Complex clinico-instrumental diagnosis of diffuse liver diseases

One hundred and twelve subjects including 82 patients with diffuse hepatic diseases were examined by clinico-biochemical and instrumental methods. The latter methods included liver scintigraphy and radionuclide study with technetium-99M-colloid, ultrasonic exploration of the liver and spleen, and computer-aided tomography. According to the changes in the clinical and biochemical symptomatology and to the instrumental diagnosis data all the patients were divided into several groups. The first group comprised 30 subjects with fatty liver dystrophy (FD). In these patients, ultrasonic examination revealed two types of changes depending on the disease duration and severity. Seven patients had associated hepatitis and FD of the liver. In patients with active hepatitis (15 cases) and persistent hepatis (17 cases), scintigraphy revealed liver enlargement twice as often. In patients with liver cirrhosis, ultrasonic diagnosis was helpful in revealing differences at the initial and advanced stages of disease. Scintigraphy appeared to be the most sensitive method, whereas computer-aided tomography the least sensitive. Computer-aided tomography and ultrasonography proved to be the most specific.     

MR半傅立叶单次激发快速自旋回波序列与超声检查在胎儿颅脑疾病的对比分析

目的探讨MR半傅立叶单次激发快速自旋回波序列(half-Fourier acquisition single-shot turbo spin-echo,HASTE)在胎儿颅脑疾病的应用价值。材料与方法选取超声诊断或疑诊胎儿颅脑发育异常孕妇46例,应用HASTE序列对胎儿头颅行轴面、冠状及矢状面扫描,对两种方法诊断结果进行对比分析。结果超声提出诊断34例,疑诊病变12例。HASTE共发现病变35例,检出病变45个。超声在液性病变诊断方面,在测量异常值≥3 mm时,诊断侧脑室扩张及枕大池增宽与HASTE符合率达96%(26/27);在超声测量异常值3 mm时,诊断侧脑室扩张及枕大池增宽与HASTE符合率为25%(3/12)。在诊断中线结构病变及复杂颅内病变方面,HASTE序列显示病变数明显多于超声检查。结论 HASTE序列在胎儿颅脑产前诊断中可进一步验证或修正超声诊断,且在颅脑中线结构及脑实质病变方面诊断明显优于超声检查。     

高频超声对原发性甲状旁腺疾病的诊断价值

目的：探讨高频超声对原发性甲状旁腺疾病的诊断价值。方法：对100例正常人及30例拟诊为原发性甲状旁腺疾病的患者行甲状旁腺超声检测，检查结果与病理诊断、血清甲状旁腺激素等临床资料综合分析。结果：正常组在20人中发现27个正常甲状旁腺，甲状旁腺的检出率为20％（20／100）。在30例疑为甲状旁腺疾病的患者中超声检出患甲状旁腺疾病者19例，病变甲状旁腺21个，包括甲状旁腺腺瘤、腺癌、无功能囊肿、单纯性甲状旁腺肿大等，假阳性3例；正常甲状旁腺11例，超声检出的最小甲状旁腺直径4．5mm，无假阴性。结论：高频超声不仅能检出10mm左右的甲状旁腺腺瘤，而且可能检出＞5mm正常或轻度肿大的甲状旁腺，为临床除外甲状旁腺疾病首选的可靠方法。     

晶状体疾病的超声检查

目的 探讨晶状体疾病超声检查的临床意义.方法 应用彩色多普勒超声检测821只患眼的晶状体病变情况,并分析其声像图特点.结果 超声诊断白内障748只眼,晶状体脱位30只眼,晶状体破裂8只眼;合并各类眼内病479只眼,占58.3%(479/8 21).结论 超声能准确诊断晶状体疾病,并对眼内伴随疾病作出定性诊断,对手术方式的选择和评价术后效果有重要的临床意义.     

