• 【支气管内超声引导的经支气管针吸(EBUS-TBNA)-从形态学到分子检测。】 复制标题 收藏 收藏
    DOI:10.21037/jtd.2017.03.158 复制DOI
    作者列表:Righi L,Franzi F,Montarolo F,Gatti G,Bongiovanni M,Sessa F,La Rosa S
    BACKGROUND & AIMS: :In recent years, endobronchial ultrasound-guided TBNA (EBUS-TBNA) has emerged as an innovative technique for diagnosis and staging of lung cancer and has been successfully introduced into daily clinical practice with several advantages including minimally invasive approach, safe, cost-effective, real time image guidance, broad sampling capability, and rapid on-site evaluation (ROSE). Both cytological and histological approach could be useful to have material for diagnosis, immunohistochemical and molecular analyses which may be very important for targeted therapy with successful rate ranging from 89% to 98%. The utility of ROSE during EBUS-TBNA has been matter of debate. Indeed, although some evidence concluded that ROSE does not increase the diagnostic efficacy of EBUS-TBNA, other demonstrated that it improves the diagnostic yield of the procedure up to 30%, allows to avoid repetition of additional diagnostic procedures and reduces risk of complications. Furthermore the sample preparation by cytopathologist is optimized with the aid of direct macroscopic inspection, optimal smearing techniques, and triage of the sample permitting to obtain adequate tissue for diagnosis, ancillary techniques and molecular testing, when needed. Some pathological issues on EBUS-TBNA are reviewed and discussed with particular focus on ROSE and molecular testing.
    背景与目标: :近年来,支气管内超声引导下的TBNA(EBUS-TBNA)已成为诊断和分期肺癌的创新技术,并已成功引入日常临床实践中,具有多种优势,包括微创方法,安全,具有成本效益,实时图像导航,广泛的采样功能以及快速的现场评估(ROSE)。细胞学和组织学方法均可用于诊断,免疫组织化学和分子分析的材料,这对于靶向治疗非常重要,成功率从89%到98%不等。在EBUS-TBNA期间,ROSE的实用性一直存在争议。确实,尽管一些证据得出结论,ROSE不会增加EBUS-TBNA的诊断功效,但其他证据表明,ROSE可以将手术的诊断率提高多达30%,可以避免重复进行其他诊断程序并降低并发症的风险。此外,借助于直接的宏观检查,最佳的涂片技术和样品分类,可以优化细胞病理学家的样品制备,从而在需要时能够获得足够的组织用于诊断,辅助技术和分子检测。对EBUS-TBNA的一些病理学问题进行了回顾和讨论,特别是在ROSE和分子测试方面。
  • 【内侧上con炎:超声引导自体血注射是一种有效的治疗方法吗?】 复制标题 收藏 收藏
    DOI:10.1136/bjsm.2006.029983 复制DOI
    作者列表:Suresh SP,Ali KE,Jones H,Connell DA
    BACKGROUND & AIMS: OBJECTIVE:To assess if ultrasound guided autologous blood injection is an effective treatment for medial epicondylitis. METHODS:Twenty patients (13 men, 7 women) with refractory medial epicondylitis with symptom duration of 12 months underwent sonographic evaluation. Tendinosis was confirmed according to three sonographic criteria: echo texture, interstitial tears and neovascularity. The tendon was then dry needled and autologous blood was injected. Patients were reviewed at 4 weeks and at 10 months. VAS scores and modified Nirschl scores were assessed pre-procedure and post-procedure. RESULTS:There was significant reduction in VAS pain score between pre-procedure and 10 months post-procedure when it had a median (IQR) of 1.00 (1-1.75), range 0-7. The median (IQR) Nirschl score, which at pre-procedure was 6.00 (5-7), range 4-7, had decreased at 4 weeks to 4.00 (2.25-5), range 2-7, and at 10 months to 1.00 (1-1.75), range 0-7, revealing a significant decrease (z = 3.763, p<0.001). The hypo-echoic change in the flexor tendon significantly decreased between pre-procedure, when there was a mean (SD) of 6.45 (1.47), and at 10 months, when it was 3.85 (2.37) (p<0.001). Doppler ultrasound showed that neovascularity decreased between pre-procedure, when there was a mean (SD) of 6.10 (1.62), range 4-9, and at 10 months, when it was 3.60 (2.56), range 0-9 (p<0.001). DISCUSSION:The combined action of dry needling and autologous blood injection under ultrasound guidance appears to be an effective treatment for refractory medial epicondylitis as demonstrated by a significant decrease in VAS pain and a fall in the modified Nirschl scores.
