MRI增强扫描及DWI扫描在肝脏良恶性肿瘤鉴别诊断中的应用

目的探讨腹部磁共振成像(MRI)增强扫描及弥散加权成像(DWI)技术在行手术治疗肝脏肿瘤患者良恶性鉴别诊断中的应用。方法研究纳入2018年1月至2021年6月行手术治疗肝脏结节患者共160例,均行腹部MRI增强扫描及DWI扫描检查,根据肿瘤类型分组,分析各类病灶DWI序列下表观弥散系数(ADC)值,比较腹部MRI增强扫描及DWI扫描单用或联用诊断肝脏良恶性肿瘤符合率。结果在弥散敏感系数(b)值分别设置为50 s/mm³、400 s/mm³及800 s/mm³条件下,肝细胞癌及肝转移癌病灶ADC值均显著低于肝血管瘤、肝囊肿(P<0.05);b值设置为800 s/mm³条件下肝脏良恶性病灶ADC值均显著低于50 s/mm³、400 s/mm³(P<0.05);同时b值设置为400 s/mm³条件下肝脏良恶性病灶ADC值均显著低于50 s/mm³(P<0.05);腹部MRI增强扫描联合DWI扫描用于肝...     

3.0T核磁共振成像LAVA动态增强在乳腺良恶性病变的诊断价值

目的研究3.0T核磁共振成像LAVA动态增强对乳腺恶性肿瘤的鉴别价值,为治疗提供依据。方法选择2013-02—2016-03间收治的36例乳腺良恶性病变患者为观察对象。采用SIMENS 3.0T超导MRI对患者进行平扫及LAVA动态增强扫描,与术后病理穿刺检测结果进行比较。计算动态增强的灵敏度、特异度、准确度。结果乳腺癌患者LAVA动态增强曲线呈早期信号快速上升,中晚期信号强度逐渐降低表现。患者动态增强曲线呈逐渐上升改变。3.0TMRI平扫显示乳腺良恶性病变信号无统计学意义,LAVA显示良恶性肿瘤形态差异明显。良性肿瘤表现为Ⅰ型曲线,诊断的特异度较高(97.3%),恶性肿瘤表现为Ⅲ型曲线,诊断准确度较高(83.2%)。结论 3.0T核磁共振成像LAVA动态增强序列,可以清晰显示乳腺良恶性病变的形态、边缘,具有较高诊断价值。     

磁共振DWI及动态增强对前列腺癌的诊断

目的 探讨磁共振弥散加权成像及动态增强在前列腺癌诊断中的价值.方法 分别对24例前列腺癌（PCa）患者、30例前列腺增生（BPH）患者行前列腺DWI及动态增强扫描,15名健康志愿者进行前列腺DWI扫描.分析3组DWI图、ADC图的信号表现,测量ADC值,比较PCa组及BPH组动态增强曲线.所有PCa病例、BPH病例均经手术或穿刺活检病理证实.结果 DWI上PCa表现为高信号影,BPH呈混杂信号,志愿者外周带呈稍高信号.PCa癌灶平均ADC值0.98×10-3mm2/s,增生结节平均ADC值1.46×10-3mm2/s,志愿者前列腺外周带平均ADC值1.85×10-3mm2/s,三者之间的差异互有统计学意义（P＜0.05）.动态增强PCa主要表现为早期强化,BPH主要表现为逐渐强化,PCa与BPH的时间-信号强度曲线类型差异有统计学意义（P＜0.05）.结论 在DWI图像上,PCa癌灶信号较高.PCa癌灶的ADC值低于正常前列腺外周带及前列腺增生.动态增强时PCa癌灶以早期强化为主.这二者均可作为前列腺癌的诊断依据.     

乳腺动态增强核磁共振检查的临床应用价值

目的　研究乳腺动态增强MRI在临床的应用价值。方法　5 6例患者接受了乳腺动态增强MRI检查。其中37例、4 5个实性病灶经病理证实。结合手术、病理回顾性分析乳腺MRI的临床价值。结果　除1例为双乳多发囊性肿块外,其余4 5个实性肿块中,良性17个,恶性2 8个。MRI显示了所有肿块,包括2例多发乳腺癌隐性癌灶、1例乳腺癌保乳术后残留、2例导管内癌,其中肿块最小直径为4mm。MRI对病灶的显示率为10 0 % ,诊断的敏感度、特异度和准确率分别是92 %、92 %、90 %。结论　乳腺动态增强MRI,对发现肿瘤病灶具有非常高的敏感性,并且能较为准确的进行定性诊断。     

