Objective:To explore the high-frequency ultrasonographic and clinical features of superficial intravascular tumors.Methods:Thirteen superficial intravascular tumor patients who underwent ultrasound examination form Beijing Jishuitan Hospital during 2016-2020 were retrospectively analyzed. The location, anatomic blood vessels, shape, size, boundary, internal echo, blood flow and clinical characteristics of the tumors were analyzed.Results:Among the 13 cases, most of the tumors were oval like or long strip, and a few were round like. All 11 cases of primary intravascular tumors showed hypoechoic mass; 2 cases of intravascular metastasis or recurrence showed solid hypoechoic with hyperechoic mass. Arterial blood flow spectrum was detected in 12 cases. Two patients with glomus tumor showed typical tenderness at the fixed point. Two patients had a history of bone tumors in the upper or lower extremities.Conclusions:High frequency ultrasound can clearly recognize the location of the superficial intravascular tumors, describe the morphological characteristics and sonographic features of the tumor, then help to make a more accurate qualitative diagnosis.

患者女,67岁,因"右下肢包块渐大半年"就诊我院骨肿瘤科,无疼痛无活动受限等不适.超声所见:右大腿内侧肌层见实性低回声肿物,大小约16.2 cm×8.7 cm×5.8 cm,形态欠规则,边界不清,与肌纹理相延续,内回声不均,可见肌纹理样及腱膜回声,突破深筋膜侵犯皮下脂肪,见图1,可见丰富血流信号,并测得高速动脉频谱.右腹股沟多发肿大淋巴结,大者约3.4 cm×1.2 cm,血流较丰富,超声提示:右大腿肌层实性肿物并右腹股沟淋巴结肿大,考虑恶性病变,不除外淋巴瘤软组织侵犯.

Purpose An automatic evaluation technology based on artificial intelligence and three-dimensional ultrasonography (3D US) is proposed for hip US inspection plane selection. This study aimed to evaluate the consistency of the alpha angle as measured using 3D US to select the section plane and two-dimensional ultrasonography (2D US) to manually select the Graf image, as well as to explore the feasibility of diagnosing developmental dysplasia of the hip (DDH) using 3D US and reconstruction technology. Methods A total of 216 infant hips were included and assessed by doctors using 3D US layer-by-layer. The researchers used a computer to identify the coronal images that met the Graf standard and then compared the alpha(X) values obtained with the alpha(G) values measured artificially by 2D US. Results Compared with 2D US, 3D US more clearly showed the relative positions of the ilium, ischia, and pubis. The measured alpha value of the optimal section obtained by 3D US showed good agreement with the measured alpha value of the standard Graf section. Conclusion The artificial intelligence and 3D US-based automatic evaluation technology for section selection and inspection for DDH showed good agreement with the Graf method based on standard sections.

目的 探讨超声筛查发育性髋关节发育不良(DDH)应用“婴儿髋关节超声检查固定床架”的实用性.方法 对100例婴幼儿筛查DDH,按Graf法检查标准,甲、乙两组不同水平医师在使用床架的方式下,乙组同时在无床架的方式下,分别对同一婴儿进行检查,以甲组测值为金标准,以200髋a角及检查时间为评价指标,将乙组测值及检查时间分别与甲组对比分析.结果 配对样本t检验差异无统计学意义(P＞0.05);差值Biand-Altman分析,甲乙有床架测值组之间的一致性优于无床架组;有床架组检查时间少于无床架组.结论 使用床架进行超声筛查DDH,提高了测量的准确度,检查时间缩短,实用性强.

患者女,27岁,7年前发现右颈部拇指大小肿物,无疼痛,不伴右上肢麻木,进行性增大,右手伸指渐困难;既往无特殊疾病.查体:右肩关节及肘关节活动度正常,右掌指关节屈曲畸形,右手内在肌萎缩;右尺侧腕伸肌、指伸肌、拇长伸肌、拇长展肌及拇短伸肌肌力0级.超声:右锁骨上区臂丛神经走行处7.6 cm×7.0 cm×4.2 cm不均匀低回声实性肿物(图1A),边界尚清,可见囊性结构,内见少量血流信号;右侧桡神经主干及深支多发梭形低回声肿物(图1B),最大5.0 cm×2.5 cm×1.5 cm,呈长约10.5 cm串珠样排列,边界清,内见少量血流信号;考虑右侧臂丛神经和桡神经神经源性肿瘤.

