实时灰阶谐波超声造影诊断肾动脉狭窄的初步研究

目的评价实时灰阶谐波超声造影诊断肾动脉狭窄的临床价值。方法肾动脉狭窄患者16例，包括4例肾动脉支架置入术后者。超声造影剂使用SonoVue。所有患者均接受彩色多普勒超声与谐波造影两种检查方法。诊断结果分3级：①不能得到诊断结果；②可疑诊断；③诊断明确。检查结果与数字减影血管造影术、CT、MRI等结果相对照。结果彩色多普勒超声明确诊断的有8例（50．0％），可疑诊断5例（31．3％），不能得到诊断结果3例（18．7％）。结合谐波造影检查后明确诊断13例（81．3％），可疑诊断2例（12．5％），不能得到诊断结果1例（6．2％）。常规彩色多普勒超声诊断的敏感性63．6％（7／11），特异性40．0％（2／5），准确性56．3％（9／16）；谐波造影诊断的敏感性83．3％（10／12），特异性100％（4／4），准确性87．5％（14／16）。结论谐波造影能够更直观地显示血管管壁与管腔的边界，进而可直观地反映流道的变化，有助于肾动脉狭窄的诊断。     

超声造影在浅表淋巴结疾病鉴别诊断中的应用研究

目的 探讨超声造影在浅表淋巴结疾病鉴别诊断中的应用价值。方法 对43例患者的75个浅表肿大淋巴结（良性28个，转移性39个，淋巴瘤8个）进行常规二维、彩色多普勒超声检查和灰阶超声造影，观察淋巴结造影剂灌注特征，并与病理对照，比较造影前后超声诊断的准确性。结果 良性淋巴结中57％（16／28）造影表现为均匀增强型，36％（10／28）表现为淋巴门不均匀增强型；转移性淋巴结中77％（30／39）表现为实质不均匀增强型，21％（8／39）表现为微弱增强型。常规超声诊断良恶性淋巴结的敏感性70％，特异性86％，准确性75％；超声造影诊断的敏感性87％，特异性93％，准确性89％，超声造影诊断的准确率显著提高（P〈0．05）。结论 灰阶超声造影发现淋巴结疾病的不同灌注特征，为良恶性淋巴结疾病的鉴别诊断提供了有价值的依据。     

超声造影对肝局灶性结节增生的诊断价值

目的探讨超声造影对肝局灶性结节增生（FNH）的诊断价值。方法对17例FNH的灰阶超声、彩色多普勒超声、超声造影诊断情况进行分析比较。结果灰阶超声对FNH无特异的声像图改变；彩色多普勒超声诊断为FNH6例，符合率为35．3％（6／17）；超声造影检查11例，均探测到供血动脉及动脉早期轮辐状增强，诊断符合率为100％。结论超声造影可提高对FNH的诊断水平。     

灰阶谐波超声造影评价兔肾动脉狭窄的实验研究

目的评价实时灰阶谐波超声造影在诊断兔肾动脉狭窄模型中肾动脉狭窄的价值。方法手术建立10只兔肾动脉狭窄的模型,其中6只右肾动脉,4只左肾动脉。兔造模前接受常规超声检查;造模后,接受常规超声检查及灰阶谐波超声造影检查。其结果与数字减影血管造影检查对照。结果谐波超声造影检查肾动脉狭窄24％～69％的4只,70％～89％的5只,1只兔子因麻醉过深而死亡;数字减影血管造影证实。肾动脉狭窄31％～64％4只,71％～93％的5只;两者有很好的相关性（r=0．97）。结论实时灰阶谐波超声造影显示的管腔结构较二维及彩色多普勒超声等检查更接近于实际管腔,有望成为判断肾动脉狭窄程度的新方法。     

灰阶及彩色多普勒超声在老年患者下肢深静脉血栓诊断中的应用价值

目的：探讨老年患者下肢深静脉血栓（DVT）应用灰阶及彩色多普勒超声检查的诊断价值。方法：选取2021年6月—2023年6月菏泽鲁心医院收治的85例疑似DVT患者,回顾性分析患者的影像学资料,均实施灰阶及彩色多普勒超声检查,以静脉造影结果为金标准,判定灰阶及彩色多普勒超声检查对老年DVT的诊断价值,并分析血栓类型、血栓情况。结果：85例疑似DVT患者经静脉造影检查结果显示：下肢DVT患者52例（61.18%）;血栓类型：中央型30例、周围型14例、混合型8例;血栓情况：1级16例、2级28例、3级8例。以静脉造影检查结果为金标准,灰阶超声检查检出下肢DVT患者44例,彩色多普勒超声检查检出下肢DVT患者51例;彩色多普勒超声诊断灵敏度为92.31%、特异度90.91%、准确率91.76%、阳性预测值94.12%、阴性预测值88.24%,均高于灰阶超声诊断的76.92%、87.88%、81.18%、90.91%、70.73%,其中灵敏度、准确率差异有统计学意义（P <0.05）;彩色多普勒超声对中央型下肢DVT检出率高于灰阶超声（P <0.05）;彩色多普勒超声对1级下肢DVT...     

