微泡对比剂应用于高强度聚焦超声治疗子宫肌瘤疗效观察北大核心CSCD

目的探讨六氟化硫微泡应用于高强度聚焦超声(HIFU)对不同T_2WI信号强度子宫肌瘤疗效。方法 64例行HIFU治疗的子宫肌瘤患者依据术前MR检查结果分为T_2WI低信号组(n=24)、等信号组(n=22)、高信号组(n=18),术后1 d行MR检查评估消融效果,记录并比较各组治疗相关参数(治疗功率、辐照时间、治疗剂量)和疗效相关指标(体积消融率、能效因子、治疗时间)。结果 T_2WI低信号组、等信号组、高信号组体积消融率分别为(84.83±18.49)%、(78.72±17.76)%、(71.11±23.87)%,能效因子分别为(6.87±7.77)J/mm^3、(7.99±6.58)J/mm^3、(12.93±9.38)J/mm^3,治疗时间分别为(102.12±54.45)min、(153.86±66.04)min、(141.50±69.56)min,T_2WI高信号子宫肌瘤与低信号、等信号子宫肌瘤体积消融率、能效因子、治疗时间差异均有统计学意义。3组患者共出现下腹痛6例(6/64,9.4%),全身酸麻3例(3/64,4.7%),下肢麻木1例(1/64,1.6%),所有患者未发生治疗区皮肤烧伤等严重并发症。结论六氟化硫微泡联合HIFU对T_2WI低信号、等信号子宫肌瘤疗效优于高信号子宫肌瘤,低信号子宫肌瘤治疗时间较等信号、高信号子宫肌瘤短,六氟化硫微泡是HIFU安全有效的增效剂。     

动态血管模型在六氟化硫微泡联合高强度聚焦超声消融富血供子宫肌瘤中的增效作用

【摘要】　目的?探讨动态血管模型（dynamic vascular pattern，DVP）在六氟化硫微泡（声诺维）联合高强度聚焦超声（HIFU）消融富血供肌瘤中的增效作用及安全性。方法?回顾性分析2014年7月至2018年6月行单纯HIFU治疗36例（HIFU组），非DVP增效组32例（非DVP组）和DVP组28例患者的临床资料，比较3组患者的超声辐照时间、手术时间、超声灰度变化时间、消融率、能效因子（EEF）、治疗效率、治疗剂量、无灌注区体积（NPV）等治疗参数。比较患者治疗6个月时的子宫肌瘤体积缩小率、症状评分、生活质量评分、月经评分。根据SIR分类，统计3组患者HIFU治疗后的不良事件。结果?3组间消融率、EEF、治疗效率、治疗剂量、NPV等治疗参数比较差异具有统计学意义（P＜0.05）。治疗后6个月比较3组间的症状评分、生活质量评分、月经评分，差异有统计学差异（P＜0.05）。不良事件发生率3组间比较差异无统计学意义（P＞0.05）。 结论?DVP可提高声诺维在HIFU治疗富血供肌瘤中的增效作用，是一种安全有前景的增效方法。     

高强度聚焦超声消融子宫肌瘤的MRI评价

目的 观察高强度聚焦超声(HIFU)消融治疗子宫肌瘤的客观疗效、不良反应和临床转归情况.方法 2006年12月-2008年3月解放军第307医院参与多中心临床验证的子宫肌瘤确诊患者38例(包括多发肌瘤患者17例),使用HIFU治疗系统一次性消融治疗子宫肌瘤47个,其中肌瘤最大直径11.6cm.观察不良反应并定期随访,随访期间应用增强磁共振(MRI)评价HIFU治疗后子宫肌瘤的消融坏死体积及消融率,测量治疗后子宫和肌瘤体积的变化,判断临床转归规律.结果 治疗后随访37例共46个肌瘤,增强MRI显示所有肌瘤均出现消融坏死区并持续存在,HIFU消融率为65.1%±21.7%.与治疗前相比,治疗后不同时间子宫和肌瘤体积均有显著缩小,1、3、6、12个月时子宫肌瘤的缩小率分别为24.1%±17.3%、39.8%±23.4%、44.6%±24.7%、60.3%±17.2%(F=15.31,P<0.01),呈现出随时间延长逐渐缩小的变化规律.HIFU治疗后的主要并发症为局部疼痛、发热等,均为轻中度,并可在1周内自行缓解.结论 HIFU消融治疗子宫肌瘤安全可行,局部消融效果确切.     

