超声造影联合Lemur-酪氨酸激酶3水平诊断甲状腺乳头状癌及预测其颈部淋巴结转移的价值

目的 探讨超声造影（CEUS）联合Lemur-酪氨酸激酶3(LMTK3)水平诊断甲状腺乳头状癌（PTC）及预测其颈部淋巴结转移的价值。方法 选取我院经手术病理证实的92例甲状腺结节患者,根据病理结果分为良性组42例和PTC组50例,其中PTC组根据有无颈部淋巴结转移进一步分为转移组28例和非转移组22例,术前均行甲状腺CEUS检查和LMTK3水平检测,比较良性组与PTC组、转移组与非转移组CEUS特征和LMTK3水平的差异。绘制受试者工作特征（ROC）曲线评估CEUS和LMTK3水平单独及联合应用诊断PTC及预测其颈部淋巴结转移的效能。结果 PTC组CEUS等增强、低增强、非均匀增强、灌注缺损、增强时边界不清晰占比及达峰时间（TTP）、CEUS量化值、LMTK3水平均高于良性组,峰值强度（PI）低于良性组,差异均有统计学意义（均P<0.001）。转移组CEUS等增强、高增强、非均匀增强、灌注缺损、增强时边界不清晰占比及TTP、PI、CEUS量化值、LMTK3水平均高于非转移组,差异均有统计学意义（均P<0.05）。ROC曲线分析显示,与CEUS和LMTK3水平单独应用比较,...     

Combination of Lymphatic and Intravenous Contrast-Enhanced Ultrasound for Evaluation of Cervical Lymph Node Metastasis from Papillary Thyroid Carcinoma: A Preliminary Study

The aim of this prospective study was to evaluate the value of the combination of lymphatic contrast-enhanced ultrasound (LCEUS) and intravenous contrast-enhanced ultrasound (IVCEUS) for the identification of cervical lymph node metastasis (CLNM) from papillary thyroid carcinoma (PTC). From November 2018 to March 2019, 24 consecutive patients with PTC were evaluated. All patients underwent routine US, LCEUS and IVCEUS. Pathology was used as the gold standard. After injection of a contrast agent into the thyroid parenchyma, lymphatic vessels and lymph nodes (LNs) could be exclusively displayed as hyper-enhancement on LCEUS. Benign LNs displayed a complete bright ring (100%) and homogeneous perfusion (88.9%) on LCEUS, while displaying centrifugal perfusion (66.7%) and homogenous enhancement (88.9%) on IVCEUS. Perfusion defects (94.9%) and interruption of the bright ring (71.8%) were the two characteristic LCEUS signs for diagnosing CLNM. On IVCEUS, CLNM appeared as centripetal perfusion (59.0%) and heterogeneous enhancement (59.0%). After comparison with pathology, perfusion defect was correlated to the metastatic foci in the medulla and interruption of the bright ring to the tumor seeding in the marginal sinus (all p values <0.05). LCEUS had more value (area under the receiver operating characteristic curve [AUC] = 0.850, 95% confidence interval [CI]: 0.682–1.000) in diagnosing CLNM than IVCEUS (AUC = 0.692, 95% CI: 0.494–0.890) and routine US (AUC = 0.581, 95% CI: 0.367–0.796). The combination of LCEUS and IVCEUS has the highest diagnostic value (AUC = 0.863, 95% CI: 0.696–1.000). LCEUS had higher diagnostic value than IVCEUS and US for CLNM from PTC. The combination of LCEUS and IVCEUS has the highest diagnostic value for CLNM.     

Clinical Application of Contrast‐Enhanced Ultrasonography in Diagnosis of Superficial Lymphadenopathy

