前列腺癌经直肠超声声像特征

本文分析了172例可疑前列腺癌者经腔内超声及其引导下穿刺活检确诊的49例前列腺癌的声像学特征。认为前列腺癌除了主要表现为低回声型特点外,尚可出现其它回声类型改变及一些间接征象。前列腺介入性超声及其指引下的穿刺活检是前列腺癌诊断及疗效随访的主要方法。     

前列腺癌的超声表现与组织结构

目的：探讨前列腺癌的超声表现与组织结构改变的关系。提高前列腺癌的超声诊断水平。方法：对71例经病理证实为前列腺腺癌的病例做前列腺超声的研究。采用前列腺超声表现与前列腺穿刺活检病理学检查的对照研究方法。结果：71例前列腺腺癌其中47例（66.20％）表现为或多个低回声结节,12例（16.90%）为均质回声无结节,9例（12.68％）为混合回声,3例（4.22%）为强回声改变。作者发现前列腺癌回声不同,但在组织构直没有明显差异,只是强回声癌改变有明显的间质纤维化。结论：前列腺腺癌的回声表现多样化,但组织结构没有明显差别。     

Sonographic appearances of superficial soft tissue lipomas.

High-resolution real-time sonography was used to evaluate 35 superficial soft tissue lipomas. Thirty were located in subcutaneous tissues and 5 in superficial muscles. The lipomas were assessed for location, shape and size, boundaries, echotexture, homogeneity, and sound through transmission. All were elongated, with their greatest diameter parallel to the skin. Twenty-three lipomas (66%) showed a homogenous echotexture. Twenty-one (60%) were well defined, and the remainder showed ill-defined margins blending into the surrounding tissues. Twenty-nine percent of the lipomas were hypoechoic, 22% were isoechoic, 29% were hyperechoic, and 20% showed a mixed pattern. An elongated isoechoic or echogenic mass in the subcutaneous tissues should suggest the diagnosis of lipoma.     

Correlation between prostate cancer grade and vascularity on color doppler imaging: preliminary findings

PURPOSE: We examined the relationship between the amount of prostate cancer-associated vascularity as seen on color Doppler imaging and the tumor grade. METHODS: Transrectal color Doppler imaging of the prostate was performed in 54 patients with prostate cancer. Color flow signal/total pixel ratios (SPRs) of selected images were calculated using the ratio of the number of pixels showing color Doppler signals to the total number of pixels within the lesion. All the patients underwent prostate biopsy guided by transrectal sonography. Gleason scores were determined from the biopsy specimens. RESULTS: Color Doppler signals were demonstrated in the lesions of 91% (49/54) of the patients. The mean SPRs of prostate cancers 3 cm or smaller and larger than 3 cm were 0.15 +/- 0.07 and 0.11 +/- 0.04 (+/- standard deviation), respectively (p < 0.05). The mean SPRs of well- (Gleason score of 2-4), moderately (Gleason 5-7), and poorly (Gleason 8-10) differentiated prostate cancers were 0.08 +/- 0.03, 0.12 +/- 0.06, and 0.17 +/- 0.11, respectively (r = 0.45; p < 0.01). CONCLUSIONS: The refinement of color Doppler equipment has improved the detection of color Doppler signals associated with prostate cancer. Our study shows a correlation between prostate cancer-associated vascularity as shown on color Doppler imaging and the tumor grade.     

Reproducibility assessment of radiomics features in various ultrasound scan settings and different scanner vendors

IntroductionRadiomics in Ultrasound (US) imaging has been investigated for the prediction and prognosis of cancers. However, inter-scanner and intra-scanner variations may affect the reproducibility of radiomics results. This study aims to evaluate the reproducibility of US textural radiomics features across various scan settings and scanner vendors.Materials and methodsUS images in quality control (QC) phantom were obtained by three scanners (Philips, Samsung, and Siemens) with different scan settings and parameters. Circular regions of interest (ROIs) inside isoechoic, hypoechoic, and hyperechoic objects were manually delineated. Forty textural radiomics features were extracted from each ROI, and then the robust features that could distinguish different echogenic objects were obtained by the Mann-Whitney U test. Reproducibility of the robust radiomics features was assessed by the intraclass correlation coefficient (ICC) and coefficient of variation (CV); ICC>0.90 and %CV<20 were considered reproducible.ResultsAccording to the Mann-Whitney U test results, ten robust features could differentiate the hypoechoic, and 15 robust features could differentiate the hyperechoic objects from the isoechoic objects (P<0.001). The total ICC of the robust features for each echogenic object was >0.95 in different scanners and scan settings. Four and seven features were individually reproducible (%CV < 20, ICC>0.90) in hypoechoic and hyperechoic objects, respectively. Also, four features seem reproducible by changing the ROI location across the horizontal and vertical lines for both convex and linear array transducers.ConclusionsMost of the US textural radiomics features in this study were not reproducible. However, several features showed high reproducibility at different scan settings and scanners. These features may also be reproducible when ROI size and location change slightly.     

