磁共振扩散加权成像联合动态增强在乳腺良恶性病变鉴别诊断中的价值

<正>以往鉴别诊断乳腺良恶性病变多采用乳腺钼靶X线、B超等,但易导致误诊、漏诊的发生[1-2]。磁共振(MRI)具有良好的软组织分辨能力,对鉴别诊断乳腺良恶性病变更为敏感。MR动态增强(DCE-MRI)及扩散加权成像(DWI)等MRI新技术已逐渐应用于临床[3-4],但二者联合应用鉴别诊断乳腺良恶性病变的文献报道相对较少。本研究探讨DCE-MRI联合DWI在乳腺良恶性病变鉴     

探讨磁共振动态增强技术(DCE-MRI)对乳腺良恶性病变的鉴别诊断价值

目的:分析磁共振动态增强技术(DCE-MRI)对乳腺良恶性病变的鉴别及诊断价值。方法:在2017年1月-2019年1月本院收治的乳腺疾病患者中选择60例作为本次的观察对象,所有患者均采取DCE-MRI扫描检测,并将其病理检测结果作为诊断金标准,对本次检测结果进行对比与分析。结果:以患者的病理检查结果作为金标准,对比其DCE-MRI检查结果发现,该检查的良性病变符合率达90.9%(20/22),恶性病变诊断符合率为100%(44/44),其诊断准确率为97.0%(64/66);DCE-MRI在乳腺良恶性病变的检查中,恶性病变与良性病变在形态、边界以及强化均匀度上均存在显著差异(P<0.05),其中恶性病变的形态不规则、边界不清晰以及强化不均匀所占比重明显高于良性病变(P<0.05)。结论:磁共振动态增强技术对乳腺良恶性病变的鉴别及诊断具有较高的应用价值,值得推广。     

乳腺触诊成像系统对乳腺病变诊断价值的初步研究

目的:探讨乳腺触诊成像系统对乳腺良恶性病变的诊断效能。方法:分析在天津医科大学肿瘤医院接受乳腺触诊成像、乳腺X线摄影和磁共振成像(magnetic resonance imaging,MRI)检查的108例患者资料。分析乳腺触诊成像的诊断效能,并进一步分析其对不同病变类型以及纤维腺体背景类型病变的诊断价值。结果:108例患者中,恶性病变76个,良性病变32个;肿块型病变57个,非肿块型病变51个;发生在致密型乳腺组61个,非致密型47个。乳腺触诊成像的各项参数中3D峰顶形状诊断效能较高。乳腺触诊成像对于肿块型病变诊断准确率为91.23%,非肿块型病变诊断准确率为70.59%。致密组中,诊断准确率为78.69%,非致密组中,诊断准确率为85.11%。结论:乳腺触诊成像对于鉴别乳腺病灶良恶性具有一定价值,主要优势表现对肿块型病变和非致密型乳腺内病变的诊断,可作为临床对乳腺病变检查的重要补充。     

磁共振扩散峰度成像在乳腺癌诊断中的研究进展

磁共振扩散峰度成像(diffusion kurtosis imaging,DKI)能够表征生物体内组织水分子的扩散受限程度及扩散的不均质性,它是基于磁共振扩散张量技术(diffusion tensor imaging,DTI)发展的一种新兴成像技术。作为一种非侵入性磁共振成像技术,扩散峰度成像由于其优异的软组织对比度和非高斯特性而越来越多地应用于乳腺病灶的诊断。近年来,乳腺癌发病率持续上升,已成为我国女性恶性肿瘤之首,而扩散峰度成像能够有效反映乳腺病灶微观结构的复杂性,在乳腺良恶性肿瘤的鉴别及乳腺癌预后评估中具有一定的价值,为临床诊疗提供信息。文章综述了DKI在乳腺良、恶性病变的鉴别诊断、乳腺癌组织学分级及与生物预后因子的关系等方面的研究进展。     

