高频超声对腹直肌及其周围疾病的诊断价值

目的探讨腹直肌及其周围病变的声像图特点及高频超声检查特异性。方法研究对象为38例经临床确诊的腹直肌及其周围病变患者,其中男17例,女21例,年龄28d至65岁,平均(38.2±1.6)岁,采用高频探头对腹直肌及其周围进行纵、横、斜切扫查,将资料分为损伤性病变、感染性病变、肿瘤性及肿瘤样病变三大类,分析各类疾病的声像图特点及超声检查特异性。结果高频超声对腹直肌及其周围病变的敏感性为97.4%(37/38),特异性73.7%(28/38),其中损伤性病变、感染性病变、肿瘤性及肿瘤样病变特异性分别为75.0%(9/12)、90.0%(9/10)、62.5%(10/16)。结论高频超声对腹直肌及其周围感染性病变及损伤性病变具有较高的特异性,对肿瘤性及肿瘤样病变特异性较低,可作为首选的影像学检查方法。     

应用高频超声对胆囊息肉样病变的观察

目的：探讨高频超声对胆囊息肉样病变的诊断价值。方法：应用高、低频探头联合检查胆囊息肉样病变，并与手术、病理相对照。结果：胆固醇息肉65例，胆囊腺肌增生症6例．胆囊腺瘤4例，胆囊癌8例。以胆囊腔内局限性隆起病变为共同声像图表现。结论：高频超声对提高胆囊息肉样病变的检出率及诊断正确率有一定价值。     

胆囊息肉样变的声像图分析

胆囊息肉样变又称胆囊隆起性病变,多无症状,85％的患者在例行体检中发现。我国成年人中,胆囊息肉样病变发生率约为5％。胆囊息肉样变病理学分为：胆固醇息肉（又称胆固醇沉着症）、炎性息肉、胆囊腺瘤（包括单纯性腺瘤和乳头状腺瘤）及胆囊肌腺瘤（腺肌增生症）。本组对42例经手术病理证实的胆囊息肉患者的声像图分析报告如下。     

37例胆囊息肉样病变术前B超与术后病理结果分析

目的 探讨胆囊息肉样病变（PLG）声像图与病理结果的相互关系。方法 回顾分析了37例胆囊息肉样病变术前声像图和术后病理结果。结果 PLG的B超诊断符合率为88．6％（31／35）,15例PLG合并有胆囊结石,占40．5％（15／37）,29例合并有不同程度的慢性胆囊炎,占78．4％（29／37）,4例胆囊腺瘤术前未能获得确诊。结论 胆囊结石和胆囊炎是PLG发生癌变的高危因素,超声不能对胆囊腺瘤早期癌变与单纯性腺瘤作出明确鉴别诊断。     

彩色超声下胆囊息肉样病变与早期胆囊癌的鉴别诊断

以往胆囊息肉样病变与早期胆囊癌在超声下的诊断有一定困难,尤其肿瘤性息肉在超声图像上与早期胆囊癌更加难以鉴别。由于彩色超声对胆囊息肉样病变的检出灵敏而准确,不但提高了对胆囊增生性病变和炎性病变的认识,并且极大地提高了胆囊癌早期发现和诊断水平。本研究探讨胆囊息肉样病变与早期胆囊癌的彩色超声图像、血流信号及频谱特点,提高对胆囊息肉样病变与早期胆囊癌的鉴别诊断。现报告如下。     

M值测定对胆囊息肉样病变的诊断及手术指征评估

目的通过测定超声下胆囊息肉样病变的M值协助临床诊断及制订治疗方案。方法选取2009年4月至2013年4月收治的胆囊息肉样病变患者280例,所有患者均行B超检查,观察并记录超声下息肉样病变部位、数目、大小、形态及胆囊壁厚度等指标,运用胆囊息肉M值进行测定并对所得数据及术后病理类型进行统计学分析。结果所有患者非肿瘤性息肉250例,肿瘤性息肉30例,M〈0者212例均为良性病变,0≤M〈2．5者43例,恶性病变11例,良性病变32例;M≥2．5者25例,恶性病变19例,良性病变6例。胆囊息肉样病变不同病理类型的发病率与M值评分呈正相关关系,M值越高其发病率越高（r=1．224,P〈O．01）。结论超声下M值测定对胆囊息肉样病变的诊断及治疗具有指导意义,有助于尽早识别胆囊癌及有恶变可能性的息肉,具有广阔的临床应用价值。     

