颈静脉孔区肿瘤的MRI和MRA诊断（附五例报告）

目的：分析颈静脉孔区肿瘤的影像学特点，探讨ＭＲＡ对其诊断与鉴别诊断的价值。材料与方法：对５例经手术病理证实的颈静脉孔区肿瘤（颈静脉球瘤２例、神经鞘瘤２例、脑膜瘤１例）病人行ＭＲＩ和ＴＯＦ法ＭＲＡ检查，应用１．０Ｔ超导ＭＲ系统，在常规ＭＲＩ基础上采用２Ｄ或３ＤＦＩＳＰ序列和ＭＩＰ图像后处理技术获取ＭＲＡ图像。４例有ＣＴ，３例有ＤＳＡ资料。结果：ＭＲＩ显示了全部病灶和颈静脉孔的扩大与破坏，准确定性诊断了４例，结合ＭＲＡ后，５例均正确定性诊断。颈静脉球瘤的ＭＲＩ瘤内流空征和ＭＲＡ血管团块征颇具特征性。神经鞘瘤与脑膜瘤的ＭＲＩ信号有别，且前者易囊变，两者ＭＲＡ均未显示肿瘤血管。结论：ＭＲＩ，尤其结合ＭＲＡ对颈静脉孔区肿瘤诊断与鉴别诊断颇有价值。     

原发性椎管内肿瘤的MRI诊断价值

目的：评价ＭＲＩ对原发性椎管内肿瘤的诊断价值。材料和方法：对６３例原发性椎管内肿瘤进行ＭＲＩ扫描，并与手术病理和临床随访结果对照分析。结果：检出神经纤维瘤及神经鞘瘤２７例，脊膜瘤１１例，髓内胶质瘤１４例，蛛网膜囊肿６例，皮样囊肿２例，淋巴瘤２例，脂肪瘤１例。与ＣＴ和脊髓造影等检查相比，ＭＲＩ对本病的检出率和诊断正确率明显提高。结论：ＭＲＩ是发现原发性椎管内肿瘤的首选方法，对本病的诊断与鉴别诊断具有重要价值。     

气管原发良性肿瘤：CT／MRI评价

气管原发良性肿瘤极为罕见。本文报道５例经手术及病理证实的气管原发良性肿瘤（平滑肌瘤２例，乳头瘤、息肉和软骨瘤各１例），其中３例行ＣＴ扫描，２例行ＭＲＩ检查。ＣＴ／ＭＲＩ均显示肿瘤起自气管壁，向腔内突出的肿块边界清楚。４例肿瘤阻塞气管腔超过７５％以上。２例肿瘤与气管壁有广基底相连，３例基底较窄，其中１例肿瘤穿过气管壁向腔外生长。本文描述了气管原发良性肿瘤的ＣＴ／ＭＲＩ特点，讨论了气管原发良、恶性肿瘤的鉴别诊断要点。我们认为，ＣＴ／ＭＲＩ在气管肿瘤的评价中具有重要作用。     

颅内多发原发性肿瘤的CT与MRI诊断

目的：报道１５例颅内多发原发性肿瘤的ＣＴ和ＭＲＩ表现，并评价ＣＴ与ＭＲＩ的诊断价值。方法：１５例颅内多发原发性肿瘤均行ＣＴ检查，其中４例行ＭＲＩ检查，均经手术病理证实。结果：多发胶质瘤４例，其中恶性室宫膜瘤３例，表现为脑室内及额顶叶脑实质内实质性肿块或囊性病变，多发星形细胞瘤１例，病变分别位于额叶及小脑蚓部；双侧听神经瘤及多发脑膜瘤各３例、ＣＴ和ＭＲＩ表现均较典型；脑膜瘤合并胶质瘤３例、脑膜瘤合并听神经瘤１例和垂体瘤合并胶质瘤１例。结论：结合肿瘤的ＣＴ和ＭＲＩ表现特点，可对大多数颅内多发原发性肿瘤作出正确诊断，ＭＲＩ对脑膜瘤的诊断优于ＣＴ。     

