IDEAL-IQ技术对骨质疏松与转移瘤所致椎体压缩骨折的诊断价值

目的探讨磁共振多点非对称回波采集与迭代最小二乘法水脂分离技术(iterative decomposition of water and fat with echo asymmetry and the least squares estimation quantification sequence,IDEAL-IQ)椎体骨髓脂肪含量测定对于鉴别骨质疏松与转移瘤所致椎体压缩骨折的可行性。方法通过IDEAL-IQ序列对骨质疏松和转移瘤所致椎体压缩骨折椎体病变区及正常对照椎体的骨髓脂肪含量FF值、R2*值进行定量测定;并计算其椎体骨髓脂肪含量FF比值。运用Mann-Whitney U检验统计分析骨质疏松和转移瘤所致椎体压缩骨折椎体病变区FF值、R2*值及FF比值之间的统计学差异,受试者工作特征(receiver operator characteristic,ROC)曲线分析判断各参数诊断效能。结果骨质疏松与转移瘤所致椎体压缩骨折椎体病变区骨髓脂肪含量FF值、R2*及FF比值间差异均有统计学意义(P<0.05)。ROC曲线分析FF值对上述两种病因鉴别诊断的临界值为10.58%。FF值、R2*值、FF比值鉴别骨质疏松所致椎体压缩骨折及转移瘤所致椎体压缩骨折的ROC曲线下面积分别为0.967、0.715、0.921。结论磁共振IDEAL-IQ椎体骨髓脂肪含量的测定对骨质疏松与转移瘤所致椎体压缩骨折的鉴别诊断具有一定的可行性和临床价值。     

磁共振扩散加权成像表观扩散系数、信号强度比对腰椎骨质疏松的定量评价

目的:探讨磁共振扩散加权成像(diffusion weighted imaging,DWI)表观扩散系数(apparent diffusion coefficient,ADC),信号强度比(signal intensity ratio,SIR)在腰椎骨质疏松定量评价中的应用价值。方法:选取2017年5月至2019年10月接受双能X线吸收(dualenergy X ray absorption,DXA)骨密度(bone mineral density,BMD),腰椎常规MRI扫描和DWI扫描检查的腰椎疾病患者175例。根据DXA骨密度T值分为骨质疏松组(64例)、骨量减少组(53例)、骨量正常组(58例)。测量比较3组腰椎L_2-L_4的ADC、SIR值;分析ADC、SIR值与BMD的相关性;采用受试者工作特征(receiver operator characteristic,ROC)曲线分析ADC,SIR值对腰椎骨质疏松与骨量减少,腰椎骨质疏松与骨量正常及腰椎骨质疏松的鉴别诊断价值。结果:3组ADC、SIR值比较差异均有统计学意义(F=41.386、37.114,均P=0.000);骨质疏松组ADC值低于骨量减少组、骨量正常组(t=3.540、9.069,P=0.001、0.000);骨质疏松组SIR值高于骨量减少组、骨量正常组(t=5.083、8.523,均P=0.000)。Spearman相关性分析显示:ADC值与BMD呈正相关(r=0.313,P=0.004);SIR值与BMD呈负相关(r=-0.589,P=0.000)。ROC曲线分析显示:ADC、SIR诊断腰椎骨质疏松骨量减少的曲线下面积(area under curve,AUC),敏感度,特异度分别为0.742,89.1%,52.8%和0.729,89.1%,50.9%(均P=0.000);ADC、SIR诊断腰椎骨质疏松骨量正常的AUC,敏感度,特异度分别为0.815,100.0%,50.0%和0.856,65.6%,93.1%(均P=0.000);ADC、SIR诊断腰椎骨质疏松的AUC,敏感度,特异度分别为0.78,89.1%,51.4%和0.795,50.0%,94.6%(均P=0.000);均有一定诊断价值。结论:ADC、SIR能够较好地反映腰椎疾病患者BMD情况,可对骨质疏松的椎体进行定量评价,二者水平对腰椎骨质疏松具有重要的辅助诊断作用。     

