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期刊信息/Journal information
中华超声影像学杂志
河北医科大学
中华超声影像学杂志

河北医科大学

张运

月刊

1004-4477

cs@hebmu.edu.cn

0311-86266994

050017

河北省石家庄市中山东路361号

中华超声影像学杂志/Journal Chinese Journal of UltrasonographyCSCD北大核心CSTPCD
查看更多>>中华医学会主办。本刊是中华医学会系列期刊中的超声医学专业学术期刊，主要反映国内超声医学研究进展及国外超声医学学术动态；主要报道临床各科超声诊断、超声造影、介入性超声等研究成果,以及组织声学特征、超声生物效应、医用超声声学成像原理等；主要栏目有临床研究、实验研究、技术研究、专家论坛、述评、综述、专题讲座、短篇论著、病例报告、作者?编者?读者等；主要读者为超声医学临床工作者、各科临床医师、超声医学工程技术人员、医用物理学工作者等。
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    经胸超声心动图检查规范化应用中国专家共识(2024版)

    谢明星姜玉新
    1-13页
    查看更多>>摘要：为推动超声心动图规范化临床应用，进一步提升超声心动图的诊断水平，特别是在我国超声心动图检查设备和从业人员分布不均衡的现状下，需建立适合我国国情的经胸超声心动图检查的评价标准，在参考国际成熟报告体系标准基础之上[1,2,3,4,5,6]，推行超声心动图标准化存图及结构化报告，达成专家共识。中华医学会超声医学分会超声心动图学组及国家超声诊断专业医疗质量控制中心专家委员会结合国内外指南、共识和最新研究进展，结合我国国情制定了经胸超声心动图规范化应用专家共识。本共识主要目的是：明确经胸超声心动图检查室基本构成，推荐超声心动图检查流程，规范超声检查报告书写格式与内容，以期推动和提高我国经胸超声心动图检查的规范化应用，从而助力国家分级诊疗政策有效实施。同时，本共识将有助于监测经胸超声心动图检查的各项质控指标，使超声心动图检查水平得以持续改进，特别是在不同医疗单位之间，以期达到经胸超声心动图报告相互认可的目的。本共识的实施亦将有助于提升临床医生解读超声心动图报告的能力。
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    可解释性人工智能超声影像特征风险模型预测甲状腺乳头状癌颈部淋巴结转移的价值

    陈阿倩曹茹李娜袁新...
    14-20页
    查看更多>>摘要：目的 构建甲状腺乳头状癌(PTC)风险特征可解释性人工智能(AI)模型，并探讨其联合临床特征预测PTC患者颈部淋巴结转移(CLNM)的价值。 方法 回顾性收集西安交通大学第二附属医院2021年1月至2022年9月行甲状腺切除术及颈部淋巴结清扫术后病理证实的PTC患者422例，共422个结节，按7∶3比例随机分为训练集和测试集，通过传统机器学习方法提取与PTC风险特征高度相关的影像组学特征，并建立风险特征概率最优智能预测模型，再联合临床特征构建预测PTC患者CLNM的风险模型，并通过绘制ROC曲线，计算曲线下面积(AUC)评估各模型的诊断效能。 结果 在测试集PTC风险特征AI可解释模型中，基于逻辑回归分类的钙化智能诊断模型表现出最高的诊断效能，AUC为0.87(P<0.05)。对比于单独PTC超声风险特征概率模型，其联合临床特征的列线图综合模型在预测PTC患者CLNM中表现出更高诊断效能，其AUC为0.97，诊断临界值为0.15，对应的准确性、敏感性及特异性分别为92.65%、92.76%及92.54%(均P<0.05)。 结论 本研究构建的PTC超声AI模型输出的可解释性风险特征结合临床特征能够有效预测PTC患者的CLNM，进而为医生决策PTC患者治疗方案提供有效信息。 Objective To construct an explainable artificial intelligence(AI) model of risk characteristics of papillary thyroid carcinoma(PTC), and to explore its value of it combined with clinical features in predicting cervical lymph node metastasis(CLNM) in PTC patients. Methods From January 2021 to September 2022, 422 patients(422 nodules) with pathologically confirmed PTC underwent thyroidectomy and neck lymph node dissection in the Second Affiliated Hospital of Xi′an Jiaotong University were retrospectively collected, the patients were randomly divided into training set and test set according to the ratio of 7∶3. Ultrasonographic features highly correlated with PTC risk characteristics were extracted by traditional machine learning method, and an intelligent prediction model with optimal probability of risk characteristics was established. Then, a risk model for predicting CLNM of PTC patients was constructed in combination with clinical features. The diagnostic effectiveness of the model was evaluated by drawing a ROC curve and calculating the area under curve (AUC). Results In the AI explaineable model of PTC risk characteristics in the test set, the intelligent diagnosis model of calcification based on logistic regression classification showed the highest diagnostic efficiency, with an AUC of 0.87 (P<0.05). Compared with the probability model of risk characteristic of PTC alone, the comprehensive model combined with clinical characteristics showed higher diagnostic efficiency in predicting CLNM of PTC patients, with AUC of 0.97, diagnostic critical value of 0.15, corresponding accuracy, sensitivity and specificity of 92.65%, 92.76% and 92.54%, respectively (allP<0.05). Conclusions The explaineble risk characteristics of PTC AI model combined with clinical features can effectively predict the cervical lymph node metastasis of PTC, and then provide effective information for clinical decision-making of PTC patients.

