超声造影评价胆囊息肉样病变形态特征的临床研究

目的：通过与常规超声技术对比,明确超声造影技术在评价胆囊息肉样病变形态特征的优势和临床价值。方法：收集我院2016年3月到2018年7月因囊息肉样病变行胆囊切除患者146例纳入研究。研究对象于胆囊切除术前分别进行胆囊常规超声及超声造影检查。根据手术病理结果,将胆囊息肉分为胆固醇性息肉组与腺瘤性息肉组。分析并记录胆囊息肉常规超声特征、患者年龄、性别、胆囊结石、息肉数量、息肉内血流、息肉最大径大小以及息肉基底部宽度并进行统计分析。两组间计量资料采用t检验,等级资料采用χ_²检验。采用多因素回归分析明确鉴别胆囊腺瘤的独立风险因素。P <0.05认为差异有统计学意义。结果：经手术病理证实104例为胆固醇性息肉,42例为腺瘤性息肉。胆固醇组与腺瘤组间在年龄、性别、胆囊结石以及息肉数量方面无统计学差异(p>0.05),息肉内血流、息肉最大径在两组间有统计学差异(p<0.05)。两组间超声测量基底部宽度与超声造影测量基底部宽度均有统计学差异(p<0.05)。两组内超声测量基底部宽度与超声造影测量基底部宽度有统计学差异(p<0.05)。多因素回归分析证实息肉内血流、超声造影测量息肉基底部宽度是与腺瘤性息肉相关的独立风险因素(p<0.05)。 结论：超声造影技术能够更准确反应胆囊息肉形态特征,有助于鉴别胆固醇性息肉与腺瘤性息肉。     

彩阶B超在超声内镜诊断胃胆疾病中的价值

本报道采用彩阶B超与超声内镜联机，对156例胃胆病变（胃癌64例，胃溃疡40例，胆囊结石28例，胆囊息肉20例，胆囊肌腺瘤4例）进行超声内镜检查及黑白灰阶图像的彩色显示，全部病例均有手术与病理对照，结果显示：良性胃溃疡的平均色量级高于胃癌（P＜0.01）；胆囊结石比胆囊息肉提高近2个色量级（P＜0.01）；B彩能不同程度地提高病灶的清晰度；B彩对病变的诊断准确率与黑白灰阶显示的结果相近，统计学无显差异。     

三维超声成像对胆囊疾病的应用价值

目的:评价三维超声成像在胆囊疾病中的临床应用价值。方法:对胆囊结石、胆囊息肉、胆囊癌和胆囊腺肌增生症共49例不同的胆囊病变进行三维重建。结果:①三维超声可清晰、直观地显示息肉的部位和表面特征,准确评价息肉是否带蒂及基底部的宽窄;②三维超声可清楚地显示胆囊癌的范围、胆囊壁的连续性以及浸润周围脏器结构的程度;③三维超声可清晰显示结石的数目及形态;④三维超声可清晰显示胆囊腺肌增生症病变累及范围。结论:三维超声重建可以更直观地显示胆囊疾病的形态特点及与周围脏器结构的关系,能够提供较二维超声更丰富的信息,对明确诊断及确定治疗方案有重要的临床意义。     

Visualization of uveal perfusion by contrast-enhanced harmonic ultrasonography at a low mechanical index: a pilot animal study.

OBJECTIVE: To evaluate contrast-enhanced harmonic ultrasonography at a low mechanical index for its usefulness in visualizing uveal perfusion. METHODS: The study was performed with 9 rabbits, 6 intact and 3 with focal impaired blood flow in the uvea. Ultrasonography was performed by harmonic imaging (transmit, 5 MHz; receive, 10 MHz) with a contrast agent. The agent was administered at a dose of 50 microL/kg. Transmission power was at a mechanical index of 0.2, which is below the US Food and Drug Administration guideline. The images were compared between the impaired and intact eyes. For uveal measurements, video signal intensity-versus-time plots were generated in all cases. The plots were analyzed to obtain the rate of signal intensity increase and peak signal intensity. RESULTS: A clear increase of signal intensity was observed after contrast agent administration. The signal intensity of the uvea was lower in the impaired eye than in the intact eye. In the impaired eye, the intensity was lower on the side with impaired flow than on the other side. The differences were significant. CONCLUSIONS: Our findings suggest that uveal perfusion can be visualized by contrast-enhanced harmonic ultrasonography in the harmonic imaging mode at a low mechanical index.     