氢质子磁共振波谱在骨质疏松诊断中的应用价值

目的：应用氢质子磁共振波谱（1 H MRS）对女性不同年龄及不同骨量腰椎骨质疏松的研究,探讨1 H MRS在女性骨质疏松诊断中的应用价值。方法以98名女性为研究对象,分为3组。青年组37例（平均27岁）、老年组45例（平均55岁）、骨质疏松组16例（平均61岁）。全部受检者先行常规腰椎MR检查（矢状位T1 WI、T2 WI及横轴位T2 WI）。采用单体素点分辨波谱法对腰3椎体进行波谱采集,采集到的数据使用SAGE 7．0软件进行分析,获得脂峰、水峰峰高（ Amp）,脂峰、水峰线宽（LW）,并计算脂水比（LWR）、脂肪比（FF）等椎体氢质子磁共振波谱相关定量指标。结果青年组LWR平均值为6．355,FF平均值为0．852;老年组LWR平均值为18．617,FF平均值为0．943;骨质疏松组LWR平均值为28．988,FF平均值为0．960。老年组LWR、FF明显高于青年组,两组差异具有显著性（ P＝0．000＜0．001）。骨质疏松组LWR、FF亦明显高于老年组（ P＝0．003＜0．01）。结论 LWR、FF随年龄增长而逐渐增高。骨质疏松者椎体骨髓内脂肪含量较同龄人明显增多。1 H MRS可作为一种无创性预测骨质疏松的检查方法。     

3T体线圈三维氢质子磁共振波谱在前列腺癌鉴别诊断中的价值

目的:探讨3T体线圈三维氢质子磁共振波谱(3D 1H-MRS)在前列腺癌鉴别诊断中的应用价值。方法:对40例临床可疑前列腺癌患者先行3T核磁共振(MRI)和磁共振波谱(MRS)检查,再行直肠B超引导下前列腺穿刺活检获得病理诊断。与病理结果对照,分析良性前列腺增生、前列腺癌、癌前病变MRS代谢特点,评估其对外周带前列腺癌的诊断效能。结果:所有患者均成功完成检查。间质、腺体增生为主内腺、内腺癌灶、外周带癌灶、正常外周带及前列腺上皮内瘤(胆碱+肌酸)/枸橼酸比值分别为:0.75±0.23、0.59±0.14、1.79±0.90、1.18±0.95、0.46±0.18、0.97±0.10。内腺癌灶与增生内腺、外周带癌灶与正常外周带差异有统计学意义(P<0.01)。外周带前列腺癌最佳诊断阈值为0.68,灵敏度88.6%,特异度88.7%。结论:3T体线圈3D 1H-MRS在前列腺癌鉴别诊断中具有较好的敏感性与特异性,对癌前病变的诊断有一定的参考价值。     

质子磁共振波谱测定大鼠椎体脂肪含量的可行性研究

目的探讨临床商用3.0 T磁共振扫描仪对大鼠椎体行质子磁共振波谱(proton magnetic resonance spectroscopy,~1H-MRS)检查评估骨髓脂肪含量的可行性。方法 15只3月龄正常雌性SD大鼠以及5只骨质疏松模型SD大鼠(去卵巢法)行多体素点分辨波谱法检查测定腰5椎体脂肪分数(fat fraction,FF),分析两名放射科医师测量正常大鼠腰5椎体FF值的一致性,并观察正常和骨质疏松模型大鼠的波谱以及病理特点。结果两名放射科医师测得的正常大鼠腰5椎体FF值分别为(10.92±3.31)%、(11.10±3.20)%,组内相关系数为0.954。~1H-MRS显示水峰明显高于饱和脂肪酸主峰(长链亚甲基质子),而不饱和脂肪酸峰烯烃质子和亚甲基质子(与烯烃质子相连)未见明确显示,HE染色显示骨髓内脂肪细胞少见,散在分布,体积较小;骨质疏松模型大鼠腰5椎体的FF值为(20.13±4.20)%,~1H-MRS显示水峰明显高于饱和脂肪酸主峰(长链亚甲基质子),但饱和脂肪酸主峰有所升高,不饱和脂肪酸峰烯烃质子和亚甲基质子(与烯烃质子相连)明确显示,信号振幅较小,HE染色显示骨髓内脂肪细胞增多,弥漫分布,体积增大。结论临床商用3.0 T磁共振扫描仪行~1H-MRS检查测定FF值评估大鼠椎体骨髓脂肪含量具备可行性。     

