乳腺肿块的高频图象特征及彩色多普勒诊断与病理分析

目的探讨良恶性乳腺肿块的高频图象特征及彩色多普勒血流状况及病理学基础。方法 98例经手术证实的乳腺肿块的高频声像图与病理结果进行了回顾性分析。结果乳腺肿块的高频声像图表现,如肿块边界、内部回声、钙化、衰减以及彩色多普勒检出血流的表现,均与病理改变有一定关系。结论高频超声和彩色多普勒结合病理学基础诊断乳腺良恶性肿瘤符合率较高,具有较大的诊断价值。     

CDFI在甲状腺疾病诊断中的临床应用价值探讨

目的探讨CDFI在甲状腺疾病诊断中的临床应用价值。方法笔者所在医院2006年1月～2010年6月应用CDFI检查甲状腺疾病132例,总结分析常见的甲状腺疾病如甲状腺腺瘤、甲状腺囊腺瘤、结节性甲状腺肿、甲状腺癌、甲状腺功能亢进症、亚急性甲状腺炎、桥本甲状腺炎的超声声像图表现及CDFI显示情况。结果 132例中经病理或实验室确诊124例,超声诊断符合率93.9%。甲状腺腺瘤、甲状腺囊腺瘤、结节性甲状腺肿、甲状腺癌、甲状腺功能亢进症、亚急性甲状腺炎、桥本甲状腺炎的超声声像图表现及CDFI显示各具特点。结论 CDFI能清晰显示甲状腺病变的大小、位置、囊实性变等,彩色多普勒超声及CDFI的应用提高了对甲状腺疾病的诊断率。     

彩色多普勒超声在小结节甲状腺癌诊断中的应用价值

目的:探讨彩色多普勒超声(color Doppler ultrasonic,CDFI)对小结节甲状腺癌的临床诊断价值.方法:回顾性分析28例小结节甲状腺癌和30例结节性甲状腺肿患者的二维超声图像与CDFI检查表现,并与手术或病理结果进行比较.结果:二维超声图像及CDFI的诊断小结节甲状腺癌的符合率分别为58.6％和84.5％,差异均有统计学意义(P＜0.05).小结节甲状腺癌主要表现为边界模糊(73.5％)、低回声(64.7％)、内部可见来见微小钙化(76.5％)及2级血流信号为主(70.6％),良恶性结节的CDFI表现差异有统计学意义(P＜0.05).结论:在二维超声图像的基础上联合CDFI可作为小结节甲状腺癌与结节性甲状腺肿诊断和鉴别诊断的首选方法之一,具有较高的临床应用价值.     

高频彩色多普勒血流显像诊断乳腺恶性肿瘤

目的探讨高频彩色多普勒血流显像（CDFI）在乳腺恶性肿瘤诊断的临床应用。方法回顾60例在我院手术治疗的乳腺恶性肿瘤的CDFI高频超声声像图特征,并与手术、术后病理结果对照。结果乳腺恶性肿瘤在形态、边缘、包膜、内部回声、后方回声、纵横比具有特异性,乳腺恶性肿瘤内及周边血流信号丰富,肿瘤内部出现粗大彩色血流信号。结论高频彩色多普勒超声是一种对乳腺恶性肿瘤的诊断具有重要的临床应用价值的无创伤性检查方法。     

