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中华医学超声杂志（电子版）

中华医学超声杂志（电子版）

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Chinese Journal of Medical Ultrasound(Electronic Edition)
本刊为中华医学会主办的医学超声专业学术电子期刊，是一本在载体形式上与纸媒体相补的多媒体光盘期刊（CD-ROM）。本刊以电子期刊特有的表现形式，图文声像并茂,具有很强的互动性。并以医学超声、影像、介入及相关专业医生和技术人员为主要读者对象，报道医学超声领域领先的科研成果、临床诊断治疗技术和经验，以及与医学超声技术密切相关的医学和工程基础理论研究。本刊的办刊宗旨是：贯彻党和国家的卫生工作方针政策，贯彻理论与实践、普及与提高相结合的办刊方针，反映我国医学超声临床和科研工作的重大进展，促进国内外超声医学学术交流。
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  • 发文量：4177
  • 被引量：2239
  • H指数：2
  • 开始收录时间：2004,1(1)
  • CNKI综合因子：0.657
  • 维普期刊影响因子： 1.007
  • 万方期刊影响因子：1.22
  • 创刊时间：2004
  • 国内刊号/CN：11-9115/R
    国际刊号/ISSN：1672-6448
  • 发行周期：月刊
    邮发代号：80-313
  • 主管单位：中华人民共和国卫生部
    主办单位：中华医学会
中华医学超声杂志（电子版）-联系信息
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  • 邮箱：csbjb@cma.org.cn
  • 地址：北京东河沿街69号616室
  • 邮编：100052
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  • 摘要：目的总结单一鼻唇冠状切面与常规三切面加特殊切面法在胎儿唇腭裂畸形筛查中的应用价值。方法对3790例胎儿唇腭部采用单一切面法（鼻唇冠状切面组965例）和常规三切面（鼻唇冠状切面、颜面部正中矢状切面、唇水平横切面）加特殊切面法（常规三切面加特殊切面组2825例，经下颌或下唇斜冠状切面、矢状切面、经梨状孔硬腭斜冠状切面、经面颊部斜横切面）行产前超声筛查，并与出生儿颜面部检查结果进行对照分析，总结鼻唇冠状切面与常规三切面和特殊切面检查方法的超声声像图特征，比较单一切面与三切面加特殊切面超声扫查方法的诊断符合率。结果3790例胎儿产前超声共检出唇腭裂畸形32例（0．84％，32／3790），其中鼻唇冠状切面组检出胎儿唇腭裂畸形8例（0．83％，8／965），出生儿颜面部检查证实唇腭裂畸形12例，产前超声诊断符合率为66．67％（8／12），漏诊4例，漏诊率为33．33％（4／12）；常规三切面加特殊切面组产前超声检出胎儿唇腭裂畸形24例，出生儿唇腭部检查证实唇腭裂畸形24例，产前超声无一例漏诊，超声诊断符合率为100％（24／24）。产后检查证实唇腭裂畸形36例，发生率为0．95％（36／3790）。32例唇腭裂胎儿产前超声声像图特征：（1）单侧唇腭裂14例，超声表现为上唇皮肤连续性中断（12／12），鼻孔塌陷和上牙槽突裂（12／12）；上腭连续性回声中断12例（12／14）。（2）双侧唇裂3例，超声均表现为上唇皮肤连续性中断，上牙槽突裂。（3）双侧唇腭裂2例，超声表现为上唇皮肤连续性中断，鼻孔塌陷和上牙槽突裂，上腭连续性回声中断。（4）中央唇腭裂1例，超声表现为上唇皮肤连续性中断，鼻孔塌陷，上牙槽突裂和上腭连续性回声中断。结论与单一鼻唇冠状切面检查法比较，产前超声采用常规三切面加特殊切面法有助于准确检出胎儿唇腭裂，尤其对唇腭部复合畸形胎儿的检查有重要临床应用价值。%Objective To discuss the value of the approach combining routine and special planes in diagnosis of cleft lip and palate .Methods The prenatal ultrasound screening for fetal lips and palate were conducted in 3790 cases with different methods: single-plane (nasolabial coronary plane ) approach in 965 cases and routine-triple-plus-special-plane approach in 2825 cases.After birth, the facial appearances of infants were observed.The diagnostic accuracy rates of the two approaches were compared .Results Among the 3790 cases, 36 (36/3790,0.95%) fetal cleft lip and palate malformations were confirmed , in which 32 cases were demonstrated in prenatal ultrasound with 4 missed cases.The overall accuracy rate of prenatal ultrasound was 88.89%(32/36).For single-plane approach, 8/12 fetal cleft lip and palate malformations were detected in prenatal ultrasound with 4 missed cases.The diagnostic accuracy rate was 66.67%(8/12) with a missed diagnosis rate of 33.33%( 4/12 ).With regard to the routine-triple-plus-special-plane approach, all 24 fetal cleft lip and palate cases were detected in prenatal ultrasound .The diagnostic accuracy rate was 100%(24/24).There was a significant difference between the two groups in accuracy rate of prenatal ultrasound in screening fetal cleft lip and palate .Conclusion For fetal cleft lips and palate, it is of great value to combine the routine and special planes in prenatal ultrasound screening , especially in the case of complex malformations.
  • 摘要：目的探讨肾移植术前不同血液透析时间对原发性肾小球肾炎尿毒症患者心脏结构与功能的影响。方法根据肾移植术前是否血液透析和不同血液透析时间对206例原发性肾小球肾炎尿毒症患者进行分组：透析龄≤1年（90例）、透析龄≤3年（77例）、透析龄＞3年（39例）共3组，应用超声心动图测量3组患者肾移植前、肾移植后1个月和3个月的左心室结构和功能的参数，并进行比较。结果肾移植术后患者左心收缩及舒张功能均有降低趋势；心脏各房、室腔均有不同程度缩小，室间隔和室壁搏幅增加，厚度变薄，左心室短轴缩短率、左心室射血分数等心功能测值较肾移植术前明显改善，扩大的左心房、左心室较肾移植术前缩小。尤其术前透析龄≤1年组患者，心肌和心脏明显缩小。肾移植术后二尖瓣口舒张早期血流峰值流速升高，舒张晚期峰值流速降低，E／A比值升高，E峰减速时间及等容舒张时间明显缩短。透析龄≤1年、透析龄≤3年、透析龄＞3年的患者术前、术后1个月、术后3个月左心房收缩末期内径、左心室舒张末期内径、左心室收缩末期内径、室间隔厚度、左心室后壁厚度、左心室短轴缩短率、左心室射血分数、二尖瓣E峰最大流速、二尖瓣A峰最大流速、E／A比值、E峰减速时间、左心室等容舒张时间比较，差异均有统计学意义（P＜0．01）；透析龄≤1年的患者分别与透析龄≤3年、透析龄＞3年组患者比较，各参数间差异均有统计学意义（P ＜0．01）。结论随血液透析时间的延长，原发性肾小球肾炎尿毒症患者心脏结构和功能均逐渐发生变化，应尽可能缩短肾移植术前血液透析时间，避免透析时间多于1年，以提高长期存活率，减少术后并发症的发生率。%Objective To compare the structure and function of left ventricular before and after renal transplantation .To discover the effect of kidney transplantation based on different dialysis duration . Methods Two handred six pre-renal transplants were assigned into 3 groups based on the dialysis duration:group A, non-dialyzed group,≤1 year group (90 cases); group B, ≤3 years group (77 cases);group C,>3 years group (39 cases).The structure and function of left ventricular was evaluated 1 and 3 months after kidney transplantation using Echocardiography .Results The echocardiographic results of all 3 groups showed decrease of the heart chambers , the thickness of interventricular septum and left ventricular posterior wall.The left ventricular short axis shorten rate and the left ventricular ejection fraction improved .For patients with no dialysis or less than 1 year, the heart size decreased significantly .The early diastolic peak velocity of mitral valve increased, the late diastolic peak velocity decreased , the E/A value rose, the E peak deceleration time and the isovolumic relaxation time shorten remarkably .The left ventricular structure and function improvement of pre-transplant, 1 month and 3 months after transplant in group A was more significant than that in group B and C(P<0.01).Conclusions The structure and function of left ventricular change gradually with the extended dialysis duration before renal transplantation .Shorten the dialysis duration to less than 1 year would be beneficial to prolonged survival rate and reduced incidence of renal transplant complication .
