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中华解剖与临床杂志
中华解剖与临床杂志

苗华 周建生（执行）

双月刊

2095-7041

jpylc@byyfy.com.cn；3062505@163.com

0552-3062505

233004

安徽省蚌埠市长淮路287号

中华解剖与临床杂志/Journal Chinese Journal of Anatomy and ClinicsCSTPCD
查看更多>>本刊是由解剖学专家临床医学专家共同创办的跨学科学术期刊，以广大解剖与临床工作者为主要读者对象，以促进解剖与临床两大学科间的信息交流为宗旨，坚持基础与临床、理论与实践、普及与提高相结合的工作方针，面向临床，服务于临床。
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    四维自动左心房定量技术在慢性肾病患者左心房功能受损评估及敏感参数筛选中的临床应用

    李易颖陈勇杨菲包萍...
    73-82页
    查看更多>>摘要：目的 探讨四维自动左心房（左房）定量（4D Auto LAQ）分析技术在慢性肾脏病（CKD）患者的左房容积和应变功能改变评估中的作用，同时筛选出能够早期识别CKD患者左房功能受损的敏感参数。 方法 回顾性队列研究。选取2022年8月—2023年3月在大连医科大学扬州临床医学院肾内科住院治疗的、未进行透析的CKD患者90例作为病例组，根据患者肾小球滤过率进行CKD分期，进而分别纳入CKD3、CKD4、CKD5组；另选取同期健康体检的志愿者34例作为对照组。采用单因素方差分析、χ²检验和非参数检验分析基线资料的组间差异。采集并对比各组被试者左心室（左室）后壁厚度（LVPWD）、左室射血分数（LVEF）、左房前后径（LAD），左室收缩末期内径（LVESD）、左室舒张末期内径（LVEDD）、二尖瓣口舒张早期峰值流速（E峰）、二尖瓣口舒张晚期峰值流速（A峰）、二尖瓣环舒张早期运动速度峰值（e’峰）、E/A值和E/e’值等二维常规超声心动图参数，左房最小容积（LAVmin）、左房最大容积（LAVmax）、左房收缩前容积（LAVpreA）、左房最大容积指数（LAVImax）、左房射血容量（LAEV）；左房射血分数（LAEF）等4D Auto LAQ分析的左房容积参数，以及储存期纵向应变（LASr）和周向应变（LASr-c）、管道期纵向应变（LAScd）和周向应变（LAScd-c）、收缩期纵向应变（LASct）和周向应变（LASct-c）等4D Auto LAQ分析的左房应变参数。应用Pearson相关分析左房应变参数与LAEF和LAVImax的相关性，绘制受试者操作特征（ROC）曲线寻找评价左房功能的最优参数，并通过Pearson相关和Spearman相关探讨其相关性。 结果 （1）基线资料组间比较：与对照组相比，CDK3组、CKD4组和CKD5组患者血肌酐和脑钠肽水平均升高，CKD4组和CKD5组收缩压和舒张压均升高，差异均有统计学意义（P值均<0.05）。与CKD3组相比，CKD4和CKD5组收缩压和血肌酐均升高，CKD5组脑钠肽升高，差异均有统计学意义（P值均<0.05）；与CKD4组相比，CKD5组血肌酐和脑钠肽均升高，差异有统计学意义（P值均<0.05）。各组被试者年龄、性别、体表面积、体质量指数比较，差异均无统计学意义（P值均>0.05）。（2）二维常规超声心动图参数测量值组间比较：9个常规超声心动图参数中，LVEDD、LVESD、LVPWD、A峰、E/e’、LAD 4组间比较差异均有统计学意义（P值均<0.05），LVEF、E峰、E/A 4组间比较差异无统计学意义（P值均>0.05）。CKD4组和CKD5组LVEDD、LVPWD、A峰、E/e’、LAD均高于对照组；CKD5组LVESD低于对照组、CKD3组和CKD4组，CKD5组LVEDD高于CKD3组、E/e’高于CKD3组和CKD4组，差异均有统计学意义（P值均<0.05）。（3）4D Auto LAQ参数测量值组间比较：CKD3组LAVmin、LAVpreA、LASr、LAScd、LASr-c、LAScd-c，以及CKD4组和CKD5组12个4D Auto LAQ参数与对照组比较差异均有统计学意义（P值均<0.05）；CKD5组LAVmax、LAEV及LASct的绝对值高于CKD3组，LASr低于CKD3组，差异均有统计学意义（P值均<0.05）。病例组各组LAVmax、LAVmin、LAVpreA、LAVImax、LAEV、LASct、LASct-c的绝对值均高于对照组，且随CKD分期增加而增加；LAEF及LASr、LAScd、LASr-c、LAScd-c的绝对值均低于对照组，且除LASr-c外，其他4个参数值随CKD分期增加而降低。以上各指标4组间总体比较，差异均有统计学意义（P值均<0.05）。（4）相关性分析：LAEF与 LAScd、LASct、LAScd-c、LASct-c均呈负相关（r=0.298、-0.219、-0.323、-0.293，P值均<0.05），与LASr、LASr-c均呈正相关（r=0.466、0.574，P值均<0.001）；LAVImax与LASr、LASr-c呈负相关（r=-0.322、-0.433，P值均<0.001），与LAScd-c呈正相关（r=0.327，P<0.001）。（5）ROC曲线分析结果显示，左房应变参数LASr的ROC曲线下面积最大［AUC为0.922（95％CI 0.877~0.967），灵敏度为67.80％，特异度为100.00％，截断值为0.175］，优于其他参数。（6）对基线资料与应变参数（LASr、LASr-c）的相关性进行分析，血肌酐、收缩压、脑钠肽与LASr的均呈负相关（r=-0.589、-0.441，rs=-0.578，P值均<0.001）。在观察者内和观察者间进行重复性检验时，ICC>0.75，表示重复性较好。 结论 CKD患者左房容积增大，储备功能、管道功能降低，泵功能代偿性升高。LASr是早期识别CKD患者左房功能受损的敏感参数，血肌酐、收缩压和脑钠肽与左房功能受损相关。4D Auto LAQ技术是评估CKD患者左房功能的有效方法，在临床工作中具有一定的指导作用。 Objective This study aimed to investigate the role of four-dimensional automatic left atrial quantitative technique (4D Auto LAQ) analysis in evaluating left atrial volume and strain function changes in patients with chronic kidney disease (CKD) and preserved ejection fraction. We also screened sensitive parameters that could identify early left atrial function impairment in patients with CKD. Method In this prospective cohort study, 90 non-dialysis patients with CKD hospitalized in the Department of Nephrology, Yangzhou Clinical College of Dalian Medical University from August 2022 to March 2023 were selected as the case group and divided into stages 3-5 groups (CKD3, CKD4, and CKD5) according to the glomerular filtration rate. A total of 34 healthy volunteers during the same period were selected as the control group. Univariate ANOVA, chi-square test and non-parametric test were used to analyze the differences between groups in baseline data. The left ventricular posterior wall dimensions (LVPWD), left ventricular ejection fraction (LVEF), left anteroposterior atrial diameter (LAD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), mitral orificum peak diastolic flow velocity at early stage (E peak), mitral orificum peak diastolic flow velocity at late stage (A peak), and mitral annular diastole were collected and compared in each group. Moreover, two-dimensional (2D) conventional echocardiographic parameters such as early motion velocity peak (e 'peak), E/A value and E/e 'value, Left atrial minimum volume (LAVmin), left atrial maximum volume (LAVmax), left atrial pre-systolic volume (LAVpreA), left atrial maximum volume index (LAVImax), left atrial ejection volume (LAEV), left atrial ejection fraction (LAEF), and other left atrial volume parameters were analyzed by 4D Auto LAQ. The left atrial strain parameters were analyzed by 4D Auto LAQ, including longitudinal strain (LASr) and circumferential strain (LASr-c) during storage, longitudinal