高分子微泡不同机械指数兔肾超声造影参数比较

目的 探讨不同机械指数对高分子微泡新西兰大白兔肾脏超声造影相关参数的影响.方法 高分子微泡经兔耳缘静脉团注,比较不同机械指数0.04、0.08、0.16、0.31兔肾脏超声造影的始增时间(AT)、达峰时间(TP)、平均渡越时间(MTT)、峰值强度(PI)、曲率(SLP)、曲线下面积(AUC)等参数的变化情况.结果 随着机械指数升高,兔肾超声造影的AT、TP、MTT均逐渐缩短,MI 0.31组MTT缩短尤其明显.高分子微泡兔肾超声造影的时间-强度曲线呈“双峰”形,第一峰PI随机械指数升高明显上升,而第二峰与第一峰PI比值逐渐降低,曲率随着机械指数升高平稳上升,曲线下面积呈先升高后降低的变化趋势.结论 高分子微泡超声造影时间-强度曲线参数随机械指数改变发生规律性变化,这可能与一定机械指数的超声作用使微泡稳定性降低有关.     

结直肠肿瘤腔内造影剂充盈超声检查法及常规经腹超声检查法诊断价值对比

目的比较肠充盈超声检查法与常规经腹超声检查法在结直肠肿瘤中的诊断价值。方法对2008年6月-2009年6月64例经临床病理确诊的结直肠肿瘤患者分别经腹常规超声及肠充盈超声检查。在肠充盈状态下观察病变的形态,对病变进行定位并观察结直肠肿瘤的彩色多普勒血流信号。比较肠充盈超声检查法及常规经腹超声检查法在结直肠肿瘤的检出、定位和显示血流的能力的差异。结果常规经腹部超声检查发现32例结直肠肿瘤（32/64）,病灶敏感性为50%;肠充盈超声检查法发现病灶55例（55/64）,病灶敏感性为85.9%。经腹常规超声检查的定位准确率为21.9%（7/32）,肠充盈超声检查法对结直肠肿瘤的定位准确率为89.1%（49/55）。两种方法比较差异有统计学的意义（P〈0.05）。结论肠充盈超声检查法在结直肠肿瘤的病变敏感性检出、定位准确性等方面优于经腹常规超声检查;而不同病理类型的结直肠肿瘤具有不同的超声声像图特征。     

超声造影在胃癌临床分期上的诊断价值及局限性

目的探讨超声造影在胃癌分期诊断上的临床价值及其局限性。方法对50例胃癌患者超声检查的结果及其TNM分期与胃镜或术后病理结果相比较分析。结果超声对胃癌浸润深度T1、T2、T3和T4诊断的符合率分别为42.9%,50.0%,78.9%和85.7%,总符合率70.0%;对淋巴结转移诊断符合率为N090.5%、N155.0%、N222.2%,总符合率64.0%;对肝脏、腹膜转移的诊断符合率为100%。结论超声造影诊断胃癌的价值在于它有较高的病灶检出率,对胃底部、胃大弯以外的进展期胃癌的TNM分期有着较高的诊断符合率,尤其对胃癌M分期具有较高的临床应用价值;其局限性在于对早期胃癌的T分期诊断符合率低,对胃底部肿瘤易漏诊。总之,超声造影在胃癌分期上具有一定的实用价值。     

Comparison of Gray-Scale Contrast-Enhanced Ultrasonography with Contrast-Enhanced Computed Tomography in Different Grading of Blunt Hepatic and Splenic Trauma: An Animal Experiment

