转化生长因子-β1与乳腺病变弹性特征的相关性

目的探讨转化生长因子-β1(TGF-β1)与乳腺病变弹性特征的相关性。资料与方法选取经手术、穿刺活检或旋切活检的130例患者135个乳腺病变,其中良性84个,恶性51个。于手术或活检前对其进行剪切波弹性成像检查,记录病变的最大弹性模量、平均弹性模量、最小弹性模量,与周围组织弹性比值及“硬环征”等,采用免疫组化法检测TGF-β1的表达水平。比较良、恶性病变弹性特征及TGF-β1表达水平的差异,分析TGF-β1表达水平与上述弹性参数的相关性。结果恶性病变与良性病变的最大弹性模量[(161.9±79.5)kPa比(58.2±50.5)kPa]、平均弹性模量[(99.6±51.9)kPa比(35.9±26.4)kPa]、病变与周围组织弹性比值(6.0±4.1比2.1±1.7)、“硬环征”检出率[74.5%(38/51)比4.8%(4/84)]及TGF-β1表达水平(0.299±0.011比0.104±0.009)比较,差异均有统计学意义(P均<0.001);TGF-β1表达水平与最大弹性模量、平均弹性模量、病变与周围组织弹性比值均呈强正相关(r=0.879、0.821、0.741,P<0.001);有无“硬环征”的病变TGF-β1表达水平比较,差异有统计学意义(0.308±0.010比0.115±0.010,P<0.001)。结论乳腺病变的TGF-β1表达水平与最大弹性模量、平均弹性模量、病变与周围组织弹性比值及病变边缘“硬环征”等均具有相关性。     

实时剪切波弹性成像鉴别甲状腺结节良恶性的定量分析

目的应用剪切波弹性成像测定甲状腺结节的杨氏模量值,探讨其在结节良恶性鉴别诊断中的价值.资料与方法对79例甲状腺结节患者进行实时剪切波弹性成像,测得结节的杨氏模量值,以病理结果为“金标准”,绘制 ROC 曲线,分析鉴别良恶性病灶的参考界值.结果79例共分析甲状腺结节88个,良性63个,恶性25个,良性结节的平均、最大杨氏模量值分别为(27.56±25.22)kPa 和(41.79±30.66)kPa,恶性结节的平均、最大杨氏模量值分别为(88.38±35.27)kPa 和(137.36±56.81)kPa ;良恶性结节杨氏模量最大值和平均值差异有统计学意义(P <0.05);甲状腺结节杨氏模量最大值与平均值诊断恶性病变的 ROC 曲线下面积为0.971和0.802(P <0.05),分别以结节杨氏模量最大值90.34kPa 和平均值60.25kPa 作为诊断界值,其诊断敏感度、特异度为90.34%、86.89%和63.67%、91.66%;2名观察者间符合率为93.2%(Kappa =0.83).结论剪切波弹性成像测得的甲状腺结节杨氏模量最大值与平均值可以定量评价病灶硬度,有助于甲状腺结节良恶性的鉴别诊断.     

PI3K/AKT信号通路与乳腺病变弹性特征的相关性

目的 探讨磷脂酰肌醇-3-激酶/丝苏氨酸蛋白激酶(PI3K/AKT)信号通路与乳腺病变弹性特征的相关性。资料与方法前瞻性分析2021年5月—2022年5月于解放军总医院接受手术的114例患者共115个乳腺病变,术前行超声和剪切波弹性成像检查。采用免疫组化染色检测组织标本中PI3K/AKT蛋白水平的表达,分析染色结果与剪切波弹性成像最大弹性模量值、平均弹性模量值、最小弹性模量值、病变与周围组织弹性比值的相关性。结果 115个乳腺病变中,手术病理显示乳腺良性病变50个,恶性病变65个(25个伴腋窝淋巴结转移)。良性病变与恶性病变不伴腋窝淋巴结转移、恶性病变伴腋窝淋巴结转移的最大弹性模量值(F=40.47)、平均弹性模量值(F=45.11)、病变与周围组织弹性比值(F=48.98)、“硬环征”检出率(χ²=62.25)、PI3K/p-PI3K表达水平(F=15.19、58.95)及AKT/p-AKT表达水平(F=46.94、74.21)比较,差异均有统计学意义(P<0.05)。PI3K/pPI3K及AKT/p-AKT表达水平与最大弹性模量值、平均弹性模量值、病变与...     

