肝癌的核素诊断

肝癌的早期诊断主要依赖于对高危人群(慢性肝病)定期进行血清AFP 放免测定,再辅以影像学检查予以确诊.本文从核医学角度,结合US(超声)、CT、MRI 的最新进展,略述当前核素显像检查对肝癌的诊断价值.肝癌的核素显像检查问题:肝胶体显像检查对肝     

原发性肝癌168例临床诊断分析

目的:评介AFP、B超、彩色多普勒血流图像(CDFI)、CT、MRI、DSA和术中B超(IOUS)对肝癌的诊断意义。方法:对病理诊断并作AFP、B超(US)、CT扫描及部分其他影像检查的168例原发性肝癌(HCC)的临床诊断进行分析。结果:AFP大于正常参考值者101例(60.1％)。6种影像对肝占位病变的总检出率为96.4％。US、CT、CDFI、MRI、DSA和IOUS诊断与病理诊断符合率分别为:89.3％(150/16R)、88.1％(148/168)、93.7％(15/16)、100％(6/6)、85.7％(6/7)和100％(11/11)。结论:①US与CT对AFP阴性及低浓度阳性HCC具有一定的独立诊断价值,在US及AFP检查受限时,CDFI及IOUS对小肝癌有进一步诊断意义;②AFP增高和/或有肝占位病变,对多数病例具有诊断意义,但对不易诊断病例,特别是AFP阴性或低浓度增高小肝癌,不易与其他非癌性肝占位病变鉴别,必须长期动态观察,直到排除或确立诊断为止。     

原发性肝癌螺旋CT多期扫描和MRI研究

经手术和病理证实原发性肝癌69例,术前均行螺旋CT多期扫描和MRI检查。本文研究了螺旋CT多期扫描和MRI对原发性肝癌的影像学特征。结果表明原发性肝癌行螺旋CT多期扫描的确诊率为95％,行MRI平扫加顺磁增强的确诊率为100％。结论：螺旋CT多期扫描和MRI均为原发性肝癌诊断的安全和有效的手段,后者比前者更优越。     

多排螺旋CT与MRI对乙型肝炎肝硬化背景小肝癌检出的比较研究

目的:比较多排螺旋计算机断层扫描(CT)与磁共振成像(MRI)对乙型肝炎肝硬化背景小肝癌的检出准确性和诊断价值。方法:将2014年1月~2016年12月我院收治的120例乙型肝炎肝硬化背景疑似小肝癌患者纳入研究,所有患者均接受多排螺旋CT和MRI检查,分析多排螺旋CT和MRI检查结果,以手术病理诊断结果为金标准,计算和比较多排螺旋CT、MRI对乙型肝炎肝硬化背景小肝癌的诊断灵敏度、特异度、准确性。根据手术病理诊断结果,将确诊乙型肝炎肝硬化背景小肝癌按照病灶直径分为微小肝癌(1cm)和小肝癌(1~3cm),比较CT、MRI对不同大小病灶的检出情况。结果:120例纳入病例中,共有88例患者经手术病理诊断确诊为乙型肝炎肝硬化背景小肝癌,包括35例微小肝癌、53例小肝癌。经计算,MRI对乙型肝炎肝硬化背景小肝癌的诊断灵敏度、特异度、准确性分别为96.59%、96.88%、96.67%,均高于CT诊断的86.36%、75.00%、83.33%(P0.05)。MRI对微小肝癌、小肝癌的诊断符合率分别为97.14%、96.23%,均明显高于CT诊断的80.00%、81.13%(P0.05)。结论:相比于多排螺旋CT,采用MRI对乙型肝炎肝硬化背景小肝癌的诊断灵敏度、特异度和准确性均更加优越,可有效检出微小肝癌病灶。     

早期股骨头缺血性坏死不同诊断方法的应用分析

目的：探讨MRI、CT和X线片三种影像学方法对早期股骨头缺血性坏死的诊断价值.方法：选择30例30个病变经临床病理确诊的股骨头缺血性坏死患者的临床资料及影响学资料进行回顾性分析,比较X线平片、CT扫描及MRI影响学结果表现情况.结果：30个病变股骨头中X线平片仅显示了其中的l4个,检出率为46.7%,CI、扫描显示了其中12个,检出率为63.3%,MRI对所有病例均能够作出诊断,检出率为100% X线平片与CT扫描的检出率无显著性差异（P〉0.05）,MRI的检出率远高于X线平片与CT扫描,有显著性差异（P〈0.01）.结论：MRI诊断早期早期股骨头缺血性坏死的敏感性明显优于X线平片和CT扫描,对于股骨头缺血性坏死的高危人群和已有髋关节症状的患者应直接行MRI检查.     

