超声在肝多房棘球蚴病诊疗中的应用进展

肝多房棘球蚴病因浸润性缓慢生长,感染者早期症状不明显,就诊时往往已为晚期,预后较差.因此,肝多房棘球蚴病早期诊断尤为重要.随着超声技术不断创新和发展,肝多房棘球蚴病诊断准确率不断提高,而且超声技术在治疗、评估疗效等方面也发挥了重要作用.本文主要就超声技术在肝多房棘球蚴病诊疗中的应用进展进行综述.     

超声造影及声辐射力脉冲弹性成像技术在甲状腺结节诊断中的应用研究进展

甲状腺结节是内分泌常见的疾病之一。超声造影(contrast-enhanced ultrasound,CEUS)能提供甲状腺结节内部的微血管灌注信息,声辐射力脉冲弹性成像(acoustic radiation force impulse-imaging,ARFI)技术能反映组织内部的软硬度,两者对甲状腺良恶性结节鉴别诊断有一定价值。该文对近年来CEUS及ARFI技术在诊断甲状腺结节良恶性方面的研究进展作一综述。     

声脉冲辐射力成像技术评估肝纤维化的临床应用

目的探讨声脉冲辐射力成像技术(ARFI)评估不同程度肝纤维化的临床应用价值。方法对健康志愿者250例、肝病患者361例行ARFI检测,测量其声触诊组织量化值(VTQ),统计归纳出肝纤维化程度的增加与VTQ相关性及相应界限值。结果受检361例患者中348例行超声引导下肝脏穿刺活检并行S0～S4分期,不同时期肝纤维化VTQ平均值(m/s):S0(1.21±0.14)、S1(1.26±0.13)、S2(1.36±0.13)、S3(1.77±0.32)、S4(2.23±0.20),正常组(1.11±0.17);各组间除S0和S1期的病例组(P=0.048)并不能说明实际临床上VTQ值差异是否具有临床意义外,其余组间VTQ值差异均有统计学意义(P均<0.001);慢性肝病程度的加重,弹性参数值也随之增加,两者具有一定相关性。结论 ARFI能对肝纤维化程度进行量化分析,从而避免肝脏穿刺活检,为临床提供一种无创、操作简单、可重复性强的肝纤维化程度及疗效的评估手段。     

HER-2表达与乳腺癌超声造影及声脉冲辐射力成像表现的关联性研究

目的探讨HER-2表达水平与乳腺癌超声造影(CEUS)及声脉冲辐射力成像(ARFI)表现的关联性。方法 108例乳腺癌患者术前进行CEUS及ARFI检查,术后对其肿块进行HER-2表达水平的测定,分析HER-2表达水平与乳腺癌CEUS以及ARFI的关系。结果 (1)不同HER-2表达水平组超声造影的造影剂分布、穿支血流、超范围、灌注缺损以及TIC曲线的峰值时间、上升支斜率、曲线下面积的差异具有统计学意义(P0.05)。(2)不同HER-2表达水平组的VTQ表现上差异有统计学意义(P0.05)。(3)CEUS的增强强度、峰值强度及ARFI的VTI技术与HER-2表达水平的比较上,差异无统计学意义(P0.05)。结论乳腺癌CEUS及ARFI表现与HER-2表达水平之间存在一定的关联性,主要反映在灌注缺损、穿支血流、VTQ等。     

瞬时弹性成像和声脉冲辐射力成像技术诊断慢性乙型肝炎肝纤维化的价值

目的 瞬时弹性成像和声脉冲辐射力成像技术(ARFI)对慢性乙型肝炎患者肝纤维化进行诊断,并评价诊断表现.方法 随机选择2015年3月至2019年7月之间联勤保障部队第九○四医院入院治疗的慢性乙型肝炎患者152例,男性93例,女性59例,平均年龄(44.3±9.1)岁.患者符合慢性乙型肝炎防治指南(2015年版本)诊断要...     

MRI用于肝多房棘球蚴病铁沉积评估的初步研究

目的　探索MRI联合血清铁蛋白用于肝多房棘球蚴病患者肝脏铁沉积评估的效果。方法　对96例肝多房棘球蚴病确诊患者和30例健康志愿者行常规1.5T 磁共振扫描,并采集相关实验室检查资料,分析肝脏/肌肉信号强度比、血清铁蛋白水平、肝功能指标及其相关性等。结果　肝多房棘球蚴病患者与健康志愿者肝脏/肌肉信号强度比分别为（1.95 ± 0.57）和（2.22 ± 0.28）,差异有统计学意义（t = 2.022,P < 0.05）,且肝多房棘球蚴病患者肝脏/肌肉信号强度比与血清铁蛋白水平呈中度负相关( rs = –0.446,P < 0.01)。 结论　肝多房棘球蚴病患者肝脏内多存在异常铁沉积,而血清铁蛋白检测可辅助判断肝多房棘球蚴病患者肝脏内异常铁沉积。MRI测量的肝脏/肌肉信号强度比可作为无创性评估肝多房棘球蚴病患者肝脏铁沉积的一种方法。     

