膀胱前列腺病变的三维超声诊断

目的：探讨三维超声在膀胱、前列腺病变诊断中的价值。方法：应用Voluson730三维超声诊断仪，对30例膀胱病变及8例前列腺增生病变进行三维重建成像，重建模式选用表面成像模式。结果：重建后的三维图像逼真形象，采用Electronic scalpel(电子刀)技术可以充分显示病变的范围、空间位置及表面结构，与大体标本相似。结论：结合“电子刀”技术，三维重建图像更有利于对病变性质的诊断及鉴别。     

三维超声成像在膀胱癌诊断中的应用

目的：运用三维重建模式及三维多普勒重建模式对膀胱癌进行了三维重建，以探讨三维及三维多普勒超声在膀胱癌诊断中的应用价值。方法：对16例膀胱癌患，进行二维、三维及三维多普勒超声成像，并描述了膀胱癌的三维及三维多普勒超声图像特征。结果：三维及三维多普勒超声图像清晰、形态直观、立体感强、空间位置关系及血供状况明确，并可确定病变的部位、范围、表面结构和对膀胱壁的浸润及基底血管的情况，可以检出二维遗漏的微小病变。结论：在临床应用中，三维及三维多普勒超声成像对膀胱癌的诊断和鉴别诊断，有着二维图像无法比拟的优点，为制定治疗方案提供了更为丰富的信息，应用前景广阔。     

三维超声对胎儿骨骼畸形的研究

目的 探讨三维超声在胎儿骨骼系统发育畸形成像中的临床价值。方法 采用表面及最大透明成像方法，对22例产前常规二维超声检查怀疑胎儿骨骼异常的病例，进行三维超声成像检查，并在诊断中运用电子刀技术，动态三维技术。通过和产后病理解剖对照，比较二维、三维图像提供畸形的部位及细节的准确性。结果 21例能进行三维扫查，并得出表面或最大透明图像，产前二维超声对病变部位及细节判断准确分别为16例（72.7%）,和9例(40.9%)，而三维超声判断准确分别为21例（95.5%）和20例(91%)。结论 表面三维超声立体成像能够得出骨骼畸形的外貌特征，采用最大透明成像方式，能够了解畸形的骨骼数量和形态改变。三维超声为胎儿骨骼系统发育异常的诊断，提供了重要手段，是二维超声的重要补充。诊断中，电子解剖刀，动态三维技术进一步提高了三维图像的准确性。     

经阴道三维超声诊断子宫腔内病变的价值

目的 探讨三维超声在子宫腔内病变诊断中的价值.方法 对36例子宫腔内病变进行三维超声重建成像,重建选用表面成像模式.结果 16例内膜息肉表现为官腔内稍强团状回声,子宫内膜基底线完整;10例黏膜下肌瘤表现为官腔内团状低回声,可显示团块突入肌层的程度;8例单纯内膜增生表现为增生内膜与子宫肌层分界清晰;2例内膜癌表现为紊乱团状回声与子宫肌层分界不清.结论 三维超声重建图像更有利于对病变性质诊断和鉴别.     

三维超声成像在肝胆疾病中的应用

本文利用不同的三维超声重建模式重建部分肝胆疾病的三维图像，旨在探讨三维超声的重建方法及其在肝胆疾病中的临床应用价值，同时描述了部分肝胆疾病的三维超声图像特征。所用仪器为Ｖｏｌｕ－ｓｏｎ５３０Ｄ三维超声成像系统，探头为三维容积探头，频率３．５／５ＭＨｚ，重建模式选用表面成像模式及透明成像模式。结果表明：（１）用表面成像模式，可清晰反映病变组织的外观形态、轮廓大小及表面细微结构特征，如肝硬化、肝癌、胆囊结石、胆囊息肉等。（２）用透明成像最小回声模式重建的肝内血管及扩张的胆管的三维图像，其血管树或胆管树连续性好，管道间空间关系明确，可显示末端细小的分支或属支，并可显示肝内血管或胆管的异常走行及异常通道。该模式与Ｘ线模式组合，能显示肝内血管或扩张胆管与病变组织的空间位置关系，并可显示引起胆管扩张病理因素的位置及其与远端胆管的空间关系。因此，三维超声重建可为肝胆疾病提供较二维超声更为丰富的信息，对全面了解病情、明确诊断及制定治疗方案有极大的临床意义     