Sonographic features of breast hamartomas.

OBJECTIVE: The purpose of this study was to elucidate the sonographic characteristics of breast hamartomas. METHODS: Data and sonographic images of 14 breast hamartomas were retrospectively reviewed. RESULTS: All patients had clinically palpable lumps. The median patient age was 39.5 years (range, 24-60 years). Eleven (78.6%) tumors occurred in the right breast, and 3 (21.4%) were in the left. The median tumor size measured by sonography was 2.8 cm (range, 1.2-4.9 cm). The median longest transverse dimension-anteroposterior diameter ratio of the tumors was 2.44 (range, 1.52-3.73). All tumors were oval and compressible with transducer pressure. Thirteen (92.9%) tumors were well circumscribed with smooth tumor margins, and 1 (7.1%) had indistinct margins. The internal echo texture was hyperechoic in 6 (42.9%), mixed (heterogeneous) echogenicity in 5 (35.7%), and isoechoic in 3 (21.4%). Four (28.6%) tumors had echogenic halos, and 2 (14.3%) had anechoic halos. Ten (71.4%) tumors had no retrotumor acoustic phenomena. Two (14.3%) had bilateral edge shadowing; 1 (7.1%) had posterior enhancement; and 1 (7.1%) had a mixture of enhancement and shadowing. CONCLUSIONS: Breast hamartomas were well-circumscribed, solid, oval tumors without intratumor microcalcification. The internal echo texture of most hamartomas is either hyperechoic or composed of mixed echogenicity. Retrotumor acoustic phenomena were absent in most hamartomas.     

Is a Visible (Hypoechoic) Lesion at Biopsy an Independent Predictor of Prostate Cancer Outcome?

The aim of this study was to evaluate the prognostic implications of the sonographic appearance of prostate cancers. All patients with biopsy-proven prostate cancer between January 2003 and July 2004 (and at least 5 years of follow-up) were selected retrospectively. After exclusions, 101 patients constituted our study population and were divided into isoechoic (or nonvisible) and hypoechoic (or visible) lesion. The clinical outcomes of these two groups were compared. The outcomes for the two groups were significantly different (p < 0.01). For nonvisible lesions, 37 of the 41 patients (90.2%) had no disease relapse and 2 (4.9%) had biochemical failure. For the visible lesions, 37 of the 60 (61.6%) patients were free of recurrence, 7 (11.7%) had systemic metastases and 10 (16.7%) died of complications related to prostate cancer. Our data show that patients with nonvisible prostate cancer had significantly better outcomes than patients with visible lesions during a five-year period of evaluation.     

Follow‐up of the Transrectal Ultrasonographic Features of the Prostate After Biopsy

OBJECTIVE: The purpose of this study was to evaluate the transrectal ultrasonographic features of the prostate after biopsy and to find out whether any ultrasonographically detectable lesion forms secondary to biopsy. METHODS: Prebiopsy transrectal ultrasonographic findings in 60 consecutive patients who underwent repeated biopsies were evaluated. Detected lesions that were not defined before the first biopsy were considered postbiopsy-formed lesions and were sampled during the second biopsy. All transrectal ultrasonographically detected lesions were correlated with histopathologic results in the same locations. RESULTS: There were 7 (11.6%) patients with new hypoechoic lesions formed after the first biopsy. Histopathologic analysis of postbiopsy-detected lesions showed that 38.5% were cancer; 62.5% of the detected benign lesions were prostatitis foci. CONCLUSIONS: Prostate biopsy does not give rise to formation of fibrotic scar tissue in the peripheral zone. Most postbiopsy-detected lesions are prostatitis foci, but all hypoechoic lesions must be sampled during repeated prostate biopsies because of the 38.5% cancer detection rate.     

