彩色多普勒血流显像对前列腺癌的诊断意义

目的：观察前列腺被膜上动脉和前列腺被膜下－动脉以及结节内的异常血流信号,旨在探索经直肠彩色普勒血流显像对前列腺癌的诊断意义。方法：以经直肠彩色多普勒血流显像对１４例前列腺癌患者和３０名正常人前列腺被膜上,下动脉进行检测。所用指标为：最大流速（Ｖｍａｘ）;最低流速（Ｖｍｉｎ）,平均流速（Ｖｍｅｎａ）;博动指数（ＰＩ）,阻力指数（ＲＩ）和最大流速与最低流速之比（Ａ／Ｂ值）。结果：前列腺癌组患者的最大流     

直肠腔内彩超对前列腺癌及前列腺增生的鉴别诊断价值研究

目的：探讨前列腺增生,前列腺癌的形态及血流变化。方法：应用经直肠彩超对20例正常人,16例前列腺癌,130例前列腺增生进行观察,结果：前列腺增生体积明显增大。结节以强回声为主,分布在内腺范围居多,前列腺癌体积增大,结节以弱回声为主分布于外腺且双侧叶不对称,前列腺癌的血流分布更丰富,血管内径＞0．2cm,在血流峰值与阻力指数两者无明显差异P＞0．05,但病变组与对照组有差异P＜0．01,结论：前列腺癌与前列腺增生在形态和血流方面均有不同点。     

经直肠彩色多普勒超声对移行区前列腺癌诊断价值

目的：探讨经直肠彩色多普勒超声对移行区前列腺癌的诊断价值。方法：对28例血清PSA升高而直肠指检和经直肠灰阶超声均无明显异常发现的双侧前列腺移行区行经直肠彩色多普勒超声探测，观察移行区有无异常血流分布区域。结果：28例(56个移行区)前列腺穿刺活检病理证实前列腺癌14例(18个)；前列腺增生症14例(38个)。移行区血流信号增加在前列腺癌组12个，前列腺增生症组3个。结论：经直肠彩色多普勒超声检查是提高移行区前列腺癌病灶检出率的有效方法。     

经直肠彩色多普勒血流显像评价良性前列腺增生症临床治疗效果

目的 :探讨前列腺大小及内腺动脉血流动力学参数对良性前列腺增生症 (BPH)疗效评估的意义。方法 :2 48例 BPH患者随机分为 A、B两组 ,分别应用保列治和益气通淋冲剂进行治疗 ,采用经直肠彩色多普勒血流显像技术对治疗前、后的前列腺进行观察。结果 :A、B两组前列腺厚径及上下径于治疗前、后均无明显差异 ,P>0 .0 5 ;每组中的内腺动脉血流收缩期峰值速度 (Vs)、舒张期血流速度 (Vd)、阻力指数 (RI)、血管内径 (D)于治疗后均有显著下降(P<0 .0 5 ,P<0 .0 0 1)。结论 :前列腺内腺动脉血流动力学主要参数可用于 BPH临床疗效的评估 ,而前列腺大小不能作为疗效观察指标 ,益气通淋冲剂治疗 BPH,其疗效与保列治相似 ,适用于临床推广应用。     

原发性肝癌三维能量多普勒显像及与血管造影的相关性

目的 :评价三维能量多普勒描述原发性肝癌内血管分布的能力。方法 :对 4 3例原发性肝癌患者 4 3个病灶行二维及三维能量多普勒检查 ,其中 14例患者接受了血管造影检查。比较两种能量多普勒超声显示的瘤内多普勒信号丰富程度及血供类型。对 14例接受了二维、三维能量多普勒及血管造影检查的患者 ,定量比较了瘤内的血管分布情况。结果 :1.　 4 3个病灶中 ,三维能量多普勒显示瘤内血管分布丰富程度及分布类型与二维能量多普勒均有明显差异 (均 P<0 .0 0 1) ;2 .二维、三维能量多普勒及血管造影显示的血管密度分别是 4 .3% ,4 6 .0 %及 4 8.5 %。三维能量多普勒与血管造影结果高度相关 (r=0 .87,P<0 .0 0 1) ,而二维能量多普勒相关性较低 (r=0 .4 9,P>0 .0 5 )。结论 :三维能量多普勒描述原发性肝癌内血管分布优于二维能量多普勒 ,并与血管造影结果高度相关。     