Diagnosis of gallbladder diseases by contrast-enhanced phase-inversion harmonic ultrasonography

We evaluated the usefulness of contrast-enhanced ultrasonography(US) for detecting and differentiating gallbladder lesions. Contrast-enhanced coded phase-inversion harmonic US was performed on 90 patients with gallbladder abnormalities. After administering Levovist, we observed the gallbladders in real time. Contrast-enhanced coded phase-inversion harmonic ultrasonography was compared with B-mode US and contrast-enhanced computer tomography (CT) with regard to the sensitivity and specificity in depicting the elevated gallbladder lesions. Furthermore, we assessed how the vascular patterns of the elevated gallbladder lesions depicted by contrast-enhanced US correlated with the diagnosis. Contrast-enhanced US efficiently discriminated true lesions from biliary sludge, unlike B-mode US. Consequently, contrast-enhanced US was more specific (100%) than B-mode US (81%), although their sensitivities were similar (98% and 96%, respectively). Contrast-enhanced US was also more sensitive that contrast-enhanced CT (98% versus 79%), although the two methods were equally sensitive (100% versus 95%). We classified the vascular patterns of the abnormalities depicted by contrast-enhanced US in the 90 cases into types 1 to 4, which represent branch-like, heterogeneous, homogeneous, and avascular patterns, respectively. All type 1 and 2 lesions were over 10 mm in size while most (88%) type 3 lesions were 10 mm or less in size. While the majority of carcinomas (86%) were type 1 or 2, three benign lesions also showed these patterns. Thus, the vascular pattern may simply reflect the size of the lesion and therefore its usefulness in diagnosing gallbladder lesions may be limited. Nevertheless, contrast-enhanced US is clearly superior to the other techniques in discriminating biliary sludge from other lesions.     

Evaluation using contrast-enhanced harmonic gray scale sonography after radio frequency ablation of small hepatocellular carcinoma: sonographic-histopathologic correlation.

OBJECTIVE: To evaluate the usefulness of contrast-enhanced harmonic wideband gray scale sonographic images obtained after radio frequency-induced coagulation necrosis, we compared the morphologic and histopathologic characteristics of the ablated tumors with sonographic images of the tumors. METHODS: Forty-eight patients with 72 hepatocellular carcinomas with a maximal diameter of 3 cm or less were treated percutaneously using radio frequency ablation. Six treated tumors in 4 patients were resected 1 month after ablation; the remaining 66 treated tumors were evaluated by a biopsy procedure performed with an 18-gauge fine needle 1 month after ablation. The excised tumors and biopsy specimens were then examined by histopathologic methods, and the findings were compared with those obtained on contrast-enhanced harmonic wideband gray scale sonography. Hematoxylin-eosin-stained specimens were inconclusive as to whether cellular viability remained; therefore, cell viability was determined by a positive result after histochemical (lactate dehydrogenase and nicotinamide adenine dinucleotide phosphate-diaphorase) staining. RESULTS: Contrast-enhanced harmonic wideband gray scale sonography after radio frequency ablation showed residual tumor enhancement in 5 (6.9%) of the 72 tumors; the histopathologic results for these 5 tumors were also positive for tumor residue. The remaining 67 tumors (93.1%) did not show any residual tumor enhancement when examined by sonography; however, only 66 tumors did not reveal tumor residue when examined histopathologically. Contrast-enhanced harmonic wideband sonographic imaging provided results that were comparable with histopathologic findings, the criterion standard for diagnosis; the sensitivity and specificity of the sonographic images for the detection of residual tumor tissue in ablated tumors were 83.3% (5 of 6) and 100% (66 of 66), respectively. CONCLUSIONS: Contrast-enhanced harmonic wideband gray scale sonography is a potentially useful technique for evaluating the therapeutic effects of radio frequency ablation on hepatocellular carcinoma.     

