目的 探讨术前基于CT平扫影像组学模型预测肾透明细胞癌(Clear cell renal cell carcinoma,ccRCC)世界卫生组织/国际泌尿病理学会(WHO/ISUP)分级中低级别(Ⅰ～Ⅱ级)与高级别(Ⅲ～Ⅳ级)的价值.方法 回顾性分析经手术病理证实的201例ccRCC患者共203枚病灶的CT平扫数据(低级别组147枚,高级别组56枚),用图像分割软件获取3D肿瘤感兴趣区(3D-ROI),从3D-ROI中提取5种特征.基于上述特征建立逻辑回归(LR)模型.结果 LR模型训练集预测高级别ccRCC的准确度为82.35％、精确度为63.51％,最佳点的敏感性和特异性分别为83.93％和81.76％,AUC为0.893(95％CI:0.8479～0.9381);对应的测试集准确度为79.90％、精确度为60.27％,最佳点的敏感性和特异性分别为78.57％和80.41％,AUC为0.864(95％CI:0.8106～0.9174).结论 基于CT平扫影像组学模型可以对ccRCC WHO/ISUP分级进行术前预测,可为患者的治疗及预后提供参考依据.

目的 探讨CT影像组学模型在诊断糖尿病足患者足底神经病变中的价值.方法 回顾性分析2019年7月至2020年12月于我院就诊的并发糖尿病足的29例糖尿病患者(糖尿病足组)及47例同期单侧足部创伤患者(非糖尿病组)的临床资料及足部CT影像学资料.基于足部CT图像采用深睿科研平台提取1743个影像组学特征,使用特征间线性相关检查和F检验进行特征筛选,随后采用Logistic回归分析进行模型构建.采用五折交叉验证训练模型,在训练组与验证组中应用受试者操作特征(Receiver Operating Characteristic,ROC)曲线对模型进行验证,评价影像组学特征在诊断糖尿病足患者足底神经病变中的效能.结果 经过特征筛选,最终选取12个影像组学特征用于构建糖尿病足患者足底神经病变诊断模型.训练组中诊断模型的ROC曲线下面积(Area Under Curve,AUC)为0.97(95％CI:0.94～1.00),敏感度为90.20％,特异度为89.13％,诊断准确率为89.69％;验证组AUC为0.89(95％CI:0.82～0.95),敏感度为84.31％,特异度为80.43％,诊断准确率为82.47％.结论 基于足部CT图像的影像组学模型对糖尿病足患者足底神经病变有较高的诊断效能.

Objective: To analyze the relationship between tumors of the musculoskeletal system and adjacent nerves by reconstructing images of peripheral nerves, and explore its value in surgical treatment. Methods: From May 2016 to April 2019, a total of 27 patients were collected in Department of Imaging,Shougang Hospital, who were with skeletal muscle system tumors, including 15 primary soft tissue tumors, 9 primary bone tumors, 3 metastatic tumors, all of them were closely related to nerves. There were 17 males and 10 females, aged 13-67 years, with an average age of 34 years. Before the operation, CT volume scanning was performed, and curved planar reconstruction (CPR) was used to reconstruct the peripheral nerves. All patients were operated within 2 weeks after the examination. According to the image characteristics before the operation, the nerve invasion was judged. The sensitivity, characteristic, positive predictive value and negative predictive value of the tumor invasion (compression) nerve were calculated according to the intraoperative findings as the gold standard. Result: Of the 27 cases, 25 cases (25/27, 92.6%) could show the relationship between the tumors and the adjacent nerves at the same level, and 22 cases (22/25, 88.0%) had the same preoperative image judgments as the intraoperative findings. In the reconstructed images, the peripheral nerve was a continuous strip-like structure on the same level with the tumor. The invaded nerve became thicker and the edge was blurred. Enhanced scan showed enhancement. The sensitivity, specificity, positive predictive value and negative predictive value of neuroimaging reconstruction were 100.0%, 89.5%, 75.0% and 100.0% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the nerve compression were 92.3%, 100.0%, 100.0% and 80.0% respectively. Conclusions: Neurological reconstructed images can help clinicians evaluate the relationship between lesions and adjacent nerves quickly and intuitively. They can guide the selection of surgical methods, reduce the risk of intraoperative nerve injury, and have high sensitivity and specificity for nerves invasion.

