胃腔充盈下超声联合谐波超声造影对胃良性病变诊断与胃镜对照研究

目的应用胃腔充盈下超声联合谐波超声造影技术观察胃良性病变,并与胃镜结果进行对比研究,探讨胃良性病变的超声特征及胃腔充盈下超声联合谐波超声造影技术在胃部疾病诊断中的应用价值。方法口服胃窗声学造影剂后二维超声观察胃良性病变,再以反向脉冲谐波显像技术对二维超声难以定性的病变行谐波超声造影检查,分析胃良性病变的造影灌注特征。以二维超声及超声造影结果与胃镜结果进行对照。结果口服胃窗声学造影剂后二维超声胃炎表现为胃壁增厚层次可见,溃疡可见胃壁局部凹陷,胃间质瘤见起自胃壁的局限性肿物,胃绒毛管状腺瘤可见胃腔内蘑菇形低回声肿物。谐波超声造影实时观察,胃炎性病变增厚胃壁与周围正常胃壁同步增强及退出,小溃疡边界更为清晰,较大溃疡谐波超声造影技术早期可见溃疡底部及周边增厚胃壁内纵行梳齿状的微血管,胃间质瘤清晰显示肿物起自胃壁,胃绒毛管状腺瘤造影可见肿物整体快速增强,而后缓慢退出。超声检查胃黏膜下及外生性肿物病理符合率高于胃镜,胃镜对溃疡及慢性胃炎诊断病理符合率优于超声。结论胃腔充盈下超声联合谐波超声造影技术能够很好地显示胃壁全层病变的形态范围,并能结合病变区域微血管灌注情况,对病灶的定位、良恶性鉴别有更进一步的判断。与胃镜结合能够明显提高病变诊断准确性。     

超声双重造影对胃良恶性病变鉴别诊断的临床研究

目的 探讨超声双重造影(口服胃充盈超声造影联合静脉超声造影)在胃良恶性病变鉴别诊断中的价值.方法 对68例患者进行胃充盈常规超声检查.其中发现病变的31例患者同时进行了低机械指数谐波超声造影成像检查,观察其静脉造影特征,对其进行定性诊断.结果 31例病变中,胃充盈常规超声检查诊断良恶性病变准确率分别为66.7%、76%.超声双重造影诊断良恶性病变准确率分别为83.3%、96%.二者存在明显差异,具有统计学意义(P＜0.05),与临床诊断具有较高的一致性.结论 胃充盈常规超声检查发现病变敏感性高.双重造影对胃病变的定性诊断准确性高,是一种简便、有效、客观的检查方法.     

意外发现的胃部病变CT诊断

目的:探讨上腹部常规CT检查时意外发现的胃肿瘤的CT表现及检查方法。材料与方法:在日常腹部CT扫描中或阅片时对偶然发现的胃壁增厚加服造影剂或服温水600-800ml以提高胃充盈度确定胃壁是否增厚。结果:CT意外发现证实的胃病变31例。26例进展期胃癌表现为胃壁局限性不规则增厚,厚度平均为2.6cm。胃外扩散占81％。5例良性病变。4例胃炎,3例肥厚性及糜烂性胃炎表现为胃体部胃壁广泛均匀增厚,厚度平均为1.3cm,1例贲门糜烂性炎症胃壁呈不规则增厚。ⅰ例胃柿石表现为胃体腔内多发圆形低密度类似充盈缺损。结论:胃的良恶病变均可引起胃壁增厚。在胃充盈好时,如果阅片时多注意胃是很容易意外发现胃肿瘤。而胃充盈不佳,观察不仔细是造成漏诊、设诊的主要原因。     

灰阶超声造影评价胃浸润性病变苗

目的探讨灰阶超声造影成像技术评价胃浸润性病变的价值。方法对18例二维超声明确诊断胃壁增厚患者,经静脉团注SonoVue进行胃壁灰阶超声造影。观察并存储注射造影剂后0-3分钟的动态图像,利用定量分析软件进行离机时间-强度曲线（TIC）分析。分别计算达峰时间（AT）、峰值强度变化（A）、TIC曲线的斜率（β）。结果病变位于黏膜下层者,胃壁黏膜下层增强达峰时间较肌层明显提前,斜率变大;全层胃壁病变表现为病变区快速增强,时间在10-16秒,廓清亦较迅速;病变侵及浆膜及浆膜层以外时,浆膜面不光滑、边缘不规则,增强的血管向外延伸;胃壁间囊肿,囊壁与胃壁同步增强,同步廓清,囊腔内无增强征象。结论灰阶超声造影成像技术结合TIC曲线分析,可反映胃壁增厚性病变及肿物的实时血流灌注情况,重点在于能区别病变侵犯层次,对鉴别炎症性病变及肿瘤的分期有一定帮助。     