    甲状腺乳头状癌颈部淋巴结转移传统机器学习风险特征人工智能模型列线图

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    知识蒸馏算法训练在胎儿心脏超声图像三血管气管切面精细化分割中的应用

    狄敏蔡祈文马明明田园诗...
    21-26页
    查看更多>>摘要：目的 探索基于知识蒸馏算法训练构建的胎儿心脏超声图像分割网络模型在胎儿心脏超声图像三血管气管切面精细化分割中的应用价值。 方法 回顾性收集2016年1月至2021年12月在浙江大学医学院附属邵逸夫医院接受胎儿心脏超声检查的正常中晚孕期胎儿1 300例，分析胎儿心脏超声三血管气管切面二维灰阶超声图像，将其分为训练集、验证集和测试集。应用训练集与验证集构建辅助诊断网络模型，再用测试集对不同网络模型(U-Net、DeepLabv3＋)进行测试，由一名有经验的医生收集并注释三血管气管切面作为参考标准。以交并比(IoU)、像素精度(PA)和骰子系数(Dice)为3个定量评估分割精度指标，评估该知识蒸馏算法训练模型的诊断效能。并对本模型及最常用的分割模型进行识别，对结果进行比较。随机选取101张图像，分别交由低年资医生、AI及低年资医生辅助AI判读，绘制Bland-Altman图像评价其分别与参考标准的一致性，并对三者结果进行比较。 结果 知识蒸馏算法训练模型在所有评价指标上均取得了比U-Net、DeepLabv3＋模型更好的结果，平均IoU、PA、Dice分别为68.6%、81.4%、81.3%。与U-Net及DeepLabv3＋模型相比，本模型获得了更精确的分割边界，并且在定量评价指标上均有提高。经过该模型辅助，低年资医生对于诊断的精确度有所提高。 结论 知识蒸馏算法训练模型分割方法可在胎儿心脏超声图像的三血管气管切面识别胎儿心脏的解剖结构，其识别结果明显优于相关方法，并可提高低年资医生对于其图像识别的准确度。 Objective To explore the application value of fetal heart ultrasound image segmentation network model based on knowledge distillation technology in the fine segmentation of fetal heart ultrasound image at three-vessel and trachea (3VT) views. Methods One thousand and three hundred fetals were retrospectively collected from Sir Run Run Shaw Hospital, Zhejiang University College of Medicine from January 2016 to December 2021, the two-dimensional grayscale ultrasound images of fetal heart at 3VT views were analyzed and then divided into training, validation, and test sets. The training and validation sets were used to construct the auxiliary diagnostic network models, and the test set was used to test the reliability of different network models (U-Net, DeepLabv3+ ). The 3VT views were collected and annotated by an experienced doctor as the reference standard. The intersection over union (IoU), pixel accuracy (PA) and Dice coefficient (Dice) were used as the 3 indexes to evaluate the segmentation accuracy, and the diagnostic efficiency of the training model was evaluated. The training model and the most commonly used segmentation models were identified, and the results were compared. A total of 101 images were randomly selected and assigned to junior doctors, AI and junior doctors assisted AI interpretation. Bland-Altman images were drawn to evaluate their consistency with the reference standard, and the results were compared. Results The training model of knowledge distillation algorithm achieved better results than U-Net, DeepLabv3+ models on all evaluation indexes, and the average IoU, PA and Dice were 68.6%, 81.4% and 81.3%, respectively. Compared with the U-Net model and DeepLabv3+ model, more accurate segmentation boundaries were obtained by the knowledge distillation algorithm training model, and the quantitative evaluation indexes were improved. With the aid of the model, the diagnostic accuracy of junior doctors was improved. Conclusions The knowledge distillation algorithm training model segmentation method can identify the anatomical structure of the fetal heart in the 3VT view of the fetal heart ultrasound image, and the recognition result is obviously better than other related methods, and can improve the accuracy of image recognition for doctors with low experience.

