1
|
Zhang HP, Liang RX, Lin XY, Xue ES, Ye Q, Zhu YF. Application of contrast-enhanced ultrasound in diagnosis and grading of bladder urothelial carcinoma. BMC Med Imaging 2024; 24:26. [PMID: 38273224 PMCID: PMC10809509 DOI: 10.1186/s12880-024-01199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024] Open
Abstract
PURPOSE To explore the application of contrast-enhanced ultrasound (CEUS) for the diagnosis and grading of bladder urothelial carcinoma (BUC). METHODS The results of a two-dimensional ultrasound, color Doppler ultrasound and CEUS, were analyzed in 173 bladder lesion cases. The ultrasound and surgical pathology results were compared, and their diagnostic efficacy was analyzed. RESULTS There were statistically significant differences between BUC and benign lesions in terms of color blood flow distribution intensity and CEUS enhancement intensity (both P < 0.05). The area under the time-intensity curve (AUC), rising slope, and peak intensity of BUC were significantly higher than those of benign lesions (all P < 0.05). The H/T (height H / basal width T)value of 0.63 was the critical value for distinguishing high- and low-grade BUC, had a diagnostic sensitivity of 80.0% and a specificity of 60.0%. CONCLUSION The combination of CEUS and TIC can help improve the diagnostic accuracy of BUC. There is a statistically significant difference between high- and low-grade BUC in contrast enhancement intensity (P < 0.05); The decrease of H/T value indicates the possible increase of the BUC grade.
Collapse
Affiliation(s)
- Hui-Ping Zhang
- Department of Ultrasound, Fujian Medical University Union Hospital, Antai Street & Xin Quan Road 29, Fuzhou, Fujian Province, China
| | - Rong-Xi Liang
- Department of Ultrasound, Fujian Medical University Union Hospital, Antai Street & Xin Quan Road 29, Fuzhou, Fujian Province, China
| | - Xue-Ying Lin
- Department of Ultrasound, Fujian Medical University Union Hospital, Antai Street & Xin Quan Road 29, Fuzhou, Fujian Province, China
| | - En-Sheng Xue
- Department of Ultrasound, Fujian Medical University Union Hospital, Antai Street & Xin Quan Road 29, Fuzhou, Fujian Province, China
| | - Qin Ye
- Department of Ultrasound, Fujian Medical University Union Hospital, Antai Street & Xin Quan Road 29, Fuzhou, Fujian Province, China.
| | - Yi-Fan Zhu
- Department of Ultrasound, Fujian Medical University Union Hospital, Antai Street & Xin Quan Road 29, Fuzhou, Fujian Province, China
| |
Collapse
|
2
|
Cannella R, Pilato G, Mazzola M, Bartolotta TV. New microvascular ultrasound techniques: abdominal applications. LA RADIOLOGIA MEDICA 2023; 128:1023-1034. [PMID: 37495910 PMCID: PMC10473992 DOI: 10.1007/s11547-023-01679-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023]
Abstract
Microvascular ultrasound (MVUS) is a new ultrasound technique that allows the detection of slow-velocity flow, providing the visualization of the blood flow in small vessels without the need of intravenous contrast agent administration. This technology has been integrated in the most recent ultrasound equipment and applied for the assessment of vascularization. Compared to conventional color Doppler and power Doppler imaging, MVUS provides higher capability to detect intralesional flow. A growing number of studies explored the potential applications in hepatobiliary, genitourinary, and vascular pathologies. Different flow patterns can be observed in hepatic and renal focal lesions providing information on tumor vascularity and improving the differential diagnosis. This article aims to provide a detailed review on the current evidences and applications of MVUS in abdominal imaging.
