20例常见部位骨折漏诊误诊X线平片分析

近几年来因交通事故，民事纠纷及意外伤害患者不断增多，部份病例由于损伤范围广，临床症状不明显加之放射医(技)师对正常之X线解剖结构不熟悉等诸多因素，造成的漏诊误诊屡见不鲜。为了减轻病人的痛苦和经济负担，避免因漏诊误诊引起的不必要的医疗纠纷，现将我科1995年-2004年间20例常见部位骨折X线平片漏诊误诊原因作出分析，以提高认识。     

X线平片肋骨骨折漏诊4例

2001年1月至2003年2月，因胸部外伤，来我科进行X线摄片的诊断的病人中，有4例肋骨骨折被漏诊。本文就4例肋骨骨折病人发生漏诊原因进行探讨，并提出相关防止措施。     

先天性心脏病X线平片误漏诊原因分析

本文对５９例经手术证实的常见先天性心脏病中误渥诊１６例（占２７．１％）,进行总结分析。肯定了Ｘ线平片对先天性心脏病检查的意义,并认为放射科医生在掌握典型病变的基础上,应加强对不典型病变、合并畸形、复杂畸形的认识。临床医生应对Ｘ线检查给予重视,明确检查目的,应全面准确地提供病史、体征及必要的辅助检查资料,以利于诊断符合率的提高。     

乳腺X线摄影对早期乳腺癌的诊断价值分析

目的探讨乳腺X线摄影对早期乳腺癌的诊断价值。方法对70例乳腺X线摄影IB-RADS评分4级及以上,经病理证实的病例,进行X线诊断结果与病理结果对照比较。结果良性3例,恶性67例,正确诊断率95.7%。其中肿块及其它征象47例,仅表现微钙化征象23例。结论肿块及微小钙化是乳腺癌最直接、最主要的X线征象,乳腺X线摄影对乳腺组织结构显示清晰,特别是对微小钙化。     

CT与X线平片诊断肺结核38例分析

尽管人们在努力寻求肺结核新的诊断方法，但目前痰液查抗酸杆菌与X线胸部平片仍是主要的诊断手段之一。近几年来，随着CT的广泛应用，在肺部疾病的诊断中发挥着越来越多的作用，在某些情况下CT也的确有很大帮助，在一定意义上，CT比平片有较大的优越性。     

数字钼靶X线诊断乳腺癌分析

目的 探讨数字钼靶X线摄影在诊断乳腺癌中的价值.方法 回顾性分析36例经病理证实的乳腺癌的数字钼靶X线片.结果 X线显示肿块22例(61.1%),肿块伴钙化7例(19.4%),不对称性密度增高伴结构紊乱4例(11.1%),Pagets病1例(2.7%),仅有钙化者3例(8.33%),异常血管影3例(8.33%),皮肤增厚4例(8.73%).结论数字钼靶X线摄影对乳腺癌早期诊断及鉴别诊断有重要意义.     

乳腺癌的X线诊断

目的：探讨乳腺癌的X线特征性表现，提高乳腺癌的诊断符合率。方法：对36例患者常规拍侧位及轴位片，观察乳房密度和肿块形态、边缘和内部密度。结果：36例患者中，肿块伴毛刺者11例，有钙化者9例。结论：钼靶X线对乳腺癌的诊断有很高的敏感性。     

乳腺癌X线钼靶片漏误诊分析

资料：13例患者均为女性，年龄22-50岁，平均36岁，病程1W-2Y不等。临床表现：8例表现为乳房肿块，3例病程有疼痛。1例为CT发现右乳小结节要求检查。1例为体检。右乳8例。左乳5例。     

不同部位放大像与普通X线平片对照分析

目的．探讨放大像与普通Ｘ线平片对同一部位骨南病变的诊断效果。材料与方法：对２１０便（男１２０例、女９０例）既有Ｘ线平片又有放大像的病例所摄照片进行分析、对比。结果：放大像发现病变的阳性率为７２％；Ｘ线平片发现病变的阳性率为５９％。结论：当临床高度怀疑有骨质病变，常规Ｘ线平片表现为正常或怀疑异常时，应摄放大像以减少漏诊。     

