超声造影在肝占位性病变鉴别诊断中的应用价值

目的:观察超声造影(CEUS)中肝脏占位性病变(FLL)的不同图像特点。初步探讨超声造影在原发性肝癌(HCC)及肝内血管瘤病变的鉴别诊断中的应用价值。方法:20例肝占位性病变进行实时超声造影检查,其中12例原发性肝癌,8例肝血管瘤,全部病例均经病理证实。分析两组病例常规超声图像及CEUS灌注特点,探讨两种病变的鉴别诊断特征。结果:经超声造影后,HCC多表现为动脉相快速显像,门脉相快速消退,呈"快进快出"型;肝血管瘤动脉相对无明显变化,增强方式以门静脉期周边缓慢增强,呈向心样填充,造影剂显影持续时间较长。结论:HCC及肝血管瘤在实时超声造影中能表现出不同的时相特点,可以帮助提高超声诊断的特异性、敏感性及准确性。     

超声造影在原发性肝癌和肝血管瘤鉴别诊断中的价值

目的观察超声造影（CEUS）中肝脏占位性病变（FLL）的不同图像特点,初步探讨超声造影在原发性肝癌（HCC）及肝血管瘤病变的鉴别诊断中的应用价值。方法对53例肝占位性病变进行实时超声造影检查,其中32例原发性肝癌,21例肝血管瘤,全部病例均经病理证实。分析两组病例常规超声图像及CEUS灌注特点,探讨两种病变的鉴别诊断特征。结果经超声造影后,HCC表现多为动脉相快速显影,门脉相快速消退,呈“快进快出”型;肝血管瘤动脉相时无明显变化,增强方式以门静脉期周边缓慢增强,呈向心样填充,造影剂显影持续时间较长。结论HCC及血管瘤在实时超声造影中能表现出不同的时相特点,可以帮助提高超声诊断的特异性、敏感性及准确性。     

肝脏少见病例超声造影表现

目的 分析肝脏少见病例超声造影表现. 方法对常规超声检查不能确诊的肝脏局灶性病变患者,进行超声造影检查并获得明确病理检查结果的患者129例,对其中7例肝脏少见病例超声造影表现进行回顾性分析. 结果 2例肝胆管细胞癌中1例表现为动脉相病灶环状增强,增强部分呈快进快出;另1例为瘤体整体呈不规则增强,增强呈快进快出.1例肝紫癜表现为动脉相病灶部分增强,增强呈快进快出.1例肝血管上皮样肿瘤表现为动脉相病灶整体增强,增强呈快进慢出.1例肝副神经节瘤表现为动脉相病灶整体增强,增强呈快进慢出.1例肝炎性假瘤超声造影各时相均未见增强.1例肝外伤后血肿超声造影各时相均未见增强,病灶区大小测量较二维超声时增加. 结论肝少见病例病理类型不同其超声造影表现不同;部分病种有多种组织学分型,导致同一类型的肿瘤造影表现不同.     

超声造影在肝脏占位性病变中的诊断价值

目的探讨超声造影技术在不同肝脏占位病变中诊断价值。方法对23例肝脏占位患者进行超声造影检查,并实时观察病灶内灌注过程及回声变化。结果肝细胞肝癌均表现为动脉相整体快速增强,并在门脉相快速或缓慢消退,肝实质相呈现低回声区;肝血管瘤呈现自周围向心性缓慢性充填式增强,并持续较长时间;肝局灶性结节增生表现为快速增强,但在实质期开始消退;肝转移癌与肝脓肿及囊肿伴感染虽都在动脉期周边增强,但消退时间不同,转移性肝癌在门脉相开始消退,至实质相呈低回声,而肝脓肿和囊肿伴感染则在实质相缓慢消退;2例局灶性炎症,2例脂肪肝及2例慢性肝病的动脉相、门脉相、实质相均未见异常增强区和廓清区。结论不同肝脏占位性病变超声造影检查有不同特征性声像图表现,能明显提高肝实质占位性病变诊断率。     

低声压动态超声造影技术对肝脏局灶性病变诊断价值的研究

目的:评价低声压超声造影技术在肝占位性病变中的鉴别诊断价值.方法:应用Sonovue超声造影剂对181例共209个肝脏病灶行超声造影,并对造影结果进行分析.病灶经病理证实或随访6～12个月证实.结果:144个原发性肝细胞性肝癌(HCC)病灶和血管肉瘤、胆管细胞癌、结核各1个病灶呈现"快进快出"模式;25个血管瘤病灶呈现"慢进慢退";21个肝硬化不典型增生结节,动脉期无增强,门脉期增强;5例转移性肝癌均为快速廓清,但动脉相增强方式不同;1例FNH和炎性假瘤呈"快进慢出";5例脓肿为快速融合性增强;3例炎性假瘤2例结核未见造影增强.结论:低声压超声造影技术对肝脏局灶性病变定性诊断提供一种选择模式,超声造影较CDFI可显著提高局灶性肝脏病变的发现和定性诊断率.     

