超声弹性成像技术联合血清学标志物预测2型糖尿病的应用价值

<正>多项研究表明,非酒精性脂肪性肝病患者(NAFLD)发生2型糖尿病(type 2 diabetes mellitus,T2DM)的风险是正常人的5倍^[1-3]。在T2DM患者中,NAFLD的患病率可高达70%^[4]。肝脏瞬时弹性成像技术(tran-sient elastography,TE)是近年来新兴的超声无创检查方法,主要基于超声信号在肝组织中传播受肝细胞中脂滴的影响而出现显著衰减的原理来评估肝脏脂肪性病变,     

实时组织弹性成像在乳腺肿瘤诊断中的应用

目的：探讨实时组织弹性成像（RTE）诊断乳腺肿瘤的应用价值。方法：对120例乳腺肿块患者，共135个病灶，先用B型图像和彩色多谱勒血流图（CDFI）检查，再行弹性成像检查，用5分法对弹性图进行评分。以手术后病理诊断结果为标准，分别计算应用弹性评分及二维超声表现结合弹性评分诊断乳腺恶性肿瘤的敏感性、特异性和一致性。结果：如弹性评分大于4分诊断乳腺恶性肿瘤敏感性为85．45％，特异性为83．75％，一致性为84．4％；应用二维超声表现结合弹性评分诊断乳腺恶性肿瘤的敏感性为100％，特异性为95％，一致性为97％。结论：RTE与二维图像相结合可提高乳腺恶性肿瘤的诊断正确性，具有良好的临床应用前景。     

常规超声结合超声弹性成像对乳腺导管内癌诊断的效果分析

目的探讨常规超声结合超声弹性成像对乳腺导管内癌诊断的效果。方法选择我院2013年2月~2016年2月期间收治的共30例术后病理证实为乳腺导管内癌患者作为研究对象,使用随机分配的方式分为观察组和对照组,每组15例。对照组患者进行常规超声检查,观察组患者进行常规超声结合超声弹性成像检查,观察比较两组的成像特征。结果观察组患者的诊断符合率为93.3%,对照组患者的诊断符合率为80.0%,采用常规超声结合超声弹性成像的观察组的诊断符合率显著高于采用常规超声检查的对照组,差异具有统计学意义(P0.05)。结论常规超声结合超声弹性成像对乳腺导管内癌诊断符合率较高,诊断效果较好,值得临床推广。     

Role of Bowel Ultrasound in the Diagnosis and Follow-up of Patients with Crohn's Disease

Crohn's disease (CD) is an inflammatory chronic bowel disorder; it can involve the whole gastrointestinal tract, but its localization in the ileum or colon is most common. The reference standard for the diagnosis of CD is ileocolonoscopy with histologic assessment. The reference standard for the detection of any complications is surgery. However, imaging techniques have an important role both in the detection/localization of CD and in the follow-up of CD patients. In the last few years, the technical development of ultrasound equipment, the advent of new technologies such as elastography and mostly the increased expertise of sonographers have boosted the role of bowel ultrasound in assessment of the gastrointestinal tract. In fact, bowel ultrasound is particularly attractive thanks to its widespread availability, non-invasiveness, low cost and good reproducibility, as it can be easily repeated during follow-up. The aim of this article is to provide an extensive overview of the actual role of bowel ultrasound in the detection and follow-up of patients with CD.     

Application of Various Additional Imaging Techniques for Thyroid Ultrasound: Direct Comparison of Combined Various Elastography and Doppler Parameters to Gray-Scale Ultrasound in Differential Diagnosis of Thyroid Nodules

This study was conducted to evaluate the role in the differential diagnosis of thyroid nodules of various elastographic and Doppler parameters when added to gray-scale ultrasonography (US). One-hundred seventy-one thyroid nodules (63 malignant, 108 benign) in 169 patients were included. Elastography (strain and shear wave elastography) and Doppler (power Doppler, superb microvascular imaging and microflow imaging) images of the same thyroid nodule were obtained using a single US machine. The diagnostic performance parameters of gray-scale US with and without elastography and those of Doppler US were calculated and compared. The specificity, positive predictive value and accuracy of gray-scale US were significantly higher than those of US combined with elastographic parameters (all p values?<?0.05). The area under the receiver operating characteristic curve for gray-scale US was 0.877, significantly higher than that for US combined with elastography patterns, shear wave elastography ratio (all p values?<?0.05) and Doppler parameters. Adding additional imaging modalities such as elastography and Doppler does not improve the diagnostic performance of gray-scale US in differentiating thyroid nodules.     

