彩色多普勒超声在诊断T1期乳腺癌中的价值

Ｔ１期乳腺癌组６３例，乳腺良性肿块（≤２ｃｍ）组４５例，用彩色多普勒方法检测。结果显示：①乳腺癌组均显示有丰富血流，而良性肿块组血流信号检出率仅２８．９％。②乳腺癌组均可检出高速动脉血压，最大血流速度（Ｖｍａｘ）为０．２±０．１ｍ／ｓ，显著高于良性肿块组（０．１±０．０５ｍ／ｓ）（Ｐ值＜０．００１）。③乳腺癌组动脉内阻力指数（ＲＩ）为０．７±０．１，也明显高于良性肿块组（０．６±０．１）（Ｐ值＜０．０１）。以显示有丰富血流，检出高速动脉血流和ＲＩ增高作为判断乳腺癌的指标，则两维超声结合彩色多普勒大大地提高了对２ｃｍ以下乳腺良恶性肿块判断的敏感性、特异性和准确性，对Ｔ１期乳腺癌诊断的准确率由单用两维超声的８１％提高到９８．４％（Ｐ值＜０．０１）。     

小乳腺癌的彩色多普勒超声综合指标诊断探讨

小乳腺癌≤２ｃｍ，在二维超声上鉴别诊断较困难，我科自１９９１年开始利用彩色多普勒双功能超声，诊断小乳腺肿块５０例，其中乳腺癌及良性病变各２５例，使用Ａｃｕｓｏｎ１２８ＸＰ／１０型彩色电脑超声诊断仪，进行乳腺多普勒检查，患者均为女性，年龄２８～６８岁，平均４５岁，彩色多普勒在恶性病灶中１００％可探到动脉型血流，ＲＩ值为０．７５±０．０６，Ｐ＜０．００１，中等量至丰富血流（～级）占７６％，且７２％为丰富血流，８４％的病灶血管数在３条以上；而良性病灶中，９２％为无至少量血流（０～级），中等量至丰富血流占８％，最多为２条血管，ＲＩ值为０．６０±０．０６，Ｐ＜０．００１，因此把病灶的特征、间接征象和血流动力学改变、综合性指标结合起来，可提高小乳腺癌的正确诊断率     

经静脉声学造影剂增强乳腺肿块彩色血流信号的初步研究

本文探讨经静脉声学造影剂对乳腺肿块彩色血流信号的增强作用及鉴别良恶性病变的应用价值。１０例患者中７例为乳腺癌，３例为良性肿块，经静脉注射声学造影剂后，病灶区彩色血流信号显著增强：６例乳腺癌和１例良性肿块病灶内见有片状彩色血流区，血管数增多２～６条；１例直径＜１．０ｃｍ的乳腺癌见有１条彩色血流束；２例良性肿块中１例无彩色信号而另１例仅有１条血管。结果提示：经静脉声学造影剂能显著增强乳腺肿块彩色多普勒血流信号，更准确地反映肿块血供状况；有助于准确鉴别乳腺良、恶性病变。     

彩色多普勒血流显像对乳腺肿块的临床研究

本文应用彩色多普勒血流显像检查了７６例乳腺肿块。恶性肿瘤血流信号检出率（９１％）明显高于良性肿块（４１．９％，Ｐ＜０．０５）。根据血流信号的数量和大小把肿块内血流丰富程度分成四个等级：０级、Ⅰ级、Ⅱ级和Ⅲ级，８７％的良性肿块为０级和Ⅰ级，７８％的恶性肿瘤为Ⅱ级和！级。在直径小于２ｃｍ肿块中，９５％的良性肿块为０级和Ⅰ级，８６％的恶性肿瘤为Ⅱ级和Ⅲ级。二者有显著差异（Ｐ＜０．０５），具有鉴别诊断意义。与单纯应用Ｂ型超声相比，Ｂ型超声检查辅以彩色多普勒检查可以提高乳癌诊断率，尤其是可提高２ｃｍ以下小癌的诊断率。     