全数字化乳腺摄影在乳腺病变中的临床应用价值

目的探讨全数字化乳腺摄影(FFDM)在乳腺病变中的临床应用价值。资料与方法搜集经手术病理证实有完整临床资料的乳腺病变共102例,所有患者均行FFDM,结合病理进行影像学分析。结果 102例乳腺病变中乳腺癌31例,乳腺良性病变71例。临床触及肿块者63例,未触及肿块者39例。影像表现为肿块80例,单纯成簇微小钙化4例,结构紊乱并粗长毛刺2例,结构紊乱并微小钙化1例,局部片状致密影14例,无明显影像表现1例。FFDM对乳腺癌诊断敏感性为90.3%,特异性为94.4%,准确性为93.1%。结论 FFDM能清晰显示乳腺病变的X线征象,尤其能够显示乳腺癌的主要X线征象,为临床早期诊断乳腺病变创造了条件,尤其对临床未触及肿块的早期乳腺癌具有重要的临床价值。     

Contrast-Enhanced Spectral Mammography: Comparison with Conventional Mammography and Histopathology in 152 Women

Objective

The goal of the study was to compare conventional mammography (MG) and contrast-enhanced spectral mammography (CESM) in preoperative women.

Materials and Methods

The study was approved by the local Ethics Committee and all participants provided informed consent. The study included 152 consecutive patients with 173 breast lesions diagnosed on MG or CESM. All MG examinations and consults were conducted in one oncology centre. Non-ionic contrast agent, at a total dose of 1.5 mL/kg body weight, was injected intravenous. Subsequently, CESM exams were performed with a mammography device, allowing dual-energy acquisitions. The entire procedure was done within the oncology centre. Images from low and high energy exposures were processed together and the combination provided an "iodine" image which outlined contrast up-take in the breast.

Results

MG detected 157 lesions in 150 patients, including 92 infiltrating cancers, 12 non-infiltrating cancers, and 53 benign lesions. CESM detected 149 lesions in 128 patients, including 101 infiltrating cancers, 13 non-infiltrating cancers, and 35 benign lesions. CESM sensitivity was 100% (vs. 91% for MG), specificity was 41% (vs. 15% for MG), area under the receiver operating characteristic curve was 0.86 (vs. 0.67 for MG), and accuracy was 80% (vs. 65% for MG) for the diagnosis of breast cancer. Both MG and CESM overestimated lesion sizes compared to histopathology (p < 0.001).

Conclusion

CESM may provide higher sensitivity for breast cancer detection and greater diagnostic accuracy than conventional mammography.     

Use of Artificial Intelligence for Reducing Unnecessary Recalls at Screening Mammography: A Simulation Study

ObjectiveTo conduct a simulation study to determine whether artificial intelligence (AI)-aided mammography reading can reduce unnecessary recalls while maintaining cancer detection ability in women recalled after mammography screening.Materials and MethodsA retrospective reader study was performed by screening mammographies of 793 women (mean age ± standard deviation, 50 ± 9 years) recalled to obtain supplemental mammographic views regarding screening mammography-detected abnormalities between January 2016 and December 2019 at two screening centers. Initial screening mammography examinations were interpreted by three dedicated breast radiologists sequentially, case by case, with and without AI aid, in a single session. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and recall rate for breast cancer diagnosis were obtained and compared between the two reading modes.ResultsFifty-four mammograms with cancer (35 invasive cancers and 19 ductal carcinomas in situ) and 739 mammograms with benign or negative findings were included. The reader-averaged AUC improved after AI aid, from 0.79 (95% confidence interval [CI], 0.74–0.85) to 0.89 (95% CI, 0.85–0.94) (p < 0.001). The reader-averaged specificities before and after AI aid were 41.9% (95% CI, 39.3%–44.5%) and 53.9% (95% CI, 50.9%–56.9%), respectively (p < 0.001). The reader-averaged sensitivity was not statistically different between AI-unaided and AI-aided readings: 89.5% (95% CI, 83.1%–95.9%) vs. 92.6% (95% CI, 86.2%–99.0%) (p = 0.053), although the sensitivities of the least experienced radiologists before and after AI aid were 79.6% (43 of 54 [95% CI, 66.5%–89.4%]) and 90.7% (49 of 54 [95% CI, 79.7%–96.9%]), respectively (p = 0.031). With AI aid, the reader-averaged recall rate decreased by from 60.4% (95% CI, 57.8%–62.9%) to 49.5% (95% CI, 46.5%–52.4%) (p < 0.001).ConclusionAI-aided reading reduced the number of recalls and improved the diagnostic performance in our simulation using women initially recalled for supplemental mammographic views after mammography screening.     