实时剪切波弹性成像对乳腺小肿块的各向异性与良恶性的评估价值

【摘要】目的：探讨剪切波弹性模量对乳腺小肿块（<2cm）的各向异性及乳腺小肿块良恶性的评估价值。方法：采集乳腺小肿块的横向、纵向及45°方向的弹性图像并记录其BI-RADS分类的结果。采用两种勾画方法选定兴趣区并记录肿块的弹性模量参数。分析正常对照组、良性肿块组、恶性肿块组之间的弹性参数，比较弹性模量均值及Asp在横向、纵向及45°方向上的差异，并绘制ROC曲线。结果：乳腺小肿块的弹性模量在横向、纵向、45°方向上有差异有统计学意义（良性肿块组F=3.53，P=0.03；恶性肿块组F=8.5，P=0.001），而正常对照组差异无统计学意义（F=0.65，P=0.52）。比较良性组与恶性组的弹性参数EMax、Asp，其差异均有统计学意义（P＜0.01）。以病理结果为标准，分别绘制弹性参数EMax和Asp的ROC曲线，其曲线下面积、敏感度、特异度分别为0.947、89.9%、90.0%和0.791、60%、89.9%，将弹性参数EMax、Asp的诊断临界值分别为26.95kPa、0.68时和BI-RADS分级联合诊断，BI-RADS与EMax、与Asp联合诊断提高了BI-RADS分类诊断的特异度与符合率。结论：乳腺肿瘤组织具有各向异性特征，该特征可由剪切波弹性模量进行定量分析。BI-RADS分类与弹性模量、组织各向异性相结合可以提高乳腺肿块诊断的效能。     

剪切波弹性成像对非肿块型乳腺病变良恶性的诊断价值

目的运用实时剪切波弹性成像(SWE)技术定量测量非肿块型乳腺病变的弹性模量参数,探讨该技术对非肿块型乳腺病变的诊断价值。方法运用实时剪切波弹性成像(SWE)技术定量测量非肿块型乳腺病变的弹性模量参数,探讨该技术对非肿块型乳腺病变的诊断价值。结果 45例患者中病理诊断良性22例(23个病灶),恶性23例(24个病灶)。非肿块型乳腺良恶性病灶的Emax值、Emean值比较,差异均有统计学意义(t=-8.42、-6.44,P均0.05),而良恶性病灶的Emin值比较,差异无统计学意义(t=-1.59,P0.05)。分别以Emax=63.2kPa和Emean=40.9kPa为诊断界点时, ROC曲线下面积分别为0.929和0.887,诊断的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为85.2%、83.3%、95.7%、95.0%、81.5%和80.7%、79.2%、91.3%、88.9%、72.4%。将BI-RADS分级与Emax值相结合,诊断的准确性和特异度与常规超声相比显著提高(χ~2=5.115、9.610,P均0.05);将BI-RADS分级与Emean值相结合,诊断的准确性和特异度与常规超声相比显著提高(χ~2=5.109、8.021,P均0.05)。结论 SWE技术有助于非肿块型乳腺病变的诊断,可在一定程度上提高诊断的准确性、特异度及阳性预测值,"硬环征"在一定程度上有助于非肿块型乳腺良恶性病变的鉴别。     

超声萤火虫成像联合剪切波弹性成像鉴别乳腺良恶性结节的应用价值

目的：对比分析超声萤火虫成像与剪切波弹性成像（SWE）单独及联合应用在乳腺良恶性结节中的诊断价值。方法 ：选取行手术切除或穿刺活检的乳腺结节患者92例,共114个结节,均行二维超声、SWE及超声萤火虫成像检查;以病理结果为金标准,分析萤火虫成像、SWE单独及两者联合诊断的特异度、敏感度及准确率。结果：病理结果示,114个结节中,良性70个（61.4%）,恶性44个（38.6%）。两者联合应用的敏感度、特异度及准确率均高于单独使用（均P<0.05）。结论：超声萤火虫成像与SWE联合应用可显著提高乳腺结节良恶性的诊断效能。     

