目的探讨颅脑损伤患者视神经鞘直径与格拉斯哥昏迷评分（Glasgow coma scale，GCS）及CT图像计分（Rotterdam CT评分及HelsinkiCT评分1之间的关系。方法对63例本院抢救室接诊的成年颅脑损伤患者评估GCS、超声测量视神经鞘直径，并行头...目的探讨颅脑损伤患者视神经鞘直径与格拉斯哥昏迷评分（Glasgow coma scale，GCS）及CT图像计分（Rotterdam CT评分及HelsinkiCT评分1之间的关系。方法对63例本院抢救室接诊的成年颅脑损伤患者评估GCS、超声测量视神经鞘直径，并行头颅CT平扫进行CT图像计分。视神经鞘直径与CT图像计分、GCS相关性采用Spearman相关性检验。根据GCS评分将患者分为轻度、中度及重度组；根据CT图像计分将患者分为低分、中分及高分组。三组间视神经鞘直径比较采用ANOVA方差分析，并采用LSD-t检验进行两两比较。结果视神经鞘直径与GCS、Rotterdam CT评分和HelsinkiCT评分相关性均良好（r=-0．540，P〈0．01；r=0．654，P〈0．01；r=0．663，P〈0．01）。根据GCS将患者分为轻度、中度和重度三组，三组视神经鞘直径均值分别为（3．89±0．70）mm、（4．50±0．65）mm和（4．81±0．72）mm，中度组或重度组与轻度组间视神经鞘直径比较差异有统计学意义（P〈0．05或P〈0．01），中度组与重度组间视神经鞘直径比较差异无统计学意义（P〉0．05）。根据RotterdamCT评分，低分、中分、高分组三组间平均视神经鞘直径差异有统计学意义[（3．74±0．64）mmw．（4．31±0．73）mmvs（5．09±0．57）mm，P〈0．01或P〈0．05）]；根据Helsinki CT评分，低分、中分、高分三组间平均视神经鞘直径差异有统计学意义（3．54±0．61vs．4．46±0．73VS．5．16±0．37mm，P〈0．01）。结论视神经鞘直径与CT图像计分、格拉斯哥昏迷评分相关性良好，超声测量视神经鞘直径有助于早期床旁判断颅脑损伤患者的病情严重程度。展开更多
AIM： To construct a noninvasive assessment model consisting of routine laboratory data to predict significant fibrosis and cirrhosis in patients with chronic hepatitis B （CHB）. METHODS： A total of 137 consecutive ...AIM： To construct a noninvasive assessment model consisting of routine laboratory data to predict significant fibrosis and cirrhosis in patients with chronic hepatitis B （CHB）. METHODS： A total of 137 consecutive patients with CriB who underwent percutaneous liver biopsy were retrospectively analyzed. These patients were divided into two groups according to their aminotransferase （ALT） level. The sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV）, the likelihood ratio （LR） of aminotransferase/platelet ratio index （APRI） ≥ 1.5 or 〈 1.5 in combination with different hyaluronic acid （HA） cut-off points were calculated for the presence of moderate to severe fibrosis/cirrhosis （fibrosis stages 2 and 4） and no to mild fibrosis/cirrhosis （fibrosis stages 0 and 1）. RESULTS： The APRI correlated with fibrosis stage in CriB patients. The APRI ≥1.5 in combination with a cut-off HA cut-off point 〉 300 ng/mL could detect moderate to severe fibrosis （stages 2-4） in Crib patients. The PPV was 93.7%, the specificity was 98.9%. The APRI 〈 1.5 in combination with different HA cut-off points could not detect no to mild fibrosis in CHB patients. CONCLUSION： The APRI ≥ 1.5 in combination with a HA cut-off point 〉 300 ng/mL can detect moderate to severe fibrosis （stages 2-4） in Crib patients.展开更多
Nonalcoholic fatty liver disease(NAFLD)refers to the accumulation of fat(mainly triglycerides)within hepatocytes.Approximately 20%-30%of adults in the general population in developed countries have NAFLD;this trend is...Nonalcoholic fatty liver disease(NAFLD)refers to the accumulation of fat(mainly triglycerides)within hepatocytes.Approximately 20%-30%of adults in the general population in developed countries have NAFLD;this trend is increasing because of the pandemicity of obesity and diabetes,and is becoming a serious public health burden.Twenty percent of individuals with NAFLD develop chronic hepatic inflammation[nonalcoholic steatohepatitis(NASH)],which can be associated with the development of cirrhosis,portal hypertension,and hepatocellular carcinoma in a minority of patients.And thus,the detection and diagnosis of NAFLD is important for general practitioners.Liver biopsy is the gold standard for diagnosing NAFLD and confirming the presence of NASH.However,the invasiveness of this procedure limits its application to screening the general population or patients with contraindications for liver biopsy.The development of noninvasive diagnostic methods for NAFLD is of paramount importance.This review focuses on the updates of noninvasive diagnosis of NAFLD.Besides,we review clinical evidence supporting a strong association between NAFLD and the risk of cardiovascular disease because of the cross link between these two disorders.展开更多
