Continued pemetrexed and platin-based chemotherapy in patients with malignant pleural mesothelioma (MPM): value of 18F-FDG-PET/CT

Purpose

To prospectively analyze different FDG-PET/CT-parameters (modified RECIST, SUVmax, TLG, PETvol) in patients with malignant pleural mesothelioma (MPM) under continued pemetrexed and platin based treatment.

Methods

Patients with biopsy proven MPM undergoing treatment with pemetrexed and platin based treatment were prospectively included in the study. Integrated FDG-PET/CT imaging was performed within 2 weeks before therapy and after every three consecutive cycles of combined chemotherapy. All CT-images were evaluated according to the modified RECIST (modRECIST) criteria. All FDG-PET/CT images were analyzed using SUVmax (maximum Standard Uptake Value) according to the EORTC criteria, change in Total Lesion Glycolysis (TLG) and FDG volume (PETvol). Percent change in all parameters compared to the initial, pre-therapeutic and the previous FDG–PET/CT scan. ModRECIST, EORTC guidelines, increase or decrease in TLG and PETvol was correlated with overall survival (OS) using the Log Rank Test.

Results

41 patients with MPM were prospectively included in this study. The median OS of the study population is 439 days (111–1128). 41 patients had initial staging, 41 patients completed 3 cycles, 28 patients completed 6 cycles, 19 patients completed 9 cycles, 11 patients completed 12 cycles, 5 patients completed 15 cycles, 4 patients completed 18 cycles and 1 patient completed 21 cycles of chemotherapy. Chemotherapy was well tolerated up to 21 cycles. SUVmax showed a high variance over time for individual patients and change in SUVmax using EORTC guidelines did not predict OS at any time point. Ongoing morphological response in CT using modRECIST had highest correlation with OS and predicted survival up to the 15th cycle of continued permetrexed and platin based treatment. The correlations of response of the volume based PET parameters (TLG and PETvol) and OS are inferior to the morphological modRECIST parameter.

Conclusion

Permetrexed and platin based treatment in MPM patients can be given over a prolonged time with good tolerance. Therapy response should be assessed by modRECIST in CT but not with SUVmax in FDG-PET. Long term permetrexed and platin therapy should be considered in MPM patients with good tolerance of treatment and ongoing morphological response in CT.     

Evaluation of pleural disease using MR and CT. With special reference to malignant pleural mesothelioma

Purpose: To evaluate MR imaging and CT in differentiating malignant pleural mesothelioma from other malignancies or benign pleural disease.Material and Methods: Thirty-four patients (18 pleural mesotheliomas, 9 other malignancies, 7 benign pleural diseases) were examined using enhanced CT and MR. Two radiologists reviewed the CT and two others the MR images. Comparisons were made between the diagnostic groups and the imaging methods.Results: The abnormalities commonly found in malignant disease, but significantly less frequently in benign pleural disease, were focal thickening and enhancement of interlobar fissures. In mesothelioma, enhancement of interlobar fissures, tumour invasion of the diaphragm, mediastinal soft tissue or chest wall, were significantly more often observed than in other malignancies and MR was the most sensitive method. In other malignancies, invasion of bony structures was a more common finding and was also better shown by MR. The contrast-enhanced T1 fat-suppressed (CET1fs) sequence detected these features better than other MR sequences.Conclusion: MR, especially the CET1fs sequence in three planes, gave more information than enhanced CT. Focal thickening and enhancement of interlobar fissures were early abnormalities indicating malignant pleural disease. MR could be clinically useful for differentiating mesothelioma from other pleural diseases.     

Size determination and response assessment of liver metastases with computed tomography—Comparison of RECIST and volumetric algorithms

Objective

To compare different three-dimensional volumetric algorithms (3D-algorithms) and RECIST for size measurement and response assessment in liver metastases from colorectal and pancreatic cancer.

