床旁彩色多普勒超声在经皮肾镜碎石取石术后肾假性动脉瘤出血中的诊断价值

目的探讨床旁彩色多普勒超声对经皮肾镜碎石取石术（PCNL）术后并发肾假性动脉瘤出血的临床应用价值。方法对2017年11月~2019年11月在南方医院采用介入栓塞治疗的9例PCNL术后并发肾出血患者的行床旁彩色多普勒超声检查、临床资料、数字减影血管造影检查及治疗效果进行回顾性分析。结果9例行肾动脉栓塞术治愈的患者（造影结果详细列出：单纯动脉损伤5例,假性动脉瘤4例,动静脉瘘0例）,动脉栓塞前均行床边彩超检查,其中床旁彩超诊断出4例肾假性动脉瘤,最终经肾动脉造影确诊。结论床旁彩色多普勒超声,对PCNL术后继发肾假性动脉瘤的诊断有较大的优越性和临床价值。     

Emergency Point-of-Care Ultrasound Diagnosis of a Femoral Artery Pseudoaneurysm

BackgroundIatrogenic femoral artery pseudoaneurysm formation after intervention of the femoral artery may present weeks after intervention. We report a case of a patient with delayed pseudoaneurysm diagnosis that was ultimately diagnosed with bedside ultrasound. Importantly, our case demonstrates a patient who had a left-sided atherectomy and angioplasty with microcatheter access of the right femoral artery.Case ReportA 68-year-old man with multiple comorbidities presented to the Emergency Department (ED) with right inguinal pain, swelling, and overlying skin changes 17 days after an interventional radiology-guided left-sided femoral artery atherectomy and angioplasty. His first postoperative ED visit at an outside hospital led to the diagnosis of a hematoma vs. abscess, with attempted bedside drainage. On presentation to our ED, a bedside ultrasound confirmed arterial pseudoaneurysm formation of the right femoral artery.Why Should an Emergency Physician Be Aware of This?In patients presenting with the constellation of symptoms after arterial site intervention of either side, iatrogenic pseudoaneurysm should be in the differential. Although the patient had atherectomy and angioplasty of the left femoral artery, it is important to highlight that both femoral arteries were accessed during intervention, and thus, both sites are at risk for pseudoaneurysm formation. Emergency sonography can be a useful tool to diagnose, expedite treatment, and avoid potentially harmful invasive procedures in patients presenting with pain and swelling after arterial site intervention.     

肝癌16层螺旋CT肝动脉三期强化特点分析

目的：探讨肝癌在动脉三期的强化特点及临床应用价值。方法：肝癌27例，分别行动脉三期扫描，动脉早期、中期和晚期的扫描时间是在注射造影剂后的18s、24s、30s。结果：动脉早期无强化13例，强化14例，其中血管样强化9例，肿瘤实质样强化5例。动脉中期无强化3例，强化24例，其中血管样强化16例，肿瘤实质样强化8例。动脉晚期均有不同程度强化，其中血管样强化4例，肿瘤实质样强化23例。结论：动脉三期均能很好反应肝癌的强化特点，动脉中期肿瘤血管显影较佳，动脉晚期肿瘤整体强化较佳。     

Pelvic arterial pseudoaneurysm-a rare complication of Cesarean section: diagnosis and novel treatment.

An uncommon cause of delayed postpartum hemorrhage is a pseudoaneurysm of the uterine artery. Pelvic arterial pseudoaneurysm is generally treated by laparotomy and hemostatic sutures or by uterine artery embolization. We describe two cases of late postpartum hemorrhage following Cesarean section, attributed to pelvic arterial pseudoaneurysm, that were successfully treated by direct thrombin injection under ultrasound guidance. Percutaneous or transvaginal ultrasound-guided direct thrombin injection is a simple procedure that does not require any sophisticated surgical or radiological equipment.     