Liver disease accounts for approximately 2 million deaths per year worldwide.All chronic liver diseases(CLDs),whether of toxic,genetic,autoimmune,or infectious origin,undergo typical histological changes in the struct...Liver disease accounts for approximately 2 million deaths per year worldwide.All chronic liver diseases(CLDs),whether of toxic,genetic,autoimmune,or infectious origin,undergo typical histological changes in the structure of the tissue.These changes may include the accumulation of extracellular matrix material,fats,triglycerides,or tissue scarring.Noninvasive methods for diagnosing CLD,such as conventional B-mode ultrasound(US),play a significant role in diagnosis.Doppler US,when coupled with B-mode US,can be helpful in evaluating the hemodynamics of hepatic vessels and detecting US findings associated with hepatic decompensation.US elastography can assess liver stiffness,serving as a surrogate marker for liver fibrosis.It is important to note that interpreting these values should not rely solely on a histological classification.Contrast-enhanced US(CEUS)provides valuable information on tissue perfusion and enables excellent differentiation between benign and malignant focal liver lesions.Clinical evaluation,the etiology of liver disease,and the patient current comorbidities all influence the interpretation of liver stiffness measurements.These measurements are most clinically relevant when interpreted as a probability of compensated advanced CLD.B-mode US offers a subjective estimation of fatty infiltration and has limited sensitivity for mild steatosis.The controlled attenuation parameter requires a dedicated device,and cutoff values are not clearly defined.Quan-titative US parameters for liver fat estimation include the attenuation coefficient,backscatter coefficient,and speed of sound.These parameters offer the advantage of providing fat quantification alongside B-mode evaluation and other US parameters.Multiparametric US(MPUS)of the liver introduces a new concept for complete noninvasive diagnosis.It encourages examiners to utilize the latest features of an US machine,including conventional B-mode,liver stiffness evaluation,fat quantification,dispersion imaging,Doppler US,and CEUS for focal liver lesion chara展开更多
AIM To assess liver fibrosis(LF) in hepatitis C virus(HCV) and alcoholic liver disease(ALD), estimate health outcomes and costs of new noninvasive testing strategies METHODS A Markov model was developed to simulate LF...AIM To assess liver fibrosis(LF) in hepatitis C virus(HCV) and alcoholic liver disease(ALD), estimate health outcomes and costs of new noninvasive testing strategies METHODS A Markov model was developed to simulate LF progression in HCV and ALD for a cohort of 40-yearold men with abnormal levels of transaminases. Three different testing alternatives were studied: a single liver biopsy; annual Enhanced liver fibrosis(ELF?) followed by liver stiffness measurement(LSM) imaging as a confirmation test if the ELF test is positive; and annual ELF test without LSM. The analysis was performed from the perspective of a university hospital in Spain.Clinical data were obtained from published literature. Costs were sourced from administrative databases of the hospital. Deterministic and probabilistic sensitivity analyses were performed.RESULTS In HCV patients, annual sequential ELF test/LSM and annual ELF test alone prevented respectively 12.9 and 13.3 liver fibrosis-related deaths per 100 persons tested, compared to biopsy. The incremental costeffectiveness ratios(ICERs) were respectively €13400 and €11500 per quality-adjusted life year(QALY). In ALD, fibrosis-related deaths decreased by 11.7 and 22.1 per 100 persons tested respectively with sequential ELF test/LSM and annual ELF test alone. ICERs were €280 and €190 per QALY, respectively.CONCLUSION The use of the ELF test with or without a confirmation LSM are cost-effective options compared to a single liver biopsy for testing liver fibrosis in HCV and ALD patients in Spain.展开更多
