磁共振成像在子宫内膜癌的诊断及分期中的作用研究

目的:探讨MRI在子宫内膜癌的诊断、分期中的作用.方法:回顾性研究273例经术后病理检查明确诊断的子宫内膜癌患者,根据其术前MRI表现,以FIG02009新分期方法结合病理分期结果进行评估.结果:273例患者中Ⅰa期136例,Ⅰb期46例,Ⅱ期51例,Ⅲa期8例,Ⅲb期7例,Ⅲcl期8例,Ⅲ2期4例,Ⅳa期6例,Ⅳb期7例,MRI对子宫内膜癌分期正确率为93.4％,与病理分期比较无显著统计学差异(P＞0.05).结论:MRI对子宫内膜癌的诊断及分期具有较高准确性,在临床治疗方式及预后评估中具有重要意义.     

A novel mouse model for segmental orthotopic colon cancer

Spontaneous colon tumor mouse strains offer numerous advantages in modeling disease. However, the wide temporal window in which lesions form and the stochastic nature of lesion location require larger cohorts for assessment of disease modulation. Reliable, reproducible and inexpensive mouse models of early-stage and invasive cancer would add to existing transgenic models. We show a new method for the creation of orthotopic murine tumors centered in the mucosal and submucosal layers anywhere in the colon, allowing creation of lesions of known age, location and extent. The system overcomes the disadvantages of heterotopic implantation and allows evaluation of lesions distally in the colon as well as proximally, thereby providing an additional method to study the effects of regionality. Invasion, host vascularization and application to disparate cell lines are demonstrated. Noninvasive imaging with magnetic resonance and colonoscopy, allowed in part by the tumor location, show potential applications of this approach.     

Complementary role of adjunctive breast magnetic resonance imaging and scintimammography in patients of all ages undergoing breast cancer surgery

The aims of this study were to assess breast MRI and scintimammography (SMM) for the detection of breast cancer, and to determine any complementary role of these tests to each other and conventional imaging. Seventy‐two patients (age 35–81 years) with a suspicious breast mass were investigated by mammography, breast ultrasound, breast MRI and SMM before undergoing surgical excision of the breast mass. Sensitivity, specificity and area under receiver operator characteristic curves were calculated for each test. Of the 72 patients, there were 66 proven malignant tumours, including two patients with bilateral breast cancer. When comparing the diagnostic sensitivity of breast MRI and SMM for lesion size, both tests showed higher sensitivities for lesions >25 mm in size, particularly for SMM. When these tests were compared for patient age, patients less than 51 years showed higher sensitivities for both tests. This was statistically significant for breast MRI. The overall respective diagnostic sensitivities for mammography, mammography with breast ultrasound, breast MRI and SMM were 56, 67, 86 and 85%. The differences were significant between mammography, mammography/ultrasound and both breast MRI and SMM. Breast MRI and SMM offer incremental diagnostic advantage in the diagnosis of breast cancer. Although improved diagnostic accuracy is seen in patients of all ages, those patients less than 51 years of age receive the greatest diagnostic benefit.     

肺癌DW-MRI临床应用研究进展

目的：总结国内外关于磁共振弥散加权成像在肺癌中的研究进展。方法：应用PubMed和CNKI期刊全文数据库检索系统,以“肺肿瘤、磁共振成像、DwI”为关键词,检索2007-01-2013-05的相关文献,共检索到英文文献103篇,中文文献304篇。纳入标准：1）磁共振弥散加权成像对肺癌的诊断价值;2）磁共振弥散加权成像对转移淋巴结的诊断价值;3）磁共振弥散加权成像对肺癌疗效监测的价值。根据纳入标准,符合分析文献29篇。结果：磁共振弥散加权成像能够区分肺部肿瘤的良恶性,其敏感性、特异性与18F-FDGPET相当,并能够依据表观弥散系数（apparentdiffusioncoeffi-cient,ADC）值及信号强度对肿瘤的病理类型进行初步鉴别。转移性淋巴结的ADC值较低,DwI在发现微小淋巴结转移方面,准确性和敏感性均比PET-CT高。ADC值可以早期评价肺癌放化疗及射频消融疗效,特异性和敏感性均优于PET-CT。结论：DW-MRI能明确诊断肺部肿瘤,并能早期评价肺癌疗效,可以成为新的肺癌诊疗手段。     

