Clinical Hemorheology and Microcirculation - Volume 82, issue 4

Authors: Lin, Jia | Lin, Wenqiang | Xu, Liang | Lin, Teng

Article Type: Research Article

Abstract: BACKGROUND: The early detection of infected hydronephrosis is critical before lithotripsy. A feasible and noninvasive diagnostic method is of considerable clinical attention. OBJECTIVES: This retrospective study was performed to find some quantitative evaluation parameters of B-mode Gray-scale ultrasound histogram analysis that might assist the early diagnosis of infected hydronephrosis and test their diagnostic efficacy. MATERIALS AND METHODS: The ultrasound images and clinical data of 245 patients with hydronephrosis were retrospectively analyzed. Image J software was applied to obtain the gray-scale maps and the analysis results of the signal strength. The difference in the data between the …infected and non-infected groups and the diagnostic value of the parameters were calculated. RESULTS: In this retrospective study, 70 patients with infected hydronephrosis and 175 patients with non-infected hydronephrosis were enrolled. The echogenicity of internal effusion and the echogenicity ratio of infected cases were significantly higher than those of non-infected cases (p  < 0.05). The cutoff values were 23.82 (AUC = 0.859) of echogenicity of internal effusion, while 0.27 (AUC = 0.832) of echogenicity ratio. CONCLUSION: The quantitative evaluation of gray-scale ultrasound histogram is an objective and reliable method in differentiating infected from non-infected hydronephrosis. Show more

Keywords: Gray-scale, histogram, hydronephrosis, infection, ultrasound

DOI: 10.3233/CH-221414

Citation: Clinical Hemorheology and Microcirculation, vol. 82, no. 4, pp. 295-301, 2022

Authors: Huang, Xiao | Nie, Fang | Zhu, Ju | Liu, Luping | Wang, Nan

Article Type: Research Article

Abstract: BACKGROUND: Conventional ultrasound (US), which include gray scale US and Doppler US, is the first-line imaging modality for the evaluation of renal allograft; however, conventional US indicators have limitations. OBJECTIVE: To explore the application value of shear-wave elastography (SWE) combined with monochrome superb microvascular imaging (mSMI) in renal allograft chronic rejection (CR). METHODS: From November 2021 to February 2022 in the Lanzhou University Second Hospital, the US features of 54 patients with renal allograft were retrospectively analyzed. Patients were categorized into two groups: stable group(n  = 44) and CR group(n  = 10), with clinical diagnosis as reference standard. …The vascular index (VI) on mSMI and parenchymal stiffness were measured in the middle cortex of all renal allografts and receiver operating characteristic (ROC) curves were drawn to evaluate the feasibility of differentiation. Statistically significant US features and biochemical indicators such as creatinine were scored, and the results of the scores were analyzed by ROC curve. RESULTS: The VI on mSMI of the stable group (49.5±2.0) was significantly greater than that of the CR group (33.8±5.9) (P  = 0.028). There was a statistically significant difference in parenchymal stiffness between stable group (16.2kPa±1.2) and CR group (33.9kPa±6.6) (P  = 0.027). The sensitivity was 90% and specificity was 81.8% of the scores in the differentiation of stable group from CR group (cut-off value, 2; P  = 0.000). CONCLUSION: SWE combined with mSMI may help differentiate stable renal allograft from renal allograft CR and have the potential application value in the diagnosis of renal allograft CR. Show more

Keywords: Shear-wave elastography, monochrome superb microvascular imaging, ultrasound; renal allograft chronic rejection

DOI: 10.3233/CH-221443

Citation: Clinical Hemorheology and Microcirculation, vol. 82, no. 4, pp. 303-311, 2022

Authors: Passos, Andreas | Louka, Marinos | Vryonidis, Charalambos | Inglezakis, Antonis | Loizou, Constantinos | Nikiphorou, Elena | Psarelis, Savvas | Kaliviotis, Efstathios

Article Type: Research Article

Abstract: BACKGROUND: The erythrocyte sedimentation rate (ESR) test is commonly used in clinical practice for monitoring, screening and diagnosing pathological conditions and diseases related to the inflammatory response of the immune system. Several ESR techniques have been developed over the years improving the reliability, the precision and the duration of the measurement. OBJECTIVE: In the present study a new low cost micro-ESR technique is described providing the major advantage of reducing the measurement time and the blood sample volume by multiple times compared to the commercial methods. METHODS: Blood samples were obtained from healthy donors within the …age group of 24–28 years and the haematocrit was adjusted to 30%, 40% and 50%. The ESR of the samples was measured utilizing a surface tension driven (STD) microfluidic chip and a monitoring device. RESULTS: The evaluation of the method showed a high correlation (0.94, p  < 10–5 ) at all haematocrit levels with the commercial instrument indicating the feasibility of the technique. CONCLUSIONS: This micro-ESR technique provides the potential for a simple, low cost and fast tool for ESR measurement using low blood volume acquired by finger prick. Show more

