Purpose To evaluate the value of a combined model based on multiphase contrast-enhanced CT radiomics and clinical features for differentiating hypovascular pancreatic neuroendocrine tumors (hypo-PNETs) from pancreatic ductal adenocarcinoma (PDAC). Methods A total of 297 patients with pathologically confirmed pancreatic tumors, including 99 hypo-PNETs and 198 PDACs, were retrospectively enrolled. Radiomics features were extracted from non-contrast, arterial-phase, venous-phase, and combined three-phase CT images. After feature selection, radiomics models were established using multiple machine-learning classifiers. Independent clinical predictors were identified by logistic regression and integrated with the optimal radiomics signature to construct a combined model. Model performance was assessed using receiver operating characteristic analysis, calibration curves, decision curve analysis, net reclassification improvement, and integrated discrimination improvement. Results Pancreatic duct dilatation, tumor composition, age, and maximum tumor diameter were identified as independent predictors. Among the radiomics models, the combined three-phase SVM model achieved the best performance, with AUCs of 0.814 and 0.812 in the training and test sets, respectively. The combined model yielded the highest AUCs (0.886 in the training set and 0.849 in the test set); however, because several between-model comparisons in the test set did not reach statistical significance, its advantage should be interpreted as a potential incremental benefit rather than definitive superiority. Conclusion A combined model integrating multiphasic CT radiomics and clinical features showed promising performance for differentiating hypo-PNETs from PDAC. This model may provide complementary support for preoperative diagnosis, although its incremental value over the radiomics-only model requires further validation.
Objective:To analyze the changes in white matter volume of the temporal lobe subre-gions in patients with medial temporal lobe epilepsy with hippocampal sclerosis(MTLE-HS)by auto-matic brain segmentation technique(FreeSurfer)and to investigate its clinical application value in MTLE-HS.Methods:A total of 53 patients diagnosed with MTLE-HS through postoperative pathology or magnetic resonance imaging(MRI)from January 2021 to September 2023 were collected,including 30 patients with left MTLE-HS(LMTLE-HS)and 23 patients with right MTLE-HS(RMTLE-HS).Meanwhile,43 gender-and age-matched healthy controls were recruited.All participants underwent T1-weighted three-dimensional magnetization-prepared rapid acquisition gradient echo sequence(3D-T1 WI-MPRAGE)scanning on a 3.0T MR.The FreeSurfer software was used to perform whole-brain segmentation on the T1-MPRAGE images,and white matter volume data of the temporal lobe subre-gions(posterior superior temporal gyrus,temporal pole,superior temporal gyrus,middle temporal gy-rus,inferior temporal gyrus,fusiform gyrus and parahippocampal gyrus)were collected.Paired t-tests were used to compare the differences in white matter volumes of each subregion between the left and right temporal lobes in the control group.Independent samples t-tests were used to compare the differ-ences in white matter volumes of each temporal lobe subregion between the control group and the LM-TLE-HS and RMTLE-HS groups,as well as between the affected and unaffected sides within the LM-TLE-HS and RMTLE-HS groups.Results:There were statistically significant differences in white mat-ter volumes of the transverse temporal gyrus,superior temporal gyrus,middle temporal gyrus,inferior temporal gyrus,fusiform gyrus and parahippocampal gyrus between the left and right sides in the con-trol group(P＜0.05).Significant differences in white matter volumes were found in the affected side of the LMTLE-HS group compared to the left side of the control group(temporal pole,transverse temporal gyrus,superior temporal gyrus,middle temporal gyrus,inferior temporal gyrus,fusiform gy-rus and parahippocampal gyrus)(P＜0.05).Significant differences in white matter volumes were found in the unaffected side of the LMTLE-HS group(posterior superior temporal gyrus,superior temporal gyrus,middle temporal gyrus,inferior temporal gyrus,fusiform gyrus and parahippocampal gyrus)and in the affected side of the RMTLE-HS group(posterior superior temporal gyrus,middle temporal gyrus,inferior temporal gyrus,fusiform gyrus and parahippocampal gyrus)compared to the right side of the control groups(P＜0.05).There were no statistically significant differences in volume among the other subregions(P＞0.05).Conclusion:The quantitative analysis of temporal lobe white matter volume using the automatic brain segmentation technique is of certain significance for preoper-ative evaluation and surgical approach selection in patients with hippocampal sclerotic medial temporal lobe epilepsy.
