乳腺单纯性黏液癌的超声诊断及其病理学基础

目的 分析乳腺单纯性黏液癌常规超声声像图与弹性成像特征及其病理学基础,以提高超声诊断准确率. 方法 回顾性分析15例单纯性乳腺黏液癌术前常规超声声像图表现及超声弹性成像参数（弹性图评分、弹性指数及弹性应变比值）,并与术后病理组织学对照. 结果 单纯性乳腺黏液癌不同于其他浸润性乳腺癌的声像图特点为多具有膨胀感,边界清晰,部分向脂肪层突出,呈中等近似脂肪回声,后方回声增强,肿物内部彩色多普勒血流信号不丰富,周边可见血流绕行,缺乏穿入型血流.15例肿块弹性图评分较低为3.2 ±0.77,病灶整体弹性指数为2.91 ±1.03,弹性应变比值为1.88 ±0.41.其病理学特点为癌细胞被大量黏液包绕,黏液间可见稀少的间质纤维分隔. 结论 乳腺黏液癌特殊的病理学特点决定了超声声像图表现及弹性成像特征,正确认识其病理学基础有助于单纯性黏液癌的超声诊断及鉴别诊断.     

三维能量多普勒超声在老年人颈动脉狭窄诊断中的应用价值

目的 探讨三维能量多普勒超声(3D-PDI)在老年人颈动脉狭窄诊断中的应用价值.方法 72例老年高血压、冠状动脉粥样硬化性心脏病、糖尿病、高脂血症经彩色多普勒超声(CDFI)检查诊断为颈动脉狭窄的患者,行自由臂模式3D-PDI检查,测量颈动脉狭窄的情况,并于1周内进行数字减影血管造影(DSA)检查,以DSA为颈动脉狭窄诊断的金标准,对3D-PDI诊断颈动脉狭窄的敏感性、特异性、阳性预测值、阴性预测值等进行分析. 结果 3D-PDI可直观显示狭窄区的立体形状,包括斑块大小、狭窄部位、血管腔大小及血流空间走行等征象.72例85条狭窄颈动脉,CDFI和3D-PD测得的内径狭窄率(分别为(49.2±0.7)oA和(52.3±0.3)%]比较,差异无统计学意义(P>0.05).面积狭窄率[分别为(53.2士0.7)%和(59.3士0.4)%]比较,差异有统计学意义(P<0.01).3D-PDI和CDFI诊断颈动脉轻度、中度和重度狭窄敏感性分别为88.9%、100.0%、100.0%和100.O%、70.4%、58.1%,二者比较,差异有统计学意义(均为P<0.01);3D-PDI对中度和重度狭窄的敏感性好,准确性高,特异性较CDFI低. 结论 3D-PDI判断老年人颈动脉狭窄程度具有较高的敏感性和准确性,与DSA检查的结果较吻合,町作为老年人颈动脉狭窄诊断的重要手段之一.     

超声引导下细针穿刺组织学检查联合细胞块免疫组织化学与粗针组织学检查在浅表淋巴结病变诊断中的对比研究

目的对比分析超声引导下细针穿刺组织学检查联合细胞块免疫组织化学与粗针组织学检查对于诊断浅表淋巴结疾病的临床应用价值。方法选取淋巴结病变患者75例,超声引导下分别采用25G细针及18G活检针穿刺取材,所获得标本分别送细胞学检查结合细胞块免疫组织化学以及组织学检查结合免疫组织化学检测。对两者的诊断结论并结合随访结果进行回顾性分析及对比。结果本组病例细针穿刺取材成功率为93.3%(70/75),粗针穿刺取材成功率为96.0%(72/75)。70例细针穿刺患者中,64例细胞学检查与细胞块免疫组织化学联合诊断结果与随访结果相符,临床诊断符合率为91.4%(64/70)。72例粗针穿刺患者中,67例组织学检查结合免疫组织化学联合诊断结果与随访结果相符,临床诊断符合率为93.1%(67/72)。两种不同方法检测结果比较,其穿刺取材成功率及临床诊断符合率差异无统计学意义(P0.05)。结论超声引导细针抽吸细胞学检查联合细胞块免疫组织化学诊断浅表淋巴结病变简便实用、安全可靠,与粗针组织学检查的临床诊断符合率无差异。     

应用超声检查评价高血压患者血管僵硬度与心功能的关系

Objective To assess the relationship between arterial stiffness and heart function in patients with hypertension using ultrasonography. Methods A total of 167 patients with hypertension and 165 controls were enrolled, and the parameters of arterial stiffness and heart function were measured and calculated. The results were analyzed and compared. Results The ratio of peak early-diastolic mitral orifice flow velocity and peak early-diastolic mitral annular velocity in left ventricular posterior wall (E/e), and Tei index were significantly higher in hypertension group than in controls(E/e: 10.92±3.14 vs. 7.70 ±1.56, Teiindex: 0.58±0.13 vs. 0.45±0.09, both P＜0.05), but there was no significant difference in ejection fraction (EF) between the two groups. In hypertension group, the parameters of arterial stiffness including β value, pressure-strain elastic modulus (Ep), pulse wave velocity (PWVβ) and arterial compliance were 11.0±5.2, (172.6±83.8)kPa, (7.8±1.6) m/s and (0.6±0.2) mm2/ kPa. In control group, the corresponding data were 7.5±3.0, (97.1±45.4) kPa, (5.9±1.3) m/s and (0.8±0.3) mm2/kPa. There were significant differences between the two groups (all P＜0.05). The E/e was positively correlated with Ep and PWVβ(γ=0.316 and 0.296, both P＜0.05). The Tei index was positively correlated with Ep,augmentation index (AI) and PWVβ(γ=0.278, 0.300 and 0.323, P＜0.05-0.01). There was no significant correlation between EF and arterial stiffness. Conclusions The arterial stiffness and damage of heart function can result from hypertension. The arterial stiffness can be one of monitoring indexes for the heart function damage in early time.     

