静脉超声造影诊断子宫内膜癌的定量参数分析及其与临床病理因素的相关性

目的：探讨静脉超声造影（CEUS）诊断子宫内膜癌的定量参数及其与临床病理因素的相关性。方法 ：选择90例经病理确诊的子宫内膜癌患者为观察组,另选择90例经病理确诊的子宫内膜良性病变患者为对照组。比较2组患者CEUS定量参数,即上升时间（RT）、达峰时间（TTP）、峰值强度（PI）;应用ROC曲线比较不同参数对子宫内膜癌的诊断效能;比较不同临床特征子宫内膜癌患者的CEUS定量参数;分析CEUS定量参数与子宫内膜癌临床病理因素的相关性。结果：观察组CEUS定量参数PI明显高于对照组（P<0.05）,RT、TTP均显著低于对照组（均P<0.05）。ROC曲线显示,RT、TTP、PI联合诊断子宫内膜癌的AUC为0.886,PI单独诊断的AUC为0.860,高于RT、TTP,PI截断值20.5 dB,RT截断值8.41 s,TTP截断值14.71 s。PI单独诊断的敏感度最高,为93.65%;RT单独诊断的特异度最高,为97.12%。不同手术病理学分期、病理分化程度、肌层浸润程度子宫内膜癌患者的RT、TTP、PI比较,差异均有统计学意义（均P<0.05）。PI与手术病理学分期、...     

高强度聚焦超声治疗子宫腺肌病影响因素的初步分析

目的 :探讨高强度聚焦超声(HIFU)治疗子宫腺肌病的影响因素。方法 :对20例(共33处病灶)子宫腺肌病患者行一次性超声消融治疗。术前1~2 d及术后第7天所有患者均行盆腔子宫MRI平扫加强化评估其消融率,分析年龄、病灶位置、病灶弥散程度、团块灰度出现与否等因素对消融率的影响。结果:病灶位置不同、弥散程度不同消融率差异均有统计学意义(均P0.05)。子宫前壁、后壁和宫底病灶的平均消融率分别为(82.81±5.16)%、(75.73±8.24)%、(69.80±5.99)%,其中宫底病灶和后壁病灶的平均消融率均前壁病灶的平均消融率,差异有统计学意义(P0.05);局限病灶、弥散病灶平均消融率分别为(81.14±7.00)%、(75.08±8.10)%,差异有统计学意义(P0.05)。结论 :病灶位置、弥散程度影响HIFU治疗子宫腺肌病的消融率。     

高强度聚焦超声消融子宫肌瘤的MRI评价

目的 观察高强度聚焦超声(HIFU)消融治疗子宫肌瘤的客观疗效、不良反应和临床转归情况.方法 2006年12月-2008年3月解放军第307医院参与多中心临床验证的子宫肌瘤确诊患者38例(包括多发肌瘤患者17例),使用HIFU治疗系统一次性消融治疗子宫肌瘤47个,其中肌瘤最大直径11.6cm.观察不良反应并定期随访,随访期间应用增强磁共振(MRI)评价HIFU治疗后子宫肌瘤的消融坏死体积及消融率,测量治疗后子宫和肌瘤体积的变化,判断临床转归规律.结果 治疗后随访37例共46个肌瘤,增强MRI显示所有肌瘤均出现消融坏死区并持续存在,HIFU消融率为65.1%±21.7%.与治疗前相比,治疗后不同时间子宫和肌瘤体积均有显著缩小,1、3、6、12个月时子宫肌瘤的缩小率分别为24.1%±17.3%、39.8%±23.4%、44.6%±24.7%、60.3%±17.2%(F=15.31,P<0.01),呈现出随时间延长逐渐缩小的变化规律.HIFU治疗后的主要并发症为局部疼痛、发热等,均为轻中度,并可在1周内自行缓解.结论 HIFU消融治疗子宫肌瘤安全可行,局部消融效果确切.     

超声造影对肝细胞癌微波消融疗效评估及对局部复发预测价值研究

目的 探讨超声造影(CEUS)对肝细胞癌(HCC)患者微波消融(MWA)疗效的评估价值及对局部复发的预测价值。方法 选取中南大学湘雅医学院附属海口医院自2020年1月至2022年1月收治的106例接受MWA治疗的HCC患者为研究对象。所有患者分别于术前、术后1个月,进行超声造影(CEUS)与增强CT(CECT)检查。根据1年随访结果将患者分为复发组(n=21)与未复发组(n=85)。记录并比较两组术前CEUS的上升时间(RT)、达峰时间(TTP)、峰值强度、平均通道时间、曲线下面积。采用多因素Logistic回归分析检验HCC患者MWA后局部复发的影响因素。绘制受试者工作特征(ROC)曲线分析CEUS定量参数对肿瘤复发的预测价值。结果 CEUS、CECT评估消融疗效的准确性分别为92.45%(98/106)、94.34%(100/106),差异无统计学意义(P>0.05)。复发组、未复发组患者肿瘤直径比较,差异有统计学意义(P<0.05)。复发组患者RT、TTP均低于未复发组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,RT、TTP均为...     

