MRI常规扫描及SWI、DWI序列在新生儿缺氧缺血性脑病诊断中的应用价值研究

目的 研究磁共振成像(MRI)常规扫描及磁敏感加权成像(SWI)、弥散加权成像(DWI)序列在新生儿缺氧缺血性脑病(HIE)诊断中的应用价值.方法 回顾性分析本院2016年8月至2020年8月收治的86例HIE患儿的临床资料,观察病灶密度、边界、与周围组织关系等特征,比较不同MRI序列诊断HIE的临床价值.结果 86例...     

磁共振弥散成像及灌注成像在短暂性脑缺血发作中的应用价值

目的:探讨磁共振弥散成像(DWI)及磁共振灌注成像(PWI)在短暂性脑缺血发作(TIA中的应用价值。方法:选择2014年2月至2018年2月就诊于湖南省中医药研究院附属医院的短暂性脑缺血患者63例,将其分为DWI组、PWI组与MRI组,每组21例。MRI组采用常规磁共振检查,DWI组和PWI组分别采用DWI和PWI检查,比较各组缺血性病灶检出情况。结果:DWI与PWI组缓解期和发作期阳性病灶检出率均高于MRI组(P0.05),经过1～2周的治疗后,DWI组8例和MRI组1例发展为脑梗死。结论:磁共振弥散加权成像及灌注成像对于短暂性脑缺血发作患者缺血病灶的检出率明显高于常规磁共振成像,对治疗及预后判断有重要意义。     

扩散加权磁共振成像在急性脑梗死诊断中的价值

目的：探讨扩散加权磁共振成像在急性脑梗死诊断中的价值。方法：采用Philips Gyroscan Intera 1．5T磁共振系统．对19例临床诊断为急性脑梗死的患者行扩散加权磁共振成像(MRI—DWI)，并与常规MRI结果比较，其中男11例，女8例，年龄35～70岁，平均年龄52．5岁。结果：19例患者中，MRI—DWI在发病6h以内提示急性脑梗死者17例，DWI和常规MRl的敏感性分别为100％和5．88％，其特异性均为100％，2例排除了脑梗死。结论：扩散加权磁共振成像对6h以内发病的急性脑梗死的诊断明显高于常规MRI，并对脑梗死的临床治疗有指导意义。     

MRI检查对宫颈癌的诊断价值研究

目的 探讨宫颈癌的MRI表现,评价MRI成像对宫颈癌诊断及判断周围侵犯的价值.方法 对经病理证实的20例宫颈癌患者(术前)行常规MRI及增强检查;行盆腔的轴面SET1WI,轴面及矢状面脂肪抑制(SPIR)T2WI,轴面弥散加权成像(DWI)及欧乃影(Gd-DTPA)增强后轴面、矢状面SET1WI扫描.在MRI图像上观察原发肿瘤的位置、信号特征及侵犯范围.结果 MRI常规序列及增强检查检出全部病例,准确率100％.宫颈癌的MRI表现颇具特征性,T2WI呈较高信号,T1WI呈等或低信号,DWI普通呈高信号,Gd-DTPA增强后T1WI可轻度强化.结论 MRI能多方位清晰显示宫颈癌瘤灶及侵犯范围与途径,明显优于其他影像学检查方法.     

急性脑梗死患者MRI弥散加权成像联合灌注加权成像的评估效果

目的:分析急性脑梗死(Acutecerebralinfarction,ACI)患者行磁共振成像(MRI)弥散加权成像联合灌注加权成像的评估效果.方法:选择我院2018年12月至2021年4月收治的106例高度疑似ACI患者作为研究对象,均行MRI弥散加权成像联合灌注加权成像检查,并经脑血管造影检查明确诊断.比较ACI患...     

