Review of oral and pharyngolaryngeal benign lesions detected during esophagogastroduodenoscopy

Recent advancements in endoscopy equipment have facilitated endoscopists’detection of neoplasms in the oral cavity and pharyngolaryngeal regions.In particular,image-enhanced endoscopy using narrow band imaging or blue laser imaging play an integral role in the endoscopic diagnosis of oral and pharyngolaryngeal cancers.Despite these advancements,limited studies have focused on benign lesions that can be observed during esophagogastroduodenoscopy in the oral and pharyngolaryngeal regions.Therefore,this mini-review aimed to provide essential information on such benign lesions,along with representative endoscopic images of dental caries,cleft palate,palatal torus,bifid uvula,compression by cervical osteophytes,tonsil hyperplasia,black hairy tongue,oral candidiasis,oral and pharyngolaryngeal ulcers,pharyngeal melanosis,oral tattoos associated with dental alloys,retention cysts,papilloma,radiation-induced changes,skin flaps,vocal cord paresis,and vocal fold leukoplakia.Whilst it is imperative to seek consultation from otolaryngologists or dentists in instances where the diagnosis cannot be definitively ascertained by endoscopists,the merits of attaining foundational expertise pertaining to oral and pharyngolaryngeal lesions are unequivocal.This article will be a valuable resource for endoscopists seeking to enhance their understanding of oral and pharyngolaryngeal lesions.

Efficiency of EBUS-TBNA for diagnosing benign and malignant lymphadenopathy

Objective:To determine whether endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can rapidly distinguish among lung cancer,tuberculosis and sarcodosis,and to explore its sensitivity and specificity.Methods:Clinical data of patients with enlarged mediastinal or hilar lymphadenopathy who underwent EBUS-TBNA at our hospital between September 1,2012 and June 30,2015 for were retrospectively analyzed.The sensitivity,specificity,positive predictive value,and negative predicted value [including 95% confidence interval (CI)] were calculated..Results:A total of 299 lymph nodes from 201 patients underwent EBUS-TBNA were selected and no serious complications occurred.EBUS-TBNA showed a sensitivity of 87.9% (124/141) (95% CI:81%-92%),a specificity of 100.0% (124/124) (95% CI:97%-100%),and a negative predicted value of 41.3% (95% CI:23%-61%) in the detection of lung cancer.The sensitivity and specificity of diagnosis of mediastinal tuberculosis lymphadenitis were 72.4% (21/29) (95% CI:53%-87%) and 100.0% (95% CI:82%-100%);while sensitivity and specificity of diagnosis of sarcoidosis were 71.4% (5/7) (95% CI:29%-96%) and 100.0% (95% CI:91%-100%).Conclusions:The sensitivity and specificity of EBUS-TBNA do not significantly differ for a diagnosis of lung cancer versus tuberculosis or sarcodosis.

CA19-9 antigen levels can distinguish between benign and malignant pancreaticobiliary disease