  • 摘要：目的探讨彩色多普勒超声检查对小儿急性睾丸附件扭转的诊断及鉴别诊断价值。方法回顾性分析2010年1月至2012年1月上海市儿童医院收治的因急性阴囊肿痛而行彩色多普勒超声检查的262例患儿的超声声像图特征，并与手术病理、临床最终诊断结果相比较。结果262例患儿最终诊断为急性睾丸附件扭转78例，超声诊断为小儿急性睾丸附件扭转76例，诊断符合率为97．43％（76／78），2例误诊为附件炎。78例患儿（100％，78／78）睾丸上极上方或睾丸上极与附睾头间见类圆形或椭圆形结节，呈高回声或低回声不等，内部回声不均匀，伴有患侧附睾头肿大；22例患儿（28．21％，22／78）患侧精索增粗；16例患儿（20．51％，16／78）伴睾丸肿大；11例患儿（14．10％，11／78）阴囊壁水肿。彩色多普勒血流成像示扭转的附件内均未见血流信号。78例急性睾丸附件扭转患儿左侧扭转54例，右侧扭转24例；其中32例接受手术探查，均手术切除，余46例接受保守治疗，治疗后症状、体征逐步改善、消失。急性睾丸扭转25例，超声诊断符合率100％（25／25），23例为完全扭转，2例不完全扭转。急性附睾炎56例，超声诊断符合率100％（56／56），右侧附睾炎30例，左侧附睾炎26例。腹股沟疝103例，超声诊断符合率100％（103／103），右侧腹股沟疝51例，左侧腹股沟疝39例，双侧腹股沟疝3例。结论彩色多普勒超声检查对小儿急性睾丸附件扭转具有较高的诊断及鉴别诊断价值，是临床首选的影像学检查方法。%Objective To explore the diagnostic and differential value of color Doppler ultrasound in children′s acute torsion of the testicular appendage .Methods A retrospective analysis was made on the color Doppler ultrasound sonographic features of 262 cases of children with acute scrotal swelling and pain in Children′s Hospital of Shanghai from January 2010 to January 2012.And the ultrasound findings were compared with the surgical pathological ,and clinical diagnoses.Results In the study,acute testicular torsion of appendix were confirmed in 78 cases.Among them,76 cases were successfully diagnosed by ultrasound with 2 cases misdiagnosed as adnexitis .The diagnostic accuracy ratewas 97.43%(76/78).The ultrasonographic features included:a circular or oval nodule attached on the testis′s upper pole with inhomogeneous echotexture and various echogenic level ,the ipsilateral epididymal head enlargement (100%,78/78),the ipsilateral spermatic cord thickening (28.21%,22/78),the swollen testis(20.51%,16/78)and the scrotal edema(14.10%,11/78).CDFI showed no blood flow signals in the torsional appendage .Of 78 cases,54 cases occurred in left side and the rest 24 cases in the right side.A total of 32 patients underwent a surgical exploration and their necrotic testis and appendage were surgically removed .The rest 46 patients received medical treatment and got recovered .There were 25 cases of acute testicular torsion with ultrasound diagnostic rate of 100%(25/25).Of them,23 cases were complete type and the rest two cases were incomplete type . There were 56 cases(30 on right and 26 on left side)of acute epididymitis with ultrasound diagnostic rate of 100%(56/56).There were 103 cases(51 on right side,39 on left side and 3 on bilateral sides)of inguinal hernia with ultrasound diagnostic rate of 100%(103/103).Conclusion Color Doppler ultrasound is the most useful and convenient imaging modality in diagnosis of children′s acute torsion of testicular appendage .
  • 摘要：目的探讨声辐射力脉冲弹性成像（ARFI）技术判断甲状腺单发实性结节良恶性的价值。方法选取2011年4月至2012年2月上海市第十人民医院经常规超声检查发现甲状腺单发实性或以实性为主（囊性＜25％）结节的42例患者，共42个结节。对42例患者42个结节行常规超声检查，采用声触诊组织定量（VTQ）技术检测病灶组织剪切波速度（SWV），采用声触诊组织成像（VTI）技术对病灶组织进行VTI弹性分级。常规超声以符合3项及以上恶性结节超声表现、VTQ以SWV值≥2．87 m／s、VTI以VTI分级≥Ⅳ级、常规超声＋VTI／VTQ以常规超声或VTI／VTQ其中之一诊断为恶性作为恶性结节诊断标准。以病理学诊断结果作为金标准，计算常规超声、VTQ、VTI及常规超声＋VTI／VTQ诊断甲状腺恶性单发实性结节的敏感度、特异度、阳性预测值、阴性预测值。结果42个甲状腺结节经手术后病理证实良性结节30个（结节性甲状腺肿16个，腺瘤性甲状腺肿13个，亚急性甲状腺炎1个），恶性结节12个（均为乳头状癌）。常规超声检查有3项及以上恶性结节超声表现的结节14个，包括良性结节4个，恶性结节10个；少于3项恶性结节超声表现的结节28个，包括良性结节26个，恶性结节2个。常规超声诊断甲状腺恶性单发实性结节的敏感度、特异度、阳性预测值、阴性预测值分别为83．3％（10／12）、86．7％（26／30）、71．4％（10／14）、92．9％（26／28）。 SWV值≥2．87 m／s的结节15个，包括良性结节5个，恶性结节10个；SWV值＜2．87 m／s的结节27个，包括良性结节25个，恶性结节2个；VTQ诊断甲状腺恶性单发实性结节的敏感度、特异度、阳性预测值、阴性预测值分别为83．3％（10／12）、83．3％（25／30）、66．7％（10／15）、92．6％（25／27）。 VTI分级≥Ⅳ级的结节19个，包括良性结节8个，恶性结节11个；VTI分级＜Ⅳ级的结节23个，包括良性结节22个，恶性结节1个；VTI诊断甲状腺恶性单发实性结节的敏感度、特异度、阳性预测值、阴性预测值分别为91．7％（11／12）、73．3％（22／30）、57．8％（11／19）、95．7％（22／23）。常规超声＋VTI诊断甲状腺恶性单发实性结节的敏感度、特异度、阳性预测值、阴性预测值分别为91．7％（11／12）、80．0％（24／30）、64．7％（11／17）、96．0％（24／25）。而常规超声＋VTQ诊断甲状腺恶性单发实性结节的敏感度、特异度、阳性预测值、阴性预测值分别为91．7％（11／12）、83．3％（25／30）、68．8％（11／16）、96．2％（25／26）。结论单独的ARFI技术诊断甲状腺单发实性结节良恶性的能力并不优于常规超声，但是两者联合应用可提高甲状腺单发实性结节良恶性鉴别诊断水平。%Objective To explore the value of virtual touch tissue imaging (VTI) and virtual touch tissue quantification ( VTQ) of acoustic radiation force impulse ( ARFI) elastography in the differential diagnosis between benign and malignant solitary solid thyroid nodules in ultrasound .Methods The ARFI elastography characteristics and ultrasound (US) features of 42 histologically proven solid or predominantly solid thyroid nodules in 42 patients with a solitary nodule were reviewed .The pathological diagnosis was the gold standard and the sensitivity ,specificity,positive predictive value (PPV) and negative predictive value (NPV) of US, VTQ and VTI in diagnosis of malignant solitary solid thyroid nodules were caculated. Results Forty-two nodules included 30 benign lesions(16 nodular goiters,13 adenomatous goiters and one subacute thyroiditis)and 12 malignant lesions(papillary carcinomas).The sonographic features that suggested malignancy include hypoechogenicity , irregular or microlobulated margin, microcalcification, intranodular bloodflow and taller than wide shape .Forteen nodules(four benign nodules and ten malignant nodules ) had three or more of these features and 28 nodules(26 benign nodules and two malignant nodules ) had less than three of these features.The sensitivity,specificity,PPV and NPV of US was 83.3%(10/12),86.7%(26/30), 71.4%(10/14) and 92.9%(26/28).The shear wave velocities(SWV) of 15 nodules(five benign nodules and ten malignant nodules ) were greater than or equal to 2.87 m/s and those of 27 nodules (25 benign nodules and two malignant nodules ) were less than 2.87 m/s.The sensitivity,specificity,PPV and NPV of VTQ was 83.3%(10/12),83.3%(25/30),66.7%(10/15) and 92.6%(25/27),respectively.The VTI scores of 19 nodules(eight benign nodules and 11 malignant nodules) were greater than or equal to Ⅳand those of 23 nodules (22 benign nodules and one malignant nodule ) were less than Ⅳ.The sensitivity, specificity,PPV and NPV of VTI was 91.7%(11/12),73.3%(22/30),57.8%(11/19) and 95.7%(22/23),respectively.The sensitivity,specificity,PPV and NPV of US combining VTI was 91.7%(11/12), 80.0%(24/30),64.7%(11/17) and 96.0%(24/25),respectively.The sensitivity,specificity,PPV and NPV of US combining VTQ was 91.7%(11/12),83.3%(25/30),68.8%(11/16) and 96.2%(25/26), respectively.Conclusion ARFI alone is not superior to US in predicting malignancy in thyroid nodules but can be used as a supplementary tool to improve the diagnostic level .
