基于增强MRI纹理分析鉴别诊断眼眶淋巴瘤和炎性假瘤

目的探讨增强MRI序列纹理分析在鉴别眼眶淋巴瘤和炎性假瘤中的诊断价值。 方法回顾性分析2013年1月至2019年4月于苏北人民医院经病理证实的眼眶淋巴瘤25例和炎性假瘤24例，术前进行MRI常规序列和脂肪抑制T1WI增强扫描，选取每例患者增强图像上肿瘤的最大层面区域，应用Mazda软件勾画肿瘤感兴趣区并计算灰度直方图纹理参数。提取出9个特征参数分别为：均值(mean)、方差(variance)、偏度(skewness)、峰度(kurtosis)和第1、10、50、90、99百分位数(Pere.1%、Pere.10%、Pere.50%、Pere.90%、Pere.99%)，分别比较淋巴瘤和炎性假瘤各个纹理参数之间的差异，其中符合正态分布的参数采用双样本t检验，不符合正态分布的参数采用秩和检验，并采用受试者工作特征曲线(receiver operaling characteristic curve，ROC)分析曲线下面积(area under curve，AUC)、敏感度、特异度。运用多变量Logistic回归分析对有统计学意义的纹理参数进行建模并绘制ROC曲线评价模型效能。 结果2种肿瘤在均值、方差、第50、90、99个百分位数参数中差异有统计学意义(P<0.05)。在偏度、峰度和第1百分位数参数中差异无统计学意义(P>0.05)。2组间纹理参数方差在阈值为113.20时具有最佳诊断效能，对应的敏感度、特异度、AUC分别是95.83%、76.00%、0.930(54.87%～90.64%)。 结论增强MRI序列纹理分析可以用于眼眶淋巴瘤和炎性假瘤的鉴别诊断，且参数方差具有最佳诊断效能。     

扩散加权成像序列图像纹理分析鉴别诊断乳腺良恶性肿瘤的价值

目的探讨扩散加权成像序列(DWI)图像纹理分析鉴别诊断乳腺良恶性肿瘤的价值。 方法回顾性分析泰州市人民医院手术病理证实的28例乳腺良性肿瘤与28例恶性肿瘤的DWI图像的影像特征及纹理特征。采用MaZda软件提取所有患者DWI图像中肿瘤病灶的直方图与灰度游程矩阵参数,包括均值(mean)、方差(variance)、偏度(skewness)、峰度(kurtosis)和第1、10、50、90、99百分位数(Pere.1%、Pere.10%、Pere.50%、Pere.90%、Pere.99%)及短游程因子(SRE)、长游程因子(LRE)、灰度不均匀度(GLNU)、游程长不均匀度(RLNU)、游程中的图像分数(fraction)(包括水平、垂直、45dgr、135dgr 4个方向),采用独立样本t检验(正态分布数据)或非参数检验Mann-Whitney U检验(偏态分布数据)分析良恶性肿瘤病灶DWI图像纹理参数的差异,提取差异有统计学意义的纹理特征参数,使用ROC曲线分析有统计学意义的纹理参数鉴别良恶性肿瘤的诊断效能,运用多变量Logistic回归分析对差异有统计学意义的纹理参数进行建模并绘制ROC曲线评价模型效能。 结果直方图参数中的方差(variance)与灰度游程矩阵参数中的游程长不均匀度(RLNU)(包括水平、垂直、45dgr、135dgr 4个方向)在两组间的差异有统计学意义(P<0.05),其中游程长不均匀度水平方向(HRLNU)以447.5517为阈值时诊断效能最佳,对应的AUC、灵敏度和特异度分别为0.874、85.71%、78.58%;通过对差异有统计学意义的纹理特征参数建立多参数Logistic回归诊断模型,对应的AUC、灵敏度及特异度为0.940、96.40%、82.10%。 结论DWI图像纹理分析鉴别诊断乳腺良恶性肿瘤具有良好的应用价值。     

