改变时间分辨力对宫颈癌螺旋CT灌注及辐射剂量的影响

目的研究不同时间分辨力对宫颈癌CT灌注参数以及灌注曲线的影响。方法对10例经临床确诊的宫颈癌患者行CT灌注扫描,原始数据采样时间分辨力为0.75s,然后将原始数据按不同时间分辨力进行分组,分别为1.5、2.25、3、3.75、4.5、5.25、6s组(实验组),各组按照相同的数学模型及相同部位感兴趣区(ROI),分别计算灌注参数血流量(BF)、血容量(BV)、平均通过时间(MTT)、渗透系数(PS)并与原始数据组(对照组)进行比较分析。结果 BF与MTT对时间分辨力的改变较敏感,当时间分辨力为3s时,即产生显著影响;PS与BV对时间分辨力变化的敏感性较差,当时间分辨力为4.5s时,对PS产生显著影响,当时间分辨力为5.25s时,才对BV产生显著影响。结论改变时间分辨力会导致灌注曲线及灌注参数发生相应改变,但在不影响诊断目的前提下,适当减低宫颈癌CT灌注扫描的时间分辨力(循环扫描时间≤2.25s)可以有效降低辐射剂量。     

ELISA法检测血清胃泌素释放前体肽诊断小细胞肺癌的系统评价

目的 评价酶联免疫吸附(ELISA)法检测血清胃泌素释放前体肽(Pro-GRP)诊断小细胞肺癌(SCLC)的价值.方法 检索PubMed、Cochrane、ISI Web of Knowledge等数据库,检索时间为1990～2009年发表的文献,收集关于ELISA法检测血清Pro-GRP诊断SCLC的相关文献并进行信息统计、科学性评估及质量分级;采用Meta-Disc1.4软件进行数据分析;通过汇总敏感度、特异度、汇总似然比及汇总受试者工作特征曲线(SROC曲线)等统计指标综合评价ELISA法检测血清Pro-GRP对SCLC的早期诊断价值.结果 共纳入11篇文献,其中英文文献6篇,中文文献5篇,样本量为3554例,其中经病理学确诊的SCLC为1122例,NSCLC为2432 例.异质性检验显示纳入研究齐性好,通过确定模型的汇总计算得出汇总敏感度为0.75(0.73,0.78),汇总特异度为0.93(0.92,0.94),汇总阳性似然比11.44,汇总阴性似然比0.27,SROC曲线下面积为0.93.结论 Pro-GRP在早期诊断SCLC中具有一定的参考价值,可作为较重要的参考指标之一.     

普通支气管镜联合自发性荧光支气管镜在肺癌早期定位诊断中的系统评价

目的采用Meta分析方法评价普通荧光支气管镜联合自发性荧光支气管镜在肺癌早期诊断中的价值,为临床应用提供依据。方法检索PubMed、ISI Web of Knowledge、Chest、Cochrane等数据库,检索时间为1990～2010年,收集普通荧光支气管镜联合自发性荧光支气管镜对肺癌早期诊断的相关文献;按纳入与排除标准筛选文献并对纳入文献进行质量评价;采用MetaDisc1.4软件对数据进行异质性分析,计算汇总敏感度、特异度、汇总似然比及汇总受试者工作特征曲线(SROC曲线),综合评价普通支气管镜联合自发性荧光支气管镜在肺癌早期诊断中的价值。结果共纳入10篇文献,样本量为2 157例,共获取活检标本4 804例,其中经病理证实为中重度不典型增生、原位癌及侵袭癌的标本为2 183例。异质性检验提示无阈值效应,但存在其他原因导致的异质性,按随机效应模型进行Meta分析得出汇总灵敏度为0.84(95%CI:0.81～0.86),汇总特异度为0.61(95%CI:0.60～0.63),汇总阳性似然比为2.25(95%CI:2.12～2.39),汇总阴性似然比为0.27(95%CI:0.23～0.32),SROC曲线下面积为0.839 5。亚组分析结果显示,6个使用肺成像荧光屏内镜(LIFE)系统的SROC曲线下面积为0.841 5,4个使用D-light Storz系统的SROC曲线下面积为0.884 1。结论普通荧光支气管镜联合自发性荧光支气管镜在肺癌的早期诊断中具有一定的特异性,敏感性较高,有一定的诊断价值,可作为临床较重要的参考指标。     

