磁共振胰胆管成像对恶性胆道梗阻的诊断价值

目的：评价磁共振胰胆管成像（MRCP）对恶性胆道梗阻性疾病的临床诊断价值，探讨肝外恶性胆道梗阻的MRCP、MRI诊断及鉴别诊断。方法：回顾性分析69例恶性胆道梗阻患者的MRI及MRCP表现，并与CT、US、直接胆道造影和手术病理结果对照。MRCP采用二维（2D）和／或三维（3D）屏气半傅立叶转换快速自旋回波（FASE）序列T2加权成像技术。结果：69例MRCP检查均一次成功，全部病例胰胆管显示满意，与直接胆道造影对照，二者所获图像极其相似。MRCP对恶性胆道梗阻定位诊断准确率为98．5％定性诊断准确率为95．6％。结论：MRCP对恶性胆道梗阻定位及定性诊断优于CT和US，是诊断恶性胆道梗阻的一种有效的非侵袭性的检查方法。     

MRCP联合MRI在胰胆管梗阻性疾病中诊断的价值

目的:探讨MRCP联合MRI对胰胆管梗阻性疾患定位和定性诊断的价值.方法:对2000年9月～2007年9月842例梗阻性黄疸患者的MRCP及MRI的图像进行分析,并与CT、US、直接胆道造影和临床手术病理结果对照.结果:全部病例MRCP 检查均一次成功,其中320例行直接胆道造影,与MRCP 对照,二者所获图像极其相似.MRCP 对梗阻定位诊断准确率为96.79%,MRCP联合MRI可提高到100%;MRI对梗阻定性诊断准确率为89.19%,联合MRCP可提高至97.74%.CT对梗阻的定位、定性诊断率分别为78.61%,77.59%;US对梗阻的定位、定性诊断率分别为89.73%,82.47%.结论:MRCP联合MRI作为无创性检查技术,对胆胰管梗阻性疾病的定位与定性诊断准确率均高于CT及US;可作为胆系梗阻性病变诊断的首选检查.     

CT、MRI、MRCP对胆道梗阻的诊断价值

目的　探讨CT、MRI、MRCP对胆道梗阻的诊断价值。方法　分析经病理和临床随访确诊 3 0例 (恶性 2 2例 ,良性 8例 )胆道梗阻患者CT、MRI、MRCP表现。结果　CT、MRI、MRCP对胆道梗阻定位诊断率分别为 86.7%、93 .3 %、10 0 % ,CT、MRI、CT MRI MRCP定性诊断率分别为 80 %、73 %、90 %。结论　综合分析CT、MRI、MRCP表现能提高胆道梗阻的定位、定性诊断率     

CT、MRI及MRCP在恶性胆道梗阻中的诊断价值

目的:探讨CT、MRI和MRCP对恶性胆道梗阻的综合诊断价值。方法:搜集2000年9月~2007年9月经手术病理和临床治疗证实的胰胆管恶性肿瘤298例,包括肝内胆管癌13例,肝门胆管癌56例,胆总管癌34例,壶腹癌19例,胆囊癌20例,胰头癌156例。回顾性分析其CT、MRI及MRCP的表现。结果:全部患者MRCP检查均一次成功,胆管及胰管显示满意;MRCP对胆道梗阻定位符合率为94.3%,MRCP结合MRI定位符合率提高到100%;CT、MRI和MRCP对恶性胆道梗阻病变的定性诊断符合率分别为80.5%、84.2%和76.2%,MRI结合MRCP定性诊断符合率为89.6%。CT、MRI及MRCP定性诊断符合率提高至91.6%。结论:MRCP联合MRI能够提高恶性胆道梗阻的定位符合率,综合分析CT、MRI及MRCP表现能提高恶性胆道梗阻的定性诊断符合率。     

胆道梗阻病变的CT、MRI影像学诊断(附94例分析)

