MRI诊断子宫腺肌病的价值

目的 :探讨MRI诊断子宫腺肌病的价值。材料和方法 :通过对 92例临床疑为子宫腺肌病 /子宫肌瘤的患者行MRI和超声检查 ,并与术后病理结果对比 ,以评估MRI对子宫腺肌病的诊断符合率。结果 :经术后病理检查证实 ,根据临床表现诊断子宫腺肌病准确性较差 ,痛经者 85 .6 %、月经改变 5 0 .0 % ;B超诊断子宫腺肌病的灵敏度 5 3 .4%、特异度 5 5 .9% ;MRI对该病诊断的灵敏度 94.5 %、特异度 10 0 % ;既能定性 ,又能定位 ,而且此检查无创伤 ,方便快捷。结论 :MRI为临床诊断子宫腺肌病提供了一种最有价值的检查方法 ,为及时、正确治疗该病带来了重要的临床意义。     

声脉冲辐射力弹性成像对甲状腺结节良恶性鉴别诊断价值

目的 分析声脉冲辐射力（ARFI）弹性成像对甲状腺结节良恶性鉴别诊断价值。方法 选取2020年6月至2022年11月医院收治的甲状腺结节患者72例（85个结节）为研究对象,均接受常规超声及ARFI弹性成像检查,以组织病理结果为“金标准”,分析ARFI弹性成像鉴别诊断甲状腺结节良性恶。结果 本研究中85结节,经病理明确诊断良性病灶57个,恶性病灶28个;常规超声诊断在85个结节中共检出61个良性病灶,24个恶性病灶,诊断灵敏度60.7%(17/28)、特异度87.8%(50/57)、准确度为78.7%(67/85);恶性组声触诊组织成像（VTI）面积比、剪切波速度（SWV）、SWV比值均高于良性组,差异有统计学意义（P<0.05）;ARFI弹性成像参数绘制受试者工作特征（ROC）曲线结果显示,VTI面积比、SWV、SWV比值及联合诊断甲状腺结节良恶性的曲线下面积（AUC）均>0.7,具有一定诊断价值,且联合诊断价值最高。结论 ARFI弹性成像诊断甲状腺良恶性灵敏度、特异度较高,具有较高诊断价值。     

声辐射力脉冲成像技术对肝纤维化分级的应用价值

目的探讨声辐射力脉冲成像技术(ARFI)对慢性乙型肝炎病毒引起的肝纤维化的诊断价值。方法对239例经肝穿刺活检病理检查、26例临床确诊的乙肝肝硬化患者(列为F4级),应用ARFI技术测定肝脏剪切波速,检测肝纤维化程度,根据病理S0～S4分期,将患者分为F0～F4级。比较ARFI与血清肝纤维化标志物对肝纤维化程度的诊断价值,建立本地区的最佳界限值。设立50例正常对照组。结果 239例肝活检患者中病理诊断为S0～S4期的病例数分别为58例、48例、54例、59例和20例,ARFI平均值分别为(1.17±0.25)m/s、(1.39±0.36)m/s、(1.91±0.49)m/s、(2.66±0.51)m/s、(2.75±0.41)m/s。265例中,F0期与F1期,F3期与F4期的ARFI值之间差异无统计学意义。F0期与F2期、F3期、F4期之间,F1期与F2期、F3期、F4期之间,F2期与F3期、F4期之间差异有统计学意义(P<0.05)。ARFI分级结果与肝纤维化病理分期的相关性高于血清肝纤维化标志物,肝剪切波速中值数2.7是ARFI检查肝纤维化与肝硬化的交界点。结论 ARFI技术可较客观的评价肝纤维化分级,为临床提供一种无创评价肝纤维化程度的检查方法。     

