Portal vein computed tomography imaging characteristics and their relationship with bleeding risk in patients with liver cirrhosis undergoing interventional therapy

BACKGROUND This study aimed to analyze the predictive value of multi-slice spiral computed tomography(CT)perfusion imaging for upper gastrointestinal bleeding in patients with cirrhotic portal hypertension.A total of 62 patients with cirrhotic portal hypertension and 28 healthy individuals were included.The results showed that multi-slice spiral CT perfusion imaging had a significant predictive value for upper gastrointestinal bleeding in patients with cirrhotic portal hypertension.The vascular area,number of vascular cross-sections,and gastric coronary vein diameter(GCVD)showed high predictive values,with the vascular area having the best predictive value.AIM To investigate the predictive accuracy of multi-slice spiral CT perfusion imaging for upper gastrointestinal bleeding in patients with cirrhosis and portal hypertension.METHODS This study included 62 patients with cirrhotic portal hypertension(disease group)and 28 healthy individuals(control group).The disease group was further divided into two subgroups:Group A(n=27,bleeding)and group B(n=35,no bleeding).All patients underwent multi-slice spiral CT perfusion imaging at our hospital,and we compared various parameters such as liver blood flow,vein size,number of blood vessels,and blood vessel area between the two groups.We employed statistical analysis to identify factors associated with upper gastrointestinal bleeding and created a graph comparing the predictive value of different factors for bleeding.RESULTS We found no difference in hepatic artery(HAP)levels among the three groups(all P>0.05).The portal vein levels in groups A and B were much lower than in the control group;group A was much lower than group B(all P<0.05).The HAP perfusion index levels in groups A and B were much higher than in the control group;group A was much higher than group B(all P<0.05).The portal vein diameter,splenic vein diameter,and GCVD levels in groups A and B were much higher than in the control group;those in group A were much higher than those in group B(all P<0.05).The number of blood vessels and blood vessel area in groups A and B were much higher than in the control group;those in group A were much higher than those in group B(all P<0.05).The statistical method showed a strong link between GCVD,number of blood vessels,blood vessel area,and upper gastrointestinal bleeding(odds ratio=1.275,1.346,1.397,P<0.05).The graph showed that GCVD,number of blood vessels,and blood vessel area could predict bleeding well,with blood vessel area having the best prediction power.CONCLUSION That multi-slice spiral CT perfusion imaging can predict upper gastrointestinal bleeding well in patients with cirrhosis and high blood pressure in the portal vein.GCVD,number of blood vessels,and blood vessel area had high prediction power.The blood vessel area had the best prediction power,with an area under the curve of 0.831.

Impact of random and scattered coincidences from outside of field of view on positron emission tomography/computed tomography imaging with different reconstruction protocols

Image quality in positron emission tomography(PET)is affected by random and scattered coincidences and reconstruction protocols.In this study,we investigated the effects of scattered and random coincidences from outside the field of view(FOV)on PET image quality for different reconstruction protocols.Imaging was performed on the Discovery 690 PET/CT scanner,using experimental configurations including the NEMA phantom(a body phantom,with six spheres of different sizes)with a signal background ratio of 4:1.The NEMA phantom(phantom I)was scanned separately in a one-bed position.To simulate the effect of random and scatter coincidences from outside the FOV,six cylindrical phantoms with various diameters were added to the NEMA phantom(phantom II).The 18 emission datasets with mean intervals of 15 min were acquired(3 min/scan).The emission data were reconstructed using different techniques.The image quality parameters were evaluated by both phantoms.Variations in the signal-to-noise ratio(SNR)in a 28-mm(10-mm)sphere of phantom II were 37.9%(86.5%)for ordered-subset expectation maximization(OSEM-only),36.8%(81.5%)for point spread function(PSF),32.7%(80.7%)for time of flight(TOF),and 31.5%(77.8%)for OSEM+PSF+TOF,respectively,indicating that OSEM+PSF+TOF reconstruction had the lowest noise levels and lowest coefficient of variation(COV)values.Random and scatter coincidences from outside the FOV induced lower SNR,lower contrast,and higher COV values,indicating image deterioration and significantly impacting smaller sphere sizes.Amongst reconstruction protocols,OSEM+PSF+TOF and OSEM+PSF showed higher contrast values for sphere sizes of 22,28,and 37 mm and higher contrast recovery coefficient values for smaller sphere sizes of 10 and 13 mm.

