新生儿肛门闭锁经会阴部二维超声诊断及其临床意义

目的 探讨二维超声诊断先天性肛门闭锁的方法、准确性及其临床意义.方法 对比分析61例先天性肛门闭锁患儿的经会阴超声、X线平片及手术结果,男55例,女6例,出生1～10 d.结果 二维超声检查诊断中高位肛门闭锁24例,术前超声诊断符合率92.0％,低于X线平片(95.8％),但差异无显著性(P＞0.05).诊断低位肛门闭锁37例,术前超声诊断符合率94.4％,高于X线平片(44.4％),差异有高度显著性(P＜0.01).应用直肠盲端至肛门隐窝皮肤间的距离(P-Pe)、直肠盲端位置、肛门括约肌的声像图诊断先天性肛门闭锁的特异性分别为94.4％、88.8％、94.4％;准确性分别为91.8％、88.5％、93.4％.结论 新生儿肛门闭锁经会阴部二维超声诊断可行,可作为首选的无创性影像学方法,对手术方法选择有重要意义.     

超声检查在先天性肛门直肠畸形诊断中的临床意义

[目的]探讨超声检查在先天性肛门直肠畸形诊断中的价值.[方法]运用高频探头对46例先天性肛门直肠畸形患儿进行超声检查测量直肠盲端距皮肤的距离,观察耻骨直肠肌与直肠盲端的关系,并与X线影像结果及手术结果进行比较.[结果]46例经超声检查诊断高、中、低位先天性直肠畸形,与手术结果对照符合率达95.2%.[结论]超声检查诊断肛门直肠畸形简单易行,诊断符合率高,费用低廉,是诊断肛门直肠畸形的首选检查方法.     

MRI在小儿先天性肛门直肠畸形诊断中的应用及准确性分析

目的探讨小儿先天性肛门直肠畸形(ARM)诊断中磁共振(MRI)的应用及其准确性。方法选取2017年1月至2018年12月该院收治的60例ARM患儿为研究对象,所有患儿均进行倒立位X线片检查与MRI检查。将手术病理检查结果作为金标准。比较两种诊断方法最终的诊断结果、诊断准确率。结果 MRI诊断的高位肛门闭锁型ARM 24例、中位肛门闭锁型ARM 33例,直肠盲端均位于PC线以上,其距肛门窝的距离均≥2.1cm。倒立位X线片诊断的高位肛门闭锁型ARM 20例、中位肛门闭锁型ARM 30例,直肠盲端均于PC线基本水平,其距肛门窝的距离约为1.8cm。MRI诊断的高位肛门闭锁型ARM、中位肛门闭锁型ARM例数多于倒立位X线片检查例数,差异有统计学意义(P<0.05)。结论 ARM诊断中,MRI的诊断结果准确、可靠,适宜在临床上多加推广。     

中老年人非外伤性食管裂孔疝的超声诊断研究

目的 探讨经腹超声诊断中老年人非外伤性食管裂孔疝的临床床价值.方法 采用空腹及饮水胃充盈法,对32例患者进行半坐位或立位、仰卧位与仰卧右前斜位超声检查,并与X线钡餐造影、内镜检查或(和)手术对照.结果 滑动性食管裂孔疝29例,嵌入性疝3例,超声诊断符合率100%.声像图直接征象为膈肌食管裂孔增宽(≥1.37 cm)、膈上疝囊及疝囊中可见胃黏膜回声,三者显示率分别为100%、100%、15.6%.结论 经腹超声可简便、准确地诊断中老年人非外伤性食管裂孔疝.     

高频凸阵探头对儿童先天性肛门直肠畸形的诊断价值

目的 探讨高频凸阵探头对儿童先天性肛门直肠畸形的超声图像特征及诊断价值.方法 应用高频凸阵探头对78例先天性肛门直肠畸形患者进行检查,分析其声像图特点,并于术前行X-线检查.结果 78例先天性肛门直肠畸形中,直肠盲端距肛穴皮肤>20 mm(高位畸形)者30例,15～20 mm(中间位畸形)者13例,<15 mm(低位畸形)者35例.高频凸阵探头判定失误2例,X-线检查判定失误9例,直肠盲端与肛穴皮肤间距的超声测量与外科检测结果基本一致,在本类疾病的临床分型中,高频凸阵探头检查明显优于X-线.结论 应用高频凸阵探头对患有先天性肛门直肠畸形的儿童进行检查,图像清晰,解剖层次分明,对本类疾病的临床分型有极为实际的应用价值.     