利用3.0T磁共振观察子宫恶性肿瘤组织弥散效应的初步研究

目的： 利用磁共振成像（MRI）的弥散加权成像（DWI）技术,观察子宫恶性肿瘤的弥散受限程度。方法: 采用3.0 T磁共振成像仪,对子宫颈癌病例及正常子宫颈对照组、子宫内膜癌病例及正常子宫内膜对照组进行常规MRI及DWI扫描,测量其表观弥散系数（ADC）,并对子宫颈癌与正常子宫颈、子宫内膜癌与正常子宫内膜的ADC值进行统计学分析。结果: (1)37例子宫颈癌和16例正常子宫颈的ADC值分别为（0.92±0.20）×10-3 mm2/s和（1.26±0.24）×10-3 mm2/s,子宫颈癌和正常子宫颈2组ADC值比较有显著差异（P<0.01）。(2)14例子宫内膜癌和14例正常子宫内膜的ADC值分别为（0.87±0.17）×10-3 mm2/s和 （1.34±0.26）×10-3 mm2/s,子宫内膜癌和正常子宫内膜2组ADC值比较有显著差异（P<0.01）。结论: 子宫颈癌和子宫内膜癌较正常子宫组织弥散受限,3.0T磁共振DWI的ADC值测量能够定量反映子宫恶性肿瘤的弥散受限程度。     

弥散加权成像结合常规磁共振成像在强直性脊柱炎不同时期诊断差异的研究

目的研究弥散加权成像(DWI)结合常规磁共振成像(MRI)在强直性脊柱炎的诊断及区分炎症活动期、稳定期差异。方法本研究采取2018年6月到2021年6月在烟台市烟台山医院进行诊断治疗的强直性脊柱炎患者80例作为研究对象, 炎症活动期患者39例, 稳定期患者41例。分别对患者采取DWI结合常规MRI检查, 分析两组患者DWI以及动态对比增强磁共振成像(DCE-MRI)检查各个参数之间的差异, 及表观扩散系数(ADC)与达峰时间(TTP)、峰值信号强度(Sipeak)、最大上升斜率(MSI)、信号增强比率(SER)的相关性。结果活动组患者的ADC、TTP 、Sipeak、MSI、SER均显著高于稳定组患者, 患者的ADC数值与TTP、Sipeak、MSI、SER呈正相关, 联合检测对强直性脊柱炎患者的诊断特异度显著高于单独检测。结论 DWI结合常规MRI在强直性脊柱炎诊断具有积极的意义, 通过对患者的影像学诊断转化为量化指标, 对于区分炎症活动期、稳定期具有积极的临床意义。     

磁共振弥散加权成像与动态增强MRI诊断乳腺良恶性病变的应用价值对比评价

目的对比分析磁共振弥散加权成像与动态增强MRI在诊断乳腺良恶性病变的临床价值。方法选取2014年1月~4月我院收治的乳腺肿瘤患者59例,对所有患者均分别采用磁共振弥散加权成像和动态增强MRI扫描,将结果与病理学结果对比,分析评价二者在诊断乳腺良恶性肿瘤方面的临床价值。结果 MRI分析有恶性23例,良性36例,TIC分析有恶性24例,良性35例,MRI组符合率为92.0%(23/25),TIC组符合率为96.0%(24/25)。结论磁共振弥散加权成像与动态增强MRI均可有效判断乳腺肿瘤的性质,在乳腺癌的早期诊断中具有较高的应用价值,但比较来看磁共振弥散加权成像诊断准确性更高。     

大脑锥体束华勒氏变性影像学研究进展

原发性脑损伤可导致病灶远端的锥体束发生华勒氏病变,基于磁共振技术(magnetic resonance imaging,MRI)的弥散加权成像(diffusion weighted imaging,DWI)、弥散张量成像(diffusion tensor imaging,DTI)等成像技术对于华勒氏变性的检测有不同的特点和优势,本文针对华勒氏变性各个阶段不同的影像学表现进行了综述,并对临床检测早期华勒氏变性做出了指导。     

