海绵状血管瘤的MRI诊断

本文总结了我院自89年以来的24例经手术和病理证实的海绵状血管瘤,就期MRI表现特征,诊断与鉴别诊断要点作了较详细的分析研究。认为MRI对此病的检出率及定位正确性有着传统方法及CT不可比拟的优点,但其定性诊断的正确率有待进一步提高。随着MRI仪的不断普及和放射科医生经验的不断积累,人们对海绵状血管瘤这一少见的血管性病变的认识一定会不断提高。     

脑海绵状血管瘤的MRI与临床特征及其治疗(附二例报告)

目的:探讨脑海绵状血管瘤的临床特征。方法:回顾分析29例脑海绵状血管瘤的临床资料,对其临床表现、诊断和治疗进行总结。结果:主要临床表现为头痛和癫痫发作,MRI有助于明确诊断。结论:MRI是诊断脑海绵状血管瘤最敏感的方法,对有症状者施行积极的显微外科治疗能收到良好效果     

脑海绵状血管瘤的MRI与临床特征及其治疗（附二例报告）

目的：探讨脑海绵状血管瘤的临床特征。方法：回顾分析29例脑海绵状血管瘤的临床资料,对其临床表现、诊断和治疗进行总结。结果：主要临床表现为头痛和癫痫发作,删有助于明确诊断。结论：MRI是诊断脑海绵状血管瘤最敏感的方法,对有症状施行积极的显微外科治疗能收到良好效果。     

不同分化程度的原发性肝癌MRI初步临床研究

目的:探讨原发性肝癌不同分化程度、细胞类型的MRI图像特征、参数。方法:回顾性分析肝硬化再生结节27例、肝细胞癌75例81处病灶(高度分化15例,中度分化40例,低度分化26例)、肝内胆管癌20例的病理结果及MRI影像学数据,比较再生结节、肝细胞癌和肝内胆管癌之间,以及肝细胞癌各种组织分化程度之间的ADC值、强化程度差异。结果:常规MRI平扫结合LAVA可准确诊断大部分原发性肝癌病例。再生结节、肝细胞癌及肝内胆管癌ADC值均值的具有显著统计学差异(P0.01);肝细胞癌高分化组、中分化组及低分化组ADC值均值均具有显著统计学差异(P0.01),但中、低分化肝细胞癌ADC值均值的差异无实际临床意义;高分化肝细胞癌与肝内胆管癌ADC值均值的差异无统计学意义(P=0.27)。结论:常规MRI结合DWI、多期动态增强扫描有助于区分原发性肝癌各种组织分化程度及细胞类型。     

磁共振成像对非小细胞肺癌的诊断价值分析

目的:探讨磁共振成像(Magnetic resonance imaging,MRI)对非小细胞肺癌的诊断价值。方法:选择2016年9月-2019年4月南京医科大学附属脑科医院(胸科院区)放射科收治的肺部结节患者74例,包括病理证实为肺部良性病变54例(良性组)和非小细胞肺癌20例(肺癌组)。所有患者都给予常规MRI、增强MRI与磁共振扩散加权成像(Diffusion weighted imaging,DWI),记录影像学特征并评估其诊断价值。结果:肺癌组的病灶形态、边缘等MRI特征与良性组对比差异无统计学意义(P0.05)。在b值=0、600、800、1000 s/mm~2条件下,肺癌组的病灶表观扩散系数(Apparent diffusion coefficient,ADC)值都显著低于良性组(P0.05)。肺癌组的病灶MRI增强Ⅰ型+Ⅱ型比例显著高于良性组(P0.05)。MRI鉴别诊断非小细胞肺癌的敏感性与特异性为98.1%和94.4%。结论:MRI用于非小细胞肺癌的诊断能反映病灶组织的血流动力学与水分子活动状况,具有较高的诊断敏感性与特异性。     

