虚拟导航超声造影与常规超声造影定位检测肝局灶性病变的比较

目的 比较虚拟导航超声造影与常规超声造影检出二维超声显示困难肝局灶性病变的差异,探讨虚拟导航超声造影的应用价值.方法 47个CT或MR提示但二维超声无法显示的肝局灶性病变,分别行虚拟导航超声造影和常规超声造影,对比两种造影方法的病灶检出率.结果 常规超声造影和虚拟导航超声造影的病灶检出率分别为 36.2%(17/47)和 78.7%(37/47),后者明显高于前者(P<0.01).虚拟导航超声造影时图像融合成功率达100%,平均对位用时5 min.当病灶位于肝边缘受肋骨或肺气影响、肝实质背景杂乱及病灶异常灌注时相较短或灌注差异不明显时,虚拟导航超声造影比常规超声造影更容易定位并检出病灶.结论 虚拟导航超声造影可明显提高二维超声无法显示肝局灶性病变的造影检出率.

Abstract：

Objective To evaluate virtual navigation assisted contrast-enhanced ultrasound(VN-CEUS) by comparing VN-CEUS with routine CEUS in detecting focal liver lesion(FLL) invisible in B-mode ultrasound(BUS).Methods Forty-seven FLLs invisible in BUS were identified by CT/MR,and received VN-CEUS and routine CEUS respectively.Results The detection rate of VN-CEUS and routine CEUS were 78.7%(37/47) and 36.2%(17/47),the former was much higher than the later (P<0.01).In all the cases,fusion of CT/MR with ultrasound was achieved successfully and average time for image fusion was 5 min.compared with routine CEUS,VN-CEUS could more easily find FLLs shadowed by lung or ribs,FLLs in inhomogeneous liver background,and FLLs with brief or inapparent abnormal enhancement.ConclusionsVN-CEUS can greatly improve the detection rate of FLL that was invisible in BUS.     

肝血管平滑肌脂肪瘤的超声造影与增强螺旋CT对比研究

Objective To observe the perfusion pattern of hepatic angiomyolipomas using contrastenhanced ultrasound(CEUS) and compare diagnostic efficacy of contrast-enhanced ultrasound with contrastenhanced helical CT(CECT).Methods Nineteen patients with 21 resected and pathologically proven hepatic angiomyolipomas were included in this study.Low mechanical index (mechanical index less than 0.2) realtime CEUS was performed in nineteen patients (5 patients with pulse inversion harmonic, 14 patients with contrast pulse sequencing, CPS) after 2.4ml bolus injection of contrast agent SonoVue.CECT was performed using 16-slice helical CT and contrast agent Ultravist.The diagnostic performance was calculated by considering histologic results as the reference standards.Results Fifteen tumors were correctly diagnosed as hepatic angiomyolipomas,4 tumors were misdiagnosed (including 1 hepatocellular carcinoma,2hepatic adenomas, 1 hemangioma) and 2 tumors were characterized as benign lesions by CEUS.Eight tumors were correctly diagnosed as hepatic angiomyolipomas, 13 tumors were misdiagnosed (including 7hepatocellular carcinoma, 1 liposarcoma, 2 lipomas, 1 hepatic adenomas, 2 hemangiomas) by CECT.The preoperative diagnostic accuracy was 71.4% for CEUS and 38.1 % for CECT(P＜0.05 ).Conclusions CEUS can demonstrate typical imaging characteristics of most hepatic angiomyolipomas, and has higher diagnostic performance than CECT in characterization of hepatic angiomyotipomas.     

