| Objective:1. To analyze the change of elasticity of the traumatic lesions;2. Toevaluate the value of Ultrasound Elastography in the diagnosis of hepatic trauma;3.To assess the effects of local tissue repair in blunt hepatic trauma after haemostaticinjection under contrast enhanced ultrasound (CEUS) guidance.Materials and Methods:1. Part one:16Healthy New Zealand rabbits were used tocreated hepatic trauma lesions. Shear wave elastography was used to measure thestiffnessof normal liver and traumatic lesions at5minutes,30minutes, and60minutes after the lesions were created. The stiffness changes of the traumatic lesionswere analyzed using repeated measures analysis of variance. The stiffness of normalliver and traumatic lesions at60minutes after injury was analyzed using receiveroperating characteristic curve (ROC curves) analysis.2. Part two: Thirty-three NewZealand white rabbits were used to create hepatic trauma lesions and were treatedwith hemostatic injection at once Shear wave elastography measurement wasperformed immediately,1,2,4and8weeks later. Puncture biopsy of the treated areawas also done at the same time. Animals were sacrificed at week8for pathologicstudies. Repeated measures analysis of variance was used to analyze the changes ofstiffness.Results:1. Experiment one: the maximum stiffness of traumatic lesion5,30and60minutes after injury were （7.44±1.55）kPa、（13.96±2.84）kPa、（17.09±3.32）kParespectively, the mean stiffness were （5.43±0.83） kPa、（9.75±1.51） kPa、（12.68±1.80）kPa respectively, and the minimum stiffness were （4.10±1.02）kPa、（7.60±1.75）kPa、（9.88±2.02）kPa respectively. Repeated measures analysis ofvariance revealed significant differences among the maximum, mean and minimum stiffness in the different time points after injury.（P max=0.000, F max=108.591，P mean=0.000, F mean=199.704，P min=0.000, F min=86.928）. Generalexamination revealed eminences and hematoma in liver surface and microscopydemonstrated rupture of local liver capsule, hemorrhage, and inflammatory cellinfiltration in the traumatic lesions. The maximum stiffness of liver traumatic lesionsat60minutes after injury was （17.2±4.3）kPa, the mean stiffness was （11.06±1.33）kPa, and the minimum stiffness was（8.34±1.8）kPa, whereas the stiffness of normalliver was（10.68±1.89）kPa、（8.26±1.01）kPa、（6.51±0.77）kPa respectively（P＜0.05）. The diagnostic sensitivity was96.7%and the specificity was83.3%when12.44kPa was taken as the threshold of maximum stiffness; The diagnositicsensitivity was90%and specificity was96.7%when10.05kPa was taken as thethreshold of mean stiffness; The diagnostic sensitivity was70%and specificity was86.7%when7.23kPa was taken as the threshold of minimum stiffness.2. Experimenttwo: Thirty-one lesions of blunt liver trauma were successful established. Themaximum stiffness of traumatic lesions were (63.05±21.01) kPa,(54.29±13.18)kPa,(41.08±13.29) kPa,(32.09±9.91) kPa and (32.77±9.97) kPa immediately, oneweek later, two weeks later, four weeks later and eight weeks later respectively; Themean stiffness were (46.59±14.32) kPa,(43.31±9.31) kPa,(31.62±9.66) kPa,(25.23±7.66) kPa,(26.57±7.77) kPa respectively; and the minimum stiffness were(31.18±10.37) kPa,(28.06±11.24) kPa,(21.57±7.54) kPa,(17.51±7.42) kPa,(16.39±6.69) kPa respectively. Repeated measures analysis of variance revealedsignificant differences between maximum，mean，and minimum stiffness of traumaticlesions in different time points (P max=0.000, F max=19.568，P mean=0.000, Fmean=22.865，P min=0.000, F min=13.799). Histopathologic examinationrevealed mild congested hepatic sinusoid, and mild inflammation infiltration in andsurrounding the traumatic lesion in the first two weeks. In the fourth week to eighthweek, swallowed reaction of foreign body by macrophagocytes, bile duct reactivehyperplasia and interstitial fibrosis were found, however. Omentum adhesion andcover of the traumatic lesion, as well as superficial cicatricial tissues were observedunder general examination in the eighth week. Conclusions:1. The stiffness of liver traumatic lesions were different from normalliver tissue, which was valuable for the diagnosis of liver trauma.2. The maximum,mean and minimum stiffness of liver trauma lesions at60minutes after injury weredifferent from normal liver tissue. ROC curve analysis revealed the best sensitivityand specificity of mean stiffness for the diagnosis of liver trauma.3. Stiffness wereeffective in evaluating the prognosis of blunt hepatic trauma after haemostaticinjection treatment under CEUS guidance. This method might be a new approach forclinical prognostic assessment for non-surgical treatment of liver trauma... |
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