Correlation of real-time gray scale contrast-enhanced ultrasonography with microvessel density and vascular endothelial growth factor expression for assessment of angiogenesis in breast lesions.

OBJECTIVE: The purpose of this study was to determine the correlation of real-time gray scale contrast-enhanced ultrasonographic (CEUS) patterns and parameters with microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression for assessment of angiogenesis in breast lesions. METHODS: Real-time gray scale CEUS was performed in 53 women with breast lesions. Contrast-enhanced ultrasonographic patterns and quantitative parameters were analyzed. Mean MVD and VEGF expression in breast lesions were measured by immunohistochemical analysis. RESULTS: Surgical pathologic analysis showed 25 benign and 28 malignant lesions. Different CEUS patterns were observed in the high- and low-MVD and -VEGF groups. Microvessel density and VEGF expression were significantly associated with heterogeneous enhancement with or without perfusion defects and radial or penetrating vessels surrounding the lesions (P< .05). The enhancement order and degree were significantly related to MVD (P< .01) but not correlated with VEGF expression (P> .05). Malignant and benign lesions did not differ significantly in time-intensity parameters (P> .05). The peak intensity, rise in intensity, maximum rise slope of the curve, wash-out slope of the curve, and area under the time-intensity curve (area) were statistically correlated with MVD (P< .05). The highest correlation (r=0.56; P< .001), however, was between the area and MVD. No significant association was found between any CEUS parameters and VEGF expression (P> .05). CONCLUSIONS: Contrast-enhanced ultrasonographic patterns and parameters of breast lesions are more closely correlated with MVD than VEGF expression. Real-time gray scale CEUS has a potential role in evaluating angiogenesis in breast lesions, but CEUS parameters are not correlated with the malignancy or benignity of breast tumors.     

Clinical efficacy of contrast-enhanced ultrasonography (CEUS) in the diagnosis of ruptured hepatocellular carcinoma (HCC)

Purpose To evaluate the role of contrast-enhanced ultrasonography (CEUS) in the diagnosis of ruptured hepatocellular carcinoma (HCC). Methods CEUS and angiography were performed in ten cases of ruptured HCC. We evaluated whether this technique allowed us to determine the bleeding point by observing an extravasation of contrast media into the ascites. Results In four of the ten cases, CEUS demonstrated an extravasation of Levovist into ascites. Angiography showed an extravasation of contrast medium in three of these four cases. In three of the remaining six cases, in which CEUS did not show the presence of contrast medium in ascites, angiography demonstrated an extravasation. In eight cases, it yielded cessation of bleeding. In two cases, embolization was not successful. The bleeding point was not determined by CEUS or angiography in one case. Conclusion CEUS allows us to differentiate active bleeding (presence of contrast medium in the ascites) from nonactive bleeding.     

Preliminary study of contrast-enhanced harmonic endosonography with second-generation contrast agents

Purpose We developed a novel echoendoscope that enables contrast harmonic imaging using ultrasound contrast agents and performed contrast-enhanced harmonic endosonography (EUS) both in vitro and in vivo. Methods An experimental convex-array echoendoscope equipped with a wideband transducer and a specific mode for contrast harmonic imaging was used. A Doppler phantom model was employed in in vitro experiments to determine the optimal mechanical indices for contrast harmonic imaging by the echoendoscope. In the in vivo experiments, the echoendoscope was inserted into the stomachs of dogs. The digestive organs were observed after intravenous infusion of a contrast agent, Definity, using contrast-enhanced harmonic EUS. Two patients, one with pancreatic carcinoma and one with a gastrointestinal stromal tumor (GIST), underwent contrast-enhanced harmonic EUS. Results In vitro experiments revealed that the optimal mechanical indices were 0.35–0.40 for intermittent imaging and 0.30 or less for real-time imaging. In the in vivo experiments, branching vessels and subsequent homogeneous distribution of the signal in the pancreatic tissue were observed. During clinical application, typical vascular patterns were observed in pancreatic carcinoma and a GIST. Conclusion Contrast-enhanced harmonic EUS visualized parenchymal perfusion and the fine vascular structure in digestive organs and should be a useful and powerful method for clinical investigations.     

