目的:研究超声影像智能辅助诊断方法对甲状腺良恶性结节的鉴别诊断价值.方法:收集221例(共273个甲状腺结节)于我院接受甲状腺穿刺或手术的甲状腺癌患者的甲状腺结节超声图像.所有超声图像由不同年资医生、超声图像人工智能辅助诊断方法单独或联合对甲状腺结节超声图像进行分析诊断,对结节进行TI-RADS分类;以甲状腺结节病理结果为"金标准",分别计算不同年资医生单独或联合人工智能辅助诊断方法对不同类型甲状腺结节分级的敏感度、特异度、阳性预测值、阴性预测值,绘制受试者工作特征曲线(ROC曲线).结果:病理确诊恶性结节218个,良性结节55个.低年资医生诊断甲状腺结节良恶性敏感度、特异度、准确度分别为68.81％(150/218)、61.82％(34/55)、67.40％(184/273);高年资医生诊断甲状腺结节良恶性敏感度、特异度、准确度分别为87.61％(191/218)、81.82％(45/55)、86.45％(236/273);超声图像人工智能辅助诊断甲状腺结节良恶性敏感度、特异度、准确度分别为83.49％(182/218)、78.18％(43/55)、82.42％(225/273);低年资医生联合超声图像辅助诊断甲状腺结节良恶性敏感度、特异度、准确度分别为77.52％(169/218)、74.55％(41/55)、76.92％(210/273);高年资医生联合超声图像辅助诊断甲状腺结节良恶性敏感度、特异度、准确度分别为88.99％(194/218)、83.64％(46/55)、87.91％(240/273).低年资医生诊断结果与病理结果一致性表现一般,而超声图像人工智能辅助系统与高年资诊断结果相当,且与病理结果一致性较好;超声图像人工智能辅助系统联合医生诊断能够提高诊断结果与病理结果的一致性.结论:超声图像人工智能辅助诊断方法定性甲状腺结节的准确度优于低年资医生,与高年资医生诊断一致性相当;与单纯依靠超声图像诊断相比,低年资医生结合人工智能辅助超声可显著提高诊断准确率.

Objective. To explore the application value of color Doppler ultrasonography combined with thyroid autoantibody tests in the early diagnosis of thyroid cancer. Methods. The medical data of 100 patients with thyroid nodules treated in our hospital from June 2019 to June 2021 were retrospectively analyzed; all patients received color Doppler ultrasonography and thyroid autoantibody tests before surgery and were divided into the benign lesion group (n=45) and the malignant lesion group (n=55) according to the postoperative pathological findings (the gold standard), so as to compare and analyze the application value of color Doppler ultrasonography, thyroid autoantibody tests, and their combination in the early diagnosis of thyroid cancer. Results. Compared with the pathological findings, the accuracy rate, sensitivity, specificity, positive predictive value, and negative predictive value of the combined diagnosis were significantly higher than those in the single diagnosis of color Doppler ultrasonography, TgAb test, TPOAb test, and TRAb test (P < 0.05), and by plotting the ROC curves to analyze the effect of these modalities in diagnosing early thyroid diseases, the results showed that the areas under the curve from large to small were combined diagnosis, color Doppler ultrasonography, TgAb test, TPOAb test, and TRAb test. Conclusion. Color Doppler ultrasonography has many advantages in the diagnosis of thyroid nodules, such as easy operation, painlessness, noninvasiveness, high efficiency, and repeatable detection, and the high-definition probe is able to show tiny lesions, echogenicity, blood flow signal, and other characteristics of foci. Combining color Doppler ultrasonography with testing thyroid autoantibodies such as TgAb, TPOAb, and TRAb can effectively improve the detection rate of early thyroid cancer, presenting significant reference value and meaning to clinical diagnosis and treatment of thyroid cancer.

