弹性成像、二维超声与多普勒超声在乳腺肿块鉴别诊断中比较分析

目的对比在乳腺癌患者的临床诊断中,应用弹性成像、二维超声和多普勒超声的临床诊断价值。方法将2013年6月至2014年12月期间确诊的230例乳腺肿块患者作为研究对象,分别采用弹性成像、二维超声和多普勒超声进行鉴别诊断。所有数据均采用SPSS17.0软件进行统计分析,以病理结果为金标准,良、恶性乳腺病变弹性成像分级间的比较采用配对χ~2检验;二维超声和弹性成像及联合应用的诊断效能,采用χ~2检验,以P0.05认为差异有统计学意义。结果病理结果显示,此次共有良性和恶性病灶各113个和130个。弹性成像结果显示,其敏感度为93.85%(122/130),特异度94.69%(107/113),准确率为94.24%(229/243),其准确率显著高于二维超声(81.89%,199/243)和多普勒超声(213/243,87.65%),差异有统计学意义(P0.05)。结论在乳腺癌患者的临床诊断中,应用弹性成像的诊断价值较高,其准确性显著优于二维超声和多普勒超声,可准确诊断肿块的良恶性,建议广泛推广。     

经阴道三维超声在宫腔粘连术前的诊断价值

目的分析经阴道三维超声在宫腔粘连术前的诊断价值。方法选取2016年7月至2017年7月医院收治的宫腔粘连患者80例,术前分别采用经阴道二维超声与经阴道三维超声进行检查,对两种技术检查情况进行统计分析。结果以宫腔镜及病理诊断结果作为标准,在宫腔粘连程度诊断方面,与经阴道二维超声诊断准确率75.0%相比,经阴道三维超声诊断准确率95.0%显著提高(P0.05),且在轻度宫腔粘连诊断准确率方面,经阴道三维超声诊断91.8%显著高于经阴道二维超声诊断率69.4%(P0.05);在宫腔粘连分型方面,与经阴道二维超声诊断准确率85.0%相比,经阴道三维超声诊断准确率95.0%显著提高(P0.05)。结论对宫腔粘连疾病患者进行经阴道三维超声成像技术诊断能够提供更全面、直观地信息,在粘连程度、分型方面均具有较高的准确率,能够为宫腔粘连的诊断与治疗提供科学依据,值得临床应用与推广。     

三维超声造影在乳腺肿块鉴别诊断中的应用价值

目的探讨三维超声造影在乳腺肿块鉴别诊断中的应用价值。方法回顾性收集2013年7月到2016年2月期间于笔者所在医院诊治并经手术病理学检查证实乳腺肿块性质的120例患者,其中包括良性患者70例(良性组)与恶性患者50例(恶性组),所有患者均接受常规二维超声与三维超声造影检查,比较良性组和恶性组患者的影像学特征,并比较二维超声与三维超声造影对乳腺肿块的诊断价值。结果与良性组相比,恶性组的各项二维超声特征,包括肿块形态不规则、边界不清晰、内部回声不均匀、微钙化、侧方声影及回声衰减的比例均较高(P0.05)。恶性组与良性组的三维超声造影评分比较差异有统计学意义(P0.05),恶性组的得分较高,良性组的评分多为2、3分,而恶性组多为4、5分。二维超声和三维超声造影诊断乳腺肿块的灵敏度分别为97.1%(68/70)和98.6%(69/70),特异度分别为80.0%(40/50)和96.0%(48/50),三维超声造影的特异度高于二维超声(P0.05)。结论二维超声与三维超声造影对乳腺肿块均有一定的诊断价值,而三维超声造影能够通过评估肿瘤组织微血管的丰富程度以获得更多的信息,从而提高了诊断特异度,值得推广应用。     

