OBJECTIVES:To assess the value of ultrasonography (US) features for determining the malignant potential of complex cystic lesions.METHODS:Seventy-nine complex cystic lesions were reviewed retrospectively. They were classified into four types according to US features in type I, the masses have a thick outer wall, thick internal septa, or both; in type II, the masses are an intracystic type with one or more discrete solid mural lesions within a cyst; in type III, the masses contain mixed cystic and solid components and are at least 50% cystic portion in a mass; in type IV, there are predominantly (at least 50%) solid masses with eccentric or central cystic foci. Positive predictive values were calculated for all types.RESULTS:The frequency of malignancy was higher among type III and IV lesions than among the other two types. Lesions with a diameter greater than or equal to 20 mm, margins not circumscribed, resistance index greater than or equal to 0.7, and axillary abnormal nodes had a high probability of malignancy.CONCLUSIONS:US is an important adjunct to evaluate the malignant potential of complex cystic lesions.

ObjectiveTo investigate the diagnostic value of endorectal ultrasonography in rectal tumors with sterile coupling gels filling the rectum.MethodsSixty patients with rectal tumors underwent endorectal ultrasonography with sterile coupling gels filling the rectum. The ultrasound findings were compared with histological diagnosis.ResultsThere were 8 patients with rectal adenoma, 40 patients with rectal cancer and 12 patients with rectal stromal tumors.The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of endorectal ultrasonography for rectal tumors was 7.27%, 100%, 100%, 94.2%, 95.0%, respectively.ConclusionEndorectal ultrasonography with sterile coupling gels filling the rectum is a valuable diagnostic method for rectal tumors and to provide reference for clinical management.

Objective To investigate the diagnostic value of ultrasound in thyroid cancer in children.Methods The ultrasonographic features of 27 patients with renal metastases confirmed by biopsy or surgical pathology or follow up were reviewed.Results A total 33 cases of the kidney were identified in the 27 patients.19 of these 33 cases were both unilateral and solitary;2 were unilateral and diffuse,and the rest 12 cases were bilateral and multiple.73.7％ (14/19) of solitary lesions were located at either pole of the kidneys.22 cases were detected by ultrasound and 11 cases were missed.The rate of missed diagnosis was 33.3％.The renal metastases were more often irregular shape(13/22),ill defined(15/22),exophytic(13/22),higher or close to the echo of the renal cortex(20/22),heterogenous(18/22),with or without cystic degeneration(12/22).There was no significant difference in the sonographic features of renal metastases derived from lung cancer and esophageal cancer.Conclusions In the detection and diagnosis of renal metastasis,ultrasound has certain limitations.Thus,as for the new renal lesion in patients with a history of primary tumor,we should be vigilant the possibility of metastasis.

Objective To investigate the value of ultrasonography in the diagnosis and differential diagno-sis of lymphoma and stromal tumor of the small intestine. Methods The clinical characteristics and ultrasound findings of 36 patients with small intestine lymphoma and 69 patients with small intestine stromal tumor confirmed pathologically in Cancer Hospital of Chinese Academy of Medical Sciences between January 2009 and January 2016 were retrospectively analyzed and compared. Results There were statistically significant differences in echotexture,presence of echoless area,intratumoral gas,and ultrasonographic pattern between small intestine lymphoma and small intestine stromal tumor( all P ﹤0. 001 ),whereas no statistically significant difference in clinical characteristics,lesion size,contour,or lobulated mass. On ultrasound,small intestine lymphoma mainly demonstrated as infiltrative or mass-forming type,with homogeneous echotexture without cystic necrotic area;while small intestine stromal tumor demonstrated as mass-forming type with heterogeneous echotexture and cystic necrotic area. Conclusions Lymphoma and stromal tumor of the small intestine both have some characteristic ultrasound features,the difference between which may help in the diagnosis and differential diagnosis of these two conditions.