    背景与目标: 目的:评估超声引导下自体血注射是否是治疗内侧上con炎的有效方法。
    方法:对20例症状持续时间为12个月的难治性内侧上con炎患者(13例男性,7例女性)进行超声检查。根据三个超声检查标准确认了腱鞘病:回声纹理,间质性眼泪和新生血管。然后将肌腱干针并注射自体血。在第4周和第10个月对患者进行检查。在手术前和手术后评估VAS评分和修正的Nirschl评分。
    结果:术前至术后10个月,VAS疼痛评分的中位数(IQR)为1.00(1-1.75),范围为0-7,显着降低。术前Nirschl评分中位数(IQR)为6.00(5-7),范围为4-7,在第4周时降至4.00(2.25-5),范围为2-7,在10个月时降至1.00 (1-1.75),范围为0-7,显示出显着下降(z = 3.763,p <0.001)。在术前平均屈伸(SD)为6.45(1.47)时和10个月屈伸肌腱的低回声变化为3.85(2.37)(p <0.001)时,显着降低。多普勒超声显示,术前两次平均血管密度(SD)为6.10(1.62),范围为4-9,而在10个月时为3.60(2.56),范围为0-9(p < 0.001)。
    讨论:超声引导下干针刺和自体血液注射的联合作用似乎是治疗难治性内侧上con炎的有效方法,其表现为VAS疼痛明显减轻,Nirschl评分降低。
  • 【扩张型心肌病的左心室多普勒充盈模式:与血流动力学和左心房功能的关系。】 复制标题 收藏 收藏
    DOI:10.1016/s0894-7317(97)70005-1 复制DOI
    作者列表:Ito T,Suwa M,Otake Y,Moriguchi A,Hirota Y,Kawamura K
    BACKGROUND & AIMS: :This study attempted to examine the relation of left ventricular filling patterns to hemodynamic status and left atrial function in dilated cardiomyopathy. Transesophageal echocardiography and cardiac catheterization were performed in 41 patients with dilated cardiomyopathy (six with an ischemic origin). Transmitral, left atrial appendage, and pulmonary venous flow velocities were recorded with the pulsed Doppler method. Left atrial systolic function was assessed by the peak velocity of the left atrial appendage emptying wave and pulmonary venous flow reversal during atrial systole. Patients were classified into three groups according to their left ventricular filling patterns. Group 1 showed an abnormal relaxation pattern (E wave/A wave ratio <1, n = 17), group 2 had a normal or pseudonormal pattern (1 < or = E/A < 2, n = 11), and group 3 had a restrictive pattern (E/A > or = 2, n = 13). No differences were found among the groups with regard to age, gender, heart rate, and M-mode echocardiographic indices of left ventricular function. Compared with patients in group 1, those in groups 2 and 3 had more symptoms (New York Heart Association functional class III or IV) and had higher left ventricular filling pressures. The sensitivity of an E/A ratio > or = 1 for predicting a pulmonary capillary wedge pressure > or = 15 mm Hg was 75% and the specificity was 94%. Despite a similar increase of filling pressures, group 3 patients had a lower left atrial appendage emptying velocity, pulmonary venous flow reversal velocity, and mitral A velocity than did group 2 patients. The sensitivity and specificity of an E/A ratio > or = 22 for detecting left atrial dysfunction (left atrial appendage emptying velocity < or = 40 cm/sec) was 85% and 86%, respectively. In conclusion, among patients with dilated cardiomyopathy, those who had a restrictive or pseudonormal filling pattern were in a higher functional class and had higher filling pressures. Further studies are needed to determine the therapeutic and prognostic significance of left atrial dysfunction, which was common in patients with a restrictive pattern.
    背景与目标: :这项研究试图检查扩张型心肌病的左心室充盈模式与血流动力学状态和左心房功能的关系。经食道超声心动图和心脏导管检查术治疗了41例扩张型心肌病(其中6例是缺血性)。用脉冲多普勒法记录经颅,左心耳和肺静脉血流速度。通过心房收缩期间左心耳排空波的峰值速度和肺静脉血流逆转来评估左心收缩功能。根据患者的左心室充盈模式将其分为三组。第1组显示异常的放松模式(E波/ A波比<1,n = 17),第2组显示正常或伪正常模式(1 <或= E / A <2,n = 11),第3组显示限制性模式(E / A>或= 2,n = 13)。在年龄,性别,心率和左心室功能的M型超声心动图指数方面,各组之间未发现差异。与第1组的患者相比,第2和3组的患者出现更多症状(纽约心脏协会功能性III或IV级),并且左心室充盈压更高。 E / A比>或= 1预测肺毛细血管楔压>或= 15 mm Hg的敏感性为75%,特异性为94%。尽管充盈压增加相似,但第3组患者的左心耳排空速度,肺静脉血流逆转速度和二尖瓣A速度均低于第2组患者。 E / A比值≥22的检测左心功能不全(左心耳排空速度≤40 cm / sec)的敏感性和特异性分别为85%和86%。总之,在扩张型心肌病患者中,充盈受限或假正常的患者功能类别较高,充盈压力较高。需要进一步的研究以确定左心功能不全的治疗和预后意义,这在限制性模式患者中很常见。
  • 【变性和血管性痴呆中的脑血管反应性:经颅多普勒研究。】 复制标题 收藏 收藏
    DOI:10.1159/000103642 复制DOI
    作者列表:Vicenzini E,Ricciardi MC,Altieri M,Puccinelli F,Bonaffini N,Di Piero V,Lenzi GL
    BACKGROUND & AIMS: BACKGROUND:An impairment of cerebral microvessels is reported both in normal ageing and in senescence-associated processes, as well as in Alzheimer's disease (AD) and vascular dementia (VaD). The aim of this study was to explore cerebral hemodynamics by transcranial Doppler in VaD and AD, compared with age-matched control subjects. METHODS:Transcranial Doppler was investigated in all patients in the basal condition. Cerebral vasoreactivity to hyper- and hypocapnia was evaluated with CO2 mixture inhalation followed by hyperventilation. RESULTS:We studied 60 AD and 58 VaD patients and 62 nondemented controls. Both AD and VaD subjects showed lower flow velocities (FV) and higher pulsatility indices (PI) as compared with controls. Lower total vasomotor reactivity and lower response to hypercapnia were observed in the AD and VaD groups as compared with controls. AD and VaD patients did not show significant differences in FV, PI values or cerebral vasoreactivity. CONCLUSIONS:Reduced FV and increased PI with a significant vasoreactivity reduction in VaD and AD patients are indicators of impairment of cerebral microvasculature circulation in both diseases. The identification of vascular function impairment in all kinds of dementia could be of help in identifying patients who would thus benefit more from specific therapeutic approaches.
