血流灌注对高强度聚焦超声消融子宫肌瘤的影响

高强度聚焦超声（HIFU）治疗时,血流灌注会带走部分组织热量。为了保证治疗的安全性和有效性并提高治疗效率,需要在HIFU治疗过程中考虑血流灌注的影响。目前临床治疗已观察到血流灌注会降低HIFU疗效,但针对血流灌注的量化及如何控制血流灌注以提高HIFU疗效仍不明确。本研究以HIFU消融子宫肌瘤为例,分别从血流灌注对HIFU疗效的影响、子宫肌瘤血流灌注的检测、如何控制血流灌注以提高HIFU疗效这几个方面进行综述,旨在明晰血流灌注对HIFU疗效的影响,为临床控制并利用血流灌注提高HIFU疗效提供参考。     

超声造影结合实时弹性成像技术评估乳腺癌患者血流动力学指标

【摘要】目的:探讨分析超声造影结合实时弹性成像技术对乳腺癌患者血流动力学指标的评估价值。方法:选择127例女性患者156个乳腺肿块,肿块均经病理证实,患者术前均经超声造影、实时弹性成像及彩色多普勒超声血流动力学检查。以病理检查结果作为标准,分析良恶性肿瘤患者超声造影、实时弹性成像及血流动力学相关指标差异。结果:超声造影显示良性肿块121个,恶性肿块35个。实时弹性成像显示良性肿块120个,恶性肿块36个。恶性肿块组收缩期峰值血流速度和阻力指数高于良性肿块组（P<0.05）。超声造影、实时弹性成像联合血流动力学诊断灵敏度和特异度高于超声造影、实时弹性成像和血流动力学单项诊断。结论:超声造影、实时弹性成像技术联合血流动力学诊断乳腺癌具有重要意义,可提高灵敏度和特异度。     

超声检查对乳头区域乳腺病变的诊断价值

目的评价超声检查在诊断乳头区域乳腺疾病中的价值。方法对159例经超声检查并经临床或病理明确诊断的乳头区域病灶进行回顾性分析,计算其超声诊断符合率,并对其声像图特点包括二维、彩色多普勒、弹性成像特点进行归纳分析。结果所有病例包括乳腺导管扩张症73例;导管内乳头状瘤10例;导管内乳头状增生8例;纤维腺瘤16例;乳腺囊肿29例;软纤维瘤3例;腺病10例;炎性病灶5例;乳头湿疹样癌(Paget病)1例;浸润性导管癌4例。超声检出率100%,诊断符合率94.97%。结论乳头后方乳腺病变声像图有特异性表现,超声检查可作为其首选检查方法。     

超声检查在乳腺良恶性肿瘤中的应用价值

目的：探讨超声检查在乳腺良恶性肿瘤中的应用价值。方法应用灰阶超声对乳腺良恶性肿瘤的位置、形态、大小、边界、包膜、内部回声、纵/横比、有无钙化灶、后方有无衰减、肿块压缩变形等情况进行观察;彩色多普勒血流成像(CDFI)对乳腺良恶性肿瘤的血流情况进行分析。结果50例乳腺良恶性肿瘤中可疑良性病例40例,有38例经手术病理确诊为良性肿瘤,符合率95%,可疑恶性肿瘤10例中有8例经手术病理确诊为恶性肿瘤,符合率80%。结论灰阶超声和CDFI检查对乳腺良恶性肿瘤应用具有十分重要意义,为临床手术提供了术前重要参考依据。     

基于因子分析法的超声肝灌注定量分析初步研究

局灶性肝结节(FLLs)通常可从超声造影图像序列中提取的时间强度曲线进行量化评价.为了克服人工选择的主观性并自动提取曲线,提出一种用于因子分析的基于顶点搜寻的替代-近似(RA)算法.该算法将高维图像序列映射到一维空间,先找到与生理结构对应的两个顶点.然后,根据这两个已知点的信息,在二维空间中可以寻找到第3个顶点.这3个顶点对应着3条不同的目标曲线.实验采用6个在患者自由呼吸运动下采集的肝细胞癌病例对RA算法进行验证.实验结果表明,此方法能准确提取到具有生理意义的因子曲线和相应的因子图,提取的因子曲线与感兴趣区域(ROI)测定曲线的平均相关系数值为0.91±0.03.初步证明了RA算法在FLLs灌注的量化分析具有可行性.     

