Emerging roles for transthoracic ultrasonography in pulmonary diseases

As a result of many advantages such as the absence of radiation exposure, non-invasiveness, low cost, safety, and ready availability, transthoracic ultrasonography (TUS) represents an emerging and useful technique in the management of pleural and pulmonary diseases. In this second part of a comprehensive review that deals with the role of TUS in pleuropulmonary pathology, the normal findings, sonographic artifacts and morphology of the most important and frequent pulmonary diseases are described. In particular, the usefulness of TUS in diagnosing or raising suspicion of pneumonia, pulmonary embolism, atelectasis, diffuse parenchymal diseases, adult and newborn respiratory distress syndrome, lung cancer and lung metastases are discussed, as well as its role in guidance for diagnostic and therapeutic interventional procedures. Moreover, the preliminary data about the role of contrast enhanced ultrasonography in the study of pulmonary pleural-based lesions are also reported. Finally, the limits of TUS when compared with chest computed tomography are described, highlighting the inability of TUS to depict lesions that are not in contact with the pleura or are located under bony structures, poor visualization of the mediastinum, and the need for very experienced examiners to obtain reliable results.     

肺部病变声像图特征研究与诊断

目的：探讨肺部肿瘤、非肿瘤的声像特征及其诊断价值。材料和方法：９０ 处肺部病变,对其超声征象特征进行前瞻性观察、研究,并与Ｘ 线、ＣＴ、病理结果进行比较研究。结果：１ 、归纳出肺部肿瘤、非肿瘤的声像图特征：团块征、分叶征、结节征、舌征、支气管充气征、森林一阳光征等十二个征象; ２ 、超声对肺部疾病诊断的准确率：８８ ．２ ％ ,对肿瘤诊断的敏感性９７ ．６７ ％ ,特异性６９ ．５７ ％ ,对非肿瘤诊断的敏感性８５ ．３ ％ ,特异性９３ ．４ ％ 。结论：１ 、超声诊断对肺部疾病的诊断与鉴别诊断有重要价值。２ 、Ｂ 超对ＣＴ、Ｘ 线诊断有不可忽视的补充和修正价值,联合诊断可大大提高诊断准确率（Ｐ＜ ０ ．０５ ～０ ．０１）     

子宫肌瘤的超声影像与病理对照（附86例分析）

目的：探讨子宫肌瘤超声影像与病理的相关性及期误诊原因。方法：对86例子宫肌瘤的超声、手术、病理资料进行回顾性总结分析。结果：超声与病理完全符合69例、基本符合11例,总符合率93%。误诊6例,占7%,其中将子宫内膜息肉、子宫肌腺病、局限型子宫腺肌瘤、浆膜下子宫内膜异位误诊为子宫肌瘤各1例。将宫颈部肌瘤误诊为卵巢肿瘤2例。结论：超声对子宫肌瘤的诊断符合率达90%以上,误诊原因是多方面的。     

小儿腹部神经母细胞性肿瘤超声图像特征及病理对照研究

 目的 探讨超声对各类小儿腹部神经母细胞性肿瘤的诊断价值.方法 总结15例小儿腹部神经母细胞性肿瘤(节细胞瘤2例,节细胞神经母细胞瘤2例,神经母细胞瘤11例)的彩色多普勒超声图像特点并与病理结果对照分析.结果 15例中超声诊断的准确率为66.7%.声像图表现与病理特点是密切相关的,节细胞瘤、节细胞神经母细胞瘤及神经母细胞瘤超声表现的共同特点为腹膜后巨大包块,73.3%包绕和挤压腹部大血管(11/15),86.7%含散在的细小钙化灶(13/15).节细胞瘤、节细胞神经母细胞瘤和神经母细胞瘤的差别在于肿瘤的边界、内部回声的均匀性和血流信号的丰富程度.结论 超声对判断肿瘤的神经母细胞来源、良恶性的可能性、与周围脏器关系、有无继发性出血坏死具有较大的帮助.     

