APPLICATION OF TRANSVAGINAL CDFI IN THE DISTINGUISHMENT BETWEEN BENIGN AND MALIGNANT OVARIAN TUMORXUE

Objective To assess the value of transvaginal CDFI in the diagnosis of malignant ovarian tumors and to discriminate the benign from malignant ovarian tumors. Methods96 patients pelvic masses were studied by transvaginal ultrasonograph mass scoring, and by CDFI through pulsatility index (PI) and resistance index (RI) of peripheral blood flow of mass analyses.ResultsMass ultrasonic scoring: scoring＞9, 91.9% masses were malignant tumors. Scoring≤9, 91.5% masses were benign tumors. PI and RI of peripheral blood flow of masses were detected by CDFI: PI＜1.0, 92.5% cases; RI＜0.5, 97.4% cases were malignant tumors. The diagnosis match rate of malignant ovarian tumors was 97.0%. The diagnosis match rate of benign ovarian tumor was 96.2%. The diagnosis match rate was improved.ConclusionOvarian mass ultrasonic scoring＞9 and PI＜1.0, RI＜0.5 of mass peripheral blood flow are the special ultrasonic features of malignant ovarian tumor and the better methods to distinguish the benign ovarian tumor from the malignant one.     

APPLICATION OF TRANSVAGINAL CDFI IN THE DISTIN- GUISHMENT BETWEEN BENIGN AND MALIGNANT OVARIAN TUMOR

Objective To assess the value of transvaginal CDFI in the diagnosis of malignant ovariantumors and to discriminate the benign from malignant ovarian tumors. Methods 96 patients pelvic masses were studied by transvaginal ultrasonograph mass scoring, and by CDFI through pulsatility index (PI) and resistance index (RI) of peripheral blood flow of mass analyses. Results Mass ultrasonic scoring : scoring >9, 91.9% masses were malignant tumors. Scoring ≤<9, 91.5% masses were benign tumors. PI and Rl of peripheral blood flow of masses were detected by CDFI: Pl< 1 .0 . 92.5% cases; RI<0.5, 97.4% cases were malignant tumors. The diagnosis match rate of malignant ovarian tumors was 97.0% . The diagnosis match rate of benign ovarian tumor was 96 .2% . The diagnosis match rate was improved. Conclusion Ovarian mass ultrasonic scoring>9 and PI< 1 .0 , RI<0 .5 of mass peripheral blood flow are the special ultrasonic features of malignant ovarian tumor and the better methods to distinguish the benign ovarian tumor fro     

彩色多普勒阴道超声对卵巢肿瘤的诊断价值

121 patients who recieved ovarian operation among 1200 cases investigation were analyzed in the results on Doppler ultrasonic examination and pathological reports. The results indicated that it need a continuous observation to make a differential diagnosis between benign and malignant ovarian tumor according to its blccd supply, quality, stage and invasion.     

Diagnosis of intrathoracic masses by transesophageal color Doppler echocardiography.

OBJECTIVE To evaluate the value of transesophageal color Doppler echocardiography in the diagnosis of intrathoracic masses.

METHODS Twenty patients with intrathoracic masses were examined by transesophageal echocardiography (TEE), including 12 patients with central lung masses and 8 with mediastinal masses. The neoplasms were explored by two-dimensional realtime ultrasonography, Doppler color flow imaging (DCFI) and pulsed Doppler (PD). The results were compared with computed tomography (CT), operative and pathological examination findings.

RESULTS We were able to identify the size, structure (solid or cystic), anatomic relationship, metastatic lymph nodes and venous carcinoembolus of the masses. Furthermore, the hemodynamic data in the vasculature inside the masses were detected.

CONCLUSIONS As a new method, TEE with Doppler technique is not only valuable in differentiating malignant and benign neoplasms but also useful for preoperative evaluation of the mass resectability in patients with intrathoracic neoplasms.