实时超声造影在肝脏肿瘤鉴别诊断中的价值

目的评价超声造影技术在肝脏肿瘤诊断中的价值。方法应用超声造影技术检查47例肝脏肿瘤患者(良性肿瘤10例10个病灶;恶性肿瘤37例41个病灶)。观察注射第二代超声造影剂SonoVue后肝脏肿瘤的动态增强表现,并作出造影诊断。结果肝脏恶性肿瘤的超声造影表现为"快进快出";肝血管瘤的超声造影表现为"慢进慢出";肝局灶性结节性增生表现为早期动脉相强化,但持续时间较长;肝硬化结节与肝实质呈同步强化。结论超声造影能动态显示肝脏肿瘤不同时相的增强情况,对肝脏肿瘤的诊断、鉴别诊断有重要的临床应用价值。     

超声造影对肝脏局灶性病灶良恶性鉴别诊断的价值

目的 探讨实时超声影成像技术在肝脏局灶病灶鉴别诊断中的价值.方法 对40例患者共45个肝内实质性局灶性病灶进行实时谐波超声造影检查,分析其血流灌注特征。结果 原发性肝癌及肝转移癌多表现为动脉期呈快速均匀或不均匀的高增强,门脉期快速消退,呈等或低增强,延迟相病灶的增强信号消退更明显,呈低增强或黑洞征;肝血管瘤多表现为动脉相周边环状、结节状增强,门脉相增强信号继续向心性填充,延迟相无消退,呈均匀或不均匀高增强;肝硬化结节及不均匀脂肪肝表现为自动脉相至门脉相及延迟相与周围肝实质同步均匀性增强,病灶边界消失。结论 实时超声造影能反映不同肝脏病变血流灌注的特征,对肝脏局灶性病变的鉴别诊断有重要价值。     

超声造影对肝硬化背景下小肝癌和增生结节的诊断价值

目的探讨在肝硬化背景下小肝癌和增生结节的超声造影特征。方法收集临床肝硬化背景下局灶性病变41例患者,共48个结节,观察病灶区对比剂的灌注过程及造影前后声像图特征进行分析,并与手术或超声引导下穿刺活检病理诊断结果进行比较。结果小肝癌结节40个,超声造影示均为动脉相快速充盈呈高增强,其中28个结节门脉相迅速减退呈低增强,即＂快进快退＂型,12个结节门脉相呈等增强,延迟期缓慢减退呈低增强,即＂快进慢退＂型。肝硬化增生结节8个,其中2个结节动脉相稍高增强,门脉相及延迟相呈等增强,6个动脉相无增强,门脉相及延迟相呈等增强。结论超声造影在肝硬化背景下对小肝癌与增生结节的鉴别诊断具有重要临床诊断价值。     

Sonovue超声造影对小肝癌的诊断价值

目的：探讨实时超声造影对小肝癌的早期诊断价值。方法：对36例患者肝内单发实质性小病灶进行实时超声造影研究,所有患者均进行了增强CT或增强MRI检查,且均经穿刺病理证实。造影剂使用Sonovue,剂量2.4 ml,经肘静脉团注,在动脉相、门脉相及实质相观察病灶的灌注情况。结果：36例小肝癌患者,中-低分化癌31例呈＂快进快出＂,高分化癌3例呈＂快进慢出＂,透明细胞癌2例呈＂慢进慢出＂。结论：应用Sonovue超声造影对小肝癌的诊断具有较大的价值,能够明显提高检出率。     