经胸心脏彩色多普勒超声和常规心电图诊断心脏病的对比分析

目的 对比分析经胸心脏彩色多普勒超声和常规心电图诊断心脏病的临床应用价值.方法 选取2018年1月至2020年1月本院就诊的88例心脏病患者作为研究对象,均行经胸心脏彩色多普勒超声、常规心电图诊断.对比两种诊断方式的临床诊断价值.结果 经胸心脏彩色多普勒超声诊断的左心室增大检出率、左心室肥厚检出率、主动脉弹性减退检出率...     

磁共振与超声在胆道系统疾病诊断中的价值

 目的 评价磁共振与超声在胆道系统疾病诊断中的价值.方法 收集手术治疗的病例92例,并将其术前的磁共振胆胰管造影(MRCP)及超声结果与手术结果作对比,利用ROC曲线进行分析.结果 超声诊断胆囊炎、胆囊结石价值比磁共振高,但磁共振对胆总管结石的检出率较高.结论 超声在胆道系统病变诊断中应作为首选,而对胆总管直径超过8 mm的病例术前应做MRCP以便正确选择手术方式.     

经直肠经阴道超声在无症状镜下血尿诊断中的应用

目的评价经直肠经阴道超声检查对诊断无症状镜下血尿病变的临床意义。方法85例临床怀疑泌尿道疾病患者（49例男性和36例女性，年龄22～75岁，平均36-3岁）于镜下血尿出现后接受了经直肠或经阴道超声检查。全部患者的超声检查操作是采用5．0～7．5MHz的探头在膀胱轻度充盈状态下进行的。结果85例患者中，膀胱与前列腺病见于25例，其中，8例超声疑诊膀胱癌患者经手术和病理证实为早期膀胱移行细胞癌。本组膀胱癌的检出率为9．4％（8／25）。结论经直肠或经阴道超声检查对诊断无症状镜下血尿的病变具有高度敏感性，故应作为仅早发现膀胱癌的常规方法。     

CT-guided transthoracic needle biopsy

CT-guided biopsy of pulmonary and mediastinal lesions is safe and effective. It is most valuable in those cases in which fluoroscopic guidance is not possible due to resolution or anatomic consideration. CT guidance permits puncture of lesions as small as 0.5 cm, typically not seen fluoroscopically. Sensitivity of biopsy in malignant lung lesions in our series of 83 cases was 92%. Pneumothorax is the most frequent complication (10–60%) and requires chest tube insertion in 5–15% of patients.     

Quantitative analysis of contrast-enhanced ultrasonography of the bowel wall can predict disease activity in inflammatory bowel disease

Purpose

To evaluate the accuracy of quantitative analysis of bowel wall enhancement in inflammatory bowel disease (IBD) with contrast enhanced ultrasound (CEUS) by comparing the results with vascular density in a biopsy sample from the same area of the intestinal tract, and to determine the usefulness of this analysis for the prediction of disease activity.

Materials and methods

This prospective study was approved by our institute's ethics committee and all patients gave written informed consent. We enrolled 33 consecutive adult patients undergoing colonoscopy and biopsy for IBD. All patients underwent CEUS and the results were quantitatively analyzed. Vessel count per high-power field on biopsy specimens was compared with colonoscopy, baseline ultrasonography, and CEUS findings, and with analysis of peak intensity, time to peak, regional blood volume, mean transit time, and regional blood flow. Results in patients with high and low vascular density were compared using Fisher's test, t-test, Pearson's correlation test, and receiver operating characteristic curve (ROC) analysis. Cutoff values were determined using ROC analysis, and sensitivity and specificity were calculated.

