术中超声引导下脑实质内小病灶切除的应用研究

目的探讨术中超声在指导脑实质内小病灶切除中的应用价值.方法开颅术中超声引导下对12例脑实质内小病灶进行手术切除,分析术中超声引导病灶定位及指导手术切除情况.结果12例12个病灶术中超声均能清晰显示,准确定位,位于运动功能区6例、语言功能区2例、非功能区4例.不同病灶有其特征性的声像图表现,利用彩色多普勒模式可清楚显示血管畸形或血供丰富的肿瘤内的血流动力学情况.术中超声引导下对2例脑胶质瘤、2例转移瘤、2例动静脉畸形、2例寄生虫、1例海绵状血管瘤和1例脑脓肿病变均完整切除;1例胶质瘤大部分切除,1例胶质瘤病部分切除.结论术中超声可对脑实质内小病灶实时、精准定位,有助于将病灶完整切除,减轻脑组织损伤.     

超声在颅脑占位病变术中的应用

目的 探讨术中超声在颅脑占位性病变切除术的应用价值.方法 56例经CT、MRI诊断为颅内占位的患者,术前超声经骨窗常规探测,术中超声完整显示整个瘤体的位置、范围、深度、性质以及与毗邻血管的关系,实时监控瘤体切除范围,手术结束前再次探测有无肿瘤和血肿残留.结果 ①术前超声经骨窗探测,25例颅内占位可显示,显示率45%,可提供肿瘤的位置和大致范围,无法判断肿瘤性质.②术中超声探测,肿瘤显示率100%,所有病灶均可准确定位,并提供最佳入路点.③成功引导术者完成肿瘤切除胶质瘤39例,脑膜瘤2例,海绵状血管瘤3例,脑脓肿3例,脑转移癌5例,炎性病灶3例,垂体瘤1例;探测部位深在的肿瘤11例,其中4例位于小脑髓质,5例位于脑岛周围,2例位于脑室;肿瘤的病理性质不同,其声像图表现各有差异.④超声图像提示的残留肿瘤病灶和血肿均在术中得以证实.结论 术中超声可以清晰显示颅内占位的位置、大小、性质以及与正常脑组织的边界,帮助术者准确定位,实时监控肿瘤切除情况,及时发现残留肿瘤和血肿,提高手术成功率.     

术中超声与病理评价颅脑胶质瘤切除程度的对照研究

目的 探讨术中超声评价脑胶质瘤切除程度的应用价值.方法 对48例颅内胶质瘤患者术前采用超声定位病灶,肿瘤切除术后,应用超声评价肿瘤切除程度,对超声判断的瘤腔周围残余肿瘤及脑组织进行活检,以病理结果为金标准,评价术中超声判断残余肿瘤的敏感度和特异度.结果 48例颅内胶质瘤患者中,低级别胶质瘤26例,高级别胶质瘤22例,术中共活检150次.术中超声诊断残余肿瘤的敏感度为69.6%,特异度为91.4%,术中超声判断低级别胶质瘤的敏感度和特异度高于高级别胶质瘤,以向残腔周围脑组织突入的不规则偏强回声团为超声诊断残余肿瘤标准具有较高的诊断特异度.结论 术中超声评价肿瘤切除程度具有较高的敏感度和特异度,可提高颅脑胶质瘤全切除率.     

术中超声在脑胶质瘤切除术中的应用价值

目的应用术中超声确定脑胶质瘤位置及超声特点,评估其在神经外科手术中的应用价值。方法46例脑胶质瘤患者,术中超声确定肿瘤的位置、手术切除范围及切除术后是否有残余肿瘤。结果46例胶质瘤患者,术中超声清晰显示肿瘤的位置及性质,对病灶的显示率为100％;与术前MRI、CT对照,术中超声探查40例肿瘤部位、大小与其基本一致,6例开颅后与术前影像定位发生不同程度的漂移,术中超声重新准确定位。经手术最大程度切除肿瘤,均未损伤颅脑功能区。结论术中超声可更精确地帮助手术医师确定肿瘤的部位及切除范围,提高手术安全性及治疗效果,成为神经外科手术重要的辅助手段之一。     

