Objective： To evaluate the clinical value of contrast-enhanced ultrasound（CEUS） in transthoracic biopsy of anterior-medial mediastinal lesions.Methods： A total of 123 patients with anterior or middle mediastinum l...Objective： To evaluate the clinical value of contrast-enhanced ultrasound（CEUS） in transthoracic biopsy of anterior-medial mediastinal lesions.Methods： A total of 123 patients with anterior or middle mediastinum lesions required ultrasound guided transthoracic biopsy for pathological diagnosis. Among them, 72 patients received CEUS examinations before biopsy. After CEUS, 8 patients were excluded from biopsy and the rest 64 patients underwent biopsy（CEUS group）. During the same period, 51 patients received biopsy without CEUS examination（US group）. The ultrasonography characteristics, the number of biopsy puncture attempts, diagnostic accuracy rate and the incidence of complications were recorded and compared between the two groups.Results： A large portion of necrosis area or superficial large vessels was found in 8 patients, so the biopsy was cancelled. The internal necrosis was demonstrated in 43.8% of the lesions in CEUS group and in 11.8% of US group（P0.001）. For thymic carcinoma, CEUS increased the detection rate of internal necrosis and pericardial effusion than conventional ultrasound（62.5% vs. 18.8%, P=0.012; 56.3% vs. 12.5%, P=0.023）. The average number of punctures in CEUS group and US group was 2.36±0.70 and 2.21±0.51 times, respectively（P0.05）. The diagnostic accuracy rate of biopsy in CEUS group（96.9%, 62/64） was significantly higher than that in US group（84.3%, 43/51）（P=0.022）. In US group, 2 patients suffered from mediastinal bleeding（3.9%）, while no major complications occurred in CEUS group.Conclusions： CEUS examination provided important information before transthoracic mediastinum biopsy and improved diagnostic accuracy rate in biopsy of anterior and middle mediastinum lesions than conventional ultrasound.展开更多
目的:探讨高帧率超声造影(high frame rate contrast-enhanced ultrasound,H-CEUS)定性特征联合定量参数对前列腺良恶性疾病的鉴别诊断价值。方法:选取2022年02月至2023年01月在我院就诊疑似前列腺癌(prostate cancer,PCa)并进行前列腺...目的:探讨高帧率超声造影(high frame rate contrast-enhanced ultrasound,H-CEUS)定性特征联合定量参数对前列腺良恶性疾病的鉴别诊断价值。方法:选取2022年02月至2023年01月在我院就诊疑似前列腺癌(prostate cancer,PCa)并进行前列腺穿刺活检的患者60例(共67个病灶),根据病理结果分为良性组和恶性组,穿刺前行经直肠常规超声及H-CEUS,记录前列腺基本情况、造影定性特征并绘制时间强度曲线获得定量分析参数,比较两组间差异;以病理结果为“金标准”绘制受试者工作特征(receiver operating characteristic,ROC)曲线,应用Z检验比较H-CEUS定性特征、定量参数单独及联合应用对于前列腺病变良恶性的诊断效能。结果:与良性组相比,恶性组H-CEUS定性特征为供血动脉形态不规则(1/33 vs 11/34)及走形异常(3/33 vs 20/34)、快进(9/33 vs 29/34)、高增强(4/33 vs 25/34)、造影剂分布不均匀(9/33 vs 13/34)的比例较大,差异具有统计学意义(χ2=30.41、18.37、22.96、25.72、8.06,P<0.001、<0.001、<0.001、<0.001、=0.005);定量参数PCa较良性组造影到达时间早[(16.93±3.69)s vs(21.54±3.86)s],峰值强度[(48.8±5.58)dB vs(45.77±4.42)dB]、强度差[4.87(0.87,8.03)vs-0.44(-2.22,2.35)]及强度比[(1.15±0.24)vs(1.01±0.97)]的值较良性大,差异具有统计学意义(t/U=4.24、-2.324、151、-2.535,P<0.001、=0.025、=0.004、=0.015)。ROC曲线示H-CEUS定性及定量联合应用的AUC=0.938,截断值为0.44时诊断效能最佳,约登指数、敏感度、特异度、准确度、阳性预测值及阴性预测值为0.750、89.29%、85.71%、87.75%、89.3%、85.7%。根据净重新分类指数NRI值,联合应用对定性特征及定量参数均为正改善(P<0.05)。结论:H-CEUS应用于前列腺有助于观察造影灌注细节、分析成像特征,对于前列腺良恶性疾病具有较好的鉴别诊断能力,将造影灌注定性特征与定量参数结合的诊断效能优于单独应用。展开更多