Objective. The purpose of this study was to evaluate the value of contrast‐enhanced ultrasonography (CEUS) in differential diagnosis of superficial lymphadenopathy. Methods. Ninety‐four superficial enlarged lymph nodes in 94 patients were studied by conventional ultrasonography (gray scale and color Doppler) and CEUS. Contrast‐enhanced sonograms were analyzed using contrast‐specific quantification software. All of the results were compared with pathologic diagnoses. Results. Of the 94 lymph nodes examined, 44 were benign and 50 were malignant (33 metastases and 17 lymphomas). The sensitivity, specificity, and accuracy of conventional ultrasonography in differential diagnosis between benign and malignant nodes were 51%, 47%, and 55%, respectively. Contrast‐enhanced ultrasonography showed intense homogeneous enhancement in 39 of 44 benign lymph nodes, inhomogeneous enhancement in 32 of 33 metastases, and intense homogeneous enhancement and absence of perfusion in 9 of 17 and 6 of 17 lymphomas, respectively. The sensitivity specificity, and accuracy of CEUS were 84%, 79%, and 80%. After time‐intensity curve gamma variates were calculated, the area under the curve of the benign lymph nodes was greater than those of the metastatic lymph nodes and lymphomas (P < .01). Conclusions. These results indicate that the use of CEUS and contrast‐specific software has a higher degree of diagnostic accuracy than conventional ultrasonography for evaluations of superficial lymphadenopathy. The contrast enhancement patterns and time‐intensity curves provide valuable diagnostic information for differential diagnosis of benign and malignant lymph nodes.     

CEUS鉴别诊断颈部不同大小淋巴结的良恶性

目的 观察CEUS对颈部不同大小良恶性淋巴结的鉴别诊断价值。方法 将经病理证实的142枚颈部增大淋巴结（良性68枚,恶性74枚）按最大径分为<1 cm、1~2 cm和>2 cm组,行常规超声及CEUS检查,观察其常规超声特征及造影灌注模式,并与病理对照。结果 良性淋巴结55.88%（38/68）表现为均匀高增强型,26.47%（18/68）表现为有规则无灌注区的不均匀增强型或环状增强型;恶性淋巴结中72.97%（54/74）表现为有不规则灌注缺损区的不均匀增强型,14.86%（11/74）为微弱增强型。常规超声鉴别诊断<1 cm、1~2 cm和>2 cm 3组淋巴结良恶性的准确率分别为62.16%（23/37）、69.49%（41/59）和78.26%（36/46）,CEUS诊断的准确率分别为81.08%（30/37）、86.44%（51/59）和86.96%（40/46）;相比常规超声,CEUS能够显著提高对最大径1~2 cm良恶性淋巴结的诊断准确率（P=0.02）。结论 CEUS对鉴别诊断良恶性淋巴结具有一定价值,尤其对最大径1~2 cm淋巴结。     

Contrast-enhanced ultrasound–based nomogram for predicting malignant involvements among sonographically indeterminate/suspicious cervical lymph nodes in patients with differentiated thyroid carcinoma

This prospective study was aimed at assessing the value of nomograms based on conventional and contrast-enhanced ultrasound (CEUS) features in the pre-operative diagnosis of sonographically indeterminate/suspicious lymph node metastasis (LNM) in patients with differentiated thyroid carcinoma (DTC). A total of 72 cervical LNs from 47 patients with DTC from January to June 2018 were included in the primary data set, and 30 LNs from 15 patients with DTC from July to August 2018 were included in the external validation data set. The LNs of the included patients were preoperatively evaluated by conventional ultrasound (US) and CEUS. Each included LN was labeled by puncture localization with carbon nanoparticle suspension injection (Canalin) under US guidance and dissected separately to ensure the one-to-one correspondence between ultrasonic features and pathology status. Univariate logistic regression analysis was used to identify risk factors for LNM. A nomogram was used to construct a prediction model for cervical metastatic LNs. Round shape, absence of hilar structure, peripheral or mixed blood flow and centripetal or mass enhancement were risk factors for lymph node metastases. The area under the receiver operating characteristic curve of the nomogram model based on conventional US and CEUS features was 0.93 (95% confidence interval: 0.872–0.985), which was superior to that of the nomogram based on conventional US features(0.85, 95% confidence interval: 0.707–0.989). CEUS features can provide incremental benefit in the diagnosis of LNM among DTC cohorts. Nomograms based on conventional US and CEUS features can predict LN status with high accuracy.     