strain (LAScd) and circumferential strain (LASCt-c) during pipeline, and longitudinal strain (LASct) and circumferential strain (LASct-c) during the systolic period. Pearson correlation analysis was used to analyze the correlation between left atrial strain parameters and LAEF and LAVImax. An receive operating characteristic (ROC) curve was drawn to find the optimal parameters to evaluate left atrial function. The correlation was discussed by Pearson and Spearman correlation analysis. Results (1) Comparison between baseline data groups: Compared with the control group, the serum creatinine and brain natriuretic peptide levels of the CDK3, CKD4, and CKD5 groups increased, and systolic blood pressure and diastolic blood pressure of the CKD4 and CKD5 groups increased the differences were statistically significant (all P values < 0.05). Compared with the CKD3 group, systolic blood pressure and serum creatinine in the CKD4 and CKD5 groups increased ,brain natriuretic peptide lerels in the CKD5 group increased, and the differences were statistically significant (all P values < 0.05). Compared with the CKD4 group, serum creatinine and brain natriuretic peptide in the CKD5 group increased, and the differences were statistically significant (all P values < 0.05). We found no significant differences in age, gender, body surface area, and body mass index among all groups (all P values > 0.05). (2) Comparison of 2D conventional echocardiographic parameter measurements between groups: Among the 9 conventional echocardiographic parameters, LVEDD, LVESD, LVPWD, peak A, E/e 'and LAD were statistically significant between the 4 groups (all P values < 0.05), while LVEF, peak E and E/A were not statistically significant between the 4 groups (all P values > 0.05). LVEDD, LVPWD, peak A, E/e 'and LAD in CKD4 and CKD5 groups were higher than those in control group, LVESD in CKD5 group was lower than that in control group, CKD3 group and CKD4 group, LVEDD in CKD5 group was higher than that in CKD3 group, E/e 'was higher than that in CKD3 group and CKD4 group, and the differences were statistically significant (all P values < 0.05). (3) Comparison of 4D Auto LAQ parameters between groups: LAVmin, LAVpreA, LASr, LAScd, LASr-c, and LAScd-c in the CKD3 group and 12 4D auto LAQ parameters in the CKD4 and CKD5 groups were significantly different from those in the control group (all P values < 0.05). The absolute values of LAVmax, LAEV, and LASct in the CKD5 group were higher than those in the CKD3 group, and LASr was lower than that in the CKD3 group the differences were statistically significant (all P values < 0.05). The absolute values of LAVmax, LAVmin, LAVpreA, LAVIm ax, LAEV, LASct, and LASct-c in the case group were higher than those in the control group, and they increased with the increase in CKD stage. The absolute values of LAEF, LASr, LAScd, LASr-c, and LAScd-c were lower than those of the control group, and they decreased with the increase in CKD stage (excepted LASr-c) the differences were statistically significant ( P < 0.05). (4) Correlation analysis: LAEF was negatively correlated with LAScd, LASct, LAScd-c, and LASct-c but positively correlated with LASr and LASr-c( r = -0.298, -0.219, -0.323, -0.293, 0.466, 0.574 all P values < 0.05) LAVImax was negatively correlated with LASr and LASr-c but positively correlaled with LAScd-c ( r = -0.322, -0.433, 0.327 all P values < 0.001). (5) ROC curve analysis results showed that the left atrial strain parameter had the largest area under the LASr ROC curve (AUC = 0.922[95% CI = 0.877-0.967], sensitivity = 67.80%, specificity = 100.00%, and cut-off value = 0.175), which was superior to other parameters. (6) The correlation between baseline data and strain parameters (LASr and LASr-c) was analyzed by Pearson correlation analysis. Serum creatinine (scr), systolic blood pressure (SBP), and NT-proBNP were significantly correlated with LASr (r = -0.589, 0.441, rs = -0.578, all P values < 0.001). When performing repeatability tests within and between observers, ICC > 0.75 indicated good repeatability. Conclusion In patients with CKD, the left atrial volume increases, reserve function and duct function decrease, and compensatory increase of pump fuction. LASr is a sensitive parameter for the early identification of left atrial function impairment in patients with CKD. Serum creatinine, brain matriuretic peptide, and systolic blood pressure are related to left atrial function impairment. 4D Auto LAQ technology is an effective method to evaluate left atrial function in patients with CKD, and it has a certain guiding role in clinical work.

