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| 1 | 计算弥散加权成像在胆囊良恶性病变诊断中的价值显示文摘目的:探讨计算弥散加权成像(computed diffusion-weighted imaging,cDWI)诊断胆囊良恶性病变的价值。方法:回顾性选取某院2018年2月至2022年2月经病理确诊的54例胆囊疾病患者的临床资料,其中胆囊恶性肿瘤患者27例(恶性组)、胆囊良性病变患者27例(良性组)。使用MR设备对2组患者进行检查并生成表观扩散系数(apparent diffusion coefficient,ADC)图像,将生成的ADC图像传输到Ziostation,根据标准的单指数拟合生成b值分别为1500、2000、3000、4000 s/mm^(2)的cDWI图像。对比2组患者的ADC值并采用ROC曲线分析ADC的诊断效能;对比不同高b值下cDWI及cDWI联合ADC对胆囊良恶性病变的诊断效能,以及在b=1000 s/mm^(2)和b=1500 s/mm^(2)下单独的常规弥散加权成像(common diffusion weighted imaging,mDWI)、cDWI及mDWI联合ADC、cDWI联合ADC对胆囊良恶性病变的诊断效能。采用SPSS 21.0软件进行统计学分析。结果:恶性组的平均ADC值为1.697×10^(-3)mm^(2)/s,显著低于良性组(2.203×10^(-3)mm^(2)/s),差异有统计学意义(P<0.05);当ADC值为1.796×10^(-3)mm^(2)/s时AUC最大,为0.858,敏感度和特异度分别为81.3%、90.9%;b=1500 s/mm^(2)时cDWI联合ADC显示了最佳的诊断效能,敏感度、特异度和准确率分别为92.59%、85.19%和88.89%,准确率和特异度均高于b=1000 s/mm^(2)时mDWI、b=1000 s/mm^(2)时mDWI联合ADC和b=1500 s/mm^(2)时cDWI,差异有统计学意义(P<0.05),而敏感度比较差异无统计学意义(P>0.05)。结论:b=1500 s/mm^(2)时cDWI联合ADC对胆囊良恶性病变具有较高的诊断效能,且相较于mDWI更具优势。 | 蒋衡梓 杨季春 | 2023 | 医疗卫生装备2023，44，11： | 0 |
| 2 | 术中超声在胆道外科的应用进展显示文摘胆道外科的发展趋势是微创化,以最小创伤来解决复杂的临床问题。术中超声在胆道外科的应用大大推进了胆道外科微创化的发展,形成了多种依赖于术中超声的新型术式。术中超声可在术中对胆管结石、肿瘤、炎症、胆管变异等关键结构精准定位并引导相关操作(如引导胆道镜及器械取石、置管引流、穿刺活检、肿瘤消融)。术中超声可指导选择最佳断肝平面及脉管结扎点,最大限度地保留重要脉管结构及残肝功能。随着精准胆道外科的发展,术中超声将会向探头微小化、术中穿刺技术、超声造影、弹性成像、融合导航等方向发展,使手术更加微创、精准和高效。 | 王彦冬 经翔 | 2022 | 医学综述2022，28，10： | 0 |
| 3 | Evaluation of remote radiologist-interpreted point-of-care ultrasound for suspected dengue patients in a primary health care facility in Colombia显示文摘Background Early identification of plasma leakage may guide treatment decisions in dengue patients.This study evaluated the value of point-of-care ultrasound(POCUS)to detect plasma leakage and predict hospitalization or referral to a higher level of care in suspected dengue patients under routine conditions at a primary care facility in Colombia.Methods We conducted a cohort study between April 2019 and March 2020 in a primary care hospital in Cali,Colombia.We prospectively included and followed 178 patients who were at least 2 years old with fever of less than 10 days and clinician-suspected dengue.A trained general practitioner performed a standardized POCUS protocol.Images were quality-rated and overread by an expert radiologist,and her results and those of the general practitioner were compared using the Kappa index.Logistic regression was used to identify factors associated with plasma leakage at enrollment and explore its prognostic value regarding hospital admission or referral to a higher level of care.Results Half(49.6%)POCUS images were of suitable quality to be interpreted.The proportion of plasma leakage reported by the radiologist was 85.1%(95%CI:78.6-90.2%)and 47.2%by the study physician(Kappa=0.25,95%CI:0.15-0.35).The most frequent ultrasound findings were ascites(hepatorenal 87.2%,splenorenal 64%,or pelvic 21.8%)and gallbladder wall thickening(10.5%).Plasma leakage was higher in subjects with thrombocytopenia(aOR=4,95%CI:1.3-12.1)and lower in patients 30-59 years old(aOR=0.1,95%CI:0.0-0.4)than in those 18 years old or younger.POCUS evidence of plasma leakage(aOR=8.2,95%CI:2.2-29.9),thrombocytopenia(aOR=6.3,95%CI:2.4-16.0)and pulse pressure(aOR=1.1,95%CI:1.07-1.2)were associated with hospital admission or referral to a higher level of care.Conclusions Ultrasound is useful to detect plasma leakage in primary care and,challenges remain to guarantee high-quality images and diagnostic accuracy,for which a standardized dengue POCUS protocol and training program is needed. | Lyda Osorio Iñigo Prieto Daniela Zuluaga Deliana Ropero Neelesh Dewan Jonathan D.Kirsch | 2023 | Infectious Diseases of Poverty2023，12，5： | 0 |
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