Progress in the treatment of acute myocardial infarction (AMI)， chronic coronary artery disease and their immediate complications has led to an increasing number of surviving patients with residual left ventricular dysfunction. It has been shown that viable myocardium in post-AMI patients and chronic heart failure patients plays an important role in predicting their prognosis and making clinical decisions. Viable myocardium refers to myocardium with reversible contractile dysfunction that occurs in coronary ischemia or after ischemia-reperfusion, but still has contractile reserve. Myocardial microvascular integrity is in correspondence with myocardial viability. Myocardial contrast echocardiography can evaluate the microvascular integrity of myocardial dysfunctional areas in patients with AMI or chronic coronary artery disease, detect viable myocardium， predict the potential for functional recovery in dysfunctional areas following reperfusion， and provide clinicians with valuable information for individualized treatment.
【摘要】 目的 讨论胃充盈超声造影在胃溃疡患者术后的应用价值。 方法 2002年6月-2009年6月对因胃溃疡行手术的72例患者采用饮水法充盈胃进行术后超声检查随访，观察术后胃的容量变化、术后近期并发症及远期并发症。 结果 所有胃术后的患者，近期胃容量较前减少60%～70%，随着时间的延长，容量逐渐恢复，最大恢复至术前的50%。吻合处胃壁僵直，蠕动波消失。十二指肠残端漏2例，近期吻合口狭窄5例，胃瘫综合症3例，吻合口反流40例，有临床症状的患者10例，无临床症状的患者30例，复发性溃疡1例，未发现残胃癌及远期吻合口梗阻。 结论 胃充盈超声造影是胃溃疡术后简单易行的随访方法，具有重要的临床应用价值。【Abstract】 Objective To evaluate the use of contrast-enhanced ultrasonography of gastric filling in gastric ulcer patients after the operation. Methods A total of 72 patients who underwent the operation due to gastric ulcer between June 2002 and June 2009 were selected. We used water-drinking method for filling stomach to perform the ultrasonic examination and the patients were followed up. The post-operation changes in the capacity of the stomach, postoperation complication and long-term complication were observed. Results The reduction of recent stomach capacity was 60%-70% in of the patients after the operation. As time goes on, the capacity gradually recovered, and the largest recovery was 50%. Anastomosis gastric wall was stiff, and peristaltic wave disappeared. Drain off residual duodenum was found in 2 patients, anastomotic stricture near was in 5, delayed gastric emptying was in 3, anastomotic reflux was in 40, clinical symptoms was in 10, no clinical symptoms was in 30, and recurrent ulcer was in 1. No gastric remnant cancer or long-term anastomtic obstruction was observed. Conclusion Contrast-enhanced ultrasonography of gastric filling is a simple and practicable ultrasound follow-up method after gastric ulcer.
【摘要】 目的 比较肠充盈超声检查法与常规经腹超声检查法在结直肠肿瘤中的诊断价值。 方法 对2008年6月-2009年6月64例经临床病理确诊的结直肠肿瘤患者分别经腹常规超声及肠充盈超声检查。在肠充盈状态下观察病变的形态，对病变进行定位并观察结直肠肿瘤的彩色多普勒血流信号。比较肠充盈超声检查法及常规经腹超声检查法在结直肠肿瘤的检出、定位和显示血流的能力的差异。 结果 常规经腹部超声检查发现32例结直肠肿瘤（32/64），病灶敏感性为50%； 肠充盈超声检查法发现病灶55例（55/64）， 病灶敏感性为85.9%。经腹常规超声检查的定位准确率为21.9%（7/32），肠充盈超声检查法对结直肠肿瘤的定位准确率为89.1%（49/55）。两种方法比较差异有统计学的意义（Plt;0.05）。 结论 肠充盈超声检查法在结直肠肿瘤的病变敏感性检出、定位准确性等方面优于经腹常规超声检查；而不同病理类型的结直肠肿瘤具有不同的超声声像图特征。【Abstract】 Objective To compare the diagnostic value between intraluminal contrast-enhanced hydrocolon ultrasonography and conventional transabdominal ultrasonography for of colorectal neoplasms. Methods The conventional transabdominal ultrasonography and hydrocolonic ultrasonography using an intraluminal contrast agent were performed on 62 patients from June 2008 to June 2009. The morphological features and location of the lesion were observed and the blood flow signals were observed. The different diagnostic value between conventional transabdominal ultrasonography and intraluminal contrast-enhanced hydrocolon ultrasonography was compared. Results The sensitivity of the intraluminal contrast-enhanced hydrocolon ultrasonography in the depiction of the colorectal neoplasms (55/64, 85.9%) was higher than that of the conventional transabdominal ultrasonography (32/64, 50%, Plt;0.05). And the accuracy of the intraluminal contrast-enhanced hydrocolon ultrasonography in locating the colorectal neoplasms (48/55, 87.3%) was higher than that of the conventional transabdominal ultrasonography (7/32, 53.2%, Plt;0.05). Conclusion Intraluminal contrast-enhanced hydrocolon ultrasonography is more valuable for colorectal neoplasms than conventional transabdominal ultrasonography in detecting and locating colorectal neoplasms. Colorectal neoplasms with different pathological types may have different ultrasonic features.
