经阴道超声弹性成像在宫颈癌诊断中的价值

目的探讨探讨超声弹性成像技术在宫颈癌诊断的应用价值。方法应用超声弹性成像技术检测2013年6月~2014年9月就诊于我院的32例宫颈癌患者病灶和宫颈上皮内瘤变（CIN）患者5例及20例正常宫颈,记录图像及测量相关数值进行分析统计。结果32例宫颈癌患者,有5例诊断为良性,5例CIN患者中,有2例诊断为恶性,对于20正常宫颈中有3例诊断为恶性,超声弹性成像诊断宫颈癌的敏感度84.37%、特异度80%、准确度82.45%。结论超声弹性成像在宫颈癌的诊断中有较高的应用价值,具有临床推广意义,但是超声弹性成像在癌前病变与宫颈癌的评分中存在交叉,由于样本量的限制,需更大的样本量进行验证。同时超声弹性成像有望用于宫颈癌化疗效果的评价以及在临床分期中提供客观的依据。     

弹性成像技术在宫颈癌应用中的影响因素

目的探讨宫颈癌病灶大小及位置对弹性评分的影响.方法宫颈癌50例,根据病灶大小将其分为肿块大小＜20 mm、20～＜40 mm、≥40 mm 3组,比较各组间弹性评分的差别,以及根据病灶位置将其分为内生型及外生型2组,比较各组间弹性评分的差别.结果不同大小及不同位置的病灶弹性评分间有差异(P＜0.05).结论 宫颈癌大小及位置对弹性评分结果有一定影响.     

超声弹性成像在宫颈癌前病变及宫颈癌诊断中的初步研究

目的:研究分析超声弹性成像初步诊断宫颈癌前病变、宫颈癌的临床价值。方法:于2019年2月—2020年2月本院接收的57例宫颈癌前病变患者、57例宫颈癌患者,均在术前进行超声弹性成像初步诊断,根据弹性分级,对比分析病理分期,探讨超声弹性成像诊断正确率,另选取57例健康体检者进行对照。结果:宫颈癌前病变、宫颈癌与健康体检者的超声弹性成像内容差异明显,同时宫颈癌前病变与宫颈癌患者的弹性分级检出率存在显著差异(P<0.05)。结论:宫颈癌前病变、宫颈癌进行超声弹性成像诊断,有利于临床下一步诊疗活动。     

超声多模态成像在宫颈癌中的研究进展

宫颈癌是女性最常见第二大妇科上皮恶性肿瘤,90%以上患者感染高危型人乳头瘤病毒是主要病因,发病率及死亡率在年轻群体中呈升高趋势.临床常将病理学检查作为宫颈癌诊断及预后评估的常用手段,但其存在有创、漏诊及感染等问题.随着影像技术的不断发展,常规超声、超声造影及超声弹性成像等在宫颈癌的诊断及预后评估方面起到了重要作用.     

弹性成像在肌骨超声中的应用

硬度属于肌腱、肌肉和神经等软组织的力学特性,当发生肌腱病或撕裂时,组织的力学特性会随之变化。近年来弹性成像在肌腱、肌肉和神经等软组织病变的诊断、鉴别诊断以及疗效随访中的应用日益增多。本文就弹性成像在肌骨超声中的应用现状和前景做一述评。     

宫颈癌超声弹性成像特征及诊断价值分析

目的 分析宫颈癌的超声弹性成像特征,探讨其诊断价值。方法 选取于我院就诊的83例宫颈癌患者（宫颈癌组）和80例慢性宫颈炎患者（宫颈良性病变组）,均行超声弹性成像检查,比较两组应变率比值的差异;绘制受试者工作特征（ROC）曲线分析应变率比值对宫颈癌的诊断效能。进一步将宫颈癌患者根据不同病灶大小、浸润深度、病理类型及有无淋巴结转移分组,比较各亚组应变率比值的差异。结果 宫颈癌组与宫颈良性病变组应变率比值分别为3.79±1.13、2.41±0.95,差异有统计学意义（t=6.157,P<0.05）。ROC曲线分析显示,应变率比值诊断宫颈癌的截断值为3.15时,其灵敏度、特异度、准确率、曲线下面积分别为72.9%、81.9%、78.5%、0.86。不同类型宫颈癌患者超声弹性成像检查结果比较：(1)根据病灶大小分为最大径≤3 cm者47例和最大径>3 cm者36例,应变率比值分别为3.41±1.01和4.29±1.09,差异有统计学意义（t=3.309,P<0.05）;(2)根据浸润深度分为浸润深度≤1/2者50例和>1/2者33例,应变率比值分别为3.43±0.82和4...     

