超声造影与CT增强扫描对肝占位性病变的诊断价值比较

目的 :对比超声造影与CT增强扫描在肝占位性病变中的诊断价值,为临床诊断肝占位性病变提供参考依据。方法 :回顾性分析71例肝占位性病变患者的临床资料,比较超声造影与CT增强扫描的诊断阳性率,对比2种检查方法的诊断价值。结果:超声造影对肝癌、肝血管瘤及肝局灶性结节增生的诊断阳性率分别为83.33%、88.00%及82.14%,而CT增强扫描分别为88.89%、92.00%及85.71%,2种检查方法的诊断阳性率比较差异无统计学意义(P0.05)。此外,2种检查方法对肝癌、肝血管瘤及肝局灶性结节增生均具有较高的诊断效能(P0.05)。结论:超声造影与CT增强扫描对肝占位性病变的诊断价值相当。     

超声造影、增强CT及增强MRI对肾脏占位性病变的诊断价值比较

目的：比较超声造影、增强CT及增强MRI对肾脏占位性病变的诊断价值。资料与方法对78例经常规超声诊断为肾脏占位性病变患者的80个病灶进行实时超声造影检查,39个行增强CT检查,28个行增强MRI检查,其中5个同时行增强CT及增强MRI检查。以病理结果为“金标准”,比较超声造影、增强CT及增强MRI诊断肾脏占位性病变良恶性的价值。结果80个病灶中,57个为恶性病变,23个为良性病变;超声造影诊断肾脏病变良恶性的敏感度、特异度、阳性预测值、阴性预测值分别为93.0%、69.6%、88.3%、80.0%;增强CT诊断肾脏病变良恶性的敏感度、特异度、阳性预测值、阴性预测值分别为96.4%、72.7%、90.0%、88.9%;增强MRI诊断肾脏病变良恶性的敏感度、特异度、阳性预测值、阴性预测值分别为86.4%、66.7%、90.5%、57.1%;3种检查诊断效果间差异无统计学意义（P>0.05）。结论超声造影、增强CT及增强MRI对于肾脏占位性病变良恶性的诊断效果相当,临床可以根据各个检查技术的特点,为不同的患者选择适宜的检查,联合应用两种检查方法为肾脏占位性病变的诊断提供了更丰富的信息。     

超声造影及增强CT诊断肾脏外伤的对比研究

目的评价超声造影(contrast-enhanced ultrasonography,CEUS)与增强CT在肾脏外伤诊断中的应用价值。方法 57例肾脏外伤患者分别进行超声造影与增强CT检查,根据美国创伤外科协会(AAST)肾外伤分级标准及肾外伤CT分级判断外伤程度,并对结果进行对照研究。结果超声造影发现1例I级肾外伤,而增强CT未发现;CEUS漏诊2例I级肾外伤;1例CEUS将Ⅲ级高估为Ⅳ级;2例将Ⅳ级低估为Ⅲ级。增强CT与CEUS各自的诊断符合率分别为98.2%、91.2%,两者诊断结果具有较好的一致性(P=0.000)。结论 :CEUS在评价实质器官外伤上具有优势,而增强CT在判断腹部合并伤方面更具优势,两种检查技术的有机组合必将大大提高诊断准确率。     

超声造影在膀胱占位性病变诊断中的应用

目的:探讨超声造影在膀胱占位性病变诊断中的临床应用价值.方法:对25例膀胱占位性病变行实时超声造影, 观察并分析病灶的超声造影表现,总结超声造影灌注时相的动态变化规律,并与病理结果相对照.结果:超声造影提示膀胱恶性肿瘤17例(26个病灶),经手术病理证实膀胱移行细胞癌18例.超声造影诊断膀胱癌的敏感性为94.4%(17/18),特异性为100%(7/7),准确性为96.0%(24/25).结论:超声造影能够实时观察膀胱占位性病变的血流灌注情况,对占位性病变的诊断和鉴别诊断具有较高的临床应用价值.     