超声造影用于诊断腹部疾病

目的：探讨超声造影在腹部疾病诊断中的应用价值。方法：对37例肝脏局灶性病变（FLLs）、5例肾细胞癌和12例血管疾病的患者进行超声造影检查,观察分析靶目标的常规超声和超声造影表现,并与2008年欧洲超声造影指南对照。结果：FLLs彩色多普勒超声显示17个病灶测及彩色血流,而超声造影显示36个病灶内有血流进入。不同类型的FLLs有不同的增强表现,超声造影判定恶性FLLs的敏感性为83%,特异性为93%,准确性为87%。肾细胞癌的超声造影表现多样。超声造影更有助于血管疾病的准确诊断。结论：超声造影在诊断FLLs中的临床应用价值高,在其他腹部疾病的诊断方面也有一定的应用价值。     

完全性大动脉转位的超声诊断与鉴别

目的：对照手术或心导管／心血管造影结果探讨超声诊断完全性大动脉转位的价值。方法：对照手术或心导管／心血管造影结果，回顾性分析彩色多普勒超声诊断完全性大动脉转位的73例结果。结果：超声诊断73例患中心房正位，心室右袢大动脉右转位（SDD）型61例占83．5％，心房反位，心室左袢大动脉左转位（ILL）型8例占11％，心房反位，心室右袢大动脉左转位（IDL）型4例占5．5％，经手术证实的36例，其中SDD型30例占83．3％；ILL型2例占5．6％，IDL型1例占3．0％，右室双出口3例占8％，经心导管及造影证实的37例，其中SDD型26例占70％，ILL型3例占8％，IDL4例占11％，右室双出口4例占11％，结论：综合手术及心导管及造影得出结果，超声诊断符合率达90．2％，误诊率9．8％。     

实时超声造影对胆囊良恶性病变鉴别诊断的价值

目的 探讨实时灰阶谐波超声造影技术在胆囊良恶性病变鉴别诊断中的价值。方法 73例经手术病理证实的病变，其中包括胆固醇性息肉25例，胆囊炎7例，腺肌瘤样增生5例，腺瘤6例，胆囊附壁结石7例，胆囊癌23例。观察病灶开始增强时间（t1），达峰时间（t2）及病灶回声低于肝实质时间（t5），并比较不同时相胆囊病灶与肝实质回声强弱。结果 7例始终未出现增强的病变病理证实为胆囊附壁结石或胆泥。其余66例胆囊病变均增强。增强的66例病变中，良性病变组的t3明显晚于恶性组（P＜0．05）；良性组在延迟期病灶回声低于肝实质回声的百分数18．6％（8／43）明显低于恶性组的95．7％（22／23）。若用延迟期病灶回声低于同期肝实质回声作为诊断胆囊恶性肿瘤的指标，其敏感度、特异度及诊断准确率分别为95．7％（22／23），84．0％（42／50）和87．7％（64／73）。结论 灰阶谐波超声造影在鉴别胆囊良恶性病变方面有重要价值。     

彩色多普勒超声与X-线膀胱造影和CT扫描对照诊断膀胱癌的临床价值

目的探讨彩色多普勒超声与X-线膀胱造影和CT扫描对照诊断膀胱癌的临床价值。方法应用彩色多普勒超声诊断膀胱癌76例，并与X-线膀胱造影和CT扫描进行对照诊断，分别对其检测结果和临床分期进行比较．彩色多普勒超声具有典型的声像特征和较高的临床应用价值。结果76例膀胱癌全部经手术病理证实。术前超声检出73例，超声检出率96．1％(73／76)，漏诊2例，占2．6％(2/76)，误诊1例，占1．3％(1／76)。其中35例进行X-线膀胱造影检查，检出率54．3％(19／35)，漏诊16例，占45．7％(16／3j)；42例进行CT扫描，检出率90．5％(38／42)．漏诊2例，占4．8％(2／42)，误诊2例，占4．8％(2／42)。术前超声分期与术后病理分期相符66例，符合率90．4％(66／73)，其中T1期符合率93．8％(15／16)。T2期符合率72．7％(16／22)，T3和T4期符合率均为100％；X-线膀胱造影不能进行分期；CT扫描不能分出T1和T2期，T3和T4期符合率均为100％。结论彩色多普勒超声对膀胱癌的诊断和分期符合率高，可作为膀胱肿瘤检测的首选方法。     

