常规超声、实时组织弹性成像及应变率比值弹性成像鉴别诊断乳腺结节的比较研究

为探讨常规超声(US)、实时组织弹性成像(UE)及应变率比值弹性成像(SR)在乳腺结节良恶性鉴别诊断中的应用价值。采用回顾性分析95个乳腺结节的US、UE及SR图像方法。常规超声采用BI-RADS分类判断结节性质,UE采用5级评分法判断结节性质,SR测量结节与周围同一水平乳腺的应变率比值,利用ROC曲线比较常规超声、UE、SR的曲线下面积(AUC),判定诊断效能。结果显示,常规超声判断乳腺结节良恶性的敏感度、特异度、准确度分别为:81.7%(49/60)、80.0%(28/35)、81.1%(77/95)。UE判断乳腺结节良恶性的敏感度、特异度、准确度、分别为:86.7%(52/60)、80.0%(28/35)、84.2%(80/95)。良、恶性结节的SR平均值分别为(2.49±0.81)、(3.53±0.95),以3.14作为诊断良恶性结节的最佳截断值时,SR判断乳腺结节良恶性灵敏度、特异度、准确性分别为93.3%(56/60)、91.4%(32/35)、92.6%(88/95);US、UE、SR诊断乳腺良、恶性结节的曲线下面积AUC分别为0.808,0.833,0.924,差异有统计学意义(P=0.000)。由此可知,US、UE及SR均有助于鉴别诊断乳腺良、恶性结节,UE优于US,SR优于UE及US。     

弹性应变率比值法与声触诊组织量化技术对乳腺良恶性肿块的诊断价值

目的探讨超声弹性应变率(strain ratio,SR)比值法、声触诊组织量化(virtual touch tissue quantification,VTQ)技术)及两者联合对乳腺良恶性肿块的诊断价值。方法选取2017年10月-2018年4月因乳腺肿块在石河子大学医学院第一附属医院乳腺外科就诊并行手术切除的90例女性乳腺患者,共112个乳腺病灶,术前应用弹性应变率比值技术和VTQ技术检查,获得每个肿块的SR比值、剪切波速度(shear wave velocity,SWV)值,以手术的病理结果作为诊断标准,比较弹性应变率比值法、声触诊组织量化技术以及两者技术联合对乳腺良恶性肿块的诊断价值。结果以手术病理结果证实的112个乳腺肿块,78个为良性,34个为恶性。弹性应变率比值法(2.43±0.99 vs 5.36±1.93)及VTQ技术(3.30 m/s±1.75 m/s vs 8.75 m/s±1.08 m/s)诊断乳腺良恶性肿块有统计学差异(P均0.05)。SR比值(最佳截断值为3.10)诊断乳腺良恶性肿块的曲线下面积(area under the curve,AUC)、敏感性、特异性、准确性、阳性预测值(Positive Predictive values,PPV)、阴性预测值(negative Predictive values,NPV)分别为0.940、90%(70/78)、94%(32/34)、91%(102/112)、97%(70/72)、80%(32/40),SWV值(最佳截断值为5.13m/s)诊断乳腺良恶性肿块的曲线下面积(area under the curve,AUC)、敏感性、特异性、准确性、PPV、NPV分别为0.963、92%(72/76)、97%(33/34)、94%(105/112)、99%(72/73)、85%(33/39)。SR比值法与VTQ技术曲线下面积比较无统计学差异(Z=0.786,P0.05)。两者联合后诊断乳腺良恶性肿块敏感性、特异性、准确性、PPV、NPV分别为97%(73/75)、100%(37/37)、98%(110/112)、100%(73/73)、95%(37/39)。结论弹性应变率比值法和声触诊组织量化技术均对乳腺良恶性肿块有一定的诊断价值,弹性应变率比值法与声触诊组织量化技术对乳腺良恶性肿块的诊断价值相当,两者联合后可以提高对乳腺良恶性肿块的诊断。     

乳腺占位性病变采用超声成像诊断的价值研究

探究超声成像技术在乳腺占位性病变诊断中的应用价值。将2015年10月~2017年3月期间正宁县人民医院收治的乳腺占位性病变患者235例患者作为研究对象,共发现264个病灶。所有患者均进行超声弹性成像检查,将手术病理结果作为金标准,分析超声弹性成像诊断结果及诊断价值。金标准结果显示共264个病灶中,良性病变为197个,恶性病变为67个,超声弹性成像结果显示良性病变为193个,恶性病变为71个,良性准确率为97.41%(188/193),恶性准确率为87.32%(62/71),敏感度为95.43%(188/197),特异性为92.54%(62/67)。超声成像检测能较好地对乳腺占位性病变进行诊断,准确率、敏感度、特异性均较高,值得临床应用推广。     