    人工智能知识蒸馏算法训练胎儿心脏超声图像

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    早孕期胎儿复杂先天性心脏病的超声诊断

    杨水华梁蒙凤覃桂灿梁艳...
    27-35页
    查看更多>>摘要：目的 探讨妊娠11～13＋6周超声对检测胎儿先天性心脏病诊断准确性，并评估其预后。 方法 前瞻性选取2015年1月至2022年12月于广西壮族自治区妇幼保健院进行超声检查的11～13＋6周胎儿，利用规范化超声切面对胎儿进行检查，对可疑先天性心脏病胎儿尽量完善心脏超声检查切面，随访后续超声检查结果、产前诊断、病理解剖及妊娠结局。 结果 72 242例混合风险胎儿共检出先天性心脏病539例，早孕期发生率为0.75%(539/72 242)，软指标阳性胎儿先天性心脏病发生率9.20%(287/3 118)，胎儿多发畸形先天性心脏病发生率16.22%(235/1 449)。复杂先天性心脏病诊断符合率97.42%。对于复杂先天性心脏病，早孕期超声的敏感性90.41%，特异性99.98%，假阳性率0.02%，假阴性率9.59%，结合本研究结果推荐复杂先天性心脏病异常切面模式图。252例行染色微阵列或基因测序，42.46%(107/252)阳性。 结论 规范化超声检查对早孕期胎儿先天性心脏病有较高的检出率，声束对心脏的横向扫描可以显著提高心脏切面灰阶图像的显示，参照心脏切面模式图，有利于胎儿先天性心脏病早期诊断。 Objective To determine the diagnostic accuracy and prognosis of fetal congenital heart disease (CHD) detected by ultrasound at 11-13 weeks gestation. Methods Fetuses at 11 to 13+ 6 weeks gestation in the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region between January 2015 and December 2022 were prospectively collected. Standrardized ultrasound was used to examine the fetuses. For the suspected fetal CHD, the section of cardiac ultrasound was improved as far as possible, and ultrasonic results, prenatal diagnosis, pathological anatomy and pregnancy outcome were followed up. Results A total of 539 cases of CHD were detected in 72 242 fetuses with mixed risk in the first trimester, the incidence was 0.75% (539/72 242). The incidence of CHD in the fetuses with positive soft markers was 9.20% (287/3 118), and the incidence of multiple fetal malformations was 16.22% (235/1 449). The diagnostic accordance rate of complex CHD was 97.42%. For complex CHD, the sensitivity, specificity, false positive rate and false negative rate of first-trimester ultrasound were 90.41%, 99.98%, 0.02%, 9.59%. Combined with the results of this study, the abnormal section model of complex CHD was recommended. A total of 252 cases underwent staining chromosomal microarray or gene sequencing, of which 42.46% (107/252) were positive. Conclusions Standardized ultrasound examination has a very high detection rate for fetal CHD in the first trimester. Transverse scanning of the heart can significantly improve the display of gray scale cardiac section, and reference to the cardiac section pattern map is beneficial to the early diagnosis of fetal CHD.

