目的 观察甲状腺滤泡癌中是否存在血管包绕的肿瘤细胞巢(VETC)结构,分析其特点.方法 选取甲状腺滤泡癌患者10例、乳头状癌患者21例,收集患者年龄、肿瘤大小等资料,通过免疫组化染色检测CD31、血管生成素-2(Ang-2)和CXCR4蛋白表达;通过公共数据库资料分析蛋白表达与患者预后关系;通过超声造影影像学分析VETC结构对超声造影表现的影响;采用t检验进行2组间数据的统计学比较.结果 甲状腺滤泡癌组织中均存在VETC结构,乳头状癌中均不存在VETC结构;甲状腺滤泡癌的VETC结构可整体发生淋巴结、血管转移.Ang-2蛋白在甲状腺滤泡癌中呈高表达.甲状腺滤泡癌超声造影表现为"全肿瘤均匀式快速充盈"的灌注方式,乳头状癌则为"非均匀式充盈"的方式;与甲状腺乳头状癌〔(2.82±0.23)s〕比较,滤泡癌〔(2.02±0.07)s〕患者其始增至达峰时间在单位距离内时间更短,t=5.708,P=0.005.结论 甲状腺滤泡癌具有VETC结构,且其超声造影具有"全肿瘤均匀式快速充盈"的特点,Ang-2蛋白是甲状腺滤泡癌的潜在治疗靶点.

目的 探讨常规超声联合超声造影(CEUS)诊断甲状腺结节的价值,分析联合诊断中误诊结节的特征及原因.方法 选择广西壮族自治区人民医院2019年1月至2021年6月收治的甲状腺结节患者481例(共522个结节),均先接受常规超声检查,后再行常规超声联合CEUS检查.其中男130例,女351例,年龄19～71(37.2±15.3)岁,病灶最大径0.5～3.9(1.8±0.7)cm.比较常规超声及联合CEUS对甲状腺良恶性结节的诊断效能,分析联合诊断误诊结节的特征.结果 522个结节中,经病理检查证实为恶性结节203个,良性结节319个.常规超声联合CEUS检查共修改59例结节的TI-RADS分类和诊断,错误修改6例.联合检查共误诊53例结节,其中41例良性结节误诊为恶性,12例恶性结节误诊为良性.良性误诊为恶性的结节均包含≥2个以下常规超声特征:低回声、纵横比≥1、边界不清、形态不规则、包膜侵犯、微钙化等.恶性误诊为良性的结节表现出等增强、高增强、环状增强等CEUS特征.Kappa一致性分析检验显示,常规超声和常规超声联合CEUS检查结果与病理检查结果具有一致性(P<0.05),但常规超声联合CEUS鉴别诊断甲状腺良恶性结节的特异度、灵敏度、准确率均高于常规超声(87.15％vs 81.19％;94.09％vs 84.73％;89.85％vs 82.57％).结论 常规超声联合CEUS可提高对甲状腺结节的诊断价值,但良恶性结节在常规超声及CEUS特征上均有一定程度的交叉重叠,可导致误诊.

目的 探讨术前超声造影、术中快速冰冻病理切片诊断血管包绕肿瘤细胞巢(VETC)癌巢型肝细胞癌(HCC)的价值及最优手术方式的选择.方法 收集2013-10～2018-10经术后常规病理确诊的164例HCC的临床资料.免疫组化CD34染色观察VETC癌巢型、非癌巢型HCC形态学特点.统计癌巢型与非癌巢型HCC发生癌旁转移的比例.随访VETC癌巢型与非癌巢型HCC患者术后2年的复发率.分析解剖性肝切除与非解剖性肝切除对VETC癌巢型HCC患者术后2年复发率的影响.分析术前超声造影检查、术中快速冰冻病理切片诊断VETC癌巢型HCC的价值.结果 164例HCC中,VETC癌巢型HCC占40.24％(66/164),其癌旁转移发生率为30.30％(20/66),显著高于非癌巢型HCC的10.20％(10/98)(P<0.05).VETC癌巢型HCC和非癌巢型HCC术后2年的复发率分别为53.33％和36.90％.在VETC癌巢型HCC患者中,解剖性肝切除可显著降低HCC患者术后2年的复发率(P<0.05).术前超声造影诊断VETC癌巢型HCC的灵敏度为81.82％,特异度为91.84％,准确率为87.80％,与术后常规病理检查结果具有较好的一致性(Kappa=0.744,P=0.000).术中快速冰冻病理切片诊断VETC癌巢型HCC的灵敏度为93.94％,特异度为91.84％,准确率为92.68％,与术后常规病理检查结果具有较好的一致性(Kappa=0.849,P=0.000).结论 术前超声造影和术中冰冻病理切片可有效诊断VETC癌巢型HCC,解剖性肝切除是癌巢型HCC患者的优选术式.

