Clinical evaluation of pulsatile flow detection for qualitative diagnosis of hepatic tumors complicated with liver cirrhosis

An apparatus for pulsatile flow detection (PFD), by which all characteristic pulsatile flow alone is selectively visualized in the same color in color Doppler ultrasonography, has recently been developed. Detection of pulsatile flow is derived from changes in the velocity, variance, and power values of blood flow. We evaluated both the accuracy of selective visualization of pulsatile flow in a single color and the clinical usefulness of this method in patients with hepatic tumors associated with liver cirrhosis. The subjects were 13 patients with hepatocellular carcinoma and 3 patients with adenomatous hyperplasia who underwent both conventional color Doppler ultrasonography and PFD. In the intratumoral blood flow in patients with hepatocellular carcinoma, pulsatile flow, indicated in green and confirmed by color Doppler ultrasonography as flowing into the tumor, and continuous blood flow, indicated in red or blue, were visualized by PFD. This method will contribute to qualitative diagnosis and treatment of tumors complicated with liver cirrhosis and the choice of treatment for those tumors.     

Volumetric tumor measurement using three-dimensional ultrasound: in vitro phantom study on measurement accuracy under various scanning conditions

Factors influencing volumetric tumor measurement using 3-D ultrasound (US) were investigated. A 3-D US unit equipped with 4- to 8-MHz curved-array and 5- to 10-MHz linear-array mechanical volume transducers, and a US phantom made of 20 ham pieces (8.6 approximately 10.5 mL) embedded in agar gel that simulated hyperechoic tumors, were used. Volumetric tumor measurement was significantly affected by the position of US focus and tumor depth. When focus was at 2 cm and 8 cm below the transducer, 5-cm-deep tumors were measured 5.6% +/- 2.8% (mean +/- SD) and 8.3% +/- 2.2% bigger, respectively, than when focus was at 5 cm below the transducer, the same position as tumors (p < 0.01). Tumors were measured 11.8% +/- 2.9% bigger when they were 8-cm deep below the transducer than when they were 5-cm deep below the transducer (p < 0.001). Setting focus at the same position as tumors and keeping tumor depth consistent during serial 3-D US examinations may be necessary for reliable volumetric assessment of tumors.     

原发性肝脏肿瘤的CT灌注研究

目的采用多层螺旋CT及肝脏灌注软件进行肝脏原发肿瘤的灌注研究,对比和评价肝癌与肝脏良性高血供肿瘤(HBHT)以及肿瘤与周围肝实质间的CT灌注差别。方法对30例肝癌患者和22例HBHT患者行肝脏多层螺旋CT灌注扫描,并分别测量两组肝脏肿瘤及周围肝实质的CT灌注值,包括血流量(BF)、血容量(BV)、平均通过时间(MTT)、表面通透性(PS)、肝动脉分数(HAF)及到达时间,并获得相应的灌注图。结果肝癌病灶的BF、BV及HAF平均值高于周围肝实质(P均为0.000)。HBHT病灶BF和HAF的平均值也高于周围肝实质(P=0.004及0.000)。肝癌及HBHT病灶MTT的平均值均短于相应周围肝实质(P=0.015及0.027),同时肝癌病灶的MTT也短于HBHT病灶(P=0.039)。肝癌病灶及周围肝实质的HAF均高于HBHT病灶及周围肝实质(P=0.036及0.044)。结论肝脏良恶性肿瘤间以及肝脏肿瘤与周围肝组织间存在灌注上差别,可为肿瘤诊断及鉴别诊断提供帮助。     

儿童肝脏肿瘤的CT诊断价值

目的探讨儿童肝脏肿瘤的CT诊断价值。方法回顾性分析30例经病理证实的儿童肝脏肿瘤的CT表现。其中男18例,女12例,年龄12天~10岁。12例经手术,18例经穿刺活检病理证实。结果30例儿童肝脏肿瘤中,肝母细胞瘤18例,肝脏未分化肉瘤1例,肝脏血管内皮瘤7例,肝间叶错构瘤2例,肝局灶型结节性增生2例。结论CT是目前鉴别儿童肝脏肿瘤的较好的检查方法,对病灶范围及明确病灶性质有较高诊断价值。     