Sonographic features with histologic correlation in two cases of palpable breast cancer after breast augmentation by liquid silicone injection

Sonography is rarely used to evaluate the breasts in patients who have undergone liquid silicone injections for breast augmentation because strong acoustic shadowing from the resulting silicone granulomas hampers the examination. We report on 2 patients who underwent silicone injection 18 and 20 years earlier and in whom breast cancers (1 invasive ductal carcinoma and 1 carcinosarcoma) were diagnosed by sonographically guided core-needle biopsy. On sonograms, both cancers had a peripheral hypoechoic rim surrounding an echogenic center. The echogenic center corresponded histologically to a silicone granuloma in 1 patient and to a large area of necrosis in the other; the hypoechoic rims corresponded to areas of cancer in both patients.     

Preoperative serum prostate-specific antigen (PSA) below 10 microg/l predicts neither the presence of prostate cancer nor the rate of postoperative PSA failure

Recent information on the relationship of serum prostate-specific antigen (PSA) to prostate cancer and new reports on death rates in men warrant a reassessment of how we diagnose and treat prostate cancer. We now know for the first time that the annual death rate from prostate cancer in men > or =65 years of age is only 226 per 100 000 men. At least 40 000 of 100 000 men over age 65 (40%) have invasive prostate cancer as judged by examination of prostates in 3- to 4-mm step-sections. Thus, only 1 of every 177 men 65 years of age or older (226 in 40 000) with invasive prostate cancer dies annually from his cancer. Serum PSA between 2 and 10 microg/L is used almost universally as an indication to biopsy the prostate. When 10-20 biopsies are commonly taken, it is not surprising that approximately 40% of men are biopsy-positive for prostate cancer. Despite this reliance on serum PSA as an indication for biopsy, data at Stanford show no clinically useful relationship between preoperative serum PSA (in the range 2-10 mg/L) and the volume of Gleason grade 4/5 cancer or the volume of Gleason grades 3, 2, and 1 cancer, nor can we show any useful relationship of such preoperative PSA concentrations (2-10 microg/L) to biochemical PSA failure rates after radical prostatectomy. We urgently need a better serum marker for prostate cancer. Because PSA biochemical failure rates after radical prostatectomy are directly proportional to the amount of Gleason grade 4/5 cancer in the prostate, a serum marker of Gleason grade 4/5 carcinoma could be ideal.     

经直肠彩色多普勒超声鉴别前列腺周缘区低回声性质的价值

目的 探讨经直肠彩色多普勒超声对前列腺周缘区低回声结节良恶性诊断的价值。方法 对77例前列腺周缘区低回声结节行经直肠彩色多普勒超声探测，利用彩色直方图软件计算结节内彩色血流面积与选定结节面积比值(black and white color ratio，BCR)和整个前列腺血流BCR并比较二者的BCR，如结节内BCR高于整个前列腺内5％则为血流增多。结果 77例前列腺周缘区低回声结节穿刺活检证实前列腺癌51例，前列腺增生症26例。周缘区低回声内血流增多共50例，其中前列腺癌41例。经直肠彩色多普勒超声检查结节内血流增加对诊断前列腺癌的敏感性、特异性、阳性预测值分别为80．4％，65．4％，82．0％。结论 经直肠彩色多普勒超声检查前列腺周缘区低回声结节内血流并用BCR解释其丰富程度对结节良恶性的鉴别诊断有一定帮助。     

The common ultrasonographic features of pilomatricoma.