目的:探讨黄色肉芽肿性胆囊炎的CT、MRI影像特征性表现及其发生病理基础.材料及方法:回顾性分析我院手术并经病理证实的28例XGC患者的CT、MRI影像及病理资料.结果:22例胆囊增大,其中20例为弥漫增厚.胆囊内结石20例(包括胆囊颈(管)结石8例),合并胆总管结石2例.CT17例、M R20例于增厚胆囊壁内见结节样、斑点片样及斑块样黄色肉芽肿性病变.结论:增强CT及增强MR联合应用,有利于XGC与胆囊癌的鉴别,对临床治疗有指导意义.

Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery.Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan.2019 to Dec.2019 in Beijing United Family Hospital and other 18 medical centers,including 78 cases of renal tumor,2 cases of bladder cancer,2 cases of adrenal gland tumor,1 cases of renal cyst,1 case of prostate cancer,1 case of sweat gland carcinoma with lymph node metastasis,1 case of pelvic metastasis after radical cystectomy.All the patients underwent operations.In the laparoscopic surgery group,there were 27 cases of partial nephrectomy,1 case of radical prostatectomy,2 cases of radical cystectomy and 2 cases of adrenalectomy.In the da Vinci robotic surgery group of 54 cases,there were 51 cases of partial nephrectomy,1 case of retroperitoneal lymph node dissection,1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis.There were 41 partial nephrectomy patients with available clinical data for statistic,with a median age of 53.5 years (range 24-76),including 26 males and 15 females.The median R.E.N.A.L score was 7.8 (range 4-11).Before the operation,the engineers established the holographic image based on the contrast CT images and reports.The surgeon applied the holographic image for preoperative planning.During the operation,the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen.Results All the procedures had been complete uneventfully.The holographic images helped surgeon in understanding the visual three-dimension structure and relation of vessels supplying tumor or resection tissue,lymph nodes and nerves.By manipulating the holographic images extracorporeally,the fused image guide surgeons about location vessel,lymph node and other important structure and then facilitate the delicate dissection.For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy,the median operation time was 140 (range 50-225) min,the median warm ischemia time was 23 (range 14-60) min,the median blood loss was 80(range 5-1 200) ml.In the robotic surgery group,the median operation time was 140 (range 50-215)min,the median warm i schemia time was 21 (range 17-40)min,the median blood loss was 150(range 30-1 200)ml.In the laparoscopic surgery group,the median operation time was 160(range 80-225)min,the median warm ischemia time was 25 (range 14-60)min,the median blood loss was 50 (range 5-1 200) ml.All the patients had no adjacent organ injury during operation.There were 2 cases with Clavien Ⅱ complications.One required transfusion and the other one suffered hematoma post-operation.However,the tumors were located in the renal hilus for these 2 cases and the R.E.N.A.L scores were both 11.Conclusions Holographic image navigation can help location and recognize important anatomic structures during the surgical procedures..This technique will reduce the tissue injury,decrease the complications and improve the success rate of surgery.

人体研究保护项目认证协会(AAHRPP)目前为全球人体研究保护公认的标准体系.将AAHRPP理念正确地应用于国内人体研究保护项目(HRPP)体系的构建中,从而提高人体研究过程中对受试者的保护和对医学伦理规范的实施,使国内机构的HRPP体系更具合规性、质量性和效率性.

缺血性脑血管病占脑血管疾病的80％,具有发病率高、致残率高和病死率高的特点,是威胁人类健康的常见疾病之一,其主要分为短暂性脑缺血发作(transient ischemic attack,TIA)和脑梗死.大脑中动脉(middle cerebral artery,MCA)慢性狭窄或闭塞是引起TIA反复发作的常见原因.当MCA发生狭窄或者闭塞时,将导致脑组织出现缺血、缺氧改变,如果不及时临床干预,常引起责任血管供血区脑组织缺血性脑梗死,对其进行病因学诊断及脑组织血流动力学改变评价对指导早期治疗干预意义重大 [1～3].

