超声造影在肝脏肿瘤中的应用进展

声学对比剂不断发展，声学造影成像技术和定量分析技术不断出现新的突破，超声造影越来越受到人们重视。本文综述近年来国内外超声造影配合新型超声显像技术在肝脏肿瘤方面的应用，为临床诊断和治疗肝脏肿瘤提供依据。     

超声造影在肾脏疾病中的应用及前景

超声检查常常是评价肾脏疾病的首选成像方式。在多普勒成像中引入超声对比剂是超声检查中一项重大的进步,与CT或MR成像相比,由于超声对比剂无辐射,成本低,且不会扩散到血管外,故可实现实时多维成像,有利于快速诊断。随着声学对比剂的发展和成像软件的开发,超声造影已成为重要的诊断手段之一。就超声造影在常见肾脏疾病中的应用及前景予以综述。     

超声造影对移植肝脏局灶性病变的诊断价值

目的：评价超声造影对移植肝脏局灶性病变的诊断价值。方法：对30例移植肝脏局灶性病变患者,用西门子Sequoia 512彩色多普勒超声诊断仪和超声对比剂Sonovue进行超声造影检查,观察三个时相的对比剂灌注模式,并用自动跟踪对比量化技术（Axius ACQ）对病灶及周围肝组织进行定量分析。所有病例均经病理及临床随访证实。结果：30例移植肝脏局灶性病变患者,超声造影正确诊断29例,包括肝癌复发18例、非均质脂肪肝5例、肝血管瘤4例、梗死灶2例;超声造影误诊1例,超声造影怀疑肝癌复发,经穿刺活检诊断为局灶性脂肪浸润。结论：移植肝脏局灶性病变具有各自典型的增强模式,超声造影技术有助于移植肝脏局灶性病变的鉴别诊断,具有重要临床价值。     

超声造影诊断肝脏实质性病灶的临床价值

超声造影是利用对比剂后散射回声增强,明显提高超声诊断的分辨力、敏感性和特异性的技术.超声造影检查在肝脏实质性病变具有重要临床价值,本文收集189例肝脏实质性病变患者超声造影检查临床资料[1,2],探讨超声造影检查对肝脏实质性病变的诊断价值. 1材料与方法 本组189例患者,男116例,女73例,年龄32～76岁,平均59.6岁.所有病例均经手术病理证实.     

超声造影技术临床应用进展

 超声造影是近年来超声诊断学领域里一个重要的进展,它可增强二维超声影像和彩色多普勒信号,反映和观察正常组织和病变组织的血流灌注情况,是继二维超声、多普勒和彩色血流成像之后超声发展史上的第三次革命。利用超声造影技术使超声的无创性观察活体组织器官的微循环灌注成为可能,将超声从形态学成像过渡到功能性成像的发展阶段。超声造影发展迅速,已经在临床上普及应用,并发挥了重要作用。
      超声造影自应用于临床以来,用于肝脏检查最早、最多、也最成熟。近年来关于肝脏以外器官的研究报道逐渐增多,如：甲状腺、胰腺、膀胱、前列腺及体腔内造影等,其临床应用范围及价值尚待考证,笔者归纳总结了除肝脏以外的一些组织器官的超声造影技术的临床应用及相关发展情况,并且对其应用前景进行了展望。     

彩色多普勒超声造影在肝移植术的应用

随着超声对比剂与造影技术迅速发展,超声造影在临床的应用日见深入,不少研究报道了其在肝移植术方面的应用。本文将以Levovist超声对比剂为例,对超声造影在肝移植术前检查和术后血管并发症的应用价值作一综述。超声造影的价值及意义超声造影(contrast ultrasonography)是将具有     

三维超声造影技术在肝脏的临床应用和研究进展

三维超声造影(3D- CEUS)是在已经较成熟的三维成像和二维超声造影的基础上发展起来的一项技术,在临床应用中具有其独特的优势,可用于评估肝脏和肝脏肿瘤的血供、内部结构和边界等.目前,国内外关于此技术的研究尚属于探索阶段.本文就三维超声造影的临床应用及研究进展作一系统综述.     

