超声弹性成像诊断老年肝脏局灶性病变的临床价值

目的探讨超声弹性成像对老年肝脏局灶性病变的诊断价值。方法选择疑似肝脏局灶性病变老年患者127例(144个病灶),术前或病变穿刺前均行常规超声检查及超声弹性成像,然后手术取出病灶或穿刺病灶行病理检查。以病理结果为金标准,观察常规超声检查及超声弹性成像诊断与病理结果的一致性,比较常规超声检查及超声弹性成像诊断肝脏恶性肿瘤的敏感性、特异性、准确性。结果 144个病灶经手术或穿刺病理检查共发现肝脏恶性病灶86个,良性病灶58个。常规超声检查诊断恶性病灶78个,良性病灶66个,其诊断与病理检查结果基本一致(Kappa=0.686)。超声弹性成像检查发现恶性肿块81个,良性病灶63个。其诊断与病理检查结果高度一致(Kappa=0.865)。超声弹性成像诊断肝脏恶性肿瘤敏感性、特异性、准确性分别为86.0%、87.9%、86.8%,常规超声检查分别为72.1%、72.4%、72.2%;两者比较差异均有统计学意义(P均<0.05)。结论超声弹性成像对老年肝脏局灶性病变的诊断有重要价值。     

超声弹性成像与超声造影诊断肝脏占位性病变性质价值分析

目的 探讨超声弹性成像与超声造影（CUES）对肝脏占位性病变性质的鉴别诊断价值。方法 2015年1月~2016年12月我院诊治的肝局灶性病变患者186例（206个病灶）。所有的受试者均接受超声造影和超声弹性成像检查,参照欧洲肝脏超声造影指南（2012版）标准进行肝局灶性病变良恶性的鉴别诊断。应用ROC曲线下面积判断指标诊断的效能。结果 在186例肝脏占位性病变患者中,肝左右叶病灶126例,肝左叶病灶29例,肝右叶病灶31例;超声共发现病灶206个,其中良性病灶78个（37.9%）,恶性病灶128个（62.1%）。在78个良性病灶中,血管瘤51个,肝脓肿10个,错构瘤4个,结节性增生5个,炎性假瘤8个。在128个恶性病灶中,原发性肝癌124个,转移癌4个;超声造影检查诊断的ROC曲线下面积为0.967,显著优于超声弹性成像检查的0.803（P<0.05）,超声造影检查诊断的敏感性、特异性和准确性分别为95.6%、98.6%和96.8%,显著优于超声弹性成像检查的89.1%、76.8%和84.4%（P<0.05）。结论 CUES检查对判断肝占位性病变的性质具有较高的诊断效能,与超声弹性成像检查具有协同作用,临床医师可以通过这些检查确定肝内病灶的性质。     

常规超声和超声造影在肝脏良恶性局灶性病变鉴别诊断中的价值对比

目的探讨常规超声和超声造影在肝脏良恶性局灶性病变鉴别诊断中的价值对比。方法回顾性分析常规超声和超声造影检查的230例肝脏良恶性局灶性病变患者共246个病灶的临床资料,比较两种检查方法鉴别诊断肝脏良恶性局灶性病变的效能。结果在246个病灶中,常规超声诊断得出肝脏局灶性病变良性结果53个,肝脏局灶性病变恶性结果136个,共准确诊断189个;超声造影诊断得出肝脏局灶性病变良性结果88个,肝脏局灶性病变恶性结果144个,共准确诊断232个。常规超声和超声造影对肝脏局灶性病变良恶性诊断的敏感度(91.3%,96.6%)、特异度(54.6%,90.7%)、阳性预测值(75.6%,94.1%)、阴性预测值(80.3%,94.6%)及准确性(76.8%,94.3%),除敏感性外,其余指标差异均有统计学意义(均P0.05)。结论在肝脏良恶性局灶性病变鉴别诊断中,超声造影的出现和发展为肝脏良恶性局灶性病变的鉴别诊断提供了新的途径,与常规超声鉴别诊断相比较,具有更高的诊断效能。     

