脂肪肉瘤彩色多普勒超声特征分析

目的 探讨脂肪肉瘤的超声声像图特征。方法 回顾性分析我院经手术切除病理证实为脂肪肉瘤的31例患者资料、超声声像图特征。结果 31例患者中,去分化脂肪肉瘤13例,高分化脂肪肉瘤10例,多形性脂肪肉瘤4例,粘液样脂肪肉瘤4例,肿瘤平均最大长径约(16.97±9.70)cm,病灶以等-高回声为主61.3%(19/31),回声分布不均匀90.3%(28/31),多表现为乏血供,以Adler血流分级为0级51.6%(16/31)和I级41.2%(14/31)为主。主要的病理亚型高分化脂肪肉瘤超声特征以高回声为主70.0%(7/10),去分化脂肪肉瘤则表现为低回声46.2%(6/13)和高回声30.8%(4/13)的双相模式。结论 脂肪肉瘤超声声像图表现具有一定的特征性,对于超声准确诊断该病能够提供一定的帮助。     

Retroperitoneal liposarcoma: MR characteristics and pathological correlative analysis

Background Liposarcoma is the most common primary retroperitoneal malignant neoplasm. However, preoperative diagnosis is a common problem due to lack of characteristic clinical presentations. It has been assumed that MRI, based on its high soft-tissue resolution, could discover and discern different subtypes of this tumor. Moreover, there has been little in the literature to compare the MRI features with pathological appearances of the retroperitoneal liposarcomas. Methods We retrospectively analyzed 19 cases of retroperitoneal liposarcoma (11 males and 8 females, aged 41–79 years) proved surgically and histologically. All patients underwent MRI examination before and after the administration of contrast agent. The MRI features and postoperative pathological appearances were studied correlatively. Results Nine cases were located in the anterior pararenal space, four cases in the posterior pararenal space and six cases in the perirenal space. Among all cases, ten cases were present in the right retroperitoneum and nine cases in the left. The average diameter of the tumors was 14.7 cm (range from 7.5 cm to 26 cm). The MR signal intensity of liposarcoma was heterogeneous and varied greatly, depending on the components of the tumor and the different histological patterns. There are five subtypes of retroperitoneal liposarcoma. Myxoid liposarcoma (n = 7) exhibited low signal intensity on T1W image and high signal intensity on T2W image. On histologic analysis, myxoid liposarcoma consists of a myxoid matrix as the predominant component and small amounts of mature fat. Enhanced solid tissues and thickened septa of myxoid liposarcoma were seen on post-contrast image. Well-differentiated liposarcoma (n = 5) presented in high signal intensity on T1W images, intermediate signal intensity on T2W images, drop-out signal intensity on fat-suppressed MR images; The enhanced tenuous septa and solid tissues were seen on post-contrast image. Round-cell liposarcoma (n = 2) and pleomorphic liposarcoma (n = 2) exhibited soft-tissue tumor signal intensity without characteristic fat signal. One case of round-cell liposarcoma appeared with intratumoral hemorrhage and invaded the inferior vena cava. Dedifferentiated liposarcoma (n = 3) exhibited small amounts of fatty components with a clear demarcation between fat and nonadipose solid tissue on MR images. One case of dedifferentiated liposarcoma invaded the kidney. Conclusion MRI can clearly demonstrate shape, margin, internal components and surrounding tissues. Different subtypes of retroperitoneal liposarcoma exhibited varying MRI features, depending on tumor histological components. MRI should be an ideal method for diagnosing retroperitoneal liposarcoma.     