Methods

The volumes of a total of 102 liver metastases in 45 patients (pancreatic cancer, n = 22; colon cancer, n = 23) were estimated using three volumetric methods (seeded region growing method, slice-based segmentation, threshold-based segmentation) and the RECIST 1.1 method with volume calculation based on the largest axial diameter. Each measurement was performed three times by one observer. All four methods were applied to follow-up on 55 liver metastases in 29 patients undergoing systemic treatment (median follow-up, 3.5 months; range, 1–10 months). Analysis of variance (ANOVA) with post hoc tests was performed to analyze intraobserver variability and intermethod differences.

Results

ANOVA showed significant higher volumes calculated according to the RECIST guideline compared to the other measurement methods (p < 0.001) with relative differences ranging from 0.4% to 41.1%. Intraobserver variability was significantly higher (p < 0.001) for RECIST and threshold based segmentation (3.6–32.8%) compared with slice segmentation (0.4–13.7%) and seeded region growing method (0.6–10.8%). In the follow-up study, the 3D-algorithms and the assessment following RECIST 1.1 showed a discordant classification of treatment response in 10–21% of the patients.

Conclusions

This study supports the use of volumetric measurement methods due to significant higher intraobserver reproducibility compared to RECIST. Substantial discrepancies in tumor response classification between RECIST and volumetric methods depending on applied thresholds confirm the requirement of a consensus concerning volumetric criteria for response assessment.     

Tumor response and clinical outcome in metastatic gastrointestinal stromal tumors under sunitinib therapy: Comparison of RECIST,Choi and volumetric criteria

Purpose

Purpose of the study was to compare radiological treatment response according to RECIST, Choi and volumetry in GIST-patients under 2nd-line-sunitinib-therapy and to correlate the results of treatment response assessment with disease-specific survival (DSS).

Patients and methods

20 patients (mean: 60.7 years; 12 male/8 female) with histologically proven GIST underwent baseline-CT of the abdomen under imatinib and follow-up-CTs 3 months and 1 year after change to sunitinib. 68 target lesions (50 hepatic, 18 extrahepatic) were investigated. Therapy response (partial response (PR), stable disease (SD), progressive disease (PD)) was evaluated according to RECIST, Choi and volumetric criteria. Response according to the different assessment systems was compared and correlated to the DSS of the patients utilizing Kaplan–Meier statistics.

Results

The mean DSS (in months) of the response groups 3 months after therapy change was: RECIST: PR (0/20); SD (17/20): 30.4 (months); PD (3/20) 11.6. Choi: PR (10/20) 28.6; SD (8/20) 28.1; PD (2/20) 13.5. Volumetry: PR (4/20) 29.6; SD (11/20) 29.7; PD (5/20) 17.2.Response groups after 1 year of sunitinib showed the following mean DSS: RECIST: PR (3/20) 33.6; SD (9/20) 29.7; PD (8/20) 20.3. Choi: PR (10/20) 21.5; SD (4/20) 42.9; PD (6/20) 23.9. Volumetry: PR (6/20) 27.3; SD (5/20) 38.5; PD (9/20) 19.3.

Conclusion

One year after modification of therapy, only partial response according to RECIST indicated favorable survival in patients with GIST. The value of alternate response assessment strategies like Choi criteria for prediction of survival in molecular therapy still has to be demonstrated.     

Metabolic response assessment with 18F-FDG-PET/CT is superior to modified RECIST for the evaluation of response to platinum-based doublet chemotherapy in malignant pleural mesothelioma

