磁共振3D-VIBE序列在肝门胆管癌术前评价的应用价值

目的探讨三维快速梯度回波T1加权磁共振成像序列（volumetric interpolated breath—hold examination，3D-VIBE）在术前评价肝门胆管癌的诊断价值。方法前瞻性纳入并经随后手术证实的31例肝门胆管癌患者术前行上腹部综合磁共振（magnetic resonance imaging，MRI）检查，序列包括快速自旋回波T2加权（T2 weighted，T2W）、二维（two dimension，2D）梯度回波T1加权（T1 weighted，T1W）平扫，2D磁共振胆胰管成像（magnetic resonance cholangiopancreatography，MRCP），Gd对比剂（Gd-DTPA）增强的3D-VIBE三期动态扫描和增强2DT1W（平衡期）。分析肿瘤的形态、胆管侵犯范围和有无血管侵犯，并比较3D-VIBE和2DT1W序列判断能否手术根治性切除肿瘤的可靠性。结果①3D-VIBE序列直接显示了所有31例病例的肝门部肿瘤，并准确判断形态学分类；8例浸润型肝门胆管癌病例在2D T1W序列增强图像上肿瘤未获直接显示（25．8％）。②根据Bismuth-Corlette分类法，3D-VIBE显示胆管纵向侵犯范围的准确性接近MRCP（93．5％），而常规2DT1w增强图像倾向于低估胆管侵犯范围（32．3％）。③3D-VIBE显示了更多的肝动脉、门静脉及其分支侵犯。④在判断本组肝门胆管癌病例能否手术切除方面。3D-VIBE序列阳性预测值为84．2％，准确性为90．3％；2DT1W序列分别为64．0％和71．0％。结论3D-VIBE在判断肝门胆管癌形态学类型、胆管纵向侵犯范围和手术切除性等方面优于其它MRI序列。     

超声造影联合多层螺旋CT增强检查对胰腺癌可切除性评估的临床研究

目的探讨术前超声造影联合多层螺旋CT(MSCT)增强扫描在胰腺癌可切除性评估中的临床价值。方法回顾性分析2017年1月~2018年12月我院行超声造影及MSCT增强扫描且经病理证实的胰腺癌患者54例胰腺癌患者的临床资料,以手术及病理结果为金标准,评价超声造影、MSCT及二者联合术前评估胰腺癌可切除性的诊断效能。结果54例患者,超声造影术前评估可切除肿瘤39例,不可切除肿瘤15例;超声造影诊断胰腺癌可切除的敏感性、特异性、准确性分别为92.31%、80.00%、88.89%。MSCT术前评估可切除肿瘤41例,不可切除肿瘤13例;MSCT增强扫描诊断胰腺癌可切除的敏感性、特异性、准确性分别为94.87%、73.33%、88.89%。二者联合胰腺癌可切除的敏感性、特异性、准确性分别为92.31%、93.33%、92.59%,相比于单项检查准确性有所提高,但差异无统计学意义(P>0.05)。结论超声造影与MSCT均在胰腺癌可切除性的术前评估中有重要价值,二者联合可在一定程度上提高诊断准确性。     

Hilar cholangiocarcinoma: preoperative evaluation with a three dimensional volumetric interpolated breath-hold examination magnetic resonance imaging sequence