小b 值表观扩散系数图监测子宫肌瘤高能聚焦超声后疗效的价值

目的：探讨小 b值表观扩散系数图(ADC maps)监测子宫肌瘤高能聚焦超声(HIFU)术后消融灶的价值。方法收集25例共34个子宫肌瘤患者进行HIFU治疗,所有患者术前、术后24 h内均行常规MRI、CE-T1 WI及b值分别取150、600、1000 s/mm2的单指数扩散加权成像(DWI)检查。采用单因素方差分析分析各b值术前、术后消融灶和残留未消融灶的平均ADC值变化。对各b值的ADC伪彩图消融灶与增强MRI的吻合度进行分级评定。结果 b值为150 s/mm2时,术后消融灶平均ADC值[(1.48±0.27)×10-3 mm2/s]低于术前[(2.06±0.21)×10-3 mm2/s]及残留未消融灶平均ADC值[(1.98±0.23)×10-3 mm2/s](P<0.05);b值为600、1000 s/mm2消融灶术前、术后ADC值以及残留未消融灶平均ADC值差异无统计学意义(P>0.05)。b值为150 s/mm2的ADC伪彩图消融灶与增强MRI的无灌注区域容积(non-perfused volume,NPV)有较高视觉吻合,优于 b 值为600、1000 s/mm2 ADC 图消融灶(P<0.05)。结论小b值(150 s/mm2)ADC图可间接反映子宫肌瘤HIFU治疗后的血供改变和消融范围,借此评估治疗效果。     

低频超声辐照载5-氟尿嘧啶的纳泡靶向治疗裸鼠射频消融后残留肝癌的效果

目的 探讨低频超声辐照载5-氟尿嘧啶(5-FU)的纳泡对射频消融治疗后裸鼠残留肝癌的治疗效果.方法 取6～8周龄BALB/c裸鼠60只,用人肝癌HepG2细胞构建裸鼠肝癌模型,经射频消融约80％后,将其随机分为生理盐水组、载5-FU的纳泡(5-FU)组、非低频超声辐照载5-FU的纳泡(非低频超声+5-FU)组、低频超声...     

磁共振引导高强度聚焦超声完全消融子宫肌瘤:可行性、安全性和远期疗效

目的 评估MRI引导高强度聚焦超声(MRgHIFU)完全消融子宫肌瘤的可行性、安全性和远期疗效.方法 对43例(平均年龄41.4岁)共51个子宫肌瘤,平均大小为(7.1±1.4)em,均进行一次MRI引导高强度聚焦超声消融术.治疗后即刻MRI增强测量靶肌瘤的体积及其无灌注区的体积,子宫肌瘤无灌注区的完全覆盖靶肌瘤为完全消融.对完全消融的子宫肌瘤在治疗后3个月、6个月、1年、2年和3年通过MRI进行随访复查肌瘤的体积变化;在术前、3、6个月采用UFS-QOL症状评分方法对患者症状评分,并随访3年观察其症状的变化.同时对这些肌瘤的特征、治疗后不良事件、聚焦超声能量及治疗效率等进行了分析.结果 经MRgHIFU治疗后肌瘤平均消融率为84.3％±15.7％(范围33.8％～ 100％),肌瘤部分消融(消融率＜90％)、几乎完全消融(消融率为90％～99％)和完全消融的病例分别为23例、10例和10例,平均治疗时间为(2.2±0.8)h(范围1.0 ～ 4.3 h),治疗后均未发生并发症.10例13个完全消融的肌瘤术前MRI均为T2低信号表现而其血供类型不同;超声治疗的能效因子(EEF)为:(3.6±2.1)J/mm3(0.7 ～ 6.8 J/mm3).治疗后3、6个月症状严重程度评分(SSS)分别为从术前的33.9±7.1下降至16.6±9.0和8.1±3.4(P＜ 0.01),1年或2年后10例患者的症状完全消失.治疗后3、6个月和3年肌瘤体积分别缩小39.5％±10.2％、59.1％±9.0％和93.3％±3.1％(P＜0.01).治疗后3年随访肌瘤均未出现复发.结论 MRI引导高强度聚焦超声完全消融子宫肌瘤是可行的、安全的和有效的,MRI T2WI低信号肌瘤可在治疗后取得完全消融.     

