乳腺超声自动容积成像联合超声造影微血管成像在乳腺病灶鉴别诊断及肿瘤TNM分期中的应用价值

目的探索乳腺超声自动容积成像联合超声造影微血管成像在乳腺病灶鉴别诊断及肿瘤TNM分期中的应用价值。方法收集乳腺肿块患者64例,入院后均行超声自动容积成像和超声造影微血管成像检查,将患者分为乳腺癌组和良性肿块组。比较超声造影微血管成像乳腺良恶性肿瘤血流检出率,分析诊断乳腺癌TNM分期与病理分期的符合率,评估超声造影微血管成像、全容积超声成像、二者联合的灵敏度、特异度。结果乳腺癌组造影后周边血流、内部血流检出率均明显高于良性肿块组(P0. 05)。所有乳腺癌TNM分期中,超声自动容积成像与病理符合率是58. 82%,而超声造影微血管成像与病理符合率是85. 29%,两者具体统计学差异(P0. 05)。二者联合成像的特异度显著高于单独超声造影微血管成像、自动容积成像诊断,差异有统计学意义(P0. 05)。两者联合诊断的Kappa最高,病理判断一致性最好。结论超声自动容积成像和超声造影微血管成像能准确客观地提供乳腺癌血管生成水平和病灶的结构变化,有助于乳腺癌的临床诊断。联合应用的灵敏度和病理结果一致性最好。     

乳腺癌超声弹性成像与组织学特征、分子生物学指标的相关性

目的探讨乳腺癌超声弹性成像与组织学特征、分子生物学指标的相关性。方法选择孕激素受体乳腺癌患者200例,采用超声弹性成像进行弹性评分;采用免疫组化法测定人表皮生长因子受体(Her)-2、雌激素受体(ER)和孕激素受体(PR)表达。观察超声弹性成像评分、组织学特征及Her-2、ER和PR表达阳性情况,超声弹性成像评分与组织学和分子生物学水平的关系。结果超声弹性成像评分中,评分3分9例、评分4分24例、评分5分167例。肿瘤大小≥2. 0 cm患者54例,浸润型导管癌患者168例,淋巴结转移患者73例。Her-2阳性表达患者125例,ER阳性表达患者139例,PR阳性表达患者145例。不同肿瘤大小超声弹性成像评分比较差异无统计学意义(P>0. 05);浸润型导管癌超声弹性成像评分5分多于浸润型小叶癌和其他,淋巴结转移超声弹性成像评分5分多于无淋巴结转移,Her-2阳性者超声弹性成像评分5分比例显著多于阴性者,ER阳性者超声弹性成像评分5分比例显著多于阴性者,PR阳性者超声弹性成像评分5分比例显著多于阴性者,差异有统计学意义(P<0. 05)。结论乳腺癌超声弹性成像与组织学病理及Her-2、ER和PR阳性表达具有一定相关性,二者联合可作为乳腺癌早期诊断及预后评估指标。     

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。     

实时超声弹性成像在老年甲状腺恶性结节诊断中的价值

目的探讨实时超声弹性成像技术在老年甲状腺良恶性结节患者诊断中的价值。方法 154例甲状腺病变患者(185个结节)均有超声影像学资料且均经病理证实,其中恶性结节75个,良性结节110个,对比超声弹性成像与病理结果,计算超声弹性成像诊断甲状腺良恶性结节的灵敏度、特异度、准确率等诊断指标。结果 110个良性结节中94个超声弹性成像评级为1~2级,13个3~4级,75个恶性结节中7个评级为1~2级,68个3~4级;甲状腺良、恶性结节超声弹性成像分级差异有统计学意义(P<0.05);与常规超声相比,超声弹性成像诊断甲状腺结节的灵敏度、特异度、阳性阴性预测值及诊断符合率均更好(P<0.05);甲状腺良、恶性结节两组的超声弹性成像图形态、最大直径、包膜情况、边界、钙化情况、回声水平差异有统计学意义(P<0.05)。结论超声弹性成像在鉴别老年甲状腺良恶性结节中具有无创、便捷、准确的优点。     

