Differential diagnosis of Crohn’s disease and intestinal tuberculosis based on ATR-FTIR spectroscopy combined with machine learning

BACKGROUND Crohn’s disease(CD)is often misdiagnosed as intestinal tuberculosis(ITB).However,the treatment and prognosis of these two diseases are dramatically different.Therefore,it is important to develop a method to identify CD and ITB with high accuracy,specificity,and speed.AIM To develop a method to identify CD and ITB with high accuracy,specificity,and speed.METHODS A total of 72 paraffin wax-embedded tissue sections were pathologically and clinically diagnosed as CD or ITB.Paraffin wax-embedded tissue sections were attached to a metal coating and measured using attenuated total reflectance fourier transform infrared spectroscopy at mid-infrared wavelengths combined with XGBoost for differential diagnosis.RESULTS The results showed that the paraffin wax-embedded specimens of CD and ITB were significantly different in their spectral signals at 1074 cm^(-1) and 1234 cm^(-1) bands,and the differential diagnosis model based on spectral characteristics combined with machine learning showed accuracy,specificity,and sensitivity of 91.84%,92.59%,and 90.90%,respectively,for the differential diagnosis of CD and ITB.CONCLUSION Information on the mid-infrared region can reveal the different histological components of CD and ITB at the molecular level,and spectral analysis combined with machine learning to establish a diagnostic model is expected to become a new method for the differential diagnosis of CD and ITB.

Diagnostic performance of texture analysis in the differential diagnosis of perianal fistulising Crohn’s disease and glandular anal fistula

BACKGROUND Perianal fistulising Crohn's disease(PFCD)and glandular anal fistula have many similarities on conventional magnetic resonance imaging.However,many patients with PFCD show concomitant active proctitis,but only few patients with glandular anal fistula have active proctitis.AIM To explore the value of differential diagnosis of PFCD and glandular anal fistula by comparing the textural feature parameters of the rectum and anal canal in fat suppression T2-weighted imaging(FS-T2WI).METHODS Patients with rectal water sac implantation were screened from the first part of this study(48 patients with PFCD and 22 patients with glandular anal fistula).Open-source software ITK-SNAP(Version 3.6.0,http://www.itksnap.org/)was used to delineate the region of interest(ROI)of the entire rectum and anal canal wall on every axial section,and then the ROIs were input in the Analysis Kit software(version V3.0.0.R,GE Healthcare)to calculate the textural feature parameters.Textural feature parameter differences of the rectum and anal canal wall between the PFCD group vs the glandular anal fistula group were analyzed using Mann-Whitney U test.The redundant textural parameters were screened by bivariate Spearman correlation analysis,and binary logistic regression analysis was used to establish the model of textural feature parameters.Finally,diagnostic accuracy was assessed by receiver operating characteristic-area under the curve(AUC)analysis.RESULTS In all,385 textural parameters were obtained,including 37 parameters with statistically significant differences between the PFCD and glandular anal fistula groups.Then,16 texture feature parameters remained after bivariate Spearman correlation analysis,including one histogram parameter(Histogram energy);four grey level co-occurrence matrix(GLCM)parameters(GLCM energy_all direction_offset1_SD,GLCM entropy_all direction_offset4_SD,GLCM entropy_all direction_offset7_SD,and Haralick correlation_all direction_offset7_SD);four texture parameters(Correlation_all direction_offset1_SD,cluster prominence_angle 90_offset4,Inertia_all direction_offset7_SD,and cluster shade_angle 45_offset7);five grey level run-length matrix parameters(grey level nonuniformity_angle 90_offset1,grey level nonuniformity_all direction_offset4_SD,long run high grey level emphasis_all direction_offset1_SD,long run emphasis_all direction_offset4_SD,and long run high grey level emphasis_all direction_offset4_SD);and two form factor parameters(surface area and maximum 3D diameter).The AUC,sensitivity,and specificity of the model of textural feature parameters were 0.917,85.42%,and 86.36%,respectively.CONCLUSION The model of textural feature parameters showed good diagnostic performance for PFCD.The texture feature parameters of the rectum and anal canal in FS-T2WI are helpful to distinguish PFCD from glandular anal fistula.

