患儿男,2个月.在产前32周首次发现肺动脉主干较主动脉根部细.产前35周复查发现主动脉瓣上、肺动脉瓣上血流速度增快:主动脉瓣上血流Vmax 1.67 m/s,肺动脉瓣上血流 Vmax 1.99 m/s.产后2个月,患儿面容未见明显异常.超声所见:主动脉窦部及升主动脉内径正常,窦管交界处狭窄,内径5.3 mm.肺动脉狭窄,内径分别为4.2 mm(主干近端)、4.3 mm(左肺动脉)、3.3 mm(右肺动脉).主动脉瓣上窦管交界处前向血流增快Vp 3.0 m/s;肺动脉前向血流增快:主肺动脉Vp 3.6 m/s、左肺动脉Vp 2.5 m/s、右肺动脉Vp 4.1 m/s.超声诊断:主动脉瓣上狭窄,肺动脉瓣上及分支狭窄,Williams-Beuren综合征?行基因+染色体检测:7q11.23区域基因杂合缺失,临床确诊为Williams-Beuren综合征.随后进一步相关检查,发现患儿还有高磷(2.13 mmol/L)、高钙(2.74 mmol/L)、甲状腺功能低下(促甲状腺激素10.66 uIU/mL)、双侧腹股沟疝、双侧睾丸鞘膜积液等.

卵巢甲状腺肿(Struma ovarii,SO)是一种非常少见的疾病,属于卵巢成熟畸胎瘤中的一种,是来源于单胚层的生殖细胞肿瘤,其内以甲状腺组织为主,大多数为良性病变,极少数有恶变倾向[1].因SO发病率低,恶性发病率更低,对其超声图像认识不足,在临床诊断中,极易造成漏诊、误诊. 子宫附件超声造影作为近年来新兴的检查手段,对于判断子宫及附件区肿块的良恶性有其明显的优势. 近期我院诊治了1例恶性SO患者, 现就其术前子宫附件常规超声及超声造影检查的图像特点,结合手术及术后病理等相关资料进行讨论分析.

女性乳腺疾病的发生率逐年增加,乳腺癌成为了我国女性发病率最高的恶性肿瘤,乳腺良恶性实性肿块的鉴别诊断一直是医学影像学研究的重点难点.超声造影使实性肿瘤中的低速低流量的微小血管得以显示,并进行实时动态评估,从而提高了诊断及鉴别乳腺良恶性肿块的准确率.该文就超声造影在乳腺实性肿块良恶性诊断中的应用价值进行综述.

目的 探讨子宫超声造影对产后宫内残留性病变(RPOC)的诊断价值.资料与方法回顾性分析行常规超声及子宫超声造影检查考虑存在RPOC的患者42例,以术中所见及病理检查结果为对照,分析RPOC的常规超声及超声造影特征,评估超声造影的诊断符合率.结果 超声造影清晰显示宫内残留物与子宫内膜及肌壁内的血管灌注情况,观察造影剂灌注的时间变化,诊断宫内胎盘残留28例,胎盘植入11例,宫内积血3例,2例胎盘粘连植入误诊为胎盘残留,诊断符合率为95％,与病理结果一致性较好(Kappa=0.905,P＜0.05),两种检查结果高度一致.常规超声的诊断符合率仅为73.8％.结论 子宫超声造影对RPOC有特异性的表现,能有效区分产后宫内胎盘残留、胎盘植入及宫内积血,可为临床后续诊疗提供更多有价值的信息.

目的 探讨经阴道子宫输卵管动态三维超声造影与腹腔镜通染液术评价输卵管通畅性及其相关因素.方法 对88例不孕患者共176条输卵管,行动态三维超声造影,结果与腹腔镜通染液术进行对照.探讨影响输卵管通畅性相关因素.结果 176条输卵管,超声造影结果显示输卵管通畅66条,通而不畅50条,阻塞60条.腹腔镜通染液术显示输卵管通畅64条,通而不畅54条,阻塞58条.动态三维超声造影诊断输卵管通畅、通而不畅、阻塞符合率为90.9％、92％、87.7％,采用Kappa检验,P＞0.05,两种检查方式高度一致.动态三维超声造影诊断输卵管通畅性灵敏度为91.1％、特异度93.7％、阳性似然比8.19、阴性似然比0.12.经Logistic回归分析推注造影剂剂量、推注造影剂压力、推注造影剂反流量与通畅性有密切相关性P＜0.05.结论 动态三维超声造影评价输卵管通畅性与腹腔镜通染液术具有高度一致性和诊断价值;对通畅性相关因素研究,大大提高了诊断准确率.