彩色多普勒超声诊断甲状腺疾病的临床价值分析

目的通过病理对照分析，评价二维及彩色多普勒超声对甲状腺疾病的诊断价值。方：法回顾性分析2002～2006年收治的甲状腺疾病患者398例，采用二维及彩色多普勒超声进行检测，全部进行术后病理诊断对照。结果本组中甲状腺疾病的诊断符合率为90．7％（361／398），其中良性病变符合率为91．6％（327／357），恶性病变符合率为83．0％（34／41）。结论应用二维声像图特征，结合彩色多普勒及脉冲多普勒血流参数测值，对甲状腺疾病可做出较准确的诊断。     

Differential diagnosis of gallbladder diseases with contrast-enhanced harmonic gray scale ultrasonography.

OBJECTIVES: We evaluated the usefulness of contrast-enhanced harmonic gray scale ultrasonographic findings for differential diagnosis of gallbladder diseases. METHODS: We evaluated contrast-enhanced harmonic gray scale ultrasonographic images from 33 patients with 35 polypoid gallbladder disease lesions larger than 10 mm in diameter, consisting of 12 biliary sludge lesions, 8 cholesterol polyps, 1 inflammatory polyp, 2 adenomas, and 12 carcinomas. After a galactosepalmitic acid contrast agent was injected, lesions were scanned by contrast-enhanced harmonic gray scale ultrasonography in 2 phases: early vascular and late vascular. RESULTS: None of the biliary sludge lesions (n = 12) showed either tumor vessels or tumor enhancement. Lesions showing tumor vessels and tumor enhancement on contrast-enhanced harmonic gray scale ultrasonography were diagnosed as cholesterol polyp, inflammatory polyp, adenoma, or carcinoma. Three (38%) of the 8 cholesterol polyps showed dotted-type tumor vessels. Branched-type tumor vessels were observed in 5 (62%) of the 8 cholesterol polyps, the 1 (100%) inflammatory polyp, both (100%) adenomas, and 3 (25%) of the 12 carcinomas. Tortuous-type tumor vessels were observed in 9 (75%) of the 12 carcinomas. Lesions with tumor enhancement and tortuous-type tumor vessels on contrast-enhanced harmonic gray scale ultrasonography were diagnosed as carcinomas, and the sensitivity, specificity, and accuracy of this diagnosis with the current modality were 75% (9/12), 100% (23/23), and 91% (32/35), respectively. CONCLUSIONS: Evaluation of tumor vessels on contrast-enhanced harmonic gray scale ultrasonography may be a useful modality for differentiating gallbladder carcinoma from other polypoid gallbladder disease lesions.     

Evaluation of hepatic focal nodular hyperplasia with contrast-enhanced gray scale harmonic sonography: initial experience.

OBJECTIVE: To assess the potential of contrast-enhanced gray scale harmonic sonography in the evaluation of the typical vascular and enhancement patterns of hepatic focal nodular hyperplasia. METHODS: Thirteen patients with 13 lesions of hepatic focal nodular hyperplasia underwent contrast-enhanced gray scale harmonic sonography. After the injection of a microbubble contrast agent (SH U 508A), gray scale harmonic sonographic studies using a Coded Harmonic Angio technique were performed with a combination of a period of continuous scanning to assess the vascular pattern (vascular imaging) and interval delay scanning to determine the sequential enhancement pattern (acoustic emission imaging). Each imaging pattern was categorized and analyzed by consensus of 2 experienced radiologists. RESULTS: In 12 (92%) of 13 lesions, vascular imaging during the arterial phase showed central arteries of a spoked wheel pattern, whereas the remaining lesion had stippled vascularity. On acoustic emission imaging, 11 (85%) of 13 lesions were hyperechoic during the early phase, and the remaining 2 (15%) were isoechoic compared with surrounding parenchyma. Ten (77%) of 13 lesions remained either hyperechoic (5 of 13) or isoechoic (5 of 13) during the delay phase, whereas the remaining 3 lesions (23%) were hypoechoic. CONCLUSIONS: Contrast-enhanced gray scale harmonic sonography showed the typical vascularity of a spoked wheel pattern during the vascular phase and persistent enhancement on serial acoustic emission imaging in most cases of hepatic focal nodular hyperplasia, and thereby it can be a promising technique in noninvasive diagnosis of this entity.     

