瞬时弹性成像探测仪FibroScan在华支睾 吸虫病中的临床应用

目的　探索瞬时弹性成像探测仪FibroScan应用于华支睾吸虫病的临床意义,以期为患者驱虫治疗的疗效评估提供新思路。方法　采用FibroScan检测华支睾吸虫病确诊患者驱虫治疗前后的肝脏硬度（LSM）值,并收集患者年龄、性别、体质指数（BMI）、食用鱼生持续时间、食用鱼生总量等指标,评价其与LSM的相关性。结果　华支睾吸虫病确诊病例年龄、性别、BMI、食用鱼生持续时间、食用鱼生总量与治疗前LSM值间均无相关性（r/rs分别为0.189、0.073、0.180,0.071、–0.098、0.033,0.166、0.309、0.172,0.235、0.247、0.209,0.164、0.277、0.088;P均 > 0.05）。同一患者驱虫治疗前第7、8、9肋间的LSM值差异有统计学意义（F = 3.259,P < 0.05）,而驱虫治疗后差异则无统计学意义（F = 0.851,P > 0.05）,驱虫治疗后患者各肋间的LSM值均显著低于较驱虫治疗前（t = 6.724、5.603、2.884,P均 < 0.05）。结论　FibroScan可用于华支睾吸虫病患者驱虫治疗疗效评估,但在不同部位检测可影响LSM值。     

Endorectal elastography in the evaluation of rectal tumours

Aim Real‐time elastography visualizes tissue compliance using an ultrasound platform. Elastography has been used, particularly in the breast, to characterize indeterminate lesions on B‐mode imaging as either benign or malignant. The primary aim of this study was to assess the feasibility of routine endorectal elastography to evaluate rectal neoplasia. The secondary aim was to correlate elastography data with histopathological end‐points. Method Sixty‐nine patients referred to the outpatient clinic of the Department of Colorectal Surgery at Haukeland University Hospital for the evaluation of rectal tumours were included in this prospective cohort study. All patients underwent digital rectal examination, rigid rectoscopy with biopsy, endorectal ultrasonography and endorectal elastography. In each case a strain ratio was calculated, comparing the tumour tissue with adjacent reference tissue that appeared normal on ultrasound scanning. Results Histopathologically there were 23 adenomas and 45 adenocarcinomas. One patient died before surgical treatment. Adequate elastography images were obtained in 66/69 (96%) patients. Optimal discrimination of malignant and benign lesions was obtained using a strain ratio cut‐off value of 1.25 (sensitivity, 0.93; specificity, 0.96; and accuracy, 0.94). Conclusion Endorectal elastography can be performed as an integral part of the clinical evaluation of rectal tumours and has good patient compliance. The method is a promising modality for the discrimination between adenocarcinoma and adenoma of the rectum.     

Decreased brain stiffness in Alzheimer's disease determined by magnetic resonance elastography

Purpose:

To test patient acceptance and reproducibility of the 3D magnetic resonance elastography (MRE) brain exam using a soft vibration source, and to determine if MRE could noninvasively measure a change in the elastic properties of the brain parenchyma due to Alzheimer's disease (AD).

Materials and Methods:

MRE exams were performed using an accelerated spin‐echo echo planar imaging (EPI) pulse sequence and stiffness was calculated with a 3D direct inversion algorithm. Reproducibility of the technique was assessed in 10 male volunteers, who each underwent four MRE exams separated into two imaging sessions. The effect of AD on brain stiffness was assessed in 28 volunteers, 7 with probable AD, 14 age‐ and gender‐matched PIB‐negative (Pittsburgh Compound B, a PET amyloid imaging ligand) cognitively normal controls (CN?), and 7 age‐ and gender‐matched PIB‐positive cognitively normal controls (CN+).

Results:

The median stiffness of the 10 volunteers was 3.07 kPa with a range of 0.40 kPa. The median and maximum coefficients of variation for these volunteers were 1.71% and 3.07%. The median stiffness of the 14 CN? subjects was 2.37 kPa (0.44 kPa range) compared to 2.32 kPa (0.49 kPa range) within the CN+ group and 2.20 kPa (0.33 kPa range) within the AD group. A significant difference was found between the three groups (P = 0.0055, Kruskal–Wallis one‐way analysis of variance). Both the CN+ and CN? groups were significantly different from the AD group.

