Fibro Touch瞬时弹性成像诊断慢性乙型肝炎合并肝癌患者肝纤维化程度应用研究

目的探讨Fibro Touch瞬时弹性成像技术在诊断慢性乙型肝炎合并肝癌患者肝纤维化程度中的应用价值。方法选取2015年5—8月第二军医大学附属东方肝胆外科医院收治的慢性乙型肝炎合并肝癌患者446例,其中,测试组288例,验证组158例。所有患者均根据病理标准诊断肝纤维化程度(S0~S4期);同时,术前接受Fibro Touch瞬时弹性成像检查,采用受试者工作特征曲线(ROC)评价Fibro Touch瞬时弹性成像技术诊断慢性乙型肝炎合并肝癌患者肝纤维化程度的敏感度与特异度。结果根据病理标准诊断,测试组患者中,肝纤维化程度S0期35例,S1期47例,S2期83例,S3期37例,S4期86例;验证组患者中,S0期27例,S1期18例,S2期45例,S3期16例,S4期53例。根据Fibro Touch瞬时弹性成像诊断,测试组中,无或轻度肝纤维化(S0/S1期)、明显肝纤维化(S2/S3/S4期)、严重肝纤维化(S3/S4期)及肝硬化(S4期)的ROC曲线下面积分别为0.89(95%可信区间0.85~0.93),0.86(95%可信区间0.82~0.90),0.84(95%可信区间0.80~0.88)及0.85(95%可信区间0.81~0.89);验证组中,则分别为0.94(95%可信区间0.90~0.97),0.91(95%可信区间0.86~0.95),0.87(95%可信区间0.81~0.92)及0.86(95%可信区间0.79~0.91)。测试组诊断≥S1期的敏感度与特异度分别为88.14(95%可信区间83.5~91.9)与77.14(95%可信区间59.9~89.6),验证组分别为84.96(95%可信区间77.7~90.6)与81.48(95%可信区间61.9~93.7);测试组诊断≥S2期的敏感度与特异度分别为82.04(95%可信区间76.1~87.0)与69.51(95%可信区间58.4~79.2),验证组分别为78.07(95%可信区间69.4~85.3)与86.96(95%可信区间73.7~95.1);测试组诊断≥S3期的敏感度与特异度分别为82.11(95%可信区间74.2~88.4)与66.06(95%可信区间58.3~73.2),验证组分别为79.71(95%可信区间68.3~88.4)与79.12(95%可信区间69.3~86.9);测试组诊断=S4期的敏感度与特异度分别为76.74(95%可信区间66.4~85.2)与72.28(95%可信区间65.6~78.3),验证组分别为71.70(95%可信区间57.7~83.2)与81.31(95%可信区间72.6~88.2)。结论 Fibro Touch瞬时弹性成像技术对诊断慢性乙型肝炎合并肝癌患者肝纤维化程度具有一定的准确性,可作为术前评估的参考。     

256层螺旋CT冠状动脉成像与冠状动脉造影对比分析

目的 探讨256层螺旋CT冠状动脉成像(CTA)在冠心病诊断中的价值并与冠状动脉造影(ICA)结果比较.资料与方法 回顾性分析93例临床疑似和诊断为冠心病患者的影像资料,行256层螺旋CTA和常规ICA.管腔狭窄程度≥50％作为明显狭窄的诊断结果,检查结果与常规ICA结果对比分析,共分析了93例患者的372支血管共1349个可评估血管节段,ICA共发现215处狭窄.采用受试者工作特征(ROC)曲线下面积(AUC)评价CTA相对于ICA诊断的准确性.结果 基于患者分析中,CTA对冠状动脉狭窄诊断的AUC为0.767(95％可信区间为0.578～0.956),敏感性为98.8％,特异性为54.5％,阳性预测值(PPV)为94.2％,阴性预测值(NPV)为85.7％;基于血管分析中,CTA对冠状动脉狭窄诊断的AUC为0.921(95％可信区间为0.888 ～0.954),敏感性为93.4％,特异性为90.8％,PPV为83.1％,NPV为96.6％;基于血管节段分析中,CTA对冠状动脉狭窄诊断的AUC为0.948(95％可信区间为0.927～0.969),敏感性为93.0％,特异性为96.6％,PPV为83.7％,NPV为98.6％.CTA对心率＞70次/min和心率≤70次/min患者的冠状动脉狭窄诊断的AUC分别为0.951(95％可信区间为0.929 ～ 0.974)和0.964(95％可信区间为0.927 ～1.000).结论 256层螺旋CTA作为无创的检查对血管狭窄诊断的敏感性高,有较高的预测价值;检查受心率影响较小,无需控制心率,可以作为冠心病患者早期筛查的可靠方法.     

