Gray scale ultrasonography in the diagnosis of thyroid swellings

Thyroid masses which fail to concentrate radioactive iodine may be benign or malignant cysts or solid tumors. A-scan examination through any thyroid mass permits the differentation of a solid from a cystic consistency. The nature of solid masses is difficult to determine using the conventional B-scan ultrasound equipment. Our experience to date suggests that the difficulty can be resolved by the use of high quality gray-scale techniques which display the structure of normal glandular tissue, while malignant replacement is apparent as defects in this normal anatomy. The size and site of the thyroid implies that greatly improved resolution could be obtained by scanners dedicated to the examination of small superficial organs.     

Ultrasonic evaluation of intrathoracic masses

B mode ultrasound can be used to evaluate intrathoracic masses that contact the chest wall. It provides a noninvasive technique to distinguish cystic from solid lesions and to assess the internal structure. Four cases are reported in which this procedure was used to provide diagnostic information.     

女性盆腔肿块的CT和TVS诊断探讨

目的 探讨CT和TVS对女性盆腔肿块的诊断价值。方法 收集33例先后作CT和TVS检查的女性盆腔肿块病例，均经手术和病理证实。结果 CT对肌瘤囊变、钙化、假包膜及肌瘤内部强化后出现的不规则低密度区较为敏感，而对粘膜下肌瘤所致宫腔影变形容易忽略（确诊率71％，5／7）。TVS对肌瘤所表现出旋涡状低回声能准确判断，但对肌瘤囊变所致无回声及宫腔内异常光团容易误诊（确诊率71％，5／7）。3例子宫内膜癌，TVS均能准确测得内膜增厚且回声不规则（确诊率100％，3／3），CT表现为宫体中央规则或不规则低密度区，缺乏特异性（确诊率33％，1／3）。结合二种影像学检查方法，仔细观察单纯囊肿、巧克力囊肿及囊腺瘤的囊液性质、壁结构、分隔及存在的赘生物，确诊率可明显提高：单纯囊肿（100％，4／4），巧克力囊肿（67％，2／3），囊腺瘤（75％，3／4）。畸胎瘤因具有脂质及钙化成分，CT对此极为敏感，再结合薄层扫描技术，确诊率（100％，3／3）。恶性实性肿块边缘呈分叶状、结节状且强化明显，良性实性肿块边缘往往光整且强化不明显，CT对实性肿瘤良恶性鉴别确诊率（100％，4／4），TVS扫描只能显示实性肿物，不能提供良恶性鉴别。CT和TVS对盆腔脓肿的诊断，均应结合临床综合考虑。结论 对女性盆腔肿块的诊断，CT检查应该重视结合TVS图像，这样才能提高诊断的准确性。     

运用高频超声鉴别诊断浅表软组织肿物

为探讨高频超声鉴别诊断浅表软组织肿物的价值,本文使用7.5～15MHz高频探头观察了131例浅表软组织肿块,结果显示海绵状血管瘤、腱鞘囊肿、腘窝囊肿、皮下脂肪瘤高频声像较具特征性,而表皮样囊肿、皮脂腺囊肿、脓肿等声像类似实性肿块,恶性淋巴瘤声像类似囊性肿块。文中对其鉴别诊断及高频超声探头使用价值进行了讨论。作者认为,鉴别浅表软组织囊、实性肿块的主要因素为后方回声增强程度、肿块形态及内部回声水平。     

浅表组织肿块超声诊断与术后病理对照分析

目的评价高频彩色多普勒血流显像及频谱多普勒对浅表组织肿块诊断价值。方法应用Philipsiu22彩色多普勒高频超声对79例患者的浅表组织肿块进行二维（大小、形态、内部回声）、彩色多普勒（肿块内外血供）及频谱多普勒血流参数（血流速度及阻力指数）检测;并逐一追踪术后病理结果,将二者结果进行对照分析。结果良性病变74例,恶性病变5例;实性病变45例,囊性病变18例,混合性病变16例。超声对病变检出率为100％（79／79）,与术后病理对照诊断符合率96％（76／79）,良恶性病变频谱参数（峰值流速及阻力指数）存在统计学差异（P〈0．05）。结论超声检查具有检出率高和病理符合率高的特点,可作为诊断首选方法,彩色多普勒及频谱参数鉴别肿块的良恶性具有较高的价值。     

