超声造影和超声弹性成像鉴别诊断甲状腺良恶性结节的价值

  目的  评价超声造影和超声弹性成像在甲状腺良恶性结节中的鉴别诊断价值。  方法  对164个经手术病理证实的甲状腺良恶性结节的超声造影和弹性成像特征进行对比分析, 评估两种诊断方法的灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率。  结果  164个甲状腺结节中, 良性病灶96个, 恶性病灶68个良性结节在注射造影剂后均早于周围腺体增强, 晚于周围腺体廓清, 多数结节表现为周边环状增强, 恶性结节大多以低增强为主, 增强回声不均匀, 早于周边甲状腺组织消退超声造影的灵敏度、特异度、阳性预测值及阴性预测值分别为91.18%、93.75%、91.18%及93.75%;弹性成像的灵敏度、特异度、阳性预测值及阴性预测值分别为88.24%、91.67%、88.24%及91.67%: 两者联合诊断的灵敏度、特异度、阳性预测值及阴性预测值分别为97.06%、85.42%、82.50%及97.62%。  结论  超声造影和弹性成像对甲状腺良恶性结节有较高的鉴别诊断价值, 两者联合可提高对该病的诊断率。      

常规超声与超声弹性成像检测良恶性甲状腺肿瘤的临床价值

目的探讨常规超声与超声弹性成像诊断甲状腺良恶性肿瘤的临床价值。方法选取2010年4月至2014年9月间鄂东医疗集团黄石市中心医院收治的91例甲状腺结节患者,共99个结节,均采用常规超声和超声弹性成像检查。以甲状腺细针穿刺细胞学诊断为标准,比较图像变化及敏感性等。结果良性甲状腺结节61个,恶性甲状腺结节38个,其中恶性以乳头状癌最常见(94.7%),良性以滤泡增生结节常见(83.6%)。常规超声灵敏度、特异性和准确性分别为72.2%(26/36)、81.0%(51/63)和77.8%(77/99),超声弹性成像灵敏度、特异性和准确性分别为85.7%(30/35)、87.5%(56/64)和86.9%(86/99),常规超声联合超声弹性成像灵敏度、特异性和准确性分别为94.6%(35/37)、95.2%(59/62)和94.9%(94/99),常规超声联合超声弹性成像和常规超声或超声弹性成像任一单项比较,差异均有统计学意义(均P<0.05)。常规超声良恶性结节在形态、边界、后方衰减、钙化、血流分支和走形上比较,差异有统计学意义(P<0.05),而在内部回声、内部回声均匀度、供血情况和阻力指数等方面比较,差异无统计学意义(P>0.05);弹性成像在各个等级上差异均有统计学意义(均P<0.05)。结论常规超声与超声弹性成像检测对判断甲状腺肿瘤良恶性临床价值高。     

超声造影联合弹性成像在甲状腺微小乳头状癌诊断中的应用研究

目的 探讨超声造影联合弹性成像在甲状腺微小乳头状癌诊断中的应用价值.方法 选取甲状腺微小乳头状癌患者59例,共85个结节.分别对患者行超声造影、弹性成像及超声造影联合弹性成像检查.以病理诊断为"金标准",比较超声造影、弹性成像及二者联合诊断甲状腺微小乳头状癌的准确度、敏感度、特异度、阳性预测值及阴性预测值.结果 恶性结节超声造影增强模式的各项指标与良性结节比较,差异均无统计学意义(P﹥0.05);超声造影联合弹性成像诊断甲状腺微小乳头状癌的敏感度、特异度、阳性预测值及阴性预测值均高于超声造影、弹性成像单独检测,但差异无统计学意义(P﹥0.05);超声造影联合弹性成像诊断甲状腺微小乳头状癌的准确度为95.29%,高于超声造影的81.18%及弹性成像的83.53%,差异有统计学意义(P﹤0.05).结论 采用超声造影联合弹性成像对甲状腺微小乳头状癌进行诊断,可显著提高诊断的准确度,减少误诊、漏诊的发生,具有临床推广意义.     

