肝脏Gd—DTPA快速动态增强MRI的临床应用——较小HCC与FNH的动…

目的：运用梯度回波（ＧＲＥ）的快速场回波（ＦＦＥ）技术，对２０例肝肿块进行Ｇｄ－ＤＴＰＡ动态增强，旨在探明不同肿块的增强规律，提高肝肿块的诊断和鉴别诊断能力。材料与方法：选取经过其他影像学检查未确诊的２０例肝肿块，作常规自旋回波（ＳＥ）平扫后作Ｇｄ－ＤＴＰＡ ＦＦＥ序列快速动态增强扫描，分别测量病灶信号强度，灶周正常肝脏信号强度，背景噪声信号强度和标准差（ＳＩ ｎｏｉｓｅｃ±ｓ），计算不同病变不同     

GANGLIOSIDE GM_1 POTENTIATES NERVE GROWTH FACTOR EFFECTS ON REGENERATION OF CRUSHED SCIATIC NERVE IN RATS

ＧＡＮＧＬＩＯＳＩＤＥＧＭ１ＰＯＴＥＮＴＩＡＴＥＳＮＥＲＶＥＧＲＯＷＴＨＦＡＣＴＯＲＥＦ┐ＦＥＣＴＳＯＮＲＥＧＥＮＥＲＡＴＩＯＮＯＦＣＲＵＳＨＥＤＳＣＩＡＴＩＣＮＥＲＶＥＩＮＲＡＴＳＷＡＮＧＭｉｎ－ｓｈｅｎｇ（王民生），ＣＨＥＮＺｈｏｎｇ－ｗｅｉ（陈...     

NERVE DEFECT REPARATION BY VEIN BRIDGING WITH SCHWANN CELL IMPLANTATION

ＮＥＲＶＥＤＥＦＥＣＴＲＥＰＡＲＡＴＩＯＮＢＹＶＥＩＮＢＲＩＤＧＩＮＧＷＩＴＨＳＣＨＷＡＮＮＣＥＬＬＩＭＰＬＡＮＴＡＴＩＯＮＣＨＥＮＺｈｅｎｇ－ｒｏｎｇ（陈峥嵘），ＣＨＥＮＺｈｏｎｇ－ｗｅｉ（陈中伟），ＺＨＡＮＧＦｅｎｇ（张峰），ＣＨＥＮＧＧａｎｇ（...     

乳腺增强MRI

文内综述了乳腺Ｇｄ－ＤＴＰＡ增强ＭＲＩ的现状。重点介绍了自旋回波（ＳＥ）及梯度回波（ＦＬＡＳＨ、ＦＩＳＰ）序列正常及乳腺病变的增强ＭＲＩ表现和脂肪抑制技术在乳腺良恶性病变鉴别、术后乳腺及硅胶假体乳腺的评价等方面的实用价值。特别强调动态ＭＲ检查乳癌、腺瘤及小叶增生等的时间－强化曲线特征。     

Clinical Significance of Acute Phase Hyperglycemia in Patients with Severe Head Injury

ＣＬＩＮＩＣＡＬＳＩＧＮＩＦＩＣＡＮＣＥＯＦＡＣＵＴＥＰＨＡＳＥＨＹＰＥＲＧＬＹＣＥＭＩＡＩＮＰＡＴＩＥＮＴＳＷＩＴＨＳＥＶＥＲＥＨＥＡＤＩＮＪＵＲＹＺＨＡＮＧＳａｉ（张赛），ＹＡＮＧＳｈｕ－ｙｕａｎ（杨树源），ＷＡＮＧＭｉｎｇ－ｌｕ（王明璐）Ｏｂｊ...     