超声造影在肝硬化背景下鉴别肝内结节样病灶的应用价值

目的探讨超声造影在肝硬化背景下鉴别肝内结节样病灶的应用价值。方法对64例肝硬化合并83个肝内结节样病灶患者进行超声造影,并比较不同病变的肝脏超声造影特点。结果 51个恶性结节样病灶中,1个病灶病理结果显示为ICC,造影表现为"快进快出"(2%),2个病灶病理结果显示为HCC,造影表现为"快进慢出"(4%),2个病灶病理结果显示为HCC,造影表现为"慢进快出"(4%),其余46个HCC造影后均在动脉期增强而在门脉期消退,呈"快进快出"模式(90%)。32个肝脏良性结节样病灶中,7个超声造影表现动脉期快速增强,延迟期缓慢消退,为"快进慢出"(22%),24个超声造影表现为"同进同出"(75%),还有1个表现为动脉期缓慢增强,延迟期缓慢消退,即"慢进慢出"(3%)。结论超声造影在肝硬化背景下对鉴别肝内结节样病灶具有重要的临床意义和应用价值。     

肝转移癌的超声造影表现及其临床应用价值

目的观察肝转移癌超声造影表现并探讨其临床应用价值。方法采用低机械指数实时灰阶谐波反相超声造影技术对21例共21个肝转移癌病灶进行超声造影,分析研究其造影增强各时相的特征。结果21个肝转移癌中,19个(90.5%)超声造影表现为快进快出,动脉相21个病灶均可见增强,12个(57.1%)为快速弥漫增强,8个(38.1%)为快速环状增强,余1个较大的病灶呈缓慢不均匀轻度增强;延迟相20个病灶(95.2%)呈边界清晰的低回声,3个(14.3%)发现更多的肝内病灶。结论肝转移癌的超声造影有特征性表现,可将其作为筛查及诊断的可靠依据。     

实时超声造影诊断不典型肝脓肿

目的探讨实时超声造影(CEUS)对不典型肝脓肿的诊断价值。方法采用DU8彩色多普勒超声仪,对32例临床上怀疑肝内占位病变的患者进行CEUS,机械指数设置为0.08～0.11,造影剂选用SonoVue,取2.4ml经肘部浅静脉于5s内快速推注。结果32例患者共发现36个病灶,经穿刺证实均为肝脓肿。注射SonoVue后,所有病灶均呈快速整体型增强,平均开始增强时间为(14.48±3.62)s,达峰时间为(22.92±4.35)s,出现低回声的时间为(80.30±35.30)s。峰值时有93.8%(30/32)病灶呈现具有特征性的蜂窝状表现;门脉期中有37.5%(12/32)呈低回声改变,62.5%(20/32)呈等回声改变。结论CEUS有助于提高不典型肝脓肿超声诊断的准确性。     

超声造影在肝脏良恶性肿瘤鉴别诊断中的价值

目的:探讨超声造影在肝脏良恶性肿瘤鉴别诊断中的价值。方法:采用超声造影技术对83个肝脏肿瘤患者123个病灶进行检查,并比较不同病变的肝脏超声造影增强的特点。结果:所有103个肝脏恶性肿瘤动脉期或门脉期均表现为快速增强,98个(95%)延迟期快速退出,仅有5个(5%)缓慢退出。其中69个肝细胞癌病灶中53个(77%)表现为动脉期整体均匀增强,16个(23%)由于病灶中央有低回声表现为不均匀增强,66个(96%)表现迅速快退,仅3个(4%)表现为缓慢退出。在34个转移性肝癌病灶中,24个(71%)表现为动脉期不均匀增强,10个(29%)表现为动脉期或门脉期的均匀增强,32个(94%)表现为快速退出,2个(6%)表现为缓慢退出。而另外在20个肝良性肿瘤中,18个(90%)表现为缓慢不均匀增强,14个(70%)表现为轻度增强,20个(100%)表现为缓慢退出。结论:超声造影有助于肝脏良恶性肿瘤的鉴别。     

实时超声造影在肝脏占位性病变鉴别诊断中的应用

目的探讨超声造影对肝脏占位性病变鉴别诊断的应用价值。方法对57例经彩色多普勒超声诊断为肝脏占位性病变的患者进行肝脏超声造影,实时动态记录超声造影过程,观察病灶区造影剂的灌注过程及造影前后声像图特点。结果 57例肝占位患者中,多囊肝1例,肝血管瘤21例,肝癌20例,肝癌合并肝血管瘤2例,局灶性增生3例,肝血管瘤合并局灶性增生1例,不均匀性肝脂肪浸润8例,肝包虫病1例。其中多囊肝,肝包虫病未见造影剂充填,其余病例均出现不同程度的强化过程。肝癌表现为典型的"快进快出";血管瘤表现为向心性环状增强;局灶性增生呈离心性轮辐状增强;不均匀性肝脂肪浸润则未见造影剂聚集,与肝实质呈均匀强化。结论实时超声造影能提高肝内占位性病变诊断的准确性,具有重要的临床应用价值。     