Conclusion:

3D MRE of the brain can be performed reproducibly and demonstrates significantly reduced brain tissue stiffness in patients with AD. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.

     

Estimation of liver fibrosis by noncommercial serum markers in comparison with transient elastography in patients with chronic hepatitis C virus infection receiving direct‐acting antiviral treatment

Treatment decisions are based on extent of fibrosis in patients with chronic hepatitis C (HCV) infection. Noninvasive diagnostic tools may help to avoid liver biopsy. We investigated the diagnostic accuracy of noncommercial serum scores in comparison with transient elastography (TE). Data analysis was undertaken based on 2458 patients enrolled in the German Hepatitis C Registry, in a prospective, observational study. Aspartate aminotransferase‐to‐platelet ratio index (APRI), FORNS index and FIB‐4 score were calculated and the diagnostic accuracy was compared to TE. As estimated by TE, 955 (38.9%) patients had absence of significant fibrosis (SF), 736 (29.9%) patients had SF, and 767 (31.2%) patients were shown to have cirrhosis. Patients with absence of SF had a sustained virological response (SVR) rate of 97.9%, whereas SVR was attained in 96.2% and 92.2% in those with SF and cirrhosis, respectively (P < 0.0001). The area under the receiver operator characteristic curve (AUROC), sensitivity and specificity in discriminating of SF were 0.789, 0.596 and 0.939 by APRI; 0.838, 0.852 and 0.748 by FORNS index; and 0.828, 0.658 and 0.946 by FIB‐4 score. AUROCs for the prediction of cirrhosis, sensitivity and specificity were 0.881, 0.851 and 0.854 by APRI; 0.846, 0.948 and 0.628 by FORNS index; and 0.907, 0.907 and 0.848 by FIB‐4 score. In conclusion, in the present multicentre real‐world cohort, SF and cirrhosis were predicted with high accuracy with noncommercial serum markers using TE as reference. Further prospective long‐term follow‐up is necessary to compare biomarkers with TE concerning liver‐related outcome and overall mortality.     

Transurethral prostate magnetic resonance elastography: Prospective imaging requirements

Tissue stiffness is known to undergo alterations when affected by prostate cancer and may serve as an indicator of the disease. Stiffness measurements can be made with magnetic resonance elastography performed using a transurethral actuator to generate shear waves in the prostate gland. The goal of this study was to help determine the imaging requirements of transurethral magnetic resonance elastography and to evaluate whether the spatial and stiffness resolution of this technique overlapped with the requirements for prostate cancer detection. Through the use of prostate‐mimicking gelatin phantoms, frequencies of at least 400 Hz were necessary to obtain accurate stiffness measurements of 10 mm diameter inclusions, but the detection of inclusions with diameters as small as 4.75 mm was possible at 200 Hz. The shear wave attenuation coefficient was measured in vivo in the canine prostate gland, and was used to predict the detectable penetration depth of shear waves in prostate tissue. These results suggested that frequencies below 200 Hz could propagate to the prostate boundary with a signal to noise ratio (SNR) of 60 and an actuator capable of producing 60 μm displacements. These requirements are achievable with current imaging and actuator technologies, and motivate further investigation of magnetic resonance elastography for the targeting of prostate cancer. Magn Reson Med, 2011. © 2010 Wiley‐Liss, Inc.     

评价常规超声联合超声弹性成像诊断甲状腺癌的临床价值

目的本研究旨在探讨常规超声联合弹性成像在甲状腺癌诊断中的应用价值。方法选取甲状腺肿物患者128例,共168个结节,行常规超声和超声弹性成像检查,以病理结果为＂金标准＂,计算常规超声及与弹性超声成像联合诊断甲状腺癌的敏感性、特异性和准确性。结果常规超声诊断甲状腺癌的敏感性90.0%、特异性84.6%、准确性86.9%。常规超声联合弹性成像诊断的敏感性94.3%、特异性93.9%、准确性94.0%。两者准确性比较,差异有统计学意义（2=4.974,P〈0.05）。结论常规超声联合弹性成像可以提高超声对甲状腺结节良恶性诊断的准确性。     

