乳腺脂肪坏死的超声表现及病理对照分析

目的：探讨乳腺脂肪坏死的超声表现及病理基础。方法：回顾性分析经病理证实的33例（其中4例为双侧乳腺脂肪坏死，共37个病变）乳腺脂肪坏死超声表现，并与病理结果对照。结果：主要超声表现：等回声病灶5个（13．5％），低回声病灶16个（43．2％），无回声病灶10个（27．0％），囊实混合回声病灶6个（16．2％）。所有病灶均无血流信号，部分病灶可伴钙化，边界不清，低、无回声病灶后方回声可增强或衰减。病灶位于皮下组织层内7个，腺体内30个。病理表现：①脂肪细胞坏死液化，融合成大的脂肪空泡，周边可见上皮样细胞及泡沫细胞聚集，外围有薄层肉芽组织，伴有大量淋巴细胞和部分浆细胞浸润；②囊壁不同程度增厚，纤维化和玻璃样变，可出现钙盐沉积；⑧病灶已部分或全部被纤维组织取代，周围残留部分纤维组织形成小腔或瘢痕。通常不同病理形式的超声表现常同时出现。结论：超声检查对诊断乳腺脂肪坏死具有重要价值。     

乳腺导管内原位癌和内癌微小浸润的声像图表现及其病理基础

目的探讨乳腺导管内原位癌（ductal carcinoma in situ，DCIS）和乳腺导管内癌微小浸润（intraductal carcinoma with microinvasion，DCMI）的声像图改变。 方法使用Philips HDI 3000型超声诊断仪分析8例DCIS或DCMI的声像图，并与病理对照。 结果8例均为单发病灶，其中5例形态不规则，3例呈椭圆形；边界均不清晰；内部均呈低回声，其中1例伴有囊变；6例伴有点状强回声；病变后方回声均无改变；5例内部可见少量血流信号。大体标本均未见有包膜。6例病理诊断为DCMI，2例为DCIS，其中分别有5例和1例伴有粉刺状坏死。 结论DCIS及DCMI在声像图上具有一些特点。     

高频超声对乳腺脂肪坏死的诊断价值

目的总结乳腺不同位置脂肪坏死病灶的声像图表现,探讨高频超声对乳腺脂肪坏死的诊断价值。 方法回顾性分析2014年1月至2019年9月首都医科大学附属天坛医院收治的经手术病理证实的63例乳腺脂肪坏死患者的临床及影像学资料,63例患者共69个病灶,所有患者术前均行超声检查。根据病灶的所在部位（皮下脂肪层、皮下脂肪层与腺体层均累及、腺体层）,将其分为腺外型、交界型和腺内型。总结并比较不同类型组间的超声特征。 结果63例患者中22例有外伤或手术史,7例既往有乳腺炎性病变。患者多无临床症状或因偶然发现肿物就诊。根据超声声像图中病灶位置将69个病灶分为腺外型31个、交界型26个、腺内型10个,2个漏诊。腺外型与腺内型声像图特征差异均无统计学意义（P均>0.05）。交界型同腺外型和腺内型的声像图比较,部分表现差异有统计学意义,包括形状、边界、病灶血流情况、与周围组织分界、与周围皮肤关系及同侧腋窝淋巴是否肿大（P=0.045、0.001、0.025、0.001、0.001、0.019）;而有无包膜、回声类型、钙化类型、后方回声情况及患者病灶数目3组间比较差异均无统计学意义（P均>0.05）。超声漏诊2个病灶（2/69,2.9%）,误诊为可疑恶性病灶（BI-RADS 4b类）5个（5/67,7.5%）。 结论乳腺脂肪坏死的声像图及临床表现多样,应用高频超声观察不同位置病灶的声像图表现,详细了解相关病史,特别是外伤史、手术史等临床信息,有助于术前正确诊断乳腺脂肪坏死。     

乳腺脂肪坏死的超声诊断

目的：探讨乳腺脂肪坏死的声像图特点，以提高诊断率。方法：回顾性分析46例乳腺脂肪坏死的超声表现。结果：绝大多数肿块分布于皮下脂肪层内。依其病理变化的发展过程，脂肪坏死可表现为强回声型、低回声型和无回声型，而彩色多普勒则基本上表现为无血流型。结论：超声图像特征为乳腺脂肪坏死的诊断提供了重要信息。     

