常规超声联合超声造影诊断甲状腺微小乳头状癌研究

目的探讨常规超声(US)联合超声造影(CEUS)对甲状腺微小乳头状癌(PTMC)的诊断价值。方法选取自2016年6月至2017年3月解放军202医院收治的37例PTMC患者为研究对象,共计41枚结节,最大径均≤1 cm。术前均行US及CEUS检查,分别记录良、恶性结节的US及CEUS表现特征,计算US、CEUS及US联合CEUS的诊断效能。结果 US检查中,恶性结节表现为微钙化、纵横比>1、边界不完整、低回声;良性结节表现为边界完整、钙化灶粗大、纵横比<1、低回声。CEUS检查中,良性结节多表现为不均匀低增强,造影增强后边界清晰,增强后面积不变;恶性结节多表现为不均匀低增强、增强后边界不清,增强后面积减小。US检查的符合率为80.4%(33/41),CEUS检查的符合率为90.2%(37/41),US联合CEUS检查的符合率为92.6%(38/41),高于前两者,差异有统计学意义(P<0.05)。结论 US检查是发现甲状腺微小结节的基础,通过实时CEUS可以获得更多信息,两者联合可提高诊断准确率,具有重要的诊断价值。     

彩色多普勒联合超声造影对肾盂癌诊断价值分析

目的:探讨彩色多普勒联合超声造影(CEUS)对肾盂癌临床诊断的价值。方法:选取29例有完整临床资料的患者,对其肾脏行彩色多普勒、CEUS及CT增强扫描,并与病理结果进行比较。结果:常规彩色多普勒检查诊断肾盂癌的敏感性为51.72%(15/29);彩色多普勒联合CEUS的敏感性为79.31%(23/29);CT敏感性为82.76%(24/29)。CT诊断准确性明显高于常规超声,差异有统计学意义(P<0.05),但与彩色多普勒联合CEUS比较,二者差异无统计学意义(P>0.05)。8例肾盂癌CEUS的血流灌注方式:6例呈"同增早退",2例呈"早增早退";肿块显影高峰强度:4例等同于肾实质,4例稍低于肾实质。结论:彩色多普勒联合CEUS可以提高诊断肾盂癌的敏感性。     

超声造影对宫颈癌术前诊断的效果研究

目的探讨超声造影(CEUS)对宫颈癌的诊断及临床分期的价值。方法选取2008年5月—2012年5月于我院就诊的70例疑为宫颈癌的患者,经临床病理证实,宫颈癌45例,宫颈上皮内瘤变10例,正常15例,均进行普通超声和CEUS检查,分析其阴道超声图谱声像特征以及造影增强特征。结果宫颈癌CEUS可以清晰显示癌灶的范围,宫颈病变造影参数结果显示宫颈癌组早期增强时间以及峰值时间较短,其强度明显高于对照组和宫颈上皮瘤变组,且CEUS的符合率明显高于普通超声(US),差异均具有统计学意义(P<0.05)。结论经阴道CEUS技术不仅可以显著提高宫颈癌的临床诊断率,还可以明确宫颈癌的临床分期,对宫颈癌的早期诊断、治疗和预后都有重要的价值。     

超声造影联合细针穿刺手感对甲状腺乳头状癌的诊断价值

 目的 探讨超声造影(contrast enhanced ultrasound, CEUS)和超声引导下细针穿刺细胞学检查(fine-needle aspiration cytology, FNAC,简称“穿刺手感”)及二者联合诊断甲状腺乳头状癌(papillary thyroid carcinoma ,PTC)的价值。方法 回顾性分析2017-09至2020-01解放军总医院海南医院超声诊断科进行超声检查、CEUS及超声引导下穿刺手感患者312例(312个结节),每个结节在穿刺过程中均记录穿刺手感,最终以手术病理结果为金标准。采用特征曲线(ROC)评价CEUS、穿刺手感和两者联合应用的诊断效果。结果 312例中共有良性结节116个,196个诊断为PTC。穿刺手感联合CEUS的准确率(97.450%)高于单独使用CEUS(87.244%)或穿刺手感(63.776%),差异有统计学意义(P<0.05)。CEUS和穿刺手感联合诊断甲状腺结节ROC曲线下面积(0.767)大于单独使用超声造影(0.734)及穿刺手感(0.711),差异均有统计学意义(P<0.05),但CEUS与穿刺手感在诊断PTC ROC曲线下面积差异无统计学意义。结论 CEUS联合穿刺手感对PTC诊断的准确性高于单一使用超声造影或穿刺手感。     

