医疗差错可导致患者病情延误、加重以及医疗费用的增加.超声广泛应用于各种疾病的筛查、诊断及随访,但由于存在一定操作者依赖性及主观性,其诊断过程中所出现的认知偏倚(即在思考、判断时偏离正确或理性的分析)也不容忽视.本研究总结了超声诊断中认知偏倚所致误诊的原因.在解读声像图的过程中应认识这些偏倚所带来的影响,并尽可能避免这些影响,或将这些影响最小化,从而避免误诊.

In this study, we retrospectively reviewed the clinical and sonographic features of patients with trichilemmal cysts.

Triple-negative breast cancer (TNBC), which is a kind of aggressive breast cancer, has a much higher recurrence rate and a shorter overall survival rate than other breast cancer subtypes owing to its lack of expression of the progesterone receptor (PR), estrogen receptor (ER) and HER2. For improving the therapeutic efficacy of TNBC, we developed a new kind of multifunctional cationic porphyrin-grafted lipid (CPGL) microbubble loaded with HIF 1α siRNA (siHIF@CpMB). Owing to the amphiphilic structure of CPGL, it can be self-assembled into microbubbles (MBs) with conventional lipids and the porphyrin group could be used as a photosensitizer for photodynamic therapy (PDT), while the amino group could adsorb HIF 1α siRNA (siHIF) through electrostatic adsorption. Such MBs possess a remarkably high drug loading content and less premature drug release. Distribution of MBs could be easily monitored by real-time US imaging (3-12 MHz). Furthermore, with the assistance of ultrasound targeted microbubble destruction (UTMD), siHIF@CpMBs could be efficiently converted into nanoparticles in situ, facilitating the accumulation of porphyrin and siRNA at the tumor site through the cavitation effect. HIF 1α siRNA down-regulated the HIF 1α level, which was induced by the common hypoxic tumor environment or the ROS (generated by PDT), enhanced the PDT efficacy and partly inhibited the tumor progression. Therefore, UTMD assisted combination of PDT and gene therapy was believed to be an effective therapeutic strategy for TNBC.

目的 分析肉芽肿性小叶性乳腺炎(GLM)与乳腺导管原位癌(DCIS)的超声特征,为临床鉴别诊断两者提供影像学依据.资料与方法 选取经病理证实的63例GLM和43例DCIS患者的临床与超声检查资料,结合超声乳腺影像报告和数据系统(BI-RADS)分类方法对GLM、DCIS患者进行分类,并分析其声像图特征.结果 GLM组65个病灶中,47个病灶(72.3％)术前超声BI-RADS分类为4A类,55个病灶(84.6％)边缘模糊,43个病灶(66.2％)存在成角,51个病灶(78.5％)表现为实质回声不均匀,所有病灶均未发现钙化,38个病灶(58.5％)后方回声增强,51个病灶(78.5％)周围水肿、回声增强;DCIS组43个病灶中,13个病灶(30.2％)为4A类,28个病灶(66.7％)表现为低回声肿块,22个病灶(51.2％)存在微小钙化,所有病灶均未发现周围组织水肿.GLM组与DCIS组上述指标比较,差异均有统计学意义(P＜0.01);GLM血供比DCIS丰富,差异有统计学意义(P＜0.01).结论 超声表现有助于临床鉴别GLM与DCIS,对指导临床诊治有一定的价值.

目的:对彩色多普勒超声诊断设备进行系列体外实验、技术性能测试及临床对比评价研究,综合评估国产高端彩超的临床应用价值.方法:选取4台国产彩超(分别定义为1号机、2号机、3号机和4号机)及参照评价进口高端彩超(定义为对比机),通过体外仿血流体模进行物理技术评价,进行不同级别医院临床基本功能对比评价,将体外实验与临床对比评分结果进行权重,进行综合评估.结果:国产彩超的1号机、2号机、3号机和4号机体外实验权重后评分结果分别为96.00分、98.00分、95.00分和96.00分,对比机为100.00分;临床对比评价结果分别为347.57分、372.24分、330.90分和348.13分,对比机400.00分.结论:对4台国产彩超进行综合评价,初步得出被评价超声品牌的优劣,将结果反馈给厂家,为进一步提升国产彩超的技术性能提供参考,促进国产彩超的技术发展.