彩色多普勒对112例胆囊占位病变诊断分析

目的：探讨彩色多普勒超声检查在胆囊占位性病变中的诊断和鉴别诊断价值。方法：回顾性分析2004年2月-2008年6月应用彩色多普勒超声检查、经手术及病理检查结果证实的胆囊占位性病变112例。结果：112例术前超声诊断中,胆囊结石87例,超声诊断85例,符合率97．7％;胆囊息肉12例,超声诊断10例,符合率80％;胆囊恶性肿瘤9例,超声诊断6例,符合率66．7％。结论：彩色多普勒超声检查,对胆囊良性病变诊断符合率为88．5％,对胆囊恶性病变的诊断符合率66．7％。     

椎管内占位性病变的脊髓造影(包括CTM)与MRI的对比分析

目的 :对比分析脊髓造影、脊髓造影 CT及 MRI在椎管内占位性病变中的作用。方法 :对资料完整的 6 4例椎管内占位性病变病人进行了脊髓造影、CTM、MRI影像学比较研究。脊髓造影采用常规脊髓造影和 CTM相结合 (以下称脊髓造影 )。CTM在常规脊髓造影后 4～ 6 h进行。 MRI采用 SE序列加 GE序列。椎管内占位性病变的病灶检出率、定位和定性准确率做一统计和分析。结果 :脊髓造影 CT与 MRI的检出敏感性分别为 88.6 % ,85 .7% ,定性准确率分别为 6 6 .2 % ,79.6 % ,定位准确率分别为 90 .6 % ,92 .3% ,病变检出率及定位准确率在造影与 MRI之间无显著差异 ,而定性准确率存在显著差异 ( P<0 .0 5 )。结论 :脊髓造影 CT与 MRI结合将有利于椎管内病变的检出、定位及定性能力的提高     

CT增强扫描与支气管镜检查对肺部占位性病变的诊断价值

目的 :探讨CT增强扫描与支气管镜检查对肺部占位性病变的诊断价值。方法 :选取2013年1月至2014年12月我院收治的肺部病变患者140例,均行CT增强扫描、支气管镜及病理学检查。将CT增强扫描、支气管镜检查结果与病理检查结果进行对照,分析2种检查方法对肺癌诊断的准确度、敏感度及特异度,2种检查方法与病理结果的吻合度采用Kappa检验。结果:140例中病理学确诊肺癌76例,良性病变64例。CT增强扫描、支气管镜检查对肺癌诊断的准确率、敏感度、特异度、K值分别为(81.43%、81.58%、81.25%、0.672),(80.0%、63.16%、100.00%、0.601)。CT增强扫描诊断准确率与支气管镜比较,差异无统计学意义(P0.05);CT增强扫描敏感度、特异度与支气管镜检查比较,差异均有统计学意义(均P0.05)。结论:支气管镜检查对肺癌诊断的特异度高于CT增强扫描检查,但敏感度和准确度低于CT增强扫描,肺癌的初步诊断应首选CT增强扫描,临床确诊需要结合支气管镜检查。     

MRI与CT诊断胆囊腺肌增生症的临床价值分析

目的探讨MRI与CT对不同类型胆囊腺肌症的诊断价值。方法选取80例医院收治的胆囊腺肌症患者,均行MRI与CT检查,分析不同类型胆囊腺肌症的影像学特征。结果手术病理学检查发现80例患者中局限型胆囊腺肌症26例,节段型胆囊腺肌症25例,弥漫型胆囊腺肌症29例;MRI在该三种类型中的诊断准确率为96.15%、96%、93.1%;CT诊断准确率为76.92%、76%、72.41%,MRI在各类型胆囊腺肌症的诊断准确率均明显高于CT(P<0.05)。结论MRI与CT在胆囊腺肌增生症临床诊断中均有一定的应用价值,MRI检查诊断准确率高于CT检查。     

