慢性肾小球滤过功能不全移植肾皮质的微循环血流灌注特征

背景:慢性移植肾功能不全病理变化会直接影响肾小球的血流灌注,通过对肾皮质微循环血流灌注的观测就可了解肾小球血流灌注情况,从而对慢性肾功能不全的移植痫变情况进行更加深入的评价.目的:利用SonoVue超声造影技术对移植肾皮质微循环血流灌注进行实时观测,总结慢性肾小球滤过功能不全的移植肾皮质微循环血流灌注的病变特征.方法:同种异体移植肾肾小球滤过功能不全患者32例,男21例,女11例,年龄38～60岁.所有患者肾移植时间均大于6个月,且血清肌酐、尿素氮均高丁正常标准值.利用SonoVue超声造影技术对移植肾皮质微循环血流灌注进行实时观测,持续观察并实时存储图像,造影检查结束后,同放图像进行分析.结果与结论:32例肾移植患者均成功进行了移植肾超声造影检查,图像均符合分析标准.32例移植肾皮质内造影剂灌注的达峰时间PT均大于25 ms,对比剂灌注时间T均大于15 ms;皮质内对比剂分布不均匀(即皮质回声强度不均匀),包膜下皮质的回声强度较近髓皮质的回声强度低.结果说明利用SonoVue超声造影成像可以实时监测移植肾发生慢性肾小球滤过功能不全时肾皮质微循环血流灌注的病变特征.     

New potential and applications of contrast-enhanced ultrasound of the breast: Own investigations and review of the literature

Imaging of angiogenesis is a challenge for modern imaging. Velocimetry in malignant breast lesions and density of malignant vessels are very low. In breast imaging, first results of contrast-enhanced ultrasound (CEUS) were disappointing. Microbubbles are fragile when examined with high frequency US, commonly used in breast imaging. Second-generation contrast agents increase intensively the signal level of breast lesions and new sequences like CPS (Coherence Pulse Sequencing) might be accurate to detect malignant vessels in breast lesions for characterization, to assess the extent of infiltrative breast carcinoma or to evaluate the tumor response after chemotherapy. Another interesting clinical application is the differentiation between post-operative changes and recurrences. In this review, we detail the main results obtained with contrast ultrasonography in a characterization study. In malignant lesions, enhancement was fast, starting with less than 20s. Compared to MR, enhancement appeared faster. Malignant vessels were predominant in the external ring of the nodule, conversely vessels were seen in the center of the lesion in benign nodules. Malignant vessels were also seen outside the lesion. This knowledge could lead the surgeon to perform a larger lumpectomy in these cases, to obtain sane margins and to reduce recurrences.     

Predictive value of time–intensity curves obtained with contrast-enhanced ultrasonography (CEUS) in the follow-up of 30 patients with Crohn's disease

Objectives

CEUS can provide accurate quantitative estimates of intestinal wall microvascularization in Crohn''s disease. We hypothesized that inflammation of the intestinal wall is correlated not with the amount of wall vascularization (study of vascularization patterns, SVP) but with the degree of wall flow during a period of time (time–intensity study, TIS). Our objective was to discover whether CEUS SPV and/or CEUS-TIS reflect(s) vascular inflammation of the intestinal wall and display(s) correlation with clinical activity of the disease at the time of the examination (T0) or at the 3- and 6-month follow-up (T3, T6).

Materials and methods

30 patients with Crohn''s disease (12 men, 18 women, mean age: 41.96 years; treatment: 5-ASA (n = 8), steroids (n = 13), anti-TNF (n = 7), azathioprine (n = 2) were studied with CEUS SPV and CEUS-TIS and followed for at least 6 months. The sonographic examinations were performed with SonoVue (BR1, Bracco) and a dedicated scanner (TECHNOS MPX, Esaote) equipped with software for calculation of time–intensity curves. Four vascular patterns (1: vascularization of the entire wall; 2: vascularization of >50% of the wall; 3: flow exclusively within the submucosal layer; 4: no signal). The semiquantitative analysis consisted in measurement of the area under the curve (AUC) (cut-off between active and inactive disease, 15), mean intesnity (IMA) (cut-off = 10). Each examination (180 s) was digitally recorded and analyzed.