    超声检查,产前早孕期先天性心脏病

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    妊娠期糖尿病孕妇胎儿大脑沟回发育的超声评价

    张小林朱兆领王睿丽高园...
    36-41页
    查看更多>>摘要：目的 分析妊娠期糖尿病(GDM)孕妇晚孕期胎儿大脑沟回超声特征及血流灌注情况。 方法 前瞻性选取2022年1－10月河南省人民医院进行中晚孕系统筛查的孕28～34周孕妇1 540例，纳入GDM孕妇100例为GDM组，根据控制血糖效果将GDM组分为控制血糖效果满意组(GDM 1组)、控制血糖效果不满意组(GDM 2组)，每组各50例。同时纳入妊娠28～34周的50例健康孕妇作为对照组。比较三组胎儿外侧裂、顶枕沟、距状沟以及扣带沟的深度之间差异，分析大脑沟回测量值与控制后血糖水平的相关性，并对三组间胎儿脐动脉搏动指数(MCPI)、大脑中动脉搏动指数(UAPI)、静脉导管搏动指数(DVPI)进行比较，以评估三组胎儿血流灌注情况的差异。 结果 GDM 1组与对照组外侧裂、顶枕沟、扣带沟、距状沟深度测值之间差异无统计学意义(均P>0.05)，但均大于GDM 2组(P<0.05)。外侧裂、顶枕沟、扣带沟及距状沟深度与空腹血糖、餐后1 h血糖、餐后2 h血糖呈负相关(均P<0.05)。对照组与GDM 1组MCAPI、UAPI、DVPI差异无统计学意义(均P>0.05)，GDM 2组MCAPI小于对照组及GDM 1组，UAPI及DVPI大于对照组及GDM 1组(均P<0.05)。 结论 GDM孕妇的胎儿大脑沟回发育成熟度与孕妇血糖控制情况有关，孕妇持续高血糖状态，胎儿血流灌注改变可能引起大脑沟回发育迟缓。 Objective To evaluate the development of fetal cerebral sulci and gyrus and the blood perfusion in pregnant women with gestational diabetes mellitus(GDM) by ultrasound. Methods A total of 1 540 pregnant women with 28-34 weeks of pregnancy who underwent systematic screening in Henan Provincial People′s Hospital from January 2022 to October 2022 were prospectively selected, 100 pregnant women with GDM were selected as the GDM group. According to the effect of blood glucose control, the GDM group was divided into 2 groups: the satisfied control group (GDM group 1), and the dissatisfied control group (GDM group 2), with 50 cases in each group. At the same period, 50 healthy pregnant women at 28-34 weeks of gestation were enrolled as the control group. The differences of the sylvian fissure, parietooccipital sulci, calcarine sulci and cinguli sulci among the 3 groups were statistically analyzed. And the correlations between the deep of the brain cerebral sulci and gyrus and controlled blood glucose levels were evaluated. The umbilical artery pulsation index(UAPI), middle cerebral artery pulsation index(MCAPI) and ductus venosus pulsation index(DVPI) among the 3 groups were compared, and the differences in fetal blood perfusion among the 3 groups were evaluated. Results There were no significant differences in the depths of the sylvian fissure, parietooccipital sulci, calcarine sulci and cinguli sulci between the control group and the GDM group 1 (all P>0.05), and they were larger than those of the GDM group 2 (allP<0.05). The depths of lateral fissure, parieto-occipital sulcus, cingulate sulcus and calcarine sulcus were negatively correlated with fasting blood glucose, 1 h and 2 h postprandial blood glucose (allP<0.05). There were no significant differences in MCAPI, UAPI and DVPI between the control group and GDM1 group (allP>0.05). The MCAPI in GDM 2 group was lower than that in the control group and GDM 1 group, and the UAPI and DVPI values were higher than those in the control group and GDM1 group(allP<0.05). Conclusions The maturity of fetal cerebral sulci and gyrus in GDM pregnant women is related to the blood glucose control of pregnant women. The change of blood perfusion caused by persistent hyperglycemia in pregnant women and intrauterine hypoxia may cause the development retardation of cerebral sulci and gyrus.

    超声检查妊娠期糖尿病胎儿大脑沟回

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    经颅超声评估注意缺陷多动障碍儿童黑质回声的应用研究

