肝脏局限性结节性增生的超声与病理对照研究

目的：讨论肝脏局限性结节性增生（FNH）的超声表现及病理基础。方法：回顾性分析13个病理证实的FNH的超声特点并与病理对照。结果：结节大小为2．4－13．7cm,低回声8例,等回声4例,中高回声1例,5例病灶内见星状强回声区,B超显示4例结节内血管图像,多普勒超声于病灶内记录到丰富的低阻动脉频谱（能量多普勒显示全部病灶,彩色多普勒示11／13呈富血供）,7例病灶内血管呈放射状排列。结论 ;彩色多普勒和能量多普勒超声能够显示FNH的特征性血流表现,提高对FNH的诊断率。     

Abdominal ultrasonogram of autoimmune pancreatitis: Five cases of pancreatic lesions accompanied by Sjögren syndrome

The concept of autoimmune pancreatitis has recently been established, and ultrasonographic findings we obtained from five cases consistent with autoimmune pancreatitis are reported here. Case 1, a 77-year-old man, was admitted complaining of loss of body weight. Serum hepatobiliary enzymes and γ-globulin levels were elevated, and antinuclear antibody was positive, Abdominal ultrasonography showed dilatation of the intrahepatic bile duct, wall thickening of the common bile duct and hypoechoic swelling of the pancreatic head and body. ERCP revealed multiple stenosis of the intra-and extra-hepatic bile ducts, and diffuse irregular narrowing of the main pancreatic duct. The patient complained of thirst, and the minor salivary gland was examined histologically. Our diagnosis was Sjögren syndrome accompanied by sclerosing cholangitis and a pancreatic lesion. Obstructive jaundice also developed, and PTCD was therefore performed. Both the pancreatic swelling and multiple stenosis of the bile duct improved after steroids were administered. Case 2, a 71-year-old man, was admitted with jaundice. Abdominal ultrasonography showed hypoechoic swelling of the pancreas. ERCP showed stenosis of the common bile duct in the pancreatic head region and diffuse irregular narrowing of the main pancreatic duct. Histological examination of the minor salivary gland suggested Sjögren syndrome. Steroids were therefore administered because the presence of both hyper-γ-globulinemia and positive antinuclear antibody suggested involvement of the autoimmune mechanism. Steroid therapy improved the jaundice as well as the findings from the cholangiograms and pancreatograms. We also encountered three similar cases, all consistent with the concept of autoimmune pancreatitis. The ultrasonographic findings of the pancreatic lesion (1) showed them as homogeneous and markedly hypoechoic areas and, (2) visualized the main pancreatic duct in the lesion, which facilitated a differential diagnosis of the neoplastic lesions. (3) Steroid therapy effectively decreased the hypoechoic area; in some cases, however, a hypoechoic area remained around the main pancreatic duct.     

肝内胆管细胞癌的超声诊断

目的:探讨肝内胆管细胞癌的超声声像图特点与诊断。方法:回顾总结85例经手术和(或)穿刺病理证实的肝内胆管细胞癌的超声声像图表现。其中彩超检查64例。结果:病灶直径11～130mm,单发69例(81.2%)。病灶呈不均匀低回声者占72.4%;形态不规则,边界不清青占85.2%;病灶内测及动脉血流45例(70.3%),其中阻力指数大于0.6者40例(88.9%)。定位诊断正确83例(97.6%),漏诊2例。诊断恶性肿瘤65例(76.5%):其中正确提示肝内胆管细胞癌仅11例。疑似恶性肿瘤12例(14.1%)。不能定性及误诊各3例。结论:典型肝内胆管细胞癌的超声声像图表现为形态不规则、边界不清的低回声不均质肿块,病灶内多能测及高阻动脉血流。多种影像学诊断方法结合有助于该病的诊断。     

Solitary metastasis from renal cell carcinoma presenting as diffuse pancreatic enlargement

Late metastasis of renal cell carcinoma (RCC) to the pancreas is uncommon. Diffuse pancreatic metastasis of any carcinoma rarely causes global enlargement of the pancreas. We present the case of a 73-year-old man diagnosed with metastatic RCC of the pancreas 9 years after radical nephrectomy had been performed and describe our radiologic findings. The disease involved the entire pancreas, which was hypoechoic on sonography, hypodense on CT without contrast enhancement, and markedly hyperdense after intravenous administration of a contrast agent. Color Doppler sonography showed that the involved areas of the pancreas had increased color flow signals, indicating that the metastatic tumor was characteristically hypervascular. In patients with a history of RCC, color or power Doppler sonographic demonstration of diffuse enlargement of the pancreas with evidence of hypervascularity may indicate metastasis of RCC to the pancreas.     

Ultrasound and Power Doppler findings in jumper's knee - preliminary observations.

