超声造影在诊断乳腺癌肝转移中的应用价值

目的:探讨超声造影(CEUS)在诊断乳腺癌肝转移中的应用价值。材料和方法:对89例常规超声疑似乳腺癌肝转移者行CEUS和增强CT(CECT)后,采用穿刺活检、手术病理、影像学随访超过半年临床最后确诊。结果:89例常规超声疑似乳腺癌肝转移经CEUS及相关检查临床最后确诊为良性41例。48例乳腺癌肝转移经CEUS明确诊断47例。CEUS对乳腺癌肝转移诊断的敏感度为97.92%(47/48),假阴性率为2.08%(1/48),特异度为100%(41/41),阳性预测值为100%(47/47),阴性预测值为97.62%(41/42)。经CEUS发现新增转移病灶10例。CEUS从常规超声53.93%(48/89)的诊断准确度提高到98.88%(88/89)。CEUS对乳腺癌肝转移的诊断率与CECT在统计学上无差异(P=0.833)。结论:CEUS能发现乳腺癌较小的肝转移灶,提高了超声诊断乳腺癌肝转移的鉴别能力和准确度。     

实时超声造影在乳腺肿块诊断中的价值

目的:研究实时超声造影在乳腺良恶性肿块诊断中的价值。方法:实时观察48例乳腺肿块内造影剂微泡的分布,分析造影增强特点,并用ACQ分析软件进行时间-强度曲线分析。结果:乳腺恶性肿块的周围可见蟹足样等一些特征性表现;恶性组明显增强时间及达峰时间比良性组早,峰值强度及曲线下面积较良性组高。结论:实时超声造影有助于乳腺良恶性肿块的鉴别及估测预后。     

超声造影在乳腺良恶性结节鉴别诊断中应用

目的总结乳腺良恶性病灶超声造影的特征。方法回顾性分析自2016年9月至2017年12月在北部战区总医院就诊的87例乳腺肿块患者的超声造影检查结果,观察并记录良恶性病灶的造影特征及时间-强度(TIC)曲线参数。结果恶性病灶患者34例,包括:浸润性导管癌25例(73. 5%),浸润性混合性癌7例(20. 6%),导管内原位癌2例(5. 9%);良性病灶患者53例,包括:纤维腺瘤45例(84. 8%),导管内乳头状瘤2例(3. 8%),乳腺腺病3例(5. 7%),乳腺炎1例(1. 9%),分叶状肿瘤(良) 2例(3. 8%)。恶性病灶多表现为以高增强为主、不均匀增强、增强后边界均显示不清、造影后肿块明显增大、有穿支血管及造影剂滞留。良性病灶多表现为均匀增强、增强后边界多清晰、大部分造影后无明显增大、无穿支血管显影及造影剂滞留。良、恶性病灶的增强程度、增强方式、增强后边界、增强后病灶大小、穿支血管、造影剂滞留情况比较,差异均有统计学意义(P <0. 05)。两组达峰时间及峰值强度比较,差异无统计学意义(P> 0. 05)。结论乳腺超声造影具有特征表现,是鉴别乳腺良恶性肿块的有效方法。     

实时超声造影在乳腺病灶诊断中的应用

目的 观察实时超声造影检查在乳腺良、恶性病灶中的不同表现,探讨该技术对乳腺疾病的诊断价值.方法 应用SonoVue观察30例乳腺腺病病灶、24例纤维腺瘤病灶、15例乳腺癌病灶的造影特征,分析不同类型病灶的时间-强度曲线、增强模式、边界特征以及病灶与其供支血管增强的差异.结果 69例病灶中3例无显著增强,其余病灶均有不同程度的增强.时间-强度曲线显示:病灶增强均为快速增强型,增强起始时间为12.6±3.2s,达峰时间为19.8±7.62s,峰值强度为30.65±12.3dB.增强模式:纤维腺瘤与腺病警快速均匀增强型,乳腺癌呈快速周边增强或快速不均匀增强,所有病灶未观察到缓慢增强型病灶.边界特征:腺病病灶增强与正常腺体组织无明显边界,纤维腺瘤、乳腺癌与正常腺体组织分界明显.供支血管:腺病及纤维腺瘤组供支血管峰值强度低于病灶内部峰值强度,乳腺癌供支血管峰值强度与病灶内部峰值强度无显著差异.结论 乳腺良、恶性病灶在超声造影下呈现不同的造影特征,实时超声造影对乳腺疾病的诊断具有重要临床价值.     