    马冰沈耀红陈艳朱俊益...
    42-48页
    查看更多>>摘要：目的 利用经颅超声(TCS)技术分析儿童注意缺陷多动障碍(ADHD)患儿的超声神经影像学特点，探讨TCS对辅助诊断儿童ADHD的临床应用价值。 方法 前瞻性纳入2021年8月至2022年8月于苏州市立医院和苏州大学附属儿童医院就诊的50例6～12岁ADHD儿童(ADHD组)和年龄匹配的45例健康儿童(对照组)，ADHD的诊断以美国精神病学会《精神疾病诊断与统计手册》第5版(DSM-Ⅴ)为标准，并根据患儿临床症状特征将其分为3种亚型，其中注意缺陷为主型14例，多动冲动为主型3例，混合型33例。应用TCS观察两组儿童中脑黑质(SN)的变化，测量SN强回声面积并计算SN强回声面积与中脑面积的比值(S/M)，比较两组间各参数的差异。采用Pearson相关分析法分析ADHD组SN强回声面积和S/M与DSM-Ⅴ评分的相关性。 结果 半定量分析：ADHD组SN强回声≥Ⅲ级比例明显大于对照组[96.00%(48/50)比13.33%(6/45)，P<0.05]。定量分析：ADHD组SN强回声面积、S/M大于对照组[0.32(0.22，0.38)cm2比0.00(0.00，0.00)cm2，7.08(5.11，8.75)%比0.00(0.00，0.00)%，均P<0.05]。相关性分析：ADHD组SN强回声面积和S/M与DSM-Ⅴ评分之间无明显相关性(r＝0.144、0.142，均P>0.05)。 结论 TCS可以发现ADHD患儿SN回声增强，SN回声增强比例、SN强回声面积及S/M明显高于正常儿童，但SN强回声面积和S/M与DSM-Ⅴ评分无明显相关性。 Objective To determine the clinical application value of transcranial sonography (TCS) in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children. Methods A total of 50 children aged 6-12 years diagnosed with ADHD (ADHD group) and 45 age-matched healthy children (control group) who presented to Suzhou Municipal Hospital and Children′s Hospital of Soochow University from August 2021 to August 2022 were prospectively enrolled for TCS examination. ADHD was diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-Ⅴ) criteria established by the American Psychiatric Association.Based on clinical symptom characteristics, ADHD was further classified into 3 subtypes, including 14 cases of predominantly inattentive, 3 cases of predominantly hyperactive/impulsive, and 33 cases of combined presentation. The substantia nigra(SN) hyperechoic area and the ratio of SN hyperechoic area to midbrain area (S/M) were measured and compared between the two groups. The examination of the correlation was performed between SN hyperechoic area, S/M ratio, and DSM-Ⅴ scores within the ADHD group. Results Semi-quantitative analysis: the proportion of the SN grade Ⅲ or more in ADHD group was significantly higher than that in control group [96.00%(48/50) vs 13.3%(6/45), P<0.05]. Quantitative analysis: the area of SN hyperechogenicity and the ratio of S/M were significantly larger in ADHD group than in control group [0.32(0.22, 0.38)cm2 vs 0.00(0.00, 0.00)cm2, 7.08(5.11, 8.75)% vs 0.00(0.00, 0.00)%, all P<0.05]. Correlation analysis: The SN hyperechoic area and S/M ratio showed no significant correlations with DSM-Ⅴ scores in the ADHD group (r=0.144, 0.142, all P>0.05). Conclusions TCS can detect the SN echo enhancement of ADHD children, and the proportion of SN echo enhancement, SN hyperechoic area and S/M ratio are significantly higher than those of normal children, but the SN hyperecho area and S/M ratio are not significantly correlated with DSM-Ⅴ scores.

    超声检查,经颅注意缺陷多动障碍儿童黑质

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    不同类型心房颤动患者心房容积及应变参数对病程进展的预测价值