OBJECTIVES: The purpose of this series was to describe typical ultrasonographic features of 20 cases of pilomatricoma and to improve its diagnostic rate with the use of an ultrasonographic approach. METHODS: For 20 pilomatricomas in 19 patients with preoperative ultrasonography from 1995 to 2004, we reviewed age, sex, symptoms, duration, referring clinician, and tumor sites. The ultrasonographic findings were retrospectively analyzed for tumor location, shape, size, margin, echo texture, echogenicity, presence, amount, and shape of calcification, presence of a hypoechoic rim, and Doppler flow pattern. RESULTS: The mean age of the 19 patients was 6.9 years (range, 1-21 years), and the female-male ratio was 1.1:1. Patients had a painful palpable mass in 10 cases (50%). Nine lesions occurred in the neck, 5 in the cheek, 2 in the preauricular region, and 4 in the extremity. All tumors were located in the subcutaneous layer. The mean size of the tumors was 13.4 mm. Fourteen pilomatricomas (70%) appeared as well-defined oval masses. Tumors were heterogeneously hyperechoic in 80% of cases. All tumors had internal echogenic foci. A hypoechoic rim was seen in 17 cases (85%). Doppler flow signals were observed in the peripheral region in 14 cases (70%). A correct preoperative diagnosis was made in 33% on the basis of clinical findings and in 76% by ultrasonography. CONCLUSIONS: Diagnosis of pilomatricoma should be considered when a well-defined mass with inner echogenic foci and a peripheral hypoechoic rim or a completely echogenic mass with strong posterior acoustic shadowing in the subcutaneous layer of the head, neck, or extremity is found on ultrasonography.     

Should prostate-specific antigen or prostate-specific antigen density be used as the determining factor when deciding which prostates should undergo biopsy during prostate ultrasound

Prostate ultrasound has been accepted as the appropriate tool for prostate biopsy guidance to determine the presence of prostate cancer if the prostate-specific antigen (PSA) level is not normal. Prostate-specific antigen density (PSAD) has been used to determine if an increased PSA level may be because of benign enlargement of the gland or possible presence of cancer. The specific "cutoff" for PSA and PSAD to delineate which patients are at highest risk has been controversial. We attempted to assess which PSA level or PSAD level should be used. A retrospective analysis of 600 consecutive men, referred for prostate ultrasound and possible biopsy because of an abnormal DRE result or increased PSA level was undertaken. All had prostate volume determined by biplanar endorectal ultrasound. One hundred sixty-six men had cancer confirmed by biopsy. This latter group was further analyzed and was divided into PSA <4.0, PSA 4 to 10, or PSA >10.0 ng/ml. Groups were divided according to those with PSAD <0.10, <0.12, and <0.15 ng/ml. Correlation with Gleason grade of the tumor was made. Of the 166 men with cancer, 15 had PSA levels <4 ng/ml (all palpable), and 81 had PSA levels between 4.0 and 10.0 ng/ml (48 were not palpable by digital rectal examination [DRE]). There were 38 (22.8%) of 166 men with cancer who had a PSAD <0.15. Using the Gleason scoring system, 30 of 38 men had mid-grade or high-grade cancers. Twenty-one (12.6%) of 166 men with cancer had a PSAD <0.12. Of these, 17 of 21 men had mid-grade or high-grade cancers. Fifteen (9.0%) of 166 men with cancer had a PSAD <0.10. Of these, 13 of 15 had mid-grade or high-grade cancer. If the PSA level is more than 4.0 ng/ml, even if no palpable lesion is discerned by DRE, suspicion for the presence of cancer should be raised. The use of PSAD threshold of 0.15 is not inclusive enough to identify clinically important cancer, and it should not be used. Our data demonstrate that 7.9% of men with cancer had a PSAD <0.15 and mid-grade or high-grade, i.e., clinically important, cancer. Although more negative biopsy results will be obtained, we recommend the use of a lower PSAD "cutoff" than the literature has suggested. We recommend that those men with PSA levels more than 4 ng/ml and a PSAD higher than 0.10 should undergo a prostate biopsy to detect clinically important cancer.     

Sonographic findings of Sister Mary Joseph’s nodule from ovarian cancer

Sister Mary Joseph’s nodule (SMJN), which is known as a malignant tumor metastasized to the umbilicus, is a rare condition. We report ultrasonic findings of SMJN secondary to ovarian cancer in a 66-year-old woman. The umbilical tumor was observed as a hypoechoic mass with punctate hyperechoic foci. A pathological specimen obtained by needle biopsy confirmed adenocarcinoma with psammoma bodies. A comparison of the ultrasonographic findings with the pathological findings of the resected specimen suggested that the hyperechoic foci corresponded to psammoma bodies. When hyperechoic foci are observed inside SMJN by ultrasonography, adenocarcinoma from ovarian cancer should be included in the differential diagnosis.     