彩色多普勒血流显像对老年股动脉假性动脉瘤的诊断及治疗价值

目的 探讨彩色多普勒血流显像(CDFI)对老年经皮穿刺腔内冠状动脉成形(PTCA)术后并发股动脉假性动脉瘤的诊断及治疗价值.方法 采用CDFI诊断26例老年PTCA术后并发股动脉假性动脉瘤,并在超声引导下探头垂直加压假性动脉瘤通道或破裂口直至通道内无血流通过,如压迫失败,再在超声引导下经皮瘤腔内注射巴曲酶.结果 26例老年PTCA术后并发股动脉假性动脉瘤的CDFI诊断明确,与临床诊断符合率100%,CDFI引导下22例经单纯压迫治愈,3例经瘤腔内注射巴曲酶加压治愈,1例治疗失败而行外科手术修补.结论 CDFI对老年PICA术后并发股动脉假性动脉瘤的诊断准确、治疗有效,可作为诊断和治疗老年PTCA术后并发股动脉假性动脉瘤的首选方法.     

超声造影定量评估大动脉炎性肾动脉炎患者肾皮质血流灌注的价值

目的 探讨超声造影定量分析技术评估大动脉炎性肾动脉炎(TARA)患者肾皮质血流灌注情况的临床价值.方法 选取我院临床确诊为TARA患者21例(TARA组,42个肾)和排除肾脏、心脏或血管疾病的患者22例(对照组,44个肾),应用超声造影定量分析技术获取两组肾皮质血流灌注的时间-强度曲线及相关参数,包括曲线下面积(AUC...     

应用超声检查评价高血压患者血管僵硬度与心功能的关系

Objective To assess the relationship between arterial stiffness and heart function in patients with hypertension using ultrasonography. Methods A total of 167 patients with hypertension and 165 controls were enrolled, and the parameters of arterial stiffness and heart function were measured and calculated. The results were analyzed and compared. Results The ratio of peak early-diastolic mitral orifice flow velocity and peak early-diastolic mitral annular velocity in left ventricular posterior wall (E/e), and Tei index were significantly higher in hypertension group than in controls(E/e: 10.92±3.14 vs. 7.70 ±1.56, Teiindex: 0.58±0.13 vs. 0.45±0.09, both P＜0.05), but there was no significant difference in ejection fraction (EF) between the two groups. In hypertension group, the parameters of arterial stiffness including β value, pressure-strain elastic modulus (Ep), pulse wave velocity (PWVβ) and arterial compliance were 11.0±5.2, (172.6±83.8)kPa, (7.8±1.6) m/s and (0.6±0.2) mm2/ kPa. In control group, the corresponding data were 7.5±3.0, (97.1±45.4) kPa, (5.9±1.3) m/s and (0.8±0.3) mm2/kPa. There were significant differences between the two groups (all P＜0.05). The E/e was positively correlated with Ep and PWVβ(γ=0.316 and 0.296, both P＜0.05). The Tei index was positively correlated with Ep,augmentation index (AI) and PWVβ(γ=0.278, 0.300 and 0.323, P＜0.05-0.01). There was no significant correlation between EF and arterial stiffness. Conclusions The arterial stiffness and damage of heart function can result from hypertension. The arterial stiffness can be one of monitoring indexes for the heart function damage in early time.     

小肠恶性间质瘤扭转540°1 例

患者男 ,5 9岁 ,一年来间歇性下腹部隐痛 ,发作 4～ 5次 ,下腹部阵发性绞痛伴腹胀 4天 ,且逐渐加重。无恶心、呕吐 ,每日排便一次 ,无血便或黏液便。查体 :下腹部可触及约 12ｃｍ× 12ｃｍ肿物 ,有压痛、上界清晰 ,活动性差。疑急性尿潴留或下腹部肿物。超声检查发现膀胱内有少量尿液 ,未见明显异常。膀胱上方可见一个 12 1ｃｍ× 10 5ｃｍ× 8 7ｃｍ的低回声区 ,内有部分不规则的无回声区 ,边界清晰 (图 1)。彩色多普勒超声检查 :虽然将仪器的速度标尺降低至最低 (6ｃｍ/ｓ) ,彩色增益调到噪音信号刚好消失 ,在其内部和周边部位均未探及…     

彩色多普勒能量图在诊治腹膜后肿块中的应用价值

目的探讨彩色多普勒能量图（ＣＤＥ）在诊治腹膜后肿块（ＲＰＭ）中的应用价值。方法对３４例ＲＰＭ进行二维超声（２Ｄ）和ＣＤＥ检查,采用Ａｄｌｅｒ半定量法对肿块血流信号进行分级。结果①ＣＤＥ对ＲＰＭ的定位准确性为９１％。②根据ＣＤＥ血流信号分级,０、１级提示良性肿块,２、３级提示恶性肿块,则其判断ＲＰＭ良恶性的敏感性为８５％、特异性为８９％、准确性为８８％。③ＣＤＥ能够良好显示肿块与周围大血管的位置关系,其显示率为６２％。结论ＣＤＥ结合２Ｄ能够明显提高对ＲＰＭ定位和良恶性判断的准确性,为临床制定治疗方案提供重要依据,并可作为非手术治疗ＲＰＭ疗效判断的有效客观指标之一。