乳腺表皮样囊肿的超声表现

目的：探讨乳腺表皮样囊肿的高频超声图像特征。方法：对18例因乳腺肿块就诊,经术前超声及手术病理证实为表皮样囊肿患者的病例资料进行回顾性分析。在灰阶声像图上观察肿块位置、形状、大小、边界、内部回声及后方回声。应用彩色多普勒成像（CDFI）观察病灶内部及周围血流分布和供应情况。结果：灰阶声像图显示肿块多位于乳腺皮下或皮下脂肪层;16例呈圆形或椭圆形,2例形态不规则;肿块最大长径8～55mm;14例边界清晰,可见薄的包膜回声,4例边界部分不清;15例肿块内部回声不均匀,呈高低回声相间,可伴无回声（2例肿块内见微小钙化）,3例为相对均匀低回声;15例肿块后方回声增强,3例后方回声无明显改变。CDFI检查,16例肿块内部及周边均未探及血流信号,2例肿块边缘可探及血流信号。结论：乳腺表皮样囊肿声像图有一定的特征性,高频超声具有较高的诊断价值。     

高频彩色多普勒超声综合指标诊断乳腺肿块的价值分析

目的 探讨高频彩色多普勒超声综合指标诊断乳腺肿块的价值，旨在提高乳腺癌的诊断率。方法 对45例经手术病理证实的乳腺肿块的高频彩色多普勒超声特征进行回顾性分析。结果 其中良性肿块26例，恶性肿块19例，其中多发1例，共21个肿块。彩色多普勒声像图特点：（1）良性肿块：形态规则，边缘光滑，内部回声均匀，纵横比小于0．7（89％），后方回声无衰减，血流情况0～1级（96．2％）。（2）典型乳腺癌：外形不规则，边缘不光滑，内部回声不均匀，微小钙化，纵横比大于0．7（81％），后方回声衰减，正常或增强，血流情况2～3级（76．2％）。结论 高频彩色多普勒超声综合指标对乳腺肿块有较高的诊断价值，全面分析可提高乳腺癌诊断率，但仍有局限性。     

乳腺肿块的超声声像图多元回归分析

目的：探讨超声声像图多元参数列乳腺良恶性肿块判别的意义。方法：回顾性分析382例经病理确诊乳腺良恶性肿块的超声声像图多元参数进行多元逐步回归分析。结果：诊断乳腺肿块的价值：内部回声〉钙化〉淋巴结〉后方声影〉边缘〉纵横比〉形态。回归方程：乳腺肿块良恶性情况=-1．40＋0．53（内部回声）＋0．49（淋巴结）＋0．16（形态）＋0．39（后方声影）＋0．25（边缘）＋0．21（纵横比）＋0．52（钙化），决定系数R^2=0．56。结论：综合乳腺超声声像图各参数。对判别乳腺肿块的良恶性有重要意义。     

重症乳腺增生症彩色多普勒超声的分型探讨

目的探讨重症乳腺增生症的彩色多普勒超声声像图分型与病理组织类型的关系。方法抽取85例重症乳腺增生症患者行彩色多普勒超声检查资料，将其声像图与病理学组织类型进行对比分型。结果小叶增生型44例，占51．8％；囊性增生型18例，占21．2％；腺瘤样增生型11例，占12．9％；混合型12例，占14．1％。彩色多普勒血流显像（CDFI）示15例检测到异常血供，占17．6％，其中4例为小叶增生，6例为腺瘤样增生型，5例为混合型，无1例为囊性增生型，本组误诊8例，误诊率为9．5％，其中4例误诊为乳腺癌，1例误诊为乳腺结核，2例误诊为乳腺纤维腺瘤，1例误诊为脂肪瘤。结论重症乳腺增生症的彩色多普勒超声声像图与病理学组织类型对照具有特征性表现，有较大的临床应用价值，可提高诊断符合率。     

