乳腺脂肪坏死的超声表现及病理对照分析

目的：探讨乳腺脂肪坏死的超声表现及病理基础。方法：回顾性分析经病理证实的33例（其中4例为双侧乳腺脂肪坏死，共37个病变）乳腺脂肪坏死超声表现，并与病理结果对照。结果：主要超声表现：等回声病灶5个（13．5％），低回声病灶16个（43．2％），无回声病灶10个（27．0％），囊实混合回声病灶6个（16．2％）。所有病灶均无血流信号，部分病灶可伴钙化，边界不清，低、无回声病灶后方回声可增强或衰减。病灶位于皮下组织层内7个，腺体内30个。病理表现：①脂肪细胞坏死液化，融合成大的脂肪空泡，周边可见上皮样细胞及泡沫细胞聚集，外围有薄层肉芽组织，伴有大量淋巴细胞和部分浆细胞浸润；②囊壁不同程度增厚，纤维化和玻璃样变，可出现钙盐沉积；⑧病灶已部分或全部被纤维组织取代，周围残留部分纤维组织形成小腔或瘢痕。通常不同病理形式的超声表现常同时出现。结论：超声检查对诊断乳腺脂肪坏死具有重要价值。     

Two small intrahepatic cholangiocarcinomas with different sonographic appearances.

We report on 2 cases of small intrahepatic (or peripheral) cholangiocarcinomas initially detected by sonography and completely resected. The lesions had a peripheral hypoechoic component and a central isoechoic or hyperechoic component. One had posterior acoustic shadowing on sonography, and the other did not. Comparison with pathologic findings in both cases indicated that severe fibrotic changes may have caused the posterior acoustic shadowing. This finding is extremely rare. We found only 1 previously reported case of cholangiocarcinoma accompanied by acoustic shadowing.     

超声诊断巨大肾血管平滑肌脂肪瘤

目的 探讨巨大肾血管平滑肌脂肪瘤(最大径大于5 cm)的声像图特点. 方法 回顾性分析手术病理证实的17个巨大肾血管平滑肌脂肪瘤的超声表现,包括病变大小、边界、位置、内部回声及血流特点. 结果 采用超声检查,11个准确定位(其中9个正确诊断为RAML),5个定位不清,1个误诊为肾上腺占位;声像图表现为边界清晰的高回声、低回声、中等回声或高低回声相间的混合性回声.较大的高回声、大多数混合性回声及所有低回声病灶内可探及程度不等的血流信号,其声像图表现类型与病灶内脂肪、平滑肌和血管的组成和分布密切相关. 结论 巨大肾血管平滑肌脂肪瘤具有特征性的声像图表现,超声结合其他影像学检查,对多数病灶可于术前明确诊断.     

Hurthle cell neoplasms of the thyroid: sonographic appearance and histologic characteristics

OBJECTIVE: The purpose of this study was to determine the sonographic features of Hürthle cell neoplasms (HCNs) of the thyroid. METHODS: We retrospectively analyzed the sonographic appearance of 15 histologically proven HCNs in 15 patients aged 16 to 70 years (mean age, 44 years). Sonographic features that were reviewed included the size and echogenicity of the tumors, the presence of cystic areas or calcifications, and detectable blood flow on color Doppler imaging. Correlation of sonographic findings with pathologic results was performed. RESULTS: The tumors ranged from 0.4 to 7 cm in diameter, but most were less than 3 cm in diameter. Four (27%) of the 15 tumors were homogeneously hypoechoic. Two tumors (13%) were predominantly hypoechoic with isoechoic areas to thyroid parenchyma. Two (13%) neoplasms were isoechoic to thyroid parenchyma. Four (27%) tumors were predominantly isoechoic, containing hypoechoic areas, and 3 (20%) tumors were hyperechoic. Three neoplasms contained cystic components. None of the tumors contained calcifications. One tumor was avascular on Doppler examination. One neoplasm showed only peripheral blood flow. Thirteen tumors showed internal vascularity, 7 of them with peripheral blood flow. Twelve HCNs were benign, and 3 were malignant on pathologic examination. CONCLUSIONS: Hürthle cell neoplasms show a spectrum of sonographic appearances from predominantly hypoechoic to hyperechoic lesions and from peripheral blood flow with no internal flow to extensively vascularized lesions. Pathologic criteria differentiating benign and malignant HCNs (absence or presence of a capsular breach, vascular or extrathyroidal tissue invasion, nodal involvement, and distant metastasis) are beyond the resolution of sonography and fine-needle aspiration biopsy and require removal of the entire lesion. This precludes diagnosis and characterization of HCNs by sonography.     