Background Early detection and accurate staging are crucial for planning treatment and improving survival rate of hilar cholangiocarcinomas. This study investigated the diagnostic value of a three dimensional, spoiled gradient echo, Tl-weighted magnetic resonance （MR） imaging sequence （3D volumetric interpolated breath-hold examination, 3D-VIBE） in the preoperative evaluation of hilar cholangiocarcinoma. Methods Thirty-one patients with surgically and histologically confirmed hilar cholangiocarcinomas underwent preoperative MR imaging examination. Unenhanced two-dimensional T1- and T2-weighted images, 2D MR cholangiopancreatographs （MRCP）, gadolinium enhanced 3D-VIBE images in the early arterial, late arterial and portal venous phases followed by 2D Tl-weighted images in the equilibrium phase were acquired. Images from 3D-VIBE, 2D T1-weighted enhanced sequences and 2D MRCP were interpreted by two abdominal radiologists through consensus reading in blind manner, focussing on the assessment of the morphological type, the longitudinal extent of tumor infiltration in the bile ducts and the involvement of neighbouring blood vessels. The accuracy of 3D-VIBE and 2D T1-weighted enhanced sequences in assessing the tumor resectability was compared. Results All the 31 tumors were directly displayed and accurately classified on 3D-VIBE images whereas 8 periductal infiltrating tumors （8/31, 25.8%） were not depicted on 2D T1-weighted enhanced images. Using the Bismuth Corlette classification, 3D-VIBE was closer to MRCP in delineating the intraductal extent of tumor infiltration than 2D T1-weighted enhanced （28/31, 90.3%; 10/31, 32.3%; x^2=22.0, P〈0.05）. Involvement of the hepatic artery, the portal venous trunk and their branches was shown more frequently on 3D VIBE than 2D T1-weighted enhanced images. The positive predictive value and accuracy of 3D-VIBE （84.2%; 90.3%） for assessing tumor resectability were higher than those of 2D T1-weighted enhanced images （64.0%; 71.0%, all P〈0.05）. Conclusion Gadolinium enhanced 3D-VIBE is better than 2D T1-weighted enhanced sequence in the preoperative assessment of the morphologicalal type, the intraductal infiltrating extent and the tumor resectability of hilar cholangiocarcinomas.     

超声内镜在小胰癌诊断中的价值探讨

目的探讨超声内镜（EUS）在小胰癌的诊断、TNM分期和预测可切除性中的价值。方法回顾性分析手术病理确诊的10例肿瘤直径≤3cm的胰腺癌病人的临床资料以及B超（US）、螺旋CT、超声内镜（EUS）检查资料。结果10例小胰癌患者肿瘤平均直径1.92cm（0.8～3cm）;US检查有5例（50%）胰腺病变,螺旋CT检查有7例（70％）胰腺病变,超声内镜检查胰腺均有改变。EUS诊断肿瘤侵犯门脉系统的准确率100％,对肠系膜上动脉的浸润的诊断准确率略低;对肿瘤T分期的准确率90％,N分期为70％,“TN”分期为60％,根据EUS诊断10例患者均可行手术切除,而术中发现2例患者失去手术时机,阳性预测值80％。结论超声内镜检查对小胰癌的诊断、分期及可切除性的评估有重要意义,超声内镜是目前临床使用的各种影像技术中对小胰癌显示最好的方法,值得临床推广。     

MRCP结合轴位T2WI与CT对胰腺癌的诊断价值

目的评价磁共振胰胆管成像（magnetic resonance cholangiopancreatography,MRCP）结合轴位T2加权图像（T2WI）与CT两期增强诊断胰腺癌及评价其可切除性的准确性.方法回顾性分析经手术和/或病理证实的胰腺癌19例,术前均有MRCP及CT两期增强资料.根据图像资料进行诊断及评价胰腺癌的可切除性.结果MRCP结合轴位T2WI诊断阳性率为78.9%（15/19）;CT两期增强扫描诊断阳性率为89.5%（17/19）.MRCP结合轴位T2WI评价为可切除的3例,手术证实可切除的为2例;CT两期增强扫描诊断者评价可切除的为4例,手术证实可切除为3例.结论MRCP结合轴位T2WI与CT两期增强扫描对胰腺癌的诊断有相同的准确性,CT两期增强扫描对胰腺癌可切除性评价优于MRCP结合轴位T2WI.     

乳腺良恶性肿瘤超声弹性成像鉴别诊断的价值研究

目的探讨超声弹性成像对乳腺良、恶性肿瘤鉴别诊断的应用价值。方法回顾性分析用超声弹性成像诊断的143例乳腺肿瘤患者共170个病灶,与术后的病理结果对照。结果超声弹性成像对乳腺良、恶性肿瘤诊断的敏感性为93.7%(59/63),特异性为75.7%(81/107),准确性为82.4%(140/170)。结论超声弹性成像技术对乳腺良、恶性肿瘤的诊断和鉴别诊断具有重要的参考价值。     