剪切波弹性成像及自动乳腺全容积成像在乳腺肿块鉴别诊断中的价值

目的 探讨剪切波弹性成像(SWE)联合自动乳腺全容积成像(ABVS)在鉴别乳腺良恶性肿块中的价值。方法 选取我院乳腺中心就诊的患者94例,共115个肿块,采用SWE与ABVS技术对乳腺肿块进行检测,获取肿块内剪切波弹性模量最大值Emax、剪切波弹性模量平均值Emean、肿块与周围脂肪组织弹性模量比值Eratio(单位为k Pa)及ABVS冠状面图像,比较良恶性肿块的剪切波弹性模量值,判断冠状面超声征象。以穿刺组织学和手术病理为金标准,绘制受试者工作特征(ROC)曲线,确定诊断价值最高的一组弹性模量值,获得最佳诊断截点。结果 乳腺恶性病灶的ABVS冠状面“汇聚征”出现率高于良性病灶,差异有统计学意义(2=53274,P 0. 05);恶性病灶组的Emax、Emean、Eratio均高于乳腺良性病灶组,差异均有统计学意义(P 0. 05),乳腺肿块Emax、Emean、Eratio对应ROC曲线下面积分别为0. 972、0. 961及0. 908,其中,肿块内Emax的诊断价值最高,其诊断截点为57. 5kPa。ABVS冠状面“汇聚征”、肿块内Emax及两者联合诊断乳腺肿块良恶性的敏感度、特异度、准确性、阳性预测值及阴性预测值分别为91. 9%、90. 9%、92. 7%,76. 9%、96. 6%、98. 3%,81. 7%、93. 9%、95. 6%,65. 4%、96. 2%、98. 1%,95. 2%、92. 1%、93. 6%。结论 ABVS冠状面“汇聚征”及SWE技术联合应用能提高鉴别诊断的敏感度、特异度、阳性预测值及准确性。     

多模态超声在非肿块乳腺病变诊断中的应用

目的分析良、恶性非肿块乳腺病变(NML)的灰阶超声(US)、超声造影(CEUS)及剪切波弹性成像(SWE)特征,探讨US、CEUS联合SWE诊断非肿块乳腺病变的价值.资料与方法前瞻性分析2021年1—8月于解放军总医院行US、CEUS及SWE检查,随后均行穿刺活检、旋切活检或手术的44例女性患者,共47个乳腺病灶,对N...     

MR-DWI对非哺乳期乳腺炎与非肿块强化乳腺恶性肿瘤的鉴别诊断

目的：探讨 MR-DWI 及其表观弥散系数（ADC）值对乳腺炎性病变与非肿块样强化乳腺恶性肿瘤鉴别诊断价值。方法：回顾性分析2013年1月-2014年2月经手术或穿刺活检病理确诊的乳腺炎性病变患者共32例与同时期非肿块样强化的乳腺恶性病变45例的乳腺 MR-DWI 表现及 ADC 值。32例炎性病变中12例为超声引导下穿刺活检病理证实,20例行手术病理证实,恶性病变均行手术治疗,获得组织病理结果证实。分析所有患者的术前 MRI 表现,包括 DWI图像中病变形态、信号表现,并测定 ADC 值,以探讨 MR-DWI 对乳腺炎性病变与非肿块强化恶性病变的鉴别诊断价值。结果：32例乳腺炎性病变 DWI 上全部检出,其中23例含脓肿或微脓肿病例,DWI 均可见不均匀高信号,部分可见显著高信号灶,边界清晰。与乳腺恶性肿瘤相比乳腺炎病例较多表现为 DWI 及 STIR 均呈高信号（P ＜0．01）;乳腺恶性肿瘤病例较乳腺炎病例多表现为 DWI 高信号、STIR 稍低信号（P ＜0．01）。32例乳腺炎病例的周围炎性渗出或增生肉芽组织ADC 值为（1．48±0．21）×10-3 mm2/s,其中23例含脓腔或微脓腔的乳腺炎性病变,其显著高信号脓腔的 ADC 值为（0．91±0．19）×10-3 mm2/s。45例乳腺恶性肿瘤实性成分的 ADC 值为（1．15±0．23）×10-3 mm2/s。结论：MR-DWI 联合 STIR 及 ADC 值对于非哺乳期乳腺炎性病变与非肿块样强化的乳腺恶性病变的鉴别诊断具有较大价值。     

MRI对乳腺X线摄影中含成簇微钙化病变的诊断

目的：探讨乳腺磁共振成像对乳腺X线摄影中含成簇微钙化病变的鉴别诊断价值。方法：搜集行乳腺钙化灶立体定位下活检术或术前钩丝定位局切活检术的97例病例,所有患者术前均行乳腺X线摄影和MRI检查且病灶钙化表现为成簇微钙化灶,分析含不同形态成簇微钙化病变的MRI表现及其鉴别诊断价值,并与组织病理学结果进行对照。结果：病灶总数为97个,其中病理结果为良性者73个（75.3%）,恶性24个（24.7%）。良恶性病变乳腺X线上表现均以无定形钙化为主者,分别占57.5%（42/73）、37.5%（9/24）。MRI对含成簇微钙化的恶性病灶诊断的阳性预测值72.4%（21/29）高于乳腺X线摄影28.9%（22/76）（P=0.000）。MRI对含成簇无定形钙化的恶性病灶诊断的阳性预测值66.7%（8/12）高于乳腺X线摄影17.6%（9/51）（P=0.002）。MRI上节段性强化诊断恶性病变的阳性预测值为100.0%（9/9）;无强化对诊断含成簇钙化病变的阴性预测值为100.0%（9/9）。含成簇微钙化的恶性病变早期强化率平均值为109.6%±78.5%,高于良性病变62.8%±25.9%（P=0.000）。结论：MRI对含成簇微钙化特别是无定形成簇微钙化的乳腺病变具有较好的鉴别诊断价值。     

