MRI在鉴别鼻咽癌放疗后局部复发与纤维化的应用研究

本研究对经CT 扫描证实鼻咽部有软组织密度肿块的36例鼻咽癌放疗后患者行MRI 扫描,并以8例未经治疗的鼻咽癌患者作对照。对各病变信号强度的分析结果显示:放疗后纤维化在T_1WI 和T_2WI 上多显示为低或稍低信号强度;肿瘤在T_1WI 上多显示为稍高信号强度,但与纤维化有一定重叠,在T_2WI 上肿瘤信号强度明显增强,与纤维化区别最明显,对诊断起主要作用.但肿瘤的信号强度变化缺乏特异性,放疗后水肿和炎症可有类似表现,应注意鉴别。     

鼻咽癌颈部淋巴结转移的磁共振成像

本文总结了32例鼻咽癌患者颈部淋巴结转移的磁共振成像(MRI)。结果表明:转移淋巴结在T_1加权像为中等信号强度,介于肌肉与脂肪之间,近似于或稍高于原发灶。区分肿瘤与脂肪组织用T_1加权像最好,而T_2加权像则有利于区分淋巴结与肌肉。MRI 尚能够显示CT 不能显示的咽后外侧淋巴结。MRI 作用在于发现临床上不能触到的深在部位的淋巴结,以及鉴别放疗后颈部纤维化与淋巴结转移。另外,当临床上发现单个或单侧淋巴结转移时,MRI 有助于进一步显示多个或双侧淋巴结转移。     

鼻咽顶后壁增厚的MRI表现及临床意义

目的:探讨常规颅脑MRI矢状面扫描对及早发现鼻咽部病变的临床价值。方法:统计7 138例行常规颅脑MRI检查鼻咽顶后壁增厚患者,回顾性分析其中经病理证实的371例的临床及MRI资料。结果:371例中,慢性鼻咽炎289例,MRI表现为鼻咽部黏膜弥漫性增厚,均匀显著强化,黏膜线完整;腺样体肥大43例,表现为增殖体前方气道不同程度变窄;鼻咽癌25例,表现为鼻咽腔不对称狭窄或不规则肿块突起,颅底及邻近组织结构多受累;Tornwaldt’s囊肿9例,表现为鼻咽正中线上圆形或椭圆形囊性结构,TSE T_2WI均呈高信号,T_1WI信号因囊液成分不同而异;鼻咽淋巴瘤5例,多表现为鼻咽黏膜弥漫性、对称性增厚,病灶信号均匀,增强扫描均匀轻度强化,多合并咽后及颈部淋巴结肿大。结论:常规颅脑MRI矢状面扫描细致观察鼻咽顶后壁对鼻咽部病变的及早诊断具有重要作用。     

腹膜后纤维化CT及MRI的评价

我们有五例活检证实的腹膜后纤维化(RPF)作了CT及MRI,MRI显示在T_1权重像RPF为低信号强度,T_2权重像为不均匀中等信号。MRI冠状面显示腹膜后肿块:形状、信号强度和输尿管、大血管变化表现为RPF特征。索引术语:腹膜后、疾病——腹膜后、纤维化——MRI,对照研究——CT,对照研究。     

鼻咽癌108例两种活检方法对远处转移的影响

目的 分析鼻咽部取样活检和颈淋巴结活检对远处转移的影响。方法 108全鼻咽癌病人给予放射治疗。69例经鼻咽部取样活检。39例经颈淋巴结取样活植。结果 经鼻咽活检病人五年存活率54.7％,远处转移率30.4％。经颈淋巴结活检病人五年存活率33.4％．远处转移率65.5％。结论 经颈淋巴结活检可以增加鼻咽癌远处转移的发生率。     

鼻咽癌CT表现类型与c-erbB-2蛋白表达的相关性研究

目的探讨鼻咽癌(NPC)CT表现类型与c-erbB-2的关系，更全面的认识NPC生物学特性。材料与方法搜集放疗前进行CT检查并有详细临床记录的NPC标本70例，采用S-P法进行c-erbB-2免疫组织化学染色，分析c-erbB-2表达与NPCCT表现类型和临床预后关系。结果NPC的c-erbB-2阳性率为84.29％，与病理组织学类型和病理分级无关；11I型NPC的c-erbB-2阳性率显著高于Ⅱ型(P=0、018)；c-erbB-2的表达与颈淋巴结转移和放疗后局部复发以及远处转移无关。结论远离鼻咽腔生长的NPC较邻近鼻咽腔生长者，c-erbB-2阳性率要高，恶性程度更高。     