    心房功能,左超声心动描记术,压力慢性肾脏病四维自动定量分析左房容积参数左房应变参数

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    基于产前3.0 T MRI true FISP序列胎儿腰椎发育与孕周关系的影像学观察

    张辉康琦尚华马得廷...
    83-87页
    查看更多>>摘要：目的 探讨孕中晚期宫内胎儿腰椎3.0 T MRI真稳态进动梯度回波序列（true FISP）矢状位二维定量指标与孕周的关系。 方法 横断面研究。纳入2020年1月—2023年4月青岛大学附属泰安市中心医院行产前MRI检查的59例胎儿的影像资料。孕妇年龄19~41（29.8±5.1）岁，孕周26+1~39+2（32.7±3.7）周。采用3.0 T MR扫描仪对胎儿行MRI检查，采集true FISP图像。在true FISP图像上测量腰椎长轴矢状位二维定量指标（腰椎总长度，L1、L3椎体骨化中心的上下径、前后径）。分析胎儿腰椎二维定量指标与孕周的相关性，并应用线性回归分析获得相应的腰椎生长动力学回归方程。 结果 Y ^ Y ^ None L 1 Y ^ None L 3 Y ^ None L 1 Y ^ None L 3 59例胎儿腰椎总长度及L1和L3椎体骨化中心的上下径、前后径与孕周均呈正相关，差异均有统计学意义（r=0.79~0.95，P值均<0.001）。胎儿腰椎总长度及L1和L3椎体骨化中心的上下径、前后径均随孕周增加呈线性增长，线性回归方程：腰椎总长度=-0.153+0.141 X孕周（R²=0.90，P<0.001），上下径=-0.226+0.023 X孕周（R²=0.77，P<0.001），上下径=-0.264+0.025 X孕周（R²=0.80，P<0.001），前后径=-0.284+0.029 X孕周（R²=0.63，P<0.001），前后径=-0.274+0.030 X孕周（R²=0.63，P<0.001）。 结论 孕中晚期胎儿腰椎3.0 T MRI true FISP序列矢状位二维定量指标与孕周均呈正相关，生长动力学特征符合线性回归模型，可为产前评估胎儿的腰椎发育情况提供参考。 Objective To explore the relationship between the 2D quantitative measurements of the sagittal lumbar spine and gestational age (GA) during middle and late fetal pregnancy on the basis of true fast imaging with steady-state precession (FISP) images of 3.0 T magnetic resonance imaging (MRI). Methods The cross-sectional study was conducted. This study used the imaging data of 59 pregnant women who underwent MRI examinations at the Affiliated Taian City Central Hospital of Qingdao University from January 2020 to April 2023. The women were aged 19-41 (29.8±5.1) years, and GA was 26+1-39+2 (32.7±3.7) weeks. The fetus was examined using a 3.0 T magnetic resonance scanner, and true FISP images were collected. The 2D sagittal position with the long axis of the lumbar spine on the true FISP images was measured (total length of lumbar spine, the superior-inferior and anteroposterior diameters of the ossification centers of the L1 and L3 vertebrae). The correlation between the 2D quantitative indexes of the fetal lumbar spine measurement index and GA was analyzed, and linear regression analysis was performed to obtain the corresponding regression equation for the growth kinetics of the lumbar spine. Results Y ^ Y ^ s u p e r i o r i n f e r i o r d i a m e t e r s o f - L 1 Y ^ s u p e r i o r i n f e r i o r d i a m e t e r s o f - L 3 Y ^ o p o s t e r i o r d i a m e t e r s o f L 1 Y ^ a n t e r o p o s t e r i o r d i a m e t e r s o f L 3 Among the 59 cases, a positive correlation was observed between GA and the length of the fetal lumbar spine and the superior-inferior and anteroposterior diameters of the ossification centers of the L1 and L3 vertebrae. The differences were statistically significant (r = 0.79-0.95, all P values < 0.001). The length of the fetal lumbar spine and the superior-inferior and anteroposterior diameters of the ossification centers of the L 1 and L3 vertebrae exhibited linear growth with increasing GA. The linear regression equations were as follows:total length of lumbar spine = -0.153 + 0.141 XGA, (R2 = 0.90, P < 0.001) = -0.226 + 0.023 XGA, (R2 = 0.77, P < 0.001) = -0.264 + 0.025 XGA, (R2 = 0.80, P < 0.001) = -0.284 + 0.029 XGA, (R2 = 0.63, P < 0.001) and = -0.274 + 0.030 XGA, (R2 = 0.63, P < 0.001). Conclusion On the basis of 3.0 T true FISP MRI, the 2D quantitative measurements on the sagittal lumbar spine are positively correlated with GA during middle and late fetal pregnancy. The growth dynamics characteristics fit a linear regression model, which can provide reference for the prenatal assessment of fetal lumbar spine development.

    胎儿发育腰椎磁共振成像真稳态进动梯度回波序列产前检查

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    基于多参数MRI的影像组学模型对子宫内膜样腺癌微卫星不稳定状态的术前预测价值