产前超声测量肺头比值评价先天性肺隔离症胎儿预后

目的通过中孕期超声测量并计算先天性隔离肺(PS)胎儿肺头比(CVR)值,探讨CVR评估PS胎儿预后风险的价值。方法收集88例中孕期超声诊断为PS胎儿的超声及临床资料,根据产前测算的胎儿CVR值,分为CVR≥1.6组和CVR1.6组,对比两组胎儿胎儿水肿发生率、产后呼吸窘迫症状及存活率。结果 88例PS胎儿中,中孕期超声诊断叶内型(ILS)62胎(62/88,70.45%),叶外型(ELS)I型19胎(19/88,21.59%),ELSⅡ型7胎(7/88,7.95%)。活产81胎(81/88,92.05%),引产5胎(51/88,5.68%),死胎2胎(2/88,2.27%)。CVR≥1.6组44胎,呼吸窘迫发生率为81.82%(36/44),胎儿水肿发生率为88.64%(39/44),活产率为84.09%(37/44);CVR1.6组44胎,3胎(3/44,6.82%)产后发生呼吸窘迫,3胎(3/44,6.82%)发生胎儿水肿,活产率为100%(44/44)。两组胎儿水肿发生率、产后呼吸窘迫发生率及存活率的差异均有统计学意义(P均0.05)。结论 CVR是产前中孕期超声筛查评价PS胎儿预后的有效指标。     

产前四维超声对先天性心脏畸形诊断效果观察

目的探讨产前四维超声在先天性心脏畸形诊断中的应用效果。方法抽取2013-04—2016-02间在漯河医专附院进行产前检查的478例孕妇,均于产前进行二维超声及四维超声检查,并随访至分娩后1个月。对两种检测方法在先天性心脏畸形检出率及诊断准确率进行比较。结果四维超声检出率(3.77%)显著优于二维超声(1.67%),差异有统计学意义(P0.05);引产后确诊先天性心脏畸形19例,其中四维超声18例、二维超声8例(42.11%),差异有统计学意义(P0.05)。结论对孕妇产前实施四维超声检查,有利于早期对先天性心脏畸形作出正确诊断。     

经直肠三维超声联合双平面超声在直肠癌术前分期中的临床应用价值分析

目的探讨经直肠三维超声与双平面超声联合应用对直肠癌术前分期的临床意义。方法 76例直肠癌患者采用经直肠三维超声联合双平面超声检查,与术后分期诊断结果进行对比,计算单纯经直肠三维超声及经直肠三维超声联合双平面超声对直肠癌术前分期诊断的准确率,并进行对比分析。结果联合应用经直肠三维超声与双平面超声检查对直肠癌术前分期的准确率为93.4%(71/76),显著高于单纯经直肠三维超声检查的82.9%(63/76),P0.05。结论经直肠三维超声与双平面超声联合应用于直肠癌的术前分期诊断,准确性较高,对于手术方案的制定以及患者预后均具有重要意义。     

胎儿主动脉弓离断的产前超声诊断

目的探讨胎儿主动脉弓离断的超声诊断特点。方法回顾性分析产前超声诊断为胎儿主动脉弓离断的35胎胎儿资料,同时纳入180胎正常胎儿。二维超声判断胎儿内脏及心脏位置,获取四腔心切面、左右心室流出道切面、三血管切面及三血管-气管切面等横断面,并扫查腔静脉长轴切面、主动脉弓切面及动脉导管弓切面等矢状切面。测量主动脉弓离断胎儿左右心室内径比值及主动脉与肺动脉内径比值,并与相应孕周的正常胎儿进行比较。结果产前二维超声诊断A型、B型及C型主动脉弓离断分别为16、18及1胎,均伴室间隔缺损,共27胎经尸体检查或产后检查证实产前诊断,3胎诊断错误,余5例新生儿失访。四腔心切面及三血管切面发现主动脉弓离断胎儿左右心室内径比值和主动脉与肺动脉内径比值显著小于相应孕周正常胎儿,差异有统计学意义(P均0.01)。矢状切面对主动脉追踪连续扫查可确定主动脉的分支及走行,可明确诊断及分型。A型、B型及C型离断升主动脉走行及分支分别呈现典型的"W型"、"Y型"及"I型"。矢状面扫查及横断面扫查对胎儿主动脉弓离断的诊断率分别为90.00%(27/30)及56.67%(17/30),差异有统计学意义(P0.01)。结论产前二维超声可诊断胎儿主动脉弓离断,横断面扫查可发现某些线索,矢状面连续扫查对诊断胎儿主动脉弓离断具有重要意义。     

