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。     

Liposomes and Micelles to Target the Blood Pool for Imaging Purposes

Abstract

The blood pool is among body compartments of a special interest for imaging using magnetic resonance (MR) and computed tomography (CT), since with the help of selective blood-pool contrast agents blood perfusion and various cardiac parameters as well as a status of the blood flow and vascular system in any organ can be evaluated. Blood pool-specific imaging agents can also provide minimally invasive angiography, image guidance of minimally invasive procedures, oncologic imaging of angiogenesis, ascertaining organ blood volume, and identifying hemorrhage. Particulate contrast agents (such as liposomes and micelles) whose distribution is limited to the blood pool, should have a size larger than fenestrated capillaries (> 10 nm), contain the reporter (paramagnetic or radiopaque) moiety structurally incorporated within the particulate, and be able to stay in the blood long enough to obtain clinically useful images. We describe here a new generation of long-circulating Gd-loaded liposomes and iodine-loaded micelles to provide an efficient blood pool MR and CT imaging, respectively. In this study, we developed the optimized protocol to prepare a liposomal MR contrast agent with high relaxivity and narrow size distribution. Liposomes were loaded with Gadolinium (Gd) via so called polychelating amphiphilic polymer (PAP) that represents a low-molecular-weight DTPA-polylysine linked via its N-terminus to a lipid anchor, NGPE-PE. Gd-containing liposomes were additionally modified with PEG to provide the longevity in vivo. We demonstrated also that upon the intravenous administration in rabbits and dogs, a new preparation causes prolonged decrease in the blood Tl value, permits to obtain sharp and clear MR images of the vasculature, and may be considered as a potential contrast agent for MRI of the blood pool. In addition, to prepare micellar contrast agents for CT blood-pool imaging, we synthesized an iodine-containing amphiphilic block-copolymer consisting of methoxypoly(ethyleneglycol) and polyl?,N-(triiodobenzoyl)]-L-lysine. In aqueous solutions, it forms stable micelles with an average diameter of 80 nm and an iodine content of 35–40% wt. Iodine-containing micelles were intravenously injected into rats and rabbits at a dose of 170 mg I/kg and produced significant and sustained enhancement of the blood pool (aorta and heart), liver and spleen for a period of at least 3 hours providing clear and informative CT images.     

影像学在肾癌靶向治疗中的临床应用价值-现状与展望

肾癌为最常见的肾脏恶性肿瘤,其易复发及易出现远隔转移,靶向治疗已逐渐成为肾癌治疗中不可或缺的治疗手段。由于RECIST标准评价实体瘤疗效具有明显的局限性,临床实践中常使用电子计算机断层扫描(CT)、磁共振成像(MRI)评价疗效。随着技术的不断发展,很多新颖的影像学手段如动态增强超声(DCE-US)、正电子发射断层显像(PET-CT)等可以更准确更早期地评价及预测靶向治疗的疗效。本文对肾癌靶向治疗的影像学现状及展望进行综述。     

Quantitative evaluation of internal marks made using MRgFUS as seen on MRI,CT, US,and digital color images – A pilot study

This pilot study compared the detectability of internal thermal marks produced with MRI-guided focused ultrasound (MRgFUS) on MRI, computed tomography (CT), ultrasonography (US), and color images from digital scanning. Internal marks made using MRgFUS could potentially guide surgical, biopsy or radiotherapy procedures. New Zealand White rabbits (n = 6) thigh muscle were marked using a Philips MRgFUS system. Before and after sonications, rabbits were imaged using T₁- and T₂-weighted MRI. Then rabbits were sacrificed and imaging was performed using CT and US. After surgical excision specimens were scanned for color conspicuity analysis. Images were read by a radiologist and quantitative analysis of signal intensity was calculated for marks and normal muscle. Of a total of 19 excised marks, approximately 79%, 63%, and 62% were visible on MRI, CT, and US, respectively. The average maximum temperature elevation in the marks during MRgFUS was 39.7 ± 10.1 °C, and average dose diameter (i.e., the diameter of the area that achieved a thermal dose greater than 240 cumulative equivalent minutes at 43 °C) of the mark at the focal plane was 7.3 ± 2.1 mm. On MRI the average normalized signal intensities were significantly higher in marks compared to normal muscle (p < 0.05). On CT, the marked regions were approximately 10 HU lower than normal muscle (p < 0.05). The results demonstrate that MRgFUS can be used to create internal marks that are visible on MRI, CT and US.     

