高频彩色多普勒超声诊断乳腺实性肿块的价值研究

目的 探讨高频彩色多普勒超声在乳腺实性肿块良恶性鉴别诊断中的价值。方法 对27例乳腺良性肿块和44例乳腺癌肿块进行彩色多普勒超声检查,分析病灶的声像图特点,并与病理结果进行对照。结果彩色多普勒超声对良、恶性肿块的诊断符合率分别为89％、93％。良、恶性肿块在二维灰阶声像图及彩色多普勒血流分级方面比较差异均有统计学意义（P〈0．05）。结论 二维灰阶声像图结合彩色血流成像的典型表现,可以判断其性质,对一些非典型病例,还应结合病史综合分析,以便做出正确判断。     

早期难免流产胎盘绒毛间隙循环的超声评价

目的探讨正常与异常早孕胎盘结构及绒毛间隙血流循环的超声特征，评价灰阶和彩色能量多普勒超声在早期难免流产胎盘诊断中的价值。方法对孕周在7～12周的40例早期难免流产和40例要求终止妊娠的正常早孕应用灰阶超声显像观察胎盘超声表现及绒毛间隙的移动点状回声，利用彩色能量多普勒超声成像评价胎盘组织内的血流循环特征。结果早期难免流产组胎盘绒毛间隙移动点状回声、片状低回声区显示率明显大于正常早孕组，孕7～9周末，两组间差异具有统计学意义（P〈0．001），孕10～12周末，两组间差异无统计学意义（P〉0．05）。早期难免流产中胎盘绒毛间隙移动点状回声显示率高于彩色能量多普勒血流显示率，差异具有统计学意义（P〈0．01）。结论胎盘绒毛间隙弥漫移动点状回声和胎盘中央低回声区（母池）是孕10周前早期难免流产的重要超声表现。灰阶超声检测胎盘绒毛间隙循环的敏感性高于彩色能量多普勒成像。     

彩超对急性动脉栓塞和急性动脉血栓的鉴别诊断

目的 探讨彩色多普勒超声对急性动脉栓塞和急性动脉血栓的鉴别诊断价值。 方法 对手术证实的89条动脉栓塞及123条动脉血栓的超声特点进行分析，对病程、血管的病变部位、管壁结构、病变近端和远段的血流动力学进行比较。 结果 急性动脉栓塞和急性动脉血栓在病程、有无侧支血管、管壁结构和病变远段阻力指数两组间差异显著（P〈0．05）。病变近端内径两样本均数差异有显著意义（P〈0．05）。病变近端最高血流速度、加速度时间、阻力指数两组差异无显著性意义（P〉0．05），病变远段内径最高血流速度及加速度时间两组差异无显著性意义（P〉o．05）。 结论 彩色多普勒超声参数有助于动脉栓塞和动脉血栓鉴别诊断。     

三维血管容积显像在慢性移植肾肾病中的诊断价值

目的探讨三维血管容积显像在慢性移植肾肾病（CAN）中的诊断价值。方法85例移植肾患者,彩色多普勒超声检测其血流指数、搏动指数,三维血管容积显像检测其血管指数、血管血流指数、灰阶指数及体积指数。结果与44例移植肾肾功能稳定组比较,41例CAN组彩色多普勒能量显像血流分级I～Ⅲ级,阻力指数和搏动指数均升高;三维血管能量血流分级2—4级,血管指数、血流指数、血管血流指数均降低,灰阶指数、体积均升高（P〈0．05）。ROC曲线分析表明血管指数与血管血流指数诊断CAN的特异性、敏感性均高于阻力指数和搏动指数（P〈0．05）,其最佳临界点分别为23．18％、11．05％,对CAN的阳性预测值分别为90．0％、90．5％。结论三维血管容积显像诊断CAN的特异性和敏感性较彩色多普勒高,可能为早期诊断CAN提供新的有用指标。     

彩色多普勒超声在宫腔积液病因诊断中的应用

目的：探讨彩色多普勒超声在宫腔积液病因诊断中的应用价值。方法：经阴道或经腹彩色多普勒超声对108例宫腔积液患者进行病因诊断，结果与临床病理诊断相对照。结果：超声病因诊断与临床病理基本相符84例（77．8％），误诊15例（13．9％），漏诊9例（8．3％）。阴道超声的诊断符合率高于腹部超声，差异有显著性（P〈0．05）。结论：彩色多普勒超声对常见宫腔积液的病因诊断能够提供相当准确的客观依据，具有较高的诊断符合率。可作为宫腔积液病因筛查的首选方法。     