超声弹性成像在甲状腺恶性结节诊断中的价值

目的探讨超声弹性成像技术在甲状腺恶性结节诊断中的应用价值。方法选择我院住院患者62例83个甲状腺病灶,分别进行常规超声检查及超声组织弹性成像检查,并与手术病理结果对照分析。结果超声弹性成像法诊断甲状腺恶性结节的敏感性、特异性、准确性分别为87.88%、94.00%、91.56%,高于常规超声(敏感性、特异性、准确性分别为42.42%、82.00%、66.62%)。结论超声弹性成像在甲状腺恶性结节诊断中具有重要的临床价值。     

冠状动脉光学相干断层成像与血管内超声成像临床应用进展

光学相干断层成像技术和血管内超声成像技术是现行两种主要的冠状动脉血管内成像技术。光学相干断层成像技术具有分辨率高,组织相关性良好等特点;血管内超声成像技术具有穿透性高,成像范围广等特点。在临床应用中,两种技术有着各自的优势,两者的结合应用可以提供更多的一临床信息。现就不同临床应用中光学相干断层成像技术与血管内超声成像技术的评价能力进行对比,并对光学相干断层成像技术与血管内超声成像技术的结合应用进行简要介绍。     

甲状腺结节TI-RADS分级与超声弹性成像对比研究

目的比较甲状腺显像报告和数据系统(TI-RADS)分级与超声弹性成像(UE)在甲状腺结节鉴别诊断中的应用。方法选择100例符合条件的患者。先行超声探查,进行TI-RADS分级,再行超声弹性成像检查,进行弹性成像评分,并记录结果。结果 TI-RADS及弹性成像与病理结果的一致性极好(Kappa=0.703,P0.001;Kappa=0.711,P0.001)。结论 TI-RADS分级、超声弹性成像均对甲状腺结节良恶性方面的鉴别诊断具有很好的临床意义。     

超声增强剂在超声心动图中的临床应用现状及进展

2018年3月美国超声心动图学会发布了超声增强剂(UEA)在超声心动图中的临床应用指南,对其应用范围进行了更新。UEA已广泛应用于左心室结构与功能评估、心内异常、负荷超声心动图、血管成像、重症及急诊监测以及部分儿科心脏成像等。其新型应用也在不断扩展中,包括超声溶栓、分子成像、靶向药物及基因传递等。UEA有益于心血管疾病的早期诊治与治疗,临床成本效益显著。     

超声弹性成像与超声造影用于诊断肝肿瘤的临床价值

目的探讨超声弹性成像与超声造影用于诊断肝肿瘤的临床价值。方法收集我院2014年10月至2017年10月收治肝肿瘤科患者103例,观察患者的超声造影和超声弹性成像特征,对比两种检查方式的ROC曲线下面积、特异性、敏感度和准确率,分析两种方式的诊断价值。结果超声造影检查69例检出为恶性,34例检出为良性,良性比例为33.0%;超声弹性成像检查73例检出为恶性,30例检出为良性,良性比例为29.1%;超声造影、超声弹性成像诊断肝肿瘤良恶性的ROC曲线下面积分别为0.956和0.832。超声造影特异性为81.5%(22/27),超声弹性成像特异性为88.9%(24/27),两组检查方式特异性差异无统计学意义(P0.05);超声造影敏感度为88.2%(67/76),超声弹性成像敏感度为96.1%(73/76),两组检查方式敏感度差异无统计学意义(P0.05);超声造影准确率为86.4%(89/103),超声弹性成像准确率为94.2%(97/103),两组检查方式准确率差异有统计学意义(P0.05)。结论超声弹性成像与超声造影在诊断肝肿瘤中均具有较高的价值,值得进一步应用推广,临床上可以联合两种方式提高检测准确性。     

