Shiomi S, Kuroki T, Jomura H, Ueda T, Ikeoka N, Kobayashi K, Ikeda H, Ochi H
Third Department of Internal Medicine, Osaka City University Medical School, Japan.
J Nucl Med. 1995 Apr;36(4):593-8.
We investigated the possibility that fuzzy reasoning might be used to standardize diagnosis of liver disease based on scintigraphic results and compared the results with those obtained when scintiscans were scored conventionally.
Seventy-five patients with chronic liver disease (11 patients had chronic persistent hepatitis, 26 had chronic aggressive hepatitis and 38 had cirrhosis) and 25 controls were studied. Another 75 patients with hepatitis or cirrhosis were examined to test the effectiveness of the membership functions. Liver scintiscans were taken 20 min after the intravenous injection of 111 MBq of 99mTc-phytate. Fuzzy reasoning was used to evaluate the following five items: the ratio of the sizes of the left and right lobes, splenomegaly, radioactivity in the bone marrow, deformity of the liver and distribution of radioactivity in the liver. The degree of conformity to each of the three liver diseases being investigated was substituted into the membership function for the conclusion. The center of gravity for each patient's results was calculated. Conventional scoring was made with three levels for each of the five items examined by fuzzy reasoning.
Distinctions between chronic persistent hepatitis and chronic aggressive hepatitis were difficult to assess with fuzzy reasoning and conventional scoring. The diagnostic accuracy was 95% for patients with cirrhosis and 88% for patients with chronic hepatitis with fuzzy reasoning. With conventional scoring the accuracy was 86% for patients with cirrhosis and 75% for patients with chronic hepatitis. When fuzzy reasoning was used to examine the other 75 patients with chronic liver diseases, the accuracy was 93% for patients with cirrhosis and 86% for patients with chronic hepatitis.
The method is simple and can be used routinely in clinical settings.
我们研究了基于闪烁扫描结果使用模糊推理来标准化肝病诊断的可能性，并将结果与传统方式对闪烁扫描进行评分时获得的结果进行了比较。
对75例慢性肝病患者（11例为慢性持续性肝炎，26例为慢性活动性肝炎，38例为肝硬化）和25例对照进行了研究。另外对75例肝炎或肝硬化患者进行检查以测试隶属函数的有效性。静脉注射111MBq的99mTc-植酸盐后20分钟进行肝脏闪烁扫描。使用模糊推理评估以下五项：左右叶大小之比、脾肿大、骨髓放射性、肝脏畸形和肝脏放射性分布。将与所研究的三种肝病中每种的符合程度代入结论的隶属函数。计算每位患者结果的重心。对模糊推理所检查的五项中的每一项采用三个等级进行传统评分。
用模糊推理和传统评分难以评估慢性持续性肝炎和慢性活动性肝炎之间的区别。对于肝硬化患者，模糊推理的诊断准确率为95%，对于慢性肝炎患者为88%。采用传统评分时，肝硬化患者的准确率为86%，慢性肝炎患者为75%。当使用模糊推理检查另外75例慢性肝病患者时，肝硬化患者的准确率为93%，慢性肝炎患者为86%。
该方法简单，可在临床环境中常规使用。
