肺部疾病影像诊断分析

目的 评价X线胸片、CT及磁共振成像对几种常见肺疾患的诊断准确率及选择诊断方法的考虑。方法347例肺疾患包括肺炎97例、肺结核85例、肺癌108例、支气管扩张50例,以及其他7例,均经至少一种影像技术检查,其中,149例经手术病理证实,198例经临床验证。结果X线胸片对肺炎与肺结核的诊断准确率较高,分别为95％和80％,而CT对肺癌与支气管扩张的诊断准确率较高,分别为92．5％和100％。结论不同影像技术的诊断准确性随肺疾患的病种不同而异,这对合理选择诊断方法具有实际指导意义。通常,肺部炎症和结核多数以X线平片就能确诊,当平片上影像与临床不符或形态不典型,以及单靠平片难以确定时,则需借助于CT或核磁进一步观察病灶内结构及其与周围组织的关系,以获得准确诊断。     

Diagnostic accuracy of breast sonography. Comparison among three different techniques]

Mechanical arc scanning is widely used for breast sonography in Japan. The authors have used three different kinds of devices over the past seven years. The diagnostic accuracy was compared among three groups of patients with pathologically confirmed breast masses. In group A, 309 cases (77 carcinomas) were evaluated with a 10 MHz contact compound scanner, and the sensitivity, specificity and accuracy rates were 77.9%, 97.8% and 92.9%, respectively. In group B, 306 cases (56 carcinomas) were evaluated with a 5 or 7.5 MHz mechanical arc scanner, and the sensitivity, specificity and accuracy rates were 89.3%, 84.8% and 85.6%, respectively. In group C, 296 cases (71 carcinomas) were evaluated with a 7.5 MHz real time scanner, and the sensitivity, specificity and accuracy rates were 95.8%, 92.4% and 93.2%, respectively. In cases with T1 breast cancer, the methods had sensitivities of 60.0%, 85.7% and 94.5%, respectively. The sensitivity of the real-time scanner was not significantly different from that of the mechanical arc scanner. In conclusion, the hand-held real-time scanner with high-frequency transducer is a simple, useful device with high diagnostic accuracy for breast examination and can be used as a substitute for the mechanical arc scanner.     

Diagnostic accuracy of 99mTc-sestamibi breast imaging: multicenter trial results.

Although mammography is well established as a first-line tool for breast cancer screening and detection, efforts to develop complementary procedures continue. Observation of 99mTc-sestamibi tumor uptake provided the impetus for its evaluation as an adjunctive technique. This trial's objectives were to determine in a multicenter trial the diagnostic accuracy of 99mTc-sestamibi in women with suspected breast cancer and to investigate factors influencing diagnostic accuracy. METHODS: Our multicenter trial enrolled 673 women (387 with nonpalpable abnormalities; 286 with palpable abnormalities) scheduled for excisional biopsy or mastectomy. Blinded and unblinded interpretations of scintigraphic images were compared with core laboratory established histopathologic diagnoses to define the diagnostic accuracy of 99mTc-sestamibi breast imaging. RESULTS: Blinded readers' diagnostic accuracy was 78%-81%. Inter-reader agreement was excellent, ranging from 95% to 100% (kappa = 0.82-0.99). Overall institutional sensitivity and specificity for 99mTc-sestamibi breast imaging were 75.4% and 82.7%, respectively. In this population with a 40.1% disease prevalence, the positive predictive value was 74.5% and the negative predictive value was 83.4%. The negative predictive value was 94% in patients with a 40% or lower mammographic likelihood of breast cancer. Sensitivity was higher for palpable abnormalities; specificity was higher for nonpalpable abnormalities. Sensitivity was decreased for tumors <1 cm in largest dimension but appeared not to be affected by patient's age. CONCLUSION: As an adjunct to current procedures, 99mTc-sestamibi breast imaging may contribute to patient management decisions in selected populations, including women with dense breasts, mammographically indeterminate lesions >1 cm, and palpable abnormalities.     

