摘要：肺腺癌侵袭性评估一直是胸部影像研究的热点与难点，且肺腺癌患病率和死亡率还在不断增加。影像组学是医学图像分析领域飞速发展的产物，它能通过数字医学图像提取高通量影像组学特征，能定量的反映较传统计算机图像特征更详细的特征，为肺腺癌侵袭性评估提供重要信息。本文主要简谈影像组学技术的概念、步骤，并综述影像组学在肺腺癌侵袭性研究中的进展。

目的 采用Meta分析评价磁敏感加权成像(SWI)在帕金森病(PD)诊断及Hoehn-Yahr分级中的应用.方法 检索PubMed、Web of science、Embass、CNKI、万方和维普数据库,搜集关于SWI在PD诊断及Hoehn-Yahr分级中应用的文献.采用RevMan5.3统计软件进行分析.结果 共纳入文献13篇.早期PD组与对照组黑质、苍白球相位值总体效应检验[Z=2.39、2.66,P=0.02、0.008,95％CI(-0.05,-0.01)、95％CI(-0.06,-0.01)]差异有统计学意义.中晚期PD组与对照组黑质、苍白球、壳核及尾状核相位值总体效应检验[Z=3.82、2.08、3.75、2.05,P=0.0001、0.04、0.0002、0.04,95％CI(-0.08,-0.03)、95％CI(-0.15,-0.00)、95％CI(-0.09,-0.03)、95％CI(-0.01,-0.00)]差异有统计学意义.中晚期PD组与早期PD组黑质、苍白球相位值总体效应检验[Z=3.64、2.39,P=0.0003、0.02,95％CI(-0.06,-0.02)、95％CI(-0.10,-0.01)]差异有统计学意义.结论 早期PD在黑质、苍白球存在异常铁沉积且随着病情进展而增加,SWI对PD的早期诊断及病情评估有重要意义.

目的 探讨CT炎性值及分级评估COVID-19肺炎严重程度的诊断价值及与临床分型的相关性.方法 回顾性分析55例确诊COVID-19患者的实验室检查指标、肺炎的分布、大小、密度、CT炎性值在临床分型中的差异和诊断价值以及CT炎性值分级与临床分型的相关性.结果 重型组的年龄,肺炎的分布、大小、密度、CT炎性值均高于普通组(t=-2.138,-5.055,-6.775,-4.863,-6.064,P<0.05).CT炎性值分级在普通型与重型两组患者间存在显著性差异(χ2=28.212,P<0.05).CT炎性值分级与临床分型相关性:Cramer's V 0.759(P<0.05).CT炎性值的ROC曲线下面积为0.867(P<0.05).结论 CT炎性值与分级对COVID-19肺炎严重程度的评估具有较高的诊断价值和相关性.

目的 采用Meta分析方法评价超声、MRI对妊娠期阑尾炎的诊断效能.方法 检索Cochrane Library、Pubmed、Embase、中国知网、万方医学网和维普数据库中关于超声和/或MRI诊断妊娠期阑尾炎的文献,检索时间从建库至2019年9月.依据纳入及排除标准筛选文献,并进行质量评价.采用Stata15.0、Meta-Disc1.4软件进行统计分析.结果 最终纳入19篇文献(2 379例疑诊妊娠期阑尾炎患者),仅超声诊断妊娠期阑尾炎文献4篇,仅MRI诊断11篇,同时采用超声及MRI诊断4篇.超声对妊娠期阑尾炎的诊断敏感度和特异度分别为0.68[95％CI(0.60,0.75)]和0.98[95％CI(0.95,0.99)],诊断比值比及受试者工作特征(ROC)曲线下面积(AUC)分别为12.53[95％CI(5.78,27.19)]和0.86.MRI对妊娠期阑尾炎的诊断敏感度和特异度分别为0.95[95％CI(0.91,0.98)]和0.98[95％CI(0.97,0.98)],诊断比值比及AUC分别为331.84[95％CI(161.42,682.16)]和0.99,其AUC明显高于超声(Z=7.41,P＜0.001).结论 MRI对妊娠期阑尾炎的诊断效能明显高于超声.