Results

T0: cDAI <150 in 22 pts; cDAI > 150 in 8; T3: 22 pts. with cDAI<150, 8 with cDAI >150. At T0 CEUS SPV and CEUS-TIS both displayed low specificity, diagnostic accuracy, and negative predictive values (p = ns). At T0, CEUS SPV produced 8 true positives (TP), 15 true negatives (TN), 8 false positives (FP), 0 false negative (FN) (sensitivity: 100%; specificity: 68.2%; diagnostic accuracy: 69.5%; Positive predictive value (PPV): 100%; negative predictive value (NPV: 53.3%), and CEUS-TIS produced 6 TP, 18 TN, 4 FP, 2 FN (sensitivity 75%; specificity: 81.8%; diagnostic accuracy: 75%; PPV: 60%; NPV: 90%). At T3, CEUS SPV produced 8 TP, 12 TN, 7 FP, 3 FN (sensitivity: 72.7%; specificity: 63.2%; diagnostic accuracy: 50%; PPV: 53.3%; NPV: 80%), and CEUS SIT produced the following results: 10 TP, 19 TN, 0 FP, 1 FN (sensitivity: 90,9%; specificity: 100%; diagnostic accuracy: 96,5%; PPV: 100%; NPV: 95%).At T3 CEUS-SVP displayed low sensitivity and low diagnostic accuracy, whereas SIT was able to predict clinical activity during follow-up in all but one case (which showed reactivation after 6 months) (p = 0.001)

Conclusion

CEUS-TIS alone was found to reflect vascular inflammation of the intestinal wall in Crohn''s disease and predicted clinical activity during follow-up.     

实时灰阶超声造影在药物流产不全诊断中的应用

目的探讨超声造影刺声诺维（SonoVue）及实时造影匹配成像技术（CnTI技术）在药物流产不全诊断中的应用价值。方法收集32例药物流产后阴道持续出血时间大于14天,常规超声检查宫腔内有异常回声的患者。采用sonoVue及CnTI技术进行实时灰阶超声造影检查,观察病灶区造影剂灌注过程及造影声像图特点。所有患者造影后即行清宫术,刮出物送病理检查。按病理结果将研究对象分成残留组和非残留组,探讨药物流产不全实时灰阶超声造影的表现和规律。结果超声造影时残留组病例可见宫腔内局灶性造影剂灌注丰富,回声高于肌层。非残留组部分病例可见宫腔内局灶性造影剂灌注,回声强度与肌层相近：部分病例仅见肌层及内膜缓慢均匀增强。结论超声造影能更清晰的显示残留病灶。对药物流产不全的诊断有一定的临床应用价值。     

HIFU联合SonoVue辐照山羊肝脏组织对声通道血管的影响

变;HE染色和血管弹力纤维和胶原纤维染色结果显示,声通道血管均未见损伤.实验组和对照组没有差别.结论 HIFU联合SonoVue辐照肝脏组织不会对声通道血管造成损伤.     

Pretreatment Evaluation with Contrast-Enhanced Ultrasonography for Percutaneous Radiofrequency Ablation of Hepatocellular Carcinomas with Poor Conspicuity on Conventional Ultrasonography

Objective

To determine whether pretreatment evaluation with contrast-enhanced ultrasonography (CEUS) is effective for percutaneous radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) with poor conspicuity on conventional ultrasonography (US).

