目的 探讨实时组织弹性成像(RTE)技术的组织弥散定量分析对结节性甲状腺肿伴纤维化与甲状腺乳头状癌的鉴别诊断价值.方法 对常规超声检查中可疑恶性的105例患者(107个结节)进行应变弹性成像检查,获得11个组织弥散定量分析参数.依据病理结果选取结节性甲状腺肿伴纤维化为一组,甲状腺乳头状癌为一组,对两组间11个参数进行比较分析.结果 两组间应变均值(MEAN)、标准偏差(SD)、蓝色区域面积(％AREA)、对比度(CONT)、均等性(ENT)、杂乱度(IDM)、一致性(ASM)7个参数差异均有统计学意义(P＜0.05).将7个组织弥散定量分析参数绘制ROC曲线,以％AREA及MEAN 2个参数诊断价值最高,曲线下面积分别为0.779及0.720,诊断临界值为97.12％及28.61％,其灵敏度、特异度分别为88.9％和82.4％、60.3％和66.7％.结论 组织弥散定量分析对结节性甲状腺肿伴纤维化与甲状腺乳头状癌的鉴别诊断有参考价值,以％AREA及MEAN价值最高.

目的 ACR TI-RADS与结合弹性成像TI-RADS分类对于甲状腺结节良恶性诊断的价值及临床管理方法的对比.方法 回顾性分析结节313例.根据ACR TI-RADS与结合弹性成像的TI-RADS对其进行分类,以病理为金标准.结果 本研究TI-RADS AUC高于ACR TI-RADS (0.842/0.792),P＞0.05,灵敏度(77.25％/78.06％),P=0.071＞0.05,特异度(94.31％/80.38％),P=0.000＜0.05.建议FNA结节(210例/130例)恶性率(59.5％/50.8％).恶性结节建议FNA,本研究更具优势(125例/66例),占比(80.6％/42.5％),P=0.000.仅4例恶性结节进入无需处理组(4例/30例),占比(0.03％/19.4％),P=0.000.结论 本中心结合弹性成像的TI-RADS相对于ACR TI-RADS诊断效能更高.ACR TI-RADS建议进入有创环节患者数量较本研究分类少.本研究分类在筛选恶性结节建议FNA及避免恶性结节建议无需处理方面更具优势.

目的 探讨超声应变力成像对诊断甲状腺良性结节纤维化的应用价值.方法 选取本中心经病理证实为良性的甲状腺结节155个,术前均行超声弹性成像检查,依据病理结果 将其分为伴纤维化组(n=125)、无纤维化组(n=30),并对2组间应变率比值进行对比分析.以病理结果为金标准,计算应变率比值在诊断甲状腺良性结节是否伴有纤维化的敏感度和特异度.结果伴纤维化组应变率比值[3.14(1.143,7.050)]高于良性无纤维化组[1.41(1.020,2.345)](P<0.05).经ROC曲线分析,应变率比值>2.62,提示甲状腺良性结节可能存在纤维化,此时应变率比值的曲线下面积为0.664(0.548,0.780),敏感度为56.7％,特异度为77.6％.结论 超声弹性成像应变率比值对诊断甲状腺良性结节纤维化有一定的应用价值.

Objective Comparatively analysing the evaluating value of acoustic radiation force impulse elastography (ARFI) and real-time tissue elastography (RTE) for liver stiffness of patients with biliary atresia (BA).Methods 45 patients with BA were collected from in Tianjin First Central Hospital.ARFI and RTE were used to measure the stiffness of the liver,expressed as ARFI value and MEAN value.30 healthy volunteer children as control.The ROC curve was used to evaluate the detection value.Recording the serum liver function index of each patients,calculating the correlation between each other.Results The ARFI value of patients with BA was significantly higher than that of control group,The MEAN value was lower,differences had statistical significance (P＜ 0.01);Analysed by ROC curve,the biggest area under the ROC curve,sensitivity,and specificity of the ARFI value,MEAN value to evaluate the liver stiffness were 0.99,97.8 ％,100 ％ and 0.88,100 ％,80 ％,respectively.The correlation between ARFI value and AST,TBIL,DBIL,IBIL was positive,and ALB,GGT was negative (All P＜0.05).Whereas,the MEAN value was only negatively correlated with DBIL (P＜0.05).Conclusions The evaluating value of ARFI and RTE for liver stiffness of BA were similar high.Compare with each other,the sensitivity was similarly,but the specificity and accuracy of ARFI were better than RTE,and ARFI has good correlation with liver function.

