结节性甲状腺肿的高频超声表现

目的研究结节性甲状腺肿的高频超声表现。方法搜集我院2004年1~6月经病理证实的153例结节性甲状腺肿,术前均作高频超声检查,回顾性分析其超声表现。结果甲状腺肿大23例,甲状腺肿大伴结节41例,甲状腺多发占位伴钙化89例。结论结节性甲状腺肿的高频超声表现多样,超声是诊断结节性甲状腺肿的一种重要方法。     

In Vitro Ultrasound Biomicroscopic Imaging of Colitis in Rats

Objective. The purpose of this study was to show the feasibility of 50‐MHz ultrasound biomicroscopy (UBM) to image the rat colon. Methods. B‐mode images were obtained from ex vivo colon samples (n = 4) collected from Rattus norvegicus (Berkenhout, 1769) rats, with 2,4,6‐trinitrobenzene sulfonic acid–induced colitis in 3 of them. Left colon rectangular fragments (5 × 5 mm) were obtained after necropsy, and UBM images were acquired with the samples immersed in saline at 37°C. All layers of the normal intestinal wall were analyzed according to their thickness and the presence of uneven bowel mucosa (ulcers). The folds and layers detected by UBM were correlated with histopathologic analysis. Results. The 4 layers of the normal colon were identified on the UBM images: the mucosa (hyperechoic), muscularis mucosae (hypoechoic), submucosa (hyperechoic), and muscularis externa (hypoechoic). On 2 UBM images, superficial ulcers were detected, approximately 0.5 mm in size, with intestinal involvement limited to the mucosa. The histopathologic analysis verified enlargement of submucosa layers due to an edema associated with sub‐mucosa leukocyte infiltration. On 1 UBM image, it was possible to detect a deep ulcer, which was confirmed by the light microscopic analysis. Conclusions. An ultrasound imaging system was scaled and optimized to visualize the rat colon. Ultrasound biomicroscopy provided axial and lateral resolutions close to 25 and 45 μm, respectively, and adequate penetration depth to visualize the whole thickness of an inflamed colon. The system identified the colon layers and was able to detect mural changes and superficial ulcers on the order of 500 μm.     

High‐Frequency Ultrasound in Blistering Skin Diseases: A Useful Method for Differentiating Blister Locations

Bullous pemphigoid and pemphigus vulgaris, which belong to the group of subepidermal and intraepidermal bullae, respectively, are two potentially devastating blistering skin diseases. We used high‐frequency ultrasound (US) in 3 cases of these diseases as prototypes to study the value of high‐frequency US in discriminating blister locations. Our findings showed that high‐frequency US has a strong correlation with histomorphometric findings because of its high resolution, and we hope that it will be helpful for differentiating blister locations.     

Tissue Harmonic Imaging Improves Organ Visualization in Trauma Ultrasound When Compared with Standard Ultrasound Mode

The focused abdominal sonography for trauma (FAST) examination is complicated by brightly lit trauma bays, limited time, and body habitus. Recently, new ultrasound (US) technology has become available that improves organ visualization in abdominal scans. OBJECTIVE: The hypothesis was that a new US mode, tissue harmonic (TH) imaging, improves visualization of critical organ relationships in the FAST examination by making use of previously unused frequencies. The authors performed a blind, prospective observational study to compare the images obtained in typical FAST views with those obtained in standard US and TH modes. METHODS: Blunt trauma patients presenting to a level I trauma center between April and September 2000 were enrolled on a convenience basis. Typical FAST views were obtained in standard and TH modes. The emergency ultrasonographer (EU) switched between modes for each view, optimizing the gain each time. Multiple digital still images were made with all indications of the mode used disguised. For each view on a patient, the best image in each mode was selected in a blinded fashion. Three experienced EUs, blinded to the mode used, rated each image pair for resolution, detail, and total image quality as previously defined on a ten-point Likert scale, 10 being the best for each category. Wilcoxon signed-ranks test, 95% confidence intervals (95% CIs), and interobserver correlation were calculated. RESULTS: A total of 76 image groups (39 of Morison's pouch, 20 splenorenal, and 17 bladder) from 52 patients were rated. Tissue harmonics produced improved resolution, detail, and quality when compared with the standard US mode, with median scores of 6.7 vs. 6.0, 6.7 vs. 6.0, and 6.3 vs. 6.0, respectively. The differences of 0.7 (95% CI = 0.4 to 0.93), 0.7 (95% CI = 0.4 to 0.93), and 0.33 (95% CI = 0.17 to 0.67) were statistically significant, with p = 0.0001, 0.0001, and 0.0003, respectively. There was good interobserver agreement (kappa = 0.74; 95% CI = 0.68 to 0.79). CONCLUSIONS: Tissue harmonics produced FAST images higher in detail, resolution, and total image quality than standard-mode US images.     

