Usefulness of contrast enhanced ultrasound in monitoring therapeutic response after hepatocellular carcinoma treatment

In the last years, the development in the oncology field has been huge and rapid. In particular, the evaluation of response to anti-tumour treatments has been being object of intense research, producing significant changes. Response assessment after therapy in solid neoplasias has always used radiological imaging techniques, with tumour size reduction representing a presumed therapeutic efficacy. However, with the introduction of anti-angiogenetic drugs the evaluation of tumour size has become unsuitable because some tumours, under treatment, show only tumour perfusion changes rather than lesion shrinkage. Between different imaging techniques with contrast-enhancement, contrastenhanced ultrasound(CEUS) and, in particular, dynamic CEUS have arisen as a promising and non-invasive device for monitoring cancer treatments. Moreover, the introduction of perfusion software has even more refined the technique since it is able to provide quantitative parameters related to blood flow and blood volume that can be associated with tumour response and clinical outcome such as the progression free survival and the overall survival. Here, we give an overview of the current status of CEUS in monitoring hepatocellular carcinoma response to different kind of treatments.

Evaluation of the Therapeutic Effect of Contrast-Enhanced Ultrasound on Different Types of Knee Osteoarthritis in the Elderly

Objective: To evaluate the curative effect of the Traditional Chinese Medicine (TCM) external therapy on knee osteoarthritis patients with different TCM constitutions using musculoskeletal ultrasonography and contrast-enhanced ultrasonography, and to explore the application value of contrast-enhanced ultrasonography in knee joint diseases. Methods: A total of 57 patients diagnosed with knee osteoarthritis in Shaanxi University of Traditional Chinese Medicine from December 2019 to May 2021 were collected, and they were divided into qi stagnation and blood stasis type group (23 cases) and cold-dampness obstruction type group (34 cases) according to the traditional Chinese medicine method. All patients were given acupuncture combined with TCM fumigation and washing. All patients underwent musculoskeletal ultrasonography and contrast-enhanced ultrasonography before and after treatment, observed and recorded relevant data, and compared the treatment effects between the two groups. Results: 85.96% (49/57) of knee osteoarthritis (KOA) patients had suprapatellar bursa effusion, 42.1% (24/57) had iliotibial band bursae effusion, some of which had poor sound transmission, and thickened synovium was seen in most effusions, 33.33% (19/57) had osteophyte formation. Compared with before treatment, the depth of suprapatellar sac effusion in the Qi stagnation and blood stasis type group decreased after treatment (P Conclusion: Musculoskeletal contrast-enhanced ultrasonography was used to quantitatively evaluate the efficacy of TCM external therapy on KOA for different TCM constitutions. Dynamic observation of synovial lesions of knee osteoarthritis provides a valuable imaging method for evaluating the efficacy of traditional Chinese medicine.

基于CT平扫的急性缺血性卒中血管内治疗术前影像学评估的研究进展

急性缺血性卒中治疗的关键在于尽早开通阻塞血管,挽救缺血半暗带。DAWN和/或DEFUSE-3试验将急性缺血性卒中血管内治疗的时间窗从6 h延长至24 h,然而资源要求高、高辐射、造影剂引起的肾损伤和较长的检查时间使得多模态影像筛选方案的实际应用有限。越来越多的证据表明,基于CT平扫的影像标准在选择缺血性卒中合并大血管闭塞患者进行血管内治疗可能是安全有效的。本文将根据血管内治疗的时间窗与梗死核心,从早期时间窗、延长时间窗、超时间窗、大梗死核心血管内治疗4个方面对基于CT平扫的急性缺血性卒中血管内治疗术前影像学评估的研究进展进行综述。