磁共振多模态影像在脑胶质瘤诊断及其分级中的应用分析

多模态磁共振是将不同功能的磁共振技术融合到为患者进行诊断和检查的一种新兴颅脑成像技术。由于具有精确度高,图像分辨率高,检查侵入性低等优势,同时还可以提供颅脑组织解剖、脑部代谢、细胞功能等信息,多模态磁共振技术已被广泛的运用到各种脑组织病变和神经疾病的诊断和治疗中。本文重点综述了多模态磁共振在诊断脑胶质瘤和对其进行分级中的应用。     

基于CAIPIRINHA-Dixon-TWIST-VIBE技术动态增强MRI对乳腺病变的定量参数分析

目的探究超快速并行采集技术(CAIPIRINHA)、水脂分离压脂技术(Dixon)及时间分辨交叉随机轨迹成像(TWIST)三种技术的容积插入法屏气扫描检查(VIBE)(CDT-VIBE)序列在超快速/高空间分辨率动态增强磁共振(DCEMRI)的可行性,并探究定量参数在乳腺病变鉴别诊断中的应用价值。方法对86例乳腺疾病的患者行3T DCE-MRI检查,采用4通道专用相控阵表面线圈,动态增强采用CDT-VIBE序列行35期扫描(空间分辨率为1 mm×1 mm×1.5 mm,时间分辨率为11.24 s)。测得所有病灶的血流动力学参数(K~(trans)、Ve、K_(ep))。对良恶性病变的定量参数进行T检验分析,并用ROC曲线对其进行诊断效能分析。结果采用CDT-VIBE序列的DCE-MRI可成功应用于病人的灌注扫描,其对于病灶边缘锐利度和内部结构特征显示较清晰。良性病变的定量参数K~(trans)、K_(ep)、Ve分别为0.22±0.11/ml、0.44±0.17/ml、0.51±0.09;恶性病变的定量参数K~(trans)、K_(ep)、V_e分别为(0.37±0.16/ml、(0.91±0.33)/ml、0.42±0.09。所有定量参数在良恶性病变之间均具有显著的统计学差异。K~(trans)诊断的敏感度、特异度、截断值、曲线下面积分别为92.3%、58.3%、0.193/ml、0.808;K_(ep)诊断的敏感度、特异度、截断值、曲线下面积分别为92.3%、75%、0.546/ml、0.922;Ve诊断的敏感度、特异度、截断值、曲线下面积分别为83.3%、66.7%、0.455/ml、0.743。结论:CDT-VIBE可以应用于乳腺高时间/空间分辨率的动态增强磁共振成像。由CDT-VIBE序列获取的定量参数K~(trans)、K_(ep)、Ve在病变诊断方面具有较高的敏感性及准确性,其中K_(ep)诊断效能最佳。     

ROC曲线分析评价超声评分在乳腺良恶性结节鉴别中的应用价值

乳腺癌在全球范围女性恶性肿瘤中的发病率已经上升到第一位[1],目前乳腺癌几乎无法预防,因此,早期发现、早期治疗对于彻底治愈至关重要,对于临床医生选择合适的治疗方式具有指导意义。超声是检查乳腺结节的主要影像学手段,随着超声检查的普及以及仪器分辨率的提高,乳腺结节的超声检出率也越来越高。并且由于超声无创、方便常为临床首选。本次研究通过乳腺结节超声诊断结果和病理结果的对比,来探讨超声在乳腺结节良恶性鉴别中的     