发育性髋关节发育不良(developmental dysplasia of the hip,DDH)是髋臼发育不良、髋关节半脱位及髋关节脱位疾患的统称[1].20世纪80年代之前,该疾病被称为先天性髋关节脱位,由于该疾患与生长发育密切相关,1992年北美骨科年会将其更名为DDH.DDH是小儿骨科最常见的髋关节疾患,出生后髋关节脱位发生率为1‰～2‰,地域间有差异性.DDH的发病有其内在因素和外在因素,其中臀位产是最为确定的诱因.此外,家族史、头胎、孕期羊水过少、襁褓等也被认为是可能影响DDH的危险因素[1].

目的 探讨肢体横纹肌肉瘤的超声诊断价值.方法 回顾性分析经手术病理确诊的22例肢体横纹肌肉瘤患者的临床、超声及影像学结果.结果 22例肿瘤病理分型:腺泡性19例,胚胎性2例,多形性1例.病变均位于肌层,其中大腿5例,小腿6例,上臂2例,前臂3例,手部6例.9例肿瘤呈不规则形,7例呈椭圆形,6例呈分叶形,22例肿瘤均未见明显包膜,13例边界清晰,9例肿瘤边界不清.肿瘤内部均表现为实性不均匀低回声,其中17例肿瘤内可见类似肌纤维纹理样高回声,4例肿瘤内可见液化坏死区,肿瘤内均未见钙化.多数肿瘤血流信号丰富(n = 20).频谱多普勒示肿瘤内部动脉阻力指数(RI)为0.77±0.09.结论 肢体横纹肌肉瘤的超声表现具有一定特征性,能为临床诊断提供重要信息.

Objective:To measure the pubo-femoral distance of hips of the infants diagnosed with Graf type Ⅰ by high frequency ultrasound.Methods:A total of 1 084 infants(2 168 hips) diagnosed with Graf type Ⅰ by ultrasonography were collected in Beijing Jishuitan Hospital from June 2019 to May 2020. The ultrasonographic examinations included Graf method and pubo-femoral distance measurement. The 95% medical reference value was adopted to confirm range of normal values of the pubo-femoral distance. And the differences of the pubo-femoral distance between different gender, age and bilateral hip were compared.Results:The pubo-femoral distance of hips diagnosed with Graf type Ⅰ was (0.27±0.06)cm, the pubo-femoral distance of males was(0.27±0.06)cm, the pubo-femoral distance of females was (0.27±0.07)cm. The 95% medical reference value was 0.15-0.38 cm. The 95% medical reference value of males was 0.15-0.39 cm, and the 95% medical reference value of females was 0.13-0.41 cm. There were no significant differences between the sexes or between the age(all P>0.05). The difference between the bilateral hip joints from the same infant was statistically significant[(0.274±0.064)cm vs (0.265±0.064)cm, P<0.05]. Conclusions:The 95% medical reference value of hip diagnosed with Graf type Ⅰ is 0.15-0.38 cm.

Background: Although plain radiology is the primary method for assessing joint space width (JSW), it has poor sensitivity to change over time in regards to determining longitudinal progression. We, therefore, developed a new ultrasound (US) measurement method of knee JSW and aimed to provide a monitoring method for the change of JSW in the future. Methods: A multicenter study was promoted by the Professional Committee of Musculoskeletal Ultrasound, the Ultrasound Society, and the Chinese Medical Doctor Association. US study of knee specimens determined the landmarks for ultrasonic measurement of knee JSW. The US of 1,272 participants from 27 centers was performed to discuss the feasibility and possible influencing factors of knee JSW. The landmarks for US measurement of knee JS, the inflection point of medial femoral epicondyle and the proximal end of the tibia, were determined. Results: The mean knee JSW1 (medial knee JSW) was 8.57 +/- 1.95 mm in females and 9.52 +/- 2.31 mm in males. The mean knee JSW2 (the near medial knee JSW) was 9.07 +/- 2.24 mm in females and 10.17 +/- 2.35 mm in males. The JSW values of males were significantly higher than those of females, with a statistical difference. JSW values were negatively correlated with age and body mass index (BMI) to different degrees and positively correlated with height. Conclusions: The novel US measurement method can be used to measure knee JSW.