基于CT增强的直方图对腮腺多形性腺瘤与腺淋巴瘤的应用价值

目的探讨基于CT增强的放射组学特征直方图参数对鉴别腮腺多形性腺瘤(PA)与腺淋巴瘤(AL)的应用价值。 方法收集经病理确诊的23例AL与21例PA,运用MaZda软件提取并分析CT增强静脉期图像中的肿瘤放射组学直方图参数,包括均值、方差、偏度、峰度和第1、10、50、90、99百分位数,运用受试者工作特征曲线(ROC)对组间有统计学意义的参数进行分析并评价诊断效能,利用多变量Logistic回归分析对组间有统计学意义的参数进行建模并运用ROC曲线评价其模型效能。 结果两组中5个直方图参数(均值与方差、第50、90、99百分位数)间的差异有统计学意义(P均<0.05),其中第99百分位数在两组中具有最高的鉴别诊断效能,曲线下面积(AUC)达0.85,对应的特异度及灵敏度均为80%。利用这5个直方图参数建立多参数Logistic回归诊断模型的AUC、特异度及灵敏度分别为0.945、92.7%、86.3%。 结论基于CT增强的放射组学特征直方图参数能够有效的对PA与AL进行鉴别。     

速效救心丸治疗冠状动脉粥样硬化性心脏病的真实世界研究

目的评价真实世界中速效救心丸治疗冠状动脉粥样硬化性心脏病的临床疗效。方法基于中国中医科学院中医临床基础医学研究所建立的37家三级甲等医院的信息管理系统(HIS)数据,以主要诊断为冠状动脉粥样硬化性心脏病病人为研究对象。以使用速效救心丸的病人为观察组,按照性别、年龄、入院病情并1∶1匹配对照组(未使用速效救心丸组),以用药疗效为结局评价指标,采用GBM倾向性评分法平衡两组间的混杂因素,再通过3种Logistic评分方法(单变量的Logistic回归、倾向性评分加权的Logistic回归、带协变量的倾向性评分加权的Logistic回归)比较两组间治疗冠状动脉粥样硬化性心脏病的疗效差异。结果采用带协变量的倾向评分加权Logistic回归(无未平衡的协变量),观察组治疗效果优于对照组(回归系数为-0.8510,P<0.05)。结论基于现有数据分析发现,使用速效救心丸治疗冠状动脉粥样硬化性心脏病比未使用速效救心丸治疗冠状动脉粥样硬化性心脏病的临床疗效更佳。     

基于CT增强扫描图像的灰度直方图纹理分析评估胰腺癌分化程度

目的探究CT增强图像灰度直方图纹理分析技术在术前评估胰腺癌恶性程度的可行性，评价灰度直方图参数和胰腺癌病理分级、分化程度的关系。 方法回顾性分析扬州大学附属苏北人民医院术后病理证实的胰腺癌患者49例，其中高分化组27例，中-低分化组22例。选取2组肿瘤CT增强扫描静脉期横断位图像最大层面，采用Mazda软件勾画感兴趣区，并进行灰度直方图纹理分析，对高分化、中-低分化两组直方图特征参数进行统计分析。对有统计学意义的参数建立受试者工作特征曲线(receiver operating characterist，ROC)，最终对各参数其诊断效能进行比较分析。此外，对差异有统计学意义的参数与高分化、中-低分化组别之间的相关性进行检测。 结果采用灰度直方图分析提取的9个参数特征中，其中均值(Mean)、第1百分位数(Perc.01%)、第10百分位数(Perc.10%)、第50百分位数(Perc.50%)在高分化、中-低分化2组的差异有统计学意义(P<0.05)，变异度(Variance)、偏度(Skewness)、峰度(Kurtosis)、第90百分位数(Perc.90%)、第99百分位数(Perc.99%)在2组中差异无统计学意义(P>0.05)。采用Spearman相关性分析可知均值、Perc.01%、Perc.10%、Perc.50%与分化程度之间呈正相关(r值分别为0.04、0.29、0.32、0.33，P均<0.05)。评估胰腺癌恶性程度时，均值的诊断效能最高(AUC＝0.695)；当均值取值147.27时，其对应的敏感度和特异度分别为86.4%、44.4%；当Perc.01%取值117时，其对应的敏感度和特异度分别为95.5%、40.7%；当Perc.10%取值120时，其对应的敏感度和特异度分别为72.7%、63%；当Perc.50%取值146时，其对应的敏感度和特异度分别为86.4%、44.4%。 结论CT增强图像灰度直方图分析的特征参数在高分化、中-低分化胰腺癌之间存在差异，给术前评估胰腺癌恶性程度提供了新的方法。     

