基于密集网络改进的肺结节良恶性分类模型

目的 探讨改进后的卷积神经网络模型对肺结节进行良恶性分类的准确率。方法 以分类模型密集网络（DenseNet）为基础模型,采用中间密度投影方法将肺结节的三维信息输入卷积神经网络进行训练,并针对肺结节良恶性分类问题适应性改进神经网络结构,将传统损失函数Cross Entropy Loss替换为Focal Loss,使网络能着重学习难以分辨的肺结节。结果 改进后神经网络模型对良恶性肺结节分类的准确率为89.93%,曲线下面积为0.947。结论 适应性改进后的卷积神经网络模型判断良恶性肺结节准确率较高。     

彩色多普勒对甲状腺结节良恶性的诊断价值

目的：探讨彩色多普勒对甲状腺结节良恶性的诊断价值。方法：分析经手术和病理证实的120例良性甲状腺结节和65例恶性甲状腺结节的超声表现。结果：185个结节中,良性结节120个,其中结节性甲状腺肿85个,甲状腺瘤30个,桥本病5个。甲状腺癌共65个,乳头状癌59个,滤泡癌6个。在彩色血流分布类型比较上,良性结节以II型和IV型为主,分别占51％和35％;恶性结节以III型为主,占42％。结论：彩色多普勒可以为甲状腺结节良恶性的诊断、鉴别诊断和随访观察提供更多的辅助指标,有重要的诊断价值。     

肝脏不典型腺瘤样增生结节的MRI应用价值

目的：探讨肝脏不典型腺瘤样增生结节的MRI应用价值。方法选取该院2003年1月—2014年5月肝脏不典型腺瘤样增生结节的病人50例,常规T1 T2WI序列及正反相位序列,LAVA序列动态增强扫描。结果50例病人60个病灶,所有病灶均表现为T1WI高或稍高信号,T1WI脂肪抑制序列病灶为高信号或稍高信号,反相位序列病灶仍为高信号或稍高信号,T2WI加强病灶为低或稍低信号,该组60个病灶,其中55个病灶动态增强扫描动脉期门静脉期及延迟期病灶无强化,5个病灶呈轻中度强化。结论肝脏不典型腺瘤样增生结节的MRI表现具有一定特征性,MRI可以很好显示肝脏不典型腺瘤样增生结节病灶,是诊断肝脏不典型腺瘤样增生结节首选的影像方法,具有重要的临床应用价值。     

SFE-AFCE-SFMN 2022 consensus on the management of thyroid nodules: Synthesis and algorithms

The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a condition that is a frequent reason for consultation in endocrinology. In more than 90% of cases, patients are euthyroid with benign and non-progressive nodules that do not warrant specific treatment. The clinician's objective is to detect malignant thyroid nodules at risk of recurrence and death, toxic nodules responsible for hyperthyroidism or compressive nodules warranting treatment. The diagnosis and treatment of thyroid nodules requires close collaboration between endocrinologists, nuclear medicine physicians and surgeons but also involves other specialists. Therefore, this consensus statement was established jointly by 3 societies, the French Society of Endocrinology (SFE), the French Association of Endocrine Surgery (AFCE) and the French Society of Nuclear Medicine (SFMN); the various working groups included experts from other specialties (pathologists, radiologists, pediatricians, biologists, etc.). This specific text is a summary chapter taking up the recommendations from specific sections and presenting algorithms for the exploration and management of thyroid nodules.     

Zinc chloride (smoke bomb) inhalation lung injury: clinical presentations, high-resolution CT findings, and pulmonary function test results

STUDY OBJECTIVES: Zinc chloride smoke inhalation injury (ZCSII) is uncommon and has been rarely described in previous studies. We hypothesized that structural changes of the lung might correlate with pulmonary function. To answer this question, we correlated findings from high-resolution CT (HRCT) scan and the results of pulmonary function tests (PFTs) in patients with ZCSII. DESIGN: Retrospective cohort study. SETTING: University hospital. PATIENTS: Twenty patients who had been hospitalized with ZCSII-related conditions. MEASUREMENTS: The study included HRCT scan scores (0 to 100), static and dynamic lung volumes, and diffusing capacity of the lung for carbon monoxide (D(LCO)). RESULTS: HRCT scans and PFTs were performed initially after injury (range, 3 to 21 days) in all patients and during the follow-up period (range, 27 to 66 days) in 10 patients. The predominant CT scan findings were patchy or diffuse ground-glass opacities with or without consolidation. The majority of patients showed a significant reduction of FVC, FEV1, total lung capacity, and D(LCO), but normal FEV1/FVC ratio values. Changes of functional parameters correlated well with HRCT scan scores. Substantial improvements in CT scan abnormalities and pulmonary function were observed at follow-up. CONCLUSIONS: The majority of our patients with ZCSII presented with a predominant parenchymal injury of the lung that was consistent with a restrictive type of functional impairment and a reduction in Dlco rather than with obstructive disease. Our results suggest that HRCT scanning and pulmonary function testing may reliably predict the severity of ZCSII.     

