实时超声造影技术诊断肝脏微小局灶性病变的价值

目的:探讨肝脏微小局灶性病变(最大径≤2cm)的实时超声造影诊断价值。材料和方法:对205个≤2cm肝脏局灶性病变分别进行实时超声造影及常规超声检查,将诊断结果分为良性、恶性和不能确定,最终诊断经病理学、同期其他影像及实验室检查证实,并随访10~30个月。结果:恶性肿瘤65个病灶,良性病灶140个。与病理诊断比较,超声造影诊断的敏感性、特异性及准确性分别为85.0%、90.5%及88.5%,常规超声分别为40.0%、47.6%及42.6%。病灶动脉期高增强及门静脉期或延迟期低增强为诊断恶性的重要指标。结论:实时超声造影技术对鉴别诊断肝脏微小(≤2cm)局灶性病变具有重要的临床应用价值。     

实时超声造影在肝脏局灶性病变诊断中的应用

目的:评价实时超声造影技术在肝脏局灶性病变诊断中的作用及意义.方法:采用实时超声造影技术,对我院269例肝脏局灶性病变进行超声造影检查.结果:92.4%恶性病变动脉相呈现回声增强.病灶动脉相呈现高增强或等增强、延迟相消退为低增强或无增强,在良性病变中占13.8%(19/138),恶性病变中为94.7%(124/131);实时超声造影诊断肝脏局限性病灶的敏感度89.6%,特异度97.5%,诊断符合率93.2%.结论:实时超声造影可显示肝局灶性病变的血流灌注特点,对肝局灶性病变的分类诊断有重要的应用价值.     

超声造影诊断胰腺局灶性病变的诊断价值

目的探讨超声造影诊断胰腺局灶性病变的价值.材料和方法对140个胰腺局灶性病变进行常规超声及超声造影检查,所有病例均经病理诊断.结果恶性肿瘤80个病灶,良性病灶60个.超声造影诊断的敏感性、特异性及准确性分别为85.0%、85.0%及85.0%,常规超声诊断分别为62.50%、46.67%及55.71%,超声造影诊断的阳性预测值为93.15%,阴性预测值为87.93%.结论实时超声造影技术对鉴别诊断胰腺局灶性病变具有较高的临床应用价值.     

超声造影与CT增强扫描对肝占位性病变的诊断价值比较

目的 :对比超声造影与CT增强扫描在肝占位性病变中的诊断价值,为临床诊断肝占位性病变提供参考依据。方法 :回顾性分析71例肝占位性病变患者的临床资料,比较超声造影与CT增强扫描的诊断阳性率,对比2种检查方法的诊断价值。结果:超声造影对肝癌、肝血管瘤及肝局灶性结节增生的诊断阳性率分别为83.33%、88.00%及82.14%,而CT增强扫描分别为88.89%、92.00%及85.71%,2种检查方法的诊断阳性率比较差异无统计学意义(P0.05)。此外,2种检查方法对肝癌、肝血管瘤及肝局灶性结节增生均具有较高的诊断效能(P0.05)。结论:超声造影与CT增强扫描对肝占位性病变的诊断价值相当。     

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。     

灰阶超声造影在肝脏局灶性病变诊断中的应用

目的探讨实时灰阶超声造影在肝脏局灶性病变诊断与鉴别诊断中的应用价值。方法回顾性分析36例肝脏局灶性病变患者的超声造影表现,评价病灶增强时相及其形态学特征,并进行血流动力学分析。同时与CDFI进行比较,部分病例与CT进行对照。结果不同性质占位性病变具有不同的造影增强表现;与CDFI相比,超声造影可明显提高病灶血流显示率;同时,对于直径≤1.0cm病灶,检出率明显提高。结论超声造影在肝脏局灶性病变诊断和鉴别诊断中具有重要意义。     

