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.     

超声检查在乳腺癌诊断中价值的探讨

目的：探讨二维及彩色多普勒超声在乳腺癌诊断方面的临床应用价值。方法：对60例经手术病理证实的乳腺肿块病例的二维及彩色多普勒超声检查与病理结果进行回顾性分析。结果：乳腺癌诊断中,大多数恶性肿块表现为形态不规则、边缘粗糙、边界不清、内部回声不均匀、后方回声衰减。恶性肿块的血流显示率明显高,血流分布以Ⅱ、Ⅲ级为主。结论：二维声像图及彩色多普勒在乳腺癌诊断方面有较高的临床应用价值。由于良恶性肿物的影像互有交叉,其诊断符合率并非是100%。须两者联合应用,综合分析,方可提高超声对乳腺良恶性肿块的诊断符合率。     

彩色多普勒超声检查对胎儿颅内畸形筛查的应用价值及染色体异常分析

摘要 目的：探讨彩色多普勒超声检查对胎儿颅内畸形筛查的应用价值,并进行染色体异常分析。方法：选择2016年2月至2019年5月本院收治的进行胎儿颅内畸形筛查的高危孕妇120例,所有孕妇都给予彩色多普勒二维超声与三维超声筛查,对超声筛查异常者进行染色体异常分析,记录预后情况。结果：在120例孕妇中,二维超声诊断为胎儿颅内畸形12例,三维超声诊断为13例(预后都确诊为胎儿颅内畸形)。染色体核型筛查检出胎儿颅内畸形12例,其中21-三体综合征8例,18-三体综合征3例,13-三体综合征1例。确诊为胎儿颅内畸形的孕妇超声NT值都显著高于非胎儿颅内畸形孕妇,差异都有统计学意义(P<0.05)。孕妇选择终止妊娠10例,选择继续妊娠3例,继续妊娠3例胎儿都最终死亡。结论：产前彩色多普勒超声结合染色体核型在胎儿颅内畸形筛查中具有很高的价值,两者可互相补充,共同发挥诊断与预后评估价值。     

Construction of a Preclinical Multimodality Phantom Using Tissue-mimicking Materials for Quality Assurance in Tumor Size Measurement

World Health Organization (WHO) and the Response Evaluation Criteria in Solid Tumors (RECIST) working groups advocated standardized criteria for radiologic assessment of solid tumors in response to anti-tumor drug therapy in the 1980s and 1990s, respectively. WHO criteria measure solid tumors in two-dimensions, whereas RECIST measurements use only one-dimension which is considered to be more reproducible ^{1, 2, 3,4,5}. These criteria have been widely used as the only imaging biomarker approved by the United States Food and Drug Administration (FDA) ⁶. In order to measure tumor response to anti-tumor drugs on images with accuracy, therefore, a robust quality assurance (QA) procedures and corresponding QA phantom are needed.To address this need, the authors constructed a preclinical multimodality (for ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI)) phantom using tissue-mimicking (TM) materials based on the limited number of target lesions required by RECIST by revising a Gammex US commercial phantom ⁷. The Appendix in Lee et al. demonstrates the procedures of phantom fabrication ⁷. In this article, all protocols are introduced in a step-by-step fashion beginning with procedures for preparing the silicone molds for casting tumor-simulating test objects in the phantom, followed by preparation of TM materials for multimodality imaging, and finally construction of the preclinical multimodality QA phantom. The primary purpose of this paper is to provide the protocols to allow anyone interested in independently constructing a phantom for their own projects. QA procedures for tumor size measurement, and RECIST, WHO and volume measurement results of test objects made at multiple institutions using this QA phantom are shown in detail in Lee et al. ⁸.     