实时超声造影在肝转移癌中的诊断与应用研究

肝转移癌是临床较常见的恶性病变之一,其发病率和恶性程度较高。超声声像图检查时对于不典型或合并肝弥漫性病变、原发性肝癌、肝内局灶性病变与肝内转移灶的鉴别诊断较为困难,有着一定的局限性。近年来,超声造影技术在临床上越来越得到广泛应用,不同的超声造影剂在肝、肾、乳腺等器官中的占位性病变诊断中的临床研究已有较多报道。随着新型超声造影剂及造影成像技术的发展,造影增强技术对肝转移癌的诊断研究有着重要的作用。研究表明,超声造影能有效增强肝脏的二维超声表现,反映出正常肝组织与病变组织的血流灌注的不同,从而提高超声诊断的灵敏性和特异性。本研究应用超声造影剂声诺维,以实时灰阶超声造影匹配技术,观察肝脏转移癌的灌注时间、回声变化规律,并与常规超声及CT比较,探讨超声造影的诊断价值。     

肝脏磁共振扩散加权成像技术及其研究进展

临床应用的肝脏CT和MR影像学检查方法有:动态增强CT(dynamic contrast-enhanced computed tomography),动脉造影CT (computed tomography arteriography,CTA) 及动脉性门静脉造影CT(CT arterial portography,CTAP)和经肝动脉造影CT(CT during hepatic arterioportography,CTHP),顺磁性对比剂动态增强MR成像,及超顺磁性对比剂(例如SPIO)动态增强MR成像等,这些检查能发现肝脏局灶性病变并确定其影像特征,互相补充和完善.     

超声造影技术在肝癌诊断及治疗中的研究进展

超声造影（CEUS）又称声学造影,是利用造影剂使后散射回声增强,显著提高超声诊断的分辨力、敏感度和特异性的技术。CEUS技术除了常规的造影谐波成像外,还有间歇式超声成像、能量对比谐波成像、反脉冲谐波成像、受激声波发射成像、低机械指数成像、造影剂爆破成像等。随着新型造影剂的不断研发和相关造影成像技术的飞速发展,CEUS技术取得了突破性进展,CEUS在肝癌诊断和治疗中的应用越来越为业内所肯定。现就CEUS技术在肝癌诊断及治疗中的进展综述如下。     

Vascular patterns in nodules of intraductal papillary mucinous neoplasms depicted under contrast-enhanced ultrasonography are helpful for evaluating malignant potential

Objectives

The purpose of this study is to evaluate the feasibility of contrast-enhanced ultrasonography (CE-US) to differentiate between benign and malignant intraductal papillary mucinous neoplasms (IPMN).

Patients and methods

Contrast-enhanced ultrasonography with a contrast agent was performed on 22 consecutive patients with IPMN suspected of being malignant. This revealed 10 carcinomas, 1 borderline lesion and 11 adenomas. All patients underwent surgery, and the histological diagnosis was confirmed by examination of resected specimens. CE-US was performed using a contrast agent. The detection rates of mural nodules were compared between CE-US and contrast-enhanced computed tomography (CE-CT), and the imaging of mural nodules depicted under CE-US was analyzed.

Results

Seventeen of 22 resected specimens (77.3%) had mural nodules. There was no significant difference in the detection rate between CE-US (n = 15; 88.2%) and CE-CT (n = 12; 70.6%). In 12 (80.0%) of these patients, CE-US revealed small vessels in the mural nodule. The spotty or linear-shaped pattern was detected in 4 patients and the branch-shaped pattern in 8. The branch-shaped pattern lesion was associated with carcinoma. These mural nodules were 10 mm or more in height. In the perfusion image phase, cystic walls and mural nodules were also enhanced in all cases.

Conclusion

The vessel shapes of the mural nodules depicted under CE-US were associated with size and pathological findings. These results suggested that CE-US with a contrast agent is a powerful modality with which to evaluate the malignant potential of IPMN.     

Color power Doppler US and contrast-enhanced US features of abdominal solid organ injuries

Utilization of color power Doppler and sonographic contrast agents to basic ultrasound (US) further improve the detection and characterization of abdominal injuries, increasing the diagnostic accuracy and value of US as an important technique in the evaluation of the abdominal trauma. This paper provides an illustrated summary of our clinical experience with color power Doppler US (CD-US) and contrast-enhanced US (CE-US) in the evaluation of abdominal solid organ injuries, involving 32 documented cases over a 2-year period. The findings of the CD-US and CE-US were compared with those provided by state-of-the-art contrast-enhanced multidetector 16-row CT.     