Six cases report of differential diagnosis of periapical diseases

The distinction of some particular forms of periapical area, involving diseases from regular periapical disease, is a matter of considerable importance when choosing a correct treatment. The aim of this study is to describe the differential diagnosis of F,eriapical diseases from six rare cases in clinical practice. The six rare cases are examples of situations where it is difficult to make a differential diagnosis in clinical practice. By retrospective surveys on the clinical examination, radiographs and pathological results, six patients referred to endodontic treatment in our department were analyzed for the accuracy of diagnosis and therapy. The pathoses of the six cases included two atypical radical cysts, periapical cemental dysplasia, cemento-ossifying fibroma, thymus cancer metastasis in the periapical site and tuberculosis. This report indicates that endodontists should be cognizant of a few particular circumstances when clinically treating periapical diseases.

Potential model for differential diagnosis between Crohn's disease and primary intestinal lymphoma

AIM To evaluate the usefulness of different parameters to differentiate Crohn's disease(CD) from primary intestinal lymphoma(PIL).METHODS The medical records of 85 patients with CD and 56 patients with PIL were reviewed retrospectively. Demographic, clinical, laboratory, endoscopic, and computed tomographic enterography(CTE) parameters were collected. The univariate value of each parameter was analyzed. A differentiation model was established by pooling all the valuable parameters. Diagnostic efficacy was analyzed, and a receiver operating characteristic(ROC) curve was plotted.RESULTS The demographic and clinical parameters that showed significant values for differentiating CD from PIL included age of onset, symptom duration, presence of diarrhea, abdominal mass, and perianal lesions(P < 0.05). Elevated lactate dehydrogenase and serum β2-microglobulin levels suggested a PIL diagnosis(P < 0.05). The endoscopic parameters that showed significant values for differentiating CD from PIL included multiple-site lesions, longitudinal ulcer, irregular ulcer,and intraluminal proliferative mass(P < 0.05). The CTE parameters that were useful in the identification of the two conditions included involvement of ≤ 3 segments, circular thickening of the bowel wall, wall thickness > 8 mm, aneurysmal dilation, stricture with proximal dilation, "comb sign", mass showing the "sandwich sign", and intussusceptions(P < 0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the differentiation model were 91.8%, 96.4%, 93.6%, 97.5%, and 88.5%, respectively. The cutoff value was 0.5. The area under the ROC curve was 0.989.CONCLUSION The differentiation model that integrated the various parameters together may yield a high diagnostic efficacy in the differential diagnosis between CD and PIL.

Clinical Application Value of Combined Detection of CG and TBA in Differential Diagnosis of Hepatobiliary System Diseases

Objective: To understand the clinical value of combined detection of cholyglycine CG and TBA in differential diagnosis of hepatobiliary diseases. Methods: Serum samples from 50 healthy people were collected as healthy control group. According to the latest disease diagnosis and treatment plan, 58 cases of HBV asymptomatic carrier group, 17 cases of viral hepatitis group, 49 cases of cirrhosis group, 50 cases of primary liver cancer group and 50 cases of other hepatobiliary diseases groups were collected respectively. The concentration levels of cholyglycine and total bile acid in each group were detected, and the differences among each group were compared. Results: By statistical analysis, serum CG concentration in viral hepatitis group, cirrhosis group, primary liver cancer group and other hepatobiliary diseases group was significantly higher than that in asymptomatic HEPATITIS B carriers and healthy control group, the differences were statistically significant (p 0.05). There was no significant difference in CG concentration among viral hepatitis group, liver cirrhosis group, primary liver cancer group and other hepatobiliary diseases group (p > 0.05). The serum TBA levels of asymptomatic carriers, viral hepatitis group, cirrhosis group, primary liver cancer group and other hepatobiliary system diseases group were significantly higher than those of healthy control group, the difference was statistically significant, p 0.05. Conclusion: Serum CG expression can not only detect liver lesions, but also distinguish different liver lesions. The positive rate of CG combined with TBA detection in patients with hepatobiliary diseases is significantly higher than that of single CG index detection. CG combined with TBA detection can significantly improve the sensitivity and accuracy of the diagnosis of hepatobiliary diseases, which is worthy of popularization and application.

