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.     

超声显像在肾肿瘤影像诊断中的作用

报告了我院1986年～1993年临床拟诊断为肾肿瘤,且均行过手术及病理检查的106例患者的各项影像检查诊断结果。诊断正确率:B型超声93.33％(84/90),CT 94.73％(36/38);磁共振成像93.75％(15/16);肾分泌造影82.41％(75/91);肾动脉造影71.43％(5/7);同位素肾动态显像62.50％(25/40)。初步探讨了B超在肾肿瘤诊断中的作用。     

DIAGNOSTIC VALUE OF MINIPROBE ULTRASONOGRAPHY IN ESOPHAGEAL PROTRUDING LESIONS

Objective To investigate the diagnostic value of miniprobe ultrasonography (MPS) in the protruding lesions of esophagus. Methods Sixty-two patients with protruding lesions of esophagus were examined with MPS. Results The MPS examination showed diseases of esophageal polyp, inflammatory protruding, esophageal leiomyoma, esophageal leiomyosarcoma, esophageal venous aneurysm, esophageal lipoma, esophageal cyst, esophageal carcinoma, and extra esophageal compression including aorta compression, lung tumor compression and spina compression. Fourteen patients were verified by surgical operations and pathological examinations, resulting in 92.86% (13/14) diagnosis accuracy rate. Forty-eight cases had results of gastroscope examination consistent with that of MPS. Twelve cases had results of CT and MRI examination consistent with that of MPS. Follow-up was completed on 22 patients. Conclusion Besides imaging the esophageal layer, MPS can precisely locate the histological layer of the esophageal protruding lesions and predict their characters. This indicates its value in the diagnosis and differential diagnosis of the protruding lesions of esophagus. Furthermore, the miniature probe used in MPS examination can pass the structured esophagus, enabling wider application of the examination.     

DETECTION OF STRAND BREAKS OF DNA IN HUMAN EARLY CHORIONIC VILLUS CELLS INDUCED BY DIAGNOSTIC ULTRASOUND USING ^32P-LABELED ALU HYBRIDIZATION

Genetic effects of ultrasound on fetus havebeen extensively studied since ultrasonograph waswidely appliedin obstetric practice.In recent years,there have been reports onin vivomolecular geneticeffects of diagnostic ultrasound[1-4].In vitroexperi-ments have found that single-stranded breaks(ssbs)and double-stranded breaks(dsbs)in DNA are themain indices for DNA lesions induced by ultra-sound[5].But,no reports on whether ultrasound cancausein vivossbs and dsbs in DNAare available.Tofurther …     

~(99)Tc~m-HL91在肺部肿瘤诊断中的临床价值

目的　应用99Tcm HL91进行肺部肿瘤阳性显像 ,探讨其在肿瘤良恶性诊断中的临床应用价值。方法　对 42例高度怀疑肺部肿瘤的患者注射99Tcm HL91后行 2h、4h平面显像及 4hSPECT/CT断层融合显像 ,使用ROI技术计算肿块与对侧正常肺组织的比值 (T/N)。结果　恶性组在 2h、4h平面及 4h断层图像上T/N值分别为 1.50±0 .17、1.71± 0 .2 2、2 .72± 0 .75,良性病变组分别为 1.2 1± 0 .10、1.2 5± 0 .2 2、1.49± 0 .3 6,各组间均有显著性差异 (P均 <0 .0 1) ;恶性组 4h延迟平面像组较 2h组T/N比值明显增高 (P <0 .0 1) ,而良性组无明显增高 (P >0 .0 5) ;各病理类型各时相之间无显著性差异 (P <0 .0 5) ;以恶性组横断层T/N值 x -1s为诊断阈值 ,其诊断灵敏度、特异度、准确性分别为 84.85%、88.89%和 85.71% ;以良性组 x + 1s为诊断阈值 ,灵敏度、特异度及准确性分别为 90 .91%、88.89%和 95.2 4%。结论　99Tcm HL91作为一种肿瘤阳性显像剂 ,对肺部肿瘤的定性诊断具有较高价值     

