:A case report

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World Journal of Clinical Cases 2023年第13期11卷 3052-3061页

作者： hui-Li Zhang Song-Yuan Yu Chuan-Wu Cao Jing-E Zhu Jia-Xin Li Li-Ping Sun hui-xiong xu Department of Medical Ultrasound Center of Minimally Invasive Treatment for TumorShanghai Tenth People’s HospitalShanghai 200072China Department of Interventional and Vascular Surgery Shanghai Tenth People’s HospitalShanghai 200072China Department of Ultrasound Zhongshan HospitalShanghai 200032China

BACKGROUND Vaginal myomectomy is the most common form of radical treatment for prolapsed submucosal leiomyoma and is typically performed under general anesthesia.However,an alternative treatment approach is needed for patients who cannot tolerate general anesthesia.We describe a case with such a patient who was successfully treated via a minimally invasive method under local anesthesia.CASE SUMMARY A 46-year-old female suffered from abnormal uterine bleeding,severe anemia,and a reduced quality of life attributed to a massive prolapsed submucosal leiomyoma.She could not tolerate general anesthesia due to a congenital thoracic malformation and cardiopulmonary insufficiency.A new individualized combined treatment,consisting uterine artery embolization(UAE),percutaneous microwave ablation(PMWA)of the pedicle and the endometrium,and transvaginal removal of the leiomyoma by twisting,was performed.The lesion was completely removed successfully under local anesthesia without any major complications.The postoperative follow-up showed complete symptom relief and a significant improvement in the quality of life.CONCLUSION UAE combined with PMWA can be performed under local anesthesia and is a promising alternative treatment for patients who cannot tolerate general anesthesia.

关键词： Submucous leiomyoma Percutaneous microwave ablation Uterine artery embolism Transvaginal myomectomy Case report

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Hepatocellular carcinoma after ablation:The imaging follow-up scheme

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World Journal of Gastroenterology 2013年第6期19卷 797-801页

作者： Lin-Na Liu hui-xiong xu Yi-Feng Zhang Jun-Mei xu Department of Medical Ultrasound Shanghai Tenth People's Hospital Tenth People's Hospital of Tongji University

Percutaneous ablation using thermal or chemical methods has been widely used in the treatment of hepatocellular carcinoma (HCC).Nowadays,contrast-enhanced imaging modalities such as computed tomography (CT),magnetic resonance imaging (MRI),and contrast-enhanced ultrasound (CEUS) are widely used to evaluate local treatment response after ablation therapies.CEUS is gaining increasing attention due to its characteristics including real-time scanning,easy performance,lack of radiation,wide availability,and lack of allergy reactions.Several studies have documented that CEUS is comparable to CT or MRI in evaluating local treatment efficacy within 1 mo of treatment.However,little information is available regarding the role of CEUS in the followup assessment after first successful ablation treatment.Zheng et al found that in comparison with contrastenhanced computed tomography (CECT),the sensitivity,specificity,positive predictive value,negative predictive value and overall accuracy of CEUS in detecting local tumor progression (LTP) were 67.5%,97.4%,81.8%,94.4% and 92.3%,respectively,and were 77.7%,92.0%,92.4%,76.7% and 84.0%,respectively for the detection of new intrahepatic recurrence.They concluded that the sensitivity of CEUS in detecting LTP and new intrahepatic recurrence after ablation is relatively low in comparison with CECT,and CEUS cannot replace CECT in the follow-up assessment after percutaneous ablation for HCC.These results are meaningful and instructive,and indicated that in the follow-up period,the use of CEUS alone is not sufficient.In this commentary,we discuss the discordance between CT and CEUS,as well as the underlying mechanisms involved.We propose the combined use of CT and CEUS which will reduce false positive and negative results in both modalities.We also discuss future issues,such as an evidence-based ideal imaging follow-up scheme,and a cost-effectiveness analysis of this imaging follow-up scheme.

关键词： Hepatocellular carcinoma Radiofrequency ablation Ethanol ablation Contrast-enhanced ultrasound Follow-up Treatment response Computed tomography

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Liver fibrosis index-based nomograms for identifying esophageal varices in patients with chronic hepatitis B related cirrhosis

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World Journal of Gastroenterology 2020年第45期26卷 7204-7221页

作者： Shi-Hao xu Fang Wu Le-Hang Guo Wei-Bing Zhang hui-xiong xu Department of Medical Ultrasound Shanghai Tenth People’s Hospital of Nanjing Medical UniversityShanghai 200072China Department of Ultrasonography The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325000Zhejiang ProvinceChina Department of Gastroenterology The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325000Zhejiang ProvinceChina

