Enhanced Temporal Correlation for Universal Lesion Detection

Universal lesion detection(ULD)methods for computed tomography(CT)images play a vital role in the modern clinical medicine and intelligent automation.It is well known that single 2D CT slices lack spatial-temporal characteristics and contextual information compared to 3D CT blocks.However,3D CT blocks necessitate significantly higher hardware resources during the learning phase.Therefore,efficiently exploiting temporal correlation and spatial-temporal features of 2D CT slices is crucial for ULD tasks.In this paper,we propose a ULD network with the enhanced temporal correlation for this purpose,named TCE-Net.The designed TCE module is applied to enrich the discriminate feature representation of multiple sequential CT slices.Besides,we employ multi-scale feature maps to facilitate the localization and detection of lesions in various sizes.Extensive experiments are conducted on the DeepLesion benchmark demonstrate that thismethod achieves 66.84%and 78.18%for FS@0.5 and FS@1.0,respectively,outperforming compared state-of-the-art methods.

Breast non-mass-like lesions on contrast-enhanced ultrasonography: Feature analysis, breast image reporting and data system classification assessment

BACKGROUND Breast non-mass-like lesions(NMLs)account for 9.2%of all breast lesions.The specificity of the ultrasound diagnosis of NMLs is low,and it cannot be objectively classified according to the 5th Edition of the Breast Imaging Reporting and Data System(BI-RADS).Contrast-enhanced ultrasound(CEUS)can help to differentiate and classify breast lesions but there are few studies on NMLs alone.AIM To analyze the features of benign and malignant breast NMLs in grayscale ultrasonography(US),color Doppler flow imaging(CDFI)and CEUS,and to explore the efficacy of the combined diagnosis of NMLs and the effect of CEUS on the BI-RADS classification of NMLs.METHODS A total of 51 breast NMLs verified by pathology were analyzed in our hospital from January 2017 to April 2019.All lesions were examined by US,CDFI and CEUS,and their features from those examinations were analyzed.With pathology as the gold standard,binary logic regression was used to analyze the independent risk factors for malignant breast NMLs,and a regression equation was established to calculate the efficiency of combined diagnosis.Based on the regression equation,the combined diagnostic efficiency of US combined with CEUS(US+CEUS)was determined.The initial BI-RADS-US classification of NMLs was adjusted according to the independent risk factors identified by CEUS,and the diagnostic efficiency of CEUS combined with BI-RADS(CEUS+BI-RADS)was calculated based on the results.ROC curves were drawn to compare the diagnostic values of the three methods,including US,US+CEUS,and CEUS+BI-RADS,for benign and malignant NMLs.RESULTS Microcalcification,enhancement time,enhancement intensity,lesion scope,and peripheral blood vessels were significantly different between benign and malignant NMLs.Among these features,microcalcification,higher enhancement,and lesion scope were identified as independent risk factors for malignant breast NMLs.When US,US+CEUS,and CEUS+BI-RADS were used to identify the benign and malignant breast NMLs,their sensitivity rates were 82.6%,91.3%,and 87.0%,respectively;their specificity rates were 71.4%,89.2%,and 92.9%,respectively;their positive predictive values were 70.4%,87.5%,and 90.9%,respectively;their negative predictive values were 83.3%,92.6%,and 89.7%,respectively;their accuracy rates were 76.5%,90.2%,and 90.2%,respectively;and their corresponding areas under ROC curves were 0.752,0.877 and 0.903,respectively.Z tests showed that the area under the ROC curve of US was statistically smaller than that of US+CEUS and CEUS+BI-RADS,and there was no statistical difference between US+CEUS and CEUS+BI-RADS.CONCLUSION US combined with CEUS can improve diagnostic efficiency for NMLs.The adjustment of the BI-RADS classification according to the features of contrastenhanced US of NMLs enables the diagnostic results to be simple and intuitive,facilitates the management of NMLs,and effectively reduces the incidence of unnecessary biopsy.