Diagnosis of liver cirrhosis with contrast-enhanced ultrasound

The assessment of the extent of liver fibrosis is very important for the prognosis and clinical management of chronic liver diseases. Although liver biopsy is the gold standard for the assessment of liver fibrosis, new non-invasive diagnostic methods are urgently needed in clinical work due to certain limitations and complications of biopsy. Noninvasive imaging studies play an important role in the diagnosis of focal liver disease and diffuse liver diseases. Among them, ultrasonography is the first choice for study of the liver in clinical work. With the development of ultrasound contrast agents and contrast specific imaging techniques, contrast-enhanced ultrasound (CEUS) shows good performance and great potential in the evaluation of liver fibrosis. Researchers have tried different kinds of contrast agent and imaging method, such as arrival time of contrast agent in the hepatic vein, and quantitative analysis of the enhancement level of liver parenchyma, to evaluate the degree of liver fibrosis during the past 10 years. This review mainly summarizes the clinical studies concerning the assessment of liver fibrosis using CEUS.     

Diagnostic efficacy of SonoVue, a second generation contrast agent, in the assessment of extracranial carotid or peripheral arteries using colour and spectral Doppler ultrasound: a multicentre study

The purpose of this study was to demonstrate the improvement in diagnostic quality and diagnostic accuracy of SonoVue microbubble contrast-enhanced ultrasound (CE-US) versus unenhanced ultrasound imaging during the investigation of extracranial carotid or peripheral arteries. 82 patients with suspected extracranial carotid or peripheral arterial disease received four SonoVue doses (0.3 ml, 0.6 ml, 1.2 ml and 2.4 ml) with Doppler ultrasound performed before and following each dose. Diagnostic quality of the CE-US examinations was evaluated off-site for duration of clinically useful contrast enhancement, artefact effects and percentage of examinations converted from non-diagnostic to diagnostic. Accuracy, sensitivity and specificity were assessed as agreement of CE-US diagnosis evaluated by an independent panel of experts with reference standard modality. The median duration of clinically useful signal enhancement significantly increased with increasing SonoVue doses (p< or =0.002). At the dose of 2.4 ml of SonoVue, diagnostic quality evaluated as number of inconclusive examinations significantly improved, falling from 40.7% at baseline down to 5.1%. Furthermore, SonoVue significantly (p<0.01) increased the accuracy, sensitivity and specificity of assessment of disease compared with baseline ultrasound. SonoVue increases the diagnostic quality of Doppler images and improves the accuracy of both spectral and colour Doppler examinations of extracranial carotid or peripheral arterial disease.     

The value of magnetic resonance tomography in the detection and differential diagnosis of focal liver lesions]

Magnetic resonance imaging (MRI) of the liver has made considerable progress due to improvements in the examination technique. Sensitivity for the detection of focal liver lesions is higher for MRI than for CT. In the differential diagnosis of liver tumors MRI is remarkably accurate. This is particularly true for hemangiomas, liver cell carcinomas and focal nodular hyperplasias. From a clinical view point differentiation between hemangiomas and metastases is of utmost importance. Future improvements in MR diagnosis of liver diseases are expected due to fast imaging techniques and liver-specific contrast agents.     

Perfusion characteristics of parotid gland tumors evaluated by contrast-enhanced ultrasound

Purpose

Contrast enhanced ultrasound (CE-US) is a promising imaging modality for non-invasive analysis of parotid gland lesions because their vascularisation differs from normal gland tissue. This clinical study should further investigate CE-US as a diagnostic tool for parotid gland tumors.

Materials and methods

39 patients underwent CE-US measurements after intravenous application of a contrast agent (SonoVue, Bracco, Italy) before surgical tumor resection. Time–intensity curves gradients were calculated and parameters of intratumoral microcirculation were analysed. The vascularisation parameters were compared among the different tumor entities as defined per definitive histological diagnosis.

Results

Histological analyses revealed 17 pleomorphic adenoma, 15 cystadenolymphoma and 7 malignoma. A significant difference of area below intensity time curve (AUC) and mean transit time (MTT) was measured in the malignant lesions compared to benign tumors (p < 0.05). A significant difference of AUC and maximum of signal increase (ΔSI_max) for pleomorphic adenoma versus cystadenolymphoma was found (p < 0.05).