Mammography screening for breast cancer: Four years of nationwide screening in Finland

Biennial breast cancer screening with two-view screen-film mammography started on a nationwide basis in Finland in January 1987. Women have been invited by birth year cohort to attend a free-of-charge examination. The program has progressively expanded to include two or three new birth year cohorts yearly of women between 50 and 59 years of age. Participation has averaged 89% and the breast cancer detection rate has ranged from 3.8 to 3.3 per thousand compared with an expected annual incidence of breast cancer in this age group of 1.6 per thousand. The positive predictive value has increased from 33% to 53%. Results to date, collected by the radiologists responsible for each screening centre, indicate an acceptable sensitivity and specificity for the program. Specificity is much better than that which had generally been considered possible or practical. Double reading of all films, intensive training in both mammography and mammography screening, and careful evaluation of ongoing results by the radiologists involved are all believed to be important factors leading to a high sensitivity and specificity of mammography screening. Correspondence to: M. Pamilo     

Clinical Image Quality in Daily Practice of Breast Cancer Mammography Screening

Objective

To assess the quality of screening mammograms performed in daily practice in the Quebec Breast Cancer Screening Program.

Subjects and Methods

Clinical image quality of a random subsample of 197 screening mammograms performed in 2004-2005 was independently evaluated by 2 radiologists based on the criteria by Canadian Association of Radiologists (CAR). When disagreement occurred for overall judgement or positioning score, the mammograms were reviewed by a third radiologist. Cohen's kappas for interrater agreement were computed. Multivariable robust Poisson regression models were used to study associations of overall quality and positioning with body mass index (BMI) and breast density.

Results

The CAR criteria were not satisfied for 49.7% of the mammograms. Positioning was the quality attribute most often deficient, with 37.2% of mammograms failing positioning. Interrater agreement ranged from slight (kappa = 0.02 for compression and sharpness) to fair (kappa = 0.30 for exposure). For overall quality, women with a BMI ≥ 30 kg/m² had a failure proportion of 67.5% compared with 34.9% for women with a BMI<25 kg/m² (risk ratio 2.1 [95% confidence interval, 1.5-3.0]). For positioning, women with a BMI ≥ 30 kg/m² had a failure proportion of 53.8% compared with 27.9% for women with a BMI < 25 kg/m² (risk ratio 1.9 [95% confidence interval, 1.2-3.1]). Effects of breast density on image quality differed among radiologists.

Conclusion

Despite measures to ensure high-quality imaging, including CAR accreditation, approximately half of this random sample of screening mammograms failed the CAR quality standards. It would be important to define quality targets for screening mammograms carried out in daily practice to interpret such observations.     