彩色多普勒超声对高强度聚焦超声治疗子宫肌瘤、腺肌瘤的疗效评价

目的:探讨彩色多普勒血流显像(color Doppler flow imaging,CDFI)对高强度聚焦超声(high intensity focused ultra-sound,HIFU)治疗子宫(腺)肌瘤的近期疗效及其实用性。方法:对经临床及阴道超声确诊子宫(腺)肌瘤的136例患者行HIFU治疗,应用CDFI观察比较治疗前后瘤体大小、回声、血流动力学等不同的改变。结果:136例子宫(腺)肌瘤HIFU治疗后1~6个月CDFI随访统计,瘤体明显缩小者86例,瘤体内回声明显增强改变113例,血流信号消失或明显明显减少者110例,月经期经量明显减少,临床症状明显改善者105例。HIFU治疗子宫(腺)肌瘤总有效率为83.09%(113/136)。结论:彩色多普勒超声能较好地观察子宫肌瘤HIFU治疗前后瘤体的回声、血供和体积大小的改变,是HIFU术后随访及疗效评价的有效手段之一。     

实时剪切波弹性成像及超声造影技术评估慢性肾病临床分期的价值

目的 探讨实时剪切波弹性成像(SWE)及超声造影(CEUS)技术评估不同分期慢性肾脏疾病(CKD)中肾实质的弹性及肾皮质血流灌注改变的临床价值。方法 选取我院收治的109例CKD患者(CKD组)和20例健康志愿者(对照组)。分别进行肾SWE、CEUS检查，获得肾实质弹性参数：最大值(Emax)、最小值(Emin)、平均值(Emean)、标准差(SD)和肾皮质血流灌注参数：曲线上升支斜率(A)、曲线下降支斜率(α)、曲线下面积(AUC)、峰值强度(PI)、达峰时间(TTP)。观察CKD组和对照组以及不同分期CKD患者上述参数的差异。结果 CKD组Emax、Emean、SD、AUC、TTP、A均高于对照组，差异有统计学意义(P<0.05),Emin、 PI低于对照组，差异有统计学意义(P<0.05)。不同CKD分期SWE参数比较发现：CKD 4～5期组患者Emax、Emean、SD、AUC、TTP、A均高于CKD 1～3期组，差异有统计学意义(P<0.05),Emin、 PI低于CKD 1～3期组，差异有统计学意义(P<0.05)。不同CKD分期肾皮质血流灌注参数比...     

乳腺肿瘤高频彩超及超声造影与微血管密度的相关性

目的 分析乳腺良恶性肿瘤高频彩超、超声造影(CEUS)与微血管密度(MVD)的相关性,探讨超声造影对乳腺肿瘤的诊断价值.资料与方法 82例原发性乳腺肿瘤患者于术前行常规高频彩超检查,观察病灶灰阶图像特征及血流特征;启动造影模式行实时灰阶谐波超声造影检查,应用时间-信号强度曲线分析软件分析病灶增强达峰时间(TTP)、峰值强度(PI)、曲线下面积(AUC);采用免疫组化测定肿瘤内MVD,分析超声造影定量参数与MVD的相关性.结果 恶性组肿瘤血流Adler分级低于良性组(P＜0.05);超声造影显像特点:恶性组血管数量多且粗细不等,良性组血流束细窄、平直;恶性组TTP低于良性组,PI及AUC高于良性组(P＜0.05),MVD显著高于良性组(P＜0.001);肿瘤MVD计数随血流Adler分级升高而升高,CDF1血流丰富程度与MVD呈正相关(r=0.456,P＜ 0.01); PI与MVD呈显著正相关(r=0.783,P＜0.01).结论 超声造影能客观评价乳腺肿瘤血供,术前应用CDFI结合超声造影在体检查肿瘤血管,可为早期诊断乳腺肿瘤提供信息.     

