超声造影与DSA定位诊断胰岛素瘤

目的 比较超声造影(CEUS)和数字减影血管造影(DSA) 在胰岛素瘤定位诊断中的价值.方法 回顾性分析42例有明确术后病理诊断的胰岛素瘤患者的影像学资料,所有患者均行CEUS检查,29例行DSA检查,比较两种方法对胰岛素瘤的定位诊断准确率.结果 CEUS检查对胰岛素瘤检查准确率为90.48%,DSA检查的准确率为86.21%,两种检查方法对胰岛素瘤的定位诊断准确率差异无统计学意义.结论 CEUS可作为胰岛素瘤术前定位诊断的首选方法.     

灰阶超声造影与增强CT、MRI在胰岛素瘤诊断中的对比研究

目的 探讨超声造影、增强CT和MRI对胰岛素瘤术前定位诊断的价值.方法 回顾性分析31例有明确术后病理诊断的胰岛素瘤患者的影像学资料.在术前31例患者均进行了超声造影检查,30例进行了增强CT检查,28例进行了MRI检查.结合手术病理结果,比较分析以上3种影像学方法对胰岛素瘤术前诊断的价值.结果 超声造影、增强CT及MRI对胰岛素的检出率分别为96.8%、63.3%、96.2%,超声造影高于增强CT(P=0.0018),与MRI结果一致(P=0.1828).结论 超声造影诊断胰岛素瘤的准确率较高,在胰岛素瘤的术前诊断中具有较大潜力.     

常规超声与超声造影在胰岛素瘤术前定位诊断中的对比研究

目的 比较分析常规超声与超声造影对胰岛素瘤术前定位诊断的价值.方法 回顾性分析经手术证实的47例胰岛素瘤患者的常规超声及超声造影图像,比较两种影像学方法对胰岛素瘤定位诊断的准确性.结果 与手术病理结果比较,常规超声诊断胰岛素瘤的敏感性和准确性均为27.7%;超声造影诊断胰岛素瘤的敏感性和准确性分别为91.5%、84.3%;两种影像学技术对胰岛素瘤的定位诊断准确率存在统计学差异(P<0.05,P＝0.0000).结论 在胰岛素瘤的术前定位诊断中,超声造影较常规超声定位更准确,在术前定位中具有重要的应用价值.     

胰岛素瘤的超声造影研究

目的 探讨胰岛素瘤超声造影的灌注特征,研究超声造影在胰岛素瘤术前诊断中的价值.方法 对临床确诊的31例胰岛素瘤患者进行超声造影检查,其结果 与术后病理结果 进行对照分析.结果 31例患者超声造影发现胰岛素瘤30例,其诊断敏感性约为96.77%;而常规超声检出4例,其诊断敏感性约为12.9%.超声造影在胰岛素瘤中的诊断敏感性显著高于常规超声(χ2＝44,P<0.001),与手术病理结果 相关(r＝1.0,P>0.05).结论 超声造影可以无创性显示胰岛素瘤,其诊断准确率高,在胰岛素瘤术前定位诊断中具有重要的意义.     

探讨经腹超声造影与内镜超声联合应用对胰岛素瘤的术前定位的价值

目的 探讨经腹超声造影及超声内镜两种方法 联合对胰岛素瘤的术前定位的准确性.方法 44例明确诊断为胰岛素瘤的患者在我院进行胰岛素瘤术前定位,其中包括CT平扫加增强、超声造影、内镜超声,对比分析经腹超声造影及内镜超声联合应用与增强CT在胰岛素瘤定位诊断的准确性.结果 44例胰岛素瘤均经外科手术治疗;41例患者进行了术前CT平扫及增强CT检查,其中23例患者的肿瘤定位准确,准确率为56.1%,33例患者联合超声造影与内镜超声定位,30例患者定位准确(90.9%),联合超声造影与内镜超声的定位准确性与CT平扫加增强定位准确性存在统计学差异(P<0.05).结论 与CT平扫加增强比较,联合应用超声造影及内镜超声两种方法 可以显著提高胰岛细胞瘤定位诊断的准确性,值得在临床上进一步推广应用.     

