MSCT三期扫描对肾上腺腺瘤和转移瘤鉴别诊断的研究

目的:探讨MSCT三期增强对肾上腺腺瘤和转移瘤鉴别诊断的意义。材料和方法:38例肾上腺疾病患者进行螺旋CT薄层扫描,层厚1.6~3.2mm,螺距0.825,造影剂80~100ml,注射速度2~2.5ml/s,注射造影剂后23~27s进行快速扫描,为动脉期;60~80s扫描为静脉期。结果:①肾上腺腺瘤24例,肾上腺转移瘤14例。其中25例经病理证实,全部病例均经过5~15个月的随访。②肾上腺腺瘤与肾上腺转移瘤三期扫描的CT值有差异,肾上腺腺瘤在增强扫描的动脉期肿瘤实质的CT值高于静脉期的CT值;肾上腺转移瘤在增强扫描的动脉期肿瘤实质的CT值低于静脉期的CT值。结论:MSCT对肾上腺腺瘤和转移瘤的三期扫描显示了造影剂在肾上腺腺瘤和转移瘤中的进入和排出的时间有差异,提高了CT对肾上腺腺瘤和转移瘤的鉴别能力。     

Contrast‐Enhanced Ultrasound Guidance for Interventional Procedures

Since its introduction, contrast‐enhanced ultrasound (CEUS) has gained an important role in the diagnosis and management of abdominal and pelvic diseases. Contrast‐enhanced ultrasound can improve lesion detection rates as well as success rates of interventional procedures when compared to conventional ultrasound alone. Additionally, CEUS enables the interventionalist to assess the dynamic enhancement of different tissues and lesions, without the adverse effects of contrast‐enhanced computed tomography, such as exposure to ionizing radiation and nephrotoxicity from iodinated contrast material. This review article describes the various applications and advantages of the use of CEUS to enhance performance of ultrasound‐guided interventions in the abdomen and pelvis.     

彩色多普勒超声在乳腺肿块诊断中的临床应用价值分析

目的:探讨彩色多普勒超声在乳腺肿块诊断中的临床应用价值分析。方法:从2018年6月-2019年5月于我院进行彩色多普勒超声检查的乳腺肿块患者中随机抽取80例患者的病例资料进行回顾性分析,比较与手术病理学确诊结果对比的准确率、良性肿块和恶性肿块的图像特征。结果:彩色多普勒超声诊断良性肿块准确率98.31%,恶性肿块准确率85.71%;在彩色多普勒超声乳腺肿块图像表现中,良性肿块和恶性肿块的回声和后方衰竭比较不具有统计学意义(P>0.05),病灶边缘、微钙化特征比较具有统计学意义(P<0.05)。结论:彩色多普勒超声在乳腺肿块的临床诊断中具有较高的诊断价值。     

高频超声对腹股沟肿块的诊断价值及误诊分析

目的探讨高频超声对腹股沟肿块的诊断价值及误诊分析。方法对57例患者62个临床确诊并经手术或穿刺证实的腹股沟肿块,进行超声声像图回顾性分析。结果 62个腹股沟肿块中,腹股沟疝48个、炎性淋巴结肿块7个、精索鞘膜积液1个、隐睾5个和非霍奇金淋巴瘤转移1个。术前超声确诊肿块性质58个,占93.5%;误诊3个,占4.8%;漏诊1个,占1.6%。结论高频超声对腹股沟肿块具有较高的诊断价值。     

成人肾上腺术中超声表现

目的 观察成人肾上腺术中超声（IOUS）表现。方法 收集71例因肝脏、胆道或胰腺病变而接受外科手术治疗患者,观察肾上腺IOUS表现,并与CT/MRI双侧肾上腺显示率和厚度测值进行比较。结果 成人肾上腺IOUS表现为边界清晰、形态不规则的双侧弱回声结构。CT/MRI肾上腺显示率为97.18%（138/142）。IOUS肾上腺显示率为95.07%（135/142）,右侧92.96%（66/71）、左侧97.18%（69/71）,且可见4侧CT/MRI未能显示的肾上腺;IOUS所测肾上腺厚度均大于CT/MRI（P均<0.05）。结论 IOUS中,成人肾上腺表现为边界清晰、形态不规则的双侧弱回声,左侧显示率高于右侧。     