经直肠超声造影评估前列腺癌新辅助内分泌治疗反应的价值

目的:探讨经直肠超声造影(contrast-enhanced transrectal ultrasound)时间-强度曲线(time-intensity curve,TIC)参数评估前列腺癌(prostate cancer,PCa)患者对新辅助内分泌治疗(neoadjuvant hormonal therapy,NHT)的反应程度。方法:纳入27例接受NHT的PCa患者的临床资料,根据术后病理学检查结果分为有效组(n=16)和无效组(n=11)。对比两组患者临床病理学特征、治疗前后血清前列腺特异性抗原(prostate-specific antigen,PSA)和CETRUS检查指标及其变化率,以筛选与NHT反应性有关的潜在指标。进一步采用相关性分析评价其在评估患者对NHT反应方面的价值。结果:有效组和无效组在临床病理学特征、治疗前的血清PSA和C E T R U S检查指标方面的差异无统计学意义(均P>0.05)。治疗后,仅有效组的TIC曲线下面积(area under curve,AUC)低于无效组(560 dB·s vs 710 dB·s),其变化率大于无效组(-27.1%vs-5.3%)(均P<0.05)。相关性分析显示AUC变化率与组织学反应评分之间的相关性略高于治疗后AUC(r为-0.690 vs-0.630)。结论:CETRUS TIC参数中,NHT后的AUC及其变化率在评估PCa患者对NHT反应方面具有较好的价值。其中,AUC变化率可能与治疗反应程度更相关。

急性缺血性脑卒中血管内治疗后造影剂外渗的研究进展

脑卒中是目前导致人类致死、致残的主要疾病。脑卒中的发病率、死亡率随着年龄增长而增高,随着我国人口老龄化的加剧,脑卒中给我国患者、家庭、社会带来沉重的负担。在全部卒中类型中,急性缺血性脑卒中占70%~80%,而血管内治疗已经成为急性缺血性卒中患者的主要治疗方法。但治疗中可能发生的造影剂外渗已成为较常见现象,临床上识别造影剂渗出及预测渗出对患者临床预后的影响非常重要。现就急性缺血性脑卒中血管内治疗后发生造影剂外渗的原因、危险因素、临床预后做一综述。

超声造影在中晚期肝细胞癌非手术治疗效果评估中的应用研究现状

中晚期肝细胞癌(HCC)的治疗以非手术治疗为主,如何制定个性化的治疗方案或根据疗效及时调整方案是目前临床急需解决的关键问题,因此,早期准确地评估中晚期HCC的治疗效果尤为重要。目前,公认的主要评估方式是增强CT和增强MRI,但是CT具有辐射性,不适合反复多次检查;MRI价格昂贵、部分患者检查受限。超声造影(CEUS)能实时、动态、无辐射、高敏感性地识别肿瘤的活性。该文综述了CEUS在中晚期HCC非手术治疗效果评估中的应用研究现状。

Review of treatment assessment using DCE-MRI in breast cancer radiation therapy

As a noninvasive functional imaging technique, dynamic contrast-enhanced magnetic resonance imaging(DCEMRI) is being used in oncology to measure properties of tumor microvascular structure and permeability. Studies have shown that parameters derived from certain pharmacokinetic models can be used as imaging biomarkers for tumor treatment response. The use of DCE-MRI for quantitative and objective assessment of radiation therapy has been explored in a variety of methods and tumor types. However, due to the complexity in imaging technology and divergent outcomes from different pharmacokinetic approaches, the method of using DCE-MRI in treatment assessment has yet to be standardized, especially for breast cancer. This article reviews the basic principles of breast DCE-MRI and recent studies using DCE-MRI in treatment assessment. Technical and clinical considerations are emphasized with specific attention to assessment of radiation treatment response.

“Wait and scan” management of patients with vestibular schwannoma and the relevance of non-contrast MRI in the follow-up

Vestibular schwannoma(VS) is a slow-growing benign neoplasm. There has been an evolution in the management of VS from active treatments(microsurgery and stereotactic radiotherapy) to conservative management(wait and scan). Regular MRI scanning is necessary to monitor tumor progression. Conservative management causes significantly less complications and offers a higher quality of life compared with active treatments. The mean growth rate of VS varies from 0.4 to 2.9 mm/year, and spontaneous shrinkage is observed in 3.8 percent of tumors during observation. If significant growth occurs, active treatment is considered. Significant growth is defined as an increase of at least 3 mm in the largest extrameatal diameter in any plane between the first and last available scans. The vestibulocochlear nerve is surrounded by cerebrospinal fluid, which provides natural contrast for MRI; thus, gadolinium may not be needed to detect VS. Specific sequences have high sensitivity, specificity, and accuracy for detection of progression. Hypointense signal in the ipsilateral inner ear fluid might be a useful sign to distinguish VS from meningioma. In this paper, we summarize the current status of research on conservative management and non-contrast MRI for the detection of VS.