Sonography of Common Peripheral Nerve Disorders With Clinical Correlation

Sonography is now considered an effective method to evaluate peripheral nerves. Low cost, high resolution, the ability to image an entire limb in a short time, and dynamic assessment are several of the positive attributes of sonography. This article will review the normal appearance of peripheral nerves as shown with sonography. In addition, the most common applications for sonography of the peripheral nerves will be reviewed, which include entrapment neuropathies, intraneural ganglion cyst, nerve trauma, and peripheral nerve sheath tumors. Clinical information related to nerve disorders is also included, as it provides valuable information that can be obtained during sonographic examinations, increasing diagnostic accuracy.     

高频超声对外伤性虹膜病变的诊断价值

目的 探讨高频超声诊断外伤性虹膜病变的价值及声像图特点。方法 应用Logic 700彩色多普勒超声仪对27例眼外伤患采用眼部轴向切面和虹膜水平的冠状切面检查。结果 高频超声显示虹膜后粘连12只眼，前粘连10只眼，虹膜挫伤5只眼(包括3例虹膜根部离断)。1例虹膜根部离断漏诊。结论 高频超声能准确诊断虹膜病变，常规轴向切面配合冠状切面可以提高病变检出率。     

Prehospital Ultrasound by Paramedics: Results of Field Trial

Objectives: The objective was to determine if 9‐1‐1 paramedics trained in ultrasound (US) could adequately perform and interpret the Focused Assessment Sonography in Trauma (FAST) and the abdominal aortic (AA) exams in the prehospital care environment. Methods: Paramedics at two emergency medical services (EMS) agencies received a 6‐hour training program in US with ongoing refresher education. Paramedics collected US in the field using a prospective convenience methodology. All US were performed in the ambulance without scene delay. US exams were reviewed in a blinded fashion by an emergency sonographer physician overreader (PO). Results: A total of 104 patients had an US performed between January 1, 2008, and January 1, 2009. Twenty AA exams were performed and all were interpreted as negative by the paramedics and the PO. Paramedics were unable to obtain adequate images in 7.7% (8/104) of the patients. Eighty‐four patients had the FAST exam performed. Six exams (6/84, 7.1%) were read as positive for free intraperitoneal/pericardial fluid by both the paramedics and the PO. FAST and AA US exam interpretation by the paramedics had a 100% proportion of agreement with the PO. Conclusions: This pilot study shows that with close supervision, paramedics can adequately obtain and interpret prehospital FAST and AA US images under protocol. These results support a growing body of literature that indicates US may be feasible and useful in the prehospital setting. ACADEMIC EMERGENCY MEDICINE 2010; 17:624–630 © 2010 by the Society for Academic Emergency Medicine     

高、低频超声诊断肝包膜下小肿块的对比研究

目的探讨高、低频超声对肝包膜下小肿块的诊断价值。方法对23例24个直径0．9～2．2cm的肝包膜下小肿块进行高、低频超声的灰阶超声和彩色多普勒超声分析、诊断，病例均经螺旋CT、病理等证实。结果对肿块边界、包膜、内部回声的观察及血流检出方面高频超声明显优于低频超声，低频超声的诊断符合率58％，高频超声的诊断符合率92％。结论对肝包膜下小肿块的超声诊断，使用高频超声可明显提高诊断率。     