胃肠超声造影检查、CT检查、胃镜检查进展期胃癌TNM分期中的诊断价值比较

目的比较胃肠超声造影检查、CT检查、胃镜检查在进展期胃癌TNM分期诊断中的临床意义,为后期胃癌的诊断治疗提供指导依据。方法:选取2021年12月—2022年4月甘肃省人民医院(学习期间)、白银市第一人民医院超声科进行胃肠超声造影检查的入院接受手术治疗的40例进展期胃癌患者。所有患者术前均未接受其他治疗,术前分别接受胃镜、CT与胃肠超声造影检查。以术后病理结果为金标准,比较胃镜、CT与胃肠超声造影检查在进展期胃癌TNM分期中的诊断效果。结果:与术后病理诊断结果相比:胃肠超声造影对进展期胃癌术前T期诊断准确率90.00%(36/40),胃镜诊断准确率为100.00%(40/40),CT诊断准确率为65.0%(26/40),胃肠超声造影诊断准确率高于CT诊断准确率,差异有统计学意义(P<0.05),T分期诊断中胃肠超声造影、胃镜两种方法诊出结果比较,差异无统计学意义(P> 0.05)。比较术后病理结果:胃肠超声造影、CT诊断N分期准确率分别为75.00%(30/40)、72.50%(29/40),胃肠超声造影诊断进展期胃癌N期判断准确率与CT比较,差异无统计学意义(P>0....     

术中超声在胰岛素瘤定位诊断及精准切除中的应用

目的探讨术中超声在胰岛素瘤定位诊断以及肿瘤精准切除中的应用价值。方法 18例胰岛素瘤患者均行术前经腹超声、增强CT扫描及术中超声检查,并对比分析结果。结果 18例患者共20个病灶,经腹部超声及螺旋薄层增强CT诊断准确率分别为75%、70%,而术中超声定位准确率100%;术中精准切除肿瘤14例。结论术中超声对胰岛素瘤定位准确,有助于肿瘤的尽可能精准切除,可减少手术创伤,保护胰腺外分泌功能,减少术后并发症,提高患者术后生活质量。     

术中超声在胰岛素瘤定位诊断及精准切除中的应用

目的探讨术中超声在胰岛素瘤定位诊断以及肿瘤精准切除中的应用价值。方法 18例胰岛素瘤患者均行术前经腹超声、增强CT扫描及术中超声检查,并对比分析结果。结果 18例患者共20个病灶,经腹部超声及螺旋薄层增强CT诊断准确率分别为75%、70%,而术中超声定位准确率100%;术中精准切除肿瘤14例。结论术中超声对胰岛素瘤定位准确,有助于肿瘤的尽可能精准切除,可减少手术创伤,保护胰腺外分泌功能,减少术后并发症,提高患者术后生活质量。     

术中超声在胰岛素瘤定位诊断中的价值

目的 探讨术中超声在胰岛素瘤定位诊断中的价值。方法 对２８例胰岛素瘤患者的术前Ｂ超,ＣＴ,ＭＲＩ和选择性动脉造影检查的定位资料进行分析,统计了术中超声与术中门诊,术中脾门静脉穿刺置管分段取血快速胰岛素测定（ＰＶＳ）３种方法对胰岛素瘤的定位准确率,并进行了比较研究。     

腹腔镜超声在腹腔镜肝部分切除术中的应用

目的探讨腹腔镜超声在腹腔镜肝部分切除术中的作用。方法在16例腹腔镜肝部分切除术中,应用腹腔镜超声进行检查。结果术中超声纠正了2/17例(11.8%)术前诊断,因此改变术式。1例(5.9%)发现伴有胆总管结石,予切开胆总管取石。1例(5.9%)发现Ⅳ段有1cm×1cm×1cm大小子灶,予一并切除。17例均有超声辅助确定肝切除线。术后病理证实切缘无肿瘤残余。17例患者均在腹腔镜下完成手术。术中未出现不能控制并发症。结论应用腹腔镜超声探查肝脏,补充和纠正术前影像学检查的错漏;进行准确的病灶边界定位;找到肝段的胆管、血管蒂控制出血,可提高诊断准确率及腹腔镜肝切除的安全性,对腹腔镜肝部分切除术具有实用价值。     

