肺结核和肺癌影像诊断进展

随着CT技术的进一步发展。尤其是高分辨力CT（High-Resolution CT，HRCT）应用于临床以来．不仅对周围肺野疾患的显示更加清楚。而且使得原来在常规CT影像上不能显示的肺部正常结构-“肺小叶”结构影像在一定程度上也能得到比较正确的认识与理解。因此，CT尤其是HRCT作为一种新的影像技术，可以较准确地、全面地反映肺结核病变的病理解剖特点。通过病理与CT影像的关联性研究，对肺结核和肺癌的影像认识也进一步深化。同时随着新诊断技术的不断推出，对肺结核和肺癌的诊断与鉴别，不仅丰富了基础理论、     

早期胰头癌的CT诊断

胰腺癌是胰腺常见的恶性肿瘤，胰头则是胰腺癌的好发部位。既往由于认识不足及受影像设备的限制。加之胰腺本身位置深，发生病变时症状出现较晚等因素，使胰腺癌的早期诊断甚为困难。待患者出现明显症状，临床上发现胰头发生癌肿，大多已为中晚期，难以手术切除。近年来，随着对早期胰腺癌研究的深入及影像技术的发展，尤其是螺旋CT的应     

胰腺癌基国诊断研究进展

胰腺癌是人类恶性程度较高的肿瘤之一,目前常规的诊断技术难以早期发现.同所有肿瘤一样,胰腺癌的发生、发展是多种基因表达异常的结果.基因诊断是胰腺癌早期诊断的发展方向,尤其是基因芯片技术的应用,可快速检测胰腺癌细胞全部基因表达情况,为胰腺癌的早期诊断展现了新的曙光.     

内镜超声在早期胰腺癌诊断中的作用

胰腺癌具有高侵袭性,且缺乏典型的早期症状,大多数患者诊断时已失去最佳治疗时间,胰腺癌的早期诊断、早期治疗尤为重要。目前临床上常用的CT、MRI等影像学检查对早期胰腺癌诊断的敏感度低,而内镜超声的高分辨率使其成为早期胰腺癌最敏感的检测手段,内镜超声下谐波造影增强、弹性成像、细针抽吸术以及液体活检等技术进一步提高了早期胰腺癌的诊断能力。     

蛋白质芯片在胰腺癌研究中的应用现状

胰腺癌是一种进展迅速的恶性肿瘤.临床迫切需要寻找胰腺癌的早期诊断标志物和发现新的治疗靶点.蛋白质芯片技术的发展,带来了很多机遇和挑战.此文对蛋白质芯片在胰腺癌中的应用现状作一综述,包括早期诊断、肿瘤标志物、治疗靶点及良恶性胰腺疾病的鉴别等.     

影像技术在诊断非酒精性脂肪性肝病中的应用

非酒精性脂肪性肝病是一种与胰岛素抵抗和遗传易感性相关的代谢应激性肝疾病。其疾病谱包括:非酒精性单纯性脂肪肝、非酒精性脂肪性肝炎和其相关的肝硬化和肝细胞癌。该病起病隐匿,具有进展为肝纤维化、肝细胞癌倾向,因而早期诊断、早期治疗具有重要意义。目前肝活检仍是该病诊断的"金标准",但因其具有显著创伤性且价格较贵难以普及。普通的影像诊断技术如超声、CT、MRI等,仅对该病定性诊断有一定价值,但不能作出相应定量诊断,无法满足临床需求。随着影像和相关软件技术的进一步发展,使得定量诊断非酒精性脂肪性肝病成为可能。本文就影像技术诊断非酒精性脂肪性肝病的进展予以概述。     

周围型肺癌早期影像诊断方法研究

在我国,肺癌的发病率呈逐渐增高趋势,中国预防科学院公布,在今后30年肺癌将成为中国居民的主要死因,因此肺癌的早期诊断依然是胸部影像检查的重点和难点。中央型肺癌的早期诊断由CT检查漏诊病例较常见。临床诊断主要依赖于支气管镜及痰细胞学检查。本仅针对周围型肺癌的早期影像诊断方法加以详述。     