Qualitative visual trichotomous assessment improves the value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in predicting the prognosis of diffuse large B-cell lymphoma

Introduction:Fluorine-18 fluorodeoxyglucose(18F-FDG)positron emission tomography/computed tomography(PET/CT)is a powerful tool for monitoring the response of diffuse large B-cell lymphoma(DLBCL)to therapy,but the criteria to interpret PET/CT results remain under debate.We investigated the value of post-treatment PET/CT in predicting the prognosis of DLBCL patients when interpreted according to qualitative visual trichotomous assessment(QVTA)criteria compared with the Deauvil e criteria.Methods:In this retrospective study,final PET/CT scans of DLBCL patients treated with rituximab-based regimens between October 2005 and November 2010 were interpreted using the Deauvil e and QVTA criteria.Survival curves were estimated using Kaplan-Meier analysis and compared using the log-rank test.Results:A total of 253 patients were enrol ed.The interpretation according to the Deauvil e criteria revealed that 181patients had negative PET/CT scan results and 72 had positive results.The 3 year overal survival(OS)rate was significantly higher in patients with negative scan results than in those with positive results(91.6%vs.57.5%,P<0.001).The72 patients with positive scan results according to the Deauville criteria were divided into two groups by the interpretation according to the QVTA criteria:29 had indeterminate results,and 43 had positive results.The 3 year OS rate was significantly higher in patients with indeterminate scan results than in those with positive results(91.2%vs.33.5%,P<0.001)but was similar between patients with negative and indeterminate scan results(91.6%vs.91.2%,P=0.921).Conclusions:Compared with the Deauvil e criteria,using the QVTA criteria for interpreting post-treatment PET/CT scans of DLBCL patients is likely to reduce the number of false positive results.The QVTA criteria are feasible for therapeutic outcome evaluation and can be used to guide risk-adapted therapy.

The practical value of 3-dimensional computed tomography on diagnosis of bladder tumor

Objective To study the practical value of 3-dimensional computed tomography on diagnosis of bladder tumor, Methods Fifteen patients with bladder masses were examined by thin-layer computed tomography. The results of 3-dimensional reconstructed images were compared with the final diagnosis and the pathological stages. Results According to 3-dimensional reconstructed images, among the 15 cases, 12 cases of bladder cancer were diagnosed, and the pathological types were transitional carcinoma. Two cases were diagnosed as benign tumor (leiomyoma), and the other one was colon cancer, which invaded bladder. The accuracy was 100% . The clinical stages were determined. Of the 12 bladder carcinomas,5 was in stage T1, 3 in T2,, 3 in T3 and 1 in T4.The accuracy of staging was up to 83% (10/12) compared with pathological stages. Conclusion The 3-dimensional reconstructed technology may improve the accuracy of staging of bladder carcinoma, and to provide important evidence for surgery options. 3 refs,2 figs.

优化双下肢动脉能谱CT血管造影成像方案

目的优化双下肢动脉能谱CT血管造影(CTA)成像方案。方法回顾性分析30例疑诊双下肢动脉硬化性闭塞症(ASO)患者双下肢动脉能谱CTA资料,经重建获得40~80 keV(间隔5 keV)单能量(共9种)及100 kVp混合能量图像,对比双下肢动脉在不同图像中的CT值、噪声(SD)值、信噪比(SNR)及对比度噪声比(CNR);针对50、60 keV单能量和100 kVp混合能量图像质量及血管节段的可诊断性进行主观评估,观察40、45、50、60 keV单能量和100 kVp混合能量图像的自动去骨能力。结果40~80 keV范围内,随keV升高,各动脉在图像中的CT值、SD值、SNR及CNR均逐渐降低。相比100 kVp,腘动脉(PA)及其近端动脉的CT值、CNR及SNR均在40~55 keV图像中升高(P均<0.05);50~55 keV图像中SD值升高(P均<0.05),而60 keV图像中差异无统计学意义(P>0.05)。50及60 keV图像质量主观评分及可诊断动脉节段数与100 kVp差异均无统计学意义(P均>0.05)。PA以远节段的SNR及CNR在各单能量图像及100 kVp图像中差异均无统计学意义,其CT值在40~45 keV图像中、SD在40 keV图像中均高于100 kVp(P均<0.05),但SD在45 keV与100 kVp图像中差异无统计学意义(P>0.05);50 keV图像中,PA以远节段图像质量主观评分及可诊断节段数均高于60 keV及100 kVp(P均<0.05)。40 keV图像对9例(9/30,30.00%)、45 keV图像对6例(6/30,20.00%)不能自动去骨,50及60 keV、100 kVp对30例(30/30,100%)均可自动去骨。结论行双下肢动脉能谱CTA时,对PA及其近端节段以60 keV单能量成像较佳,对其以远或双下肢全程则以50 keV单能量成像较佳。