Keywords: Erythrocyte sedimentation rate (ESR), micro-ESR, microfluidics, surface tension driven flow, point-of-care

DOI: 10.3233/CH-221476

Citation: Clinical Hemorheology and Microcirculation, vol. 82, no. 4, pp. 313-322, 2022

Authors: Wu, Shi-Ji | Tan, Long | Ruan, Jing-Liang | Qiu, Ya | Hao, Shao-Yun | Yang, Hai-Yun | Luo, Bao-Ming

Article Type: Research Article

Abstract: OBJECTIVES: To investigate the application value of The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) category combined with other ultrasound features of nodules in distinguishing follicular thyroid carcinoma (FTC) from thyroid follicular adenoma (FTA). METHODS: We collected and retrospectively analyzed clinical and ultrasound data for 118 and 459 patients with FTCs and FTAs, respectively, at our hospital. Next, we used ACR TI-RADS classification combined with other ultrasound features of nodules to distinguish FTC from FTA. Multivariate Logistic regression was used to screen independent risk factors for FTC, which were subsequently used to construct …a nomogram for predicting FTC. RESULTS: ACR TI-RADS categories 4 and 5, unilateral multiple nodules, and halo thickness≥2 mm were independent risk factors for FTC. ACR TI-RADS category combined with number of nodules, halo features of the nodule was a significantly better prediction model for FTC diagnosis (AUC = 0.869) than that of ACR TI-RADS classification alone (AUC = 0.756). CONCLUTIONS: Clinicians need to pay attention to the halo of nodules when distinguishing FTA from FTC. Notably, ACR TI-RADS combined with other nodule ultrasound features has superior predictive performance in diagnosis of FTC compared to ACR TI-RADS classification alone, thus can provide an important reference value for preoperative diagnosis of FTC. Show more

Keywords: ACR TI-RADS, thyroid follicular carcinoma, thyroid follicular adenoma, ultrasound

DOI: 10.3233/CH-221507

Citation: Clinical Hemorheology and Microcirculation, vol. 82, no. 4, pp. 323-334, 2022

Authors: Gawaz, Andrea | Gonser, Lena | Strölin, Anke | Kofler, Lukas | Häfner, Hans-Martin | Kofler, Katrin

Article Type: Research Article

Abstract: BACKGROUND: Although inflammation and thrombosis are tightly connected, only 45% of patients with lower leg cellulitis receive anticoagulant therapy. Available data about the prevalence of concomitant deep venous thrombosis (DVT) in patients with cellulitis of the lower extremity is scarce and general guidelines regarding diagnosis and prevention of venous thromboembolism are missing. OBJECTIVE: We sought to determine how frequently DVT occurs as an incidental finding in patients with cellulitis and to provide recommendations for diagnostics and anticoagulant therapy. METHODS: Patients’ records were analysed and 192 consecutive patients with cellulitis were included in this study. The prevalence …of concomitant DVT was examined by duplex ultrasound, as well as comorbidities and risk factors. RESULTS: We detected thrombosis in 12.0% of the patients with lower leg cellulitis, of which 43.5% were located in a proximal vein and 52.2% in the veins of the calf. CONCLUSIONS: Our results clearly indicate that cellulitis is not only a differential diagnosis, but should be considered a risk factor for venous thrombosis. Therefore, prophylactic anticoagulation should be considered in patients suffering from cellulitis and a systematic screening for venous thrombosis in patients with cellulitis should be performed. Show more

Keywords: Cellulitis, inflammation, venous thrombosis

DOI: 10.3233/CH-221519

Citation: Clinical Hemorheology and Microcirculation, vol. 82, no. 4, pp. 335-340, 2022

Authors: Tews, H.C. | Kandulski, A. | Schmid, S. | Schlosser, S. | Schirner, S. | Putz, F.J. | Cosma, L. | Gülow, K. | Müller, M. | Jung, E.M.