声脉冲辐射力成像技术对肝纤维化的诊断价值

肝纤维化是肝脏在多种致病因素长期作用下,肝细胞外基质成分在肝组织中大量沉积,进而引起肝内结缔组织过度增生,最终演变至肝硬化;肝纤维化是肝硬化的早期阶段,组织学病理表现为肝细胞炎症坏死、局部网状支架塌陷,融合而形成胶原纤维。肝纤维化阶段病因明确及时治疗,往往可以逆转,一旦病情持续进展,往往演变成假小叶,最终发展至肝硬化。     

超声表现诊断肝多房棘球蚴病的效果评价及因素分析

目的 了解肝多房棘球蚴病(HAE)病灶不同的超声表现,为提高HAE在常规超声下的检出率和诊断准确率提供可靠的依据。方法 将2018年1月至2021年4月于新疆医科大学第一附属医院行常规超声检查并经手术病理确诊为HAE的患者作为研究对象,收集研究对象性别、年龄、民族、超声影像学分型结果等相关资料。选取研究对象超声原始图像中HAE病灶最清晰完整的图像进行分析,记录病灶的超声表现(病灶位置、大小、边界和形态、实性部分回声、钙化情况、液化坏死情况、血流信号、胆管和血管的侵犯等)并赋值,多发病灶分开描述;结合手术后病理结果判定病灶超声诊断符合情况。对HAE病灶的各种超声表现进行单因素分析,将单因素分析有统计学意义的因素设为自变量,病灶超声诊断符合情况设为因变量,进行logistic多因素分析,建立回归模型并用受试者工作特征(ROC)曲线验证;采用logistic多因素分析筛选出的结果构建列线图,采用ROC曲线、校准曲线、决策分析曲线评估其性能。结果 纳入研究的HAE患者数为141例,年龄分布在9～65岁,平均年龄(37.4±13.6)岁;男性71例,女性70例;藏族患者87例,占61.7%。14...     

肝多房棘球蚴病的综合治疗现状和进展

多房棘球蚴病是一种危害严重的人兽共患寄生虫病。根治性手术切除是目前治疗肝多房棘球蚴病的首选方法，难以根治性切除的晚期肝多房棘球蚴病可行包括姑息性手术联合药物治疗、肝脏移植、单纯药物治疗、射频微波消融术等治疗手段。本文就肝多房棘球蚴病综合治疗现状和进展进行综述。     

肝多房棘球蚴病的综合治疗现状和进展

多房棘球蚴病是一种危害严重的人兽共患寄生虫病。根治性手术切除是目前治疗肝多房棘球蚴病的首选方法,难以根治性切除的晚期肝多房棘球蚴病可行包括姑息性手术联合药物治疗、肝脏移植、单纯药物治疗、射频微波消融术等治疗手段。本文就肝多房棘球蚴病综合治疗现状和进展进行综述。     

肝豆状核变性患者肝脏剪切波速度的变化

目的 采用超声声辐射力脉冲成像(ARFI)技术检测肝豆状核变性(HLD)患者肝脏剪切波速度(SWV)的变化.方法 2017年6月～2019年6月我院收治的38例HLD患者、49例非HLD的慢性肝脏疾病患者和56例健康体检者,采用超声观察肝脏表现,并应用ARFI技术测量肝脏SWV.采用原子吸收光谱法测定血清铜离子(Cu2...     

声脉冲辐射力弹性成像技术评估周围型肺部肿瘤的可行性研究

目的探讨声脉冲辐射力弹性成像技术(acoustic radiation force impulse,ARFI)用于评价周围型肺部肿瘤的可行性。方法使用ARFI技术,测量肺部肿块剪切波速度值(SWV),统计分析不同病理类型肿瘤之间SWV的差异,同时采用roc曲线评价SWV对周围型肺癌良恶性的鉴别诊断价值。结果良恶性病灶SWV比较,差异具有统计学意义,恶性组中肺腺癌和肺鳞癌SWV比较,差异没有统计学意义。以SWV=1.2 m/s作为鉴别良恶性病变截断点。结论声脉冲辐射力弹性成像技术对于评估周围型肺部肿块的良恶性具有可行性,展现了良好的应用前景。     

Factors correlating with acoustic radiation force impulse elastography in chronic hepatitis C

