经体表高频超声在肛周脓肿和肛瘘诊断中的应用

目的:回顾分析经体表高频超声诊断肛周脓肿和肛瘘的价值.方法:应用6～14MHz高频探头,对89例肛周脓肿和(或)肛瘘患者在肛门周围进行超声检查并与手术结果对比分析.结果:本组中,经体表高频超声对肛周脓肿诊断的灵敏度94.3%,特异度100%,阳性预测值100%,对肛瘘诊断的灵敏度85.4%,特异度95.1%,阳性预测值95.3%.结论:经体表高频超声能方便、直接、无痛苦、较为准确地诊断肛周脓肿和肛瘘.     

应用高频彩超诊断乳腺肿瘤的临床价值

目的:探讨高频彩色多普勒超声检查对乳腺肿瘤的诊断价值.方法:将27例患者行乳腺肿块切除的术前超声检查与术后病理结果对照分析.结果:高频彩色多普勒超声检查对检出乳腺肿瘤的良、恶性诊断符合率分别为89%及94%.结论:高频彩色多普勒超声检查对乳腺肿瘤的诊断有较高的临床应用价值.     

端扫式凸阵腔内超声探头与高频线阵超声探头定位肛瘘内口的临床研究

目的:探讨应用端扫式凸阵腔内探头经阴道或会阴部超声检查定位肛瘘内口的临床应用价值。方法:选取65例肛瘘患者,术前分别通过高频线阵探头与端扫式凸阵腔内探头检查,按照截石位12点时钟方法记录内口位置、大小及瘘管数量。以手术病理结果为参照标准,分析对比2种探头的诊断敏感度、特异度及其与病理结果的一致性。结果:65例手术共发现肛瘘内口85个,瘘管91个;应用高频线阵超声探头术前共诊断肛瘘内口68个,瘘管70个;应用端扫式凸阵腔内探头术前共诊断肛瘘内口79个,瘘管82个。端扫式凸阵腔内探头诊断肛瘘内口与手术病理结果的一致性较好(K=0.653),诊断肛瘘内口的敏感度92.9%、特异度73.7%、符合率89.4%,诊断瘘管的敏感度90.1%、特异度68.4%、符合率86.3%。高频线阵探头诊断肛瘘内口与手术病理结果的一致性一般(K=0.425),诊断肛瘘内口的敏感度80.0%、特异度68.4%、符合率77.8%;诊断瘘管的敏感度80.2%、特异度63.1%、符合率77.3%。结论:端扫式凸阵腔内超声探头诊断肛瘘内口与手术病理结果一致性较好,其敏感度及特异度均优于高频线阵探头。     

彩色多普勒超声诊断下肢深静脉血栓形成的临床价值分析

目的探讨彩色多普勒超声(CDUS)诊断下肢深静脉血栓形成的临床价值。方法对我院进行DVT检查的疑似患者76例作为研究对象,所有患者均行彩色多普勒超声检查和静脉造影检查。观察DCUS及DAS两种方法检测的下肢静脉血栓分布情况,并进行比较。结果 DCUS总计检查出72例静脉血栓,DAS总计检查出76例血栓,以DAS作为检查金标准,DCUS检查灵敏度为97.12%(68/70),特异度为83.33%(5/6),临床诊断符合率为92.11%(70/76),对于两种检测方法进Kappa一次性检验,其值为0.7130.05,因此两个结果准确率无明显差异。结论彩色多普勒超声检查对于下肢深静脉血栓形成的诊断具有灵敏度和特异度好,能为下肢深静脉血栓的诊断提供确切的影像学依据。     

MSCT血管成像和彩色多普勒超声诊断肠系膜上动脉栓塞临床价值分析

目的 探讨MSCT血管成像和彩色多普勒超声诊断肠系膜上动脉栓塞临床价值。方法 选取肠系膜上动脉疾病患者85例，行超声检查和MSCT肠系膜血管成像检查，分析其影像特征。结果 超声检查检出阳性46例，阴性39例；MSCT检出阳性44例，阴性41例。MSCT检查准确率、灵敏度、特异度、阴性预测值、阳性预测值均高于彩色多普勒超声检查(P<0.05)。检出肠系膜上动脉栓塞55例，肠系膜上静脉栓塞30例。结论 MSCT比彩色多普勒超声具有优势，可通过肠系膜血管成像准确掌握病变位置。     

