超声引导下穿刺活检诊断前列腺上皮内肿瘤

目的探讨经直肠超声引导下穿刺活检在前列腺上皮内肿瘤（ＰＩＮ）诊断中的临床价值。方法回顾分析３１７例疑前列腺疾病患者经穿刺活检证实的３８例ＰＩＮ的临床资料。结果２６例ＰＩＮ于前列腺周围区见低回声结节,其中ＰＩＮ并前列腺癌和非癌ＰＩＮ各占３４．２１％（１３／３８）;另１２例ＰＩＮ超声未见明确病灶,占３１．５８％（１２／３８）。ＰＩＮ并前列腺癌的前列腺特异抗原（ＰＳＡ）和前列腺特异抗原密度（ＰＳＡＤ）测     

超声造影在肝脏恶性肿瘤活检假阴性病例分析中的应用价值

目的探讨超声造影引导肝脏恶性肿瘤经皮穿刺活检的临床应用价值.方法超声引导下对287例患者342灶肝脏占位病变行穿刺活检,病理组织学诊断为恶性肿瘤203例238灶、未见恶性84例104灶.未见恶性病灶中增强CT、MRI、血管造影或肿瘤标志物等检查可疑恶性或不能排除恶性的22例肝占位病变者为本文研究对象.采用造影剂SonoVue行灰阶超声造影引导再次穿刺活检.病变大小0.8～13.2cm,平均3.4cm.穿刺活检采用21～18G手动抽吸活检针或自动活检针,标本送病理科行组织学和细胞学检查.取材量满足病理诊断为取材成功.结果22例肝占位病变平均穿刺次数1.7次(38/22),取材成功率为100%.21例病理组织学诊断为恶性病变,为首次常规超声引导穿刺活检假阴性病例,1例穿刺活检病理结果仍为阴性排除恶性.恶性肿瘤首次常规超声引导穿刺活检假阴性率为9.4%(21/224).穿刺病理最终诊断结果为增生结节合并癌变5例,肝癌合并变性坏死7例,肝转移癌坏死及微小灶4例,手术或介入治疗后残留或新生5例.本组无1例并发症发生.结论超声造影可确认恶性肿瘤的活性区域、变性或坏死区域以及微小恶性肿瘤;超声造影引导穿刺活检可有效提高经皮穿刺活检的确诊率、降低常规超声引导穿刺活检的假阴性率,其临床应用价值应予以重视.     

超声造影对提高肝多发占位穿刺活检的应用价值

目的：探讨超声造影（CEUS）对提高肝多发占位穿刺活检诊断率的临床应用价值。方法：对来我科就诊的128例常规超声检查诊断性质不明的肝多发占位患者随机分为两组,其中62例注射超声造影剂SonoVue行CEUS后行超声引导穿刺活检（CEUS组）,66例只采用常规超声引导穿刺活检（US组）。男86例,女42例;年龄36～74岁,平均53.2岁。穿刺病灶共178个,大小0.5~2.9 cm,平均1.4 cm。对比分析两组穿刺活检结果。取材量满足病理诊断为取材成功。结果：穿刺≤2针即获较满意标本量者CEUS组明显多于US组（P=0.000 2）。CEUS组76灶中确诊72灶（94.7%）;US组102灶中确诊为86灶（84.3%）（两组比较P=0.029）,差异有统计学意义。微小恶性肿瘤（≤2 cm）的确诊率CEUS组94.6%,明显高于US组的78.1%。本组无并发症发生。结论：CEUS可准确分辨肝内病灶的坏死区,敏感反映病灶血流灌注情况。CEUS引导穿刺活检可有效提高经皮穿刺活检的确诊率、降低常规超声引导穿刺活检的假阴性率,在肝多发占位穿刺活检中有重要的临床价值。     

超声引导肝穿刺活检并发症及处理对策

目的 探讨超声引导肝穿刺活检的并发症及处理对策.方法 对我院175例超声引导下经皮肝穿265针次活检病例资料进行回顾性分析,总结术后出现的并发症及处理对策,并随访疗效.结果 肝穿刺后出现并发症16例(9.1%),其中迷走神经反射5例(2.9%),需要药物缓解的疼痛4例(2.2%),肝包膜下出血3例(1.7%),低血糖反应3例(1.7%),严重腹腔内积血1例(0.6%).前4项一般并发症经对症处理均能缓解,1例腹腔大量积血经超声造影发现肝出血点,即刻行微波消融治疗止血.结论 超声引导肝穿刺活检并发症发生率低;腹腔大量积血为严重并发症,经超声造影引导下肝局部微波消融可有效止血.