    王柳青宋宏宁曹省胡波...
    49-56页
    查看更多>>摘要：目的 应用二维斑点超声心动图(2D-STE)及实时三维超声心动图(RT-3DE)评估持续性心房颤动(per-AF)及阵发性心房颤动(PAF)患者心脏形态及功能参数，探究其对心房颤动发生及进展的预测价值。 方法 回顾性纳入2022年5月至2023年5月于武汉大学人民医院行超声心动图检查的30例per-AF患者(per-AF组)、30例PAF患者(PAF组)和25例健康体检者(对照组)。2D-STE评估代表储存、管道和收缩功能的左/右心房纵向应变(LASr/RASr、LAScd/RAScd、LASct/RASct)，并计算左心房僵硬度(LASI)。RT-3DE获取三维左/右心房最大容积指数(LAVImax/RAVImax)、左/右心房最小容积指数(LAVImin/RAVImin)和左/右心房总排空分数(LAEF/RAEF)。将心房颤动患者分为LAVI正常组及LAVI增大组，比较各组间心房应变的差异。利用ROC曲线评价超声参数对左心房容积正常的心房颤动患者的总体诊断效果及截断值。将以上超声参数建立多因素Logistic回归模型，筛选出与不同类型心房颤动发生的相关超声参数。 结果 ①结构上，对照组、PAF组、per-AF组左心房前后径(LAD)、右心房左右径(RAD)、RAVImin逐次增大，LAEF、RAEF逐次减小(均P<0.05)。②应变上，对照组、PAF组、per-AF组LASr逐次减小(均P<0.05)；与对照组相比，PAF组及per-AF组LAScd、RASr、RAScd绝对值明显减小，PAF组LASct、RASct绝对值明显减小(均P<0.05)。③与LAVI正常组比较，LAVI增大组LASr、LAScd、LASct绝对值降低，LASI升高(均P<0.05)；与对照组比较，LAVI正常组左、右心房各应变参数降低，LASI升高(均P<0.05)。构建左心房容积正常受试者心房应变参数ROC曲线，显示RASr识别心房颤动患者的ROC曲线下面积(AUC)最大。④多因素Logistic回归分析显示，LAVImin、RASr是PAF的影响因素(OR＝1.521、0.907，95%CI＝1.173～1.972、0.825～0.998，P＝0.002、0.044)；LASr是per-AF的影响因素(OR＝0.858，95%CI＝0.802～0.917，P<0.001)。 结论 运用2D-STE和RT-3DE可评估双心房结构和功能变化，其中LAVImin、LASr、RASr对心房颤动的发生及进展有一定预测价值。 Objective To evaluate the cardiac morphological and functional parameters of patients with persistent atrial fibrillation (per-AF) and paroxysmal atrial fibrillation (PAF) using two-dimensional speckle tracking echocardiography (2D-STE) and real-time three-dimensional echocardiography (RT-3DE), and to explore their predictive value for the occurrence and progression of atrial fibrillation. Methods A retrospective study was conducted on 30 per-AF patients (per-AF group), 30 PAF patients (PAF group) and 25 non-AF subjects (control group) who underwent echocardiography at Wuhan University People′s Hospital from May 2022 to May 2023. The left/right atrial longitudinal strain of reservoir, conduct and contraction (LASr/RASr, LAScd/RAScd, LASct/RASct), and calculated left atrial stiffness (LASI) were assessed by 2D-STE. Three-dimensional left and right atrial maximum volume index (LAVImax/RAVImax), minimum volume index (LAVImin/RAVImin) and emptying fraction (LAEF/RAEF) were obtained by RT-3DE. Then, patients with atrial fibrillation were divided into the normal LAVI group and enlarged LAVI group, and the differences of atrial strain among each group were compared. ROC curve was used to evaluate the overall diagnostic efficiency and cutoff values of ultrasonic parameters in patients with normal volume of atrial fibrillation. Finally, a multivariate Logistic regression model was established to identify the ultrasonic parameters associated with the occurrence and progression of different types of atrial fibrillation. Results ①Structurally, LAD, RAD and RAVImin in control, PAF and per-AF groups increased gradually, while LAEF and RAEF decreased gradually (all P<0.05). ②In terms of strain, LASr in control, PAF and per-AF groups decreased gradually (allP<0.05) Compared with the control group, LAScd, RASr and RAScd in PAF and per-AF groups were significantly decreased, and LASct and RASct in PAF group were significantly decreased (allP<0.05). ③Compared with the normal LAVI group, the LASr, LAScd and LASct in the enlarged LAVI group were significantly decreased, while LASI was significantly increased (allP<0.05) Compared with control group, the left and right atrial strain parameters in LAVI normal group were decreased, and LASI was increased (allP<0.05). The atrial strain parameter ROC was constructed in all subjects with normal left atrial volume, and RASr was the most sensitive indicator.④Multi-factor Logistic regression analysis showed that LAVImin and RASr were the influence factors of PAF (OR=1.521, 0.907 95%CI=1.173-1.972, 0.825-0.998 P=0.002, 0.044), LASr was the influence factor of pre-AF (OR=0.858, 95%CI=0.802-0.917, P<0.001). Conclusions 2D-STE and RT-3DE can be used to evaluate the structural and functional changes of both atria, especially LAVImin, LASr and RASr, which have certain predictive value for the occurrence and progression of atrial fibrillation.