B超在先天性肛门闭锁术前定位的应用价值

目的:探讨超声检查对先天性肛门闭锁的定位诊断价值。方法:对30例先天性肛门闭锁患儿术前使用超声及X线检查,测定直肠盲端与肛门隐窝皮肤之间的距离(P-P间距)及设立耻尾线(PC线)。并与手术结果对照。结果:30例患儿均获得满意的直肠盲端及肛区皮肤声像图,28例患儿能准确测得P-P间距,24例患儿能满意设立PC线。与手术结果对照,超声定位诊断符合率达93.3%,X线检查的符合率为76.6%,二者差异有统计学意义(P<0.05)。结论:与X线检查相比,超声检查应用于肛门闭锁术前定位诊断,具有准确率高、安全简便、实用等优点,值得临床推广应用。     

彩色多普勒超声对左肾静脉受压综合征的诊断探讨

目的 探讨彩色多普勒超声诊断左肾静脉受压综合症(nut-cracker syndrome,简称NCS)的价值.方法 对100例健康体检者(对照组)与74例NCS患者(病例组)仰卧位、站立背伸位及跪位时,测量左肾静脉(LRV)位于腹主动脉(AO)和肠系膜上动脉(SMA)问段内径(a)、LRV近肾端内径(b),计算b/a值.测量a、b段最大流速(Va、Vb);计算最窄处峰值静脉压(△P).测量仰卧位时AO和SMA形成的夹角,将两组所得数据进行对比分析.结果 仰卧位和站立位时,b/a值病例组较对照组大;b/a≥3者病例组有59例(79.73%),而对照组有4例(4.00%);站立背伸位检查,b/a≥4者病例组有72例(97.30%),而对照组0例;AP示病例组比对照组明显增高;以上参数两组间比较差异均有显著性(P＜0.01).病例组AO和SMA夹角均小于30°,87.84%病例≤20°.结论 通过仰卧位及站立背伸位超声联合检查,可为诊断NCS提供客观依据,对NCS的诊断具有重要价值.     

高频彩色多普勒超声诊断乳腺癌的准确率及临床意义分析

目的:分析高频彩色多普勒超声诊断乳腺癌的准确率及临床意义。方法:选取本院超声科2018年1月至2021年12月接诊的70例疑似乳腺癌患者,分别给予X线钼靶、高频彩色多普勒超声检查,将病理活检穿刺检查结果作为金标准,对比X线钼靶、高频彩超诊断的准确率、灵敏度、特异度,Kappa检验X线钼靶、高频彩超与金标准的一致性。对比良性乳腺病变组、乳腺癌组超声血流参数、声像特征、血流信号特征。结果:高频超声诊断准确率(87.14%)、灵敏度(87.27%)均高于X线钼靶(58.57%、58.18%),P<0.05(χ²=14.448、11.733,P=0.000、0.001),X线钼靶特异度(60.00%)与高频超声(86.67%)比较,P>0.05(χ²=2.727,P=0.099)。X线钼靶与病理活检穿刺检查的一致性一般,P<0.05(Kappa值=0.586),高频彩超与病理活检穿刺检查的一致性较好,P<0.05(Kappa值=0.775)。良性乳腺病变组Vmax、PI、RI均低于乳腺癌组,P<0.05。良性乳腺病变组微...     

螺旋CT在先天性肛门直肠畸形术前的应用

目的 探讨螺旋CT在先天性肛门直肠畸形(CARM)术前诊断及指导临床治疗的价值.方法 30例CARM患儿于术前接受X线倒立侧位腹部平片和盆腔螺旋CT检查,分别测量直肠盲端到肛窝距离,分析两种检查方法的测量结果与手术结果的相关性;并结合CT三维重建图像判断骶骨有无畸形.结果 CT测量直肠盲端到肛窝距离与术中测量结果呈正相关(r=0.99,P<0.01);诊断骶尾椎弯曲1例.X线平片与手术测量结果无相关性(r=0.31,P>0.05).结论 螺旋CT检查在术前可准确描述CARM直肠盲端的位置及骶骨发育情况,为临床选择最佳术式及判断预后提供可靠的依据.     

维生素D缺乏性佝偻病的影像学检测对比分析

目的比较高频超声与X线平片对早期佝偻病小儿尺桡骨远端干骺端的检测结果,评价此两种影像学检查方法对早期佝偻病的诊断价值.方法随机选择63例早期佝偻病患儿(0～24个月)及相同年龄段的40例正常小儿作为对照组,双盲法分别做左腕7 MHz高频超声及双腕X线平片检查.结果高频超声诊断佝偻病组阳性47例,阴性18例,对照组阳性8例,阴性32例,诊断的敏感性72.31%,特异性80%,准确性75.24%,阳性预测值85.45%,阴性预测值64%,X线诊断佝偻病组阳性4例,阴性61例,对照组阳性0例,阴性40例,其相应的指标分别为6.15%,100%,41.91%,100%,39.60%.X线诊断的特异性与B超比较有显著性差异(P＜0.05),X线诊断的特异性高于高频超声诊断;高频超声诊断的敏感性、准确性与X线诊断比较有显著性差异(P＜0.01).结论X线诊断佝偻病的客观性较高,但不能反映佝偻病的早期状态;高频超声能清晰显示干骺端、继发骨化中心的有无、大小以及骨骺软骨的情况,可提高佝偻病诊断的敏感性和准确性.     