AIM: To determine the effect of second-generation motion correction (MC2) on image quality and measurement reproducibility of cardiac CT images in patients with a myocardial bridge and mural coronary artery (MB-MCA) compared to standard (STD) images without motion correction and with first-generation motion correction (MC1). MATERIALS AND METHODS: A total of 66 patients with MB-MCA in the left anterior descending branch who underwent 256-detector CT with single-heartbeat acquisition were included. Images were reconstructed at 45% and 75% R-R intervals using STD, MC1, and MC2 algorithms. Image quality for MB-MCA was assessed by two observers on a four-point scale (1 = poor and 4 = excellent) and compared among STD, MC1, and MC2. Depth and length of MB, lumen area, and minimal diameter of MCA were measured and compared. RESULTS: At 45% R-R interval, image quality scores were 1.59 +/- 0.78, 2.21 +/- 0.97, and 3.21 +/- 0.62 for MCA, and 2.48 +/- 0.79, 2.76 +/- 0.75, and 3.58 +/- 0.58 for MB with STD, MC1 and MC2, respectively. At 75% R-R interval, these values were 2.26 +/- 0.60, 3.03 +/- 0.89, and 3.59 +/- 0.55 for MCA and 3.00 +/- 0.93, 3.17 +/- 0.83, and 3.80 +/- 0.44 for MB. Although MC1 was superior to STD in displaying MCA, there was no statistical difference between the two algorithms for MB (p>0.05). Compared with STD and MC1, MC2 statistically improved image quality and interpretability for both MCA and MB and had narrower limits in interobserver agreement for measurements at both 45% and 75% R-R intervals. CONCLUSION: MC2 improves CT image quality and measurement reproducibility in patients with MB-MCA compared to STD and MC1. (c) 2023 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.
To retrospectively analyze the computed tomography (CT) features in patients with pre-invasive lesions and early-stage lung adenocarcinoma and to explore the correlation between tumor morphological changes and pathological diagnoses. CT morphological characteristics in 2106 patients with pre-invasive (stage 0) and early-stage (stage I) lung adenocarcinoma were analyzed; lesions were confirmed by surgical pathology. Based on the morphological characteristics, the lesions were divided into eight types: I (cotton ball, ground-glass nodules), II (solid fill), III (granular), IV (dendriform), V (bubble-like lucencies), VI (alveolate or honeycomb), VII (scar-like), and VIII (notched or umbilication). The different distributions of eight morphological types in pathological types of the lesions and subtypes of invasive adenocarcinoma were analyzed by chi-squared or Fisher’s exact test. Correlation between the percentage of ground-glass opacity in the lesions and pathology types were analyzed by two-tailed Pearson’s test. A negative correlation was observed between the pathological types and proportion of ground-glass component in the lesions (p < 0.001 and r = − 0.583). Significant differences in morphological characteristics among various pathological types of pre-invasive lesions and early lung adenocarcinomas were observed (p < 0.05). Furthermore, among the different pathological subtypes of stage I invasive adenocarcinoma, the differences in their manifestation as morphological types I, II, III, and VI were statistically significant (p < 0.05). The eight types of morphological classification of pre-invasive lesions and early-stage (stage 0 or stage I) lung adenocarcinoma has different pathological bases, and morphological classification may be useful for the diagnosis and differential diagnosis of lung adenocarcinoma. • CT morphological classification of pre-invasive lesions and lung adenocarcinoma is intuitive. • CT morphological classification characterizes morphological changes of the entire lesion. • Different pathological types of lung adenocarcinoma have different morphological features.