乳腺结节的超声声像图表现与病理结果的对比分析

目的通过对比分析乳腺结节的超声图像表现与病理诊断结果 ,以提高超声对乳腺结节的定性诊断。方法回顾性分析2017年1月至2017年12月在本院诊治的198例超声检查提示乳腺结节的患者的临床资料,对比分析超声声像图表现及其病理结果。结果在198例患者中共286个乳腺结节,超声提示乳腺良性结节246个,其中乳腺腺病145个,乳腺腺病伴纤维腺瘤30个,乳腺纤维瘤52个,肉芽肿性乳腺炎9个,导管内乳头状瘤10个;提示恶性结节40个。穿刺活检或手术病理结果为良性结节239个,其中乳腺腺病150个,乳腺腺病伴纤维腺瘤34个,乳腺纤维腺瘤40个,肉芽肿性乳腺炎7个,导管内乳头状瘤8个;恶性结节47个。超声对乳腺良性结节的定性诊断的符合率为97.2%,对恶性结节诊断符合率85.1%。良性乳腺结节超声表现为形态规则,边界清,可有包膜,内部回声较均匀,后方回声无衰减或轻度增强,纵横比多小于1,少见钙化或见粗大钙化,彩色多普勒血流以0～Ⅰ级为主,RI多数小于0.7;恶性结节形态不规则,无包膜,边界不清,边缘呈"毛刺样"或"蟹足样",纵横比≥1,周边可见高回声晕,内部回声不均匀,可见"砂粒样"微小钙化,后方回声衰减较明显,彩色多普勒血流以Ⅱ～Ⅲ级为主,RI多数大于0.7,腋窝可见淋巴结转移。结论超声对乳腺结节的定性诊断与病理诊断具有较高的符合率,能为临床制定治疗方案提供了重要的参考依据。     

高频彩色多普勒超声诊断甲状腺癌的声像图特征分析

目的观察应用高频彩色多普勒超声诊断甲状腺癌的声像图特征,分析高频彩色多普勒超声对诊断甲状腺癌的应用价值。方法对笔者所在医院2008年4月～2010年12月应用高频彩色多普勒超声诊断甲状腺癌的声像图特征进行总结分析。结果甲状腺癌以乳头状癌最多见,其彩色多普勒超声的声像图特征主要表现为彤态不规则、边界清晰的低同声,内部多有钙化,以砂砾样钙化为多见,部分病例后方回声有衰减,含纤维组织越多的病灶,衰减越明显,病灶纵横比接近1：1,血流信号没有特点。滤泡状癌为低回声,多有完整包膜,边缘欠规整,血流多丰富。木分化癌与髓样癌体积较大,回声不均,无包膜,未分化癌常有坏死液化及钙化,髓样癌可有钙化。结论高频彩色多普勒超声的广泛应用为甲状腺癌的诊断及鉴别诊断提供了可靠的依据。     

高频彩色多普勒超声在白线疝诊断中的应用

目的探讨研究高频彩色多普勒超声在白线疝诊断中的应用价值。 方法回顾性分析2007年1月至2014年12月解放军总医院24例经外科手术证实为白线疝患者的临床资料和声像图表现。 结果术前高频彩色多普勒超声检查发现，疝的发生部位均位于剑突与脐孔之间的腹壁中线处，腹白线缺损处（疝环）直径0.4～2.8 cm，疝囊大小（1.1 cm×0.3 cm×1.0 cm）～（8.0 cm×3.1 cm×7.2 cm），疝囊形态多不规则，疝囊内回声因内容物不同而表现不同，主要分为3类，第1类内容物为腹膜外脂肪，声像图表现为较均匀或不均匀的低回声，第2类内容物主要为网膜，声像图表现为中等稍低回声，第3类内容物主要为肠管，声像图表现为疝囊内可见肠管样回声，动态观察并可见其蠕动。 结论高频彩色多普勒超声可以清楚地显示腹白线的连续性情况、测量缺损的直径、疝囊的大小、判断疝的内容物以及有无嵌顿疝等情况，并具备无损伤、廉价、可重复性好、可动态观察等优势，对于白线疝的诊断有很好的敏感性和特异性，因此对白线疝的临床诊断具有非常重要的价值。     

结节性甲状腺肿伴瘢痕形成与甲状腺微小乳头状癌的超声鉴别诊断

目的:探讨结节性甲状腺肿伴瘢痕形成与甲状腺微小乳头状癌的超声声像图特征。方法:比较我院2017年2月—2018年2月收治的52例结节性甲状腺肿伴瘢痕形成患者与48例甲状腺微小乳头状癌患者临床资料。所有患者均采用超声诊断,评估结节的构成、回声、形状、边缘及局灶性强回声。结果:两组在结节单/多发、边界、回声、形态及钙化、血流分级上均存在显著差异(P0.05)。甲状腺微小乳头状癌患者检查区域血流分级Ⅱ级发生率、颈动脉收缩期最大流速(PSV)、阻力指数(RI)均较结节性甲状腺肿伴瘢痕形成患者高(P0.05)。结论:结节性甲状腺肿伴瘢痕形成与甲状腺微小乳头状癌鉴别较困难,临床需结合多种超声指标进行综合诊断,方能减少误诊、漏诊发生率。     