Small Breast Lesion Classification Performance Using the Normalized Axial-Shear Strain Area Feature

Breast cancers that are found and confirmed because they are causing symptoms tend to be larger and are more likely to have already spread to the lymph nodes and beyond. Thus, early detection and confirmation are of paramount importance. The normalized axial–shear strain area (NASSA) feature from the axial-shear strain elastogram (ASSE) has been shown to be a feature that can identify the boundary-bonding conditions that are indicative of the presence of cancer. Recently, we investigated and reported on the potential of the NASSA feature for breast lesion classification into fibroadenomas and cancers. In this article, we investigate the size distribution of the lesions that were part of the previous study and analyze classification performance specifically on small lesions (<10 mm diameter). A total of 33 biopsy-proven malignant tumors and 30 fibroadenomas were part of the study that involved three observers blinded to the Breast Imaging Reporting and Data System (BIRADS) ultrasound scores. The observers outlined the lesions on the sonograms and the lesion size (maximum circle-equivalent diameter in millimeters) was computed from this outline. The ASSE was automatically segmented and color-overlaid on the sonogram, and the NASSA feature from ASSE was computed semi-automatically. Receiver operating characteristic curves were then generated for the subset of cases involving small lesions. Box plots were produced for the two different lesion size groups, small and large, from a logistic regression classifier that was built previously. The results of our study show that approximately 38% and 22% of the fibroadenomas and cancers, respectively, were small. Furthermore, it was found that the NASSA feature resulted in a perfect classification of the small lesions, both in the training data and in the cross-validation. For lesions <10 mm the difference in fibroadenoma and cancer mean scores was 0.73 ± 0.13 (p < 0.001), whereas lesions >10 mm had a difference of 0.52 ± 0.24 (p < 0.001). The results also showed that the small lesions actually had better classification than the larger lesions (>10 mm). These results suggest that the ASSE feature can work equally well, even on small lesions, to improve the standard ultrasound BIRADS–based breast lesion classification of fibroadenoma and malignant tumors.     

Bidirectional Ultrasound Elastographic Imaging Framework for Non-invasive Assessment of the Non-linear Behavior of a Physiologically Pressurized Artery

Studies of non-destructive bidirectional ultrasound assessment of non-linear mechanical behavior of the artery are scarce in the literature. We hereby propose derivation of a strain–shear modulus relationship as a new graphical diagnostic index using an ultrasound elastographic imaging framework, which encompasses our in-house bidirectional vascular guided wave imaging (VGWI) and ultrasound strain imaging (USI). This framework is used to assess arterial non-linearity in two orthogonal (i.e., longitudinal and circumferential) directions in the absence of non-invasive pressure measurement. Bidirectional VGWI estimates longitudinal (μ_L) and transverse (μ_T) shear moduli, whereas USI estimates radial strain (?_r). Vessel-mimicking phantoms (with and without longitudinal pre-stretch) and in vitro porcine aortas under static and/or dynamic physiologic intraluminal pressure loads were examined. ?_r was found to be a suitable alternative to intraluminal pressure for representation of cyclic loading on the artery wall. Results revealed that μ_T values of all samples examined increased non-linearly with ε_r magnitude and more drastically than μ_L, whereas μ_L values of only the pre-stretched phantoms and aortas increased with ?_r magnitude. As a new graphical representation of arterial non-linearity and function, strain–shear modulus loops derived by the proposed framework over two consecutive dynamic loading cycles differentiated sample pre-conditions and corroborated direction-dependent non-linear mechanical behaviors of the aorta with high estimation repeatability.     

弹性定量参数在触诊阴性乳腺实性肿块中的应用价值

目的 探讨弹性定量参数在临床触诊阴性乳腺病(non-palpablebreast lesions,NPBL)中的诊断价值。方法 选取2013年1月-2015年6月在我院行高频超声并经手术病理证实的NPBL患者。依照手术后病理结果分为良性病灶组(A组,n=110),恶性病灶组(B组,n=40)。分别比较并分析两组弹性应变率(SR)比值、直径变化率、面积比及二维超声检查。应用受试者操作特性曲线(ROC)曲线分析SR比值、直径变化率、面积比、二维超声及三种弹性定量参数联合诊断乳腺癌的ROC曲线下面积(AUC)、最佳界值、敏感度和特异度。结果B组SR水平(6.04±2.53)显著高于A组水平(2.86±1.51),差异有统计学意义(t=5.031；p=0.000)。根据两组SR水平制作ROC曲线,AUC为0.844,以5.22作为最佳界值,诊断乳腺癌的敏感度为57.5％,特异度为96.4％。B组病灶的直径变化率(0.28±0.12)显著高于A组(0.17±0.09),同时面积比(1.96±0.28)亦显著高于A组(1.12±0.33)(p值均<0.05)。通过SR、直径变化率、面积比水平联合诊断乳腺癌,敏感度为77.5％,特异度为94.5％,AUC为0.937,高于单项指标。结论 通过三种弹性定量参数联合诊断能够提高对乳腺癌的诊断能力。