BACKGROUND:CA19-9 is a carbohydrate tumor-associated antigen which is frequently upregulated in pancreatobiliary neoplasia.However,it may also be elevated in patients with jaundice in the absence of a tumor due to biliary obstruction,and in other non-hepato-pancreatico-biliary conditions.This study aimed to evaluate whether CA19-9 levels could accurately differentiate between benign and malignant pancreatobiliary disease.METHODS:All patients referred to a single surgeon for investigation of pancreaticobiliary disease in 2003 in whom a firm diagnosis had been established were included.For malignant disease,a histological diagnosis was required but for benign disease a firm radiological diagnosis was deemed adequate.The patients were divided into 4 categories:pancreatic adenocarcinoma(PCa);cholangiocarcinoma(CCa);chronic pancreatitis(CP)and biliary calculous disease(Calc).Bilirubin and alkaline phosphatase levels corresponding to the point of assessment of CA19-9 were also noted.RESULTS:Final diagnoses were made of pancreatic adenocarcinoma(PCa,n=73),cholangiocarcinoma(CCa,n=19),ampullary carcinoma(Amp,n=7),neuroendocrine carcinoma(Neu,n=4),duodenal carcinoma(Duo,n=3),chronic pancreatitis(CP,n=115),and biliary calculous disease(Calc,n=27).Median CA19-9 levels(U/ml)were:PCa,653;CCa,408;Duo,403;Calc,27;CP,19;Neu,10.5;Amp,8(reference range:0-37).The CA19-9 levels were significantly greater for malignant than for benign disease,could differentiate PCa from CCa/Duo,and were significantly higher in unresectable than in resectable PCa.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)for CA19-9 were 84.9%,69.7%,67.7%and 86.1%,respectively.A ROC analysis provided an area under the curve for CA19-9 of 0.871(0.820-0.922),giving an optimal CA19-9 of 70.5 U/ml for differentiating benign from malignant pathology.Using this cut-off,the sensitivity was 82.1%,while specificity,PPV and NPV improved to 85.9%,81.3%and 86.5%,respectively.When standard radiology was included(US/ CT/MRCP)in the decision process,the results improved to 97.2%,88.7%,86.6%,and 97.7%.For benign disease,the CA19-9 correlated directly with the serum bilirubin,but for malignant disease,CA19-9 levels were elevated independent of the bilirubin level.CONCLUSIONS:CA19-9 is useful in the differentiation of pancreatobiliary disease and when using an optimized cut-off and combining with routine radiology,the diagnostic yield is improved significantly,thus stressing the importance of a multi-disciplinary approach to pancreatobiliary disease.

Combination of acoustic radiation force impulse imaging, serological indexes and contrast-enhanced ultrasound for diagnosis of liver lesions

AIM To assess the value of combined acoustic radiation force impulse(ARFI) imaging, serological indexes and contrast-enhanced ultrasound(CEUS) in distinguishing between benign and malignant liver lesions. METHODS Patients with liver lesions treated at our hospital were included in this study. The lesions were divided into either a malignant tumor group or a benign tumor group according to pathological or radiological findings. ARFI quantitative detection, serological testing and CEUS quantitative detection were performed and compared. A comparative analysis of the measured indexes was performed between these groups. Receiver operating characteristic(ROC) curves were constructed to compare the diagnostic accuracy of ARFI imaging, serological indexes and CEUS, alone or in different combinations, in identifying benign and malignant liver lesions. RESULTS A total of 112 liver lesions in 43 patients were included, of which 78 were malignant and 34 were benign. Shear wave velocity(SWV) value, serum alpha-fetoprotein(AFP) content and enhancement rate were significantly higher in the malignant tumor group than in the benign tumor group(2.39 ± 1.20 m/s vs 1.50 ± 0.49 m/s, 18.02 ± 5.01 ng/m L vs 15.96 ± 4.33 ng/m L, 2.14 ± 0.21 d B/s vs 2.01 ± 0.31 d B/s; P < 0.05). The ROC curve analysis revealed that the areas under the curves(AUCs) of SWV value alone, AFP content alone, enhancement rate alone, SWV value + AFP content, SWV value + enhancement rate, AFP content + enhancement rate and SWV value + AFP content + enhancement rate were 85.1%, 72.1%, 74.5%, 88.3%, 90.4%, 82.0% and 92.3%, respectively. The AUC of SWV value + AFP content + enhancement rate was higher than those of SWV value + AFP content and SWV value + enhancement rate, and significantly higher than those of any single parameter or the combination of any two of parameters.CONCLUSION The combination of SWV, AFP and enhancement rate had better diagnostic performance in distinguishing between benign and malignant liver lesions than the use of any single parameter or the combination of any two of parameters. It is expected that this would provide a tool for the differential diagnosis of benign and malignant liver lesions.

