imaging

成像
  • 文章类型: Journal Article
    目的:腹膜后筋膜的复杂解剖结构决定了疾病在腹膜后的传播,目前尚不完全清楚。相互矛盾的报告导致放射学文献中的解剖学概念不足和不正确。
    方法:这篇综述将讨论放射学文献中普遍存在的先前概念,并将重点介绍它们的缺点。从最近的解剖学和胚胎学研究的新见解,连同成像示例,将用于阐明这些概念无法解释的腹膜后疾病传播模式。
    结果:融合筋膜和肾筋膜特别是产生平面和空间,充当腹膜后疾病传播的载体。其中一些平面和结构,比如肾筋膜的尾部延伸,以前没有在放射学文献中描述过。
    结论:新见解,包括各种筋膜,潜在的空间和平面,被纳入一个更新的组合腹膜后筋膜概念。
    OBJECTIVE: Spread of disease in the retroperitoneum is dictated by the complex anatomy of retroperitoneal fasciae and is still incompletely understood. Conflicting reports have led to insufficient and incorrect anatomical concepts in radiological literature.
    METHODS: This review will discuss previous concepts prevalent in radiological literature and their shortcomings will be highlighted. New insights from recent anatomical and embryological research, together with imaging examples, will be used to clarify patterns of disease spread in the retroperitoneum that remain unexplained by these concepts.
    RESULTS: The fusion fascia and the renal fascia in particular give rise to planes and spaces that act as vectors for spread of disease in the retroperitoneum. Some of these planes and structures, such as the caudal extension of the renal fascia, have previously not been described in radiological literature.
    CONCLUSIONS: New insights, including the various fasciae, potential spaces and planes, are incorporated into an updated combined retroperitoneal fascial concept.
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    文章类型: Journal Article
    本文旨在回顾当前描述的主要线条和角度,并将其收集在单个文章中,并以系统的方式进行安排,以促进对小儿足部畸形的评估过程。
    这篇综述是一篇范围界定的文献综述。电子数据库网站,如PubMed,欧洲PMC,科克伦图书馆,和谷歌学者除了一些关于解剖学和人体运动生物力学的书籍,诊断放射学,和骨科为本综述的主题搜索相关文章。本综述未应用统计学分析。
    本评论中包含的30篇文章的数据被安排到不同的副标题中。在前后视图(AP)中,后足偏离的评估是通过AP距骨-跟骨角度(风筝角度);前足和中足外展和内收对齐是通过AP距骨-第一跖骨角度,距骨第二跖骨角,跟骨-第二跖骨角,跟五角;前足和中足旋转是通过观察meta骨轴线的正常近端会聚。在侧视图中,后足矢状平面对齐的评估是通过胫骨-跟骨外侧角度进行的;后足内翻或外翻通过距骨-跟骨外侧角度进行的;距骨对齐通过距骨倾角和胫骨-距骨角度进行的;跟骨对齐通过跟骨倾角和胫骨-跟骨角度进行的;足底弓的中足和前足矢状平面通过外侧距骨-迈里角对齐,跟骨倾角,和外侧跟骨-Hibbs-角;通过观察the轴的重叠阴影并绘制其轴线,前足和中足旋转对齐。
    用系统的方法绘制某些线条和角度来评估儿童射线照相胶片中足部的不同区域,可以促进对足部(作为一个整体)畸形的评估过程。
    UNASSIGNED: This article aimed to review the main currently described lines and angles and gather them in a single article and arrange them in a systematic way to facilitate the process of assessment of the pediatric foot for deformities.
    UNASSIGNED: The review was a scoping literature review. Electronic database websites such as PubMed, Europe PMC, Cochrane Library, and Google Scholar in addition to some books on anatomy and human movements biomechanics, diagnostic radiology, and orthopedics were searched for relevant articles for the topic of the present review. No statistical analysis was applied in this review.