儿童浅表组织肿块超声诊断的分析研究

目的探讨儿童浅表组织肿块的超声图像特征,以提出诊断思路。方法回顾性分析经病理确诊的101例(101个肿块)儿童浅表组织肿块的超声图像特征。结果儿童浅表软组织肿块以良性常见(98/101,97.03%),其中囊性肿块占43.88%(43/98),实性肿块占56.12%(55/98)。囊性肿块以表皮样囊肿、血肿多见(58.14%,25/43),实性肿块以脂肪瘤、血管瘤常见(41.81%,23/55)。恶性浅表组织肿块3例,呈浸润性生长,无完整包膜,内部回声不均,瘤体内测及血流信号,动脉血流阻力指数多为高阻力改变。结论超声医师在诊断儿童浅表组织肿块时,根据超声图像特征,结合临床资料,能够对大多数病变作出正确诊断,为临床治疗提供可靠的图像依据。     

Sonographic findings of solid and papillary epithelial neoplasm of the pancreas.

OBJECTIVE: To evaluate the sonographic findings of solid and papillary epithelial neoplasm of the pancreas, a rare tumor occurring in young women. METHODS: The sonographic findings of 11 cases of pathologically proven solid and papillary epithelial neoplasm of the pancreas were retrospectively evaluated. RESULTS: In 6 cases (55%), combined cystic and solid portions of the masses were observed, whereas only solid-looking masses without anechoic cystic portions were seen in 4 cases (36%). One case (9%) had marginal calcification, consequently, the internal architecture was not evaluated by sonography. Internal echoes were seen in 3 of 6 cystic and solid masses. Septa were seen in 3 cases. Among 11 cases of solid and papillary epithelial neoplasm, tumor margins were well defined in 10, and tumor capsules were detected in 9 (echogenic in 7 and hypoechoic in 2). Calcifications were seen in 3 cases (27%). CONCLUSIONS: The characteristic sonographic findings of solid and papillary epithelial neoplasm were well-encapsulated, cystic, and solid masses, but sometimes the mass was seen as a pure solid-looking mass or had internal septations or calcifications.     

腮腺基底细胞腺瘤的CT特征

目的探讨腮腺基底细胞腺瘤(BCA)的CT特征。方法回顾分析22例经手术病理证实的腮腺BCA患者的临床资料及CT增强图像。结果 22例均为单发,位于腮腺浅叶19例,同时累及浅、深叶2例,位于深叶1例。类圆形及圆形16例,形态不规则6例,边缘均清晰。肿瘤直径为1.1~4.3 cm,其中3例直径3.0 cm。5例密度均匀,17例伴有囊变,2例伴有钙化。平扫肿瘤实性部分与肌肉软组织密度基本相同,15例增强扫描呈显著强化,增强幅度大于40 HU,静脉期的增强幅度较动脉期略有下降,7例肿块的实性部分表现为轻中度渐进性强化(增强幅度小于40 HU)。结论腮腺浅叶的孤立性结节、体积小、易囊变、动脉期肿瘤实性部分显著强化,静脉期增强幅度略有下降是腮腺BCA典型的CT征象,结合临床特点对于肿瘤的定性诊有很大帮助。     

High‐Resolution Sonographic Findings of Ovarian Granulosa Cell Tumors

Objective. This study was performed to determine the high‐resolution sonographic findings of ovarian granulosa cell tumors (GCTs) and to correlate the sonographic findings with the pathologic findings. Methods. A retrospective review of sonographic findings was conducted on 16 patients with surgically proven ovarian GCTs. Patients' ages ranged from 10 to 64 years (mean, 37.7 years). We evaluated the sizes and morphologic appearances of the ovarian tumors. The blood flow patterns of the tumors were assessed with Doppler sonography (n = 6). Sonographic findings were compared with pathologic findings. Results. The maximal diameters of the masses were 2.0 to 15.4 cm (mean, 8.2 cm). The morphologic appearances of the masses were classified into 3 patterns; solid and cystic (n = 10), solid with a sponge form appearance (n = 4), and entirely solid (n = 2). The measured resistive index and pulsatility index of the solid portions were 0.23 to 0.5 and 0.26 to 0.62, respectively. Pathologic diagnoses of 13 adult ovarian GCTs and 3 juvenile GCTs were obtained. The solid and cystic masses had GCTs with macrofollicular and microfollicular patterns pathologically. The solid masses with a sponge form appearance had prominent hemorrhagic necrosis and diffuse proliferation of granulosa cells with trabecular and microfollicular patterns. The entirely solid masses had diffuse cellular proliferation with a trabecular pattern without cystic changes or hemorrhagic foci. Conclusions. Sonographic findings of ovarian GCTs included solid and cystic masses, solid masses with a sponge form appearance, and entirely solid masses, and the sonographic findings correlated well with the histopathologic findings.     