Endoscopic sonography in the diagnosis of gallbladder wall lesions in patients with gallstones

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of endoscopic sonography (EUS) in the detection of gallbladder wall lesions in patients with and without gallstones. METHODS: We retrospectively reviewed the medical records, sonograms, and sonographic reports of 62 patients who underwent cholecystectomy for gallbladder wall lesions evaluated by EUS. We assessed the accuracy of EUS in diagnosing gallbladder wall lesions in the presence or absence of gallstones and on the basis of the size and number of stones and the size of the gallbladder wall lesions. We also evaluated the effect of acoustic shadowing. The EUS results were compared with the histopathologic results. RESULTS: EUS correctly diagnosed the gallbladder wall lesions in 17 (71%) of 24 patients with gallstones and in 34 (89%) of 38 patients without gallstones. The diagnostic accuracy of EUS was 86% in patients with gallbladder wall lesions smaller than 20 mm and 79% in patients with gallbladder wall lesions 20 mm or larger. The diagnostic accuracy was 75% in patients with gallstones smaller than 5 mm and 67% in patients with stones 5 mm or larger. The accuracy was 67% in patients with 1-5 stones and 83% in patients with 6 or more stones. None of these differences was statistically significant. Acoustic shadowing did not affect the diagnostic accuracy of EUS. CONCLUSIONS: The diagnostic accuracy of EUS for gallbladder wall lesions is not affected by the presence of gallstones. However, better diagnostic criteria must be established based on larger studies, and technical refinements of the equipment are needed to increase the accuracy of EUS in the diagnosis of gallbladder wall lesions.     

Left-sided hepatic hydrothorax diagnosed by contrast-enhanced ultrasonography with intraperitoneal injection of Levovist

A 62-year-old Japanese woman was admitted to our hospital with dyspnea. Chest X-ray revealed massive pleural effusion on the left side. Contrast-enhanced ultrasonography using Levovist was performed to confirm the transdiaphragmatic passage of ascitic fluid into the pleural cavity. After injection of Levovist into the peritoneal cavity, an enhanced pulsative flow into the pleural cavity was detected. This is the first report of hepatic hydrothorax diagnosed by contrast-enhanced ultrasonography. This method is safe and useful for the diagnosis of hepatic hydrothorax, and it allows observation of the real-time movement of ascitic fluid from the peritoneal cavity to the pleural space and detection of the site of the peritoneopleural communication.     

实时灰阶超声造影诊断甲状腺乳头状癌的临床价值

目的观察总结实时灰阶超声造影显示甲状腺乳头状癌的增强方式和特征。方法对57例65个甲状腺乳头状癌病灶进行常规超声和超声造影检查,所有病灶均由手术病理证实。使用PHILIPSiU22超声诊断仪,造影时仪器预设置始终保持一致,造影剂为SonoVue。观察分析甲状腺结节的开始增强时间、内部和边缘的增强情况。结果实时灰阶超声造影显示乳头状癌中56.9%(37/65)的结节增强晚于甲状腺实质,为延迟增强;在造影增强达峰时,72.3%(47/65)的结节内部增强强度低于甲状腺组织,73.8%(48/65)的结节呈不均匀增强,60.0%(39/65)的结节显示无边缘结构。结论实时灰阶超声造影显示甲状腺乳头状癌有一定的特征性表现,可为临床鉴别诊断提供更多的信息。     