基于增强CT影像组学预测食管鳞癌淋巴血管侵犯状态的价值

目的:探讨基于增强CT影像组学预测食管鳞癌(ESCC)淋巴血管侵犯(LVI)的价值。方法:回顾性搜集行根治性切除术并经术后病理证实的224例食管鳞癌患者,其中包括66例LVI阳性和158例LVI阴性患者。所有患者均在术前2周内进行胸部增强CT扫描。将入组的患者按照7:3的比例随机分为训练集和测试集。使用3D Slicer软件逐层勾画全肿瘤感兴趣区(ROI),采用Python软件的Pyradiomics包提取肿瘤组织的影像组学特征,建立影像组学模型用于预测食管鳞癌的LVI状态并进行验证。采用受试者工作特征(ROC)曲线的曲线下面积(AUC)、敏感度、特异度、准确度、阳性预测值和阴性预测值来评价影像组学模型的诊断效能,使用校准曲线评价影像组学模型在训练集和测试集中的拟合程度。使用决策曲线分析(DCA)评价影像组学模型的临床应用价值。结果:从全肿瘤ROI中提取了1130个组学特征,经过筛选最终保留了7个影像组学特征,并使用多因素logistic回归建立影像组学预测模型。在训练集中,影像组学模型预测LVI的AUC值为0.930,敏感度为0.851,特异度为0.919,准确度为0.899,阳性预测值为0.816,阴性预测值为0.936;在测试集中,AUC值为0.897,敏感度为0.789,特异度为0.787,准确度为0.788,阳性预测值为0.600,阴性预测值为0.902。校准曲线显示影像组学模型在训练集及测试集中的预测概率与实际概率的一致性良好。DCA曲线显示影像组学模型具有良好的临床应用价值。结论:基于增强CT构建的影像组学模型,能够在术前有效预测食管鳞癌的LVI状态。

定量CT评价胸椎骨密度及与年龄相关的骨丢失

目的探讨胸椎定量CT(QCT)测量骨密度及骨丢失率的可行性。方法选取因健康体检及急腹症行全腹部CT扫描的患者708例,使用QCT软件测量T10-L3椎体骨密度。将受检者按每10岁为一个年龄段分组。计算每个年龄组的胸椎及腰椎骨密度,并计算各组别的峰值骨密度及骨丢失率。胸椎与腰椎骨密度及其与年龄的相关性采用Pearson相关分析。结果男性、女性骨密度峰值均在20~29岁年龄组,30岁以后胸腰椎骨密度开始不同程度减低,80~89岁女性胸椎及腰椎累计骨丢失率分别为60.61%及61.34%,而男性分别为44.45%及49.35%。男性与女性胸腰椎骨密度均与年龄呈负相关(P<0.01)。胸椎与腰椎骨密度呈正相关(男性r=0.96、女性r=0.98,P<0.01)。结论胸椎及腰椎QCT均能准确地显示不同年龄组的骨密度及骨丢失情况,胸椎QCT可以作为评价和监测骨丢失的一种方法。

基于不同管电压的人工智能重建算法对胸部体模CT扫描图像质量和辐射剂量的影响研究

目的:基于成年男性仿真胸部体模(PH-N1)CT扫描,探究不同管电压结合人工智能(AI)重建(CI)算法对胸部体模CT扫描图像质量和辐射剂量的影响。方法:采用512层超高端CT分为4种管电压对体模进行扫描,分别为70 kV、80 kV、100 kV和120 kV,对不同管电压的CT扫描图像采用10%、30%、50%、70%和90%CI算法重建1 mm薄层图像,比较4组扫描的容积剂量指数(CTDIvol)和剂量-长度乘积(DLP)。测量图像主动脉、腹壁脂肪及竖棘肌的CT值、标准偏差(SD)值,由两名5年以上工作经验的高年资诊断医师独立双盲的对图像质量进行5分制评估,并行Kappa一致性检验。采用单因素方差分析比较图像目标组织的CT值、SD值差异。采用Friedman秩和检验比较组间主观图像质量的差异。结果:4种不同管电压的CTDIvol和DLP比较,差异有统计学意义(F=1855.617、3996.118,P<0.05)。在70 kV管电压下,10%、30%、50%、70%和90%CI算法重建的主动脉、腹壁脂肪及竖棘肌的CT值比较,差异均无统计学意义(P>0.05),而SD值差异均有统计学意义(F=32.267、53.327、14.873,P<0.05)。在90%权重的CI算法重建4种不同管电压下,主动脉、腹壁脂肪及竖棘肌的CT值随着管电压的降低,CT值逐渐降低,差异有统计学意义(F=139.899、2563.93、219.231,P<0.05)。两名诊断医师对各组图像的主观评分一致性较好(Kappa=0.712~0.869)。结论:CI算法在70 kV管电压下90%权重的CI算法重建图像与80 kV、90 kV、120 kV图像相比,可以明显降低辐射剂量,同时图像具有良好信噪比。