泌尿系造影联合彩色多普勒对小儿先天性肾积水的诊断价值评估

摘要 目的：探讨泌尿系造影联合彩色多普勒对小儿先天性肾积水的诊断价值。方法：选取2018年11月～2021年11月在本院治疗的88例先天性肾积水患儿为研究对象,所有患儿均完善静脉肾盂造影及彩色多普勒超声检查,以病理诊断结果为金标准,对比两种检查方法对小儿先天性肾积水的诊断价值。结果：彩色多普勒超声检查结果显示,肾积水轻度、中度、重度患儿分别为10例、39例、39例,不同病情程度患儿比较,重度组收缩期峰值速度（PSV）、舒张期最小流速（EDV）均低于中度组和轻度组,重度组血流阻力指数（RI）高于中度组和轻度组（P<0.05）,但轻度组与中度组PSV、EDV、RI比较差异无统计学意义（P>0.05）。与病理学诊断检查结果对比,彩色多普勒超声对中度、重度先天性肾积水患儿具有较高的诊断效能,其准确度分别为90.91%、93.18%,与病理诊断kappa值分别为0.795、0.862,具有较高的一致性;但对轻度肾积水诊断效能较低,kappa值为0.629,一致性一般。静脉肾盂造影对轻度先天性肾积水患儿具有较高的诊断效能,准确度为96.59%,与病理诊断kappa值为0.824,具有较高的一致性;但对中度、重度肾积水诊断效能较低,kappa值分别为0.583、0.565,一致性一般。彩色多普勒超声联合静脉肾盂造影诊断准确率高达94.32%,明显高于两检查方法单独应用（P<0.05）。结论：不同病情程度的先天性肾积水患儿具有不同超声征象,彩色多普勒超声对中、重度肾积水患儿具有较好的诊断价值,而静脉肾盂造影诊断轻度肾积水患儿的效能较好,将二者联合可提高对先天性肾积水的诊断准确率。     

超声检查在乳腺癌诊断中价值的探讨

目的:探讨二维及彩色多普勒超声在乳腺癌诊断方面的临床应用价值。方法:对60例经手术病理证实的乳腺肿块病例的二维及彩色多普勒超声检查与病理结果进行回顾性分析。结果:乳腺癌诊断中,大多数恶性肿块表现为形态不规则、边缘粗糙、边界不清、内部回声不均匀、后方回声衰减。恶性肿块的血流显示率明显高,血流分布以Ⅱ、Ⅲ级为主。结论:二维声像图及彩色多普勒在乳腺癌诊断方面有较高的临床应用价值。由于良恶性肿物的影像互有交叉,其诊断符合率并非是100%。须两者联合应用,综合分析,方可提高超声对乳腺良恶性肿块的诊断符合率。     

高危孕妇胎儿缺氧与彩色多普勒超声结合四维超声检查的相关性研究

摘要 目的：探讨与研究高危孕妇胎儿缺氧与彩色多普勒超声结合四维超声检查的相关性。方法：2018年2月到2020年1月在本院进行建档分娩的高危孕妇108例作为研究对象,都给予彩色多普勒超声结合四维超声检查,记录影像学特征,判定胎儿缺氧发生情况并进行相关性分析。结果：在高危孕妇108例中,发生宫内缺氧28例（宫内缺氧组）,发生率为25.9 %;宫内缺氧组的大脑中动脉、脐动脉的阻力指数（RI）、搏动指数（PI）、收缩期峰值流速舒张期流速比值（S/D）均高于非宫内缺氧组（P<0.05）;宫内缺氧组的上腔静脉血流心室收缩期峰值流速（S波）、心房收缩期速度（A波）、心室舒张期峰值流速（D波）均高于非宫内缺氧组（P<0.05）;高危孕妇108例中,Spearsman分析显示大脑中动脉、脐动脉的RI、PI、S/D以及上腔静脉血流S、D、A均与宫内缺氧都存在相关性（P<0.05）;logistic多因素回归分析显示：大脑中动脉、脐动脉的S/D与上腔静脉血流S、A为导致胎儿缺氧的主要影响因素（P<0.05）。结论：高危孕妇胎儿缺氧与彩色多普勒超声结合四维超声检查特征具有相关性,彩色多普勒超声结合四维超声可作为检查胎儿缺氧的可行、简单无创、方便快捷的方式,具有极高的应用价值。     