Accuracy of nasopharyngeal carcinoma staging by magnetic resonance imaging

To audit the accuracy of magnetic resonance (MR) staging of nasopharyngeal carcinoma (NPC) in daily reporting, the MR images of 101 adult patients with newly diagnosed NPC reported between December 1996 and February 2002 were reviewed retrospectively. Based on the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) TNM staging criteria (1997), the tumour staging obtained from the MR reports and the MR films was compared by two experienced head and neck radiologists. The number of patients being upstaged, downstaged or unchanged was noted. In all stages, the NPC staging obtained from the MR reports revealed 18 (17.8%) understaged, eight (7.9%) overstaged and 75 (74.2%) the same stage when compared to the staging obtained from the MR films based on the AJCC/UICC criteria. The percentage of patients being understaged or overstaged, in decreasing order of frequency, were stages II, III, IV and I. Magnetic resonance of NPC should be reported by radiologists who are not only familiar with the pathology of this condition and its pattern of spread but who should also base their reports on the AICC/UICC staging criteria. The necessity to improve our MR staging accuracy is largely because it determines the type of therapy to be given and this has to be appropriate and adequate for a successful treatment.     

Fast magnetic resonance imaging in spinal trauma

In a prospective comparison between fast magnetic resonance imaging (MRI) sequences and conventional spin-echo in a series of 20 patients, gradient-echo imaging was found to be inferior to spin-echo, especially in the visualization of spinal cord oedema, and the use of a rapid spin-echo sequence was limited by inferior visualization of haemorrhage. While the use of a combination of these two fast imaging techniques resulted in equivalent results to conventional spin-echo, the increased imaging time suggests that fast MRI cannot, as yet, replace conventional spin-echo techniques in acute spinal trauma.     

磁共振弥散加权成像(DWI)在食管癌放疗中的应用进展

DWI作为MR功能成像的重要组成部分,可以提供定性和定量的信息以帮助肿瘤评估,更好的区分食管病灶及纵隔淋巴结转移。DWI-CT融合图像更有利于靶区勾画。在食管癌的放疗或同步放化疗中,监测ADC值变化有助于早期疗效预测和预后判断,DWI检查能弥补单纯依据造影评价食管癌近期疗效的不足。本文综述了DWI在食管癌诊断、靶区勾画、疗效评估及判断预后等在放疗中的应用进展。     

磁共振弥散加权成像在肺癌中的应用

磁共振弥散加权成像(DWI)作为一种无辐射、无创伤的检查手段,对肺癌的诊断及分期有很大帮助,其表观弥散系数(ADC)的测定对肺癌的疗效评估也显示出较高的临床应用价值.作为CT的补充手段,MRI-CT图像融合使肺癌放疗靶区勾画更为准确.     

The use of magnetic resonance imaging for image-guided brachytherapy

Progress has been made in the delivery of brachytherapy, from low-dose rate (LDR) to high-dose rate (HDR) treatments, allowing for dose optimisation, conformal treatments, improved radiation protection, and improved accuracy and efficiency. Image-guided brachytherapy, incorporating spatial and temporal changes, is now possible with advanced imaging and treatment technology. This report reviews the evidence for the benefits of image-guided brachytherapy using magnetic resonance imaging (MRI), mainly for cervix and prostate cancer, but also possibilities for other tumour sites. It also emphasises the need for a dedicated MRI unit for brachytherapy.     

Characterization of a novel transplantable orthotopic rat bladder transitional cell tumour model

An animal tumour model that mimics the human counterpart is essential for preclinical evaluation of new treatment modalities. The objective of this study was to develop and characterize such a model. To accomplish this, the established AY-27 rat bladder transitional cell carcinoma (TCC) cell line was transplanted orthotopically into Fischer CDF344 female rats. AY-27 TCC cells were grown in monolayer cell culture and instilled intravesically as single cell suspensions into bladders that had been conditioned with mild acid washing. Tumour growth was assessed weekly by subjecting the rats to magnetic resonance imaging (MRI). At intervals following implantation and MRI tumour detection, the animals were sacrificed for necropsy, histological examination and immunocytochemical studies. Flow cytometry was also performed for detection of Fas or Fas-ligand expression on AY-27 cells. The overall tumour establishment was 95% (97/102 rats) at 12-50 days, while in a subgroup of animals sacrificed at 16 days, 80 out of 82 animals (97%) developed TCC, the majority of which was superficial. Tumour stage was assessed by gross pathology and light microscopy. Histological examination of the tumour specimens confirmed the presence of grade II-III TCC. Immunocytochemistry confirmed that the tumour model maintained the features of TCC. The changes seen on MRI correlated well with the extent of tumour invasion identified histologically. Patchy carcinoma in situ could be detected histologically 12-13 days post-inoculation, and progressed to papillary tumour or invasive disease thereafter. Neither Fas nor Fas-ligand was expressed on AY-27 cells. The orthotopic AY-27 TCC model is highly reproducible and is ideal for preclinical studies on experimental intravesical therapies.     

