MRI评价乳腺癌腋窝淋巴结转移的价值

目的：探讨 MRI评估乳腺癌腋窝淋巴结转移的应用价值。方法对60例乳腺癌患者进行术前 MRI检查,评价乳腺内肿瘤最大径、瘤体最大信号增强率(SERmax )及同侧腋窝淋巴结的大小、形态、边缘、信号强度和强化方式,并与术后同侧腋窝淋巴结状态进行对照分析。结果60例乳腺癌患者 MRI显示28例同侧腋窝淋巴结有转移,病理证实22例腋窝淋巴结有转移。MRI 检出腋窝淋巴结转移的灵敏度、特异度、准确率为90.91%、78.95%、83.33%。57例同时行超声检查,超声检查诊断淋巴结转移的灵敏度、特异度、准确率分别为59.09%、94.29%、80.70%。腋窝淋巴结转移组淋巴结大小(1.20±0.59)cm,无转移组淋巴结大小(0.85±0.24)cm,2组间腋窝淋巴结大小差异有统计学意义(t=3.258,P=0.001<0.05)。腋窝淋巴结无转移与有转移组间乳腺内肿瘤 SERmax值差异有统计学意义(t=4.167,P=0.000<0.05),转移组 SERmax值大于无转移组。转移性淋巴结多表现为形态不规则,边缘不规整,信号强度及强化不均匀。结论乳腺 MRI能在检出乳腺癌的同时全面评价腋窝淋巴结,是术前评估腋窝淋巴结状态的有效检查方法。     

腋窝淋巴结分析在乳腺疾病诊断中的价值

目的 探讨乳腺X线摄影中腋窝淋巴结特点对于乳腺疾病诊断的价值.方法 对乳腺疾病患者行乳腺X线摄影检查,筛选出腋窝淋巴结显影者46例,其中乳腺癌20例,良性病变26例,比较显影淋巴结的位置、数目、大小、密度、形态.结果 26例乳腺良性疾病的腋窝淋巴结有16例单侧显影,10例双侧显影,数目2枚以上多发者15例,直径≥1 cm者13例,高密度6例,中等密度20例,所有淋巴结边缘均未见分叶改变;20例乳腺癌的腋窝淋巴结有12例为双侧显影,8例单侧显影,15例多发,直径≥1 cm者13例,高密度16例,边缘分叶状改变4例,实心圆12例.2组间的淋巴结在密度上有显著统计学差异,在位置、数目、大小上无统计学意义.同时在形态上乳腺癌的腋窝淋巴结以分叶和实变占明显优势.结论 腋窝淋巴结的密度和形态与乳腺疾病的良恶性有一定的相关性,可以作为2类疾病鉴别诊断的辅助指标.     

乳腺MRI用于乳腺癌病人术前腋窝淋巴结评估:能否除外进展期淋巴结病变?

<正>摘要目的评价乳腺MRI在术前评估乳腺癌病人腋窝淋巴结转移(ALNM)的价值,并评价乳腺MRI是否可以用于排除进展期淋巴结病变。方法本研究共纳入425例病人,并     

MRI在乳腺癌腋窝前哨淋巴结转移的诊断价值

【摘要】目的：探讨MRI在乳腺癌腋窝前哨淋巴结（SLN）转移中的诊断价值。方法：回顾性分析2015年1月-2017年6月在我院就诊的85例乳腺癌患者的临床资料及MRI影像学资料。采用秩和检验比较MRI检查和美兰示踪法检出SLB的数目、采用Spearman分析两种方法检出SLB的相关性，评估MRI诊断乳腺癌腋窝前哨淋巴结转移的敏感性、特异性和准确度。结果：85例患者，MRI检查定位145枚M-SLN，美兰示踪定位167枚D-SLN，两种方法检出的SLB的数目比较差异有统计学意义（P＜0.05），但两种方法存在明显相关性（Rs=0.773，P＜0.05）。MRI诊断M-SLN阳性92枚，阴性53枚，良恶性淋巴结的形态大小（长/短径）、淋巴门是否存在、周围脂肪间隙、DWI信号和ADC值、强化程度等方面的差异具有统计学意义（P＜0.05）。MRI诊断乳腺癌腋窝前哨淋巴结转移的灵敏度为95.8%（91/95），特异度为98.0%（49/50），准确度为96.6%（140/145）。结论：MRI具有无辐射、软组织对比好、安全性高等优点，诊断乳腺癌腋窝前哨淋巴结转移的准确度较高，可成为临床专科医师术前常规检查方法。     

