目的:探讨人工智能(AI)肺结节定量参数预测亚实性结节(SSN)肺腺癌浸润程度的临床价值.方法:回顾性分析经手术病理证实的 89 例(共 94 个结节)SSN肺腺癌患者的临床及胸部CT资料.根据病理结果,将其分为非浸润性病变组:原位腺癌(AIS)6 个、微浸润性腺癌(MIA)29 个;浸润性病变组:浸润性腺癌(IAC)59 个.比较 2 组临床资料及结节AI定量参数间的差异,采用单因素与多因素二元logistic回归分析筛选SSN肺腺癌浸润程度的独立因素并建立预测模型,以ROC曲线分析模型预测概率和独立预测因子对肺腺癌浸润程度的预测价值.结果:2 组间年龄、长径、短径、恶性概率、体积、质量、最大CT值、平均CT值、CT值方差、球型度、最大面面积、表面积、3D长径、长短径平均值、紧凑度差异均有统计学意义(均P＜0.05).logistic回归分析显示,质量(OR=1.002,P=0.005)和平均CT值(OR=1.006,P=0.001)是SSN肺腺癌浸润程度的独立预测因子,诊断阈值分别为 202.2 mg、-463.5 HU.预测模型为logit(P)=0.002X1+0.006X2+2.554.结论:AI量化参数对预测SSN肺腺癌浸润程度有一定临床参考价值,质量和CT平均值可作为诊断浸润程度的可靠指标.模型预测概率较质量、CT平均值更准确预测IAC的发生.

目的:探讨新型冠状病毒肺炎(COVID-19)报告与数据系统(CO-RADS)评分及临床特征诊断COVID-19的价值.方法:回顾性分析本院COVID-19疫情期间就诊的169例患者的临床及影像资料,其中男68例,女101例,年龄15～98岁,平均(58.0±15.5)岁,入院后均行胸部CT、核酸及抗体检测.由两位影像医师独立进行CO-RADS评分,评价结果一致性,最终评分结果由两者协商确定.以核酸及抗体结果为金标准,分析CO-RADS评分的诊断效能,采用二元logistics回归分析评分预测COVID-19发生的风险.结果:169例患者中共139例确诊为COVID-19,临床症状以发热、咳嗽较常见(59.7％,51.8％),COVID-19患者CRP升高(χ2=15.93,P=0.000)及淋巴细胞百分比降低(χ2=4.11,P=0.043)较非COVID-19患者发生率高.COVID-19患者CT主要表现为病变多发(115/139,82.7％),下叶受累常见(102/139,73.4％),多位于外周或胸膜下(125/139,89.9％),磨玻璃密度(109/139,78.4％)伴铺路石征(83/139,59.7％)是特征表现之一.两位医生对169例患者CO-RADS评分具有较好一致性,线性加权Kappa分析系数值为0.84(95％CI:0.78～0.89).COVID-19患者评分较非COVID-19患者高(Z=-7.473,P=0.000).CO-RADS评分诊断COVID-19的ROC曲线下面积(AUC)为0.91(95％CI:0.85～0.95,Z=13.71,P<0.0001),最佳截断值为3,其敏感度、特异度分别为88.5％、83.3％.单因素二元logistics回归分析显示CO-RADS评分是诊断COVID-19的危险因素,评分为2～5分时其风险是1分的3.43、4.67、45.00、312.00倍.结论:不同医师的CO-RADS评分一致性好,诊断效能高,评分越高COVID-19的风险越大.