超声弹性成像在BI-RADS Ⅲ级乳腺病变中的诊断价值

目的探讨超声弹性成像对BI-RADSⅢ级乳腺病变的临床诊断价值.方法选择137例患者的156个BIRADSⅢ级病灶,同时行超声弹性成像检查,依据TES超声弹性成像评分标准行弹性评分.结果 156个乳腺病灶中,恶性病灶为7个(4.49%),良性病灶为149个(95.51%).弹性成像4,5分组(高风险组)恶性发病率为11.76%(4/34),与总发病率比较显著增高(P0.05),弹性成像1,2,3分组(低风险组)恶性发病率为2.46%(3/122).弹性成像的敏感性为57.14%,特异性为79.87%,阳性预测值和阴性预测值分别为11.76%和97.54%.结论超声弹性成像能够为BI-RADSⅢ级病灶提供额外的诊断信息,使检查者鉴别出需要立即行活检的高风险组患者,可提高乳腺恶性病变的检出率.     

超声弹性成像对甲状腺良恶性结节鉴别诊断价值

探讨超声弹性成像在甲状腺良恶性结节鉴别诊断中的应用价值。将2015年3月~2016年10月期间于甘肃省高台仁济医院进行检查的甲状腺结节患者135例作为本次研究观察对象,所有患者均进行常规超声检查、超声弹性检查以及临床病理检查,将病理检查结果作为检验金标准,比较两种检查方法的良性预测值、恶性预测值、敏感度以及特异性。135例甲状腺结节患者病理检查结果显示良性结节114例,恶性结节21例,超声检查显示良性105例,恶性30例,超声弹性成像检查结果显示良性111例,恶性24例。两种检查方法良性预测值、恶性预测值、敏感度、特异性等各项结果比较,超声弹性成像检查均明显优于超声检查,差异具有统计学意义(P0.05)。应用超声弹性成像对甲状腺良恶性结节进行鉴别诊断,效果显著,准确性高,敏感度及特异性好,值得临床推广。     

声触诊组织量化技术在甲状腺癌诊断中的临床应用价值

探讨声脉冲辐射力(ARFI)声触诊组织量化(VTQ)技术定量的组织弹性参数剪切波速度(SWV)在甲状腺癌诊断中的应用。采用德国西门子公司S2000超声诊断仪,对83例患者共107个甲状腺疾病术前行常规高频超声和实时声辐射力脉冲成像(ARFI)技术检查,所有病变均检测其SWV值,以手术或穿刺活检后病理结果为金标准,分为良性及恶性病变。甲状腺良性和恶性病变的SWV平均值分别为(2.08±0.76)m/s(范围:0.59~9.00m/s)和(4.47±2.58)m/s(范围:2.3~9.00m/s),两组甲状腺病变的组织弹性参数剪切波速度比较差异有显著统计学意义(P0.05)。超声弹性成像ARFI技术对甲状腺良恶性病变的鉴别诊断有较大的应用价值,为早期诊断甲状腺癌提供新的参考指标。     

实时超声弹性成像对变性子宫肌瘤的诊断价值

目的:探讨实时超声弹性成像在变性子宫肌瘤诊断中的价值.方法:选取拟手术治疗的子宫肌瘤患者81例(116个肌瘤病灶)作为研究对象.术前采用实时超声弹性成像技术对子宫肌瘤进行评分,评分标准为1~5分.术后经病理检查判断肌瘤有无变性.将B超弹性图像评分与肌瘤病理检查有无变性的结果进行对比,并运用受试者工作曲线(ROC)曲线判断弹性成像评分的价值.结果:病理检查报告未变性子宫肌瘤97个(83.62%),其中93个超声弹性图像评分为4分(95.9%);变性子宫肌瘤19个(16.37%),其中13个(68.4%)超声弹性图像评分为2~3分,两组评分比较差异具有显著性意义(P0.05).以超声弹性评分4分作为判断子宫肌瘤未变性的标准其ROC曲线下面积为0.82,敏感性95.9%,特异性68.4%,准确性91.4%,以超声弹性评分≤3分作为判断子宫肌瘤变性的标准,其敏感性68.4%,特异性95.9%,准确性91.4%.结论:实时超声弹性成像评分≤3分可以作为判断子宫肌瘤变性的初步标准.     

