MSCT与超声诊断肾癌病理分级的价值比较

目的 :比较MSCT和超声在判断肾癌病理分级上的应用价值,并对2种方法行一致性检验,为临床诊断肾癌病理分级提供诊断依据。方法:选取80例肾透明细胞癌(CCRCC)患者,随机分为CT组和超声组各40例,术前CT组行MSCT常规平扫和双期增强扫描,超声组行常规超声和超声造影,观察不同分级肿瘤的CEUS增强模式、程度、均匀性及肿瘤周边环状高增强(PHR)情况。结果 :经手术取病理活检Fuhrman病理分级,CT组Ⅰ级9例,Ⅱ级17例,Ⅲ级11例,Ⅳ级3例;超声组Ⅰ级8例,Ⅱ级19例,Ⅲ级10例,Ⅳ级3例。2组在年龄、性别、病程等方面差异均无统计学意义(均P0.05)。MSCT组各病理级别平扫CT值及相对密度指数差异不大(P0.05),而皮质期及髓质期扫描,病理级别越高,CT值、CT差值、增强百分比、增强指数明显降低(均P0.05)。超声造影显示不同Fuhrman分级CCRCC的PHR差异有统计学意义(P0.05)。FuhrmanⅠ级肿瘤中PHR检出率相对较高,Ⅳ级肿瘤PHR检出率相对较低。各级肿瘤在强化均匀性和CEUS增强模式上差异无统计学意义(P0.05)。MSCT和超声造影对不同Fuhrman病理分级的CCRCC诊断效能差异无统计学意义(P0.05),具有中度一致性(K=0.527,P0.0001),Fuhrman病理分级不同,两者的诊断效能一致性也有差异。结论:MSCT和超声造影对肾癌不同Fuhrman病理分级的判断具有可行性,诊断效能与Fuhrman具有相关性,但两者诊断效能差异无统计学意义,可为临床诊断CCRCC的Fuhrman病理分级提供更多依据,值得临床推广应用。     

彩色多普勒联合超声造影对肾盂癌诊断价值分析

目的:探讨彩色多普勒联合超声造影(CEUS)对肾盂癌临床诊断的价值。方法:选取29例有完整临床资料的患者,对其肾脏行彩色多普勒、CEUS及CT增强扫描,并与病理结果进行比较。结果:常规彩色多普勒检查诊断肾盂癌的敏感性为51.72%(15/29);彩色多普勒联合CEUS的敏感性为79.31%(23/29);CT敏感性为82.76%(24/29)。CT诊断准确性明显高于常规超声,差异有统计学意义(P<0.05),但与彩色多普勒联合CEUS比较,二者差异无统计学意义(P>0.05)。8例肾盂癌CEUS的血流灌注方式:6例呈"同增早退",2例呈"早增早退";肿块显影高峰强度:4例等同于肾实质,4例稍低于肾实质。结论:彩色多普勒联合CEUS可以提高诊断肾盂癌的敏感性。     

超声造影与增强CT对肾癌的诊断分析

目的:本研究旨在比较超声造影(CEUS)和增强CT(CECT)在肾癌病灶中的诊断价值,探讨超声造影在肾癌的诊断价值。方法:对54例患者临床诊断为肾脏内占位性病灶进行CEUS和CECT检查,通过分析病灶CEUS和CECT的特点,比较两种方法的诊断效能。结果:54个病灶中34个为肾脏恶性肿瘤,20个为肾脏良性病灶,CEUS和CECT诊断敏感性、特异性、准确性、阳性预测值、阴性预测值分别为97.05%、85.0%、92.59%、91.67%、94.44%与91.18%、80.00%、87.04%、88.57%、84.21%。两种方法诊断差异无统计学意义(P>0.05)。结论:分析比较CEUS和CECT在诊断肾癌过程中,两种方法诊断效能无明显差异,均能为临床诊断提供重要依据,但CEUS对微循环灌注方面及假包膜的观察优于CECT;CEUS定量评价肾肿瘤血管现处于动物实验阶段,临床上特异指标的找寻仍有待于进一步研究。     

