MRI与彩色多普勒超声对乳腺癌的诊断价值

目的探讨彩色多普勒超声（US）与磁共振（MRI）对乳腺癌的诊断价值。方法对71例乳腺肿块病人均行US及MRI检查[平扫（TR 9 145ms,TE 75ms,TI 150ms,层厚2.8mm,FOV 320mm×320mm,矩阵256mm×512mm）、动态增强扫描（TR 12mm,TE 4.6mm,层厚1.8mm,翻转角25°,FOV 320mm×320mm,矩阵512mm×512mm）],图像处理后结合血流动力学进行分析。结果 71例病人行US联合MRI检查的乳腺癌正确率明显高于行US和MRI检查（93.0%vs 78.9%、88.7%,P〈0.05）。71例病人行MRI检查的特异度明显高于行US检查（88.0%vs 64.0%,P〈0.05）、误诊率明显低于行US检查（12.0%vs 36.0%,P〈0.05）,71例病人行US联合MRI检查的敏感度、特异度、准确率均明显高于US、MRI检查（95.7%、88.0%、93.0%vs 87.0%、64.0%、78.9%、89.1%、88.0%、88.7%,均P〈0.05）、误诊率、漏诊率均明显低于行US检查（12.0%、4.3%vs36.0%、13.0%,均P〈0.05）。结论 US联合MRI对乳腺癌的诊断具有较高的特异度和准确率,并可早发现、早诊断乳腺癌,对临床治疗方案的选择提供依据。     

声触诊组织定量技术在甲状腺弥漫性病变诊断中的应用

目的探讨声触诊组织定量（virtual touch quantification,VTQ）技术对甲状腺弥漫性病变的诊断价值。方法应用VTQ技术对20例正常甲状腺者（正常对照组）和85例甲状腺弥漫性病变患者（病例组）进行检测,同时采用VTQ分析软件计算组织弹性顺应力的横向剪切波速度,分析甲状腺弥漫性病变的VTQ相关数据。结果正常对照组（正常甲状腺）横向剪切波速度值为（1.54±0.42）m.s-1,病例组中的单纯性甲状腺肿横向剪切波速度值为（1.83±0.31）m.s-1,甲状腺功能亢进横向剪切波速度值为（1.96±0.53）m.s-1,亚急性甲状腺炎横向剪切波速度值为（2.34±0.24）m.s-1,甲状腺功能减低横向剪切波速度值为（3.34±0.12）m.s-1,桥本甲状腺炎横向剪切波速度值为（3.83±0.37）m.s-1。病例组中的单纯性甲状腺肿、甲状腺功能亢进、亚急性甲状腺炎、甲状腺功能减低、桥本甲状腺炎横向剪切波速度值与正常对照组比较差异均有统计学意义（均P〈0.05）,单纯性甲状腺肿横向剪切波速度值与甲状腺功能亢进比较差异无统计学意义（P〉0.05）,甲状腺功能减低、亚急性甲状腺炎、桥本甲状腺炎横向剪切波速度值与单纯性甲状腺肿、甲状腺功能亢进比较差异均有统计学意义（均P〈0.05）,甲状腺功能减低、亚急性甲状腺炎横向剪切波速度值与桥本甲状腺炎比较差异均有统计学意义（P〈0.01）。结论 VTQ技术在甲状腺弥漫性病变的诊断和鉴别诊断中具有较高的临床参考价值。     

Changes in cisternal udder compartment induced by milking interval in dairy goats milked once or twice daily