腔内三维超声自由解剖切面联合容积对比成像诊断周围型宫腔粘连

目的 评价腔内三维超声自由解剖切面(OmniView)联合容积对比成像(VCI)用于诊断周围型宫腔粘连(IUA)的价值。方法 对53例疑诊IUA患者行经阴道二维超声(2D-TVS)及腔内三维超声OmniView-VCI检查;以宫腔镜检查结果为金标准,与2D-TVS对比,评价OmniView-VCI对周围型IUA的诊断效能。结果 宫腔镜检查确诊48例周围型IUA、5例无明显粘连。腔内三维超声OmniView-VCI准确诊断41例周围型IUA、4例无粘连,诊断准确率为84.91%(45/53);2D-TVS准确诊断32例周围型IUA、2例无粘连,诊断准确率64.15%(34/53);二者诊断准确率差异具有统计学意义(P=0.01)。受试者工作特征(ROC)曲线结果显示,OmniView-VCI和2D-TVS诊断周围型IUA的曲线下面积(AUC)分别为0.83[95%CI(0.61,1.00)]和0.53[95%CI(0.26,0.81)]。结论 腔内三维超声OmniView-VCI可有效诊断周围型IUA。     

产前超声诊断胎儿尿道下裂进展

尿道下裂是胎儿常见泌尿系统先天畸形。产前二维及三维超声检查均可用于诊断胎儿尿道下裂,二者联合可提高诊断效能;在此基础上进行彩色多普勒超声检查可进一步明确尿道开口位置,提高诊断准确率,降低误诊率。本文对产前超声诊断胎儿尿道下裂进展进行综述。     

常规超声和超声造影在肝移植术后活动性出血的诊断价值对比

目的探讨常规超声和超声造影在肝移植术后活动性出血的诊断价值。方法对2019年4月至2021年7月发生肝移植术后活动性出血33例患者的常规超声和超声造影图像进行分析。以手术探查或腔镜手术为"金标准"。结果常规超声及超声造影对肝移植术后活动性出血的诊断准确率分别为27.3%(9/33)、96.9%(32/33),差异有统计学意义(χ^(2)=31.165,P<0.05),出血点位置的诊断准确率分别为27.3%(9/33)、87.8%(29/33),差异有统计学意义(χ^(2)=22.393,P<0.05)。结论超声造影较常规超声不仅能准确地诊断肝移植术后活动性出血,还能明确出血点位置,对出血点位置明确的患者可在超声引导下行微创止血。     

Evaluación de las fístulas perianales mediante ecografía endoanal tridimensional y correlación con los hallazgos intraoperatorios