腹腔镜超声在肾肿瘤部分切除术中的应用

目的 初步探讨腹腔镜超声在肾肿瘤部分切除术中的临床应用价值.方法 对32例肾肿瘤患者行腹腔镜肾部分切除术,术中行腹腔镜超声探查,观察肿瘤形态、边界、回声、血流等,并与术前常规经腹部超声检查结果进行对比.结果 32例肾肿瘤患者均顺利完成手术.术中腹腔镜超声示恶性肿瘤形态欠规则,边界清,内部回声不均匀,彩色多普勒显示肿瘤内部和(或)周边均可探及较丰富血流信号,明显优于术前常规超声检查.良性肿瘤形态较规则,边界清,内部回声不均匀,彩色多普勒显示肿瘤内可探及少量低速静脉血流,而常规超声检查肿瘤内血流信号不明显.结论 腹腔镜超声较常规超声检查更清晰,有助于术中指导手术步骤及提供准确信息,在腹腔镜肾部分切除术中有重要指导价值.     

Preoperative laparoscopic examination using surgical manipulation and ultrasonography for pancreatic lesions

BACKGROUND AND STUDY AIMS: Unnecessary laparotomies in patients with advanced pancreatic disease are unlikely to provide any benefits and may compromise both the quality and duration of survival. The purpose of this study was to determine the contribution of laparoscopy and laparoscopic ultrasound to the diagnosis or staging, or both, of pancreatic lesions. PATIENTS AND METHODS: Fifty-two patients were diagnosed preoperatively with pancreatic cancer. The diagnoses made by laparoscopic ultrasonography (LUS) were compared with those made prior to the operation. Laparoscopic visualization of the body of the pancreas was obtained via an infragastric approach. For the laparoscopic examination of the head of the pancreas, a retroduodenal approach was used. RESULTS: In 52 patients with cancer of the pancreatic head and body, unresectable findings were observed in 13 patients. Portal vein displacement without other unresectable findings was evident in six patients using LUS, and was confirmed at exploratory laparotomy in five patients. The surgical approaches were changed, with seven patients undergoing an open exploration for biliary drainage and the other six patients receiving endoscopic endoprostheses. In six of the 52 patients, LUS-guided needle biopsies and frozen-section examinations detected chronic pancreatitis (n = 4), a malignant lymphoma (n = 1), and an abdominal tuberculosis (n = 1), which were diagnosed preoperatively as pancreatic cancers and cysts. Only one patient undergoing the laparoscopic procedure had acute pancreatitis; this patient was treated conservatively. CONCLUSIONS: LUS, when combined with laparoscopic manipulations, may overcome many of the limitations of laparoscopy alone in the investigation of pancreatic lesions by providing an accurate diagnosis and assessment of the size and extent of the local dissemination.     