肾囊性肿物超声造影征象诊断恶性肾囊性肿物的价值

目的 探讨肾囊性肿物超声造影征象对恶性肾囊性肿物的诊断价值.方法 对103例患者119个肾囊性肿物行超声造影,测量肿物囊壁、分隔厚度,记录肿物有无囊壁增厚(＞2 mm)、分隔增厚(＞2 mm)、囊壁强化、分隔强化、实性成分强化、分隔较多(囊腔数≥5)等征象.手术病理和随诊结果证实119个肾囊性肿物中良性64个,恶性55个.以手术病理和随诊结果作为金标准,计算囊壁增厚、分隔增厚、囊壁强化、分隔强化、实性成分强化、分隔较多等征象诊断恶性肾囊性肿物的敏感度、特异度、准确性、阳性预测值和阴性预测值并进行比较.结果 良、恶性肾囊性肿物囊壁厚度的M(QR)分别为0.22(0.10)cm、0.43(0.27)cm,差异有统计学意义(χ2=32.2989,P＜0.0001),分隔厚度的M(QR)分别为0.12(0.12)cm、0.36(0.25)cm,差异也有统计学意义(χ2=36.6528,P＜0.001).囊壁增厚、分隔增厚、囊壁强化、分隔强化、实性成分强化、囊腔数≥5诊断恶性肾囊性肿物的敏感度分别为90.91%、78.18%、96.36%、90.91%、67.27%、67.27%,特异度分别为34.38%、76.56%、1.56%、23.44%、87.50%、79.69%,准确性分别为60.50%、77.31%、45.37%、54.62%、78.15%、73.95%,阳性预测值分别为54.38%、74.14%、45.69%、50.51%、82.22%、74.00%,阴性预测值分别为81.48%、80.83%、33.33%、75.00%、75.68%、73.91%.囊壁增厚、囊壁强化、分隔强化诊断恶性肾囊性肿物的敏感度较高,但特异度较低;分隔增厚、实性成分强化、分隔较多诊断恶性肾囊性肿物的准确性较高.结论 肾囊性肿物超声造影征象中分隔增厚、实性成分强化、分隔较多对恶性肾囊性肿物有较好的诊断价值.将分隔厚度＞2 mm定义为分隔增厚能较好地鉴别良、恶性肾囊性肿物.     

卵巢浆液性囊腺癌的螺旋CT表现

目的　探讨卵巢浆液性囊腺癌的CT表现及螺旋CT在卵巢恶性肿瘤诊断中的优越性。方法　回顾性分析 2 3例经手术病理证实的卵巢浆液性囊腺癌的CT表现 ,着重观察卵巢肿瘤的形态与结构 ,以及对周围结构的侵犯与远处转移、腹水。结果　 2 3例中 15例为双侧 ,共 3 8个肿瘤 ,2 2个表现为囊实混合性 ,9个以实性为主 ,7个表现为囊性。结论　浆液性囊腺癌双侧多见 ,发病年龄较高 ,肿块多表现为囊实混合性 ,常伴有周围侵犯、远处转移和大量腹水 ;囊壁及分隔不均匀增厚超过 3mm ,囊壁上有乳头状突起及肿瘤周围血管的异常增多是浆液性囊腺癌的特征。     

小儿肝脏未分化性胚胎性肉瘤9例的超声观察

目的总结小儿肝脏未分化性胚胎性肉瘤(Undifferentiated embryonal sarcoma of the liver,ES)的超声图像特点,为了提高超声对本病的正确诊断.方法回顾性分析9例UES的临床病理及影像特征并结合文献复习加以讨论.结果 9例均经病理证实.7例超声表现为低回声与高回声混合的实性为主兼有囊性的肿块.2例表现为囊性为主,囊间有少部分中等偏强回声的实性区域.9例肿瘤边界清楚,未见明显钙化,也未见转移.CT图像7例显示为囊性为主病灶,单房或多房,腔内少许软组织密度影,例显示为软组织密度的病灶.结论 UES超声表现为实性为主兼有部分囊腔,亦可囊性为主,但以前者多见,与CT图像恰恰相反.本组病例AFP阴性.     

