超声造影诊断甲状腺乳头状癌可行性研究

目的:探讨超声造影(CEUS)诊断甲状腺乳头状癌(PTC)的可行性。方法:对51例超声疑似PTC的患者,术前经灰阶及CDFI检查后行CEUS检查,动态观察微泡在病灶灌注的全过程、灌注模式及边缘灌注情况。结果:PTC结节大小与超声造影表现有显著相关性(P<0.001),始增时间、峰值时间在正常甲状腺组织与PTC组织有显著差异(P<0.001),但边缘增强和消退时间并无此发现(P>0.05)。结论:灌注缺损、淡淡弱灌注及不均匀增强三种灌注模式在一定程度上提示PTC,较常规灰阶超声能更早、更敏感地评价PTC乏血供灌注特征。     

常规超声及超声造影对甲状腺囊性乳头状癌的诊断价值

目的：探究常规超声及超声造影对甲状腺囊性乳头状癌(囊性亚型)的诊断价值。方法：回顾69例囊性亚型及300例甲状腺经典型乳头状癌(经典亚型)的常规超声、CEUS特征,并对时间 强度曲线定量参数进行分析。结果：囊性亚型与经典亚型的最大径、边界、形态、纵横比、实性成分回声、钙化灶、Adler血流分级、CEUS微血管灌注特征的差异有统计学意义(P＜0.05)。ＴIC参数峰值强度、曲线下面积和上升斜率的差异无统计学意义(P＞0.05),参数达峰时间、上升时间、峰值强度减半时间和造影剂平均渡越时间的差异有统计学意义(P＜0.05)。结论：在常规超声的基础上,结合CEUS的灌注特征和ＴIC定量参数,可以为甲状腺囊性乳头状癌的诊断提供更多有价值的信息。     

超声造影在甲状腺微小乳头状癌诊断中的应用价值分析

目的探讨超声造影在甲状腺微小乳头状癌(PTMC)诊断中的应用价值。方法选取甲状腺小结节患者70例,共计88个结节,分析各结节超声造影特征。结果88个结节中,PTMC共计54个,良性结节34个,PTMC与良性结节直径比较,差异无统计学意义(P>0.05)。PTMC结节增强时间慢进、低/等增强、增强后大小改变和边界不清的比例均明显高于良性结节,而环状增强比例明显低于良性结节,差异均有统计学意义(P<0.01)。PTMC结节PEAK、SImax、SImean均明显低于良性结节,差异均有统计学意义(P<0.01)。结论超声造影在PTMC诊断中有较好的应用价值,可提供影像征像及定量参数以便诊断。     

超声造影不均匀低增强对甲状腺乳头状癌的诊断价值

目的:探讨超声造影（CEUS）不均匀低增强对甲状腺乳头状癌的诊断价值。方法:选取2015年2月至2017年2月于延安大学附属医院行甲状腺手术并于术前行超声造影检查的患者,回顾性分析,将增强模式表现进行分类,并与病理结果进行对照。结果:72例患者共74个结节。不均匀低增强43个结节,其中31个乳头状癌,9个结节性甲状腺肿,2个桥本氏甲状腺炎,1个髓样癌;超声造影不均匀低增强诊断甲状腺乳头状癌的敏感性、特异性及准确率分别为86.11%(31/36)、68.42%(26/38)和77.03%(57/74)。结论:超声造影诊断甲状腺乳头状癌具有其独特的优势,但是仅仅依靠“不均匀低增强”诊断PTC存在较高的误诊率,所以诊断过程中还应注意结节增强后的边界、形态及甲状腺包膜完整性等观察指标。     

超声造影联合弹性成像在甲状腺微小乳头状癌诊断中的应用研究

目的 探讨超声造影联合弹性成像在甲状腺微小乳头状癌诊断中的应用价值.方法 选取甲状腺微小乳头状癌患者59例,共85个结节.分别对患者行超声造影、弹性成像及超声造影联合弹性成像检查.以病理诊断为"金标准",比较超声造影、弹性成像及二者联合诊断甲状腺微小乳头状癌的准确度、敏感度、特异度、阳性预测值及阴性预测值.结果 恶性结节超声造影增强模式的各项指标与良性结节比较,差异均无统计学意义(P﹥0.05);超声造影联合弹性成像诊断甲状腺微小乳头状癌的敏感度、特异度、阳性预测值及阴性预测值均高于超声造影、弹性成像单独检测,但差异无统计学意义(P﹥0.05);超声造影联合弹性成像诊断甲状腺微小乳头状癌的准确度为95.29%,高于超声造影的81.18%及弹性成像的83.53%,差异有统计学意义(P﹤0.05).结论 采用超声造影联合弹性成像对甲状腺微小乳头状癌进行诊断,可显著提高诊断的准确度,减少误诊、漏诊的发生,具有临床推广意义.     