腰椎脂肪定量MR （IDEAL-IQ）技术在骨质疏松症中的应用

目的 初步研究MR（IDEAL-IQ）技术测量的腰椎椎体骨髓脂肪分数（FF）在骨质疏松症临床诊断中的应用价值。方法 收集2018年6月至2018年11月在我院同时行腰椎脂肪定量MR检查与双能X线骨密度检查的患者,测量椎体（L1~4）脂肪分数和骨密度(常规用T值),进行Spearman相关分析。根据T值,将患者分为骨量正常组、骨量减少组和骨质疏松组。用单因素方差分析FF值在3组间的差异,用Mann-Whitney非参数检验分析每两组间差异,最后基于受试者工作特征曲线（ROC曲线）分析FF值对骨质疏松症的诊断效能。结果 总共收集病例55例,其中47例纳入数据分析。脂肪分数（FF）与骨密度值呈负相关（r= –0.66,P<0.05）,随着椎体骨密度的增高,脂肪分数降低。骨质疏松组与其他两组之间差异均有统计学意义（P<0.05）,骨量减少组与正常组之间的P值为0.1,差异没有统计学意义,ROC曲线下面积（AUC）为0.79,选择阈值48.05%来诊断骨质疏松症,灵敏度为0.871,特异性为0.625。结论 MR IDEAL-IQ技术通过快速精准评估腰椎椎体骨髓脂肪含量的变化,能够为骨质疏松症的诊断提供有价值的信息。     

非梗阻性无精子症患者睾丸体积、生殖激素水平与睾丸穿刺取精结果的相关性研究

目的:探讨非梗阻性无精子症患者睾丸体积、生殖激素水平与睾丸穿刺取精术(TESA)结果的相关性,以及可用于预测TESA结果的睾丸体积、生殖激素水平的切点值,从而为非梗阻性无精子症患者进一步诊疗提供重要资料。方法:121例研究对象均为非梗阻性无精子症患者(NOA),测定其睾丸体积和生殖激素水平,并根据TESA结果分为无精子组和有精子组。结果:无精子组和有精子组的左侧睾丸体积(ml)、右侧睾丸体积(ml)、泌乳素(PRL,ng/ml)、卵泡刺激素(FSH,mIU/ml)、黄体生成素(LH,mIU/ml)、雌二醇(E2,pmol/L)、血清总睾酮(TT,nmol/L)水平分别为7.07±1.06和11.75±1.38、7.37±1.37和11.70±1.98、12.43±11.69和9.60±4.55、15.77±10.84和8.01±7.43、6.12±2.92和8.11±20.11、119.36±43.52和141.12±48.33、11.43±4.05和12.46±4.60。无精子组血清FSH和PRL水平平均值高于有精子组,并且有显著的统计学差异。虽然无精子组的睾丸体积平均数小于有精子组,但两组之间没有统计学差异。对于年龄、血清E2和TT水平,两组之间也没有统计学差异。利用ROC曲线优选的睾丸体积切点值为9 ml,此点其敏感性为93.8%/89.6%(左/右),特异性为100%/94.3%(左/右),睾丸体积ROC曲线的AUC为0.984/0.961(左/右),表明其诊断准确性较高;优选的血清FSH水平切点值为8.18 mIU/ml,此点其敏感性为71.2%,特异性为75.0%,FSH水平ROC曲线的AUC为0.743,表明其诊断准确性中等。结论:睾丸体积和FSH水平对于预测NOA患者TESA结果具有重要意义,并且睾丸体积诊断准确性明显优于FSH。     