CK和CK-MB在急性心肌梗死诊断中的价值探讨

目的探讨CK、CK-MB与CK-MB/CK在诊断急性心肌梗死（AMI）中的临界值。方法对2006年9月至2008年4月在苏州大学附属第一医院住院的612例次急性心肌梗死（AMI）患者和463例非急性心肌梗死患者,使用OLYMPUSAU5421生化分析仪,和日本第一化学株式会社生产的CK检测试剂对心肌酶（CK）及心肌酶同工酶（CK-MB）进行检测。采用回归分析研究CK、CK-MB以及CK-MB/CK的比值在诊断急性心肌梗死中的价值,并使用接受者工作特征曲线（ROC）分析CK、CK-MB两个指标在诊断急性心肌梗死的临界值。结果回归分析CK的预计值是0.0276,标准误为0.00189,卡方值为213.3050,P〈0.0001,标化预计值为21.0765;CK-MB的预计值是-4.6792,标准误为0.3298,卡方值为201.3519,P〈0.0001,标化预计值为-227.5;CK-MB/CK的预计值是0.0484,标准误为0.3282,卡方值为0.0217,P值0.8828,标化预计值为0.00534。ROC分析CK曲线下面积（AUC）为0.811,95%可信区间0.786～0.834,Z值为22.595,P值为0.0001,界值为148,敏感性为86.58,敏感性的95%的可信区间为83.1～89.6,特异性为64.38,特异性的95%的可信区间为60.4～68.2,阳性似然比为2.43,阳性似然比的95%的可信区间为2.3～2.6,阴性似然比为0.21,阴性似然比的95%的可信区间为0.2～0.3;CK-MBAUC为0.840,95%可信区间为0.816～0.861,Z值为26.578,P值为0.0001,界值为29.8;敏感性为76.89,敏感性的95%的可信区间为72.8～80.7,特异性为74.18,特异性的95%的可信区间为70.5～77.6,阳性似然比为2.98,阳性似然比的95%的可信区间为2.8～3.2,阴性似然比为0.31,阴性似然比的95%的可信区间为0.3～0.4;CK-MB/CK比值AUC为0.533,95%可信区间0.503～0.563,Z值为1.857,P值为0.0633。ROC分析结果两两相比为CK-MB诊断效能优于CK,有显著性差异。而CK-MB/CK比值无统计学意义。结论当CK〉148,和（或）CK-MB〉29.8时,诊断急性心肌梗死的敏感性和特异性最好,而CK-MB/CK的比值缺乏统计学意义。     

静脉肾盂造影和CT尿路造影对泌尿系统疾病诊断价值的比较研究

目的 评估静脉肾盂造影(IVP)和多层螺旋CT尿路造影(MSCTU)对泌尿系统疾病的诊断价值.方法 检索Cochrane图书馆、PubMed、OVID、Embase数据库1990～2008年公开发表的英文文献,以及中国期刊网1998～2008年的中文文献,按照Cochrane协作网推荐的诊断试验的纳入标准筛选文献,提取纳入研究的特征信息.对2种方法 进行异质性检验,并选择相应的效应模型对所有研究加权定量合并,计算汇总灵敏度和特异度及其95%可信区间.绘制汇总受试者工作特征曲线(SROC)并计算曲线下面积,进行敏感性分析.统计学分析采用Meta-Test和SPSS11.0软件.结果 按照纳入标准共获取文献13篇,其中有关MSCT诊断泌尿系统疾病者7篇,IVP为2篇,二者共同研究者4篇.2组研究均有异质性,但异质性均在允许范围内,按照随机效应模型对纳入文献行汇总分析.结果 显示, MSCTU与IVP扫描的汇总灵敏度和特异度及95%可信区间分别为0.95(0.93～0.96)/0.95(0.85～0.98)、0.94(0.91～0.96)/0.61(0.57～0.65);二者的SROC曲线下面积(%)分别为:98.88%和68.57%.结论 汇总分析MSCT平扫加尿路造影与IVP扫描诊断泌尿系统疾病的研究显示,前者的诊断价值明显高于后者.     