Abstract：

Objective To investigate the features,prevention and treatment of complications of ultrasound-guided hepatic puncture biopsy.Methods One hundred and seventy-five cases underwent ultrasound-guided hepatic puncture biopsy were retrospectively analyzed.Results The incidence of complications was 16 cases (9.1%),including 5 cases with vasovagal episodes(2.9%),4 cases with ache which needed medicine treatment (2.2%),3 cases with hemorrhage in liver capsule(1.7%),3 cases with hypoglycemia(1.7%),1 case with serve hemorrhage in abdominal cavity(0.6%).Hemorrhage limited in liver capsule,vasovagal episodes,hypoglycemia and ache were relieved with corresponding treatments.One case with hemorrhage in abdominal cavity was handled with percutaneous microwave ablation therapy guided by contrast-enhanced ultrasound.Conclusions Ultrasound-guided hepatic puncture biopsy has good value and low complication.The most severe complication is hemorrhage,which can be handled with percutaneous microwave ablation therapy guided by contrast-enhanced ultrasound.     

超声引导经皮穿刺活检在大网膜病变诊断中的价值

目的 探讨超声引导经皮穿刺活检在大网膜病变诊断中的价值。方法63例腹胀和（或）腹水原因待查患者，超声显示大网膜增厚，用BARD自动活检枪和18G活检针行超声引导下经皮穿刺活检。结果大网膜病变穿刺活检成功率100％，取材满意率92．1％。60例获得明确病理诊断，包括结核病变21例，转移性腺癌31例，恶性间皮瘤3例，腹膜假性黏液瘤4例，原发渗出性淋巴瘤1例；3例因组织标本量少未提示病理诊断。本组诊断准确性95．2％，无严重并发症发生。结论超声引导经皮穿刺大网膜病变活检是一种简便、安全、有效、诊断准确性高的方法，可使一些不明原因的腹胀腹水患者获得明确的病理诊断，为临床治疗提供依据。     

超声引导经直肠前列腺穿刺活检个体化方案的探讨

目的探讨个体化前列腺直肠径路穿刺活检方案的可行性。方法回顾性分析325例疑为前列腺癌患者首次穿刺的临床资料。采用系统12针组合穿刺方案,对可疑病变处补充1～2针,根据穿刺结果,分析穿刺阳性率与针数、体积的关系。结果126例患者确诊为前列腺癌。6、8、10针最大阳性率分别与12针穿刺阳性率比较,差异均有统计学意义。3个不同体积组比较,体积〈40ml组8针与10针阳性率差异无统计学意义,而40.1～60ml组8针与10针,〉60ml组10针与12针阳性率差异均有统计学意义。结论根据前列腺体积和超声表现制定个体化穿刺方案是可行的,体积〈40ml前列腺采用8针,40.1～60ml采用10针和〉60ml采用12针穿刺是合适的。     

超声引导经皮肾穿刺活检方法的改进

目的 改进肾穿刺方法,以减少肾穿刺的并发症,提高标本质量。方法 将１００例有肾穿刺适应症的患者随机分成３组,均在Ｂ超经导下用穿刺枪取材。Ａ组：定位于右肾下极外侧,略偏近髓质,垂直进针;Ｂ组：定位于右肾上极外侧皮 主的部位,垂直进针;Ｃ组：定位于右肾上下极外侧,靠近肾外缘处,穿刺时针略向内倾斜,针尖对准肾皮质较厚的部位。结果 每厘米肾组织中肾小球个数Ｃ组最多,Ｂ 组次之,Ａ组最少。穿刺的成功率三组相     

超声引导穿刺活检对中心型肺肿瘤的诊断价值

目的：对其他检查方法不能作出定性诊断的中心型肺肿瘤进行超声引导穿刺活检,探讨该方法对中心型肺肿瘤的诊断价值。方法：通过实变肺行超声检查确认肿瘤,并设定穿刺线路。采用21G日产八光手动负压穿刺针摄取组织,3．0cm以上的肿瘤同时加用美国Bard自动活检枪及21G细针活检,针腔内残留液均做细胞学检查,结果：52例接受穿刺者组织学检查诊断正确率为71．2％（37例）,细胞学检查诊断正确率为69．2％（36例）,二种方法互补诊断正确率达84．6％（44例）,组织定性诊断率达80．8％（42例）,并发症7例（13．5％）,其中气胸2例,咳血痰5例（10％）,无严重并发症发生。结论：超声引导细针穿刺活检对肺中心型肿瘤的定性诊断,为确定治疗方案提供了依据,有较高临床应用价值,但中心型小肿瘤的超声显示和确认仍为穿刺活检的首要条件,应予以重视。     