造影剂Sono Vue和对比脉冲序列成像技术诊断肝脏局灶性病变的价值

目的探讨新型造影剂SonoVue和对比脉冲序列(CPS)成像技术对肝脏局灶性病变(FLL)的诊断价值.材料和方法对126例(142个病灶)FLL患者进行超声造影检查,103例经手术或穿刺病理证实,余23例经CT、MRI增强检查和临床综合资料证实(肝细胞性肝癌63个,肝内胆管细胞癌5个,转移性肝癌15个,肝血管瘤28个,肝局灶性结节性增生10个,肝炎性假瘤3个,肝腺瘤3个,局灶性脂肪肝7个,肝硬化结节8个).结果恶性组与良性组相比达峰时间、消退时间提前,持续时间缩短(P＜0.05);原发性肝癌比转移性肝癌消退时间提前(P＜0.05).在动脉相,41个(65%)中低分化肝细胞性肝癌(Hcc)病灶呈高增强,3个(5%)高分化HCC病灶在所有时相均呈等增强;3个肝内胆管细胞癌和8个转移性肝癌病灶在动脉相呈环状增强.18个(18/28)血管瘤在动脉相,呈周边结节状增强,门脉相呈向心性填充;6个(6/10)肝局灶性结节性增生动脉相呈轮辐状增强;2个肝腺瘤动脉相呈高增强;2个炎性假瘤于3个时相均未见增强.所有的局灶性脂肪肝和肝硬化结节在3个时相呈等增强.结论超声造影是鉴别FLL的一种很有前途的影像手段,极大地提高了超声对FLL的诊断价值.     

超声造影检查肝脏局灶性病灶的临床价值分析

目的探讨超声造影在肝脏局灶性病变良恶性临床鉴别与诊断中的应用价值。方法对收治的肝脏局灶性病变患者分别采用常规超声和实时超声造影(contrast-enhanced ultrasound,CEUS)进行检查,以手术病理确诊结果为金标准进行两种方法的诊断效果进行对比分析。结果病理确诊病灶类型:肝细胞肝癌38例,血管瘤8例,局灶性结节性增生3例,不均匀脂肪肝5例,硬化结节6例,结核球2例,术后包裹性积液1例,肝转移癌5例。常规超声诊断肝脏局灶性病变的敏感性为65.12%,特异性为72.00%,准确性为67.65%;超声造影诊断肝脏局灶性病变的敏感性为88.37%,特异性为92.00%,准确性为89.71%;经统计学分析发现发现超声造影对肝脏局灶性病变诊断的敏感性为、特异性、准确性明显高于常规超声,且差异具有统计学意义。恶性组的开始增强时间、增强峰值时间、消退时间及峰值强度与良性组比较存在明显差异,且差异具有统计学意义。结论应用时间-强度曲线取得的超声造影定量参数变化特征能够反映肝肿瘤微小血管血流分布情况及灌注量,对鉴别诊断肝脏局灶性病变具有较高的临床应用价值。     

超声造影诊断肝脏局灶性结节状增生的价值

目的：探讨超声造影诊断肝脏局灶性结节状增生的价值。材料和方法：回顾分析了11例肝脏局灶性结节状增生的超声造影表现。9例于造影后经超声引导穿刺确诊,2例经手术确诊。结果：11例病灶动脉期均快速显著增强。9例病灶动脉早期呈轮辐状增强,造影三期回声强于周边肝实质,实质期可见轮辐状低回声；2例病灶动脉早期快速增强,动脉期及门脉期回声强于周边肝实质,实质期回声与肝实质等同,未见轮辐状低回声。结论：超声造影所显示的肝脏局灶性结节状增生的增强特征,有助于临床诊断。部分病灶超声造影表现缺乏特异性,确诊仍需要结合其他影像学方法和穿刺活检。     

肝脏局灶性结节性增生2例报告及文献复习

目的通过分析肝脏局灶性结节增生的影像表现，提高其诊断准确性。方法2例经手术病理证实的肝脏局灶性结节增生患者均接受超声、CT和MRI检查，其影像表现结合文献复习进行了分析。结果超声显示了2例的肝右叶实性占位性病变。1例CT平扫肝右叶病灶显示不清，增强扫描后，肝右叶前段有一直径约3．1cm的类圆形病灶呈均匀强化。MR平扫见2例的肝内结节病灶均呈等T1、等T2信号，增强扫描动脉期病灶明显强化，门脉期和延迟期病灶的强化程度逐渐下降。结论腹部超声可提示本病的诊断，而CT和MRI，尤其是增强扫描，可清晰显示病灶的血供特点和强化特征，为定性诊断提供重要依据。     

Performance of FDG-PET/CT for diagnosis of recurrent uterine cervical cancer

The purpose is to evaluate the accuracy of integrated FDG-PET/CT, compared with PET alone, for diagnosis of suspected recurrence of uterine cervical cancer. Fifty-two women who had undergone treatment for histopathologically proven cervical cancer received PET/CT with suspected recurrence. PET-alone and integrated PET/CT images were evaluated by two different experienced radiologists by consensus for each investigation. A final diagnosis was confirmed by histopathology, radiological imaging, and clinical follow-up for over 1 year. Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/CT were 92.0% (23/25), 92.6% (25/27), and 92.3% (48/52), respectively, while for PET, the corresponding figures were 80.0% (20/25), 77.8% (21/27), and 78.8% (41/52), respectively. PET/CT resolved the false-positive PET results due to hypermetabolic activity of benign/inflammatory lesions and physiological variants, and was able to detect lung metastasis, local recurrence, peritoneal dissemination, para-aortic lymph node metastasis, and pelvic lymph node metastasis missed by PET alone. However, tiny local recurrence and lymph node metastasis could not be detected even by PET/CT. FDG-PET/CT is a useful complementary modality for providing good anatomic and functional localization of sites of recurrence during follow-up of patients with cervical cancer.     