癫痫持续状态严重程度评分量表判断癫痫持续状态患者生存情况Meta分析

目的探讨癫痫持续状态严重程度评分量表(STESS)判断癫痫持续状态(SE)患者生存情况的临床应用价值。方法检索Pub Med、EMBASE、中国生物医学文献数据库(CBM)、中文期刊全文数据库(CNKI),检索时间为2005年1月至2016年10月,收集关于STESS研究的相关文献。依据诊断试验文献质量评价标准(QUADAS)对纳入文献进行质量评价。采用Meta Disc 1.4和STATA 12.0软件进行Meta分析,计算合并灵敏度、特异度、诊断比值比(DOR)及95%可信区间,绘制合并受试者工作特征(SROC)曲线,计算曲线下面积(AUC),并进行亚组分析、敏感性分析及发表偏倚的评估。结果本研究共纳入8篇文献,包含9项研究,共计纳入1 029例患者。文献存在非阈值效应引起的异质性,采用随机效应模型计算STESS判断SE患者死亡的合并灵敏度和特异度分别为0.817(95%可信区间0.752～0.870)和0.527(95%可信区间0.492～0.561),其DOR为4.822(95%可信区间2.936～7.918);SROC-AUC为0.740。结论 STESS对于诊断SE患者生存情况具有中等度效能,可以作为重要参考,但仍需要更大样本更高质量研究验证。     

MRI和超声对产前胎盘植入诊断价值的Meta分析

目的通过Meta分析对MRI和超声对产前胎盘植入的诊断价值进行系统评价。方法检索PubMed、Web of Science、EMBASE、Cochrane图书馆、中国生物医学文献数据库、中国知网、维普、万方数据库中建库至2018年7月8日公开发表的有关MRI和超声对产前胎盘植入诊断研究的中、英文文献。对纳入文献进行数据提取和质量评估后,采用Stata15.1统计软件进行随机效应模型的Meta分析。计算所纳入研究的合并敏感度、合并特异度、合并阳性似然比、合并阴性似然比、合并诊断比值比以及相对应的95%可信区间(CI),绘制森林图和合并受试者操作特征(SROC)曲线,并计算SROC曲线下面积(AUC)。采用I2评估研究之间的统计学异质性。结果共纳入30项研究,总样本病例数2 266例。MRI对产前胎盘植入诊断的合并敏感度、合并特异度、合并阳性似然比、合并阴性似然比、合并诊断比值比、AUC分别为0.83(95%CI:0.79～0.87)、0.90(95%CI:0.84～0.94)、8.6(95%CI:5.2～14.2)、0.18(95%CI:0.14～0.24)、47(95%CI:24～91)、0.91(0.88～0.93)。US的上述相应的诊断指标值分别为0.81(95%CI:0.76～0.85)、0.88(95%CI:0.82～0.92)、6.6(95%CI:4.5～9.8)、0.22(95%CI:0.17～0.28)、31(95%CI:18～52)、0.90(0.87～0.92)。MRI和US诊断的敏感度和特异度均有较高异质性(I~2均50%,P均0.001)。Deek漏斗图提示存在发表偏倚(MRI,P=0.021;US,P=0.049)。结论 MRI对产前胎盘植入的诊断价值略高于超声,是其临床评估的一种有效且无创的检查方法。     