Stress MR imaging for evaluation of popliteal artery entrapment

The popliteal artery entrapment (PAE) syndrome has been recognized as a cause of arterial occlusion in young people. It is the result of an anomaly of the relationship between the popliteal artery and the gastrocnemius muscle. Eight young healthy volunteers (16 legs) and six patients (10 legs) with suspected PAE underwent magnetic resonance (MR) imaging. Gradient-echo images were obtained in axial planes with the leg at rest and during active plantar flexion against resistance. Imaging at rest allowed identification of PAE signs in only one leg, which had an anomalous medial course of the popliteal artery. In the other cases, only the stress technique was able to show signal loss in the popliteal artery due to muscular compression (two legs) or the presence of accessory muscle slip around the vessel (two legs), as confirmed at surgery. MR imaging is therefore a useful technique for the diagnosis of PAE because of its capability of combining information obtainable with other modalities.     

MR imaging of muscle and tender points in fibromyalgia

Fibromyalgia is a syndrome manifested by chronic, diffuse muscu-loskeletal aching and soreness, palpable muscle tender points, and other symptoms. Standardized clinical diagnostic criteria have recently been developed. Skeletal muscle has been postulated as the end organ in this disease. Biochemical, histologic, electromyographic, and conventional radiographic studies have demonstrated no definitive abnormality. This study sought to establish whether magnetic resonance (MR) imaging could demonstrate any abnormality in these patients. Eighteen patients were entered in the study, 14 of whom were able to complete their examinations. T1 -weighted, T2-weighted, gradient-echo, and STIR (short-tau inversion-recovery) sequences were performed in all patients, with selected patients examined with T1weighted, gadopentetate dimeglu-mine-enhanced sequences. The trapezius and suboccipital regions were imaged in patients who, clinically, had active fibro-myalgia. No abnormalities could be detected. The authors conclude that the conventional MR imaging used in this study was unable to depict any primary skeletal muscle abnormality in fibromyalgia.     

Controversies in cervical spine imaging in trauma patients

No area of emergency radiology has generated as much discussion in recent years as the subject of cervical spine imaging for trauma patients. This review will be in three parts. The first will examine the indications for cervical imaging and will focus on those factors that make patients at high risk or low risk for cervical injury. The second part will discuss the merits of radiography and computed tomography as the main screening diagnostic examination. In addition to the roles of each modality in the evaluation process, such factors as efficacy of diagnosis, time (duration) of study, and cost will be discussed. Finally, the third part will explore the methods currently employed to clear the cervical spine in comatose patients.Presented at the Annual Meeting of the American Society of Emergency Radiology, Las Vegas, Nevada, 22–25 October, 2003     

Uterine contractions: Possible diagnostic pitfall at MR imaging

A total of 206 nongravid patients with various gynecologic problems underwent pelvic magnetic resonance (MR) examinations that included both sagittal T2-weighted and contrast agent–enhanced T1-weighted images. MR images were retrospectively reviewed to identify changes in endometrial configuration on serial images obtained during the same MR examination. In 20 MR examinations (all in women of reproductive age), endometrial distortion due to myometrial bulging was noted on T2-weighted or contrast-enhanced T1-weighted images. It was absent on other MR images obtained at different times. Myometrial bulging exhibited low signal intensity in 18 examinations. The finding resembled adenomyosis or leiomyoma on T2-weighted or contrast-enhanced T1-weighted images. These results evidence the presence of transient myometrial bulging and transient low-intensity myometrium in the nongravid uterus. This phenomenon is thought to represent uterine contraction. Clinicians should be aware of the potential presence of transient low-signal-intensity myometrial bulging that could present diagnostic problems in the normal uterus.     

Brodie Abscess: MR imaging appearance in 10 patients

The magnetic resonance (MR) imaging features of Brodie abscess have not yet been fully evaluated. Ten patients with Brodie abscess, eight of long bone and two of vertebra, were studied with MR imaging. Long bone abscess had a characteristic “target” appearance with four layers: (a) a center with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR (short-inversion-time inversion recovery) images, (b) an inner ring isointense to muscle on T1-weighted images and with high signal intensity on T2-weighted and STIR images, (c) an outer ring hypoin-tense on all images, and (d) a peripheral halo hypointense on T1-weighted images. In six of eight cases, a soft-tissue mass was found. The two vertebral abscesses had a less specific appearance, with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR images. Only the peripheral halo was clearly identified in both cases.     