宽体探测器CT血管造影与超声心动图对小儿先天性心脏病的诊断效能

目的探讨宽体探测器CT血管造影(computer tomography angiography,CTA)与超声心动图(ultrasound cardiogram,UCG)在小儿先天性心脏病(congenital heart disease,CHD)的诊断效能。方法回顾性分析2019-08/2023-09月作者医院收治的65例疑似CHD患儿的影像学资料,所有患儿均行心脏CTA及UCG检查。对两种检查方式的图像质量进行主观评价并比较其差异;以手术或数字减影血管造影(digital subtraction angiography,DSA)为“金标准”,对比两种检查方式在诊断CHD的灵敏度、特异度、阳性预测值、阴性预测值及准确率的差异,并应用Kappa检验比较与“金标准”结果的一致性;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析两种检查方式对小儿CHD的诊断效能。结果CTA诊断小儿CHD心外畸形图像质量主观评分明显高于UCG,二者比较差异具有统计学意义(P<0.05),心内畸形图像质量主观评分二者比较差异无统计学意义(P>0.05)。两名医师对图像质量主观评分的一致性较好(κ=0.802)。CTA、UCG诊断小儿CHD心内畸形准确率比较差异无统计学意义(P>0.05);CTA诊断小儿CHD心外畸形准确率为96.43%,显著高于UCG 50.00%,组间比较差异具有统计学意义(P<0.05)。CTA诊断小儿CHD的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为90.00%、60.00%、96.43%、33.33%及87.69%,与手术或DSA结果一致性较好(κ=0.766);UCG诊断CHD的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为83.33%、20.00%、92.59%、9.09%及79.81%,与手术或DSA结果一致性一般(κ=0.522)。CTA、UCG两种检查方式诊断小儿CHD的灵敏度、特异度、阴性预测值及准确率差异比较均有统计学意义(P均<0.05)。ROC曲线分析结果显示,CTA与UCG诊断小儿CHD的曲线下面积(area under the cure,AUC)分别为0.853和0.773,二者比较差异有统计学意义(P<0.05)。结论宽体探测器CTA在小儿CHD心外畸形方面的诊断效能优于UCG,而在心内畸形方面稍差,因此建议二者联合检查,诊断价值更高。

螺旋CT三维扫描重建联合3D打印用于髋臼骨折手术的价值研究

目的:探讨螺旋CT三维扫描重建联合3D打印技术在髋臼骨折外科手术中的应用价值。方法:选取2018年1月至2020年12月新疆维吾尔自治区人民医院收治的71例髋臼骨折并接受手术治疗的患者,依据治疗方式的不同将其分为观察组(38例)和对照组(33例),观察组采用螺旋CT三维重建,并以3D打印辅助内固定治疗,对照组采用常规手术治疗。比较两组患者手术效果及恢复情况。结果:观察组骨折复位质量评分及分项百分制髋功能评分高于对照组,术中出血量、术中透视次数、手术用时及住院时间均明显低于对照组,差异均有统计学意义(t=23.426、4.216、3.425、17.783,P<0.05);观察组和对照组骨折复位优良率分别为94.74%和78.79%,差异有统计学意义(x^(2)=4.059,P<0.05);观察组患者髋关节功能评分中疼痛、功能及关节活动均高于对照组,差异有统计学意义(t=-4.873、-5.776、-6.247,P<0.05);观察组并发症发生率明显低于对照组,差异有统计学意义(x^(2)=4.059,P<0.05)。结论:在髋臼骨折围术期应用螺旋CT三维重建结合3D打印可进一步保证手术的安全性和可行性,提高手术质量和效率,促进术后恢复。