Ultrasonography of mediastinal teratoma

We have studied real-time sonograms of 11 surgically proven benign mediastinal teratomas. Eight cystic teratomas were sonographically visualized as various kinds of masses: four complex, two solid, and two cystic. The echo patterns of cystic teratomas were determined by the serous or nonserous nature of the cysts. In the presence of serous fluid, the tumor was visualized as a cystic mass. If, on the other hand, the cyst of the tumor was nonserous or was sebaceous, it appeared as a solid or complex tumor. The remaining three solid teratomas, which had some small cysts, appeared as complex tumors.     

Ultrasonic appearance of acute poststreptococcal glomerulonephritis.

We have described a case of acute post-streptococcal glomerulonephritis in which the ultrasound findings resemble multiple solid renal masses. The diagnosis of this inflammatory lesion should be considered in the proper clinical setting.     

胰腺实性假乳头状瘤的超声表现

目的探讨胰腺实性假乳头状瘤（SPTP）的声像图特征及其超声诊断价值。方法回顾性分析24例SPTP患者二维及彩色多普勒超声结果，并与病理相对照，分析肿瘤的发生部位、形态、边界、内部回声、血流分布等特征。结果24例SPTP多见于20-30岁女性，发生部位无特异性，声像图均表现为边界清晰、形态规则的胰腺外生性肿瘤，75％为囊实性，25％为实性。3例恶性SPTP无特征性声像图表现。4例胰尾肿瘤误诊为其他脏器病变。结论超声检查结合临床资料可对SPTP作出正确诊断，对于胰尾SPTP应予以重视以免误诊。     

浅表软组织肿块的超声检查评价

目的探讨二维高频超声及彩色多普勒超声对浅表软组织肿块的诊断价值.方法对121例浅表软组织肿块应用二维高频超声及彩色多普勒超声进行检查和分析.全部病例均经手术和病理学检查证实.结果良性肿块102例(其中脂肪瘤65例,腱鞘囊肿12例,神经鞘瘤7例,神经纤维瘤2例,血管瘤8例,结核脓肿5例,内膜移位1例).恶性肿块19例(其中恶性神经鞘瘤5例,恶性纤维组织细胞瘤4例,隆突性皮肤纤维肉瘤4例,脂肪肉瘤4例,恶性颗粒细胞瘤1例,横纹肌肉瘤1例).良性肿块中边界不清者40例(39%),圆度系数＞2.0者59例(57.8%),内部回声多半分布均匀,彩色血流检出率20.58%.恶性肿块边界清晰者10例(52.6%),圆度系数＜1.5者12例(63.1%),内部回声多半不均匀,彩色血流检出率100%.结论二维高频和彩色多普勒超声有助于确定浅表软组织肿块的形态、大小及深度,区分肿块的囊实性与血流特征,具有一定的临床应用价值.     

Sonographic appearance of Krukenberg tumor from gastric carcinoma

Sonographic findings in 16 cases of Krukenberg tumor from gastric carcinoma were analyzed. The patients' ages ranged from 25 to 52 years (mean 42 years). The tumor involved both ovaries in 14 patients with asymmetrical masses in 9 of 14 cases. Ascites was noted in 15 cases. Echogenicity of the tumor varied from solid to predominantly cystic: solid in 8, mixed in 6, and predominantly cystic in 2 cases. Solid masses tended to be smaller than mixed or cystic masses. The primary gastric carcinoma had been diagnosed before emergence of the tumors in only 7 cases. The findings suggest that in relatively young patients with ovarian mass, particularly bilateral tumors, careful evaluation for gastrointestinal tract involvement should be done.     