MRI动态增强及重建在乳腺病变诊断中的应用

目的分析50例乳腺病变MRI表现,说明MR在乳腺病变诊断中的补充作用.材料与方法对50例乳腺病变的MR表现进行回顾性研究,并与术后病理结果相比较.结果50例乳腺病变中,恶性病变18例:分别为浸润性导管癌14例(左乳10例,右乳4例),左乳浸润性导管癌术后复发1例,右乳浸润性小叶癌1例,左乳导管内癌1例,右乳粘液癌1例.良性病变22例:分别为乳腺病伴(或不伴)纤维腺瘤10例,纤维(囊性)乳腺病9例.左乳导管内乳头状瘤1例,左乳分叶状肿瘤1例,双乳错构瘤1例.乳腺感染性病变4例.脂肪坏死2例.乳腺外伤后改变1例.双乳假体术后3例.结论MR作为乳腺病变检查的一种重要补充方法,对病变多方位的显示,具有无射线损伤,广阔的视野,良好的软组织对比度等优势,结合动态增强曲线及重建,在病变诊断及临床治疗中有重要价值.     

声辐射力脉冲弹性成像鉴别诊断乳腺良恶性病变的研究进展

弹性成像依据病变组织硬度差异鉴别其良恶性,填补了常规超声的缺陷。声辐射力脉冲弹性成像(ARFI)能够无创、定性、定量获取组织弹性信息,具有一定的临床应用价值。本文对ARFI鉴别诊断乳腺良恶性病变的研究进展进行综述。     

数字化乳腺摄影联合超声与MRI对乳腺良、恶性疾病诊断的对照观察

目的评价数字化乳腺摄影联合超声与MRI在乳腺良恶性疾病诊断中的意义及临床应用价值。方法对105例乳腺疾病患者的数字化乳腺摄影联合超声诊断结果与MRI诊断结果进行回顾性分析。结果 105例患者共110个病灶,其中恶性62个,良性48个。所有病灶均被病理证实。数字化乳腺摄影联合超声对乳腺恶性病变的诊断敏感度、特异度分别为90.32%（56/62）、91.67%（44/48）;MRI对乳腺恶性病变的诊断敏感度、特异度分别为91.94%（57/62）、87.50%（42/48）。结论数字化乳腺摄影联合超声检查诊断准确性高,适用于乳腺疾病的常规检查;MRI空间分辨力及组织分辨力高,适用于前二者检查难以定性的病变及乳腺癌的术前评估。     

动态增强MRI定性诊断乳腺导管上皮非典型增生

目的 观察动态增强MRI（DCE-MRI）定性诊断乳腺导管上皮非典型增生（ADH）的价值。方法 回顾性分析经穿刺活检或局部切除组织活检诊断的64例乳腺单发ADH患者,以手术病理结果为金标准,比较恶性与良性病变患者临床资料及乳腺X线、DCE-MRI征象,分析DCE-MRI预测乳腺恶性ADH的效能。结果 64例乳腺单发ADH中,28例为恶性（恶性组）,36例非恶性（非恶性组）,组间活检方式、病灶最大径、MRI示乳腺实质背景强化（BPE）、乳腺X线表现差异均有统计学意义（P均<0.1）;将上述因素纳入Logistic多因素回归分析,结果显示仅BPE为乳腺恶性ADH的独立影响因素[OR=7.550,95%CI（1.575,36.197）,P=0.011]。DCE-MRI诊断BI-RADS 4A及以下者27例,其中3例为恶性;4A类以上（4B及4C）37例,25例为恶性,诊断敏感度89.29%（25/28）,特异度66.67%（24/36）,阳性预测值67.57%（25/37）,阴性预测值88.89%（24/27）。结论 DCE-MRI可用于定性诊断乳腺ADH;其所示中重度BPE为术后病理恶性的正相关因素。     