下肢高分化及黏液型脂肪肉瘤的影像表现与病理分析

目的探讨下肢高分化及黏液型脂肪肉瘤影像学表现与病理学的关系,提高影像诊断准确率。方法回顾分析12例下肢脂肪肉瘤的影像学表现,与术后病理类型进行对照分析。结果8例高分化型脂肪肉瘤边界清楚,T,WI及T2WI呈高或稍高信号,内部分隔厚度〉2mm;CT为均匀低密度,分隔轻中度强化。病理见较多分化好的脂肪细胞。4例黏液型边界大部分清楚,T,WI等低信号,3例夹杂少许高信号脂肪影,T2WI以高信号为主,内见多房分隔：CT上呈等、低混杂密度,不均匀团片样、云絮状强化,实性成分及粗大间隔强化明显。病理上疏散黏液中见短梭形细胞或单泡状脂母细胞。结论高分化型脂肪肉瘤影像学表现典型,多数黏液型脂肪肉瘤伴有少量脂肪,MRI及CT在一定程度上能反映肿瘤的分化程度。     

Sonographic appearance of parotid glands in patients treated with intensity-modulated radiotherapy or conventional radiotherapy for nasopharyngeal carcinoma

This study aimed to investigate and compare the sonographic appearances of parotid glands in nasopharyngeal carcinoma patients treated with conventional radiotherapy (RT) or intensity-modulated radiotherapy (IMRT), and to compare them with healthy subjects. Totally 43 patients treated with conventional RT, 38 patients treated with IMRT and 58 healthy subjects were recruited and underwent parotid ultrasonography. Parotid glands were assessed for their size, echogenicity and internal architectures. The mean transverse dimension of parotid glands in patients treated with conventional RT and those treated with IMRT were significantly smaller than that in healthy subjects (p < 0.05). Parotid glands of the IMRT group tended to be hyperechoic (93%), homogenous (62%), without hypoechoic areas (64%) and with marginally-seen intra-parotid ducts (89%), which are similar to those in healthy subjects. Parotid glands in the conventional RT group tended to be hypoechoic (51%), heterogeneous (98%), with hypoechoic areas (94%) and had obviously-seen intra-parotid ducts (64%). For accurate diagnosis, post-RT changes of parotid glands should be noted in ultrasound examination of patients with previous radiotherapy. (E-mail: htmying@polyu.edu.hk)     

Retroperitoneal liposarcoma: sonographic findings

This study, based on sonographic (US) results of 10 cases with histologically proven retroperitoneal liposarcoma (eight well-differentiated and two pleomorphic types), shows that the presence of fine echogenic lines within the tumor is a useful sign for diagnosing a well-differentiated liposarcoma. Presence of numerous fine fibrous septa in the lipomatous tumor tissue is thought to be responsible for this interesting phenomenon. Of interest is the fact that the direction of these lines changed according to the probe format used: parallel horizontal lines when using a linear probe and concentric lines converging toward the probe when using a sector or curved linear probe. In contrast, pleomorphic liposarcoma does not show this US sign. Knowledge of these US findings is useful for the diagnosis of retroperitoneal liposarcoma. Received: 10 January 2000/Accepted: 9 February 2000     

Investigation of Sonographic Criteria for Reliable Identification of T1–T2 Low-Grade Malignant Tumors of the Parotid Gland

The aim of this study was to investigate sonographic findings of low-grade malignant tumors of the parotid gland. The sonographic findings of all patients treated for T1–T2 low-grade carcinomas of the parotid gland between 2003 and 2018 were retrospectively examined and compared with those of patients with pleomorphic adenomas for the following parameters: definition of tumor margins, echotexture, echogenicity, shape and vascularization. Statistical analysis was performed using the χ² test. A p value of <0.05 was considered statistically significant. A total of 310 patients (62 with T1–T2 low-grade malignant tumors, 248 with pleomorphic adenomas) were evaluated. Our analysis detected a statistically significant difference in the definition of margins, echotexture, echogenicity and shape. Furthermore, we could detect a specific pattern (anechoic islets in a small hypoechoic lesion with distal enhancement) appearing far more frequently in low-grade malignant lesions. It seems that there is still potential to reduce the incidence of the false working hypothesis “benign lesion” on imaging of low-grade malignant tumors.     