Can TCM Treatment be Performed on the Basis of Differential Diagnosis of the Diseases Instead of the Syndromes?

Great advances have been achieved in the integration of western and traditional Chinese medicine (TCM).More and more TCM physicians in their practice accept the term 'differential diagnosis of the diseases' instead of the syndromes since western medicine has been introduced into the TCM circle.

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。

Gingival enlargements: Differential diagnosis and review of literature

Gingival enlargement is one of the frequent features of gingival diseases. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. They can be categorized based on their etiopathogenesis, location, size, extent, etc. Based on the existing knowledge and clinical experience, a differential diagnosis can be formulated. Subsequently, after detailed investigation, clinician makes a final diagnosis or diagnosis of exclusion. A perfect diagnosis is critically important, since the management of these lesions and prevention of their recurrence is completely dependent on it. Furthermore, in some cases where gingival enlargement could be the primary sign of potentially lethal systemic diseases, a correct diagnosis of these enlargements could prove life saving for the patient or at least initiate early treatment and improve the quality of life. The purpose of this review article is to highlight significant findings of different types of gingival enlargement which would help clinician to differentiate between them. A detailed decision tree is also designed for the practitioners, which will help them arrive at a diagnosis in a systematic manner. There still could be some lesions which may present in an unusual manner and make the diagnosis challenging. By knowing the existence of common and rare presentations of gingival enlargement, one can keep a broad view when formulating a differential diagnosis of localized(isolated, discrete, regional) or generalized gingival enlargement.

External anal sphincter electromyography in multiple system atrophy:implications for diagnosis,clinical correlations,and novel insights into prognosis

Multiple system atrophy is a sporadic,progressive,adult-onset,neurodegenerative disorder characte rized by autonomic dysfunction symptoms,parkinsonian features,and cerebellar signs in va rious combinations.An early diagnosis of multiple system atrophy is of utmost impo rtance for the proper prevention and management of its potentially fatal complications leading to the poor prognosis of these patients.The current diagnostic criteria incorporate several clinical red flags and magnetic resonance imaging marke rs supporting diagnosis of multiple system atrophy.Nonetheless,especially in the early disease stage,it can be challenging to differentiate multiple system atrophy from mimic disorders,in particular Parkinson’s disease.Electromyography of the external anal sphincter represents a useful neurophysiological tool for diffe rential diagnosis since it can provide indirect evidence of Onuf’s nucleus degeneration,which is a pathological hallmark of multiple system atrophy.However,the diagnostic value of external anal sphincter electromyography has been a matter of debate for three decades due to controve rsial reports in the literature.In this review,after a brief ove rview of the electrophysiological methodology,we first aimed to critically analyze the available knowledge on the diagnostic role of external anal sphincter electromyography.We discussed the conflicting evidence on the clinical correlations of neurogenic abnormalities found at external anal sphincter electro myography.Finally,we repo rted recent prognostic findings of a novel classification of electromyography patterns of the external anal sphincter that could pave the way toward the implementation of this neurophysiological technique for survival prediction in patients with multiple system atrophy.

A modified method for locating parapharyngeal space neoplasms on magnetic resonance images: implications for differential diagnosis

The parapharyngeal space(PPS) is an inverted pyramid-shaped deep space in the head and neck region, and a variety of tumors, such as salivary gland tumors, neurogenic tumors, nasopharyngeal carcinomas with parapharyngeal invasion, and lymphomas, can be found in this space. The differential diagnosis of PPS tumors remains challenging for radiologists. This study aimed to develop and test a modified method for locating PPS tumors on magnetic resonance(MR) images to improve preoperative differential diagnosis. The new protocol divided the PPS into three compartments: a prestyloid compartment, the carotid sheath, and the areas outside the carotid sheath. PPS tumors were located in these compartments according to the displacements of the tensor veli palatini muscle and the styloid process, with or without blood vessel separations and medial pterygoid invasion. This protocol, as well as a more conventional protocol that is based on displacements of the internal carotid artery(ICA), was used to assess MR images captured from a series of 58 PPS tumors. The consequent distributions of PPS tumor locations determined by both methods were compared. Of all 58 tumors, our new method determined that 57 could be assigned to precise PPS compartments. Nearly all(13/14; 93%) tumors that were located in the pre-styloid compartment were salivary gland tumors. All 15 tumors within the carotid sheath were neurogenic tumors. The vast majority(18/20; 90%) of trans-spatial lesions were malignancies. However, according to the ICA-based method, 28 tumors were located in the pre-styloid compartment, and 24 were located in the post-styloid compartment, leaving 6 tumors that were difficult to locate. Lesions located in both the pre-styloid and the post-styloid compartments comprised various types of tumors. Compared with the conventional ICA-based method, our new method can help radiologists to narrow the differential diagnosis of PPS tumors to specific compartments.

