目的通过超声动态观察Stanford A型主动脉夹层不同受累分型的肾内血流动力学参数及肾血流灌注变化.资料与方法前瞻性纳入北京安贞医院2016年1—12月接受Sun's手术治疗的Stanford A型主动脉夹层患者40例共80个肾脏,分别于术前1 d、术后24 h、术后48 h测量双肾叶间动脉收缩期峰值流速(PSV)、舒张期最小流速(EDV)、平均流速(Vm)、搏动指数(PI)、阻力指数(RI),以CT血管成像(CTA)结果将肾脏灌注来源分为真腔型、假腔型、肾动脉受夹层累及型,比较术前1 d、术后24 h、术后48 h每个时间不同分型肾脏血流动力学参数的差异,以及同一分型肾脏在不同时间血流动力学参数的差异,并将不同肾动脉受累分型与超声彩色多普勒半定量评级进行分析.结果80个肾脏中,真腔型54个,假腔型21个,双腔或肾动脉受累型5个.真腔型肾的Vm、PI、RI在3个时间点差异均有统计学意义(F=3.083、3.630、7.050,P均<0.05).术前1 d不同分型肾叶间动脉RI差异有统计学意义(F=3.222,P<0.05),其余时间点各血流动力学参数差异无统计学意义(P>0.05).术后48 h不同分型肾血流灌注半定量评级差异有统计学意义(F=0.442,P<0.05).假腔型肾血流灌注半定量0～2级的比例为66.7％(14/21),真腔型肾血流灌注半定量0～2级的比例为31.5％(17/54),真腔型术后肾血流灌注半定量主要为3级血流,而假腔型和肾动脉受夹层累及型术后肾血流灌注半定量主要为2级血流.结论超声对于Stanford A型主动脉夹层肾动脉不同受累分型的血流动力学参数中,Vm、PI、RI对临床具有很好的参考价值.术后肾脏血流灌注半定量评级对肾损伤状态具有直观的指导意义.

目的 探讨超声评分和磁共振在胎盘植入性疾病诊断中的应用价值.方法 纳入本院收治的怀疑胎盘植入患者53例,产前应用超声评分及磁共振对胎盘植入及严重程度作出诊断,以手术或病理结果为标准,比较两种方法的诊断效能并分析妊娠结局.结果 无胎盘植入9例,胎盘植入44例,其中粘连型23例,重型21例(15例植入型和6例穿透型).超声评分诊断重型胎盘植入准确度为88.68％、灵敏度为85.71％、特异度为90.63％;磁共振诊断重型胎盘植入准确度为88.68％、灵敏度为80.95％、特异度为93.75％.重型者产后出血率、子宫全部或部分切除率及胎儿早产率均明显高于粘连型(P＜0.05).结论 超声评分和磁共振对重型胎盘植入均具有较高诊断价值,超声评分简便经济可作为首选方法,必要时联合应用.

目的:探讨冠状动脉旁路移植(CABG)术前常规超声检查锁骨下动脉的价值.方法:超声检查拟CABG术患者1546例共3092条锁骨下动脉,分析锁骨下动脉狭窄及同侧椎动脉、乳内动脉的血流频谱情况,发现锁骨下动脉中度以上狭窄时以血管造影为金标准,评价椎动脉及乳内动脉逆流诊断锁骨下动脉狭窄的价值.结果:103例患者(124条锁骨下动脉)存在锁骨下动脉起始段中度以上狭窄,狭窄发生率为6.7％.锁骨下动脉狭窄侧椎动脉逆流51条,无逆流73条,余锁骨下动脉无狭窄侧椎动脉均无逆流;锁骨下动脉狭窄侧乳内动脉逆流11条,无逆流113条,余锁骨下动脉无狭窄侧乳内动脉均无逆流.以椎动脉逆流诊断同侧锁骨下动脉狭窄的敏感性为41.1％,特异性为100％,ROC曲线下面积为0.706;以乳内动脉逆流诊断同侧锁骨下动脉狭窄的敏感性为8.87％,特异性为100％,ROC曲线下面积为0.544.结论:根据椎动脉及乳内动脉逆流诊断同侧锁骨下动脉狭窄的价值均较低,常规超声检查锁骨下动脉对指导CABG术桥血管选择避免出现冠状动脉锁骨下动脉窃血综合征是非常重要的.