利用神经网络构建超声多普勒栓子信号自动检测系统

对血液中栓子的早期检测有着重要的临床诊断意义。超声多普勒技术使栓子的无损检测成为可能,但是目前的检测尚依赖于医生的手动操作和临床经验,仍缺乏可靠的自动检测系统。本文基于小波包变换和主元分析提取对栓子敏感的特征参数,并利用神经网络构建超声多普勒栓子信号的自动检测系统。仿真研究和临床实验表明:该系统有效提高了栓子检测的准确性,有望应用于临床诊断。     

Accuracy of colour Doppler ultrasound velocity measurements in small vessels

Colour Doppler ultrasound offers the possibility of imaging small vessels not visible by B-mode alone. The colour Doppler image of velocities allows the course of small vessels to be imaged in the X-Y plane of the scan provided the Doppler frequency shift is of sufficient magnitude. This permits alignments of the Doppler cursor, allowing angle correction to provide true velocity measurements from the Doppler shift obtained. Before attempting to make velocity measurements, however, it is essential to be aware of the possible error in the Z plane caused by the thickness of the Doppler sample volume. To quantify this source of error, hydrophone and flow-rig measurements were performed on an Acuson 128 colour Doppler scanner with both 5 MHz linear-array and 3.5 MHz phased-array transducers. Measurements of the transmitted pulses using a point hydrophone showed that both probes employ approximately 3.5 MHz Doppler pulses (in both colour and pulsed Doppler modes). The two transducers have the same axial resolution. In colour Doppler mode the axial length of the sample volume increases automatically with depth by up to 0.5 mm. Measurements of colour and pulsed Doppler signal strength were obtained in a controlled flow rig. Both transducers produced accurate colour flow images of the phantom at their optimum depths; flow velocity errors due to Z-plane thickness are < 5%. There was, however, substantial error outside these optimum conditions (up to 20%).     

对比分析四维容积超声及彩色多普勒超声在胎儿肺静脉异位引流诊断中的应用

摘要 目的：对比分析四维容积超声及彩色多普勒超声在胎儿肺静脉异位引流（APVC）诊断中的应用价值。方法：采用回顾性分析方法,2019年1月到2022年1月选择在本院进行诊治的胎儿肺静脉异位引流孕妇60例作为研究对象,都给予四维容积超声及彩色多普勒超声,记录影像学特征并判断诊断价值。结果：在60例孕妇中,彩色多普勒超声检查判断为胎儿肺静脉异位引流51例,诊断敏感性为85.0 %;四维容积超声检查判断为胎儿肺静脉异位引流59例,诊断敏感性为98.3 %,四维容积超声检查对胎儿肺静脉异位引流的诊断敏感性明显高于彩色多普勒超声检查（P<0.05）。彩色多普勒超声检查与四维容积超声检查诊断的特异性都为100.0%。在60例孕妇中,判断为胎儿肺静脉异位引流心上型32例,心下型28例;心上型的肺静脉引流途径为肺静脉-垂直静脉-右上腔静脉22例、肺静脉-垂直静脉-左上腔静脉10例,心下型的肺静脉引流途径为肺静脉-垂直静脉-左头臂静脉-右上腔静脉6例、肺静脉-垂直静脉-门静脉22例。合并心脏畸形32例,合并畸形率为53.3 %;有51例孕妇终止妊娠,9例孕妇继续妊娠,其中8例未经治疗者新生儿期死亡,1例在3月龄死亡。结论：相对于彩色多普勒超声,四维容积超声在胎儿肺静脉异位引流诊断中的应用可提高诊断敏感性,可有效反映肺静脉回流情况,可指导临床进行早期干预。     