47例局限性脂肪肝超声分析

目的 本文为的探讨声声对局限性脂肪肝的诊断价值。方法 对47例拟诊局限性脂肪肝的患者行超声定位、声像图表现及血流变化检测,并结合血脂、血糖进行综合分析,所有病例与CT、病理及治疗中随访作对照。结果:47例根据声像图表现分为2型、Ⅰ型35例,Ⅱ型12例;5例与手术病理一致,11例与CT对照相符合,29例治疗中追踪随访有效;38例血脂增高、16例血糖增高。结论:超声对局限性脂肪肝的诊断及鉴别诊断是很重要的影像学方法,具有较高的诊断价值。     

超声对肺外周及胸膜转移癌的早期诊断

目的 探讨超声对肺外周及胸膜≤2cm转移癌的诊断价值及声像图特征。方法 对中晚期肺、乳腺及消化系等恶性肿瘤患者行肋间及肋缘下肺底扫查,观察肺外周及胸膜下≤2cm小转移癌声像图特征及诊断率。结果 经确诊小转移癌61例中,超声显示56例（91.8%）,其中约半现灶≤1cm。声像图表现多呈类圆形（83.9%）,边界清晰规整（73.2%）,内部呈均匀的弱回声或无回声（78.6%）,局部胸膜不清晰或中断（75％),后方显示典型的长“彗星尾征”（89.3%）。根据以上特征,25例（44.6%）在未知X线、CT、临床诊断结果情况下超声作出诊断,其中6例为超声首诊。超声对检出的病灶定性诊断较X线、CT敏感,但易漏诊,肩胛骨、肋骨、肺气体等为主要影响因素。结论 对于肺周及胸膜下的转移癌,超声检查不受肺气体干扰,显示率较高,声像图典型,尤其后方长“彗星尾征”为敏感的超声指征。超声作为X线、CT的辅助诊断手段,有助于提高肺周转移癌的早期诊断率。     

髋关节翻修术中冰冻病理切片与99Tcm三相同位素骨扫描共用诊断髋关节假体周围感染

背景：常规血清学、影像学和实验室诊断方法诊断假体周围感染难以达到理想的灵敏度、特异度和准确性。尤其对于假体置换后晚期假体低毒性感染性松动和无菌性松动之间的鉴别诊断还缺乏普遍接受的诊断标准。术前、术中和术后多种诊断方法的联合运用对于明确感染诊断和制定手术翻修策略有重要的临床意义。目的：通过初次髋关节置换后翻修术前和术中联合运用99Tcm三相同位素骨扫描和冰冻病理切片多形核白细胞计数方法诊断髋关节假体周围感染,并与常规诊断手段相比较。方法：2008年4月至2013年5月共收治44例髋关节置换后翻修病例,结合临床症状和血清学检查指标,18例患者血沉和C-反应蛋白增高诊断为临床怀疑感染病例组;26例血清学指标正常诊断为临床怀疑无菌性松动病例组。所有患者翻修前进行99Tcm三相同位素骨扫描检查,同时结合翻修手术过程中组织冰冻病理切片结果。如两项结果均为阴性,诊断为假体无菌性松动,行一期翻修手术;反之则诊断为假体周围感染,行二期手术翻修。通过术后临床随访血清学指标及手术疗效,采用受试者工作曲线的统计学方法评估联合运用99Tcm三相同位素骨扫描和组织冰冻病理切片的诊断价值。结果与结论：18例临床感染病例组中16例患者术前99Tcm三相同位素骨扫描结果和术中冰冻病理结果均为阳性,诊断为感染,二期翻修;2例结果均阴性,排除感染,一期翻修。26例松动病例组中,25例术前99Tcm三相同位素骨扫描结果和术中冰冻病理结果阴性,诊断为无菌性松动,一期翻修;1例患者术后病原菌微生物学培养送检3个标本中1个标本培养出金黄色葡萄球菌,诊断为假体周围感染,仍采取一期翻修。增加99Tcm三相同位素骨扫描和冰冻病理切片多形核白细胞计数的方法后,工作特征曲线面?     

The radiology of cavernous hemangioma of the liver

This article reviews the epidemiology, pathology, and diagnosis of cavernous hemangioma of the liver. This lesion is very common; it is the most common benign tumor of the liver. While small hemangiomas (less than 3 cm) have a characteristic ultrasonographic appearance, lesions larger than 3 cm in diameter may have a whole host of ultrasonic findings and this technique becomes less reliable in making the diagnosis. Initial experience with dynamic CT has shown it to be reliable in differentiating hemangiomas from other lesions. Later, some metastatic lesions were described to mimic hemangiomas on CT. Furthermore, a diagnostic CT is hard to get in small lesions because of the difficulty in getting a small lesion in the scanning plane repeatedly. Blood pool scintigraphy with planar imaging has been shown to be very sensitive and specific for that lesion. This technique is not very reliable for small (less than 2 cm) or deeply seated lesions. We have shown that blood scintigraphy is more reliable for those situations. Recent reports have shown that MRI is highly reliable for the detection and characterization of liver hemangiomas. This technology is very expensive and is unlikely to be used in evaluating all patients suspected of having cavernous hemangiomas; it should be reserved for cases with uncharacteristic ultrasound or blood pool scan findings.     