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。     

超声联合肌电诱发电位诊断战士臂丛训练伤临床应用

目的探讨采用超声联合肌电诱发电位诊断战士臂丛训练伤的临床效果。方法选取自2017年1—9月解放军208医院收治的军事训练过程中疑似臂丛神经损伤的53例战士为研究对象。所有患者均存在不同程度手部肌肉、肩胛、臂部等部位的麻痹症状,均行超声、肌电诱发电位及超声联合肌电诱发电位检查,根据诊断结果分别评估不同检查方式的诊断效果,比较不同检查方法诊断患者的灵敏度、特异性及诊断符合率。结果超声诊断灵敏度为81.1%(30/37),特异度为100.0%(16/16),诊断符合率为86.8%(46/53);肌电诱发电位诊断灵敏度为89.2%(33/37),特异度为87.5%(14/16),诊断符合率为88.7%(47/53);超声联合肌电诱发电位诊断灵敏度为97.3%(36/37),特异度为100.0%(16/16),诊断符合率为98.1%(52/53)。超声联合肌电诱发电位诊断灵敏度及诊断符合率均高于超声、肌电诱发电位检查,差异有统计学意义(P<0.05)。结论采用超声联合肌电诱发电位检查诊断臂丛损伤患者诊断准确率高,利于患者的早期诊治。     

超声综合检查和99Tc^m-硫胶体检测对乳腺癌前哨淋巴结的价值比较

目的探讨超声综合检查,包括经皮超声造影(CEUS)和常规超声检查,或99Tc^m-硫胶体前哨淋巴结检测对乳腺癌前哨淋巴结(SLN)的诊断价值比较。方法选取本院进行乳腺癌检查的患者120例为研究对象。患者均行常规超声、CEUS、99Tc^m-硫胶体前哨淋巴结检测,并以手术病理结果为标准,以ROC曲线分析常规超声、CEUS、99Tc^m-硫胶体前哨淋巴结检测对乳腺癌前哨淋巴结的诊断价值。结果120例乳腺癌患者中,经病理学诊断共检出168个淋巴结,其中转移性62个,非转移性106个。且以病理检查为标准,常规超声检查对乳腺癌前哨淋巴结转移的敏感度为69.4%,特异度为95.3%;CEUS检查的敏感度为83.9%,特异度为97.2%;99Tc^m-硫胶体检查的敏感度为88.7%,特异度为98.1%;三者联合检查的敏感度为93.5%,特异度为99.1%。另ROC曲线分析显示,常规超声、CEUS及99Tc^m-硫胶体检查及三者联合诊断的乳腺癌前哨淋巴结转移的AUC为0.823、0.905、0.934、0.963,联合诊断价值更高。结论CEUS、99Tc^m-硫胶体前哨淋巴结检测对乳腺癌前哨淋巴结的诊断价值均高于常规超声,且三者联合诊断敏感度、特异性更高。     

