甲状腺转移癌的超声征象

  目的  探讨甲状腺转移癌的超声特征。  方法  回顾性分析本院1988年4月至2013年7月收治的10例甲状腺转移癌患者的临床资料, 分析其超声图像及超声报告, 记录并总结甲状腺转移癌的超声特征。  结果  1例肺癌及1例食管癌患者的转移灶表现为甲状腺增大, 弥漫性回声不均, 余8例表现为甲状腺结节。8例表现为甲状腺结节的超声特征:5例多发, 3例单发; 2例病灶累及右侧叶, 1例病灶累及左侧叶, 5例病灶累及双侧叶; 结节平均最大径为3.8 cm(0.6~6.6 cm); 5例边界不清, 3例边界尚清; 7例病灶形态不规则, 1例报告中未描述; 7例表现为低回声, 1例表现为高回声; 2例病灶为囊实性, 6例表现为实性; 6例伴点状、条状强回声, 1例无强回声, 1例报告中未描述; 彩色多普勒血流成像显示:4例病灶内血流丰富, 1例周边内部条状血流, 1例周边见少许血流信号, 1例无血流, 1例报告中未描述。甲状腺转移灶与原发病灶具有相似的超声特征。  结论  甲状腺转移癌超声表现多种多样, 多表现为甲状腺结节, 也可表现为弥漫性回声不均。结节的超声表现多为多发、体积较大、边界不清、形态不规则、实性、低回声、钙化、血流丰富。了解甲状腺转移癌的超声特征有利于可疑病例的发现。     

产前超声透明隔腔水平横切面用于诊断胼胝体发育不全

目的 观察产前超声透明隔腔水平横切面用于诊断胼胝体发育不全（ACC）的价值。方法 纳入26胎ACC胎儿（ACC组），以90胎正常胎儿作为对照组。根据对照组颅脑容积数据对透明隔腔水平横切面进行再认识，观察其中胼胝体压部声像图特征并进行组间比较；分析ACC组内低回声带消失或前移率与常规间接征象（侧脑室扩张、透明隔腔变小或消失）的检出率的差异。结果 透明隔腔水平横切面于对照组90胎均显示胼胝体压部，表现为韦氏腔后方低回声带，横跨大脑纵裂与左右大脑半球相连；于ACC组25胎（25/26，96.15%）见低回声带消失或前移，高于超声对常规间接征象的检出率（73.08%，P<0.05）。结论 产前超声透明隔腔水平横切面显示低回声带消失或前移可用于诊断胎儿ACC。     

肉芽肿性乳腺炎的超声表现及临床、病理分析

目的 探讨肉芽肿性乳腺炎(GM)的超声表现及临床病理特征。方法 回顾性分析经病理确诊的15例GM患者的超声表现、临床症状及病理特征。结果 12例病灶位于左侧乳房,3例位于右侧;10例为单发,5例为多发;肿块大小2.10~9.70 cm,平均(9.38±2.26)cm。超声均呈不均质低回声,其中6例可见无回声,4例无回声内可见细点状中-强回声;13例边界不清,形态不规则,其中4例主要表现为多个导管样回声延续,3例主要表现为分叶和成角,1例同时呈现以上2种表现,5例主要表现为弥漫性腺体回声紊乱,余2例边界清晰,为卵圆形。CDFI示12例病灶血流丰富。11例合并同侧腋下淋巴结肿大;3例伴皮肤增厚,其中1例伴皮下积液,1例窦道形成。术后病理显示2例W-S反应阳性,发现特异性猫抓病病原菌。结论 GM的主要超声表现为不均匀、不规则的低回声、多呈管样或结节样肿物内有丰富血流信号,确诊需结合临床表现及病理结果。     