Utility of positron emission tomography-computed tomography scan in detecting residual hepatocellular carcinoma post treatment:Series of case reports

BACKGROUND Multi-phase computed tomography(CT)or magnetic resonance imaging(MRI)has been the standard of care for hepatocellular carcinoma(HCC)diagnosis for years.CASE SUMMARY We report a case series of four patients in whom positron emission tomographycomputed tomography(PET-CT)scan complemented the conventional CT/MRI scans in evaluating treatment response.In these four cases the conventional multi-phase CT and MRI failed to identify residual HCC disease post-treatment,while PET-CT complemented and aided in treatment response evaluation.In each case,the addition of PET-CT identified and located residual HCC disease,allowed retreatment,and altered medical management.CONCLUSION This case series suggests that PET-CT should perhaps play a role in the HCC management algorithm,in addition to the conventional contrast-enhanced multiphase scans.

造影剂肾病发病机制及中医药防治研究进展

随着临床医学诊断和治疗的发展,医学影像学成为临床疾病诊治的重要手段,尤其是经皮冠状动脉介入治疗术的发展,含碘造影剂是其必不可少的媒介,通过冠状动脉造影检查可以明确显示冠状动脉病变的具体位置、程度和范围。但是此过程可引起造影剂肾病的发生,造影剂肾病已经逐渐成为一个不可忽视的临床问题。造影剂肾病为急性肾损常见三大病因之一,对患者的生存质量及预后产生严重影响,目前造影剂肾病的发病机制尚未明确,西医无有效防治措施,中医药在防治造影剂肾病上取得一定进展。该文通过从肾髓质缺血缺氧、造影剂直接毒性作用、氧化应激、炎症反应等方面对造影剂肾病的发病机制进行综述,并分析中医学病因病机,对中药单体及其提取物、中药复方及中成药防治造影剂肾病的发生进行总结,以期进一步发挥中医药防治造影剂肾病的作用。

腘动脉超声造影评估外周动脉疾病腔内治疗疗效的探索性研究

目的 探索腘动脉超声造影(CEUS)评估外周动脉疾病(PAD)腔内治疗(EVT)的疗效。方法 回顾性收集2019年7月—2021年6月于复旦大学附属华东医院成功接受EVT的老年PAD患者临床资料。患者完成EVT前、后的腘动脉CEUS检查,收集CEUS灌注参数(PPs)。比较EVT前、后腘动脉PPs的差异,分析PPs和踝肱指数(ABI)的相关性。结果 共入组27例老年PAD患者(27条肢体),年龄67~84岁,平均(76.8±5.5)岁,其中男性16例、女性11例。EVT技术成功率100%,临床成功率100%。与EVT前比较,EVT后ABI升高[(0.54±0.08)vs(0.79±0.11),P<0.001];EVT后峰值收缩速度加快,达峰时间(TTP)降低(P<0.001)。EVT前后峰值强度和平均通过时间差异无统计学意义(P>0.05)。术后PI与术后ABI存在弱相关(R2=0.154,P=0.043),术后TTP与术后ABI存在中等相关(R2=0.545,P<0.001)。结论 腘动脉CEUS可以用于判断PAD患者EVT的疗效,TTP可能是ABI的潜在替代指标。

无缝隙优质护理模式对下肢动脉硬化闭塞症患者术后对比剂肾病的预防效果

目的:探讨无缝隙优质护理模式对下肢动脉硬化闭塞症(ASO)患者术后对比剂肾病(CIN)发生的预防效果。方法:选取130例ASO患者为研究对象,按照护理方式不同将患者分为观察组和对照组,每组各65例。对照组采用常规护理;观察组采用无缝隙优质护理。比较两组患者的治疗依从性,术后肾功能及尿量的情况、肾功能恢复时间等。结果:观察组自我监护、心理调适、坚持锻炼等治疗依从性方面均高于对照组(P<0.05)。术后48、72 h,观察组患者尿量多于对照组(P<0.05);血尿素氮、血清肌酐均低于对照组(P<0.05);估算肾小球滤过率高于对照组(P<0.05);CIN发生率低于对照组(P<0.05),术后肾功能恢复时间、住院时间均短于对照组(P<0.05)。结论:无缝隙优质护理能够预防提高ASO患者治疗依从性,预防CIN的发生,有利于术后康复。