  • 摘要：Objective To discuss the effect of the pressure of inferior vena cava on the liver stiffness.Methods Sixteen New Zealand rabbits were used in this study ,in which the inferior vena cava was ligated in the level superior to the secondary porta of liver .Heparinized normal solution was infused to increase the pressure of inferior vena cava to 25 cm H2 O (1 cm H2 O=0.098 kPa),and liver stiffness was measured before and after ligation and under venous pressure of 15 cm H2 O,20 cm H2 O and 25 cm H2 O. Results Liver stiffness was (7.57 ±0.99) kPa before ligation,and was (14.40 ±0.78) kPa,(18.99 ±1.22) kPa and (25.73 ±1.46) kPa respectively when the venous pressure was 15 cm H2 O,20 cm H2 O and 25 cm H2 O. Five minutes after recanalization the liver stiffness decreased to (7.33 ±0.95) kPa.There was a significant difference in liver stiffness among different time points ( F =686.99, P <0.01).Multi-comparison was performed,and significant differences were observed on liver stiffness in each adjacent pair (pre-ligation vs 15 cm H2 O,q=22.78,P<0.01;15 cm H2 O vs 20 cm H2 O,q=15.30,P<0.01;20 cm H2 O vs 25 cm H2 O, q=22.50,P <0.01;25 cm H2 O vs recanalization,q =61.38,P <0.01).A significant correlation was observed between liver stiffness and venous pressure (r=0.943,P<0.01).Conclusion The value of liver stiffness was significantly affected by pressure of inferior vena cava and there is a significant correlation between the venous pressure and liver stiffness .%　　目的探讨肝段下腔静脉压力对兔肝脏弹性的影响。方法16只新西兰大白兔，开腹后于第二肝门上方结扎下腔静脉，通过静脉内滴注肝素生理盐水溶液使下腔静脉压力逐渐上升至25 cm H2 O（1 cm H2 O＝0．098 kPa），然后解除结扎。分别于下腔静脉阻断前、下腔静脉阻断后压力为15、20和25 cm H2 O时及下腔静脉再通5 min后采用剪切波弹性成像技术测定实验动物肝脏弹性值。结果下腔静脉阻断前实验动物肝脏弹性平均值为（7．57±0．99） kPa，下腔静脉阻断后压力为15、20和25 cm H2 O时实验动物肝脏弹性平均值分别为（14．40±0．78）、（18．99±1．22）和（25．73±1．46） kPa，下腔静脉再通5 min后实验动物肝脏弹性平均值为（7．33±0．95） kPa。不同时间点之间肝脏弹性平均值差异有统计学意义（F＝686．99，P＜0．01）。每个时间点肝脏弹性值与后一时间点肝脏弹性值差异均有统计学意义（阻断前vs阻断后下腔静脉压力为15 cm H2 O时，q＝22．78，P＜0．01；阻断后下腔静脉压力为15 cm H2 O时vs阻断后下腔静脉压力为20 cm H2 O时，q＝15．30，P＜0．01；阻断后下腔静脉压力为20 cm H2 O时vs阻断后下腔静脉压力为25 cm H2 O时，q＝22．50，P＜0．01；阻断后下腔静脉压力为25 cm H2 O时vs再通后，q＝61．38，P＜0．01）。肝脏弹性平均值与下腔静脉压力之间呈显著正相关（r＝0．943，P＜0．01）。结论下腔静脉压力升高可提高肝脏弹性值，且与静脉压力呈显著相关。
  • 摘要：目的分析总结肝移植术后肝动脉并发症伴侧支形成超声造影（CEUS）表现，探讨CEUS评价肝移植术后肝动脉并发症伴侧支形成的价值。方法2004年4月至2011年12月中山大学附属第三医院肝移植中心所有肝移植术后常规超声或临床表现疑似肝动脉并发症行CEUS检查、并行数字减影血管造影（DSA）检查和（或）CT＋CT血管成像（CTA）证实有及无肝动脉侧支形成患者30例。回顾性分析比较肝动脉并发症伴侧支与无侧支患者肝动脉 CEUS表现。结果30例肝移植患者中，11例CT＋CTA和（或）DSA检查证实肝动脉有侧支，19例DSA检查证实肝动脉无侧支。肝动脉有侧支患者肝动脉并发症诊断时间晚于肝动脉无侧支患者［304 d（144～1917 d） vs 47 d（5～232 d）， U＝20，P＜0．01］。11例肝动脉有侧支患者均有肝动脉并发症，且以肝动脉血栓多见（9／11，81．8％）；而19例肝动脉无侧支患者肝动脉并发症以肝动脉狭窄多见（15／19，78．9％），有1例患者无肝动脉并发症；肝动脉有侧支和无侧支患者肝动脉并发症类型差异有统计学意义（Fisher 精确概率法，P ＝0．001）。肝动脉有侧支患者临床表现多平稳，但常规超声检查发现多数病例胆管异常（10／11）。肝动脉侧支CEUS表现有一定特征：（1）肝固有动脉多不能显示（10／11）；（2）肝门部多条细小迂曲的侧支动脉聚集，呈网状（5／11）或片状增强（6／11），伴细条状增强（2／11）。肝动脉无侧支患者除了3例肝动脉血栓外，肝固有动脉均可见显示，肝门部均未见除肝动脉以外的其他动脉。结论肝移植术后肝动脉并发症伴侧支形成CEUS表现具有一定特点，CEUS有可能成为诊断肝移植术后肝动脉并发症伴侧支形成的新方法。%Objective To summarize the contrast-enhanced ultrasonographic (CEUS) features of hepatic artery complication with collateral transformation after liver transplantation and to explore the diagnostic value of CEUS for collateral transformation of hepatic artery .Methods All 30 post-orthotopic liver transplantation patients suspected hepatic artery complication by color Doppler flow imaging or clinical manifestation were performed CEUS ,digital subtraction angiography ( DSA) and/or computed tomography combining computed tomography angiography (CT+CTA) at liver transplantation center of the Third Affiliated Hospital of Sun Yat-sen University between April 2004 and December 2011.Hepatic artery CEUS features of patients with collateral transformation of hepatic artery and patients without collateral transformation of hepatic artery were retrospectively compared.Results There were 30 post-orthotopic liver transplantation patients , including 11 patients with collateral transformation of hepatic artery confirmed by CT +CTA or DSA and 19 patients without collateral transformation of hepatic artery confirmed by DSA .The diagnostic time of hepatic artery complication in patients with collateral transformation of hepatic artery was significantly later than that of patients without collateral transformation of hepatic artery (144-1917 d,median 304 d vs 5-232 d,median 47 d,U=20,P<0.01).All 11 patients with collateral transformation of hepatic artery had hepatic artery complication and most of them were hepatic artery thrombosis (HAT) patients(9/11,81.8%);however,most of patients without collateral transformation of hepatic artery were hepatic artery stenosis ( HAS) patients (15/19,78.9%) and one of them had normal hepatic artery .The distribution of hepatic artery complication types between two groups was significantly different (Fisher′s exact test,P=0.001).Patients with collateral transformation of hepatic artery hadn not evident clinical symptoms , but most of them showed bile duct abnormality(10/11) in conventional ultrosonography .Hepatic artery CEUS features of patients with collateral transformation of hepatic artery had particular features as follows:(1)Proper hepatic artery in most patients could not be displayed(10/11).(2)Small,tortuous arteries gathered as reticulate (5/11) or patchy(6/11) pattern,accompanied with stripe enhanced pattern (2/11) in porta hepatis.The proper hepatic arteries were displayed and no other arteries at porta hepatic were displayed in all patients without collateral transformation of hepatic artery except 3 HAT patients.Conclusion Collateral transformation of hepatic artery in patients with hepatic artery complication after liver transplantation had some particular features in CEUS which may be a new method to diagnose collateral transformation of hepatic artery .