经阴道彩色多普勒超声诊断异位妊娠的临床价值分析

目的:探讨经阴道彩色多普勒超声诊断用于诊断异位妊娠的检出率与准确率,为其临床应用提供参考。方法:选取2016年1月-2017年12月我院收治的疑似异位妊娠患者174例,依据随机数字表方法将其分为观察组和参考组,每组87例。参考组应用经腹部彩色多普勒超声予以诊断,观察组采用经阴道彩色多普勒超声进行诊断,比较两组的检出率与准确率。结果:观察组检出率为96.5%,明显高于参考组(86.2%,P0.05);观察组的准确率达97.6%,明显高于参考组(85.7%,P0.05)。在对大病灶的诊断中,两组的诊断准确率比较差异无统计学意义(P0.05);在小病灶诊断中,观察组的诊断准确率为97.6%,明显高于参考组(76.9%,P0.05)。观察组在胎囊型和飘浮型中的诊断率均明显的高于参考组(P0.05);在包块型的诊断中,两组诊断准确率比较差异无统计学意义(P0.05)。结论:与经腹部彩色多普勒超声相比,经阴道彩色多普勒超声诊断应用于异位妊娠中具有较高的检出率与准确率,尤其针对一些较小的病灶诊断有优势。     

彩色多普勒超声用于评估妊娠高血压缺氧程度的临床价值

目的:探讨彩色多普勒超声用于评估妊娠高血压缺氧程度的临床价值。方法:将我院自2017年6月至2019年6月收治的妊娠高血压患者106例作为研究组及同期产检正常孕妇103例作为对照组,采用彩色多普勒超声检查仪监测两组孕妇的子宫动脉血流动力学情况,并分析新生儿的缺氧程度。结果:研究组孕妇脐血流搏动指数(pulsatility index,PI)、脐血流阻力指数(resistance index,RI)和脐动脉血流收缩期/舒张期(S/D)水平均明显高于对照组(P0.05),舒张早期切迹发生率为47.17%,亦明显高于对照组8.74%(P0.05)。研究组孕妇平均孕周、新生儿体重和体重指数均明显少于对照组(P0.05),其早产率为19.81%、剖宫产率为64.15%、胎儿窘迫发生率为15.09%,均明显高于对照组(5.83%、19.42%、4.85%,P0.05)。研究组中切迹组孕周、新生儿体重均明显小于非切迹组(P0.05)。研究组羊水异常发生率为16.00%,早产率为40.00%,新生儿窒息率为14.00%,胎儿窘迫发生率为26.00%,均明显高于对照组(5.36%、1.79%、1.79%、5.38%,P0.05)。结论:采用彩色多普勒超声仪检测孕妇子宫动脉血流频谱可作为了解子宫-胎盘-胎儿循环的检查方式,评估妊娠并发症的发生风险,监测胎儿宫内生长发育。     

A Novel Application of Musculoskeletal Ultrasound Imaging

Ultrasound is an attractive modality for imaging muscle and tendon motion during dynamic tasks and can provide a complementary methodological approach for biomechanical studies in a clinical or laboratory setting. Towards this goal, methods for quantification of muscle kinematics from ultrasound imagery are being developed based on image processing. The temporal resolution of these methods is typically not sufficient for highly dynamic tasks, such as drop-landing. We propose a new approach that utilizes a Doppler method for quantifying muscle kinematics. We have developed a novel vector tissue Doppler imaging (vTDI) technique that can be used to measure musculoskeletal contraction velocity, strain and strain rate with sub-millisecond temporal resolution during dynamic activities using ultrasound. The goal of this preliminary study was to investigate the repeatability and potential applicability of the vTDI technique in measuring musculoskeletal velocities during a drop-landing task, in healthy subjects. The vTDI measurements can be performed concurrently with other biomechanical techniques, such as 3D motion capture for joint kinematics and kinetics, electromyography for timing of muscle activation and force plates for ground reaction force. Integration of these complementary techniques could lead to a better understanding of dynamic muscle function and dysfunction underlying the pathogenesis and pathophysiology of musculoskeletal disorders.     

