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利用三相计算机断层扫描、B 型、彩色血流、能量及脉冲波多普勒超声对犬肝脏肿块进行评估,并与组织病理学分类进行相关性分析。

Evaluation of canine hepatic masses by use of triphasic computed tomography and B-mode, color flow, power, and pulsed-wave Doppler ultrasonography and correlation with histopathologic classification.

作者信息

Griebie Erin R, David Frederic H, Ober Christopher P, Feeney Daniel A, Anderson Kari L, Wuenschmann Arno, Jessen Carl R

出版信息

Am J Vet Res. 2017 Nov;78(11):1273-1283. doi: 10.2460/ajvr.78.11.1273.

Abstract

OBJECTIVE To determine clinical relevance for quantitative and qualitative features of canine hepatic masses evaluated by use of triphasic CT and B-mode, color flow, power, and pulsed-wave Doppler ultrasonography and to compare diagnostic accuracy of these modalities for predicting mass type on the basis of histopathologic classification. ANIMALS 44 client-owned dogs. PROCEDURES Dogs with histopathologic confirmation (needle core, punch, or excisional biopsy) of a hepatic mass were enrolled. Triphasic CT and B-mode, color flow, power, and pulsed-wave Doppler ultrasonography of each hepatic mass were performed. Seventy quantitative and qualitative variables of each hepatic mass were recorded by 5 separate observers and statistically evaluated with discriminant and stepwise analyses. Significant variables were entered in equation-based predictions for the histopathologic diagnosis. RESULTS An equation that included the lowest delayed-phase absolute enhancement of the mass and the highest venous-phase mass conspicuity was used to correctly classify 43 of 46 (93.5%) hepatic masses as benign or malignant. An equation that included only the lowest delayed-phase absolute enhancement of the mass could be used to correctly classify 42 of 46 (91.3%) masses (with expectation of malignancy if this value was < 37 Hounsfield units). For ultrasonography, categorization of the masses with cavitations as malignant achieved a diagnostic accuracy of 80.4%. CONCLUSIONS AND CLINICAL RELEVANCE Triphasic CT had a higher accuracy than ultrasonography for use in predicting hepatic lesion classification. The lowest delayed-phase absolute enhancement of the mass was a simple calculation that required 2 measurements and aided in the differentiation of benign versus malignant hepatic masses.

摘要

目的 确定使用三相CT以及B型、彩色血流、能量和脉冲波多普勒超声评估犬肝脏肿块的定量和定性特征的临床相关性,并比较这些检查方法基于组织病理学分类预测肿块类型的诊断准确性。 动物 44只客户拥有的犬。 方法 纳入经组织病理学确诊(针芯活检、打孔活检或切除活检)肝脏肿块的犬。对每个肝脏肿块进行三相CT以及B型、彩色血流、能量和脉冲波多普勒超声检查。由5名独立观察者记录每个肝脏肿块的70个定量和定性变量,并通过判别分析和逐步分析进行统计学评估。将显著变量纳入基于方程的组织病理学诊断预测中。 结果 一个包含肿块最低延迟期绝对强化值和最高静脉期肿块显影度的方程能够将46个肝脏肿块中的43个(93.5%)正确分类为良性或恶性。一个仅包含肿块最低延迟期绝对强化值的方程可用于将46个肿块中的42个(91.3%)正确分类(如果该值<37亨氏单位,则预期为恶性)。对于超声检查,将有空洞的肿块分类为恶性的诊断准确率为80.4%。 结论及临床相关性 在预测肝脏病变分类方面,三相CT的准确性高于超声检查。肿块最低延迟期绝对强化值是一个简单的计算,只需进行2次测量,有助于鉴别肝脏肿块的良性与恶性。

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