目的 探讨CT、MR对胆道梗阻的诊断价值.方法 收集经手术病理证实的胆道梗阻性病变患者共94例,回顾性分析其CT、MRI表现.结果 胆道结石40例,胆管炎性狭窄8例,胆囊癌12例,胆管癌21例,壶腹癌7例,胰头癌6例.CT、MRI对胆道梗阻的定位诊断符合率达96.8％、100％.CT、MRI对胆道梗阻病变的定性诊断符合率分别为78.7％,83％,应用CT与MRI联合分析对胆道梗阻的定性诊断符合率为89.4％.结论 CT与MRI对胆道梗阻均能做出准确的定位诊断,定性诊断的准确性也较高,应用CT与MRI联合分析可以提高对胆道梗阻病变的定性诊断符合率.     

高位胆道梗阻的CT与MRI、MRCP诊断价值

目的　探讨CT、MRI和MRCP对高位胆道梗阻的临床诊断价值。方法　对 12例高位梗阻 (恶性 11例 ,良性 1例 )进行了常规MRI、2DFSE序列MRCP检查 ,其中 10例恶性病变进行了CT检查 (平扫 7例 ,增强 3例 )。结果　CT、MRI和MRCP对高位梗阻定位诊断准确率分别为 90 %、92 %和 10 0 % ,定性诊断准确率分别为 80 %、83%和 6 7% ,MRI +MRCP定性诊断准确率提高到 92 %。10例恶性梗阻CT检查显示肿物 5例 ,胆总管环形增厚 3例。 12例MRI扫描显示肿物 8例 ,肝内转移 2例。MRCP显示梗阻近端形态较为特征 ,截断状以肝癌多见 ,锥状以胆管癌和转移癌多见 ,漏斗状见于良性病变。MRCP显示多发狭窄的长度和范围。结论　CT和MRI对高位梗阻具有同样重要的定性诊断价值。MRCP确定病变部位和范围具有独特的价值。MRI和MRCP结合可提高定位和定性诊断正确率     

超声造影、增强CT及增强MRI对肾脏占位性病变的诊断价值比较

目的：比较超声造影、增强CT及增强MRI对肾脏占位性病变的诊断价值。资料与方法对78例经常规超声诊断为肾脏占位性病变患者的80个病灶进行实时超声造影检查,39个行增强CT检查,28个行增强MRI检查,其中5个同时行增强CT及增强MRI检查。以病理结果为“金标准”,比较超声造影、增强CT及增强MRI诊断肾脏占位性病变良恶性的价值。结果80个病灶中,57个为恶性病变,23个为良性病变;超声造影诊断肾脏病变良恶性的敏感度、特异度、阳性预测值、阴性预测值分别为93.0%、69.6%、88.3%、80.0%;增强CT诊断肾脏病变良恶性的敏感度、特异度、阳性预测值、阴性预测值分别为96.4%、72.7%、90.0%、88.9%;增强MRI诊断肾脏病变良恶性的敏感度、特异度、阳性预测值、阴性预测值分别为86.4%、66.7%、90.5%、57.1%;3种检查诊断效果间差异无统计学意义（P>0.05）。结论超声造影、增强CT及增强MRI对于肾脏占位性病变良恶性的诊断效果相当,临床可以根据各个检查技术的特点,为不同的患者选择适宜的检查,联合应用两种检查方法为肾脏占位性病变的诊断提供了更丰富的信息。     

胆道扩张的形态学MR表现对胆道梗阻性病变的诊断分析

目的根据胆道扩张的形态学的影像表现对不同胆道梗阻性病变进行分析,判断其原发病灶的性质。方法收集我院2014年1月~2016年3月共计95例梗阻性黄疸患者,行磁共振成像及磁共振胰胆管造影(MRCP)检查,所有患者进行手术或逆行胰胆管造影(ERCP)检查获得病理结果。根据所有患者的影像学资料分析其肝内胆管扩张的程度、形态,肝外胆管扩张末端变化,梗阻部位及原发病性质。结果良性梗阻多为轻度胆管扩张,呈枯枝状;即使中度扩张也极少呈软藤状,而较多呈残根状。恶性梗阻多为中、重度胆管扩张,且多呈软藤状;高、中位胆道梗阻多见于恶性病变,低位胆道梗阻良性与恶性病变发生的比例相近;恶性梗阻扩张肝外胆管末端突然中断,良性梗阻扩张肝外胆管末端逐渐变细。结论磁共振胰胆管成像对良、恶性胆道梗阻病病变具有较高的诊断价值,分析胆道扩张的形态特征,对鉴别良、恶性梗阻病变有较大意义,有利于指导临床治疗。     