甲状腺微小乳头状癌的超声诊断进展

甲状腺微小乳头状癌(PTMC)近年来的发病率逐渐增高.由于高频超声的广泛应用和空间分辨率的提高,且具有无创和重复性好的特点,超声(US)是目前对甲状腺疾病筛查首选的影像学方法,特别是对PTMC.全文简述PTMC常见超声表现的病理学基础,重点阐述了PTMC在常规超声中的表现及一些利于诊断PTMC的超声新技术.     

常规超声联合超声造影鉴别甲状腺结节良恶性的价值

目的 探讨常规超声联合超声造影技术鉴别甲状腺良恶性结节的价值.方法 对62例患者的75个甲状腺低回声结节进行常规超声及超声造影检查,测量结节大小,观察结节形态、边界、位置、有无微小钙化、血流情况及超声造影检查结果.结果 甲状腺结节内部具有多发微小钙化低回声结节13个,形态不规则低回声结节69个,边界不清晰低回声结节69个,结节邻近包膜浸润11个.造影后37个低回声结节呈无增强,38个低回声结节呈低增强,28个低回声结节体积变小.经常规超声检查诊断甲状腺恶性结节65个,经超声造影检查诊断甲状腺恶性结节64个,术后病理证实甲状腺乳头状癌62个,结节性甲状腺肿13个.常规超声联合超声造影诊断甲状腺恶性结节64个,灵敏度为100％,特异度为84.6％,Kappa=0.901.结论 常规超声联合超声造影有助于提高对甲状腺恶性结节的诊断能力.     

增强与常规超声对甲状腺乳头状癌患者颈部淋巴结转移的预测价值

目的 探究增强与常规超声对甲状腺乳头状癌患者颈部淋巴结转移的预测价值.方法 选择经病理确诊的128例甲状腺乳头状癌患者,分别对其实施超声与增强超声检测,以病理学检查结果为金标准(颈部淋巴结转移者56例,未转移者72例),分析2种检测方式对甲状腺乳头癌患者是否出现颈部淋巴结转移检测的一致性、灵敏度、特异度、阳性预测值和阴...     

彩色多普勒超声对甲状腺乳头状癌的诊断价值分析

目的 探讨彩色多普勒超声对甲状腺乳头状癌（PTC）的诊断价值。方法 对经手术病理证实的115例PTC及129例甲状腺良性肿瘤的超声图像特征进行比较分析,采用χ²检验与Logistic回归分析影响诊断PTC的因素。结果 彩色多普勒超声诊断PTC的准确性为82.07％,特异性为86.75％,其中边缘及回声的敏感度为87.20％和84.80％,纵横比、微小钙化的特异度为92.59％和86.75％。单因素分析显示,形态、边界、回声、微小钙化等结节超声特征是对鉴别诊断PTC有意义的特征变量;Logistic回归多因素分析显示,回声（OR=3.13,95%CI：1.58～6.19）和微小钙化（OR=2.03,95%CI：1.19～3.48）是诊断PTC的独立预测因素。结论 彩色多普勒超声特征中的回声和微小钙化两项指标有助于提高诊断PTC的准确率。     

甲状腺乳头状癌超声造影的定量分析

超声造影是目前超声医学研究的热门课题,其对肝脏肿瘤的良恶性鉴别已比较成熟,但在甲状腺癌的诊断和鉴别中的应用目前尚处于探索阶段。回顾我院20例临床怀疑为甲状腺乳头状癌患者的超声造影检查,对其超声造影     