目的探讨基于前列腺影像报告和数据系统(prostate imaging reporting and data system,PI-RADS)V2.1版的动态对比增强磁共振成像(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)定量值对外周带前列腺癌(prostate cance...目的探讨基于前列腺影像报告和数据系统(prostate imaging reporting and data system,PI-RADS)V2.1版的动态对比增强磁共振成像(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)定量值对外周带前列腺癌(prostate cancer,PCa)和局灶性慢性前列腺炎(chronic prostatitis,CP)的鉴别价值。材料与方法回顾性分析2022年1月至2023年4月期间芜湖市第二人民医院收治的57例外周带PCa患者(研究组)和21例局灶性CP患者(对照组),所有患者接受T2WI、扩散加权成像(diffusion weighted imaging,DWI)、DCE-MRI检查,比较两组双参数(bi-parameter,bp)-MRI(T2WI+DWI)、多参数(multi-parameter,mp)-MRI(T2WI+DWI+DCE-MRI)扫描方案的PI-RADS V2.1评分、DCE-MRI扫描定量值,采用受试者工作特征(receiver operating characteristic,ROC)曲线评估各诊断方案对外周带PCa的诊断价值。结果研究组bp-MRI、mp-MRI扫描方案PI-RADS V2.1评分分别为(4.12±0.88)、(4.31±0.70)分,分别高于对照组的(2.42±1.14)、(2.52±1.22)分,P<0.05。研究组DCE-MRI定量值容积转运常数(volume transport constant,K^(trans))、速率常数(rate constant,K_(ep))均高于对照组(P<0.001),两组血管外细胞外间隙容积分数(extravascular extracellular volume fraction,V_(e))比较差异无统计学意义(P>0.05)。ROC分析显示,bp-MRI、mp-MRI、K^(trans)、K_(ep)诊断外周带PCa的ROC曲线下面积(area under the curve,AUC)[95%置信区间(confidenceinterval,CI)]分别为0.780(0.672~0.866)、0.857(0.759~0.926)、0.734(0.622~0.828)、0.818(0.716~0.896),mp-MRI诊断效能较bp-MRI稍高(P<0.05),其余各项比较差异无统计学意义(P>0.05)。采用logit(p)法建立ROC拟合诊断模型,结果显示K_(ep)+K^(trans)、mp-MRI+K^(trans)、mp-MRI+K_(ep)对外周带PCa诊断效能差异均无统计学意义(P>0.05);K_(ep)+K^(trans)的诊断效能与bp-MRI、mp-MRI、K^(trans)、K_(ep)比较差异均无统计学意义(P>0.05);mp-MRI+K^(trans)的诊断效能分别高于bp-MRI、mp-MRI、K_(ep)、K^(trans)(P<0.05);mp-MRI+K_(ep)的诊断效能分别高于bp-MRI、K^(trans)(P<0.05)。结论基于PI-RADS V2.1 mp-MRI、bp-MRI与DCE-MRI定量值K^(trans)、K_(ep)对外周带PCa与局灶性CP的鉴别诊断效能相当,且两定量参数联合,或分别与mp-MRI联合能有效提高诊断效能,能够为临床不同适应症患者的诊断提供更多选择。展开更多
In many areas of oncology, dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) has proven to be a clinically useful, non-invasive functional imaging technique to quantify tumor vasculature and tumor perfusio...In many areas of oncology, dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) has proven to be a clinically useful, non-invasive functional imaging technique to quantify tumor vasculature and tumor perfusion characteristics. Tumor angiogenesis is an essential process for tumor growth, proliferation, and metastasis. Malignant lesions demonstrate rapid extravasation of contrast from the intravascular space to the capillary bed due to leaky capillaries associated with tumor neovascularity. DCE-MRI has the potential to provide information regarding blood flow, areas of hypoperfusion, and variations in endothelial permeability and microvessel density to aid treatment selection, enable frequent monitoring during treatment and assess response to targeted therapy following treatment. This review will discuss the current status of DCE-MRI in cancer imaging, with a focus on its use in imaging prostate malignancies as well as weaknesses that limit its widespread clinical use. The latest techniques for quantification of DCE-MRI parameters will be reviewed and compared.展开更多