磁共振扩散结合灌注成像技术对可疑恶性乳腺病变的鉴别诊断价值

目的应用扩散加权成像(diffusion-weighted imaging,DWI)技术及灌注成像技术对钼靶诊断为乳腺成像报告和数据系统4类的乳腺病变即可疑恶性的乳腺病变进行影像学分析,并将影像诊断结果与组织病理学进行对照研究,探讨联合应用两种技术对乳腺疾病的鉴别诊断价值。材料与方法选取2014年5月至2017年5月在河北省人民医院接受乳腺磁共振成像检查的83例患者共95个乳腺病灶为研究对象。由两名高年资的医师回顾性分析乳腺病变的磁共振影像特征,并测量所有病变区域的表观扩散系数(apparent diffusion coefficient,ADC)值及灌注定量参数[容量转移常数(volume transfer constant,K~(trans))、速率常数(rate constant,K_(ep))和血管外细胞外间隙容积分数(extravascular extracellular volume fraction,V_e)]。把可疑恶性的乳腺病灶按病理结果分为良性和恶性两组,把这两组间的ADC值的差异及灌注定量参数K~(trans)、K_(ep)及V_e的差异进行统计学分析。结果全部95个乳腺病灶中良性病变组有46个病灶,恶性病变组有49个病灶。上述2组中恶性病变组的平均ADC值显著低于良性组(P0.05),该平均ADC值差异性具有统计学意义(P0.05)。良、恶性病变组的灌注定量参数平均K~(trans)、K_(ep)差异具有统计学意义(P0.05)。结论 DWI技术结合灌注成像技术能够有效区分乳腺良、恶性病变。     

乳腺超声诊断的现况与展望

随着高频超声及彩色多普勒超声技术的迅速发展,超声图像的分辨率及对低速血流的敏感性不断提高,乳腺癌及乳腺良性病变的超声诊断、鉴别诊断成为影像学研究热点,乳腺超声临床应用的进一步普及,使超声对乳腺疾病的诊断进入了一个新阶段.     

磁共振乳腺动态增强曲线在乳腺疾病诊断中的价值

目的:探讨磁共振乳腺动态增强曲线在磁共振检查乳腺疾病诊断中的应用价值。材料与方法:对25例乳腺疾病的患者进行磁共振平扫及动态增强扫描检查,扫描采用GE公司HDe 1.5T磁共振机配备8通道乳腺线圈进行检查,动态增强采用团注12时相扫描法检查。结果:25例乳腺病变均经过病理证实,其中恶性病变6例,动态增强曲线表现为Ⅲ型4例,Ⅱ型2例,良性病变19例,Ⅰ型曲线17例,Ⅱ型曲线2例。结论:乳腺动态增强曲线在磁共振乳腺疾病的诊断中提供了可靠的依据,结合动态增强后的病变征象,对提高乳腺疾病诊断的正确性起到了重要的价值。     

Ultrasonographic and Mammographic Findings of Male Breast Disease

Most male breast diseases are benign, although malignancies can also occur. Gynecomastia, the most common abnormality in the male breast, has characteristic imaging findings differentiating it from cancer. Fewer than 1% of patients with breast cancer are men, but the incidence of male breast cancer is increasing worldwide. Additionally, breast cancer often presents at a more advanced stage in men than in women due to delayed diagnosis. Understanding imaging features of male breast disease is important for an accurate diagnosis and optimal care. This article reviews ultrasonography and mammography findings of benign and malignant diseases of the male breast.     

磁共振成像对形态学表现为良性特征的乳腺恶性肿瘤诊断价值

MRI具有软组织分辨率高、多方位和多参数成像的特点,对乳腺病变诊断的准确性高于X线和超声,使得部分形态学呈良性特征而X线和超声检查定性诊断困难的病变(如囊内乳头状癌、黏液腺癌、髓样癌、化生性癌、恶性叶状肿瘤和恶性淋巴瘤等)于术前可得以明确诊断。     