Suture granulomas: sonography enables a correct preoperative diagnosis

The purpose of this study was to examine if suture granulomas display distinct sonographic signs and if these signs enable an accurate preoperative diagnosis. In a retrospective and prospective study, the sonographic findings of 22 consecutive suture granulomas were investigated and correlated with subsequent operative results. The sonographic appearance of various surgical sutures in a water bath was also investigated. Sonography was performed with commercially available 5- to 13-MHz linear transducers. The sonographic findings of the suture granulomas included hypoechoic lesions in all cases and hyperechoic double or single lines within the hypoechoic lesions in 20 of 22 cases. Sonography enabled the correct preoperative diagnosis for the investigating radiologists in 20 cases. The sonographic appearance of sutures in a water bath was that of hyperechoic double or single lines. The sonographic signs of suture granulomas (hyperechoic double or single lines within hypoechoic lesions) indicate the correct preoperative diagnosis in a high percentage of cases.     

Sonographic findings of immunoglobulin G4-related sclerosing sialadenitis

Purpose

We evaluated the sonographic findings of immunoglobulin G4-related sclerosing sialadenitis (IgG4-SS).

Methods

Nineteen patients with IgG4-SS and 12 healthy volunteers (controls) were enrolled. The following sonographic features were evaluated: (1) enlargement of the submandibular gland by measurement of the longitudinal diameter and thickness; (2) the contour texture of the submandibular gland (smooth or rough); (3) the internal echo texture, categorized into three sonographic patterns (homogeneous, multiple hypoechoic nodule, and diffuse hypoechoic); and (4) quantitative color Doppler signaling.

Results

The longitudinal diameter and the thickness (mean ± SD) of the submandibular gland were significantly greater in patients than in controls (p = 0.005 and p < 0.001, respectively). Contour roughness was seen in 62.9 and 8.3 % of patients and controls (p < 0.001), respectively. Homogeneous echo textures alone were seen in controls, whereas multiple hypoechoic nodule patterns were seen in 60 % of the patients, and diffuse hypoechoic patterns were seen in 40 %. Color Doppler signaling (mean ± SD) was significantly higher in patients as compared with controls (p < 0.001).

Conclusion

Patients could be distinguished from healthy volunteers using four distinctive sonographic findings, suggesting that ultrasonography would be a useful diagnostic tool for IgG4-SS.

     

Breast and Scrotal Sparganosis

Objective. Sparganosis is caused by the tapeworm larva of the geneus Spirometra. Because sparganosis usually manifests as a migrating subcutaneous mass, sonography can play an important role in its diagnosis. Methods. In this series, we investigated 4 cases of subcutaneous sparganosis and focused on the sonographic findings. Three of the cases involved the breast, and the other involved the scrotum, as confirmed by surgery. Results. The characteristics of subcutaneous sparganosis included a poorly defined hyperechoic lesion with internal serpiginous tubular structures, anechoic serpiginous tubular structures with a surrounding hyperechoic lesion, and an elongated hyperechoic mass with a hypoechoic nodular lesion in the central portion. Conclusions. We suggest that a mass combined with a hypoechoic tubular structure should raise the suspicion of subcutaneous sparganosis.     

High-frequency endoluminal ultrasonography of the esophagus in human autopsy specimens

A 20 MHz ultrasound transducer housed in a 6.2 Fr catheter was used to image human esophageal autopsy specimens from six cadavers. Histologic sections taken from the areas imaged were correlated with cross-sectional sonographic images. Six echo layers were seen in the non-fluid-filled esophagus whereas seven echo layers were seen in the fluid-filled esophagus. These seven layers correspond to the following histologic structures: first hyperechoic layer--mucosa (including squamous epithelium and lamina propria); second thin hypoechoic layer--muscularis mucosae; third very bright hyperechoic layer--submucosa; fourth hypoechoic layer--circular smooth muscle; fifth thin hyperechoic layer--intermuscular connective tissue; sixth hypoechoic layer--longitudinal smooth muscle; seventh hyperechoic layer--adventitia.     