目的:分析新型冠状病毒肺炎(coronavirus disease 2019,COVID-19),的高分辨率CT(high resolution CT,HRCT)影像表现,探讨CT肺部炎症指数(pulmonary inflammation index,PII)和临床多项实验室指标的相关性.方法:回顾性分析重庆医科大学附属永川医院2020年1至2月感染专科病房收治的57例COVID-19患者肺部HRCT影像表现,计算PII,分析PII与年龄、细胞沉降率(erythrocyte sedimentation tate,ESR)、C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin-6,IL-6)、淋巴细胞计数(lymphocyte,LYM)及氧合指数(oxygenation index,OI)的相关性.结果:肺部阴性者3例,阳性病变54例.HRCT表现早期8例,进展期45例,转归期1例,合并双侧少量胸腔积液1例、支气管扩张1例、继发性肺结核3例、主动脉壁或(及)心脏冠状动脉壁钙化7例、肺气肿5例.PII与年龄、ESR、CRP、IL-6呈正相关(P＜0.05);PII与LYM、OI呈负相关性(P＜0.05).结论:COVID-19的HRCT表现具有一定特征性,PII和临床多个实验室指标均具有相关性,可作为半定量评估COVID-19肺部损伤的手段之一.

目的 探讨磁共振水脂分离Dixon技术在非酒精性肝脂肪变性中的肝脏脂肪定量分析中的可行性及临床价值.材料与方法 选取临床确诊为脂肪肝的患者行常规肝脏MRI平扫和双回波水脂分离Dixon技术(T1-VIBE-Dixon)、单体素磁共振波谱分析(magnetic resonance spectroscopy,MRS)序列扫描,获得同相位(in-phase,IP)和反相位(out-phase,OP)及MRS图像,Dixon扫描所得序列通过设备自带软件获得脂肪分数图,将脂肪分数图和MRS序列所测得的脂肪分数(fat fraction,FF)进行回归和相关分析分析其相关性.结果 T1-VIBE-Dixon序列所测得的FF值与1-MRS所测得的FF值相关系数分别为0.99637、0.97917、0.9354,具有高度相关性.结论 采用3.0 T MRI双回波水脂分离Dixon技术定量分析非酒精性肝脂肪变性中的肝脏脂肪是可行的,其结果对非酒精性脂肪肝患者的诊断、随访、治疗效果监测中具有一定的价值.

目的:探究新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)胸部CT半定量评分及分级与临床分型的相关性.方法:回顾性分析2020年1至2月重庆医科大学附属永川医院收治的71例COVID-19患者的临床和影像资料,将患者依据《新型冠状病毒肺炎诊疗方案(试行第六版)》分为轻型(8例)、普通型(53例)、重型(8例)、危重型(2例),比较不同临床分型患者的实验室检查结果,并分析其胸部CT影像表现,根据病变的部位、范围、密度进行半定量评分,计算肺部炎症指数并将其分为5级,分析肺部炎症指数分级与临床分型的相关性.结果:COVID-19的主要临床症状为发热(49例)、咳嗽(43例)等.不同临床分型间淋巴细胞计数、C反应蛋白、红细胞沉降率及降钙素原差异具有统计学意义(P＜0.05).CT表现中,PII 0级中轻型患者8例(100％);PII Ⅰ级中普通型患者34例(97.1％),重型患者1例(2.9％);PII Ⅱ级中普通型患者17例(94.4％),重型患者1例(5.6％);PII Ⅲ级中普通型患者2例(28.6％),重型患者5例(71.4％);PII Ⅳ级中重型患者1例(33.3％),危重型患者2例(66.7％),其差异具有统计学意义(P＜0.05).CT肺部炎症指数分级与临床分型呈正相关,相关系数r=0.75.结论:COVID-19患者的胸部CT半定量评分及分级与临床分型间具有较好的相关性,对临床诊治具有指导意义.

