MR全身弥散加权成像与核素骨扫描对骨转移瘤诊断价值的对比研究

目的 对比磁共振全身弥散加权成像(WB-DWI)与全身核素骨扫描在诊断骨转移瘤中的价值.方法 连续收集经病理证实的恶性肿瘤患者22例,对病人同期行WBDWI及全身核素骨扫描检查,分区域记录WB-DWI及全身核素骨扫描显示的病灶数目以及受累区域.以受累区域为单位分析2种检查方法诊断骨转移瘤的灵敏度及特异度,并采用ROC曲线分析2种方法诊断骨转移瘤的效能.结果 经活检及常规MR断层显示18例有骨转移瘤,共计病灶数目182个,受累区域63处.WB-DWI共检出病灶161个,全身核素骨扫描共检出病灶157个,以受累区域为单位,WB-DWI诊断骨转移瘤的灵敏度为87.3%,特异度为92.7%,曲线下面积为0.900;核素骨扫描诊断骨转移瘤的灵敏度为84.1%,特异度为90.5%,曲线面积为0.873,采用Hanley-McNeil检验对曲线下面积行差异性检验,Z值=1.582,P>0.05,其差异无显著统计学意义.结论 WB-DWI与核素骨扫描诊断骨转移瘤的效能无明显差异,WB-DWI可作为一种新的、无辐射的检查方法应用于骨转移瘤的诊断.     

1．5T磁共振全身弥散加权成像对肺癌骨转移的应用

目的：探讨背景抑制快速全身磁共振弥散成像（WB-DWI）技术在肺癌骨转移中的初步应用价值。方法：对40例健康志愿者和56例经病理证实为肺癌的患者进行WB-DWI检查,经三维-最大密度投影（3D-MIP）重建和黑白翻转后处理,将骨骼系统分为8个区域,分别记录每个患者各区域WB-DWI阳性病例数。对所有WB—DWI影像与同位素骨扫描（SPECT）影像表现比较分析。结果：WB-DWI阳性病例为42例,受累区域85处,共检出病灶数为207处;SPECT阳性病例为39例,受累区域81处,共检出病灶数为199处。结论：WB-DWI与SPECT有非常好的一致性,且WBCDWI检查廉价快捷无辐射,重复性好,在肺癌骨转移检出和治疗后随访方面具有重要的临床应用价值。     

全身MR扩散加权成像与骨扫描探测骨转移灶的初步对比研究

目的 通过与单光子发射计算机体层摄影术(SPECT)骨扫描对比,初步探讨全身MR扩散加权成像(DWI)技术探测骨转移灶的可行性.方法 对42名正常志愿者及38例可疑合并骨转移的恶性肿瘤患者行全身MR DWI及SPECT骨扫描,并将骨骼系统分为8个区域,分别记录每例患者各区域全身MR DWI和SPECT骨扫描分别显示的病灶数目及各区域阳性病例数,进行每一患者及每一区域的全身MR DWI及骨扫描的对照分析.结果 全身MR DWI阳性病例30例,受累区域69处,共探测出病灶数169处;骨扫描阳性病例29例,受累区域68处,共探测出病灶数156处;全身MR DWI阳性而SPECT骨扫描阴性者2例,SPECT骨扫描阳性而全身MR DWI阴性者1例;SPECT骨扫描阴性而全身MR DWI阳性区域8例,其中,脊柱3例、骨盆2例、股骨3例;骨扫描阳性而全身MRDWI阴性区域7例,其中颅骨4例、肩胛骨2例、胸锁骨1例.结论 全身MR DWI与SPECT骨扫描对检测骨转移病灶有很好的一致性,且两者可互相补充;全身MR DWI还可检测各脏器及淋巴结病灶,适用于肿瘤患者随访.     