超声造影在头颈部淋巴结良恶性病变鉴别诊断中的应用

目的分析头颈部淋巴结病变超声造影(CEUS)特点。方法对38例(89枚)头颈部淋巴结肿大患者进行CEUS检查,观察淋巴结的强化分布类型并对其时间-强度曲线进行分析。结果 89枚淋巴结中,穿刺或手术后病理证实33枚(37.1%)为良性淋巴结,56枚(62.9%)为转移性淋巴结。良性淋巴结表现以均匀强化为主(26/33,78.8%,P=0.000),转移性淋巴结以不均匀强化为主(32/56,57.1%,P=0.000)。良性淋巴结时间-强度曲线形态以快退为主(19/33,57.6%,P=0.000),转移性淋巴结以慢退为主(50/56,89.3%,P=0.000)。CEUS鉴别诊断良恶(转移)性淋巴结的敏感度、特异度分别为92.9%、72.7%,常规超声为82.1%、69.7%,两者之间比较差异无统计学意义(P=0.649,P=0.239);两种手段结合应用敏感度、特异度分别为98.2%、84.8%,与常规超声比较,仅敏感度差异具有统计学意义(P=0.011)。结论 CEUS可以对颈部淋巴结进行良恶性鉴别,能够在强化分布、灌注模式(进退方式)方面提供有用的信息,与常规超声结合使用,则可明显提高其诊断的敏感度。     

常规超声及超声造影对无灌注缺损型颈部淋巴结良恶性的诊断价值

目的分析无灌注缺损型颈部淋巴结的超声特征,构建淋巴结良恶性预测模型,探讨该模型对良恶性病变的诊断价值。 方法回顾性分析2013年1月至2020年5月于浙江大学医学院附属杭州市胸科医院就诊的57例患者共计61个颈部淋巴结,所有病变淋巴结均经常规超声及超声造影（CEUS）检查,且CEUS均未显示灌注缺损征象。依据病理及Gene X-pert MTB/RIF检查结果将淋巴结分为良性组45个、恶性组16个,比较2组淋巴结长径与短径比值（L/S）、皮质回声、淋巴门、钙化灶、淋巴结后方回声、彩色多普勒血流成像（CDFI）及CEUS灌注特征,采用单因素χ²检验或Fisher检验及多因素Logistic回归分析,筛选恶性病变的危险因素,建立Logistic回归模型,绘制ROC曲线评价该模型预测能力。 结果常规超声及CEUS特征单因素分析显示：L/S（χ²=5.785,P＜0.05）、淋巴门（χ²=4.419,P＜0.05）、钙化灶（P＜0.05）、CDFI（χ²=16.775,P＜0.001）、灌注模式（χ²=13.090,P＜0.001）和淋巴门增强（χ²=15.993,P＜0.001）,2组间比较差异有统计学意义。二分类Logistic回归分析显示CDFI非门型、向心性灌注模式、淋巴门无增强为恶性病变的危险因素,这3项特征变量构建Logistic回归模型,即Y=-4.732+1.795X₄+1.989X₅+2.734X₆,ROC曲线下面积为0.921（95%CI：0.846~0.996）,其预测恶性淋巴结的敏感度、特异度、阳性预测值、阴性预测值分别为81.3%、93.3%、81.3%、93.3%。 结论基于常规超声及CEUS特征构建的预测模型对无灌注缺损型颈部淋巴结良恶性具有较高的鉴别诊断价值,可为临床提供一定的诊断依据。     

超声评估甲状腺癌颈部转移淋巴结的研究进展

甲状腺癌近年来呈高发趋势,尤其是乳头状癌（PTC）。PTC预后较好,但部分患者就诊时已有淋巴结转移,后者是术后复发的重要危险因素。常规灰阶超声可评估甲状腺结节及颈部淋巴结形态、大小、边界、内部回声及血流模式等,结合超声造影血流增强模式动态显示及定量参数评估、超声弹性成像可定性判断及测定结节硬度,超声引导下细针穿刺细胞病理学及分子检测可进一步提升对甲状腺乳头状癌颈部转移性淋巴结的诊断能力。本文主要对超声评估甲状腺癌颈部转移淋巴结的研究进展做一综述。     

Meta-Analysis: Contrast-Enhanced Ultrasound Versus Conventional Ultrasound for Differentiation of Benign and Malignant Breast Lesions