目的 探讨射频消融术在无法实施手术的原发性肝癌患者中的临床应用效果。方法 回顾性分析2007年9月至2011年3月期间我院收治的58例由于各种原因无法手术治疗的大肝癌（＞5cm）并接受射频消融治疗患者的临床资料，射频消融前后结合超声造影的方法，术后随访并定期复查血清甲胎蛋白水平和超声造影或者肝脏增强CT。结果 58例中无一例发生与射频消融相关的死亡，22例达到完全消融（37.9%，22/58）。共51例（87.9%，51/58）获得随访，随访至2012年5月，随访时间（12.6±6.4）个月（2～21个月），随访12个月以上患者有20例（39.2%，20/51），有10例（19.6%，10/51）无肿瘤复发或者转移的迹象。22例达到完全消融的患者无瘤生存时间为（13.6±10.4）个月（3～21个月）；36例未能达到完全消融的患者中，有19例随访期间死亡，生存时间（8.3±6.1）个月（4～16个月）。结论 由于各种原因不能接受手术的大肝癌患者，射频消融作为一种有效、安全治疗方法，部分能达到完全消融的效果，而部分作为姑息性治疗手段，能一定程度上减轻患者的疼痛，达到提高生活质量的目的。
ObjectiveTo explore the safety and feasibility of contrast enhanced intraoperative ultrasonographyguided percutaneous radiofrequency ablation with artificial hydrothorax to hepatocellular carcinoma in the hepatic dome. MethodsThe clinical data of nine patients with hepatocellular carcinoma in the hepatic dome underwent ultrasonographyguided percutaneous radiofrequnecy ablation with artificial hydrothorax from January 2008 to June 2009 at Department of Hepatobiliopancreatic Surgery of West China Hospital were retrospectively analyzed. The perioperative results and recurrence of tumor were also analyzed. ResultsAll of nine patients with twelve tumors received successfully radiofrequency ablation with artificial hydrothorax of (2 444±464) ml (2 000-3 000 ml). The ablation time was 12-24 min (median 12 min), with an average of (15±5) min for each tumor. No hemothorax, pneumothorax, and death occurred during operation. One patient had ascites of 2 000 ml after ablation due to hypoalbuminenia, and ascites disappeared by infusion of abumin on 4 d after operation. The total volume of pleural drainage was 250-1 420 ml, with an average of (717±372) ml for each patient, and the drainage tube was withdrawn on 3-5 d after operation. The followup time was 7-23 months (mean 15 months). Tumor recurrence was found in three patients on 5, 6, and 7 months after operation, respectively. Of them, two patients were in stable disease stage after interventional and conservative therapy, respectively, and one case recurred at six months after operation and died of hypertensive heart disease and hepatic function deterioration at sixteen months after operation. The rest patients survived and no recurrence and metastasis was observed during the follow-up period.ConclusionThe technique of percutaneous radiofrequency ablation with artificial hydrothorax increases the feasibility of the minimal invasive treatment for hepatoma, which can be applied to hepatocellular carcinoma in the hepatic dome with high safety and clinical application value.