Diagnostic imaging of aortic diseases

Summary The aim of this overview is the comparison between noninvasive tomographic imaging modalities such as surface echocardiography, transesophageal echocardiography, X-ray computed tomography and magnetic resonance imaging with the previous gold standard angiography in the setting of acute and chronic aortic diseases. Methods: The groundwork for the comparison between various noninvasive modalities is the validation of findings with angiography or intraoperative and histopathological results. Results and conclusions: Noninvasive modalities such as transesophageal echocardiography, X-ray computed tomography and magnetic resonance imaging are suitable methods for reliable diagnosis or exclusion of aortic dissection both in the ascending and descending segment of the thoracic aorta. Other more rare pathologies of the aorta such as intramural hemorrhage as a precursor of dissection, aortic ulcers, aneurysms as well as congenital and posttraumatic lesions may also be subjected to transesophageal echocardiography or magnetic resonance imaging with excellent sensitivity and specificity; both techniques have also proven to be safe procedures in critically ill patients and have, in our view, replaced angiography for the diagnosis of acute aortic syndromes. Thus, in acute aortic diseases invasive angiographic procedures should be relegated to a complementary role, while transesophageal echocardiography, X-ray computed tomography (especially helical CT) in acute, and magnetic resonance imaging in chronic cases represent prefered diagnostic options. In addition to primary diagnostics the noninvasive approaches using transesophageal echocardiography and magnetic resonance imaging are superbly suitable for serial follow-up imaging in all forms of aortic pathology. Eingegangen am 23. Januar 1997 Angenommen am 23. Januar 1997     

Diagnostic imaging for breast cancer

With the westernization of the Japanese diet and way of life, the mortality due to breast cancer continues gradually to increase. This disease, however, is a type of cancer that can be well controlled by primary preventive measures and early detection. Numerous techniques of diagnostic imaging for breast cancer have been established, but the most common are mammography and ultrasonography. For X-ray mammography, a low tube voltage is necessary so that small differences in X-ray absorption by the various tissues within the breast may be detected, but when the surface dose is increased, it is a source of anxiety because of the possible development of secondary carcinoma. Ultrasonography of the breast, however, is free from the dangers of radiation exposure, and may be conducted in conjunction with palpation, thus representing a highly reliable approach. The diagnostic reliability of mammography and ultrasonography was investigated in 251 cases in which breast cancer was confirmed by these methods in a total of 752 outpatients who visited the Department of Breast Surgery of the Aichi Cancer Center Hospital in Nagoya, Japan. As a diagnostic procedure for breast cancer, mammography was shown to have a sensitivity of 89.2%, a specificity of 92.6%, and an accuracy rate of 91.5%, the respective values for the ultrasound technique being 84.9%, 88.9%, and 87.5%. These results are superior even to those of surgeons with 30 years of experience specializing in the breast (86.9%, 85.3%, and 85.8%), especially when tumors cannot be palpated.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diagnostic accuracy of different imaging modalities in detection of proximal caries

Objective

The purpose of this study was to assess the in vitro diagnostic ability of visual inspection, film, charge-coupled device (CCD) sensor, photostimulable phosphor (PSP) sensor and cone beam CT in the detection of proximal caries in posterior teeth compared with the histological gold standard.

Methods

Visual inspection, film, CCD, PSP and cone beam CT images were used to detect proximal caries in the mesial and distal surfaces of 138 teeth (276 surfaces). Visual inspection and evaluation of all intraoral digital and conventional radiographs and cone beam CT images were performed twice by three oral radiologists. Weighted kappa coefficients were calculated to assess intra- and interobserver agreement for each image set, and scores were compared with the histological gold standard using receiver operating characteristic (ROC) analysis to evaluate diagnostic ability.

Results

Intraobserver kappa coefficients calculated for each observer for each method of detecting caries ranged from 0.739 to 0.928. Strong interobserver agreement ranging from 0.631 to 0.811 was found for all detection methods. The highest Az values for all three observers were obtained with the cone beam CT images; however, differences between detection methods were not statistically significant (P > 0.05).

Conclusion

Visual inspection, film, CCD, PSP plates and cone beam CT performed similarly in the detection of proximal caries.     

Diagnostic accuracy of 68Ga-DOTANOC PET/CT imaging in pheochromocytoma

Purpose

The purpose of the present study was to evaluate the diagnostic accuracy of ⁶⁸Ga-DOTANOC positron emission tomography (PET)/CT in patients with suspicion of pheochromocytoma.

Methods

Data of 62 patients [age 34.3?±?16.1 years, 14 with multiple endocrine neoplasia type 2 (MEN2)] with clinical/biochemical suspicion of pheochromocytoma and suspicious adrenal lesion on contrast CT (n?=?70), who had undergone ⁶⁸Ga-DOTANOC PET/CT, were retrospectively analyzed. PET/CT images were analyzed visually as well as semiquantitatively, with measurement of maximum standardized uptake value (SUV_max), SUV_mean, SUV_max/SUV_liver, and SUV_mean/SUV_liver. Results of PET/CT were compared with ¹³¹I-metaiodobenzylguanidine (MIBG) imaging, which was available in 40 patients (45 lesions). Histopathology and/or imaging/clinical/biochemical follow-up (minimum 6 months) was used as reference standard.