Role of computed angiopulmonography in current diagnosis of pulmonary artery thromboembolism

AIM: To study potentialities of tomographic methods in diagnosis of pulmonary artery thromboembolism (PATE). MATERIAL AND METHODS: Electron-beam tomography (EBT) was used for diagnosis in 34 patients (mean age 41.3 +/- 16.5 years) suspected of PATE (Imatron C-150 unit, USA). The procedure included standard examination of the lungs and EBT angiopulmonography in intravenous introduction of the contrast agent (80-100 ml, the rate 3-3.5 ml/s). RESULTS: The pulmonary artery was found to contain thrombi in 56% patients. 18% of PATE patients had pulmonary infarction. A complete coincidence of EBT and scintigraphy was registered in 31% cases, no PATE by both methods was in 19% cases. Angiopulmonography and EBT findings were the same. In 1 case the result of pulmonary scintigraphy was false negative. 24% patients showed symptoms of thrombophlebitis or varicosity of the lower limbs. EBT has detected signs of PATE in 83% of them. CONCLUSION: EBT-angiopulmonography is a precise, highly informative non-invasive method in diagnosis of PATE.     

超声诊断静脉瘤样病变

目的 探讨二维超声及彩色多普勒血流成像（CDFI）对静脉瘤样病变的诊断价值。方法 回顾性分析26例本院诊治的静脉瘤样病变患者的声像图特征及临床表现,根据不同CDFI表现进行分类总结。结果 诊断静脉瘤样病变26例,根据其声像图特征大致分为三种类型：①静脉瘤样扩张;②外伤性血肿;③静脉内膜剥离。其中静脉瘤样扩张及内膜剥离型的静脉内膜连续性良好,外伤性血肿型则可见静脉管壁全层中断。结论 二维超声及CDFI对静脉瘤样病变具有较高的诊断价值,并可为临床诊断及治疗提供可靠依据。     

67-Galliumscintigraphy as an auxiliary method for differentiation of mass lesions of the liver (author's transl)]

Liver scintigraphy with 67-Ga citrate and alphafetoprotein (afp) determinations in the serum were carried out in 84 patients with liver mass lesions in the preceding sulphur colloid scans. Among these patients 51 cases were histologically verfied and 33 patients were regarded as clinically-proven cases. Scanning was carried out 72 hours after the intravenous injection of 3 mC 67-Ga-citrate. Corresponding to the intensity of 67-Ga uptake within the former liver lesions 3 groups of 67-Ga scans were differentiated: Ga 0 (the lesion showed no Ga uptake), Ga plus (the Ga uptake within the lesion was equal to that of the surrounding liver tissue) and Ga plus plus (the Ga uptake within the former lesion exceeded the physiological Ga uptake in the normal liver tissue). The number of cases, results of Ga scintigraphy and afp examinations as well as histological, clinical and nuclear medical diagnosis were correlated. It was shown that Ga plus plus cases were strongly suspect of hepatoma, whereas in Ga 0 cases a diagnosis of hepatoma could be excluded. In patients with Ga plus further investigations have to be performed (repeated afp examinations, angiography of the coeliac artery), because cirrhotic regeneration nodules, metastases and necrotic hepatomata were all found within this group. According to our experience liver scanning with 67Ga represents a useful auxiliary examination in liver diagnosis. Ga citrate scintigraphy of the liver is indicated in all cases with mass lesions detected by the routine sulphur colloid scan and in all patients in whom there is clinical suspicion of hepatoma, inorder to differentiate the origin of the lesions. In 2 cases of hepatoma marked Ga uptake was observed at a time when the afp was still negative.     

