超声弹性成像在肿瘤良恶性鉴别中的应用

超声弹性成像技术自问世以来,迅速发展并得到广泛的临床应用,已成为超声诊断的重要工具。本文对超声弹性成像在乳腺、甲状腺、前列腺、肝脏肿瘤的良恶性鉴别以及子宫、肾脏、淋巴结、涎腺、胰腺、胆囊良恶性肿瘤评估中的应用进行综述。     

螺旋CT与超声结合在结肠癌诊断中应用价值

目的探讨l6层螺旋CT与超声结合在结肠癌诊断中的价值。方法选取2007年1月至2013年2月在我科进行影像学检查并行结肠癌根治术的78例患者为研究对象。78例患者术前全部行螺旋CT检查和超声检查,将检查结果与术后病理确诊结果进行比较。结果术前16层螺旋CT确诊61例,确诊率78.21%;超声确诊58例,确诊率74.36%;2种方法结合确诊75例,确诊率96.15%。螺旋CT与超声比较,确诊率差异无统计学意义(P>0.05);螺旋CT与CT+超声比较以及超声与CT+超声比较,确诊率差异均有统计学意义(P<0.05)。结论螺旋CT与超声检查相结合,能提高结肠癌的术前诊断准确率。     

不同肠道准备方法在CT小肠造影(CTE)中的应用研究

目的:分析不同肠道准备方法对行CT小肠造影(CTenterography,CTE)患者的应用效果。方法:回顾性分析2020年2月~2021年1月我院收治的小肠病变患者122例临床资料,根据其肠道准备方法进行分组,观察不同肠道准备方法行CTE后的效果;A组43例扫描前16h进食半流质食物,给予番泻叶6g进行导泻,检测前12h禁食,检测前1h每隔15min口服甘露醇;B组40例与A组相同方法进行肠道准备,但将甘露醇更换为饮用水;C组39例检查前6h禁食,检查前1h每隔15min尽量口服饮用水。3组患者口服对比剂10min后进行CTE检查。结果:三组患者造影剂使用量经单因素方差分析显示(P<0.05);其中A、B组明显高于C组(P<0.05)。A、B小肠各肠腔充盈情况得分明显高于C组;A组又明显高于B组(P<0.05)。122例患者中共检出135处病变,根据最终临床诊断结果显示:A组出现10例误诊,B组共出现22例、C组共出现23例;A组诊断准确率明显高于B、C组;B、C组比较(P>0.05)。结论:分次口服甘露醇有助于CTE检查时小肠病变的显示与检出。     

256螺旋CT冠脉成像与DSA血管造影的对比研究

目的:对比256层螺旋计算机断层扫描(MSCT)与数字减影血管造影(DSA)在临床冠脉疾病诊断中的应用。方法:回顾性分析80例疑似冠脉疾病并在1周内分别采用256层MSCT、DSA诊断者的临床资料。对比二者对不同冠脉分段狭窄程度的评估结果;将DSA结果记为“金标准”,分析256层MSCT诊断冠脉狭窄的效能;统计256层MSCT对不同冠脉分段斑块形成的诊断结果。结果:冠脉血管节段可评价率为96.14%;256层MSCT、DSA对不同冠脉分段及总狭窄程度分布、狭窄检出率对比差异均无统计学意义(P>0.05);256层MSCT诊断冠脉狭窄的灵敏度、特异度、准确度、约登指数分别为97.92%、99.45%、98.57%、0.974;256层MSCT检出的568个冠脉狭窄段中共检出1036个斑块,其中钙化斑块、非钙化斑块、混合斑块分别有429个、200个、407个,占比分别为41.41%、19.31%、39.29%。结论:256层MSCT可诊断冠脉疾病,其诊断价值与DSA相当,且还可检出冠脉斑块形成情况及斑块性质。     