Collapse
Affiliation(s)
- Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
| | - Giulia Pilato
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Mariasole Mazzola
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Tommaso Vincenzo Bartolotta
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| |
Collapse
|
3
|
Zhong C, Chen J, Ling Y, Liu D, Xu J, Wang L, Ge C, Jiang Q. Indocyanine Green-Loaded Nanobubbles Targeting Carbonic Anhydrase IX for Multimodal Imaging of Renal Cell Carcinoma. Int J Nanomedicine 2023; 18:2757-2776. [PMID: 37250472 PMCID: PMC10224680 DOI: 10.2147/ijn.s408977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023] Open
Abstract
Background and Purpose The early diagnosis and differential diagnosis of renal cell carcinoma (RCC) has always been a clinical difficulty and a research focus. Carbonic anhydrase IX (CA IX) is highly expressed on the cell membrane of RCC but is not expressed in normal renal tissues. In this study, nanobubbles (NBs) targeting CA IX with ultrasound and photoacoustic multimodal imaging capabilities were prepared to explore a new method for the diagnosis and differential diagnosis of RCC. Methods Indocyanine green (ICG)-loaded lipid NBs (ICG-NBs) were prepared by using the filming rehydration method, and anti-CA IX polypeptides (ACPs) were attached to their surfaces to prepare CA IX-targeted NBs (ACP/ICG-NBs). The particle size, zeta potential and ICG encapsulation efficiency of these nanobubbles were measured, and their specific targeting and binding abilities to RCC cells were determined. The in vitro and in vivo ultrasound, photoacoustic and fluorescence imaging characteristics of these nanobubbles were also assessed. Results The particle size of the ACP/ICG-NBs was 475.9 nm in diameter, and their zeta potential was -2.65 mV. Laser confocal microscopy and flow cytometry both confirmed that ACP/ICG-NBs had specific binding activity and ideal affinity to CA IX-positive RCC cells (786-O) but not to CA IX-negative RCC cells (ACHN). The intensities of the in vitro ultrasound, photoacoustic and fluorescence imaging were positively correlated with the concentrations of ACP/ICG-NBs. In in vivo ultrasound and photoacoustic imaging experiments, ACP/ICG-NBs exhibited specific enhanced ultrasound and photoacoustic imaging effects in 786-O xenograft tumors. Conclusion The ICG- and ACP-loaded targeted nanobubbles that we prepared had the capability of ultrasound, photoacoustic and fluorescence multimodal imaging and could specifically enhance the ultrasound and photoacoustic imaging of RCC xenograft tumors. This outcome has potential clinical application value for the diagnosis of RCC at the early stage and the differential diagnosis of benign and malignant kidney tumors.
Collapse
Affiliation(s)
- Chengjie Zhong
- The Second Clinical Medical College, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Jiajiu Chen
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400038, People’s Republic of China
| | - Yi Ling
- Department of Ultrasound, Southwest Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Deng Liu
- Department of Ultrasound, Southwest Hospital, Army Medical University, Chongqing, 400042, People’s Republic of China
| | - Jing Xu
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400038, People’s Republic of China
| | - Luofu Wang
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400038, People’s Republic of China
| | - Chengguo Ge
- Department of Urology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Qing Jiang
- Department of Urology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| |
Collapse
|
4
|
Aziz MU, Eisenbrey JR, Deganello A, Zahid M, Sharbidre K, Sidhu P, Robbin ML. Microvascular Flow Imaging: A State-of-the-Art Review of Clinical Use and Promise. Radiology 2022; 305:250-264. [PMID: 36165794 PMCID: PMC9619200 DOI: 10.1148/radiol.213303] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 11/11/2022]
Abstract
Vascular imaging with color and power Doppler is a useful tool in the assessment of various disease processes. Assessment of blood flow, from infarction and ischemia to hyperemia, in organs, neoplasms, and vessels, is used in nearly every US investigation. Recent developments in this area are sensitive to small-vessel low velocity flow without use of intravenous contrast agents, known as microvascular flow imaging (MVFI). MVFI is more sensitive in detection of small vessels than color, power, and spectral Doppler, reducing the need for follow-up contrast-enhanced US (CEUS), CT, and MRI, except when arterial and venous wash-in and washout characteristics would be helpful in diagnosis. Varying clinical applications of MVFI are reviewed in adult and pediatric populations, including its technical underpinnings. MVFI shows promise in assessment of several conditions including benign and malignant lesions in the liver and kidney, acute pathologic abnormalities in the gallbladder and testes, and superficial lymph nodes. Future potential of MVFI in different conditions (eg, endovascular repair) is discussed. Finally, clinical cases in which MVFI correlated and potentially obviated additional CEUS, CT, or MRI are shown.
