超声引导下骶管麻醉的研究进展

骶管麻醉具有操作简便、并发症少、效果确切、麻醉平面低等优势,目前在疼痛诊疗及临床麻醉中应用广泛。传统实施骶管麻醉是根据骨性标志定位,然而由于骶管裂孔及骶角解剖结构具有变异性,故传统方法可能存在定位不准等不足。近年超声引导下骶管穿刺逐渐被临床应用,本文对该方法的优势、应用及进展进行综述。     

高强度聚焦超声在肝癌临床治疗中的应用现状及发展

高强度聚焦超声是一种肝癌局部治疗新技术.与手术治疗和其他局部治疗(如射频消融、肝动脉栓塞化疗、酒精注射等)方法相比,因其具有无创伤、精确度高、肿瘤组织坏死确切及术后并发症少等诸多优势,故得到临床广泛认可.作为一种重要的肝癌治疗手段,该法正逐步普及于临床.本文对高强度聚焦超声治疗肝癌的机制、现状进行综述,并对其临床应用前景和发展方向加以探讨.     

高频彩色多普勒血流显像诊断乳腺恶性肿瘤

目的探讨高频彩色多普勒血流显像（CDFI）在乳腺恶性肿瘤诊断的临床应用。方法回顾60例在我院手术治疗的乳腺恶性肿瘤的CDFI高频超声声像图特征,并与手术、术后病理结果对照。结果乳腺恶性肿瘤在形态、边缘、包膜、内部回声、后方回声、纵横比具有特异性,乳腺恶性肿瘤内及周边血流信号丰富,肿瘤内部出现粗大彩色血流信号。结论高频彩色多普勒超声是一种对乳腺恶性肿瘤的诊断具有重要的临床应用价值的无创伤性检查方法。     

超声造影在乳腺肿瘤诊断中的应用

目前,超声造影(contrast ultrasonography,CEUS)在人体微细血管和组织灌注检测与成像方面具有的独到作用,在医学临床检测中得到越来越多的应用[1]。CEUS作为一种新技术已用于乳腺疾病的诊断和鉴别诊断,初步研究表明其在显示乳腺肿瘤新生血管、鉴别乳腺肿块、判断乳腺癌的分期等方面具有一定的应用价值[2～5]。     

定量超声在骨质疏松中的应用及评价

定量超声技术具有设备成本及检查费用低、无电离辐射、简便快速、可携带、可反映骨的微结构等优点,在评价松质骨状况和诊断骨质疏松症方面受到国内外医学界的高度重视。但由于骨超声仪器之间差别较大,难以进行有效的质量控制,故定量超声技术在骨质疏松方面的临床应用还存在着一些问题。本文将从技术原理、测量部位、临床价值及质量控制方面对定量超声在骨质疏松中的应用进行综述,为其进一步研究以及在临床上的推广应用奠定基础。     

胆囊息肉样病变的超声图像分析

目的　探讨与分析胆囊息肉样病变 (PL G)的超声特征、临床应用价值。方法　对经手术病理证实的 1 0 1例 PL G与超声结果进行了回顾性对比分析。结果　非肿瘤性息肉 88例 ,占 87.1 3% ;肿瘤性息肉 1 0例 ,占 9.90 % ,病变直径 >1 0mm,单发 ,以肿瘤性息肉为多见。结论　超声诊断该病敏感性高 ,结合彩色多普勒可早期发现胆囊癌 ,同时对临床治疗方案的制定具有重要价值     

超声评价移植肾功能障碍

肾移植术后早期各种并发症的防治是临床关注的一大问题。应用彩色多普勒及二维灰阶成像监测移植肾功能，具有快速、准确、无创等优点，是评价移植肾功能的有效方法。本文综述超声诊断移植肾功能的研究现状。     

超声心输出量监测仪用于心输出量测定的研究进展和评价

心输出量(cardiac output,CO)是反映心脏功能最直接的指标之一,准确监测CO及相关的血流动力学指标对指导临床治疗具有重要意义.超声心输出量监测仪(ultrasonic cardiac output monitor,USCOM)是目前较新的一种CO临测仪,具有无创、快速、准确等特点,近年来刚刚投入临床试用,对此技术的优越性还有待于在临床来进一步检验和改进.现就此对国内外相关文献进行综述,以便了解和评定USCOM的临床应用价值.     

