彩色多普勒超声对浅表软组织肿物的诊断价值

目的探讨高频彩色多普勒超声对浅表软组织肿物的诊断价值。方法回顾性分析2008年111月70例经手术、活检病理证实的浅表软组织肿物的声像图特征,包括肿物的部位、形态大小、内部回声、边界及其与周边组织的关系、长径与厚度比值（L/T）及病变周边与内部血流分布情况。结果超声对浅表肿块病灶的显示率为100%,良性肿瘤有脂肪瘤、表皮囊肿、滑膜囊肿、神经鞘瘤,血管瘤、异物肉芽肿等,恶性肿物包括皮肤纤维肉瘤,转移性腺癌。结论彩色多普勒超声对浅表肿块的检出、定位及物理性质可做出准确的诊断,综合分析肿物的边界、形态、内部回声及血流分布等特点对肿物的良恶性诊断具有重要价值。     

Benign neck masses showing restricted diffusion: Is there a histological basis for discordant behavior?

Diffusion weighted imaging (DWI) evolved as a complementary tool to morphologic imaging by offering additional functional information about lesions. Although the technique utilizes movement of water molecules to characterize biological tissues in terms of their cellularity, there are other factors related to the histological constitution of lesions which can have a significant bearing on DWI. Benign lesions with atypical histology including presence of lymphoid stroma, inherently increased cellularity or abundant extracellular collagen can impede movement of water molecules similar to malignant tissues and thereby, show restricted diffusion. Knowledge of these atypical entities while interpreting DWI in clinical practice can avoid potential misdiagnosis. This review aims to present an imaging spectrum of such benign neck masses which, owing to their distinct histology, can show discordant behavior on DWI.     

Novel fork-tip needles versus standard needles for EUS-guided tissue acquisition from solid masses of the upper GI tract: a matched cohort study

Background: There are very few available data on the novel SharkCore? needles for EUS-FNB.

Aim: Comparison of the performance of the SharkCore? needles with the standard EUS-FNA needles for the diagnosis of solid upper GI masses.

Patients and methods: Single-center, retrospective cohort study in an academic tertiary referral hospital. Patients were matched 1:1 for the site of the lesion and the presence or absence of rapid on-site evaluation (ROSE).

Results: A total of 102 patients were included. There was no statistically significant difference in the mean number of passes (3.3?±?1.3 versus 3.4?±?1.5; p?=?.89). Similar results were observed at the subgroup with ROSE (4.3?±?1.3 versus 3.7?±?1.5; p?=?.26). More histological specimens were obtained with the SharkCore? needles compared to standard needles (59 versus 5%; p?<?.001). Diagnostic test characteristics were not significantly different (sensitivity: 91.5 versus 85.7; specificity: 100 versus 100%; accuracy: 92.2 versus 85.4% for SharkCore? versus standard needles, p?>?.05 in all cases). At multivariable analysis, there was no statistically significant difference in the mean number of passes in all patients (p?=?.23) and in the ROSE subgroup (p?=?.66). However, the SharkCore? needle obtained significantly more histological material than the standard needle (odds ratio 66; 95% confidence interval: 11.8, 375.8, p?<?.001). There was no significant difference in complication rates (p?=?.5).

Limitations: Retrospective study, single-center.

Conclusion: The SharkCore needles were similar to standard FNA needles in terms of the number of passes to reach diagnosis, but obtained significantly more histological specimen.     

Role of Ultrasound in Characterization of Ovarian Masses

Background: Ovarian cancer is the second most common malignancy in Pakistani women, accounting for 4%of all cancers in the female population. The aim of this study was to determine sensitivity, specificity, positive andnegative predictive values and 95% confidence intervals for ultrasound in characterization of ovarian masses inpatients presenting at public and private tertiary care hospitals in Karachi, Pakistan. Materials and Methods:We adopted a cross-sectional analytical study design to retrospectively collect data from January 2009-11 frommedical records of two tertiary care hospitals. Using a non-probability purposive sampling technique, werecruited a sample of 86 women aged between 15 and 85 years fulfilling inclusion criteria with histopathologicallyproven ovarian masses presenting for an ultrasound examination in our radiology departments. Results: Ourretrospective data depicted sensitivity and specificity of ultrasound to be 90.7%, 95%CI (0.77, 0.97) and 91.4%,95%CI (0.76, 0.98) respectively. Positive predictive value was 93%, 95%CI (0.79, 0.98) and negative predictivevalue was 89%, 95%CI (0.73, 0.96). A total of 78 ovarian masses were detected, out of which 42 were malignantand 36 were benign. Conclusions: Results of our study further reinforce the conclusion that ultrasound shouldbe used as an initial modality of choice in the workup of every woman suspected of having an ovarian mass. Itnot only results in decreasing the mortality but also avoids unnecessary surgical interventions.     