25例卵巢甲状腺肿的超声声像图分析

目的探讨卵巢甲状腺肿的声像图表现。方法回顾性分析经手术病理证实的25例卵巢甲状腺肿患者的临床病理资料以及超声声像图表现。结果 25例卵巢甲状腺肿超声声像图表现为单房囊性3例;多房囊性11例;9例囊性内有实性成分,其中多房6例,单房3例,6例内有＂甲状腺肿突起＂;实性2例。结论卵巢甲状腺肿超声声像图表现以单房、多房囊性或囊性内有实性成分为主,声像图特点不典型,术前诊断较困难。     

TI-RADS 4类甲状腺良性结节的超声声像图特征与病理特征分析

目的总结甲状腺影像报告和数据系统(TI-RADS)4类甲状腺良性结节的超声声像图特征及病理学特征。方法回顾性分析2016年6月至2017年6月期间于南京中医药大学附属医院行超声检查示TI-RADS 4类的46例甲状腺良性结节患者、共计52个结节的术前超声声像图特征及术后病理学特征。结果 52个TI-RADS 4类结节中,4A类32个(61.54%),4B类12个(23.08%),4C类8个(15.38%);超声声像图主要表现为低回声(90.38%)、实性或实性为主(98.08%)、直径1 cm(61.54%)、边界(尚)清(63.46%)、微钙化(50.00%)、较丰富/点条状血流(65.39%)、边缘规则(90.38%)、纵横比≤1(92.31%)及无可疑淋巴结(86.54%)。术后病理学检查提示结节性甲状腺肿伴纤维化/钙化20个(38.46%),结节性甲状腺肿伴腺瘤形成16个(30.77%),结节性甲状腺肿5个(9.61%),桥本甲状腺炎9个(17.31%),甲状腺滤泡性腺瘤2个(3.85%)。结论结节性甲状腺肿(伴纤维化/钙化或伴腺瘤形成)、桥本甲状腺炎以及甲状腺滤泡性腺瘤行超声检查时可具有甲状腺癌的声像图特征,临床需结合其他检查方法进行综合评估。     

Color Doppler sonography in cold thyroid nodules for malignancy prediction

The aim of the present study was to assess the usefulness of thyroid nuclear medicine studies, fine needle aspiration biopsy (FNAB) and color doppler sonography in the evaluation of thyroid nodules. Our study group consists of 81 patients with a solitary hypoactive thyroid nodule or with multinodular goiter having dominant nodule. Perinodular and intranodular blood flow, diameter of inferior thyroid artery and its flow velocity were the parameters measured by color doppler sonography. Also estimation of arterio-venous (A-V) shunt formation was another important parameter indicating the angioneogenesis. Results were not significant to distinguish the malignant and benign thyroid nodules (p > 0.05); 66% (n: 14) of 21 patients who had A-V shunt, had the final diagnosis of thyroid carcinoma. These data revealed sensitivity, specificity, negative and positive predictive values of color doppler sonography in carcinoma diagnosis among the patients with solitary hypoactive nodules or multinodular goiters having dominant nodule, as corresponding: 66%, 100%, 83% and 100%. In conclusion, arterio-venous shunt detected with color doppler sonography was the only parameter having high predictive value for malignancy. Recent studies on this topic imply that color doppler sonography will take place in algorithm of thyroid nodule evaluation.     

彩色多普勒在甲状腺结节诊断中的应用

目的:评估彩色多普勒在甲状腺结节诊断中的应用价值。方法:选取术后病理证实的结节性甲状腺肿150例和甲状腺癌151例,回顾性分析其术前超声图像特征。结果:150例结节性甲状腺肿与151例甲状腺癌的超声图像在结节数量、有无沙砾样钙化、内部回声、血流分布方面有统计学差异(P0.05),而在边界是否清晰方面无统计学意义(P0.05)。甲状腺恶性结节在结节数量、边界是否清晰、有无沙砾样钙化、内部回声、血流分布方面的相对危险度分别为11.78、0.72、12.20、58.90、41.53。结论:应用彩色多普勒,可以对结节良恶性进行鉴别诊断,从而为制定治疗方案提供有价值的信息。     