     

磁共振动态增强扫描血管图在乳腺癌诊断中的应用

Total 52 patients with breast lesions underwent dynamic contrast-enhanced breast MRI; and the breast vascularization was scored on the MRI vascular maps with a range of 0 to 3. The mean number of vessels per ipsilateral breast in malignant cases was higher than that of benign cases (3.8±2.0 vs. 1.3± 1.0; P=0.000). When the breast vascularity score 0-1 was defined as benign and 2-3 was defined as malignant, the sensitivity and specificity was 79% and 83%, respectively. Results indicate that dynamic contrast-enhanced breast MRI is of value in diagnosis of malignant breast lesions.     

Role of laparoscopy in the diagnosis and treatment of adnexal masses

Background Laparoscopy has been accepted for years as a management of benign ovarian tumors. The aim of this study was to estimate the feasibility and safety of laparoscopy in diagnosis and management of adnexal masses. Methods A total of 2083 patients with benign adnexal mass were treated by laparoscopy at Peking Union Medical College Hospital from January 2000 to December 2003. Their clinical data were reviewed retrospectively. All the adnexal masses suspicious of malignancy at the time of laparoscopy were sent for frozen section evaluation intraoperatively. The rates of unexpected intracystic vegetation and low malignant potential （LMP） tumor or malignancy were investigated. The sensitivity, specificity, positive predictive value, and negative predictive value of laparoscopic diagnosis for LMP or ovarian malignancies were calculated. The ratios were compared by Chi-square test and the continuous variables were tested using two-tailed t test. Results Of the 2083 patients, 16 had LMP or invasive tumors （0.77%）, among which 14 were diagnosed histologically intraoperatively and 2 postoperatively. Fifty-five （2.6%） of the 2083 patients had unexpected intracystic vegetations. Their frozen sections showed benign tumors in 41 （74.5%）, LMP tumors in 8 （14.5%）, and focal invasive ovarian cancers （stage Ic） in 6 （10.9%）. The final pathological diagnosis were benign tumors in 41 （74.5%）, LMP tumors 7 （12.7%）, and focal invasive ovarian cancers （stage Ic） in 7 （12.7%）. Laparoscopy achieved a sensitivity of 87.5%, specificity of 98%, positive predictive value of 25.5%, and negative predictive value of 99.9% in the diagnosis of ovarian malignancies. 2067 cases with benign adnexal masses underwent laparoscopy successfully. No conversion to laparotomy, or intra- and postoperative complications in this series. Of the 16 patients with LMP or invasive ovarian cancer, seven underwent laparoscopic surgery including immediate staging laparoscopy in 3. The mean follow-up was 17.3 months for the 16 patients. Among them, 1 developed a recurrent LMP tumor in the contralateral ovary 36 months after laparoscopic salpingo-oophorectomy, and received subsequent laparoscopic cystectomy and pelvic lymph node sampling; the others had no evidence of recurrent tumor during the follow-up. Contusion Laparoscopy is feasible for diagnosis of adnexal masses, and the surgery is safe for patients with benign ovarian tumors.     

