In order to find an easy and accurate procedure for diagnosis of diffuse goitre in children, we examined 50 patients with diffuse goitre using fine needle aspiration biopsy cytology, thyroid antibody detection, thyroi...In order to find an easy and accurate procedure for diagnosis of diffuse goitre in children, we examined 50 patients with diffuse goitre using fine needle aspiration biopsy cytology, thyroid antibody detection, thyroid hormone analysis and ultrasound imaging. In the meantime, 109 healthy children (control) were examined by ultrasound imaging. The results showed that thyroid imaging in health children was a smooth echo pattern with stronger homogenous echogram than surrounding muscle tissues. The patients with diffuse goitre showed an normally enlarged thyroid volume. In 22 (84. 6 %) of 26 children With chronic lymphocytic thyroiditis, a varied patch hypoechogenicity was found, of whom 18 (81. 8 % ) had positive results of antibody testing. On the contrary, echo-pattern was normal in 17 (70. 8 %) of 24 patients with diffuse thyroid proliferation and only the remainder (7/24, 29. 1% ) had abnormal echo-pattern as well as elevated auto-antibody titers, of whom 2 were confirmed as chronic lymphocytic thyroiditis by a repeat fine needle aspiration biopsy 1 year later. By using combined ultrasound imaging and antibody determination, 92 % of the cases with chronic lymphocytic thyroiditis could be diagnosed. Our study suggests that ultrasonic imaging is an easy, non-invasive, reproducible and effective procedure in the differen,tial diagnosis of chronic lymphocytic thyroiditis in children.展开更多
BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS re...BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS reduces unnecessary biopsies and improves consistency of imaging recommendations.Despite its widespread adoption,there are few studies to date assessing the inter-reader agreement amongst radiology trainees with limited ultrasound experience.We hypothesize that in PGY-4 radiology residents with no prior exposure to ACR TIRADS,a statistically significant improvement in inter-reader reliability can be achieved with a one hour training session.AIM To evaluate the inter-reader agreement of radiology residents in using ACR TIRADS before and after training.METHODS A single center retrospective cohort study evaluating 50 thyroid nodules in 40 patients of varying TI-RADS levels was performed.Reference standard TI-RADS scores were established through a consensus panel of three fellowship-trained staff radiologists with between 1 and 14 years of clinical experience each.Three PGY-4 radiology residents(trainees)were selected as blinded readers for this study.Each trainee had between 4 to 5 mo of designated ultrasound training.No trainee had received specialized TI-RADS training prior to this study.Each of the readers independently reviewed the 50 testing cases and assigned a TI-RADS score to each case before and after TI-RADS training performed 6 wk apart.Fleiss kappa was used to measure the pooled inter-reader agreement.The relative diagnostic performance of readers,pre-and post-training,when compared against the reference standard.RESULTS There were 33 females and 7 males with a mean age of 56.6±13.6 years.The mean nodule size was 19±14 mm(range from 5 to 63 mm).A statistically significant superior inter-reader agreement was found on the post-training assessment compared to the pre-training assessment for the following variables:1.“Shape”(k of 0.09[slight]pre-training vs 0.67[substantial]post-training,P<0.001),2.“Echogenic foci”(k of 0.28[fair]pre-training vs 0.45[moderate]post-training,P=0.004),3.