超声造影及声辐射力脉冲成像技术对甲状腺结节的诊断价值

目的探讨超声造影(CEUS)及声辐射力脉冲成像技术(ARFI)对甲状腺良恶性结节的诊断价值。方法对88个甲状腺结节进行CEUS,分析其超声造影表现。并应用ARFI对甲状腺结节的硬度进行评估,获得结节内部及周边正常甲状腺组织的SWV值,通过绘制ROC曲线获得SWV值的曲线下面积及诊断界限值。评估各诊断方法的灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率。所有病例均经病理证实。结果 88个结节中恶性29个,良性59个。CEUS诊断甲状腺恶性结节的灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率分别为79.3%、91.5%、82.1%、90%、87.5%。以2.565 m/s作为诊断界限值,ARFI诊断甲状腺恶性结节的灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率分别为75.9%、94.9%、88.0%、88.9%、88.6%,AUC为0.878,CEUS与ARFI两种检查无统计学差异,但两者结合诊断甲状腺恶性结节的灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率分别为93.1%、89.8%、81.8%、96.3%、90.9%,分别高于CEUS及ARFI检查。结论 CEUS及ARFI对甲状腺良恶性结节有一定的鉴别诊断价值,二者联合可以提高诊断的符合率。     

两种成像方法在鉴别诊断甲状腺良恶性结节中的研究

将我院收治的123例甲状腺结节患者作为本次观察主体,对比其病理结果、超声弹性成像面积比值法(EIAR)与声脉冲辐射力成像(ARFI)的测量值、EIAR与ARFI的敏感性与特异性。149个结节中良、恶性结节分别为86与63个;良性结节与恶性结节的SWV与EIAR测量值差异较大(P<0.05);63个恶性结节中EIAR与ARFI的敏感性、特异性差异较大(P<0.05)。EIAR与ARFI对甲状腺良、恶性结节均具较高的诊断价值,可互为补充。     

声辐射力脉冲弹性成像在甲状腺单发实性结节良恶性鉴别诊断中的应用价值

目的探讨声辐射力脉冲弹性成像(ARFI)技术判断甲状腺单发实性结节良恶性的价值.方法选取2011年4月至2012年2月上海市第十人民医院经常规超声检查发现甲状腺单发实性或以实性为主(囊性<25%)结节的42例患者,共42个结节.对42例患者42个结节行常规超声检查,采用声触诊组织定量(VTQ)技术检测病灶组织剪切波速度(SWV),采用声触诊组织成像(VTI)技术对病灶组织进行VTI弹性分级.常规超声以符合3项及以上恶性结节超声表现、VTQ以SWV值≥2.87 m/s、VTI以VTI分级≥Ⅳ级、常规超声+VTI/VTQ以常规超声或VTI/VTQ其中之一诊断为恶性作为恶性结节诊断标准.以病理学诊断结果作为金标准,计算常规超声、VTQ、VTI及常规超声+VTI/VTQ诊断甲状腺恶性单发实性结节的敏感度、特异度、阳性预测值、阴性预测值.结果42个甲状腺结节经手术后病理证实良性结节30个(结节性甲状腺肿16个,腺瘤性甲状腺肿13个,亚急性甲状腺炎1个),恶性结节12个(均为乳头状癌).常规超声检查有3项及以上恶性结节超声表现的结节14个,包括良性结节4个,恶性结节10个;少于3项恶性结节超声表现的结节28个,包括良性结节26个,恶性结节2个.常规超声诊断甲状腺恶性单发实性结节的敏感度、特异度、阳性预测值、阴性预测值分别为83.3%(10/12)、86.7%(26/30)、71.4%(10/14)、92.9%(26/28). SWV值≥2.87 m/s的结节15个,包括良性结节5个,恶性结节10个;SWV值<2.87 m/s的结节27个,包括良性结节25个,恶性结节2个;VTQ诊断甲状腺恶性单发实性结节的敏感度、特异度、阳性预测值、阴性预测值分别为83.3%(10/12)、83.3%(25/30)、66.7%(10/15)、92.6%(25/27). VTI分级≥Ⅳ级的结节19个,包括良性结节8个,恶性结节11个;VTI分级<Ⅳ级的结节23个,包括良性结节22个,恶性结节1个;VTI诊断甲状腺恶性单发实性结节的敏感度、特异度、阳性预测值、阴性预测值分别为91.7%(11/12)、73.3%(22/30)、57.8%(11/19)、95.7%(22/23).常规超声+VTI诊断甲状腺恶性单发实性结节的敏感度、特异度、阳性预测值、阴性预测值分别为91.7%(11/12)、80.0%(24/30)、64.7%(11/17)、96.0%(24/25).而常规超声+VTQ诊断甲状腺恶性单发实性结节的敏感度、特异度、阳性预测值、阴性预测值分别为91.7%(11/12)、83.3%(25/30)、68.8%(11/16)、96.2%(25/26).结论单独的ARFI技术诊断甲状腺单发实性结节良恶性的能力并不优于常规超声,但是两者联合应用可提高甲状腺单发实性结节良恶性鉴别诊断水平.     