乳腺癌钼靶X线表现与癌组织骨桥蛋白、骨连接蛋白表达的相关性研究

目的 检测骨桥蛋白（OPN）、骨连接蛋白（ON）在乳腺癌组织中的表达,探讨二者与乳腺癌钼靶X线征象的关系。资料与方法 采用免疫组织化学S-P法检测61例浸润性乳腺癌、8例导管内乳头状瘤和21例乳腺纤维腺瘤组织中OPN、ON的表达,并分析与钼靶X线表现及临床病理的关系。结果 61例乳腺癌组织OPN、ON高表达率分别为72．13％和77．05％,明显高于乳腺良性肿瘤（x^2=6．310,x^2=13．126,P〈0．05）;钙化组乳腺癌OPN、ON高表达率分别为87．50％和91．67％,与无钙化组比较,有显著性差异（x^2=4．649,x^2=4．781,P〈0．05）;钼靶片中肿块表现、毛刺征和腋下淋巴结转移及其他各项临床病理表现与OPN、ON高表达均无统计学意义（P〉0．05）。结论 OPN、ON在乳腺癌组织中高表达,钼靶X线表现在一定程度上反映了肿瘤组织中OPN、ON的表达水平,对评估乳腺癌生物学行为和预后具有一定的参考价值。     

乳腺肿块的钼靶,超声和立体定位穿刺与病理的对照研究

目的：应用钼靶、超声和立体定位穿刺与病理对照研究来估价检测乳腺癌的敏感性和特异性。材料与方法：７３例乳腺肿块患者均行两则乳腺钼靶、超声检查，再对肿块行立体定位穿刺，作细胞学检查。结果：在７３例乳腺肿块患者中，Ｘ线钼靶摄片诊断乳腺癌４６例，敏感性为９０．４％；超声诊断乳腺癌４８例，准确率为８３％；立体定位穿刺诊断恶性病变５６例，敏感性为９７％，特异性为９３％，准确率为９５．９％，无假阳性。结论：钼靶     

全数字化乳腺X线摄影与传统乳腺X线摄影对比分析

目的:探讨全数字化乳腺X线摄影(FFDM)与传统乳腺X线摄影(SFM)的临床应用效果.方法:回顾分析使用传统乳腺X线机及使用全数字化乳腺机摄影各800例的影像及临床资料,分别统计两组病例的平均曝光次数、平均检查时间,同时对乳房各部分细微结构显示率进行评价,并将两组病例中经手术病理证实为乳腺癌病例的病理结果与术前X线诊断作对照.结果:SFM组平均曝光次数5.12次/人,平均检查时间20分钟/人;FFDM组平均曝光次数4.22次/人,平均检查时间6.3分钟/人.同时清晰显示乳房各部分微细结构显示率为SFM组284例(35.5%);FFDM组791例(98.9%).SFM与FFDM诊断乳腺癌的敏感度、特异度、准确度分别为80.2%时87.5%;79.8%对85.2%;81.3%对88.5%.结论:与传统乳腺X线摄影对比,全数字化乳腺X线摄影操作简单,成像快捷,图像质量好,在乳腺癌(尤其是早期乳癌)诊断方面优于传统乳腺X线摄影.     

乳腺癌腋窝淋巴结的乳腺X线摄影评价

目的探讨乳腺X线摄影对判断乳腺癌腋窝淋巴结有无转移的价值。资料与方法搜集39例乳腺癌患者根治术后422枚腋窝淋巴结,用数字乳腺X线机对每例患者根治术后的腋窝淋巴结按大小顺序编号后行乳腺X线摄影,然后逐一行组织病理学检查,分析淋巴结的影像学表现并与其病理结果对照。结果转移淋巴结114枚,非转移淋巴结308枚。淋巴结长径≥12 mm时,两者分别为60枚、92枚;淋巴结短径≥8 mm时,两者分别为73枚、103枚;长×短径值≥130 mm2时,两者分别为66枚、52枚。两者类圆形分别为10枚、41枚;类椭圆形分别为42枚、133枚;不规则形分别为62枚、134枚。淋巴结内有脂肪密度者24枚、202枚;淋巴结有融合者分别为41枚、10枚。结论两组淋巴结在长径、短径、长×短径值、密度及有无融合方面经χ2检验差异有统计学意义,形状方面差异无统计学意义。乳腺X线摄影对判断乳腺癌腋窝淋巴有无结转移有一定价值。但在实际工作中,对临床指导意义有限。