高频彩色多普勒超声在小儿阑尾炎诊断中的应用价值

目的 观察高频彩色多普勒超声在小儿阑尾炎诊断中的应用价值.方法 将2018年3月至2019年9月兴化市戴南人民医院检查疑为阑尾炎后转入兴化市人民医院手术证实的68例患儿作为研究对象.入选患儿术前均接受高频彩色多普勒超声检查诊断,将手术结果作为"金标准",对高频彩超检查诊断的特异度、敏感度和准确度进行分析.结果 68例疑...     

经阴道彩色多普勒超声对不全性药物流产的诊断

目的探讨经阴道彩色多普勒超声对不全性药物流产的诊断价值及声像图特点。方法应用经阴道彩色多普勒超声,观察分析182例不全性药物流产可疑病例的二维声像图及血流特点,并经刮宫病理证实。结果 182例不全性药物流产可疑病例中,经刮宫病理确诊宫内药物流产不全168例。经阴道彩色多普勒超声诊断药物流产不全的灵敏度为96.4%,特异度为78.6%,准确性为95.0%,阳性预测值为98.2%,阴性预测值为64.7%。结论经阴道彩色多普勒超声在不全性药物流产的诊断中有重要临床价值。     

高频超声及弹性成像对甲状腺微小结节病变中的诊断价值

目的对比分析甲状腺微小癌和甲状腺微结节病变的高频超声及弹性成像的声像图特征,探讨高频超声及弹性成像对微小良恶性甲状腺结节鉴别诊断中的应用价值。方法选取在我院接受甲状腺切除术的99例患者(116个甲状腺结节)。常规高频超声采用半定量评分法判断结节性质,超声弹性成像采用5级评分法判断结节性质。以病理检查为金标准,计算灵敏度、特异度、准确度。结果经病理检查证实,116个甲状腺结节中,良性结节86个,恶性结节30个。常规高频超声诊断甲状腺良恶性结节的灵敏度为60.0%,特异度为69.8%,准确度67.2%;超声弹性成像诊断甲状腺结节的灵敏度为93.3%,特异度为91.9%,准确度为92.2%。灵敏度、特异度、准确度在两种检查方式之间,差异具有统计学意义(P0.05)。结论超声弹性成像的诊断准确率明显优于常规高频超声检查,值得进一步推广临床使用。     

高频浅表与腔内探头联合应用对肛周脓肿手术的指导价值

目的探讨联合应用高频浅表小器官探头及经直肠腔内探头超声检查对肛周脓肿手术的指导价值。方法回顾性分析经手术治疗且术前超声检查的110例肛周脓肿患者的临床资料。以手术结果为依据,比较高频浅表联合腔内探头与单纯应用高频浅表探头对肛周脓肿的检查情况及术后治愈情况。结果单纯应用高频浅表探头患者53例,其中,对脓肿合并肛瘘、瘘管内口位置诊断符合率分别为73．8％（31／42）、57．1％（24／42）,一次性手术治愈率为64．2％;高频浅表联合腔内探头患者57例,对脓肿合并肛瘘、瘘管内口位置诊断符合率为94．5％（52／55）、90．9％（50／55）,一次性手术治愈率为93．0％。联合超声检查与单纯浅表超声探头检查比较,不论是脓肿合并肛瘘、瘘管内口位置诊断符合率还是一次性手术治愈率,差异均具有统计学意义（P〈0．05）。结论高频浅表与腔内探头联合应用对肛周脓肿手术具有较高的指导价值。     