18F-FDG符合线路SPECT显像联合CT、B超、MRI在结直肠癌术后复发及转移中的诊断价值

目的探讨18F-FDG 符合线路 SPECT 显像联合传统显像(CT、B 超、MRI)在结直肠癌术后复发及转移中的诊断价值.资料与方法107例结直肠癌术后患者行18F-FDG 符合线路 SPECT 显像,并联合 CT、B 超、MRI 诊断结直肠癌术后复发及转移.结果107例患者最终确定复发及转移共29例.18F-FDG 符合线路 SPECT 显像与传统显像诊断均为阳性的15例患者中,传统显像检出病灶20个,符合线路 SPECT 显像检出病灶26个.传统显像检出3个符合线路 SPECT 显像未发现的转移病灶,而符合线路 SPECT 显像检出9个传统显像未发现的病灶.18F-FDG 符合线路 SPECT 显像诊断结直肠癌术后复发及转移的灵敏度、特异性和准确率分别为79.3%、89.7%和86.9%;传统显像的诊断效能分别为62.1%、88.5%和81.3%;二者联合的诊断效能分别为89.7%、92.3%和91.6%.二者联合诊断结直肠癌术后复发及转移的灵敏度和准确率明显优于传统显像(P <0.05).结论18F-FDG 符合线路 SPECT 显像联合 CT、B 超、MRI 在监测结直肠癌术后复发及转移中具有重要临床价值.     

超声造影在诊断乳腺癌肝转移中的应用价值

目的:探讨超声造影(CEUS)在诊断乳腺癌肝转移中的应用价值。材料和方法:对89例常规超声疑似乳腺癌肝转移者行CEUS和增强CT(CECT)后,采用穿刺活检、手术病理、影像学随访超过半年临床最后确诊。结果:89例常规超声疑似乳腺癌肝转移经CEUS及相关检查临床最后确诊为良性41例。48例乳腺癌肝转移经CEUS明确诊断47例。CEUS对乳腺癌肝转移诊断的敏感度为97.92%(47/48),假阴性率为2.08%(1/48),特异度为100%(41/41),阳性预测值为100%(47/47),阴性预测值为97.62%(41/42)。经CEUS发现新增转移病灶10例。CEUS从常规超声53.93%(48/89)的诊断准确度提高到98.88%(88/89)。CEUS对乳腺癌肝转移的诊断率与CECT在统计学上无差异(P=0.833)。结论:CEUS能发现乳腺癌较小的肝转移灶,提高了超声诊断乳腺癌肝转移的鉴别能力和准确度。     

18F-FDG PET/CT在胃癌复发及转移监测中的临床价值

目的 探讨18F-FDG PET/CT在胃癌术后复发及转移监测中的临床价值。 方法 回顾性分析2013年1月至2017年8月行18F-FDG PET/CT及增强CT检查的52例胃癌术后疑似复发转移患者[男性40例,女性12例,年龄30～86（61.73±11.44）岁]。通过定量分析与半定量分析的比较,确定吻合口复发的最大标准化摄取值（SUV_max）的临界值。采用ROC曲线分析吻合口的SUV_max临界值,t检验比较组间SUV_max,χ2检验比较定性分析与半定量分析及18F-FDG PET/CT与增强CT对于胃癌术后吻合口、淋巴结、远处转移的诊断效能。 结果 吻合口SUV_max临界值取3.14时,18F-FDG PET/CT诊断吻合口复发的特异度高于定性分析法,差异有统计学意义（χ2=5.439,P<0.05）。吻合口复发的SUV_max明显高于吻合口炎,差异有统计学意义（t=4.701,P<0.05）。18F-FDG PET/CT与增强CT诊断吻合口复发、淋巴结、远处转移的灵敏度的比较,差异有统计学意义（90.48% vs. 23.81%、92.00% vs. 60.00%、87.50% vs. 34.38%,χ2=19.363、5.373、16.804,均 P<0.05）;特异度的比较均无统计学意义（100% vs. 100% 、 100% vs. 92.5% 、 100% vs. 95.00% , χ2 = 0.000、2.850、1.412 , 均 P>0.05）。 结论 18F-FDG PET/CT诊断胃癌术后复发转移优于CT,对胃癌术后复发转移的监测有重要临床价值。     

