超声造影对增强计算机层析成像肝脏低密度病灶的诊断价值

目的探讨超声造影（CEUS）对增强计算机层析成像（CECT）肝脏低密度病灶的诊断价值。方法回顾性分析47例CECT提示肝脏低密度病灶的CEUS检查结果。结果47例病灶的病理结果为20例转移癌,9例炎性假瘤,6例血管瘤,4例原发性肝癌,2例囊肿,2例脓肿,2例结核,1例肝脏局灶性结节性增生（FNH）,1例肝脏局部脂肪组织浸润。45例CEUS诊断结果与病理或临床诊断相符合。囊肿和炎性假瘤在整个CEUS时相无增强,但炎性假瘤内可有穿行的血管。肝脏局部脂肪组织浸润与肝脏同步增强。乏血供转移癌中80％（12／15）的表现为周边快速、轻度增强,内部轻微均匀增强;富血供转移癌中80％（4／5）表现为整体明显快速增强。脓肿和结核在CEUS中的强化程度与坏死程度有关,表现为快速不均匀增强。血管瘤周边向中心缓慢增强,其持续增强时间较转移癌长,差异有统计学意义。FNH的CEUS表现由中心向外快进快出的典型增强方式。原发性肝细胞肝癌CEUS表现为整体快进快出的增强方式。结论CEUS对CECT肝脏低密度病灶有一定的诊断价值,有助于此类病灶的鉴别诊断。     

增强CT和超声造影检查在肝癌射频消融中的应用价值

目的:探讨肝癌射频消融(radiofrequency ablation,RFA)手术前后,对比增强计算机体层摄影术(contrastenhanced computed tomography,CECT)和对比增强超声检查(contrast-enhanced ultrasonography,CEUS)在判断肿瘤病灶中的应用价值.方法:对2008年5月-2010年9月接受RFA的90例肝癌患者(原发性肝癌65例,转移性肝癌25例)的临床资料进行回顾性分析.共104个肝内肿瘤病灶在B超或CT引导下行RFA.RFA术前1周及术后1个月行CECT和CEUS,评价CECT和CEUS在术前肿瘤病灶检出及术后疗效评价中的作用.结果:RFA治疗前,CECT共检出93个肝内肿瘤病灶,CEUS共检出96个肝内肿瘤病灶,CECT结合CEUS共检出104个肝内肿瘤病灶.RFA治疗后1个月,CECT显示90个病灶无增强表现,CEUS显示91个病灶无增强表现,CECT结合CEUS显示86个病灶无增强表现:CECT检出5个肝内新发肿瘤病灶,CEUS检出8个肝内新发肿瘤病灶,CECT结合CEUS检出11个肝内新发肿瘤病灶.结论:CECT结合CEUS可提高RFA治疗前肝内肿瘤病灶检出率及RFA治疗后肝内残留肿瘤和新发肿瘤病灶的检出率.     

超声造影评价肝脏恶性肿瘤高危人群的价值

目的：探讨超声造影（ CEUS）评价肝脏恶性肿瘤（ HMT）高危人群的价值。方法选择经临床评估为HMT高危人群的300例患者,接受CEUS检查。比较分析CEUS检出肝内恶性病灶和定性诊断的能力。结果在增强磁共振成像检出的119个恶性病灶（87例患者）中, CEUS检出112个,彩色多普勒超声检出95个, CEUS 对肝内恶性病灶的检出率（94．1％）高于彩色多普勒超声（79．8％）,差异有统计学意义（P＜0．01）。17．2％（15／87）的患者因增加了CEUS检查而检出彩色多普勒超声未发现的恶性病灶。经病理检查或长期随访明确诊断者177例,彩色多普勒超声和CEUS均能检出的病灶共215个,其中恶性病灶118个,良性病灶97个。 CEUS判断肝内病灶良恶性的准确率为91．6％（197／215）,彩色多普勒超声的准确率为59．1％（127／215）,差异有统计学意义（P＜0．01）。CEUS提高了35．0％（62／177）患者的诊断准确率。对于首次发现肝内病灶的96例患者（105个病灶）,与其最终临床诊断比较,CEUS诊断的符合率为92．4％（97／105）。 CEUS在观察者之间和在观察者内部,定性诊断肝内实质性病灶均有较高的重复可靠性（ Kappa值分别为0．866和0．934）。结论CEUS显著提高了HMT高危人群的肝内恶性病灶检出率和定性诊断准确率;对首发病灶CEUS具有较高的诊断符合率,有望成为HMT高危人群一种方便、准确、可靠的一线检查手段。     