Color Doppler Sonography in Cold Thyroid Nodules for Malignancy Prediction

The aim of the present study was to assess the usefulness of thyroid nuclear medicine studies, fine needle aspiration biopsy (FNAB) and color doppler sonography in the evaluation of thyroid nodules. Our study group consists of 81 patients with a solitary hypoactive thyroid nodule or with multinodular goiter having dominant nodule. Perinodular and intranodular blood flow, diameter of inferior thyroid artery and its flow velocity were the parameters measured by color doppler sonography. Also estimation of arterio-venous (A-V) shunt formation was another important parameter indicating the angioneogenesis. Results were not significant to distinguish the malignant and benign thyroid nodules (p > 0.05); 66% (n: 14) of 21 patients who had A-V shunt, had the final diagnosis of thyroid carcinoma. These data revealed sensitivity, specificity, negative and positive predictive values of color doppler sonography in carcinoma diagnosis among the patients with solitary hypoactive nodules or multinodular goiters having dominant nodule, as corresponding: 66%, 100%, 83% and 100%.

In conclusion, arterio-venous shunt detected with color doppler sonography was the only parameter having high predictive value for malignancy. Recent studies on this topic imply that color doppler sonography will take place in algorithm of thyroid nodule evaluation.     

经直肠超声造影在外周带前列腺癌诊断中的应用价值

目的探讨经直肠超声造影在外周带区前列腺癌（PCa）诊断中的应用价值。方法对56例经病理证实为前列腺癌患者的超声造影表现进行回顾性分析。观察灰阶超声、彩色多普勒超声特点,以及病灶造影增强模式.用Q-LAB软件对病灶及其周围组织造影参数进行对比分析。结果 56例外周型前列腺癌患者,常规灰阶超声低回声结节42例,高回声结节8例,混合回声结节6例;彩色血流异常丰富38例。前列腺癌超声造影表现以快速高增强为主,45例前列腺癌表现为高增强,8例前列腺癌表现为等增强,3例表现为低增强,同时16例增强病灶内存在无增强区。结论经直肠超声造影检查对前列腺外周带癌的诊断有重要价值。     

Isthmectomy: A Conservative Operation for Solitary Nodule of the Thyroid Isthmus

Purpose : To assess the results obtained in patients with nontoxic uninodular goiter confined to the isthmus undergoing isthmectomy.

Methods : Between April 1994 and June 2006, 330 consecutive patients with nontoxic uninodular goiter underwent thyroidectomy at our institution. In 31 patients, lesions were limited to the thyroid isthmus with evidence of benign or undetermined pathology on ultrasound-guided fine-needle aspiration biopsy. Total isthmectomy was performed. Results : Preoperatively, thyroid nodules on ultrasonography were solid in 26 patients and mixed with cystic and solid components in 2. The mean size of nodules was 2.43 (± 0.88) cm. No intraoperative or postoperative complications occurred. Histological examination showed nodular hyperplasia in 29 cases, follicular adenoma in 1 and papillary thyroid carcinoma in 1. The patient with papillary carcinoma underwent bilateral lobectomy 7 days later. A total of 24 patients (77.4%) attended clinical visits at follow-up (mean 70, 57 months). Ultrasonographic scanning revealed thyroid nodules in 17 patients, in 16 of which nodules range from one to five (0.5 to 2 cm in size) and further surgery was not indicated. One patient with a 4-cm nodule and tracheal displacement found at ultrasonography 2 years after isthmectomy had inconclusive results of FNAB. This patient was re-operated for completion thyroidectomy, which was successfully performed without technical difficulties. The detection of recurrent nodules was independent of the time elapsed since thyroid isthmectomy.

Conclusions : These findings document the feasibility and efficacy of isthmectomy in solitary thyroid nodules confined to the isthmus.     