360°环阵经直肠腔内超声对肛瘘的价值

目的探讨经直肠新型360°环阵腔内超声对肛瘘的诊断价值。方法收集2014年6月~2015年5月期间肛瘘患者64例,术前超声Parks分型与术后手术记录Parks分型对照。结果经直肠腔内超声能清晰显示内外括约肌。手术64例患者中,41例单纯性肛瘘,23例为复杂性肛瘘,其中括约肌间型29例,经括约肌型17例,扩约肌上型10例,括约肌外型8例。64例肛瘘共86个原发瘘管,89个内口,80个外口,42个肛周脓肿,超声对原发瘘管、肛周脓肿、内口显示的灵敏度分别为89.5%、100%和88.2%,特异度分别为91.5%、97.5%、86.3%。结论 360°经直肠腔内超声诊断肛瘘具有简便、实时、易操作等特点,能清楚显示内外括约肌,能为术前肛瘘的准确定位提供极有帮助的影像学信息,从而具有较高临床价值。     

彩色多普勒超声联合D-二聚体对周围型下肢深静脉血栓筛查的价值

目的探讨彩色多普勒超声(CDUL)联合D-二聚体检测对周围型下肢深静脉血栓的筛查价值。方法对1821例下肢深静脉血栓的高危患者行下肢深静脉CDUL检查及D-二聚体的检测。分别计算CDUL、血浆D-二聚体浓度水平检测以及二者联合对高危人群中周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值以及Kappa值。结果CDUL诊断周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值、Kappa值为95.8%、94.5%、88.2%、98.1%、0.881。血浆D-二聚体浓度检测诊断周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值、Kappa值为85.2%、95.6%、89.3%、93.8%、0.818。二者联合诊断周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值、Kappa值为98.0%、100.0%、100.0%、99.1%、0.986。CDUL联合D-二聚体检测与单独行D-二聚体检测及CDUL检查的差异均有统计学意义(均P<0.05)。结论CDUL检查联合血清D-二聚体检测对筛查周围型下肢深静脉血栓有较高的诊断准确率,具有较高的临床价值。     

甲状腺微小癌诊断中应用二维超声、彩色多普勒超声及弹性成像的价值分析

目的：探讨二维超声、彩色多普勒超声及弹性成像对甲状腺微小癌的诊断价值。方法随机选取医院收治的2015年1月～2016年1月50例病理证实为甲状腺微小癌患者,并且依据随机数字表方法,分为研究组（25例）、对照组（25例）。给予对照组患者临床中,应用二维超声诊断,研究组中患者,采取彩色多普勒超声及弹性成像诊断,对比两组临床诊断效果,对两组患者临床资料进行分析。结果对于研究组中,临床经彩色多普勒超声及弹性成像诊断后,诊断准确率达到92．0％,对照组诊断准确率为72．3％,两组对照存在统计学意义（ P＜0．05）;同时,在临床彩色多普勒超声及弹性成像诊断中,可以提升其临床诊断敏感性、特异性,在临床诊断甲状腺微小癌中发挥重要诊断价值。结论在临床对甲状腺微小癌中,应用彩色多普勒超声及弹性成像技术,不仅提升临床诊断准确率,同时还可以提升临床诊断敏感性与特异性,发挥积极诊断价值。     

低机械指数灰阶超声造影诊断下肢深静脉血栓的价值

目的:对比分析应用低机械指数灰阶超声造影与彩色多普勒超声诊断下肢深静脉血栓(deep vein thrombosis,DVT)的价值。方法:分析30例临床拟诊为下肢DVT患者的临床及影像资料,以X线静脉造影或手术结果为金标准,对比分析彩色多普勒超声与实时灰阶超声造影与DSA或手术结果的一致性。结果:彩色多普勒超声与SonoVueTM低机械指数实时灰阶超声造影诊断下肢DVT的敏感度、特异度、准确率、阳性预测值、阴性预测值分别为81.25%、55.00%、73.53%、81.25%、55.00%和93.75%、70.00%、86.76%、88.24%、82.35%;诊断小腿DVT的敏感度、特异度、准确率、阳性预测值、阴性预测值分别为55.56%、55.00%、55.26%、52.63%、57.89%和83.33%、70.00%、76.32%、71.43%、82.35%;2种方法诊断大腿DVT的结果与金标准一致;超声造影微泡灌注到达时间、达峰时间和峰值强度健侧均小于患侧;对比剂微泡与股总静脉管壁间低回声厚度健侧小于患侧。结论:低机械指数实时灰阶超声造影与彩色多普勒超声均是诊断下肢DVT的良好方法;超声造影是超声诊断下肢DVT的一种补充手段,尤其是在常规超声显示困难的小腿DVT诊断中具有优势,值得进一步推广和应用。     