急性胰腺炎患者的CT、MRI影像学表现及其诊断价值对比研究

摘要 目的：比较急性胰腺炎患者的电子计算机断层扫描（CT）、磁共振成像（MRI）影像学表现及其诊断价值。方法：选择2018年1月-2019年12月我院收治并初步诊断为急性胰腺炎的患者124例,所有患者均同时行CT和MRI检查,并比较两种检查方式诊断急性胰腺炎的影像学表现,以临床最终诊断结果作为参考,比较两种检查方式诊断急性胰腺炎的价值。结果：124例患者,经临床最终诊断为急性胰腺炎96例,28例为非急性胰腺炎,以临床最终诊断结果为\"金标准\",CT诊断急性胰腺炎的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为84.38%、75.00%、92.05%、58.33%、82.26%,MRI诊断急性胰腺炎的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为95.83%、78.57%、93.88%、84.62%、91.94%,MRI诊断急性胰腺炎的灵敏度、阴性预测值和准确度显著高于CT（P<0.05）,两种检查方式诊断急性胰腺炎的特异度、阳性预测值比较无统计学差异（P>0.05）。结论：CT和MRI影像学表现有利于急性胰腺炎的诊断,两者对急性胰腺炎诊断均具有较高的灵敏度、特异度和准确度, 但MRI诊断急性胰腺炎的灵敏度、准确度优于CT。     

宫颈癌腹主动脉旁淋巴结转移相关危险因素的研究分析

摘要 目的：分析上海市第一人民医院2015年至2019年期间250例分期为IB～IIA期的宫颈癌患者腹主动脉旁淋巴结（para-aortic lymph node,PALN）转移的危险因素,并探讨在早期宫颈癌手术中PALN清扫的意义。方法：回顾性分析250例宫颈癌患者的临床及病理资料,这些患者均接受了腹腔镜或开腹根治性子宫切除术+双侧盆腔淋巴结（pelvic lymph node,PLN）及PALN清扫术,采用统计学方法,通过单因素分析及多因素分析来讨论影响PALN转移的危险因素。结果：在250例宫颈癌患者中,PLN的转移率为27.60 %（69/250）,PALN的转移率为6.40 %（16/250）,在PLN转移阳性中,有15例PALN转移阳性的患者,转移率为21.74 %（15/69）。单因素分析显示,肿瘤最大直径、分期、淋巴脉管间隙浸润（lymph vascular space invasion,LVSI）、PLN转移以及鳞状上皮细胞癌抗原(SCC-Ag)与PALN转移有关（P＜0.05）,而多因素分析显示,分期为IIA期、PLN转移阳性以及PLN转移的个数≥3个是PALN转移的独立危险因素。将这些危险因素代入回归方程以建立临床预测模型,Y=-5.691+1.497×IIA期+3.627×PLN转移（Y代表PALN转移率）,利用受试者工作特征（receiver operating characteristic,ROC)曲线评估这些独立危险因素对于判断PALN转移是否具备一定的诊断价值,此时截断值（cut-off value）为0.064,灵敏度为93.80 %,特异度为76.90 %,曲线下面积（AUC）为0.907（P＜0.001,95 % CI：0.859～0.955）,H-L检验（Hosmer-Lemeshow）发现该模型拟合优度效果较好（P＞0.05）。同时通过绘制ROC曲线发现,当PLN转移个数≥3个以及肿瘤最大直径≥3.4 cm时,对判断是否存在PALN转移也具有一定的临床价值。结论：通过分析表明IIA期、PLN转移阳性以及转移个数≥3个是PALN转移的独立危险因素,可以对这些因素展开进行充分的评估与诊断,从而更加优化宫颈癌患者的分期、手术方式、治疗方案,为患者提供个体化临床诊疗,以期提高宫颈癌患者的生存质量,减少术后的并发症,改善患者的预后等。     

头颈部木村病的CT、MRI影像学表现

目的:探讨头颈部木村病的CT、MRI的影像学表现。方法:对6例经手术或活检病理证实的头颈部木村病的CT及MRI影像学表现进行回顾性分析。结果:本组6例以中青年男性患者多见,病灶位于耳周2例、颊面部1例、颌下区1例,腮腺区1例、头皮下1例,均表现为无痛性肿块。3例CT表现为单侧或双侧、单发或多发等或略高密度软组织肿块,密度均或不均,边缘清楚或局部欠清,伴邻近皮下组织受累;增强扫描病灶表现为不同程度强化。3例MRI表现为对比邻近肌肉信号,病灶在T1WI上为等、稍高信号,在T2WI上为高信号,大部分病灶中等至明显强化。本组6例病变均伴有周围多发淋巴结肿大及实验室检查外周血嗜酸性粒细胞增多,可伴病侧局部皮下脂肪层萎缩。结论:头颈部木村病的CT、MRI影像表现有一定特征性,结合临床病史及实验室检查,可提高木村病的诊断准确率。     