    UNASSIGNED: Data from thirty articles included in this review were arranged into different subheadings. In the anteroposterior view (AP), assessment of the hindfoot deviation was by the AP talo-calcaneal angle (Kite\'s angle); the forefoot and midfoot for abduction and adduction alignment was by the AP talo-first metatarsal angle, the talo-second metatarsal angle, the calcaneo-second metatarsal angle, the calcaneofifth metatarsal angle; the forefoot and midfoot rotation was by observing the normal proximal convergence of the metatarsal bones axes. In the lateral view, assessment of the hindfoot sagittal plane alignment was by the lateral tibio-calcaneal angle; hindfoot varus or valgus deviation by the lateral talo-calcaneal angle; talus bone alignment by talar declination angle and the tibio-talar angle; calcaneal bone alignment by the calcaneal inclination angle and the tibio-calcaneal angle, the midfoot and forefoot sagittal plane alignment for the plantar arch by the lateral talo-first metatarsal -Meary\'s- angle, the calcaneal inclination angle, and the lateral calcaneofirst metatarsal -Hibbs- angle; forefoot and midfoot rotational alignment by observing the overlap shadows of the metatarsals\' shafts and drawing their axes.
    UNASSIGNED: Drawing certain lines and angles with a systematic approach to assess different regions of the foot in the radiographic films of children can facilitate the process of assessment of the foot (as a whole) for deformities.
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  • 文章类型: Journal Article
    我们对视网膜眼底摄影图像的人工智能(AI)研究进行了系统回顾。我们强调了各种人工智能算法的使用,包括深度学习(DL)模型,用于眼科和非眼科应用(即,系统性)障碍。我们发现使用人工智能算法来解释视网膜图像,与临床数据和医生专家相比,代表了一种创新的解决方案,在识别许多眼科(例如,糖尿病视网膜病变(DR),年龄相关性黄斑变性(AMD),视神经疾病),和非眼科疾病(例如,痴呆症,心血管疾病)。这项研究有大量的临床和影像学数据,导致AI和DL的潜在整合,以进行自动化分析。人工智能有潜力通过提高准确性来改变医疗保健,速度,和工作流,降低成本,越来越多的访问,减少错误,并转变医护人员的教育和培训。
    We conducted a systematic review of research in artificial intelligence (AI) for retinal fundus photographic images. We highlighted the use of various AI algorithms, including deep learning (DL) models, for application in ophthalmic and non-ophthalmic (i.e., systemic) disorders. We found that the use of AI algorithms for the interpretation of retinal images, compared to clinical data and physician experts, represents an innovative solution with demonstrated superior accuracy in identifying many ophthalmic (e.g., diabetic retinopathy (DR), age-related macular degeneration (AMD), optic nerve disorders), and non-ophthalmic disorders (e.g., dementia, cardiovascular disease). There has been a significant amount of clinical and imaging data for this research, leading to the potential incorporation of AI and DL for automated analysis. AI has the potential to transform healthcare by improving accuracy, speed, and workflow, lowering cost, increasing access, reducing mistakes, and transforming healthcare worker education and training.
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  • 文章类型: Case Reports
    我们介绍了严重脑积水后皮质层状坏死的情况,以强调对多模式脑自动调节监测的考虑因素,以确定神经系统紧急情况下的平均动脉压(MAP)阈值,以及脑室腹膜分流(VPS)患者的术后头颅造影。
    一名40岁女性,有ChiariII畸形和非交通性脑积水的病史,并伴有VPS,表现为来自骶骨伤口的感染性休克。结肠造口术后一周粪便转移,患者昏迷,脑电图(EEG)逐渐减慢至完全抑制.