Collapse
Affiliation(s)
- Muhammad Usman Aziz
- From the Department of Radiology, University of Alabama at
Birmingham, 619 S 19th St, Suite JTN361, Birmingham, AL 35233 (M.U.A., M.Z.,
K.S., M.L.R.); Department of Radiology, Thomas Jefferson University,
Philadelphia, Pa (J.R.E.); and Department of Radiology, King’s College
London, King’s College Hospital, London, UK (A.D., P.S.)
| | - John R. Eisenbrey
- From the Department of Radiology, University of Alabama at
Birmingham, 619 S 19th St, Suite JTN361, Birmingham, AL 35233 (M.U.A., M.Z.,
K.S., M.L.R.); Department of Radiology, Thomas Jefferson University,
Philadelphia, Pa (J.R.E.); and Department of Radiology, King’s College
London, King’s College Hospital, London, UK (A.D., P.S.)
| | - Annamaria Deganello
- From the Department of Radiology, University of Alabama at
Birmingham, 619 S 19th St, Suite JTN361, Birmingham, AL 35233 (M.U.A., M.Z.,
K.S., M.L.R.); Department of Radiology, Thomas Jefferson University,
Philadelphia, Pa (J.R.E.); and Department of Radiology, King’s College
London, King’s College Hospital, London, UK (A.D., P.S.)
| | - Mohd Zahid
- From the Department of Radiology, University of Alabama at
Birmingham, 619 S 19th St, Suite JTN361, Birmingham, AL 35233 (M.U.A., M.Z.,
K.S., M.L.R.); Department of Radiology, Thomas Jefferson University,
Philadelphia, Pa (J.R.E.); and Department of Radiology, King’s College
London, King’s College Hospital, London, UK (A.D., P.S.)
| | - Kedar Sharbidre
- From the Department of Radiology, University of Alabama at
Birmingham, 619 S 19th St, Suite JTN361, Birmingham, AL 35233 (M.U.A., M.Z.,
K.S., M.L.R.); Department of Radiology, Thomas Jefferson University,
Philadelphia, Pa (J.R.E.); and Department of Radiology, King’s College
London, King’s College Hospital, London, UK (A.D., P.S.)
| | - Paul Sidhu
- From the Department of Radiology, University of Alabama at
Birmingham, 619 S 19th St, Suite JTN361, Birmingham, AL 35233 (M.U.A., M.Z.,
K.S., M.L.R.); Department of Radiology, Thomas Jefferson University,
Philadelphia, Pa (J.R.E.); and Department of Radiology, King’s College
London, King’s College Hospital, London, UK (A.D., P.S.)
| | - Michelle L. Robbin
- From the Department of Radiology, University of Alabama at
Birmingham, 619 S 19th St, Suite JTN361, Birmingham, AL 35233 (M.U.A., M.Z.,
K.S., M.L.R.); Department of Radiology, Thomas Jefferson University,
Philadelphia, Pa (J.R.E.); and Department of Radiology, King’s College
London, King’s College Hospital, London, UK (A.D., P.S.)