超声造影与MRI增强扫描对不确定性盆腔肿块良恶性判断的比较研究

目的 比较超声造影（CEUS）与MRI增强扫描对不确定性盆腔肿块良恶性的诊断价值。方法 对46例常规超声检查发现不确定性（使用国际卵巢肿瘤分析中的简易准则判断）盆腔肿块行实时CEUS以及MRI增强扫描检查,2名超声科医师及2名放射科医师在结合患者病史以及血清肿瘤标志物前后分别对检查结果独立作出诊断,以术后病理结果（n = 43）或临床治疗后的最终随访诊断结果（n = 3）作为金标准,对比结合病史及肿瘤标志物前后2种影像技术的诊断价值。结果 结合患者病史及肿瘤标志物前,CEUS对不确定性盆腔肿块的诊断准确度为67.4%,低于MRI增强扫描的80.4%,两者比较结果差异有统计学意义（P < 0.05）;结合病史和（或）结合肿瘤标志物后,2种影像技术对不确定性盆腔肿块的诊断准确度比较差异均无统计学意义（P均> 0.05）。CEUS结合患者病史和肿瘤标志物对不确定性盆腔肿块诊断准确度为91.3%,与不结合任何病史资料的CEUS比较差异有统计学意义（P < 0.05）。结论 在结合患者病史和血清肿瘤标志物的情况下,CEUS与MRI增强扫描对不确定性盆腔肿块的诊断准确度相当,CEUS对不确定性盆腔肿块的良恶性判断具有良好的临床应用价值。     

Incidental intra‐adrenal splenule

Splenules can be found in the adrenals and should be considered in the differential diagnosis of adrenal incidentalomas.     

WJ多功能介入性超声导向穿刺器的研制及其临床应用

本文报道ＷＪ多功能介入性超声导向穿刺器的研制及导向穿刺各种疾病２０３例。共２７４次，全部获得成功。研究表明，该导向刺器可附加在各种规格的线阵Ｂ超探头上，并适用于任何型号的穿刺针，活检针，导管针穿刺。     

Endoscopic ultrasound-guided fine-needle aspiration of right adrenal masses: report of 2 cases

OBJECTIVE: Although transgastric endoscopic ultrasound (EUS)-guided biopsy is a safe and accurate method for sampling of the left adrenal gland, only 2 reports describing EUS-guided fine-needle aspiration (FNA) of the right adrenal gland have been published to date. The aim of this series was to report 2 additional successful cases of EUS-FNA of right adrenal masses. METHODS: In this retrospective single-center case series, prospectively updated cytology and EUS databases between January 1997 and September 2007 were reviewed to identify all patients who underwent attempted EUS-FNA of either adrenal gland. Those who underwent EUS-FNA of the right adrenal gland were identified and reviewed. RESULTS: Of 52 consecutive patients who underwent EUS-FNA of either adrenal gland, 2 had attempted biopsy of the right adrenal gland and constituted the study population. The first patient had a history of colon cancer and was found to have a right adrenal mass during workup of jaundice. The second patient also had a history of colon cancer and was found to have an enlarging right adrenal mass and a subcarinal mass during follow-up computed tomography. Endoscopic ultrasound-guided FNA showed a pheochromocytoma in the first patient and metastatic colon cancer in the second patient. No complications were encountered during either procedure. CONCLUSIONS: This series further shows that EUS-FNA of right adrenal masses is feasible and may be an option for sampling of these lesions. Prospective studies comparing EUS with percutaneous FNA of adrenal masses are indicated to help delineate the indications and limitations of each technique.     

乳腺肿块三维超声成像的临床应用

目的探讨三维超声在乳腺肿块中的应用价值。方法对22例32个乳腺肿块,在二维超声检查的基础上,进行三维重建并与手术、病理结果对照分析。三维各切面方位的确定用水槽内鹌鹑蛋模拟试验和人体颈动脉检查比较。结果三维超声能用多角度、多切面对病灶进行切割,因此能直接提供乳腺肿块的立体形态学特点,使图像更逼真。同时,三维能量图模式上血管的细粗、多少、走行的自然和陡直更提供了一种直观的血流分布模式．对鉴别乳腺疾病提供了帮助。结论三维超声成像可弥补二维超声的不足,提供了直观的、立体的形态学和肿块血供的三维能量图模式特点,对疾病分析又多了一种方法。     

二维及彩色多普勒超声在乳腺肿块鉴别诊断中的应用

目的探讨二维及彩色多普勒超声在乳腺肿块鉴别诊断方面的临床应用价值。方法对106例经手术病理证实的乳腺肿块病例的二维及彩色多普勒超声表现与病理结果进行回顾性对比分析。结果在乳腺肿块的声像图诊断中，以形态、边界特征最为重要，它是肿块良、恶性鉴别的关键，大多数良性肿块表现为形态规则、边缘整齐光滑、有完整包膜、内部回声均匀、后方回声增强；而大多数恶性肿块表现为形态不规则、边缘粗糙、边界不清、内部回声不均匀、后方回声衰减。恶性肿块的血流显示率明显高于良性肿块，血流分布以Ⅱ、Ⅲ级为主，良性肿块则以0、Ⅰ级为主。结论乳腺肿块的超声诊断应以二维声像图为基础，同时结合彩色多普勒血流丰富程度，两者联合应用可提高超声对乳腺肿块的诊断符合率。     