鼻咽癌PET/CT影像表现及临床价值

目的研究鼻咽癌及其颈部淋巴结转移的PET／CT影像表现。方法初诊鼻咽癌患者51例、鼻咽部炎症患者14例及鼻咽癌治疗后患者36例。皆行^18F-脱氧葡萄糖（FDG）PET／CT显像。鼻咽部炎症患者和鼻咽癌治疗后患者临床随访时间皆〉6个月，淋巴结随访时间6～14个月。结果①51例鼻咽癌初诊患者和14例鼻咽部炎症患者的PET和CT影像表现差异明显。以鼻咽部软组织肿块（或组织增厚）处PET呈结节状、块状代谢增高为鼻咽癌PET／CT诊断标准，则灵敏度为96．0％，特异性为85．7％。PET／CT在鼻咽癌病灶的定位、病灶边界的确定及显示病灶对周围组织的侵犯方面优于PET和CT。②36例鼻咽癌治疗后患者，以鼻咽部软组织肿块（或组织增厚）处PET呈结节状或块状代谢增高为PET／CT诊断鼻咽癌复发、残余的标准，而以鼻咽部组织增厚作为CT诊断鼻咽癌复发、残余的标准，则PET／CT和CT对复发、残余病灶的检出灵敏度分别为84．6％和92．3％．特异性分别为91．3％和56．5％，假阳性率分别为8．6％和43．4％。③87例鼻咽癌患者中，6l例有颈部淋巴结增大，PET／CT和MRI诊断淋巴结转移的灵敏度分别为91．8％和88．8％（P〉0．05），特异性分别为82．2％和51．1％（P〈0．05）。结论PET／CT显像在诊断鼻咽癌及其淋巴结转移和复发方面优于单纯PET和CT。     

MRI在鼻咽癌TNM分期中的价值

目的:探讨鼻咽癌侵犯周围组织的MRI表现及其临床价值。方法:搜集经病理证实的200例鼻咽癌的MRI资料,分析其MRI表现特征及相关病理改变,以提高诊断水平。结果:鼻咽癌MRI表现如下:151例呈长T1长T2信号,49例呈等T1等T2信号。侵犯鼻腔12例,口咽40例,茎突前间隙75例,茎突后间隙42例,上颌窦5例,蝶窦30例,岩尖23例,枕骨斜坡32例,淋巴结92例,腮腺4例,腭帆提肌和腭帆张肌140例,翼外肌21例,翼内肌23例,头长肌68例,颈长肌42例,颞肌1例,舌根4例,海绵窦13例,硬膜4例。188例放疗后复查MRI,177例有不同程度好转,11例病灶未见明显变化。结论:MRI可以清晰显示鼻咽部肿块、邻近结构的侵犯和颈部淋巴结转移,在鼻咽癌的诊断和分期中有重要价值,在鼻咽癌放疗后的随访及疗效评价中,也发挥着不可取代的作用。     

MRI在鼻咽癌放疗后随访中的应用价值

目的:探讨MRI在鼻咽癌放疗后随访中的应用价值。方法:72例鼻咽癌放疗后病人,均行MRI扫描,其中32例行Gd-DTPA强化扫描。结果:局部软组织肿块33例,颅底骨质破坏49例,肌肉受累23例,淋巴结增大25例,放射性脑病12例,27例鼻咽部出现放疗后纤维化表现。结论:MRI在鼻咽癌放疗后随访中具有明显优势。     

鼻腔和鼻旁窦平滑肌肉瘤的影像学表现(附5例报告)

目的：分析鼻腔鼻旁窦平滑肌肉瘤的CT与MRI表现，评价其临床价值。资料与方法：回顾分析经病理证实的鼻腔鼻旁窦平滑肌肉瘤5例，均行CT检查，其中2例加增强扫描；MRI检查2例，均为平扫加增强扫描。结果：肿瘤原发于鼻腔2例，上颌窦1例，1例肿瘤范围广已无法确定其原发部位，还有1例为鼻咽癌放射治疗14年的右后鼻孔－鼻咽区的复发肿瘤，肿瘤涉及范围包括鼻腔、筛窦、鼻咽部、眼眶、翼腭窝、颞下窝、咽部间隙、硬腭甚至口咽侧壁、中颅窝等。该类肿瘤呈浸润性生长及局部较广泛骨质破坏，无1例发生钙化及颈淋巴结转移。肿块在CT上3例呈较均匀的中等密度，2例密度不均；MRI T1WI呈无效中等信号，T2WI表现为略不均匀的中等到稍高信号，注射对比剂后肿瘤轻度强化或仅有部分强化。结论：鼻部平滑肌肉瘤表现为较广泛浸润性生长及骨质破坏，无钙化。CT能较好地显示肿瘤涉及范围及骨质破坏情况；MRI在区别肿瘤与周围炎性等病变方面较清楚。     