超声微泡对比剂增强高强度聚焦超声治疗作用研究进展

高强度聚焦超声(HIFU)是非侵袭性治疗肿瘤的一种重要手段,其安全性、有效性已得到医患的一致认可,但治疗时间长,消融效率低限制了其应用.近年来,关于HIFU增效剂的研究已有进展,超声微泡对比剂作为一种安全有效的HIFU增效剂,能有效缩短治疗时间,提高消融效率,是当前研究的热点.本文就超声对比剂增强HIFU治疗作用的现状及进展作一综述.     

氟碳对比剂的制备及生物特性的实验研究

目的:制备氟碳微泡声学对比剂并对其生物特性进行研究。方法:采用三种不同组分的溶液进行声振。A组:50%葡萄糖6ml;B组:50%葡萄糖4ml 人血白蛋白2ml;C组:50%葡萄糖4ml 人血白蛋白2ml 全氟丙烷气体(C3F8)1ml。在显微镜下对上述三种声振微泡进行观测,将微泡直径分别与红细胞进行对比并计数。然后将声振微泡经静脉注入,观察开胸犬心腔和心肌显影状况,记录显影时间。结果:A、B、C三组造影微泡的平均直径分别为8.6±2.1μm,7.8±1.6μm和3.4±1.3μm。A组对比剂仅能右心显影,左心系统未见造影微泡:B组对比剂大部分充盈右心系统,左心腔可见少许造影微泡;C组对比剂于静脉团注20s后左室腔即可显影,30~60s心肌开始显影,造影持续时间20~30min。结论:研究表明氟碳声振微泡直径显著小于红细胞,在血液中可保持较好的稳定性,完全可满足左心腔和心肌造影的要求。     

MRI导航和温度监控下高强度聚焦超声治疗子宫肌瘤

目的 评价高强度聚焦超声(HIFU)在MR导航定位和靶区焦域温度监控下治疗子宫肌瘤的可行性和疗效.方法 采用西门子1.5 T Avanto TIM MR导航和温度监控JM-HIFU进行HIFU治疗52例子宫肌瘤共61个肌瘤.肌瘤大小(6.1±2.1)cm,其中浆膜下10枚、肌壁间46枚和黏膜下5枚.治疗前、后采用增强扫描MRI检查,测量肌瘤体积、消融坏死区域大小占肌瘤体积的比率,并记录治疗时间和超声释放剂量.治疗后3个月MRI检查观察肌瘤的缩小情况;同时观察和评估其并发症及不良反应事件发生,并对治疗前后患者症状变化进行评分.结果 MR导航HIFU(MRgHIFU)治疗前和治疗后3个月肌瘤平均体积分别为(113.3±87.7)cm3和(58.1±45.0)cm3,肌瘤体积平均缩小(48.7±16.4)%(P＜0.05);每个肌瘤被消融区域占整个肌瘤体积平均为(78.8±18.8)%(51%～100%);聚焦超声治疗时间(19.8±8.8)min,治疗所用的超声热剂量为(7.1±6.7)焦耳/mm3.患者症状平均总分治疗前、后从(24.7±4.8)下降至(16.7±3.2)分(P＜0.05),除1例术中出现腹壁皮下轻度烫伤,余无并发症及不良反应事件.结论 MRgHIFU治疗子宫肌瘤是一种可行、安全、有效的无创治疗方法,而且单次热消融可达到肌瘤大部分甚至完全凝固性坏死,并使其短期内缩小的治疗效果.     

