目的 探讨超声造影LI-RADS分类标准对乙肝肝硬化患者肝细胞癌的一致性.方法 选取我院2018年12月～2019年11月收治的疑似肝细胞癌患者112例,所有患者均于入院后行超声造影检查,根据LI-RADS分类标准进行诊断.将超声造影LI-RADS分类标准结果与病理诊断结果进行比较,以病检结果为金标准,计算前者的灵敏度、特异度、准确率.经Kappa检验分析LI-RADS分类标准与病检诊断的一致性.结果 在112例乙肝肝硬化患者中,观察者之间一致性的Kappa值分别为0.624和0.633.肝细胞癌的始增时间、达峰时间、始消时间、持续时间均短于其他类型肝癌,具有统计学意义(P＜0.05).经超声造影检出103个单发病灶,其中LR-1类21(20.39％)个、LR-2类6(5.80％)个、LR-3类5(4.80％)个、LR-4类26(25.24％)个、LR-5类15(14.56％)个、LR-M类30(29.13％)个.绘制ROC曲线评价的阳性预测值为65.22％,阴性预测值为89.17％,ROC曲线评价的AUC为0.774,拟合效果良好.结论 超声LI-RADS分类诊断乙肝肝硬化病变具有一定的临床应用价值,超声造影LI-RADS分类标准对乙肝肝硬化患者肝细胞癌的评价具有一致性.

目的 探讨二维超声、多普勒超声、实时剪切波弹性成像等超声指标预测肝移植术后胆道梗阻的价值.方法 对62例肝移植术后患者移植肝和脾脏进行上述超声指标检查,随访至首次确诊胆道梗阻或术后满24个月,根据有无胆道梗阻分为研究组和对照组,比较组间超声指标差异.结果 13例患者出现胆道梗阻,肝动脉阻力指数(HARI)和肝脏硬度(LS)在两组之间有显著差异(P＜0.05).研究组HARI低于对照组(0.56±0.08 vs 0.66+0.07),HARI预测肝移植后胆道梗阻的受试者工作特征曲线下面积(AUC)为0.856,以0.60为界,灵敏度为84.6％,特异度为79.6％;研究组LS高于对照组[(11.50±6.82)kPa vs(7.29±1.04)kPa],LS预测胆道梗阻的AUC为0.714,以8.15 kPa为界,灵敏度为69.2％,特异度为81.6％.结论.原位肝移植术后LS＞8.15 kPa、HARI＜0.60时发生胆道梗阻并发症的可能性增加.

目的 使用灰阶、多普勒及实时剪切波弹性成像等无创超声建立肝硬化食管胃静脉曲张破裂出血(EVB)预测模型.资料与方法超声测量肝硬化患者门脾静脉主干内径和流速、脾脏长度(SL)、脾脏厚度(ST)、肝脏硬度(LS)、脾脏硬度(SS),随访至出现EVB或截至2020年11月1日,根据随访结局分为出血组和未出血组,对组间有显著差异的指标进行Logistic回归分析,建立回归模型.结果 纳入67例肝硬化,出血组15例,未出血组52例.两组ST、SL、LS、SS差异均有统计学意义(t=-2.978、-2.732、-2.423、-2.784,P＜0.05).回归分析发现:ST和SS为独立危险因素(OR=1.063、1.123,P＜0.05),建立回归模型(SSST) =0.116×SS+0.061×ST-7.481.LS、SL、SS、ST、SSST预测EVB的ROC曲线下面积分别为0.706、0.733、0.737、0.753、0.867,界值分别为16.5 kPa、132.5 mm、28.4 kPa、45.0 mm、-0.94,敏感度分别为66.7％、100.0％、60.0％、93.3％、73.3％,特异度分别为80.8％、46.2％、82.7％、53.8％、90.4％.结论 超声测得SL＜132.5mm、ST＜45.0 mm可排除EVB的发生,基于ST和SS的超声无创预测模型SSST具有良好的预测价值和高度特异性.

木村病又称嗜酸性淋巴肉芽肿,以皮下无痛性肿块并周围淋巴结肿大为特征[1],是一种罕见的良性疾病,其发病可能与不明原因的慢性炎症及免疫紊乱有关[2].目前,关于木村病超声特征的研究报道较少.本组回顾性分析4例木村病患者的临床及超声检查资料,以期提高对本病超声特征的认识.

目的:研究基于超声的实时剪切波弹性成像(SWE)技术测量肝脾硬度联合肝脂肪变性指数(HSI)在诊断非酒精性脂肪性肝病(NAFLD)患者脂肪肝严重程度中的应用价值.方法:纳入2017年1月-2018年6月就诊于西安交通大学第一附属医院符合纳入标准者,以上腹部CT平扫为参考标准,将研究对象分为对照组及轻度、中度、重度脂肪肝四组,比较SWE所测肝脏硬度(LS)、脾脏硬度(SS)及HSI在组间的差异,计算单个指标及联合指标诊断脂肪肝的ROC曲线.结果:LS、SS、HSI在组间的差异均具有统计学意义(P＜0.05),两两比较发现LS、SS、HSI鉴别相邻级别脂肪肝能力欠佳,因此进一步计算其检出中重度脂肪肝的ROC曲线,ROC曲线下面积(AUROC)分别为0.895±0.030、0.730±0.041、0.788±0.036(P＜0.05),诊断界值分别为7.35 kPa、23.65 kPa、36.32.进一步计算联合指标ROC曲线,LS+HSI的AUROC为0.904±0.028 (P＜0.05)、灵敏度88.3％、特异度87.0％;SS+HSI的AUROC为0.824±0.033 (P＜0.05),灵敏度75.0％,特异度77.2％.结论:SWE所测LS、SS联合HSI可准确检出中重度NAFLD,其中以LS+HSI诊断绩效最高,具有良好的临床应用价值.