常规超声联合超声造影鉴别甲状腺结节良恶性的价值

目的 探讨常规超声联合超声造影技术鉴别甲状腺良恶性结节的价值.方法 对62例患者的75个甲状腺低回声结节进行常规超声及超声造影检查,测量结节大小,观察结节形态、边界、位置、有无微小钙化、血流情况及超声造影检查结果.结果 甲状腺结节内部具有多发微小钙化低回声结节13个,形态不规则低回声结节69个,边界不清晰低回声结节69个,结节邻近包膜浸润11个.造影后37个低回声结节呈无增强,38个低回声结节呈低增强,28个低回声结节体积变小.经常规超声检查诊断甲状腺恶性结节65个,经超声造影检查诊断甲状腺恶性结节64个,术后病理证实甲状腺乳头状癌62个,结节性甲状腺肿13个.常规超声联合超声造影诊断甲状腺恶性结节64个,灵敏度为100％,特异度为84.6％,Kappa=0.901.结论 常规超声联合超声造影有助于提高对甲状腺恶性结节的诊断能力.     

甲状腺超声造影评分与弹性成像评分对TI-RADS分级的修正价值分析

目的:探讨甲状腺超声造影评分联合弹性成像评分对甲状腺影像报告与数据系统（TI-RADS分级）的修正价值。方法:回顾性分析了自2014年1月至2016年12月的83例患者,共计131个甲状腺结节,所有结节行二维超声检查评估TI-RADS分级,随后根据超声弹性成像评分、超声造影评分对TI-RADS分级进行修正,以术后病理学诊断为金标准,应用相应的统计学方法,分析并对比修正前后TI-RADS分级对甲状腺结节良恶性诊断的价值。结果:经病理学诊断共有90个恶性结节,41个良性结节,单独应用TI-RADS鉴别甲状腺结节良恶性时灵敏度55.56%、特异度78.05%、正确率62.60%、阳性预测值84.75%、阴性预测值44.44%、正确指数33.60%、AUC值0.729,分别应用超声弹性成像、超声造影评分修正后诊断效能的各项指标均有所提高,AUC值分别为0.884、0.889,而当两者评分联合修正时AUC值为0.916,修正前后AUC值之间的差异具有统计学意义（P均<0.001）。结论:单独应用TI-RADS鉴别甲状腺结节良恶性具有一定价值,不过应用超声造影、弹性成像分别修正TI-RADS可获得较高诊断效能,且两者联合应用修正TI-RADS可使其在鉴别甲状腺结节良恶性方面具有更高的诊断价值。     

超声成像在甲状腺结节良恶性鉴别中的应用价值

目的探讨常规超声、超声造影和剪切波弹性成像超声在甲状腺结节良恶性鉴别中的应用价值。方法选取2015年7月至2017年2月间新疆医科大学附属肿瘤医院收治的90例甲状腺结节患者,均采用常规超声、超声造影和剪切波弹性成像超声进行检测,以病理诊断结果为准,比较三种不同检验方法的诊断敏感性、特异性及准确性。结果常规超声的诊断敏感性、特异性及准确性分别为70.0%、74.3%和73.3%,超声造影的分别为66.7%、75.0%和73.2%,剪切波弹性成像超声的分别为90.0%、80.0%和82.2%。常规超声与超声造影比较,差异无统计学意义(P>0.05);剪切波弹性成像超声显著高于常规超声和超声造影,差异均有统计学意义(均P<0.05)。联合诊断结果显示,常规超声联合剪切波弹性成像超声诊断价值最高,诊断敏感性、特异性及准确性分别为100.0%、80.0%和83.3%。结论剪切波弹性成像超声较常规超声和超声造影,在甲状腺结节良恶性的术前鉴别诊断中,应用价值最高,具有较好的敏感性、特异性和准确性,值得临床推广。     

超声造影联合弹性成像诊断甲状腺癌的价值分析

目的 探讨超声造影联合弹性成像诊断甲状腺癌的价值。方法 收集2014年3月至2015年12月经筛查的139例患者的168个甲状腺结节。根据检查方法分为：超声造影组52例患者共66个结节,弹性成像组56例患者共68个结节,超声造影和弹性成像联合组31例患者共34个结节,所有结节均行细针穿刺病理活检。分析结节的病理、常规彩超检查结果及各组的影像学表现情况,采用受试者工作特征曲线（ROC）分析各组在诊断甲状腺癌中的效能。结果 168个甲状腺结节均经病理组织学证实,其中良性112个,恶性56个。超声造影组良性41个,恶性25个;弹性成像组良性47个,恶性21个;联合组良性24个,恶性10个。超声造影联合弹性成像、弹性成像及超声造影诊断甲状腺结节良恶性的ROC曲线下面积分别为0.924、0.883、0.847;其灵敏性、特异性、准确性分别为70.0％、75.0％、73.0％,96.8％、94.4％、94.6％和90.0％、77.7％、80.0％。超声造影联合弹性成像的诊断效能优于弹性成像及超声造影单独使用。结论 超声造影联合弹性成像技术可大大提高甲状腺癌的诊断率,在临床上有较高的应用价值。     