骨密度和25羟维生素D在骨质疏松性髋部骨折的作用

目的 在股骨颈骨密度达到骨质疏松阈值的情况下,比较髋部骨折与无髋部骨折患者的年龄、骨密度和25羟维生素 D,了解这些因素对髋部骨折的影响。方法 对137例骨密度达到骨质疏松阈值的绝经后女性患者进行研究,无髋部骨折组 62例,髋部骨折组75例,检测股骨颈骨密度和血清25羟维生素D,比较二组年龄、股骨颈骨密度和25羟维生素D水平。结果 无髋部骨折组：年龄：（67. 92 ±8. 52)岁,股骨颈骨密度：（0. 5064 ±0. 0706)g/cm2,T 值：-3. 10 ±0. 60,25OHD： (24. 90 ± 8. 98)ng/ml。髋部骨折组：年龄：（78. 49 ± 8. 52)岁,股骨颈骨密度：（0. 4506 ± 0. 0983 ) g/cm2,T 值：-3. 51 ± 1. 18, 25OHD： (l4.89±8.94)ng/ml。结论 在股骨颈骨密度达到骨质疏松阈值的情况下,髋部骨折患者具有更高年龄,更低骨密度和25羟 维生素D。     

肝脏脂肪含量MRI定量诊断与病理对照研究

目的探讨频率饱和反转恢复序列(spectral saturation inversion recovery,SPIR)、梯度回波化学位移MRI及磁共振氢谱(proton magnetic resonance spectroscopy,1H-MRS)在定量分析肝脏脂肪含量中的价值。方法对31例健康自愿者及22例可获得肝脏标本的病例行常规T1加权和T2加权(不压脂+压脂)、梯度回波T1加权同相位/反相位(in-phase/opposed-phase,IP/OP)成像及肝脏1H-MRS检查。测得T1WI和T2WI压脂前、后及IP/OP的信号强度值(SInonfat1、SIfat1、SInonfat2、SIfat2、SIin及SIout),计算相对信号强度(relative signal intensity,RSI1及RSI2)和脂变指数(fat index,FI);测得1H-MRS的峰值及峰下面积,计算肝细胞相对脂肪含量(relative lipid con-tent,RLC)。病例组22例患者于MRI扫描后接受肝脏外科手术切除,切下的肝脏进行病理组织学检查,并用图像分析软件测量肝细胞中脂变细胞百分比(proportion of fatty degenerative cells,PFDC)。结果①脂肪肝组RSI1、FI及RLC的平均值均高于非脂肪肝组(P<0.05),但RSI2的平均值2组间差异无统计学意义(P>0.05)。②脂肪肝不同病理分级间RLC的差异具有统计学意义,且随脂肪肝病理级别的增加而增高(P<0.05);随着病理级别的增加,RSI1及FI逐渐增高,但差异无统计学意义(P>0.05);RSI2在脂肪肝不同病理分级间的差异亦无统计学意义(P>0.05)。③FI及RLC与PFDC之间存在线性正相关关系(r=0.468,P=0.027;r=0.771,P<0.000 1);RSI1及RSI2与PFDC之间无相关性(r=0.411,P=0.057;r=0.191,P=0.392)。结论 SPIR、梯度回波化学位移MRI及1H-MRS三种方法可在一定程度上区分有无脂肪肝;1H-MRS有助于脂肪肝的分级;在肝脏脂肪含量定量分析方面,1H-MRS较梯度回波化学位移MRI更具优越性,有助与肝脏脂肪的量化分析;而SPIR价值有限。     

