移植肾超声研究进展

肾移植是治疗终末期肾脏疾病的有效方法,但肾移植术后排异和各种并发症常导致移植肾功能障碍和丧失,移植肾排异和与移植有关的并发症常表现为形态改变、血供缺失和血流动力学紊乱。超声检查由于可同时提供移植肾形态学和血液循环状况方面的信息,已成为肾移植术后监测的重要组成部分。移植肾超声研究进展与超声技术的发展密不可分,本文概述二维超声、彩色多普勒超声的研究成果,着重论述新技术对移植肾研究的进展。1概述1.1正常声像图移植肾多置于患者右髂窝,位置表浅且几乎不受呼吸影响,故移植肾成像较原位肾清晰,呈椭圆形,边界规整。肾内皮…     

超声诊断移植肾淋巴瘤1例

患者男,65岁。半年前因尿毒症行同种异体肾移植术,术后予免疫抑制剂治疗,肾功能正常。近一周发现血肌酐水平升至160μmol/L(参考值:40~120μmol/L)。体检:右下腹髂窝处触及肿大移植肾,质中,无压痛,无其他异常体征。超声检查:移植肾大小为132mm×55mm×64mm,肾实质内见38mm×48mm、54mm×44mm团状低回声(图1),形态不规则,肾盂内透声差(图2),彩色多普勒血流显像示低回声团块,内见彩色线状血流,测及动脉频谱,阻力指数0.60。超声诊断:移植肾实质占位侵犯肾盂可能。同期CT显示:移植肾上极团块状异常密度阴影,欠均匀,平扫呈中等密度,病灶动脉期…     

肝门部淋巴结结核的超声表现1例

患者女,22岁。因右上腹部持续性胀痛1个月余入院。查体:皮肤及巩膜无黄染,浅表淋巴结无肿大,心肺未见异常,专科检查:腹部平坦,未见胃肠形及蠕动波,无静脉曲张,全腹软,右侧肋下胆囊点下方可触及一5cm×5cm大小包块,界限不清,活动度差,表面不光滑,有结节感,质硬,无囊性感,未触及波动及搏动。超声所见:于第一肝门处胆囊颈部后方,下腔静脉前方可见5.6cm×4.4cm×3.6cm的低回声团,形态欠规则,边界尚清,其内回声欠均匀,可见点状强回声,周围血管受推挤,肝动脉呈单翼抬高征,下腔静脉后移,CDFI:肿块内有少许血流信号,周围可见血管绕行(图1)。超声诊…     

三维超声动态观察移植肾体积变化及其临床意义

目的:探讨三维超声观察移植肾的体积变化及其临床意义。方法:利用三维超声体元模型法重建移植肾进行体积测量,对9例移植肾进行了动态观察,随访期1年。同时利用二维超声椭圆体积法计算肾脏的体积;利用多普勒超声在移植肾不同部位采样测量阻力指数(RI)和波动指数(PI)。比较几项指标的变化情况及临床意义。结果:9例患者共发生排异反应7次。出现排异反应时,肾脏体积均增大,增大率为18%±10%,范围7%~36%,抗排异治疗后,肾脏体积复原,非排异反应期间,肾脏体积较稳定。三维体积测量较二维测量有更好的稳定性和重复性。移植肾早期,RI值均较高,以后逐渐降低,大约6个月后趋于稳定。结论:三维体元模型法体积测量能够较敏感地反映移植肾体积的变化,动态观察移植肾体积的变化有助于排异反应的诊断和抗排异疗效判定。     

超声检查对颈部淋巴结病变的诊断价值

颈部淋巴结引流丰富,其淋巴结肿大往往也是全身疾病在颈部的一个局部表现.准确判断颈部淋巴结肿大的性质有助于准确把握疾病发展程度、指导治疗与判断预后.超声检查具有操作简便、观察直观且清晰度高等特点,具有较高的敏感性和准确性.随着超声造影、弹性成像等新技术的发展和应用,超声检查在诊断淋巴结肿大中的作用也不断得到提高,已成为颈部淋巴结病变最重要的影像检查方法之一.     

