瞬时弹性成像对慢性乙肝肝纤维化诊断的研究

目的:探讨瞬时弹性成像(FibroScan)诊断慢性乙型肝炎肝纤维化的准确性。方法:选取慢性乙型肝炎患者289例,其中未做病理组198例,病理组91例,正常对照50例,病理组患者行病理肝纤维化检测,未做病理组患者检查B超,全部患者及正常对照应用FibroScan进行肝脏硬度检测(liver stiffness measurement,LSM)值测量。分析未做病理组慢乙肝组与正常对照组间及未做病理组慢乙肝组B超肝纤维化各级间LSM值的差异;病理慢乙肝组采用受试者工作特征(Receiver Operating haracteristic,ROC)曲线分析FibroScan诊断肝纤维化的准确性,并得出各期诊断界值;根据该诊断界值对未做病理慢乙肝组进行FibroScan肝纤维化分期,分析其与B超肝纤维化分级的一致性。结果:LSM值在未做病理慢乙肝组和正常对照组间及B超肝纤维化各级间差别显著(P0.05);其中病理组统计结果显示F1、F2、F3、F4期肝纤维化的ROC曲线下面积(Area under Receiver Operating Characteristic,AUROC)分别为0.726、0.847、0.806、0.864,诊断界值分别为6.5、7.4、10.1、17.0 kPa,敏感性分别为69.62%、68.33%、66.67%、72.22%,特异性分别为66.67%、87.10%、85.71%、91.78%;肝纤维化的FibroScan分期和B超分级具有一致性(Kappa值=0.366,P0.05)。结论:FibroScan对慢性乙型肝炎肝纤维化尤其是严重肝纤维化及肝硬化诊断准确性高,具有良好的临床应用价值。     

超声造影联合声辐射力脉冲成像鉴别诊断盆腔肿物的价值

目的:评价超声造影及声辐射力脉冲成像技术在诊断及鉴别诊断盆腔良恶性肿块性质中的优越性。方法:分析术前超声造影及声辐射力脉冲成像技术在48例盆腔肿块中的检查结果,探讨两种技术对于肿块性质判定的应用价值。结果:48例中,良性肿块28例,恶性肿块20例。超声造影、声辐射力脉冲成像技术与常规超声相比,诊断的敏感性、特异性、漏诊率、误诊率、诊断准确性等指标均有统计学差异(P0.05),两者联合应用组与常规超声组相比上述指标的统计学差异更加明显(P0.01),超声造影技术和声辐射力脉冲成像技术在判断肿块良恶性方面诊断的敏感性、特异性、漏诊率、误诊率、诊断的准确性没有统计学差异(P0.05);超声造影与声辐射力脉冲成像对盆腔良恶性肿块定性诊断与病理诊断具有一致性,两者联合具有更好的一致性(Kappa=0.8362,0.7126,0.9241)。良恶性盆腔肿块中,实性为主者ARFI值均高于囊实混合性者;实性为主和囊实混合性的恶性盆腔肿块ARFI值均高于良性盆腔肿块,差异有统计学意义(均P0.05)。结论:实时超声造影联合声辐射力脉冲成像技术较常规超声更具优势,可提高盆腔肿物诊断及鉴别诊断的准确性。     

超声弹性成像技术在前列腺癌诊断中的应用

超声弹性成像技术是一项新兴的超声成像方法,可通过分析不同组织间机械组织差异区分组织软硬度,早期主要应用于乳腺、甲状腺结节的区分和定性。随着科技的进步和医疗水平的提高,目前弹性成像技术可在二维声像图的基础上,对感兴趣区域进行定性诊断和定量分析,已逐步应用于医学各领域相关研究和临床疾病的鉴别诊断。本文介绍了弹性成像的基本原理和目前弹性成像技术在医学领域中的相关应用,叙述了前列腺癌的发展趋势和目前常用的筛查、诊断方法,详细阐述了弹性成像技术在前列腺癌诊断中的应用方法和现状,分析总结了弹性成像技术在前列腺癌诊断中的应用价值。运用弹性成像技术无创、经济便捷、实时动态、可重复性好等优点,联合前列腺癌相关筛查、诊断检查,可有效帮助早期诊断前列腺癌,减少前列腺穿刺术的针数,提高前列腺癌的检出率。     