经颅彩色多普勒超声及经颅超声造影在颅内动脉瘤诊断中的应用

目的探讨经颅彩色多普勒超声(TCCS)及经颅超声造影(CE-TCCS)在颅内动脉瘤诊断中的应用价值。方法对30例颅内动脉瘤患者分别行经颅彩色多普勒超声及经颅超声造影检查,并对造影前后不同大小及不同部位颅内动脉瘤的检出结果进行比较。结果 (1)经颅彩色多普勒超声及经颅超声造影均未检出小型动脉瘤(0/3),经颅超声造影对一般型、大型及巨大型颅内动脉瘤的显示例数(24/30)多于经颅彩色多普勒超声(20/30)。(2)经颅超声造影可显示全部直径≥1.0cm的颅内动脉瘤(18/18),而直径1.0cm的动脉瘤经颅超声造影显示例数较少(6/12)。(3)经颅彩色多普勒超声及经颅超声造影可显示全部大脑中动脉动脉瘤(7/7)。结论经颅超声造影可提高对颅内动脉瘤尤其是直径≥1.0cm颅内动脉瘤的显示率。     

颅内血管网织细胞瘤的术中超声应用研究

目的探讨术中超声在颅内血管网织细胞瘤手术中的应用价值。方法对17例颅内血管网织细胞瘤患者（术前均行核磁共振检查发现35个肿瘤）行术中超声检查，常规及彩色多普勒超声定位肿瘤及瘤结节，确定肿瘤位置、深度、大小、范围及其与周边组织结构的关系，确定造瘘口的位置及造瘘方向。对于较大的实性肿瘤，应用彩色多普勒及脉冲多普勒超声寻找供血动脉及引流静脉，观察其来源及走行，确定手术切除入路。肿瘤切除后，残腔灌注生理盐水，超声探查并了解肿瘤切除程度。结果17例患者术中超声探及32个肿瘤。术中超声探及最小实性肿瘤的直径为7mm。囊实质型及囊结节型肿瘤术中超声与核磁共振诊断结果一致，13个实质型肿瘤中术中超声漏诊3个，此3个肿瘤大小为3～6mm，距脑表面2～5cm。结论术中超声对颅内血管网织细胞瘤的检出率较高，可协助临床提高颅内病变全切率。     

颅内动脉瘤手术中载瘤动脉临时阻断对手术风险的影响分析

目的探讨颅内动脉瘤手术中载瘤动脉临时阻断对手术风险的影响。方法对56例颅内动脉瘤手术患者的临床资料进行回顾性研究。所有患者入院后均进行显微外科技术临时阻断栽瘤动脉,显露动脉瘤颈部,清除颅内血肿并对动脉瘤实行手术夹闭。对患者手术过程以及结果进行分析。结果 56例颅内动脉瘤手术患者中共发现动脉瘤62个,其中进行临时阻断载瘤动脉为59个。阻断时间1.2~15.0 min,平均时间(8.3±5.1)min。56例患者中,有1例患者后交通动脉瘤因动脉硬化较为严重在进行夹闭动脉瘤时发生动脉瘤整体脱落,导致载瘤动脉局部缺损行动脉瘤旷治术,术后患者出现肢体偏瘫;有2例患者发生小缺血病灶,但并无明显的神经功能障碍;有1例早期进行手术的患者术后发生严重的血管痉挛并导致梗死死亡。结论颅内动脉瘤手术中,载瘤动脉临时阻断能够有效降低动脉瘤内的压力,可以明显暴露动脉瘤颈,夹闭动脉瘤,短时间阻断载瘤动脉是安全的。     