Objective To analyze the clinical value of two-dimensional and color Doppler ultrasound combined with elastography in diagnosis of papillary thyroid microcarcinoma.Methods Clinical data of 41 cases of papillary thyroid microcarcinoma with 56 malignant nodules confirmed by post-surgery pathological examination from January 2014 to December 2016 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed.The patients were divided into observation group and control group according to different ultrasonic examination methods.In observation group(21 cases),28 nodules were detected by elastography,two-dimensional and color Doppler ultrasound;the control group (20 cases) had two-dimensional and color Doppler ultrasound and 28 nodules were found.Diagnostic accuracy for thyroid malignant nodules was compared between groups.Results There were 34 unilateral single nodules (60.7％) and 22 bilateral single or multiple nodules(39.3％).The smallest nodule was 2.0 mm × 2.0 mm × 3.0 mm and the largest one was 9.0 mm × 9.0 mm × 10.0 mm.Among the 56 nodules,2 nodules(3.6％) showed very low echo,50 nodules(89.3％) showed low echo,3 nodules (5.4％) showed solid-cystic echo and 1 nodule(1.8％) was iso-echo;6 nodules(10.7％) had clear boundaries and 50 nodules (89.3％) were unclear;9 nodules (16.1％) presented regular morphology and 47 nodules (83.9％) were irregular;53 nodules(94.6％) had aspect ratio-1 and 3 nodules(5.4％) had aspect ratio ＜ 1;3 nodules(5.4％) had coarse calcification and 53 nodules(94.6％) had micro-calcification.Diagnostic accuracy in observation group was significantly higher than that in control group[96.4％ (27/28) vs 75.0％ (21/28)] (P =0.002).Condasions Elastography can help to improve the diagnostic accuracy of papillary thyroid microcarcinoma in combination with two-dimensional and color Doppler ultrasound.Hypoechoic nodules with irregular shape,blurred border,angular border,lobulate and speculate border,multiple punctate and gravel-like microcalcification,aspect ratio≥ 1,elastography score 4-5 are characteristic changes of papillary thyroid microcarcinoma.

目的 探讨胎儿颈项透明层(NT)不同厚度与妊娠不良结局的关系.方法 选取胎儿NT值增厚的孕妇78例,根据NT不同厚度分为四组:Ⅰ组2.5～3.0 mm,Ⅱ组3.1～4.0 mm,Ⅲ组4.1～5.0 mm,Ⅳ组NT＞5.0 mm,随访NT增厚胎儿妊娠结局.结果 胎儿NT增厚者包括单纯NT增厚者45例,妊娠结局不良者33例,妊娠结局不良组较单纯NT增厚组在孕妇年龄、胎儿NT厚度、染色体及结构异常发生率比较均有统计学意义(P＜0.05).NT值不同厚度分组比较,NT值＞4.0 mm的Ⅲ、Ⅳ组妊娠不良结局发生率明显高于Ⅰ、Ⅱ组(P＜0.05),发生率分别为100％、92％.结论 胎儿NT厚度可以作为孕早期筛查预测妊娠不良结局的重要指标.随着NT测值增加,胎儿妊娠不良结局的概率增大.

目的 探讨彩色多普勒超声对感染性心内膜炎致外周血管感染性假性动脉瘤的诊断及疗效评估价值.方法 回顾性分析2009年1月—2018年6月首都医科大学附属北京安贞医院收治9例外周血管感染性假性动脉瘤患者的超声图像特征,主要包括动脉瘤所在位置、瘤体大小、破口宽度、附壁血栓情况.结果 9例感染性假性动脉瘤分别位于股动脉、胫前动脉、腘动脉、胫后动脉、肌间动脉、尺动脉、腮腺动脉、锁骨下动脉、肠系膜上动脉.感染性假性动脉瘤瘤体上下径(54.86±21.25)mm,前后径(40.71±15.47)mm,破口宽度(2.47±0.94)mm,附壁血栓2例.行外科手术切除治疗3例,其中1例同时行人工血管替换术;介入治疗5例,其中行弹簧圈封堵2例,单纯支架置入2例,弹簧圈封堵同时行支架置入1例;保守治疗1例.术后血管血流通畅,未见血栓形成.结论 彩色多普勒超声对感染性假性动脉瘤具有较高的诊断价值,可以作为感染性假性动脉瘤诊断及疗效评估的首选检查方法.