ObjectiveTo investigate the value of contrastenhanced ultrasonography in differential diagnosis between benign and malignant breast mass. MethodsTotally 65 patients with 70 breast masses were evaluated by general ultrasonography and contrastenhanced ultrasonography with contrast agent SonoVue. The related indexes, such as the degree and mode of contrast enhancement, the lesion boundaries and dissipation mode, were used to describe the difference between benign and malignant mass, which was also compared with pathological results. ResultsHistopathological examination revealed that benign mass was in 37 cases and malignant in 28 cases. The sensitivity, accuracy, positive predictive value, and negative predictive value of contrastenhanced ultrasonography with contrast agent SonoVue were significantly higher than that of general ultrasonography (Plt;0.05), while no significant difference in diagnostic specificity and misdiagnosis rate was observed between them (Pgt;0.05). All tumors showed contrast enhancement in various degrees. Of 28 patients with enhanced mass, hyperenhancement in 22 cases and nodular inhomogeneous enhancement in 21 cases were observed and the boundaries of malignant tumor were irregular with ill-defined and radial enhancement. Most of benign tumors were represented by weak, homogeneous enhancement, and the shape was regular with smooth and tidy boundary and intact capsule except seven cases with unclear boundary. These imaging characteristics of benign and malignant tumors were obviously different (P=0.000). In the resolution phase, both benign and malignant mass showed heterogeneous or homogeneous dissipation, which was not significantly different (P=0.791). ConclusionCompared with general ultrasonography, contrast enhanced ultrasonography may be more helpful for the differential diagnosis of benign and malignant breast tumors.
Objective To approach the enhancing patterns of hepatic focal nodular hyperplasia (FNH) under contrast-enhanced ultrasound, and improve the recognition on diagnosis for FNH by contrast-enhanced ultrasound. Methods The clinical data of 12 patients with histologically proved FNHs having accepted contrast-enhanced ultrasound examination from May 2007 to February 2009 in West China Hospital of Sichuan University were retroptectively analyzed, and related literatures were reviewed. Results All FNHs were rapidly enhanced in arterial phase and spoke-wheel-like sign was detected in 9/12 lesions. Slightly hyper-enhancement or iso-enhancement were showed in 11/12 lesions, while 1/12 lesions showed hypo-enhancement in late phase. Conclusion Contrast-enhanced ultrasound can display the dynamic blood perfusion of FNH, especially spoke-wheel-like arterial flow in early arterial phase, which is of great value for the diagnosis of FNH.
Objective To investigate the value of contrast enhanced ultrasound (CEUS) in evaluating the short term therapeutic response to radiofrequency ablation (RFA) of primary hepatocellular carcinoma. Methods One hundred and ten lesions were studied in 96 patients. Each patient underwent CEUS within a week before RFA, the number, size, border, inner echo and perfusion pattern of lesions were observed. One month after ultrasound-guided RFA, color Doppler flow imaging, CEUS and contrast enhanced computed tomography (CECT, reference standard) were performed to assess the therapeutic response. Results Before RFA, in 96 cases with 110 lesions, 83 lesions showed homogeneous hyper-enhancement and the other 27 heterogeneous hyper-enhancement in arterial phase, and 98 lesions were hypo-enhanced in portal venous phase and late phase and the other 12 iso-enhanced. One month after RFA, 99 of 110 lesions were found no-enhancement in entire CEUS procedure, while 11 lesions showed local enhancement on the edge of lesion. Ninety-six of 110 lesions showed no-enhancement and other 14 with irregular enhancement by CECT. There was no statistical significance between CEUS and CECT (χ2=0.406, Pgt;0.05). Fourteen lesions as tumor residual by CECT were underwent RFA again, and then 1 month after RFA no-enhancement was showed by both CECT and CEUS. Conclusion CEUS can play a role in assessing the short term therapeutic response to RFA of hepatocellular carcinoma.
目的 探讨超声造影对门静脉癌栓和血栓的鉴别诊断价值。方法 应用超声造影剂（SonoVue）对16例门静脉癌栓及8例门静脉血栓行实时低机械指数超声造影，观察并分析其造影增强特征。 结果 16例癌栓超声造影动脉相10例呈整体均匀性增强，2例呈整体不均匀性增强，2例呈整体轻度增强，2例栓子一部分增强，另一部分无增强； 门脉相特别是门脉相晚期和延迟相14例栓子呈充盈缺损状态，2例栓子仍呈轻微强化。4例常规彩超检查未能检出动脉血流信号而不能确诊的癌栓，超声造影均显示其动脉相增强。8例血栓行超声造影后整个造影过程栓子均未见增强。结论 超声造影可敏感地反映门静脉栓子的血流灌注，门静脉癌栓和血栓在超声造影后有显著的特征，有助于两者的鉴别诊断。