16层螺旋CT多期动态扫描在肝癌诊断中的应用价值

目的 探讨16层螺旋CT对肝癌多期扫描的影像特征和临床应用价值.方法 对100例肝癌患者先行全肝CT平扫,其中80例无论肿瘤大小(包括23例结节型)先作病灶动脉期扫描,再作全肝静脉期扫描,最后进行病灶平衡期扫描;20例仅行动脉期及静脉期扫描.结果 100例中67例为肿块型(67%),23例为结节型(23%),10例为弥漫型(10%).80例中CT平扫、动脉期、静脉期及平衡期病灶的显示率分别为87%、97%、90%、96%.结论 16层螺旋CT多期扫描能获得肿瘤在各期的增强征象,为肝癌的定性、定量诊断提供更多的影像诊断信息;尤其在肝癌早期,动脉期扫描可得到非常重要的诊断依据.     

影像学检查评估TACE治疗的原发性肝癌患者术后残余肿瘤活性价值研究

目的 探讨超声(US)、电子计算机断层扫描(CT)和磁共振成像(MRI)检查评估原发性肝癌(PLC)患者在经导管动脉栓塞化疗(TACE)治疗术后肿瘤活性的价值。方法 2015年3月~2019年1月我院放射介入科行TACE治疗的60例PLC患者,术后3~5周行 US、CT、MRI及数字减影血管造影(DSA)检查。以DSA检查结果为金标准,评判US、CT和MRI对残余病灶活性检出率的差异。结果 在60例PLC患者,术后DSA 检测出72个病灶,以此为金标准,结果MRI检出65个(90.3%)病灶,US检出34个(47.2%)病灶,CT检出55个(76.4%)病灶,提示US检出率最低(P<0.05);MRI检出的灵敏度、特异度和准确性分别为87.5%、95.8%和83.3%,而US检出分别为41.6%、97.9%和39.5%,CT检出分别为75.0%、89.5%和64.5%,提示MRI检出的灵敏度和准确性显著高于US或CT检查(P＜0.05),而三种方法检出的特异度无显著性差异(P>0.05)。结论 介入手术治疗后,需采用影像学方法检查及时评估残余肿瘤活性,以决定后期治疗,以MRI检查的效能最好,但其费用可能较高。     

消化道肿瘤CT动脉造影分析83例

目的:总结消化道肿瘤CT动脉造影情况,探讨CT动脉造影诊断消化系统疾病价值．方法:选CT等其它法已明确和未明确的消化道肿瘤性患者83例,采用Seldinger技术经股动脉插管,行CT动脉造影,肝脏肿瘤同时行CT门脉造影．分析影像所见并与超声、CT、MRI等比较,结合临床探讨CT动脉造影诊断消化道肿瘤价值．结果:CT等已明确诊断肝癌的42例患者中,35例新发现卫星灶或周边小灶．14例临床疑肝癌,CT、彩超无异常,通过CT动脉造影10例诊断早期肝癌,2例弥漫性肝癌,2例正常．10例结肠癌患者,CT等方法未见肝转移,CT动脉造影发现7例有早期肝转移．7例肝占位待查患者,6例符合肝癌,1例符合血管瘤．6例疑胆囊癌患者,4例确诊胆囊癌．2 例胰腺癌患者,CT动脉造影显示明显强化．2例胃癌患者可清楚显示病变范围、血运程度及与周围脏器关系．结论:CT动脉造影可发现超声、CT等其它法不能发现的卫星小灶或肝内其它小癌灶,对诊断早期肝癌特殊敏感,对显示肝内早期转移灶和定性诊断优于其它影像技术,CT动脉造影更能准确显示病灶血运情况、病变范围及与邻近脏器关系．     