Sono-myography and Sono-myoelastography of the Tender Points of Women with Fibromyalgia

Sono-myography and sono-myoelastography have been found useful in the investigation of myofascial trigger points. The objective of this study was to use the same techniques to investigate the morphology, stiffness and blood flow of tender points in women with fibromyalgia and to compare the results with those for samples from healthy patients. Algometry tests indicated significant differences between groups (p < 0.001). Elliptical and hypoechoic areas were observed in the ultrasound images of the upper trapezius in both groups. No differences between groups were found in the number of hypoechoic areas (p = 0.167, t = 1.008); blood flow also did not differ between the groups. Larger hypoechoic areas were found in the fibromyalgia group (p = 0.139, t = 1.317). Sono-myoelastography did not reveal greater stiffness in these areas compared with the rest of the muscle. These results lead us to believe that sono-myoelastography and sono-myography, used in the diagnosis of myofascial trigger points, may not be able to discriminate tender points.     

肾上腺髓样脂肪瘤的超声诊断

目的 探讨肾上腺髓样脂肪瘤的声像图特点和超声诊断价值.方法 回顾性分析10例经病理证实的肾上腺髓样脂肪瘤患者超声表现,对病变的大小、包膜、内部回声特点及血流特点进行总结.结果 1例左肾上腺病变漏诊,其余9例的声像图特点为边界清晰,形态基本规则,内部呈均匀中等强回声或中等强回声与低回声相间,肿瘤内部未见无回声区,内部未测及血流信号.结论 肾上腺髓样脂肪瘤具有特征性的声像图表现,超声检查可作出正确诊断.     

实时剪切波弹性成像定量评价颈动脉粥样硬化斑块

目的 应用剪切波弹性成像技术（SWE）定量评估颈动脉粥样硬化斑块软硬度。方法 对183例颈动脉粥样硬化斑块患者行SWE检测,获得不同回声颈动脉粥样硬化斑块的平均、最小和最大弹性模量值,比较不同位置（前壁、后壁和侧壁）的强回声斑块和低回声斑块的弹性模量值。结果 共检出强回声斑块133个,低回声斑块128个;强回声斑块的平均、最小、最大弹性模量值分别为（52.67±14.09）kPa、（40.94±15.94）kPa和（62.39±20.38）kPa,低回声斑块分别为（16.83±6.47）kPa、（10.14±5.82）kPa和（24.76±8.56）kPa,差异均有统计学意义（P均<0.01）。前壁、后壁和侧壁斑块间强回声斑块以及低回声斑块的平均、最小、最大弹性模量值差异均无统计学意义（P均>0.05）;2名操作者测得的弹性模量值的差异无统计学意义（P均>0.05）。结论 SWE可根据弹性模量值评价斑块软硬度,为定量评估动脉粥样硬化斑块提供更多信息。     

Sonography of Fat Necrosis Involving the Extremity and Torso With Magnetic Resonance Imaging and Histologic Correlation

Objective. The purpose of this study was to describe the sonographic appearance of pathologically proven isolated fat necrosis involving the extremities or torso with magnetic resonance imaging (MRI) correlation. Methods. A query of the Department of Pathology database at our institution for the diagnosis of fat necrosis resulted in 1539 cases. Review of the cases and medical records excluded cases without sonographic imaging, those involving the breast, and those within or adjacent to a primary process, including masses or prior surgery, which resulted in a total of 5 cases of primary fat necrosis, 2 of which were evaluated with MRI. Sonograms were reviewed by 2 musculoskeletal radiologists and characterized with regard to location, echogenicity, shadowing, posterior through‐transmission, a hypoechoic rim or halo, definition of borders, homogeneity, a mass effect, and vascularity. The patient medical records, histologic results, and MRI findings were also reviewed. Results. Of the 5 cases of isolated fat necrosis, 2 involved the torso and 3 the lower extremities. On sonography, all were located in the subcutaneous fat; 2 were isoechoic; 3 were hyperechoic; 2 had a hypoechoic halo; none showed shadowing or posterior through‐transmission; 2 were well defined; 3 were masslike; 4 were heterogeneous; and 2 showed increased flow on color or power Doppler imaging. Magnetic resonance imaging showed an intermediate signal and either diffuse or ring enhancement. Conclusions. Isolated fat necrosis of the extremities and torso had 2 sonographic appearances, which included a well‐defined isoechoic mass with a hypoechoic halo and a poorly defined hyperechoic region in the subcutaneous fat.     