静音MR血管成像在颅内动脉瘤诊断中的可行性研究

目的 对比性评估静音MRA的图像质量以及诊断效价,探讨静音MRA在颅内动脉瘤病变诊断中的可行性。方法 前瞻性收集2015年12月至2018年12月于江苏省苏北人民医院诊断疑似脑血管病变患者27例,共有动脉瘤病灶32个。所有病例于CTA检查前同日行3.0 T MRI扫描。两名神经放射医师采用双盲法分别对静音MRA及时间飞跃法(TOF)MRA图像质量(信号均匀度、病灶显著性、静脉信号或干扰以及诊断可信度4个方面)进行评估(采用四分法)。定量测量脑动脉瘤瘤体长径值,并根据动脉瘤长径将动脉瘤分为微小动脉瘤组(长径≤3 mm)和较大动脉瘤组(长径>3 mm)。两种MRA图像质量评分差异比较分别采用Wilcoxon秩和检验。采用组内相关系数(ICC)检验分别评估两种MRA与CTA间测量结果的一致性。结果 32个颅内动脉瘤病灶中,静音MRA和TOF MRA图像的信号均匀度分别为3.38±0.49、3.00±0.62,静脉信号/干扰分别为3.77±0.42、2.65±0.48,两者比较差异具有统计学意义(Z=-2.21,P=0.02;Z=-5.69,P=0.01)。静音MRA和TOF MRA图像的病灶显著性分别为3.19±0.56、3.15±0.46,诊断可信度分别为3.27±0.44、3.12±0.51,两者比较差异无统计学意义(P均>0.05)。关于动脉瘤长径的测量,微小动脉瘤组内静音MRA测量结果与CTA结果之间呈极高度一致,ICC (95%可信区间)为0.94(0.82~0.98),TOF MRA测量结果与CTA结果之间呈高度一致,ICC(95%可信区间)为0.72 (0.30~0.91);较大动脉瘤组内,静音MRA、TOF MRA测量结果与CTA结果之间均呈极高度一致,ICC (95%可信区间)分别为0.98 (0.95~0.99)、0.95(0.87~0.98)。结论 与TOF MRA相比,静音MRA可以提供更高的图像质量和准确率,且与CTA具有更高的一致性,有望进一步常规应用于临床。     

动态增强CT净增值鉴别孤立性肺结节的价值评价

目的:应用Meta分析方法对动态增强CT扫描中以净增CT值鉴别诊断孤立性肺结节(SPNs)良恶性的价值进行评价。方法:检索Cochrane图书馆,PUBMED/MEDLINE、EMBASE、OVID、SPRINGLINK数据库(1990年1月~2006年12月)以及中国期刊网(CNKI,1994年1月~2006年12月)的英文和中文文献,筛选出与动态增强CT扫描SPNs有关的文献。采用Meta-Test 0.9软件对数据进行分析,计算汇总灵敏度、特异度及其95%可信区间,绘制出汇总受试者工作特征曲线(SROC),计算曲线下面积,评价动态增强CT扫描对SPNs的诊断价值。结果:按照制定标准共筛选出文献13篇。以动态增强扫描后SPNs净增CT值≥15HU诊断为恶性的汇总灵敏度、特异度及95%可信区间为0.96(0.93-0.98),0.56(0.50-0.62);SPNs净增CT值≥20HU诊断为恶性的汇总灵敏度、特异度及95%可信区间为0.95(0.90-0.98),0.65(0.56-0.74);两者的SROC曲线下面积分别为:0.9587,0.9584。结论:以动态增强扫描净增CT值方法对恶性SPNs诊断价值很高。以15HU和20HU分别作为诊断阈值时,两者诊断价值无明显差异(P=0.9964)。     