目的 探讨超声对臂丛神经转移性肿瘤的诊断价值.方法 回顾分析30例病理结果为臂丛神经转移性肿瘤的超声检查结果,总结超声图像特征.28例有明确恶性肿瘤手术病史,于我科就诊时间平均距原发肿瘤手术7.8年,2例无明确肿瘤病史.结果 30例患者中超声图像表现为软组织肿块25例,包绕臂丛神经根部或干部9例,位于锁骨下区包绕臂丛神经束部16例,肿块最大6.4 cm×6.4 cm×4.8 cm,最小1.9 cm×1.8 cm×1.7 cm,均呈不均质实性低回声,形态不规则,12例乳腺癌病灶中可见沙砾样钙化.5例超声图像仅表现为臂丛神经增粗,回声减低,正常神经束组结构消失.7例病灶周围可见多发异常增大淋巴结,5例周围肌层内可见多发肿瘤浸润病灶.结论 对于有明确恶性肿瘤病史并出现臂丛神经损伤症状的患者,超声可以作为首选的影像学检查方法,其对于臂丛神经转移性肿瘤较高诊断价值.

目的 探讨不同病理分型的肢体脂肪肉瘤的超声表现,为临床诊断治疗提供参考性建议.方法 对我院手术病理证实的47例肢体脂肪肉瘤的临床资料进行回顾性分析,总结不同病理分型脂肪肉瘤的超声图像特点.结果 47例肢体脂肪肉瘤中,高分化型19例,去分化型10例,黏液样11例,多形性7例.高分化脂肪肉瘤以高回声为主,大部分边界不清、可见细线状分隔、病灶血供不明显或较少.去分化脂肪肉瘤以低回声为主,部分肿物呈高、低回声混合,两种回声之间分界清,大部分肿物边界不清、血供较丰富.黏液样脂肪肉瘤多呈低回声,部分与高回声混杂、内可见细线状分隔,大部分肿物边界清、血供较丰富,液化较常见.多形性脂肪肉瘤多呈低回声,部分与高回声混杂、内可见细线状分隔,大部分肿物边界清、血供较丰富.除多形性脂肪肉瘤,其余三种病理分型均可见钙化.结论 不同病理分型的脂肪肉瘤的超声表现有一定特征性,能够为临床诊断、鉴别诊断及治疗提供较重要参考依据.

目的 通过婴儿髋屈曲外展位髋内侧超声声像图表现,探讨在婴儿发育性髋关节发育不良(DDH)挽具治疗中,应用超声评估股骨头复位情况的临床应用.方法 收集在我院就诊32例单侧髋关节脱位的DDH患儿,即患侧经Graf法诊断为Graf D、Ⅲ、Ⅳ型,健侧诊断为Graf Ⅰ型.应用挽具治疗,髋屈曲外展位髋内侧超声观察髋关节解剖结构,评估股骨头与髋臼的位置关系.结果 通过超声检查单侧髋关节脱位患儿的健侧髋,即挽具治疗前超声诊断为Graf Ⅰ型,展示髋屈曲外展位髋内侧超声的正常髋关节相关解剖结构及声像图表现.同时,规定具体操作步骤及其超声切面,提高检查的可重复性.结论 佩戴挽具治疗婴儿DDH的过程中,髋屈曲外展位经髋内侧行超声检查可以清晰显示并识别髋关节相关结构,有助于临床评估股骨头与髋臼的对位关系.