肝血管平滑肌脂肪瘤的超声造影与增强螺旋CT对比研究

Objective To observe the perfusion pattern of hepatic angiomyolipomas using contrastenhanced ultrasound(CEUS) and compare diagnostic efficacy of contrast-enhanced ultrasound with contrastenhanced helical CT(CECT).Methods Nineteen patients with 21 resected and pathologically proven hepatic angiomyolipomas were included in this study.Low mechanical index (mechanical index less than 0.2) realtime CEUS was performed in nineteen patients (5 patients with pulse inversion harmonic, 14 patients with contrast pulse sequencing, CPS) after 2.4ml bolus injection of contrast agent SonoVue.CECT was performed using 16-slice helical CT and contrast agent Ultravist.The diagnostic performance was calculated by considering histologic results as the reference standards.Results Fifteen tumors were correctly diagnosed as hepatic angiomyolipomas,4 tumors were misdiagnosed (including 1 hepatocellular carcinoma,2hepatic adenomas, 1 hemangioma) and 2 tumors were characterized as benign lesions by CEUS.Eight tumors were correctly diagnosed as hepatic angiomyolipomas, 13 tumors were misdiagnosed (including 7hepatocellular carcinoma, 1 liposarcoma, 2 lipomas, 1 hepatic adenomas, 2 hemangiomas) by CECT.The preoperative diagnostic accuracy was 71.4% for CEUS and 38.1 % for CECT(P＜0.05 ).Conclusions CEUS can demonstrate typical imaging characteristics of most hepatic angiomyolipomas, and has higher diagnostic performance than CECT in characterization of hepatic angiomyotipomas.     

二维及三维灰阶超声造影在肝移植肝动脉评价中的应用价值

目的 探讨二维灰阶超声造影(2D-CEUS)及三维灰阶超声造影(3D-CEUS)技术在肝移植肝动脉评价中的优劣.方法 26例肝移植供体或怀疑肝动脉并发症的肝移植受体行2D-CEUS和3D-CEUS检查.其中经CTA或MRA或DSA证实的15例患者纳入研究组,比较两种技术的图像质量、对肝动脉病变的诊断水平,并评估两者提供的肝动脉解剖信息有无差别.结果 ①2D-CEUS和3D-CEUS的图像质量评分分别为(3.62±0.41)分和(2.52±0.93)分,两者比较差异有统计学意义(P<0.05).②在肝总动脉(CHA)及肝固有动脉(PHA)段,2D-CEUS和3D-CEUS显示动脉解剖学特征的能力相当(P>0.05),但在左肝动脉(LHA)、右肝动脉(RHA)及段动脉(SHA)水平,3D-CEUS明显优于2D-CEUS(P<0.05).③15例患者中确诊5例肝动脉病变,2D-CEUS和3D-CEUS能肯定诊断并与结果相符的均为4例(80%).2D-CEUS另将1例肝动脉迂曲折转误诊为肝动脉狭窄,3D-CEUS予以纠正.结论 3D-CEUS能提供更丰富的肝动脉解剖形态学信息,能对2D-CEUS发现的一些肝动脉病变予以证实或纠正,但图像质量不如2lYCEUS.将两种方法联合运用,可显著提高肝移植肝动脉并发症及肝动脉解剖变异的超声诊断水平,从而减少DSA的应用.

Abstract：

Objective To assess the difference between two-dimensional contrast-enhanced ultrasonography ( 2D-CEUS ) and three-dimensional contrast-enhanced ultrasonography ( 3D-CEUS ) in evaluating hepatic arteries in the liver transplantation. Methods Both 2D-CEUS and 3D-CEUS were used to examine 26 liver transplantation donors and recipients. Fifteen patients who were confirmed by CTA or DSA or MRA were analyzed. The image' s quality and diagnostic levels of 2D-CEUS and 3D-CEUS were compared, and the diagnostic information about anatomic features of hepatic arteries provided by the two methods was evaluated. Results 1) The image' s quality of 2D-CEUS and 3D-CEUS were 3. 62 ± 0. 41, 2. 52 ± 0. 93, respectively. The difference between them was statistically significant ( P <0. 05). 2)When evaluating anatomic features ,2D-CEUS and 3D-CEUS had no significant difference in common hepatic artery (CHA) and proper hepatic artery (PHA). But 3D-CEUS was prior to 2D-CEUS in left hepatic artery (LHA) ,right hepatic artery(RHA) and segmental hepatic artery(SHA) ( P <0. 05). 3)Five hepatic artery complications were discovered by CTA or DSA or MRA in 15 patients. In 4 patients (80%) ,both 2D-CEUS and 3D-CEUS made the affirmative diagnoses in accordance with the results. However, 2D-CEUS made a false positive diagnosis and 3D-CEUS corrected it. Conclusions The 3D-CEUS could provide more diagnostic information,could confirm or correct some diagnosis of 2D-CEUS,but,its image's quality is not as good as 2D-CEUS. Therefore,combining the 3D-CEUS with 2D-CEUS has practical clinical value in liver transplantation.     