红细胞分布宽度、血小板计数与乳酸水平对慢加急性肝衰竭患者经血浆置换治疗预后评估价值

目的探讨红细胞分布宽度(RDW)、血小板计数(PLT)与乳酸(LA)对慢加急性肝衰竭(ACLF)患者经血浆置换治疗的预后评估价值。方法回顾性分析自2015年1月至2018年6月收治的确诊为ACLF的90例患者的临床资料。根据治疗结果将患者分为病死组(n=35)与存活组(n=55),比较两组患者的RDW、PLT及LA水平。对存活组患者进行6个月随访,通过受试者工作特征曲线(ROC)评估RDW、PLT及LA对ACLF患者接受血浆置换治疗后短期死亡的预测价值,采用Kaplan-Meier法、对数秩和检验进行生存分析。结果病死组患者RDW、LA水平高于存活组,PLT低于存活组,差异有统计学意义(P<0.05)。RDW、PLT及LA水平预测ACLF接受血浆置换治疗后短期死亡的曲线下面积分别为0.859(95%可信区间:0.775～0.908,P<0.05)、0.833(95%可信区间:0.704～0.888,P<0.05)、0.642(95%可信区间:0.500～0.778,P<0.05),对应的敏感度分别为77.9%、78.3%、63.8%,特异性分别为84.6%、83.2%、74.7%。联合三项指标的曲线下面积为0.903(95%可信区间:0.800～0.944,P<0.05),敏感度为85.5%,特异性为70.3%。生存分析结果表明,与低RDW组、高PLT组及低LA水平组比较,高RDW组、低PLT组及高LA组患者的存活率显著降低,生存时间显著缩短。结论 RDW、PLT及LA对ACLF患者接受血浆置换治疗后的短期死亡及长期预后均有较高的预测价值,且三者联合应用的预测效果优于单一指标应用。     

CT血管造影对颈动脉狭窄诊断价值的Meta分析

目的 评价CT血管造影（CTA）诊断颈动脉狭窄程度的准确性。方法 计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国生物医学文献数据库（CBM）、中国知网数据库（CNKI）、万方数据库、维普数据库（VIP）有关CTA诊断颈动脉狭窄的文献，检索时间为2000年1月至2022年12月，使用Stata 15.1统计分析软件进行Meta分析。结果 纳入15篇文献，共2 041支血管节段。Meta分析结果显示，CTA诊断颈动脉轻度狭窄的合并敏感度（Sen）、特异度（Spe）和AUC分别为0.93(95%CI:0.86～0.96)、0.98(95%CI:0.96～0.99)和0.99(95%CI:0.98～1.00); CTA诊断颈动脉中度狭窄的合并Sen、Spe和AUC分别为0.87(95%CI:0.80～0.92)、0.96(95%CI:0.94～0.98)和0.98(95%CI:0.96～0.99);CTA诊断颈动脉重度狭窄的合并Sen、Spe和AUC分别为0.92(95%CI:0.87～0.96)、0.98(95%CI:0.95～0....     

尿沉渣分析红细胞计数复检规则探讨

目的 探寻尿中红细胞计数可靠高效的实验检测方法 和规则.方法 以SY-slide计数池计数法为标准,比较Sysmex UF-1000i、迪瑞H-800及涂片镜检对同一份尿中RBC的检测结果,评价3种方法 对尿中RBC检测的优缺点.结果 迪瑞H-800干化学法检出阳性标本最多,但特异度较低;显微镜镜检检出率最低,但特异度最高;Sysmex UF-1000i的检出率、特异度和敏感度适中.结论 尿中RBC的检测应Sysmex UF-1000i、迪瑞H-800同时检测,同为阴性时可直接发送结果 （泌尿内外科患者及尿浑浊患者除外）;有一种或两种方法 为阳性的,都需镜检方可发出报告,结果 以镜检为准.必要时用SY-slide计数池计数进行校正.     

UF-500i尿沉渣分析仪细菌计数在指导临床送检尿培养中的作用

目的通过UF-500i全自动尿沉渣分析仪（简称UF-500i）对中段尿中的细菌进行定量分析,指导临床合理送检中段尿培养标本,合理使用抗生素。方法对700例新鲜中段尿标本做细菌培养菌落计数和UF-500i尿沉渣分析仪细菌计数进行比较。结果122例UF-500i细菌计数〉1000／μl时,细菌培养达到鉴定标准;569例细菌计数〈100／μl时,细菌培养无菌生长或仅有几个菌落生长,培养未达到鉴定标准。判为阴性;有9例细菌计数介于100～1000／μl时,细菌培养3例阳性,6例阴性。结论当UF-500i检测出细菌数〉1000／μl时可送检中段尿做细菌培养,以指导临床合理用药;UF-500i检测出细菌数〈100／μl时无需送检中段尿培养：而当UF-500i检测出细菌数介于100～1000／μl时,可根据临床和UF-500i的另一些参数如WBC（白细胞）、NIT（硝酸盐）和尿沉渣涂片革兰染色镜检细菌来决定是否需要培养。     