显微手术在矢状窦镰旁脑膜瘤中的治疗效果分析

目的:研究显微手术在矢状窦镰旁脑膜瘤中的治疗效果。方法:选取2014年7月至2015年6月本院收治的150例矢状窦镰旁脑膜瘤患者,根据投硬币法分为观察组和对照组,每组75例。观察组采取显微手术进行治疗,对照组采用常规开颅手术方式进行治疗,比较两组患者的手术指标、手术切除率、临床疗效及并发症的发生率。结果:观察组的术中输血量、出血量均显著少于对照组(P0.05),两组患者手术时间、手术切除程度、改善率、致残率及死亡率比较差异均无统计学意义(P0.05)。观察组总的并发症发生率显著低于对照组(P0.05)。结论:经显微手术治疗矢状窦镰旁脑膜瘤患者术中输血量和出血量较少,手术效果良好,安全性高。     

正常肾脏的磁共振扩散峰度成像研究

目的:验证肾脏扩散峰度成像(DKI)的可行性,并明确年龄因素对肾脏水分子扩散特性是否存在影响。方法:用3.0T磁共振扫描仪对年龄范围在20-60岁之间的41名健康志愿者进行磁共振DKI扫描。按年龄因素分四组(20-29岁)、(30-39岁)、(40-49岁)、(50-59岁),行t-test及方差分析及比较不同年龄因素对肾皮质和髓质的分数各向异性(FA)值、平均扩散(MD)值、峰度各向异性(FAK)值、平均峰度(MK)值的影响并进行统计学分析。结果:正常肾皮质的FA值、FAK值、MK值(0.327±0.047,0.325±0.088,0.688±0.087)显著低于髓质(0.389±0.062,0.396±0.091,0.802±0.124);而正常肾皮质MD值(1.633±0.157)显著高于髓质(1.588±0.162)。不同年龄段之间的FA、MD、FAK、MK值均无统计学差异(P0.05);左、右肾之间的比较无统计学差异(P0.05)。结论:正常肾脏DKI良好的揭示了肾皮质与髓质的水分子扩散特性;年龄因素对肾脏水分子扩散特性没有影响。     

^H磁共振波谱在脑胶质瘤的应用进展

磁共振波谱（magnetic resonance spectroscopy,MRS）技术的出现使活体检测组织的代谢和生化信息成为可能,随着其技术的不断成熟,其在临床的应用范围日益扩大。脑胶质瘤具有与正常脑组织不同的代谢特征,借助MRS技术一方面可以反映其代谢特征,另外可将其与正常脑组织区分,因此MRS技术特别是^1H-MRS在脑胶质瘤的诊断、鉴别诊断、分级及预后评估中应用日益广泛。本文就相关进展进行综述。     

Three-dimensional reconstruction of brain surface anatomy based on magnetic resonance imaging diffusion-weighted imaging: A new approach

Fifty normal noninfarct patients and 12 cases with infarcts of the cerebrum were examined with routine magnetic resonance imaging and echo-planar diffusion-weighted imaging. The diffusion-weighted three-dimensional images were reconstructed with volume-rendering processing on workstation. Precentral gyrus, post-central gyrus, superior parietal lobule, superior frontal gyrus, precentral sulcus, central sulcus, postcentral sulcus, intraparietal sulcus and superior frontal sulcus were best shown of all structures with an arbitrary score of 2.61–2.77. Supramarginal gyrus, middle frontal gyrus, inferior frontal gyrus and lateral sulcus were clearly shown in the majority of the cerebra with average scores of 2.0–2.49; angular gyrus, inferior frontal sulcus and superior temporal gyrus were not demonstrated satisfactorily and their average scores were 1.67–1.89. Middle temporal gyrus, inferior temporal gyrus, superior temporal sulcus and inferior temporal sulcus were difficult to identify, and thus had average scores of 0.87–1.26. Brain surface structures were better displayed in the older group of individuals than in the younger group. The structures in the 12 cases with acute or chronic cerebrum infarcts were also satisfactorily demonstrated with this new technique.     