Xanthogranulomatous pyelonephritis (XGP) is an unusual form of chronic pyelonephritis in which the renal parenchyma is destroyed and replaced by lipid-laden foamy macrophages. It usually affects middle-aged women with a history of recurrent urinary tract infection, diabetes, or kidney stones. The inflammatory process is usually diffuse and can extend beyond the kidney. The rare focal forms may simulate primary renal tumours. The preoperative imaging diagnosis may be difficult. We reported five cases of XGP, The findings of ours were recorded including kidney size, shape, contour, the echogenecity of the renal parenchyma, the internal echoes of the dilate collecting system, the presence of perinephric fluid accumulation and obstruction. One of the 5 cases was a male patient, and the other four were female, with a mean age of 53 years. He affected kidneys of the 5 cases swelled in different degrees, and one of them was found with line-like anechoic fluid. Among the 5 cases, one kidney appeared as diffusely reducing of the parenchyma echogenicity, multiple hypoechoic areas, disappearance of corticomedullary differentiation and multiple hyperecho with shadow. A round cystic anechoic lesion was found in one kidney, with internal punctate echo and peripheral fluid. Ultrasonographic finding of 1 case was extremely hypoechoic lesion on the left kidney, protruding from the outline of the kidney, with the partial renal capsule discontinuous, the less clear boundary, and a little blood flow in it. Ultrasonographic demonstration of 2 cases was mild dilatation of the collecting system with irregular wall thickening and internal hypoechogenicity, and 1 case was solid lesion with less clear boundary to the pelvic wall and a small amount of blood flow signal, the another 1 case was showed floccule without internal blood flow. Three cases were caused by chronic obstruction verified by operation, of which one was staghorn calculi, one was poorly differentiated squamous cell carcinoma in the middle part of the ureter, and one was inflammatory stricture of upper ureteral. Through analysis of the above five cases and review of related literature, we explored diagnoses and management of the patients with XGP. Xanthogranulomatous pyelonephritis (XGP) is a rare chronic variant of pyelonephritis characterized by destruction of the renal parenchyma. Combining ultrasonographic features of XGP with clinical recurrent urinary infection and chronic obstruction, XGP can be included in the differentiation. The diagnosis of XGP suspected by ultrasound can be clarified by CT, MRI, contrast-enhanced ultrasound.

Multidrug resistance remains one of the main obstacles to efficient chemotherapy of colorectal cancer. Herein, an efficient combination therapeutic strategy is proposed based on porphyrin/camptothecin-floxuridine triad microbubbles (PCF-MBs) with high drug loading contents, which own highly stable co-delivery drug combinations and no premature release. The triad PCF-MBs can act not only as a contrast agent for ultrasound (US)/fluorescence bimodal imaging but also a multimodal therapeutic agent for synergistic chemo-photodynamic combination therapy. Upon local ultrasound exposure under the guidance of ultrasound imaging, in situ conversion of PCF-MBs into porphyrin/camptothecin-floxuridine nanoparticles (PCF-NPs) leads to high accumulation of chemo-drugs and photosensitizer in tumors due to the induced high permeability of the capillary wall and cell membrane temporarily via sonoporation effect, greatly reducing the risk of systemic exposure. Most importantly, it was found that the PCF-MB-mediated photodynamic therapy could significantly reduce the expression of adenosine-triphosphate (ATP)-binding cassette subfamily G member 2 (ABCG2), which is responsible for the drug resistance in chemotherapy, resulting in a prominent intracellular camptothecin increase. In vivo experiments revealed that the PCF-MBs in combination with ultrasound and laser irradiation could achieve a 90% tumor inhibition rate of HT-29 cancer with no recurrence. Therefore, such triad PCF-MB-based combination therapeutic strategy shows great promise for overcoming drug resistance of colorectal cancer and other cancers.