超声造影和增强CT对肝血管瘤的诊断价值比较

目的 探讨增强CT与超声造影(CEUS)对肝血管瘤的诊断价值,从而提高肝血管瘤的诊断水平.方法 回顾性分析在本院同时进行上腹部CT多期扫描和CEUS检查的肝血管瘤患者61例.统计分析2种检查对肝血管瘤的诊断效率.并进一步分别比较增强CT对不同大小的瘤体的检出率及CEUS对脂肪肝患者及非脂肪肝患者肝血管瘤的检出率,并对其结果分别做了统计学分析.结果 61例患者中,增强CT共发现52例,CEUS共发现54例,二者的差别无统计学意义(P>0.05).增强CT对于瘤体直径>4 cm的肝血管瘤完全检出;对于<4 cm的,直径越小检出率越低且其差别具有统计学意义(P<0.05).CEUS对于脂肪肝组患者的检出率为61.54%,对非脂肪肝组患者的检出率为95.83%,差异具有统计学意义(P<0.05).结论 增强CT和CEUS对于肝血管瘤的诊断各有优势,合理选择可以明显地提高诊断准确率.     

兔VX2肝肿瘤射频消融疗效评价——超声造影、增强CT与病理对比研究

目的 探讨超声造影(CEUS)与增强CT检查在评价肝肿瘤VX2肝肿瘤模型射频消融(RFA)疗效方面的作用. 资料与方法 9只兔VX2肝肿瘤模型作RFA治疗后1周同时作CEUS与增强CT检查,与病理作对照,比较CEUS与增强CT在评价RFA疗效的准确性. 结果 9只中8只病理发现残留肿瘤灶,1只完全消融,残留灶在CEUS与增强CT上均可见强化.3只炎性反应带能被CEUS正确评价,而增强CT将其中2只误认为是残留灶.1只残留灶位于肋骨下未能被CEUS检出.CEUS、增强CT、两者联合诊断的敏感率、特异性和诊断准确率分别为86%、88%、86%,90%、78%、85%,94%、75%、91%.三组之间差异均无统计学意义(P<0.05). 结论 CEUS与增强CT均能较可靠评价RFA疗效,两者具有良好的相关性和一致性; CEUS与增强CT联合评价可提高评价准确率.     

CT对肾脏占位性病变及病变性质鉴别诊断价值分析

目的 分析CT对肾脏占位性病变（SORL）及病变性质的鉴别诊断价值。方法 选取2020年3月至2021年2月我院SORL患者82例，对所有患者实施CT检查和超声造影（CEUS）检查，以病理结果为“金标准”，统计CT和CEUS诊断SORL及病变性质的诊断结果和诊断效能。结果 本组82例SORL患者中，经病理检查确诊恶性58例、良性24例；CT诊断出恶性62例、良性20例；CEUS诊断出恶性58例、良性24例；CT诊断灵敏度96.6%(56/58)、准确度90.2%(74/82)较CEUS诊断灵敏度84.5%(49/58)、准确度78.0%(64/82)高，漏诊率3.4%(2/58)较CEUS诊断15.5%(9/58)低（P<0.05）。结论 CT检查对SORL及病变性质具有较高灵敏度和准确度，能显著降低漏诊情况的发生，诊断价值突出。     

胆囊癌的CT分级和手术可切除性评价

目的　探讨胆囊癌的CT分级 ,术前对胆囊癌可切除性进行评价。方法　参照文献对 80例手术病理证实及影像学检查肯定诊断的胆囊癌进行CT分级 ,结合手术及病理结果对各级胆囊癌的手术可切除性进行评价。结果　本组中Ⅰ级 9例 ,Ⅱ级 18例 ,Ⅲ级 42例 ,Ⅳ级 11例。根治性手术切除 3 2例 ,其中Ⅰ级、Ⅱ级胆囊癌 2 7例 ,Ⅲ级胆囊癌 5例 ;姑息性切除 3 1例 ,均为Ⅲ级胆囊癌 ;因不能切除而行探察术 9例 ,其中Ⅲ级胆囊癌 6例 ,Ⅳ级胆囊癌 3例 ;另有 8例CT表现均为Ⅳ级 ,未能手术而采取其他治疗方法。结论　应用CT检查对胆囊癌进行分级 ,有助于术前对胆囊癌的手术可切除性进行评价 ,以选择最佳的治疗方案。     