磁共振成像DWI联合3D-ASL对急性脑梗死的诊断效能及在血流动力学评估中的应用

目的:探讨磁共振成像（MRI）DWI联合3D-ASL对急性脑梗死（ACI）的诊断效能及在血流动力学评估中的应用价值。方法:收集因ACI就诊的80例患者的临床资料,全部入选者均接受1.5T/3.0T MRI进行扫描,分别分析患者脑梗死的DWI、3D-ASL图像表现,并评估DWI联合3D-ASL检查ACI是否具有更高的诊断价值。结果:有49例ACI患者在DWI图像上显示为弥散受限,面积为（673±319） mm2,68例患者在3D-ASL图像上显示为低灌注,低灌注面积为（1 953±803） mm2,其中面积ASL>面积DWI的患者有62例,存在缺血半暗带。在DWI图像上显示为弥散受限的患者中,左侧高信号者的CBF绝对值均低于右侧（22.34±4.36 vs 40.58±9.01, P<0.001）,右侧高信号者的CBF绝对值均低于左侧（19.48±5.67 vs 46.01±11.15, P<0.001）。DWI联合3D-ASL检查诊断ACI的灵敏度、特异度、阳性预测值和阴性预测值均高于单独DWI检查。结论:DWI联合3D-ASL检查评估ACI中梗死灶和缺血半暗带具有很大的应用价值。     

鼻咽癌颈部淋巴结转移MR多b值DWI成像研究分析

目的：研究在鼻咽癌(nasopharyngeal carcinoma,NPC)颈部淋巴结转移的评价中1.5T MR多b值扩散加权成像(diffusion weighted imaging,DWI)的应用价值。方法：对良性淋巴结增大病人15例及鼻咽癌病人37例进行常规MR及多b值DWI检查,对不同b值的DWI图像质量进行比较。对不同b值下良、恶性淋巴结ADC值的ROC曲线进行记录。结果：b=800 s/mm2时鼻咽部变形小,图像背景抑制充分,伪影少,周围软组织与病灶具有较好的对比度,小淋巴结显示清楚;鼻咽癌、良性淋巴结及颈部转移性淋巴结的ADC值随着b值增大均呈下降趋势,8种b值下转移性淋巴结与鼻咽癌原发灶向比较,ADC值差异无统计学差异(P>0.05)。而良性淋巴结与转移性淋巴结相比较,ADC值差异均有统计学差异(P<0.05);b=800 s/mm2时对良恶性淋巴结的鉴定效果最好,灵敏度为100%,特异度为83.2%。结论：1.5T MR扩散加权成像(DWI)技术能有效鉴别淋巴结性质,b值取800 s/mm2时,DWI图像具有较好的质量,且对良恶性淋巴结的鉴定诊断效果最好,可在临床鼻咽癌颈部淋巴结转移的诊断中推广应用。     

A New Technique to Map the Lymphatic Distribution and Alignment of the Penis

The present study was to examine the distribution of lymphatic vessels in the penis of normal adult males, which could provide an anatomical basis for improvement of incisions in penile lengthening surgery, and may also help to prevent postoperative refractory edema. Thirteen normal adult male volunteers were recruited for this study. Contrast agent was injected subcutaneously in the foreskin of the penis, and after two minutes magnetic resonance lymphangiography (MRL) was performed. The acquired magnetic resonance images were analyzed to determine the changes in the number and diameter of lymphatic vessels in different parts of the penis. Maximum intensity projections (MIP) and materializes interactive medical image control system (MIMICS) were applied to analyze the overall distribution of lymphatic vessels in the penis. Magnetic resonance imaging (MRI) showed that the lymphatic vessels were in conspicuous contrast with surrounding tissues and could be clearly identified. Penile lymphatic vessels were clearly visible in the root of the penis. At the junction of the penis and the abdominal wall, all lymphatic vessels were found to be concentrated in the dorsal part of the penis. MIP two‐dimensional reconstruction showed that the overall distribution of relatively large lymphatic vessels in the dorsal and ventral parts of the penis could be seen clearly on bilateral 45° position, but not inside the abdominal wall because some of lymphatic vessels were overlapped by other tissues in the abdomen. MIMICS three‐dimensional reconstruction was able to reveal the overall spatial distribution of lymphatic vessels in the penis from any angle. The reconstruction results showed that there were 1–2 main lymphatic vessels on the root of dorsal penis, which coursed along the cavernous to the first physiological curvature of the penis. Lymphatic vessels merged on both sides of the ventral penis. At the root of the penis, lymphatic vessels gradually coursed to the dorsal surface of the penis and folded at the abdominal wall to the outside, and finally merged into the inguinal lymph nodes. The changes in distribution, number and diameter of the lymphatic vessels in the penis were observed by MRI. MIP and MIMICS reconstructions directly revealed the anatomical features of penile lymphatic vessels such as spatial distribution, overall alignment, and the relations to adjacent structures, drainage and reflux. The study will provide the anatomical basis for penile surgery, penile lymphatic reflux disorders caused by trauma or lymphatic vessels obstruction, and lymph node metastasis in penile cancer. Anat Rec, 298:1465–1471, 2015. © 2014 Wiley Periodicals, Inc.     

