MRI检查方案对子宫及卵巢肿瘤诊断价值分析

目的;分析和探讨MRI不同成像序列及扫描位置对显示正常女性盆腔结构和诊断盆腔肿瘤的价值,并进一步确定诊断子宫及卵巢肿瘤的最佳MRI检查方案。方法：对20例正常女性贫腔和40例经手术病理证实的子宫或卵巢肿瘤患者的盆腔磁共振成像检查资料进行了定量及定性分析。所有检查均采用SE T1WI及FSE T2WI序列,分别行横断、矢状及冠状面扫描。在20例患有子宫肿瘤的患者中,11例加做了与子宫腔长轴平行的冠斜位T1WI和T2WI序列扫描。结果：对于正常子宫及直肠的辨别能力,FSE T2WI图像明显好于SE T1WI图像,两者之间有显著性统计学差异。对于子宫肿瘤患者,分析子宫肿瘤与正常子宫结合带的CNR值,结果表明T2WI图像明显高于T1WI图像且两者之间有显著性统计学差异;联合应用T1WI及T2WI扫描序列在横断、矢状及冠状位对子宫肿瘤的检出准确性分别为64.3%,96.4%,53.6%,且矢状与横断及冠状位之间差异有显著性统计学意义。在11例加做与子宫腔长轴平行的冠斜位患者中,对肿瘤检出及定位,定性的诊断准确性方面,8例（73.0%)显示明显优于其他3种位置。对于卵巢肿瘤的观察结果表明：3种扫描位置的检出能力无明显显著性差异,横断,矢状及冠状位的准确性分别为100％,95％,100％,但对于恶性肿瘤是否伴有髂血管区淋巴结转移及盆壁是否侵犯的观察,横断及冠状面显示最佳。结论：T2WI序列矢状位为诊断子宫肿瘤的首选MRI检查方法,必要时辅以与子宫腔长轴平行的冠斜位;而观察卵巢肿瘤及盆壁情况,横断及冠状位为必备检查位置。     

MRI在诊断宫颈癌复发中的价值

目的：探讨MRI在评估诊断宫颈癌复发中的价值。方法：36例经病理证实宫颈癌复发患者,均行盆腔的MRI轴位T1WI、T2WI、SPIR以及GD-DTPA增强扫描后T1WI轴位、矢状位扫描。在不同序列MRI图像上观察复发肿瘤的形态、大小及信号改变。结果：326例病人中出现复发36例,发生率为11%。25例宫颈癌手术后复发病例,MRI可见在阴道残端或盆腔内出现软组织信号肿块影,增强扫描可见肿块明显强化。其中5例可见肿块侵及一侧输尿管,其上方输尿管扩张积水。11例宫颈癌放化疗后复发病例,MRI可见宫颈较前明显增厚,肿块T1WI为略低信号,T2WI为略高信号,增强扫描可见肿块呈不均匀强化。其中2例可见肿块侵及膀胱壁。结论：由于MRI具有非常好的软组织分辨率,MRI成像已成为宫颈癌手术前后或放化疗前后检查和随访最重要的手段,它能够准确判断宫颈癌临床分期,并且可以早期、及时发现肿瘤复发;在评估宫颈癌复发诊断中有重要价值。     

MR imaging features that distinguish spinal cavernous angioma from hemorrhagic ependymoma and serial MRI changes in cavernous angioma

Cavernous angiomas of the spinal cord exhibit imaging characteristics that may overlap with those of hemorrhagic ependymoma. In the present study, we aimed to identify specific magnetic resonance imaging (MRI) findings that could be used to differentiate cavernous angioma from hemorrhagic ependymoma, and to evaluate serial MRI changes in cases of cavernous angioma. We retrospectively evaluated MR images of spinal cord tumors collected at our hospital from 2007 to 2015. From this cohort of images, 11 pathologically confirmed cavernous angiomas and 14 pathologically confirmed hemorrhagic ependymomas were compared with respect to the size of the tumor, longitudinal location, axial location, enhancement pattern, syrinx, edema, tumor margin, signal intensity of T2WI, signal intensity of T1WI, and longitudinal spreading of the hemorrhage. Serial MR images of seven spinal cavernous angiomas were reviewed. Small size, eccentric axial location, minimal enhancement, and absence of edema were more frequently observed on images of cavernous angioma compared to those of hemorrhagic ependymoma (p?<?0.01). Serial MRI changes in cases of cavernous angioma included increased longitudinal spreading of the hemorrhage (6/7, 86?%) and emergence of high signal intensity on T1WI (1/7, 14?%). Small size, eccentric axial location, minimal enhancement, and absence of edema are significant MRI findings that may be used to distinguish Type I and Type II spinal cavernous angiomas from hemorrhagic ependymomas. Furthermore, longitudinal spreading of the hemorrhage may be observed on follow-up MRIs of cavernous angiomas.     

