超声评价乳腺癌新辅助化疗后的病理反应性

目的 探讨超声术前评价新辅助化疗后乳腺癌残存病变病理反应状态的价值.资料与方法 60例新辅助化疗结束后行术前超声检查的乳腺癌患者,参考Miller&Payne反应性分级将患者的病理反应性分为5级,5级为病理完全缓解,其余为浸润癌残余,4级和5级为组织学显著反应,并以此作为“金标准”,评估超声检查结果的敏感性、特异性、准确性、阳性预测值及阴性预测值.结果 术前超声测量残余癌最大直径与病理测得残余癌最大直径呈显著正相关(r=-0.7797,P＜0.01).超声对化疗后浸润癌残余判断的敏感性为92.3％,特异性为50.0％,准确性为86.7％,阳性预测值为92.3％,阴性预测值为50.0％;超声对化疗后组织学显著反应判断的敏感性为86.7％,特异性为84.4％,准确性为85.0％,阳性预测值为81.2％,阴性预测值为86.4％. 结论 超声对于乳腺癌新辅助化疗后浸润癌残余和组织学显著反应的评价有较高的敏感性和准确性,有助于新辅助化疗后术前无创性评价乳腺癌的病理反应性.     

MRI动态增强扫描时间-信号强度曲线评估骨肉瘤化疗效果的临床价值

目的：探讨MRI动态增强扫描TIC评估骨肉瘤新辅助化疗疗效的临床价值。方法：回顾性分析经手术病理证实的骨肉瘤患者24例,均于实施新辅助化疗前和化疗4个周期后行DCE-MRI检查。通过后处理软件观察骨肉瘤新辅助化疗前后肿瘤的强化形态和TIC类型。根据病理肿瘤坏死率（TNR）分级法,分为反应良好组（TNR ≥ 90%）和无反应组（TNR<90%）。采取Fisher精确检验比较2组间化疗前后及2组组内化疗前后TIC类型分布差异。结果：反应不良组共12例,化疗前TIC以Ⅱ、Ⅲ型（33.3%、58.3%）为主,化疗后仍以Ⅱ、Ⅲ型（41.7%、33.3%）居多,化疗前后TIC分布差异无统计学意义（P=0.570）;反应良好组共12例,化疗前TIC以Ⅱ型（66.7%）为主,化疗后以Ⅰ型（83.3%）为主,化疗前后TIC分布差异有统计学意义（P=0.002）。2组间化疗前TIC分布差异无统计学意义（P=0.103）,而化疗后TIC分布差异有统计学意义（P=0.024）。结论：MRI动态增强扫描的TIC类型可评估骨肉瘤新辅助化疗疗效,Ⅰ型曲线反映新辅助化疗疗效显著。     

肉芽肿性乳腺炎的MRI灌注成像及其与非肿块型乳腺癌的鉴别

目的 探讨肉芽肿性乳腺炎(GM)的MRI灌注成像表现及其与非肿块型乳腺癌的鉴别诊断特征.方法 回顾性分析经病理证实的20例GM和23例非肿块型乳腺癌患者资料.所有患者均行乳腺MRI检查.采用卡方检验比较GM与非肿块型乳腺癌患者的时间-信号强度曲线(TIC)类型.用Wilcoxon检验比较病灶血流动力学参数,包括早期强化率和峰值强化率.P＜0.05为差异具有统计学意义.结果 GM的TIC为Ⅰ或Ⅱ型,非肿块型乳腺癌的TIC多为Ⅱ或Ⅲ型,少数为Ⅰ型,两者间差异具有统计学意义.GM的早期强化率和最大强化率分别为1.119和2.023;非肿块型乳腺癌的早期强化率和最大强化率分别为0.901和1.614.GM和非肿块型乳腺癌的血流动力学参数间无显著性差异.结论 GM与非肿块型乳腺癌的诊断需要密切结合临床、其他影像检查及MRI形态特征进行综合判断,MRI灌注成像对GM和乳腺癌的鉴别有一定意义,但其血流动力学半定量参数有重叠,有待进一步研究.     

