超声诊断涎腺腺样囊性癌

目的 探讨涎腺腺样囊性癌的声像图特点。 方法 结合病理特征,对经手术病理证实的36例涎腺腺样囊性癌的声像图表现进行回顾性分析。 结果 36例涎腺腺样囊性癌均为单发,实质呈低回声,其中22例(22/36,61.11%)肿瘤形态不规则,21例(21/36,58.33%)肿瘤边界不清,28例(28/36,77.78%)病灶内部回声不均匀,肿瘤血流信号少量及中等量各15例(15/36,41.67%)。超声定性诊断为恶性肿瘤的符合率为58.33%(21/36)。 结论 腺样囊性癌具有涎腺恶性肿瘤常见的灰阶声像表现,但彩色多普勒表现具有特征性。超声检查结合临床表现有助于正确诊断。     

18F-FDG PET/CT诊断肾细胞癌合并静脉瘤栓

目的 探讨PET/CT诊断肾细胞癌（RCC）合并静脉瘤栓的价值。方法 回顾性分析27例肾癌合并静脉瘤栓患者的PET/CT资料。将PET/CT瘤栓分级与临床分级进行对照,根据病理结果将患者分为瘤栓侵犯静脉壁组和未侵犯静脉壁组,分析2组原发肿瘤SUV_max、瘤栓SUV_max及下腔静脉最大径的差异。结果 PET/CT检出瘤栓27例,瘤栓检出率100%（27/27）,静脉瘤栓SUV_max平均6.98±5.50;PET/CT正确分级26例（26/27,96.30%）。8例合并下腔静脉血栓,PET/CT诊断准确率87.50%（7/8）,静脉血栓平均SUV_max为1.30±0.28。瘤栓SUV_max明显高于血栓（P<0.001）。2组肿瘤原发灶SUV_max、瘤栓SUV_max及下腔静脉最大径差异均无统计学意义（P均>0.05）。结论 PET/CT对RCC合并静脉瘤栓及血栓具有较高的检测准确率,瘤栓分级准确率较高,但评估瘤栓是否侵犯静脉壁的能力有限。     

彩色多普勒超声诊断恶性肿瘤合并颈内静脉血栓临床分析

目的总结恶性肿瘤合并颈内静脉血栓的超声表现。方法回顾性分析31例恶性肿瘤合并颈内静脉血栓患者的超声声像资料。结果超声诊断颈内静脉血栓30例,诊断准确率96.8%,1例误诊为淋巴结。颈内静脉血栓二维超声表现为静脉管径改变,腔内实质回声,加压探头管腔不能被压闭,深吸气屏气后静脉内径不增宽;彩色多普勒超声表现为腔内无血流信号或信号充盈缺损;脉冲多普勒未测及血流频谱或测及低速血流频谱。结论彩色多普勒超声有助于恶性肿瘤患者颈内静脉血栓的诊断。     

异位甲状腺的超声成像特征

  目的  探讨灰阶超声和彩色多普勒超声在异位甲状腺诊断中的应用价值。  方法  回顾性分析北京协和医院1997年9月至2014年5月收治的13例异位甲状腺患者的临床资料及超声图像资料, 对照核医学检查、手术及病理结果, 分析其超声图像特征。  结果  13例中9例行异位甲状腺切除, 病理结果示单纯异位甲状腺3例(23.1%), 异位甲状腺乳头状癌1例(7.7%), 异位甲状腺合并甲亢治疗后改变1例(7.7%), 合并结节性甲状腺肿2例(15.4%), 合并结节性甲状腺肿伴淋巴细胞性甲状腺炎1例(7.7%), 合并结节性甲状腺肿伴纤维化、钙化及腺瘤样增生1例(7.7%)。超声声像图显示13例(100%)异位甲状腺均边界清晰; 12例(92.3%)为形态规则的圆形、类圆形或椭圆形, 1例(7.7%)形态欠规则; 6例(46.2%)呈混合回声, 3例(23.1%)呈中等回声, 4例(30.8%)呈低回声; 6例(46.2%)为囊实性, 7例(53.8%)为实性。彩色多普勒显示10例(76.9%)内部可见较丰富血流信号, 2例(15.4%)内部可见条状血流信号, 1例(7.7%)内部可见点状血流信号。  结论  异位甲状腺具有典型的超声成像特征, 可为临床决策提供有价值的诊断信息。     