目的 探讨新型冠状病毒肺炎(COVID-19)胸部CT表现及其诊断价值.方法 242例患者入院24 h内行胸部CT检查及RT-PCR新型冠状病毒核酸检测,72 h内复查核酸1次,89例患者出院前接受新型冠状病毒血清特异性抗体检测.观察胸部CT有无病变,并分别评价以核酸检测、核酸或血清特异性抗体检测为诊断标准下的胸部CT诊断效能.结果 242例患者临床症状以发热(63.2％)和咳嗽(44.6％)为主.188例患者胸部CT可见炎症表现,以双肺受累多见(88.8％),病变多位于肺野外带及胸膜下(83.5％),右肺和左肺下叶常见(68.1％和62.8％),可见磨玻璃影(86.2％)、混合密度影(88.8％)及实变影(52.1％),磨玻璃影伴铺路石征(44.1％)、晕征(37.8％)、网格征(35.1％),实变病灶常伴空气支气管征(41.5％),部分实变内见肺小血管增粗(13.3％).纵隔淋巴结增大(30.3％)较常见,胸腔少量积液(8.5％)、胸膜增厚(12.2％)、心包积液(4.8％)少见.以核酸检测为诊断标准时,胸部CT诊断COVID-19的灵敏度、特异度、阳性预测值、阴性预测值和AUC分别为89.8％、41.1％、70.2％、72.2％和0.65[95％CI(0.59～0.71)],而以核酸或血清特异性抗体检测为诊断标准时,胸部CT诊断COVID-19的灵敏度、特异度、阳性预测值、阴性预测值和AUC分别为91.3％、78.7％、94.7％、68.5％和0.85[95％CI(0.80～0.89)],后者诊断效能更高(P＜0.01).结论 COVID-19患者胸部CT特征表现是双肺下叶外带的磨玻璃影,以核酸或血清特异性抗体为诊断标准时的灵敏度和特异度均较高,具有重要的诊断价值.

目的 探讨新型冠状病毒肺炎(COVID-19)患者胸部高分辨CT(HRCT)表现及演变规律.方法 回顾性分析我院经RT-PCR确诊COVID-19患者45例,男16例,女29例,年龄25～88岁,平均(47.7±18.2)岁,所有患者均于病程早期(病初1～7 d)、进展期(起病后8～14 d)、恢复期(起病后15～21 d)行HRCT检查,记录各病程期病变肺叶、相对位置、数量、大小、形态、密度、肺外病变及CT征象,比较影像学表现在各病程期有无差异,分析演变规律.结果 45例患者中,全身及呼吸循环系统症状比其他症状更常见(χ2=96.3,P<0.05).病变发生的肺叶、相对位置、数量、大小、密度在各病程期差异无统计学意义(P>0.05),同一病程期内主要分布在双肺下叶、肺野外周及外周+中心,以单发或多发常见;病变形态在各病程期存在差异(Z=12.782,P=0.002),其中斑片状vs.条索状、条索状vs.团块状(Z=-3.067,P<0.01;Z=-2.595,P=0.009),斑片状vs.团块状(Z=-1.280,P=0.201),条索状病变发生率在进展期及恢复期高于早期,呈上升趋势.胸膜增厚、胸腔积液及纵隔淋巴结增大、心包积液在各病程期差异无统计学意义(Z=2.912,P=0.088;Z=-1.291,P=0.197).45例患者各病程期可见充气支气管征、铺路石征、晕征、胸膜下线、网格征.病变主要进展方式有:(1)病灶增大(31/45,68.9％);(2)病灶数量增多(33/45,72.5％);(3)密度改变(39/45,86.7％);(4)病灶局部增多、局部吸收(12/45,26.7％).结论 COVID-19患者肺部病变HRCT表现及演变复杂多样,条索状病变随着病程推进而增加可能是特征性表现之一.

The coronavirus disease 2019 (COVID-19) that occurred in Wuhan, Hubei Province, China, has been declared a public health emergency of international concern and a pandemic by the World Health Organization. The Chinese government has temporarily taken strong response measures and effective procedures to stop the further expansion and development of the epidemic. It is important for clinicians to screen, diagnose, and monitor COVID-19.

目的:通过对尿毒症患者无明显发热症状2019新冠肺炎(COVID-19)与尿毒症肺炎胸部CT影像对比分析,提高尿毒症患者无发热症状COVID-19与尿毒症肺炎鉴别诊断水平.方法:回顾性分析2019年12月15日-2020年2月22日武汉市第一医院13例尿毒症患者初次CT检查无明显发热症状COVID-19及2019年1月1日-2020年2月22日25例尿毒症肺炎患者CT影像表现.结果:COVID-19的磨玻璃影(10/13)、实变影(2/13)及空气支气管征(3/13)占比与尿毒性肺炎(11/25、2/25、2/25)无明显区别(P>0.05);尿毒症肺炎小叶间隔增厚(10/25)及胸腔积液(9/25)明显多于COV-ID-19(0/13、0/13)(P<0.01及P<0.05);COVID-19"铺路石征"或"晕征"(5/13)明显多于尿毒症肺炎(0/25)(P<0.01);COVID-19病灶仅肺外周分布(9/13)及单肺分布(3/13)明显多于尿毒症肺炎(0/25、0/25)(P<0.01及P<0.05),而尿毒症肺炎病灶肺中心分布或中心及外周同时分布(22/25)、双肺分布(25/25)多于COVID-19(4/13、10/13)(P<0.01及P<0.05).结论:CT检查在尿毒症患者中能够鉴别COVID-19与尿毒症肺炎,对此类人群中无发热症状COVID-19患者早发现、早隔离、减少交叉感染起到一定作用.

