PET/CT诊断乳腺癌及腋窝淋巴结状态的作用评价

目的：评价PET／CT诊断乳腺癌和腋窝淋巴结转移的临床价值。方法：对33例疑似乳腺癌病人进行PET／CT检查，定性分析肿瘤病灶、淋巴结摄取氟脱氧葡萄糖（FDG）的程度，半定量测量标准摄取值（SUV），根据乳腺和淋巴结的FDG摄取强度诊断乳腺癌和淋巴结转移，检验SUV与乳腺癌分化程度、有丝分裂计数的关联性。结果：PET／CT诊断乳腺癌和腋窝淋巴结转移的敏感度、特异度和精确度分别为92．6％、100％、93．9％和82．3％、90％、85．2％；SUV与乳腺癌分化程度、有丝分裂计数显著相关（P〈0．05）；诊断乳腺癌的Kappa指数=0．835，μ=8．48，（P〈0．01）。结论：PET／CT诊断乳腺癌和腋窝淋巴结转移的敏感度、特异度较高，作为一种非侵袭性检查方法，可提供乳腺癌在活体内的多方面生物学信息，为选择合理的手术方式及新辅助化疗提供参考，弥补传统检查方法的不足。     

45岁以上女性乳腺癌数字化X线成像筛查结果的分析

女性乳腺癌可通过人群筛查获得早期诊断，从而提高患者生存质量并明显降低死亡率。筛查的主要手段是乳腺检查及乳腺X线成像检查。在欧美定期的乳腺X线成像筛查已获得了广泛的肯定，国内近年也开始重视对乳腺癌的筛查工作。本研究报道了一个特定小样本人群的乳腺癌X线筛查结果，希望对国内开展这方面工作提供一些初步的经验。     

胰腺内分泌肿瘤术前影像学定位诊断方法的选择

目的:评估经腹部超声(TAUS)、内镜超声(EUS)、CT、MR、选择性血管造影(SAG)及动脉钙刺激静脉采血测定胰岛素(ASVS)在胰腺内分泌肿瘤(PET)术前定位中的价值。方法:对65例经手术及病理证实的PET的术前影像学检查资料进行回顾性分析,比较不同检查方法对PET的定位结果,并探讨PET的影像学表现和特点。结果:各种检查方法术前定位的敏感性和准确性分别为:TAUS为47.4%和41.5%,EUS为90.0%和75.0%,CT为86.9%和82.8%,MR为85.7%和77.4%,SAG为16.7%和16.7%及ASVS为83.3%和83.3%。结论:PET的术前影像学检查方法的选择应从易到难,先行非侵入性的TAUS、MSCT或MR检查;如仍为阴性,则考虑EUS或ASVS;最后为手术探查及术中超声检查。     

乳腺癌的MRI和X线钼靶摄影对照研究

乳腺癌是妇女最常见的恶性肿瘤之一，发病率逐年上升，平均年增长率为2．3％。乳腺癌的5年生存率在原位癌为100％，Ⅰ期为84％～100％，Ⅱ期为76％～87％，Ⅲ期为38％～77％。因此，早期诊断有重要的临床意义。乳腺X线摄影是常规检查手段，但有其相应的局限性；乳腺核磁共振（MRI）近年来应用较多，本研究就两种检查手段对乳腺癌的诊断价值作对照分析。     

MRI对小乳腺癌的诊断价值

目的:探讨MRI对小乳腺癌的诊断价值。方法:2008年6月至2009年6月间经临床怀疑为小乳腺癌(直径≤2 cm)而行MRI检查,MRI诊断结果按乳腺影像报告及数据系统(breast imaging reporting and data system,BI-RADS)分类为Ⅲ类、Ⅳ类及Ⅴ类者共62例。其中31例近期(1周内)接受了乳腺X线摄影检查(mammography,MG),并按BI-RADS分类法进行分类。所有病例均经病理学证实,比较MRI及MG两种检查方法对小乳腺癌的检出率、灵敏度、阳性预测值的差异。结果:所有62例乳腺小病灶中经病理证实为乳腺癌者50例,31例行MG检查的病例中小乳腺癌为21例,MRI对小乳腺癌的检出率、灵敏度均高于MG,分别为100%比85.7%和94.0%比61.9%(P<0.05)。结论:MRI对小乳腺癌的检出率和灵敏度优于MG。     