青年与中老年乳腺浸润性导管癌MRI增强形态类型的差异及病理基础初探

目的探讨乳腺浸润性导管癌MRI增强形态类型与年龄的相关性及其病理基础。方法收集经病理学证实的乳腺浸润性导管癌97例,均进行了MRI动态增强检查。2名放射科医生独立阅片确定肿瘤MRI增强后形态类型(肿块/非肿块样强化)及大小。2名病理科医生确定浸润性导管癌成分的组织学分级及肿瘤内是否含有导管内原位癌(ductal carcinoma in situ,DCIS)。分析MRI增强形态类型与年龄段的相关性,青年与中、老年MRI增强形态类型是否有显著差异,肿块与非肿块型乳腺癌病变大小、浸润性导管癌成份组织学分级及DCIS存在与否的差异性。结果 MRI增强形态类型与年龄显著相关(P=0.000);40岁(含)以下青年中的非肿块型乳腺癌比40岁以上中老年的明显增多(P=0.000)。非肿块型乳腺癌大小大于肿块型(P=0.022)。非肿块型乳腺癌中病理含DCIS者明显多于肿块型乳腺癌(P=0.000),且前者浸润性导管癌成分的组织学分级明显低于后者(P=0.006)。结论非肿块型乳腺癌更易发生于青年,肿块型乳腺癌更易发生于中老年。非肿块型乳腺癌与存在DCIS显著相关,但浸润性导管癌成分组织学分级相对较低,其恶性程度未必差于肿块型乳腺癌。     

MRI 鉴别诊断慢性乳腺炎与乳腺癌的价值

目的：比较慢性乳腺炎与乳腺癌的 MRI 表现,探讨 MRI 鉴别诊断两者的价值。方法回顾性分析20例经穿刺活检或手术病理证实为慢性乳腺炎的 MRI 检查资料,同时期经病理证实的30例乳腺癌作为对照。评估两者的形态学征象与动态增强表现并作统计学分析。形态学征象包括：病灶形状、毛刺征、环形强化、病灶周围水肿、皮肤增厚、乳头受累、腋窝淋巴结肿大。动态增强表现(DCE)包括计算早期强化率,绘制时间-信号强度曲线(TIC)。结果乳腺炎与乳腺癌形状、环形强化、灶周水肿等征象存在统计学差异,毛刺征、皮肤增厚、乳头受累、腋窝淋巴结肿大等征象无统计学差异。乳腺炎早期强化率1.156±0.635,乳腺癌1.253±0.499,两者无统计学差异(t=0.604,P =0.548)。乳腺炎Ⅰ、Ⅱ、Ⅲ型 TIC 病例分别为11、6、3例,乳腺癌分别为4、11、15例。两者 TIC 有统计学差异(χ2=8.713,P =0.013)。结论乳腺炎常呈非肿块样外观,环形强化、灶周水肿、偏良性的 TIC 等 MRI 征象可作为与乳腺癌鉴别诊断的依据。     

乳腺癌新辅助化疗前后DCE-MRI血流动力学与病理学对照

目的:探讨乳腺癌新辅助化疗前后动态增强MRI血流动力学变化特点,对新辅助化疗的疗效和预后的评价提供更多依据.方法:新辅助化疗的乳腺癌患者26例,新辅助化疗前后进行乳腺动态增强MRI检查.比较时间-信号强度曲线(TIC)及血流半定量参数在化疗前后变化;化疗后残留病灶的TIC类型与病理学评级进行对照研究.结果:新辅助化疗患...     