脑胶质瘤超声造影定量参数与微血管密度的相关研究

目的 探讨术中超声造影在评价不同病理级别脑胶质瘤血管生成变化中的应用价值.方法 对33例脑胶质瘤患者行超声造影检查,实时观察肿瘤血流灌注情况及增强特点,绘制时间-强度曲线获取定量指标.术后对切除的病灶行常规病理检查和免疫组织化学检测,记录肿瘤的微血管密度,定量分析不同级别脑胶质瘤血流灌注指标与术后病理微血管密度的相关性.结果 低级别和高级别脑胶质瘤的造影达峰时间和微血管密度值比较差异均有统计学意义(P=0.0001);不同分化程度的脑胶质瘤超声造影达峰时间与微血管密度之间呈负相关关系(r=-0.79,P=0.0001).结论 术中超声造影可以实时动态地观察微血管的灌注情况,超声造影可提示肿瘤内微血管密度,有助于术者准确判定脑胶质瘤病理分级,指导肿瘤的手术切除.

Abstract：

Objective To investigate the value of intraoperative contrast-enhanced ultrasound(CEUS) in evaluating pathological grades of cerebral gliomas. Methods Intraoperative CEUS was performed in 33 patients of cerebral gliomas of different pathological grades. Real-time blood perfusion and enhance characteristics of these tumors were observed,quantitative parameters from the automatically derived time-intensity curve (TIC) were obtained, and compared with the tumor microvessel density (MVD) by immunostaining with anti-CD34. Results The time to peak was significantly shorter and the MVD was significantly higher in the high grade cerebral gliomas compared with the low grade ones ( P <0. 05). The time to peak was negatively correlated with the MVD by immunostaining (r = -0.79, P < 0. 05). Conclusions Intraoperative CEUS could be used to observe microvascular perfusion in real-time, and could indirectly reflect the information of MVD in cerebral gliomas, which is of help to grade cerebral gliomas and guide surgical resections.     

布-加综合征门体分流术后肝再生结节的常规超声及超声造影表现

目的 探讨布-加综合征(BCS)患者门体分流术后肝内再生结节的常规超声及超声造影表现.方法 对18例BCS门体分流术后出现肝内结节患者行常规超声及超声造影检查.结果 常规超声显示18例患者中15例肝内再生结节为多发,3例单发;多数病例结节直径较小,周边常伴有"声晕",彩色多普勒显示较大结节内血供较丰富.超声造影检查18例患者结节均表现为"快进慢出"模式,16例动脉相表现为"中央离心型"增强,2例动脉相表现为"周边向心型"增强.结论 BCS患者门体分流术后肝内再生结节常规超声及超声造影特征对判断结节性质有重要价值.

Abstract：

Objective To investigate the routine ultrasound and contrast-enhanced ultrasound (CEUS) features of hepatic nodules in Budd-Chiari syndrome(BCS) after portacaval anastomosis.Methods Routine ultrasonography and CEUS were performed in 18 BCS patients with hepatic nodules after portacaval anastomosis.Results Appearance after portosystemic anastomosis,multiplicity,small size,presence of peripheral rim and hypervascularization were important ultrasound imaging features of hepatic regenerative nodules in patients with BCS.Nodules showed " quick wash-in and slow wash-out" pattern in CEUS.Sixteen cases showed center-to-periphery enhancement pattern in arterial phase and hyper-enhancement in portal phase and late phase.Two cases showed periphery-to-center enhancement pattern in arterial phase and periphery enhancement in portal phase and late phase.Conclusions Hepatic regenerative have different features on routine ultrasound and CEUS in patients with BCS after portacaval anastomosis,which are useful for differential diagnosis.     