超声波与声学造影剂在溶栓中的作用

血栓形成是导致心肌梗塞、缺血性卒中等疾病和死亡的重要原因。超声波和声学造影剂（微泡）可通过空化效应、机械作用等多种生物学效应直接溶栓和增强溶栓药物作用。在微泡的介导下，其潜在的携药载体作用和靶向结合能力为进一步提高溶栓效率提供了可能，该方法有着广阔的临床应用前景。     

Diffusion and practice of ultrasound in emergency medicine departments in Italy

Introduction

This paper reports data from a cognitive survey on the diffusion, practice and organization of ultrasound (US) in emergency medicine departments (EMDs) in Italy. The study was carried out by the Emergency Medicine Section of the Italian Society for Ultrasound in Medicine and Biology (SIUMB) in collaboration with the Italian Society for Emergency Medicine and Urgent Care (SIMEU).

Methods

We created a questionnaire with 10 items, relating to 4 thematic areas. The questionnaires were administered from September 2007 to February 2008, by email, telephone or regular mail. In August 2008 the data were subjected to nonparametric statistical analysis (Spearman''s Rho and Pearson''s chi-square – software SPSS).

Results

We analyzed 170 questionnaires from the EMDs of all Italian regions. A US scanner is present in 64.7% of the ERs, emergency US (E-US) is practiced only in 47.6% of the ERs, and only in 24% of these more than 60% of the ER team members have training in US. The diffusion of US in other operative units of the EMDs ranges from 8.2% to 26.5%.

Discussion

The presence of a US scanner in the ER is essential for the practice and training and is correlated with the level of the EMD. The use of US appears to be less common in less equipped hospitals, regardless of the size of the ER and the availability of radiological services. Wider diffusion of US and greater integration with other services for the installment of the required equipment is to be hoped for.     

Bedside US imaging in multiple trauma patients. Part 1: US findings and techniques

Objectives

The aim of this review article is to present the current views and visions of the role of ultrasound (US) in the management of patients with multiple trauma. The article is divided into two parts. Part 1 (US findings and techniques) will mainly deal with the technical aspects of US imaging in trauma patients and is written also for educational purposes. Part 2 (pathophysiology and US imaging in trauma patients) will deal with integration of US in the clinical and pathophysiological management of multiple trauma patients.

Methods

A non-systematic review of the literature through PubMed search (restricted to the last 10 years) of original articles and review articles.

Results

80 publications were selected for Part 1. Of these 80 articles, the author selected 50 according to personal criteria on the basis of their innovative or original contents (48 original articles and 2 literature review articles); 19 articles were furthermore extracted from the references of the selected publications. The information extracted from these 69 publications was organized into sections dealing with different fields of applications of US imaging in multiple trauma patients.

Conclusions

US imaging in trauma has evolved from the initial use, i.e., early diagnosis of peritoneal effusion (focused abdominal sonography for trauma), to a wider use known as resuscitative ultrasonography, and is today considered as an extension of physical examination to implement a more effective approach to clinical problems and increase the timeliness and safety of interventions.     

Development of ultrasonic investigations in medicine and biology in the U.S.S.R

Ultrasonic research in biology and medicine, both fundamental and applied, has become so vast in scope, that a mere listing of specific subject-areas would take up too much space. This article is intended to give an overview of Soviet scientists' contribution to the field, with the emphasis on the most important and promising subject-areas which are now given priority in the U.S.S.R. Among specific subject-areas in ultrasonics are the studies of the biological action of ultrasound and ultrasonic safety in medicine, the effect of focused ultrasound, acoustic spectroscopy of solutions of biological media and acoustic specification of biological objects, acoustic visualization and microscopy and clinical ultrasonics.     