睾丸微小结石症高频超声诊断及临床意义

睾丸微小结石症(testicular microlithiasis,TM)是一种较少见的睾丸疾病,多无明显临床症状,多因其他疾患或体检偶然发现.越来越多的研究提示,TM可能是睾丸肿瘤的癌前病变或影像学标志[1],TM的检出具有重要的临床意义.高频超声的广泛应用为TM的临床诊断提供了快捷、准确且价格较低廉的检查手段.总结我院近年应用高频超声诊断TM45例患者临床资料,报道如下.     

经食管超声心动图在小儿先天性心脏病手术中的应用

术中经心外膜超声心动图对小儿先天性心脏病 (先心病 )手术方案的选择具有重要意义 ,但对手术视野有干扰 ,临床应用受到限制〔1〕。随着小儿经食管超声心动图 (ＴＥＥ)探头的研制成功 ,婴幼儿先心病术中超声心动图监测成为可能。现总结我们 1996年 10月至 1997年 5月在 2 3例小儿先天性心脏病术中应用ＴＥＥ的情况 ,探讨该技术的安全性、实用性及临床价值。临床资料和方法　 2 3例病儿中男 12例 ,女 11例 ;年龄 6个月～ 11岁。体重 5 5～ 2 3.0ｋｇ ,其中 <10ｋｇ者 8例 ,10～ 2 0ｋｇ 11例 ,>2 0ｋｇ 4例。术前均经体表超声心动图和心导管…     

Association of Clinical Assessments of Hand Function and Quantitative Ultrasound Metrics in First Carpometacarpal Osteoarthritis

Background

Thumb carpometacarpal (CMC) osteoarthritis (OA), a degenerative condition affecting hand use, is typically evaluated through radiographs and clinical examination. Although this can determine treatment, it is difficult to evaluate functional limitations. Shear wave elastography (SWE) is a quantitative ultrasound technique that characterizes tissue stiffness.

Questions/Purposes

This pilot study aimed to establish data of the SWE findings in the thenar eminence muscles in patients with first CMC OA and correlate these findings with the clinical tests of hand function.

Methods

This cross-sectional study correlated the SWE stiffness of thenar eminence muscles to clinical tests of hand function in patients with first CMC OA and in asymptomatic control subjects, using Spearman’s correlation coefficient. Mean SWE values of the thenar eminence muscles in patients were compared with those in control subjects. The study was performed in a non-profit tertiary care hospital setting. Patients and control subjects were recruited on a volunteer basis.

Results

SWE values in the abductor pollicis brevis and flexor pollicis brevis muscles showed moderate to very strong correlation with multiple measures of hand function. Mean SWE values of the thenar eminence muscles in first CMC OA patients were lower than those in asymptomatic control subjects.

Conclusions

Correlations between mean SWE values in the thenar eminence muscles and clinical measures of hand function suggest decreased function in subjects with less stiff thenar eminence muscles.

     

Role of shear wave elastography measured in the flaccid state in predicting arteriogenic erectile dysfunction

The gold-standard method for diagnosing arteriogenic erectile dysfunction (AED) is the penile Doppler ultrasonography. We proposed a novel method for predicting AED using ultrasonic shear wave elastography (SWE) considering that the former was invasive and variable. A total of 98 male patients were enrolled in our study, referred for ED between December 2018 and October 2020. For comparison, we also included 42 volunteers from the Healthy Physical Examination Center of our hospital. The Penile Doppler Ultrasonography (PDU) and SWE were performed for all patients with the intracavernosal injection (ICI). We named three groups as AED group, nonvascular ED group and healthy controls group. No statistically significant differences were found among the three groups in terms of demographic and clinical characteristics. There were no significant differences in IIEF-5 between AED and nonvascular ED. A significant (r = 0.642, p < 0.0001) positive correlation between flaccid and erectile SWE was observed. With a cut-off value of 13.45 KPa, the area under curve, specificity, and sensitivity of the SWE values under the flaccid state in distinguishing AED from healthy subjects were 0.867, 0.786 and 0.896 respectively. The SWE value in the flaccid state can distinguish the AED from healthy subjects.     