超选择血管造影CT在胰岛细胞瘤术前诊断中的价值

目的 探究超选择血管造影CT(SSCTA)在胰岛细胞瘤术前诊断中的价值.方法 2013年至2015年收治的54例术后病理确诊为胰岛细胞瘤患者,所有患者均进行SSCTA检查,对其术前不同影像学检查方法的资料进行回顾性分析,行经腹部超声(TAUS)检查42例;超声内镜(EUS)检查48例;超声造影(CEUS)检查51例;增强CT检查30例;增强MRI检查48例;血管造影(SAG)检查54例,分析各检查方法的定位灵敏度及准确率,以指导更好地选择术前诊断方法.结果 各种检查方法的诊断的定位灵敏度及准确率:经腹部超声为21.4％,14.3％;超声造影为82.4％,58.8％;EUS为87.5％,68.8％;增强CT为70.0％,60.0％;增强MRI为87.5％,81.3％;血管造影为72.2％,44.4％;SSCTA为94.4％,88.9％.SSCTA定位诊断胰岛细胞瘤的灵敏度及准确率明显高于其它诊断方法(P＜0.05),54例患者行SSCTA检查后均未出现任何严重并发症.结论 SSCTA对胰岛细胞瘤的术前诊断具有重要价值,且安全可靠.     

双螺旋CT肾段动脉造影的临床研究

目的　探讨双螺旋CT血管造影 (DSCTA)对主肾动脉和肾段动脉的显示及其临床价值。方法　 43例肾动脉检查患者 ,行连续容积扫描。然后以CT轴位图像为基础 ,结合多种重建图像综合分析。结果　 43例中共显示肾动脉 98条 ,主肾动脉皆显示清晰 ,Ⅲ级分支显示率 95 .3 % ,Ⅳ级分支 67.1% ,Ⅴ级分支 3 2 .9%。单螺旋CT中Ⅲ级显示率为 60 % ,Ⅳ级为 5 % ,Ⅴ级为 0 %。结论　DSCTA较单螺旋CT血管造影提高了肾段动脉显示率 ,从而提高了对肾段动脉狭窄和肾肿瘤的诊断价值     

超声造影与增强CT在胆囊疾病诊断中的对比分析

目的:比较超声造影(contrast-enhanced ultrasound,CEUS)和CT增强(contrast-enhanced helicalcomputedtomography,CECT)检查在胆囊占位性病变诊断中血流灌注过程中的的特点,探讨其在胆囊占位性病变诊断中的价值。方法:对比分析78例胆囊占位性病变的超声造影和增强CT在不同时相的增强及灌注特征。结果:超声造影和增强CT具有相似的表现。但对于小于5 mm的病变,超声造影的检出率高于增强CT,78例胆囊占位性病变中,胆囊癌35例,胆囊息肉29例,局限性胆囊腺肌增生症14例,增强CT准确率分别为84.35%,89.63%和80.13%,超声造影准确率分别为83.12%,93.79%和79.72%。结论:增强CT和超声造影检查均有助于胆囊疾病诊断,两者结合可提高胆囊疾病的诊断符合率。     