The present study aimed to evaluate the value of serum amyloid A (SAA) in coronavirus disease 2019 (COVID-19) and compared the efficacy of SAA and C-reactive protein (CRP) in predicting the severity and recovery of COVID-19. A retrospective study was conducted on COVID-19 patients hospitalized in Wuhan No. 1 Hospital (Hubei, China) from January 21, 2020 to March 4, 2020. A two-way ANOVA analysis was used to compare the serum CRP and SAA levels between mild group and severe group during hospitalization days. Linear regression was used to analyze the relationship between the serum CRP, SAA levels and treatment days in recovered patients. The Logistic regression analysis and the area under curve (AUC) were calculated to determine the probability for predicting the severity and recovery of COVID-19. The severe group displayed higher CRP and SAA levels compared with the mild group during hospitalization (P<0.001). Logistic regression indicated that SAA and CRP were independent risk factors for the severity of COVID-19. The corresponding AUC of CRP and SAA values for severity of COVID-19 were 0.804 and 0.818, respectively. Linear regression analysis revealed that CRP and SAA levels were negatively correlated with treatment days in recovered patients (r=-0.761, -0.795, respectively). Logistic regression demonstrated that SAA was an independent factor for predicting the recovery of COVID-19. However, CRP could not predict the recovery of COVID-19. The corresponding AUC of SAA for the recovery of COVID-19 was 0.923. The results of the present study indicated that SAA can be considered to be a biomarker for predicting the severity and recovery of COVID-19.

Objective This paper compared the Results between cardiac MSCT and echocardiography, to evaluate the left ventricular function using coronary CT angiography (CTA).Methods 43 patients [16 men, 27 women, range from 44~87, mean age (62.2±8.7)] were collected in this study. All patients underwent cardiac MSCT, echocardiography (EC) was taken within 48 h. The data were transferred to the postprocessor workstation, and left ventricular ejection fraction (EF) and left ventricular fractional shortening (FS) were given automatically by cardiovascular software. The difference of EF and FS measured by the two Methods were compared. The correlation and concordance of Results between MSCT and echocardiography were also assessed.Results The Results of EF and FS for CTA and EC were (64.05±5.74)%, (60.81±4.6)% and (26.42±3.68)%, (31.16±3.66)%, respectively. There was a significant statistically difference in the EF and FS between the two Methods (t=6.94,P=0.000;t=-16.5,P=0.000). However, the EF and FS measured by CTA have better correlation and consistency with those measured by EC (r=0.85,P=0.000, bias 3.05% andr=0.87,P=0.000, bias 1.89%).Conclusion Application of coronary CTA is quick and convenient to measure the left ventricular function, and the measurement Results with EC has better correlation and consistency.

PurposeTo evaluate multislice spiral CT (MSCT) in diagnosing abdominal anaphylactoid purpura (AAP), and to explore its role in treatment follow-up.Materials and Methods Clinical and MSCT data of 13 patients with confirmed AAP were retrospectively analyzed. All patients underwent abdominal CT scan and thin layer reconstruction. Upper endoscopy was performed in 8 patients prior to treatment. MSCT was performed in 10 patients and endoscopy in 4 patients posttreatment, then clinical and CT features were compared to pretreatment findings.Results In pretreatment CT scan, single segment bowel involvement was found in 2 cases, multisegmental bowel involvement in 10 cases, and no positive finding in 1 patient. The duodenum and jejunum were involved in 8 patients and stomach in 5 patients. The diseased bowel wall showed swelling and thickening with decreased attenuation and homogeneous luminal narrowing with equivocal lining and "double loop" sign. Infiltration was found in 10 patients, small ascites in 3 patients. Patients were misdiagnosed as acute pancreatitis in 2 cases, acute cholecystitis, small bowel obstruction and peritonitis in 1 case respectively. Of 13 patients, five patients were cured, and the other 8 patients were improved. The clinical symptoms including rash, abdominal pain, occult blood, leukocytosis, vomiting, melena, urine occult blood were improved (χ2=5.59-18.33,P<0.05 orP<0.01). Post treatment CT showed significant improvement of bowel edema and infiltration (P<0.01). There was no statistically significant difference in change of ascites (P>0.05).Conclusion MSCT findings of AAP are nonspecific. CT diagnosis is difficult before skin rash. Combining CT characteristics of multisegmental bowel edema and clinical manifestations is helpful. CT examination can effectively follow up treatment response.