18 F-FDG PET显像与99Tcm-MDP全身骨显像诊断肿瘤远处转移的比较

目的　评价18F 脱氧葡萄糖 (FDG)PET肿瘤显像与99Tcm 亚甲基二膦酸盐 (MDP)全身骨显像对检出骨和远处转移的价值。方法　对 16例恶性肿瘤放化疗后的患者进行18F FDGPET显像和99Tcm MDP全身骨显像 ,并对两种结果进行了比较。结果　 16例肿瘤患者中18F FDGPET显像皆阳性 ,其中 14例患者有远处转移 ,转移病灶共 62处 ,其中骨转移病灶 2 0处 ;在全身骨显像中 ,11例有局限性异常放射性浓聚 ,其中 2例为单一病灶 ,9例为多发病灶 ,共检出病灶 5 7处 ,另 5例骨显像正常。结论　18F FDGPET对恶性肿瘤的诊断具有较高的准确性和特异性 ,但对骨转移灶的诊断价值相对较差 ;99Tcm MDP显像阴性或单一病灶的可疑转移瘤患者有必要进行18F FDGPET检查 ,以明确诊断其他远处转移灶     

^18F—FDG PET显像与^99Tc^m—MDP全身骨显像诊断肿瘤远处转移的比较

目的 评价^18F-脱氧葡萄糖（FDG）PET肿瘤显像与^99Tc^m-亚甲基二膦酸盐（MDP）全身骨显像对检出骨和远处转移的价值。方法 对16例恶性肿瘤放化疗后的患者进行^18F-FDG PET显像和^99Tc^m-MDP全身骨显像，并对两种结果进行了比较。结果 16例肿瘤患者中^18F-FDG PET显像皆阳性，其中14例患者有远处转移，转移病灶共62处，其中骨转移病灶20处；在全身骨显像中，11例有局限性异常放射性浓聚，其中2例为单一病灶，9例为多发病灶，共检出病灶57处，另5例骨显像正常。结论 ^18F-FDG PET对恶性肿瘤的诊断具有较高的准确性和特异性，但对骨转移灶的诊断价值相对较差；^99Tc^m-MDP显像阴性或单一病灶的可疑转移瘤患者有必要进行^18F－FDG PET检查，以明确诊断其他远处转移灶。     

全身弥散加权成像与同位素骨扫描诊断乳腺癌骨转移对比研究

目的：比较全身弥散加权成像（w昏DwI）、同位素骨扫描（radionuclidebonescan）技术在乳腺癌骨转移的应用价值。方法：40例经病理证实为乳腺癌的患者分别作WB—DWI及同位素骨扫描检查。wB_DWl检查使用反转恢复平面回波弥散序列行全身扫描,将骨骼系统分为3个区域,分别记录每个患者各区域WB-DWI阳性病例数。对所有w睁DwI及同位素骨扫描影像表现的乳腺癌转移例数及发生部位行统计学比较。结果：WB-DWI阳性病例为35例,共检出病灶数为146个;同位素骨扫描阳性病例为30例,共检出病灶数为141个,wB_DwI的病灶检出率高于同位素骨扫描;wHrDwI与同位素骨扫描诊断乳腺癌骨转移例数及发生部位无统计学差异。结论：WB-DWI检查无辐射,覆盖范围大,具有较高的敏感性,对乳腺癌骨转移早期筛查、诊断及预后评价方面具有重要的临床应用价值。     

MR全身弥散加权成像在肝细胞癌M分期中的价值

目的探讨MR全身弥散加权成像(WB-DWI)在肝细胞肝癌(hepatic cell carcinoma,HCC)M分期中的价值。方法回顾性分析23例经临床、病理证实的HCC患者首次行WB-DWI检查的图像,统计肝外非淋巴结转移灶的分布及数目并进行对比分析。结果 WB-DWI未发现全身转移(M0)者11例,余12例均发现肝外转移灶(M1),主要为肺转移及骨转移。肺转移5例共14个病灶,WB-DWI发现12个,2个转移灶在WB-DWI上显示不清,结合胸部CT表现,肺部转移灶检出率较高(12/14,85.7%);骨转移8例共17个病灶,骨骼系统转移灶全部检出(17/17)。其余脏器脑部、脾、胰腺、肾上腺及泌尿生殖系统等均未见明显转移灶。全身非转移性病灶共计37处。结论 WB-DWI能够评估HCC患者全身情况,指导异常信号灶进行必要的相关检查,对于HCC患者M分期具有重要的价值。     