Objective To investigate the value of ultrasonography (US) in estimating the risk of malignancy in small intestinal stromal tumors. Method The US features were evaluated retrospectively in 55 patients with patholog-ically and immunohistochemically confirmed small intestinal stromal tumors, who were divided into high-risk (n =44), moderate-risk (n = 3), and low-risk (n = 8) of malignancy groups based on mitotic activity, location and size of the tumors. The US features included tumor size, lobulation, heterogeneity, cystic change, hyperechoic foci, calcifica-tion and color Doppler flow. The correlation of US features with the risk of malignancy was evaluated using either Fisher ’s exact test or ANOVA. Result The maximum diameter of the tumors was 3.5 - 28.0 cm, and the mean di-ameters of tumors were 4.3 cm, 7.2 cm, 11.2 cm in low-, moderate-, and high-risk groups, respectively. The propor-tions of heterogeneity, lobulation, cystic change in low-risk group were less than that of moderate- and high-risk group (25% vs 100.0% vs 88.6%, 37.5% vs 100.0% vs 86.4%, and 25.0% vs 66.7% vs 81.8%), indicating a correla-tion with the risk of malignancy (P < 0.05). Tumor size, heterogeneity, lobulation and cystic changes differed signifi-cantly among groups (P < 0.05). Hyperechoic foci appeared more in moderate- (1/3, 33.3%) and high-risk group (8/44, 18.2%) than in low-risk group (0/8, 0); and abundant color signals were more frequent in high-risk group (17/44, 38.6%) than in intermediate-risk group (1/8, 12.5%) and low-risk group (0/8, 0), but without significant difference. Conclusion Certain US features are associated with increased risk of malignancy in small intestinal stromal tumors.

OBJECTIVE To investigate the value of ultrasonography in diagnosis of carotid body tumor. METHODS We retrospectively analyzed the sonography imaging data of carotid body tumor in 29 cases(32 nodules). RESULTS There were 29 cases with 32 nodules in total. Of them, 26(89.7%) cases were single, the other 3(10.3%) were bilateral. All of these nodules were detected by ultrasonography, 31 were diagnosed as carotid body tumor, and the other one was misdiagnosed as schwannoma. The diagnostic accordance rate of the ultrasonography was 96.9%(31/32). Twenty-seven(84.4%) nodules were located at the carotid artery bifurcation, and 5(15.6%) nodules were located posterior to the bifurcation. As for the margins, 30(93.8%) nodules were well-circumscribed,and the other 2(6.2%) were ill-def ined. Thir t y one(96.9%) nodules were regular shapes,and one(3.1%) nodule was irregular with a lobulated shape. All nodules were hypoechoic with heterogenic texture, and 29(90.6%) nodules had tortuous tubular structures inside. The angles of the carotid artery bifurcation were enlarged caused by compression of the tumors in 27(84.4%) nodules, while the angles presented nor mal in 5(15.6%) nodules. Internalcarotid artery and external carotid artery were found pass though the nodules in 23(71.9%) lesions or along their margins with encasement in 9(28.1%) lesions. All nodules showed abundant vascular supply. CONCLUSION Sonography imaging has certain characteristics on carotid body tumor, and could be used as valuable method for diagnosis of carotid body tumor.

目的 探讨超声造影对甲状腺微小实性结节良恶性鉴别诊断的价值.方法 回顾分析113例(126个结节)经手术病理证实的甲状腺微小实性结节患者的超声造影特征,评估其诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值及约登指数.结果 126个微小实性结节中,恶性结节74个(58.7％),良性结节52个(41.3％).74个甲状腺微小恶性结节超声造影特征多表现为:向心性(67.5％)、不均匀性(83.8％)、低增强(82.4％)、慢进同出(66.1％)、周边等增强(93.2％),超声造影诊断甲状腺微小恶性结节的敏感性、特异性、准确性、阳性预测值、阴性预测值、约登指数分别为62.2％、96.2％、76.2％、95.8％、64.1％、58.4％;52个甲状腺微小良性结节超声造影多表现为周边环状高增强(63.5％).结论 超声造影对甲状腺微小实性结节的良恶性鉴别诊断有较高的应用价值.