To compare the diagnostic value of contrast-enhanced ultrasonography (CEUS) with contrast-enhanced computed tomography (CECT) for the detection of different grading of solid organ injuries in blunt abdominal trauma in animals. A self-made miniature tools were used as models to simulate a blunt hepatic or splenic trauma in 16 and 14 anesthetized dogs, respectively. Baseline ultrasound, CEUS and CECT were used to detect traumatic injuries of livers and spleens. The degree of injuries was determined by CEUS according to the American Association for the Surgery of Trauma (AAST) scale and the results compared with injury scale based on CECT evaluation. CEUS showed 22 hepatic injury sites in 16 animals and 17 splenic injury sites in other 14 animals. According to AAST scale, 2 grade I, 4 grade II, 3 grade III, 5 grade IV and 2 grade V hepatic lesions were present in 16 animals; 2 grade I, 4 grade II, 6 grade III and 2 grade IV splenic lesions in 14 animals. On CECT scan, 21 hepatic and 17 splenic injuries were demonstrated. According to Becker CT scaling for hepatic injury, 1 grade I, 2 grade II, 4 grade III, 5 grade IV and 2 grade V hepatic injuries were present. On the basis of Buntain spleen scaling, 2 grade I, 5 grade II, 5 grade III, 2 grade IV splenic injuries were showed. After Spearman rank correlation analysis, the agreement of CEUS with CECT on the degree of hepatic and splenic injury is 93.3% and 92.9%, respectively. CT is currently considered as the reference method for grading blunt abdominal trauma, according to experiment results, CEUS grading showed high levels of concordance with CECT. CEUS can accurately determine the degree of injury and will play an important role in clinical application. (E-mail: txiner@vip.sina.com)     

多巴胺和去甲肾上腺素对肾皮质血流灌注影响的对比超声评价

目的应用对比超声定量评价多巴胺(DA)和去甲肾上腺素(NE)对肾脏皮质血流灌注的影响。方法10只实验犬分别在基础状态、以及三种不同剂量DA和NE作用下,进行对比超声(CEU)检查,并测量左肾动脉血流量。采用经静脉微泡连续输注法进行CEU,观察肾皮质的平台声强度(A),造影剂再充填速率(β)和A与β的乘积(A×β)。结果在低、中剂量DA作用时,肾皮质的β值和A×β值与静息相比明显增加,且随剂量的增加而增加(P<0.05);在高剂量DA作用时,β值和A×β值与静息相比也有明显增加(P<0.05),但与低、中剂量DA相比,增加的程度减少(P<0.05);而肾皮质的A值仅在中等剂量DA作用时,与静息相比有明显增加(P<0.05);三种剂量DA作用下,肾皮质的β值与A×β值之间有良好的正相关(P<0.05,r=0.85)。在三种剂量NE作用下,肾皮质的A值、β值和A×β值与静息相比均明显减少(P<0.05),且随剂量的增加而减少幅度增大(P<0.05)。三种剂量NE作用下,肾皮质的A值和β值与A×β值之间均有良好的正相关(P<0.05,r值分别为0.83和0.71)。结论CEU可作为定量评价多巴胺(DA)和去甲肾上腺素(NE)对肾脏皮质血流灌注影响的一种较佳方式。     

The Degree of Contrast Washout on Contrast-Enhanced Ultrasound in Distinguishing Intrahepatic Cholangiocarcinoma from Hepatocellular Carcinoma

We aim to assess the role and degree of contrast washout in the differential diagnosis of intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC) on contrast-enhanced ultrasound (CEUS). Fifty-six histopathology-confirmed ICC nodules and 184 HCC nodules were included in this study. The nodules' washout degree on CEUS at 1, 2 and 3 min was semi-quantitatively and qualitatively assessed using gray-scale video signal intensity. Semi-quantitative assessment showed that the washout degree of ICCs at 1, 2 and 3 min were significantly lower than those of HCCs (p < 0.001) and similar results were found in the same size range subgroups. There were no significant differences in the washout degree of ICCs between patients with chronic hepatitis and those without. The areas under receiver operating characteristic curves, using the nodules' washout degree at 1, 2 and 3 min to differentiate ICC from HCC, were 0.957, 0.979 and 0.982, respectively. The qualitative assessment showed the washout of ICCs was more rapid and obvious than that of HCCs. At 3 min, moderate and marked washout were observed in all ICCs, but in only 12.5% HCCs (p < 0.001). In conclusion, ICCs displayed much higher degree of contrast washout than HCCs on CEUS, which allowed for differentiation from HCCs.     