钝性肝脾肾损伤的CT平扫与增强扫描比较

目的:比较CT平扫与增强扫描对肝脾肾钝性损伤的诊断能力。方法:回顾性分析临床疑似钝性肝脾肾损伤,并经手术和临床观察证实的CT平扫和增强扫描的患者84例。结果:平扫确定的损伤:肝12例,脾25例,肾5例;平扫可疑损伤:肝22例,脾15例,肾5例。增强确定的损伤:肝32例,脾40例,肾12例(全肾梗塞1例,局限性梗塞3例);对比剂外溢(活动性出血)3例;无可疑损伤。平扫无异常而增强确定有损伤:肝10例,脾5例,肾2例。增强显示的损伤灶比平扫范围明显大、病灶多、界限清楚。结论:CT增强扫描显示肝脾肾损伤明显优于平扫,延时扫描有助于发现活动性出血,应常规增强扫描。     

常规超声联合超声造影成像对宫颈癌诊断及分期初步研究

目的探讨常规超声联合超声造影检查(CEUS)在诊断宫颈癌及分期中的应用价值。方法对36例临床诊断为宫颈癌的患者,在术前进行超声及CEUS根据肿块部位、大小、对周围组织的侵犯情况进行分期,并与手术病理分期对照,分析其诊断宫颈癌分期的准确性。结果常规超声联合CEUS诊断宫颈癌Ⅰb、Ⅱ、Ⅲ、Ⅳ期准确率分别为100.0%(4/4)、75.0%(9/12)、92.9%(13/14)和100.0%(6/6),总准确率达88.9%(32/36),两者检查结果高度一致(Kappa值=0.866)。结论超声联合CEUS诊断宫颈癌分期的准确率较高,可以作为主要影像学检查方法之一。     

肾结核的CT诊断与误诊分析

目的 探讨CT诊断肾结核的临床效果,并对引起CT误诊的相关因素进行分析.方法 选取经病理组织学证实为肾结核的32例患者分别行B超及CT检查,并与病理组织学结果进行对比.结果 经病理组织学证实Ⅰ型肾结核 7例,Ⅱ型肾结核 8例,Ⅲ型肾结核 6例,Ⅳ型肾结核 6例,Ⅴ型 5例.CT诊断中Ⅰ型肾结核7例,Ⅱ型肾结核 6例,Ⅲ型肾结核 6例,Ⅳ型肾结核 6例,Ⅴ型7例,符合率为93.75%（30例）.B超诊断证实Ⅰ型肾结核6例,Ⅱ型肾结核 8例,Ⅲ型肾结核 7例,Ⅳ型肾结核 7例,Ⅴ型 4例,符合率为81.25%（26例）.与B超诊断相比,CT诊断符合率较高,差异有统计学意义（P〈0.05）.CT诊断中有2例（6.25%）患者出现误诊,1例将其诊断为肾囊肿,1例为假性动脉瘤合并脓肿误诊为结核.结论 对肾结核患者应用CT诊断具有较高的诊断价值,可作为临床诊断肾结核的重要手段.     

Evaluating the perfusion of occupying lesions of kidney and bladder with contrast-enhanced ultrasound

PurposeTo evaluate the clinical diagnostic value of contrast-enhanced ultrasound (CEUS) for occupying lesions of kidney and bladder.Materials and MethodsCEUS was performed for a total of 50 kidney and bladder occupying lesions in 47 cases, and CEUS manifestations of these lesions were observed and analyzed. Patterns of dynamic changes in perfusion phases of CEUS were summarized and compared with results of postoperative pathology, enhanced computed tomography (CT), magnetic resonance imaging (MRI), and follow-ups.ResultsCEUS results showed that there were 22 cases of malignant renal tumors, 11 cases of benign lesions, two cases of renal column hypertrophy, and 12 cases of malignant bladder tumors (15 lesions). Renal cell carcinoma exhibited various CEUS manifestation, with the majority showing fast filling and hyper-enhancement. CEUS manifestation of renal hamartoma was characterized by slow filling and slow outflow. Renal cystic lesions always exhibited no enhancement within the cysts. Renal column hypertrophy exhibited the same enhancement pattern as the renal cortex. CEUS manifestation of bladder carcinoma was mainly characterized by quick filling, quick outflow, and hyperenhancement.ConclusionsCEUS offers real-time observation of perfusion in occupying lesions of kidney and bladder, but the enhancement pattern of kidney occupying lesions was complex; therefore, combination of enhanced CT, MRI, and CEUS may be necessary.     

