An audit of a hospital-based Doppler ultrasound quality control protocol using a commercial string Doppler phantom

Results from a four-year audit of a Doppler quality assurance (QA) program using a commercially available Doppler string phantom are presented. The suitability of the phantom was firstly determined and modifications were made to improve the reliability and quality of the measurements. QA of Doppler ultrasound equipment is very important as data obtained from these systems is used in patient management. It was found that if the braided-silk filament of the Doppler phantom was exchanged with an O-ring rubber filament and the velocity range below 50 cm/s was avoided for Doppler quality control (QC) measurements, then the maximum velocity accuracy (MVA) error and intrinsic spectral broadening (ISB) results obtained using this device had a repeatability of 18 ± 3.3% and 19 ± 3.5%, respectively. A consistent overestimation of the MVA of between 12% and 56% was found for each of the tested ultrasound systems. Of more concern was the variation of the overestimation within each respective transducer category: MVA errors of the linear, curvilinear and phased array probes were in the range 12.3–20.8%, 32.3–53.8% and 27–40.7%, respectively. There is a dearth of QA data for Doppler ultrasound; it would be beneficial if a multicentre longitudinal study was carried out using the same Doppler ultrasound test object to evaluate sensitivity to deterioration in performance measurements.     

An ultrasound based non-invasive method for the measurement of intrinsic foot kinematics during gait

Soft tissue artefact (STA) and marker placement variability are sources of error when measuring the intrinsic kinematics of the foot. This study aims to demonstrate a non-invasive, combined ultrasound and motion capture (US/MC) technique to directly measure foot skeletal motion. The novel approach is compared to a standard motion capture protocol. Fourteen participants underwent instrumented barefoot analysis of foot motion during gait. Markers were attached to foot allowing medial longitudinal arch angle and navicular height to be determined. For the US/MC technique, the navicular marker was replaced by an ultrasound transducer which was secured to the foot allowing the skeletal landmark to be imaged. Ultrasound cineloops showing the location of the navicular tuberosity during the walking trials were synchronised with motion capture measurements and markers mounted on the probe allowed the true position of the bony landmark to be determined throughout stance phase. Two discrete variables, minimum navicular height and maximum MLA angle, were compared between the standard and US/MC protocols. Significant differences between minimum navicular height (P=0.004, 95% CI (1.57, 6.54)) and maximum medial longitudinal arch angle (P=0.0034, 95% CI (13.8, 3.4)) were found between the measurement methods. The individual effects of STA and marker placement error were also assessed. US/MC is a non-invasive technique which may help to provide more accurate measurements of intrinsic foot kinematics.     

超声介入治疗常见妇科囊性炎症包块的疗效评价*

摘要目的：比较超声引导介入治疗盆腔脓肿、输卵管积脓、输卵管积液、包裹性积液及宫颈囊肿的临床效果,了解超声引导介入 治疗常见的妇科囊性炎症包块的临床价值。方法：选取我院妇科门诊2007 年1 月～2011 年3月收治的常见妇科囊性炎症包块共 108例,其中盆腔脓肿11 例、输卵管积脓19 例、输卵管积液43 例、盆腔包裹性积液31 例、宫颈囊肿4 例,给予超声实时引导抽囊 液、甲硝唑冲洗治疗,治疗后3 个月内复查超声评价和比较疗效。结果：盆腔脓肿、输卵管积脓、盆腔包裹性积液包块均明显缩小 (12/43)或消失(29/43),治疗有效率100%;输卵管积液包块治疗有效率95％(41/43),宫颈囊肿均痊愈。各组间比较无统计学差异 （P>0.05）。结论：超声引导介入治疗对输卵管积脓、盆腔脓肿、盆腔包裹性积液均有显著的疗效,且治疗效果无差异,值得推广应 用,代替传统的非必要的手术治疗。     

老年慢性心力衰竭患者肿瘤坏死因子、脑钠肽水平变化及其相关性分析*

摘要目的：探讨老年慢性心力衰竭（CHF）肿瘤坏死因子琢（TNF-α）以及脑利钠肽水平的变化,并对其进行相关性分析。方法：选 择老年CHF患者59 例,根据心功能分级,Ⅱ级19 例,Ⅲ级25 例,Ⅳ级15 例;另选心功能正常的老年人36例。所有入选者予以血 清BNP、TNF-α测定,并采用彩色多普勒超声测定左心室舒张末内径并计算左室射血分数（LVEF）。结果：与对照组比较,CHF组 心功能Ⅲ、Ⅳ级患者TNα-琢水平明显升高（P＜0.05）,心功能Ⅱ、Ⅲ、Ⅳ级患者血BNP水平明显升高（P＜0.05）,并随心功能分级加 重而增加。血TNF-α水平与BNP 呈正相关（r=0.57,P＜0.05）。CHF患者中血清TNF-α和BNP 水平与LVEF比较均呈负相关 （r=-0.48, r=-0.64, P＜0.05）。结论：老年CHF患者血TNF-α显著升高,并与BNP及LVEF关系密切,是反应CHF患者心功能恶化 的重要预测指标。     

超声分子成像的研究进展

超声成像无创、无放射性、低成本、实时成像的优点,使其成为目前世界上应用最广的成像手段之一。特别是超声造影剂引入之后,超声成像的图像分辨率和灵敏度得到了大大提高,使超声成像在临床上得到了进一步应用。近年来,随着分子生物学和超声成像技术的不断发展,人们提出了"超声分子成像"的概念。它是一项结合了分子靶向造影剂和超声影像技术的能在分子水平下观察病理变化的新兴技术,目前这一技术还处于研究初期阶段。但大量临床前的研究成果已表明超声分子成像在诊断血管生成、炎症和血栓三种疾病具有很大应用前景。本文主要综述了目前常用超声造影剂的种类以及超声分子成像技术的研究现状,并对该技术进行了讨论和展望。     