Role of transvaginal contrast-enhanced ultrasound in the early diagnosis of endometrial carcinoma

Background  Endometrial carcinoma is one of the most common gynecological malignancies among women. Early diagnosis and correct preoperative evaluation of myometrial invasion are necessary to improve the prognosis. This study aimed to determine whether features and time-intensity curves (TIC) of transvaginal contrast-enhanced ultrasound (CEUS) differ from those of conventional ultrasound for endometrial carcinoma, and to further explore the clinical role of transvaginal CEUS in the early diagnosis of endometrial carcinoma.

Methods  Forty women with a normal uterus and seventy-nine patients with endometrial carcinoma were examinedby the transvaginal CEUS with SonoVue (Bracco, Imaging B.V, Switzerland). The enhancement patterns and TIC of lesions were analyzed. The results of CEUS were compared with those of conventional ultrasound and pathology.

Results  In the early and late enhanced stages, the intensity of enhancement of the normal endometrium was always lower than that in the myometrium, and the boundary between normal endometrium and myometrium was clear. A total of 65.8% (52/79) of lesions presented with inhomogeneous enhancement, 34.2% (27/79) presented with homogeneous enhancement; 60.8% (48/79) presented with hyperechoic enhancement, 27.8% (22/79) presented with isoechoic enhancement, and 11.4% (9/79) presented with hypoechoic enhancement. The average arrival time, time to peak, rise time, half-wash out time of lesions were shorter than of normal endometrium (P <0.05). The average peak intensity, relative rise in intensity, half-wash out intensity of lesions were higher than of normal endometrium (P <0.05). There were 49 (must be and may be present) cases of endometrial carcinoma by ultrasound (US); 24 cases were consistent with pathology results, 16 cases were underestimated and 9 cases were overestimated. There were 72 (must be and may be present) cases of endometrial carcinoma by CEUS; 53 cases were consistent with pathology results, 12 cases were underestimated and 7 cases were overestimated. The qualitative diagnosis of endometrial carcinoma by CEUS was more accurate and definite than that by US (P <0.01).

Conclusions  By evaluating contrast-enhanced patterns and analyzing TIC, we found that CEUS can increase the accuracy of ultrasound qualitative diagnosis of endometrial carcinoma. CEUS shows lesions more clearly than conventional ultrasound, which is an advantage in evaluating the encroachment of endometrial carcinoma.

     

超声造影在肝脏局灶性病变中的应用研究

目的探讨肝脏局灶性病变超声造影增强模式特征及其在鉴别诊断中的意义。方法86例肝脏局灶性病变患者行超声造影检查,记录病灶始增时间及始退时间,并观察分析病灶增强方式。结果良恶性病变的始增时间均可小于30秒;始退时间小于90秒全部为恶性病灶,大于180秒消退者主要是良性病变。恶性病变组与良性组始增时间及消退时间比较均有显著性差异。原发性肝癌主要呈整体均匀增强或不均匀增强;肝转移癌呈周边环状增强或整体增强;肝血管瘤主要呈周边节结状增强;FNH主要呈自中央轮辐状增强。结论超声造影可清晰显示肝脏局灶性病变动态灌注过程,提高肝脏局灶性病变鉴别诊断水平。     

手术证实的肝脏局灶性结节增生超声造影特征与大小的关系

目的 研究肝脏局灶性结节增生(focal nodular hyperplasia,FNH)超声造影(contrast enhanced ultrasound,CEUS)的典型征象,及其与病灶大小及脂肪肝背景的关系.方法 回顾性分析2017年10月—2019年12月复旦大学附属中山医院经手术切除病理证实的51例FNH患者...     