Primary malignant pericardial mesothelioma with difficult antemortem diagnosis:A case report

BACKGROUND Primary malignant pericardial mesothelioma(PMPM)is an extremely rare malignant tumor,and it is difficult to diagnose definitively before death.We present a case in which PMPM was diagnosed at autopsy.We consider this case to be highly suggestive and report it here.CASE SUMMARY A 78-year-old male presented with transient loss of consciousness and falls.The transient loss of consciousness was considered to result from complications of diastolic dysfunction due to pericardial disease,fever with dehydration,and paroxysmal atrial fibrillation.Ultrasound cardiography(UCG)and computed tomography showed cardiac enlargement and high-density pericardial effusion.We considered pericardial disease to be the main pathogenesis of this case.Cardiac magnetic resonance imaging and gadolinium contrast-enhanced T1-weighted images showed thick staining inside and outside the pericardium.Pericardial biopsy was considered to establish a definitive diagnosis,but the patient and his family refused further treatment and examinations,and the patient was followed conservatively.We noticed a thickening of the pericardium and massive changes in the pericardium on UCG over time.We performed an autopsy 60 h after the patient died of pneumonia.Giemsa staining of the autopsy tissue showed an epithelial-like arrangement in the pericardial tumor,and immunostaining showed positive and negative factors for the diagnosis of PMPM.Based on these findings,the final diagnosis of PMPM was made.CONCLUSION PMPM has a poor prognosis,and early diagnosis and treatment are important.The temporal echocardiographic findings may provide a clue for the diagnosis of PMPM.

基于瘤体及瘤周多参数MRI对乳腺病变良恶性诊断列线图预测模型的构建与评价

目的:建立基于瘤体及瘤周多参数MRI的乳腺病变良恶性鉴别诊断的列线图模型,并验证其预测效能。方法:纳入经病理学检查明确乳腺病变性质的100例患者作为研究对象,所有患者均行核磁共振(MRI)检查和病理检查,根据病理检查结果分为乳腺良性病变组(n=62)和乳腺恶性病变组(n=38)。收集患者临床资料、瘤体各参数、瘤周各参数以及乳腺病变良恶性情况。多因素Logistic回归分析筛选乳腺恶性病变的危险因素并构建列线图预测模型,采用受试者工作特征(ROC)曲线和Hosmer-Lemeshow拟合优度检验验证模型的预测效能及拟合优度;内部验证采用Bootstrap。结果:乳腺恶性病变组病灶直径、平均扩散峰度(MK)、MDp/t、瘤周与瘤体MKp/n高于乳腺良性病变组(均P<0.05);乳腺恶性病变组表观扩散系数(ADC)值、平均扩散率(MD)、非对称磁化转移率(MTRasym)、MKp/t、MDp/n低于乳腺良性病变组(均P<0.05)。多因素分析结果显示,病灶直径、MK、MDp/t、MKp/n升高,ADC值、MD、MTRasym、MKp/t、MDp/n降低是乳腺恶性病变的独立影响因素(均P<0.05)。基于上述独立影响因素构建乳腺恶性病变的列线图预测模型,曲线下面积(AUC)为0.827。Hosmer-Lemeshow拟合优度检验显示P值为0.004。采用Bootstrap法,生成的校准曲线拟合良好。结论:瘤体及瘤周多参数MRI对乳腺病变良恶性鉴别诊断具有重要预测价值,基于乳腺恶性病变的独立影响因素构建的列线图预测效果良好,能直观预测乳腺发生恶性病变的概率。

高分辨率CT用于肺部小结节良恶性鉴别诊断的效果分析

目的分析高分辨率CT对肺部小结节良恶性的鉴别诊断效果。方法选取2021年2月至2023年4月我院收治的肺部小结节患者96例,均予以常规CT及高分辨率CT检查,评估图像质量,以最终手术病理结果为依据,分别进行两种检查方法与手术病理结果的一致性分析,比较两种检查方式的诊断效能。结果高分辨率CT图像质量优良率显著高于常规CT(P<0.05)。96例患者经手术病理检查确诊为肺癌阳性70例,阴性26例;高分辨率CT与手术病理诊断结果的一致性较好(κ=0.906,P<0.001);常规CT与手术病理诊断结果的一致性一般(κ=0.729,P<0.001)。高分辨率CT的灵敏度、特异度、准确率分别为97.14%、92.31%、95.83%,显著高于常规CT的80.00%、50.00%、71.88%(P<0.05)。结论与常规CT相比,高分辨率CT在肺部小结节良恶性鉴别诊断中的图像质量更佳,诊断效能更好,值得临床应用。