实时灰阶超声造影评价乳腺导管内病变血流灌注特征的初步探讨

目的分析乳腺导管内病变实时灰阶超声造影血流灌注特征,探讨良恶性病变增强的特点和差异。方法分析19例21个乳腺导管内病变的超声造影增强表现,比较研究良恶性病变血流灌注特征。结果虽然增强达峰值时恶性病变以整体增强为主(80%,4/5),良性病变以部分增强多见(68.7%,11/16),但两者间差异无统计学意义(p>0.05)。注射造影剂后62.5%的良性病变(10/16)呈点线状增强,80%的恶性病变(4/5)呈团块状增强,消退期全部良性病变均呈不均匀消退,40%的恶性病变(2/5)呈均匀消退。良恶性病变早期增强模式和消退方式间有明显差异(p<0.05)。结论实时灰阶超声造影可以动态观察乳腺导管内病变微血管血流灌注,研究良恶性病变灌注特征有助于提高此类疾病的诊断水平。     

胃间质瘤超声造影和胃镜检查应用比较

目的探讨超声造影诊断胃间质瘤的价值。方法本院门诊或住院患者21例,经口服高回声型的胃超声造影剂,显示胃壁肿块,其中4例给予经静脉的双重超声造影(口服胃超声造影剂加静脉注射SonoVue对胃肿块血流灌注进行观察)。结果 21例肿瘤均为单发,经口服超声造影表现为低回声或近似无回声肿物,瘤体大小为3～9.3cm,平均(4.1±1.4)cm,其内可探及血流信号。双重超声造影提示良性病变3例,恶性病变1例,均与手术病理结果相符合。超声造影提示恶性胃间质瘤4例,与手术病理符合率为80.0%(4/5),良性胃间质瘤15例,符合率为93.75%(15/16),提示良性可能性大和恶性可能性大者各1例。胃镜检出16例,活检提示良性胃间质瘤13例,恶性3例,与手术病理符合率为100%,2例肌壁间型和3例腔外型未检出。手术病理结果为恶性间质瘤5例,良性16例。结论超声造影诊断胃间质瘤有较高的临床价值,可作为临床诊断的首选方法。     

不同胆囊良恶性病变超声造影征象及鉴别诊断分析

目的分析超声造影中不同胆囊良恶性病变的征象,并对良恶性病变鉴别诊断进行分析总结。方法收集75例不同胆囊占位性病变患者超声造影的征象,并对比良恶性病变的超声造影征象的差异。结果胆囊良恶性病变超声造影征象在晚期增强水平、增强模式、胆囊壁连续性及病变内部血管形态方面有统计学差异(P0.05);胆囊良性病变达峰时间及峰值强度小于恶性病变,消退时间及平均渡越时间大于恶性病变,差异均有统计学意义(P0.05)。结论超声造影可显示胆囊良恶性病变血流灌注特征和胆囊壁的连续性情况,对辅助鉴别病变性质具有较高的临床应用价值。     

胃间质瘤超声表现一例

患者女，33岁。胃部不适5年，偶然发现并触及胃区肿物半个月就诊。超声检查于胃体小弯侧可见不均匀低回声肿块，边界清晰，大小约54mm×50mm，肿块的胃腔侧可见一内凹，宽10mm，深9mm，表面不光滑。超声提示：胃壁实性肿块（胃间质瘤伴溃疡，图1）。     

B超诊断胃内蛔虫1例

患者男,56岁.因左上腹疼痛3 d来诊.临床诊断：胃炎？嘱患者饮水约300 ml后,取坐位扫查.超声所见：饮水后,胃腔充盈良好.胃壁厚约0.5 cm,胃壁层次大部分清楚;胃腔内探及长约7.0 cm双线状强回声带（管状长条形）稍强回声（图1）.动态观察,可见其蠕动.超诊诊断：胃内蛔虫.     

胃间质瘤超声造影表现与良恶性的相关性分析

目的探讨超声造影(CEUS)在鉴别胃间质瘤良恶性中的应用价值。方法参照2013年版WHO胃肠间质瘤预后分组标准~([1]),将17例经病理证实的胃间质瘤患者进行良恶性分组。回顾性分析良恶性两组的常规二维超声和超声造影表现。结果恶性胃间质瘤与良性胃间质瘤相比最大径更大[(8.53±3.64)cm vs(3.64±2.31)cm],形状多不规则(4/6,66.67%vs 1/10,10.00%),超声造影动脉期多可见粗大不规则的血管(5/6,83.33%vs 1/10,10.00%),实质期多不均匀增强(5/6,83.33%vs 0/10,0.00%)(P值均0.05)。超声造影对良恶性胃间质瘤鉴别诊断的准确度高于常规二维超声(87.50%vs 81.25%)。结论超声造影可较常规二维超声更加准确地鉴别胃间质瘤的良恶性。     