Improved visibility of colorectal tumor by texture and color enhancement imaging with indigo carmine

BACKGROUND Accurate diagnosis and early resection of colorectal polyps are important to prevent the occurrence of colorectal cancer.However,technical factors and morphological factors of polyps itself can lead to missed diagnoses.Imageenhanced endoscopy and chromoendoscopy(CE)have been developed to facilitate an accurate diagnosis.There have been no reports on visibility using a combination of texture and color enhancement imaging(TXI)and CE for colorectal tumors.AIM To investigate the visibility of margins and surfaces with the combination of TXI and CE for colorectal lesions.METHODS This retrospective study included patients who underwent lower gastrointestinal endoscopy at the Toyoshima Endoscopy Clinic.We extracted polyps that were resected and diagnosed as adenomas or serrated polyps(hyperplastic polyps and sessile serrated lesions)from our endoscopic database.An expert endoscopist performed the lower gastrointestinal endoscopies and observed the lesion using white light imaging(WLI),TXI,CE,and TXI+CE modalities.Indigo carmine dye was used for CE.Three expert endoscopists rated the visibility of the margin and surface patterns in four ranks,from 1 to 4.The primary outcomes were the average visibility scores for the margin and surface patterns based on the WLI,TXI,CE,and TXI+CE observations.Visibility scores between the four modalities were compared by the Kruskal-Wallis and Dunn tests.RESULTS A total of 48 patients with 81 polyps were assessed.The histological subtypes included 50 tubular adenomas,16 hyperplastic polyps,and 15 sessile serrated lesions.The visibility scores for the margins based on WLI,TXI,CE,and TXI+CE were 2.44±0.93,2.90±0.93,3.37±0.74,and 3.75±0.49,respectively.The visibility scores for the surface based on WLI,TXI,CE,and TXI+CE were 2.25±0.80,2.84±0.84,3.12±0.72,and 3.51±0.60,respectively.The visibility scores for the detection and surface on TXI were significantly lower than that on CE but higher than that on WLI(P<0.001).The visibility scores for the margin and surface on TXI+CE were significantly higher than those on CE(P<0.001).In the sub-analysis of adenomas,the visibility for the margin and surface on TXI+CE was significantly better than that on WLI,TXI,and CE(P<0.001).In the sub-analysis of serrated polyps,the visibility for the margin and surface on TXI+CE was also significantly better than that on WLI,TXI,and CE(P<0.001).CONCLUSION TXI+CE enhanced the visibility of the margin and surface compared to WLI,TXI,and CE for colorectal lesions.

Precision in detecting colon lesions:A key to effective screening policy but will it improve overall outcomes?

Colonoscopy is the gold standard for the screening and diagnosis of colorectal cancer,resulting in a decrease in the incidence and mortality of colon cancer.However,it has a 21%rate of missed polyps.Several strategies have been devised to increase polyp detection rates and improve their characterization and delimi-tation.These include chromoendoscopy(CE),the use of other devices such as Endo cuffs,and major advances in endoscopic equipment[high definition,magnification,narrow band imaging,i-scan,flexible spectral imaging color enhancement,texture and color enhancement imaging(TXI),etc.].In the retrospective study by Hiramatsu et al,they compared white-light imaging with CE,TXI,and CE+TXI to determine which of these strategies allows for better definition and delimitation of polyps.They concluded that employing CE associated with TXI stands out as the most effective method to utilize.It remains to be demonstrated whether these results are extrapolatable to other types of virtual CE.Additionally,further investigation is needed in order to ascertain whether this strategy could lead to a reduction in the recurrence of excised lesions and potentially lower the occurrence of interval cancer.