目的 探讨多模态磁共振成像(MRI)对高级别胶质瘤术后复发和假性进展的鉴别诊断价值.方法 回顾性分析重庆医科大学附属永川医院肿瘤科2016年1月至2018年12月期间收治且经病理证实的21例高级别胶质瘤术后复发患者和17例假性进展患者的临床和影像资料,所有患者均行常规MRI及扩散加权成像(DWI)、磁共振波谱成像(1H-MRS)、灌注加权成像(PWI)影像扫描.结果 术后复发与假性进展患者发生时间分别为18(11,25)个月和2(2,5)个月,差异具有统计学意义(P<0.05);术后复发与假性进展的脑血容量(rCBV)比值分别为2.95(1.54,4.82)、0.96(0.45,4.18),脑血流量(rCBF)比值为2.68(1.91,4.16)和1.21(0.79,3.19),差异均具有统计学意义(P<0.05),而平均通过时间(rMTT)、达峰时间(rTTP)、表观弥散系数(rADC)、胆碱/N-乙酰天门冬氨酸(Cho/NAA)、胆碱/肌酸(Cho/Cr)比较差异均无统计学意义(P>0.05);rCBV、rCBF和各参数联合诊断肿瘤复发及假性进展的ROC曲线下面积(AUC)分别为0.780、0.793、0.867.结论 多模态MRI的联合应用对高级别胶质瘤术后复发和假性进展的鉴别具有更高的诊断价值,可为临床治疗方案的选择及评估预后提供参考.

Objective To explore the correlation between lymphocyte subtypes and CT pulmonary inflammatory index in patients with coronavirus disease 2019 (COVID-19). Methods Clinical data of 80 COVID-19 patients identified by nucleic acid test and clinical symptoms admitted in our hospital from January to February 2020 were collected in this study. They were 45 males and 35 females, and at an average age of 51.2 years. According to the severity of the disease, they were divided into the non-severe group (ordinary type, n=68) and the severe group (serious and critical type, n=12). The clinical data, chest CT findings and pneumonia index of the patients were observed and analyzed. Spearman analysis was employed to analyze the correlation between pneumonia index and lymphocyte subtypes count. Results The results showed that the T lymphocyte subsets of patients with COVID-19 were normal or decreased, and the levels of C-reactive protein and IL-6 were increased or normal. During the following courses of disease, within 1 week, weeks 1~2 and 2 weeks later, counts of CD3+ and CD4+ T cells in the severe group were decreased significantly at above 3 periods (P < 0.05), CT pulmonary inflammatory index was obviously elevated at the 3 periods (P < 0.05), and CD8+ T cells count was decreased during the former 2 periods (P < 0.05), when compared with the non-severe group. It was found that the peak time of CT pulmonary inflammation was mainly within 2 weeks after onset, and the beginning time of pneumonia absorption was mainly within 1~3 weeks. The pneumonia index was negatively correlated with CD3+, CD4+, CD8+ T cells and Lym counts (P < 0.05). Conclusion The lower counts of lymphocyte subsets are, the severer the CT pulmonary inflammation is, and the more serious the condition is in COVID-19 patients.

目的:通过Meta分析系统评价Tl mapping定量指标[初始T1值和细胞外容积分数(ECV)]与弥漫性心肌纤维化(DMF)程度的相关性.方法:系统检索2019年9月以前发表于PubMed、Cochrane Library,Medline、CNKI、维普、万方数据库中关于初始T1值和ECV与DMF程度相关性的中英文文献.采用诊断准确性试验质量评价工具2(QUADAS-2)对纳入文献进行质量评价,并应用Stata 15.0软件对纳入文献的r值进行统计学分析.结果:最终纳入11篇文献.初始T1值与DMF程度呈中度正相关(r=0.54,P=0.00,95％CI:0.41?0.65),ECV与DMF程度呈强正相关(r = 0.62,P = 0.00,95％CI:0.54?0.69).结论:初始T1值和ECV与DMF程度存在较好的相关性,T1 mapping可早期无创评估心肌纤维化,指导临床诊疗.

