胆囊作为贮存和浓缩胆汁的器官，其内的胆汁易于析出、凝集而形成结石。胆囊最常见的疾病多与结石相关，如胆石症、急慢性胆囊炎、胆囊癌等； 其他影响胆囊的病理状态还包括胆道动力障碍、术后改变等。超声对胆囊结石及胆囊炎的诊断有较高的敏感性及特异性，还可通过摄取高脂食物前后对比评价胆囊功能，是胆囊疾病的传统影像检查手段，但对肥胖患者其图像质量及解剖细节显示较差。目前，常规MRI已经成为重要的胆囊成像方法之一，并可引入经胆道排泄的造影剂进一步清晰显示其解剖及生理。对于超声不能很好评价的胆囊疾病患者应首选MRI检查。
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。
Objective To investigate the value of new double-phasic MR contrast agent (gadobenate dimeglumine， Gd-BOPTA) in diagnosis of hepatocellular carcinoma (HCC) with correlation of pathology. Methods MRI scan was performed on 33 patients suspected of having focal liver lesions by CT or ultrasonography. The MRI scan protocol included routine axial T1WI and T2WI, coronal T2WI and 3D-MRCP, Gd-BOPTA enhanced 3D gradient-echo sequence of T1W (LAVA sequence) acquiring dynamic data at 15 s, 55 s and 90 s respectively, delayed LAVA acquisition at 5 min, 10 min, and at 40 min, 80 min respectively. Surgical specimen was collected for pathological analysis. Results Surgery confirmed the diagnosis of HCC in 21 patients with 27 lesions. The sensitivity, specificity and accuracy of MR imaging with combined phases (including hemodynamic phase and hepatobiliary phase) were 92.9%,93.3%, 92.9% respectively. ①In the hemodynamic phase: 22 lesions showed early enhancement in arterial phase, fast “washout” in portal venous phase, and hypointense in delayed phase. Four lesions showed slight enhancement, while 1 lesion showed no enhancement in all hemodynamic phases. ②In the hepatobiliary phase: 23 lesions showed homogeneous hypointensity compared to the enhanced liver background, but 4 lesions (3 well-differentiated and 1 moderately-differentiated) had patchy or dot-like slightly hyperintense areas scattered within the lesions. Pathologically cholestatic changes of tumor cells were observed and bile-containing small ducts were present. Conclusion Gd-BOPTA enhanced MRI can both depict the hemodynamic characteristics and reflect the absence of normal hepatocyte function in HCC lesions, thus contributing greatly to the diagnosis of HCC.
Objective To investigate the value of contrast-enhanced ultrasonography in detection and diagnosis of small primary liver cancer. Methods SonoVue-enhanced ultrasonography were performed on 353 patients with 378 primary liver cancer, less than 3 cm in diameter. Enhancement patterns and enhancement phases of hepatic lesions on contrast-enhanced ultrasonography were analyzed and compared with the results of histopathology. Results In all hepatic tumors, 96.6% （365/378） lesions enhanced in the arterial phase. Among them, 317 (83.9%) tumors enhanced earlier than liver parenchyma and 48 (12.7%) tumors enhanced synchronously with liver parenchyma, and 342 (90.5%) tumors showed early wash-out in the portal and late phases. With regard to the enhancement pattern, 329 (87.0%) tumors presented whole-lesion enhancement, 35 (9.3%) to be mosaic enhancement and 14 (3.7%) to be rim-like enhancement. If taking the whole-lesion enhancement and mosaic enhancement in arterial phase as diagnotic standard for primary liver cancer on contrast-enhanced ultrasonography, the sensitivity was 92.9%(351/378), and if the earlier or synchronous enhancement of the tumor compared with liver parenchyma in arterial phase and the wash-out in portal phase were regarded as the stardand, the sensitivity was 87.3%(330/378). Conclusion Contrast-enhanced ultrasonography could display real-time enhancement patterns as well as the wash-out processes both in hepatic tumors and the liver parenchyma. It might be of clinical value in diagnosis of primary liver cancer based on the hemodynamics of hepatic tumors on contrast-enhanced ultrasonography.