Age-related MRI changes at 0.1 T in cervical discs in asymptomatic subjects

The age-dependent occurrence of cervical degenerative changes was studies using 0.1 T MRI in 89 asymptomatic volunteers aged 9 to 63 years. The degree of DD (disc darkening on T2^*-weighted images), disc protrusions and prolapses, narrowing of disc spaces, dorsal osteophytes and spinal canal stenosis were assessed. Abnormalities were commoner in older subjects, 62% of being seen in those over 40 years old. In subjects aged less than 30 years there were virtually no abnormalities. DD was the most common abnormality, seen in 10% of discs; 57% DD was in subjects aged over 40. DD at the C5/6 level was the most common finding. No differences in abnormal findings between males and females was observed, nor any statistically significant association between DD and other abnormalities. Thus, DD begins later age in the cervical spine than in the lumbar region. Asymptomatic degenerative changes are common on MRI in the cervical spine after 30 years of age.     

3.0TMRI高b值扩散加权成像在宫颈癌分期中的应用

目的：探讨3.0T MRI 扩散加权成像(DWI)单一序列在宫颈癌诊断及分期中的应用价值。方法2名观察者分别独立分析65例宫颈癌患者术前 T2 WI、DWI 和 LAVA-Flex 动态增强图像,比较三者对宫颈癌影像学分期结果的差异,对肿瘤的 T2 WI、DWI 和 LAVA-Flex 动态增强图像进行分期效能评估。结果DWI 检测到所有的病灶,其中3例病灶在常规 T2 WI 序列未能发现,1例在动态增强图像上未能发现。DWI、T2 WI 与 LAVA-Flex 动态增强对宫颈癌总体分期准确率分别为90.8%、78.5%、87.7%。DWI 单一序列分期的准确率高于单一 T2 WI 序列(P =0.04),DWI 序列与多期动态增强序列分期准确率无显著差异(P =0.39)。结论单一的 DWI 序列在宫颈癌分期中的准确性优于单一的 T2 WI 序列,在不具备增强的条件下 DWI 有望替代 MRI 动态增强序列,对宫颈癌做出准确的分期。     

无骨折脱位型颈髓损伤的MRI分析

目的 :探讨无骨折脱位型颈髓损伤的发生机理、好发部位及MRI特点。材料和方法 :回顾性分析 43例无骨折脱位型颈髓损伤的MRI表现。结果 :共发现脊髓异常MR信号 46处 ,多位于C4-6水平 ,异常信号T1WI为低信号、等信号或高信号 ;T2WI为信号均匀或不均匀的高信号。结论 :MRI能显示脊髓损伤的范围和病理改变 ,明确脊髓损伤处有无突出椎间盘的持续性压迫。是无骨折脱位型颈髓损伤最好的检查方法     

脊髓亚急性联合变性磁共振诊断价值

目的:评价MRI对恶急性联合变性(SCD)的诊断价值。方法:搜集21例临床怀疑SCD的患者行MRI矢状面T1 WI和T2WI、横轴面T2WI,其中8例行Gd DTPA增强扫描,10例治疗后行MRI复查。结果:所有患者均显示 T2WI上颈髓、胸髓后部、侧索呈高信号,有1例前索出现类似病灶,Gd-DTPA增强扫描所有病变区均未见明显强化。10 例经维生素B12治疗6-12个月后复查,示T2WI上原高信号病灶范围明显缩小或消失,与患者临床症状和体征的缓解和改善呈正相关。结论:MRI有助于SCD的诊断并可观察临床疗效。     

MRI in stage I carcinoma of the uterine cervix: evaluation of residual uninvolved myometrium and pericervical tissues

The purpose of the present prospective study was, to determine the efficacy of MRI in predicting extracervical tumour invasion on the basis of the presence of a very thin (< 3 mm) univolved cervical stromal ring. Forty-seven consecutive patients with uterine cervical carcinoma (FIGO stages Ib–IIa) were examined with axial and sagittal T2-weighted MRI sequences. Pathological proof after hysterectomy was obtained in all women. On he basis of the MRI visualisation of a thinned stroma (<3 mm), the sensitiivity in predicting extracervical involvement was 94.1% and the specificity 73.3% (accuracy 80.85%). On the basis A the detection of complete stromal disruption the MRI sensitivity ill predicting extracervical involvement was 76.5% and specificity 93.3% (accuracy 87.23%). The results of our study indicate that in the interpretation of MRI findings, the visualisation of an uninvolved cervical stromal ring at least 3 min thick can predict the presence of extracervical tumour with very high sensitivity.     

Postsurgical follow-up by MRI of anterior cervical discectomy without fusion.

