经静脉左心声学造影的临床应用价值

用自制的１％葡萄糖白蛋白声学造影剂对６２例患者静注０．０８～０．２２ｍｌ／ｋｇ造影剂后，左室显影≥２＋者达７６．７％～９６．７％；３０例疑诊冠心病患者行常规平板负荷试验前后静注造影剂０．２２ｍｌ／ｋｇ使左室内膜边界的可辨率分别提高２５．４％及２９．４％；２１例患者多普勒检查发现，静注造影剂后可使肺静脉多普勒频谱信号明显增强；同时１８例二尖瓣返流者的返流彩色多普勒血流信号于静注造影剂后也显著增强。     

彩色多普勒血流会聚法定量二尖瓣返流的临床应用

为在临床上应用彩色多普勒血流会聚法定量评价二尖瓣返流，本文应用频谱多普勒法评估二尖瓣返流作对照，评价其定量返流的临床应用价值，文中研究了２４例二尖瓣返流患者，用二维超声心动图计算出主动脉瓣口和二尖瓣口的面积，用频谱多普勒计算出收缩期主动脉瓣口血流的速...     

二尖瓣关闭不全脉冲多普勒血流频谱分析

本文以脉冲多普勒超声心动图检测不同病因的二尖瓣关闭不全患者111例的血流频谱特点,探测二尖瓣关闭不全返流喷射方向,发现不同病因返流方向不同,风湿性心脏病二尖瓣关闭不全者返流喷射方向在左室长轴多向左房后部,心尖四腔则多向左房外侧,冠心病和心肌病多向左房后部及外侧。尤其对二尖瓣脱垂可根据异常多普勒信号喷射方向作为确定哪个瓣叶脱垂的一项参考指标。参照Seller分级法和Veyrat返流指数法,估测二尖瓣关闭不全返流严重程度,左室长轴与心尖四腔之间有差异。测量左室长轴及心尖四腔左房面积,计算左房面积与返流指数的相关系数呈不相关。在风湿性心脏病患者中,多普勒发现异常返流频谱者在左室长轴为84％,在心尖四腔为100％。而其中仅31％用二维超声心动图发现有二尖瓣口裂隙,提示对探测风湿性二尖瓣关闭不全,多普勒优于二维超声心动图。     

二维及彩色多普勒超声心动图对经皮气囊导管二尖瓣狭窄分离术疗效观察

本文应用二维显像、频谱及彩色多普勒对9例二尖瓣狭窄患者行经皮气囊导管二尖瓣分离术(PBMC),现将有关资料报告如下。资料和方法患者9例(男3例,女6例),年龄25～54岁,平均38.6岁。术前超声诊断风心病二尖瓣狭窄伴返流2例,主动脉瓣返流6例,三尖瓣返流7例,肺动脉瓣返流3例,主动脉瓣狭窄加三尖瓣狭窄1例。除二尖瓣狭窄中重度外,其余瓣口返流及狭窄均为     

静脉持续输注利声显对心梗后病人心肌灌注的评价

心肌造影超声心动图(MCE)评价心肌灌注是目前国际上的研究热点,利声显是我国卫生部批准临床应用的唯一心肌造影剂,方理刚等已对其增强超声心动图多普勒信号的作用进行了研究,但利声显能否用于心肌灌注的研究目前仍在探索之中。本临床实验目的在于应用静脉持续输注利声显并用触发谐波能量多普勒显像,观察心梗后病人心肌灌注的情况。     