Contrast-enhanced ultrasonography in the diagnosis of solid renal tumors.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of contrast-enhanced ultrasonography (CEUS) in the diagnosis of solid renal tumors. METHODS: Twenty-nine patients with solid tumors detected on gray scale ultrasonography underwent resection for suspected renal malignancy. Findings of arterial phase contrast computed tomography (CT) and CEUS were compared for each diagnosis. RESULTS: Histopathologic examination of resected lesions showed malignancy in 26 patients (clear cell carcinoma, n = 18; papillary renal cell carcinoma, n = 6; collecting duct carcinoma, n = 1; and infiltrative urothelial carcinoma, n = 1) and benign tumors in 3 patients (oncocytoma, n = 2; and angiomyolipoma, n = 1). Contrast CT failed to show tumor blood flow in 5 of 29 patients, whereas CEUS showed this in all patients. Positive predictive values of CEUS and contrast CT in the diagnosis of renal malignancy were 100% and 82.8%, respectively. Among clear cell carcinomas, hypervascularity was observed on contrast CT in 16 of 18 patients and on CEUS in 17 of 18 patients. On the basis of hypervascularity, diagnostic sensitivity values for clear cell carcinoma were 94.4% for CEUS and 88.9% for contrast CT, whereas specificity values were 45.5% for CEUS and 72.7% for contrast CT. Among papillary cell carcinomas, contrast CT showed avascular lesions in 4 of 6 patients. However, CEUS showed blood flow in these lesions, leading to diagnosis of hypovascular renal tumors. CONCLUSIONS: Contrast-enhanced ultrasonography was more sensitive for detecting slight tumor blood flow than contrast CT and was useful in preoperatively diagnosing malignant hypovascular renal tumors but was less so for hypervascular renal tumors.     

超声造影和增强磁共振在不同大小肝癌肝动脉化疗栓塞术后的疗效评价

目的:探究超声造影(contrast-enhanced ultrasonography,CEUS)、增强磁共振(contrast-enhanced MRI,CE-MRI)在不同大小原发性肝癌TACE(transcatheter arterial chemoembolization)术后疗效评估的价值与意义,以期为原发性肝癌(hepatocellular carcinoma,HCC)患者在TACE后复查中影像学方法的选择提供依据。方法:本研究收集2018年1月至2018年12月在徐州医科大学附属医院介入放射科接受TACE治疗的33例HCC患者(共83个病灶),TACE术后1个月1周内依次行CEUS,CE-MRI,数字减影血管造影(digital subtraction angiography,DSA)检查,如发现病灶再次TACE,以DSA结果为金标准分别对三者的检查结果进行Kappa检验以及Mc Nemar检验,比较三者其对TACE术后肿瘤残存、复发病灶检出的敏感性,特异性,诊断准确性及检查结果的一致性。结果:CEUS和CEM R I的诊断准确性分别为91.6%和100%,CE-MRI的诊断准确性优于CEUS,差异有统计学意义;但CEUS与CE-MRI检查一致性较强(Kappa=0.794);CE-MRI敏感度、特异度比均为100%,CEUS的分别为88.9%,100%;在>3 cm的病灶中,CEUS与CE-MRI的一致性强(Kappa=0.891),CEUS的准确性、敏感度及特异度分别为96.1%,95.0%和100%。在≤3 cm的病灶中,CEUS与CE-MRI的一致性一般(Kappa=0.669),CEUS的准确性、敏感度及特异度分别为84.4%,78.3%和100%。结论:CEUS,CE-MRI与金标准DSA对于原发性肝癌TACE治疗后的诊断一致性相当,CEUS可作为原发性肝癌TACE短期复查的替代影像学检查方法。     

超声造影在肝脏局灶性病变定性诊断中的价值

目的探讨超声造影在肝脏局灶性病变良恶性定性诊断中的价值。方法回顾性分析我院250例肝脏局灶性病变患者共258个病灶的常规超声和超声造影检查结果,比较两种检查方法对其良恶的定性诊断效能。结果 258个病灶中,常规超声准确诊断202个,其中良性54个,恶性148个;超声造影准确诊断242个,其中良性87个,恶性155个;超声造影对肝脏局灶性病变良恶性诊断的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为95.7%、90.6%、94.5%、92.6%、93.8%,与常规超声(91.4%、56.3%、77.9%、79.4%、78.3%)比较,除敏感性外,差异均有统计学意义(P0.05)。结论超声造影在肝脏局灶性病变的定性诊断中具有较高的应用价值。     

