脾脏错构瘤1例

患者男性,61岁。主因“无明显诱因出现腹部疼痛3天”入院。体格检查：腹平坦,未见肠形及蠕动波,左上腹压痛,无反跳痛及肌紧张,未触及异常肿物,肝脾未触及,M ur-phy征阳性,肝肾区无叩痛,移动性浊音阴性,肠鸣音正常。门诊CT检查回报：脾脏体积增大,脾内类圆形混杂密度病变;胆囊炎。入院后初步诊断：腹痛待查;脾脏肿物待查;胆囊炎。患者入院后行超声检查显示：脾脏中部见一类圆形略强回声区,边界不清,范围约52mm ＆#215;42mm ,CDFI ：略强回声区血流呈抱球样改变,脉冲多普勒可测到动、静脉频谱。行超声造影检查：经肘静脉团注超声造影剂 Sono Vue 1．2ml后,脾脏正常组织增强时间为18s ,病灶开始增强时间为16s ,略早于脾脏正常组织,动脉期呈不均匀增强,先为中心高增强,并迅速充填周围病灶组织,达峰时间为42s ,实质期呈低增强,逐渐缓慢廓清,基本廓清时间3min20s。超声造影提示：脾内实质性占位。造影剂呈快进慢出型,考虑：良性病变（图1,2）。     

脾脏占位性病变的超声诊断

目的:探讨脾脏占位性病变的超声诊断价值.方法:分析15例经病理和临床证实的脾脏占位性病变的超声资料,包括脾卡波西氏肉瘤1例,脾血管肉瘤1例,脾弥漫性非何杰金氏淋巴肉瘤1例,脾非霍奇金氏淋巴瘤2例,脾何杰金氏病(结节型)1例,脾转移癌4例,脾淋巴管瘤2例,脾囊肿2例,脾脓肿1例.结果:超声检查能清楚的显示,脾脏占位病变的大小、形态回声特征与周围器官组织的关系;超声对脾脏占位性病变的检出率100%,定性准确率为73.3%.结论:超声对脾脏占位性病变有较高的诊断价值,可作为首选的影像学检查方法.     

超声造影在移植肝脏局灶性低回声病灶鉴别诊断中的应用

 目的 评价超声造影技术在肝移植术后肝脏局灶性低回声病灶鉴别诊断中的应用价值.方法 对肝移植术后肝脏出现局灶性低回声病灶患者,用西门子 Sequoia512彩色多普勒超声诊断仪和超声造影剂Sonovue进行超声造影检查,观察3个时相的造影剂灌注模式,并用自动跟踪对比量化技术(Axius ACQ)对病灶及周围肝组织进行定量分析.结果 10例出现局灶性低回声病灶的患者中,超声造影明确诊断梗死灶5例(低回声病灶为无增强,ACQ分析无造影剂灌注),非均质脂肪肝3例(低回声病灶在动脉相、门脉相呈高增强,ACQ分析该区域为正常肝组织,周围肝组织为血流灌注不良区域),肝癌复发2例(其特征为动脉相快速均匀高增强,门脉相及延迟相快速消退).结论 超声造影技术能较好评估肝实质的血流灌注分布情况,有助于移植肝脏梗死灶、非均质性脂肪肝及肿瘤复发的鉴别诊断.     

超声造影对肾脏小占位的诊断分析

目的:探讨不同病理类型肾脏肿瘤的造影特点,评价超声造影诊断肾脏良恶性肿瘤的应用价值,为临床诊断提供依据。方法:应用声学造影剂声诺维对27例超声诊断为肾脏占位病变或可疑肾脏占位病变的患者进行超声造影检查,分析其造影增强图像特点。结果:27例患者均满意获得清晰的肿瘤动态造影灌注图像,大部分与其正常肾组织回声等强,10例肾恶性肿瘤的造影显像比其正常肾组织快,3例肾良性肿瘤造影显像为"同进慢出";4例肾柱肥大造影后与正常肾组织造影剂显像一致;2例肾囊肿内无造影剂显示。结论:超声造影成像技术能清晰显示肾肿瘤的血流灌注特点,对肾脏肿瘤的诊断具有一定实用价值。     

超声造影诊断肝孤立性坏死结节的价值

目的:探讨超声造影诊断肝孤立性坏死结节的价值。材料和方法:回顾分析了12例肝孤立性坏死结节的超声造影表现。结果:12例病灶造影动脉期、门脉期、实质期均无增强,呈边界清晰的造影剂充盈缺损区。结论:超声造影对诊断肝孤立性坏死结节具有较高的价值。目的:探讨超声造影诊断肝孤立性坏死结节的价值。材料和方法:回顾分析了12例肝孤立性坏死结节的超声造影表现。结果:12例病灶造影动脉期、门脉期、实质期均无增强,呈边界清晰的造影剂充盈缺损区。结论:超声造影对诊断肝孤立性坏死结节具有较高的价值。     