脑梗死患者颅外段颈动脉及椎动脉的超声诊断价值

目的 探讨彩色多普勒超声对脑梗死患者颅外段颈动脉及椎动脉超声检查的临床价值.方法 对91例脑梗死住院患者行颅外段颈动脉、椎动脉彩色多普勒检查,观察其动脉壁的形态病变性质和动脉管腔的内径及椎动脉的最大流速(PSV)、阻力指数(RI).结果 91例脑梗死患者中,内径超过正常范围的颈总动脉最多,其中左侧17例,右侧22例.斑块生长部位以颈总动脉多见,类型以扁平斑最多,其次为硬斑.椎动脉PSV减低多见,其中左侧52例,右侧57例;RI超出正常范围的,左侧22例,右侧36例.结论 脑梗死患者颅外段颈动脉及椎动脉的彩色多普勒超声常规检查,提供了形态学及血流动力学改变,为临床诊断及治疗提供了重要的信息. Abstract： Objective To evaluate the clinical value of the color Doppler ultrasound for cerebral infarction in patients with extracranial carotid artery and vertebral artery. Methods Ninty-one cases of cerebral infarction patients in the hospital were examined of extracranial internal carotid artery, vertebral artery by color Doppler ultrasound. The pathological change patterns of arterial wall and the inner diameter of the arterial lumens and the peak flow rate (PSV), resistent index (RI)of the vertebral artery were observed.Results In the 91 cases of cerebral infarction patients, the inner diameter of carotid artery beyond the normal range, there were 17 cases in the left, 22 cases in the right.The most plaqueslie in carotid artery.The type of plaques was flat applanation spot at most, following was hard spot.Vertebral artery's peak flow rate was usually reduce, 52 cases in left, 57 cases in right. 22 patients' resistent index beyond the normal range in the left, and 36 cases in right.Conclusions The color Doppler ultrasound to extracranial carotid artery and vertebral artery provides the morphology and hemodynamics's change, offers important messages for the clinical diagnosis and treatment in the cerebral infarction.     

EVALUATION OF THE DIAGNOSTIC CRITERIA FOR THE LOCALIZATION OF ACQUIRED ARTERIOVENOUS FISTULAS BY COLOR DOPPLER FLOW IMAGING

Objective. To evaluate the diagnostic criteria for the localization of acquired artoriovenous fistulas (AVFs) by color Doppler flow imaging (CDFI) based on the features of their hemodynamic changes. Met hods. The shape and hemodynamic changes of involved vessels which could be helpful to localize the sites of fistulas were studied according to the observation of 10 cases of acquired AVFs. Results. The sites of the fistulas could be shown by two-dimensional ultrasonography and color flow imaging in 40% and 80% cases, respectively. In all cases, turbulent high-velocity flow was present at the sites of the fistulas, low resistant flow was present in the arteries proxlmaI to the fistulas, and artery-like flow was detected in the veins. Conclusion. CDFI was accurate for the localization of acquired AVFs, which were mainly localized by their hemody,amic changes shown by pulse Doppler ultrasound.     

Clinical Value of Contrast-enhanced Ultrasound in Differentiating Benign and Malignant Focal Liver Lesions

To explore the clinical value of contrast-enhanced ultrasound （CEUS） in differentiating benign and malignant focal liver lesions （FLLs） with SonoVue, CEUS was used to examine 113 patients with focal liver lesions （FLLs） in our hospital during July 2005 to December 2006. All the patients underwent contrast-enhanced CT （CECT） or contrast-enhanced MRI （CEMRI）. Except for patients with focal fatty sparings （n=18） and with hemangiomas （n=8）, all the patients were confirmed by operation or ultrasonic-guided liver puncture biopsy. A sulfur hexafluoride gas-based contrast agent was used with a MI of 0.15 to 0.17. Forty-eight cases of malignant FLLs, including 30 hepatocellular carcinomas （HCCs）, 2 cholangiocarcinomas and 16 metastatic tumors, were detected. Seventy-eight cases of benign FLLs, including 33 hemangiomas, 9 focal nodular hyperplasias （FNHs）, 19 focal fatty sparings, 5 abscesses, 7 regenerative nodules and 2 inflammatory pseudo-tumor, were involved. The contrast pattern of benign and malignant FLLs was quite different. CEUS has higher specificity and sensitivity than conventional ultrasound in differentiating benign and malignant FLLs.     

Differential diagnosis of isolated calf muscle vein thrombosis and gastrocnemius hematoma by high-frequency ultrasound