浅表淋巴结超声检查临床应用

1984～1986年,Bruneton等首次报道,用7.5 MHz灰阶超声诊断鼻咽部肿瘤转移和乳癌转移引起的颈部和腋窝淋巴结肿大.1988年,Solbiati等采用更高频率超声(10～13 MHz)不仅能够显示正常浅表淋巴结的皮质、髓质和门部,而且提出正常和病理性淋巴结的鉴别诊断方法.1988～1989年Sutton、Tohno su,1992年Vassallo等结合细针穿刺活检提出良恶性淋巴结肿大的灰阶超声声像图鉴别指标.     

移植肾血栓超声诊断分析

目的 探讨超声诊断移植肾血栓的特异度.方法 回顾分析我院1996年1月至2011年3月1517例肾移植术患者中术后1年内超声诊断为移植肾血栓的22例患者超声检查资料,并与磁共振血管造影、CT血管造影、手术探查及术后病理结果比较.结果 22例超声诊断为移植肾血栓的患者中,超声诊断为移植肾主动脉血栓4例,其中3例经手术探查及术后病理证实,另1例手术发现超声检查误诊.超声诊断为移植肾下极血栓1例,经手术探查证实.超声诊断为移植肾主肾静脉血栓8例,其中4例经手术探查和术后病理证实,2例术后病理结果证实均为急性排斥,余2例未行手术探查而通过其他检查方法排除超声检查结果.超声诊断为移植肾主肾静脉部分血栓形成9例,其中1例经手术探查证实超声检查误诊,3例根据其他检查结果排除超声检查结果,5例行溶栓治疗后超声复查无血栓形成.结论 目前所采用的移植肾血栓超声诊断标准诊断移植肾动脉血栓的特异度高,而诊断移植肾静脉血栓的特异度低.     

超声引导移植肾穿刺活检的临床应用

目的 探讨超声引导移植肾穿刺活检对肾移植术后并发症诊断的临床应用价值及穿刺技术要点.方法 对24例患者的移植肾组织活检方法、病理结果与临床资料进行分析研究.结果 24例患者术后共行36次肾穿,取材失败1次,穿刺成功率为97.2%,取材质量良好率为83.3%.病理诊断急性排斥反应22次、急性肾小管坏死9次、慢性排斥反应2次、其它肾组织病变17次.临床诊断与病理诊断完全符合者6次,约占17%;部分符合者21次,约占60%;完全不符合者8次,约占23%.结论 超声引导移植肾穿刺活检对临床正确诊断术后并发症及选择治疗方案有重要价值.灵活选择移植肾穿刺路径和注意穿刺时机可更有效地避免穿刺并发症.     

移植肾输尿管内膜钙化误诊为输尿管结石1例

病例 男，54岁，因同种异体肾移植术后5个月，出现继发性高血压和继发性糖尿病半个月入院。常规检查：血压175/120mmHg，空腹血糖18.8mmol/L,血尿：红细胞40-50个/HP，血清肌酐，尿素氮正常。超声检查提示肾移植术后移植肾积水，移植肾存活良好。     

胰肾联合移植的超声观察

目的　探讨胰肾联合移植的声像图特征。方法　对 3例胰肾联合移植患者行超声检测。结果　移植胰、肾术后短期内内部回声极低 ,形态饱满 ,1～ 3月内胰头、胰尾相对较大 (P <0 .0 1或0 .0 5) ;移植胰周围及腹腔内可出现局限性积液。移植胰、肾动、静脉显示清晰 ,供胰动脉Vmax(63 .3±1 2 .5)cm/s,RI=0 .68± 0 .0 7,主肾动脉Vmax(71 .0± 2 9.9)cm/s,RI =0 .73± 0 .0 6。结论　超声检测移植胰、肾图像清晰 ,操作方便 ,无创 ,可反复检查 ,但对检测移植胰排异反应无特异性 ,可通过观察移植肾血流变化 ,了解是否存在胰排异反应     

Sonographic appearances of cervical lymph nodes: variations by age and sex.