基金supported by Beijing Municipal Health System Special Funds of High-Level Medical Personnel Construction (No. 2013-3-086)the Natural Science Foundation of Beijing (No. 7152031)Beijing Baiqianwan Talents Project
文摘Objective： To evaluate the clinical value of contrast-enhanced ultrasound（CEUS） in transthoracic biopsy of anterior-medial mediastinal lesions.Methods： A total of 123 patients with anterior or middle mediastinum lesions required ultrasound guided transthoracic biopsy for pathological diagnosis. Among them, 72 patients received CEUS examinations before biopsy. After CEUS, 8 patients were excluded from biopsy and the rest 64 patients underwent biopsy（CEUS group）. During the same period, 51 patients received biopsy without CEUS examination（US group）. The ultrasonography characteristics, the number of biopsy puncture attempts, diagnostic accuracy rate and the incidence of complications were recorded and compared between the two groups.Results： A large portion of necrosis area or superficial large vessels was found in 8 patients, so the biopsy was cancelled. The internal necrosis was demonstrated in 43.8% of the lesions in CEUS group and in 11.8% of US group（P0.001）. For thymic carcinoma, CEUS increased the detection rate of internal necrosis and pericardial effusion than conventional ultrasound（62.5% vs. 18.8%, P=0.012; 56.3% vs. 12.5%, P=0.023）. The average number of punctures in CEUS group and US group was 2.36±0.70 and 2.21±0.51 times, respectively（P0.05）. The diagnostic accuracy rate of biopsy in CEUS group（96.9%, 62/64） was significantly higher than that in US group（84.3%, 43/51）（P=0.022）. In US group, 2 patients suffered from mediastinal bleeding（3.9%）, while no major complications occurred in CEUS group.Conclusions： CEUS examination provided important information before transthoracic mediastinum biopsy and improved diagnostic accuracy rate in biopsy of anterior and middle mediastinum lesions than conventional ultrasound.
文摘目的:探讨高帧率超声造影(high frame rate contrast-enhanced ultrasound,H-CEUS)定性特征联合定量参数对前列腺良恶性疾病的鉴别诊断价值。方法:选取2022年02月至2023年01月在我院就诊疑似前列腺癌(prostate cancer,PCa)并进行前列腺穿刺活检的患者60例(共67个病灶),根据病理结果分为良性组和恶性组,穿刺前行经直肠常规超声及H-CEUS,记录前列腺基本情况、造影定性特征并绘制时间强度曲线获得定量分析参数,比较两组间差异;以病理结果为“金标准”绘制受试者工作特征(receiver operating characteristic,ROC)曲线,应用Z检验比较H-CEUS定性特征、定量参数单独及联合应用对于前列腺病变良恶性的诊断效能。结果:与良性组相比,恶性组H-CEUS定性特征为供血动脉形态不规则(1/33 vs 11/34)及走形异常(3/33 vs 20/34)、快进(9/33 vs 29/34)、高增强(4/33 vs 25/34)、造影剂分布不均匀(9/33 vs 13/34)的比例较大,差异具有统计学意义(χ2=30.41、18.37、22.96、25.72、8.06,P<0.001、<0.001、<0.001、<0.001、=0.005);定量参数PCa较良性组造影到达时间早[(16.93±3.69)s vs(21.54±3.86)s],峰值强度[(48.8±5.58)dB vs(45.77±4.42)dB]、强度差[4.87(0.87,8.03)vs-0.44(-2.22,2.35)]及强度比[(1.15±0.24)vs(1.01±0.97)]的值较良性大,差异具有统计学意义(t/U=4.24、-2.324、151、-2.535,P<0.001、=0.025、=0.004、=0.015)。ROC曲线示H-CEUS定性及定量联合应用的AUC=0.938,截断值为0.44时诊断效能最佳,约登指数、敏感度、特异度、准确度、阳性预测值及阴性预测值为0.750、89.29%、85.71%、87.75%、89.3%、85.7%。根据净重新分类指数NRI值,联合应用对定性特征及定量参数均为正改善(P<0.05)。结论:H-CEUS应用于前列腺有助于观察造影灌注细节、分析成像特征,对于前列腺良恶性疾病具有较好的鉴别诊断能力,将造影灌注定性特征与定量参数结合的诊断效能优于单独应用。
