ABSTRACT
Objective:To investigate the clinical value of virtual monoenergetic images (VMI) and electron density map (EDM) derived from the dual-layer spectral detector CT (DLCT) in the differential diagnosis of benign and malignant pulmonary ground glass nodules (GGN).Methods:From July 2019 to August 2020, a total of 65 patients with lung GGN (27 benign GGNs and 38 malignant GGNs) confirmed by pathology were retrospectively enrolled in Gulou Clinical Medical College of Nanjing Medical University. All the patients underwent DLCT plain scanning within two weeks before the surgery. The conventional 120 kVp polyenergetic image (PI), EDM and 40-80 keV VMI were reconstructed. The differences of CT and electron density (ED) values between benign and malignant lesions on different images were compared by Mann-Whitney U test. Independent t-test was used to compare the lesion size and χ 2 test was used to analyze the CT features (including lesion location, shape, edge, internal structure, adjacent structure, nodule type) between benign and malignant lesions. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of different energy spectrum quantitative parameters in the differential diagnosis of benign and malignant GGN. The statistically significant CT signs and energy spectrum quantitative parameters were analyzed by logistic regression analysis to find out the independent risk factors of malignant GGN, and then ROC curve analysis was performed for each independent risk factor alone or in combination. Results:There were significant differences in lesion shape, spiculation, lobulation, location and size between benign and malignant groups ( P<0.05). The CT value of pulmonary GGN in PI, 40-80 keV VMI and the ED value in EDM were statistically different between benign and malignant lesions ( P<0.05). The area under ROC curve (AUC) were 0.680, 0.682, 0.683, 0.686, 0.694, 0.676 and 0.722, respectively, among which the ED value had the highest AUC. Binary logistic regression analysis was carried out with GGN shape, spiculation, lobulation, location, size, ED value and CT value in PI, 40-80 keV VMI as independent variables, and malignant GGN as dependent variables. The results showed that ED value (OR=1.045, 95%CI 1.001-1.090, P=0.044), lesion size (OR=1.582, 95%CI 1.159-2.158, P=0.004), spiculation sign (OR=11.352, 95%CI 2.379-54.172, P=0.002) were independent risk factors for malignant GGN. ROC curve analysis showed the AUC of ED value, lesion size, spiculation sign and combination of the three for differential diagnosis of benign and malignant GGN were 0.722, 0.772, 0.698 and 0.885. The AUC for the combined parameters was the largest, with sensitivity of 92.1% and specificity of 74.1%. Conclusion:The diagnostic efficacy of EDM is higher than that of other VMI in the differential diagnosis of pulmonary GGN by DLCT images; The efficacy is further improved when EDM is combined with lesion size and spiculation sign for comprehensive diagnosis.
ABSTRACT
Objective To compare the effects of general anesthesia and epidural anesthesia on short -term cognitive function in elderly patients after orthopedic surgery.Methods According to the digital table,90 elderly orthopedic patients were divided into the control group and observation group,45 cases in each group.The control group was given general anesthesia,and the observation group was given epidural anesthesia.Before anesthesia and 6h,12h,12h,72h after anesthesia,cognitive function was detected according to MMSE,and before anesthesia and operation,30min after operation,postoperation heart rate (HR)and blood pressure (BP)were measured.Results Before anesthesia,before operation,30 min intraoperation and after operation,the HR between the two groups had no significant differences(t =0.094,0.113,0.188,0.348,all P >0.05),and BP between the two groups also had no significant differences (t =0.190,0.179,0.181,0.271,all P >0.05).Compared with the scores of MMSE in the control group at postoperative 24h,the scores of MMSE in the observation group was significantly higher (t =37.947, P 0.05).Compared with pre -induction,the scores of MMSE in the control group at postopera-tive 6h,12h and 24h were significantly lower(t =29.912,41.000,39.528,all P 0.05).Conclusion Compared with general anesthesia,epidural anesthesia has less impact on short -term cognitive function.and the anesthetic effect is better.