不同类型乳腺黏液腺癌彩色多普勒超声特征对比研究

目的探讨不同病理类型乳腺黏液腺癌的超声声像图特征以及误诊原因。方法分析68例乳腺黏液腺癌患者（单纯型乳腺黏液腺癌45例,混合型乳腺黏液腺癌23例）的临床及声像图资料,探讨不同类型乳腺黏液腺癌在肿瘤直径、形态、边界、边缘、内部回声、后方回声、钙化、肿瘤血管性、峰值血流速度（PSv）、良恶性、阻力指数（RI）等方面的差异。结果单纯型黏液腺癌病例肿瘤边界清楚（31．1％,14／45）与边界不清（51．1％,23／45）均占有较大的比例;而混合型黏液腺癌多表现为边界不清（73．9％,17／23）。单纯型黏液腺癌肿瘤较多表现为边缘局限（31．1％,14／45）和边缘模糊（44．4％,20／45）,混合型黏液腺癌则以边缘模糊（43．5％,10／23）和边缘毛刺（34．7％,8／23）多见。在肿瘤后方回声方面,单纯型黏液腺癌多表现为后方回声增强（88．9％,40／45）,而混合型黏液腺癌肿瘤后方回声增强（60．9％,14／23）、衰减（26．1％,6／23）以及无改变（13．0％,3／23）都占有较高的比例。在本病的误诊方面,17例（37．8％,17／45）单纯型黏液腺癌病例误诊为良性肿瘤,而混合型黏液腺癌中仅有3例（13．0％,3／23）误诊。不同类型乳腺黏液腺癌上述特征的差异均有统计学意义（P均〈0．05,Fisher确切概率法）。45例单纯型乳腺黏液腺癌病例中,40例（88．9％,40／45）病例病变内可检出不同程度的血流信号,其中25例（55．6％,25／45）可检出动脉血流频谱。23例混合型黏液癌病例中,21例（9113％,21／23）病例病变内可检出不同程度的血流信号,其中19例（82．6％,19／23）病例可检出动脉血流频谱。但不同类型乳腺黏液癌患者肿瘤内峰值血流速度及阻力指数差异无统计学意义（t=-0．656、1．165,P=0．514、0．251）。结论单纯型黏液腺癌较混合型黏液腺癌多表现为肿瘤边界清楚、边缘局限或模糊、后方回声增强等类似良性病变特征,需引起临床及影像科医师的重视,避免误诊。     

乳腺黏液腺癌超声误诊原因分析

目的:分析乳腺黏液腺癌的超声表现,探讨超声误诊原因。方法:回顾性分析手术病理证实的16例乳腺黏液腺癌的超声表现,归纳其声像图特征,总结导致误诊的原因。结果:乳腺黏液腺癌病灶均呈低回声,分布不均匀75.0%,表现为分叶状75.0%,边界清晰81.3%;肿块内部出现无回声区者占31.3%,后方回声增强者56.3%。病灶周边或中央显示线状或分枝状彩色血流者12例。超声诊断恶性肿瘤12例,准确率75.0%;超声诊断良性病变4例,误诊率25.0%。结论:乳腺肿块边界清楚,内部出现无回声区和后方回声增强是黏液腺癌的声像图特征,充分认识其超声表现可减少误诊。     

乳腺黏液癌的声像图特点及病理学基础

目的探讨乳腺黏液癌的超声特征及病理学基础.方法对44例乳腺黏液癌的超声与病理特点进行回顾性分析.结果单纯型:本组28例,超声呈低或等回声,形态规则,边界清,内部回声均质,后方回声增强.病理黏液量多,部分边缘呈膨胀性生长.本组误诊率64%(18/28).混合型:本组16例,超声呈低或等回声,形态不规则,边界不清,内部回声不均质,后方回声不增强.病理黏液量少,边缘均呈浸润表现.误诊率19%(3/16).结论单纯型黏液癌类似良性疾病,了解其声像图特点对提高诊断率有一定帮助.     

Metastatic tumors in the breast: sonographic findings

The sonographic findings observed in eight patients with metastatic tumors in the breast were reviewed. Solitary breast nodules were present in four patients; multiple metastases were seen in the other four patients, with bilateral lesions in two of them. A total number of 20 breast masses was appreciated. All lesions had a round or oval shape and hypoechoic, solid echopattern, when compared with the surrounding breast parenchyma. In three patients, they presented with many small medium-level internal echoes while, in the other five patients they were almost anechoic, with only a few low-level echoes within. Regular and well-defined margins were seen in four patients; in the remaining four patients, irregular walls were seen. The posterior walls of the lesions were well defined, and great acoustic attenuation was never seen. In one case, slight acoustic enhancement was present posterior to the lesions from non-Hodgkin's lymphoma. Multiple masses in the same patient always had the same sonographic features. While evaluating a breast mass in a patient with a known malignancy elsewhere in the body, the absence of an acoustic shadow posterior to the lesion may allow the metastatic nature of the disease to be considered as a diagnostic possibility.     

