卵巢原发性乳头状甲状腺癌的CDFI分析及探讨

目的 探讨卵巢原发性乳头状甲状腺癌的二维及彩色多普勒血流显像特点.方法 对2例经病理学检查确诊的卵巢原发性乳头状甲状腺癌进行二维及彩色多普勒血流显像分析,结合文献对其声像图和血流特点进行探讨.结果 超声显示盆腔或下腹部囊实性包块,多数包块内部以实性回声为主,伴有多房小囊;少数以囊性成分为主伴有分隔及实性结节,彩色多普勒显示实性部分有血供较丰富的高速低阻血流.2例均没有临床恶变及转移的证据.结论 卵巢原发性乳头状甲状腺癌的声像图缺乏明显特征性,必须结合彩色多普勒及其他影像学和实验室检查与其他卵巢肿瘤相鉴别;肿瘤以多房囊实性或多房囊性内有实性成分多见,同时伴有实性部分的低阻动脉血流信号.因此,在超声疑为畸胎瘤的瘤体内测到有明显血流供应的实质或厚分隔成分时,结合临床应高度怀疑卵巢原发性乳头状甲状腺癌.     

含囊性成分肾细胞癌的彩色多普勒超声诊断分析

目的探讨含囊性成分肾细胞癌的彩色多普勒超声特征并与肾脏其他类似病变进行比较,总结其诊断和鉴别诊断特点。方法对49例含囊性成分的肾细胞癌和46例含囊性成分的肾脏良性病变的彩色多普勒超声特征进行回顾性分析,将其分为以囊性为主和以实性为主2种类型,对4组病变的声像图特征进行比较分析。结果与囊性为主型肾良性病变相比,囊性为主型肾细胞癌具有更不光滑的囊壁与分隔,实性部分回声以等回声或低回声为主,囊性结构更多表现为多囊性结构,囊壁发生结节更多,内部更常探及动脉血流信号,周边出现抱球样血流信号,分隔内探及更多的动脉血流。而与实性为主型肾良性病变相比,实性为主型的肾细胞癌则表现为实性部分回声以等回声或低回声为主,具有更多的囊性结构,内部可更多的探及动脉血流信号,周边大多都出现抱球样血流信号。与囊性为主型肾细胞癌相比,实性为主型肾细胞癌在各个超声特征方面均具有明显的差异。结论与同类型的良性病变相比,含囊性成分的肾细胞癌具有特征性的声像图表现,依据囊性成分比例的不同而应用不同的超声指标可更准确地对其进行定性诊断。     

肝脏胆管囊腺癌影像学诊断的价值

目的:探讨彩色多普勒超声和介入超声技术及其他影像学检查在肝脏胆管囊腺癌(HBCAC)诊断中的价值。方法:回顾性分析1995年~2005年6例临床材料完整且经病理证实的HBCAC。结果:HBCAC患者的临床表现和实验室检查缺乏特异性;影像学表现为肝内单发或多发囊性病灶,囊壁明显增厚,囊壁上可见结节回声,囊内探及分隔回声,囊壁及囊内分隔探及血流信号,囊壁结节探及血流信号,无肝内外胆管扩张。二维及彩色多普勒超声和介入超声技术结合CT及MRI对HBCAC的诊断符合率较高。结论:彩色多普勒超声技术应作为诊断HBCAC的首选方法,增强CT、MRI检查、超声引导下穿刺或病灶囊液抽吸涂片检查具有确诊断值。     

胰腺实性-假乳头状瘤的超声和CT诊断及鉴别诊断

目的探讨超声和CT对胰腺实性-假乳头状瘤的诊断及鉴别诊断依据。方法回顾性分析经手术及病理证实的9例胰腺实性-假乳头状瘤的超声和CT影像表现。结果二维超声瘤体表现为囊、实混合性团块,其中以囊性结构为主5例,实性结构为主1例,囊、实结构比例相近3例。彩色多普勒血流显像(CDFI)4例检出血流信号,其中仅1例血流信号较丰富。CT平扫病灶呈类圆形低密度团块影;增强扫描显示实性部分明显强化,囊性部分各期均无强化。结论胰腺实性-假乳头状瘤超声和CT影像具有一定特征性,有利于诊断及鉴别诊断。     