脾脏炎性假瘤的影像学表现（附三例报告）

目的 报道3例脾脏炎性假瘤的影像学表现,以提高对本病的认识。方法 复习3例脾脏炎性假瘤的超声、CT扫描和1例MRI表现,并与病理表现进行对照。结果 B超表现为单发球形病变,回声不均匀、边界清楚,其中1例见环状强回声伴后方声影。3例CT平扫见脾内边界清楚的低密度肿块,1例见周边蛋壳样环状钙化;2例作增强扫描,1例静脉期略有增强,另1例延迟扫描病变强化程度与脾实质接近;1例又作MR平扫,T1、T2WI均以低信号为主。结论 脾脏炎性假瘤应列入脾单发肿物的鉴别诊断,其影像表现与肿块内纤维组织和炎性肉芽组织的多少有关。超声表现为边界清楚、回声不均的肿块;CT增强扫描以病变延迟强化为特点;MRT2WI常以低信号为主。     

超声造影诊断肝脏局灶性结节状增生的价值

目的：探讨超声造影诊断肝脏局灶性结节状增生的价值。材料和方法：回顾分析了11例肝脏局灶性结节状增生的超声造影表现。9例于造影后经超声引导穿刺确诊,2例经手术确诊。结果：11例病灶动脉期均快速显著增强。9例病灶动脉早期呈轮辐状增强,造影三期回声强于周边肝实质,实质期可见轮辐状低回声；2例病灶动脉早期快速增强,动脉期及门脉期回声强于周边肝实质,实质期回声与肝实质等同,未见轮辐状低回声。结论：超声造影所显示的肝脏局灶性结节状增生的增强特征,有助于临床诊断。部分病灶超声造影表现缺乏特异性,确诊仍需要结合其他影像学方法和穿刺活检。     

经静脉声学造影诊断睾丸扭转的价值

目的:探讨睾丸扭转时超谐波造影增强后血流灌注特点及诊断价值.材料和方法:对10例疑诊睾丸扭转病例行间歇超谐波声学造影,间歇成像触发间隔1～4s,造影剂剂量0.003ml/kg体重.结果:注射造影剂后16～22s睾丸周边及实质血管显影,回声增强;触发间隔3s时睾丸实质回声强度最大.8例确诊睾丸扭转,睾丸实质内见完全性或区域性造影缺损;2例排除睾丸扭转,睾丸实质内见带状增强回声弥漫性充填.结论:间歇超谐波声学造影低剂量水平即能够敏感地显示组织血流灌注特点,有助于睾丸扭转的诊断.     

超声造影对肝脏转移癌的诊断应用价值

目的:探讨超声造影对肝脏转移癌的诊断应用价值.方法:对49例恶性肿瘤患者肝脏行常规超声检查及低机械指数超声造影检查,对肝内转移性病灶超声造影表现进行分析.结果:经超声造影新发现47个病灶,其中小于1.0cm的病灶占55.3%(26/47).肝转移病灶的增强模式可分为4种:A.病灶周边快速环状强化60/131(45.8%),病灶内部呈低或无增强,之后周边增强部分造影剂迅速退出呈低增强;B.病灶于动脉期呈快速整体强化并迅速廓清51/131(38.9%);C.病灶于动脉期和门脉期基本与肝脏实质同步强化,延迟晚期呈低增强12/131(9.2%);D.病灶于造影三期均低于肝实质呈低增强表现8/119(6.1%).结论:肝脏转移病灶来源和大小不同其增强模式表现亦不相同;实时超声造影可提高对肝脏转移病灶尤其可提高直径小于1.0cm的微小转移灶的检出率.     