Peripheral zone hypoechoic lesions of the prostate: evaluation with contrast-enhanced gray scale transrectal ultrasonography.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of contrast-enhanced gray scale transrectal ultrasonography (TRUS) for detection of prostate cancer in peripheral zone hypoechoic lesions of the prostate. METHODS: The study involved 66 patients with peripheral zone hypoechoic lesions detected by TRUS. The lesions were evaluated with contrast-enhanced TRUS to differentiate prostate cancer from benign lesions, and the results were compared with color Doppler ultrasonographic findings. RESULTS: Transrectal ultrasonographically guided biopsy of the hypoechoic lesions revealed prostate cancer in 30 patients and benign prostatic diseases in 36. Flow signals within the lesions were classified as no, increased, equal, and decreased flow compared with surrounding peripheral zone tissue as follows: 1, 16, 12, and 1, respectively, in the prostate cancer group and 10, 12, 10, and 4 in the benign disease group. If we considered an increased flow signal within a peripheral hypoechoic lesion as a sign of prostate cancer, color Doppler ultrasonography had low sensitivity and specificity (55.2% and 53.8%, respectively). The enhancement intensity within the lesions was classified as no, increased, equal, and decreased enhancement compared with surrounding peripheral zone tissue as follows: 2, 20, 3, and 5 in the prostate cancer group and 14, 8, 4, and 10 in the benign disease group. The difference was statistically significant (P<.05). Thus, the peak enhancement intensity would be the optimal parameter for discriminatory performance (area under the receiver operating characteristic curve, 0.74; 95% confidence interval, 0.60-0.88). CONCLUSIONS: Contrast-enhanced TRUS could reveal the presence of vasculature within peripheral zone hypoechoic lesions more objectively than color Doppler ultrasonography and could be promising in guidance of prostate biopsy.     

Diagnostic efficacy of contrast-enhanced ultrasonography in solid renal parenchymal lesions with maximum diameters of 5 cm.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic efficacy of contrast-enhanced ultrasonography (CEUS) using a sulfur hexafluoride contrast agent and the cadence contrast pulse sequencing mode in differentiating solid renal parenchymal lesions (SRPLs) with a maximum diameter of 5 cm. METHODS: Seventy-one patients with 72 SRPLs with a maximum diameter of 5 cm underwent conventional ultrasonographic and CEUS examinations in our department. The final diagnoses were 44 renal cell carcinomas (RCCs; confirmed by pathologic examination), 24 renal angiomyolipomas (4 by pathologic examination and 20 by computed tomography, magnetic resonance imaging, and follow-up studies), 1 oncocytoma (by pathologic examination), 2 hypertrophied columns of Bertin, and 1 renal abscess (both by computed tomography, magnetic resonance imaging, and follow-up studies). Three observers who were blinded to other results and the final diagnoses reviewed the conventional ultrasonographic and CEUS images. RESULTS: Hyperenhancement in the late phase (30-90 seconds after agent injection) was the most important finding for predicting SRPLs with a maximum diameter of 5 cm to be RCCs. With this criterion, the specificity and sensitivity for diagnosing solid RCCs (相似文献   

The use of contrast-enhanced ultrasonography in the selection of patients with hepatocellular carcinoma for radio frequency ablation therapy.

OBJECTIVE: The purpose of this study was to evaluate the use of contrast-enhanced ultrasonography (CEUS) in selecting patients with hepatocellular carcinoma (HCC) for radio frequency ablation (RFA). METHODS: One hundred seventy-nine patients with HCC were divided into 2 groups before receiving RFA: a CEUS group and a control group. The patients were concatenated and alternately apportioned into these 2 groups. In the CEUS group, 92 patients underwent pre-RFA CEUS using the contrast agent sulfur hexafluoride and enhanced computed tomography or magnetic resonance imaging before RFA for selecting suitable cases for RFA, and in the control group, conventional ultrasonography and enhanced computed tomography or magnetic resonance imaging were performed in 87 patients for selecting patients. RESULTS: In the CEUS group, 9 patients (9.8%) were excluded for RFA therapy by CEUS. The other 83 patients (90.2%), with a total of 114 lesions, were treated by RFA. In the control group, 5 patients (5.7%) were excluded for RFA. The other 82 patients (94.3%), with a total of 107 lesions, were treated by RFA. During the follow-up period of 18 to 50 months, the primary technique effectiveness rates in the CEUS and control groups were 94.7% and 87.9%, respectively (P = .1182). The local tumor progression rate, the new HCC rate, and the repeated RFA rate of the CEUS group were significantly lower than those of the control group (P = .033, .004, and .001, respectively). CONCLUSIONS: Pre-RFA CEUS provides important information for selecting suitable patients for RFA. The use of CEUS in selecting patients with HCC can decrease post-RFA local tumor progression and improve the efficacy of RFA therapy.     