Role of color Doppler echography in the visualization of perianal fistulae with injections of physiologic solutions

PURPOSE: To prove the diagnostic value of color Doppler US in the evaluation of perianal external fistulae, using an endocavitary probe and a saline solution injection, in order to show the location of the fistulae, their extension, possible secondary tracts, residual abscesses and the relationship with adjacent tissues. MATERIAL AND METHODS: From October 1999 to December 1999, thirty-five consecutive patients (21 males and 14 females, mean age 47.5) affected with Crohn's disease were examined prospectively. These patients presented postoperative recurring external perianal fistulae. From this first group, 10 patients (6 males and 4 females, mean age 45) were selected as the external fistula was open. A biplanar transrectal 7.5 MHz probe was used for the examination. First the external opening of the fistula was cannulated with a soft plastic catheter. Then the probe, covered with a lubricated condom filled with US gel, was introduced into the anal canal (males) or the vagina (females). An initial gray-scale US study was performed. Finally the color-box was positioned on the tract, the Pulse Repetition Frequency (PRF) adjusted and the saline solution introduced. The study was completed with axial and linear scans. RESULTS: The mean examination duration was 31 minutes. Only two patients found the examination annoying because of partial anorectal stricture. The wall layers and their thickness were clearly located and distinguished. Gray-scale US showed the local anatomy in all patients. In 4 patients it depicted the primary fistula as a thin hypoecoic line (40%, three intersphinteric and one transphinteric). Color Doppler US detected the fistula in all patients (100%, seven intersphinteric and three transphinteric). Moreover it showed 2 small secondary tracts in 2 patients. No abscesses were found at the time of the examination. In the patients who underwent a second operation, surgical findings showed a good correlation (90-100%) with color Doppler findings. DISCUSSION AND CONCLUSIONS: This study demonstrated a greater diagnostic value of endosonography with color Doppler and saline solution injection as compared to conventional gray-scale endosonography in the evaluation of fistulae. Since this technique is also cost-effective and well tolerated by most patients we conclude that at present it makes an important diagnostic tool in the preoperative assessment of perianal fistulae.     

X线摄影、彩色多普勒超声和立体定位穿刺对早期乳腺癌的诊断价值

目的 探讨X线摄影、彩色多普勒超声（简称彩超）和立体定位穿刺对早期乳腺癌的诊断价值,提高其诊断率。方法 55例早期乳腺癌和25例乳腺良性病变均行两侧X线摄影、彩超检查,再经立体定位穿刺,作病理学检查。结果 在55例早期乳腺癌中,X线钼靶摄影诊断早期乳腺癌45例,其敏感性和特异性分别为82．0％和88．0％;彩超诊断早期乳腺癌43例,其敏感性和特异性分别为78．2％和84．0％,准确性为80．0％;立体定位穿刺诊断早期乳腺癌53例,其敏感性和特异性分别为96．4％和92．0％,准确性为95．0％,无假阳性。综合影像诊断早期乳腺癌54例,其敏感性和特异性分别为98．2％和96．0％,准确性为97．5％。结论X线摄影、彩超和立体定位穿刺联合应用,可提高早期乳腺癌诊断的敏感性和准确性。     