简化MRI联合超声S-Detect模型对乳腺肿块良恶性鉴别的价值

目的  探究简化MRI联合超声S-Detect模型对乳腺肿块良恶性鉴别的价值。方法  选取华北理工大学附属唐山市妇幼保健院2021年3月~2023年1月行乳腺超声和MRI检查的154例患者（159个病灶）作为研究对象。以病理活检结果为金标准。简化MRI Ⅰ为乳腺影像报告和数据系统（BI-RADS）分类模型;简化MRI Ⅱ将BI-RADS分类4A及以下定义为良性,将BI-RADS分类4B及以上定义为恶性。采用Kappa检验分析不同方法鉴别乳腺肿块良恶性结果与病理结果的一致性;采用Logistic回归构建简化MRI Ⅰ和超声S-Detect+简化MRI Ⅰ鉴别乳腺肿块良恶性的模型;采用ROC曲线和决策曲线分析评价不同方法鉴别乳腺肿块良恶性的价值。结果  病理结果显示,乳腺肿块中良性43例,恶性116例。超声S-Detect+简化MRI Ⅰ鉴别乳腺肿块良恶性的准确率高于超声S-Detect（P < 0.05）,与简化MRI Ⅰ、简化MRI Ⅱ和超声S-Detect+简化MRI Ⅱ的准确率差异无统计学意义（P > 0.05）。超声S-Detect+简化MRI Ⅰ的Kappa值高于超声S-Detect、简化MRI Ⅰ、简化MRI Ⅱ和超声S-Detect+简化MRI Ⅱ。超声S-Detect+简化MRI Ⅰ鉴别乳腺肿块良恶性的ROC曲线下面积高于超声S-Detect、简化MRI Ⅰ、简化MRI Ⅱ和超声S-Detect+简化MRI Ⅱ（P < 0.05）。决策曲线分析结果显示,在全风险阈值范围内,超声S-Detect+简化MRI Ⅰ鉴别乳腺肿块良恶性的净收益高于超声S-Detect和简化MRI Ⅱ;在绝大部分风险阈值范围内,超声S-Detect+简化MRI Ⅰ鉴别乳腺肿块良恶性的净收益高于简化MRI Ⅰ和超声S-Detect+简化MRI Ⅱ。结论  简化MRI联合超声S-Detect模型有助于乳腺肿块良恶性鉴别,其价值高于单纯简化MRI和超声S-Detect。     

超声造影对附件区不同回声类型肿块良恶性鉴别中的应用价值

目的探讨超声造影对附件区不同回声类型肿块良恶性鉴别的临床应用价值。方法选取36例附件区肿块的患者,先行常规经阴道超声检查,根据二维超声声像图表现分为单纯性囊性肿块组、囊性为主混合性肿块组、实性肿块组及实性为主混合性肿块组,再行超声造影成像并分析其增强特点及时间-强度曲线,主要指标包括充盈起始时间(AT)、达峰时间(TTP)、廓清时间(WT)、造影曲线总时间(OT)、起始强度(AI)、峰值强度(PI)及曲线下面积(AUC)等。结果所有病例均获得病理诊断,其中单纯性囊性肿块组及囊性为主混合性肿块组均为良性;研究显示AT在囊性为主混合性肿块组及实性为主混合性肿块组晚于实性肿块组(P<0.01);AI及PI在囊性为主混合性肿块组低于实性肿块组(P<0.05,P<0.01)。在实性肿块组中,恶性组AT早于良性组(P<0.05),AI及PI高于良性组(P<0.01)。在实性为主混合性肿块组中,恶性组AT早于良性组(P<0.05),TTP晚于良性组(P<0.05)。结论超声造影对附件区不同回声类型肿块的良、恶性鉴别有一定的临床应用价值。     

超声引导下介入治疗盆腔脓肿的临床价值

目的探究超声引导下介入治疗盆腔脓肿的临床价值。方法选取2013年1月至2015年1月期间该院收治的100例盆腔囊肿患者为研究对象。采用随机数表法将100例患者分为观察组和对照组,各50例。其中观察组采用超声引导下介入治疗,对照组采用抗生素进行临床常规保守治疗,对比两组患者的治疗效果以及临床应用价值,并对治疗后两组患者的不良反应以及并发症情况进行分析。结果两组患者相比,观察组症状消失时间明显比对照组时间短,且住院天数和住院费用更少,差异有统计学意义（ P＜0．05）,观察组与对照组疗效比较,观察组总有效率高达100％,高于对照组94％,差异有统计学意义（ P＜0．05）。观察组出现下腹疼痛7例,面色潮红2例,腹痛3例,但不良反应极轻,无需进行特殊处理。与对照组相比,差异无统计学意义（P＞0．05）。结论超声引导下介入治疗盆腔脓肿疗效显著,患者在治疗过程中没有明显的并发症以及不良反应,尤其适用于对临床常规治疗无效的患者,值得在临床上进一步推广和使用。     