声脉冲辐射力弹性成像在诊断乳腺小肿瘤中的价值

目的 探讨声脉冲辐射力弹性成像技术在诊断乳腺小肿瘤中的价值.资料与方法 纳入68例经病理证实的乳腺小肿瘤患者共71个病灶,应用声脉冲辐射力成像技术测量肿瘤声触诊组织成像模式下与二维模式下的面积比(AR)、声触诊组织量化模式下肿瘤内部及瘤缘处组织的横向剪切波速度,并与病理结果进行比较.结果 68例乳腺小肿瘤患者的71个病灶中,良性32个,恶性39个.良性肿瘤的平均AR为0.98±0.19,明显低于恶性肿瘤的1.74±0.48 (t=8.48,P＜0.05);良性肿瘤内部的横向剪切波速度为(1.92±0.43) m/s,明显低于恶性肿瘤内部的(5.69±3.00) m/s(t=7.02,P＜0.05);良性肿瘤周边组织的横向剪切波速度为(1.19±0.34) m/s,低于恶性肿瘤周边组织的(1.96±0.95) m/s(t=4.34,P＜0.05).结论 声脉冲辐射力弹性成像技术为乳腺小肿瘤的鉴别诊断提供了一种定量的弹性诊断方法.     

子宫腺肌病的超声诊断价值探讨

目的探讨子宫腺肌病的声像图特征,提高超声诊断率。方法对经手术及病理证实的63例子宫腺肌病的超声图像特征进行分析。结果患者术前超声诊断与术后病理结果对照,超声诊断子宫腺肌病的符合率为88．9％（56／63）,63例子宫腺肌病中有7例误诊为子宫肌瘤,误诊率为11％（7／63）。结论超声诊断子宫腺肌病有较高的准确性,有较好的临床应用价值。     

子宫动脉栓塞对子宫腺肌病的治疗效果

目的评价子宫动脉栓塞术对子宫腺肌病的疗效。方法对30例经超声和磁共振成像证实的子宫腺肌病患者行子宫动脉栓塞治疗,栓塞后随访评价临床症状改善情况。结果30例患者行子宫动脉栓塞治疗后28例痛经完全缓解,2例明显缓解。术后29例患者月经量较术前明显减少,月经周期无明显改变,未出现严重并发症。结论子宫动脉栓塞治疗子宫腺肌病疗效显著,可作为该病的常规治疗方法之一。     

正常成年女性子宫声辐射力脉冲成像量化值的参考范围探讨

目的 探讨正常成年女性子宫声辐射力脉冲成像(acoustic radiation force implese imageing,ARFI)量化值的参考范围.方法 对84名健康成年女性子宫前壁和后壁分别进行ARFI检测,比较子宫前后壁ARFI数值及不同年龄ARFI数值,正常子宫的ARFI测值采用x-±1.96s计算.结果 不同年龄组子宫ARFI检测值之间差异无统计学意义(P＞0.05).子宫前壁和后壁ARFI检测值差异无统计学意义(P＞0.05).子宫正常参考值范围:0.81～4.43m/s.结论 ARFI为子宫的硬度检测提供一种定量评价方法,为以后子宫疾病的诊断打下了基础.     

声脉冲辐射力成像在颈部淋巴结疾病中的应用研究

目的 :探讨声脉冲辐射力成像(acoustic radiation force impulse,ARFI)在颈部淋巴结疾病诊断中的应用。方法:对我院76例颈部淋巴结肿大的患者行ARFI,分别获取病灶的VTI面积比和VTQ值。根据病理结果将淋巴结分为良性、恶性2组,绘制ROC曲线,并确定VTI面积比和VTQ值的诊断临界值。结果:所有受检颈部淋巴结中,良恶性的VTI面积比分别为1.06±0.26、1.82±0.63,VTQ平均值分别为(2.28±0.83)、(6.61±1.63)m/s,差异均有统计学意义(均P0.05)。结论:ARFI技术应用于诊断颈部淋巴结疾病具有一定的可行性。     

子宫腺肌病的超声诊断

子宫腺肌病是妇科常见病,为子宫内膜异位于子宫肌壁内的良性病变,多发于35～50岁经产妇。为提高对子宫腺肌病的诊断率,现将我院经手术病理证实的98例子宫腺肌病声像图表现及误诊原因分析如下。     