短轴追踪扫查法在肛瘘经体表超声检查中的诊断价值

 目的 探讨短轴追踪扫查法在肛瘘经体表超声检查中的诊断价值。方法 回顾性分析解放军总医院海南医院超声诊断科2019-10至2021-10经体表超声检查的617例肛瘘患者资料,对纳入完成长轴和短轴追踪扫查的炎性肛瘘者,比较长轴、短轴追踪扫查对肛瘘内口、主瘘管及支瘘管的诊断准确率。结果 入组患者共75例,包含33例常规超声联合经瘘管超声造影。常规超声检查时,短轴追踪对内口的诊断准确率高于长轴追踪,差异有统计学意义(77.33% vs. 34.67%,P<0.05);主瘘管和支瘘管的诊断准确率对比,长轴、短轴追踪差异均无统计学意义(主瘘管86.67% vs. 85.33%;支瘘管44.12% vs. 38.24%)。联合超声造影后,短轴追踪对内口的诊断准确率高于长轴追踪,差异有统计学意义(90.91% vs. 66.67%,P<0.05);对主瘘管和支瘘管的诊断准确率上长轴与短轴追踪差异均无统计学意义(主瘘管87.88% vs. 93.94%;支瘘管71.43% vs. 66.67%)。结论 经体表短轴追踪扫查可提高肛瘘的超声诊断准确率。     

Transrectal ultrasound color Doppler in the evaluation of recurrence of anal canal cancer

OBJECTIVE: aim was to obtain elements for a differential diagnosis between post-radiation fibrosis and residual tumor or local relapse in anal canal cancer through detection of presence/absence of intralesional blood flow. Transrectal ultrasound and color Doppler were compared. METHODS: 43 patients underwent transrectal ultrasound sonography and color Doppler before and after therapy to assess intralesional blood flow and flow pattern (spotty and linear signals). All diagnostic imaging results were compared to histological analysis. Specificity was submitted to statistical analysis using McNemar test. RESULTS: before therapy 34 lesions (79%) showed color signal; no signal in 9 (21%), which were excluded from our analysis. Eighteen of the 34 patients considered, presented complete response to therapy, 14 partial response and two no response. After therapy, signal disappeared in 17 patients (94%); one false-positive (6%) presented spotty signals; 16 of 34 patients presented changed color signal. Color Doppler showed higher specificity than grey scale transrectal ultrasound in the differentiation of fibrosis from tumor. Response was confirmed by histological examination, considered gold standard. McNemar test demonstrated the significance of color Doppler (P < 0.0001). CONCLUSION: color Doppler considerably increases transrectal ultrasound specificity in differentiating tumor relapse from fibrosis in anal canal cancer.     

Magnetic resonance imaging evaluation of perianal fistula

Aim of work

To clarify the role of MRI in diagnosis and classification of perianal fistula and to evaluate the additional clinical value of preoperative MR imaging and its benefit to surgeon.

Methods

This prospective study contained 25 patients (21 males and 4 females; age range 10–60 years; mean age 34.8 years) selected from 40 patients referred to the Radiodiagnosis department with perianal sepsis, the study was conducted between October 2009 and September 2011, MRIs were performed and the results were ensured by surgical results, sensitivity, specificity and predictive values of MRIs were determined.

Results

25 patients with perianal sepsis were included in this study, 3 cases grade 1 (simple linear intersphincteric fistula), 2 cases grade 2 (intersphincteric fistula with abscess or secondary track), 9 cases grade 3 (trans-sphincteric fistula), 9 cases grade 4 (trans-sphincteric fistula with abscess (5 cases), secondary track within the ischiorectal fossa (3 cases) and both (1 case)) and 2 cases grade 5 (supralevator and translevator disease one case for each).

Conclusion

MRI is a useful procedure for successful management of peri-anal fistula by correct assessment of the extent of disease and relationship to sphincter complex. Also it helps in identification of secondary extensions, particularly horseshoe tracts and abscesses resulting in complete evaluation and highest possible diagnostic accuracy aiding successful surgical interventions, aiming to reduce complications and recurrences.