超声在睾丸表皮样囊肿诊断中的价值探讨

目的：探讨超声在睾丸表皮样囊肿诊断中的价值。方法：回顾性分析6例经病理证实为睾丸表皮样囊肿的声像图资料,进行分析和总结。结果：6例病灶均边界清晰,内无血流信号。4例病灶典型声像图为＂洋葱皮＂样或＂漩涡＂状改变,周边有环状或蛋壳样强回声,另2例为囊实性回声或囊性回声,内有斑片状回声或细点状回声。结论：睾丸表皮样囊肿的声像图表现具有一定的特征性,超声对其准确诊断有助于临床中手术方式的选择。     

甲状腺结节的二维及彩色多普勒超声诊断研究

目的：探讨二维及彩色多普勒超声对甲状腺良、恶性结节的诊断及鉴别诊断价值。方法：120例甲状腺结节经二维超声了解其声像图表现，然后用彩色多普勒检查，观察结节内部及周边血流分布情况，并将其分为4级。结果：120例302个甲状腺结节中，良性结节264个，恶性结节38个。二维超声显示：恶性结节以实性低回声为主，内可见砂粒样钙化，边界不清，无声晕及包膜；良性结节以等、高回声及囊性、囊实性结节为主，形态规则，边界清，多有声晕及包膜。彩色多普勒超声显示：恶性结节的血流显示率明显高于良性结节，收缩期最高血流速度及阻力指数总体上高于良性结节，且以Ⅱ、Ⅲ级血流为主。结论：二维及彩色多普勒超声诊断甲状腺良、恶性结节准确率高。具有较大的临床应用价值。     

乳腺导管内乳头状瘤的彩色多普勒超声评价

目的探讨乳腺导管乳头状瘤的彩色多普勒超声表现分型及其临床意义。方法回顾性分析74例经手术和病理证实的乳腺导管内乳头状瘤患者的彩色多普勒超声表现。根据手术结果将术前超声有无局灶性病灶及局灶性病灶的超声表现进行分型,分析其临床意义。结果手术证实74例有87个病灶,其中9例彩超检查无阳性发现,33例为囊实性混合性回声灶,21例为单纯导管扩张,11例表现为实性结节;21个病灶内检出彩色血流信号。结论提高对典型和不典型乳腺导管内乳头状瘤超声表现的认识,掌握检查技巧,有利于提高显示率,更好地服务临床。     

彩色多普勒高频超声对涎腺肿物的诊断价值

目的:探讨二维高频超声及彩色多普勒显像对涎腺肿物的诊断价值。方法:对121例涎腺肿物应用高频探头二维超声和彩色多普勒超声进行检查和分析,全部病例经手术及活检或临床治疗性诊断证实。结果:炎性病变37例,囊肿30例,肿瘤54例。通过比较发现慢性炎性腺体多无特征性表现,而有局限性炎症包块时,易与恶性肿瘤的影像混淆。口外型舌下囊肿较多见,且超声图像较为典型,诊断可靠。良性肿瘤均边界清楚,内部回声均匀,诊断可靠。结论:超声有助于确定肿物大小、深度,鉴别肿物的囊实性,发现肿物的内部及周围的血流信号,可提高诊断水平。     

肾血管平滑肌脂肪瘤的超声诊断与鉴别诊断

目的探讨肾血管平滑肌脂肪瘤的声像图特征及其鉴别诊断。方法应用二维超声，彩色多普勒血流显像（CDFI），频谱多普勒（PW）对经手术病理证实的21例肾血管平滑肌脂肪瘤进行研究。结果肾血管平滑肌脂肪瘤的典型声像图为高回声或混合性回声呈洋葱样，不典型声像图为低回声。CDFI示肿瘤内血流信号少，PW测及其动脉血流为低速高阻型。结论肾血管平滑肌脂肪瘤声像图表现与血管、平滑肌、脂肪含量有关。典型声像图较易诊断。不典型声像图需结合彩色多普勒及CT增强扫描进行综合分析，并与肾癌相鉴别。     

睾丸畸胎瘤的彩色多普勒超声表现及其诊断价值

目的探讨睾丸畸胎瘤的彩色多普勒超声表现及其诊断价值。方法回顾性分析经病理证实的11例睾丸畸胎瘤的二维声像图,彩色多普勒及脉冲多普勒频谱特征。结果在11例睾丸畸胎瘤中,恶性畸胎瘤2例(18%),良性畸胎瘤9例(82%)。本组睾丸畸胎瘤超声表现共同特征是:患侧睾丸增大,内部可见实质性或混合性回声团。彩色多普勒超声显示睾丸恶性畸胎瘤内部及周边血流信号丰富,杂乱,动脉血流频谱(PSV:6～7cm/s,RI:0.34～0.37),睾丸良性畸胎瘤内部及周边无或偶见点状血流信号。结论彩色多普勒超声诊断睾丸畸胎瘤具有较高的准确性,是诊断睾丸畸胎瘤的主要方法。     

