Objective To evaluate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in obstructive jaundice. Methods Forty eight consecutive patients with obstructive jaundice were examined by MRCP, all results were testified during and /or after operation. Results Different causes of obstruction had their own characteristic manifestations. Level of obstruction was accurate in 100%, the accuracy in distinguishing obstructive causes was 93.8%. Conclusion MRCP is quite effective, safe and reliable in diagnosis of obstructive jaundice.
目的阐明数字减影血管造影（DSA）监控在区域性置管栓塞化疗治疗肝癌中的重要性。方法比较152例肝癌区域性置管中DSA监控置管与注射美蓝指导下置管的导管位置准确性； 并对术后发生与置管有关的并发症进行分析。结果DSA监控置管准确率肝动脉及门静脉均为100%，注射美蓝指导下置管肝动脉和门静脉的导管位置准确率分别为70.2%和76.1%，两组比较差异有显著性意义（P＜0.01)。术后有导管移位、肝动脉胆管瘘、导管阻塞、药液外漏、硬化性胆管炎等并发症。结论DSA指导下置管准确，又能保证血管内介入治疗的彻底性； 术后行DSA监控，以指导下一步的治疗，并可防止并发症的发生。
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 observe the image characteristics of autofluorescence (AF) in central serous chorioretinopathy (CSC). Methods A total of 85 eyes of 72 patients with CSC were examined by Headberg HRA2 laser scanning fundus fluorescein angiography (FFA), redfree light photography, and Kowa fundus colorizedphotography. The grey AF images were obtained with 488 nmwave-length laser and comparatively analyzed with results of fundus colorized photography, redfree light photography and FFA. Results In 85 eyes, single faint AF of the CSC focus was in 14 (16.5%); faint AF pool containing b lamellar focus was in 39 (45.9%); faint AF pool combining with mottling focus was in 25 (29.4%); local dense or scattered mottling AF at the posterior pole was in 7 (8.2%). FFA fluorescein leakage point or abnormal fluorescence were in accordance with abnormal AF in 60 eyes (70.6%); the changes of ocular fundus, results of FFA, and changes of AF were not accordance in 25 eyes (29.4%). AF of CSC focus during different disease course was different, which showed single platelike faint AF pool and b mottling AF complex focus in and out of the faint AF in the period of onset of the disease, while b mottling combining with faint mottling AF and various multiinfection fields in the period of chronicity. Conclusions The AF of CSC mainly demonstrates single faint AF, b mottling combining with faint mottling AF and multiinfection AF in macular fields. AF examination associates with fundus colorized photography and FFA can be mutually complemented in observing the images of CSC.
ObjectiveTo evaluate the diagnostic value of contrast enhanced ultrasound (CEUS) to the sentinel lymph node (SLN) of breast cancer. MethodsSeventy-two operable breast cancer patients with clinically negative axillary lymph node were enrolled.Sulphur hexafluoride microbubbles for injection (SonoVue) was used alone as the tracer agent for the sentinel lymph node biopsy (SLNB), and axillary dissection was performed after the methylene blue location.All SLNs were examined pathologically with HE staining.The SLN diagnosis result of contrast enhanced ultrasound and postoperative pathological examination result were comparative analyzed. ResultsAfter the injection of SonoVue can obtain a clear image of the lymphatic vessels and SLN.The success rate of CEUS imaging was 84.72% (61/72) in this group of 72 patients, and the false negative rate was 12.12% (4/33).The sensitivity and specificity of diagnosis by CEUS was 92.50% (37/40) and 92.59% (50/54), respectively, the diagnostic odds ratio (DOR) was 154.17.By the pathology results as the gold standard, the internal consistency of these two methods was good (Kappa value=0.848, P < 0.01). ConclusionCEUS may be a useful orientation and determination method for SLNs.
目的:探讨磁共振血管造影(MRA)以及计算机断层扫描血管成像(CTA)对地震挤压伤下肢血管病变的临床价值。方法:对5·12汶川大地震中我院收治的已确诊为地震挤压伤致双下肢横纹肌溶解症3例患者进行双下肢MRA检查,并对严重挤压伤及下肢毁损,并行截肢的另三名患者进行术后CTA检查。对MRA图象双下肢动脉进行回顾性分析,总结MRA征象,同时总结截肢术后患者CTA表现及临床价值,并评价二者检查在挤压伤所至横纹肌溶解症的临床诊治中的作用。结果:3例未行截肢患者MRA双下肢主要动脉未见确切狭窄及闭塞征象,管腔内未见充盈缺损影。3例已行截肢患者可见残余肢体的明显肿胀,双侧髂血管以及部分截断肢体远端血管内见止血弹簧钢圈影像,部分截断肢体远端动脉分支变细。截断血管未见再通,周围无渗血改变。结论:MRA、CTA能直观显示双下肢动脉损伤及术后情况,在临床应用中各有优势和局限性。对二者的合理选择能为临床诊治提供有利信息。
Objective To observe ophthalmoscopic image characteristics of central serous chorioretinopathy (CSC). Methods Twenty-one eyes of the 18 patients diagnosed with CSC were enrolled in this study．The patients included 12 males (14 eyes) and six females (seven eyes)．The patients ages ranged from 26 to 47 years，with a mean age of (39.1plusmn;5.4) years. There were nine patients (11 eyes) with acute CSC, seven patients (seven eyes) with chronic CSC, and two patients (three eyes) with recurrent CSC. All the patients were examined using color fundus photography including infrared (IR), auto-fluorescence (AF), near infrared ray-auto-fluorescence (NIR-AF), fluorescein angiography (FA) and indocyanine green angiography (ICGA) photography. The ophthalmoscopic image characteristics of CSC were comparared. Results The circular serous retinal detachments of 21 eyes were depicted in color images of the ocular fundus, which in the IR showed the hypo-fluorescence. Ten eyes displayed mottled hyper-fluorescent spots associated with serous retinal detachments corresponding to the leakage points. The serous retinal detachments of 15 eyes in the AF images showed hypo-fluorescence, six eyes showed hyper-fluorescence. Fourteen eyes presented with hypo-or hyper-fluorescent spots corresponding to the leakage points, seven eyes presented without abnormal fluorescence corresponding to the leakage points. In addition, three eyes with acute CSC showed many scattered hyper-fluorescent spots, which showed hypo-fluorescence in the ICGA. The serous retinal detachment of 15 eyes exhibited hypo-fluorescence in the NIR-AF images, six eyes showed hyper-fluorescence. Fourteen eyes presented with hypo- or hyper-fluorescent spots corresponding to the leakage points, seven eyes presented without abnormal fluorescence corresponding to the leakage points. Twenty-one eyes in FA identified the leakage. Eight eyes showed regional choroidal delayed filling, 13 eyes exhibited regional choriocapillary dilatation during 1-5 minutes after injection of ICGA. During 1-5 minutes after injection of ICGA, six eyes showed more lesions than FA, three eyes showed obvious patchy hypo-fluorescence whereas the FA were normal. Conclusions CSC has its own characteristic fundus images in the IR, FA and NIR-A. FA is still the photographic method of choice, but ICGA can reveal lesions of the choroid in CSC. IR, FA and NIR-AF are not as good as FA and ICGA for detecting of leakage points.