腰椎体积CT值对诊断骨质疏松症的应用价值

目的 评估基于双层光谱CT腰椎扫描获得的椎体体积HU值在骨质疏松诊断中的应用价值。方法 回顾性收集2022年10月至2023年3月北京积水潭医院脊柱外科门诊患者91例。所有患者均接受过腰椎双层光谱CT扫描,包括QCT。同时测量纳入患者L1和L2椎体的体积HU值和基于QCT扫描的体积骨密度值。依据腰椎QCT骨密度诊断骨质疏松症的标准将研究对象分为骨量正常组、低骨量组和骨质疏松组,比较3组患者的一般情况,分析体积HU值与QCT测量的体积骨密度的关系。使用ROC曲线分别计算体积HU值诊断骨量减少和骨质疏松最佳诊断阈值以及使用逻辑回归模型确定性别、年龄和体积HU值与骨质疏松发生的关系。结果 L1和L2的平均体积HU值与QCT测量的BMD之间有极好的相关性（r= 0.941, P<0.001）;ROC诊断骨量减少和骨质疏松的最佳阈值分别为154.73 HU（灵敏度为92.9 %）和106.52 HU（灵敏度为86.6 %）;年龄和基于双层光谱CT测量的体积HU值与骨质疏松的发生显著相关（P<0.001）,OR值分别为1.172和0.928。结论 基于双层光谱CT测量的体积HU值和QCT测量的体积BMD之间有较好的相关性;基于腰椎体积HU值的阈值能准确预测骨量异常减低和骨质疏松,因此,体积HU值可以作为临床机会性筛查骨质疏松的补充手段。     

Magnetic resonance imaging and magnetic resonance spectroscopic imaging of prostate cancer

Magnetic resonance imaging (MRI) and magnetic resonance spectroscopic imaging (MRSI) are evolving techniques that offer noninvasive evaluation of anatomic and metabolic features of prostate cancer. The ability of MRI to determine the location and extent of the tumor and to identify metastatic spread is useful in the pretreatment setting, enabling treatment decision-making that is evidence-based. MRSI of the prostate gland expands the diagnostic assessment of prostate cancer through the detection of cellular metabolites, and can lead to noninvasive differentiation of cancer from healthy tissue. MRI/MRSI can also be used to evaluate both local and systemic recurrence, with endorectal MRI being capable of detecting local recurrence, even in patients with rising serum PSA level but no palpable tumor on digital rectal examination. Considering the benefits that MRI and MRSI have been shown to offer patients, the skills and technology required to perform these tests should be widely disseminated to make their routine use possible. Teamwork between members of radiology, pathology, urology and radiation oncology departments is essential in order to exploit these technologies fully.     

Assessment of bone mineral and matrix using backscatter electron imaging and FTIR imaging

The resistance of bone to fracture is determined by its geometric and material properties. The geometry and density can be determined by radiographic methods, but material properties such as collagen structure, mineral composition, and crystal structure currently require analysis by invasive techniques. Backscatter electron imaging provides quantitative information on the distribution of the mineral within tissue sections, and infrared and other vibrational spectroscopic methods can supplement these data, providing site-specific information on mineral content as well as information on collagen maturity and distributions of crystal size and composition. This information contributes to the knowledge of “bone quality.”     

Adrenal imaging. Computed tomographic scanning and magnetic resonance imaging

On the basis of this review and others, adrenal imaging using MRI requires functional biochemical data, such as scintigraphy (NP-59 and MIBG), for cortical adrenal assessment. For medullary hyperfunction such as intra-adrenal pheochromocytomas and neuroblastomas, MRI provides excellent staging and localization. Computed tomography is preferred for biochemically established hyperfunction such as Cushing's and Conn's syndromes.     