DWI及DCE-MRI评价新辅助化疗对不同分子分型乳腺癌的疗效

目的探讨MRI功能成像评价乳腺癌新辅助化疗疗效的价值。方法回顾性分析本院38例经手术病理证实为浸润性乳腺癌行术前新辅助化疗的患者资料。依据化疗前后组织病理学改变进行疗效评价,将病例资料分为病理完全缓解组(pCR)和病理非完全缓解组(NpCR);对比分析两组免疫组化差异及化疗前后MRI检查指标数值变化的差异,以病理反应性标准分组为金标准,对其中有统计学意义的参数进行ROC曲线分析,并计算曲线下面积(AUC),评价其对NAC疗效的预测效能;最后应用相关分析结果建立乳腺癌新辅助化疗疗效预测模型logistP。结果38例中pCR13例,NpCR25例。两组免疫组化参数(ER/PR、HER-2、ki-67)及分子分型、ΔADC%差异均无统计学意义,化疗前后两组ΔD%、ΔV%、ΔS%、ΔSmax%、ΔTIC差异有统计学意义(P<0.05);ΔD%、ΔV%、ΔS%、ΔSmax%、ΔTIC的AUC分别为0.748、0.822、0.708、0.828、0.700,灵敏度/特异度分别为0.769/0.68、0.846/0.72、0.538/0.84、0.769/0.80、0.692/0.64,其logistP与病理组织学疗效的AUC为0.846(95%CI0.708~0.984)。结论乳腺癌新辅助化疗早期动态增强MRI参数变化能预测NAC疗效。     

乳腺癌新辅助化疗的动态增强磁共振成像评价

目的:探讨乳腺癌患者新辅助化疗(NAC)后通过动态增强MRI评估肿瘤边界的准确性;观察NAC前、后时间-信号强度曲线(TIC)变化。方法:搜集57例行NAC乳腺癌患者,化疗前后均行病理及MRI检查,以病理结果作为金标准,将NAC后MRI所测肿瘤最大径与其进行比较;观察记录NAC前、后TIC类型。结果:化疗后MRI测量的肿瘤最大径与病理量出的最大径有很高的相关性(r=0.926,P<0.005);NAC后TIC类型变化多样。结论:动态增强MRI可以对乳腺癌NAC后进行有效评价。化疗前、后的TIC变化可以为临床评价NAC疗效提供丰富的信息。     

非肿块型浸润性乳腺癌MRI征象与分子分型相关性研究

目的 探讨非肿块型浸润性乳腺癌MRI影像学表现与分子分型的关系。方法 选取并分析187例非肿块型浸润性乳腺癌患者MR图像，分析病灶的强化方式、分布、时间-信号强度曲线(TIC)、腋窝肿大淋巴结及表观扩散系数(ADC)与分子分型的关联。以病理结果为金标准，用方差分析分析不同分子分型ADC值差异；用χ²检验或Fisher确切概率法分析不同分子分型非肿块样强化病变强化方式、分布、TIC、腋窝肿大淋巴结组间差异。结果 非肿块样强化病变不同分子分型间强化方式、分布、腋窝肿大淋巴结差异有统计学意义(P<0.05),TIC与非肿块型浸润性乳腺癌分子分型差异无统计学意义(P>0.05);利用方差分析对不同分子分型ADC值进行比较，差异无统计学意义(F=0.694,P=0.597),按α=0.05水准不拒绝H0,尚不能认为各分子分型间ADC值存在不同。结论 非肿块型浸润性乳腺癌的MRI征象与分子分型存在一定相关性。     

青年女性三阴乳腺癌的MRI表现

【摘要】目的：探讨青年女性（年龄＜35岁）三阴乳腺癌的MRI特征。方法：搜集病理及免疫组化证实为女性三阴乳腺癌患者（＜35岁）16例术前MRI检查资料，分析MRI征象。结果：16例病灶均为肿块型，其中11例为单发病灶，5例为多发病灶；圆形3例，椭圆形7例，不规则形6例；4例边缘光整，10例边缘不规则，2例边缘见毛刺；不均匀强化10例，边缘强化6例；平扫T2WI图像等信号3例，稍高信号9例，高信号4例；DWI 16例均为高信号，其中5例为环形高信号；平扫T2WI图像上7例可见明显高信号；TIC曲线：Ⅱ型9例，Ⅲ型7例。结论：青年女性三阴乳腺癌的MRI表现有一定特征性。     

Diagnosis of bronchial rupture with MR imaging

Tracheobronchial rupture is a serious injury occurring in approximately 1.5% of cases of major chest trauma. This injury is associated with significant mortality and morbidity and may be difficult to recognize both clinically and radiologically. Radiologic signs are mostly nonspecific, with pneumothorax and pneumomedi-astinum being the most common. A high level of suspicion is required to make the diagnosis. Computed tomography (CT) can be helpful; however, it provides only indirect evidence for the diagnosis. This report describes a case of complete transection of the right main bronchus, suspected at plain radiography and CT and clearly shown on magnetic resonance (MR) images. MR imaging, with its multiplanar capabilities, can be helpful in defining the location and extent of injury and in diagnosing injury not suspected or clearly demonstrated with other imaging modalities.     

