超声造影的应用和研究进展

超声造影在临床上的应用日渐深入,根据近年来超声造影在国外研究进展,本文阐述了超声造影剂的发展阶段、成像的技术,并讨论了其在治疗和诊断上的应用和发展前景.     

In vitro studies on the development of a high-density contrast medium for double contrast of the colon

Investigations with an electron microscope and phantom imaging studies showed, that from micro-particle barium sulphate a high-density contrast medium can be produced for double-contrast-investigations of the colon. As stabilizing agent a substance with the same physical and chemical action as 0.6 g CMC (Sodium-Carboxy-Methyl-Cellulose) per 100 g barium sulphate should be used. With a second stabilizer, having the same effect as mixed pectin, the thickness of the contrast film can be modified, while the flow time of the contrast medium remains constant. Flow curves lead to the conclusion, that a maximum concentration of 140 GV% can be used for patients. The measurement of density and flow time of the suspension allow to check the high density and low viscosity requirements. The density of the barium sulphates used for investigation was 4,000 g/l.     

甘露醇作为口服对比剂用于小肠MR检查的技术研究

目的探讨甘露醇作为对比剂用于小肠MRI的价值。方法将20名志愿者随机分为两组,每组10人,分别口服目前研究较多的甘露醇混合液和2.5%甘露醇,行MR扫描,从扩张度、图像质量、不良反应几个方面对两组进行对比。结果从小肠平均扩张度和不良反应方面两者无显著统计学意义(P>0.05),从4、5、6段小肠的扩张度和图像质量方面对比,甘露醇混合液较2.5%甘露醇效果好,两者有统计学意义(P<0.05)。结论甘露醇作为对比剂用于小肠MR检查效果较好,甘露醇混合液对小肠的扩张效果和图像质量较2.5%甘露醇好。     

离子型对比剂与非离子型对比剂在螺旋CT增强中的对比研究

目的通过对比研究离子型对比剂与非离子型对比剂在螺旋CT增强扫描中的应用,探讨离子型对比剂临床应用的安全性,以最好的效价比选择对比剂。方法分别观察离子型对比剂泛影葡胺(60%)106例、非离子型对比剂碘海醇(300mg/ml)120例的螺旋CT增强扫描,比较其不良反应发生率和图像增强效果。结果泛影葡胺(60%)、碘海醇(300mg/ml)均未发生严重不良反应。轻、中度不良反应发生率分别为5.7%、1.7%。二者之间无统计学意义(P>0.05)。泛影葡胺(60%)、碘海醇(300mg/ml)所获图像质量均能达到诊断要求,二者之间无统计学意义(P>0.05)。结论离子型对比剂泛影葡胺(60%)在应用于非高危人群时,是相对安全的,能有效降低检查费用。     

超声造影--医学超声发展新的里程碑

回顾医学超声发展的历史,我们看到,70年代崛起的实时灰阶超声(real-time grey-scale ultrasound)即B型超声或二维灰阶超声断层扫描技术,奠定了现代超声诊断的基础,为超声极为广泛地临床应用铺平了道路;80年代发展起来的彩色多普勒成像技术,使现代超声影像诊断极具特色,为心血管和全身器官组织血流的无损检测和血流动力学研究开创了新的领域;90年代以来,许多超声新技术的出现可谓层出不穷,其中对医学超声最具影响力并能进一步提升其在现代影像技术中地位者,莫过于超声造影成像,即造影增强超声(contrast enhanced ultrasound).     