    背景与目标: 背景:在正常的衰老和衰老相关的过程中,以及在阿尔茨海默氏病(AD)和血管性痴呆(VaD)中都报告了大脑微血管的损伤。这项研究的目的是探讨与年龄匹配的对照对象相比,经颅多普勒在VaD和AD中的脑血流动力学。
    方法:对所有基础状态的患者进行经颅多普勒检查。通过吸入二氧化碳,然后换气过度,评估对高碳酸血症和低碳酸血症的脑血管反应性。
    结果:我们研究了60位AD和58位VaD患者以及62位非痴呆对照。与对照组相比,AD和VaD受试者均显示出较低的流速(FV)和较高的搏动指数(PI)。与对照组相比,在AD和VaD组中观察到较低的总血管舒缩反应性和对高碳酸血症的较低响应。 AD和VaD患者的FV,PI值或脑血管反应性均无明显差异。
    结论:在VaD和AD患者中,FV降低和PI升高以及显着的血管反应性降低是这两种疾病中脑微血管循环障碍的指标。在所有类型的痴呆症中识别血管功能障碍可能有助于识别哪些患者将从特定治疗方法中受益更多。
  • 【卡内基开发阶段的应用在怀孕初期统一了人类和狒狒的超声检查结果。】 复制标题 收藏 收藏
    DOI:10.1016/j.ultrasmedbio.2007.03.005 复制DOI
    作者列表:Santolaya-Forgas J,De Leon-Luis J,Friel LA,Wolf R
    BACKGROUND & AIMS: :The objective of this study was to determine if very early ultrasonographic measurements obtained from human and baboon are comparable. For this purpose, the gestational, amniotic and yolk sacs, embryonic crown rump length (CRL) and heart rate were measured ultrasonographically between 35 and 47 days from the mean day of a three-day mating period in baboons (n=18) and between 42 to 58 days from fertilization as calculated from the CRL measurements in human pregnancies (n=82). Ultrasonographic measurements from both species were then plotted in the same graph using Carnegie stages of embryonic development as the independent variable to allow for visual comparisons. Mean gestational age at ultrasonographic studies was significantly different for humans and baboons (50.4 vs. 41 days, respectively; p>0.01). Significant correlations (p>0.01) were noted between ultrasonographic measurements and Carnegie stages of development in both humans and baboons. Only the gestational and the yolk sacs were significantly smaller in baboons than in humans (p>0.05). The findings that embryonic CRL, extra-embryonic space and heart rate are very similar between the 17th and 23rd Carnegie developmental stages make the baboon a promising surrogate of human pregnancy for investigations using celocentesis.
    背景与目标: :这项研究的目的是确定从人类和狒狒获得的非常早期的超声检查结果是否具有可比性。为此,从狒狒交配三天的平均天数(n = 18)到第35天到第47天之间(n = 18),以超声波方式对妊娠,羊膜和卵黄囊,胚冠臀长(CRL)和心率进行超声测量。根据人类怀孕的CRL测量结果计算,受精后42到58天(n = 82)。然后,使用卡内基胚胎发育阶段作为自变量,将两个物种的超声测量结果绘制在同一张图中,以便进行视觉比较。在超声检查中,人和狒狒的平均胎龄显着不同(分别为50.4天和41天; p> 0.01)。在人和狒狒的超声测量结果与卡内基发育阶段之间发现了显着的相关性(p> 0.01)。狒狒中只有胎囊和卵黄囊比人小得多(p> 0.05)。在第17和第23卡内基发育阶段之间,胚胎CRL,胚外空间和心率非常相似的发现使狒狒成为使用开腹穿刺技术进行调查的有希望的替代人类妊娠方法。
  • 【超声可在前正畸,卵巢切除术诱导的骨质疏松模型中增强牙槽骨重塑。】 复制标题 收藏 收藏
    DOI:10.1016/j.ultrasmedbio.2017.04.009 复制DOI
    作者列表:Alhazmi KS,El-Bialy T,Afify AR,Merdad LA,Hassan AH
    BACKGROUND & AIMS: :The aim of the study was to investigate the effects of low-intensity pulsed ultrasound (LIPUS) on dentoalveolar structures during application of force to a cultured mandible slice taken from an ovariectomized rat model of osteoporosis. Rats were divided based on whether they had ovariectomy and/or LIPUS application into four groups: control osteoporosis group, control normal group, ultrasound-treated osteoporosis group and ultrasound-treated normal group. The mandibles were dissected, sliced and cultured before application of a 0.5-N force. Tissue specimens from five rats per group received LIPUS; the remaining rats served as untreated controls. Tissue sections were evaluated histologically and histomorphometrically. Osteoporosis significantly affected the alveolar bone without any effect on the dentin-pulp complex. LIPUS enhanced osteoporotic alveolar bone remodeling and increased cementum and predentin thickness. Furthermore, LIPUS application significantly increased odontoblast and periodontal ligament cell counts (p < 0.05) in both groups. Therefore, LIPUS enhances alveolar bone remolding and increases cementum and predentin formation in osteoporotic rat mandible slice organ cultures.