双胎之一完全性葡萄胎产前超声特征与临床结局对照分析

目的探讨双胎之一完全性葡萄胎产前超声声像图特征及超声诊断的临床意义。 方法对北京大学第三医院2010年1月至2015年1月产前超声诊断或可疑为双胎之一完全性葡萄胎11例孕妇的临床、超声图像检查资料进行分析,并与胎儿临床结局及病理诊断结果对照。 结果11例孕妇中产前超声提示孕11~13周双胎之一完全性葡萄胎9例,可疑双胎之一完全性葡萄胎2例（1例分娩后证实为双胎之一胚胎停育后胎盘梗死灶,1例产后证实为部分性葡萄胎）,其中6例为体外受精-胚胎移植后妊娠,均移植新鲜或冻胚胎2枚,1例为服用促排卵药物后妊娠。双胎之一完全性葡萄胎声像图均表现为宫腔内正常发育的胎儿、胎盘,另可见胎盘旁葡萄胎声像图。9例双胎之一完全性葡萄胎中8例早孕期超声检查（孕6~10周）,其中5例均存在异常声像图,其声像图均表现为宫腔内正常胎囊、胎芽及胎心搏动,另可见胎囊旁不均质不规则团块状中等或低回声,类似宫内早孕合并宫腔积血或胚胎停育的声像图表现。全部病例均经病理和染色体分析证实。 结论孕11~13周双胎之一完全性葡萄胎具有典型的声像图特征,早孕期超声检查具有异常声像,需与宫内早孕合并宫腔积血或双胎之一胚胎停育鉴别;需根据β-hCG水平与增长情况、葡萄胎大小与增长情况、孕周及有无并发症决定继续妊娠或终止妊娠等临床处理方式。因此,超声在双胎之一完全性葡萄胎诊断及后续治疗中均有重要临床价值。     

Biliary atresia in infants with prolonged cholestatic jaundice: diagnostic accuracy of hepatobiliary scintigraphy

Background Cholestatic jaundice during infancy is one of the most problematic challenges for pediatricians. Biliary atresia (BA) and neonatal hepatitis syndrome (NHS) are major causes of cholestatic jaundices. Our aim was to compare the diagnostic accuracy of hepatobiliary scintigraphy with liver biopsy and ultrasonography in excluding BA. Methods Seventy consecutive patients, all suffering from prolonged cholestatic jaundice (>1 month), were included. Laparotomy with surgical cholangiography was considered as the gold standard; however, in nine patients, based on the patient’s recovery from jaundice and the normalization of laboratory values during the clinical follow-up period (=6–12 months), the diagnosis of NHS was verified and performing laparotomy was unnecessary. All patients underwent hepatobiliary scintigraphy, liver biopsy and ultrasonography and their results were compared. Results Based on the gold standards mentioned above, 46 patients (46/70 = 65.7%) had BA. The sensitivity, specificity, PPV, NPV, and accuracy of the hepatobiliary scintigraphy in diagnosis of BA were 90%, 80%, 91.8%, 76.2%, and 84.5%, respectively. The respective values for liver biopsy were 92.5%, 88.9%, 94.9%, 84.2%, and 90.1% and for ultrasonographic analysis were 41.7%, 90.9%, 90.9%, 41.7%, and 66.3%. Conclusion Hepatobiliary scintigraphy is an important imaging technique in the diagnostic evaluation of infants with prolonged cholestatic jaundice. It is a convenient and reliable method of differentiating BA from NHS, with a diagnostic accuracy superior to that of US but slightly inferior to that of liver biopsy. Ultrasonography is the least sensitive and specific available modality and its findings should be confirmed by scintigraphy or liver biopsy.     

超声诊断肝外胆管癌的价值

目的分析肝外胆管癌的声像图特点,探讨早期超声诊断的临床价值。方法50例超声拟诊为肝外胆管癌患者,经临床手术、其他影像学及(或)经皮胰胆管逆行造影证实,分析其患者临床及超声影像学资料。结果肝外胆管癌超声直接征象分为乳头型、团块型、截断型和狭窄型;间接征象为肝内及肝外胆管扩张、肝内及肝门部淋巴结转移和腹水。误诊3例,其中1例为胆总管结石,2例为十二指肠憩室。结论超声显像对肝外胆管癌的诊断有重要价值。     

60例自身免疫性肝病超声影像分析

目的 了解自身免疫性肝病的超声表现，从而提高该病的诊断准确率。方法 对经临床及病理确诊的60例自身免疫性肝病患者的超声影像资料进行回顾性综合分析。结果 自身免疫性肝炎50例，原发性胆汁型肝硬化8例，原发性硬化性胆管炎2例。结论 超声显像对于自身免疫性肝病的诊断具有重要的意义。     

Peripheral joint scanning with technetium pertechnetate. Application in clinical practice.

