比较腹盆腔增强CT、盆腔MRI平扫在正确预测淋巴结状态方面的诊断性能

目的探讨在卵巢癌淋巴结转移诊断中,腹盆腔增强CT与盆腔MRI平扫的诊断性能对比。方法选取卵巢癌患者46例作为研究对象,安排接受腹盆腔增强CT与盆腔MRI平扫,以病理结果为参照计算两种方法的灵敏度、特异度、阳性预测值以及阴性预测值。结果CT扫描检查结果显示,腹盆腔增强CT在卵巢癌盆腔淋巴结转移诊断中,灵敏度为45.00%,特异度为73.08%;盆腔MRI平扫在卵巢癌盆腔淋巴结转移诊断中,灵敏度为60.00%,特异度为80.77%;腹盆腔增强CT联合盆腔MRI平扫在卵巢癌盆腔淋巴结转移诊断中,灵敏度为85.00%,特异度为92.31%。结论在卵巢癌淋巴结转移诊断中,相较于腹盆腔增强CT,盆腔MRI具有较高的诊断灵敏度和特异度,但两者联合运用取得的诊断效能更高。

CT和MRI动态增强扫描诊断和评估原发性肝癌患者微血管浸润价值研究

目的研究使用电子计算机断层扫描(CT)和磁共振(MRI)动态增强扫描诊断和评估原发性肝癌(PLC)患者微血管浸润(MVI)的价值。方法2020年1月~2023年1月我院收治的PLC患者50例,术前均接受腹部CT和MRI检查,记录肿瘤边缘模糊征象、瘤内新月征、静脉浸润的双预测因子(TTPVI)、门静脉癌栓(PVTT)和表观弥散系数(ADC)。行肝叶切除术治疗,取术后组织行病理学检查诊断MVI。结果经术后组织病理学检查,诊断肝细胞癌(HCC)32例和胆管细胞癌18例,存在MVI者29例,无MVI者21例;CT检查MVI患者肿瘤边缘模糊、局部外凸结节、包膜不完整、多结节融合、瘤内新月征、TTPVI和PVTT等影像学征象占比分别为82.8%、17.2%、31.0%、17.2%、13.8%、65.5%和17.2%,显著高于无MVI患者(分别为14.3%、4.8%、4.8%、4.8%、0.0%、9.5%和0.0%,P<0.05);MRI检查MVI患者肿瘤边缘模糊、局部结节、包膜不完整、多结节融合、瘤内新月征、TTPVI和PVTT等影像学征象占比为89.7%、24.1%、37.9%、27.6%、13.8%、72.4%和24.1%,显著高于无MVI患者(分别为23.8%、9.5%、9.5%、9.5%、0.0%、14.3%和0.0%,P<0.05);经Logistic回归分析显示,CT和MRI检查发现病灶边缘模糊、TTPVI和PVTT是PLC患者发生MVI的独立影响因素(P<0.05)。结论CT和MRI动态增强扫描可通过特殊征象判断PLC患者MVI的存在,可帮助临床医生做出合理的诊治策略。

胸部CT增强扫描、MRI检查对良恶性前纵隔肿瘤的鉴别诊断价值

目的 探讨胸部CT增强扫描、MRI检查对良恶性前纵隔肿瘤的鉴别诊断价值。方法 选取127例经病理检查确诊的前纵隔肿瘤患者,根据病理结果分为良性组(n=82)和恶性组(n=45),全部患者均采取胸部CT增强扫描,其中24例患者同时进行了MRI检查。比较良性组和恶性组患者的CT、MRI影像学特征,并比较两种检查方法的诊断效能。结果 良性组与恶性组患者CT影像学特征中形态、包膜、边界、密度、强化程度、强化均匀情况比较,差异均有统计学意义(P﹤0.05)。恶性组与良性组患者MRI影像学特征中形态、分布、肿瘤成分、边界比较,差异均有统计学意义(P﹤0.05)。胸部CT增强扫描诊断恶性前纵隔肿瘤的灵敏度以及准确度均高于MRI,特异度低于MRI。结论 胸部CT增强扫描、MRI检查对恶性前纵隔肿瘤均有一定的诊断效能,且CT增强扫描的诊断效能更好,为进一步避免检查中出现漏诊和误诊的情况,可考虑进行联合诊断。

