乳腺癌的超声造影表现

目的:探讨SonoVue实时超声造影在乳腺癌诊断中的表现。方法:选用SonoVue超声造影剂,对21例经手术病理证实的乳腺癌常规超声及超声造影声像图进行回顾性分析。常规超声观察乳腺肿瘤部位,大小、形态、边界、内部回声、彩色血流分布情况。超声造影观察病灶的增强时相和方式,包括起始时间、达峰值时间、开始减退时间、完全廓清时间及病灶内部结构的增强表现。结果:常规超声显示21肿块最大直径范围1.1cm-6.0cm,实质回声团块21个,伴钙化5个。18个肿块边界清楚,3个边界尚清楚,均未见明显包膜。19个肿块发现较丰富或丰富彩色血流信号,2个显示周边少量血流信号,21个肿块测及动脉血流信号,平均Vmax 37.5cm/s(范围15.1-95.4 cm/s),RI 0.63-0.83。术前常规超声诊断符合率为85.71%(18/21)。超声造影时21个肿块平均增强起始时间(14.54±3.24)s、达峰值时间(22.64±4.15)s、开始消退时间(59.09±10.25)s、完全廓清时间(115.45±16.70)s乳腺癌造影后内部表现:16例(乳腺浸润性导管癌15例,乳腺神经内分泌癌1例)表现为不均匀增强,其中5例周围见放射状血管;3例(乳腺浸润性导管癌)表现为不完全增强;1例(乳腺浸润性筛状癌)周边不均匀增强,内部始终未见造影剂进入;1例(乳腺黏液腺癌)周边环状增强,边缘显示一穿支血管进入肿块内,走行弯曲,其余部分显示零星增强。乳腺癌造影后边界表现:18例乳腺肿瘤边界模糊,造影后肿块测值均大于常规超声大小,1例(乳腺黏液腺癌)边界清楚;2例(1例乳腺浸润性筛状癌,1例乳腺神经内分泌癌)边界尚清楚,呈分叶状。超声造影后诊断符合率为95%(20/21)。结论:实时超声造影有助于提高乳腺癌诊断的准确性。     

Contrast‐Enhanced Ultrasonography With SonoVue

Objective. We investigated the ability of contrast‐enhanced ultrasonography with SonoVue (Bracco SpA, Milan, Italy), a sulfur hexafluoride microbubble contrast agent, to reveal differences between benign and malignant focal splenic lesions. Methods. In a prospective study we investigated 35 lesions in 35 patients (24 male and 11 female; mean age ± SD, 54 ± 15 years) with focal splenic lesions detected by B‐mode ultrasonography. After intravenous injection of 1.2 to 2.4 mL of SonoVue, the spleen was examined continuously for 3 minutes using low–mechanical index ultrasonography with contrast‐specific software. The final diagnosis was established by histologic examination, computed tomography, or magnetic resonance imaging. Results. In 14 patients, the splenic lesions were malignant (metastasis, n = 6; non‐Hodgkin lymphoma, n = 6; and Hodgkin lymphoma, n = 2). In 21 patients, the focal splenic lesions were benign (ischemic lesion, n = 6; echogenic cyst, n = 5; abscess, n = 4; hemangioma, n = 3; hematoma, n = 1; hemophagocytosis syndrome, n = 1; and splenoma, n = 1. Typical findings for benign lesions were 2 arrival patterns: no contrast enhancement (neither in the early nor in the parenchymal phase; P < .05) and the beginning of contrast enhancement in the early phase followed by contrast enhancement in the parenchymal phase 60 seconds after injection. In contrast, the combination of contrast enhancement in the early phase followed by rapid wash‐out and demarcation of the lesion without contrast enhancement in the parenchymal phase (60 seconds after injection) was typical for malignant lesions (P < .001). Conclusions. Contrast‐enhanced ultrasonography is helpful in the differentiation between benign and malignant lesions of the spleen.     

Imaging of the ovine corpus luteum microcirculation with contrast ultrasound

Ultrasound contrast agents have been the subject of microvascular imaging research. The sheep corpus luteum (CL) is a microvascular tissue that provides a natural angiogenic and antiangiogenic process, which changes during the luteal phase of the estrous cycle of the ewe. It can also be controlled and monitored endocrinologically, providing a very attractive in vivo model for the study and development of microvascular measurement. The perfusion of the fully developed CL between days 8 and 12 of the estrous cycle was studied in six ewes. A Philips iU22 ultrasound scanner (Bothell, WA, USA) with the linear array probe L9-3 was used to capture contrast-enhanced images after an intravenous bolus injection of 2.4 mL SonoVue (Bracco S.P.A., Milan, Italy). Time-intensity curves of a region of interest inside the CL were formed from linearized image data. A lagged-normal model to simulate the compartmental kinetics of the microvascular flow was used to fit the data, and the wash-in time was measured. Good contrast enhancement was observed in the CLs of all animals and the wash-in time averaged at 5.5 s with 9% uncertainty. The regression coefficient was highly significant for all fits. These data correlated with stained endothelial area in the histology performed postmortem. Two ewes were injected with prostaglandin F2alpha to induce CL regression, which resulted in an increase of wash-in time after a few hours. The CL of the ewe is thus proposed as an ideal model for the study and development of microvascular measurements using contrast ultrasound. Our initial results demonstrate a highly reproducible model for the study of the microvascular hemodynamics in a range of tissues and organs. (E-mail: Vassilis.Sboros@ed.ac.uk)     

声诺维在乳腺癌早期诊断中的应用价值

目的 探讨声诺维超声造影技术在乳腺癌早期诊断中的应用价值.方法 对31例病理确诊为乳腺癌的患者进行乳腺彩色超声及超声造影的回顾性分析.结果 乳腺彩超误诊6例,超声造影误诊2例,超声造影的诊断结果 与病理符合率达93.5%.结论 超声造影技术提高了乳腺癌的早期诊断准确率.     