前列腺外周带血流高阻力指数(RI) 对前列腺癌的诊断价值

目的探索彩色多普勒超声的血流指标对前列腺癌的诊断价值.方法采用彩色多普勒双平面直肠腔内探头检测前列腺,重点检测前列腺外周带血流参数指标.结果前列腺增生67例,前列腺癌58例.前列腺外周带血流2级以上前列腺增生58%,前列腺癌74.13%,P＜0.10;前列腺增生和前列腺癌的Vmax均值分别是10.77 cm/s和12.91 cm/s,RI分别是0.71和0.82,Vmax和RI在两组间有显著统计学差异(P＜0.001);以RI 0.75为临界值,对前列腺癌诊断的敏感性87.5%、特异性92.4%、准确性75%和阳性预测值84%.结论前列腺外周带血流增多,RI＞0.75时,对前列腺癌的诊断价值明显提高.     

经直肠彩色多普勒超声对前列腺增生和前列腺癌的血流动力学研究

目的：探讨前列腺增生和前列腺癌时前列腺内血流动力学变化特征及其临床应用价值。方法：经直肠彩超过30例正常人,55例前列腺增生,13例前列腺癌患者彩色多普勒（CDFI）参数进行对比分析。结果：病变组前列腺内血流信号较对照组明显增多,以前列腺癌组更为显著。病变组前列腺内动脉收缩期峰值（PS）、阻力指数（RI）、加速指数（AI）均有相变变化,其中RI、AI明显。对照组、增生组、癌组RI、AI平均值分别为0．59、0．67、0．80;0．61／s、1．07／s、1．93/s。三组间RI、AI均有极显著差异（P＜0．01）。结论：前列腺增生和前列腺癌时前列腺内血供丰富,RI、AI增高,前列腺癌组RI、AI显著大于增生组。前列腺内动脉RI、AI可作为前列腺癌早期诊断的一项指标。     

Clinical efficacy of prostate cancer detection using power doppler imaging in American and Japanese men

PURPOSE: The aim of this study was to compare the detection rates of tumor vascular flow as measured by power Doppler imaging (PDI) in 2 populations and to determine whether PDI can reduce the number of unnecessary prostate biopsies in men with serum prostate-specific antigen (PSA) concentrations less than 10.1 ng/ml. METHODS: The patient populations were Japanese (group 1) and American (group 2) men with either serum PSA concentrations of 4.1-10.0 ng/ml or abnormal findings on digital rectal examination (DRE) plus PSA concentrations less than 4.1 ng/ml. We compared the overall diagnostic accuracy of DRE, gray-scale transrectal sonography (TRUS), and PDI between the 2 groups. RESULTS: In total, 275 men were studied, 154 in group 1 and 121 in group 2. Cancer was identified in 27% of men in group 1 and in 60% of group 2. Men with cancer in both groups differed significantly in age, peripheral zone volume, and mean number of positive biopsy cores. The sensitivity and specificity of PDI in group 2 were significantly inferior to those in group 1. The negative predictive value (NPV) of PDI was significantly higher for group 1 than for group 2. The NPV of PDI in group 1 was equivalent to that for the combination of DRE and TRUS, whereas the NPV for PDI in group 2 was significantly inferior to that of DRE and TRUS.CONCLUSIONS: Tumor vascularity could be detected by PDI more effectively in Japanese men with cancer than in American men with cancer. We hypothesize that this difference was a result of larger cancer volumes and smaller prostates in the Japanese men. PDI did not provide any performance advantage over DRE and TRUS in avoiding unnecessary biopsies.     

Quantitative colour Doppler and greyscale ultrasound for evaluating prostate cancer

IntroductionAlthough transrectal ultrasound is routinely performed for imaging prostate lesions, colour Doppler imaging visualizing vascularity is not commonly used for diagnosis. The goal of this study was to measure vascular and echogenic differences between malignant and benign lesions of the prostate by quantitative colour Doppler and greyscale transrectal ultrasound.MethodsGreyscale and colour Doppler ultrasound images of the prostate were acquired in 16 subjects with biopsy-proven malignant or benign lesions. Echogenicity and microvascular flow velocity of each lesion were measured by quantitative image analysis. Flow velocity was measured over several cardiac cycles and the velocity–time waveform was used to determine microvascular pulsatility index and microvascular resistivity index. The Wilcoxon rank sum test was used to compare the malignant and benign groups.ResultsMedian microvascular flow velocity of the malignant lesions was 1.25 cm/s compared to 0.36 cm/s for the benign lesions. Median pulsatility and resistive indices of the malignant lesions were 1.55 and 0.68, respectively versus 6.38 and 1.0 for the benign lesions. Malignant lesions were more hypoechoic relative to the surrounding tissue, with median echogenicity of 0.24 compared to 0.76 for the benign lesions. The differences between the malignant and benign groups for each measurement were significant (p < 0.01).ConclusionMarked differences were observed in flow velocity, microvascular pulsatility, microvascular resistance, and echogenicity of prostate cancer measured with quantitative colour Doppler and greyscale ultrasound imaging. Vascular differences measured together with echogenicity have the combined potential to characterize malignant and benign prostate lesions.     

