磁共振功能成像对颅内血管外皮细胞瘤的诊断价值

目的探讨磁共振功能成像在诊断颅内血管外皮瘤中的价值。方法回顾性分析10例经病理证实的颅内血管外皮瘤患者的磁共振常规扫描及灌注加权成像(PWI)、弥散加权成像(DWI)、弥散张量成像(DTI)、波谱成像(MRS)、磁敏感加权成像(SWI)等功能成像的影像学特征。结果颅内血管外皮细胞瘤外形呈不规则分叶状,肿瘤实性部分在T1WI呈等或略低信号,T2WI为等或略高信号,T1WI增强后肿瘤呈明显不均匀强化。DWI多为等、稍高信号,PWI成像示肿瘤实质均呈明显高灌注,高于正常皮层血管区。肿瘤在MRS上为胆碱(Cho)峰升高、肌酸(Cr)峰及N-乙酰天门冬氨酸(NAA)峰降低,肌醇(m I)峰可表现为轻度升高,部分瘤体出现明显高耸的脂质(Lip)峰。DTI纤维束重建图可见皮质脊髓束纤维的中断、移位。SWI序列可以显示瘤体内出现大量斑片状或点状微出血灶。结论 MRI常规扫描结合功能成像在颅内血管外皮细胞瘤的诊断、鉴别诊断中具有突出的价值。     

MRI增强及DWI对鼻咽癌放疗后复发的诊断价值研究

目的探讨磁共振平扫和增强扫描及弥散加权成像(diffusion weighted imaging,DWI)对鼻咽癌放疗后复发的诊断价值。材料与方法收集惠州市中心人民医院经病理证实为鼻咽癌并接受放射治疗的病例共380例,所有患者在放疗结束后进行6月至3年的随访复查并接受至少1次以上磁共振检查,常规进行MRI平扫和增强扫描,其中168例行DWI扫描。结果在复查过程中,共有32例证实为放疗后复发,复发的肿块形态不规则,T1WI呈等、稍低信号,T2WI呈等或稍高信号,增强后呈中等-明显强化,其中19例伴有新发颅底骨质破坏,12例伴有新增淋巴结肿大。复发肿块DWI呈高或稍高信号,其表观弥散系数(apparent diffusion coefficient,ADC)值为(0.96±0.08)×10~(-3) mm~2/s;无复发者DWI大部分呈等、稍高信号,部分呈稍低信号,其ADC值为(1.31±0.16)×10~(-3) mm~2/s,二者ADC值组间差异有统计学意义(P0.05)。结论 MRI增强和DWI成像对鼻咽癌放疗后复发诊断具有重要价值。     

MRI与DWI在直肠癌术后局部复发中的诊断价值

目的:探讨常规磁共振成像(magnetic resonance imaging,MRI)和弥散加权成像(diffusion-weighted imaging,DWI)对直肠癌根治术后局部复发患者的诊断价值.方法:对74例直肠癌术后复发患者分别进行常规MRI和DWI检查,并以病理学检查结果为标准,应用受试者工作特征(re...     

肝癌射频消融术后疗效的CT形态学和功能学评价

射频消融已成为治疗肝癌的公认的有效方法;CT以其突出优势成为射频消融术后疗效评价的重要影像学手段。正确认识射频消融灶在不同阶段的形态学及功能学改变,有助于及时准确发现局部残留或复发,实行有效干预,改善患者预后。本研究就CT增强扫描及灌注成像在肝癌射频消融术后疗效评价方面的研究进展进行综述。     

经食管超声联合斑点追踪技术对房颤射频消融术后复发的预测研究

目的 应用经食管超声联合斑点追踪成像技术评估房颤患者射频消融术后复发的预测研究。方法 初次行经导管射频消融术的阵发性房颤(PAF)患者269例,按临床随访结果分为复发组79例、成功组190例。应用经食管超声(TEE)测量左心耳血流速度(LAA-v),常规测量左心房前后径(LAD)、左心房容积指数(LAVI)及CAAP-AF评分,二维斑点追踪成像技术(2D-STI)测量左心房储器期应变(LASr)、左心房管道期应变(LAScd)、左心房泵期应变(LASct),比较各参数与复发的相关性。结果 Logistic回归分析提示左心房储器期应变、左心耳血流速度是阵发性房颤预测射频消融术后复发的敏感指标。结论 超声参数可以多指标联合筛选术后易复发的患者,为临床治疗提供参考降低手术复发率。     