Results of a prospective study to evaluate the clinical usefulness of radioisotope joint scanning in the practice of rheumatology are reported. The radiopharmaceutical used was technetium pertechnetate, increased synovial blood flow being the main contributory factor to abnormal joint images. Strict adherence to a procedural protocol was necessary to assure reproducible images. Joint scintigraphy was performed on 56 control subjects without joint disease and 51 patients with different rheumatic disorders. There was excellent agreement between clinical examination and joint scintigraphy in all groups studied. In cases of disagreement, the joint scintigram generally was more sensitive. This high sensitivity for the detection of synovitis was accompanied by a lack of specificity, because it failed to diagnose the nature of the joint involvement. The joint scan was helpful for diagnosing early or steroid-suppressed synovitis and also for suspected nonarticular rheumatism. It aided in delineating the pattern of joint involvement. Joint scintigraphy is the only objective nontraumatic permanent record documenting joint inflammation.     

SPECT/CT ~(131)I-MIBG肾上腺髓质显像在肾上腺疾病中的应用

目的:评价SPECTCT131I-MIBG肾上腺髓质显像对肾上腺疾病的诊断价值。方法:回顾性对照分析42例拟诊肾上腺疾病的患者SPECTCT131I-MIBG肾上腺髓质显像、B超、CT、MRI、尿-香草基杏仁酸(A)及术后病理结VM果。结果:42例拟诊肾上腺疾病的患者中SPECTCT131I-MIBG肾上腺髓质显像诊断为嗜铬细胞瘤18例(42.85%),肾上腺髓质增生7例(16.67%)。经术后病理结果证实的13例嗜铬细胞瘤和3例肾上腺髓质增生SPECTCTI-MIBG显像分别诊131断为嗜铬细胞瘤13例(阳性率100%)及肾上腺髓质增生3例,明显高于MRI、CT、B超及24小时尿VMA。结论:SPECTCTI-MIBG肾上腺髓质显像对嗜铬细胞瘤、异位嗜铬细胞瘤和肾上腺髓质增生具有良好的定位、定性价值,明显优于B131超、CT、MRI、尿VMA等检查。     

腹膜后恶性淋巴结肿大的超声声像图特征及其临床意义

目的：研究腹膜后恶性淋巴结肿大的超声声像图特征及其临床价值。方法：对95例癌性患者恶性淋巴结肿大进行超声检查。结果：晚期胃癌、肝癌、胰腺癌、胆囊癌、前列腺癌、卵巢癌、宫颈癌、食道癌、回盲部及升结肠癌均可伴发腹膜后淋巴结肿大，表现淋巴结宽径明显增大、内部回声状增强、变形、挤压血管、粘连等。结论：对恶性淋巴结肿大声像图特征（淋巴结宽径增大，L／S＜2，边不规则，内部回声片状或云雾状增强，淋巴门消失或变小，周围粘连）及发生部位进行分析，有利于提高肿瘤的定位定性诊断，为临床治疗方案提供有力依据，具有很重要的临床意义。     

^67Ga、^210TL与^99mTC—MiBi肺肿瘤阳性显像的诊断分析

目的：对比分析^67Ga、^201TL与^99TC-甲氧基异丁基异腈（MiBi)肺肿瘤显像的诊断价值。方法：对184例使用^67Ga201,25例使用^201TL与48例使用^99TC-MiBi进行肺肿瘤显像,患均经穿刺活组织检查,手术切除或其他方法获得病理结果,其中肺癌174例,肺良性病变83例,结果：^67Ga对肺癌显像的灵敏度为79.5%,特异性79.9%,准确率79.3%.^201TL的灵敏度为66.7%,特异性85%,准确率72%,^99mTC-MiBi的显像灵敏度、行异性和准确率均为75%。结论:^67Ga、^201TL以及^99mTC用于肺肿瘤阳性显像对肺肿瘤的诊断及鉴别其良恶性肿瘤具有一定的实用价值。     

多探头联合运用在输尿管中段结石诊断中的价值

目的探讨联合运用多种超声探头诊断输尿管中段结石的价值。方法对176例高度怀疑为输尿管中段结石的患者行多种探头联合应用的超声探查,结果与腹部平片、静脉尿路造影检查对比分析。结果应用单一的影像学检查共检出输尿管中段结石159例,多种超声探头联合运用的超声检查发现117例（117／159,73．6％）,其中腹部凸阵探头检出71例,高频线阵探头检出27例,腔内探头检出19例。结论联合运用多种超声探头在诊断输尿管中段结石方面成功率较高,有较好的临床价值。