多模态超声检查在乳腺良恶性结节鉴别诊断中的应用

目的对比常规超声、弹性成像、容积成像及联合应用在乳腺良恶性结节鉴别诊断中的应用。方法选取2014年1月至2015年8月间广州中医药大学第一附属医院收治的经手术病理证实的214例乳腺结节患者,均采用超声检查,部分患者联合乳腺MR、钼靶检查,以旋切术等手术获得样本病理检验作为金标准。结果高频超声检出结节病灶230例,手术证实恶性结节84个,良性结节146个。联合诊断敏感性、特异性、阳性预测值、阴性预测值和符合率分别为98.8%、91.1%、86.5%、99.3%和93.9%,常规超声为84.5%、69.2%、61.2%、88.6%和74.8%,弹性超声为76.2%、84.9%、74.4%、86.1%和81.7%,三维容积成像为83.3%、80.8%、71.4%、89.4%和81.7%。联合诊断敏感性、特异性、阳性预测值、阴性预测值和符合率均高于常规超声、弹性超声和三维容积成像,差异均有统计学意义(均P<0.05)。结论常规超声、弹性超声和容积成像单独应用时诊断效用差异不大,各有优劣,联合应用时可提高诊断效用。     

超声弹性成像对桥本甲状腺炎合并结节的诊断价值

目的探讨超声弹性成像和常规超声在桥本甲状腺合并结节中的诊断价值。方法选取2013年1月至2014年12月间青岛市第三人民医院收治的42例经术后病理证实为桥本甲状腺炎合并结节的患者,同时接受常规超声和超声弹性成像检查,对两种诊断方法结果进行观察记录。以手术后病例诊断结果为准,对超声弹性成像和常规超声的诊断结果进行分析比较。结果42例患者共有48个病灶,其中恶性结节32个,平均直径为(1.30±0.62)cm;良性结节16个,平均直径为(1.40±0.56)cm,良恶性结节直径比较,差异无统计学意义(P>0.05)。32个恶性结节中,常规超声诊断恶性19个,良性13个;超声弹性成像诊断恶性30个,良性2个。16个良性结节中,常规超声诊断恶性3个,良性13个;超声弹性成像诊断恶性2个,良性14个。常规超声敏感度为59.4%,特异性为81.3%,阳性预测值为86.4%,阴性预测值为50.0%,符合率为66.7%。超声弹性成像敏感度为93.8%,特异性为87.5%,阳性预测值为93.8%,阴性预测值为87.5%,符合率为91.7%。结论在桥本甲状腺炎合并结节性质的诊断中,超声弹性成像敏感度高,具有较高的诊断价值。     

超声弹性成像技术联合常规超声诊断乳腺癌的准确性

目的 研究超声弹性成像技术联合常规超声诊断乳腺肿瘤的准确性,分析易误诊病例的影像学特征.方法 回顾性分析301例乳腺肿物患者的临床病历资料,共322个病灶,所有患者均分别用常规超声和超声弹性成像技术进行检查,判断病灶的良恶性倾向,再经病理检查确认、随访.计算不同检查方法的灵敏度、特异度、诊断效率、阳性预测值、阴性预测值及漏诊率,以1-特异度为横轴,灵敏度为纵轴绘制ROC曲线.结果 病理检查良性病灶245个,恶性病灶77个;弹性成像技术联合常规超声诊断的特异度、诊断效率、阳性预测值、阴性预测值分别为93.47%、93.79%、82.02%、98.28%,均较常规超声、超声弹性成像技术单独诊断高.常规超声联合弹性成像技术诊断的灵敏度为94.81%,低于常规超声的96.10%.ROC曲线下面积,常规超声为0.814,VTI弹性成像技术为0.796,两者联合诊断为0.941.结论 超声弹性成像技术联合常规超声诊断乳腺癌的准确度较高,具有良好的应用价值,但临床普及前,诊断标准、规范和相关技术手段仍需完善.     