多功能磁共振造影剂研究进展

磁共振成像技术因对人体无创、任意方向断层扫描三维图像且分辨率较高、提供形态与功能两方面诊断评价等突出优点,成为了临床上用于疾病诊断的重要手段之一。临床上使用磁共振造影剂可以提高成像的分辨率和灵敏度,提高图像质量,增强对比度和可读性。但是,各种成像技术由于实现原理不同,具有各自的优势和缺陷,靠传统单一的诊断模式无法提供疾病的全面信息,因而在对各种复杂疾病进行诊断时会受到一定的限制。因此,将磁共振成像与其他成像技术如CT成像、超声成像等联合起来使用,则可以达到优势互补的效果,能为疾病的临床诊断提供更快捷精确的信息,同时可将磁共振成像与各种治疗方式结合在一起,即开发基于磁共振成像的诊断治疗一体化试剂,以实现对疾病的即时治疗和实时监控。本文主要介绍了磁共振成像造影剂的原理和种类,并且综述了目前国内外在基于磁共振成像的多功能造影剂/诊疗制剂这一领域的研究进展,最后就未来可能的研究方向进行了展望。     

Preparation, characterization and in vivo assessment of Gd-albumin and Gd-dendrimer conjugates as intravascular contrast-enhancing agents for MRI

We report in vivo and in vitro MRI properties of six gadolinium-dendrimer and gadolinium-albumin conjugates of derivatized acyclic diethylenetriamine-N,N′,N′,N″, N″-pentaacetic acid (1B4M) and macrocyclic 1,4,7,10-tetraazacyclododecane-N,N′,N″,N?-tetraacetic acid (C-DOTA). The three albumin-based agents have comparable protein to chelate ratios (1:16-18) as well as molar relaxivity (8.8-10.4 mM^− 1 s^− 1). The three dendrimer based agents have blood clearance half-lives ranging from 17 to 66 min while that of the three albumin-based agents are comparable to one another (40-47 min). The dynamic image obtained from use of the albumin conjugate based on the macrocycle (C-DOTA) showed a higher contrast compared to the remaining two albumin based agents. Our conclusion from all of the results is that the macrocyclic-based (DOTA) agents are more suitable than the acyclic-based (1B4M) agent for in vivo use based on their MRI properties combined with the kinetic inertness property associated with the more stable Gd(III) DOTA complex.     

Using two palpable measurements improves the subject-specific femoral modeling

Subject-specific musculoskeletal models are essential to biomedical research and clinical applications, such as customized joint replacement, computer-aided surgical planning, gait analysis and automated segmentation. Generating these models from CT or magnetic resonance imaging (MRI) is time and resource intensive, requiring special skills. Therefore, in many studies individual bone models are approximated by scaling a generic template. Thus, the primary goal of this study was to determine a set of clinically available parameters (palpable measures and demographic data) that could improve the prediction of femoral dimensions, as compared to predicting these variables using uniform scaling based on palpable length. Similar to previous non-homogenous anthropometric scaling methods, the non-homogenous scaling method proposed in this study improved the prediction over uniform scaling of five key femoral measures. Homogenous scaling forces all dimensions of an object to be scaled equally, whereas non-homogenous scaling allows the dimensions to be scaled independently. The largest improvement was in femoral depth, where the coefficient of determination (r²) improved from 0.22 (homogenous) to 0.60 (non-homogeneous). In general, the major advantage of this non-homogenous scaling method is its ability to support the accurate and rapid generation of subject-specific femoral models since all parameters can be collected clinically, without imaging or invasive methods.     