Effect of contrast-enhanced ultrasound on differential diagnosis of intrahepatic cholangiocarcinoma and arterial phase enhanced hepatic inflammatory lesions

Objective: To investigate differential diagnosis between intrahepatic cholangiocarcinoma (ICC) and arterial phase enhanced hepatic inflammatory lesions in patients without liver cirrhosis using contrast-enhanced ultrasound (CEUS). Methods: ICC and hepatic inflammatory lesions cases with CEUS and pathological diagnosis between Sep 2013 and Oct 2016 were investigated retrospectively. Imaging features of conventional ultrasound and CEUS were analyzed. The parameters of time intensity curve (TIC), including the arrival time, peak intensity (PI) in the lesions, the starting time for washout, and the intensity difference at 3 min (Delta I-3) after contrast agent infection between the lesion and the liver parenchyma, were compared between ICC and hepatic inflammatory lesions. Results: Twenty-five ICC and fifteen inflammatory patients were included in this study. Seventeen ICC (68.0%) and two inflammatory cases (13.3%) showed bile duct dilatation on conventional ultrasound. Using CEUS, three ICC cases (12.0%) were misdiagnosed as inflammatory lesions and three inflammatory lesions (20.0%) as ICC; two ICC (8.0%) and one inflammatory case (6.7%) could not be made definite diagnosis. Washout started at 34.5 +/- 3.5 s and 61.5 +/- 12.9 s for ICC and inflammatory lesions respectively (P < 0.001). The intensity difference between lesion and liver parenchyma at 3 min after contrast agent injection was 10.8 +/- 3.1 dB in ICC and 4.2 +/- 2.3 dB in inflammatory group (P < 0.001). The sensitivity and specificity differentiating ICC and inflammatory lesions were 76% and 87% if the cut-off value of the intensity difference was 7.7 dB. Conclusions: Combined with TIC analysis, and particularly with the characteristic of the early-starting and obvious washout in ICC, CEUS can be useful in differential diagnosis between hepatic inflammatory lesions and ICC.

Enhanced recovery after surgery program in the patients undergoing hepatectomy for benign liver lesions

Background:Enhanced recovery after surgery(ERAS)has shown effectiveness in terms of reducing the hospital stay and cost.However,the benefit of ERAS in patients undergoing hepatectomy for benign liver lesions is still unclear.Methods:ERAS was implemented in our center since March 1st,2018.From September 2016 to Febru-ary 2018,109 patients were enrolled into the control group,and from March 2018 to June 2019,124 patients were enrolled into the ERAS group.All the indicators related to operation,liver functions,and postoperative outcomes were included in the analysis.Results:The clinicopathologic baselines were similar in these two groups.A significantly higher propor-tion of patients underwent laparoscopic surgery in the ERAS group.On the whole,intraoperative blood loss(100.00 mL vs.200.00 mL,P<0.001),blood transfusion(3.23%vs.10.09%,P=0.033),total bilirubin(17.10μmol/L vs.21.00μmol/L,P=0.041),D-dimer(2.08μg/mL vs.2.57μg/mL,P=0.031),postoperative hospital stay(5.00 d vs.6.00 d,P<0.001),and postoperative morbidity(16.13%vs.32.11%,P=0.008)were significantly shorter or less in the ERAS group than those in the control group.After stratified by operation methods,ERAS group showed significantly shorter postoperative hospital stay in both open and laparoscopic operation(both P<0.001).In patients underwent open surgery,ERAS group demonstrated significantly shorter operative duration(131.76±8.75 min vs.160.73±7.23 min,P=0.016),less intra-operative blood loss(200.00 mL vs.450.00 mL,P=0.008)and less postoperative morbidity(16.00%vs.44.44%,P=0.040).Conclusions:ERAS program may be safe and effective for the patients underwent hepatectomy,especially open surgery,for benign liver lesions.