高弥散敏感因子(b)值DWI 及ADC 值对前列腺癌与前列腺炎鉴别诊断的应用对比分析

目的:探讨高弥散敏感因子(b)值扩散加权成像(DWI)及表面扩散系数(ADC)在前列腺癌和前列腺炎鉴别诊断的应用价值。方法:回顾性分析2018年4月—2019年9月经手术、活检病理或随访证实最终诊断的前列腺癌21例(25个病灶)和前列腺炎20例(28个病灶)。所有患者于手术或穿刺前行MRI扩散加权成像,b值选择1000、2000、3000 s/mm^2,观察不同b值的DWI及ADC值对前列腺癌和前列腺炎的定性诊断准确率。比较不同b值的DWI及ADC值在前列腺癌和前列腺炎病变诊断中有无统计学意义,分别计算出不同的b值DWI诊断前列腺癌和前列腺炎的诊断效能。结果:b值选择为1000、2000、3000 s/mm^2 DWI在前列腺癌和前列腺炎病变鉴别诊断中均有统计学意义(P<0.05),b值选择1000、2000、3000 s/mm^2在DWI诊断前列腺癌和前列腺炎的特异性、准确度分别为71.4%、84.9%,92.9%、92.5%,100.0%、96.2%,b值选择2000、3000 s/mm^2 DWI诊断前列腺癌和前列腺炎的特异性、准确度高于b值选择1000 s/mm^2 DWI。b值选择为1000、2000、3000 s/mm^2时,前列腺癌的ADC值均低于前列腺炎,并且b值选择为1000、2000、3000 s/mm^2所测得的ADC值前列腺癌和前列腺炎组间差异有统计学意义(P<0.05)。结论:采用高b值DWI及ADC值可以准确区分前列腺癌和前列腺炎,具有良好的定性诊断价值。     

3.0 T MR弥散加权成像对鉴别胰腺癌与慢性肿块型胰腺炎的价值

目的探讨在3．0T磁共振（MR）平台上应用弥散加权成像（diffusion—weighted imaging，DWI）鉴别诊断胰腺癌与慢性肿块型胰腺炎的价值。方法纳入经手术病理和临床随访证实的胰腺癌患者13例、慢性肿块型胰腺炎患者7例和健康志愿者14例，在行上腹部常规MR扫描后进行胰腺DWI检查。采用自旋回波回波平面成像技术和空间敏感性编码技术，分别取弥散梯度b值=400、600、800和1000s／mm^2获得相应的DWI图像，测量感兴趣区（ROI）的ADC值，并进行统计学分析。结果①健康志愿者胰腺DWI呈中等信号。②胰腺癌患者癌组织在DWI上呈均匀高信号，边界较清楚；各b值（400、600、800和1000s／mm^2）下，测得ADC值分别为（1．63&#177;0．235）、（1．42&#177;0．126）、（1．36&#177;0．170）及（1．26&#177;0．178）&#215;10^-3mm^2／s，明显低于癌周胰腺组织[（2．11&#177;0．444）、（1．83&#177;0．230）、（1．81&#177;0．426）及（1．60&#177;0．230）&#215;10^-3mm^2／s]及健康志愿者胰腺的ADC值[（1．85&#177;0．350）、（1．69&#177;0．290）、（1．67&#177;0．268）及（1．42&#177;0．221）&#215;10^-3mm^2／s]，P〈0．05。③慢性肿块型胰腺炎在DWI上呈不均匀稍高信号，边界不清；各b值下测得ADC值分别为（1．69&#177;0．150）、（1．56&#177;0．119）、（1．59&#177;0．172）及（1．35&#177;0．080）&#215;10^-3mm^2／s，均高于胰腺癌组织的ADC值，但仅当b值-800s／mm^2时，与胰腺癌组织间差异有统计学意义（P〈0．05）。结论DWI可以清楚显示胰腺肿瘤病灶及范围，结合ADC的测量值能够为鉴别胰腺癌与慢性肿块型胰腺炎提供一定的信息。     

核磁共振测量乳房和肿瘤体积的应用前景

目的探讨磁共振扫描测量乳房和肿瘤体积的准确性,评估其在保乳手术中的应用价值。方法选择2010年3～12月术前空芯针穿刺活检证实为乳腺癌50例,行磁共振扫描检查,使用Argus软件测量乳房和肿瘤体积,行改良根治术后由病理科测量切除的乳房和肿瘤标本体积,将两者进行统计学分析。结果本组50例乳房体积磁共振扫描测得208～1027 ml,（516.5±184.8）ml,病理测得180～980 ml,（517.2±188.9）ml;肿瘤体积核磁共振扫描测得0.4～47.6 ml,（8.1±8.8）ml,病理测得0.3～43.6 ml,（7.9±8.3）ml。统计结果显示两种检测方法显著相关,乳房和肿瘤体积相关系数分别为0.94及0.90。结论磁共振扫描可以准确测量乳房和肿瘤体积并计算出两者体积比例,此方法可以应用于乳腺癌保乳手术的术前评估。     