    超声心动描记术心房颤动心房容积纵向应变

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    同轴针技术辅助凝血功能异常患者经皮肝脏穿刺活检：一项多中心研究

    李凤尧郭光辉吴宇轩贺需旗...
    57-62页
    查看更多>>摘要：目的 探究应用同轴针穿刺技术对于凝血功能异常的患者在经皮肝脏穿刺活检中的有效性和安全性。 方法 回顾性收集2018年12月至2021年5月在三个中心超声引导下采用同轴针技术行经皮肝脏穿刺活检210例患者的临床资料，分析凝血功能异常组和凝血功能正常组间的穿刺成功率、取样次数、病理合格率、穿刺术中出血及术后出血发生率等指标，并进行组间比较。 结果 经倾向性评分匹配后，两组各有105例患者，穿刺成功率均为100%，所有样本的病理合格率均为100%。两组术中出血分别为78例(74.3%，78/105)和64例(61.0%，64/105)，两组间差异有统计学意义(P＝0.006)。术后出血两组分别有3例(2.9%，3/105)和0例，两组间差异无统计学意义(P＝0.081)。 结论 对于凝血功能异常患者，采用同轴针技术进行经皮肝脏穿刺活检，在获取适量组织标本的同时具有良好的安全性。 Objective To investigate the effectiveness and safety of the coaxial needle technique in percutaneous liver biopsy for patients with coagulation function abnormalities. Methods Clinical data of 210 patients who underwent percutaneous liver biopsy using the coaxial needle technique under ultrasound guidance from December 2018 to May 2021 in 3 centers were collected. A retrospective analysis was conducted to compare the puncture success rate, number of samples obtained, pathology qualification rate, intraoperative and postoperative bleeding rates between the group with coagulation function abnormalities and the group with normal coagulation function. Results After propensity score matching, there were 105 patients in each group, with a puncture success rate of 100% in both groups. The pathology qualification rate was 100% for all samples.Intraoperative bleeding occurred in 78 cases (74.3%, 78/105) in the coagulation function abnormalities group and in 64 cases (61.0%, 64/105) in the normal coagulation function group, with a statistically significant difference between the two groups (P=0.006). Postoperative bleeding occurred in 3 cases (2.9%, 3/105) in the coagulation function abnormalities group and in 0 case in the normal coagulation function group, with no statistically significant difference between the two groups (P=0.081). Conclusions The use of the coaxial needle technique for percutaneous liver biopsy in patients with coagulation function abnormalities not only allows for obtaining an adequate tissue sample but also demonstrates good safety.

    同轴针经皮肝脏穿刺活检凝血功能异常术后出血

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    基于超声造影影像组学预测局部进展期直肠癌新辅助放化疗病理完全缓解的应用研究

    秦琼吴玉泉文荣白秀梅...
    63-70页
    查看更多>>摘要：目的 评估基于超声造影的影像组学模型对局部进展期直肠癌(LARC)患者新辅助放化疗(nCRT)后病理完全缓解(pCR)的预测效能。 方法 本研究回顾性纳入2018年4月至2023年4月在广西医科大学第一附属医院接受nCRT后行全直肠系膜切除的106例LARC患者，以6∶4随机划分为训练集63例(pCR者14例)和验证集43例(pCR者12例)。基于PyRadiomics从超声造影图像肿瘤感兴趣区域提取影像学特征。采用类内相关系数、Mann-Whitney U检验、最小绝对收缩和选择算子算法对特征进行降维。最后选取7个与pCR相关的影像学特征，基于R语言使用弹性网络回归构建超声造影影像组学模型，并与临床特征融合构建一个联合模型。采用ROC曲线下面积(AUC)评估模型的诊断效能。 结果 训练集中，超声造影影像组学模型的AUC为0.695(95%CI＝0.532～0.859)，联合模型的AUC为0.726(95%CI＝0.584～0.868)。验证集中，超声造影影像组学模型的AUC为0.763(95%CI＝0.625～0.902)，联合模型的AUC为0.790(95%CI＝0.653～0.928)。单因素及多因素逻辑回归分析均表明CA199(P<0.05)和超声造影影像组学评分(P<0.001)可作为LARC患者nCRT后pCR的独立预测因子。 结论 超声造影影像组学评分对LARC患者nCRT后是否达到pCR具有一定预测价值，有可能为预测LARC患者nCRT后达到pCR提供一种无创影像学生物标志物。 Objective To evaluate the diagnostic performance of radiomics model based on contrast-enhanced ultrasound(CEUS) in predicting pathological complete response(pCR) after neoadjuvant chemoradiotherapy(nCRT) in patients with locally advanced rectal cancer(LARC). Methods One hundred and six patients with LARC who underwent total mesorectal excision after nCRT between April 2018 and April 2023 in the First Affiliated Hospital of Guangxi Medical University were retrospectively included, the patients were randomly divided into a training set of 63(14 pCR patients) and a validation set of 43(12 pCR patients) in a 6∶4 ratios. Radiomics features were extracted from the tumors′ region of interest of CEUS images based on PyRadiomics. Intra-class correlation coefficient(ICC), Mann-Whitney U test, and least absolute shrinkage and selection operator(LASSO) algorithms were used to reduce features dimension. Finally, 7 radiomics features relevanted to pCR were selected to construct an ultrasomics model using elastic network regression, based on the R language. A combined model was constructed by jointing clinical feature. The performance of the models was assessed with the area under the ROC curve(AUC). Results The AUC of the ultrasomics model and the combined model was 0.695(95%CI=0.532-0.859) and 0.726(95%CI=0.584-0.868) respectively in the training set. The AUC of the ultrasomics model and the combined model was 0.763(95%CI=0.625-0.902) and 0.790(95%CI=0.653-0.928) respectively in the validation set. Both univariate and multivariate Logistic regression analyses showed that CA199(P<0.05) and ultrasomics score(P<0.001) could be an independent predictor of pCR after nCRT in patients with LARC. Conclusions The CEUS-based radiomics scores has certain predictive value for whether LARC patients achieve pCR after nCRT, and may provide a non-invasive imaging biomarker for predicting LARC patients achieve pCR after nCRT.