Multiphase convolutional dense network for the classification of focal liver lesions on dynamic contrast-enhanced computed tomography

BACKGROUND The accurate classification of focal liver lesions(FLLs)is essential to properly guide treatment options and predict prognosis.Dynamic contrast-enhanced computed tomography(DCE-CT)is still the cornerstone in the exact classification of FLLs due to its noninvasive nature,high scanning speed,and high-density resolution.Since their recent development,convolutional neural network-based deep learning techniques has been recognized to have high potential for image recognition tasks.AIM To develop and evaluate an automated multiphase convolutional dense network(MP-CDN)to classify FLLs on multiphase CT.METHODS A total of 517 FLLs scanned on a 320-detector CT scanner using a four-phase DCECT imaging protocol(including precontrast phase,arterial phase,portal venous phase,and delayed phase)from 2012 to 2017 were retrospectively enrolled.FLLs were classified into four categories:Category A,hepatocellular carcinoma(HCC);category B,liver metastases;category C,benign non-inflammatory FLLs including hemangiomas,focal nodular hyperplasias and adenomas;and category D,hepatic abscesses.Each category was split into a training set and test set in an approximate 8:2 ratio.An MP-CDN classifier with a sequential input of the fourphase CT images was developed to automatically classify FLLs.The classification performance of the model was evaluated on the test set;the accuracy and specificity were calculated from the confusion matrix,and the area under the receiver operating characteristic curve(AUC)was calculated from the SoftMax probability outputted from the last layer of the MP-CDN.RESULTS A total of 410 FLLs were used for training and 107 FLLs were used for testing.The mean classification accuracy of the test set was 81.3%(87/107).The accuracy/specificity of distinguishing each category from the others were 0.916/0.964,0.925/0.905,0.860/0.918,and 0.925/0.963 for HCC,metastases,benign non-inflammatory FLLs,and abscesses on the test set,respectively.The AUC(95%confidence interval)for differentiating each category from the others was 0.92(0.837-0.992),0.99(0.967-1.00),0.88(0.795-0.955)and 0.96(0.914-0.996)for HCC,metastases,benign non-inflammatory FLLs,and abscesses on the test set,respectively.CONCLUSION MP-CDN accurately classified FLLs detected on four-phase CT as HCC,metastases,benign non-inflammatory FLLs and hepatic abscesses and may assist radiologists in identifying the different types of FLLs.

Clinical value of contrast-enhanced ultrasonography in the characterization of focal liver lesions:a prospective multicenter trial

BACKGROUND: Contrast-enhanced ultrasonography (CEUS) is increasingly accepted in clinical settings for diagnostic imaging of focal liver lesions (FLLs). This study aimed to assess the efficacy of CEUS in the characterization of FLLs in comparison with final diagnosis based on gold standard assessment. METHODS: The study was approved by the local ethics committee and participating patients provided written informed consent. A total of 148 patients with 164 FLLs were studied. Unenhanced ultrasonography (US) and CEUS were performed using fundamental and harmonic imaging, respectively. Contrast enhancement was assessed during the arterial, portal and late vascular phases after intravenous administration of contrast (SonoVue (R), Bracco, Italy). Sensitivity, specificity and diagnostic accuracy of US and CEUS were compared in identifying the lesion as benign, malignant or indeterminate and its actual tumor type. Final diagnosis was established by biopsy (129/164), MR imaging (11/164) or medical history (24/164). RESULTS: When compared to the gold standard, the number of indeterminate diagnoses was reduced from 56.7% (93/164) as assessed by fundamental imaging to 6.1% (10/164) after SonoVue (R) enhanced US examination. Sensitivity and specificity improved from 49% and 25% at baseline US to 93% and 75% with CEUS, respectively (P<0.01). Diagnostic accuracy of CEUS was 88% in contrast to 41% of baseline US. CONCLUSION: SonoVue (R) enhanced US improves the characterization of FLLs and may limit the need for further investigations.