乳腺疾病的CT诊断

目的明确乳腺疾病的ＣＴ征象，评价ＣＴ扫描在乳腺癌及腋窝淋巴结转移诊断中的价值。材料与方法报告乳腺疾病５３例，包括乳腺癌３０例，良性疾病２３例，均行ＣＴ扫描，其中４４例同时进行钼靶摄影。结果（１）乳腺癌ＣＴ表现为：圆形、椭圆形或不规则形肿块，边缘毛刺，导管牵拉征，库伯韧带受累，局部皮肤胸壁浸润及周围脂肪间隙变形。良性疾病：单纯增生表现为不规则形肿块及患侧腺体增厚；囊性增生典型表现为多发圆形含液体密度囊肿。（２）ＣＴ与钼靶摄影结果相比较，两者在良恶性乳腺疾病的鉴别方面具有相同价值。但在肿块靠近腋窝或胸壁等情况下，ＣＴ较钼靶更为实用；并且ＣＴ有助于乳腺癌腋窝淋巴结转移的诊断。结论ＣＴ扫描在乳腺病变的发现、病变良恶性的鉴别诊断以及腋窝淋巴结转移的诊断方面有很大价值。     

乳腺疾病的MRI诊断

目的：探讨乳腺疾病的MRI平扫与增强扫描的影像特点。方法：收集乳腺疾病33例，其中乳腺癌12例，良性病变18例，隆乳术后患者3例，均行MRI扫描，22例同时进行钼靶摄影。结果：①乳腺癌MRI表现为：形态不规则结节或肿块，边缘分叶或毛刺，增强扫描多呈不均匀强化，毛刺样结构显示更清晰。②良性病变：纤维腺瘤病灶呈圆形或类圆形，边缘光滑，无毛刺样结构，增强后均匀强化；乳腺增生表现为乳腺腺体增厚，形态规则。③MRI与钼靶结果比较，MRI在发现病灶，了解病变范围以及显示淋巴结转移方面优于钼靶。结论：MRI是评价乳腺疾病的一种有效的影像学方法。     

腋窝淋巴结的钼靶X线表现及其对乳腺疾病的诊断价值

目的：探讨数字化乳腺摄影腋窝淋巴结的X线表现及其对乳腺疾病的诊断价值。材料和方法：回顾性分析130例（196侧）经数字化乳腺摄影发现腋窝淋巴结的病例，用高精度医用显示器观察乳腺及腋窝的淋巴结数目、大小、形态、密度、边界及临近组织结构。结果：正常乳腺、乳腺增生改变、纤维腺瘤及囊肿的腋窝淋巴结数目、大小范围跨度大，形态多样，密度多数不均匀，边界清楚，临近组织结构清晰。乳腺恶性肿瘤的转移性淋巴结表现为椭圆或圆形，患侧淋巴结数目较少，密度高且均匀，边界模糊，其周围常有增粗的网格样或条索样影。结论：乳腺增生改变、纤维腺瘤及囊肿的腋窝淋巴结与正常乳腺的腋窝淋巴结无法明确区分。腋窝淋巴结的良、恶性鉴别应重点依据淋巴结的密度、边界、形态及临近组织结构的X线表现，而其数目、大小指标仅能做为辅助的鉴别参考。     

乳腺癌MRI诊断的临床应用价值

目的 评价MRI在乳腺癌临床诊断中的应用价值。资料与方法 30例临床或乳腺X线摄影诊断有困难的患者行乳腺和腋窝MRI检查，17例经组织病理证实为乳腺癌，分析MRI显示乳腺癌病灶和胸肌浸润以及淋巴结转移的敏感性，所有结果均与病理对照。结果 17例乳腺癌患者共检出35个病灶，包括6例多中心性乳腺癌、4例多灶性乳腺癌和7例单发病灶(包括2例隐匿性乳腺癌)。6例(35．3％)出现胸肌浸润；腋窝淋巴结转移11例，其中9例病理证实，其敏感性为81．8％。结论乳腺MRI对检出隐匿性乳腺癌，多灶性和多中心性乳腺癌，评估胸肌有无浸润以及腋窝淋巴结有无转移具有重要价值。     