乳腺黏液癌30例的超声图像分析

目的 评价超声对乳腺黏液癌的诊断价值.方法 对手术病理证实的30例乳腺黏液癌的超声图像进行分析,分析内容包括边缘形态、内部回声、血流显像等.结果 乳腺黏液癌超声声像图表现为:边缘清(93%,28/30),形态较规则(67%,20/30),低回声不均质团块(90%,27/30),纵横比≤0.77(83%,25/30),内部血流稀少(0级22例,1级8例),后方回声轻度增强21例;超声诊断与病理诊断相符16例(53%);病理为乳腺黏液癌,而超声诊断为其它良性病变5例(17%);超声诊断为未定性实质团块,而病理为乳腺黏液癌9例(30%).结论 乳腺黏液癌恶性特征不明显,超声容易漏诊误诊,尤其是单纯型.     

卵巢子宫内膜异位囊肿的超声表现及误诊分析

目的探讨卵巢子宫内膜异位囊肿二维及彩色多普勒超声特征性表现,分析超声误诊原因。方法对手术病理证实为卵巢子宫内膜异位囊肿93例患者的术前超声表现进行回顾性分析并行超声分型。结果 93例107个囊肿超声分型表现:Ⅰ型囊肿(正常卵巢型)表现为稍增大卵巢内可见小无回声区,术前超声均未检出(0/3),仅提示卵巢稍增大或含液性改变;Ⅱ型囊肿(单纯囊肿型)表现为无回声区,边界清晰,伴后方回声增强;术前超声仅检出1个囊肿,误诊10个囊肿(10/11);Ⅲ型囊肿(囊内点状高回声型)表现为无回声区,内部见均匀点状高回声,似云雾状;术前超声检出26个囊肿,仅误诊2个囊肿(2/28);Ⅳ型囊肿(多囊型)表现为无回声区,内部见带状间隔或伴密集点状高回声;术前超声检出16个囊肿,误诊13个囊肿(13/29);Ⅴ型囊肿(混合型)表现为无回声区内见稍高回声或伴密集点状高回声及带状间隔,或表现分层征;术前超声检出22个囊肿,误诊11个囊肿(11/33);Ⅵ型囊肿(实质型)表现为低回声,内部可见稍高回声;术前超声均未检出囊肿(0/3)。107个囊肿术前超声以Ⅲ型囊肿检出个数居多(26/28),误诊个数少(2/28);6型中共误诊42个囊肿(39.3%),分别为Ⅰ型(3/3)、Ⅱ型(10/11)、Ⅳ型(13/39)、Ⅴ型(11/33)和Ⅵ型(3/3)。其中误诊为卵巢单纯囊肿15个、卵巢囊腺瘤7个、卵巢畸胎瘤2个、卵巢肿瘤6个、子宫浆膜下肌瘤2个、炎性包块2个、囊肿性质待定5个,卵巢稍大或含液性改变3个。结论Ⅲ型卵巢子宫内膜异位囊肿声像图表现为无回声区,边界清晰,壁毛糙或稍增厚,内部可见点状高回声,结合临床表现超声易于作出正确诊断;Ⅰ、Ⅱ、Ⅳ、Ⅴ及Ⅵ型卵巢子宫内膜异位囊肿均易误诊,需与卵巢单纯囊肿、畸胎瘤、囊腺瘤、子宫浆膜下肌瘤及盆腔炎性肿块声像图相鉴别。     

