Ultrasound

The Department of Medical Ultrasound of the Fourth Hospital of Harbin Medical University was established in 2004. It is a national key clinical discipline designated by the National Health Commission; a medical-imaging research center and key discipline of Heilongjiang Province; a specialist-physician training base of the Ministry of Health; a national ultrasound training center; a national standardized residency-training base; a Chinese Precision Health Communication Base; a national precision-health communication base for promoting cardiopulmonary resuscitation in hundreds of millions of households; and a Heilongjiang science-popularization education base. It has advanced instruments with elastography, four-dimensional imaging, contrast-enhanced imaging and other functions. It offers internationally leading gastrointestinal ultrasound, transesophageal ultrasound, contrast-enhanced ultrasound, fetal systematic screening and ultrasound-guided interventions. It has developed multiple ultrasound-guided minimally invasive treatments and won more than 20 first- and second-prize Heilongjiang medical new-technology awards, including triple-drug-embedding treatment for ectopic pregnancy and cesarean-scar pregnancy, radiofrequency ablation of uterine fibroids, and biopsy and sclerotherapy of tiny thyroid nodules. It undertakes nearly 20 research projects, including National Natural Science Foundation and provincial key natural-science projects. Department physicians provide public health education year-round. A medical-science platform for the public and physicians disseminates medical knowledge and new technologies (search WeChat for “Heilongjiang Medical Association Science Popularization Branch” and tap “Follow”).

Teaching: The department teaches theoretical and practical courses to Harbin Medical University undergraduates, postgraduates and residents in standardized training, visiting physicians, junior-college students and evening-university imaging undergraduates, and accepts primary-level ultrasound physicians free of charge year-round. It emphasizes talent development and organizes lectures, difficult-case discussions, image review and literature reading for staff, postgraduates, residents and visiting physicians. Its trained postgraduates and visiting physicians have become departmental leaders locally. For many years it has helped compile national textbooks for undergraduates, postgraduates, residents, pharmacy and clinical medicine; hosts national and provincial continuing-education programs annually; provides lectures and training in operation of large national instruments, family-planning systems, new ultrasound technologies and nationwide birth-defect intervention; and organizes assistance teams and free-clinic groups to counties and townships to lecture to and train primary-level physicians.

Applications:

Ultrasound new technology I—Contrast-enhanced ultrasound Contrast-enhanced ultrasound is performed after injection of an ultrasound contrast agent through the cubital vein. It resembles contrast CT but offers real-time dynamic imaging, no radiation and repeatability. Enhanced contrast helps distinguish tumors from non-tumors and benign from malignant lesions, and assess the efficacy of interventional treatment. Indications: 1. Differentiate benign and malignant lesions of parenchymal organs; 2. Assess treatment response, such as after intervention for liver cancer or uterine fibroids; 3. 4D hysterosalpingographic contrast examination can noninvasively assess tubal patency.

Ultrasound new technology II—Gastrointestinal ultrasound The gastrointestinal tract is a gas-containing “管道,” so conventional ultrasound cannot accurately show its lesions. After drinking a “gastrointestinal display agent” to fill the stomach, ultrasound shows lesions much more clearly. The agent contains coix seed, Chinese yam, dried tangerine peel and other Chinese medicines; it is nutritious, palatable and without toxic or adverse effects. The examination clearly displays lesions in the stomach, gastric wall and adjacent organs; detects early gastric cancer and gastric ulcer; observes gastric motility, pyloric reflux and enlarged surrounding lymph nodes; and evaluates infiltration and surrounding metastasis. Indication: suitable for health examinations at any age; if a noninvasive examination finds a lesion, invasive gastroscopy can then be performed.

Ultrasound new technology III—Ultrasound elastography Every organ, lesion and tumor has a different hardness, whether benign or malignant. Benign tumors are generally softer and malignant tumors harder. Elastography uses the difference in hardness between a tumor or other lesion and normal surrounding tissue: after applying pressure, differences in strain are color-coded to determine tissue elasticity and infer severity or benign/malignant tendency. Advantage: under direct ultrasound visualization, the required tissue or lesion can be located precisely, avoiding the limitations of clinical palpation. Indications: 1. Differentiate benign and malignant tumors of the thyroid, breast, prostate, liver and other parenchymal organs; 2. Assess hepatic fibrosis and cirrhosis; simultaneous ultrasound and elastography can reduce cost.