实时超声在神经外科手术中的应用

目的应用B超实时对神经外科开颅手术中病变进行超声扫描,探讨其成像特征和应用价值。方法常规开颅后在硬膜外和硬膜下应用B超,结合术前资料,进行病灶的实时定位,帮助选择皮层切口和手术路径,并用B超判定病灶切除程度。结果42例中,全部病变定位准确,准确率达100%,34例病变全部切除,6例次全切,2例死亡。结论术中B超能实时显示病变的部位和轮廓,有助于病变的术中定位和定性,减少手术副损伤。     

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。     

~(99m)Tc-MIBI甲状腺癌阳性显像

目的　研究99mTc -MIBI三相显像对甲状腺癌的定性诊断价值。方法　将 1 5 0例受检者分甲状腺癌 ( 5 8例 )和甲状腺良性结节 ( 92例 )两组 ,以患侧 /健侧摄取比值 (UR)为定量指标 ,观察其 5min和 60min摄取比值变化。结果　甲状腺癌组动脉血流灌注异常增高占 74 1 3% ,而良性结节组仅为 31 .5 2 % ;甲状腺癌组 5min和 60minUR值分别为 1 86± 0 65和 1 63±0 49,而良性结节组分别为 0 81 3± 0 1 8和 0 82 7± 0 1 6,两组两时相UR值比较均有显著性差异 (P <0 0 1 )。结论　99mTc MIBI三相显像对甲状癌的定性诊断具有较高价值。     

~(99m)TC-MIBI心肌显像对扩张型心肌病的诊断价值

为探讨心肌显像对扩张型心肌病（DCM）的诊断价值，对34例DCM患者和14例以心衰为突出表现的其它心脏增大患者进行99mTc－MIBI心肌灌注断层显像。34例DCM患者表现左室重度扩大者32例（占94％），其中72％（23／32）同时伴有不同程度的右室扩大，心肌出现多节段花斑样改变者占85％；6例缺血性，C肌病（ICM）患者主要表现为轻度和中度的左室扩大；以二尖瓣狭窄为主的风湿性心脏病（RHD）患者主要表现为右室扩大。提示该显像技术可用于DCM的诊断及鉴别诊断。     

52例脑囊虫病所致癫痫的诊断和治疗

本科１９８２年～１９９２年住院确诊为脑囊虫所致的癫痫５２例，占同期住院的癫痫患者３９５例的１３．１６％（５２／３９５）。作者对其诊断及治疗的资料做了分析，结果在明ＭＲＩ／ＣＴ是诊断脑囊虫病先进可靠的方法。血清及脑脊液快速酶联免疫抗体测定有助于定性诊断，脑脊液的阳性率较血清高。丙硫咪唑、吡喹酮均有较好的疗效，但后者的副作用高于前者（Ｐ＜０．０５），应首造丙硫咪唑。从而看出近１０多年来诊疗技术的飞速进步使脑囊虫病的防治前景大为改观。     

脑肿瘤~(99m)Tc-MIBI脑SPECT显像的影像特征及应用价值

为探讨 99m Tc-甲氧基异丁基异腈 ( MIBI)脑 SPECT显像在脑肿瘤中的影像特征及应用价值 ,对 1 0例正常对照者和 30例脑内病变患者进行99m Tc- MIBI脑SPECT显像。结果 :对照组脑实质内均无核素浓聚 ,脑肿瘤组表现为阳性结果者 1 9例 ,显示出脑实质内有局限性核素浓聚 ;表现为阴性结果者 6例 ,均为脑肿瘤术后无复发者 ;5例非肿瘤组良性病变患者均表现为阴性结果。本组术前诊断脑肿瘤的灵敏度与特异性均为 1 0 0 %。表明该显像方法可用于脑肿瘤的诊断 ,尤其是发现并鉴别脑肿瘤术后残留、复发及软化灶形成。     