Objective To evaluate the performance of ultrasonography (US) for the preoperative staging of papillary thyroid carcinoma (PTC). Methods One hundred and twenty-one patients with cytologically proven PTC were prospectively collected. Patients were recruited at the Chinese Academy of Medical Sciences Cancer Hospital from January 2014 to November 2014. Preoperative US was performed for the evaluation of primary tumor size, extrathyroidal extension and neck lymph node metastasis according to the 6th UICC TNM staging system. Results The sensitivity, specificity, positive predictive value (PPV) and negative predicative value (NPV) of US in predicting extrathyroidal extension were 89.6%(60/67), 72.2%(39/54), 80.0%(60/75), 84.8%(39/46), respectively. The accuracies of preoperative US for T1, T2, T3, T4 stage were 75.0%(36/48), 100%(1/1), 81.9%(59/72), 0, respectively. The sensitivity, specificity, PPV, and NPV of US in predicting neck lymph node metastasis were 47.5%(29/61), 90.0%(54/60), 82.9%(29/35), 62.8%(54/86), respectively. Conclusion Ultrasonography is a feasible tool for preoperative staging of PTC and is helpful for accurate prediction of extrathyroidal tumor extension and lateral neck lymph node metastasis.

目的 探讨儿童甲状腺癌的超声特点及诊断价值.方法 回顾性分析44例经病理证实的儿童甲状腺癌超声表现.结果 儿童甲状腺癌声像图表现为3种类型:结节性病灶(77.3％)、结节性病灶合并腺叶弥漫性病变(6.8％)、腺叶弥漫性病变(15.9％).结节多表现为形态不规则(54.3％)、边界不清晰(63.0％)、周边无声晕(97.8％)、低回声(91.3％)、回声不均匀(82.6％)、内见微小钙化(82.6％)、以Ⅲ型血流为主(82.6％).微小钙化为儿童甲状腺癌最具特征声像图表现.结论 儿童甲状腺癌声像图典型,超声是其首选的有效影像学检查方法.

目的 探讨超声对原发性小肠淋巴瘤的诊断价值.方法 对29例原发性小肠淋巴瘤的声像图特征和病理结果进行对照分析.结果 单发13例,多发16例,位于回肠者最多.声像图分为4型:浸润型(5例)、肿块型(13例)、肠系膜型(2例)、混合型(8例);29例均为非霍奇金淋巴瘤,B细胞淋巴瘤26例,T细胞淋巴瘤3例.超声诊断准确度75.9％.结论 原发性小肠淋巴瘤超声表现具有一定特点,超声检查在其诊断中具有较高价值.

PurposeTo compare the diagnostic performance of contrast-enhanced ultrasound (CEUS) with MRI for complex cystic renal masses.MethodsThe study received approval from our Ethics Committee, and all subjects provided informed consent. Seventy-one complex cystic renal masses were assessed using CEUS and MRI in 59 patients (44 men and 15 women; age range, 21-78 years; mean age, 49.6 years). The masses were classified as malignant or benign based on the Bosniak classification system (benign, categories II and IIF; malignant, categories III and IV). The diagnostic performances of CEUS and MRI for complex cystic renal masses were compared with the final diagnosis in each case obtained by histopathology (n=43) or imaging follow-up (n=28).ResultsAmong 71 complex cystic renal masses, 35 were benign and 36 were malignant. The sensitivity, specificity, and overall accuracy of CEUS in assessing the masses were 97.2%, 71.4%, and 84.5% versus 80.6%, 77.1%, and 78.9% for MRI; the areas below the receiver operating characteristic curves of CEUS and MRI were 0.84 and 0.79, respectively. The agreement between the classification using CEUS and the final diagnoses was fair to good (=0.70), and the agreement between MRI and the final diagnoses was also fair to good (=0.58).ConclusionsCEUS has higher diagnostic sensitivity and accuracy but lower specificity than MRI for classifying complex cystic renal masses. (c) 2014 Wiley Periodicals, Inc. J Clin Ultrasound43:203-209, 2015