DCE-MRI联合IVIM定量参数在布氏杆菌性脊柱炎治疗评价中的应用

目的应用动态对比增强MRI(dynamic contrast-enhanced MRI,DCE-MRI)联合体素内不相干运动(intravoxel incoherent motion,IVIM)定量参数评估布氏杆菌性脊柱炎急性期治疗效果,观察各定量参数在疾病治疗过程中的变化情况,筛选出最佳评估定量参数。材料与方法前瞻性招募首次确诊的布氏杆菌性脊柱炎急性期患者30例,所有患者在首次确诊及治疗后3个月接受常规MRI、DCE-MRI和IVIM扫描,对照研究病变最显著区(强化最明显区域)容积转运常数(Ktrans)、血管外细胞外容积分数(Ve)、速率常数(Kep)、慢速扩散系数(D)、快速扩散系数(D*)、灌注分数(f);采用SPSS 25.0统计学软件进行数据分析,各定量参数均呈非正态分布,以中位数±四分位数间距(M±Q)表示,采用Wilcoxon秩和检验对各定量参数进行统计学分析。结果布氏杆菌性脊柱炎首次确诊及治疗后3个月Ktrans值分别为(0.53±0.02)、(0.22±0.01)min-1,Ve值分别为0.45±0.01、0.48±0.03,Kep值分别为(1.18±0.04)、(0.46±0.04)min-1,D值分别为(0.53±0.01)×10-3、(0.91±0.01)×10-3 mm2/s,D*值分别为(6.01±0.26)×10-3、(5.81±0.21)×10-3 mm2/s,f值分别为0.32±0.04、0.29±0.03;Ktrans、Kep、D值组内差异均有统计学意义(Z值分别为-4.784、-4.783、-4.786,P均<0.01)。结论本研究首次应用DCE-MRI联合IVIM定量参数评估布氏杆菌性脊柱炎急性期治疗效果,从微观角度评估病变微环境变化更科学、客观,为指导临床用药提供了新的依据。

超声分子靶向造影剂的应用研究进展

超声分子靶向造影剂通过外周静脉注射进入血液循环之后,与相应受体结合,增强了目标病灶的成像信号,可实现疾病的早期诊断、分期、疗效评估及靶向治疗等。超声分子靶向造影剂还能通过微泡进行靶向药物或基因递送。纳米级的靶向造影剂还可透过血管内皮进入组织间隙内进行成像或治疗。超声分子靶向造影剂的研究目前多停留在临床前实验阶段,有一些临床试验已经在人体中开展,初步证实了靶向超声造影剂的安全性和可行性,超声分子靶向造影剂具有广阔的临床应用前景。

脑血管介入治疗所致造影剂脑病临床特点分析

造影剂脑病(contrast-induced encephalopathy,CIE)是一种罕见的急性且可逆的神经系统疾病,与动脉内注射碘化造影剂有关。该文收集了湖南省脑科医院进行脑血管介入术后出现的3例CIE患者。3例CIE患者中,2例出现精神症状,1例神志改变;3例患者均出现肢体乏力,1例肢体抽搐。3例影像学提示有新增梗死灶,1例有造影剂渗出,1例脑出血增多。对症治疗后,2例患者基本好转,1例患者有肢体无力后遗症。文献回顾发现,脑血管介入术后CIE的临床表现有精神行为异常、视力下降、偏瘫、失语等;影像学表现可能出现脑水肿、新发脑梗死、蛛网膜下腔高密度影和高信号影等,部分患者影像学无异常。经对症治疗后,大部分患者症状完全消失,少数患者有后遗症。

心肌声学造影评估冠脉慢性完全闭塞病变介入治疗效果及预后的价值

目的探讨心肌声学造影(myocardial contrast echocardiography,MCE)评估冠脉慢性完全闭塞病变(chronic total occlusion,CTO)介入治疗效果及预后的价值。方法选取2021年4月—2022年3月广西壮族自治区民族医院超声医学科收治的行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的冠状动脉慢性完全闭塞病变患者60例为研究对象。所有患者于PCI术前1 d及术后3个月行MCE检查。根据“金标准”,分析目测半定量法、图像定量法对存活心肌的诊断效能。结果与金标准相比,心肌声学造影目测半定量法对存活心肌的评估敏感度73.39%,假阴性率26.61%,假阳性率25.96%,特异度74.04%,准确性73.66%,阳性预测值79.80%,阴性预测值66.57%;心肌声学造影图像定量法对存活心肌的评估为敏感度88.07%、假阴性率11.93%、假阳性率28.53%、特异度71.47%、准确性81.15%、阳性预测值81.18%、阴性预测值81.10%。结论心肌声学造影图像定量法用于评估冠状动脉慢性完全闭塞病变介入治疗,可以更客观、更准确地评估存活心肌数目,判断冠状动脉微循环的血流灌注,能为临床医师提供一定参考。