‘TI-RADS level’(k of 0.14[slight]pre-training vs 0.36[fair]post-training,P<0.001)and 4.‘Recommendations’(k of 0.36[fair]pre-training vs 0.50[moderate]post-training,P=0.02).No significant differences between the preand post-training assessments were found for the variables'composition','echogenicity'and'margins'.There was a general trend towards improved pooled sensitivity with TI-RADS levels 1 to 4 for the post-training assessment while the pooled specificity was relatively high(76.6%-96.8%)for all TI-RADS level.CONCLUSION Statistically significant improvement in inter-reader agreement in the assigning TI-RADS level and recommendations after training is observed.Our study supports the use of dedicated ACR TI-RADS training in radiology residents.展开更多
目的甲状腺结节的精准分割在医学影像处理中具有重要意义,然而,超声图像中的结节通常具有尺寸多变和边缘模糊的特点,这为其准确分割带来了挑战。为有效应对这一挑战,本文提出了一种结合卷积神经网络(convolutional neural network,CNN)...目的甲状腺结节的精准分割在医学影像处理中具有重要意义,然而,超声图像中的结节通常具有尺寸多变和边缘模糊的特点,这为其准确分割带来了挑战。为有效应对这一挑战,本文提出了一种结合卷积神经网络(convolutional neural network,CNN)和Transformer的分割网络,命名为TransUNet,旨在实现对甲状腺结节超声图像的精准分割。方法首先,使用卷积神经网络对超声图像进行编码,以生成特征图。接着,将特征图转换为序列向量,并利用Transformer的编码机制来捕捉上下文信息。此外,为保持局部细节特征的完整性,研究组还引入了跳跃连接,将其用于在解码器中对编码特征进行上采样,这对于处理边缘模糊等问题尤为重要。结果通过在甲状腺结节图像分割任务中进行广泛的实验,验证TransUNet的有效性。具体而言,骰子系数(dice coefficient,DICE)为0.75,交并比(intersection over union,IoU)为0.60,F1分数(F1 Score)为0.72,准确率高达0.93,AUC(area under the ROC curve)为0.91。这些性能指标反映了该方法在处理尺寸多变和边缘模糊等挑战方面的出色表现。结论本文提出的TransUNet为甲状腺结节超声图像分割任务带来了显著的性能提升。相较于传统的U-Net方法,TransUNet不仅更好地处理了尺寸多变和边缘模糊等挑战,而且在分割性能上具有更为出色的表现,为医学图像处理领域的进一步研究和临床应用提供了有力支持。展开更多
目的 评估甲状腺结节超声恶性危险分层中国指南(Chinese-thyroid imaging reporting and data system,C-TIRADS)联合超声造影(contrast-enhancedultrasound,CEUS)评估桥本甲状腺炎4类结节。方法 回顾性分析2022年6月至12月于益阳市中心...目的 评估甲状腺结节超声恶性危险分层中国指南(Chinese-thyroid imaging reporting and data system,C-TIRADS)联合超声造影(contrast-enhancedultrasound,CEUS)评估桥本甲状腺炎4类结节。方法 回顾性分析2022年6月至12月于益阳市中心医院就诊的79例桥本甲状腺炎患者的120个C-TIRADS4类甲状腺结节资料。CEUS检查时如结节表现可疑的1种或多种良/恶性特征,均采取降/升一级的处理,以最终手术病理结果为金标准。绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线),比较诊断效能。结果 CEUS后再次分级的C-TIRADS诊断甲状腺结节良恶性的敏感度、特异性和准确性分别为93.0%、87.8%和90.8%(P<0.05)。ROC曲线下面积分别为0.811和0.904(P<0.05)。结论 C-TIRADS联合CEUS评估桥本甲状腺炎4类结节具有更好的诊断效能。展开更多
文摘In order to find an easy and accurate procedure for diagnosis of diffuse goitre in children, we examined 50 patients with diffuse goitre using fine needle aspiration biopsy cytology, thyroid antibody detection, thyroid hormone analysis and ultrasound imaging. In the meantime, 109 healthy children (control) were examined by ultrasound imaging. The results showed that thyroid imaging in health children was a smooth echo pattern with stronger homogenous echogram than surrounding muscle tissues. The patients with diffuse goitre showed an normally enlarged thyroid volume. In 22 (84. 6 %) of 26 children With chronic lymphocytic thyroiditis, a varied patch hypoechogenicity was found, of whom 18 (81. 8 % ) had positive results of antibody testing. On the contrary, echo-pattern was normal in 17 (70. 8 %) of 24 patients with diffuse thyroid proliferation and only the remainder (7/24, 29. 1% ) had abnormal echo-pattern as well as elevated auto-antibody titers, of whom 2 were confirmed as chronic lymphocytic thyroiditis by a repeat fine needle aspiration biopsy 1 year later. By using combined ultrasound imaging and antibody determination, 92 % of the cases with chronic lymphocytic thyroiditis could be diagnosed. Our study suggests that ultrasonic imaging is an easy, non-invasive, reproducible and effective procedure in the differen,tial diagnosis of chronic lymphocytic thyroiditis in children.