    赵锦瑫崔艳芬贾亚菊任嘉梁...
    88-96页
    查看更多>>摘要：目的 探讨基于多参数MRI影像组学模型术前预测子宫内膜样腺癌患者微卫星不稳定（MSI）状态的应用价值。 方法 回顾性队列研究。纳入2017年1月—2021年12月山西省肿瘤医院经病理证实为子宫内膜样腺癌的患者225例。患者年龄29~78（55.1±7.5）岁，均行全子宫+双附件切除术，并于术前行盆腔多参数MRI检查。将225例患者按7∶3的比例随机分为训练集（158例）和验证集（67例），根据手术标本病理免疫组织化学检查结果分为高度微卫星不稳定（MSI-H）组58例和低度微卫星不稳定/微卫星稳定（MSI-L/MSS）组167例。对每例患者的快速自旋回波压脂序列T2加权像、增强T1加权像、表观弥散系数（ADC）3个序列进行图像分割和特征提取，在训练集中采用组内相关系数（ICC）、Mann-Whitney U检验、Spearman相关及Boruta算法进行图像特征筛选，并使用朴素贝叶斯（NB）、随机森林（RF）及支持向量机（SVM）3种分类器构建影像组学模型。在训练集、验证集中分别采用受试者工作特征（ROC）曲线、Delong检验、决策分析曲线（DCA）评估并验证3种模型对MSI状态的诊断性能、预测性能、净收益。将筛选出的影像组学特征纳入诊断效能较高的最佳模型中，对每例患者进行影像组学评分，分别在训练集、验证集中评估MSI-H组和MSI-L/MSS组影像组学评分的分布情况。 结果 训练集与验证集间比较，患者肿瘤分化程度差异有统计学意义（χ 2=8.40，P=0.015），患者年龄、体质量指数、国际妇产科联盟分期，以及肌层浸润深度等临床病理资料差异均无统计学意义（P值均>0.05）。在训练集中，MSI-H组与MSI-L/MSS组比较，患者是否绝经2组间差异有统计学意义（χ 2=4.56，P=0.033），其他临床病理资料2组间差异均无统计学意义（P值均>0.05）；在验证集中，2组间各临床病理差异均无统计学意义（P值均>0.05）。多参数MRI图像经特征提取后，每例患者获得4 245个影像组学特征，在训练集中筛选出6个关键特征构建模型。在训练集中NB模型、RF模型及SVM模型预测子宫内膜样腺癌患者MSI状态的ROC曲线下面积（AUC）分别为0.764［95%可信区间（CI）0.682～0.846］、0.821（95%CI 0.751~0.892）和0.905（95% CI 0.848~0.961），验证集中AUC分别为0.712（95% CI 0.568～0.856）、0.812（95% CI 0.710~0.915）、0.875（95% CI 0.762~0.988），结果表明SVM模型的诊断性能最佳。Delong检验结果显示，训练集中SVM模型与NB模型、RF模型AUC间差异均有统计学意义（Z=-3.45、-2.33，P值均<0.05），而在验证集中AUC差异均无统计学意义（P值均>0.05）。DCA曲线显示，在训练集和验证集中，SVM模型预测MSI状态的净收益均优于NB模型、RF模型，也优于将所有患者MSI状态都看作MSI-H或MSI-L/MSS。采用最佳模型SVM模型对每例患者进行影像组学评分，训练集及验证集中MSI-H组与MSI-L/MSS组影像组学评分分布有明显差异。 结论 基于多参数MRI的SVM模型对于子宫内膜样腺癌患者MSI状态具有一定的术前预测价值。 Objective This study aimed to evaluate the application value of multiparameter magnetic resonance imaging (MRI)-based radiomics models for the preoperative prediction of microsatellite instability (MSI) status in patients with endometrioid adenocarcinoma. Methods This retrospective cohort study included 225 patients, with an average age of 29-78 (55.1±7.5) years, with pathologically proven endometrioid adenocarcinoma in Shanxi Cancer Hospital between January 2017 and December 2021. All patients underwent pelvic MRI scans before complete hysterectomy with oophorotomy and were randomly divided into training set (158 cases) and validation set (67 cases) at a ratio of 7∶3. Patients were divided into MSI-H group (58 cases) and MSI-L/MSS group (167 cases) according to pathological IHC results. Image segmentation and features were extracted on T2-weighted imaging fat suppression, contrast-enhanced T1WI images, and apparent diffusion coefficient (ADC) maps for each patient. In the training set, intraclass correlation coefficient (ICC), Mann-Whitney U test, Spearman correlation analysis, and Boruta algorithm were used for feature selection. Three classification algorithms including naive Bayesian algorithm (NB), random forest (RF), and support vector machine (SVM) were applied to build radiomics models. The diagnostic performance, predictive performance, net benifit, and reliability of the three radiomics models were tested by ROC curve, Delong test, and decision analysis curve (DCA) and verified in the validation set. The selected imaging features were included in the best model, and radscore measurement was performed for each patient. The distribution of radscore in the MSI-H and MSI-L/MSS groups was evaluated in the training and validation sets, respectively. Results Between the training and validation sets, the difference between patients' tumor grade was significant (χ 2=8.40, P=0.015) but not between other indicators such as age, body mass index, Federation of Gynecology and Obstetrics, and depth of myometrial invasion (all P values > 0.05). In the training set, patients before or after menopause had statistically significant difference between the MSI-H and MSI-L/MSS groups ( χ 2=4.56, P=0.033). The other indicators were not statistically different between the two groups (all P values > 0.05). In the validation set, clinical and pathological data were not different between the two groups (all P values > 0.05). After feature extraction of multiparameter MRI images, 4 245 imaging features were obtained for each patient. Six key radiomics features were selected for model building. The area under curve (AUC)of the NB, RF, and SVM models were 0.764 (95% credibility interval [ CI] 0.682-0.846), 0.821 (95% CI 0.751-0.892), 0.905 (95% CI 0.848-0.961) and 0.712 (95% CI 0.568-0.856) as well as 0.812 (95% CI 0.710-0.915), 0.875 (95% CI 0.762-0.988) in the training and validation sets, respectively. The SVM model had the best performance in the training and validation sets. Delong test results showed that in the training set, the AUC difference in the SVM, NB, and RF models was statistically significant (Z=-3.45, -2.33, all P values < 0.05), and that in the validation set was not statistically significant (all P values > 0.05). The DCA results showed that the SVM model achieved higher net benefits than the other models and was better than treating all patients as MSI-H or MSI-L/MSS in the training and validation sets. The best model SVM was used for radscore measurement for each patient, and no significant differences in the distribution of radscore were found between the MSI-H and MSI-L/MSS groups in the training and validation sets. Conclusion The SVM model based on multi-parameter MRI can be used for the preoperative evaluation of MSI status in patients with endometrioid adenocarcinoma.