腹膜后良性神经源性肿瘤的MRI表现

目的 分析腹膜后良性神经源性肿瘤的MRI表现,以期提高诊断正确率.方法 复习经手术及病理证实并行MRI检查的腹膜后良性神经源性肿瘤23例,包括神经鞘瘤10例,肾上腺外嗜铬细胞瘤8例,神经节细胞瘤及神经纤维瘤各2例,副神经节瘤1例,对肿瘤的部位、大小、形态、边缘及信号特点进行分析.结果 23个肿瘤中位于腹膜后脊柱右侧者18例,左侧4例,椎前腹主动脉与下腔静脉之间1例.肿瘤横断面最大径3.1～14.5 cm,平均6.5cm.肿瘤呈类球形改变的22例,占95.7%,不规则形仅1例,类球形肿瘤中有10例(45.5%)可见病变部分呈鸟嘴样伸入椎间孔或下腔静脉后.肿瘤边界清楚,T2WI可检出包膜者17例(73.9%).T1WI肿瘤均以低信号或等信号为主,其中病灶内混杂高信号影2例.T2WI肿瘤信号多不均匀(19例,占82.6%),内均可见明显高信号区,其中表现为"靶征"8例,占全部病例的34.8%,包括神经鞘瘤5例,神经节细胞瘤2例,神经纤维瘤1例,嗜铬细胞瘤无一例出现"靶征".T2WI表现信号均匀4例.增强扫描不均匀强化19例,T2WI肿物内的明显高信号区出现强化10例(52.6%).T2WI显示"靶征"者增强扫描显示"靶心"强化.增强扫描均匀强化者4例.结论 腹膜后良性神经源性肿瘤的MRI表现有一定特征性,可为肿瘤的鉴别诊断提供依据.     

原位膀胱癌动物模型的建立及应用

背景与目的:表浅性膀胱癌术后膀胱灌注丝裂霉素等药物进行化疗,肿瘤仍有较高的复发率.有研究报道往膀胱内灌注小型干扰RNA(siRNA)可抑制裸鼠膀胱肿瘤生长.本研究目的是建立荷人膀胱癌的原位动物模型,通过磁共振成像(magnetic resonance imaging,MRI)监测肿瘤生长过程,并利用此模型评价靶向Survivin的干扰质粒对丝裂霉素的增效作用.方法:直视下经尿道机械损伤BALB/c裸鼠膀胱粘膜,将人膀胱癌细胞T24经尿道种植于25只裸鼠膀胱,建立荷人膀胱癌原位动物模型.以钆-二乙三胺五乙酸作为膀胱造影剂,用MRI监测肿瘤的生长,同时取裸鼠膀胱组织标本行HE染色进行病理学检查.同法建立膀胱癌裸鼠动物模型18只,分为对照组、丝裂霉素组和联合组3组,每周两次膀胱灌注,联合组为靶向Survivin的干扰质粒和丝裂霉素交替用药;膀胱灌注6次后荷瘤膀胱称重.结果:25只裸鼠在种植T24细胞后均形成膀胱肿瘤.种植后7天裸鼠膀胱MRI检查无明显变化,14、21、28天MRI检查均可发现膀胱不同程度的充盈缺损,MRI图像与肿瘤实际大小吻合.病理检查显示:种植后7天,肿瘤生长于裸鼠膀胱粘膜或浅层肌肉;14～28天局限于肌层;35天时侵及浆膜层.丝裂霉素组和联合组的抑瘤率分别为33.45%、56.34%,联合组优于丝裂霉素组(P＜0.05).结论:成功建立了裸鼠原位膀胱癌动物模型,肿瘤生长基本模拟了人膀胱癌的发生、发展过程;MRI检查可作为对裸鼠膀胱原位肿瘤动态观察的可靠方法.靶向Survivin的干扰质粒增加了丝裂霉素的抗肿瘤作用.     

The value of F-18-fluorodeoxyglucose PET for the 3-D radiation treatment planning of malignant gliomas

Purpose: The aim of the study was to determine the impact of positron emission tomography using the glucose analogue fluorine-18-fluorodeoxyglucose (FDG-PET) on the delineation of the target volume in three-dimensional radiation treatment planning of primary brain tumors.

Methods and Materials: In 18 patients with histologically proven (8× biopsy, 10× subtotal resection) primary brain tumors (8 astrocytomas °III, one mixed glioma °III, and 9 glioblastomas), magnetic resonance imaging (MRI) with gadolinium-DTPA and FDG-PET were performed in radiation treatment position within the same week. A computer program was developed for fusion of the PET and MR images. On corresponding axial slices, FDG uptake was compared to contrast enhancement in T1-weighted and to signal hyperintensity in T2-weighted MR images. Based on PET and MRI data, three-dimensional treatment planning was performed. All patients underwent linear accelerator (LINAC) radiotherapy.

Results: In MRI, all tumors and the surrounding edema were visible as hyperintense lesions in the T2-weighted images. 17/18 tumors showed contrast enhancement. In FDG-PET, 16 tumors showed hypermetabolism compared to normal white matter, whereas only 8/18 tumors showed hypermetabolism compared to normal gray matter. White matter edema was associated with decreased FDG uptake in all patients. The area of increased FDG uptake correlated closely with contrast enhancement, only in one case the volume of increased FDG uptake was larger than the area of contrast enhancement. Mean tumor volumes obtained by MRI T1 + Gd, T2, and PET were 30, 106, and 10 ml, respectively. Survival was comparable to data in the literature with a 1-year survival of 39% and a median survival of 310 days.

Conclusion: Only in a minority of patients did FDG-PET provide additional information for radiation treatment planning. This is mainly caused by the high intensity of FDG uptake in normal brain tissue. PET may be of greater value in the definition of regions that should obtain a radiation dose boost.     

多排螺旋CT对诊断膀胱癌的价值

目的：探讨联合应用多排螺旋CT（MDCT）多种后处理技术对诊断膀胱癌的不同价值，建立完善合理的膀胱癌CT检查程序.方法：对临床怀疑膀胱癌患者34例进行MDCT检查，在膀胱充分充盈后，行CT平扫和增强扫描（包括动脉晚期、平衡期、排泄期）.将不同时相的数据分别应用多平面重组（MPR）及仿真内窥镜（CTVE）等后处理方式顺序观察膀胱壁各部，分别记录病变的数目、位置、大小等.评价MDCT各种图像对膀胱肿瘤的检出情况.应用SAS软件对评价结果进行统计学分析.结果：34例膀胱癌患者于CT检查1周内手术，证实58枚肿瘤，其中2例并发输尿管癌.平扫MPR、动脉晚期/平衡期MPR、排泄期MPR、CTVE、联合平衡期MPR和CTVE五种方式对膀胱癌的检出率分别为70.7%、86.2%、89.7%、87.9%、100%.平扫MPR的检出率明显低于其他四种方式（P＜0.05）.平衡期MPR和CTVE两种图像相结合较其他四种方式具有更高的检出率（P＜0.05）.动脉晚期/平衡期MPR、排泄期MPR、CTVE三种方式对膀胱癌的检出率无统计学差异.结论：膀胱MDCT检查可不进行平扫和动脉期扫描，只行平衡期、排泄期检查，扫描范围应包括全部泌尿系统，并联合应用MPR与CTVE等后处理技术，是诊断、评价膀胱肿瘤可靠、无创的方法.     

18F-FDG PET/CT显像中应用“反复排尿再充盈法”提高膀胱病灶检出率的临床研究

背景与目的：¹⁸F-FDG经过由尿液排泄,膀胱中尿液的高放射性影响了膀胱病灶的检出,本研究介绍一种¹⁸F-FDG PET/CT检查中提高膀胱恶性病灶检出率的简便方法——“反复排尿再充盈法”,即：¹⁸F-FDG注射后反复饮水-排尿、最后憋尿检查。方法：回顾性分析了48例(35例原发、13例非原发)膀胱恶性肿瘤患者¹⁸F-FDG常规显像后,通过反复饮水-排尿、再憋尿进行盆腔延迟显像的结果。结果：89%的患者(43/48)在首次延迟显像时,尿液SUV_max(SUV最大值)从33.14(9～66.80)降至3.23(1.35～5.65),差异有统计学意义,(t=8.703, P<0.01),2次显像的平均间隔时间为2 h,而膀胱病灶的SUVmax为2.8～25.0。该延迟显像方法对膀胱癌诊断灵敏度为90.5%(19/21)、特异度为81.5%(22/27)、准确性为85.4%(41/48)。结论：反复饮水-排尿、最后憋尿情况下的盆腔延迟显像能在保持膀胱壁解剖对比的同时,有效降低膀胱尿液放射性本底、增加病灶靶/本比,进而增加膀胱癌灶检出率,且简单易行,值得推广。     

2D和3D MRI结合技术在胰腺癌诊断中的应用

目的探讨多种MRI成像技术和改良增强扫描方案在胰腺癌诊断中的价值。方法对49例胰腺癌患者进行MRI检查,平扫序列分别为T1WI 2D快速小角度单次激发(FLASH)、T1WI 3D屏气容积内插法(VIBE)脂肪抑制、快速自旋回波(TSE)T2WI和T2WI半傅立叶转换单次激发快速自旋回波(HASTE)脂肪抑制MR胰胆管成像(MRCP);增强扫描方法为3D FLASH冠状位与T1WI 3D VIBE横断位交替扫描方式,即动脉期和门静脉期采用冠状位扫描,胰腺期和延迟期采用横断位扫描;最后采用T1WI 2D FLASH完成整个上腹部扫描。冠状位原始图像经最大信号强度投影(MIP)分别获得胰腺周围主要动脉和门静脉影像,用多平面重建技术获得胰腺及周围组织动脉期和门静脉期图像。结果(1)在3D VIBE平扫中,45例肿瘤为低信号,4例为等信号;在2D FLASH序列中,46例肿瘤为低信号,3例为等信号;脂肪抑制TSE T2WI 3例肿瘤为等信号,其余46例均为等和略高信号,并与周围胰腺实质均无明显分界。(2)胰腺期增强扫描,除1例肿瘤为等信号外,其余均呈相对低信号,39例肿瘤周围呈环形强化,其中24例肿瘤门静脉期及延迟期可见边缘结节样和内部分隔样强化。6例延迟强化呈等和略高信号。动脉期肿瘤均未见明显强化。(3)37例手术探查的患者,MRI 磁共振血管成像(MRA)误诊7条血管,包括3例肠系膜上动脉和4例肠系膜上静脉,其余血管均判断正确。结论应用2D和3D MRI结合技术1次检查即可同时了解胰腺肿瘤、胰胆管和血管等多系统的情况,对胰腺癌的术前诊断和手术切除性判断有重要价值。     

Surrounding muscle edema detected by MRI is valuable for diagnosis of intramuscular myxoma

We recently experienced 4 cases of intramuscular myxoma and analyzed MRI findings, comparing them with histological ones. Results showed that all tumors were depicted with a homogeneous low signal intensity on T1-weighted images and a markedly high signal intensity on T2-weighted images, findings which are similar to those of cystic lesions like intramuscular ganglions. However, tumors were diffusely and finely enhanced on T1-weighted images with intravenous gadolinium administration. Three cases showed the characteristic fat rim and fat cap. A diffuse edematous lesion demonstrating intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images was also found in the adjacent muscle surrounding the tumor in 3 of 4 cases. In this lesion, tumor invasion, diffuse and severe muscle degeneration, blood and lymphatic congestion with exudates, and reactive adipose tissue formation were observed. The present results suggested that for the clinical diagnosis of intramuscular myxoma with MRI examination, the combination of three MRI signs such as homogeneous low signal intensity on T1-weighted mages, markedly high signal intensity on T2-weighted images, and an enhancement effect with contrast medium are important, but the fat rim or fat cap, and the surrounding muscle edema as detected by MRI are also characteristic and allow for a more firm diagnosis. We presume that the diffuse and severe muscle fiber degeneration induced by tumors may cause such specific surrounding muscle edema.     

人膀胱癌裸鼠原位移植瘤动物模型的建立和MRI检测

Objective:To establish an orthotopic bladder cancer model bearing human bladder cancer for experimental research, and monitor tumor progression by magnetic resonance imaging (MRI). Methods: The mucosa was mechanically damaged transurethrally under direct vision, and then human bladder cancer cell line T24 was inoculated into the bladders of BALB/c nude mice to establish orthotopic bladder cancer model. To find a suitable concentration of Gd-DTPA for this research. MRI was performed weekly to assess tumor growth, using Gd-DTPA as contrast agent. The pathologic morphology of the bladders and other specimens were observed with HE stain. Results: All the 25 mice developed bladder cancer after inoculation. The best concentration of Gd-DTPAwas 1.408 mg/mL. On MRI, no change in the bladders was observed on day 7 after inoculation, filling defect in the bladders, accordant to actual tumor size, was detected on days 14, 21 and 28. Pathologic examination showed that tumor grew in the mucosa or superficial muscle of bladder on day 7, confined in muscle layer on days 14-28, and invaded serosa on day 35. Conclusion: Transurethrally damaged bladder mucosa under direct vision and instilled bladder cancer cell T24, we successfully established an orthotopic bladder cancer model. Tumor growth simulated the progression of human bladder cancer approximately. MRI was a reliable way for dynamic detection of murine orthotopic bladder tumor.     

荷人膀胱癌原位移植瘤裸小鼠动物模型的建立

目的建立模拟人的原位裸小鼠模型,评价抗人膀胱癌免疫毒素临床前的疗效。方法将体外培养的人移行细胞癌细胞系（BIU-87）原位移植于经酸处理的裸小鼠膀胱内,定期用核磁共振成像（MRI）检查,并进行解剖、组织学检查和免疫细胞化学的检测。结果在第7～36天内,成瘤率为92．9％（52／56）;其中第12～13天处死的裸小鼠中,95．2％（40／42）发展成移行细胞癌,以浅表性为主。组织学检查证实为Ⅱ～Ⅲ级;免疫细胞化学证实,该模型具有BIU-87细胞的特征。在肿瘤的发生发展中,MRI检查的结果与组织学检查的结果密切相关。接种后第7—9天可以检测出原位癌（CIS）,其后发展成乳头状瘤或浸润性疾病。结论模拟人的原位裸小鼠模型重复性好,是临床前研究膀胱灌注治疗的理想模型。     

胆管癌的磁共振成像表现及其临床意义

目的：通过磁共振成像(MR)征象与手术对照分析，探讨胆管癌的MR特点。方法：27例患行常规轴位SE，12加权成像和呼吸门控FSE，12加权成像，并做冠状位：MRCP成像，所有患经手术和病理证实，分析病灶信号特征、形态、范围，并与术中所见进行比较。结果：16例肝门型胆管癌在磁共振成像上多呈放射状(89％)，术中所见病灶沿胆管浸润生长，且病灶范围比MRI所见大。所有胆管癌病灶在TIWI上均呈低信号(100％)，4例肝内胆管癌在T2WI上为混杂信号，11例肝门型胆管癌在，T2WI上呈等(61％)或稍高信号(39％)，2例壶腹癌在T2WI上呈低信号。在MRCP上所有病人表现为胆道梗阻。16例(89％)：MRCP分型与临床分型一致。结论：胆管癌在磁共振成像上有较特征性表现，且能提供病变准确部位，但对病变范围估计不足，MRCP用于肝门型胆管癌临床分型是可行的。     

Prognostic significance of matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1 in voided urine samples from patients with transitional cell carcinoma of the bladder.

PURPOSE: To study the role of urinary matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in bladder cancer and their relationship to tumor progression. EXPERIMENTAL DESIGN: MMP-1 and TIMP-1 were measured by ELISA in urine samples from 131 patients with bladder tumors (7 cis, 74 Ta, 29 T1, and 21 T2-T4; 46 G(1), 41 G(2), and 37 G(3)), 5 patients with prostate cancer, 33 patients with benign lower urinary tract disorders, and 36 healthy volunteers. Complete clinical data were available for 100 patients with bladder cancer with a median follow-up time of 24 months (range: 4-39 months). RESULTS: MMP-1 was detected in urine samples from 21 of 131 (16%) patients with bladder cancer but was undetectable in samples from all other groups (P < 0.0001). Urinary MMP-1 was detected in a higher percentage of patients with T2-T4 tumors and G(3) tumors than patients with cis/Ta/T1 or G(1)-G(2) tumors (P = 0.04 and P = 0.0074, respectively). Patients with detectable concentrations of urinary MMP-1 had higher rates of disease progression (P = 0.04) and death from bladder cancer (P = 0.02) than patients with undetectable urinary MMP-1. All patient groups had higher urinary TIMP-1 concentrations than healthy volunteers (P = 0.02). Patients with muscle-invasive tumors had higher concentrations of urinary TIMP-1 than patients with cis/Ta/T1 tumors (P = 0.037), but there was no association between TIMP-1 and tumor grade. Urinary TIMP-1 levels strongly correlated with tumor size (P = 0.0002). Progression-free survival rates were lower for patients with urinary TIMP-1 concentrations above the median (1.8 ng/ml, P = 0.04), but urinary TIMP-1 levels were not related to disease-specific survival. Patients with T2-T4 tumors and G(3) tumors had significantly lower urinary MMP-1:TIMP-1 ratios than patients with Ta/T1 bladder tumors (P = 0.039) or G(1)-G(2) tumors (P = 0.0415). CONCLUSIONS: Where urinary MMP-1 is detectable, the patient is more likely to have a bladder tumor of advanced stage or grade and may be at increased risk of disease progression and death of bladder cancer. The relationship between urinary TIMP-1, muscle-invasion, and disease progression in bladder cancer is at variance with its role as an inhibitor of MMPs and warrants additional evaluation.     

T24-多柔比星原位膀胱癌多药耐药模型的建立及检测

 目的　建立T24-多柔比星（ADM）模拟人类原位膀胱癌多药耐药模型并行耐药性检测。方法　采用细胞移植法将T24-ADM耐药株及T24细胞敏感株移植到两组裸鼠膀胱后定期观察其一般情况。28 d后处死裸鼠,称成瘤膀胱质量、测体积,行组织病理学和细胞学检测,反转录聚合酶链反应（RT-PCR）检测多药耐药基因-1（MDR-1）的表达,MTT法测瘤组织制成的细胞悬液耐药性。结果　T24-ADM组及T24组裸鼠膀胱的成瘤率分别为80 %（8／10）和90 %（9／10）,成瘤膀胱平均体质量和体积分别为 （0.8±0.3）g、（1.0±0.5）g、（875±158）mm3、（903±192）mm3,组间比较差异均无统计学意义（t＝1.332和t＝1.215,P＞0.05）。组织病理学：T24-ADM组4只出现右肾增大,T24组2只出现右肾增大,1.0 cm×1.8 cm,色暗灰到暗红。膀胱肿瘤组织切片细胞结构排列较乱,形态不规则,向肌层不同深度浸润,未突破浆膜层,两组间差异不明显。RT-PCR测MDR-1表达两组间差异有统计学意义（t＝3.612,P＜0.01）。MTT检测T24-ADM组裸鼠肿瘤细胞较T24组对ADM有明显的耐药性,差异有统计学意义（F＝412.107,P＜0.01）,且对其他几种药物也有耐药性,差异有统计学意义（P＜0.05）。结论　细胞移植法成功建立了T24-ADM原位膀胱癌耐药模型,并具有多药耐药特性。     

子宫颈癌术前磁共振成像诊断与术后病理分期对比分析

 目的　探讨磁共振成像（MRI）术前分期的准确性与病理分期的准确性,以及对子宫颈癌治疗方式的指导价值。方法　回顾性分析50例子宫颈癌患者（鳞癌47例,腺癌2例,鳞腺癌1例）的临床及MRI资料。所有患者行平扫及增强扫描,23例行三期动态增强扫描。38例经手术治疗的患者,对术前MRI分期与术式的选择及术后病理分期进行对照分析。结果　33例MRI分期为Ⅰ～ⅡA期子宫颈癌分期准确率约为82.35 %,患者行子宫全切术及盆腔淋巴结清扫术。ⅢA～ⅣB期的诊断准确率约100 %。MRI对子宫颈癌分期总的准确率约为84.21 %。结论　MRI能多方位显示子宫颈癌病灶及其侵犯范围,术前分期具有较高的准确性,有利于术前评估、手术方式的制定及治疗方案的选择。     

Development of a high risk pancreatic screening clinic using 3.0 T MRI

Selective screening for pancreatic cancer (PC) has been proposed. We describe the establishment of a comprehensive multidisciplinary screening program using 3.0 T MRI. Criteria for screening included the presence of PC in: ≥ 2 first degree relatives (FDR), 1 FDR and 1 s degree relative (SDR), ≥ 3 any degree relatives (ADR), or any known hereditary cancer syndrome with increased PC risk. Imaging with 3.0 T MRI was performed routinely and endoscopic ultrasound was used selectively. Screening was completed in 75 patients (pts). Hereditary cancer syndromes were present in 42 (56%) of the 75 pts: BRCA2 (18), ATM (8), BRCA1 (6), CDKN2A (4), PALB2 (3), Lynch (2), and Peutz-Jeghers (1). A family history of PC was present in ≥?2 FDR in 12 (16%) pts, 1 FDR and 1 SDR in 5 (7) pts, and ≥?3 ADR in 16 (21%) pts. Of the 65 pts who received screening MRI, 28 (43%) pts had pancreatic cystic lesions identified, including 1 (1%) patient in whom a cholangiocarcinoma was diagnosed as well. No patient underwent surgical resection. Using a 3.0 T MRI to screen patients at high risk for developing PC identified radiographic abnormalities in 43% of patients, which were stable on subsequent surveillance. Specific guidelines for the frequency of surveillance and indications for surgery remain areas of active investigation as the global experience with high risk screening continues to mature.     

Allelic imbalances in human bladder cancer: genome-wide detection with high-density single-nucleotide polymorphism arrays

BACKGROUND: Bladder cancer is characterized by genomic instability. In this study, we investigated whether genome-wide screening using single-nucleotide polymorphism (SNP) arrays could detect allelic imbalance (loss or gain of at least one allele) in bladder cancers. METHODS: For microarray analysis, DNA was isolated from microdissected bladder tumors and leukocytes from 11 patients. The stage T1 tumor (connective tissue invasive) and the subsequent stage T2-4 tumor (muscle invasive) were available from eight of these patients, and only the first muscle-invasive stage T2-4 tumor was available from three of the 11 patients. The microarray contained 1494 biallelic polymorphic sequences. For microsatellite analyses, DNA was isolated from tumors and leukocytes of nine patients with primary T2-4 tumors and 13 patients with Ta (noninvasive) tumors. All statistical tests were two-sided. RESULTS: We assigned a genotype to 1204 loci, 343 of which were heterozygous. Allelic imbalance was detected in known areas of imbalance on chromosomes 6, 8, 9, 11, and 17, and a new area of imbalance was detected on the p arm of chromosome 6. Microsatellite analysis of nine other T2-4 tumors and 13 Ta tumors showed that allelic imbalance was more frequent in T2-4 tumors than in Ta tumors (P<.001). We detected 8.5 allelic imbalances (median) in 348 informative loci in T1 tumors and 28 allelic imbalances (median) in 329 informative loci in T2-4 tumors. When pairs of T1 and T2-4 tumors were analyzed from eight patients, 68% of imbalances detected in T1 tumors (146 imbalances) occurred in the subsequent T2-4 tumors (99 imbalances). Homozygous TP53 mutations were more often associated (P =.005) with high allelic imbalance than with low allelic imbalance. CONCLUSION: SNP arrays are feasible for high-throughput, genome-wide scanning for allelic imbalances in bladder cancer.     