Results

High vascular density (>265 vessels per field) on histological examination was significantly correlated with active disease on colonoscopy, baseline ultrasonography, and CEUS (p < .0001). Quantitative analysis showed a higher enhancement peak, a shorter time to peak enhancement, a higher regional blood flow and regional blood volume in patients with high vascular density than in those with low vascular density. Cutoff values to distinguish between active and inactive disease were identified for peak enhancement (>40.5%), and regional blood flow (>54.8 ml/min).

Conclusion

Quantitative analysis of CEUS data correlates with disease activity as determined by vascular density. Quantitative parameters of CEUS can be used to predict active disease with high sensitivity and specificity.     

晚期肺癌并胸腔积液的双介入治疗—附40例报道

采用胸腔穿刺抽去胸水后，腔内注射顺铂、联合支气管动脉化疗治疗肺癌并胸腔积液４０例，结果１０例完全缓解，２０例部分缓解，总有效率７５％，对延长患者生存期，减轻痛苦，提高生活质量，是一种较好的治疗方法。国内未见报道过，值得临床应用。     

肺泡蛋白沉积症的MSCT表现与病理对照分析

目的：通过分析肺泡蛋白沉积症（PAP）的MSCT表现与相应的病理改变,探讨MSCT对PAP的诊断价值。方法：经病理证实的9例PAP患者术前均行MSCT扫描,对其CT表现及其病理学改变进行对照分析。结果：PAP胸部影像表现呈多样化改变,其中碎路石样改变4例,地图样改变9例,肺实变表现（支气管充气征）6例,肺间质纤维化样表现3例。支气管肺泡灌洗液（BALF）石蜡包埋切片,显微镜下示片状嗜伊红性颗粒状蛋白性物质,其中可见针状裂隙。组织化学染色示肺泡腔内或BALF中嗜伊红性细颗粒状蛋白性物质淀粉酶消化后的过碘酸雪夫染色（D-PAS）阳性,奥新兰染色（AB）阴性。结论：PAP典型的胸部MSCT表现与病理改变一致,具有一定特征性,CT是临床诊断本病的有价值的方法。     

B超预测急性胆囊炎行腹腔镜胆囊切除术难度的价值

目的：评价术前B超预测腹腔镜胆囊切除术（LC）的难度。方法：收集140例急性胆囊炎行腹腔镜切除术患者术前8hB超及手术的详细资料，以B超中各参数为自变量，手术难度记分为因变量，采用多元回归分析法，评估术前B超对腹腔镜胆囊切除术难度预测作用。结果：胆囊壁厚度与LC的难度呈正相关，胆囊管长度与LC的难度呈负相关。结论：术前超声检查对预测腹腔镜胆囊切除术的难度有价值。     

快速MRI技术与超声在胎儿Dandy-Walker 综合征中诊断价值的对比研究

目的：探讨快速 MRI 技术对胎儿 Dandy-Walker 综合征（DWS）的诊断价值,并与超声结果对照。方法：回顾性分析13例经尸检或随访证实为 DWS 胎儿的病例资料,所有胎儿均于行超声检查后72h 内行快速 MRI 检查。结果：13例 DWS 中快速 MRI 明确诊断13例,并正确诊断合并的其它中枢神经系统畸形7例,与产后尸检及 MRI 检查结果一致。超声明确诊断6例,可疑3例,漏诊4例;明确诊断合并畸形3例,可疑2例,漏诊2例。结论：快速 MRI 技术对胎儿 Dan-dy-Walker 综合征及合并畸形的诊断优于超声,可作为超声检查的重要补充手段。     

超声对胰岛素瘤的诊断价值

目的探讨超声对胰岛素瘤术前诊断和定位的价值。方法就10例胰岛素瘤患者的术前和术中超声应用的情况进行回顾性分析。结果5例术前超声有阳性发现，10例术中超声均给予肿瘤准确的定位。结论超声对胰岛素瘤的准确定位对手术方式的选择起着重要的作用。     