Contrast echocardiography

Contrast echocardiography is the technique of injecting an echo-producing, biologically compatible solution into the bloodstream and using M-mode and/or two-dimensional echocardiography to observe intracardiac bloodflow patterns revealed by the resulting cloud of echoes. This information was previously available only from angiocardiography. Contrast echocardiography has become a well-established adjunct to M-mode and two-dimensional echocardiographic examination and is valuable in the identification and validation of normal and abnormal cardiac structures, for the demonstration (and exclusion) of intracardiac as well as extracardiac shunts, and in the diagnosis of valvular regurgitation. In addition many clinical applications are being developed. Future research directions include development of videodensitometric techniques for contrast quantitation, finding contrast agents capable of passing the lung capillary bed and measurement of right heart pressures using microbubble resonance techniques.     

Contrast nephropathy

Contrast nephropathy will increase mortality up to 30% following angiographic procedures. Before performing such procedures a careful reassessment of the risk/benefit ratio should be performed. Mannitol and diuretics play no role in prevention. Hydration and correction of abnormal electrolyte levels should be done in all patients. Pre-treatment with acetylcysteine and theophylline is a well-accepted strategy and should always be utilized. If creatinine levels are above 2.5 to 3 mg/dl, fenoldopam may provide additional protection, particularly in diabetic patients. However, the role of fenoldopam is controversial. Prophylactic hemodialysis may prove to be an additional tool in the fight against this disease in selected patients.     

应用自制声学造影剂经静脉心肌造影的实验研究

目的　探讨经静脉注射自制造影剂进行心肌造影的可行性。方法　应用超声粉碎仪振荡 5 %白蛋白和低分子右旋糖酐 (4 0 )混合溶液 ,加入全氟化碳 (C3 F8)气体自制声学造影剂 ;应用HP 5 5 0 0超声诊断系统 ,选择左室短轴乳头肌切面 ,采用Contrast程序 ,双触发间歇二次谐波成像 ,对 14条正常犬进行 32次经静脉心肌造影 ,应用自编Mat lab软件可以定量进行心肌造影强度分析。结果　 32次经静脉注射自制造影剂后 31次获得满意的心肌显影。左室各壁心肌显影最大视频密度值为 4 9.4± 17.3至 117.3± 2 3.4 ,明显高于本底对照 (18.6± 8.11至 86 .3± 15 .6 6 ,P <0 .0 1)。结论　经静脉注射自制造影剂可以成功地进行心肌造影并可对心肌显影强度进行定量研究。     

Ultrasonographic Contrast Media

OBJECTIVE: The aim of this work was to review the technical aspects and clinical applications of contrast media (microbubbles and nanomolecular agents) in obstetric and gynecologic ultrasonographic imaging. METHODS: With the use of a computerized database (MEDLINE) and several Web-based search engines (Google Scholar and Copernic), relevant articles on ultrasonographic contrast media were reviewed. References cited in these articles and not obtained via the search engines were also reviewed. RESULTS: Ultrasonographic contrast media constitute a new and expanding technology. They are frequently used, for example, in adult cardiology. Extensive research in laboratory setups, animals, and human subjects has shown their safety and huge potential as an adjunctive tool in clinical practice. They increase signals returning from insonated tissues and are particularly effective as intravascular agents, enhancing color and Doppler signals, for instance. Preliminary results in tumor imaging are encouraging. The ultrasonographic contrast media permit pharmacokinetic perfusion studies, which may be of enormous clinical importance in the study of early cancer development. Targeted imaging and therapies are becoming a reality. Microbubbles have already brought a new dimension to diagnostic ultrasonographic imaging. Many authors have described the clinical value of these agents in liver, prostate, and breast imaging, among others. Newer types of media, the nanomolecules, are now emerging as the latest in imaging enhancers as well as therapeutic agent carriers. CONCLUSIONS: Although showing potential in imaging of the uterus and fallopian tubes as well as some obstetric applications, the contrast media, in particular the nanomolecules, seem to be most promising in ovarian cancer.     

能量多普勒造影技术在经静脉心肌声学造影研究中的临床初步应用

目的：观察能量多普勒造影技术（ＰＣＩ）行静脉心肌声学造影（ＭＣＥ）的效果。方法：利用ＰＣＩ技术观察６例非特异性胸痛患者及３例陈旧性心肌梗塞患者的经静脉心肌声学造影效果。其中,心肌梗塞患者在ＭＣＥ后一周内行核素检查。结果：６例非特异性胸痛患者均未见节段室壁运动异常,在声学造影剂注射后见全部心肌组织均匀显影 ３例陈旧性心肌梗塞患者则见梗塞相应部位室壁运动异常,且声学造影检查发现该部位多普勒能量信号缺失