超声引导经皮双极射频消融治疗良性甲状腺结节的局部疗效观察

正甲状腺良性结节通常无需处理,但随着结节增大可能影响美观或有压迫不适感,此时多需要治疗。射频消融(radiofrequency ablation,RFA)作为一种微创治疗方式,目前临床已广泛用于甲状腺结节的治疗~([1])。本组旨在对行超声引导经皮双极RFA治疗的良性甲状腺结节的局部疗效进行分析。     

实时超声弹性成像技术结合TI-RADS标准在甲状腺结节性质鉴别诊断中的应用价值

目的 探讨实时超声弹性成像技术(UE)结合TI-RADS标准在甲状腺结节性质鉴别诊断中的应用价值。方法 选取2015年1月至2016年12月于我院超声科检出的125例甲状腺结节患者作为研究对象。所有患者均经手术及病理证实为甲状腺结节并明确结节性质,共发现190处结节,根据结节直径将所有结节分为<1cm组与≥1cm组,患者均接受常规超声以及UE检查,参考甲状腺影像学报告及数据系统(TI-RADS)以及弹性评分评估结节的性质,构建UE、TI-RADS的工作特征曲线,评估单纯TI-RADS、单纯UE、二者联合对甲状腺结节性质的鉴别诊断价值。 结果 UE诊断甲状腺结节的灵敏度与准确度明显高于TI-RADS,二者联合诊断的灵敏度、特异度、准确度均明显高于单纯应用UE、TI-RADS;<1cm组中UE诊断准确率高于TI-RADS,但在≥1cm组中TI-RADS诊断准确率高于UE;UE构建的ROC曲线下面积明显大于TI-RADS,联合后构建的ROC曲线SAUC明显高于单纯UE、TI-RADS组(P<0.05)。 结论 UE结合TI-RADS标准对甲状腺良恶性结节的鉴别诊断具有较高的准确性,诊断效能高,通过UE结合TI-RADS可相互弥补单一技术在鉴别诊断应用中的缺陷与不足,具有较好的临床应用及推广价值。     

中老年2型糖尿病患者甲状腺结节的患病情况分析

目的：了解中老年2型糖尿病患者甲状腺结节的患病情况,为甲状腺疾病的防治提供理论基础。方法收集550例中老年2型糖尿病患者（糖尿病组）的临床资料,检测糖化血红蛋白（HbA1 c）,应用高分辨率彩超进行甲状腺彩超检查;同时收集550例健康体检的非糖尿病患者（非糖尿病组）的临床资料及甲状腺彩超,比较二组甲状腺结节的发病率,并分析糖尿病组不同年龄、不同性别、不同病程、不同 H bA1 c水平合并甲状腺结节的发病情况。结果①糖尿病患者甲状腺结节发病率显著高于非糖尿病患者（63．8％v s50．7％;P＜0．01）。②糖尿病组不同年龄甲状腺结节的发病率不同（ P＜0．01）,而且发病率随年龄增长而升高。女性甲状腺结节发病率高于男性（75．2％ v s52．9％;P＜0．01）。糖尿病组甲状腺结节发病率与糖尿病病程无关（P＞0．05）,与不同糖化血红蛋白水平有关（P＜0．01）,随着 HbA1 c的升高,甲状腺结节的发病率增高（P＜0．01）。结论中老年2型糖尿病患者甲状腺结节发病率较高,所以临床上对中老年2型糖尿病患者常规筛查甲状腺彩超有重要意义。     

CT薄层影像特征制定的肺结节分级评估系统区分良恶性肺结节的应用价值

目的探究CT薄层影像特征制定的肺结节分级评估系统区分孤立性肺结节(SPN)良恶性的应用价值。方法回顾性分析我院2018年9月至2020年7月确诊的122例SPN患者的临床资料。采用CT薄层影像特征制定的肺结节分级评估系统进行分级评定,并以病理诊断结果为“金标准”,分析其准确性、敏感度及特异度,并通过Kappa检验分析其与病理诊断结果的一致性。结果病理诊断证实良性SPN 56例,占45.9%(56/122),多为不典型增生及错构瘤,占28.6%(16/56),恶性SPN 66例,占54.1%(66/122),多为腺癌及鳞癌;肺结节分级标准分类2级31例、3级29例、4A级9例、4B级53例;肺恶性结节中,空泡征、宝石征、肿瘤血管征、毛刺征的发生率明显高于肺良性结节(均P<0.05),而病灶周围有卫星病灶的发生率明显低于肺良性结节(P<0.05);将肺结节分级标准中3级及以下归为阴性结节,4级及以上归为阳性结节,诊断准确率为90.2%。肺结节分级标准诊断肺良性结节与病理结果表现出了较好的一致性(Kappa=0.803),以肺结节分级标准诊断肺良性结节的结果与“金标准”(病理诊断结果)比较,得到的敏感度87.9%(58/66)和特异度92.9%(52/56)。结论影像诊断时,合理利用基于CT薄层影像特征制定的肺结节分级评估系统能有效地分类CT筛查出的肺结节,较好区分SPN的良、恶性。