    背景与目标: :该研究的目的是研究在对从卵巢切除的骨质疏松大鼠模型中取出的培养的下颌骨切片施加力的过程中,低强度脉冲超声(LIPUS)对牙槽结构的影响。根据是否进行卵巢切除术和/或应用LIPUS将大鼠分为四组:对照组骨质疏松症组,对照组正常组,超声治疗的骨质疏松症组和超声治疗的正常组。在施加0.5 N的力之前,将下颌骨解剖,切片并进行培养。每组五只大鼠的组织标本接受了LIPUS。其余大鼠作为未治疗的对照。组织切片在组织学和组织形态学上进行评估。骨质疏松症明显影响了牙槽骨,而对牙本质-牙髓复合体没有任何影响。 LIPUS增强骨质疏松性牙槽骨的重塑,并增加牙骨质和前牙本质的厚度。此外,在两组中使用LIPUS均可显着增加成牙本质细胞和牙周膜细胞计数(p <0.05)。因此,LIPUS增强了骨质疏松大鼠下颌骨切片器官培养物中牙槽骨的重塑并增加了牙骨质和前牙本质的形成。
  • 【双嘧达莫-多普勒试验在诊断冠状动脉疾病中的有用性。】 复制标题 收藏 收藏
    DOI:10.1016/0002-9149(90)91422-3 复制DOI
    作者列表:Agati L,Arata L,Neja CP,Manzara C,Iacoboni C,Vizza CD,Penco M,Fedele F,Dagianti A
    BACKGROUND & AIMS: :Two-dimensional and Doppler echocardiographic studies and a hemodynamic investigation were performed during dipyridamole testing in 42 subjects (13 control subjects and 29 patients with coronary artery disease [CAD]), to evaluate the ability of dipyridamole Doppler echocardiography in identifying patients with ischemic left ventricular dysfunction. In the control group, after dipyridamole infusion, Doppler-derived parameters increased significantly from baseline (p less than 0.001). In patients with CAD, peak flow velocity, flow velocity integral and stroke volume failed to increase after dipyridamole infusion (0.89 +/- 0.21 to 0.85 +/- 0.18 m/s, difference not significant; 14 +/- 3 to 12 +/- 4 cm, difference not significant, and 56 +/- 13 to 50 +/- 14 ml/beat, p less than 0.05, respectively). Heart rate, rate pressure product, systemic vascular resistance and mean right atrial pressure had similar variations in the 2 groups. Changes in the 3 Doppler-derived parameters are closely related to the variations of peak positive dP/dt, stroke volume (thermodilution) and left ventricular end-diastolic pressure and are closely related to the coronary angiography jeopardy score and to the appearance of wall motion abnormalities. Thus, by combining Doppler and 2-dimensional echocardiography, dipyridamole-induced myocardial ischemia may be detected in a high percentage of CAD patients, providing a sensitive tool for identifying patients with high-risk coronary artery anatomy.
