Radiation studies in the detection of early signs of lung tissue lesion in sarcoidosis

The capacities of various radiation techniques in the study of patients with pulmonary sarcoidosis are analyzed. The sequence of their use, which ensures a high informative value, is proposed. By analyzing the X-ray semiotics in 45 patients with pulmonary sarcoidosis, the authors give the diagnostic signs of early lung parenchymal damage in this disease. Particular emphasis is placed on the procedure of lung X-ray computed tomography.     

Complex radiation diagnosis of the intrathoracic thyroid

The study deals with a complex radiation diagnosis of mass lesions of the distopic thyroid. Forty five patients with mass lesions of the anterior mediastenum were examined. They were 28 with retrosternal and intrathoracic goiter, 6 with teratodermoid tumors, 11 with cysts of the anterior mediastenum. A complex radiation study included serial routine X-ray tomography in 2 standard projects, sonography, computed tomography. The diagnosis was verified on the basis of transthoracic and transbronchial needle biopsy with compulsory morphological confirmation. An intergroup comparison has shown that X-ray study is a screening method to detect a tumor, to define its site and its relationship with the adjacent organs. Ultrasound study reveals pathognomonic signs of the distopic goiter. Of the greatest informative value is X-ray CT which allows one to state about the structure of a tumor and its densitometric signs.     

循环肿瘤细胞在肺癌诊断中的应用及临床意义

为了探讨循环肿瘤细胞(circulating tumor cells,CTCs)在肺癌诊断中的应用及临床意义,本研究收集了我院2014年10月至2017年12月收治并确诊的肺癌患者87例、健康体检者40名以及肺部良性疾病患者50例作为研究对象,采用人循环肿瘤细胞试剂盒测定外周血CTC水平,两组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis检验,利用ROC曲线评价CTC在肺癌诊断上的灵敏度以及特异度。实验发现肺癌患者CTC水平(M=12.67 Unints/3 mL)显著高于肺部良性病患者(M=4.76 Unints/3 mL)和健康者(M=4.48 Unints/3 mL),差异存在统计学意义(p<0.001)。在不同性别、不同年龄段以及不同病理类型之间肺癌患者的CTC水平比较差异无统计学意义(p>0.05)。Ⅲ+Ⅳ期肺癌患者CTC水平显著高于Ⅰ+Ⅱ期患者,差异存在统计学意义(p<0.001)。有远处转移的肺癌患者CTC水平显著高于无远处转移的肺癌患者,差异存在统计学意义(p<0.001)。ROC曲线下面积为0.878(95%CI 0.820~0.936),临界值为6.34 Unints/3 mL,对应的灵敏度为0.77,特异度为0.989。本研究初步认为,CTC检测对肺癌诊断具有较高的灵敏度以及特异度,可能存在重要的临床应用价值。     

Potentialities of ultrasound and computed tomography in the diagnosis of metastases of lung cancer in the mediastinal lymph nodes]

The results of routine roentgenotomography, CT and USI in the diagnosis of intrathoracic metastases of lung cancer were compared in 69 patients (central type--52, peripheral--17). These results were compared with operative findings in 45 patients. The sensitivity of USI in the diagnosis of enlarged paravasal lymph nodes exceeded that of roentgenotomography and was slightly inferior to CT. CT was informative for all mediastinal lymph nodes whereas tomography and USI were informative in certain areas only. The authors recommend to combine the use of routine and ultrasound tomography to assess the spreading of lung cancer to the mediastinum. The information obtained increases the accuracy of staging and specifying a process, slightly yielding CT results.     

Significance of the method of fractal dimension assessment of x-ray images in the differential diagnosis of spherical formations of the lungs

A posterior processing of tomograms was made in 210 patients with spherical formations of the lungs of various etiological factors. The method based on tomograms delicate texture study according to the system of 7 diagnostic signs by means of the fractal dimension of X-ray pictures of the pathological focuses made the tomography diagnosis more informative in lung spherical formations substrate recognition. The method of fractal estimation allowed to reach a 14.7% rise of the precision, a 12.6% rise of the sensitiveness and a 17.1% rise of the specificity of diagnosis as compared with the routine X-ray research.     