Female striated urogenital sphincter contraction measured by shear wave elastography during pelvic floor muscle activation: Proof of concept and validation

Aims

Investigation of the function of the striated urogenital sphincter (SUS) is challenging because it is difficult to access and requires invasive measures. Ultrasound shear wave elastography (SWE) is a non‐invasive real‐time technique used to estimate tissue stiffness. As muscle stiffness can be used as an estimate of muscle force, SWE provides an opportunity to study contraction of the peri‐urethral musculature. Validation of SWE to study SUS during functional tasks, such as pelvic floor muscle contractions, is required prior to application in clinical populations.

Methods

Ten healthy females (34[5] years) participated. Stiffness in a region expected to contain the SUS was quantified using SWE at rest and during a pelvic floor muscle contractions performed at 10%, 25%, and 50% of maximal voluntary contraction (MVC). Two repetitions were performed for 10 s.

Results

During contraction, stiffness increased in the region of the SUS in all participants and at all contraction intensities. Multiple regions of increased stiffness were detected, with 95.8% of regions situated ventral to the mid‐urethra within the anatomical area of the SUS. The increase in stiffness was greater for 50% MVC than both 10% and 25% MVC contraction intensities (P < 0.01).

Conclusions

Stiffness increased within the anatomical region of the SUS during voluntary pelvic floor muscle contractions with predictable response to changes in contraction intensity. These observations support the potential for ultrasound SWE to study SUS function non‐invasively.     

剪切波弹性成像在乳腺良恶性病变中的应用进展

乳腺癌发病率逐年上升,且趋于年轻化。鉴别乳腺良恶性病变是预防、诊断及治疗乳腺癌的重点。剪切波弹性成像是一项新的超声定量技术,已在乳腺、甲状腺、腮腺、睾丸等组织病变呈现出重要临床应用价值。本文就剪切波弹性成像对鉴别诊断乳腺良恶性病变的应用进展进行综述。     

Effects of age and pathology on shear wave speed of the human rotator cuff

Rotator cuff tears are common and often repaired surgically, but post‐operative repair tissue healing, and shoulder function can be unpredictable. Tear chronicity is believed to influence clinical outcomes, but conventional clinical approaches for assessing tear chronicity are subjective. Shear wave elastography (SWE) is a promising technique for assessing soft tissue via estimates of shear wave speed (SWS), but this technique has not been used extensively on the rotator cuff. Specifically, the effects of age and pathology on rotator cuff SWS are not well known. The objectives of this study were to assess the association between SWS and age in healthy, asymptomatic subjects, and to compare measures of SWS between patients with a rotator cuff tear and healthy, asymptomatic subjects. SWE images of the supraspinatus muscle and intramuscular tendon were acquired from 19 asymptomatic subjects and 11 patients with a rotator cuff tear. Images were acquired with the supraspinatus under passive and active (i.e., minimal activation) conditions. Mean SWS was positively associated with age in the supraspinatus muscle and tendon under passive and active conditions (p ≤ 0.049). Compared to asymptomatic subjects, patients had a lower mean SWS in their muscle and tendon under active conditions (p ≤ 0.024), but no differences were detected under passive conditions (p ≥ 0.783). These findings identify the influences of age and pathology on SWS in the rotator cuff. These preliminary findings are an important step toward evaluating the clinical utility of SWE for assessing rotator cuff pathology. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:282–288, 2018.     

