| Objective: To evaluate the imaging of self-made gastrointestinal ultrasound contrast agent,to explore the clinical value of combined with intravenous contrast enhanced ultrasound in diagnosis and T staging of gastric cancer. Methods:(1)Preparation of ultrasound contrast agents and evaluation of ultrasound imaging. ①The Chinese yam power, black sesame paste, commercially available as raw material. Each food powder was selected into different combinations according to the suitable dose, which then were dissoloved in 500 ml of boiling water, and were mixed well, cooled to 30-40℃. First of all, the normal people carried out oral administration. When the stomach cavity was filled with food contrast agents, its performance were observed by color Doppler ultrasonography. According to the echo intensity and the evenness of the food contrast agents, the clarity of the shown gastric wall structure, emptying time as well as price, a comprehensive evaluation was determined and the optimal combination was chosen. ②The images of the contrast zone of the optimal combination substitute and the “Tian Xia†brand gastrointestinal contrast agent were analysed and compared by the ultrasonic histogram respectively by using Two independent samples T-test.(2)Between Jan 2012 and Dec 2014, 151 patients with gastric cancer proved by operation and pathology were enrolled in this study,different degrees of abdominaldiscomfort, pain, anorexia, weight loss, anemia and other symptoms were observed. Examination was performed using oral self made gastrointestinal ultrasound contrast agent alone or combined with intravenous contrast agent. Position, size, extent of the lesion and infiltration depth based on hierarchy and perfusion of the stomach wall were recorded if tumor or ulcer suspected malignant by using self made gastrointestinal ultrasound contrast agent. Results of diagnosis and T staging of gastric cancer were made, and compared with postoperative pathologic findings, Rates were compared by chi-square. Results:(1)The combination of the “Nan Fang†brand black sesame paste 40 grams and yam paste 20 grams were chosen as the optimal combination ultimately. When the “Nan Fang†brand black sesame paste combination agents were used.(2)The effect of imaging evaluation: the ultrasonic contrast zone image histogram peak position was 20.4±2.3db, width was 10.3±1.8db(two indicators were compared with the control group, had no significant difference, P>0.05), the gastric wall structure was shown clear, emptying time were more than 1 hour. For ultrasonic diagnosis of different diseases, the contrast effect of the “Nan Fang†brand black sesame paste was closed to the “Tian Xia†brand contrast agent.(3)The results of oral self made gastrointestinal ultrasound contrast agent : In 151 cases of the patients, 101 cases of gastric cancer were detected by using simple oral self made gastrointestinal ultrasound contrast agent, The accuracy rate was 66.89%, stomach ulcer and tumor or irregular thickening of the gastric wall, destroy of the hierarchy were detected.(4)128cases of gastric cancer were detected by using double contrast gastrointestinal ultrasonography, The accuracy rate was 84.77%. It was found that lesions enhanced more rapidly than the surrounding normal tissues on arterial phase, and fade more quickly on the venous phase.(5)Among 151 gastric cancer, the number of clinical stage T1, T2, T3+T4 were 45 cases, 65 cases, 41 cases respectively. The accuracy number was 24 cases, 46 cases, 31 cases respectively in self made oral gastrointestinal ultrasound contrast agent group, the total accuracy rate was 66.89%( T1 53.33%,T2 70.77%,T3+T4 75.61%), ultrasound features of each T staging of gastric cancer by using self made oral gastrointestinal ultrasound contrast agent: T1 staging lesions invading the mucosa or submucosa; T2 staging invading the muscular; T3 staging lesions invading the serous, but did not penetrate; T4 staging lesions penetrate serous and invasion of adjacent organs. The accuracy number was 33 cases, 56 cases, 39 cases respectively in double contrast gastrointestinal ultrasound group, the total accuracy rate was 84.77%( T1 73.33%,T2 86.15%,T3+T4 95.12%). Ultrasound features of each T staging of gastric cancer by using double contrast gastrointestinal ultrasound: T1 staging contrast enhanced ultrasound in mucosa or submucosa fading fast in venous phase, T2 staging mucosa, submucosa, muscular layer enhancing on arterial phase and fading on venous phase, T3 staging mucosa, submucosa, muscular and serous layer enhancing rapidily on artery phase, T4 staging the gastric wall and adjacent organs enhancing on arterial phase and fading on venous phase. There was statistically significantdifferences between both group on diagnosis of preoperative T staging of gastric cancer(p<0.05).Conclusion:(1).The “Nan Fang†brand black sesame paste combination agents could serve as substitute of gastrointestinal contrast agent and could satisfy the need of diagnosis.(2).Simple oral self-made ultrasound contrast agent and double contrast gastrointestinal ultrasound for the diagnosis of gastric cancer, simple operation, deserve the clinical expansion.(3).Irregular thickening of the stomach wall, ulcers and tumor formation enhancing rapidly on arterial phase and in fading rapidly on vein phase under intravenous contrast ultrasound can be used as the diagnostic criteria of gastric cancer; The scope of invasion under the intravenous ultrasound contrast can be used as ultrasound indicators of T staging of gastric cancer.(4).For clinical T staging of gastric cancer, the accuracy rate of double contrast gastrointestinal ultrasound group was higher than that pure oral self made gastrointestinal ultrasound contrast agent group in T1, T2, T3, T4 staging.(5)double contrast gastrointestinal ultrasound is a useful method in patients with gastric cancer on pre-operation assessment, treatment options and the prognosis. |
