超声造影诊断肾脏占位性病变的临床研究

目的:探讨超声造影在肾脏占位性病变中的临床应用价值。方法:对16例经手术病理或随访证实的肾脏占位性病变患者行超声造影,观察并分析病灶对比剂灌注时相和变化规律。结果:9例肾透明细胞癌,超声造影表现多种多样,与正常肾皮质相比较:快进7例,同进2例,快退3例,同退3例,慢退3例;与正常肾皮质强化程度相比较:6例高强化,3例等强化。3例肾囊性病灶,超声造影轮廓较二维超声清晰,但内部始终未见强化。2例肾血管平滑肌脂肪瘤表现为慢进慢退,回声呈等、低强化表现。2例肾柱肥大超声造影增强动态变化时间、强度与正常肾实质一致。结论:超声造影能够实时观察肾脏占位性病变的血流灌注情况,对肾脏占位性病变的诊断和鉴别诊断具有较高的临床应用价值。     

小肾癌的血管造影诊断：药物血管造影的作用及其与CT和超声的对 …

目的：评价血管造影尤其药物血管造影对小肾癌的诊断的鉴别诊断价值。材料与方法：２６例直径３ｃｍ以下肾脏小肿物血管造影前均进行了二维超声和ＣＴ平扫与增强检查。先行腹主动脉和肾动脉的标准血管造影，然后根据动脉造影表现确定是否再行药物性血管造影。后者是指先经肾动脉注入肾上腺素１０μｇ，１０￣２０秒后再行肾动脉造影。并对ＣＴ、超声和血管造影的诊断结果做了统计分析了与对比。结果：２６例肾脏病变最后确定依断小肾     

超声造影鉴别诊断肾脏占位性病变的价值

目的:探讨超声造影鉴别诊断肾脏占位性病变的意义。材料和方法:对29例肾脏占位性病变进行超声造影检查。观察并分析良、恶性病变的超声造影表现及灌注特征。结果:肾脏恶性病灶造影剂退出时间多早于肾实质(15/16);其中,肾透明细胞癌在造影晚期多表现为病灶周边环状强回声带(8/11)。肾脏良性病灶中,错构瘤6例造影剂退出与肾实质相似,5例晚于肾实质,与肾脏恶性病灶存在显著性差异(P<0.05);1例肾嗜酸细胞瘤及1例中胚叶肾瘤造影开始减退时间早于肾实质,造影晚期亦可见病灶周边环状强回声带,难以与肾恶性病灶鉴别。结论:超声造影能够实时观察肾脏占位性病变的血流灌注情况,对肾占位性病变的诊断及鉴别诊断具有一定的临床意义。     

超声造影在肝脏疾病中的应用进展

随着一代代新型超声对比剂的相继问世和造影成像技术的不断发展 ,超声造影成像已成为超声医学界关注的热点 ,其在肝脏疾病诊断、鉴别诊断与肝肿瘤非手术治疗疗效监测中的应用不但广泛 ,而且具有独到的优点和重要的临床价值。本文综合文献资料 ,对超声对比剂与成像技术加以概括 ,并将超声造影在肝脏疾病中的临床应用现状与进展进行综述。     

超声造影对肾脏小占位的诊断分析

目的:探讨不同病理类型肾脏肿瘤的造影特点,评价超声造影诊断肾脏良恶性肿瘤的应用价值,为临床诊断提供依据。方法:应用声学造影剂声诺维对27例超声诊断为肾脏占位病变或可疑肾脏占位病变的患者进行超声造影检查,分析其造影增强图像特点。结果:27例患者均满意获得清晰的肿瘤动态造影灌注图像,大部分与其正常肾组织回声等强,10例肾恶性肿瘤的造影显像比其正常肾组织快,3例肾良性肿瘤造影显像为"同进慢出";4例肾柱肥大造影后与正常肾组织造影剂显像一致;2例肾囊肿内无造影剂显示。结论:超声造影成像技术能清晰显示肾肿瘤的血流灌注特点,对肾脏肿瘤的诊断具有一定实用价值。     

肾脏恶性肿瘤的CPS超声造影灌注特点探讨

目的:研究对比脉冲序列(CPS)造影成像技术对肾脏恶性肿瘤的临床诊断价值。方法:对13例经手术病理证实的,肾脏恶性肿瘤(肾透明细胞癌11例,肾盂癌2例)患者进行CPS超声造影观察,分析其造影增强图像特点。结果:13例患者均满意获得清晰的肿瘤动态造影灌注图像。肾癌的造影特点表现多样,主要表现为高造影灌注,强化程度多高于肾皮质;强化持续时间更倾向于长于肾皮质。主要造影表现为稀疏条带样、斑片状、不规则网篮状强化和整体呈明亮的造影团。肾盂癌的强化呈“快进快出”表现,强化程度弱于肾皮质。结论:CPS造影成像技术能清晰显示肾癌的血流灌注特点,为肾肿瘤的超声诊断提供了更多信息。     