SWE与实时组织弹性成像技术在甲状腺结节良恶性鉴别诊断中的价值分析

目的探究采用剪切波弹性成像(SWE)与实时组织弹性成像技术(RTE)对鉴别诊断甲状腺结节良恶性的价值。方法选择2015年10月至2016年10月收治的行甲状腺手术60例患者进行回顾性分析,共68个甲状腺结节。均在术前同时行SWE检查和RTE检查,并且所有患者均接受手术病理证实。结果 SWE检查甲状腺恶性结节的杨氏模值显著高于良性结节,差异有统计学意义(P0.05)。SWE与RTE两种诊断技术的灵敏度、特异度、阳性预测值及阴性预测值之间的差异无统计学意义(P0.05)。RTE诊断直径≤1 cm甲状腺结节良恶性的灵敏度显著高于SWE,差异有统计学意义(P0.05)。SWE技术诊断直径≥3 cm甲状腺结节良恶性的灵敏度、阳性预测值及阴性预测值均高于RTE,差异有统计学意义(P0.05)。结论 SWE与RTE鉴别诊断甲状腺结节良恶性均具有较高诊断价值,SWE对于大结节良恶性鉴别诊断具有更高价值,而直径≤1 cm的甲状腺结节宜采用RTE技术进行诊断。     

Supraspinatus muscle elasticity measured with real time shear wave ultrasound elastography correlates with MRI spectroscopic measured amount of fatty degeneration

Background

Fatty Degeneration (FD) of the rotator cuff muscles influences functional and anatomical outcome after rotator cuff repair. The MRI based estimation of fatty degeneration is the gold standard. There is some evidence that Ultrasound elastography (EUS) can detect local differences of tissue stiffness in muscles and tendons. Shear-wave elastography (SWE) was evaluated to determine the extent to which shear wave velocity was associated with measures of fatty degeneration. MRI-spectroscopic fat measurement was used as a reference to quantify the amount of fat in the muscle belly.

Methods

Forty-two patients underwent SWE of the supraspinatus muscles at its thickest diameter. After ultrasound evaluation an MRI-spectroscopic fat measurement of the supraspinatus muscle was performed using the SPLASH-technique. A gel filled capsule was used to locate the measured area in the MRI. The values of shear wave velocity (SWV) measured with SWE and spectroscopic fat measurement were correlated statistically using Pearson’s correlation test.

Results

Correlation of the fat amount measured with MRI-spectroscopy and the SWV measured with SWE was ρ =0.82. Spectroscopic measured fat ratio of the supraspinatus muscle ranged from 0% to 77.41% and SWV from 1.59 m/s to 5.32 m/s. In 4 patients no sufficient SWE could be performed, these individuals showed a larger diameter of the overlying soft tissue. SWV measured with SWE showed a good correlation with MRI spectroscopic fat amount of the supraspinatus muscle.

Conclusion

These preliminary data suggest that SWE may be a sufficient tool in detecting and estimating the amount of fatty degeneration in the supraspinatus muscle in real time. Large overlying soft tissue may be a limitation in performing sufficient EUS.Ethical Committee Approval: Nr: 156/14 Date 12th August 2014.Level of Evidence: III.

     

Objective evaluation of fat tissue induration after breast reconstruction using a deep inferior epigastric perforator (DIEP) flap

Problems in breast reconstruction with deep inferior epigastric perforator (DIEP) flaps include postoperative fat induration and necrosis. A resulting clinical symptom is palpable indurated tissue, but it is difficult to measure the stiffness of transplanted fat tissues objectively at a deep site. The ability to perform shear-wave elastography (SWE) was recently added to some common ultrasonic echo devices, enabling objective three-dimensional measurements of tissue stiffness. In this study, we measured the stiffness of transplanted DIEP flaps using SWE to examine the effects of measurement sites, flap size and perforator patterns on stiffness. The subjects were 26 patients who showed induration of a transplanted flap on palpation in follow-up observation performed more than 6?months after breast reconstruction with a DIEP flap. The effects of the weight of the transplanted flap, and the diameter, number and location of the perforators on the stiffness of fat tissue were also analyzed. Within each zone, distal regions showed higher values, but in Zone II, significantly higher stiffness was also found in the proximal region. Multivariate regression analysis including all measurement sites, the weight of transplanted flap, and diameter, number and location of perforators showed that the stiffness of fat tissue was significantly higher in subjects with a larger weight flap. For safe reconstruction, it will be useful to examine the stiffness of fat tissue in individual regions of a transplanted flap retrospectively, because the examination results can be used in actual clinical practice.     