Comparison of the Imaging Manifestations and Diagnostic Values of Multi-slice Spiral CT and Enhanced MRI Scans of Primary Liver Cancer(PLC)Intrahepatic Lesions

Objective:To compare and analyze the clinical diagnostic value of multi-slice spiral CT and enhanced MRI for primary liver cancer(PLC),and to summarize the imaging findings.Methods:The research subjects in this article were 50 patients with PLC who were admitted to our hospital from 2017 April to 2018 September.After the patients were admitted,they were examined by multi-slice spiral CT and enhanced MRI scanning,and the pathological diagnosis results were followed up.Relevant information was reviewed and analyzed.Results:The detection rate of multi-slice spiral CT was higher than that of MRI in the portal venous phase lesion detection.The difference was statistically significant(P<0.05).The detection rate of lesions in the arterial phase and delayed phase was not statistically significant(P>0.05);the diagnostic accuracy of multi-slice spiral CT was 85.96%,and the diagnostic accuracy of enhanced MRI scanning was 91.11%,which was not statistically significant(P>0.05).MRI scans showed the capsules of primary liver cancer better than CT,but the difference was not statistically significant(P>0.05).Conclusion:In conclusion,both multi-slice spiral CT and enhanced MRI can be used for the effective diagnosis of primary liver cancer intrahepatic lesions.The diagnostic value of the two is equivalent,but enhanced MRI has a slightly higher diagnostic accuracy and can be used as the preferred method.

CT增强扫描和MRI检查在原发性肝癌患者诊断中的应用价值比较

目的分析CT增强扫描和磁共振成像(magnetic resonance imaging,MRI)检查诊断原发性肝癌(hepatic cell carcinoma,HCC)的价值。方法选取2022年4月—2023年4月丹江口市第一医院收治的96例疑似HCC患者。均接受CT增强扫描、MRI检查,以病理检查为“金标准”,分析2种方法诊断HCC的价值。结果96例疑似HCC患者中,“金标准”共检出67例,MRI共检出66例,CT增强扫描共检出58例;MRI诊断HCC的敏感度为97.01%(65/67)、准确度为96.88%(93/96)、阴性预测值为93.33%(28/30),高于CT增强扫描的83.58%(56/67)、86.46%(83/96)、71.05%(27/38),差异有统计学意义(P<0.05);Kappa检验显示,MRI与“金标准”的一致性极好(Kappa=0.927,P<0.001);CT增强扫描与“金标准”的一致性中等(Kappa=0.705,P<0.001)。结论与CT增强扫描相比,MRI诊断准确率较高,此文的研究结果为HCC后期诊断标准制定提供了有关的借鉴内容,存有一定的诊断效能。

MRI弥散加权成像与CT增强扫描对宫颈癌的诊断价值分析

目的分析磁共振(MRI)弥散加权成像(DWI)与CT增强扫描在宫颈癌诊断中的应用价值。方法回顾性分析103例疑似宫颈癌患者的临床资料,均行CT增强扫描和DWI-MRI检查,以病理组织活检结果为“金标准”,比较DWI-MRI、CT增强扫描诊断结果、诊断效能(灵敏度、特异度、漏诊率、误诊率、准确度)、诊断预测值(阳性预测值、阴性预测值);并统计DWI-MRI确诊的符合病理结果的恶性、良性患者相关参数[流入速率(WIR)、流出速率(WOR)、最大相对增强率(MRE)、达峰时间(TTP)、扩散系数(ADC)]变化。结果103例疑似宫颈癌患者,经病理组织活检诊断出恶性87例,良性16例;DWI-MRI诊断恶性84例,良性13例;CT增强诊断恶性71例,良性10例。DWI-MRI检查灵敏度、准确度较CT增强扫描高,漏诊率较CT增强扫描低(P<0.05);DWI-MRI阴性预测值(81.25%)较CT增强扫描高(P<0.05);恶性宫颈癌患者WIR、WOR、MRE、ADC参数较良性患者高,TTP参数较良性患者低(P<0.05)。结论与CT增强扫描相比,DWI-MRI诊断宫颈癌灵敏度和准确度高,可降低漏诊率,且恶性和良性患者DWI-MRI参数存在较大差异,具有良好预测值,可为临床科学诊断提供依据。