This meta-analysis aimed to compare the diagnostic performance of contrast-enhanced ultrasound (CEUS), conventional ultrasound (US) combined with CEUS (US?+?CEUS) and US for distinguishing breast lesions. From thorough literature research, studies that compared the diagnostic performance of CEUS versus US or US?+?CEUS versus US, using pathology results as the gold standard, were included. A total of 10 studies were included, of which 9 compared the diagnostic performance of CEUS and US, and 5 studies compared US?+?CEUS and US. In those comparing CEUS versus US, the pooled sensitivity was 0.93 (95% CI: 0.91–0.95) versus 0.87 (95% CI: 0.85–0.90) and pooled specificity was 0.86 (95% CI: 0.84–0.88) versus 0.72 (95% CI: 0.69–0.75). In studies comparing US?+?CEUS versus US, the pooled sensitivity was 0.94 (95% CI: 0.92–0.96) versus 0.87 (95% CI: 0.84–0.90) and pooled specificity was 0.86 (95% CI: 0.82–0.89) versus 0.80 (95% CI: 0.76–0.84). In terms of diagnosing breast malignancy, areas under the curve of the summary receiver operating characteristic (of both CEUS (p?=?0.003) and US?+?CEUS (p?=?0.000) were statistically higher than that of US. Both CEUS alone and US?+?CEUS had better diagnostic performance than US in differentiation of breast lesions, and US?+?CEUS also had low negative likelihood ratio.     

Value of Contrast-Enhanced Ultrasound in Differentiating Clinically Atypical Subacute Thyroiditis from Papillary Thyroid Carcinomas

Our objective was to provide the various sonographic characteristics of clinically atypical subacute thyroiditis (CAST) in distinguishing CAST from papillary thyroid carcinomas (PTCs) by using conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). Forty-six CAST patients and 50 PTC patients were enrolled in this study. We evaluated the size, shape, margin, echogenicity, calcification, vascularity and CEUS parameters for each nodule. The final diagnosis of CAST was confirmed via fine-needle aspiration (FNA) or surgery. Of the 46 CASTs, 13 (28.3%) were confirmed by surgery to be benign, and 33 (71.7%) were proven by FNA to be benign. Univariate analysis indicated that compared with PTCs, CAST lesions more frequently had wider-than-taller shapes, blurred margins, the absence of microcalcifications, peripheral high echogenicity, the absence of internal vascularity, hypo-enhancement, centrifugal perfusion and a peak intensity index <1 and area under the curve index <1 on pre-operative US and CEUS. A multivariate analysis revealed that clear margins, microcalcifications and centripetal perfusion were independent characteristics related to PTCs for their differentiation from CAST (all p values <0.05). Our study indicated that the pre-operative multiparameter US characteristics may serve as a useful tool for distinguishing CAST from malignant thyroid nodules to avoid surgical excisions or unnecessary FNAs.     

超声造影定量参数与甲状腺乳头状癌组织中微血管密度、颈部淋巴结转移的关系

目的:探究超声造影(contrast-enhanced ultrasound,CEUS)定量参数与甲状腺乳头状癌(papillary thyroid carcinoma,PTC)组织中微血管密度(microvessel density,MVD)、颈部淋巴结转移的关系。方法:抽取2016年9月至2019年1月河南省中医药研究院附属医院手术病理确诊的75例PTC患者,根据颈部淋巴结病理结果分为转移组(24例)、未转移组(51例)。术前均行CEUS检查,获得PTC结节内及周围正常甲状腺组织相关血流灌注参数,取PTC结节、正常组织病理标本经免疫组织化学染色获取MVD,并进行统计学分析。结果:PTC结节达峰时间(time peak,TP)、平均渡越时间(mean transit time,MTT)显著高于周围正常组织,峰值强度(peak intensity,PI)及曲线下面积(area under the curve,AUC)显著低于周围正常组织(P<0.05),且MVD显著低于周围正常组织(P<0.05)。Spearman秩相关性分析显示PTC结节的造影参数TP,MTT与MVD无明显相关性(P>0.05),而PI,AUC与MVD明显正相关(P<0.05)。与未转移组相比,转移组PI,AUC,MVD显著增高(P<0.05),TP,MTT未见明显差异(P>0.05)。PI,AUC预测颈部淋巴结转移的受试者工作特征(receiver operating characteristic,ROC)的AUC分别为0.864,0.877,确定临界值后PI和AUC预测颈部淋巴结转移的敏感度均≥75.0%,特异度均为88.2%。多因素logistic同归分析显示病灶数目、肿瘤大小、PI和AUC为预测颈部淋巴结转移的独立危险因素(P<0.05)。结论:CEUS血流灌注参数PI、AUC与PTC组织中MVD显著相关,并对颈部淋巴结转移有一定预测价值,可作为PTC术前评估的无创性方法。     