Objective To discuss the value of femoral head coverage (FHC) in the follow-up of infants with developmental dysplasia of the hip(DDH). Methods Two hundred and seventeen DDH infants(434 hips) diagnosed by clinical examination and ultrasonography were chosed as treatment group, and then received the brace treatment and followed up with ultrasonography. Four hundred and sixteen infants(832 hips) with normal hips diagnosed by clinical examination and ultrasonography were chosed as control group. The ultrasonographic examination included Graf method and FHC measurement. The infants in the treatment group were followed up with ultrasonography examination up to the age of 6 months. Results The FHC in the control group was (59.69±4.36)%. In the treatment group, 302 hips were diagnosed to be DDH.Among them, 36 hips were Graf type Ⅱa, 132 hips were Graf type Ⅱb, 69 hips were Graf type Ⅱc, 8 hips were Graf type D, 41 hips were Graf type Ⅲ, and 16 hips were Graf type Ⅳ. The FHC of these hips were (51.33±5.18)%, (53.07±3.94)%, (44.52±5.32)%, (38.70±5.85)%, (27.23±6.82)% and 0, respectively. After treatment, 222 hips became Graf type Ⅰ, 49 hips were improved, and their FHC increased. Twenty-eight hips were not significantly improved after treatment, but the FHC of most hips (including 14 hips of type Ⅱb, 3 hips of Ⅱc and 4 hips of type Ⅲ) increased. Three hips of Graf type Ⅲ aggravated to Graf type Ⅳ, and the FHC decreased to 0. Conclusions The FHC has important value in the follow-up of infants with DDH. Key words: Ultrasonography; Developmental dysplasia of the hip; Femoral head coverage; Infant; Follow-up

Objective To summarize the clinical and electroencephalogram features of neuronal ceroid lipofus-cinosis (NCL). Methods A retrospective analysis of the clinical phenotypes and electroencephalogram features of pa-tients diagnosed with NCL in Department of Pediatrics,Peking University First Hospital from February 2000 to August 2015 were conducted. Results Among the 30 patients,18 were male and 12 were female. The age of onset was between 9 months to 7 years old. The first symptoms included seizure in 22 patients,psychomotor developmental delay or regre-ssion in 7 cases,and visual loss in 1 case. Clinical manifestations included psychomotor regression in 29 cases,epilepsy in 28 cases,visual impairment in 19 cases,ataxia in 20 patients,and positive pyramidal tract sign in 13 cases. Twenty-one patients accepted fundus oculi examination. Seven patients were found with macular degeneration,8 cases with optic nerve atrophy,2 cases with retinal pigment degeneration,and 8 patients were normal. Brain atrophy were found in all 30 cases,including diffuse brain atrophy in 14 cases,only cerebellar atrophy in 6 cases,and cerebral atrophy with periven-tricular T2W high signal in 10 cases. Video electroencephalogram(EEG)examination was performed in 27 patients and their backgrounds were diffuse slow waves. Seven patients didn't have physiological vertex sharp waves or sleep spin-dles. Generalized epileptiform discharges were captured in 6 cases,focal epileptiform discharges in 15 cases. Both of generalized and focal epileptiform discharges were captured in 6 cases. Generalized slow wave burst in 4 cases,and in-termittent photic stimulation evoked epileptiform discharges in 3 cases. Ten patients were observed with clinical sei-zures,including 4 cases of myoclonic episodes,3 cases of atypical absences,3 cases of focal seizures,1 case of atonic and one of tonic spasms. Peripheral blood enzyme examination was taken in 13 patients,among whom 8 patients were identified with tripeptidyl peptidase 1 (TPP1)deficiency and 1 patient with palmitoyl protein thioesterase 1 (PPT1) deficiency. Twenty-eight patients accepted skin and/or muscle electron microscope examination. Osmiophilic granular was found in 2 cases,curvilinear bodies in 15 cases,fingerprint profiles in 2 cases,curvilinear and linear bodies in 1 case,fingerprint profiles and osmiophilic granular in 1 case. NCL-related gene detection was conducted in 3 patients, with 1 patient identified with CLN6 compound heterozygous mutations and 2 patients with TPP1 homozygous mutations. Thirty patients were classified into 3 groups based on the onset age,enzymatic examination results and pathological examination of skin and muscle,including 5 cases of infantile NCL,20 cases of late-infantile NCL,and 5 cases of juvenile NCL. Conclusions The clinical features of NCL included multiple types of epileptic seizures (among which myoclonus was the most common type),psychomotor developmental delay or regression,vision loss,ataxia,and positive pyramidal tract sign. Its MRI was characterized with brain atrophy. EEG showed diffuse slow wave activity,with focal and/or generalized epileptiform discharges. Specific enzyme examination,and skin or muscle pathology or gene test could help to make diagnosis.