胆道闭锁 ( biliary atresia , BA ) 是婴儿期以进行性肝内外胆道闭塞为特征的疾病 ,其病理改变为胆管进行性炎症和肝纤维化 ,可迅速发展为胆汁性肝硬化[1 ] .B A患儿肝纤维化到肝硬化的进展速度虽然很快 ,但其病情严重程度存在明显差别 ,明确其疾病严重程度有利于指导治疗方式的选择 ,以改善预后.儿童终末期肝病模型 (pediatric end-stage liver disease , PELD ) 是一种儿童期慢性肝病评估系统 ,被认为可准确预测等待接受肝移植患儿3个月病死率 ,其适用于12岁以下儿童[2-3] .本研究依据PELD评分系统 ,初步探讨声触诊组织定量技术 (virtual touch tissue quantification ,VTQ) 评价肝移植术前BA患儿病情的应用价值.

Objective To evaluate the clinical significance of acoustic radiation force impulse ( ARFI) technique in the assessment of non-surgical complications after liver transplantation . Methods Three hundred and seventy-two patients with abnormal liver function after liver transplantation undergone ARFI exam before liver biopsy ( excluding surgical complications) . The shear wave velocity ( SWV ) between different groups divided according pathological results after biopsy was compared ,and SWV of 23 patients with normal liver function after liver transplantation was compared too . Moreover , 26 normal people were random selected as control group . Results ① Among the 372 patients ,there were 100 cases of rejection ,82 cases of biliary complications ,52 cases of hepatitis virus infection ,49 cases of drug induced liver injury ,56 cases of non-specific manifestation ,9 cases of steatosis ,3 cases of hypoxic-ischemic ,2 cases of inappropriate preserve injury and 19 cases of diagnosis were not clear . ② SWV of control group was ( 1 .49 ± 0 .66) m/s ,of normal liver function group was ( 1 .64 ± 0 .68) m/s ,of abnormal liver function group was ( 2 .08 ± 0 .66) m /s . Abnormal liver function group had higher SWV than normal liver function group and control group ( P < 0 .01) . There was no significant difference between normal liver function group and control group ( P > 0 .05) . ③ In the specific pathology manifestation patients ,hepatitis virus infection group had the highest SWV[ ( 2 .29 ± 0 .72) m /s] ,drug induced liver injury group had the lowest SWV [ ( 1 .94 ± 0 .57) m /s] ,and there were significant differences between two groups ( P < 0 .01) . ④ The ROC results showed that the area under curve of ARFI was 0 .688 for patients with abnormal liver function after liver transplantation , and 0 .655 for differential diagnosis between drug induced liver injury and hepatitis virus infection .Conclusions As a noninvasive technique ,ARFI is correlated with histopathology and has clinical value in the differential diagnosis of non-surgical complications after transplantation .

甲状腺嗜酸性细胞肿瘤(HCNs)是一种较为特殊的分化型甲状腺肿瘤,目前对该肿瘤的研究已到了分子水平.HCNs女性多发,临床上一般认为该肿瘤良性者更具侵袭性及潜在恶性倾向,恶性者有较高转移率和预后差等特点,对HCNs的治疗也存在争议.目前术前诊断HCNs的方法均有一定局限性,而近年来超声在诊断及鉴别诊断甲状腺肿瘤上取得了突飞猛进的发展.本文总结对HCNs的认识现状及超声对该肿瘤的研究进展,以进一步加深对HCNs的认识,以期早发现、早治疗,提高患者生存率.

Objective To investigate the value of ultrasound multiplex mode in the evaluation ot liver damage caused by brain death.Methods Brain death model were established in 12 Ba-Ma pigs by gradual intracranial compression method.Color Doppler flow imaging (CDFI),contrast-enhanced ultrasonography (CEUS) and real-time elastography (RTE) were performed respectively before the model had been established which defined as control group,and at 0 h,3 h,6 h,9 h after brain death,the data were analyzed.According to the pathological changes of liver,the livers were divided into different groups for ROC curve analysis,and the effectiveness of single mode ultrasound and multiplex were compared.Results ①Compared with control group,velocity of portal vein (PVV) decreased,and resistance index(RI),hepatic artery systolic velocity/diastolic velocity (S/D),pulsatility index (PI) increased in experimental group (all P ＜ 0.05);arrival time of the hepatic artery(ATHA),arrival time of the portal vein(ATPV) and arrival time of the inferior vena cava(ATIVC) increased with the extension of brain death time (all P ＜0.05);mean value (MEAN),standard deviation(SD) of the relative strain value within the ROI,area of low strain within the ROI (％ AREA),complexity of low strain area within the ROI (COMP),skewness (SKEW),correlation(CORR) were significant different between experimental group and control group (all P ＜0.05).②RI,ATHA and MEAN demonstrated the highest diagnostic accuracy (AUC =0.518,0.833,0.917) among CDFI,CEUS and RTE indexes.③Combined with ATHA and MEAN had the highest effectiveness in ultrasound multiplex mode to evaluate liver injury caused by brain death.Conclusions Ultrasound multiplex mode combining CEUS and RTE in evaluation of liver injury caused by brain death has higher sensitivity and accuracy.

