常规MRI图像纹理分析对颞叶癫痫海马硬化的诊断价值

目的探讨常规MRI图像纹理分析对颞叶癫痫海马硬化的诊断价值。材料与方法应用Mazda软件分析22例病理证实为颞叶癫痫海马硬化患者的术前斜冠状位海马T2 FLAIR图像纹理。采用3种特征选择方法[Fisher系数(fisher coefficient,Fisher)、分类错误概率联合平均相关系数(classification error probability combined with average correlation coefficients,POE+ACC)、交互信息(mutual information,MI),3种方法联合简称为FPM]提取患者双侧海马的纹理特征;4种统计方法[线性判别分析(linear discriminant analysis,LDA)、非线性判别分析(nonlinear discriminant analysis,NDA)、原始数据分析(raw data analysis,RDA)、主要成分分析(principal component analysis,PCA)]判别患者海马硬化侧与正常侧,结果以错判率表示。同时由2名影像医师对22例患者的MR图像进行诊断。比较两种判断结果的差异。结果采用FPM选择方法及NDA统计学方法误判率最小(2/44,4.55%),较影像医师的错判率(11/44,25%)低,差异有统计学意义(P0.05)。结论常规MRI纹理分析可为颞叶癫痫海马硬化的诊断提供可靠的客观依据。     

低剂量CT对亚实性肺腺癌结节影像分期的研究

目的:评价低剂量CT(low-dose CT,LDCT)在孤立性亚实性肺腺癌结节影像分期中的价值。方法:搜集LDCT筛查发现并经病理学检查证实的亚实性肺腺癌结节53例,其中男性19例,女性34例,平均年龄55岁。采用Kappa检验回顾性分析影像与病理分期的一致性,以及不同胸部影像科医师之间影像分期的一致性。结果:LDCT对亚实性肺腺癌结节影像T和N分期的准确率分别为88.7%(47/53)和94.3%(50/53)。影像与病理分期及不同胸部影像科医师之间影像分期的一致性良好(Kappa=0.803,0.733;P0.05)。结论:亚实性肺腺癌结节多为早期肺癌,淋巴结或远处转移发生率低, LDCT适用于其术前影像分期。     

高分辨率多层螺旋 CT 在孤立性肺结节定性中的诊断分析

目的：探讨高分辨率多层螺旋 CT 在孤立性肺结节定性中的诊断价值。 方法：回顾性分析 2020 年 1~12 月 90 例孤立性 肺结节患者临床资料,全部患者均接受高分辨率多层螺旋 CT 检查与病理检查,观察孤立性肺结节的高分辨率多层螺旋 CT 影像 表现,以病理检查结果为“金标准”,分析高分辨率多层螺旋 CT 在孤立性肺结节定性诊断中的价值。 结果： 90 例孤立性肺结节患者 中,恶性 28 例,占比 31.11% ,良性 62 例,占比 68.89% ;恶性病变中,腺癌占比最高,为 13.33% ;高分辨率多层螺旋 CT 对孤立性肺 结节良恶性鉴别的灵敏度为 92.86% （ 26/28 ）、特异度为 93.55% （ 58/62 ）、准确度为 93.33% （ 84/90 ）、阴性预测值为 96.67%(58/60) 、阳 性预测值为 86.67% （ 26/30 ）,均较高。 结论：高分辨率多层螺旋 CT 对良恶性孤立性肺结节诊断的影像学表现有一定差异,用于孤 立性肺结节良恶性的鉴别诊断有一定价值,鉴别良恶性的效能较高,可为术前评估与手术方案拟定提供指导。     

孤立性肺部分实性结节CT影像表现与肺腺癌病理亚型对照分析

目的:对比分析孤立性肺部分实性结节C T影像表现与病理在临床诊断中的作用.方法:对2019年7月—2021年6月内江市第一人民医院诊疗的74例孤立性肺部分实性结节患者的C T影像及病理资料进行回顾性分析.经肺肿瘤新分类标准分为浸润前病变(15例)、微浸润腺癌(21例)及浸润性腺癌(38例).比较不同病理亚型孤立性肺部分...     