目的 探讨256排冠状动脉CT血管成像(CCTA)用于慢性阻塞性肺疾病(COPD)患者自由呼吸下检查的可行性.方法 回顾性分析自2017年1月至2019年10月收治的74例COPD患者和74例无屏气困难患者的临床资料.两组患者均行256排CCTA,其中,COPD患者在自由呼吸状态下完成,而无屏气困难患者则在标准屏气状态下完成.比较两组患者的辐射剂量相关指标(有效辐射剂量、容积CT剂量指数、剂量长度乘积)、图像质量可判读性指标(每位受试者、每支血管、每个节段)及冠状动脉图像质量评分.结果 两组患者的辐射剂量相关指标、图像质量可判读性指标及图像质量主观评分比较,差异均无统计学意义(P>0.05).结论 COPD患者在自由呼吸状态下行256排CCTA,图像质量和辐射剂量均与标准屏气状态接近.

To investigate the CT features imaging and clinical significance of the chest before hemoptysis in patients with microscopic polyangiitis (MPA). In this study, 48 patients with MPA from May 2018 to December 2019 were selected and confirmed by chest CT, and their clinical data were analyzed retrospectively. According to whether the patients had hemoptysis, patients were divided into two groups. 28 patients in the non-hemoptysis group and 20 patients in the hemoptysis group. The clinical significance of chest CT examination was discussed by comparing the characteristics of chest CT images of the two groups. The clinical manifestations of the two groups were compared, compared with the non-hemoptysis group, the hemoptysis group had more respiratory symptoms, anemia, heart fatigue, shortness of breath and chest pain, these differences have statistical significance (P<0.05); there was no significant difference between the two groups in systemic symptoms and extrapulmonary manifestations (P>0.05). For the two groups of microscopic chest CT manifestations, MPA hemoptysis group patients with consolidation shadows, patchy foci, ground-glass opacity, reticular shadows and other lesions were significantly higher than those of non-hemoptysis group, which was statistically significant (P<0.05); there was no significant difference in CT findings between the two groups, such as nodular shadow, interlobular septal thickening, cavity, bronchiectasis, mediastinal lymph node enlargement, pulmonary bullae, pleural effusion and fibrous streak shadow (P>0.05). The indexes of erythrocyte sedimentation rate, sCRP and white blood cells in hemoptysis group were higher than those in control group, the difference was statistically significant (P<0.05). In the hemoptysis group, 8 patients died in 3 months follow-up, the mortality rate was 40.00%; There was no death in the non-hemoptysis group. Comparison of mortality between the two groups, the difference between the two groups was significant (P<0.05). There was no significant difference between the two groups in the treatment of maintenance hemodialysis (P<0.05). The mortality of patients with MPA hemoptysis is very high, the inflammation index of patients is obviously increased, and they have serious symptoms such as heart fatigue, shortness of breath, expectoration, cough, chest pain, etc.; the chest CT imaging examination shows that the patients with MPA hemoptysis have reticular shadows, ground-glass opacity, consolidation shadows, patchy foci, etc., which can be diagnosed in early stage according to the above characteristics, providing basis for clinical treatment and reducing the mortality.

目的 探讨高机械指数超声辐照微泡对结肠癌Lovo细胞骨架及侵袭、迁移能力的影响.方法 体外培养Lovo细胞,分为4组:空白对照组、超声辐照+微泡组、超声辐照组、微泡组.其中超声辐照以声诺维为造影剂,探头频率1.5 MHz,机械指数1.7,显像深度4 cm;微泡指仅添加声诺维.处理完毕后,采用激光共聚焦显微镜观察各组细胞微管及微丝变化,采用细胞划痕实验及Transwell侵袭实验检测细胞迁移及侵袭能力.结果 超声辐照+微泡组划痕愈合率、细胞侵袭数目明显低于其它三组(P<0.05),超声辐照组、微泡组及空白对照组划痕愈合率、细胞侵袭数目对比,差异无统计学意义(P>0.05).超声辐照组、微泡组、空白对照组微管染色表现均呈细胞致密的丝状网络结构,放射性延伸至细胞边缘;超声辐照+微泡组丝状网络结构稀疏,主要沿细胞长轴排列.超声辐照组、微泡组、空白对照组微丝染色均呈细胞致密网络状细丝结构,向四周伸出大量短小的毛刺状突起,呈拉丝状,有明显的方向型;超声辐照+微泡组细胞质中部细丝明显减少,荧光暗淡,未构成明显的网络状,周边毛刺状突起减少.结论 高机械指数超声辐照微泡能够抑制结肠癌Lovo细胞的侵袭及迁移能力,这可能与其能够破坏Lovo细胞骨架结构有关.