乳腺黏液癌的影像学特征分析

目的 评价乳腺黏液癌的超声、X线等影像学特征及其与病理组织类型的相关性.方法 回顾性分析21例经手术病理证实的乳腺黏液癌患者(22个病灶)的超声、X线特征及与病理组织类型之间的关系.结果 病理组织学分类包括14个单纯型(6个富细胞型,8个少细胞型)和8个混合型病灶.超声:所有病例均存在实性肿块,85.71％(12/14)的单纯型肿块境界清晰,回声等或略低于皮下脂肪,92.86％(13/14)的单纯型病灶后方回声增强;75.00％(6/8)的混合型和14.29％(2/14)的单纯型肿块边界较模糊并细小毛刺,内部回声较脂肪回声低.超声和X线片术前怀疑恶性的比例均为63.64％(14/22).恶性X线表现包括肿块(10个)、局限性不对称致密影(2个)、结构扭曲并恶性钙化和单纯不定性钙化(各1个).肿块主要为高密度,单纯型边界清楚或呈浅分叶状,混合型边界不规则和毛刺改变.81.82％(18/22)的病灶被超声或X线之一疑诊恶性,45.45％(10/22)的病灶术前超声和X线均疑为恶性.结论 乳腺黏液癌尤其单纯型影像学特征不典型,超声和X线诊断均可能诊断为良性病变;肿块边缘特征是鉴别良恶性的重要依据,混合型肿块较单纯型更具有浸润性特征;超声和X线联合诊断有利于避免误诊,两者之一怀疑恶性时,即应行穿刺活检以明确诊断.     

Sonography of wrist ganglion cysts: variable and noncystic appearances.

OBJECTIVE: In our clinical practice, we have noted wrist ganglion cysts that do not fulfill the criteria for simple cysts. This study retrospectively evaluated the sonographic features of wrist ganglia. METHODS: After Institutional Review Board approval, medical records from 1993 through 2003 were searched using International Classification of Diseases, Ninth Revision codes and key words, and sonography log books from 2000 through 2004 were reviewed, which identified 20 wrist ganglion cysts in 16 patients that were proven at surgery or aspiration. A retrospective review of sonographic images was carried out by 2 musculoskeletal radiologists by consensus. Images were evaluated for cyst location, volume, largest dimension, joint or tendon extension, echogenicity, septations, internal echogenicity, posterior acoustic enhancement, margins, lobularity, and vascularity. RESULTS: Of the 20 wrist ganglia, 15 were volar (10 between the flexor carpi radialis and the radial artery), and 5 were dorsal (2 over the scapholunate ligament). The mean volume was 2081 mm3 (range, 90-15,000 mm3), and the mean largest dimension was 17.3 mm (range, 7-30 mm). Seven volar ganglia showed joint communication. Ten ganglia were anechoic; 7 were hypoechoic; and 3 had anechoic and hypoechoic areas. Eight had septations; 8 had internal echogenic areas; 15 had posterior acoustic enhancement; 13 had well-defined margins; 12 were lobular; and none were vascular. Cysts that were anechoic (P < .0001) or with posterior acoustic enhancement (P = .04) were significantly larger than those that were hypoechoic or without posterior acoustic enhancement. CONCLUSIONS: Small wrist ganglion cysts (< or = 10 mm in the mean largest dimension) often appear hypoechoic without posterior acoustic enhancement and do not fulfill the criteria for a simple cyst.     

Analysis of posterior echoes using reconstructed vertical ultrasound images

Purpose To evaluate the role of vertical images reconstructed using 3-D data in the analysis of posterior echoes. Methods Reconstructed vertical images of US phantoms with the following artifacts were retrieved and analyzed: acoustic shadowing (clean and dirty); posterior echo enhancement (with/without lateral shadowing); and reverberation artifacts (clean and dirty). Results For acoustic shadowing, a stone and posterior clean acoustic shadowing were imaged as an echogenic mass or an echogenic ring containing a central echo-free area. However, the stone and dirty acoustic shadowing were imaged as an echogenic mass or an echogenic mass consisting of many fine echo spots disseminated throughout the whole mass. For posterior echo enhancement, when lateral shadowing is present, the cyst and posterior echo enhancement are imaged as a round anechoic mass or a triple circle consisting of a thin anechoic outer rim, an echogenic ring, and an anechoic center. However, when lateral shadowing is absent, they are imaged as a round anechoic mass or a double circle consisting of an echogenic outer rim and an anechoic center. For clean reverberation artifacts and dirty reverberation artifacts, vertical images of clean reverberation artifacts consist of either a homogeneous echogenic area or an absent signal. However, vertical images of dirty reverberation artifacts consist of a homogeneous echogenic area and an area consisting of fine echo spots. Conclusion Our study suggests that reconstructed, previously unattainable, vertical plane images help us better understand the mode of posterior echoes.