Materials and Methods

This retrospective study was approved by the institutional review board and informed consent was waived. From June 2008 to July 2011, 82 patients having HCCs (1.2 ± 0.4 cm) with poor conspicuity on planning US for RFA were evaluated with CEUS prior to percutaneous RFA. We analyzed our database, radiologic reports, and US images in order to determine whether the location of HCC candidates on planning US coincide with that on CEUS. To avoid incomplete ablation, percutaneous RFA was performed only when HCC nodules were identified on CEUS. The rate of technical success was assessed. The cumulative rate of local tumor progression was estimated with the use of the Kaplan-Meier method (mean follow-up: 24.0 ± 13.0 months).

Results

Among 82 patients, 73 (89%) HCCs were identified on CEUS, whereas 9 (11%) were not. Of 73 identifiable HCCs on CEUS, the location of HCC on planning US corresponded with that on CEUS in 64 (87.7%), whereas the location did not correspond in 9 (12.3%) HCCs. Technical success was achieved for all 73 identifiable HCCs on CEUS in a single (n = 72) or two (n = 1) RFA sessions. Cumulative rates of local tumor progression were estimated as 1.9% and 15.4% at 1 and 3 years, respectively.

Conclusion

Pretreatment evaluation with CEUS is effective for percutaneous RFA of HCCs with poor conspicuity on conventional US.     

超声造影对输卵管通畅性分级评价的价值

目的探讨声诺维（SonoVue）超声造影剂对输卵管通畅性分级评价的应用价值。方法对34例临床怀疑输卵管阻塞导致不孕的患者行声诺维超声造影术及X线碘造影检查,观察宫腔及输卵管形态结构,并对输卵管阻塞程度作分级判断。超声造影结果与X线碘造影检查结果对比,同时观察超声造影术后并发症。结果 34例患者宫腔结构形态正常,双输卵管通畅16例,双侧梗阻5例,单侧通畅、另一侧部分阻塞13例;与X线碘造影检查结果对比,超声造影准确性为97.06%（33/34）。超声造影术后,7例患者有轻微下腹胀痛,27例患者无明显不适。结论输卵管声诺维超声造影术操作简便、经济、无不良反应,可清晰显示输卵管内造影剂的走向,判断其狭窄程度,定位阻塞部位,值得临床广泛应用。     

SonoVue输卵管超声造影声像图分析

目的总结SonoVue输卵管超声造影的声像图特征。方法回顾分析133例不孕症患者SonoVue输卵管超声造影的声像图资料。结果 61例双侧通畅;6例双侧通而不畅;26例一侧通畅,另一侧通而不畅;29例一侧通畅,另一侧不通(含6例单侧切除);11例双侧不通(含4例单侧切除)。结论 SonoVue输卵管超声造影图像清晰,可全面观察输卵管形态,是简便、安全、有效的检查方法。     

可携基因超声造影剂的制备及其体内外显影效果

目的制备一种新型的超声造影剂,研究其理化性质及体内、外显影效果。方法选用体内可降解的两种脂质体二软脂酰卵磷脂（DPPC）和1,2-二油烯氧基-3-三甲氨基丙烷（DOTAP）,采用薄膜分散法制备超声造影剂,观察其外观和形态及粒径分布。以声诺维超声造影剂、PBS和水合液作为对照组,比较其基因携带能力。采用体内、外显影实验,观察自制超声造影剂的显影效果和时间。结果光学显微镜下显示,自制超声造影剂形态规则,呈球形,大小均一,平均粒径为6.969μm。自制超声造影剂与声诺维超声造影剂相比有较好的基因携带能力,而声诺维超声造影剂与PBS及水合液的携基因能力无明显差异。体外超声显影显示,自制超声造影剂在Skeletalmuscular模式下显影时间为18min,造影模式下显影时间为14min,两种模式下管内均表现为强回声,有很好的影像增强效果;体内超声显影（造影模式）显示,大鼠尾静脉注射造影剂后1s时下腔静脉开始显影,3s时腹主动脉中下段开始显影,内均可见强回声充填。结论脂质体包裹的微泡理化性质稳定,具有较好的基因携带能力,体内外显影效果较好,有望成为一种新型的可携带基因和药物的超声造影剂。