What is the pelvic lymph node normal size? Determination from normal MRI examinations

Purpose

There are few previous reports on maximal pelvic lymph node sizes and no data on normal mesorectal nodes. Therefore, the aim of the study was to estimate the normal size of pelvic lymph nodes and to determine the upper limits of the normal range.

Materials and methods

Pelvic magnetic resonance imaging (MRI) examinations were prospectively carried out using a Intera 1.5 T magnet (Philips, the Netherlands), on 36 healthy volunteers (22 females, 14 males, mean age 25 years). A balanced fast field echo (b-FFE) sequence was used with the following parameters: 3-mm-thick contiguous slice, matrix 512 × 512. Short axis diameters of pelvic and inguinal lymph nodes were measured in each anatomic territory (internal iliac, external iliac, common iliac, mesorectum and inguinal). After normalization of the measurements, the influences of age, gender, laterality and territory were evaluated. Upper limits (95th percentile) were then calculated.

Results

A total of 1147 lymph nodes were measured. Age, gender and side (right/left) had no significant influence on size. The upper limits of the normal range were, respectively, 5.3, 4.4, 6.3 and 3.9 mm for the external and common iliac, internal iliac, inguinal and mesorectum nodes.

Conclusion

This work presents maximal normal values for each pelvic area, and the values for mesorectum nodes are reported for the first time.

Advances in knowledge

The mesorectum nodes should be considered as abnormal when they are over 4 mm in short diameter. For the other node areas, the upper limits of the normal range were, respectively, 6, 6, 5, 7 mm for the external and common iliac, internal, iliac and inguinal nodes for the short axis.

     

骶前区血管网磁共振成像动态增强扫描不同对比剂剂量成像效果的比较

目的探讨不同剂量对比剂磁共振成像（MRI）动态增强扫描对骶前区血管网三维成像的效果,并评价减少对比剂用量的可行性及临床应用价值。方法选取2012年2月至5月间于本院就诊的40例因盆腔良性病变常规行MRI检查的成年女性患者,数字随机法随机分为两组,A组对比剂剂量为钆浓度0．5mol,L20ml,B组为40ml。采用ACHIEVA3．0TX双源磁共振扫描仪对患者行盆腔e-THRIVE3D等体素动态增强MRI序列扫描,采用最大密度投影（MIP）及容积再现重组（VR）后处理技术进行骶前区血管网重建成像,观察骶前区血管的正常解剖及走行,计算骶正中动脉、骶前区横干静脉显示率和骶正中动脉横径。以骶正中动脉为靶点,分别对两组MIP图像质量采取5分制主观评价方法,通过测定信号强度（SI）、信噪比（SNR）和对比噪声比（CNR）的客观评价指标进行综合比较。结果两组患者图像中骶正中动脉均显示清晰,成功率为100％;骶前区横干静脉的总显示率为72．5％（29／40）,其中A组显示率为75％（15／20）,B组显示率为70％（14／20）,差异无统计学意义。在e-THRIVE序列横断位图像上A组骶正中动脉横径与B组差异无统计学意义[（1．42±0．06）mm比（1．38±0．07）mm,P=0．117]。A组骶正中动脉MIP图像质量主观评价评分略低于B组,但差异无统计学意义[（2．95±0．69）分比（3．10±0．66）分,P=0．479]。A组骶正中动脉MIP图像质量客观评价SI、SNR与B组差异无统计学意义（SI：719．63±124．91比811．66±170．60,SNR：61．71±17．35比74．97±27．91,均P〉0．05）,而CNR低于B组（45．68±13．35比62．41±23．37,P〈0．05）。结论采用体素动态增强成像序列扫描及后处理技术可以清晰显示骶前区血管网。0．5mol/L20ml钆双胺的剂量同样能达到双倍剂量的显像效果,均可显示骶正中动脉及横干静脉的形?     