OBJECTIVES:To explore the best individualized systematic prostate biopsy method. METHODS:We retrospectively analyzed the clinical data of 1211 patients who underwent 12-core systematic prostate biopsy guided by transrectal ultrasound from January 2011 to March 2018. Other biopsy core methods (6-, 8-, and 10-core) were estimated from the 12-core biopsy that was performed. Differences in the detection rates of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) were compared. RESULTS:A total of 498 cases of PCa (41.1%) were detected, and 423 cases (34.9%) were csPCa. There was no significant difference between the 12- and 10-core prostate biopsy strategies in the total detection rates of PCa and csPCa (P > .05). In the subgroup of patients with a maximal prostate cross-sectional area of less than 15 cm2 , there was a significant difference between the 12-core method and the standard 6-core method (P = .03) but no significant differences between the other methods in the detection rate of PCa (P > .05), but in the detection rate of csPCa, the 12-core method differed significantly from the other methods (P = .02-.04) except for the 10-core method (P > .05). In patients with a prostate-specific antigen concentration of 20 ng/mL or higher, there were no significant differences between the 12-core method and all of the other methods (P > 0.05). In patients younger than 70 years and 70 years or older, the 12-core method differed significantly from the other methods (P < .01-.03) except for the 10-core method (P > .05). CONCLUSIONS:Ten- or 12-core biopsy showed a higher detection rate than the other schemes. However, for patients with a prostate-specific antigen concentration of 20 ng/mL or higher, the 6-core systematic biopsy is preferred.

Objective To explore the correlation factors of cervical lymph node metastasis in patients with differ entiated thyroid carcinoma.Methods The clinical and ultrasonic data of 336 patients with differentiated thyroid carcinoma confirmed by operation and pathology were retrospectively analyzed.The clinical features and ultrasonic features of primary thyroid lesions and cervical lymph node metastasis were compared.Results By single variable analysis,cervical lymph node metastasis rate was higher in patients with the follow features including age ＜45 years,male,primary thyroid tumor multifocality,tumor maximum diameter longer than 1 cm,irregular shape,the primary tumor adjacent to or invasion of thyroid capsule,abundant blood supply in tumor,and tumors located at the dorsal side of thyroid(P＜0.05).Patient age,primary tumor invasion or adjacent to the thyroid capsule and abundant blood supply in tumor were the independent risk factors for cervical lymph node metastasis of differentiated thyroid cancer by multivariate analysis(logistic regression analysis).According to OR value,the sequence of correlation was as follows,primary tumor invasion or adjacent to the thyroid capsule ＞ abundant blood supply in tumor ＞ age (younger than 45 years old).Conclusions There are some risk factors for cervical lymph node metastasis in patients with differentiated thyroid carcinoma.For the patients with high risk factors,more attention should be paid in preoperative ultrasound scanning,in order to looking for signs of cervical lymph node metastasis carefully.

The combination of camptothecin (CPT) and fluoropyrimidine derivatives acts synergistically at a 1:1 molar ratio. Practically, the greatest challenge is the development of a single liposomal formulation that can both encapsulate and maintain this drug combination at an exact 1:1 ratio to achieve coordinated pharmacokinetics. Consequently, a new type of liposome‐like nanocapsule (NC) is developed from a highly symmetric Janus camptothecin–floxuridine conjugate (JCFC) amphiphile, which is synthesized by coupling two hydrophobic CPT molecules and two hydrophilic floxuridine (FUDR) molecules to multivalent pentaerythritol via a hydrolyzable ester linkage. JCFC NCs possess remarkably high drug‐loading contents, and no premature release because of the highly stable co‐delivery of the drug combination without the need for any carrier. It is shown that JCFC NCs consistently provide synergy and avoid antagonism in a broad panel of tumor cell lines. In vivo delivery of JCFC NCs leads to longer blood retention half‐life, higher tumorous accumulation and cellular uptake of drugs, and greatly enhanced efficacy in murine tumor models compared to CPT, FUDR, and CPT + FUDR. This liposomal strategy can be extended to other hydrophilic and hydrophobic anticancer drugs that are coupled to pentaerythritol to self‐assemble into nanocapsules for drug self‐delivery, pointing to potential clinical translation in near future.