Statistical combination schemes of repeated diagnostic test data

RATIONALE AND OBJECTIVES: When diagnostic tests are repeated and combined, a number of schemes may be adopted. Guidelines for their interpretations are required. MATERIALS AND METHODS: Three combination schemes, "and" (A), "or" (O), and "majority" (M), are considered. To evaluate these schemes, dependency by specifying kappa values quantifying repeated test agreement was structured. In a pilot study, the combined accuracies of magnetic resonance imaging using six different pulse sequences of medial collateral ligaments of the elbows of 28 cadavers, with eight having lesions artificially created surgically, were examined. Images were evaluated simultaneously by using a five-point ordinal scale. For each pulse sequence, individuals for whom the diagnosis varied from once to three repetitions were considered. RESULTS: Scheme M improves diagnostic accuracy when sensitivity and specificity of a single test exceed 0.5, with maximal improvement at 0.79. Under scheme A, sensitivity decreases to 0.38-0.59. Under scheme O, sensitivity increases to 0.53-0.79. Scheme M yields a small improvement, reaching 0.50-0.71. Under scheme A, specificity increases to 0.95-0.98. Under scheme O, specificity decreases to 0.91-0.98. Scheme M also yields a small improvement, reaching 0.94-0.98. CONCLUSION: Scheme A is recommended for ruling in diagnoses, scheme O is recommended for ruling out diagnoses, and scheme M is neutral. Consequently, different schemes may be used to optimize the target diagnostic accuracy.     

MRI膀胱影像报告和数据系统诊断肌层浸润性膀胱癌的Meta分析

目的 通过Meta分析探讨MRI膀胱影像报告和数据系统（VI-RADS）对肌层浸润性膀胱癌（MIBC）的诊断效能。 方法 检索PubMed、Web of Science、Embase、Ebsco、中国生物医学文献数据库、中国知网、万方及维普数据库2018年1月1日—2020年4月11日有关VI-RADS诊断MIBC的中英文文献。对纳入文献进行数据提取和质量评估后,采用Stata15.1统计软件计算所纳入研究的合并敏感度、合并特异度、合并阳性似然比、合并阴性似然比及诊断比值比。绘制森林图和综合受试者操作特征（SROC）曲线,并计算相应曲线下面积（AUC）。采用I ²评估文献之间的异质性大小。采用回归分析和亚组分析探讨异质性来源。 结果 最终纳入12项国内外研究,包括1 508例病人（共1 624个病灶）。纳入研究的合并敏感度、合并特异度、合并阳性似然比、合并阴性似然比、诊断试验比值比及SROC曲线下面积分别为0.85（95%CI：0.81~0.88）、0.92（95%CI：0.89~0.94）、11.1（95%CI：8.0~15.2）、0.16（95%CI：0.13~0.21）、68（95%CI：44~106）及0.89（95%CI：0.85~0.91）。Meta回归分析显示,MRI场强（P=0.01）与诊断阈值（P=0.01）可能为异质性来源。亚组分析结果显示,使用3.0 T MR时VI-RADS诊断MIBC的合并敏感度及特异度均高于使用1.5 T或1.5 T/3.0 T MR。以VI-RADS≥3分为阈值诊断MIBC的合并敏感度高于VI-RADS≥4分,合并特异度则低于VI-RADS≥4分。Deek’s漏斗图提示纳入研究不存在明显发表偏倚（P=0.41）。 结论 MRI VI-RADS评分对MIBC的诊断具有较高的敏感度和特异度。     

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.     

