• Contrast-enhanced ultrasound
• Diagnosis
• Hepatocellular carcinoma
• Prognosis
• Staging
• Surveillance
• Ultrasonography

• Children
• Complications
• Contrast-enhanced ultrasound
• Intracavitary
• Intravenous
• Kidney
• Liver
• Transplant
• Ultrasound
• Ultrasound contrast agents

Angiopoietin like protein 4 (ANGPTL4) is a secreted glycoprotein of the angiopoietin like protein family. Upregulation of ANGPTL4 expression can promote tumor angiogenesis. Contrast-enhanced ultrasound (CEUS) can objectively reflect tumor microcirculation perfusion and provide the hemodynamic information.

To investigate the correlation between ANGPTL4 expression and the perfusion parameters of CEUS in hepatocellular carcinoma (HCC).

Eighty-four HCC patients (84 tumors) who underwent surgical resection at Zhejiang Xiaoshan Hospital were selected as study subjects. According to the ANGPTL4 expression status, the patients were divided into either an ANGPTL4 positive expression group (48 cases) or an ANGPTL4 negative expression group (36 cases). All patients underwent CEUS within 3 d before operation. The perfusion parameters were analyzed, including enhancement intensity (EI) and peak to time (TTP). Serum vascular endothelial growth factor (VEGF), ANGPTL4 expression, and microvessel density (MVD) were measured. The correlation between the perfusion parameters of CEUS and the ANGPTL4 expression was analyzed.

The EI in the ANGPTL4 positive expression group was significantly higher than that in the ANGPTL4 negative expression group (P < 0.05). The TTP in the ANGPTL4 positive expression group was significantly shorter than that in the ANGPTL4 negative expression group (P < 0.05). The MVD and VEGF in the ANGPTL4 positive expression group were significantly higher than those in the ANGPTL4 negative expression group (P < 0.05) There was a positive correlation between EI and ANGPTL4 expression in HCC (r = 0.753, P < 0.05), and a negative correlation between TTP and ANGPTL4 expression (r = -0.730, P < 0.05).

There is a certain correlation between the perfusion parameters of CEUS and ANGPTL4 expression in HCC. Thus, the perfusion parameters of CEUS can reflect the ANGPTL4 expression level in HCC in vivo and indirectly evaluate its angiogenesis.

• Hepatocellular carcinoma
• Contrast-enhanced ultrasound
• Time-intensity curve
• Angiopoietin like protein 4
• Microvessel density

• Gallbladder
• contrast enhanced ultrasound (CEUS)
• differential diagnosis
• focal wall thickening
• linear transducer

• Adult
• Aged
• Cell Differentiation
• Contrast Media/therapeutic use
• Female
• Gallbladder/diagnostic imaging
• Gallbladder/pathology
• Gallbladder Neoplasms/diagnostic imaging
• Gallbladder Neoplasms/pathology
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Transducers
• Ultrasonography/methods
• Young Adult

• Contrast media
• Contrast-enhanced ultrasound
• Diagnostic performance
• Hepatic artery occlusion
• Liver transplantation
• Ultrasonography

Focal nodular hyperplasia (FNH) has very low potential risk, and a tendency to spontaneously resolve. Hepatocellular adenoma (HCA) has a certain malignant tendency, and its prognosis is significantly different from FNH. Accurate identification of HCA and FNH is critical for clinical treatment.

To analyze the value of multi-parameter ultrasound index based on logistic regression for the differential diagnosis of HCA and FNH.

Thirty-one patients with HCA were included in the HCA group. Fifty patients with FNH were included in the FNH group. The clinical data were collected and recorded in the two groups. Conventional ultrasound, shear wave elastography, and contrast-enhanced ultrasound were performed, and the lesion location, lesion echo, Young’s modulus (YM) value, YM ratio, and changes of time intense curve (TIC) were recorded. Multivariate logistic regression analysis was used to screen the indicators that can be used for the differential diagnosis of HCA and FNH. A ROC curve was established for the potential indicators to analyze the accuracy of the differential diagnosis of HCA and FNH. The value of the combined indicators for distinguishing HCA and FNH were explored.

Multivariate logistic regression analysis showed that lesion echo (P = 0.000), YM value (P = 0.000) and TIC decreasing slope (P = 0.000) were the potential indicators identifying HCA and FNH. In the ROC curve analysis, the accuracy of the YM value distinguishing HCA and FNH was the highest (AUC = 0.891), which was significantly higher than the AUC of the lesion echo and the TIC decreasing slope (P < 0.05). The accuracy of the combined diagnosis was the highest (AUC = 0.938), which was significantly higher than the AUC of the indicators diagnosing HCA individually (P < 0.05). This sensitivity was 91.23%, and the specificity was 83.33%.

The combination of lesion echo, YM value and TIC decreasing slope can accurately differentiate between HCA and FNH.

• Hepatocellular adenoma
• Focal nodular hyperplasia
• Ultrasound
• Logistic regression

Hepatic artery embolism is a serious vascular complication after liver transplantation. If not detected and handled promptly, it will lead to insufficient perfusion of liver parenchyma, ischemia of the biliary tract, failure of liver transplantation, and even death. Contrast-enhanced ultrasound (CEUS) can effectively display the perfusion status of micro-vessels and accurately evaluate whether the micro-vessels are patent or not.