DCE-MRI定量参数预测高强度超声消融术治疗症状性子宫肌瘤首次体积消融率价值

目的 探讨DCE-MRI定量渗透性与T1灌注分析预测高强度超声消融术(HIFU)治疗子宫肌瘤首次体积消融率价值.方法 搜集本院29例症状性子宫肌瘤行HIFU消融治疗患者(36个肌瘤,直径3.1 ～9.2 cm),治疗前、后3天内分别行DCE-MRI和常规MRI检查,术前测量子宫肌瘤DCE-MRI定量参数值(Ktrans、Kep、Ve、Vp、BF、BV),术后测量肌瘤首次体积消融率,根据体积消融率划分为消融70％以上组(H组)和70％以下组(L组),回顾性分析这两组病例术前渗透性与T1灌注定量参数值有无差别及其与体积消融率的相关性,然后采用ROC曲线评价各参数值的预测价值,寻找术前预测首次体积消融率的最佳临界值.结果 (1)H组(n=20)Ktrans、Kep、Ve、BF低于L组(n=16),差异有统计学意义(P值均＜0.05),余两组各参数间无统计学差异.(2)Ktrans、BF、BV与首次体积消融率呈负相关(r分别为-0.471、-0.452、-0.396,P值均＜0.05).(3)Ktrans、BF、BV值预测首次体积消融率ROC曲线下面积(AUC)分别为0.803、0.809、0.750(P值均＜0.05).以体积消融率70％分界,均获得较高的敏感性和特异性.结论 不同消融率组之间术前Ktrans、Kep、Ve、BF存在差异,Ktrans、BF、BV与首次体积消融率呈负相关,即术前Ktrans、BF、BV值越高,首次体积消融率越低,这三种参数中BF预测效能最好,Ktrans次之.术前DCE-MRI定量参数值可用于预测瘤灶的首次体积消融率,为HIFU消融治疗子宫肌瘤病例筛选和初步判断疗效提供依据.     

Preliminary results of colour Doppler-guided intratendinous glucocorticoid injection for Achilles tendonitis in five patients

BACKGROUND: It is debated as to whether Achilles tendonitis (AT) has an inflammatory component. The intratendinous hyperaemia demonstrated with colour Doppler has been interpreted as neovascularisation. Glucocorticoid injection around the tendon is a common therapeutic procedure. HYPOTHESES: The intratendinous hyperaemia seen with ultrasound (US) colour Doppler represents an inflammatory background. Glucocorticoid injections will be effective if administered inside the tendon where the inflammation seems to be. STUDY DESIGN: An uncontrolled, prospective study with a minimum follow-up of 3 months. METHODS: Six tendons in five patients were evaluated with grey-scale US and colour Doppler before and after US-guided intratendinous glucocorticoid injection. Pain at rest and at activity was evaluated on a visual analogue scale. RESULTS: With colour Doppler all tendons had intratendinous flow. Pain and colour Doppler activity decreased during a mean follow-up of 182 days (range 92-309 days). One tendon relapsed after 199 days. CONCLUSION: Intratendinous glucocorticoid injections seem to have a marked effect on both symptoms and colour Doppler findings, which may be taken as an indication of an inflammatory component in the disease. Colour Doppler adds significant information to grey-scale US with regard to diagnosis, location and follow-up of AT.     

Unusual new signs of pneumothorax at lung ultrasound

Background

The diagnosis of pneumothorax with a bedside lung ultrasound is a powerful methodology. The conventional lung ultrasound examination consists of a step-by-step procedure targeted towards the detection of four classic ultrasound signs, the lung sliding, the B lines, the lung point and the lung pulse. In most cases, a combination of these signs allows a safe diagnosis of pneumothorax. However, the widespread application of sonographic methodology in clinical practice has brought out unusual cases which raise new sonographic signs. The purpose of this article was to introduce some of these new signs that are described after the analysis of unusual and complex cases encountered during the clinical daily practice in an emergency department.