肾实性肿块边界超声造影特征及其临床意义

目的 探讨肾实性肿块边界的超声造影模式及其诊断价值.方法 回顾分析225例肾实性肿块患者的239个病灶(肾癌组133个病灶,良性组106个病灶)超声造影时肿块边界的增强模式;对比观察133个肾癌病灶的病理切片,记录假包膜是否存在.结果 肾肿块边界的超声造影模式分5型:Ⅰ型,始终为等增强边界,占82.85%(198/239);Ⅱ型,灌注早期出现环状高增强边界,中、晚为等增强边界,占4.18%(10/239);Ⅲ型,持续环状高增强边界,占9.62%(23/239);Ⅳ型,灌注早期为等增强边界,中、晚期出现环状高增强边界,占1.25%(3/239);Ⅴ型,早期周边为造影剂无灌注区,中、晚期造影剂缓慢充填,呈等增强边界,占2.09%(5/239).Ⅰ、Ⅱ、Ⅲ型组间分布的差异有显著统计学意义(P=0.000,0.046,0.000);Ⅳ、Ⅴ型组间分布的差异无显著统计学意义(P=0.256,0.068);环状高增强边界组间的分布差异有显著统计学意义(χ2=29.681,P=0.000).以环状高增强边界作为肾癌的诊断标准,其敏感性26.32%(35/133),特异性99.06%(105/106),阳性预测值97.22%(35/36),阴性预测值51.72%(105/203),准确性58.58%(140/239);肾癌病灶超声造影检出的环状高增强边界与假包膜的关联性无显著统计学意义(P=1.000).结论 肾肿块边界的超声造影模式分5型;环状高增强边界对肾癌的诊断有重要价值;肾癌病灶检出的环状高增强边界与假包膜无显著关联性.

Abstract：

Objective To investigate the characteristic and the value of renal solid lesions' boundary at contrast-enhanced ultrasonography(CEUS). Methods The study included 225 patients (124 males, 101 females) with renal 239 solid lesions [133 renal cell carcinoma(RCC) and 106 benign lesions]. The enhanced mode of lesion boundary at CEUS was observed. The histopathologic pseudocapsule of RCCs was analysed.Results Enhanced modes of all lesions' boundary at CEUS were classified as: type Ⅰ , iso-enhanced boundry in whole phase, 82.85 % (198 of 239) ;type Ⅱ , a perilesional annular highly-enhanced signal at early phase,4.18% (10 of 239);type Ⅲ ,perilesional annular highly-enhanced signal in whole phase,9.62% (23 of 239) ;type Ⅳ, perilesional annular highly-enhanced signal in midium and late phase, 1.25 % (3 of 239) ;type Ⅴ ,iso-enhanced boundry in the mdium and late phase with no enhancment at early phase, 2. 09% (5 of 239). The distribution of types Ⅰ , Ⅱ , Ⅲ between groups were significant different( P=0.000, 0.046,0. 000), the type Ⅳ and Ⅴ was not ( P = 0.256,0.068). The distribution of perilesional annular highlyenhanced signal between benign and RCC groups was statistically different (x2=29. 681, P=0.000).Regared it as a diagnostic criteria of RCC,the sensitivity was 26.32% (35/133) ,the specificity was 99.06%(105/106) ,the positive predictive value was 97.22% (35/36),the negative predictive value was 51.72%(105/203) ,and the accuracy was 58.58% (140/239). The perilesional annular highly-enhanced signal was not correlated with the pseudocapsule in pathology ( P = 1. 000). Conclusions The boundary enhancement mode of renal solid lesions at CEUS was divided into five types. The perilesional annular highly-enhanced signal was important in diagnosis of RCC,which was not correlated with the pseudocapsule in pathology.     

多平面三维超声诊断膀胱肿瘤及其术前分期

目的 探讨多平面三维超声结合表面三维成像诊断膀胱肿瘤及其术前分期的应用价值.方法 对75例膀胱肿瘤患者进行二维、多平面三维和表面三维超声检查,并与手术病理诊断和分期结果及CT术前分期结果进行对照.结果 二维与三维超声诊断符合率分别为 93.3%与 98.7%;二维与三维超声分期诊断符合率分别为 83.5%与 93.2%,两者差异有统计学意义(P＜0.05);术前CT对膀胱肿瘤的诊断符合率为 90.7%,分期符合率为 79.7%.将三维超声分期符合率与CT分期对照,两者差异有统计学意义(P＜0.05).结论 多平面三维超声结合表面三维诊断膀胱肿瘤及其对肿瘤的术前分期符合率较高,可为临床诊断本病提供更多的信息.