    癌,子宫内膜样微卫星不稳定磁共振成像影像组学预测

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    基于多参数MRI的影像组学融合模型对直肠癌脉管侵袭的术前预测价值

    谢玉莹崔艳芬杨晓棠全帅...
    97-104页
    查看更多>>摘要：目的 探讨基于多参数MRI的影像组学融合模型术前预测直肠癌脉管侵袭（LVI）的应用价值。 方法 回顾性队列研究。纳入2016年1月—2019年12月在山西省肿瘤医院行直肠癌根治性切除术的224例直肠癌患者的临床病理资料和多参数MRI数据，其中男129例、女95例，年龄28~83（61.3±9.7）岁。按7∶3的比例随机分为训练集157例和验证集67例。使用ITK-SNAP图像分割软件，在高分辨率T2加权像（T2WI）、弥散加权成像（DWI）及增强T1加权像（cT1WI）上，逐层手动勾画肿瘤感兴趣区得到全容积感兴趣区（VOI），将DWI的勾画信息复制到表观弥散系数（ADC）图像（由2个不同b值的DWI图像自动计算生成）。采用最小冗余最大相关（mRMR）、最小绝对收缩与选择算子（LASSO）算法及多因素logistic回归的三步降维法，筛选影像组学特征并构建影像组学标签。通过多因素logistic回归分析筛选出临床病理特征和MRI表现特征中的独立预测因子。分别构建基于T2WI、ADC、cT1WI单一序列和联合序列的影像组学模型及纳入临床病理特征后的融合模型并制作列线图。采用受试者操作特征曲线下面积（AUC）、校准曲线、决策曲线（DCA）评估模型的效能及临床效益。 结果 224例直肠癌患者经术后病理证实LVI阳性70例、阴性154例。训练集和验证集的临床病理特征及MRI表现特征比较，差异均无统计学意义（P值均>0.05）。三步降维法筛选后得到6个与直肠癌LVI相关的关键特征（P值均<0.05）。血清癌胚抗原（CEA）是直肠癌LVI的独立预测因子［比值比（95%可信区间）2.071（1.038~4.131），P=0.039］。基于T2WI、ADC、cT1WI单一序列及联合序列的影像组学模型在训练集中的AUC分别为0.765、0.772、0.776、0.878，在验证集中的AUC分别为0.741、0.739、0.764、0.846；纳入CEA构建的融合模型训练集和验证集的AUC分别为0.899、0.876，预测效能最佳。校准曲线显示融合模型有良好的校正性能。验证集的DCA曲线显示，阈值概率范围在0.10~0.20和0.35~0.90时融合模型的净收益最大。 结论 基于多参数MRI的影像组学特征和CEA构建的融合模型在直肠癌LVI的术前预测中有较高的诊断效能，其可视化列线图可以作为术前预测LVI的有效工具。 Objective This study aims to investigate the application value of a fusion model based on multiparameter magnetic resonance imaging (MRI) for the preoperative prediction of lymphovascular invasion (LVI) in rectal cancer. Methods Retropective cohort study was conduted. The clinicopathological data and multi-parameter MRI data of 224 patients with rectal cancer who underwent radical resection for rectal cancer in Shanxi Province Tumor Hospital from January 2016 to December 2019 were analyzed, including 129 males and 95 females, aged 28 to 83 (61.3±9.7) years old. The patients were randomly divided into two groups, namely, the training group (n=157) and the validation group (n=67), According to a ratio of 7∶3. ITK-SNAP image segmentation was used to manually delineate the ROI of tumor slice by slice on the images of T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and enhanced T1-weighted imaging (cT1WI) sequences to obtain the volume of interest. The delineation information of DWI was copied onto the apparent diffusion coefficient (ADC) map. A three-step dimensionality reduction method based on the maximum relevance minimum redundancy, least absolute shrinkage and selection operator regression, and multiple logistic regression was used for feature selection and radiomics signature building. Independent predictors of clinicopathologic features and MRI features were screened by multivariate logistic regression analysis. A radiomic model based on single and combined sequences of T2WI, ADC, and cT1WI and fusion models with clinicopathological features were constructed, and the corresponding nomogram was made. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve were used to evaluate the efficacy and clinical benefit of the model. Results Postoperative pathological examination confirmed LVI in 70 patients and negative in 154 patients. No significant differences in clinicopathologic features and MRI findings were observed between the training and validation groups (all P values > 0.05). Six key features related to LVI of rectal cancer were obtained after three-step screening (all P values < 0.05). Carcinoembryonic antigen (CEA) was an independent predictor of colorectal cancer (odds ratio[95% confidence interval] 2.071 [1.038~4.131], P = 0.039). The AUC of the radiomics model based on single and combined sequences of T2WI, ADC, and cT1WI were 0.765, 0.772, 0.776, and 0.878 in the training group and 0.741, 0.739, 0.764, and 0.846 in the validation group,respectively. The AUC of the fusion model training group and validation group constructed by CEA were 0.899 and 0.876, respectively, which showed the best prediction efficiency. The calibration curve showed that the fusion model had a good calibration performance. The decision curve of the verification group showed that the fusion model had the maximum net benefit when the threshold probability ranged from 0.10 to 0.20 and from 0.35 to 0.90. Conclusion The fusion model constructed based on the radiomic features of multi-parameter MRI and CEA has high diagnostic efficacy in predicting LVI of rectal cancer before surgery. The visual nomogram of this model can be used as an effective tool for predicting LVI before surgery.