A Randomized Trial Assessing the Value of Ultrasound-Guided Puncture of the Femoral Artery for Interventional Investigations

Using a prospectively collected database of patients undergoing diagnostic or therapeutic angiography via transfemoral access, we sought to determine those patients who may benefit from ultrasound-guided puncture of the femoral artery. One-hundred-twelve patients with normal anticoagulation parameters were randomized in two groups. Fifty-six patients received ultrasound-guided puncture of the femoral artery, 56 patients underwent traditional palpation-guided vessel cannulation. Parameters assessed included procedure-time, number of attempts for successful puncture, intensity of the arterial pulse, previous ipsilateral punctures, history and risk factors of arteriosclerosis and leg circumference at the site of puncture. The data was analyzed by using outcome measures according to evidence-based medicine criteria. Only in patients with weak arterial pulse and thoses with a leg circumference of 60 cm or greater ultrasound guidance significantly decreased the number of attempts needed as well as the time for successful arterial puncture. In both patient subgroups, the number needed to treat (NNT) was 2, the absolute benefit increase (ABI) was 50 and 57%, respectively. In contrast, time for vessel cannulation was increased in patients with strong arterial pulse using ultrasound guidance. No significant differences were found with respect to diminished complications neither comparing both patient groups nor comparing risk subgroups. In conclusion ultrasound guidance for femoral artery access is recommended only in patients with a weak or absent arterial pulse and obese patients.     

高频超声在腹壁肿块诊断中的应用

目的探讨高频超声在腹壁肿块诊断和鉴别诊断中的价值。方法应用高频探头对49例腹壁肿块进行纵、横、斜多切面多角度扫查,将其二维声像图特征和彩色多普勒血流显像特点进行综合分析,部分经手术及病理证实。结果 49例病例中,腹壁脓肿或血肿15例;腹壁良性肿瘤17例;腹壁恶性肿瘤3例;腹壁切口处子宫内膜异位症11例;腹壁切口疝1例;脐尿管囊肿1例,腹壁瘘管1例。结论高频超声能清晰显示腹壁各层次,可对肿块作出定位和定性诊断,是腹壁肿块最重要的检查方法。。     

心血管介入术患者的围术期护理

目的探讨心血管介入术患者的围术期护理干预效果。方法回顾性分析2012年1—12月在解放军总医院南楼心血管一科行心血管介入治疗的40例患者的临床资料,并总结其围术期护理措施。结果40例患者介入手术治疗均成功,成功率为100％,未出现并发症。结论全面的护理干预可有效降低心血管介入术后患者并发症的发生率,提高患者的生活质量。     

介入超声治疗盆腔脓肿的临床价值

目的探讨盆腔脓肿在超声引导下穿刺实施硬化治疗的远期疗效及临床实用价值。方法彩色多普勒超声随机检查对疑似盆腔脓肿进行超声引导下穿刺（直径〉4．5cm），如有脓液析出则按规定行无水乙醇硬化治疗。结果19例盆腔脓肿全部行细菌培养及药敏试验。除1例未经硬化治疗仅做了抗生素冲洗后2周后复发，其余均得到治愈。治疗半年复查盆腔超声未见异常，随访18个月无复发。结论介入超声治疗盆腔脓肿是临床上一种较好的治疗方法，尤其是对继发盆腔手术后感染形成的脓肿效果更佳，而且能够明显缓解临床上高热等症状。     

Assessment of fetal adrenal gland volume using three-dimensional ultrasound

To assess the normal fetal adrenal gland volume during normal gestation, we performed a prospective study on 119 normal fetuses with gestational age ranging from 21 to 40 weeks using a 3-D ultrasound (US) volume scanner with a pure cross-sectional design. Polynomial regression analysis was calculated to find the best-fit model between gestational age (GA) and adrenal gland volume. In addition, estimated fetal weight (EFW) was also measured to demonstrate the correlation between adrenal gland volume and fetal weight. Our results showed that fetal adrenal gland volume is highly correlated with GA. Furthermore, using GA as the independent variable and adrenal gland volume as the dependent variable, the best-fit regression equation was adrenal glands volume (mL) = -0.2683 x GA + 0.0082 x GA(2) + 3.1927 (r = 0.93, n = 119, p < 0.0001). For clinical use, a chart of normal growth centiles of fetal adrenal gland volume in utero was then calculated based on this equation. In addition, fetal adrenal gland volume during normal gestation is also highly correlated with EFW (p < 0.0001). In conclusion, our data of fetal adrenal gland volume assessed by 3-D US can serve as a useful reference in evaluating fetal growth status during gestation.