彩色多普勒超声在乳腺疾病中的应用及相关因素

目的：回顾性分析１６２例乳腺疾病的血流情况,旨在寻求彩色多普勒超声在乳腺疾病中的应用价值及相关因素。方法：经彩色多普勒检查,了解病灶内部及周边的血流情况,分析流速最高的一束血流的多普勒频谱,并根据血流丰富程度分成四个等级。结果：良性疾病血流检出率为４２％,恶性为９１％,两者有显著差异。良性疾病血流丰富程度以０级或Ⅰ级为主,０＋Ⅰ级占７９％,恶性肿瘤为Ⅱ或Ⅲ级为主,Ⅱ＋Ⅲ级占８５．４％。血流检出率和血流丰富程度与乳腺疾病的病理类型、病灶大小、恶性乳腺肿块的恶性程度等有关。良恶性疾病的搏动指数（ＰＩ）、阻力指数（ＲＩ）、收缩期流速峰值（Ｖｍａｘ）均有显著差异。若以Ｖｍａｘ≥１０ｃｍ／ｓ且ＲＩ≥０．７作为良恶性乳腺疾病的临界值,其敏感性８４％,特异性７２％,准确性７９％,阳性预测值９１％,阴性预测值５９％。结论：彩色多普勒技术不仅能提供乳腺疾病的血流检出情况血流丰富程度的非定量指标,而且能提供血流动力学的定量指标,但受疾病的病理类型、病灶大小、恶性乳腺肿块的恶性程度等因素有关。     

彩色多普勒超声在乳腺小肿块良恶性鉴别诊断中的应用价值

目的 探讨乳腺小肿块（直径〈2cm）的超声表现特征及彩色多普勒超声对其良恶性的鉴别诊断价值。方法 64例乳腺小肿块经手术病理证实,其中恶性肿块27例,良性肿块37例。分析乳腺小肿块患者的彩色多普勒超声表现特征,应用彩色多普勒血流显像（CDFI）观察其血流分布特征,频谱多普勒检测血流参数阻力指数（RI）的大小。结果 乳腺小肿块良性组和恶性组的形态、边界包膜、纵横比及内部有无微小钙化比较,差异有统计学意义（P〈0．05）。恶性肿块血流分级≥Ⅱ级,RI〉0．7,血流频谱表现为峰值前移,舒张末期无血流信号或可见反向血流;良性肿块血流分级多为0-I级,RI〈0．7,血流频谱表现为以静脉血流频谱为主。9例恶性肿块伴有同侧腋窝淋巴结肿大,2例良性肿块为反应增生肿大。结论 彩色多普勒超声对乳腺小肿块良恶性的鉴别诊断具有重要价值,结合声像图特征和CDFI表现能有效诊断。     

二维彩色血流显像诊断乳腺小肿块的价值

目的探讨二维彩色多普勒诊断乳腺小肿块的价值。方法６０例乳腺小肿块女性病人,平均年龄５１．５岁,经二维彩色多普勒检查,手术与病理证实小乳腺癌和良性小肿块各３０例。彩色血流按信号丰富程度分四级：０、Ⅰ、Ⅱ、Ⅲ级。结果彩色多普勒在小乳腺癌中可探到８０％动脉血流,且７０％属Ⅱ、Ⅲ级。良性肿块可探到４３．３％动脉血流,且１０％属Ⅱ、Ⅲ级。经ｔ检验有显性差异（Ｐ＜０．０５）。结论把二维特点、间接征象和血流动     

彩色多普勒超声显示甲状腺肿物中的高速血流信号──产生机理及临床意义

５３例手术病理证实的甲状腺肿块经彩色多普勒超声检查，其中２１例肿块内部及／或周边探及高速血流信号（＞７０ｃｍ／ｓ）。结果显示，这些肿块高速血流信号的产生机理可能为：１）恶性病灶中的动－静脉瘘；２）血供丰富的肿块；３）环绕肿块周边的动脉血管受压变窄；４）这３种因素的相互作用。因此，动一静脉瘘并非甲状腺肿块中高速血流信号的唯一原因。另外，本研究结果对各种脏器肿块高速血流信号的研究具有普遍借鉴作用，需要深入广泛地探讨。     