Abdominal angiography with stereoscopic magnification

A new technique for stereoscopic magnification angiography has been developed and combined with routine abdominal angiography. The technique utilizes two divergent x-ray beams at a 34° angle, with a 3.5 cm focal spot separation at a 94 cm focalfilm distance, produced by a synchronous arc rotation of a microfocus x-ray tube. The synchronous motion of the tube is maintained by using an electromechanical device. A magnification factor of 2.0 to 3.0 is used, and 12 films are exposed in a series, the fastest sequence being 1.5 films per second. This technique provides the advantages of magnification and stereoscopic angiography, with excellent demonstration of small arterial branches and abnormal vascularity in three dimensions.     

Comparison of Transvaginal Ultrasonography with Hysterosonography as a Screening Method in Patients with Abnormal Uterine Bleeding

Objective

To assess the utility of hysterosonography (HS) as a screening method in patients with abnormal uterine bleeding.

Materials and Methods

We retrospectively reviewed transvaginal ultrasonography (TVS) and HS for 105 patients whose diagnosis was confirmed pathologically. All 105 patients were initially evaluated on the same day with both TVS and HS. On TVS and HS examination, endometrial cavitary lesions were classified as diffuse hyperplasia, endometrial polyp, endometrial cancer, uterine synechia and submucosal leiomyoma. Hysteroscopy with biopsy (n=35), curettage (n=60) or hysterectomy (n=10) was performed, and the results of TVS and HS examination were correlated with the pathological findings.

Results

The sensitivity and specificity were 79.0% and 45.8% for TVS, and 95.1% and 83.3% for HS, respectively. The positive and negative predictive values were 83.0% and 39.3% for TVS, and 95.1% and 83.3% for HS, respectively. Twenty-seven showed a discrepancy between the TVS and HS, and eight cases showed a discrepancy between HS and the pathologic diagnosis.

Conclusion

TVS is a sensitive method to evaluate the endometrial cavitary lesions, but it often does not provide the physician with sufficient diagnostic information. With its higher sensitivities, specificities and positive and negative predictive values, HS can be better used than TVS in evaluating those patients with abnormal uterine bleeding.     

Acute spinal ligament disruption: MR imaging with anatomic correlation

Disruption of spinal ligaments can lead to instability that jeopardizes the spinal cord and nerve roots. Magnetic resonance (MR) imaging can directly image spinal ligaments; however, the sensitivity with which this modality demonstrates ligament injury has, to the authors' knowledge, not been reported. On a biomechanical testing machine, 28 cadaveric spines were subjected to controlled injury that resulted in ligament tears. The spines were then imaged with plain radiography, computed tomography, and MR imaging (1.5 T). The images were analyzed for evidence of ligament injury before dissection of the specimen. Forty-one of 52 (79%) ligament tears of various types were correctly identified at MR imaging. Disruptions of the anterior and posterior longitudinal ligaments were most conspicuous and were detected in all seven cases in which they were present (no false-positive or false-negative results); disruptions of the ligamentum flavum, capsular ligaments, and interspinous ligaments could also be identified but less reliably (three false-positive and 11 false-negative results). That MR imaging can reliably and directly allow assessment of spinal ligament disruption in this in vitro model suggests its potential utility for this assessment in patients.     