Computed tomography and sonographic findings of hepatic metastases from gastrointestinal stromal tumors after chemotherapy

OBJECTIVE: The purpose of this study was to evaluate the computed tomography (CT) and sonographic findings in patients with hepatic metastases from gastrointestinal stromal tumors (GISTs) after STI-571 treatment. METHODS: Computed tomography and sonographic findings of 8 lesions in 6 patients with hepatic metastases from GISTs that were treated with STI-571 were retrospectively analyzed. The change in size, attenuation, and echogenicity of the hepatic metastases from GISTs after STI-571 treatment was evaluated. RESULTS: After treatment with STI-571, the hepatic metastases were decreased in size and the attenuation of the hepatic metastases was homogeneously hypodense on CT. Sonography revealed the hepatic metastases to be centrally cystic with a thin wall (n = 4) or predominantly solid (n = 4) after STI-571 treatment. On color Doppler sonography, no blood flow was identified within the solid portion of the mass. CONCLUSION: After treatment with STI-571, although the hepatic metastases from GISTs exhibit a cystic appearance on CT, they may appear as solid masses on sonography.     

Color flow Doppler characterization of focal hepatic lesions.

OBJECTIVE. The purpose of this study was to determine the sensitivity and specificity of color flow Doppler sonography for the specific diagnosis of focal hepatic lesions. SUBJECTS AND METHODS. Color flow Doppler images of 118 focal hepatic lesions in 108 patients were analyzed prospectively. In most patients, liver disease was suspected or known to be present before the Doppler images were obtained. Experienced sonologists obtained and interpreted all sonograms. The lesions were classified, according to their color flow pattern, into two main categories: lesions with internal vascularity and lesions with no internal vascularity. The color flow Doppler pattern of each lesion was correlated with the diagnosis of the lesion on a lesion-by-lesion basis. One hundred two lesions were proved by biopsy and 16 lesions were confirmed by evaluation with other imaging techniques. Lesions included 29 hepatocellular carcinomas, 64 metastases, one cholangiocarcinoma, and 24 benign lesions. The sensitivity and specificity of vascularity as shown by color Doppler imaging in the diagnosis of hepatocellular carcinoma were determined. RESULTS. The majority of hepatocellular carcinoma lesions (76%) had internal vascularity. Most of the metastases (67%) and benign lesions (75%) had no internal vascularity. When the presence of internal vascularity was used as the discriminating criterion, the sensitivity of color flow Doppler findings for the diagnosis of hepatocellular carcinoma was 0.76. The specificity of internal vascularity for the diagnosis of hepatocellular carcinoma vs other focal lesions was 0.69; for hepatocellular carcinoma vs metastases it was 0.67. CONCLUSION. Although most hepatocellular carcinomas have internal vascularity on color flow Doppler images, a significant number of metastases also have internal vascularity. This overlap limits the usefulness of color flow Doppler imaging for distinguishing hepatocellular carcinoma from metastatic tumors.     

鼻咽癌颈转移淋巴结的多普勒血流信号特征

目的研究鼻咽癌颈转移淋巴结的彩色多普勒血流信号特征.材料与方法鼻咽癌伴颈淋巴结转移患者52例共134枚颈转移淋巴结,在接受治疗前行彩色多普勒血流检查,分析其血流信号特征和血供强度与淋巴结大小、部位的关系.结果鼻咽癌颈转移淋巴结的动脉血管多分布在淋巴结的周边,血流阻抗(RI)高;淋巴结血流强度的分布因淋巴结部位、大小的变化而不同,大淋巴结较小淋巴结血供丰富;中、下颈淋巴结较上颈淋巴结血供丰富.结论鼻咽癌颈转移淋巴结以周边型高阻血流信号为主.血供强度与淋巴结大小、部位有关.     