肾脏疾病超声诊断的研究近况

近年来多普勒技术、超声造影技术的应用和发展,超声检查逐渐成为许多疾病的常规或首选检查手段。本文就一些常见肾脏输尿管疾病的超声诊断价值加以概述。肾脏输尿管结石的超声诊断肾脏输尿管结石是泌尿系常见的疾病之一,可以引起放射性侧腹痛、血尿等症状,也常合并感染。当结石完全梗阻时,若不能及时解除梗阻,还可致肾功能丧失。此病的诊断一般采用腹部X线平片、静脉尿路造影(intravenousurography ,IVU)、经膀胱镜输尿管内插入导管摄片或逆行肾盂造影等检查。但上述方法受许多因素的影响,如腹部X线平片对肾输尿管结石诊断有很大的局限性,…     

超声造影在肝脏肿瘤中的应用进展

声学对比剂不断发展，声学造影成像技术和定量分析技术不断出现新的突破，超声造影越来越受到人们重视。本文综述近年来国内外超声造影配合新型超声显像技术在肝脏肿瘤方面的应用，为临床诊断和治疗肝脏肿瘤提供依据。     

超声弹性成像联合超声造影在甲状腺良恶性结节鉴别诊断中的临床价值

目的 探讨超声弹性成像联合超声造影在甲状腺良恶性结节鉴别诊断中的临床价值.方法 将收治的甲状腺结节性病变患者49例作为研究对象,全部患者均实施常规超声检查、彩色多普勒血流成像检查以及超声造影检查,将病理学诊断作为金标准,统计并对比常规超声和超声弹性成像联合超声造影的临床诊断结果.结果 超声弹性成像联合超声造影检查诊断甲状腺良恶性结节的敏感度、特异性、阳性预测值、阴性预测值以及诊断符合率均要显著高于常规超声检查(P＜0.05).结论 在甲状腺良恶性结节鉴别诊断中应用超声弹性成像联合超声造影检查具有较高临床价值,能够显著提高鉴别诊断的准确性与特异性.     

彩色多普勒超声和多层螺旋CT在肾脏良恶性肿瘤诊断中的应用比较简

目的：比较彩色多普勒超声（US）和多层螺旋CT（MSCT）在诊断肾脏良恶性肿瘤中的临床应用价值。方法对35例肾肿瘤患者分别行超声和螺旋CT检查,将两者检查结果与手术后病理结果进行对比,比较两种检查方法的诊断准确率。结果肾良性肿瘤及病变25例,超声诊断准确率为84％,CT为88％;肾癌10例,超声诊断准确率为80％,CT检查为90％。结论 US和MSCT在诊断肾脏良恶性肿瘤中,超声是筛查肾脏肿瘤首选检查方法,其价格低廉,无电离辐射,简单易行,患者容易接受。MSCT检查在特异性和准确性方面要高于超声,但在敏感性方面超声要优于CT,两者都能较准确地判断肾脏肿瘤及病变的良恶性。     

CT灌注成像在肾肿瘤样疾病诊疗中的应用价值

CT(computer tomography)灌注成像,是指在静脉血管注射对比剂的同时,进行快速动态扫描,这种方法可以计算出密度差,血流量,血容量,对比剂的平均通过时间等,由这些参数得到血液动力学方面的信息,属于功能影像学范畴。现在对其在肾肿瘤及肿瘤样疾病的定性诊断,鉴别诊断,肿瘤分级分期中的临床应用作一综述。     

Genitourinary MR: Kidneys and adrenal glands

Due to its high tissue contrast and multiplanar imaging capabilites, MRI provides a detailed display of renal and adrenal anatomy. Recent technical developments overcoming the problem of respiration induced motion artifacts and the use of paramagnetic contrast agents have further improved the performance of MRI which has now evolved as an alternative or complementary imaging modality to ultrasound, excretory urography and computed tomography. Dynamic contrast-enhanced studies will usually allow to detect even small enhancing solid areas within the cyst wall. Use of a fast (turbo) spoiled gradient echo sequence allows for assessment of contrast enhancement dynamics in renal and adrenal masses. For tumor staging, the multiplanar imaging capabilities of MRI are advantageous. Perinephric extent is best detected using opposed-phase GRE images resulting in an artifical accentuation of renal contours. Extension into venous structures is best diagnosed by using a GRE sequence allowing for distinction between flowing blood and tumor thrombus. Noninvasive differentiation of adrenal lesions can be performed with an unprecedented accuracy using chemical-shift imaging.     

Contrast agents for functional and cellular MRI of the kidney

Low-molecular-weight gadolinium (Gd) chelates are glomerular tracers but their role in evaluation of renal function with magnetic resonance (MR) imaging is still marginal. Because of their small size, they diffuse freely into the interstitium and the relationship between measured signal intensity and concentration is complex. New categories of contrast agents, such as large Gd-chelates or iron oxide particules, with different pharmacokinetic and magnetic properties have been developed. These large molecules could be useful for both functional (quantification of perfusion, quantification of glomerular filtration rate, estimation of tubular function) and cellular imaging (intrarenal phagocytosis in inflammatory renal diseases).