目的 分析经阴道四维子宫输卵管超声造影(4D-HyCoSy)与腹腔镜检查诊断输卵管通畅一致性并评价其应用价值.方法 选择2018-08 ～ 2019-11该院接治的不孕症患者60例(共120条输卵管)作为研究对象.所有研究对象均接受经阴道4D-HyCoSy检查和腹腔镜检查对输卵管的通畅情况进行诊断,分析两种检查方法诊断结果的一致性.分析经阴道4D-HyCoSy检查过程中造影剂盆腔弥散及卵巢包绕情况与输卵管通畅度的关联性.结果 腹腔镜检查显示输卵管通畅55条,通而不畅37条,阻塞28条;经阴道4D-HyCoSy检查结果显示输卵管通畅58条,通而不畅35条,阻塞27条.两种方法检查结果具有高度一致性(Kappa=0.908,P=0.000).输卵管通畅者,盆腔造影剂多呈均匀弥散(82.76％),以环状包绕卵巢为主(91.38％);输卵管通而不畅者,盆腔造影剂多呈不均匀弥散(88.57％),以半环状包绕卵巢为主(88.57％);输卵管阻塞者,盆腔造影剂呈无弥散(100.00％),以无包绕卵巢为主(92.59％).经阴道4D-HyCoSy检查过程中造影剂盆腔弥散及卵巢包绕情况与输卵管通畅度具有关联性(P＜0.05).结论 经阴道4D-HyCoSy检查与腹腔镜下通染液检查在输卵管通畅情况评判方面具有高度一致性,具有较高的临床应用价值.

目的 探讨非哺乳期妇女乳腺炎性肿块的超声图像及超声造影特征.方法 收集该院2008-01～2016-12 52例非哺乳期乳腺炎性肿块患者的影像学资料进行超声图像和超声造影特征分析.结果 52例非哺乳期乳腺炎性肿块,其高频彩色超声图像表现为不规则实质低回声、混合型肿块、位置较表浅、与皮肤层分界不清、表面皮肤水肿增厚或层次模糊、肿块常有类似恶性肿瘤的表现.超声造影特征表现为非均质高增强强度,进入肿块的范围常较二维超声图像的范围明显增大,周围及内部有较粗大的条状血管增强;最具有特征性表现是丰富的造影剂进入后呈分隔状,内可见单个及多个无增强区,呈圆及椭圆状.彩色高频超声诊断符合率为57.69％(30/52),结合超声造影检查后诊断的符合率为82.69％(43/52),超声US-BI-RADS分级为Ⅲ～V级.结论 非哺乳期乳腺炎性肿块超声图像及超声造影可呈现一定的特征表现,两者结合检查有助于降低误诊及漏诊率,提高诊断符合率.

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.

OBJECTIVE:The purpose of the present study was to explore the correlation between the contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) characteristics of breast cancers and the expression of human epidermal growth factor receptor 2 (HER-2). METHODS:HER-2 expression levels in the tumor masses of 167 clearly diagnosed cases of breast cancer were measured and analyzed. The enhancement features and time intensity curve (TIC) of CEUS and virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ) technology of ARFI were employed to analyze the relationship between HER-2 expression and the CEUS and ARFI characteristics of breast cancer. RESULTS:(1) Statistically significant differences in the distribution of the contrast agent, perforator blood flow, the overranging phenomenon and perfusion defects between the study groups with different HER-2 expression levels (P < 0.05) were observed on CEUS. In addition, statistically significant differences in the TIC peak time (PT), slope of the ascending branch (K) and area under the curve (AUC) were found in the groups expressing different levels of HER-2 (P < 0.05). In contrast, the degree of contrast agent enhancement and TIC peak intensity (PI) were found to be independent of the expression status of HER-2, as they were not statistically significant (P > 0.05). (2) Statistically significant differences in the VTQ results between the groups with different HER-2 expression levels were found (P < 0.05). However, no statistically significant differences in VTI image characteristics were detected between the groups expressing different levels of HER-2 (P > 0.05). CONCLUSION:A correlation was found between the CEUS and ARFI characteristics of breast cancer and HER-2 expression levels. This correlation was principally reflected in perfusion defects, perforator blood flow, PI, PT, K and VTQ.