3.0TMR弥散加权成像评价肝细胞癌射频消融治疗疗效

目的 评价3.0T MR表观弥散系数(ADC)检测射频消融治疗后肝细胞癌(HCC)变化的价值,探讨弥散加权成像(DWI)在检测HCC射频消融治疗后不同病理改变的价值.方法 40例HCC患者在射频消融治疗后3～7天、2个月、6个月接受3.0T MR DWI检查,b值为600 s/mm2,测量、分析射频消融治疗后病灶ADC值.结果 射频消融治疗后3～7天、2个月、6个月坏死区ADC值明显降低,2个月、6个月时射频消融中心坏死区ADC值高于治疗后3～7天;3～7天与2个月、6个月时坏死组织的ADC值比较,差异均有统计学意义(P<0.01),治疗后2个月与6个月时坏死组织的ADC值差异无统计学意义(P>0.05).治疗后3～7天、2个月、6个月时活性残留或复发肿瘤组织ADC值差异均无统计学意义(P>0.05).结论 ADC值可用于鉴别射频消融治疗HCC后坏死组织与复发或残留肿瘤组织.     

弥散加权成像及增强CT对下咽癌术后放射治疗后并发症及复发的诊断价值

目的：探究弥散加权成像(diffusion weighted imaging,DWI)及增强CT对下咽癌术后放射治疗(以下简称“放疗”)后并发症及复发的诊断价值。方法：选择2020年6月至2022年6月在唐山市协和医院接受治疗的122例下咽癌患者作为研究对象。所有下咽癌患者在放疗后进行常规磁共振成像(magnetic resonance imaging,MRI)(包括DWI序列)及增强CT检查。观察、比较下咽癌患者的常规MRI、增强CT的影像学特点;对比肿瘤复发组(n=46)、肉芽组织增生组(n=51)、感染组(n=34)以及正常组(n=17)患者的表观弥散系数(apparent diffusion coefficient,ADC)值;比较DWI、增强CT在诊断下咽癌患者术后并发症及肿瘤复发上的诊断效能。结果：肿瘤复发组、肉芽组织增生组、感染组以及正常组患者的ADC值按照从低到高依次为肿瘤复发组<肉芽组织增生组<感染组<正常组;多组间、2组间比较差异均有统计学意义(均P<0.05)。DWI在诊断下咽癌并发症以及肿瘤复发上的敏感度、特异度、准确度以及阳性预测值、阴...     

扩散加权成像诊断鼻咽癌放疗后颅底斜坡复发

目的 探讨DWI诊断鼻咽癌颅底斜坡复发瘤价值。方法 收集经病理活检或随访证实的22例鼻咽癌放疗后颅底斜坡复发瘤患者和48例无复发患者,分析其常规MRI以及DWI特征,比较二者ADC值的差异,绘制ROC曲线,确定ADC诊断鼻咽癌颅底斜坡复发瘤的阈值。结果 MR平扫示复发与无复发患者的病灶均呈稍长T1稍长T2信号,增强后呈无强化至明显强化。复发患者中,77.27%（17/22）病灶DWI呈高信号,18.18%（4/22）呈等信号,其中21例（21/22,95.45%）病灶ADC图像均呈低或稍低信号;1例（1/22,4.55%）病灶DWI呈等信号、ADC图像呈稍高信号。无复发患者中,91.67%（44/48）病灶DWI呈高信号、ADC图像呈等或稍高信号,8.33%（4/48）病灶DWI呈等或稍低信号,ADC图像呈等或稍低信号。复发患者与无复发患者病灶ADC值差异有统计学意义[（0.78±0.17）]×10^-3mm²/s vs（1.67±0.34）×10^-3mm²/s, P=0.002）。以1.018×10^-3mm²/s为ADS诊断复发瘤阈值,其诊断敏感度和特异度分别为95.45%（21、22）和91.67%（44、48）,ROC曲线下面积为0.984。结论 DWI诊断鼻咽癌颅底斜坡复发瘤效能较高,具有重要临床应用价值。     