超声造影鉴别肝脏局灶性病变良恶性的临床意义

目的评价超声造影技术在鉴别良恶性肝脏局灶性病变中的临床意义,并与常规超声比较。方法 83例经穿刺活检及手术或临床证实的肝脏局灶性病变(38例恶性和45例良性)均经常规超声和超声造影检查,对肝脏局灶性病变在造影检查中的强化型式与时相特征逐例进行了观察与记录,并用卡方检验比较了两种方法对肝脏局灶性病变的诊断效能。结果肝脏局灶性病变随其良性与恶性而表现为不同的强化型式与时相特征。超声造影正确诊断34例恶性和43例良性病变,其诊断敏感性、特异性和准确性分别为89.5%、95.6%和92.8%,而常规超声正确诊断23例恶性和22例良性病变,其诊断敏感性、特异性和准确性分别为60.5%、48.9%和54.2%。两种方法诊断效能比较有统计学差异(P<0.01)。结论超声造影技术在肝脏局灶性病变良恶性鉴别诊断中具有重要的临床应用价值,并可取代常规超声。     

乳腺磁共振成像联合乳腺数字三维断层摄影技术对乳腺良恶性病变鉴别价值

目的 探讨乳腺磁共振成像(MRI)联合乳腺数字三维断层摄影技术(DBT)对乳腺良恶性病变的鉴别价值。方法 收集自2020年4月至2022年6月于江汉大学附属医院行乳腺DBT及MRI检查,且行病理检查确诊的206例乳腺结节性病变患者的临床资料、影像资料及病理资料。绘制受试者工作特征(ROC)曲线,比较DBT、MRI、DBT+MRI诊断乳腺良恶性病变的曲线下面积(AUC)及诊断效能。结果 DBT诊断阳性预测值为80.65%,阴性预测值为86.72%。MRI诊断阳性预测值为81.25%,阴性预测值为81.64%。DBT+MRI诊断阳性预测值为83.18%,阴性预测值为98.99%。DBT+MRI诊断乳腺良恶性病变的AUC为0.911,高于DBT诊断的0.837,差异有统计学意义(Z=1.958,P<0.05)。DBT+MRI诊断乳腺良恶性病变的敏感度为98.89%,特异度为84.48%,准确度为90.78%。结论 乳腺DBT+MRI检查鉴别乳腺结节性病变良恶性效能优于单独DBT检查,与单独乳腺MRI检查诊断效能无明显差异。     

常规MRI结合DWI序列对肠梗阻良恶性病因的诊断价值

目的 探讨常规磁共振平扫结合DWI序列对于肠梗阻良、恶性病因的诊断价值.方法 分析我院收治的经手术病理证实的89例肠梗阻磁共振常规平扫结合DWI序列成像资料,其中良性梗阻44例,恶性梗阻45例;评价磁共振成像对肠梗阻病因的良恶性判定价值以及良恶性梗阻病因的诊断符合率.结果 常规磁共振结合DWI对于89例肠梗阻的定位诊断符合率100％,病因诊断符合率82.0％（73/89）;对肠梗阻病因的良、恶性判定符合率为97.8％（87/89）,对良、恶性肠梗阻的病因诊断符合率分别为72.7％（32/44）和91.1％（41/45）,二者差异具有统计学意义（χ^2=5.10,P=0.024＜0.05）.结论 常规MRI结合DWI序列对肠梗阻致病因素的良恶性具有较高的诊断价值,可以作为肠梗阻病因尤其是恶性病因的重要检查手段.     