彩色多普勒超声与瞬时弹性成像诊断乙肝后肝硬化的价值研究

彩色多普勒超声检查与瞬时弹性成像技术是诊断乙肝后肝硬化的无创检查。彩色多普勒超声可通过肝脏形态、门静脉血流动力学与半定量评分对乙肝后肝硬化进行诊断,瞬时弹性成像可通过肝脏硬度值对肝硬化进行诊断。本文主要综述了目前彩色多普勒超声是如何对肝硬化进行诊断以及其在临床上的诊断应用、瞬时弹性成像是如何对肝硬化进行诊断以及其在临床上的诊断应用,二者联合诊断肝硬化的临床应用等方面,对肝硬化的诊断提供一定的参考意义,以期指导临床治疗。     

剖宫产术后CSP采用MRI动态增强与经阴超声检查的影像学表现及诊断效能对比

目的：探究剖宫产术后瘢痕妊娠（CSP）采用 MRI 动态增强与经阴超声检查的影像学表现及诊断效能对比。方法：选择 2017 年 1 月～2020 年 10 月期间于我院进行诊治且经病理学证实为剖宫产术后 CSP 的 53 例患者作为研究对象,对其经 MRI 动态增强、阴道超声检查后的结果进行比较分析。结果：53 例患者中,经 MRI 动态增强扫描诊断为单纯孕囊型的有 30 例,不均质包块型有 21 例,诊断准确率为 96. 23%（51/53）;经阴道超声检查诊断后为单纯孕囊型有 28 例,不均质包块型有 19 例,诊断准确率为 88. 68%（47/53）;MRI 动态增强与经阴超声检查的准确率相比无统计学意义（χ²=2. 163,P=0. 141）。两组在瘢痕形态及与孕囊关系的诊断率比较中均无明显差异（χ²=0. 051,P=0. 462）。53 例中,胚芽、卵黄囊、原始心管搏动、孕囊瘢痕浸润的 MRI 动态增强扫描分别检出 1 例、2例、0 例、3 例,经阴超声检查分别检出 11 例、10 例、8 例、14 例,经阴超声检查的检查率高于...     

胸部CT图像中孤立性肺结节良恶性快速分类

目的：为突破医学影像诊断学依据医学征象进行定性诊断准确度不高的瓶颈,针对胸部CT图像中孤立性肺结节（SPN）定性诊断问题,寻求能够有效表示SPN病理特性的图像特征,实现快速准确地SPN良恶性计算机辅助诊断系统。方法：首先,采取交互式分割方法从胸部CT图像中提取出SPN;其次,直接计算SPN图像的多分辨率直方图得到768维空间信息特征样本集;然后,充分利用具有处理高维数据集优势的支持向量机（SVM）构造SPN良恶性分类器;最后,通过测试样本集对经训练后的SVM分类器进行测试以评价分类性能。结果：经214例病例实验结果表明：240个SPN图像的768维特征计算所用时间为4.83秒,SVM分类器训练测试所用时间为2.24秒,敏感性71.33%,特异性70%,准确度71.67%,接受者操作特性曲线(ROC)下面积(AUC) 0.7864。结论：该系统提取的高维图像空间信息特征能够有效表示SPN特性;没有考虑医学征象进行SPN定性诊断的准确度就达到了71.67%,同时分类速度比传统纹理算法提高了近50倍,为医学影像学解决SPN定性诊断问题提供了便捷、客观的辅助手段。     

Ultrastructural and cytochemical changes in the liver of primary biliary cirrhosis patients

The aim of this paper is to establish whether there are cytochemical or ultrastructural alterations in the hepatocytes of patients with primary biliary cirrhosis (PBC) at stages I and II compared with the biopsies from individuals with normal liver. Cytochemical technique with ATP as substrate, transmission electron microscopy (TEM) and freeze fracture were used for the studies.
In the normal liver biopsies the ultrastructural cytochemical localization of the enzymatic activity was clearly shown in the bile canaliculi. In the PBC biopsies, the enzymatic activity is increased in the bile canaliculi and is also present in the lateral membranes of the hepatocyte.
TEM of the lateral surface of the hepatocyte in normal livers showed a smooth surface without microvilli but in PBC livers a large number of microvilli were seen in the lateral membranes. The Golgi apparatus in these patients was localized not only near the canaliculi (normal livers) but also in front of the microvilli. Freeze-fracture showed normal features in the bile canaliculus junctions of the PBC patients.
We suggest that the localization of the enzymatic reaction, microvilli and Golgi apparatus at the PBC hepatocyte lateral membranes may represent a compensatory mechanism for derivation of bile flow and other components from the hepatocyte to the intercellular space.     