MRI与CT在介入治疗肝癌后癌肿残留及复发的早期诊断应用

目的:运用CT扫描及核磁共振成像(MRI)检查技术,对介入治疗后肝癌患者的检测结果进行对比分析,探讨MRI和CT成像技术在肝癌残留及复发病灶早期诊断方面的临床应用价值。方法:选取80例肝癌患者,分别进行CT扫描及MRI检查,并将其早期诊断结果与随访复查结果相比较。结果:MRI检查介入治疗后,患者肝癌残留及复发病灶准确率明显高于CT扫描(P0.05)。结论:MRI扫描检查在介入治疗后,患者肝癌残留及复发病灶早期诊断方面具有更高的准确率。     

低剂量CT结肠成像联合MRI对结直肠癌的诊断价值

目的探讨低剂量CT结肠成像联合MRI在结直肠癌诊断中的临床价值。方法回顾性分析2013年7月到2017年11月海安县人民医院收治的60例疑似结直肠癌患者的临床资料,所有患者均经手术探查及术后病理检查,分析患者的低剂量CT结肠成像及MRI影像特征,比较低剂量CT结肠成像、MRI及二者联合检查对结直肠癌的诊断效能。结果 60例疑似结直肠癌患者,术后病理检查确诊结直肠癌患者52例(86. 67%),良性病变8例(13. 33%)。低剂量CT结肠成像联合MRI检测与病理检查结果的一致性最高(kappa=0. 932,P 0. 05)。低剂量CT结肠成像联合MRI检查的敏感性(98. 08%)和阴性预测值(88. 89%)均高于两者单独检查,特异性(100%)和阳性预测值(100%)高于低剂量CT检查。低剂量CT结肠成像联合MRI对结直肠癌分期诊断的准确率(86. 27%)高于两者单独诊断,且kappa值为0. 807(P 0. 05),与病理分期的一致性高。结论低剂量CT结肠成像联合MRI检查,可提高结直肠癌诊断的敏感性和阴性预测值,与病理诊断及分期的一致性高,可用于临床对结直肠癌开展的早期检测。     

内镜超声检查术对胰腺肿瘤早期诊断的价值

目的探讨内镜超声检查术（EUS）、管内超声检查术（IDUS）及超声内镜引导下细针穿刺术（EUS-FNA）对胰腺肿瘤早期诊断的价值。方法回顾性分析和比较188例胰腺小占位病灶的EUS、IDUS、EUS—FNA及其他影像学检查结果。结果（1）EUS诊断小胰腺癌的准确率是95．6％（44／46）,优于B超58．6％（27／46）、CT77．4％（24／31）、MRI76．2％（16／21）及内镜逆行胰胆管造影术（ERCP）85．3％（29／34）。小胰腺癌EUS声像图主要表现为类圆形、边界清楚、边缘不规则的低回声肿块,内部回声多均匀。（2）25例胰腺小占位病灶行IDUS检查,其准确率是100．0％（25／25）,明显优于B超32．0％（8／25）、CT52．9％（9／17）及MRI57．9％（11／19）等检查。（3）18例胰腺小占位病灶行EUS—FNA,其准确率是66．7％（12／18）。（4）EUS诊断胰腺假性囊肿的准确率是100．0％（27／27）,明显优于13超52．0％（13／25）、CT66、7％（12／18）、MRI82．4％（14／17）及ERCP78．9％（15／19）;对胰腺囊性肿瘤分类鉴别诊断总的准确率是57．7％（15／26）,优于B超19．2％（5／26）、CT36．4％（8／22）、MRI37．5％（6／16）及ERCP50．0％（7／14）等检查。结论EUS、IDUS及EUS-FNA对胰腺肿瘤的早期诊断具有重要价值。     

EUS for detection of the hepatocellular carcinoma: results of a prospective study