    超声造影影像组学局部进展期直肠癌新辅助放化疗病理完全缓解

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    剪切波弹性成像评估局部晚期直肠癌新辅助放化疗后T再分期的应用价值

    钱清富卓敏玲唐懿林晓东...
    71-76页
    查看更多>>摘要：目的 探讨剪切波弹性成像(SWE)在局部晚期直肠癌新辅助放化疗(nCRT)后T再分期评估中的应用价值。 方法 前瞻性收集2021年10月至2023年3月在福建医科大学附属协和医院接受nCRT，并接受全直肠系膜切除术的局部晚期直肠癌患者271例，记录临床、经直肠腔内超声(ERUS)和SWE检查资料。分析并筛选出低T分期的独立预测因子，构建Logistic回归模型。采用独立的测试集数据验证模型的预测性能，并与超声医师的诊断结果进行比较。 结果 二元多因素Logistic回归分析结果显示，病灶周围系膜杨氏模量平均值(Emean)、病灶厚径、肠周肿大淋巴结是诊断低T分期的独立预测因子，OR值分别为1.089、1.214、0.183。采用病灶周围系膜Emean、病灶厚径、肠周肿大淋巴结建立的Logistic回归模型A和采用病灶周围系膜Emean建立的Logistic回归模型B均具有较高的诊断效能(ROC曲线下面积分别0.931、0.918，准确性分别为0.888、0.887)，两者的诊断准确性差异无统计学意义(P＝1.000)，但显著高于超声医师(均P<0.001)。 结论 SWE可以有效预测局部晚期直肠癌nCRT后肿瘤是否为低T分期，对评估直肠癌nCRT后T再分期具有较高的应用价值。 Objective To investigate the application value of shear wave elastography (SWE) in the evaluation of T re-staging after neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer. Methods Clinical, endorectal ultrasound (ERUS) and SWE data of 271 patients with locally advanced rectal cancer who underwent nCRT and total mesorectal excision in Fujian Medical University Union Hospital from October 2021 to March 2023 were prospectively collected. The independent predictors for low T staging were analyzed and screened, and the Logistic regression model was constructed. An independent test set was used to validate the prediction performance of the models and compare them with the diagnostic results of sonographers. Results Binary multivariate Logistic regression analysis showed that Emean of the mesentery around the lesion, thickness, and enlarged lymph nodes around the rectum were the independent predictors for low T staging, and the odds ratios were 1.089, 1.214, 0.183, respectively. The Logistic regression model A established by Emean, thickness and enlarged lymph nodes around the lesion and the Logistic regression model B established by Emean around the lesion had high diagnostic efficiencies (area under the ROC curve were 0.931, 0.918, respectively, the accuracy were 0.888 and 0.887, respectively). There was no significant difference in diagnostic accuracy between the two models (P=1.000), and both models were significantly higher than that of sonographers (all P<0.001). Conclusions SWE can effectively predict whether the tumor is of low T staging after nCRT in locally advanced rectal cancer, and can be used as an important supplement to ERUS in evaluating the T re-staging of rectal cancer after nCRT.

    超声检查,经直肠腔内直肠癌新辅助放化疗弹性成像

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