76例孤立性结核瘤CT误诊为肺癌的影像分析

肺内孤立性结节的诊断与鉴别诊断是临床经常遇到的难题,近年来,随着多排螺旋CT和高分辨率CT技术的进展,发现肺内孤立性结节呈上升趋势。作者2005年至2012年回顾性分析76例孤立肺结节结核瘤CT误诊肺癌的影像分析,以边缘不规则分叶状且有显著强化大结节型孤立肺结节结核瘤容易误诊,通过分析,以提高孤立肺结节结核瘤CT诊断。报道如下。     

CT三维重建技术对肺内孤立性结节的诊断价值

肺内孤立性结节的诊断及鉴别诊断一直是胸部影像学的重点和难点,充分显示其特征是诊断的关键。影像检查中常见的病变,因其缺乏典型的影像特征,以及影像检查设备的局限性和检查者体位与扫描方法的影响使其容易漏诊,尤以≤3 cm结节为甚。近年来随着CT三维重建技术的改革和发展,让很多学者对肺内孤立性结节的诊断和鉴别诊断有了进一步飞跃认识。通过多层螺旋CT(MSCT)三维后处理技术(VR、MPR、CPR、MIP、SSD等方法)对肺内孤立性结节进行三维回顾性的重建,能够清晰地显示病灶的分叶征、空气支气管征、毛刺征、空泡征、血管集束征、棘突征、胸膜凹陷征等征象,为肺内孤立结节的定位、定性提供了更可靠的依据。     

螺旋CT与高分辨率CT扫描在孤立性肺结节诊断中的应用价值对比

目的:探究分析16排螺旋CT与高分辨率CT(High Resolution CT,HRCT)扫描在孤立性肺结节诊断中的应用价值。方法:选择于2021年5月至2023年5月期间,在我院行CT检查的孤立性肺结节患者作为分析对象,共66例。所有受检者均进行16排螺旋CT检查和HRCT检查。以手术病理结果作为诊断“金标准”,对比分析16排螺旋CT和HRCT的影像学征象、两种检查方法的诊断效能。结果:经手术病理诊断,阴性(良性结节)患者共26例,阳性(恶性肿瘤)患者共40例。16排螺旋CT和HRCT检查方法在分叶征、钙化征、胸膜凹陷征、空泡征、气泡征、短毛刺征、血管集束征中的检查率比较存在显著性差异(P<0.05);以手术病理结果为“金标准”,HRCT检查的诊断效能,包括灵敏度、特异性、准确率、阳性预测值、阴性预测值、Kappa值均高于16排多层螺旋CT诊断。结论:16排螺旋CT与高分辨率CT扫描在孤立性肺结节诊断中均有一定的诊断价值,与常规螺旋CT相比,高分辨率CT的诊断效能更高,为后续临床治疗能提供更有力的参考依据。     

影像组学在甲状腺结节良恶性鉴别中的应用研究

目的:探讨影像组学在甲状腺结节良恶性鉴别中的应用价值。方法:回顾性分析我院经病理证实的90例甲状腺结节患者,其中良性结节45例,恶性结节45例。入选的病例都有完整的病理检查结果及在我院行双能量CT扫描。应用纹理分析软件MaZad对甲状腺CT扫描的静脉期图像进行分析,在结节最大层面手动勾画感兴趣区(ROI),通过分析得出300多个纹理参数。对所得出的纹理参数使用Fisher系数、分类误差概率与平均相关系数(POE+ACC)及互信息(MI)等三种降维方式进行处理,得到10个鉴别最佳的纹理参数。采用MaZad自带的B11软件进行纹理参数的判别,对每种降维方式分别进行原始数据分析(RDA)、主成分分析(PCA)、线性判别分析(LDA)及非线性判别分析(NDA)等四种分析,分别获得不同模型对甲状腺结节鉴别诊断的准确度、特异度和灵敏度。结果:在三种降维方法中相关度 S(2,-2)都被筛选出来,其中Fisher/NDA诊断效能最佳,灵敏度为89.36%;预测准确率为 91.11%。而特异度最高的是MI/NDA法,为97.05%。结论:利用影像组学的方法可以可靠的鉴别出CT双能量扫描中甲状腺结节的良恶性,为临床进一步的诊断和治疗提供帮助。     