  • 摘要：目的探讨超声造影定量分析对肝脏炎性病灶的诊断价值。方法对22例经手术或穿刺活检病理证实为肝脏炎性病灶的患者共22个病灶进行常规超声及超声造影检查。其中16个病灶为肝脏炎性假瘤，6个为肝脓肿。采用5级评分法对常规超声及超声造影诊断结果进行评分。利用Sonoliver软件进行数据分析，获得肝脏炎性病灶与病灶周围肝实质超声造影上升时间（RT）、达峰值时间（TTP）、平均渡越时间（mTT）、峰值强度（Imax）等参数以及动态血管模型（DVP）参数图并进行比较。结果以评分为1～2分定为诊断准确，本组22个肝脏炎性病灶常规超声检查诊断准确率为13．6％（3／22），超声造影诊断准确率为63．6％（14／22），超声造影诊断准确率高于常规超声检查，且差异有统计学意义（χ2＝11．6，P＜0．01）。22个肝脏炎性病灶RT为（25．1±9．7）s，TTP为（29．0±13．9）s，均早于病灶周围肝实质的（32．4±8．8） s、（39．3±11．2） s，且差异均有统计学意义（t值均为－2．6， P均＜0．05）；22个肝脏炎性病灶mTT及Imax与病灶周围肝实质比较差异无统计学意义。16个肝脏炎性假瘤病灶与6个肝脓肿病灶RT、TTP、mTT、Imax差异均无统计学意义。22个肝脏炎性病灶DVP曲线Ⅰ型高增强未消退型占18．2％（4／22），Ⅱ型高增强消退型占36．4％（8／22），Ⅲ型低增强型占45．4％（10／22）。16个肝脏炎性假瘤病灶与6个肝脓肿病灶仅动脉期强化方式及实质期坏死区形态差异有统计学意义（χ2值分别为9．9、8．32，P均＜0．05），而动脉期峰值时增强形态、峰值时病灶边界差异以及实质期廓清速度、病灶边界差异无统计学意义。结论超声造影可提高肝脏炎性病灶的诊断准确率，超声造影定量分析可更客观地显示肝脏炎性病灶与肝脏的血流灌注特征，具有较好的临床应用价值。%Objective To investigate the diagnostic value of contrast enhanced ultrasound (CEUS) in quantitative analysis of liver inflammatory lesions .Methods A total of 22 lesions in 22 patients [16 patients with inflammatory pseudotumor of liver ( IPL) and 6 patients with liver abscess ] were analyzed retrospectively.Both conventional ultrasound (US)and CEUS were performed in all patients .The diagnosis of liver inflammatory lesions was confirmed by operation or ultrasound guided biopsy .A diagnostic score of 1 to 5 was given to each lesion at US and CEUS .Sonoliver software was used to analyze the dynamical process of both lesion and normal liver tissue with CEUS respectively .The rise time(RT),time to peak(TTP),mean transit time(mTT),maximum intensity(Imax) and the dynamic vascular pattern (DVP) curve was obtained to analyze the differences between liver inflammatory lesions and normal liver tissue ,as well as between IPL and liver abscess.The vascular characteristics of the IPL and liver abscess was analyzed .Results Using the score of 1-2 as diagnostic criteria,the accuracy rate of CEUS(63.6%,14/22) was obviously higher than that of US(13.6%,3/22)(χ2 =11.6,P<0.01).RT of liver inflammatory lesions(25.1 ±9.1)s was obviously earlier than that of normal liver tissue (32.4 ±8.8) s(t =-2.6,P<0.05).TTP of liver inflammatory lesions(29.0 ±13.9)s was obviously earlier than that of normal liver tissue (39.3 ±11.2)s (t=-2.6,P<0.05).The mTT and Imax were not significantly different between liver inflammatory lesions and normal liver tissue.The RT,TTP,mTT and Imax between IPL and liver abscess were not significantly different .All the DVP curve of liver inflammatory lesions could be divided into three types:Ⅰ.hyperenhancement without wash-out (18.2%,4/22),Ⅱ.hyperenhancement with wash-out(36.4%,8/22),andⅢ.hypoenhancement(45.4%,10/22). Enhancement pattern in arterial phase and shape of necrosis in parenchymal phase were significantly different between IPL and liver abscess (χ2 =9.9,8.32;P<0.05).In the arterial phase the shape and boundary between IPL and liver abscess were not significantly different .The wash-out rate and boundary between IPL and liver abscess in parenchymal phase were not significantly different .Conclusions CEUS could improve the diagnostic accuracy in liver inflammatory lesions .Quantitative analysis of liver inflammatory lesions with CEUS could provide an objective evaluation on lesion vascularity .
  • 摘要：目的探讨胎儿肺动脉超声多普勒流速曲线收缩期加速时间／射血时间（AT／ET）比值产前预测新生儿呼吸窘迫综合征（NRDS）的价值。方法对49例早产单胎孕妇应用超声多普勒测量胎儿主肺动脉中段、左（或右）肺动脉中段和肺内动脉近段AT／ET比值。根据新生儿结局，将49例研究对象分为NRDS组和非NRDS组，比较两组胎儿AT／ET比值在3个不同多普勒取样位置间的差异和产前预测NRDS的效率。结果多普勒取样框分别放置在胎儿主肺动脉中段、左（或右）肺动脉中段和肺内动脉近段，获得满意多普勒流速曲线的胎儿分别为49例（49／49，100％）、45例（45／49，91．8％）和14例（14／49，28．6％）。 NRDS组胎儿主肺动脉中段AT／ET比值低于非NRDS组，且差异有统计学意义（0．197±0．015 vs 0．232±0．018，t＝－5．659，P＜0．001），两组胎儿左（或右）肺动脉中段、肺内动脉近段AT／ET比值差异无统计学意义。胎儿主肺动脉中段AT／ET比值以0．215为切割值，受试者操作特性曲线下面积为0．958，产前预测NRDS的敏感度和特异度分别为1．000和0．897。结论胎儿主肺动脉多普勒AT／ET比值可能是一个非常有潜力的产前无创性预测NRDS的参数。%Objective To explore the prenatal predictive value of neonatal respiratory distress syndrome(NRDS) by Doppler waveform systolic acceleration time/ejection time(AT/ET) ratio in the fetal pulmonary arteries.Methods Fourty nine cases of singleton pregnant women with premature outcome underwent ultrasonic Doppler measurement of AT/ET ratio in the middle of fetal main pulmonary artery ,in the middle of the left (or right) branch pulmonary artery and in the proximal segment of pulmonary artery . According to the clinical neonatal outcome ,49 subjects were divided into NRDS group and non-NRDS group. The values of AT/ET ratio were compared between groups in the three different Doppler sampling points respectively and prenatal predictive efficiency of AT/ET ratio in NRDS was also assessed.Results Doppler sampling points were placed in the middle of fetal main pulmonary artery ,the middle of the left (or right) branch pulmonary artery and the proximal segment of pulmonary artery .Satisfied Doppler waveforms were obtained in 49 cases(100%,49/49),45 cases(91.8%,45/49)and 14 cases(28.6%,14/49)respectively. In the middle of fetal main pulmonary artery ,AT/ET ratio in NRDS group was significantly lower than that in non-NRDS group (0.197 ±0.015 vs 0.232 ±0.018,t =-5.659,P <0.05).However there were no statistical differences of AT/ET ratio in the middle of the left (or right) branch pulmonary artery and the proximal segment of pulmonary artery .The cut-off value of AT/ET ratio in the middle of fetal main pulmonary artery for prenatal predicting NRDS was 0.215 and the area under receiver operating characteristic curve was 0.958,with the sensitivity and specificity of 1.000 and 0.897 respectively.Conclusion Doppler AT/ET ratio in the fetal main pulmonary artery may be a promising and non-invasive parameter to predict NRDS prenatally.
  • 摘要：目的总结肝内胆管细胞癌的超声造影表现。方法回顾性分析2009年1月至2011年12月复旦大学附属中山医院收治的经手术及穿刺活检病理证实的56例肝内胆管细胞癌患者超声造影表现。结果56例肝内胆管细胞癌患者共70个病灶，所有病灶超声造影均表现为“快进快出”，门脉期及延迟期均呈低回声。肝内胆管细胞癌超声造影开始增强时间、达峰时间、表现为等回声时间、表现为低回声时间分别为（14．50±3．82）s、（22．29±4．97）s、（30．38±7．97）s、（43．54±16．80）s。70个病灶中，42个（60．0％，42／70）表现为动脉期病灶边缘不规则环状增强，28个（40．0％，28／70）表现为整体增强；动脉期增强过程中，49个病灶（70．0％，49／70）表现为“树枝状”由周边向中央延伸的特征性的增强方式。超声造影增强达峰值时，51个病灶（72．9％，51／70）表现为不均匀增强，19个（27．1％，19／70）表现为均匀增强。21个病灶（30．0％，21／70）常规二维超声检查病灶边界显示不清，超声造影病灶边界均清晰。所有病灶在门脉期及延迟期均表现为低回声。56个病灶（80．0％，56／70）超声造影表现为“快进快出”、环状增强和（或）树枝状增强。结论肝内胆管细胞癌的超声造影具有“快进快出”、环状增强和（或）树枝状增强等表现，对其诊断和鉴别诊断具有一定的价值。%Objective To investigate the diagnostic value of contrast-enhanced ultrasonography (CEUS ) for peripheral intrahepatic cholangiocarcinoma .Methods Fifty-six cholangiocarcinoma cases confirmed by pathology in Zhongshan Hospital of Fudan University had been analyzed retrospectively .Results All lesions manifested“fast in and fast out”after contrast injection and hypoechoic in portal and delayed phase.The enhancement start time,peak time,time to isoechogenity and hypoechogenity was (14.50 ±3.82) s,(22.29 ±4.97)s,(30.38 ±7.97) s and (43.54 ±16.80) s,respectively.Forty-two lesions (60.0%, 42/70)showed irregular rim-like enhancement while the rest (40.0%,28/70)showed gross enhancement. During the arterial phase,a characteristic pattern“branch enhancement” ( from periphery to centre ) was observed in 49 lesions (70.0%,49/70).At peak intensity,51 tumors (72.9%,51/70)were inhomogeneous and 19 (27.1%,19/70)were homogeneous.The boundary of lesions was unclear in conventional ultrasound and became distinct after contrast injection.Conclusions In CEUS,peripheral intrahepatic cholangiocarcinoma shows“fast in and fast out”,rim-like enhancement and/or branch enhancement.CEUS can help to diagnose of peripheral intrahepatic cholangiocarcinoma .