大鼠心肌冷冻消蚀与心室重构的高频超声显像研究

为了评价大鼠心肌冷冻消蚀后心脏形态、功能以及组织学改变，进一步论证冷冻消蚀与心室重构的关系。我们应用心脏高频二维超声显像方法，对６４只成年Ｗｉｓｔａｒ大鼠随机分成心肌冷冻组２９只和梗塞组３５只进行研究。结果显示：在冷冻和梗塞损伤范围相同的情况下，冷冻组有３６％的大鼠冷冻区室壁回声密度增高，节段运动减弱，但无局部膨展表现。与冷冻组对照，梗塞组除有４１．６７％的大鼠显示室壁局部变薄、运动减弱或消失外，其中２只合并室壁膨展。冷冻组大鼠消蚀前、后不同时期各观察指标与梗塞组的比较显示，左室舒张末期容积增大幅度较低，发生较晚，恢复较早。自术后２天开始，冷冻组和梗塞组的室壁扩张指数均较术前明显上升，其中冷冻组冷冻后２天和４天的上升程度略小于１周和２周，且增幅小于梗塞组。证实冷冻消蚀也可引起与心室重构有关的心室形态、功能的改变，但程度小于心肌梗塞。     

自由扫查超声成像技术在软组织大范围病变的应用

目的 探讨自由扫查超声成像技术在临床的应用价值。方法 在使用二维、CDFI、CDE及Doppler对25例四肢软组织病变患者进行扫查基础上，使用自由扫查超声成像技术对病变区进行全景成像，并对图像进行对比分析。结果 自由扫查超声成像技术不仅能完整记录并反映病变的大小和特征，而且能准确反映病变的位置，及与周边组织的关系。结论 自由扫查超声成像技术与实时二维超声技术和血流检测技术结合能为临床提供更多的信息有助于诊断，是二维超声技术的有益补充和完善。     

Freehand 3-D Ultrasound Imaging: A Systematic Review

Two-dimensional ultrasound (US) imaging has been successfully used in clinical applications as a low-cost, portable and non-invasive image modality for more than three decades. Recent advances in computer science and technology illustrate the promise of the 3-D US modality as a medical imaging technique that is comparable to other prevalent modalities and that overcomes certain drawbacks of 2-D US. This systematic review covers freehand 3-D US imaging between 1970 and 2017, highlighting the current trends in research fields, the research methods, the main limitations, the leading researchers, standard assessment criteria and clinical applications. Freehand 3-D US systems are more prevalent in the academic environment, whereas in clinical applications and industrial research, most studies have focused on 3-D US transducers and improvement of hardware performance. This topic is still an interesting active area for researchers, and there remain many unsolved problems to be addressed.     

ROC方法评价高频彩超、超声弹性成像及钼靶X线在乳腺病变鉴别诊断中的价值

目的：比较高频彩超、超声弹性成像及钼靶X线对乳腺良恶性病变进行鉴别诊断的价值.材料与方法：回顾分析经病理证实的59例乳腺肿块的高频彩超、钼靶X线、超声弹性成像及高频彩超与弹性成像联合诊断结果的敏感性、特异性、准确性,并对诊断结果进行ROC分析.结果：超声弹性成像诊断乳腺良恶性病灶的准确性93.24％、敏感性89.6％、特异性90.6％,略高于钼靶X线的89.9％、89.7％和84.4％.高频超声诊断乳腺肿块良恶性具有较高的敏感性（75.9％）但特异性较差（62.5％）.高频彩超＋弹性成像组合得到最高的敏感性93.1％,但特异性提高不明显,仅为65.6％.超声弹性成像的AUC值0.958,高于钼靶X线、高频彩超和高频彩超＋弹性成像三者的AUC值（0.921、0.827和0.887）,弹性成像与高频彩超和二者结合的AUC之间的差异具有统计学意义（P=0.0077、0.0416）.结论：超声弹性成像对乳腺病变诊断具有较高的敏感性和特异性,与高频超声联合应用能够明显提高超声检查在乳腺良恶性病变中的鉴别诊断准确性.     

Potential Errors in the Diagnosis of Pericardial Effusion on Trauma Ultrasound for Penetrating Injuries

OBJECTIVE: To evaluate ultrasound error in patients presenting with penetrating injury with a potential for pericardial effusion. METHODS: Residents and faculty from an emergency medicine training program at Level 1 trauma center with an active ultrasound program were asked to view digitized video clips of subxiphoid cardiac examinations in patients with chest trauma. Participants were asked to fill out a standardized questionnaire on each video clip asking whether a pericardial effusion was present. Other questions included size of effusion and presence of tamponade. The study also asked participants to rate their confidence in their impressions. Data were analyzed using interquartile ranges and confidence levels. RESULTS: All participants had difficulty distinguishing between epicardial fat pads and true pericardial effusions. The overall sensitivity was 73% and specificity was 44%. Confidence shown by participants in their answers increased with level of training or experience, regardless of whether they were correct or incorrect. Additional views were frequently requested to help decide whether an effusion was present. CONCLUSIONS: A serious potential exists for misdiagnosing epicardial fat pads as pericardial effusion in critically ill trauma patients. Emergency physicians need to be aware of this and should consider one of two suggested alternative methods to improve the accuracy of diagnosis.     