高频肺部超声结合分区域扫查早期鉴别新生儿肺透明膜病及湿肺的研究

摘要 目的：探讨高频肺部超声结合分区域扫查早期鉴别新生儿肺透明膜病（HMD）及湿肺（TTN）的临床价值。方法：选取2019年1月～2020年7月因呼吸窘迫进入我院新生儿重症监护室的163例新生儿作为研究对象,患儿均接受X线和高频肺部超声检查,采用最终临床诊断作为金标准,采用受试者工作曲线（ROC）计算超声和X线诊断HMD和TTN的灵敏度、特异性、阳性预测值、阴性预测值、曲线下面积（AUC）、95％CI。结果：超声诊断HMD的灵敏度、特异性、阳性预测值、阴性预测值、AUC均高于X线检查。Z检验显示超声与X线诊断HMD的AUC存在统计学意义（Z=3.996,P=0.001）。超声诊断TTN的灵敏度、特异性、阳性预测值、阴性预测值、AUC均高于X线。Z检验显示,超声与X线诊断TTN的AUC存在统计学差异（Z=4.188,P＜0.001）。结论：高频肺部超声结合分区域扫查早期鉴别新生儿肺透明膜病及湿肺的临床价值高于X线,值得临床推广应用。     

A place of digital X-ray fluorography in the detection of lung diseases in the public health facilities of the Russian Federation

The paper shows the authors' opinion as to the use of digital X-ray fluorography (DXF) to detect pathology of the lung, primarily its tuberculosis and cancer from organizational-and-methodological and purely diagnostic standpoints. Based on a great body of data pooling 21,295 studies of patients, which comprised two (screening and routine clinical) groups, they authors state their views on the place and role of lung DXF in the work of public health facilities in the Russian Federation (RF). The objectivity of the authors' opinion is confirmed by the different nature of a lung abnormality detected by DXF at both the municipal and regional levels of the RF public health system and by a comparative analysis of the findings with those of film fluorography, routine X-ray study, linear tomography, X-ray computed tomography (XCT), and surgical evidence. The study has allowed the authors to express their opinion by recommending DXF as a method for primary diagnosis of lung diseases instead of film fluorography and routine X-ray study and to appreciate it in screenings. The authors' data indicate that XCT in its simplest variant rather than linear tomography should become the optimum method that specifies the diagnosis of lung diseases detected by DXT.     

Diagnosing and Mapping Pulmonary Emphysema on X-Ray Projection Images: Incremental Value of Grating-Based X-Ray Dark-Field Imaging

Purpose

To assess whether grating-based X-ray dark-field imaging can increase the sensitivity of X-ray projection images in the diagnosis of pulmonary emphysema and allow for a more accurate assessment of emphysema distribution.

Materials and Methods

Lungs from three mice with pulmonary emphysema and three healthy mice were imaged ex vivo using a laser-driven compact synchrotron X-ray source. Median signal intensities of transmission (T), dark-field (V) and a combined parameter (normalized scatter) were compared between emphysema and control group. To determine the diagnostic value of each parameter in differentiating between healthy and emphysematous lung tissue, a receiver-operating-characteristic (ROC) curve analysis was performed both on a per-pixel and a per-individual basis. Parametric maps of emphysema distribution were generated using transmission, dark-field and normalized scatter signal and correlated with histopathology.

Results

Transmission values relative to water were higher for emphysematous lungs than for control lungs (1.11 vs. 1.06, p<0.001). There was no difference in median dark-field signal intensities between both groups (0.66 vs. 0.66). Median normalized scatter was significantly lower in the emphysematous lungs compared to controls (4.9 vs. 10.8, p<0.001), and was the best parameter for differentiation of healthy vs. emphysematous lung tissue. In a per-pixel analysis, the area under the ROC curve (AUC) for the normalized scatter value was significantly higher than for transmission (0.86 vs. 0.78, p<0.001) and dark-field value (0.86 vs. 0.52, p<0.001) alone. Normalized scatter showed very high sensitivity for a wide range of specificity values (94% sensitivity at 75% specificity). Using the normalized scatter signal to display the regional distribution of emphysema provides color-coded parametric maps, which show the best correlation with histopathology.

Conclusion

In a murine model, the complementary information provided by X-ray transmission and dark-field images adds incremental diagnostic value in detecting pulmonary emphysema and visualizing its regional distribution as compared to conventional X-ray projections.     

AD-MPE与TPE患者血常规参数变化及其诊断价值

目的:比较结核性胸腔积液(tuberculous pleural effusion,TPE)和肺腺癌性胸腔积液(malignant pleural effusion associated with lung adenocarcinoma,AD-MPE)血常规参数及相关炎症指标的比值,探讨单项指标或联合分析的鉴别诊断价值...     