MRI与增强CT对原发性肝癌的诊断效能比较

目的对比MRI与增强CT诊断原发性肝癌的效能。方法纳入2021年3月至2023年4月期间在我院就诊的94例疑似原发性肝癌患者,均进行MRI与增强CT检查。以肝穿刺活检结果为金标准,分析MRI与增强CT诊断原发性肝癌的效能,比较MRI与增强CT对不同肿瘤直径病灶的检出情况。结果增强CT与肝穿刺活检诊断结果的一致性一般(Kappa=0.714,P<0.001),MRI与肝穿刺活检诊断结果的一致性较好(Kappa=0.893,P<0.001)。MRI诊断原发性肝癌的灵敏度、特异度、准确率均明显高于增强CT(P<0.05)。MRI对直径<1 cm肝癌病灶的检出率明显高于增强CT(P<0.05)。结论MRI诊断原发性肝癌的效能优于增强CT,可提高诊断准确率。

CT平扫和MRI检查在诊断急性缺血性脑卒中的效果及检出率评价

目的对比在急性缺血性脑卒中的临床诊断中应用计算机断层扫描(computed tomography,CT)和核磁共振成像(magnetic resonance imaging,MRI)检查的效果与检出率。方法选取2022年12月—2023年12月临沂河东医院收治的90例疑似急性缺血性脑卒中患者为研究对象,以病理结果作为金标准,分别实行CT平扫和MRI检查,比较两种检查方式在急性缺血性脑卒中的检出情况和诊断效能。结果病理结果显示,90例疑似急性缺血性脑卒中患者中共检出阳性41例、阴性49例,检出率为45.56%。CT平扫共检出阳性29例、阴性61例,检出率为32.22%。MRI检查共检出阳性40例、阴性50例,检出率为44.44%。CT平扫和MRI检查的在急性缺血性脑卒中的特异度(89.80%vs 97.96%)比较,差异无统计学意义(χ^(2)=2.840,P>0.05)。MRI检查的灵敏度(95.12%)、准确度(96.67%)、阳性预测值(97.50%)、阴性预测值(96.00%)均高于CT平扫(58.54%、75.56%、82.76%、72.13%),差异有统计学意义(χ^(2)=15.413、16.769、4.601、11.034,P均<0.05)。结论与CT平扫相比,MRI检查具有更高的诊断效能,应用于急性缺血性脑卒中的诊断结果更佳。

骨肿瘤诊断中MRI检查联合CT扫描的价值研究

分析在骨肿瘤诊断中MRI检查联合CT扫描的诊断价值。选取贵州省盘州市中医医院2021年3月—2023年3月收治的68例骨肿瘤患者为研究对象,对所有患者均实施MRI检查和CT扫描,对比单独检出率和联合检出率。结果显示,68例患者经过病理检查,确诊为良性骨肿瘤的患者有45例,确诊为恶性骨肿瘤的患者有23例。MRI检查联合CT扫描的良恶性检出率均显著高于单独MRI检查和单独CT扫描,差异具有统计学意义(P<0.05)。研究发现,在骨肿瘤的诊断中,MRI检查联合CT扫描的检出率均较高,MRI检查的影像学特征主要表现为软组织肿块和骨髓水肿,而CT扫描的影像学特征则主要表现为骨膜反应和骨质增生硬化。两种检查方式联合诊断,可提升骨肿瘤的检出率,辅助医生更好地诊断患者的疾病,为后续治疗工作的顺利开展提供有效的影像学数据支持。