THE INJURIOUS EFFECTS OF HEMODYNAMIC CHANGES RESULTING FROM GUNSHOT WOUNDS ON REMOTE ORGANS

ＴＨＥＩＮＪＵＲＩＯＵＳＥＦＦＥＣＴＳＯＦＨＥＭＯＤＹＮＡＭＩＣＣＨＡＮＧＥＳＲＥＳＵＬＴ┐ＩＮＧＦＲＯＭＧＵＮＳＨＯＴＷＯＵＮＤＳＯＮＲＥＭＯＴＥＯＲＧＡＮＳＬＩＳｈｕ－ｇｕａｎｇ（李曙光），ＬＩＵＹｉｎ－ｑｉｕ（刘荫秋），ＷＡＮＧＪｉａｎ－ｍｉｎ...     

A STUDY OF THE RELATIONSHIP BETWEEN RENAL INJURY SEVERITY AND HIGH ENERGY SHOCK WAVE DOSES APPLIED

ＡＳＴＵＤＹＯＦＴＨＥＲＥＬＡＴＩＯＮＳＨＩＰＢＥＴＷＥＥＮＲＥＮＡＬＩＮＪＵＲＹＳＥＶＥＲＩＴＹＡＮＤＨＩＧＨＥＮＥＲＧＹＳＨＯＣＫＷＡＶＥＤＯＳＥＳＡＰＰＬＩＥＤＪＩＡＮＧＪｕｎ（江军），ＦＡＮＧＹｕ－ｈｕａ（方玉华），ＪＩＮＦｅｎｇ－ｓｈｕｏ（...     

AN EVALUATION OF PREOPERATIVE CT SCANNING FOR SELECT-ING ADAPTIVE NAILS IN 78 CASES OF SHAFT FRACTURE

ＡＮＥＶＡＬＵＡＴＩＯＮＯＦＰＲＥＯＰＥＲＡＴＩＶＥＣＴＳＣＡＮＮＩＮＧＦＯＲＳＥＬＥＣＴ┐ＩＮＧＡＤＡＰＴＩＶＥＮＡＩＬＳＩＮ７８ＣＡＳＥＳＯＦＳＨＡＦＴＦＲＡＣＴＵＲＥＣＡＩＲｕ－ｂｉｎ（蔡汝宾），ＬＩＬｉ－ｑｕｎ（李力群），ＤＥＮＧＬｅｉ（邓磊...     

快速序列动态增强MRI对前列腺癌的诊断价值

目的 研究快速成像序列动态增强对前列腺癌的检出和定性价值。方法 对经活检证实的２５例,临床证实的６例,共３１例前列腺癌患者作了前瞻性增强ＭＲＩ研究。先行ＳＥＴ１ＷＩ、快速自旋回波（ＦＳＥ）Ｔ２Ｗ序列扫描,然后行快速多怪面干扰梯度回波（ＦＭＰＳＰＧＲ）序列团注增强扫描,共４个回合,研究病灶增强情况,并对增强后图像与常规ＦＳＥＴ２ＷＩ进行比较。结果 ＦＭＰＳＰＧＲ增强后扫描,共发现病灶２９个,可疑病灶     

A Comparison in Healing of Skull Defect Repaired with Four Different Kinds of Graft Materials in Rabbits

ＡＣＯＭＰＡＲＩＳＯＮＩＮＨＥＡＬＩＮＧＯＦＳＫＵＬＬＤＥＦＥＣＴＲＥＰＡＩＲＥＤＷＩＴＨＦＯＵＲＤＩＦＦＥＲＥＮＴＫＩＮＤＳＯＦＧＲＡＦＴＭＡＴＥＲＩＡＬＳＩＮＲＡＢ┐ＢＩＴＳＤＩＮＧＺｈｅｎ－ｑｉ（丁真奇）１，ＴＡＮＦｕ－ｓｈｅｎｇ（谭富生）２，...     