低频与高频探头超声对急性阑尾炎诊断的比较

目的比较低频与高频探头超声对急性阑尾炎的诊断价值。方法对2010年1月-2011年6月120例急性阑尾炎的手术病理结果与超声检查结果进行回顾性分析,比较低、高频探头超声对急性阑尾炎的诊断价值。结果 120例急性阑尾炎中,通过低频探头超声检出67例(55.8%),通过高频探头超声检出105例(87.5%);单纯性阑尾炎以及化脓性和坏疽性阑尾炎高频探头超声检出例数明显大于低频探头超声,差异有统计学意义(P<0.05);阑尾周围脓肿低、高频探头超声均全部检出。结论高频探头超声对急性阑尾炎的检出率高于低频探头超声,但二者各有所长,在临床中联合应用能有效提高急性阑尾炎的超声诊断符合率。     

超声对阑尾病变的诊断价值

目的：探讨阑尾病变的超声图像特征及超声对阑尾病变的诊断价值。方法：应用低频超声(简称低频)及高频超声(简称高频)对89例可疑阑尾病变进行检查并诊断，全部经手术与病理证实。结果：阑尾病变的超声诊断符合率；低频为43．8％，高频为93．2％。结论：高频对阑尾病变的显示率明显高于低频，其对阑尾病变的直观显示可为临床提供客观的诊断依据。     

高功率聚焦超声高温破坏肝肿瘤的影像学检测

本文报告彩超、ＣＴ和ＭＲＩ观察高功率聚焦超声（ＨＩＦＵ）破坏兔肝肿瘤前、后影像特征变化，旨在探讨这三种影像学技术检测ＨＩＦＵ疗效的可行性。１０只兔肝肿瘤模型由肝内注射Ｆｒｅｕｎｄ完全佐剂，一周后形成炎性假瘤结节制成。ＨＩＦＵ治疗参数采用频率１．１ＭＨｚ，功率５００Ｗ／ｃｍ２，连续超声波照射时间２０秒。结果显示：彩超能有效检测ＨＩＦＵ破坏肝肿瘤疗效。经ＨＩＦＵ照射后，表现为强回声病灶变为低回声，且Ｄｏｐｐｌｅｒ血流消失，２４ｈ后病灶边缘出现强回声带。这些特征性变化与病理改变相一致。而ＣＴ和ＭＲＩ在本实验中未能检测到ＨＩＦＵ破坏肿瘤的特征性改变     

经阴道超声对女性尿道憩室的诊断价值

目的探讨经阴道超声检查女性尿道憩室的声像图表现及诊断价值。方法回顾性分析40例女性尿道憩室患者临床及超声资料,总结其声像图特点。结果 40例经阴道超声诊断为尿道憩室。其中38例为单发憩室,2例多发憩室。均位于尿道中段,背侧为主。环形11个,马鞍形25个,类圆形7个。复杂性憩室37个,单纯性憩室6个。憩室最大径0.9~6.2 cm(中位3.0 cm),其中复杂性憩室最大径1.5~6.2 cm(中位3.0 cm),单纯性憩室最大径0.9~2.2 cm(中位1.5 cm)。壁厚0.2~0.5 cm(中位0.3 cm)。32个憩室呈无回声,11个憩室为片絮状弱回声。34个憩室内多发分隔,9个憩室内无分隔。26个憩室内点片状强回声结石,17个无强回声。43个憩室内均未见实性肿瘤。29个憩室开口位置与术中所见相符,14个憩室开口与术中所见不相符或未得到手术证实。28个憩室壁或分隔可见少量低速高阻动脉血流信号。结论女性尿道憩室的声像图具有特征性,有助于术前诊断及鉴别诊断。