实时三维超声心动图诊断二尖瓣叶裂

目的 探讨实时三维超声(RT-3DE)在二尖瓣叶裂(MVC)诊断中的价值。 方法 对17例经二维超声心动图诊断MVC的患者在左心室长轴切面和二尖瓣短轴切面实施RT-3DE全容积显像,在三个方位(冠状位、矢状位、水平位)、六个方向对图像进行剖析观察,对二尖瓣瓣叶裂进行定位诊断,测量裂口宽度及长度,观察裂口与周围结构的空间位置关系。 结果 RT-3DE全容积图像可以清晰显示瓣叶裂的位置、宽度、长度及裂口宽度随心动周期的变化及其与周围腱索、主动脉瓣的空间位置关系。 结论 RT-3DE能为超声医生对MVC的诊断提供更明确的诊断依据,为心脏外科医生的手术方式的选择提供更全面的参考信息。     

磁共振DKI成像预测直肠癌TN分期、分化和脉管侵犯的应用价值

目的：探讨磁共振DKI成像技术预测直肠癌TN分期、分化和脉管侵犯的应用价值。方法：选取2017年至2019年南通市肿瘤医院住院的43例直肠癌患者，行常规MRI及DKI扫描，经后处理软件获得DKI参数，并于1周内行病灶切除及送病理检查。结果：随着T分期增加，MK值升高，各参数在各组患者间差异均有统计学意义（P<0.05），MD值组间差异无统计学意义。直肠腺癌病理分化程度越低，MD值越低，MK值越高，各组患者总体差异均有统计学意义（P<0.05）。有脉管侵犯的病例MK值较无脉管侵犯者更大，两者间差异有统计学意义（P<0.05），AUC为0.772，灵敏度为81.0%，特异度为68.7%。MK及MD值在有无淋巴结转移的直肠癌组间差异有统计学意义（P<0.05）。结论：MK值可辅助诊断直肠癌T分期情况；MK联合MD值可预测直肠癌病理分化程度。MK值可预测直肠癌周围脉管有无侵犯；MK联合MD可辅助诊断直肠癌是否发生淋巴结转移，具有更好的诊断效能。     

快速评估心脏MR左心室长轴应变及其与左心室整体纵向应变的相关性

目的 探讨快速评估左心室长轴应变（LAS）的方法及其与左心室整体纵向应变（GLS）的相关性。方法 对77名健康志愿者行心脏MR检查,于收缩末期和舒张末期分别测量二尖瓣瓣环插入点连线中点与左心室心尖的心外膜边缘的距离（方法1）、二尖瓣室间隔侧插入点与左心室心尖的心外膜边缘的距离（方法2）以及二尖瓣瓣环游离壁插入点与左心室心尖的心外膜边缘的距离（方法3）,计算3种方法的LAS值,并测量左心室心功能参数及GLS,比较3种LAS测值的差异,并分析其与GLS的相关性。取3种LAS值的均值,观察LAS及GLS与左心室射血分数（LVEF）的相关性。分析观察者间及观察者内测量上述参数的一致性。结果 3种方法所测LAS值差异无统计学意义（F=0.97,P=0.41）。方法1的LAS值与GLS呈显著正相关（r=0.86,P<0.001）,方法2的LAS值与GLS呈中度正相关（r=0.57,P<0.001）,方法3的LAS值与GLS呈较好正相关（r=0.64,P<0.001）。LAS及GLS与LVEF均呈中度负相关（r=-0.38、-0.42,P=0.04、0.02）。观察者内和观察者间一致性均好（ICC均>0.75）。结论 通过计算不同位点在心脏舒张和收缩末期相对位移的百分比可快速、简便评估LAS,且后者与GLS呈正相关。     

Ultrasound findings in perihepatitis associated with pelvic inflammatory disease.

The width of the right anterior extrarenal tissue was increased on ultrasound examination in 9 patients with perihepatitis (Fitz-Hugh-Curtis syndrome). Normal values were obtained in 72 women without detectable or known disease and were found to be between 1 mm and 5 mm (mean 1.8 mm). The 9 patients with laparoscopically verified perihepatitis who demonstrated this thickening had values ranging from 6 mm to 12 mm, (mean 7.7 mm). Although the incidence of this inflammatory thickening in perihepatitis is not known, its value is that in its ultrasonic demonstration a careful search should be made for inflammatory disease in structures related to the anterior pararenal space.     