声脉冲辐射力弹性成像鉴别甲状腺结节良恶性的价值

目的探讨声脉冲辐射力(ARFI)弹性成像在甲状腺局灶性病变良恶性鉴别诊断中的价值。方法应用ARFI弹性成像声触诊组织定量(VTQ)技术检测甲状腺结节120个,记录结节的横向剪切波速度(SWV),并计算每个结节与其周围甲状腺组织的SWV比值。结果甲状腺良性和恶性结节的SWV平均值分别为(2.28±0.84)m/s(范围:0.61～9.00m/s)和(5.04±2.78)m/s(范围:2.32～9.00m/s)(P=0.000)。甲状腺良恶性病灶的SWV值分布情况有显著性差别。良性和恶性结节的病灶SWV与周围甲状腺组织的SWV比值平均值分别为1.14±0.42(范围:0.31～2.59)和2.39±1.43(范围:0.89～6.16)(P=0.000)。甲状腺良恶性病灶SWV与周围组织的SWV比值分布情况有显著性差别。将病灶SWV值及病灶SWV与周围组织的SWV比值用于鉴别甲状腺结节的良恶性,受试者工作特征曲线(ROC曲线)的曲线下面积(AUC)分别为0.849及0.806。结论 ARFI可反映甲状腺结节的弹性特征,对甲状腺结节的良恶性鉴别诊断有一定的帮助。     

声辐射力弹性成像对甲状腺恶性结节的诊断价值

目的探讨声辐射力弹性成像（ARFI）声触诊组织定量（VTQ）技术对甲状腺恶性结节的诊断价值。方法对62例甲状腺结节患者术前行常规超声检查、ARFI检查,记录甲状腺结节的剪切波速度（SWV）,以术后病理结果为金标准,绘制VTQ值诊断甲状腺恶性结节的ROC曲线;根据约登指数的最高临界点确定诊断界值,并计算该临界值下的敏感性、特异性和准确率。结果甲状腺良性结节SWV的平均值为（2.61±0.38）m/s,恶性结节SWV的平均值为（3.92±0.95）m/s,两者比较差异有统计学意义（P〈0.05）。ROC曲线诊断甲状腺良恶性结节的曲线下面积为0.903,95%CI：0.827～0.978,约登指数为0.643;当VTQ临界值为2.94 m/s时,VTQ技术诊断甲状腺恶性结节的敏感性、特异性、准确率分别为73.68%、90.63%、86.75%。结论 ARFI可以显著提高超声诊断甲状腺恶性结节的准确率,有较高的临床应用价值。     

声脉冲辐射力弹性成像联合常规超声对甲状腺良恶性结节的诊断应用

目的探讨声脉冲辐射力弹性成像(ARFI)联合常规超声对甲状腺良恶性结节的诊断应用。方法选择我院收治的接受甲状腺手术的患者130例,于术前同一时间分别接受ARFI和常规超声检查。所有患者均经手术病理证实。以手术病理结果作为金标准,分别计算ARFI、常规超声检查以及两者联合诊断甲状腺良恶性结节的真实性、可靠性以及收益评价,并分别建立ROC曲线评价系统,计算ROC曲线下面积(AUC)。结果常规超声诊断:灵敏度为80%、特异度为71.43%,可靠性:粗一致性为82.86%。收益评价:约登指数=(灵敏度+特异度)-1=51.43%;ARFI诊断:灵敏度为85%、特异度为85.71%,可靠性:粗一致性为85.14%。收益评价:约登指数为70.71%;两者联合诊断真实性:灵敏度为92.5%、特异度为89.29%;可靠性:粗一致性为91.89%。收益评价:约登指数为81.79%。联合诊断较常规超声和ARFI比较,真实性和可靠性明显提高,差异具有统计学意义(P0.05);以病理诊断为诊断"金标准",三组在甲状腺良恶性结节中的ROC曲线下面积分别为0.77、0.81、0.91。结论常规超声和ARFI均可用于鉴别诊断甲状腺良恶性结节,但两者联合诊断可明显提高真实性、可靠性以及收益评价,值得临床应用。     