利声显增强显像观察TAE治疗肝癌效果

目的：用超声造影剂利声显增强显像, 观察原发性肝癌逆行肝动脉插管栓塞化疗（ＴＡＥ）前后肿瘤图像的彩色多普勒信号变化。方法： 使用ＨＰＳｏｎｏｓ ２５００型彩超仪, 探头频率２．５ＭＨｚ, 仪器检查条件一致, 对２０例原发性肝癌患者于ＴＡＥ治疗前和治疗后５～７日内各检查１次, 每次检查使用１支利声显, 增强结果用两种方法评价。结果： ＴＡＥ治疗前, 肿瘤血供丰富, 利声显增强效果明显; ＴＡＥ治疗后, 肿瘤血供减少, 尽管利声显增强效果确实,彩色信号仍明显减弱。计算机数字化显示ＴＡＥ治疗前利声显增强前后肿瘤内彩色点的百分比值为５．１９±４．８５Ｖｓ ２６．５２±１５．８３, ＴＡＥ治疗后利声显增强前后肿瘤内彩色点的百分比值为１．４２±１．１１ Ｖｓ１０．２７±７．３８。结论： 利声显对肝癌肿瘤的彩色多普勒信号具有确实的增强效果; ＴＡＥ治疗后, 肝癌肿瘤彩色多普勒信号明显减少; 用计算机分析利声显的增强效果, 结果更加直观、可靠, 对判断ＴＡＥ疗效具有实际的临床价值和意义。     

产前超声心动图诊断胎儿左心发育不良综合征

目的探讨产前超声心动图诊断胎儿左心发育不良综合征（HLHS）的技术要点。方法对产前超声检出的25例HLHS胎儿的临床及超声资料进行回顾性分析，重点探讨合并房间隔异常的HLHS胎儿超声声像图改变及血流动力学变化特点，并与尸检和出生后超声检查结果进行对比分析。结果25例HLHS胎儿中7例为二尖瓣及主动脉瓣闭锁，左心室重度发育不良；16例为二尖瓣闭锁合并不同程度主动脉瓣狭窄及主动脉缩窄，其中2例主动脉瓣狭窄伴主动脉缩窄随孕周进展其发育不良的左心室心内膜回声增强及左心室收缩力明显降低；另2例二尖瓣增厚和瓣膜开启运动受限伴主动脉瓣狭窄及主动脉弓缩窄。25例中7例伴房间隔完整，超声示房间隔增厚及卯园孔不开放，多普勒超声示房水平无分流信号，另外18例有房水平左向右少量分流；25例均见动脉导管逆向血流信号。结论产前超声心动图可早期诊断胎儿HLHS，除检出导致左心室发育不良系列左心系统病变外，房间隔完整或卵园孔径小及房水平的左向右分流也是评价HLHS预后及出生后手术治疗的重要指征。     

自制氟烷超声造影剂增强兔肾显像的实验研究

目的探讨自制氟烷微泡超声造影剂对兔肾的显影作用。方法健康新西兰大白兔10只，耳缘静脉输入自制的白蛋白微泡造影剂O．05ml／kg，分别用二维、彩色多普勒及能量多普勒超声观察白蛋白氟烷超声造影剂对兔肾的显影作用。目测观察造影前后肾回声强度和彩色多普勒及能量多普勒信号的变化。用国产“DFY型超声图像定量分析诊断仪”测量造影前后的回声强度。结果造影后兔肾显影明显增强，彩色多普勒和能量多普勒信号增加，回声强度也明显增强。结论自制白蛋白氟烷超声造影剂可明显增强兔肾显影。     

利声显超声造影在超声导向微波凝固治疗中的应用

利声显(Levovist)超声造影能增强二维、彩色和频谱超声多普勒信号强度,改善低速血流的彩色多普勒血流显像,为研究组织的血流灌注提供了有力的手段。本研究将对利声显超声造影应用于超声导向微波凝固治疗肿瘤和疾病鉴别诊断作一探索。 资料与方法 本组18例,男13例、女5例;年龄30～70岁,平均年龄50.61岁;进行了32例次利声显超声造影。其中经过超声、CT等检查,临床诊断肝肿瘤患者15例、转移性肺癌1例、肾癌1例、胰腺肿瘤1例。拟进行利声显超声造影和超声导向活组织检查,进一步确诊后,作超声导向微波肿瘤凝固治疗。仪器为ACUSON 128XP10/ART,TCR电脑声像仪,探头频率4MHz。超声造影剂为德国先灵公司生产的利声显,浓度为300mg/ml,每次1支,经肘静脉推注时间为30至60秒。造影前用二维超声纪录肿瘤大小、内部回声;彩色多普勒血流图和能量图观察瘤内及瘤周血流情况和频谱。注射造影剂后观察血流信号增强情况、增强时间等。整个过程采用SONY AG 7350E高保真录像机和TOMTEC P90图像工作站同步纪录,进行脱机分析。造影过程中心电图全程监护并作为R波触发。     