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。     

高强度超声聚焦热消融治疗子宫腺肌病效果探讨

目的:观察高强度超声聚焦热消融治疗子宫腺肌病的效果.方法:选择于2015年8月-2016年10月在我院接受高强度超声聚焦热消融治疗的子宫腺肌病患者120例作为观察对象,观察患者临床症状的改善情况、影像学变化来评价高强度聚焦超声在子宫腺肌病疗中的应用价值.结果:治疗结果显示120例患者中98例临床症状消失,子宫及肿瘤体积缩小2/3以上;20例患者临床症状明显改善,肿瘤体积缩小1/2以上;2例患者术后病情未好转,出现失血性贫血而行子宫切除术.治疗总有效率高达98.33％(118/120).1例患者术后发生尿潴留,尿管保留24 h后可正常排尿;1例患者出现大腿跟部疼痛,1周后自行消失,且在治疗过程中未出现骶神经损伤、皮肤烧灼的并发症.结论:高强度超声聚焦热消融治疗在子宫腺肌病的治疗中具有较高的应用价值,具有疗效显著、安全性高的优点,值得临床推广应用.     

高强度聚焦超声治疗子宫腺肌病临床研究进展

高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗为近年来兴起的一项无创技术,因其安全、无创、无辐射、可重复等优点,广泛应用于各种实体肿瘤的治疗。本文对HIFU治疗子宫腺肌病的作用机制、适应证、禁忌证、治疗方法、安全性及有效性和并发症进行综述。     

Haemodynamic parameters of the hepatic artery and vein can detect liver metastases: assessment using contrast-enhanced ultrasound

This study was to assess the changes in the haemodynamic parameters of the hepatic artery and vein in the diagnosis of liver metastases by contrast-enhanced ultrasound (CEUS). 52 patients with proven liver metastases (patient group) and 23 normal volunteers (control group) were recruited in this study. Each subject was administered an intravenous bolus injection of SonoVue (0.6 ml). The arrival time in the hepatic artery (AT HA), time to peak in the hepatic artery (TTP HA), peak intensity of the hepatic artery (PI HA), arrival time in the hepatic vein (AT HV), time to peak in the hepatic vein (TTP HV) and peak intensity of the hepatic vein (PI HV) were measured with the use of time-intensity curve software. The hepatic artery to vein transit time (HAVTT) was calculated as the difference between the arrival times in the hepatic artery and the hepatic vein. AT HA, TTP HA, AT HV, TTP HV and HAVTT in the patient group were significantly shorter than those of the control group (P<0.01). PI HA and PI HV in the patient group were significantly higher than those of the control group (P<0.01). These results suggest that CEUS assessment of changes in the haemodynamic parameters of the hepatic artery and vein help to diagnose liver metastases. This functional imaging technique may contribute to the early detection of micrometastases in the liver.     

超声造影评估慢性肾动能不全患者肾血流灌注的研究

目的 探讨超声造影定量分析技术评估肾功能不全患者肾血流灌注的应用价值.资料与方法 36例慢性肾功能不全患者(研究组)及42例无肾脏疾病者(对照组)行超声造影检查,使用随机QLAB分析软件获取肾脏超声造影血流灌注时间-强度曲线(TIC)及相关参数[曲线下面积(AUC)、曲线上升支斜率(A)、峰值强度(PI)、达峰时间(TTP)、曲线下降支斜率(α)],并分析其与血肌酐(Scr)及尿素氮(BUN)水平的关系.结果 研究组肾皮质血流灌注TIC上升、下降均缓慢,TTP延迟;与对照组比较,研究组肾皮质定量灌注参数中,AUC增大、PI减低、A增大、TTP延长(P＜0.05).AUC、TTP、A与Scr(r=0.89、0.73、0.70,P＜0.05)、BUN(r=0.84、0.77、0.65,P＜ 0.05)呈正相关,PI与Scr(r=-0.64,P＜0.05)、BUN(r=-0.71,P＜0.05)呈负相关;α与Scr(r=0.04,P＞ 0.05)、BUN (r=0.05,P＞0.05)无显著相关性.结论肾脏实时超声造影定量分析技术可实时观察肾皮质血流灌注过程,其定量灌注参数可反映慢性肾功能不全患者肾皮质血流灌注的真实水平,与Scr及BUN水平有良好的相关性.     