超声造影联合弹性成像对BI-RADS 4类乳腺肿块的诊断价值

目的探讨超声造影(CEUS)联合弹性成像(UE)对BI-RADS 4类乳腺病灶的诊断价值。方法回顾性分析经手术病理证实的190枚BI-RADS 4类病灶的UE及CEUS声像图特点,以手术病理结果为"金标准",采用受试者工作特征(ROC)曲线分别评估两者单独及联合应用调整BI-RADS分类的诊断效能。结果 190枚病灶,病理结果显示良性71枚,恶性119枚。CEUS各增强特点良恶性组间差异均有统计学意义。CEUS、UE及常规超声的受试者工作特征曲线下面积(AUROC)分别为0.848,0.767,0.818,均小于UE联合CEUS调整BI-RADS分类的方法(AUROC为0.935),诊断效能具有统计学意义(P0.01)。常规超声、UE、CEUS的敏感度、特异度、准确率分别为97.5%,67.6%,86.3%;68.1%,76.1%,71.1%;65.5%,91.5%,75.3%。CEUS联合UE调整BI-RADS分类后的敏感度98.3%,特异度88.7%,准确率94.7%。结论 CEUS在乳腺良恶性病灶的鉴别上有一定的应用价值,CEUS联合UE能进一步提高BI-RADS 4类乳腺病灶的良、恶性鉴别诊断。     

MRI 联合经阴道彩色多普勒超声诊断早期宫颈癌的价值

目的：探讨 MRI 联合经阴道彩色多普勒超声(TVCDS)诊断早期宫颈癌的价值。方法回顾性分析35例经手术证实的早期宫颈癌患者(临床分期为Ⅰb 和Ⅱa 期)的 MRI 及 TVCDS 资料,统计分析单独应用 MRI、TVCDS 及两者联合应用诊断宫颈癌的准确率。结果在肿瘤大小、宫颈间质浸润、阴道浸润、宫旁组织受侵及淋巴结转移5项指标中,MRI 联合 TVCDS 的诊断准确率为88.4%、79.2%、89.4%、97.4%、92.3%,其准确率明显优于单一检查,差异有统计学意义(P <0.05)。结论 MRI 联合TVCDS 对早期宫颈癌的诊断具有明显的临床应用价值,显著提高术前评估的准确度,为选择最佳治疗方案提供参考。     

超声造影后粗针穿刺活检在颈部肿大淋巴结鉴别诊断中应用

目的探讨超声造影后粗针穿刺活检技术在颈部肿大淋巴结鉴别诊断中的应用,为临床提供有价值的参考依据。方法选取自2015年5月至2016年5月在沈阳军区总医院就诊的73例颈部淋巴结肿大患者为研究对象,将所有患者随机分为A组(n=37)和B组(n=36)。A组患者行超声引导下粗针活检穿刺,B组患者行超声造影后粗针活检穿刺,比较两组患者的取材成功率、诊断准确率及并发症发生率。结果 B组患者取材成功率为100.0%(36/36),诊断准确率为100.0%(36/36),均高于A组的取材成功率89.2%(33/37)及诊断准确率89.2%(33/37),差异有统计学意义(P<0.05);B组患者的并发症发生率为0,低于A组的8.1%(3/37),差异有统计学意义(P<0.05)。结论超声造影后粗针穿刺颈部肿大淋巴结活检能提高取材成功率及诊断准确率,减少穿刺过程中的并发症。     

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.     

超声造影在乳腺肿瘤诊断中的应用

目的探讨超声造影在乳腺肿瘤中的鉴别诊断价值。方法通过对经病理证实的139例148个乳腺肿瘤病灶分析,比较常规超声与超声造影联合常规超声诊断结果的差异。结果148个病灶中,病理结果显示良性病灶76个,恶性病灶72个。超声造影联合常规超声在对恶性肿块诊断中的灵敏度为86．1％,特异度为93．4％,准确率为89．9％,均优于单纯常规超声（灵敏度为79．2％,特异度为88-2％,准确率为83．8％）,差异具有统计学意义。结论超声造影的应用可以有效提高超声对乳腺肿瘤良恶性的鉴别能力。     