Background Differential diagnosis of isolated calf muscle vein thrombosis （ICMVT） and gastrocnemius hematoma is essential for early identification of deep vein thrombosis （DVT）.This study aimed to investigate the diagnostic value of high-frequency color Doppler ultrasound for differential diagnosis of ICMVT and gastrocnemius hematoma.Methods A retrospective case series of 35 ICMVT （M∶F,21∶14; mean age （64.5±10.6） years） and 23 gastrocnemius hematoma （M∶F,16∶7; mean age （75.4±11.8） years） patients with bilateral/unilateral lower limb pain was conducted between January 2006 and September 2012.Characteristics and the morphology of high-frequency color Doppler ultrasonography of the lower limb deep vein,great saphenous vein,calf muscles,skin,and soft tissue were examined.Results ICMVT hypoechoic signals were characterized by long,tube-like masses on longitudinal sections and oval masses on transverse sections,with apparent muscle thrombosis boundaries,distal and proximal venous connections,and,often,lower limb DVT.Gastrocnemius hematoma hypoechoic signals were characterized by large volumes,enhanced posterior hematoma echo,hyperechoic muscle boundaries,no hematoma blood flow,and no DVT,and clear differences in trauma/exercise-and oral anticoagulant-induced hematomas were readily apparent.According to the measurement,the ratio of long diameter/transverse diameter （D/T） in ICMVT patients was about less than 2.0,whereas in gastrocnemius hematoma patients the ratio was more than 2.0.Early stage isoechoic and hypoechoic signals were detected with gradually increasing ovular anechoic areas.Partial muscle fibers in the hematoma due to muscle fractures were apparent.Conclusion High-frequency color Doppler ultrasound was found to be a sensitive and reliable method for differential diagnosis of ICMVT and gastrocnemius hematoma due to trauma and exercise or prolonged oral anticoagulant use.     

超声造影联合血清CA125检测在卵巢肿块良恶性鉴别诊断中的初步应用

目的探讨超声造影联合血清CA125检测在卵巢肿块良恶性鉴别诊断中的应用价值.方法回顾性分析49个卵巢肿块的彩色多普勒、超声造影表现以及血清CA125检测水平,并与临床诊断结果进行对照.结果 49个卵巢肿块中,彩色多普勒超声检查判断肿块良恶性的准确率、敏感度和特异度分别为67.35%(33/49)、70.00%和63.16%,超声造影检查判断卵巢肿块良恶性的准确率、敏感度和特异度分别为85.71%(42/49)、86.67%和84.21%,超声造影检查联合血清CA125检测判断卵巢肿块良恶性的准确率、敏感度和特异度分别为97.96%(48/49)、100.00%和94.74%.3种检查方法的诊断准确率、敏感度和特异度的差异均有统计学意义(P值均<0.05).结论超声造影检查能显示卵巢肿块内微小血管的血流灌注和血管形态,超声造影检查结合血清CA125检测能进一步提高对卵巢肿块良恶性的鉴别诊断价值.     

261例绝经后妇女卵巢肿块分析

目的探讨绝经后妇女卵巢肿块的性质、诊断及处理原则。方法通过对261例绝经后妇女卵巢肿块患者的临床资料进行回顾性分析,探讨绝经后卵巢肿块合理的诊断措施和处理方式。结果本组绝经后卵巢肿块中恶性肿瘤占27.9%,交界性肿瘤占5.36%。44.4%的患者无任何症状。术前可经B超、彩超和CA-125检测初步鉴别肿瘤的性质。良性肿瘤多数行患侧附件切除,恶性肿瘤行细胞灭减术。结论绝经后妇女应定期进行妇科检查,必要时结合B超、彩超及CA-125检测协助诊断。绝经后卵巢肿块应予以重视,一旦确诊卵巢肿块,只要患者病情允许,应尽早剖腹探查。     

彩色多普勒超声对乳腺良恶性肿块诊断的价值

目的应用彩色多普勒观测乳腺肿块的血流特点,评价其在鉴别乳腺良恶性肿块方面的意义。方法应用高频彩色多普勒对135例156个乳腺肿块进行扫查,观察肿块的彩色血流信号、血流分布部位及血流参数,与手术病理结果对照分析。结果恶性组血流检出率明显高于良性组,前者以Ⅱ、Ⅲ级为主,后者以0、Ⅰ级为主;良性组血流分布以周边及内部血流为主;恶性以穿入及内部血流为主;良性组的峰值流速及阻力指数均明显低于恶性组。结论彩色多普勒超声是鉴别乳腺良恶性肿块的重要指标。     