    背景与目标: :对双嘧达莫进行了二维和多普勒超声心动图研究,并在42名受试者(13例对照受试者和29名冠心病[CAD])中进行了血流动力学研究,以评估双嘧达莫多普勒超声心动图对缺血性左心病患者的识别能力心室功能不全。在对照组中,双嘧达莫输注后,多普勒衍生的参数较基线显着增加(p小于0.001)。在患有冠心病的患者中,双嘧达莫输注后峰值流速,流速积分和每搏量未能增加(0.89 /-0.21至0.85 /-0.18 m / s,差异不显着; 14 /-3至12 /-4 cm,差异不显着,分别为56 /-13至50 /-14 ml / beat,p分别小于0.05)。在两组中,心率,速率压力乘积,全身血管阻力和平均右心房压力具有相似的变化。 3个多普勒衍生参数的变化与峰值dP / dt,中风量(热稀释)和左室舒张末期压力的变化密切相关,并且与冠状动脉造影危险分数和壁运动的出现密切相关。异常。因此,通过将多普勒和二维超声心动图相结合,可以在高百分比的CAD患者中检测出双嘧达莫引起的心肌缺血,从而为识别具有高风险冠状动脉解剖结构的患者提供了灵敏的工具。
  • 【连续波超声对K562人白血病细胞的膜损伤作用。】 复制标题 收藏 收藏
    DOI:10.7863/jum.2012.31.12.1977 复制DOI
    作者列表:Wang P,Li Y,Wang X,Guo L,Su X,Liu Q
    BACKGROUND & AIMS: OBJECTIVES:This study investigated the bioeffects of ultrasound with a frequency of 1.1 MHz on human chronic myelogenous leukemia cell line K562. METHODS:Membrane potential changes were evaluated by flow cytometry using fluorescent probe bis-(1,3-dibarbituric acid)-trimethine oxanol staining. Other related changes such as potassium ion efflux and intracellular calcium ion overload were also measured. The plasma membrane integrity was monitored by flow cytometry combined with fluorescein diacetate and propidium iodide double fluorescent dye staining. A cell-counting assay and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide analysis were used to examine the viability of K562 cells after ultrasound exposure. The acoustic cavitation activity in ultrasound fields was assessed by monitoring hydroxyl radical production. RESULTS:As the ultrasonic intensity increased, the hydroxyl radical produced in the medium increased, and cell membrane damage and cell viability loss were enhanced. The ultrasonic intensity at 0.64 W/cm(2) did not cause substantial cell damage, whereas ultrasound exposure at 1 and 2.1 W/cm(2) could induce serious cell death (14.0% and 40.7%, respectively). Moreover, ultrasound at 0.64 W/cm(2) did not cause substantial membrane potential changes, whereas ultrasound exposure at 1 W/cm(2) could induce depolarization, and fast hyperpolarization occurred when the ultrasonic intensity increased to 2.1 W/cm(2). In addition, compared with control cells, in different ultrasound-treated cells, the potassium ion continuously outflowed with a prolonged incubation time, whereas the intracellular calcium ion oscillations became more apparent. CONCLUSIONS:The damaging effects of ultrasound on the cell membrane and cell viability were intensity dependent. The membrane potential changes may be due to acoustic cavitation accompanied by alterations in the balance of ions on opposite sides of the cellular membrane.
    背景与目标: 目的:本研究研究了频率为1.1 MHz的超声对人慢性骨髓性白血病细胞K562的生物效应。
    方法:采用荧光探针双-(1,3-二巴比妥酸)-三甲胺氧烷染色,通过流式细胞术评估膜电位的变化。还测量了其他相关变化,例如钾离子流出和细胞内钙离子超负荷。通过流式细胞术结合二乙酸荧光素和碘化丙啶双荧光染料染色监测质膜的完整性。细胞计数测定法和3-(4,5-二甲基噻唑-2-基)-2,5-二苯基四唑溴化物分析用于检查超声暴露后K562细胞的活力。通过监测羟基自由基的产生来评估超声场中的声空化活性。
    结果:随着超声强度的增加,培养基中产生的羟自由基增加,细胞膜损伤和细胞活力丧失增强。超声强度为0.64 W / cm(2)不会对细胞造成实质性损害,而超声暴露为1和2.1 W / cm(2)时则可能导致严重的细胞死亡(分别为14.0%和40.7%)。此外,以0.64 W / cm(2)的超声波不会引起实质性的膜电位变化,而以1 W / cm(2)的超声波暴露会引起去极化,并且当超声强度增加到2.1 W / cm(2)时会发生快速超极化。 )。另外,与对照细胞相比,在不同的超声处理细胞中,钾离子以延长的孵育时间连续流出,而细胞内钙离子振荡变得更加明显。
    结论:超声对细胞膜和细胞活力的破坏作用与强度有关。膜电位的变化可能是由于声空化,伴随着细胞膜相对两侧离子平衡的变化。
  • 【超声和超声造影在囊性和囊性样肝病变鉴别诊断中的诊断性能和信心。】 复制标题 收藏 收藏
    DOI:10.2214/AJR.16.17062 复制DOI
    作者列表:Corvino A,Catalano O,Corvino F,Sandomenico F,Petrillo A
    BACKGROUND & AIMS: OBJECTIVE:The aims of this study were to assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the characterization of atypical cystic and cysticlike focal liver lesions in comparison with conventional US and to determine whether the use of CEUS can reduce the need for further diagnostic workup. SUBJECTS AND METHODS:In a 3-year period 48 patients with 50 atypical cystic and cysticlike lesions found at conventional US underwent CEUS. Diagnostic confirmation was obtained in cytohistopathologic examinations, with other imaging modalities, and in follow-up. Overall, there were 24 cystic lesions and 26 cysticlike solid lesions, specifically 32 benign and 18 malignant lesions. The conventional US and CEUS images and cine loops were reviewed by two blinded readers independently. Sensitivity, specificity, area under the ROC curve (Az), and interobserver agreement were calculated. RESULTS:Diagnostic performance improved after review of CEUS examinations by both readers (conventional US Az = 0.781 vs 0.972; CEUS Az = 0.734 vs 0.957). Interreader agreement increased, although slightly (conventional US weighted κ = 0.894; CEUS weighted κ = 0.953). In terms of differential diagnosis, the occurrence of correctly characterized lesions increased after CEUS for both readers (reader 1, 62% to 98%; reader 2, 56% to 96%). CONCLUSION:The development of low-acoustic-power CEUS has made it possible to identify several imaging features of cystic and cysticlike focal liver lesions that, in association with history and clinical findings, may help to correctly characterize them. Our data indicate the usefulness of CEUS in the evaluation of patients with these lesions.