Objective To evaluate the diagnostic value of multi-slice computed tomography (MSCT)for incisional hernia of ab-dominal wall before operations.Methods Thirty patients with incisional hernia in abdominal wall confirmed by the pathology were enrolled in this study.All patients underwent MSCT examination with sagittal and coronal MPRs,and 21 cases underwent ultra-sound (US)examinations.The value of transverse scan and MPRs & MSCT and US on demonstrating the number,location,con-tents of incisional hernia,and accompanying intestinal obstruction or other complications were retrospectively evaluated and com-paired.Results Of 30 cases,there were 40 hernias,the rate of MSCT and US in detecting incisional hernias were 97.5% and 56.0%, respectively.MSCT performed better than US on demonstrating the incisional hernias (P =0.000).On MSCT,there was no signif-icant difference in the detection for isolated incisional hernia between the MPRs and axial scans (P = 1.000 ).However,MPR showed a more accurate rate for two or multiple incisional hernias diagnosis (P =0.006),and the sagittal reconstruction displayed more correct than coronal reconstruction on two or multiple incisional hernias (P =0.01 9).Furthermore,MSCT can exactly reveal the complications of incisional hernias (7 cases of intestinal obstruction,5 cases of intestinal ischemia and edema,and 1 case of me-tastasis in incisional hernia),which were not detected by US.Conclusion MSCT can correctly demonstrate the incisional hernia of abdominal wall and its complication,it can provide important imaging reference for clinical therapy.

Objective:To assess the value of MRI in the diagnosis of placenta previa as well as accompanying placenta accreta.Methods:The clinical and imaging materials of 25 pregnant patients with placenta previa were included in this stud-y,the age ranged from 21~43y (mean,29.4±6.2y),the gestational age of the fetuses at the time of MRI ranged from 21~38w (mean,32.9±4.0w).All patients underwent MR and ultrasonography (US)before delivery.Taking pathology and the final clinical diagnosis during delivery as gold standard,the value of these two imaging modalities were compared and ana-lyzed.Results:Among the 25 pregnant women with placenta previa,there were central complete type (19 cases),partial type (3 cases)and marginal type (3 cases).MRI and US correctly diagnosed 20 cases and 18 cases respectively,with no signifi-cant statistic difference (P>0.05).The sensitivity and specificity of MRI and US for accompanying placenta accreta was 71.4%,66.7% and 72.7%,69.2%,respectively;the negative predictive value (NPV)and positive predictive value (PPV) was 76.9%,66.7% and 66.7%,69.2%,respectively.On MRI,the placenta accreta demonstrated partial loss of deciduum, focal thinness or absence of myometrium,nodular interface between placenta and uterus,heterogeneous signal intensities within placenta,bands of hypo-intensities within placenta on T2 WI,loss or diminish of the inter-space between placenta and bladder.Conclusion:MRI and US play an important role in the diagnosis of placenta previa and accompanying placenta accre-ta,they are complementary.