PurposeEfficient monitoring of tumor responsiveness to chemotherapy is essential to mitigate high mortality risks and cytotoxic effects of chemotherapeutics. However, there is no consensus on the most suitable diagnostic technique/parameters for assessing response to chemotherapy in malignant pleural mesothelioma (MPM). We compared the tumor responsiveness of MPM patients as assessed using modified RECIST (mRECIST) criteria and integrated 18F-FDG-PET/CT.MethodsHistologically confirmed MPM patients (N = 82) who were treated with three cycles of cisplatin and pemetrexed, or carboplatin and pemetrexed, were included. mRECIST and integrated 18F-FDG-PET/CT were used to evaluate MPM tumor response to chemotherapy. Metabolic non-responders were defined as those with a 25% or greater increase in SUVmax compared with the previous value. Time to progression (TTP) and overall survival (OS) were compared between metabolic-responders and non-responders.ResultsAfter three cycles of chemotherapy, 62(75.6%) of the patients were classified as having SD, 15 (18%) with partial remission (PR), and 5 (6%) with progressive disease (PD), based on mRECIST criteria. The cumulative median OS was 728.0 days (95% confidence interval [CI]: 545.9–910.1) and cumulative median TTP was 365.0 days (95% CI: 296.9–433.1). For the 82 patients, the disease control rate was 93.9%, whereas the metabolic response rate was only 71.9% (p < 0.001). All PD and PR patients were found to be metabolic responders on 18F-FDG-PET/CT; however, among the 62mRECIST SD patients, 18 (29%) were classified as metabolic non-responders. The median TTP for metabolic responders was 13.7 months, while it was 10.0 months for non-responders(p < 0.001). Metabolic responders had a trend toward longer OS, although the difference did not reach statistical significance (metabolic responders:33.9 months; non-responders: 21.6 months; p > 0.05).ConclusionSeveral mRECIST-confirmed SD MPM patients may be classified as metabolic non-responders on18F-FDGPET/CT. Metabolic response is significantly correlated with the median TTP, suggesting it should be included in the evaluation of the response to chemotherapy in MPM patients classified as mRECIST SD, to identify non-responders.     

Subcutaneous tumor volume measurement in the awake,manually restrained mouse using MRI

Purpose:

To describe a combination of techniques using the excellent volumetric capacities of magnetic resonance imaging (MRI) while avoiding anesthesia and maintaining high‐throughput capability for tumor volume measurement in the awake mouse. This approach presents an alternative to calipers which, although cheap, fast, and easy to use, introduce many biases for tumor volume estimation.

Materials and Methods:

The murine CaNT subcutaneous xenograft model was used. A quiet and modestly T2‐weighted spin‐echo scan was acquired at 4.7T (TE = 15 msec, TR = 1100 msec, 0.5 mm isotropic resolution) while the awake mouse was held by hand in the magnet. This method was compared to standard MR in the anesthetized mouse and caliper measurements.

Results:

The combination of techniques used allows rapid, accurate, and reproducible measurement of subcutaneous tumor volumes in awake mice. It is less sensitive to both intra‐ and interoperator‐derived biases and avoids confounds from the compliance of the fat and skin around the tumor, as well as from the tumor itself. Moreover, the data remain available for retrieval and scrutiny and reanalysis.

Conclusion:

Rapid, accurate, and precise tumor volumetry can be performed in the awake mouse by handheld positioned MR. J. Magn. Reson. Imaging 2013;37:1499–1504. © 2012 Wiley Periodicals, Inc.     

Evaluation of inter-observer variability according to RECIST 1.1 and its influence on response classification in CT measurement of liver metastases

ObjectiveThe aim of this study is the evaluation of inter-observer variability in the measurement of liver metastases according to RECIST and its influence on response classification.Patients and methodsA total of 100 radiologists measured liver target lesions, on pre- and post-chemotherapy CT scans of three patients. Each observer filled out a questionnaire about his personal and work features. The evaluations of a well experienced radiologist, considered as “the gold standard”, were compared to those taken by the observers.The percentage of the observers in agreement with the reviewer, in terms of the response category and in terms of inter-observer variability, was calculated for each patient.ResultsThe percentage of the inter-observer agreement was elevated. Most of the observers in agreement with the reviewer were senior radiologists, while those who disagreed were junior radiologist, but this result did not reach a statistical significance. More than 30% of observers disagreed with the reviewer at least in one of the three cases.ConclusionsRECIST measurements are reproducible on a large and heterogeneous population of radiologists. Age and expertise of the radiologist remain the most critical factors: this suggests a revision by well-experienced radiologists in clinical trials.     

