彩色多普勒超声在诊断浅表淋巴结良恶性中的临床价值

目的:探讨彩色多普勒超声在诊断浅表淋巴结良恶性中的临床价值。方法:选择2018年7月~2019年7月于本院行彩色多普勒超声检查浅表淋巴结的患者110例,以病理结果为标准计算超声诊断浅表淋巴结的灵敏度与特异度,比较良、恶性淋巴结超声图像特征。结果:与病理结果相比超声诊断浅表淋巴结的特异度88.13%,敏感度88.23%。恶性淋巴结的长经、短经明显大于良性淋巴结组,差异具有统计学意义(P<0.05),恶性淋巴结的血流阻力指数明显低于良性淋巴结组,差异具有统计学意义(P<0.05)。恶性淋巴结组淋巴门消失、边界不清、周边型血流的例数明显高于良性组,差异具有统计学意义(P<0.05)。结论:彩色多普勒超声诊断浅表淋巴结的良恶性较高,可作为诊断淋巴结良恶性的首选检查。     

Microvascular heart involvement in systemic autoimmune diseases: The purinergic pathway and therapeutic insights from the biology of the diseases

Heart involvement – often asymptomatic – is largely underestimated in patients with systemic autoimmune diseases (SADs). Cardiovascular events are more frequent in patients with SADs compared to the general population, owing to the consequences of inflammation and autoimmunity and to the high prevalence of traditional risk factors. Coronary microvascular disease (CMD) is a form of cardiac involvement that is increasingly recognised yet still largely neglected. CMD, the incapacity of the coronary microvascular tree to dilate when myocardial oxygen demand increases or when there is a microvascular spasm (or subclinical myocarditis), is increasingly reported because of the widespread use of new cardiac imaging tools, even in a subclinical phase. The assessment of myocardial coronary flow reserve (CFR) emerged as the most effective clinical tool to detect microvascular damage. The potential causes of microvascular damage, molecular and cellular inflammation along with a pathological CD39-CD73 axis, need always to be considered because data show that they play a role in the occurrence of acute coronary syndromes, heart failure and arrhythmias, even in the early asymptomatic stage. Data suggest that controlling disease activity by means of methotrexate, biologic drugs, antimalarial medications, statins and aspirin, according to indication, might reduce the cardiovascular risk related to macrovascular and microvascular damage in most patients with SADs, provided that they are used early and timely to control diseases. The need of new biomarkers and a careful assessment of myocardial CFR emerged as the most effective clinical tool to detect microvascular damage.     

Diagnostic value of color Doppler ultrasonography and MDCT angiography in complications of hemodialysis fistulas and grafts

Purpose

The purpose of the study was to compare the diagnostic value of color Doppler ultrasonography (CDUS) and multidetector computed tomography (MDCT) angiography against that of digital subtraction angiography (DSA) or surgery in the evaluation of failing hemodialysis arteriovenous fistulas (AVFs).

Materials and methods

CDUS and MDCT angiography were performed with 41 patients (24 men, 17 women; mean age 55.8) with dysfunctional hemodialysis fistulas. The presence of stenosis, thrombosis, aneurysm, pseudoaneurysm and seroma were recorded. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy of CDUS and MDCT angiography were calculated both individually and in combination for the detection of vascular segments with significant stenosis, thrombosis, aneurysms, pseudoaneurysms, perivascular complications and stenosis subgroups.

Results

Sixty-four segmental lesions were diagnosed by DSA or surgery. Sensitivity, specificity, PPV, NPV and accuracy of CDUS for all vascular tree lesions were 85.9%, 99.2%, 96.4%, 96.7% and 94.5%, respectively. For MDCT angiography the figures were 96.8%, 99.6%, 98.4%, 99.2% and 98.5%, respectively. When both tests were used in combination, sensitivity, specificity, PPV, NPV and accuracy for all vascular tree lesions rose to 100%.

Conclusion

Combined use of MDCT and CDUS for diagnosis of AVF dysfunctions is of equivalent value to surgery or DSA, a gold standard technique.     

Ultrasound evaluation of cervical lymphadenopathy: Can it reduce the need of histopathology/cytopathology?

Background

The differentiation between the causes of cervical lymphadenopathy is of paramount importance as these have different modalities of treatment with varying prognosis. The aim of this study was to evaluate the efficacy of B Mode and colour Doppler ultrasound (CDUS) to differentiate between benign and metastatic lymph nodes.

Sonographic characteristics of carotid artery plaques: Implications for follow-up planning?

