实时超声弹性成像在甲状腺占位性病变中的初步应用

目的探讨实时超声弹性成像在甲状腺疾病诊断中的应用价值。方法分析40例(44个病灶)甲状腺占位性病变的超声弹性图表现,将图像分为0～IV级,并与病理结果作对比。结果良性病变以0～II级多见,而恶性病变以III～IV级多见。以III级以上(含III级)作为判断恶性的标准,则其敏感性为100%,特异性为77.1%,准确性81.8%。结论超声弹性成像对甲状腺结节的诊断提供较大帮助。     

综合应用三种超声弹性成像指标鉴别甲状腺结节的良恶性

目的:探讨综合应用超声弹性成像评分法、应变率法和应变率比值法鉴别甲状腺结节良恶性的价值。方法:分析167例患者212个结节的超声弹性成像表现,分别用应变率、应变率比值、弹性评分进行评估每个结节的良恶性,然后再用综合法进行评估,并与病理结果作对比。分析综合法鉴别甲状腺结节良恶性的敏感度、特异度、准确度等指标。结果:综合法鉴别甲状腺结节的良恶性的敏感度为89.6%,特异度为94.8%,准确度为92.9%,阳性预测值为90.8%,阴性预测值为94.1%,阳性然似比为17.2,阴性然似比为0.11,约登指数为0.844。结论:三种超声弹性成像技术指标的综合应用,对提高筛查甲状腺癌的准确性的价值很高。     

超声弹性成像在乳腺实性小肿块性质诊断及鉴别中的价值研究

目的：探讨超声弹性成像在乳腺小肿块性质诊断及鉴别诊断中的应用价值。方法方便选取并回顾该院于2014年1月—2016年1月收治的80例乳腺小肿块患者手术病理及超声资料,并加以分析。结果80例患者术后病理结果显示恶性肿块31例、良性肿块49例。以病理结果为“金标准”,常规超声检查诊断乳腺小肿块性质的准确度为77.50%(62/80)、敏感度为77.42%(24/31)、特异度为77.55%(38/49);超声弹性成像诊断准确度为91.25%(73/80)、敏感度为90.32%(28/31)、特异度为91.84%(45/49),差异有统计学意义(P<0.05);超声弹性成像评分中1~3分、4~5分评分结果与病理结果一致性程度极好(Kappa=0.86、0.78)。结论超声弹性成像诊断乳腺小肿块性质具有较高的准确度、敏感度及特异度,仍需结合常规超声,可为临床诊治提供重要信息。     

Liver investigations: Updating on US technique and contrast-enhanced ultrasound (CEUS)

Over the past few years, the cross sectional imaging techniques (Computed Tomography – CT and Magnetic Resonance – MR) have improved, allowing a more efficient study of focal and diffuse liver diseases. Many papers had been published about the results of a routinely clinical use of the dual source/dual energy CT techniques and the use of hepatobiliary contrast agents in MR liver studies.As a consequence, these new improvements have diverted the attention away from the Ultrasound technique and its technical and conceptual evolutions.In these years of disinterest, US and especially Contrast Enhanced Ultrasound (CEUS) have consolidated and grown in their application in clinical routine for liver pathologies. In particular, thanks to the introduction of new, dedicated software packages, CEUS has allowed not only qualitative, but also quantitative analysis of lesion microcirculation, thus opening a new era in the evaluation of lesion characterization and response to therapy.Moreover, the renewed interest in liver elastography, a baseline ultrasound-based imaging modality, has led to the development of a competitive technique to assess liver stiffness and then for the evaluation of the progression towards cirrhosis, and characterization of focal liver lesions, opening the way to avoid, in selected cases, liver biopsy.The aim of this review is to offer an up-to-date overview on the state of the art of clinical applications of US and CEUS in the study of focal and diffuse liver pathologies. Besides, it aims to highlight the emerging role of perfusion techniques in the assessment of local and systemic treatment response and to show how the liver evolution from steatosis to fibrosis can be revealed by elastography.     