胰腺癌早期诊断与治疗的研究进展

胰腺癌的发病率不断升高,早期诊断困难,临床治疗效果差,是目前预后最差的恶性肿瘤. 遗传因素和环境因素在胰腺癌的发生中具有重要作用,胰腺上皮内瘤变(pancreatic intraepithelial neoplasia,PanIN) 是胰腺癌的癌前病变. CT 、MRI 、超声内镜、ERCP 和血清标志物检测为胰腺癌诊断提供了有效手段,手术与辅助化疗、放疗以及分子靶向治疗等综合治疗有望改善胰腺癌患者的预后. 建立灵敏高效的预警和早期诊断体系,加强多学科合作开展综合治疗,是提高胰腺癌临床诊疗水平的主要途径.     

三维CT重建影像技术在胫骨平台骨折诊断中的应用价值分析

目的 研讨胫骨平台骨折诊断中运用三维CT重建影像技术的价值.方法 采用回顾性分析方式,对我院2015年1月-2019年10月接受诊疗的30例胫骨平台骨折患者临床资料进行分析,分别运用三维CT重建影像技术及X线检查,评估标准为手术分型结果 ,诊断结果 分别纳入实验组及对照组.结果 对比对照组,实验组诊断准确率明显更高,统计学表达存在明显差异(P<0.05).结论 胫骨平台骨折诊断中运用三维CT重建影像技术,价值较高,提高了诊断准确率.     

CT仿真内窥镜在喉癌诊断中的应用

CT扫描诊断喉癌病变有重要价值，但其对咽喉管腔表面病变形态及范围不能做出直观描述。CT仿真内窥镜（CTVE）是一种非侵袭检查方法，可获得纤维内窥镜样管腔内表面影像的成像技术。近年来，我们将CT横断面影像与CTVE影像技术用于喉癌诊断。现报告如下。     

Advances in imaging for pancreatic disease

Pancreatic imaging is an essential tool in the early diagnosis and staging of pancreatic disease. This review analyzes the most recent advances in pancreatic imaging. The specific modalities discussed include helical computed tomography (HCT) and multislice CT (MSCT), CT angiography, magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and positron emission tomography (PET). At present, MSCT is generally viewed as the most efficient modality for initial detection and staging of pancreatic carcinoma, with an accuracy rate of about 95% to 97% for initial detection and virtually 100% for staging. CT is also the initial imaging modality used in evaluation of acute pancreatitis. However, recently, MRI has been viewed increasingly as a more precise diagnostic tool in this subgroup of patients. MRCP has been accepted as the primary imaging technique in the diagnosis of chronic pancreatitis. PET imaging, on the other hand, has an increasing role in the staging of pancreatic carcinoma, for which it may be the modality of choice in detection of extrapancreatic metastasis.     

Imaging diagnosis of pancreatic cancer:A state-of-the-art review

Pancreatic cancer(PC)remains one of the deadliest cancers worldwide,and has a poor,five-year survival rate of 5%.Although complete surgical resection is the only curative therapy for pancreatic cancer,less than20%of newly-diagnosed patients undergo surgical resection with a curative intent.Due to the lack of early symptoms and the tendency of pancreatic adenocarcinoma to invade adjacent structures or to metastasize at an early stage,many patients with pancreatic cancer already have advanced disease at the time of their diagnosis and,therefore,there is a high mortality rate.To improve the patient survival rate,early detection of PC is critical.The diagnosis of PC relies on computed tomography(CT)and/or magnetic resonance imaging(MRI)with magnetic resonance cholangiopancreatography(MRCP),or biopsy or fine-needle aspiration using endoscopic ultrasound(EUS).Although multi-detector row computed tomography currently has a major role in the evaluation of PC,MRI with MRCP facilitates better detection of tumors at an early stage by allowing a comprehensive analysis of the morphological changes of the pancreas parenchyma and pancreatic duct.The diagnosis could be improved using positron emission tomography techniques in special conditions in which CT and EUS are not completely diagnostic.It is essential for clinicians to understand the advantages and disadvantages of the various pancreatic imaging modalities in order to be able to make optimal treatment and management decisions.Our study investigates the current role and innovative techniques of pancreatic imaging focused on the detection of pancreatic cancer.     