岩下窦采样和MR 检查在儿童、青少年Cushing病中的对比研究

目的 评价超声诊断小儿声带麻痹的可行性。方法 首先通过2个喉标本研究儿童声带及杓状软骨的超声表现。对33名年龄0.5~14岁的儿童进行喉部超声检查,其中男20名,女13名;所有儿童经同期鼻咽纤维喉镜检查诊断为声带麻痹患儿12例,单侧8例(均为左侧),双侧4例;声带活动正常儿童21名。所用超声诊断仪为GELogiq9,应用12MHz高频探头,仰卧位颈前探查,观察内容包括声带、杓状软骨结构以及运动特征。结果 在横断面声像图上,儿童声带表现为长三角形低回声结构,杓状软骨为类椭圆形极低回声结构。正常儿童双侧声带活动对称,随呼吸内收、外展,声门随之闭合、开大;发声时声门闭合紧密。声带麻痹患儿双侧声带结构不对称,在呼吸及发音状态下受累声带内收和(或)外展受限,声带固定不动或仅有部分活动度,发音状态下声门多闭合不全。超声对声带活动度的判断与喉镜具有较高的一致性(Kappa值为0.959)。结论 喉部超声对儿童声带活动度的判断与喉镜的一致性较高,且具有安全、无创、便捷、经济等优点,可以在一定程度上辅助临床对儿童声带麻痹的诊断。     

超声诊断糖尿病周围神经病变

目的 探讨超声在糖尿病周围神经病变(DPN)诊断中的应用价值。方法 收集我院DPN患者40例(DPN组),选取正常对照30名(正常对照组),观察两组坐骨神经、腓总神经、胫神经的连续性和神经内部回声,测量并比较两组神经的前后径(D₁)和横径(D₂),并计算横截面积(CSA)。结果 正常对照组神经纵断面声像图呈束条状高或中等回声,内含多数平行、被高回声分开断续的线状低回声;横断面呈圆形、卵圆形高回声,其内分布细点状低回声。DPN组表现为受累神经肿大、增粗,内部回声减低,神经内平行线状结构消失。DPN组坐骨神经、腓总神经、胫神经的D₁、D₂、CSA均较正常对照组明显增加,差异均有统计学意义(P均<0.01)。结论 超声能够清晰显示DPN患者受累神经结构、位置以及病变范围,对DPN有较高的诊断价值,并可指导临床选择治疗和手术方案。     

MSCT诊断颈外静脉瘤

目的 探讨MSCT诊断颈外静脉瘤的应用价值。方法 回顾分析接受MSCT检查并经手术病理证实的11例颈外静脉瘤,评价MSCT显示颈外静脉瘤的位置、大小、载瘤静脉、引流静脉、是否伴钙化和(或)血栓以及与周围组织关系等。结果 11例颈外静脉瘤均为单侧单发,男1例,女10例;左侧6例,右侧5例;8例引流静脉为同侧锁骨下静脉,3例为同侧颈内静脉;5例伴附壁血栓,2例伴钙化。结论 MSCT能清楚显示颈外静脉瘤,具有较高诊断价值。     

超声诊断阴茎硬结症的价值

目的 探讨超声检查诊断阴茎硬结症（PD）的价值。方法 分析48例PD患者的超声特征,比较超声与临床触诊检出阴茎斑块数目的差异。结果 临床触诊检出阴茎斑块66个,超声检出80个,差异有统计学意义（Z=1.812 5,P<0.05）。超声检出的80个阴茎斑块中,48个（48/80,60.00%）呈中高回声,24个（24/80,30.00%）呈强回声,6个（6/80,7.50%）呈低回声,2个（2/80,2.50%）呈高回声伴条状强回声;4个斑块周边及5个斑块内部可检测到条状或点状血流信号,1个斑块内部及周边均探及条状血流信号。2例PD患者合并阴茎动脉功能不良,1例合并阴茎静脉闭塞功能障碍。结论 超声检出PD患者阴茎斑块明显优于触诊,且能评价PD合并勃起功能障碍患者的阴茎血管功能,为临床治疗PD及预后评估提供依据。     

