Clinical value of contrast-enhanced ultrasound in improving diagnostic accuracy rate of transthoracic biopsy of anteriormedial mediastinal lesions

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.

Study on correlation between pathology and the contrast-enhanced ultrasound characteristics of primary liver cancer

Objective:The aim of this study was to evaluate the value of contrast-enhanced ultrasound(CEUS) for blood perfusion of primary liver cancer(PHC) and investigate the correlation between microvascular architecture of PHC and pathological differentiation.Methods:Two hundred and seventy-eight patients with 329 PHC lesions were examined by CEUS and analysised the contrast enhancement pattern and correlation with pathology.Results:1.CEUS patterns of PHC:71.7%(236/329) showed "swift enhancement in the arterial phase and swift expurgation in the portal phase",13.4%(44/329) for as "swift enhancement and slow expurgation",7.3%(24/329) as "swift enhancement and simultaneity expurgation",4.3%(14/329) for the "slow enhancement and swift expurgation",2.1%(7/329) as "slow enhancement and expurgation",1.2%(4/329) as "not fast forward".2.90.3%(297/329) of PHC lesions were hypervascular liver cancer and 9.7%(32/329) were hypovascular.Hepatocellular carcinoma(HCC) were hypervascular lesions and intrahepatic cholangiocarcinoma(ICC) were hypovascular lesions.3.PHC size had a significant difference on the contrast media purfusion pattern(P < 0.05),but not on the contrast media expurgation pattern.4.The accuracy of PHC by CEUS were 97.3% and compared to pathology,9 lesions of PHC were misdiagnosed.Conclusion:CEUS can show the different blood perfusion characteristics of PHC with closely related to pathological differentiation,which be valuable to diagnose liver cancer.

超声造影对甲状腺可疑结节的定性诊断价值

目的探讨超声造影对不同病理类型甲状腺可疑结节的诊断价值。方法对358例患者424个甲状腺结节行超声造影检查,给予超声造影后定性诊断结果,以术后病理结果为金标准,对超声造影诊断结果与病理结果进行对比,应用χ2检验,对比良、恶性结节不同病理类型的诊断有无差异。结果 (1)超声造影对甲状腺结节良恶性诊断的灵敏度85.3%,特异度为65.4%,阳性预测值为91.6%,阴性预测值为50.0%,诊断符合率为81.6%。(2)恶性结节中甲状腺乳头状癌超声造影诊断符合率为92.2%,误诊率为7.8%;甲状腺微小乳头状癌诊断符合率为91.4%,误诊率为8.6%;结甲并乳头状癌诊断符合率为53.8%,误诊率为46.2%;桥本氏甲状腺炎并乳头状癌诊断符合率为72.7%,误诊率为27.3%,χ2=45.700,不同病理类型甲状腺恶性结节的超声造影诊断有显著差异,并且其差异具有统计学意义(P<0.01)。(3)良性结节中结节性甲状腺肿诊断符合率为66.7%,误诊率为33.3%;结节性甲状腺肿合并胶原变、纤维化或乳头状增生诊断符合率为71.7%,误诊率28.3%;桥本氏甲状腺炎诊断符合率为42.9%,误诊率为57.1%,χ2值为3.973,不同病理类型甲状腺良性结节的超声造影诊断的差异不具有统计学意义(P>0.05)。结论超声造影对于甲状腺乳头状癌、微小乳头状癌及桥本背景下的乳头状癌诊断符合率较高,误诊率较低,对于结甲合并乳头状癌的诊断符合率较低,误诊率较高,不同病理类型甲状腺良性结节的超声造影诊断无明显差异。

超声造影定量分析与增强CT诊断肝细胞肝癌的对比研究

目的对比研究肝细胞肝癌(hepatocellular carcinoma,HCC)的超声造影(contrast-enhanced ultrasonography,CEUS)定量分析和增强CT(contrast-enhanced computed tomography,CECT)影像学特点,评价CEUS定量分析技术对提高HCC诊断准确性的临床价值。方法对46例可疑肝脏病灶进行CEUS定量分析、常规CEUS和CECT检查,以病理诊断为金标准,对三种方法诊断HCC的敏感性、特异性和诊断符合率进行比较。结果 CEUS定量分析技术诊断HCC的敏感性和诊断符合率明显高于常规CEUS及CECT,特异性较CEUS高(P<0.05),与CECT比较差异无统计学意义。结论 CEUS定量分析技术可明显提高HCC诊断的准确性,具有一定临床实用价值。