ObjectiveThis study aims to assess the accuracy of three-dimensional endoanal ultrasound (3D-US), two-dimensional ultrasound (2D-US) and physical examination (PE) for the diagnosis of perianal fistulas and correlate the results with intraoperative findings.Materials and methodsA prospective, observational study with consecutive inclusion of patients was performed between December 2008 and August 2009. Twenty-nine patients diagnosed with a perianal fistula due to undergo surgery were included. All patients underwent PE, 2D-US and 3D-US, and the results were compared to intraoperative findings. The examinations were repeated with hydrogen peroxide instilled through the external opening.ResultsInternal opening (IO): no significant differences with regards to the number of IO diagnosed by PE and 2D-US or 3D-US (P>0.05). Primary tract: good concordance between 3D US and surgery (k=0.61), and this was higher than any of the other techniques used (PE: k=0.41; 2D-US: k=0.56). Secondary tracts: both 2D and 3D-US show good concordance with surgery (86%, k=0.66; 90%, k=0.73, respectively). Abscesses/cavities: The ultrasound examinations showed a moderate concordance with surgery (k=0.438, k=0.540, respectively).Conclusions3D-US shows a higher diagnostic accuracy than 2D-US when compared with surgery to estimate primary fistula height in transphincteric fistulas. 3D-US shows good concordance with surgery for diagnosing primary and secondary tracts and a high sensitivity and specificity for diagnosis of the IO. There was a tendency to overestimate fistula height with 2D-US as shown by the lower specificity of 2D-US for the diagnosis of high transphincteric fistulas and lower sensitivity of 2D-US for low transphincteric fistulas.     

Clinical validation of three-dimensional ultrasound for abdominal aortic aneurysm

ObjectiveThree-dimensional ultrasound (3D-US) examination is a relatively new modality that can be used for abdominal aortic aneurysm (AAA) surveillance, and may offer improved reproducibility over conventional two-dimensional ultrasound (2D-US) examination. The aim of this study was to evaluate the interoperator reproducibility of maximum anterior-to-posterior diameter by nonphysician ultrasound technicians in a typical vascular laboratory setting, on patients with infrarenal AAAs using 3D-US and 2D-US examination.MethodsA total of 134 consecutive patients with asymptomatic infrarenal AAAs were screened. Of the 134 patients, 28 (21%) were screen failures. From the remaining 106 patients, 3 (2.8%) had missing data and 13 (12.3%) had technically unacceptable image quality. As a result, 90 patients were included for final analysis. Ultrasound image acquisitions were performed during the single visit. The 2D-US images were evaluated at the time of examination by the respective ultrasound technicians who acquired them. All 3D-US images were evaluated offline by both ultrasound technicians after a wash-out period of at least 6 weeks.ResultsExcellent interoperator reproducibility was observed for measuring maximum diameter using 3D-US (intraclass correlation coefficient, 0.97), and good agreement among ultrasound technicians (mean difference, −0.08 mm; limits of agreement, −3.17; 3.00 mm). When using 3D-US examination, 74 of the 90 patients (82%) were estimated within 2 mm of interoperator variability. Of 90 patients, 52 (58%) were estimated to be within the same variability by 2D-US examination. Estimating AAA diameter using 3D-US was superior to 2D-US with respect to interoperator reproducibility.ConclusionsBoth 3D-US and 2D-US examination demonstrated good reproducibility among two vascular ultrasound technicians with superior agreement from 3D-US examination. The present results support the broader use of 3D-US in standard AAA surveillance programs.     

超声诊断单脐动脉与伴发胎儿畸形

目的观察产前超声诊断单脐动脉（SUA）与伴发胎儿各系统畸形的关系。方法回顾性分析我院超声诊断的71胎SUA的超声资料,并与产后及病理学检查结果进行对照分析。结果34胎SUA（47．89％）胎儿伴发畸形,其中心血管系统畸形居首（15／34,44．12％）,次为泌尿系统畸形（11／34,32．35％）;SUA合并心内强回声灶（EIF）胎儿中,心血管系统畸形发生率约41．18％（7／17）,高于无EIF胎儿（8／54,14．81％,P〈0．05）;SUA合并中枢神经系统畸形发生率约20．59％（7／34）;SUA伴发畸形中,44．12％（15／34）为复合畸形。结论SUA胎儿伴发畸形率高,产前超声应对SUA胎儿各系统依序进行筛查并动态随访。     