Clinical features and gallium scan in the detection of post-surgical infection in the elderly

Common signs of infection, such as an elevated level of C-reactive protein (CRP), raised white blood cell (WBC) count and increased temperature, may not be present in elderly patients when infection occurs. In addition, these typical signs may be normal events during the postoperative period. Therefore, early detection of post-surgical infection may be difficult in the elderly population. In this study, we evaluated the usefulness of gallium scan in the detection of infection in elderly patients after colorectal surgery and compared it with CRP, WBC count and ear temperature (ET) examinations. Thirty-three patients undergoing colorectal surgery and aged over 60 years were enrolled in the study. All patients underwent a gallium scan and CRP, WBC and ET examinations. Of the 33 patients, 18 (54.5%) were diagnosed with infection. The diagnostic sensitivity was 100% for both gallium scan and the CRP test, but only 44.4% and 61.1% for the WBC count and ET, respectively. The diagnostic specificity of the gallium scan, WBC count and ET was 80% or more, whereas that of the CRP test was only 53.3%. The diagnostic accuracy of gallium scan, CRP test, WBC count and ET was 90.9%, 78.8%, 60.6% and 72.7%, respectively. In conclusion, both WBC and ET examinations show low sensitivity in the detection of infection in the elderly population after colorectal surgery. The CRP test has good sensitivity but low specificity. Of the four diagnostic modalities, gallium scan had the highest overall diagnostic accuracy (90.9%) while the WBC test had the lowest (60.6%).     

钼靶、超声和 MRI对乳腺肿块诊断价值的 Meta 分析

目的：应用 Meta 分析法评价钼靶、超声和磁共振成像(MRI)对乳腺肿块的诊断价值。方法中文文献主要从中国知网(CNKI)、中国生物医学文献数据库(CBM)及重庆维普(VIP)数据库中检索,英文文献主要从荷兰医学文摘(EMBASE OvidSP)、PubMed 及 The Cochrane Library 数据库中检索,检索乳腺肿块诊断中与钼靶、超声和 MRI 相关的文献,评价所有纳入研究的文献质量并提取相关信息,运用 Meta-disc 1.4软件进行 Meta 分析,将综合受试者工作特征曲线(SROC)图用 Review Manager 5.3软件绘制,并计算曲线下面积(AUC)。结果钼靶+超声+MRI 和 MRI 的诊断效能均明显比钼靶、超声高(P<0.05);是否依据 BI-RADS 诊断标准影响着钼靶研究异质性来源,患者的平均年龄影响着超声研究间异质性来源,各协变量均不会影响到 MRI 回归分析显示的研究间异质性来源;钼靶的敏感度76%(95%CI：0.73~0.79)、特异度72%(95%CI：0.69~0.75)、诊断比值比(DOR)为8.19(95%CI：5.27~12.75);超声的敏感度85%(95%CI：0.82~0.87)、特异度70%(95%CI：0.67~0.73)、DOR 为11.09(95%CI：6.10~20.16);MRI 的敏感度95%(95%CI：0.93~0.96)、特异度72%(95%CI：0.69~0.75)、DOR 为64.69(95%CI：27.67~152.48);SROC AUC：钼靶82.0%、超声88.5%、MRI 97.4%、钼靶+超声+MRI 98.3%。结论钼靶、超声及 MRI 对乳腺肿块均有较高诊断价值,以钼靶+超声+MRI 3项联合对乳腺肿块诊断效能最高。     

Use of cross-sectional imaging in predicting surgical location of parotid neoplasms