OBJECTIVE: to examine a group of high risk athletes, for signs of inflammation in jumper's knee (JK) by gray-scale ultrasonography (US) and color/Power Doppler findings in JK. SUBJECTS AND METHODS: eighteen high-elite basketball players participated in the investigation after a match. Seven players were examined by ultrasound before the match as well. The players were clinically examined for signs of JK and filled in a questionnaire concerning previous and present knee symptoms. RESULTS: clinical signs of JK were found in 13 knees. Of these knees, ten had hypoechoic areas and six had Power Doppler flow. Four players reported symptoms of JK and clinical examination suspected the same. Three of them had both hypoechoic areas and Power Doppler flow. Fourteen players were asymptomatic at the time of examination but both hypoechoic areas and Power Doppler flow was found in the patellar tendons of four players. No correlation was found between clinical findings, symptoms of JK and US findings - including Power Doppler. The risk of type II error in this material is considerable. CONCLUSION: an association between gray-scale US and color/Power Doppler was found in JK which may suggest an inflammatory component to be a part of the pathogenesis of JK.     

Peripheral bone metastasis from hepatocellular carcinoma: sonographic findings

BACKGROUND AND METHODS: We reviewed medical and radiologic records of five patients with bone metastasis from hepatocellular carcinoma (HCC) to evaluate the role of sonography (US) in the diagnosis of this bone metastasis. RESULTS: The metastatic lesions were clearly visualized by US as expansive, homogeneous, soft tissue masses with bony destruction, and color Doppler US showed fine vessels within the lesions. After treatment, US showed a decrease in tumor size with an increase in echogenicity and a decrease in blood flow. Hepatic US at the time of bone metastasis showed a portal tumor thrombus in all cases. CONCLUSION: When US detects a portal venous tumor thrombus in HCC patients, attention should be directed not only to the liver but also to bone to improve patient care. US is useful not only in detecting the metastatic lesion but also in evaluating the treatment effect.     

肉芽肿性小叶性乳腺炎的灰阶及彩色多普勒超声显像

目的回顾性分析肉芽肿性小叶性乳腺炎的灰阶和彩色多普勒超声表现，力求为这种少见的疾病提供诊断依据。方法12例手术病理证实的患者全部经过超声检查，先用二维观察肿块的部位、形态、大小等，再用彩色多普勒血流成像（CDFI）探测，按照Adler半定量方法进行血流分级，用频谱多普勒测量血管最高流速（PSV）、阻力指数（RI）、搏动指数（PI）。结果灰阶超声可分三型：（1）不规则低回声肿块，5例。（2）低回声结节，4例。（3）混合回声型，3例。CDFI探查，大部分病例病灶内血流较丰富；频谱测量，PSV8～22cm／s，平均（15±6）cm／s；P10．8～1．6，平均1．2±0．3；R10．51～0．79，平均0．65±0．14，测值范围较宽，无特异性。结论灰阶超声对肉芽肿性小叶性乳腺炎的诊断起着重要的作用，彩色血流显示较丰富，频谱分析未见明显的特异性。     

Sonographic Findings of Tuberculous Vasitis

The purpose of this series was to describe the sonographic findings of tuberculous vasitis. We conducted a retrospective analysis of 3 cases of tuberculous vasitis. The following grayscale and color Doppler sonographic features were analyzed: location, echogenicity of the lesion, epididymal or testicular involvement, presence of hydrocele, and blood flow within the lesion. All 3 patients had focal (n = 2) or multifocal (n = 1) involvement of the scrotal segment of the vas deferens. The sonographic findings for tuberculous vasitis were heterogeneously hypoechoic in all of the cases. On color Doppler sonography, no blood flow was identified within the lesions of the vas deferens. All 3 patients had tuberculous epididymitis in addition to tuberculous vasitis. Tuberculous vasitis presents with infection along with tuberculous epididymitis, and it appears as a heterogeneously hypoechoic lesion in the scrotal segment of the vas deferens adjacent to the epididymal tail.     

Renal arteriovenous malformation: sonographic findings

BACKGROUND AND METHODS: Renal arteriovenous malformation (RAVM) is a relatively rare congenital disease. Although sonography (US) currently is the first diagnostic tool for examining the kidney, its US and color Doppler findings have seldom been reported. We reviewed the clinical manifestations and US results of five cases of RAVM to clarify the role and limitations of US in the diagnosis. RESULTS: The lesions were solitary in all cases, and the affected side was the right in four cases and the left in one case. In four cases, the patients complained of hematuria, but the remaining case had no symptoms. US did not detect the lesion, but in all cases color Doppler US showed a focal vascular lesion with posterior color spots. US reexamination with knowledge of the Doppler results did not show any focal lesion. CONCLUSION: US was not diagnostic for RAVM, and color Doppler US should be performed immediately in patients with hematuria.     