Evaluation using contrast-enhanced harmonic gray scale sonography after radio frequency ablation of small hepatocellular carcinoma: sonographic-histopathologic correlation.

OBJECTIVE: To evaluate the usefulness of contrast-enhanced harmonic wideband gray scale sonographic images obtained after radio frequency-induced coagulation necrosis, we compared the morphologic and histopathologic characteristics of the ablated tumors with sonographic images of the tumors. METHODS: Forty-eight patients with 72 hepatocellular carcinomas with a maximal diameter of 3 cm or less were treated percutaneously using radio frequency ablation. Six treated tumors in 4 patients were resected 1 month after ablation; the remaining 66 treated tumors were evaluated by a biopsy procedure performed with an 18-gauge fine needle 1 month after ablation. The excised tumors and biopsy specimens were then examined by histopathologic methods, and the findings were compared with those obtained on contrast-enhanced harmonic wideband gray scale sonography. Hematoxylin-eosin-stained specimens were inconclusive as to whether cellular viability remained; therefore, cell viability was determined by a positive result after histochemical (lactate dehydrogenase and nicotinamide adenine dinucleotide phosphate-diaphorase) staining. RESULTS: Contrast-enhanced harmonic wideband gray scale sonography after radio frequency ablation showed residual tumor enhancement in 5 (6.9%) of the 72 tumors; the histopathologic results for these 5 tumors were also positive for tumor residue. The remaining 67 tumors (93.1%) did not show any residual tumor enhancement when examined by sonography; however, only 66 tumors did not reveal tumor residue when examined histopathologically. Contrast-enhanced harmonic wideband sonographic imaging provided results that were comparable with histopathologic findings, the criterion standard for diagnosis; the sensitivity and specificity of the sonographic images for the detection of residual tumor tissue in ablated tumors were 83.3% (5 of 6) and 100% (66 of 66), respectively. CONCLUSIONS: Contrast-enhanced harmonic wideband gray scale sonography is a potentially useful technique for evaluating the therapeutic effects of radio frequency ablation on hepatocellular carcinoma.     

低机械指数谐波超声造影评估肝细胞癌介入治疗效果

目的 探讨低机械指数谐波超声造影在肝细胞癌(HCC)介入治疗中对疗效的评估价值.方法 对82例介入治疗的HCC患者分别于治疗前后进行低机械指数超声谐波造影、常规二维灰阶超声、彩色多普勒血流成像(CDFI)和增强CT和(或)MRI检查,记录病灶数目、大小,观察病灶内血供.结果 82例患者介入治疗前二维超声及CDFI共检出病灶119个,超声造影共检出病灶142个;治疗前后超声造影显示病灶范围均较二维超声所示增大;病灶内血流信号检测以超声造影最准确.结论 超声造影能较好地评估HCC介入治疗的疗效.     

Contrast-enhanced, wide-band harmonic gray scale imaging of hepatocellular carcinoma: correlation with helical computed tomographic findings.

We evaluated the usefulness of contrast-enhanced, wide-band harmonic gray scale imaging for the diagnosis of hepatocellular carcinoma and compared it with helical computed tomography. Forty-eight patients with 61 hepatocellular carcinoma lesions were scanned by contrast-enhanced, wide-band harmonic gray scale imaging after an intravenous bolus injection of the contrast agent Levovist. Fifty-seven of the 61 hepatocellular carcinoma lesions showed hypervascular enhancement, and intratumoral vessels could be observed in 40 of the 57 lesions. Helical computed tomography revealed a high-attenuation area in 54 of the 61 lesions, whereas the other lesions showed an equivocal-attenuation area. Contrast-enhanced, wide-band harmonic gray scale imaging is a useful method for diagnosing the vascularity of hepatocellular carcinoma.     