三维超声成像在眼科疾病的应用价值

目的 评价三维超声成像在眼科疾病中的应用价值。方法 本文对15例正常眼球和50例病变眼球进行三维超声成像研究，描述了正常眼球和眼球内不同疾病的三维成像特征。图像采集方式为磁场空间定位自由扫查。结果 三维超声能弥补二维超声不足，三维超声成像所建图像逼真、形象直观、立体感强、空间关系明确，并可确定病变的形态、范围和其表面及内部的细微结构特征。结论 三维超声检查有助于眼科疾病的诊断与鉴别诊断，提高准确率，为临床制定手术方案提供科学依据。     

三维超声成像在肾肿块诊断中的应用

目的 探讨三维超声成像在肾脏肿块诊断中的应用价值。方法 对81例肾脏肿块进行三维重建，并与二维进行对比，经肾穿刺或手术病理证实。结果 三维超声重建图像清晰，形态直观，立体感强，能够显示肿块内部结构特征，确定病变与相邻结构的空间关系。结论 三维超声图像从多切面、多角度获取更多的临床信息，在一定程度上弥补了二维超声的不足，为疾病的诊断与鉴别诊断提供了可靠的形态学依据。     

二维超声与三维超声对妊娠早期胎芽胎儿成像图的比较分析

目的：应用三维超声表面成像技术重建胎芽胎儿表面外观图像,并与以往二维超声断层图像进行对比,就两种不同成像方法尝试进行超声诊断价值特别是超声胎儿胚胎学临床价值评价与探讨。方法：用6.5MHz阴道二维图像及三维立体图像。结论：二维断层显像在胎儿脏器评价上占优势,三维立体图像对胎儿外观真实性观察是二维超声无法比拟的。     

三维超声成像技术在胆系占位性病变中的临床应用

目的　探讨三维超声成像技术在胆系占位性病变中的临床应用价值。方法　对胆囊隆起性病变、胆囊癌和胆管癌等 33例不同的胆系占位性病变行三维重建。结果　重建后的胆系三维图像清晰、直观 ,立体感强 ,可以显示胆系占位性病变的表面形态、空间位置、基底情况及其与周围组织结构的解剖关系 ,与术中所见相符。结论　三维超声成像技术有助于胆系占位性病变的诊断和鉴别诊断 ,有利于病变进程的评价和手术方式的确定 ,作为二维超声的补充手段 ,具有重要的临床应用价值。     

动脉血管腔内超声显像的三维重建

超声诊断动脉血管病变日益广泛。血管腔内显象技术的应用，可从二维血管腔成像成为三维（立体）显示。为了能更好显示动脉血管的三维形态，我们建立了血管腔内超声显象的计算机三维重建系统。通过计算机三维重建表面提取法，依次标出每个切面中冠状动脉的内膜面和外膜面，最后得到其数字化了的三维图像。结果显示，经计算机三维重建的５０个正常人离体右冠状动脉血管腔内超声切面，其形态和实际十分接近。     

Characterization of Single Thyroid Nodules by Contrast-Enhanced 3-D Ultrasound

High-resolution ultrasonography (HRUS) has potentialities in differential diagnosis between malignant and benign thyroid lesions, but interpretative pitfalls remain and accuracy is still poor. We developed an image processing technique for characterizing the intra-nodular vascularization of thyroid lesions. Twenty nodules (10 malignant) were analyzed by three-dimensional (3-D) contrast-enhanced ultrasound imaging. The 3-D volumes were preprocessed and skeletonized. Seven vascular parameters were computed on the skeletons: number of vascular trees (NT); vascular density (VD); number of branching nodes (or branching points) (NB); mean vessel radius (MR); 2-D (DM) and 3-D (SOAM) tortuosity; and inflection count metric (ICM). Results showed that the malignant nodules had higher values of NT (83.1 vs. 18.1), VD (00.4 vs. 0.01), NB (1453 vs. 552), DM (51 vs. 18), ICM (19.9 vs. 8.7) and SOAM (26 vs. 11). Quantification of nodular vascularization based on 3-D contrast-enhanced ultrasound and skeletonization could help differential diagnosis of thyroid lesions. (E-mail: filippo.molinari@polito.it)     

Learning Curve for the Detection of Deep Infiltrating Endometriosis and Adenomyosis with 3-D Transvaginal Water Contrast Sonography