超声引导粗针与细针穿刺活检比较

目的　比较粗针(18G)、细针(21G)超声引导下经皮穿刺组织活检的临床应用价值。方法用粗针及细针于超声引导下经皮穿刺组织活检共1302例患者。所取组织能作出明确组织病理诊断者为取材满意,否则为不满意。以术后病理诊断或随访6个月的结果为最后诊断。结果　粗针活检455例,平均进针2.2次/例,细针847例,平均进针2.8次/例。同一部位取材满意率粗、细针间无显著性差异(P>0.05),细针后腹膜、肺及胸膜取材满意率低于其他脏器。粗、细针间诊断的敏感性、特异性、准确性及并发症发生率均无显著性差异。结论　超声引导下粗针穿刺组织活检同细针一样安全,并且所取标本较大、较完整,有利于病理科处理和组织学分型,值得在临床推广应用,但仍应掌握适应症     

超声造影引导下穿刺活检在肝占位性病变中的应用价值

目的探讨超声造影（CEUS）引导下穿刺活检在肝占位性病变中的应用价值。 方法收集2016年9月至2017年11月浙江大学医学院附属第一医院拟接受超声引导下经皮肝占位性病变穿刺活检术的患者42例。所有患者穿刺活检前均进行CEUS,在CEUS引导下对肝占位性病变靶向定点经皮肝穿刺活检。以穿刺活检获取组织材料送病理学诊断达到要求为取材满意。活检病理诊断结果为恶性或手术病理结果确诊。未见恶性肿瘤时,结合电子计算机断层扫描（CT）、磁共振成像（MRI）、CEUS、正电子发射计算机断层显像（PET）、发射型计算机断层扫描（ECT）、血管造影、肿瘤标志物［甲胎蛋白（AFP）、糖类抗原199（CA199）等］等检查,随访超过3个月无变化者,考虑为良性病变。 结果本组42例肝占位性病变患者最终临床诊断结果为：肝细胞癌19例,胆管细胞癌3例,转移性肝癌9例,结节性肝硬化3例,炎症5例,海绵状血管瘤1例,局灶性结节增生1例,不典型增生结节1例。在CEUS引导下,选择增强强度和方式为恶性的增强活性区进行了穿刺活检取材,穿刺次数1~2次,平均穿刺（1.74±0.21）次。本组42例肝占位性病变患者穿刺活检病理结果为：肝细胞癌19例,胆管细胞癌3例,转移性肝癌9例,结节性肝硬化3例,炎症5例,海绵状血管瘤1例,局灶性结节增生1例,不典型增生结节1例。CEUS引导下穿刺活检取材成功率100%（42/42）,穿刺阳性率100%（42/42）,穿刺活检诊断符合率100%（42/42）。所有患者穿刺活检后均无肝周肠间隙或腹盆腔出血、气胸、针道种植、胆漏、大血管损伤等并发症发生。 结论CEUS可敏感显示肝占位性病变内微血供情况,准确判断病灶的活性区与坏死液化区域,确认常规超声分辨不清的微小占位,可提高穿刺活检取材成功率、穿刺阳性率、穿刺活检定性诊断符合率以及恶性病变确诊率。     

Contrast-enhanced three-dimensional fusion sonography of small liver metastases with pathologic correlation

PURPOSE: To demonstrate that liver metastases with a diameter of < or =40 mm show characteristic features on three-dimensional (3D) fusion sonographic images and that these sonographic findings can be correlated with histopathologic features of surgical specimens. METHODS: Liver metastases measuring < or =40 mm were examined via contrast-enhanced 3D fusion sonography. The characteristic sonographic findings of 17 tumor nodules in 11 patients with a histopathologically confirmed diagnosis of liver metastases were investigated, and their correspondence to the pathologic features were examined in 12 resected nodules. RESULTS: On sonograms, central vessels were visualized in all 17 tumor nodules and peripheral vessels were visualized in 12 nodules. On histopathologic examination, the portal triad vessels corresponded to the central vessels and were located at the center of the tumors. A thin layer of peritumoral hepatocytes showing various changes was also observed, and a group of tiny vessels were seen running along this layer of cells. CONCLUSIONS: Liver metastases measuring 40 mm or less in diameter were characterized by the presence of both central and peripheral vessels on contrast-enhanced 3D fusion sonography. There was good correlation between sonographic and histopathologic findings.     