AIM: To investigate the factors other than fibrosis stage correlating with acoustic radiation force impulse(ARFI) elastograpy in chronic hepatitis C. METHODS: ARFI elastograpy was performed in 108 consecutive patients with chronic hepatitis C who underwent a liver biopsy. The proportion of fibrosis area in the biopsy specimens was measured by computerassisted morphometric image analysis. RESULTS: ARFI correlated significantly with fibrosis stage(β = 0.1865, P < 0.0001) and hyaluronic acid levels(β = 0.0008, P = 0.0039) in all patients by multiple regression analysis. Fibrosis area correlated significantly with ARFI by Spearman’s rank correlation test but not by multiple regression analysis. ARFI correlated significantly with body mass index(BMI)(β =-0.0334, P = 0.0001) in F 0 or F 1, with γ-glutamyltranspeptidase levels(β = 0.0048, P = 0.0012) in F 2, and with fibrosis stage(β = 0.2921, P = 0.0044) and hyaluronic acid levels(β = 0.0012, P = 0.0025) in F 3 or F 4. The ARFI cutoff value was 1.28 m/s for F ≥ 2, 1.44 m/s for F ≥ 3, and 1.73 m/s for F 4. CONCLUSION: ARFI correlated with fibrosis stage and hyaluronic acid but not with inflammation. ARFI was affected by BMI, γ-glutamyltranspeptidase, and hyaluronic acid in each fibrosis stage.     

Evaluation of acoustic radiation force impulse imaging for determination of liver stiffness using transient elastography as a reference

AIM: To evaluate cut-off values and performance of acoustic radiation force impulse imaging (ARFI) using transient elastography [FibroScan^© (FS)] as a reference.METHODS: Six hundred and six patients were enrolled in this study. All patients underwent liver stiffness measurement with FS (FS-LS) and ARFI (with shear wave velocity quantification; ARFI-SWV) and the performance of ARFI in comparison to FS was determined. Sixty-eight patients underwent liver biopsy.RESULTS: Significantly higher success rates for the determination of liver stiffness were found using ARFI as compared to FS [604/606 (99.7%) vs 482/606 (79.5%), P < 0.001]. ARFI-SWV correlated significantly with FS-LS (r = 0.920, P < 0.001). ARFI-SWV increased significantly with the stage of fibrosis (1.09 ± 0.13 m/s for patients with no significant fibrosis (FS-LS < 7.6 kPa); 1.46 ± 0.27 m/s for patients with significant liver fibrosis (7.6 < FS-LS ≤ 13.0 kPa); and 2.55 ± 0.77 m/s for patients with liver cirrhosis (FS-LS > 13.0 kPa)). ARFI-SWV cut-off values were identified for no significant fibrosis (1.29 m/s; sensitivity 91.4% and specificity 92.6%) and for liver cirrhosis (1.60 m/s; sensitivity 92.3% and specificity 96.5%). The optimal cut-off value for predicting liver fibrosis (F ≥ 2) was 1.32 m/s (sensitivity 87.0% and specificity 80.0%) and for liver cirrhosis (F4) 1.62 m/s (sensitivity 100% and specificity 85.7%), for patients who underwent liver biopsy. An excellent inter-and intraobserver reproducibility was observed for ARFI-SWV determinations.CONCLUSION: An ARFI-SWV cut-off value of 1.29 m/s seems to be optimal for patients with no significant liver fibrosis and 1.60 m/s for patients with liver cirrhosis.     

Renal tissue elasticity by acoustic radiation force impulse: A prospective study of healthy kidney donors

Background:Some studies reported the correlations between renal parenchymal stiffness measured by transient elastography or acoustic radiation force impulse (ARFI) and the extent of interstitial fibrosis. This study was prospectively designed to evaluate the correlation between clinical, histological findings and the kidney shear wave velocity (SWV, m/s) assessed by ARFI elastography to identify factors affecting the kidney SWV in normal patients.Methods:Seventy-three adult living kidney transplantation donors were enrolled in our center between September 2010 and January 2013. Before transplantation, all donors were evaluated by ARFI elastography to identify the range of SWV in kidneys. Time-zero biopsies were performed on all graft kidneys before implantation.Results:Mean age of donors was 42.0 ± 11.3 years. The mean SWV and depth were 2.21 ± 0.58 m/s and 5.37 ± 1.06 cm. All histological findings showed mild degree of the Banff score, only grade I. In univariate analyses, the SWV was not associated with all histological parameters. Age (r = -0.274, P = .019) diastolic blood pressure (DBP, r = -0.255, P = .030) and depth for SWV measurement (r = -0.345, P = .003) were significantly correlated with the SWV. In multivariate linear regression analysis, age, gender, body mass index (BMI), and depth for SWV measurement were significantly correlated with the SWV (P = .003, .005, .002, and .004, respectively).Conclusions:We demonstrated that all histological findings are not correlated with the SWV of donor kidney. Otherwise, factors influencing the kidney SWV assessed by ARFI elastography are age, gender, BMI, and depth for the SWV measurement in donors for kidney transplantation.     