Contrast-enhanced ultrasound in diagnosis and characterization of focal hepatic lesions

The extensive use of imaging techniques in differential diagnosis of abdominal conditions and screening of hepatocellular carcinoma in patients with chronic hepatic diseases,has led to an important increase in identification of focal liver lesions.The development of contrastenhanced ultrasound(CEUS) opens a new window in the diagnosis and follow-up of these lesions.This technique offers obvious advantages over the computed tomography and magnetic resonance,without a decrease in its sensitivity and specificity.The new second generation contrast agents,due to their intravascular distribution,allow a continuous evaluation of the enhancement pattern,which is crucial in characterization of liver lesions.The dual blood supply in the liver shows three different phases,namely arterial,portal and late phases.The enhancement during portal and late phases can give important information about the lesion's behavior.Each liver lesion has a different enhancement pattern that makes possible an accurate approach to their diagnosis.The role of emerging techniques as a contrastenhanced three-dimensional US is also discussed.In this article,the advantages,indications and technique employed during CEUS and the different enhancement patterns of most benign and malignant focal liver lesions are discussed.

Contrast-enhanced ultrasonography in the evaluation of incidental focal liver lesions: A cost-effectiveness analysis

AIM To determine whether contrast-enhanced ultrasonography(CEUS) as the first-line method is more costeffective in evaluating incidentally discovered focal liver lesions(FLLs) than is computed tomography(CT) and magnetic resonance imaging(MRI). METHODS Between 2010 and 2015, our prospective study enrolled 459 patients with incidentally found FLLs. The biological nature of FLLs was assessed by CEUS in all patients. CT or MRI examinations were added in unclear cases. The sensitivity and specificity of CEUS were calculated. The total costs of CEUS examinations and of the added examinations performed in inconclusive cases were calculated. Afterwards, the theoretical expenses for evaluating incidentally discovered FLLs using CT or MRI as the first-line method were calculated. The resultswere compared. RESULTS The total cost of the diagnostic process using CEUS for all enrolled patients with FLLs was 75884 USD. When the expenses for additional CT and MRI examinations performed in inconclusive cases were added, the total cost was 90540 US dollar(USD). If all patients had been examined by CT or MR as the first-line method, the costs would have been 78897 USD or 384235 USD, respectively. The difference between the cost of CT and CEUS was 3013 USD(4%) and that between MRI and CEUS was 308352 USD(406.3%). We correctly described 97.06% of benign or malignant lesions, with 96.99% sensitivity and 97.09% specificity. Positive predictive value was 94.16% and negative predictive value was 98.52%. In cases with 4 and more lesions, malignancy is significantly more frequent and inconclusive findings significantly less frequent(P < 0.001).CONCLUSION While the costs of CEUS and CT in evaluating FLLs are comparable, CEUS examination is far more costeffective in comparison to MRI.

Clinical Value of Contrast-enhanced Ultrasound in Differentiating Benign and Malignant Focal Liver Lesions

To explore the clinical value of contrast-enhanced ultrasound （CEUS） in differentiating benign and malignant focal liver lesions （FLLs） with SonoVue, CEUS was used to examine 113 patients with focal liver lesions （FLLs） in our hospital during July 2005 to December 2006. All the patients underwent contrast-enhanced CT （CECT） or contrast-enhanced MRI （CEMRI）. Except for patients with focal fatty sparings （n=18） and with hemangiomas （n=8）, all the patients were confirmed by operation or ultrasonic-guided liver puncture biopsy. A sulfur hexafluoride gas-based contrast agent was used with a MI of 0.15 to 0.17. Forty-eight cases of malignant FLLs, including 30 hepatocellular carcinomas （HCCs）, 2 cholangiocarcinomas and 16 metastatic tumors, were detected. Seventy-eight cases of benign FLLs, including 33 hemangiomas, 9 focal nodular hyperplasias （FNHs）, 19 focal fatty sparings, 5 abscesses, 7 regenerative nodules and 2 inflammatory pseudo-tumor, were involved. The contrast pattern of benign and malignant FLLs was quite different. CEUS has higher specificity and sensitivity than conventional ultrasound in differentiating benign and malignant FLLs.