经胸超声心动图实时心肌造影成像定量评价动脉粥样硬化兔心肌灌注

目的探讨经胸超声心动罔实时心肌造影成像评价动脉粥样硬化兔模型心肌灌注的应用价值。方法取口本大耳兔20只,随即分为动脉粥样硬化组(AS组)和对照组,每组10只。应用声学造影剂SonoVue,取左事乳头肌水平短轴切面行经胸超声心动图实时心肌造影检查。比较两组前壁、前间隔心肌灌注再充盈曲线的A值、β值、A×β值。结果 AS组前壁和前间隔心肌灌注显著降低,表现为前壁和前间隔β值和A×β值较对照组降低(P0.05),A值在两组问差异无统计学意义(P0.05)。结论经胸超声心动图实时心肌造影成像是无创性定量评价动脉粥样硬化免模型心肌灌沣的有效方法。     

PPAR-γ在兔动脉粥样硬化模型中的表达及替米沙坦的干预作用

目的 探讨过氧化物酶体增殖物激活受体-γ（peroxisome proliferator-activated receptor-γ,PPAR-γ）在兔动脉粥样硬化模型中的表达，以及替米沙坦的干预作用。方法 32只雄性日本大耳白兔随机分为高脂饮食组（A组）、高脂饮食＋替米沙坦组（B组）、高脂饮食＋氯沙坦（c组）和正常饮食组（D组）四组，每组8只。各组分别在喂养16周末时处死，称重，免疫组化法检测PPAR-γ，全自动生化分析仪检测血脂的表达水平。结果 PPAR-γ的表达水平A、B组分别与C、D有显著差异（P〈0．01）。B组PPAR-γ表达与A组元显著差异（P〉0．05）。B组总胆固醇（TC）、低密度脂蛋白（LDL）和甘油三酯（TG）水平与A、C、D组差异显著（P〈0．01）；C组和A组差异元显著性（P〉0．05）。体重B、D组分别与A、C组有显著差异（P〈0．01）。结论 PPAR-γ在动脉粥样硬化模型中表达增高受多因素调节；替米沙坦具有较氯沙坦更强的抗动脉粥样硬化作用，可能和上调PPAR-γ表达的作用有关。     

高频超声在观察兔动脉粥样硬化消退治疗中的应用

目的应用高频超声技术观察兔动脉粥样硬化(AS)的自然消退及祛瘀消斑胶囊消退AS的作用。方法12周末16只AS造型兔随机分为自然消退组和中药组,于实验开始、12周末和24周末分别进行血脂和超声检测,并与病理检测结果对比。结果造型后血脂显著升高,腹主动脉内中膜厚度(IMT)显著增厚(P均<0.01)。24周末两组兔血脂均显著降低,与自然消退组比较,中药组的各项血脂指标均显著降低(P均<0.05),IMT显著减小[(0.472±0.059)mmvs(0.617±0.125)mm,P<0.01],AIIc%较造型后显著增大(80.35±8.41vs69.61±8.40,P<0.01)。两组形态学检查有明显差异。结论祛瘀消斑胶囊具有消退和稳定实验兔AS的作用,高频超声技术可作为定性和定量随访AS动态变化的可靠方法。     

Irregular Defects in Hepatocellular Carcinomas During the Kupffer Phase of Contrast-Enhanced Ultrasonography with Perfluorobutane Microbubbles: Pathological Features and Metastatic Recurrence After Surgical Resection

The present study aimed to elucidate the association between post-vascular–phase (Kupffer-phase) images from contrast-enhanced ultrasonography (CEUS) with perfluorobutane microbubbles and metastatic recurrences after the resection of hepatocellular carcinoma (HCC). The study examined 73 patients with solitary HCC ≤5 cm in diameter who underwent CEUS before resection. HCC was defined as irregular type (including an irregular defect on Kupffer-phase images) or non-irregular type. Intrahepatic metastatic recurrence was defined as >3 intrahepatic recurrences. Metastatic recurrence included both extrahepatic and intrahepatic recurrences. Frequencies of microscopic portal invasion and intrahepatic metastasis were significantly higher in the irregular group than in the non-irregular group. Cumulative 5-y metastatic recurrence rates in the irregular and non-irregular groups were 43% and 7% (p = 0.028), respectively. Multivariate analyses identified Kupffer-phase findings as a factor significantly related to metastatic recurrence. In conclusion, HCCs with an irregular defect during Kupffer-phase CEUS are characterized by more frequent microscopic vascular invasion and intrahepatic metastasis and are significantly associated with metastatic recurrence after resection.     

