Study Of Liver Lesions Caused By Obstructive Jaundice Based On Real-time Ultrasound Elastography

Object: Obstructive jaundice,as a common clinical,multiple disease,is a serious threat to human health.Real-time ultrasound elastography is one of the new technologies of ultrasound imaging.In recent years,this technology has been widely used for the thoracic and abdominal diseases examination and diagnosis.At present,the technology used in liver disease and other important organ disease diagnosis and treatment is a frontal project.In this study,quantitative analysis of real-time ultrasound elastic imaging technique was used in obstructive jaundice patients and rat model.The aim of this study was to explore the quantitative value of real-time ultrasound elasticity imaging for the obstructive jaundice liver changes by using diffusion tensor quantitative analysis.Methods: Fundamental animal research: Thirty adult male SD rats with specific pathogen free,2.5~3.0 months of age and body weight of 280~330g were selected(By the Mudanjiang Medical College Medical Research Center specific pathogen free SPF class animal room,license number: SYXK(hei)2015-007).They were divided randomly into group A(test group)and group B(control group).Group A rats underwent surgery to establish obstructive jaundice model,group B rats use same surgical procedures as Group A which simply exposed bile duct which not be ligated.Ultrasound diagnostic diffusion tensor imaging software was used to analyze the liver Ultrasound elasticity before and after the model was set up and 2 weeks after when obstruction was removed,and the diffusion tensor quantitative elastic images were analyzed.The percentage of blue areas(%AREA)and strain mean(MEAN)within the region of interest(ROI)of the rat liver were measured and recorded.The changes of %AREA and MEAN in the two groups were compared.Clinical studies: from June 2015 to October 2016 in Mudanjiang Medical College Red Flag Hospital and Affiliated Second Hospital,43 patients with obstructive jaundice were collected.According to the total bilirubin level in the clinical laboratory,43 patients with malignant obstructive jaundice were divided into mild jaundice group(20 cases),moderate jaundice group(12 cases)and severe jaundice group(11 cases).All cases were treated with PTCD external shunt,PTCD internal and external shunt or ERCP internal and external shunt surgery to remove obstructive jaundice.At the same period,31 normal adults were choose,as the control group.The real-time ultrasound elasticity image was analyzed by the tissue dispersion quantitative analysis software of HI VISION Ascendus color ultrasonic diagnostic apparatus.The preoperative and postoperative mean value of strain(MEAN)and percentage of blue field(%AREA)were measured and recorded in all patients with ROI.MEAN and %AREA were compared between the groups.Results: Fundamental animal research: There was no significant difference in %AREA and MEAN between the two groups(P> 0.05)at preoperative and 2 weeks after obstruction relieving.At 2 weeks after modeling,the AREA and MEAN of group A were compared with group B,the difference was statistically significant(P<0.05).At group A,the AREA and MEAN values at 2 weeks after modeling were compared with those at preoperative and 2 weeks after obstruction relieving,the difference was statistically significant(P<0.05).Clinical study results: The mean MEAN and %AREA values of 43 patients with obstructive jaundice were compared with the control group,the differences were statistically significant(P<0.05).Among them,there was no significant difference in the %AREA(P>0.05),between the severe jaundice group and the moderate jaundice group,the mild jaundice group and the non-jaundice group.The difference between the other groups was statistically significant(P<0.05).The Spearman rank correlation analysis of Spss19.0 shows that the obstructive jaundice patients with MEAN values were negatively correlated with the degree of jaundice and %AREA was positively correlated with the degree of jaundice at preoperative.38 patients with obstructive jaundice were treated by three surgical procedures to remove obstructive jaundice,the mean MEAN of 11 patients with mild jaundice was significantly higher than that before operation(P<0.05).There was no significant difference between the two groups(P>0.05),the mean MEAN and %AREA values of other cases were significantly improved,the difference was statistically significant(P<0.05).After three surgical procedures for obstructive jaundice,there was no significant difference in mean MEAN and %AREA after operation(P> 0.05).Conclusions: The quantitative analysis of RTE can reflect liver changes caused by obstructive jaundice.After treatment of obstructive jaundice,MEAN and %AREA in liver ROI could be significantly changed.MEAN and %AREA are closely related to the degree of obstructive jaundice and can be used as a quantitative index for the assessment of obstructive jaundice.