CYFRA21-1对早期非小细胞肺癌诊断价值的Meta分析

目的评价CYFRA21-1对早期非小细胞肺癌诊断的价值。方法收集已公开发表的有关CYFRA21-1对早期非小细胞肺癌诊断价值的文献,按Meta分析的要求对检索到的原始研究的质量进行评估,对符合条件的所有研究结果进行Meta分析。结果共纳入9篇文献,其中中文文献6篇,英文文献3篇,样本量为670例,其中经病理学确诊的Ⅰ、Ⅱ期及可手术治疗的NSCLC为276例,异质性检验显示纳入研究齐性较好,通过确定模型的汇总计算得出汇总敏感度为41%(35%～46%),汇总特异度为94%(91%～96%),汇总阳性预测值为5.65(3.45～9.27),汇总阴性预测值为0.64(0.54～0.76),合并受试者工作特征曲线(SROC)的曲线下面积为0.85。结论 CYFRA21-1对早期非小细胞肺癌有一定的诊断价值,可作为较重要的参考指标之一,但需要更多高质量、大样本、多中心的研究加以验证。     

多跨连续布置钢绞线张拉伸长值计算分析

多跨连续布置钢绞线曲线形式复杂,需要解决理论伸长值的计算方法。利用规范内的计算公式,将复杂曲线分解后逐段计算,并使用计算机电算得到理论伸长值数据。通过对比厦门中洲大桥160m长钢束理论伸长值与实际量测数据,并对计算方法及施工因素进行分析,表明采用EXCEL电子表格及其函数功能进行分段计算汇总能够解决实际问题。     

周围性肺栓塞螺旋CT强化扫描肺密度测量的研究

目的　探讨螺旋CT平扫与强化扫描肺实质密度测量在周围性肺栓塞诊断中的作用。方法　 8只犬于DSA下复制为单侧周围性肺栓塞动物模型后进行螺旋CT平扫和强化扫描 ,根据DSA发现的栓塞肺动脉的位置 ,于螺旋CT平扫和强化扫描图像上分别测量栓塞区与对侧肺正常肺实质的CT值 ,比较双肺的CT值差异与净增CT值差异。结果　螺旋CT平扫栓塞区的CT值与对侧正常肺实质的CT值之间无明显差异 (P >0 .0 5 ) ;螺旋CT强化扫描显示栓塞区的CT值明显低于正常肺实质的CT值 (P <0 .0 1) ,而且栓塞区的净增CT值也明显低于正常肺实质的净增CT值 (P <0 .0 1)。结论　螺旋CT强化扫描可以发现周围性肺栓塞所致的低灌注区 ,是诊断周围性肺栓塞的重要间接征象     

低剂量螺旋CT对高危人群肺癌筛查价值的Meta分析

目的应用Meta分析法综合评价低剂量螺旋CT(low-dose spiral computed tomography,LDCT)在肺癌筛查中的价值。方法在PubMed、Cochrane等数据库检索1996年至2010年期间的相关文献资料;根据纳入标准筛选符合条件的文献;对文献进行信息统计、科学性评估及质量分级;采用随机效应模型进行数据分析;通过似然比(likelihoodratio,LR)、加权灵敏度和特异度(pooled sensitivity and specificity)及汇总受试者工作特征曲线(summary receiveroperator characteristic curve,SROC曲线)等统计指标综合评价LDCT在肺癌筛查中的价值。结果共纳入12篇英文文献,由9个独立研究构成,研究对象28 024例。文献质量评估结果提示纳入文献质量较好;LDCT在肺癌筛查中价值的合并阳性似然比(+LR)为3.35,阴性似然比(-LR)为0.29,加权灵敏度为0.735(0.730～0.740),特异度为0.791(0.747～0.830),SROC曲线下面积(area under curve,AUC)为0.847 3。结论多数独立研究单位报道的LDCT在早期肺癌筛查中的价值评价一致。通过汇总相关研究结果显示,LDCT在早期肺癌筛查中具有较高的价值,但仍需要高质量的随机对照研究以更准确地评价其临床价值。     