实时三维超声对膀胱占位性病变的诊断价值

目的 :探讨实时三维超声对膀胱占位性病变的诊断价值,提高对膀胱占位性病变的检出率。方法 :对56例膀胱占位性病变患者行二维超声及二维联合实时三维超声扫查,对比2种方法对膀胱占位性病变的显示率。结果:56例膀胱占位性病变共65个病灶,二维超声检查共发现52个病灶,漏诊13个,准确率为80%;二维超声联合实时三维超声发现65个病灶,准确率为100%。2种检查方式检出准确率比较差异有统计学意义(P0.05)。结论 :二维超声联合实时三维超声可以明显提高膀胱占位性病变的诊断准确性。     

不同类型肾脏占位病变的超声造影特征及其诊断价值探讨

目的:探讨不同类型肾脏占位病变的超声造影特征及其诊断价值.方法:搜集肾脏占位病变手术患者100例,术前均行超声造影检查,根据手术病理结果将病变分为恶性病变(肾癌41例、肾盂癌19例)和良性病变(肾错构癌29例、肾囊肿11例),分析不同类型病变超声造影特征.结果:肾癌、肾盂癌以快进快出型或快进慢出型为主,错构瘤以慢进慢出型为主,而肾囊肿以平台型为主,不同类型肾脏占位病变的超声造影增强模式差异有统计学意义(P＜0.05).根据时间-信号强度曲线采集相关参数,肾癌、肾盂癌峰值强度、曲线尖度、曲线下面积均明显高于肾错构癌、肾囊肿,达峰时间明显低于肾错构癌、肾囊肿,差异均有统计学意义(P＜0.05).超声造影对肾脏占位性病变良恶性的鉴别诊断灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为75.00％、62.50％、75.00％、62.50％和70.00％.结论:不同类型肾脏占位病变的超声造影增强模式及时间-信号强度曲线差异显著,超声造影对肾脏占位病变良恶性的鉴别诊断灵敏度和阳性预测值较高.     

超声造影与增强CT对肾癌的诊断分析

目的:本研究旨在比较超声造影(CEUS)和增强CT(CECT)在肾癌病灶中的诊断价值,探讨超声造影在肾癌的诊断价值。方法:对54例患者临床诊断为肾脏内占位性病灶进行CEUS和CECT检查,通过分析病灶CEUS和CECT的特点,比较两种方法的诊断效能。结果:54个病灶中34个为肾脏恶性肿瘤,20个为肾脏良性病灶,CEUS和CECT诊断敏感性、特异性、准确性、阳性预测值、阴性预测值分别为97.05%、85.0%、92.59%、91.67%、94.44%与91.18%、80.00%、87.04%、88.57%、84.21%。两种方法诊断差异无统计学意义(P>0.05)。结论:分析比较CEUS和CECT在诊断肾癌过程中,两种方法诊断效能无明显差异,均能为临床诊断提供重要依据,但CEUS对微循环灌注方面及假包膜的观察优于CECT;CEUS定量评价肾肿瘤血管现处于动物实验阶段,临床上特异指标的找寻仍有待于进一步研究。     

Value of contrast-enhanced ultrasonography for detecting renal infarcts proven by contrast enhanced CT. A feasibility study

The effectiveness of contrast-enhanced ultrasonography (CEUS) in the evaluation of patients with acute renal infarcts was investigated, using contrast-enhanced helical computed tomography (CT) as the reference imaging procedure. Twenty-seven consecutive patients with acute renal infarcts detected with contrast-enhanced helical CT underwent CEUS. Digital cine-clips of CEUS were evaluated by two independent readers blinded to CT findings. Image quality was rated subjectively on a four-point scale. Then, readers were asked to assign a confidence level in diagnosis of renal infarct at the upper pole, medium portion, and lower pole of each kidney according to a five-degree scale, ranging from definitely absent to definitely present. ROC curve analysis was employed to assess the overall confidence of diagnosis of infarct, and weighted kappa values were calculated to assess inter-reader agreement. The subjective image quality of CEUS was lower than the image quality of CT at the upper poles. However, the diagnostic performance of CEUS was excellent (area under receiver-operator characteristic curve 0.992 ± 0.006 for reader 1; 0.991 ± 0.007 for reader 2), with very good inter-reader agreement (weighted kappa value = 0.83). CEUS is a reproducible tool to detect acute renal infarcts in men, with a diagnostic performance approaching that of CT. This study was presented as a scientific paper for ECR 2007 (control number: 3596)     