目的 探讨颈部血管彩超与DSA对颈动脉狭窄病变的诊断价值.方法 选取2016年1月-2017年1月期间于我院就诊的120例疑似颈动脉狭窄病变患者为实验对象,且均进行DSA、颈部血管彩超.结果 颈部血管彩超检查对1级狭窄率诊断正确率为96.88％,对2级狭窄率诊断正确率为96.30％,对3级狭窄率诊断正确率为96.00％,对4级狭窄率诊断正确率为93.75％;对斑块诊断正确率为97.37％,对轻度诊断正确率为96.88％,对中度诊断正确率为93.33％,对重度诊断正确率为90.00％,对闭塞诊断正确率为100.00％.同时对颈动脉狭窄病变特异性、敏感性、漏诊率、误诊率分别为90.00％、96.00％、4.00％、10.00％.结论 颈部血管彩超用于颈动脉狭窄病变中具有一定价值性,可推广于基层医院,但不可代替DSA.

Objective To compare the efficiency of serum screening,ultrasound screening and the combination of both in the screening of&nbsp;chromosomal disorders including Down syndrome and trisomy 18,in order to reduce the incidence of birth defects,as well as to provide a scientific foundation for the effective implementation of prenatal screening. Methods 38 165 singleton pregnancies between 15 and 20 weeksˊgestation who carried out prenatal screening during November 2013 to November 2014 were retrospectively studied. 2 ml of venous blood were used to detect the concentration of freeβ-human chorionic gonadotropin(fHCG),α-fetoprotein(AFP)and /or estriol(uE3). The risk value of Downˊs syn-drome,trisomy 18 syndrome and neural tube defects were caculated by using algorithms,and Pregnancies with high risk of Downˊs syndrome or tri-somy 18 who signed informed consent would underwent karyotypeanalysis. 10 727 cases who performed ultrasound screening between 15 and 28weeksˊgestation were included in the study. Fetuses who were detected with abnormal ultrasound findings were considered screening positive. All utrasonography screening positive women who signed informed would underwent prenatal diagnose. Results There were 1 708 women accepted prenatal diagnose who were Down syndrome and trisomy 18 screen-positive,69 cases with abnormal fetal karyotype were found with the abnormal rate of 4. 0%,among which there were 38 cases with aneuploid,including 25 cases of 21 trisomy,8 cases of trisomy 18,and chromosome structur-al aberrations of 31 cases. Among 10 727 cases with ultrasound screening,236 fetues were found congenital structural abnormality and detection rate was 2. 2%. 170 fetuses who were detected with abnormal ultrasound findings accepted fetal chromosome karyotypes analysis,means abnormal fetal karyotype positive rate was 28. 8%(49/170). When combined maternal serum screening with ultrasound,one of them screen-positive and underwent prenatal diagnose had 1819 cases,the abnormal rate was 5. 7%(103/1 819). While it was identified 59 cases of abnormal fetal karyo-type in which the mother had undergone both a serum screen and a second trimester ultrasound,the karyotype abnormal rate was 25. 4%,the rate of detection significantly higher than only maternal serum screening,but there were no significant differences with ultrasound. Conclusion Sec-ond trimester maternal serum screening is an effective method of screening for fetal neural tube defects,trisomy 21,trisomy 18 and other chromo-somal disorders,pregnancies who screen-positive underwent further confirmed,can reduce the incidence of birth defects. It has important social and economic benefits. The performance of ultrasound sreening and the combination of ultrasound and maternal serum screening are better than simple maternal serum screening,when combine the two together,it can increase the accuracy. Second trimester ultrasound screening can diagnose most of the structural malformations,reduced birth defects. At the same time,fetal structure abnormalities are the effective ultrasound indicator for fetus chromosomal abnormalities,and second trimester ultrasound screening is effective in detecting fetus with trisomy 18.