肝硬化患者腹腔镜胆囊切除术前彩色多普勒超声应用价值

目的探讨彩色多普勒超声在肝硬化患者腹腔镜胆囊切除术（Laparascopic cholecystectomy，LC）术前的应用价值。方法肝硬化胆石症纽35例．依据肝功能Child-Pugh分级标准分为3个亚组，正常对照组20例。运用彩色多普勒超声检测门脉系血管，测量门静脉最大内径、门静脉平均血流速度等血流动力学参数。结果门静脉平均血流速度随肝功能分级而逐渐降低，组间和组内均存在显著性差异（P〈0．01，P〈0．05）；门静脉内径组间存在差异（P〈0．05），组内无显著性差异；除脐静脉重开外，其余门脉系血管内径增粗在Child-Pugh分级B、C二级存在较大重叠。结论彩色多普勒有助于全面评估门静脉压力和门脉侧支开放及代偿情况，为筛选LC手术病人提供重要依据。     

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。     

甲状腺癌与甲状腺良性结节的多普勒超声对比研究

【目的】探讨多普勒超声对甲状腺良恶性结节的诊断价值。【方法】应用多普勒超声观察并记录甲状腺病灶内部的血流丰富程度、血流形态及血流动力学特征,测量血流峰值流速（PS）和阻力指数（RI）,在甲状腺癌组与甲状腺良性结节组之间进行对比分析。【结果】①Ⅱ级或Ⅲ级血流在甲状腺癌组中的检出率高于良性组（P〈0．05）。分支型或穿入型的血管在甲状腺癌组中的检出率高于良性组（P〈0．05）。②PS值在甲状腺良、恶性肿瘤间的差异无显著性（P〉0．05）,R1大于0．7,在甲状腺癌组中的栓出率高于良性组（p〈0．05）。【结论】多普勒超声在提高鉴别诊断甲状腺癌与甲状腺良性结节方面有较高的临床应用价值。     

胃癌彩色多普勒血流分级与微血管密度、血管内皮生长因子的表达及其相关性研究

目的探讨彩色多普勒超声检测胃癌血流分级与病理微血管密度（MVD）和血管内皮生长因子（VEGF）表达的临床病理关系。方法术前测定60例各期胃癌患者肿瘤区域和正常胃壁的彩色多普勒血流显像（CDFI）,根据血流显示情况进行血流分级;术后免疫组化技术检测相对应标本内MVD、VEGF的表达。结果随着胃癌病灶区域内血流信号增多,血流分级增高,病理MVD计数和VEGF表达呈上升趋势（P=0．000）;胃癌癌组织血流分级和MVD计数均高于癌旁正常组织（P〈0．05）,进展期高于早期（P〈0．05）;VEGF表达水平癌组织则低于癌旁正常组织（P=0．000）,进展期高于早期（P=0．000）;MVD值同VEGF表达密切相关（P〈0．05）,而胃癌癌旁正常组织进展期与早期血流分级、MVD值和VEGF表达比较差异均无统计学意义（P〉0．05）。结论彩色多普勒超声所检测的胃癌内血流信号与病理MVD测值和VEGF表达有较好的相关性,胃癌术前CDFI血流检测可间接评价肿瘤组织内的血管生成状态,为胃癌的预后评估提供有益的信息。     

小儿肠系膜淋巴结炎的彩色多普勒超声诊断

目的探讨彩色多普勒超声对小儿肠系膜淋巴结炎诊断价值。方法将71例彩色多普勒超声检查诊断为肠系膜淋巴结炎患儿的淋巴结大小、数目及血流情况与33例正常组的彩色多普勒超声检查肠系膜淋巴结的情况进行统计、对比分析。结果71例彩色多普勒超声诊断为肠系膜淋巴结炎的患儿中,5例剖腹探查诊断为阑尾炎合并阑尾周围淋巴结肿大,5例失访。余61例患儿淋巴结大小、同一切面淋巴结数目与正常组比较,差异有统计学意义（P〈0．01）,淋巴结内血流情况与正常组比较,差异有统计学意义（P〈0．05）。结论彩色多普勒超声在肠系膜淋巴结炎的诊断中有重要的意义,是临床诊断小儿肠系膜淋巴结炎的首选辅助检查方法之一。     

Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma: color Doppler US, contrast-enhanced US, and fine-needle biopsy

Background We assessed the role of contrast-enhanced ultrasound (CEUS) in the differential diagnosis between benign and malignant portal vein thrombosis in patients who had cirrhosis with hepatocellular carcinoma (HCC). Methods Fifty-four consecutive patients who had cirrhosis, biopsy-proved HCC, and thrombosis of the main portal vein and/or left/right portal vein on US were prospectively studied with color Doppler US (CDUS) and CEUS. CEUS was performed at low mechanical index after intravenous administration of a second-generation contrast agent (SonoVue, Bracco, Milan, Italy). Presence or absence of CDUS signals or thrombus enhancement on CEUS were considered diagnostic for malignant or benign portal vein thrombosis. Twenty-eight patients also underwent percutaneous portal vein fine-needle biopsy (FNB) under US guidance. All patients were followed-up bimonthly by CDUS. Shrinkage of the thrombus and/or recanalization of the vessels on CDUS during follow-up were considered definitive evidence of the benign nature of the thrombosis, whereas enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered consistent with malignancy. CDUS, CEUS, and FNB results were compared with those at follow-up. Results Follow-up (4 to 21 months) showed signs of malignant thrombosis in 34 of 54 patients. FNB produced a true-positive result for malignancy in 19 of 25 patients, a false-negative result in six of 25 patients, and a true-negative result in three of three patients. CDUS was positive in seven of 54 patients. CEUS showed enhancement of the thrombus in 30 of 54 patients. No false-positive result was observed at CDUS, CEUS, and FNB. Sensitivities of CDUS, CEUS, and FNB in detecting malignant thrombi were 20%, 88%, and 76% respectively. Three patients showed negative CDUS and CEUS and positive FNB results; follow-up confirmed malignant thrombosis in these patients. One patient showed negative CDUS, CEUS, and FNB findings. Howewer, follow-up of the thrombus showed US signs of malignancy. Another FNB confirmed HCC infiltration of the portal vein. Conclusion CEUS seems to be the most sensitive and specific test for diagnosing malignant portal vein thrombosis in patients with cirrhosis.     

Role of ultrasound and color Doppler imaging in the detection of carotid paragangliomas

IntroductionCarotid body paragangliomas (PGLs) are highly vascularized lesions that arise from the paraganglia located at the carotid bifurcation.PurposeTo evaluate the usefulness of gray-scale ultrasound (US) and color Doppler ultrasound (CDUS) in the detection and follow-up of carotid PGLs of the neck.Materials and methodsThe authors retrospectively reviewed US and CDUS examinations of the neck performed in 40 patients with PGL syndrome type 1 and single or bilateral neck PGLs confirmed by CT or MRI; the patients had a total of 60 PGLs of the neck. US and CDUS outcome was compared to the outcome of second-line imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT). The following findings were considered: presence/absence of focal lesions at US imaging and difference in maximum diameter of the lesion measured at US and MRI/CT. Results were compared using the Student's t-test.ResultsOf the 60 PGLs of the neck only 5 (8.3%) were not visualized at US or CDUS examination. The difference in maximum diameter of these lesions measured at CT/MRI and US/CDUS ranged between ?5 mm and +16 mm (mean difference 2.2 ± 6.0). This difference was statistically significant (p = 0.008).ConclusionsUS and CDUS are useful methods for identifying carotid PGLs also measuring less than 10 mm in diameter. However, diagnostic accuracy of US and CDUS is reduced in the measurement of the exact dimensions of the lesions.     

二维彩色多普勒超声在腹主动脉瘤腔内隔绝术的应用价值

目的⑶探讨二维彩色多普勒超声在腹主动脉瘤腔内隔断术的应用价值⒚方法⑶应用二维彩色多普勒超声⒉２ Ｄ Ｃ Ｄ Ｕ Ｓ⒕对 １４ 例 Ａ Ａ Ａ 腔内隔绝术前后进行检测⒙术前重点观察瘤颈的长度、瘤体的大小、瘤体出口距髂动脉分叉的距离等⒛术后重点检测瘤体与血流隔绝情况⒙有无内漏等并发症⒙将 ２ Ｄ Ｃ Ｄ Ｕ Ｓ 检测结果与螺旋 Ｃ Ｔ、数字减影血管造影相对照⒚结果⑶超声在术前诊断 Ａ Ａ Ａ 的敏感性为 １０ ０％ ⒚术后成功地观察到了所有 Ａ Ａ Ａ 腔内移植物⒙其中 ４ 例患者发现内漏⒙经螺旋 Ｃ Ｔ 检查证实⒚结论⑶２ Ｄ Ｃ Ｄ Ｕ Ｓ 在 Ａ Ａ Ａ 腔内隔绝术术前可进行准确诊断⒙术后可对疗效评价⒚     