Findings

The double lung point consists of the alternating patterns of sliding and non-sliding lung intermittently appearing at the two opposite sides of the scan. The septate pneumothorax allows B lines and lung pulse to be still visible in a condition of pneumothorax with absent sliding. In hydropneumothorax, the air/fluid border is imaged by lung ultrasound as the interposition between an anechoic space and a non-sliding A-pattern, a sign that may be named hydro-point.

Conclusions

In bedside lung ultrasound, the operator should be aware and interpret double lung point, septate pneumothorax and hydro-point. The conventional diagnostic protocol of bedside lung ultrasound for pneumothorax should be occasionally adapted to such complex cases.     

The fetal spine

Summary Ultrasonography has made it possible to evaluate the fetal spine in utero. Vertebral ossifications are demonstrable by ultrasonography in the early second trimester. Most spinal defects are apparent by 20–22 weeks menstrual age. Early detection of spinal anomalies allows for parental counseling and appropriate obstetrical management. Realtime equipment allows the fetal spine to be examined in parasagittal, transverse and coronal planes. The transverse plane provides the best view of the three ossification centers that form each fetal vertebra. Evaluation of the neural arch ossifications in the transverse view is crucial in detecting spina bifida defects. Ultrasonography of the fetal spine complements the use of alpha-fetoprotein levels in screening for neural tube defects. Examination of the fetal spine is also important in detecting vertebral ossification defects, particularly in cases of short-limbed dwarfs and infants of diabetic mothers.     

Transhepatic intravascular ultrasound for evaluation of portal venous involvement in patients with cancer of the pancreatic head region

The aim of this study was to evaluate the ability of intravascular ultrasound to diagnose tumor involvement of the portal and the superior mesenteric veins using the preoperative percutaneous, transhepatic approach, and to compare the findings with those made at concomitant direct portography, surgery, and histopathological examination. Ten patients with a preoperative diagnosis of a resectable tumor in the pancreatic head region were examined with percutaneous transhepatic portography (PTP) and intravascular ultrasound (IVUS). The surgeon's intraoperative evaluation and the histopathological examination in combination revealed tumor involvement of the portal or superior mesenteric veins in six of the ten patients. Percutaneous transhepatic portography suggested tumor involvement of the veins in six patients but two of the examinations were false positive and another two were false negative. Intravascular ultrasound showed signs of tumor involvement in eight patients. The examination was, however, false positive in two patients, but there were no false negatives. Complications of the percutaneous transhepatic procedure occurred in six patients including severe pain, bleeding, and related death. Percutaneous transhepatic IVUS of the portal vein may be a useful tool in the preoperative selection of the subgroup of patients with tumor of the pancreatic head region that could benefit from surgery. There is a need for technical improvement as well as studies with larger patient series to definitely decide the role of the technique.     

Era of diagnostic and interventional ultrasound

It is an era of diagnostic and interventional ultrasound (US).Various new techniques such as three-dimensional US(3D US),interventional US,and contrastenhanced US(CEUS)have been introduced into clinical practice.Dr.Xu and his colleagues have taken advantage of these techniques and carried out a series of relevant studies.Their use of 3D US in the liver,gallbladder,liver tumor volumetry,guidance for ablation,and 3D CEUS has widened the application of 3D US in the clinic.They found that prognosis in patients with hepatocellular carcinoma(HCC)after thermal ablation with curative intent was determined by treatment response to ablation,pretreatment serum AFP,and liver function reserve.Tumor response to treatment was the most predictive factor for long-term survival.They compared the use of percutaneous microwave ablation and radiofrequency ablation for the treatment of HCC and found that both are effective methods in treating HCCs.The local tumor control,complications related to treatment, and long-term survival were equivalent for the two modalities.They first compared the enhancement patterns of HCC and intrahepatic cholangiocarcinoma(ICC)and proposed the diagnostic clues for ICC,liver angiomyolipoma(AML),gallbladder cancer,renal carcinoma,and renal AML,which have greatly enhanced the role ofCEUS in the clinic.They also evaluated the diagnostic performance of CEUS in characterizing complex cystic focal liver lesions and the agreement between two investigators with different experience levels;and found that CEUS is especially useful for the young investigator.They assessed the effect of anti-angiogenic gene therapy for HCC treated by microbubble-enhanced US exposure and concluded that gene therapy mediated by US exposure enhanced by a microbubble contrast agent may become a new treatment option for HCC.     