彩色多普勒超声在诊治股动脉假性动脉瘤中的应用价值

目的评价彩色多普勒超声对股动脉假性动脉瘤的诊断价值及彩超引导下对其压迫修复的疗效。方法对28例股动脉插管术后穿刺部位出现搏动性肿块和（或）血管杂音的患者行彩色多普勒超声检查，并在彩超引导下对股动脉假性动脉瘤进行压迫治疗，治疗后经彩超跟踪复查评价其疗效。结果28例股动脉假性动脉瘤患者全部检出，与临床和MRI、血管造影或手术结果符合率100％（28／28）。彩超引导下25例股动脉假性动脉瘤经压迫治愈，3例压迫后未能完全修复而行手术治疗。结论彩色多普勒超声对股动脉假性动脉瘤有较高的诊断价值，且在引导压迫修复股动脉假性动脉瘤方面简便、安全、可靠，可作为首选的治疗方法，对不适宜压迫修复的患者行手术等治疗。     

Diagnosis of a Facial Artery Pseudoaneurysm Using Emergency Bedside Ultrasound

Background: Pseudoaneurysms of the extracranial arterial system are rare. We report a case of a facial artery pseudoaneurysm initially mistaken for an abscess. With bedside ultrasound performed in the Emergency Department (ED) by the treating physician, the mass was identified as a pseudoaneurysm. Objectives: In this report we review the anatomy of the extracranial arterial system of the head and neck, discuss the pathogenesis and clinical presentation of pseudoaneuryms, and present diagnostic imaging and treatment options for pseudoaneurysms of the face. Case Report: A 51-year-old man presented with facial swelling and pain at the site of a laceration that he had sustained 1 month previously. Before incision and drainage, bedside ultrasound was performed in the ED by the treating physician to confirm the presumptive diagnosis of abscess with possible foreign body. The ultrasound revealed the mass to be a pseudoaneurysm. Conclusions: Although pseudoaneurysms of the head and neck are rare, a history of trauma should prompt the consideration of a vascular injury with the need for imaging before drainage procedures of a presumed abscess. To our knowledge, the use of clinician-performed bedside ultrasound to detect facial artery pseudoaneurysms has never been reported.     

Multiple episodes of postpancreatectomy hemorrhage resolved by endoscopy and ultrasound-guided percutaneous thrombin injection into a common hepatic artery aneurysm: a case report

Postpancreatectomy hemorrhage (PPH) is one of the most common complications after pancreatoduodenectomy (PD). It mainly includes gastrointestinal hemorrhage and abdominal hemorrhage. With the development of digestive endoscopy and ultrasonic/radiological interventional technology, hemostasis can be effectively performed by minimally invasive methods in many patients with PPH. This report describes the successful treatment of multiple episodes of postoperative hemorrhage after PD. The patient developed anastomotic hemorrhage after PD and was successfully treated by endoscopic hemostasis. However, he also developed intra-abdominal hemorrhage after PD caused by a pseudoaneurysm that had formed next to the common hepatic artery. We effectively performed hemostasis by injecting lyophilized thrombin powder into the pseudoaneurysm with ultrasound guidance, which is a rarely used method. This case indicates that digestive endoscopy provides great advantages in the treatment of gastrointestinal hemorrhage after PD. For patients who develop PPH with a pseudoaneurysm, interventional ultrasonography is an option if transcatheter arterial embolization or covered stenting fails.     

Duplex pulsed Doppler sonography of hepatocellular carcinoma treated with transcatheter arterial embolization.

Thirty-one patients with hepatocellular carcinoma underwent duplex scanning of their lesions with comparative angiography and serum alpha-fetoprotein determinations before and after transcatheter arterial embolization. Duplex ultrasound correctly identified 26 patients with patent tumor vessels after embolization. The Doppler signals became undetectable after embolization in the other five patients. Comparative angiography demonstrated good devascularization of their lesions. However, tiny tumor blush or small satellite nodules around the periphery of the devascularized masses were found. Therefore, the presence of signals after therapy indubitably needs further embolization. The timing of the second embolization for the patient with undetectable Doppler signals after the first embolization needs to be justified by further evaluations.     

Assessment of image quality of contrast-enhanced power doppler imaging in hepatocellular carcinoma with the personal ultrasound imager: Comparison with the conventional machine