高帧频超声造影在鉴别浅表淋巴结性质中的应用

目的应用高帧频超声造影（H-CEUS）技术观察浅表淋巴结微循环灌注模式,评价H-CEUS对浅表淋巴结良恶性的鉴别诊断效能。 方法选取2019年7月至2020年1月因怀疑浅表淋巴结异常而就诊于解放军总医院第一医学中心并行穿刺活检术或手术切除取得病理结果的患者39例,对39例浅表淋巴结先后进行H-CEUS、常规帧频超声造影（CEUS）检查,对比观察2种造影模式下淋巴结动脉期微血管灌注模式（向心性、离心性、混合性）显示的敏感度,并与病理结果对照,采用χ²检验分析两种超声检查模式的特异度、敏感度、准确性,并采用受试者操作特征（ROC）曲线分析2种超声造影模式的诊断效能。 结果H-CEUS对于浅表淋巴结动脉期微血管灌注模式的显示敏感度优于CEUS。CEUS的诊断特异度、敏感度、准确性分别为87.5%、73.3%、82.1%。H-CEUS的诊断特异度、敏感度、准确性分别为92.0%、85.7%和89.7%。H-CEUS与CEUS的ROC曲线下面积分别为0.889、0.813。H-CEUS与CEUS对淋巴结性质的鉴别与病理结果对比,差异均无统计学意义（P均>0.05）;Kappa一致性分别为0.777和0.616。 结论H-CEUS可以通过提高造影图像的帧频而获得更高的时间分辨力,对于浅表淋巴结动脉期的微血管构架及动脉期灌注细节显示更清晰直观,可为诊断浅表淋巴结的性质提供更多有价值的信息。     

多模态超声在颈部淋巴瘤诊断中的价值

目的探讨多模态超声检查在颈部淋巴瘤诊断中的价值。 方法回顾性分析杭州市红十字会医院2016年6月至2018年4月疑似颈部淋巴瘤的98例患者的超声声像图资料，包括二维超声、实时超声弹性成像及超声造影图像。所有患者均取得穿刺活检或手术病理结果。分析颈部淋巴瘤的超声图像特征，并以病理结果为"金标准"，评价单一检查方式及多模态超声对颈部淋巴瘤的诊断价值。 结果98例颈部淋巴结的病理结果为：淋巴瘤58例，转移性淋巴结14例，淋巴结结核13例，反应性增生淋巴结13例。二维超声诊断淋巴瘤的敏感度、特异度与准确性分别为63.8%、60.0%、62.2%。超声造影诊断淋巴瘤的敏感度、特异度与准确性分别为72.4%、72.5%、76.5%。应用二维超声、实时超声弹性成像及超声造影的多模态超声联合诊断淋巴瘤的敏感度、特异度与准确性分别为79.3%、82.5%、80.6%，高于单一检查方法。颈部淋巴瘤二维超声图像中低或极低回声背景下见条状、网格样回声（38/58，65.5%）及超声造影弥漫性增强（47/58，81.0%）、峰值时呈均匀增强（53/58，91.4%），与非淋巴瘤组比较差异有统计学意义（P均<0.05）。而淋巴瘤组实时弹性成像评分≤2分的占46.6%（27/58），弹性成像评分≥3分的占53.4%（31/58），与非淋巴瘤组比较差异无统计学意义（P>0.05），弹性评分不能有效区分淋巴瘤。 结论多模态超声检查的应用可为颈部淋巴瘤的诊断提供更多信息，避免了单一超声模式的局限性，尤其超声造影暴风雪样增强与二维超声淋巴结呈低回声背景下条状或网格状回声的特征，更有助于对颈部淋巴瘤的超声诊断。     

A Pilot Study on Diagnostic Performance of Contrast-Enhanced Ultrasonography for Detection of Early Cervical Cancer

In this cohort study of 49 women with all stages of cervical cancer and 21 healthy controls, we compared contrast-enhanced ultrasonography (CEUS) filling pattern and semi-quantitative parameters in the two groups. Participants were examined with conventional grayscale and power Doppler ultrasound (US) followed by CEUS, using a 2.5?mL bolus of intravenous contrast agent. CEUS video clips were analyzed with regard to contrast distribution (focal or global) and semi-quantitative parameters. Focal contrast distribution was found in 3% (1/32) of the women with no tumor versus 89% (34/38) of women with histologically detectable tumor. A semi-quantitative analysis showed that the amount of contrast over a period of the whole tumor (area under the curve [AUC[ 0.92, 95% confidence interval [CI] 0.87–1.0), and the maximal intensity area (AUC 0.94, 95% CI 0.84–1.0) could accurately distinguish tumors from healthy tissue. In conclusion, the CEUS parameters differ significantly between tumors and healthy cervical tissue.     