Hurthle cell neoplasms of the thyroid: sonographic appearance and histologic characteristics

OBJECTIVE: The purpose of this study was to determine the sonographic features of Hürthle cell neoplasms (HCNs) of the thyroid. METHODS: We retrospectively analyzed the sonographic appearance of 15 histologically proven HCNs in 15 patients aged 16 to 70 years (mean age, 44 years). Sonographic features that were reviewed included the size and echogenicity of the tumors, the presence of cystic areas or calcifications, and detectable blood flow on color Doppler imaging. Correlation of sonographic findings with pathologic results was performed. RESULTS: The tumors ranged from 0.4 to 7 cm in diameter, but most were less than 3 cm in diameter. Four (27%) of the 15 tumors were homogeneously hypoechoic. Two tumors (13%) were predominantly hypoechoic with isoechoic areas to thyroid parenchyma. Two (13%) neoplasms were isoechoic to thyroid parenchyma. Four (27%) tumors were predominantly isoechoic, containing hypoechoic areas, and 3 (20%) tumors were hyperechoic. Three neoplasms contained cystic components. None of the tumors contained calcifications. One tumor was avascular on Doppler examination. One neoplasm showed only peripheral blood flow. Thirteen tumors showed internal vascularity, 7 of them with peripheral blood flow. Twelve HCNs were benign, and 3 were malignant on pathologic examination. CONCLUSIONS: Hürthle cell neoplasms show a spectrum of sonographic appearances from predominantly hypoechoic to hyperechoic lesions and from peripheral blood flow with no internal flow to extensively vascularized lesions. Pathologic criteria differentiating benign and malignant HCNs (absence or presence of a capsular breach, vascular or extrathyroidal tissue invasion, nodal involvement, and distant metastasis) are beyond the resolution of sonography and fine-needle aspiration biopsy and require removal of the entire lesion. This precludes diagnosis and characterization of HCNs by sonography.     

Ultrasonic multifeature tissue characterization for prostate diagnostics

A new system for prostate diagnostics based on multifeature tissue characterization is proposed. Radiofrequency (RF) ultrasonic echo data are acquired during the standard transrectal ultrasound (US) imaging examination. Nine spectral, texture, first order and morphologic parameters are calculated and fed into two adaptive neuro-fuzzy inference systems (FIS) working in parallel. The outputs of the FISs are fed into a postprocessing procedure evaluating contextual information before being combined to form a malignancy map in which areas of high cancer probability are marked in red. The malignancy map is presented to the physician during the examination to improve the early detection of prostate cancer. The system has been evaluated on 100 patients undergoing radical prostatectomy. The ROC curve area using leave-one-out cross-validation over patients is A(Z) = 0.86 when distinguishing between hyperechoic and hypoechoic tumors and normal tissue and A(Z) = 0.84 when distinguishing between isoechoic tumors and healthy tissue, respectively. Tumors that are not visible in the conventional B-mode image can be located. Diagnosis of the prostate carcinoma using multifeature tissue characterization in combination with US imaging allows the detection of tumors at an early stage. Also, biopsy guidance and therapy planning can be improved.     

彩色多普勒超声鉴别甲状腺结节良恶性价值的再探讨

目的探讨彩色多普勒超声在甲状腺结节良恶性鉴别中的价值。方法回顾性分析857个以实性及实性为主的甲状腺结节,评估每个结节的彩色多普勒超声特征,包括血管模式和血供程度。根据结节大小及结节内部回声又各分成2个亚组(≤1cm组和>1cm组、极低/低回声组和中等/高回声组)。所有结节根据病理结果分成良性组和恶性组。经统计学检验,分析彩色多普勒超声特征在鉴别甲状腺良恶性方面的作用。结果 857个实性及实性为主的结节中,良恶性结节均以混合血管型为主,良性结节以高血供为主,恶性结节则以低血供为主。根据结节大小分组,恶性结节在≤1cm组和>1cm组中均以低血供为主,但结节变大,高血供所占比例上升;良性结节在≤1cm组中以低血供为主,在>1cm组中以高血供为主。根据内部回声分组,恶性结节在极低/低回声组和中等/高回声组中均以低血供为主;良性结节在极低/低回声组中以低血供为主,在中等/高回声组中以高血供为主。结论不同分组的血管模式和血供程度在良恶性结节中存在一定的重叠性,对鉴别甲状腺结节的良恶性意义有限。     