  • 摘要：Objective To assess the ischemic stroke in older hypertension patients with nonvalvular atrial fibrillation by carotid ultrasound.Methods Seventy-seven patients with hypertension,74 patients with hypertension and nonvalvular atrial fibrillation and 70 controls were studied by carotid ultrasound examination.The parameters of total plaque area ( TPA), carotid artery diameter ( CAD), intima-media thickness( IMT),carotid artery maximum shear rate ( SR-max),minimum shear rate (SR-min),pulsatility index(PI),resistance index(RI) were measured and calculated.And the type of plaque and incidence of ischemic stroke were compared between the three groups .Results TPA,CAD,IMT,SR-max and SR-min were (20.59 ±5.43)mm 2 ,(7.08 ±0.95)mm,(1.38 ±0.32)mm,(365.5 ±129.5)s-1 ,and (132.3 ±46.2)s-1 in hypertension group;(40.46 ±8.18)mm 2 ,(7.21 ±0.83)mm,(1.61 ±0.57)mm,(313.7 ±101.5)s-1 , and (105.3 ±51.1) s-1 in hypertension and nonvalvular atrial fibrillation group;(9.14 ±4.12) mm 2 , (6.49 ±0.87)mm,(0.67 ±0.12) mm,(419.0 ±138.9) s-1 ,and (145.7 ±49.3) s-1 in control group respectively.Compared with control group ,obvious increase in TPA,CAD,IMT and significant decrease in SR-max,SR-min were shown in hypertension group ,and hypertension and nonvalvular atrial fibrillation group (hypertension group vs control group,q =5.92,16.14,15.90,4.61,3.44;hypertension and nonvalvular atrial fibrillation group vs control group,q=7.23,20.91,43.54,8.99,3.44;all P<0.05).Compared with hypertension group,TPA and IMT significantly increased in hypertension and nonvalvular atrial fibrillation group,while SR-max and SR-min significantly decreased (q=5.22,27.99,4.53,8.16,all P<0.05).The incidence of ischemic stroke in hypertension and nonvalvular atrial fibrillation group was significantly higher [37.8%(28/74)] than that in control group [5.7%(4/70)] and hypertension group [19.5%(15/77)] ( χ2 =21.9,6.9,both P <0.05).Compared with control group [11.4%(8/70),4.3%(3/70)], the incidence of hypoechoic plaque and mixed echo plaque were significantly higher in hypertension group [25.9%(20/77),25.9%(20/77)], and hypertension and nonvalvular atrial fibrillation group [45.9%(31/74),21.6%(16/74)] ( hypertension group vs control group, χ2 =5.8,12.1;hypertension and nonvalvular atrial fibrillation group vs control group,χ2 =16.9,9.5;all P<0.05).However compared with hypertension group,only hypoechoic plaque incidence significantly increased in nonvalvular atrial fibrillation group(χ2 =4.2,P<0.05).Conclusions Carotid ultrasound is one of the important methods of evaluating carotid atherosclerosis in ischemic stroke .Hypertension and nonvalvular atrial fibrillation are the major risk factors of carotid atherosclerosis ,and increase the incidence of ischemic stroke .%　　目的评价颈动脉超声检查预测原发性高血压合并非瓣膜性心房颤动（简称房颤）患者缺血性卒中的价值。方法对原发性高血压患者（高血压组，77例）、原发性高血压合并非瓣膜性房颤患者（高血压合并房颤组，74例）和健康对照者（健康对照组，70例）进行颈动脉彩色多普勒超声检查，测量、计算并比较各组受试者粥样斑块总面积（TPA）、颈动脉内径（CAD）、颈动脉内中膜厚度（IMT）、颈动脉最大剪切率（SR－max）、颈动脉最小剪切率（SR－min）、搏动指数（PI）、阻力指数（RI），并对各组受试者缺血性卒中发生率和斑块类型进行比较。结果高血压组患者TPA、CAD、IMT、SR－max、SR－min分别为（20．59±5．43） mm 2、（7．08±0．95） mm、（1．38±0．32） mm、（365．5±129．5） s－1、（132．3±46．2）s－1；高血压合并房颤组患者上述参数分别为（40．46±8．18）mm 2、（7．21±0．83）mm、（1．61±0．57）mm、（313．7±101．5）s－1、（105．3±51．1）s－1；健康对照组上述参数分别为（9．14±4．12）mm 2、（6．49±0．87）mm、（0．67±0．12）mm、（419．0±138．9）s－1、（145．7±49．3）s－1。与健康对照组比较，高血压组及高血压合并房颤组患者TPA、CAD、IMT均增加，而SR－max、SR－min均下降，且差异均有统计学意义（高血压组与健康对照组比较，q值分别为5．92、16．14、15．90、4．61、3．44；高血压合并房颤组与健康对照组比较，q值分别为7．23、20．91、43．54、8．99、3．44；P均＜0．05）。与高血压组患者比较，高血压合并房颤组患者TPA、IMT均增加，而 SR－max、SR－min均下降，且差异均有统计学意义（q值分别为5．22、27．99、4．53、8．16，P均＜0．05）。高血压合并房颤组患者缺血性卒中发生率为37．8％（28／74），高于健康对照组受试者［5．7％（4／70）］和高血压组患者［19．5％（15／77）］，且差异均有统计学意义（χ2值分别为21．9、6．9，P均＜0．05）。健康对照组受试者低回声斑块、混合回声斑块检出率为11．4％（8／70）、4．3％（3／70），高血压组及高血压合并房颤组患者对应的值为25．9％（20／77）、25．9％（20／77）和45．9％（31／74）、21．6％（16／74）。与健康对照组比较，高血压组及高血压合并房颤组患者低回声斑块、混合回声斑块检出率均增高，且差异均有统计学意义（高血压组与健康对照组比较，χ2值分别为5．8、12．1；高血压合并房颤组与健康对照组比较，χ2值分别为16．9、9．5；P均＜0．05）；而与高血压组患者比较，高血压合并房颤组患者仅低回声斑块检出率增加（χ2＝4．2， P＜0．05）。结论颈动脉超声检查可作为评价缺血性卒中颈动脉硬化的重要方法；高血压、非瓣膜性房颤是颈动脉硬化斑块形成的主要危险因素，并增加缺血性卒中发生率。
  • 摘要：Objective To investigate the value of contrast-enhanced ultrasonography (CEUS) for the detection of sentinel lymph node (SLN) in breast cancer.Methods Eighteen VX2 breast cancer lymph node metastasis models in rabbit were established .Experimental methods:(1)Conventional two-dimensional, color and energy Doppler images and Doppler velocity tracings of axillary lymph nodes were obtained after injection of tumor cell suspension for 4 to 5 weeks;(2)After injected subcutaneously with SonoVue around the tumor,nodes perfusion images were collected;(3) Methylene blue tracer was subcutaneously injected around the tumor;(4)Axillary lymph nodes resected for pathological examination .Results Fifteen VX2 breast cancer lymph node metastasis models in rabbit were successfully established .A total of 39 lymph nodes were resected for pathologic examination and 30 were metastasis.(1)A total of 35 lymph nodes were detected by gray-scale ultrasound,of which,23 metastasized and 12 non-metastasized.The results showed that metastatic lymph nodes were mostly with rounded shape ( aspect ratio <2 ), irregular margins, lack of hilar or displacement,cortical thickening,heterogeneous echotexture ,calcification,necrosis,and peripheral or mixed vascular pattern.The detection accuracy,sensitivity and specificity of metastatic lymph node by gray-scale ultrasound were 77.1%(27/35),75.9%(22/29) and 83.3%(5/6).(2)A total of 35 SLNs were injected with ultrasound contrast agents ,of which,33 metastasized and 2 non-metastasized.The lymphatic channels were demonstrated as linear hyperechoic structures leading from the injection site and could be readily followed to their SLNs.The detection accuracy,sensitivity,specificity rate of SLNs by CEUS were 82.9%(29/35),96.6%(28/29) and 16.7%(1/6).