Mesenteric panniculitis: sonographic findings

BACKGROUND: Mesenteric panniculitis (MP) is a relatively rare disease, and sonographic (US) and color Doppler findings have been infrequently reported. METHODS: We reviewed the clinical data and US and Doppler results of three cases of MP to determine the role and limitations of these techniques. RESULTS: The sole presenting clinical sign was a soft mass. On US the lesion was imaged as a poorly margined echogenic mass with hypoechoic areas. Color Doppler US visualized the nondeviated mesenteric vessels within the mass, which enabled us to perform a safe guided biopsy. CONCLUSIONS: US is useful as an initial diagnostic tool, but its results must be interpreted carefully. Color Doppler US is very useful in demonstrating fine vessels and helps in performing a safe needle biopsy.     

经直肠彩色多普勒超声鉴别前列腺周缘区低回声性质的价值

目的 探讨经直肠彩色多普勒超声对前列腺周缘区低回声结节良恶性诊断的价值。方法 对77例前列腺周缘区低回声结节行经直肠彩色多普勒超声探测，利用彩色直方图软件计算结节内彩色血流面积与选定结节面积比值(black and white color ratio，BCR)和整个前列腺血流BCR并比较二者的BCR，如结节内BCR高于整个前列腺内5％则为血流增多。结果 77例前列腺周缘区低回声结节穿刺活检证实前列腺癌51例，前列腺增生症26例。周缘区低回声内血流增多共50例，其中前列腺癌41例。经直肠彩色多普勒超声检查结节内血流增加对诊断前列腺癌的敏感性、特异性、阳性预测值分别为80．4％，65．4％，82．0％。结论 经直肠彩色多普勒超声检查前列腺周缘区低回声结节内血流并用BCR解释其丰富程度对结节良恶性的鉴别诊断有一定帮助。     

Ultrasound findings of diffuse metastasis of gastric signet-ring-cell carcinoma to the thyroid gland

It has been shown that metastases to the thyroid from extrathyroidal malignancies occur as solitary or multiple nodules, or may involve the whole thyroid gland diffusely. However, diffuse metastasis of gastric cancer to the thyroid is extremely rare. Here, we report a case of a 74-year-old woman with diffuse infiltration of gastric adenocarcinoma (signet-ring-cell carcinoma/poorly differentiated adenocarcinoma) cells in the thyroid. The pathological diagnosis was made based on upper gastrointestinal endoscopy with biopsy and fine-needle aspiration cytology of the thyroid. An 18F-FDG PET/CT revealed multiple lesions with increased uptake, including the bilateral thyroid gland. On thyroid ultrasound examination, diffuse enlargement with internal heterogeneity and hypoechoic reticular lines was observed. On color Doppler imaging, a blood-flow signal was not detected in these hypoechoic lines. These findings were similar to those of diffuse metastases caused by other primary cancers, such as lung cancer, as reported earlier. Therefore, the presence of hypoechoic reticular lines without blood-flow signals is probably common to diffuse thyroid metastasis from any origin and an important diagnostic finding. This is the first report to show detailed ultrasound findings of diffuse gastric cancer metastasis to the thyroid gland using color Doppler.     

Pancreatic arteriovenous malformation presenting as cysts: Doppler sonographic diagnosis

A 50-year-old man presented with multiple lesions resembling cysts throughout the pancreas on gray-scale sonography. Pulsatile blood flow detected within the lesions on color Doppler sonography led to the diagnosis of pancreatic arteriovenous malformation (PAVM). Most previously reported PAVMs have been described as having a poorly defined, reticular, or mosaic-like hypoechoic appearance on gray-scale sonography; the cystic appearance of the PAVM seen in our case is unusual.     

乳腺髓样癌的超声诊断及其病理基础

目的 探讨乳腺髓样癌的声像图特征及病理基础。方法 应用彩色多普勒超声检查11例乳腺髓样癌患者（13个病灶）,观察其声像图表现及血供特点（包括大小、边界、大体形态、内部回声、后方回垢、血流灌注等）,并与病理对照。结果 乳腺髓样癌具有特征性声像图表现,包括边界清楚但无包膜、常有分叶、内部回声低而后方回声、血供丰富等,其上述特征相应的病理基础为：癌组织主要为大量的肿瘤细胞成分,间质成分少,肿瘤呈膨胀生长等。结论 超声检查可有助于对本病与乳腺良性肿瘤及其他类型乳腺癌的鉴别诊断。     

高频超声对乳腺黏液腺癌的诊断及病理学对照研究

目的 探讨乳腺黏液腺癌的声像图特征及其病理基础.方法 回顾性分析我院2000～2008年经手术和病理证实的46例乳腺黏液腺癌(50个病灶)声像图表现及血供特点(包括大小、边界、大体形态、内部回声、后方回声、血流灌注等),并与病理学对照.结果 乳腺黏液腺癌具有特征性声像图表现,包括边界清楚但无包膜、形态尚规则、内部回声低而后方回声增强、血供不丰富等,上述特征相应的病理基础为:包块生长缓慢,约半数呈膨胀性生长,境界清楚,甚至假包膜形成,肿瘤富含黏液,质地较软等.结论 超声检查有助于对本病与乳腺良性肿瘤及其他类型乳腺癌的鉴别诊断.     