BACKGROUND: Early detection of hepatocellular carcinoma (HCC) and accurate determination of the number of lesions are critical in determining eligibility for liver transplantation or resection. Current diagnostic modalities (CT and magnetic resonance imaging [MRI]) often miss small lesions. OBJECTIVE: To compare the accuracy of the EUS with CT for the detection of primary tumors of the liver. DESIGN: Prospective single-center study. SETTING: Academic medical center. PATIENTS: Subjects at high risk of HCC (hepatitis B, hepatitis C, or alcoholic cirrhosis) were enrolled. INTERVENTIONS: US, CT, MRI, and EUS examinations of the liver were performed. Liver lesions identified during EUS underwent EUS-guided FNA (EUS-FNA). RESULTS: Seventeen patients were enrolled in the study. Nine of these patients had liver tumors (HCC, 8; cholangiocarcinoma, 1). EUS-FNA established a tissue diagnosis in 8 of the 9 cases. The diagnostic accuracy of US, CT, MRI, and EUS/EUS-FNA were 38%, 69%, 92%, and 94%, respectively. EUS detected a significantly higher number of nodular lesions than US (P = .03), CT (P = .002), and MRI (P = .04). For HCC lesions, a trend was observed in favor of EUS for the detection of more lesions than US (8 vs 2; P = .06) and CT (20 vs 8; P = .06). No complications were observed as a result of EUS-FNA. LIMITATIONS: Small sample size. CONCLUSIONS: EUS-FNA is a safe and accurate test for the diagnosis of HCC. EUS increases the accuracy of intrahepatic staging of the HCC by delineation of lesions, which are missed by CT and MRI. We recommend EUS for suspected HCC, particularly in cases that are being considered for liver transplantation.     

Characterization of focal liver lesions with SonoVue(R)-enhanced sonography: International multicenter-study in comparison to CT and MRI

AIM: To evaluate in a multicenter study whether the sonographic characterization of focal liver lesions can be improved using SonoVue(R)-enhancement; and to compare this method with computed tomography (CT) and magnetic resonance imaging (MRI). METHODS: One hundred and thirty four patients with one focal liver lesion detected in baseline ultrasound (US) were examined with conventional US, contrastenhanced US ( n = 134), contrast-enhanced CT ( n = 115) and/or dynamic contrast-enhanced MRI ( n = 70). The lesions were classified as malignant, benign or indeterminate and the type of lesion was determined.The final diagnosis based on the combined information of all imaging examinations, clinical information and histology ( n = 32) was used. Comparisons were made to see whether the addition of contrast-enhanced US led to the improvement of the characterization of doubtful focal liver lesions. RESULTS: In comparison with unenhanced US, SonoVue(r) markedly improves sensitivity and specificity for the characterization (malignant/benign) of focal liver lesions. In comparison with CT and/or dynamic MRI, SonoVue(r) -enhanced sonography applied for characterization of focal liver lesions was 30.2% more sensitive in the recognition of malignancy and 16.1% more specific in the exclusion of malignancy and overall 22.9% more accurate. In the subgroup with confirmative histology available ( n = 30), sensitivity was 95.5% (CEUS), 72.2% (CT) and 81.8% (MRI), and specificity was 75.0% (CEUS), 37.5% (CT) and 42.9% (MRI). The sensitivity and specificity of CEUS for the identification of focal nodular hyperplasia (FNH) and hemangiomas was 100% and 87%, resulting in an accuracy of 94.5%. CONCLUSION: SonoVue(r)-enhanced sonography emerges as the most sensitive, most specific and thus most accurate imaging modality for the characterization of focal liver lesions.     