实时超声弹性成像技术在宫颈癌的应用研究

目的 探讨助力式及声力式弹性成像技术在宫颈癌诊断的应用价值.方法 应用助力式弹性成像技术(ETE)及声触诊组织量化技术(VTQ)检测44例宫颈癌患者病灶及50例正常宫颈,记录图像及测量相关数值进行分析统计.结果 ETE诊断宫颈癌的敏感度88.6％,特异度94％;宫颈癌VTQ均值(2.68±0.49) m/s,明显大于正常宫颈VTQ均值(1.53±0.47) m/s (P＜0.05).结论 ETE及VTQ检查均显示宫颈癌病变的硬度明显增加,且随着宫颈癌分期越高硬度越硬,说明弹性超声成像技术在协助宫颈癌的诊断上有应用价值.     

阴式超声弹性成像技术在宫颈癌诊断中的应用研究

目的：评估阴式超声弹性成像技术对宫颈癌的诊断价值。方法选取我院2009年8月至2010年11月妇科患者共92例,行经阴道二维超声检查及实时组织弹性成像,对宫颈组织图像进行采集、评分,并与病理结果对照,分析宫颈良、恶性病变的超声弹性成像特点。结果（1）正常宫颈、宫颈良性病变、宫颈上皮内瘤变（ CIN）组间弹性图像评分差异无统计学意义（ P＞0.05）,三者与宫颈癌组弹性图像评分差异均有统计学意义（P＜0.05）;（2）正常宫颈、宫颈良性病变、CIN弹性评分多为1～3分,宫颈癌弹性评分多为4～5分;（3）经阴道二维超声检查诊断宫颈癌的符合率为59.4％,实时组织超声弹性成像对宫颈癌的诊断符合率为84.4％;（4）两名医师分别对弹性图像评分的Kappa值为0.82,一致性较高。结论实时组织弹性成像为宫颈癌的诊断提供了方便、无创的新方法,有助于良、恶性病变的鉴别,是诊断宫颈癌的一项重要检查方法;与二维超声相结合可提高超声对宫颈癌的诊断率,但对于宫颈原位癌和早期镜下浸润癌诊断价值有限。     

经阴道实时超声弹性成像技术在宫颈癌及癌前病变鉴别诊断中的应用价值探讨

目的探讨经阴道实时超声弹性成像技术在宫颈癌及癌前病变鉴别诊断中的应用价值。方法回顾性分析2018年5月至2019年6月我院收治且经手术或宫颈活检确诊的62例宫颈癌、60例宫颈癌前病变患者的临床资料,同期纳入58例宫颈正常体检者作为对照组。比较三组超声弹性成像评分、超声弹性成像表现情况,并分析不同截断值下超声弹性成像评分诊断宫颈癌的敏感性、特异性及准确性。结果宫颈癌组超声弹性成像评分为3、4、5分比例、应变率比值均显著高于癌前病变组(P<0.01),且宫颈癌组评分为3、4、5分比例亦高于对照组(P<0.01);将评分≥3分作为截断值时,超声弹性成像可有效提高宫颈癌的诊断敏感性、特异性及准确性,其诊断敏感性、特异性及准确性分别为93.55%、91.53%、92.22%;且超声弹性成像诊断宫颈癌病灶长径、横径及前后径与手术结果比较差异无统计学意义(P>0.05)。结论经阴道实时超声弹性成像技术可有效鉴别诊断宫颈癌与宫颈癌前病变,能准确评估病变大小,临床应用价值较高,可作为早期诊断宫颈癌的一种无创手段。     

超声弹性成像在乳腺疾病中的初步应用

目的探讨超声弹性成像对乳腺疾病的诊断价值。方法分析28例(31个病灶)乳腺疾病的超声弹性图表现,将图像分为0~V级,并与病理结果作对比。结果良性病变以0～II级多见,而恶性病变以III~V级多见。结论超声弹性成像对乳腺疾病的诊断提供另一种新指标。     

Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma

BACKGROUND Cervical lymph node metastasis in papillary thyroid carcinoma(PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients; however, it is not accurate in determining lymph node metastasis.AIM To evaluate the value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in PTC.METHODS A total of 94 patients with PTC were recruited. According to pathological results,lymph nodes were divided into two groups: metastatic group(n = 50) and reactive group(n = 63). The routine ultrasound findings, contrast-enhanced ultrasound and elastography data were recorded and compared. Logistic regression was used to generate predictive probability distributions for the diagnosis of lymph node metastasis with different indicators. Receiver operating characteristic curve analysis was used to test the efficacy of contrast-enhanced ultrasound combined with elastography based on routine ultrasound in evaluating PTC cervical lymph node metastasis.RESULTS The ratio of long diameter/short diameter(L/S) ≤ 2, irregular marginal morphology, missing lymphatic portal, peripheral or mixed blood flow distribution, peak intensity(PI), non-uniform contrast distribution and elasticity score in the metastatic group were significantly higher than those in the reactive group(P < 0.05). L/S ratio, missing lymphatic portal, PI and elasticity score had a significant influence on the occurrence of PTC cervical lymph node metastasis(P< 0.05). Furthermore, the area under the curve(AUC) for lymph node metastasis diagnosed using the combination of PI ratio, elasticity score, missing lymphatic portal and LS was 0.936, which was significantly higher than the AUC for PI ratio alone. The difference was statistically significant(P < 0.05). The fitting equation for the combined diagnosis was logit(P) =-12.341 + 1.482 × L/S ratio + 3.529 ×missing lymphatic portal + 0.392 × PI + 3.288 × elasticity score.CONCLUSION Based on the gray-scale ultrasound, the combination of contrast-enhanced ultrasound and elastography can accurately assess PTC cervical lymph node metastasis.     

甲状腺超声弹性成像结合颈部淋巴结彩超探查在诊断甲状腺良恶性病变中的应用

目的 探讨甲状腺超声弹性成像结合颈部淋巴结彩超探查在诊断甲状腺良恶性病变中的应用价值。 方法 收集来我院进行甲状腺弹性成像检查并检出颈部淋巴结的95例患者资料,共119个结节病灶,所有病例经外科手术或超声引导下穿刺活检确诊,应用超声弹性成像技术结合颈部淋巴结探查判断甲状腺结节的良恶性,并与病理诊断进行对比研究,评价此方法的诊断价值。 结果 甲状腺超声弹性成像结合颈部淋巴结彩超探查诊断弹性3分并淋巴结肿大的甲状腺结节灵敏度80%,特异度91.7%,诊断弹性4分并淋巴结肿大的结节灵敏度94.1%,特异度75%,诊断弹性5分并淋巴结肿大的结节灵敏度94.7%,特异度100%,与单纯的甲状腺弹性评分相比较,对评分3分、5分结节灵敏度及特异度明显提高,对评分4分的结节灵敏度明显提高(P<0.01)。结论 将弹性超声技术与颈部淋巴结探查相结合,可明显提高甲状腺结节良恶性病变诊断的准确性,具有广阔的临床应用前景。     

E-cervix 弹性成像评估足月妊娠宫颈成熟度的临床价值

目的 探讨E-cervix弹性成像技术评估宫颈成熟度及预测阴道分娩的临床价值。方法 选取在我院生产的87例足月孕妇,根据分娩情况分为顺产组（61例）和剖宫产组（26例）。经阴道超声检查,应用E-cervix弹性成像技术测量宫颈弹性参数,包括硬度比值（HR）、弹性对比指数（ECI）、宫颈内外口应变值（IOS、EOS）及宫颈内外口应变比值（IOS/EOS）;均行Bishop评分,测量其宫颈长度。比较两组律宫缩前后宫颈各参数的差异,绘制受试者工作特征（ROC）曲线分析宫颈各参数预测阴道分娩的截断值及其效能。结果 两组Bishop评分、HR、IOS、EOS比较差异均有统计学意义（均P＜0.05）,宫颈长度、ECI、IOS/EOS比较差异均无统计学意义。其中18例孕妇在规律宫缩开始及宫颈扩张之间进行了再次评估,仅顺产组在规律宫缩前后HR、IOS、EOS比较差异均有统计学意义（均P＜0.05）。ROC曲线结果显示,HR预测阴道分娩效能最佳,AUC为0.84,截断值为51.94%,优于宫颈长度及Bishop评分。结论 E-cervix弹性成像技术可较为客观、便捷、准确地反映孕晚期宫颈的变化情况,对临床评估宫颈成熟度有一定价值。     