(3)The number of lymph nodes stained by methylene blue was 32 while that of non-stained was 7.The detection rate of SLN by CEUS was higher than that by blue dye test,but there was no statistically significant differences [89.7%(35/39) vs 82.1%(32/39), χ2 =0.95, P>0.05].The detection accuracy,sensitivity,specificity rate of metastatic lymph node by CEUS was higher than that by gray-scale ultrasound,but there was no statistically significant differences (χ2 =0.36,P>0.05;Fisher′s exact test,P=0.05).The detection accuracy rate of metastatic lymph node by CEUS was lower than that by gray-scale ultrasound,and there was no statistically significant differences too (Fisher′s exact test,P=0.08).Conclusions CEUS can be used for real-time observing both lymphatic perfusion and lymph node metastasis,and for non-invasive localization of SLN.It has the potential ability to determine lymph node metastases.CEUS has similar detection rate ,accuracy and sensitivity to blue dye test .It is suggested that the CEUS-guided method using SonoVue may be a novel useful method for SLN identification .%　　目的探讨经皮超声造影在实验兔VX2乳腺癌前哨淋巴结（SLN）检测中的应用价值。方法18只实验兔以肿瘤接种方法建立VX2乳腺癌转移淋巴结动物模型。实验方法：（1）注射肿瘤细胞悬液4～5周后采集实验动物腋窝淋巴结二维灰阶超声、彩色多普勒超声和能量多普勒超声及血流流速曲线图像；（2）在实验动物肿瘤周围皮下注射造影剂SonoVue，采集淋巴结造影灌注图像；（3）肿瘤周围皮下注射亚甲蓝注射液示踪SLN；（4）取检实验动物腋窝淋巴结进行病理检查，光镜下观察转移和非转移淋巴结病理形态。结果18只实验动物中15只接种肿瘤细胞成功，病理检查证实15只实验动物腋窝转移性淋巴结30枚，非转移性淋巴结9枚。（1）二维灰阶超声检出实验动物腋窝转移性淋巴结23枚（病理证实转移性淋巴结22枚，非转移性淋巴结1枚），非转移性淋巴结12枚（病理证实转移性淋巴结7枚，非转移性淋巴结5枚）。转移性淋巴结超声声像图表现：淋巴结纵横比＜2、边缘不清晰、淋巴门缺失或移位、内部回声不均匀、内部有钙化或坏死、淋巴结皮质偏心性宽阔、呈混合型或边缘型血流。（2）经皮超声造影检出转移SLN 33枚（病理证实转移性淋巴结28枚，非转移性淋巴结5枚），非转移性淋巴结SLN 2枚（病理证实转移性淋巴结1枚，非转移性淋巴结1枚），造影显示淋巴管从注射部位发出的节段线性高回声及从肿瘤至淋巴管流注到SLN的全过程。（3）亚甲蓝染色法检出SLN 32枚，未染色非SLN 7枚。经皮超声造影SLN检出率高于亚甲蓝染色SLN检出率，但差异无统计学意义［89．7％（35／39） vs 82．1％（32／39），χ2＝0．95，P＞0．05］。以病理检查结果作为金标准，二维灰阶超声检测转移性淋巴结的准确性为77．1％（27／35）、敏感度为75．9％（22／29）、特异度为83．3％（5／6）；经皮超声造影检测转移性淋巴结的准确性为82．9％（29／35）、敏感度为96．6％（28／29）、特异度为16．7％（1／6）。经皮超声造影检测转移性淋巴结的准确性和敏感度均高于二维灰阶超声，但差异均无统计学意义（χ2＝0．36，P＞0．05；Fisher 确切概率法，P＝0．05）；经皮超声造影检测转移性淋巴结的特异度低于二维灰阶超声，且差异也无统计学意义（Fisher 确切概率法，P＝0．08）。结论经皮超声造影可实时观察淋巴管与淋巴结灌流情况，无创定位SLN，可判定淋巴结内有无转移灶；经皮超声造影SLN检出率与亚甲蓝染色法相似，有望成为一种诊断SLN的新方法。
  • 摘要：Objective To evaluate the value of tissue motion tracking of mitral annular displacement (TMAD) method and longitudinal strain in the assessment of longitudinal systolic function of left ventricule in healthy subjects.Methods Forty healthy subjects were enrolled in this study .Left ventricular end-diastolic dimension(LVEDd),left ventricular end-systolic volume ( LVESV),left ventricular end-diastolic volume( LVEDV) and left ventricular ejection fraction ( LVEF) were measured by using two-dimensional echocardiography.The maximal displacement of the six points (anteroseptal,lateral,inferior,anterior,posterior and septal regions ) on mitral annulus ( Ds) and peak systolic longitudinal strain of 18 segments were measured.The average value of left ventricular longitudinal strain in 18 segments was taken as global longitudinal strain(GLS).The correlation between mean displacement (MDS) and LVEF,GLS and LVEF,MDS and GLS were analyzed.Results The systolic displacements of mitral annulus at anteroseptal,lateral, inferior,anterior,posterior and septal regions were (12.37 ±2.05)cm,(12.94 ±2.85)cm,(12.79 ±2.48)cm, (12.97 ±2.29)cm,(12.33 ±2.34)cm and (11.59 ±1.99)cm respectively.But the differences were not statistically significant among six points (F =2.245,P =0.051).The left ventricular systolic GLS was gradually increasing from base to apex.But the differences were not statistically significant among different segments(F=2.988,1.902,2.379,3.164,1.278,0.044,all P>0.05).Also,the systolic peak GLS was significantly different among different segments at the same level (F=2.871,2.752,1.560,all P>0.05).A good correlation was showed between TMAD [(12.67 ±1.57) cm] and LVEF[(57.98 ±4.37)%],GLS [(21.81 ±2.61) cm] and LVEF,and TMAD and GLS ( r =0.853, -0.75, -0.72,all P <0.01). Conclusions The significant correlations were found among two-dimensional strain,TMAD and LVEF by two-dimensional ultrasound speckle tracking technology .Sampling in mitral annulus is simple, fast and non-angle-dependent.TMAD is expected to become a new method to evaluate global left ventricular systolic function.%　　目的探讨定量组织运动二尖瓣环位移（TMAD）技术及左心室心肌的纵向应变在评价健康人左心室长轴收缩功能中的价值。方法选取健康志愿者40名，二维测量左心室舒张末期内径、舒张末期容积、收缩末期容积和左心室射血分数（LVEF）。测量二尖瓣环6个位点（前间隔、侧壁、下壁、前壁、后壁、后间隔）的收缩期最大位移（Ds）及左心室各节段纵向应变收缩期峰值，左心室各节段纵向应变收缩期峰值平均值为左心室整体纵向应变（GLS），并分析平均Ds及左心室GLS与简化双平面Simpson法测得的LVEF的相关性。结果二尖瓣环前间隔位移为（12．37±2．05）cm，侧壁位移为（12．94±2．85）cm，下壁位移为（12．79±2．48） cm，前壁位移为（12．97±2．29） cm，后壁位移为（12．33±2．34）cm，后间隔位移为（11．59±1．99）cm，二尖瓣环6个位点位移比较差异无统计学意义（F＝2．245，P＝0．051）。从基底部到心尖部左心室不同节段（前间隔、前壁、侧壁、后壁、下壁、后间隔）纵向应变收缩期峰值基本呈现逐步递增的趋势，但差异均无统计学意义（F＝2．988、1．902、2．379、3．164、1．278、0．044，P均＞0．05）；基底部、中部、心尖部同一水平不同节段纵向应变收缩期峰值差异亦均无统计学意义（F＝2．871、2．752、1．560，P均＞0．05）。二尖瓣环6个位点平均Ds为（12．67±1．57）cm，与简化双平面Simpson法测得的LVEF［（57．98±4．37）％］呈显著正相关（r＝0．853，P＜0．01）；左心室GLS为（－21．81±2．61）cm，与LVEF呈显著负相关（r＝－0．75，P＜0．01）；二尖瓣环6个位点平均Ds与左心室GLS呈显著负相关（r＝－0．72，P＜0．01）。结论应用二维斑点追踪技术测定的二维应变及TMAD与LVEF存在显著相关性，二尖瓣环取点简便、快捷、无角度依赖，TMAD有望成为定量评价左心室收缩功能的新方法。
  • 摘要：目的探讨超声造影（CEUS）对灰阶超声不易发现的肝癌的显示率，评价CEUS实时引导射频消融治疗肝癌的可行性。方法2010年1月至2011年4月复旦大学附属中山医院住院拟行局部射频消融治疗，MRI发现并提示为肝癌而灰阶超声未发现病灶或疑似病灶患者45例，共45个病灶，包括原发性肝癌38例，转移性肝癌7例。在CEUS下病灶最清晰的时候（动脉期或门脉期）或基波状态下隐约显示时将射频针插入病灶内进行穿刺行射频消融治疗。结果所有病灶CEUS均有不同程度增强，动脉期呈高、稍高或等回声，其中门脉期呈低回声者30个，病灶显示率100％（45／45）。即刻在CEUS引导下进行穿刺者34例，在CEUS 后即刻于基波灰阶超声状态引导下进行穿刺者11例。一次穿刺成功率达100％。全部病例均进行射频治疗。1个月后CEUS和MRI提示病灶均完全坏死。结论CEUS下引导穿刺能进一步提高穿刺准确率。 CEUS引导下射频治疗是提高肝癌局部治疗效果的有效方法。%Objective To evaluate whether real time contrast-enhanced ultrasound (CEUS)guided radiofrequency ablation(RFA) can be performed effectively in hepatic malignances which were invisible or poor visible in gray-scale ultrasonography.Methods From Jan.2010 to Apr.2011,45 consecutive in-patients with 45 hepatic malignances in Zhongshan Hospital of Fudan University were included .All lesions including 38 primary and 7 metastatic hepatic malignancies were planned to undergo RFA therapy.CEUS guided RFA was conducted when the optimal image of a lesion was obtained.At the same time,digital cine-clips of the entire procedure were stored on the hard disk.Results After SonoVue injection,all lesions showed hyper-enhanced or iso-enhanced in arterial phase with sharp margins.Thirty lesions showed hypo-enhanced in portal-vein phase.The overall detection rate of CEUS was 100%(45/45).The insertions of RF electrodes were monitored by CEUS in 34 patients and baseline ultrasound immediately after CEUS in the remaining 11 patients.One month after RFA,complete tumor ablation were obtained for all lesions .Conclusion CEUS guided RFA is a promising technique for targeting of lesions and improving the treatment efficiency of hepatic malignances.