Characterization of focal liver lesions with SonoVue(R)-enhanced sonography: International multicenter-study in comparison to CT and MRI

AIM: To evaluate in a multicenter study whether the sonographic characterization of focal liver lesions can be improved using SonoVue(R)-enhancement; and to compare this method with computed tomography (CT) and magnetic resonance imaging (MRI). METHODS: One hundred and thirty four patients with one focal liver lesion detected in baseline ultrasound (US) were examined with conventional US, contrastenhanced US ( n = 134), contrast-enhanced CT ( n = 115) and/or dynamic contrast-enhanced MRI ( n = 70). The lesions were classified as malignant, benign or indeterminate and the type of lesion was determined.The final diagnosis based on the combined information of all imaging examinations, clinical information and histology ( n = 32) was used. Comparisons were made to see whether the addition of contrast-enhanced US led to the improvement of the characterization of doubtful focal liver lesions. RESULTS: In comparison with unenhanced US, SonoVue(r) markedly improves sensitivity and specificity for the characterization (malignant/benign) of focal liver lesions. In comparison with CT and/or dynamic MRI, SonoVue(r) -enhanced sonography applied for characterization of focal liver lesions was 30.2% more sensitive in the recognition of malignancy and 16.1% more specific in the exclusion of malignancy and overall 22.9% more accurate. In the subgroup with confirmative histology available ( n = 30), sensitivity was 95.5% (CEUS), 72.2% (CT) and 81.8% (MRI), and specificity was 75.0% (CEUS), 37.5% (CT) and 42.9% (MRI). The sensitivity and specificity of CEUS for the identification of focal nodular hyperplasia (FNH) and hemangiomas was 100% and 87%, resulting in an accuracy of 94.5%. CONCLUSION: SonoVue(r)-enhanced sonography emerges as the most sensitive, most specific and thus most accurate imaging modality for the characterization of focal liver lesions.     

Characterization of focal liver lesions with SonoVue- enhanced sonography： International multicenter-study in comparison to CT and MRI

AIM： To evaluate in a multicenter study whether the sonographic characterization of focal liver lesions can be improved using SonoVue-enhancement; and to compare this method with computed tomography （CT） and magnetic resonance imaging （MRI）.
METHODS： One hundred and thirty four patients withone focal liver lesion detected in baseline ultrasound （US） were examined with conventional US, contrastenhanced US （n = 134）, contrast-enhanced CT （n = 115） and/or dynamic contrast-enhanced MRI （n = 70）. The lesions were classified as malignant, benign or indeterminate and the type of lesion was determined. The final diagnosis based on the combined information of all imaging examinations, clinical information and histology （n = 32） was used. Comparisons were made to see whether the addition of contrast-enhanced US led to the improvement of the characterization of doubtful focal liver lesions.
RESULTS： In comparison with unenhanced US, SonoVue markedly improves sensitivity and specificity for the characterization （malignant/benign） of focal liver lesions. In comparison with CT and/or dynamic MRI, SonoVue -enhanced sonography applied for characterization of focal liver lesions was 30.2% more sensitive in the recognition of malignancy and 16.1% more specific in the exclusion of malignancy and overall 22.9% more accurate. In the subgroup with confirmative histology available （n = 30）, sensitivity was 95.5% （CEUS）, 72.2% （CT） and 81.8% （MRI）, and specificity was 75.0% （CEUS）, 37.5% （CT） and 42.9% （MRI）. The sensitivity and specificity of CEUS for the identification of focal nodular hyperplasia （FNH） and hemangiomas was 100% and 87%, resulting in an accuracy of 94.5%.
CONCLUSION： SonoVue-enhanced sonography emerges as the most sensitive, ost specific and thus most accurate imaging modality for the characterization of focal liver lesions.     

内镜超声检查对胆囊癌的诊断价值

目的探讨内镜超声检查(EUS)对胆囊癌的诊断价值.方法对18例胆囊癌患者行EUS检查并与体表B超(B超),X线电子计算机断层扫描(CT)/磁共振成像(MR1)结果进行比较.结果18例中,EUS诊断17例,CT/MRI诊断15例,B超诊断5例.EUS诊断胆囊癌的敏感性与准确性高于B超,与CT/MRI相当.13例行手术治疗,与手术病理比较,EUS诊断正确率为92%,CT/MRI为76.9%(P＞0.05),B超为41.6%(P＜0.01).EUS对小病灶的显示明显优于B超,并优于CT/MRI.结论EUS对胆囊癌有较高的诊断价值.     