鞍隔胺膜瘤的CT,MRI诊断（附18例报告）

提高对鞍隔脑膜瘤的影像学诊断水平及其临床意义。方法鞍隔脑膜瘤１８例，１７例经ＣＴ检查，其中６例同时行ＭＲＩ检查，１例单纯行ＭＲＩ检查。全部经手术病理证实。将影像检查结果与手术病理进行对照分析。结果１８例例肿瘤位于鞍上及鞍内，１７例ＣＴ平扫表现为均匀等密度或稍高密度１５例、不均匀高密度２例，明显均匀增强１４例、环形增强３例；ＭＲＩ（７例）Ｔ１ＷＩ为均匀等信号６例，略低信号１例；Ｔ２ＷＩ略高信号６例，     

颅底骨源性肿瘤的MRI影像诊断

目的：分析颅底骨源性肿瘤的ＭＲＩ表现并与ＣＴ和病因对照，研究ＭＲ在诊断中的价值与限度。材料与方法：搜集了经手术病理证实的颅底骨源性肿瘤２２例（软骨肉瘤３例，软骨瘤２例，转移瘤２例，脊索瘤１０例，骨巨细胞瘤２例，恶性纤维组织瘤１例，骨化性纤维瘤２例），全部行ＭＲ检查（１１例行增强检查），８例行ＣＴ检查。结果：绝大部分肿瘤均有一清晰的边缘，Ｔ１Ｗ上呈低或等信号，Ｔ２Ｗ上呈不均匀高信号，Ｔ１Ｗ上呈低信号     

较大肾上腺嗜铬细胞瘤的MRI及DSA诊断(附6例分析)

目的：评估较大肾上腺嗜铬细胞瘤的ＭＲＩ及ＤＳＡ的诊断价值。材料与方法：６例经手术病理证实的较大肾上腺嗜铬细胞瘤,均行ＭＲ平扫及腹主动脉、肾上腺动脉造影检查。结果：６例ＭＲ表现均为长Ｔ１长Ｔ２信号,２例见囊变和坏死信号。５例主要波及肝右叶和肾上极,１例主要波及胰头并包绕下腔静脉。６例中,４例颖诊嗜铬细胞瘤,２例诊断为巨块型肝癌。ＤＳＡ显示瘤体由肾上腺动脉供血,肿瘤血管丰富,染色浓密,诊断为嗜铬细胞瘤     

原发性输尿管癌的诊断:传统尿路造影术与CT、MRI比较(附15例分析)

目的：评价传统尿路造影、ＣＴ与ＭＲＩ在原发性输尿管癌诊断中的价值。材料和方法：本１５年（１６个部位）经手术和病理证实的病例中，１３例（１４次）行静脉肾孟造影（ＩＰＶ），６例（７例）逆行肾盂造影；１例肾穿刺造影；６例ＣＴ检查，其中４例加增强扫描；２例ＭＲＩ检查，先以自旋回波（ＳＥ）序列做轴有冠状面Ｔ１和Ｔ２加仅扫描，再做冠状面磁共振尿路选影（ＭＲＵ）．结果：传统尿路造影共８例９次（６４％）获得术前     

膀胱癌的MRI诊断及分期

目的；探讨ＭＲＩ在膀胱癌的术前诊断及分期的应用价值。材料与方法：搜集２０例采用０．５Ｔ磁共振扫描检查，经手术病理证实的膀胱癌，分析其ＭＲＩ表现。结果：根据肿瘤的ＭＲＩ表现将其分为腔内型，浸润型和腔外型。术前ＭＲＩ诊断与ＴＮＭ分期符合率为８０％（１６／２０），ＭＲＩ较病理分期偏高。结论：Ｔ１加权像主要用于肿瘤的定性诊断，Ｔ２加权像主要用于肿瘤的术前分期：ＭＲＩ与病理分期有较高的符合性。     