超声造影鉴别诊断肾脏占位性病变的价值

目的:探讨超声造影鉴别诊断肾脏占位性病变的意义。材料和方法:对29例肾脏占位性病变进行超声造影检查。观察并分析良、恶性病变的超声造影表现及灌注特征。结果:肾脏恶性病灶造影剂退出时间多早于肾实质(15/16);其中,肾透明细胞癌在造影晚期多表现为病灶周边环状强回声带(8/11)。肾脏良性病灶中,错构瘤6例造影剂退出与肾实质相似,5例晚于肾实质,与肾脏恶性病灶存在显著性差异(P<0.05);1例肾嗜酸细胞瘤及1例中胚叶肾瘤造影开始减退时间早于肾实质,造影晚期亦可见病灶周边环状强回声带,难以与肾恶性病灶鉴别。结论:超声造影能够实时观察肾脏占位性病变的血流灌注情况,对肾占位性病变的诊断及鉴别诊断具有一定的临床意义。     

多普勒超声和超声造影对肝脏局灶性结节样增生的诊断价值

目的:探讨多普勒超声(DUS)和造影增强超声(CEUS)对肝脏局灶性结节样增生(FNH)的诊断价值和影像表现。方法:应用低机械指数超声造影技术(CPS和CPI)对16例FNH的多时相造影增强表现进行分析,并与DUS表现进行对比,来评价它们对FNH的诊断价值。结果:尽管16例FNH多普勒超声均可显示内部血流信号,但与二维超声相比,二者对病灶良、恶性判断的差异并无显著性意义(P>0.05)。16例FNH的超声造影表现:增强自病灶中央开始呈星状或辐射状(81%);门脉和延迟相可见中央瘢痕(69%),除中央瘢痕外,病灶呈均匀增强(100%);延迟相病灶呈等增强或稍高增强(93%)。CEUS对FNH诊断的准确符合率为87.5%,诊断为良性病变的准确符合率达100%,与DUS比较差异有显著意义(P<0.01)。结论:造影增强超声可显著提高FNH诊断的准确性。     

Contrast enhanced ultrasound of splenic lymphoma involvement

Objective

The aim of this study was to compare the value of contrast-enhanced ultrasonography (CEUS) with standard B-mode ultrasound (US) for diagnosis of splenic lymphoma involvement.

Methods

From 04/2005 to 10/2008 n = 250 lymphoma patients were investigated by standard B-mode US. A homogeneous splenic echotexture was found in 199 patients (79%). To clarify the benefit of CEUS in this group a pilot series was performed with 16 of the 199 lymphoma patients. All patients with an abnormal splenic echotexture on standard B-Mode US (n = 51) including focal hypoechoic splenic lesions (n = 41) and an inhomogeneous splenic texture (n = 10) were studied by CEUS. CEUS data were retrospectively evaluated. The diagnoses included indolent lymphoma (n = 27), aggressive lymphoma (n = 14), and Hodgkin's disease (n = 10). Number and size of lesions were determined by B-mode US and CEUS. The visualisation of splenic lymphoma involvement by CEUS in comparison to B-mode US was classified as worse, equal, or better.

Results

All patients with a homogeneous spleen on B-mode US (n = 16) had no visible focal lesions on CEUS. Study patients with focal lesions (n = 41) had a hypoechoic (n = 22) or isoechoic (n = 19) enhancement during the arterial phase, and a hypoechoic enhancement during the parenchymal phase (n = 41). The visualisation of focal splenic lymphoma was equal (n = 32), better (n = 6), or worse (n = 3). In all study patients with an inhomogeneous spleen on B-mode US (n = 10) no focal lesions were found by CEUS and the value of CEUS therefore was classified as worse.

Conclusion

CEUS has no clear advantage for diagnosis of splenic lymphoma involvement.     

Evaluation of hepatocellular carcinoma using SonoVue,a second generation ultrasound contrast agent: correlation with cellular differentiation

The appearance of hepatocellular carcinoma (HCC) with contrast-enhanced ultrasound (CEUS) in the vascular phase is described and evaluated as to whether the enhancement pattern correlates with the degree of cellular differentiation. One hundred four HCCs were prospectively evaluated with CEUS using coherent-contrast imaging (CCI) and SonoVue with a low mechanical index (<0.2). The enhancement of HCCs in the vascular phase was analyzed according to the degree of pathological differentiation obtained by fine-needle biopsy. In the arterial phase, all HCCs except for four well differentiated ones (96.2%) showed enhancement (P<0.05). Histological differentiation of hypoechoic lesions in the early portal phase (7 HCCs; 16%) significantly differed from hyperechoic (1 HCC; 1%) or isoechoic lesions (87 HCCs; 83.6%) (P<0.05), with a significant probability of a worse differentiation in hypoechoic lesions. Histological differentiation of isoechoic lesions in the late phase (30 HCCs; 28.8%) significantly differed from hypoechoic lesions (74 HCCs; 71.2%) (P<0.05), with a significant probability of a better differentiation in isoechoic lesions. CEUS using CCI and SonoVue revealed enhancement in the arterial phase in >95% of HCCs, with a few well-differentiated cases not being diagnosed due to the absence of enhancement. Echogenicity in the portal and late phases correlated with cellular differentiation.     