MR及CT对胰腺癌术前分期及可切除性评估的价值

目的探讨MR及CT对胰腺癌术前分期及可切除性评估的价值。方法回顾性观察经病理证实的25例胰腺癌患者的MR及CT表现,并与手术及病理结果进行对照分析。结果 MR诊断胰腺癌Ⅰ期12例,Ⅱ期11例,Ⅲ期1例,Ⅳ期1例;CT诊断胰腺癌Ⅰ期11例,Ⅱ期12例,Ⅲ期2例,Ⅳ期0例。以病理结果为金标准,MR判断Ⅰ期、Ⅱ期的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为90.91%,85.71%,88.00%,83.33%,92.31%;83.33%,92.31%,88.00%,90.91%,85.71%。CT判断Ⅰ期、Ⅱ期的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为81.82%,85.71%,84.00%,81.82%,85.71%;83.33%,84.62%,84.00%,83.33%,84.62%。MR对胰腺癌术前分期的总的准确率为88.00%。CT对胰腺癌术前分期的的准确率为80.00%。结论 MR及CT对胰腺癌术前分期及可切除性评估具有较高价值且MR优于CT。     

MSCT与MRI对胰腺囊性肿瘤钙化、囊性成分的观察价值

目的总结胰腺囊性肿瘤MSCT(多层螺旋CT)及MRI(磁共振)影像学特点,分析MSCT与MRI诊断及鉴别胰腺囊性肿瘤的临床价值。方法回顾性分析我院自2012年5月-2015年6月收治的39例胰腺囊性肿瘤患者的临床资料,所有患者均接受MSCT及MRI检查,且影像学资料完整,分析MSCT与MRI对胰腺囊性肿瘤钙化及囊性成分的鉴别价值。结果 MRI诊断导管内乳头状粘液性肿瘤(IPMN)准确率为100.0%,高于MSCT的62.5%;MRI诊断胰腺囊性肿瘤准确率为82.1%,高于MSCT的61.5%(P0.05)。结论 MSCT、MRI均可显示胰腺囊性肿瘤血供及形态,MSCT在显示囊壁附近及中心钙化方面优势好,MRI在显示肿瘤囊性成分、壁结节及分隔方面有优势。     

椎管内占位病变的高场强MRI诊断与鉴别诊断

目的 探讨高场强MR对椎管内占位病变的诊断与鉴别诊断价值。方法 回顾性分析53例经手术病理证实的椎管内占位病变的MRI资料．肿瘤位于颈椎管18例，胸椎管23例，腰椎管12例。病理上属神经鞘瘤17例，脊膜瘤8例，神经纤维瘤4例，转移瘤9例，星形细胞瘤3例，室管膜瘤2例，蛛网膜囊肿3例，淋巴瘤1例，脊索瘤2例，海绵血管瘤2例，血肿1例，畸胎瘤1例。结果 MRI检查结果：①肿瘤部位：脊髓内肿瘤5例，脊髓外硬膜内肿瘤20例，硬膜外腔肿瘤24例，4例硬膜外与硬膜下均受累且通过椎间孔到达椎旁；MRI诊断符合率92．45％；②不同肿瘤在发病部位、肿瘤MRI信号、强化特征、硬膜信号与形态、脊髓形态与蛛网膜下腔改变以及脊椎骨质等都有各自特点。结论 高场强MRI在椎管内占位病变的诊断中与鉴别诊断有重要价值。     

超声显像对肾上腺肿瘤的诊断与鉴别诊断价值

目的探讨超声显像对肾上腺肿瘤的定位与定性诊断与鉴别诊断价值。方法对96例疑为肾上腺肿瘤病人进行超声显像检查,经手术与病理等证实为皮质腺瘤45例,皮质腺癌8例,嗜铬细胞瘤24例,肾上腺转移癌16例,髓样脂肪瘤3例。结果肾上腺肿瘤的病理类型不同,声像图表现亦各不相同。超声显像定位诊断符合率为95.8%(92/96),定性诊断符合率为92.7%(89/96)。结论超声显像对肾上腺肿瘤的定位与定性诊断价值较大,可作为临床诊断本病的首选检查方法。但由于不同病理类型肾上腺肿瘤的声像图表现缺乏特异性,因此熟练掌握超声显像诊断与鉴别诊断方法,密切结合临床表现与其他影像学检查,对于进一步提高超声显像诊断本病的准确率具有重要意义。     

ASSESSING THE RESECTABILITY OF PANCREATIC DUCTAL ADENOCARCINOMA： COMPARISION OF DUAL－PHASE HELICAL CT ARTERIALPORTOGRAPHY WITH CONVENTIONAL ANGIOGRAPHY