    CT成像显示脑积水,最可能是由于腹膜内手术的VPS远端阻塞。尽管神经外科和神经重症监护管理,MRI证实弥漫性皮质缺氧缺血性损伤。
    神经危重症护理协会针对神经系统紧急情况的紧急神经系统生命支持(ENLS)方案侧重于控制颅内压升高(ICP),但未设定MAP目标。脑疝时ICP可能很高,我们的案例表明,维持充足的循环可能需要更高的MAP。为了确定最佳MAP目标,床边多模态监测,包括ICP监测员,经颅多普勒,和近红外光谱,可以帮助建立个体化的脑自动调节引导阈值。在神经重症监护室外面,EEG可以监测脑血流并在检查或成像改变之前指示用于干预的窗口。此外,我们的案例证明了VPS患者应如何考虑术后CT监测.
    UNASSIGNED: We present a case of cortical laminar necrosis after severe hydrocephalus to highlight considerations for multimodal cerebral autoregulation monitoring to determine mean arterial pressure (MAP) thresholds during neurological emergencies, as well as postoperative head imaging for patients with ventriculoperitoneal shunts (VPS).
    UNASSIGNED: A 40-year-old woman with a history of Chiari II malformation and non-communicating hydrocephalus with VPS presented in septic shock from a sacral wound. One week after colostomy for fecal diversion, the patient became comatose and had progressive slowing to full suppression on electroencephalogram (EEG).
    UNASSIGNED: CT imaging revealed hydrocephalus, most likely due to VPS distal obstruction from intraperitoneal surgery. Despite neurosurgical and neurocritical care management, MRI confirmed diffuse cortical hypoxic ischemic injury.
    UNASSIGNED: The Neurocritical Care Society\'s Emergency Neurological Life Support (ENLS) protocol for neurological emergencies focuses on managing increased intracranial pressure (ICP) but does not set MAP goals. As ICP may be very high during brain herniation, our case demonstrates that higher MAP may be required to maintain adequate circulation. To determine the optimal MAP target, bedside multimodality monitoring, including ICP monitors, transcranial doppler, and near infrared spectroscopy, can help establish individualized cerebral autoregulation guided thresholds. Outside of a neurological intensive care unit, EEG can monitor cerebral blood flow and indicate windows for intervention before exam or imaging changes. Additionally, our case demonstrates how a post-operative surveillance CT head should be considered for patients with VPS.
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  • 文章类型: Journal Article
    聚集,总结,并评估现有证据:1)胸部CT扫描诊断儿童COVID-19的准确性,2)与儿童COVID-19肺炎相关的胸部CT扫描特征性发现。
    我们全面搜索了数据库(MEDLINE,COCHRANE),临床试验登记处,选定研究的书目清单,和相关研究的未发表数据。无痛循证医学和美国国立卫生研究院质量评估工具的指导问题用于评估研究质量。
    一项质量较差的研究显示,胸部CT扫描诊断儿童COVID-19的敏感性为86.0%(95%CI73.8,93.0),特异性为75.9%(95%CI67.1,83.0)。描述COVID-19儿童胸部CT扫描的39项观察性研究显示,1028名研究对象中有717人出现异常。该人群中常见的胸部CT扫描结果包括:1)磨玻璃影,斑驳的阴影,和整合,2)下叶受累,3)单侧肺部病变。
    调查胸部CT扫描诊断儿童COVID-19的准确性的研究受到人群异质性和样本量小的限制。虽然胸部CT扫描发现斑驳阴影,磨砂玻璃不透明,合并在COVID-19儿童中很常见,这些可能与其他呼吸道病毒性疾病的影像学表现相似。
    UNASSIGNED: To gather, summarize, and appraise the available evidence on: 1) the accuracy of chest CT scan in diagnosing COVID-19 among children, and 2) the characteristic chest CT scan findings associated with COVID-19 pneumonia in children.
    UNASSIGNED: We comprehensively searched databases (MEDLINE, COCHRANE), clinical trial registries, bibliographic lists of selected studies, and unpublished data for relevant studies. Guide questions from the Painless Evidence Based Medicine and the National Institutes of Health Quality Assessment Tools were used to assess study quality.