自杀基因治疗鼠C6脑胶质瘤模型的动态MRI研究

目的：用高分辨ＭＲＩ动态观察携带ＨＳＶＴＫ自杀基因的逆转录病毒载体及ＧＣＶ治疗系统对在体大鼠Ｃ６脑胶质瘤模型的治疗效果及ＭＲＩ表现的演变规律。材料与方法：３６只ＳＤ大鼠，使用颅内立体定向接种法制作模型。按接种细胞类型分４组：①Ｃ６胶质瘤；②Ｃ６ｔｋ；③Ｃ６＋Ｃ６ｔｋ（１∶１）；④Ｃ６＋ＰＡ３１７ｔｋ。瘤龄７天后腹腔注射ＧＣＶ３０ｍｇ／ｋｇ／天，共１４天。用１．５ＴＭＲ机行Ｔ１ＷＩ、Ｔ２ＷＩ和增强扫描，１次／１～２周；并行常规病理、免疫组化（ＧＦＡＰ和Ｓ１００蛋白）、凋亡和电镜检查。结果：ＭＲＩ显示①组瘤龄１４天时病灶呈圆形长Ｔ１长Ｔ２信号，明显强化，中心见坏死区，肿瘤平均１９６ｍｍ３，中位存活期１６天。②～④组，自然存活期大于１８０天，１４天时病灶平均体积３５ｍｍ３；２８天时肿瘤消失率８０％，１８０天肿瘤消失率９３％。结论：１．５ＴＭＲ扫描可清楚显示肿瘤的大小、形态和内部结构，与病理结果高度相关；ＭＲＩ动态观察可证实ＨＳＶＴＫ／ＧＣＶ系统治疗在体颅内胶质瘤有效     

原发性心脏心包肿瘤的MRI诊断

目的；评价MRI在原发性心脏心包肿瘤诊断中的价值。资料与方法：回顾分析14例经手术病理或临床证实的原发性心脏心包肿瘤的MRI表现，并与ICG检查结果比较。结果：除1例右心房粘液瘤漏诊，1例定位错误外，其余定位和良恶性定性均正确，10例术前组织学定性正确，与MRI比较，UCG另有3例定位定性错误，结论：MRI对心腔内肿瘤不仅定位准确，还多可定性；对肌壁肿瘤的良，恶性区别也有重要价值。对心包肿瘤多因其好发部位与特殊信号诊断不难，MRI是诊断和评价原发性心脏心包肿瘤重要的影像检查方法。     

原发性心脏肿瘤（非粘液瘤）的影像学诊断

目的：研究与比较原发性心脏肿瘤的各种影像学特征性表现及其诊断价值。材料和方法：1957年至1994年间经手术病理证实原发性心脏肿瘤17例。良性11例(海绵状血管瘤2例、错构瘤2例、纤维瘤4例、纤维间皮瘤2例、脂肪组织浸润1例)．恶性6例(平滑肌肉瘤2例、血管肉瘤4例)。影像学检查有：胸片(正侧位）及UCG各17例：CT2例；MRI4例；ACG(电影或DSA)9例；冠状动脉造影3例。结果：X线平片检查无特征性表现，UCG征象为云絮状或团块状回声(敏感性100%)。MRI图像能显示肿块轮廓．大小、与心腔壁的关系及有无心包积液等．优于一般CT，ACG（DSA或Cine)能在动态下观察肿瘤对血液动力学的影响及与周围组织(如瓣膜、大血管等）的关系．结论：UCG及MRI对心脏肿瘤诊断敏感性高，且能同时显示心包及心肌的改变，能确诊．应作为首选和必需的检查方法。ACG在准备手术的病例中应用。不同性质肿瘤之间鉴别困难。     

Characterization of adrenal masses using MR imaging with histopathologic correlation.

OBJECTIVE: The purpose of this study was to evaluate the sensitivity, specificity, and accuracy of MR imaging in the characterization of adrenal masses by correlating imaging findings with histopathologic results. In addition, adrenal tumors that were of an indeterminate nature on MR imaging were analyzed. SUBJECTS AND METHODS: For 114 patients with 134 adrenal masses, MR findings were compared with histologic results. In all patients, MR imaging was performed using T2-weighted fast spin-echo imaging and unenhanced and gadolinium-enhanced T1-weighted spin-echo imaging. Chemical-shift imaging was performed in 92 patients and dynamic gadolinium-enhanced studies in 108 patients. Chemical-shift images were analyzed quantitatively and qualitatively, and dynamic gadolinium-enhanced studies were qualitatively assessed. RESULTS: The sensitivity of MR imaging in differentiating between benign and malignant adrenal masses was 91%, the specificity was 94%, and the accuracy was 93%. The diagnosis at MR imaging differed from that at histology in 12 (9%) of 134 patients. Results of quantitative analyses of chemical-shift imaging techniques showed significant differences between adenomas and nonadenomas (-36.0% versus -3.7%; p < .001). Qualitative analysis provided a similar diagnostic confidence compared with quantitative analysis. Both chemical-shift and dynamic gadolinium-enhanced studies proved to be unreliable in characterizing borderline tumors (epithelial tumors with high malignant potential). Moreover, such imaging failed to allow correct diagnosis of adenomas in two patients. CONCLUSION: The characterization of an adrenal mass can be made with high sensitivity and specificity using MR imaging. The increased reliance on MR imaging seems to be based mainly on findings from chemical-shift and dynamic gadolinium-enhanced studies. The need to perform histologic sampling of incidentally discovered adrenal masses may be reduced to some problematic lesions, which will remain during the era of MR imaging.     