超声造影技术及其在卵巢肿瘤诊断中的应用

超声造影(contrast enhanced ultrasound,CEUS)是当前超声医学的热门研究课题,超声造影剂的发展使医学超声开始进入人体微循环系统诊断及疾病治疗的新阶段[1]。近年来,超声造影剂及其相关造影成像技术取得了突破性进展,使超声医学进入一个新的历史时期。超声造影剂1968年Gramia     

BI-RADS在乳腺超声诊断中的应用

<正> 1992年,美国放射学会(The American Collegeof Radiology,ACR)制定了乳腺影像学报告及数据系统(brest imaging reporting and data system,BIRADS)。该系统针对乳腺钼靶摄影影像进行了规范而详尽的描述,运用该系统对乳腺X线影像进行分级评估,对乳腺疾病诊断的敏感性、特异性及准确性均有较大提高。该标准2003年第4版修订时同     

超声造影在卵巢癌中的应用

卵巢癌是女性生殖系统常见的恶性肿瘤.目前最常见的诊断方法有妇科三合诊、血清CA125检测和超声检查.这三种方法联合应用是卵巢癌的主要筛查方法.近年来超声造影技术的应用受到了广泛的关注,它可以有效地改善超声对病变血管的检测,从而提高卵巢癌的诊断率,超声造影被认为是超声发展的新技术,是超声领域的第三次革命[1].     

超声造影定量分析在肿瘤诊疗中的应用

超声造影（contrast-enhanced ultrasound,CEUS）定量分析是指通过特定的数据模型获取肿瘤血流灌注定量参数,对肿瘤进行早期诊断和早期动态评估抗肿瘤治疗的效果。近年来随着CEUS在肿瘤诊疗领域的广泛应用,CEUS定量分析也逐步体现出重要的临床价值。本文全面阐述了CEUS定量分析的理论基础、在肿瘤诊疗中的应用、局限性和未来发展方向。     

超声造影在膀胱占位性病变诊断中的应用

目的:探讨超声造影在膀胱占位性病变诊断中的临床应用价值.方法:对25例膀胱占位性病变行实时超声造影, 观察并分析病灶的超声造影表现,总结超声造影灌注时相的动态变化规律,并与病理结果相对照.结果:超声造影提示膀胱恶性肿瘤17例(26个病灶),经手术病理证实膀胱移行细胞癌18例.超声造影诊断膀胱癌的敏感性为94.4%(17/18),特异性为100%(7/7),准确性为96.0%(24/25).结论:超声造影能够实时观察膀胱占位性病变的血流灌注情况,对占位性病变的诊断和鉴别诊断具有较高的临床应用价值.     

超声造影技术在肝癌诊断及治疗中的研究进展

超声造影（CEUS）又称声学造影,是利用造影剂使后散射回声增强,显著提高超声诊断的分辨力、敏感度和特异性的技术。CEUS技术除了常规的造影谐波成像外,还有间歇式超声成像、能量对比谐波成像、反脉冲谐波成像、受激声波发射成像、低机械指数成像、造影剂爆破成像等。随着新型造影剂的不断研发和相关造影成像技术的飞速发展,CEUS技术取得了突破性进展,CEUS在肝癌诊断和治疗中的应用越来越为业内所肯定。现就CEUS技术在肝癌诊断及治疗中的进展综述如下。     

彩色多普勒超声及超声造影在乳腺癌新辅助化疗疗效评估中的价值

目的探讨彩色多普勒超声及超声造影对乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)疗效评估中的应用价值。方法选取2014年1月—2015年6月收治的行NAC乳腺癌患者60例,分别于NAC前和NAC后应用彩色多普勒超声记录病灶大小、血流分级、血流阻力指数等指标;对其中26例行超声造影检查患者记录造影相关参数,包括造影剂到达肿瘤的时间、达峰时间及峰值强度。根据NAC前、后各项指标变化情况评估NAC疗效。结果NAC后病灶最大径、形态、边界、周边晕带、内部回声变化、血流分级及血流阻力指数均较NAC前差异有统计学意义（P<0.05）。NAC后造影相关参数到达肿瘤的时间、达峰时间及峰值强度均较NAC前有明显变化,差异有统计学意义（P<0.05）。结论超声造影可以通过检测乳腺癌NAC前、后各项指标变化情况,准确评估NAC疗效。     