甲状腺转移癌的超声征象

  目的  探讨甲状腺转移癌的超声特征。  方法  回顾性分析本院1988年4月至2013年7月收治的10例甲状腺转移癌患者的临床资料, 分析其超声图像及超声报告, 记录并总结甲状腺转移癌的超声特征。  结果  1例肺癌及1例食管癌患者的转移灶表现为甲状腺增大, 弥漫性回声不均, 余8例表现为甲状腺结节。8例表现为甲状腺结节的超声特征:5例多发, 3例单发; 2例病灶累及右侧叶, 1例病灶累及左侧叶, 5例病灶累及双侧叶; 结节平均最大径为3.8 cm(0.6~6.6 cm); 5例边界不清, 3例边界尚清; 7例病灶形态不规则, 1例报告中未描述; 7例表现为低回声, 1例表现为高回声; 2例病灶为囊实性, 6例表现为实性; 6例伴点状、条状强回声, 1例无强回声, 1例报告中未描述; 彩色多普勒血流成像显示:4例病灶内血流丰富, 1例周边内部条状血流, 1例周边见少许血流信号, 1例无血流, 1例报告中未描述。甲状腺转移灶与原发病灶具有相似的超声特征。  结论  甲状腺转移癌超声表现多种多样, 多表现为甲状腺结节, 也可表现为弥漫性回声不均。结节的超声表现多为多发、体积较大、边界不清、形态不规则、实性、低回声、钙化、血流丰富。了解甲状腺转移癌的超声特征有利于可疑病例的发现。     

18F-FDG PET/CT诊断静脉瘤栓

目的 探讨¹⁸F-FDG PET/CT对静脉瘤栓的诊断价值。方法 回顾性分析34例静脉瘤栓患者的PET/CT资料,观察瘤栓放射性摄取程度及形态学改变,测量瘤栓及原发肿瘤的最大标准化摄取值（SUV_max）。按照美国Mayo Clinic瘤栓分级标准,采用PET/CT及增强CT分别对20例肾脏肿瘤导致的下腔静脉瘤栓进行分级。分析静脉瘤栓与原发肿瘤SUV_max的相关性和PET/CT与增强CT对瘤栓分级的一致性。结果 瘤栓共累及53个静脉节段,以下腔静脉（n=16）、肾静脉（n=16）及门静脉（n=7）为主;瘤栓代谢高于血池本底51个,等于或低于血池本底各1个;48个呈条状,5个呈结节状;41个伴静脉增宽,31个患者瘤栓与原发肿瘤相延续。静脉瘤栓平均SUV_max为7.54±5.06,原发肿瘤平均SUV_max为9.25±6.17,二者呈正相关（r=0.76,P<0.001）。PET/CT明确诊断静脉瘤栓31例,诊断正确率为91.18%（31/34）。PET/CT与增强CT对瘤栓分级的一致性较好（Kappa=0.87,P<0.001）。结论 ¹⁸F-FDG PET/CT对静脉瘤栓具有良好的诊断价值。     

基于5.0T MRI的磁敏感加权成像诊断肝细胞癌合并静脉癌栓

目的 观察基于5.0T MRI的磁敏感加权成像(SWI)诊断肝细胞癌(HCC)合并静脉癌栓的价值。方法 回顾性分析63例HCC患者,其中17例合并静脉癌栓; 观察5.0T SWI检出静脉癌栓的效能,比较5.0T与3.0T 图像质量。结果 5.0T SWI显示16例癌栓,未能检出1例位于门静脉左支左外叶上段的癌栓。5.0T增强MRI门静脉期和肝胆期图像显示肝脏边缘评分、整体图像质量评分、信噪比和对比度噪声比均高于3.0T(P均<0.05)。结论 5.0T SWI有助于诊断HCC合并静脉癌栓。     

甲状腺乳头状癌声像图表现与其颈部淋巴结转移的关系

目的 探讨甲状腺乳头状癌（PTC）声像图表现与其颈部淋巴结转移的关系。方法 收集145例PTC患者的声像图资料,其中60例颈部淋巴结转移,85例无颈部淋巴结转移,回顾性分析患者年龄、性别及声像图表现（病灶数、最大径、边缘、纵横比、是否侵犯包膜、内部回声、微钙化、内部血供）,并采用Logistic回归分析获得PTC颈部淋巴结转移的独立危险因素。结果 单因素分析显示,PTC颈部淋巴结转移与未转移患者间年龄、肿瘤最大径、侵犯包膜、内部血供差异均有统计学意义（P均<0.01）。Logistic回归分析结果显示,患者年龄≤50岁、肿瘤内部中高血供及侵犯包膜是PTC颈部淋巴结转移的独立危险因素（P均<0.05）。结论 患者年龄及肿瘤是否侵犯包膜、内部血供情况与PTC发生颈部淋巴结转移有关。     