WB-DWI在恶性肿瘤淋巴结转移中的应用

目的:探讨磁共振全身弥散加权成像(whole body diffusion-weighted imaging,WB-DWI)在恶性肿瘤淋巴结转移瘤中的应用价值。方法:对110例疑似恶性肿瘤淋巴结转移患者行WB-DWI检查,并于扫描后1周内对可疑骨转移部位及原发恶性肿瘤部位行常规MRI/CT检查。根据MRI/CT及临床综合诊断结果,将所有患者分为淋巴结转移组及非淋巴结转移组,对资料进行统计学分析,比较单独应用WB-DWI、MRI/CT及二者联合应用(WB-DWI+MRI/CT)在恶性肿瘤淋巴结转移中的诊断价值。分别测定淋巴结转移组及非淋巴结转移组的ADC值,比较其在良恶性病变鉴别诊断中的价值。结果:①将淋巴结按长径大小分为<2cm,2～3cm,>3cm,WB-DWI、MRI/CT及WB-DWI+MRI/CT对长径<2cm淋巴结转移的检出差异具有统计学意义。进一步两两比较,单独应用MRI/CT与WB-DWI+MRI/CT的差异具有统计学意义(χ2=6.519,P=0.011)。②ROC分析结果显示,WB-DWI+MRI/CT诊断恶性肿瘤淋巴结转移的特异度、诊断准确性、阳性预测值及阴性预测值诊断最高。③淋巴结转移组ADC值明显低于良性淋巴结病变组,在良恶性淋巴结转移鉴别诊断中具有一定作用。结论:WB-DWI是常规MRI、CT的有益补充,与MRI/CT的联合应用可以提高恶性肿瘤淋巴结转移的诊断率,结合ADC值测定,在恶性肿瘤淋巴结转移诊断和鉴别方面具有一定价值。     

SPECT/CT融合显像对可疑骨转移灶的诊断效能

目的：评价SPECT/CT融合显像对可疑骨转移灶的诊断效能。方法回顾性分析64例恶性肿瘤患者经全身骨显像发现的96个可疑骨转移病灶,对可疑病灶行同机SPECT/CT融合显像,由两名核医学医师分别对SPECT、CT及SPECT/CT融合显像进行分析并评分,以病理学结果或6个月以上复查影像学及临床随访结果作为最终确诊依据。SPECT/CT融合显像对可疑病灶的诊断效能通过受试者工作特征曲线（ROC曲线）进行评价。结果 SPECT/CT显像诊断可疑骨转移灶的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为93．1%、86．8%、90．6%、91．5%和89．2%;ROC曲线下面积：SPECT/CT融合图像为0．956,CT图像为0．897,SPECT图像为0．710。结论 SPECT/CT融合显像较SPECT及CT显像具有较高的诊断效能。     

全身弥散加权成像对恶性肿瘤骨转移的临床应用

目的 研究全身弥散加权成像(WBDWI)对恶性肿瘤远处骨转移的临床应用.方法 62例经病理证实的恶性肿瘤患者,均在2周内分别行WBDWI及核素骨显像.将骨骼分为10个部位分析,分别为颅骨、胸骨、颈椎、胸椎、腰椎、骶椎、肋骨、肩胛骨、骨盆、股骨.以核素骨显像见异常浓聚灶或稀疏灶,WBDWI见高信号为阳性,分析比较两者所显示的病灶数.结果 62例患者中,WBDWI显示362处病灶,核素骨显像显示281处病灶.WBDWI可以发现更多的骨外器官及淋巴结的病变.结论 WBDWI对骨转移具有很好的诊断价值,可以与核素骨显像互相补充,为临床提供更加全面的信息.     

Ex Vivo Evaluation of Ferromagnetism,Heating, and Artifacts of Breast Tissue Expanders Exposed to a 1.5-T MR System

Three breast tissue expanders were evaluated for compatibility with MR imaging (1.5 Tesla). The metallic components of the breast tissue expanders were shown to be nonferromagnetic, heating .2°C and the artifacts varied. These results indicate that MR procedures may be performed safely in patients with these implants; however, artifacts may obscure Implant leaks or breast lesions if located near and metal portion of the breast tissue expanders.     