SENTINEL NODE BIOPSY BY TWO KINDS OF BLUE DYES IN PATIENTS WITH BREAST CANCER

Ｓｅｎｔｉｎｅｌｎｏｄｅｂｉｏｐｓｙ (ＳＮＢ)ｔｅｃｈｎｉｑｕｅｉｓｌｉｋｅｌｙｔｏｒａｄｉｃａｌｌｙｍｏｄｉｆｙｔｈｅｓｕｒｇｉｃａｌｍａｎａｇｅｍｅｎｔｏｆｔｈｅａｘｉｌｌａｉｎｂｒｅａｓｔｃａｎｃｅｒｐａｔｉｅｎｔｓ[1 6] .ＴｈｅｐｏｓｓｉｂｉｌｉｔｙｏｆＳＮＢｍａｙｅｎａｂｌｅｓｕｒｇｅｏｎｔｏｒｅｆｒａｉｎｆｒｏｍａｘｉｌｌａｒｙｌｙｍｐｈｎｏｄｅｄｉｓｓｅｃｔｉｏｎ (ＡＬＮＤ )ｉｎｃｌｉｎｉｃａｌｌｙｎｏｄｅｎｅｇａｔｉｖｅｂｒｅａｓｔｃａｎｃｅｒ ｐａｔｉｅｎｔｓｗｉｔｈｈｉｓｔｏｌ…     

DIAGNOSIS AND TREATMENT OF PHEOCHROMOCYTOMAS IN URINARY BLADDER

Objective To investigate the diagnosis and treatment of pheochromocytomas in urinary bladder and review relative literatures. Methods The clinical data of 6 cases of bladder pheochromocytoma were retrospectively analyzed. Bladder submucosal mass was detected by B-ultrasound in 6 cases,computerized tomography (CT) in 4,and cystoscopy in 3.All patients were treated with surgical operation.Results Two patients showed obvious fluctuation of blood pressure during operation.All patients were pathologically diagnosed as pheochromocytoma postoperatively.Five patients were followed up (from 3 months to 7 years),and their blood pressure returned to normal No patient had relapse and malignancy.Conclusion Typical hypertension during urination and hematuria constitute the chief symptoms of bladder pheochromocytoma.B-ultrasound,CT,and cystoscopy are the main methods for the localization of the lesions.Partial cystectomy or excision of the tumor is the preferred management and postoperative long-term follow-up is necessary.     

影像学检查对乳腺肿瘤诊断价值的探讨

液晶、透照、X线对276例乳腺包块进行术前检查与病理对比,其中乳癌120例,3项检查诊断符合率分别为74％、56％、74％,3项联合诊断符合率达92％。各项检查诊断符合率与患者年龄、病灶大小有密切关系。液晶、透照检查操作简易、无损伤、诊断迅速,可作为临床及普查首选方法。液晶、X线检查对早期癌诊断有较高的诊断率。本文强调联合诊断,互为补充,减少漏、误诊,提高诊断符合率。     

DIAGNOSTIC VALUE OF SERUM PROGRP31-98 IN PATIENTS WITH SMALL-CELL LUNG CANCER

Small celllungcancer (SCLC )isasubtyperepresentingapproximately 15 %to 2 0 %ofallpri marylungcarcinomaoccurringinChina .Ingener al,SCLCishighlysensitivetochemotherapyandhasafrequenttendencytometastasizeatanearlystage .Thus ,itisveryimportanttomakeanearlydiagnosisforthetreatmentofSCLC patients .NSEhaslongtermbeenusedasSCLCearlydiagnosismarkerinclinic[1] .However ,therelativelyhighfalse positiveratehasforcedthedoctorstolookforthemorespecificandsensitivemarker[2 ] .SincePro gastrin relea…     