声触诊组织成像定量技术鉴别诊断甲状腺结节良恶性的初步探讨

目的:评价声脉冲辐射力成像(acoustic radiation force impulse,ARFI)和声触诊组织成像定量(virtual touch tissue imaging quantification,VTIQ)剪切波弹性成像技术鉴别诊断甲状腺结节良恶性的应用价值。方法:对62例患者80个甲状腺结节分别行ARFI及VTIQ检查,测量病灶内部横向剪切波速度(shear wave velocity,SWV),以手术后病理学检查或经细针穿刺细胞学检查(fine needle aspiration cytology,FNAC)结果为金标准,绘制ARFI和VTIQ鉴别诊断甲状腺结节良恶性的受试者工作特征(receiver operating characteristic,ROC)曲线,并比较两曲线的曲线下面积(area under curve,AUC)。结果:80个甲状腺结节中恶性病灶有34个,良性病灶46个;ARFI和VTIQ测得的甲状腺恶性结节平均SWV均高于良性结节平均SWV,差异有统计学意义(P0.05)。VTIQ和ARFI鉴别诊断甲状腺结节良恶性的ROC曲线的曲线下面积(0.86 vs 0.77)差异有统计学意义(P0.05)。结论:与ARFI比较,VTIQ技术能明显提高甲状腺结节良恶性的鉴别诊断能力。     

超声弹性面积比值法与声脉冲辐射力成像鉴别诊断甲状腺结节的对比研究

目的 对比评价超声弹性成像面积比值法(EIAR)及声脉冲辐射力成像(ARFI)在鉴别诊断甲状腺良恶性结节中的价值.方法 对65例患者共78个甲状腺结节进行EIAR和ARFI检测,以病理结果为金标准,构建EIAR与ARFI鉴别诊断甲状腺结节良恶性的ROC曲线,分析两者曲线下面积,并比较其敏感性和特异性.结果 EIAE曲线下面积(0.840)与ARFI曲线下面积(0.856)差异无统计学意义(P＞0.05);以EIAR值≥1.23、ARFI测值≥3.18 m/s为诊断临界值,诊断甲状腺恶性结节的敏感性、特异性分别为71.4％、86％和85.7％、74.0％.结论 EIAR与ARFI技术鉴别诊断甲状腺良恶性结节的价值无明显差别,但均对甲状腺良恶性结节的鉴别诊断具有重要作用.     

声脉冲辐射力弹性成像技术在鉴别诊断甲状腺良、恶性结节中的作用

目的 探究声脉冲辐射力弹性成像技术（ARFI）在鉴别诊断甲状腺良、恶性结节中的作用。方法 选择2018年1月至2020年9月我院经穿刺活检或手术病理证实的甲状腺结节患者67例（82个甲状腺结节）,给予常规彩色多普勒超声检查与ARFI技术中的声触诊组织成像技术（VTI）和声触诊组织定量技术（VTQ）检查。比较VTI面积与二维（2D）超声图像结节面积比值（AR）、VTQ剪切波速度（SWV）及结节与周围正常甲状腺组织剪切波速度比值（R-SWV）3种方式鉴别甲状腺良、恶性结节结果的差异。结果 甲状腺恶性结节VTI显示图像较甲状腺良性结节更黑。甲状腺恶性结节的AR、SWV及R-SWV平均值较甲状腺良性结节明显增高（P<0.001）;AR、SWV、R-SWV诊断甲状腺恶性结节的Cut off值分别为1.47、2.12 m/s、1.30。结论 应用AFRI技术中的VTI、VTQ技术能定量、定性反映甲状腺结节的弹性成像特征,对甲状腺良、恶性结节具有一定的辅助诊断价值。     

声辐射力脉冲成像技术对乳腺肿块鉴别诊断价值的初步研究

目的 利用声辐射力脉冲成像技术(ARFI)测量剪切波速度(SWV)的方法定量评价正常乳腺组织及乳腺肿块的硬度,分析其对乳腺良、恶性肿块鉴别诊断的临床价值.方法 利用常规超声和ARFI技术对101例患者的正常乳腺组织及146枚肿块进行检查,测量正常乳腺组织及乳腺肿块的SWV值.对结果进行对比分析,鉴别诊断肿块良、恶性.结果 正常乳腺腺体组织的SWV值为(1.63±0.47) m/s,乳腺良性肿块的SWV值为(2.38±0.55) m/s,恶性肿块的SWV值为(7.34±1.76) m/s.正常乳腺组织、乳腺良性肿块及恶性肿块SWV值之间的差异有统计学意义(P＜0.05).以实性肿块中央部位SWV值为xxx m/s为诊断乳腺恶性肿瘤的标准,ARFI诊断乳腺恶性肿瘤的敏感性、特异性、准确度及阳性预测值分别为90.0％、100％、97.9％、100％.该标准结合BIRADS分类,诊断乳腺恶性肿瘤的敏感性、特异性、准确度及阳性预测值分别为100％、97.4％、98.6％、90.9％.结论 ARFI技术可定量评价组织硬度,结合常规超声检查可提高乳腺恶性肿瘤诊断的敏感度和准确度.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.