不同超声成像技术在乳腺良恶性肿瘤鉴别诊断中的应用价值

探讨了BI—RADS分类法与超声弹性成像改良5分法、面积比法对乳腺良恶性病灶的鉴别诊断价值。对经手术病理证实的185例患者共196个病灶（良性146个,恶性50个）先进行BI—PADS分类,再进行超声弹性成像检查,以改良5分法对病灶进行评分;测量病灶在灰阶图及弹性图中的长径和面积,计算面积比,以病理诊断为金标准,构建受试者应用曲线,比较3种方法对乳腺肿物的诊断价值。BI—RADS分类法、改良5分法、面积比法对乳腺良恶性肿瘤进行鉴别诊断,其敏感性分别为57％、87％、89％,特异性分别为68％、89％、90％,准确性分别为73％、90％、89％,分别构建3种诊断标准的ROC曲线,BI—RADS分类法0．901,改良5分法为0．906,面积比法为0．959。超声弹性改良5分法与面积比法对乳腺肿物的诊断价值相似（P〉0．05）,而改良5分法、面积比法均优于BI—RADS分类法（P〈0．05）。超声弹性改良5分法和面积比法在乳腺良恶性肿瘤的鉴别诊断中具有较高的价值,其诊断的敏感性、特异性、准确性均高于BI—RADS分类法,而超声弹性改良5分法和面积比法对乳腺肿物的诊断价值相似。     

超声弹性成像与常规超声在甲状腺良恶性结节临床诊断中的对比分析

目的:分析超声弹性成像与常规超声在甲状腺良恶性结节临床诊断对比情况.方法:选取某院收治的78例甲状腺结节患者分为观察组和对照组.给予对照组常规超声检测,观察组在对照组的基础上实施超声弹性成像检测.结果:观察组检测误差为1例,检测准确率为94.11%,对照组检测误差为6例,检测准确率为64.71%,观察组高于对照组,差异具有统计学意义(P0.05).观察组特异性为93.24%,对照组特异性为75.61%,观察组与对照组在诊断检查结果对比上的差异具有统计学意义(P0.05).结论:通过对超声弹性成像与常规超声在甲状腺良恶性结节临床诊断中的对比研究,发现超声弹性成像能够提高甲状腺良恶性结节临床诊断的准确率,具有一定的临床应用价值.     

剪切波弹性成像联合超声加权评分法对乳腺肿块诊断的应用价值

目的:探讨剪切波弹性成像(SWE)联合超声加权评分法对乳腺肿块诊断的应用价值。方法:回顾性选取2018年5月至2020年5月本院收治的120例乳腺肿块患者作为研究对象，其中良性组62例，恶性组58例。两组均行乳腺常规超声和SWE检查，比较两组SWE最大值、SWE最小值、平均值和超声加权评分，并采用ROC曲线分析剪切波弹性成像评分联合超声加权评分法对乳腺肿块的诊断效能。结果:乳腺超声加权评分恶性组为(7.97±4.01)分，明显高于良性组(4.48±2.34)分(t=5.771,P<0.05);超声加权评分和SWE联合超声加权评分对乳腺肿块分级的诊断两组结果比较，差异无统计学意义(P>0.05)。SWE最大值、SWE平均值良性组低于恶性组(P<0.05);两组SWE最小值比较，差异无统计学意义(P>0.05);二元Logistic回归分析结果提示，SWE最大值、SWE平均值及超声加权评分均为乳腺良恶性肿块的影响因素(P<0.05);ROC曲线分析显示，联合SWE最大值、SWE平均值和超声加权评分法诊断乳腺肿块的AUC为0.931,高于超声加权评分法的0.76...     