Use of three-dimensional spiral computed tomography imaging for staging and surgical planning of head and neck cancer

We compare four different three-dimensional (3D) reconstruction methods of spiral computed tomography (CT) data for head and neck cancer to establish the method best suited for specific uses, eg, staging of lymph nodes and viewing of spatial relationships between the tumor, fascial spaces, adjacent soft tissues, and others structures. We evaluated a series of 10 patients (six men and four women), aged 32 to 60 years. Of these, five were histologically diagnosed with squamous cell carcinoma, two with lymphoma, one with thyroid cancer, one with Kikuchi’s disease or necrotizing lymphadenitis, and one with esthesioneuroblastoma. All scans were obtained using highresolution spiral CT (General Electric Medical Systems, Milwaukee, WI). The collimations used were 3 mm and 5 mm, matrix 512 × 512, and reconstruction interval not more than 3 mm. Scanning was performed from the skull base to the aortic arch. Iodinated contrast medium was injected so that the blood vessels were clearly differentiated from nodes. Different techniques of three-dimensional reconstruction were employed, including shaded surface display (SSD), multiplanar reconstructions (MPR), maximum intensity projection (MIP), 3D volume rendering (VR), and combined techniques. The reconstructions were performed in a variety of planes, including sagittal, coronal, and oblique views. In our series of selected patients, the technique of 3D VR showed potential advantages over other techniques. The MIP technique was useful in analyzing the patency of vessels and to exclude thrombus, compression, or displacement by tumor. The use of combined techniques such as SSD and MPR, accurately demonstrated the levels of lymph nodes and the relationship between the tumor projection of interest and various anatomic structures. In conclusion, 3D reconstruction of CT data is useful in the localization and staging of neck tumors and assists in surgical planning and radiation treatment.     

三种3D序列显示腰骶丛神经及影像解剖的比较

目的　探讨3D-T2W-FFE、3D-STIR-TSE、DWIBS三种序列腰骶丛神经显示、影像解剖和3D重建效果。 方法　收集49名志愿者常规腰椎磁共振和腰骶丛神经成像数据,其中3D-T2W-FFE 序列48例、3D-STIR-TSE序列47例、DWIBS 序列43例。计算三种序列神经根和骨骼肌的对比度噪声比（CNRN/M）、右侧骶1神经根直径及神经节体积;分别采用各自4等级评分比较这三种序列对腰骶丛神经的显示效果和3D重建效果。 结果　三种序列的CNR N/M不全相同,其中3D-T2W-FFE序列与3D-STIR-TSE、DWIBS序列均有统计学差异,P<0.05。三种序列的神经节体积无统计学差异（P=0.050）。三种序列的神经根直径不全相同,其中3D-STIR-TSE序列与DWIBS序列间有统计学差异（P<0.05）。三种序列神经显示评分不全相同,其中DWIBS序列与3D-T2W-FFE、3D-STIR-TSE序列均有统计学差异（P<0.05）。三种序列神经3D重建评分无统计学差异（P=0.025）。 结论 3D-T2W-FFE 序列和3D-STIR-TSE FFE序列神经显示和影像解剖评分无差别,较DWIBS序列好。三种序列神经3D重建评分无差别,其中DWIBS序列重建过程最易实现。     