Objective To evaluate the usefulness of contrast-enhanced power Doppler imaging with the personal ultrasound imager in depicting intratumoral vascularity in hepatocellular carcinoma. Materials and Methods Contrast-enhanced power Doppler imaging was used to examine 52 hepatocellular carcinoma nodules in 29 patients, using both the personal ultrasound imager and the conventional ultrasound machine in combination with intravenous injection of Levovist^?. Results obtained using dynamic CT were used as the gold standard. The ability of the personal ultrasound imager to detect intratumoral vascularity was compared with that of the conventional ultrasound machine, and the usefulness of the personal ultrasound imager in assessing therapeutic effect after nonsurgical treatment was compared with that of dynamic CT at the same time. Results The personal ultrasound imager and the conventional ultrasound machine, using the fundamental power Doppler imaging mode (p=0.13) and contrast-enhanced power Doppler imaging mode (p=0.41), did not differ significantly in depicting the vascularity of the 52 hepatocellular carcinomas. The sensitivity, specificity, and accuracy of contrast-enhanced power Doppler imaging on the personal ultrasound imager were 95.5%, 87.5%, and 94.2%, respectively, in close agreement with results obtained using dynamic CT. After the 22 hepatocellular carcinomas were treated, the personal ultrasound imager provided diagnostic accuracy of 90.9% on residual tumors when compared with results obtained by dynamic CT, and results obtained using the conventional ultrasound machine were similar. Conclusion The highly portable personal ultrasound imager using Levovist^?-enhanced power Doppler imaging can clearly depict the intratumoral vascularity of hepatocellular carcinoma nodules before and after treatment, achieving results very close to those obtained using the conventional diagnostic ultrasound machine. The personal ultrasound imager is an alternative to the conventional ultrasound machine for depicting tumor vascularity.     

超声造影对高强度聚焦超声联合肝动脉栓塞化疗治疗肝癌的疗效评价

目的探讨超声造影(CEUS)评价高强度聚焦超声(HIFU)联合肝动脉栓塞化疗(TAE)治疗肝恶性肿瘤疗效的应用价值。方法 24例肝癌患者,其中原发性肝癌15例,转移癌9例,治疗病灶总计31个,TAE治疗后1周内行HIFU治疗,于治疗前和治疗后7～14 d行CEUS检查,并与同期彩色多普勒超声(CDFI)、增强MRI检查结果比较。结果 CEUS观察31个病灶治疗覆盖区,19个(61.3%)在各期均为无增强,提示肿瘤完全灭活,12个(38.7%)病灶边缘或中央局部动脉期高增强,门脉期或延迟期减退为低增强,提示为肿瘤残存。以最终诊断为金标准,CEUS诊断准确性90.3%,增强MRI为93.5%,彩色多普勒超声为48.4%。CEUS与增强MRI在评价肿瘤灭活方面的敏感性、特异性、准确性差异均无统计学意义(P>0.05),CEUS对肿瘤灭活诊断的准确性高于CDFI(P<0.05)。结论 CEUS可较准确地判断HIFU联合TAE治疗后肿瘤灭活程度,可为肝癌治疗近期疗效评价提供依据,有较高临床应用价值。     

螺旋CT肝动脉期肝癌强化形态及血供与介入栓塞治疗后碘油聚集形态及量的关系

目的探讨螺旋CT肝动脉期原发性肝癌强化形态及血供与经肝动脉插管栓塞治疗后碘油聚集形态及量的关系。方法回顾性对32例螺旋CT肝动脉期原发性肝癌强化形态及血供表现与其栓塞治疗后肿瘤内碘油分布情况进行对比分析。结果32例肝癌栓塞治疗后肿瘤内碘油分布分为5种类型:均匀致密型(11例)、不均匀致密型(7例)、稀疏型(5例)、缺损型(3例)及混合型(3例)。肝动脉期肝癌肿瘤组织明显强化、或多量强化肿瘤血管影,栓塞后肿瘤内碘油多为均匀致密型或不均匀致密型。肝动脉期肝癌肿瘤组织无或轻度强化、或少量、稀散、僵硬强化肿瘤血管,栓塞后肿瘤内碘油分多为稀疏型、缺损型或混合型。肝动脉期肿瘤内多血供明显强化区,碘油聚集量多。无或轻度强化少血供区,碘油聚集量多较少或无碘油聚集。结论螺旋CT肝动期原发性肝癌强化血管形态及血供对预测其碘油栓塞治疗术后聚集形态及聚集量有重要价值。     

肝细胞癌介入术后疗效的影像学评价

以导管肝动脉化疗栓塞术为代表的介入治疗作为不能手术切除肝癌的首选治疗方法 已得到了广泛应用.正确评价肝癌介入术后疗效对制定治疗方案有重要意义.本文介绍肝癌介入术后疗效评价的各种影像学方法,阐述其优势、前景与不足.     

Hepatocellular carcinoma: assessment of vascularity with single-level dynamic ultrasonography during the arterial phase.