MRI纹理分析鉴别诊断肝硬化背景下小肝癌与增生结节

目的 探讨常规MRI纹理分析鉴别诊断肝硬化背景下小肝癌与增生结节的价值。方法 回顾分析经病理证实的33例小肝癌和19例肝增生结节患者的MRI资料。采用MaZda软件手工勾画ROI,提取T1WI、T2WI、频率选择性预脉冲脂肪抑制T2WI及T1WI增强扫描图像中病变的纹理特征。通过Fisher系数、分类错误概率联合平均相关系数（POE+ACC）、交互信息（MI）及三者联合（FPM）的方法选择最佳纹理参数集合。使用原始数据分析（RDA）、主要成分分析（PCA）、线性判别分析（LDA）和非线性判别分析（NDA）进行纹理分类。同时由2名MRI诊断医师共同评估所有影像学资料。比较纹理分析与医师鉴别诊断两种病变结果的差异。结果 52例中,共60个病灶。鉴别小肝癌与增生结节的纹理特征主要来自T2WI,误判率最小为8.33%（5/60）。纹理特征选择方法中,FPM的误判率（8.33%~26.67%）均低于MI （20.00%~38.33%）、Fisher （18.33%~41.67%）和POE+ACC （8.33%~40.00%）。纹理特征分类方法中,NDA判别两种病变的误判率（8.33%~20.00%）均低于RDA （26.67%~41.67%）、PCA （28.33%~43.33%）和LDA （21.67%~45.00%）。影像医师的误判率为23.33%（14/60）,高于采用纹理分析鉴别两种病变的误判率（5/60,8.33%;χ²=58.73,P=0.002）。结论 常规MRI纹理分析可用于鉴别肝硬化背景下小肝癌与增生结节。     

肺部孤立性肿块的CT诊断

肺部孤立性肿块(或)结节是指肺内单个边缘相对光整的圆形(或)类圆形病灶,是胸部放射线检查中最常见的病变之一,定性诊断比较困难.本研究主要探讨有关病灶螺旋CT的影像诊断价值.     

多层螺旋CT对血管集束征显示及对周围型肺癌的诊断

目的:探讨多层螺旋CT对血管集束征的显示及对周围型肺癌的诊断价值。方法:对58例周围型肺癌和18例其他孤立肺结节行多层螺旋CT平扫及增强,然后按层厚1.25mm重组,并按血管走行方向作多平面重组,重点观察肿块外周血管集束征的CT表现。结果:血管集束征在周围型肺癌的出现率为94.8((55/58)比其他孤立肺结节50%(9/18)高。结论:多层螺旋CT扫描后薄层重组结合多平面重组能良好地显示血管与肿瘤的关系,血管集束征对周围型肺癌有诊断价值。     

常规MRI纹理分析鉴别诊断眼眶淋巴瘤与炎性假瘤

目的 探讨常规MRI纹理分析在眼眶淋巴瘤和炎性假瘤鉴别诊断中的应用价值。方法 回顾性分析经病理或治疗随访证实的15例眼眶淋巴瘤及17例炎性假瘤患者的MRI资料。应用MaZda软件手工勾画ROI,并提取T1WI、脂肪抑制T2WI及脂肪抑制T1WI增强扫描图像中病变的纹理特征。通过Fisher系数、分类错误概率联合平均相关系数（POE+ACC）、交互信息（MI）及三者联合（FPM）的方法选择最佳纹理参数集合。使用线性判别分析（LDA）和非线性判别分析（NDA）进行纹理分类。比较最佳分类序列上两种病变的纹理特征差异。结果 T1WI及T2WI最佳纹理参数主要源于共生矩阵及游程矩阵,增强T1WI最佳纹理参数主要源于共生矩阵及直方图。T2WI纹理特征鉴别眼眶淋巴瘤及炎性假瘤能力最佳,其中FPM选择纹理特征联合NDA分类的误判率最低,为1.56%。眼眶淋巴瘤T2WI纹理特征参数中的能量及长游程补偿均高于炎性假瘤（P均<0.005）,而熵及短游程补偿均低于炎性假瘤（P均<0.005）。结论 常规MR图像纹理分析可用于鉴别眼眶淋巴瘤和炎性假瘤。     