CT、MRI增强扫描对胰腺癌与慢性胰腺炎的鉴别诊断价值

目的评估磁共振成像(MRI)增强扫描、电子计算机断层增强扫描(CT)及二者联合对胰腺癌和慢性胰腺炎的鉴别诊断价值。方法选取2018年6月—2023年6月于通辽市科尔沁区第一人民医院就诊的50例胰腺癌患者和65例慢性胰腺炎患者作为研究对象,均行CT和MRI增强扫描检查,以病理诊断结果为金标准,采用Kappa一致性检验法评估CT、MRI及二者联合对胰腺癌和慢性胰腺炎鉴别诊断结果与病理诊断结果的一致性。结果CT:慢性胰腺炎局部表现为胰腺体积缩小,多为不规则或分叶状、边缘粗糙的肿块;出现粗大、广泛、弥散性分布的点片状钙化,胰腺实质密度均匀或局部下降。胰腺癌多表现为在局部增大的胰腺基础上形成实质性肿块,边缘光滑,一般无分叶;较少钙化;腺体呈弥漫或局部肿大,呈等或稍低密度。MRI:慢性胰腺炎T1WI呈低信号,T2WI信号混杂,偶为高信号;增强扫描后呈斑点状弱或无强化。胰腺癌T1WI呈低或稍低信号,T2WI呈高或等高信号,胰胆管呈不规则扩张;增强扫描后呈不均匀、低强化。与慢性胰腺炎患者相比,胰腺癌患者胰腺体积增大、侵袭周围组织及大血管、周围淋巴结肿大、胰胆管不规则扩张发生率高,病变侵袭周围囊肿、病变组织钙化、延迟期强化发生率低,差异有统计学意义(P<0.05)。胰腺癌患者动脉期、胰腺期、延迟期的CT值较慢性胰腺炎患者低,差异有统计学意义(P<0.05)。CT联合MRI增强扫描诊断胰腺癌、慢性胰腺炎的准确率分别为96.00%(48/50)、96.92%(63/65),高于CT诊断的74.00%(37/50)、70.77%(46/65)和MRI增强扫描的86.00%(43/50)、75.38%(49/65),且CT联合MRI增强扫描鉴别诊断胰腺癌、慢性胰腺炎的Kappa值为0.829,高于CT、MRI增强扫描单独鉴别诊断的0.548、0.614。结论CT、MRI增强扫描对胰腺癌、慢性胰腺炎的鉴别诊断价值均较好,但二者联合可提供更高的诊断效能。

Dynamic contrast-enhanced MRI versus ^(18)F-FDG PET/CT: Which is better in differentiation between malignant and benign solitary pulmonary nodules?

Objective： To prospectively compare the discriminative capacity of dynamic contrast enhanced-magnetic resonance imaging（DCE-MRI） with that of^18F-fluorodeoxyglucose（^18F-FDG） positron emission tomography/computed tomography（PET/CT） in the differentiation of malignant and benign solitary pulmonary nodules（SPNs）.Methods： Forty-nine patients with SPNs were included in this prospective study. Thirty-two of the patients had malignant SPNs, while the other 17 had benign SPNs. All these patients underwent DCE-MRI and ^18F-FDG PET/CT examinations. The quantitative MRI pharmacokinetic parameters, including the trans-endothelial transfer constant（K^trans）, redistribution rate constant（Kep）, and fractional volume（Ve）, were calculated using the Extended-Tofts Linear two-compartment model. The ^18F-FDG PET/CT parameter, maximum standardized uptake value（SUV（max））, was also measured. Spearman＇s correlations were calculated between the MRI pharmacokinetic parameters and the SUV（max） of each SPN. These parameters were statistically compared between the malignant and benign nodules. Receiver operating characteristic（ROC） analyses were used to compare the diagnostic capability between the DCE-MRI and ^18F-FDG PET/CT indexes.Results： Positive correlations were found between K^trans and SUV（max）, and between K（ep） and SUV（max）（P〈0.05）.There were significant differences between the malignant and benign nodules in terms of the K^trans, K（ep） and SUV（max） values（P〈0.05）. The areas under the ROC curve（AUC） of K^trans） K（ep） and SUV（max） between the malignant and benign nodules were 0.909, 0.838 and 0.759, respectively. The sensitivity and specificity in differentiating malignant from benign SPNs were 90.6% and 82.4% for K^trans; 87.5% and 76.5% for K（ep）; and 75.0% and 70.6%for SUV（max）, respectively. The sensitivity and specificity of K^trans and K（ep） were higher than those of SUV（max）, but there was no significant difference between them（P〉0.05）.Conclusions： DCE-MRI can be used to differentiate between benign and malignant SPNs and has the advantage of being radiation free.