超声造影时间-强度曲线诊断老年肝脏局灶性病灶的临床观察

目的探讨超声造影时间-强度曲线(TIC)诊断老年肝脏局灶性病灶临床应用价值。方法选取80例老年肝脏局灶性病灶患者为研究对象,所有对象行超声造影、穿刺活检或手术病理诊断,将穿刺活检或手术病理诊断结果作为"金标准",分析超声造影诊断灵敏度、特异度、准确度、阳性预测值及阴性预测值,并观察肝脏局灶性病灶超声造影增强模式、良恶性病灶TIC声学定量指标。结果经穿刺活检或手术病理诊断得知,80例老年肝脏局灶性病灶患者中26例确诊为恶性,12例原发性肝癌,14例肝转移癌;54例确诊为良性,32例肝血管瘤,16例肝硬化再生结节,6例局灶性结节性增生。依据穿刺活检或手术病理诊断"金标准",超声造影诊断灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为92.31%、94.44%、93.75%、88.89%、96.23%;超声造影诊断与穿刺活检或手术病理诊断结果具有极好的一致性(Kappa=0.859)。原发性肝癌、肝转移癌超声造影多以不均匀增强模式为主,肝血管瘤以向心性增强模式为主,肝硬化再生结节、局灶性结节性增生均为等增强模式。良恶性病灶强度增量比较,差异无统计学意义(P0.05);良性病灶增强时间明显高于恶性病灶,上升支斜率、下降支斜率均明显低于恶性病灶,差异均有统计学意义(均P0.05)。结论超声造影诊断老年肝脏局灶性病灶具有良好应用价值,可有效区分病灶良恶性,而不同类型病灶超声造影增强模式不同,且良恶性病灶TIC声学定量指标存在差异。     

超声造影在肝脏局灶性病变鉴别诊断中的应用分析

目的 探究超声造影在肝脏局灶性病变鉴别诊断中的临床应用效果.方法 我院经超声造影诊断为肝脏局灶性病变的患者中,选取64例作为此次调查的对象,术前超声发现93个病灶,按照病例的结果 ,比较超声造影与病例结果 的符合率.结果 经过穿刺活检,或者手术切除后的病理检查结果 显示,良性病灶31个,恶性病灶62个.其中,常规超声检查:良性病灶25个,符合率为80.64%,恶性病灶32个,符合率为51.61%;敏感性为56.14%,特异性为44.64%.而超声造影检查:良性病灶27个,符合率为87.09%,恶性病灶59个,符合率为95.16%;敏感性为92.18%,特异性为90.0%.结论 对于肝脏局灶性病变鉴别诊断中,超声造影能够提供准确可靠的依据,且敏感性和特异性较高,值得推广.     

超声造影对老年肝硬化合并肝内局灶性小病灶的诊断价值

目的探讨超声造影对老年肝硬化合并肝内局灶性小病灶(≤3.0cm)患者的诊断价值。方法收集2013年4月—2015年4月我院收治的老年肝硬化合并肝内局灶性小病灶(≤3.0cm)患者的临床病历资料。以病理诊断结果为"金标准",比较超声造影与常规超声对老年肝硬化合并肝内局灶性小病灶(≤3.0cm)的诊断价值。结果 73例老年肝硬化合并肝内局灶性小病灶(≤3.0cm)患者经病理检查结果证实共有95个小病灶,良性病变37个,恶性病变58个。超声造影诊断老年肝硬化合并肝内局灶性小病灶(≤3.0cm)的灵敏度、特异度、阳性预测值、阴性预测值以及准确率分别为91.89%、93.10%、89.47%、94.74%以及92.63%,常规超声的灵敏度、特异度、阳性预测值、阴性预测值以及准确率分别为72.97%、81.03%、69.23%、82.14%及76.84%,超声造影对老年肝硬化合并肝内局灶性小病灶(≤3.0cm)的诊断价值高于常规超声,差异有统计学意义(P0.05)。结论超声造影对老年肝硬化合并肝内局灶性小病灶(≤3.0cm)具有诊断价值高的特点,有重要的临床参考价值。     