Article Type: Research Article

Abstract: The aim was to describe the small bowel morphology with conventional B-mode and elastography and additionally to evaluate dynamic effects of COVID-19 associated small bowel microvascularization using CEUS with color coded perfusion parameters. Thirteen patients with severe COVID-19 acute respiratory distress syndrome (ARDS) were investigated. 13 patients required intensive care treatment with mechanical ventilation. Five patients required extracorporeal membrane oxygenation (ECMO). Contrast-enhanced ultrasound (CEUS) was performed by an experienced investigator as a bolus injection of up to 2.4 ml sulfur hexafluoride microbubbles via a central venous catheter. In the parametric analysis of CEUS, the flare of microbubbles over time is …visualized with colors. This is the first work using parametric analysis of CEUS to detect perfusion differences in the small bowel. Parametric analysis of CEUS in the intestinal phase was carried out, using DICOM loops for 20 seconds. In 5 patients, parametric analysis revealed intraindividual differences in contrast agent behavior in the small bowel region. Analogous to the computed tomography (CT) images parametric analysis showed regions of simultaneous hyper- and hypoperfusion of the small intestine in a subgroup of patients. In 5 patients, the parametric image of transmural global contrast enhancement was visualized. Our results using CEUS to investigate small bowel affection in COVID-19 suggest that in severe COVID-19 ARDS systemic inflammation and concomitant micro embolisms may lead to disruption of the epithelial barrier of the small intestine. This is the first study using parametric analysis of CEUS to evaluate the extent of small bowel involvement in severe COVID-19 disease and to detect microemboli. In summary, we show that in COVID-19 the small bowel may also be an important interaction site. This is in line with the fact that enterocytes have been shown to a plenitude of angiotensin converting enzyme (ACE)-2 receptors as entry sites of the virus. Show more

Keywords: Contrast enhanced ultrasound (CEUS), parametric imaging, COVID-19, small bowel

DOI: 10.3233/CH-221540

Citation: Clinical Hemorheology and Microcirculation, vol. 82, no. 4, pp. 341-360, 2022

Authors: Liu, Zhining | Li, Chen

Article Type: Research Article

Abstract: OBJECTIVE: This study aims to investigate the relationship of cervical lymph node metastasis (LNM) with contrast-enhanced ultrasound (CEUS) features, microvessel density (MVD) and microvessel area (MVA) in patients with papillary thyroid carcinoma (PTC), and to evaluate the diagnostic value of CEUS for PTC. METHODS: A total of 108 patients diagnosed with PTC at the First Affiliated Hospital of Jinzhou Medical University from January 2016 to December 2018 were selected and underwent preoperative CEUS of the thyroid, surgical resection and postoperative histopathological examination of their resected lesion. They were divided into a lymphatic metastasis-positive group (LNM+, n  = 61) and …a lymphatic metastasis-negative group (LNM–, n  = 47) based on their lymph node status. The CEUS quantitative parameters, MVD and MVA, were compared between the two groups, and risk factors for LNM were analyzed by univariate and multivariate logistic regression. RESULTS: Compared with patients with in the LNM–group, the tumor diameter and the proportion of capsule contact of patients in the LNM+group were significantly greater and the patients in this group were younger. The rise time (RT), peak intensity (PI), area under the curve (AUC), MVD, and MVA were also significantly higher in the LNM+group than in the LMN–group, while there was no significant difference in time to peak (TP), mean transit time (mTT), velocity of intensity increase (IIV), and velocity of intensity decrease (IDV) between the two groups. Univariate and multivariate correlation analysis indicated that tumor size, RT, PI, AUC, MVD, and MVA were risk factors for LNM, and ROC curves further suggested that RT had the best overall predictive performance. CONCLUSION: Tumor size, RT, PI, AUC, MVD and MVA are risk factors for LNM in PTC. In other words, CEUS is an important non-invasive and preoperative tool for evaluating PTC, with MVD and MVA identified as vital postoperative diagnostic indicators. Show more

Keywords: Contrast-enhanced ultrasound (CEUS), Papillary thyroid carcinoma (PTC), Microvessel density (MVD), Microvessel area (MVA), Lymph node metastasis

DOI: 10.3233/CH-221545

Citation: Clinical Hemorheology and Microcirculation, vol. 82, no. 4, pp. 361-370, 2022

Authors: Rasyid, Al | Riyanto, Dinda Larastika | Harris, Salim | Kurniawan, Mohammad | Mesiano, Taufik | Hidayat, Rakhmad | Wiyarta, Elvan