卵巢-附件超声报告和数据系统分类联合超声图像特征对卵巢附件良恶性肿块的鉴别诊断价值

目的 探讨卵巢-附件超声报告和数据系统(O-RADS)分类联合超声图像特征对卵巢附件良恶性肿块的鉴别诊断价值。方法 选取O-RADS分类为3~5类的140例卵巢附件肿块患者,所有患者均接受彩色多普勒超声检查。以病理检查结果为金标准,绘制受试者工作特征曲线,计算曲线下面积(AUC),分析O-RADS分类、多项超声图像特征单独及联合检查对卵巢附件恶性肿块的诊断价值。结果 病理检查结果显示,140例患者中共147个卵巢附件肿块,恶性56个(包括交界性肿瘤),良性91个;O-RADS分类3类46个,4类61个,5类40个。O-RADS分类联合肿块实性部分最大径、血流评分、肿块形态诊断卵巢附件恶性肿块的AUC为0.959,高于各指标单独检查的0.738、0.882、0.913、0.894。结论 在O-RADS分类定性诊断卵巢附件肿块的基础上,结合肿块实性部分最大径线、血流评分、肿块形态等彩色多普勒超声图像特征可进一步提高卵巢附件良恶性肿块的鉴别诊断效能。

MSCT在孤立性肺结节良恶性鉴别诊断中的应用价值分析

目的探究多层螺旋CT(MSCT)在孤立性肺结节良恶性鉴别诊断价值。方法选取河南科技大学附属许昌市中心医院2021年1月至2023年1月收入孤立性肺结节总计72例,所有患者入院后均接受常规CT及MSCT检查,并以病理检查结果作为诊断金标准,分析MSCT在孤立性肺结节诊断效能以及良性结节与恶性结节CT征象特征。结果72例孤立性结节患者经病理检查,结果显示良性结节51例(70.83%)、恶性结节21例(29.17%)。MSCT的诊断准确率、特异性(93.06%、94.12%),高于常规CT(79.17%、80.39%),差异有统计学意义(P<0.05);恶性结节中钙化(14.29%)低于良性结节(39.22%),恶性结节中分叶征、毛刺征、胸膜凹陷征(85.71%、76.19%、71.43%),高于良性结节(13.73%、15.69%、7.84%),差异有统计学意义(P<0.05),而良性结节与恶性结节在空泡征对比差异无统计学意义(P>0.05);恶性结节中常规CT、MSCT中定量参数增强峰值(PH)、孤立性肺结节与主动脉强化峰值的比值(S_(PH)/A_(PH))均高于良性结节,差异有统计学意义(P<0.05)。结论MSCT应用于孤立性肺结节良恶性鉴别诊断中具有较高准确性,同时良恶性结节CT征象上差异显著,为临床早期鉴别诊断提供合理依据,医师能依据诊断结果制定出合理治疗方案。