超声造影和增强磁共振在不同大小肝癌肝动脉化疗栓塞术后的疗效评价

目的:探究超声造影(contrast-enhanced ultrasonography,CEUS)、增强磁共振(contrast-enhanced MRI,CE-MRI)在不同大小原发性肝癌TACE(transcatheter arterial chemoembolization)术后疗效评估的价值与意义,以期为原发性肝癌(hepatocellular carcinoma,HCC)患者在TACE后复查中影像学方法的选择提供依据。方法:本研究收集2018年1月至2018年12月在徐州医科大学附属医院介入放射科接受TACE治疗的33例HCC患者(共83个病灶),TACE术后1个月1周内依次行CEUS,CE-MRI,数字减影血管造影(digital subtraction angiography,DSA)检查,如发现病灶再次TACE,以DSA结果为金标准分别对三者的检查结果进行Kappa检验以及Mc Nemar检验,比较三者其对TACE术后肿瘤残存、复发病灶检出的敏感性,特异性,诊断准确性及检查结果的一致性。结果:CEUS和CEM R I的诊断准确性分别为91.6%和100%,CE-MRI的诊断准确性优于CEUS,差异有统计学意义;但CEUS与CE-MRI检查一致性较强(Kappa=0.794);CE-MRI敏感度、特异度比均为100%,CEUS的分别为88.9%,100%;在>3 cm的病灶中,CEUS与CE-MRI的一致性强(Kappa=0.891),CEUS的准确性、敏感度及特异度分别为96.1%,95.0%和100%。在≤3 cm的病灶中,CEUS与CE-MRI的一致性一般(Kappa=0.669),CEUS的准确性、敏感度及特异度分别为84.4%,78.3%和100%。结论:CEUS,CE-MRI与金标准DSA对于原发性肝癌TACE治疗后的诊断一致性相当,CEUS可作为原发性肝癌TACE短期复查的替代影像学检查方法。     

Contrast-enhanced ultrasonography in the diagnosis of solid renal tumors.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of contrast-enhanced ultrasonography (CEUS) in the diagnosis of solid renal tumors. METHODS: Twenty-nine patients with solid tumors detected on gray scale ultrasonography underwent resection for suspected renal malignancy. Findings of arterial phase contrast computed tomography (CT) and CEUS were compared for each diagnosis. RESULTS: Histopathologic examination of resected lesions showed malignancy in 26 patients (clear cell carcinoma, n = 18; papillary renal cell carcinoma, n = 6; collecting duct carcinoma, n = 1; and infiltrative urothelial carcinoma, n = 1) and benign tumors in 3 patients (oncocytoma, n = 2; and angiomyolipoma, n = 1). Contrast CT failed to show tumor blood flow in 5 of 29 patients, whereas CEUS showed this in all patients. Positive predictive values of CEUS and contrast CT in the diagnosis of renal malignancy were 100% and 82.8%, respectively. Among clear cell carcinomas, hypervascularity was observed on contrast CT in 16 of 18 patients and on CEUS in 17 of 18 patients. On the basis of hypervascularity, diagnostic sensitivity values for clear cell carcinoma were 94.4% for CEUS and 88.9% for contrast CT, whereas specificity values were 45.5% for CEUS and 72.7% for contrast CT. Among papillary cell carcinomas, contrast CT showed avascular lesions in 4 of 6 patients. However, CEUS showed blood flow in these lesions, leading to diagnosis of hypovascular renal tumors. CONCLUSIONS: Contrast-enhanced ultrasonography was more sensitive for detecting slight tumor blood flow than contrast CT and was useful in preoperatively diagnosing malignant hypovascular renal tumors but was less so for hypervascular renal tumors.     