声脉冲辐射力成像定量技术对非酒精性脂肪肝的初步探讨

目的:探讨声脉冲辐射力成像技术(acoustic radiation force Impulse,ARFI)定量检测非酒精性脂肪肝(non-al-coholic fatty liver disease,NAFLD)的临床价值。方法:选择NAFLD患者139例及健康人群70例为研究对象,利用ARFI定量测定肝脏剪切波速,比较NAFLD与对照组肝脏剪切波速的关系。结果:139例NAFLD与70例健康对照组肝脏平均剪切波速分别为1.08m/s、1.11m/s,两组比较无显著性差异(P=0.25)。结论:ARFI在NAFLD与健康人群中不存在差异,肝活检仍然是评价NAFLD的金标准。     

Initial experience of acoustic radiation force impulse ultrasound imaging of cervical lymph nodes

The aim of this study was to evaluate acoustic radiation force impulse imaging for cervical lymphadenopathy in routine clinical practice and to correlate the acoustic radiation force impulse values with the morphological signs and the pathological results, which were used as the reference standard. The virtual touch tissue quantification values were analyzed in 123 patients (mean age 40.8 years, range 1–81 years) with 181 cervical lymph nodes (87 benign, 94 malignant). The diagnostic performance of acoustic radiation force impulse values were evaluated with respect to sensitivity, specificity, and area under the curve using a receiver operating characteristic curve analysis. The mean virtual touch tissue quantification values of the benign lesions (2.01 ± 0.95 m/s) differed from that of the malignant lesions (4.61 ± 2.56 m/s; P < 0.001). The cutoff level for virtual touch tissue quantification value for malignancy was estimated to be 2.595 m/s. Using the receiver operating characteristic curve curves with the cutoff value, the virtual touch tissue quantification value predicted malignancy with a sensitivity of 82.9%, specificity of 93.1% and gave an areas under the curve of 0.906 (95% CI 0.857–0.954). Acoustic radiation force impulse is feasible for cervical lymph nodes and provides quantitative elasticity measurements, which may complement B-mode ultrasound and potentially improve the characterization of cervical lymph nodes.     

The value of acoustic radiation force impulse (ARFI) in the differential diagnosis of thyroid nodules

Objectives

The aim of this study was to investigate the value of shear wave velocity value (SWV) and shear wave velocity ratio (SWR) in differentiating between malignant and benign thyroid nodules using virtual touch tissue quantification (VTQ) of acoustic radiation force impulse (ARFI) technology.

Methods

The SWV and SWR were analyzed in 155 thyroid nodules in 155 patients (93 benign and 62 malignant) and eighty normal thyroid glands. The diagnostic performance of SWV and SWR were compared.

Results

The mean value of SWV of malignant nodules differed significantly from those of the benign nodules (6.34 ± 2.58 m/s vs. 2.15 ± 0.59 m/s, P < 0.05) and the normal thyroid (1.96 ± 0.31 m/s, P < 0.05). There was no statistically significant difference between the mean value of SWV of benign nodules and normal thyroid (P > 0.05). The mean value of SWR of malignant nodules differed significantly from those of the benign nodules (2.99 ± 1.45 vs. 1.07 ± 0.34, P < 0.05). The sensitivity, specificity, positive predictive values, negative predictive values and accuracy of SWV in differentiating between malignant and benign nodules were 96.80%, 95.70%, 93.75%, 97.80% and 96.13% respectively based on the cutoff point as 2.84 m/s. Those of SWR were 91.90%, 81.70%, 77.03%, 93.83% and 85.83% based on the cutoff point as 1.32. The diagnostic accuracy rate of SWV was statistically higher than that of SWR (P < 0.05).

Conclusion

VTQ of ARFI technology provides the quantitative information of thyroid tissue elasticity and has high accuracy rate in differentiating between malignant and benign nodules. It is a useful complement for conventional ultrasonography.     