公路工程概、预算中建设单位管理费汇总浅谈

公路工程概预算的汇总现有的计算软件基本上都提供以下汇总方式:各部分费用直接相加;以汇总后建安费为基数等汇总方法。不管哪种汇总方式只要不存在以其他费用为基数的累进办法计算的费用,其计算结果都是一致的,然而公路工程中建设单位(业主)管理费的计算则是以累进办法计算的费用。而这在公路工程概预算中编制中,还没有引起足够的重视;下面就概预算中建设单位(业主)管理费的汇总谈一下自己的一点看法。     

高等级公路中桩边桩统一坐标的计算

对位于直线、缓和曲线、圆曲线的几个公路基本平面线形上的点，进行了中桩、边桩统一坐标的计算，并对一些复杂线形中要用到的非完整非对称缓和曲线上点的坐标计算进行了分析。通过编程计算出各中桩边桩坐标，可便于全站仪、GPSRTK的坐标放样。     

现行桥梁设计流量计算方法

对我国现行桥梁设计流量计算方法进行了汇总,同时对设计洪水过程线的推求方法进行了总结,对现行桥梁设计流量计算方法的优势与存在的问题进行了分析,指出设计流量推求过程中需要注意的事项,提供一个较为全面的桥梁设计流量计算理论汇总,用于指导桥梁工程水文设计工作。     

Classification decision tree algorithm assisting in diagnosing solitary pulmonary nodule by SPECT/CT fusion imaging

Objective To develop a classification tree algorithm to improve diagnostic performances of 99mTc-MIBI SPECT/CT fusion imaging in differentiating solitary pulmonary nodules (SPNs). Methods Forty-four SPNs, including 30 malignant cases and 14 benign ones that were eventually pathologically identified, were included in this prospective study. All patients received 99Tcm-MIBI SPECT/CT scanning at an early stage and a delayed stage before operation. Thirty predictor variables, including 11 clinical variables, 4 variables of emission and 15 variables of transmission information from SPECT/CT scanning, were analyzed independently by the classification tree algorithm and radiological residents. Diagnostic rules were demonstrated in tree-topology, and diagnostic performances were compared with Area under Curve (AUC) of Receiver Operating Characteristic Curve (ROC). Results A classification decision tree with lowest relative cost of 0.340 was developed for 99Tcm-MIBI SPECT/CT scanning in which the value of Target/Normal region of 99Tcm-MIBI uptake in the delayed stage and in the early stage, age, cough and specula sign were five most important contributors. The sensitivity and specificity were 93.33% and 78. 57e, respectively, a little higher than those of the expert. The sensitivity and specificity by residents of Grade one were 76.67% and 28.57%, respectively, and AUC of CART and expert was 0.886±0.055 and 0.829±0.062, respectively, and the corresponding AUC of residents was 0.566±0.092. Comparisons of AUCs suggest that performance of CART was similar to that of expert (P=0.204), but greater than that of residents (P<0.001). Conclusion Our data mining technique using classification decision tree has a much higher accuracy than residents. It suggests that the application of this algorithm will significantly improve the diagnostic performance of residents.     

BLOOD FLOW PATTERN AND QUANTITATIVE STUDY IN SOLITARY PULMONARY NODULES WITH DYNAMIC CONTRAST-ENHANCED MRI

Objective To evaluate the efficacy of contrast enhanced dynamic MRI in differentiating solitary pulmonary nodules(SPNs). Methods Eighty-three patients with SPNs undertaken contrast enhanced dynamic MRI. Time-signal intensity curve (T-SI Curve) was made. Peak height (PH), steepest slope (SS), maximum enhancement (Emax) and the enhancement rates of signal intensity were recorded at the first ( E1 ), second ( E2 ),third (E3) , fourth ( E4), fifth (E5) , and sixth (E6) minute after injection. Results Malignant nodules and inflammatory nodules enhanced significantly higher than benign nodules, and malignant nodules and inflammatory nodules showed obviously higher PH, SS, Emax, E1-E6 values than benign nodules( P ＜ 0. 01 ). There were no significant differences in PH, SS, E E1-E6 values between malignant nodules and inflammatory nodules( P ＞ 0. 05 ).Conclusion Contrast enhanced dynamic MR imaging can provide SPNs' hemodynamic information and is helpful in differentiating SPNs.     

