This study investigated the diagnostic performance of dual-energy computed tomography (CT) and deep learning for the preoperative classification of equivocal lymph nodes (LNs) on CT images in thyroid cancer patients. In this prospective study, from October 2020 to March 2021, 375 patients with thyroid disease underwent thin-section dual-energy thyroid CT at a small field of view (FOV) and thyroid surgery. The data of 183 patients with 281 LNs were analyzed. The targeted LNs were negative or equivocal on small FOV CT images. Six deep-learning models were used to classify the LNs on conventional CT images. The performance of all models was compared with pathology reports. Of the 281 LNs, 65.5

To investigate the diagnostic value of the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) for clinically significant prostate cancer (CsPCa). We also aimed to combine PI-RADS v2.1 with prostate-specific antigen (PSA) derivatives to improve the predictive value of CsPCa. We retrospectively collected relevant data who underwent standard MRI examinations of the prostate and subjected to a prostate biopsy at Shenzhen People’s hospital from November 2014 to November 2019. Included 125 cases of CsPCa and 383 cases of non-CsPCa. All cases were scored using the PI-RADS v2.1. The clinical data collected included age, PSA, free PSA/total PSA, prostate volume and PSA density (PSAD). A univariate analysis was performed to identify statistically significant indicators. Logistic regression was used to analyze the predictive value of the multi-parameter combination on CsPCa. Except age, the difference in all of indicators between the CsPCa group and non-CsPCa group was statistically significant. The PI-RADS score and PSAD value had the highest diagnostic value. Logistic regression analysis revealed that the PI-RADS score and PSAD value were independent predictors of CsPCa, with a regression model AUC of 0.935. CsPCa detection rates were low when the PI-RADS score ≤ 2 or the PI-RADS score = 3 and the PSAD value ≤ 0.33 ng/ml/ml. Combining the PI-RADS score and PSAD value improved the predictive performance of CsPCa. Patients with a PI-RADS score ≤ 2 or a PI-RADS score = 3 and a PSAD value ≤ 0.33 ng/ml/ml can avoid an unnecessary biopsy.

The significant progress in cancer treatment, including chemotherapy, immunotherapy, radiotherapy, and combination therapies, has led to higher long-term survival rates in cancer patients, while the cardiotoxicity caused by cancer treatment has become increasingly prominent. Cardiovascular magnetic resonance (CMR) is a non-invasive comprehensive imaging modality that provides not only anatomical information, but also tissue characteristics and cardiometabolic and energetic assessment, leading to its increased use in the early identification of cardiotoxicity, and is of major importance in improving the survival rate of cancer patients. This review focused on CMR techniques, including myocardial strain analysis, T1 mapping, T2 mapping, and extracellular volume fraction (ECV) calculation in the detection of early myocardial injury induced by cancer therapies. We summarized the existing studies and ongoing clinical trials using CMR for the assessment of subclinical ventricular dysfunction and myocardial changes at the tissue level. The main focus was to explore the potential of clinical and preclinical CMR techniques for continuous non-invasive monitoring of myocardial toxicity associated with cancer therapy.

目的 探讨前列腺影像报告和数据系统(PI-RADS)2.1版对前列腺癌(PCa)的诊断效能,结合PI-RADS v2.1及前列腺特异性抗原(PSA)衍生指标,评价其对PCa阳性穿刺结果的预测效能.资料与方法 收集行MRI检查并行首次前列腺穿刺活检术的180例患者,其中良性前列腺增生(BPH)111例,PCa 69例,包括临床有意义的前列腺癌(CsPCa)57例.所有患者均进行PI-RADS v2.1评分,同时收集患者年龄、PSA、游离PSA/总PSA(fPSA/tPSA),并计算PSA密度(PSAD).采用单因素分析各指标在BPH组与PCa组间及非CsPCa组与CsPCa组间的差异,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价各参数对PCa的诊断效能;采用二元Logistic回归分析PI-RADS v2.1联合临床指标对PCa的预测价值.结果 PI-RADS v2.1评分、PSA、fPSA/tPSA、PSAD及前列腺体积在BPH组与PCa组间及非CsPCa组与CsPCa组间差异均有统计学意义(P均<0.05),且PI-RADS v2.1评分对PCa的诊断效能最高,AUC为0.882(P<0.01);Logistic回归分析显示,PI-RADS v2.1评分及PSAD分层是PCa的独立预测因子,回归模型的AUC为0.897(P<0.01);当PI-RADS≤2分且PSAD≤0.350 ng/ml2及PI-RADS=3分且PSAD≤0.150 ng/ml2时,CsPCa阳性率为0.结论 PI-RADS v2.1评分结合PSAD有助于提高PCa的诊断效能,辅助指导临床穿刺决策.当患者PI-RADS≤2分且PSAD≤0.350 ng/ml2或PI-RADS=3分且PSAD≤0.150 ng/ml2时,不提示CsPCa.

患者 男,39 岁.2 年前发现右颊部黄豆大小结节,缓慢增大,现为拇指大小;2 月前右颌下新发核桃大小肿物.入院查体:体温36.3℃,右颊部、颌下分别扪及约5 cm×3 cm、2 cm×2 cm大小肿物,边界清晰,活动度佳,质地中等偏硬,无压痛,表面较光滑;颞下颌关节无压痛,张口度开口型正常;双侧腮腺及颌下腺导管口无红肿,分泌物清亮;双侧颈部及颌下均未触及肿大淋巴结.