胸部定量CT对COPD患者治疗反应预测因素分析

目的分析胸部定量CT扫描对慢性阻塞性疾病(COPD)患者治疗反应的预测因素。方法回顾性分析2018年8月至2021年2月接受治疗COPD患者120例的临床资料,对其随访1年,根据肺功能检测结果将其分为有治疗反应组[n=24,第1秒用力呼气容积(FEV_(1))增加≥0.225 L]和非无治疗反应组(n=96,FEV_(1)增加<0.225 L)。对2组一般资料进行单因素分析,对其中差异有统计学意义的变量进行多因素Logistic回归分析,从而筛选出预测COPD患者治疗反应的因素。结果单因素分析结果显示,有治疗反应组和无治疗反应组在EI、ATI、Pi10、WA%、T方面的差异有统计学意义(P<0.05),而2组间性别比、年龄、体重指数、GOLD分期、入院肺功能检测的差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,Pi10为预测COPD患者治疗反应的因素(OR=2.321,P<0.05)。ROC曲线显示,Pi10在预测COPD患者治疗反应中具有极高的临床价值,ROC曲线显示,Pi10预测COPD患者治疗反应的曲线下面积为0.701,95%CI为0.610~0.781,约登指数为0.354,最佳截断值为4.65 mm,灵敏度为85.40%,特异度为50.00%。结论胸部定量CT扫描参数Pi10能够帮助预测COPD患者治疗反应。

基于定量CT身体组分、^(18)F-FDG PET/CT显像预测手术联合新辅助化疗治疗早期乳腺癌预后的价值

目的 分析定量CT (QCT)身体组分、^(18)F-氟脱氧葡萄糖正电子发射型计算机断层显像(^(18)F-FDG PET-CT)对手术联合新辅助化疗(NAC)治疗早期乳腺癌患者预后的预测效能,为临床治疗提供参考。方法 选取2020年3月至2022年10月于南阳市第二人民医院接受手术联合NAC治疗的82例早期乳腺癌患者纳入研究,在NAC前和化疗1、3个周期后检测记录QCT参数[L_(1)、L_(2)水平的皮下脂肪面积(SFA)、内脏脂肪面积(VFA)、骨密度(BMD)、L_(3)水平的椎旁肌肉面积(TMA)]、^(18)F-FDG PET/CT显像的最大标准摄取值(SUV_(max))、肿瘤代谢体积(MTV)。NAC结束后进行手术,随访12个月(失访2例),依据有无复发转移分为预后良好组43例和预后不良组37例,比较不同预后患者的QCT参数、^(18)F-FDG PET/CT显像指标,采用受试者工作特征(ROC)曲线获取曲线下面积(AUC)分析其对早期乳腺癌患者预后的预测效能。结果化疗1个周期后,预后良好组患者的SFA、BMD、VFA、MA水平分别为(45.23±4.07) cm^(2)、(128.97±26.53) mg/m^(2)、(78.07±6.69) cm^(2)、(37.36±5.74) cm^(2),明显高于预后不良组的(42.52±3.32) cm^(2)、(112.54±25.82) mg/m^(2)、(73.73±7.25) cm^(2)、(32.94±5.31) cm^(2),差异均有统计学意义(P<0.05);化疗3个周期后,预后良好组患者的SFA、BMD、VFA、MA水平分别为(40.95±3.92) cm^(2)、(113.55±15.87) mg/m^(2)、(73.59±6.17) cm^(2)、(32.67±4.98) cm^(2),明显高于预后不良组的(37.51±3.56) cm^(2)、(95.18±17.45) mg/m^(2)、(70.30±5.14) cm^(2)、(28.52±4.42) cm^(2),差异均有统计学意义(P<0.05);化疗1个周期后,预后良好组患者的SUV_(max)、MTV分别为5.43±1.25、(3.86±0.87)×10^(4)mm,明显低于预后不良组的6.04±1.07、(4.27±0.85)×10^(4)mm,差异均有统计学意义(P<0.05);化疗3个周期后,预后良好组患者的SUV_(max)、MTV分别为3.94±1.06、(2.61±0.70)×10^(4)mm,明显低于预后不良组的4.73±1.21、(3.05±0.93)×10^(4)mm,差异均有统计学意义(P<0.05);经ROC曲线分析结果显示,SFA、BMD、VFA、MA、SUV_(max)、MTV联合预测手术联合NAC治疗早期乳腺癌患者预后的AUC分别为0.898 (95%CI:0.809~0.954)、0.919 (95%CI:0.836~0.968)。结论 NAC过程中检测QCT参数、^(18)F-FDG PET/CT显像指标可预测手术联合NAC治疗早期乳腺癌患者的预后,联合预测的价值较高。