中国数字化可视人体鞍上池的横断面解剖与CT、MRI对照研究

目的:探讨鞍上池在中国数字化可视人体(Chinese visible human,CVH)与CT、MRI上的横断面解剖形态学表现。方法:选择做64层螺旋CT和MRI头部检查的健康志愿者各60例,获得5mm层厚横断面图像。从第2例中国数字化可视人体数据集中选取与CT、MRI相对应层面的头部薄层连续横断面标本图像,对照观察鞍上池在CVH、MRI与CT图像上的正常解剖形态、毗邻及内部结构。结果:CVH图像上,鞍上池表现为六角形和五角形两种形状。CVH薄层横断面图像能连续、清晰地显示鞍上池的正常形态、毗邻及内部结构。60例CT及MRI图像上,鞍上池全部显示,但解剖结构均不及CVH清晰。鞍上池在CT、MRI横断面图像上形状变化更大,以六角形最多,五角形次之,四角形最少,相应毗邻及内部结构也有所不同。六角形鞍上池在CVH、CT、MRI上有良好的对应关系,五角形鞍上池部分相匹配,CVH图像上无四角形鞍上池。结论:通过与CT、MRI进行对照研究,中国数字化可视人体能为颅脑疾病的影像识别和诊断提供断层解剖学依据。     

基于SIFT特征和近似最近邻算法的医学CT图像检索

针对医学X线计算机断层（Computed Tomography,CT）图像,提出了一种基于尺度不变特征变换（Scale InvariantFeature Transform,SIFT）特征和近似最近邻算法的检索方法。首先通过SIFT算法得到图像的特征点和相应的特征向量,再采用近似最近邻算法进行SIFT特征向量的匹配搜索,得到数据库中与参考图像最相似的图像序列。实验结果表明,该法能检索到与目标图像细节相符的结果,大大提高了检索速度。与传统的基于纹理的检索方法相比,查准率和检索结果与目标图像的相似程度方面更佳,符合医学CT图像检索的要求。     

MRI与CT检查对卵巢癌病理分期及复发转移的诊断价值对比研究

摘要 目的：对比磁共振成像（MRI）与计算机断层扫描（CT）检查对卵巢癌病理分期及复发转移的诊断价值。方法：纳入2017年1月～2019年1月于我院接受诊治的卵巢癌患者100例进行研究。所有患者术前均进行MRI与CT检查,并以术后病理组织活检结果为金标准,对比MRI与CT诊断卵巢癌与卵巢癌病理分期的准确率。所有患者均于首次检查6个月后进行复诊,对比MRI与CT诊断卵巢癌复发转移的准确率。结果：MRI诊断卵巢癌的确诊率为94.00%（94/100）,高于CT诊断的81.00%（81/100）;漏诊率为2.00%（2/100）,低于CT诊断的10.00%（10/100）（均P＜0.05）。MRI诊断卵巢癌Ⅰ期、Ⅱ期、Ⅲ期的准确率分别为93.33%（14/15）、95.00%（19/20）、93.33%（28/30）,高于CT诊断的60.00%（9/15）、65.00%（13/20）、73.33%（22/30）（均P＜0.05）。MRI诊断肠管及周围、盆腔淋巴结、腹膜后淋巴结、肝脏等远处侵袭和转移中的准确率分别为100.00%（26/26）、88.89%（24/27）、75.00%（18/24）、95.00%（19/20）,高于CT诊断的76.92%（20/26）、48.15%（13/27）、41.67%（10/24）、45.00%（9/20）（均P＜0.05）。结论：相较于CT检查,MRI检查诊断卵巢癌的准确率更高,漏诊率更低,且在卵巢癌病理分期以及复发转移的诊断准确率更高,具有较好的临床应用价值。     