MRI影像组学用于心脏疾病的诊断价值及其研究进展

影像组学是一种基于医学影像数据的分析方法,传统的心脏磁共振扫描序列与其相结合可以从原始数据中获取定量空间数据,能够更加精准诊断心脏疾病的类型、严重程度和进展情况。基于此,本文就MRI影像组学在心脏疾病的诊断方面已体现的价值及不同序列MRI影像组学用于心脏疾病的研究进展进行综述。

Routine diagnosis of intestinal tuberculosis and Crohn's disease in Southern India

AIM:To investigate whether routinely measured clinical variables could aid in differentiating intestinal tuberculosis(ITB)from Crohn’s disease(CD).METHODS:ITB and CD patients were prospectively included at four South Indian medical centres from October 2009 to July 2012.Routine investigations included case history,physical examination,blood biochemistry,ileocolonoscopy and histopathological examination of biopsies.Patients were followed-up after 2 and 6 mo of treatment.The diagnosis of ITB or CD was re-evaluated after 2 mo of antituberculous chemotherapy or immune suppressive therapy respectively,based on improvement in signs,symptoms and laboratory variables.This study was considered to be an exploratory analysis.Clinical,endoscopic and histopathological features recorded at the time of inclusion were subject to univariate analyses.Disease variables with sufficient number of recordings and P<0.05 were entered into logistic regression models,adjusted for known confounders.Finally,we calculated the odds ratios with respective confidence intervals for variables associated with either ITB or CD.RESULTS:This study included 38 ITB and 37 CD patients.Overall,ITB patients had the lowest body mass index(19.6 vs 22.7,P=0.01)and more commonly reported weight loss(73%vs 38%,P<0.01),watery diarrhoea(64%vs 33%,P=0.01)and rural domicile(58%vs 35%,P<0.05).Endoscopy typically showed mucosal nodularity(17/31 vs 2/37,P<0.01)and histopathology more frequently showed granulomas(10/30vs 2/35,P<0.01).The CD patients more frequently reported malaise(87%vs 64%,P=0.03),nausea(84%vs 56%,P=0.01),pain in the right lower abdominal quadrant on examination(90%vs 54%,P<0.01)and urban domicile(65%vs 42%,P<0.05).In CD,endoscopy typically showed involvement of multiple intestinal segments(27/37 vs 9/31,P<0.01).Using logistic regression analysis we found weight loss and nodularity of the mucosa were independently associated with ITB,with adjusted odds ratios of 8.6(95%CI:2.1-35.6)and 18.9(95%CI:3.5-102.8)respectively.Right lower abdominal quadrant pain on examination and involvement of≥3 intestinal segments were independently associated with CD with adjusted odds ratios of 10.1(95%CI:2.0-51.3)and 5.9(95%CI:1.7-20.6),respectively.CONCLUSION:Weight loss and mucosal nodularity were associated with ITB.Abdominal pain and excessive intestinal involvement were associated with CD.ITB and CD were equally common.