超声内镜对胰腺癌诊断及评估价值

目的：探讨EUS诊断胰腺癌的敏感性，准确性及其评估肿瘤特征的价值。方法：以126例经病理确诊并在确诊前半月内先后接受EUS、US、CT检查的胰腺癌患者为研究对象，回顾性分析三种成像方法及EUS对于不同类型胰腺癌的检查结果，应用t检验或u检验评估这些检查结果的差异有无显著性，结果：EUS诊断胰腺癌准确性较US高，尤其对于小胰腺癌准确性更高，二者差异有显著性（P＜0．05）；EUS诊断敏感性，准确性与CT比较差异无显著性，联合应用EUS及CT检查，则诊断敏感性及准确性大为提高，与单独应用US、EUS或CT相比，差异均有显著性（P＜0．05）；EUS与CT显示肿瘤间接征象的准确性无显著性差异，结论：EUS对于胰腺癌是一种较好的检查方法，尤其对于怀疑为小胰腺癌者应作为常规检查，联合应用EUS和CT检查胰腺癌值得推广。     

Diagnosis of pancreatic cancer

The ability to diagnose pancreatic carcinoma has been rapidly improving with the recent advances in diagnostic techniques such as contrast-enhanced Doppler ultrasound (US), helical computed tomography (CT), enhanced magnetic resonance imaging (MRI), and endoscopic US (EUS). Each technique has advantages and limitations, making the selection of the proper diagnostic technique, in terms of purpose and characteristics, especially important. Abdominal US is the modality often used first to identify a cause of abdominal pain or jaundice, while the accuracy of conventional US for diagnosing pancreatic tumors is only 50-70%. CT is the most widely used imaging examination for the detection and staging of pancreatic carcinoma. Pancreatic adenocarcinoma is generally depicted as a hypoattenuating area on contrast-enhanced CT. The reported sensitivity of helical CT in revealing pancreatic carcinoma is high, ranging between 89% and 97%. Multi-detector-row (MD) CT may offer an improvement in the early detection and accurate staging of pancreatic carcinoma. It should be taken into consideration that some pancreatic adenocarcinomas are depicted as isoattenuating and that pancreatitis accompanied by pancreatic adenocarcinoma might occasionally result in the overestimation of staging. T1-weighted spin-echo images with fat suppression and dynamic gradient-echo MR images enhanced with gadolinium have been reported to be superior to helical CT for detecting small lesions. However, chronic pancreatitis and pancreatic carcinoma are not distinguished on the basis of degree and time of enhancement on dynamic gadolinium-enhanced MRI. EUS is superior to spiral CT and MRI in the detection of small tumors, and can also localize lymph node metastases or vascular tumor infiltration with high sensitivity. EUS-guided fine-needle aspiration biopsy is a safe and highly accurate method for tissue diagnosis of patients with suspected pancreatic carcinoma. (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been suggested as a promising modality for noninvasive differentiation between benign and malignant lesions. Previous studies reported the sensitivity and specificity of FDG-PET for detecting malignant pancreatic tumors as being 71-100% and 64-90%, respectively. FDG-PET does not replace, but is complementary to morphologic imaging, and therefore, in doubtful cases, the method must be combined with other imaging modalities.     

Prediction of liver cirrhosis,using diagnostic imaging tools

Early diagnosis of liver cirrhosis is important. Ultrasoundguided liver biopsy is the gold standard for diagnosis of liver cirrhosis. However, its invasiveness and sampling bias limit the applicability of the method. Basic imaging for the diagnosis of liver cirrhosis has developed over the last few decades, enabling early detection of morphological changes of the liver by ultrasonography(US), computed tomography, and magnetic resonance imaging(MRI). They are also accurate diagnostic methods for advanced liver cirrhosis, for which early diagnosis is difficult. There are a number of ways to compensate for this difficulty, including texture analysis to more closely identify the homogeneity of hepatic parenchyma, elastography to measure the stiffness and elasticity of the liver, and perfusion studies to determine the blood flow volume, transit time, and velocity. Amongst these methods, elastography using US and MRI was found to be slightly easier, faster, and able to provide an accurate diagnosis. Early diagnosis of liver cirrhosis using MRI or US elastography is therefore a realistic alternative, but further research is still needed.