Acute infarct selective MRI contrast agent

To determine the infarct affinity of a low molecular weight contrast agent, Gd(ABE-DTTA), during the subacute phase of myocardial infarct (MI). Dogs (n = 7) were examined, using a closed-chest, reperfused MI model. MI was generated by occluding for 180 min the Left Anterior Descending (LAD) coronary artery with an angioplasty balloon. DE-MRI images with Gd(ABE-DTTA) were obtained on days 4, 14, and 28 after MI. Control DE-MRI by Gd(DTPA) was carried out on day 27. T2-TSE images were acquired on day 3, 13 and 27. Triphenyltetrazolium chloride (TTC) histomorphometry validated postmortem the existence of infarct. Gd(ABE-DTTA) highlighted the infarct on day 4, but not at all on day 14 or on day 28, following MI. On day 4, the mean ± SD signal intensity (SI) of infarcted myocardium in the presence of Gd(ABE-DTTA) significantly differed from that of healthy myocardium (45 ± 6.0 vs. 10 ± 5.0, P < 0.05), but it did not on day 14 (11 ± 9.4 vs. 10 ± 5.7, P = NS), nor on day 28 (7 ± 1.5 vs. 7 ± 2.4, P = NS). The mean ± SD signal intensity enhancement (SIE) induced by Gd(ABE-DTTA) was 386 ± 165% on day 4, significantly different from mean SIE on day 14 (9 ± 20%), and from mean SIE on day 28 (12 ± 18%), following MI (P < 0.05). The last two mean values did not differ significantly (P = NS) from each other. As control, Gd(DTPA) was used and it did highlight the infarct on day 27, inducing a mean SIE value of 312 ± 40%. The mean SIE on day 3, 13, or 27 did not vary significantly (P = NS) on the T2-TSE images (114 ± 41%, 123 ± 41%, and 150 ± 79%, respectively). Post mortem, the existence of infarcts was confirmed by TTC staining. The infarct affinity of Gd(ABE-DTTA) vanishes in the subacute phase of scar healing, allowing its use for infarct age differentiation early on, immediately following the acute phase.     

Prolonged contrast of kidney tumors using an oily x-ray contrast medium

In 194 patients with tumourous kidney disease an angiographic investigation with the oily x-ray contrast medium Iodolipol was carried out. A selective tropism of oily-x-ray contrast media was found that was only retained in zones of malignant disease. The application of the preparation caused no complications. The oily x-ray contrast medium persisted in the tumours over several weeks or months. After embolization of the renal artery a moderate size reduction of malignant tumours in the first 10-14 d was seen. The ability of Iodolipol for a lasting retainment in malignant tumour tissue allows a follow-up of the involution of the pathologic focus after arterial embolization of the tumour vessels.     

原发性肝癌超声造影与磁共振增强表现比较研究

目的 观察原发性肝癌超声造影与磁共振增强表现的差别,并探讨出现这些差别的原因.方法 22例原发性肝癌患者经超声造影及磁共振增强检查.结果 对比观察25个结节在2种影像学检查中的图像特点,经病理证实,20例中的23个结节为肝细胞癌,另外2例中的2个结节为肝内胆管细胞癌.肝细胞癌中17个结节超声造影检查与磁共振增强扫描具有相似的增强模式.其余6个肝细胞癌结节及2个肝内胆管细胞癌结节超声造影与磁共振增强检查增强模式不同.结论 2种影像学检查手段所采用造影剂在组织内分布特征不同以及肿瘤自身结构特点不同可能是影像学表现出现差异的原因.     

开放式低场MRI动态增强扫描在上腹部疾病诊断中的应用

目的 评估低场MRI 动态增强检查在上腹部病变诊断中的应用价值.方法 收集行低场MRI 检查的上腹部病变患者90例,所有病例均做平扫及动态增强扫描,动态后即刻扫描T1WI/ SE得到普通增强扫描图像.将取得的MRI 平扫+普通增强形态学及MRI平扫+动态增强形态学+动态曲线在上腹部病变的定性影像诊断与病理结果的诊断符合率进行比较.结果 MRI平扫+动态增强+动态曲线在上腹部病变的定性影像诊断与病理诊断的符合率为89.7%,MRI 平扫+普通增强为75.8%.MRI 平扫+动态增强形态学+动态曲线对于检查上腹部病变的定性影像诊断的能力明显优于MRI 平扫+普通增强形态学,差异具有统计学意义(P=0.031).结论 低场MRI动态增强检查对于鉴别上腹部肿块的良恶性有突出显著的作用,对病变的定性、定位、划定边界优于常规自旋回波增强扫描.     