彩色多普勒超声在肝细胞癌与胆管细胞癌鉴别诊断中的价值

目的　探讨彩色多普勒超声在肝细胞癌与胆管细胞癌鉴别诊断中的价值。方法　对 30 例肝细胞癌与28例胆管细胞癌侵犯门静脉的彩色多普勒超声表现进行对比分析。结果　30例肝细胞癌发生门静脉瘤栓56条,受侵血管壁全部显像清晰,管腔内见瘤栓实体(100%);28 例胆管细胞癌侵犯门静脉 29 条,其中仅 6.9%(2/29)血管壁显像清晰。肝细胞癌组门静脉瘤栓内 75.0%(42/56)测及动静脉血流,60.7%(34/56)测及高速动脉血流;胆管细胞癌组受侵门静脉内仅 13.8%(4/29)测及血流信号。肝细胞癌组与胆管细胞癌组受侵门静脉周边测及高速动脉血流者分别占 80.4%(45/56)与 31.0%(9/29)。以上结果均有非常显著性意义(P<0.01)。结论　彩色多普勒超声在肝细胞癌与胆管细胞癌的鉴别诊断中具有重要的临床意义。     

MSCT诊断颈外静脉瘤

目的 探讨MSCT诊断颈外静脉瘤的应用价值。方法 回顾分析接受MSCT检查并经手术病理证实的11例颈外静脉瘤,评价MSCT显示颈外静脉瘤的位置、大小、载瘤静脉、引流静脉、是否伴钙化和(或)血栓以及与周围组织关系等。结果 11例颈外静脉瘤均为单侧单发,男1例,女10例;左侧6例,右侧5例;8例引流静脉为同侧锁骨下静脉,3例为同侧颈内静脉;5例伴附壁血栓,2例伴钙化。结论 MSCT能清楚显示颈外静脉瘤,具有较高诊断价值。     

Gray-scale and color Doppler findings in bilateral internal jugular vein thrombosis caused by anaplastic carcinoma of the thyroid

Bilateral internal jugular vein thrombosis is a rare complication of thyroid cancer. The most common manifestation of this condition is superior vena cava syndrome. We report the sonographic findings in a case of bilateral internal jugular vein thrombosis with mild symptoms. There was evidence of direct infiltration of anaplastic thyroid carcinoma into the left internal jugular vein. Sonographic and CT examinations also demonstrated multiple dilated collateral veins.     

The Effect of Rigid Cervical Collars on Internal Jugular Vein Dimensions

Objectives:  Prior research has demonstrated that rigid cervical collars cause an increase in intracranial pressure (ICP). The mechanism for this effect is unclear and one proposed mechanism involves obstruction of venous outflow in the neck. Ultrasound (US) allows assessment of internal jugular vein dimensions and may yield information regarding the mechanism for the increase in ICP seen with rigid collar application.
Methods:  Forty-two healthy volunteers underwent US examination of the internal jugular vein before and after cervical collar application. Internal jugular vein cross-sectional areas were compared with and without the cervical collar in place.
Results:  The cross-sectional area of the internal jugular vein increased significantly (p < 0.0001) after application of the cervical collar. The mean percentage increase in cross-sectional area was 37% (95% confidence interval [CI] = 20% to 53%).
Conclusions:  Internal jugular vein cross-sectional area increases after application of a rigid cervical collar. This supports the hypothesis that venous obstruction in the neck may contribute to the increase in ICP seen after rigid collar application.
ACADEMIC EMERGENCY MEDICINE 2010; 17:100–102 © 2009 by the Society for Academic Emergency Medicine     

复发性喉癌CT诊断

目的：着重研究复发性喉癌的CT表现特征及诊断价值。材料和方法：对经活检/手术和病理证实的56例复发性喉癌CT资料进行回顾性研究。结果：本组56例复发性喉癌以术后多种喉部和颈部组织结构受侵为主要CT表现特征。喉旁不规则强化肿块23例,占40%;颈淋巴结肿大16例,占28.6%;喉软骨破坏3例,占5.3%;颈动脉鞘受累5例,占8.9%;颈椎骨质破坏2例,占3.6%;气管造漏口癌5例,占8.9%。结论：喉癌术后的定期CT复查,可及时发现复发性喉癌,能为临床诊断提供重要CT影像学信息。     