SonoVue超声造影在肾盂癌诊断中的应用

目的:探讨超声造影对肾盂癌的诊断价值。方法:选择78例患者,其中46例患者有无痛性血尿,18例患者腰痛,14例患者腰部肿块伴血尿,分别采取常规超声、静脉团注SonoVue造影剂造影法进行检查,对比超声诊断结果。结果:常规超声、SonoVue造影剂造影法检查敏感性及诊断符合率分别为46.2%、88.5%,84.6%、96.2%,两种方法差异有统计学意义(P<0.05)。结论:造影剂SonoVue能使肾盂肿块显示更清晰,有助于肾盂癌的诊断。     

Liver Contrast-Enhanced Ultrasound Improves Detection of Liver Metastases in Patients with Pancreatic or Periampullary Cancer

The aim of this study is to provide a diagnostic performance evaluation of contrast-enhanced ultrasonography (CEUS) in detecting liver metastases in patients with suspected of pancreatic or periampullary cancer. Computed tomography (CT) is often insufficient for detection of liver metastases, but their presence plays a crucial role in the choice of therapy. Eighty-nine patients with suspected pancreatic or periampullary cancer were included in this prospective study with retrospective analysis. Patients underwent an abdominal CT and CEUS. Fifteen patients had liver metastases. The CT sensitivity was 73.3% (11/15), the specificity 93.2% (69/74), the positive predictive value (PPV) 68.8% (11/16) and the negative predictive value (NPV) 94.6% (69/73). Based on CEUS, the sensitivity was 80% (12/15), specificity 98.6% (73/74), PPV 92.3% (12/13) and NPV 96.1% (73/76). CEUS improved characterization of liver lesions in patients with suspected pancreatic or periampullary cancer compared with CT. CEUS can better detect benign liver lesions and distinguish false-positive or indeterminate CT results.     

Occlusion Angiography Using Intraoperative Contrast-enhanced Ultrasound Scan (CEUS): A Novel Technique Demonstrating Segmental Renal Blood Supply to Assist Zero-ischaemia Robot-assisted Partial Nephrectomy

Background

Recent innovations in technology and operative techniques have enabled safe performance of robot-assisted zero-ischaemia partial nephrectomy (PN), thus preventing the deleterious effect of warm ischaemia time.

Objective

To describe a novel technique of occlusion angiography using intraoperative contrast-enhanced ultrasound scan (CEUS) for zero-ischaemia robot-assisted PN (RAPN).

Design, setting, and participants

We used a prospective cohort evaluation of five patients who had imaging suspicious of renal cell carcinoma (RCC) treated at a single centre.

Surgical procedure

We used computed tomography with three-dimensional reconstruction to identify renal arterial anatomy and its relationship to the tumour. Then, RAPN was performed with selective clamping and demonstration of a nonperfused segment of kidney (occlusion angiography) using intraoperative CEUS.

Outcome measurements and statistical analysis

We prospectively collected data on baseline, perioperative, and postoperative parameters.

Results and limitations

We describe the effects seen on ultrasound contrast administration. Contrast flare is seen in the segment of the kidney that is perfused. When selective clamping is performed, a watershed (line of demarcation) between the perfused and nonperfused segments of the kidney is clearly seen, allowing excision of the tumour in a relatively avascular plane and ensuring an adequate oncologic margin, when feasible. The mean age was 68.2 yr of age (range: 36–85), and the mean tumour size was 29.6 mm (range: 20–42). The mean intraparenchymal extension of the tumour was 22.6 mm (range: 12–30). Three tumours were located on the right kidney and two on the left. The mean blood loss was 420 ml (range: 200–1000). The histology revealed clear cell RCC in two patients, oncocytoma in two patients, and type 1 papillary RCC in one patient. All the surgical specimens had negative surgical margins. The mean decrease in glomerular filtration rate was 8.4 ml (range: 0–24). The mean follow-up was 6.4 mo (range: 5–8), with no evidence of recurrence in any patient. The only limitation in adopting this technique is the need for an intraoperative ultrasound probe with a CEUS mode. However, most specialists who perform minimally invasive surgery for small renal tumours believe that intraoperative ultrasound scan imaging is essential to achieving adequate resection margins.

Conclusions

Intraoperative CEUS can be a useful adjunct in determining whether zero-ischaemia RAPN is feasible by delineating the area of nonperfusion. This technique has several advantages over the currently available techniques, such as indigo carmine green and Doppler probes.