Evaluation of gall bladder carcinoma with dynamic magnetic resonance imaging and magnetic resonance cholangiopancreatography

The objective of this study is to evaluate the efficacy of dynamic MRI with magnetic resonance cholangiopancreatography (MRCP) in the preoperative assessment of gall bladder carcinoma. Magnetic resonance imaging and MRCP were carried out in 15 patients with gall bladder carcinoma before surgery and the imaging findings correlated with surgical and pathological findings. Gall bladder carcinoma manifested as focal or diffuse wall thickening in 73% (11/15) and as a mass replacing the gall bladder in 27% (4/15). All tumours showed enhancement in the early phase, which persisted into the delayed phase. The sensitivity and specificity of MRI with MRCP in detecting hepatic invasion, lymph node metastasis and bile duct invasion was 87.5 and 86%, 60 and 90%, and 80 and 100%, respectively. Magnetic resonance imaging correctly diagnosed duodenal invasion in only 50% and in none of the two patients with peritoneal metastasis. In conclusion, dynamic MRI with MRCP is an accurate and a reliable method of showing gall bladder carcinoma and in assessing its local and regional extent as part of preoperative assessment.     

Preoperative breast magnetic resonance imaging in early breast cancer

BACKGROUND:

Accelerated partial breast irradiation (APBI) of patients with early breast cancer is being investigated on a multi‐institutional protocol National Surgical Adjuvant Breast and Bowel Project (NSABP) B‐39/RTOG 0413. Breast magnetic resonance imaging (MRI) is more sensitive than mammography (MG) and may aid in selection of patients appropriate for PBI.

METHODS:

Patients with newly diagnosed breast cancer or ductal carcinoma in situ (DCIS) routinely undergo contrast‐enhanced, bilateral breast MRI at the Cleveland Clinic. We retrospectively reviewed the medical records of all early‐stage breast cancer patients who had a breast MRI, MG, and surgical pathology data at our institution between June of 2005 and December of 2006. Any suspicious lesions identified on MRI were further evaluated by targeted ultrasound ± biopsy.

RESULTS:

A total of 260 patients met eligibility criteria for NSABP B‐39/RTOG 0413 by MG, physical exam, and surgical pathology. The median age was 57 years. DCIS was present in 63 patients, and invasive breast cancer was found in 197 patients. MRI identified suspicious lesions in 35 ipsilateral breasts (13%) and in 16 contralateral breasts (6%). Mammographically occult, synchronous ipsilateral foci were found by MRI in 11 patients (4.2%), and in the contralateral breast in 4 patients (1.5%). By univariate analysis, lobular histology (infiltrating lobular carcinoma [ILC]), pathologic T2, and American Joint Committee on Cancer stage II were significantly associated with additional ipsilateral disease. Of patients with ILC histology, 18% had ipsilateral secondary cancers or DCIS, compared with 3% in the remainder of histologic subtypes (P = .004). No patient older than 70 years had synchronous cancers or DCIS detected by MRI.

CONCLUSIONS:

Breast MRI identified synchronous mammographically occult foci in 5.8% of early breast cancer patients who would otherwise be candidates for APBI. Cancer 2009. © 2009 American Cancer Society.     

Case report of male breast cancer detected on magnetic resonance imaging

Male breast cancers (MBC) are rare, accounting for <1% of all breast cancers. The use of magnetic resonance imaging (MRI) for male breast cancer is not generally indicated. We present an unusual case where conventional imaging for a suspected MBC was equivocal and MRI was required to assist in diagnosis.     