超声造影对肝脏局灶性病变诊断价值的研究

目的探讨超声造影对肝脏局灶性病变的诊断价值。方法收集2013年7月至2015年6月于广西南宁市第二人民医院经病理确诊为肝脏局灶性病变的68例患者,所有患者均接受常规超声及超声造影检查,分析超声造影对肝脏局灶性病变的诊断价值。结果 (1)动脉期24例HCC患者超声造影可见瘤内血管,以瘤内血管作为HCC超声造影诊断标准,其准确率为77.42%;门静脉期26例HCC可见均质或不均质增强,以其作为诊断HCC标准,准确率为83.87%;延迟期以血管充填作为良性病灶诊断标准,其诊断准确率高达81.82%。(2)恶性病变增强开始时间[(14.87±4.68)s]短于良性病变[(18.12±5.78)s],抵达增强峰值时间[(34.08±10.26)s]短于良性病变[(81.62±32.31)s],其增强减退时间[(71.64±17.48)s]同样短于良性病变[(313.54±105.21)s],差异均有统计学意义(P0.05)。(3)超声造影后,良性病灶显示率自27.27%提高至63.64%,造影前后良性病灶血流显示率对比差异有统计学意义(P0.05),46例恶性病灶血流显示率自60.87%上升至86.96%,对比差异有统计学意义(P0.05)。结论超声造影对良恶性病变血流显示率高,且恶性病变者增强开始时间、抵达峰值时间与消退时间均快于良性病变,可将其作为良恶性肝脏病变鉴别诊断的依据。     

超声造影在肝脏局灶性病变良恶性诊断中的临床价值

目的:进一步研究超声造影在肝脏局灶性病变良恶性鉴别诊断中的价值.方法:选取肝局灶性病变患者262例为研究对象,行常规超声和超声造影检查,并与病理结果做对比.结果:常规超声及超声造影诊断肝脏局灶性病变良恶性的敏感性、特异性、阳性预测值、阴性预测值、诊断符合率分别为88.8%、75.2%、76.6%、88.0%、81.7%及99.2%、98.5%、98.4%、99.3%、98.8%,二者比较差异有统计学意义(P0.05).超声造影与病理诊断一致性较好(Kappa=0.976).结论:超声造影提高了对肝脏局灶性病变的定性诊断能力,具有重要临床价值.     

超声内镜弹性成像在良恶性胰腺病变鉴别中的应用价值

目的:探讨超声内镜弹性成像(endoscopic ultrasound,EUS)在胰腺占位病变良恶性鉴别中的应用价值.方法:影像学结果并经超声内镜检查确定有胰腺占位性病变的患者入选,对目标病变行超声内镜弹性成像检查,按照弹性成像5分法对组织弹性成像进行评分,将弹性成像评分为12分归为良性,3-5分归为恶性病变.结果:自2009-06/2011-06,共27例符合标准的胰腺占位病变患者入选,其中胰腺癌19例,超声内镜弹性成像评分3分(n=11)、4分(n=5)、5分(n=3),无功能性良性内分泌肿瘤(4分)及低度恶性神经内分泌肿瘤(5分)各1例,炎性病变6例,评分1分(n=1)、2分(n=3)、3分(n=2).超声内镜弹性成像对27例胰腺占位病变良恶性鉴别中24例诊断准确,诊断灵敏度100%,特异度57.14%,阳性预测值86.96%,阴性预测值100%.结论:超声内镜弹性成像对胰腺良恶性病变的鉴别具有较高的准确性,可望为疾病诊断提供新的影像学手段,但其仍为一种影像学手段,具有一定的局限性,并不替代胰腺的细胞病理学检查.     