    背景与目标: 目的:本研究的目的是评估与常规超声检查相比,超声造影(CEUS)在表征非典型性囊性和囊性样局灶性肝病中的诊断性能,并确定使用CEUS是否可以减少对超声造影的需求。进一步的诊断工作。
    研究对象和方法:在3年的时间里,对48例常规美国超声检查中发现的50例非典型囊性和囊样病变患者进行了CEUS。在细胞组织病理学检查,其他影像学检查和随访中获得了诊断确认。总体上,有24个囊性病变和26个囊样实性病变,特别是32个良性病变和18个恶性病变。两个盲人分别对常规的US和CEUS图像以及电影放映机进行了审查。计算灵敏度,特异性,ROC曲线下面积(Az)和观察者之间的一致性。
    结果:两位读者对CEUS进行检查后,诊断性能均得到改善(常规US Az = 0.781 vs 0.972; CEUS Az = 0.734 vs 0.957)。阅读器之间的一致性有所提高,尽管有所提高(常规美国加权κ= 0.894; CEUS加权κ= 0.953)。在鉴别诊断方面,两种阅读器在CEUS后正确表征病变的发生率均增加(阅读器1、62%至98%;阅读器2、56%至96%)。
    结论:低声功率CEUS的发展使得鉴别囊性和囊样性局灶性肝病的几种影像学特征与历史和临床发现相关联,可能有助于正确地表征它们。我们的数据表明CEUS在评估这些病变患者中的有用性。
  • 【经支气管内超声引导经支气管针吸术诊断为肺动脉肉瘤。】 复制标题 收藏 收藏
    DOI:10.1016/j.athoracsur.2013.01.080 复制DOI
    作者列表:Shingyoji M,Ikebe D,Itakura M,Nakajima T,Itami M,Kimura H,Iizasa T
    BACKGROUND & AIMS: :Pulmonary artery sarcoma (PAS) is a rare tumor that is often detected at an advanced stage, when disease is so widespread that a radical surgical procedure is no longer indicated. Therefore, less invasive biopsy techniques are required to establish a definitive preoperative diagnosis. Endobronchial ultrasound (EBUS) is useful for producing real-time images of both lymph nodes and the interior of pulmonary arteries adjacent to the bronchi. We report a case with masslike lesions in the pulmonary artery that were observed by EBUS and from which tissue was obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to establish a diagnosis of PAS.
    背景与目标: :肺动脉肉瘤(PAS)是一种罕见的肿瘤,通常在晚期阶段被发现,这是因为疾病如此广泛以至于不再需要进行彻底的外科手术。因此,需要较少的侵入性活检技术来确定明确的术前诊断。支气管内超声(EBUS)可用于生成淋巴结和邻近支气管的肺动脉内部的实时图像。我们报道了一例EBUS观察到的肺动脉肿块样病变,并通过支气管内超声引导下经支气管穿刺针抽吸术(EBUS-TBNA)从中获得组织以建立PAS的诊断。
  • 【超声在评估Takaayasu动脉炎中的作用。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Buckley A,Southwood T,Culham G,Nadel H,Malleson P,Petty R
    BACKGROUND & AIMS: :Duplex ultrasound was used to assess the vascular status and predict the angiographic findings in 3 patients with Takayasu's arteritis. The most striking sonographic feature was the presence of concentric arterial wall thickening. Using pulsed Doppler, stenotic lesions were quantified, occlusive lesions were identified and collateral circulation was demonstrated. A high resistive flow pattern was demonstrated in diseased vessels compared with carotid wave-forms of control subjects. Subtle mural irregularity, minor stenotic lesions and areas of stenosis in branch vessels were missed by duplex evaluation. The thoracic aorta and occasionally major arterial branches in the abdomen were impossible to evaluate with ultrasound. Vascular magnetic resonance imaging was successful in delineating major aortic branches but was inferior to real-time ultrasound in resolving mural thickening. While angiography plays a major role as a baseline assessment of the entire vascular tree, duplex ultrasound can monitor disease progression and the effects of therapy. Serial duplex studies should greatly reduce the need for interval angiographic followup.