B超诊断胆囊息肉样病变与病理对照分析

目的：本通过对胆囊息肉样病变的超声诊断与病理结果分析，以探讨不同类型胆囊息肉样病变的声像图特征，为早期分类诊断提供依据。方法：对75例胆囊息肉样病变患的超声图像与手术后病理诊断进行对照分析。结果：胆固醇性息肉64例，腺瘤并局部不典型增生及癌变4例，单纯性腺瘤2例，粘膜息肉样变1例，慢性胆囊炎4例。在病理诊断为胆囊息肉样病变中合并慢性胆囊炎61例，合并胆囊结石3例。超声与病理诊断符合率为94．67％。结论：应用超声图像分析，可以提高对胆囊息肉样病变的良性病变与恶性病变及病理分型的诊断率，特别是对胆囊癌前病变及早期胆囊癌的预防和早期诊断有重要价值。     

彩色多普勒超声对胆囊息肉样病变45例诊断分析

目的探讨彩色多普勒超声在胆囊息肉样病变诊断中的价值。方法对45例胆囊息肉样病变患者的声像图表现及病理结果进行回顾性分析。结果胆囊癌5例,其中3例瘤体内探及到血流信号;胆囊息肉39例,其中有10例探及血流信号;胆囊良性腺瘤1例,瘤体内部未探及血流信号;良性病灶的阻力指数明显低于恶性病灶。结论彩色多普勒超声可对胆囊息肉样病变做出较为准确的诊断,具有很高的临床价值。     

60例胆囊息肉样病变的B超诊断

胆囊息肉样病变是一种常见的胆囊疾患。本组６０例Ｂ超诊断为胆囊息肉,经手术后病理检查与声像图改变进行对照分析,从而获得胆囊息肉样病变不同类型的声像图表现特征,为早期诊断提供依据。１临床资料１．１一般资料６０例均为住院患者,平均年龄４６（２５～７０）岁。...     

25例胆囊息肉临床诊断和治疗

胆囊息肉是一级胆囊腔内外观形态为息肉样的非结石性占位病变。从病理角度来看，包括真性肿瘤（胆囊癌、单纯腺瘤、乳头状腺瘤）、炎病性息肉、胆固醇性息肉、增生性息肉。现将收治的25例胆囊息肉样病变病人，结合文献，加以探讨。fiB床资料l·125例病人均经B型超声检查确诊。行胆囊造影的5例中，4例阳性（80％）。2例CT检查阳性。1例胆囊腺肌增生症经磁共振（MRI）检查为阴性。肝肾功能及实验室检查正常。1．225例胆囊息肉样病变中真性肿瘤21例（84％），其中胆囊癌12例（48％），乳头状瘤4例（1％），单纯腺瘤5例（20％），胆固醇息肉2…     

彩色多普勒超声对胆囊息肉样病变167例诊断分析

目的分析胆囊息肉样病变彩色多普勒超声（cDFI）检查结果。方法回顾性分析我院1995～2007年间167例通过经病理检查证实的胆囊息肉样病变CDFI检查情况。结果经彩色多普勒超声首诊的胆囊息肉样病变157例，10例为胆汁淤积。结论二维超声成像结合彩色多普勒血流显像对胆囊息肉样病变的良恶性鉴别诊断及恶性肿瘤的早期诊断有重要价值。     

超声造影在胆囊息肉样病变鉴别诊断中的价值

目的探讨超声造影在胆囊息肉样病变鉴别诊断中的价值。方法对照病理诊断结果,分析32例胆囊息肉样病变的超声造影特征与常规超声图像。结果 32例胆囊息肉样病变病理结果为胆囊癌7例,胆囊息肉20例,腺瘤4例,胆泥1例。超声造影提示胆囊癌8例,胆囊息肉23例,胆泥1例。常规超声提示胆囊癌9例,胆囊息肉21例,胆泥2例。与病理结果对照,超声造影的诊断准确率(90.6%)高于常规超声的诊断准确率(65.6%)相比,差异有统计学意义(P<0.05)。结论超声造影有助于胆囊息肉样病变的鉴别诊断。     

Differential diagnosis of gallbladder diseases with contrast-enhanced harmonic gray scale ultrasonography.