超声诊断乳腺小肿块的应用价值

目的探讨彩色多普勒超声对乳腺小肿块（直径≤20mm）良、恶性病变鉴别诊断中的应用价值。方法应用彩色多普勒超声常规检查67例共91个乳腺小肿块对良、恶性肿块的二维超声图像与彩色多普勒血流（CDFI）特点进行总结。并将超声与病理结果相对照。结果良性乳腺小肿块超声诊断与病理诊断符合率为92．6％（50／54），恶性乳腺小肿块超声诊断与病理诊断符合率为89．2％（33／37），良、恶性乳腺小肿块纵/横径比、后方回声、肿块内血流信号丰富程度及血流动力学参数等存在差异。结论二维超声与彩色多普勒结合能进一步提高乳腺小肿块的鉴别诊断能力。     

高分辨力钼靶X线与彩超双盲法定性诊断乳腺结节对照研究

目的　评价高分辨力钼靶Ｘ 线与彩色多普勒超声检查对乳腺结节的诊断价值。方法　对直径≤２ｃｍ的１１８ 例钼靶Ｘ线、彩超乳腺结节资料采用双盲法进行前瞻性分析、研究作出定性诊断并与手术后病理结果对照。结果　钼靶Ｘ 线与彩超对乳腺结节灶性质的判断,灵敏度分别为９６１５ ％ 、８５９％ ,特异度分别为１００ ％ 、９２５ ％ ;总一致性比较,钼靶Ｘ 线（９７４６ ％ ） 优于彩超（８８１４ ％ ）（ ｕ ＝ ２．８５ ,Ｐ＜ ０ ．０１） ;二者联合诊断与单独钼靶Ｘ 线诊断比较,灵敏度、特异性、总一致性均无显著差异（ｕ ＝ ０ ．３８５ ,Ｐ＞ ０ ．０５） ;彩色多普勒血流显像（ＣＤＦＩ） 检测良、恶性乳腺结节灶血流信号比率有明显差异（χ２ ＝ ２２ ．８６９ ,Ｐ＜ ０ ．００１） ;血流丰富比率亦有显著统计学意义（χ２ ＝ １５．００３ ,Ｐ＝ ０ ．００１） ;良、恶性结节灶内检测到的血流阻力指数（ＲＩ） 及血流搏动指数（ＰＩ） 均无显著差异。结论　高分辨力钼靶Ｘ 线与彩超均为诊断乳腺结节较理想的设备,钼靶Ｘ 线优于彩超,但二者在诊断乳腺结节性质方面有很强的互补性;ＣＤＦＩ检测乳腺结节灶内血流敏感性高,可作为Ｂ型超声检查鉴别乳腺结节性质的辅助手段     

超声多普勒功率及其在检测颅内血流分布上的应用

本文结合背向散射超声多普勒信号模型对超声多普勒功率的概念及其特性进行了阐述，并提出了一种用超声多普勒功率来检测颅内血管血流分布的方法。实验结果证明，该方法能在噪声背景下灵敏准确地反应沿声束指向一维空间各个位置是否存在血流以及血流强度的大小。这一方法已被用于经颅多普勒（ＴＣＤ）脑血流分析仪中，解决了现有经颅多普勒检查时只能凭经验盲目搜寻颅内血管的问题，并提供了颅内血管分布的相对位置信息以帮助临床医生更方便准确地判定所检测的是哪一根血管。     