Objective To investigate the safety and efficacy of fusion of real-time US with CT images guided selective lumbosacral nerve root injection.Methods Forty patients with lumbar radiculopathy who received guided injection therapy were reviewed.They were randomly divided into fusion-Imaging guidance group(20 cases)and single-US guidance group (20 cases).Needle positioning of two groups were identified by x-ray fluoroscopy.The total puncture time and fluoroscopy times were recorded respectively.Then the sequential therapies were performed by the pain physician.Results All forty patients were successfully completed puncture.In fusion imaging group,the total time of puncture was 13-18 min,the mean (15.7±1.4) min;fusion imaging time was 4-8 min,mean (6.9±1.3) min;registration error was 3.0-5 mm,average (4.1±0.61) mm;the distance of D was 1.2-2.2 cm,average (1.60± 0.25) cm and the number of x-ray fluoroscopy were 3-5 times,mean (3.9±0.8) times.In single-US group,the total time of puncture was 9-21 min,the mean (16.4±2.6) min and the number of x-ray fluoroscopy was 4-8 times,mean (6.1± 1.1) times.For x-ray fluoroscopy there was significant difference between two groups (t =6.914,P＜ 0.001).Conclusions Fusion imaging is safe and effective for selective nerve root injection therapy for lumbosacral radiculopathy patients.

ObjectivesTo assess the diagnostic accuracy and performance of 360° endoanal sonography for preoperative evaluation of perianal fistulas using surgical results as a reference standard.MethodsBetween January 2012 and May 2016, 122 patients with suspicious anal fistulas and perianal abnormalities had real‐time endoanal sonographic examinations using a 360° cross‐sectional endoanal transducer (5–13 MHz) for preoperative evaluation of the disease. All patients underwent surgical interventions. The sonographic findings, including the fistulas and other inflammatory lesions, were correlated with surgical results. The types of fistulas on endoanal sonography were compared with the surgical classification of Parks et al (Br J Surg 1976; 63:1–2), and the internal opening of the fistula on endoanal sonography was confirmed by surgical results as a reference standard.ResultsThe 122 patients studied included 111 male and 11 female patients. Endoanal sonography was able to show and track hypoechoic lesions, their locations, and internal openings of the fistulas. Compared with surgical results, endoanal sonography had sensitivity of 92.2%, specificity of 100%, and accuracy of 93.4% for the diagnosis of perianal fistulas. Also, endoanal sonography had accuracy of 87.4% for determining fistula types based on the Parks classification and 94.6% for identifying internal openings of the fistulas.ConclusionsEndoanal sonography is an accurate and noninvasive imaging modality for evaluation of fistulas. It is a very useful tool for preoperative management and surgical planning by providing precise and detailed information on fistulas.

Nanoparticles (NPs)-based diagnosis and phototherapy are emerging as the cutting-edge technologies for detection and treatment of cancer but their applications are still limited since insufficient and heterogeneous NPs accumulation in cancer often causes recurrence. To overcome these limitations, multifunctional microbubbles (MBs) were constructed with 1, 1-dioctadecyl-3, 3, 3, 3-tetramethylindotricarbocyanine iodide (DiR) and porphyrin grafted lipid (PGL). Both DiR and PGL self-assembled as microbubbles, the as-designed PGL-DiR MBs possess remarkably high drug loading contents (5.8% PGL and 10.38% DiR) and stable co-delivery drug combinations. In vivo experiments showed PGL-DiR MBs could serve as an excellent ultrasound contrast agent to enhance ultrasound imaging greatly for identifying the location and size of the tumors. Upon exposure to ultrasound, in situ conversion of PGL-DiR MBs into nanoparticles resulted in a remarkable increase in fluorescence intensity (similar to 5 folds) in tumor compared with PGL-DiR NPs, validating the enhanced tumor accumulation and cellular uptake of therapeutic agents. PGL-DiR MBs showed complete tumor ablation without recurrence in vivo, while PGL-DiR NPs showed only 72.6% tumor growth inhibition at the same dose. We believe that PGL-DiR MBs will soon reach their full potential as an important class of phototherapeutic formulations and will contribute to remarkable advances in cancer treatments.

桥本甲状腺炎(HT)合并甲状腺结节患者日益增加.超声对HT背景下甲状腺结节良恶性鉴别诊断有重要价值,本文对近年来超声对其诊断的声像图特征做一综述.

[Summary] This paper reported a patient suffering from hemorrhage after percutaneous liver biopsy treated by contrast enhanced ultrasound-guided percutaneous injection of thrombin in June 2015.Firstly,we performed contrast-enhanced ultrasound examination to find the position of active bleeding.And then,percutaneous injection of thrombin was performed under the guidance of ultrasonography.The active bleeding was stopped successfully.