Impact of bedside right upper quadrant ultrasonography on radiology imaging

Many Emergency Departments (ED) use emergency ultrasonography of the right upper quadrant (RUQ) to capture images of the gallbladder in patients with suspected gallstones. It is unclear what impact this practice has on additional imaging performed by radiology. Patients were enrolled 24 h a day by ED residents and attending physicians who have completed an educational program in limited RUQ ultrasound. All ultrasounds were videotaped and later reviewed. According to the American College of Emergency Physicians’ credentialing standards, 25 ultrasounds were required before using the results clinically. A total of 352 patients were enrolled by 42 physicians over a 1-year period. Two hundred twelve (60.2%) of the ultrasounds were performed clinically, with the rest performed for teaching purposes. One hundred seventy-nine (50.9%) of the ultrasounds were performed by credentialed physicians. One hundred forty-nine (70%) clinical and 29 (20.7%) teaching ultrasounds had additional imaging. The average time to follow up imaging after discharge from the ED was 8.51 days. Most patients receiving emergency ultrasound of their RUQ had follow-up imaging by radiology.     

Advances in ultrasound

Ultrasound (US) has undergone dramatic changes since its inception three decades ago; the original cumbersome B-mode gantry system has evolved into a high resolution real-time imaging system. This review describes both recent advances in ultrasound and contrast media and likely future developments. Technological advances in electronics and computing have revolutionized ultrasound practice with ever expanding applications. Developments in transducer materials and array designs have resulted in greater bandwidths with improvements in spatial and contrast resolution. Developments in digital signal processing have produced innovations in beam forming, image display and archiving. Technological advances have resulted in novel imaging modes which exploit the non-linear behaviour of tissue and microbubble contrast agents. Microbubble contrast agents have dramatically extended the clinical and research applications of ultrasound. Not only can Doppler studies be enhanced but also novel non-linear modes allow vessels down to the level of the microcirculation to be imaged. Functional and quantitative studies allow interrogation of a wide spectrum of tissue beds. The advent of tissue-specific agents promises to improve the sensitivity and specificity of ultrasound in the detection and characterization of focal liver lesions to rival that of computed tomography (CT) and magnetic resonance imaging (MRI). Ultrasound has recently moved into therapeutic applications with high intensity focused ultrasound (HIFU) and microbubble assisted delivery of drugs and genes showing great promise.     

经腹超声及术中超声在胰腺结石诊断、治疗中的应用

目的:探讨经腹超声及术中超声在胰腺结石诊断、治疗中的价值。材料和方法:对25例胰腺结石患者行经腹和术中超声检查。经腹超声主要观察胰管扩张程度,胰腺结石大小、位置,是否合并胆囊及胆道结石、胰腺假性囊肿等。术中超声观察是否有结石残留。结果:经腹超声显示25例患者主胰管扩张,胰腺实质增粗、增强。结石位于头部9例,位于全胰腺16例,伴有胆道梗阻征象13例,其中合并胆囊及胆道结石8例,并发胰腺假性囊肿3例,合并胰腺癌2例;术中超声形式显示6例未见残留结石,19例有残留结石,手术取出残留结石24枚。结论:经腹超声诊断主胰腺管结石敏感性较高,术中超声在判断残留结石及鉴别胰小管结石与胰腺实质钙化灶方面具有重要价值。     

经阴道超声在早早孕诊断中的价值

目的探讨经阴道超声在早早孕诊断中的价值。方法79例临床疑诊早早孕者行经腹超声和经阴道超声检查,并与临床随访及手术结果进行对比分析。结果经阴道超声检查在早期宫内孕及宫外孕诊断中的符合率(96.9%,92.3%)均高于经腹超声检查(32.3%,38.5%,P<0.01,P<0.05)。结论经阴道超声在早早孕诊断中明显优于经腹超声。