超声造影在肝癌介入治疗中的应用价值

目的探讨超声造影技术在肝癌介入治疗中的应用价值。方法应用超声造影技术(CEUS),对56例经过介入治疗的肝癌患者的65个病灶治疗前后进行诊断,并与常规彩超进行对比研究。结果比较常规彩超和CEUS对肝癌的诊断,发现CEUS对原发性肝癌和<10 mm肝癌病灶的诊断阳性率明显高于常规彩超,差异有明显的统计学意义(P<0.05),CEUS对肝癌介入的诊断情况与增强CT的诊断结果比较,有一致性,Kappa>0.72,P<0.05,而与常规彩超检查结果不一致,Kappa>0.45,P<0.05。结论 CEUS是一种判定肝癌介入治疗疗效并及时指导治疗的有效方法。     

超声造影在肝细胞癌诊断及治疗中的研究进展

肝细胞癌(HCC)是我国高发肿瘤, 起病隐匿、进展快、复发早、预后差, 多数患者就诊时已处于中晚期, 失去最佳手术时机, 因此对HCC早诊断早治疗至关重要。近年来超声造影(CEUS)技术已广泛应用于肝脏疾病诊断, 尤其在HCC诊断治疗方面有着无可替代的作用, 同时在CEUS基础上发展起来的影像融合技术更能凸显CEUS在HCC诊疗中的价值。     

肝硬化背景下小肝癌超声造影与增强计算机体层扫描的表现特点

目的探讨超声造影(CEUS)与增强计算机体层扫描(CECT)对肝硬化背景下小肝癌(SHCC)的诊断价值及增强特点。方法选取2012年4月至2014年4月间新疆医科大学第二附属医院感染科住院肝硬化患者198例,分别采用CECT及CEUS诊断。观察两种检测方法对SHCC诊断的敏感度、特异度、正确诊断率和增强特点,评价CEUS对CECT的补充诊断价值。结果 170个SHCC病灶中,CEUS检查发现151个,CECT检查发现132个。CEUS对SHCC诊断的特异度优于CECT(P<0.05),两者诊断的敏感度及正确率比较差异无统计学意义(P>0.05)。CECT和CEUS在SHCC各时期的增强分级比较差异无统计学意义(P>0.05)。CECT漏诊38个SHCC病灶,均经CEUS检出为SHCC,对照病理诊断结果,24个病灶诊断正确。结论 CECT和CEUS对肝硬化背景下SHCC的诊断敏感度、准确度及增强模式相似,均能较好地反映SHCC肿瘤学血供特点,两者联合应用,可提高肝硬化背景下SHCC的诊断准确性。     

超声造影技术与三维超声成像对乳腺良恶性结节的鉴别诊断价值

目的：探讨超声造影技术（ CEUS）与三维超声成像检查对乳腺良恶性结节的鉴别诊断价值。方法对89例乳腺肿块患者,共计113个病灶分别进行CEUS及三维超声成像检查,分析两种方法的病灶特点,并根据术后病理检查结果进行诊断学效能评价。结果根据术后病理检查结果分为恶性结节51例、良性结节62例,三维超声成像在113个乳腺良恶性结节良恶性鉴别中均具有显著差异（P＜0．05）。 CEUS检查在增强、边缘强化及增强程度方面对良恶性鉴别均具有显著差异（P＜0．05）;在消退模式方面CEUS鉴别良恶性差异不显著（P＞0．05）。三维超声成像检查鉴别结节的灵敏度,特异度、阳性预测值、阴性预测值,与病理学检查结果的一致性Kappa值均高于CEUS;两者联合检查的灵敏度为96．08％、特异度为95．16％、漏诊率为4．84％、误诊率为3．92％、阳性预测值为94．23％、阴性预测值为96．72％、Kap-pa为0．911。结论对乳腺良恶性结节鉴别诊断,单独应用三维超声成像的诊断效能与单独使用CEUS检查相当,将两者联合应用能够显著提高术前诊断与术后病理诊断的一致性。     