超声二次谐波声面声学造影评价冠脉的微血管血流灌注

目的：本文获取冠状动脉血流变化所致的心肌灌注类型,以了解冠脉的微血管血流灌注变化。方法：36人先后完成冠状动脉影,静脉注射声学造影剂利声显（Levovist),通过超声二次谐波技术获取心肌灌注图像,按心肌灌注积分指数将病人分为三组。结果：三组病人的冠状动脉狭窄程度、心肌灌注积分指数明显差异（P＜0．001）,冠状动脉狭窄波＜75％者,病人心肌灌注多为正常,随着冠状动脉狭窄程度加重,出现不同程度的心肌灌注异常。8例完全阻塞的冠状动脉有不同的冠状动脉侧支循环表现为不同的心肌灌注类型。结论：静脉心肌声学造影是反映心肌灌注的有效方法,能够反应冠状动脉血流的改变及微循环结构的完整性变化,从而弥补冠状动脉造影仅能显示心外膜下的冠状动脉而无法观察毛细血管水平的心肌灌注之缺限。当心肌灌注不良时,MCE能提示冠状动脉病变的存在,及其严重性,但要注意侧支循环对心肌灌注之影响,可影响对冠脉病变程度判断的精确性。冠状动脉造影确定某支冠脉病变时,MCE心机灌注有助于评价侧支循环状态。     

CT灌注成像对正常前列腺的血流动力学研究

目的 应用CT灌注成像对正常前列腺的血流灌注特点进行前瞻性研究.方法 应用GE lightspeed 8 slices螺旋CT对30例正常前列腺进行CT灌注成像.在工作站对灌注原始图像进行处理,在原始图上分别沿前列腺外周区和中央腺画出感兴趣区(ROI),对所有ROI的血流量(BF)、血容量(BV)、对比剂平均通过时间(MTY)和毛细血管表面通透性(PS)进行统计学分析.结果 正常前列腺外周区的BF、BV、MTT和PS分别为(10.57±5.65)ml/(100ml·min)、(2.71±1.34)ml/100ml、(22.36±4.12)s及(12.31±7.78)ml/(100 ml·min),中央腺依次为(9.92±4.08)ml/(100 ml·min)、(3.03±1.37)ml/100 ml、(23.78±3.73)s及(14.06±9.08)ml/(100ml·min).将整个层面的前列腺组织设为一个ROI,前列腺外周区与中央腺的灌注参数之间差异无统计学意义(P值分别为0.690、0.825、0.433和0.853).对正常前列腺的BF和年龄进行相关性分析,P=0.600.结论 正常前列腺为低血流灌注器官,随年龄增长,前列腺在正常情况下的灌注量无明显改变.     

基于曲线拟合算法的超声造影定量分析

随着第二代造影剂的引入,逐渐兴起了根据时间-强度曲线(time-intensity curves,TICs)使用定量分析技术来计算灌注参数的方法.本文提出一种模型,它运用最小二乘曲线拟合的方法来得到TICs,根据TICs计算造影强度的峰值、达到峰值的时间、造影剂到达的时间、曲线下面积等参数.该曲线在造影强度增强前处于基准线阶段,然后突然上升到峰值点,紧接着是造影强度下降的过程.     

超声造影增强模式在乳腺良恶性肿块鉴别诊断中的价值

目的探讨超声造影增强模式对乳腺良恶性肿块鉴别诊断的价值。方法选择40例经病理组织检查证实的乳腺肿瘤患者,均为女性,年龄25～54岁,平均年龄35岁。其中良性肿块25例,恶性肿块15例。使用Siemens Sequoia 512彩色多普勒超声诊断仪,造影剂采用SonoVue,行超声造影增强方式检查。结果乳腺良恶性肿块超声增强方式不同,良性肿块以整体不同程度地均匀型增强改变为主(80%,20/25),恶性肿块主要表现为不均匀增强或周边增强(86.7%,13/15)。结论乳腺良恶性肿块超声造影增强模式不同,可为鉴别诊断提供帮助。     

计算机辅助系统在诊断乳腺良恶性肿瘤中的应用

目的:探讨计算机辅助诊断系统在良恶性肿瘤检测与特征提取基础上的分类对于乳腺肿瘤的诊断价值。方法:回顾性分析乳腺超声检查发现肿瘤且经过病理学证实的617例患者影像资料,采用手工提取的方式得到乳腺超声图像的感兴趣区域及病灶轮廓,再利用方向梯度直方图（HOG）、局部二值模式（LBP）和灰度共生矩阵（GLCM）3个特征进行乳腺肿瘤的良恶性病变真假阳性检测;最后用受试者操作特征曲线（ROC）分别分析每个特征对于两类病变判别的诊断性能和应用所有特征集合的分类诊断性能。结果:多特征融合方法的各项诊断效能及ROC曲线下面积（AUC）值均优于单特征LBP、HOG、GLCM（P值均<0.05）。与人工诊断相比,多特征融合的敏感性无显著差异,但特异度显著升高达98.57%（Z值=2.25, P<0.05）,同时AUC值为0.985,显著优于人工诊断的0.910（Z值=1.99, P<0.05）。结论:计算机辅助系统乳腺超声肿瘤良恶性检测的算法是有效的,能够对乳腺癌鉴别诊断提供有益的参考。     