超声造影诊断肝脏局灶性病变(直径≤3 cm)的价值研究

目的对直径≤3 cm的局灶性肝脏病变进行超声造影检查,并探讨该方法对肝脏疾病诊断的指导意义。方法回顾性分析我院2014年8月至2016年8月收治的68例肝脏局灶性病变患者的临床资料,根据患者的病灶直径大小进行分组,并进行超声造影检查,记录分析结果,并与最终的诊断对比分析。结果超声造影检验对肝内局灶性病变的准确率为95.6%,敏感性为95.7%,特异性为95.6%,阳性预测值为91.7%,阴性预测值为97.7%;对不同直径的病灶病理检查发现,不同直径(0~1、1~2和2~3 cm)的病灶良恶性的比例无显著差别(P0.05);不同时相的造影结果显示,门静脉期中,1~2 cm的超声造影增强强度低的比例显著少于2~3cm病灶组,差异有统计学意义(P0.05),动脉相与延迟相的比较,两组病灶的增强强度无显著差异(P0.05)。结论超声造影对于≤3 cm的肝内局灶性病灶诊断价值较高,而门静脉期时,直径≤2 cm的肝内恶性病灶的影像学表现不典型,进行诊断时需结合其他临床表现及辅助检查。     

Comparison of the background echotexture between automated breast ultrasound and handheld breast ultrasound

This study aimed to compare the background echotexture (BE) between automated breast ultrasound (ABUS) and handheld breast ultrasound (HHUS) and evaluate the correlation of BE with mammographic (MG) density and background parenchymal enhancement (BPE) on magnetic resonance imaging (MRI). A total of 212 women with newly diagnosed breast cancer who had undergone preoperative ABUS, HHUS, MG, and MRI were included. Two breast radiologists blinded to the menopausal status analyzed the BE of the contralateral breasts of the patients with breast cancer in consensus. The MG density and BPE of breast MRI on the radiologic reports were compared with the BE in the ultrasound. We used the cumulative link mixed model to compare the BE and Spearman rank correlation to evaluate the association between BE with MG density and BPE. BE was more heterogeneous in ABUS than in HHUS (P < .001) and in the premenopausal group than in the postmenopausal group (P < .001). The heterogeneity of BE in the premenopausal group was higher with ABUS than with HHUS (P = .013). BE and MG density showed a moderate correlation in the postmenopausal group, but a weak correlation in the premenopausal group. BE and BPE showed moderate correlations only in the premenopausal group. ABUS showed a more heterogeneous BE, especially in the premenopausal group. Therefore, more attention is required to interpret ABUS screening in premenopausal women.     

Endoscopic ultrasound using ultrasound probes for the diagnosis of early esophageal and gastric cancers

Endoscopic ultrasound(EUS) devices were first designed and manufactured more than 30 years ago,and since then investigators have reported EUS is effective for determining both the staging and the depth of invasion of esophageal and gastric cancers.We review the present status,the methods,and the findings of EUS when used to diagnose and stage early esophageal and gastric cancer.EUS using high-frequency ultrasound probes is more accurate than conventional EUS for the evaluation of the depth of invasion of superficial esophageal carcinoma.The rates of accurate evaluation of the depth of invasion by EUS using high-frequency ultrasound probes were 70%-88% for intramucosal cancer,and 83%-94% for submucosal invasive cancer.But the sensitivity of EUS using high-frequency ultrasound probes for the diagnosis of submucosal invasive cancer was relatively low,making it difficult to confirm minute submucosal invasion.The accuracy of EUS using highfrequency ultrasound probes for early gastric tumor classification can be up to 80% compared with 63% for conventional EUS,although the accuracy of EUS using high-frequency ultrasound probes relatively decreases for those patients with depressed-type lesions,undifferentiated cancer,concomitant ulceration,expanded indications,type 0-Ⅰ lesions,and lesions located in the upper-third of the stomach.A 92% overall accuracy rate was achieved when both the endoscopic appearance and the findings from EUS using high-frequency ultrasound probes were considered together for tumor classification.Although EUS using high-frequency ultrasound probes has limitations,it has a high depth of invasion accuracy and is a useful procedure to distinguish lesions in the esophagus and stomach that are indicated for endoscopic resection.     

Ultrasound techniques in the evaluation of the mediastinum,part I: endoscopic ultrasound (EUS), endobronchial ultrasound (EBUS) and transcutaneous mediastinal ultrasound (TMUS), introduction into ultrasound techniques

Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography (EUS and EBUS) should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [EBUS combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [EUS fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all mediastinal lymph nodes can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review, in two integrative parts, is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part I is dealing with an introduction into ultrasound techniques, mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques and part II with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.     