超声造影对乳腺 BI-RADS 4类结节鉴别诊断价值

目的:研究超声造影对乳腺 BI-RADS 4类结节良恶性的鉴别诊断价值。方法:回顾性分析本院60例乳腺 BI-RADS 4类结节常规超声及超声造影检查资料,观察乳腺超声造影增强模式,分析良恶性结节之间超声造影增强特征的差异,并与穿刺活检或术后病理结果对照。结果:乳腺良恶性结节超声造影增强过程中其增强强度、增强时间、增强完整性方面有显著性差异（P<0.05）,但在超声造影增强过程中增强顺序、增强均匀性方面尚未发现有显著差异（P>0.05）。常规超声 BI-RADS对乳腺良恶性结节诊断效能的的灵敏度、特异度、阳性预测值、阴性预测值分别为81.8%（18/22)、73.7%(28/38)、64%(18/28)和87.5%（28/32）,超声造影判断乳腺 US BI-RADS 4类结节良恶性的灵敏度、特异度、阳性预测值、阴性预测值分别为90.9%(20/22)、86.8%(33/38)、88.0%(22/25)和94.3%（33/35）。超声造影对乳腺良恶性结节的诊断价值与病理结果的Kappa 值为0.75,具有较好的一致性。结论:乳腺超声造影不同增强特征对乳腺 BI-RADS 4类结节良恶性判断有较高的准确性,在指导临床治疗策略方面具有明确的应用价值。     

超声造影与增强CT在评价肝癌行TACE后疗效的对照研究

目的:通过超声造影与增强CT在肝癌行肝动脉化疗栓塞术（TACE）后的影像对照研究,探讨超声造影在肝癌TACE后评估中临床价值。方法:对42例行TACE后的原发性肝癌患者,术后一个月分别行超声造影、增强CT检查,之后行DSA检查,有未栓塞完全病灶再次行TACE,之后将二者的检查结果与术中DSA结果进行对照研究,分析超声造影的特征。结果:行DSA造影后,41名患者行TACE,1名患者未行TACE。而增强CT示36例患者的病灶栓塞不完全,有强化表现,需要再次行TACE,敏感度为87.8%,特异度为100%,阳性预测值为100%,阴性预测值为16.7%,准确度为88.1%。超声造影示40例患者病灶栓塞不完全,有强化表现,需要再次进行TACE,敏感度为97.6%,特异度为100%,阳性预测值为100%,阴性预测值为50%,准确度为97.6%。两组检查结果无统计学差异(P＞0.05)。结论:超声造影检查结果的准确度高于增强CT检查结果,接近DSA检查结果,可以应用于肝癌行TACE后的评价。     

甲状腺乳头状癌声像图特征探讨

目的：评价甲状腺乳头状癌（papillary thyroid carcinoma,PTC）的声像图特点。方法：回顾性分析34例经手术和病理证实的PTC彩色多普勒超声图像特点。结果：32例（94.1%）低回声,30例（88.2%）结节纵/横≥1,26例（76.5%）伴细微钙化,23例（67.6%）毛剌边缘,29例（85.3%）结节单发,20例（58.8%）边界不清晰,14例（41.2%）侧后方声影,6例（17.6%）检出血流信号,8例（23.5%）颈淋巴结肿大。出现上述异常声像图特征2项以上者占73.5%（25/34）。结论：低回声、微钙化、纵/横≥1、边界、毛剌是PTC具有特征性的超声表现。     

甲状腺乳头状癌声像图特征探讨

目的:评价甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的声像图特点。方法:回顾性分析34例经手术和病理证实的PTC彩色多普勒超声图像特点。结果:32例(94.1%)低回声,30例(88.2%)结节纵/横≥1,26例(76.5%)伴细微钙化,23例(67.6%)毛剌边缘,29例(85.3%)结节单发,20例(58.8%)边界不清晰,14例(41.2%)侧后方声影,6例(17.6%)检出血流信号,8例(23.5%)颈淋巴结肿大。出现上述异常声像图特征2项以上者占73.5%(25/34)。结论:低回声、微钙化、纵/横≥1、边界、毛剌是PTC具有特征性的超声表现。     

Role of contrast enhanced ultrasound in radiofrequency ablation of metastatic liver carcinoma