直肠癌Miles术后会阴部切口感染的原因分析

目的：研究直肠癌术后会阴部切口感染的原因.方法：120例直肠癌患者均采用标准的Miles手术方式.A组：关闭盆底,经右下腹骶前间隙双套管负压吸引,间断夹闭尿管（5 d）的患者30例;B组：关闭盆底,经右下腹骶前间隙单管引流,间断夹闭尿管（5 d）的患者30例;C组：关闭盆底,经右下腹骶前间隙双套管负压吸引,持续开放尿管（5d）的患者30例;D组：不关闭盆底,经右下腹骶前间隙双套管负压吸引和间断夹闭尿管（5 d）的患者30例.结果：A、B、C、D组会阴部切口感染率分别为13.3％,23.3％,19.7％和20.0％.A组与B组、A组与C组、A组与D组比较,差异均有统计学意义（x2=1.105,P＜0.05）.结论：会阴部切口感染与术后骶尾前间隙积液引流是否通畅、骶尾前间隙残腔是否能及时闭合、盆底腹膜是否关闭均有关.     

Water Enema Transvaginal Ultrasound for Local Staging of Stenotic Rectal Carcinoma

Background: To increase the value of ultrasound in the staging of stenotic rectal carcinoma. Methods: Water enema transvaginal ultrasound (WE-TVUS) was performed in 21 consecutive female patients with severely stenotic rectal tumor (adenocarcinoma histologically proved) who were selected on the basis of clinical and double-contrast barium enema study. All patients underwent surgery, and histopathologic correlation was possible. Results: Rectal tumors were well demonstrated in all cases, and a good correlation between perirectal neoplastic infiltration, and lymph node involvement at WE-TVUS and histologic data were observed. Compared with histologic results, WE-TVUS correctly staged 19 of 21 tumors (overall accuracy = 90%); one case was understaged (T4 as T3) and one case was overstaged (T3 as T4). In the detection of lymph node involvement, the sensitivity was 50% and specificity was 78%. Conclusion: WE-TVUS is a potentially valuable technique for defining the local extension of severely stenotic rectal tumors in women. Received: 10 December 1997/Accepted: 28 January 1998     

2型糖尿病周围神经病变患者正中神经剪切波弹性成像特征

目的 探讨2型糖尿病周围神经病变（DPN）患者正中神经（MN）的剪切波弹性成像（SWE）特征。方法 收集2型糖尿病患者120例,根据电生理检查结果和临床症状,分为DPN组（n=60）及非DPN组（n=60）;选取同期60名健康志愿者为对照组。采用高频超声和SWE检查MN,测量其宽径、厚径、周长、横截面积及杨氏模量值,比较3组上述参数的差异,观察3组弹性图像颜色变化。绘制ROC曲线,分析杨氏模量值鉴别诊断DPN与非DPN的敏感度及特异度。结果 3组MN厚径的差异无统计学意义（P>0.05）;DPN组MN的宽径、横截面积、周长、杨氏模量值均大于非DPN组及对照组（P均<0.05）;非DPN组MN的杨氏模量值大于对照组（P<0.001）,但2组MN的宽径、横截面积、周长的差异均无统计学意义（P均>0.05）。弹性图像上,DPN组表现为黄绿色,非DPN组表现为绿蓝色,对照组表现为蓝色。杨氏模量值阈值为61.25 kPa时,ROC曲线下面积为0.822（P<0.001）,鉴别诊断DPN与非DPN的敏感度、特异度分别为78.30%、70.00%。结论 2型糖尿病合并DPN患者的杨氏模量值大于非DPN患者,以杨氏模量值鉴别诊断DPN与非DPN有助于早期诊断2型糖尿病合并DPN。     

利用血流剪应力定量分析软件评价颈动脉粥样硬化

目的 应用血流剪应力定量分析软件,与传统Hagen-Poiseuille公式法进行比较,分析健康颈总动脉与内中膜增厚处颈总动脉壁面剪应力（WSS）,探讨血流剪应力定量分析软件评估颈动脉WSS值的价值。方法 运用剪应力定量分析软件分析50名健康体检者（健康组）和50例颈总动脉内中膜增厚（厚度为1.0~1.3 mm）患者（增厚组）颈总动脉多普勒血流图像,以Matlab为软件平台绘制血流剪应力二维空间分布图、三维空间分布图及剪应力融合图像,计算颈总动脉WSS分布均值（WSS值）,并与Hagen-Poiseuille公式计算结果进行比较。结果 健康组血流剪应力定量分析软件计算所得颈总动脉WSS值为（6.91±1.20）dyne/cm²,Hagen-Poiseuille公式法结果为（7.13±1.24）dyne/cm²（P>0.05）;增厚组两种方法计算得出的颈总动脉WSS值分别为（2.87±0.59）dyne/cm²、（3.12±0.65）dyne/cm²,差异无统计学意义（P>0.05）,均显著低于健康组（P<0.05）。结论 利用血流剪应力定量分析软件可以准确、快捷地评估动脉血流WSS。     