Diagnosis of Crohn's disease in India where tuberculosis is widely prevalent

AIM:To define the parameters that positively predict diagnosis of Crohn's disease (CD) and differentiate it from gastrointestinal tuberculosis (GITB). METHODS:This prospective study over 3 years was carried out in the consecutive Indian patients with definite diagnosis of CD and equal numbers of patients with definite diagnosis of GITB. Demographic, clinical, laboratory, morphological and histological features were noted in all the patients. Serological tests such as p-ANCA, c-ANCA, IgA ASCA and IgG ASCA, were performed. Endoscopic biopsy and/or surgical tissue specimens were subjected to smear and culture for acid-fast bacilli (AFB) and tissue polymerase chain reaction for tuberculosis (TB PCR). Diagnosis of CD and GITB was based on the standard criteria. Data were analyzed using univariate Chi-square test and multiple logistic regression (MLR). RESULTS:The study is comprised of 26 patients with CD (age 36.6 ± 8.6 year, male:female, 16:10) and 26 patients with GITB (age 37.2 ± 9.6 year, male:female, 15:11). The following clinical variables between the two groups (CD vs TB) were significant in univariate analysis:duration of symptoms (58.1 ± 9.8 vs 7.2 ± 3.4 mo), diarrhoea (69.2% vs 34.6%), bleeding per rectum (30.7% vs 3.8%), fever (23.1% vs 69.2%), ascites (7.7% vs 34.6%) and extra-intestinal manifestations of inflammatory bowel disease (61.5% vs 23.1%). Of these, all except ascites and extra-colonic manifestations were found statistically significant by MLR. Accuracy of predicting CD was 84.62% based on the fever, bleeding P/R, diarrhoea and duration of symptoms while it was 63.4% when histology was reported as inflammatory bowel disease and 42.3% when there was recurrence of disease after surgery. Accuracy of predicting GITB was 73.1% when there was co-existing pulmonary lesions and/or abdominal lymphadenopathy;75% when tuberculosis was reported in histology;63.4% when granuloma was found in histology;82.6% when TB PCR was positive;and 61.5% when smear and/ or culture was positive for AFB. Serological test was not useful in differentiation of CD from GITB. Positivity rates for CD and GITB were:p-ANCA-3.8% and 3.8%, c-ANCA-3.8% and 0%, IgA ASCA-38.4% and 23.1%, and IgG ASCA-38.4% and 42.3%, respectively. CONCLUSION:Simple clinical parameters like fever, bleeding P/R, diarrhoea and duration of symptoms have the highest accuracy in differentiating CD from GITB.

MRI诊断马德龙病并颈部脂肪瘤1例并文献复习

回顾性地分析1例MRI诊断马德龙病并颈部脂肪瘤的临床相关资料,并进行相关文献的分析。马德龙病具有特征性的影像学表现,虽然影像表现不能作为诊断的金标准,但通过影像检查可在客观上为临床提供一种极佳的手术依据,对临床的诊疗活动有一定指导作用。

Diagnostic value associated with the combination of saliva pepsin and microorganisms in functional heartburn and gastroesophageal reflux disease

Heartburn is a common symptom shared by both gastroesophageal reflux disease(GERD)and functional heartburn(FHB),which can make it challenging to differentiate between the two conditions.However,examining oral manifestations of GERD can be a cost-effective and readily available method to aid in this differentiation process.It may serve as a valuable tool in distinguishing GERD from FHB.

Primary biliary cholangitis presenting with granulomatous lung disease misdiagnosed as lung cancer:A case report

BACKGROUND There are few cases of pulmonary granulomatous changes secondary to primary biliary cirrhosis(PBC).No case of granulomatous lung disease secondary to PBC misdiagnosed as lung cancer had been reported.CASE SUMMARY A middle-aged woman presented with lung nodules and was misdiagnosed with lung cancer by positron emission tomography/computed tomography.She underwent left lobectomy,and the pathology of the nodules showed granulomatous inflammation,which was then treated with antibiotics.However,a new nodule appeared.Further investigation with lung biopsy and liver serology led to the diagnosis of PBC,and chest computed tomography indicated significant reduction in the pulmonary nodule by treatment with methylprednisolone and ursodeoxycholic acid.CONCLUSION Diagnosis of pulmonary nodules requires integrating various clinical data to avoid unnecessary pulmonary lobectomy.