Evaluation of Acute Kidney Injury Using Contrast Ultrasonography in a Rabbit Model of Crush Syndrome

This study aimed to investigate the feasibility of evaluating acute kidney injury (AKI) using contrast ultrasonography in a rabbit model of crush syndrome. Sixty-four New Zealand white rabbits were anesthetized and the left hind limb was wrapped and compressed for 4 h with a sphygmomanometer. Contrast ultrasonography of the left kidney using microbubbles as the contrast medium was performed. The serum levels of blood urea nitrogen (BUN), creatine (Cr), creatine kinase (CK) and lactate dehydrogenase (LDH) were significantly increased in comparison to before the compression. Correlation analysis showed that peak intensity was negatively correlated with the biochemical parameters and area under the curve (AUC) was positively correlated with these parameters. Contrast ultrasonography is thus sensitive to the changes in renal perfusion after limb crush injury in rabbits. The ultrasonography results correlated well with the biochemical parameters that are related to muscle injury and AKI.     

造影前后彩色多普勒超声诊断血管疾病的对照研究

目的:评价彩色多普勒超声造影对血管疾病的诊断价值。方法:不同部位血管疾病患者22例。应用美国Acuson 128-XP10型超声诊断仪及超声造影剂SonoVue。所有患者均接受常规及造影后的彩色多普勒超声检查,诊断结果与DSA、手术结果及CT、MRI等相对照。记录注射造影剂后彩色血流信号的增强时间。结果:造影前诊断明确的比例为72.7%(16/22),造影后为100%(22/22)。常规彩超诊断的敏感性为92.3%,特异性22.2%,阳性预测值63.2%,阴性预测值66.7%。造影后诊断的敏感性为93.3%,特异性100%,阳性预测值100%,阴性预测值87.5%。经外周静脉缓慢推注造影剂(速度约1ml.min-1),总的增强时间约10min。结论:超声造影剂的应用提高了检查者的诊断信心及诊断能力,特别表现在常规彩超检查有困难的部位。     

腺苷对兔缺血再灌注心肌和ET-1作用的研究

目的评价腺苷对缺血再灌注心肌的作用和对ET-1的影响,探讨腺苷预处理对缺血再灌注心肌保护作用的可能机制。方法家兔24只,随机分成对照组、腺苷预处理组、腺苷治疗组,每组8只。冠状动脉结扎40min,再灌注3h制备缺血再灌注模型。测定缺血前和再灌注3h后血CK的变化和心肌梗死区重量的大小,比较各组再灌注3h后SOD和MDA的变化。采用放免法测定结扎冠脉前,再灌注时,再灌注后30、60、120min血浆ET-1的变化。结果与对照组和腺苷治疗组相比,腺苷预处理组在再灌注3h后血清中CK、SOD、MDA的水平降低(P<0.01),心肌梗死面积明显减少(P<0.01);与对照组和腺苷治疗组相比,腺苷预处理组除结扎冠脉前,其余时间点ET-1的水平明显降低(P<0.01)。结论腺苷预处理可减轻再灌注损伤,对缺血再灌注心肌具有明显的保护作用,腺苷可能通过保护内皮细胞减少血浆ET-1的水平,减轻缺血再灌注损伤。     

