目的:探讨超声造影(contrast-enhanced ultrasound,CEUS)时间-强度曲线(time intensity curve,TIC)定量模型在中晚期宫颈癌患者同步放化疗(concurrent chemoradiotherapy,CCRT)效果评估中的临床价值.方法:选取2018年8月—2020年8月于江苏省肿瘤医院放疗科住院接受CCRT治疗的中晚期宫颈癌患者16例,所有患者在接受治疗前、治疗2周和外照射结束后行经阴道CEUS检查,并采用CEUS联合TIC定量模型进行分析.结果:整体患者及TP方案组CCRT治疗2周和外照射结束后达峰时间分别较治疗前明显缩短;TP方案组CCRT治疗2周曲线下面积较治疗前明显增加.结论:CEUS联合TIC能够体现中晚期宫颈癌CCRT治疗后肿瘤内部血流灌注变化情况,具有一定的早期疗效评估价值.

目的 超声较易分辨典型的乳腺肿块,但对于乳腺非肿块样病变的诊断目前研究较少.文中旨在分析乳腺非肿块样病变的超声表现,探究多模态超声对乳腺非肿块样病变的诊断效能,以提高诊断准确性.方法 回顾性分析2019年6月至2020年12月江苏省肿瘤医院超声科收治的62例乳腺非肿块样病变患者临床资料.采用常规超声、自动乳腺全容积成像(ABUS)、多模态超声进行诊断.与病理结果对照,探究多模态超声检查的准确度、敏感度、特异度、阳性预测值和阴性预测值.结果 62例病灶中,病理诊断为良性18例、恶性44例.以病理诊断为金标准进行诊断试验结果显示,常规超声诊断、ABUS检测和多模态超声等三种超声诊断结果一致性检验均具有统计学意义(P<0.05),其kappa值分别为0.337、0.499和0.531,依次升高.多模态超声的诊断准确度、敏感度和特异度分别为82.26％、83.67％和76.92％,阳性预测值和阴性预测值为93.18％和55.56％.结论 多模态超声的诊断敏感度和特异度等指标优于常规超声诊断、ABUS检测,其对乳腺非肿块样病变具有较高的临床诊断意义.

目的:对超声诊断的BIRADS4级乳腺进行弹性成像分析及经皮超声引导下穿刺活检,对比二者诊断价值.方法:对2013年6月—2016年3月我院130例超声诊断为BIRADS4级的乳腺肿块进行回顾性分析,以手术病理为金标准,对比弹性超声成像及经皮超声引导穿刺的诊断价值.结果:经弹性应变率比值分析,130例BIRADS4级肿块中有68例仍为BIRADS4级,19例升级为BIRADS5级,43例降级为BIRADS3级.对照术后大病理,经超声弹性应变率比值分析与经超声引导穿刺活检的灵敏度,特异度及准确率分别为87.03%、77.63%、81.53%及83.33%、96.05%、90.76%,在良性肿块的诊断上二者差异无统计学意义(P>0.05),在恶性肿块的诊断上二者差异具有统计学意义(P<0.05).结论:经皮超声引导下乳腺肿块穿刺对BIRADS4级肿块的诊断价值大于弹性应变率比值分析,是仅次于术后大病理的一种诊断方式.

Objective To evaluate the accuracy of CDFI and FFDM for diagnosis of breast lesions.Methods 298 breast lesions(128 benign and 170 malignant) in 254 patients were prospectively classified according to the imaging features by CDFI and FFDM.The results were compared with pathological results.Results The groups were classified as probably benign,indeterminate and probably malignant respectively by CDFI and FFDM.We considered the pathological results as standard,the accuracy of diagnosis in benign group in 86 patients were 92.19% and 75.00% respectively by CDFI and FFDM,The accuracy of diagnosis in malignant group in 170 patients were 90.00% and 87.65% respectively by CDFI and FFDM,CDFI and FFDM could complement at diagnosis in benign and malignant breast lesions.Conclusions CDFI and FFDM are valuable technique in benign and malignant breast lesions,combination of the CDFI and FFDM can improve the diagnostic accuracy to breast lesions.

目的探讨彩色多普勒超声检查在诊断和治疗浅表淋巴结病变中的临床应用价值.方法对96例患者肿大淋巴结,包括炎症、淋巴瘤和转移癌进行了彩色多普勒超声检查,观察其二维声像和彩色血流特征,并测量长短轴比例(L/S)、最大血流速度(Vmax)和阻力指数(RI),对部分病例治疗前后进行了随访观察.结果肿大淋巴结数目、大小、L/S于各组间存在交叉重叠.二维声像均表现为回声不均,淋巴结门消失或偏心.但各组病史不同;转移瘤回声多样,可伴有液化或钙化;炎症组血流Ⅰ～Ⅱ级,中央型为主,Vmax约9～19mm/s,RI 0.53～0.64;淋巴瘤血流Ⅱ～Ⅲ级,周边型与混合型,Vmax 23～51cm/s,RI 0.43～0.76,转移瘤血流0～Ⅲ级,表现无血流型、周边型或混合型,Vmax 11～42cm/s,RI 0.46～0.89.治疗后淋巴结消失或缩小,血流信号消失或减少,Vmax下降;恶性组治疗无效病例表现淋巴结体积缩小不明显,血流信号及Vmax不下降.结论彩色多普勒超声检查,为临床诊断和鉴别诊断、疗效判断及预后估计提供了可靠依据.