螺旋CT及MRI在鉴别肾脏囊性占位病变中的作用

目的分析肾脏囊性占位病变的CT与MRI表现,并评价其对鉴别良恶性病变的临床意义。方法 151例由手术病理证实的肾脏囊性占位病变患者,包括多发囊肿125例,海绵状血管瘤16例及囊性肾癌10例,均经CT与MRI平扫及增强扫描。比较了CT与MRI对肾脏囊性占位病变的诊断能力。结果 151例中,CT诊断肾囊肿118例,血管瘤16例,以及囊性肾癌17例,其诊断敏感性,特异性及准确性分别为58.8%,95.0%及95.4%;MRI诊断肾囊肿122例,血管瘤16例,以及囊性肾癌13例,其诊断敏感性,特异性及准确性分别为76.9%,98.8%及98.0%。CT对肾良性病变低估7例,对恶性病变高估了7例,而MRI对肾良性病变低估3例,对恶性病变高估3例。结论 CT与MRI二者都能对血管瘤作出正确诊断,而在肾囊肿与囊性肾癌的诊断及鉴别诊断中,MRI明显优于CT。     

恶性胆管梗阻的磁共振胰胆管造影与手术病理对照研究

目的探讨磁共振胰胆管造影（ＭＲＣＰ）诊断恶性胆管梗阻的价值。方法３２例临床怀疑梗阻性黄疸的病人进行了ＭＲＣＰ检查，并全部经手术病理证实。结果ＭＲＣＰ对恶性胆管梗阻部位诊断的准确率为９６．９％，而ＣＴ为８８．５％，超声为７６．０％。ＭＲＣＰ的定性诊断准确率为９６．９％。结论ＭＲＣＰ在恶性胆管梗阻的定位诊断上明显高于超声     

肾上腺常见肿瘤的MRI与CT对照研究

目的：将肾上腺常见肿瘤的MRI影像学特征与CT进行比较,结合病理诊断和生化结果评价MRI在肾上腺肿瘤诊断中的价值。方法：对我院于2000年5月-2008年6月收治并经病理证实的36例肾上腺肿瘤进行回顾性分析,所有病例均有详尽的MRI／及CT影像资料。结合病理,分析MR／和CT的影像特点。结果：36例中,CT和MRI发现阳性率分别为94％和100％;肾上腺癌及转移瘤10例,CT及MRI诊断准确率分别为4／10、10／10,其中,肾上腺癌伴腔静脉癌栓6例,CT和MRI诊断准确率分别为33％和100％。结论：CT和MRI在肾上腺肿瘤的诊断和鉴别诊断上有很好的互补性,MRI对良、恶性肿瘤的鉴别诊断价值及对静脉腔瘤栓的显示上优于CT。     

Magnetic resonance cholangiopancreatography in conjunction with 3D for assessment of different biliary obstruction causes

Objective

To assess the diagnostic value of magnetic resonance imaging in conjunction with 3D-MRCP, with maximum intensity projections and volume rendered images in different biliary obstruction causes.

Patient and methods

This study retrospectively reviewed the radiology records of 29 patients (18 females and 11 males) suffering from obstructive jaundice. All patients were subjected to magnetic resonance imaging (MRI), 3D-MRCP with maximum intensity projection (MIP) and volume rendered (VR) reformatted images for biliary obstruction diseases in Zagazig University Hospitals between November 2008 and January 2010. MR studies were performed with 1.5-T superconductive magnet (Philips Achieva, class II a). The patient ages were ranging from 23 to 66 years (mean age: 34 years). This study was done to evaluate the diagnostic value and accuracy of the new MRI techniques as a non-invasive tool to diagnose and differentiate between benign and malignant variants of biliary obstruction diseases and to facilitate the management planning. All cases were evaluated by clinical examination, laboratory values, grey and colored scale ultrasonography, conventional MRI, three-dimensional (3D-MRCP), MIP, and VR images. Our results were correlated with the histology of the resected specimen, operative (ERCP) or image-guided biopsy in inoperable patients.