彩色多普勒超声诊断滋养细胞肿瘤盆腹腔转移灶

目的探讨滋养细胞肿瘤盆腹腔转移灶的彩色多普勒超声特征。方法对13例滋养细胞肿瘤患者（绒毛膜癌4例，侵蚀性葡萄胎9例）盆腹腔转移灶的彩色多普勒及频谱多普勒超声特征及其临床血清β-hCG检测情况进行回顾性分析。结果13冽滋养细胞肿瘤中4冽绒毛膜癌彩色多普勒超声显示盆腹腔转移灶（2例宫旁转移灶、1例结肠壁转移灶、1例宫旁血窦），其中3例伴血清β-hCG升高；9例葡萄胎清除术后1～3个月发生侵蚀性葡萄胎，彩色多普勒超声均显示子宫肌壁病变及盆腹腔转移灶（宫旁血窦3例、盆侧壁网状转移2例，实性病灶中宫旁转移1例、腹腔转移1例、右肾转移1例，结肠壁转移1例），9例均伴血清β-hCG升高。13例中绒毛膜癌或侵蚀性葡萄胎患者的盆腹腔转移灶与其子宫或卵巢病灶的声像图表现极其相似，以网状结构（3例）、血窦（4例）及实性转移灶（盆腹腔转移灶6例）为特征；彩色多普勒超声显示血流丰富，频谱阻力指数范围0．34±0．07，与侵蚀子宫肌壁病变一样呈高速低阻血流。12例盆腹腔转移灶经手术或化疗取得效果后均消失，1例侵蚀性葡萄胎化疗后右肾转移灶未完全消退。结论彩色多普勒超声检查对发现子宫以外的滋养细胞肿瘤盆、腹腔转移灶有重要作用。     

超声造影在脑胶质瘤手术中的应用价值

目的 研究超声造影在脑胶质瘤手术中的应用价值.方法 对31例脑胶质瘤患者于术中瘤体摘除前后进行常规超声及超声造影检查,观察肿瘤及瘤周造影显像特点、对照核磁成像对肿瘤定位、明确边界、术后判断肿瘤残余情况以辅助手术.结果 31例脑胶质瘤(Ⅰ级2例,Ⅱ级13例,Ⅲ级11例,Ⅳ级5例)超声造影均可明确肿瘤边界、判断瘤周水肿带,术后肿瘤残余18处,超声造影判断残余肿瘤的灵敏度85.71％、特异度90.32％,常规超声判断残余肿瘤的灵敏度61.91％、特异度83.87％.结论 术中超声造影在脑胶质瘤手术中具有较好的临床辅助价值.     

超声检查在颅内动脉瘤诊治中的应用

颅内动脉瘤是常见的脑血管疾病,动脉瘤夹闭术仍是目前治疗最佳方法。超声检测不仅在血流动力学监测方面具有优越性,还具备无创和快速方便的特点。颅内动脉瘤夹闭术中实时超声监测是显示动脉瘤周围显微解剖关系,夹闭后的动脉瘤及周围血管进行血流动力学判定,判定重建血管是否通畅、动脉瘤是否完全夹闭、血管是否狭窄或痉挛等的简单而有效的方法。超声造影通过超声造影剂来放大超声能量散射,提高信噪比,提高了经颅多普勒(transcranial doppler,TCD)在脑血管病中的诊断价值。在颅内动脉瘤疾病的诊治过程中,合理应用超声检查技术,可以减少迟发性缺血性神经功能障碍和术后再破裂出血等并发症的发生率,提高颅内动脉瘤治疗效果,降低死亡率和致残率。     

超声对肝局灶性结节样增生的诊断价值

目的探讨肝局灶性结节样增生(FNH)的超声表现及其诊断价值.方法 28例均行超声及生化检查,并均经手术及病理证实.结果 28例FNH中共有30个病灶,超声全部检出.二维超声多表现为低或稍低回声(83%),多发生于近肝缘处(79%);13例彩色多普勒显示动脉频谱者占69%,呈轮辐状血流信号者占23%.生化检查发现所有病例AFP均阴性.结论常规超声结合彩色多普勒超声和AFP阴性可提高FNH的诊断准确性.     

布加综合征肝静脉和下腔静脉的超声表现

目的 探讨布加氏综合征肝静脉（ＨＶ）、下腔静脉（ＩＶＣ）的灰阶和彩超表现。方法 对２５例布加氏综合征（ＢＣＳ）进行灰阶和彩超检查,均经手术或下腔静脉造影证实。结果 灰阶超声发现２７支肝静脉（占４２％）和４支肝右下静脉扩张。彩色多普勒显示肝静脉、下腔静脉异常的血流情况;频谱多普勒显示肝静脉、下腔静脉呈低速、平坦、单向的血流流速曲线。结论 灰阶超声对布加氏综合征仅能提供肝静脉、下腔静脉的内径、管腔及梗     

Differential diagnosis of solid breast lesions: contribution of Doppler studies to mammography and gray scale imaging.