肝纤维化不同部位超声造影定量参数差异性的研究

目的:探讨肝纤维化患者肝脏不同部位超声造影定量参数有无差异性。方法:研究对象为经病理证实的肝纤维化患者16例,均经肘静脉团注对比剂SonoVue 2.4ml,采集实时动态造影数据3min,使用超声造影定量分析软件进行脱机分析。分别记录浅层、中层、深层肝实质造影始增时间及强度,达峰时间、达峰强度和曲线上升斜率。结果:浅层、中层和深层肝实质各项参数中:中层肝实质造影始增时间较深层明显缩短(P<0.05),浅层肝实质造影始增强度明显低于中、深层(P<0.05),浅层肝实质达峰强度显著高于深层(P<0.05),浅、中层肝实质曲线上升斜率显著高于深层(P<0.05),达峰时间组间两两比较差异无统计学意义(P>0.05)。结论:超声造影定量参数可反映肝纤维化患者肝脏不同部位的血流灌注特征。     

Contrast enhanced ultrasound quantitative parameters for assessing neoadjuvant chemotherapy response in patients with locally advanced breast cancer

Objectives:To evaluate the role of contrast-enhanced ultrasound (CEUS) quantitative parameters in predicting neoadjuvant chemotherapy (NACT) response in patients with locally advanced breast cancer (LABC).Methods:30 patients with histologically proven LABC scheduled for NACT were recruited. CEUS was performed using a contrast bolus of 4.8 ml and time intensity curves (TICs) were obtained by contrast dynamics software. CEUS quantitative parameters assessed were peak enhancement (PE), time-to-peak (TTP), area under the curve (AUC) and mean transit time (MTT). The parameters were documented on four consecutive instances: before NACT and 3 weeks after each of the three cycles. The gold-standard was pathological response using Miller Payne Score obtained pre NACT and post-surgery.Results:A decrease in mean values of PE and an increase in mean values of TTP and MTT was observed with each cycle of NACT among responders. Post each cycle of NACT (compared with baseline pre-NACT), there was a statistically significant difference in % change of mean values of PE, TTP and MTT between good responders and poor responders (p-value < 0.05). The diagnostic accuracy of TTP post-third cycle was 87.2% (p = 0.03), and MTT post--second and third cycle was 76.7% (p = 0.004) and 86.7% (p = 0.006) respectively.Conclusion:In responders, a decrease in the tumor vascularity was reflected in the CEUS quantitative parameters as a reduction in PE, and a prolongation in TTP, MTT.Advances in knowledge:Prediction of NACT response by CEUS has the potential to serve as a diagnostic modality for modification of chemotherapy regimens during ongoing NACT among patients with LABC, thus affecting patient prognosis.     

High intensity focused ultrasound treatment of adenomyosis: The relationship between the features of magnetic resonance imaging on T2 weighted images and the therapeutic efficacy

ObjectivesTo investigate the relationship between the features of magnetic resonance imaging (MRI) on T2 weighted images (T2WI) and the therapeutic efficacy of high intensity focused ultrasound (HIFU) on adenomyosis.Materials and methodsFrom January 2011 to November 2015, four hundred and twenty-eight patients with symptomatic adenomyosis were treated with HIFU. Based on the signal intensity and the number of hyperintense foci in the adenomyotic lesions on T2WI, the patients were classified into groups. The day after HIFU ablation patients underwent contrast-enhanced MRI and a comparison was made of non-perfused volume (NPV) ratio, energy efficiency factor (EEF), treatment time, sonication time, and adverse effects.ResultsNo significant difference in terms of HIFU treatment settings and results was observed between the group of patients with hypointense adenomyotic lesions and the group with isointense adenomyotic lesions (P > 0.05). However, the sonication time and EEF were significantly higher in the group with multiple hyperintense foci compared to the group with few hyperintense foci. The NPV ratio achieved in the lesions with multiple hyperintenese foci was significantly lower than that in the lesions with few hyperintense foci (P < 0.05). No significant difference was observed in the rate of adverse effects between the two groups.ConclusionsBased on our results, the response of the adenomyotic lesions to HIFU treatment is not related to the signal intensity of adenomyotic lesions on T2WI. However, the number of the high signal intensity foci in the adenomyotic lesions on T2WI can be considered as a predictive factor to help select patients for HIFU treatment.     