经直肠彩色超声对前列腺癌诊断分析

目的：经直肠彩超检查,对照病理结果,探讨PCa的彩色多普勒超声表现和特征。方法：对经直肠彩超引导下穿刺活检确诊为PCa的30例患者35个恶性结节和BPH的25例患者42个增生结节的回顾,分析在二维声像图和彩色多普勒血流显像中的不同。结果：PCa结节出现在外周带为主,占86％（30／35）,内部以低回声多见,占88％（31／35）;BPH结节多出现在内腺,占81％（22／42）,内部高低回声均可见。BPH结节和PCa结节血供均增加,但PCa结节比BPH结节血流更丰富,动脉收缩期最高流速峰值、舒张末期血流峰速,加速指数、血流阻力指数明显增高,两者差异有统计学意义（P〈0．05）。结论：经直肠彩超有助于前列腺良恶病变的定性诊断,更有利于穿刺活检的准确定位。     

A case of popliteal cystic degeneration with pathological considerations

Adventitial cystic degeneration of the popliteal artery is seldom encountered; only 39 cases have been reported up to now in Japan. The pathogenesis of this disease remains controversial, and the authors describe a case in which the pathological findings differed from cases reported in the previous literature. The subject was a 74-year-old man admitted to our hospital complaining of intermittent claudication. The characteristic findings of cystic degeneration of the popliteal artery were uncovered by contrast-enhanced computed tomography (CT) and duplex sonography. The contrast-enhanced CT showed a low-density area and duplex sonography revealed a multi-lobulated low-echoic lesion. The Doppler signal of the low-echoic lesion could not be detected. While some cysts were found in the adventitia, they were mainly located in the media. The media also showed a remarkable decrease of smooth muscle cells and a prominent mucinous degeneration that had occurred circumferentially. These findings suggest that the medial degeneration noted had occurred prior to cystic formation. Because of this and other findings, we recommend the use of the termcystic degeneration of the popliteal artery in addition to the termcystic adventitial disease of the popliteal artery.     

腔镜甲状腺次全切除术治疗结节性甲状腺肿72例

目的 探讨腔镜下甲状腺叶次全切除术治疗结节性甲状腺肿的方法及临床意义.方法 2004年6月至2009年12月,西南医院乳腺中心共完成216例腔镜甲状腺手术中,采用腺叶次全切除术治疗结节性甲状腺肿72例,左侧22例,右侧31例,双侧19例.单发结节41例,多发结节31例,共113个结节,结节直径0.4～6.3 cm,平均2.8 cm.结果行双侧甲状腺次全切19例,手术时间80～150 min,平均97 min;单侧次全切53例,手术时间25～120 min,平均65 min.术中出血5～120 ml,平均45 ml.行颈丛加局麻68例,耐受良好66例(97%),全麻4例.术后出现暂时性声音嘶哑2例,穿刺道内出血2例.随访3～5年,医患双方对美容效果均非常满意.1例术后半年复查出现单侧结节复发,复发率为1.4%.结论 经前胸壁入路或经乳房途径腔镜下甲状腺叶次全切除是治疗结节性甲状腺肿的有效方法,局麻加颈丛在大多数病例安全可靠,游离甲状腺时避免直接抓夹甲状腺组织或肿块,采用钝性推、挡法及超声刀的正确使用可有效减少术中出血,提高安全性.     

Fundus microvascular flow monitoring during retrograde cerebral perfusion: an experimental study

BACKGROUND: Retrograde cerebral perfusion (RCP) through the superior vena cava was clinically introduced as a supportive technique to protect the brain during deep hypothermic circulatory arrest. This study searched for a direct monitor of cerebral blood flow to evaluate the effect of cerebral perfusion. METHODS: Retinal microvascular perfusions were studied in six piglets using fundus fluorescein angiography (FFA) and color Doppler sonography before cardiopulmonary bypass and retrograde cerebral perfusion during deep hypothermic circulatory arrest. RESULTS: FFA showed initial filling of the fundus venae in 2.5 minutes, and complete filling in 4.5 minutes with partial filling of the arteriae. Arteriae completely filled in 8 minutes, and all of the arteriae and venae filled from 15 to 17 minutes. Color Doppler sonography showed that flow signals were detected in all of the fundus vessels during RCP. CONCLUSIONS: FFA and color Doppler sonography are direct and sensitive methods for observing cerebral blood flow and assessing the effect of cerebral perfusion.