Current status of body MR imaging: fast MR imaging and diffusion-weighted imaging

The recent technical advances in fast MR imaging have greatly enhanced the clinical value of MR imaging of the body. Advances in T₁-weighted images have enabled the acquisition of dynamic contrast-enhanced MR imaging, which is currently central to hepatic MR imaging for detection and characterization of liver tumors and is also useful for the evaluation of myometrial invasion in uterine cor-pus cancer. Advances in rapid T₂-weighted MR imaging with single-shot fast spin-echo images have enabled MR cholangiopancreatography and MR urography. Application of respiratory triggering can also provide T₂-weighted images of high quality. Cine MR imaging utilizing ultrafast MR sequences enables the assessment of the respiratory motion of the lung for evaluating thoracic wall invasion by tumors. Diffusion-weighted images can provide excellent tissue contrast based on molecular diffusion and have the potential to demonstrate malignant tumors. Quantitative measurement of apparent diffusion coefficient values may also be valuable in distinguishing malignancies from benign lesions.     

Hapten-derivatized nanoparticle targeting and imaging of gene expression by multimodality imaging systems

Non-invasive gene monitoring is important for most gene therapy applications to ensure selective gene transfer to specific cells or tissues. We developed a non-invasive imaging system to assess the location and persistence of gene expression by anchoring an anti-dansyl (DNS) single-chain antibody (DNS receptor) on the cell surface to trap DNS-derivatized imaging probes. DNS hapten was covalently attached to cross-linked iron oxide (CLIO) to form a 39+/-0.5 nm DNS-CLIO nanoparticle imaging probe. DNS-CLIO specifically bound to DNS receptors but not to a control single-chain antibody receptor. DNS-CLIO (100 microM Fe) was non-toxic to both B16/DNS (DNS receptor positive) and B16/phOx (control receptor positive) cells. Magnetic resonance (MR) imaging could detect as few as 10% B16/DNS cells in a mixture in vitro. Importantly, DNS-CLIO specifically bound to a B16/DNS tumor, which markedly reduced signal intensity. Similar results were also shown with DNS quantum dots, which specifically targeted CT26/DNS cells but not control CT26/phOx cells both in vitro and in vivo. These results demonstrate that DNS nanoparticles can systemically monitor the expression of DNS receptor in vivo by feasible imaging systems. This targeting strategy may provide a valuable tool to estimate the efficacy and specificity of different gene delivery systems and optimize gene therapy protocols in the clinic.     

Magnetic particle imaging: Introduction to imaging and hardware realization

Magnetic Particle Imaging (MPI) is a recently invented tomographic imaging method that quantitatively measures the spatial distribution of a tracer based on magnetic nanoparticles. The new modality promises a high sensitivity and high spatial as well as temporal resolution. There is a high potential of MPI to improve interventional and image-guided surgical procedures because, today, established medical imaging modalities typically excel in only one or two of these important imaging properties. MPI makes use of the non-linear magnetization characteristics of the magnetic nanoparticles. For this purpose, two magnetic fields are created and superimposed, a static selection field and an oscillatory drive field. If superparamagnetic iron-oxide nanoparticles (SPIOs) are subjected to the oscillatory magnetic field, the particles will react with a non-linear magnetization response, which can be measured with an appropriate pick-up coil arrangement. Due to the non-linearity of the particle magnetization, the received signal consists of the fundamental excitation frequency as well as of harmonics. After separation of the fundamental signal, the nanoparticle concentration can be reconstructed quantitatively based on the harmonics. The spatial coding is realized with the static selection field that produces a field-free point, which is moved through the field of view by the drive fields.This article focuses on the frequency-based image reconstruction approach and the corresponding imaging devices while alternative concepts like x-space MPI and field-free line imaging are described as well. The status quo in hardware realization is summarized in an overview of MPI scanners.     

Optoacoustic spectroscopy and imaging

Optoacoustic methods are based on the thermoelastic effect, according to which a short laser pulse is absorbed in a medium and generates an acoustic wave following rapid heating and thermal expansion. This study it sought to demonstrate how the optical properties and structure of the sample can be obtained from acoustic signals that are measured on the surface of the medium. This was pursued on the hand by using broadband piezo-electric and optical sensors, and on the other hand by means of theoretical simulations. For optically one-dimensional media, where the optical properties depend only on one direction in space, the measurement of a plane wave in the acoustical near field of the sample yielded directly the depth distribution of absorbed energy. In the far field, this simple relationship was not valid, due to acoustic diffraction. The distribution, however, could be reconstructed mathematically. Far field signals could also be used to image the contours of optical structures.     