房颤患者术前二尖瓣反流程度与射频消融术后复发的相关性研究

目的 心房颤动(AF)患者常合并MR,但二尖瓣反流程度与导管消融(CA)结果之间的关系尚不清楚。本研究阵发性房颤患者术前二尖瓣反流程度与射频消融术后复发房颤的相关性。方法 选择首次射频消融术治疗患者阵发性房颤患者274例,收集包括临床特征、术前超声心动图参数、二尖瓣功能参数等,采用Logistic回归法分析术前二尖瓣反流程度与射频消融术后复发的相关性。结果(1) 274例行射频消融治疗的阵发性房颤患者中,射频术前二尖瓣无反流患者172例(62.77%),轻度反流72例(26.28%),中度反流21例(7.66%),重度反流9例(3.28%);(2)不同程度的二尖瓣反流患者在脑卒中史、吸烟史、LAD、LAV、LVESD、EF、消融术后复发率等,差异有统计学意义(P<0.05);Logistic回归分析显示二尖瓣反流、LAD是房颤射频消融术后复发独立因素(P<0.05或P<0.01),在未调整、初步调整以及充分调整协变量后显示,二尖瓣反流程度的加重增加了房颤射频消融术后复发风险。结论术前二尖瓣反流程度是房颤射频术后复发的危险因素,并且术后复发风险随着二尖瓣反流程度的加重而增加,提示可能是预测房颤射频消融术后复发的因子。     

左心房与肺静脉容积比预测导管消融术后心房颤动复发

目的 观察左心房容积(LAV)与肺静脉容积(PVV)比(LAV/PVV)预测导管消融术后心房颤动(AF)复发的价值。方法 纳入95例接受导管消融术治疗的AF患者，根据术后随访1年内有无AF复发将其分别归入复发组(n=23)与未复发组(n=72)。采用2种方法(方法1,对各支肺静脉均渲染至距肺静脉开口部后2 cm;方法2,对各支肺静脉均渲染至肺静脉分叉后1 cm)基于心脏CT血管成像(CTA)测量左肺上静脉容积(LSPVV)、左肺下静脉容积(LIPVV)、右肺上静脉容积(RSPVV)及右肺下静脉容积(RIPVV),计算LAV及PVV;比较2种方法测值，评估LAV/PVV预测导管消融术后AF复发的价值。结果 方法1、2所测LIPVV差异有统计学意义(P<0.05)。根据单因素分析结果，性别、年龄、体质量指数(BMI)、心力衰竭、LAV及LAV/PVV均为导管消融术后AF复发的危险因素；多因素分析结果显示，仅LAV/PVV为AF复发的危险因素。以8.27为方法1所获LAV/PVV的最佳截断值，其预测导管消融术后AF复发的曲线下面积(AUC)、敏感度及特异度分别为0.774、78.26%...     

Treatment of recurrent hepatocellular carcinoma following liver resection,ablation or liver transplantation

Hepatocellular carcinoma(HCC) is the most common primary liver malignancy and causes one third of cancer related deaths world-wide. Approximately one third of patients with HCC are eligible for curative treatments that include hepatic resection, liver transplantation or imaging guided tumor ablation. Recurrence rates after primary therapy depends on tumor biology and pre-treatment tumor burden with early recurrence rates ranging from 30%-80% following surgical resection and ablation. HCC recurs ...     

The role of contrast-enhanced sonography for radiofrequency ablation of liver tumors.

OBJECTIVE: To assess the feasibility and usefulness of contrast-enhanced sonography for tumor detection and guidance of liver VX2 tumor ablation and to evaluate post radiofrequency ablation effectiveness. METHODS: VX2 tumors were implanted into the livers of 6 rabbits. Both conventional and harmonic gray scale and power Doppler imaging were performed with a commercially available scanner to evaluate the liver tumors before and after intravenous injection of a sonographic contrast agent before and after radiofrequency ablation. Contrast-enhanced imaging was used to detect the tumors before ablation, to guide needle insertion, and to measure the ablation sites after radiofrequency ablation. Pathologic examination was performed for comparison. RESULTS: Three tumors were seen without contrast enhancement, whereas 10 tumors (<1 cm) were detected with contrast enhancement. Intentionally, 2 tumors were completely ablated and 5 tumors were partially ablated. In 3 cases, incompletely ablated tumors could only be identified on contrast-enhanced Doppler imaging by enhancing the detection of residual tumor vascularity. There was excellent concordance between sonographic imaging and gross pathologic findings. CONCLUSIONS: Contrast-enhanced sonographic imaging appears useful for detection of liver tumors and for guiding and monitoring tumor ablation therapies.     