超声弹性成像技术与常规超声诊断甲状腺良恶性结节的价值研究

目的将超声弹性成像技术及常规超声诊断用于甲状腺良恶性结节中,对其诊断价值进行研究分析。方法对2016年6月-2017年2月于我院进行检查的78例甲状腺结节患者进行研究,对其临床资料进行回顾分析,78例患者均进行超声弹性成像技术检查及常规超声检查,均经病理手术病理学检查证实。将超声弹性成像技术与常规超声诊断结果进行比较,包括诊断敏感性、特异性、精准性,分析其诊断甲状腺良恶性结节的应用价值。结果经常规超声检查敏感性为60.0%,特异性为58.21%,诊断精准性为58.82%;经超声弹性成像技术检查分别为94.29%、98.51%、97.06%,两种诊断方式相比超声弹性成像技术敏感性、特异性、精准性明显更高(P0.05);超声弹性成像诊断良性结节多为1级、2级;恶性结节多在4级、5级。结论超声弹性成像技术用于甲状腺结节诊断中价值较高,相比常规超声检查具有更高的诊断敏感性、特异性及精准性,值得临床应用。     

Advanced imaging in COPD: insights into pulmonary pathophysiology

Chronic obstructive pulmonary disease (COPD) involves a complex interaction of structural and functional abnormalities. The two have long been studied in isolation. However, advanced imaging techniques allow us to simultaneously assess pathological processes and their physiological consequences. This review gives a comprehensive account of the various advanced imaging modalities used to study COPD, including computed tomography (CT), magnetic resonance imaging (MRI), and the nuclear medicine techniques positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Some more recent developments in imaging technology, including micro-CT, synchrotron imaging, optical coherence tomography (OCT) and electrical impedance tomography (EIT), are also described. The authors identify the pathophysiological insights gained from these techniques, and speculate on the future role of advanced imaging in both clinical and research settings.     

Imaging of the thyroid: Recent advances

Although thyroid scintigraphy and ultrasound continues to be the mainstay of the diagnostic imaging of the thyroid gland, there have been several recent advances that are of interest to both radiologists and endocrinologists. In this review article, the authors discuss recent progress in imaging of the thyroid by use of radionuclide imaging including single photon-emission computed tomography/positron emission tomography, ultrasonography (USG), USG elastography, computed tomography (CT), magnetic resonance imaging (MRI), and optical coherence tomography.     

Hepatocellular carcinoma in cirrhosis: semeiology and performance of magnetic resonance imaging and lipiodol computed tomography

OBJECTIVES: a) Describe hepatocellular semiology in magnetic resonance imaging and lipiodol computerized tomography in patients with cirrhosis, who are candidates for surgery; b) Clarify the respective roles of magnetic resonance imaging and lipiodol computerized tomography in hepatocellular detection. METHODS: Twenty four patients with suspected hepatocellular carcinoma underwent successive magnetic resonance imaging and lipiodol computerized tomography. Thirty-four of the 67 lesions seen by lipiodol computerized tomography and 28 of 52 lesions seen by magnetic resonance imaging were confirmed histologically. RESULTS: In lipiodol computerized tomography, 44% of hepatocellular carcinomas had a dense and homogeneous pattern; 24% had a homogeneous but slightly dense pattern. Sixteen distinct deposits were described: 4 were confirmed as hepatocellular carcinoma and 12 were not controlled histologically. In magnetic resonance imaging 57% of hepatocellular carcinomas have a high intensity on T1 and T2 weighted spin echo images, 38% were hyperintense on T2 and hypo or isointense on T1 weighted images. Eighty-six percent of hyperintense T1 and T2 weighted images were hepatocellular carcinoma. When the gold standard was histology, lipiodol computerized tomography sensitivity (81%) was higher than magnetic resonance imaging (68%). When the gold standard was lipiodol computerized tomography, the sensitivity of magnetic resonance imaging was 47 +/- 12%. CONCLUSIONS: a) The sensitivity of lipiodol computerized tomography was better than resonance magnetic imaging; b) the homogeneous and slightly dense pattern corresponded to a hepatocellular carcinoma in 50% of cases; c) on magnetic resonance imaging any lesions with high intensity on T1 and T2 spin echo images strongly suggests hepatocellular carcinoma; d) if surgical resection after ultrasonography is being considered, the second step should be an magnetic resonance imaging.     