乏氏窦瘤破裂的彩色多普勒超声诊断

本组14例乏氏窦瘤破裂（RASV）患者通过彩色多普勒超声（CDU）与手术对照研究，表明：CDU能准确地显示窦瘤的形态、起源部位，破入心腔及血流动力学改变。本组RASV超声表现：（1）二维超声（2－DE）的直接征象：可见乏氏窦扩张呈袋状光带，突入邻近心腔，在破裂的瘤体上可见连续中断的破口；（2）彩色多普勒血流显像（CDFI）：在窦瘤及其破裂口处可见多彩镶嵌的分流信号通过破口进入相应心腔，频谱检测呈连续性双期湍流频谱。CDU还能准确地检出合并室间隔缺损、主动脉瓣返流等。     

Contrast-enhanced color Doppler sonography of uveal melanomas

PURPOSE: The purpose of our study was to evaluate the use of the galactose microbubble-based contrast agent Levovist in color Doppler sonography of uveal melanomas. We also evaluated the use of the resistance index and pulsatility index in differentiating tumor-associated vessels from normal vessels in patients with uveal melanomas. METHODS: In this prospective study, 40 patients with uveal melanoma were examined with color Doppler sonography before and after the administration of the contrast agent Levovist. The Doppler signals were recorded from both the tumor and the orbit and were evaluated quantitatively and qualitatively. RESULTS: Tumor-associated vessels were detected without contrast enhancement in 36 of 40 patients and with contrast enhancement in 38 of 40 patients. The spectral characteristics of the Doppler signals did not change after the injection of Levovist. There were no differences-qualitative or quantitative-in Doppler signals between normal and tumor-associated vessels. CONCLUSIONS: The injection of Levovist slightly improved the detection of small vessels in uveal melanomas and the orbit but did not help to differentiate between normal vessels and tumoral vessels. The differentiation of a solid tumor from subretinal hemorrhage or effusion was improved.     

经周围静脉注射Levovist彩色多普勒超声造影诊断肝肿瘤的研究

本文采用经周围静脉注射Levovist超声造影检查了30例肝脏肿瘤患者。应用Levovist后，正常肝脏血管彩色多普勒血流显像明显增强，不同的肝脏肿瘤显示了常规彩超检查没有见到的不同的血管形态，11例原发性肝癌肿块中心显示了血管。相反3例肝脏转移癌，在肿瘤周边显示了更多的血流，6例肝脏血管瘤，常规彩超检查未见明确血流，造影后在肿瘤周边见到点状或短条状血流。Levovist对于正常肝脏实质、不同肝脏肿瘤二维图像的增强作用是有差异的，它使肝脏肿瘤显示更清晰。结果表明：Levovist彩色多普勒超产造影对于肝脏肿瘤的诊断具有重要的临床应用价值。     

利声显对肝、肾、子宫肿瘤血流信号增强作用的研究

目的　评价利声显对肝、肾、子宫肿瘤彩色多普勒信号的增强作用。方法　对３５ 例原发性肝癌、５ 例继发性肝癌、３ 例肝血管瘤、１ 例肝硬化结节、３ 例肾癌、３ 例子宫肌瘤进行研究。将７ ｍｌ 浓度为３００ ｍｇ／ｍｌ 的利声显由外周静脉注入,观察肿瘤彩色多普勒信号增强程度及脏器实质区图像。结果　３２ 例原发性肝癌和１ 例较大的胆囊转移性肝癌的彩色多普勒信号明显增强,肝血管瘤的略增强,肝硬化结节的无增强,肾癌和子宫肌瘤的增强均好,且实质区图像改善,于４ 例原发性肝癌患者的肝区内又探及新的小病灶。结论　利声显对肝、肾、子宫肿瘤的血流信号均有增强作用,它对判断肿瘤的血供情况、分析肿瘤的病理性质,提高超声诊断的敏感性很有益处。     