磁共振增强三维短时反转恢复变角激发T2WI快速自旋回波序列在成人精道解剖结构显示中的应用价值

目的 探讨MR增强三维短时反转恢复变角激发T₂加权成像(T₂WI)快速自旋回波(3D STIR T₂WI SPACE)序列对成人精道解剖结构显示的可行性及应用价值。方法 回顾性研究。收集2016 年11 月—2019 年3 月复旦大学附属华东医院MR室58 例成年男性腹盆腔MRI资料,年龄29~87 岁,按年龄分为低龄组(≤60岁,22 例)和高龄组(＞60岁, 36例)两组。所有患者均在德国西门子Syngo Via数据后处理工作站3D Viewer薄层最大强度投影(MIP)后行多平面重组(MPR)及曲面重组(CPR)。用3D Viewer行薄层MIP,获得冠状位、轴位、矢状位薄层MIP重建图。观察输精管壶腹段、后腹膜段和精囊腺的形态、走行、信号强度、背景抑制情况,参照日本Oh-Oka团队的评分标准,分别在MPR轴位和CPR 图像对输精管壶腹段、后腹膜段和精囊腺进行图像质量评分。采用Wilcoxon符号秩检验对比分析MPR轴位与CPR图像分别在输精管壶腹段、后腹膜段和精囊腺的图像质量评分,Wilcoxon秩和检验对比分析低龄组和高龄组在CPR图像上的图像质量评分。统计前列腺小囊检出率,并在3D Viewer获得的冠状位、轴位、矢状位三个方位薄层MIP重建图上测量前列腺小囊三个方位的径线值。结果 58例男性腰腿痛患者116侧输精管后腹膜段、壶腹段和精囊腺MR增强3D STIR T₂WI SPACE序列 MPR轴位和CPR图像质量评分分别为3(3,3)、2(2,2)、2(1,2)分和2(2,2)、2(1,2)、2(1,2)分,差异均有统计学意义(Z=10.232、5.196、2.000, P值均＜0.05)。22例(44侧)低龄组和36例(72侧)高龄组腰腿痛患者输精管后腹膜段、壶腹段和精囊腺MR增强3D STIR T₂WI SPACE序列CPR图像在的图像质量评分分别为2(1,2)、2(1,2)、1(1,2)分和2(2,2)、2(2,2)、2(1,2)分,组间比较差异均有统计学意义(Z=2.673、2.249、3.042, P值均＜0.05)。58例患者前列腺小囊检出率为27.58%(16/58),前列腺小囊冠、横、矢三个方位径线值分别为5.35(4.33,6.88)、7.50(5.90,9.00)、8.00(6.43,10.78)mm。结论 MR增强3D STIR T₂WI SPACE序列能较清晰显示精囊腺、输精管壶腹段、后腹膜段以及前列腺小囊等精道精细结构解剖,可为指导临床提供影像学参考。     

腹腔淋巴结影像断层解剖学的研究

目的为腹腔淋巴结的临床诊断提供断层影像解剖学资料。方法对6具尸体标本的上腹部横断层、CT、MRI扫描图像进行观察,观察腹腔淋巴结的位置,测量其横断面矢径和横径,辨认在MRI、CT扫描图像中的腹腔淋巴结。结果共观察到8个腹腔淋巴结,单具标本腹腔淋巴结的数目有1～2个;其横断面呈椭圆形或长椭圆形,矢径为（5.27±2.18）mm,横径为（2.35±1.12）mm,组织疏松较软,横断面上可见管腔断面;在MRI扫描图像上能被清晰分辨,在尸体标本的CT扫描图像上与周围结构界线不清。结论腹腔淋巴结与腹腔神经节的鉴别,在断面标本中可通过观察组织是否致密,有无管腔断面进行确定;在CT、MRI扫描图像上主要根据他们的位置关系进行确定。