MRI诊断转移性骨肿瘤

目的探讨常规MR检查及类PET成像技术诊断转移性骨肿瘤的价值。方法对30例转移性骨肿瘤患者进行MR检查,其中25例接受CT检查,17例接受X线检查,对检查结果进行对比分析。行常规MR T1W/T2W序列及DWI成像后,通过三维图像重组、黑白翻转技术获得类PET图像。结果 MRI对30例患者（30/30,100%）均做出正确诊断,诊断准确率高于CT平扫（21/25,84.00%）及X线平片（12/17,70.59%,P均〈0.05）。结论常规MR检查及类PET成像技术可以提高对转移性骨肿瘤的准确诊断率。     

正确认识MRI的乳腺癌诊断价值

2013年美国放射学院发行了第5版乳腺影像报告与数据系统,规范了乳腺影像报告的书写。随着乳腺癌综合治疗的个体化、规范化的逐步推广,乳腺MRI在乳腺癌诊疗中应用越来越普遍。从乳腺MRI报告的标准化到应用于高危人群筛查、癌症分期、疗效评估、观察术后残留和评估假体,正确认识乳腺MRI的标准化报告模式和临床中的应用,有助于优化病人的影像学检查,继而使其受益。     

一体化PET/MR应用进展

一体化PET/MR具有PET功能成像和MR精准定位及多参数成像的优势。随着图像重建、衰减矫正及伪影控制技术的提高,一体化PET/MR扫描时间逐步缩短,辐射剂量降低,在临床及科研中的应用领域进一步拓宽。本文对一体化PET/MR的应用进展进行综述。     

乳腺癌中腋淋巴结的分期:正电子发射断层摄影(PET)的评估价值

女性乳腺癌中，腋淋巴结状态是最重要的预后因素，凡有受侵者提示隐匿性转移灶的存在，并需要辅助治疗的应用。唯一可靠的信息仅依靠胶部清扫。现可用’‘氟一荧光一2一脱氧一D一葡萄糖（‘丫一FDG）作PET检查，由于癌细胞具有较高的糖酵解率，‘SF－FDG－PET可显示原发乳腺癌和转移病灶。作者对50例乳腺癌病人进行了术前PET检查，检查前禁食至少6小时以标准化血糖值，在双盲情况下由有经验的影像学家确定PET的结果。在PET检查前2周完成体检，明确有无可们及的腋淋巴结，并在PET检查后1周内作细针穿刺细胞学检查或腋淋巴结解剖。…     

超声与钼靶摄片对乳腺癌早期诊断的意义

目的： 评估超声与钼靶摄片检查在乳腺癌早期诊断中的作用,以提高乳腺癌的早期筛查效率。 方法：收集乳腺癌早期诊断的女性患者528例临床资料,其中经B超查出隐匿性乳腺癌132例,经钼靶摄片查出乳癌病灶396例。比较两种检查方式获得初步诊断的乳腺癌患者的临床与影像学特征、手术方式与组织病理学特征、分子生物学标志物与分型的差异。 结果：两者比较显示,绝经前、年青、汉族（相对维吾尔族）女性及致密乳房组织和影像学BI-RADS 4级的乳腺癌超声检查较钼靶摄片更易检出（均P<0.05）;超声检查较钼靶摄片检出的患者更多实行保乳手术,且淋巴结转移阳性率较低,更易发现单发、直径≤1 cm、分化较好的乳腺癌及早期阶段的浸润性乳腺癌（均P<0.05）;超声检查对ER（+）、luminal A乳腺癌检出率高,而钼靶摄片对Her-2（+）、Her-2型乳腺癌检出率高（均P<0.05）。 结论：超声检查较钼钯摄片更容易发现致密乳房组织中的侵袭性与恶性程度较低的早期癌灶,对于检出不同分子分型的早期乳腺癌两者各有优势。故联合应用更利于乳腺癌患者早期筛查。     

Molecular Imaging in Breast Cancer - Potential Future Aspects

SUMMARY: Molecular imaging aims to visualize and quantify biological, physiological, and pathological processes at cellular and molecular levels. Recently, molecular imaging has been introduced into breast cancer imaging. In this review, we will present a survey of the molecular imaging techniques that are either clinically available or are being introduced into clinical imaging. We will discuss nuclear imaging and multiparametric magnetic resonance imaging as well as the combined application of molecular imaging in the assessment of breast lesions. In addition, we will briefly discuss other evolving molecular imaging techniques, such as phosphorus magnetic resonance spectroscopic imaging and sodium imaging.     