Results

The sensitivity, specificity, and accuracy of ⁶⁸Ga-DOTANOC PET/CT was 90.4, 85, and 88.7 %, respectively, on patient-based analysis and 92, 85, and 90 %, respectively, on lesion-based analysis. ⁶⁸Ga-DOTANOC PET/CT showed 100 % accuracy in patients with MEN2 syndrome and malignant pheochromocytoma. On direct comparison, lesion-based accuracy of ⁶⁸Ga-DOTANOC PET/CT for pheochromocytoma was significantly higher than ¹³¹I-MIBG imaging (91.1 vs 66.6 %, p?=?0.035). SUV_max was higher for pheochromocytomas than other adrenal lesions (p?=?0.005), MEN2-associated vs sporadic pheochromocytoma (p?=?0.012), but no difference was seen between benign vs malignant pheochromocytoma (p?=?0.269).

Conclusion

⁶⁸Ga-DOTANOC PET/CT shows high diagnostic accuracy in patients with suspicion of pheochromocytoma and is superior to ¹³¹I-MIBG imaging for this purpose. Best results of ⁶⁸Ga-DOTANOC PET/CT are seen in patients with MEN2-associated and malignant pheochromocytoma.     

Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer

PURPOSE: To prospectively assess accuracy of mammography, clinical examination, ultrasonography (US), and magnetic resonance (MR) imaging in preoperative assessment of local extent of breast cancer. MATERIALS AND METHODS: Institutional review board approval and informed patient consent were obtained. Results of bilateral mammography, US, and contrast-enhanced MR imaging were analyzed from 111 consecutive women with known or suspected invasive breast cancer. Results were correlated with histopathologic findings. RESULTS: Analysis included 177 malignant foci in 121 cancerous breasts, of which 89 (50%) foci were palpable. Median size of 139 invasive foci was 18 mm (range, 2-107 mm). Mammographic sensitivity decreased from 100% in fatty breasts to 45% in extremely dense breasts. Mammographic sensitivity was highest for invasive ductal carcinoma (IDC) in 89 of 110 (81%) cases versus 10 of 29 (34%) cases of invasive lobular carcinoma (ILC) (P < .001) and 21 of 38 (55%) cases of ductal carcinoma in situ (DCIS) (P < .01). US showed higher sensitivity than did mammography for IDC, depicting 104 of 110 (94%) cases, and for ILC, depicting 25 of 29 (86%) cases (P < .01 for each). US showed higher sensitivity for invasive cancer than DCIS (18 of 38 [47%], P < .001). MR showed higher sensitivity than did mammography for all tumor types (P < .01) and higher sensitivity than did US for DCIS (P < .001), depicting 105 of 110 (95%) cases of IDC, 28 of 29 (96%) cases of ILC, and 34 of 38 (89%) cases of DCIS. In anticipation of conservation or no surgery after mammography and clinical examination in 96 breasts, additional tumor (which altered surgical approach) was present in 30. Additional tumor was depicted in 17 of 96 (18%) breasts at US and in 29 of 96 (30%) at MR, though extent was now overestimated in 12 of 96 (12%) at US and 20 of 96 (21%) at MR imaging. After combined mammography, clinical examination, and US, MR depicted additional tumor in another 12 of 96 (12%) breasts and led to overestimation of extent in another six (6%); US showed no detection benefit after MR imaging. Bilateral cancer was present in 10 of 111 (9%) patients; contralateral tumor was depicted mammographically in six and with both US and MR in an additional three. One contralateral cancer was demonstrated only clinically. CONCLUSION: In nonfatty breasts, US and MR imaging were more sensitive than mammography for invasive cancer, but both MR imaging and US involved risk of overestimation of tumor extent. Combined mammography, clinical examination, and MR imaging were more sensitive than any other individual test or combination of tests.     