OBJECTIVES: We evaluated the usefulness of contrast-enhanced harmonic gray scale ultrasonographic findings for differential diagnosis of gallbladder diseases. METHODS: We evaluated contrast-enhanced harmonic gray scale ultrasonographic images from 33 patients with 35 polypoid gallbladder disease lesions larger than 10 mm in diameter, consisting of 12 biliary sludge lesions, 8 cholesterol polyps, 1 inflammatory polyp, 2 adenomas, and 12 carcinomas. After a galactosepalmitic acid contrast agent was injected, lesions were scanned by contrast-enhanced harmonic gray scale ultrasonography in 2 phases: early vascular and late vascular. RESULTS: None of the biliary sludge lesions (n = 12) showed either tumor vessels or tumor enhancement. Lesions showing tumor vessels and tumor enhancement on contrast-enhanced harmonic gray scale ultrasonography were diagnosed as cholesterol polyp, inflammatory polyp, adenoma, or carcinoma. Three (38%) of the 8 cholesterol polyps showed dotted-type tumor vessels. Branched-type tumor vessels were observed in 5 (62%) of the 8 cholesterol polyps, the 1 (100%) inflammatory polyp, both (100%) adenomas, and 3 (25%) of the 12 carcinomas. Tortuous-type tumor vessels were observed in 9 (75%) of the 12 carcinomas. Lesions with tumor enhancement and tortuous-type tumor vessels on contrast-enhanced harmonic gray scale ultrasonography were diagnosed as carcinomas, and the sensitivity, specificity, and accuracy of this diagnosis with the current modality were 75% (9/12), 100% (23/23), and 91% (32/35), respectively. CONCLUSIONS: Evaluation of tumor vessels on contrast-enhanced harmonic gray scale ultrasonography may be a useful modality for differentiating gallbladder carcinoma from other polypoid gallbladder disease lesions.     

超声造影在胆囊息肉样病变鉴别诊断中的应用价值

目的比较各种类型胆囊息肉样病变超声造影表现,探讨超声造影在胆囊息肉样病变鉴别诊断中的应用价值。方法回顾性分析2007年5月至2012年11月上海市第十人民医院经手术病理证实的112例胆囊息肉样病变患者超声造影表现,包括胆囊癌18例、胆囊腺瘤20例、胆囊胆固醇性息肉及炎性息肉63例、胆囊腺肌增生症6例、胆泥5例。记录各种类型胆囊息肉样病变病灶大小、病灶增强时间、增强水平、血管形态、病变邻近胆囊壁层次结构的完整性及病变的基底部特征。各病变病灶直径、超声造影增强时间比较应用单因素方差分析,进一步组间两两比较应用LSD-t,检验。结果胆囊癌病灶直径大于其他各病变,且差异均有统计学意义（,值分别为1．474、8．553、3．984、1．362、3．488,P均〈0．05）。胆囊癌、胆囊腺瘤、胆囊胆固醇性及胆囊炎性息肉、胆囊腺肌增生症超声造影多表现为早期高增强及晚期低增强模式,而胆泥超声造影增强早期及晚期均表现为无增强。胆囊癌开始增强时间均晚于胆囊腺瘤及胆固醇性息肉,且差异均有统计学意义（t值分别为2．321、2．219,P均〈0．05）,其余各病变开始增强时间差异无统计学意义;胆囊癌组达峰时间均晚于其他各病变,且差异均有统计学意义（t值分别为3．562、4．588、2．004、12．361,P均〈0．05）;胆囊癌、胆囊腺瘤增强变等时间均晚于胆固醇性息肉,且差异均有统计学意义（t值分别为5．407、2．924,P均〈0．05）;胆囊腺瘤增强变低时间均晚于其他各病变,且差异均有统计学意义（t值分别为3．109、6．342、1．811、6．012,P均〈0．05）。与胆囊良性息肉样病变比较,胆囊癌患者均为宽基底,胆囊壁结构不完整,层次不清晰。结论超声造影是胆囊息肉样病变常规超声检查的重要补充,综合分析其增强模式、增强时间及胆囊壁形态学改变指标有助于胆囊癌与胆囊良性息肉样病变的鉴别诊断。     

Differential diagnosis of gallbladder polypoid lesions using contrast-enhanced ultrasound

Abdominal Radiology - The purpose of the study is to evaluate the utility of contrast-enhanced ultrasound (CEUS) for the differential diagnosis of gallbladder polypoid lesions (GPLs). Thirty-six...     

Comparison of three- and two-dimensional sonography in diagnosis of gallbladder diseases: preliminary experience.