Magnetic resonance. Principles and applications

Magnetic resonance is a unique, noninvasive imaging modality which allows direct, multiplanar imaging and the possibility of obtaining biochemical information in vivo. Presently, MR appears most applicable to the evaluation of central nervous system abnormalities. The high sensitivity of MR in the evaluation of intracranial pathology suggests that it may eventually replace CT for many suspected diseases, if future investigations are able to improve its specificity. As previously noted, MR may be more diagnostic than other radiologic studies in the evaluation of suspected Chiari malformation, syringomyelia, congenital abnormalities, tumors of the spinal axis, and disc space infection. In the chest, MR appears to be more accurate than CT in the determination of the extent of mediastinal tumor, but at present cannot replace CT because of the lack of experience in imaging parenchymal nodules and benign diseases. MR of the breast is promising, but the size of the lesion may prove to be a limiting factor with magnetic field strengths commonly being utilized. There are inherent difficulties in the evaluation of cardiac disease with MR, but it offers a noninvasive method of investigating congenital heart disease and may provide valuable information in suspected myocardial ischemia and altered cardiac function. MR provides a new method of evaluating the vascular system, both in terms of providing anatomic information on large and medium-sized vessels and flow analysis. In the abdomen, MR appears to be most sensitive in the evaluation of suspected hepatic masses, but as with the brain, greater specificity will be needed to replace CT. At the present time, MR offers no distinct advantage over conventional imaging modalities in the evaluation of pancreatic disease, it maybe more accurate than CT in the staging of renal cell carcinoma. Larger studies are needed to determine the role of MR in the investigation of retroperitoneal adenopathy and adrenal abnormalities. In the pelvis, MR offers the hope of earlier diagnosis of prostatic carcinoma and may replace CT for staging of prostatic carcinoma and transitional cell carcinoma of the bladder. Limited MR experience with benign disease of the female pelvis suggests that it is currently more accurately evaluated with ultrasound. MR appears to be highly sensitive and specific for the diagnosis of avascular necrosis and may provide an early clue in suspected osteomyelitis. Finally, in vivo MR spectroscopy may provide unique metabolic information that was unobtainable prior to the advent of magnetic resonance, if this proves to be technically feasible.     

3.0T MR扩散加权和动态增强对乳腺小肿块性病灶的诊断价值

目的 3.0T MR扩散加权(DWI)和动态增强(DCE)对乳腺小肿块性病灶的诊断价值。方法回顾性分析62例采用MRI扩散加权和动态增强检查的乳腺良恶性病灶,其横轴像最大长径为10mm。结果常规的MRI的敏感性100%,特异性75.9%,与良性病变相比,恶性病灶的ADC值显著降低。利用受试者工作特性曲线(ROC)分析得出良恶性病变ADC值的分界值是1.11×10-3mm2/s。动力学曲线分析揭示II、III型曲线多考虑恶性。结论研究表明DWI和DCE-MRI技术易于评估。通过DWI获得的表观扩散系数(ADC)值能够用来鉴别良恶性乳腺肿瘤,从而使MRI具有较高的诊断敏感性和特异性。而且,动态增强后测得的动力学曲线对乳腺良恶性肿瘤的鉴别亦提供了较准确的判断。     

Architectural-based interpretations of breast MR imaging

Architectural features extracted from high spatial resolution MR images of the breast can help distinguish malignant from benign breast abnormalities and can help predict specific histopathologic diagnoses. Various breast pathologies consistently display certain MR architectural features. Individual architectural features have been incorporated into interpretation models that can improve the diagnostic performance of MR imaging over the use of individual features alone.     

2010年河南省辉县市慢性病发病流行病学特征分析

目的 了解河南省辉县市全人群脑血管病、缺血性心脏病、恶性肿瘤以及糖尿病等四大类慢性病的发病状况和分布特征,为制定相应防控策略和措施提供依据。 方法 利用辉县市慢性病发病监测系统获取当地2010年全人群四大类慢性病的发病报告数据,统计分析各类慢性病年发病率和构成比。 结果 2010年共报告慢性病发病11 917例,四大类慢性病总的年发病率为1455.37/10万,其中,脑血管病、缺血性心脏病、恶性肿瘤以及糖尿病年发病率分别为723.47/10万(构成比为49.71%)、360.15/10万(构成比为24.75%)、259.51/10万(构成比为17.83%)和112.23/10万(构成比为7.71%)。恶性肿瘤中,发病率居前5位的分别为食管癌、胃癌、肺癌、乳腺癌和肠癌。 结论 辉县市全人群四大类慢性病发病率较高,特别是心脑血管疾病和恶性肿瘤成为威胁居民生命和健康的重要疾病危险因素,建议加强慢病综合防治工作。     