CT reconstruction with priori MRI images through multi-group datasets expansion

Computed tomography (CT) reconstruction with a well-registered priori magnetic resonance imaging (MRI) image can improve reconstruction results with low-dose CT, because well-registered CT and MRI images have similar structures. However, in clinical settings, the CT image of patients does not always match the priori MRI image because of breathing and movement of patients during CT scanning. To improve the image quality in this case, multi-group datasets expansion is proposed in this paper. In our method, multi-group CT-MRI datasets are formed by expanding CT-MRI datasets. These expanded datasets can also be used by most existing CT-MRI algorithms and improve the reconstructed image quality when the CT image of a patient is not registered with the priori MRI image. In the experiments, we evaluate the performance of the algorithm by using multi-group CT-MRI datasets in several unregistered situations. Experiments show that when the CT and priori MRI images are not registered, the reconstruction results of using multi-group dataset expansion are better than those obtained without using the expansion.     

电子阴道镜结合HPV16、18及沙眼衣原体检测对宫颈上皮内瘤样病变的诊断价值

目的　通过对电子阴道镜检查宫颈上皮内瘤样病变(CIN ),以及 HPV16、18 型、沙眼衣原体与 CIN关系的研究,探讨电子阴道镜结合HPV16、18及沙眼衣原体检测对 CIN的诊断价值。方法　采用电子阴道镜观察宫颈形态,PCR法检测宫颈组织中HPV16、18及免疫层析法检测宫颈分泌物中沙眼衣原体(CT),并与病理检查结果对照分析。结果　电子阴道镜诊断CIN的灵敏度为67%,特异度为75%,阳性预测值63%,阴性预测值78%;HPV16、18阳性病例中CIN的发生率显著高于阴性病例,电子阴道镜诊断CIN的准确率在 HPV16、18 阳性病例中显著高于阴性病例,在CT阳性与阴性病例间无显著性差异。结论　电子阴道镜适合作为CIN的诊断方法; HPV16、18 检测可作为诊断CIN的方法之一,与电子阴道镜结合可提高诊断的准确率,电子阴道镜结合CT检测对诊断CIN帮助不大。     

ROLE OF 99Tcm-SESTAMIBI DUAL-PHASE PARATHYROID SCINTIGRAPHY IN PREOPERATIVE LOCALIZATION IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM

Objective To evaluate the application of 99Tcm-sestamibi dual-phase parathyroid scintigraphy in the preoperative localization in patients with primary hyperparathyroidism and to compare the diagnostic efficacy of various imaging modalities. Methods Ninety-two consecutive patients, diagnosed as hyperparathyroidism and presented with hypercalcaemia as the predominant symptom, were included. All the patients underwent dual-phase parathyroid scintigraphy using 99Tcm-sestamibi and parathyroid ultrasound scan. Among them, 48 patients underwent parathyroid computed tomography (CT). All patients were referred for parathyroidectomy. Results 99Tcm-sestamibi dual-phase parathyroid scintigraphy revealed the diagnostic sensitivity of 76.5%, 80%, 75% and 33.3% for the subgroup of single adenomas, multiple adenomas, ectopic parathyroid and parathyroid hyperplasia respectively. The specificity was 100% for all leisons. 99Tcm-sestamibi dual-phase parathyroid scintigraphy was proved to be superior to the other imaging modalities (ultrasound and CT) in terms of the preoperative diagnostic accuracy. The lesion weight was found to be an underlying factor leading to the false negative result. Conclusion 99Tcm-sestamibi dual-phase parathyroid scintigraphy was found to have higher diagnostic accuracy in comparison with other imaging modalities and is recommended preoperatively in order to reduce the sugery time and unnecessary neck exploration.     

基于Web平台孤立性肺结节影像计算机辅助诊断的研究

目的构建基于Web文本层面的孤立性肺结节(SPN)计算机辅助系统,探讨计算机帮助医生对SPN性质进行辅助诊断的可能性及价值。方法系统硬件设备包括1台路由器、1台交换机、2台服务器以及若干计算机和其他外部设备。Web服务器采用的操作系统为Windows 2000 Server,Web服务程序为Web Logic 8.1。数据库服务器采用的操作系统为RedHat Linux9.0,数据库系统为Oracle9i for Linux,在J2EE架构下开发SPN辅助诊断系统。SPN辅助诊断系统包括病例上传子系统、辅助诊断子系统以及维护和管理子系统。结果将待诊的SPN临床及CT图像原始文字信息录入辅助诊断子系统,该诊断模型依据输入的SPN属性,自动访问诊断规则数据库并提取相应SPN诊断规则进行比对分析,其诊断结果以报告的形式出现,包括典型层面的CT图像和诊断意见两部分,诊断意见分为5个层次:恶性、可能恶性、良性、可能良性、不能确定,并附有可信度值。结论基于Web的SPN计算机辅助诊断系统构建的方法是可行的,该系统可以辅助医师对SPN的良恶性做出辅助诊断。     