肝内胆管癌超声造影的增强特点

目的 探讨肝内胆管癌（ICC）超声造影的增强特点。 方法 13例ICC患者共13个病灶接受了超声造影检查（CEUS）。CEUS采用造影剂Sono Vue和低机械指数成像技术对比脉冲序列（CPS）。 结果 动脉期13个（100％）病灶呈不均匀增强。9个（69．2％）病灶为低增强，其中7个在周边见高回声的不规则环状增强。另外4个（30．8％）在动脉期显示为高（n=1）或等增强（n=3）。门静脉期全部病灶呈不均匀低增强，其中6个（46．2％）病灶低增强范围有所扩大。至延迟期全部病灶呈均匀低增强。 结论 ICC在CEUS各时相的增强模式具有特征性，对ICC的定性诊断可提供帮助。     

Color Doppler imaging of the prostate: important adjunct to endorectal ultrasound of the prostate in the diagnosis of prostate cancer

The purpose of this article is to evaluate color Doppler imaging (CDI) as an adjunctive tool to gray-scale ultrasound (US) in the diagnosis of prostate cancer and to correlate CDI-positive lesions to cancer grade. We retrospectively analyzed 619 consecutive patients who underwent prostate US, CDI, and biopsy because of abnormal digital rectal examination results or prostate-specific antigen levels. All had directed (into a specific lesion) biopsies or directed biopsies along with systematic four-quadrant or sextant biopsies, or systematic biopsy alone. Color Doppler imaging was compared with gray-scale findings and histologic results. There were 222 (35.9%) biopsy-proven cancers (n = 197) or prostatic intraepithelial neoplasia (n = 25). Of these, 106 (47.7%) had color-flow abnormalities. Of these 106 patients, 26 (24.5%), or 11.7% of all cancer patients, had relatively normal gray-scale US findings but had focal CDI abnormalities as the method of identification. Overall, 76.9% of these were moderate to high Gleason grades and were considered clinically significant lesions. Color Doppler imaging can identify a large number (11.7%) of clinically significant prostate cancers that are poorly seen by gray-scale US. Positive lesions on CDI are of clinical importance because 76.9% are histologically, moderately, or poorly differentiated. We recommend that CDI be used in all diagnostic and biopsy-guided US examinations of the prostate.     

Efficacy of including the transition zone in routine biopsies of the prostate in men at high risk

Prostate cancer originates in the outer gland in 80% of patients and in the transition zone (TZ) in 20%. Transition zone lesions have historically been the most difficult to identify. There have been discrepancies regarding the importance of routinely performing biopsies of the inner gland when performing biopsies of the outer gland. To determine how often TZ tumors were diagnosed as the sole area of cancer, and to determine how frequently TZ tumors contained higher-grade cancer than the outer gland, we attempted to assess the value of including the TZ in routine biopsies of the prostate when no lesions are seen by gray-scale ultrasound (US). A retrospective review of 619 consecutive ultrasound-guided biopsies divided the subjects into: 1) directed biopsies of specific US-identified lesions (N = 140); 2) directed biopsies of specific US-identified lesions and quadrants (N = 165) or sextants (N = 174), including the TZ; and 3) quadrant (N = 46) or sextant (N = 93) biopsies without a focal US-identified lesion. Overall, 185 patients (29.9%) with cancer were identified. Of these, 21.4% (N = 30) of men with US-identified, focal lesion biopsies alone had cancer. Of those men with cancer, 35.8% (N = 59) with US-identified lesions and quadrant biopsies had cancer; 37.4% (N = 65) of those with focal lesions and sextant biopsies had cancer; 23.9% (N = 11) of men without focal lesions but quadrant biopsies had cancer; 21.5% (N = 20) of men without focal lesions but with sextant biopsies had cancer. A total of 267 sextant biopsies were performed: 3.0% (N = 8) of these patients were found to have cancer in the TZ alone without involvement of the outer gland; 12.4% (N = 33) had TZ and outer gland cancers, of which 18.2% (N = 6) had a higher Gleason grade cancer in the TZ than in the outer gland. Routine sextant biopsies in lieu of quadrant biopsies, including the TZ, for men with or without focal lesions will yield a small increase in the number of prostate cancers diagnosed or may identify a higher grade of cancer than would be expected from using quadrant biopsies alone.