BACKGROUND Esophageal varices(EV)are the most fatal complication of chronic hepatitis B(CHB)related cirrhosis.The prognosis is poor,especially after the first upper gastrointestinal hemorrhage.AIM To construct nomograms to predict the risk and severity of EV in patients with CHB related cirrhosis.METHODS Between 2016 and 2018,the patients with CHB related cirrhosis were recruited and divided into a training or validation cohort at The First Affiliated Hospital of Wenzhou Medical University.Clinical and ultrasonic parameters that were closely related to EV risk and severity were screened out by univariate and multivariate logistic regression analyses,and integrated into two nomograms,respectively.Both nomograms were internally and externally validated by calibration,concordance index(C-index),receiver operating characteristic curve,and decision curve analyses(DCA).RESULTS A total of 307 patients with CHB related cirrhosis were recruited.The independent risk factors for EV included Child-Pugh class[odds ratio(OR)=7.705,95%confidence interval(CI)=2.169-27.370,P=0.002],platelet count(OR=0.992,95%CI=0.984-1.000,P=0.044),splenic portal index(SPI)(OR=3.895,95%CI=1.630-9.308,P=0.002),and liver fibrosis index(LFI)(OR=3.603,95%CI=1.336-9.719,P=0.011);those of EV severity included Child-Pugh class(OR=5.436,95%CI=2.112-13.990,P<0.001),mean portal vein velocity(OR=1.479,95%CI=1.043-2.098,P=0.028),portal vein diameter(OR=1.397,95%CI=1.021-1.912,P=0.037),SPI(OR=1.463,95%CI=1.030-2.079,P=0.034),and LFI(OR=3.089,95%CI=1.442-6.617,P=0.004).Two nomograms(predicting EV risk and severity,respectively)were well-calibrated and had a favorable discriminative ability,with C-indexes of 0.916 and 0.846 in the training cohort,respectively,higher than those of other predictive indexes,like LFI(C-indexes=0.781 and 0.738),SPI(C-indexes=0.805 and 0.714),ratio of platelet count to spleen diameter(PSR)(C-indexes=0.822 and 0.726),King’s score(C-indexes=0.694 and 0.609),and Lok index(C-indexes=0.788 and 0.700).The areas under the curves(AUCs)of the

关键词： Real-time tissue elastography Chronic hepatitis B Cirrhosis Esophageal varices Nomogram Decision curve analysis

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Percutaneous ultrasound-guided thermal ablation for liver tumor with artificial pleural effusion or ascites

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Chinese Journal of Cancer 2010年第9期29卷 830-835页

作者： Lin-Na Liu hui-xiong xu Ming-De LU Xiao-Yan Xie Department of Medical Ultrasonics the First Affiliated Hospital Sun Yat-sen University Guangzhou Gongdong 510080 P. R. China Department of HepatobUiary Surgery the First Affiliated Hospital Sun Yat-sen University Guangzhou Gongdong 510080 P. R. China

Background and Objective:Percutaneous ultrasound-guided thermal ablation is one of the major treatment methods for liver cancer.Tumor location close to the diaphragm or gastrointestinal tract was regarded as the treatment contraindication before due to poor visibility of the tumor or increased risk of thermal injury to the adjacent organs.This study used artificial pleural effusion or ascites to extend the indications of thermal ablation for liver cancer.Methods:Artificial pleural effusion (20 cases) or ascites (36 cases) was performed in 56 difficult cases of percutaneous thermal ablation for liver tumors.The technical success rates, the rate of approaching the procedure goal, complications, and local treatment response were assessed.Results:The technical success rates were 95%(19/20) for artificial pleural effusion and 100% (36/36) for artificial ascites, the achieve purpose rates were 100%(19/19) and 91.7% (33/36), the complete ablation rates were 84.2% (16/19) and 93.9% (31/33), respectively.Coughing, transient hematuria, and subcutaneous effusion were observed in 3 patients after the procedure of artificial pleural effusion, and hydrothorax in the right chest occurred in 1 patient during the artificial ascites process.Conclusions:Thermal ablation with the use of artificial pleural effusion or ascites is a safe and effective treatment for liver tumors, and the technique can widen the indications of thermal ablation for liver tumors.

关键词：肝肿瘤人工腹水胸水引导超声局部治疗胸腔积液

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Thermal ablation and immunotherapy for hepatocellular carcinoma:Recent advances and future directions

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World Journal of Gastrointestinal Oncology 2021年第10期13卷 1397-1411页

作者： Xiao-Wan Bo Li-Ping Sun Song-Yuan Yu hui-xiong xu Center of Minimally Invasive Treatment for Tumor Department of Medical UltrasoundShanghai Tenth People’s HospitalUltrasound Research and Education InstituteClinical Research Center for Interventional MedicineSchool of MedicineTongji UniversityShanghai 200072China Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment National Clinical Research Center for Interventional MedicineShanghai 200072China