左室流出道梗阻继发感染性二尖瓣穿孔的超声心动图2例

目的探讨左室流出道梗阻继发感染性二尖瓣前叶穿孔的超声心动图特点。方法选择左室流出道梗阻继发感染性二尖瓣前叶穿孔及单纯左室流出道梗阻病例,采用数字化超声心动图技术,比较2种情况下二尖瓣返流的特点及二尖瓣形态学改变。结果左室流出道梗阻继发感染性二尖瓣前叶穿孔时有下列特点:(1)二尖瓣返流由源于前叶体部及瓣叶对合缘的2束返流构成,在心尖四腔切面上返流束呈“Y”字形;(2)二尖瓣返流连续多普勒频谱为2束返流共同形成的叠加频谱;(3)二尖瓣前叶体部可见结构改变。单纯左室流出道梗阻者无上述特点,其二尖瓣返流为单一起源的偏心返流束。结论左室流出道梗阻继发感染性二尖瓣前叶穿孔时,二尖瓣返流束的起源、形态、频谱及二尖瓣前叶结构均有特征性改变。     

Combined use of contrast-enhanced 2-dimensional and color Doppler echocardiography for improved left ventricular endocardial border delineation using Levovist, a new venous echocardiographic contrast agent

Transthoracic echocardiography often provides inadequate endocardial border visualization, particularly of the left ventricular apex. The aim of this study was to determine whether the transpulmonary echocardiographic contrast agent, Levovist, could improve endocardial visualization. Accordingly, 43 patients underwent 2-dimensional echocardiography before and after intravenous administration of Levovist. Definition of the left ventricular septal, apical and lateral borders was graded: 0 = no definition, 1 = partial definition, 2 = complete definition. Color Doppler was performed before and after contrast in 32/43 patients and similarly scored to determine any further benefit in apical border detection. There was significant (p %lt; 0.001) improvement of the average end-diastolic scores of the septal, apical and lateral regions (1.4 %plusmn; 0.5, 0.6 %plusmn; 0.7 and 0.9 %plusmn; 0.5 before and 1.8 %plusmn; 0.4, 1.4 %plusmn; 0.6 and 1.7 %plusmn; 0.5 after Levovist). The average end-systolic score was significantly different (p %lt; 0.001) from end-diastolic values in the apex only (0.3 %plusmn; 0.6 before and 0.8 %plusmn; 0.7 after Levovist). Average apical scores using color Doppler improved from 0.3 %plusmn; 0.6 and 0.1 %plusmn; 0.2 during end-diastole and end-systole to 1.7 %plusmn; 0.5 and 1.2 %plusmn; 0.6, respectively, after Levovist (p %lt; 0.001); the average end-diastolic contrast-enhanced color Doppler score was significantly higher than the corresponding grey scale score (p %lt; 0.001). We conclude that left ventricular endocardial border definition is significantly improved by Levovist. The use of contrast enhanced color Doppler can compensate for limited efficacy of this method in the apex.     

Correlation between microbubble contrast-enhanced color doppler sonography and immunostaining for Kupffer cells in assessing the histopathologic grade of hepatocellular carcinoma: preliminary results

PURPOSE: The aim of this study was to determine the histopathologic grades of hepatocellular carcinomas (HCCs) on the basis of the presence of Kupffer cells, using color Doppler sonography with the liver-specific microbubble contrast agent Levovist. METHODS: Color Doppler sonograms generated by stimulated acoustic emission were obtained 7 minutes after intravenous injection of 5 ml of Levovist (300 mg/dl) in patients with histopathologically confirmed HCCs. CT scans were also obtained and evaluated, and hematoxylin and eosin staining for morphologic examination and immunostaining (anti-CD68) for detecting Kupffer cells were performed for confirmation of the sonographic findings. RESULTS: Eighteen tumors had a defect in the color Doppler signal (color void) that corresponded with the baseline gray-scale image of the tumor. On histopathologic examination, these 18 tumors were all found to be either poorly or moderately differentiated HCCs with either a marked reduction in the number of or the absence of Kupffer cells. The remaining 2 tumors showed color signals. Histopathologic examination of these 2 tumors disclosed well-differentiated components within the tumors, with Kupffer cells in the tumor tissue. CONCLUSIONS: Color Doppler sonography using a liver-specific microbubble ultrasound contrast agent appears to reflect the histopathologic features of HCCs and may thus be useful for differentiating liver tumors and determining a treatment strategy.     