Spiral computed tomography in the diagnosis of limb osteomyelitis

The results of radiation studies in 121 patients of different age (4 to 75 years) examined for limb osteomyelitis are analyzed. All the patients underwent routine X-ray study and computed tomography (CT), 26 patients had X-ray fistulography; 8, linear tomography; 10, CT fistulography; 6, scintigraphy, and 15, ultrasound study. Acute hematogenous osteomyelitis (AHO), chronic hematogenous osteomyelitis (CHO), and atypical (here Garre's sclerosing osteomyelitis and Brodie's abscess) osteomyelitis were ascertained in 10.6, 26.4, and 10.1% of cases, respectively. Posttraumatic osteomyelitis was diagnosed in almost 50% of the patients. CT defined the phase of chronic limb osteomyelitis. Spiral CT has proven to be the most effective technique for diagnosing limb osteomyelitis as compared with routine X-ray study: the accuracy of X-ray study was 81.8%, its sensitivity, 84.9%, and specificity, 60.0% and those of computed tomography were 96.7, 99.1, and 80.0%, respectively.     

Spiral computed tomography in the diagnosis of limb osteomyelitis

The results of radiation studies in 121 patients of different age (4 to 75 years) examined for limb osteomyelitis are analyzed. All the patients underwent routine X-ray study and computed tomography (CT), 26 patients had X-ray fistulography; 8, linear tomography; 10, CT fistulography; 6, scintigraphy, and 15, ultrasound study. Acute hematogenous osteomyelitis (AHO), chronic hematogenous osteomyelitis (CHO), and atypical (here Garre's sclerosing osteomyelitis and Brodie's abscess) osteomyelitis were ascertained in 10.6, 26.4, and 10.1% of cases, respectively. Posttraumatic osteomyelitis was diagnosed in almost 50% of the patients. CT defined the phase of chronic limb osteomyelitis. Spiral CT has proven to be the most effective technique for diagnosing limb osteomyelitis as compared with routine X-ray study: the accuracy of X-ray study was 81.8%, its sensitivity, 84.9%, and specificity, 60.0% and those of computed tomography were 96.7, 99.1, and 80.0%, respectively.     

X-ray diagnosis of lung cancer and its morphological variants

The purpose of the study was to substantiate the capacities of X-ray recognition of the histological types of lung cancer and different tumor differentiation grades. The data available on 238 patients were studied; of them 169 patients were diagnosed as having primary lung cancer that was morphologically verified. In 154 patients, the tumor was not greater than 3.0 cm in diameter and belonged to the main histological types. X-ray study, analogue, digital tomography, X-ray surgery with percutaneous needle biopsy and rapid cytology were used. The diagnosis made by WHO ICD-10 C34.1-3 BDU (probable) and C34.1-3 M (valid) was a criterion for the quality of a accomplished diagnostic case. Of 13 traditional X-ray sings of lung cancer, 6 characteristics of a tumor image were taken for a following analysis. A number of signs correlate with the histological type of lung cancer in the symptom complexes that characterize the image of its histological types. Thus, "specula" are detectable in adenocarcinoma; a lobate pattern and minor focal clarification are also almost without exception characteristic. The differences between the images of squamous-cell carcinoma and adenocarcinoma were statistically significant (p < 0.05). The statistical models of lung cancer and its types were tested on 60 patients. Implementation of the optimized symptom complex positively changed the parameters of X-ray diagnosis: there were increases in the sensitivity from 68.6% to 80.0%, in the specificity from 24.3% to 65.0%; in the prognostic value of a positive result from 55.6% to 82.1%; in that of a negative result from 34.0% to 64.9%, and in the accuracy from 50.0% to 75.0%.     

Syndromic approach in the radiodiagnosis of maxillofacial injuries

Radiodiagnosis of maxillofacial injury (MFI) is a topical problem of modern medicine. A complex of currently available highly informative methods, which comprises spiral computed tomography, digital X-ray study, and ultrasonography, used on the basis of a syndromic diagnostic approach substantially increases the informative value of a radiodiagnostic stage, provides a clear picture of the pattern of lesions, and defines, on the findings, an adequate treatment policy.     