Enhancement characteristics of benign and malignant focal peripheral nodules in the peripheral zone of the prostate gland studied using contrast-enhanced transrectal ultrasound

AIM: To assess the value of contrast-enhanced grey-scale transrectal ultrasound (CETRUS) in predicting the nature of peripheral zone hypoechoic lesions of the prostate. MATERIALS AND METHODS: Ninety-one patients with peripheral zone hypoechoic lesions on ultrasound were evaluated with CETRUS followed by lesion-specific and sextant transrectal ultrasound-guided biopsies. The enhancement patterns of the lesions were observed and graded subjectively using adjacent peripheral zone tissue as the reference. Time to enhancement (AT), time to peak intensity (TTP) and peak intensity (PI) were quantified within each nodule. Ultrasound findings were correlated with biopsy findings. RESULTS: Transrectal ultrasound-guided biopsy of the hypoechoic lesions revealed prostate cancer in 44 patients and benign prostatic diseases in 47. The intensity of enhancement within the lesions were graded as no enhancement, increased, equal, or decreased compared with adjacent peripheral zone tissue in two, 30, five and seven in the prostate cancer group and 14, 15, four and 14 in the benign group, respectively. The difference was statistically significant (p<0.05). The peak enhancement intensity was found to be the most optimal discriminatory parameter (area under curve AUC 0.70; 95% CI: 0.58, 0.82). CONCLUSION: Malignant hypoechoic nodules in the peripheral zone of the prostate are more likely to enhance early and more intensely on CETRUS. A non-enhanced hypoechoic peripheral zone lesion was more likely to be benign.     

Features of time-intensity curve parameters of colorectal adenocarcinomas evaluated by double-contrast enhanced ultrasonography: initial observation

Purpose

This study is to investigate the value of double contrast-enhanced ultrasonography (DCEU) in assessing microcirculation of colorectal adenocarcinomas and to describe the perfusion features of the tumours.

Material and methods

DCEUS was performed in 42 patients with adenocarcinoma. The time–intensity curve parameters (arrival time (AT), time-to-peak (TTP), peak intensity (PI) and area under the curve (AUC)) within the tumours were extracted. The parameters were compared among the tumours with different CEUS features and stages.

Results

The mean values of AT, TTP, PI and AUC of the colorectal adenocarcinomas were 13.68 ± 13.36 s, 32.61 ± 19.56 s, 19.82 ± 16.54 dB and 271.10 ± 159.19 dB s, respectively. In the adenocarcinomas with necrosis, the mean values of AUC was significantly lower than that of the adenocarcinomas without (231.10 ± 219.27 dB s, 278.10 ± 123.20 dB s, p = 0.004). In the adenocarcinomas with necrosis, the AUC and PI of the non-necrotic part were significantly higher than that of the necrotic part (p = 0.007, 0.0025, respectively). AUC increased progressively in the subgroups of T2, T3 and T4 and the difference of AUC between T2 and T4 subgroup was significant (p = 0.008).

Conclusions

Double contrast-enhanced ultrasonography is a valuable technique for quantifying tumour vascularity of colorectal adenocarcinomas. AUC was significantly different in the subgroups of different T stage. AUC and PI could reflect the different perfusion status of tumours with or without necrosis.     

Evaluation of short-term response of high intensity focused ultrasound ablation for primary hepatic carcinoma: Utility of contrast-enhanced MRI and diffusion-weighted imaging

Objective

To explore the significance of contrast-enhanced MRI (CE-MRI) and diffusion-weighted imaging (DWI) in evaluating the short-term response of high intensity focused ultrasound (HIFU) ablation for primary hepatic carcinoma (PHC).

Methods

Thirty-nine lesions in the livers of 27 patients were performed HIFU ablation. Conventional MRI sequences, CE-MRI and DWI were performed 1 week before HIFU and 1 week, 3 months after the therapy, respectively. The short-term responses of HIFU for all lesions were evaluated with MRI.

Results

28 of the 39 lesions (28/39, 71.8%) showed complete necrosis with no enhancement 1 week and 3 months after HIFU. The apparent diffusion coefficient (ADC) values 1 week and 3 months after HIFU were significantly higher than those 1 week before treatment (p < 0.05). The tumor recurrence was detected in 7 of the 39 lesions (7/39, 17.9%) which had no significant enhancement 1 week after HIFU. On the 3 months follow-up, focal nodules were found on the inner aspects of the treated areas. The ADC values had no significant difference between 1 week before and after treatment (p > 0.05), however, they were significantly higher 3 months after HIFU (p < 0.05). The tumor residuals were detected in 4 of the 39 lesions (4/39, 10.3%) showing enhancement 1 week after treatment and increased size 3 months after HIFU. The ADC values had no significant difference among 1 week before HIFU, 1 week and 3 months after treatment (p > 0.05).

Conclusion

CE-MRI and DWI can be employed to evaluate the short-term response of HIFU ablation for PHC and to guide the patient management.