目的 探讨CT周围神经重建技术在显示坐骨神经穿梨状肌变异中的应用价值及其临床意义.方法 顺序选取2018年12月至2019年5月间无明确坐骨神经痛的、并在北京大学首钢医院医学影像科行盆腔CT检查的住院患者50例;男17例,女33例;平均年龄61.8(36～82)岁.对扫描所得的原始CT图像,分别进行常规盆腔重建和双侧坐骨神经重建,按照潘铭紫对国人坐骨神经与梨状肌的关系分型,判断有无坐骨神经穿梨状肌变异,并比较两种重建方法有无差异.结果 本组50例患者共计左右两侧梨状肌及坐骨神经100侧,均可完成常规重建及神经重建.常规图像通过梨状肌形态(肌肉间是否出现低密度条片影)判断有无坐骨神经变异,共发现坐骨神经变异27例(27％),其中能确定为Ⅱ型变异的10侧;神经重建图像通过显示坐骨神经形态(坐骨神经是否出现分离)判断,共发现坐骨神经变异32侧(32％),其中能确定为Ⅱ型变异的28侧,能确定为Ⅵ型变异的1侧.常规组与重建组显示异常变异数差异无统计学意义(χ2=0.601,P=0.438),但是在判断变异类型数方面,重建组明显高于常规组(χ2=18.767,P<0.001).结论 虽然CT周围神经重建技术和常规重建技术均可发现坐骨神经变异,但CT周围神经重建图像更易判断变异类型,并且在同一层面直接显示坐骨神经自身形态,可以直观、准确地反映坐骨神经有无变异及神经与周围组织关系,为进一步研究坐骨神经痛提供一种新的影像学方法.

目的 CT引导下穿刺活检在骨盆病变精准医疗中的诊断价值.方法 分析我院CT引导下骨盆穿刺活检病例86例临床资料,对其成功率、准确性及后续诊治情况进行随访.结果 86例穿刺病例中,穿刺成功率为98.8％ (85/86),穿刺活检阳性率为96.5％(83/86).穿刺活检在鉴别病变是否为恶性方面的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为82.80％、100％、90.60％、100％、76.3％;溶骨性骨质破坏59例,成骨性骨质破坏11例,混合性骨质破坏16例,溶骨性病灶与非溶骨性病灶穿刺活检准确率无明显差异(x2 =2.35,P=0.13);1例非霍其金淋巴瘤患者,术后穿刺针道区域出现少许血肿;45例接受了手术治疗,41例行包括放疗、化疗、抗痨、抗炎等在内的非手术治疗.结论 CT引导下穿刺骨盆病变活检是诊断准确率高、损伤小的微创检查,为临床精准治疗提供可靠依据.

目的 评估基于深度学习(DL)的人工智能(AI)乳腺X线影像病灶检出系统的临床价值.方法 回顾性分析484例乳腺X线影像及诊断报告,对其中存在BI-RADS 3类及以上病灶者评估AI检出敏感度,并结合双向表x2检验,验证AI对不同类型和BI-RADS分类病灶的敏感度差异.由3名高年资医师对诊断报告显示BI-RADS 1类和2类、但AI提示阳性病例进行审核,并按照不同类型和BI-RADS分类进行统计.结果 BI-RADS 3、4a、4b、4c、5类病灶分别为103、79、23、40和11个,AI检出敏感度分别为82.52％(85/103)、97.47％(77/79)、100％(23/23)、100％(40/40)和100％(11/11),总敏感度为92.19％(236/256).AI系统对不同类型(钙化、肿块、非对称、结构扭曲)和BI-RADS分类病灶的敏感度差异均无统计学意义(P均＞0.05).254例BI-RADS 1类和2类病例中,203例AI提示阳性发现,其中75例(80个病灶)为BI-RADS 0类,需结合其他检查确认,21例(23个病灶)为BI-RADS 3类及以上,多检出BI-RADS 3类及以上病灶类型差异无统计学意义(P均＞0.05).结论 AI系统对BI-RADS 3类及其以上病灶有较高敏感度,可有效辅助影像医师减少漏诊.