Results

The mean age of benign patients was 30 years compared with 54 years in malignant biliary obstruction. Seventeen patients had benign cases 58.6% (6 cases of benign stricture and 11 cases with choledocholithiasis). The other 12 cases had malignant aetiology. Twenty-three patients were subjected to operative procedures, while the remaining six had ERCP/PTC and stenting. The MRI/MRCP images were of good quality in all patients. The intra- and extra-hepatic biliary radicals were visualized completely including the proximal and distal extent of the stricture. Regarding the benign cases (16/17) were satisfactorily diagnosed, however, one case was false negative, due to missed small stone at the MIP reconstructions. The 12 malignant biliary obstruction cases were as follows: five cases were cholangiocarcinoma (one peripheral type, one perihilar position, one Klatskin’s type, and two cases of the distal type), three pancreatic neoplastic lesions, two ampullary carcinoma, and two malignant lymph nodes. Regarding the benign cases 3D-MRCP had 94.1% diagnostic accuracy, otherwise more accuracy reported in malignant causes 100%.

Conclusion

3D-MRCP with MIP creates global images for pancreatico-biliary system. It is as effective as ERCP in detection of biliary obstruction and can precisely determine its level as well. Furthermore, it can provide a road map for management planning. By avoiding the flow artifacts, the false negative results that previously reported in past studies can be reduced.     

Diagnostic imaging of carcinomas of the gallbladder and the bile ducts

Early diagnosis and accurate staging of carcinomas of the gallbladder and the bile ducts are helpful in improving the prognosis. Ultrasonography (US), a useful initial modality when exploring the background of jaundice or non-specific gastrointestinal complaints, sensitively reveals bile duct obstruction in particular. In unclear cases, or if US suggests a resectable biliary malignancy, computed tomography (CT), magnetic resonance imaging (MRI) with magnetic resonance cholangiography (MRC) and / or traditional cholangiography often provide additional information, and imaging-guided fine-needle biopsy or an endoscopic brush sample may verify the malignant nature of the tumor. Complementary modalities are usually needed for accurate staging, and traditional cholangiography is often performed for therapeutic purposes as well. Comparative studies of MRI with MRC and multidetector CT in biliary cancers would be welcome.     

肝外胆管梗阻的磁共振胆胰管造影诊断

目的 评价磁共振胆胰管造影（ＭＲＣＰ）对肝外胆管梗阻性疾病的临床诊断价值。方法 对５４例肝外胆管梗阻性疾病（肝外胆管结石３０例,恶性胆管梗阻２４例）进行ＭＲＣＰ检查,并与临床诊断或手术和病理结果对照分析。ＭＲＣＰ采用不屏气快速自旋回波（ＴＳＥ）序列重工Ｔ２ＷＩ扫描,结合呼吸触发及脂护抑制技术,原始图像以最大信号强度投影（ＭＩＰ）法进行三维重建。结果 全部５４例ＭＲＣＰ检查均一次成功,５２例胆胰管显     

Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis of ovarian carcinoma

Our objective was to compare US, CT, and MR imaging in differentiation of malignant from benign ovarian tumors. Through an electronic literature search and manual review of bibliographies (January 1990 to June 2006), relevant studies on the diagnostic performance of US, CT, and MR imaging in the differentiation between benign and malignant ovarian tumours were identified. Sixty-nine articles were included, yielding 143 studies. Data on the accuracy of the different imaging modalities were analyzed and compared by constructing summary receiver-operating characteristic (ROC) curves. Our results suggest that US techniques seems to be similar with CT and MRI in differentiation of malignant from benign ovarian tumors. The results also revealed that color Doppler flow imaging alone is significantly inferior to combined US techniques, morphologic assessment alone and contrast enhanced US in diagnosis of ovarian cancer. In conclusion, US morphologic assessment still is the most important and common modality in detect ovarian cancer.