Peripheral zone hypoechoic lesions of the prostate: evaluation with contrast-enhanced gray scale transrectal ultrasonography.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of contrast-enhanced gray scale transrectal ultrasonography (TRUS) for detection of prostate cancer in peripheral zone hypoechoic lesions of the prostate. METHODS: The study involved 66 patients with peripheral zone hypoechoic lesions detected by TRUS. The lesions were evaluated with contrast-enhanced TRUS to differentiate prostate cancer from benign lesions, and the results were compared with color Doppler ultrasonographic findings. RESULTS: Transrectal ultrasonographically guided biopsy of the hypoechoic lesions revealed prostate cancer in 30 patients and benign prostatic diseases in 36. Flow signals within the lesions were classified as no, increased, equal, and decreased flow compared with surrounding peripheral zone tissue as follows: 1, 16, 12, and 1, respectively, in the prostate cancer group and 10, 12, 10, and 4 in the benign disease group. If we considered an increased flow signal within a peripheral hypoechoic lesion as a sign of prostate cancer, color Doppler ultrasonography had low sensitivity and specificity (55.2% and 53.8%, respectively). The enhancement intensity within the lesions was classified as no, increased, equal, and decreased enhancement compared with surrounding peripheral zone tissue as follows: 2, 20, 3, and 5 in the prostate cancer group and 14, 8, 4, and 10 in the benign disease group. The difference was statistically significant (P<.05). Thus, the peak enhancement intensity would be the optimal parameter for discriminatory performance (area under the receiver operating characteristic curve, 0.74; 95% confidence interval, 0.60-0.88). CONCLUSIONS: Contrast-enhanced TRUS could reveal the presence of vasculature within peripheral zone hypoechoic lesions more objectively than color Doppler ultrasonography and could be promising in guidance of prostate biopsy.     

超声造影鉴别前列腺结节良恶性的初步探讨

目的 探讨超声造影在鉴别前列腺结节良恶性中的价值.方法 应用造影剂声诺维(SonoVue)对20例经腹超声发现的前列腺结节患者进行前列腺超声造影,观察并分析结节的超声造影特征.结果 本组20例25个前列腺低回声结节中,结节位于内腺14个,外腺11个.内腺结节均为良性增生结节,外腺结节中3个为良性增生结节,8个为前列腺癌.不同部位不同性质的结节超声造影表现也不相同.内腺低回声增生结节表现为与周围内腺实质同步灌注的均匀增强模式;外腺低回声增生结节表现为与周围外腺实质增强强度相似的灌注模式;外腺低回声恶性结节表现为增强强度高于内腺前列腺组织,明显高于周围外腺前列腺组织.所有结节均经前列腺穿刺活检病理证实.结论 超声造影在鉴别前列腺结节良恶性中有一定的应用价值.     

Correlation between hypoechoic nodules on ultrasonography and benign hyperplasia in the prostatic outer gland.

OBJECTIVE: The purpose of this investigation was to study the correlation between hypoechoic nodules detected on ultrasonography and benign hyperplasia in the prostatic outer gland (POG) diagnosed by transrectal ultrasonography (TRUS)-guided biopsies. METHODS: The TRUS-guided biopsies were performed on 472 patients suspected of having prostate cancer. Specimens obtained by biopsies were independently assessed by pathologists at 3 hospitals. RESULTS: The histologic results of 310 patients (65.68%) were benign. Focal hypoechoic nodules located in the POG were found in 240 patients (50.8%) on TRUS scans. Among them, in 22 patients (9.17% of the 240 patients with hypoechoic nodules), benign hyperplasia was found in focal hypoechoic nodules located in the POG. Focal nodules were seen as well circumscribed with an ovoid shape and smooth surface in 18 patients. CONCLUSIONS: Benign hyperplasia may sometimes originate in the POG and may appear as a hypoechoic nodule, similar to the appearance of prostate cancer.     