Institutional experience of PTH evaluation on fine-needle washing after aspiration biopsy to locate hyperfunctioning parathyroid tissue

Assaying parathyroid hormone (PTH) in the washing liquid after fine-needle aspiration biopsy (FNAB) seems to be a valid approach to locate parathyroid tissue. PTH-FNAB was evaluated in 47 patients with a clinical picture of primary hyperparathyroidism (PHP) and ultrasonography (US) suggestive of parathyroid lesion. The patients were subdivided into two groups on the basis of the absence or presence of US thyroid alterations. The result of PTH-FNAB was compared with those of cytology, scintigraphy and, in 24 patients, surgical outcome. PTH-FNAB samples with a value higher than that recorded in the serum and higher than our institutional cut-off were deemed to be probable samples of parathyroid tissue. Cytology proved diagnostic for benign thyroid lesions, non-diagnostic for thyroid lesions, hyperplastic parathyroid tissue, undetermined or malignant thyroid lesions and other lesions in 45%, 30%, 17%, 4%, and 4% of cases, respectively. In 47% of cases, PTH-FNAB indicated that the sample had been taken in parathyroid tissue. In patients without US alterations, the diagnostic accuracy of PTH-FNAB was greater than that of scintigraphy. After surgery, comparison between the results of PTH-FNAB and scintigraphy, in terms of positive predictive value (PPV), revealed the superiority of PTH-FNAB; PPV was 94% for FNAB and 71% for scintigraphy, while sensitivity was 83% and 69%, respectively. PTH-FNAB evaluation after FNAB appears to be more diagnostic than cytology and scintigraphy. Of all the procedures used, PTH-FNAB appears to be the method of choice when the target is US suggestive and reachable. PTH-FNAB appears to be a useful method of guiding surgical intervention.     

Computer simulation on reliability of retention index with FDG–PET and optimization of dual-time-point imaging protocol

The inherent noise in positron emission tomography （PET） leads to the instability of quantitative indicators, which may affect the diagnostic accuracy for differentiating malignant and benign lesions in the management of lung cancer. In this paper, the reliability of retention index （RI） is systematically investigated by using computer simulation for the dual-time-point imaging protocol. The area under the receiver operating characteristic （ROC） curve is used to evaluate the optimal protocol. Results demonstrate that the reliability of RI is affected by several factors including noise level, lesion type, and imaging schedule. The RIs with small absolute values suffer from worse reliability than those larger ones. The results of ROC curves show that over delayed second scan cannot help to improve the diagnostic performance further, while an early first scan is expected. The method of optimization based on ROC analysis can be easily extended to comprise as many lesions as possible.     

Computer simulation on reliability of retention index with FDG-PET and optimization of dual-time-point imaging protocol

The inherent noise in positron emission tomography (PET) leads to the instability of quantitative indicators, which may affect the diagnostic accuracy for differentiating malignant and benign lesions in the management of lung cancer. In this paper, the reliability of retention index (RI) is systematically investigated by using computer simulation for the dual-time-point imaging protocol. The area under the receiver operating characteristic (ROC) curve is used to evaluate the optimal protocol. Results demonstrate that the reliability of RI is affected by several factors including noise level, lesion type, and imaging schedule. The Ris with small absolute values suffer from worse reliability than those larger ones. The results of ROC curves show that over delayed second scan cannot help to improve the diag- nostic performance further, while an early first scan is expected. The method of optimization based on ROC analysis can be easily extended to comprise as many lesions as possible.     

Computer simulation on reliability of retention index with FDG–PET and optimization of dual-time-point imaging protocol

The inherent noise in positron emission tomography (PET) leads to the instability of quantitative indicators, which may affct the diagnostic accuracy for diffrentiating malignant and benign lesions in the management of lung cancer. In this paper, the reliability of retention index (RI) is systematically investigated by using computer simulation for the dual-time-point imaging protocol. The area under the receiver operating characteristic (ROC) curve is used to evaluate the optimal protocol. Results demonstrate that the reliability of RI is a?ected by several factors including noise level, lesion type, and imaging schedule. The RIs with small absolute values su?er from worse reliability than those larger ones. The results of ROC curves show that over delayed second scan cannot help to improve the diagnostic performance further, while an early ?rst scan is expected. The method of optimization based on ROC analysis can be easily extended to comprise as many lesions as possible.     

Diagnosis of prostate cancer by quantitative analysis of 3DMRSI data: A new model

Prostatecancer (PC)hasthehighestmorbidityrateinmaleurinarysystemdisordersinEuropeandAmerica ,anditisoneoftheprimaryreasonsofmaledeath[1] .InChina ,althoughtheattackofPCisrela tivelylow ,ithasa growingtrendinrecent 10years[2— 4 ] .Inclinicalpractice ,magneticresonanceimaging (MRI)could providehighresolutionmor phologicalstructureandhasthecapabilityofmulti parameterimaging ,butitcannotreliablydifferentiatePCfrombenignprostatehyperplasia (BPH)andnor maltissues ,particularlyforthepatientswi…     

Diagnosis of prostate cancer by quantitative analysis of 3DMRSI data: A new model

Three-dimensional magnetic resonance spectroscopic imaging (3DMRSI) is helpful to identify prostate cancer (PC)from benign prostate hyperplasia (BPH) and to show the distribution of tumor infiltration. Combined with the (Cho + Cre)/Cit ratio, the z-score model can effectively discriminate prostate cancer from stromal benign prostate hyperplasia (sBPH) and detect small malignant lesions (SML).     