CT平扫图像纹理分析鉴别浸润性肺腺癌与非钙化结核球

目的 探讨基于CT平扫图像纹理分析鉴别诊断浸润性肺腺癌与非钙化结核球的可行性。方法 回顾性分析52例经病理证实的单发肺结节患者的平扫CT资料，其中31例浸润性肺腺癌，21例非钙化结核球。采用MaZda软件于2种病灶各提取300个纹理特征，之后以费希尔参数法（Fisher）、最小分类误差与最小平均相关系数法（POE+ACC）、相关信息测度法（MI）分别筛选出10个最佳纹理特征，并将其合并得到3种方法联合的最佳纹理特征组合（MPF）。采用线性判别分析（LDA）和非线性判别分析（NDA）对4组最佳纹理特征进行分类，LDA及NDA分别以K-近邻分类器（K-NN）及人工神经网络（ANN）进行分类。分析4组纹理特征鉴别2种病变的最小错误率，比较2组病变间30个最佳纹理特征的差异，并绘制其鉴别2种病变的ROC曲线，计算AUC，评价其诊断效能。结果 对于单组最佳纹理特征，NDA/ANN-Fisher法的错误率最低，为7.69%（4/52）；对于MPF，NDA/ANN-MPF法的错误率最低，为5.77%（3/52）；而NDA/ANN-Fisher法的错误率与NDA/ANN-MPF法差异无统计学意义（χ²=0.15，P>0.05）。2种病变间存在10个纹理特征差异有统计学意义，其中差异熵S（1，1）、差方差S（1，1）及梯度方差的诊断效能较好（AUC=0.71、0.71、0.70），3者间AUC差异无统计学意义（P均>0.05）。结论 基于CT平扫图像纹理分析可较好地区分浸润性肺腺癌和非钙化肺结核球，为鉴别诊断提供可靠的客观依据。     

An integrated approach to evaluation of the solitary pulmonary nodule

In this article, we describe an integrated approach for detection and evaluation of solitary pulmonary nodules. Initial evaluation of the solitary pulmonary nodule includes tomography, fluoroscopy, and comparison with previously obtained roentgenograms. Subsequently, thin-section computed tomography and phantom densitometry can be used for analysis, if indicated. The rationale for the use of computed tomography in the radiologic staging of bronchogenic carcinoma is to expedite and assist in the identification of the subset of patients with resectable tumors. For nonsurgical tissue diagnosis, fiberoptic bronchoscopy is generally the initial procedure for lesions 2.0 cm or larger in diameter, and transthoracic needle biopsy is used for those smaller than 2.0 cm.     

Focal eosinophilic infiltration of the liver: a mimick of hepatic metastasis

We present three cases of focal eosinophilic infiltration in the liver that mimicked hepatic malignancy on computed tomography during hepatic arteriography (CTHA) and computed tomography during arterial portography (CTAP). In all patients, focal eosinophilic liver infiltration appeared as a solitary nodule or as two nodules without hepatosplenomegaly and showed homogeneous hyperattenuation on CTHA and hypoattenuation on CTAP. Received: 10 June 1998/Revision accepted: 26 August 1998     

Fluorine-18 fluorodeoxyglucose positron emission tomography in the management of solitary pulmonary nodule: a review

Solitary pulmonary nodules are common radiologic findings and their detection has increased due to the introduction and improvement of diagnostics. Since a nodule can be an expression of early lung cancers, a proper classification and management are required because its treatment might lead to decreased morbidity and mortality. In this regard, prominent guidelines are available although they are characterized sometimes by discordant and misleading evidences. Furthermore, the same results of studies in the literature appear conflicting. Aim of this work is to evaluate the role of imaging through an extensive literature review but focusing on 18-fluorine fluorodeoxyglucose positron emission tomography combined with computed tomography (¹⁸F-FDG-PET/CT) in order to assess the limits and future perspectives of solitary pulmonary nodule characterization in early detection of lung cancer.