Objective To evaluate the real-time contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of retroperitoneal occupying lesions. Methods Thirty patients with retroperitoneal occupying lesions, including 10 benign and 20 malignant lesions, were performed with CEUS, thus describing the perfusion of contrast agent, the entering style of contrast agent and the vascular morphous. And the entering styles were divided into two patterns: peripheral type or central type while the vascular morphous were divided into 4 levels: level 0, level 1, level 2 and level 3. All of these were compared between benign and malignant lesions. Compared the results of diagnosis malignant lesions by common ultrasonography with CEUS. Results 1/5 case of benign substantive lesions presented as contrast agent perfusion defect, and 11/20 cases of substantive malignant lesions presented as contrast agent perfusion defect. 14/20 of malignant lesions were central type; 9/10 of benign lesions were peripheral type (P=0.005 2). In benign lesions, level 0 had 7/10， level 1 had 2/10 and level 3 had 1/10. In malignant lesions, level 0 had 1/20, level 1 had 3/20, level 2 had 8/20 and level 3 had 8/20, too (P=0.000 5). The rate of missed diagnosis was 40.00% and the accuracy was 66.67% by common ultrasonography, while the rate of missed diagnosis was 10.00% and the accuracy was 86.67% by CEUS combined with the entering style of contrast agent and the vascular morphous. Conclusion The CEUS applies a new way to discriminate malignant from benign in retroperitoneal occupying lesions.
ObjectiveTo evaluate the clinical application and the efficacy of contrast enhanced ultrasonography (CEUS)guided percutaneous radiofrequency ablation (RFA) in patients with liver metastases. MethodsTotal 136 patients with 219 liver metastatic tumors, which were detected by CEUS before RFA therapy, were analyzed retrospectively. The diamter of tumors was (3.2±1.2) cm. Among them, the largest tumor more than 3 cm in diameter were found in 48.5% (66 patients), and 57.4% (78 patients) were with solitary metastasis. Enhanced CT and (or) MRI, and laboratory tests were applied to evaluate the outcomes after RFA treatment by regular followup. ResultsTumors were not detected by conventional ultrasonography in two cases, and 47.0% (63/134) of the patients with the largest tumor were 0.3 cm larger by CEUS than by conventional ultrasonography. More 40 tumors were detected in 18.4% (25/136) patients by CEUS. Followup ranged from 3 to 68 months (median time of 12 months). Early tumor necrosis rate one month after therapy was 98.2% (215/219 tumors). The incidence of local recurrence, new intrahepatic metastasis, and extrahepatic metastasis was 16.9% (23/136), 38.2% (52/136), and 8.8% (12/136), respectively. Local recurrence and new intrahepatic metastasis happened 2-25 months (median time of 6 months) after treatment. Local recurrence rates of the largest tumors ≥ 3 cm and tumor lt; 3 cm was 22.7% and 11.4%， respectively (P=0.079). The rate of new intrahepatic metastasis for the solitary metastasis cases was significantly lower than that for multiple metastases cases (25.6% versus 55.2%, P=0.000). The 1, 2, 3year survival rates were 82.5%, 64.3%, and 50.1%, and the 1, 2, 3year local recurrence free survival rates were 67.7%, 53.8%, and 38.3%, respetively. Patients with solitary metastasis survived longer than that with multiple metastases (P=0.034). ConclusionPatients with liver metastases treated by CEUSguided percutaneous RFA can get better survival rate, and CEUS is of much value for clinic application.
Conventional transcatheter aortic valve replacement is normally recommended with transthoracic echocardiography, and contrast agent mediated fluoroscopy under anesthesia to guide a better implantation of the transcatheter valve. However, iodine-containing contrast agent possibly damages the patient’s kidney, and even induces the acute kidney injury. We reported a 75-year-old patient diagnosed with severe aortic valve stenosis, moderate regurgitation, and chronic renal failure. We performed the aortic valve replacement under the guidance of fluoroscopy and transesophageal ultrasound without contrast agent. Seven days after surgery, the patient recovered well and discharged with alleviated aortic stenosis and fixed transcatheter aortic valve.