Diagnostic accuracy of MRI textural analysis in the classification of breast tumors

ObjectiveTo investigate whether textural analysis (TA) of MRI heterogeneity may play a role in the clinical assessment and classification of breast tumors.Materials and methodsFor this retrospective study, patients with breast masses ≥1 cm on contrast-enhanced MRI were obtained in 69 women (mean age: 51 years; range 21–78 years) with 77 masses (38 benign, 39 malignant) from 2006 to 2018. The selected single slice sagittal peak post-contrast T1-weighted image was analyzed with commercially available TA software [TexRAD Ltd., UK]. Eight histogram TA parameters were evaluated at various spatial scaling factors (SSF) including mean pixel intensity, standard deviation of the pixel histogram (SD), entropy, mean of the positive pixels (MPP), skewness, kurtosis, sigma, and Tx_sigma. Additional statistical tests were used to determine their predictiveness.ResultsEntropy showed a significant difference between benign and malignant tumors at all textural scales (p < 0.0001) and kurtosis was significant at SSF = 0–5 (p = 0.0026–0.0241). The single best predictor was entropy at SSF = 4 with AUC = 0.80, giving a sensitivity of 95% and specificity of 53%. An AUC of 0.91 was found using a model combining entropy with sigma, which yielded better performance with a sensitivity of 92% and specificity of 79%.ConclusionTA of breast masses has the potential to assist radiologists in categorizing tumors as benign or malignant on MRI. Measurements of entropy, kurtosis, and entropy combined with sigma may provide the best predictability.     

Diagnostic accuracy of diffusion-weighted imaging in differentiating benign from malignant ovarian lesions

Purpose

To clarify the diagnostic accuracy of diffusion‐weighted imaging (DWI) in differentiating benign from malignant ovarian lesions.

Materials and Methods

We retrospectively analyzed magnetic resonance images of 123 ovarian lesions in 119 patients. We defined lesions with abnormal signal intensity as malignancy and assessed the location of abnormal intensity within the lesions on DWI. We also assessed the mean and lowest apparent diffusion coefficient (ADC) values of the solid portion for each ovarian lesion.

Results

The majority of malignant ovarian tumors and mature cystic teratomas, and almost half of the endometriomas, showed abnormal signal intensity on DWI, whereas most fibromas and other benign lesions did not. The main locations of abnormal signal intensity were solid portions in malignant ovarian tumors, cystic components suggestive of keratinoid substances and Rokitansky protuberance in mature cystic teratomas, and intracystic clots in endometriomas. On DW imaging, receiver‐operating characteristic analysis yielded mean Az values of 0.703. There was no significant difference in mean and lowest ADC values between malignant and benign lesions.

Conclusion

DWI of ovarian lesions and ADC values of the solid component are not useful for differentiating benign from malignant ovarian lesions. This knowledge is essential in avoiding misinterpretation in the diagnosis of ovarian lesions. J. Magn. Reson. Imaging 2008;28:1149–1156. © 2008 Wiley‐Liss, Inc.     

18F-FDG代谢显像对原发性乳腺癌的诊断价值

目的探讨利用符合线路(DHC)18F-FDG代谢显像对原发性乳腺癌鉴别诊断的临床价值.方法51例乳腺包块患者行DHC18F-FDG代谢显像,利用计算机感兴趣区(ROI)技术,计算靶/非靶比值(T/NT),全部患者均显像后经细针穿刺组织学活检确诊分为良性组和恶性组.结果活检病理组织学确诊乳腺癌33例(65%),良性乳腺包块18例(35%);定性诊断18F-FDG代谢显像33例,恶性患者中29例显像阳性,4例阴性;良性组3例为阳性,其余为阴性;DHC18F-FDG显像定性诊断的灵敏度、特异性和准确度分别为88%、83%和86%.恶性组和良性组摄取18F-FDG的T/NT比值分别为2.25±0.18和1.35±0.37(P＜0.01);以T/NT比值1.5为诊断阈值,DHC18F-FDG显像诊断的灵敏度、特异性和准确度分别为94%、89%和92%.结论 DHC18F-FDG显像诊断乳腺癌具有一定的临床价值,定性与定量结合有利于提高诊断效能.     

扩散加权成像在乳腺疾病中的临床应用及成像影响因素

扩散加权成像技术可以反映组织细胞内水分子的扩散运动特性,进而对活体组织结构及功能状态进行无创性检测,其在乳腺疾病的鉴别诊断、术前评估、术后复发监测及治疗后反应等诸多方面具有重要价值.就扩散加权成像在乳腺疾病中的临床应用新进展及成像技术因素等予以综述.     

Diagnostic accuracy of magnetic resonance imaging techniques for treatment response evaluation in patients with high-grade glioma,a systematic review and meta-analysis

Objective

Treatment response assessment in high-grade gliomas uses contrast enhanced T1-weighted MRI, but is unreliable. Novel advanced MRI techniques have been studied, but the accuracy is not well known. Therefore, we performed a systematic meta-analysis to assess the diagnostic accuracy of anatomical and advanced MRI for treatment response in high-grade gliomas.

