磁共振在乳腺癌临床诊断中的价值

目的：评估磁共振（MRI）检查在乳腺癌中的诊治价值。方法：53例临床和（或）钼靶摄片上疑有乳腺恶性病变的女性病人，行MRI检查：所有病人都接受外科手术和病理学诊断。结果：41例乳腺癌病人中，MRI检查检出乳腺癌37例，检出率为90．24％：钼靶摄片检出乳腺癌33例，检出率为80．48％；二者有显著统计学意义（P〈0．05）；有2例乳腺癌病人．因术前MRI提示有多发病灶而未能行保乳手术。结论：增强MRI诊断乳腺病变有较高的敏感性，对钼靶摄片评价较为困难的致密（型）乳腺尤有一定独到之处。二者联合使用可大为提高乳腺癌的诊断率。MRI检查有利于乳腺癌分期并指导其临床治疗。     

How to differentiate uterine leiomyosarcoma from leiomyoma with imaging

Uterine leiomyomas, the most frequent benign myomatous tumors of the uterus, often cannot be distinguished from malignant uterine leiomyosarcomas using clinical criteria. Furthermore, imaging differentiation between both entities is frequently challenging due to their potential overlapping features. Because a suspected leiomyoma is often managed conservatively or with minimally invasive treatments, the misdiagnosis of leiomyosarcoma for a benign leiomyoma could potentially result in significant treatment delays, therefore increasing morbidity and mortality. In this review, we provide an overview of the differences between leiomyoma and leiomyosarcoma, mainly focusing on imaging characteristics, but also briefly touching upon their demographic, histopathological and clinical differences. The main indications and limitations of available cross-sectional imaging techniques are discussed, including ultrasound, computed tomography, magnetic resonance imaging (MRI) and positron emission tomography/computed tomography. A particular emphasis is placed on the review of specific MRI features that may allow distinction between leiomyomas and leiomyosarcomas according to the most recent evidence in the literature. The potential contribution of texture analysis is also discussed. In order to help guide-imaging diagnosis, we provide an MRI-based diagnostic algorithm which takes into account morphological and functional features, both individually and in combination, in an attempt to optimize radiologic differentiation of leiomyomas from leiomyosarcomas.     

术前普美显增强核磁共振成像对肝细胞癌微血管侵犯的预测价值

背景与目的 微血管侵犯（MVI）是肝细胞癌（HCC）患者术后早期复发的重要危险因素,对合并有MVI的HCC行解剖性肝切除或较宽切缘的肝切除可能切除更多的MVI,从而减少复发率,改善患者的无瘤生存率和总生存率。但MVI是基于术后组织病理学的诊断,因此术前准确预测MVI对HCC个体化治疗方案的制定有着重要价值。普美显（Gd-EOB-DTPA）最大优势在于肝胆期的特异性影像表现,因此,在肝胆期行普美显增强磁共振（EOB-MRI）能清晰显示病灶的边界,大大提高了对病灶的显示及诊断能力。本研究通过分析术前EOB-MRI影像学特征,探讨其对HCC患者MVI的预测价值。方法 回顾2014年7月—2017年6月南京大学医学院附属鼓楼医院肝胆外科147例术前行EOB-MRI检查并接受根治性肝切除的HCC患者临床病理及影像资料。分析预测MVI的危险因素,并检测EOB-MRI的预测效能。结果 在147例患者中,MVI阳性49例,MVI阴性98例。单因素分析显示,肿瘤直径（P=0.001）、肝胆期非结节型肿瘤（P<0.001）、动脉期瘤周强化（P=0.016）、动脉期瘤周高信号环（P=0.014）、肝胆期肿瘤混杂信号（P=0.001）和肝胆期瘤周低信号（P<0.001）是MVI的预测因素。多因素分析显示,肝胆期非结节型肿瘤（OR=5.075,95% CI=1.587~16.223,P=0.006）、肝胆期肿瘤混杂信号（OR=2.750,95% CI=1.102~6.866,P=0.030）和肝胆期瘤周低信号（OR=7.130,95% CI=2.679~18.977,P<0.001）是MVI的独立预测因素。3种EOB-MRI影像学特征（肿瘤大体分型、肝胆期肿瘤混杂信号、肝胆期瘤周低信号）预测MVI的敏感度分别为89.8%,57.1%和61.2%;特异度分别为51.0%,72.4%和89.8%。当3种EOB-MRI影像学特征同时具备时,其特异度高达98.0%。结论 肝胆期非结节型肿瘤、肿瘤混杂信号和瘤周低信号是预测MVI的独立危险因素。当同时具备3种EOB-MRI影像学特征时,预测MVI具有较高的特异度。     