恩替卡韦和替诺福韦酯治疗乙型肝炎肝硬化的实验室及超声指标比较

目的 :分析恩替卡韦和替诺福韦酯治疗乙型肝炎肝硬化疗效和安全性。方法 :选取我院2014年8月至2017年6月收治的89例乙型肝炎肝硬化患者进行研究,随机分为观察组与对照组,对照组治疗药物为恩替卡韦,观察组为替诺福韦酯,治疗48周后观察两组患者丙氨酸氨基转移酶(ALT)复常率、病毒学应答率、乙型肝炎E抗原(HBeAg)血清学转换率、总胆红素(TBIL)、天门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、肝脾超声指标及安全性。结果 :治疗后观察组ALT复常率、病毒学应答率及HBeAg血清学转换率均较对照组高,差异有统计学意义(P<0.05)。治疗前肝功能指标组间比较差异无统计学意义(P>0.05)。治疗后两组患者AST、TBIL均较治疗前下降,ALB较治疗前增高,差异均有统计学意义(P<0.05)。治疗后观察组AST、TBIL低于对照组,ALB高于对照组,差异有统计学意义(P<0.05)。治疗前肝脾超声指标组间比较差异无统计学意义(P>0.05)。治疗后两组患者门静脉内径、脾静脉内径及脾厚度均降低,与治疗前比较差异有统计学意义(P<0.05)。治疗后观察组门静脉内径、脾静脉内径及脾厚度均低于对照组,差异有统计学意义(P<0.05)。治疗期间,两组患者均无病毒学突破及严重不良反应发生,耐受性和安全性良好。结论:替诺福韦酯清乙肝病毒清除效果优于恩替卡韦,可有效控制乙型肝炎肝硬化病情进展,安全性好。     

Computerized morphometry of the cirrhotic liver: comparative analysis in primary biliary cirrhosis, alcoholic cirrhosis, and posthepatitic cirrhosis

Fibrosis and nodular regeneration are the hallmarks of liver cirrhosis. To assess the degree of fibrosis and the severity of the structural changes affecting parenchymal and extraparenchymal components in liver cirrhosis, a computerized morphometric model has been applied to liver specimens from patients undergoing liver transplantation for primary biliary cirrhosis, posthepatitic and alcoholic cirrhosis. Fifty-eight hepatectomy specimens from patients undergoing liver transplantation for cirrhosis were analyzed: 17 alcoholic, 28 posthepatitic (HBV-related and HCV-related cirrhosis), and 13 primary biliary cirrhoses. Liver specimens were fixed in 10% neutral-buffered formalin and embedded in paraffin. Sections were stained with chromotrope-aniline blue method and monoclonal antibodies against cytokeratin 7 and CD31. Volume fractions of parenchymal compartment and fibrosis were stereologically determined on the specimens stained with chromotrope-aniline blue method. Volume fractions of portal bile ducts, proliferated bile ductules, and hepatocytes with biliary metaplasia were measured on cytokeratin 7 stains, while volume fractions of capillary units have been evaluated on CD31 staining. Volume fraction of fibrosis was higher in primary biliary cirrhosis than in the other disease-induced cirrhosis. The main differences were related to immunohistochemical staining. Volume fraction of hepatocytes with biliary metaplasia was higher in HCV-related cirrhosis, whereas volume fractions of biliary structures were more prominent in HBV-related cirrhosis. Primary biliary cirrhosis was characterized by a reduced number of bile ducts and by a wider expression of cytokeratin 7 into periportal hepatocytes. Capillary units were more prominent in primary biliary cirrhosis than alcoholic and posthepatitic cirrhosis. Our computerized morphometric model well describes and quantifies the morphological alterations of the liver and it could represent an adjunctive tool to evaluate the degree of dysplastic phenomena involving parenchymal and extraparenchymal compartments.     