目的 采用心脏磁共振特征追踪技术(CMR-FT)量化急性ST段抬高型心肌梗死(STEMI)患者急性期左心室心肌应变及心功能改变,探讨其检测心肌梗死伴微血管阻塞(MVO)的可行性.方法 收集78例急性STEMI患者(梗死组)和10名健康志愿者(对照组)的CMR动态电影序列图像及钆对比剂延迟强化成像(LGE)资料.采用CMR-FT分析电影序列图像左心室整体心肌应变[整体峰值径向应变(GPRS)、周向应变(GPCS)及纵向应变(GPLS)]、节段心肌应变[节段峰值径向应变(PRS)、周向应变(PCS)及纵向应变(PLS)]和左心室心功能[左心室射血分数(LVEF)、左心室舒张末期容积指数(LVEDVi)、左心室收缩末期容积指数(LVESVi)及心脏指数(CI)].根据LGE评估是否存在MVO,将患者分为MVO组(n=50)和无MVO组(n=28),将其左心室心肌节段分为MVO节段组(n=173)和无MVO节段组(n=1 075).根据左心室节段应变绘制ROC曲线,并计算AUC值.结果 梗死组左心室GPRS、GPCS、GPLS、PRS、PCS及PLS与对照组差异均有统计学意义(P均＜0.001);梗死组左心室LVEF、LVEDVi、LVESVi与对照组差异有统计学意义(P均＜0.05);MVO节段组左心室PRS、PCS、PLS与无MVO节段组差异均有统计学意义(P均＜0.001);PRS和PCS取24.65％和-14.05％时检测MVO的敏感性、特异性、AUC分别为89.0％、60.6％、0.816和75.7％、75.9％、0.818.结论 采用CMR-FT测量左心室心肌节段峰值应变可检测急性STEMI患者是否发生MVO,为临床对急性STEMI患者进行早期风险分层管理提供了无创、便捷的新方法.

目的 探讨PI-RADS v2.1联合临床指标对有临床意义前列腺癌(CsPCa)穿刺结果的预测价值.方法 回顾性收集2018年1月～2019年6月于我院行MRI检查并经前列腺穿刺活检的243例患者.分析MRI资料并进行前列腺影像报告与数据系统(PI-RADS v2.1)评分,收集患者临床指标,包括年龄、前列腺特异性抗原(PSA)、游离PSA/总PSA(fPSA/tPSA)、前列腺体积(PV)及前列腺特异性抗原密度(PSAD),并进行单因素分析及多因素分析.多因素Logistic回归分析确定CsPCa独立危险因子并建立回归预测模型,比较预测模型与各独立危险因子的曲线下面积(AUC),评估其诊断效能.校准曲线和决策曲线分别用于评估预测模型校准度及其净效益.并对独立危险因子进行等级划分和组合.结果 入组患者中CsPCa 57例,无临床意义前列腺癌和前列腺增生共186例.多因素Logistic回归分析显示PI-RADS v2.1评分和PSAD是CsPCa独立危险因子.联合上述独立危险因子建立CsPCa预测模型,其AUC值为0.959.校准曲线显示模型有良好的校准度,决策曲线显示当风险阈值大于等于0.05时可获得净收益.将PI-RADS v2.1评分和PSAD值进行组合,当PI-RADS v2.1评分小于等于2且PSAD小于等于0.27 ng/ml2或PI-RADS v2.1评分等于3且PSAD小于0.17 ng/ml2时,CsPCa阳性率为0％.结论PI-RADS v2.1评分与PSAD联合预测模型对CsPCa穿刺结果的预测具有重要价值,将二者等级划分和组合有助于穿刺前对CsPCa的风险评估和决策.

目的 探讨磁共振动脉质子自旋标记(ASL)成像在梗阻性肾病-肾纤维化模型中的应用.材料与方法 将48只SD大鼠随机分为梗阻前组及梗阻后l、2、3、4、5d组,每组8只.采用手术梗阻左侧肾脏,以右肾作为对照.使用3.0T磁共振进行肾脏ASL成像以获得双肾血流量(RBF).扫描后处死动物并行病理学检查,将影像结果与病理结果进行对照.结果 梗阻后1、2、3、4、5d组大鼠肾脏RBF随梗阻时间延长而逐步下降,梗阻后5d组大鼠梗阻侧RBF相当于对侧的29.3％.α-平滑肌肌动蛋白(α-SMA)阳性面积比逐渐升高,梗阻后5d组大鼠梗阻侧α-SMA阳性面积比为(9.37±2.26)％,较对侧[(0.19±0.03)％]显著增高,差异有统计学意义(P＜0.01).梗阻后各组肾脏RBF与α-SMA阳性面积比呈负相关(r=0.72,P＜0.01).结论 磁共振ASL可作为一种无创且不使用造影剂的新技术用于检测梗阻性肾病-肾纤维化进程中RBF的变化,有助于反映肾脏疾病的早期病理生理改变.