Performance of deep learning for differentiating pancreatic diseases on contrast-enhanced magnetic resonance imaging: A preliminary study

PurposeThe purpose of this study was to evaluate the ability of deep learning to differentiate pancreatic diseases on contrast-enhanced magnetic resonance (MR) images with the aid of generative adversarial network (GAN).Materials and MethodsA total of 504 patients who underwent T1-weighted contrast-enhanced MR examinations before any treatments were included in this retrospective study. First, the MRI examinations of 398 patients (215 men, 183 women; mean age, 59.14 ± 12.07 [SD] years [range: 16-85 years]) from one hospital were used as the training set. Then the MRI examinations of 50 (26 men, 24women; mean age, 58.58 ± 13.64 [SD] years [range: 24–85 years]) and 56 (30 men, 26 women; mean age, 59.13 ± 11.35 [SD] years [range: 26–80 years]) consecutive patients from two hospitals were separately collected as the internal and external validation sets. An InceptionV4 network was trained on the training set augmented by synthetic images from GANs. Classification performance of trained InceptionV4 network for every patch and every patient were made on both validation sets, respectively. The prediction agreement between convolutional neural network (CNN) and radiologist was measured by the Cohen's kappa coefficient.ResultsThe patch-level average accuracy and the micro-averaging area under receiver operating characteristic curve (AUC) of InceptionV4 network were 71.56% and 0.9204 (95% confidence interval [CI]: 0.9165–0.9308) for the internal validation set, and 79.46% and 0.9451 (95%CI: 0.9320–0.9523) for the external validation set, respectively. The patient-level average accuracy and the micro-averaging AUC of InceptionV4 network were 70.00% and 0.8250 (95%CI: 0.8147–0.8326) for the internal validation, 76.79% and 0.8646 (95%CI: 0.8489–0.8772) for the external validation set, respectively. Evaluated by human reader, the average accuracy and micro-averaging AUC for internal and external validation sets were 82.00% and 0.8950 (95%CI: 0.8817–0.9083), 83.93% and 0.9063 (95%CI: 0.8968–0.9212), respectively. The Cohen's kappa coefficients between InceptionV4 network and human reader for the internal and external invalidation sets were 0.8339 (95%CI: 0.6991–0.9447) and 0.8862 (95%CI: 0.7759–0.9738), respectively.ConclusionDeep learning using CNN and GAN had the potential to differentiate pancreatic diseases on contrast-enhanced MR images.     

The value of magnetic resonance imaging in the diagnosis of penile fracture

Purpose

We studied the use of magnetic resonance imaging in the diagnosis of penile fracture.

Materials and Methods

Between 1997 and 2012, fifteen patients (age range 17-48 years, mean age 37 years) with suspected penile fracture underwent MRI examinations. Ten patients were injured during sexual intercourse, whereas four patients were traumatized by non-physiological bending of the penis during self manupilation, one patient was traumatized falling from the bed. Investigations were performed with 1.5T MR unit. With the patient in the supine position, the penis was taped against the abdominal wall and surface coil was placed on the penis. All patients were studied with axial, coronal, sagittal precontrast and postcontrast T1-weighted TSE(TR/TE:538/13 msn) and T2-weighted TSE(5290/110 msn) sequences. All patient underwent surgical exploration. The follow-up ranged from 3 months to 72 months. Clinically all patients showed normal healing process without complications. In 11 patients a shortening and thickening of tunica albuginea was observed. Three patients have post traumatic erectil disfunction.