Ultrasound new technology IV—Fetal systematic and cardiac screening Fetal systematic screening is a head-to-toe series of ultrasound examinations to detect lethal structural malformations and others seriously affecting postnatal quality of life. Fetal cardiac screening is a dedicated ultrasound examination to detect severe congenital heart disease. Four-dimensional ultrasound is not equivalent to fetal systematic screening: four-dimensional ultrasound is an examination instrument, whereas systematic screening refers to examination content; detecting fetal malformations belongs to fetal screening, not to the four-dimensional instrument. Three important screening periods: 1. Nuchal translucency (NT): 11–13+6 gestational weeks; 2. Fetal systematic and cardiac screening: 20–24 weeks; 3. Fetal supplementary screening: 28–34 weeks.

Ultrasound new technology V—Transesophageal echocardiography A mini ultrasound probe is inserted into the esophagus to examine the heart from behind at close range. This avoids interference from ribs, chest wall, fat and pulmonary gas, producing clearer, higher-quality images and greater sensitivity and reliability for cardiovascular diagnosis. Indications: 1. Difficult transthoracic imaging, such as obesity, emphysema, thoracic deformity, or recent surgery/trauma; 2. Areas difficult to visualize conventionally, such as the left atrial appendage, superior vena cava, pulmonary veins and descending thoracic aorta; 3. Diagnosis of difficult conditions, including aortic lesions, prosthetic-valve dysfunction, intracardiac thrombus, tumors or foreign bodies, atrial-septal lesions, infective endocarditis, vegetations and valve perforation.

Ultrasound new technology VI—Ultrasound-guided interventional treatment This minimally invasive treatment involves no radiation, incision or puncture; fine-needle puncture is safe and causes little trauma or pain. For patients who do not need surgery, cannot undergo surgery, have poor postoperative results or complications, it is a valuable option. As a branch of modern ultrasound medicine, ultrasound intervention developed to meet clinical diagnostic and therapeutic needs. Under real-time ultrasound monitoring or guidance, biopsy, aspiration, catheterization and drug injection can be performed, avoiding some surgery while achieving comparable results. Indications: 1. Thoracic disease: diagnostic thoracentesis and catheter drainage; biopsy of chest-wall tumors; 2. Abdominal disease: interventional treatment of hepatic cysts/abscesses, renal cysts, abdominal abscesses and loculated ascites; diagnostic paracentesis and catheter drainage; biopsies of hepatic, renal and abdominal tumors and diffuse hepatic/renal lesions; 3. Gynecologic and obstetric disease: ovarian and chocolate cysts, hydrosalpinx, loculated pelvic fluid, pelvic abscess, unruptured ectopic, scar and cornual pregnancy; 4D hysterosalpingography; biopsy of ovarian/pelvic tumors; radiofrequency ablation of uterine fibroids; 4. Other: fine-needle biopsy of thyroid nodules, lymph-node biopsy and intervention for perianal abscess.

Ultrasound new technology VII—Ultrasound-guided 4D hysterosalpingography The department’s four-dimensional tubal contrast ultrasound displays in real time the entire passage of contrast through the uterine cavity and fallopian tubes. The agent “illuminates” the tubes; four-dimensional imaging observes them through 360°, clearly showing their course, patency and obstruction. This enables comprehensive assessment and more accurate diagnosis. Immediate treatment is also possible: pressurized drug injection can reopen the tubes, while local targeted anti-inflammatory medication treats tubal and surrounding pelvic inflammation, reducing recurrent obstruction or poor patency. Advantages over previous methods: 1. Accurate, radiation-free, inexpensive and highly repeatable; 2. Extremely low adverse-reaction rate, with no skin-sensitivity test required; 3. Immediate treatment after obstruction is diagnosed; 4. No toxicity or radiation, and pregnancy is possible in the same month—no need to wait three months!

Ultrasound new technology VIII—Ultrasound-guided minimally invasive treatment of uterine fibroids A radiofrequency needle is inserted through the natural vaginal route into the uterine cavity. Under real-time ultrasound monitoring it is placed in the fibroid according to the planned layout; radiofrequency heating causes local necrosis, which the body gradually encapsulates and absorbs, curing the fibroid without affecting uterine or ovarian structure and function. Advantages: 1. Minimally invasive, with no incision; 2. Precise and visible, with real-time ultrasound monitoring; 3. Safe and reliable, with negligible risk to normal tissue; 4. Short treatment, about 10 minutes to half an hour, usually without hospitalization; 5. Inexpensive and repeatable for recurrent or multiple fibroids. Indications: 1. Submucosal uterine fibroids; 2. Intramural fibroids, single or multiple, ideally 3–5 cm in diameter.