甲状腺结节的良恶性鉴别对于制定治疗方案及手术方式至关重要.细针穿刺细胞学检查是术前明确甲状腺结节性质的首选检查,然而仍有部分甲状腺结节即使经过穿刺细胞学检查仍不能明确诊断.基于美国甲状腺协会风险分级的甲状腺超声检查对于甲状腺结节的恶性风险评估具有重要的临床价值;此外,超声造影或其结合弹性成像、分子病理检查等方法均进一步提高了对细胞学检查不能明确甲状腺结节的诊断准确性.本文主要针对超声检查在细针穿刺细胞学检查不能明确甲状腺结节的良恶性鉴别中应用价值的研究进展进行综述.

目的 探讨经阴道二维超声联合超微血管成像(SMI)在宫颈癌术前分期诊断中的应用价值.方法 选取2018年11月—2019年12月广西壮族自治区人民医院收治的经病理检查确诊为宫颈癌拟手术治疗的76例患者.所有患者术前行阴道二维超声联合SMI及磁共振成像(MRI)检查.以术后病理结果为金标准,分析2种检查方法对宫颈癌分期的准确率及敏感性.结果 76例宫颈癌患者中,ⅠA期3例,ⅠB期57例,Ⅱ期16例.二维超声联合SMI诊断宫颈癌分期总的准确率为77.6％(59/76),MRI为73.7％(56/76),差异无统计学意义(P>0.05).二维超声联合SMI诊断ⅠB1、ⅠB2期的准确率均高于MRI(P<0.05).肿瘤直径<2 cm、2～<4 cm时,二维超声联合SMI诊断敏感性为87.5％和93.8％,优于MRI的84.0％和87.5％.结论 二维超声联合SMI在早期宫颈癌术前分期诊断上具有价格低廉、可反复操作、无创等优势,可为宫颈癌治疗方案的制定提供重要依据.

目的:探讨经阴道四维子宫输卵管超声造影(4D-HyCoSy)在输卵管通畅性评价中应用价值.方法:采用经阴道4D-HyCoSy及腹腔镜通染液术检查输卵管通畅性,比较两种检查方法对诊断输卵管通畅性的一致性.结果:经阴道4D-HyCoSy共110条输卵管,输卵管通畅52条,通而不畅33条,阻塞25条.腹腔镜检查输卵管通畅48条,通而不畅30条,阻塞22条.4D-HyCoSy检查输卵管通畅性符合率92.30％,输卵管通而不畅的符合率90.91％,输卵管阻塞的符合率88％,采用Kappa检验结果,Kappa值=0.793,P>0.05,两种检查方式高度一致.结论:经阴道4D-HyCoSy评价输卵管通畅性与腹腔镜术检查具有高度一致性.