MRI in lung transplant recipients using hyperpolarized 3He: comparison with CT

PURPOSE: To elucidate the ability of 3He-MRI to detect ventilation defects in lung transplant recipients, 3He-MRI was compared to CT for concordance. MATERIALS AND METHODS: We examined 14 lung recipients using 3He-MRI on a 1.5 T MR scanner. CT served as a reference method. Up to four representative ventilation defects were defined for each lung on 3He-MRI and compared to corresponding areas on CT. RESULTS: Altogether, 59 representative ventilation defects were defined on 3He-MRI. Plausible CT correlates were found for 29 ventilation defects; less plausible CT correlates were found for eight defects. In 22 defects (37%) no corresponding CT changes were detected. CT demonstrated correlates for ventilation defects seen on 3He-MRI in only 63% of the cases. CONCLUSION: 3He-MRI yields a clear increase in the number of detected ventilation defects compared to CT. This may have an important impact on the early detection of bronchiolitis obliterans in lung transplant recipients.     

眼部病变的MRI征象及与CT的比较研究

目的：通过分析病变MRI征象，并与CT比较，加深对眼部病变MRI和CT的认识．材料和方法：53例的MRI和CT，其中43例手术证实，其余临床随访证实。结果：MRI诊断符合率为88.79％，CT77.2%，常见的眼眶病变如血管瘤，炎性假瘤、泪腺混合瘤等都具有一定信号特征．结论：本文着重讨论了眼眶病变的MRI表现，认为可以根据病变部位以及MRI信号特征对大多数的眼眶病变做出准确诊断，MRI的定性能力是肯定的．     

MRI, volumetry, 1H spectroscopy, and cerebropetal blood flowmetry in childhood idiopathic anatomic megalencephaly

PURPOSE: To evaluate cerebral abnormalities in childhood idiopathic anatomic megalencephaly (MC) by means of different magnetic resonance (MR) modalities. MATERIALS AND METHODS: MRI, volumetry, spectroscopy, and cerebropetal blood flowmetry were performed in six children with idiopathic anatomic MC, and seven volunteers. RESULTS: MRI revealed an increased ventricular system in five of six patients. A thalamic hamartoma was found in one patient and a Chiari I malformation was found in two. Volumetric analysis showed a disproportional increase of ventricular volume but normal subarachnoid cerebrospinal fluid (CSF) volume. Supratentorial volume was disproportionally increased compared to cerebellar volume. Intracranial volume correlated significantly with skull circumference. MR spectroscopy (MRS) N-acetyl aspartate/choline (NAA/Cho) peak ratios in WM were significantly higher in patients than in controls. Choline/creatine (Cho/Cr) peak ratios in WM were significantly lower in patients. Cortical gray matter (GM) MRS ratios were unaltered. Cerebropetal flow was increased in MC, possibly related to increased brain volume. CONCLUSION: This study reveals associated developmental anomalies for idiopathic anatomic MC. A relative ventriculomegaly was found, which should not be misinterpreted as true hydrocephalus. In contrast to metabolic MC, MRS showed no severe disturbances. Total intracranial volume is correlated to skull circumference and cerebropetal blood flow.     