The role of EUS in relation to other imaging modalities in the differential diagnosis between mass forming chronic pancreatitis, autoimmune pancreatitis and ductal pancreatic adenocarcinoma

Differential diagnosis of solid pancreatic lesions remains as an important clinical challenge, mainly for the differentiation between mass forming chronic pancreatitis, autoimmune pancreatitis and pancreatic adenocarcinoma. Endoscopic ultrasound (EUS), computed tomography (CT) and magnetic resonance imaging (MRI) can all provide valuable and complementary information in this setting. Among them, EUS has the unique ability to obtain specimens for histopathological diagnosis and can therefore play a crucial role in the evaluation patients with inconclusive findings on initial examinations. Nowadays, new developed techniques associated to EUS, like elastography and contrast enhancement, have shown promising results for the differential diagnosis of these pancreatic lesions.     

Prognostication and response assessment in liver and pancreatic tumors:The new imaging

Diffusion-weighted imaging(DWI), dynamic contrastenhanced magnetic resonance imaging(DCE-MRI) and perfusion computed tomography(CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations.Nevertheless, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography(PET)CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging,therefore these techniques could be used also for posttreatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart frommolecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations,prognostic stratification and post-treatment monitoring.     

Pancreatic tumors: role of imaging in the diagnosis,staging, and treatment

Because most patients with pancreatic cancer present with biliary obstruction, percutaneous transhepatic cholangiopancreatography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP) is often performed first to relieve obstruction. Fine needle biopsy (FNA) provides a tissue diagnosis, but is often nondiagnostic due to sampling error. Computed tomography (CT) is the workhorse of oncology, but is poor at defining the nature of pancreatic lesions. Small primary tumors are often not visualized. Fast magnetic resonance imaging (MRI) techniques allowing dynamic imaging after IV gadolinium and new contrast agents allow better characterization of the lesions for patients having contraindications for IV CT contrast agents. Magnetic resonance cholangiopancreatography (MRCP) allows noninvasive visualization of the biliary tree. Endoscopic ultrasonography (EUS) allows evaluation of the detailed regional anatomy with the possibility of FNA. ¹⁸F-Fluorodexoglucose (FDG) is the most common tracer used in positron emission tomography (PET), and most malignant tumors, including pancreatic carcinoma, have increased FDG uptake compared with normal cells. This functional imaging does not replace but is complementary to morphological imaging. FDG PET is particularly helpful: (1) for the diagnosis in patients with suspected pancreatic cancer in whom CT fails to identify a mass, or those in whom FNAs are nondiagnostic; (2) for staging by detecting CT-occult metastases; (3) for detecting recurrence; and (4) for monitoring therapy. Limitations include false-positive inflammatory processes and false-negative carcinoma in patients with diabetes and hyperglycemia, and islet cell tumors.     

Diagnosis of pancreatic cancer

The ability to diagnose pancreatic carcinoma has been rapidly improving with the recent advances in diagnostic techniques such as contrast-enhanced Doppler ultrasound (US), helical computed tomography (CT), enhanced magnetic resonance imaging (MRI), and endoscopic US (EUS). Each technique has advantages and limitations, making the selection of the proper diagnostic technique, in terms of purpose and characteristics, especially important. Abdominal US is the modality often used first to identify a cause of abdominal pain or jaundice, while the accuracy of conventional US for diagnosing pancreatic tumors is only 50-70%. CT is the most widely used imaging examination for the detection and staging of pancreatic carcinoma. Pancreatic adenocarcinoma is generally depicted as a hypoattenuating area on contrast-enhanced CT. The reported sensitivity of helical CT in revealing pancreatic carcinoma is high, ranging between 89% and 97%. Multi-detector-row (MD) CT may offer an improvement in the early detection and accurate staging of pancreatic carcinoma. It should be taken into consideration that some pancreatic adenocarcinomas are depicted as isoattenuating and that pancreatitis accompanied by pancreatic adenocarcinoma might occasionally result in the overestimation of staging. T1-weighted spin-echo images with fat suppression and dynamic gradient-echo MR images enhanced with gadolinium have been reported to be superior to helical CT for detecting small lesions. However, chronic pancreatitis and pancreatic carcinoma are not distinguished on the basis of degree and time of enhancement on dynamic gadolinium-enhanced MRI. EUS is superior to spiral CT and MRI in the detection of small tumors, and can also localize lymph node metastases or vascular tumor infiltration with high sensitivity. EUS-guided fine-needle aspiration biopsy is a safe and highly accurate method for tissue diagnosis of patients with suspected pancreatic carcinoma. (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been suggested as a promising modality for noninvasive differentiation between benign and malignant lesions. Previous studies reported the sensitivity and specificity of FDG-PET for detecting malignant pancreatic tumors as being 71-100% and 64-90%, respectively. FDG-PET does not replace, but is complementary to morphologic imaging, and therefore, in doubtful cases, the method must be combined with other imaging modalities.     