超声心动图对高血压心室肥厚患者左心功能的评价及意义

目的:本研究利用超声心动图检测高血压心室肥厚患者左心房结构,探讨当左心结构发生变化时心脏功能所受到的影响,为高血压及其并发症的临床诊断提供检测及诊断参考。方法:选取2011年5月-2013年1月在我院接受检查的高血压心室肥厚患者76例作为观察组,另选取同期经体检的健康人群60例为健康对照组,利用超声心动图观察左心功能和结构,比较两组研究对象的左心房内径(LAD)、心肌质量(LVMM)、舒张末容积(LVEDV)、收缩末容积(LVESV)、左心室射血分数(LVEF)及二尖瓣口舒张末期流速比值(E/A)。结果:两组间心室收缩功能无显著性差异(P0.05);高血压组LAD高于对照组,LVEF及E/A低于对照组,差异具有统计学意义(P0.05);高血压Ⅰ期、Ⅱ期、Ⅲ期患者间比较,左房内径随血压的升高逐渐递增,而左心室射血分数和二尖瓣口舒张期流速比值则逐渐递减,差异具有统计学意义(P0.05)。结论:超声心动图可以直观的显示高血压心室肥厚患者左心功能及血流动力学的变化,对临床诊断具有积极的意义。     

基于改进C-V模型的超声心动图像轮廓的提取方法

目的:通过超声图像预处理和对图像分割方法的改进,完成超声心动图中心腔轮廓的提取。方法:首先,运用基于斑点指数的滤波方法对超声图像进行去噪。其次,对超声图像进行分段非线性灰度变换,提高图像对比度。最后,利用改进的基于C-V模型的水平集算法对超声图像进行分割,得到精确的初始轮廓。结果:1基于斑点指数的图像滤波方法可以在不丢失细节的情况下对超声图像进行噪声滤除。2分段非线性灰度变换可以有效提高超声图像的对比度。3改进的C-V模型可以成功的对含有斑点噪声的超声图像进行分割。结论:本文的超声图像预处理方法和分割算法可以有效提取心腔轮廓,降低斑点噪声对图像分割结果的影响。     

超声弹性成像技术在乳腺肿块诊断中的研究进展及应用

超声弹性成像技术(UE)是一种新的超声成像技术,能够根据组织硬度进行成像,估计出组织内部的弹性信息,从而反映它的结构特点,该技术较传统触诊检查更加客观,在乳腺肿块的鉴别诊断中有较高的价值,其临床应用广泛并且得到了快速的发展。现就国内外文献对UE技术的原理、图像分析方法、技术研究进展及其在乳腺肿块鉴别诊断中的应用进行综述。     

代谢综合征与非酒精性脂肪肝临床特征的关系

目的:探讨代谢综合征(metabolic syndrome,MS)与非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)临床特征之间的相关性。方法:从我院2012年1月-2014年2月健康体检资料中抽选326例经超声确诊为NAFLD的患者,作为NAFLD组,并随机抽选335例无脂肪肝患者作为对照组;观察两组患者间的临床特征,并采用Logistic回归分析MS与NAFLD临床特征之间的相关性。结果:NAFLD组患者体重指数(BMI)、血压、丙氨酸氨基转移酶(ALT)、空腹血糖(FBG)、血尿酸(UA)、高密度脂蛋白(HDL-C)、甘油三酯(TG)、天冬氨酸氨基转移酶(AST)水平显著高于对照组(P0.05):两组间低密度脂蛋白(LDL-C)、总胆固醇(TC)比较无显著性(P0.05)。NAFLD组中MS、血脂及糖代谢异常、肥胖以及高血压的检出率明显高于对照组(P0.05)。经Logistic回归分析显示,NAFLD、BMI、TG、HDL-C、高血压及血糖是MS的独立危险因素。结论:NAFLD患者中存在MS的各种组分聚集特征,MS患病率明显升高,NAFLD是MS的独立危险因素之一,因此MS与NAFLD关系密切。     

类风湿关节炎拇长屈肌腱病变的超声特点

目的:总结类风湿关节炎(RA)患者拇长屈肌腱(FHL)病变的超声特点及二者间的相关性。方法:回顾性分析2010年2月至2011年6月因足部疼痛于我院就诊的60例(120足)RA患者资料。应用彩色多普勒超声诊断仪探查拇长屈肌腱,根据超声探查拇长屈肌腱病变情况的结果将患者分为3组:肌腱完整组(A组,45足),肌腱周围炎症组(B组,49足),肌腱断裂组(C组,26足)。对拇长屈肌腱病变的特点及部位进行描述,并将拇长屈肌腱病变严重程度与患者年龄及病程进行相关性分析。结果:45足肌腱完整,49足出现不同部位的肌腱周围炎症(内踝转折处17足,henrry’s结节处11足,第一跖趾关节跖侧21足),26足发生肌腱断裂(9足发生于内踝转折处,17足发生于跖趾关节跖侧)。肌腱病变的发生率71%。A组平均年龄49.9±9.2岁,病程4.7±2.6年;B组平均年龄56.2±9.2岁,病程16.2±7.4年;C组平均年龄54.7±8.0岁,病程20.9±4.4年。三组间上述参数差异具有统计学意义(P0.05)。结论:拇长屈肌腱是类风湿关节炎足部结构的常见受累部位,其病变多发生于内踝转折处,henrry's结节处及第一跖趾关节跖侧,但henrry’s结节处的断裂少见。在对类风湿关节炎平足患者进行肌腱转位手术时,应充分考量拇长屈肌腱的病变。