OBJECTIVE: To evaluate the hemodynamic features of hepatocellular carcinoma on single-level dynamic ultrasonography during the arterial phase. METHODS: Twenty-two hepatocellular carcinomas were examined by single-level dynamic ultrasonography with high transmit intensity and SH U 508A. The scans were performed for 40 seconds with a 1-second interval between each ultrasound transmission and with individual optimization of the scan delay time. The times of initiation of enhancement for both the hepatic artery and the tumor and the time of maximal enhancement for the tumor were recorded, and the mean echo values at every second for the tumor and hepatic parenchyma were measured. RESULTS: Twelve tumors showed hyperechoic enhancement compared with hepatic parenchyma throughout the scans. The other 10 showed hyperechoic enhancement during some segments (range, 8-34 seconds) and either isoechoic (n = 5) or hypoechoic (n = 5) enhancement during the remaining parts; the hyperechoic segments were often short (< 20 seconds, 14%). Although the times for initiation of enhancement for the hepatic artery and hepatocellular carcinoma and the time of maximal enhancement for the tumor varied, the tumor usually initiated enhancement immediately after the hepatic artery (r = 0.986; P = .000001). The interval between the time of initiation of enhancement for the tumor or hepatic artery and that of maximal enhancement for the tumor was significantly correlated with the tumor size (r = 0.700; P = .008; and r = 0.780; P = .002). CONCLUSIONS: With individual optimization of the scan delay time, single-level dynamic ultrasonography is useful for depicting the hypervascularity of hepatocellular carcinoma during the arterial phase.     

含脂质肝癌超声造影表现与MRI表现的对照研究

目的 总结含脂质肝癌的超声造影表现,并与其MRI表现进行比较。方法2010年7月至2012年12月解放军第三О二医院收治的MRI双回波序列成像提示病灶内含有脂质成分的17例肝细胞癌患者,共17个病灶。其中15例患者经增强MRI和增强CT确诊,另2例患者经手术病理证实。分析其常规超声、超声造影及增强MRI的表现。超声造影与增强MRI诊断结果的一致性采用Kappa分析进行检验。结果本组17个病灶二维超声显示9个病灶呈不均质低回声,5个病灶呈低回声;其中13个病灶边界清晰,4个病灶边界欠清晰;彩色多普勒超声观察11个病灶内部无明显血流信号,5个病灶周边可见血流信号,1个病灶可见丰富血流信号。超声造影动脉期15个病灶快速高增强,1个病灶同步等增强,1个病灶轻度增强;门脉期10个病灶廓清,1个病灶呈同步等增强,1个病灶轻度增强;延迟期16个病灶廓清,1个病灶呈等增强;其中6个病灶内存在斑片状、不规则的三期无增强区域。超声造影诊断符合率为82％（14／17）,MRI诊断符合率为88％（15／17）,两者一致性检验的Kappa值为0．628,超声造影与MRI诊断结果一致性较好。结论含脂质肝癌病灶内部或周边始终可见三期无增强区域;含脂质肝癌超声造影的某些特征对于诊断含脂质肝癌具有一定的参考价值。     

彩色多普勒超声对假性动脉瘤的诊断和治疗

目的：本文旨在总结假性动脉瘤的彩色多普勒超声表现，并介绍彩色多普勒超声引导下的压迫治疗方法。方法：对１９９５～１９９８年我院经彩色多普勒超声诊断的１３例假性动脉瘤进行分析。在彩色多普勒超声引导下压迫治疗２例假性动脉瘤。结果：１３例假性动脉瘤病人中１１例经手术证实。另２例压迫治疗成功。结论：彩色多普勒超声对假性动脉瘤诊断准确率较高。彩色多普勒超声引导下压迫治疗假性动脉瘤是一种安全、有效的非介入性方法     

实时超声造影在肝癌射频消融治疗前的应用研究

目的　探讨肝癌射频消融（RFA）前实时超声造影对确定消融范围和选择治疗方案的应用价值。方法　对RFA前239例肝癌患者315个病灶进行常规超声和低机械指数（MI〈0．2）实时超声造影检查（造影剂为Sono　Vue）,比较分析肝癌常规超声与超声造影的图像差异及其对确定消融范围和选择治疗方案的影响。结果　192个病灶（60．9％）超声造影后肿瘤大小测值较造影前明显增大（P〈0．01）,其中163个病灶设计消融范围较超声造影前明显扩大,29例因肿瘤≥6cm而改为手术切除;125个病灶（39．7％）超声造影后肿瘤形态更加不规则（P〈0．01）,其中16例因显示形态不规则的肿瘤邻近重要结构而改为手术切除。结论　与常规超声比较,RFA前超声造影可以更清晰、更准确地显示肝癌的大小、形态和浸润范围,为确定消融范围和选择治疗方案提供可靠的依据。     