Abstract：

Objective To evaluate the clinical value of multi-tomographic imaging mode of three-dimensional ultrasound combined with surface imaging in diagnosing and staging bladder tumors.Methods Seventy-five patients were examined with three-dimensional ultrasound and two-dimensional ultrasound.In addition,54 cases were undergone preoperative multislice spiral CT.All cases were proved by pathology after operation.Results The qualitation accuracy in the diagnosis of bladder tumor with two-dimensional ultrasound was 93.3%(70/75) and that of three-dimensional ultrasound was 98.7%(74/75).The staging accuracy rates with two-dimensional ultrasound and three-dimensional ultrasound were 83.5%(106/127) and 93.2%(123/132) respectively.The difference of bladder tumor staging between three-dimensional ultrasound and two-dimensional ultrasound was significant (P＜0.05).The qualitation accuracy in the diagnosis of bladder tumor with CT was 90.7%(49/54).The preoperative staging rate of CT was 79.7%(59/74),compared with that of three-dimensional ultrasound,the difference was significant(P＜0.05).Conclusions Multi-tomographic imaging mode of three-dimensional ultrasound combined with surface imaging can provide useful information and makes an improvement in detecting and staging bladder tumors.     

超声造影对Ⅰ期子宫内膜癌分型的价值探讨

目的 探讨超声造影是否有助于区分子宫内膜癌IA期和IB期.方法 对经诊刮证实为子宫内膜癌的76例患者进行经腹超声及超声造影检查,选取48例手术后病理证实为子宫内膜癌I期的患者进行研究.以术后病理为金标准,检验常规经腹超声和超声造影诊断子宫内膜癌IA期(无肌层侵犯或侵犯浅肌层)和IB期(侵犯深肌层)的效能.结果 21例(43.75%,21/48) 子宫内膜癌增强早于或等于周边肌层及宫颈,其中12例为IA期,9例为IB期(P<0.05);27例(56.25%,27/48) 增强晚于肌层及宫颈.经腹常规超声和超声造影判断IB期子宫内膜癌的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为 61.25% 对 69.23%,77.14% 对 85.71%,50.00% 对 64.28%,72.92% 对 88.23%,72.92% 对 81.25%,两种方法诊断子宫内膜癌IA期和IB期的差异无统计学意义(P>0.05).结论 超声造影判断I期子宫内膜癌侵犯肌层深度方面没有显著的优势.

Abstract：

Objective To evaluate the accuracy of contrast enhanced ultrasonography (CEUS) in determining the depth of myometrial invasion in endometrial carcinoma in stage Ⅰ.Methods Seventy-six patients previously diagnosed of endometrial carcinoma by curettage of uterine underwent transabdominal sonography (TAS) and CEUS to assess myometrial invasion,among which 48 patients proved to endometrial carcinoma in stage Ⅰ after total abdominal hysterectomy and bilateral salpingo-oophorectomy were studied.The findings of TAS and CEUS to determine endometrial carcinoma IA (no myometrial involvement or invasion of the inner half of the myometrium) and IB( invasion of the outer half of the myometrium) were compared with pathology after abdominal hysterectomy.Results Twenty one tumours (43.75%,21/48) were enhanced earlier than or simultaneously as myometrium and cervix,among which 12 cases were IA stages,while 9 cases were IB stages (P<0.05);and 27 tumors (56.25%,27/48)were enhanced late than myometrium and cervix.There was no statistical difference between TAS and CEUS in detecting endometrial carcinoma in IA and IB(P>0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of TAS and CEUS in diagnosing endometrial carcinoma in IB were 61.25% vs 69.23%,77.14% vs 85.71%,50.00% vs 64.28%,72.92% vs 88.23%,72.92% vs 81.25% respectively.Conclusions CEUS is not superior to TAS in detecting deep invasion of endometrial carcinoma in stage Ⅰ.     