原发性肝细胞癌多普勒超声影像与β-catenin异位表达相关性分析

目的探讨原发性肝细胞癌的多普勒血流特点与β-catenin在肿瘤细胞异位表达的相关性。方法采用多普勒超声记录40例原发性肝细胞癌患者肝脏肿瘤的大小、血流分级、测定血流阻力指数（RI）,取术后肿瘤组织进行免疫组化检测β-catenin在其细胞膜、细胞浆的表达情况。结果随着血流分级的增高β-catenin异位表达逐渐增多（P〈0.05）,随着血流分级的增高肿瘤的分化程度逐渐降低（P〈0.05）,RI随肿块的增大而增高（P〈0.05）,随肿瘤的分化程度降低而升高（P〈0.05）,不同大小肿块间的β-catenin异位表达无统计学差异（P〉0.05）,β-catenin的异位表达随肿瘤的分化程度升高逐渐降低（P〈0.05）。结论彩色多普勒超声对于判断原发性肝细胞癌恶性程度有一定帮助,可以为临床的治疗和预后判断提供一定的客观依据。     

Role of contrast enhanced ultrasound in characterization of focal liver lesions

Aim

The purpose of the study was to describe the enhancement patterns of focal liver lesions (FLLs) on contrast enhanced sonography (CEUS), assessing the potential of this technique for characterizing the lesions and to compare its diagnostic accuracy with conventional baseline sonography including color Doppler.

Materials and methods

Between August 2009 and July 2010, 50 patients with FLLs underwent gray scale sonography, color Doppler and CEUS. The enhancement patterns of these FLL’s were analyzed throughout the arterial phase, the portal venous phase and the extended portal venous phase (the late parenchymal phase). The final diagnosis was established on the basis of histopathologic examination or CT/MRI imaging.

Results

Out of these 50 FLLs, 33 were malignant (4 hepatocellular carcinoma and 29 metastasis) and 17 were benign (5 hemangioma, 5 abscess, 2 cyst and 1 each of FNH, focal fat sparing area, focal fatty infiltration, adenoma and benign/granulomatous lesion). The enhancement patterns after injecting microbubble contrast agent allowed characterization of FLLs. The malignant lesions showed intratumoral and/or peritumoral vascularity during the arterial phase and perfusion defect during the late parenchymal phase. Contrast enhanced sonography improved sensitivity in detecting malignancy (CEUS vs. baseline sonography, 100% vs. 81.8%).

Conclusion

CEUS improves detection and characterization of FLLs. It should be used as problem solving tool in cases where conventional gray scale and color Doppler sonography are non-diagnostic.     

Differentiation of benign and malignant tumors of the parotid gland: value of pulsed Doppler and color Doppler sonography

To establish criteria for the differentiation of benign and malignant tumors of the parotid gland using color Doppler sonography (CDS) and pulsed Doppler sonography (PDS) we examined 37 patients with parotid tumors by gray-scale ultrasound, CDS, and PDS. Tumor vascularization displayed by CDS was graded subjectively on a 4-point scale (0 = no vascularization, 3 = high vascularization). From the Doppler spectrum, the highest systolic peak flow velocity, the resistive index (RI), and the pulsatility index (PI) were calculated. There were 11 malignant and 26 benign tumors. Tumor vascularization by CDS was grade 0 or 1 in 88.5 % of benign lesions, whereas it was grade 2 or 3 in 82 % of malignant lesions (P < 0.0001). The highest systolic peak flow velocity was statistically significantly higher in malignant lesions than in benign lesions. Using a threshold systolic peak flow velocity of 25 cm/s, sensitivity was 72 % and specificity was 88 % for the detection of a malignant tumor. Evaluation of tumor vascularization by CDS and PDS cannot differentiate between benign and malignant parotid tumors with certainty. However, high vascularization and high systolic peak flow velocity in tumor vessels should raise the suspicion of malignancy, even if tumor morphology on gray-scale sonography indicates a benign lesion. Received 5 February 1998; Accepted 5 March 1998     

彩色双功能超声在诊断颈内动脉粥样硬化狭窄中的临床应用

目的:探讨彩色双功能超声在颈内动脉粥样硬化狭窄中的临床应用价值。方法:对58例由于动脉粥样硬化导致颈内动脉狭窄的患者进行二维超声及彩色多普勒血流显像检查,并利用脉冲多普勒对动脉血管狭窄处及狭窄前的血流信号进行测量,同时测量颈总动脉的血流速度。结果:通过测量颈内动脉狭窄处收缩期峰值流速和舒张末期血流速度、颈总动脉收缩期峰值流速和舒张末期血流速度,将二者血流速度相比较并进行分析,同时与彩色多普勒血流显像通过狭窄处血管面积的变化所测的狭窄程度相对照,共检出62支颈内动脉狭窄,其中5支颈内动脉血管腔内血栓形成。二者相结合诊断颈内动脉狭窄的灵敏性和准确性分别为96%和94%。结论:彩色双功能超声在颈内动脉狭窄的诊断中具有重要的临床价值。     