晕征在诊断肝良恶性肿瘤中的价值──超声、CT、CT动脉造影的比较

本文目的在于评价晕征在诊断肝良、恶性病变中的价值。重点对肝癌的表现进行了讨论，阐明了晕征对诊断肝癌的意义并将晕征在超声、CT及CTA的表现进行了比较。材料与方法：71例肝占位性病变病人行超声检查，其中对26例有低回声晕征者还作了CT及CTA检查。结果：71例病人中超声表现为强回声40例，低回声26例，等回声3例，混合回声2例。原发性肝癌41例，有晕征者24例，且多为强回声型（56．1％）。11例肝转移癌中6例有晕征（54．5％），余13例肝血管瘤及6例肝脓肿有晕征者各1例。结论：本文结果表明晕征对区别肝良、恶性病变十分有价值，对肝癌的定性诊断很有帮助，尤其对以强回声为主要表现的病变，其作用更为重要。     

Sonographic features of hepatic adenomas with pathologic correlation

BACKGROUND: We compared the sonographic characteristics of hepatic adenomas with pathologic findings. METHODS: Information over 10 years was collected on 12 patients (six men, six women; mean age = 47 years) with surgically proven hepatic adenomas. Clinical data, sonographic features, and histopathologic findings were reviewed. RESULTS: The tumors in males were smaller and simpler than those in women (p < 0.05, Fisher's exact test). Four of the six larger tumors (>5 cm) showed mixed-echoic patterns corresponding with pathologically intratumoral hemorrhage and necrosis. Four homogeneously hypoechoic tumors had less change in tumor composition. Three homogeneously hyperechoic tumors had evident fatty changes inside. One isoechoic tumor had a hypoechoic rim, that correlated mostly to the tumor itself and compressed liver parenchyma. Seven of the 12 tumors had thin fibrous capsules that were not seen on sonography. CONCLUSION: Hepatic adenomas have variable sonographic appearances depending on changes in the tumor. Hypoechoic, hyperechoic, and mixed-echoic patterns represent simple adenoma, adenoma with fatty metamorphosis, and hemorrhagic necrosis, respectively, in tumors.     

Sonographic detection of clinically unsuspected swallowed toothpicks and their gastrointestinal complications

We retrospectively analyzed the clinical presentation and imaging investigation in 4 cases of surgically (2 cases) or endoscopically (2 cases) proven toothpick-related gastrointestinal perforation. The toothpick perforated the stomach (2 cases), the sigmoid (1 case), and the ileum (1 case). Sonographic appearance of the toothpick was a linear, hyperechoic (3 cases) or hypoechoic (1 case) image of variable length (mean: 2.5 cm) with inconsistent posterior shadowing in the longitudinal axis. In transverse section a hyperechoic dot (4 cases) with clear, thin, sharp, posterior shadowing (3 cases) was seen. Following sonography (4 cases), CT scan (2 cases), and upper GI study (2 cases), the preoperative diagnosis of GI perforation by foreign body compatible with toothpick was made in all cases, although none of the patients was aware of having swallowed a toothpick. This information will be of help in making early sonographic diagnosis of toothpick-related GI perforation in patients with or without symptoms. © 1994 John Wiley & Sons, Inc.     

Ultrasound of the fetal thymus

A prospective study was performed in 340 obstetric sonograms to evaluate the sonographic characteristics of the fetal thymus. The thymus was identified as a homogeneous structure in the anterior fetal mediastinum in 251 cases (74%). The thymus was categorized as either hyperechoic, isoechoic, or hypoechoic relative to fetal lung. Seventy one of 115 cases (62%) prior to 27 weeks gestation were hyperechoic relative to fetal lung whereas 100 of 136 cases (73%) after 27 weeks were hypoechoic relative to lung (p less than .0001). Thymic measurements and shape were also recorded. The anterior-posterior AP thickness, measured in the midline at the sternum, ranged from 2 mm at 14 weeks to 20.8 mm at term. This study demonstrates that the thymus can be imaged in most fetuses.     