产前超声联合MRI诊断胎儿先天性食管闭锁

目的探讨产前超声联合MRI对胎儿先天性食管闭锁(CEA)的诊断价值。方法回顾性分析31胎经引产后尸体解剖或出生后手术及影像学检查证实的CEA胎儿(CEA组)的产前超声及MRI资料,并与31胎产后正常胎儿(正常对照组)进行对照。以病理结果为金标准,分析产前超声联合MRI诊断胎儿CEA的阳性率。比较2组间产前超声指标胎儿双顶径(BPD)、头围(HC)、腹围(AC)、股骨长(FL)、羊水深度(AFD)、羊水指数(AFI)、胎盘厚度、脐动脉峰谷比(S/D)、胎儿吞咽指数及估算胎儿体质量(EFW)的差异。结果产前超声联合MRI诊断胎儿CEA的阳性率为67.74%(21/31)。CEA组胎儿HC、AC、吞咽指数、EFW均低于正常对照组(P均0.05),S/D、AFI均高于对照组(P均0.05);2组间BPD、FL、AFD、胎盘厚度差异均无统计学意义(P均0.05)。结论产前超声无法直接诊断胎儿CEA,当发现胃泡持续72h不显示(间隔72h复查)或羊水过多时,结合MRI对产前诊断胎儿CEA具有一定价值。产前超声指标中,胎儿HC、AC、AFI、S/D、吞咽指数、EFW可能对CEA具有一定提示作用。     

胎儿颜面部畸形高频超声尸体解剖学研究

目的研究胎儿尸体颜面部畸形产后高频超声检查的准确性。方法对产前超声检查诊断为严重畸形或染色体检查为异常而引产、且其父母同意尸体解剖的71例引产胎儿颜面部行产后高频超声检查，并将结果与尸体解剖对比。结果产后超声发现71例中共有24例胎儿存在颜面部畸形，共有颜面部畸形51处，经尸体解剖证实，PMFU灵敏度、准确率均达100％。从不破坏尸体完整性、操作的简便性、获得结果的快捷性方面进行评估，51处颜面部畸形中，PM—FU在22处优于尸体解剖。结论产后超声检查为胎儿尸体解剖学检查开辟了新领域，可以作为尸体检查的选择方法之一，在胎儿尸体解剖遇到障碍时代替运用，或在尸体解剖前运用作为尸体解剖思路、步骤、方法等的指导。     

Microcystic congenital pulmonary airway malformation with hydrops fetalis: steroids vs open fetal resection

Background/PurposeCongenital pulmonary airway malformations (CPAM) are rare lesions often diagnosed during routine prenatal ultrasound. The presence of hydrops fetalis is an indicator of poor prognosis. Here we present a retrospective review of fetuses undergoing either open fetal surgery or steroids for predominantly microcystic CPAM with hydrops fetalis.MethodA retrospective review of patients undergoing open fetal surgery or steroids for CPAM at our institution was performed. The primary outcome was survival.ResultsA retrospective review of all patients referred to our institution with the diagnosis of CPAM was performed. Fetuses with predominantly microcystic CPAM and the presence of hydrops fetalis treated with steroid or surgery were included. Thirteen patients were treated with steroids, and 11 patients underwent open fetal surgery. In the steroid group 12 (92%) of 13 fetuses survived to delivery versus 9 (82%) of 11 in the open fetal surgery group. Only 5 (56%) of 9 of the patients in the open fetal surgery group survived to neonatal discharge compared to 10 (83%) of 12 in the steroid group.ConclusionsIn the present retrospective study, improved survival was seen in fetuses with hydrops fetalis and predominantly microcystic CPAM treated with steroids when compared with open fetal surgery. Steroids should be considered for first-line therapy in these cases.     