基于多参数MRI影像组学模型预测直肠腺瘤癌变的研究

目的基于多参数MRI影像组学模型预测直肠腺瘤癌变。方法回顾性分析山东省千佛山医院2016年11月至2018年12月46例经病理证实为直肠腺瘤(n=25)和直肠腺瘤癌变患者(n=21)。所有患者均在术前2周接受盆腔MRI检查,包括高分辨率T2WI序列及弥散加权成像序列(DWI)。通过RadCloud v2.2平台分别从高分辨率T2WI和DWI序列中提取1396个影像组学特征。采用LASSO算法从1396个T2WI特征、1396个DWI特征及2792个联合特征(T2WI序列和DWI序列)中筛选直肠腺瘤癌变相关特征。采用Logistic regression(LR)算法和五折交叉验证构建三个影像组学预测模型:模型1(T2WI)、模型2(DWI)、模型3(T2WI+DWI)。通过准确度、敏感度、特异度和曲线下面积(AUC)评估影像组学模型的预测性能。结果三个影像组学模型预测直肠腺瘤癌变的AUC分别为0.80、0.84、0.92,模型3的诊断效能最优。模型3的准确度、敏感度、特异度分别为0.85、0.81、0.88。结论基于多参数MRI的影像组学模型具有预测直肠腺瘤癌变的潜力,联合高分辨率T2WI及DWI序列比单一序列预测效能更佳。     

基于影像学参数及临床指标的列线图模型对高血压性心脏病早期筛查价值研究

目的：探讨基于磁共振成像(magnetic resonance imaging,MRI)参数列线图模型对高血压性心脏病(hypertensive heart disease,HHD)早期诊断价值。方法：选择2020年9月至2021年12月我院接诊的145例HHD患者为病例组，同期健康体检的高血压患者145例为对照组。比较两组对象一般资料、心脏彩色多普勒超声检查指标及核磁共振检查指标，以LASSO回归筛选变量后行多因素Logistic回归筛选出影响因素，根据Logistic回归结果构建列线图模型，并对模型进行验证。结果：经LASSO回归筛选的变量为因变量，以是否HHD为自变量，行多因素二元Logistic逐步回归，结果显示：病程、SBP、DBP、LVEF、 T1及ECV为HHD发生的影响因素[OR(95%CI)分别为：1.047(1.001～1.094)、1.022(1.004～1.041)、1.032 (1.007～1.057)、0.930 (0.895～0.965)、1.011(1.008～1.014)、1.147(1.042～1.262),P <0.05]。ROC分析显示，模...     

脑胶质瘤中MAGE-D4和CORO1C mRNA表达水平及其临床意义

目的 分析脑胶质瘤中黑色素瘤相关抗原(MAGE)-D4和肌动蛋白结合蛋白CORO1C mRNA的表达水平,探讨二者的相关性及临床意义.方法 通过基因表达谱交互式分析(GEPIA)数据库收集脑胶质瘤样本数据681例[低级别脑胶质瘤(LGG)518例,胶质母细胞瘤(GBM)163例],正常脑组织样本数据207例,比较其MA...     