PURPOSE: The purpose of this study was to evaluate the age- and sex-related variations in the numbers and sonographic appearances of normal cervical lymph nodes. METHODS: One hundred thirty-three healthy subjects (67 men and 66 women) underwent sonographic examinations of the neck, during which 1,299 lymph nodes were detected. The lymph nodes were assessed for their size, shape (short-to-long-axis ratio), and border sharpness, as well as for the presence of an echogenic hilum. The subjects were categorized by age (20-29, 30-39, 40-49, and > or = 50 years) and subcategorized by sex. The differences between the groups in the number of nodes and in their appearance were evaluated. RESULTS: The mean number of nodes visualized on sonography was significantly higher (p < 0.05) in subjects aged 20-29 and 30-39 years than in subjects aged 40-49 and 50 years or older. The difference in the mean sizes of the cervical nodes between men and women was not statistically significant. The lymph nodes in subjects aged 20-29 and 30-39 years were commonly smaller than those in subjects aged 40-49 and 50 years or older, but the differences were not statistically significant. Neither the shape nor the border sharpness of the cervical lymph nodes varied significantly by age or sex. The incidence of an echogenic hilum within the lymph nodes increased significantly with age in both sexes (p < 0.05). CONCLUSIONS: This study provides information about the sonographic appearances of and variations between normal cervical lymph nodes. The presence of an increased number of cervical lymph nodes and the absence of an echogenic hilum within the nodes may help to identify an abnormality more in older patients than in younger patients.     

CEUS鉴别诊断颈部不同大小淋巴结的良恶性

目的 观察CEUS对颈部不同大小良恶性淋巴结的鉴别诊断价值。方法 将经病理证实的142枚颈部增大淋巴结（良性68枚,恶性74枚）按最大径分为<1 cm、1~2 cm和>2 cm组,行常规超声及CEUS检查,观察其常规超声特征及造影灌注模式,并与病理对照。结果 良性淋巴结55.88%（38/68）表现为均匀高增强型,26.47%（18/68）表现为有规则无灌注区的不均匀增强型或环状增强型;恶性淋巴结中72.97%（54/74）表现为有不规则灌注缺损区的不均匀增强型,14.86%（11/74）为微弱增强型。常规超声鉴别诊断<1 cm、1~2 cm和>2 cm 3组淋巴结良恶性的准确率分别为62.16%（23/37）、69.49%（41/59）和78.26%（36/46）,CEUS诊断的准确率分别为81.08%（30/37）、86.44%（51/59）和86.96%（40/46）;相比常规超声,CEUS能够显著提高对最大径1~2 cm良恶性淋巴结的诊断准确率（P=0.02）。结论 CEUS对鉴别诊断良恶性淋巴结具有一定价值,尤其对最大径1~2 cm淋巴结。     

Ultrasonographic differentiation between metastatic and benign lymph nodes in patients with papillary thyroid carcinoma.

OBJECTIVE: The purpose of this study was to evaluate the ultrasonographic characteristics of metastatic lymph nodes in patients with papillary thyroid carcinoma. METHODS: The ultrasonographic characteristics of lymph nodes were analyzed in 112 consecutive patients who underwent thyroidectomy and lymph node dissection, with the diagnosis being confirmed by anatomopathologic examination. RESULTS: A total of 198 lymph nodes were metastatic, and 152 were benign (normal or with nonspecific lymphadenitis). Minimum axial diameters of 7 mm for level II (upper internal jugular chain) and 6 mm for the rest of the neck were observed in 93% of metastatic lymph nodes, absence of an echogenic hilum in 88%, hyperechogenicity in relation to the adjacent muscles in 86%, a round shape in 80%, calcifications in 49.5%, and intranodal cystic necrosis in 20%. These ultrasonographic characteristics were observed in 17%, 10%, 4.5%, 29.5%, 0%, and 0% of benign lymph nodes, respectively. CONCLUSIONS: Even basic ultrasonographic characteristics (shape, echogenicity and echogenic hilum, calcifications, and intranodal cystic necrosis) help in the differentiation between metastatic and nonmetastatic lymph nodes in patients with papillary thyroid carcinoma.     