血流向量成像技术分析高血压合并主动脉瓣关闭不全的能量损耗

目的 采用血流向量成像技术(VFM)探讨高血压(HP)和主动脉瓣关闭不全(AR)患者的左心室舒张末期平均能量损耗(AELEDLV)对左心房前后径及室间隔厚度的影响。方法 将患者分为正常组、AR组、HP组及HP+AR组,每组15例。采用VFM分析各组心电图R波顶点四腔心的AELEDLV,测量舒张期末室间隔厚度和左心房前后径。结果 HP+AR组AELEDLV显著高于HP组、AR组及正常组(P均<0.01),HP组及AR组高于正常组(P<0.01);AELEDLV、左心房前后径及室间隔厚度均为HP+AR组> HP组> AR组>正常组,AELEDLV与左心房前后径呈正相关(r=0.98,P=0.025)。结论 AR及HP均可增加AELEDLV,HP合并AR可进一步增加AELEDLV,AELEDLV的增加可能是导致左心房增大及室间隔增厚的重要因素之一。     

Transrectal ultrasound in the diagnosis and management of inflammatory bowel disease

BACKGROUND AND STUDY AIMS: To aim of the present study was to determine the value of transrectal ultrasonography (TRUS) in the assessment of disease activity in ulcerative colitis patients, and in differentiating between mucosal inflammation and transmural inflammation. PATIENTS AND METHODS: TRUS examinations were used to study 30 control individuals and 76 patients with inflammatory bowel disease, including 50 cases of ulcerative colitis and 26 of Crohn's disease. A rigid linear endorectal probe was used to examine the rectal wall. RESULTS: In the 30 control individuals, the rectal wall showed five layers, with a mean total diameter of 2.6 mm. There were significant differences between patients with quiescent ulcerative colitis, active ulcerative colitis, and control individuals with regard to the total rectal wall thickness (P<0.001), submucosal thickness (P<0.001) and mucosal thickness (P<0.001). Using cut-off values, differentiation between active ulcerative colitis and remission ulcerative colitis was found to be 100% specific and 73 % sensitive for submucosal thicknesses. TRUS revealed a 100% specificity in differentiating between remission ulcerative colitis and control cases based on the total rectal wall thickness, submucosal, and mucosal thicknesses. In the differential diagnosis of active and remission ulcerative colitis, an increase in submucosal wall thickness and the existence of arterial and venous capillary flow in the submucosa were found to be specific and more sensitive than the other parameters. TRUS examination revealed transmural inflammation in 21 of the 26 Crohn's disease patients, and mucosal inflammation in all 50 of the ulcerative colitis patients. CONCLUSION: TRUS is a reliable and easy method of assessing ulcerative colitis activity and differentiating between rectal diseases.     

原发性骶前肿瘤26例临床诊断与治疗

目的探讨原发性骶前肿瘤的诊断与手术治疗。方法分析1993年4月至2005年10月我院收治26例原发性骶前肿瘤的诊断和治疗情况,结合文献进行讨论。结果术前诊断主要依靠直肠指诊、B超、CT等相关检查。手术方法有:经骶尾部切除12例,经腹切除8例,经腹骶尾部联合入路切除6例。其中合并切除直肠2例,肿瘤完整切除20例,部分切除5例,未切除1例。并发症有出血3例、直肠损伤2例、术后骶前感染2例、脓肿形成1例。结论对于原发性骶前肿瘤均应手术完整切除肿瘤,合理选择手术径路是切除肿瘤的关键。     

Post-treatment fistulas in patients with rectal cancer: MRI with rectal superparamagnetic contrast agent

MRI is the standard modality in the pre- and post-treatment evaluation of patients with rectal cancer, particularly in those cases with locally advanced disease. We routinely employ a superparamagnetic iron oxide (SPIO) contrast enema to distend the rectal lumen and achieve maximal tumor-to-lumen contrast gradient. This practice also allowed the identification of a fistula in 24% of patients treated for rectal cancer. Contrast agent-related low intensity signal could be seen filling the tract and eventually opacifying surrounding organs (i.e., vagina) or collections (i.e., presacral abscess). Fistula formation after radiochemotherapy and surgery for rectal cancer is not uncommon. MRI with dark lumen contrast enema allows an effective demonstration of this complication in a high number of patients.     