Objective. To evaluate the respective value of dual-phase helical CT arterial petrography (CTAP) and conventional angiography in preoperative predicting resectability of pancreatic ductal adenecarcinoma. Subjects and methods. Tumor resectability was prospectively evaluated in 54 patients with pathologically proven pancreatic ductal adenecarcinoma who later underwent surgery. Both dual-phase helical CT scanning and selective angiography were obtained in each patient preoperatively. For optimal enhancement of pancreas and major peripancreatic vessels, two catheters connected to an automatic injector via a Y-shaped tube were placed after selective angiography, one in celiac trunk, the other in superior mesenteric artery. Then the patient underwent dualphase helical CTAP of pancreas and liver. The criteria of irresectability for CTAP include: tumor dimne-ter≥5 cm, extrapancreatic invasion, distant metastases and vascular involvement(occlusion, stenosis or semicircular encasementofsuperiormesentericartery, hepaticartery, splenicartery, celiac axis; pertalvein, superiormesenteric vein or splenic vein). The results of both madalities were correlated with findings from surgery or pathology. Results. Thirty-eight of 54 patients had nonresectable disease. In prediction the irresectability, sensitivi-ty, specificity, positive predictive value, negative predictive value and overall accuracy were 94. 7%, 100%, 100%, 88.9%, 96. 3% respectively for helical CTAP and 63.2%, 93.8%, 96.0%, 51.7%, 72. 2% respectively for selective angiography. In assessing vascular involvements, dual-phase helical CTAP was also superior to selective angiography. Conclusion. Dual-phase helical CTAP is superior to angiography in assessing resectability of pancreatic duetal adenocercinoma. The combination of the two modalities may further improve overall accuracy of assessment.     

CT对胰腺癌的诊断及手术可切除性评估

目的探讨CT在胰腺癌的诊断及手术可切除性评估中的价值。方法回顾性分析40例拟诊胰腺癌随后又行手术治疗患者的CT征象,并与手术病理结果对照。根据国内外CT对胰腺癌的诊断及术前可切除性评价的标准,判断胰腺癌的手术可切除性。结果40例中,胰腺癌35例,非胰腺癌5例。CT诊断准确性87.5％(35／40)。35例胰腺癌中,CT发现胰腺肿块31例,4例未发现肿块;周围结构侵犯、转移情况:25例胰周血管侵犯,CT诊断21例(84.0％);胃肠道侵犯10例,CT诊断6例(60.0％);21例淋巴结肿大,CT诊断17例(81.0％);11例肝转移,CT诊断8例(72.7％);9例腹膜转移,CT诊断5例(55.6％)。10例术前认为可切除,实际术中切除7例,可切除准确度70％;25例手术前认为不可切除,实际手术不可切除23例,不可切除准确度92％,进行统计学分析,Kappa值为0.64。结论CT可准确诊断胰腺癌、淋巴结转移及胰周血管侵犯。CT对胰腺癌的手术可切除性判断也有较大的价值。     