应用ARFI技术评估肝脏纤维化和肝占位患者术前肝储备功能

目的:探讨声脉冲辐射力弹性成像(ARFI)技术评估肝脏纤维化和肝占位患者肝脏储备功能的临床应用价值.方法:选取肝占位患者112例(肝占位组),健康志愿者34例(对照组),采用ARFI技术测量患者肝实质硬度(LS)值;采用吲哚氰绿(ICG)排泄实验记录ICG 15分钟滞留率(ICG-15R)和ICG血浆清除速率(ICG-K);采用Metavir分期对肝纤维化进行病理分期.LS值与肝纤维化分期、ICG-15R、ICG-K的相关性采用Pearson相关分析;比较肝脏占位组与对照组、手术治疗与非手术治疗患者及肝纤维化各病理分期之间的LS值并进行统计学分析;以肝纤维化病理分期为标准,采用受试者工作特性(ROC)曲线计算LS值对肝占位患者肝纤维化分期的诊断效能.结果:LS值与肝脏病理分期呈显著正相关(r=0.823,P＜0.001),并且LS值在评估不同分期纤维化时均有较高的特异度和敏感度;LS值与ICG-15R呈显著正相关(r=0.716,P＜0.001),与ICG-K呈显著负相关(r=-0.717,P＜0.001).肝占位组LS值为(1.78±0.48) m/s,对照组LS值为(1.19±0.11) m/s,差异有统计学意义(P＜0.001).非手术患者LS值为(2.49±0.27)m/s,手术患者LS值为(1.49±0.37) m/s,差异有统计学意义(P＜0.001).纤维化各病理分期之间的LS值差异有统计学意义(H=83.226,P＜0.001).结论:ARFI技术通过测量LS值能对肝纤维化进行量化分析,同时可有效评估肝占位患者的肝脏储备功能,为临床提供一种简单、无创的肝纤维化程度和术前肝储备功能的评估手段.     

Adapting MRI acoustic radiation force imaging for in vivo human brain focused ultrasound applications

A variety of magnetic resonance imaging acoustic radiation force imaging (MR‐ARFI) pulse sequences as the means for image guidance of focused ultrasound therapy have been recently developed and tested ex vivo and in animal models. To successfully translate MR‐ARFI guidance into human applications, ensuring that MR‐ARFI provides satisfactory image quality in the presence of patient motion and deposits safe amount of ultrasound energy during image acquisition is necessary. The first aim of this work was to study the effect of motion on in vivo displacement images of the brain obtained with 2D Fourier transform spin echo MR‐ARFI. Repeated bipolar displacement encoding configuration was shown less sensitive to organ motion. The optimal signal‐to‐noise ratio of displacement images was found for the duration of encoding gradients of 12 ms. The second aim was to further optimize the displacement signal‐to‐noise ratio for a particular tissue type by setting the time offset between the ultrasound emission and encoding based on the tissue response to acoustic radiation force. A method for measuring tissue response noninvasively was demonstrated. Finally, a new method for simultaneous monitoring of tissue heating during MR‐ARFI acquisition was presented to enable timely adjustment of the ultrasound energy aimed at ensuring the safety of the MR‐ARFI acquisition. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.     

两种声脉冲辐射力成像技术与慢性肾脏损害程度的相关性研究

目的研究两种声脉冲辐射力成像技术(ARFI)与慢性肾脏损害程度的相关性。方法选取61例慢性肾病患者作为肾病组(其中17例为IgA肾病患者),54名健康成年作为对照组;应用声触诊组织成像技术(VTI)联合灰阶图像定量分析软件与声触诊组织定量分析技术(VTQ),分别测定两组受检者肾实质灰阶值与剪切波(SWV),评估其与慢性肾病肾小球滤过率(GFR)分期及其与IgA肾病Lee病理分级之间的相关性。结果 (1)肾病组患者肾实质的SWV值为(2.83±0.67)m/s,对照组患者肾实质的SWV值为(3.56±0.45)m/s;肾病组患者肾实质的灰阶值为(88.46±17.42)dB,对照组患者肾实质的灰阶值为(64.04±11.00)dB;(2)慢性肾病患者肾实质灰阶值与GFR分期呈正相关性(r=0.72,P<0.05),其SWV值与GFR分期呈负相关性(r=-0.56,P<0.05);IgA肾病患者的肾实质灰阶值与其Lee病理分级呈正相关(r=0.71,P<0.05),其SWV值与Lee病理分级呈负相关(r=-0.79,P<0.05)。结论 VTQ技术测得的SWV值以及VTI技术结合灰阶图像分析软件所测得的灰阶值均可定量反映慢性肾脏损害程度。     