Objective:To investigate the change of fatty liver stiffness by real time shear wave elastography (SWE),and to obtain the diagnostic threshold of fatty liver by comparing with conventional two-dimensional ultrasound and MR mDixon sequence which were used to detect the liver fat content.To analyze the correlation between fatty liver stiffness and fat content.And to assess the value of ultrasound SWE technique in diagnosis of fatty liver.Methods:28 healthy volunteers were examined by conventional two dimensional ultrasound,SWE and MR mDixon sequence.The consistency between the observers of SWE technique was examined by the Bland-Altman plot.The repeatability within the observers of the SWE technique was examined by calculating Pearson correlation coefficient r1、r2.The consistency of the ultrasound SWE techniques,MR mDixon sequence and traditional ultrasound in the detection and grade of fatty liver were analyzed to obtain the diagnostic threshold (kPaMean) combined with the scatter plot.To analyze the correlation of two imaging methods by calculating the Pearson correlation coefficient.The correlation of two imaging methods were analyzed by calculating the Pearson correlation coefficient.Results:Bland-Altman plot showed that 24 cases were within the 95 ％ agreement limit in 26 healthy volunteers.Intra-group correlation coefficients were r1=0.917,r2 0.921 (P＜0.05).Kappa values of kPaMean =4,5,6 were calculated respectively.When Young's modulus diagnostic threshold (kPaMean) was seted at 5kPa,Kappa value=0.819 ＞0.75 (P＜0.05).Pearson correlation coefficient was r hardness-0.877＞0.85,r velocity=0.867＞0.85,with a significantly statistical difference (all P＜0.05).Conclusion:SWE imaging technique can be applied to the measurement of fatty liver with good stability,it can be used not only in clinical detection of fatty liver,but also can provide information about liver stiffness in patients with fatty liver,and it has a high correlation with liver fat content detected by MR mDixon sequence.

Objective To observe the features of superficial cutaneous branches of radial nerve disease in high frequency ultrasound and discuss the application value.Methods Retrospective analysis the sonographic records of 45 patients with superficial cutaneous branches of radial nerve disease from and compared with the findings of clinical data.Results Superficial cutaneous branches of radial nerve lesion 10 cases before branch and 35 cases after branch found by ultrasonic diagnosis.Among which confirmed by surgery or clinical examination,1 case tumor,1 case nerve dysplasia,6 cases complete rupture after trauma,10 cases severe traumatic nerve injury,21 cases mild to moderate injury,2 cases amputation neuroma,1 case nerve surrounded by soft tissue tumor,3 cases postoperative change.Ultrasonic diagnosis and clinical diagnosis were consistent.Conclusions Ultrasound was useful in evaluating superficial cutaneous branches of radial nerve disease including location and type,which should be an important imaging method in diagnosing.

Objective: To investigate the relationship among the latest WHO classification of thymoma,myasthenia gravis (MG) and clinical stages. Methods: To review the pathological sections of 74 patientswith thymoma from 1980-2004 using WHO classification (1999), the statistical software was used to analyzethe relationship among the WHO classification, MG and clinical stages. Results: (1) Two cases of typeA, 23 cases of type AB, 4 cases of type B1, 27 cases of type B2, 16 cases of type B3 and 2 cases of type Cwere classified. Type B2 more likely accompanied MG (P<0.05), while none with MG occurred for typeC. (2) One patient was in stage I, 30 were in stage II, 38 were in stage III, and 5 were in stage IV. Thelatest histologic classification was significantly correlated with Masaoka stages (P<0.01). Conclusion:The latest WHO classification was correlated with occurrence of MG and finely reflected clinical stage. Itcan also evaluate the prognosis of patients.