肺孤立结节的动态CT增强研究

目的：采用同层动态CT增强评价肺孤立性结节。方法：选择41例直径≤4cm的肺孤立性结节进行研究，其中肺癌29例，肺结核球7例，肺炎性结节3例，肺错构瘤2例。静注碘剂100ml前后，对病灶中心作薄层扫描，测量增强前后CT值。结果：肺癌和肺炎性结节显强化，肺结核球和肺错构瘤轻度强化或不强化，肺癌和肺结核在75s和135s时间段增强比较中均有统计学显性差异（P＜0.05)。结论：①动态CT增强对肺癌与肺结核球等结节的鉴别极有价值，并可将增强后CT净增值＜20HU，作为良恶性结节的阈值指标；②动态CT增强中应重视淋巴结的观察，有利于SPN的定性诊断。     

Comparison of neuroendocrine tumor detection and characterization using DOTATOC-PET in correlation with contrast enhanced CT and delayed contrast enhanced MRI

Purpose

We evaluated the rate of successful characterization of gastroenteropancreatic neuroendocrine tumors (NETs) present with an increased somatostatin receptor, comparing CE-CT with CE-MRI, each in correlation with DOTATOC-PET.

Methods and materials

8 patients with GEP-NET were imaged using CE-MRI (Gd-EOB-DTPA), CE-CT (Imeron 400) and DOTATOC-PET. Contrast-enhancement of normal liver-tissue and metastasis was quantified with ROI-technique. Tumor delineation was assessed with visual-score in blind-read-analysis by two experienced radiologists.

Results

Out of 40 liver metastases in patients with NETs, all were detected by CE-MRI and the lesion extent could be adequately assessed, whereas CT failed to detect 20% of all metastases. The blind-read-score of CT in arterial and portal phase was median −0.65 and −1.4, respectively, and 2.7 for delayed-MRI. The quantitative ROI-analysis presented an improved contrast-enhancement-ratio with a median of 1.2, 1.6 and 3.3 for CE-CT arterial, portal-phase and delayed-MRI respectively.

Conclusion

Late CE-MRI was superior to CE-CT in providing additionally morphologic characterization and exact lesion extension of hepatic metastases from neuroendocrine tumor detected with DOTATOC-PET. Therefore, late enhanced Gd-EOB-DTPA-MRI seems to be the adequate imaging modality for combination with DOTATOC-PET to provide complementary (macroscopic and molecular) tumor characterization in hepatic metastasized NETs.     

Dynamic contrast enhanced MRI in the differential diagnosis of adrenal adenomas and malignant adrenal masses

OBJECTIVE: To evaluate the value of dynamic MR imaging in the differential diagnosis of adrenal adenomas and malignant tumors, especially in cases with atypical adenomas. MATERIALS AND METHODS: Sixty-four masses (48 adenomas, 16 malignant tumors) were included in this prospective study. Signal loss of masses was evaluated using chemical shift MR imaging. Five dynamic series of T1-weighted spoiled gradient echo (FFE) images were obtained, with the acquisition starting simultaneously with i.v. contrast administration (0-100 s) followed by a T1-weighted FFE sequence in the late phase (5th minute). Contrast enhancement patterns in the early (25th second) and late (5th minute) phase images were evaluated. For the quantitative evaluation, signal intensity (SI)-time curves were obtained according to the SIs on the 0th, 25th, 50th 75th and 100th second. Also, the wash-in rate, maximum relative enhancement, time-to-peak, and wash-out of contrast at 100 s of masses in both groups were calculated. The statistical significance was determined by Mann-Whitney U test. To evaluate the diagnostic performance of the quantitative tests, receiver operating characteristic (ROC) analysis was performed. RESULTS: Chemical shift MR imaging was able to differentiate 44 out of 48 adenomas (91.7%) from non-adenomas. The 4 adenomas (8.3%) which could not be differentiated from non-adenomas by this technique did not exhibit signal loss on out-of-phase images. With a cut-off value of 30, SI indices of adenomas had a sensitivity of 93.8%, specificity of 100% and a positive predictive value of 100%. On visual evaluation of dynamic MR imaging, early phase contrast enhancement patterns were homogeneous in 75% and punctate in 20,83% of the adenomas; while patchy in 56.25% and peripheral in 25% of the malignant tumors. On the late phase images 58.33% of the adenomas showed peripheral ring-shaped enhancement and 10.41% showed heterogeneous enhancement. All of the malignant masses showed heterogeneous enhancement. At the 25th second, the SIs and wash-in rates of the adenomas were significantly higher than those of the malignant masses (p=0.010). Time-to-peak enhancement of the malignant masses was significantly longer than that of the adenomas. With a cut-off value of 52.85 s, the time-to-peak enhancement had 87.5% sensitivity and 80% specificity. CONCLUSION: Chemical shift MR has a high sensitivity and specificity in the differential diagnosis of adenomas and malignant adrenal masses. However, taking into consideration only the atypical adenomas, chemical shift MRI is of no diagnostic value. Although the diagnostic value of dynamic MRI is lower than chemical shift MRI, in the atypical cases contrast enhancement patterns and time-to-peak and wash-in rates derived from SI-time curve of dynamic MRI give are contributory to the results of chemical shift MRI.     