In vitro investigation of detectability of colorectal lymph nodes and diagnosis of lymph node metastasis in colorectal cancer using B-mode sonography

PURPOSE: The aim of this in vitro study was to assess the feasibility of using high-frequency sonography to identify colorectal lymph nodes and to diagnose colorectal lymph node metastasis. METHODS: In part 1 of this study, resected colorectal tissues from 13 patients with colorectal cancer were scanned in a water bath using B-mode sonography performed at high frequency (10 MHz) to identify lymph nodes. The colorectal tissues were then carefully dissected to remove all lymph nodes. Detectability was calculated as the ratio of the number of sonographically detected nodes to the total number of histopathologically confirmed nodes. Student's t test was performed to compare sizes between these groups; a p value of less than 0.05 was considered significant. In part 2, 4 features of lymph nodes identified on B-mode sonography--size, shape, border, and echogenicity--and their combinations were evaluated for their ability to diagnose lymph node metastasis. Discriminant and receiver operating characteristic curve analyses were performed. RESULTS: In part 1, B-mode sonography performed in vitro detected 79 (48%) of the 165 histopathologically identified lymph nodes and 34 (87%) of the 39 histopathologically identified metastatic nodes. The mean size, or mean longest axis (+/- standard deviation), of the sonographically detected nodes (6.4 +/- 2.9 mm) was significantly larger than that of undetected nodes (3.6 +/- 1.7 mm; p < 0.01). In part 2, the most effective feature distinguishing metastatic from nonmetastatic lymph nodes was echogenicity, followed by size, shape, and border. However, a combination of at least 2 features (eg, echogenicity and size) provided better distinction of nodes than did any 1 feature. In the receiver operating characteristic curve of the 4-feature combination, an increase in sensitivity is accompanied by a decrease in specificity: at a sensitivity of 100%, specificities decreased to 60% or less. However, even with the optimal combination of features, the sensitivity and specificity did not both reach 85% at any operating point. CONCLUSIONS: The results of this node-by-node in vitro study show the current limitations and potential of sonography for assessing colorectal lymph nodes. High-frequency sonography may be insufficient for identifying lymph node metastasis in colorectal cancer.     

应变弹性成像与声触诊组织成像定量技术鉴别诊断颈部良、恶性淋巴结北大核心CSCD

目的观察应变弹性成像(SE)与声触诊组织成像定量(VTIQ)技术鉴别诊断颈部良、恶性淋巴结的价值。方法纳入106例接受颈部超声及颈部淋巴结组织病理学检查患者、共123个颈部异常淋巴结,根据病理结果将其分为良性组(n=34)和恶性组(n=89)。采用SE检测异常淋巴结所占面积(AREA%),以VTIQ技术检测淋巴结剪切波速度(SWV),比较2组淋巴结超声特征的差异;以病理结果作为金标准,观察SE与VTIQ技术鉴别诊断良、恶性淋巴结的效能。结果恶性组淋巴结门消失、纵横比(L/S)<2、血流阻力指数(RI)>0.7、AREA%>45.23%及SWV>3.05 m/s占比均大于良性组(P均<0.05)。以AREA%=45.23%为最佳截断值,鉴别诊断良、恶性淋巴结的敏感度为84.27%,特异度为70.59%,曲线下面积(AUC)为0.74;以SWV=3.05 m/s为最佳截断值,敏感度为88.76%,特异度为73.53%,AUC为0.84,显著大于AREA%的AUC(Z=2.83,P<0.01)。SE鉴别诊断良、恶性淋巴结的敏感度和特异度分别为76.13%和68.00%,VTIQ技术的诊断敏感度和特异度分别为84.55%和73.53%,与SE差异均无统计学意义(χ^(2)=0.27,P=0.60;χ^(2)=0.25,P=0.62)。结论SE及VTIQ技术均可定量评估颈部淋巴结硬度以鉴别其良恶性;VTIQ的诊断效能较高,SWV大于3.05 m/s提示为恶性淋巴结。     