规范化治疗下超声双重造影联合双源CT对胃十二指肠患者术前TNM分期的诊疗价值

目的:分析规范化治疗下胃十二指肠充盈超声造影联合增强CT对胃十二指肠患者术前TNM分期的诊疗价值。方法:回顾性分析50例胃十二指肠患者的临床资料,所有患者术前均行胃十二指肠充盈超声造影和西门子SOMATOM DEFINITION FLASH双源CT(简称增强CT)检查,以术后病理检查结果为金标准,分析胃十二指肠充盈超声造影和增强CT对胃十二指肠患者术前TNM分期的评价价值。结果:T期、N期胃癌联合诊断总准确率均高于胃十二指肠充盈超声造影和增强CT(P<0.05)。M期胃癌总准确率比较差异无统计学意义(P>0.05)。结论:胃十二指肠充盈超声造影联合增强CT对T、N期胃癌术前诊断的准确性高于单独诊断,表明联合使用有助于提高术前诊断的准确性,值得临床推广应用。

中西药治疗牛环形泰勒虫病的效果观察

托克逊县是牛环形泰勒虫病的疫区之一,准确诊断以及有效治疗是防控该病的要点。论文采用流行病学调查、实验室方法检测和临床诊断的方法综合确诊45头舍饲患牛作为研究对象。将45头阳性牛随机分为西药治疗组、中药治疗组以及空白组,按1、2、3、4、5d以及1周,分别对每组患牛进行临床症状观察、体温测定、血涂片观察、染虫率统计,评价治疗效果。结果表明,托克逊县夏乡5个镇散养户的194头牛血液涂片中62份有环形泰勒虫虫体;PCR检测有57份DNA样品得到与预期结果相同的534bp条带;临床诊断有45头牛表现为牛环形泰勒虫病症状;西药治疗组治愈率为93.33%(14/15)明显高于中药治疗组治愈率为73.33%(11/15)。西药组对于治疗环形泰勒虫病具有显著的效果,可为新疆有效治疗环形泰勒虫病提供参考。

人工调控措施对云油3号苗木生长的影响

为了探明能否通过人工调控相关生态环境因素的方法来提高油茶苗木生长质量,开展浇水次数(1次/日、2次/日)、种植密度(64株/m2、36株/m2)、遮阴程度(1层遮阳网、2层遮阳网)和紫外灯光照射(1次/日、2次/日) 4种对比试验,63d后调查苗木的苗高和地径生长量,比较不同调控措施对云油3号苗木生长的影响。结果表明,扣棚条件下云油3号苗高生长量高于不扣棚条件,但其差异不显著。在扣棚与不扣棚的条件下,紫外线照射1次/日的方法对云油3号苗木的高生长和地径生长的促进作用均排在第一位。排在第二位的试验方法为,扣棚条件下1层遮阳网。其它人工调控方法对云油3号苗木的苗高生长和地径生长产生了不同程度的影响,有的是促进作用,有的则是阻碍作用。

超声引导下射频消融治疗甲状腺峡部微小乳头状癌的安全性和有效性

目的评估超声引导下射频消融(RFA)治疗甲状腺峡部微小乳头状癌(PTMC)的安全性和有效性。资料与方法回顾性分析行RFA的65例PTMC患者的治疗结果,术前均获得明确病理结果,术后1、3、6、12、18个月行超声及超声造影(CEUS)随访,观察凝固性坏死区体积,计算体积缩小率(VRR)。结果术后1、3、6、12、18个月,灰阶超声测量的凝固性坏死区VRR逐渐增大,分别为59(41,77)%、88.00(80,95)%、100(94,100)%、100(100,100)%、100(100,100)%;CEUS测量的凝固性坏死区VRR亦逐渐增大,分别为73(57,86)%、93.00(86,97)%、100.00(98,100)%、100(100,100)%、100(100,100)%。消融后1、3、6个月灰阶超声与CEUS测量的凝固性坏死区VRR比较,差异有统计学意义(P均<0.001),CEUS测量坏死区吸收率高于灰阶超声,差异有统计学意义(P均<0.001)。术后18个月,65个结节完全吸收消失。所有患者术后均无不良反应及并发症发生,无局部肿瘤进展。结论RFA治疗PTMC术后无不良反应及并发症发生,超声短期观察无转移征象,凝固性坏死区吸收良好,具有较好的安全性和有效性。