Muscle cross-section measurement by magnetic resonance imaging

Muscle cross-section areas were measured by magnetic resonance imaging (MRI) in the thigh of a human cadaver, the results being compared with those obtained by photography of corresponding anatomic macroslices. A close correlation was found between MRI and photographic evaluation, differences between the methods ranging from nil to 9.5%, depending on the scan position and the muscle groups. In vivo MRI measurements were performed on 12 female and 16 male students, the objectivity, the test-retest reliability and the variability of the MRI measurements being studied by fixing the scan position either manually or by coronary scan. The latter method appeared to be more objective and reliable. The coefficients of variation for muscle cross-section areas measured by MRI were in the range of those for the planimetry of given cross-section areas. Allowing for differentiation between several small muscle bundles in a given area, MRI proved to be a suitable method to quantify muscle cross-sections for intra- and interindividual analysis of muscle size.     

Fast Keyhole MR Imaging Using Optimized k-Space Data Acquisition

In some dynamic magnetic resonance imaging (MRI) applications, the sample is still, and only the signal intensity changes with time. For such cases, the keyhole imaging principle can be used. In standard keyhole imaging, a low-frequency image signal is acquired, using a limited number of phase-encoding steps, which correspond to the rectangular sampling region in the k-space center. However, such a region practically never coincides with the position of the k-space points, which carry the most relevant low-frequency image information. In this paper we propose an improved keyhole method, which allows dynamic acquisition of a low-frequency image signal from selected most relevant k-space points via fast imaging mechanisms. Dynamic data acquisition is executed in the presence of time-varying magnetic-field (MF) gradients after single sample excitation. Special care has been taken in the design of the gradient sequence to minimize gradient load. This improved keyhole imaging method has been considered theoretically and verified experimentally on a model system.     

超顺磁性造影剂的研究进展

超顺磁性造影剂是一种新型的磁共振造影剂,对肝脾等部位的成像效果显著,已成为国内外研究的热点之一。本文对超顺磁性造影剂的增强原理和制备方法进行了总结及评论。     

CT、常规MRI序列和SWI诊断弥漫性轴索脑损伤比较

目的：探讨弥漫性轴索损伤（DAI）的CT、常规MRI序列和磁敏感加权成像（SWI）表现与诊断价值。方法：回顾分析42例DAI患者的影像资料,分析、比较CT、MRI和SWI的信号特征及脑内病灶显示率。结果：SWI显示病灶最多、最敏感;脑CT扫描次之;常规MRI序列敏感性差,只有部分病灶显示。结论：CT、MRI和SWI对DAI早期诊断、治疗及评价预后具有重要参考价值,SWI是诊断DAI最有效的首选影像学检查方法。     

^1HMRS在定性诊断乙肝后早期肝硬化中的初步研究

目的：研究慢性乙型肝炎后早期肝硬化患者的氢质子磁共振波谱图像特点,旨在探讨^1HMRS成像技术诊断慢乙肝后早期肝硬化的可行性,为早期肝硬化的定性诊断提供新的方法。方法：首先,筛选出15例健康志愿者及15例慢乙肝后早期肝硬化患者。并将15例患者依据肝穿结果分为S2期、S3期和S4期三组;然后,对15例健康志愿者及15例慢乙肝后肝硬化组患者进行常规MRI扫描,包括三平面定位,横断面T1加权像（T1WI）、T2加权像（T2WI）,于T2WI上选取感兴趣区进行单体素氢质子波谱扫描。分别采集各化合物峰,通过GE公司波谱分析软件校正,测量各波峰峰值和峰下面积,分析正常组和病例组各波峰和峰下面积变化特征。结果：正常组均得到谷氨酸和谷氨酰氨复合物（glumatic acid and glutamylamnnia complex,GIX）峰与胆碱／磷酸肌酸（choline／phosphoric creatine acid,Cho／Pcr）峰,病例纽除上述两峰外,还得到乳酸（Lactate,Lac）峰和脂质（Lipid,Lip）峰。经统计学分析正常组与病例组Glx、Cho／Pcr峰值及峰下面积无明显差异（P〉0．05）,而Lac、Lip峰值及峰下面积有差异统计学意义（P〈0.05）。病例组内的S2、S3及S4期三组各自的Glx、Cho／Pcr、Lac、Lip峰值及峰下面积差异无统计学意义（P〉0．05）。结论：1H磁共振波谱成像技术是一种非创伤性定性检测慢乙肝后早期肝硬化的方法。