超声造影对不典型肝脏局灶性病灶的鉴别诊断价值

目的 探讨超声造影（contrast enhanced ultrasound,CEUS）对肝脏不典型局灶性病灶的鉴别诊断价值.方法 对108例患者的119个肝脏不典型局灶性病灶进行超声造影,检查结果与病理（手术或穿刺活检）或增强CT（contrast enhanced computed tomography,CECT）、增强MRI（contrast enhanced magnetic resonance imaging,CEMRI）结果进行对照.结果 119个常规超声检查不能明确性质的肝内声像图不典型局灶性病灶中,确定87个占位性病变,其中39个病灶CEUS考虑恶性病变,经手术、穿刺病理证实或CECT、CEMRI等确诊恶性病灶36个,临床最终诊断恶性病灶37个;CEUS诊断48个良性病灶,误诊1例,临床最终诊断良性病灶50个;CEUS排除肝内占位性病变32个,其中非均匀性脂肪肝19个,再生结节13个.超声造影诊断肝内声像图不典型局灶性病灶的准确率、灵敏度、特异度、Youden指数、阳性预测值、阴性预测值分别为95.4%、92.2%、97.0%、0.892、97.9%、90.2%.结论 超声造影可有效地反映肝脏局灶性病变的血流灌注特征,对肝脏不典型局灶性病灶的诊断及鉴别诊断有重要价值.     

超声造影在肾透明细胞癌检出和诊断中的应用

Background Renal clear cell carcinoma （RCCC） is the most common malignant renal tumor. It is highly malignant, does not cause clinical symptoms in its early stages, and cannot be diagnosed using conventional ultrasound. This study was aimed to investigate the contrast-enhanced ultrasound （CEUS） mode and characteristics of the time-intensity curve for RCCC and its pathological basis.
Methods Forty-two patients with pathologically diagnosed RCCC underwent CEUS examination before surgery. The patients＇ kidneys were visualized after injection of contrast agents using the Technos MPX DU8. We analyzed the CEUS mode, time-intensity curve, and pathological findings.
Results The detection rate of RCCC with conventional ultrasound was about 71%, while the rate using CEUS was 100%. Larger tumors （33 cases） showed non-uniform enhancement with defective filling. CEUS modes were divided into 4 types： type Ⅰ, ＂quick in and out＂ （26.19%, 11/42）; type Ⅱ, ＂quick in and slow out＂ （40.48%, 17/42）; type Ⅲ, ＂Simultaneous in and out＂ （16.67%, 7/42）; and type Ⅳ ＂slow in and out＂ （16.67%, 7/42）. All types had a close correlation to the pathological basis. Time-intensity curve of CEUS consisted of 3 phases, the perfusion phase, regression phase, and lag phase. Cases of types Ⅰ and Ⅲ only had a perfusion and regression phase, those of type Ⅱ and Ⅳ had a perfusion phase, regression phase, and lag phase. Quantitative analysis of the time-intensity curve showed that the time-to-peak （FTP） of the lesions was shorter than that of normal renal parenchyma （P 〈0.0001）, the mean value of the up slope rate of the absolute value of lesions was higher than that of the ipsilateral normal renal parenchyma （P 〈0.0001）, and that the mean value of descent slope rate of the absolute value of lesions was lower than that of the ipsilateral normal renal parenchyma （P 〈0.0001）.
Conclusions CEUS is useful in detecting small vessels in tumors. Although there are several different CEUS modes, type Ⅰ ＂quick in and out＂ and type Ⅱ ＂quick in and slow out＂ accounted for the most cases that had a close correlation to pathologic angiogenesis. Time-intensity curves also showed some special characteristics. These data could provide valuable information for the clinical diagnosis of RCCC.     

Clinical Value of Contrast-enhanced Ultrasound in Differentiating Benign and Malignant Focal Liver Lesions

To explore the clinical value of contrast-enhanced ultrasound （CEUS） in differentiating benign and malignant focal liver lesions （FLLs） with SonoVue, CEUS was used to examine 113 patients with focal liver lesions （FLLs） in our hospital during July 2005 to December 2006. All the patients underwent contrast-enhanced CT （CECT） or contrast-enhanced MRI （CEMRI）. Except for patients with focal fatty sparings （n=18） and with hemangiomas （n=8）, all the patients were confirmed by operation or ultrasonic-guided liver puncture biopsy. A sulfur hexafluoride gas-based contrast agent was used with a MI of 0.15 to 0.17. Forty-eight cases of malignant FLLs, including 30 hepatocellular carcinomas （HCCs）, 2 cholangiocarcinomas and 16 metastatic tumors, were detected. Seventy-eight cases of benign FLLs, including 33 hemangiomas, 9 focal nodular hyperplasias （FNHs）, 19 focal fatty sparings, 5 abscesses, 7 regenerative nodules and 2 inflammatory pseudo-tumor, were involved. The contrast pattern of benign and malignant FLLs was quite different. CEUS has higher specificity and sensitivity than conventional ultrasound in differentiating benign and malignant FLLs.