Fourteen Murciano-Granadina dairy goats were used to evaluate udder compartments (cisternal and alveolar) and cisternal recoil after an oxytocin (OT) challenge at different milking intervals (8, 16, and 24 h) during wk 7 of lactation. Goats were milked once (1x; n = 7) or twice (2x; n = 7) daily from wk 2 of lactation. Average milk yields for wk 4 and 8 were 1.76 and 2.24 L/d, for goats milked 1x and 2x, respectively. For each half udder, cisternal area was measured by ultrasonography and cisternal milk was measured by machine milking after i.v. injection of an OT receptor blocking agent. Alveolar milk was then obtained after i.v. injection of OT. Regardless of milking frequency, alveolar milk increased from 8 to 16 h after milking, but did not change thereafter. Cisternal area and cisternal milk increased linearly (R2 = 0.96 to 0.99) up to 24 h, indicating continuous milk storage in the cistern at any alveoli filling degree. Cisternal to alveolar ratio increased with milking interval (from 57:43 to 75:25), but differences between milking intervals were significant at 8 h only, at which time goats milked 2x showed a greater ratio (1x = 51:49; 2x = 62:38). Despite extended milking intervals, cisterns of goats milked 1x did not become larger than cisterns of goats milked 2x after 5 wk of treatment. The highest correlation between cisternal area and cisternal milk was detected at 8 h after milking (r = 0.74). Primiparous goats had smaller cisternal areas and less cisternal milk than multiparous goats at all milking intervals. Cisternal recoil was studied in a sample of multiparous goats milked 1x (n = 4) and 2x (n = 4) by scanning cisterns by ultrasonography at 0, 5, 15, and 30 min after an OT challenge for each milking interval. Cisternal area increased after OT injection for the 8- and 16-h milking intervals, but no differences were observed for the 24-h interval. Unlike cows, no changes in cisternal area were observed after OT injection, indicating the absence of cisternal recoil in goats. We conclude that goats show a large cisternal compartment that increases linearly after milking. Nevertheless, cisternal size did not increased after 1x milking, probably because of lesser milk yield. Multiparous goats had larger cisterns than primiparous goats and were able to store more milk in their cisterns at all milking intervals. Because of the high capacity of goat cisterns, no milk return from cistern to alveoli is expected if milking is delayed after milk letdown.     

Accuracy of a pregnancy-associated glycoprotein ELISA to determine pregnancy status of lactating dairy cows twenty-seven days after timed artificial insemination

To determine the accuracy of a pregnancy-associated glycoprotein (PAG) ELISA in identifying pregnancy status 27 d after timed artificial insemination (TAI), blood samples were collected from lactating Holstein cows (n = 1,079) 27 d after their first, second, and third postpartum TAI services. Pregnancy diagnosis by transrectal ultrasonography (TU) was performed immediately after blood sample collection, and pregnancy outcomes by TU served as a standard to test the accuracy of the PAG ELISA. Pregnancy outcomes based on the PAG ELISA and TU that agreed were considered correct, whereas the pregnancy status of cows in which pregnancy outcomes between PAG and TU disagreed were reassessed by TU 5 d later. The accuracy of pregnancy diagnosis was less than expected when using TU 27 d after TAI (93.7 to 97.8%), especially when pregnancy outcomes were based on visualization of chorioallantoic fluid and a corpus luteum but when an embryo was not visualized. The accuracy of PAG ELISA outcomes 27 d after TAI was 93.7, 95.4, and 96.2% for first, second, and third postpartum TAI services, respectively. Statistical agreement (kappa) between TU and the PAG ELISA 27 d after TAI was 0.87 to 0.90. Pregnancy outcomes based on the PAG ELISA had a high negative predictive value, indicating that the probability of incorrectly administering PGF_2α to pregnant cows would be low if this test were implemented on a commercial dairy.     

Cross‐sectional area calculation for arbitrary shape in the image using star algorithm with Green's theorem

Calculation of the cross‐sectional area is an important diagnostic tool in medical imaging modality. Curvature points arrangement (CPA) is an important step in the calculation, where the Star algorithm had been shown to be effective in segmenting the carotid artery. The algorithm however works under the assumption of circular or ellipsoid shapes, and the ability to determine its center of gravity is done by exploiting the features of equi‐space diameter of the circle. In this paper, a method of calculation of the cross‐sectional area of an arbitrary shape is discussed. The Star algorithm is modified to arrange the points of the object's edge through the CPA process in order to form a simple closed curve. Several rays are emanated from a point inside the region of interest with different angles to the far points within the segmented area. The cross‐sectional area is then calculated by using Green's theorem. To validate the concepts, several regular shaped images with different noise types (Gaussian, speckles, and salt and pepper) and ultrasound images are used in the experiments. The result shows that this method can calculate the cross‐sectional area with negligible error for an arbitrary object within the image and with different types of noises. © 2013 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc.     