    UNASSIGNED: A poor quality study showed 86.0% (95% CI 73.8, 93.0) sensitivity and 75.9% (95% CI 67.1, 83.0) specificity of chest CT scan in diagnosing COVID-19 in children. Thirty-nine observational studies describing chest CT scan in children with COVID-19 showed abnormal findings in 717 of 1028 study subjects. Common chest CT scan findings in this population include: 1) ground glass opacities, patchy shadows, and consolidation, 2) lower lobe involvement, and 3) unilateral lung lesions.
    UNASSIGNED: Studies which investigate the accuracy of chest CT scan in the diagnosis of COVID-19 in children are limited by heterogeneous populations and small sample sizes. While chest CT scan findings such as patchy shadows, ground glass opacities, and consolidation are common in children with COVID-19, these may be similar to the imaging findings of other respiratory viral illnesses.
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  • 文章类型: Journal Article
    目的:这篇叙述性综述旨在提出成像中的价值概念,并探讨为什么我们进行低价值程序,如何减少这种浪费的使用,以及我们可以从减少低价值成像中获得什么。
    结果:对患者进行低值成像会导致数千公吨的二氧化碳排放,每年花费数十亿美元。低值成像减少20%,我们将减少与720万个程序相关的资源浪费,同时,降低偶发瘤的风险,过度诊断,和过度治疗,并减少需要高价值影像服务的患者的等待时间。需要针对社会和医疗保健各个层面的障碍采取多成分举措,以减少低价值成像。放射技师是医学成像的关键角色,可以通过以下方式为这项工作做出重大贡献:和放射科医生一起,推荐人,和经理,确保所进行的所有成像程序在可持续性的四个方面都是可持续的:价值,成本,风险,和环境。
    结论:考虑到四个关键维度(价值,成本,辐射,和环境)应该在社会和医疗保健的各个层面上,从政府管理到个人医护人员。放射技师对于获得可持续性至关重要,以确保仅进行可持续的成像程序。
    结论:在评估成像程序的适当性时,我们需要考虑环境,安全,有效性,和效率。为了获得这个,我们需要在当地集体和协调的努力,全国,并在国际上提供可持续的成像服务。
    OBJECTIVE: This narrative review aims to present the concept of value in imaging and explore why we conduct low-value procedures, how to reduce this wasteful use, and what we could gain from reducing low-value imaging.
    RESULTS: Imaging of low value to the patient contributes to thousands of metric tons of CO2 emissions, costing several billion US dollars annually. With a 20% reduction in low-value imaging, we would reduce the waste of resources related to 7.2 million procedures and, at the same time, reduce the risk of incidentalomas, overdiagnosis, and overtreatment and reduce wait times for patients in need of imaging services of high value. Multi-component initiatives targeting barriers in all levels of society and healthcare are needed to reduce low-value imaging. Radiographers are key actors in medical imaging and can make substantial contributions to this effort by, together with the radiologists, referrers, and managers, ensuring that all imaging procedures conducted are sustainable along four dimensions of sustainability: value, cost, risk, and environment.
    CONCLUSIONS: Efforts to secure sustainable imaging considering the four crucial dimensions (value, cost, radiation, and environment) should be made at all levels of society and healthcare, from governmental management to the individual healthcare worker. Radiographers are vital in obtaining sustainability to ensure only sustainable imaging procedures are conducted.
    CONCLUSIONS: When assessing the appropriateness of imaging procedures, we need to consider the environment, safety, effectiveness, and efficiency. To obtain this, we need a collective and coordinated effort locally, nationally, and internationally to deliver sustainable imaging services.