乏血供肝转移瘤超声造影与CT增强扫描的对比研究

目的:探讨乏血供肝转移瘤超声造影(CEUS)血流灌注特点及其与CT增强扫描的差异。方法:选择CT增强扫描提示为乏血供肝转移瘤的12例(20个病灶)行常规超声及造影检查。二维超声观察病灶的部位、大小、边界、内部回声;CEUS观察病灶各期的强化模式、强化水平,重点观察动脉期(0～25s),并与CT增强扫描进行比较。结果:12例共20个病灶,CT增强扫描动脉期:1个病灶轻度增强(5%),11个环形强化(55%),2个不均匀强化(10%),6个无强化(30%)。CEUS动脉期:11个病灶弥漫性均匀强化(55%),7个环形强化(35%),2个不均匀强化(10%)。结论:CEUS显示乏血供肝转移瘤动脉期血供情况优于CT增强扫描;对于CT增强扫描怀疑为乏血供肝转移瘤患者,尤其是单发转移瘤,CEUS检查对临床诊断和治疗有很大帮助。     

Enhancement pattern of hepatocellular carcinoma: comparison of real-time contrast-enhanced ultrasound and contrast-enhanced computed tomography

We compared the enhancement pattern of 98 hepatocellular carcinoma nodules in 92 patients on contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT). Contrast-enhanced ultrasound was performed with SonoVue and a low mechanical index method. In arterial phase, 98 nodules were hyperenhancing on CEUS and 94 on CECT. In portal phase, 82 nodules were hypoenhancing on CEUS and 83 on CECT. Peripheral thin-rim-like enhancement was exhibited in 30 nodules on CEUS and 31 on CECT. Intratumoral vessels were visualized in 94 nodules on CEUS and 36 on CECT.     

超声造影在肝硬化及小肝癌诊断中的应用进展

本文介绍超声造影在肝硬化、小肝癌及肝癌病理分化的应用及其目前存在的问题。同时,综述国内外的最新研究成果,展现出超声造影是目前超声医学发展最快速的应用之一,它使超声医学步入一个崭新的领域。可作为CT等影像诊断的补充手段,有助于提高肝硬化背景下小肝癌的早期诊断率。     

Comparison of contrast-enhanced ultrasonography versus baseline ultrasound and contrast-enhanced computed tomography in metastatic disease of the liver: diagnostic performance and confidence

Aim: The aim of this study was to compare contrast-enhanced ultrasonography (CEUS) to baseline US and contrast-enhanced computed tomography (CT) in metastatic disease of the liver diagnosed or suspected by US during presurgical staging or postsurgical follow-up for primary malignancies. Materials and methods: Two hundred-fifty-three patients considered suitable for US due to the complete explorability of the liver and with one to five proven or suspected liver metastases at baseline US were included. All patients underwent US before and after microbubble injection, and multiphase contrast-enhanced CT. Independent panels of readers reviewed US and CT scans and recorded liver metastases according to a 5-grade scale of diagnostic confidence. Sensitivity, specificity (diagnostic performance) and area under the receiver operating characteristics (ROC) curve (diagnostic confidence) were calculated. Results: Reference standards revealed no metastases in 57/253, more than five in 59/253, and one to five in 137/253 patients. In patients with one to five metastases, CEUS versus baseline US revealed more metastases in 64/137 and the same number in 73/137 patients while CEUS versus CT revealed more metastases in 10/137, the same number in 99/137, and lower number in 28/137. Sensitivity, specificity, and area under ROC curve of CEUS (83%, 84%, 0.929, respectively) differed from baseline US (40%, 63%, 0.579, respectively; P<0.01) while did not differ from CT (89%, 89%, 0.945, respectively; P>0.05). Conclusion: CEUS improved liver metastases diagnosis in comparison with baseline US while it revealed similar diagnostic performance and confidence to contrast-enhanced CT in patients considered suitable for US and with proven or suspected liver metastases at baseline US.     