Vascular perfusion of human lung cancer in a rat orthotopic model using dynamic contrast-enhanced magnetic resonance imaging

Lung cancer is the leading cause of death among cancers. Early detection and diagnosis present a major goal in the efforts to improve survival rates of lung cancer patients. Changes in angiogenic activity and microvascular perfusion properties in cancers can serve as markers of malignancy. The aim of this study was to employ MRI means to measure the microvascular perfusion parameters of orthotopic nonsmall cell lung cancer, using the experimental rat model. Anatomical and dynamic contrast-enhanced lung images were acquired at high spatial resolution, and registered and analyzed, pixel by pixel and globally, by means of a model-based algorithm. The MRI output yielded color-coded parametric images of the influx and efflux transcapillary transfer constants that indicated rapid microvascular perfusion. The transfer constants were about 1 order of magnitude higher than those found in other tumors or in nonorthotopic lung cancer, with the influx constant median value of 0.42 min(-1) and the efflux constant median value of 1.61 min(-1). The rapid perfusion was in accord with the immunostaining of the capillaries, which suggested the tumor exploitation of the existing alveolar vessels. The results showed that high resolution, dynamic, contrast-enhanced MRI is an effective tool for the quantitative measurement of spatial and temporal changes in lung cancer perfusion and vasculature.     

An orthotopic implantation mouse model of human malignant pleural mesothelioma for in vivo photon counting analysis and evaluation of the effect of S‐1 therapy

Human malignant pleural mesothelioma (HMPM) is an aggressive neoplasm that is highly resistant to conventional therapies. We established 3 HMPM cell lines (TCC‐MESO‐1, TCC‐MESO‐2 and TCC‐MESO‐3) from Japanese patients; the first 2 from the primary and metastatic tumors of a patient with the epithelioid type of HMPM, and the third from a patient with biphasic characteristics of the tumor (epithelioid and sarcomatous phenotypes). The 3 cell lines resembled the original HMPMs in their morphological and biological features, including the genetic alterations such as lack of p16 expression and mutation of p53. Their tumorigenicity was determined in SCID mice by orthotopic implantation (20–46%). The tumorigenicity of the HMPM cell lines, which was relatively low, was enhanced by repeated subcultures and orthotopic implantations, and 3 competent tumorigenic sublines were produced (Me1Tu, Me2Tu and Me3Tu sublines from the TCC‐MESO‐1, TCC‐MESO‐2 and TCC‐MESO‐3 cell lines, respectively). The resultant HMPM sublines efficiently generated tumors in the SCID mice (100%) following orthotopic implantation. SCID mice implanted with the competent sublines, into one of which the luciferase gene was introduced, displayed quantitative fluctuation of the bioluminescence for the tumor volume in vivo. Oral administration of S‐1, an anticancer agent, suppressed the proliferation of the luciferase gene‐expressing Me1Tu subline in the mouse models in vivo, with a treated‐to‐control ratio of the mean tumor volume of 0.2. The orthotopic implantation mouse model proved to be useful for quantitative evaluation of the efficacy of novel anticancer drugs and also for studying the biology of HMPMs in vivo.     

磁共振弥散加权成像在食管癌精确放疗中的应用价值

目的 探讨磁共振弥散加权成像(DWMRI)技术在食管癌精确放疗中的应用价值。方法 2010—2011年经病理证实食管癌患者 37例,放疗前均在CT机及MRI机下定位并靶区勾画。比较DWMRI与食管钡餐造影、食管镜、CT所示食管病变长度差异及CT与DWMRI所示病变最大横径、体积差异。正态分布且方差齐性资料用方差分析和配对t检验。结果 食管钡餐造影、食管镜、CT、DWMRI所示病变长度分别为5.70、6.06、7.97、5.79 cm,CT与其他3种方法所示病变长度均不同(F=4.88,P=0.003);DWMRI、CT所示病变最大横径分别为3.79、3.81 cm (t=－0.32,P=0.751),所示大体肿瘤体积分别为45.75、38.05 cm³(t=5.30,P=0.001)。CT与DWMRI共同诊断53个淋巴结转移,DWMRI排除25个CT诊断阳性的淋巴结,15个淋巴结DWMRI显示高信号而CT诊断阴性,其中6个为食管旁淋巴结。DWMRI使 6例患者的临床分期发生改变。结论 DWMRI所示病变长度与食管钡餐造影结果最为接近;DWMRI易发现与食管粘连的食管旁沟肿大淋巴结,DWMRI可使部分患者靶区范围和临床分期发生改变。     