医学论文中正确、合理使用专业名词可以精简文字,节省篇幅,使文章精炼易懂.现将放射学专业领域为大家所熟知的专业名词缩略语公布如下(按照英文首字母顺序排列),以后本刊在论文中将对这一类缩略语不再注释其英文全称和中文.
《放射学实践》杂志自 2018 年 4 月起正式加入 OSID 开放科学计划.通过在杂志每篇论文上添加开放科学(资源服务)标识码(Open Science Identity,OSID),为读者和作者们提供增值服务.每一篇被纳入 OSID开放科学计划的论文,将匹配一个专属的 OSID识别码.此码就如同一个具有交互功能的论文"身份证",给作者提供了更好地与业界同伴交流成果的途径.
目的:探讨根据食管癌临床及超声特征确定下颈部淋巴结转移(LNM)的危险因素.方法:根据纳排标准搜集在我院行手术治疗的72例食管癌患者,行超声内镜检查并确定患者肿瘤位置、病变位置、浸润深度、病变处黏膜结构以及附近淋巴结情况.根据下颈部超声扫描结果分析各临床特征与下颈部LNM的相关性,确定下颈部LNM分区情况,并采用二元logistic回归分析确定下颈部淋巴结转移的危险因素.结果:超声检查结果显示,72例食管癌患者中27例发生了下颈部淋巴结转移,检出转移淋巴结共112枚.根据患者临床特征与是否发生LNM进行相关性分析,结果显示肿瘤分期、病变长度及淋巴结个数与LNM相关(P均＜0.05).LNM分区主要位于Ⅱ和Ⅲ亚区,但其分布差异无统计学意义(P＞0.05).logistic回归分析结果显示肿瘤分期、病变长度及淋巴结个数属于下颈部发生LNM的危险因素(P均＜0.05).结论:肿瘤分期、病变长度及淋巴结数目为食管癌患者发生下颈部LNM的危险因素,对于食管癌的临床诊断和治疗具有重要意义.
Objective:The aim of this study was to analyze the MRI features of 28 cases of fetal cervical cystic mass and to improve the prenatal MRI diagnostic level.Methods:28 patients with fetal cervical cystic lesions found by prenatal ultrasound in Hubei Maternal and Children’s Hospital from October 2014 to October 2021 were examined by fetal neck MRI within three days and analyzed retrospectively.Results:Among 28 cases of fetal cervical cystic mass, 15 cases were located in the left side, 3 cases in the middle of the neck, and 9 cases in the right side.Of all the cases, six cases were across the midline, and 11 cases were presented as multilocular masses.The signal characteristics showed as low signals on T 1 WI and high signals on T 2 WI.In 2 cases, the T 1 WI signal increased in varying degrees during the neonatal period, and the gas-fluid and fluid-fluid levels could be seen.In the follow-up after birth, 15 cases of cystic hygroma（including 1 case of cystic hygroma located in the front of the neck with a small volume subsided naturally after birth）,8 cases of branchial cleft cysts, 1 case of thyroglossal duct cyst and 4 cases of esophageal atresia confirmed by operation or pathology after induced labor.Conclusion:Fetal MRI examination can be a remedy for the downsides of fetal ultrasound examination and obtain more prenatal diagnostic information.
WHO 第 4 版《中枢神经系统肿瘤分类》将 H3 K27 M改变弥漫性中线胶质瘤列为新的胶质瘤亚型,属于 WHO4 级胶质瘤.H3 K27 M基因状态对于该肿瘤的诊断、靶向药物治疗具有重要作用.目前对于 H3 K27 M基因状态的确定主要是通过免疫组织化学法测定,而获得肿瘤组织存在有创和假阴性等缺点.多模态磁共振成像已经广泛应用于胶质瘤的诊断分级、预后判断、疗效评价、基因分子标记物预测等方面.因此,本文主要就多模态磁共振成像在预测弥漫性中线胶质瘤组蛋白 H3 K27M基因突变状态的应用进行综述,为临床应用及研究提供新思路.