超声造影在甲状腺良恶性结节鉴别诊断中的应用

目的探讨实时灰阶超声造影在甲状腺结节良恶性鉴别诊断中的应用价值。方法 85例甲状腺结节患者(选取85个结节),其中男性29例,女性56例;年龄21～78岁,平均年龄42.5岁。采用声诺维(SonoVue)行超声造影检查,造影过程中观察结节的增强特点,比较增强模式在良恶性鉴别诊断中的价值。结果 85个结节中良性52个,恶性33个。结节超声造影表现为5种增强模式(弥漫性),即无增强、斑点样增强、均匀低增强、均匀高增强、均匀等增强。37个结节性甲状腺肿中,16个为均匀低增强,11个为均匀等增强,3个为均匀高增强,5个为环状增强,2个为斑点样增强中不均匀增强。9个腺瘤中6个为均匀高增强,2个为均匀低增强,1个为均匀等增强。26个甲状腺乳头状癌中15个不均匀增强,8个均匀低增强,1个均匀等增强,2个均匀高增强。6个滤泡性腺癌,4个为不均匀增强,均匀低增强和等增强各1个。不均匀增强特征对甲状腺恶性结节诊断的灵敏度、特异度和准确率分别为57.5%、94.0%和79.5%。环状增强对结节性甲状腺肿有较高的诊断特异度,而均匀高增强对甲状腺腺瘤有较高的诊断特异度。结论甲状腺良恶性结节的超声造影特征存在差异,不均匀增强对甲状腺恶性结节有较高的诊断价值。     

Serum DPPIV activity and CD26 expression on lymphocytes in patients with benign or malignant breast tumors

The aim of this work was to determine serum DPPIV activity as well as the percentage of CD26+ white blood cells and of CD26+ lymphocytes and the mean fluorescence intensity (MFI) of CD26 expression on lymphocytes in groups of patients with benign or malignant breast tumors and in healthy control people. Serum DPPIV activity was determined by colorimetric test, while CD26+ cells were counted using flow cytometer. Results of this study show that there is no statistically significant difference in serum DPPIV activity between examined groups of patients and healthy controls. However, two times higher frequency of patients with breast cancers had the enhanced DPPIV enzymatic activity in comparison to controls. Significant decrease in the percentage of CD26+ total white blood cells was found in the group of breast cancer patients and in patients with benign breast tumors compared to that found for healthy people. Although there was decrease in the percentage of lymphocytes in patients with breast tumors it was not statistically significant. The MFI of CD26 expression on these cells was significantly lower for cancer patients in comparison to healthy controls.In conclusion, this work showed the enhanced frequency of breast cancer patients with higher serum DPPIV activity. Decreased percentage of CD26+ white blood cells and decreased CD26 expression on lymphocytes are also characteristics of this group of patients.Determination of the clinical outcome of analyzed patients, 1 and 2 years after the surgical resection of the tumor, would clarify potential prognostic values of examined parameters for breast cancer.     

B超与X线对中国人乳腺癌诊断价值的对照研究

目的 比较X线摄影、B超及两者联合应用对中国人乳腺癌的诊断价值,为临床选择检查方法提供参考。方法 根据体检结果,把473例经病理证实的乳腺占位病人分为可触及肿块与未触及肿块两组,采用诊断性试验的方法分别比较两组中X线摄影、B超及两者联合应用(串联、并联)的诊断准确率。结果 可触及肿物组,灵敏度:并联>B超>X线>串联;特异度:串联>B超>X线>并联。未触及肿物组,灵敏度:并联>X线>B超>串联;特异度:串联>B超>X线,并联。B超、X线乳腺摄影及联合应用的灵敏度与特异度亦无明显差异,结果与病检高度一致。结论 B超应作为中国人乳腺癌诊断的首选检查,联合应用X线检查不能提高诊断效率。     

Distribution of dense core granules in normal, benign and malignant breast tissue