Three-dimensional rectosonography (RSG) is a transvaginal sonography technique using rectal water contrast and 3-D acquisitions. The main points of interest of 3-D RSG could be its easy accessibility and its quick learning curve, especially with respect to rectosigmoid lesions. The objective of this prospective observational study was to assess the learning curve of 3-D RSG for the diagnosis of rectosigmoid lesions and for various other locations of deep endometriosis (DE), endometriomas and adenomyosis. From April 2017 to November 2017, 116 patients with suspected pelvic endometriosis were referred to the Croix-Rousse University Hospital, and those who underwent 3-D RSG were included in our study. After a short training period, four residents were asked to perform 3-D RSG by themselves. Each procedure was systematically controlled immediately afterward by a single expert sonographer. The success of the procedure involved the correct identification of various locations of endometriosis (rectosigmoid, uterosacral ligament, retrocervical space, vagina, bladder and ovaries) and adenomyosis, using the expert sonographer's examination as the reference technique. The learning curve was generated using these data and assessed using the Learning Curve Cumulative Summation Test (LC-CUSUM) method. The pooled LC-CUSUM revealed that the required level of achievement was reached after 24 3-D RSGs were performed for the diagnosis of rectosigmoid lesions. All four residents were significantly competent in diagnosing rectosigmoid lesions at the end of their training period, with an α risk <0.05 (T1, p = 0.03; T2, p = 0.0002; T3, p = 0.05; T4, p = 0.02). The LC-CUSUM analysis confirmed that competency was achieved for vaginal DE, torus uterinum DE, US DE, bladder DE, endometriomas and adenomyosis within 17, 27, 38, 19, 17 and 33 scans, respectively. This study provides evidence that the skills required to diagnose endometriosis lesions and adenomyosis with 3-D RSG can be acquired after a brief learning period in an expert center.     

肝脏肿瘤三维超声成像的临床意义

目的探讨彩色三维多普勒超声对肝脏实性占位病变形态、大小及内部血供的诊断价值.方法对常规灰阶超声显示有肝脏实性占位病变的患者28例,采用腹部彩色三维超声成像仪自由臂方式对肝脏病变处及其周围进行扫查取像,取样结束后在三维超声仪上进行脱机后处理,以病变处为中心,对X、Y、Z 3个互相垂直切面上的病变范围进行勾划,生成三维的肿瘤球体,计算程序可自动计算球体体积、内部血流容积及两者之比.结果肿瘤体积最大为117 cm3,最小为2.0 cm3.三维超声可显示肿瘤供给血管走行及其分支情况,并可透视肿瘤内部血管分布情况.部分病变在二维图像上显示为"晕环"、"绕行"的肿瘤周边血管,在三维重建后显示出"抱球征",展现血管全貌,进入肿瘤内部后呈现出"提篮征",发出多支小血管,显示了恶性肿瘤的血供特征.结论彩色三维超声可对肝脏实性占位性病变的形态、体积、周边及内部血供进行综合评价,丰富了超声诊断依据.     

Three-dimensional ultrasonography in the diagnosis of rotator cuff lesions

Two-dimensional (2-D) ultrasound (US) of rotator cuff lesions is a well-established tool. The aim of this study was to elucidate if the use of 3-D sonography can increase the diagnostic yield of US. A total of 40 patients were preoperatively evaluated using 2-D and 3-D sonography, and these results were compared to intraoperative findings. Ultrasound was performed on a 530D US machine (Kretztechnik, Zipf, Austria) with a 10-MHz transducer. We found an increased validity of 3-D imaging, mainly based on the higher reliability in the diagnosis of partial-thickness cuff lesions. Sensitivity and specificity were found to be 91% and 82% for 3-D sonography and 74% and 82% for 2-D sonography, respectively. With 3-D US partial-tear rotator cuff lesions can be predicted more accurately.     