声辐射力脉冲成像技术与尿beta2-微球蛋白检测联合诊断高尿酸肾病的临床研究

目的：探讨声辐射力脉冲成像(ARFI)技术与尿beta2- 微球蛋白(beta2-MG)检测联合诊断高尿酸肾病(HUAN)的临床价值。方法：回 顾性分析和比较192 例原发性高尿酸血症患者(PHUA 组)、162 例HUAN患者(HUAN 组)和360例健康体检者(对照组)的血尿酸 (UA)、血尿素氮(BUN)、血肌酐(Cr)及尿beta2-MG 水平、二维超声检测结果及ARFI 技术检测的肾皮质、髓质和肾窦SWV 值,分析 HUAN患者的SWV 值与临床分期的相关性,其肾实质、肾窦SWV 值与尿beta2-MG 水平的相关性。结果：162 例HUAN 患者中,肾 实质回声增强76 例(46.91%),肾窦增宽89 例(54.94%),肾皮质髓质结石49 例(30.25%);192 例PHUA患者和360 例健康体检者 肾皮质和髓质回声均无明显异常,肾窦结石分别为3 例(0.83%)和5 例(2.60%)。HUAN 组肾皮质、髓质和肾窦SWV 值分别为 3.32± 0.45 m/s、3.02± 0.51 m/s和1.58± 0.45 m/s;PHUA组分别为2.92± 0.64 m/s、2.51± 0.51 m/s 和1.41± 0.35 m/s;对照组分别 为2.73± 0.58 m/s、2.26± 0.43 m/s和1.21± 0.21 m/s;三组SWV 值均为肾皮质> 肾髓质>肾窦(P<0.05)。HUAN组尿beta2-MG 水平 明显高于PHUA 组和对照组(P<0.05)。HUAN组尿beta2-MG 水平与肾实质SWV 值呈线性正相关(r=0.442,P<0.001),而与肾窦呈零 相关性(r=0)。Ⅰ、Ⅱ、Ⅲ期HUAN患者肾皮质SWV 值比较无明显差异(P>0.05),Ⅱ-Ⅴ期肾髓质、肾窦SWV 值均高于Ⅰ期(P<0. 05);Ⅳ、Ⅴ期肾皮质SWV值高于Ⅲ期(P<0.001)。结论：HUAN 患者在BUN和Cr升高之前,ARFI技术的SWV 值和尿beta2-MG 水 平均显著升高。ARFI技术联合尿beta2-MG 检测可作为评估肾实质组织弹性硬度及诊断早期HUAN 的重要方法.     

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。     

弹性成像技术在子宫肌瘤射频治疗中的应用价值

目的:探讨实时超声弹性成像(Real-time ultrasound elastography,RTE)在子宫肌瘤射频消融治疗(radiofrequency ablation,RFA)中的应用价值。方法:对34例行RFA治疗的子宫肌瘤患者(共38个病灶)于术前、术后1小时、术后3个月进行阴式超声、RTE及超声造影(contrast-enhanced ultrasonography,CEUS)检查。在2D、RTE、CEUS三种条件下分别测量病灶的直径。分析术前弹性图特征并分组,测量病灶弹性应变比率(E/E_0),对比分析组间、组内的E/E_0。比较2D、RTE、CEUS条件下病灶直径之间的差异。术后以弹性图像上病灶显示蓝绿相间为判定消融不全的标准,与CEUS对比,分析RTE与CEUS对消融程度评估的一致性。结果:根据术前肌瘤弹性图像将病灶分为蓝色组8个(21.1%),蓝色为主组20个(52.6%),绿色为主组10个(26.3%),术前3组病灶之间E/E_0差异明显,术后1小时、术后3个月E/E_0差异无统计学意义(P0.05),组内RFA术后1小时、3个月病灶E/E_0较术前明显增大,术后3个月E/E_0大于术后1小时(P0.05);术前RTE检测病灶直径大于2D及CEUS(P0.05),术后1小时2D测量直径大于RTE及CEUS(P0.05),三种成像技术在术后3个月测量病灶直径差异无统计学意义(P0.05);RFA术后1小时及术后3个月RTE对病灶消融程度评估结果与CEUS基本一致,Kappa值分别为0.46、0.54。结论:RFA术后肌瘤逐步变硬,RTE检查能够反映这种硬度变化,并且能够评估消融病灶的范围并预估消融程度,因此RTE在子宫肌瘤RFA治疗中有一定的应用价值。     

