脂肪肝CT图像、肝穿活检病理图像定量形态测量软件的设计和应用

实时超声和CT平扫可提示脂肪肝的肝脏肿大和肝实质内弥漫性或局灶性回声或密度改变，定性或半定量地判断脂肪肝的程度及类型。笔者制作了1年图像处理软件，对用面罩式覆盖法得到的肝脏CT图像进行数字化处理，得出整个肝脏脂肪变性程度的参数，同样可用于病理图像的处理，从而达到了定量诊断的目的。     

影像组学在乳腺癌的应用研究进展

影像组学可无创地定量描述肿瘤的异质性,能够为乳腺癌的早期诊断、疗效预测及预后评估等提供丰富信息。近年影像组学与基因等数据的结合运用进一步促进了乳腺癌精准医疗的发展。就影像组学在乳腺癌诊断、分子分型预测、疗效评估、预后预测及复发风险等方面的研究进展予以综述。     

定量诊断脂肪肝的影像学研究进展

近年来,随着生活水平的提高和饮食结构的改变,脂肪肝的发生率呈明显上升趋势。脂肪肝虽为良性病变,但部分病例可进展为脂肪性肝炎、肝纤维化、肝硬化,甚至肝功能衰竭和肝细胞癌,严重危害生命健康。早期诊断、及时治疗可使发生脂肪变性的肝细胞恢复正常,通过无创性方法定量诊断脂肪肝并随访观察疗效在临床工作中具有非常重要的意义。对超声、CT和MR成像(包括梯度回波同/反相位T1WI和MR波谱)在脂肪肝定性、定量诊断中的研究现状和进展予以综述。     

原发性双侧乳腺癌

原发性双侧乳腺癌有同时性和异时性,发病率不高,病因尚不清楚,但与遗传及基因突变等多方面因素有关。乳腺钼靶照片、螺旋CT、PET/CT、MRI及超声检查可用于该病的早期诊断,治疗与单侧乳腺癌一样以手术治疗为主,结合术后的放疗、化疗和内分泌治疗等,其预后与单侧乳腺癌相似。     

在非酒精性脂肪肝病人使用USPIO增强MR成像无创性鉴别肝脂肪变性和脂性肝炎:概念证实性研究

正摘要目的 (a)研究超顺磁性氧化铁(USPIO)增强MRI在非酒精性脂肪肝的合适扫描时间和剂量;(b)评估在非酒精性脂肪肝中肝脏对于USPIO的摄取是否会降低;(c)研究USPIO增强MR成像对于诊断非酒精性脂肪肝和单纯性肝脂肪变性的准确性。材料与方法该前瞻性的研究得到了当地伦理委员会的批准,所有病人均签署知情同意书。在注射USPIO时和之后72 h采集量化的肝脏R2*MR影像,被试对     

RSNA2021乳腺影像学

【摘要】2021年RSNA大会中关于乳腺影像学方面的研究热点和重点主要包括以下几个方面：①乳腺X线摄影如何提高乳腺癌的检出率及降低召回率,测量乳腺腺体密度并评估乳腺癌患病风险;②超声在乳腺癌诊断、腋窝淋巴结评价方面的应用,引用人工智能辅助系统可提高诊断性能,采用冷冻消融新技术治疗低级别乳腺癌;③探讨简化乳腺MRI序列早期筛查乳腺癌的可行性,乳腺多参数MRI、影像组学及深度学习系统在乳腺癌非肿块病变的诊断、乳腺腺体分类、预测预后和新辅助化疗应答方面的应用。     

超声误诊男性乳腺癌1例

男性乳腺癌（MBC）是一种少见的男性恶性肿瘤，临床需与乳腺良性结节进行鉴别，早期发现，改善预后。常见的乳腺癌恶性影像征象较易诊断，但不典型者类似于良性结节的影像表现较易误诊。本文报道1例我院收治的MBC患者，术前误诊为良性肿块，术中证实为乳腺癌，遂行右腋下前哨淋巴结活检+右乳切除术，术后根据病理结果行化疗及内分泌治疗。通过查阅文献，回顾此病的诊治过程，探讨MBC的影像学特征及鉴别诊断，提高对MBC的认识，从而减少对此病的误诊率。     

肝脏CT灌注成像的临床应用及研究进展

肝脏CT灌注成像可对肝脏组织灌注进行定性和定量评估。它可用于评估各种肝癌治疗方式的疗效和预测早期治疗反应,预测微血管侵犯情况和肿瘤复发,用于肝内占位性病变的诊断及鉴别诊断,以及于肝纤维化、肝硬化以及肝储备功能的评价等。本文对肝脏CT灌注成像的临床应用及研究进展做一综述。     

磁共振成像定量非酒精性脂肪性肝病可逆性病变的研究

【摘要】非酒精性脂肪性肝病（NAFLD）可由单纯性脂肪肝进展为肝硬化甚至肝癌。诊断其早期可逆性病变,对疾病预后至关重要。目前磁共振影像技术在诊断脂肪肝和肝纤维化方面表现出巨大潜力,本文就磁共振成像技术对单纯性脂肪肝及肝纤维化的定量诊断做一综述。     