Imaging studies of the cadaver hand using transmission ultrasound

Ultrasonic transmission imaging has already demonstrated potential for evaluating structures in the hand. In this study, a cadaver hand was imaged using a transmission scanner with improved imaging capability. The hand was then frozen and serially sectioned and comparisons were made between the sectional anatomy and the corresponding image. Bone (in silhouette), muscle, cartilage, and tendon were visualized with high resolution.     

Advanced multimodality imaging of inflammatory bowel disease in 2015: An update

The diagnosis and effective management of inflammatory bowel disease (IBD) requires a combination clinical, endoscopic, histological, biological, and imaging data. While endoscopy and biopsy remains the gold standard for diagnosis of IBD, imaging plays a central role in the assessment of extra mural disease, in disease surveillance and in the assessment of response to medical treatments, which are often expensive. Imaging is also vital in the detection and diagnosis of disease related complications, both acute and chronic. In this review, we will describe, with illustrative images, the imaging features of IBD in adults, with emphasis on up-to-date imaging techniques focusing predominantly on cross sectional imaging and new magnetic resonance imaging techniques.     

颅内动脉粥样硬化的高分辨力血管壁成像特征及临床应用

颅内动脉粥样硬化是缺血性脑卒中最主要的原因。高分辨力磁共振血管壁成像（VM-MRI）可以直接对血管壁进行成像,评价血管狭窄程度、血管重构、斑块负荷、斑块成分与分布,被认为是唯一能对颅内血管壁进行成像的无创检查技术。近年来颅内VW-MRI发展迅速,现就VW-MRI技术、VW-MRI对颅内动脉粥样硬化斑块的评价及其临床应用做一综述。     

Diagnostic algorithm: how to make use of new 2D, 3D and 4D ultrasound technologies in breast imaging

The aim of this publication is to present a time saving diagnostic algorithm consisting of two-dimensional (2D), three-dimensional (3D) and four-dimensional (4D) ultrasound (US) technologies. This algorithm of eight steps combines different imaging modalities and render modes which allow a step by step analysis of 2D, 3D and 4D diagnostic criteria. Advanced breast US systems with broadband high frequency linear transducers, full digital data management and high resolution are the actual basis for two-dimensional breast US studies in order to detect early breast cancer (step 1). The continuous developments of 2D US technologies including contrast resolution imaging (CRI) and speckle reduction imaging (SRI) have a direct influence on the high quality of three-dimensional and four-dimensional presentation of anatomical breast structures and pathological details. The diagnostic options provided by static 3D volume datasets according to US BI-RADS analogue assessment, concerning lesion shape, orientation, margin, echogenic rim sign, lesion echogenicity, acoustic transmission, associated calcifications, 3D criteria of the coronal plane, surrounding tissue composition (step 2) and lesion vascularity (step 6) are discussed. Static 3D datasets offer the combination of long axes distance measurements and volume calculations, which are the basis for an accurate follow-up in BI-RADS II and BI-RADS III lesions (step 3). Real time 4D volume contrast imaging (VCI) is able to demonstrate tissue elasticity (step 5). Glass body rendering is a static 3D tool which presents greyscale and colour information to study the vascularity and the vascular architecture of a lesion (step 6). Tomographic ultrasound imaging (TUI) is used for a slice by slice documentation in different investigation planes (A-,B- or C-plane) (steps 4 and 7). The final step 8 uses the panoramic view technique (XTD-View) to document the localisation within the breast and to make the position of a lesion simply reproducible.     