Primary biliary cirrhosis degree assessment by acoustic radiation force impulse imaging and hepatic fibrosis indicators

AIM: To evaluate the assessment of primary biliary cirrhosis degree by acoustic radiation force impulse imaging(ARFI) and hepatic fibrosis indicators. METHODS: One hundred and twenty patients who developed liver cirrhosis secondary to primary biliary cirrhosis were selected as the observation group, with the degree of patient liver cirrhosis graded by Child-Pugh(CP) score. Sixty healthy individuals were selected as the control group. The four indicators of hepatic fibrosis were detected in all research objects, including hyaluronic acid(HA), laminin(LN), type Ⅲ collagen(PC Ⅲ), and type Ⅳ collagen(Ⅳ-C). The liver parenchyma hardness value(LS) was then measured by ARFI technique. LS and the four indicators of liver fibrosis(HA, LN, PC Ⅲ, and Ⅳ-C) were observed in different grade CP scores. The diagnostic value of LS and the four indicators of liver fibrosis in determining liver cirrhosis degree with PBC, whether used alone or in combination, were analyzed by receiver operating characteristic(ROC) curve.RESULTS: LS and the four indicators of liver fibrosis within the three classes(A, B, and C) of CP scores in the observation group were higher than in the control group, with C class B class A class; the differences were statistically significant(P 0.01). Although AUC values of LS within the three classes of CP scores were higher than in the four indicators of liver fibrosis, sensitivity and specificity were unstable. The ROC curves of LS combined with the four indicators of liver fibrosis revealed that: AUC and sensitivity in all indicators combined in the A class of CP score were higher than in LS alone, albeit with slightly decreased specificity; AUC and specificity in all indicators combined in the B class of CP score were higher than in LS alone, with unchanged sensitivity; AUC values(0.967), sensitivity(97.4%), and specificity(90%) of all indicators combined in the C class of CP score were higher than in LS alone(0.936, 92.1%, 83.3%). CONCLUSION: The diagnostic value of PBC cirrhosis degree in liver cirrhosis degree assessment by ARFI combined with the four indicators of serum liver fibrosis is of satisfactory effectiveness and has important clinical application value.     

Liver reserve function assessment by acoustic radiation force impulse imaging

AIM: To evaluate the utility of liver reserve function by acoustic radiation force impulse (ARFI) imaging in patients with liver tumors.METHODS: Seventy-six patients with liver tumors were enrolled in this study. Serum biochemical indexes, such as aminotransferase (ALT), aspartate aminotransferase (AST), serum albumin (ALB), total bilirubin (T-Bil), and other indicators were observed. Liver stiffness (LS) was measured by ARFI imaging, measurements were repeated 10 times, and the average value of the results was taken as the final LS value. Indocyanine green (ICG) retention was performed, and ICG-K and ICG-R15 were recorded. Child-Pugh (CP) scores were carried out based on patient’s preoperative biochemical tests and physical condition. Correlations among CP scores, ICG-R15, ICG-K and LS values were observed and analyzed using either the Pearson correlation coefficient or the Spearman rank correlation coefficient. Kruskal-Wallis test was used to compare LS values of CP scores, and the receiver-operator characteristic (ROC) curve was used to analyze liver reserve function assessment accuracy.RESULTS: LS in the ICG-R15 10%-20% group was significantly higher than in the ICG-R15 < 10% group; and the difference was statistically significant (2.19 ± 0.27 vs 1.59 ± 0.32, P < 0.01). LS in the ICG-R15 > 20% group was significantly higher than in the ICG-R15 < 10% group; and the difference was statistically significant (2.92 ± 0.29 vs 1.59 ± 0.32, P < 0.01). The LS value in patients with CP class A was lower than in patients with CP class B (1.57 ± 0.34 vs 1.86 ± 0.27, P < 0.05), while the LS value in patients with CP class B was lower than in patients with CP class C (1.86 ± 0.27 vs 2.47 ± 0.33, P < 0.01). LS was positively correlated with ICG-R15 (r = 0.617, P < 0.01) and CP score (r = 0.772, P < 0.01). Meanwhile, LS was negatively correlated with ICG-K (r = -0.673, P < 0.01). AST, ALT and T-Bil were positively correlated with LS, while ALB was negatively correlated with LS (P < 0.05). The ROC curve revealed that the when the LS value was 2.34 m/s, the Youden index was at its highest point, sensitivity was 69.2% and specificity was 92.1%.CONCLUSION: For patients with liver tumors, ARFI imaging is a useful tool for assessing liver reserve function.