Advances in medical imaging

The field of medical imaging, stimulated by advances in digital and communication technologies, has grown tremendously. New imaging techniques that reveal greater anatomical detail are available in most diagnostic radiology departments. We discuss vascular imaging with ultrasound, high-resolution computed tomography of the thorax, magnetic resonance imaging applications, and picture archiving and communication systems. Vascular imaging with ultrasound requires duplex and color flow Doppler, which combine gray-scale ultrasound and the Doppler phenomenon. High-resolution computed tomography modifies conventional computed tomography technology and results in images with higher spatial resolution. Magnetic resonance imaging applications for all areas of the body are being investigated and are replacing older roentgenographic techniques such as computed tomography, arthrography, myelography, and even angiography in a growing number of indications. With these new digital imaging modalities, image management has become an important consideration that can be addressed by picture archiving and communication systems.     

The Role of Positron Emission Tomography in the Management of Recurrent Colorectal Cancer: A Review

Purpose Surgery remains the only option for potential cure in patients with recurrent colorectal cancer. Accurate staging modalities aid in the avoidance of futile surgery, which may result in considerable morbidity in patients with incurable disease. Current imaging techniques used in disease staging often are not sensitive enough to identify low-volume metastatic disease. This study reviews the role of positron emission tomography in the assessment of patients with suspected recurrent colorectal cancer. Methods A literature search using the PubMed, MEDLINE, and Embase database was performed, locating English language articles on positron emission tomography, positron emission tomography, recurrent colon, and/or rectal cancer. The references of these papers were searched manually for further references. Results Positron emission tomography is more sensitive and more specific than conventional diagnostic imaging for metastatic disease and local recurrence respectively. Studies confirm the superior ability of positron emission tomography scans compared with conventional diagnostic imaging in differentiating between scar tissue and invasive tumor. Positron emission tomography scanning is more sensitive and specific for the assessment of liver metastases (and probably in patients with lung metastasis) than conventional diagnostic imaging. Positron emission tomography is superior to conventional diagnostic imaging in the investigation of raised carcinoembryonic antigen in the postoperative patient and alters management in approximately 37 percent of patients with recurrent colorectal cancer. The limitations and cost effectiveness of positron emission tomography are discussed. Conclusions Positron emission tomography scanning is emerging as the imaging modality of choice for patients being considered for surgery for locally recurrent colorectal cancer. Positron emission tomography has the greatest impact by detecting unresectable disease and thereby averting inappropriate surgery. Despite the high set-up costs, its use seems to be cost effective. Reprints are not available.     

Positron emission tomography for assessment of viability

PURPOSE OF REVIEW: The recent success of magnetic resonance imaging for viability assessment has raised questions about the future role of positron emission tomography and older imaging modalities in the assessment of viability. Recent information, however, indicates that positron emission tomography will remain a valuable tool. RECENT FINDINGS: The primary positron emission tomography tracer used for assessment of viability is 18F-fluorodeoxyglucose, a glucose analogue that exhibits enhanced uptake in ischemic tissue. The finding of enhanced 18F-fluorodeoxyglucose uptake and a relative reduction in perfusion is considered the positron emission tomography correlate of myocardial hibernation. The mismatch pattern has been shown to identify patients with improvement in systolic function, heart failure symptoms, and prognosis with revascularization. Mismatch identifies a subset of patients with vulnerable myocardium who have a higher likelihood of a cardiac event compared with those without significant mismatch. Delay in revascularization may pose extra risk for those with mismatch. Positron emission tomography and magnetic resonance imaging demonstrate a close correlation in the detection of viable myocardium. The development of combined positron emission tomography/computed tomography scanners can reduce imaging time and improve functional-anatomic correlations. SUMMARY: Positron emission tomography imaging utilizing 18F-fluorodeoxyglucose and perfusion tracers provides valuable diagnostic and prognostic information in patients with ischemic left ventricular dysfunction and has comparable accuracy to competing technologies for detection of viability.     