经直肠彩色多普勒超声鉴别前列腺周缘区低回声性质的价值

目的 探讨经直肠彩色多普勒超声对前列腺周缘区低回声结节良恶性诊断的价值。方法 对77例前列腺周缘区低回声结节行经直肠彩色多普勒超声探测，利用彩色直方图软件计算结节内彩色血流面积与选定结节面积比值(black and white color ratio，BCR)和整个前列腺血流BCR并比较二者的BCR，如结节内BCR高于整个前列腺内5％则为血流增多。结果 77例前列腺周缘区低回声结节穿刺活检证实前列腺癌51例，前列腺增生症26例。周缘区低回声内血流增多共50例，其中前列腺癌41例。经直肠彩色多普勒超声检查结节内血流增加对诊断前列腺癌的敏感性、特异性、阳性预测值分别为80．4％，65．4％，82．0％。结论 经直肠彩色多普勒超声检查前列腺周缘区低回声结节内血流并用BCR解释其丰富程度对结节良恶性的鉴别诊断有一定帮助。     

Contrast-enhanced transrectal ultrasound for assessing vascularization of hypoechoic BPH nodules in the transition and peripheral zones: comparison with pathological examination

The purpose of this study was to investigate the vascularization of zonal location of hypoechoic benign prostatic hyperplasia (BPH) nodules and to evaluate the clinical value of contrast-enhanced transrectal ultrasound (CETRUS) for assessing vascularity of hypoechoic BPH nodules. Sixty-two patients with hypoechoic biopsy-proven BPH nodules in transition zone (TZ) (32 patients) or peripheral zone (PZ) (30 patients) of the prostate gland underwent CETRUS examination between January 2006 and September 2006. The enhancement characteristics of hypoechoic BPH nodules were observed and time to enhancement (AT), time to peak intensity (TTP) and peak intensity (PI) were measured with ACQ time-intensity curve analysis software. In addition, microvessel density (MVD) and vascular endothelial growth factor (VEGF) immunoreactivity were determined in the biopsy specimens. Microvessels were identified by immunohistochemical staining of endothelial cells for CD34. Findings were compared between hypoechoic BPH nodules located in PZ and TZ. The most common enhancement characteristic of hypoechoic BPH nodules in PZ was nonenhanced area inside (21/30), while most of hypoechoic BPH nodules in TZ appeared homogeneous enhancement (28/32). The average AT and TTP were significantly longer, the average PI was significantly lower in hypoechoic BPH nodules located in PZ than TZ (p < 0.01). The VEGF expression and MVD were significantly higher in hypoechoic BPH nodules located in TZ than PZ (p < 0.01). PI was found to be an important parameter strongly correlated with degree of vascularity of hypoechoic BPH nodules. Hypoechoic BPH nodules located in PZ and TZ showed significant difference in vascularization, which indirectly verified our finding that BPH nodule could occur in the peripheral zone. CETRUS could afford information on the vascularity of hypoechoic BPH nodules in a noninvasive manner and this could be used to improve selection of nodules for biopsy.     

经直肠彩色多普勒能量图对前列腺癌的诊断价值

目的：探讨经直肠彩色多普勒能量图（CDE）对前列腺癌的诊断价值。方法：对经病理证实的24例前列腺癌（34个结节）和30例前列腺良性病变患者采用经直肠CDE检查,10例为正常对照组,将前列腺腺体及结节CDE血流图分别进行0－3级分级评定,并与彩色多普勒血流显像（CDFI）比较。结果：（1）前列腺癌血流图分级以2,3级为主,占88．2％,前列腺良性病变则以0,1级为主,占80．0％,（2）CDE诊断前列腺癌的敏感性为88．2％,特异性为80．0％,阳性预期值为79．0％,阴性预期值为88．9％;（3）CDE在前列腺癌的血液显示方面优于CDFI,但二者在血流分级及判断前列腺良恶性病变方面无显著差别（P＜0．05）。结论：经直肠CDE检查对前列腺癌的诊断具有重要价值。当CDE显示前列腺结节周边和（或）内部有异常增多的血流,尤其当结节位于周围带时,应高度怀疑前列腺癌的可能。     