目的 分析乳腺复杂囊肿声像图特征及钼靶BI-RADS分级并与病理对照,为临床提出进一步处理意见.方法 回顾性分析乳腺复杂囊肿患者56例,共58个病灶.根据病灶内部囊性、实性成分比例和分布特点将其分为四型,计算每一类型恶性病灶阳性预测值,同时分析病灶的卢像图特征,包括大小、边界、血流和阻力指数、钙化、腋下淋巴结并对这些病灶的良恶性行钼靶BI-RADS分级,用多元线性回归方法分析这些因素与恶性病灶的相关性.结果 58个复杂囊肿中,Ⅰ型11个(19.0％),Ⅱ型14个(24.1％),Ⅲ型13个(22.4％),Ⅳ型20个(34.5％),阳性预测值分别为9.0％、28.6％、53.8％和55.0％,且各类型间阳性预测值有显著性差异,P=0.04,Ⅲ型和Ⅳ型阳性预测值明显高于Ⅰ型和Ⅱ型.病灶≥2.0 cm、边界不清、探及血流且阻力指数≥0.7及钼靶BI-AIDS分级与恶性复杂囊肿间有明显相关性,相关系数分别为0.238、0.501、5.361及0.234,P值分别约0.035、0.007、0.001及0.039.腋下淋巴结、钙化与恶性病灶无明显相关性.结论 乳腺复杂囊肿超声分型、声像图特征并结合钼靶BI-AIDS分级有助于影像科医师评估其良恶性,进而为临床提出相应处理意见.

目的:探讨肾上腺皮质大腺瘤的影像学及病理学表现,以提高对该肿瘤的认识.资料与方法:回顾性分析我院自2006年1月-2012年8月经手术及病理证实的肾上腺皮质大腺瘤(直径大于4.0 cm)的影像学及病理学资料,共12例,全部病例均行MRI和超声检查,MRI检查包括平扫及多期动态增强扫描,其中4例患者行CT平扫及增强检查.结果:12例肾上腺大腺瘤患者,其中男5例,女7例,年龄25～72岁,平均(42±17.4)岁.均为单侧单发,位于左侧肾上腺6例,右侧肾上腺6例.肿瘤直径4.0～8.8 cm,平均(5.5±1.6)cm.MRI表现:12例肿物均边界清晰,2例信号均匀,10例信号不均匀,T2WI均呈等-高信号,T1WI以等-低信号为主,3例T1WI见少许斑片状稍高信号;3例T1WI正相位见斑片状高信号,反相位信号有减低.动态增强扫描10例呈渐进性填充样强化,2例呈均匀强化.声像图表现:12例肿物均为边界清晰,有包膜,10例内部回声不均,呈等-低或等-高回声,2例呈均匀低回声.CT表现:4例均表现为肿物密度不均,其中3例见粗大钙化,2例内见少量脂肪成分,2例肿物中心见不规则低密度区.病理学表现:12例肿瘤均有完整包膜.2例质地均匀,7例内部呈结节状,伴粗大纤维分隔;3例肿物内见钙化;3例见囊变;3例肿物内出血;2例肿物中心坏死;3例含脂质成分.结论:肾上腺皮质大腺瘤影像具有体积大、包膜完整,成分复杂,可伴纤维化、钙化、出血、囊变、坏死,而脂质含量少等特点,增强扫描动脉期和静脉期呈渐进性填充样强化,延迟期强化程度减低.以上影像学及病理学特点均与常见肾上腺腺瘤表现不同,因此在日常工作中应提高对该病的认识.