Methods

Databases were searched systematically. Study selection and data extraction were done by two authors independently. Meta-analysis was performed using a bivariate random effects model when ≥5 studies were included.

Results

Anatomical MRI (five studies, 166 patients) showed a pooled sensitivity and specificity of 68% (95%CI 51–81) and 77% (45–93), respectively. Pooled apparent diffusion coefficients (seven studies, 204 patients) demonstrated a sensitivity of 71% (60–80) and specificity of 87% (77–93). DSC-perfusion (18 studies, 708 patients) sensitivity was 87% (82–91) with a specificity of 86% (77–91). DCE-perfusion (five studies, 207 patients) sensitivity was 92% (73–98) and specificity was 85% (76–92). The sensitivity of spectroscopy (nine studies, 203 patients) was 91% (79–97) and specificity was 95% (65–99).

Conclusion

Advanced techniques showed higher diagnostic accuracy than anatomical MRI, the highest for spectroscopy, supporting the use in treatment response assessment in high-grade gliomas.

Key points

? Treatment response assessment in high-grade gliomas with anatomical MRI is unreliable ? Novel advanced MRI techniques have been studied, but diagnostic accuracy is unknown ? Meta-analysis demonstrates that advanced MRI showed higher diagnostic accuracy than anatomical MRI ? Highest diagnostic accuracy for spectroscopy and perfusion MRI ? Supports the incorporation of advanced MRI in high-grade glioma treatment response assessment

     

乳腺乳头病变的MRI特点

【摘要】目的：回顾性分析良恶性乳头病变的乳腺MRI特点,以提高诊断正确率。方法：搜集2012年9月-2015年9月本院经手术病理证实且术前行MRI检查的13例乳头病变患者的病例资料,分析病灶的形态学特征及强化特点。所有病例MRI表现由2名从事乳腺影像诊断的放射科医师共同阅片,讨论达成一致诊断意见。结果：13例患者的病理结果分别为：软纤维瘤2例,乳头腺瘤2例,乳腺炎性病变累及乳头3例,乳头派杰病（PD）6例。在MRI上,2例乳头软纤维瘤均表现为乳头上小结节,轻度强化。2例乳头腺瘤MRI表现为乳头增大伴乳头内强化结节。3例乳头炎性病变中,1例MRI上表现为乳头内环形强化结节,乳腺内未见异常强化;另外2例MRI上表现为乳头轻度或明显异常强化,乳腺内可见异常强化炎性灶。6例乳头PD中,乳腺内均有异常强化恶性病灶;其中5例MRI上表现为患侧乳头明显不均匀强化,另1例患侧乳头未见异常强化。结论：乳腺乳头病变在MRI上多发表现为乳头内强化结节或乳头不均匀强化,结合乳头病变强化特点及乳腺内有无可疑恶性病灶,有助于鉴别诊断。     

Diagnostic accuracy of thoracic imaging modalities for the detection of COVID-19

The ongoing coronavirus disease 2019 (COVID-19) pandemic continues to present diagnostic challenges. The use of thoracic radiography has been studied as a method to improve the diagnostic accuracy of COVID-19. The ‘Living’ Cochrane Systematic Review on the diagnostic accuracy of imaging tests for COVID-19 is continuously updated as new information becomes available for study. In the most recent version, published in March 2021, a meta-analysis was done to determine the pooled sensitivity and specificity of chest X-ray (CXR) and lung ultrasound (LUS) for the diagnosis of COVID-19. CXR gave a sensitivity of 80.6% (95%CI: 69.1-88.6) and a specificity of 71.5% (95%CI: 59.8-80.8). LUS gave a sensitivity rate of 86.4% (95%CI: 72.7-93.9) and specificity of 54.6% (95%CI: 35.3-72.6). These results differed from the findings reported in the recent article in this journal where they cited the previous versions of the study in which a meta-analysis for CXR and LUS could not be performed. Additionally, the article states that COVID-19 could not be distinguished, using chest computed tomography (CT), from other respiratory diseases. However, the latest review version identifies chest CT as having a specificity of 80.0% (95%CI: 74.9-84.3), which is much higher than the previous version which indicated a specificity of 61.1% (95%CI: 42.3-77.1). Therefore, CXR, chest CT and LUS have the potential to be used in conjunction with other methods in the diagnosis of COVID-19.