双源CT能谱参数定性诊断甲状腺乳头状癌术后颈部转移淋巴结

目的 探讨双源CT能谱参数对定性诊断甲状腺乳头状癌（PTC）术后颈部转移淋巴结的价值。方法 选取PTC术后颈部淋巴结肿大患者30例、共74枚肿大淋巴结,其中49枚为转移性淋巴结（转移组）,25枚为非转移性淋巴结（非转移组）。另选30例良性病变患者作为良性增生组（30枚良性肿大淋巴结）。行双源CT平扫及增强扫描,测量并比较组间平扫、动脉期、静脉期碘浓度（分别记为IC_平扫、IC_动脉、IC_静脉）及标准化碘浓度（NIC）、能谱曲线斜率（K）。结果 3组间IC_平扫、IC_动脉、IC_静脉、NIC及K值差异均有统计学意义（P均<0.05）;转移组IC_平扫低于非转移组及良性增生组,IC_动脉、NIC及K值均高于非转移组及良性增生组（P均<0.05）;非转移组与良性增生组间IC_平扫、IC_动脉、IC_静脉、NIC及K值差异均无统计学意义（P均>0.05）。结论 双源CT能谱参数可用于定性诊断PTC术后颈部转移淋巴结。     

超声在激光消融甲状腺乳头状癌颈部转移性淋巴结中的应用价值(附3例报告)

目的:探讨超声在经皮激光消融(percutaneous laser ablation,PLA)治疗甲状腺乳头状癌颈部转移性淋巴结中的应用价值。方法:对3例甲状腺乳头状癌颈部转移性淋巴结患者行超声引导下PLA治疗,术后采用彩色多普勒超声观察淋巴结血供,术后即刻和3 d采用超声造影观察消融灶范围,并观察有无并发症发生。术后30 d对淋巴结进行超声随访及血清甲状腺球蛋白水平测定。结果:3例患者均采用局部麻醉成功进行了PLA治疗,未发生明显并发症。术后彩色多普勒超声观察发现消融区无彩色血流信号,术后即刻和术后3 d超声造影显示消融范围内无明显造影剂灌注,术后30 d超声随访发现淋巴结有不同程度的缩小,而患者的血清甲状腺球蛋白水平在治疗前后保持稳定,未升高。结论:超声在PLA治疗甲状腺乳头状癌颈部转移性淋巴结中具有一定的应用价值。     

彩色多普勒超声结合针吸细胞学检查在宫颈癌腹股沟淋巴结复发转移中的诊断价值

目的：评价彩色多普勒超声（Color doppler ultrasonography,CDU）结合超声引导下针吸细胞学检查（Ultrasound guided fine needle aspiration cytology,US-FNAC）在宫颈癌治疗后患者腹股沟淋巴结复发转移中的诊断价值。方法对308例宫颈癌治疗后患者的580枚腹股沟淋巴结行CDU检查,记录其形态、内部回声、皮髓质结构、淋巴门结构及内部血流状况等超声图像特征,并将其诊断结果和US-FNAC的结果相对比,评价超声诊断宫颈癌腹股沟淋巴结复发转移的准确性。结果580枚淋巴结中566枚取材满意,78枚淋巴结为转移性淋巴结。转移性与非转移性腹股沟淋巴结的形态、内部回声、皮髓质结构、淋巴门结构及内部血流状况等超声表现差异均有统计学意义（P〈0.05）,表现为类圆形或融合状、内部均匀低回声、皮髓质结构不清、淋巴门消失或偏心性、血流丰富的淋巴结具有复发转移倾向,其诊断准确率分别为90.8%、82.3%、80.6%、58.7%、67.0%。结论宫颈癌治疗后患者的复发转移性腹股沟淋巴结在形态、内部回声、皮髓质结构、淋巴门结构及内部血流等方面均有显著的特征性,US-FNAC可进一步对腹股沟淋巴结的病理性质作出判断,提高诊断的准确性。     

Hypoechoic focal liver lesions: characterization with contrast enhanced ultrasonography