超声联合微泡对不同细胞周期血管平滑肌细胞增殖和凋亡的影响

Objective To investigate the effect of microbubbles mediated ultrasound insonation on proliferation and apoptosis of vascular smooth muscle cells (VSMCs) in different phase of cell cycle. Methods Rat thoracic aortic VSMCs were cultured in vitro by the method of tissue adherence. The cells were synchronized by the methods of serum starvation and double thymidine block. The synchronization results were detected by flow eytometer. VSMCs in different phases of cell cycle were exposed to 1 MHz continuous waves ultrasound for 120 s at intensity 0.3 W/cm2 in the presence of lipid-coated microbubbles (1 ml/L). Apoptosis of VSMCs was analyzed by AnnexinV/PI staining using flow eytometry. The proliferation and the proliferating cell nuclear antigen(PCNA) protein expression of VSMCs were detected by MTT assay and immunoeytochemistry, respectively. Results The synchronized G0/G1 and S phase VSMCs were achieved, with synchronized rates to 89.53 % and 66.87 %, respectively. Ultrasound sonication for 120 s with microbubbles could significantly inhibit the proliferation and downregulate the PCNA expression of S phase VSMCs,but the proliferation and PCNA expression of G0/G1 phase VSMCs were not affected. After treatment of ultrasound with microbubbles, the apoptotic ratio were found to reach (7.05 ± 2.04)% in G0/G1 phase VSMCs and (27.01 ±3.87)% in S phase VSMCs. Conclusions Microbubbles mediated ultrasound insonation can significantly inhabit the proliferation and induce apoptosis in VSMCs at proliferation stage.     

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.     

三维超声造影对肾良恶性肿瘤的鉴别诊断

目的 探讨三维超声造影对肾良恶性肿瘤的鉴别诊断价值.方法 对68例肾良恶性肿瘤进行常规超声及二维超声造影检查,在此基础上行三维重建,并与二维造影进行对比,分析三维超声造影对肾良恶性肿瘤的鉴别诊断价值及表现.所有病例均经手术病理证实.结果 肾良性肿瘤18例,二维造影多表现为等增强或低增强,呈"慢进慢出";三维造影表现为病灶内较少的平直规则的周边血管和内部血管.肾恶性肿瘤50例,二维造影多表现为高增强,呈"快进快出";三维造影多表现为病灶内多支蜿蜒扭曲的周边血管和内部紊乱的微小血管组成的血管网.三维超声造影可直观立体显示肿瘤血管分布特征,在显示肿瘤血管方面优于二维超声造影(P＜0.05).结论 三维超声造影可显示肾肿瘤血管特征及其空间分布,对鉴别肾肿瘤的良恶性有重要的实用价值.     

三维超声造影在腹部肿瘤血管显示中的应用

目的 探讨三维超声造影在腹部肿瘤血管显示中的价值.方法 对69例腹部肿瘤进行三维超声造影.其中包括原发性肝细胞癌11例,肝血管瘤23例,肾细胞癌3例,肾血管平滑肌脂肪瘤2例,胰腺癌1例,膀胱癌1例,子宫肌瘤25例,宫颈癌2例和卵巢纤维瘤1例.经静脉注射超声造影剂SonoVue后观察各种病灶的血管特征.结果 三维超声造影显示出病灶部位血管的立体图像,肿瘤的供血血管和内部血管,血管的走行、分布及其空间关系.恶性肿瘤血管特征为滋养血管蜿蜒扭曲,内部血管杂乱密集.肿瘤治疗后无血供的部位表现为"空洞"样的立体图像.结论 三维超声造影可显示肿瘤血管特征及其空间分布,并可作为一种监测临床治疗和疗效评价的新方法.     