SWE联合SMI在甲状腺良恶性结节鉴别诊断中的应用

目的探讨剪切波弹性成像(SWE)联合超微血管成像(SMI)技术在甲状腺良恶性结节鉴别诊断中应用的准确性与可行性。方法选取2021年1月至2022年12月我院超声科检出甲状腺结节并接受超声引导细针抽吸活检或术后组织病理完善的190例患者为研究对象,共检出224个甲状腺结节(病理学明确诊断良性结节74个,恶性结节150个)。患者甲状腺均进行超声、SWE和SMI检查,并计算组织杨氏模量相关参数以及微细血流、穿支血管情况。以组织病理结果作为金标准构建受试者操作特征(ROC)曲线,分析SWE联合SMI对甲状腺良恶性结节鉴别诊断的效果,比较不同检查方法在甲状腺结节诊断中的效能差异。结果甲状腺良性与恶性结节内部成分、回声、边缘、钙化、纵横比比较均有统计学差异(均P<0.05),但二者平均直径比较无统计学差异(P>0.05)。与甲状腺恶性结节比较,甲状腺良性结节弹性最大值、弹性均值、弹性比率、微血流评分、剪切波峰值速度、剪切波平均速度差异均有统计学意义(均P<0.05)。ROC曲线分析结果显示,弹性最大值曲线下面积最大,截断值为29.52 kPa;微血流评分截断值为2.3分。诊断效能分析结果显示,SWE联合SMI的灵敏度与特异度最高,分别为94.67%、94.59%。结论SWE联合SMI可进一步提高甲状腺良恶性结节的诊断效能,并可实现病灶的量化评估与动态观察,具有应用及推广价值。

CT增强扫描结合后处理技术对良恶性甲状腺病变的诊断价值

目的观察CT增强扫描结合后处理技术对良恶性甲状腺病变的诊断价值。方法将本院2018年9月到2022年9月期间收集的134例经病理证实的甲状腺结节患者作为研究对象,所有患者均接受了CT增强扫描结合后处理技术,探讨该技术在甲状腺良恶性病变诊断中的价值,并比较不同患者间图像特征、平扫期CT值、动脉期CT值和静脉期CT值差异,同时关注病灶内钙化情况。结果134例甲状腺结节患者中,病理检测恶性74例,良性60例,螺旋CT增强诊断恶性76例,良性58例,以病理学检测为金标准,螺旋CT增强扫描诊断甲状腺良恶性结节敏感度为97.30%,特异性为93.33%,准确率为95.52%;恶性组甲状腺结节不规则形态、边界模糊及肿大淋巴结比例显著高于良性组(P<0.05);两组间平扫期CT值、动脉期CT值以及静脉期CT值差异比较无统计学意义(P>0.05);恶性组有钙化点比例显著高于良性组(P<0.05)。结论螺旋CT增强扫描及后处理技术在甲状腺良恶性结节鉴别诊断中具有重要意义,图像特征及钙化特征显示较为明显,为临床诊治提供重要参考依据。

肿瘤患者互联网诊疗应用前景与展望

目的/意义探究与展望互联网在建立和完善肿瘤诊疗体系中的应用前景。方法/过程通过文献调研法和实地调研法,从肿瘤早期筛查、肿瘤慢病管理、肿瘤循证多学科诊疗、肿瘤康复及肿瘤辅助诊疗平台的搭建5个维度深入探析。结果/结论互联网诊疗模式在肿瘤早预防、早诊断、早治疗方面使患者获益;“全方位、全周期”的健康管理及院外随访与宣教,可有效延长肿瘤患者的生存时间,改善生活质量。