Postoperative magnetic resonance imaging (MRI) findings are described in selected patients with cervical radiculopathy and a cervical soft disc herniation, treated by anterior cervical discectomy (ACD) without fusion. Six months postoperatively, 45 patients underwent MRI examination using a 0.5 T superconductive unit. T1- and T2-weighted spin echo sequences were acquired on sagittal and axial planes. A low signal intensity on T2-weighted images was visualized at the ACD level in all patients. Five patients were found to have a slight kyphosis at the discectomy level. There was no residual disc material at any ACD level. In 5 patients, areas of diminished signal intensity on T1- and T2-weighted images on adjacent vertebrae was noticed, indicating sclerosis of the cortical bone adjacent to the ACD level. In 3 patients, cervical disc protrusions without impression on the dura were visualized postoperatively: 2 below and 1 above the ACD level. One patient developed a cervical disc herniation without complaints one level above the operated one. No patient developed infolding or degenerative swelling of the ligamenta flava and no intrinsic cord abnormalities were present. MRI provided useful information on pathology, allowing a non-invasive evaluation following ACD and enabling a better understanding of surgical consequences.     

MRI在子宫颈癌的诊断与分期中的应用价值

目的分析子宫颈癌的MR影像表现,并评价其诊断价值。方法74例经病理确诊的子宫颈癌患者于手术前均经盆腔轴位T1WI,T2WI,SPIR,矢状位T1WI,T2WI,增强扫描轴位及矢状位抑脂T1WI。根据肿瘤的位置、大小、信号特征、浸润范围、以及宫旁和盆壁的受累情况,将MRI所见进行影像学分期,并与国际妇产科联合会（FIGO）的分期结果相比较。结果子宫颈癌病变在末增强的T1WI上呈等信号,在T2WI上呈等信号或稍高信号,在T2WI上肿瘤与低信号的子宫颈基质和高信号的子宫颈内膜及子宫旁脂肪具有良好的对比,SPIR上肿瘤呈稍高信号,增强扫描肿瘤呈轻度强化或不明显强化,3D-动态MRI增强扫描肿瘤明显强化。MRI对子宫颈癌的定位诊断准确性为100％,分期准确性为91．88％。结论MRI具有很高的解剖分辨率,特别是采用3D-动态增强扫描,可为子宫颈癌的诊断与分期提供直接的解剖基础和客观依据。     

MRI快速场回波技术对椎间盘 突出症的诊断评价

目的评价MRI快速场回波技术对椎间盘突出症的诊断价值。方法对颈、腰椎间盘突出症患者各40例，采用1.0T场强MRI成像系统分别进行SE序列T     

Usefulness of tumor size on MR imaging in assessing the prognosis of uterine cervical cancer treated with radiation]

The purpose of this study was to assess the usefulness of MR imaging (MRI) in evaluating the primary tumor and predicting the prognosis after radiotherapy for uterine cervical carcinoma. MRI was performed before radiotherapy in 25 patients with squamous cell carcinoma. According to the staging of FIGO, 3 patients were classified as stage Ib, 1 as IIa, 5 as IIb, 13 as IIIb, 2 as IVa, and 1 as IVb. Three-dimensional diameters (transverse, anteroposterior, and craniocaudal) of the primary tumor were evaluated on T2-weighted images. For patients with tumors < or = 4 cm in craniocaudal diameter, i.e., the length of the tumor parallel to the long axis of uterine body, five-year disease-free survival (DFS) was 70%. For patients with tumors > 4 cm in craniocaudal diameter, the 5-year DFS was 37%. The difference between the two groups was statistically significant. For patients with tumors < or = 4 cm and > 4 cm in transverse or anteroposterior diameter, 5-year DFS was 63% and 50% respectively. There was no statistically significant difference between the two groups. The results showed the craniocaudal diameter of the tumor to be the most critical factor in predicting prognosis after radiation therapy in uterine cervical cancer. Moreover, MRI was an important means of evaluating the depth of uterine cervical carcinoma. In conclusion, MRI is useful in evaluating the effect of radiotherapy and predicting prognosis in uterine cervical cancer.     

Disseminated tuberculomas in spinal cord and brain demonstrated by MRI with gadolinium-DTPA

Summary Intramedullary tuberculoma is rare, and there has been no report of concurrent intramedullary and intracerebral tuberculomas. We report a 30-year-old man with miliary tuberculosis of the lung. He suffered sudden paraplegia due to tuberculomas in the thoracic spinal cord and MRI showed more tuberculomas in the cervical spinal cord, brain stem, and cerebral and cerebellar hemispheres. The tuberculomas were isointense on the T1-weighted images, and hyperintense on the T2-weighted images; there was marked enhancement with intravenous gadolinium-DTPA. All the tuberculomas were very small 1 year after antituberculous chemotherapy.