Results

In all patient corpus cavernosum fractures were clearly depicted on a discontinuity of the low signal intensity of tunica albuginea. These findings were most evident on T1WI and also depicted on T2W sequences. Images obtained shortly after contrast medium administration showed considerable enhancement only in rupture site. Subcutaneous extratunical haematoma in all patients were also recognizable on T2 WI. MRI findings were confirmed at surgery.

Conclusions

Magnetic resonance imaging is of great value for the diagnosis of penile fracture. Furthermore this method is well suited for visualising the post-operative healing process     

The value of magnetic resonance imaging geometric parameters in pre-assessing the surgical approaches of pelvic fracture urethral injury

BackgroundTo investigate the correlation between the magnetic resonance urethrography and the surgical approach and complexity for the patients with pelvic fracture urethral injury (PFUI) by combining the geometry with magnetic resonance imaging (MRI).MethodsForty-three male patients with PFUI (part of the patients complicated with rectal injury) from January 2016 to December 2018 were analyzed in this retrospective research. All the patients underwent a delayed anastomotic urethroplasty and were divided into 2 groups according to the approaches (simple perineal approach or inferior pubectomy). For magnetic resonance urethrography, we measured and calculated the geometric parameters such as the gap distance between two urethral ends, the pubourethral vertical distance (PUVD), and the rectourethral median distance (RUMD).ResultsOf the 43 patients, 16 underwent inferior pubectomy and 27 underwent simple perineal approach. The numbers of patients with and without rectal injury history were 17 and 26, respectively. The operation time and intraoperative blood loss was significantly higher in the inferior pubectomy group. Multivariate logistic analysis revealed that gap distance and PUVD were independent factors of the surgical approaches. The accuracies were 83.7% and 67.4% respectively in the ROC curve analysis. In addition, the RUMD was significantly shorter in the patients with rectal injury history (1.4, 1.8 cm).ConclusionsLonger gap distance and shorter PUVD were the two independent factors of the inferior pubectomy approach. Furthermore, among the patients with rectal injury history, the tissue posterior to the urethra was often weaker and should be carefully handled during the surgery.Trial registrationThis research has been registered on the Chinese Clinical Trial Registry. The registration number is ChiCTR2000030573.     

Predictive value of magnetic resonance imaging in lumbosacral fusion decision making. A case report

Study design: A case report of a L4-5 Modic I discopathy and its post operative clinical and MRI outcome emphazise importance of adjacent disc pre operative assessement.Objective: To assess the need of a correct strategy in lumbosacral fusion decision making.Summary and background data: Modic classification is well known but evolution and relations between the three different stages is not well documented.Methods: A L4-5 fusion performed with Titanium instrumentation enables to document a Modic I stage becoming Modic II after successfull fusion. In the mean time the upper adjacent disc L3-4 Modic III deteriorated in Modic I. A new fusion L3-Sacrum enabled to document the same outcome L3-4 Modic I becoming after successfull fusion Modic II.Result: this specific case demonstrates twice the efficiency of postero lateral fusion in the treatment of discopathy. Modic II stage assessing local stability correlated in our case to good clinical evolution. It also demonstrates the risk of adjacent disc failure in case of Modic I image.Conclusion: M.R.I. pre operative finding needs to be taken in account in fusion decision making. Discopathy can be cured by successful postero lateral fusion. Thus anterior intervertebral fusion or postero lumbar interbody fusion is not mandatory as demonstrated twice in this specific case. Levels of fusion needs correct assessement and can explain poor results.     