体部立体定向放疗的放射生物学进展

相比常规照射方式,SBRT照射次数少(1~5次),单次剂量较高(8~30 Gy)。然而在低剂量、多分割方案中适用的LQ模型并不能准确评价大剂量射线的放射生物效应。有学者提出了USC、LQL、gLQ等修正模型,希望能更好地预测SBRT的放射生物学效应。目前SBRT成为肺部、肝脏、脊柱、胰腺等部位原发病灶或少发转移病灶的重要治疗手段之一。放射生物学的进展可以更深入地探索SBRT的临床应用,对提高肿瘤放疗疗效有重要作用。     

对比增强超声与增强CT对诊断肝癌病灶大小可靠性的对比研究

目的 探讨对比增强超声（CEUS）与增强CT（CECT）对中肝癌（最大径3.0～5.0 cm）与非中肝癌（最大径＜3.0 cm或＞5.0 cm）病灶大小诊断的可靠性。方法 回顾性分析2013年6月至2016年6月我院收治的手术并经病理组织学证实的肝癌患者197例,患者均为单发病灶,分为中肝癌组96例和非中肝癌组101例。患者均行CEUS与CECT检查。采用χ2检验比较CEUS与CECT在不同病灶大小肝癌诊断中的差异。结果 CEUS与CECT诊断197例肝癌病灶大小的受试者工作特征（ROC）曲线下面积分别为0.774和0.706,差异无统计学意义（P＞0.05）。96例中肝癌组中,CEUS诊断的特异度为80.6％～85.8％,灵敏度为73.2％～91.6％;CECT诊断的特异度为65.1％～77.2％,灵敏度为63.2％～85.3％。101例非中肝癌组中,CEUS与CECT的诊断准确率分别为92.1%和91.1%,差异无统计学意义（P＞0.05）;96例中肝癌检查组中,两种方法检查的诊断准确率分别为97.9%和89.6%,差异有统计学意义（P＜0.05）。结论 对于肝癌病灶大小的测量尤其是中肝癌,术前优先选择CEUS具有更高的应用价值。     

Sonazoid超声造影剂在肝脏肿瘤诊疗中的应用

肝脏肿瘤的疾病进展与患者的预后及生活质量息息相关,对于肝脏肿瘤的治疗应该建立在准确诊断的基础上。超声造影技术已成为当今超声发展的重大技术革新和研究方向,因其能动态观察病灶的灌注过程,有效反映病变的血流动力学变化,从而对肝脏肿瘤诊断和治疗起到了重要的作用。目前在中国广泛应用的造影剂声诺维（Sonovue）是第二代造影剂,属于血池显像,不会进入组织内部。Sonazoid(GE Healthcare,Waukesha,WI,USA)是第二代造影剂的一种,之前应用于韩国、日本和挪威。它可以聚集在网状内皮系统,例如肝和脾。在肝脏肿瘤的临床诊断及治疗中,Sonazoid超声造影起着至关重要的作用,本文针对Sonazoid在肝脏肿瘤中的应用进行综述。     

Quantitative analysis of microcirculation blood perfusion in patients with hepatocellular carcinoma before and after transcatheter arterial chemoembolisation using contrast-enhanced ultrasound