Burn depth assessments by photoacoustic imaging and laser Doppler imaging

Diagnosis of burn depths is crucial to determine the treatment plan for severe burn patients. However, an objective method for burn depth assessment has yet to be established, although a commercial laser Doppler imaging (LDI) system is used limitedly. We previously proposed burn depth assessment based on photoacoustic imaging (PAI), in which thermoelastic waves originating from blood under the burned tissue are detected, and we showed the validity of the method by experiments using rat models with three different burn depths: superficial dermal burn, deep dermal burn and deep burn. On the basis of those results, we recently developed a real‐time PAI system for clinical burn diagnosis. Before starting a clinical trial, however, there is a need to reveal more detailed diagnostic characteristics, such as linearity and error, of the PAI system as well as to compare its characteristics with those of an LDI system. In this study, we prepared rat models with burns induced at six different temperatures from 70 to 98 °C, which showed a linear dependence of injury depth on the temperature. Using these models, we examined correlations of signals obtained by PAI and LDI with histologically determined injury depths and burn induction temperatures at 48 hours postburn. We found that the burn depths indicated by PAI were highly correlative with histologically determined injury depths (depths of viable vessels) as well as with burn induction temperatures. Perfusion values measured by LDI were less correlative with these parameters, especially for burns induced at higher temperatures, being attributable to the limited detectable depth for light involving a Doppler shift in tissue. In addition, the measurement errors in PAI were smaller than those in LDI. On the basis of these results, we will be able to start clinical studies using the present PAI system.     

Breast pain and imaging

Breast pain is a common reason for consultation and a source of anxiety for patients. Cyclical breast pain can be distinguished from non-cyclical pain and breast pain with other symptoms. Many causes, usually benign are possible and the clinical enquiry and physical examination are essential to establish predisposing factors. Although imaging is not always needed for isolated breast pain, it is still useful for the diagnosis of specific causes such as tension cysts, giant adenofibromas or Mondor's thrombophlebitis. Ultrasound is the first line investigation before mammography, MRI or biopsy, which may be indicated for suspicious abnormalities. Some cancers may be associated with pain, which implies that radiologists and physicians should always take breast pain seriously.     

Modern imaging and stereotaxy

The authors present their technique of utilization in stereotaxic neurosurgery of CT and IRM documents realized in standard condition. Besides, they present an original apparatus that allows to combine the advantages of Leksell and Talairach's stereotaxic system.     

Clinical investigation and imaging

Adolescent idiopathic scoliosis (AIS) affects 2–4 % of children and is diagnosed between age 10 and skeletal maturity. The female to male ratio for mild curves less than 20° is 1.5:1; however, progression to a severe deformity occurs more often in females (Weinstein in JAMA 289(5):559–567, 2003). Despite significant ongoing research, including into the genetic basis for AIS, there are currently no identifiable causes, and therefore the disorder still remains a diagnosis of exclusion. History, physical examination and radiographic assessment must exclude other possible causes of spinal deformity and are crucial in predicting the risk of curve progression. History should focus on family history, menarche, presence or absence of pain, sports activities and neurologic changes. Physical examination concentrates on anthropometric data, pubertal staging, neurologic testing and specific investigation of the spine, with the Adams’ forward bending test being the most meaningful step to evaluate trunk rotation. Definitive diagnosis cannot be made without imaging. The gold standard remains plain radiography with assessment of the Cobb angle on a standing coronal radiograph of the entire spine. A lateral X-ray is used for assessing sagittal balance and for evaluating the deformity in the sagittal plane. If available, surface topography can accompany the follow-up in AIS, reducing the radiation exposure. The role of magnetic resonance imaging (MRI) in AIS is an ongoing matter of debate. Common indications for MRI are the presence of an atypical curve pattern and abnormal neurological findings.     

Diagnosis and imaging of ankle instability

Ankle instability is a major cause of symptoms following an ankle sprain. With a thorough history and examination, appropriate additional investigations, including cross-sectional imaging, and thoughtful interpretation of the information, one should rarely be caught out by misdiagnosis, multiple diagnoses, or unusual causes.