OBJECTIVE: The purpose of this study was to determine the diagnostic accuracy of using the retromandibular vein as seen on cross-sectional imaging to help differentiate superficial lobe from deep lobe tumors. METHODS: Of the patients who had parotid neoplasms between January 1997 and July 2002, we were able to identify 44 patients with preoperative imaging studies that were available for evaluation. The films were reviewed by a single head and neck radiologist to determine whether the neoplasms involved the superficial, deep, or both lobes of the parotid gland (total). The lateral margin of the retromandibular vein was used as a marker for the facial nerve, since the nerve is not always visible on CT and MRI scans. The radiologist's findings were then compared with the findings during surgery. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of predicting the location of neoplasms were then calculated. RESULTS: For lesions in the superficial lobe, cross-sectional imaging was able to predict the location of the neoplasm with a sensitivity of 0.91 (95% CI, 0.70-0.98), specificity of 0.86 (95% CI, 0.63-0.96), PPV of 0.88 (95% CI, 0.67-0.97), and NPV of 0.90 (95% CI, 0.67-0.98). For lesions in both lobes (total), cross-sectional imaging was able to predict the location of the neoplasm with a sensitivity of 0.94 (95% CI, 0.68-0.99), specificity of 0.89 (95% CI, 0.71-0.97), PPV of 0.83 (95% CI, 0.58-0.96), and NPV of 0.96 (95% CI, 0.78-0.99). CONCLUSION: Use of the retromandibular vein as a marker for the facial nerve is a sensitive method for identifying the location of parotid gland neoplasms on cross-sectional imaging. This supports the accuracy of using preoperative imaging to detect the position of parotid neoplasms with respect to the facial nerve.     

甲状腺微小乳头状癌多种CT征象的多因素分析

目的探讨多种CT征象在甲状腺微小乳头状癌(PTMC)诊断中的价值。方法回顾性分析经组织病理学证实的231例249枚PTMC以及与同期直径≤1.0 cm的205例266枚微小结节性甲状腺肿(MNG)的CT征象(包括结节形态、咬饼征、微钙化及增强后范围缩小/模糊),通过多因素Logistic回归分析对4种CT征象进行统计分析,并计算不同阳性CT征象及其联合在PTMC诊断中的敏感度和特异度。结果多因素Logistic回归分析显示结节形态不规则、咬饼征及增强后范围缩小/模糊更常见于PTMC中(P0.05),OR值分别为9.009(95%CI:4.709~17.236)、10.372(95%CI:5.495~19.579)和12.623(95%CI:6.910~23.057),微钙化在多因素分析中无统计学意义(P0.05)。3种阳性单一征象中,形态不规则敏感度最高(90.4%),咬饼征特异度最高(90.2%),两种联合征象中,结节形态不规则+增强后范围缩小/模糊的敏感度(81.9%)最高,结节形态不规则+咬饼征特异度(95.4%)最高,3种征象联合时,敏感度及特异度分别为59.4%、96.6%。结论结节形态不规则、咬饼征及增强后范围缩小/模糊在PTMC的诊断中具有重要价值,多种征象联合可以进一步提高PTMC诊断的特异度,从而减少误诊的发生。     

A meta-analysis of the accuracy of prostate cancer studies which use magnetic resonance spectroscopy as a diagnostic tool

OBJECTIVE: We aimed to do a meta-analysis of the existing literature to assess the accuracy of prostate cancer studies which use magnetic resonance spectroscopy (MRS) as a diagnostic tool. MATERIALS AND METHODS: Prospectively, independent, blind studies were selected from the Cochrane library, Pubmed, and other network databases. The criteria for inclusion and exclusion in this study referenced the criteria of diagnostic research published by the Cochrane center. The statistical analysis was adopted by using Meta-Test version 6.0. Using the homogeneity test, a statistical effect model was chosen to calculate different pooled weighted values of sensitivity, specificity, and the corresponding 95% confidence intervals (95% CI). The summary receiver operating characteristic (SROC) curves method was used to assess the results. RESULTS: We chose two cut-off values (0.75 and 0.86) as the diagnostic criteria for discriminating between benign and malignant. In the first diagnostic criterion, the pooled weighted sensitivity, specificity, and corresponding 95% CI (expressed as area under curve [AUC]) were 0.82 (0.73, 0.89), 0.68 (0.58, 0.76), and 83.4% (74.97, 91.83). In the second criterion, the pooled weighted sensitivity, specificity, and corresponding 95% CI were 0.64 (0.55, 0.72), 0.86 (0.79, 0.91) and 82.7% (68.73, 96.68). CONCLUSION: As a new method in the diagnostic of prostate cancer, MRS has a better applied value compared to other common modalities. Ultimately, large scale RCT (randomized controlled trial) randomized controlled trial studies are necessary to assess its clinical value.