实时组织弹性成像在评价肝脏肿瘤中的初步应用

目的:探讨实时组织弹性成像对肝肿瘤诊断及鉴别诊断中的价值.方法:用弹性成像技术对51例共67个肝实性占位性病变进行良恶性的鉴别诊断,并与病理结果进行对照.结果:(1)弹性成像诊断恶性肿瘤的敏感度为80%,特异度为95.5%,阳性预测值为97.3%.阴性预测值为70%;(2)弹性成像诊断≤ 2cm的恶性肿瘤的准确性较高.结论:实时组织弹性成像有助于肝良恶性肿瘤的鉴别,并对≤ 2cm的病灶诊断准确率较高.     

超声弹性成像诊断甲状腺结节的价值

目的:研究弹性成像诊断甲状腺结节过程中的价值应用。方法:选取本院自2012年1月~2013年12月间进行甲状腺超声诊断66例患者进行研究,将66例患者按照切面的方式不同分为纵向切面超声弹性和横切面超声弹性图,另外依据甲状腺的恶性肿瘤诊断标准对病理结果进行对比分析。结果:对于超声的弹性纵切面诊断敏感性为100%,诊断的准确性为80.3%,特异性为84.9%;相对应的横切面诊断的敏感性为100%,准确性为77.2%,特异度为86.2%,因此对于甲状腺横切面和纵切面的诊断上无显著性差异(P>0.05),无统计学意义。结论:利用超声弹性成像诊断,在甲状腺结节的诊断中具有很大的应用价值,而且采用超声诊断,有助于提高诊断者的自信心,值得临床的应用和推广。     

超声弹性成像技术对腋窝淋巴结性质的诊断价值

目的:研究超声成像技术对腋窝淋巴结性质的诊断价值。方法:从2013年5月至2014年2月,选择我院50例乳腺癌患者,对所有患者进行弹性成像技术检测出74个腋窝淋巴结。对所有腋窝淋巴结使用四分法进行评分,将其与手术病理结果进行比较。结果:74个腋窝淋巴结中,反应性淋巴结有42个,纵径为(0.9-2.4)cm,平均纵径为(1.31±0.33)cm;乳腺癌腋窝淋巴结转移个数为25个,纵径为(1.2±3.8)cm,平均纵径为(2.04±0.72)cm。良性淋巴结弹性评分大多为1分(54.55%)以及2分(27.27%),恶性淋巴结评分多为3分(63.33%)以及4分(20.00%)。恶性淋巴结评分为(3.12±0.61)分,良性淋巴结评分为(1.68±0.74)分,结果显示,两组淋巴结弹性评分具有较大差异(即P<0.05),具有可比性。结论:综上所述,超声弹性成像技术操作较为简便,效果较为直观,评分法能够提供组织的硬度信息,在临床工作中,与常规超声联合应用有利于提高评价腋窝淋巴结良恶性性质的准确度。值得临床推荐使用。     