Objective To evaluate the value of ultrasound in the diagnosis of accessory renal artery in patients with hypertension.Methods Comparison of velocity and diameter of the relationship between the main renal artery,renal artery,accessory renal artery.Results 110 cases of accessory renal artery in patients with accessory renal artery,a total of 118,is located in the right 70,left 48,102 cases of unilateral accessory renal artery,8 cases were bilateral accessory renal artery.No variation side velocity of RA (104.86 ± 24.08) cm/s,diameter (0.51 ± 0.07) cm;lateral variation velocity of MRA (104.86 ± 34.24) cm/s,diameter (0.39-±-0.07) cm;lateral variation velocity of ARA (106.72±33.10)cm/s,diameter (0.29±0.07) cm.There was no significant difference between the RA and the variant side of the MRA diameter;There was no significant difference in flow velocity;There was a significant difference in MRA and ARA between the variant sides;There was no significant difference in flow velocity.There was no significant difference between the RA and the variant side of the ARA diameter;There was no significant difference in flow velocity.Conclusions Accessory renal artery is a variation of renal artery blood supply,and will have a certain impact on the screening of renal artery stenosis.As a kind of simple and economical imaging method,color Doppler ultrasound can be used as screening methods for detection of accessory renal artery.

Objective To analyze the ultrasound and elastography characteristics of different parts of papillary thyroid carcinoma.Methods Pathologically confirmed papillary carcinoma of thyroid nodules were 64 cases,according to the location of the lesions will nodules is divided into an upper pole,middle,lower pole three groups,observation and different parts of nodules of gray scale and color flow and elasticity imaging characteristics of.Results Papillary thyroid cancer nodules on gray scale image as hypoechoic nodules,unclear boundary,irregular shape,vertical and hor izontal ratio is greater than 1,characteristics of flow distribution in level Ⅱ and Ⅲ,elastic score to Ⅲ and Ⅳ.There was no significant difference in the blood flow resistance index (RI) of the three groups (P＞0.05).The difference was found between the upper pole andthe lower pole (P 0.02).Conclusions There is no significant difference in color Doppler flow imaging of papillary thyroid carcinoma at different sites.Upper pole nodule hardness was higher than that of inferior pole.

目的 探讨超声微血流成像(SMI)技术在评价颈动脉溃疡斑块内新生血管的应用价值.方法 对19例患者的23个溃疡斑块行超声微血流成像检查,测量斑块厚度,观察斑块内新生血管位置及密度,并对比实时超声造影检查结果.结果 SMI检查结果与实时超声造影检查结果显示23个溃疡斑块内均可见新生血管.其中2例患者为2个溃疡斑块,1例患者为3个溃疡斑块.23个斑块中低回声斑块14个,低回声为主混合回声斑块9个,斑块厚度0.23～0.63 cm,平均厚度(0.40±0.10) cm.新生血管位置位于斑块肩部10例,位于斑块基底部2例,斑块肩部、基底部均见新生血管11例.结论 SMI超声微血流成像技术可以观察颈动脉溃疡斑块内新生血管情况,评价斑块易损性.溃疡斑块内有较丰富新生血管,SMI可以作为诊断颈动脉溃疡斑块新生血管的首选影像学检查方法.

目的 评价三维颈动脉超声成像在颈动脉狭窄诊断中与数字减影脑血管造影(DSA)的一致性,并分析其在缺血性脑血管病中的应用价值.方法 选取我院住院的缺血性脑血管病患者42例(共54条血管),首先行DSA检查及常规颈动脉超声,再利用三维颈动脉超声扫描系统进行扫查,并进行颈动脉三维重建,测量斑块数目及管腔狭窄率,与DSA进行对比分析,得出一致性.结果 三维颈动脉超声对颅外段颈动脉的斑块检出率高于DSA.对于颈动脉直径狭窄率超过70％的重度狭窄,三维超声与DSA检查的一致性Kappa值为0.908,提示三维超声结果可靠.结论 三维颈动脉超声无创、无放射性,可直观显示颈动脉颅外段详细的三维解剖结构,斑块形态及位置,并能较准确判定颈动脉狭窄程度,有望成为评价颈动脉斑块及狭窄的重要检查方法.