社区空巢老年脑卒中患者自我效能状况及对策分析

目的 分析社区空巢老年脑卒中患者自我效能水平,探求影响自我效能的因素,并提出相应护理对策.方法 于2011年3 ～11月抽取郑州市某三个社区的99例社区空巢老年脑卒中患者,采用一般资料问卷、慢性病患者自我效能量表及社会支持评定量表调查及其自我效能水平并分析影响因素.全部数据采用SPSS 13.0统计学软件进行统计学分析.不同经济收入、诊断类型及自理程度组间自我效能得分差异比较采用秩和检验Mann-Whitney或Kruskal-WallisH检验;不同年龄、性别、文化程度、合并类型组间自我效能得分比较采用独立样本t检验;对有统计学差异的指标再进行非条件logistic回归检验分析影响因素,并计算优势比(OR).结果 社区空巢老年脑卒中患者的自我效能水平处于低中等水平,得分为0.6 ～6.0(3.54±1.72)分;自我效能和社会支持呈中度正相关性(r=0.509,P=0.000);不同诊断类型、自理水平、合并症状数量之间自我效能水平差异均具有统计学意义(Z/H=17.430、13.081、19.520,P＜0.05);Logistic回归结果显示主观支持、自理水平及合并症状是自我效能的影响因素.结论 社区空巢老年脑卒中患者的自我效能水平普遍较低;自理能力差和遗留症状多为危险因素,主观支持高为保护因素.     

CEA、SCC-Ag和SF在肺癌淋巴结转移中的诊断价值

目的应用Logistic回归和ROC曲线探讨血清癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)和铁蛋白(SF)检测在肺癌淋巴结转移中的诊断价值。方法分别检测100例手术前肺癌患者血清中三种肿瘤标志物水平,行手术确定淋巴结转移情况,通过Logistic回归建立回归模型,用ROC曲线分析三项指标对肺癌淋巴结转移的价值。结果淋巴结有转移组CEA、SCC-Ag的阳性率显著高于无转移组(P0.01,P0.05),而SF在两组间的阳性率比较差异无统计学意义(P0.05);建立回归模型Y=1/[1+EXP(1.584X1+0.935X2-0.425)],新变量Y的AUC高于三种单一肿瘤标志物的AUC。结论综合运用Logistic回归和ROC曲线分析CEA、SCC-Ag和SF对肺癌淋巴结转移的诊断具有较高的价值,可提高其诊断的准确性。     

Using arterial spin labeling blood flow and its histogram analysis to distinguish early-stage nasopharyngeal carcinoma from lymphoid hyperplasia

To investigate the feasibility of arterial spin labeling (ASL) blood flow (BF) and its histogram analysis to distinguish early-stage nasopharyngeal carcinoma (NPC) from nasopharyngeal lymphoid hyperplasia (NPLH).Sixty-three stage T1 NPC patients and benign NPLH patients underwent ASL on a 3.0-T magnetic resonance imaging system. BF histogram parameters were derived automatically, including the mean, median, maximum, minimum, kurtosis, skewness, and variance. Absolute values were obtained for skewness and kurtosis (absolute value of skewness [AVS] and absolute value of kurtosis [AVK], respectively). The Mann–Whitney U test, receiver operating characteristic curve, and multiple logistic regression models were used for statistical analysis.The mean, maximum, and variance of ASL BF values were significantly higher in early-stage NPC than in NPLH (all P < 0.0001), while the median and AVK values of early-stage NPC were also significantly higher than those of NPLH (all P < 0.001). No significant difference was found between the minimum and AVS values in early-stage NPC compared with NPLH (P = 0.125 and P = 0.084, respectively). The area under the curve (AUC) of the maximum was significantly higher than those of the mean and median (P < 0.05). The AUC of variance was significantly higher than those of the other parameters (all P < 0.05). Multivariate analysis showed that variance was the only independent predictor of outcome (P < 0.05).ASL BF and its histogram analysis could distinguish early-stage NPC from NPLH, and the variance value was a unique independent predictor.     

Lung CT densitometry in systemic sclerosis: correlation with lung function, exercise testing, and quality of life