Conventional MRA and contrast- enhanced MRA of extracranial vessel segments

Summary The introduction of fast gradient systems allows a reliable visualization of the extracranial carotid vessels by the magnetic resonance angiography (MRA) which meanwhile is implemented into clinical routine. By the mainly applied time-of-flight (TOF) technique, vessels can be imaged without contrast agent (CA). Due to the application of ultra-fast gradient-echo-sequences, the first-pass evaluation of an intravenous bolus-injection of Gadolinium in the carotids from the aortic arch up to the skull base can be performed in less than 30 s. In this study, advantages and disadvantages of both techniques are discussed. For a qualitatively optimal contrast enhanced MRA (CE-MRA) timing parameters like injection delay, flow rate and the adjustment of sequence parameters have to be considered in relation to the fast venous return from the sinus to the jugular veins. First, the optimal time point of the data acquisition have been determined at a model and with a computer simulation in reference to the presence of CA in the arteries. As a result, 90 % of the contrast contribution is defined by 16 % of the symmetrically acquired central k-space lines. A measuring protocol for clinical use was obtained by a gradual variation of spacial resolution, measuring time and CA-injection parameters and was proved in normal volunteers and patients. An exact determination of the bolus-arrival-time by means of a test-bolus injection was acquired. The best qualitative results were achieved by a double-dose injection at 2 ml/s injection rate. The temporal reserves of ultra-fast sequences should be invested in the improvement of the spatial resolution. To date, further investigations related to the problem of optimal CA-application may improve the potentials of CE-MRA procedures.      

Dynamic contrast enhanced MRI in prostate cancer

Angiogenesis is an integral part of benign prostatic hyperplasia (BPH), is associated with prostatic intraepithelial neoplasia (PIN) and is key to the growth and for metastasis of prostate cancer. Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) using small molecular weight gadolinium chelates enables non-invasive imaging characterization of tissue vascularity. Depending on the technique used, data reflecting tissue perfusion, microvessel permeability surface area product, and extracellular leakage space can be obtained. Two dynamic MRI techniques (T2*-weighted or susceptibility based and T1-weighted or relaxivity enhanced methods) for prostate gland evaluations are discussed in this review with reference to biological basis of observations, data acquisition and analysis methods, technical limitations and validation. Established clinical roles of T1-weighted imaging evaluations will be discussed including lesion detection and localisation, for tumour staging and for the detection of suspected tumour recurrence. Limitations include inadequate lesion characterisation particularly differentiating prostatitis from cancer, and in distinguishing between BPH and central gland tumours.     

Application of a biodegradable macromolecular contrast agent in dynamic contrast‐enhanced MRI for assessing the efficacy of indocyanine green‐enhanced photothermal cancer therapy

Purpose

To investigate the effectiveness of a polydisulfide‐based biodegradable macromolecular contrast agent, (Gd‐DTPA)‐cystamine copolymers (GDCC), in assessing the efficacy of indocyanine green‐enhanced photothermal cancer therapy using dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI).