Abstract Rationale: Undifferentiated carcinoma with osteoclast-like giant cells (UC-OGCs) of the pancreas is an extremely rare and aggressive pancreatic malignancy. To our knowledge, the computed tomography (CT) findings of this disease have rarely been analyzed. Patient concerns: A 65-year-old man who experienced weight loss of about 4 kg over 3 months presented to our clinic. The abdominal ultrasound (US) detected a 5.8 × 5.5 cm well-defined, cystic-solid mass in the head of the pancreas, which had been present for 1 month. Diagnosis: A benign pancreatic tumor was initially suspected on the basis of the US findings. The patient then received serum tumor markers and CT examinations for further diagnosis, including carbohydrate antigen 199 (CA199), carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), contrast-enhanced CT (CECT) and CT angiography (CTA). His CA199, CEA, and CA125 marker levels were normal, which supported the diagnosis of a benign tumor. CECT showed a well-defined cystic-solid mass in the head of the pancreas, with a slightly enhanced solid portion and pancreatic ductal dilatation, which led us to consider the possibility of a malignant tumor. CTA revealed that the tumor nourishing arteries emitted from the pancreaticoduodenal superior and inferior arteries into the mass. Then, the patient underwent a pancreaticoduodenectomy. Finally, postoperative pathology and immunohistochemistry confirmed UC-OGC of the pancreas. Interventions: The patient has been treated by a pancreaticoduodenectomy alone. Outcomes: The operation had no complications, and the patient recovered well after surgery. Ten months after surgery, the patient reviewed the CECT, and no recurrence or metastasis was noted. Lessons: Old patients with cystic-solid lesions in the pancreas should be aware of UC-OGC. CT findings usually show a clear boundary and a slightly enhanced mass with pancreatic duct expansion.

OBJECTIVE To evaluate the utility of combined liver stiffness measurement (LSM) and spleen stiffness measurement (SSM), by transient elastography, along with measurement of portal vein width (PVW) for evaluating risk of bleeding in patients with esophageal and gastric varices (EV). METHODS A total of 73 patients with cirrhosis who were treated in the Department of Gastroenterology of the Second Affiliated Hospital of Xi'an Jiaotong University between April 2014 and March 2015 were included in the study. Child-Pugh classifications were obtained, portal vein widths were measured by ultrasound, liver and spleen stiffness were measured by transient elastography using FibroTouch®. Patients were examined by electronic endoscopy, upper abdominal computed tomography and standard serum testing. The serum indexes of fibrosis (aspartate aminotransferase (AST) to platelet ratio index (APRI), and AST to alanine aminotransferase ratio (AAR)) were calculated. Patients were grouped according to the results of gastroscopy, with severe (EV) and high risk of bleeding comprising group A and no or mild-to-moderate EV and low risk of bleeding comprising group B. Statistical analysis was carried out with t-test for continuous variables and χ(2) test for categorical variables to first screen out variables different between groups then the correlation with severe EV was assessed by generating receiver operating characteristic (ROC) curves. Lastly, binary logistic regression was used to evaluate the performance of combined variables for diagnosing severe EV and their predictive value for risk of bleeding. RESULTS Group A and B showed significant differences for LSM, SSM and PVW (all P < 0.05). The cutoff values for diagnosing severe EV were 23.4 kPa for LSM, 40.3 kPa for SSM and 11.5 mm for PVW, with areas under the ROC curve (AUROC) as 0.655, 0.788 and 0.709 respectively. For combined measurements, the AUROC was 0.773 for LSM plus PVW and 0.840 for LSM plus PVW (with highest diagnostic performance). CONCLUSIONS Combination of SSM plus PVW measurement shows high diagnostic performance for evaluating severe EV, and better performance than LSM plus SSM plus PVW and LSM plus PVW, with good predictive value for risk of EV bleeding.

Objective To analyze the stomach abscess and summarize its etiology,clinical manifestation, diagnosis and treatment.Methods The cases of stomach abscess were searched from Chinese Journals Full-text Database,VIP Chinese Science and Technology Periodical Database and Wanfang Digital Peridical database published before August 201 5, a total of 22 patients were reported in domestic, the general situation, etiology, clinical manifestation,diagnostic methods,treatment and prognosis were analysed.Results The incidence was higher in male (13/22); main symptoms included abdominal pain, chills, fever and abdominal mass; common cause included infection,stomach injury because of foreign matter and stomach surgery;diagnostic methods included gastroscope and endoscopic ultrasonography,CT and exploratory laparotomy;treatments included anti-infection symptomatic treatment and surgical treatment;twenty patients were cured and two patients died.Conclusion Stomach abscess is rare and can be cured by early diagnosis and medical treatment to obviate the risk of serious complications and surgery.