高分辨率CT与常规CT检查对肺小结节及早期肺癌诊断价值的对比研究

目的:对比高分辨率电子计算机断层扫描(CT)与常规CT检查对肺小结节及早期肺癌的诊断价值。方法:将2018年6月2020年1月我院收治的肺小结节及早期肺癌患者94例纳入研究。以随机数字表法将其分为观察组及对照组,每组各47例,对照组实施常规CT检查,观察组则实施高分辨率CT检查。比较两组CT肿瘤征象情况(主要包括毛刺征、分叶征、棘突征、钙化征、空泡征、支气管征、胸膜凹陷征、血管集束征),CT扫描图像质量,诊断肺小结节及早期肺癌的效能。结果:观察组各项CT肿瘤征象人数占比均高于对照组(P<0.05)。观察组CT扫描图像质量优良率为97.87%(46/47),高于对照组的72.34%(34/47)(P<0.05)。高分辨率CT诊断早期肺癌的灵敏度及准确度、特异度分别为96.67%(29/30)、95.74%(45/47)、94.12%(16/17),高于常规CT检查的74.19%(23/31)、74.47%(35/47)、75.00%(12/16)。结论:高分辨率CT检查对肺小结节及早期肺癌诊断价值显著高于常规CT检查,可作为临床肺小结节及早期肺癌诊断的有效影像学手段,值得临床应用。     

Radiation diagnosis of diffuse lung diseases: Part I

Based on the data on 150 patients with diffuse lung diseases, the authors present the X-ray and computed topographic semiotics of changes in lung tissue in a number of diseases from this group. The differential diagnosis of diffuse lung diseases has certain difficulties whose solution is association with the application of complex radiation studies (digital fluorography, classical X-ray study, X-ray computed tomography, and magnetic resonance imaging). These techniques not only assess the status of the parenchyma of the lung and the extent of a process, but also permit a follow-up monitoring and evaluation of the efficiency of the therapy performed.     

肿瘤/肝脏比值在~(18)F-FDG符合线路SPECT/CT显像在肺癌诊断中的价值

目的:探讨18F-FDG符合线路SPECT/CT显像在肺癌病灶的检测能力以及肿瘤/肝脏比值对肺部良恶性病灶及胸部小病灶诊断的临床价值。方法:回顾性分析2011年6月至2013年4月期间于西安交通大学第一附属医院行18F-FDG符合线路SPECT/CT显像的肺癌疑诊患者41例CT测量肺部原发病灶最大直径4.16±2.81厘米(最小直径1.3厘米,最大直径16厘米),以病理结果作为判断标准,通过t检验及接受者操作特征曲线(receiver operating characteristic,ROC)研究18F-FDG符合线路SPECT/CT显像对肺部病灶、肺及纵膈小病灶的诊断价值。结果:18F-FDG符合线路SPECT/CT显像肺部良恶性病灶的肿瘤/肌肉(T/N)、肿瘤/肝脏(T/L)比值差异均具有显著统计学意义(P0.01),T/L比值在肺部良恶性病灶和肺及纵膈最大横径小于3 cm的病灶ROC曲线的曲线下面积分别为0.857、0.810,均大于T/N比值相应的ROC曲线下面积(分别为0.825、0.760)。T/N=3.5为界值时,诊断肺部病灶的灵敏度为90%,特异度为71.4%,准确度为0.614;诊断最大横径小于3 cm病灶的灵敏度为70%,特异度为80%,准确度为0.50。T/L=2.3时诊断肺部病灶的灵敏度为80%,特异度为85.7%,准确度为0.657。T/L=1.6时诊断最大横径小于3 cm病灶的灵敏度为90%,特异度为80%,准确度为0.70。结论:T/N=3.5为界值时,对于肺部病灶及肺及最大横径小于3 cm病灶良恶性的鉴别能力较好。T/L比值对于肺部良恶性病灶和肺及纵膈最大横径小于3 cm的病灶诊断价值均高于传统常用的T/N比值,具有较高的准确性,可以良好的应用于18F-FDG符合线路SPECT/CT显像对肺癌的诊断中。     