瞬时弹性成像技术对非酒精性单纯性脂肪肝的诊断价值及受控衰减系数与糖脂代谢的相关性分析

目的:探讨瞬时弹性成像技术(FibroTouch)对非酒精性单纯性脂肪肝(NAFLD)的诊断价值及受控衰减系数(CAPTM)与糖脂代谢的相关性分析。方法:选取2017年8月~2019年8月期间本院收治的NAFLD患者117例为研究对象,纳入实验组,另选同期在我院进行健康体检的健康受试者80例为对照组。对实验组患者和对照组受试者进行FibroTouch检查、腹部彩色多普勒超声检查、糖脂代谢指标生化检查。对比两组受试者的糖脂代谢指标水平、CAPTM水平、FibroTouch检查与彩色多普勒超声检查诊断NAFLD的准确率,分析CAPTM水平与糖脂代谢指标水平的相关性。结果:实验组空腹血糖(FPG)、糖化血红蛋白(HbA1C)、空腹胰岛素(FINS)水平均高于对照组(P<0.05)。实验组甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、载脂蛋白A(apoA)、CAPTM水平均高于对照组(P<0.05)。FibroTouch检查NAFLD的准确率高于彩色多普勒超声检查(P<0.05)。经Pearson相关性分析显示,CAPTM与各项糖脂代谢指标均呈正相关性(P<0.05)。结论:相比于彩色多普勒超声检查,FibroTouch用于NAFLD的诊断准确率更高,FibroTouch检查参数CAPTM与糖脂代谢指标存在明显的相关性,可辅助用于NAFLD的诊断和病情评估。     

Acoustic Radiation Force Impulse Imaging for Noninvasive Evaluation of Renal Parenchyma Elasticity: Preliminary Findings

Objective

To evaluate the diagnostic value of acoustic radiation force impulse (ARFI) to test the elasticity of renal parenchyma by measuring the shear wave velocity (SWV) which might be used to detect chronic kidney disease (CKD).

Methods

327 healthy volunteers and 64 CKD patients were enrolled in the study. The potential influencing factors and measurement reproducibility were evaluated in the healthy volunteers. Correlations between SWV and laboratory tests were analyzed in CKD patients.?Receiver-operating characteristic curve (ROC) analyses were performed to assess the diagnostic performance of ARFI.

Results

The SWV of healthy volunteers correlated significantly to age (r = −0.22, P<0.001, n = 327) and differed significantly between men and women (2.06±0.48 m/s vs. 2.2±0.52 m/s, P = 0.018, n = 327). However, it did not correlate significantly to height, weight, body mass index, waistline, kidney dimension and the depth for SWV measurement (n = 30). Inter- and intraobserver agreement expressed as intraclass coefficient correlation were 0.64 (95% CI: 0.13 to 0.82, P = 0.011) and 0.6 (95% CI: 0.31 to 0.81, P = 0.001) (n = 40). The mean SWV in healthy volunteers was 2.15±0.51 m/s, while was 1.81±0.43 m/s, 1.79±0.29 m/s, 1.81±0.44 m/s, 1.64±0.55 m/s, and 1.36±0.17 m/s for stage 1, 2, 3, 4 and 5 in CKD patients respectively. The SWV was significantly higher for healthy volunteers compared with each stage in CKD patients. ARFI could not predict the different stages of CKD except stage 5. In CKD patients, SWV correlated to e-GFR (r = 0.3, P = 0.018), to urea nitrogen (r =  −0.3, P = 0.016), and to creatinine (r =  −0.41, P = 0.001). ROC analyses indicated that the area under the ROC curve was 0.752 (95% CI: 0.704 to 0.797) (P<0.001). The cut-off value for predicting CKD was 1.88 m/s (sensitivity 71.87% and specificity 69.69%).

Conclusion

ARFI may be a potentially useful tool in detecting CKD.     

Evaluation of Transient Elastography,Acoustic Radiation Force Impulse Imaging (ARFI), and Enhanced Liver Function (ELF) Score for Detection of Fibrosis in Morbidly Obese Patients

Background

Liver fibrosis induced by non-alcoholic fatty liver disease causes peri-interventional complications in morbidly obese patients. We determined the performance of transient elastography (TE), acoustic radiation force impulse (ARFI) imaging, and enhanced liver fibrosis (ELF) score for fibrosis detection in bariatric patients.