目的:探讨在CTU检查中利用改良分离团注技术提高全尿路的显示情况.方法:120例泌尿系统CTU检查病例,随机分成单次团注组(对照组)、分离团注组(实验组),每组60例,对照组扫描包括常规平扫、皮质期、髓质期、延迟期,延迟期,实验组包括常规平扫、髓质期、皮质-排泄期,所有病例进行三维重建显示全尿路,分析比较两组成像质量和辐射剂量.结果:在显示输尿管全程方面,两组图像质量无统计学差异(P>0.05);实验组辐射剂量明显低于对照组(t=21.55,P<0.05);所有病例均能对肾动脉情况进行良好显示.结论:应用改良分离团注技术进行CTU扫描,可降低病人辐射剂量.同时,又可获得优质的可用于诊断的清晰尿路全程影像.

目的 通过CT神经重组技术观察腰椎退行性侧凸(LDS)对神经根-硬膜囊夹角(N-E角)的影响,并初步探讨其临床意义.方法 搜集2016年11月至2017年6月本院收治的LDS的患者47例(LDS组),均行腰椎CT检查,采用改良Cobb法测量侧凸角.选取同一时期患有腰腿痛的,并经过腰椎CT检查无腰椎侧弯的患者24例为对照组(NLDS组).将腰椎容积数据进行后处理,同层显示双侧腰N-E角.采用SPSS 21.0软件进行统计学分析.结果 腰椎侧凸Cobb角7.3～28.8°,平均(15.71±6.04)°,右侧凸31例(65.96％),左侧凸16例(34.04％).在神经重组图像中,腰神经是发自硬膜囊的条索状结构,与硬膜囊呈一定的夹角.LDS组凹侧的N-E角与凸侧比较,P=0.01.NLDS组两侧N-E角比较,P=0.419.NLDS组双侧N-E角角度差为(1.14±3.81)°,LDS组N-E角角度差为(6.27±7.65)°,两组N-E角角度差比较,P=0.00.LDS组中,N-E角度差与腰椎侧凸Cobb角无相关性(P=0.200,R=0.190).结论 基于CT神经重组图像,可以清晰显示N-E角,LDS组N-E角在Cobb角＜10°时已与NLDS组N-E角存在差异,且凹侧角度大于凸侧,这与LDS患者多出现凹侧疼痛相符,为以后探讨LDS引起神经根性疼痛的原因时,提供一种新的思路及影像形态学方法.由于腰椎侧凸Cobb角与N-E角无明显相关性(R=0.190),提示单纯矫正LDS Cobb角可能对N-E角影响不大.

目的 探讨高磁场强度下多b值扩散加权成像结合双指数模型在骨肿瘤定性诊断中的价值.方法 对北京大学首钢医院骨肿瘤科的76例患者行常规MRI及多b值(0、50、100、150、200、400、600、800、1000、1500、2000 s/mm2)扩散加权成像检查.利用基于体素内不相干运动(intravoxel incoherent motion,IVIM)理论的双指数模型计算快速表观弥散系数(fast ADC,ADCfast)、慢速表观弥散系数(slow ADC,ADCslow)和灌注相关体积分数(perfusion fraction,f),利用单指数模型计算标准表观弥散系数(Standard ADC,ADCtot).根据病理结果,将病变分为良性(17例)、中间型(25例)及恶性(34例),以患者自身正常骨髓作为对照,并对3组肿瘤之间以及肿瘤与对照组之间ADCtot、ADCfast、ADCslow及f值的差异进行统计学分析.结果 良性骨肿瘤的b值-信号强度曲线斜率高于恶性骨肿瘤.4组ADCslow值组间比较差异均有统计学意义(P<0.05),恶性组ADCslow值明显低于良性组和中间型组,对照组ADCslow值最小,明显低于其余3组(P<0.05);各组ADCfast值均大于ADCslow值,且各组ADCfast组间比较,仅恶性组与对照组差异有统计学意义,即前者明显大于后者(P<0.05);良性组f值明显小于恶性组和对照组(P<0.05);4组ADCtot值均大于相应各组ADCslow值,各组间比较差异均无统计学意义(P>0.05),但恶性组排除脊索瘤患者后,良性组ADCtot值明显高于恶性组(P<0.05).结论 Mb-DWI可作为MRI检查的有益补充对骨肿瘤不同性质病变进行定性诊断,ADCslow有助于区分良性、中间性和恶性肿瘤,提高骨肿瘤的诊断准确性.