OBJECTIVE: To assess the role of Doppler sonography when used in conjunction with mammography and gray scale sonography in differentiating solid breast lesions and to find out whether lesion size is a limiting factor for Doppler evaluation. METHODS: One hundred twelve lesions (70 malignant and 42 benign) detected with mammography and sonography were prospectively examined with color, power, and pulsed Doppler sonography. Vascularity was analyzed morphologically (vessel location, form, and color tone) and semiquantitatively (by spectral indices) to determine the valuable diagnostic flow characteristics. The lesions were classified by 2 observers as benign or malignant on the basis of each diagnostic technique (namely, a combination of mammography and gray scale sonography, presence or absence of blood flow, morphologic flow analysis, and spectral flow analysis). The results were compared with the histologic diagnosis in 105 lesions and with the clinical and radiologic diagnosis after at least 2 years of follow-up in 7 lesions. RESULTS: The sensitivity and specificity of the mammography-gray scale sonography combination were 98.6% and 76.2%, respectively. Neither morphologic nor spectral Doppler analysis proved to be successful on its own, however, information obtained from investigated morphologic and spectral flow features increased the specificity of mammography and gray scale sonography for lesions 10 mm and smaller (from 88.9% to 100%) and those larger than 10 mm (from 70% to 96.6%). CONCLUSIONS: Our data show that Doppler sonography is a beneficial adjunct to mammography and gray scale sonography for solid breast lesions 10 mm and smaller and those larger than 10 mm.     

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.     

高频灰阶超声与彩色多普勒超声结合扫查在阴囊急症中的应用价值

目的:探讨高频灰阶超声及彩色多普勒超声(CDFI)结合扫查在阴囊急症的应用价值。方法:采用高频灰阶超声及彩色多普勒超声相结合对59例阴囊急症(肿块型)进行检查。结果:59例阴囊急症(肿块型)中40例经非手术治疗及超声随访证实诊断,19例经手术及病理确诊,高频灰阶超声及彩色多普勒超声结合扫查诊断符合率达89.8%(53/59)。结论:高频灰阶超声及彩色多普勒超声结合扫查能够提高急性阴囊肿痛中的睾丸扭转、急性炎症及睾丸肿瘤感染等引起的疾病的诊断率,在阴囊急症中有较高的临床应用价值。     

Diffuse prostatic lesions: role of color Doppler and power Doppler ultrasonography.

The purpose of this study was to assess the role of color Doppler ultrasonography and power Doppler ultrasonography in the identification of diffuse prostatic lesions. Forty male patients underwent gray scale transrectal ultrasonography, color and power Doppler sonography, and transrectal ultrasonographically guided biopsy. Transrectal ultrasonographically guided biopsy revealed cancer in 23 patients and benign lesions in 17 patients. Among the prostatic cancers 82.6% (19 of 23) showed increased flow signals, whereas 23.5% (four of 17) of benign lesions showed increased flow signals on color or power Doppler ultrasonography. If we consider increased flow signal on color or power Doppler sonography as a sign of a prostate cancer in diffuse prostatic lesions, these modalities have a sensitivity of 82.6%, specificity of 76.5%, and positive predictive value of 82.6%. On the basis of our study, we may conclude that color and power Doppler ultrasonography are useful in the identification of diffuse prostatic lesions.     

Gray scale and color Doppler sonography in the third stage of labor for early detection of failed placental separation.