    直肠肿瘤肿瘤浸润预测脉管侵袭磁共振成像影像组学诊断模型

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    基于增强CT的影像组学模型对肾嗜酸细胞腺瘤与肾透明细胞癌的鉴别诊断

    宋鑫殷满心苏巧娜马欣雨...
    105-110页
    查看更多>>摘要：目的 探讨基于增强CT影像组学模型在肾透明细胞癌（ccRCC）和肾嗜酸细胞腺瘤（RO）鉴别诊断中的价值。 方法 回顾性队列研究。纳入山西省肿瘤医院2013年6月—2022年7月收治的经病理确诊的肾肿瘤患者100例，其中男63例、女37例，年龄42~81（60.8±8.7）岁。100例中，ccRCC患者75例（ccRCC组），其中男52例、女23例，年龄42~79（59.9±8.5）岁；RO患者25例（RO组），其中男11例、女14例，年龄46~81（63.5±8.8）岁。将入组患者按照3∶7随机分为测试集（30例）和训练集（70例）。患者均行增强CT检查。从门静脉期CT图像中提取1 409个影像组学特征，使用Variance Threshold、SelectKBest以及最小绝对收缩与选择算子算法进行特征筛选，构建影像组学模型；绘制受试者操作特征曲线（ROC曲线），计算曲线下面积（AUC）。用灵敏度、特异度、精确度以及F1-score来评估不同影像组学模型诊断效果。 结果 ccRCC组和RO组患者的年龄比较，差异无统计学意义（t=1.82，P=0.072）；2组患者的性别比较，差异有统计学意义（χ 2=5.16，P=0.023）。1 409个影像组学特征中最终筛选出12个最具相关性的组学特征，建立5个影像组学模型用于鉴别ccRCC和RO，分别为支持向量机、逻辑回归（LR）模型、决策树模型、K-近邻模型、随机森林模型。结果表明，这5个模型在训练集和测试集中的AUC值分别为0.905［95%可信区间（CI） 0.826~0.984］、0.870（95%CI 0.742~0.996），0.910（95%CI 0.717~0.989）、0.853（95%CI 0.717~0.989），0.885（95%CI 0.787~0.983）、0.628（95%CI 0.353~0.903），0.925（95%CI 0.873~0.977）、0.638（95%CI 0.416~0.861），0.980（95%CI 0.954~1.000）、0.821（95%CI 0.673~0.968）。综合各项指标可见，在5个模型中LR模型性能最优，具有较理想的诊断效能。 结论 基于增强CT的影像组学模型，可以提高对ccRCC和RO鉴别诊断的准确性。 Objective This study aimed to explore the value of enhanced CT imaging model combined with machine learning in the differential diagnosis of renal clear cell carcinoma (ccRCC) and renal eosinophilic adenoma (RO). Methods Retropective cohort study was conduted. A total of 100 patients with renal cancer diagnosed pathologically admitted to Shanxi Cancer Hospital from June 2013 to July 2022 were included, including 63 males and 37 females, aged 42-81 (60.8±8.7) years. Of the 100 patients, 75 were pathologically confirmed as ccRCC patients, including 52 males and 23 females, aged 42-79 (59.9±8.5) years. There were 25 RO patients in the RO group, including 11 males and 14 females, aged 46-81 (63.5±8.8) years. The patients were classified into test cohort (30%) and training cohort (70%) with a random method, and all of them underwent enhanced CT examination. Then, 1 409 imaging features were extracted from portal venous CT images, and variance threshold, SelectKBest, and least absolute shrinkage and selection operator algorithms were used in feature extraction. We constructed an image omics model and drew the receiver operating characteristic curve. Sensitivity, specificity, accuracy, and F1-score were used in evaluating the performance of different imaging models. Results No statistically significant difference in age was found between the groups (t=-1.82, P=0.072). The gender showed statistically significant difference between the groups (χ2=5.16, P=0.023). The 12 most relevant features were selected from 1 409 image omics features, and five models were established to differentiate between ccRCC and RO: support vector machine, logistic regression (LR) model, decision tree model, K-nearest neighbor model, and random forest model. Results showed that the AUC values of the five models in the training and test cohorts were 0.905 (95% confidence interval [CI] 0.826-0.984), 0.870 (95% CI 0.742-0.996), 0.910 (95% CI 0.717-0.989), 0.853 (95% CI 0.717-0.989), 0.885 (95% CI 0.787-0.983), 0.628 (95% CI 0.353-0.903), 0.925 (95% CI 0.873-0.977), 0.638 (95% CI 0.416-0.861), 0.980 (95% CI 0.954-1.000), and 0.821 (95% CI 0.673-0.968). In summary, the LR model showed the best performance and had ideal diagnostic performance. Conclusion Enhanced CT-based image omics features can improve the accuracy of the differential diagnosis of ccRCC and RO.

    肾肿瘤嗜酸细胞腺瘤透明细胞癌CT影像组学

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    股骨近端交锁髓内钉治疗股骨转子间骨折术后医源性外侧壁骨折的影响因素分析