Conclusion

CE-US seems to be a quantitative and independent method for the assessment of malign and benign parotid gland tumors. Further studies and clinical experience will have to validate this method as a reliable diagnostic tool that facilitates preoperative planning.     

Contrast-enhanced color Doppler ultrasound characteristics in hypervascular breast tumors: comparison with MRI

The aim of this study was to evaluate the accuracy of contrast-enhanced color Doppler ultrasound (CE-US) in comparison with contrast-enhanced MR imaging (CE-MRI) in the discrimination of hypervascularized breast tumors. An additional CE-US of the breast was preoperatively performed in 40 patients with a hypervascular breast lesion detected on CE-MRI. The presence of blood flow signals and the morphological characteristics of the vessels in the breast lesions were evaluated pre- and post-contrast administration, as well as the dynamic aspects of the Doppler signal, including time interval to maximum signal enhancement and persistence of the signal enhancement. Twenty-three carcinomas and 17 fibroadenomas were explored. Considering initial signal enhancement > 100 % after the administration of contrast material as a criterion suggesting malignancy, CE-MRI showed a sensitivity of 100 % and a specificity of 76.5 % in the detection of malignant breast tumors. Color Doppler signals were consistently demonstrated in all carcinomas and in 68.7 % of fibroadenomas after the administration of Levovist, with CE-US showing a sensitivity of 95.6 % and a specificity of 5.9 %. Neither the mean number of vessels per tumor, nor the location of vessels, the time to maximum increase of the Doppler signal or the persistence of signal enhancement showed significant differences between benign and malignant lesions. Additional CE-US does not increase the low specificity of MRI in patients with hypervascularized breast tumors. Received: 17 July 2000 Revised: 22 August 2000 Accepted: 24 August 2000     

Liver-specific MR contrast agents: current status and prospects]

Liver-specific MR contrast agents include superparamagnetic iron oxide (SPIO) particles and hepatobiliary paramagnetic agents. SPIO particles are phagocytosed by reticuloendothelial cells in the liver, resulting in negative enhancement of the liver parenchyma on T2- or T2*-weighted images. Ferumoxides and related iron oxide formulations have been tested clinically throughout the world, and have been demonstrated to improve the detection and characterization of hepatic neoplasms. Hepatobiliary paramagnetic agents are partially taken up by hepatocytes, yielding positive, sustained enhancement of the liver parenchyma on T1-weighted images. These agents are referred to as "value-added" versions of extracellular gadolinium compounds because they increase tumor-liver contrast in both the perfusion phase and hepatobiliary phase. Although only ferumoxides are currently available for clinical use, many agents are in the pipeline. The possibility of "one-stop shopping" diagnosis by liver-specific MR contrast agents is an attractive alternative to the existing multistep diagnosis in liver imaging. Further studies to analyze the cost-benefit ratio will follow, to determine whether liver-specific MR contrast agents lead to change in patient treatment and whether such a decision would be reliable.     

原发性肝癌靶向对比剂的研究进展

原发性肝癌(primary Hepatocarcinoma,PHC)是最常见的恶性肿瘤之一,早期诊断与治疗对于改善肝癌患者预后和降低死亡率有着极为重要的意义.常规和增强影像学检查因其无创且相对准确的独特优势已逐渐成为诊断肝癌的首选方法,然而其在肝癌的早期诊断和评估疗效等方面仍存在较大的局限性,肝癌靶向对比剂的出现在一定...     

超声造影在肝癌介入治疗后疗效评价中的应用

目的:探讨实时灰阶超声造影(contrast-enhanced grey-scale ultrasonography,CE-US)在肝癌介入治疗后疗效评价中的应用价值。方法:经肘前浅静脉团注超声对比剂SonoVue,观察各时相病灶的强化特点,并与治疗前CE-US、治疗后CT、MRI图像及随访结果进行比较,综合判断介入治疗效果。结果:CE-US可以清晰地显示病灶内有无局部或整体强化,能准确评价肝癌介入治疗后疗效。结论:CE-US在评价肝癌介入疗效时具有重要的临床价值。