胸部CT对系统性红斑狼疮淋巴结肿大的评估及其与疾病进程关系的研究

目的:探讨胸部CT对系统性红斑狼疮淋巴结肿大的评估价值及其与疾病进程的关系。方法:选择2020年7月至2023年7月亳州市人民医院收治的70例系统性红斑狼疮患者,按照胸部CT检查显示是否存在淋巴结肿大将其分为淋巴结肿大组(35例,短径>10 mm)和非淋巴结肿大组(35例,短径<8 mm)。采集两组患者基线资料,检测实验室指标并进行对比,将上述指标中差异有统计学意义的因素纳入多因素logistic回归分析,筛选系统性红斑狼疮患者发生淋巴结肿大的危险因素,分析典型病例的影像学图像。结果:淋巴结肿大组患者关节炎的发生率高于非淋巴结肿大组,肾损害的发生率低于非淋巴结肿大组,差异有统计学意义(x^(2)=4.769、4.884,P<0.05);淋巴结肿大组患者抗核抗体(ANA)、抗ds-DNA抗体及抗Sm抗体阳性率均高于非淋巴结肿大组,差异有统计学意义(x^(2)=4.590、5.040、5.833,P<0.05),白细胞计数(WBC),补体C3和C4水平均低于非淋巴结肿大组,红细胞沉降率(ESR)、免疫球蛋白G(IgG)及系统性红斑狼疮疾病活动指数(SLEDAI)评分均高于非淋巴结肿大组,差异有统计学意义(t=28.179、20.791、26.192、16.173、41.142、10.057,P<0.05);logistic回归分析结果显示,补体C3、IgG及SLEDAI评分是系统性红斑狼疮患者发生淋巴结肿大的危险因素(OR=3.034、2.721、1.127,P<0.05),而年龄大、肾损害为保护因素(OR=0.259、0.254,P<0.05)。结论:淋巴结肿大的出现预示着患者的疾病进展的过程中发生多系统损害的风险较大,且病情活动度较为严重。

PET/CT联合血清lncRNA THRIL、miR-98-5p检测对孤立性肺结节良恶性的诊断价值

目的 探究正电子发射断层扫描和计算机断层扫描(PET/CT)联合血清长链非编码RNA THRIL(lncRNA THRIL),微小RNA-98-5p(miR-98-5p)检测对孤立性肺结节(SPN)良恶性的鉴别诊断价值。方法 选取2022年5月至2023年5月在南阳市中心医院收治的115例SPN患者作为研究对象,根据病理检查结果将SPN患者分为良性组(75例)和恶性组(40例),比较两组血清lncRNA THRIL、miR-98-5p表达水平。Pearson法分析血清lncRNA THRIL与miR-98-5p的相关性。一致性Kappa检验比较PET/CT、血清lncRNA THRIL、miR-98-5p单独及联合诊断SPN恶性与病理结果的一致性。受试者工作特征(ROC)曲线分析PET/CT检查联合血清lncRNA THRIL、miR-98-5p水平对恶性SPN的诊断价值。结果 恶性组血清lncRNA THRIL水平比良性组高,miR-98-5p水平比良性组低(P<0.05)。Pearson分析显示,lncRNA THRIL与miR-98-5p表达呈负相关(r=-0.491,P<0.05),且lncRNA THRIL与miR-98-5p有靶向结合位点。PET/CT、血清lncRNA THRIL、miR-98-5p联合共诊断出38例恶性SPN患者,与病理诊断的一致性较高,Kappa值为0.729(P<0.05),联合诊断恶性SPN的特异度、灵敏度、阳性预测值、阴性预测值、准确性均最高,分别为90.67%、95.00%、84.44%、97.14%、92.17%。PET/CT、血清lncRNA THRIL、miR-98-5p联合诊断恶性SPN的曲线下面积(AUC)为0.921(95%CI:0.874~0.968),均优于各自单独检测(Z=2.235、2.478、2.444,P<0.05)。结论 PET/CT联合血清lncRNA THRIL、miR-98-5p检测可提高对恶性SPN诊断的灵敏度及准确性,对SPN良恶性的鉴别诊断具有一定的应用价值。