Patients and Methods

41 patients (median BMI 47 kg/m²) underwent 14-day low-energy diets to improve conditions prior to bariatric surgery (day 0). TE (M and XL probe), ARFI, and ELF score were performed on days -15 and -1 and compared with intraoperative liver biopsies (NAS staging).

Results

Valid TE and ARFI results at day -15 and -1 were obtained in 49%/88% and 51%/90% of cases, respectively. High skin-to-liver-capsule distances correlated with invalid TE measurements. Fibrosis of liver biopsies was staged as F1 and F3 in n = 40 and n = 1 individuals. However, variations (median/range at d-15/-1) of TE (4.6/2.6–75 and 6.7/2.9–21.3 kPa) and ARFI (2.1/0.7–3.7 and 2.0/0.7–3.8 m/s) were high and associated with overestimation of fibrosis. The ELF score correctly classified 87.5% of patients.

Conclusion

In bariatric patients, performance of TE and ARFI was poor and did not improve after weight loss. The ELF score correctly classified the majority of cases and should be further evaluated.     

超声辐射力成像评估食管静脉曲张程度及出血风险的价值

摘要 目的：探究超声辐射力成像（acoustic radiation force impulse,ARFI）在评估食管静脉曲张（esophageal varices,EV）程度以及出血风险中的应用价值。方法：选择2018年1月至2020年1月于我院接受治疗的82例肝硬化患者,均对其开展ARFI、胃镜与血清学实验室检测,记录患者的肝、脾剪切波速度值（SWV _L 、SWV _S ）,参考胃镜检测结果将患者区分为EV组（61例）和无EV组（21例）,再根据胃镜结果将EV组区分为轻度（EV-G1,20例）、中度（EV-G2,21例）和重度（EV-G3,20例）,比较分析EV组与无EV组、不同EV病变程度组间的SWV _L 、SWV _S 差异;将患者根据食管静脉曲张出血（esophageal variceal bleeding,EVB）风险区分为低风险组（27例）和高风险组（34例）,对比低风险和高风险患者SWV _L 、SWV _S 差异;最后探究ARFI在评估EVB中的临床价值。结果：（1）比较显示EV组的SWV _L 、SWV _S 、血清总胆红素、白蛋白、凝血酶原时间等与无EV组差异明显（P<0.05）;（2）组间比较不同EV病变程度患者SWV _S 、血清总胆红素、白蛋白、凝血酶原时间差异明显（P<0.05）;（3）低风险组与高风险组患者间SWV _S 、血清总胆红素、白蛋白、凝血酶原时间差异明显（P<0.05）;（4）相关性分析SWV _S 与EV分级呈正相关（P<0.05）,SWV _S 对EVB诊断AUC为0.9622,95 % CI为0.9141-1.000（P<0.001）;结论：超声辐射弹力成像在评估食管静脉曲张程度以及出血风险中应用价值较高,其中SWV _S 诊断出血风险较为敏感,可将其应用于指导患者临床治疗和预后评估中。     

Acoustic radiation force optical coherence elastography for evaluating mechanical properties of soft condensed matters and its biological applications

Evaluating mechanical properties of biological soft tissues and viscous mucus is challenging because of complicated dynamic behaviors. Soft condensed matter models have been successfully used to explain a number of dynamical behaviors. Here, we reported that optical coherence elastography (OCE) is capable of quantifying mechanical properties of soft condensed matters, micellar fluids. A 7.5 MHz focused transducer was utilized to generate acoustic radiation force exerted on the surface of soft condensed matters in order to produce Rayleigh waves. The waves were recorded by optical coherence tomography (OCT). The Kelvin‐Voigt model was adopted to evaluate shear modulus and loss modulus of soft condensed matters. The results reported that various concentrations of micellar fluids can provide reasonable ranges of elasticity from 65.71 to 428.78 Pa and viscosity from 0.035 to 0.283 Pa·s, which are close to ranges for actual biological samples, like mucus. OCE might be a promising tool to differentiate pathologic mucus samples from healthy cases as advanced applications in the future.     