Transrectal ultrasound color Doppler in the evaluation of recurrence of anal canal cancer

OBJECTIVE: aim was to obtain elements for a differential diagnosis between post-radiation fibrosis and residual tumor or local relapse in anal canal cancer through detection of presence/absence of intralesional blood flow. Transrectal ultrasound and color Doppler were compared. METHODS: 43 patients underwent transrectal ultrasound sonography and color Doppler before and after therapy to assess intralesional blood flow and flow pattern (spotty and linear signals). All diagnostic imaging results were compared to histological analysis. Specificity was submitted to statistical analysis using McNemar test. RESULTS: before therapy 34 lesions (79%) showed color signal; no signal in 9 (21%), which were excluded from our analysis. Eighteen of the 34 patients considered, presented complete response to therapy, 14 partial response and two no response. After therapy, signal disappeared in 17 patients (94%); one false-positive (6%) presented spotty signals; 16 of 34 patients presented changed color signal. Color Doppler showed higher specificity than grey scale transrectal ultrasound in the differentiation of fibrosis from tumor. Response was confirmed by histological examination, considered gold standard. McNemar test demonstrated the significance of color Doppler (P < 0.0001). CONCLUSION: color Doppler considerably increases transrectal ultrasound specificity in differentiating tumor relapse from fibrosis in anal canal cancer.     

Color Doppler sonography of hepatocellular carcinoma before and after treatment by transcatheter arterial embolization.

Color Doppler sonographic findings on 38 lesions in 31 patients who had primary hepatocellular carcinoma were evaluated before and after transcatheter arterial embolization and compared with dynamic CT and hepatic arteriographic findings. All lesions that were observed with dynamic CT or arteriography were correctly identified on color Doppler sonography. Peritumoral pulsatile flow was the predominant color Doppler flow seen in all lesions. Mixed pulsatile and continuous flow were noted in larger tumors and in tumors with a higher degree of vascularity, as determined by arteriography. Two weeks after treatment, color Doppler flow was still identified in 18 lesions (47%), corresponding to dynamic CT or arteriographic findings documenting residual tumor. Histopathologic examination, performed in 10 other lesions, showed that the tumor was completely necrotic in five. These five necrotic tumors were not visible on color Doppler flow images after treatment. Viable tumor was observed in the five remaining lesions, all of which were shown on color Doppler flow images after treatment. During the 6- to 16-month follow-up period, color Doppler flow images showed recurrence of 13 (50%) of 26 lesions, corresponding to tumor recurrence as shown by CT and arteriography. We conclude that color Doppler sonography is useful for imaging hepatocellular carcinoma, for evaluating residual tumor after treatment, and for imaging tumor recurrence during follow-up.     

Gray scale and color Doppler sonography in the diagnosis of carpal tunnel syndrome

Purpose

To determine the diagnostic accuracy of gray scale and color Doppler sonography in the diagnosis of patients with carpal tunnel syndrome.

Patients and methods

A total of 53 wrists in 41 consecutive patients with clinical suspicion of carpal tunnel syndrome, referred from the Department of Physical medicine, Rheumatology & Rehabilitation were examined with ultrasonography using a 12 MHz linear array transducer. The presence of median nerve edema, swelling, and bowing of the flexor retinaculum was evaluated by gray scale sonography, while intraneural hypervascularity was evaluated by color Doppler sonography. Sensitivity and specificity were calculated for each sonographic feature and compared with electrodiagnostic test (EDT) results.

Results

Electrodiagnostic tests confirmed carpal tunnel syndrome in 48 wrists. A median nerve cross sectional area (CSA) of 11 mm² was calculated as a definition of median nerve swelling. In comparison with electrodiagnostic tests, median nerve swelling showed the highest accuracy (89%) among the gray scale sonographic criteria, and the presence of median nerve hypervascularization showed the highest accuracy (94%) among all sonographic criteria. Median nerve edema and bowing of the flexor retinaculum showed accuracies of 81% and 77% respectively.

Conclusion

Median nerve intraneural hypervascularity detected by color Doppler sonography is more accurate in detection of median nerve involvement than gray scale sonography criteria in patients with suspected carpal tunnel syndrome.