High-sensitivity power Doppler imaging of normal superficial lymph nodes

PURPOSE: This study was conducted to describe the various patterns of vascularity of the normal superficial lymph nodes detected using high-sensitivity power Doppler imaging according to the dimension and anatomic location of the nodes. SUBJECTS AND METHODS: A total of 712 lymph nodes (416 in the neck, 205 in the groin, and 91 in the axilla) were studied in 118 patients with high-sensitivity Power doppler. Three categories of vascularity were defined: absence of vascularity (type 1), hilar and perihilar vascularity (type 2), and vascularity in the entire node (type 3). The 3 types of vascularity were correlated with the anatomic location and the dimension (maximum transverse diameter) of the nodes. RESULTS: Type 3 vascularity was found in all lymph nodes with a maximum transverse diameter > 6 mm, in the 67.9% (133/196) of lymph nodes between 4 and 6 mm in diameter, and in 45.7% (42/92) of lymph nodes between 2 and 4 mm in diameter. In lymph nodes with transverse diameters of 2-6 mm, type 3 vascularity was detected in 80.7% (46/57) of the axillary nodes, in 69.0% (87/126) of the inguinal nodes, and in 40.0% (42/105) of the cervical nodes. Type 2 vascularity was seen in 14.2% (101/712) of all examined lymph nodes. The absence of vascularity (type 1) was noted in only 1.9% (8/416) of cervical and 2.0% (4/205) of inguinal nodes. CONCLUSIONS: State-of-the-art power Doppler equipment can demonstrate type 3 vascularity in a high percentage of normal superficial lymph nodes. This pattern of intense, extensive-but harmonious-vascularity must be considered as an indicator of benignity.     

Clinical Application of Contrast‐Enhanced Ultrasonography in Diagnosis of Superficial Lymphadenopathy

Objective. The purpose of this study was to evaluate the value of contrast‐enhanced ultrasonography (CEUS) in differential diagnosis of superficial lymphadenopathy. Methods. Ninety‐four superficial enlarged lymph nodes in 94 patients were studied by conventional ultrasonography (gray scale and color Doppler) and CEUS. Contrast‐enhanced sonograms were analyzed using contrast‐specific quantification software. All of the results were compared with pathologic diagnoses. Results. Of the 94 lymph nodes examined, 44 were benign and 50 were malignant (33 metastases and 17 lymphomas). The sensitivity, specificity, and accuracy of conventional ultrasonography in differential diagnosis between benign and malignant nodes were 51%, 47%, and 55%, respectively. Contrast‐enhanced ultrasonography showed intense homogeneous enhancement in 39 of 44 benign lymph nodes, inhomogeneous enhancement in 32 of 33 metastases, and intense homogeneous enhancement and absence of perfusion in 9 of 17 and 6 of 17 lymphomas, respectively. The sensitivity specificity, and accuracy of CEUS were 84%, 79%, and 80%. After time‐intensity curve gamma variates were calculated, the area under the curve of the benign lymph nodes was greater than those of the metastatic lymph nodes and lymphomas (P < .01). Conclusions. These results indicate that the use of CEUS and contrast‐specific software has a higher degree of diagnostic accuracy than conventional ultrasonography for evaluations of superficial lymphadenopathy. The contrast enhancement patterns and time‐intensity curves provide valuable diagnostic information for differential diagnosis of benign and malignant lymph nodes.