Objective To investigate the imaging feature of elbow joint synovial osteochondromatosis.Methods Fourteen cases of elbow joint synovial osteochondromatosis proved by surgery were collected in this study.The clinical manifestation and imaging findings were analyzed retrospectively.9 sides elbows performed X-ray film,and 6 elbows taken MSCT examination,and 1 elbow performed both X-ray film and MR imaging.Results In 14 cases,there were 10 male cases,4 female cases,and average age was 41.9 years.Unilateral elbow joint involved in 13 cases,bilateral elbow joint in 1 case,the right elbow joint in 12 cases,and the left in 3 cases.Multiple intra-articular calcification or nodules in round or oval could be found in all 9 cases on radiograph.The nodules appeared unequally in magnitude and amounts,uneven density,and presented ring or half ring of high-density.6 cases performed MSCT scan.The results showed bodies.Furthermore,loose bodies in concealed site which were negative on X-ray could be demonstrated on MSCT,as well as thickened synovial,cartilage erosion and the articular cavity effusion.Multiple nodules in elbow joint could be displayed in 1 case who performed MR examination,with the nodules in distinct border,medium or low signal intensity on T1WI,low signal intensity on T2WI.Synovial thickening,little effusion in articular cavity showed clearly on T2WI added STIR sequence.Conclusion The imaging feature of elbow joint synovial osteochondromatosis was typical.The diagnosis could be made if combined with patient′s history.

OBJECTIVE To explore the magnetic resonance imaging (MRI) features and diagnostic value of special-site ectopic pregnancy. METHODS The MRI features of special-site ectopic pregnancy on 39 pathologically confirmed cases were retrospectively analyzed. All cases received ultrasonic inspection, MRI plain scan and 11 cases underwent enhanced scan. RESULTS In 39 cases, there were 3 cases of interstitial tubal pregnancy (n = 3), cornual pregnancy (n = 8) and uterine scar pregnancy (n = 28). The accuracy rates of location and diagnosis were 94.9% and 82.1% respectively. And they were both higher than the rates of ultrasound. They were classified into two groups by clinical outcomes:pregnancy and miscarriage. In 22 cases of pregnancy, there were sac in sac (n = 9) and complete fertilized egg (n = 13). In 17 cases of miscarriage, there were irregular honeycomb (n = 7), ring (n = 6) and mass (n = 4). Among 11 enhanced cases, there were significant enhancement (n = 4), flake or cord-like enhancement (n = 5), a little strengthen on edge (n = 1) and no enhancement (n = 1). The group had intrauterine decidual tissue hyperplasia (n = 22), ovarian cyst (n = 8), pelvic fluid (n = 6), adenomyosis (n = 3), fibroid (n = 2), endometriosis in pelvic and abdominal wall scar area (n = 1) and mild hydrops in right kidney and ureter (n = 1). CONCLUSION The MRI features of special-site ectopic pregnancy are characteristic and important for clinical treatment.

Purpose To investigate the MRI features of intraspinal primary primitive neuroectodermal tumor (PNET). Materials and Methods Six patients with pathology proven PNET were selected, all patients underwent MRI, five additionally underwent contrast enhancement. The location, size, morphological features, signal intensity, contrast enhancement characteristics, involvement of paraspinal soft tissues and adjacent bony structures of PNET were analyzed. Results Five of six cases in epidural region and one case in intradural extramedullary region. Six cases were single lesions with relatively well-defined margin, it appeared lobulate (n=3), stripped and rod-like (n=3). The lesions demonstrated heterogeneous iso-or hyposignal intensity on T1WI and slightly hypersignal intensity on T2WI, and heterogeneously slightly enhanced. The lesion extended through the intervertebral foramen with a paraspinal soft tissue mass in three cases, and adjacent vertebral bone or appendages involvement was demonstrated in four cases. Conclusion MRI is useful in delineating the size, location,extent and involvement of adjacent tissues of PNET, it should be considered when MR imaging demonstrates an intraspinal mass which extends from intervertebral foramen and invades paraspinal soft tissues, vertebral body or appendage.

Objective To determine the usefulness of multi-slice CT(MSCT) with multiple planar reconstruction(MPR) images in the diagnosis of traumatic diaphragm injuries(TDIs).Methods Thirty three patients of TDIs were reviewed retrospectively in this study,including 28 men and 5 women,aged from 1~76 years.Thirty three cases respectively underwent MSCT examinations.Sagittal and coronal MPRs were performed in all cases.The clinical data and MSCT appearances(such as the diaphragmatic discontinuity sign,the collar sign,the bread sign,and intra-thoracic location of herniated abdominal contents) were analyzed.Results Of 33 cases,2 cases were simple contusion,31 cases were blunt trauma injuries(left 26 cases,right 5 cases),The herniation intruding into the thoracic cavity consisted mainly of stomach or fluid gas bowel loops(left 25 cases,right 1 case),liver(only right 3 cases) and abdominal fat(left 16 cases,right 2 cases).The sensitivity of MSCT detecting the abnormality of the diaphragm was 100%.On MSCT images,21 cases(67.7%) showed diaphragmatic discontinuity sign,10 cases(32.2%) showed diaphragm thickening sign,and collar sign and bread sign were seen in 5 cases(16.1%) respectively.Compared with transverse CT scan,MPRs performed better for demonstrating the diaphragmatic discontinuity sign(19 cases vs 8 cases,P<0.05.Conclusion MSCT examinations are useful in the diagnosis of TDIs,especially when MSCT sagittal and coronal MPR images are obtained.