超声引导下肝癌微波凝固治疗的疗效及声像图分析

目的:探讨超声引导下经皮微波凝固治疗(MCT)肝癌的声像图改变及疗效。资料与方法:经穿刺活检、手术病理证实的肝癌患者25例,共32个结节,进行单次或分点多次凝固治疗,对比术前、术后患者的声像图改变、病理、AFP及ALT的变化。结果:治疗过程中,结节回声增强,直至覆盖整个病灶。术后结节以不均质低回声为主。MCT后有20个结节进行病理检查,80%(16/20)完全坏死,其中直径<3.5cm的结节坏死率100%(5/5)。随访半年,71.9%结节缩小。CDFI显示治疗后肿瘤血供消失68.8%,减少31.2%。治疗后AFP 81.3%(13/16)降低或恢复正常。ALT呈一过性升高,3周内96%(24/25)恢复术前水平。结论:超声引导微波凝固治疗可以有效灭活单发、直径<3.5cm的肝癌结节,对直径≥3.5cm的结节,多次凝固可不同程度控制肿瘤增长。声像图表现有助于判断微波治疗的疗效。     

1例肝脏原发性去分化脂肪肉瘤超声造影表现

<正>患者女，51岁，体检发现右上腹占位2个月；既往无特殊病史。查体：腹膨隆，右上腹扪及直径约15cm质硬包块，活动度差。实验室检查未见明显异常。超声：肝右叶15cm×12cm杂乱回声肿块，形态较规则，边界不清，内部及周边见数个斑片状强回声（图1A）；超声造影见动脉期肿块呈不均匀高增强（图1B），门脉期及延迟期相强化程度逐渐减低，下份见片状无增强区（图1C）；考虑肿瘤性病变，     

Natural history of focal nodular hyperplasia of the liver: An ultrasound study

Sixteen cases of focal nodular hyperplasia (FNH) of the liver were followed by ultrasound (US) for a mean of 33 months (range 6–81). In 69% of the cases, the diagnosis was incidental. On US the lesions were single in 75% of the cases, localized in the right lobe in 75%, and subcapsular in 50%. No specific US-pattern could be identified. A central scar was found in 19% of the patients. At the end of the follow-up, the size was reduced in 7/16 cases, and in 1/16 the lesion disappeared. The spontaneous reduction of nodules in FNH must be considered in the management of this pseudotumor. © 1996 John Wiley & Sons, Inc.     

经静脉声学造影检测转移性肝癌彩色血流信号的研究

目的:探讨转移性肝癌造影增强后的彩色血流特点。方法:46例转移性肝癌(共106个瘤结节)行经静脉声学造影检查,对比观察造影前、后瘤结节内及瘤周彩色血流变化。结果:造影增强后,瘤体彩色血流信号增多,彩色血流信号检出率显著提高,瘤体血流由42.5%提高到83.9%,瘤周血流由54.7%提高到90.6%。增强效果:0级,17个;I级,76个;II级,13个。瘤体彩色血流信号呈点状、条状、小片状及蛛网状等多种形态。12个瘤体(11.3%)血供较周围肝组织丰富,另94个瘤体(88.7%)血供不如周围肝组织丰富。动态观察,瘤体晚于周围肝组织1～2s显影,但早15～35s消退。结论:经静脉声学造影能提高转移性肝癌彩色血流信号检出率,获得更为丰富血流信息,对其诊断及鉴别诊断也有一定的帮助。     

Focal nodular hyperplasia of the liver: Radiologic findings

A retrospective analysis of the results of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) of 24 cases (28 lesions) of proven focal nodular hyperplasia (FNH) is presented. While US exhibited nonspecific features, CT frequently showed characteristic features: hypodensity on precontrast scans (69%), transient immediate enhancement after bolus injection (96%), and homogeneity (85%). A scar was noted in 31% of the cases. The typical MR triad of isointensity on T1- and/or T2-weighted (T2-WI), homogeneity, and a scar which shows hyperintensity on T2-WI was seen in only 12% of our cases. The most common finding was homogeneity (94%). In two cases the scar was hypointense on T2-WI. To our knowledge, this finding has not been described before. We conclude that the features of FNH, although fairly constant, are at times indistinguishable from those of other hepatic tumors, such as hepatic adenoma (HA), fibrolamellar hepatocellular carcinoma (FLHCC), small hepatocellular carcinoma, and a hyperplastic nodule. Therefore, a multimodality approach is essential for the correct diagnosis in order to prevent unnecessary surgery.     