Effects of Low‐Intensity Microwave Radiation on Oxidant‐Antioxidant Parameters and DNA Damage in the Liver of Rats

The continuously increasing usage of cell phones has raised concerns about the adverse effects of microwave radiation (MWR) emitted by cell phones on health. Several in vitro and in vivo studies have claimed that MWR may cause various kinds of damage in tissues. The aim of this study is to examine the possible effects of exposure to low‐intensity MWR on DNA and oxidative damage in the livers of rats. Eighteen Sprague–Dawley male rats were divided into three equal groups randomly (n = 6). Group 1 (Sham‐control): rats were kept under conditions the same as those of other groups, except for MWR exposure. Group 2: rats exposed to 1800 MHz (SAR: 0.62 W/kg) at 0.127 ± 0.04 mW/cm² power density, and Group 3: rats exposed to 2,100 MHz (SAR: 0.2 W/kg) at 0.038 ± 0.03 mW/cm² power density. Microwave application groups were exposed to MWR 2 h/day for 7 months. At the end of the exposure period, the rats were sacrificed and DNA damage, malondialdehyde (MDA), 8‐hydroxydeoxyguanosine (8‐OHdG), and total oxidant‐antioxidant parameter analyses were conducted in their liver tissue samples. It was found that 1800 and 2100 MHz low‐intensity MWR caused a significant increase in MDA, 8‐OHdG, total oxidant status, oxidative stress index, and comet assay tail intensity (P < 0.05), while total antioxidant status levels (P < 0.05) decreased. The results of our study showed that whole‐body exposure to 1800 and 2100 MHz low‐intensity MWR emitted by cell phones can induce oxidative stress by altering oxidant‐antioxidant parameters and lead to DNA strand breaks and oxidative DNA damage in the liver of rats. Bioelectromagnetics. 2021;42:76–85. © 2020 Bioelectromagnetics Society     

Effects of Pillar Height and Junction Depth on the Performance of Radially Doped Silicon Pillar Arrays for Solar Energy Applications

The effects of pillar height and junction depth on solar cell characteristics are investigated to provide design rules for arrays of such pillars in solar energy applications. Radially doped silicon pillar arrays are fabricated by deep reactive ion etching of silicon substrates followed by the introduction of dopant atoms by diffusion from a phosphorus oxide layer conformally deposited by low‐pressure chemical vapor deposition. Increasing the height of the pillars has led to doubling of the efficiency from 6% for flat substrates to 12% for 40 μm high pillars with a 900 nm junction depth because of an increase in the total junction area and lower optical reflection. For higher pillars, the current density and efficiency is decreased, which is attributed to the increasing presence of defect states at the surface introduced during the etching process. This effect can be counteracted by an Al₂O₃ passivation layer on the pillar surface. An optimum efficiency of 13% is found for a junction depth of 790 nm for 40 μm pillar height. At increased junction depths, the efficiency is decreased due to the ever thinner undoped core of the pillars, causing pillars with a large junction depth to become less efficient than flat silicon substrates.     

Effects of UV‐A Radiation on Desmodesmus armatus: Changes in Growth Rate,Pigment Content and Morphological Appearance

Laboratory cultures of Desmodesmus armatus (R. Chod. ) Hegew. were grown under different levels of photosynthetically active radiation (PAR) supplemented with 3.75 mW · cm^–2 UV‐A radiation. Growth rate was monitored daily, chlorophyl‐a concentration, total carotenoid content, cell number and the relative abundance of different coenobial forms was determined at the end of each experiment. Exposure to UV‐A radiation resulted in an increasing inhibition of growth towards higher PAR levels, reaching 100% at 400 µmol · m^–2 · s^–1. Cellular carotenoid content was higher in the presence of UV‐A radiation, on the other hand no differences were observed in cellular chlorophyll‐a concentration. UV‐A radiation also induced changes in coenobium formation with a decreasing proportion of 4‐celled coenobia and an increase in the abundance of 2‐celled and teratologic coenobia, suggesting that high intensity UV‐A radiation may influence cell cycle events or morphology development. (© 2006 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)