提出使用磁共振图像(MRI)超短回波时间(UTE)成像序列结合T2*映射技术,对耳软骨T2*值进行在体无创检测,探究既能对耳软骨进行非侵入性成像又能定量评估在体耳软骨生物成分的方法,为耳软骨再造和修复整形手术评价的标准化提供新思路。首先...提出使用磁共振图像(MRI)超短回波时间(UTE)成像序列结合T2*映射技术,对耳软骨T2*值进行在体无创检测,探究既能对耳软骨进行非侵入性成像又能定量评估在体耳软骨生物成分的方法,为耳软骨再造和修复整形手术评价的标准化提供新思路。首先,使用1个UTE和5个短回波时间(TE)的成像组合序列采集30名志愿者右侧外耳的MRI图像;然后,利用采集到的每名志愿者的图像进行组内刚性配准及手动分割耳软骨与外耳轮廓(包含耳软骨及周围组织,如皮肤、脂肪和其他软组织)的预处理;接下来,分别运用单指数和双指数衰减模型在分割出来的耳软骨和外耳区域进行T2*值测量;最后,分别使用这两种模型拟合耳软骨信号强度随回波时间变化的衰减曲线,并比较拟合模型的准确性。结果显示,在30例右耳的单成分分析(单指数模型)实验中,外耳的T2*m平均值为(49.269±16.979)ms,耳软骨的T2*m平均值为(23.799±9.629)ms。在双成分分析(双指数模型)中,外耳的短成分T2*s平均值为(11.713±3.111)ms,长成分T2*l平均值为(65.128±13.132)ms,耳软骨的短成分T2*s平均值为(5.577±1.830)ms,长成分T2*l平均值为(30.628±8.413)ms。统计分析显示,单成分分析计算得到的T2*m,和双成分分析计算得到的T2*s、T2*l,在外耳和耳软骨区域均存在显著差异(P<0.05)。在曲线拟合中,双指数模型优于单指数模型(R^2[bi]=0.999±0.001 vs R^2[mono]=0.905±0.014,P<0.05)。实验结果表明,超短回波时间成像序列结合T2*映射技术对在体耳软骨进行T2*值无创检测具备可行性,有望为软骨组织工程和3D生物打印技术制作的耳软骨-支架复合物应用在耳廓修复和再造中提供医学影像学的支撑,也为小耳畸形外科整形手术术后定量评估耳软骨提供一种可行性方案。展开更多
文摘AIM： To construct a noninvasive assessment model consisting of routine laboratory data to predict significant fibrosis and cirrhosis in patients with chronic hepatitis B （CHB）. METHODS： A total of 137 consecutive patients with CriB who underwent percutaneous liver biopsy were retrospectively analyzed. These patients were divided into two groups according to their aminotransferase （ALT） level. The sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV）, the likelihood ratio （LR） of aminotransferase/platelet ratio index （APRI） ≥ 1.5 or 〈 1.5 in combination with different hyaluronic acid （HA） cut-off points were calculated for the presence of moderate to severe fibrosis/cirrhosis （fibrosis stages 2 and 4） and no to mild fibrosis/cirrhosis （fibrosis stages 0 and 1）. RESULTS： The APRI correlated with fibrosis stage in CriB patients. The APRI ≥1.5 in combination with a cut-off HA cut-off point 〉 300 ng/mL could detect moderate to severe fibrosis （stages 2-4） in Crib patients. The PPV was 93.7%, the specificity was 98.9%. The APRI 〈 1.5 in combination with different HA cut-off points could not detect no to mild fibrosis in CHB patients. CONCLUSION： The APRI ≥ 1.5 in combination with a HA cut-off point 〉 300 ng/mL can detect moderate to severe fibrosis （stages 2-4） in Crib patients.
文摘Nonalcoholic fatty liver disease(NAFLD)refers to the accumulation of fat(mainly triglycerides)within hepatocytes.Approximately 20%-30%of adults in the general population in developed countries have NAFLD;this trend is increasing because of the pandemicity of obesity and diabetes,and is becoming a serious public health burden.Twenty percent of individuals with NAFLD develop chronic hepatic inflammation[nonalcoholic steatohepatitis(NASH)],which can be associated with the development of cirrhosis,portal hypertension,and hepatocellular carcinoma in a minority of patients.And thus,the detection and diagnosis of NAFLD is important for general practitioners.Liver biopsy is the gold standard for diagnosing NAFLD and confirming the presence of NASH.However,the invasiveness of this procedure limits its application to screening the general population or patients with contraindications for liver biopsy.The development of noninvasive diagnostic methods for NAFLD is of paramount importance.This review focuses on the updates of noninvasive diagnosis of NAFLD.Besides,we review clinical evidence supporting a strong association between NAFLD and the risk of cardiovascular disease because of the cross link between these two disorders.