超声造影对高回声肾肿瘤的诊断价值

目的 探讨超声造影对高回声肾良恶性肿瘤的鉴别诊断价值.方法 对19例高回声肾肿瘤的超声造影检查与手术病理结果进行对照分析.结果 11例血管平滑肌脂肪瘤,8例肾透明细胞癌.11例血管平滑肌脂肪瘤中6例显示造影后增强和局部增强,呈快进慢出(6/11);1例表现为快进快出(1/11);4例表现为先增强,随后造影剂廓清完全,呈不增强(与肾皮质对比瘤体呈负显影,4/11).5例肾透明细胞癌均呈快进快出(5/8);2例表现出快进慢出(2/8);1例为完全不增强(负显影,1/8);5例有假包膜.肾透明细胞癌快进快出的比例与肾血管平滑肌脂肪瘤比较差异有统计学意义(P<0.05).而两种肾肿瘤的快进慢出和"负显影"的超声造影表现差异无统计学意义(P>0.05).结论 超声造影对高回声肾肿瘤的鉴别诊断有一定价值,高回声肾肿瘤的超声造影特征仍有待进一步研究.     

超声造影与增强CT诊断良、恶性肾脏占位性病变的对照研究

目的比较良、恶性肾脏占位性病变超声造影（CEUS）和增强CT灌注特点,评价CEUS与增强CT对良、恶性肾脏占位性病变的诊断价值。方法回顾性分析山西医科大学第一医院2008年1月至2010年12月收治的52例肾脏占位性病变患者共52个病灶的CEUS与增强CT检查资料,并进行比较。所有患者均经手术和病理证实。结果 52个肾脏占位性病灶中,恶性病灶42个,包括透明细胞癌32个（其中囊性肾癌4个）,嫌色细胞癌2个,乳头状细胞癌4个,移行细胞癌4个;良性病灶10个,包括肾血管平滑肌脂肪瘤6个,肾囊肿3个,肾球旁细胞瘤1个。42个恶性肾脏占位性病灶CEUS及增强CT均以快进快退及高增强为主。10个良性肾脏占位性病灶CEUS均以慢进慢退及低增强为主,而增强CT则均以快进慢退及低增强为主。CEUS、增强CT诊断良、恶性肾脏占位性病变的敏感度、特异度及准确性分别为88.1%、80.0%、86.5%和90.5%、60.0%、82.7%,两种方法诊断效果间差异无统计学意义（Fisher精确概率检验,P值分别为1.000、0.628、0.780）。结论 CEUS和增强CT在肾脏占位性病变良、恶性诊断中均有较高价值,两者结合有助于肾脏占位性病灶良、恶性的明确诊断。     

超声造影在肾细胞癌分型中的应用价值

目的 探讨超声造影在肾细胞癌分型中的应用价值.方法 对经手术病理证实的70个肾细胞癌(包括58个肾透明细胞癌,7个乳头状细胞癌,5个嫌色细胞癌)的超声造影图像进行分析,对比观察肿瘤及瘤旁肾皮质显影过程,检测指标包括开始增强方式、消退方式、到达时间、达峰时间、达峰强度及消退强度(后4项由时间-强度曲线得到).结果 53个透明细胞癌表现为肿瘤开始增强较肾皮质早或同时,消退较慢,肿瘤内造影剂灌注量多于肾皮质,即富血供表现.以富血供表现诊断透明细胞癌的特异性及敏感性为100%和91%.其余肾细胞癌为乏血供表现,其中嫌色细胞癌全部以均匀增强、消退期肿瘤周边出现高增强晕环,达峰强度稍低于肾皮质为特征性表现;乳头状细胞癌及乏血供透明细胞癌造影表现有交叉.结论 超声造影有助于肾细胞癌的分型诊断.     

超声造影诊断肾盂癌

目的 探讨超声造影(CEUS)诊断肾盂癌的潜在价值.方法 对22例经手术病理证实为肾盂癌患者的常规超声及CEUS声像图进行回顾性分析.常规超声观察肾占位大小、回声、边界、有无彩色血流信号.CEUS观察肿块的增强时相和增强方式,包括肿块的增强、消退时间和灌注表现.结果 本组22个肿块直径范围1.5～8.5 cm.常规超声显示扁平样肿块7个,不规则团块样肿块15个;伴同侧肾脏积水11例.5个肿块内发现较丰富彩色血流信号,9个仅周边少量彩色血流信号,8个未显示彩色血流信号.CEUS显示皮质期22个肿块均增强;同步增强8个,缓慢增强14个;达峰值呈低回声18个,高回声3个,等回声1个;实质期快速消退20个,同步消退1个,缓慢消退1个.常规超声和CEUS的诊断准确率分别为63.64%(14/22)和81.82%(18/22).结论 CEUS可改善肾盂癌的血供显示,提高诊断率.     