彩色多普勒超声在乳腺肿瘤良恶性鉴别诊断中的价值

提取乳腺肿瘤多普勒超声图像的肿瘤血管区域,研究肿瘤内血流信号的丰富程度与肿瘤良恶性的关系,以及肿瘤的大小与血流信号检出率的关系。结合Hill-Climbing算法和K-means聚类算法对乳腺肿瘤彩色多普勒超卢图像进行分割,提取肿瘤血管区域。然后根据成像原卵和临』术知以没定三条准则统计肿瘤血管数日,以此判别乳腺肿瘤的良恶性。实验结果表明恶性肿瘤的血管丰富化程度高于良性,当选取肿瘤眦符数目临界值为5时,判别结果达到了70．16％。肿瘤内血管的丰富程度与肿瘤的尺寸成一定的正相关关系,即肿瘤越大,其内部血管越多．因此,血管的丰富程度能够反映良恶性乳腺肿瘤的病变情况,彩色多普勒超声对于鉴别乳腺肿瘤的良恶性是有效的。     

Using Doppler ultrasonography on day 34 of pregnancy to predict pregnancy loss in lactating dairy cattle

The objective of this experiment was to determine whether uterine or ovarian vascular dynamics could be used to identify cows at risk for pregnancy loss. Our hypothesis was that cows that subsequently lose their pregnancy will have decreased corpus luteal (CL) perfusion, or an increased resistance index (RI; reduced blood flow), or both, at d 34 of pregnancy. Day 34 was chosen because it is a common time for dairy cattle to be checked for pregnancy. This experiment was performed in 2 replicates from November 2011 to April 2012 (n = 69) and from November 2012 to April 2013 (n = 53). Cows were bred via timed artificial insemination using Ovsynch-56 and checked for pregnancy on d 32 after artificial insemination. At d 34, cows confirmed pregnant were examined via transrectal Doppler ultrasonography. Blood samples collected via coccygeal vein were used to measure circulating plasma progesterone concentrations. Diameter of the corpus luteum and crown-rump length were measured. Color power Doppler ultrasonography was used to determine vascular perfusion to the CL, and RI was measured for the uterine arteries just after branching from the umbilical artery. Records were later examined to identify pregnancy status of cows after reconfirmation. Abortion rate did not differ between replicates (11.6% in replicate 1, 9.4% in replicate 2). Mean crown-rump length of embryos that were carried to term was greater on d 34 than that in cows that aborted (14.23 ± 0.27 vs. 13.21 ± 0.53 mm). Circulating progesterone concentration at d 34 was greater for cows that carried pregnancies to term than for those that aborted (9.1 ± 0.7 vs. 7.5 ± 1.0 ng/mL). The final logistic regression model consisted of crown-rump length, progesterone concentration, and RI of the uterine artery contralateral to pregnancy. Decreased crown-rump length and progesterone concentration tended to be associated with increased odds ratio for pregnancy loss, whereas CL perfusion and uterine blood flow were not associated with increased odds ratio of pregnancy loss. In conclusion, examining CL perfusion and RI of the uterine arteries on d 34 of pregnancy does not offer a method to identify lactating Dairy cattle at risk for pregnancy loss after d 34.     

年轻乳腺恶性肿瘤患者的临床病理与超声声像图特征

目的 　总结年轻乳腺恶性肿瘤患者的临床病理特征及超声声像图特征。方法 　回顾性分析2007 年1 月至2008 年12月在本院进行手术并被病理证实为乳腺恶性肿瘤的40例年轻患者(≤35岁)的临床病理资料与超声影像资料。结果 　40例患者平均年龄（29.88±5.12）岁。14例患者（35%）有肿物短期内快速生长病史。3例患者为妊娠哺乳期乳腺癌。35例患者（共40个恶性病灶）接受超声检查，超声漏诊5个病灶，误诊4个病灶，31个病灶在术前超声诊断为恶性肿瘤，诊断准确率为77.5%。超声声像图主要表现为形态不规则（97.1%）、边界不清（82.9%）、内部回声不均匀（97.1%）、微小钙化常见（74.3%）、血流丰富（Ⅱ^Ⅲ级80.0%）。15例（37.5%）患者采用保乳术，4例（10.0%）采用乳房单纯切除术，21例（52.5%）采用乳腺癌改良根治术。病理类型以浸润性导管癌最常见，占67.5%（27/40）。22例（55%）患者有腋窝淋巴结转移。对40例患者平均随访（64.08±5.87）个月，8例（20%）患者出现复发或转移。平均复发时间为术后（17.17±12.02）个月。结论 　年轻乳腺恶性肿瘤患者的肿瘤复发率高，淋巴结转移率高，超声声像图表现多样。     

