开放式磁共振导引胸腰椎体病变骨钻活检的应用价值

目的探讨0.23T开放式磁共振介入系统导引胸腰椎病变穿刺活检的可行性、安全性及准确性。方法利用0.23T开放式磁共振联合iPath 200光学导航系统经椎弓根入路对34例胸、腰椎椎体病变患者行经皮穿刺活检术,穿刺胸椎病变13例,腰椎病变21例。将经皮穿刺活检得到的病理结果与外科手术的病理和/或临床随访12个月以上的最终结果进行比较,计算磁共振导引经皮胸、腰椎体穿刺活检的准确率。结果所有患者均一次穿刺成功并取得足量标本,穿刺组织病理检查诊断为恶性病变18例,良性病变14例,性质不明的2例;外科手术病理及临床随访的最终结果为恶性病变20例,良性病变14例。开放式磁共振导引胸、腰椎体病变穿刺活检的敏感度为90%(18/20),特异度为100%(14/14),准确度为94.1%(32/34),阳性预测值为100%(18/18),阴性预测值为87.5%(14/16)。所有患者均未出现严重并发症。结论 0.23T开放式磁共振导航系统导引经椎弓根穿刺活检胸、腰椎椎体病变是一种安全、准确的诊断方法。     

MRI导引介入技术临床应用的探讨

目的　评价磁共振成像介入导引技术的初步临床应用经验。方法应用常规0．5T磁共振成像扫描机做了20例MRI引介入诊断和治疗，其中门例活俭，3例肾囊肿硬化剂治疗，用19GMRI兼容的抽吸穿刺针做穿刺。采用快速梯度回波和快速自旋回波技术扫描。结果MRI导引经皮活检刺中率为100％，活检正确率88．2％。本组所有病例无非发症出现。结论MRI导引介入技术是一种安全而有效的技术。     

84例胆道病变影像学检查的分析

胆道病变影像学检查技术比较多,目前,中等以上的医院都有计算体层摄影(CT),B型灰阶超声(B超),经皮穿刺肝胆管造影术(PTC),逆行胰胆管造影(ERCP),常规X线胆系造影,大医院还有磁共振成像术(MRI)等影像检查技术。在这些影像检查中,哪一种比较敏感可靠而又经济方便呢?这是临床医     

MRI导引与监控微创介入治疗技术

目的:MRI导引与监控介入治疗系统主要由开放式实时MRI成像系统、磁共振兼容导引系统两大部分组成,此系统与磁共振兼容治疗设备结合,可实现精确及有效的微创介入治疗,是目前用于导引与监控介入治疗的新兴技术。MRI导引与监控系统能够将介入手术器械的信息(包括它的位置、方向等)以虚拟针影的形式与病变实时显示在同一张MR图像上,术者能够实时了解手术器械与靶区病灶位置关系,及时调整手术器械的进针点与进针方向,有效避开神经、血管等重要组织结构,从而降低穿刺过程的风险;通过实时MRI成像技术,监控治疗过程中靶区病变的信号变化,有效判断、控制治疗范围,使治疗过程中的副损伤更小、预后更好;与X线为基础的影像设备相比,MRI导引介入对患者和术者无放射性危害。     

颞下间隙病变磁共振导引下经皮活检术

目的 研究颞下间隙病变磁共振(MR)导引下经皮活检术的临床应用。方法 借助开放式0．2T MR对7例颞下间隙肿块病灶进行穿刺活检。结果 磁共振导引下经皮活检靶中率100％，活检正确率85．7％，无并发症出现。结论 磁共振导引下经皮活检术有助于颞下间隙病变的诊断。     

软组织病变的3.0T磁共振成像诊断

目的:探讨软组织病变的3.0T磁共振成像表现及其诊断价值.方法:回顾性分析经手术穿刺活检病理证实的38例软组织病变患者的MRI资料,包括男19例、女19例,年龄11～81岁,应用3.0T磁共振成像仪,影像诊断病理结果进行对照.结果:良性病变23例,恶性病变15例,MRI成像诊断良性或恶性病变的定性诊断符合率91.3%和80%;组织学诊断符合率分别为78.3%和53.3%.结论:3.0T磁共振成像对软组织病变定性诊断符合率高,具有非常重要的意义,为临床诊断及手术治疗提供有力的影像学依据.     