甲状腺乳头状癌颈部淋巴结转移的超声检查方法

甲状腺乳头状癌（Papillary thyroid carcinoma, PTC）作为惰性内分泌肿瘤,发病率及检出率日益增高,其发生颈部淋巴结转移(Cervical lymph node metastasis, CLNM)率高达20-80%。超声诊断作为最基础的影像检查对中央区CLNM的检出有着重要地位。但由于超声特征存在假阴性,或者超声技术本身存在局限性,仍有转移的淋巴结在术前未能及时发现,这将影响外科手术术式的选择以及预后的评估。因此选择适合的超声诊断方式至关重要。本文即对目前几种常用的评估PTC患者CLNM的超声诊断方法的应用进展做出综述。     

实时组织弹性成像与常规超声诊断甲状腺癌术后颈部淋巴结转移癌的对比研究

目的探讨实时组织弹性成像(RTE)与常规超声鉴别甲状腺癌术后颈部淋巴结病变的价值。方法对69例甲状腺癌术后患者行颈部淋巴结检查,常规超声观察淋巴结大小、形状、边界、内部回声、皮髓质界限及淋巴门的血流情况;RTE观察淋巴结及其周围组织。113枚病变淋巴结均经活检手术病理证实。结果本组非转移性淋巴结常规超声评分多在5～6分(Ⅰ～Ⅱ级),甲状腺癌术后颈部淋巴结转移常规超声评分多在7～10分(Ⅲ～Ⅴ级)。RTE鉴别甲状腺癌术后颈部淋巴结病变的准确性、敏感性、特异性、阳性预测值、阴性预测值及Kappa值分别为90.6%、86.7%、89.2%、92.0%、75.9%及0.91,常规超声的准确性、敏感性、特异性、阳性预测值、阴性预测值及Kappa值分别为80.1%、90.1%、59.5%、81.0%、51.7%及0.72。RTE的诊断一致性较常规超声好。结论 RTE具有简便、准确的诊断一致性的特点,有助于甲状腺癌术后复查时颈部淋巴结转移情况的鉴别诊断。     

Time-Harmonic Ultrasound elastography of the Descending Abdominal Aorta: Initial Results

Stiffening of central large vessels is considered a key pathophysiologic factor within the cardiovascular system. Current diagnostic parameters such as pulse wave velocity (PWV) indirectly measure aortic stiffness, a hallmark of coronary diseases. The aim of the present study was to perform elastography of the proximal abdominal aorta based on externally induced time-harmonic shear waves. Experiments were performed in 30 healthy volunteers (25 young, 5 old, >50 y) and 5 patients with longstanding hypertension (PWV >10 m/s). B-Mode-guided sonographic time-harmonic elastography was used for measurement of externally induced shear waves at 30-Hz vibration frequency. Thirty-hertz shear wave amplitudes (SWAs) within the abdominal aorta were measured and displayed in real time and processed offline for differences in SWA between systole and diastole (ΔSWA). Data were analyzed using the Kruskal–Wallis test and receiver operating characteristic curve analysis. The change in SWA over the cardiac cycle was reduced significantly in all patients as assessed with ΔSWA (volunteers: mean = 10 ± 5 μm, patients: mean = 4 ± 1 μm; p < 0.001). The best separation of healthy volunteers from patients was obtained with a ΔSWA threshold of 4.7 μm, resulting in a sensitivity of 0.9 and a specificity of 1.0, with an overall area under the curve of 0.96. Time harmonic elastography of the abdominal aorta is feasible and shows promise for the exploitation of time-varying shear wave amplitudes as a diagnostic marker for aortic wall stiffening. Patients with elevated PWVs suggesting increased aortic wall stiffness were best identified by ΔSWA—a parameter that could be related to the ability of the vessel walls to distend on passages of the pulse wave.     