To evaluate the clinical value of digital subtraction angiography (DSA) and CEUS in evaluating early hepatic artery thrombosis (HAT) after liver transplantation.

Twenty-one patients who were suspected of having HAT after liver transplantation were selected as study subjects. CEUS was performed to observe whether there was HAT after liver transplantation and the whole hepatic perfusion. The result of DSA was used as the "gold standard" for comparative analysis.

DSA showed that 16 patients developed HAT. CEUS showed that hepatic arteries were not displayed in the arterial phase, hepatic arteries were unobstructed in five patients, and hepatic arteries were clearly displayed in the arterial phase. The sensitivity, specificity, and accuracy of CEUS in evaluating early HAT after liver transplantation were all 100%.

CEUS can effectively monitor hepatic artery blood flow and hepatic perfusion after liver transplantation, thus providing a reliable imaging method for early detection of HAT.

• Contrast-enhanced ultrasound
• Liver transplantation
• Hepatic artery thrombosis

• Focal nodular hyperplasia
• Hemangioma
• Liver cysts
• Ultrasonography
• Washout

Primary hepatocellular carcinoma (HCC) has a high incidence and mortality in China, posing a serious threat to people's health. HCC is a blood-rich malignant liver neoplasm, and its development, progression, invasion, and metastasis have obvious vascular dependence. Pathological examination is the golden standard for evaluating the microangiogenesis of HCC, but it is traumatic. Contrast-enhanced ultrasound can dynamically monitor the blood perfusion process of tumor tissue in real time and thus assess the microangiogenesis in tumor tissue. It is of great significance to evaluate the microangiogenesis of HCC by contrast-enhanced ultrasound for evaluation of its clinical treatment.

To analyze the blood perfusion status of HCC by contrast-enhanced ultrasound, and evaluate its correlation with microvessel density.

Sixty-eight patients with HCC (68 lesions) who underwent surgical resection and were confirmed by pathology at Zhejiang Tumor Hospital were selected as subjects. All patients underwent contrast-enhanced ultrasound before operation. The peak intensity and the area under the curve were measured by the time-intensity curve, and the correlations between peak intensity, the area under the curve, and microvessel density were analyzed.

The peak intensity and the area under the curve were significantly higher in HCC than in tumor adjacent tissues (P < 0.05). The microvessel density of HCC was significantly higher than that of adjacent tissues (P < 0.05). The peak intensity and the area under the curve were positively correlated with microvessel density in HCC (r = 0.840, P < 0.05; r = 0.781, P < 0.05).

Contrast-enhanced ultrasound can quantitatively evaluate the blood perfusion of HCC. The correlation between the parameters of blood perfusion and microvessel density is good. Contrast-enhanced ultrasound can provide valuable information for non-invasive assessment of angiogenesis of HCC.

• Hepatocellular carcinoma
• Ultrasound
• Microbubble contrast agent
• Blood perfusion
• Pathology

Ultrasonography is a generally accepted imaging technique for diagnosing and monitoring cystic renal lesions. The widely used Bosniak classification (I-IV) categorizes renal cystic lesions into five distinctive groups according to ultrasonography and computed tomography (CT) image criteria. For solid renal lesions, determination of vascularity is discriminatory for malignancy in most instances. In indeterminate cases, contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging/CT-ultrasound image fusion are able to detect and characterize difficult pathologies, with superior performance to either technique alone. In contrast to multislice CT (MS-CT), ultrasound image fusion is a real-time imaging technique that can be used in combination with other cross-sectional imaging modalities. This technical note describes state-of-the-art image fusion of CEUS and MS-CT to detect and characterize unclear renal pathologies.

• Bosniak classification
• Contrast enhanced ultrasound
• Cystic renal masses
• Image fusion
• Multislice-CT

The need for extended liver resection is increasing due to the growing incidence of liver tumors in aging societies. Individualized surgical planning is the key for identifying the optimal resection strategy and to minimize the risk of postoperative liver failure and tumor recurrence. Current computational tools provide virtual planning of liver resection by taking into account the spatial relationship between the tumor and the hepatic vascular trees, as well as the size of the future liver remnant. However, size and function of the liver are not necessarily equivalent. Hence, determining the future liver volume might misestimate the future liver function, especially in cases of hepatic comorbidities such as hepatic steatosis. A systems medicine approach could be applied, including biological, medical, and surgical aspects, by integrating all available anatomical and functional information of the individual patient. Such an approach holds promise for better prediction of postoperative liver function and hence improved risk assessment. This review provides an overview of mathematical models related to the liver and its function and explores their potential relevance for computational liver surgery. We first summarize key facts of hepatic anatomy, physiology, and pathology relevant for hepatic surgery, followed by a description of the computational tools currently used in liver surgical planning. Then we present selected state-of-the-art computational liver models potentially useful to support liver surgery. Finally, we discuss the main challenges that will need to be addressed when developing advanced computational planning tools in the context of liver surgery.

• Liver resection
• function prediction
• liver metabolism
• liver regeneration
• liver surgical planning
• multi-scale modeling
• risk assessment
• systems medicine