胸部病变CT导引下穿刺活检的临床应用

现代影像学检查很容易发现胸部病变,定位诊断一般也不难,但定性诊断往往受到诸多限制。CT导引下胸部病变穿刺活检是一项重要诊断技术,是诊断与鉴别诊断胸部病变的重要方法之一。因其诊断正确率高,并发症少,而越来越受到临床重视,并逐渐得到广泛应用。本研究报道82例胸部病变的CT导引下穿刺活检,比较其穿刺方法,评价其临床应用价值,探讨提高其阳性率,降低并发症发生率的可能性。材料和方法一、一般资料2000年3月至2002年5月,我们对82例胸部病变患者进行了CT导引下穿刺活检,其中男46例,女36例。年龄35~82岁,50岁以上者65例。肺野内病变69例…     

磁共振扩散加权成像和磁共振波谱在卵巢肿瘤中的应用

磁共振扩散加权成像(DWI)和磁共振波谱(MRS)均属于无创性MRI功能成像技术,分别通过分析组织扩散系数的差异和对组织代谢物的定量分析来描述病变的特征,实现了影像检查技术从形态学到功能学的转变,对卵巢肿瘤的鉴别诊断有重要意义,本文就其原理及其在卵巢肿瘤的临床应用价值做一综述。     

单层TSE序列及多层HASTE序列磁共振胰胆管成像技术在临床应用价值的比较

目的:比较磁共振胰胆管成像技术的2种成像方法,探讨有助于临床诊断胆系病变的磁共振检查的最佳方法。方法:分析经手术病理或活检证实的35例胰胆管病变患者2种不同方法(单层TSE序列及多层HASTE序列)MRCP影像表现,比较二者显示胰胆管病变的优缺点。结果:单层TSE序列采集时间短,空间分辨率高,受运动伪影影响小;多层HASTE序列采集时间较长,运动伪影明显。结论:单层TSE-MRCP成像结合常规SE及梯度序列冠轴位相扫描是胰胆管病变的磁共振检查的最佳方法之一。     

Pinpont立体定位导引系统在介入穿刺中的应用

介入放射学是以影像诊断为基础,并在影像设备的导引下,利用经皮穿刺技术和导管技术等对某种疾病进行穿刺并可取得组织学、细胞学甚至生理、生化学等信息的一门新兴学科.高精度、低辐射和微创技术已成为目前介入放射学的重点研究课题.Pinpont立体定位导引系统就是这一新技术的发展结果.现收集我院2001-02～2002-05应用Pinpont 立体定位导引系统经皮穿刺活检的37例患者进行分析,旨在了解此技术在影像学介入穿刺中的应用价值.     

急性心肌炎的CMR应用进展

急性心肌炎临床症状具有不典型、多样性等特点,早期明确诊断对病人的治疗与预后具有重要的临床价值。心脏MR(CMR)成像具有显示心肌水肿、瘢痕和其他组织异常的能力,已成为急性心肌炎病人的主要无创性诊断技术。随着MRI检查技术的发展,特别是T1mapping、T2mapping的应用,可进一步提高诊断价值。综述CMR成像在急性心肌炎应用的最新进展,以指导急性心肌炎的诊断与研究。     

Clinical magnetic resonance imaging with nuclear medicine correlation

The current role of magnetic resonance imaging (MRI) in different organ systems is discussed and compared to nuclear medicine and to other available clinical diagnostic modalities. The value of optimizing radiofrequency pulse sequence selection to provide additional tissue characterization is also described. The results of nuclear medicine and MRI studies in 56 patients are compared to evaluate the clinical diagnostic contribution of each imaging modality for various pathological processes. In addition, the state-of-the-art MRI systems and future development in MRI technology with its potential contribution is defined.     

前列腺健康指数在前列腺癌早期诊疗中的应用

前列腺癌是影响男性健康的常见病之一,早期诊断和治疗对改善患者预后有重要作用。目前,前列腺特异抗原(PSA)作为前列腺癌筛查中应用最广泛的血清学指标,在提高早期诊断率和降低死亡率方面起着非常重要的作用,但PSA灵敏度较高,使很多非前列腺癌患者接受了不必要的穿刺活组织检查或过度治疗。与PSA相比,新血清学指标前列腺健康指数...     

Diagnostic performance of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents

To determine the diagnostic performances of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents we compared them with arthroscopic findings in a consecutive series of pediatric patients (< or = 16 years old). Stratification effects by patient age and magnetic resonance imaging center were examined. There were 139 lesions diagnosed clinically, 128 diagnosed by magnetic resonance imaging, and 135 diagnosed arthroscopically. There was no significant difference between clinical examination and magnetic resonance imaging with respect to agreement with arthroscopic findings (clinical examination, 70.3%; magnetic resonance imaging, 73.7%), overall sensitivity (clinical examination, 71.2%; magnetic resonance imaging, 72.0%), and overall specificity (clinical examination, 91.5%; magnetic resonance imaging, 93.5%). Stratified analysis by diagnosis revealed significant differences only for sensitivity of lateral discoid meniscus (clinical examination, 88.9%; magnetic resonance imaging, 38.9%) and specificity of medial meniscal tears (clinical examination, 80.7%; magnetic resonance imaging, 92.0%). For magnetic resonance imaging, children younger than 12 years old had significantly lower overall sensitivity (61.7% versus 78.2%) and lower specificity (90.2% versus 95.5%) compared with children 12 to 16 years old. There was no significant effect of magnetic resonance imaging center. In conclusion, selective magnetic resonance imaging does not provide enhanced diagnostic utility over clinical examination, particularly in children, and should be used judiciously in cases where the clinical diagnosis is uncertain and magnetic resonance imaging input will alter the treatment plan.     