脑发育性静脉畸形9例临床影像特征分析及文献复习

目的:研究脑发育性静脉畸形(Cerebral Developmental Venous Anomalies,CDVA)临床及影像学特征及复习CDVA文献。方法:回顾性收集了自2011年11月至2014年3月我科确诊的9例CDVA的病人,对其临床特征、影像学检查方法包括电子计算机断层扫描(Computed Tomography,CT)、核磁共振成像(Magnetic Resonance Imaging,MRI)、数字减影血管造影(Digital Subtraction Angiography,DSA)及特征进行分析并对相关文献进行复习。结果:(1)临床症状:9例病人的临床症状包括头晕4例(4/9)、头痛4例(4/9)、恶心不适2例(2/9)、站立不稳1例((1/9)、小脑出血史1例(1/9)、眼部症状行眼科检查偶然发现小脑CDVA1例(1/9);(2)病变部位:病变位于幕上4例(4/9);幕下5例(5/9);(3)影像学检查:9例病人中,6例行CT平扫或增强扫描(3例平扫,3例平扫+增强);4例行MRI(1例平扫,3例平扫+增强);3例行DSA检查;(4)影像学特点:CT增强及重建、MRI的T1WI增强、SWI、MRA及DSA静脉期像均可显示出髓静脉及其形成的特征性\"海蛇头\"征象和其引流静脉。结论:CT、MRI、DSA影像学方法均可用于CDVA的诊断,在临床实践中需根据需要优化选择联合应用。     

CT和MRI鉴定腹膜后间隙脂肪肉瘤与组织病理学特征相关

本研究选取2012年1月至2018年1月在我院治疗的腹膜后间隙脂肪肉瘤患者33例,分析患者术前CT、MRI图像及术后病理结果,旨在探讨不同类型腹膜后间隙脂肪肉瘤病理学及影像学特征。研究结果表明:33例患者中术后病理诊断为高分化脂肪肉瘤19例,去分化脂肪肉瘤7例,黏液性脂肪肉瘤7例;不同病理分型脂肪肉瘤病灶大小比较差异无统计学意义(p>0.05);高分化脂肪肉瘤其CT密度同皮下脂肪,CT值-10～-110 Hu,肿瘤内可见不规则增厚的间隔;去分化脂肪肉瘤部分区域呈脂肪密度(CT值-70～30 Hu),部分区域呈软组织肿块(CT值为30～50 Hu);黏液性脂肪肉瘤CT密度接近水,增强扫描时肿块呈网状、片状、延迟强化,CT值20～40 Hu;高分化脂肪肉瘤MRI信号同皮下脂肪;黏液性脂肪肉瘤MRI呈长T1,长T2信号,与水相似;CT和MRI诊断腹膜后间隙脂肪瘤准确率分别为69.70%和73.33%,差异比较无统计学意义(p>0.05)。本研究得出初步结论,不同病理类型腹膜后间隙脂肪肉瘤的CT、MRI表现有所差异;CT和MRI术前诊断腹膜后间隙脂肪肉瘤准确性相似。     