Acute and long-term results of slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia--an analysis of the predictive factors for arrhythmia recurrence

BACKGROUND: Predictors of atrioventricular nodal reentrant tachycardia (AVNRT) recurrence after radiofrequency ablation including the importance of residual slow pathway conduction are not known. The aim of this study was to report the acute and long-term results of slow pathway ablation in a large series of consecutive patients with AVNRT and to analyze the potential predictors of arrhythmia recurrence with a particular emphasis on the residual slow pathway conduction after ablation. METHODS: The study included 506 consecutive patients with AVNRT (mean age 52.6 +/- 16 years, 315 women) who underwent slow pathway ablation using a combined electrophysiological and anatomical approach. The end point of ablation procedure was noninducibility of the arrhythmia. The primary end point of the study was the recurrence of AVNRT. RESULTS: Acute success was achieved in 500 patients (98.8%). After ablation, 471 patients (93%) were followed up for a mean of 903 +/- 692 days. Of the 465 patients with successful ablation, 24 patients (5.2%) developed AVNRT recurrences during the follow-up. No significant differences in the cumulative rates of AVNRT recurrence were observed in groups with or without electrophysiological evidence of residual slow pathway conduction (P = 0.25, log-rank test). Multivariate analysis identified only age as an independent predictor of AVNRT recurrence (hazard ratio 0.96, 95% confidence interval 0.94-0.99, P = 0.004) with younger patients being at an increased risk for arrhythmia recurrence. CONCLUSIONS: Our study demonstrated that only younger age, but not other clinical or electrophysiological parameters including residual slow pathway conduction predicted an increased risk for AVNRT recurrence after slow pathway radiofrequency ablation.     

介入栓塞化疗联合射频消融术治疗原发性肝癌

目的探讨介入栓塞化疗联合射频消融治疗原发性肝癌的方法．疗效及前景。方法20例肝癌患者经过一次或多次介入化疗栓塞仍有肿瘤残余,且均存在无法再栓塞的情况,然后在超声引导下进行射频消融术。术后观察AFP的动态变化、影像资料、评估肿瘤坏死率、以及患者的生存情况。结果肿瘤完全坏死率达95％,肿瘤复发率10％,随访8月～1．5年,仅有2例出现了局部复发和远处转移。结论介入栓塞化疗联合射频消融术治疗原发性肝癌是安全、有效的方法,其效果明显优于单纯的介入化疗栓塞,具有广阔的应用前景,值得推广。     

Elastographic imaging of thermal lesions in the liver in vivo following radiofrequency ablation: preliminary results

Radiofrequency (RF) ablation is an interstitial focal ablative therapy that can be used in a percutaneous fashion. This modality provides in situ destruction of hepatic tumors. However, local recurrence rates after RF ablative therapy are as high as 34% to 55%, believed to be due in part to the inability to visualize accurately the zone of necrosis (thermal lesion). This can lead to the incomplete ablation of the tumor, generally in areas near the tumor edges. In this paper, we show that ultrasound (US)-based in vivo elastography can accurately depict thermal lesions after thermal therapy. However, elastography of the liver and other abdominal organs is challenging due to the difficulty in providing controlled and reproducible compression. The use of the RF ablation probe as the compressor/displacement device reduces lateral slippage or nonaxial motion that may occur with externally applied compressions or imaging during the respiratory cycle. This technique also provides controlled and reproducible compressions of the liver for in vivo elastographic imaging. Comparison of elastograms with histology of ablated tissue demonstrates a close relationship between elastographic image features and histopathology.     