血清LAPTM4B-35及DKK1联合低剂量超声造影在肝肿瘤良恶性诊断中的应用价值

目的探讨溶酶体相关4次跨膜蛋白B-35(LAPTM4B-35)、Dickkopf相关蛋白1(DKK1)在肝肿瘤血清中的表达以及联合低剂量超声造影在肝肿瘤良恶性诊断中的应用价值。方法收集2021年1月至2022年8月青岛市中心医院急诊创伤外科进行治疗的160例肝肿瘤患者临床资料。根据病理学结果,将患者分为良性组(n=74)和恶性组(n=86)。比较两组血清LAPTM4B-35、DKK1水平及低剂量超声造影指标;多因素Logistic回归分析肝恶性肿瘤的影响因素;ROC曲线分析血清LAPTM4B-35、DKK1联合低剂量超声造影对肝恶性肿瘤的诊断效能。结果恶性组患者血清LAPTM4B-35、DKK1表达水平均高于良性组(P<0.05)。恶性组达峰时间低于良性组(P<0.05),峰值强度显著高于良性组(P<0.05)。多因素Logistic回归分析,结果显LAPTM4B-35、DKK1、达峰时间、峰值强度是发生肝恶性肿瘤的影响因素(P<0.05)。ROC曲线显示,血清LAPTM4B-35、DKK1、低剂量超声造影联合检测诊断肝恶性肿瘤的AUC为0.960,敏感性为89.53%,特异性为91.89%,优于其各自单独预测(Z两者联合-LAPTM4B-35=5.116、Z两者联合-DKK1=4.986、Z两者联合-达峰时间=4.657、Z两者联合-峰值强度=4.214,P<0.05)。结论肝肿瘤恶性患者血清LAPTM4B-35、DKK1表达水平显著升高,联合低剂量超声造影在肝恶性肿瘤的诊断中具有较高的应用价值。

磁共振扩散加权成像鉴别诊断前列腺良恶性增生的效能及影像特点分析

目的:探讨磁共振扩散加权成像(DWI)对前列腺良恶性增生的鉴别诊断效能和影像特点。方法:回顾性分析2021年3月至2023年3月于本院行前列腺常规MRI检查和DWI检查患者126例,分析前列腺良恶性增生患者DWI影像特点,比较常规MRI检查、DWI检查对前列腺良恶性增生诊断情况及诊断效能。以前列腺良、恶性病理检查结果为依据将患者分为恶性组、良性组,比较两组患者DWI的ADC值,受试者工作特征(ROC)曲线分析ADC值对前列腺恶性增生的诊断价值。结果:经前列腺组织病理确诊前列腺恶性病变(前列腺癌)89例(70.63%),前列腺良性病变(前列腺炎性增生结节)37例(29.37%)。当扩散敏感因子(b)值分别为0s/mm 2、1000s/mm 2、2000s/mm 2时,前列腺良性增生患者列腺中央腺体表现为等、稍高、高信号,ADC图出现稍低信号;而前列腺恶性增生患者前列腺右侧中央腺体及移行区表现为稍低、高、亮信号,ADC图出现明显低信号。常规MRI检出列腺恶性增生104例、前列腺良性增生22例,其中准确率为84.92%、阳性预测值为83.65%、阴性预测值为90.91%,灵敏度、特异度分别为97.75%、54.05%,kappa值为0.588;DWI检查前列腺恶性增生94例、前列腺良性增生32例,其中准确率为91.27%、阳性预测值为91.49%、阴性预测值为90.63%,灵敏度、特异度分别为96.63%、78.38%,kappa值为0.781。恶性组患者的ADC值为(0.91±0.28)×10^(-3)mm^(2)/s,明显低于良性组患者的ADC值(1.59±0.33)×10^(-3)mm^(2)/s(t=11.769,P<0.001)。ADC值对前列腺恶性增生诊断的曲线下面积为0.895(95%CI:0.836~0.954),最佳临界值为1.20610^(-3 )mm ^(2)/s,灵敏度为86.52%,特异度为78.38%。结论:前列腺恶性增生组织DWI信号强度较前列腺良性增生显著增强,但ADC图信号明显降低,DWI检查对前列腺恶性增生诊断与病理诊断的一致性较强,ADC值对前列腺恶性增生表现出良好的诊断价值。