Preliminary study of 3T 1H MR spectroscopy in bone and soft tissue tumors

Background Magnetic resonance spectroscopy （MRS） is one method that can examine noninvasively the alive specimen of the organ, metabolism of the organ and cell, and the biochemistry change. MRS provides the biochemistry information that may be used to diagnose tumors or differentiate the malignant tumor from benign. The objective of this study is to investigate the benign and malignant bone and soft tissue tumors by 1H-MR spectroscopy （^1H-MRS） on a 3 Tesla MR scanner, then to assess the usefulness of ^1H-MRS in diagnosing bone and soft tissue tumors and distinguishing benign from malignant tumors.
Methods Fifty-six patients with bone and soft tissue tumors proved clinically and pathologically were examined with ^1H-MRS. ^1H-MRS was performed to study malignant musculoskeletal tumors, benign tumors and normal muscle adjacent to lesions to analyze the characteristics, and single-voxel point-resolved spectroscopy sequence was used. Proton brain exam-single voxel of ^1H-MRS which directly appeared in the spectrum, was observed to find the peak height of choline compounds （Cho） opposite to the creatine （Cr）, and whether there was a Cho peak. Metabolite values were calculated automatically from the area under each metabolite peak by the Functool 3.1 software. Metabolite ratios of Cho/Cr were manually calculated. Then according to the results, it was judged whether there existed benign or malignant tumors. The Kappa statistical test was used to analyze the MRS results, the histopathology data and the surgical situation. Statistics processing was performed using the software packaqe SPSS11.5 for Windows.
Results ^1H-MRS spectra style of bone and soft tissue tumors was different from that of normal muscle, and differences also existed between benign and malignant tumors. Choline level in malignant tumor was markedly higher than that in benign tumors. Cho/Cr in malignant tumor was higher than in benign tumor significantly （P〈0.05）. The true positive rate of bone and soft tissue between benign and malignant tumors was 34/36, the true negative rate was 15/18, the false positive rate was 3/18 and the false negative rate was 2/36. Therefore in the group, sensitivity of the ^1H-MRS was 94% （34/36）, specificity was 83% （15/18）, positive predictive value was 92% （34/37）, negative predictive value was 88% （15/17） and the accuracy rate was 91% （49/54）. The MRS results and the histopathology inspection conclusions had very good uniformity. The K value was 0.76±0.10 （P 〈0.01）.
Conclusions The increase of Cho level measured by ^1H-MRS is related to the bone and soft tissue malignant tumor. Cho/Cr in malignant tumor was higher than in benign tumor, so they will play a vital role in the diagnosis and differential diagnosis of bone and soft tissue tumors.     

探讨MR1连续动态增强对肝癌的诊断价值及与常规CT多期增强的比较

目的 探讨MRI连续动态增强扫描对肝细胞癌的价值,提高肝细胞癌诊断符合率.方法 39例经组织学或临床证实的肝细胞癌患者同时行CT平扫,多期增强扫描和MRI平扫,连续动态增强扫描.观察连续动态增强肿瘤表现出的强化模式;在连续动态增强扫描MRI,绘制肿瘤、主动脉、门静脉及肝组织的时间-信号强度曲线,并重建各期动态图像.对2种增强所表现的良、恶性特征进行分类、计数和比较.结果 在39例肝细胞癌的连续动态增强扫描时间-信号强度曲线类型,速升速降型27例、速升平缓降(或台)型6例、缓升下降型5例、缓慢上升型1例;多期增强的强化模式,动脉期强化、门静脉期及延迟期密度(信号)减低20例;动脉期强化、门静脉期及延迟期密度(信号)不减低5例,动脉期不强化、门静脉及延迟期强化4例;动脉期不强化、门静脉期及延迟期密度(信号)低于肝组织1 0例.MRI连续动态增强扫描表现出的恶性征象明显高于多期动态扫描的强化模式(x2=37.375,P＜0.000).在肿瘤的综合诊断中,诊断等级定为肯定良性、可能良性、不能确定、可能肝细胞癌和肯定肝细胞癌,连续动态增强扫描等级例数相应为1、2、3、5、2 8;多期动态扫描分别为2、3、6、7、21,连续动态增强扫描的诊断符合率明显高于多期增强扫描(x2=49.259,P＜0.000).结论 MRI连续动态增强扫描能获得组织完整的对比剂流入和廓清状态,与多期增强比较,有利于对肿瘤个性化分析,对肝细胞癌诊断符合率高,具有推广价值.     

磁共振胰胆管成像对梗阻性黄疸的诊断价值

目的评价磁共振胰胆管成像(MRCP)对胆道梗阻性疾病的临床诊断价值,探讨肝外胆道梗阻的MRCP、MRI诊断和鉴别诊断。方法总结与回顾216例胆道梗阻性疾病患者的MRCP及MRI表现,并与C11、超声和手术病理结果对照。结果MRCP对胆道梗阻定位诊断准确率为98．6％;定性诊断准确率为95．4％。结论MRCP对胆道梗阻性疾病定位及定性诊断优于CT、超声,是诊断胆道梗阻性疾病的安全、有效的检查手段。     