The efficacy of MRI with ultrasmall superparamagnetic iron oxide particles (USPIO) in head and neck cancers

BACKGROUND: The objective was to evaluate the diagnostic accuracy of ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) compared to plain MRI in patients with a clinical N+ neck using histology as a gold standard. MATERIALS AND METHODS: Twenty-eight patients underwent unenhanced and USPIO-enhanced MRI using T1-weighted spin echo (SE) sequences and high resolution Turbo-Spin-Echo (TSE) T2-weighted sequences, as well as T2-weighted Gradient Echo (GE) sequences in axial and sagittal slice orientation. The signal intensity (SI) decrease was measured by a region of interest evaluation and visual analysis was performed. RESULTS: Histopathological evaluation of 363 lymph nodes revealed 34 as metastatic. USPIO MRI detected 28 metastases (sensitivity 82.3%) and 329 non-metastatic lymph nodes (specificity 100%). Regarding lymph node size, USPIO MRI was correct in all patients who underwent surgery. One lymph node with microinfiltration of tumor cells was detected by USPIO MRI. CONCLUSION: There were no side-effects during or after application of the contrast agent. This study confirms the efficacy of MRI with USPIO in patients with head and neck cancer. USPIO-enhanced MRI could have an important effect on surgery planning. Because of its high specificity, USPIO-enhanced MRI seems to be a diagnostic modality able to differentiate borderline-sized lymph nodes.     

Comparison of MRI pulse sequences in defining prostate volume after permanent implantation

PURPOSE: To determine the relative value of three MRI pulse sequences in defining the prostate volume after permanent implantation. METHODS AND MATERIALS: A total of 45 patients who received a permanent 125I implant were studied. Two weeks after implantation, an axial CT scan (2 mm thickness) and T1-weighted, T1-weighted fat saturation, and T2-weighted axial MRI (3-mm) studies were obtained. The prostate volumes were compared with the initial ultrasound planning volumes, and subsequently the CT, T1-weighted, and T1-weighted fat saturation MRI volumes were compared with the T2-weighted volumes. Discrepancies in volume were evaluated by visual inspection of the registered axial images and the registration of axial volumes on the sagittal T2-weighted volumes. In a limited set of patients, pre- and postimplant CT and T2-weighted MRI studies were available for comparison to determine whether prostate volume changes after implant were dependent on the imaging modality. RESULTS: T1-weighted and T1-weighted fat saturation MRI and CT prostate volumes were consistently larger than the T2-weighted MRI prostate volumes, with a volume on average 1.33 (SD 0.24) times the T2-weighted volume. This discrepancy was due to the superiority of T2-weighted MRI for prostate definition at the following critical interfaces: membranous urethra, apex, and anterior base-bladder and posterior base-seminal vesicle interfaces. The differences in prostate definition in the anterior base region suggest that the commonly reported underdose may be due to overestimation of the prostate in this region by CT. The consistent difference in volumes suggests that the degree of swelling observed after implantation is in part a function of the imaging modality. In patients with pre- and postimplant CT and T2-weighted MRI images, swelling on the T2-weighted images was 1.1 times baseline and on CT was 1.3 times baseline, confirming the imaging modality dependence of prostate swelling. CONCLUSION: Postimplant T2-weighted MRI images provided superior prostate definition in all critical regions of the prostate compared with CT and the other MRI sequences tested. In addition to defining an optimal technique, these findings call two prior observations into question. Under dosing at the anterior base region may be overestimated because of poor definition of the prostate-bladder muscle interface. The swelling observed after implantation was lower on T2-weighted images as well, suggesting that a fraction of postimplant swelling is a function of the imaging modality. These findings have implications for preimplant planning and postimplant evaluation. As implant planning techniques become more conformal, and registration methods become more efficient, T2-weighted MRI after implantation will improve the accuracy of postimplant dosimetry.