Objective To analyze CT morphologicl characteristics of tibial nerve,lateral and medial plantar nerves and their clinical significances in the diabetic foot (DF) patients.Methods Bilateral feet (DF group) of 33 patients diagnosed as type 2 diabetes mellitus with DF were examined with CT.Meanwhile,36 uninjured feet (NDF group) of patients with single-side foot wound were taken as the controls.CT findings of distal part of tibial nerve,medial plantar nerve and lateral plantar nerve on the same plane were observed with CT post-processing technique.The morphological measurements were done at the points of A1 (tibial nerve measuring position),A2 (proximal part of medial plantar nerve measuring position),A3 (distal part of medial plantar nerve measuring position) and A4 (lateral plantar nerve measuring position).Both of the anteroposterior and transverse diameters were measured and compared between DF and NDF groups.Results Plantar nerves (tibial nerve,medial plantar nerve and lateral plantar nerve) of DF patients were thick (52/66,78.79 ％),and the edges of nerve were indistinct (51/66,78.78％).The anteroposterior and transverse diameters of measurement points A1,A2 and A4 in DF group were larger than those in NDF group (all P＜0.01).There was no statistical difference of the anteroposterior and transverse diameters of point A3 between the two groups (both P＞0.05).Conclusion The plantar nerves of DF patient were thick with indistinct edges.The observation of continuous morphological characteristics and the diameter measurements of the plantar nerve can be performed with CT post-processing technique,which can provide more information for clinical diagnosis of DF.

Objective To study the clinical applicability of mammography-guided percutaneous hook wire localization in diagnosing clusters of calcified breast lesions. Methods Clustered calcification localized biopsy was performed on 68 cases of patients, who were classified as Ⅳ and Ⅴaccording to the breast imaging reporting and data system (BI-RADS). Lesions were also scanned by mammography to find out whether the lesions were excised completely before pathological results were obtained. Results Forty clusters of calcified breast lesions that were highly suspicious of malignancy were detected in 68 patients.Mammography-guided percutaneous hook wire localization and surgery were successful in all the patients.The removed tissues of the 68 lesions were subjected to pathological analysis which confirmed 52 of cases malignant lesions, including 23 cases of infiltrating ductal carcinoma and 29 cases of ductal carcinoma in situ, and 16 cases of benign lesions. The sensitivity of mammography to breast diagnosis was 84.62%,specificity was 75.00%, the positive predictive value was 91.67% and negative predictive value was 60.00%. The Kappa value was 0.549 (P<0.05). Conclusion This biopsy technique of mammography-guided percutaneous hook wire localization is simple and feasible, making possible timely diagnosis and treatment of clusters of calcified breast lesions while improving the early diagnosis rate of breast cancer.

目的 探讨CT对不同病理分型阑尾炎的特征分析和诊断价值,以及对预后的意义.方法 对本院160例阑尾炎患者术前进行CT影像学评估及分型,并于术后病理分型进行对照.结果 CT对阑尾炎病理分型符合率为95.0％,患者预后良好,未出现明显并发症.结论 CT对阑尾炎分型诊断与临床病理分型符合率较高,可以为阑尾炎诊断及手术方式的选择提供较准确的临床指导,有效减少阑尾炎术后并发症,对预后恢复具有重要意义.

目的:探讨吸烟、戒烟与中老年人群椎体骨折的关系.方法:对3403例参加北京市肺癌早期筛查项目的社区人群(42～72岁)进行吸烟、戒烟情况调查.在低剂量胸部CT扫描的侧位定位像上,采用Genant椎体骨折半定量法对T4～L4椎体进行骨折评价.分析椎体骨折的分布情况;比较不同性别、年龄段的椎体骨折阳性率差异;比较不同吸烟指数、戒烟年限人群的椎体骨折阳性率差异.结果:共有703例研究对象(20.7％)发现1077个椎体骨折,其中T12、T11、L1骨折数量占前3位,1级骨折占92.3％.年龄<65岁的各年龄段人群中,男性椎体骨折阳性率高于女性(P<0.001);年龄≥65岁的男女性间椎体骨折阳性率差异无统计学意义.吸烟组、戒烟组椎体骨折阳性率分别为23.3％ 、21.8％,均高于非吸烟组(14.2％),且差异有统计学意义(P<0.01).轻、中、重度吸烟组椎体骨折阳性率分别为19.2％ 、27.7％ 、23.2％,中、重度吸烟组与非吸烟组差异有统计学意义(P<0.001).戒烟<5年、5～10年、>10年组椎体骨折阳性率分别为23.1％ 、19.9％ 、23.1％,其中戒烟<5年组与非吸烟组差异有统计学意义(P=0.003).结论:吸烟指数≥200年支及戒烟5年内的椎体骨折阳性率升高,应加以关注.