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 探讨HER-2表达水平与乳腺癌超声造影(CEUS)及声脉冲辐射力成像(ARFI)表现的关联性.方法 108例乳腺癌患者术前进行CEUS及ARFI检查,术后对其肿块进行HER-2表达水平的测定,分析HER-2表达水平与乳腺癌CEUS以及ARFI的关系.结果 (1)不同HER-2表达水平组超声造影的造影剂分布、穿支血流、超范围、灌注缺损以及TIC曲线的峰值时间、上升支斜率、曲线下面积的差异具有统计学意义(P＜0.05).(2)不同HER-2表达水平组的VTQ表现上差异有统计学意义(P＜0.05).(3)CEUS的增强强度、峰值强度及ARFI的VTI技术与HER-2表达水平的比较上,差异无统计学意义(P＞0.05).结论 乳腺癌CEUS及ARFI表现与HER-2表达水平之间存在一定的关联性,主要反映在灌注缺损、穿支血流、VTQ等.

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.

Objective To analyze the changes of carotid artery elasticity in the patients with obstructive sleep apnea hypopnea syndrome ( OSAHS) after the treatment with ET Technique .Methods Thirty patients with OS-AHS were selected and given individualized treatment for three consecutive months .The intima-media thickness ( IMT) was measured by high frequency linear ultrasound probe .An ultrasonic echo-tracking method was used to e-valuate common carotid artery elastic modulus , including pressure-strain clastic modulus ( Eρ) , stiffness parameter (β) , arterial compliance ( AC) , one point pulse wave velocity ( PWVβ) and augment index ( AI) .Results After the treatment, Eρ,βand PWVβdecreased and AC increased compared with those after the treatment (P<0.01).AI de-creased to some extent after the treatment , but no difference was found before and after the treatment ( P>0.05 ) . Conclusion ET can accurately detect the changes of carotid artery elasticity in the patients with obstructive sleep ap -nea hypopnea syndrome before and after the treatment .The changes of ET parameters can guide the clinical treatment of OSAHS and indicate atherosclerosis in an early stage .

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.

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 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 .

Purpose To observe the change of renal parenchyma elasticity in patients with chronic glomerulonephritis (CGN), and to explore the value of acoustic radiation force impulse (ARFI) in the assessment of renal histological damages in CGN. Materials and Methods 123 patients with CGN and 27 healthy volunteers were enrolled, CGN patients were divided into three groups according to renal histologic scores: mildly, moderately, and severely impaired. Shear wave velocities (SWV) of the renal parenchyma were measured and compared in different groups, the correlation between the SWV measurements and renal fibrosis Katafuchi scores, serum creatinine (Scr) and estimated glomerular filtration rate (e-GFR) was accessed, and receiver operating characteristic (ROC) curves analyses were also performed to assess the value of ARFI for the diagnosis of pathology impairment degree in CGN. Results There were statistically significant differences in SWV measurements between each CGN patient group and the control group (F=16.592, P<0.01); the mean SWV in patients with severe kidney impairment was significant lower than that of mildly impaired, moderately impaired, and the control groups (P<0.001). SWV measurements correlated significantly with renal fibrosis Katafuchi scores (r=-0.481, P<0.01), Scr (r=-0.441, P<0.01), and e-GFR (r=0.546, P<0.01); ROC analyses indicated that the sensitivity was 63.4%, 71.4%, 93.8%, specificity was 77.8%, 71.3%, 79.9%, and the area under the curve was 0.730, 0.738 and 0.870, when using the optimal cut-off value of 2.65 m/s for the diagnosis of mildly impaired kidneys, 2.50 m/s for moderately impaired kidneys, and 2.34 m/s for severely impaired kidneys, respectively. Conclusion ARFI is expected to become an effective tool for non-invasive evaluating of renal histological fibrosis in CGN patients.

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 .

目的 对比评价实时灰阶超声造影(real-time gray scale contrast-enhanced ultrasound,CEUS)及钼靶对乳腺肿块良恶性诊断及鉴别诊断的应用价值.方法 收集62例乳腺肿块患者影像学资料,分析超声造影及钼靶表现,以病理组织结果为金标准.结果 本组62例病灶,其中恶性病灶31个,良性病灶31个;超声造影及钼靶诊断恶性病变灵敏度为96.8％和83.9％,特异度为90.3％和80.6％,准确率为93.5％和82.2％,超声造影诊断恶性病变高于钼靶,两者之间差异具有统计学意义(P＜0.05).结论 实时灰阶超声造影对乳腺肿块良恶性诊断敏感性、特异度及诊断准确率均高于钼靶检查,有助于提高乳腺癌的诊断率.