超声造影与彩色多普勒超声诊断肝实质性肿块对照研究

 目的 比较彩色多普勒超声和实时超声造影对肝实质性肿块的诊断价值.方法 应用彩色多普勒超声及超声造影技术对常规二维超声难以定性的27例共31个肝实质性肿块进行检查,结果与手术及病理结果相对照.结果 31个肿块中原发性肝细胞性肝癌24个,肝血管瘤3个,肝脏局灶性结节增生3个,肝孤立性坏死结节1个.彩色多普勒超声在肿块内部或肿块周边能检测到动脉血流频谱者共19例21个肿块;超声造影除一例肝孤立性坏死结节外,其余30个病灶均在不同时相出现不同程度强化现象.如以动脉相呈高回声而门脉相及延迟相呈低回声为恶性肿块的诊断标准,则超声造影对肝癌诊断的准确率为91.67%;如以肿块内部检测到动脉样血流频谱为诊断恶性肿块的诊断标准,则彩色多谱勒超声诊断肝癌的准确率为75%.超声造影诊断肝实质性肿块准确率为93.54%,彩色多普勒超声诊断肝实质性肿块准确率为64.52%.二者差别有统计学意义(P＜0.05).结论 实时超声造影显著提高肝内实质性肿块的诊断准确性,对肝脏实质性肿块良、恶性的诊断及鉴别诊断具有重要价值.     

The added value of contrast enhanced spectral mammography in identification of multiplicity of suspicious lesions in dense breast

Objective

To evaluate the additive value of Contrast Enhanced Spectral Mammography (CESM) in the preoperative assessment of malignant lesions in dense breast parenchyma regarding multiplicity.

相对造影参数在乳腺肿物良恶性鉴别诊断中的价值

目的利用超声造影技术,探讨相对造影参数在乳腺病灶良恶性鉴别诊断中的价值。方法选用造影剂SonoVue,对34例乳腺病灶进行超声造影(良性14例,恶性20例),应用随机配置的Qontraxt定量分析软件,对病灶及病灶旁组织勾勒感兴趣区,测量其声学定量参数,进一步获得相对造影参数。结果病灶的相对峰值强度、相对达峰时间、相对曲线下面积,良恶性病灶之间差异均具有统计学意义(P<0.05)。病灶的相对曲线尖度,良恶性病灶之间差异无统计学意义(P>0.05)。结论乳腺良恶性病灶的超声造影灌注模式各有特点。超声造影研究中,应充分重视病灶周围腺体的增强情况,病灶的相对造影参数有助于良恶性的鉴别诊断。     

Differentiating benign from malignant solid breast lesions: Combined utility of conventional ultrasound and contrast-enhanced ultrasound in comparison with magnetic resonance imaging

Objective

To prospectively evaluate the diagnostic efficacy of conventional ultrasound (US), contrast-enhanced US (CEUS), the combined use of two modalities, and magnetic resonance imaging (MRI) in the differentiation of focal solid breast lesions.

Materials and methods

61 patients with BI-RADS category 3–5 breast lesions detected at conventional US underwent CEUS and MRI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of conventional US, CEUS, combination of two modalities and MRI for discrimination between benign and malignant breast lesions.

Results

Tissue specimens of 61 breast lesions were obtained either from surgical resection (n = 46) or from needle biopsy (n = 15). Histopathologic diagnosis revealed 28 benign and 33 malignant lesions. The diagnostic performance of conventional US and CEUS in differentiating benign from malignant breast lesions showed no significant difference (P = 0.741). The combination of two modalities significantly improved the diagnostic accuracy compared with either conventional US or CEUS alone (P = 0.031 and P = 0.012, respectively). The area under the ROC curve (A_z) value for the combined use of two modalities for discrimination between benign and malignant breast lesions was 0.94, and that for MRI was 0.91, whereas no statistical difference was found between them (P = 0.296).

Conclusion

The combined use of conventional US and CEUS has a better diagnostic performance than either method alone and displays good agreement with MRI in the differentiation capability for benign and malignant breast lesions.     