Abdominal ultrasonography in myelofibrosis.

The findings at abdominal ultrasonography (US) in 40 patients with myelofibrosis were reviewed, 20 patients being examined at initial diagnosis and 31 at later stages. Splenomegaly was found in 80% at initial diagnosis and in 97% at later stages. The spleen of 2 patients appeared homogeneously hypoechoic and inhomogeneous in one. Focal splenic lesions were seen in 5, and calcifications in 6. Mixed splenic lesions proved to be metastases in one and hyperechoic lesions in another patient were due to extramedullary hematopoiesis. Hepatomegaly was found in 25% at primary diagnosis and in 39% at later stages. Focal hepatic lesions were seen in 7 patients, and proved to be metastases in 3. The focal lesions in 2 of these patients were extramedullary hematopoiesis, which was hypoechoic in one and hyperechoic in the other. Ascites was seen in 4 patients and lymphadenopathy in one. US could not reliably differentiate between extramedullary hematopoiesis and malignancy. Fine-needle biopsy may be performed for definitive diagnosis.     

Intrahepatic peripheral cholangiocarcinoma (IPCC): comparison between perfusion ultrasound and CT imaging

PURPOSE: This study was done to compare the perfusion patterns of intrahepatic peripheral cholangiocarcinoma (IPCC) on contrast-enhanced ultrasound (CEUS) and dynamic computed tomography (CT). MATERIALS AND METHODS: We retrospectively reviewed 23 histologically proven cases of IPCC. All lesions were studied by CEUS with sulfur hexafluoride-filled microbubbles coated with a phospholipid capsule, and by dynamic CT. Contrast-enhancement patterns were evaluated in the arterial phase (CEUS 10-20 s after the injection; CT 25-30 s after the injection) and in the delayed phase (CEUS 120 s after the injection; CT>2-3 min after the injection). RESULTS: Lesions were single in 18/23 cases (78%), single with nearby satellite lesions in 1/23 (4%) cases and multifocal with distant secondary lesions in 4/23 (17%) cases. Lesion diameter was 2-5 cm in 7/23 cases (30%), 5-7 cm in 13/23 cases (57%) and >7 cm in 3/23 (13%) cases. On CEUS, lesions were hypervascular in 16/23 cases (70%). On delayed-phase CEUS, 22/23 lesions (96%) were markedly hypoechoic. CT showed that the lesions were hypovascular in the arterial phase in 15/23 cases (66%) and hypervascular in 7/23 (30%) cases; one lesion (1/23; 4%) was isovascular. On delayed-phase CT, lesions were hyperdense in 17/23 cases (74%), hypodense in 5/23 (22%) cases and isodense in 1/23 (43%) cases. CONCLUSIONS: Enhancement discrepancy between delayed-phase CEUS (hypoechogenicity) and CT (hyperdensity) is common semiological findings in the study of IPCC.     

Real-time contrast-enhanced ultrasound imaging of focal liver lesions in fatty liver

PurposeThe objective of this study was to investigate the contrast-enhanced ultrasound (CEUS) imaging features of focal liver lesions (FLLs) in fatty liver.MethodOne hundred FLLs in 98 patients with fatty liver were evaluated with real-time CEUS.ResultsAll malignant FLLs showed hyperenhancement in arterial phase and contrast washout in portal and late phases. Among the FLLs, 3.3% of hemangiomas, 12.5% of focal nodular hyperplasias (FNHs), and 2.5% of focal fatty sparing lesions showed contrast washout in the late phase. The sensitivity and specificity for the characterization of hepatocellular carcinoma, metastasis, hemangioma, FNH, and focal fatty sparing lesions were 100% and 95.6%, 60% and 100%, 93.3% and 98.6%, 87.5% and 97.8%, and 92.6% and 100%, respectively.ConclusionsCorrect characterization of FLLs in fatty liver by CEUS is possible based on their typical enhancement patterns.     

Evaluation of renal urothelial carcinoma by contrast-enhanced ultrasonography

Purpose

To observe ultrasonographic features of urothelial carcinoma in renal pelvis and evaluate contrast-enhanced ultrasound (CEUS) in diagnosis.

Materials and methods

Fifty-two patients with urothelial carcinoma underwent preoperative conventional US, colour Doppler flow imaging (CDFI) and CEUS.