超声内镜联合Photoshop软件在不同级别直肠神经内分泌肿瘤中的鉴别应用

目的 探讨Photoshop(PS)软件联合超声内镜(EUS)在不同级别直肠神经内分泌肿瘤(NENs)中的应用价值.方法 选择温州市三大医院140例经病理及免疫组化确诊且均行EUS的NENs患者,收集相关临床资料和EUS图片,根据肿瘤的病理核分裂象及免疫组化Ki-67指数,将直肠NENs分为低级别组(G1组)和中级别组...     

Cardiac myocardial perfusion imaging using dual source computed tomography

Purpose of this study was the evaluation of the thoracic aortic wall thickness as a potential identifier of patients at increased risk for future cardiac events. Thoracic aortic wall thickness was measured with MDCT in 160 patients. The CT-scans were implemented as non-invasive coronary angiography studies. Relationships between aortic wall thickness, sex, age, major risk factors and atherosclerotic plaque burden of the coronary arteries were explored. Higher values of maximum aortic wall thickness of the descending aorta (women P = 0.02, men P = 0.01) were found in patients with coronary atherosclerosis, compared to patients with same gender but excluded atherosclerosis. Aortic wall thickness of the mid-portion of the descending aorta of 3.0 mm is associated with coronary artery disease (CAD) with a specificity of 96.6% (sensitivity 27.5%) and a positive predictive value (PPV) of 93.3%. For patients with two or more major risk factors and a maximum wall thickness of equal or more than 2.6 mm we found a PPV of 100%. We conclude that measurements of maximum wall thickness of the descending aorta are a potential tool for detecting patients with coronary atherosclerosis. The potential effect of combining measurements of aortic wall thickness at routine chest CT studies with a possible cardiovascular screening is substantial and merits further study.     

超声数据3D打印制作二尖瓣模型的可行性

目的 探讨以3D-经食管超声心动图（TEE）为数据源，采用3D打印技术制作二尖瓣（MV）模型的可行性。方法 获取30例患者的MV 3D-TEE图像，其中MV正常、MV狭窄、MV脱垂各10例，使用铸模硅胶灌注成型法制作MV 3D模型。测量并对比3D模型及3D-TEE图像上二尖瓣前后径、前外后内侧径、瓣环周长、瓣环面积及瓣膜开放幅度，计算二者间MV上述测值的绝对差值。结果 30例3D-TEE图像均成功后处理并打印制作出MV 3D模型。3D模型与3D-TEE图像间各参数测值差异均无统计学意义（P均>0.05），且各参数测值的绝对差值均较小。结论 采用3D-TEE和3D打印技术制作MV模型可行，且具有高保真度。     

三种经胸肺部超声检查技术诊断间质性肺疾病的可重复性及一致性

目的 探讨3种经胸肺部超声检查（TLUS）技术诊断间质性肺疾病（ILD）的可重复性及一致性。方法 由2名超声科医师对40例ILD患者分别采用简化的14肋间隙扫查法、28肋间隙扫查法、72肋间隙扫查法行TLUS，对比同一医师及不同医师采用不同技术检测结果的可重复性、一致性及扫查时间。结果 同一医师和不同医师利用3种超声技术对B线评价的可重复性及一致性均较高，其中同一医师利用14肋间隙扫查法的可重复性[ICC=0.989 1，95%CI（0.977 2，0.994 8）]及一致性最高[界限宽度0.57±2.79，95%CI（-0.47，1.61）]，不同医师利用14肋间隙扫查法的可重复性[ICC=0.9795，95%CI（0.9575，0.9902）]及一致性最高[界限宽度0.70±3.77，95%CI（-0.71，2.11）]。同一医师、不同医师利用14肋间隙扫查法观察胸膜线严重程度的一致性高（Kappa值=0.948、0.895，P均<0.001）。3种超声技术扫查时间差异有统计学意义（P<0.001），其中14肋间隙扫查法时间最短，72肋间隙扫查法最长。结论 3种TLUS技术中，14肋间隙扫查法的可重复性及一致性最高，且用时最短。     

低位三管引流治疗直肠癌术后吻合口瘘的临床护理

目的总结采用低位三管引流（经肛管在直肠腔内放置2根引流管，经肛管旁途径于骶前间隙放置1根双套引流管）治疗89例直肠癌术后吻合口瘘患者的护理经验。方法1995年1月至2007年12月，对89例直肠癌一期切除吻合术后吻合口瘘患者采用低位三管引流法进行治疗及护理。结果仅1例患者进行结肠造瘘，其余患者均临床治愈；平均治愈时间为（24．8±11．4）d。结论定时冲洗低位引流管并保持引流管的通畅，辅以必要的饮食护理及心理护理是治疗取得成功的重要保证。     