CT联合DCE-MRI在鉴别骶尾部骨巨细胞瘤和脊索瘤的价值研究

目的CT联合DCE-MRI-TIC曲线变化分析对比骶尾部脊索瘤和骨巨细胞瘤影像特征。方法回顾性分析35例骶尾部脊索瘤及骨巨细胞瘤患者的CT、核磁共振影像资料,所有病例均有手术病理结果。脊索瘤患者21人,骨巨细胞瘤患者14人。病程15天至5年。结果35名患者全部接受了CT平扫、DCEMRI检查。19例脊索瘤患者肿瘤多发生于S3椎体以下部位,靠近脊椎中线;12例骨巨细胞瘤以S2椎体及以上部位发生、偏离中轴骨,8例骨巨细胞瘤累及骶髂关节。脊索瘤CT影像上常表现为形态不规则,可见残存骨或钙质密度影,以致正常椎体形态消失或被包块代替;而骨巨细胞瘤常造成椎体骨壳不完整,但椎体轮廓尚可见。MRI上脊索瘤病灶内见高或更高T2信号影伴点、片状低信号结节,骨巨细胞瘤多呈等或稍高信号影。DCE-MRI脊索瘤具有延迟强的特点,TIC曲线类型多呈流入型;而大部分骨巨细胞瘤多早期呈显著强化而后造影剂迅速减退,信号减低;MCER、EP平均值较脊索瘤组明显升高,TIC曲线类型多呈流出型。结论CT联合DEC-MRI有助于骶尾部脊索瘤与骨巨细胞瘤的诊断及鉴别诊断,能为临床提供可靠的影像依据。

多参数MRI在前列腺癌与前列腺炎鉴别诊断中的应用研究

目的探究多参数MRI(Mp-MRI)在前列腺癌与前列腺炎鉴别诊断中的应用价值。方法选取2020年1月至2023年1月医院收治的78例前列腺病变患者作为研究对象,均接受Mp-MRI检查。以病理检查结果为金标准,分析Mp-MRI对前列腺癌与前列腺炎的鉴别诊断价值,以及前列腺癌组与前列腺炎组的Mp-MRI参数、成像特征。结果病理检查结果显示,78例患者中前列腺癌50例,前列腺炎28例。以病理检查结果为金标准,Mp-MRI的诊断灵敏度为96.00%,特异度为92.86%。Mp-MRI影像显示,前列腺癌组的表观扩散系数(ADC)低于前列腺炎组,信号强度-时间曲线(ST-T)参数中强化峰值高于前列腺炎组,到达增强峰值时间短于前列腺炎组,差异均有统计学意义(P<0.05);前列腺癌病灶多为单侧,而前列腺炎病灶多为双侧,差异有统计学意义(P<0.05);两组的局灶非结节低信号检出率比较,差异无统计学意义(P>0.05);前列腺癌组的局灶结节状低信号、占位信号检出率高于前列腺炎组,弥漫性低信号、患侧外周带肿胀检出率低于前列腺炎组,差异均有统计学意义(P<0.05)。结论Mp-MRI对前列腺癌与前列腺炎的诊断灵敏度、特异度均较高,可通过不同参数与成像特征进行鉴别诊断。

DCE-MRI定量参数联合血清VEGF、ProGRP水平检测对肺部良恶性病变的鉴别诊断价值

目的探讨动态增强磁共振成像(DCE-MRI)定量参数联合血清血管内皮生长因子(VEGF)、胃泌素释放肽前体(ProGRP)水平检测对肺部良恶性病变的鉴别诊断价值。方法回顾性选取疑似肺癌患者95例,并根据穿刺活检病理结果,将患者分为良性病变(46例)及恶性病变(49例),分别纳入良性组、恶性组。比较两组DCE-MRI定量参数[速率常数(Kep)、容量转移常数(Ktrans)、血管外细胞外间隙容积比(Ve)]及血清VEGF、ProGRP水平,分析DCE-MRI定量参数联合血清VEGF、ProGRP水平检测对肺部恶性病变的诊断价值。结果恶性组形状不规则、边缘毛刺征、内部强化不均匀、早期增强率≥60%占比大于良性组(P<0.05);恶性组Kep、Ktrans、Ve值及血清VEGF、ProGRP水平高于良性组,且联合诊断肺部恶性病变的AUC为0.898,最佳诊断敏感度为91.84%,特异度为86.96%,约登指数为0.788。结论DCE-MRI定量参数Kep、Ktrans、Ve及血清VEGF、ProGRP水平与肺部恶性病变密切相关,联合检测具有一定诊断价值,可作为临床鉴别诊断肺部良恶性病变有效检查方案之一。

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。