OBJECTIVE: The purpose of this study was the characterization of normal and abnormal third stage placental separation using gray scale and color Doppler sonography. METHODS: The third stage of labor was examined in 62 patients using gray scale and color Doppler sonography. After identification of placental basal plate vessels by color Doppler sonography, the placentation site was examined throughout the third stage with combined gray scale and color Doppler mode. Placental separation from the myometrium was defined clinically and correlated to cessation of color Doppler detected blood flow in basal plate vessels. RESULTS: Three sonographic phases of placental separation were: (1) latent = interval between delivery of the fetus and beginning placental separation; (2) detachment = mono- or multiphasic shearing off of the placenta and (3) expulsion = interval between completed separation and vaginal delivery of the placenta. In 57 cases with clinically normal placental separation blood flow between placenta and myometrium ceased immediately after delivery of the fetus during the latent period. In five cases manual or instrumental removal was necessary because of placenta adhaerens in one case and placenta accreta in four cases. The latter showed maternal blood flow from the myometrium deep into the placenta beyond the latent phase. CONCLUSION: Cessation of blood flow between the basal placenta and myometrium following delivery of the baby is the sonographic hallmark of normal placental separation. Persistent blood flow demonstrated by color Doppler sonography is suggestive of placenta accreta.     

Complex pelvic mass as a target of evaluation of vessel distribution by color Doppler sonography for the diagnosis of adnexal malignancies: results of a multicenter European study.

OBJECTIVE: To compare the diagnostic accuracy of gray scale sonography and color Doppler imaging in the differential diagnosis of adnexal malignancies from benign complex pelvic masses in a multicenter prospective study. METHODS: The study was performed as a collaborative work at 3 European university departments of obstetrics and gynecology. A total of 826 complex pelvic masses on which transvaginal sonography and evaluation of cancer antigen 125 plasma concentrations were performed before surgical exploration were included in the study. The scanning procedure was the same in the 3 institutions. An adnexal mass was first studied in gray scale sonography, and a probable histologic type was predicted. Second, solid excrescences or solid portions of the tumor were evaluated for vascular flow with color Doppler sonography (conventional or power). A mass was graded malignant if flow was shown within the excrescences or solid areas and benign if there was no flow. The overall agreement between the test result and the actual outcome was calculated by kappa statistics. RESULTS: Color Doppler evaluation was more accurate in the diagnosis of adnexal malignancies in comparison with gray scale sonography (kappa = 0.82 and 0.65, respectively) because of significantly higher specificity (0.94 versus 0.84; P < .001). The evaluation of the cancer antigen 125 plasma concentration did not seem to increase the accuracy of either method. CONCLUSIONS: The evaluation of vessel distribution by color Doppler sonography in complex adnexal cysts seems to increase the diagnostic accuracy of gray scale sonography in the detection of adnexal malignancies in a large study population.     

彩超对肝脏囊性病变的鉴别诊断价值

目的　探讨彩色多普勒超声在肝脏囊性病变鉴别诊断中的价值。方法　对临床和病理证实的 2 0例肝脏囊性恶性肿瘤、 2 4例肝脓肿和 4 8例肝脏囊性良性肿瘤 (肝囊肿 )的灰阶超声及彩色多普勒超声表现进行了分析。对每类病灶的大小、形态、边界、囊壁回声、囊内分隔及彩色血流的有无、部位、性质进行统计比较。结果　灰阶超声和彩色多普勒超声可以反映肝脏囊性病变的结构特征及血流特征。肝脏囊性恶性肿瘤中 ,囊壁及囊壁结节内检出血流信号、囊内出现分隔、囊壁有结节或乳头的比例显著高于肝脓肿和肝囊肿 (P<0 .0 5 ) ,以囊内检出血流信号为标准 ,鉴别肝囊性恶性肿瘤的敏感性、特异性分别为 85 .0 %和 94 .4 %。结论　灰阶超声在肝脏囊性病变的鉴别诊断中有一定的意义 ,彩色多普勒在囊壁、分隔或乳头上检出血流信号对肝脏囊性恶性肿瘤诊断具有很高的特异性和敏感性     

Evaluation of palpable breast masses with color Doppler sonography and gray scale imaging.

Excisional biopsy is the standard method of distinguishing benign from malignant masses of the breast. However, alternative, less invasive methods of diagnosis are needed to reduce the number of unnecessary biopsies, allay anxiety of the patient, and control costs. In this study, we evaluated breast masses in a series of patients using color Doppler sonography and gray scale ultrasonographic features. In all cases, the pathologic diagnosis of the breast mass was subsequently established by excisional biopsy. The accuracy of gray scale sonography exceeded that of color Doppler sonography at a significance level of P < 0.005.