Application of contrast-enhanced ultrasound in the diagnosis of solid pancreatic lesions—A comparison of conventional ultrasound and contrast-enhanced CT

Objective

To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) by comparison with conventional ultrasound (US) and contrast-enhanced CT (CECT) in solid pancreatic lesions.

Method

Ninety patients with solid pancreatic focal lesions were enrolled, including 36 cases of pancreatic carcinoma, 28 cases of pancreatitis, 6 cases of pancreatic neuroendocrine tumor, 12 cases of solid pseudopapillary tumor of the pancreas, 6 cases of pancreatic metastases, 1 case of cavernous hemolymphangioma and 1 case of lymphoma. US and CEUS were applied respectively for the diagnosis of a total of 90 cases of solid pancreatic lesions. The diagnostic results were scored on a 5-point scale. Results of CEUS were compared with CECT.

Results

(1) 3-score cases (undetermined) diagnosed by CEUS were obviously fewer than that of US, while the number of 1-score (definitely benign) and 5-score (definitely malignant) cases diagnosed by CEUS was significantly more than that of US. There was a significant difference in the distribution of final scores using the two methods (p < 0.001). The overall diagnostic accuracies of the 90 cases for CEUS and US were 83.33% and 44.44%, respectively, which indicated an obvious advantage for CEUS (p < 0.001). (2) The diagnostic consistency among three ultrasound doctors: the kappa values calculated for US were 0.537, 0.444 and 0.525, compared with 0.748, 0.645 and 0.795 for CEUS. The interobserver agreement for CEUS was higher than that for US. (3) The sensitivity, specificity and accuracy of the diagnosis of pancreatic carcinoma with CEUS and CECT were 91.7% and 97.2%, 87.0% and 88.9%, and 88.9% and 92.2%, respectively, while for the diagnosis of pancreatitis, the corresponding indices were 82.1% and 67.9%, 91.9% and 100%, and 88.9% and 90%, respectively, showing no significant differences (p > 0.05).

Conclusion

CEUS has obvious superiority over conventional US in the general diagnostic accuracy of solid pancreatic lesions and in the diagnostic consistency among doctors. The performances of CEUS are similar to that of CECT in the diagnosis of pancreatic carcinoma and focal pancreatitis.     

Real-time contrast-enhanced ultrasound of the spleen: examination technique and preliminary clinical experience