剪切波弹性成像对后方回声衰减型乳腺肿物的鉴别诊断价值

目的研究剪切波弹性成像(SWE)联合彩色多普勒超声对后方回声衰减型乳腺肿物良恶性的鉴别诊断价值。 方法选取后方回声衰减型乳腺肿物患者100名,随机均分为对照组(彩色多普勒超声)和联合组(SWE联合彩色多普勒超声),按病理结果分为良性组和恶性组。比较各组超声诊断结果和SWE参数。根据病理结果评价SWE联合彩色多普勒超声的诊断效力。 结果与单纯SWE诊断及单纯超声诊断相比,联合组SWE+超声诊断的假阳性率最低；恶性组SWE弹性模量平均值(E_mean)、最大值(E_max)明显高于良性组。ROC曲线分析发现,SWE和彩色多普勒超声联合检测对后方回声衰减型乳腺肿物良恶性的鉴别诊断价值高于单独检测。 结论SWE联合彩色多普勒超声检测可更精准地评估后方回声衰减型乳腺肿物的良恶性,但不排除发生假阳性结果的可能。     

彩色多普勒超声血流阻力指数联合血清CA125测定在卵巢肿瘤诊断中的应用价值

目的 分析彩色多普勒超声血流阻力指数(RI)联合血清癌抗原125(CA125)测定在卵巢肿瘤诊断中的应用价值.方法 选取2012年11月至2016年11月间于深圳市宝安区人民医院妇科接受手术治疗的卵巢肿瘤患者90例为研究对象,均接受超声及血清CA125检查,比较卵巢良恶性肿瘤患者RI、中心血流及血清CA125的差异.以手术病理结果为金标准,分析和比较超声RI、血清CA125检查对卵巢良恶性肿瘤的诊断效力.结果 卵巢恶性肿瘤RI为(0.41±0.12),明显低于卵巢良性肿瘤的(0.62±0.16),存在中心血流的比例为53.3%,明显高于卵巢良性肿瘤的31.1%,差异均有统计学意义(P<0.05).卵巢恶性肿瘤CA125水平为(546.5±192.3)U/mL,明显高于卵巢良性肿瘤的(28.7±14.3)U/mL,差异有统计学意义(P<0.05).单独应用超声RI、血清CA125对卵巢良恶性肿瘤诊断敏感性、特异性等均低于85%.两者联合应用诊断效力提高,诊断敏感性、特异性、阳性预测值、阴性预测值及诊断符合率分别达88.9%、91.1%、90.9%、89.1%及90.0%.结论 超声RI、血清CA125对卵巢良恶性肿瘤的鉴别诊断具有较高的应用价值,联合应用可以提高诊断效力.     

经阴道彩色多普勒超声对卵巢肿瘤良恶性鉴别的意义

目的探讨经阴道彩色多普勒超声（TVS—CD）对卵巢肿瘤良恶性鉴别的意义。方法TVs—CD检测92例卵巢实性或囊实性肿块的二维灰阶图像特点及血流动力学,与术后病理对照。结果71例引出动脉血流肿块中以阻力指数（RI）〈0．5作为恶性肿瘤的诊断标准,其诊断的敏感性为96．6％,特异性为93．3％。92例肿块中以RI〈0．5作为诊断标准,加用二维灰阶超声标准,诊断的敏感性为90．0％,特异性为90．3％。结论RI能提高超声对恶性卵巢肿瘤的诊断率,经阴道彩色多普勒超声对鉴别卵巢肿瘤良恶性具有重要的临床意义。     