动态模式多普勒显示及其实验研究

动态模式多普勒仪是一种新型脑血流状况分析仪器。它采用波束方向上连续采样点的深度能量彩色编码直观地显示血流状况的二维信息，较业已成熟的经颅多普勒仪能够更加全面地获取和分析血流动力学参数，因而性能优越。本文结合经颅多普勒仪阐述动态模式显示的原理，对照频谱图介绍其显示方式和功能，并以显示实验来探索M-mode显示的实现方法。     

多层螺旋CT联合彩色多普勒超声对小儿先天性胆总管囊肿的诊断价值分析

摘要 目的：探讨多层螺旋CT（MSCT）联合彩色多普勒超声对小儿先天性胆总管囊肿（CCC）的诊断价值。方法：选取2018年1月～2021年12月来我院治疗的78例CCC患儿为研究对象,所有患儿均接受彩色多普勒超声检查及MSCT检查,以病理诊断结果为金标准,对比两种检查方法对CCC的诊断价值。结果：所有CCC患儿中均未出现肝门部纤维斑块（TC征）阳性、肝动脉内径增宽,33例出现囊肿内胆泥沉积和肝内胆管扩张,16例出现胆囊异常;囊肿长径、宽径分别为（5.41±0.60）cm、（3.26±0.38）cm,脾脏内径为（1.56±0.17）cm。所有患者的Todani分型结果显示：Ⅰ型67例,Ⅱ型2例,Ⅲ型2例,Ⅳ型5例,Ⅴ型2例。与病理学诊断结果对比,彩色多普勒超声对CCC患儿Todani分型有一定的诊断效能,对Ⅰ型、Ⅳ型、Ⅴ型的诊断准确率分别为83.33%、93.59%、93.59%（P＜0.05）。与病理学诊断结果对比,MSCT对CCC患儿Todani分型有较好的诊断效能,对Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型、Ⅴ型的诊断准确率分别为88.46%、89.74%、93.59%、94.87%、97.43（P＜0.05）。彩色多普勒超声联合MSCT检查的诊断准确率高达96.15%,明显高于两种方法单独应用（P＜0.05）。结论：不同Todani分型的CCC患儿具有不同的超声征象,彩色多普勒超声及MSCT对CCC患儿Todani分型均有一定的的诊断价值,且两者联合应用时诊断价值较高。     

彩色多普勒超声应用于乳腺癌诊断及其新辅助化疗疗效评价的临床价值研究

目的:探讨彩色多普勒超声对乳腺良恶性肿瘤的鉴别诊断价值以及其对乳腺癌患者新辅助化疗疗效的评估价值。方法:选取2017年1月到2018年11月期间在我院接受治疗的乳腺癌患者88例作为乳腺癌组,另选取同期在我院接受治疗的乳腺良性肿瘤患者60例作为良性对照组,良性对照组在治疗前,乳腺癌患者在化疗前后采用彩色多普勒超声进行检查,记录所有患者的二维超声表现、彩色多普勒超声表现。结果:乳腺癌组的形态不规则、边界不清晰、内部回声不均匀、后方回声异常的比例均高于良性对照组,差异有统计学意义(P<0.05),两组患者的血流分级分布情况整体比较差异有统计学意义(P<0.05),乳腺癌组的血流阻力指数(RI)高于良性对照组(P<0.05)。化疗后,治疗有效组的乳腺肿瘤体积小于治疗无效组,治疗有效组的形态不规则、边界不清晰、内部回声不均匀、后方回声异常的比例低于治疗无效组(P<0.05),治疗有效组的血流分级分布情况及RI与治疗无效组比较差异亦有统计学意义(P<0.05)。结论:彩色多普勒超声对乳腺良恶性肿瘤具有较高的鉴别诊断价值,同时也可用于乳腺癌患者新辅助化疗疗效的评估。     

Evaluation of antral follicle growth in the macaque ovary during the menstrual cycle and controlled ovarian stimulation by high‐resolution ultrasonography