血清PCT、CRP与sTREM-1在肺癌患者术后肺部感染中表达及其诊断价值分析

目的:探究血清降钙素原(PCT)、C-反应蛋白(CRP)与可溶性人髓系细胞触发受体-1(sTREM-1)在肺癌患者术后肺部感染中表达及其诊断价值。方法:选择2016年2月至2019年10月期间在我院行肺癌根治术的420例肺癌患者作为研究对象,根据术后患者是否发生肺部感染进一步划分为380例未感染组和40例感染组。感染组根据治疗结局进一步划分为29例治疗好转亚组与11例未好转亚组。采用酶联免疫吸附法检测各组的血清PCT、CRP与s TREM-1水平,采用受试者工作特征(ROC)曲线分析血清PCT、CRP和s TREM-1对肺癌患者术后肺部感染的预测价值。结果:与未感染组相比,感染组手术后血清PCT、CRP和s TREM-1水平均明显升高(P0.05)。与治疗好转亚组相比较,治疗未好转亚组手术后以及感染后血清PCT、CRP和s TREM-1水平均明显升高(P0.05)。ROC曲线显示,PCT的曲线下面积(AUC)为0.713,最佳截断值为1.23 ng/mL,灵敏度、特异度分别为0.81、0.79,准确度为0.82;CRP的AUC为0.752,最佳截断值为36.07 mg/L,灵敏度、特异度分别为0.83、0.81,准确度为0.83;s TREM-1的AUC为0.792,最佳截断值为20.58 pg/mL,灵敏度、特异度分别为0.86、0.84,准确度为0.85;PCT、CRP联合s TREM-1预测肺癌患者术后肺部感染的AUC为0.884,灵敏度、特异度分别为0.89、0.91,准确度为0.92。结论:肺癌根治术后肺部感染发生与患者血清PCT、CRP和s TREM-1水平相关,早期联合检测血清PCT、CRP和s TREM-1有助于预测肺癌根治术患者肺部感染发生风险,在肺癌根治术后肺部感染的预测和诊断中具有一定临床价值。     

X-ray study in infants of the first year of life who had congenital heart diseases: traditions, specific features, new capacities

The paper analyzes the experience with ultrafast computed tomography (CT) used for 4 years to examine 178 babies with complicated congenital heart diseases (CHD), admitted to A.N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, for surgical treatment. It shows the comparative capacities of X-ray study, CT, and catheterized angiography in the diagnosis of CHD and concomitant lung diseases in patients of the first year of life in terms of the physiological and anatomic features of the course of disease. A complex of noninvasive radiation studies is shown to be of high informative value in evaluating the actual anatomy of complicated cardiac and pulmonary anomalies and in detecting the predictors of respiratory complications. The introduction of CT into the traditional algorithm of preoperative examination of patients with CHD has resulted in a considerable reduction in intracardiac diagnostic studies in neonates and infants of the first year of life.     

Efficiency of serum copper/zinc ratio for differential diagnosis of patients with and without lung cancer

We examined serum copper (Cu), serum zinc (Zn), and the serum copper/zinc ratio (Cu/Zn) in 162 patients. All of them were seen to have an abnormal shadow in the chest X-ray films, that is, 109 patients with lung cancer (LC) and 53 patients with no lung cancer (NLC). The mean Cu and Cu/Zn in LC patients were significantly higher than those in NLC patients (p<0.05). In LC patients, Cu and Cu/Zn were higher and Zn was lower in advanced tumors than early ones. There was a significantly clear relation between Cu or Cu/Zn and the tumor (T) stages. When the relative risk (RR) of LC was estimated, it was seen that the higher Cu and Cu/Zn became, the higher RR became. Furthermore, we showed the sensitivity of the receiver operator characteristic of the test (ROC) curve for Cu, Cu/Zn, and carcinoembryonic antigen (CEA) to diagnose LC, as explained in a paragraph of methods.The determinations of Cu, Zn, and Cu/Zn are simple and inexpensive. They also appear to have a great diagnostic value in determining the local invasion of LC and as a screening test in the high-risk patients for LC.     

Radiation-induced modification of human somatic cells’ chromosome sensitivity to the testing mutagenic exposure of bleomycin in vitro in lung cancer patients in delayed terms following chernobyl accident

The above-background level of cytogenetic effect has been studied using the modified G₂-bleomycin sensitivity assay, the value of which was a marker of hidden chromosome instability (HCI). The following three groups were examined: (1) Chernobyl disaster liquidators (CDLs) (occupational group I), (2) patients with lung cancer (LC) who denied voluntary contact with ionizing radiation (comparative group); and (3) patients with LC participating in the liquidation of the Chernobyl disaster (occupational group 2). Significant interindividual variations in the cytogenetic effects induced by bleomycin and the absence of a positive correlation with the background and above-background frequency of chromosome aberrations have been revealed for all the three groups. It was established that occupational group 2 experienced the highest level of above-background cytogenetic effect and therefore had the highest number of patients with HCI. The data allowed us to hypothesize the existence of an association between a radiation-induced increase in individual susceptibility to testing mutagenic exposure and the development of cancer pathologies in patients exposed to ionizing radiation. The results showed the feasibility of using the G₂-bleomycin sensitivity assay for the examination of irradiated contingents for the detection of HCI as an informative marker of predisposition to cancer.