胆囊旁肝肿瘤射频消融治疗附加方法及疗效

目的根据超声引导射频消融(RFA)治疗胆囊旁肝肿瘤的过程及特点，探讨总结治疗方法及疗效，并分析治疗中和治疗后并发症的对应措施。方法行超声引导射频治疗的338例肝肿瘤患者763个病灶中，43例计48个病灶经超声或CT确认与胆囊关系密切；其中原发性肝细胞癌32例，肝转移癌11例。48个病灶中17个与胆囊壁分界不清，9个对胆囊壁有压迹，二者共占54．2％(26个灶)；余22个灶(45．8％)邻近胆囊距离≤0．5cm。肿瘤大小平均2．7cm(1．0～7．4cm)。患者随访时间平均19．9个月。结果射频布针次数为1～11次，平均3次。治疗后24h或1个月CT检查肿瘤完全灭活41个病灶(85．4％)；利用Kaplan Meier统计学方法显示治疗后半年无复发率为83．7％，1年无复发率78．8％。治疗中出现的生命体征改变及并发症状如下：38例(82．6％)出现心前区疼痛、右肩部疼痛或右上腹痛；16例(37．2％)治疗中发生不同程度心率减慢，最低达27次／min，均采用立即注射阿托品并吸氧后改善；18例(39．1％)治疗中及治疗后发生胆囊壁增厚；2例(4．4％)治疗后并发亚急性胆囊炎，经保守治疗后症状缓解；无一例需外科于预治疗的严重并发症。结论对胆囊旁肝肿瘤射频消融治疗重视操作技巧及应用附加方法，多数可获得较高的灭活效果，并且较少发生严重并发症，为安全可行的治疗方法。     

声触诊组织成像量化技术无创评价慢性肝病肝纤维化程度的初步临床研究

目的 探讨声触诊组织成像量化(VTQ)技术无创评价慢性肝病患者肝纤维化程度的临床价值.方法 应用VTQ技术对115例拟行超声引导下肝穿刺活检慢性肝病患者和80例健康成人行肝检查,并对检查结果进行对比分析.结果 慢性肝病组和健康组之间VTQ值差异有显著统计学意义(P=0.0000);慢性肝病患者不同病理分期间的VTQ值除S0与S1外,其他病理分期间差异均有统汁学意义(P=0.0212或P=0.0000);将S0-S2合并为轻度肝纤维化,S3-S4合并为中一重度肝纤维化,用ROC曲线分析阈值,当VTQ值≥1.4 m/s时,诊断中-重度肝纤维化的敏感度和特异度分别为85.4%和64.7%.结论 VTQ检查作为无创、量化的检查手段,可用来评价慢性肝病患者的肝纤维化程度.     

乙氨醚代谢试验对肝癌患者肝脏贮备功能评价研究

目的探讨乙氨醚代谢试验在原发性肝癌患者肝脏贮备功能评价中的应用。方法38例原发性肝癌患者,其中非肝硬化15例,肝硬化23例,术前行常规肝功能检测与乙氨醚代谢试验,术后行病理学检查。监测并发症和预后。比较非肝硬化组与肝硬化组、有并发症组与无并发症组、预后良组与预后差组、ChildA组与非ChildA组乙氨醚及其代谢产物对乙酰氨基酚血浓度。结果在肝硬化与非肝硬化患者、有并发症与无并发症患者、预后差与预后良患者、ChildA级与非ChildA级患者,对乙酰氨基酚与乙氨醚的血浓度及其比值有统计学差异（P〈0．01）,预后差与预后良患者组间凝血酶原时间有统计学差异,其他常规肝功能指标均无统计学差异（P〉0．05）。结论乙氨醚代谢试验评价肝脏功能比现有分级方法更为灵敏、可靠。     

Prior iterative reconstruction (PIR) to lower radiation dose and preserve radiologist performance for multiphase liver CT: a multi-reader pilot study

Abdominal Radiology - Prior iterative reconstruction (PIR) spatially registers CT image data from multiple phases of enhancement to reduce image noise. We evaluated PIR in contrast-enhanced...     