对比能谱CT碘图与单能量图对微小肺动脉栓子的检出效能

目的对比观察碘图与单能量图对微小肺动脉栓子的检出效能。方法回顾性分析62例接受双能CT肺动脉造影的肺动脉栓塞患者,比较碘图与单能量图对1~4级肺动脉栓子及5~7级肺动脉栓子的检出情况,比较2种图像均能显示的肺动脉栓子径线。结果62例中,碘图共发现50个1~4级肺动脉栓子,单能量图发现48个(P>0.05);碘图共发现47个5~7级肺动脉栓子,多于单能量图的35个(P<0.05)。83个栓子碘图与单能量图均明确显示,碘图显示栓子径线(1.77±1.00)cm,大于单能量图所示的(1.53±0.97)cm(P<0.001)。结论能谱CT碘图对微小肺动脉栓子的检出效果优于单能量图。     

Multiparametric magnetic resonance imaging: Current role in prostate cancer management

Digital rectal examination, serum prostate‐specific antigen screening and transrectal ultrasound‐guided biopsy are conventionally used as screening, diagnostic and surveillance tools for prostate cancer. However, they have limited sensitivity and specificity. In recent years, the role of multiparametric magnetic resonance imaging has steadily grown, and is now part of the standard clinical management in many institutions. In multiparametric magnetic resonance imaging, the morphological assessment of T2‐weighted imaging is correlated with diffusion‐weighted imaging, dynamic contrast‐enhanced imaging perfusion and/or magnetic resonance spectroscopic imaging. Multiparametric magnetic resonance imaging is currently regarded as the most sensitive and specific imaging technique for the evaluation of prostate cancer, including detection, staging, localization and aggressiveness evaluation. This article presents an overview of multiparametric magnetic resonance imaging, and discusses the current role of multiparametric magnetic resonance imaging in the different fields of prostate cancer management.     

Future generation CT imaging

X-ray CT technology has been available for more than 30 years, yet continued technological advances have kept CT imaging at the forefront of medical imaging innovation. Consequently, the number of clinical CT applications has increased steadily. Other imaging modalities might be superior to CT imaging for some specific applications, but no other single modality is more often used in chest imaging today. Future technological developments in the area of high-resolution detectors, high-capacity x-ray tubes, advanced reconstruction algorithms, and improved visualization techniques will continue to expand the imaging capability. Future CT imaging technology will combine improved imaging capability with advanced and specific computer-assisted tools, which will expand the usefulness of CT imaging in many areas.     

Imaging intervertebral disc degeneration

Magnetic resonance imaging provides excellent anatomic detail of spinal tissues, but fails to provide the type of information that permits a definitive diagnosis in many patients with back pain. New imaging strategies that can be applied to the study of intervertebral disc degeneration include diffusion-weighted imaging, magnetic resonance imaging, diffusion tensor imaging, magnetic resonance spectroscopy, functional magnetic resonance imaging, dynamic computed tomography and magnetic resonance imaging, and T2 relaxometry. With dynamic imaging, the relative motions of normal and degenerated lumbar motion segments can be evaluated noninvasively. With further evaluation of the technique, hypermobile segments may be distinguishable from those with normal relative motion. T2 measurements obtained by T2 relaxometry appear to have important advantages with regard to spinal imaging because this modality provides a continuous and objective measure of the content of free water in the disc, which decreases with aging and degeneration. Anatomic imaging of the spine is highly accurate in the evaluation of nonmechanical causes of back pain and less beneficial in the evaluation of back pain that is due to mechanical causes. The development of functional imaging strategies of the spine will likely improve the management of patients with back pain. This article outlines the current magnetic resonance imaging protocols for intervertebral disc degeneration, indicates deficiencies in current imaging, and describes functional imaging strategies for the spine that will likely improve the evaluation of patients with back pain. It also reviews recent published articles on magnetic resonance imaging and computed tomographic imaging of the spine and details the results of studies that have explored the future potential of spine imaging.     

Diagnostic neuroimaging by magnetic resonance imaging: update

Magnetic resonance (MR) imaging remains the most versatile technique in diagnostic imaging. In addition to conventional imaging sequences such as T(1)-weighted imaging, T(2)-weighted imaging, or fluid-attenuated inversion recovery imaging, various techniques specific for certain pathological conditions are being continuously introduced. Pulse sequences for various imaging contrasts are becoming mature, and studies on high (3 T), or even ultra-high (7 T) field systems are emerging as a golden standard for neurosurgical practices. MR spectroscopic imaging capable of providing a pictorial display of the chemical properties of the brain and microscopic imaging providing images with significantly high anatomical resolution equivalent to histological preparations are now becoming essential for presurgical evaluation.     