运用单光子发射计算机断层扫描显像诊断帕金森病和血管性帕金森综合征

目的探讨99Tcm-TRODAT-1{99Tcm-2β-[N,N′-双(2-巯乙基)乙撑二胺基]甲基,3β-(4-氯苯基)托烷}脑显像在早期帕金森病(PD)和血管性帕金森综合征(VP)鉴别诊断中的意义。方法对确诊的47例早期PD患者、26例VP患者和30例年龄匹配的正常对照者分别进行99Tcm-TRODAT-1SPECT脑显像,应用计算机感兴趣区(regions ofinterest,ROI)技术分别计算各组双侧纹状体/小脑的放射性计数比值,并对结果进行比较分析。结果早期PD患者患肢对侧纹状体对99Tcm-TRODAT-1的摄取减少,患肢同侧和对侧纹状体/小脑的放射性计数比值均较正常对照者均值明显降低(P<0.05)。VP患者双侧纹状体区对99Tcm-TRODAT-1的摄取接近正常,患肢同侧和对侧纹状体/小脑的放射性计数比值与正常对照者双侧均值无显著差异(P>0.05)。结论99Tcm-TRODAT-1显像及半定量分析有助于PD的早期诊断及与VP的鉴别诊断。     

EFFECT OF PREOPERATIVE CHEMOTHERAPY ON METASTASIZED LYMPH NODES IN PATIENTS WITH ADVANCED ESOPHAGEAL CARCINOMA

Recent advances in surgical teChniques and pe-rioperative management have significantly im-proved the resect rate, long-term survival and op-erative mortality of patients with esophageal can-cer. However, treatment of surgery only does notimprove the extremely poor prognosis of the pa-tients with local advanced squamous cell carcino-ma[lj. Multimodal therapy is needed to improve theprognosis for patients with locally advancedesophageal cancer. Most investigators have foundthat adjuvant treatme…     

METANEPHRIC ADENOMA IN CHILDREN: REPORT OF TWO CASES AND REVIEW OF LITERATURE

Objective To analyze the clinical manifestations and the imaging mainly CT of metanephric adenoma in chidren. Methods We reviewed the manifestations of clinics and the imaging mainly CT at our institution and reported observations on the diagnosis of metanephric adenoma in children based on these 2 patients and an additional 10 cases from the literature. Results More cases of metanephric adenoma could have polycythemia at presentation. Also in more patiens, US image depicted well-circumscribed hyperechoic mass. Un-enhanced CT scan showed the higher attenuation mass with calcification, some cases had cystic mass with a single solid mural nodule. At contrast-enhanced CT, the degrees of enhancement varied. In our new cases, one showed a large polycystic mass abounded with fat-attenuation material. Conclusion Manifestations of metanephric adenoma varied from each other, we should analyze the clinical manifestations as well as the characteristics of imagings and it would help for diagnosis. But the diagnosis of the tumors must be based on histological examinations.     

MR ASSESSMENT OF LUNG DEVELOPMENT IN FETAL ANOMALIES USING RATIO OF LUNG TO LIVER SIGNAL INTENSITIES

Objective To evaluate the monitoring and diagnostic potential of MR in fetal lung development using lung signal intensity changes in the fetus. Methods The lung-to-liver intensity ratio was calculated by means of region-of-interest analysis in all 35 fetuses including 7 bilateral urinary anomalies, 9 unilateral urinary anomalies, 5 pulmonary anomalies, and 14 others. Results All fetuses with urinary anomalies and pulmonary anomalies showed low ratio of lung-to-liver signal intensity. Conclusion Low ratio of lung-to-liver signal intensity on MR imaging indicates pulmonary hypoplasia after 22 weeks' gestation.     

多发性腔隙性脑梗塞的EEG、BEAM、CT/MRI对比分析

对54例经颅脑CT(X线电予计算机断层扫描)或MRI(核磁共振成象)检查确诊为多发性腔隙性脑梗塞病人的EEG(脑电图)、BEAM(脑电地形图)检查结果进行了对比分析。结果表明,BEAM在定位价值上逊于CT或MRI,优于EEG(P<0.01),反映脑功能变化的敏感性方面,BEAM也优于EEG(P<0.05)。BEAM的改变以慢波频段能量增高明显,其分布部位以额颠部最明显,枕颠及额区次之(P<0.05)。认为BEAM对于多发性腔隙性脑梗塞病人不失为一种敏感性较高、对病人无损伤、价廉、易普及的早期辅助检查方法。