患儿男,4岁,因"查体发现阴囊肿物2个月"入院,两年前因先天性胆道闭锁于本院行原位肝移植术。入院时检测EB病毒抗原（+）。患儿无明显不适,阴囊外观无红肿,触诊双侧附睾尾增厚,于左侧阴囊底部触及2处肿物,质韧,表面光滑,无压痛。超声:左侧阴囊底部皮下探及2处低回声结节,大小分别约1.7cm×1.0cm×1.2cm,1.5cm×0.9cm×1.6cm（图1A）,右侧附睾尾部探及低回声结节,约1.2cm×1.1cm×1.0cm,形态不规则,边界欠清,回声不均。CDFI:结节周边及

Objective To study the changes of left atrial function by left atrial volume tracing (LAVT)and investigate the relationship between left atrial and ventricular functions in patients with end-stage renal disease (ESRD). Methods The enrolled 113 participants were all from Tianjin First Center Hospital,including 65 cases of ESRD who received hemodialysis (ESRD group)during December 2014 to October 2016,and 58 volunteers with normal results of physical examination, laboratory examination,electrocardiogram and echocardiography performed during the same period (control group). The left ventricular function parameters (LVEF,FS,E,e′)were measured by color Doppler echocardiography and left atrial function parameters (LAVImax,LAVIp,LAVImin ) were measured by LAVT software,and LATEF,LAPEF and LAAEF were calculated. Results Compared with the control group,LVEF,FS,E and e′ were lower,but E/ e′ was increased in ESRD group (P < 0. 05). Compared with the control group,LAVImax,LAVIp,LAVImin,LATEF,LAAEF increased while LAPEF decreased in ESRD group (P < 0. 05). LATEF was negatively correlated with LVEF,and LAVImax,LAVIp,LAVImin, LATEF,LAAEF were positively correlated with E/ e′ in ESRD group (P < 0. 05). LAVImax was positively correlated with LAVIp,LAVImin,LATEF;LAVImin was positively correlated with LATEF;and LATEF,LAPEF were positively correlated with LAAEF in ESRD group (P < 0. 05). Conclusion Left atrial reservoir and booster pump functions are increased whereas conduit function is decreased in ESRD patients. Reservoir function plays an important role in the left ventricular early diastolic filling,while the booster pump function plays a key role in the active filling of the left ventricle.

Objective To explore hepatic hemodynamic changes and relative factors in the early stage of brain death by color Doppler flow imaging (CDFI) on pig.Methods 12 Ba-ma pigs were established brain death model by respiration and circulation supports and maintained for 12 hours,using the improved slow intracranial pressure method.Pigs before brain death as the control group,after the brain death as the experimental group,blood pressure,heart rate and liver blood flow parameters were motored in the former,0h,3h,6h,9h after brain death,including portal venous velocity (PV) and portal venous flow (PVF),hepatic artery systolic velocity (S),diastolic velocity (D),hepatic artery resistance index (RI),hepatic artery S/D,hepatic artery pulsatility index (PI),hepatic vein flow velocity (V).Compare the difference between the groups and the correlation with blood pressure and heart rate.Results (1) Compared with the control group,the systolic and diastolic blood pressure were significantly lower in the brain each death group,the difference between 9h and 0h in systolic blood pressure was statistically significant (P＜0.05).(2) Compared with control group,RI,S/D,PI were increased in each experimental group and PV was decreased in 3h and 6h group (P＜0.05).(3) PV and systolic blood pressure were positively correlated (P＜0.05).Conclusions In the early stage of brain death,the pigs sustained hypotension,and there was a significant change in the hepatic hemodynamics,PV shows a significant reduction,the systolic velocity and RI of hepatic artery increased.Therefore,the relative resistance parameters of the hepatic artery were more sensitive than the hepatic artery in the early stage of liver disease after brain death.