西安市男性吸烟、饮酒与食管癌关系的Meta分析

目的　探讨西安市男性吸烟、饮酒与食管癌的病因关系。方法　应用Meta分析对吸烟、饮酒与食管癌病例对照研究的文献进行综合评价。结果　纳入本次Meta分析的 5篇研究吸烟的文献中 ,病例组 5 30例 ,对照组 4 0 0 5例 ,异质性检验结果P >0 .0 5 ,支持固定效应模式 ,计算的OR为 2 .88(2 .32～ 3.5 8)。研究饮酒的 4篇文献中 ,病例组 4 6 5例 ,对照组 385例 ,异质性检验P <0 .0 5 ,按随机效应模式计算的OR为 1.81(1.0 8～ 3.0 5 )。结论　吸烟、饮酒与食管癌呈中等联系强度 ,是西安市男性食管癌的危险因素。     

肝移植术后并发症的影像学诊断

目的系统分析肝移植术后正常及常见并发症的影像学表现。方法使用Philips Secura螺旋CT扫描仪对50例肝移植术后患者进行检查,CT扫描范围自膈顶至腰3椎体下缘水平,对比剂1.3mL/kg体质量,注药流率2.5mL/s,延迟时间30、60、120s。对拔除T管后出现胆管并发症患者使用Philips Gyroscan NT1.5T磁共振扫描仪检查。使用GE Advance Lp/Lc数字血管造影机,经股动脉穿刺进行肝动脉造影。结果27例肝移植术后患者出现移植肝下积液及右侧胸腔积液,门静脉伴行影像4例,肝动脉吻合口狭窄2例,肝动脉血栓1例,门静脉吻合口狭窄2例,胆管吻合口部位狭窄1例,非吻合口狭窄3例,胆瘘4例,肿瘤复发4例。结论CT、磁共振胆道水成像(MRCP)和数字减影(DSA)可以清晰显示肝移植术后血管、胆管并发症及其他少见并发症。     

Improvement of efficiency and flexibility in multi-slice helical CT

One of the main aspects in computed tomography (CT) development is to make CT rapidly scan a large longitudinal volume with high z-axis resolution. The combination of helical scanning with multi-slice CT is a promising approach. Image reconstruction in multi-slice CT becomes, therefore, the major challenge. Known algorithms need to derive the complementary data or work only for certain range of pitches. A reconstruction algorithm was presented that works with the direct data as well as arbitrary pitches. Filter interpolation based on the proposed method was implemented easy. The results of computer simulations under kinds of conditions for four-slice CT were presented. The proposed method can obtain higher efficiency than the conventional method.     

494例甲状腺癌分布特征及诊断方法评价

目的　研究我省甲状腺癌的分布、诊断、治疗状况 ,评价其诊断方法并为该病生存分析提供基础资料。方法　收集 1 985年 1月至 1 999年 4月两所省级及医学院附属医院全部住院治疗的甲状腺癌病患者 494例及部分良性甲状腺肿瘤患者 2 2 3例的临床资料。结果　 494例甲状腺癌患者中以乳头状癌最多占 6 1 5 % ,其他组织类型依次为滤泡状癌 (2 3 1 % ) ,未分化癌(8 9% ) ,髓样癌 (6 5 % )。甲状腺癌发病年龄较其他癌偏低 ,除未分化癌其他均女性高于男性。以病理检查结果为标准评价细针穿吸及同位素检查 ,前者灵敏度为 85 2 % ,特异度为 85 7% ;后者灵敏度为 87 8% ,特异度为 2 5 0 %。结论　甲状腺癌在本省的分布与以往资料相似。细针穿吸法灵敏度和特异度均较高 ,而同位素法灵敏度与细针穿吸法相近 ,特异度较低。