彩色多普勒血流显像评价肾癌的血管性——一种新的超声造影剂的应用价值

目的：评价超声造影剂利声显对彩超检测肾细胞癌血流状况的增强效应,并探讨其临床应用价值。资料与方法：应用彩色多普勒血流显像检查１９例（个）肾细胞癌,均经手术病理证实,经周围静脉注射超声造影剂利声显（ＳＨＵ５０８Ａ）,浓度３００ｍｇ／ｍｌ,平均注射剂量７９ｍｌ。观察注射前后瘤内血流信号显像情况。结果：超声造影前１９个肾癌彩超显示４个无血流信号,１１个周边部分环绕血流,４个瘤周瘤内见散在点状、短条状血流;超声造影后,１９个肾癌瘤内血流信号均增强,１６／１９（８４．２１％）明显增强,３／１９（１５．７９％）轻度增强,增强效应主要表现为血流信号明显增多,分布区域增大,血管显示段延长,分枝更清晰完整。结论：超声造影剂利声显能显著增强肾细胞癌内彩色多普勒血流信号,更完整显示肾癌的血管形态、分布等,明显改善彩超对肾癌血供的评价,对肾肿瘤诊断有重要的临床应用价值。     

Levovist超声造影在肝癌疗效判断中的临床价值

目的：研究Levovist彩色多普勒超声造影对肝癌疗效判断的作用。方法：对接受过介入治疗的24个肝癌病灶进行CDFI超声造影，病灶直径1～10cm，平均3．3cm。造影剂采用Levovist(Schering AG，Berlin，Germany)。结果：24例治疗后的肝癌瘤内血流显示率由造影前的29．1％(7／24)提高至造影后的58．3％(14／24)，肿瘤内血流信号强度分级在造影后也有提高。5个病灶做了治疗前后的超声造影对比。对于造影后2例显示有瘤内血流的病灶，又追加了PEIT治疗。结论：CDFI超声造影可以提高肿瘤内血流信号检测，反映肿瘤坏死情况或有无复发，指导治疗方案的选择和制定。     

利声显造影显像观察超声引导下微波凝固治疗肝癌效果

目的 用利声显造影显像,观察超声引导下微波凝固治疗（PMCT）前后肝癌图像的彩色多普勒血流变化。方法 对28例肝癌进行44次PMCT治疗,在PMCT前和治疗后5d内各检查1次,增经结果用半定量方法评价。治疗前应用利声显造影,增加了肿瘤内血管树的彩色血流信号;治疗时以血管树主干作为凝固治疗的重点;治疗后再用利声显超声造影,观察肿瘤内血流变化,判断疗效。结果 PMCT治疗前,肿瘤血供丰富,利声显增强效果明显;PMCT治疗后彩色信号明显减少或消失。结论 利声显对肝癌的彩色多普勒信号具有确定的增强效果;用利声显造影定位血管树主干作为凝固治疗的重点,可提高疗效,而且,利声显造影对判断PMCT疗效具有实际的临床价值。     

Enhanced color flow images in small hepatocellular carcinoma

BACKGROUND: Features of enhanced color flow images in small hepatocellular carcinoma (HCC) are not fully elucidated. The purpose of this study was to clarify the characteristic vascular images in small HCC observed by enhanced color Doppler. METHODS: Enhanced color Doppler using the contrast agent Levovist was performed on 13 patients with HCC smaller than 30 mm. Enhanced color flow appearance was compared with angiographic findings. Time-intensity changes after injection of the contrast agent were analyzed in HCC nodules. RESULTS: Significant improvement in the detection of color flow signals was obtained in small HCC using Levovist, from 33% in precontrast to 92% in postcontrast (p < 0.005). Three patterns of enhanced color flow images, which were related to the angiographic findings, were observed. The time-intensity curve was classified into two types by "time to peak" and "time on plateau" and was associated with the patterns of enhanced images. CONCLUSION: Enhanced color flow imaging promises to be a useful method for evaluating tumor vascularity noninvasively and to contribute to the elucidation of the hemodynamics in small HCC.