肉芽肿性小叶性乳腺炎超声表现

目的探讨肉芽肿性小叶性乳腺炎(GLM)的高频超声图像特征。方法对23例以乳腺包块就诊,经术前超声及手术病理证实为GLM患者的病例资料进行回顾性分析。在灰阶声像图上观察肿块大小、形状、边界、内部回声及后方回声。应用彩色多普勒血流成像(CDFI)观察病灶内部及其周围血流分布和供应情况。结果23例GLM患者(均经手术后病理证实)均为经产妇,年龄20～43岁。灰阶声像图显示12例表现为连续或不连续的不规则管状结构样低回声区,低回声区周围为高回声;5例表现为单发或多发、边界相对清楚、不均质低回声结节或肿块,其内可伴无回声区;5例表现为病变区腺体结构紊乱,未见明确边界,内部回声强弱不一,病变内可见无回声区;1例表现为边界模糊、形态不规则的低回声实质肿块伴后方回声衰减。23例中患处皮肤层增厚8例,6例伴有皮肤破溃,窦道形成。CDFI示22例(22/23)病变内部及周边动静脉血流信号明显增加。结论GLM病变的超声表现具有一定的特点,但这些表现不具有特征性,确诊仍需病理学检查。     

Focal hepatic fatty infiltration as a cause of pseudotumors: ultrasonographic patterns and clinical differentiation

Focal hepatic fatty infiltration may be mistaken for hepatic neoplasm on ultrasonography. A sonographic feature mimicking "space occupying lesions" was identified in 41 cases with focal fatty liver, which led to the recognition of four sonographic patterns: (1) Ten patients in whom the livers were characterized by irregular configurations of hyperechoic and hypoechoic areas. Although confusing to inexperienced sonographers, all of them were properly interpreted by experienced sonographers. (2) One patient in whom the hepatic sonography revealed a hyperechoic nodule, but which was correctly diagnosed by computed tomography (CT) scan. (3) Six patients in whom the livers were characterized by multiple confluent hyperechoic lesions, which were all misinterpreted by sonographers and misinterpreted following CT scans in 4 cases and angiography in 3 cases. (4) Twenty-four patients in whom the livers revealed focal spared areas, which was misdiagnosed by sonographers in 14 cases, but correctly diagnosed by CT scan in all 24 cases.     

Myxoid liposarcoma of the spermatic cord: US and MR imaging findings

We report a patient with myxoid liposarcoma of the spermatic cord in whom combined use of both ultrasound (US) and MRI helped to suggest the diagnosis. The lesion was solid at US and vascularized at color Doppler. T1‐weighted MRI did not show fat within it; on T2‐weighted images it had high signal intensity, with a cyst‐like appearance. It is known that fat‐poor myxoid liposarcomas with high water content may mimic a cystic lesion on non‐contrast‐enhanced MR; then, a combination of MRI findings, suggesting a cyst, and of US findings, showing the mass was actually solid and vascularized, allowed preoperatively the diagnosis of fat‐poor myxoid liposarcoma. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :96–99, 2014     

Ultrasonic evaluation of benign and malignant nodules in echographically multinodular thyroids

In 165 patients with ultrasound findings of multinodular thyroids in whom thyroid resection was performed, sonographic features and pathohistologic findings of removed nodules were analyzed. Of 426 nodules removed, 70 were carcinomas and 356 benign. Carcinomas are more often hypoechogenic (p < 0.01) and contain nodular calcifications (p < 0.01), while benign nodules are more often iso-hyperechogenic (p < 0.01), showing intranodular cystic degenerative changes (p < 0.01), showing intranodular cystic degenerative changes (p < 0.01) and perinodular hypoechogenic rim (p < 0.01). Mean diameter of carcinomatous nodules is lwoer than in benign nodules (p = 0.022). The relative proportion of malignant nodules is highest in the upper halves of thyroid lobes (p < 0.01). Although certain sonographic signs increase the likelihood of a given lesion being malignant or benign, the lack of absolute specificity in the ultrasound evaluation of thyroid nodules was confirmed. © 1994 John Wiley & Sons, Inc.     