Article Type: Research Article

Abstract: INTRODUCTION: The second wave of COVID-19 in Indonesia occurred due to delta variant transmission with up to 2266 cases. This variant could cause higher rate of morbidities and mortalities. This study reported coagulation profile of COVID-19 patients with acute stroke and its association with patients’ outcome. METHOD: This is a cohort-retrospective study conducted during the second wave of COVID-19, June-August 2021 in Cipto Mangunkusumo General Hospital. Inclusion criteria were adult patients with confirmed COVID-19 and diagnosed with acute stroke confirmed by radiological evidences. Exclusion criteria were COVID-19 patients with prior diagnosis of acute stroke. Coagulation factors were analyzed …and presented with tables and graphs. RESULTS: A total of 33 patients included in this study with majority experienced ischemic stroke (84.8%), followed by ischemic with haemorrhagic transformation (9.1%), and the rest with haemorrhagic stroke. The median of fibrinogen and D-dimer was 487.1(147–8,943)mg/dL and 2,110(250–35,200)ug/L respectively. Prothrombin time (PT) ratio was 0.95(0.82–1.3) and activated partial thromboplastin time (APTT) ratio was 1.01(0.64–2.72). On observation, 33.3% died during hospitalization, D-dimer value in these patients was significantly higher with 9,940ug/L compared to those who survived with 1,160ug/L(p  = 0.009). The highest D-dimer value during hospitalization was also significantly higher with the median of 14,395ug/L compared to 3,740 ug/L (p  = 0.014). DISCUSSION: D-dimer value on initial assessment and its highest value during hospitalization were significantly higher in patient with poor outcome, showing that D-dimer can be one predictor of mortality in COVID-19 patients with acute stroke Show more

Keywords: COVID-19, acute stroke, delta variant, coagulation factors, D-dimer

DOI: 10.3233/CH-221546

Citation: Clinical Hemorheology and Microcirculation, vol. 82, no. 4, pp. 371-377, 2022

Authors: Koutsiaris, Aristotle G. | Riri, Konstantina | Boutlas, Stylianos | Panagiotou, Thomas N. | Kotoula, Maria | Daniil, Zoe | Tsironi, Evangelia E.

Article Type: Research Article

Abstract: BACKGROUND & OBJECTIVE: To quantify the hemodynamic and thrombotic effect of COVID-19 on the eye microcirculation of patients with thromboprophylaxis, shortly after hospital discharge. METHODS: This case-control study included 17 COVID-19 survivors (named “COVID-19 Group”) and 17 healthy volunteers (named “Control Group”). Axial blood velocity (Vax) and percentage of occluded vessels (POV) were quantified by Conjunctival Video Capillaroscopy (CVC). Microvessels were identified and classified as “capillaries” (CAP), “postcapillary venules of size 1” (PC1), and “postcapillary venules of size 2” (PC2). RESULTS: The COVID-19 Group did not differ significantly in basic demographics from the Control Group. In …the COVID-19 Group, there was a statistically significant (p  < 0.001) reduction of Vax (39%, 49% and 47%, for CAP, PC1, and PC2, respectively) in comparison to the Control Group and a sizeable (p  < 0.001) increase of POV (600%) in comparison to the Control Group. CONCLUSIONS: COVID-19 not only reduces significantly axial blood velocity in the capillaries and postcapillary venules of the eye but has also a devastating effect on microthrombosis (POV) despite thromboprophylaxis treatment. This gives a possible explanation for long COVID and a hint about the existence of a possibly unknown coagulation factor. Show more

Keywords: COVID-19, eye, thromboprophylaxis, microcirculation, blood velocity, occluded microvessels, microthrombosis, conjunctival video capillaroscopy

DOI: 10.3233/CH-221554

Citation: Clinical Hemorheology and Microcirculation, vol. 82, no. 4, pp. 379-390, 2022

Authors: Tang, Cong-yu | Guan, Pei-shan | You, Qi-qin | Yuan, Hai-xia | Wang, Wen-ping

Article Type: Research Article

Abstract: Encapsulated papillary carcinoma is a rare malignant breast tumor with low malignancy, and is most commonly found in postmenopausal women. On ultrasound, encapsulated papillary carcinoma has an envelope, and anechoic areas inside the lesion. Contrast-enhanced ultrasound shows marked enhancement without size expand, and ultrasonic elastography suggests soft parenchyma in the lesion. However, it is often challenging to differentiate between encapsulated papillary carcinoma and other breast tumors, especially some benign lesions. Here, we reported a case of encapsulated papillary carcinoma in a 65-year-old female patient who discovered a breast mass three years ago and presented with nipple discharge and pain six …months before. This case report demonstrated the ability of multimodal ultrasound to diagnose encapsulated papillary carcinoma. Show more

Keywords: Encapsulated papillary carcinoma, ultrasound, breast cancer

DOI: 10.3233/CH-221558

Citation: Clinical Hemorheology and Microcirculation, vol. 82, no. 4, pp. 391-396, 2022