Diagnostic imaging for pancreatic cancer: computed tomography, magnetic resonance imaging, and positron emission tomography

Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) are sophisticated modalities typically used in the second-line diagnosis following routine clinical practice. Among them, CT is regarded as the standard imaging in diagnosing pancreatic cancer at present in Japan due to its popularity and reasonable reliability in wide-ranging diagnostic ability. However, even with multidetector row CT (MDCT), the demonstration of pancreatic cancer less than 1 cm in size remains nearly impossible. CT staging is considered accurate in one-half to two-thirds of patients, but limitations in the imaging of peripancreatic microinvasion and nodal or hepatic micrometastases still have a tendency to underestimate tumor extension. With recent advancement in imaging techniques, MRI has proven to be equal or superior to other imaging modalities in diagnosing pancreatic cancer. Most of all, it is expected that MRCP will become as effective an instrument as ultra-sonography (US) in the screening of pancreatic cancer. Functional imaging with PET using the glucose analog FDG can be used in the diagnosis of pancreatic cancer, but systemic or local disturbance of glucose metabolism may result in an incorrect diagnosis. The usefulness of PET is now considered in assessing tumor viability, monitoring tumor response to treatment, and detecting distant metastases.     

A multispecialty approach to the diagnosis and management of pancreatic cancer

This article reviews recent developments in pancreatic cancer research and offers a multispecialty perspective on the diagnosis and management of this challenging disease. Current findings in the molecular biology of the disease and their implications for management are examined, as well as development in diagnostic techniques, including helical computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangio-pancreatography (MRCP), and, particularly, endoscopic ultrasound-guided fine-needle aspiration. Surgical management, the role of adjuvant/neoadjuvant chemoradiation therapy, and the critical importance of accurate preoperative imaging are also addressed in this review. Palliative techniques, including endoscopic stenting for malignant obstructive jaundice and chemotherapy for locally advanced and metastatic disease, are discussed, and results of recent clinical trials in pancreatic cancer are summarized. Finally, future directions for research are identified.     

Diagnosis and management of rheumatoid arthritis; What is the current role of established and new imaging techniques in clinical practice?

Ultrasound and magnetic resonance imaging (MRI) have become established imaging techniques for the management of rheumatoid arthritis. Several publications have pointed out the advantages of these techniques for a more complete evaluation of the inflammation and structural damage at joint level. Recently new imaging techniques as the positron emission tomography (PET) associated with computed tomography (CT) or MRI scan, and the optical imaging have been introduced in the panorama. This article presents the advantages and limitations of each imaging techniques in light with the recent publications.     

Agenesis of the dorsal pancreas

Developmental anomalies of the pancreas have been reported but dorsal pancreatic agenesis is an extremely rare entity. We report an asymptomatic 62-year-old woman with complete agenesis of the dorsal pancreas. Abdominal computed tomography （CT） revealed a normal pancreatic head, but pancreatic body and tail were not visualized. Magnetic resonance imaging （MRI） findings were similar to CT. At magnetic resonance cholangiopancreatography （MRCP）, the major pancreatic duct was short and the dorsal pancreatic duct was not visualized. The final diagnosis was dorsal pancreatic agenesis.