影像学检查对头颈部病变的临床应用价值

头颈部是指颅底到胸廓入口的解剖区域，包括眼、耳、鼻、副鼻窦、咽喉、颅底及颈部结构。这些部位解剖结构复杂，病变种类多样，影像学检查方法包括X线检查、超声、CT、MRI、DSA、SPECT、PET。现简述该部不同病变的优选检查程序。     

肝恶性肿瘤血流灌注成像的影像学研究进展

大量研究表明恶性肿瘤的发生、发展需经过不同性质的多阶段才能逐步完成，伴随恶性特征的形成，肿瘤血管因子诱发的毛细血管向肿瘤内生长是必不可少的步骤。因此，研究肿瘤病变的血管和血供变化可反应肿瘤的生长及演变过程，可对病变进行早期诊断、恶性程度分级或分期、随诊复查及预后评估。近年来应用灌注成像技术评价肿瘤的血流动力学变化已成为影像学研究的热点，本将对肝脏恶性肿瘤血流灌注成像的应用进展综述如下。     

RSNA2014头颈部影像学

随着转化医学的深入以及循证医学的发展,头颈部各种成像方式逐渐规范化、个体化,各种功能成像技术逐步临床化。能谱CT技术、低管电压技术、C型臂CT机的应用更加广泛,以提高图像质量及降低头颈部CT扫描的放射剂量;4D-CT成像、扩散加权成像(单指数模型、质子内不相干运动、非高斯分布的扩散峰度成像)、动态增强MR成像、CT灌注成像、PET-CT/MR以及超声弹性成像等正逐渐应用于头颈部病变的诊断且逐步拓展至对组织功能以及病变疗效的评估。     

影像学新技术在头颈部肿瘤诊断的应用

随着医学及医学工程学的发展,影像学诊断技术在头颈部肿瘤诊断的应用受到普遍重 视。它不仅能明确病变的部位,而且能显示病变的范围,有利于治疗方案的制定。自70年代以来,CT的开发及MRI的临床应用,大大丰富了头颈部肿瘤影像诊断手段。 近年来,我国头颈部肿瘤诊断、治疗领域     

头颈部病变MR扩散成像的初步研究

目的探讨MR扩散加权成像（DWI）在头颈部病变中的诊断价值。方法回顾性分析57例头颈部病变共85个病灶，其中恶性肿瘤22个（22例），良性肿瘤13个（13例），囊性或液性病灶13例共17个病灶，包括囊肿12个（8例），肿瘤坏死4个（4例），脓肿1个（1例）；淋巴结病灶33个。所有患者均经临床追踪或手术病理证实。分析各病灶在扩散敏感因子（b值）为0、500和1000s·mm^-2时DWI特点及其表观扩散系数（ADC）值。结果良、恶性肿瘤在DWI表现有所不同，13个良性肿瘤与脊髓（或脑干）的信号比值随b值增加迅速下降；22个恶性肿瘤与脊髓（或脑干）信号比值随b值增加变化不明显。恶性肿瘤的平均ADC值[（0．78±0．24）×10^-3mm^2·s^-1]低于良性肿瘤[（1．48±0．20）×10^-3mm^2·s^-1]，差异有统计学意义（t=8．9，P〈0．01）；良、恶性肿瘤的ADC值受试者特异性曲线（ROC）下面积Az值为0．971±0．030，当ADC值取1.13×10^-3mm^2·s^-1时，判断良、恶性肿瘤的敏感度为100％，特异度为90．5％，准确度90．5％。鳞状细胞癌的ADC值与分化程度相关，分化好者其ADC值高。囊性或液性病变（12个）、肿瘤坏死（4个）和脓肿（1个）在DWI上的信号强度与其组织病理成分相关，具有一定的信号特征和ADC值。淋巴结转移瘤的平均ADC值[（0．81±0．11）×10^-3mm^2·s^-1]高于良性淋巴结病变[（0．69±0．04）×10^-3mm^2·s^-1]，差异有统计学意义（t=3．48，P〈0．01），但是两者之间有较大的重叠，且在DWI上表现相仿。结论DWI和ADC值在头颈部病变的鉴别诊断中具有重要价值。     