Objective To analyze the sonographic ifndings of large adrenal cortical adenoma. Methods The sonographic characteristics of thirteen cases of large adrenal cortical adenoma (diameter≥4.0 cm) which were diagnosed by surgery from January 2006 to August 2012 were retrospectively reviewed. Results In all cases, the adenomas had distinct margins. The mean size of lesions was (5.5±1.6) cm, ranging from 4.0 cm to 8.8 cm. On echotexture, three lesions were homogeneous and the remaining ten lesions were heterogeneous. In addition, seven contained hypoechoic nodules and hyperechoic septum, three had anechoic area, three had extremely hyperechoic area with acoustic shadow, and two had patchy hyperechoic area. On Doppler, most lesions had no lfow signal. Conclusions Large adrenal adenomas have complete capsule and heterogeneous internal echoes with septum, calciifcation, necrosis and hemorrhages. These characteristics are less frequently seen incommon adrenal adenoma, therefore may be helpful in recognition of large adrenal adenoma in clinical practice.

A 31-year-old male presented with a palpable abdominal mass discovered by himself incidentally without any symptoms. He has no previous systemic disease. Physical examination revealed a large and firm mass in lower abdomen without tenderness. Laboratory test was not remarkable.

Our purpose was to study the accuracy of using endorectal ultrasonography (ERUS) with sterile coupling gels filling the rectum in the preoperative T-staging of rectal carcinoma. A total of 189 patients with confirmed rectal carcinoma were recruited. All underwent ERUS and surgery within the week following sonography. EURS was performed by introducing sterile coupling gel into the rectum. Two radiologists looked at the images at the same time and agreed upon staging. Rectal carcinoma was staged from Tis to T4. The accuracy of T-staging by ERUS was 89.95%. The sensitivity, specificity, PPV and NPV for ERUS at different stages were calculated. For early stage (Tis and T1), these values were 93.62%, 97.89%, 93.62% and 97.89%, respectively. ERUS filling with sterile coupling gel in the rectum overcomes the pressure effect from a water bath and the restriction caused by tumor stenosis, thus, greatly improving the accuracy of T-staging. The examination is real-time, safe and inexpensive.

A 53-year-old man was admitted to hospital manifested with bloody stool for a month without other symptoms. Colonoscopy found a cauliflower-like mass in anterior rectal wall. The distance of the tumor lower margin from the anal verge was 5 cm. Biopsy pathology results showed adenocarcinoma.

Papillary thyroid microcarcinoma (PTMC) is a malignant thyroid tumor of less than 1 cm in size. Ultrasound (US) is the preferred imaging modality for PTMC. This study retrospectively evaluated the US results from 113 consecutive cases of PTMC with 127 nodules and correlated the results with the histopathologic findings. The results showed none of the PTMC nodules had a cystic element. Half of the PTMC nodules had a well-defined boundary and the remaining half had an ill-defined boundary. A percent (6.3%) of the nodules had a halo sign. Microcalcification was present in approximately half of the PTMC nodules. The cancerous tissue with a papillary structure was hypoechogenic and the amount of fibrous stroma determined whether the nodule echogenicity was heterogeneous or homogeneous. Heterogeneous echogenicity was associated with a fibrous stroma proportion of >20%. Only PTMC nodules with predominantly follicular structures containing a large proportion of colloid demonstrated isoechogenicity. Well-defined boundaries on US were associated with well-defined histologic margins, with or without the presence of an intact fibrous pseudo-capsule. A halo sign with a well-defined boundary detected by US was associated with the presence of an intact fibrous pseudo-capsule. Half of the PTMC nodules with ill-defined boundaries exhibited infiltration into the surrounding thyroid tissue, while the remaining half of the PTMC nodules with ill-defined boundaries on US presented irregular nodule margins by histology, rather than nodule infiltration. Psammoma bodies detected at a frequency ≥5 per ×200 microscopic field of view were detectable on US as microcalcifications.