PURPOSE: To report our preliminary experience in the evaluation of the spleen using a real-time contrast-specific ultrasound module in combination with a second-generation contrast agent. MATERIALS AND METHODS: In a 7-month period, 55 patients (34 males and 21 females, aged 5-77 years) with spleen disorders were evaluated by means of contrast-enhanced ultrasound. Two patients were studied because of baseline evidence of an accessory spleen and both underwent ultrasound follow-up. Twenty-five patients were studied for abdominal trauma and results were correlated with those of helical CT. Three patients were examined for suspected splenic infarction and for all CT correlation was obtained. Finally, twenty-five subjects were examined for focal diseases, such as lymphomas (17 cases) and focal lesions (8 cases); contrast-enhanced US results were correlated with those of CT (8 cases), MRI (2 cases), ultrasound follow-up (8 cases), biopsy (2 cases) or splenectomy (1 case). After an initial baseline study, the contrast-enhanced examinations were carried out using a dedicated unit equipped with a continuous contrast-specific module at low acoustic pressure. The examination started immediately after rapid contrast injection and lasted approximately 4 minutes. In the comparison between baseline and contrast-enhanced ultrasound, the following aspects were considered: detection rate of parenchymal changes, lesion extent (equal to CT, under- or overestimated), and lesion conspicuity (lesion-to-parenchyma gradient, from 0 = absent to 3 = high). RESULTS: In the 2 patients with accessory spleen, an enhancement very similar to that of the adjacent parenchyma was present and a small vascular pedicle was noted. Among the trauma patients, 18 had a direct splenic injury and one showed splenic contraction and hypoperfusion due to shock. In 74% of cases, a peritoneal effusion was demonstrated both with baseline and contrast-enhanced ultrasound; perisplenic blood collections (58% of cases) were identified in 42% of patients by both baseline and contrast-enhanced ultrasound; post-traumatic infarction was always revealed by contrast-enhanced ultrasound (11% of cases) but never by baseline ultrasound; parenchymal injuries were detected with a sensitivity of 63% by baseline ultrasound and a sensitivity of 89% by contrast-enhanced ultrasound. Moreover, contrast-enhanced ultrasound revealed findings undetectable on conventional ultrasound: global splenic hypoperfusion in 2 cases (due to shock in one and pedicle avulsion in the other), intraparenchymal contrast collections in 21% of positive cases (as confirmed by CT), extrasplenic contrast leakage in 1 of 2 cases demonstrated by CT. Of the 3 cases of splenic infarction, baseline sonography only only identified two, whereas the contrast-enhanced examination clearly identified three. Contrast-enhanced ultrasound revealed 35 of 39 focal lesions in patients studied for Hodgkin's disease and splenic focal lesions. Baseline ultrasound had a lower sensitivity (23 lesions). Lesion extension shown by contrast-enhanced sonography was equivalent to that provided by standard methods in 88% of cases (underestimated in 9% and overestimated in 3%); baseline US correctly estimated lesion size in 52% of cases, under- and overestimating them in 35% and 13% of cases, respectively. Lesion conspicuity was graded as 1 (low) in 16%, 2 (moderate) in 67%, and 3 (high) in 17% of the cases identified by enhanced sonography. Baseline ultrasound was less effective: conspicuity was graded as 1 in 42%, 2 in 39%, and 3 in 19% of cases. CONCLUSIONS: The spleen is the ideal organ to be studied with second-generation contrast media due to its superficial location, high vascularity, small size and homogeneous texture. Contrast-enhanced ultrasound is a simple, poorly-invasive and accurate tool for the evaluation of splenic disorders. If our data are confirmed, it will be possible to reduce the use of more complex technologies such as CT and MRI.     

超声造影在诊断乳腺癌肝转移中的应用价值

目的:探讨超声造影(CEUS)在诊断乳腺癌肝转移中的应用价值。材料和方法:对89例常规超声疑似乳腺癌肝转移者行CEUS和增强CT(CECT)后,采用穿刺活检、手术病理、影像学随访超过半年临床最后确诊。结果:89例常规超声疑似乳腺癌肝转移经CEUS及相关检查临床最后确诊为良性41例。48例乳腺癌肝转移经CEUS明确诊断47例。CEUS对乳腺癌肝转移诊断的敏感度为97.92%(47/48),假阴性率为2.08%(1/48),特异度为100%(41/41),阳性预测值为100%(47/47),阴性预测值为97.62%(41/42)。经CEUS发现新增转移病灶10例。CEUS从常规超声53.93%(48/89)的诊断准确度提高到98.88%(88/89)。CEUS对乳腺癌肝转移的诊断率与CECT在统计学上无差异(P=0.833)。结论:CEUS能发现乳腺癌较小的肝转移灶,提高了超声诊断乳腺癌肝转移的鉴别能力和准确度。