血清Betatrophin水平与2型糖尿病合并非酒精性脂肪肝病的相关性

目的 :分析2型糖尿病患者血清促代谢因子(Betatrophin)水平与合并非酒精性脂肪肝病的相关性。方法 :选取我院2017年9月至2019年3月收治的93例2型糖尿病患者作为病例组,按照是否合并非酒精性脂肪肝病分为合并NAFLD组与未合并NAFLD组,另选取50例健康体检者作为对照组,比较各组间一般资料、糖脂代谢指标及Betatrophin等指标,分析Betatrophin表达水平与2型糖尿病患者合并非酒精性脂肪肝病的相关性。结果 :病例组与对照组FPG、FINS、HbA1c、TC、TG、HDL-C、LDL-C、Betatrophin等指标比较差异均有统计学意义(P<0.05)。合并NAFLD组与未合并NAFLD组年龄、BMI、TC、TG、HDL-C、LDL-C、Betatrophin等指标比较差异均有统计学意义(P<0.05)。多因素分析发现Betatrophin与TG是2型糖尿病患者合并非酒精性脂肪肝的独立危险因素(P<0.05)。相关性分析发现,Betatrophin与TG呈正相关(r=0.504,P<0.05)。Betatrophin预测非酒精性脂肪肝病的ROC曲线下面积为0.658,具有一定预测价值(P=0.003)。结论 :Betatrophin可能通过影响脂质代谢促进2型糖尿病患者合并非酒精性脂肪肝病的发生。     

GND accumulation in bi-crystal deformation: Crystal plasticity analysis and comparison with experiments

A three-dimensional, large deformation crystal plasticity model is presented in which the lengthscale effect is incorporated through the explicit coupling of the density of geometrically necessary dislocations (GNDs) with the crystallographic slip rule.The channel-die bi-crystal compression tests carried out by Sun et al. [1998. Mesoscale investigation of the deformation field of an aluminium bicrystal. Scripta Material 39(4/5), 501-508; Sun, S., Adams, B.L., King, W.E., et al., 2000. Observations of lattice curvature near the interface of a deformed aluminium bicrystal. Philosophical Magazine 80 (1), 9-25] have been assessed and the crystal plasticity model has been employed to predict the distributions of GNDs local to the grain boundary. Quantitative comparisons of the predicted distributions with those determined experimentally show reasonable agreement. The qualitative comparisons of crystal reorientation predicted by the model with those observed by Zaefferer et al. [2003. On the influence of the grain boundary misorientation on the plastic deformation of aluminium bicrystals. Acta Materialia 51, 4719-4735] show good agreement. Further analyses of the bi-crystal have been carried out both with and without the development of GNDs. The results show that the crystal re-orientations local to the grain boundary are different if GND accumulation is included, suggesting that conventional, non-lengthscale crystal plasticity models are unlikely to be capable of capturing correctly the deformations arising at grain boundaries.     