增强CT中病灶皮质衰减比在小肾肿瘤良恶性鉴别诊断中的应用研究

目的提出全新参数—病灶皮质衰减比;并讨论其在增强CT中小肾肿瘤(病灶直径<4cm)的良恶性鉴别诊断中的临床应用价值。方法回顾性收集我院及四川省人民医院肾脏肿瘤患者的术前多期增强CT 70例。由两名有临床诊断经验的放射科医生采用双盲法分别记录肾脏肿瘤增强CT中的典型影像征象(边缘形态、强化类型、血管侵犯、肾周脂肪侵犯等)。并于肿瘤及邻近肾皮质区域分别选取感兴趣区域,计算病灶皮质衰减比。观察以上指标在小肾脏肿瘤不同良恶性亚型(肾嗜酸细胞腺瘤、平滑肌瘤、透明状细胞癌、乳头状细胞癌)间的表现。结果不同于恶性肾脏肿瘤,本研究中全部的良性肾脏肿瘤均呈现边缘清晰、无血管或肾周脂肪侵犯。肾嗜酸细胞腺瘤的病灶皮质衰减比与透明状细胞癌(P<0.05)和乳头状细胞癌(P<0.05)均有统计学差异。结论肾脏增强CT中病灶皮质衰减比可将有代表性的肾细胞癌(肾透明状细胞癌)与良性肿瘤(肾嗜酸细胞腺瘤)显著分层。具有临床应用价值。

探究高分辨率CT征象对GGN患者良恶性的临床诊断价值

目的探究高分辨率CT征象对肺部磨玻璃结节(GGN)患者良恶性的临床诊断价值。方法82例GGN患者,根据肿瘤良恶性分为良性组(8例)和恶性组(74例)。所有患者均行高分辨率CT检查。比较两组高分辨率CT影像学特征(病灶大小、病灶形状、分叶征、毛刺征、界面、囊状透光影、空泡征、支气管征、血管集束征、密度、胸膜凹陷征),采用多因素Logistic回归分析恶性GGN患者的影像学危险因素,同时分析影像学检测对恶性GGN的诊断价值。结果两组病灶大小、病灶形状、空泡征、支气管征、血管集束征、胸膜凹陷征比较,无明显差异(P>0.05)。恶性组患者有分叶征55例、有毛刺征56例、有囊状透光影54例、界面清楚光整45例、界面清楚毛躁20例、界面模糊9例、密度为密度均匀的纯磨玻璃结节(pGGN)20例,良性组分别为1、2、1、1、1、6、6例,比较差异较大(P<0.05)。Logistic回归模型显示分叶征、毛刺征、囊状透光影、界面和密度是恶性GGN的影响因素(P<0.05)。高分辨率CT检测对恶性GGN的诊断价值最高的为分叶征,最低的为界面。结论对于GGN患者应用高分辨率CT检查,判别其良恶性效果较好,且分叶征诊断价值最高,可为临床诊断鉴别提供参考。

DCE-MRI定量参数联合小视野弥散加权成像对甲状腺良恶性结节鉴别的价值

目的探讨动态对比增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)定量参数联合小视野弥散加权成像在甲状腺良恶性结节鉴别中的应用价值。材料与方法收集2022年1月至2023年10月于滨州医学院附属医院诊治并经手术病理证实为甲状腺结节的患者38例(52个结节),将其分为良性结节组和恶性结节组。术前患者均行3.0 T MRI扫描,包括常规MRI、小视野弥散加权成像(b值取0、800 s/mm^(2))和DCE-MRI检查,并测量其表观弥散系数(apparent diffusion coefficient,ADC)值和DCE-MRI定量参数,包括对比剂容积转运常数(volume transport constant,K^(trans))、速率常数(rate constant,K_(ep))、血管外细胞外间隙容积分数(extravascular extracellular volume fraction,V_(e))。对甲状腺良恶性结节组的ADC、K_(ep)、V_(e)、K^(trans)采用独立样本t检验分析,以P<0.05为差异有统计学意义,后将差异有统计学意义的变量进行逐步logistic回归模型分析,得到甲状腺良恶性结节的独立预测因素,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析ADC、K^(trans)独立诊断模型及ADC与K^(trans)联合诊断模型的诊断效能。结果良性结节组平均ADC值、K^(trans)值、K_(ep)值分别为(1.659±0.370)×10^(-3)mm^(2)/s、(0.427±0.214)min^(-1)、(0.966±0.225)min^(-1),恶性结节组平均ADC值、K^(trans)值、K_(ep)值分别为(1.182±0.195)×10^(-3)mm^(2)/s、(0.178±0.073)min^(-1)、(0.600±0.248)min^(-1)。良性结节组的ADC、K^(trans)、K_(ep)值均高于恶性结节组,差异均有统计学意义(P<0.001)。经过独立样本t检验及逐步logistic回归分析显示,ADC值和K^(trans)差异具有统计学意义(P<0.05),是鉴别甲状腺结节良恶性的独立预测因子。单独ADC值曲线下面积(area under the curve,AUC)为0.915、单独K^(trans)值AUC为0.827。ADC值与K^(trans)联合诊断模型AUC为0.973,较二者单独应用明显增高,联合诊断模型诊断效能最高。经DeLong检验,联合诊断模型与单独K^(trans)诊断差异存在统计学意义(P<0.05)。ADC值与K^(trans)联合诊断模型在鉴别甲状腺良恶性结节中敏感度为97.3%,较ADC、K^(trans)更高,特异度为84.6%,较ADC值更高。结论ADC值和K^(trans)是鉴别甲状腺良恶性结节的重要参数,两者联合诊断可提高临床诊断准确性,为术前诊断提供重要依据。