多层螺旋CT与MR评估胰腺肿瘤血管不可切除性的比较

目的比较多层螺旋CT(MSCT)与MR评估胰腺肿瘤血管不可切除性的应用价值。方法回顾性分析14例胰腺癌患者的MSCT及MR胰腺增强扫描图像,对胰周主要血管的受累情况进行评价和比较。对经手术治疗者以手术结果为金标准,比较二者对血管不可切除性的评估有无显著差异,并计算二者的准确性。结果MSCT及MR检查对血管受累分级及血管不可切除性评估均有显著性差异(P<0.05)。MSCT评估血管不可切除性的敏感度、特异度、准确度、阳性预测值及阴性预测值分别为77.8%、95.0%、91.8%、77.8%和95.0%,MR则分别为66.7%、90.0%、85.7%、60.0%和92.3%。结论在胰腺肿瘤的血管不可切除性判定方面,增强MSCT在一定程度上优于增强MR。     

肿瘤标志物联合检测在恶性肿瘤诊断中的价值

目的探讨恶性肿瘤特异性生长因子(TSGF)、甲胎蛋白(AFP)、癌胚抗原(CEA)3项血清肿瘤标志物联合检测在各种恶性肿瘤中的诊断价值。方法通过对348例恶性肿瘤患者血清TSGF、AFP、CEA的测定,评价其对恶性肿瘤联合检测的临床诊断评价指标。结果3项肿瘤标志物联合检测敏感性为87.6%,准确性为93.8%,特异性为97.4%。结论TSGF、AFP、CEA联合检测模式能明显提高恶性肿瘤诊断的敏感性,减少漏诊,在临床肿瘤血清学诊断和筛查中有其重要应用价值。     

膝关节半月板损伤的MRI影像分析

目的与关节镜结果相对照，回顾性分析膝关节半月板损伤的MRI表现。方法收集具有完整MRI与关节镜检查资料的患者58例，分析MRI影像改变，根据半月板内部MR信号特征将半月板损伤分为Ⅰ-Ⅲ级。结果58例患者、85个半月板中，MRI诊断工级损伤7个，Ⅱ级损伤34个，Ⅲ级损伤44个。以关节镜检查结果作为标准，MRI对半月板撕裂诊断的准确度为87．06％，敏感度为92．31％，特异度82．61％，阳性预测值为81．82％，阴性预测值为92．68％，MRI与关节镜检查对半月板撕裂的诊断差异无统计学意义。结论MRI检查对膝关节损伤的诊断具有明显独特性，可作为临床诊断膝关节半月板损伤的常用检查方法。     

超声造影在胰腺癌可切除性评估中的价值

目的 利用超声造影检查了解胰腺癌侵犯周围血管的情况,探讨术前超声造影对胰腺肿瘤可切除性的评估价值.方法 收集45例术前超声造影检查资料完整且经术后病理学检查证实为胰腺癌患者的临床资料.回顾并记录术前超声造影检查显示的胰周大血管受侵犯情况、根据分型标准对肿块可切除性（根治性或姑息性手术）的评价结果以及最终手术方式选择情况,分析术前超声造影评估胰腺癌肿块可切除性的阳性和阴性预测值以及敏感性和特异性.结果 术前超声造影检查显示,45例患者共67条胰周大血管受侵,其中腹腔动脉、肠系膜上动脉、肠系膜上静脉、肝总动脉的受侵率分别为31.1%、22.7%、22.2%和22.2%.术前超声造影评估可切除肿块20例,实际切除（根治性手术）17例,阳性预测值85.0%;评估不可切除肿块25例,实际未切除（姑息性手术）20例,阴性预测值80.0%（20/25）;判断肿瘤可切除性的敏感性和特异性分别为77.3%和86.9%.结论 超声造影可较为准确地     

新型超声造影剂声诺维在肝癌消融治疗中的应用

目的:探讨超声造影在肝癌消融治疗中的应用价值。方法:对100例肝癌患者进行了超声造影、增强CT/MR和(或)病理检查。其中56例进行射频消融治疗,15例行氩氦刀消融治疗,24例采取无水酒精量化治疗,5例用超声刀治疗。结果:超声造影诊断肝癌的敏感性、特异性和准确性分别为96.9%、95.1%和96.2%。射频消融20m in和1个月后超声造影分别发现4例和2例患者动脉相早期病灶有部分强化。氩氦刀消融1个月后2例患者见到动脉相早期病灶内有强化。结论:超声造影有助于肝肿瘤消融治疗适应证的选择,确定消融范围,是评价消融疗效的一种有效方法,且能明确残存部位,引导补充治疗。