Objectives: To assess the value of contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) imaging for the differential diagnosis of benign and malignant thyroid nodules. Methods: CEUS was performed in eighty-eight thyroid nodules. The patterns of CEUS were analyzed, and ARFI was then performed. The shear wave velocities (SWVs) of the nodules and the surrounding normal thyroid tissue were obtained. The areas under the curve (AUCs) and cut-off value were obtained by a receiver operating characteristic (ROC) curve analysis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic rate of each modality were assessed and compared using pathological diagnosis. Results: Among 88 nodules, 29 nodules were malignant and 59 were benign. The sensitivity, specificity, PPV, NPV, and diagnostic rate of CEUS were 79.3, 91.5, 82.1, 90, and 87.5%, respectively. Using a cut-off value of 2.565 m/s for SWV, the sensitivity, specificity, PPV, NPV and diagnostic rate for malignancy were 75.9, 94.9, 88.0, 88.9, and 88.6%, respectively. The AUC was 0.878. The sensitivity, specificity, PPV, NPV and diagnostic rate of CEUS in combination with ARFI were 93.1, 89.8, 81.8, 96.3, and 90.9%, respectively. Conclusion: Both CEUS and ARFI are valuable for the differential diagnosis of benign and malignant thyroid nodules. Combining these two methods can improve the diagnostic rate.

目的:探讨纤维性囊性乳腺病的声像图特征、超声分型与临床病理表现的关系.资料与方法:回顾性分析经病理证实的91例纤维性囊性乳腺病的声像图特征并进行超声分型,将超声表现与病理进行对照分析.结果:按声像图特征将纤维性囊性乳腺病分为V型:单纯液性暗区型、极低回声型、囊实混合型、低回声型及钙化型.本组病例中1例囊实混合型、1例低回声型及1例钙化性纤维性囊性乳腺病误诊为乳腺癌.2例囊实混合型纤维性囊性乳腺病误诊为导管内乳头状瘤.超声对肿块的检出率100％,超声和病理诊断符合率为94.51％(86/91),误诊率5.49％,Kappa值0.82,P=0.006.结论:纤维性囊性乳腺病的超声诊断及分型是一种简便、适用、易行的方法,能提高纤维性囊性乳腺病的诊断准确性.

Objective: To detect the possible molecular mechanisms of the formation of vessels that encapsulated tumor clusters (VETC) and identify the relationship between vimentin protein expression in endothelial cells and contrast-enhanced ultrasound characters in VETC (+ ) hepatocellular carcinoma (HCC). Methods: A total of 64 paraffin embedded HCC tissue samples were collected, all of which the tumor diameters were between 2 cm and 5 cm measured by the preoperative ultrasound. Immunohistochemistry staining for CD34 was used to detect the formation of VETC and the expressions of angiopoietin-2 (Ang-2) and vimentin were also determined. Human umbilical vein endothelial cells (HUVECs) were treated with 150 ng/ml recombinant human Ang-2 protein (rhAng-2) at various times and the protein expression of vimentin was detected by western blot assay. The contrast-enhanced ultrasound characters were also analyzed in both VETC (+ ) and VETC (-) HCC. Results: Tumor clusters encapsulated by vessels to form cobweb-like networks, which were identified as VETC phenotype, were observed in 27 HCC tissues (42.18%). In VETC (+ ) HCC tissues, Ang-2 was overexpressed in tumor cells and endothelial cells while vimentin was only upregulated in endothelial cells. With the treatment of 150 ng/ml rhAng-2 protein, the expression of vimentin in HUVECs was 0.878±0.102 and 0.918±0.092 at 12 h and 36 h, significantly upregulated when compared to the 0.322±0.061 at 6 h (P<0.01). In contrast-enhanced ultrasound, a crack and tendon-like filling character was observed in VETC (+ ) HCC during the arterial-phase, while the large scale and diffuse-like filling character was observed in VETC (-) HCC. The filling time of unit diameter in VETC (+ ) HCC was (3.95±0.22)s, significantly longer than (2.28±0.27)s of VETC (-) HCC (P<0.01). Conclusions: The overexpressions of Ang-2 and vimentin are positively correlated with the formation of VETC and considered as potential therapeutic targets of VETC (+ ) HCC. The crack and tendon-like filling characters in arterial-phase of contrast-enhanced ultrasound indicates the VETC (+ ) HCC.