肝良恶性肿瘤超声造影定量分析的对比研究

目的 探讨超声造影技术对肝良恶性肿瘤的鉴别诊断价值.方法 应用超声造影技术检查91例肝肿瘤患者(良性肿瘤37例43个病灶,恶性肿瘤54例79个病灶),观察注射造影剂SonoVue后良恶性肿瘤结节的血流灌注特征,绘制时间一强度曲线,分析曲线的形态特征及定量参数变化.结果 肝血管瘤的增强造影表现为"慢进慢出",肝硬化结节和不均性脂肪肝的增强与肝实质同步;肝恶性肿瘤表现为"快进快出".肝良性肿瘤的时间一强度曲线呈单峰或多峰,上升支及下降支多缓慢且部分有转折;恶性肿瘤的曲线呈单峰,上升支陡峭,成角明显,下降支相对缓慢.良恶性肿瘤的始增时间(14.19±6.26)s vs(10.36±2.80)s、峰值时间(51.33±25.76)s vs(20.88±5.71)s、斜率(0.08±0.03)vs(0.19±0.28)、增强速率(0.67±0.69)dB/s vs(1.86±0.95)dB/s比较,差异均有统计学意义(P＜0.05).结论 超声造影能动态显示肝肿瘤不同时相的增强情况,定量分析肝肿瘤时间一强度曲线能明显提高超声对肝肿瘤定性诊断率.     

原发性进展期胆囊癌的超声诊断及其判断转移性的价值

目的:探讨进展期胆囊癌的超声声像图特征及判断其转移性对临床治疗的价值。方法:对经手术及病理证实的39例进展期胆囊癌的手术记录及超声声像图进行回顾性对比分析。结果:超声声像图分为囊壁增厚型、蕈伞型、混合型、实块型,同时能观察到肝内转移、肝浸润、区域淋巴结转移及胆囊结石、肝内外胆管扩张等征象。结论:进展期胆囊癌的正确诊断及判断其转移性情况对临床手术治疗有重要价值。     

Early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma: utility of gray scale harmonic ultrasonography with a microbubble contrast agent.

OBJECTIVE: To evaluate the utility of gray scale harmonic ultrasonography with a microbubble contrast agent in the early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma. METHODS: Seventy-five patients with 81 nodular hepatocellular carcinomas (1.3-4.8 cm) treated with percutaneous radio frequency ablation were evaluated with contrast-enhanced gray scale harmonic ultrasonography after intravenous bolus injection of a galactose-based microbubble contrast agent. The vascularity within the ablation zones was evaluated with a continuous scan for 3 to 5 seconds between 15 and 30 seconds after initiation of contrast agent injection. To evaluate the perfusion of the ablation zones, intermittent stimulated acoustic emission imaging was performed with a rapid sweeping technique from the end of the continuous scan. All patients underwent follow-up 3-phase helical computed tomography at 1 month after radio frequency ablation and were followed for at least 1 year. The results of contrast-enhanced ultrasonography were compared with those of follow-up computed tomography in terms of the presence or absence of residual unablated tumors. RESULTS: In 10 (12%) of the 81 treated hepatocellular carcinomas, contrast-enhanced ultrasonography showed either nodular or crescentic enhancing foci at the margins of ablation zones, suggesting residual unablated tumors. Contrast-enhanced computed tomography obtained 1 month after radio frequency ablation confirmed the residual unablated tumors in the same 10 lesions. Diagnostic agreement between 1-month follow-up computed tomography and contrast-enhanced ultrasonography was achieved in all 81 cases (100%). CONCLUSIONS: Contrast-enhanced gray scale harmonic ultrasonography can be a reliable alternative to contrast-enhanced computed tomography in the early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma.