CT及MRI在直肠癌诊断和分期的应用价值研究

目的:探究在直肠癌的诊断以及分期方面,CT与MRI技术的应用价值。方法:选取我院近年来经过病理检测,确诊为直肠癌的患者160例,随机分为两个实验组,其中一组采取CT成像方法,另一组患者采取MRI成像。并记录在不同的分期中CT及MRI的应用价值。CT诊断包含了常规CT平扫以及CT增强扫描,MRI诊断包括轴位DWI、T2W1冠状位以及矢状位、轴位T1WI、轴位T2WI的图像。结果:在直肠癌的诊断中,CT诊断的T分期与病理性T分期差异不大,其准确率为70.0%。MRI诊断的T分期和病理性T分期差异极小,其准确率为85.0%。CT诊断的N分期与病理性N分期差异不大,准确率为72.5%;MRI诊断的N分期与病理性N分期差异较小,其准确率为87.5%。CT诊断的T分期以及N分期的准确率与MRI诊断的T分期以及N分期的准确率之间差异均存在统计学意义(P0.05)。结论:在直肠癌的术前诊断以及局部分期中,MRI诊断与CT诊断相比,有更高的诊断价值。     

Susceptibility Weighted Imaging: A New Tool in the Diagnosis of Prostate Cancer and Detection of Prostatic Calcification

Background

Susceptibility weighted imaging (SWI) is a new MRI technique which has been proved very useful in the diagnosis of brain diseases, but few study was performed on its value in prostatic diseases. The aim of the present study was to investigate the value of SWI in distinguishing prostate cancer from benign prostatic hyperplasia and detecting prostatic calcification.

Methodology/Principal Findings

23 patients with prostate cancer and 53 patients with benign prostatic hyperplasia proved by prostate biopsy were scanned on a 3.0T MR and a 16-row CT scanner. High-resolution SWI, conventional MRI and CT were performed on all patients. The MRI and CT findings, especially SWI, were analyzed and compared. The analyses revealed that 19 out of 23 patients with prostate cancer presented hemorrhage within tumor area on SWI. However, in 53 patients with benign prostatic hyperplasia, hemorrhage was detected only in 1 patient in prostate by SWI. When comparing SWI, conventional MRI and CT in detecting prostate cancer hemorrhage, out of the 19 patients with prostate cancer who had prostatic hemorrhage detected by SWI, the prostatic hemorrhage was detected in only 7 patients by using conventional MRI, and none was detected by CT. In addition, CT demonstrated calcifications in 22 patients which were all detected by SWI whereas only 3 were detected by conventional MRI. Compared to CT, SWI showed 100% in the diagnostic sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) in detecting calcifications in prostate but conventional MRI demonstrated 13.6% in sensitivity, 100% in specificity, 75% in accuracy, 100% in PPV and 74% in NPV.

Conclusions

More apparent prostate hemorrhages were detected on SWI than on conventional MRI or CT. SWI may provide valuable information for the differential diagnosis between prostate cancer and prostatic hyperplasia. Filtered phase images can identify prostatic calcifications as well as CT.     

The role of endoscopic ultrasound in the evaluation of rectal cancer

Accurate staging of rectal cancer is essential for selecting patients who can undergo sphincter-preserving surgery. It may also identify patients who could benefit from neoadjuvant therapy. Clinical staging is usually accomplished using a combination of physical examination, CT scanning, MRI and endoscopic ultrasound (EUS). Transrectal EUS is increasingly being used for locoregional staging of rectal cancer. The accuracy of EUS for the T staging of rectal carcinoma ranges from 80-95% compared with CT (65-75%) and MR imaging (75-85%). In comparison to CT, EUS can potentially upstage patients, making them eligible for neoadjuvant treatment. The accuracy to determine metastatic nodal involvement by EUS is approximately 70-75% compared with CT (55-65%) and MR imaging (60-70%). EUS guided FNA may be beneficial in patients who appear to have early T stage disease and suspicious peri-iliac lymphadenopathy to exclude metastatic disease.     

Détection des tumeurs T1 et T2 des voies aérodigestives supérieures : comparaison des performances diagnostiques en IRM et en TEP/TDM-FDG

ObjectiveExtracranial head and neck tumors classified T1 and T2, because of their small size, are more difficult to diagnose by imaging than the tumors of higher stage. The aim of this study is to evaluate and compare FDG-PET/CT and MRI accuracy for detection of small extracranial head and neck tumors.Materials and methodsA retrospective study was led on 21 patients having a histopathologically proven tumors involving the upper aerodigestive tract, classified T1 or T2 according to TNM staging, which received pre-therapeutic MRI and FDG-PET/CT. Tumoral detection ability was estimated on MRI and FDG-PET/CT by a qualitative scale. Sensitivities of the two methods of imaging were compared between then. The SUVmax and the percentage of enhancement were measured for each tumor and analysed according to T staging.ResultsAmong the 21 tumors, 17 were detected by FDG-PET/CT against 12 by MRI. None of the 4 unidentified lesions by FDG-PET/CT was visible on MRI. FDG-PET/CT correctly identified 5 of the 9 MRI false-negative results. The sensitivity was 80.9 % for FDG-PET/CT and 57.1 % for MRI, on the verge of the statistically significant difference (P = 0.06). There was no significant correlation of the SUVmax to the T staging.ConclusionFDG-PET/TDM could be useful for the identification of primary extracranial head and neck tumors, even small-sized, classified T1 or T2, with a sensitivity higher than MRI.     

CT与MRI对肝硬化背景下小肝癌检出率的比较

目的:分析比较CT与MR对肝硬化背景下小肝癌检出情况,探究CT与MR在肝硬化背景下小肝癌的诊断价值。方法:选择2010年6月~2015年6月期间,我院收治确诊为肝硬化背景下小肝癌患者91例为研究对象,病理及临床相关方法确诊102个病灶,其中小肝癌69个和微小肝癌33个,患者均在不同时期或序列下行多排螺旋CT与MRI检查,分析比较两者对小肝癌和微小肝癌的检出率。结果:多排螺旋CT检查发现肝癌小病灶91个,其中66个小肝癌,25个微小肝癌;MRI检查发现95个病灶,小肝癌67个,微小肝癌28个;69个小肝癌病灶,检出率最高的为CT动脉期(92.75%)与LAVA动脉期(92.75%),检出率最低的为CT平扫(76.81%);33个微小肝癌病灶,检出率最高为LAVA动脉期(75.76%),检出率最低的为LAVA平衡期(36.36%);CT平扫、门静脉期、动脉期、平衡期、MRI-IN-PHASE、LAVA平衡期、LAVA平扫对小肝癌的检出率显著高于对微小肝癌的检出率(P0.05);CT对小肝癌的检出率显著高于微小肝癌的检出率(P0.05),MRI对小肝癌与微小肝癌的检出率无显著差异(P0.05);MRI与CT对小肝癌的检出率不存在差异(P0.05),但MRI对微小肝癌的检出率显著高于CT(P0.05)。结论:MRI-LAVA的动脉期序列对小肝癌病灶与微小肝癌病灶的检出率最高;CT与MRI在对小肝癌的检出率不存在差异,但MRI对微小肝癌的检出具有更明显的优势。     

Detection of bone erosions in rheumatoid arthritis wrist joints with magnetic resonance imaging, computed tomography and radiography

Background

The objectives of the present study were, with multidetector computed tomography (CT) as the reference method, to determine the performance of magnetic resonance imaging (MRI) and radiography for the detection of bone erosions in rheumatoid arthritis wrist bones, and to test whether measuring volumes of erosions on CT and MRI is reproducible and correlated to semiquantitative assessments (scores) of erosions on CT, MRI and radiography.

Methods

Seventeen patients with rheumatoid arthritis and four healthy control individuals underwent CT, MRI and radiography of one wrist, performed on the same day. CT was performed on a Philips Mx8000IDT unit (voxel size 0.4 mm × 0.4 mm × 1 mm) and MRI was performed on a Philips Panorama 0.6T unit (voxel size 0.4 mm × 0.4 mm × 0.4 mm). Images were evaluated separately for erosions in all wrist bones and were scored according to the principles of the Outcome Measures in Rheumatology Rheumatoid Arthritis MRI Scoring System (CT and MRI) and the Sharp/van der Heijde (radiographs) scoring methods. Measurements of erosion volumes of all erosions were performed twice with a 1-week interval.

Results

With CT as the reference method, the overall sensitivity, specificity and accuracy (concordance) of MRI for detecting erosions were 61%, 93% and 77%, respectively, while the respective values were 24%, 99% and 63% for radiography. The intramodality agreements when measuring erosion volumes were high for both CT and MRI (Spearman correlation coefficients 0.92 and 0.90 (both P < 0.01), respectively). Correlations between volumes and scores of individual erosions were 0.96 for CT and 0.99 for MRI, while they were 0.83 (CT) and 0.80 (MRI) for persons' total erosion volume and total score (all P < 0.01).

Conclusion

With CT as the reference method, MRI showed moderate sensitivity and good specificity and accuracy for detection of erosions in rheumatoid arthritis and healthy wrist bones, while radiography showed very low sensitivity. The tested volumetric method was highly reproducible and correlated to scores of erosions.     

Prediction of Nodal Involvement in Primary Rectal Carcinoma without Invasion to Pelvic Structures: Accuracy of Preoperative CT,MR, and DWIBS Assessments Relative to Histopathologic Findings

Objective

To investigate the accuracy of preoperative computed tomography (CT), magnetic resonance (MR) imaging and diffusion-weighted imaging with background body signal suppression (DWIBS) in the prediction of nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures.

Methods and Materials

Fifty-two subjects with primary rectal cancer were preoperatively assessed by CT and MRI at 1.5 T with a phased-array coil. Preoperative lymph node staging with imaging modalities (CT, MRI, and DWIBS) were compared with the final histological findings.

Results

The accuracy of CT, MRI, and DWIBS were 57.7%, 63.5%, and 40.4%. The accuracy of DWIBS with higher sensitivity and negative predictive value for evaluating primary rectal cancer patients was lower than that of CT and MRI. Nodal staging agreement between imaging and pathology was fairly strong for CT and MRI (Kappa value = 0.331 and 0.348, P<0.01) but was relatively weaker for DWIBS (Kappa value = 0.174, P<0.05). The accuracy was 57.7% and 59.6%, respectively, for CT and MRI when the lymph node border information was used as the criteria, and was 57.7% and 61.5%, respectively, for enhanced CT and MRI when the lymph node enhancement pattern was used as the criteria.

Conclusion

MRI is more accurate than CT in predicting nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures. DWIBS has a great diagnostic value in differentiating small malignant from benign lymph nodes.     

Lymphoprostatic scintigraphy in regional lymphatic mapping in patients with prostate cancer

The purpose of the investigation was to upgrade the diagnosis quality for metastatic lesion to the regional lymp nodes in prostate cancer. The results of the most widely used diagnostic techniques (computed tomography (CT), magnetic resonance Imaging, (MRI), radionuclide studies (RNS), and ultrasonography (USG)), which had been compared with those of histology of removed lymph nodes, were assessed. For this, 74 patients with prostate cancer were comprehensively examined and treated at the Central Research X-ray Radiolological Institute. The comparative assessment of radiodiagnostic techniques (USG, CT, MRI, and RNS) showed the high informative value of retroperitoneal lymph nodal MRI in the detection of structural-and-morphological and anatomic-and-topographic changes in the lymph nodes (87.5% sensitivity, 83.3% specificity, and 85.7% accuracy). The developed lymphoprostatic scintigraphy (LPSG) is an informative technique that allows the better diagnosis of prostate metastases to the regional lymph nodes (92.4% sensitivity, 91.7% specificity, and 92.1% accuracy; the prognostic value of a positive result is 90.7%). LPSG is superior in its informative value to small pelvic USG and CT and inferior to indirect lymphoscintigraphy and yields valuable additional information on the physiological function of the small pelvic lymphatic collector.     

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。     

Detection of Rib Metastases in Patients with Lung Cancer: A Comparative Study of MRI,CT and Bone Scintigraphy

We retrospectively investigated the imaging findings of bone scintigraphy, chest CT and chest MRI in 55 cases of lung cancer. The sensitivity, specificity and accuracy of the detection of rib metastases were compared between imaging modalities on both a per-lesion and a per-patient basis. On a per-lesion basis, MRI sensitivity and accuracy were significantly higher than that of bone scintigraphy and CT (P<0.05). The sensitivities, specificities, and accuracy levels between CT and bone scintigraphy did not differ on either a per-lesion or per-patient basis (P>0.05). MRI appears to be superior for the detection of ribs metastases in lung cancer.     

肿瘤/肝脏比值在~(18)F-FDG符合线路SPECT/CT显像在肺癌诊断中的价值

目的:探讨18F-FDG符合线路SPECT/CT显像在肺癌病灶的检测能力以及肿瘤/肝脏比值对肺部良恶性病灶及胸部小病灶诊断的临床价值。方法:回顾性分析2011年6月至2013年4月期间于西安交通大学第一附属医院行18F-FDG符合线路SPECT/CT显像的肺癌疑诊患者41例CT测量肺部原发病灶最大直径4.16±2.81厘米(最小直径1.3厘米,最大直径16厘米),以病理结果作为判断标准,通过t检验及接受者操作特征曲线(receiver operating characteristic,ROC)研究18F-FDG符合线路SPECT/CT显像对肺部病灶、肺及纵膈小病灶的诊断价值。结果:18F-FDG符合线路SPECT/CT显像肺部良恶性病灶的肿瘤/肌肉(T/N)、肿瘤/肝脏(T/L)比值差异均具有显著统计学意义(P0.01),T/L比值在肺部良恶性病灶和肺及纵膈最大横径小于3 cm的病灶ROC曲线的曲线下面积分别为0.857、0.810,均大于T/N比值相应的ROC曲线下面积(分别为0.825、0.760)。T/N=3.5为界值时,诊断肺部病灶的灵敏度为90%,特异度为71.4%,准确度为0.614;诊断最大横径小于3 cm病灶的灵敏度为70%,特异度为80%,准确度为0.50。T/L=2.3时诊断肺部病灶的灵敏度为80%,特异度为85.7%,准确度为0.657。T/L=1.6时诊断最大横径小于3 cm病灶的灵敏度为90%,特异度为80%,准确度为0.70。结论:T/N=3.5为界值时,对于肺部病灶及肺及最大横径小于3 cm病灶良恶性的鉴别能力较好。T/L比值对于肺部良恶性病灶和肺及纵膈最大横径小于3 cm的病灶诊断价值均高于传统常用的T/N比值,具有较高的准确性,可以良好的应用于18F-FDG符合线路SPECT/CT显像对肺癌的诊断中。     

A role for magnetic susceptibility in synthetic computed tomography

PurposeRadiotherapy treatment planning based on magnetic resonance imaging (MRI) benefits from increased soft-tissue contrast and functional imaging. MRI-only planning is attractive but limited by the lack of electron density information required for dose calculation, and the difficulty to differentiate air and bone. MRI can map magnetic susceptibility to separate bone from air. A method is introduced to produce synthetic CT (sCT) through automatic voxel-wise assignment of CT numbers from an MRI dataset processed that includes magnetic susceptibility mapping.MethodsVolumetric multi-echo gradient echo datasets were acquired in the heads of five healthy volunteers and fourteen patients with cancer using a 3 T MRI system. An algorithm for CT synthesis was designed using the volunteer data, based on fuzzy c-means clustering and adaptive thresholding of the MR data (magnitude, fat, water, and magnetic susceptibility). Susceptibility mapping was performed using a modified version of the iterative phase replacement algorithm. On patient data, the algorithm was assessed by direct comparison to X-ray computed tomography (CT) scans.ResultsThe skull, spine, teeth, and major sinuses were clearly distinguished in all sCT, from healthy volunteers and patients. The mean absolute CT number error between X-ray CT and sCT in patients ranged from 78 and 134 HU.ConclusionSusceptibility mapping using MRI can differentiate air and bone for CT synthesis. The proposed method is automated, fast, and based on a commercially available MRI pulse sequence. The method avoids registration errors and does not rely on a priori information, making it suitable for nonstandard anatomy.     

Preoperative T Staging of Potentially Resectable Esophageal Cancer: A Comparison between Free-Breathing Radial VIBE and Breath-Hold Cartesian VIBE,with Histopathological Correlation

Purpose: To compare the T staging of potentially resectable esophageal cancer using free-breathing radial VIBE (r-VIBE) and breath-hold Cartesian VIBE (C-VIBE), with pathologic confirmation of the T stage. Materials and Methods: Fifty patients with endoscopically proven esophageal cancer and indeterminate T1/T2/T3 stage by CT scan were examined on a 3-T scanner. The MRI protocol included C-VIBE at 150 seconds post–IV contrast, immediately followed by a work-in-progress r-VIBE with identical spatial resolution (1.1 mm × 1.1 mm × 3.0 mm). Two independent readers assigned a T stage on MRI according to the 7th edition of UICC-AJCC TNM Classification, and postoperative pathologic confirmation was considered the gold standard. Interreader agreement was also calculated. Results: The T staging agreement between both VIBE techniques and postoperative pathologic T staging was 52% (26/50) for C-VIBE, 80% (40/50) for r-VIBE for reader 1, and 50% (25/50), 82% (41/50) for reader 2, respectively. For the esophageal cancer with invading lamina propria, muscularis mucosae, or submucosa (T1 stage), r-VIBE achieved 86% (12/14) agreement for both readers 1 and 2. For invasion of muscularis propria (T2 stage), r-VIBE achieved 83% (25/30) for both readers 1 and 2, whereas for the invasion of adventitia (T3 stage), r-VIBE could only achieve agreement in 50% (3/6) and 67% (4/6) for readers 1 and 2, respectively. Conclusion: Contrast-enhanced free-breathing r-VIBE is superior to breath-hold CVIBE in T staging of potentially resectable esophageal cancer, especially for T1 and T2.     

G-protein beta-3 subunit gene C825 T polymorphism: influence on plasma sodium and potassium concentrations in essential hypertensive patients

The C825T polymorphism of the beta-3 subunit of the protein G (GNB3) has been related to an increased activity of the Na+/H+ exchanger (NHE-1) through the synthesis of an anomalous hyperactive protein. Because of the important role of this system in essential hypertension (EH), we analysed the distribution of the different genotypes of this polymorphism in normotensive subjects (NS) and essential hypertensive patients (EHP), their relationship with the condition of salt sensitivity, plasma sodium and potassium concentrations and plasma renin activity (PRA) in EHP. 144 subjects (78 EHP and 76 NS) were studied. Salt sensitivity was assessed by the rapid protocol of Weinberger and genotype determination for GNB3 C825T polymorphism was performed by PCR. The distribution of the different genotypes was similar among EHP (CC 37.2%; CT 41.1%; TT 16.7%) and NS (CC 32.9%; CT 55.3%; TT 11.8%). In regard to general characteristics of EHP (including blood pressure levels) and the condition of salt sensitivity, there were no differences among the different genotypes. Plasma sodium concentration was higher and plasma potassium was lower in TT patients (141.0+/-1.7 and 3.7+/-0.1) than in CC patients (139.1+/-1.9 and 4.0+/-0.3) p<0.05. CT patients had intermediate values (139.9+/-1.9 and 3.9+/-0.2). PRA values were similar in the three genotypes as were the rest of analytical parameters studied. Our data demonstrate an association between the C825T polymorphism of the GNB3 and plasma sodium and potassium concentrations in EHP, as expression of an increase in NHE-1 activity, without modifications in PRA nor relationship with salt sensitivity.     

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。     

The Value of T2* in Differentiating Metastatic from Benign Axillary Lymph Nodes in Patients with Breast Cancer - A Preliminary In Vivo Study

Background

Accurate detection and determination of axillary lymph node metastasis are crucial for the clinical management of patients with breast cancer. Noninvasive imaging methods including ultrasound (US), computed tomography (CT), or conventional magnetic resonance imaging (MRI) are not yet accurate enough. The purpose of this study was to investigate the value of in vivo T2* in differentiating metastatic from benign axillary lymph nodes in patients with breast cancer.

Methodology/Principal Findings

In this institutional review board approved study, 35 women with breast cancer underwent multi-echo T2* weighted imaging (T2*WI) of the axillary area on a 3.0 T clinical magnetic resonance (MR) imaging system. T2* values of pathologically proven benign and metastatic axillary lymph nodes were calculated and compared. Receiver operating characteristics (ROC) analysis was conducted to evaluate the diagnostic ability. The areas under the ROC curve (AUCs) and the confidence intervals (CIs) were assessed. In total, 56 metastatic and 65 benign axillary lymph nodes were identified in this study. For metastatic lymph nodes, the average T2* value (55.96±11.87 ms) was significantly longer than that of the benign lymph nodes (26.00±5.51 ms, P<0.05). The AUC of T2* in differentiating benign from metastatic lymph nodes was 0.993. The cut-off value of 37.5 milliseconds (ms) gave a sensitivity of 94.6%, a specificity of 98.5%, a positive predictive value of 98.17 and a negative predictive value 95.54.

Conclusions

In vivo T2* can differentiate benign from metastatic axillary lymph nodes in patients with breast cancer. The high sensitivity and specificity as well as the easiness suggest its high potential for use in clinical practice.     

Computed tomography in the evaluation of regional metastases of lung cancer

The rate of metastatic spread of different groups of intrathoracic lymph nodes has been studied in depending on localization of the tumor by the nodes using CT method. 126 patients were examined with verified diagnosis of lung cancer. The central form was diagnosed in 55 (43.6%) patients, peripheral--in 71 (56.4%), a tumor was located in the upper lobe in 72 (57.1%), in the lower lobe--in 47 (37.4%), and in the middle lobe--in 7 (5.5%). CT-semiotic of metastatic lymph nodes was studied. The indices of the efficiency of diagnostic imaging when using CT were analyzed as well. The analysis of data obtained has shown that CT has great possibilities in evaluation of regional metastases of lung cancer.     

TEP-TDM au FNa et IRM avec séquences de diffusion dans la détection des métastases osseuses : étude comparative prospective par lésion

IntroductionThe development of technologies aimed to detect bone metastases in nuclear medicine and radiology prompts us to compare their performance in their most effective form: positron emission tomography (PET) with NaF combined with computed tomography (CT) and magnetic resonance imaging (MRI) using anatomical and diffusion weighted sequences (T1-STIR, and DWI MRI), as well as to study several factors involved in the visualization of these lesions (anatomo-functional correlation, nature, size and localization).Materials and methodsThirteen patients underwent NaF PET-CT and T1-STIR-DWI MRI in a prospective study. One hundred and sixty-four lesions were found. For each, a malignancy score of 1 to 5 was assigned. Expert consensus and follow-up data for each patient, available in their medical records, determined the final diagnosis as gold standard.ResultsThe sensitivities, specificities, precision and AUC of the lesion-based analysis were respectively 78.3%, 93.8%, 89.3% and 0.85 for NaF PET-CT and 60.9%, 97.4%, 86.7% and 0.81 for T1-STIR-DWI MRI. Results were independent on the nature, size or location of the metastases. A significant change in AUC when CT was combined with PET, and when DWI was combined with T1-STIR was found for one of the two observers in both fields.ConclusionThe performance of PET-CT at NaF and T1-STIR-DWI MRI appeared equivalent. The combination of functional and morphological images is beneficial in both fields (nuclear and magnetic resonance) but its contribution varies depending on the observer.     

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。     

Pilot, multicenter and prospective trials with an anti-CEA antibody.

In this paper we summarize the investigations performed by our group utilizing an anti-CEA monoclonal antibody (F023C5) labelled with different radionuclides in humans. Since 1983 radioimmunoscintigraphy (RIS) was performed on 51 patients with 64 localizations of colo-rectal carcinoma (pilot study). A multicenter clinical trial in a large number of patients (509 pts of which 284 with gastrointestinal cancer) was subsequently carried out in collaboration with ten nuclear medicine centres. High sensitivity and specificity values were obtained by these studies and many unsuspected lesions were recorded. In order to better define the clinical role of RIS, a prospective study was performed on 59 patients with suspected local relapses of colo-rectal cancer. A comparative evaluation of RIS, CT scan, US and MRI was done. RIS and MRI had the highest accuracy (86%) followed by CT scan (68%) and US (54%).