Distinction between high-grade gliomas and solitary metastases using peritumoral 3-T magnetic resonance spectroscopy,diffusion, and perfusion imagings

This study compared the effectiveness of relative cerebral blood volume, apparent diffusion coefficient, and spectroscopic imaging in differentiating between primary high-grade gliomas and solitary metastases. A 3.0-T MR unit was used to perform proton MR spectroscopy, diffusion imaging, and conventional MR imaging on 26 patients who had solitary brain tumors (14 high-grade gliomas and 12 metastases). All diagnoses were confirmed by biopsy. Twelve perfusion MR studies (8 high-grade gliomas and 4 metastases) were also performed. The results showed that the choline to creatine ratio and relative cerebral blood volume in the peritumoral regions of high-grade gliomas were significantly higher than they were in the metastases. The apparent diffusion coefficient values in tumoral and peritumoral regions of metastases were significantly higher than they were in the primary gliomas. Although conventional MR imaging characteristics of solitary metastases and primary high-grade gliomas may sometimes be similar, the peritumoral perfusion-weighted and spectroscopic MR imaging enable distinction between the two. Diffusion-weighted imaging techniques were complementary techniques to make a differential diagnosis between the two malignant tumors.     

Reliability of MR imaging-based virtual cystoscopy in the diagnosis of cancer of the urinary bladder

OBJECTIVE: Our purpose was to evaluate MR imaging-based virtual endoscopy in patients with urinary bladder cancer compared with conventional cystoscopy as the gold standard. SUBJECTS AND METHODS: Twenty-five patients with urinary bladder cancer diagnosed on conventional cystoscopy underwent MR imaging of the pelvis. Patients were examined without external bladder filling or administration of IV contrast medium. No medications were administered. The data obtained by MR imaging were reconstructed for virtual endoscopy on a workstation. The locations and sizes of tumors were individually determined and compared with results of conventional cystoscopy. RESULTS: Twenty-four patients were evaluated; one patient's examination was excluded from analysis because of metallic artifacts. Seventeen patients were diagnosed with a single bladder tumor. Five patients had two tumors each, and two patients had three tumors. Tumor diameter ranged from 0.4 to 6.4 cm. Thirty (90.9%) of 33 tumors detected on cystoscopy were visualized with virtual endoscopy. The detection rate for 23 tumors of 1 cm or greater was 100%. Difficult conditions for conventional cystoscopy, including hematuria, anterior wall involvement, and urethral strictures, had no deleterious impact on virtual cystoscopy. Difficulties in detection on virtual endoscopy were associated with flat bladder tumors with minimal surface elevation. CONCLUSION: The results of this study suggest a high reliability in the diagnosis of urinary bladder cancer by MR imaging-based virtual cystoscopy-a noninvasive method, independent of medication or contrast enhancement, that may be of value for screening, primary diagnosis, and surveillance. Virtual MR cystoscopy may be indicated when conventional cystoscopy cannot be performed or is ineffective.     

MRI findings of choroid plexus tumors in the cerebellum

Choroid plexus tumors (CPTs) are uncommon primary intracranial tumors. Here, we describe two patients with CPTs of the cerebellum: one had a choroid plexus papilloma located in the left cerebellar hemisphere that presented as an irregular, lobulated and solid-cystic mass, whereas the other had a choroid plexus carcinoma that exhibited a poorly defined, mixed-intensity mass associated with invasion of adjacent brain parenchyma. Contrast-enhanced MR imaging showed prominent heterogeneous enhancement. CPTs should be considered in the differential diagnosis for irregular, heterogeneous and intensely enhancing masses that occur in the cerebellum.     