PET/CT评估IA期肺腺癌浸润程度及增殖活性的临床研究

目的探讨正电子发射计算机断层(PET/CT)显像半定量参数对IA期肺腺癌的诊断价值及与肿瘤增殖细胞核抗原(Ki-67)的相关性。方法回顾性分析2021年10月至2023年6月成都市第二人民医院收治的51例IA期肺腺癌患者的PET/CT影像学及病理学资料,按浸润程度不同分为非浸润腺癌组22例和浸润性腺癌组29例,比较两组患者的病灶最大标准化摄取值(SUVmax)及Ki-67表达值的差异,绘制受试者工作曲线(ROC)分析SUVmax对浸润性腺癌的诊断效能,采用Pearson分析SUVmax与Ki-67表达值的相关性。结果浸润性腺癌组患者的平均SUVmax为6.65±1.17,明显大于非浸润腺癌组的1.01±0.53,差异有统计学意义(P<0.05);经ROC分析结果显示,SUVmax=1.75为最佳诊断临界值,敏感度为82.8%,特异度为95.5%;浸润性腺癌组患者的平均Ki-67阳性表达值为(23.34±3.7)%,明显高于非浸润腺癌组的(1.36±0.65)%,差异有统计学意义(P<0.05);经Pearson相关性分析结果显示,Ki-67阳性表达值与SUVmax呈正相关(r=0.725,P<0.05)。结论不同浸润程度的IA期肺腺癌PET/CT表现存在差异,SUVmax对诊断浸润性腺癌有一定帮助,并且与Ki-67表达值显著相关。

探讨定量CT及生物电阻抗测定内脏脂肪面积和骨密度的关系

目的:探讨采用定量CT(Quantitative computer tomography,QCT)及生物电阻抗(Bioelectrical impedance analysis,BIA)测定内脏脂肪面积(Visceral fat area,VFA)与骨密度(Bone density,BMD)的关系。方法:回顾性选取郑州大学第一附属医院健康管理中心1131例体检者行QCT和BIA测定的VFA及BMD,采用Pearson相关系数、多因素线性回归、单因素和多因素Logistic回归分析二者的相关性;并采用Bland-Altman评估两者测定VFA的一致性。结果:Pearson相关分析显示QCT和BIA测定的VFA与BMD呈负相关(r=-0.197和r=-0.288)。多因素Logistic回归分析显示VFA(BIA)是骨量下降的危险因素(OR=1.010,95%CI:1.005~1.015);VFA(QCT)是骨量下降的危险因素(OR=1.003,95%CI:1.001~1.005);Bland-Altman分析显示,QCT和BIA测量VFA具有较高的一致性。结论:VFA是骨量下降的危险因素,测定VFA的QCT和BIA两者具有较高的一致性,可以采用BIA测定的VFA评估骨量下降。

疑诊原发性甲状旁腺功能亢进症的患者术前^(99m)Tc-MIBI SPECT/CT显像结果的影响因素分析

目的探讨疑诊原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)的患者术前^(99m)Tc-甲氧基异丁基异腈(methoxyisobutylisonitrile,MIBI)单光子发射计算机断层扫描/计算机断层扫描(single-photon emission computed tomography/computed tomography,SPECT/CT)(以下简称MIBI SPECT/CT)显像结果的影响因素。方法将2019年1月至2023年8月于首都医科大学附属北京朝阳医院疑诊PHPT并在术前完善甲状旁腺MIBI SPECT/CT显像的257例患者作为研究对象。比较MIBI SPECT/CT显像阳性组和阴性组的实验室检查、病理特征及影像特征。采用多因素Logistic回归分析MIBI SPECT/CT显像结果的影响因素。结果单因素分析显示,与阴性组相比,血清总钙、血清甲状旁腺激素(parathyroid hormone,PTH)、碱性磷酸酶(alkaline phosphatase,ALP)水平在阳性组显著升高(P<0.05);病灶的病理类型、最大径、体积及位置在两组间差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,术前血清PTH水平、病灶病理类型、位置及最大径与MIBI SPECT/CT显像结果阳性显著相关(P<0.05)。结论疑诊PHPT患者术前MIBI SPECT/CT显像结果受多重因素影响,术前血清PTH水平、病灶病理类型、位置及最大径是MIBI SPECT/CT显像结果的独立影响因素。