目的 探讨个体化低管电压的扫描方案对心脏CTA检查图像质量和辐射剂量的影响.方法 选取120例行心脏CTA检查的患者,心率控制在70次/分以下,按BMI指数分组,给予不同管电压、自动管电流扫描,选用心动周期的70％-80％为全剂量扫描时间窗,单次心跳采集数据.多组间采用单因素方差分析的统计学方法对三组心脏CTA检查的数据及双盲法评价图像的质量进行比较分析.结果 A、B、C三组ED值进行组间比较:C组ED值明显大于A组(P＜0.001)和B组(P＜0.001),A组ED值明显小于B组(P=0.001);三组病人图像的CNR、SNR不同组间比较无统计学差异;两名医师双盲法评定图像质量一致性较好,Kappa值为0.961.结论 个体化低管电压扫描方案能显著降低了心脏CTA辐射剂量,并图像质量得以保障,值得在临床上应用和推广.

Objective To estimate the application value of head-neck CT angiography (CTA) and whole brain CT perfusion (CTP) in patients with chronic cerebral ischemia by the correlation comparison study of head-neck CTA and brain CTP. Methods A total of 150 patients' CTA and CTP were analyzed for their correlations with the distribution of perfusion region, responsible blood vessels and perfusion abnormalities. Results The responsible vessels of 98.72% perfusion abnormal region were moderate vascular stenosis. With the aggravation of the degree of the stenosis of the responsible vessels, the proportion of abnormal region of perfusion was significantly increased. The degree of responsible vascular stenosis was moderately positively correlated with the staging of CTP in the pre-infarction stage. Conclusions Combined with the results of head-neck CTA and whole brain CTP, the degree of chronic ischemia in patients with chronic cerebral ischemia can be comprehensively evaluated, which is more conductive to the selection of clinical treatment.

Objective:To study the imaging and pathology manifestations of primary nonHodgkin lymphoma (NHL) of spine.Methods:The imaging materials of twelve patients with pathology confirmed primary NHL of spine were retrospectively analyzed.All of the twelve patients had plain CT,of them,9 patients had contrast-enhanced CT.Eleven patients had plain MRI,ten cases with contrast-enhancement.Pathology diagnosis was obtained in 2 patients with surgical resection and 10 patients with needle biopsy.Results:Of the twelve patients,seven cases had solitary vertebral involvement,including cervical spine (one case),thoracic spine (four cases) and lumbar spine (two cases).Five patients had multiple vertebral involvement,with skipped lesions in two cases and contiguous lesions in four cases (one case one case had also skipped lesions).Associated pathology fracture of vertebrae were found in six cases;four cases had collapsed vertebra.CT showed osteolytic lesion with soft tissue mass in nine cases,including seven cases with moth-eaten appearance and two cases with infiltrative bone destruction;mixed osteolytic and osteosclerosis in one case.On MRI,soft tissue mass surrounding vertebrae destruction could be revealed,appearing as low signal on T1WI,high signal on T2 WI.The soft tissue mass showed mild-to-moderate enhancement after contrast administration on CT and MRI.The pathology diagnosis was NHL in these 12 patients,with ten cases as diffuse larger B-cell lymphomas (10/12).Conclusion:The imaging findings of primary NHL of the spine mainly manifested as a single or multiple contiguous vertebral body with osteolytic destruction (moth-eaten,infiltrative destruction or associated with osteosclerosis),extra-dural soft tissue mass surrounding the vertebral lesion,normal intervertebral space,yet without periosteal reaction or calcification.Needle biopsy is an important approach for the early diagnosis of primary NHL.