Cerebral growth in Fragile X syndrome: review and comparison with Down syndrome

Neuroimaging studies have shown selective changes in brain size in Fragile X syndrome (FraX), which include reductions in the posterior cerebellar vermis, age-dependent increases in hippocampal volume, and enlarged caudate nucleus and thalamus. Contrasting with these limbic and subcortical anomalies, much less is known about the neocortex in FraX. The present study attempted to examine cerebral and lobar-level volumetric changes in young males with FraX (2-7 years), by comparing groups of subjects with full mutation (FM) and mosaicism (Mos) with both age-matched controls and subjects with developmental language delay (DLD) and Down syndrome (DS). For this purpose, we used high resolution (i.e, SPGR) MRI scans and semi-automated methods for segmenting (tissue class) and parcellating (i.e., Talairach) the brain. In agreement with previous studies, we found no changes in overall brain or cerebrum size in FraX. Nevertheless, boys with FM FraX had relative reductions in temporal lobe volume (primarily gray matter) and relative preservation/enlargement of parietal white matter volume. While temporal lobe reductions were not specific, since they were also observed in DLD and DS subjects, parietal preservation/enlargement was only seen in FraX. The relevance of these preliminary findings was emphasized by comparisons between FraX groups, which revealed more marked changes in FM FraX than in Mos FraX (i.e., gene dosage). While cross-sectional analyses revealed marked age-dependent decreases in DS, a group showing marked global and lobar volumetric reductions, there were no changes over time in FraX. These neuroimaging data are discussed in the context of FraX neurobiology and other developmental disorders.     

脑萎缩与皮质下缺血性血管病患者认知功能损害的关系

目的 :分析脑萎缩与皮质下缺血性血管病(Subcortical ischemic vascular disease,SIVD患者认知功能损害的关系。方法 :应用头颅MRI检查、视觉等级量表评分、脑白质疏松程度评分和腔隙性脑梗死计数,评价142例SIVD患者脑萎缩状态,并应用简易智力状态检查量表(mini-mental state examination,MMSE)评价患者认知功能。使用Pearson相关性分析、二元逐步Logistic回归分析,总结脑萎缩状态对患者MMSE评分的影响。结果:142例患者中94例(66.20%)MMSE评分<27分,纳入认知功能障碍组,其余48例为认知功能正常组。除顶叶视觉等级量表评分外,认知功能障碍组额叶、颞叶视觉等级量表评分以及各区域脑白质疏松程度评分、腔隙性脑梗死计数均高于认知功能正常组,差异有统计学意义(P <0.05)。Pearson相关性分析得出,视觉等级量表评分、脑白质疏松程度评分、腔隙性脑梗死计数与SIVD患者MMSE评分均呈负相关(P <0.05),颞区腔隙性脑梗死计数与患者MMSE评分相关性不明显(P> 0.05)。Logistic回归分析结果,在排除性别、年龄、合并症等因素影响后,受教育年限是影响SIVD患者MMSE评分的保护因素,视觉等级量表评分、脑白质疏松程度评分、腔隙性脑梗死计数均为影响SIVD患者MMSE评分的独立危险因素(P <0.05)。结论 :脑白质疏松程度、腔隙性脑梗死计数、脑萎缩均可造成SIVD患者认知功能下降,且三者对患者认知功能损害的影响依次加剧。     

特发性肺纤维化患者血清肿瘤标志物水平与疾病严重程度关系

目的:分析特发性肺纤维化(Idiopathic pulmonary fibrosis,IPF)患者血清肿瘤标志物水平与疾病严重程度的关系。方法:选取2013年3月—2016年3月74例IPF患者,检测患者血清甲胎蛋白(AFP)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段(Cyfra21-1、)、鳞状上皮细胞内抗原(SCC)、糖类抗原19-9(CA19-9)、CA15-3、CA125等肿瘤标志物,分析上述指标与患者肺功能、全肺纤维化高分辨率CT(high-resolution CT,HRCT)评分的相关性。结果:IPF患者FEV1为57.58±5.46、FVC为55.19±5.82、FEV1/FVC为85.04±2.28,患者HRCT评分为(2.26±0.43)分,Pearson相关性分析示,CEA、CA19-9、CA15-3与患者肺功能呈负相关,CEA、CA19-9、CA153、CA125与患者全肺纤维化HRCT评分呈正相关(P<0.05)。结论:IPF患者血清CEA、CA19-9、CA153、CA125水平与其疾病严重程度具有一定关联,据此了解患者肺间质受损程度有望为临床诊治及病情控制提供参考。