BACKGROUND: To ascertain if analysis of lung density histograms in thin-section CT was more reproducible than visual assessment of lung changes in systemic sclerosis (SSc), and if such density histogram parameters as mean lung attenuation (MLA), skewness, and kurtosis could more closely reflect pulmonary function as well as exercise and quality of life impairment. METHODS: The intraoperator and interoperator reproducibility of visual and densitometric lung CT analysis in 48 SSc patients examined with CT were evaluated by means of weighted kappa statistics. Univariate and multivariate regression analyses were applied to evaluate the relationship of visual and densitometric CT measurements with functional parameters including functional residual capacity (FRC), FVC, FEV(1), diffusion capacity of the lung for carbon monoxide (Dlco), 6-min walking testing (6MWT), and health-related quality of life questionnaire (QLQ) parameters. RESULTS: The intraoperator and interoperator reproducibility of MLA (intraobserver weighted kappa = 0.97; interobserver weighted kappa = 0.96), skewness (intraobserver weighted kappa = 0.89; interobserver weighted kappa = 0.88), and kurtosis (intraobserver weighted kappa = 0.89; interobserver weighted kappa = 0.88) were higher than those of visual assessment (intraobserver weighted kappa = 0.71; interobserver weighted kappa = 0.69). In univariate analysis, only densitometric measurements were correlated with some exercise and QLQ parameters. In multivariate analysis, MLA (square regression coefficient corrected [R(2)c] = 0.70), skewness (R(2)c = 0.78), and kurtosis (R(2)c = 0.77) were predicted by FRC, FVC, Dlco, 6MWT, and QLQ parameters, while visual assessment was associated only with FRC and FVC (R(2)c = 0.40). CONCLUSIONS: In SSc, densitometric analysis is more reproducible than visual assessment of lung changes in thin-section CT and more closely correlated to pulmonary function testing, 6MWT, and QLQ. Density histogram parameters may be useful for cross-sectional and longitudinal studies of lung involvement in SSc.     

Assessment of carotid plaque composition in hypertensive patients by ultrasonic tissue characterization: a validation study

OBJECTIVE : Ultrasonic tissue characterization of epi-aortic vessels may be useful to define the composition of atherosclerotic plaques. Videodensitometry provides a histogram representing the frequency distribution of gray levels corresponding to different compositions of the carotid wall. However, lack of standardization limits the clinical application of this technique. In the present study, the echoreflectivity (ER) pattern of atherosclerotic plaques in vivo was compared with their histological pattern after surgical removal, and the reproducibility of measurement was tested. DESIGN AND METHODS : We studied 19 hypertensive patients with a carotid artery stenosis >or= 70%, eligible for carotid thromboendarterectomy (TEA). Before TEA, all patients underwent standard high-resolution B-mode carotid ultrasound. ER parameters (mean gray level, broad band, skewness, and kurtosis) were obtained in a region of interest selected along the whole plaque, between the intima-blood and the media-adventitia interfaces. The plaques removed during TEA were examined by a histologist and classified into three groups on the basis of fibrous tissue (FT) content: lipidic (FT < 20%), fibrolipidic (20 50%). Discriminant function analysis was used to evaluate classification efficacy of different histological groups based on ER parameters. RESULTS : Histologically, five lesions were classified as lipidic, six as fibrolipidic and eight as fibrous. Analysis of variance showed significant between group differences in all ER parameters. The combined use of all ER parameters provided correct classification of plaques in 94.73% of cases (P < 0.0001), improving the classification made using single parameters. Intra-observer and inter-observer variabilities (Bland-Altman method) of mean gray level measurements were small. CONCLUSIONS : Videodensitometry can discriminate between tissue composition of carotid lesions and complement the quantitative assessment of intima-media thickness by additionally providing a well-reproducible semiquantitative evaluation of vascular wall constituents.     

Phase analysis of gated myocardial perfusion single-photon emission computed tomography compared with tissue Doppler imaging for the assessment of left ventricular dyssynchrony.