Objective To investigate the imaging diagnostic value for the primary soft tissue tumors of the foot.Methods 55 patients with primary soft tissue tumors of foot were enrolled in this study,including 28 men and 27 women,with age ranging 4 months-79 years.18 cases,17 cases and 44 cases underwent X-ray,CT,and MRI examination,respectively.We mainly analyzed the lesion′s anatomic location,size,morphology,signal intensity or density,characteristic of enhancement respectively.Results Of 55 cases,49 cases were benign(89.1%) and 6 cases malignant(10.9%),with size ranging from 1.1cm to 8.3cm,and predominantly solitary(n=41,74.5%).39 cases(70.9%) were qualitatively diagnosed,and 3 cases malignant tumors of the others were misdiagnosed as benign ones.X-ray,CT and MRI can effectively detect the abnormalities(sensitivity 88.9% vs 94.1% vs 100%).Some tumors could show characteristic MR signal intensity,including 19 cases of hemangioma(high light signal intensity on T2WI and STIR,internal septa can be seen),6 cases of lipoma and lipoblastoma(high signal intensity on T1WI and T2WI,low signal intensity on STIR),2 cases of synovial sarcoma(the invasive rim),3 cases of melanoma(short time on T1WI and T2WI).Of course,it is also difficult to differentiate pigmented villonodular synovitis(PVNS) from giant cell tumor of the sheath(GCTTS) because of the similar low signal intensity on T2WI and bone destruction.Conclusion Imaging examinations can accurately locate the foot tumors and also give qualitative diagnosis for some characteristic tumors.The knowledge of common tumors of the foot aids in clinical planning.

由于十二指肠位置较深,在腹部闭合性损伤中受伤儿率较低(3.7％～5.0％)[1],故十二指肠血肿临床少见,且由于症状不典型,多发生于儿童,疼痛部位、程度及发病时间常不确定,诊断比较困难,易漏误诊并导致严重并发症[2].早期诊断及合理治疗对于十二指肠血肿的预后非常重要[3],本研究回顾性分析经手术和(或)临床随访证实的16例十二指肠血肿的影像学表现,探讨多层螺旋CT (MSCT)对十二指肠血肿的诊断价值. 1资料与方法 1.1研究对象收集温州医学院附属第二医院2006-03～2010-03诊治的十二指肠血肿16例,男11例,女5例;年龄5～71岁,平均(33.4±5.2)岁,12岁以下儿童5例.受伤原因:车祸伤8例,上腹挤压伤(机器挤压及坠落)2例,锐器伤2例,胆道取石术后3例,误服盐酸后1例.临床症状:腹痛14例,呕吐9例,呼吸困难2例.16例中采取手术治疗6例,保守治疗10例;死亡2例,康复14例.

目的 分析22例消化道异位胰腺的CT表现,分析其误诊及漏诊原因,提高对该病的认识.方法 回顾性分析22例经手术及病理证实的异位胰腺的CT征象.结果 22例异位胰腺中,胃大弯2例,胃小弯4例,胃窦9例,十二指肠3例,空肠2例,回肠2例;黏膜下层8例,肌层8例,浆膜层3例、浆膜外3例;22例行CT平扫,13例行CT增强检查,6例明显强化,3例呈中等强化,4例强化不明显;13例中2例诊断为异位胰腺,6例诊断为间质瘤,1例诊断为囊肿,1例考虑为胃癌,2例诊断为淋巴结,9例因合并其他疾病而漏诊.结论 异位胰腺在CT中表现复杂,但存在特征性改变,结合临床资料,做出全面分析,可以全面提高异位胰腺的诊断率,指导临床手术方式.