隐匿性胫骨平台骨折MRI、CT检查的影像学表现及其诊断价值对比的回顾性研究

目的:研究对比隐匿性胫骨平台骨折(TPOF)磁共振成像(MRI)、电子计算机断层扫描(CT)检查的影像学表现及其诊断价值。方法:回顾性分析我院自2016年1月至2019年12月拟诊断为TPOF且X线检查表现为阴性的89例患者的临床资料,分别对所有受试者进行MRI、CT检查,且以手术检查为金标准,比较上述两种影像学检查手段诊断TPOF的效能。此外,比较MRI、CT检查诊断TPOF的表观扩散系数以及节段各向异性值以及对TPOF类型的检出率。结果:MRI检查诊断TPOF的灵敏度、特异度及准确度分别为98.61%、94.12%、97.75%,均高于CT检查的79.17%、64.71%、76.40%(均P<0.05)。MRI检查诊断TPOF的表观扩散系数高于CT检查,而节段各向异性值低于CT检查(均P<0.05)。MRI检查对骨皮质骨折的检出率低于CT检查,而对骨小梁骨折的检出率高于CT检查(均P<0.05)。结论:MRI检查诊断TPOF的价值高于CT检查,且在骨小梁骨折的检出率方面优于CT检查,但CT检查应用于骨皮质骨折的诊断价值更高。临床工作中可能通过联合MRI以及CT检查,继而达到提高TPOF检出率的目的。     

急性弥漫性轴索损伤CT与MRI对比的研究

目的:比较急性弥漫性轴索损伤患者CT及MRI表现的不同。方法:选取60例急性弥漫性轴索损伤患者,而CT无异常改变或改变轻微的病例行MRI检查。全部检查均在损伤后6天内完成。GCS评分＜8分44例,9—12分16例。结果:MRI显示具有DAI损伤表现的共41例,阳性率68．3%,其中单独具有DAIⅠ、Ⅱ和Ⅲ型损伤表现的分别为7例、12例和1例,同时具有DAIⅠ和Ⅱ型损伤表现的共12例,同时具有DAJⅠ和Ⅲ型损伤表现的共2例,同时具有DAJⅡ和Ⅲ型损伤表现的共2例,同时具有三型DAI损伤表现的共5例;CT显示具有DAI损伤表现的共3例,阳性率5．0%,其中具有DAIⅠ型损伤表现的2例,具有DAIⅡ型损伤表现的1例,具有DAIⅢ型损伤表现的0例。结论:CT缺乏异常表现或轻微异常表现的急性弥漫性轴索损伤,MRI常常能显示损伤,包括特殊的损伤部位和一些其他类型合并损伤。     

Deformation of articular cartilage during static loading of a knee joint – Experimental and finite element analysis

Novel conical beam CT-scanners offer high resolution imaging of knee structures with i.a. contrast media, even under weight bearing. With this new technology, we aimed to determine cartilage strains and meniscal movement in a human knee at 0, 1, 5, and 30 min of standing and compare them to the subject-specific 3D finite element (FE) model. The FE model of the volunteer?s knee, based on the geometry obtained from magnetic resonance images, was created to simulate the creep. The effects of collagen fibril network stiffness, nonfibrillar matrix modulus, permeability and fluid flow boundary conditions on the creep response in cartilage were investigated. In the experiment, 80% of the maximum strain in cartilage developed immediately, after which the cartilage continued to deform slowly until the 30 min time point. Cartilage strains and meniscus movement obtained from the FE model matched adequately with the experimentally measured values. Reducing the fibril network stiffness increased the mean strains substantially, while the creep rate was primarily influenced by an increase in the nonfibrillar matrix modulus. Changing the initial permeability and preventing fluid flow through noncontacting surfaces had a negligible effect on cartilage strains. The present results improve understanding of the mechanisms controlling articular cartilage strains and meniscal movements in a knee joint under physiological static loading. Ultimately a validated model could be used as a noninvasive diagnostic tool to locate cartilage areas at risk for degeneration.     

The hepatocyte phase of Gd-EOB-DTPA-enhanced MRI in the evaluation of hepatic fibrosis and early liver cirrhosis in a rat model: An experimental study

Aims

To evaluate the hepatocyte phase of Gd-EOB-DTPA-enhanced MRI in the early diagnosis of hepatic fibrosis and cirrhosis and assessment of liver function in a rat model.