Contrast enhanced ultrasound in diagnosing liver lesion that spontaneously disappeared:A case report

BACKGROUND Focal liver lesions(FLLs)are abnormal masses that are distinguishable from the surrounding liver parenchyma,solid or cystic and may be benign or malignant.They are usually detected incidentally on abdominal examinations.The classification of FLLs is very important as it directly determines the diagnosis and treatment of patients.CASE SUMMARY A 46-year-old male patient was admitted into the hospital with tarry stool,during the investigation of this issue an incidental FLL was detected.Upon further investigation of this“incidentaloma”computerized tomography and magnetic resonance imaging reached contradictory conclusions.The lesion was then further investigated using contrast-enhanced ultrasound(CEUS)with an initial diagnosis of idiopathic FLL was acquired and observation of the FLL over time need for final diagnosis,however in the follow up the FLL disappeared spontaneously.CONCLUSION CEUSs value for characterization of FLLs is undeniable,especially when other methods produce inconsistent results,is undeniable but with its limitations.Why and how the FLL disappeared is not known,and can be only hypothesized it was a pseudolesion.

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.

Application Value of Contrast-Enhanced Ultrasound in the Diagnosis of Breast Lesions

Objective:To explore the value and effect of contrast-enhanced ultrasound in the diagnosis of breast lesions.Methods:Seventy-two patients with breast lesions in Shaanxi Provincial People’s Hospital from June 2020 to December 2021 were selected as the research subjects.All 72 patients met the diagnostic criteria of breast lesions.Two patients with incomplete clinical data were excluded;hence,there were 70 patients remaining.The diagnostic results of the two examination methods and the diagnostic value of the joint examination for breast lesions were analyzed and compared.Results:The results of benign,malignant,missed,and misdiagnosed breast lesions by contrast-enhanced ultrasound were 31,32,6,and 1 cases,respectively,accounting for 44.29%,45.71%,8.57%,and 1.43%,respectively.The results of benign,malignant,missed,and misdiagnosed breast lesions by ultrasound automatic volume imaging were 21,24,17,and 8 cases,respectively,accounting for 30.00%,34.28%,24.29%,and 11.43%,respectively.There were statistical differences between the two groups for missed diagnosis and misdiagnosis,but there was no significant difference between the two groups for benign and malignant lesions.The accuracy,sensitivity,and specificity of contrast-enhanced ultrasound were 87.69%,83.62%,and 83.45%,respectively;the accuracy,sensitivity,and specificity of ultrasound automatic volume imaging were 71.39%,68.99%,and 74.69%,respectively;the accuracy,sensitivity,and specificity of contrast-enhanced ultrasound combined with ultrasound automatic volume imaging were 96.29%,92.68%,and 91.78%,respectively.Conclusion:Contrast-enhanced ultrasonography has a high clinical application value and a low inspection error rate in the diagnosis of breast lesions.It merits clinical advancement since it helps doctors diagnose and treat breast lesions more effectively.