| |
Collapse
|
5
|
Zhu YC, Du H, Jiang Q, Zhang T, Huang XJ, Zhang Y, Shi XR, Shan J, AlZoubi A. Machine Learning Assisted Doppler Features for Enhancing Thyroid Cancer Diagnosis: A Multi-Cohort Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1961-1974. [PMID: 34751458 DOI: 10.1002/jum.15873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/15/2021] [Accepted: 10/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND This pilot study aims at exploiting machine learning techniques to extract color Doppler ultrasound (CDUS) features and to build an artificial neural network (ANN) model based on these CDUS features for improving the diagnostic performance of thyroid cancer classification. METHODS A total of 674 patients with 712 thyroid nodules (TNs) (512 from internal dataset and 200 from external dataset) were randomly selected in this retrospective study. We used ANN to build a model (TDUS-Net) for classifying malignant and benign TNs using both the automatically extracted quantitative CDUS features (whole ratio, intranodular ratio, peripheral ratio, and number of vessels) and gray-scale ultrasound (US) features defined by the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS). Then, we compared the diagnostic performance of the model, the performance of another ANN model based on the gray-scale US features alone (TUS-Net), and that of radiologists. RESULTS The TDUS-Net (0.898, 95% CI: 0.868-0.922) achieved a higher area under the curve (AUC) than that of TUS-Net (0.881, 95% CI: 0.850-0.908) in the internal tests. Compared with radiologists, TDUS-Net (AUC: 0.925, 95% CI: 0.880-0.958) performed better than radiologists (AUC: 0.810, 95% CI: 0.749-0.862) in the external tests. CONCLUSIONS Applying a machine learning model by combining both gray-scale US features and CDUS features can achieve comparable or even higher performance than radiologists in classifying TNs.
Collapse
Affiliation(s)
- Yi-Cheng Zhu
- Department of Ultrasound, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Hongbo Du
- School of Computing, University of Buckingham, Buckingham, England
| | - Quan Jiang
- Department of Ultrasound, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Tao Zhang
- Department of Ultrasound, Pudong New Area Jinyang Community Healthcare Centre, Shanghai, China
| | - Xu-Juan Huang
- Department of Ultrasound, Pudong New Area Heqing Community Healthcare Centre, Shanghai, China
| | - Yuan Zhang
- Department of Ultrasound, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Xiu-Rong Shi
- Department of Ultrasound, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jun Shan
- Department of Ultrasound, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Alaa AlZoubi
- School of Computing, University of Buckingham, Buckingham, England
| |
Collapse
|
6
|
Mao Y, Mu J, Zhao J, Yang F, Zhao L. The comparative study of color doppler flow imaging, superb microvascular imaging, contrast-enhanced ultrasound micro flow imaging in blood flow analysis of solid renal mass. Cancer Imaging 2022; 22:21. [PMID: 35505388 PMCID: PMC9066849 DOI: 10.1186/s40644-022-00458-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Purposes To evaluate the value of Color Doppler Flow Imaging (CDFI), Superb Microvascular Imaging (SMI) and Contrast-enhanced Ultrasound Microflow Imaging (MFI) in display the microvascular blood flow signals in renal solid lesions. Methods 142 patients with 144 renal masses were examined by CDFI, SMI and MFI simultaneously. We compared the difference of blood flow grading and vascular architecture based on CDFI, SMI and MFI. Results The blood flow signals detection rates of CDFI, SMI and MFI were 78.5% (113/144), 88.9% (128/144) and 93.8% (135/144), respectively. Concentrated on blood flow grading, The coincidence rates of CDFI and SMI were 64.58% (93/144) and 81.25% (117/144) referring to MFI, respectively. Blood flow grade 2–3 in CDFI is significantly lower than SMI(x2 = 5.557, P = 0.018) and MFI (x2 = 10.165, P = 0.001). Whereas there was no significant difference between SMI and MFI (x2 = 2.372, P = 0.499). Concentrated on vascular architecture, the coincidence rates of CDFI and SMI were 56.25% (81/144) and 75.69% (109/144) referring to MFI, respectively. Vascular architecture type IV and V in CDFI was significantly lower than SMI (x2 = 18.217, P < 0.001) and MFI (x2 = 29.518, P < 0.001). Whereas there was no significant difference between SMI and MFI (x2 = 3.048, P = 0.550). The sensitivity and specificity of CDFI, SMI and MFI in the diagnosis of renal mass were 61.29% and 90.20%, 79.57% and 88.24%, 88.17% and 84.31% respectively. The areas under the ROC curve of the three were 0.757, 0.839 and 0.862, respectively. There was a statistically significant difference between CDFI and MFI (Z = 3.687, P = 0.0002), while there was no statistically significant difference between SMI and MFI (Z = 1.167, P = 0.2431). Conclusion SMI and MFI are superior to CDFI in showing blood flow signals in renal solid masses, and it can perform blood flow and vascular architecture more accurately. Advances in knowledge SMI is similar to MFI in its ability to display fine vessels and diagnostic efficiency, and has application value in the diagnosis and differential diagnosis of renal solid masses.