Materials and Methods

Breast cancer xenografts in mice were injected with indocyanine green and irradiated with a laser. The efficacy was assessed using DCE‐MRI with GDCC of 40 kDa (GDCC‐40) at 4 hours and 7 days after the treatment. The uptake of GDCC‐40 by the tumors was fit to a two‐compartment model to obtain tumor vascular parameters, including fractional plasma volume (f^PV), endothelium transfer coefficient (K^PS), and permeability surface area product (PS).

Results

GDCC‐40 resulted in similar tumor vascular parameters at three doses, with larger standard deviations at lower doses. The values of f^PV, K^PS, and PS of the treated tumors were smaller (P < 0.05) than those of untreated tumors at 4 hours after the treatment and recovered to pretreatment values (P > 0.05) at 7 days after the treatment.

Conclusion

DCE‐MRI with GDCC‐40 is effective for assessing tumor early response to dye‐enhanced photothermal therapy and detecting tumor relapse after the treatment. GDCC‐40 has a potential to noninvasively monitor anticancer therapies with DCE‐MRI. J. Magn. Reson. Imaging 2009;30:401–406. © 2009 Wiley‐Liss, Inc.     

The forgotten organ: contrast enhanced sonography of the spleen

OBJECTIVE: Ultrasound contrast agents in conjunction with contrast specific imaging techniques, are increasingly accepted in clinical use for diagnostic imaging in several organs. Contrast enhanced sonography (CES) of second-generation contrast media have shown a spleen-specific uptake of the microbubble contrast agent. The aim of this review is to illustrate indications for the use of CES in patients with suspected (peri-)splenic pathology. METHODS: This review based on the experience of transcutaneous CES in 200 patients with (peri-)splenic pathology diagnosed by B-mode sonography at an internal medicine center. CES studies were performed with a contrast-devoted unit (Acuson, Sequoia, Siemens medical solution) that had contrast-specific, continuous-mode software. A low mechanical index was used. A sulfur hexafluoride-based microbubble contrast medium (Sonovue, Bracco SpA, Milan, Italy) was injected. RESULTS: On our experience, there are several clinical conditions which may show an diagnostic advantage of CES in comparison to B-mode US. CES should be performed to investigate: (1) the perisplenic tumor to diagnose or exclude accessory spleen, (2) the small-sized spleen to diagnose functional asplenia/hyposplenia, (3) the inhomogenous spleen of unknown cause to diagnose focal lesions within the spleen, (4) the incidentally found hypoechoic splenic tumor to diagnose high vascular splenic hemangioma, (5) focal lesions suspect for splenic abscess, hematoma, infarction to confirme diagnosis, and (6) patients with abdominal trauma to diagnose or exclude splenic injury. CONCLUSION: CES is of diagnostic value in several clinical circumstances to diagnose accessory spleen, functional asplenia, small-sized splenic involvement, high vascular splenic hemangioma, and vascular splenic pathology like splenic infarction, splenic abscess, and splenic laceration.     

动态CT扫描对肺部孤立结节的评价

目的：应用动态ＣＴ扫描评价肺部孤立结节。材料和方法：对４７例成年患者的肺部孤立结节（直径≤４ｃｍ）进行研究。其中，恶性肿瘤２７例，结核瘤１２例，炎症结节７例，错构瘤１例，在静脉注射碘造影剂１００ｍｌ前后，对病灶进行一系列薄层扫描，测量增强前后各次扫描病灶的ＣＴ值。结果：所有恶性肿瘤和炎症结节显著增强，结核瘤无显著增强（Ｐ＜０．００１）。２６例恶性肿瘤、７例炎症结节和１例错构瘤呈全部强化型；１例恶性肿瘤和１例结核瘤呈周围强化型；４例结核瘤呈边缘环状强化型；７例结核瘤不强化。结论：（１）结节强化是恶性肿瘤和炎症结节的一个指征。（２）不强化或边缘环状强化提示结核瘤。