  • 摘要：目的探讨超声造影剂声诺维（SonoVue）联合超声辐照介导载单纯疱疹病毒Ⅰ型胸苷激酶基因（hsv1－tk－gfp）质粒转染HXO－44视网膜母细胞的可行性。方法在24孔板中设置6组：空白对照组（只有细胞，第1组）；细胞＋质粒（第2组）；细胞＋质粒＋超声辐照（第3组）；细胞＋质粒＋超声辐照＋声诺维（第4组）（辐照声强：0．5、1．0、1．5 W／cm2，辐照时间：40、60、80 s，造影剂浓度：10％、20％）；细胞＋质粒＋超声辐照＋声诺维＋昔洛韦（第5组）（辐照方案同第4组，昔洛韦设置不同的浓度：1 mg／L、10 mg／L、100 mg／L、1 g／L）；细胞＋超声辐照＋声诺维（第6组）（辐照方案同第4组）；细胞数量为1×105个／孔，质粒用量为1μl每孔。转染48 h后流式细胞仪检测各组绿色荧光蛋白转染率，MTT法观察细胞存活情况。结果辐照声强为1．5 W／cm2、辐照时间为60 s、造影剂浓度为20％的条件下绿色荧光蛋白转染率最高。加入1 g／L的昔洛韦后，辐照声强为0．5、1．0、1．5 W／cm件下，HXO－44视网膜母细胞的存活率分别为（95．29±0．94）％、（92．58±1．29）％、（77．26±16．20）％，细胞存活率差异有统计学意义（F＝11．402，P＜0．05）；辐照声强为1．5 W／cm2时细胞存活率较辐照声强为0．5、1．0 W／cm 2时下降，且差异均有统计学意义（t＝12．776、10．856，P＜0．01）。结论超声造影剂联合一定强度的超声辐照可增强载hsv1－tk－gfp质粒转染HXO－44视网膜母细胞率；hsv1－tk－gfp质粒转染率超过10％的肿瘤细胞在加入前体药物昔洛韦（浓度高于1 g／L）可出现明显的凋亡。%Objective To explore the feasibility of SonoVue combined with ultrasonic irradiation in mediating hsv1-tk-gfp plasmid DNA transfection into HXO-44 retinal matricyte.Methods Six groups were designed in this experiment:(1) only cells ( control group );(2) cells +plasmid;(3) cells +plasmid +ultrasonic irradiation;(4)cells+plasmid+ultrasonic irradiation +SonoVue[with different acoustic intensity (0.5 W/cm 2 ,1.0 W/cm 2 ,1.5 W/cm 2 ), radiating time (40 s,60 s,80 s) and micro bubble concentration (10%,20%)];(5)cells+plasmid+ultrasonic irradiation+SonoVue+drug(GCV)[with the same conditions in the fourth group in addition to different drug concentrations (1 mg/L,10 mg/L,100 mg/L,1 g/L)];cells+ultrasonic irradiation+SonoVue(with the same conditions in the fourth group ).There were 1 μl plasmid and 1 ×10 5 cells in each hole.The transfection efficiency was assessed after 48 h using flow cytometry.And the cell apoptosis was detected by MTT test .Results Under the conditions of 1.5 W/cm 2 acoustic intensity,60 s radiating time and 20% micro bubble concentration, the highest transfection rate was reached.Using 1 g/L GCV,the survival rate of HXO-44 retinal matricyte under the acoustic intensity of 0.5 W/cm2 ,1.0 W/cm2 and 1.5 W/cm2 were (95.29 ±0.94)%,(92.58 ±1.29)%,(77.26 ±16.20)%respectively with significant difference (F=11.402,P<0.05).Under 1.5 W/cm 2 irradiation,cells appeared obvious apoptosis ( t =12.776,10.856, P <0.01).Conclusions Sonovue combined with ultrasonic irradiation can enhance the transfection efficiency of hsv1-tk-gfp plasmid into HXO-44 retinal matricyte. Cells appear obvious apoptosis when the hsv1-tk-gfp plasmid transfection rate above 10% with GVC concentration higher than 1 g/L.
  • 摘要：目的探讨经颅超声成像（TCS）测量黑质（SN）高回声的面积与双侧黑质高回声总面积/中脑总面积（S/M）诊断帕金森病（PD）的临床价值。方法对92例PD患者（PD组）和98名健康人（健康对照组）进行TCS检查，分别测量中脑及SN高回声面积，计算S/M比值。比较PD组和健康对照组受检者中脑面积、SN高回声面积以及S/M的差异，采用受试者操作特性（ROC）曲线计算两种指标最佳临界点诊断PD的敏感度及特异度，同时计算联合应用2种指标诊断PD的敏感度和特异度。结果PD组患者SN高回声面积、S/M分别为（0．34±0．27）cm 2和（12．15±4．57）％，健康对照组受检者上述指标分别为（0．14±0．08）cm2和（6．37±3．30）％，2组比较差异均有统计学意义（t＝82．68、100．83，P均＜0．01）。 ROC曲线示，SN高回声面积的最佳临界点为0．20 cm2，其敏感度及特异度分别为80．40％、74．50％；S/M的最佳临界点为7．52％，其敏感度及特异度分别为89．10％、63．30％；当2种指标联合应用时，其敏感度及特异度分别为80．40％、78．60％。结论TCS快速、便捷、可重复性强，是PD的重要筛查工具。 SN高回声面积≥0．20 cm 2且S/M＞7．52％联合应用是诊断PD的最佳指标。%Objective To evaluate the clinical value of trascranial sonography (TCS) in measuring hyperechogenic substantia nigra ( SN) area and area ratio of SN to midbrain ( S/M) for the diagnosis of Parkinson′s disease( PD).Methods A total of 109 PD patients ( PD group) and 115 normal controls (control group) underwent TCS.The area of midbrain and SN and the area ratio of S/M were measured and compared between PD group and control group .Statistical analysis of the two parameters in predicting PD was performed with receive operating characteristic ( ROC) curves.The sensitivity and specificity of each parameter and their combination were calculated .Results The hyperechogenic SN area and S/M were (0.34 ±0.27)cm 2 and (12.15 ±4.57)%in PD group,whereas (0.14 ±0.08)cm 2 and (6.37 ±3.30)%in control group respectively .The difference between the two groups was statistically significant (t=82.68, 100.83,both P<0.01).ROC analysis showed that using the cut-off of 0.20 cm 2 for SN hyperechogenicity, the sensitivity and specificity were 80.40%and 74.50%.With the cut-off of 7.52%for S/M,the sensitivity and specificity were 89.10% and 63.30%.By using the combination of SN hyperechogenicity≥0.20 cm 2 and S/M>7.52%,the sensitivity was 80.4%and the specificity was 78.6%.Conclusions TCS is a fast, convenient,effective and useful tool for screening PD .The combination of the SN area and S/M provided the best diagnostic parameters.