目的：探讨组织多普勒 Tei 指数测定在评价妊娠期糖尿病孕妇胎儿心功能中的应用价值。方法：选取妊娠期糖尿病孕妇73例，按血糖水平分为控制良好（DM1）组（35例），控制不良（DM2）组（38例），另选择同孕期正常妊娠孕妇43例作为对照组。应用组织多普勒测量各组胎儿左心室等容收缩时间（ICT）、等容舒张时间（IRT）、射血时间（ET）等，并计算 Tei 指数（Tei 指数＝ICT ＋IRT／ET）。结果：控制不良组胎儿左心室 Tei 指数较正常对照组及控制良好组明显增高，ET 较其他两组明显减低，差异有统计学意义（P ＜0.05）；控制良好组与正常对照组比较，差异无统计学意义（P ＞0.05）。结论：妊娠期糖尿病血糖控制不良可导致胎儿左心室功能减低，孕期良好的血糖控制可能避免胎儿心功能受损。组织多普勒测定 Tei 指数是评价妊娠期糖尿病胎儿心功能的敏感、可靠指标。

目的：探讨改良心肌活动指数（MOD-MPI）在妊娠高血压综合征（妊高症）产妇胎儿心功能评估中的应用价值。方法妊高症产妇97例，其中妊娠期高血压（ GH）32例（ GH组），轻度子痫前期30例（ MPE组），重度子痫前期35例（ SPE组），另选择同期来院分娩的健康产妇82例为对照组。于产前1～3 d采用彩色多普勒超声检查测定各组胎儿室间隔舒张末期厚度（IVST）、等容收缩期（ICT）、等容舒张期（IRT）、射血时间（ET），以（ICT＋IRT）／ET计算MOD-MPI。记录各组围产儿情况，包括新生儿出生胎龄、出生体质量、Apgar评分、胎儿宫内窘迫发生情况、围产儿死亡情况。结果各组ICT、IRT、IVST相比，差异无统计学意义。 SPE组与其他三组相比， ET明显缩短， MOD-MPI增高（P均＜0．05）。 MPE组新生儿出生体质量及1 min Apgar评分低于GH组及对照组；SPE组新生儿胎龄、出生体质量和Apgar评分小于余三组，胎儿生长受限、围产儿死亡发生率高于余三组（ P均＜0．05）。结论子痫前期胎儿心功能受损，尤以SPE胎儿心功能受损较重；MOD-MPI在妊高症产妇胎儿心功能评价方面有较好的应用价值，可早期检出胎儿心功能异常。

Objective To investigate the hemodynamic changes between the liver transplantation and normal people before and after glucose ingestion and to probe their relationships.Method Color Doppler sonography was applied to measure hemodynamic changes between liver transplantation and the normal people before and after glucoseingestion and to probe their relationships.Results The blood flow parameters of portal vein will be different after meal comparing to the state that had no food for normal person and the person taking liver transplantation operation(P0.05).The value of blood flow parameter of portal vein when people had food was higher than that in case of people having no food.There was obvious difference in blood speed and blood flow rate between normal person and person taking liver transplantation in case of that the person had food and had no food(P0.05).The value of blood speed and blood flow rate of the person taking liver transplantation operation were obvious higher than that of normal person.There was no obvious difference between liver transplantation person and normal person in the inner diameter of portal vein if they had no food.Conclusion CDFI can give us a clue in observing the recovering state of person who received liver transplantation operation.It is necessary for us to know if the liver blood supply is normal by using the difference in the ratio of the inner diameter,flow speed and flow rate related to portal vein,between liver transplantation person and normal person.

患者女,58岁.主因间断性皮肤瘀斑2年,诊断血小板减少性紫癜2年入院.查体:T:36.0℃,脾脏增大,肋下5 cm,肝脏肋下未触及.临床诊断:脾大(脾血管瘤?血小板减少性紫癜?)增强CT示脾体积增大,实质内见大小约8 cm×10 cm×7 cm的类圆形肿块影,于动脉期不规则斑片状强化,门脉期及延迟期强化程度逐渐均匀,边界尚清,正常脾实质受压变薄,考虑脾血管瘤.彩超所见:脾脏体积明显增大,下极形态饱满,呈球形改变,实质回声均匀,见多个低回声结节样病变,直径约0.6～1.3 cm.结节回声均匀,边界尚清晰,占位效应明显,脾门抬高.