Dynamic contrast-enhanced MR imaging assessment of vascularized free fibular grafts

Magnetic resonance (MR) imaging may be a noninvasive method for assessing perfusion of vascularized bone grafts placed for treatment of avascular necrosis. One proximal femur of seven beagles was devascularized, with insertion of a vascularized fibular graft. MR imaging at 1 week (seven dogs) and 6 weeks (five dogs) after surgery included pre- and postcontrast spin-echo sequences, unenhanced twodimensional time-of-flight (TOF) vascular imaging, and dynamic gradient-echo imaging during infusion of gadolinium. Relative signal intensity values of selected regions obtained from the dynamic gradientecho images were plotted as percent enhancement versus time. In the operated hip, MR imaging did not show enhancement in six of seven femoral heads and greater trochanters at 1 week after surgery, with similar results after 6 weeks. MR imaging of fibular grafts 6 weeks after surgery showed an initial rapid increase in enhancement and a subsequent slower increase in five of five dogs, although no enhancement was seen in six of seven dogs at 1 week. These findings contrasted with a rapid initial increase in enhancement followed by slow decline in non-operated hips. Two-dimensional TOP imaging did not show the vascular pedicle of the graft in any dog. Findings of radionuclide bone scanning performed 1 week after surgery were consistent with devascularization of the operated femur and fibular graft. However, tetracycline distribution and histologic findings confirmed the viability of five of five grafts within the devascularized femurs 6 weeks after surgery. Thus, dynamic contrast-enhanced MR imaging at 6 weeks after surgery is valuable for assessing vascular bone graft perfusion, while similar imaging at 1 week may suggest otherwise.     

Right-side aortic arch with aneurysm of aberrant left subclavian artery: MR imaging appearance.

Reports of aneurysms of the subclavian artery in both normal and anomalous aortic arches have been rare. The authors describe a patient with a right-side aortic arch and an aneurysm of the aberrant left subclavian artery, which, to the authors' knowledge, is a previously unreported association. At presentation, the aneurysm appeared as a calcified left superior mediastinal mass. Magnetic resonance imaging enabled preoperative diagnosis and guided surgical planning.     

Adrenal tissue characterization with 0.5-T MR imaging: Value of T2*-weighted images

The authors investigated the value of magnetic resonance (MR) imaging at 0.5 T for distinguishing adrenal adenomas from adrenal metastases. The series included 23 adrenal adenomas (18 nonhyperfunctioning, five hyperfunctioning) and 23 adrenal metastases from various organs. Adrenal tumor–liver signal intensity ratios on T1-, T2-, and T2*-weighted images were calculated for adrenal tissue characterization. Adrenal adenomas were more precisely distinguished from adrenal metastases on T2*-weighted images (21 of 23, 91%) than on T2-weighted images (15 of 23, 65%). T1-weighted images were not useful for this distinction. In conclusion, T2*-weighted images were better than routine T2-weighted images for distinguishing adrenal adenomas from adrenal metastases. It can be postulated that the total signal intensity of adrenal adenomas, which contain some fat components, decreased on T2*-weighted images because of an out-of-phase effect.     

MR angiography of congenital heart disease: Value of segmented two-dimensional inflow technique and maximum-intensity-projection display

Magnetic resonance (MR) angiography of the cardiovascular system was evaluated in 41 patients with congenital heart disease by using a two-dimensional (2D) inflow technique based on a magnetization-prepared gradient-echo pulse sequence with segmented k-space data acquisition and electrocardiographic gating at 0.5 T. Inversion and saturation prepulses were used to suppress stationary tissue and enhance intravascular signal. Presaturation slabs were applied where certain vascular structures had to be suppressed. Sequence parameters were optimized by evaluating signal intensity and contrast characteristics for various flip angles and inversion and saturation delay times. The heart and intrathoracic vasculature were encompassed with 40–50 overlapping sections. Both 2D angiograms and maximum-intensity-projection images were evaluated. Combining data sets acquired in the sagittal and transverse orientations provided the most satisfactory information about the pulmonary arteries. The highest signal-to-noise ratios were obtained with a flip angle of 65° and short prepulse delay times. Two-dimensional MR angiography can provide useful diagnostic information but requires a thorough understanding of in-plane and hemodynamically induced signal intensity changes.