小腿肌间静脉丛血栓和腓肠肌血肿的超声诊断价值

目的 探讨彩色多普勒超声对鉴别诊断小腿肌间静脉丛血栓和腓肠肌血肿的价值。方法 对24例小腿肌间静脉丛血栓和11例腓肠肌血肿的大小、形态和声像图特点进行回顾性对比分析。结果 小腿肌间静脉丛血栓纵切为长管状、树枝状，横切为类圆形的低回声，与肌肉有整齐的分界，两端与静脉延续，多合并下肢深静脉主干的血栓。腓肠肌血肿体积较大，后方回声明显增强，与周围肌肉有高回声界限，血肿内无血流信号，多不合并下肢深静脉主干的血栓。早期为张力高的类圆形等回声或低回声，随之无回声区逐渐增多，张力减低，为卵圆形或梭形。肌肉撕裂伤引起的血肿部分肌纤维断裂，血肿占据肌肉的一部分。结论 彩色多普勒超声可作为诊断和鉴别诊断腓肠肌血肿、小腿肌间静脉丛血栓首选和可靠的影像学方法，且对临床治疗有指导意义。     

前列腺癌经直肠超声声像特征

本文分析了172例可疑前列腺癌者经腔内超声及其引导下穿刺活检确诊的49例前列腺癌的声像学特征。认为前列腺癌除了主要表现为低回声型特点外,尚可出现其它回声类型改变及一些间接征象。前列腺介入性超声及其指引下的穿刺活检是前列腺癌诊断及疗效随访的主要方法。     

Testicular epidermoid cysts: sonographic features with histopathologic correlation

Testicular epidermoid cysts are rare, accounting for 1% of all testicular tumors. We present the sonographic appearances of epidermoid cysts in 3 cases, together with the histopathologic correlation. In case 1, sonography showed an intratesticular hypoechoic mass with a well-defined echogenic rim; the mass measured 1.8 x 1.5 x 1.5 cm, and there was no evidence of calcification. In case 2, sonography showed a well-circumscribed mass measuring 1.3 x 1.3 x 1.0 cm, with alternating hypoechoic and hyperechoic rings (onion-ring appearance) and no calcifications. In case 3, sonography showed a 2.4- x 2.3- x 2.3-cm, well-circumscribed, oval mass with a heterogeneous echotexture and an outer hypoechoic halo. The mass contained plaque-like regions of increased echogenicity, with peripheral acoustic shadowing from refraction artifact. Hypoechoic clefts were visualized posterior to the plaque-like areas. The triad of findings-sonographic appearance of an onion ring, avascularity on Doppler sonography, and negative results of tumor marker studies-is highly suggestive of an epidermoid cyst.     

脂肪坏死的声像图表现

目的总结脂肪坏死的声像图表现,试图提出脂肪坏死的超声诊断标准,以利于鉴别其它严重病因的软组织肿块。方法对１２例脂肪坏死二维声像图及彩超结果的回顾分析,与手术及病理结果相对照。结果脂肪坏死的声像图表现;病变位于皮下组织层,呈圆形的极低回声区;边界光滑,无包膜;与周围皮下组织分界清楚,后部回声有衰减,彩超在病变周边及内部未探及任何彩色血流信号。结论脂肪坏死的超声图像很具特征性,超声对诊断此病有很重要的     

Sonographic subcutaneous and visceral fat indices represent the distribution of body fat volume

Background A reliable method for direct measurement of both subcutaneous and visceral fat volume is the measurement of fat tissue area from tomographic pictures by CT or by MR imaging. However, these are not widely usable because of high cost and/or exposure to radiation. Methods We compared sonographic subcutaneous and visceral fat indices with fat distribution by serial-slice MR imaging in 17 subjects. Sonographic subcutaneous or visceral fat index is standardized thickness of subcutaneous fat tissue or the intra-abdominal depth at the level of umbilicus by height. Results Sonographic visceral fat index and intra-abdominal depth were significantly correlated with visceral fat volume by serial-slice MR imaging (r = 0.746, r = 0.726, respectively). Similarly, sonographic subcutaneous fat index and subcutaneous fat thickness were significantly correlated with subcutaneous fat volume by serial-slice MR imaging (r = 0.825, r = 0.816, respectively). The ratio of sonographic visceral fat index and sonographic subcutaneous fat index was closely correlated with the ratio of the visceral fat volume and the subcutaneous fat volume by single-slice MR imaging, which proves to be related to cardiovascular disease risk (r = 0.722). Conclusion Sonographic subcutaneous or visceral fat index could be an easily measured and inexpensive indicator for the assessment of fat distribution instead of CT or MR imaging.     