Clinical perspective on renal elasticity quantification by acoustic radiation force impulse: Where we are and where we are going

Recent interests have focused on the exploration of the mechanical properties(elasticity,stiffness and deformity)of parenchymatous organs using tissue strain imaging techniques and elastosonography.Measures of the mechanical properties of the kidneys have given conflicting results.There are various conditions that affect the variability of renal parenchymal measures,the main target of the investigations.They can be classified as intrinsic(depending upon the patient),extrinsic(depending upon the operator)and mixed(both intrinsic and extrinsic).Indeed,the mechanical properties of the kidney depend on various conditions that alter its histology,mainly the amount of fibrosis in the renal parenchymal interstitium.Anatomical factors play an important role because the kidney is a highly anisotropic organ with important differences when considering the cortex and the medulla.Physical factors include the frequency of the probe,compression and distance from source to target.Many factors can affect measurements and it is necessary to find an accurate technique in order to avoid mistakes and to obtain reproducible data.Indeed,it is imperative to define a standardized examination technique in order to get comparable results.Therefore,the utility of acoustic radiation force imaging technique to predict only renal fibrosis or progression of chronic kidney disease is of dubious value because several variables-blood perfusion and urinary pressure-can contribute to a given measure,even with a standardized method able to minimize intraand inter-operator variability.     

超声弹性成像评估离体肝硬化标本结节性病变性质的初步研究

目的 探讨实时超声弹性成像评估离体肝硬化标本结节性病变性质的可行性.方法 选择38例肝移植受者新鲜离体肝标本,对感兴趣结节采用手动加压法进行实时超声弹性成像检查.感兴趣区域内肝实质本身的机械属性(应变)由彩色编码显示,将结节性病变的硬度与周围肝组织的硬度进行比较,将结节分为硬结节、中等硬度结节、软硬混合结节和软结节.所有结节均由病理明确诊断.结果 对38例肝硬化标本的44个结节性病变进行了实时超声弹件成像检查.硬结节18个,其中12个(66.7%)为肝细胞肝癌,2个(11.1%)为不典型增生,4个(22.2%)为冉生结节.中等硬度结节7个,均为再生结节.软硬混合结节11个,8个(72.7%)为肝细胞肝癌(其中4个伴有坏死组织),1个(9.1%)为不典型增生伴坏死组织,另2个(18.2%)为再生结节伴坏死组织.软结节8个,其中4个(50.0%)为坏死结节,1个为(12.5%)不典型增生伴部分癌变,1个(12.5%)为肝细胞肝癌,2个(25.0%)为再生结节.结论 实时超声弹性成像可有效评估肝硬化标本结节性病变的相对硬度,可能在鉴别肝硬化结节性病变的性质方面具有潜在的用途.     

Prospective comparative evaluation of quantitative-elastosonography (Q-elastography) and contrast-enhanced ultrasound for the evaluation of thyroid nodules: Preliminary experience

Purpose

To assess the effectiveness of semiquantitative elastosonography (Q-elastography) compared with contrast-enhanced ultrasound (CEUS) in differentiating the nature of thyroid nodules.

Methods and materials

Forty-eight consecutive patients (35 males, 13 females, range: 34–69 years, mean: 49.4 years), candidate to surgery, previously detected at color-Doppler ultrasound (CDUS), were prospectively examined with elastosonography with dedicated semiquantitative software (Q-Elastography, Toshiba XG) and CEUS (Technos Mylab 70 Gold X, and Toshiba XG) before surgery. CEUS and elastosonography were evaluated by two investigators in consensus. Comparison between the CEUS pattern and elastonographic strain ratio observed and expected frequencies for the diagnoses was evaluated with χ² test or with Fisher exact test.

Results

Fifty-three nodules (19 papillary carcinoma, 32 hyperplasia, and 2 follicular adenoma) in 48 patients were available for analysis. Regarding echogenicity score, sensitivity, specificity, PPV and NPV of conventional US were 81%, 50%, 56%, 77%; according to Q-elastography, sensitivity, specificity, PPV and NPV were 95%, 88%, 97% and 91% respectively; whereas concerning CEUS, sensitivity specificity PPV and NPV were 79%, 91%, 83% and 89% respectively. Both CEUS and Q-elastography were more specific than US (p < 0.01), with not statistical significant difference with regard to sensitivity.

Conclusions

The results of the present study suggest that Q-elastography is a valuable tool in the characterization of thyroid nodules and it seems to be more sensitive than CEUS.     