超声弹性成像在乳腺实性肿块定性诊断中的应用

目的 探讨超声弹性成像在乳腺实性肿块定性诊断中的应用价值.方法 对90例女性乳腺肿块患者共100个病灶行术前超声弹性成像检查,并进行弹性成像评分.以术后病理结果为诊断标准,评价超声弹性成像对乳腺实性肿块定性诊断的准确性.结果 100个乳腺实性肿块的术后病理检查结果:良性占位73个(63例),恶性占位27个(27例).弹性成像评分结果:良性占位(<3分)67个(57例);恶性占位(≥3分)33个(33例).超声弹性成像定性诊断乳腺实性肿块的准确性为94%.结论 超声弹性成像在乳腺实性肿块定性诊断中具有较高的准确性和独特的优势,但也存在一定的误差,故仍需结合其他检测手段和临床症状,以提高乳腺实性肿块性质鉴别的准确率.

Abstract：

Objective To explore ultrasound elastography for breast solidary masses qualitative diagnosic values. Methods Ninty female patients with 100 breast tumors was exmanined with ultrasonic elastography. The pathologic results were used as diagnostic standard to evaluate the accuracy of ultrasonic elastography in the diagnosis of breast tumors. Results One hundred breast solid masses after histopathologic examination showed: benign lesion in 63 cases (73 lesions) , malignant lesion in 27 cases (27 lesions). Elastography scores showed;67 lesions were benign ( <3 scores) and 27 lesions were malignant ( ≥3 scores) . The accuracy of ultrasonic elastography for diagnosis of breast tumors was 94%. Conclusion Ultrasound elastography in qualitative diagnosis of breast tumors has high accuracy, but it still needs to be combined with other detection methods and clinical symptoms to improve breast tumors diagnosis.     

超声弹性成像与钼靶X线成像对乳腺病灶临床诊断价值的比较

目的:比较超声弹性成像(ultrasonic elastography,UE)与钼靶X线成像(molybdenum X-rayphotography,MX-rP)对良、恶性乳腺病灶的鉴别诊断价值.方法:对83例女性患者共101个病灶术前行UE与MX-rP检查,以手术病理为诊断金标准,分析UE与MX-rP诊断乳腺疾病的准确性.结果:UE诊断乳腺恶性病变的敏感性、特异性、准确性、Youden指数、阳性和阴性预测值分别为87.06%,93.05%,91.08%,83.30%,94.36%和80.10%,阳性和阴性拟然比分别为12.41(95%CI,5.90-26.88)和0.14(95%CI,0.06～0.30).MX-rP诊断乳腺恶性病变的敏感性、特异性、准确性、Youden指数阳性和阴性预测值分别为72.4%,83.33%,80.19%,87.74%,89.55%和63.52%,阳性和阴性拟然比分别为4.34(95%CI,1.63～11.42)和0.33(95%CI,0.19～0.63).UE诊断准确性高于MX-rP(P=0.039).UE诊断乳腺良恶性病灶的受试者特征曲线下面积为0.954(95%CI,0.912～0.996).结论:UE在诊断乳房良恶性病灶时较MX-rP更有价值.     

Real time elastography for noninvasive diagnosis of liver fibrosis

Background/purpose  The accurate preoperative evaluation of liver fibrosis stage is important in determining surgical procedures. Although percutaneous liver biopsy is the gold standard, it may cause undesirable complications, such as bleeding. This study aimed to evaluate the usefulness of real-time tissue elastography for the preoperative assessment of liver fibrosis stage. Methods  We focused on a new mode of sonogram, real-time elastography, which can show tissue elasticity on images, and express the elasticity numerically. The elastic ratio of the liver for the intercostal muscle for each patient was calculated preoperatively, using the sonography device. The liver fibrosis stages were finally determined in the operative specimens from 41 patients. We examined the correlation between the elastic ratio and the histological fibrosis stage. Results  The lower the elastic ratio, the more advanced was the liver fibrosis stage. There was a significant correlation between the elastic ratio and the histological fibrosis stage. The area under the receiver-operating characteristics curve for the diagnosis of significant liver fibrosis using this device was superior to those conventionally determined by blood parameters. Conclusions  Real-time elastography is a promising sonography-based noninvasive method for the preoperative assessment of liver fibrosis.