胎儿肝脏血管瘤的产前超声影像学特征及预后

【目的】探讨胎儿肝脏血管瘤的产前超声影像学特征及预后。【方法】回顾性分析2014年1月至2018年10月在本院产前超声检查发现的胎儿肝脏实性肿块且产后证实为肝脏血管瘤的患者15例,分析产前超声影像学特征,并追踪其预后。【结果】15例病例中13例产前超声提示胎儿肝内血管瘤,2例误诊为肝母细胞瘤(其中1例引产、1例活产分娩),产前超声诊断正确率为86.7%(13/15)、误诊率为13.3%(2/15);15例中2例为高回声、1例为等回声、5例为低回声、7例为混合回声;15例中13例活产分娩、2例引产,13例活产婴儿经彩色多普勒超声或增强CT扫描或MRI检查证实为肝血管瘤,2例引产胎儿在孕妇知情同意的前提下经尸体解剖及病理检查证实为肝血管瘤。13例活产婴儿均采取保守治疗,治疗期间行彩色多普勒超声随访观察6~36个月,均预后良好。【结论】胎儿肝脏血管瘤的边界、内部回声、血流信号等有一定特点,但是缺乏特异性,产前超声对胎儿肝脏血管瘤的诊断有一定价值,肝血管瘤患儿经保守治疗预后良好。     

Sonographic features of breast hamartomas

The sonographic features of ten breast hamartomas are reported. Four masses were clinically palpable. The mammographic appearance was characteristic of hamartomas in five cases. In the remaining five lesions, because the radiographic appearance was not pathognomonic, surgical excision was required for pathologic confirmation of the diagnosis. A wide spectrum of sonographic appearances was identified, the most frequent was that of a moderate to well-circumscribed, solid, hypoechoic mass with posterior acoustic shadowing. Two isoechoic hamartomas were very difficult to visualize on sonography. We conclude that ultrasound has a minimal role in the diagnosis of breast hamartomas, in view of their wide sonographic variability.     

Fluid–fluid levels in ovarian teratomas

Background: We evaluated the imaging features of ovarian teratomas containing fluid–fluid levels on ultrasonography (US). Methods: We retrospectively reviewed US examinations of two groups with 805 masses (370 benign ovarian teratomas and 435 nonteratomatous adnexal masses). Results: In 27 teratomas and eight nonteratomatous adnexal masses, fluid–fluid levels were detected on US. According to the echogenicity of each layer, 27 teratomas were classified as three types: 1, supernatant hypoechoic and dependent hyperechoic layers (n= 16); 2, supernatant hyperechoic and dependent hypoechoic layers (n= 8); and 3, supernatant hypoechoic and dependent hypoechoic layers with bright fluid interface (n= 3). In eight (30%) of 27 teratomas, US showed floating nodules at the interface, five of which had posterior acoustic shadowing. All eight nonteratomatous adnexal masses showed type 1 fluid–fluid levels. Conclusion: The fluid–fluid level seen on US is strongly suggestive but not pathognomonic of dermoids. Fluid–fluid levels with supernatant hyperechoic and dependent hypoechoic layers, supernatant hypoechoic and dependent hypoechoic layers with bright interface, and a floating nodule might pathognomonic findings of benign ovarian teratomas. Received: 8 December 2000/Accepted: 7 February 2001     

Breast and Scrotal Sparganosis

Objective. Sparganosis is caused by the tapeworm larva of the geneus Spirometra. Because sparganosis usually manifests as a migrating subcutaneous mass, sonography can play an important role in its diagnosis. Methods. In this series, we investigated 4 cases of subcutaneous sparganosis and focused on the sonographic findings. Three of the cases involved the breast, and the other involved the scrotum, as confirmed by surgery. Results. The characteristics of subcutaneous sparganosis included a poorly defined hyperechoic lesion with internal serpiginous tubular structures, anechoic serpiginous tubular structures with a surrounding hyperechoic lesion, and an elongated hyperechoic mass with a hypoechoic nodular lesion in the central portion. Conclusions. We suggest that a mass combined with a hypoechoic tubular structure should raise the suspicion of subcutaneous sparganosis.     

Suture granulomas: sonography enables a correct preoperative diagnosis

The purpose of this study was to examine if suture granulomas display distinct sonographic signs and if these signs enable an accurate preoperative diagnosis. In a retrospective and prospective study, the sonographic findings of 22 consecutive suture granulomas were investigated and correlated with subsequent operative results. The sonographic appearance of various surgical sutures in a water bath was also investigated. Sonography was performed with commercially available 5- to 13-MHz linear transducers. The sonographic findings of the suture granulomas included hypoechoic lesions in all cases and hyperechoic double or single lines within the hypoechoic lesions in 20 of 22 cases. Sonography enabled the correct preoperative diagnosis for the investigating radiologists in 20 cases. The sonographic appearance of sutures in a water bath was that of hyperechoic double or single lines. The sonographic signs of suture granulomas (hyperechoic double or single lines within hypoechoic lesions) indicate the correct preoperative diagnosis in a high percentage of cases.     

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。