肝脂肪变性的超声检测技术及其应用前景

非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)是最常见的慢性肝病,在普通人群中的患病率约高达30%。肝脂肪变性是NAFLD的一个重要组织学特征,随着病程的发展,可导致肝纤维化或肝硬化,甚至增加肝细胞肝癌的患病风险。定量评估肝脂肪变性的金标准是肝脏穿刺活检,但其具有侵入性。影像学技术使无创、定量地评估肝脏脂肪成为可能。许多指南推荐超声作为NAFLD首选的影像学诊断手段,具有简便、实时、无创及可视化等优势。近年来,超声定量检测技术层出不穷,技术参数包括衰减系数、背向散射系数和声速。但各类超声新技术临床应用证据较少,需要大量研究探索并优化操作方法,以降低噪声对测量值的影响。本文从脂肪性肝病名称的变更、临床诊断现状、超声医学与生物世界联合会定量评估脂肪变性共识的解读入手,并介绍具有代表性的基于声衰减系数的定量超声技术,以及其在肝脂肪变性检测中的诊断价值。最后从诊断、监测、预测等角度展望超声定量检测技术的临床前景。     

MRI evaluation of fatty liver in day to day practice: Quantitative and qualitative methods

Intracellular fat accumulation is a common feature of liver disease. Steatosis is the histological hallmark of non-alcoholic fatty liver disease (NAFLD) but also may occur with alcohol abuse, viral hepatitis, HIV and genetic lipodystrophies, and chemotherapy. This condition is common in the Western population and is typically associated with obesity and the metabolic syndrome. Early diagnosis and early treatment of NAFLD are important to prevent the development of end-stage liver disease and cancer. In addition, liver fat is a risk factor for postoperative complications after liver resection and transplantation. MRI has become a primary modality to assess hepatic steatosis, both qualitatively and quantitatively. In this article we discuss various MRI methods for evaluation of hepatic steatosis.     

MR对非酒精性脂肪肝的评价

目的：评价MRI对非酒精性脂肪肝（NAFLD）的价值。方法：45例肥胖患者行MR T1dual和1H-MRS检查,评价这两种方法计算NAFLD含量临界值的意义,并与CT检查作对照。结果：MR T1dual HFF、RSID及1H-MRS等方法与CT评价脂肪肝程度的相关系数分别为-0.951、-0.935、-0.659（P〈0.01）。且各种评价方法分别与TG、GGT指标显著相关,其中RSID与TG、GGT相关性最好（r=0.406、0.457,P〈0.01）,而1H-MRS所评价的肝内脂质含量分别与ALT、TG及GGT之间有对数的线性关系。结论：MRI T1dual是一种方便、快速、安全的定量检查NAFLD方法,HFF9%、RSID 20%可作为有无肝内脂肪浸润的指标。MR T1dual中RSID及^1H-MRS可以很好的评价肝内TG水平。     

Noninvasive quantitation of human liver steatosis using magnetic resonance and bioassay methods

The purpose was to evaluate the ability of three magnetic resonance (MR) techniques to detect liver steatosis and to determine which noninvasive technique (MR, bioassays) or combination of techniques is optimal for the quantification of hepatic fat using histopathology as a reference. Twenty patients with histopathologically proven steatosis and 24 control subjects underwent single-voxel proton MR spectroscopy (MRS; 3 voxels), dual-echo in phase/out of phase MR imaging (DEI) and diffusion-weighted MR imaging (DWI) examinations of the liver. Blood or urine bioassays were also performed for steatosis patients. Both MRS and DEI data allowed to detect steatosis with a high sensitivity (0.95 for MRS; 1 for DEI) and specificity (1 for MRS; 0.875 for DEI) but not DWI. Strong correlations were found between fat fraction (FF) measured by MRS, DEI and histopathology segmentation as well as with low density lipoprotein (LDL) and cholesterol concentrations. A Bland-Altman analysis showed a good agreement between the FF measured by MRS and DEI. Partial correlation analyses failed to improve the correlation with segmentation FF when MRS or DEI data were combined with bioassay results. Therefore, FF from MRS or DEI appear to be the best parameters to both detect steatosis and accurately quantify fat liver noninvasively.     

磁共振弹性成像评价肝纤维化的研究进展

正确评价肝纤维化的程度对于慢性肝病病人的诊断、治疗及预后具有重要作用。肝穿刺活检术是目前评价肝纤维化的金标准,但因受到其固有局限性的制约,因此无创性检查备受推崇。MRI作为无创性技术具有多方位、多参数成像的特点,在肝脏疾病诊断和评价方面的优势十分突出,尤其近年发展迅速的磁共振弹性成像技术,在肝纤维化诊断和评价研究方面取得了显著进展。     

