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.

目的 探讨严重妊娠高血压疾病的颅脑影像学变化及特征,分析并发脑血管病变的临床高危因素.方法 回顾性分析我院近8年来100例重度子痫前期及子痫患者的颅脑CT及临床资料.①根据入院诊断分为:子痫组,43例;重度子痫前期组,57例;②根据颅脑CT结果分为3组:出血组7例;缺血组47例;无异常组46例.结果 子痫组脑缺血率为76.8%(33/43),高于重度子痫前期组24.6%(14/57)(χ2＝26.739,P＜0.01);两组颅内出血率无明显差异(F=0.113,P＞0.05).出血组平均动脉压156.0±22.4mmHg,高于缺血组133.6±19.9mmHg(t=2.731,P＜0.01)及无异常组136.1±19.9mmHg(t＝2.416,P＜0.05).血清乳酸脱氢酶含量出血组及缺血组均明显高于无异常组(Z值分别为2.435、2.327,均P＜0.05).出血组并发弥散性血管内凝血及HELLP综合征的发生率为42.9%,明显高于缺血组的10.6%(χ2＝5.011,P＜0.05).预后:死亡2例;植物人状态1例,2例脑缺血患者遗留视力减退.结论 子痫组比重度子痫前期组患者颅脑异常的发生率高.当平均动脉压接近156mmHg左右、乳酸脱氢酶异常增高及合并HELLP综合征、弥散性血管内凝血患者应警惕颅内出血发生.严重脑缺血或颅内出血患者预后不良.

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.

脑血管意外是妊娠期高血压疾病的严重并发症之一,几乎均发生于重度子(癎)前期(preeclampsia)及子痢(eclampsia)患者,是导致孕产妇死亡的主要原因之一[1].目前国内外关于妊娠期高血压疾病并发脑血管病的影像学研究资料较少,更鲜有系统的、大样本的临床研究资料.

Objective To evaluate hepatic enhancement technology with Multi-Slice Spiral CT(MSCT)and its clinical application. Methods One hundred and fifty eight patients underwent enhanced CT scanning using a multi-slice spiral CT scanner and an automatic injector. Total dose of contrast agent for each patient was 80 to 100 ml(1.2ml/kg) at a rate of 1.5 to 3 ml/s. Two-phase enhancement were performed at a delay of 30 and 70 seconds respectively after the initiation of bolus injection. Results Good visualizations of two phases for both hepatic artery and portal vein, in addition with branches of abdominal aorta, hepatic artery, splenic artery, portal vein, inferior vena cava and vasculatures in hepatic port, were achieved in 154 patients. The rest 4 patients did not have ideal two-phase images for various reasons. Conclusions MSCT with bolus injection using an automatic injector can satisfy the diagnosis for both hepatic and many other abdominal diseases.

目的测定正常对照、前列腺增生症( Benign prostatic hyperplasia, BPH)患者、前列腺癌患者血清核糖核酸酶( Ribonuclease, RNA酶)活性,探讨其临床意义.方法以纯酵母 RNA为底物的生化反应测定血清 RNA酶活性.结果正常对照组、 BPH组血清 RNA酶活性分别为( 0.0625± 0.0120)、( 0.0638± 0.0182), 2组无显著性差异( P>0.05).前列腺癌患者组血清 RNA酶活性为( 0.1171± 0.0252),显著高于前 2组( P<0.05).结论血清 RNA酶活性分析有助于前列腺癌的临床研究.

Objective To evaluate intravesical capsaicin for the treatment of obstinate urethral syndrome in female. Methods Thirty two female patients suffering from urethral syndrome not relieved on various therapeutic methods for a long time were treated by bladder instillation of 100 ml of 100 μmol/L capsaicin. Results 15 cases were followed up for more than 12 months with improvement in 94%.The symptoms were totally disappeared in 33% of the patients.The syndrome recurred in 53% between 3～6 months. 1 case did no response to the treatment. Bladder instillation of capsaicin induced an increase of the bladder volume.Some burning sensation was the only side effect. Conclusions Intravesical capsaicin could be a long lasting effective therapeutic method for patients with obstinate urethral syndrome.

我院1998年-2000年采用DSA超选择性肾动脉栓塞治疗肾脏急性大出血患者7例,临床疗效满意,现报告如下. 1临床资料 本组患者7例,均为男性,年龄24-62岁.2例因突发性大量肉眼血尿,其中1例伴左侧腰痛.起病后4-8h急诊入院.