实时超声弹性成像在甲状腺结节诊断中的临床价值

目的探讨实时超声弹性成像在甲状腺结节诊断中的临床应用价值。方法对2009年6~12月期间收入我院血管甲状腺腹壁疝外科并行实时超声弹性成像检查的168例甲状腺结节性疾病患者的临床资料进行回顾性分析,将实时超声弹性成像图按弹性硬度分为0~Ⅳ级(0~Ⅱ级为良性,Ⅲ~Ⅳ级为恶性),并与病理学结果进行比较。结果 168例患者共208个结节:结节性甲状腺肿125个;甲状腺腺瘤36个;甲状腺恶性肿瘤41个,其中39个为甲状腺乳头状癌,1个为甲状腺髓样癌,1个为甲状腺非霍奇金淋巴瘤;其他结节6个,包括弥漫性毒性甲状腺肿1个、灶性淋巴细胞性甲状腺炎3个、亚急性肉芽肿性甲状腺炎2个。弹性分级为0~Ⅱ级的结节148个,Ⅲ~Ⅳ级者60个。根据病理学结果,良性结节占0~Ⅱ级的97.3%(144/148),占Ⅲ~Ⅳ级的38.3%(23/60);恶性结节占0~Ⅱ级的2.7%(4/148),占Ⅲ~Ⅳ级的61.7%(37/60)。实时超声弹性成像的诊断敏感度为90.2%(37/41),特异度为86.2%(144/167),准确度为87.0%(181/208)。结论实时超声弹性成像能反映甲状腺结节的相对硬度,为诊断提供有用信息,有助于鉴别诊断甲状腺结节的良、恶性。     

Lymphangioma of the small bowel mesentery in a 7-year-old girl: a report of a case investigated with ultrasonography,elastosonography and computed tomography

Purpose

To describe the characteristics of lymphangioma reporting a pediatric case of small bowel mesentery location, showing ultrasound-elastosonographic and computed tomography findings.

Methods

A 7-year-old girl suffering from vomiting and abdominal pain underwent chest–abdomen radiography and abdomen ultrasound examination at our institution. These exams were repeated for 5 days after medical therapy and a computed tomography investigation was also performed.

Results

Abdominal ultrasound and computed tomography examinations revealed the presence of a heterogeneous mesenteric mass occupying the right hemiabdomen displacing small bowel loops. Moreover, the mass had an irregular vascularisation pattern on color-Doppler study and appeared mostly green colored, like soft tissues, on elastosonographic colorimetric map. The little patient underwent surgery with removal of both the mass and the close adherent ileal loop. Finally, anatomopathologic diagnosis of mesenteric lymphangioma was made.

Conclusions

Although mesenteric lymphangioma is a rare disease that presents neither clinical nor imaging typical features requiring invasive procedure to be diagnosed, ultrasound-elastosonographic findings can suggest a benign condition and computed tomography scan is useful in order to plan surgery.     

超声弹性成像在浅表淋巴结良恶性鉴别诊断中的价值

目的：探讨实时静态超声弹性成像对判断浅表淋巴结良恶性的诊断价值.方法：2012年1月--2012年12月上海交通大学附属胸科医院诊治98例浅表淋巴结肿大患者,共107个肿大浅表淋巴结.107个肿大的浅表淋巴结均经病理学证实其良恶性.采用灰阶超声进行病灶检查,记录淋巴结的长、短径,并计算其比值.对病灶行超声弹性成像,将感兴趣区域（ROI）内病灶区与周围组织硬度相比较,并对弹性图进行分型.结果：恶性淋巴结弹性分级≥Ⅲ级者占77.33％（58/75）,良性淋巴结弹性分级≤Ⅱ级者占68.75％（22/32）,两者比较差异有统计学意义（P＜0.01）.恶性淋巴结长短径比＜2者占90.67％（68/75）,良性淋巴结长短径比＞2者占53.13％（17/32）,两者比较差异有统计学意义（P＜0.01）.但弹性分级与长短径比两种方法之间比较,差异无统计学意义（P＞0.05）.结论：超声弹性图分级对判断浅表淋巴结良、恶性有诊断价值,但是作为诊断方法,较淋巴结长短径比值并无明显优势.