硫酸氢氯吡格雷治疗68例2型糖尿病患者下肢动脉病变的疗效观察

目的 观察硫酸氢氯吡格雷片治疗68例2型糖尿病患者下肢动脉病变的疗效。方法通过下肢血管彩超和踝肱比（ABI）测量明确有下肢动脉病变的2型糖尿病患者98例,随机分为硫酸氢氯吡格雷组（68例）,阿司匹林组（30例）,分别给与硫酸氢氯吡格雷75mg,1次／d,阿司匹林肠溶片75mg,1次／d,共6个月。观察治疗前后2型糖尿病患者下肢动脉病变的症状、股动脉、胭动脉、足背动脉的内径、血流速度和ABI的变化。结果硫酸氢氯吡格雷治疗组总有效率81．38％,阿司匹林治疗组总有效率52．24％,2组疗效差异具有显著性。治疗中无严重不良反应发生。硫酸氢氯吡格雷治疗组2型糖尿病患者胭动脉、足背动脉的内径增大,血流速度增加;ABI明显升高,差异均具有显著性。阿司匹林治疗组2型糖尿病患者胭动脉、足背动脉内径增大,血流速度有所增加,ABI有所升高,但差异无显著性。结论硫酸氢氯吡格雷通过对血小板聚集的影响,能明显改善2型糖尿病患者下肢动脉的血流,可用于2型糖尿病下肢动脉病变的治疗。     

Doppler developments in the last quinquennium

The major advances which have taken place during the last five years in the development of ultrasonic Doppler devices and methods of Doppler signal analysis are reviewed. The following aspects of instrumentation are considered: crossed beam Doppler systems, range measuring Doppler systems, duplex systems, flow mapping systems, transducers and measurements of system performance. Analytical methods are discussed in the following categories: waveform analysis, including the extraction of single-value waveforms and their applications to the diagnosis of vascular disease; spectral analysis, including the derivation of frequency spectra and their application in the study of blood flow; and volume flow estimation. It is concluded that it is likely to be in the study of the information in Doppler frequency spectra, two-dimensional real-time Doppler images and in the measurement of blood flow volume that most progress will be made.     

超声心动图多种参数在评价高血压病心室功能中的比较

目的探讨高血压病患者心室功能的改变,比较不同超声参数评价高血压心室功能的价值.方法采用脉冲及组织多普勒超声方法对轻中度高血压患者的左、右心室功能进行了评价.结果高血压病早期右心室舒张功能即出现显著性改变,而收缩功能早期变化不明显.右心室舒张功能的改变要早于收缩功能的改变,右心室收缩功能的改变亦早于左心室.结论脉冲多普勒和组织多普勒超声均能准确评价高血压病心室功能的变化,二者具有较高的一致性.     

A Rotating Cylinder Phantom for Flow and Tissue Color Doppler Testing

Ultrasound Doppler using two-dimensional (2D) techniques is commonly used to study blood flow and myocardial tissue motion. This use includes measurement of velocity and time intervals, often in relation to the electrocardiogram (ECG) signal. 2D Doppler is frequently considered a real-time technique but in reality the acquisition time can be as long as 200 ms per image. We have developed a test-phantom using a rotating cylinder to simulate blood flow and tissue motion in a whole sector or space angle to evaluate velocity and timing characteristics. The phantom can produce constant velocities for velocity testing, as well as accelerating movement for testing the timing characteristics of ultrasound systems. Our investigation shows that the cylinder phantom is especially suitable for timing measurements in 2D Doppler imaging and that time delays between the Doppler signals and the ECG signal exist in the tested ultrasound system. (E-mail: andrew.walker@ltv.se)     

Evaluation of breast tumors with color Doppler imaging: A comparison with image-directed Doppler ultrasound