超声造影对诊断肝移植术后缺血性胆道损伤预测价值的前瞻性队列研究

目的:探究超声造影(CEUS)对肝移植术后早期肝门处胆管壁增厚患者缺血性胆道损伤(ITBLs)的预测价值。方法:前瞻性纳入2020年6月25日至2022年12月28日于首都医科大学附属北京友谊医院肝移植中心行肝移植术且术后早期肝门部胆管壁增厚的45例患者,所有患者在常规超声初次发现肝门处胆管壁增厚时进行胆道CEUS,并记录胆管壁在各时相的强化模式,根据后续胆道造影的结果将患者分为ITBLs组(15例)和非ITBLs组(30例),对两组患者在CEUS各时相的强化程度进行定性分析并比较,同时评价CEUS对肝移植术后ITBLs的诊断效能。结果:两组患者供肝来源、胆道吻合方式、自身免疫性肝病、肝动脉闭塞(HAO)、排异反应、巨细胞病毒感染及胆管炎情况比较差异均无统计学意义(P>0.05)。两组CEUS动脉期增强模式比较,非ITBLs组患者中25例(占83.3%)为高增强,5例(占16.7%)为等增强,0例低增强或无增强;ITBLs组患者中3例(占20.0%)为高增强,4例(占26.7%)为等增强,8例(占53.3%)为低增强或无增强,两组比较差异有统计学意义(χ^(2)=22.946,P<0.05)。两组延迟期增强模式比较差异无统计学意义(P>0.05)。胆道CEUS提示动脉期低增强或无增强诊断ITBLs的准确率、灵敏度、特异度、阳性预测值及阴性预测值分别为84.4%,53.3%,100%,100%和84.4%。8例CEUS诊断为ITBLs患者,CEUS诊断ITBLs的时间较胆道造影提前了1~6[3.0(1~5)]个月。结论:CEUS可以在胆道出现明显的形态学改变前较准确的预测ITBLs,显著提前ITBLs的诊断时间。

经静脉超声造影在子宫局灶性病变诊断及评估中的应用现状

常见的子宫局灶性病变(focal uterine lesions,FUL)包括良性病变和恶性病变。恶性FUL早期的诊断与治疗对于提高生存率和改善预后起着至关重要的作用。不同的FUL的病理特点不同,微血管灌注也存在差异。经静脉超声造影(CEUS)技术作为有效的微血管显像方式,为鉴别诊断FUL的良恶性及进一步评估恶性病变提供了更多的信息,为临床医师管理患者方案的选择提供了客观的影像资料。本文就经静脉CEUS在常见FUL中诊断及评估的应用现状做一综述。

DCE-MRI联合DWI扫描在肝脏局灶性病变(直径≤3cm)定性诊断中的应用

目的分析磁共振动态增强扫描(DCE-MRI)联合弥散加权成像(DWI)扫描在肝脏局灶性病变(FLLs)(直径≤3cm)定性诊断中的应用价值。方法选择我院2021年4月至2024年4月收治的50例FLLs患者,均接受DCE-MRI和DWI检查,以穿刺或手术等病理结果为标准,比较不同病理类型动态增强扫描曲线分布情况、在不同弥散敏感系数(b值)下的表观弥散系数(ADC)值,并分析DCE-MRI联合DWI扫描对FLLs定性诊断的价值。结果病理结果显示,50例FLLs患者中13例为肝血管瘤,21例为原发性肝癌,16例为肝脏转移瘤。不同b值下,不同病理类型间ADC值比较均有明显差异(P<0.05),且肝血管瘤组ADC值均明显高于原发性肝癌组和肝脏转移瘤组(P<0.05)。DCE-MRI结果显示,肝血管瘤组曲线以Ⅲ型为主(占比76.92%),原发性肝癌组曲线以Ⅰ型为主(占比66.67%),肝脏转移瘤组曲线以Ⅱ型为主(占比75.00%);三组曲线类型分布情况比较有明显差异(P<0.05),且肝血管瘤组与其他两组间曲线类型分布情况比较均有明显差异(P<0.05)。检查结果显示,DCE-MRI联合DWI扫描对良性、恶性病灶诊断准确率最高,分别是92.31%(12/13)、97.30%(36/37);其次是DCE-MRI扫描,分别是69.23%(9/13)、75.68%(28/37);最低是DWI扫描,分别是61.54%(8/13)、54.05%(20/37)。不同检查方法定性诊断FLLs的灵敏度、准确度比较均有明显差异(P<0.05),且DCE-MRI联合DWI扫描诊断的灵敏度和准确度均明显高于DWI及DCE-MRI单独扫描(P<0.05)。结论在FLLs(直径≤3cm)定性诊断中应用DCE-MRI联合DWI扫描有更高的灵敏度和准确度,利于明确其良恶性质,为临床诊治提供更精确指导。