乳腺增生症的超声诊断现状及进展

乳腺增生症是由内分泌功能失调造成乳腺小叶实质、间质异常增生的非炎症、非肿瘤性疾病,与乳腺癌关系密切。超声技术以其价格低廉、无创伤、可重复性强等特点在乳腺增生患者筛查中占有重要地位。近年来随超声成像技术进展及高频彩色多普勒超声普及,超声检查已逐步成为乳腺疾病筛查首选影像学技术。本文就现阶段主要超声技术在乳腺增生症中的临床应用及进展做一综述。     

经胸超声心动图对纵隔占位性病变的诊断价值

目的探讨纵隔占位性病变的超声特点,以提高早期诊断率。方法回顾性分析我院经胸超声心动图(TTE)检出并经病理或临床结合CT证实的纵隔占位性病变7例,扫查心脏左室长轴、胸骨上窝、剑下切面,重点观察心包周围、升主动动脉前方区域、降主动脉两侧和心脏后方。结果7例中,前纵隔占位4例;3例为囊性占位,分别为皮样囊肿、胸腺囊肿和肺癌并包裹性纵隔胸膜积液;胸腺囊肿及皮样囊肿均边界清,内部透声好。肺癌并包裹性胸腔积液形态欠规则,后壁可见松软低回声物质积聚。实性占位1例,为胸内甲状腺肿,边界清,呈实性不均质回声。后纵隔占位3例,其中神经纤维瘤1例,肝癌、肺癌并后纵隔转移各1例。神经纤维瘤呈中等回声的实质性团块,边界清晰,其内回声欠均匀;肝癌、肺癌并后纵隔转移边缘不规则,呈实性不均质团块回声。结论根据TTE检查切面的特点,结合纵隔占位的图像特征,提高TTE医师对纵隔内占位性病变的扫查意识,有助于纵隔内占位性病变的早期诊断和治疗方案的制定。     

高频超声对乳腺小肿块鉴别诊断的价值

目的:评价高频超声二维征象及彩色多普勒血流指标在乳腺小肿块鉴别诊断中的价值。方法:使用高频超声诊断仪观察196个长径小于2 cm的乳腺肿块的二维超声特征(包括病灶形态,病灶内部,病灶后方有无衰减及有无微小钙化灶),然后使用彩色多普勒对病变进行多普勒血流参数测定(包括血流丰富度、PSV、RI、PI)。比较二维超声征象及彩色多普勒血流参数在乳腺良、恶性肿块中的差异并对其诊断敏感性、特异性加以分析。结果:病灶形态、病灶内部、病灶后方及有无微小钙化灶良、恶性病变间均有显著性差异。恶性肿块PSV、RI、PI值均明显高于良性肿块。结论:彩色多普勒超声血流参数测定对乳腺良、恶肿块的鉴别诊断具有重要的参考价值,与肿块的二维声像图征象相结合可提高乳腺肿块的超声诊断准确率。     

超声检查在急性阑尾炎诊断中的应用价值

目的:探讨超声诊断学在急性阑尾炎诊断中的临床应用价值。方法:采用彩色多普勒超声对93例急性阑尾炎患者进行超声检查,回顾性分析阑尾炎的声像特征,并与手术病理结果对照。结果:急性阑尾炎超声诊断符合率为89.25%(83/93)。结论:超声检查对急性阑尾炎的诊断具有很高的临床应用价值。     

超声引导下肺周和胸膜病变切割活检的临床应用研究

目的探讨超声引导下全自动组织切割活检在肺外周和胸膜病变中的临床应用价值。方法对65例肺外周和胸膜病变进行超声引导下穿刺活检。结果 65例患者全部取材成功,63例取材标本满足病理诊断,2例为血性液体,1例不张肺组织为假阴性,病理确诊率达95%;65例中62例为肺外周型病变,3例为胸膜病变。结论超声扫查发现的大多数肺外周占位病变和胸膜病变可经超声引导下自动活检术确诊,其技术简便、实时直观、易行,值得在临床上大力推广。