Differential diagnosis of pancreatic tumors using ultrasound contrast imaging

Background The development of equipment and contrast agents for ultrasound imaging has contributed to major breakthroughs in the diagnosis of pancreatic tumors. We aimed to determine the diagnostic effectiveness of contrast ultrasound with Levovist, using the Agent Detection Imaging (ADI) technique, in 50 patients with pancreatic tumors.Methods We studied 50 cases of histologically proven pancreatic disease; 39 carcinomas, 2 endocrine tumors, 4 intraductal papillary mucinous carcinomas (IPMCs), and 5 cases of tumor-forming pancreatitis (TFP). Vascular and perfusion images of contrast-enhanced ultrasound (CE-US) were used for the evaluation of tumor vascularity and parenchymal perfusion of the tumor, respectively. The hemodynamics of the tumor, and the diagnostic capacity of CE-US were compared with those shown by computed tomography (CT). The histological diagnosis in all cases was made from either biopsy or surgical specimens.Results Thirty-four cases of pancreatic carcinoma (87%) showed a hypovascular and hypoperfusion pattern. The endocrine tumors showed a heterogeneous hypervascular and hyperperfusion pattern. All IPMC cases showed hypervascularity of the nodules inside the tumors. TFP showed an isovascular and homogeneous isoperfusion pattern. When tumors showing a hypovascular or hypoperfusion pattern on CE-US were diagnosed as carcinomas, 34 of the 39 carcinomas (87%) fit this criterion, with a 95% confidence interval (CI) of 73%–96%, whereas, on CT, 31 of the 39 were diagnosed as carcinoma; (sensitivity, 79%). The sensitivity and accuracy of CT were inferior to those of CE-US. Results of comparison between the CE-US findings and the histological diagnosis were as follows. The one papillary adenocarcinoma showed a hypervascular and hyperperfusion pattern; the 32 well or moderately differentiated adenocarcinomas showed a hypovascular and hypoperfusion pattern; and in the poorly differentiated adenocarcinomas, 2 cases of scirrhous type showed a hypovascular and hypoperfusion pattern, and the 4 cases of medullary type showed an isovascular and isoperfusion pattern.Conclusions The differences in vascularity of pancreatic carcinomas depicted by CE-US were associated well with differences in histology. CE-US, by the ADI technique, is useful for the diagnosis of pancreatic tumors.This paper was given as an oral presentation at the Tenth United European Gastroenterology Week (Geneva, Switzerland, 2002), and received an award as one of the Best 200 Abstracts. A poster presentation of the paper was made at the 11th United European Gastroenterology Week (Madrid, Spain, 2003).     

组织多普勒成像与全方位M-型超声评价左心室舒张功能的临床研究

目的:探讨组织多普勒成像(TDI)与全方位M-型超声心动图对左心室舒张功能诊断的价值。方法:将29例结合常规超声和左心导管证实的左心室舒张功能障碍患者,分为A组:松弛延迟组(11例);B组:“假性正常化”组(12例);C组:限制性充盈组(6例)及15例左心室舒张功能正常对照组;使用TDI于心尖四腔心切面、左心室两腔心切面和心尖三腔心切面测定二尖瓣环运动Ea峰及Aa峰,并计算Ea/Aa。全方位M-型超声测定收缩期最大运动速度(VS)和舒张早期运动速度(VD),计算VD/VS比值。并比较二者的特异性及敏感性。结果:TDI与全方位M-型超声对左心室舒张功能减低诊断的特异性分别为96.7%和94.4%。TDI评价各阶段左心室舒张功能障碍的敏感性,分别为71.2%,90.3%,97.7%。全方位M-型超声对左心室舒张功能评价(将标准定为VD/DS≤1)时,对各阶段左心室舒张功能减低的敏感性分别为56.1%,65.3%,96.5%。结论:二者均可作为评价左心室舒张功能障碍的指标,而TDI有较高的敏感性。     

缺血性脑卒中并脑微出血的相关因素分析

目的探讨缺血性脑卒中患者合并脑微出血(CMB)的相关因素,为临床诊疗提供参考。方法选取2013年3月至2014年3月在兰州大学第二医院行头颅MRI检查的缺血性脑卒中患者142例,记录所有患者的一般临床资料及MRI检查结果。所有患者根据MRI检查结果,分为缺血性脑卒中并脑微出血组和单纯缺血性脑卒中组。对缺血性脑卒中患者脑微出血发生的可能相关因素进行Logistic回归分析。采用Mann-Whitney U检验探讨脑微出血与脑白质疏松分级之间的关系。结果缺血性脑卒中并脑微出血与高血压病、脑白质疏松相关(P0.05),与性别、年龄、2型糖尿病、高脂血症、服用抗凝药或抗血小板药无相关(P0.05)。两组脑白质疏松分级比较,差异有统计学意义(P0.05)。结论高血压病、脑白质疏松是缺血性脑卒中并脑微出血的独立危险因素。在缺血性脑卒中患者中,缺血性脑卒中并脑微出血者的脑白质疏松程度更严重。     

吉林省延边地区蜱类分布及其携带发热伴血小板减少综合征病毒调查

本文旨在探讨吉林省延边地区自然环境和动物体表蜱类分布及其消长规律,掌握其携带发热伴血小板减少综合征布尼亚病毒(Severe fever with thrombocytopenia syndrome virus,SFTSV)状况及传播病毒能力。2016年4~9月份按月采集延边州所辖8个县(市)自然环境中生长的蜱虫和放牧动物体表蜱虫进行形态学分类,对其进行构成分析。对其中部分蜱虫分组进行SFTSV核酸检测。SFTSV核酸检测方法采用了Real time RT-PCR和RT-PCR相结合的方法。结果共采集蜱虫3 446只,其中森林革蜱763只,嗜群血蜱222只,日本血蜱639只,长角血蜱515只,全沟硬蜱1 014只,其他血蜱293只;全沟硬蜱(29.43%)和森林革蜱(22.14%)为本地优势种。长角血蜱在图们市(70.88%)和珲春市(40.59%)分布较多。对部分蜱虫(1605只)SFTSV Real time RT-PCR检测结果总最低感染率为1.81%,分种最低感染率分别为嗜群血蜱8.65%、日本血蜱4.53%、长角血蜱1.59%。序列分析结果表明,本文检测到的SFTSV病毒与我国其他省份从患者身上分离到的大部分SFTSV有高度一致性(99%)且与2012年从浙江患者血清中分离到的SFTSV、2013年韩国国家疾病预防控制中心从人身上采集的长角血蜱中分离到的SFTSV处于同一分枝,把该病毒命名为YBHC-TICK1-2016/CHINA。