Objective:To investigate the application of contrast enhanced ultrasound(CEUS) in planning and guiding for radiofrequency ablation(RFA) for metastatic liver carcinoma(MLC).Methods:One hundred and thirty-five patients with clinically and pathologically diagnosed MLC(from gastrointestinal tumors) were included in the present study,and 104 of them had received CEUS prior to RFA to assess the number,size,shape,infiltration,location and enhancing features of the lesions.Among the 104 patients,21(20.1%) were excluded from RFA treatment due to too many lesions or large infiltrative range based on CEUS.The remaining 83 patients with 147 lesions underwent RFA(group A).During the same period,other 31 patients with 102 lesions serving as control group were treated based on findings of conventional ultrasound without contrast(group B).The patients underwent follow-up enhanced CT at the 1st month,and then every 3-6 months after RFA.The tumor was considered as early necrosis if no contrast enhancement was detected in the treated area on the CT scan at the 1st month.Results:In group A,72 of 147 MLC lesions(48.9%) showed increased sizes on CEUS.Among them,48 lesions(66.6%) appeared enlarged in arterial phase,and 24(33.3%) showed enlarged hypoechoic area in parenchymal phase.CEUS showed total 61 additional lesions in 35 patients(42.1%)(ranged from 8 to 15 mm) compared with conventional ultrasound(US),and 42(68.8%) of them were visualized in parenchymal phase only.There were total 208 lesions in group A underwent RFA with CEUS planning,and the tumor necrosis rate was 94.2%(196/208).In this group,local recurrence was found in 16 lesions(7.7%) during 3-42 months’ following up,and new metastases were seen in 30 cases(36.1%).For group B,the tumor necrosis rate was 86.3%(88/102),local recurrence in 17 lesions(16.7%),and new metastases in 13 cases(41.9%).Tumor early necrosis and recurrence rates were significantly different between the two groups(P=0.018,P=0.016,respectively).Conclusion: CEUS played an important role in RFA for liver metastases by candidate selecting and therapy planning, which helped to improve the outcome of the treatment.     

Serum-plasma matched metabolomics for comprehensive characterization of benign thyroid nodule and papillary thyroid carcinoma

Metabolomics offers a noninvasive methodology to identify metabolic markers for pathogenesis and diagnosis of diseases. This work aimed to characterize circulating metabolic signatures of benign thyroid nodule (BTN) and papillary thyroid carcinoma (PTC) via serum-plasma matched metabolomics. A cohort of 1,540 serum-plasma matched samples and 114 tissues were obtained from healthy volunteers, BTN and PTC patients enrolled from 6 independent centers. Untargeted metabolomics was determined by liquid chromatography-quadrupole time-of-flight mass spectrometric and multivariate statistical analyses. The use of serum-plasma matched samples afforded a broad-scope detection of 1,570 metabolic features. Metabolic phenotypes revealed significant pattern differences for healthy versus BTN and healthy versus PTC. Perturbed metabolic pathways related mainly to amino acid and lipid metabolism. It is worth noting that, BTN and PTC showed no significant differences but rather overlap in circulating metabolic signatures, and this observation was replicated in all study centers. For differential diagnosis of healthy versus thyroid nodules (BTN + PTC), a panel of 6 metabolic markers, namely myo-inositol, α-N-phenylacetyl-L-glutamine, proline betaine, L-glutamic acid, LysoPC(18:0) and LysoPC(18:1) provided area under the curve of 97.68% in the discovery phase and predictive accuracies of 84.78–98.18% in the 4 validation centers. Taken together, serum-plasma matched metabolomics showed significant differences in circulating metabolites for healthy versus nodules but not for BTN versus PTC. Our results highlight the true metabolic nature of thyroid nodules, and potentially decrease overtreatment that exposes patients to unnecessary risks.     

甲状腺腺瘤和结节性甲状腺肿Ang-1的表达及其与超声造影定量参数的关系

目的:研究甲状腺腺瘤和结节性甲状腺肿中血管生成素-1(angiopoietin-1,Ang-1)的表达情况,并探讨其与超声造影的相关性.方法:回顾性分析40例甲状腺腺瘤和40例结节性甲状腺肿患者的超声造影检查结果,根据时间强度曲线获得造影参数.术后标本用Western blot方法检测其Ang-1表达情况,并与超声造影指标进行相关性分析.结果:40例甲状腺腺瘤36例造影后肿块与周围甲状腺表现为高增强,4例为等增强.其中34例肿块内部增强均匀.40例结节性甲状腺肿患者中30例造影后结节与周围甲状腺实质等增强,6例出现高增强,4例为低增强,其中14例患者肿块内部回声不均匀.甲状腺腺瘤组mTT、IMAX 大于结节性甲状腺肿组(P<0.05);甲状腺腺瘤较结节性甲状腺肿Ang-1表达明显升高(P<0.01).Ang-1表达水平与RT、TTP、mTT呈负相关(P<0.05),与IMAX呈正相关(P<0.05).结论:Ang-1在甲状腺腺瘤中的表达水平高于结节性甲状腺肿,并与超声造影指标存在相关性,超声造影可为二者的诊断及预后提供依据.