Hurthle cell neoplasms of the thyroid: sonographic appearance and histologic characteristics

OBJECTIVE: The purpose of this study was to determine the sonographic features of Hürthle cell neoplasms (HCNs) of the thyroid. METHODS: We retrospectively analyzed the sonographic appearance of 15 histologically proven HCNs in 15 patients aged 16 to 70 years (mean age, 44 years). Sonographic features that were reviewed included the size and echogenicity of the tumors, the presence of cystic areas or calcifications, and detectable blood flow on color Doppler imaging. Correlation of sonographic findings with pathologic results was performed. RESULTS: The tumors ranged from 0.4 to 7 cm in diameter, but most were less than 3 cm in diameter. Four (27%) of the 15 tumors were homogeneously hypoechoic. Two tumors (13%) were predominantly hypoechoic with isoechoic areas to thyroid parenchyma. Two (13%) neoplasms were isoechoic to thyroid parenchyma. Four (27%) tumors were predominantly isoechoic, containing hypoechoic areas, and 3 (20%) tumors were hyperechoic. Three neoplasms contained cystic components. None of the tumors contained calcifications. One tumor was avascular on Doppler examination. One neoplasm showed only peripheral blood flow. Thirteen tumors showed internal vascularity, 7 of them with peripheral blood flow. Twelve HCNs were benign, and 3 were malignant on pathologic examination. CONCLUSIONS: Hürthle cell neoplasms show a spectrum of sonographic appearances from predominantly hypoechoic to hyperechoic lesions and from peripheral blood flow with no internal flow to extensively vascularized lesions. Pathologic criteria differentiating benign and malignant HCNs (absence or presence of a capsular breach, vascular or extrathyroidal tissue invasion, nodal involvement, and distant metastasis) are beyond the resolution of sonography and fine-needle aspiration biopsy and require removal of the entire lesion. This precludes diagnosis and characterization of HCNs by sonography.     

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.     

Hepatic focal nodular hyperplasia: findings on color Doppler ultrasound

Background: We assessed the color Doppler ultrasound (US) findings in focal nodular hyperplasia (FNH). Methods: Seven FNH lesions were imaged with color Doppler US and hepatic angiography. Results: In four lesions, color Doppler demonstrated a central stellate vascular appearance which correlated with central feeding artery with spoke-wheel sign angiographically. Except for one lesion, color Doppler US imaging correlated with angiographic findings. Conclusions: Color Doppler US is capable of demonstrating the typical findings of a central feeding artery and stellate vascular pattern in many cases of FNH. Received: 30 August 1995/Accepted after revision: 21 March 1996     

低回声型肝血管瘤的彩色多普勒超声检测

目的　探讨彩色多普勒超声在诊断低回声型血管瘤中的应用价值。方法　应用二维超声、彩色多普勒血流图 (CDFI)、彩色能量多普勒血流图 (PDI) ,结合脉冲多普勒频谱对 18例共 2 2个低回声型肝血管瘤进行研究。结果　 CDFI对低回声型肝血管瘤内血流显示率 2 7.2 7% ,PDI对低回声型肝血管瘤血流显示率 90 .91%。动脉血流检出率为 2 2 .73%。“病灶染色” 9个 (40 .91% )。低回声型肝血管瘤血流呈低速 ,阻力指数 (RI) <0 .6(6 0 % )。结论　彩色多普勒超声对低回声型肝血管瘤的诊断和鉴别诊断有重要价值。     

Chronic tuberculous epididymitis: color Doppler US findings with histopathologic correlation

BACKGROUND: The aim of this study was to determine the color Doppler features of tuberculous epididymitis and to correlate these findings with histopathologic findings. METHODS: Color Doppler ultrasound (US) findings of 12 histopathologically proven tuberculous epididymitis and tuberculous epididymo-orchitis in 11 consecutive patients were retrospectively analyzed. Color Doppler US findings of tuberculous epididymitis were correlated with histopathologic findings. RESULTS: Color Doppler US findings of tuberculous epididymitis demonstrated no blood flow in the epididymal lesions except for focal linear or spotty flow signals in the peripheral portion. These findings correlated well with pathologic findings; the central portion of the epididymal lesions demonstrated granulomas with caseation necrosis, and the peripheral portion of the epididymal lesions had several medium to small vessels. CONCLUSIONS: Color Doppler US may be helpful for differential diagnosis of tuberculous epididymitis and non-tuberculous epididymitis.