MRI动态增强及TSE序列在垂体微腺瘤的应用

目的探讨MR（magnetic resonance）动态增强,尤其是TSE（Turbo SpinEcho）快速扫描序列对垂体微腺瘤的诊断价值。方法回顾性分析28例已经确诊的垂体微腺瘤的MRI资料。结果平扫时显示病灶32．14％（9／28）,动态增强显示病灶82．14％（23／28）,常规增强扫描显示病灶57．14％（16／28）。平扫与动态增强对垂体微腺瘤的检出率间有统计学意义（P〈0．05）动态增强与常规增强扫描对垂体微腺瘤的检出率间无统计学意义（P〉0．05）平扫与常规增强扫描对垂体微腺瘤的检出率间有统计学意义（P〈0．05）。结论MRI动态增强,尤其是使用TSE快速扫描序列对垂体微腺瘤的检出率显著提高,因此,动态增强技术（TSE）应作为诊断垂体微腺瘤的常规检查方法。     

生物响应MRI对比剂的研究进展

不同组织和疾病都存在特异性的生物信号。开发能对这些生物信号响应的磁共振成像（MRI）对比剂,不仅有望增加MRI检测疾病的灵敏度,而且能够对病变产生的信号进行分子成像,提高疾病诊断的准确度。该文详细综述了白蛋白、pH、金属离子、酶、氧化还原以及其他生物分子等响应对比剂的最新进展,对未来的研究方向做了展望。     

Celiac disease: MR enterography and contrast enhanced MRI

Magnetic resonance imaging of the gastrointestinal tract is gaining increasing clinical acceptance and is being increasingly used for the evaluation of patients with celiac disease. The purpose of this article is to describe the MR features of celiac disease and its complications. The MR signal appearances of the intraluminal, mural, and mesenteric abnormalities in celiac disease can help in the evaluation of patients. Radiologists, therefore, should be familiar with the MR findings of patients with celiac disease.     

Diagnosis of submucosal tumor by injecting a water soluble contrast medium: development pattern and growing of tumors

With the application of our endoscopical method of contrasted X-ray imaging, gastric submucosal tumors were studied with chief regards to their modes of growing up and patterns of development. It has become known that, of extra-gastric developing tumors, larger ones tend to show Pattern IVa and smaller ones Pattern IVb. Generally, the tumors showed a tendency of becoming larger in older patients. Periodical checking disclosed about 15% of the tumors growing larger with the lapse of time. It has been surmised that as tumors grow up, their development possibly turns from intra-gastric to intramural and mingled in pattern. Their modes of growing could be classified as follows: Abruptly growing large at a certain time and then remaining without notable changes, step-by-step enlarging, and gradually growing up straight forwardly with years.     

Perfusion MRI using dynamic-susceptibility contrast MRI: quantification issues in patient studies

OBJECTIVES: Measurement of perfusion accurately, noninvasively, and with good spatial resolution offers the chance to characterize abnormal tissue in many clinical conditions. Dynamic-susceptibility contrast (DSC) MRI, also known as bolus-tracking MRI, is a dynamic MRI method to measure perfusion and other related hemodynamic parameters. This review article describes the principles involved in perfusion quantification using DSC-MRI as well as discusses the main issues affecting its quantification in patient studies. CONCLUSIONS: It is shown that DSC-MRI is a very powerful technique that provides important information regarding cerebral hemodynamics. The relatively high contrast-to-noise ratio, fast acquisition, and wealth of information available have made DSC-MRI the most commonly used MRI technique for the rapid assessment of the brain hemodynamics in clinical investigations. While very important advances have been achieved in the last 2 decades, there are still some remaining limitations that users should be aware of to avoid misinterpretation of the findings and to make the most of the invaluable information provided by perfusion MRI.     