Hepatocellular carcinoma(HCC)is one of most common cancers that cause death in the world.Thermal ablation(TA)is an important alternative treatment method for HCC patients who are not appropriate for surgery or liver transplantation.Particularly for small and early HCCs,TA can be considered as the first-line curative treatment.However,local and distant recurrence rates are still high even though the TA equipment and technology develop rapidly.Immunotherapy is a novel systemic treatment method to enhance the anti-tumor immune response of HCC patients,which has the potential to reduce the tumor recurrence and metastasis.The combination of local TA and systemic immunotherapy for HCCs may be an ideal treatment for enhancing the efficacy of TA and controlling the recurrence.Herein we summarize the latest progress in TA,immunotherapy,and their combination for the treatment of patients with HCC and discuss the limitations and future research directions of the combined therapy.

关键词： Hepatocellular carcinoma Thermal ablation Radiofrequency ablation Immunotherapy Recurrence Anti-tumor immune response

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Contrast-enhanced ultrasound in the biliary system:Potential uses and indications

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World Journal of Radiology 2009年第1期1卷 37-44页

作者： hui-xiong xu Department of Medical Ultrasonics The First Affiliated HospitalSun Yat-Sen UniversityThe Center of Guangdong Province for the Study of Diagnostic Ultrasound and Interventional Therapy58 Zhongshan Road 2Guangzhou 510080Guangdong ProvinceChina

Conventional ultrasound(US)is the first-line imaging investigation for biliary diseases.However,it is lack of the ability to depict the microcirculation of some lesions which may lead to failure in diagnosis for some biliary diseases.The use of contrast-enhanced US(CEUS)has reached the field of bile duct disease in recent years and promising results have been achieved.In this review,the methodology,image interpretation,enhancement pattern,clinical usefulness,and indications for CEUS in the biliary system are summarized.CEUS may be indicated in the biliary system under the following circumstances:(1)Where there is a need to make a characterization of intrahepatic cholangiocarcinoma(ICC);(2)For differentiation diagnosis between ICC and other tumors(i.***.hepatocellular carcinoma or liver metastasis)or infectious diseases;(3)For differentiation diagnosis between biliary cystadenoma and biliary cystadenocarcinoma;(4)To detect malignant change in Caroli’s disease;(5)To depict the extent of Klatskin’s tumor with greater clarity;(6)To make a distinction between gallbladder cholesterol polyp,adenoma and polypoid cancer;(7)To make a distinction between chronic cholecystitis with thickened wall and gallbladder cancer;(8)For differentiation diagnosis between motionless sludge and gallbladder cancer;(9)For differentiation diagnosis between common bile duct cancer and sludge or stone without acoustic shadowing;and(10)In patients who are suspected of having a drop of their percutaneous transhepatic cholangiodrainage tube,US contrast agent can be administered to through the tube detect the site of the tube.

关键词： Contrast-enhanced ultrasound Bile duct Gallbladder Cholangiocarcinoma Polypoid lesion Ultrasound contrast agent

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Contrast-enhanced ultrasound:The evolving applications

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World Journal of Radiology 2009年第1期1卷 15-24页

Contrast-enhanced ultrasound(CEUS)is a major breakthrough for ultrasound imaging in recent years.By using a microbubble contrast agent and contrast-specific imaging software,CEUS is able to depict the microand macro-circulation of the targeted organ,which in turn leads to improved performance in diagnosis.Due to the special dual blood supply system in the liver,CEUS is particularly suitable for liver imaging.It is evident that CEUS facilitates improvement for characterization of focal liver lesions(FLLs),detection of liver malignancy,guidance for interventional procedures,and evaluation of treatment response after local therapies.CEUS has been demonstrated to be equal to contrast-enhanced computed tomography or magnetic resonance imaging for the characterization of FLLs.In addition,the applicability of CEUS has expanded to non-liver structures such as gallbladder,bile duct,pancreas,kidney,spleen,breast,thyroid,and prostate.The usefulness of CEUS in these applications is confirmed by extensive literature production.Novel applications include detecting bleeding sites and hematomas in patients with abdominal trauma,guiding percutaneous injection therapy and therefore achieving the goal of using interventional ultrasonography in managing splenic trauma,assessing the activity of Crohn’s disease,and detecting suspected endoleaks after endovascular abdominal aneurysm repair.Contrast-enhanced intraoperative ultrasound(US)and intracavitary use of CEUS have been developed and clinically studied.The potential use of CEUS involves sentinel lymph node detection,drug or gene delivery,and molecular imaging.In conclusion,the advent of CEUS has greatly enhanced the usefulness of US and even changed the status of US in clinical practice.The application of CEUS in the clinic is continuously evolving and it is expected that its use will be expanded further in the future.

关键词： Bile duct Breast Gallbladder Pancreas Kidney Liver Contrast-enhanced ultrasound Prostate Spleen Thyroid

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