In this study breast tissue from 114 patients has been examined ultrastructurally for dense core granules (DCG). The tissue included examples of normal 'resting', pregnant and lactating breast plus various benign and malignant lesions. DCG were observed in low numbers in the apical cytoplasm in a proportion of the examples of 'resting' and pregnant breast tissue but were absent in the lactating patients. The incidence appeared to relate to hormonal changes. They were present in 50 per cent of the benign lesions examined. DCG were also observed in a high proportion of the ductal, lobular and tubular carcinomas examined and were associated with luminal differentiation. In the mucoid carcinomas over half the tumours possessed some DCG with large numbers of DCG present within certain of the malignant cells in two cases. It is possible that the granules could be related to mucin secretion. Therefore, in normal, benign and malignant (with the exception of mucoid carcinoma) breast tissue the presence of DCG would appear to be related to hormonal changes and represent prelactational differentiation rather than providing evidence of neuroendocrine differentiation. We emphasize the need for a comprehensive knowledge of the normal morphological variations within a tissue before attempting to interpret its tumours.     

Telomerase activity and its inhibition in benign and malignant breast lesions

Many types of human tumours and immortal cell lines have been demonstrated to exhibit telomerase activity with the recently formulated telomeric repeat amplification protocol (TRAP assay). However, a small proportion of undoubted tumour samples give a negative result and it has been postulated that, on occasion, the assay can be blocked by inhibitory factors in the cell or tissue extracts. To resolve this issue, a modified TRAP assay has been used to re-examine 45 previously negative breast tissue specimens. Phenol–chloroform extraction of the sample after the telomerase extension reaction revealed the presence of polymerase chain reaction (PCR) inhibitory factors in tissue from 6 of 14 (43 per cent) breast biopsies of fibrocystic disease (FCD), 6 of 12 (50 per cent) fibroadenomas (FAs), none of five carcinomas in situ, and 1 of 13 (8 per cent) invasive carcinoma (CA) tissue specimens. These results demonstrated that the enzyme telomerase can be active in some benign lesions as well as in carcinomas of the breast. Specimens which still remained negative for telomerase in the above experiment were next assayed for the presence of biologically relevant inhibitors of the enzyme by mixing the extracts with confirmed positive samples. Extracts from 12 of 17 carcinoma specimens (all of five carcinomas in situ and 7 of 12 invasive carcinomas showed dose-dependent inhibitory activity against telomere extension, whereas no inhibition was observed in those of three of eight FCD and 2 of seven FAs. These results indicate that telomerase activity may be regulated by a balance between inhibitory factors and an activated enzyme. © 1997 by John Wiley & Sons, Ltd.     

Cytogenetic findings in phyllodes tumors of the breast: Karyotypic complexity differentiates between malignant and benign tumors

Clonal karyotypic abnormalities were detected in short-term cell cultures from six phyllodes tumors of the breast. Whereas all five benign tumors had simple chromosomal changes, the highly malignant one had a near-triploid stemline, indicating that karyotypic complexity is a marker of malignancy in phyllodes tumors. Interstitial deletions of the short arm of chromosome 3, del(3)(p12p14) and del(3) (p21p23), were the only aberrations in two benign tumors. Cytogenetic polyclonality was detected in three benign tumors: two had cytogenetically unrelated clones, whereas the third had three different, karyotypically related cell populations as evidence of clonal evolution. The finding of clonal chromosome abnormalities in both the epithelial and connective tissue components of the phyllodes tumors indicates that they are genuinely biphasic, that is, that both components are part of the neoplastic parenchyma.     

乳腺良恶性肿瘤新生血管超微结构及血管生成相关分子的表达

目的 探讨乳腺良恶性不同肿瘤在新生血管超微结构及其血管生成相关分子表达方面的差异性.方法 应用透射电镜观察乳腺良恶性肿瘤新生血管超微结构改变,免疫组化技术检测CD34、VEGF及其受体Flk-1/KDR在两组肿瘤中的表达特性.结果 恶性组新生血管内皮细胞紧密连接开放,基膜不连续,缺乏平滑肌成分.内皮细胞胞体大,细胞核大,畸形,核仁增大、边集,核质比例增大,胞质内吞饮泡多.较多的单个内皮细胞呈裂隙状,血管腔闭塞或明显狭窄.恶性组MVD高于良性组(P<0.05),微血管丰富区位于痛巢边缘.VEGF在乳腺癌性上皮细胞及癌周血管内皮细胞呈强阳性表达,Flk-1/KDR在乳腺恶性肿瘤m管内皮细胞旱强阳性表达,VEGF及Flk一1/KDR尤其在癌灶边缘呈强阳性表达,良性组几乎不表达(P<0.05).结论 乳腺癌新生血管内皮细胞在超微结构及分子表达上具有异质性,VEGF或受体Flk-1/KDR可能是乳腺癌早期诊断及治疗的分子靶标,癌灶边缘可能是下一步进行乳腺癌分子影像观察的重点靶区.