多模态磁共振成像对结节型肝细胞癌TACE+RFA术后复发灶评估的价值

目的探讨多模态磁共振成像对结节型肝细胞癌TACE+RFA术后复发灶评估的价值。材料和方法回顾性收集我院自2009年9月至2014年9月经临床或病理证实单结节型肝细胞癌并采用TACE和RFA联合治疗的患者。筛查入组105例,男87例,女18例,年龄46~83岁,中位年龄63岁。从复发点按随诊间隔逆行追溯分为三组:复发组、可疑组和术后组。结合复发组定位观察其他两组介入灶肿瘤复发区各序列信号改变及形态学征象。采用卡方检验比较三组间的各序列信号及形态改变。根据复发组各序列信号、形态的百分比进行编号。使用ROC曲线比较复发组-术后组各序列信号的诊断阈值。使用Logistics回归计算各序列同时使用信号及形态特点诊断可疑组的灵敏度、特异度。再将序列进行联合找到约登指数最大时的序列搭配。结果可疑组时信号特点:T1WI低信号、混杂信号;T2WI高信号、混杂信号;弥散加权成像(diffusion weighte dimaging,DWI)高信号,肝脏三维容积快速扫描(liver acquisition with volumeacceleration,LAVA)明显强化。形态特点:各序列大多以半月形为主。诊断效能:当T1WI、T2WI、DWI、LAVA四个联合时诊断灵敏度、特异度分别为85.7%和94.3%。结论多模态磁共振成像技术对结节型原发性肝细胞TACE+RFA介入术后复发区的观测具有一定随访价值。     

胆囊旁肝癌的微创治疗

目的评价腹腔镜下热消融治疗胆囊旁肝癌的安全性及疗效。方法采用腹腔镜胆囊切除术（LC）联合腹腔镜下经皮热消融治疗各类胆囊旁肝癌21例共32个病灶,术后复查肝功能、甲胎蛋白（AFP）、增强CT,观察疗效。结论手术前后Child-pugh评分无统计学差异;本组病例均无严重并发症和死亡病例;腹腔镜下（LUS）超声发现新病灶2例共2个;术前AFP升高的15例患者术后12例显著降低,3例无改变;术后四周复查增强CT,28个病灶完全消融,4个癌灶残留,再次行经皮热消融后达完全消融。随访12个月,2例复发（9．5％）。结论LC联合热消融使胆囊旁肝癌患者获得了安全、有效的微创治疗。     

胆囊旁肝癌的微创治疗

目的 评价腹腔镜下热消融治疗胆囊旁肝癌的安全性及疗效.方法 采用腹腔镜胆囊切除术(LC)联合腹腔镜下经皮热消融治疗各类胆囊旁肝癌21例共32个病灶,术后复查肝功能、甲胎蛋白(AFP)、增强CT,观察疗效.结论手术前后Child-push评分无统计学差异;本组病例均无严重并发症和死亡病例;腹腔镜下(LUS)超声发现新病灶2例共2个;术前AFP升高的15例患者术后12例显著降低,3例无改变;术后四周复查增强CT,28个病灶完全消融,4个癌灶残留,再次行经皮热消融后达完全消融.随访12个月,2例复发(9.5%).结论 LC联合热消融使胆囊旁肝癌患者获得了安全、有效的微创治疗.     

胆囊旁肝癌的微创治疗

目的 评价腹腔镜下热消融治疗胆囊旁肝癌的安全性及疗效.方法 采用腹腔镜胆囊切除术(LC)联合腹腔镜下经皮热消融治疗各类胆囊旁肝癌21例共32个病灶,术后复查肝功能、甲胎蛋白(AFP)、增强CT,观察疗效.结论手术前后Child-push评分无统计学差异;本组病例均无严重并发症和死亡病例;腹腔镜下(LUS)超声发现新病灶2例共2个;术前AFP升高的15例患者术后12例显著降低,3例无改变;术后四周复查增强CT,28个病灶完全消融,4个癌灶残留,再次行经皮热消融后达完全消融.随访12个月,2例复发(9.5%).结论 LC联合热消融使胆囊旁肝癌患者获得了安全、有效的微创治疗.     

胆囊旁肝癌的微创治疗

目的 评价腹腔镜下热消融治疗胆囊旁肝癌的安全性及疗效.方法 采用腹腔镜胆囊切除术(LC)联合腹腔镜下经皮热消融治疗各类胆囊旁肝癌21例共32个病灶,术后复查肝功能、甲胎蛋白(AFP)、增强CT,观察疗效.结论手术前后Child-push评分无统计学差异;本组病例均无严重并发症和死亡病例;腹腔镜下(LUS)超声发现新病灶2例共2个;术前AFP升高的15例患者术后12例显著降低,3例无改变;术后四周复查增强CT,28个病灶完全消融,4个癌灶残留,再次行经皮热消融后达完全消融.随访12个月,2例复发(9.5%).结论 LC联合热消融使胆囊旁肝癌患者获得了安全、有效的微创治疗.