颈内静脉的影像学调查及颈总动脉旁颈内静脉穿刺法的研究

目的　探讨颈内静脉穿刺的最佳部位和方法。方法　随机抽取 31例无劲、胸疾患的成年患者颈部核磁共振图像和 2 0位青年志愿者颈部超声图像 ,取甲状软骨上缘、环状软骨、第七颈椎三个横截面的图像 ,分别观察和测定动、静脉的前后关系、动、静脉的内外关系、静脉到皮肌的距离。对 1 2 4例需要行中心静脉置管的患者采用颈总动脉旁颈内静脉穿刺法穿刺。结果　颈总动脉与颈内静脉紧密相连 ;颈内静脉有从上到下依次在动脉的后面过渡到平行、前面的趋势 (P <0 0 1 ) ;三个平面自上而下颈内静脉前壁与颈前皮肤的距离依次变短 (P <0 0 1 )。本组 1 2 4例患者穿刺成功 1 2 3例 ,成功率 99% ,无任何并发症。结论　环状软骨平面颈总动脉外侧 0 5cm处为颈内静脉穿刺的最佳进针点 ;颈总动脉旁颈内静脉穿刺法具有定位明确、操作安全、方便等优点     

超声对颈动脉体瘤和颈静脉球瘤的诊断价值

摘 要 目的 分析颈动脉体瘤及颈静脉球瘤的超声特征表现,探讨超声对其诊断价值。方法 结合文献复习,回顾分析经病理确诊的10例颈动脉体瘤及1例颈静脉球瘤的超声特征表现并评价超声对其诊断率。结果 颈动脉体瘤的超声表现为位于颈动脉分叉处的低回声实性团块,使颈内动脉与颈外动脉间距增宽,夹角增大,团块内可见高速低阻的丰富血流信号,上述表现具有特征性,超声诊断率较高;颈静脉球瘤超声表现为颈静脉孔区的条状低回声实性团块,向下延续至颈内静脉内,团块内可见高速低阻的丰富血流信号,超声难以明确诊断,但可清晰显示肿块与颈内静脉管壁的解剖关系。 结论 颈动脉体瘤的超声表现具有较高的特征性,可作为本病首选的诊断技术;颈静脉球瘤的超声变现具有一定的特征性,超声虽然难以确诊但可为本病的手术治疗提供有效信息。     

Improvement of internal jugular vein cannulation using an ultrasound-guided technique

Objective: To determine whether ultrasound guidance can help operators to improve the results of jugular vein access in the ICU. Design: Prospective, randomized study. Setting: General Intensive Care Unit of a University Hospital. Patients: Seven-nine patients were assigned to internal jugular vein cannulation using anatomical landmarks alone (control group, n = 42) or with ultrasound guidance (ultrasound group, n = 37). Intervention: All cannulations were performed by junior house staff under the direct supervision of a senior physician. In the ultrasound group, an ultrasonography (7.5 MHz) was used and the transducer was covered by a sterile sheath. The placement and direction of the cannulating needle were determined on the ultrasound image. Measurements and results: Internal jugular vein cannulation was successful in 37/37 (100 %) patients in the ultrasound group and in 32/42 patients (76 %) in the control group (p < 0.01). Average access time was longer in the control group (235 ± 408 s vs 95 ± 174 s, p = 0.06) and carotid artery puncture occurred in five patients in each group (p = 0.83). Jugular cannulation was successful at the first attempt in 26 % in the control group and 43 % in the ultrasound group (p = 0.11). Thirty-two patients (86 %) in the ultrasound group and 23 patients (55 %) in the control group (p < 0.05) were cannulated within 3 min. The cannula could therefore not be inserted within 3 min in 19 patients (45 %) in the control group. Failure was explained by thrombosis (n = 1), small caliber of the internal jugular vein (< 5 mm, n = 3), abnormal vascular relations (n = 3). Among the ten primary failures of cannulation, an internal jugular vein catheter was able to be inserted in four cases by an experienced physician on the side initially selected and with ultrasound guidance in two cases. The catheter was inserted into the contralateral internal jugular vein under ultrasound guidance in the remaining four cases. Conclusion: Ultrasound guidance improved the success rate of jugular vein cannulation in ICU patients. Our results suggest that ultrasound guidance should be used when the internal jugular vein has not been successfully cannulated within 3 min by the external landmark-guided technique. Received: 4 November 1996 Accepted: 22 May 1997     