Correlation between CT dynamic enhanced scanning parameters and serum tumor markers before and after radiofrequency ablation in patients with lung cancer

Objective:To study the correlation between CT dynamic enhanced scanning parameters and serum tumor markers before and after radiofrequency ablation in patients with lung cancer.Methods:60 patients with advanced non-small cell lung cancer who were treated in this hospital between January 2015 and January 2017 were divided into control group(n=30)and observation group(n=30)by random number table method.Control group received conventional intravenous chemotherapy,and observation group received intravenous chemotherapy combined with radiofrequency ablation.The differences in CT dynamic enhanced scanning parameter levels and serum tumor marker contents were compared between the two groups of patients before and after treatment.Pearson test was used to evaluate the correlation between CT dynamic enhanced scanning parameters and serum tumor marker contents in patients with advanced non-small cell lung cancer.Results:Before treatment,the differences in CT dynamic enhanced scanning parameter levels,non-organ-specific tumor marker contents and vascular tumor marker contents were not statistically significant between the two groups of patients(P>0.05).After treatment,CT dynamic enhanced scanning parameters PH and perfusion value levels of observation group were lower than those of control group(P<0.05);serum non-organ specific tumor markers CA125,CA153,CEA and CYFRA21-1 contents of observation group were lower than those of control group;serum vascular tumor markers VEGF,Ang-2,HIF-1 and MMP-9 contents were lower than those of control group(P<0.05).Pearson test showed that CT dynamic enhanced scanning parameters PH and perfusion value levels in patients with non-small cell lung cancer were positively correlated with serum non-organ specific tumor marker and vascular tumor marker contents.Conclusion:Adjuvant radiofrequency ablation can significantly reduce the tumor malignancy of patients with advanced non-small cell lung cancer.

Study of Scanning Dose Optimization on Chest and Abdomen Enhanced CT Imaging

Objective: To investigate the correlation between radiation dose and radiation risk when patients are scanned by 64-slice spiral CT. Materials and Methods: SPSS 17.0 is used statistically for analyzing the patient’s scanning parameters, radiation dose of monitoring and examining the patients who are scanning of their abdomen, chest and pelvic in our affiliated hospital. Results: SPSS statistical analysis shows that the factor related to radiation dose is scanning layer;the basic characteristics such as height and heart rate don’t affect the patient’s scan dose directly. Conclusion: Increasing the delay time after injection can reduce the scan numbers and monitoring layers of the machine, thus reduce the patient’s radiation dose and tube’s exposure time.

Diagnostic Value of Spiral CT Chest Enhanced Scan in Adult with Active Pulmonary Tuberculosis

Aim:To explore the diagnostic value of spiral CT chest enhanced scan for adults with active pulmonary tuberculosis.Methods:The clinical data of 60 adult patients with active pulmonary tuberculosis who were treated in our hospital from January 2018 to November 2019 were retrospectively analyzed.All patients underwent conventional chest radiography and spiral CT chest enhanced scan.The number of tuberculosis diagnosis,the detection rate of special site lesions,and the detection rate of active pulmonary tuberculosis signs by the two methods were compared.Results:In 60 patients,the pathological results confirmed the existence of 75 tuberculosis lesions.The detection rate of spiral CT was 98.67%,which was not statistically significant compared with the detection rate of 92.00%(P>0.05)in the conventional chest X-ray.The detection rate of spiral CT enhanced scans for tuberculosis lesions in special sites was 100.00%,which was significantly higher than that of conventional chest X-ray of 7.69%,and the accuracy rate of active pulmonary tuberculosis signs was 98.85%higher than that of conventional chest X-ray of 79.31%.P<0.05).The difference was statistically significant(P<0.05).Conclusion:Spiral CT chest enhanced scan can not only find special tuberculosis lesions that cannot be detected by conventional chest radiography,but also accurately determine active pulmonary tuberculosis in adults,which is of high diagnostic value.

Observations on the Diagnostic Effects of CT Examination(Enhanced Scan)on Hemorrhage Corpus Luteum Cyst

Objective:To investigate the diagnostic effects of enhanced CT scan on hemorrhage corpus luteum cyst(HCLC).Methods:The clinical data of 24 patients with hemorrhage corpus luteum cyst diagnosed by surgery and pathology in our hospital were collected.All patients received enhanced CT scan to evaluate the diagnostic value of CT.Results:The average diameter of the cysts in this group of patients was 5.1cm by CT.Further detection of the ruptured cyst wall showed that there was a liquid lowdensity shadow.Some of the cysts were accompanied by signs of increased density,indicating the presence of blood clots;all patients received surgical treatment.Intraoperative ultrasound examination of the cysts had an average diameter of 5.2cm and a wall of 0.2~0.4mm.Among them,19 cases of cysts contained"coffee-colored"liquid with varying degrees of blood clots,and 5 cases had no blood clots in the cysts but there were a lot of blood clots beside the cysts.Conclusion:The application of enhanced CT scan in patients with hemorrhage corpus luteum cyst is of great value.It can provide accurate data reference for clinical treatment and is worthy of promoting its clinical application.