OBJECTIVE: To compare three-dimensional sonography with two-dimensional sonography for diagnosis of gallbladder diseases. METHODS: Sixty-three patients with gallbladder diseases were examined with two- and three-dimensional sonography. The morphologic features presented on both modalities were analyzed, and the diagnostic accuracies of both modalities were evaluated and compared. RESULTS: Both two- and three-dimensional sonography facilitated correct diagnosis in all patients with gallstones. Three-dimensional sonography had no influence on the diagnosis of gallstones compared with two-dimensional sonography. Three-dimensional sonography showed the granular surfaces in 18 (81.8%) of 22 cases of polypoid lesions and the pedunculated fundus in 19 (86.4%) of 22, whereas two-dimensional sonography displayed them in 10 (45.5%) and 3 (13.6%) of 22, respectively (P < .05 and .001). Three- and two-dimensional sonography made correct differential diagnoses between non-neoplastic and neoplastic polyps in 20 (90.9%) and 12 (54.5%) of 22, respectively (P < .05). In gallbladder carcinoma, both three- and two-dimensional sonography accurately showed all the associated gallstones and intrahepatic bile duct dilatation. Two-dimensional sonography could not correctly define the locations of the lesions in 2 (28.6%) and tumor extension in 1 (14.3%) of 7 cases with pathologically proved gallbladder cancer, whereas three-dimensional sonography improved the diagnosis in these cases. CONCLUSIONS: Three-dimensional sonography adds no advantages for diagnosis of gallstones compared with two-dimensional sonography, but it is better than two-dimensional sonography for differential diagnosis of gallbladder polyps and may improve the localization and staging for gallbladder carcinoma; however, additional studies are needed for further determination.     

A useful approach to the differential diagnosis of small polypoid lesions of the gallbladder,utilizing an endoscopic ultrasound scoring system

BACKGROUND AND STUDY AIMS: The purpose of this study was to assess the accuracy of endoscopic ultrasonography (EUS) in making a differential diagnosis of small (< or = 20 mm in diameter) polypoid lesions of the gallbladder, and to construct an EUS scoring system. PATIENTS AND METHODS: The EUS findings were retrospectively analyzed in 70 surgical cases of small polypoid lesions classified into two groups: neoplastic (adenocarcinoma in 11, and adenoma in 7), and non-neoplastic (cholesterol polyp in 44, inflammatory polyp in 7 and fibrous polyp in 1). The EUS variables were the maximum diameter and height/width ratio of the largest polyps, echo level, internal echo pattern, surface patterns, number and shape of polyps, presence of hyperechoic spotting, complication of gallbladder stones. The EUS data were used for the construction of an EUS scoring system to ascertain the risk of neoplasia. RESULTS: Three EUS variables, i. e. tumor maximum size, internal echo pattern, and hyperechoic spotting were statistically significant according to multivariate analysis using stepwise logistic regression models (P < 0.01, P < 0.05, and P < 0.01, respectively). The total EUS score based on the coefficient of multivariate analysis was as follows: (maximum diameter in mm) + (internal echo pattern score; where heterogeneous = 4, homogeneous = 0) + (hyperechoic spot[s] score; where presence = - 5, absence = 0). According to our EUS scoring system, the sensitivity, specificity, and accuracy for the risk of neoplastic polyps with scores of 12 or higher were 77.8 %, 82.7 % and 82.9 %, respectively. CONCLUSIONS: The EUS scoring system will be a useful means of differentiating between neoplastic and non-neoplastic polyps of the gallbladder.     

胆道疾病的影像检查(附486例报告)

目的 评价各种影像检查方法在胆道疾病诊断中的价值。方法 回顾性复习486例经手术病理证实的胆道疾病影像资料,分析各检查方法的优势和局限性。结果 26例胆囊内阴性结石在传统造影中显示清楚。胆道直接造影能清楚显示胆道解剖形态及病因。B超和CT对胆道结石诊断阳性准确率为91.3%和90.3%,13例泥沙样胆石CT漏诊。超声诊断慢性胆囊炎和胆囊息肉符合率达100％和93.3%。MRCP的“胆管树”有助于肝门胆管癌的确诊。结论 传统造影法能较好显示胆囊阴性结石,胆道直接造影为定性诊断提供重要依据。B超和CT显示胆道结石优于其他方法。超声是慢性胆囊炎和息肉样病变最好检查方法。MRCP是诊断重度胆道梗阻的理想影像手段。     

胆囊息肉样病变超声显像与病理对照研究

本文分析我院手术治疗的胆囊息肉样病变３５例病理诊断结果，其中胆固醇性息肉２５例，乳头状腺瘤３例，单纯性脉瘤２列，上皮乳头样增生１例，上皮腺瘤样增生１例，粘膜腺瘤局限性癌变１例，慢性胆囊炎２例，超声与病理诊断符合率的９４．３％，探讨了不同类型胆囊息肉样病变的声像图特征。