剪切波弹性成像在供肝评估中的临床应用

目的探讨剪切波弹性成像(SWE)结合常规超声对供肝质量评估的临床应用价值。 方法2014年2月至2017年10月昆明医科大学附属甘美医院实施公民逝世后器官捐献肝移植共121例,供肝获取前所有供者均行常规超声及SWE检查。根据术中快速病理检查结果将供者分为正常组和异常组,异常组包括脂肪肝、肝淤血、肝纤维化和肝坏死。采用成组t检验分别比较异常组、脂肪肝组、肝纤维化组与正常组供肝杨氏模量值。绘制受试者工作特征曲线,以约登指数最高时的杨氏模量值作为区分正常和异常供肝的截断值,计算相应敏感度和特异度。 结果根据术中快速病理检查结果,121例供者分为正常组73例,异常组48例;异常组包括脂肪肝组21例、肝淤血组18例、肝纤维化组5例和肝坏死组4例。异常组和正常组供肝杨氏模量值分别为(5.55±1.56)kPa和(3.64±0.70)kPa,差异有统计学意义(t＝7.964,P<0.05)。截断值＝4.07 kPa时,约登指数最高＝0.628,SWE诊断供肝病变的敏感度为83.3%,特异度为79.5%。脂肪肝组和肝纤维化组供肝杨氏模量值分别为(5.56±1.43)和(6.67±1.36)kPa,均高于正常组,差异均有统计学意义(t＝5.974和4.933,P均<0.05)。肝淤血组和肝坏死组杨氏模量值分别为2.46～7.11 kPa和5.62～9.11 kPa。 结论SWE可以定量评估肝组织硬度,对异常和正常肝脏的鉴别具有较高特异度。SWE结合常规超声检查可以对供肝质量进行无创、定量评估,具有较高的临床应用价值。     

The efficacy of shear-wave elastography – performed simultaneously with Doppler sonography – for differentiating between testicular torsion and epididymo-orchitis

Background and aimShear-wave elastography (SWE) is a noninvasive ultrasonographic procedure that uses sound waves to measure tissue elasticity. Testicular torsion (TT) is an important emergency condition that is frequently misdiagnosed as epididymo-orchitis (EO). Doppler sonography (DS) is currently associated with false-positive and false-negative results owing to a variety of reasons, although its sensitivity and specificity for the differential diagnosis of TT and EO remain high. The aim of this study was to determine the efficacy of SWE performed simultaneously with DS for differentiating between TT and EO.Materials and methodsThe study included 32 male Wistar albino rats weighing 300–350 g. The rats were randomly divided into the following groups of 8 each: 1. Control group; 2. Sham group; 3. TT group; 4. EO group. The TT group was divided into subgroup 1 (SE and DS performed 1 h after inducing TT) and subgroup 2 (SE and DS performed 24 h after inducing TT). Scrotal SWE and DS were performed simultaneously in all the rats.ResultsThere were significant differences in velocity and stiffness between the control group and TT subgroup 1 (P < 0.005). Similarly, there were significant differences in velocity and stiffness between the sham group and TT subgroup 2 (P < 0.005), and between TT subgroup 2 and the EO group (P < 0.005). ROC curves plotted for velocity and stiffness in TT yielded cutoff values of 2.21 ms and 14.09 kPa, respectively.ConclusionWhen simultaneously performing SWE and DS for the differential diagnosis of TT and EO, high testicular velocity and stiffness values can be considered indicative of TT. Based on the present findings, we think that routine simultaneous use of SWE and DS, rather than DS only, could reduce the rates of false-negative and false-positive TT results.