超声检查在外周型胸腔肿块诊断中的价值

目的 探讨超声检查和超声引导穿刺活检在外周型胸腔肿块诊断中的应用价值.方法 分析78例性质待定的外周型胸腔肿块的声像图表现及超声引导下穿刺活检病理结果.结果 胸腔肿块的二维超声表现分为低回声型、稍强回声型、混合回声型、不均质回声型及肺实变;CDFI表现分为无血流信号、少许血流信号、丰富血流信号及正常肺血流.超声引导穿刺活检与病理诊断符合74例(94.8%).结论 超声定位和超声引导穿刺自动活检在诊断不明性质的外周型胸腔肿块中有重要的应用价值.     

Diagnosis of Gastric Varices and Evaluation of the Effectiveness of Treatment Using Transabdominal Color Doppler Ultrasonography

Objective. The aim of this study was to evaluate the hemodynamics of gastric varices using transabdominal color Doppler ultrasonography (CDUS). Methods. Using CDUS, we evaluated 41 consecutive patients with gastric varices. We examined color flow images and measured the velocity of gastric variceal blood flow using fast Fourier transform analysis. In addition, we compared detection rates of gastric varices and their outflow vessels using CDUS and computed tomography (CT). Results. Gastric varices were detected with CDUS in 41 of 41 patients (100%), and outflow vessels were detected in 34 (82.9%). Of these, 32 were gastrorenal shunts (GRSs), and 2 were GRSs and subphrenic veins. The velocity of the large and coil‐shaped varices (mean ± SD, 23.0 ± 5.8 cm/s; n = 13) was significantly higher than that of the enlarged and tortuous varices (14.1 ± 4.3 cm/s; n = 28; P < .001). With CT, gastric varices were detected in 41 of 41 patients (100%), and outflow vessels were detected in 38 (92.7%). Color Doppler ultrasonographic and CT findings were in complete agreement in 35 of 41 patients (85.4%). A total of 11 patients with a high risk of variceal rupture underwent balloon‐occluded retrograde transvenous obliteration, and CDUS and CT findings after treatments were consistent. Conclusions. Transabdominal CDUS is a useful noninvasive modality for the diagnosis of gastric variceal hemodynamics and for evaluation of the therapeutic effects of gastric variceal treatment.     

Color Doppler US pulmonary artery vessel signal: a sign for predicting the benign lesions

The lung cancer blood supply originates from the bronchial artery. If vessel signals within pulmonary lesions can be confirmed to be those of the pulmonary artery, color Doppler ultrasound (US) should be able to predict and differentiate benign lesions from lung cancers. Two hundred sixty-four patients with abutting thoracic lesions (including 125 lung cancers and 139 benign lesions) underwent color Doppler US examinations. A pulsatile flow, with the vessel signal length on sonographic appearance > or =1 cm demonstrated by color Doppler US, was arbitrarily defined as a pulmonary artery vessel signal. Of the 264 thoracic lesions, 73 (58%) lung cancers and 107 (77%) benign lesions had detectable color Doppler US pulsatile flow vessel signals. Analyzing the pulsatile flow vessel signals, the color Doppler US pulmonary artery vessel signal was present in 74 (53%) benign lesions, but was found in only two (2%) lung cancers of a specific alveolar cell carcinoma with lobar consolidation. Using the pulmonary artery vessel signal, color Doppler US can be valuable in predicting and differentiating benign lesions from lung cancers (p < 0.0001, sensitivity = 0.53, specificity = 0.98 and positive likelihood ratio 26.5). In conclusion, color Doppler US pulmonary artery vessel signal sign is useful in predicting and differentiating benign lesions from lung cancers.     