超声造影结合超声引导下穿刺活检对结直肠癌肝转移的诊断价值

目的：评价超声造影（ CEUS）结合超声引导下穿刺活检（ IU）对结直肠癌肝转移的诊断价值。方法总结经手术病理证实的结直肠癌病例21例,共切除病灶21个。后经3～25个月,其他影像学检查（ CT、MRI）发现肝内可疑转移病灶33个,（1个病灶11例,2个病灶8例,3个病灶2例）。经超声造影检查明确肝内转移病灶是否存在,经超声引导下对可疑病灶进行穿刺活检,设定CEUS为A组,IU为B组,后经手术病理结果对照。结果A、B两组与AorB组组间比较t检验,A组与B组之间无统计学差异,A、B两组分别与A orB组有统计学差异, P＜0.05。结论 CEUS结合IU可提高恶性病灶检出率。     

Performance of FDG-PET/CT in the diagnosis of recurrent endometrial cancer

Objective To evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) using 18-F-fluorodeoxyglucose (FDG), compared with PET alone, in the diagnosis of suspected endometrial cancer recurrence. Methods Thirty women who had undergone primary surgery for histopathologically proven endometrial cancer with suspected recurrence because of clinical, cytological, biochemical, and/or radiological findings were enrolled in this study. PET and integrated PET/CT images were evaluated by two different experienced radiologists by consensus for each modality. A final diagnosis of recurrence was confirmed by histopathology, other imaging and clinical follow-up for longer than 1 year. The statistical significance of differences between PET and PET/CT was determined by the McNemar test. Results Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/CT were 93% (14/15), 93% (14/15), and 93% (28/30), respectively, whereas for PET, the corresponding data were 80% (12/15), 80% (12/15), and 80% (24/30), respectively (P = 0.479, 0.479, and 0.134, respectively). CT from PET/CT resolved the false-positive PET results because of hyper-metabolic activity of benign inflammatory lesions and physiological variants and moreover detected lung metastasis and para-aortic lymph node metastasis that PET missed. However, tiny para-aortic lymph node metastasis could not be detected even with PET/CT. Conclusions Integrated FDG-PET/CT is a useful complementary modality for providing good anatomic and functional localization of sites of recurrence during follow-up of patients with endometrial cancer.     

Focal liver lesions: can SonoVue-enhanced ultrasound be used to differentiate malignant from benign lesions?

OBJECTIVE: To evaluate whether contrast-enhanced ultrasound (CEUS) with SonoVue could differentiate malignant focal liver lesions (FLLs) from benign lesions and provide lesion type diagnoses. MATERIALS AND METHODS: Four hundred fifty-six patients with 554 FLLs were examined by CEUS with SonoVue using low mechanical index, nonlinear imaging techniques. Each lesion was characterized by 2 independent off-site readers as malignant or benign and given specific lesion type diagnosis, if possible, both at baseline ultrasound (US) and after SonoVue administration (CEUS). The final diagnosis was achieved by histopathology obtained from biopsy or surgical specimens, or by typical manifestation on contrast-enhanced CT or MRI. RESULTS: The diagnostic accuracies of the 2 readers were 41.9% and 35.2% for baseline US, which improved significantly to 87.2% and 87.9% for CEUS (P < 0.05). Interreader agreement also increased with CEUS compared with baseline US (ê value changed from 0.49 to 0.77). The accuracy for lesion type diagnosis was 38.4% and 32.5% for baseline US, which increased to 77.6% and 78.0% for CEUS (P < 0.05). CONCLUSIONS: CEUS with SonoVue improves differentiation between malignant and benign FLLs, and also provides improved lesion type (differential) diagnosis.     