超声造影对正常动脉检测能力的实验研究

目的研究生理状态下彩色多普勒血流成像(CDFI)对不同深度血管血流的显示能力以及彩色多普勒超声造影(以下简称彩超造影)与实时灰阶谐波超声造影(以下简称谐波造影)的表现。方法动物选择普通家犬5只。使用意大利百胜Technos DU8超声诊断仪及SonoVue超声造影剂。二维超声分别显示犬的髂总动脉、髂外动脉、髂内动脉、股动脉及腋动脉,并测量内径,脉冲多普勒测量收缩期峰值流速(PSV)。人为增加血管深度,CDFI检查记录该深度状态的血流强度。至CDFI不能清晰显示血流时,分别利用彩超造影与谐波造影两种方法再次检测。彩超造影检测时记录血流强度及PSV。结果随着深度增加CDFI观察到的血流信号减弱,造影后血流信号均明显增强;造影后在同一部位检测到的PSV增加36.1%,两组数据比较有显著性差异;谐波造影显示注射造影剂后动脉管腔内回声迅速增强,能够清晰显示血管管壁与管腔的分界。结论造影剂的应用可明显提高CDFI对深部血流信号的检出,而谐波造影能更直观、准确地显示血管壁及流道的轮廓。     

On the feasibility of real-time,in vivo harmonic imaging with proteinaceous microspheres.

Harmonic imaging is a new contrast-specific imaging modality, which utilizes the nonlinear properties of microbubble-based sonographic contrast agents by transmitting at the fundamental frequency but receiving at the second harmonic frequency. The feasibility of improving the detection of slow, small-volume blood flow using real-time harmonic imaging has been investigated in vivo. Proteinaceous microspheres (FS069) were administrated to four dogs, two woodchucks (with multiple hepatomas), and one rabbit. Three different scanners were used to obtain real-time images of kidneys and liver (including vessels) in harmonic and conventional gray scale and color flow modes. The duration of contrast enhancement lasted significantly longer in harmonic than in conventional modes (on average 87 s; P = 0.008). Harmonic images were less susceptible to artifacts, such as acoustic shadowing, and a clear increase in the (flow) signal-to-noise ratio was observed. These preliminary in vivo results demonstrate the feasibility of performing real-time, contrast-enhanced harmonic imaging, but further studies are required to establish clinical efficacy.     

Role of duplex color Doppler ultrasound, computed tomography, and MR angiography in the diagnosis of septic puerperal ovarian vein thrombosis

Background: Septic puerperal ovarian vein thrombosis (SPOVT) is one of the underlying etiologies of puerperal fever. A correct diagnosis of this condition is important because adequate treatment requires additional administration of anticoagulants. The purpose of this study was to evaluate the role of duplex color Doppler ultrasound (CDUS), computed tomography (CT), and magnetic resonance angiography (MRA) in the detection of SPOVT. Methods: Twenty-six patients with puerperal fever suspected to be due to SPOVT and unresponsive to broad antibiotic treatment for at least 48 h were included in a prospective study using CDUS, CT, and MR imaging including MRA. Examinations were analyzed and then correlated to a standard of reference gathered from surgical and clinical follow-up data and from results of imaging. Results: SPOVT was present in nine patients (right side n = 8, bilateral n = 1). CDUS was inconclusive due to gaseous distention of the bowel or obesity in 13 of 26 cases. After counting inconclusive findings as wrong results for statistical purposes, sensitivity, specificity, and accuracy for CDUS were 55.6%, 41.2%, and 46.2%, respectively. CT had a sensitivity of 77.8% with a specificity of 62.5%; accuracy was 68.0%. MRA rendered conclusive results in all evaluated patients, resulting in a sensitivity and specificity of 100%. Conclusion: MRA is recommended in all patients with inconclusive CDUS findings and persistent suspicion for SPOVT. CT has the advantage of more rapid access and lower cost and thus will probably remain a sufficiently accurate alternative. Received 29 July 1997/Accepted 24 September 1997     

Intrarenal color duplex ultrasonography: a window to vascular complications of renal transplants.

OBJECTIVE: We analyze and discuss the importance of intrarenal color duplex ultrasonography (CDUS) in the diagnosis and differential diagnosis of vascular complications in renal transplants. METHODS: We retrospectively reviewed results of CDUS, especially intrarenal CDUS, in 102 consecutive inpatients with vascular complications of renal transplants from January 1, 2000, to December 31, 2006. Correlations between CDUS and magnetic resonance angiography, digital subtraction angiography, surgical findings, and clinical diagnoses were studied. RESULTS: Abnormal findings on intrarenal CDUS clearly represent vascular complications primarily located at the main renal vessels and intrarenal vessels. In our study, there were 5 cases of false-negative intrarenal arteriovenous fistulas, 1 case of false-positive transplant renal vein thrombosis, and 2 cases of false-negative transplant renal artery stenosis. The accuracy of detecting vascular complications of renal transplants with CDUS was 92% (94/102). CONCLUSIONS: Intrarenal CDUS is a noninvasive, accurate diagnostic tool that can be administrated portably and is easily repeatable, thereby making it not only a highly valuable imaging technique but also the method of choice in screening and diagnosing vascular complications of renal transplants.