CT与超声在肺周围型占位病变诊断中的协同定性价值

目的 应用CT、二维及彩色多普勒超声诊断肺部周围型肿块的性质。方法 回顾分析50例经病理证实的肺部肿块CT及超声特点。其中肺癌36例、炎性肿块14例。结果 CT上以肿块的边界、毛刺、分叶、密度、空泡征、血管集束及增强为依据，其诊断准确率为72％(36／50)；而超声则以肿块的形态，内部回声、小支气管显示率及血流改变为二者的鉴别依据，其诊断准确率为74％(37／50)，二者协同其诊断准确率为74％(44／50)。结论 CT与超声结合在肺周围型占位病变中有较高的定性价值。     

中心型肺癌的声像图表现

目的 评价超声对中心型肺癌的诊断价值。方法 对胸部Ｘ线或ＣＴ检查诊断为中心型肺癌伴肺实变（阻塞性肺炎、肺不张）的６１例患者进行超声检查。结果 实变肺的声像图表现为楔形或三角形低回声或等回声,肺癌为肺门附近的低回声结节或实变肺内的强回声肿块。ＣＴ在确定支气管阻塞方面优于超声（Ｐ＜0.001),而在显示肺实变及确定阻塞的肿瘤方面ＣＴ和超声没有统计学意义（Ｐ＞0.05)。结论 超声在中心型肺癌的诊断中有一定价值。     

严重急性呼吸综合症(SARS)影像学表现的初步探讨

目的 认识严重急性呼吸综合症(SARS)的影像学表现特征并探讨适宜的检查方法。方法 回顾性分析6例确诊为(SARS)影像学表现。其中：男4例,女2例,年龄25～65岁。使用TOSHIBA 800mAX线机和床旁机以及TOSHIBA Xvision螺旋CT机扫描。所有患者自入院起,每1-2天复查一次胸片和3天复查一次低剂量螺旋CT扫描。比较初次影像学表现,动态记录肺内病变的变化情况,由两位资深放射科医师进行统计分析。结果 6例病人中3例初次胸部平片检查为阴性,CT扫描见胸膜下灶性渗出,伴有磨玻璃样改变和支气管充气征象。3例初次胸部平片见局限性肺纹理增重且边缘模糊,肺野透光度下降,CT扫描见团片状磨玻璃样改变,内有小斑片实变灶。2周左右影像学表现达到高峰,随后开始逐渐吸收好转。结论 SARS影像学表现虽不典型,但早期征象以胸膜下灶性渗出为主,逐步由渗出、浸润范围扩大,病灶中央向灶性实变发展,变化仍具有特殊性。发病初期胸部平片检查易漏诊,CT扫描可以为临床诊断提供重要依据。     

比较18F-氟代胆碱PET/CT、99Tcm-甲氧基异丁基异腈SPECT/CT及超声诊断甲状旁腺功能亢进症

目的 比较¹⁸F-氟代胆碱（FCH） PET/CT、⁹⁹Tc^m-甲氧基异丁基异腈（MIBI） SPECT/CT及超声（US）诊断甲状旁腺功能亢进症（HPT）的效能。方法 回顾性分析34例HPT患者,术前2个月内均接受¹⁸F-FCH PET/CT、⁹⁹Tc^m-MIBI SPECT/CT及US检查;以术中及术后病理结果为参考,评估并比较各方法的诊断效能。结果 于34例共切除90处甲状旁腺病灶,病理证实其中81处为甲状旁腺增生或腺瘤组织,7处为甲状腺组织,2处为淋巴结。¹⁸F-FCH PET/CT诊断HPT的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为85.19%（69/81）、100%（55/55）、100%（69/69）、82.09%（55/67）及91.18%（124/136）,⁹⁹Tc^m-MIBI SPECT/CT分别为74.07%（60/81）、90.91%（50/55）、92.31%（60/65）、70.42%（50/71）及80.88%（110/136）,US分别为65.43%（53/81）、98.18%（54/55）、98.15%（53/54）、65.85%（54/82）及78.68%（107/136）。¹⁸F-FCH PET/CT诊断HPT的效能高于⁹⁹Tc^m-MIBI SPECT/CT和US （Z=2.290,P=0.022;Z=2.496,P=0.013）。结论 ¹⁸F-FCH PET/CT、⁹⁹Tc^m-MIBI SPECT/CT及US 3种方法中,¹⁸F-FCH PET/CT诊断HPT的效能最高。