弹性成像技术诊断脑梗死患者颈动脉斑块

目的 应用实时超声弹性成像量化值（面积比）评价脑梗死患者颈动脉斑块,探讨弹性成像技术评判颈动脉斑块稳定性的价值。方法 在实时状态下获得二维图和弹性图,并进行比较;以二维超声和弹性成像显示清晰斑块,勾画斑块范围,计算其面积和弹性比值。结果 45例脑梗死患者中,超声于33例中检出35处颈动脉粥样硬化斑块,其中低回声斑块4处、等回声斑块5处、高回声斑块11处,不均质回声斑块15处;低回声斑块、不均质回声斑块、等回声斑块、高回声斑块弹性比值依次增大 （F=14.25,P<0.05）,但低回声和不均质回声之间、等回声和不均质回声斑块之间差异均无统计学意义（P均>0.05）。结论 超声弹性成像技术用于判断颈动脉斑块稳定性具有重要临床意义。     

睾丸混合性生殖细胞瘤的超声表现

目的 观察睾丸混合性生殖细胞瘤（TMGCT）的超声表现。方法 回顾性分析我院经手术病理证实的48例TMGCT的超声表现。结果 48例中,22例肿瘤位于左侧睾丸,26例位于右侧睾丸。17例伴腹膜后淋巴结转移,9例伴肺转移,5例伴腹股沟区淋巴结转移,2例伴肝转移,2例伴纵隔转移,1例伴颈部淋巴结转移。28例超声可见睾丸内囊实混合回声病灶,18例低回声病灶,2例稍强回声病灶。38例肿瘤边界不清晰,10例边界清楚;29例肿瘤形态规则,19例形态不规则。CDFI示46例肿瘤内可见彩色血流信号。结论 TMGCT的超声表现有一定的特征性,可为诊断提供影像学依据。     

PET/CT联合MSCT的多平面重建对孤立性肺结节良恶性鉴别诊断的价值

目的 探讨乳腺癌非典型超声表现与其病理类型、生物学行为的关系。方法 回顾性分析12例原发乳腺癌患者的超声表现、病理结果及免疫组织化学染色测定中ER、PR、C-erbB-2的表达。结果 12例患者超声检查乳腺未见明显肿块回声,仅表现为偏低回声区,累及1~3个象限甚至全乳。该偏低回声区边界不清,形态不规则,内可见多发簇状或弥漫性分布的强回声,CDFI可见条状或柳枝状血流信号。12例乳腺癌中,导管原位癌8例,浸润性导管癌4例;发生淋巴结转移者3例。ER阳性表达者6例,PR阳性表达者6例,C-erbB-2阳性表达者10例。结论 乳腺癌非典型超声表现有助于对癌灶的生物学行为和预后进行评估。     

Sonographic measurement of the normal suprascapular nerve and omohyoid muscle

The aim of this study was to obtain normative ultrasonography (US) data on the suprascapular nerve (SSN) and omohyoid muscle (OM) in the lateral cervical region. The SSN and OM are known to be related throughout the nerve's course, yet little imaging data exists on these structures at areas more proximal than the suprascapular foramen. US data from a convenience sample of 33 asymptomatic subjects between 21 and 42 years of age were collected. Cross sectional area (CSA) of the SSN, distances from the OM to the SSN, and long-axis diameter of the OM at three reference points were obtained. The mean CSA of the SSN at both its origin and over the first rib was 1.9 mm² and at the distal clavicle was 2.0 mm². The mean distance of the OM to the SSN at these locations was 7.6 mm, 4.2 mm and 2.8 mm respectively. The mean long axis diameter of the OM was 2.4 mm at the SSN origin, 3.4 mm at the first rib, and 4.1 mm at the distal clavicle. We present US data from asymptomatic subjects on the SSN and OM. Our results show that the SSN nerve CSA is consistent throughout the nerves proximal course. Furthermore, the OM and SSN tend to approximate as they course distally. Future studies with larger samples will better characterize the normal sonoanatomy of these structures between genders and across different ages.     