目的:探讨双能量 CT 定量参数和形态学特征在鉴别肺实性结节良恶性中的应用价值.方法:回顾性连续纳入 144 例经双期双能量CT(DECT)增强扫描患者的 147 个肺实性结节,包括 76 例肺癌和 71 例良性病变.纳入结节以下特征:基于直径或体积的 Lung-RADS 分级、形态学特征以及DECT定量参数[包括动脉期和静脉期的有效原子序数(Zeff_A、Zeff_V)、碘含量(IC_A、IC_V)和标准化碘含量(NIC_A、NIC_V)].使用多因素Logistic回归筛选鉴别良恶性肺结节的独立预测因子,并构建组合模型.使用受试者操作特征曲线下面积(AUC)、敏感度、特异度评估 Lung-RADS、形态学特征、DECT定量参数及组合模型的诊断效能.使用 Delong 对比 AUC 之间的差异.结果:基于分叶(OR:25.465,95%CI:6.988～92.797)、NIC_V(OR:1.100,95%CI:1.062～1.139)构建的组合模型,AUC、敏感性、特异性分别为 0.942(0.890～0.974)、90.8%及 81.7%,且组合模型的 AUC 均优于基于直径的Lung-RADS分级、单一形态学特征及DECT定量参数(均P＜0.05).结论:基于 NIC_V 和分叶构建的组合模型,鉴别良恶性肺实性结节的诊断效能较高,在临床上有良好的应用价值.
选取 2021 年 5 月-2021 年 6 月本院接受 3.0T联影U790 行肩关节MRI扫描的 32 例患者作为本次研究对象,收集其进行的常规T2 WI和ACS T2 WI图像.统计分析两组图像的空间分辨率和三角肌与肱骨头髓腔的对比噪声比,比较其伪影、图像总体质量、冈上肌边缘上评分的高低和扫描时间长短.统计方法为weighted K 检验、配对t 检验,统计软件SPSS 23.0.两组图像的空间分辨率差异无统计学意义(0.80 mm×0.80 mm×3.00 mm vs.0.80 mm×0.80 mm×3.00 mm);相比于常规 T2 WI,ACS T2 WI组图像在图像对比噪声比、图像伪影、图像边缘清晰锐利度和整体质量评分上更有优势(23.25±10.49 vs.18.85±9.19,P=0.003;3.68±0.47 vs.3.21±0.66,P=0.000;3.84±0.37 vs.3.58±0.64,P=0.006;3.76±0.43 vs 3.32±0.73,P=0.001);ACS T2 WI 的扫描时间 45 s,远小于常规 T2 WI扫描时间 114 s.ACS技术采集的图像质量与常规T2 WI技术采集的图像质量相当甚至更好,但却大幅缩减了扫描时间,值得在肩关节图像采集中推广应用.
目的:分析锥形束CT在儿童腺样体肥大诊断中的准确性,探讨其对腺样体肥大诊断的临床应用价值.方法:收集 2018 年 1 月-2022 年 1 月因睡眠打鼾于本院耳鼻咽喉-头颈外科就诊的 158例患儿锥形束CT和电子鼻内镜资料.测量计算腺样体正中矢状面 A/N(腺样体-鼻咽腔比率)、PAS(后气道间隙)和腺样体占后鼻孔范围比值,并将患儿的锥形束 CT 诊断结果与电子鼻内镜检查结果进行比较.结果:锥形束 CT 图像上 A/N 诊断结果与鼻内镜检查相比敏感度为 86.72%、特异度为70.00%、准确性为 83.54%;PAS诊断结果与鼻内镜检查相比敏感度为 92.19%、特异度为 76.67%、准确性为 89.24%.158 例患儿合并鼻窦炎者 106 例,其中内镜诊断确诊率 18.87%,锥形束 CT诊断确诊率96.23%;158 例患儿合并中耳炎者 46 例,其中内镜诊断确诊率 71.74%,锥形束 CT 诊断确诊率78.26%.结论:锥形束CT是诊断腺样体肥大可靠和准确的工具,可以作为鼻内镜不耐受患儿的替代检查方法.且一次低剂量的精确扫描,在了解腺样体大小的同时,观察鼻窦及中耳有无积液,有助于全面把握患儿的病情,综合性考虑治疗方案.