高频彩色多普勒超声对乳腺肿块的诊断分析

目的探讨乳腺肿块的高频彩色多普勒（CDFI）超声表现及其诊断、鉴别诊断分析。方法对术前137例乳腺肿块病例进行超声检查,观察并记录乳腺的厚度、肿块内部回声、形态、边界、肿块大小,分析其有无及钙化方式、彩色血流信号等情况。结果高频CDFI诊断137例肿块中,实质性126例,囊性11例,良性肿块86,恶性肿块51例;良恶性肿块除9例与手术病理不符合外,总符合率为93.4%（128/137）;高频CDFI超声对乳腺良恶性肿块的血流检出率及血流阻力指数均有显著差异,P〈0.01。结论高频CDFI超声检查对乳腺肿块的性质、良恶性鉴别诊断有重要作用,对临床手术均有指导意义。     

Logistic回归分析在超声多参数鉴别乳腺良、恶性肿块中的应用

目的：研究高频超声多参数鉴别乳腺良、恶性肿块的价值。方法：记录145个乳腺肿块二维灰阶声像图参数和彩色多普勒血流参数,获取各肿块病理确诊结果,Logistic回归统计分析多参数综合鉴别诊断乳腺肿块良恶性的价值。结果：单独二维灰阶声像图参数的Logistic回归模型综合鉴别乳腺肿块性质的准确率为82.1%,二维灰阶声像图结合彩色多普勒多参数的Logistic回归模型综合鉴别诊断乳腺良恶性肿块的准确率为93.3%。结论：应用二维灰阶声像图结合彩色多普勒多参数的Logistic回归分析能提高乳腺良、恶性肿块鉴别的准确性。     

彩色多普勒超声血流阻力指数联合CA125检测对卵巢肿瘤的诊断价值

目的:探讨彩色多普勒超声血流阻力指数(resistance index,RI)联合血清肿瘤标记物糖链抗原125(CA125)对卵巢肿瘤的诊断价值。方法:选取经病理证实的良性卵巢肿瘤50例,恶性卵巢肿瘤42例,比较良、恶性卵巢肿瘤超声声像图表现、血流信号、RI及CA125水平,分析RI、CA125单独及联合检测卵巢肿瘤的诊断价值。结果:良性卵巢肿瘤超声多表现为囊性回声,恶性则多表现为囊实性混合回声。良、恶性卵巢肿瘤血流率分别为28.0%和85.7%,两者比较差异有统计学意义(P<0.01)。恶性卵巢肿瘤RI值显著低于良性卵巢肿瘤(P<0.01),但CA125水平明显高于良性卵巢肿瘤(P<0.01)。RI联合CA125检测卵巢肿瘤的敏感度和特异度均高于RI、CA125单独检测。结论:彩色多普勒超声血流RI联合血清CA125检测在鉴别诊断良、恶性卵巢肿瘤方面优于RI、CA125单独检测。     

彩色多普勒超声、MSCT联合血清HFA检测诊断卵巢恶性肿瘤的价值观察

目的探究彩色多普勒超声、多层螺旋CT(MSCT)联合血清人附睾上皮分泌蛋白4(HFA)检测诊断卵巢恶性肿瘤的应用价值。方法回顾性分析2016年9月至2018年9月就诊于我院妇产科经手术治疗且术后病理诊断为卵巢肿瘤的68例临床病例,术前均进行彩色多普勒超声、MSCT检查。另选取同期我院体检中心体检的30例健康志愿者为对照组,检测并比较各组血清HFA水平。以病理结果为金标准,绘制ROC曲线,计算ROC曲线下面积(AUC)分析诊断效能。结果恶性组血清HFA水平显著高于良性组与对照组,差异有统计学意义(P<0.05);而良性组与对照组血清HFA水平比较差异无统计学意义(P>0.05);彩色多普勒超声、MSCT、血清HFA检测及其三者联合诊断卵巢恶性肿瘤的AUC分别为0.833、0.906、0.789、0.938,彩色多普勒超声、MSCT联合血清HFA检测诊断卵巢恶性肿瘤的AUC显著高于单独诊断。结论彩色多普勒超声、MSCT、血清HFA检测三者联合诊断可显著提高诊断敏感度与准确性,作为卵巢恶性肿瘤诊断的有效手段,可为患者临床诊疗方案提供依据。