Ultrasound anatomy of the neck: The infrahyoid region

The infrahyoid region of the neck includes the visceral, anterior cervical, posterior cervical, carotid, retropharyngeal, and perivertebral spaces. The visceral space contains the thyroid, parathyroid glands, larynx, hypopharynx, the cervical trachea, and esophagus, the recurrent laryngeal nerve. The carotid space contains two parts, which extend from the skull base to the aortic arch and are delimited by the three layers of the deep cervical fascia (superficial, middle, and deep). It contains the internal carotid artery, the internal jugular vein, cranial nerves (IX–XII), the sympathetic plexus (suprahyoid compartment), the common carotid artery, the internal jugular vein, vagus nerve (infrahyoid compartment). The retropharyngeal space is a midlinespace containing adipose tissue that extends from the skull base to the upper mediastinum. It is located posterior to the pharynx and cervical esophagus, anterior to the danger area and the perivertebral space.The perivertebral space extends from the skull base to the clavicles and includes two parts: prevertebral and paraspinal. The prevertebral space includes the prevertebral muscles (long muscles of the neck and head), the scalene muscles (anterior, middle, and posterior), the roots of the brachial plexus, the phrenic nerve, the vertebral arteries and veins, and the vertebral bodies. The paraspinal space contains the paraspinal muscles and the posterior elements of the cervical spine.The posterior cervical space is a deep space located posterior to the sternocleidomastoid muscle. It contains the accessory nerve, the accessory chain lymph nodes, the pre-axillary component of the brachial plexus, and the dorsal scapular nerve. The anterior cervical space is located deep to the strap muscles and sternocleidomastoid muscle. It surrounds the front and sides of the visceral space and is related posteriorly to the carotid space. This article reviews the ultrasound features of the structures located in the infrahyoid region of the neck.     

迷走神经阻滞入路的相关解剖结构研究

目的：对迷走神经阻滞入路相关结构及其毗邻关系进行解剖学观测,为迷走神经阻滞入路和预防并发症的发生提供解剖学基础。方法：对60个成人颅骨（120侧,其中男60侧,女60侧）和30侧成人头、颈部标本迷走神经的毗邻结构进行解剖学观测。结果：迷走神经阻滞进针的深度（乳突尖至颈静脉孔外侧缘的距离）：男性左侧为24.5±0.5mm(17.0—30.2mm),右侧为24.9±0.7mm(19.5—30.4mm);女性左侧为23.1±0.4mm(16.0—28.5mm),右侧为22.7±0.6mm(13.0—28.3mm)。观测获得了乳突尖至茎乳孔的距离,茎乳孔至颈静脉窝外侧缘的距离。颈静脉孔的变异情况,迷走神经在颈静脉孔内、外与其他结构的关系。结论：可以乳突为标志作为预测颈静脉孔位置深度的参考数据。穿刺时,应注意避免误伤面神经和颈内静脉。     

二腹肌后腹的应用解剖及临床意义

目的 通过对二腹肌后腹大体和显微解剖,观察二腹肌后腹的位置与毗邻关系,为临床治疗提供依据。 方法 2011年2月－2012年6月,对10具20侧成人尸体标本作解剖学研究,观察二腹肌后腹与周围相邻组织结构的位置。 结果 二腹肌后腹位置恒定,其深面有重要的神经血管。依次有寰椎横突、颈内静脉、枕动脉、副神经、颈外动脉、面动脉、舌下神经及耳后动脉等重要结构。 结论 掌握二腹肌后腹的外科解剖特点,在进行颌面外科手术时,可以避免损伤有关神经和血管等重要结构,具有重要的临床指导意义。     

多灶性运动神经病周围神经超声特征

目的 观察多灶性运动神经病（MMN）患者周围神经的超声特征。方法 纳入8例MMN患者（MMN组）及18名健康志愿者（对照组）,观察MMN超声特征,并与肌电图诊断结果对比,比较组间周围神经横截面积（CSA）的差异。结果 超声与肌电图共检查8例MMN患者的96条周围神经,诊断周围神经异常率分别为32.29%（31/96）及31.25%（30/96）,均以正中神经（68.75% vs 56.25%）及尺神经（50.00% vs 56.25%）异常为主。超声及肌电图对其中73条（73/96,76.04%）的诊断结果一致,超声表现包括神经增粗、回声减低、束状结构消失及外膜回声增强。MMN组双侧正中神经、双侧尺神经及左侧腓总神经CSA明显大于对照组（P均<0.05）,其余神经CSA组间差异均无统计学意义（P均>0.05）。结论 MMN超声异常多见于上肢正中神经及尺神经,与肌电图检查结果结合可为临床诊断MMN提供更多信息。     