To date, ultrasonography of monkey ovaries is rare and typically of low resolution. The objectives of this study were to use state‐of‐the‐art, high‐resolution, transabdominal ultrasonography with real‐time Doppler capabilities to: (1) determine whether one can reliably detect in real time the large dominant follicle, the corpus luteum (CL), and small (<2 mm) antral follicles on the ovaries of rhesus monkeys during the natural menstrual cycle; and (2) predict the follicular response of rhesus ovaries to controlled ovarian stimulation (COS) protocols. Rhesus monkeys were selected for transabdominal ultrasonography using a GE Voluson 730 Expert Doppler System at discrete stages of the menstrual cycle. Subsequently, serial ultrasound scanning was employed to observe growth of antral follicles and the CL. Finally, females were scanned to assess follicular growth during COS. The dominant structure and small antral follicles (<2 mm) were reliably visualized in real time. The follicle destined to ovulate could be identified by size differential by day 3 of the follicular phase. The number of small antral follicles present before onset of COS protocol correlated positively with the number of metaphase II‐stage oocytes collected after treatment. The results of this study demonstrate that the population dynamics of antral follicle pools can be noninvasively evaluated in monkeys during natural and pharmacologic ovarian cycles. Am. J. Primatol. 71:384–392, 2009. © 2009 Wiley‐Liss, Inc.     

四维彩超技术在筛查胎儿先天性心脏病的应用价值分析

目的:探讨四维彩超技术在筛查胎儿先天性心脏病的应用价值。方法:择取我院2012年3月至2014年3月收治的行产前筛查的300例产妇为研究对象,采用四维彩色多普勒超声择取心脏三血管、四腔观、肺动脉分叉、上下腔静脉回流、动脉导管弓、主动脉弓等常规切面,予以胎心各腔血流及胎心率等多项检测,对胎儿是否存在先心病进行综合诊断,并综合胎儿大体解剖状况,与病理诊断及二维超声检查结果进行对比。结果:四维彩超检出率为6.67%,正确率为90.00%;二维超声检出率为6.00%,正确率为83.33%,两组比较差异具有统计学意义(P0.05)。结论:四维彩超技术在筛查胎儿先天性心脏病中具有至关重要的应用价值,有助于指导胎儿先天性心脏病早期治疗,保证患儿预后,值得临床借鉴。     

健康体检人群甲状腺结节多普勒超声检查结果及影响因素分析

目的:研究健康体检人群甲状腺结节多普勒超声检查结果及影响因素。方法:将从2018年1月~2019年12月,于医院接受体检的健康体检人员5270例纳入研究,对所有受试者均进行多普勒超声检查,分析超声检查结果和体检人群基线资料的关系,分析甲状腺结节多普勒超声特征。采用单因素以及多因素Logistic回归分析健康体检人群甲状腺结节的影响因素。结果:在5270例健康体检人群中,甲状腺结节检出率为51.86%(2733/5270),女性甲状腺结节检出率为52.83%(2355/4458),高于男性的46.55%(378/812),且随着年龄的不断增长,健康体检人群甲状腺结节检出率呈逐渐升高趋势(均P<0.05)。甲状腺结节患者的多普勒超声检查特征以低回声以及结节直径<2 cm为主(均P<0.05),但是结节数目以及病变部位比较无明显差异(均P>0.05)。经单因素分析发现:吸烟、甲状腺疾病家族史、高血压及糖尿病的健康体检人员甲状腺结节检出率高于不吸烟、无甲状腺疾病家族史、无高血压及无糖尿病的健康体检人员(均P<0.05),而不同民族、受教育年限、体质量指数(BMI)、是否饮酒的健康体检人员甲状腺结节检出率比较无统计学差异(均P>0.05)。经多因素Logistic回归分析发现:女性、年龄、吸烟、甲状腺疾病家族史、高血压及糖尿病均是健康体检人群甲状腺结节发生的独立危险因素(均OR>1,P<0.05)。结论:甲状腺结节多普勒超声检查特征以低回声以及结节直径≤2 cm为主,其影响因素包括年龄、性别、吸烟、甲状腺疾病家族史、高血压及糖尿病,值得临床重点关注。