Amputation, phantom pain and subjective well-being: a qualitative study

The purpose of this qualitative study was to explore the impact of an amputation and of phantom pain on the subjective well-being of amputees. Sixteen lower-limb amputees were interviewed. A semi-structured interview and two Visual Analogue Scales were used. To interpret the results, a new socio-medical model joining two models, 'The Disablement Process model' and the 'Social Production Function theory', was used. Questions were asked concerning the factors influencing patients' subjective well-being prior to, at the time of and after an amputation. These factors were patients' medical history, their phantom sensations and phantom pain, their daily activities, the social support they received, and the influence of an amputation and phantom pain on long-term behaviour and on their subjective well-being. All factors were found to have an influence on the individual's subjective well-being. All these factors, however, seemed to reinforce each other. Therefore, the greatest influence of factors on subjective well-being occurred when more than one factor was involved. Substituting certain activities by others then becomes less and less effective in inducing a sense of subjective well-being.     

Embolization of the hepatic artery in diffuse malignant tumors of the liver]

The paper presented the results of therapeutic embolization of the hepatic artery (EHA) in 20 patients with malignant tumors that involved more than 70% of the liver. Simultaneous occlusion of all the arteries running to the tumor caused a severe hepatic failure and the death of 2 out of 4 patients. The blood flow reduction in 4 patients appeared to be safe but effective partially. Successive lobular EHA resulted in the improvement of the condition in 3 patients and failed in 2 cases. Two-staged EHA (first reduction and then occlusion) turned to be safe and in 6 out of 7 patients had led to significant improvement. Advantages and faults of the embolization technique considered are discussed.     

超声造影评价肝肿瘤血管生成研究进展

肝脏恶性肿瘤的生长、转移及预后与肿瘤新生血管密切相关,通过各种影像学手段评价肿瘤血管生成和抑制血管生成疗效已成为临床的迫切需求。CEUS在评价肝肿瘤血管生成和抗血管生成疗效等方面具有重要价值;三维CEUS成像技术及特异性靶向分子CEUS技术在临床应用及科研中前景广阔。     

超声造影评价肝肿瘤血管生成的研究进展

肝脏恶性肿瘤的生长、转移及预后与肿瘤新生血管密切相关,通过各种检查手段评价肿瘤血管生成和抑制血管生成疗效已成为临床的迫切需求.CEUS在评价肝肿瘤血管生成和抗血管生成疗效等方面具有重要价值;三维超声造影成像技术及特异性靶向分子超声造影技术在临床应用及科研中前景广阔。     

Short-term evaluation of liver tumors after transarterial chemoembolization: limitations and feasibility of contrast-enhanced ultrasonography

Purpose  

To evaluate the limitations and the feasibility of contrast-enhanced ultrasonography (CEUS) for the assessment of tumor response shortly after transarterial chemoembolization (TACE).     

定量声辐射脉冲弹性成像技术评价肝肿瘤特性的初步研究

Objective To evaluate the potential value of acoustic radiation force impulse (ARFI)elastography in the characterization of solid liver tumors.Methods Forty-three patients with 56 liver tumors were evaluated with ARFI,which included 21 patients with hepatocellular carcinoma (HCC),8 patients with metastase,5 patients with cholangiocarcinoma(CCC),and 9 patients with hemangioma.The shear wave velocity of the tumor and background liver parenchyma were calculated,and results were compared with 30 healthy subjects.Statistical analysis was performed on the shear wave velocity for differentiation of normal liver,background liver parenchyma,and tumors.Results HCC and CCC had greater stiffness than metastase (P ＜0.05),there were no statistical differences between HCC and CCC (P = 0.179).Malignant liver tumors had significantly greater stiffness than hemangioma and normal liver (P = 0.000).34.5% (9/26) HCC and 33.3% (4/12) hemangioma appeared softer than the background liver.With a cut-off value of 1.5 m/s for the shear wave velocity,the sensitivity,specificity,positive predictive value and negative predictive value for malignancies were 79.5%,83.3%,94.5% and 52.6%,respectively.Conclusions ARFI elastography quantification is a promising noninvasive technique for assessing solid liver tumors.Use of ARFI elastography quantification may lead to new quantitative tissue characterization parameters for differentiating hemangioma and malignant liver tumors.     

