用Kappa统计量评估CT对腰椎间盘突出诊断的一致性

目的采用Kappa统计量评价cT诊断腰椎间盘突出症的一致性。方法回顾性分析120例患者的360个椎间盘的CT图像。由影像科A、B2名医师分别在有及无临床资料的情况下对其中60例患者进行2次评价，再在无临床资料的情况下共同对其中60例患者腰椎间盘进行评价。应用Kappa检验评价同一医生不同情况下和不同医生的诊断结果一致性。结果A、B在无和有临床资料的情况下，两次诊断具有较高的一致性，其Kappa值分别为0．646和0．639。诊断差异主要出现于正常和膨出的鉴别，前后2次诊断膨出的差异达18个和26个，分别占不相符率的47．4％（18／38）和63．4％（26／41）。在有临床资料时，椎间盘膨出的诊断较无临床资料时分别多7个和26个。不同医生之间诊断具有中度一致性，其Kappa值为0．480。诊断差异仍然主要出现在正常和膨出的鉴别，二者之间诊断膨出的差异达37个，占不相符率的61．7％（37／60）。结论应用CT诊断腰椎间盘病变，不同医生之间的诊断一致性较差，并且有无临床资料会影响同一医生的诊断一致性，尤其是影响到腰椎闻盘膨出的诊断。

Endoscopic ultrasound features of gastric schwannomas with radiological correlation:A case series report

Gastric schwannomas are rare mesenchymal tumors of the gastrointestinal tract.They are usually misdiagnosed as other submucosal tumors preoperatively.Experience of the imaging features of gastric schwannomas is extremely limited.In this report,we summarize the features of a series of endoscopic ultrasound(EUS) images of gastric schwannomas in an effort to improve the diagnosis and differential diagnosis rate.We retrospectively reviewed the endosonographic features of four patients with gastric schwannomas and their computed tomography imaging results.Gastric schwannomas had heterogeneous hypoechogenicity or isoechogenicity,and a well-demarcated margin.The tumors originated from the fourth layer.Cystic changes and calcification were uncommon.Marginal hypoechoic haloes were observed in two patients.The results described here were different from those of previous studies.In the EUS evaluation,the internal echogenicity of gastric schwannomas was heterogeneous and low,but slightly higher than that of muscularis pro-pria.These features might help us differentiate gastric schwannomas from other submucosal tumors.Further investigation is needed to differentiate these mesenchymal tumors.

Multidisciplinary imaging of liver hydatidosis

Liver hydatidosis is a parasitic endemic disease affecting extensive areas in our planet, a significant stigma within medicine to manage because of its incidence, possible complications, and diagnostic involvements. The diagnosis of liver hydatidosis should be as fast as possible because of the relevant complications that may arise with disease progression, involving multiple organs and neighboring structures causing disruption, migration, contamination. The aim of this essay is to illustrate the role of imaging as ultrasonography （US）, multi detector row computed tomography, and magnetic resonance imaging （MRI） in the evaluation of liver hydatidosis： the diagnosis, the assessment of extension, the identification of possible complications and the monitoring the response to therapy. US is the screening method of choice. Computed tomography （CT） is indi-cated in cases in which US is inadequate and has high sensitivity and specificity for calcified hydatid cysts. Magnetic resonance is the best imaging procedure to demonstrate a cystic component and to show a biliary tree involvement. Diagnostic tests such as CT and MRI are mandatory in liver hydatidosis because they allow thorough knowledge regarding lesion size, location, and relations to intrahepatic vascular and biliary structures, providing useful information for effective treatment and decrease in post-operative morbidity. Hydatid disease is classified into four types on the basis of their radiologic appearance.

儋州市某医院新建核医学科放射防护效果评价

目的 对儋州市某医院新建核医学科进行放射防护评价,了解单光子发射计算机断层成像术-计算机断层成像(single-photon emission computed tomography-computed tomography,SPECT-CT)诊断、甲功测定、甲亢治疗的放射防护水平。方法 2021年8—10月采用现场调查法和检测检验法,对儋州市某医院新建核医学科工作场所进行放射防护检测、表面污染检测、设备性能检测、通风换气检测及放射防护评价。结果 SPECT-CT工作区注射台窗口(开)、分装柜观察窗、分装柜操作口(开)、废物室防护门和留观室防护门、SPECT-CT机房防护门处的剂量率较高。SPECT-CT中的计算机断层扫描(computed tomography,CT)工作场所辐射水平的周围剂量当量率为0.13~0.19μSv/h,处于环境本底水平。核医学科放射工作场所的表面污染检测结果均小于探测下限,即<0.09 Bq/cm^(2)。SPECT-CT中的SPECT和CT的设备性能检测指标均符合相关标准。通风橱截面风速未达到1 m/s,部分放射工作场所通风换气次数<4次/h。结论 建议院方针对关注点剂量率较高的区域,加强放射防护管理,设置警示标识和中文警示说明,医护人员与受检者短暂停留,规定过程完成后不得在以上区域逗留。通风橱更换大功率风机,增大截面风速。在每个功能房间增设气流单向电动阀,避免各房间通风管道气流互通。在通风橱排风口、各功能用房排风口处增设可更换滤芯的活性炭过滤装置,并定期更换活性炭。