Efficacy and safety of mangafodipir trisodium (MnDPDP) injection for hepatic MRI in adults: results of the U.S. Multicenter phase III clinical trials. Efficacy of early imaging

The efficacy of contrast-enhanced magnetic resonance imaging (MRI) for detecting and characterizing, or excluding, hepatic masses was assessed in 404 patients, following the intravenous administration of mangafodipir trisodium (MnDPDP) injection, a hepatic MRI contrast agent. An initial contrast-enhanced computed tomography (CT) examination was followed by unenhanced MRI, injection of MnDPDP (5 micromol/kg IV), and enhanced MRI at 15 minutes post injection. Agreement of the radiologic diagnoses with the patients' final diagnoses was higher for enhanced MRI and for the combined unenhanced and enhanced MRI evaluations than for unenhanced MRI alone or enhanced CT using the clinical diagnosis as the gold standard. Mangafodipir-enhanced MRI uniquely provided additional diagnostic information in 48% of the patients, and patient management was consequently altered in 6% of the patients. MnDPDP-enhanced MRI was comparable or superior to unenhanced MRI and enhanced CT for the detection, classification, and diagnosis of focal liver lesions in patients with known or suspected focal liver disease.     

Real-time contrast-enhanced ultrasound of the spleen: examination technique and preliminary clinical experience

PURPOSE: To report our preliminary experience in the evaluation of the spleen using a real-time contrast-specific ultrasound module in combination with a second-generation contrast agent. MATERIALS AND METHODS: In a 7-month period, 55 patients (34 males and 21 females, aged 5-77 years) with spleen disorders were evaluated by means of contrast-enhanced ultrasound. Two patients were studied because of baseline evidence of an accessory spleen and both underwent ultrasound follow-up. Twenty-five patients were studied for abdominal trauma and results were correlated with those of helical CT. Three patients were examined for suspected splenic infarction and for all CT correlation was obtained. Finally, twenty-five subjects were examined for focal diseases, such as lymphomas (17 cases) and focal lesions (8 cases); contrast-enhanced US results were correlated with those of CT (8 cases), MRI (2 cases), ultrasound follow-up (8 cases), biopsy (2 cases) or splenectomy (1 case). After an initial baseline study, the contrast-enhanced examinations were carried out using a dedicated unit equipped with a continuous contrast-specific module at low acoustic pressure. The examination started immediately after rapid contrast injection and lasted approximately 4 minutes. In the comparison between baseline and contrast-enhanced ultrasound, the following aspects were considered: detection rate of parenchymal changes, lesion extent (equal to CT, under- or overestimated), and lesion conspicuity (lesion-to-parenchyma gradient, from 0 = absent to 3 = high). RESULTS: In the 2 patients with accessory spleen, an enhancement very similar to that of the adjacent parenchyma was present and a small vascular pedicle was noted. Among the trauma patients, 18 had a direct splenic injury and one showed splenic contraction and hypoperfusion due to shock. In 74% of cases, a peritoneal effusion was demonstrated both with baseline and contrast-enhanced ultrasound; perisplenic blood collections (58% of cases) were identified in 42% of patients by both baseline and contrast-enhanced ultrasound; post-traumatic infarction was always revealed by contrast-enhanced ultrasound (11% of cases) but never by baseline ultrasound; parenchymal injuries were detected with a sensitivity of 63% by baseline ultrasound and a sensitivity of 89% by contrast-enhanced ultrasound. Moreover, contrast-enhanced ultrasound revealed findings undetectable on conventional ultrasound: global splenic hypoperfusion in 2 cases (due to shock in one and pedicle avulsion in the other), intraparenchymal contrast collections in 21% of positive cases (as confirmed by CT), extrasplenic contrast leakage in 1 of 2 cases demonstrated by CT. Of the 3 cases of splenic infarction, baseline sonography only only identified two, whereas the contrast-enhanced examination clearly identified three. Contrast-enhanced ultrasound revealed 35 of 39 focal lesions in patients studied for Hodgkin's disease and splenic focal lesions. Baseline ultrasound had a lower sensitivity (23 lesions). Lesion extension shown by contrast-enhanced sonography was equivalent to that provided by standard methods in 88% of cases (underestimated in 9% and overestimated in 3%); baseline US correctly estimated lesion size in 52% of cases, under- and overestimating them in 35% and 13% of cases, respectively. Lesion conspicuity was graded as 1 (low) in 16%, 2 (moderate) in 67%, and 3 (high) in 17% of the cases identified by enhanced sonography. Baseline ultrasound was less effective: conspicuity was graded as 1 in 42%, 2 in 39%, and 3 in 19% of cases. CONCLUSIONS: The spleen is the ideal organ to be studied with second-generation contrast media due to its superficial location, high vascularity, small size and homogeneous texture. Contrast-enhanced ultrasound is a simple, poorly-invasive and accurate tool for the evaluation of splenic disorders. If our data are confirmed, it will be possible to reduce the use of more complex technologies such as CT and MRI.