Objective The hemodymamic changes in 24 lessions (15 cases) of hepatic cancer treated by microwave coagulation were evaluated. Methods The hemodynamaic changes in 24 lessions of hepatic cancer treated by microwave coagulation were detected by PDI and contrast enhanced power Doppler.Results PDI and contrast enhanced power Doppler showed: Bloodflow of both inside and around lessions disappeared in 19 lessions and reduced in 5 lessions after treatment.The bloodflow around lessions was showed in all lessions before treatment and disappeared in 20 lessions after that; Entire bloodflow of 13 lessions (Diameter2 5 cm) disappeared.Reduction and disappearance of the bolldflow corresponded to the decline of AFP and CEA level.Conclusions It is concluded that PDI and contrast enhanced power Doppler are useful to monitor the hemodynamic changer of hepatic cancer before and after microwave coagulation and to evaluate the curative effect.

经皮穿刺每次瘤内注射无水酒精治疗46例原发性大肝癌.结果治疗后随访4～48个月,75%肿瘤内部回声增强,67.1%瘤体缩小,54.6%瘤内血流消失,AFP降至＜100μg或正常水平70%.1年生存率65%,2年48%,3年17%.该治疗方法简单、实用、并发症少,是一种姑息性治疗大肝癌的有效手段.

Objective Contrast enhanced power Doppler was used to evaluate the vessel visualization in hepatic cancer after the treatment of microwave coagulation. Methods Blood flow in 24 lessions of 15 cases treated by microwave coagulation 1～2 times was observed after injecting Levovist via vein. The results were compared with pathology.Results No blood flow was visualized in all 24 lessions before contrast. Blood flow existing was not observed in 19 lessions after contrast, and their pathologic report showed that complete necrosis occurred.Liver tumor cell were found by biopsy in 5 lessions in which blood flow was visualized. Conclusions Contrast enhanced power Doppler is one of practical techniques to evaluate the curative effect of hepatic cancer.

目的比较传统临床分期、计算机断层扫描(CT)和食管腔内超声(TEUS)对食管上段癌术前分期的价值.方法 38例食管上段癌患者,术前均行TEUS和CT检查.TEUS、CT和传统临床分期结果分别与手术病理分期比较.结果传统临床分期和TEUS对食管上段癌TNM分期的准确率分别为36.8%和68.4%(P＜0.01),CT和TEUS对食管上段癌TNM分期的准确率分别为47.3%和68.4%(P＜0.05),T分期的准确率分别为39.5%和73.7%(P＜0.01),局部转移性淋巴结(N分期)的检出率分别为40.8%和71.4%(P＜0.01).结论 TEUS在术前T、TNM和N分期上具有较高的准确性和检出率,优于CT和传统临床分期,对治疗方案的选择和疗效的提高具有重要价值.

目的探讨多途径介入治疗肝癌,并对其疗效加以分析 .方法 34个肝癌病灶(26例)的多途径介入性治疗在超声引导下进行.＜3cm 20个病灶,行局部微波治疗+门静脉化疗;＞3 cm 14个病灶,12个病灶行局部无水酒精注射治疗+门静脉化疗,2个病灶行局部微波治疗+无水酒精注射治疗+门静脉化疗;7 例合并门静脉癌栓者,加做门静脉癌栓内无水酒精注射治疗.结果随访12～25个月,一年生存率100%,两年生存率88.42%.微波治疗组均经活检证实完全性坏死;无水酒精注射治疗组US及CT报告病灶稳定.门静脉化疗预防组无癌栓出现;治疗组癌栓4例缩小,3例消失. 结论多途径介入治疗对预防肝癌转移, 延迟复发,改善预后有肯定意义,明显延长生存期.

用食管腔内超声技术诊断食管肿瘤已有报道[1-3],本研究根据食管解剖特点,对颈段食管癌患者进行颈部经皮超声检查,并与正常人颈段食管作了对照,以探讨超声在颈段食管癌诊疗中的应用价值.

目的探讨宫颈病变的声像图特征并与病理对照,以提高诊断的符合率.方法对124例宫颈病变经阴道超声检查并与病理对照,分析误诊原因.结果宫颈良性病变的诊断符合率87.67%(66/73),宫颈囊肿、宫颈肌瘤、宫颈肥大声像特征明显,诊断符合率较高;宫颈恶性病变诊断符合率92.16%(47/51),且可提示宫颈周围的浸润程度.误诊原因影响诊断正确率.结论经阴道超声检查诊断宫颈病变,可为临床提供可靠的诊断依据.

目的探讨超声引导下局部治疗结合门静脉化疗在中晚期肝癌中的应用.方法超声引导下局部治疗20例(26灶):15灶(直径＜3cm)行微波治疗;11灶(直径3cm)行无水酒精注射治疗.同时行门静脉化疗.全部病灶治疗后穿刺活检或随访.结果随访时间3～25个月,一年生存率100%,两年生存率90%.微波治疗组均经活检证实完全性坏死;无水酒精注射治疗组US及CT报告病灶稳定.门静脉化疗预防组无癌栓出现;治疗组癌栓3例缩小,2例消失.结论中晚期肝癌采取局部治疗结合门静脉化疗对预防肝癌转移,延迟复发及改善预后有肯定意义,明显延长了生存期.

Objective To find the small tumor quickly,shorten the operating time and reduce the resection range by the preoperative local coloring location.Methods Guided by real time ultrasound, a nonpoisonous dye was injected to stain the small breast tumor to indicate the postition of the tumor before the patients underwent an operation.Results Gentian violet was superior to the 1% mephylene blue because of its feature of good coloring and poor diffusion.And the results of using gentian violect as the dye in 19 patients with small breast tumors were satisfactor.Conclusions The preoperative local coloring of small breast tumors enables surgenos to locate the tumor quickly during the operation,shorten the operating time,reduce the resection range in some patients,and increase the curative effects.