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  • 文章类型: Journal Article
    金属有机框架(MOFs)是新兴的材料在各种未来的生物医学用途,由于其固有的特征,如可调的孔尺寸和体积,定义明确的活跃位点,高表面积,和混合结构。MOFs的多功能性和独特的化学和生物学特性使其成为感知众多新兴生物分子的理想平台,并对护理点应用进行实时监测。这篇综述旨在为MOF在生物医学应用中的局部发展提供关键见解。合理的设计,准备稳定的MOF架构,化学和生物学特性,生物相容性,模拟酶的材料,生物传感器平台的制造,并编制了诊断和治疗系统的探索。最先进的,重大挑战,以及改进进展的迫在眉睫的观点,尤其是生物传感器平台,成像,还描述了生物医学研究中的光动力疗法。本综述可能会激发MOFs和生物医学交界处的跨学科研究。
    Metal-organic frameworks (MOFs) are emergent materials in diverse prospective biomedical uses, owing to their inherent features such as adjustable pore dimension and volume, well-defined active sites, high surface area, and hybrid structures. The multifunctionality and unique chemical and biological characteristics of MOFs allow them as ideal platforms for sensing numerous emergent biomolecules with real-time monitoring towards the point-of-care applications. This review objects to deliver key insights on the topical developments of MOFs for biomedical applications. The rational design, preparation of stable MOF architectures, chemical and biological properties, biocompatibility, enzyme-mimicking materials, fabrication of biosensor platforms, and the exploration in diagnostic and therapeutic systems are compiled. The state-of-the-art, major challenges, and the imminent perspectives to improve the progressions convoluted outside the proof-of-concept, especially for biosensor platforms, imaging, and photodynamic therapy in biomedical research are also described. The present review may excite the interdisciplinary studies at the juncture of MOFs and biomedicine.
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  • 文章类型: Journal Article
    随着近年来心血管成像领域的巨大进步,计算机断层扫描(CT)已成为动脉粥样硬化性冠状动脉疾病的表型。使用人工智能(AI)的新分析方法可以分析动脉粥样硬化斑块的复杂表型信息。特别是,使用卷积神经网络(CNN)的基于深度学习的方法促进了病变检测等任务,分割,和分类。新的放射转录组学技术甚至通过对CT图像上的体素进行高阶结构分析来捕获潜在的生物组织化学过程。在不久的将来,国际大规模牛津危险因素和非侵入性成像(ORFAN)研究将为测试和验证基于AI的预后模型提供强大的平台。目标是将这些新方法从研究环境转变为临床工作流程。在这次审查中,我们概述了现有的基于AI的技术,重点是成像生物标志物以确定冠状动脉炎症的程度,冠状动脉斑块,以及相关风险。Further,将讨论使用基于AI的方法的当前限制以及解决这些挑战的优先事项。这将为AI启用的风险评估工具铺平道路,以检测易损的动脉粥样硬化斑块并指导患者的治疗策略。
    With the enormous progress in the field of cardiovascular imaging in recent years, computed tomography (CT) has become readily available to phenotype atherosclerotic coronary artery disease. New analytical methods using artificial intelligence (AI) enable the analysis of complex phenotypic information of atherosclerotic plaques. In particular, deep learning-based approaches using convolutional neural networks (CNNs) facilitate tasks such as lesion detection, segmentation, and classification. New radiotranscriptomic techniques even capture underlying bio-histochemical processes through higher-order structural analysis of voxels on CT images. In the near future, the international large-scale Oxford Risk Factors And Non-invasive Imaging (ORFAN) study will provide a powerful platform for testing and validating prognostic AI-based models. The goal is the transition of these new approaches from research settings into a clinical workflow. In this review, we present an overview of existing AI-based techniques with focus on imaging biomarkers to determine the degree of coronary inflammation, coronary plaques, and the associated risk. Further, current limitations using AI-based approaches as well as the priorities to address these challenges will be discussed. This will pave the way for an AI-enabled risk assessment tool to detect vulnerable atherosclerotic plaques and to guide treatment strategies for patients.