Collapse
Affiliation(s)
- Yiran Mao
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jie Mu
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China. .,Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
| | - Jing Zhao
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Fan Yang
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Lihui Zhao
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China. .,Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
| |
Collapse
|
7
|
Zhang J, Liu X, Zheng M, Yin J, Xing W. Case Report: Dermoscopic, High-Frequency Ultrasound, Contrast-Enhanced Ultrasound Appearances and Special Treatment of a Patient With Syringoid Eccrine Carcinoma on the Chest. Front Oncol 2021; 11:717581. [PMID: 34868912 PMCID: PMC8634345 DOI: 10.3389/fonc.2021.717581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
This article aims to explain the use of a variety of noninvasive of minimally invasive examinations to obtain reliable diagnostic clues. The choice of treatment methods and repair techniques for wound defects are also critical in terms of the prognosis. Here, we describe the case of a 53-year-old male patient who visited our dermatology clinic due to a red plaque on the inner side of his left nipple without any symptoms for more than 30 years. He was given dermoscopy, high-frequency ultrasound (HFUS), Color Doppler flow imaging (CDFI), and contrast-enhanced ultrasound (CEUS) examinations. Currently, there are no literatures on these auxiliary examinations for this disease. Dermoscopy revealed that there were abundant blood vessels on the periphery of the skin lesion with obvious dilation. HFUS revealed an inhomegeneous hypoechoic solid mass in the dermis with clear borders and irregular shape. CDFI indicated that there are abundant blood flow signals in the periphery and central of the tumor. CEUS showed a mixed inhomogeneous, grid-like high-enhancement pattern. Based on the above auxiliary findings, the possibility of malignant lesion was suspected. Therefore, the patient was given a pathological examination, which showed that many luminal structures of the dermis layer were embedded in the hyperplastic fibrous tissue. The atypical cells were not obvious but showed an infiltrating growth pattern. Immunohistochemistry showed positive reaction for cytokeratin 7 (CK7), epithelial membrane antigen (EMA), and carcinoembryonic antigen (CEA) and a weak positive results was obtained for S-100. There was also a negative result for CK20, gross cystic disease fluid protein 15 (GCDFP-15), and P63. As a result, the patient was diagnosed with "syringoid eccrine carcinoma." The treatment was surgical excision. Mohs microsurgery was combined with the looped, broad, and deep-buried suturing technique (LBD tension-reduced suturing technique). This technique directly sutures the wound instead of carrying out traditional skin grafting or flap transfer. The postoperative follow-up results were satisfactory as no obvious keloid formed on the wound during the follow-ups. In conclusion, ultrasound is greatly advantageous in tumor morphology and hemodynamics. It orients the therapeutic management and assesses the therapeutic efficacy and the tumoral prognosis. In surgical treatments, a less-traumatic operation should be selected to reduce the patient's pain.
Collapse
Affiliation(s)
- Jing Zhang
- Department of Dermatology, The Fifth Central Hospital of Tianjin, Tianjin, China
| | - Xun Liu
- Department of Ultrasound, The Fifth Central Hospital of Tianjin, Tianjin, China
| | - Mo Zheng
- Department of Pathology, The Fifth Central Hospital of Tianjin, Tianjin, China
| | - Jing Yin
- Department of Pathology, The Fifth Central Hospital of Tianjin, Tianjin, China
| | - Weibin Xing
- Department of Dermatology, The Fifth Central Hospital of Tianjin, Tianjin, China
| |
Collapse
|