目的 探讨甲状腺低回声结节的超声造影(Contrast-enhanced Ultrasound,CEUS)增强模式.方法 回顾性分析111个甲状腺低回声结节的超声造影模式,观察造影的增强模式,并与术后病理对照.结果 病理证实恶性结节68个,良性结节43个.恶性结节超声造影表现以不均匀增强为主(55/68),良性结节多表现为环状增强(28/43).结论 超声造影有助于甲状腺低回声结节的良恶性的鉴别诊断.

目的 乳腺超声成像是乳腺疾病诊断不可或缺的主要技术,造影技术又克服了传统超声的局限性,极大提高了检测肿块低速血流的敏感性.本研究观察乳腺良恶性肿块的超声图像及超声造影表现,探讨其超声图像及超声造影的特征.方法 对2013 01-01-2015-06-30在广西壮族自治区人民医院就诊及手术治疗的451例乳腺肿块患者的超声图像特征、血流情况进行观察及实时超声造影,选用SonoVue超声造影剂,对肿块的高频超声图像、造影增强形态、强度和造影时间强度曲线特征进行观察,并与病理进行对照分析.结果 经病理确诊451例乳腺肿块中,恶性肿块240例,良性肿块211例,超声造影有其特征性表现.(1)恶性肿块表现为进入丰富,分布尚均及不均.其造影强度分别为高增强188例(78.3％),中等增强43例(17.9％),极少至低增强9例(3.8％).(2)进入肿块的增强范围常超过二维超声图像,周围可见多条粗大的血管进入肿块,恶性肿块范围增大、放射状增强、穿支血管均较良性明显增加,良性肿块可见环状增强,并为特征性改变,共59例(28.0％).(3)本组恶性肿块超声造影敏感度92.45％,特异度95.91％,阳性预测值96.66％,阴性预测值90.82％.本组恶性肿块二维超声检查敏感度82.63％,特异度65.02％,阳性预测值60.40％,阴性预测值85.29％.结论 通过系统地对乳腺恶性肿决超声图像及超声造影表现进行观察,进一步发现了不同乳腺肿块,尤其是恶性肿块的超声造影特征表现,认为超声造影可提高对乳腺肿块低速血流显示的敏感度,并有其特征性表现,有助于乳腺良恶性病变的鉴别诊断及提高诊断准确率.

目的 探讨经直肠超声检查(TRUS)引导下6点和6+X点前列腺穿刺法对前列腺癌(Pca)的临床诊断价值.方法 对229例可疑Pea患者分别行TRUS引导下6点系统及6+X点穿刺活检,比较两者穿刺阳性率及统计指标差异性.结果 229例疑似患者经穿刺最终病理证实Pca 116例,前列腺增生(BPH) 94例,前列腺炎6例,BPH伴炎性8例,前列腺梭形细胞瘤1例,前列腺结核3例,非典型增生1例.行6+-X点穿刺法活检时灵敏度为100％、特异度为95.69％.111例Pca患者如仅按6点系统穿刺法活检,其特异度为100％、灵敏度为85.34％,将会有12例患者漏诊,其漏诊率为10.81％.结论 TRUS引导下的6+X点前列腺穿刺法可以明显提高Pca的检出率,为临床诊断、鉴别诊断及治疗方案的选择提供病理学依据.

This study aimed to investigate the clinical value of the retraction phenomenon observed in 3D ultrasonography (RP-3DU) in diagnosing breast masses and evaluating their prognosis. Preoperative 3D ultrasonography was performed on 165 patients with breast masses. The observed RP of the masses was then compared with the tumor size, histological grade, lymph node status, and clinical biomarkers such as the estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (CerbB-2), and Ki-67 to analyze the correlation between RP-3DU and the above indexes. The sensitivity and specificity of RP-3DU in diagnosing malignant breast masses were 67.7% and 93.1%, respectively. The observed rate of RP in 3DU was significantly different (P < 0.001) between the invasive and non-invasive cancers. Compared to the non-RP-3DU group, the tumor size in the RP-3DU group was ≤ 20 mm (P < 0.05), and the histological grade was mostly grade II (P < 0.05). Furthermore, the RP-3DU group showed significantly higher numbers of ER and PR positive masses (P < 0.05), while there was no significant difference between the two groups with respect to lymph node status, CerbB-2, and Ki-67 expression (P > 0.05). The occurrence of RP in 3DU could therefore contribute to the prognostic evaluation of breast cancer.