小儿胰腺损伤诊治分析

目的探讨小儿胰腺损伤临床特点及诊治方法。方法我院自2004年8月～2011年12月共收治胰腺损伤患儿13例,其中Ⅰ度胰腺损伤3例,Ⅱ度7例,Ⅲ度2例,Ⅳ度1例;淀粉酶升高4例。13例患儿均经病史、腹部查体、淀粉酶检测、B超及CT明确诊断,4例经手术探查证实。结果 3例Ⅰ度及6例Ⅱ度经非手术治疗;1例Ⅱ度行腹腔广泛引流;1例Ⅲ度胰腺损伤因膜膜炎行剖探查术,术中见腹腔中等量积液,胰腺中部断裂,胰管未断裂,行断裂修补,局部引流;1例Ⅲ度因形成胰腺假性囊肿行胰腺囊肿-空肠Roux-Y吻合术;1例Ⅳ度行胰腺断裂近端缝合、远端胰腺空肠Roux-Y吻合术。所有患儿均临床治愈。结论小儿胰腺损伤因其症状往往较为隐匿,诊断较为困难,了解胰腺损伤的机制及高度警戒心理有利于胰腺损伤的早期诊断及恰当治疗。胰淀粉酶及脂肪酶升高在胰腺损伤诊断中并不可靠;螺旋CT增强扫描检查应作为胰腺损伤首选检查方法;轻度胰腺损伤多可非手术治愈,重型胰腺损伤合并腹膜炎表现需行剖腹探查并相应处理。     

Application of contrast-enhanced ultrasound in the diagnosis of solid pancreatic lesions—A comparison of conventional ultrasound and contrast-enhanced CT

Objective

To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) by comparison with conventional ultrasound (US) and contrast-enhanced CT (CECT) in solid pancreatic lesions.

Method

Ninety patients with solid pancreatic focal lesions were enrolled, including 36 cases of pancreatic carcinoma, 28 cases of pancreatitis, 6 cases of pancreatic neuroendocrine tumor, 12 cases of solid pseudopapillary tumor of the pancreas, 6 cases of pancreatic metastases, 1 case of cavernous hemolymphangioma and 1 case of lymphoma. US and CEUS were applied respectively for the diagnosis of a total of 90 cases of solid pancreatic lesions. The diagnostic results were scored on a 5-point scale. Results of CEUS were compared with CECT.

Results

(1) 3-score cases (undetermined) diagnosed by CEUS were obviously fewer than that of US, while the number of 1-score (definitely benign) and 5-score (definitely malignant) cases diagnosed by CEUS was significantly more than that of US. There was a significant difference in the distribution of final scores using the two methods (p < 0.001). The overall diagnostic accuracies of the 90 cases for CEUS and US were 83.33% and 44.44%, respectively, which indicated an obvious advantage for CEUS (p < 0.001). (2) The diagnostic consistency among three ultrasound doctors: the kappa values calculated for US were 0.537, 0.444 and 0.525, compared with 0.748, 0.645 and 0.795 for CEUS. The interobserver agreement for CEUS was higher than that for US. (3) The sensitivity, specificity and accuracy of the diagnosis of pancreatic carcinoma with CEUS and CECT were 91.7% and 97.2%, 87.0% and 88.9%, and 88.9% and 92.2%, respectively, while for the diagnosis of pancreatitis, the corresponding indices were 82.1% and 67.9%, 91.9% and 100%, and 88.9% and 90%, respectively, showing no significant differences (p > 0.05).

Conclusion

CEUS has obvious superiority over conventional US in the general diagnostic accuracy of solid pancreatic lesions and in the diagnostic consistency among doctors. The performances of CEUS are similar to that of CECT in the diagnosis of pancreatic carcinoma and focal pancreatitis.     