Magnetic resonance imaging with magnetic resonance cholangiopancreatography accurately predicts resectability of pancreatic carcinoma

Accurate preoperative staging of pancreatic malignancy aids in directing appropriate therapy and avoids unnecessary invasive procedures. We evaluated the accuracy of magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) in determining resectability of pancreatic malignancy. Twenty-one patients with suspected pancreatic malignancy underwent dynamic, contrast-en-hanced breath-hold MRI with MRCP prior to surgical evaluation. Results of this study were correlated with operative results and pathologic findings. The sensitivity, specificity, and accuracy of MRI with MRCP in detecting a mass, determining the nature of the mass, and predicting lymph node involvement and resectability were determined. MRI with MRCP correctly identified the presence of a pancreatic mass in all 21 of these patients. Following pathologic correlation, it was determined that MRI with MRCP was 81 % accurate in determining the benign or malignant nature of the pancreatic mass and 43% accurate in predicting lymph node involvement. In predicting resectability, MRI with MRCP had a sensitivity of 100%, specificity of 83%, positive predictive value of 94%, negative predictive value of 100%, and accuracy of 95%. MRI with MRCP is an accurate, noninvasive technique in the preoperative evaluation of pancreatic malignancy. Information obtained from MRI with MRCP including identification of a mass and predicting tumor resectability may be of value in staging and avoiding unnecessary invasive diagnostic procedures in patients with pancreatic cancer. Presented at the Thirty-Ninth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, La., May 17–20, 1998.     

关节软骨损伤和松质骨水肿的MRI诊断和临床意义

目的探讨关节软骨损伤和松质骨水肿的MRI诊断方法及其临床意义。方法收集我院1998～2004年间行骨关节检查并确诊有关节软骨损伤和松质骨水肿的病例72例,MR扫描采用MAGNETOMVISONplus1.5T超导型磁共振成像系统。松质骨水肿的诊断均经2名影像科医师和1名副主任医师以上职称骨科医师共同读片确诊。关节软骨损伤均以关节镜检查结果为最终诊断依据。结果松质骨水肿的MRI表现:在T1WI上表现正常35例(41处);呈斑片状、地图样略低信号30例(39处)。在T2WI上表现不明显47例(54处),16例表现为明显不均匀略高信号。病变在STIR FS序列上表现最为明显,呈明显斑片状、地图样异常高信号。关节软骨损伤的MRI表现:软骨变薄且凹凸不平9例(13处);关节软骨中断不连续5例(8处),3例(3处)仅表现为局部关节软骨表面不光滑,另有6例(10处)在MR上未见明显形态结构和信号异常。MRI显示关节软骨损伤以梯度回波序列(FLASH2D)质子密度加权像上显示最为清楚。结论MR是诊断关节软骨损伤和松质骨水肿最理想的影像学方法。     

呼吸训练对肺部感染者接受磁共振检查质量的影响

目的探讨护士提前应用呼吸训练对肺部感染者在磁共振（MRI）检查中的应用成效。 方法选取2013年1月至2015年1月本院拟接受MRI检查的肺部感染者85例。随机将患者分为观察组和对照组,其中观察组43例,对照组42例;观察组患者中男性27例,女性16例,对照组患者中男性27例,女性15例。观察组平均年龄为（56.0±3.8）岁,对照组平均年龄为（56.4±3.3）岁。两组患者均根据病情需要给予基础护理和呼吸评估,观察组在此基础上,在MRI检查前120 min开始接受呼吸训练,比较两组患者MRI的图像质量及检查耗时。 结果两组患者均完成MRI检查,观察组患者MRI检查图像质量显著优于对照组（U = 3.85、P = 0.000）;观察组患者的图像合格率显著高于对照组（97.67% vs. 76.19%,χ² = 8.704、P = 0.003）。两组患者行MRI平扫,观察组患者耗时显著短于对照组（11.3±1.7 min vs. 14.2±2.2 min,t =-6.81、P = 0.002）。行动态增强扫描,观察组患者检查时长显著短于对照组（4.1±1.0 min vs. 4.1±1.0 min,t =-3.92、P = 0.005）。 结论呼吸训练能够提高患者行MRI检查时的配合度,从而减少由自主性运动引起的MRI图像伪影,提高成像质量,减少检查时间,对小病变的检出率以及临床诊断和鉴别诊断有实际意义。     

Lumbar magnetic resonance imaging findings in patients with and without Waddell Signs

Background Context

Waddell Signs (WS), introduced as a method to establish patients with substantial psychosocial components to their low back pain, carry a negative association despite no literature evaluating whether physical disease is associated with them.