7.0 TMR关节软骨自旋锁定三维自旋-晶格弛豫时间成像与量化分析的实验研究

目的 建立MR关节软骨自旋锁定旋转坐标系中的自旋-晶格弛豫时间(T1ρ)三维成像技术和量化分析方法.方法 用7.0 T MR机和内径为6 cm的圆柱形鸟笼23Na-H射频线罔,采用自旋锁定自动补偿脉冲簇和三维自旋回波序列,自旋锁定时间(spin-locking time,TSL)分别为0、10、20、30、40和50 ms,自旋锁定频率带宽为440 Hz(自旋锁定磁场BsL),对6个不同浓度(1%～6%)琼脂糖凝胶体模和8个猪髌骨分别进行自旋锁定T1ρ成像扫描,建立自旋锁定T1ρ成像技术并评价其重复性.在Vnmr J图像终端上,利用自行编制的软件进行三维重组自旋锁定T1ρWI,并重构T1ρ弛豫时间图;采用人工标注的方法画感兴趣区,分别测定体模与髌骨软骨T1ρWI的信噪比(SNR)与T1ρ值.T1ρ值在各组间的对比,行单因素方差分析;软骨组织与琼脂糖体模SNR随时间对比关系的假设检验,行多因素方差分析.结果 关节软骨T1ρWI的SNR值、短自旋锁定时间采集图像的SNR值明显高于长自旋锁定时间采集的图像.在不同自旋锁定时间髌骨软骨T1ρWI,SNR值在48 4±8～95±8之间;不同自旋锁定时间,正常软骨SNR与1%琼脂糖体模的对比关系不同,当自旋锁定时间＜30 ms时,琼脂糖体模的图像SNR均低于正常软骨;＞30 ms时,正常软骨的图像SNR均低于1%的琼脂糖体模.随着琼脂糖浓度减少,不同自旋锁定时间采集的图像SNR值逐渐增加.各浓度琼脂糖凝胶体模T1ρ值测量的变异系数均小于10%,显示重复性好.髌骨关节软骨全层、表层、中间层、深层、钙化层T1ρ值测定结果分别为(68.9±6.3)、(80.7±12.8)、(65.7±7.0)、(82.4±7.7)、(69.7±6.4)ms(F=6.436,P＜0.05).T1ρ值在软骨表层和深层明显高于中间层、钙化层和软骨全层.结论 三维自旋锁定T1ρ成像技术是可行的、敏感的、特异的软骨分子成像技术,T1ρ弛豫时间图可量化测量关节软骨的分层状结构.     

Ultrasound Evaluation of Normal and Abnormal Fetuses: Comparison of Conventional, Tissue Harmonic, and Pulse-Inversion Harmonic Imaging Techniques

Objective

To determine the usefulness of tissue harmonic imaging (THI) and pulse-inversion harmonic imaging (PIHI) in the evaluation of normal and abnormal fetuses.

Materials and Methods

Forty-one pregnant women who bore a total of 31 normal and ten abnormal fetuses underwent conventional ultrasonography (CUS), and then THI and PIHI. US images of six organ systems, namely the brain, spine, heart, abdomen, extremities and face were compared between the three techniques in terms of overall conspicuity and the definition of borders and internal structures.

Results

For the brain, heart, abdomen and face, overall conspicuity at THI and PIHI was significantly better than at CUS (p < 0.05). There was, though, no significant difference between THI and PIHI. Affected organs in abnormal fetuses were more clearly depicted at THI and PIHI than at CUS.

Conclusion

Both THI and PIHI appear to be superior to CUS for the evaluation of normal or abnormal structures, particularly the brain, heart, abdomen and face.     

Diffusion- and perfusion-weighted MRI in a patient with a prolonged reversible ischaemic neurological deficit

We report acute and follow-up diffusion- and perfusion-weighted MRI (DWI, PWI) findings in a patient with a prolonged reversible ischaemic neurological deficit. PWI 12 h after the patient was last seen to be without symptoms revealed a large perfusion deficit in the left posterior MCA territory with a relatively inconspicuous and much smaller abnormality on DWI. Follow-up showed resolution of abnormalities on both DWI and PWI, and conventional MRI was normal, apart from a very slight abnormality, visible only on FLAIR images, at the centre of the initially DWI-positive region. These findings demonstrate the utility of PWI when be used in combination with DWI to investigate the pathophysiology of transient ischemic syndromes. Received: 26 July 1999/Accepted: 20 September 1999