Three-dimensional volume off-line analysis as compared to real-time ultrasound for assessing adnexal masses

Objective

To assess the agreement between three-dimensional volume off-line analysis as compared to real-time ultrasound for assessing adnexal masses.

Study design

Ninety-nine non-consecutive women diagnosed as having an adnexal mass were assessed by transvaginal power Doppler ultrasound. One single examiner performed all ultrasound examinations. Based on the examiner's subjective evaluation using gray scale and Doppler ultrasound findings a presumptive diagnosis (benign or malignant) was provided after real-time ultrasound was performed. Once real-time was done a 3D volume of the adnexal mass was acquired and stored by this examiner. Two examiners, unaware of the real-time ultrasound results, evaluated the 3D volumes using multiplanar display and virtual navigation and also had to provide a presumptive diagnosis (benign or malignant). These two examiners, like the first one, had information about patient's age, menopausal status and complaints. All women underwent surgery or were followed-up until cyst resolution. Histologic diagnosis was used as gold standard. Cysts that resolved spontaneously were considered as benign for analytical purposes. The Kappa index was used to assess the agreement between real time ultrasound and 3D volume analysis. Sensitivity and specificity of both methods were calculated and compared using McNemar test.

Results

Forty-one masses were malignant and 58 were benign. Agreement between real-time ultrasound and 3D volume analysis was good for both off-line examiners (Kappa index: 0.82, 95% CI: 0.70–0.93 and 0.78, 95% CI: 0.65–0.90). Sensitivities for real-time ultrasound and 3D volume analyses were 100%, 93% and 90%, respectively (p > 0.05). Specificities for real-time ultrasound and 3D volume analyses were 91%, 84% and 86%, respectively (p > 0.05).

Conclusions

Off-line 3D volume analysis may be a useful method for assessing adnexal masses, showing a good agreement with real-time ultrasound and having a similar diagnostic performance.     

子宫肿块的MRI诊断

目的：分析子宫肿块的MRI表现，探讨MRI的诊断价值及其诊断能力。方法：对经手术理证实的38例（69个病灶）子宫肿块的MRI表现进行回顾性分析，并与超声检查相对比。结果：良性病变26例，分别为子宫平滑肌瘤、腺肌病、慢性血肿。恶性病变15例，分别为子宫内膜癌、宫颈癌、子宫平滑肌肉瘤、滋养细胞肿瘤和转移瘤。有3例良恶性肿瘤同时并存。所有病例均于T2WI显示较好，T1WI对于判断肿瘤是否宫外侵犯较有帮助。MRI对子宫肿块的检出率和诊断的正确率分别为94．2％、89．8％，均高于B超（82．6％、75．3％）。结论：MRI能较准确地显示病灶数目、大小、范围、内部结构及与周围的关系，对于判断肿瘤的良恶性及肿瘤的分期有很大价值。     

DWI结合LAVA技术在肝脏占位性病变中的应用价值

目的：探讨联合运用DWI和LAVA技术在肝脏占位性病变的诊断价值。方法：回顾性分析经手术病理证实的60例肝脏占位性病变（小肝癌30例、肝血管瘤15例、肝囊肿15例）的MRI图像。扫描序列为常规自旋回波序列（T2WI、T1WI）、LAVA多期增强序列及DWI检查（b值分别为0和800 s/mm^2）。比较小肝癌、肝血管瘤、肝囊肿的ADC值是否有差异;对比分析LAVA多期增强序列（A组）、T1WI、T2WI和DWI（B组）及这2种方法联合应用（C组）在病变检出和定性诊断方面的价值。结果：在病变检出方面：A组检出67个病灶,B组检出67个,C组检出67个,A组与C组比较,对病变的检出率无差异。在结节的定性诊断方面：在取得临床或病理证实的67个病灶中,A组诊断正确57个（85.1%）,C组为65个（97%）,2组间差异有显著性意义（χ2=5.858,P〈0.05）;肝囊肿、肝血管瘤、小肝细胞癌的ADC值分别为（3.341±0.299）×10-3mm^2/s、（2.154±0.308）×10-3mm^2/s、（1.132±0.241）×10-3mm^2/s。结论：DWI结合LAVA技术对肝脏小病灶的定性诊断具有重要的临床应用价值。