    背景与目标: :Duplex超声用于评估3例Takayasu动脉炎患者的血管状况并预测血管造影结果。超声检查最显着的特征是存在同心动脉壁增厚。使用脉冲多普勒,狭窄病变被量化,闭塞性病变被确定,并证实了侧支循环。与对照受试者的颈动脉波形相比,在患病血管中显示出高阻力流型。通过双重评估错过了细微的壁不规则,狭窄的狭窄病变和分支血管狭窄的区域。超声无法评估胸主动脉和腹部的主要动脉分支。血管磁共振成像能够成功地描绘出主动脉分支,但在解决壁厚增厚方面不如实时超声检查。血管造影在整个血管树的基线评估中起着主要作用,而双工超声可以监测疾病的进展和治疗效果。连续双工研究应大大减少间隔血管造影随访的需要。
  • 【在放置血液透析之前,超声测量肱动脉的弹性:一项前瞻性研究。】 复制标题 收藏 收藏
    DOI:10.7863/jum.2012.31.10.1581 复制DOI
    作者列表:Sorace AG,Robbin ML,Umphrey H,Abts CA,Berry JL,Lockhart ME,Allon M,Hoyt K
    BACKGROUND & AIMS: OBJECTIVES:Successful hemodialysis requires reliable vascular access that can deliver adequate blood flow. An arteriovenous fistula is preferred for access because of its longevity and low frequency of complications, but up to 60% of arteriovenous fistulas created surgically are never suitable for hemodialysis because of nonmaturation (insufficient vascular dilatation). Decreased arterial elasticity may impair dilatation, thereby affecting fistula maturation. This study evaluated the feasibility of brachial artery elasticity measurement in patients with chronic kidney disease obtained during routine pre-operative mapping ultrasound (US) imaging before hemodialysis access placement and compared the measurements to those obtained in healthy volunteers. METHODS:Brachial artery functional US studies were collected from 75 patients undergoing routine preoperative mapping for hemodialysis access and 50 healthy volunteers. Vascular strain was calculated from the change in intima-media thickness between end systole and end diastole, and vascular stress was estimated from the pulse pressure. Assuming a linear elastic medium, the elastic modulus was estimated as the ratio of vascular stress to strain. RESULTS:Elastic modulus measurements were significantly higher in patients than in volunteers (130 versus 100 kPa; P = .01). With combined volunteer and patient data, there was a significant correlation between elasticity and systolic blood pressure (R2 = 0.23; P < .001). Elasticity was correlated with age in volunteers but not in patients (R2 = 0.14; P = .017; R2 < .001; P = .829, respectively). CONCLUSIONS:This analysis of clinical arterial vessel biomechanics shows that a noninvasive US measurement can detect elastic modulus differences between patients with chronic kidney disease and healthy individuals. Future studies will correlate the elastic modulus with histologic characteristics and eventual arteriovenous fistula maturation, which may provide supplemental information on arterial biomechanical properties as a useful addition to current predictors of fistula success.
    背景与目标: 目的:成功的血液透析需要可靠的血管通路,以提供足够的血流量。动静脉瘘的使用寿命长且并发症发生频率低,因此首选进入,但由于不成熟(血管扩张不足),外科手术产生的动静脉瘘中多达60%永远不适合进行血液透析。动脉弹性下降可能会损害扩张,从而影响瘘管成熟。这项研究评估了在进行血液透析通路放置之前在常规术前作图超声(US)成像过程中获得的慢性肾脏病患者肱动脉弹性测量的可行性,并将测量结果与健康志愿者的测量结果进行了比较。
    方法:从75例接受常规血液透析的术前作图的患者和50名健康志愿者收集了肱动脉功能性US研究。根据收缩末期与舒张末期之间内膜-中膜厚度的变化计算血管应变,并根据脉压估算血管压力。假设为线性弹性介质,则将弹性模量估计为血管应力与应变之比。
    结果:患者的弹性模量测量值显着高于志愿者(130 vs 100 kPa; P = 0.01)。结合志愿者和患者的数据,弹性与收缩压之间存在显着相关性(R2 = 0.23; P <.001)。志愿者的弹性与年龄相关,而患者与年龄无关(R2 = 0.14; P = .017; R2 <.001; P = .829)。
    结论:对临床血管生物力学的分析表明,无创超声测量可以检测出慢性肾脏病患者与健康个体之间的弹性模量差异。未来的研究将把弹性模量与组织学特征和最终动静脉瘘的成熟联系起来,这可能会提供有关动脉生物力学特性的补充信息,作为目前瘘管成功预测指标的有用补充。
  • 【聚焦超声在凝胶隧道中微泡的空化阈值。】 复制标题 收藏 收藏
    DOI:10.1016/j.ultrasmedbio.2007.04.018 复制DOI
    作者列表:Sassaroli E,Hynynen K
    BACKGROUND & AIMS: :The investigation of inertial cavitation in micro-tunnels has significant implications for the development of therapeutic applications of ultrasound such as ultrasound-mediated drug and gene delivery. The threshold for inertial cavitation was investigated using a passive cavitation detector with a center frequency of 1 MHz. Micro-tunnels of various diameters (90 to 800 microm) embedded in gel were fabricated and injected with a solution of Optison(trade mark) contrast agent of concentrations 1.2% and 0.2% diluted in water. An ultrasound pulse of duration 500 ms and center frequency 1.736 MHz was used to insonate the microbubbles. The acoustic pressure was increased at 1-s intervals until broadband noise emission was detected. The pressure threshold at which broadband noise emission was observed was found to be dependent on the diameter of the micro-tunnels, with an average increase of 1.2 to 1.5 between the smallest and the largest tunnels, depending on the microbubble concentration. The evaluation of inertial cavitation in gel tunnels rather than tubes provides a novel opportunity to investigate microbubble collapse in a situation that simulates in vivo blood vessels better than tubes with solid walls do.