多层螺旋CT在头颈部血管成像上的临床应用

CT技术的迅速发展，使得图像快速、多样化处理成为现实，这些新的成像技术超越了常规CT二维图像的局限性，能从多个方位、多角度冠示疾病的形态及范围。     

颅内和头颈部病变CT血管造影的三维成像

探讨螺旋ＣＴ血管造影及三维图像重建（３Ｄ－ＳＣＴＡ）在颅内和头颈部病变诊断中的价值。材料和方法：９８例头颈部病变患者接受了３Ｄ－ＳＣＴＡ检查,其中包括颅内动脉瘤３２例,颅内ＡＶＭ５例,颈动脉粥样梗化３５例,脑膜瘤１１例,硬膜型海绵状血管瘤２例,颅底神经纤维瘤３例,颈部肿块６例,颈椎椎管内神经纤维瘤４例。结果：全部患者顺利经受螺旋ＣＴ血管造影检查,３５例颈动脉粥样硬化均显示清楚,且能够检出附壁钙化性     

深入CT灌注成像研究,拓展医学影像学新领域

随着多层螺旋CT机在我国日益广泛地应用,CT灌注成像技术进入到了一个蓬勃发展的时期。近两年来关于CT灌注成像方面的论著不断涌现,说明大家都在努力把握时代的脉搏,预期到CT灌注成像这一新技术未来的光辉前景。医学影像技术不断发展,使医学影像学从以往的单一形态学成像逐渐向其他领域延伸如功能成像。传统的灌注功能成像使用放射性核素作为示踪剂的核医学一直是观察器官代谢的主要影像方法,包括正电子发射体层摄影(positron emission computed tomo-graphy,PET)和单光子发射体层摄影(single photonemission computed tomography,SPEC…     

重视与加强分子影像学研究

随着分子和（或）细胞生物学技术的进展和人类基因组计划的完成，非侵袭性、高分辨率、实时、在体分子和（或）基因显像技术日益凸现其重要性，分子影像学应运而生。广义上，分子影像学是1门活体内在细胞与分子水平对生物过程进行描述与测量的新兴交叉学科。其目的是通过研究和测试新的成像工具、试剂、方法，对活体内的重要分子，特别是对一些疾病的产生、发展有重要作用的分子及其传导途径进行成像，以便早期诊断疾病、在体筛选活性药物及直接评价治疗效果。它一改传统影像学基于解剖组织结构改变诊断疾病的模式，直接研究活体内对疾病的产生、发展具有重要作用的基因或分子及其传导途径的成像方法，使影像学超过了原有的解剖和病理学范畴，将影像学诊断引入分子和（或）基因水平。医学影像学迎来了发展史上的新纪元。     

肾上腺肿瘤的影像学诊断

肾上腺（suprarenal gland）肿瘤是指发生在肾上腺皮质、髓质及间质的良、恶性肿瘤以及转移瘤和淋巴瘤。关于肾上腺肿瘤的发生率，国内外尚无统一报道。肾上腺区肿瘤组织来源复杂，临床和影像学表现多样。随着医学影像技术的发展，对肾上腺肿瘤诊断的准确率有了明显的提高，尤其是高分辨CT、MRI等检查，不但能确定肿瘤的有无，还能了解肿块的性质及血供情况，肿块与周围组织的关系等，为临床治疗提供了可靠的影像依据。     

3D MR imaging with Gd-DTPA in head and neck lesions

Three-dimensional MR imaging technique is not a new concept, however, there is very little experience concerning clinical trials. Especially in head and neck lesions, the accuracu of this new imaging method has not yet been tested. A pilot study was performed to evaluate the diagnostic value of demonstrating the head and neck lesions and topographical structures implemented in a three-dimensional reconstruction of the entire head. The 3D reconstruction mode is based on the ray-tracting model. The application of the contrast medium Gd-DTPA proved to be helpful. Three-dimensional reconstruction revealed clear topographic details of the lesions, including the spread of infiltration and destruction of soft tissue. Additionally, the simultaneous view of multiple slices in different orientations is an ideal method for evalauting the spread of the lesion and to visualize the relation between lesion and surrounding tissue. Offprint request to: T. Vogl     

Contemporary imaging methodology for diagnosis of lesions of the head and upper neck

CT and MRI are the primary imaging modalities used to evaluate the various regions of the head and neck. From the preceding discussion one can see clearly that the choice of the appropriate imaging modality depends on a number of variables. There is no indisputable "winner" under all anatomical or pathological circumstances. The advantages and disadvantages of CT and MRI in certain clinical settings have been discussed. The information provided will enable one to exercise a rational choice in the selection of imaging modalities.     