超声造影技术评估宫颈癌预后应用价值研究

目的探讨超声造影(CEUS)技术评估宫颈癌预后的应用价值。方法选取2010年12月至2016年4月收治的宫颈癌患者40例,根据是否存在风险预后因素分为中-高风险组(15例)与低风险组(25例)。比较两组患者的CEUS表现与时间-强度曲线(TIC)参数,绘制受试者工作特征曲线(ROC)并计算增强强度(EI)最佳诊断阈值。结果宫颈癌CEUS表现以非均匀性高增强为主,两组增强水平与增强分布比较,差异无统计学意义(P>0.05);中-高风险组灌注缺损多于低风险组,差异有统计学意义(P<0.05)。两组增强时间(AT)与达峰时间(TTP)差异无统计学意义(P>0.05);中-高风险组峰值强度(PI)与增强强度(EI)高于低风险组,差异有统计学意义(P<0.05)。EI在最佳诊断阈值25.75 d B时,评估宫颈癌存在中-高风险预后因素的敏感度为93.3%、特异度为74.0%、准确度为77.5%。结论 CEUS技术在评估宫颈癌预后中具有一定的临床应用价值。     

经阴道超声联合360°直肠腔内超声在女性直肠肿瘤分期中的应用价值

目的探讨经阴道超声与经直肠360°腔内超声联合应用在女性直肠肿瘤分期的应用价值。方法应用经阴道超声和(或)360°直肠腔内超声检查女性直肠肿瘤70例,以病理结果为金标准,评估腔内超声在女性直肠肿瘤分期中的应用价值。结果直肠腺瘤9例,其中绒毛状腺管状腺瘤2例,腺管状腺瘤7例,61例直肠癌患者中绒毛状腺管状腺瘤局灶恶变3例,腺癌55例,合并黏液腺癌3例,腔内超声诊断直肠癌的总准确率为85.2%,其中判断T1期直肠癌的准确性最高,敏感度、特异度、阳性预测值、阴性预测值、准确性分别为100%、94.8%、50%、100%、95.1%。结论经阴道超声联合360°直肠腔内超声可以较准确地评估女性直肠癌并进行术前分期,为临床手术方式选择提供可靠的术前影像学依据。     

Screening for liver metastases in women with mammary carcinoma: comparison of contrast-enhanced ultrasound and magnetic resonance imaging

Objective

The objective of the present study was to compare conventional B-mode ultrasound (BMU), contrast-enhanced ultrasound (CEUS), and magnetic resonance imaging (MRI) in the detection of liver metastases at the primary staging and follow-up of women with histologically confirmed mammary carcinoma.

Patients and methods

Included in the study were 55 women (aged 57.5±11.0 years, range 27-75 years; mean disease duration 57.5 months, range 5-168 months); of these, 17 women were examined as part of primary staging (staging group) and 38 women at follow-up (follow-up group). All patients underwent BMU (Philips HDI 5000), CEUS (Philips HDI 5000; 4.8 ml SonoVue), and MRI (Siemens Avanto 1.5 T) of the liver.

Results

In the staging group (n=17), a mass was detected by BMU in 24% (n=4), by CEUS in 29% (n=5), and by MRI in 47% (n=8); masses suspicious for malignancy were identified in 6% of patients with BMU and in 12% each by CEUS and MRI. Malignancy was not confirmed in any case by cytology or surgery. In the follow-up group (n=38), masses were identified by MRI in 53% of patients with suspicion of malignancy in 18%. Malignancy was confirmed in 16% of cases identified at MRI, in 13% of cases identified with CEUS, and in 11% of cases identified with BMU. The Pearson coefficients of correlation were r=.29 (P=.03) for MRI vs. BMU; r=.42 (P=.002) for MRI vs. CEUS; and r=.75 (P≤.001) for BMU vs. CEUS. With respect to malignancy, the Pearson coefficients of correlation were r=.40 (P=.099) for BMU vs. MRI and r=.71 (P=.0009) for CEUS vs. MRI.

Conclusions

Beginning in tumor stage III, the use of CEUS and MRI is associated with a significantly greater benefit in the detection of malignant tumors of the liver compared with conventional BMU. BMU appears to be adequate for primary staging and the follow-up of lower tumor stages.     

Differentiating benign from malignant solid breast lesions: Combined utility of conventional ultrasound and contrast-enhanced ultrasound in comparison with magnetic resonance imaging

Objective

To prospectively evaluate the diagnostic efficacy of conventional ultrasound (US), contrast-enhanced US (CEUS), the combined use of two modalities, and magnetic resonance imaging (MRI) in the differentiation of focal solid breast lesions.