不同扫描延迟技术在大螺距冠状动脉CT血管成像中的对比研究

目的:比较2种扫描延迟技术在大螺距冠状动脉CT血管成像(CCTA)中运用的可行性。方法:前瞻性收集临床疑似冠心病行CCTA检查的心率≤60次/分病人58例,随机分为团注跟踪组31例和测试团注组27例。分别在主动脉根部、左主干、左前降支近段、左回旋支近段、右冠状动脉近段、肺动脉、左心房和左心室选取感兴趣区,测量CT值和噪声,计算信噪比、对比噪声比、左房室比、左室肺动脉比和主肺动脉比,评估2组图像质量,比较2组客观和主观评价指标差异。结果:2组各目标血管强化CT值、信噪比和对比噪声比差异均无统计学意义(P>0.05),团注跟踪组肺动脉CT值、左房室比、左室肺动脉比和主肺动脉比均明显低于测试团注组(P<0.01)。2组主观图像质量评分差异无统计学意义(P>0.05)。团注跟踪组CT剂量指数、剂量长度乘积、有效辐射剂量、注射流率和对比剂量均低于测试团注组(P<0.05~P<0.01)。结论:大螺距CCTA采用团注跟踪技术,可提高血管强化CT值并能降低辐射剂量和对比剂用量。

控制扫描法对头颈部肿瘤患者精确CT定位扫描的效果研究

目的:研究控制扫描(CS)法精确确定放疗标记点CT层面的位置对头颈部肿瘤患者放疗的应用效果。方法:基于CS法制作标记点层面位置(MSP)计算程序,用于位置计算的企业微信程序,以及头颈部肿瘤患者(层厚3 mm)的CT定位扫描中。选取2020年10月至2022年3月南京医科大学附属南京医院收治的60例头颈部位肿瘤患者,将使用CS法行CT定位扫描的患者纳入观察组,使用常规方法行CT定位扫描的患者纳入对照组,每组30例。对两组CT定位扫描中3个金属标记点同时显示在同1层面的例数及含标记点CT图像的层数等进行对比分析。结果:观察组和对照组患者3个标记点同时显示在同1层面上的例数分别为26例和13例,观察组比对照组增加了13例(占43.4%),差异有统计学意义(χ^(2)=12.382,P<0.05);观察组和对照组含标记点CT图像仅1层的例数分别为4例和0例,观察组比对照组增加4例(占13.3%),差异有统计学意义(χ^(2)=2.411,P<0.05)。结论:使用CS法辅助头颈部肿瘤患者的放疗CT定位扫描,可精确计算得到CT定位扫描的目标起始位置,从而使放疗患者3个金属标记点的影像尽可能出现在同1个CT层面,具有较好的应用效果。能够有效提高放疗的便捷性和工作效率。

Nomogram using F-18 fluorodeoxyglucose positron emission tomography/computed tomography for preoperative prediction of lymph node metastasis in gastric cancer

BACKGROUND Lymph node(LN)metastasis is an important prognostic factor in patients with gastric cancer(GC).However,the evaluation of LN metastasis status in the preoperative setting is not accurate.Therefore,precise preoperative prediction of LN metastasis status is crucial for optimal treatment in patients with GC.AIM To develop a preoperative nomogram for LN metastasis using F-18 fluorodeoxyglucose(F-18 FDG)positron emission tomography/computed tomography(PET/CT)and preoperative laboratory test findings in GC.METHODS In this study,the data of 566 GC patients who underwent preoperative F-18 FDG PET/CT and subsequent surgical resection were analyzed.The LN metastasis prediction model was developed in the training cohort and validated in the internal validation cohort.Routine preoperative laboratory tests,including albumin and carbohydrate antigen(CA)19-9 were performed in all patients.Univariate and multivariable logistic regression was performed to validate the preoperative predictive indicators for LN metastasis.RESULTS Of the 566 patients,232(41%)had confirmed histopathologic LN metastasis.Univariate logistic regression revealed that the tumor location,blood hemoglobin,serum albumin levels,neutrophil to lymphocyte ratio,platelet to lymphocyte ratio,CA 19-9,maximum standardized uptake value(SUVmax)of the primary tumor(T_SUVmax),and SUVmax of LN(N_SUVmax)were significantly associated with LN metastasis.In multivariate analysis,T_SUVmax(OR=1.08;95%CI:1.02–1.15;P=0.011)and N_SUVmax(OR=1.49;95%CI:1.19–1.97;P=0.002)were found to be significant predictive factors for LNmetastasis.The LN metastasis prediction model using T_SUVmax,N_SUVmax,serum albumin,and CA 19-9 yielded an area under the curve(AUC)of 0.733(95%CI:0.683–0.784,P=0.025)in the training cohort and AUC of 0.756(95%CI:0.678–0.833,P<0.001)in the test cohort.CONCLUSION T_SUVmax and N_SUVmax measured by preoperative F-18 FDG PET/CT are independent predictive factors for LN metastasis in GC.