目的 探讨新型冠状病毒肺炎(COVID-19)患者CT肺部炎症指数分级的临床应用价值.方法 回顾性分析2020年1～2月重庆医科大学附属永川医院收治的50例COVID-19患者胸部CT平扫图像和临床资料.根据5阶法对肺部病灶进行分级,其中0级4例,Ⅰ级27例,Ⅱ级12例,Ⅲ级7例,并统计分析临床特征及CT表现,采用Spearman秩相关分析CT肺部炎症指数分级与临床分型的相关性.结果 50例COVID-19确诊患者中49例(98.0％)有明确武汉接触史;发热(68.0％)及咳嗽(42.0％)是最常见的临床症状;炎症指数Ⅱ级、Ⅲ级患者体温高于0级、Ⅰ级患者,差异均具有统计学意义(P<0.05);实验室检查,44例白细胞计数正常,41例中性粒细胞百分比数正常,29例淋巴细胞计数降低,28例超敏C反应蛋白水平升高,38例血沉升高;CT肺部炎症指数分级越高者淋巴细胞计数降低越明显,差异具体统计学意义(P<0.05),CT肺部炎症指数分级越高者血沉和中性粒细胞百分比越高,差异具有统计学意义(P<0.05);炎症指数Ⅰ～Ⅲ级患者肺部CT表显示病灶多累及双肺,其中Ⅰ级COVID-19患者中8例为单发病灶、19例累及双肺;随炎症指数分级升高,肺部病灶由胸膜下转变为内带支气管束周围,且肺部病灶实变增多,差异具有统计学意义(P<0.05);相关性分析结果显示,COVID-19患者CT肺部炎症指数分级与临床分型呈正相关(r=0.701,P<0.05);4例0级均为轻型,27例Ⅰ级、11例Ⅱ级、1例Ⅲ级均为普通型,1例Ⅱ级、6例Ⅲ级为重型.结论 COVID-19患者胸部CT表现具有特征性,CT肺部炎症指数分级与临床分型呈显著正相关,能对其肺部炎症严重程度进行定量评估,此外,胸部CT能早期诊断COVID-19.

Objective:To observe the size and density of adrenal gland, and the dynamic changes in patients with COVID-19.Methods:Study sample consisted of 67 patients diagnosed as COVID-19 (COVID-19 group) and 70 normal controls. COVID-19 group were divided into two groups: ordinary cases and severe cases. The CT value and thickness of adrenal gland in the control group (uni-temporal) and the COVID-19 group (multi-temporal) were measured, the CT value of adreal/erector spinae were calculated.Results:Compared with the control group, the COVID-19 group had bigger body, medial and lateral branches of bilateral adrenal gland ( P<0.05) . There was no significant difference between the CT value of adrenal/erector spinae for the two groups. Receiver operating characteristic curve analysis showed the thickness of right medial adrenal limb in detecting diffuse adrenal hyperplasia was the best (0.881) . And there was no significant difference in the CT value of adrenal/erector spinae, thickness of bilateral adrenal body, medial and lateral branches in COVID-19 group at different times. Conclusion:The bilateral adrenal glands of COVID-19 patients were slightly swollen, adrenal body, medial and lateral branches were slightly bigger than the normal adrenal glands, but the density was normal, and there were no dynamic changes during the course of the disease.