Tuberculous adenitis: comparison of CT and MRI findings with histopathological features

Our aim was to investigate the relationship between the various histopathological features and the CT and MRI findings in routinely submitted histopathological specimens for the diagnosis of tuberculous lymphadenopathy. Twelve formalin-fixed, paraffin-embedded tissue blocks from ten patients who were clinically suspected of having tuberculous lymphadenopathy were evaluated. We assessed the presence of histopathological features including granuloma formation, caseous necrosis, and presence of Langhans-type giant cells, calcifications, fibrosis or normal lymphoid tissue. We performed polymerase chain reaction (PCR)-based assay for mycobacterial DNA and Ziehl-Neelsen staining for acid-fast bacilli (AFB). Findings were compared with those of CT and MRI, including signal intensities on unenhanced MR images, lymph node homogeneity, attenuation values on contrast-enhanced CT and enhancement patterns on MRI. Based on CT and MRI findings, four lymph node types could be defined: (1) homogeneous nodes, visible on both pre- and post-contrast images and corresponding histopathologically to granulation tissue without or with minimal caseation necrosis (n = 2); (2) heterogeneous nodes, showing heterogeneous enhancement patterns with central non-enhancing areas and corresponding to minor or moderate intranodal caseation/liquefaction necrosis (n = 3); (3) nodes showing peripheral rim enhancement and corresponding to moderate or extensive intranodal caseation/liquefaction necrosis (n = 5); (4) heterogeneous nodes showing intranodal hyperdensities on CT and hypointense areas on T1- and T2-weighted images and corresponding to fibrosis and calcifications (n = 2). On CT and MRI, the findings reflect different stages of the tuberculous process. Imaging findings depend on the presence and the degree of granuloma formation, caseation/liquefaction necrosis, fibrosis and calcifications.     

Small colorectal liver metastases: Detection with SPIO-enhanced MRI in comparison with gadobenate dimeglumine-enhanced MRI and CT imaging

The aim of this prospective study was to compare the diagnostic role of superparamagnetic iron oxide (SPIO)-enhanced liver magnetic resonance imaging (MRI) versus gadobenate dimeglumine (GbD)-enhanced MRI and computed tomography (CT) investigations for detection of small (less than 1 cm) colorectal liver metastases (LMs) of colorectal cancer. Seventy-eight LMs in 16 patients were evaluated with dynamic CT imaging, GbD-enhanced dynamic MR imaging and SPIO-enhanced MR imaging. Two radiologists were reviewed the LMs seperately. Agreement between the readers and three algorithms was analyzed. Differences between the lesion detection ratios of the methods were analyzed by two proportion z test. Sensitivity values of each modality were also calculated. Interobserver agreement values with kappa analysis were found to be the best for three modalities and kappa values were 0.866, 0.843, and 1.0 respectively. For all 78 LMs, SPIO-enhanced MRI detected all lesions (100% sensitivity). This sensitivity value was higher than GbD-enhanced MRI, and there was a significant difference (p < 0.05). GbD-enhanced MRI depicted 71 lesions and this modality could not detected 7 lesions (91% sensitivity). This modality had moderate sensitivity, and this value is greater than CT imaging, so there was a significant difference also (p < 0.05). Dynamic triphasic CT imaging detected 64 (R1) and 65 (R2) LMs. This modality had the lowest sensitivity (R1: 0.82, R2: 0.83 respectively). Only SPIO-enhanced MRI was able to detect all LMs less than 1 cm. LMs were the best detected with SPIO-enhanced MRI. We recommend SPIO-enhanced MRI to be the primary alternative modality especially for diagnosis of small colorectal LMs.     

Assessment of synovitis in the osteoarthritic knee: Comparison between manual segmentation,semiautomated segmentation,and semiquantitative assessment using contrast‐enhanced fat‐suppressed T1‐weighted MRI

Osteoarthritic joints regularly exhibit synovitis, which is ideally assessed on contrast‐enhanced MRI. Manual segmentation is the reference standard for volumetric analysis but is labor intensive. The aim was to evaluate alternative semiautomated approaches of targeted thresholding and gaussian deconvolution. Volumetric and semiquantitative synovitis assessment was compared in addition. Thirty‐two knees with osteoarthritis were scanned on a 1.5‐T system. Synovitis volumes were plotted against each other and distributions fit with linear functions. The relationship between semiquantitative scores and synovitis volumes was assessed using Spearman's correlation coefficient. Semiautomated volume measurement was more time efficient than manual segmentation and showed a high correlation with manual analysis (R² = 0.88 and 0.82). Manual segmentation was correlated with summed and with maximum semiquantitative synovitis scores (ρ = 0.71 and 0.47). In conclusion, semiautomated analysis provides comparable quantitative results when compared to manual segmentation but is approximately five times more time efficient. Semiquantitative assessment adds anatomic information on synovitis distribution. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