文摘Liver disease accounts for approximately 2 million deaths per year worldwide.All chronic liver diseases(CLDs),whether of toxic,genetic,autoimmune,or infectious origin,undergo typical histological changes in the structure of the tissue.These changes may include the accumulation of extracellular matrix material,fats,triglycerides,or tissue scarring.Noninvasive methods for diagnosing CLD,such as conventional B-mode ultrasound(US),play a significant role in diagnosis.Doppler US,when coupled with B-mode US,can be helpful in evaluating the hemodynamics of hepatic vessels and detecting US findings associated with hepatic decompensation.US elastography can assess liver stiffness,serving as a surrogate marker for liver fibrosis.It is important to note that interpreting these values should not rely solely on a histological classification.Contrast-enhanced US(CEUS)provides valuable information on tissue perfusion and enables excellent differentiation between benign and malignant focal liver lesions.Clinical evaluation,the etiology of liver disease,and the patient current comorbidities all influence the interpretation of liver stiffness measurements.These measurements are most clinically relevant when interpreted as a probability of compensated advanced CLD.B-mode US offers a subjective estimation of fatty infiltration and has limited sensitivity for mild steatosis.The controlled attenuation parameter requires a dedicated device,and cutoff values are not clearly defined.Quan-titative US parameters for liver fat estimation include the attenuation coefficient,backscatter coefficient,and speed of sound.These parameters offer the advantage of providing fat quantification alongside B-mode evaluation and other US parameters.Multiparametric US(MPUS)of the liver introduces a new concept for complete noninvasive diagnosis.It encourages examiners to utilize the latest features of an US machine,including conventional B-mode,liver stiffness evaluation,fat quantification,dispersion imaging,Doppler US,and CEUS for focal liver lesion chara
基金Supported by Siemens.Marcelo Soto received financial support from Plataforma ITEMAS PT13/0006/0009(FCRB PI043029,partially)
文摘AIM To assess liver fibrosis(LF) in hepatitis C virus(HCV) and alcoholic liver disease(ALD), estimate health outcomes and costs of new noninvasive testing strategies METHODS A Markov model was developed to simulate LF progression in HCV and ALD for a cohort of 40-yearold men with abnormal levels of transaminases. Three different testing alternatives were studied: a single liver biopsy; annual Enhanced liver fibrosis(ELF?) followed by liver stiffness measurement(LSM) imaging as a confirmation test if the ELF test is positive; and annual ELF test without LSM. The analysis was performed from the perspective of a university hospital in Spain.Clinical data were obtained from published literature. Costs were sourced from administrative databases of the hospital. Deterministic and probabilistic sensitivity analyses were performed.RESULTS In HCV patients, annual sequential ELF test/LSM and annual ELF test alone prevented respectively 12.9 and 13.3 liver fibrosis-related deaths per 100 persons tested, compared to biopsy. The incremental costeffectiveness ratios(ICERs) were respectively €13400 and €11500 per quality-adjusted life year(QALY). In ALD, fibrosis-related deaths decreased by 11.7 and 22.1 per 100 persons tested respectively with sequential ELF test/LSM and annual ELF test alone. ICERs were €280 and €190 per QALY, respectively.CONCLUSION The use of the ELF test with or without a confirmation LSM are cost-effective options compared to a single liver biopsy for testing liver fibrosis in HCV and ALD patients in Spain.
文摘提出使用磁共振图像(MRI)超短回波时间(UTE)成像序列结合T2*映射技术,对耳软骨T2*值进行在体无创检测,探究既能对耳软骨进行非侵入性成像又能定量评估在体耳软骨生物成分的方法,为耳软骨再造和修复整形手术评价的标准化提供新思路。首先,使用1个UTE和5个短回波时间(TE)的成像组合序列采集30名志愿者右侧外耳的MRI图像;然后,利用采集到的每名志愿者的图像进行组内刚性配准及手动分割耳软骨与外耳轮廓(包含耳软骨及周围组织,如皮肤、脂肪和其他软组织)的预处理;接下来,分别运用单指数和双指数衰减模型在分割出来的耳软骨和外耳区域进行T2*值测量;最后,分别使用这两种模型拟合耳软骨信号强度随回波时间变化的衰减曲线,并比较拟合模型的准确性。结果显示,在30例右耳的单成分分析(单指数模型)实验中,外耳的T2*m平均值为(49.269±16.979)ms,耳软骨的T2*m平均值为(23.799±9.629)ms。在双成分分析(双指数模型)中,外耳的短成分T2*s平均值为(11.713±3.111)ms,长成分T2*l平均值为(65.128±13.132)ms,耳软骨的短成分T2*s平均值为(5.577±1.830)ms,长成分T2*l平均值为(30.628±8.413)ms。统计分析显示,单成分分析计算得到的T2*m,和双成分分析计算得到的T2*s、T2*l,在外耳和耳软骨区域均存在显著差异(P<0.05)。在曲线拟合中,双指数模型优于单指数模型(R^2[bi]=0.999±0.001 vs R^2[mono]=0.905±0.014,P<0.05)。实验结果表明,超短回波时间成像序列结合T2*映射技术对在体耳软骨进行T2*值无创检测具备可行性,有望为软骨组织工程和3D生物打印技术制作的耳软骨-支架复合物应用在耳廓修复和再造中提供医学影像学的支撑,也为小耳畸形外科整形手术术后定量评估耳软骨提供一种可行性方案。