乳腺钼靶摄影对腋窝淋巴结的定性价值

目的 评价乳腺钼靶摄影显示腋窝淋巴结增大在乳腺疾病诊断中的价值.方法 对79例女性乳腺疾病患者行乳腺钼靶摄影检查,全部病例行常规乳腺轴、斜位投照,部分病例加照腋下加压位.分析其淋巴结X线特点,并与病理结果进行对照.结果 79例中,乳腺癌46例、纤维腺瘤7例、浆细胞乳腺炎2例,脂肪瘤2例、乳管内乳头状瘤2例,乳腺增生症20例.33例乳腺良性疾病(乳腺增生病、纤维腺瘤、脂肪瘤等)双侧腋窝淋巴结显影12例,数目1～5枚,31例直径﹤2 cm,13例有偏心性脂肪中心,周围脂肪线清晰;46例乳腺癌淋巴结中43例仅为患侧显影,数目1～4枚,17例直径≥2.0 cm,全部淋巴结致密均匀,周围脂肪线消失.并且2组间在淋巴结位置、数目、直径、密度上均有统计学差异.结论 乳腺癌和乳腺良性疾病的钼靶X线显示的腋窝淋巴结各有其特点,两者具有一定的影像学差异,可以作为2类疾病鉴别诊断的辅助指标.     

乳腺癌动态增强MRI表现与腋窝淋巴结转移及ER、PR的关系

目的探讨乳腺癌MRI表现与腋窝淋巴结转移及雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)的关系。方法选取我院乳腺癌患者83例,根据患者有无腋窝淋巴结转移、病理类型、ER、PR表达情况进行分组,分析增强MRI表现与其之间的关系。结果有腋窝淋巴结转移者与无腋窝淋巴结转移者增强MRI表现中边缘特征、早期强化模式差异有统计学意义(P<0.05)。83例乳腺癌患者其病理类型分别为浸润性导管癌55例、浸润性小叶癌8例、黏液癌20例;三种病理类型根据分析结果显示:其在边缘特征、早期强化模式、延迟期时间-信号强度曲线类型等增强MRI表现差异有统计学意义(P<0.05)。ER阳性、阴性者根据其增强MRI表现,在边缘特征、内部强化方式之间差异有统计学意义(P<0.05);PR阳性、阴性者其增强MRI表现在边缘特征、早期强化模式之间差异有统计学意义(P<0.05)。结论有腋窝淋巴结转移的患者与增强MRI表现边缘特征、早期强化模式有关;病理类型与边缘特征与强化模式有关;ER阳性与边缘特征与内部强化方式有关、PR阳性与边缘特征、早期强化模式有关。     

Axillary lymph node metastases in breast cancer: preoperative detection with dynamic contrast-enhanced MRI

Metastatic involvement of axillary lymph nodes is one of the most important prognostic variables in breast cancer. The aim of our work was to study the value of dynamic contrast-enhanced MR imaging in revealing axillary lymph node metastases from breast cancer. A total of 65 patients with invasive breast cancer treated with axillary lymph node dissection were preoperatively evaluated by MRI. T1-weighted dynamic contrast-enhanced 3D images were acquired using a coil covering the breast and the axilla. The dynamic contrast enhancement, size, and morphology of the axillary lymph nodes were registered. Histopathological examination revealed axillary lymph node metastases in 24 patients. When using a signal intensity increase in the lymph nodes of > 100 % during the first postcontrast image as a threshold for malignancy, 57 of 65 patients were correctly classified (sensitivity 83 %, specificity 90 %, accuracy 88 %). These results were not improved when lymph node size and morphology were used as additional criteria. Axillary lymph nodes can be evaluated as a part of an MR-mammography study without substantial increase in examination time, and provide the surgeon with knowledge about the localization of possible metastatic lymph nodes. Received: 25 February 1999; Revised: 3 August 1999; Accepted: 27 January 1999     

Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison

PURPOSE: To evaluate signal intensity and border characteristics of lymph nodes at high-spatial-resolution magnetic resonance (MR) imaging in patients with rectal cancer and to compare these findings with size in prediction of nodal status. MATERIALS AND METHODS: Forty-two patients who underwent total mesorectal excision of the rectum to determine if they had rectal carcinoma were studied with preoperative thin-section MR imaging. Lymph nodes were harvested from 42 transversely sectioned surgical specimens. The slice of each lymph node was carefully matched with its location on the corresponding MR images. Nodal size, border contour, and signal intensity on MR images were characterized and related to histologic involvement with metastases. Differences in sensitivity and specificity with border or signal intensity were calculated with CIs by using method 10 of Newcombe. RESULTS: Of the 437 nodes harvested, 102 were too small (<3 mm) to be depicted on MR images, and only two of these contained metastases. In 15 (68%) of 22 patients with nodal metastases, the size of normal or reactive nodes was equal to or greater than that of positive nodes in the same specimen. Fifty-one nodes were above the area imaged, and seven of these contained metastases. The diameter of benign and malignant nodes was similar; therefore, size was a poor predictor of nodal status. If a node was defined as suspicious because of an irregular border or mixed signal intensity, a superior accuracy was obtained and resulted in a sensitivity of 51 (85%) of 60 (95% CI: 74%, 92%) and a specificity of 216 (97%) of 221 (95% CI: 95%, 99%). CONCLUSION: Prediction of nodal involvement in rectal cancer with MR imaging is improved by using the border contour and signal intensity characteristics of lymph nodes instead of size criteria.     

Sentinel lymph node after intramammary injection of superparamagnetic iron oxide

The purpose of this study was to evaluate enhancement (signal loss) of the axillary lymph nodes on MR lymphography after intramammary injection of superparamagnetic iron oxide (Ferumoxides) for detection of the sentinel lymph node. MR lymphography was performed in a total of 11 patients with breast cancer without palpable axillary lymph node swelling before operation. Coronal and axial images were obtained before and after intramammary injection of 1.5 ml Ferumoxides adjacent to the breast tumor. In all patients, decreased intensity was recognized in the axillary lymph nodes. MR lymphography could detect the sentinel lymph node with its decreased signal intensity 20 minutes after the intramammary injection of Ferumoxides.     

Simultaneous bilateral breast and high-resolution axillary MRI of patients with breast cancer: preliminary results

OBJECTIVE: The aims of this study were to develop a standardized one-step procedure for simultaneous high-resolution MRI of the axilla and bilateral breast MRI and to identify nodal features suggestive of metastatic involvement. SUBJECTS AND METHODS. We studied 16 women undergoing axillary lymph node dissection after combined bilateral breast MRI and high-resolution MRI of the axilla with a maximum in-plane resolution of 0.6 x 0.4 mm. MRI was performed using a standard double breast coil and a 15-cm round flexible surface coil adapted to the axilla. High-resolution axillary sequences, including inversion recovery T2- and spin-echo T1-weighted sequences, were performed before and after gadolinium chelates bolus injection. Axillary image analysis focused on nodal morphology including size, contour regularity, cortex and hilar appearance, signal intensity, and enhancement parameters. Axillary MRI findings were compared with the final pathogic results from axillary lymph node dissection in all patients. Patients were divided into groups according to the final pathologic axillary status. Differences in MRI lymph node features across the groups were tested using a t test for quantitative data and the chisquare test or Fisher's exact test for binary data. RESULTS: The features of the axilla on high-resolution MRI that best discriminated between patients with positive pathologic findings and those with negative pathologic findings were the presence of nodes with irregular contours (p < 10(-4)), high signal intensity on T2 sequences (p < 10(-3)), marked gadolinium enhancement (p < 10(-3)), and round hila and abnormal cortexes (p < 0.05). CONCLUSION: Breast tissue and axillary lymph nodes both can be analyzed on MRI in a one-step process using a bilateral breast coil combined with a surface coil. Morphologic features observed on high-resolution MRI of the axilla can improve the identification of metastatic nodes.     

超声多参数回归模型评估乳腺癌腋窝淋巴结转移的价值

目的：建立以乳腺癌腋窝淋巴结超声诊断特征为变量的Logistic回归模型,评价常规超声及实时弹性成像技术对乳腺癌腋窝淋巴结有无转移鉴别诊断的价值。方法对病理证实的112例乳腺癌患者的113个腋窝淋巴结的常规超声及弹性成像各因素进行综合分析,建立二分类Logistic回归模型,通过绘制ROC曲线评价模型的诊断效能。结果在纳入的113个淋巴结中,术后病理证实28个无转移,85个有转移。经过前进法Logistic回归分析,筛选出弹性应变率比值（ SR）、弹性评分及形态等3个指标对乳腺癌腋窝淋巴结转移诊断有统计学意义的特征变量。 Logistic回归模型对乳腺癌腋窝淋巴结转移预报的正确率为93．8％, ROC曲线下面积为0．962。结论二分类Logistic回归模型对腋窝淋巴结性质有较好的诊断效能,弹性成像提高了常规超声诊断腋窝淋巴结的准确度。     

小乳癌的数字化乳腺摄影与超声成像对比研究

目的探讨数字化乳腺摄影与彩色多普勒超声对小乳癌及腋淋巴结转移的诊断价值。方法60例≤2.0cm(包括未形成肿块的早期乳腺癌)乳腺结节的数字化影像和超声资料分别由影像和超声医师用双盲法分析,定性诊断,并与病理对照。结果60例中,乳腺癌36例,良性病变24例;发现腋淋巴结96个,45个有转移。数字化摄影和超声在诊断小乳癌的敏感性、准确性及腋淋巴结转移的敏感性方面,二者差异显著(P(0.05);对直径≤1.0cm的病灶,数字化摄影的准确性明显高于超声(P(0.05)。结论对小乳癌及其腋淋巴结的定性诊断方面,数字化摄影为首选,二者结合有利于发现更早期的乳腺癌。     