经阴道超声联合CEA、CA125、CA153鉴别诊断子宫腔占位性病变良恶性

目的:探讨经阴道超声联合CEA、CA125、CA153鉴别子宫腔占位性病变良恶性的价值.方法:收集2021年2月-2023年5月本院疑似子宫腔占位性病变患者117例临床资料,根据刮宫或术后病理检查结果分为恶性组及良性组,其中恶性组56例,为子宫内膜癌;良性组61例,为子宫内膜良性息肉.比较两组经阴道超声及血清指标差异,受试者工作特征曲线(ROC)分析各指标鉴别诊断子宫腔占位性病变良恶性效能.结果:超声检查收缩期峰值血流速度两组无差异(P>0.05),恶性组阻力指数小于良性组、内膜厚度大于良性组;恶性组血清癌胚抗原(CEA)、糖类抗原125、CA153水平均高于良性组(均P<0.05).ROC曲线结果显示,经阴道超声、血清CEA、CA125、CA153各指标单独或联合应用鉴别诊断子宫腔占位性病良恶性的AUC分别为0.822、0.713、0.728、0.797及0.915,均有价值,但联合诊断价值最高.结论:经阴道超声、血清CEA、CA125、CA153联合应用对宫腔占位性病变良恶性鉴别诊断效能较高,有较好的临床应用价值.

Monoexponential, biexponential and stretched-exponential models based diffusion weighted imaging: a comparative study in the differential diagnosis of benign and malignant breast lesions

Objective To investgate the value of various parameters obtained from monoexponential,biexponential,and stretched exponential diffusion-weighted imaging models in the differential diagnosis of breast lesions.Methods A retrospective study was performed in 54 patients with pathologically confirmed malignant tumors(n=30),benign lesions(n=34)and normal fibroglandular

人工智能诊断系统的胸部CT肺结节检出率及良恶性诊断研究

目的 探讨临床诊断肺结节疾病采用人工智能诊断系统的胸部CT技术的检出率及鉴别诊断良恶性的价值。方法 选择2022年5月—2023年5月丹阳市人民医院接诊治疗的肺结节患者50例进行回顾性研究,所有患者均接受人工智能诊断系统的胸部CT技术检查,以手术诊断结果为金标准。结果 通过人工智能诊断系统的胸部CT技术共计检出结节126个,检出率为93.33%。进一步分析结果显示,50例肺结节患者中,35例患者为良性结节,15例患者为恶性结节。通过计算,人工智能诊断系统的胸部CT技术灵敏度为97.14%、特异性为100.00%、准确率为98.00%,与金标准比较差异无统计学意义(P>0.05)。结论 人工智能诊断系统的胸部CT技术对肺结节疾病具有一定诊断价值,且能够鉴别结节良恶性,值得推广。