目的 分析前列腺12点穿刺中12点、10点、8点、改良及经典6点法的前列腺癌的检出率,探讨合理的个体化穿刺活检方案.方法 回顾性分析我院行经直肠超声引导下前列腺12点系统性穿刺活检的病例共1 092例.分析不同PSA水平及前列腺大小时不同点数穿刺方案前列腺癌检出率的差异.结果 共检出前列腺癌447例.总体前列腺癌检出率中12点穿刺法与10点差异无统计学意义,但P值接近临界值(P=0.065),12点与其他穿刺法差异均有统计学意义.前列腺最大横断面面积＜15 cm2时采用12点穿刺法与10点、8点、改良6点差异无统计学意义,与经典6点穿刺法的差异有统计学意义.PSA≥20 ng/ml时,采用12点穿刺法与其他各种穿刺法之间的差异均无统计学意义.前列腺最大横截面面积≥15 cm2及PSA＜20 ng/ml时12点与其他穿刺法差异均有统计学意义.结论 对于前列腺最大横断面面积＜15 cm3的病例可采用改良6点穿刺法,PSA≥20 ng/ml的病例可采用6点穿刺法,其余病例可采用12点穿刺法.

Subharmonic imaging (i.e., receiving signal at half the transmitting frequency) is a promising technique to detect ultrasound contrast agents in the circulation. The aim of this study was to characterize the subharmonic enhancement of four new microbubble formulations (MBF-1 to 4), compared with three commercially-available contrast agents (Definity, Sonazoid and SonoVue), and to compare this subharmonic enhancement with the fundamental response. The new microbubble formulations consisted of either C3F8 or 2% C 3 F 8 and 98% N 2 as the inner gas, and had different shell configurations containing polyethylene glycol 4000. Equal concentrations of each reconstituted contrast agent were investigated in vitro using a flow phantom. Radiofrequency data were acquired at four transmitting frequencies (2.5, 3.0, 3.5 and 4.0 MHz), four pulse-inversion configurations (1-4 cycles/pulse) and four scanner acoustic output levels (25, 52, 77 and 100%). Enhancement was derived as the relative increase in signal amplitude after contrast was added. Subharmonic enhancement of the new microbubble formulations were generally less affected by transmitting frequency, pulse length and acoustic output level than the commercially-available contrast agents (p <; 0.05 was considered statistically significant for main and interaction effects). Mean subharmonic enhancement over all transmitting conditions for the new microbubble formulations (MBF-1 8.4 ± 4.0; MBF-2 8.5 ± 3.8; MBF-3 6.5±3.1; MBF-4 7.5±3.2 dB) were within the range exhibited by the commercially-available contrast agents (Definity 6.1±3.4; Sonazoid 7.0±3.4; SonoVue 10.7±3.2 dB). The subharmonic enhancement was similar to or higher than the fundamental response across all contrast agents investigated. Subharmonic imaging may be applied to detect the new microbubble formulations in future work.

Objective:To discuss clinical application of domestic and imported color Doppler ultrasound scanners in breast ultrasonography and the feasibility of domestic color Doppler ultrasound in different level hospitals.Methods: To make contrast evaluation of images of subjects in breast ultrasonography in the seven hospitals and give a mark.Results: Each hospital has 30 cases, so there are 210 cases in 7 hospitals. The evaluation scoring results of four domestic color Doppler ultrasound instruments are 59.17(No.1 instrument), 64.60 (No. 2 instrument), 59.86(No.3 instrument) and 60.67(No.4 instrument). The result of contrast instrument is 70.0. So the differences are statistically significant compared with the contrast instrument (t=2.41,t=2.93,t=3.11,t=3.08;P<0.05). Conclusion:Domestic color Doppler ultrasound instruments can meet the needs of breast ultrasonography and other routine work in primary hospitals.

随着超声医学的发展，超声影像学技术渗透到临床各个科室。对大多数外周血管疾病，超声检查可以取代有创的数字化血管造影（DSA）；对妇产科疾病和心血管疾病等临床诊断起着越来越重要的作用。同时，超声医学正在从形态学评价向功能学评价发展，由诊断学向治疗学发展，尤其是靶向治疗等更广阔的领域发展。