Objective To evaluate the distribution of vessels inside and adjacent to lesion region at three -dimensionalcolor histogram can be used for the differentiation of benign and malignant breast lesions .Methods Onehundred sixty five patients with breast lesions were divided into malignant lesion group (n =93) and benign lesiongroup(n =72), according to pathological findings .All cases underwent three-dimensional ultrasound exam.Threedimensionalcolor histogram was used to assess the volume and breast lesion indexes inside and outside 3 mm region,which included vascularization index(VI), flow index(FI)and vascularization-flow index(VFI ).Vascularity indexesinside were expressed respectively as V-in, VI-in, FI-in and VFI-in, and those outside surrounding region of 3 mmwere expressed respectively as V-out, VI-out, FI-out and VFI-out.All the results were compared between malignantlesion group and benign lesion group .Results VI-in, VFI-in, VI-out, FI-out and VFI-out in malignant lesion groupwere significantly higher than those in benign lesion group (P <0.05).The indices of V-in, V-out and FI-in in thetwo groups had no significant differences (P >0.05).Based on the receiver operating characteristic (ROC) curve,VI-out was the best index for the diagnosis of breast lesions .VI-in, VFI-in and VFI-out were the second one, and FIoutwas the last one.Conclusion The vascularity index of 3 mm surrounding region has certain value in the diagnosisof breast lesions.The quantitative analysis of three-dimensional color histogram has a certain value in assessing bloodflow inside and adjacent to breast lesions and improves the differential diagnosis of benign and malignant breast le -sions.

目的 系统地观察及探讨前列腺增生并前列腺炎经直肠超声(TRUS)图像与PSA表现.方法 经直肠超声引导下前列腺穿刺,系统6点加可疑结节处穿刺法;对病理学证实的44例前列腺增生并炎症患者超声图像与PSA表现进行对照比较.结果 44例前列腺增生并炎症TRUS声像图表现及特点:内回声欠均匀及不均,常在前列腺内、外腺和交界处均可见稍低或极低边界清及欠清的结节与灶性小或长条状低回声区,血清PSA值为0.41～80.02 μg/L,平均(17.89±3.03) μg/L.结论 TRUS能清晰显示前列腺内部结构,前列腺增生并炎症有一定的超声声像图特征性表现,结合临床及血清PSA检查有助于提高对前列腺病变的能力及诊断水平.

Objective To investigate the value of contrast-enhanced ultrasound(CEUS) and contrast-en-hanced CT( CECT) in the diagnosis of small liver cancer.Methods One hundred and tweleve patients with 143 small solid liver lesions (≤2.0 cm) were examined with contrast-enhanced ultrasound and contrast-enhanced CT, and the diagnoses were confirmed by pathological examination.CEUS and CECT findings of 143 small solid liver le-sions in the patients were retrospectively analyzed.Results 111 malignant lesions including 79 primary liver carcino-ma, 8 intrahepatic cholangiocarcinoma and 24 metastatic liver carcinoma and 32 benign lesions were found in 112 pa-tients with 143 lesions.Compared with the results of pathological diagnosis, the sensitivity, specificity and accuracy of CEUS and CECT were 88.3%, 84.4%, 87.3%and 86.5%, 87.5%, 86.7%, respectively, without significant differences between CEUS and CECT in the diagnosis ( P >0.05 ) .Conclusion CEUS and CECT have similar effects in the diagnosis of small liver carcinoma(≤2.0 cm) .CEUS is simpler than CECT in the diagnosis of small liver carcinoma.