Evaluation of tubal microinserts position using 3D ultrasound and pelvic X-ray

PurposeTo retrospectively compare three-dimensional ultrasonography (3D-US) and pelvic X-rays to assess the position of tubal sterilization microinserts.Material and methodsForty-four patients who underwent tubal sterilization with Essure^® microinserts in our institution were included. The microinserts’position was evaluated three months after the procedure using 3D-US and pelvic X-rays. Placement on 3D-US was binary categorized as correct or incorrect and the distance between the two devices was reported. The orientation and symmetric deployment of the microinserts and the distance between the proximal parts of the two devices was assessed on pelvic X-rays. Performance of 3D-US and pelvic X-ray were compared using Mac Nemar test. Comparison of the distance between the two devices measured on pelvic X-rays and 3D-US was made with the paired Student t test.Results3D-US images showed microinserts in 93% (41/44). Eighty-six percent (38/44) were correctly positioned on 3D-US and 82% (36/44) on pelvic X-rays. No significant differences between the performances of the two imaging techniques were found. No significant differences for the distance between the two devices measured on pelvic X-ray and 3D-US was found.Conclusion3D-US is a simple, non-ionizing technique, which appears as a promising alternate technique to pelvic X-rays to assess the correct position of Essure^® microinserts.     

产前超声发现胎儿透明隔腔异常的临床意义

目的分析产前超声发现胎儿透明隔腔(CSP)异常的临床意义。方法回顾性对比分析53胎产前超声发现CSP异常胎儿的超声及头部MRI。结果产前超声检出53胎CSP异常,包括26胎CSP未显示、18胎CSP狭小、6胎CSP增宽及3胎CSP形态异常,其中12胎产前超声及头部MRI均提示神经系统发育异常。产前超声未能显示CSP的26胎中,8胎存在神经系统异常,包括单纯性完全型胼胝体缺如3胎,完全型胼胝体缺如合并脑膨出和四肢长骨短小1胎,完全型胼胝体缺如伴脑裂畸形或叶状前脑无裂畸形各1胎,脑积水或额叶多小脑回致CSP受压未显示各1胎。产前超声显示CSP狭小的18胎中,1胎为单纯性部分型胼胝体缺如并经MRI证实。产前超声发现CSP增宽的6胎中,MRI均未检出其他神经系统异常。3胎超声显示CSP形态异常胎儿中,MRI示2胎孤立性透明隔部分发育不良及1胎部分型胼胝体缺如。结论产前超声发现胎儿CSP异常是诊断神经系统发育异常的重要线索。     

Defining hydrops and indications for open fetal surgery for fetuses with lung masses and vascular tumors

PurposeThe aim of this study was to identify the most accurate prenatal predictors of outcomes and need for fetal surgery for fetuses with high-risk lung masses and vascular tumors.MethodsThe records of all fetuses with high-risk lung mass (congenital cystic adenomatoid malformation-volume ratio > 1.6 or findings of hydrops) and vascular tumor evaluated between July 2001 and March 2011 were reviewed retrospectively. Hydrops was defined as accumulation of fluid in 2 or more compartments.ResultsOf fetuses with high-risk lung mass, hydrops was identified in 46% (11/24). Fetuses with hydrops and an abnormal echocardiogram (n = 8) demonstrated poor survival without fetal surgery (13%) compared with 100% survival in fetuses with hydrops and a normal echocardiogram (n = 3; P = .02). Of 21 fetuses with vascular tumor (11 sacrococcygeal and 8 cervical teratomas; 2 hemangioendotheliomas), hydrops was identified in 29% and an abnormal echocardiogram in 57%. All fetuses with hydrops had an abnormal echocardiogram and either died (n = 5) or required fetal surgery (n = 1). However, all fetuses with abnormal echocardiograms alone (n = 7) survived without fetal intervention.ConclusionsFor fetuses with lung mass, an abnormal echocardiogram in the setting of hydrops is the best predictor of mortality and need for fetal surgery. For fetuses with vascular tumor, hydrops in the setting of high-output physiology best predicts demise and need for fetal surgery.     

Diagnosis of congenital abnormalities with post-mortem ultrasound in perinatal death

Purpose

To determine the sensitivity and specificity of post-mortem ultrasound in the diagnosis of major congenital abnormalities of fetuses using conventional autopsy as the standard of reference.