文摘目的探讨基于前列腺影像报告和数据系统(prostate imaging reporting and data system,PI-RADS)V2.1版的动态对比增强磁共振成像(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)定量值对外周带前列腺癌(prostate cancer,PCa)和局灶性慢性前列腺炎(chronic prostatitis,CP)的鉴别价值。材料与方法回顾性分析2022年1月至2023年4月期间芜湖市第二人民医院收治的57例外周带PCa患者(研究组)和21例局灶性CP患者(对照组),所有患者接受T2WI、扩散加权成像(diffusion weighted imaging,DWI)、DCE-MRI检查,比较两组双参数(bi-parameter,bp)-MRI(T2WI+DWI)、多参数(multi-parameter,mp)-MRI(T2WI+DWI+DCE-MRI)扫描方案的PI-RADS V2.1评分、DCE-MRI扫描定量值,采用受试者工作特征(receiver operating characteristic,ROC)曲线评估各诊断方案对外周带PCa的诊断价值。结果研究组bp-MRI、mp-MRI扫描方案PI-RADS V2.1评分分别为(4.12±0.88)、(4.31±0.70)分,分别高于对照组的(2.42±1.14)、(2.52±1.22)分,P<0.05。研究组DCE-MRI定量值容积转运常数(volume transport constant,K^(trans))、速率常数(rate constant,K_(ep))均高于对照组(P<0.001),两组血管外细胞外间隙容积分数(extravascular extracellular volume fraction,V_(e))比较差异无统计学意义(P>0.05)。ROC分析显示,bp-MRI、mp-MRI、K^(trans)、K_(ep)诊断外周带PCa的ROC曲线下面积(area under the curve,AUC)[95%置信区间(confidenceinterval,CI)]分别为0.780(0.672~0.866)、0.857(0.759~0.926)、0.734(0.622~0.828)、0.818(0.716~0.896),mp-MRI诊断效能较bp-MRI稍高(P<0.05),其余各项比较差异无统计学意义(P>0.05)。采用logit(p)法建立ROC拟合诊断模型,结果显示K_(ep)+K^(trans)、mp-MRI+K^(trans)、mp-MRI+K_(ep)对外周带PCa诊断效能差异均无统计学意义(P>0.05);K_(ep)+K^(trans)的诊断效能与bp-MRI、mp-MRI、K^(trans)、K_(ep)比较差异均无统计学意义(P>0.05);mp-MRI+K^(trans)的诊断效能分别高于bp-MRI、mp-MRI、K_(ep)、K^(trans)(P<0.05);mp-MRI+K_(ep)的诊断效能分别高于bp-MRI、K^(trans)(P<0.05)。结论基于PI-RADS V2.1 mp-MRI、bp-MRI与DCE-MRI定量值K^(trans)、K_(ep)对外周带PCa与局灶性CP的鉴别诊断效能相当,且两定量参数联合,或分别与mp-MRI联合能有效提高诊断效能,能够为临床不同适应症患者的诊断提供更多选择。
文摘In many areas of oncology, dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) has proven to be a clinically useful, non-invasive functional imaging technique to quantify tumor vasculature and tumor perfusion characteristics. Tumor angiogenesis is an essential process for tumor growth, proliferation, and metastasis. Malignant lesions demonstrate rapid extravasation of contrast from the intravascular space to the capillary bed due to leaky capillaries associated with tumor neovascularity. DCE-MRI has the potential to provide information regarding blood flow, areas of hypoperfusion, and variations in endothelial permeability and microvessel density to aid treatment selection, enable frequent monitoring during treatment and assess response to targeted therapy following treatment. This review will discuss the current status of DCE-MRI in cancer imaging, with a focus on its use in imaging prostate malignancies as well as weaknesses that limit its widespread clinical use. The latest techniques for quantification of DCE-MRI parameters will be reviewed and compared.