超声造影鉴别子宫肌瘤与子宫腺肌瘤的临床应用价值

目的:探讨超声造影对子宫肌瘤与子宫腺肌瘤鉴别诊断的应用价值。方法:对38例不典型子宫病灶患者行超声造影检查,全部病例均经手术或超声引导穿刺活检证实。结果:本组经病理诊断子宫肌瘤22例,常规超声诊断符合率86.4%,超声造影诊断符合率95.5%;子宫腺肌瘤16例,常规超声诊断符合率81.3%,超声造影诊断符合率93.8%。子宫肌瘤表现为瘤体周边首先灌注呈环状强化,并分支进入瘤体内部,然后内部迅速强化;子宫腺肌瘤则表现为多支、较粗大、短线状增强信号从病灶周边进入内部,继之内部迅速强化。结论:超声造影显示子宫肌瘤与子宫腺肌瘤的血流灌注具有不同的灌注模式和特征,为两者鉴别诊断提供更准确的信息。     

比较常规超声与超声增强造影诊断脾钝性创伤的实验研究

 目的 比较常规超声与超声增强造影在脾钝性创伤中的应用价值.方法 8只健康成年杂种犬建立脾钝性创伤的动物模型18处,均行常规超声及超声增强造影检查,分析相应的声像图特点,并以病理结果为标准,比较两种检查方法的诊断准确率.结果 18处创伤常规超声诊断8处,准确率为44.4%;超声造影诊断18处,准确率为100%,二者比较差异具有统计学意义.超声造影图像中脾内创伤区始终无强化,边界清晰,与非创伤区的无强化形成了鲜明对比,破裂处可见造影剂的外渗.结论 超声造影能够清晰地显示脾外伤的范围和程度,对脾钝性创伤的诊断准确率明显高于常规超声.     

超声造影对移植肝脏局灶性病变的诊断价值

目的：评价超声造影对移植肝脏局灶性病变的诊断价值。方法：对30例移植肝脏局灶性病变患者,用西门子Sequoia 512彩色多普勒超声诊断仪和超声对比剂Sonovue进行超声造影检查,观察三个时相的对比剂灌注模式,并用自动跟踪对比量化技术（Axius ACQ）对病灶及周围肝组织进行定量分析。所有病例均经病理及临床随访证实。结果：30例移植肝脏局灶性病变患者,超声造影正确诊断29例,包括肝癌复发18例、非均质脂肪肝5例、肝血管瘤4例、梗死灶2例;超声造影误诊1例,超声造影怀疑肝癌复发,经穿刺活检诊断为局灶性脂肪浸润。结论：移植肝脏局灶性病变具有各自典型的增强模式,超声造影技术有助于移植肝脏局灶性病变的鉴别诊断,具有重要临床价值。     

Value of contrast-enhanced ultrasonography for detecting renal infarcts proven by contrast enhanced CT. A feasibility study

The effectiveness of contrast-enhanced ultrasonography (CEUS) in the evaluation of patients with acute renal infarcts was investigated, using contrast-enhanced helical computed tomography (CT) as the reference imaging procedure. Twenty-seven consecutive patients with acute renal infarcts detected with contrast-enhanced helical CT underwent CEUS. Digital cine-clips of CEUS were evaluated by two independent readers blinded to CT findings. Image quality was rated subjectively on a four-point scale. Then, readers were asked to assign a confidence level in diagnosis of renal infarct at the upper pole, medium portion, and lower pole of each kidney according to a five-degree scale, ranging from definitely absent to definitely present. ROC curve analysis was employed to assess the overall confidence of diagnosis of infarct, and weighted kappa values were calculated to assess inter-reader agreement. The subjective image quality of CEUS was lower than the image quality of CT at the upper poles. However, the diagnostic performance of CEUS was excellent (area under receiver-operator characteristic curve 0.992 ± 0.006 for reader 1; 0.991 ± 0.007 for reader 2), with very good inter-reader agreement (weighted kappa value = 0.83). CEUS is a reproducible tool to detect acute renal infarcts in men, with a diagnostic performance approaching that of CT. This study was presented as a scientific paper for ECR 2007 (control number: 3596)