Objective:To explore the applicability and application effect of formative evaluation in mind mapping combined with PBL in the teaching of medical imaging.Methods:A total of 155 students majoring in clinical medicine (general practice) from the fifth clinical college of Chongqing Medical University were recruited in the study, 56 of which were divided in the experimental group and 99 students in the control group, using mind mapping combined with PBL teaching method to carry out medical imaging practice classes. The experimental group were given formative evaluation and questionnaire survey. SPSS 20.0 was used to conduct t test and variance analysis. Results:The questionnaire indicated that 66.0% (37/56) of the students were in favor of the formative evaluation with a Likert score of (4.0±0.7). While the experimental group was superior to the control group in the review test, with statistical significance ( P<0.05). There was no significant difference in the final scores between the experimental group and the control group ( P>0.05), but the results of case-analysis questions in the experimental group were better than those in the control group ( P<0.05). Conclusion:Formative evaluation is applicable to mind mapping combined with PBL in the teaching of medical imaging, which can thoroughly evaluate students' comprehensive ability and quality, improve their sense of self-efficacy, and constantly provide motivation for their learning.

目的 系统评价扩散加权成像(DWI)及动态对比增强磁共振成像(DCE-MRI)诊断腮腺占位性病变的临床价值.资料与方法 计算机系统检索2018年4月30日前发表于PubMed、Cochrane图书馆、Embase等英文数据库,中国知网、中国生物医学文献数据库、维普数据库、万方数字化期刊等中文数据库中关于DWI及DCE-MRI诊断腮腺占位性病变的中、英文文献.采用QUADAS标准对纳入文献进行质量评价,并应用Meta-DiSc 1.4及Stata 12.0软件对纳入文献的研究资料进行统计学分析.结果 最终共纳入13篇文献,包含1221枚腮腺占位性病灶.各研究组间存在明显的异质性,因此采用随机效应模型进行统计.DWI对诊断腮腺占位性病变的合并敏感度、合并特异度、诊断比值比、汇总受试者工作特征曲线下面积和Q*值依次为0.72(95％CI 0.66～0.78)、0.75(95％CI 0.72～0.79)、9.81(95％CI 5.22～18.44)、0.8180、0.7518;DCE-MRI以上参数依次为0.85(95％CI 0.79～0.90)、0.82(95％CI 0.79～0.85)、25.47(95％CI 11.68～55.54)、0.9079、0.8398.结论 DCE-MRI对于腮腺占位性病变良恶性诊断的敏感度及特异度均高于DWI.当使用DWI对腮腺占位性病变诊断存在争议时,可通过DCE-MRI进一步检查.

目的 系统评价关于氟代脱氧葡萄糖(18F-FDG) PET/CT对诊断肾上腺皮质占位性病变的临床价值.方法 计算机系统检索PubMed、Cochrane Library、EMbase、Ovid、中国知网、万方数字化期刊数据库、中国生物医学文献数据库和维普数据库中关于18F-FDG PET/CT诊断肾上腺皮质占位性病变的相应中英文文献,截止时间为2018年2月.应用Metadisc 1.4及STATA 15.1软件对纳入文献的研究资料进行统计学分析,并对纳入文献的数据进行质量评价及异质性检验.结果 最终共纳入6篇文献符合标准,共包含195例肾上腺皮质占位性病灶.各研究组间异质性不明显,故采用固定效应模型.汇总18F-FDG PET/CT对诊断肾上腺皮质占位性病变的合并敏感度、合并特异度、诊断比数比(DOR)及受试者工作特征曲线(SROC)曲线下面积(AUC)和Q*指数分别为0.97[95％ CI(0.91,1.00)]、0.94[95％ CI(0.89,0.97)]、275.47[95％ CI (71.40,1062.82)]、0.9826、0.9423.结论 18F-FDGPET/CT对于肾上腺皮质占位性病变良恶性诊断具有较高的敏感度及特异度.