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  • 文章类型: Journal Article
    背景:超声造影(CEUS)是一种具有成本效益的无辐射诊断方法,可用于消融治疗后的肾肿瘤术后可视化。
    目的:评估肾肿瘤消融术后短期和长期随访方法与CT和MRI的CEUS诊断准确性。
    方法:在Scopus和Medline数据库中进行系统评价和荟萃分析,使用查询“(肾或肾癌*或肾癌)和(消融或RFA或MWA或冷冻*)和CEUS”。研究的终点是评估CEUS的总体准确性。
    结果:12项试验纳入本综述。以CT或MRI为参考,短期组(消融后<6周)合并敏感性为90.2%,I2=0%;合并特异性为99.3%,I2=0%;合并净现值为98.6%,I2=0%;合并PPV为94.6%,I2=0%;SROC曲线上的AUC为0.971。对于长期组(消融后>6周),合并敏感性为95.3%,I2=0%;合并特异性为97.6%,I2=0%;PPV为74.2%,I2=4%;净现值为99.4%,I2=5%;AUC=0.93。
    结论:与CT或MRI相比,CEUS在排除肾肿瘤消融术后局部复发方面具有较高的敏感性和特异性,随访6周内假阳性结果的风险更高。需要采用统一方案和形态学控制消融后局部肾肿瘤复发的进一步研究。
    BACKGROUND: Contrast-enhanced ultrasound (CEUS) is a cost-effective radiation-free diagnostic method that can be used for renal tumor postoperative visualization after ablative treatment.
    OBJECTIVE: To assess CEUS diagnostic accuracy comparing with CT and MRI as a follow-up method in short-term and long-term postoperative periods after renal tumor ablation.
    METHODS: A systematic review and meta-analysis were performed in Scopus and Medline databases using the query \"(kidney OR rena* OR RCC) AND (ablation OR RFA OR MWA OR cryo*) AND CEUS\". The endpoint of the study was the evaluation of the overall accuracy of CEUS.
    RESULTS: Twelve trials were included in the review. With CT or MRI as a reference, for a short-term group (< 6 weeks after ablation) pooled sensitivity was 90.2%, I2 = 0%; pooled specificity was 99.3%, I2 = 0%; pooled NPV was 98.6%, I2 = 0%; pooled PPV was 94.6%, I2 = 0%; the AUC on the SROC curve was 0.971. For the long-term group (> 6 weeks after ablation), pooled sensitivity was 95.3%, I2 = 0%; pooled specificity was 97.6%, I2 = 0%; PPV was 74.2%, I2 = 4%; NPV was 99.4%, I2 = 5%; AUC = 0.93.
    CONCLUSIONS: CEUS has high sensitivity and specificity in ruling out the presence of local recurrence after renal tumor ablation with a higher risk of false-positive results within follow-up > 6 weeks compared with that for CT or MRI. Further studies with a unified protocol and morphological control of local renal tumor recurrence after ablation are needed.
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  • 文章类型: Case Reports
    血管球瘤(或副神经节瘤)很少见,神经内分泌起源的良性肿瘤,出现在副神经节起源的组织中。该临床实体由于其与关键的神经血管结构的接近而提出了重大的治疗挑战。因此,疾病进展和/或治疗方法可能导致病态功能损害。虽然手术仍然是治疗这类病例的标准,放射治疗或密切观察治疗的趋势越来越大。这里,我们介绍了一个大型和不规则形状的颈鼓膜血管球瘤,并接受了容积式弧形放疗。考虑到手术后颅神经病变的风险,放射治疗是首选治疗方式。该病例证明了体积弧形放疗在治疗形状复杂的大型血管球瘤中的安全性和有效性。
    Glomus tumors (or paragangliomas) are rare, benign tumors of neuroendocrine origin that appear in tissues of paraganglionic origin. This clinical entity poses a significant treatment challenge due to its proximity to critical neurovascular structures, thus the potential of morbid functional damage caused by disease progression and/or treatment approach. While surgery remains the standard of care for such cases, there has been an increasing trend toward management with radiotherapy or close observation. Here, we present a case of a large and irregularly shaped glomus jugulotympanicum tumor that was treated with volumetric arc radiotherapy. Given the risk of cranial neuropathy with surgery, radiation was the preferred treatment modality. This case demonstrated the safety and efficacy of volumetric arc radiotherapy in the management of a large glomus tumor with a complex shape.
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