Breast MR imaging in assessing extent of disease

Breast MR imaging is valuable in assessment of extent of disease in the ipsilateral and contralateral breast in women who have breast cancer. In the ipsilateral breast, MR imaging depicts otherwise unsuspected sites of cancer in 16% (range, 6%-34%). In the contralateral breast, MR imaging depicts otherwise unsuspected sites of cancer in 6% (range, 3%-24%). MR imaging is most likely to depict additional sites of cancer in women with invasive lobular cancer and a family history of breast cancer. MR imaging can also assist in evaluating involvement of skin, pectoral muscle, and chest wall. Disadvantages of breast MR imaging include cost and additional procedures (follow-up and biopsy); furthermore, no data as yet show that breast MR imaging in the extend of disease evaluation improves disease-free or overall survival. If breast MR imaging is used in evaluating extent of disease, it is necessary to have the capability to perform biopsy of lesions detected by MR imaging only.     

自动乳腺全容积超声对乳腺导管疾病的诊断价值

目的：探讨全自动乳腺容积超声系统检查（ABVS）乳腺导管疾病的声像图特征及其临床应用.方法：采用SiemensAcuson 2000超声检查系统对乳头溢液的乳房扫查,对比常规超声检查结果,与术后病理对比,评价ABVS系统对乳腺导管疾病的诊断价值.结果：ABVS对恶性病变诊断符合率100％,良性病变诊断符合率82％,与常规超声检查诊断符合率对比差异有统计学意义（P＜0.05）.结论：ABVS可消除操作者因素造成的诊断结果差异,图像更易辨认更易被临床医生接受,提高了乳腺导管病变的检出率.     

磁共振邻近血管征对乳腺良恶性肿瘤的鉴别诊断价值

目的：分析63个乳腺肿瘤的磁共振表现,探讨病灶邻近血管征（AVS）在乳腺良恶性肿瘤鉴别诊断中的价值。材料与方法：回顾性分析经病理证实的60例63个乳腺肿瘤的MR动态增强图像,在工作站获得剪影图像及3DMIP图像,分析病灶邻近血管征与病灶良恶性、病灶大小的关系。结果：血管征在恶性肿瘤出现率（55％）明显高于良性肿瘤出现率（26．09％）,差异有统计学意义（χ2=4．944,P〈0．05）。病灶平均直径与血管征有关,病灶直径〉2cm的出现率（65．52％）明显高于直径≤2cm的出现率（26．47％）,差异具有统计学意义（χ2=9．664,P〈0．05）。血管征分3型,单支血管型17例,其中恶性12例,良性5例;多支血管型7例,其中恶性6例,良性1例;血管扩张型4例,均为恶性。血管征诊断乳腺癌的敏感性为55．0％,特异性73．91％,阳性预测值78．57％,准确度61．90％。结论：血管征在鉴别诊断中有较高价值,表现为多支血管及扩张血管征时高度提示恶性;血管征可以作为乳腺癌多因子评估的有力补充。     

MR imaging of the pericardium

Imaging of the pericardium requires understanding of anatomy and the normal and abnormal physiology of the pericardium. MR imaging is well-suited for answering clinical questions regarding suspected pericardial disease. Pericardial diseases that may be effectively imaged with MR imaging include pericarditis, pericardial effusion, cardiac-pericardial tamponade, constrictive pericarditis, pericardial cysts, absence of the pericardium, and pericardial masses. Although benign and malignant primary tumors of the pericardium may be occasionally encountered, the most common etiology of a pericardial mass is metastatic disease.