功能磁共振在食管癌应用的研究进展

目的：近些年,功能影像技术发展迅速,寻找一种准确可靠、价格合理且适宜临床推广的影像学技术成为当前研究的热点。本研究总结国内外功能磁共振成像技术在食管癌中的应用,探讨功能磁共振在食管癌诊断、治疗中的价值。方法应用 PubMed 及 CNKI 期刊全文数据库检索系统,以“食管癌、功能磁共振、磁共振动态增强、磁共振弥散加权和磁共振波谱”为关键词,检索2000-01－2015-01的中英文文献,纳入标准：（1）功能磁共振在食管癌诊断中的应用;（2）功能磁共振在食管癌疗效评价中的应用;（3）功能磁共振在食管癌预后评估中的应用。符合分析的文献56篇。结果功能磁共振在食管癌中的应用涉及磁共振动态增强成像、磁共振弥散加权成像和磁共振波谱成像,其中磁共振动态增强和磁共振弥散加权成像通过对组织血流灌注特征及水分子运动特征的分析,可用于早期评估肿瘤组织新生血管生成情况、放化疗疗效及预后,磁共振波谱成像可从分子水平上反映离体肿瘤组织生化代谢信息,在体研究仍需大量的前瞻性实验获取可靠的数据。结论功能磁共振在食管恶性肿瘤的诊断、疗效判断、预后评估中应用价值明显。     

A review of magnetic resonance imaging in spinal trauma

One hundred and ninety-five magnetic resonance (MR) images (1.5 Tesla) of 167 patients with neurological impairment following spinal trauma were reviewed. Acute cord injury produces central haemorrhagic necrosis that extends transversely and longitudinally with time and increased injury severity. Oedoma is more homogeneous, extensive and dominant in minimal lesions. Magnetic resonance appearances correlate with neurological status and outcome. Patients with MR evidence of cord blood had severe clinical lesions and failed to show useful clinical improvement. Patients with homogeneous ‘oedema’improved to useful function. Lesion signal inhomogeneity relates to a worse prognosis. The clinical level correlates closely with cord blood or signal in homogeneity but imprecisely with homogeneous oedema. Disc herniations require differentiation from epidural blood and venous engorgement, which are prominent with bone displacement. Magnetic resonance is recommended in incomplete cord syndromes and in cord injuries with no apparent fracture, particularly if clinically deteriorating. Chronic injury consists of cavitation, extensive gliosis, cord atrophy and leptomeningeal fibrosis. Progressive myelopathy may result from cystic or non-cystic intramedullary lesions. Cord cysts are common and cyst fluid signal should closely follow cerebrospinal fluid. Turbulent cyst fluid motion is commoner in larger cysts and may predict those cysts more prone to propagate. Progressive syrinxes show typical appearances, usually with transverse septa. Atrophy and propagating syrinxes usually take years to develop. Leptomeningeal cysts and spinal stenosis caused by bone displacement and accelerated adjacent disc disease may cause late deterioration. In progressive myelopathy following injury, surgically drainable cysts are clearly differentiable from cord gliosis and atrophy.     

鼻咽癌淋巴结转移规律的MRI分析

目的:探讨鼻咽癌淋巴结转移的规律。方法:收集2005年10月至2006年8月经病理证实初诊的鼻咽癌204例,全部经鼻咽部和颈部MRI扫描,采用2003年RTOG推荐的颈部淋巴结的分区标准,分析鼻咽癌淋巴结的转移规律。结果:204例中185例(90.7%)伴淋巴结转移,其中4例(2.2%)仅有咽后淋巴结转移,48例(25.9%)仅有颈部淋巴结转移,133例(71.9%)为咽后及颈部淋巴结均有转移。在各区的分布是Ⅰa区0例,Ⅰb区12例(6.5%),Ⅱa区77例(41.6%),Ⅱb区179例(96.8%),Ⅲ区67例(36.2%),Ⅳ区21例(11.4%),Ⅴ区59例(31.9%),Ⅵ区0例,咽后区137例(74.1%),耳前区2例(1.1%)。1例(0.5%)发生跳跃性转移。不同T分期淋巴结转移率差异无统计学意义,局部早期(T1～T2)和局部晚期(T3～T4)病变淋巴结转移分布之间差别无统计学意义。咽后淋巴结转移与T、N分期之间差别无统计学意义。结论:鼻咽癌淋巴结转移率高,以咽后淋巴结、颈上深组淋巴结最多见,跳跃性转移低。不同T分期淋巴结转移率无明显差别,淋巴结转移的分布与T分期无关。咽后淋巴结转移与T、N分期无关。