Doppler ultrasound is an adjunct to other imaging modalities in differentiating benign from malignant breast tumors. Two groups of patients with breast nodules were examined using a 10/4.5 MHz (imaging frequency/pulsed Doppler frequency) image-directed Doppler probe and a 7.0/5.0 MHz color Doppler imaging probe, separately. Whenever flow signals were detected within or at the margin of the breast nodule, the lesion was considered to be malignant. In detecting malignant breast tumors, the sensitivity was 77.3% and 94.5%, specificity 83.3% and 40.1%, accuracy 81% and 63.4% for image directed Doppler and color Doppler imaging, respectively. We found color Doppler to be easier and more efficient in detecting the flow signals of neovascularity in breast tumor. Color Doppler exhibits a higher sensitivity in detecting the malignant breast tumors. However, more false-positive diagnoses were made. Color Doppler ultrasound also expedited the examination, and the whole procedure could be shortened from 35 minutes to 8 minutes compared with our previous examination performed by image-directed Doppler ultrasound. Due to its higher sensitivity and saving in examination time, we use color Doppler imaging as a routine procedure when solid lesions are observed in x-ray mammography or sonography, as a supplement to the diagnosis of breast tumors. © 1995 John Wiley & Sons, Inc.     

Noninvasive in vivo measurements of hematocrit.

OBJECTIVE: To develop a clinically applicable method for noninvasive acoustic determination of hematocrit values in vivo. METHODS: The value of hematocrit was determined initially in vitro from the pulseecho measurements of acoustic attenuation. The testing was carried out in a laboratory setup with an ultrasonic transducer operating at 20 MHz and with the use of human blood samples at 37 degrees C. The attenuation coefficient measurements in blood in vivo were implemented by multigated, 20-MHz pulsed Doppler insonation. The Doppler signal was recorded in the brachial and radial arteries. Both in vitro and in vivo hematocrit data were compared with those obtained by the centrifuge method. RESULTS: The attenuation coefficient in vitro was determined from the measurements of 168 samples with hematocrit values varying between 23.9% and 51.6%. The attenuation from 20-MHz data was equal to 3.66 + 0.089 hematocrit (decibels per centimeter). The uncertainty of in vivo measurements in the brachial artery was determined to be within +/- 5% hematocrit. However, the measurements in the radial artery resulted in a clinically unacceptable uncertainty of +/- 20% hematocrit. CONCLUSIONS: The method proposed appears to be promising for in vivo determination of hematocrit, because 5% hematocrit error is adequate for monitoring changes in patients in shock or during dialysis. It was found that the multigate system largely simplified placement of an ultrasonic probing beam in the center of the blood vessel. Current work focuses on enhancing the method's applicability to arbitrarily selected vessels and to reducing the hematocrit measurement error to much less than 5% hematocrit.     

超声对布-加综合征的诊断价值

目的探讨灰阶与彩色多普勒、频谱多普勒及能量多普勒超声对布-加综合征的诊断价值。方法对38例经下腔静脉造影和／或经手术证实的布-加综合征患者的超声影像资料进行分析总结。结果38例布-加综合征患者中，超声确诊36例，漏诊2例，诊断准确率95％，与行下腔静脉造影相比，二者诊断准确率无显著性差异（P〉0．05）。其中下腔静脉型23例，肝静脉型5例，混合型10例。结论灰阶超声结合彩色多普勒、频谱多普勒、能量多普勒超声对布-加综合征的诊断符合率高，对临床治疗方式的选择具有重要意义。     

彩色多普勒联合脉冲多普勒诊断小肝癌的研究

本文就经手术及/或病理证实的≤3cm的肝内占位性病变56例(71个病灶)进行了彩色多普勒(DCFI)和脉冲多普勒(PD)的联合研究,其中原发性肝癌38例,肝血管瘤13例,肝局灶凝固性坏死3例,其它2例。DCFI与PD联合应用,在小肝癌中有86.96％可检测到动脉谱,而肝血管瘤和肝良性肿瘤组中仅分别为37％和33％,显著低于小肝癌组,多普勒流速和阻力指数(RI)显示流速在小肝癌与肝血管瘤等组之间无显著差异,如以肝小病灶内出现彩条并且测及动脉谱和RI>50％作为诊断小肝癌的指标,则其诊断小肝癌的特异性(96％)、准确性(90.14％)均显著高于单纯的二维超声(分别为56％和67.6%),而敏感性(86.96%)亦高于单纯的二维超声。作者认为彩色多普勒和脉冲多普勒联合应用可作为小肝癌诊断的新的手段。