MR imaging of infradiaphragmatic lymphadenopathy in children and adolescents with Hodgkin disease: Comparison with lymphography and CT

The ability of short-inversion-time inversion recovery (STIR) magnetic resonance imaging to depict infradiaphragmatic lymphadenopathy was evaluated in 25 consecutive patients with newly diagnosed Hodgkin disease. All patients underwent computed tomography (CT) and multiplanar STIR imaging prior to lymphography (LAG). The STIR and CT images were evaluated for paraaortic and parailiac node enlargement. Findings were compared with LAG findings, which showed the architectural pattern of the opacified lymph nodes. In the upper paraaortic region, STIR imaging showed more abnormal nodes than did CT or LAG. In the lower paraaortic and parailiac regions, lymph node enlargement was shown equally well with STIR and LAG, whereas CT showed fewer enlarged lymph nodes. LAG showed paraaortic or parailiac focal tumor infiltration in three patients with normal-size nodes, and hyperplasia in two patients with enlarged nodes. STIR imaging showed more abnormal infradiaphragmatic nodes than did CT because of improved lymph node conspicuity. STIR imaging may be a useful addition to CT for staging pediatric Hodgkin disease.     

Diagnosis of fatty liver with MR imaging.

The diagnosis of fatty liver with magnetic resonance (MR) imaging was evaluated in experimental rat models of simple fatty infiltration and fatty liver with hepatocellular injury. T1 and T2 were measured ex vivo and correlated with the histologic degree of fatty infiltration. Enhancement of fatty liver with four different cells-specific contrast agents was studied with ex vivo relaxometry and in vivo MR imaging. Quantitative analysis of conventional and chemical shift MR images was correlated with biochemically determined fat content of the liver. Diet-induced simple fatty infiltration of the liver caused a decrease in T1 of 15%, whereas the T1 of L-ethionine-induced fatty liver with hepatocellular injury increased by 12%. T2 showed a positive correlation with the degree of fatty infiltration in both models. Cell-specific hepatobiliary contrast agents showed the same liver uptake and relaxation enhancement in fatty livers as in normal livers. Conventional T1-weighted images and chemical shift images showed good correlation (r = .83 and .80, respectively) between signal intensity and the degree of fatty infiltration. However, only chemical shift imaging was reliable in the diagnosis of fatty liver.     

Radioimmunotherapy with 131I-Rituximab in a Patient with Diffuse Large B-Cell Lymphoma Relapsed After Treatment with 90Y-Ibritumomab Tiuxetan

We report a case that demonstrates the efficacy of radioimmunotherapy (RIT) with radioiodinated rituximab (¹³¹I-rituximab) for relapsed diffuse large B-cell lymphoma (DLBCL). A 79-year-old male patient with DLBCL initially achieved a complete response (CR) after six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) therapy. However, the lymphoma relapsed 20 months later. Although the patient had achieved a second and a third CR after two cycles of ⁹⁰Y-ibritumomab tiuxetan, he experienced a third relapse approximately 3 years later. Between March and June 2011, the patient received three cycles of ¹³¹I-rituximab. Although he had achieved partial response after the second cycle, the disease progressed after the third cycle, and the total progression–free survival was thus 5 months. The patient suffered only relatively mild toxicity (grade 1 thrombocytopenia) during treatment. RIT with ¹³¹I-rituximab is therefore potentially effective in patients with relapsed DLBCL, even after the failure of ⁹⁰Y-ibritumomab tiuxetan therapy.     

Prognostic value of intra-left ventricular electromechanical asynchrony in patients with mild hypertrophic cardiomyopathy compared with power athletes

Objectives

We sought to assess the indexes of myocardial activation delay, using Doppler myocardial imaging (DMI), as potential diagnostic tools and predictors of cardiac events in patients with hypertrophic cardiomyopathy (HCM) compared with power athletes.

Background

the distribution and magnitude of left ventricular (LV) hypertrophy are not uniform in patients with HCM, which results in heterogeneity of regional LV systolic function.

Methods

The study population comprised 70 young patients with HCM (mean (SD) age 29.4 (5.9) years) with mild septal hypertrophy (15–19 mm) and 85 age and sex matched athletes with septal thickness >12 mm, followed up for 44.4 (10.8) months. Using pulsed DMI, myocardial peak velocities, systolic time intervals, and myocardial intraventricular and interventricular systolic delays were measured in six different basal myocardial segments.