PURPOSE: To evaluate the late sinusoidal phase of contrast enhancement with a 2nd-generation ultrasound contrast enhanced medium in the characterization of hypoechoic focal liver lesions. METHODS: We studied 88 hypoechoic liver lesions (diameter range, 1-18 cm; with 18 lesions 2 cm or less) found on conventional grayscale sonography (US) with contrast-enhanced ultrasonography (CEUS). Final diagnosis was made using contrast enhanced helical CT, contrast enhanced MR, angiography (DSA), and/or histopathic confirmation or clinical imaging follow-up. RESULTS: There were 37/88 benign lesions demonstrated: 17 cavernous hemangiomas, 3 capillary hemangiomas, 11 focal nodular hyperplasias (FNH), 3 focal areas of sparing in hepatic steatosis, 2 adenomas, and 1 intrahepatic necrotic area. Malignant lesions demonstrated included 51/88: 27 hepatocellular carcinomas (HCC) in cirrhosis, 11 metastatic carcinomas, 10 metastatic endocrine tumors, 2 cholangiocellular carcinomas (CCC) and 1 non-Hodgkin's lymphoma (NHL). CEUS characterized 30/37 (81%) benign lesions and 45/51 (88%) malignant lesions. On the basis of the results obtained during the sinusoidal contrast enhanced phase of CEUS, diagnosis of benignancy was possible in 35/37 (95%) of benign liver lesions and diagnosis of malignancy in 49/51 (96%) of malignant liver lesions. The enhancement pattern of 13 small (< or = 2 cm in diameter) hypervascular liver lesions (3 capillary hemangiomas, 2 FNHs, 4 HCCs, 4 metastatic endocrine tumors) was better demonstrated on CEUS than on helical CT. In these cases the hyper vascularization of the lesions shown on CEUS was not confirmed on CT. CONCLUSIONS: CEUS distinguished malignant from benign hypoechoic liver lesions with an accuracy of 95%.     

Conventional Ultrasound and Contrast-Enhanced Ultrasound in the Diagnosis of Splenic Diseases

Accurate diagnosis of splenic diseases is important for timely and accurate treatment. The objective of this study was to compare the accuracy of contrast-enhanced ultrasound (CEUS) and conventional ultrasound (US) in detecting splenic lesions. A systematic literature search was undertaken, and 8 studies met the inclusion criteria. The sensitivity and specificity of the consolidated results of CEUS were 0.95 (95% confidence interval [CI], 0.92–0.97) and 0.97 (95% CI, 0.90–0.99), respectively (I² = 27.4%; area under the curve [AUC] from a summary receiver operating characteristic curve = 0.97). The sensitivity and specificity of the consolidated results of conventional US were 0.70 (95% CI, 0.56–0.80) and 0.96 (95% CI, 0.76–0.99; I² = 83.4%; AUC = 0.84). In this systematic review and meta-analysis, the sensitivity and specificity of CEUS were higher than those of conventional US in diagnosing splenic lesions. Contrast-enhanced US is a promising method for accurately diagnosing splenic lesions.     

Combining the Arterial Phase of Contrast-Enhanced Ultrasonography,Gadoxetic Acid-Enhanced Magnetic Resonance Imaging and Diffusion-Weighted Imaging in the Diagnosis of Hepatic Nodules ≤20 mm in Patients with Cirrhosis

Contrast-enhanced ultrasonography (CEUS) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) were compared with respect to diagnostic efficacy in the detection of small hepatocellular carcinoma. A new diagnostic strategy that combines the arterial phase of CEUS, the hepatobiliary phase of EOB-MRI and diffusion-weighted MR imaging (DWI) is described. One hundred sixteen nodules were enrolled to validate the performance of the strategy. For lesions ≤20 mm in size, the areas under the receiver operating characteristic curves (Az) of CEUS and EOB-MRI were 0.930 (95% confidence interval [CI]: 0.867–0.969) and 0.920 (95% CI: 0.855–0.962) (p?=?0.796), respectively. The Az value of the new diagnostic strategy was 0.985 (95% CI: 0.942–0.999) (vs. CEUS, p?=?0.026; vs. EOB-MRI, p?=?0.014). The sensitivity, specificity and diagnostic accuracy of the new strategy were 95.5% (95% CI: 88.9%–98.8%), 96.3% (95% CI: 81.0%–99.9%) and 95.7% (95% CI: 91.9%–99.4%), respectively. The new diagnostic strategy based on the arterial phase of CEUS, hepatobiliary phase of EOB-MRI and DWI represents an appealing solution for distinguishing small hepatocellular carcinomas from benign lesions, especially when the nodules present atypical enhancement patterns.