Imaging the spine

The spine can be assessed using different imaging modalities, each offering their own advantages and limitations. The decision to use a certain type of imaging should be based on a number of factors which include the clinical question to be answered, the speed that answer is needed, the availability of an imaging modality and patient compatibility. We aim to discuss how to best use imaging when investigating spinal pathologies, consider the advantages and limitations of each imaging modality and demonstrate annotated examples of pathology on imaging.     

Advances in medical imaging for the diagnosis and management of common genitourinary cancers

Medical imaging of the 3 most common genitourinary (GU) cancers—prostate adenocarcinoma, renal cell carcinoma, and urothelial carcinoma of the bladder—has evolved significantly during the last decades. The most commonly used imaging modalities for the diagnosis, staging, and follow-up of GU cancers are computed tomography, magnetic resonance imaging (MRI), and positron emission tomography (PET). Multiplanar multidetector computed tomography and multiparametric MRI with diffusion-weighted imaging are the main imaging modalities for renal cell carcinoma and urothelial carcinoma, and although multiparametric MRI is rapidly becoming the main imaging tool in the evaluation of prostate adenocarcinoma, biopsy is still required for diagnosis. Functional and molecular imaging using 18-fluorodeoxyglucose-PET and sodium fluoride-PET are essential for the diagnosis, and especially follow-up, of metastatic GU tumors. This review provides an overview of the latest advances in the imaging of these 3 major GU cancers.     

胰岛移植的分子影像示踪与监测

目的总结目前胰岛移植分子影像示踪与监测的不同方法。方法对当前国内、外有关胰岛移植分子影像示踪与监测的研究报道进行综述和分析。结果 MRI具有高敏感性,高空间分辨率,可应用于临床,可在MR实时引导下进行药物注射,无放射性损伤等优点,但缺点是无法区分肝细胞以及未存活的移植胰岛细胞,在肝铁离子过量的患者中无法进行监测。核素分子显像的优点是特异性高,只有存活的细胞产生信号,可应用于临床,但具有离子辐射,有可能会篡改基因,无解剖成像,空间分辨率低,放射性示踪半衰期较短。光学成像特异性高,只有存活的细胞产生信号,获取途径多样,无放射性损伤,但有可能会篡改基因,空间分辨率低,尚无法应用于临床。结论磁共振、核素影像、光学成像以及基于微囊胰岛的多模态影像,都可以对胰岛移植物进行分子影像的示踪与监测,基于微囊胰岛的多模态影像可能会是未来最佳的方法。     

Cervical spinal cord multiple sclerosis: evaluation with 2D multi-echo recombined gradient echo MR imaging

Abstract

Objective: The two-dimensional multi-echo recombined gradient echo (MERGE) technique automatically acquires and sums multiple gradient echoes at various echo times in cervical spine magnetic resonance (MR) imaging. This technique increases the grey–white matter contrast within the spinal cord and should also improve the depiction of cervical cord lesions. The aim of this study was to qualitatively and quantitatively evaluate MERGE imaging compared with T2-weighted fast spin-echo (T2WFSE) imaging for depicting multiple sclerosis (MS) lesions in the cervical cord.

Methods: Nineteen consecutive patients (10 males and 9 females; age range 22–62 years, mean age 43.6 years) with clinically diagnosed MS were examined with cervical spinal cord MR imaging at 3 T including both MERGE and T2WFSE imaging. Qualitative evaluation for MS lesion conspicuity was performed. The quantitative criterion utilized to compare MERGE imaging with T2WFSE imaging was the lesion-to-background contrast-to-noise ratio (CNR).

Results: MERGE imaging showed 79 lesions and missed 1 that was depicted on T2WFSE imaging. T2WFSE imaging showed 46 lesions and missed 34 that were depicted on MERGE imaging. MERGE imaging was markedly superior to T2WFSE imaging in rendering greater lesion conspicuity. In the quantitative evaluation, the lesion-to-background CNR upon MERGE imaging was significantly higher than that upon T2WFSE imaging (P < 0.001, paired t-test).

Conclusions: MERGE imaging in the cervical spinal cord increases detection and conspicuity of MS lesions. Strong consideration should be given to utilizing axial MERGE images in the diagnosis and follow-up study of cervical cord MS.