To conduct a quantitative analysis of microcirculation blood perfusion in patients with hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolisation (TACE) using contrast-enhanced ultrasound (CEUS). From 2013 June to 2105 October, a total of 106 HCC patients undergoing TACE were recruited. CEUS was performed before and after TACE to determine time–intensity curve (TIC) and perfusion quantitative parameters of the HCC lesions and surrounding liver parenchyma. Quantitative perfusion parameters were obtained using the region of interest method. The microcirculation blood perfusion was measured with a blood analysis system and microcirculation microscope. Tumour microvessel density (MVD) was detected by CD34 immunohistochemistry. Compared with surrounding liver parenchyma, the HCC lesions had earlier arrive time (AT), time to initial peak (TTP) and acceleration time, and faster slope of rise time (a3), but no differences were observed in mean transit time (MTT), slope of decrease to half of peak (a2), peak intensity (PI), increased signal intensity (ISI), area under the curve (AUC) and blood flow (BF). There were significant differences in PI, a3, ISI, AUC and BF in HCC lesions between before and after TACE. The high blood viscosity, low blood viscosity, plasma viscosity and integral viscosity in HCC lesions increased after TACE, but the velocity of nailfold microcirculation decreased after TACE. The MVD of well-differentiated HCC lesions was higher than that of poor-differentiated HCC lesions under a light microscope at 50× magnification. However, no significant differences were found in MVD between well-differentiated and poor-differentiated HCC lesions under a light microscope at 100× and 200× magnifications. The PI, ISI, AUC and BF of poor-differentiated HCC lesions were significant lower than those of well-differentiated HCC lesions, but there were no differences in AT, TTP, ACU, MTT, a2 and a3. In conclusion, these results indicate that quantitative CEUS perfusion parameters could be useful tools for assessing the efficacy of TACE for HCC.     

超声造影评价微波凝固治疗肝细胞肝癌的应用

目的：探讨超声造影在评价微波凝固治疗肝细胞癌（HCC）的应用价值。方法：经静脉注射造影剂SonoVue后,对30例（男20例、女10例）HCC患者（共33个病灶）在低机械指数状态下进行实时超声造影检查,评价微波治疗疗效,所有病灶微波治疗后半小时至2周采用超声造影检查评价疗效,并与同期增强CT检查结果进行比较,12个病灶治疗区取病理标本送检,21个病灶治疗区接受随访观察。结果：微波治疗后超声造影显示22个治疗区内部各期均无异常增强区,提示肿瘤完全灭活;11个治疗区边缘局部有早期结节状增强,判断有肿瘤残存;经穿刺活检及6个月以上的随访,证实微波治疗联合肝动脉栓塞化疗（TACE）,的2个HCC病灶,增强CT判断失误,增强CT诊断肿瘤灭活准确率为94%（31/33）;超声造影诊断肿瘤灭活准确率为97%（32/33）。统计结果显示,两者诊断肿瘤灭活差异无统计学意义（P〉0.05）。结论：超声造影不仅能评价HCC微波治疗的疗效,且能有效地评价TAE和微波凝固联合治疗HCC的疗效,因不受碘油干扰可优于增强CT。     

超声造影与增强CT对肝癌射频消融效果的一致性评价

  目的  对超声造影与增强CT对肝癌射频消融术后评价效果一致性进行分析。  方法  对35例患者共68个肿瘤病灶进行超声或CT引导下射频消融治疗,术后同时定期进行增强CT以及超声造影检查评价射频消融效果,分析超声造影以及增强CT在肿瘤完全消融率、残留率,复发率、准确性以及超声造影与增强CT一致性。  结果  68个病灶中,超声造影评价肿瘤总体完全消融率以及残留率分别为84%及16%,增强CT分别为90%及10%,二者之间比较差异无统计学意义(χ2=0.576 3,P=0.447 8),具有很高的一致性(K=0.882 9,Sk=0.120 4),68个病灶中24个月内共有13个病灶为复发病灶,超声造影对复发病灶检出率为92%(12/ 13),与增强CT 100%(13/13)之间比较差异无统计意义(P>0.05)。以增强CT作为判断RFA后肿瘤残留及复发的金标准,超声造影对68个肿瘤病灶总体诊断准确性为92%(63/68),5个病灶判断不一致。  结论  超声造影在肝癌射频消融效果评价中与增强CT具有很高准确性及一致性,能为肿瘤射频消融术后治疗提供可靠诊断依据。      