目的:对不同分子亚型乳腺癌的超声征象和病理特征进行探讨.方法:回顾性分析100例乳腺癌患者的超声资料,采用免疫组织化学检查将其分为管腔型、基底细胞样型及原癌基因人类表皮生长因子受体2(HER-2)过表达型3组,并对其超声征象和病理特征进行统计学分析.结果:100例患者中,基底细胞样型28例、管腔型56例、HER-2过表达型16例.其中组间病灶、形状及边界的差异有统计学意义(P＜0.05).结论:分子亚型可以反映乳腺癌生物学行为的差异,经超声检查可对分子亚型进行预测.

选取产后6周经检查证实的 SUI 患者30例，均为本院2014年1月~2016年1月收治，设为观察组，选取同期未育正常妇女30例，设为对照组，均行盆底超声检查，对比膀胱后角、膀胱颈移动度等指标。结果在指导下，两组 Valsalva 动作完成均较好，获取的图像质量理想，可对 Valsalva 动作后及静息状态下盆腔器官功能、位置的变化清晰显示。参数对比方面：观察组尿道旋转角、膀胱后角、膀胱移动度与对照组比较明显增大(P<0.05)。观察组尿道内口漏斗形成18例，占60%；对照组3例，占10%，对比有显著统计学差异(P<0.05)。盆底超声除可对产后 SUI患者盆底变化情况观察，得出尿道内口漏斗有无形成、膀胱颈移动度、尿道旋转角、膀胱后角等相关超声参数外，还可作为对产后 SUI 形成诊断的客观影像学指标，为评估本病提供了一项操作简便、安全高效的途径。

目的 总结分析乳腺浸润性导管癌(IDC)的声像学特征与临床表现,以对IDC的超声诊断作出指导.方法 选择IDC患者65例,均经病理检查证实,回顾性分析其临床治疗与超声检查图像特征.结果 65例患者肿块多位于外上象限,最大约8.8 cmx6.1 cm,最小1.3 cm×1.0 cm.声像图显示后方回声衰减33例(50.8％),内部存在有微钙化42例(64.6％),周围有高回声晕32例(49.2％),有毛刺征或蟹足征40例(61.5％).所有患者均有星点状、短线状血流信号,48例患者肿块内部Ps＞ 17 cm/s,RI为(0.77±0.21).所有患者均有不同程度淋巴结肿大,可见一个或数个直径小于2.0 cm大小不等低回声结节.结论 超声诊断IDC方便简单易行,主要表现为形态不规则,后方呈衰减,内部可见钙化,血流信号丰富的肿块,是诊断IDC重要手段.

Objective To investigate the diagnostic value of microcalcifications in X - ray screening mammography for breast ductal carcinoma in situ(DCIS).Methods Fifty - eight women with mammographically suspected and then pathologically and immunohistologically confirmed DCIS were retrospectively analyzed.According to Breast Imaging Reporting and Data System(BI - RADS) issued by American College of Radiology(ACR),calcifications were described including their morphology and distribution.All the 58 lesions were correlated with pathology.A Fisher's exact test was used to estimate a possible contingence between shapes of microcalciftcaions and gradings of DCIS.Results Microcalcifications were categorized according to their morphology and distribution into three groups:fine-linear branching calcifications in 46 cases(79%);amorphous - clustered calcifications in 5 cases(8%);and punctate -coarse or popcorn - like calcifications in 7 cases(12%).Of the 58 DCIS lesions,14 were low - grade(grade 1) ones,accounting for 24%,35 were of the intermediate grade(grades 2),accounting for 60%and 9 were high - grade(grade 3 ) ones,accounting for 16%.Statistically,the morphology and distribution of microcalcifications in DCIS with different gradings varied significantly(P0. 001).The contingency coefficient was 0.559(P0.001),suggesting a significant contingence between grades and characteristics of microcacifications in DCIS.Conclusions Microcalcifications help detect early DCIS,the morphology and distribution of which also characterize the grading of the lesion.A feasible reading of calcifications in X - ray mammography facilitates the accuracy of diagnosis of this disease.