目前医学领域关注的重点已经转移到细胞和分子水平.磁共振成像(MRI)作为一种能获得清晰的解剖信息的成像技术,对于分子成像其敏感度还远远不够.作为对比剂的超顺磁性纳米材料具有低毒性、多功能性、良好的生物相容性和在外加磁场下的定向移动等性质,显著提高了MRI在分子成像中的价值,在某些生物化学过程方面显示出巨大的潜力,基于可修饰性和稳定性,通过化学修饰可以与一些生物大分子或者体内细胞结合,形成聚合载体,从而牢固地吸附在有机分子的结构体内.如何利用这些材料进行无创可视化诊断和治疗是现在所面临的一个挑战.本综述介绍了超顺磁性纳米材料在分子影像学研究原发肿瘤、转移性淋巴结、免疫系统及干细胞、移植和炎症方面的进展,证明了其在分子影像研究领域的广泛应用和为精准医疗提供的新方向,阐述了目前的进展和存在的一些问题.
病例资料 患者,男,63 岁,于 2019 年 2 月 20 日因"头晕伴恶心呕吐 2 天"入院.血压 129/78 mm Hg,神志清,精神差,言语笨拙,高级神经活动下降,右口角低,四肢肌力 4 级,肌张力正常,腱反射正常,病理征未引出,闭目难立征(+).
目的:探讨乳腺癌原发病灶的常规超声(CUS)、声触诊组织量化成像技术(VTIQ)、声辐射力成像(VTI)及超声造影(CEUS)特征参数在术前评估乳腺癌腋窝淋巴结转移中的临床价值.方法:收集 2018 年 1 月-2021 年 12 月本院的乳腺癌患者,共 91 例患者 94 个病灶.所有患者术前均行CUS、VTIQ、VTI、CEUS检查,术后完善病理结果.根据术后病理结果分为腋窝淋巴结转移组与未转移组,通过单因素及多因素筛选出有意义的超声特征参数,建立 Logistic 预测模型,并对模型进行一致性检验.结果:多因素分析筛选出有意义的超声特征参数为 Alder 血流分级、增强速度、最大剪切波速度(SWVmax),曲线下面积(AUC)分别为 0.690(95%CI:0.568～0.795)、0.643(95%CI:0.520～0.754)、0.681(95%CI:0.559～0.788).基于以上三个超声特征参数建立预测模型方程 Y=-6.903+2.100×Alder血流分级+1.790×增强速度+0.423×SWVmax,该预测模型 AUC 为 0.814(95%CI:0.703～0.897),敏感度为 82.76%,特异度为 78.05%.一致性检验(Kappa=0.625,P=0.002),预测模型与病理结果检验中高度一致.结论:CUS、VTIQ联合CEUS检查对乳腺癌腋窝淋巴结转移具有较高的预测价值,可为乳腺癌术前腋窝淋巴结状态的评估提供可靠依据.