Objective To observe and explore the characteristics of ultrasonography for transrectal color Doppler ultrasound in the diagnosis of hypertophy of the prostate disease and specific antigen( PSA) and image fea-tures in clinical stages of prostate cancer( PCa)systematically.Methods Patients clinically suspected of PCa under -went prostate exam by transrectal color doppler ultrasound, then by transrectal ultrasound guided prostate biopsy by 6 points adding suspected nodes method,comparing with the PSA, pathologic results, PPBCs, Gleason score, and clin-ical stages.Results In 413 patients confirmed by pathology(149 PCa, 171 BPH, 44 BPH with inflammation, 49 BPH with PIN and AAH), prostate disease had some characteristic ultrasound images.Clinical stages A,B,C or D ( Whitmore-Jewett methods) of PCa had some different characteristics of ultrasound images.The results showed that PSA, PPBCs and Gleason grades were positively correlated with PCa stages respectively.Conclusion Transrectal&nbsp;color Doppler ultrasound not only clearly reveals the internal structure of prostate ,but also has the characteristic ultra-sound imaging.Combination of image features with PSA is helpful for improving the diagnosis of prostate disease .

Objective To investigate the value of retraction phenomenon at three-dimensional ultrasonogra-phy(3D-US) in diagnosis and prognosis evaluation in breast lesions .Methods 165 patients with breast lesions who underwent 3D-US examination were included .The presence of the retraction phenomenon in the coronal plane was e-valuated.Pathologic prognostic factors , including tumor size , histologic grade , lymph node status , estrogen receptor (ER), progesterone receptor(PR) status, human epidermal growth factor receptor 2(Cerb-B2) and Ki-67 expression were determined .The correlation of the retraction phenomenon and prognostic factors was analyzed .Results The sensitivity and specificity of retraction phenomenon in the diagnosis of breast cancers were 67.7%and 93.1%respec-tively.The detection rates of the retraction phenomenon in the invasive cancer and the non -invasive cancer were 80.3%and 11.8%( P<0.001 ) .The retraction phenomenon was correlated to the tumor size , histologic grade , es-trogen and progesterone receptor status .Compared with the breast cancer without the retraction phenomenon , the tumor size with the retraction phenomenon was more likely to show a smaller diameter less than 2 cm(P<0.05), a lower histologic grade with grade Ⅱ( P<0.05 ) , and a higher positive rate of ER and PR ( P<0.05 ) .The lymph node status and the expression of the CerB-2 and Ki-67 in the two groups had no significant difference ( P>0.05 ) . Conclusion The retraction phenomenon of three-dimensional US may be useful in the diagnosis and prognosis evalu-ation in breast lesions .

Objective To investigate the changes in the size and shape of the levator hiatus in postpartum women with different delivery methods by transperineal three-dimensional ultrasound(3D).Methods Sixty-five post-partum women after 42~45 days postpartum between December 2013 and December 2014 were included in this stud-y, with 30 cases in the cesarean group and 35 cases in the normal delivery group.25 cases of nulliparous women were included in the control group.The images of rest phase and Valsalva phase were collected.The changes in the size and shape of the levator hiatus of the two phases were observed, and the morphological parameters were measured. Results In the rest phase and Valsalva phase, the transversal diameter, anteroposterior diameter and areas in both of the cesarean group and the normal delivery group were significantly greater than those in the control group.The thicknesses of the bilateral puborectalis of the above two groups were significantly smaller than those of the control group( P<0.05 ) .The transversal diameter, anteroposterior diameter and area of the normal delivery group were greater than those of the cesarean group, and the thickness of the bilateral puborectalis of the normal delivery group was significantly smaller than that of the cesarean group(P<0.05).Conclusion Levator hiatus becomes bigger and lavatory ani muscle becomes thinner in a postpartum woman than those in a nulliparous woman.Levator hiatus be-comes bigger and lavatory ani muscle becomes thinner in a normal delivery woman than those in a cesarean woman. Transperineal 3D ultrasound is an effective imaging method for showing levator hiatus in postpartum women.