Semi-automated volumetric analysis of lymph node metastases in patients with malignant melanoma stage III/IV-A feasibility study

Therapy monitoring in oncological patient care requires accurate and reliable imaging and post-processing methods. RECIST criteria are the current standard, with inherent disadvantages. The aim of this study was to investigate the feasibility of semi-automated volumetric analysis of lymph node metastases in patients with malignant melanoma compared to manual volumetric analysis and RECIST. Multislice CT was performed in 47 patients, covering the chest, abdomen and pelvis. In total, 227 suspicious, enlarged lymph nodes were evaluated retrospectively by two radiologists regarding diameters (RECIST), manually measured volume by placement of ROIs and semi-automated volumetric analysis. Volume (ml), quality of segmentation (++/−−) and time effort (s) were evaluated in the study. The semi-automated volumetric analysis software tool was rated acceptable to excellent in 81% of all cases (reader 1) and 79% (reader 2). Median time for the entire segmentation process and necessary corrections was shorter with the semi-automated software than by manual segmentation. Bland-Altman plots showed a significantly lower interobserver variability for semi-automated volumetric than for RECIST measurements. The study demonstrated feasibility of volumetric analysis of lymph node metastases. The software allows a fast and robust segmentation in up to 80% of all cases. Ease of use and time needed are acceptable for application in the clinical routine. Variability and interuser bias were reduced to about one third of the values found for RECIST measurements.     

Diagnosis of colorectal hepatic metastases: comparison of contrast-enhanced CT, contrast-enhanced US, superparamagnetic iron oxide-enhanced MRI, and gadoxetic acid-enhanced MRI

Purpose:

To compare the diagnostic accuracy of contrast‐enhanced computed tomography (CE‐CT), contrast‐enhanced ultrasonography (CE‐US), superparamagnetic iron oxide‐enhanced magnetic resonance imaging (SPIO‐MRI), and gadoxetic acid‐enhanced MRI (Gd‐EOB‐MRI) in the evaluation of colorectal hepatic metastases.

Materials and Methods:

In all, 111 patients with colorectal cancers were enrolled in this study. Of the 112 metastases identified in 46 patients, 31 in 18 patients were confirmed histologically and the remaining 81 in 28 patients were confirmed by follow‐up imaging. CE‐CT, CE‐US, SPIO‐MRI, and Gd‐EOB‐MRI were evaluated. Mean (of three readers, except for CE‐US) area under the receiver operating characteristic curve (A_z), sensitivities, and positive predictive values (PPV) were calculated. Each value was compared to the others by variance z‐test or chi‐square test with Bonferroni correction.

Results:

For all lesions, mean A_z and sensitivity of Gd‐EOB‐MRI (0.992, 95% [56/59]) were significantly greater than those of CE‐CT (0.847, 63% [71/112]) and CE‐US (0.844, 73% [77/106]). For lesions ≤1 cm, mean A_z and sensitivity of Gd‐EOB‐MRI (0.999, 92% [22/24]) were significantly greater than those of CE‐CT (0.685, 26% [13/50]) and CE‐US (0.7, 41% [18/44]). Mean A_z (95% CI) of SPIO‐MRI for all lesions (0.966 [0.929–0.987]) and lesions ≤ 1 cm (0.961 [0.911–0.988]) were significantly greater than those of CE‐CT and CE‐US. Mean sensitivity of SPIO‐MRI for lesions ≤1 cm (63%, 26/41) was significantly greater than that of CE‐CT.