Results

DMI analysis showed in HCM lower myocardial both systolic and early diastolic peak velocities of all the segments. Patients with HCM also showed significant interventricular and intraventricular delay (p<0.0001), whereas athletes showed homogeneous systolic activation of the ventricular walls. During the follow up, seven sudden deaths occurred in the HCM group, while no cardiovascular event was observed in the group of athletes. In patients with HCM, intraventricular delay on DMI was the most powerful independent predictor of sudden cardiac death (p<0.0001). An intraventricular delay >45 ms identified with high sensitivity and specificity patients with HCM at higher risk of ventricular tachycardia and cardiac events (test accuracy 90.6%).

Conclusions

DMI may be a valid supporting tool for the differential diagnosis between HCM and “athlete''s heart”. In patients with HCM, DMI indexes of intraventricular delay may provide additional information for selecting subgroups of patients with HCM at increased risk of ventricular arrhythmias and sudden cardiac death at follow up. Accordingly, such patients may benefit from early intensive treatment and survey.

Miniabstract

Doppler myocardial imaging may represent a valid supporting tool for the differential diagnosis between mild hypertrophic cardiomyopathy (HCM) and “athlete''s heart”. In patients with HCM, DMI indexes of intraventricular delay may provide additional information for selecting subgroups of patients with HCM at increased risk of ventricular arrhythmias and sudden cardiac death at follow up.     

MR imaging assessment of experimental hepatic dysfunction with mn-DPDP

Manganese (II) N, N'-dipyridoxylethylenediamine-N, N'-diacetate 5,5′-bis(phosphate) (DPDP) is a paramagnetic magnetic resonance (MR) contrast agent that enhances the liver and is predominantly excreted through the biliary tree. The authors evaluated its utility in diffuse liver disease by assessing liver and gallbladder enhancement in 24 rabbits. Total (n = 6) or segmental (n = 6) biliary occlusion or galactosamine-induced hepatitis (n = 6) was induced 3 days before imaging. Six rabbits served as normal controls. T1- and T2-weighted axial MR images were acquired at baseline, followed by T1-weighted images every 10 minutes for 1 hour after the intravenous administration of 20 μmol/kg Mn-DPDP. Except for the segmental occlusion group, the baseline study did not allow distinction between normal and abnormal livers. The temporal hepatic enhancement pattern was statistically different for each group. The normal, segmental occlusion, and hepatitis groups showed patterns similar to one another but markedly higher signal intensity than the total-occlusion group throughout the observation period. In contrast, the gallbladder showed a greater difference in both degree of enhancement and time to peak enhancement among the four groups. Mn-DPDP produces a temporal hepatic enhancement pattern that allows recognition of markedly impaired livers, and gallbladder enhancement patterns that allow distinction of more subtly impaired livers.     

Evaluation of adrenal masses with gadolinium enhancement and fat-suppressed MR imaging

A study was undertaken to determine the ability to characterize benign and malignant masses with unenhanced and contrast material-enhanced fast lowangle shot and fat-suppressed spin-echo magnetic resonance (MR) imaging. Thirty patients with adrenal masses detected at computed tomography (CT) underwent MR imaging within 14 days after CT. CT and MR images were interpreted in a prospective, blinded fashion. Sixteen patients had 20 benign adrenal masses, and 14 patients had 18 malignant masses. Quantitative measurements included percentage of contrast enhancement on immediate postcontrast dynamic images and periphery - center signal-to-noise ratio (S/N) on gadolinium-enhanced fat-suppressed images. Qualitative evaluation included determination of the regularity of lesion margins, homogeneity of signal intensity, and local extension. MR imaging depicted all adrenal masses discovered at CT examinations. Lesions ranged in diameter from 1 to 15 (mean, 4.4) cm. No significant difference was observed in percentage of contrast enhancement between benign (90.5% ± 59.0 [standard deviation]) and malignant (110.5% ± 116.4) masses. A difference was observed between periphery - center S/N for benign (?.05 ± 1.5) and malignant (7.7 ± 9.8) masses; overlap between the two, however, occurred. Qualitative evaluation allowed correct characterization of 32 of 38 masses, comparing favorably with CT, which allowed characterization of 30 lesions.