肝细胞癌的动态增强CT扫描与MRI诊断作用分析

目的探究肝细胞癌的动态增强电子计算机断层扫描(computed tomography,CT)与磁共振成像(magnetic resonance imaging,MRI)诊断效果。方法选择2018年1月—2022年12月如东县人民医院影像科的60例疑似肝细胞癌患者的病例资料,均在术前进行动态增强CT检查、MRI检查,以手术病理结果为金标准,比较不同检查方法的诊断效能(诊断准确性、敏感度、特异度等)。结果60例患者的手术病理结果确诊出恶性35例、良性25例。MRI检查对肝细胞癌的诊断符合率(95.00%)较动态增强CT扫描(80.00%)高,诊断特异度(92.00%)高于动态增强CT扫描(68.00%),差异有统计学意义(χ^(2)=6.171、4.500,P<0.05)。结论在肝细胞癌诊断中,动态增强CT扫描、MRI检查均可取得一定的诊断效果,尤其是MRI检查,在诊断准确性、特异性方面更具有优势,能为其后续治疗方案的合理制订提供重要依据。

MRI与CT增强扫描对直肠癌术前T分期应用价值分析

探究了在直肠癌术前T分期中运用MRI与CT增强扫描的效果。选取2021年8月—2022年11月贵州省安顺市人民医院医学影像科收治的165例直肠癌患者为研究对象,均行MRI、CT增强扫描,以术后病理结果作为金标准,对MRI与CT增强扫描在术前T分期的结果进行了对比分析,同时对比两种检查方法诊断用时、患者接受度。将两种术前检查结果分别和病理检查结果进行对比,发现直肠癌术前T分期MRI检查诊断结果与病理结果相比(P>0.05);直肠癌术前T分期CT增强扫描诊断结果与病理检查相比(P<0.05),直肠癌术前T分期诊断符合率相比,结果显示MRI高于CT增强扫描,统计学对比有差异(P<0.05);对比两组诊断方法用时、患者接受度,前者MRI低于CT增强扫描,后者MRI评分更高(P<0.05)。研究发现,MRI与CT增强扫描均可用于直肠癌术前T分期,两种手段可有效对疾病进行诊断,为治疗的开展提供相关依据,实践证明,如将其联合应用,可明显提高诊断符合率。

CT增强扫描灰度直方图纹理分析技术对肺癌患者术前恶性程度评估及对预后的预测价值

目的探究CT增强扫描灰度直方图纹理分析技术对肺癌患者术前恶性程度评估及对预后的预测价值。方法选择2018年5月至2022年9月在我院就诊的且经术后病理证实的肺癌患者580例作为研究对象。依据术后病理分期,将研究对象分为高分化组(183例)、中分化组(195例)、低分化组(202例)。根据预后情况,将其分为预后良好组(356例)和预后不良组(224例)。由2名医师提取患者CT增强扫描灰度直方图纹理参数。受试者工作特征(receiver operating characteristic,ROC)曲线分析特征参数对肺癌患者术前恶性程度的诊断效能及预后的预测价值。多因素Logistic回归分析预后不良的重要影响因素并构建人工神经网络模型。Pearson分析检验参数间的相关性。结果均值、10%分位、50%分位等参数在高、中、低分化三组中有显著差异。三个参数对评估肺癌患者恶性程度均具有一定的诊断效能,且三者联合诊断效能最佳。均值、10%分位、50%分位是预后不良的保护因素,三者联合预测肺癌患者的曲线AUC值大于各指标单独预测的AUC值。ROC曲线和累积增益图表明该模型预测能力良好。纹理特征参数中,69.44%的参数具有相关性。结论CT增强扫描灰度直方图纹理参数在一定程度上反应肺癌患者术前恶性程度信息,给术前预测以及预后提供了重要方法。