肝细胞癌超声造影增强范围病理意义的探讨

目的 探讨肝细胞癌超声造影增强范围较常规超声测值增大的病理学意义.方法 35例肝细胞癌患者手术前进行常规超声和超声造影检查,比较常规超声、超声造影及手术后肿瘤大小,显微镜下观察肝细胞癌边缘癌细胞浸润深度,分析比较超声造影增强范围较常规超声测值增大的组织病理学特征.结果 35例肝细胞癌中14例(40%)超声造影增强范围较常规超声测值增大,9例肝细胞癌增大区域为癌细胞浸润,2例为瘤周脂肪变性伴炎细胞浸润,2例瘤周腺瘤样增生伴炎细胞,1例瘤周炎细胞伴肝内多发肝细胞癌.以超声造影增强 范围较常规超声测值增大作为肝细胞癌局部浸润的诊断标准,超声造影诊断肝细胞癌局部浸润的敏感性为90%,特异性为80%,准确性为82.9%,阳性预测值为64.3%,阴性预测值为95.2%.结论 与常规超声比较,超声造影判断肝细胞癌局部浸润范围更准确.     

Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans.

OBJECTIVE: The purpose of this study was to compare the diagnostic accuracy, confidence level, and recommended management of focal liver masses after contrast-enhanced ultrasonography (CEUS) compared with unenhanced ultrasonography alone. METHODS: One hundred sixty-seven patients were referred for CEUS to characterize a focal liver mass. A 2-person blind read determined benignancy or malignancy, comparative diagnosis, and accuracy on both ultrasonography and CEUS. Results were compared with the final diagnoses. RESULTS: The 2 readers could not determine benignancy or malignancy in 77 (46.1%) and 46 (27.5%) of 167 unenhanced scans compared with 2 (1.2%) and 1 (0.6%) of 167 CEUS scans. The confidence level increased from 0 responses in the 2 highest grades (4 and 5) on the unenhanced scans to 135 (81.8%) and 132 (79.5%) of 167 at level 5 for CEUS. Regarding the diagnosis, the confidence level was lowest (grade 1) on the unenhanced scans in 128 (82.1%) and 79 (65.3%) of 167 for the 2 readers and improved to the highest (grade 5) in 110 (65.9%) and 113 (68.1%) of 167. Regarding diagnostic accuracy, the unenhanced scans agreed with the correct diagnosis in 85 (50.9%) and 63 (37.7%) of 167, and CEUS agreed with the correct diagnosis in 133 (79.6%) and 142 (85%) of 167 for readers 1 and 2, respectively. Recommendations for further imaging decreased from 166 (99.4%) and 147 (88%) of 167 on the unenhanced scans to 30 (18%) and 5 (3%) of 167 on CEUS for readers 1 and 2. CONCLUSIONS: Contrast-enhanced ultrasonography improves the accuracy and confidence of diagnosis of focal liver lesions and reduces recommendations for further investigations.     

超声造影对颅外段颈动脉狭窄的评估价值

目的 探讨超声造影评估颅外段颈动脉狭窄的价值.方法 用常规超声和超声造影(CEUS)检查108例颅外段颈动脉狭窄患者,判断狭窄的部位及程度,并与数字减影血管造影(DSA)结果相对比.结果 108例患者经DSA确诊存在颅外段颈动脉轻中度狭窄62例,共81条血管(颈总动脉33条,颈内动脉43条,颈外动脉5条);重度狭窄39例,共51条血管(颈内动脉46条,颈总动脉5条);完全闭塞7例,共7条血管(均为颈内动脉).CEUS明显改善了对血管内膜面和中膜一外膜界面的显像.以DSA结果为金标准,常规超声和CEUS对轻中度狭窄、重度狭窄、完全闭塞的判断符合率分别为76.5%和91.4%(P＜0.05)、60.8%和94.1%(P＜0.001)、28.6%和100%(P＜0.05).CEUS和DSA对狭窄率计算值呈显著线性正相关(r=0.975,P＜0.001).结论 CEUS能够较为准确、无创地评估颅外段颈动脉狭窄,优于常规超声,且与DSA相关性较高.