Renal cell carcinoma sharply captured by imaging technology at an early stage in a hemodialysis patient: Usefulness of noninvasive monochrome superb microvascular imaging

It has been drawing much attention that type 2 diabetes mellitus is closely associated with increased incidence of numerous cancers and their poor prognosis. Consequently, malignancy has been recently recognized as one of diabetic complications in addition to various conventional complications. Furthermore, it is well known that the prevalence of renal cell carcinoma (RCC) is drastically increased in hemodialysis (HD) patients. Therefore, screening of RCCs in HD patients is a very important and urgent issue as there are no highly sensitive tumor markers for RCCs. Monochrome superb microvascular imaging (mSMI) is a relatively new Doppler ultrasound technique and is useful especially when evaluating very slow blood flow state, because this allows for imaging microvessels with low velocity in the absence of a contrast agent. Thus, mSMI might be also useful when contrast enhancement is not obvious on CT and/or contrast-enhanced ultrasonography using perflubutane or contrast agents are contraindicated. Moreover, it has been reported that mSMI could effectively detect vascularity of renal malignant tumor than benign renal mass in nondialysis patients. We propose that mSMI of ultrasonography could become one of the very useful methods for detecting RCCs at an early stage with high sensitivity in HD patients.     

The influence of 3 different navel dips on calf health,growth performance,and umbilical infection assessed by clinical and ultrasonographic examination

The objectives were to investigate the effect of 3 navel dips on (1) umbilical infection, (2) health events (pneumonia, diarrhea, and arthritis), and (3) average daily gain (ADG) in newborn dairy calves. A secondary aim was to compare the agreement of standardized ultrasonographic examination with clinical examination for the diagnosis of umbilical infection. In a randomized block design, newborn calves were assigned by birth order to 3 treatment groups: Navel Guard (NG; SCG-Solutions Inc., McDonough, GA), 7% iodine tincture (SI), and 2% chlorhexidine gluconate (CH). Treatment consisted of a single dip administration of the umbilicus immediately after removal of the newborn from the calving pen with 1 of the 3 navel dips. Weekly clinical examinations were carried out during the first 4 wk of life with special attention being paid to the umbilicus, joints, respiratory tract, and fecal consistency, and included ultrasonographic evaluation of the umbilical structures. Body weight was assessed by using a girth tape at first and last evaluation. Multivariable logistic regression demonstrated no statistical differences in umbilical infection or health events. Multivariable linear regression analysis showed statistical differences in ADG (least squares means ± standard errors) between groups, with 494 ± 29, 571 ± 29, and 516 ± 29 g/d in groups NG, SI, and CH, respectively. Overall mortality during the study period was 9.5% (n = 40). Postmortem examination identified diarrhea (80%) as the main disorder with 19, 4, and 9 calves in groups NG, SI, and CH, respectively. Kappa values yielded fair [0.30 (95% CI: ?0.03–0.63)], good [0.61 (95% CI 0.46–0.75)], moderate [0.53 (95% CI 0.31–0.74)], and moderate [0.49 (95% CI 0.19–0.79)] agreement for detection of omphalitis between clinical and ultrasonographic evaluation in wk 1, 2, 3, and 4, respectively. Agreement was very good for detection of omphaloplebitis, with kappa values (95% CI) of 0.91 (0.80–1.00), 0.87 (0.75–0.98), and 0.90 (0.76–1.00) in wk 2, 3, and 4, respectively, when omphalophlebitis was diagnosed. We detected no difference in the effectiveness of the 3 treatments in the prevention of umbilical infection, pneumonia, diarrhea, or arthritis.