高强度聚焦超声联合肝动脉化疗栓塞治疗门静脉癌栓的临床研究

目的 探讨高强度聚焦超声（HIFU）联合肝动脉化疗栓塞（TACE）治疗门静脉癌栓（PVTT）的安全性和有效性。方法将42例原发性肝癌（HCC）合并门静脉癌栓（PVTT）患者分为两组,A组（22例）采用HIFU联合TACE进行治疗,B组（20例）单纯采用TACE治疗。结果HIFU联合TACE组治疗后PVTT有5例消失,12例缩小,比TACE组疗效明显（P〈0．05）。HIFU联合TACE组,有11例患者恢复门静脉血流,癌栓内血供较单纯TACE治疗组明显减少（P〈0．05）。联合治疗组中位生存期13．8个月,较同期TACE组中位生存期7．9个月明显延长（P〈0．05）。结论HIFU联合TACE治疗PVTT是一种新的安全、有效、微创的治疗方法,能明显提高患者生活质量,延长寿命。     

具有肝硬化基础的肝内胆管细胞癌的超声造影及增强CT的增强模式分析

目的 探讨在肝硬化基础上的肝内胆管细胞癌的实时超声造影与增强螺旋CT的成像特征.方法 经病理确诊的胆管细胞癌并肝硬化的患者12例(手术切除11例,穿刺1例),11例采用对比脉冲造影技术,1例采用连续脉冲反向谐波造影技术,机械指数<0.2,2.4 mL造影剂SonoVue团注.将超声造影与增强CT的增强模式、术前诊断与病理结果进行对比分析.结果 超声造影动脉相5例(41.7%)为不均匀高增强,3例(25.0%)为均匀高增强,4例(33.3%)为周边环状增强.超声造影3例(25.0%)诊断为肝内胆管细胞癌,9例(75.0%)诊断为肝细胞癌.增强CT动脉期10例(83.3%)为不均匀强化,2例(16.7%)为环状强化.2例(16.7%)诊断为肝内胆管细胞,10例(83.3%)诊断为肝细胞癌.结论 肝硬化基础上的多数肝内胆管细胞癌实时超声造影与增强螺旋CT的增强模式与肝细胞癌类似,影像学鉴别诊断困难.     

原发性肝癌实时谐波超声造影

目的:探讨原发性肝癌实时超声谐波造影时间窗及动脉早期初始强化形式及意义.方法:观察完整时相,确定时间窗.分析初始强化形式以及该形式与二维图像、CDFI的关系.结果:93.4%(44/47)表现为"快进快出"特征.边界不清的病灶中10例造影后较造影前增大.肝癌病灶在超声造影中开始强化表现具有不同形态学特点.结论:原发性肝癌超声造影有自己的"时间窗".将超声增强初始强化表现与二维图像、CDFI相结合,有助于判断肿瘤的病理类型及生物学行为.     

Hepatocellular carcinoma: therapeutic experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with the contrast agent Levovist.

OBJECTIVE: To describe our experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with Levovist (SH U 508A; Nihon Schering, Osaka, Japan) for hepatocellular carcinoma after transcatheter arterial infusion. METHODS: Twenty patients (17 men and 3 women; mean age, 58.4 years) with 23 hepatocellular carcinoma nodules (mean +/- SD, 2.7 +/- 1.5 cm) underwent percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography 1 week after transcatheter arterial infusion. Therapeutic effects were assessed by contrast-enhanced computed tomography and posttreatment fine-needle biopsy. This study was performed on a prospective basis. RESULTS: After the transcatheter arterial infusion, contrast-enhanced color Doppler sonography showed intense intratumoral color signals in all 23 hepatocellular carcinomas. After the percutaneous ethanol injection, contrast-enhanced color Doppler sonography, fine-needle biopsy, and contrast-enhanced computed tomography showed no color signals, no viable tumor tissues, and no enhancement in any of the 23 hepatocellular carcinomas. Three to 5 (mean, 3.3) percutaneous ethanol injection sessions with a 5.2- to 15.6-mL (mean, 12.8-mL) total volume of ethanol per tumor were required for complete disappearance of color signals on contrast-enhanced color Doppler sonography. CONCLUSIONS: Percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography has considerable efficacy in treating hepatocellular carcinoma.