螺旋CT胆道造影及其三维重建技术的临床应用

目的 探讨螺旋CT胆道造影(SCTC)及三维重建技术的临床应用价值。方法 23例临床拟诊胆系疾病患者做螺旋CT胆道造影，图像用3D最大强度投影(MIP)及表面遮盖法(SSD)后处理。结果 23例患者共有29个病变部位，与手术结果对照，SCTC对病变检查的敏感性、定位诊断和定性诊断率分别为93．1％、93．1％、89．6％。结论 SCTC三维立体成像能多角度、多方位观察病变及周围解剖关系，有利于术前准确定位，可以作为一种准确而无创性的胆道系统检查方法。     

Comparison between Thin-Slice 3-D Volumetric Ultrasound and Conventional Ultrasound in the Differentiation of Benign and Malignant Thyroid Lesions

We explored the efficacy of thin-slice volumetric 3-D ultrasound (3-DUS) in distinguishing between benign and malignant thyroid nodules. A total of 103 thyroid nodules were evaluated prospectively using 3-D gray-scale ultrasonography. The shape, margin, halo and potential capsular invasion of the nodules were compared with the findings of conventional 2-D ultrasound (2-DUS). Of the 103 thyroid nodules, there were 50 pathologically confirmed benign lesions and 53 malignant lesions (51.5%). Shape irregularity, ill-defined margins and capsular invasion provided sensitivities of 90.0%, 47.2% and 39.6% and specificities of 88.0%, 84.0% and 100%, respectively, for the malignant lesions. The diagnosis of thyroid cancer was improved in 3-DUS compared with 2-DUS, with a sensitivity of 88.7%, specificity of 90.0%, positive predictive value of 90.4%, negative predictive value of 88.2% and accuracy of 89.3%. The sensitivity of detection for lesions with capsular invasion increased to 39.6% with 3-DUS, more than twice that of 2-DUS. Three-dimensional US is highly accurate in diagnosing thyroid nodules, particularly those with capsular invasion.     

VCI-C平面及三维超声重建对胎儿显性脊柱裂诊断价值的探讨

目的 探讨容积对比成像(Volume Contrast Imaging，VCI)-C平面及三维超声重建对胎儿显性脊柱裂的临床应用价值。方法对6例患显性脊柱裂的胎儿进行二维超声普通切面、VCI-C平面及三维超声重建，并对相关图像进行了分析。结果 本组6例胎儿显性脊柱裂二维超声普通切面声像图特征明显，定性诊断率高．达100％，但其声像图由于本身的技术特点而存在一定的不足，如图像空间立体感不强，逼真度差；VCI-C平面能显示与普通二维超声声束相垂直的声像图特征，其显像深度可在一定范围内任意调节，能从另一视角观察胎儿显性脊柱裂的声像图表现，声像图较逼真；三维超声重建在对胎儿显性脊柱裂的应用中优点为图像形象逼真，空间立体感强，缺点在于受二维超声声像图质量等多因素影响大；VCI-C平面超声成像结合三维超声重建信息量大，可以进行任意角度的图像后处理，获得了大量的超声信息。结论 VCI-C平面超声成像能在普通二维图像的基础上从另一视角观察胎儿显性脊柱裂的声像图，且图像形象逼真，空间立体感强，VCI-C平面超声成像与三维超声重建能在普通二维超声诊断胎儿显性脊柱裂的基础上提供更多的诊断信息。     

A comparison of three-dimensional ultrasound, two-dimensional ultrasound and dissections for determination of lesion volume in tendons

The purpose of this work was to evaluate the accuracy and precision of a freehand three-dimensional (3-D) ultrasonography system in the determination of lesion volume in tendons. The accuracy and precision of a 3-D ultrasonography system was assessed by performing repeated measurements on a phantom of known volume. Volume measurements of tendon lesions performed with 3-D ultrasonography were compared with measurements based on a series of two-dimensional (2-D) ultrasound (US) scans and to direct measurements from dissections. A novel method for the creation of tendon lesions in vitro was developed. 3-D US showed excellent precision and accuracy in measurements of the phantom (mean measured volume = 3.76 mL, calculated volume = 3.77 mL, coefficient of variation (CoV) = 0.54%) and good repeatability in the determination of tendon lesions (repeatability coefficient = 0.00047). All three methods examined were repeatable (repeatability coefficient for 2-D US = 0.00032, repeatability coefficient for dissections = 0.00076). However, each of the methods produced different results and no constant relationship could be found between any of the measurement methods. Both 3-D and 2-D US proved to be repeatable techniques for the measurement of the volume of a tendon lesion. Even if they produced different results, each of them can be repeatedly used individually. It was not possible to define which one provided the most accurate value as a result of difficulties encountered in lesion identification on histology, and therefore the lack of a gold standard.