经阴道超高速剪切波弹性成像技术定量评价宫颈癌及癌前病变

目的 探讨经阴道超高速剪切波弹性成像技术评价宫颈癌前病变及宫颈癌的价值。方法 对150例宫颈病变患者（150个病灶）行经阴道超高速剪切波弹性成像检查,获得宫颈癌及癌前病变的弹性模量最大值和平均值,以病理为金标准,绘制ROC曲线以评价弹性参数诊断宫颈癌的诊断效能。结果 病理诊断宫颈癌53例（53个病灶）,癌前病变97例（97个病灶）。弹性模量最大值、平均值诊断宫颈癌的ROC曲线下面积分别为0.91、0.78（Z=3.53,P<0.05）。当弹性模量最大值和平均值分别以32.38 kPa、30.16 kPa作为诊断截断值时,诊断宫颈癌的敏感度、特异度、准确率分别为86.79%（46/53）,90.72%（88/97）,89.33%（134/150）和66.04%（35/53）,80.41%（78/97）,75.33%（113/150）。结论 经阴道超高速剪切波弹性成像技术诊断宫颈癌有重要的价值,病灶的弹性模量最大值对宫颈癌的诊断价值大于弹性模量平均值。     

进展期结肠癌的超声诊断

目的 评估结肠癌的超声诊断价值。材料对５０例此例病人做回顾性研究。方法 经腹部常规超声探测。结果 超声显示假肾性或分布不匀的癌物质图像。所有病例均经过手术和病理验证。结肠的超声诊断率为９１．５％。结论 对于结肠癌病人应进行手术前常规超声探测,因为这样经济,易于操作,同时以病人的年龄及身体状况限制较小。     

A pilot study evaluating real-time shear wave ultrasound elastography of miscellaneous non-nodal neck masses in a routine head and neck ultrasound clinic

A pilot study was performed to evaluate shear wave ultrasound elastography (SWE) for miscellaneous non-nodal/salivary/thyroid neck lesions. Forty-six lesions undergoing conventional sonography also underwent SWE. Elastic moduli from the stiffest areas in lesions were correlated with diagnosis. Forty lesions were benign (9 lipomas, 8 lymphatic/venous vascular malformations, 7 thyroglossal duct cysts, 4 branchial cleft cysts, 4 abscesses/phlegmons, 3 neurogenic tumors and 1 each of paraganglioma, sebaceous cyst, pseudotumor, hypertrophic scar, ranula) and 6 were malignant (1 malignant fibrous histiocytoma, 2 primary squamous cell carcinomas and 3 intramuscular metastases [2 squamous cell carcinomas, 1 malignant melanoma]).Median stiffness of malignant lesions (226.4 kPa, range 55.6 to 300.0) was higher than benign lesions (28.3 kPa, range 4.0 to 300.0) (p < 0.001). SWE cut-off with highest accuracy (174.4 kPa) achieved 83.3% sensitivity and 97.5% specificity, and the cut-off with 100% sensitivity (55.6 kPa) achieved 75% specificity. All malignant lesions were suspected on conventional sonography. The preliminary data indicate that SWE is feasible for miscellaneous neck lesions. SWE would not have altered management in terms of detecting undisclosed malignancies, although as a quantitative technique, it may increase the diagnostic confidence of less experienced operators performing head and neck ultrasound.     

Real-time qualitative ultrasound elastography of cervical lymph nodes in routine clinical practice: interobserver agreement and correlation with malignancy

To evaluate real-time qualitative ultrasound (US) elastography for cervical lymphadenopathy in routine clinical practice, 74 nodes (37 malignant, 37 benign) in 74 patients undergoing sonography underwent US elastography prior to fine needle aspiration for cytology. Dynamic cine loops of elasticity imaging displayed using a chromatic-scale were qualitatively scored by three independent observers for the proportion of stiff areas from ES1-4 (soft to stiff). There was fair to good interobserver agreement as indicated by weighted kappa (κ) statistic from 0.374 to 0.738. Median ES for benign and malignant nodes were 2 and 3 respectively. ES was higher in malignant nodes (p = 0.0003-0.0049, Mann Whitney U tests) although areas under receiver operating characteristic curves (0.68-0.74) indicated suboptimal discrimination. The optimal discriminatory cut-off, ES > 2, achieved only 62.2% sensitivity, 83.8% specificity and 73% accuracy for malignancy. Improvements in reliability and accuracy of real-time qualitative ultrasound elastography are required for it to be adopted into routine clinical practice.