    背景与目标: :微隧道中惯性空化的研究对于超声治疗应用的发展具有重要意义,例如超声介导的药物和基因传递。使用中心频率为1 MHz的无源空化检测器研究了惯性空化的阈值。制造嵌入在凝胶中的各种直径的微隧道(90至800微米),并注入浓度为1.2%和0.2%的Optison(商标)造影剂溶液稀释在水中。持续时间为500毫秒,中心频率为1.736 MHz的超声脉冲用于使微泡产生声波。声压每隔1秒增加一次,直到检测到宽带噪声发射为止。发现观察到宽带噪声发射的压力阈值取决于微通道的直径,最小通道和最大通道之间的平均增加幅度为1.2到1.5,具体取决于微气泡的浓度。凝胶隧道而不是管中的惯性空化的评估提供了一个新的机会,可以在模拟体内血管的情况下比具有坚固壁的管更好地研究微气泡的塌陷。
  • 【二维和多普勒彩色超声心动图研究先天性Valsalva窦的动脉瘤伴右心房瘘。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Madariaga JA,Lekuona I,Serrano A,Palomar S,Salcedo A,Alcibar J,Castellanos E,Barrenetxea JI
    BACKGROUND & AIMS: :This report describe a 69-year old woman with a congenital aneurysm of the non-coronary sinus of Valsalva ruptured in the right atrium, causing severe hemodynamic derangement of the right ventricle. The site of the communication between the aneurysm and the receiving chamber was accurately diagnosed by two-dimensional color flow Doppler imaging which provided more valuable preoperative information than conventional aortography.
    背景与目标: :该报告描述了一位69岁的女性,其先天性非冠状窦Valsalva动脉瘤在右心房破裂,导致右心室严重的血流动力学紊乱。动脉瘤和接收腔之间的连通部位是通过二维彩色多普勒成像技术准确诊断的,该技术比常规的主动脉造影术能够提供更有价值的术前信息。
  • 【多普勒回声评估混合性结缔组织病患者左心室舒张期充盈。】 复制标题 收藏 收藏
    DOI:10.1159/000174589 复制DOI
    作者列表:Leung WH,Wong KL,Lau CP,Wong CK,Cheng CH,Tai YT
    BACKGROUND & AIMS: :Left ventricular diastolic function was assessed in 17 patients (2 males and 15 females; mean age 44 +/- 9 years) with mixed connective tissue disease (MCTD) and 18 sex- and age-matched healthy control subjects (2 males and 16 females; mean age 44 +/- 8 years) by means of M-mode and pulsed Doppler echocardiography. None had clinical evidence of overt myocardial disease or abnormal left ventricular systolic function. Compared with the control group, patients with MCTD had a significantly longer isovolumic relaxation time (IVRT) (59 +/- 7 versus 70 +/- 12 ms; p less than 0.01), a lower peak early diastolic flow velocity (E) (0.79 +/- 0.10 versus 0.70 +/- 0.07 m/s; p less than 0.005), a higher peak late diastolic flow velocity due to atrial contraction (A) (0.47 +/- 0.08 versus 0.54 +/- 0.08 m/s; p less than 0.05) and a reduced E/A ratio (1.72 +/- 0.37 versus 1.33 +/- 0.26; p less than 0.005). Although there was no significant correlation of left ventricular diastolic filling indexes with age, heart rate, left ventricular end-diastolic and end-systolic dimensions, interventricular septal and left ventricular posterior wall thickness, and fractional shortening, the duration of illness was significantly related to IVRT (r = 0.62; p less than 0.01), peak A (r = 0.79; p less than 0.001) and velocity half-time (r = 0.54; p less than 0.05). The results suggest the presence of an abnormal left ventricular diastolic filling pattern in patients with MCTD and may represent myocardial involvement in this disease.
    背景与目标: 评估了混合性结缔组织病(MCTD)的17例患者(2例男性和15例女性;平均年龄44 /-9岁)和18例性别和年龄相匹配的健康对照受试者(2例男性和16例女性)的左心室舒张功能;平均年龄44/8岁)通过M型和脉冲多普勒超声心动图检查。没有人有明显的心肌病或左心室收缩功能异常的临床证据。与对照组相比,MCTD患者的等容舒张时间(IVRT)明显更长(59 /-7比70 /-12 ms; p小于0.01),早期舒张早期血流速度(E)较低(0.79 / -0.10比0.70 /-0.07 m / s; p小于0.005),由于心房收缩(A)导致较高的峰值舒张末期流速(0.47 /-0.08比0.54 /-0.08 m / s; p小于0.05)降低的E / A比(1.72 / 0.37对1.33 / 0.26; p小于0.005)。尽管左心室舒张期充盈指数与年龄,心率,左心室舒张末期和收缩末期尺寸,室间隔和左心室后壁厚度以及分数缩短之间无显着相关性,但疾病的持续时间与IVRT(r = 0.62; p小于0.01),峰A(r = 0.79; p小于0.001)和速度半衰期(r = 0.54; p小于0.05)。结果表明MCTD患者存在异常的左心室舒张期充盈模式,可能代表心肌参与了该疾病。

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