Accuracy of axillary MR imaging in treated breast cancer for distinguishing between recurrent tumour and treatment effects: does intravenous Gd-DTPA enhancement help in cases of diagnostic dilemma?

AIM: To evaluate the sensitivity and specificity of axillary magnetic resonance imaging (MRI) in symptomatic patients, who had previously been treated for breast cancer, compared with clinical outcome after a minimum of 1 year.METHODS: One hundred and five patients underwent axillary MRI examinations and were diagnosed as axillary tumour, metastatic tumour, treatment effect or normal. RESULTS: At MRI, 48 patients had axillary tumour, 51 had metastatic tumour (37 had both), 27 had treatment effect and 22 were normal. At outcome (median follow-up, 484 days), 54 patients were positive for axillary tumour, 59 for metastatic disease (40 had both), 21 had treatment effect alone and 18 were clear. Magnetic resonance imaging showed 89% sensitivity, 100% specificity and 94% accuracy for recurrent axillary tumour, and 85% sensitivity, 98% specificity and 90% accuracy for metastatic tumour. Soft tissue plaques were the commonest axillary disease pattern seen (37). Small volume soft tissue plaques gave the most diagnostic difficulty. Non-dynamic enhancement with intravenous Gadopentetate dimeglumine (Gd-DTPA) in a subset of 34 patients improved sensitivity for axillary tumour from 40 to 74%, and improved diagnostic confidence in 11 patients (32%). Magnetic resonance imaging had a positive management impact leading to treatment alteration in 45 patients, 43 of whom had recurrent axillary and/or metastatic tumour.CONCLUSIONS: Tumour plaques were the commonest pattern of recurrent axillary disease. Forty-eight percent of the patients had metastatic deposits identified by MRI. Magnetic resonance imaging had excellent specificity (100%) and good sensitivity (89%) for recurrent axillary tumour compared with outcome at 1 year, which was improved by non-dynamic administration of Gd-DTPA in 32% of the subset who received it.     

Musculoskeletal system

Diagnostic imaging has played a major role in the evaluation of patients with cancers of the bone and soft tissue. The imaging modalities have included radiography, computed tomography, magnetic resonance imaging, and bone scintigraphy. Current experience suggests that functional imaging with positron emission tomography (PET) and [F-18]fluorodeoxyglucose (FDG) may also have an important role in the imaging evaluation of patients with bone and soft tissue sarcoma, including guiding biopsy, detecting local recurrence in amputation stumps, detecting metastatic disease, predicting and monitoring response to therapy, and assessing for prognosis. Prospective studies with large patient groups will be essential to define the exact diagnostic role of FDG PET in this clinical setting, which should also include an evaluation of the cost-effectiveness and the short-term and long-term benefits in clinical decision making and management. In this article, we review the diagnostic utility of dedicated PET and PET combined with computed tomography imaging system in the evaluation of patients with bone and soft tissue malignancies.     

3 T magnetic resonance imaging of the musculoskeletal system

The increasing distribution of high-field (3 T) magnetic resonance (MR) systems for clinical use has been accompanied by the need to fully understand the advantages and disadvantages that the increase in signal quality confers. Continuous development of the coils is required to fully express the potential of these systems, especially given the synergy between parallel imaging and the recent multichannel phased-array coils, which are able to improve image quality, spatial resolution and diagnostic accuracy in musculoskeletal imaging. The increase in signal offered by the high field makes possible improved visualisation of bone, cartilage, tendons and ligaments. This advantage, together with increased spatial resolution, is particularly useful when studying joints or some of their components, the evaluation of which has produced suboptimal results in non arthrographic examinations such as the glenoid labrum of the shoulder and the articular cartilage of the knee. Thanks to the greater signal-to-noise ratio and improved spatial resolution, MR imaging at 3 T is able to notably increase diagnostic performance in the musculoskeletal setting, with a consequent improvement in patient treatment and management.     