青海省70家二级以上医院超声质量控制状况分析

目的探讨青海省超声质量控制管理中面临的主要发展问题。 方法对青海省19家三级医院、51家二级医院超声科室为调查对象,通过对医院超声科室设置、亚专业、仪器状态、超声质控、工作量、人员专业及学历构成比进行χ²检验。 结果三级医院与二级医院在科室设置、亚专业设置、仪器状态、超声质控状态、工作量、人员专业、人员学历构成比较,差异均有统计学意义（χ²=30.49、38.208、36.87、7.913、28.518、7.111、322.363、P均<0.01）。 结论青海省19家三级医院超声科室上述各观察指标优于51家二级医院,积极从这些方面加强建设,建立、健全超声质量控制体系对提高我省超声诊断水平,促进我省超声诊断的同质化有很大的作用。     

高频超声对急性阑尾炎的诊断价值

目的为探讨高频超声对急性阑尾炎的诊断价值。方法回顾性分析101例经手术和（或）病理证实的急性阑尾炎。结果其声像图表现：①直接征象：阑尾不同程度肿大,阑尾纵切面显示为数厘米长的腊肠样、管状、手指状或蚯蚓状的低回声或无回声区,不均质。横断面呈“靶环征”或圆形回声;②间接征象：阑尾内粪石并声影;阑尾炎有渗出或穿孔时周围的无回声区或有沉积物回声;脓肿形成时为右下腹混合性肿块回声;肠管扩张（特别是升结肠扩张）;回盲部肠管局限性水肿或肠系膜增厚和大网膜包裹。结论超声检查简便、可重复性对急性阑尾炎诊断有很大的实用价值,应列为首选的影像检查方法。     

腹部加压法在经直肠超声前列腺弹性成像中的改良试验

目的：探讨腹部加压法对于提高经直肠前列腺结节超声弹性成像稳定性的临床应用价值。方法分别在常规和腹部加压两种情况下,用超声弹性成像技术对77个前列腺结节进行评分,得出弹性变化率比值SR和SR1,结合病理结果,计算两种情况下的敏感度、特异度、准确度、阳性预测值和阴性预测值。结果腹部加压情况下所得特异度（92.4%）、准确度（87.4%）高于常规方法（88.5%、84.4%）。结论腹部加压方式时经直肠前列腺超声弹性成像技术所得参数结果更为稳定客观。     

Induction of apoptosis in vivo in the rabbit brain with focused ultrasound and Optison

Histologic effects of focused ultrasound (FUS) exposures combined with an ultrasound contrast agent (Optison®) were investigated to examine whether the lesions were dominated by apoptosis or necrosis. The rabbit brains (n = 17) were sonicated (1.5 MHz, peak rarefactional pressure amplitude: 1.4 to 8.8 MPa) after Optison® was injected intravenously (IV). MRI and light microscopy were used to examine tissue effects. To detect apoptosis, TUNEL staining based on labeling of DNA strand breaks was used. The average number of apoptotic and necrotic cells in 300 × 220 μm microscopic fields were counted in 18 representative lesions. Lesions in the rabbit brains were created at lowered acoustic power levels when FUS was combined with Optison®. In histology, the lesions exhibited red blood cell extravasations and destruction of blood vessels. At 4 h after sonication, the lesions lost many cells, and the remaining cells exhibited both necrotic and apoptotic features. Overall, apoptosis dominated; there were, on average, 32.3 ± 13.2 apoptotic cells per microscopic field compared with only 5.1 ± 3.4 necrotic cells per field. In conclusion, FUS combined with Optison® could produce lesions that are dominated by apoptosis, presumably induced primarily via ischemia after cavitation-produced damage to the brain vasculature. (E-mail: Natalia@bwh.harvard.edu)     

不同类型穿刺针在超声导向穿刺诊断肿瘤中的应用：附151例报告

本文报告了采用四种不同针型的超声导向穿刺术在诊断肿瘤中的应用。本组15例患者中,细针检出率为75.76％(25/33),切割针检出率为95.12(39/41),两者有显著性差异(P<0.05〕。脏器不一,针型选择亦影响检出情况:肺检样中,粗针抽吸、槽式针及切割针均可获得较高检出率,以切割法为好;肝检样中,细针检出率达88.89％,且对良恶性病变有鉴别诊断意义;软组织肿瘤穿刺结果以切割法或槽式法较为满意。超声导向穿刺可以适用于全身各脏器系统的疾病诊断。本文结果表明其应用范围广泛,而且可提供较可靠的诊断依据,是一种较好的诊断方法。     

腮腺内鳃裂囊肿的超声诊断

目的 研究腮腺内鳃裂囊肿的声像图特点,探讨超声在此疾病中的诊断价值.方法 对39例经手术病理确诊的腮腺内鳃裂囊肿患者的声像图资料进行综合分析.结果 根据腮腺内鳃裂囊肿内部回声的不同分为3种类型:囊性回声型、混合回声型、实性低回声型.其中超声提示正确28例,占71.8%;误诊11例,占28.2%.结论 超声检查在此病的诊断过程中起着重要作用.同时,应提高对混合回声型及实性低回声型腮腺内鳃裂囊肿的认识,以提高超声对这2种类型的提示正确率.