CT增强检查中碘对比剂外渗病人皮肤损伤风险预测模型的构建

目的:探讨CT增强检查中碘对比剂外渗病人皮肤损伤发生风险的影响因素,构建并验证风险预测模型。方法:采用便利抽样法抽取2023年1月—7月在广西医科大学第一附属医院放射科接受CT增强检查的碘对比剂外渗病人286例作为研究对象,自制CT增强检查碘对比剂外渗病人皮肤损伤风险调查问卷对病人进行调查,采用单因素分析、Logistic回归分析筛选CT增强检查中碘对比剂外渗病人皮肤损伤发生风险的影响因素,构建风险预测模型,绘制列线图,运用受试者工作特征(ROC)曲线、校准曲线评价模型。结果:CT增强检查中碘对比剂外渗病人皮肤损伤发生率为18.5%。Logistic回归分析结果显示,过敏史、碘对比剂黏稠度、碘对比剂注射速度是CT增强检查中碘对比剂外渗病人皮肤损伤的影响因素(P<0.05),基于上述结果构建的预测模型建模组ROC曲线下面积为0.842[95%CI(0.770,0.915)],约登指数为0.667,最优截断值灵敏度为0.893,特异度为0.774;验证组ROC曲线下面积为0.924[95%CI(0.872,0.975)],约登指数为0.793,最优截断值灵敏度为0.891,特异度为0.902。Hosmer-Lemeshow检验结果显示,χ2=9.566,P=0.221 5,校准曲线与参考线相接近。结论:CT增强检查中碘对比剂外渗病人皮肤损伤风险预测模型预测效能良好,可为医务人员制订个性化的预防措施提供参考。

普美显增强MRI与增强CT在肝脏局灶性病变良恶性鉴别诊断中的应用

目的探讨普美显增强MRI与增强CT在肝脏局灶性病变良恶性鉴别诊断中的应用价值。方法回顾性分析2017年10月至2021年11月于医院收治的肝脏局灶性病变患者42例,根据病理结果分为良性组(n=21)、恶性组(n=21),两组患者均行普美显增强MRI与增强CT检查,比较两组患者影像表现,采用四格表法评估普美显增强MRI、增强CT鉴别肝脏局灶性病变良恶性的价值,采用内部一致性系数(Kappa)评价普美显增强MRI、增强CT与病理检查鉴别肝脏局灶性病变良恶性的一致性。结果42例患者恶性肿瘤21例(肝HCC7例、肝转移瘤14例),良性病变21例(肝血管瘤8例、肝FNH8例、肝硬化结节5例),普美显增强MRI均有效检出,肿块数目1个至多个。选择典型肿块为感兴趣区,比较良、恶性组影像特征发现,恶性组肿块直径水平、坏死囊变、增强动脉期环形强化、增强静脉期强化程度迅速减低、增强延迟期低信号、增强肝胆期低信号、强化方式环形强化呈快进快出比例明显高于良性组(P<0.05)。42例患者中CT影像检出病灶恶性肿瘤15例(肝HCC 5例、肝转移瘤10例),良性病变15例(肝血管瘤6例、肝FNH8例、肝硬化结节1例),选择典型肿块为感兴趣区,比较良、恶性组影像特征发现,恶性组肿块直径、肿块边缘模糊、坏死囊变、增强动脉期环形强化、增强静脉期环形强化明显异常、增强平衡期低密度、强化方式环形强化呈快进快出比例明显高于良性组(P<0.05)。普美显增强MRI鉴别肝脏局灶性病变良恶性的曲线下面积为0.810(95%CI 0.689~0.930),敏感度、特异度分别为85.71%、76.19%,阳性预测值、阴性预测值分别为78.26%、84.21%;内部一致性分析显示,普美显增强MRI、病理检查判断鉴别肝脏局灶性病变良恶性的Kappa为0.782,一致性较好(P<0.05)。增强CT鉴别肝脏局灶性病变良恶性的曲线下面积为0.767(95%CI 0.610~0.923),敏感度、特异度分别为73.33%、80.00%,阳性预测值、阴性预测值分别为78.57%、75.00%;内部一致性分析显示,增强CT、病理检查判断鉴别肝脏局灶性病变良恶性的Kappa为0.720,一致性一般(P<0.05)。结论普美显增强MRI、增强CT在鉴别肝脏局灶性病变良恶性方面具有一定价值,其中普美显增强MRI对病灶定位敏感性高,在鉴别良恶性的价值更高,值得临床推广应用。