  • 摘要：Objective To evaluate the value of GE′s Q-analysis real-time ultrasonic elastography quantitative analysis software in the diagnosis of breast diseases and explore the best cutoff point of the breast diseases diagnosis.Methods The elastograms of 71 breast lesions(66 patients)were evaluated by using the GE LOGIQ E9 with the Q-analysis software.All the 71 lesions were diagnosed as malignant and benign lesions by surgery or biopsy.The receiver operating characteristic (ROC)curves of the entirety elasticity rate and local elasticity rate was performed.We compared the areas under ROC curves ( AUC) of the two modalities and confirmed the best cutoff point of the breast diseases diagnosis .We also assessed the sensitivity and specificity of the two modalities .Lastly we assessed the ROC curves with Z test to determine whether the difference between the two modalities was significant .Results Among the 71 leisions (66 patients),there were 37 benign lesions and 34 malignant ones.The elastograms of the leisions showed that the elasticity of 37 benign leisions was good ,the hardness value was low and the texture was even .As for the 34 malignant leisions,the elasticity was bad,the hardness value was high and the texture was uneven .The AUC of the local modality was 0.899 ( >0.5).The AUC of the entire modality,was 0.985 ( >0.5).Both modalities were accurate for the diagnosis of breast diseases .When the cutoff point of entirety elasticity rate was set as 3.60,the sensitiveness was 82.4%and the specificity was 86.5%.When the cutoff point of local elasticity rate was set as 2.60,the sensitiveness was 97.1% and the specificity was 91.9%.The difference between the two modalities was significant (Z =2.621,P=0.0088).Conclusions Q-analysis real-time ultrasonic elastography quantitative analysis is able to evaluate the rigidity and texture of tissue and is valuable to distinguish benign breast lesions between malignant breast lesions .The sensitiveness and specificity of local modality are higher than that of entirety modality .%　　目的评估Q－analysis实时组织弹性成像分析诊断乳腺良、恶性病变的最佳诊断临界值及其在乳腺疾病诊断中的应用价值。方法应用GE LOGIQ E9超声诊断仪及Q－analysis分析软件对66例乳腺肿物患者71个病灶进行超声检查并进一步行实时组织弹性定量分析，所有病例均经手术或穿刺活检获得明确病理结果。绘制乳腺病灶整体弹性比率值与局部弹性比率值的受试者操作特性（ROC）曲线，比较各种病灶整体弹性比率值与局部弹性比率值曲线下的面积，确定适于诊断的临界值，分析两种方法评估乳腺病灶良恶性的敏感度及特异度，并应用Z检验分析所得出的ROC曲线，比较两种方法在乳腺疾病诊断中的差异。结果66例患者71个病灶中良性病灶37个，恶性病灶34个。弹性成像显示37个良性病灶弹性较好，整体硬度值较小，病灶质地较均匀；34例恶性病灶弹性较差，整体硬度值较大，病灶质地不均匀；实时组织弹性分析乳腺病灶整体弹性比率值法与局部弹性比率值法的ROC曲线下面积分别为0．899和0．985，均大于0．5，两种方法对乳腺疾病良恶性的鉴别具有较高的准确性；乳腺病灶整体弹性比率临界值为3．60时，其诊断的敏感度为82．4％，特异度为86．5％，乳腺病灶局部弹性比率临界值为2．60时，其诊断的敏感度为97．1％，特异度为91．9％；两种方法ROC曲线下面积间差异有统计学意义（Z＝2．621，P＝0．0088）。结论Q－analysis实时组织弹性分析技术可用来评估病灶的硬度及均匀程度，为判断乳腺疾病的良恶性提供诊断的依据。整体弹性比率值法与局部弹性比率值法均具有较高的准确性，其中局部弹性比率值法的敏感度及特异度优于整体弹性比率值法。
  • 摘要：Objective To evaluate the left atrial function and to explore its determinants in patients with hypertrophic cardiomyopathy by three-dimensional echocardiography (3DE).Methods 46 patients with HCM (obstructive HCM:25 cases,nonobstructive HCM:21 cases) and 46 healthy cases (controls) were enrolled in this study.Time-volume curve of left atrium was acquired by 3DE in all subjects.Left atrial maximal volume (LAVmax),left atrial minimal volume (LAVmin) and left atrial presystolic volume (LAVp) were acquaired.Left atrial volume index (LAVI),left atrial expansion index (LAEI),left atrium emptying fraction (LAEF),left atrium passive emptying fraction (LAPEF) and 1eft atrium active emptying fraction (LAAEF) were calculated.Comparative analysis between two groups was taken .The Spearman correlation analysis and multiple linear regression analysis between left atrial volume index (LAVI) with interventricular septal thickness (IVSd),left ventricular outflow tract peak gradient (LVOT-PG),mitral regurgitation (MI), left ventricular diastolic function (LVDF) were analyzed respectively .Results Compared to the controls LAVmax (45.67 ±11.96)ml,LAVmin (20.48 ±6.80)ml,LAVp (24.48 ±9.31)ml,LAVI 25.63 ±6.52, LAEI (1.32 ±0.49)%,LAEF (55.25 ±8.06)%,LAPEF (35.90 ±7.00)%and LAAEF (30.20 ±10.13)%, the patient with HCM had a significantly larger LAVmax (81.45 ±24.24)ml,LAVmin (44.60 ±18.96)ml, LAVp (61.00 ±21.64) ml and LAVI 45.39 ±14.17,there were significant differences among the groups (t=8.978,8.123,9.227,8.436,all P<0.01),lower LAEI(0.95 ±0.43)%,LAEF (46.15 ±11.12)%, LAPEF (25.64 ±9.09)%,there were significant differences among the groups (t=-3.865,-4.493,-6.504,all P<0.01),and slightly lower LAAEF (28.20 ±9.26)%,there were no significant differences among the groups (t=-0.656,P>0.01).There were significant positive correlation between LAVI and IVSd,LVOT-PG,MI,LVDF respectively (r=0.704,0.517,0.640,0.701,all P<0.01).Multiple linear regression analysis demonstrated that IVSd , LVOT-PG, MI and LVDF were correlated factors of LAVI (absolute standardized coeffients =0.264,0.515,0.614,0.341,all P<0.05).Conclusions 3DE could evaluate the left atrial volume and function in patients with HCM , with increased left atrial volume and decreased reservioer,conduit and booster pump function .Mitral regurgitation,obstruction of left ventricular outflow tract,left ventricular diastolic dysfunction and the thickness of left ventricular wall contributed to left atrial dysfunction at different levels ,among which mitrial regurgitation contributed the most .%　　目的应用三维超声心动图（3DE）评价肥厚型心肌病（HCM）患者左心房的功能，并探讨导致左心房功能改变的影响因素。方法46例HCM患者（梗阻性HCM组25例，非梗阻性HCM组21例）与46名健康对照者（健康对照组）入选此研究。应用3DE获得2组受检者的左心房时间－容积曲线，测量左心房最大容积（LAVmax）、左心房最小容积（LAVmin）及左心房收缩前容积（LAVp），计算左心房容积指数（LAVI）、左心房扩张指数（LAEI）、左心房排空分数（LAEF）、左心房被动排空分数（LAPEF）及左心房主动排空分数（LAAEF），2组间进行对比分析。并对所有入选者的室间隔厚度（IVSd）、左心室流出道峰值压差（LVOT－PG）、二尖瓣反流（MI）量、左心室舒张功能（LVDF）与LAVI进行Spearman线性相关分析及多元线性回归分析。结果健康对照组LAVmax（45．67±11．96）ml、LAVmin（20．48±6．80）ml、LAVp（24．48±9．31）ml、LAVI 25．63±6．52、LAEI（1．32±0．49）％、LAEF （55．25±8．06）％、LAPEF（35．90±7．00）％、LAAEF（30．20±10．13）％，HCM组LAVmax（81．45±24．24）ml、LAVmin（44．60±18．96）ml、LAVp（61．00±21．64）ml、LAVI 45．39±14．17，与健康对照组比较均明显增高，2组间差异有统计学意义（t＝8．978、8．123、9．227、8．436，P均＜0．01）；HCM组LAEI（0．95±0．43）％、LAEF（46．15±11．12）％、LAPEF（25．64±9．09）％，与健康对照组比较明显减低，2组间差异亦有统计学意义（t＝－3．865、－4．493、－6．504，P均＜0．01）；HCM组LAAEF（28．20±9．26）％，与健康对照组比较仅轻度减低，2组间差异无统计学意义（t＝－0．656，P＞0．01）。 IVSd、LVOT－PG、MI、LVDF均与LAVI在0．01水平上呈显著正相关（r＝0．704、0．517、0．640、0．701，P均＜0．01），多元回归分析得出IVSd、LVOT－PG、MI、LVDF均为LAVI的影响因素（标准回归系数绝对值分别为0．264、0．515、0．614、0．341，P均＜0．05）。结论3DE能够评估HCM患者左心房的容积及功能，主要表现为各时相左心房容积显著增加，而储蓄功能、管道功能、辅泵功能减低。 HCM患者的二尖瓣反流、左心室流出道梗阻、左心室舒张功能障碍以及室壁的增厚均为左心房功能受损的影响因素，其中二尖瓣反流对其影响最大。

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