乳腺癌及乳腺纤维瘤超声及造影特征的对比研究

目的:探讨超声及造影特征对乳腺癌的临床诊断价值。方法:2013年1月1日至2014年12月31日在包头医学院第一附属医院住院的66例乳腺癌及85例乳腺纤维瘤患者,术前行常规超声及超声造影检查,观察肿块超声及造影特征,所有病例均经手术证实并与病理结果相对照。结果:66例乳腺癌患者与85例乳腺纤维瘤患者超声造影的开始增强时间、达峰时间、渡越时间、开始消退时间、完全消退时间相比较均有统计学意义(P<0.05);乳腺癌病灶测值明显大于造影前(P<0.05),可见穿支血管并呈快进慢出,病灶内造影剂分布不均匀,造影剂呈离心性增强,局部造影剂滞留;乳腺纤维瘤病灶测值与造影前相比较差异无统计学意义(P>0.05),可见环绕血管并呈慢进快出,病灶内造影剂分布均匀,造影剂呈向心性增强,无造影剂滞留。结论:超声及造影检查对乳腺癌和乳腺纤维瘤的鉴别诊断具有重要的指导价值。

腹部实质脏器外伤出血超声造影介入治疗的急救护理

目的探讨在超声造影（CEUS）引导下，对腹部实质脏器损伤出血进行局部注射止血剂治疗后的护理。方法分析23例急诊腹部实质脏器外伤患者灰阶超声造影引导下止血治疗的急救护理经验。对患者治疗术后第1d，第2d，第3d，第7d的生命体征监测、常规超声检查及血液血红蛋白（Hb）数值进行动态观察。结果23例患者CEUS引导注射后即刻显示无活动性出血。治疗后30min内收缩压上升至正常（P〈0.05），心率及呼吸频率恢复至正常（P〈0.05）；治疗后第3d开始Hb测值缓慢升至正常；剔除其他合并伤因素，患者平均住院日7-10d。结论CEUS引导下对腹部实质脏器外伤出血进行局部止血剂注射治疗能有效控制腹部实质脏器外伤出血。急救整体护理是保证治疗获得成功的关键之一。

Clinical diagnosis and treatment of alpha-fetoprotein-negative small hepatic lesions

Objective： We examined 103 cases over the last five years and discussed diagnosis and treatment of alpha- fetoprotein （AFP）-negative small hepatic lesions. Background： Small hepatic lesions （less than 2 cm in diameter） usually have no typical imaging characteristics and therefore are difficult to diagnose, especially when AFP tests provide a negative result. Methods： A total of 103 patients with AFP-negative small hepatic lesions from January 2003 to December 2008 were retrospectively reviewed. Differential diagnosis was performed by digital subtraction angiography （DSA）, dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI）, contrast-enhanced ultrasound （CEUS）, or positron emission tomography-computed tomography （PET-CT） based on the multiplicity of lesions. Ninety-four patients with suspected cancers underwent partial hepatectomy. Clinical data were collected from hospital records and follow-up questionnaires. Results： Hepatocellular carcinoma （HCC） diagnostic sensitivity of DSA, DCE-MRI, CEUS and PET-CT was 88.2%, 93.9%, 88.9% and 88.9%, respectively. The surgery-related complication rate was 6.4%. Prognosis was good, with 1- and 3-year survival rates of 98.8% and 76.1%, respectively. Conclusions： DSA, DCE-MRI, CEUS and PET-CT are valuable for diagnosis of small hepatic lesions. Partial hepatectomy is a preferred surgical procedure. Surgery for small liver cancers usually has little risk and good prognosis, therefore it can be actively applied in suspected HCC cases.

Advantages of contrast-enhanced ultrasound in the localization and diagnostics of sentinel lymph nodes in breast cancer

Sentinel lymph nodes(SLNs)are the first station of lymph nodes that extend from the breast tumor to the axillary lymphatic drainage.The pathological status of these LNs can predict that of the entire axillary lymph node.Therefore,the accurate identification of SLNs is necessary for sentinel lymph node biopsy(SLNB)to replace axillary lymph node dissection(ALND).The quality of life and prognosis of breast cancer patients are related to proper surgical treatment after the precise identification of SLNs.Some of the SLN tracers that have been identified include radioisotope,nano-carbon,indocyanine green(ICG),and methylene blue(MB).However,these tracers have certain limitations,such as pigmentation,radiation dangers,and the requirement for costly detection equipment.Ultrasound contrast agents(UCAs)have good specificity and sensitivity,and thus can compensate for some shortcomings of the mentioned tracers.This technique is also being applied to SLNB in patients with breast cancer,and can even provide an initial judgment on SLN status.Contrast-enhanced ultrasound(CEUS)has the advantages of high distinguishability,simple operation,no radiation harm,low cost,and accurate localization;therefore,it is expected to replace the traditional biopsy methods.In addition,it can significantly enhance the accuracy of SLN localization and shorten the operation time.