目的:探讨影像组学特征预测较低级别胶质瘤(LGG)与不同免疫亚型的相关性.方法:对 133 例LGG患者的MRI影像特征和免疫相关基因数据进行影像基因组学分析.利用 3 D-slicer 软件提取胶质瘤患者的影像组学特征,通过最小绝对收缩和选择算子(LASSO)回归进一步筛选与预后显著相关的特征构建影像组学评分.利用聚类算法确定最佳的免疫分型,为了探索不同影像分型预后差异的遗传背景,差异性分析不同免疫分型与影像组学评分的关系.结果:共纳入 133 例LGG患者,异柠檬酸脱氢酶(IDH)野生型 28 例,IDH 突变型 105 例,其中野生型 1p19q共缺失 68 例.最终由 11 个影像组学特征构建影像组学风险评分,影像组学风险评分中位值将患者分为高风险组(n=66)和低风险组(n=67),高评分组患者生存期预后明显较差.受试者操作特征(ROC)曲线表明影像组学预测 LGG患者 1 年、5 年生存风险的ROC曲线下面积(AUC)分别为 0.79 和 0.86.聚类分析将LGG患者分为免疫炎症型(n=13)和免疫沙漠型两种亚型(n=113).免疫炎症型患者影像组学评分较高,提示肿瘤纯度较低,异质性较高,预后较差.结论:影像组学评分可以有效预测 LGG预后,影像组学评分与免疫分型存在一定平行关系,大部分LGG患者属于免疫沙漠型.少部分免疫炎症型患者影像组学评分较高,异质性明显高于免疫沙漠型,免疫炎症型患者可能获益于免疫治疗.
病例资料 患者,女,88 岁,15 年前无意中发现左乳肿块,近年来肿块明显增大伴肿胀.查体:患者左乳触及一枚大小约 10 cm×5 cm肿块,突出于乳房表面,质硬,边界欠清,活动度欠佳,无酒窝征,无乳头溢液,双侧腋下未触及肿大淋巴结.
目的:探究磁共振 3 D CUBE T1 WI测量腺垂体体积对女童性早熟的鉴别诊断价值,为临床性早熟患者提供非侵入性和替代性的诊断方法.方法:纳入 2020 年 5 月-2022 年 7 月华中科技大学同济医学院附属同济医院就诊的 128 名性早熟女童,根据临床诊断及促性腺激素释放激素(GnRH)激发试验分为两组:中枢性性早熟(CPP)组 57 例,单纯乳房早发育(PT)组 71 例.所有病例均接受垂体MRI 3 D CUBE T1 扫描及GnRH 激发试验.收集并测量腺垂体特征(高度及测量体积)、临床特征及血清学指标.采用单因素方差分析方法分析各参数间之间差异;Pearson 相关分析探究垂体体积与激发实验结果及血清学指标之间的相关性,并采用 ROC 曲线分析腺垂体高度及测量体积对不同类型性早熟患者的鉴别诊断价值.结果:CPP组腺垂体高度(aPH)及体积(aPV)均显著性高于PT 组(P 均＜0.001);aPV与LH/FSH、LH 基础值及血清 E2 表达水平呈高度正相关(P＜0.001);aPV 与 LH 峰值、FSH 基础值、IGF-1、IGFBP-3 表达水平呈中度正相关;aPV 与血清 COR 表达水平呈中度负相关;ROC曲线分析表明,aPV在鉴别诊断CPP与PT的诊断效能高于 aPH 具有显著性差异,aPV 的 AUC(0.879,95%CI:0.810～0.930)高于aPH 的AUC(0.755,95%CI:0.671～0.827),P=0.0183.aPV鉴别诊断两种不同类型性早熟患者的敏感度(95.27%)及阳性预测率(91.1%)远高于 aPH.结论:本研究发现磁共振 3 D CUBE T1 WI序列所得腺垂体体积可有效地鉴别中枢性性早熟与单纯乳房早发育.对腺垂体体积的评估有可能成为一种无创性诊断中枢性性早熟的方法.
病例资料 患儿,男,6 月 22 天,哭闹不止半月余,精神差 5 天.体格检查:前囟隆起,稍紧张.CT平扫示左侧颞部类圆形低密度肿块,边界清楚,平均CT值约 22 HU,边缘见斑片状高密度灶,邻近颅骨未见明显异常(图 1a).
结缔组织病(CTD)是一组全身免疫介导的多器官功能障碍性疾病,以呼吸道为靶标引起肺部受累致间质性肺疾病(ILD),可从有限的非进展性到暴发性、危及生命,是 CTD发病率和死亡率的主要原因.鉴于其不良后果,对CTD-ILD严重程度的准确评估是目前亟待解决的问题,本文就近年来高分辨率CT在CTD-ILD定量评估中的应用展开综述.