• Key messages

• Detection of solitary pulmonary nodules has increased.

• Management of solitary pulmonary nodules is still debated.

• Future perspectives of early solitary pulmonary nodule characterization.

     

Automatic detection of subsolid pulmonary nodules in thoracic computed tomography images

Subsolid pulmonary nodules occur less often than solid pulmonary nodules, but show a much higher malignancy rate. Therefore, accurate detection of this type of pulmonary nodules is crucial. In this work, a computer-aided detection (CAD) system for subsolid nodules in computed tomography images is presented and evaluated on a large data set from a multi-center lung cancer screening trial. The paper describes the different components of the CAD system and presents experiments to optimize the performance of the proposed CAD system. A rich set of 128 features is defined for subsolid nodule candidates. In addition to previously used intensity, shape and texture features, a novel set of context features is introduced. Experiments show that these features significantly improve the classification performance. Optimization and training of the CAD system is performed on a large training set from one site of a lung cancer screening trial. Performance analysis on an independent test from another site of the trial shows that the proposed system reaches a sensitivity of 80% at an average of only 1.0 false positive detections per scan. A retrospective analysis of the output of the CAD system by an experienced thoracic radiologist shows that the CAD system is able to find subsolid nodules which were not contained in the screening database.     

Clinicoradiological features of pulmonary infarctions mimicking lung cancer

OBJECTIVE: To describe presenting features of pulmonary infarction that may simulate those of lung cancer. PATIENTS AND METHODS: We reviewed the medical records of 43 patients with pulmonary infarction diagnosed by surgical lung biopsy at the Mayo Clinic in Rochester, Minn, from January 1, 1996, to December 31, 2002. Of 16 patients presenting with an undiagnosed solitary pulmonary nodule or mass, 6 had features suggestive of lung cancer on additional imaging, including abnormalities on contrast-enhancement computed tomography (CT), positron emission tomography (PET), or nonsurgical lung biopsy before surgical resection. We examined the presenting symptoms, epidemiological, clinical, and radiological features, and clinical course of these 6 patients. RESULTS: All 6 patients, ranging in age from 41 to 85 years, had a history of smoking and underlying cardiopulmonary disease. In 5 of the 6 patients, CT showed a nodule in the subpleural region of the lung. Three patients had abnormalities on contrast-enhancement CT, 2 had abnormalities on PET, and 1 had abnormal cytologic findings on a transthoracic needle biopsy of the lung; all these studies showed abnormalities suggestive of lung cancer. Surgical resection of the nodule or mass revealed pulmonary infarction associated with organizing thrombi in all 6 patients. CONCLUSIONS: Pulmonary infarctions can closely mimic the clinicoradiological characteristics of lung cancer, an association not reported previously. Furthermore, cytologic changes that occur in pulmonary infarctions may produce malignant-appearing cells on needle biopsy of the lung. The possibility of pulmonary infarction should be considered in the differential diagnosis of a solitary lung nodule or mass located in the subpleural region, even in the absence of clinically recognized venous thromboembolism.     

The radiologic appearance of solitary pulmonary nodules and their cytologic-histologic correlation

In this article, we review the various causes of solitary pulmonary nodules. Based on the underlying histology, we attempt to account for the radiologic pattern associated with each. This includes features related to density, edge characteristics, and texture. Similarly, the radiologic appearance of the nodule can be helpful to the cytologist when interpreting cytological samples obtained through image guidance.