合并主动脉瓣反流大动脉炎患者的超声心动图特征

研究目的：在大动脉炎（Takayasu arteritis, TA）患者中,主动脉瓣反流（aortic regurgitation, AR）被认为是一种严重的并发症,其预后通常不佳。本研究的主要目标是探讨TA患者中AR的特征和潜在危险因素。 方法：本研究纳入了2020年12月至2022年8月于复旦大学中山医院住院的TA患者196例,根据有无合并AR分为AR组（n=67）和非AR组(n=129)。回顾性收集患者人口统计学信息、临床数据以及实验室检查结果。此外,使用超声心动图来测量心脏参数,包括升主动脉壁的厚度和主动脉瓣叶的厚度。采用多因素Logistic回归分析与AR发生的危险因素;使用Pearson相关系数来探究主动脉参数与缩流颈宽度（vena contracta width, VCW）之间的关系。 结果：在AR组中,心肌肌钙蛋白T（cardiac troponin T, cTnT）和N-末端前脑钠肽（N-terminal pro-brain natriuretic peptide, NT-proBNP）水平显著高于非AR组（均P<0.001）。与非AR组相比,AR组的主动脉窦部和升主动脉显著增宽（SoVD 33.8±4.5 mm vs. 29.9±3.1 mm, P=0.001; AAoD 37.7±6.1 mm vs. 30.1±4.7 mm, P<0.001）;同时,AR组的升主动脉壁和主动脉瓣叶显著增厚（升主动脉壁厚度 3.7±1.5 mm vs. 2.4±0.6 mm, P<0.001; 主动脉瓣叶厚度 2.8±0.9 mm vs. 1.8±0.3 mm, P<0.001）。多变量 logistic 回归分析的结果表明, SoVD、AAoD和主动脉瓣叶厚度是TA患者中AR的独立危险因素（P<0.05）。此外,AR的缩流颈宽度（vena contracta width, VCW）与SoVD、AAoD、升主动脉壁厚度和主动脉瓣叶厚度之间存在正相关关系（P<0.05）。 结论：主动脉窦部和升主动脉的扩张以及主动脉瓣叶的增厚,是与TA患者发生AR密切相关的危险因素。随着AR的进展,主动脉窦和升主动脉持续扩张,同时,主动脉瓣叶和升主动脉管壁不断增厚。定期进行超声心动图检查为检测这些与 AR 相关的危险因素提供了宝贵的手段,从而有助于制定明智的治疗决策,并提高 TA 患者的整体预后。     

Evaluation of left ventricular dysfunction using multiphasic reconstructions of coronary multi-slice computed tomography data in patients with chronic ischemic heart disease: validation against cine magnetic resonance imaging

Purpose: Multi-slice computed tomography (MSCT) is an emerging technique for the angiographic assessment of coronary artery disease (CAD). The purpose of this work was to determine if multiphasic reconstructions of the same data used for the assessment of CAD could also be used for global functional evaluation of the left ventricle (LV). Materials and methods: Fifteen patients with chronic ischemic heart disease (CIHD) were imaged for CAD using a contrast-enhanced retrospective electrocardiographic-gated spiral technique on a MSCT scanner. The same data were reconstructed at both end-diastole and end-systole in order to measure left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), and ejection fraction (LVEF). The results were compared to values obtained using a cine true-fast imaging with steady-state precession technique on a magnetic resonance imaging (MRI) scanner. Interobserver variability in the measurement from MSCT images was also evaluated. Results: For LVEF, there was substantial agreement between MSCT and MRI (intraclass correlation coefficient of 0.825); the intermodality reproducibility for LVEF (5%) was within an acceptable clinical range. However, mean values of LVEDV and LVESV with MSCT compared to cine MRI (LVEDV: 262.0 ± 85.6 ml and 297.2 ± 98.8 ml, LVESV: 196.2 ± 75.6 ml and 218.6 ± 90.99 ml, respectively) were significantly less for both volumes (p < 0.015). Intermodality variabilities for these measurements were high (15 and 13% for LVEDV and LVESV, respectively). Readers' mean measurements of LVESV from MSCT images were significantly different (p = 0.003) resulting in differences in calculation of LVEF (p < 0.024). Still, interobserver variabilities for all values were acceptable (6, 8, and 5% for LVEDV, LVESV, and LVEF, respectively). Conclusion: Although values for LVEDV and LVESV were less with MSCT than with MRI, LVEF values were in agreement. This suggests that combined imaging of CAD and the evaluation of global LV dysfunction due to CIHD is feasible with the same MSCT acquisition.