人乳腺珠蛋白mRNA在腋窝淋巴结及外周血中的表达规律及其临床意义

目的探讨人乳腺珠蛋白mRNA（hMAM mRNA）在乳腺癌组织、腋窝淋巴结及外周血中表达的意义。方法应用实时荧光定量PCR（RQ-PCR）技术检测乳腺癌组织、腋窝淋巴结及外周血中hMAMmRNA的表达情况,并取乳腺良性肿瘤、健康志愿者外周血作为阴性对照。结果（1）在15例新鲜乳腺癌组织中有14例hMAM mRNA表达阳性,表达的敏感性为93%,在乳腺良性肿瘤及非乳腺组织中不表达;（2）在30例腋窝淋巴结中hMAM mRNA总的阳性表达率63%,其中病理阳性淋巴结hMAM mRNA的表达率为94.4%,病理阴性的淋巴结hMAM mRNA的表达为25%;（3）54例乳腺癌患者外周血中hMAM mRNA的阳性表达率为29%;其中Ⅰ期10%,Ⅱ期21%,Ⅲ期45%,Ⅳ期80%。20例乳腺纤维瘤及20例健康志愿者外周血中均未检测出hMAM mRNA的表达;hMAM mRNA的阳性表达与肿瘤临床分期有关。结论人乳腺珠蛋白是检测乳腺癌微转移的特异性指标,可以反映乳腺癌患者微转移情况,对患者预后判断有重要意义。     

间质磁共振淋巴管造影在检测乳腺癌患者前哨淋巴结转移情况中的应用价值

目的探讨间质磁共振(MR)淋巴管造影与弥散加权成像(DWI)序列相结合检测乳腺癌患者前哨淋巴结转移情况的应用价值。方法选取河南大学第一附属医院2018年6月至2019年6月30例前哨淋巴结阳性乳腺癌患者,并招募30名健康志愿者作为阴性组,给予MR间质淋巴造影检查,观察乳腺癌患者淋巴管及前哨淋巴结情况,对比分析2组淋巴管走行、管径情况和前哨淋巴结数目、大小、边缘、形态及弥散系数(ADC)值的指标。结果阳性组淋巴管走行、管径与阴性组对比差异有统计学意义(P<0.05);阳性组及阴性组前哨淋巴结平均数目差异无统计学意义(P>0.05);阳性组前哨淋巴结大小、边缘、形态及ADC值的指标均有明显差异(P<0.05)。结论 MR间质淋巴管造影与DWI序列相结合可以高分辨率的显示淋巴管和淋巴结的形态和功能,提高了乳腺癌患者前哨淋巴结转移的检出率。     

Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma

OBJECTIVE: This study compares dynamic helical CT with dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. SUBJECTS AND METHODS: Women with biopsy-proven cervical carcinoma prospectively underwent dynamic helical CT and MR imaging before surgery. A metastatic node on CT and MR imaging was defined as a rounded soft-tissue structure greater than 10 mm in maximal axial diameter or a node with central necrosis. Imaging results were compared with pathology, and receiver operating characteristic curves for size and shape were plotted on a hemipelvis basis. Nodal density and signal intensity on CT and MR images, respectively, were reviewed for differences between benign and malignant disease. RESULTS: A total of 949 lymph nodes were found at pathology in 76 hemipelves in 43 women, of which 69 lymph nodes (7%) in 17 hemipelves (22%) were metastatic. Sensitivity, specificity, positive and negative predictive values, and accuracy of helical CT and MR imaging in the diagnosis of lymph node metastasis on a hemipelvis basis was 64.7%, 96.6%, 84.6%, 90.5%, and 89.5% and 70.6%, 89.8%, 66. 7%, 91.4%, and 85.5%, respectively. Receiver operating characteristic curves for helical CT and MR imaging gave cutoff values of 9 and 12 mm in maximal axial diameter, respectively, in the prediction of metastasis. Central necrosis had a positive predictive value of 100% in the diagnosis of metastasis. Signal intensity on MR imaging and density-enhancement pattern on CT in patients with metastatic nodes did not differ from those in patients with negative nodes. CONCLUSION: Helical CT and MR imaging show similar accuracy in the evaluation of pelvic lymph nodes in patients with cervical carcinoma. Central necrosis is useful in the diagnosis of metastasis in pelvic lymph nodes in cervical cancer.