目的 探讨超声造影定量评价肾动脉狭窄支架置入术前后肾实质内血流灌注变化.方法 对17例肾动脉明显狭窄患者共18条肾动脉,行经皮腔内肾动脉支架成形术(PTRAS).术前与术后2d进行彩色多普勒超声及超声造影检查.结果 支架置入术前后CEUS获得时间-强度曲线,测得DPI、A、TTP、TTP-AT有明显差异(P＜0.05);GFR与DPI呈正相关.结论 超声造影部分灌注参数可定量评价PTRAS术前后肾实质血流灌注变化,与GFR有很好的相关性.

目的:观察超声诊断颈内动脉重度狭窄或闭塞的临床价值.方法:选取临床拟诊断为颈动脉重度狭窄或闭塞的住院患者37例,均行颈动脉常规超声与数字减影血管造影(DSA)检查.以DSA诊断结果为标准,评估彩色多普勒超声诊断颈内动脉重度狭窄或闭塞的准确度.结果:超声检查结果提示颈内动脉中度狭窄8例,重度狭窄12例,闭塞13例；DSA提示颈内动脉重度狭窄16例,闭塞17例.常规超声检查颈内动脉重度狭窄或闭塞假阳性率10.8％,过度诊断率10.8％,过轻诊断率32.4％.结论:颈动脉超声在颈动脉狭窄或闭塞的筛查中有重要作用,但必要时仍需结合DSA检查以减少漏诊、误诊.

目的 探讨超微血流成像(SMI)技术诊断颈动脉斑块内新生血管的价值.方法 对32例有症状缺血性脑血管病患者进行颈动脉规超声、SMI及超声造影检查.结果 常规颈动脉超声检查共发现100个斑块,低回声斑块(59个)及低回声为主的混合回声斑块41个.SMI可观察到新生血管的斑块39个,显示斑块内新生血管部位、形态与超声造影呈现良好的一致性、kappa值=0.72.结论 SMI血流显像技术可以作为诊断颈动脉斑块新生血管的首选影像学检查方法.

Objective To evaluate the diagnostic value of color Doppler flow imaging (CDFI) in the renal artery stenosis percutaneous transluminal angioplasty stenting (PTAS).Methods A comparative analysis of the 32cases (5 cases with bilateral renal artery stent) with renal artery stenosis in renal arterypeak systolic velocity(PSV),renal aortic ratio(RAR) and renal-interlobar ratio(RIR) before and a week after the PTAS,and compared with normal renal artery group(60 cases).Results PTAS preoperative renal artery residual cavity inside (0.24 ± 0.07) cm,postoperative renal artery stent inner diameter (0.4 ± 0.1)cm; Preoperative stenosis at PSV (313 ± 123)cm/s,postoperative (121 ± 76) cm/s; RAR preoperative 3.3 ± 1.5,postoperative 1.3 ± 0.7 ; RIR preoperative 7.8 ± 4.1,postoperative 2.8 ± 2.1 ; Cr preoperative (90.8 ± 23.9) μmol/L,postoperative (94.2 ± 22.9) μmol/L; BUN preoperative (6.9 ± 2.2) mmol/L,postoperative (6.0 ± 1.6) mmol/L.Renal artery normal controlgroup SV(92.3 ±28.6) cm/s ; RAR 1.3 ± 0.4 ; RIR 2.3 ± 0.8.Start of renal artery and renal blood perfusion in all were significantly improved,stent PSV had no obvious rise,postoperative RAR,RIR were back to normal after the PTAS.Conclusion Color doppler flow imaging is a noninvasive,convenient and reliable inspection method in evaluating renal artery stenosis PTAS.

Objective: Discussing assessment of diagnosis internal carotid artery occlusion by contrast enhanced ultrasound(CEUS).Methods: The project applies CEUS and digital subtraction angiography(DSA) to 11 patients with probable internal carotid artery occlusion,thus the value of CEUS is assessed in occlusion diagnosis.Results: Study examines 11 internal carotid arteries from 10 patients.There are 6(6/11) severe stenosis and 5(5/11) occlusion as the result of DSA.In addition,CEUS explains that 1(1/11) are occlusion and 10(10/11) are severe stenosis with the distal arteries unobstructed.Conclusion: CEUS is employed as an important imaging tool with noninvasive before DSA test,which has ability in assessing internal carotid artery occlusion.Moreover,CEUS shows therapeutic opportunities to some of the patients and provides references to clinical treating plans.