常规超声联合超声造影对乳腺囊实性复合肿块良恶性的鉴别诊断价值

目的探讨常规超声联合超声造影（CEUS）在不同超声分组乳腺囊实性复合肿块良恶性鉴别中的应用价值。 方法回顾性选取2017年4月至2019年11月苏州大学附属第一医院收治的乳腺囊实性复合肿块患者111例,共计111个乳腺病灶。根据肿块内部囊实性成分比例及分布特点将其分为3组［A组：厚壁和（或）厚分隔;B组：囊性为主;C组：实性为主］。结合病理分析各组肿块的常规超声及超声造影声像图特征。 结果111个乳腺病灶中,A组病灶28个（良性24个,恶性4个）,B组病灶36个（良性28个,恶性8个）,C组病灶47个（良性29个,恶性18个）。B、C组恶性肿块的年龄及最大径均大于良性组,差异均有统计学意义（P均＜0.05）。A组肿块CEUS后恶性肿块多表现为边缘不光整、壁和（或）分隔增厚,与良性肿块比较差异均有统计学意义（P=0.004、0.016）。B、C组恶性肿块多表现为常规超声及CEUS后实性边缘不光整、实性成分增强范围超出基底部,与良性肿块比较差异均有统计学意义（P均＜0.05）。C组良性肿块与恶性肿块间形态、后方回声、有无钙化及血供情况比较,差异均有统计学意义（P均＜0.05）。 结论常规超声联合CEUS对乳腺囊实性复合肿块的良恶性鉴别具有重要意义,可为临床评估提供可靠的诊断依据。     

Sonographic differentiation of benign and malignant cystic lesions of the breast.

OBJECTIVE: The purpose of this study was to subdivide the types of sonographic findings of benign versus malignant cystic masses and to determine appropriate patient care according to the sonographic findings with pathologic correlation. METHODS: The sonographic findings of 175 symptomatic cystic breast lesions were pathologically proven and reviewed retrospectively. Cystic lesions were classified as 6 types: simple cysts (type I), clustered cysts (type II), cysts with thin septa (type III), complicated cysts (type IV), cystic masses with a thick wall/septa or nodules (type V), and complex solid and cystic masses (type VI). Sonographic findings were compared with the pathologic results and were evaluated according to the incidence of benign and malignant masses. RESULTS: All 23 type I, 15 type II, 22 type III, and 35 type IV cases were pathologically proven to be benign. Seven (25.9%) of the 27 type V cases and 33 (62.3%) of the 53 type VI cases were proven to be malignant. We analyzed the shapes and margins of 80 cases of cystic masses with a solid component (types V and VI); 16 (44%) of 36 sonographically circumscribed masses were malignant. CONCLUSIONS: Because the sonographically detected simple cysts (type I), clustered cysts (type II), and cysts with thin septa (type III) were all benign, annual routine follow-up appears reasonable. Symptomatic complicated cysts (type IV) should be aspirated and appropriately treated according to clinical symptoms. Cystic masses with a solid component (types V and VI) should be examined by biopsy with pathologic confirmation.     

Ultrasonographic Imaging Features of Female Urethral and Peri-urethral Masses: A Retrospective Study of 95 Patients

The aim of this study was to assess the imaging features of urethral and peri-urethral masses on transvaginal or transperineal ultrasound (US) in a cohort of 95 women. In this retrospective study, medical records of 95 female patients with 98 asymptomatic or symptomatic urethral and peri-urethral masses were retrospectively reviewed. Data regarding patient demographic characteristics, symptoms, signs, imaging features on 2-D and 3-D transvaginal or transperineal US, diagnostic tests and physical and intra-operative findings were extracted. The US imaging features and clinicopathologic characteristics of each urethral or peri-urethral mass were compared. On ultrasound, 39 masses (in 39 patients) were diagnosed as urethral diverticula, which manifested mostly as complex cystic masses (24/39, 61.5%); 35 masses (in 33 patients) were diagnosed as para-urethral cysts, which manifested mostly as simple cystic masses (19/35, 54.3%); 13 hypo-echoic solid masses (in 12 patients) exhibiting blood flow signals on color Doppler imaging were diagnosed as urethral leiomyomas; hypo-echoic or heterogeneous solid masses (in 8 patients) exhibiting blood flow signals on color Doppler imaging were diagnosed as urethral caruncles, including one complicated by malignant transformation; solid masses with mixed echogenicity (in 2 patients) exhibiting blood flow signals on color Doppler imaging were diagnosed as urethral squamous cell carcinoma or adenocarcinoma, and a hypoechoic solid mass (in one patient) with blood-flow signals on color Doppler imaging was diagnosed as urethral condyloma associated with human papillomavirus infection. This study confirmed transvaginal or transperineal 2-D and 3-D ultrasonography to be a valid, non-invasive, cost-effective diagnostic modality for the differential diagnosis of urethral and periurethral masses.