IntroductionThe aim of our study was to analyze the ultrasound characteristics of carotid plaques in an outpatient population and to determine their implications for planning the ultrasound follow-up.Materials and methods: We studied 747 consecutive outpatients (397 [53%] of whom were women) who underwent color Doppler sonography of the carotid arteries. Most of the patients presented multiple cardiovascular risk factors or were being followed-up for carotid artery stenosis.Results: Stenosis ranging from 1% to 69% was observed at the level of the right internal carotid arteries (ICA) in 419 (56.1%) of the 747 patients and in the left ICA in 408 of 747 (54.5%). One hundred twenty-four (29.5%) of the 419 RICA plaques and 77 (18.8%) of the 408 LICA plaques were classified as type 1 or type 2 according to the modified Gray-Weale classification.Conclusions: Type 1 and type 2 plaques, which are referred to as “vulnerable plaques,” were found in 160 (21.4%) of the 747 patients we examined. These patients should be subjected to closer ultrasound follow-up, even if they have only moderate carotid artery stenosis.     

小乳癌的数字化乳腺摄影与超声成像对比研究

目的探讨数字化乳腺摄影与彩色多普勒超声对小乳癌及腋淋巴结转移的诊断价值。方法60例≤2.0cm(包括未形成肿块的早期乳腺癌)乳腺结节的数字化影像和超声资料分别由影像和超声医师用双盲法分析,定性诊断,并与病理对照。结果60例中,乳腺癌36例,良性病变24例;发现腋淋巴结96个,45个有转移。数字化摄影和超声在诊断小乳癌的敏感性、准确性及腋淋巴结转移的敏感性方面,二者差异显著(P(0.05);对直径≤1.0cm的病灶,数字化摄影的准确性明显高于超声(P(0.05)。结论对小乳癌及其腋淋巴结的定性诊断方面,数字化摄影为首选,二者结合有利于发现更早期的乳腺癌。     

下肢静脉畸形的彩色多普勒超声检查——附12例报告

<正> 下肢静脉畸形较少见,血管造影术仍是公认的检查诊断的金标准。高分辨力彩色多普勒超声(CDUS)系非侵入性检查方法,无辐射、不需要造影剂和血管穿刺或插管,可长时间、全病程(或疗程)多次重复检查。回顾性分析总结有血管造影证实的12例下肢静脉畸形患者的超声学资料,评价CDUS对下肢静脉畸形病变的检查价值。     

钼靶、彩超及磁共振在乳腺导管原位癌中的诊断价值

目的 探讨如何合理选用钼靶(mammography, MG)、彩超(color Doppler ultrasonography, CDUS)、磁共振(magnetic resonance imaging,MRI)对乳腺导管原位癌（ductal carcinoma in situ,DCIS）进行诊断。方法 收集2009年7月-2014年9月贵阳医学院临床医学院收治的DCIS患者资料,对26例资料完整的患者术前影像学资料进行总结分析,并用Kruskal-Wallis方法进行检验。结果 DCIS在钼靶X线上的表现有钙化（73%, 19/26）、结构紊乱（36%, 8/26）、结节（30%, 7/26）,其中特征性的表现为密集细小钙化（70%, 18/26）;在彩超上的表现有结节（85%, 22/26）、导管扩张（11.5%,3/26）,其中典型的表现为无包膜、低回声结节（59%, 13/22）;在MRI增强上的特征表现为非肿块样强化病灶（73%, 19/26）,病灶时间-信号强度（TIC）曲线多呈Ⅱ、Ⅲ型（73%, 19/26）。钼靶、彩超、磁共振对DCIS诊断率分别为77%、50%、85%,钼靶联合彩超为85%,三者联合为96%,差异有统计学意义（P＜0.05)。结论 钼靶、彩超、磁共振均可发现DCIS,各具优势,不同影像学检查相应结合,可有效提高DCIS诊断率。     

位相对比乳腺摄影和彩色多普勒超声成像对早期乳腺癌诊断价值的对比研究

目的：探讨位相对比乳腺摄影（ phase-contrast mammography,PCM）与彩色多普勒超声（ color Doppler ultrasound,CDUS）对早期乳腺癌的诊断价值。方法60例乳腺结节/肿块的乳腺拍片资料和超声资料分别由影像科和超声科医师进行双盲法分析,定性诊断,并与病理结果对照。结果60例乳腺占位中,乳腺癌36例,良性病变24例。 PCM和CDUS诊断早期乳腺癌的敏感性、准确性方面,二者差异显著（ P＜0.05）;对直径＜1.0 cm的病灶,PCM的准确性明显高于CDUS（P＜0.05）。结论对早期乳癌的定性诊断方面,PCM乳腺摄影为首选,但PCM与CDUS结合有利于发现更早期的乳腺癌。