孤立性肺结节18F-FDG PET/CT影像学特点及临床分析刘晓飞1 张婷1 周晓红1 苏家贵1 何宝明1 王仲元2(解放军第三〇九医院核医学科1 ,北京 100091；解放军第三〇九医院结核病研究所2 ,北京 100091)

目的：探讨孤立性肺结节(SPN)的临床及影像学₁₈F-FDG PET/CT影像学特点。方法：回顾性分析2009 年07月至2015 年7月间的 102例孤立性肺结节(SPN)病例,搜集患者的性别、年龄、临床症状、实验室检查及影像学特点。结果：在102例病例中,70例确诊为肺癌,32例为良性病变,男 46例,女56例,平均年龄(58.0±11.5)岁,结节标准化摄取值(3.70±3.54)(SUVmax值),均经病理学诊断或者随访3年以上;₁₈F-FDG PET/CT检查的灵敏性、特异性、精确度分别为88.1%、85.7%、87.4%,SPN为肺癌结节中,年龄≥55较年龄＜55 的明显多,血清肿瘤标记物在良恶性结节中数据差异无统计学意义,SPN有无分叶、毛刺、空泡征、胸膜凹陷征在良恶性结节诊断中数据差异有统计学意义,FDG糖代谢比值(T/NT)良恶性数据差异无统计学意义。结论：通过对102例孤立性肺结节的临床及影像学₁₈F-FDG PET/CT影像学特点研究分析,表明₁₈F-FDG PET/CT影像学特点及临床表现对良恶性的诊断有重要参考价值,₁₈F-FDG PET/CT可为无法获得病理结果患者提供理想的诊断手段。     

回顾性分析红细胞分布宽度预测急性胰腺炎患者死亡的临床价值

目的回顾性分析红细胞分布宽度(RDW)与急性胰腺炎(AP)患者死亡率之间的关系,并评估RDW预测急性胰腺炎患者的死亡率情况.方法选取急性胰腺炎患者70例,收集并分析患者的临床资料和实验室指标,采用ROC曲线分析评估RDW值预测急性胰腺炎患者死亡率的能力.结果 RDW,Ranson评分是急性胰腺炎患者的死亡的独立危险因素(P0.05),其中RDW回归系数为0.703,OR为2.218(95%CI 0.961~4.243,P=0.041);RDW曲线下面积为0.719%(CI 0.599~0.820,P=0.024),最佳截断点为14.3,敏感性为87.5%,特异性为41.94%.结论红细胞分布宽度是一个新的、敏感度高的预测急性胰腺炎患者死亡率的指标.     

端面约束对岩样全部变形特征的影响

利用编制的计算平面应变压缩岩样轴向、侧向、体积应变及泊松比的FISH函数,采用FLAC模拟了端面约束对含缺陷岩样剪切带花样、全部变形特征及侧向位移分布的影响。在峰值强度之前及之后,岩石的本构模型分别取为线弹性及莫尔库仑剪破坏与拉破坏复合的应变软化模型。计算表明,端面约束对岩样的破坏模式及剪切带倾角没有明显的影响,以致于不影响应力．轴向应变曲线及应力-侧向应变曲线软化段的斜率。端面光滑时剪切带的扩展速度及泊松比高于端面粗糙时。端面光滑时的应力一轴向应变曲线、应力·侧向应变曲线、侧向应变-轴向应变曲线及体积应变．轴向应变曲线均在端面粗糙时下方。端面光滑时的岩样失稳破坏前兆比端面粗糙时更明显。无论端面粗糙与否,岩样侧面上各节点水平位移分布都是不均匀的。通常,端面光滑时的最大侧向位移高于端面粗糙时。当轴向应变较高时,端面光滑时的侧向位移分布与端面粗糙时类似（端面上的节点除外）,这反映了类似的破坏模式。