声脉冲辐射力成像联合肝固有动脉血流动力学评估肝硬化程度

目的:探讨声脉冲辐射力成像(ARFI)联合肝固有动脉血流动力学评估肝硬化程度的价值.方法:选取135例肝硬化患者为观察组,按照Child-Pugh(CP)评分对患者肝硬化程度进行分级;选取50例健康志愿者作为对照组.检测所有研究对象(观察组和对照组)的肝固有动脉血流动力学指标,包括收缩期峰值流速(PSV)和阻力指数(RI),并进行ARFI检查,测量肝实质硬度值(LS).分析不同CP评分分级的LS值、PSV及RI,采用受试者工作特征(ROC)曲线分析LS值与PSV、RI单用或联合应用对肝硬化的诊断价值.结果:观察组CP评分A、B、C三级患者的LS值、PSV及RI值均明显高于对照组,且C级＞B级＞A级,差异均具有统计学意义(P＜0.05).CP评分与LS值、PSV及RI均呈显著正相关(r=0.727、0.683、0.608,P值均＜0.05).LS值与PSV、RI联用的ROC曲线下面积高于单个指标.结论:ARFI检测的LS值联合肝固有动脉血流动力学指标对评估肝硬化程度具有重要价值.     

Value of acoustic radiation force impulse elastography for the assessment of ascites syndrome

AIM:To assess the feasibility of performing acoustic radiation force impulse(ARFI) elastography in patients with ascites and its predictive value for the cirrhotic or non-cirrhotic etiology of ascites.METHODS:Our study included 153 patients with ascites,mean age 58.8 ± 13.1 years.One hundred and fifteen(75.2%) patients had ascites in the context of cirrhosis,29(18.9%) had non-cirrhotic ascites(diagnosed by clinical,ultrasound,endoscopic and/or laparoscopic criteria) and in 9(5.9%) cases we could not establish the etiology of ascites.We performed 10 ARFI measurements and the median value was calculated and expressed in meters/second(m/s).Among the 29 patients with non-cirrhotic ascites were included:20 laparoscopically demonstrated peritoneal carcinomatosis with histological confirmation,7 acute pancreatitis with ascites which later resolved,and one case each of lymphatic ascites and ascites in the context of a liver abscess.In 11 of the 20 patients with peritoneal carcinomatosis,the liver structure was homogenous in the ultrasound examination and in 9 patients the ultrasound exam revealed liver metastases.RESULTS:We could not obtain valid ARFI measurements in 5 patients(3.2%).The mean liver stiffness measurements by means of ARFI were statistically significantly higher in patients with cirrhotic ascites than in those with non-cirrhotic ascites:3.04 ± 0.70 vs 1.45 ± 0.59 m/s(P < 0.001).For a cut-off value of 1.8 m/s for predicting cirrhosis(and ascites in the context of cirrhosis),as obtained in a previous study,ARFI had 98.1% sensitivity,86.2% specificity,96.4% positive predictive value,92.5% negative predictive value and 95.6% accuracy for predicting cirrhotic ascites.For a cut-off value of 1.9 m/s the accuracy was 94.9% and for a 2 m/s cut-off value it was 92.8%.CONCLUSION:ARFI elastography is feasible in most patients with ascites and has a very good predictive value for the cirrhotic or non-cirrhotic etiology of ascites.     

低场MRI对子宫腺肌症的诊断价值

目的探讨子宫腺肌症的低场（0．35T）MRI影像特点和鉴别诊断价值。方法回顾分析了14例经手术病理证实的子宫腺肌症的影像特征。结果弥漫性子宫腺肌症11例，T2WI结合带弥漫性增厚，厚度12．1～37．4mm，平均15．4mm，其中，8例患者子宫肌层低信号病灶内可见多发斑点状高信号影，典型者呈“飘雪征”，3例患者的病灶呈均匀的低信号；局限性子宫腺肌症3例，结合带局限性增厚或外肌层结合带样信号灶，2例患者T2WI混杂有斑点状高信号。结论子宫腺肌症MRI表现具有明显特征性和鉴别诊断价值。