Continuous development of new contrast agents remains worthwhile to get the best adequacy between the physiological phenomenon of interest and the pharmacokinetic of the agent.     

Renal tumor versus renal cyst

The precise diagnosis of carcinoma of the kidney is of particular importance because renal mass lesions are frequently encountered which require nephrectomy if malignant, and renal tissue conservation if benign. The diagnostic problems include those of differentiating benign from malignant tumors and tumors from cysts. Delineation of the extent of tumors is also essential for treatment planning and prognostic implications. Although the sequence of diagnostic imaging procedures utilized in suspected renal mass lesions varies somewhat depending on the clinical presentation, the following techniques are frequently employed until the relevant questions have been answered: urography, ultrasound and/or computed tomography, cyst puncture and contrast injections, angiography, and renal venography. These non-operative methods usually clarify the nature and extent of renal mass lesions and therefore have a major effect on therapy. A logical, systematic approach to their application avoids duplication and achieves approapriate diagnosis most rapidly. Part II will appear in Volume 1, Number 2, 1978     

Contrast-enhanced power Doppler US in the diagnosis of renal pseudotumors

The term "pseudotumor" is used to refer to several anatomic variants that can simulate a renal mass, the most frequent of which are hypertrophied column of Bertin, persistence of fetal lobation, and the dromedary or splenic hump. We describe the findings of power Doppler US after the ultrasound contrast agent (Levovist, Schering, Berlin, Germany) administration in 4 patients with a renal focal lesion in whom gray-scale and baseline power Doppler US was not able to certainly differentiate pseudotumor from neoplasm.     

Renal failure: diagnostic work-up

The purpose of this article is to review the diagnostic work-up of renal failure, acute or chronic. The role of the radiologist is to exclude the presence of a curable etiology such as urinary tract obstruction or vascular thrombosis. Renal ultrasound with Doppler imaging is the imaging modality of choice for this indication, and the use of a contrast agent is useful to evaluate renal perfusion. Non-contrast CT remains valuable for the diagnosis of some urinary tract pathologies. Finally, MRI is the most comprehensive imaging modality for the evaluation of the urinary tract, but performed as a second line modality mainly for practical reasons but also due to the non-negligible risk of nephrogenic systemic fibrosis secondary to the intravenous administration of gadolinium based contrast agent.     

Changes of renal blood flow after ESWL: Assessment by ASL MR imaging, contrast enhanced MR imaging, and renal resistive index

The annual incidence of stone formation is increased in the industrialised world. Extracorporeal shockwave lithotripsy is a non-invasive effective treatment of upper urinary tract stones. This study is aimed to evaluate changes of renal blood flow in patients undergoing extracorporeal shock wave lithotripsy (ESWL) by arterial spin labeling (ASL) MR imaging, contrast enhanced dynamic MR imaging, and renal resistive index (RI). Thirteen patients with nephrolithiasis were examined using MR imaging and Doppler ultrasound 12 h before and 12 h after ESWL. ASL sequence was done for both kidneys and followed by contrast enhanced MR imaging. In addition RI Doppler ultrasound measurements were performed. A significant increase in RI (p < 0.001) was found in both treated and untreated kidneys. ASL MR imaging also showed significant changes in both kidneys (p < 0.001). Contrast enhanced dynamic MR imaging did not show significant changes in the kidneys. ESWL causes changes in RI and ASL MR imaging, which seem to reflect changes in renal blood flow.     

Diagnosis of liver cirrhosis with contrast-enhanced ultrasound

The assessment of the extent of liver fibrosis is very important for the prognosis and clinical management of chronic liver diseases. Although liver biopsy is the gold standard for the assessment of liver fibrosis, new non-invasive diagnostic methods are urgently needed in clinical work due to certain limitations and complications of biopsy. Noninvasive imaging studies play an important role in the diagnosis of focal liver disease and diffuse liver diseases. Among them, ultrasonography is the first choice for study of the liver in clinical work. With the development of ultrasound contrast agents and contrast specific imaging techniques, contrast-enhanced ultrasound (CEUS) shows good performance and great potential in the evaluation of liver fibrosis. Researchers have tried different kinds of contrast agent and imaging method, such as arrival time of contrast agent in the hepatic vein, and quantitative analysis of the enhancement level of liver parenchyma, to evaluate the degree of liver fibrosis during the past 10 years. This review mainly summarizes the clinical studies concerning the assessment of liver fibrosis using CEUS.     

肾癌功能成像研究进展

肾细胞癌是最常见的肾脏原发恶性肿瘤,影像检查是其主要诊断手段,近年来功能成像作用显著。功能成像从形态和功能变化两个层面对疾病的发生、发展和预后进行评估和监测,有助于肿瘤的早期检出、诊断及治疗效果与预后的评估。就国内外功能成像对肾癌的研究进展进行综述,介绍CT、MRI、核医学及超声各种功能医学成像技术在肾癌诊断与术前评估中的临床应用价值,对比各种功能成像方法的优势与不足。