Doppler ultrasound and the silent ductus arteriosus

A clinically undetectable, small ductus arteriosus was identified by Doppler ultrasonography in 21 individuals. Infants were excluded from the study and no patient had pulmonary hypertension. Persistence of the ductus arteriosus is likely to be more common than shown by less sensitive diagnostic methods. Some patients considered to have infective endocarditis with a normal heart may have a silent ductus arteriosus. Evidence of such an association would justify ligation or antibiotic cover as prophylactic measures.     

二维、三维超声对胎儿先天性心血管畸形筛查作用分析

目的：探讨二维、三维超声对胎儿先天性心血管畸形筛查作用,提高诊断效果。方法：采用随机抽样与回顾性研究方法,2013年1月到2016年4月选择在我院诊治的35例疑似胎儿心血管畸形的产妇作为研究对象,所有产妇都给予二维、三维超声,然后与病理检查结果进行对比分析,判断诊断效果。结果：在35例产妇中,病理检查结果显示出102处心脏异常情况,其中房室间隔异常35处,动脉心室连接异常28处,房室连接异常25处,动脉干异常14处。不过二维联合三维超声对各种类型心血管畸形的正确诊断率都高于二维超声(P<0.05)。二维超声检查对胎儿先天性心血管畸形的诊断敏感度、特异度、阳性预测值及阴性预测值分别为84.9%、50.0%、96.6%和16.7%,而二维联合三维超声检查分别为97.0%、100.0%、100.0%和66.7%,二维联合三维超声检查的敏感度、特异度、阳性预测值及阴性预测值都高于二维超声(P<0.05)。结论：超声检查在胎儿先天性心血管畸形诊断中具有重要的意义,二维联合三维超声检查有利于对心脏形态学进行客观评估,提高诊断效果,有很好的应用价值。     

超声波引导下压迫法与注射凝血酶法治疗心导管术后股动脉假性动脉瘤的比较

目的 :评价和比较超声引导下压迫法 (UGCR)和注射凝血酶法 (UGTI)治疗心导管术后股动脉假性动脉瘤 (PSA)的疗效和安全性。方法 :回顾性分析 2 1例心导管术后股动脉PSA的临床特征 ,以及序贯接受UGCR和UGTI法治疗的经过和结果。在彩色多普勒确定PSA后 ,UGCR法是用手压迫、加压包扎载瘤动脉近端和PSA颈部直至PSA瘤腔中血栓形成 ;UGTI法是超声波引导下将 18～ 2 0G针经皮穿刺使针头进入瘤腔内注射猪凝血酶。均于术后 2 4h、5～ 7d超声波复查。结果 :11例首次接受UGCR法治疗者中 4例成功 (首次成功率 36 .4 % ) ,5例接受重复压迫后有 1例成功 ,总成功率为 4 5 .5 % (5 / 11) ;UGCR治疗成功者的 5例中有 4例股动脉PSA最大直径 <2cm ,其中 2例接受抗凝剂治疗 ;在压迫中 10例有程度不等的局部不适、疼痛 ,有 8例在压迫中因局部疼痛而采用药物止痛 ,有 2例因出现血压增高、心绞痛发作而被迫放弃 ;UGCR治疗失败的 6例中 ,有 1例接受了外科手术治疗 ,5例改行UGTI治疗成功。采用UGTI治疗 15例股动脉PSA ,其中 10例首次接受UGTI治疗有 9例成功 (首次成功率 90 % ) ,6例为经重复UGTI治疗成功 ,UGTI总成功率为 10 0 %。单纯型PSA有 9例均一次性治疗成功 ,而 6例复杂型PSA需 2次或以上重复注射凝血酶。实际注射凝血酶剂     

Indications for ultrasound of the chest

Although ultrasound of the thorax has been used mainly for studying the heart, it is also of value for the examination of pathologic conditions in the chest other than cardiac disease and can be used to complement the diagnostic information obtained by other imaging techniques. In addition, ultrasound of the lower thorax is frequently performed "inadvertently" when the upper abdomen, the liver, and the heart are being examined sonographically. Pathologic lesions in the chest may be seen during such examinations and it is therefore important to be familiar with their appearances.