    张金星海啸于鸿杜丽萍...
    111-115页
    查看更多>>摘要：目的 探讨股骨转子间骨折患者经股骨近端交锁髓内钉治疗后发生医源性外侧壁骨折的影响因素。 方法 回顾性队列研究。纳入郑州市骨科医院2020年12月—2022年12月经股骨近端交锁髓内钉治疗的278例股骨转子间骨折患者的临床资料，其中男142例、女136例，年龄56~85（70.6±7.1）岁。术后第2天经X线或CT检查患者治疗后医源性外侧壁骨折的发生情况，采用单因素及多因素logistic回归分析其发生的影响因素。 结果 278例患者中45例术后出现医源性外侧壁骨折，发生率为16.19%。有、无外侧壁骨折的患者间比较，年龄、骨折分型及股骨外侧壁厚度差异均有统计学意义（P值均<0.05），而性别、体质量指数、合并内科疾病、尖顶距、骨密度、受伤至手术时间、受伤原因、手术时间、术中出血量及术后卧床时间等因素比较，差异均无统计学意义（P值均>0.05）；将单因素分析中差异有统计学意义的指标纳入多因素logistic回归分析，结果显示骨折分型A2.2~A3.3型（比值比1.316，95%可信区间1.016~1.705）、股骨外侧壁厚度（比值比0.546，95%可信区间0.446~0.668）为股骨转子间骨折患者术后医源性外侧壁骨折发生的独立危险因素（P值均<0.05）。 结论 骨折分型、股骨外侧壁厚度均是股骨转子间骨折患者经股骨近端交锁髓内钉术后发生医源性外侧壁骨折的独立危险因素；患者的骨折分型等级较高、股骨外侧壁较薄，发生医源性外侧壁骨折的可能性相对较高。 Objective This study aimed to analyze the influencing factors on medically induced lateral wall fractures in patients with intertrochanteric femur fractures treated with interlocking intramedullary nailing of the proximal femur. Methods A retrospective cohort study was conducted. The clinical data of 278 patients with intertrochanteric femur fractures treated by interlocking intramedullary nailing of the proximal femur in Zhengzhou Orthopedic Hospital from December 2020 to December 2022 were included. The patients included 142 males and 136 females, aged 56-85 (70.6±7.1) years. The incidence of medically induced lateral wall fractures in patients after treatment was counted, and the factors affecting their occurrence were analyzed by univariate and multivariate logistic regressions. Results Forty-five out of the 278 patients developed postoperative medically induced lateral wall fractures, with an incidence rate of 16.19%. Comparison between patients with and without posterolateral wall fractures showed that the differences in age, fracture type A2.2-A3.3, and posterolateral femoral wall thickness were statistically significant (all P values <0.05). Meanwhile, the differences in comparison of gender, body mass index, comorbid medical disorders, tarsal apical distance, bone mineral density, time from injury to surgery, cause of injury, operative time, bleeding, and postoperative bed rest time were not statistically significant (all P values > 0.05). The items with statistically significant differences in the univariate analysis were included in the multifactorial logistic regression analysis, and the results showed that fracture type A2.2-A3.3 (odds ratio 1.316, 95% confidence interval 1.016-1.705) and lateral femoral wall thickness (odds ratio 0.546, 95% confidence interval 0.446-0.668) were independent risk factors influencing the occurrence of medically induced lateral wall fracture in patients with intertrochanteric fracture of the femur after treatment (all P values < 0.05). Conclusion Fracture classification and thickness of the external wall of the femur are independent risk factors affecting iatrogenic external wall fractures in patients with intertrochanteric fractures after proximal femoral interlocking intramedullary nail treatment. The higher the grade of fracture classification and the thinner the thickness of the external wall of the femur, the greater the possibility of iatrogenic external wall fracture.

    髋骨折医源性外侧壁骨折股骨转子间骨折骨折固定术,内股骨近端交锁髓内钉影响因素

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    切除部分上关节突经椎间孔入路椎间融合内固定在高位腰椎间盘突出症治疗中的应用

    李忠伟张树文杨新明银乐乐...
    116-119页
    查看更多>>摘要：目的 探讨切除部分上关节突后经椎间孔入路椎间融合内固定治疗高位腰椎间盘突出症的可行性及临床疗效。 方法 横断面研究。纳入2018年1月—2021年6月新疆医科大学第一临床医学院综合外科骨科组高位腰椎间盘突出症患者39例，其中男21例、女18例，年龄21~73（51.2±10.7）岁。39例中，L1/2腰椎间盘突出4例、L2/3腰椎间盘突出22例、L3/4腰椎间盘突出13例，均采用切除部分上关节突经椎间孔入路椎间融合内固定术治疗。观察项目：（1）观察患者手术情况及并发症发生情况；（2）分别于术前及术后2周使用疼痛视觉模拟评分法（VSA）评分评估患者手术前后疼痛程度；（3）分别于术前、术后6个月采用Oswestry功能障碍指数（ODI）评估患者的症状及功能；（4）测量并比较手术前后责任椎间隙相对高度；（5）分别于术前及末次随访根据肌力评估量表（MMT）评估患者肌力变化情况；（6）综合评估患者椎间融合时间。 结果 39例患者手术均顺利且获得随访，随访时间9~16（11.6±2.0）个月。手术时间90~155（115.9±17.7）min，术中出血量50~150（98.7±27.8）mL，术中无硬脊膜、神经、大血管损伤。术后患者VAS评分和ODI分别为（1.71±0.45）分和20.13%±3.34%，较术前的（8.13±0.65）分和52.41%±6.86%有明显降低，差异均有统计学意义（t=53.30，24.38，P值均<0.001）。术后责任椎间隙相对高度为（0.33±0.03）mm，较术前的（0.20±0.03）mm增加，差异有统计学意义（t=-18.51，P<0.001）。术前患者肌力均有降低，其中C级6例、D级14例、E级19例，末次随访时2例术前肌力C级患者肌力无明显改善，其余患者神经功能获得不同程度改善，其中C级2例、D级2例、E级35例。39例患者中，30例为椎间融合器融合，9例为混合椎间植骨融合，其中1例采用椎间融合器融合患者在随访16个月时仍未融合，其余患者椎间融合时间为6~14（9.6±1.6）个月。 结论 切除部分上关节突经椎间孔入路椎间融合内固定治疗高位腰椎间盘突出症，安全性高、不干扰神经功能、并发症少，可作为高位腰椎间盘突出症手术治疗的选择方法。

    椎间盘移位脊柱融合术高位腰椎间盘突出症椎间孔入路椎间盘切除术

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    CT三维重建技术辅助胸腔镜扩大肺亚段切除术治疗肺段边缘孤立性结节的短期疗效观察