强化造影定量灌注参数对子宫内膜癌的预后价值

目的:评估超声造影（contrast-enhanced ultrasonography,CEUS）定量指标对子宫内膜癌的预后价值。方法:2015年05月至2016年05月期间,共纳入112例行子宫内膜癌手术治疗的患者,记录术前CEUS的定量指标,包括增强强度（enhancement intensity,EI）、上升时间（rise time,RT）和增强率（enhancement rate,ER）以及其他临床指标。采用单因素和多因素COX分析,分析术后总生存期（overall survival,OS）和无复发生存期（recurrence-free survival,RFS）的危险因素。结果:根据ROC曲线得出ER的最佳临界值为1.8 dB/s,Kaplan-Meier生存曲线表明,高ER水平患者的RFS和OS比低ER水平的患者差（RFS:P＜0.001;OS:P=0.028）。在多因素COX分析中,ER是子宫内膜癌患者RFS（HR=1.82,95%CI:1.08~4.23,P＜0.001）和OS（HR=2.08,95%CI:1.01~5.77,P=0.018）的独立危险因素。结论:CEUS定量检测指标ER是子宫内膜癌术后患者生存的有效预测因子,可指导患者选择个性化的治疗方案。     

Effect of contrast-enhanced ultrasound on differential diagnosis of intrahepatic cholangiocarcinoma and arterial phase enhanced hepatic inflammatory lesions

Objective:To investigate differential diagnosis between intrahepatic cholangiocarcinoma (ICC) and arterial phase enhanced hepatic inflammatory lesions in patients without liver cirrhosis using contrast-enhanced ultrasound (CEUS).Methods:ICC and hepatic inflammatory lesions cases with CEUS and pathological diagnosis between Sep 2013 and Oct 2016 were investigated retrospectively.Imaging features of conventional ultrasound and CEUS were analyzed.The parameters of time intensity curve (TIC),including the arrival time,peak intensity (PI) in the lesions,the starting time for washout,and the intensity difference at 3 min (△I3) after contrast agent infection between the lesion and the liver parenchyma,were compared between ICC and hepatic inflammatory lesions.Results:Twenty-five ICC and fifteen inflammatory patients were included in this study.Seventeen ICC (68.0％) and two inflammatory cases (13.3％) showed bile duct dilatation on conventional ultrasound.Using CEUS,three ICC cases (12.0％) were misdiagnosed as inflammatory lesions and three inflammatory lesions (20.0％) as ICC;two ICC (8.0％) and one inflammatory case (6.7％) could not be made definite diagnosis.Washout started at 34.5±3.5 s and 61.5± 12.9 s for ICC and inflammatory lesions respectively (P＜0.001).The intensity difference between lesion and liver parenchyma at 3 min after contrast agent injection was 10.8±3.1 dB in ICC and 4.2±2.3 dB in inflammatory group (P＜0.00 1).The sensitivity and specificity differentiating ICC and inflammatory lesions were 76％ and 87％ if the cut-offvalue of the intensity difference was 7.7 dB.Conclusions:Combined with TIC analysis,and particularly with the characteristic of the early-starting and obvious washout in ICC,CEUS can be useful in differential diagnosis between hepatic inflammatory lesions and ICC.     

超声造影时间-强度曲线在评价原发性肝癌微波消融术疗效中的作用

目的探讨超声造影时间-强度曲线在评价原发性肝癌微波消融术疗效中的作用。方法65例原发性肝癌共103个病灶采用微波消融治疗,对消融灶超声造影与增强MRI检查结果进行比较。结果治疗前,超声造影时间-强度曲线发现恶性肿瘤结节103个,增强MRI发现101个,两者差异无统计学意义(P>0.05)。治疗后,超声造影对完全消融病灶表现为肿瘤血流灌注消失,未见造影剂填充,超声造影时间-强度曲线表现为无增强,参数峰值强度(IMAX)、上升时间(RT)、达峰时间(TTP)≈0,与增强MRI相符,较好地反映了消融灶大小;而对不完全消融,其造影时相增强,时间-强度曲线明显强化,其IMAX、RT、TTP与正常组织比较,差异有统计学意义(P<0.05),与增强MRI相符,可见病灶区"快进快出"血流灌注,但增强MRI未见异常。超声造影判定微波消融术疗效的灵敏度和准确率分别为97.8%和94.2%。结论超声造影时间-强度曲线可直观、动态反映原发性肝癌微波消融术治疗前后血流灌注,在评价治疗效果中有较大的临床应用价值。     

Contrast enhanced ultrasound should be the initial radiological investigation to characterise focal liver lesions

Introduction

Contrast enhanced ultrasound (CEUS) involves the administration of a microbubble contrast agent followed by a US scan to evaluate the liver lesion through all phases of enhancement. Although technical difficulty and operator dependence can be encountered, CEUS is thought to be superior to conventional US and CT. This study aims to determine how effective CEUS is at characterising focal liver lesions and to establish its role in the diagnostic algorithm.