开展运动相关损伤的影像学研究

随着2008年北京奥林匹克运动会日益临近,我国掀起了全民健身高潮,运动医学的发展也越来越为广大医学工作者所重视.从1928年国际运动医学联合会(FIMS)成立到1978年中国运动医学会成立,再到2008年的奥运年,运动医学的发展非常迅速,涵盖的内容和服务的对象越来越广.     

Extracranial lesions of the head and neck: preliminary experience with Gd-DTPA-enhanced MR imaging

The authors report initial experience with magnetic resonance imaging enhanced with gadolinium diethylenetriaminepentaacetic acid (DTPA) in 27 patients with various extracranial lesions of the head and neck. Unenhanced T1- and T2-weighted images were compared with T1-weighted images obtained 3-30 minutes after Gd-DTPA administration. Overall, compared with precontrast T1- and T2-weighted images, Gd-DTPA improved the visibility of lesions in 11 and five of 27 patients, respectively. Gd-DTPA particularly improved the conspicuity of tumors of the nasal cavity and paranasal sinuses and tumors having perineural or intracranial extension. Gd-DTPA-enhanced images were equivalent to precontrast T1- and T2-weighted images in five and 13 patients, respectively, and inferior to them in nine and eight patients, respectively. Mixed results were obtained in two patients and one patient when Gd-DTPA-enhanced images were compared with T1- and T2-weighted images, respectively. The authors conclude that Gd-DTPA has definite but limited uses in extracranial head and neck pathologic conditions and that more research is needed to evaluate particular applications.     

开展脊神经成像的临床应用

影像医学对临床医学和基础医学的研究和发展起着十分重要的作用，近几年来，影像医学技术的开发和应用愈来愈引起人们的普遍重视。现代医学对影像学的要求越来越高，追求的目标是全面、快速、准确和无创性地给临床提供有价值的诊断信息,本期有关脊神经成像的数篇论文及以往《中华放射学杂志》所发表的有关这方面的论文，反映了我国放射学同仁应用CT、MR新技术开展周围神经成像的研究进展。     

MR imaging of the head and neck

The purpose of this paper is to describe current imaging protocols for MR imaging of the head and neck region and to define results and clinical impact. Depending on the clinical question, different MRI protocols are presented for imaging of the head and neck. The appearance of different pathologic findings on imaging studies and how adapted imaging protocols help to improve differential diagnosis is discussed. In summary, MRI is the method of choice for imaging of the head and neck.     

Tissue characterization of head and neck lesions using diffusion-weighted MR imaging with SPLICE

Purpose

The purpose of this study was to evaluate the usefulness of diffusion-weighted (DW) MR imaging with split acquisition of fast spin-echo signals (SPLICE) in the tissue characterization of head and neck mass lesions.

Patients and methods

DW MR images of 67 head and neck mass lesions were obtained using SPLICE with b-factors of 0 and 771 s/mm². The lesions were classified into three categories: 16 cysts, 32 benign tumors, and 19 malignant tumors. After ADC maps were constructed for all lesions, ADC values were calculated and compared among the three categories.

Results

No case showed severe image distortion on DW MR imaging with SPLICE, and reliable ADC maps and ADC values were obtained in all cases. The mean ADC value of cysts was 2.41 ± 0.48 × 10⁻³ mm²/s, which was significantly higher than that of benign (1.48 ± 0.62 × 10⁻³ mm²/s) and malignant (1.23 ± 0.45 × 10⁻³ mm²/s) tumors (P < 0.001). However, there was no significant difference between the ADC values of benign and malignant tumors (P = 0.246). When an ADC value of 2.10 × 10⁻³ mm²/s or higher was used as the diagnostic criterion for cysts, the sensitivity, specificity, and accuracy were 94%, 88%, and 90%, respectively.

Conclusion

SPLICE was considered a recommended DW MR imaging technique for the head and neck. Although ADC values were useful in differentiating cysts from tumors, they contributed little in predicting malignancy.