目的 采用Meta分析评价心脏MR(CMR)检出晚期微血管阻塞(MVO)及心肌内出血(IMH)对预测急性心肌梗死(AMI)再灌注患者主要不良心血管事件(MACE)的价值.方法 检索PubMed、Embase、Web of Science、中国知网、维普及万方数据库于2018年10月前发表的符合纳入及排除标准的文献.采用RevMan 5.3和STATA 15.1软件对纳入文献数据进行统计学分析和质量评价.结果 最终纳入11篇文献,其中9篇内容涉及晚期MVO(共1 872例患者),4篇内容涉及IMH(共1 017例患者).CMR检出晚期MVO对预测MACE发生的比值比(OR)为4.04[95％CI(2.95,5.55),Z=8.65,P＜0.001];CMR检出IMH对预测MACE发生的OR为2.66[95％ CI(1.78,3.96),Z=4.79,P＜0.001].结论 CMR检出晚期MVO和IMH可用于预测AMI再灌注患者随访期间发生MACE.

目的:探讨CBS结合PDG在医学影像学示教的应用效果.方法:302名临床本科全科医学方向学生,呼吸系统CBS+PDG新教学法,循环系统LBL传统教学,进行问卷调查、课堂测试和期末成绩统计对比.结果:学生对新教学法认可度超过90％,明显高于传统教学法.对新教学法三项满意度超过80％.课堂测试成绩两者有显著差异(P＜0.05),新教学法优于传统教学法.期末成绩两者差异无统计学意义(P＞0.05).结论:CBS+PDG教学法在提高影像学实践教学质量及效果和学生综合素质等方面具有积极意义,及时性效果明显优于传统教学法,远期效果有待进一步研究.

CMR and RHC have good consistency in the testing of PVR in the meta-analysis. The systematic review shows that completely noninvasive evaluation of PVR with CMR in patients with pH is feasible.

目的 通过Meta分析方法评价MRI判断颈动脉粥样硬化斑块成分的价值.方法 系统检索2017年10月前发表的与MRI颈动脉粥样硬化斑块成分分析相关,并以病理学诊断为金标准的中、英文研究文献.文献纳入与排除标准参考Cochrane协作网所推荐的内容确定.采用RevMan 5.3软件对纳入文献的研究资料进行统计学分析,并以诊断性试验准确性质量评价(QUADAS)标准进行质量评价.结果 最终纳入文献7篇,共包含813个颈动脉粥样硬化斑块.以病理结果为金标准,MRI识别颈动脉粥样硬化斑块脂质核心的95％CI为(0.80,1.27),比值比(OR)为1.01,Z值为0.06,P值为0.95;识别钙化成分的95％CI为(0.64,1.11),OR为0.85,Z值为1.19,P值为0.23.结论 MRI用以识别颈动脉粥样硬化斑块中的脂质核心及钙化成分具有较高临床价值.

目的 探讨成人腹型过敏性紫癫的临床特征及CT表现.方法 回顾性分析经临床确诊的9例成人腹型过敏性紫癫患者的临床资料及CT表现.结果 9例均有不同部位的皮肤紫癜及不同程度的消化道症状,其中3例伴肾脏损害,1例伴肾脏及关节损害.所有病例肠壁和(或)胃壁增厚或浅溃疡形成,周围脂肪间隙模糊.CT表现为肠壁多环形增厚,分层样(“靶征”)改变,增强扫描轻度或中度强化(占7例).9例均有腹痛,部位不定,可持续隐痛、胀痛,或阵发性绞痛,部分还伴有腹胀、腹泻、呕吐等症状;CT图像上病灶多发者7例,单发者2例,4例累及胃及十二指肠,6例累及空回肠,5例累及结肠,4例累及回盲部,2例累及直肠;1例伴肠梗阻,6例腹腔或腹膜后淋巴结肿大,4例腹盆腔积液.结论 成人腹型过敏性紫癫的CT表现虽缺乏一定的特异性,但可较全面的显示病灶的部位、范围及程度,结合临床资料可为临床明确诊断提供重要依据.