The reliability of assessing sternocleidomastoid muscle length and strength in adults with and without mild neck pain

Background: The sternocleidomastoid (SCM) is an important cervical spine muscle. Weakness of the SCM muscle has been implicated with cervical problems. No studies have examined the reliability of assessing the SCM muscle length or strength. Also no studies exist that have looked to see if imbalances in SCM muscle length or strength exists between the left and right sides in those with and without neck pain. Objective: To determine the reliability of assessing the SCM muscle for length and strength and to see if SCM length could predict SCM strength in those with and without neck pain. Design: Cross-sectional study. Methods: Fifty-one subjects with and without mild neck pain. Analysis: Intratester reliability was assessed for SCM muscle length and SCM muscle strength. Differences in SCM length and strength were examined in those with and without neck pain. Results: Intratester reliability was shown to be excellent (ICC (2,2) > 0.90) for the left and right SCM when assessing muscle length and muscle strength for those with and without neck pain. No differences were noted when comparing left to right SCM between those with and without neck pain regarding muscle length or muscle strength. Neither regression models were able to predict SCM muscle strength from SCM muscle length. Conclusion: SCM muscle length and SCM strength can be reliably assessed using a bubble goniometer and HHD. No differences were found when comparing left to right SCM muscle length or strength in those with or without mild neck pain.     

Dyspnea as the predominant manifestation of bilateral phrenic neuropathy

Phrenic neuropathy associated with brachial neuritis has been well described; however, bilateral phrenic neuropathy with minimal or no involvement of the brachial plexus has not. We review the clinical features, as well as the results of radiographic studies, pulmonary function tests, and electrodiagnostic studies, of 3 patients in whom dyspnea was the presenting manifestation of bilateral phrenic neuropathy. All 3 patients had acute-onset dyspnea, which led to consideration of a pulmonary or cardiac etiology. Phrenic nerve conduction studies showed bilateral axonal degeneration of the phrenic nerves. Diaphragmatic paralysis should be considered in the differential diagnosis of acute-onset dyspnea. Dyspnea increases typically when the patient lies down, and paradoxical respiration may be present. Neck, shoulder, or upper limb pain may occur at onset. Inspiratory pressures may be reduced, but a comparison of the forced vital capacity when the patient is standing and supine is more specific for diaphragmatic weakness. Phrenic nerve conduction studies and diaphragmatic electromyography may provide evidence of bilateral involvement. Subclinical evidence of brachial plexus involvement may be present. The prognosis for patients with bilateral phrenic neuropathy may be more favorable than reported previously.     

声触诊组织量化成像技术评价正常成人臂丛神经弹性特征

目的 采用声触诊组织成像量化(VTIQ)技术评价正常成人臂丛神经的弹性特征.方法 选取健康志愿者72名,测量两侧C5、C6、C7神经根出口及结节水平剪切波速度(SWV);对结果行一致性检验,对比分析两侧及同条臂丛神经出口及结节水平的SWV.结果 正常臂丛神经出口及结节水平不同测量部位的SWV差异均无统计学意义(P均＞0...     

地震致周围神经损伤的超声特征

目的 探讨地震所致周围神经损伤患者的晚期超声特征。方法 对34例地震所致周围神经损伤患者于伤后1年行高频超声检查,并与手术结果比较。结果 34例患者中,超声检出周围神经异常68条;9例为1条神经损伤, 17例2条神经损伤,8例累及3条及以上神经损伤。其中神经与周围瘢痕组织粘连、卡压48条,神经完全断裂6条,神经吻合术后5条,截肢术后神经末端创伤性神经瘤形成9条。超声与手术结果的符合率为97.06%。结论 地震所致周围神经损伤晚期以多条神经同时受损、1条神经多处损伤为特征,主要为瘢痕粘连、卡压所致。超声可对神经损伤进行定性和定位诊断。