Contrast-enhanced US and MRI for assessing the response of breast cancer to neoadjuvant chemotherapy

PurposeTo evaluate the response of breast cancers to neoadjuvant chemotherapy (NAC) with second-generation contrast-enhanced ultrasound (CEUS) and magnetic resonance (MR).Materials and MethodsWe studied 16 women aged 33–74 years (mean, 53 years; median, 38 years) with locally advanced breast carcinoma or large operable breast cancer (>2 cm; T2–T4, N0–N3, M0) that had been detected by mammography, conventional ultrasonography, and biopsy. CEUS (with SonoVue, 5 ml) and MR (with Gd-DTPA; 0.2 mM/kg) were performed under blinded conditions before, during, and after 6–8 cycles of NAC. Lesions were measured and time/signal intensity (T/SI) curves were calculated during both the examinations. The data obtained were analyzed in light of the results of surgical pathology.ResultsSix patients had complete responses manifested by the disappearance of enhancement at both CEUS and MR. Six others had partial responses (reduction of lesion enhancement >50%). In 5/6, T/SI curves obtained with CEUS and MR were both indicative of malignancy (flat curves at CEUS, type I curves at MR); the sixth had a discontinuous curve at CEUS and a type II curve at MR. Four patients had lesional enhancement reductions of <50%. In 3, concordant pictures emerged from the analysis of T/SI curves (discontinuous curves in CEUS, type II and III curves in MR); the fourth had a flat CEUS curve and a type I MR curve. Responses to NAC classified on the basis of MR and CEUS findings showed good correlation with the pathological response.ConclusionsT/SI curves recorded during CEUS correlate with those obtained during MR and may be a valid index of response to the therapy.     

磁共振乳腺动态增强曲线在乳腺疾病诊断中的价值

目的:探讨磁共振乳腺动态增强曲线在磁共振检查乳腺疾病诊断中的应用价值。材料与方法:对25例乳腺疾病的患者进行磁共振平扫及动态增强扫描检查,扫描采用GE公司HDe 1.5T磁共振机配备8通道乳腺线圈进行检查,动态增强采用团注12时相扫描法检查。结果:25例乳腺病变均经过病理证实,其中恶性病变6例,动态增强曲线表现为Ⅲ型4例,Ⅱ型2例,良性病变19例,Ⅰ型曲线17例,Ⅱ型曲线2例。结论:乳腺动态增强曲线在磁共振乳腺疾病的诊断中提供了可靠的依据,结合动态增强后的病变征象,对提高乳腺疾病诊断的正确性起到了重要的价值。     

Stable paclitaxel formulations in oily contrast medium.

Stable paclitaxel/Lipiodol solutions as well as emulsions were developed for the treatment of solid tumors including hepatocellular carcinoma. Paclitaxel could be dissolved in Lipiodol, an oily contrast medium, but precipitated out and formed aggregates with time. Paclitaxel precipitation was due to the inter- and intra-molecular hydrogen bonding of paclitaxel molecules. Time-dependent paclitaxel aggregation was completely prevented by adding small amounts of additional solvents, which are miscible with Lipiodol. It was also notable that paclitaxel helped in stabilizing the water-in-oil (w/o) type emulsion of Lipiodol and Iopamiro. The stability, physical properties and in vitro drug release profiles of the stable paclitaxel solutions and emulsions were characterized. When the stable oily paclitaxel solution was used for the treatment of B16F10 melanoma in C57BL/6 mice, the malignant cells were eradicated completely in 2 weeks, whereas the solid tumor grew rapidly and metastasized to the thigh and to other organs in the control group. Also, the mice survived for more than 1 year after the paclitaxel treatment, whereas all of those in the control group died in 40 days.