OBJECTIVES: The purpose of this study was to compare left ventricular (LV) dyssynchrony assessment by gated myocardial perfusion single-photon emission computed tomography (SPECT) (GMPS) and tissue Doppler imaging (TDI). BACKGROUND: Recently, it has been suggested that LV dyssynchrony is an important predictor of response to cardiac resynchronization therapy (CRT); dyssynchrony is predominantly assessed by TDI with echocardiography. Information on LV dyssynchrony can also be provided by GMPS with phase analysis of regional LV maximal count changes throughout the cardiac cycle, which tracks the onset of LV thickening. METHODS: In 75 patients with heart failure, depressed LV function, and wide QRS complex, GMPS and 2-dimensional echocardiography, including TDI, were performed as part of clinical screening for eligibility for CRT. Clinical status was evaluated with New York Heart Association functional classification, 6-min walk distance, and quality-of-life score. Different parameters (histogram bandwidth, phase SD, histogram skewness, and histogram kurtosis) of LV dyssynchrony were assessed from GMPS and compared with LV dyssynchrony on TDI with Pearson's correlation analyses. RESULTS: Histogram bandwidth and phase SD correlated well with LV dyssynchrony assessed with TDI (r = 0.89, p < 0.0001 and r = 0.80, p < 0.0001, respectively). Histogram skewness and kurtosis correlated less well with LV dyssynchrony on TDI (r = -0.52, p < 0.0001 and r = -0.45, p < 0.0001, respectively). CONCLUSIONS: The LV dyssynchrony assessed from GMPS correlated well with dyssynchrony assessed by TDI; histogram bandwidth and phase SD showed the best correlation with LV dyssynchrony on TDI. These parameters seem most optimal for assessment of LV dyssynchrony with gated SPECT. Outcome studies after CRT are needed to further validate the use of GMPS for assessment of LV dyssynchrony.     

Kurtosis and skewness of density histograms on inspiratory and expiratory CT scans in smokers

The aim of this study is to evaluate the relationship between lung function and kurtosis or skewness of lung density histograms on computed tomography (CT) in smokers. Forty-six smokers (age range 46?81 years), enrolled in the Lung Tissue Research Consortium, underwent pulmonary function tests (PFT) and chest CT at full inspiration and full expiration. On both inspiratory and expiratory scans, kurtosis and skewness of the density histograms were automatically measured by open-source software. Correlations between CT measurements and lung function were evaluated by the linear regression analysis. Although no significant correlations were found between inspiratory kurtosis or skewness and PFT results, expiratory kurtosis significantly correlated with the following: the percentage of predicted value of forced expiratory volume in the first second (FEV(1)), the ratio of FEV(1) to forced vital capacity (FVC), and the ratio of residual volume (RV) to total lung capacity (TLC) (FEV(1)%predicted, R = -0.581, p < 0.001; FEV(1)/FVC, R = -0.612, p < 0.001; RV/TLC, R = 0.613, p < 0.001, respectively). Similarly, expiratory skewness showed significant correlations with PFT results (FEV(1)%predicted, R = -0.584, p < 0.001; FEV(1)/FVC, R = -0.619, p < 0.001; RV/TLC, R = 0.585, p < 0.001, respectively). Also, the expiratory/inspiratory (E/I) ratios of kurtosis and skewness significantly correlated with FEV(1)%predicted (p < 0.001), FEV(1)/FVC (p < 0.001), RV/TLC (p < 0.001), and the percentage of predicted value of diffusing capacity for carbon monoxide (kurtosis E/I ratio, p = 0.001; skewness E/I ratio, p = 0.03, respectively). We conclude therefore that expiratory values and the E/I ratios of kurtosis and skewness of CT densitometry reflect airflow limitation and air-trapping. Higher kurtosis or skewness on expiratory CT scan indicates more severe conditions in smokers.     

Quantitative phase analysis in the assessment of coronary artery disease

The phase image in radionuclide ventriculography shows the timing of ventricular contraction and is valuable in the detection of abnormalities induced by coronary artery disease. The image is usually interpreted subjectively, and in the present study a histogram of left ventricular phase values was used to make interpretation more objective. The left ventricular ejection fraction and the standard deviation, skewness, and kurtosis of the phase histogram were measured at rest, during isometric exercise, and during the final two stages of maximal dynamic exercise in 25 controls and 27 patients with coronary artery disease without previous infarction. The ejection fraction and the standard deviation of the phase had the same predictive accuracy for the presence of disease when measured during the penultimate stage of dynamic exercise (89%) as during the final stage, but their accuracy was lower during maximal exercise (77%) because of motion artefact at high exercise levels. Skewness and kurtosis of the histogram were of no value for the detection of disease, and isometric exercise was of only limited value. It is concluded that the phase histogram provides an objective measurement of the synchronicity of left ventricular contraction and can increase sensitivity for the detection of abnormality. Data should be acquired at all stages of dynamic exercise, and the penultimate stage should be used if there is any doubt about the validity of the final stage.