Routine 3D magnetic resonance imaging of joints

Due to its high spatial resolution and excellent tissue contrast, magnetic resonance imaging (MRI) has become the most commonly used imaging method to evaluate joints. Most musculoskeletal MRI is performed using 2D fast spin-echo sequences. However, 3D sequences have also been used for joint imaging and have the advantage of acquiring thin continuous slices through joints, which reduces the effects of partial volume averaging. With recent advances in MR technology, 3D sequences with isotropic resolution have been developed. These sequences allow high-quality multiplanar reformat images to be obtained following a single acquisition, thereby eliminating the need to repeat sequences with identical tissue contrast in different planes. Preliminary results on the diagnostic performance of 3D isotropic resolution sequences are encouraging. However, additional studies are needed to determine whether these sequences can replace currently used 2D fast spin-echo sequences for providing comprehensive joint assessment in clinical practice.     

Diagnostic and therapeutic impact of MRI and arthrography in the investigation of full-thickness rotator cuff tears

Investigation of shoulder pain is important before surgical treatment. The presence or absence of a full-thickness rotator cuff tear (FTRCT) may determine the type of surgical treatment. Both MRI and conventional arthrography can be used, but little is known about their relative diagnostic and therapeutic impact. We performed a prospective trial assessing: (a) the influence of MRI and arthrography results on the clinician's diagnostic thinking (diagnostic impact); (b) the influence of the results on the clinician's therapeutic thinking (therapeutic impact); and (c) the diagnostic performance of the two techniques in patients with surgical confirmation. A total of 104 consecutive patients with shoulder problems referred to a specialist orthopaedic shoulder clinic underwent pre-operative investigation with MRI and arthrography. The surgeon's diagnosis, diagnostic confidence and planned treatment were measured before the investigation, and then again after the results of each investigation. Before the presentation of the investigation results, the patients were randomised into two groups. In one group MRI was presented first; in the other group, arthrography. The MRI results led to fewer changes in diagnostic category (14 of 46, 30 %) than arthrography (20 of 54, 37 %), but the difference was not significant (P > 0.5). Magnetic resonance imaging led to slightly more changes in planned management (17 of 47, 36 %) than arthrography (14 of 55, 25 %), but again the difference was not statistically significant (P > 0.3). The results of the second investigation always had less diagnostic and therapeutic impact than the first. The accuracy of MRI for FTRCT in 38 patients with surgical confirmation was 79 %, sensitivity 81 % and specificity 78 %; the accuracy of arthrography was 82 %, sensitivity 50 % and specificity 96 %. The clinical diagnosis and management plan can be adequately defined by a single radiological investigation. Magnetic resonance imaging and arthrography had fairly similar diagnostic and therapeutic impact and comparable accuracy, although MRI was more sensitive and less specific. Magnetic resonance imaging may be the preferred investigation because of its better demonstration of soft tissue anatomy. Received: 27 January 1998; Revision received: 27 May 1998; Accepted: 22 June 1998     

Imaging devices for use in small animals

Imaging devices for small animals have emerged in the past 10 years as extraordinarily useful tools in translational research and drug development. The Food and Drug Administration requires animal testing after in vitro drug discovery but before human application. Many small animal instruments have been developed in analogy to human scale devices, including positron emission tomography, single-photon emission computed tomography, computed tomography, magnetic resonance imaging, and ultrasound. Conversely, optical imaging with fluorescent and bioluminescent tracer technology, originating in single-cell in vitro studies, has been scaled up to whole-body animal imaging. Imaging that uses multiple devices permits a comparison of different aspects of function, anatomy, gene expression, and phenotype by the use of software algorithms or more recently with hybrid instruments. Animal imaging facilitates "bench-to-bedside" drug development in 2 ways. Longitudinal imaging improves the science of animal research through the benefit of paired statistics with the use of animals as their own controls while it simultaneously reduces animal sacrifice. In addition, imaging makes explicit the development of diagnostic and therapeutic agents on nearly identical molecular synthesis platforms, therefore linking drug discovery to the development of imaging tracers. This powerful paradigm, now known as diagnostic/therapeutic pairing or theranostics, is already familiar from the use of (123)I used for thyroid diagnosis and (131)I for therapy of benign and malignant thyroid conditions. Many newer examples exist, such as "cold" or "hot" octreotide and meta-iodobenzylguanidine in neuroendocrine tumors; and rituximab in pharmaceutical doses, or with beta emitter tags, for therapy of indolent non-Hodgkin's lymphoma. Theranostic agents are also rapidly emerging that use nanoparticles, aptamers, peptides, and antibodies for magnetic resonance imaging/positron emission tomography/single-photo emission computed tomography/computed tomography imaging devices in animals with subsequent therapeutic drug development for translation to human use.