Effectiveness of Contrast-Enhanced Ultrasonography for the Characterization of Small and Early Stage Pancreatic Adenocarcinoma

The purpose of this retrospective study is to evaluate the effectiveness of contrast-enhanced ultrasonography for the characterization of small and early stage pancreatic adenocarcinoma. Contrast-enhanced ultrasonography and contrast-enhanced computed tomography (CT) were performed in 200 cases, with pancreatic hypoechoic regions detected with ultrasonography. Assuming that hypo-enhancement was indicative of pancreatic adenocarcinoma, the sensitivity of each imaging modality was calculated. The sensitivities of contrast-enhanced ultrasonography and contrast-enhanced CT to characterize adenocarcinoma were 97.0% and 77.0% (p < 0.0001) for all 100 adenocarcinoma cases, 100% and 76.7% (p = 0.0016) for 43 small (≤20 mm) cancers, 100% and 58.3% (p = 0.0253) for 12 smaller (≤10 mm) cancers and 100% and 72.2% (p = 0.0016) for 36 stage IA cancers, respectively. The sensitivity of contrast-enhanced ultrasonography was sufficiently high and significantly superior to that of contrast-enhanced CT. Contrast-enhanced ultrasonography is a sensitive tool for selecting highly possible pancreatic adenocarcinoma lesions without overlooking early stage tiny adenocarcinomas among a large number of hypoechoic lesions detected with ultrasonography.     

Sonographic appearances of Morton's neuroma: differences from other interdigital soft tissue masses

The purpose of the study was to evaluate the ultrasonographic characteristics of Morton’s neuroma (MNs) and the usefulness of the “ginkgo leaf sign” for differentiating MNs from other interdigital soft tissue masses. The inclusion criteria were 27 patients with the masses in the intertarsal region with surgical proof. Fourteen masses in the 10 patients (mean age, 46) were MNs and nine cases of nine patients were ganglion cysts, seven cases (seven patients) of epidermoid tumors and one case of fibroma were included. Ultrasonographic examinations were performed by a musculoskeletal radiologist using the HDI 5000 (Philips, Bothell, WA, USA) or the Logiq E9 (GE Medical Systems, Milwaukee, WI, USA) equipped with a linear 6-15 MHz probe, and the findings were interpreted in consensus by two musculoskeletal radiologists. The ultrasonographic findings such as margin, size, echogenicity and deepness of the MNs were compared with those for other interdigital soft tissue masses. The ginkgo leaf sign was defined as the appearance of a biconcave shape of the mass from compression by adjacent structures. The mean size of the MNs was 5.6 mm. There was a significant difference in incidence between males and females (female dominant, p = 0.003). There was no difference in incidence with regard to age (p = 0.259). All lesions were hypoechoic (100%, 14/14) and 10 cases exhibited the ginkgo leaf sign (71%, 10/14, p < 0.001). The lesions were either well marginated (43%, 6/14) or poorly marginated (57%, 8/14, p = 0.075). None of the lesions abutted adjacent bony structures (p < 0.001). Interdigital MNs are primarily found in middle-aged women and often demonstrate the ginkgo leaf sign. MNs are hypoechoic and do not abut adjacent bony structures. Based on our findings, we believe ultrasound of interdigital soft tissue masses may provide useful information with respect to their location to adjacent soft tissue structures. Detection of our Gingko leaf sign may be specific for Morton’s neuromas and more studies are needed to confirm its value as a sonographic sign.