文摘BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS reduces unnecessary biopsies and improves consistency of imaging recommendations.Despite its widespread adoption,there are few studies to date assessing the inter-reader agreement amongst radiology trainees with limited ultrasound experience.We hypothesize that in PGY-4 radiology residents with no prior exposure to ACR TIRADS,a statistically significant improvement in inter-reader reliability can be achieved with a one hour training session.AIM To evaluate the inter-reader agreement of radiology residents in using ACR TIRADS before and after training.METHODS A single center retrospective cohort study evaluating 50 thyroid nodules in 40 patients of varying TI-RADS levels was performed.Reference standard TI-RADS scores were established through a consensus panel of three fellowship-trained staff radiologists with between 1 and 14 years of clinical experience each.Three PGY-4 radiology residents(trainees)were selected as blinded readers for this study.Each trainee had between 4 to 5 mo of designated ultrasound training.No trainee had received specialized TI-RADS training prior to this study.Each of the readers independently reviewed the 50 testing cases and assigned a TI-RADS score to each case before and after TI-RADS training performed 6 wk apart.Fleiss kappa was used to measure the pooled inter-reader agreement.The relative diagnostic performance of readers,pre-and post-training,when compared against the reference standard.RESULTS There were 33 females and 7 males with a mean age of 56.6±13.6 years.The mean nodule size was 19±14 mm(range from 5 to 63 mm).A statistically significant superior inter-reader agreement was found on the post-training assessment compared to the pre-training assessment for the following variables:1.“Shape”(k of 0.09[slight]pre-training vs 0.67[substantial]post-training,P<0.001),2.“Echogenic foci”(k of 0.28[fair]pre-training vs 0.45[moderate]post-training,P=0.004),3.‘TI-RADS level’(k of 0.14[slight]pre-training vs 0.36[fair]post-training,P<0.001)and 4.‘Recommendations’(k of 0.36[fair]pre-training vs 0.50[moderate]post-training,P=0.02).No significant differences between the preand post-training assessments were found for the variables'composition','echogenicity'and'margins'.There was a general trend towards improved pooled sensitivity with TI-RADS levels 1 to 4 for the post-training assessment while the pooled specificity was relatively high(76.6%-96.8%)for all TI-RADS level.CONCLUSION Statistically significant improvement in inter-reader agreement in the assigning TI-RADS level and recommendations after training is observed.Our study supports the use of dedicated ACR TI-RADS training in radiology residents.
文摘目的甲状腺结节的精准分割在医学影像处理中具有重要意义,然而,超声图像中的结节通常具有尺寸多变和边缘模糊的特点,这为其准确分割带来了挑战。为有效应对这一挑战,本文提出了一种结合卷积神经网络(convolutional neural network,CNN)和Transformer的分割网络,命名为TransUNet,旨在实现对甲状腺结节超声图像的精准分割。方法首先,使用卷积神经网络对超声图像进行编码,以生成特征图。接着,将特征图转换为序列向量,并利用Transformer的编码机制来捕捉上下文信息。此外,为保持局部细节特征的完整性,研究组还引入了跳跃连接,将其用于在解码器中对编码特征进行上采样,这对于处理边缘模糊等问题尤为重要。结果通过在甲状腺结节图像分割任务中进行广泛的实验,验证TransUNet的有效性。具体而言,骰子系数(dice coefficient,DICE)为0.75,交并比(intersection over union,IoU)为0.60,F1分数(F1 Score)为0.72,准确率高达0.93,AUC(area under the ROC curve)为0.91。这些性能指标反映了该方法在处理尺寸多变和边缘模糊等挑战方面的出色表现。结论本文提出的TransUNet为甲状腺结节超声图像分割任务带来了显著的性能提升。相较于传统的U-Net方法,TransUNet不仅更好地处理了尺寸多变和边缘模糊等挑战,而且在分割性能上具有更为出色的表现,为医学图像处理领域的进一步研究和临床应用提供了有力支持。