The role of contrast enhanced ultrasound in the differential diagnosis of segmental testicular infarction

A 43-year-old male presented to the emergency department with acute left testicular pain. Physical exam showed a tender left testicle and epididymis with mild swelling. Doppler and contrast enhanced ultrasound revealed a heterogeneous, avascular lesion with hyper vascularized surrounding. Follow-up contrast enhanced ultrasound performed a few days later showed persistence of the sparsely vascularized lesion with more hypoechoic echo structure.Despite the tumor markers being negative, a necrotic tumor could not be ruled out and a left orchiectomy was performed. Pathology report described an extensive segmental testicular infarction with no evidence of malignant tissue.We present the ultrasound and pathology findings, differential diagnostic pearls and clinical perspective of segmental testicular infarction.     

Management of hepatocellular carcinoma: The role of contrast-enhanced Tultrasound简

Hepatocellular carcinoma (HCC) is the sixth most common neoplasm and the third cause of cancer death worldwide. Contrast enhanced ultrasound (CEUS) has been applied for more than ten years and plays increasingly important roles in the management of HCC. On the basis of the Guideline and Good Clinical Practice Recommendations for CEUS in the liver-update 2012 and related literature about the management of HCC, we summarize the main roles and applications of CEUS in the management of HCC, including HCC surveillance, diagnosis, CEUS-guided treatment, treatment response evaluation and follow-up. The diagnostic algorithm for HCC is also suggested. Meanwhile, the comparisons between CEUS and contrast enhanced computed tomography/magnetic resonance imaging (CECT/CEMRI) in these areas are made. Although CEUS is subject to the same limitation as ordinary US and is inferior to CECT/CEMRI in some aspects, CEUS has proved to be of great value in the management of HCC with inherent advantages, such as sufficient high safety profile making it suitable for patients with renal failure or allergic to iodine, absence of radiation, easy reproducibility and high temporal resolution. The tremendous application of CEUS to the diagnosis and treatment of HCC provides more opportunities for patients with HCC diagnosed at different stages.     

Three-dimensional contrast enhanced ultrasound score and dynamic contrast-enhanced magnetic resonance imaging score in evaluating breast tumor angiogenesis: Correlation with biological factors

Objective

To explore the clinical value of three-dimensional contrast enhanced ultrasound (3D-CEUS) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) score systems in evaluating breast tumor angiogenesis by comparing their diagnostic efficacy and correlation with biological factors.

Methods

3D-CEUS was performed in 183 patients with breast tumors by Esaote Mylab90 with SonoVue (Bracco, Italy), DCE-MRI was performed on a dedicated breast magnetic resonance imaging (DBMRI) system (Aurora Dedicated Breast MRI Systems, USA) with a dedicated breast coil. 3D-CEUS and DCE-MRI score systems were created based on tumor perfusion and vascular characteristics. Microvessel density (MVD), vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMP-2, MMP-9) expression were measured by immunohistochemistry.

Results

Pathological results showed 35 benign and 148 malignant breast tumors. MVD (P = 0.000, r = 0.76), VEGF (P = 0.000, r = 0.55), MMP-2 (P = 0.000, r = 0.39) and MMP-9 (P = 0.000, r = 0.41) expression were all significantly different between benignity and malignancy. Regarding 3D-CEUS 4 points as cutoff value, the sensitivity, specificity and accuracy were 85.1%, 94.3% and 86.9%, respectively, and correlated well with MVD (P = 0.000, r = 0.50), VEGF (P = 0.000, r = 0.50), MMP-2 (P = 0.000, r = 0.50) and MMP-9 (P = 0.000, r = 0.66). Taking DCE-MRI 5 points as cutoff value, the sensitivity, specificity and accuracy were 86.5%, 94.3% and 88.0%, respectively and also correlated well with MVD (P = 0.000, r = 0.52), VEGF (P = 0.000, r = 0.44), MMP-2 (P = 0.000, r = 0.42) and MMP-9 (P = 0.000, r = 0.35).

Conclusions

3D-CEUS score system displays inspiring diagnostic performance and good agreement with DCE-MRI scoring. Moreover, both score systems correlate well with MVD, VEGF, MMP-2 and MMP-9 expression, and thus have great potentials in tumor angiogenesis evaluation.