多排螺旋CT静脉血管成像评估植入Cuff导管后的中心静脉

目的 探讨多排螺旋CT静脉血管成像（MDCTV）对评估双腔带Cuff中心静脉导管植入术后,导管相关功能障碍的应用价值。方法 回顾性收集110例双腔带Cuff中心静脉导管植入术后慢性肾衰竭患者,均接受胸部MDCTV检查。观察静脉导管术后相关的CT特征,包括导管置入位置、导管尖端位置、血栓形成情况及相应位置、中心静脉狭窄或闭塞情况、侧支循环形成。结果 MDCTV示Cuff导管主要从右侧颈内静脉置入（102/110,92.73%）,其次是左侧颈内静脉（5/110,4.55%）、右侧锁骨下静脉（2/110,1.82%）以及右侧头臂静脉（1/110,0.91%）。导管尖端主要位于右心房（57/110,51.82%）和上腔静脉（47/110,42.73%）,少数在下腔静脉内（6/110,5.45%）。中心静脉留置导管术后血栓发生率为58.18%（64/110）。不同导管尖端位置血栓发生率差异无统计学意义（P>0.05）。血栓组（64例）留置导管时间明显长于非血栓组（46例）,差异有统计学意义（P<0.05）。血栓主要发生于上腔静脉（41/64,64.06%）、右侧头臂静脉（23/64,35.94%）及右侧颈内静脉（14/64,21.86%）,少许见于左侧头臂静脉（3/64,4.69%）、左侧颈内静脉（3/64,4.69%）和右侧锁骨下静脉（2/64,3.13%）。中心静脉发生狭窄或闭塞者共68例（68/110,61.82%）,其中有22例累及多条静脉,其主要发生于右侧头臂静脉（45/68,66.18%）及右侧颈内静脉（28/68,41.18%）。结论 MDCTV技术可以较全面地评估中心静脉留置的带Cuff双腔导管。     

Ultrasound detection of guidewire position during central venous catheterization

Introduction

Ultrasound guidance decreases complications of central venous catheter (CVC) placement, but risks of arterial puncture and inadvertent arterial catheter placement exist. Ultrasound-assisted detection of guidewire position in the internal jugular vein could predict correct catheter position before dilation and catheter placement.

Methods

Ultrasound examinations were performed in an attempt to identify the guidewire before dilation and catheter insertion in 20 adult patients requiring CVC placement. Central venous pressures were measured after completion of the procedure.

Results

Guidewires were visible within the lumen of the internal jugular vein in all subjects. Central venous pressures confirmed venous placement of catheters. Ultrasound visualization of the guidewire predicted venous CVC placement with 100% sensitivity (95% confidence interval 80-100%) and 100% specificity (95% confidence interval 80%-100%).

Conclusions

Ultrasound reliably detects the guidewire during CVC placement and visualization of the wire before dilation and catheter insertion may provide an additional measure of safety during ultrasound-guided CVC placement.     

超声诊断囊实性甲状腺癌

目的 探讨超声诊断囊实性甲状腺癌的应用价值。方法 回顾性分析45例(共45个结节)囊实性甲状腺癌的术前声像图特征,包括结节位置、最大径、内部结构、实性部分回声、边界、边缘、形态、纵横比(A/T)、钙化、血管模式及血供程度,同时仔细检查颈部有无异常肿大淋巴结。另选取同期135例(共150个结节)甲状腺囊实性良性结节作为对照,分析良恶性甲状腺囊实性结节声像图特征的异同。结果 囊实性甲状腺癌的主要声像图特征包括:以实性为主,不均匀低回声、边界不清晰、边缘不光整、形态不规则、A/T<1、微钙化、混合型血管模式及中或高血供,同侧颈部淋巴结转移常见。囊实性甲状腺癌与囊实性良性甲状腺结节内部结构、实性部分回声、边界、边缘、形态、钙化、血管模式及血供程度的差异有统计学意义(P均<0.05),而结节位置、最大径及A/T的差异无统计学意义(P均>0.05)。结论 综合分析囊实性甲状腺癌的声像图特征可提高鉴别诊断的准确率。