OBJECTIVE:To express the fusion protein of glutathione S-transferase (GST) and human Id-2 in E. coli and prepare the polyclonal antibodies against Id-2.METHODS:The coding sequence of Id-2 gene was amplified by RT-PCR from the total RNA of breast cancer tissue. The recombinant plasmid was identified by PCR, restriction endonuclease digestion analysis and sequencing. The fusion protein GST-Id-2 expressed in E. coli following IPTG induction was purified by glutathione-agarose affinity chromatography and used to immunize rabbits to prepare the polyclonal antibodies against GST-Id-2.RESULTS:PCR, restriction endonuclease digestion and sequence analyses showed that the Id-2 gene had been correctly inserted into pGEX-6P-1 vector, and the GST-Id-2 fusion protein expressed had a relative molecular mass of approximately 40,000 as shown by SDS-PAGE. The polyclonal antibodies obtained from the rabbit sera were found to specifically react with purified Id-2 by Western blotting, ELISA and agar gel immunodiffusion (AGP).CONCLUSION:The prepared polyclonal antibodies against Id-2 allow effective Id-2 detection and facilitate further investigation of the structure and antigen epitope of Id-2.

Objective Comparative analysis of the ultrasonic appearance and the pathological findings of the breast infiltra- ting ductal carcinomas(IDC).Try to investigate the relationship between the ultrasonic features and the expression levels of Id2mRNA and Id3mRNA.Methods The real-time fluorescent quantitative RT-PCR(FQ-RT-PCR)was used to detect the expression levels of Id2mRNA and Id3mRNA in 36 IDC.The results were compared with the ultrasonic features of IDC.Re- sults The expression of Id2mRNA was higher in normal tissues than that in carcinoma tissue(P0.05)and was lower in WHOⅢgrade than that in WHOⅠgrade(P0.05),Id3mRNA inversely(P0.01,P0.05,respectively).Id2mRNA has no statistically significant with the ultrasonic appearance(P0.05).Id3mRNA was high expression in spiculate margin and peripheral duct extension(P0.01).Conclusion Uhrasonographie morphologic manifestations are closely related to pathology in IDC.The expression level of Id3mRNA can be assessed according to ultrasonic features of IDC(spiculate mar- gin and disorder structure in duct)in certain degree.

Objective To analyze the pathologic appearances and ultrasonic features of breast infiltrating lobular carcinoma (ILC),and to investigate the relationship between the ultrasonic appearance and the expression of Id1mRNA and Id2mRNA.Methods The expression of Id1mRNA and Id2mRNA in 42 cases of ILC were measured by real- time fluorescent quantitative RT- PCR(FQ-RT - PCR),and the results were compared with the ultrasonic appearances of ILC.Results The expression of Id1mRNA was lower in normal tissues than that in carcinoma tissue(P0.005),and was higher in WHOⅢgrade than that in WHOⅠgrade(P0.01), The expression of Id2mRNA was higher in normal tissues than that in carcinoma tissue(P0.05),and was lower in WHOⅢgrade than that in WHOⅠgrade(P0.05).IdlmRNA had high expression in cases with spiculate margin and high echo halo(P0.01). There was no significant difference between the expression of Id2mRNA and ultrasonic appearance(P0.05).Conclusion There is close correlation between sonogram appearance and pathologic changes in ILC.The ultrasonic appearance of ILC can reflect the expression of Id1mRNA in certain degree.

Objective:To evaluate retrobulbar blood circulatory changes in diabetic patients with ultrasonography.Methods:Thirty patients without diabetic retinopathy and thirty healthy subjects were evaluated for retrobulbar blood flow parameters in terms of the ophthalmic(OA),short posterior ciliary(PCA),central retinal arteries(CRA),and the central retinal vein(CRV) using Ultrasonography and reevaluated the aforesaid terms after 2 weeks of intensive insulin therapy.Results:This study showed that the end-diastolic velocity(EDV) of OA,CRA were lower in diabetic patients than those in control subjects,the resistent index(RI) significantly higher than control subjects.The maxlmum velocity(Vmax) and minimum velocity(Vmin) of CRV were higher in patients without diabetic retinopathy than control subjects.The RI and plasma levels of glucose,triglyeride,total cholesterol and HbA1c showed significant decreased after the therapy.Conclusion:Ultrasonography is a useful method for early detection of the retrobulbar circulation hemodynamics change in diabetic patients.

患者男,17岁,自觉右侧胸部不适1年余,伴有间断性发热,最高体温达38.3℃,咳嗽,咳脓痰,因近1个月肩背部呈顽固性疼痛就诊.查体:右胸叩痛.