腹部DCE-MRI联合IVIM诊断子宫内膜病变的临床价值

目的探究腹部磁共振成像动态对比增强成像(DCE-MRI)联合体素内不相干运动扩散加权成像(IVIM)诊断子宫内膜病变的临床价值。方法选取2022年1月至2023年2月我院行MRI检查的子宫内膜病变患者82例,以病理结果为“金标准”,将患者分为良性组(49例)和恶性组(33例),比较两组DCEMRI、IVIM参数差异,绘制ROC曲线分析DCE-MRI联合IVIM检测子宫内膜病变的诊断价值。结果良性组体积转运常数(Ktrans)、速率转运常数(Kep)、体积分数(Ve)值低于恶性组(P<0.05)。良性组慢速表观扩散系数(ADC-slow)、灌注分数(f)、水分子扩散分布指数(DDC)、扩散异质性指数(α)值高于恶性组,快速表观扩散系数(ADC-fast)值低于恶性组(P<0.05)。ROC曲线分析显示:当Ktrans、Ke p、Ve、ADCslow、ADC-fast、f、DDC、αAUC分别为0.812、0.762、0.736、0.726、0.666、0.706、0.686、0.777时,约登指数最大,其截断值分别为0.45、0.86、0.51、0.47、12.69、0.37、1.02、0.66时,联合诊断AUC为0.894(95%CI:0.812~0.975)、灵敏度84.8%、特异度93.9%、阳性预测值93.4%、阴性预测值86.2%均高于各参数单项检测(P<0.05),诊断效能最佳。结论腹部DCE-MRI联合IVIM可提高子宫内膜病变的诊断准确性,具有较高临床价值。

磁共振成像新技术在乳腺良恶性病变鉴别诊断中的应用进展

乳腺癌已成为全球第一大癌症,严重威胁女性健康。磁共振成像技术以其多参数、高软组织分辨率及无电离辐射等优点,已越来越多地应用于乳腺病变的良恶性鉴别。随着近年来磁共振技术的飞速发展,新的成像方法不断涌现,为乳腺病变的良恶性检出提供了更有价值的参考依据。其中,超快速磁共振动态对比增强成像、合成磁共振成像、磁共振指纹打印技术及一系列高级扩散加权成像技术(体素内不相干运动成像、扩散峰度成像和拉伸指数模型成像)均可以从不同角度描述乳腺病变潜在的组织学或病理学特征,为良恶性鉴别提供有力支撑。本文将从成像原理、技术特点以及临床应用等多个层面,系统地阐述上述磁共振成像新技术对乳腺病变良恶性的鉴别诊断价值。

基于DCE-MRI影像组学模型对乳腺NME病变诊断价值的研究

目的 探讨结合机器学习早期动态增强磁共振成像(DCE-MRI)的影像组学模型在鉴别良恶性乳腺非肿块强化(NME)病变中的价值。方法 选取行乳腺DCE-MRI检查并获得病理结果的NME病变患者242例,分为训练集163例、测试集55例,外部验证集24例。基于早期DCE-MRI序列的特征选择,采用支持向量机(SVM)建立组学预测模型;由2位放射科医师独立评估MRI特征,建立传统诊断模型,预测病灶的良恶性;运用测试集和外部验证集进行测试和外部验证。采用受试者工作特征(ROC)曲线评价组学模型与放射医师的诊断效能。结果 影像组学模型鉴别乳腺NME病变良恶性达到了与高年资放射医师[曲线下面积(AUC)=0.82, 95%CI 0.66, 0.89]相当的诊断水平[(AUC=0.82, 95%CI 0.67, 0.90);P=0.30],均优于低年资放射医师的评估结果(Z=2.63,P=0.01;Z=2.41,P=0.02),同时利用外部验证集进一步验证该模型的预测效能。结论 基于早期DCE-MRI组学模型可以有效地鉴别NME病变的良恶性,与高年资放射医师诊断水平相当,并优于低年资医师诊断水平,可以辅助低年资医师做出更佳诊断。