Main methods

In 2 groups of SD rats, liver fibrosis was induced in experimental animals by repetitive carbon tetrachloride injections, while the control group received saline injections. Five experimental rats and 2 control rats were randomly selected at weeks 4, 8, 12. One week after carbon tetrachloride administration, MRI (FIRM T1WI) scan was performed. Gd-EOB-DTPA (0.08 mL) was injected into the rat's tail vein and hepatocyte phase images were obtained after 20 min. The pre-enhanced phase and hepatocyte phase signal intensities (SI) were measured, and the relative contrast enhancement index (RCEI) was calculated. ANOVA analysis (LSD) of RCEI values in controls (n = 6), hepatic fibrosis (n = 7), and histopathologically-determined early cirrhosis group (n = 6) was performed.

Key findings

RECI values showed a decreasing trend in the control group, hepatic fibrosis and early cirrhosis groups (1.11 ± 0.43, 0.96 ± 0.22, and 0.57 ± 0.33, respectively). While the difference between the control and early cirrhosis groups was statistically significant (p = 0.013), there was no significant difference in the hepatic fibrosis group vs the control (p = 0.416) and the hepatic fibrosis group vs the early cirrhosis group (p = 0.054).

Significance

Hepatocyte phase RCEI values obtained with Gd-EOB-DTPA-enhanced MRI scan indicate liver injury in hepatic fibrosis and early cirrhosis. RCEI values are helpful for early diagnosis of liver cirrhosis.     

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.     

头部组织三维核磁共振电阻抗成像算法的仿真研究

文章给出了一种基于核磁共振技术的三维阻抗成像（电导率分布）重构算法,并将该方法应用于人体头部组织电导率分布重构上。该代数重构方法是利用高分辨率的核磁共振成像系统对成像物体进行三维构建和不同组织的边界区分,根据核磁共振系统中测量得到的磁感应强度Bx和By分量并结合有限元数值计算得到的电流密度分布J组成非线性矩阵,通过迭代求解此非线性矩阵,来解决三维电导率分布的重构问题。在三层球头模型（包括头皮、颅骨和大脑）上分别进行的仿真实验结果表明,该算法具有较强的抗噪声能力和较好的收敛性,重构的头部电导率分布图像具有较高的精确性。     

Functional activation studies of word processing in the recovery from aphasia

Some reviews on theories of recovery in aphasia put an emphasis on neural network models based on empirical data from evoked-potentials in aphasia as an approach to mapping recovery of cognitive function to neural structure. We will focus here on what we call an "anatomical" approach to look at recovery in aphasia. "Anatomical" theories of recovery stated by classical aphasiologists have contributed to the understanding of language representations in the human brain. But many aspects of these theories can only be investigated by using modern techniques of lesion analysis, psychometric assessment and functional imaging. Whereas structure-function relations have been primarily established by looking for the association of deficit symptoms with certain lesions, functional activation methods offer a means to study more directly the functional anatomy of recovered or retained functions in neuropsychological patients. To falsify or build up anatomical theories of recovery we will propose a stepwise approach of inference. The methodological pitfalls of this approach will be discussed by focussing on anatomical hypotheses of semantic word comprehension and its impairment and recovery in aphasia.     

A Logic Programming and Expert Statistical Systems Approach for Tissue Characterization in Magnetic Resonance Imaging

The main research goal has been to evaluate significant factors affecting the in vivo magnetic resonance imaging (MRI) parameters T, T, T₂, and ¹H density. This approach differs significantly from other such projects in that the experimental data analysis is being performed while concurrently developing automated, computer-aided analysis software for such MRI tissue parameters. In the experimental portion of the project, statistical analyses, and a heuristic minimum/maximum discriminant analysis algorithm have been explored. Both methods have been used to classify tissue types from 1.5 Tesla transaxial MR images of the human brain. The developing program, written in the logic programming language Prolog, is similar in a number of ways to many existing expert systems now in use for other medical applications; inclusion of the underlying statistical data base and advanced statistical analyses is the main differentiating feature of the current approach. First results indicate promising classification accuracy of various brain tissues such as gray and white matter, as well as differentiation of different types of gray matter and white matter (e.g.: caudate-nucleus vs. thalamus, both representatives of gray matter; and, cortical white matter vs. internal capsule as representative of white matter). Taking all four tissue types together, the percentage of correct classifications ranges from 73 to 87%.