Small animal imaging. current technology and perspectives for oncological imaging

Advances in the biomedical sciences have been accelerated by the introduction of many new imaging technologies in recent years. With animal models widely used in the basic and pre-clinical sciences, finding ways to conduct animal experiments more accurately and efficiently becomes a key factor in the success and timeliness of research. Non-invasive imaging technologies prove to be extremely valuable tools in performing such studies and have created the recent surge in small animal imaging. This review is focused on three modalities, PET, MR and optical imaging which are available to the scientist for oncological investigations in animals.     

Immunotherapy and the role of imaging

Significant advances in the genetic and molecular characterization of cancer have led to the development of effective immunotherapies. These therapeutics help the host immune system recognize cancer as foreign, promote the immune system, and relieve the inhibition that allows growth and spread of tumors. Experience with various immunotherapies, particularly the immunomodulatory monoclonal antibody ipilimumab, has demonstrated that unique patterns of response may be encountered that cannot be adequately captured by traditional response criteria, such as the World Health Organization (WHO) criteria and Response Evaluation Criteria in Solid Tumors (RECIST), which have been used primarily with cytotoxic chemotherapies. In response to these observations, several novel response criteria have been developed to evaluate patients who receive immunotherapy, including immune‐related response criteria (irRC), immune‐related RECIST (irRECIST), and immune RECIST (iRECIST). These criteria are typically used in conjunction with RECIST version 1.1 in the clinical trial setting, because approval of new therapeutics by the US Food and Drug Administration relies on the responses derived from RECIST version 1.1. Finally, a wide variety of immune‐related adverse events may affect patients who receive immunotherapy, many of which can be identified on imaging studies such as computed tomography, magnetic resonance imaging, and 2‐deoxy‐2‐(fluorine‐18)fluoro‐D‐glucose–positron emission tomography/computed tomography. In this review, the authors present the role of imaging in the evaluation of patients treated with immunotherapy, including the background and application of irRC, irRECIST, and iRECIST; the imaging of immune‐related adverse events; and future directions in advanced imaging of immunotherapy. Cancer 2018;124:2906‐22 . © 2018 American Cancer Society.     

Molecular imaging of inflammation and carcinogenesis

Development of imaging agents that can be used broadly for early detection of neoplasia at various tissue sites and at various stages of disease and that also can assess states of minimal residual disease would have tremendous utility in the diagnosis and management of cancer. In a series of articles culminating with a report in this issue of the journal (beginning on page 1536), Uddin and colleagues show their ability to systemically target the enzyme COX-2 with imaging probes that will serve as agents for early detection, risk assessment, prognosis, and intervention outcome measures. These probes will enable the detection and localization of regions of inflammation and a wide variety of premalignant lesions and cancers, with utility in monitoring the effects of cancer prevention and therapy.     

131I平面显像与SPECT/CT断层显像对分化型甲状腺癌转移灶诊断的对比分析

目的:探讨131I全身平面显像与131I- SPECT/CT同机融合显像对分化型甲状腺癌(DTC)病人术后残留甲状腺和转移灶的的诊断价值.方法: 对58例DTC术后病人,口服131I 74-185 MBq 48h后分别行全身平面显像和SPECT/CT同机融合显像,所得影像结果进行分析.结果: 临床证实133处病灶中 131I SPECT/CT同机融合影像发现131I异常摄取灶124处,阳性率为93.2%(124/133),有9处转移灶显示为阴性,假阴性率为6.8%(9/133),无假阳性病例.131I全身平面显像发现131I异常摄取灶105处,阳性率为80.2%(105/131),有26处转移灶显示为阴性,假阴性率为19.8%(26/131).有19处假阳性转移灶,假阳性率为14.5%(19/131),两组在阳性率,假阴性率比较均有显著差别. 结论: 131I- SPECT/CT同机融合显像与131I全身平面显像相比,能提高DTC转移灶检出率,明显降低假阳性率,有益于DCT术后病人转移灶的诊断和鉴别诊断.