Update in liver imaging.

Over the last decade, liver imaging has experienced a revolution providing a bewildering array of options for detection and characterisation of liver lesions. Cross-sectional imaging modalities like computed tomography and magnetic resonance imaging have improved in speed and resolution, thereby facilitating multiphasic scanning of the liver. The advent of the use of contrast agents for ultrasonography and magnetic resonance imaging has further paved the way for definitive diagnosis in an attempt to obviate the need for invasive diagnosis. This article captures advances made in ultrasonography, computed tomography, magnetic resonance imaging and positron emission tomography and brings the specialist up to date with the latest in liver imaging.     

Diffusion-weighted magnetic resonance for pulmonary nodules: 1.5 vs. 3 Tesla

The usefulness of diffusion-weighted magnetic resonance for assessing malignant pulmonary nodules was examined in 58 patients with 76 (58 malignant, 18 benign) pulmonary nodules (1.0-5.6 cm) who underwent 1.5-T and 3-Tesla imaging and (18)F-fluorodeoxyglucose positron-emission tomography prior to surgery. The sensitivities and specificities of these techniques for discriminating benign and malignant nodules were compared. The apparent diffusion coefficients of the pulmonary nodules on 1.5-T and 3-T imaging correlated significantly. The sensitivities and specificities for discriminating benign and malignant lesions were similar among the 3 imaging techniques: 1.5-T imaging, 0.91 and 0.90; 3-T imaging, 0.88 and 0.94; positron-emission tomography, 0.94 and 0.94. The apparent diffusion coefficient on 1.5-T imaging showed a significant reverse correlation with positron-emission tomography, and the correlation between 3-T imaging and positron-emission tomography was marginally significant. Both 1.5-T and 3-T diffusion-weighted magnetic resonance imaging modalities are equally useful for assessing malignant pulmonary nodules.     

CT and MR imaging of pancreatic cancer

Recent improvements in imaging techniques have made it possible to improve the diagnostic accuracy for detection, staging, and indicating surgical resectability of pancreatic cancer. The latest advance in the computed tomography technique, is the introduction of subsecond multislice helical scanning that improves z-axis resolution in the reformatted images and three-dimensional rendering with a large volume data. Magnetic resonance imaging provides versatile information including magnetic resonance cholangiopancreatography that allows noninvasive delineation of the pancreatic and biliary duct systems. The presence of pancreatic cancer may best be evaluated by dynamic computed tomography or dynamic magnetic resonance imaging with administration of intravenous contrast material. Both computed tomography and magnetic resonance imaging are valuable for the preoperative assessment of local invasion and vascular involvement. Multislice helical computed tomography is currently considered as the best single modality for the diagnosis of pancreatic cancer as it provides excellent image quality. When advanced magnetic resonance imaging equipment is used as a primary modality, in the future, it may have a possibility to replace other imaging modalities.     

Técnicas de imagen híbridas en cardiopatía isquémica

Hybrid imaging for ischemic heart disease refers to the fusion of information from a single or usually from multiple cardiovascular imaging modalities enabling synergistic assessment of the presence, the extent, and the severity of coronary atherosclerotic disease along with the hemodynamic significance of lesions and/or with evaluation of the myocardial function. A combination of coronary computed tomography angiography with myocardial perfusion imaging, such as single-photon emission computed tomography and positron emission tomography, has been adopted in several centers and implemented in international coronary artery disease management guidelines. Interest has increased in novel hybrid methods including coronary computed tomography angiography-derived fractional flow reserve and computed tomography perfusion and these techniques hold promise for the imminent diagnostic and management approaches of patients with coronary artery disease. In this review, we discuss the currently available hybrid noninvasive imaging modalities used in clinical practice, research approaches, and exciting potential future technological developments.