    常鹏侯予龙公正江海城...
    120-123页
    查看更多>>摘要：目的 探讨支气管、血管CT三维重建技术（3D-CTBA）辅助胸腔镜扩大肺亚段切除术治疗肺段边缘孤立性结节的短期疗效。 方法 回顾性队列研究。纳入2017年8月—2022年8月在徐州市肿瘤医院接受手术治疗的肺段边缘结节患者60例，其中男21例、女39例，年龄23~79（51.7±10.1）岁。根据手术方式不同分组：肺段组30例，采用3D-CTBA辅助胸腔镜扩大肺段切除术；肺亚段组30例，采用3D-CTBA辅助胸腔镜扩大肺亚段切除术。观察指标：（1）比较2组围术期指标，包括手术时间、术中出血量、切缘宽度、术后胸腔引流量及引流管留置时间、住院时间；（2）比较2组患者术前和术后6个月肺功能指标，包括用力肺活量（FVC）、每分钟最大通气量（MVV）、第一秒用力呼吸量（FEV1）；（3）比较2组患者术后6个月内并发症发生率，以及复发、转移及死亡情况。 结果 60例患者均顺利完成手术，无中转开放手术。2组患者性别、年龄、肺结节直径和部位等基线资料比较，差异均无统计学意义（P值均>0.05）。肺亚段组手术时间为（123.6±28.1）min，较肺段组的（96.5±31.9）min更长，术中出血量为（50.3±16.1）mL，较肺段组的（67.1±13.6）mL更少，差异均有统计学意义（t=3.49、4.36，P值均<0.01）；2组切缘宽度、术后胸腔引流量及引流管留置时间、住院时间比较，差异均无统计学意义（P值均>0.05）。（2）术后6个月与术前相比，2组FVC、MVV及FEV1水平均下降，组间比较肺段组各指标水平更低，差异均有统计学意义（P值均<0.001）。（3）2组患者的并发症发生率、复发、转移及死亡情况比较，差异均无统计学意义（P值均>0.05）。 结论 3D-CTBA引导下胸腔镜扩大肺亚段切除术治疗肺段边缘孤立性结节安全可行，相比于3D-CTBA引导下胸腔镜扩大肺段切除术，虽然该术式手术时间相对延长，但减少了术中出血量，对肺功能影响小，且不增加并发症风险。

    肺肿瘤孤立性肺结节三维重建胸腔镜扩大肺亚段切除术肺段边缘结节

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    磁共振成像与超声心动图检查在扩张型心肌病诊断中的对比研究

    赵杨梁晟昊郑昭
    124-127页
    查看更多>>摘要：目的 比较磁共振成像（MRI）与超声心动图在扩张型心肌病（DCM）诊断中的应用价值。 方法 回顾性队列研究。选取2020年7月—2022年8月在蒙城县第二人民医院住院治疗的80例确诊DCM患者，其中男41例、女39例，年龄31~97岁。根据检查方法不同分组：接受超声心动图检查40例为超声心动图组，接受MRI检查40例为MR组。观察指标：（1）比较2组患者的基线资料。（2）分析2种检查的影像学特征。（3）比较2组患者左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室射血分数（LVEF）水平的差异。（4）比较2种方法诊断DCM与临床综合诊断的符合率。 结果 （1）2组患者的年龄、性别、临床表现、疾病史、吸烟史等基线资料比较，差异均无统计学意义（P值均>0.05）。（2）DCM的MR影像特征主要包括弧形延迟强化、左室扩大、壁运动异常、心肌纤维化、心肌水肿；DCM的超声心动图影像学特征主要包括左室腔扩大、二尖瓣反流、室间隔和左室后壁变薄、左心房扩大、心肌收缩功能下降等。（3）MRI测量的LVEDV、LVESV水平分别为（131.96±20.38）、（48.28±8.06）mL，均高于超声心动图的（109.32±18.15）、（44.76±7.49）mL，差异均有统计学意义（t=2.02、5.25，P值均<0.05）；MRI测量的LVEF水平为57.42%±8.29%，低于超声心动图检测的结果（62.13%±9.71%），差异有统计学意义（t=2.33，P=0.022）。（4）超声心动图组40例患者中，检出DCM36例，诊断符合率90%；4例诊断结果阴性，分别为心尖肥厚型2例、双心室扩张型1例、左心室对称肥厚型1例。MR组40例患者中检出DCM39例，诊断符合率为97.5%；1例患者诊断结果阴性，表现为左心室弥漫性增厚。2组患者的DCM诊断符合率差异无统计学意义（χ 2=0.85，P=0.356）。 结论 MRI和超声心动图均能清晰显示DCM患者的心脏结构、左心室大小、形态、心肌厚度等特征；但对心功能指标的检测结果存在一定差异；两种方法均能有效诊断DCM，且MRI较超声心动图诊断符合率更高。

    心肌病,扩张型磁共振超声心动图诊断

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    双侧小隐静脉走行及汇入部位变异1例

    马明宇吴海平渠沛霖党震华...
    128-129页
    查看更多>>摘要：笔者在解剖一具成年男性尸体时，发现其双侧小隐静脉走行、汇入部位变异。尸体标本来源于长治医学院解剖实验室，身高约154 cm。标本下肢长（足底外缘至髂前上棘）68.1 cm，全腿长（外踝上缘至髂前上棘）53.4 cm，大腿长（膝关节外下缘至髂前下棘）29.2 cm，小腿长（外踝上缘至腓骨头外侧）26.1 cm。解剖下肢过程中，发现右侧小隐静脉起自足背静脉网外侧，起始处压扁直径为4.92 mm（游标卡尺测量，精确度0.01 mm）；该静脉自起始点斜向腓肠肌内侧缘走行21.65 cm处有一分支汇入，此处其压扁直径为6.34 mm。该分支斜向内上走行4.35 cm后汇入大隐静脉，该分支汇入大隐静脉前压扁直径为2.90 mm（图1A）。右小隐静脉主干沿小腿中线上行8.97 cm后进入腘窝，此处压扁直径为3.58 mm，继续上行，距起点31.23 cm处有一压扁直径为3.54 mm的属支汇入主干；主干与腘静脉之间有一压扁直径5.48 mm的吻合支，长15.30 mm，与吻合支汇合处右小隐静脉主干压扁直径4.64 mm（图1B）。正常小隐静脉应沿腘窝汇入腘静脉进而汇入股静脉，分支与大隐静脉的属支相吻合；但该例右侧小隐静脉并未汇入腘静脉，而是沿着股二头肌长头与半膜肌之间上行，与汇合处压扁直径8.54 mm的半腱肌支、股深静脉的第三穿支和第四穿支的吻合支汇合后延续为股深静脉（图1C）。右小隐静脉起点发出至此全长45.99 cm，此处压扁直径6.38 mm。股深静脉于长收肌和大收肌之间向股前内侧上行92.66 mm汇入股静脉。

    遗传,变异小隐静脉股深静脉腘静脉局部解剖学

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