多普勒声学造影与DSA检查对照观察兔肌肉VX2肿瘤血管的实验研究

目的与X线数字减影血管造影对比，探讨彩色多普勒和能量多普勒声学造影检测肿瘤血管特征的应用价值。方法将8只右侧股外侧肌肉种植有VX2肿瘤的新西兰大白兔经耳缘静脉注射自制的新型白蛋白氟碳声学造影剂，采用Acuson公司生产的Sequoia 512超声仪，分别应用彩色多普勒和能量多普勒显像观察肿瘤血管造影增强效果，并与DSA检查对照。结果二维超声检查8只荷瘤兔共发现病灶12个，呈圆形或类卵圆形，边界较清晰。造影后，肿瘤内血流显示率明显增高，血管形态变化明显，条状及分枝状血流数目增多，并有4例清晰显示滋养血管走行，与DSA检查结果相一致。结论彩色多普勒和能量多普勒声学造影(CDE)是检测肿瘤血流特征的重要手段。能量多普勒声学造影优于彩色多普勒造影显像。     

Effects of Angiotensin II and Noradrenaline on Intrarenal Haemodynamies in the Rat*

The haemodynamic effects of angiotensin II and noradrenaline were studied in the rat kidney. These pressors were given by intravenous infusion in stepwise increasing doses. Intrarenal haemodynmaics were analyzed by the 13 3enon washout technique, 85krypton autoradiography and silastic casting of the renal vascular tree. Angiotensin II induced significant changes in intrarenal haemodynamies before any changes in systemic blood pressure were detected. The decrease in mean renal blood flow (2.91 ml.min^-1.g^-1 in controls, 1.76 ml.min^-1.g^-1 in rats given 50 μg of angiotensin Il.kg^-1.h^-1) reflects a reduction in component I blood flow rate (from 3.9 to 2.9 ml.min^-1.g^-1) as well as a decrease in the fraction of total renal blood flow supplied to component I of the washout curve (from 84% to 62%). With noradrenaline an increase in total renal resistance occurred simultaneously with the elevation of mean arterial blood pressure. The resulting reduction in mean renal blood flow (from 2.76 ml.min^-1.g^-1 in controls to 1.55 ml.min^-1.g^-1 in rats given 1000 yg of noradrenaline kg^-1. h^-1) reflects a decrease in component I blood flow rate with lower infusion rates and a drop in component I flow fraction (from 82% to 52%) with higher doses. In contrast to canine kidneys, no evidence for a patchy cortical vasoconstriction was found in the rat. Using autoradiography it was possible to attribute component I to the renal cortex and subcortical area of the kidney.     

Prediction of Tubulointerstitial Injury in Chronic Kidney Disease Using a Non-Invasive Model: Combination of Renal Sonography and Laboratory Biomarkers

The goal of the study described here was to evaluate the degree of tubulointerstitial injury in patients with chronic kidney disease (CKD) using a more accurate model that combines renal sonographic parameters and laboratory biomarkers. A total of 308 patients were enrolled. The study protocol included conventional ultrasound, contrast-enhanced ultrasonography and renal biopsy. CKD patients were divided into normal and mild (≤25%), moderate (26%–50%) and severe (>50%) tubulointerstitial injury groups. We created a model comprising peak intensity, time to peak, urinary retinol-binding protein and β₂-microglobulin that could discriminate severe (>50%) tubulointerstitial injury. The area under the receiver operating characteristic curve of this model was 0.832, which had better accuracy than other individual indexes, and the sensitivity and specificity were 74.2% and 82.8%, respectively. Therefore, this model may be used to evaluate the severity of tubulointerstitial injury and may have the potential to serve as an effective auxiliary method to help nephrologists evaluate patients with CKD.     