Background parenchymal enhancement in breast magnetic resonance imaging: A review of current evidences and future trends

Background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) is a dynamic process, which varies among women and within the same woman over time due to different factors. BPE has profound implications for women with or at risk of breast cancer. Breast radiologist should be aware of factors that could potentially influence BPE and have to be familiar with its typical appearance. Marked BPE could indeed affect the diagnostic accuracy of breast MRI, but this shortcoming can be minimized through evaluation by dedicated radiologists, in order to correctly interpret and properly manage the additional findings. BPE shows promise as an imaging biomarker but many issues need to be addressed before it can be used either to determine screening strategy or the value of risk-reducing interventions. This review analyzes the clinical influence of BPE on breast MRI interpretation, breast cancer staging and surgical outcome and discusses current available evidences about BPE as an imaging biomarker.     

颈动脉粥样斑块的MRI诊断价值

目的：探讨颈动脉粥样斑块的MRI影像特点,以提高对颈动脉粥样斑块成分及性质的认识。方法回顾性分析2013年11月～2014年5月期间13例颈动脉粥样斑块的MRI病例资料,并与颈动脉内膜剥脱术的病理结果相对照,总结其影像信号特点。结果13个病例共18个粥样硬化斑块,颈动脉内膜剥脱术取出13个斑块;13例斑块存在脂质坏死池;6例纤维帽撕裂;7例斑块内出血;11例斑块内钙化;4例炎性细胞浸润。结论颈动脉粥样斑块的磁共振信号具有特征性,磁共振成像能有效评估斑块的稳定性。     

Measurement variability of liver metastases from neuroendocrine tumors on different magnetic resonance imaging sequences

Purpose

To assess dimension measurement variability of liver metastases from neuroendocrine tumors (LMNET) on different magnetic resonance imaging (MRI) sequences.

Utility of repeat magnetic resonance imaging in surgical patients with lumbar stenosis without disc herniation

BACKGROUND CONTEXT

Routine use of magnetic resonance imaging (MRI) as a diagnostic tool in lumbar stenosis is becoming more prevalent due to the aging population. Currently, there is no clinical guideline to clarify the utility of repeat MRI in patients with lumbar stenosis, without instability, neurological deficits, or disc herniation.

The current and future role of magnetic resonance imaging in prostate cancer detection and management

Purpose

Accurate detection of clinically significant prostate cancer (PC) and correct risk attribution are essential to individually counsel men with PC. Multiparametric MRI (mpMRI) facilitates correct localization of index lesions within the prostate and MRI-targeted prostate biopsy (TPB) helps to avoid the shortcomings of conventional biopsy such as false-negative results or underdiagnosis of aggressive PC. In this review we summarize the different sequences of mpMRI, characterize the possibilities of incorporating MRI in the biopsy workflow and outline the performance of targeted and systematic cores in significant cancer detection. Furthermore, we outline the potential of MRI in patients undergoing active surveillance (AS) and in the pre-operative setting.

Materials and methods

An electronic MEDLINE/PubMed search up to February 2015 was performed. English language articles were reviewed for inclusion ability and data were extracted, analyzed and summarized.

Results

Targeted biopsies significantly outperform conventional systematic biopsies in the detection of significant PC and are not inferior when compared to transperineal saturation biopsies. MpMRI can detect index lesions in app. 90% of cases as compared to prostatectomy specimen. The diagnostic performance of biparametric MRI (T2w + DWI) is not inferior to mpMRI, offering options to diminish cost- and time-consumption. Since app 10% of significant lesions are still MRI-invisible, systematic cores seem to be necessary. In-bore biopsy and MRI/TRUS-fusion-guided biopsy tend to be superior techniques compared to cognitive fusion. In AS, mpMRI avoids underdetection of significant PC and confirms low-risk disease accurately. In higher-risk disease, pre-surgical MRI can change the clinically-based surgical plan in up to a third of cases.