定量声辐射脉冲弹性成像技术评价肝肿瘤特性的初步研究

目的 探讨声辐射脉冲(acoustic radiation foroe impulse,ARFI)弹性成像技术定量评价肝肿瘤特性的价值.方法 肝肿瘤患者43例56个病灶行AR FI定量检测,其中肝细胞性肝癌21例,肝转移癌8例,胆管细胞癌5例,血管瘤9例.测量肿瘤及其周围背景肝组织剪切波速度,并对30例健康志愿者肝剪切波速度进行测量对比.统计分析不同病理类型肿瘤弹性成像特征及剪切波速度差异,并与背景肝组织、正常肝组织进行比较.结果 肝细胞性肝癌和胆管细胞癌硬度大于肝转移癌(P＜0.05),肝细胞癌和胆管细胞癌硬度无明显差异(P=0.179).恶性肿瘤的硬度明显大于血管瘤和正常肝组织(P=0.000),34.5%(9/26)的肝细胞肝癌硬度小于背景肝组织,33.3%(4/12)的血管瘤硬度小于背景肝组织.以1.5m/s为剪切波速度截断值,提示肝恶性肿瘤的敏感性、特异性、阳性预测值、阴性预测值分别为79.5%、83.3%、94.5%、52.6%.结论 定量ARFI弹性成像技术有望成为一种新的定量鉴别肝血管瘤与恶性肿瘤组织参数特征的无创性检查方法.

Abstract：

Objective To evaluate the potential value of acoustic radiation force impulse (ARFI)elastography in the characterization of solid liver tumors.Methods Forty-three patients with 56 liver tumors were evaluated with ARFI,which included 21 patients with hepatocellular carcinoma (HCC),8 patients with metastase,5 patients with cholangiocarcinoma(CCC),and 9 patients with hemangioma.The shear wave velocity of the tumor and background liver parenchyma were calculated,and results were compared with 30 healthy subjects.Statistical analysis was performed on the shear wave velocity for differentiation of normal liver,background liver parenchyma,and tumors.Results HCC and CCC had greater stiffness than metastase (P ＜0.05),there were no statistical differences between HCC and CCC (P = 0.179).Malignant liver tumors had significantly greater stiffness than hemangioma and normal liver (P = 0.000).34.5% (9/26) HCC and 33.3% (4/12) hemangioma appeared softer than the background liver.With a cut-off value of 1.5 m/s for the shear wave velocity,the sensitivity,specificity,positive predictive value and negative predictive value for malignancies were 79.5%,83.3%,94.5% and 52.6%,respectively.Conclusions ARFI elastography quantification is a promising noninvasive technique for assessing solid liver tumors.Use of ARFI elastography quantification may lead to new quantitative tissue characterization parameters for differentiating hemangioma and malignant liver tumors.     

囊型肝包虫病的CT诊断及对穿刺治疗效果的评价

目的分析43例囊型肝包虫病的CT表现,评价穿刺治疗效果.方法全部病例经病理证实;全部行CT扫描;穿刺治疗后CT随访43例.结果囊性肝包虫在CT上的征象为轮廓光滑锐利,密度均匀低密度区,分为单囊型和子囊型.5例增强CT,2例病变呈轻度强化,3例病变无强化.CT随访43例中20例痊愈,10例好转,6例稳定.结论 CT检查不仅可作出囊性肝包虫病明确诊断,而且可作出穿刺和药物治疗的疗效观察.     

供肝移植前超声快速评价供肝脂肪变性的初步研究

目的初步探讨供肝移植前超声快速评价供肝脂肪变性的价值。方法用传统二维超声诊断法及中场灰度值测量法对25例供肝移植前快速评定有无脂肪变性,并与脂肪含量测定及病理分型做对比分析。结果以脂肪含量测定为金标准,传统二维超声诊断法及以供肝中场灰度值≥40诊断脂肪肝的敏感性、特异性及准确性分别为55.6%、100%、84%及88.9%、81.2%、85%。结论供肝移植前,用超声快速评价供肝脂肪变性具有较高的特异性,以中场灰度值补充诊断,可在一定程度上提高敏感性。