Materials and methods

61 patients with BI-RADS category 3–5 breast lesions detected at conventional US underwent CEUS and MRI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of conventional US, CEUS, combination of two modalities and MRI for discrimination between benign and malignant breast lesions.

Results

Tissue specimens of 61 breast lesions were obtained either from surgical resection (n = 46) or from needle biopsy (n = 15). Histopathologic diagnosis revealed 28 benign and 33 malignant lesions. The diagnostic performance of conventional US and CEUS in differentiating benign from malignant breast lesions showed no significant difference (P = 0.741). The combination of two modalities significantly improved the diagnostic accuracy compared with either conventional US or CEUS alone (P = 0.031 and P = 0.012, respectively). The area under the ROC curve (A_z) value for the combined use of two modalities for discrimination between benign and malignant breast lesions was 0.94, and that for MRI was 0.91, whereas no statistical difference was found between them (P = 0.296).

Conclusion

The combined use of conventional US and CEUS has a better diagnostic performance than either method alone and displays good agreement with MRI in the differentiation capability for benign and malignant breast lesions.     

超声造影结合Bosniak标准在良恶性肾囊性病变鉴别诊断中的价值

目的 评价超声造影鉴别良恶性肾囊性病变的准确性,探讨超声造影结合Bosniak标准分级诊断肾囊性病变的可行性.资料与方法 对30例患者的36个肾囊性病灶进行超声造影,分析良恶性肾囊性病变的超声造影征象;按照Bosniak标准对超声造影的表现进行分级诊断,计算其敏感性、特异性、诊断符合率、阳性预测值、阳性似然比、Kappa值及验后概率,分析该方法分级诊断肾囊性病变的准确性.结果 超声造影可显示常规超声不能发现的囊内分隔及实性结构.超声造影结合Bosniak标准诊断肾囊性病变的敏感性、特异性、诊断符合率、阳性预测值、阳性似然比分别为92.9％、90.9％、94.8％、86.7％、10.2,Kappa=0.83;应用超声造影结合Bosniak标准可提高肾囊性病变良恶性诊断的验后概率.结论 超声造影结合Bosniak标准可以提高鉴别诊断肾囊性病变良恶性的准确性.     

Role of contrast-enhanced ultrasound in decision support for diagnosis and treatment of hepatic artery thrombosis after liver transplantation

Objective

To assess role of contrast-enhanced ultrasound (CEUS) in decision support for diagnosis and treatment of hepatic artery thrombosis (HAT) after liver transplantation.

Materials and methods

Between January 2005 and January 2011, 605 patients underwent liver transplantation in our medical center. All the liver transplant recipients received Doppler ultrasound scanning and CEUS examination was performed in 45 patients with suspected HAT on Doppler ultrasound. Sensitivity, specificity, accuracy, positive predict value and negative predictive value of CEUS in diagnosing HAT were determined based on the results from angiography, surgery and clinical follow-up.

Results

Fourteen HATs, including one late HAT, were diagnosed by CEUS. Twelve HAT cases were confirmed by angiographic and/or surgical findings, while the late HAT and other 31 patients with negative CEUS finding were confirmed by the clinical follow-up. There was a false positive HAT diagnosed by CEUS in which angiography revealed a patent hepatic artery. The sensitivity, specificity, accuracy, positive predict value and negative predictive value of CEUS in diagnosing HAT were 100%, 96.9%, 97.8%, 92.9% and 100%, respectively. In our series of 605 liver transplants, the incidence and mortality of HAT was 2.2% (13/605) and 53.8% (7/13), respectively.

Conclusions

Our study demonstrates the important role of CEUS in decision support for diagnosis and treatment of HAT after liver transplantation. When HAT is suspected by Doppler ultrasound, CEUS shall immediately be performed to elucidate its nature. A negative CEUS finding shall avoid invasive angiography. Such as, CEUS may alter the clinical workflow on HAT detection after liver transplantation.