MR黑血和白血技术诊断肥厚型心肌病的价值

目的：研究MR黑血和白血技术在诊断肥厚型心肌病中的价值。方法：采用心脏MR黑血和白血技术及多平面成像方式，对15例临床拟诊为肥厚型心肌病的患者进行检查。结果：MR黑白技术提供病变部位、厚度、信号、心腔形态、大小等信号。白血技术能反映心肌的运动，流出道有无狭窄及程度，二尖瓣有无返流等情况。多平面成像更全面了解病变的部位和范围，避免漏诊。MR的基本特征有室壁肥厚、心肌信号不均匀、左心室流出道狭窄、心肌运动不均匀、二尖瓣少量返流和心包积液等。结论：MR黑白和白血技术对肥厚型心肌病的诊断能提供更为准确、全面的影像学信息。     

Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography

PURPOSE: To prospectively assess accuracy of magnetic resonance (MR) imaging, MR cholangiopancreatography (MRCP), and MR angiography in patients suspected of having pancreatic tumors. MATERIALS AND METHODS: Sixty-six patients suspected of having pancreatic tumors underwent MR imaging (unenhanced and contrast material-enhanced MR, MRCP, and contrast-enhanced MR angiography). Two blinded readers prospectively analyzed the images by consensus, and results were correlated with surgery, biopsy, or follow-up findings. Results were tabulated in two-by-two tables. RESULTS: MR assessment of pancreatic lesion status (differentiation of benign vs malignant) resulted in 60 correct diagnoses (accuracy, 91%), and six (10%) false diagnoses. Among histologically proved malignant tumors, MR imaging yielded correct diagnoses in 42 of 44 patients (sensitivity, 95%; 95% CI: 85%, 99%), whereas 18 of 22 patients with benign findings were classified correctly. At MR imaging, findings in four patients with chronic pancreatitis were wrongly categorized as malignant tumors (specificity, 82%; 95% CI: 60%, 95%), and in one patient, a distal common bile duct carcinoma was not detected. In no patient with pancreatic adenocarcinoma was this tumor misdiagnosed as benign. In patients with malignant tumors who underwent resection, local-regional tumor growth and vascular infiltration were accurately classified in 89% and 94%, respectively. MR imaging depicted histologically proved synchronous hepatic metastases in 82%. The positive and negative predictive values for cancer nonresectability were 90% and 83%, respectively, and the accuracy, sensitivity, and specificity were 85%, 69%, and 95%, respectively. CONCLUSION: Unenhanced and contrast-enhanced MR imaging with MRCP and MR angiography offers potential as a noninvasive tool for assessment of patients suspected of having pancreatic tumors.     

脑胶质瘤病的MRI及MRS研究

目的 :回顾性分析大脑胶质瘤病磁共振成像 (MRI)及磁共振波谱 (MRS)特点 ,以探讨两者对本病诊断的临床价值。方法 :综合 7例患者的临床表现、影像学特点及病理诊断 ,均符合大脑胶质瘤病诊断标准。常规行SE序列平扫及增强。其中 3例行MRS研究 ,二维多体素、点分辨法 (PRESS)、TE 14 4ms。结果 :所有病例均侵犯 2个脑叶或以上。病变区呈长T2 、稍长T1异常信号 ,受累区脑组织肿胀 ,占位效应轻。 3例增强扫描见小结节或片状强化 ,4例无明显强化。 3例MRS表现均有不同程度NAA降低 ,Cho上升 ,Cho/Cr和Cho/NAA的比值上升。结论 :MRI是目前诊断大脑胶质瘤病的首选影像学方法 ,MRS对于鉴别诊断有较大价值。     

肋骨原发性骨肿瘤的影像表现（附14例报告）

目的 探讨肋骨原发性骨肿瘤的影像学表现,提高对该部位原发骨肿瘤的影像表现的认识.方法 回顾性分析14例经手术病理证实肋骨原发性骨肿瘤患者的影像资料,并结合近年来相关文献进行分析.结果 本组病例10例单发,4例多发,良性8例,恶性6例,良性肿瘤最多为骨软骨瘤（4例）,恶性肿瘤最多为骨髓瘤（3例）.结论 肋骨原发性骨肿瘤病种较多,大部分病灶表现与典型部位的典型表现相符合,能通过X线检查发现病灶并做出影像诊断,部分病灶需要通过CT检查才能得出结论,MR是对病变内部及周围软组织影像征象的补充.