Methods

All patients who underwent a liver CEUS performed by a single consultant radiologist were identified over a 5 year period. The CEUS report, CT, MRI and/or PET report, histopathology report and case notes were reviewed.

Results

127 patients were included. CEUS correctly identified 71 of 77 malignant lesions and all of the benign liver lesions. The sensitivity of CEUS for detecting and correctly characterising a malignant FLL is therefore 92% with a specificity of 100%.

Conclusion

Our study shows that CEUS has a high sensitivity and specificity for characterising focal liver lesions. CEUS has advantages over CT and MRI of a high degree of safety, good patient tolerance and often availability at the time of initial detection. We therefore suggest that CEUS should be used as the initial study in the characterisation of FLLs. The study should be followed, as appropriate, by CT and MRI or PET studies. Biopsy, with its risks of tumour seeding and false negative results should only be considered after review of the imaging studies and full MDT discussion.     

Diagnostic accuracy of contrast-enhanced ultrasound in differentiating benign and malignant focal liver lesions: a retrospective study

Purpose: The purpose of this study was to assess the diagnostic accuracy of our early experience with contrast-enhanced ultrasound (CEUS) in the characterisation of focal liver lesions (FLLs) using histopathology, contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI) or other imaging follow-up as the standard of reference. Materials and Methods: Seventy-three patients with 82 FLLs who underwent liver CEUS from January 2006 to December 2008 were retrospectively reviewed. CEUS was performed with up to 4.8 mL of SonoVue® (Bracco, Milan, Italy) using a low mechanical index mode. The CEUS findings were compared with histopathology, or where histopathology was not available, clinical and imaging follow-up over at least 12 months was used as the standard of reference. Results: Of the 82 FLLs, 50 were malignant and 32 were benign at final diagnosis. CEUS correctly identified 43 malignant FLLs, with final diagnosis confirmed by histopathology in 13 lesions and clinico-radiological follow-up in 30 lesions. Twenty-nine lesions were correctly identified as benign on CEUS, with all these lesions confirmed on clinico-radiological follow-up. CEUS demonstrated a sensitivity of 86.0% and a specificity of 90.6% in the characterisation of liver lesions as malignant, with an overall accuracy of 87.8% (P < 0.05). Conclusion: Our early experience has shown that CEUS can be accurate in differentiating malignant from benign FLLs and may become a useful first-line imaging tool where CT or MRI are not available or contra-indicated.     

超声造影定量分析在乳腺肿瘤诊断中的应用价值

目的探讨Qontraxt超声造影定量分析软件在乳腺肿瘤诊断中的临床应用价值。方法对73例患者78枚乳腺病灶进行常规超声和超声造影检查，采用Qontraxt软件分析造影参数成像图及时间强度曲线特征，并与病理检查结果对照。结果病理检查结果显示78枚乳腺病灶巾恶性病灶47枚，良性病灶31枚。恶性病灶造影参数彩图示造影剂峰值强度高低不等，达峰时间长短不一。而良性病灶造影参数彩图颜色单一，病灶每个区达峰时间较一致。时间强度曲线示恶性肿瘤组峰值强度明显大于良性肿瘤组（P〈0．05），平均达峰值时间两组无统计学意义（P〉0．05）。常规超声对乳腺癌诊断的敏感性、特异性和准确率分别为70．2％、80．6％、74．4％。超声造影的敏感性、特异性和准确率分别为87．2％、90．3％、88．5％。联合常规超声及超声造影的敏感性、特异性和准确率分别为91．5％、93．5％和92．3％。结论超声造影定量分析的造影参数成像图及时间强度曲线分析有助于乳腺肿瘤的诊断。