Conclusions

mpMRI and targeted biopsies are able to detect significant PC accurately and mitigate insignificant PC detection. As long as the negative predictive value (NPV) is still imperfect, systematic cores should not be omitted for optimal staging of disease. The potential to correctly classify aggressiveness of disease in AS patients and to guide and plan prostatectomy is evolving.     

Prevalence of Rathke cleft cysts in children on magnetic resonance imaging

PurposeThe purposes of this study were to estimate the prevalence of Rathke cleft cysts (RCC) in a pediatric population on brain MRI, to describe their appearance, and to estimate interobserver agreement in the detection of RCC.Materials and methodsThe brain MRI examinations of 460 children were retrospectively reviewed by two radiologists for the presence of RCC. There were 223 boys and 237 girls with a mean age of 8.8 ± 4.3 (standard deviation [SD]) years (range: 0.1–14.9 years). When present, RCC were analyzed with respect to internal contain and further classified as serous RCC (i.e., high signal on T2-weighted sequences and iso or low signal on T1-weighted sequences) or mucosal RCC (i.e., low signal on T2-weighted sequences and high or iso signal on T1-weighted sequences). Cohen's Kappa coefficient was used to estimate interobserver agreement between the interpretations performed by the two radiologists for the presence of RCC.ResultsA total of 14 children had a RCC present on brain MRI, yielding a prevalence of 3.04% (14/460); of these, 3/14 RCCs (21%) were of serous type and 11/14 (79%) were of mucosal type. Interobserver agreement for the presence of RCC was strong (Kappa = 0.85; 95% CI: 0.70; 0.99).ConclusionThe results of our study suggest that the prevalence of RCC in children is greater than previously described.     

乳腺磁共振成像诊断乳管内乳头状瘤的临床价值

目的：探讨乳腺磁共振成像（MRI）诊断乳管内乳头状瘤的临床价值。 方法：选择176例有术前乳腺MRI资料,行手术治疗并病理证实的女性患者,其中乳管内乳头状瘤37例、非乳管内乳头状瘤的良性病变52例和乳腺癌87例。比较3组患者临床、病理及MRI资料,后者包括时间-信号强度曲线、影像学表现、肿瘤表观弥散系数（ADC）值。 结果：37例乳管内乳头状瘤患者病灶37处,52例非乳头状瘤的良性病患者病灶56处,87例乳腺癌患者病灶92处。乳管内乳头状瘤组患者与其他两组患者比较,在发病年龄方面无统计学差异（F=2.470,P=0.088）,但在肿瘤大小、肿瘤位置、时间-信号强度曲线、MRI下表现、ADC值等方面均有统计学差异（均P<0.05）。 结论：乳管内乳头状瘤具有独特MRI的影像学特征,故辅以ADC值,MRI可以成为临床诊断乳管内乳头状瘤的重要手段。     

Gadolinium DTPA enhanced magnetic resonance imaging in acute head injury

Summary We studied the effect of contrast enhancement on magnetic resonance imaging (Gadolinium DTPA Magnetic Resonance) in 10 patients with a recent head injury. The use of contrast did not increase the number of traumatic lesions identified and we did not detect evidence of altered blood brain barrier permeability in any of the 7 patients, who had a total of 27 lesions, imaged between one and 4 days after injury. Enhancement was found in each of 3 patients imaged 6 or more days after injury. These findings suggest that traumatic cortical and intraparenchymal lesions are not associated with increased cerebrovascular permeability within the first 96 hours of a head injury.     

Anterior-sacral meningocele; value of magnetic resonance imaging and abdominal sonography

Summary With the presentation of a case of giant anterior sacral meningocele, the evident superiority of magnetic resonance imaging over any other methods for the diagnosis of this rare condition is demonstrated. Ultrasound as a screening tool is often the first to reveal the presence of the intrabdominal cystic abnormality and furthermore is an excellent means for checking the post-operative course. In addition this particular case is interesting because the dural stalk linking the meningocele to the dural abdominal sac was not entirely free from nervous structures inspite of macroscopic appearances to the contrary.