Conclusion:

Gd‐EOB‐MRI and SPIO‐MRI were more accurate than CE‐CT and CE‐US for evaluation of liver metastasis in patients with colorectal carcinoma. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

Primary staging of urinary bladder carcinoma: the role of MRI and a comparison with CT

Since the introduction, pelvic MRI has been considered the best non-invasive technique for primary staging of urinary bladder cancer. Before using MRI an understanding of normal and pathological MR images of the urinary bladder is essential. This review therefore describes the MR anatomy of the urinary bladder as well as the appearances of carcinoma. MRI plays an important clinical role in staging the primary tumour. In superficial tumours, clinical staging, which includes transurethral biopsy, is the best technique. For invasive tumours, MRI is superior to other techniques such as CT scanning, transvesical ultrasonography and clinical staging. A limitation of both MRI and CT scanning is their inability to recognize minimal tumour growth in the muscle layer of the bladder wall, or to differentiate between post-transurethral resection oedema and tumour. Therefore, in all patients with urinary bladder cancer staging should preferably start with MRI followed by clinical staging. Unfortunately, however, because of the high cost of this strategy, MRI has to be reserved for staging deeply invasive and superficial poorly differentiated tumours. Correspondence to: J. O. Barentsz     

囊性肾癌的超声、CT及MR影像学诊断

囊性肾癌(cysticrenal cell carcinoma,CRCC)是肾癌的一种少见类型,在病理上肿瘤细胞核分裂和肿瘤分期均较低,预后较好。其临床表现缺乏特异性,超声、CT及MR影像学表现与一般肾癌不同。目前对于囊性肾癌的术前诊断,CT和MRI扫描仍为主要检查手段。囊液密度或信号、囊壁及分隔厚薄和附壁结节、钙化、病灶与肾组织分界、假包膜及增强扫描表现等是影像诊断中观察的重点。其CT、MRI表现具有一定特征,表现典型者可做出明确诊断。     

烟雾病的DSA、CT和MRI诊断

目的：评价DSA、CT和MBJ对烟雾病的诊断价值。资料和方法：20例病人急性颅内出血起病13例，病情缓慢进展7例，20例DSA检查前有19例行CT检查，2例行MRI检查，1例在DSA检查后行MRI检查。结果：DSA检查具有下列特征性表现：①受累动脉狭窄或闭塞；②脑底部烟雾状毛细血管网；③大量的侧支循环形成。CT14例发现脑室内或蛛网膜下腔出血，3例儿童提示有脑组织内病变，2例表现正常。MRI检查可发现脑内血管性病变。结论：DSA检查是诊断本病的主要手段，具有明显的优点。CT检查对于急性病人一般只能提示出血部位，对于慢性儿童病人常能提示有脑组织内病变。MRI检查，因本组病例太少，其对本病的诊断价值有待进一步探讨。     

甲状腺癌的CT和MRI诊断

评价ＣＴ和ＭＲＩ对甲状腺癌的诊断价值。材料和方法：回顾分析临床、病理证实的５０例甲状腺癌：３８例进行ＣＴ扫描,２８例作ＭＲＩ检查,其中１６例兼作ＣＴ和ＭＲＩ检查。结果：肿瘤内出血６例（１２％）、相邻结构受侵１１例（２２％）、颈部淋巴结转移１５例（３０％）、甲状腺内囊变２６例（５２％）和钙化２４例（４８％）,对甲状腺的定性诊断有重要价值。ＣＴ对甲状腺癌内钙化的发现明显优于ＭＲＩ,对肿瘤侵犯相邻结构的显示与ＭＲＩ相仿。ＭＲＩ对肿瘤内囊变,出血和颈部淋巴结转移的发现优于ＣＴ。结论：在甲状腺癌的定性诊断上,ＭＲＩ优于ＣＴ,但若能将两者相结合,能更准确地作出甲状腺癌的诊断。