Results

Of 52 total lesions, 41 (78.8%) could be clearly identified by US, and 49 (94.2%) were enhanced by CEUS. Among US-imaged lesions, 39 (95.1%) were solid tumours, and two (4.9%) were mixed solid-cystic; 25 (61.0%) were isoechoic, 11 (26.8%) hypoechoic, and five (12.2%) hyperechoic. Analysis of tumour blood flow by CDFI characterised 17 avascular lesions (41.5% of total), 16 hypovascular (39.0%), and 8 hypervascular (19.5%). The resistance index ranged from 0.65 to 0.88 (mean of 0.71). Enhancement was seen in 49 lesions after injection of SonoVue. A slow enhancement pattern was observed in 36 lesions (73.5%) relative to renal cortex, and 13/49 (26.5%) showed simultaneous enhancement. At peak enhancement, 38 lesions (77.6%) were hypo-enhanced, six (12.2%) iso-enhanced, and five (10.2%) hyper-enhanced. There were 12 lesions with intertumoural necrosis or haemorrhage (24.5%) that were heterogeneously enhanced, and 37 (75.5%) were homogeneously enhanced. A fast washout pattern was observed in 46 lesions (93.9%), synchronous washout in two (4.08%), and slow washout in one (2.04%).

Conclusions

Slow-in, fast-out, and hypo-enhancement properties are associated with renal urothelial carcinoma and may thus have diagnostic value. We found that CEUS is able to identify tumours that are ambiguous by conventional US, and it thus significantly improves the confidence of diagnosis.     

Focal nodular hyperplasia: spoke-wheel arterial pattern and other signs on dynamic contrast-enhanced ultrasonography

OBJECTIVE: To evaluate the prevalence of spoke-wheel pattern and typical symptoms of focal nodular hyperplasia (FNH) by means of dynamic contrast-enhanced ultrasonography (CEUS) in relation to lesion size. METHODS: Twenty-eight patients were included in the trial, in whom, based on the CEUS, we raised suspicion of hypervascularized liver lesion; there were 30 lesions altogether. The final diagnosis of FNH was verified by means of CT, MRI or lesion biopsy. Majority of patients (26) were females, compared to 2 male, with average age of 33.3 years. Average lesion size was 45.6 mm. Besides the ultrasound examination, we used also "blood pool" ultrasound contrast agent of second generation, sulphur hexafluoride (BR1); we evaluated enhancement of the lesion until the late stage-within 5 min from application. RESULTS: In lesions larger than 3 cm (n=20), stellate vascular enhancement was found in 19 cases (95.0%) early in arterial phase. As for lesions smaller than 3 cm (n=10), spoke-wheel pattern was observed only in 3 cases (30%) and lesions smaller than 2 cm practically did not show this phenomenon at all (n=1; 17%). Generally, symptom of spoke-wheel pattern was observed in 22 cases, i.e. in 73.3%. In total, central scar was present in 63.3% (n=19) of cases. In lesions larger than 3 cm, it was present in 85.0% (n=17), in lesions smaller than 3 cm in 20% (n=2). CONCLUSION: Contrast-enhanced ultrasonography can be the final diagnostic method for FNH larger than 3 cm which has typical spoke-wheel vessel structure on CEUS. If this phenomenon is not present and the central scar is not visible, specific diagnosis of FNH cannot be based solely on CEUS findings.     

Imaging of segmental testicular infarction: our experience and literature review

PURPOSE: The purpose of this study was to evaluate the usefulness of the main methods of diagnostic imaging in patients with segmental testicular infarction (STI) for obtaining accurate clinical and therapeutic approaches. MATERIALS AND METHODS: Between January 2004 and January 2011, 798 patients were examined with colour Doppler ultrasound (CDUS) for disease of the scrotum. Fourteen patients with CDUS findings suspicious for STI were subjected to magnetic resonance imaging (MRI). In five patients, contrast-enhanced ultrasonography (CEUS) was performed. RESULTS: CDUS showed hypoechoic avascular areas suspicious for STI in 14 patients (1.75%). MRI confirmed the presence of predominantly hypointense lesions in T1- and T2-weighted sequences, with perilesional vasculature and no intrinsic contrast enhancement in 13 patients. In follow-up examinations, these abnormalities gradually decreased. This finding was confirmed in the five patients examined with CEUS. Only in one case did MRI reveal discrete intralesional contrast enhancement after injection of contrast medium, and the lesions appeared stable during the CDUS and MRI follow-up; this patient underwent orchiectomy, with a diagnosis of B-cell lymphoma. CONCLUSIONS: In our experience CDUS, CEUS and MRI proved indispensable for accurate clinical and therapeutic approaches in suspected STI.