超声造影与亚甲蓝示踪检测兔VX2乳腺癌前哨淋巴结的比较研究

目的通过与亚甲蓝(MB)示踪法比较,探讨超声造影检测乳腺癌前哨淋巴结(SLN)的前景。方法建立兔VX2乳腺癌模型24只,皮下注射SonoVue,超声造影显像SLN,观察其造影增强情况;再经皮下注射MB示踪;行腋窝淋巴结清扫术切除前哨淋巴结(sentinel lymph node,SLN)并行AE1/AE3免疫组化染色。结果 24只荷瘤兔超声造影检出回声均匀性增强的SLN 12个,回声不均匀性增强和部分充盈缺损的SLN 22个;MB示踪法检出SLN 32个;术中腋窝淋巴结清扫SLN 38个。以手术切除的SLN免疫组化结果为标准,超声造影的检出率(89.47%)、敏感性(95.24%)与MB示踪法检出率(84.21%)、敏感性(91.30%)比较无显著差异(P0.05);但其特异性(84.62%)和准确性(91.18%)均明显高于MB示踪法特异性(26.67%)和准确性(65.79%)(P0.05)。结论经皮下注射超声造影剂显像乳腺癌SLN与MB示踪法比较有一定优势,有望成为检测SLN的常用方法。     

松郁安神方对失眠大鼠基底核多巴胺和腺苷含量的影响

目的:观察松郁安神方对失眠大鼠基底核组织中神经递质多巴胺和腺苷的调节作用。方法:利用失眠大鼠模型,造模成功后分别给予阿普唑仑、松郁安神方(SYF)低剂量和高剂量用药1w。实验过程中观察大鼠的一般情况变化,治疗结束后通过酶联免疫吸附测定(Elisa)方法检测大鼠基底核组织中多巴胺(Dopamine,DA)和腺苷的含量。结果:SYF能够明显改善实验大鼠由失眠引起的症状,作用优于阿普唑仑。同对照组比较,模型组大鼠基底核组织中DA含量显著升高(P<0.01),腺苷含量显著降低(P<0.01)。同模型组比较,阿普唑仑组、SYF高剂量组和SYF低剂量组大鼠基底核组织中DA含量均显著下降(P<0.01),同时腺苷含量显著升高(P<0.01)。结论:SYF能够显著改善实验大鼠由失眠引起的症状,其机制可能与SYF抑制失眠大鼠基底核组织中DA的释放,增加腺苷的释放相关。     

Sonazoid‐Enhanced Ultrasonography for Evaluation of the Enhancement Patterns of Focal Liver Tumors in the Late Phase by Intermittent Imaging With a High Mechanical Index

Objective. The purpose of this study was to evaluate the enhancement patterns of focal liver tumors in the late phase of Sonazoid‐enhanced ultrasonography by intermittent imaging with a high mechanical index (MI). Methods. A total of 142 patients with 208 lesions, including 109 hepatocellular carcinomas (HCCs), 61 metastases, 30 hemangiomas, and 8 focal nodular hyperplasias (FNHs), were enrolled in this prospective study. Contrast‐enhanced ultrasonography with intermittent scanning at 2 frames per second (MI, 0.7–1.2) was conducted in the late phase (>5 minutes after bolus intravenous injection of the perflubutane‐based contrast agent Sonazoid; Daiichi Sankyo, Tokyo, Japan). Two blinded readers classified the enhancement patterns of the lesions. The sensitivity, specificity, and positive predictive value (PPV) of the dominant enhancement patterns and inter‐reader agreement were assessed. Results. A combination of diffuse enhancement with intratumoral vessels and intratumoral vessels alone yielded sensitivity of 85% (average of both readers), specificity of 88%, and a PPV of 88% for HCC. For metastasis, a combination of peripheral ringlike enhancement with peritumoral vessels and peripheral ringlike enhancement with intratumoral vessels yielded sensitivity of 79%, specificity of 95%, and a PPV of 85%. For hemangiomas, a combination of peripheral nodular enhancement with peritumoral vessels and peripheral nodular enhancement without peritumoral vessels yielded sensitivity of 75%, specificity of 99%, and a PPV of 92%. Diffuse enhancement with spoked wheel arteries yielded sensitivity of 82%, specificity of 100%, and a PPV of 87% for FNHs. Good inter‐reader agreement was achieved. Conclusions. Sonazoid‐enhanced ultrasonography using intermittent imaging with a high MI can potentially be used for evaluating the enhancement patterns of focal liver tumors in the late phase.