彩色多普勒超声对乳腺肿瘤与甲状腺改变的关系观察

目的 :观察乳腺病变时甲状腺的改变 ,以探讨二者之间的关系。方法 :本研究对经手术证实 10 0例乳腺癌、 5 0例乳腺腺瘤、 5 0例乳腺增生症及 10 0例正常人的甲状腺二维及多普勒超声检测。结果 :与对照组相比乳腺癌时甲状腺体积增大 ( p<0 .0 1) ,甲状腺内低回声结节增多 ( p<0 .0 5 ) ,甲状腺收缩期峰值血流速度 ( SPV)、加速度 ( SA)、减速度 ( SD)及甲状腺上、下动脉血管内径 ( D)增加 ( p<0 .0 5 ) ,乳腺腺瘤、乳腺增生症其甲状腺体积亦增加 ( p<0 .0 5 ) ,其余参数无统计学意义。结论 :乳腺癌与甲状腺病变存在某种关系     

经直肠动态能量多普勒血流显像诊断早期前列腺癌临床价值的评价

目的：评估经直肠动态多普勒能量血流显像（TRDPFI）鉴别诊断早期前列腺癌的临床价值。方法：利用TRDPFI对88例患者的前列腺结节进行观察，并进行前列腺穿刺活检和／或手术，取得病理结果。检测结果与直肠指诊（DRE）、前列腺特异抗原（PSA）、经直肠B超（TRUS）相对照。结果：88例患者中26例（29．5％）为前列腺癌，62例为良性增生结节（70．5％）。运用TRDPFI良性增生结节与癌结节内的动态检出率，结节内的动脉收缩期峰值流速，均有显著差别，经卡方检验、t检验差异有显著性意义（P＜0．05），尤其癌结节内显示穿入血流率达92．31％（24／26），本组良性增生结节无一例测及穿入血流（P＜0．01）。结论：经直肠能量多谱勒血流显像能显著提高早期前列腺癌的检出率，降低假阳性和假阴性。     

卵巢Brenner瘤的超声病理对照研究

目的 探讨卵巢Brenner瘤的超声图像特征，并与病理改变对照分析。方法 经腹与经阴道超声检查结合，观察卵巢Brenner瘤9例；全部病例经手术及病理证实。结果 Brenner瘤超声表现为：瘤体呈“蛋壳”征，后方有明显的声衰减；肿块边界清晰的不均质低回声或部分低回声病灶。4例经CDFI检查，1例恶性瘤体内探及较多血流信号，其余3例良性者瘤内均未探及明显血流信号。结论 卵巢Brenner瘤的超声表现具有一定特征。CDFI可能有利于良恶性Brenner瘤的鉴别诊断。     

Three-dimensional color Doppler sonography and uterine artery arteriography of fibroids: assessment of changes in vascularity before and after embolization.

OBJECTIVE: To assess the accuracy of three-dimensional color Doppler sonography and uterine artery arteriography in depicting changes in fibroid vascularity before and after embolization. METHODS: Preembolization and postembolization three-dimensional color Doppler sonography and selective uterine artery arteriography were retrospectively compared in 15 patients who underwent uterine artery embolization for treatment of symptomatic fibroids. Three-dimensional color Doppler sonography was performed by using a scanner with color power angiographic imaging capability. Vascularity was quantified by using an estimation of power-weighted pixel density as described by our group in previously published studies. Uterine artery arteriography was performed by using a standard selective microcatheter embolization technique. For purposes of comparison, fibroids were classified as either hypervascular or hypovascular relative to myometrial vascularity before and minutes to several hours after uterine artery embolization. Changes in fibroid vascularity (i.e., from hypervascular to hypovascular) as depicted by three-dimensional color Doppler sonography were compared with those shown on uterine artery arteriography and classified as being in agreement or disagreement. RESULTS: In 13 (87%) of 15 patients there was agreement; in 2 (13%) of 15 there was disagreement. In both cases of disagreement, three-dimensional color Doppler sonography showed collateral flow not depicted by uterine artery arteriography The mean reduction in quantitated vascularity after uterine artery embolization was 44% (range, 19%-78%). CONCLUSIONS: Three-dimensional color Doppler sonography accurately depicts fibroid vascularity and in some cases can reveal collateral flow not depicted by uterine artery arteriography.     

经直肠超声诊断前列腺癌的临床价值

目的探讨经直肠超声检查前列腺癌的临床价值。方法应用经直肠超声对临床拟诊53例前列腺癌患进行检查，观察前列腺内腺及外腺回声，发现形态不规则低回声区，仔细分辨与周围组织的关系，并行彩色及能量多普勒血流显像。结果经穿刺活检及手术病理证实46例为前列腺癌，7例为前列腺增生，诊断符合率为86．8％。结论经直肠超声显示前列腺癌声像图的敏感性及特征性较腹部超声明显增高，结合直肠指检(DRE)及前列腺特异性抗原(PSA)测定可提高前列腺癌的检出率。