Focal nodular hyperplasia of the liver: detection and characterization with plain and dynamic-enhanced MRI

Background: We compared nonenhanced and dynamic gadolinium (Gd)–enhanced magnetic resonance imaging (MRI) appearances of hepatic focal nodular hyperplasia (FNH) as depicted with breath-hold MR sequences and assessed the detectability of the individual MR sequences used. Methods: We retrospectively reviewed 48 consecutive patients with FNH. All patients underwent nonenhanced (T1 fast low-angle shot [FLASH] and T2 half-Fourier acquisition [HASTE]) and dynamic Gd-enhanced (T1 FLASH) MRI between December 1997 and March 2000. Individual MR sequences were analyzed separately for number of lesions, signal intensity features, dynamic enhancement pattern, and the presence and enhancement profile of a central scar. Ninety-five percent confidence intervals of absolute discrepancy were calculated to define differences in lesion detection. Results: Seventy-seven lesions were found in 48 patients. Nonenhanced FLASH imaging depicted 59 (76.6%) lesions in 45 patients. HASTE images showed 55 (71.4%) lesions in 44 patients. On T1- and T2-weighted images, lesions appeared predominantly hypointense (69.5%) and hyperintense (72.7%), respectively. Arterial and portal venous dominant phase Gd-enhanced MRI demonstrated all 77 lesions (100%), most of which showed hypervascular (94.8%), homogeneous (97.4%), and incomplete (except the central scar: 58.4%) enhancement in the arterial phase. Portal venous phase images showed lesion isointensity (50.6%) or moderate hyperintensity (46.8%) with complete enhancement (central scar: 94.8%). A central scar was detected on nonenhanced T1-weighted images (hypointense: 100%), T2-weighted images (hyperintense: 100%), arterial phase (hypointense: 59.7%) and portal venous phase (hyperintense: 71.4%) Gd-enhanced images in 78%, 69.1%, 77.9%, and 75.3% of tumors, respectively. Conclusion: Arterial and portal venous phase Gd-enhanced T1-weighted sequences are superior to nonenhanced images in the detection of FNH. Typical MRI appearances include hypointensity on T1-weighted and hyperintensity on nonenhanced T2-weighted images. Most commonly, FNH shows a homogeneous (without scar) and strong enhancement during the arterial phase, with lesion isointensity or slight hyperintensity during the portal venous phase. Received: 15 May 2001/Revision accepted: 22 August 2001     

Sclerosing angiomatoid nodular transformation (SANT) of the spleen: Sonographic finding

Sclerosing angiomatoid nodular transformation (SANT) is a recently recognized benign vascular lesion of the spleen. There is limited information regarding its imaging findings of this condition. Until now, the diagnosis was based on histopathologic examination of splenectomy specimens. We report the sonographic findings in a case of SANT of the spleen confirmed by ultrasound‐guided core needle biopsy. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009     

应用二维及多普勒超声对射频治疗肝癌疗效的随访观察

目的：评价应用自然组织谐波显像（NTHI）、彩色及能量多普勒（CDFI及CDE）随访观察集束电极射频治疗肝癌6－18个月的疗效。方法：NTHI、CDFI和CDE观察射频治疗前及治疗后6月的68例73个肿块、12月的40例55个肿块和18月的15例17个肿块的大小、回声和血流动力学情况。随访射频术后6月、12月、18月的患者,计算其生存率。结果：射频治疗后6月、12月、18月肿块缩小,回声增强,肿块缩小率分别为57.5%,51.8%,47.1%;肿块血流信号消失或明显减少,血流信号消失率分别为72．6％,55．1％,48．7％;肝动脉的血流速度及阻力指数降低。患者的生存率分别为100％,93．3％和85．2％。结论：应用NTHI、CDFI、CDE对肝癌患者射频治疗前后肿块的观察方法简便、无创,在疗效判断及随访中具有重要临床意义。