增强超声对乳腺肿块的描述:与MRI比较定量分析的应用

<正>目的与MRI比较,评价增强超声(CE-US)对乳腺病变定量分析的可信度。材料与方法对通过超声或乳腺X线摄影发现存在BI-RADS3-5乳腺病变的39例病人行CE-US和MRI检查。所有病变均进     

肝细胞癌动脉性富血供对比剂增强超声与钆塞酸二纳增强MRI评价的对照性研究

正摘要目的以CT肝动脉增强(CTHA)影像为参照标准,对照对比剂增强(CE)超声与钆塞酸二钠增强MRI对肝细胞癌(HCC)与发育不良性结节(DN)动脉性富血管程度的评估。方法54例连续病人纳入研究,其中组织学证实HCC57个,DN(高分级)3个。所有病例均接受了CE超声、钆塞酸二钠增强MRI与CTHA检     

超声弹性成像与动态增强MRI对非肿块型乳腺癌与肉芽肿性乳腺炎的诊断价值

目的 探讨超声弹性成像与动态增强MRI对非肿块型乳腺癌(non mass breast cancer, NMBC)与肉芽肿性乳腺炎(granulomatous mastitis, GM)的鉴别。方法 选取NMBC和GM患者90例，其中NMBC患者42例，GM患者48例。行超声弹性成像与动态增强MRI检查，分析两种检查影像特征。结果 NMBC患者B/A高于GM患者，差异有统计学意义(P<0.05)。NMBC患者TIC分型Ⅲ型高于GM患者，差异有统计学意义(P<0.05)。NMBC与GM患者病灶大小、MRI征象分布及强化特点比较，差异无统计学意义(P>0.05)。经ROC曲线分析显示，超声弹性成像联合动态增强MRI对NMBC诊断灵敏度和特异度高于超声弹性成像与动态增强MRI。结论 超声弹性成像联合动态增强MRI对NMBC与GM鉴别诊断具有一定的临床价值，为临床治疗提供有价值的信息。     

应用Gd-EOB-DTPA动态增强MRI评估慢性肝炎病人的肝脏纤维化程度

目的以组织学分析作为参考标准,研发无创评估肝脏纤维化的MRI检查方法。方法该研究已获得本院人类研究审查委员会批准并获得病人知情同意书。79例病人应用Gd-EOB-DTPA行动态增强MRI(DCE-MRI)扫描,并根据     

镰状细胞性贫血儿童疼痛性骨危象的Gd-DOTA增强MRI

为评价Gd-DOTA增强MRI在处理镰状细胞性贫血儿童疼痛性骨危象(painful osseous crises)中的作用,作者在9例患儿的11次骨危象中做了MRI、核素骨扫描和超声检查。每一病人的骨危象病因由临床医师根据患者病程、对抗生素治疗的反应和手术标本的细菌学检查作出最终诊断,结果符合急性     

动态增强MRI时间信号强度曲线在卵巢良恶性肿瘤鉴别中的价值

目的探讨动态增强MRI时间信号强度曲线(TIC)鉴别卵巢肿瘤良恶性的价值。方法收集2016年1月—2017年8月间于我院超声检查发现盆腔附件肿块的71例女性病人,年龄14～78岁,中位年龄52岁。所有病人行MRI常规及动态增强检查后经手术获得病理结果。利用工作站在肿块实性区和正常子宫外肌层设置兴趣区获取TIC,以子宫外肌层强化曲线为基准,对卵巢肿块实性区的TIC类型进行校正,分析曲线类型与良恶性卵巢肿瘤的关系。采用χ~2检验比较良恶性肿瘤间3种TIC类型差异。结果 71例病人中包括卵巢恶性肿瘤40例,良性肿瘤26例,交界性肿瘤5例。上述3种肿瘤的TIC类型的差异有统计学意义(P0.05)。良性肿瘤以Ⅰ型TIC为主(73.1%),恶性肿瘤以Ⅲ型TIC为主(77.5%)。MRI+TIC鉴别肿瘤良恶性的敏感度、特异度、阳性预测值和阴性预测值较单独常规MRI检查各指标均有不同程度提高。结论动态增强MRI及其TIC对卵巢良恶性肿瘤具有重要的鉴别诊断价值。     

肛瘘磁共振LAVA增强扫描的临床应用与评价

目的评价肛瘘MRI肝脏容积加速采集(LAVA)增强扫描的临床应用价值。方法分析27例手术治疗患者的肛瘘资料,以手术结果对照,比较MRI平扫、LAVA增强扫描、直肠腔内超声之间的差异。结果在肛瘘内口位置和数目检出与手术结果符合率方面,MRI平扫相似文献   

活体肝移植中改良移植肝右叶的肝中静脉属支闭塞:对比增强超声检查的诊断

目的研究对比剂增强超声检查对于活体肝移植术后改良移植肝右叶肝中静脉属支闭塞的诊断能力。材料与方法研究获单位伦理委员会批准,无需知情同意书。研究包括2009年2月—5月间进行活体肝移植改良肝右叶移植术的65例病人(男48例,女17例,年龄33～69岁,平均52.8岁)。所有病人均于术后1天进行对比增强超声检查和多普勒超声检查,并于超声检查后7天内进行CT检查。对比增强超声检查中,评估动脉期和门静脉期的肝中静脉属支范围的肝实质的强化方式。采用肝中静脉属支闭塞常见的强化方式为标准,比较对比增强超声与多普勒超声检查对于肝中静脉属支闭塞的诊断效能,以CT检查作为参照。利用常用的估算公式对数据进行归类分析。结果在65例病人的148支肝中静脉属支中,CT检查中发现31例病人的36支(24.3%)闭塞。以动脉期高回声或门静脉期低回声作为诊断标准时,对比增强超声敏感度、特异度和准确度分别为91%(33/36)、97%(109/112)和95%(142/148);而多普勒超声分别为83%(30/36)、86%(97/112)和85%(127/148)。对比增强超声检查对于肝中静脉属支的闭塞较多普勒超声检查有更高的特异度和准确度(P=0.024和0.01)。动脉期高回声仅出现在肝静脉闭塞组。结论对比增强超声检查有助于准确评价活体肝移植改良肝右叶肝中静脉属支的闭塞情况。对比增强超声较多普勒超声更具特异性,肝静脉闭塞时表现为受累区域的动脉期强化。     

早期诊断青少年先天性关节炎的对比增强MR影像特点

正目的研究临床症状、实验室检查、MRI测量是否能够区分青少年先天性关节炎(JIA)及其他儿童活动性关节炎。方法回顾性分析了80例临床怀疑JIA并经治疗后的病例资料,所有病人至少有1个膝关节受累且为12个月以内的活动性非感染性关节炎。对病人进行临床和实验室评估以及对比增强MRI检查。MRI不作为诊断标准。结果 44例(55%)病人临床诊断为JIA,而36例(45%)经临床和实验室检查不能诊断为JIA。27例(61.4%)JIA病人和7例(19.4%)非JIA病人经MRI诊断为滑膜炎。5个因素(男性、经医生全     

动态增强MR成像预测胶质母细胞瘤病人标准治疗后增强病灶进展的前瞻性研究

正摘要目的探讨动态对比增强MRI(DCE-MRI)在预测胶质母细胞瘤(GBM)病人术后及标准治疗后持续存在的增强病灶进展的价值。方法纳入2014年5月—2016年2月间     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…