肾肿瘤的超声造影研究

目的探讨各种不同肾肿瘤的超声造影表现。方法124例肾肿瘤（平均直径3.4cm）,应用超声造影观察肿块回声增强时间和造影剂消退时间（皮质相与延迟相）,观察肿块的假包膜（与二维声像图对比）,所有患者均行手术和病理证实。结果透明细胞癌和乳头状癌98例,移行细胞癌5例,肾盂鳞癌6例,血管平滑肌脂肪瘤7例,肾盂上皮细胞癌1例,肾母细胞瘤5例,嗜酸细胞瘤2例（潜在恶性）。透明细胞癌98中超声造影有58例出现假包膜（58/98,73.3%）,而二维声像图显示假包膜31例（31/98,17%）;造影剂呈快进快退76例,快进慢退11例,慢进慢退7例,肿块局部回声增强4例。而血管平滑肌脂肪瘤回声增强程度明显低于肾细胞癌。结论超声造影有助于鉴别肾肿瘤,有助于显示出肾细胞癌的假包膜。     

超声造影和增强CT在肾细胞癌分型中的诊断价值

目的 探讨超声造影及增强CT在肾细胞癌诊断中的作用.方法 672例肾细胞癌,其中肾透明细胞癌562例,乳头状细胞癌68例,嫌色细胞癌42例,对其先行超声造影检查,分析其时间-强度曲线,再行增强CT检查.结果 537例肾透明细胞痛瘤灶呈富血供造影表现,造影剂到达时间及曲线达峰时间低于肾皮质(P<0.05),曲线上升斜率、达峰绝对值、曲线下面积高于周围肾皮质(P<0.05),25例呈乏血供表现;肾嫌色细胞癌均呈乏血供造影表现,达峰绝对值、曲线下面积低于肾皮质(P<0.05);肾乳头状细胞癌多呈乏血供造影表现,曲线达峰时间高于周围肾皮质(P<0.05),达峰绝对值低于肾皮质(P<0.05).512例肾透明细胞癌动态增强皮质期显著不均匀强化,强化程度等于或高于周围肾皮质;肾嫌色细胞癌皮髓质期强化程度最高,但强化程度明显低于肾皮质;肾乳头状细胞癌增强扫描肿瘤实性部分轻一中度均匀强化,54例皮髓交界期强化程度与肾皮质较一致或略强于肾皮质.结论 超声造影和增强CT的时间-强度曲线分析对肾细胞癌的分型均具有一定的诊断价值.     

超声造影在囊性肾癌诊断中的应用价值

目的探讨囊性肾癌（CRCC）的超声造影表现及其应用价值。方法对21例经手术病理证实为CRCC患者的常规超声及超声造影声像图表现进行回顾性分析。常规超声观察肿瘤大小、回声、边界、有无彩色血流信号。超声造影观察病灶的增强方式和增强时相，包括起始时间、达峰值时间、消退时间及病灶内部结构的增强表现。结果21个肿瘤大小范围1．0～7．3cm。常规超声显示囊实性肿块18个，囊性肿块3个；边界清晰8个，边界不清晰13个。16个病灶的实质部分或分隔上显示出彩色血流信号，5个未显示彩色血流信号。21个肿瘤超声造影中显示动脉期快速整体增强，平均增强起始时间（14．6±3．6）S，达峰值时间（21．2±3．7）S，消退时间（31．3±5．0）S。14个（14／21）强化方式为同步增强、同步减退。21个病灶中分隔强化16个，不规则囊壁或实质部分强化5个。结论超声造影能较好反映肾囊性占位性病变的血供和复杂的内部结构，对诊断囊性肾癌有较大帮助。