网状内皮系统特异性MR对比剂菲立磁(Feridex)的临床初步应用

目的：评价菲立磁在MR检查中的诊断价值和安全性。方法：对17例肝、脾、淋巴结病变患者进行常规MR检查和菲立磁增强扫描,观察、分析、增强前后T1WI、T2WI图像上肝、脾、淋巴结的信号变化及病灶数目,以及不良反应。结果;菲立磁明显降低,肝、脾组织和含吞噬细胞的良性病变的信号强度,不影响未含吞噬细胞病灶的信号强度,同时具有早期缩短T1弛豫时间,不良反应少。结论：菲立磁在检测肝、脾局灶性病变中,敏感性高,具有一定的鉴别诊断价值。且安全。     

Nuclear magnetic resonance of the liver,spleen, and pancreas

This review includes the initial experience with NMR imaging of the liver, spleen, and pancreas at the University of California, San Francisco, using a prototype 0.35 Tesla system. This experience shows great promise for detection of hepatic metastases using T₁-weighted pulse sequences. T₂-weighted pulse sequences appear sensitive for detecting cavernous hemangioma of the liver and may allow tissue specific discrimination of the benign lesion from cancer. NMR is also suitable for evaluating diffuse metabolic alterations and is sensitive and specific for the diagnosis of iron overload. Detection of fatty liver requires use of chemical shift techniques as conventional NMR imaging pulse sequences are relatively insensitive. Motion artifacts and lack of an effective bowel contrast agent limits imaging of the pancreas and retroperitoneum, where CT remains the procedure of choice. The normal spleen has longer T1 and T2 relaxation times than liver or pancreas and NMR has not been successful in diagnosing splenic metastases or lymphoma on a routine basis. We conclude that NMR imaging will be valuable in the diagnosis of focal liver disorders; until fast scan techniques and effective magnetic contrast agents are available for oral and/or intravenous use, other abdominal applications will remain limited.     

血吸虫性肝病MRI研究进展

血吸虫肝病是严重危害人类生命健康的寄生虫病,可导致肝纤维化、肝硬化,晚期可并发肝功能障碍及肝癌。因此早期发现和确诊血吸虫肝病,对制定治疗方案、监测病变程度和病情发展及判断预后等均有重要作用。MR成像对血吸虫肝病的诊断有较高的敏感性和特异性,就常规MRI、动态对比增强MRI及功能MRI在血吸虫肝病的研究现状和进展予以综述。     

Imaging appearance of severe subcapsular hepatic steatosis: mimicking hepatic embolic infarcts

We report a case of severe subcapsular hepatic steatosis in a middle-aged woman with diabetic nephropathy requiring continuous ambulatory peritoneal dialysis (CAPD). The CT appearances of the liver were initially suspected to be due to embolic infarcts. However, an accurate diagnosis was made only after a history of intraperitoneal insulin administration was elicited, and this was confirmed on MRI with chemical shift gradient-echo pulse sequences. Haemodialysis was recommenced, and follow-up imaging 4 years later showed complete resolution of subcapsular hepatic steatosis.Subcapsular hepatic steatosis is a rare and unique form of non-alcoholic fatty liver, occurring only in individuals with diabetic nephropathy receiving continuous ambulatory peritoneal dialysis (CAPD) with intraperitoneal insulin. Imaging findings are classical, and with the appropriate history of intraperitoneal insulin administration, an accurate diagnosis can be made. Given that this disease entity has only recently been described, we hope to highlight its typical imaging appearances, which may otherwise be misinterpreted as a more insidious finding, thus averting unnecessary intervention.     

Imaging of hepatic steatosis and fatty sparing

Radiology has gained importance in the non-invasive diagnosis of hepatic steatosis. Ultrasonography is usually the first imaging modality for the evaluation of hepatic steatosis. Unenhanced CT with or without dual kVp measurement and MRI with in and out of phase sequence can allow objective evaluation of hepatic steatosis. However, none of the imaging modalities can differentiate non-alcoholic steatohepatitis/fatty liver disease from simple steatosis. Evaluation of hepatic steatosis is important in donor evaluation before orthotopic liver transplantation and hepatic surgery. Recently, one-stop shop evaluation of potential liver donors has become possible by CT and MRI integrating vascular, parenchymal, volume and steatosis evaluation. Moreover hepatic steatosis (diffuse, multinodular, focal, subcortical, perilesional, intralesional, periportal and perivenular), hypersteatosis and sparing (geographic, nodular and perilesional or peritumoral) can cause diagnostic problems as a pseudotumor particularly in the evaluation of oncology patients. Liver MRI is used as a problem-solving tool in these patients. In this review, we discuss the current role of radiology in diagnosing, quantifying hepatic steatosis and solutions for diagnostic problems associated with fatty infiltration and sparing.     

肝纤维化分子显像的研究进展

肝纤维化是一种伴随慢性肝病的病理过程,具有较高的发病率和病死率。目前诊断肝纤维化的金标准是肝活检术,但肝活检术有其局限性,且目前尚无有效的无创诊断肝纤维化的手段。在肝纤维化的早期阶段,其可通过治疗“逆转”,因此,肝纤维化的诊断和精确分期在控制该疾病中非常重要。由于分子影像学技术具有无创、特异度高等优点,因此其发展具有巨大潜力。笔者对磁共振分子影像学技术和核医学分子影像学技术在肝纤维化诊断和分期方面的最新进展进行概述。