超声造影对乳腺良恶性肿块鉴别诊断的价值

目的 探讨超声造影在乳腺良、恶性肿块鉴别诊断中的应用价值.方法 采用普通超声及SonoVue(声诺维,注射用六氟化硫微泡)超声造影分别对65例(70个肿块)乳腺肿块进行检查,通过增强程度、增强模式、增强时病灶边界是否清晰、消退模式等指标来判定包块的良、恶性,并与术后病理结果进行比较.结果 病理学诊断系良性病变37例,恶性病变28例,超声造影检查的敏感性、准确性、阳性预测值及阴性预测值均明显高于普通超声检查(P<0.05),而在特异性及误诊率的差异无统计学意义(P>0.05).超声造影显示70个病灶均有不同程度增强,其中78.6%(22/28)恶性肿瘤表现为明显增强,75.0%(21/28)为结节状不均匀增强85.7%(24/28)病灶边界不清楚、不规则,周边呈放射状增强;而良性肿块增强较弱,均匀增强,病灶边界较清晰,成团状,仅有18.9%(7/37)病灶边界不清楚,与恶性肿块比较差异有统计学意义(P=0.000).消退期,良、恶性病灶均呈现均匀或不均匀消退,两者差异无统计学意义(P=0.791).结论 与普通超声相比,超声造影对鉴别诊断乳腺良、恶性肿块的价值更高.     

薄层增强MRI多期扫描技术诊断功能性胰岛细胞瘤(附3例报告)

目的探讨薄层增强MRI多期扫描技术即探讨梯度回波MRI三维容积插入法屏气检查（volumetric interpolated breath-hold examination,3D-VIBE）序列对功能性胰岛细胞瘤的诊断价值。方法对3例临床以及实验室检查怀疑为功能性胰岛细胞瘤的患者，按以下顺序分别进行MRI常规轴位的T2W和T1W平扫、冠状位的真实稳态旋进快速成像（true fast imaging with steady state procession, True-FISP）、磁共振胆胰管成像（magnetic resonance cholangiopancreatography, MRCP）、轴位钆剂增强的3D-VIBE三期动态扫描和2DGRE T1W增强扫描。3D-VIBE三期扫描数据采集分别于注射对比剂后15、40及65s进行。将影像资料与手术和病理发现作对比分析。结果3D-VIBE序列的动脉早期、动脉晚期和门静脉期图像能准确显示功能性胰岛细胞瘤的微小病灶，并能反映病灶的血供特征，而其它常规MRI序列可能漏诊该病灶。结论薄层动态增强的MRI序列在功能性胰岛细胞瘤的显示和定性诊断中具有重要作用。     

三阴性乳腺癌的MRI研究进展

目的三阴性乳腺癌(TNBC)具有特殊的生物学行为及临床病理学特征,临床缺乏有效治疗方法,预后较差。目前MRI是诊断乳腺癌的最准确的影像学方法。MRI有助于诊断TNBC、制订治疗方案与预后评估,并能加深对其生物学行为的理解。TNBC的MRI特征包括较大的单发病灶,边缘光滑,T2WI呈高信号,增强后环形强化;而动态对比增强MRI(DCE-MRI)、DWI及MRS对于TNBC的临床应用价值有待更深入研究。     

MRI在血管球瘤诊断中的应用

目的 探讨MRI作为诊断血管球瘤的常规辅助检查的必要性.方法 2013年11月至2014年7月收治7例手部血管球瘤患者,均有典型临床症状,术前行X线片检查和(或)MRI检查,手术切除肿瘤且术后病理均确诊为血管球瘤.对病例术前检查进行分析,并检索PubMed数据库进行文献回顾性研究.结果 7例患者中,2例术前只行X线片检查,未发现病灶;3例行X线片和MRI检查,X线片均未显示明显异常,而MRI于T1、T2加权像上提示血管球瘤特征,注入钆对比剂后,病灶明显强化;2例只行MRI检查,显示血管球瘤MRI影像特征.结论 对于有典型临床症状的血管球瘤患者,MRI是一项非常有意义的辅助检查,且应作为常规检查以提高血管球瘤的诊断率.     

MRI Screening in a Clinic Population with a Family History of Breast Cancer

Background Breast MRI is increasingly being used in patients at increased risk for breast cancer; however, guidelines for MRI screening are inadequately defined. We describe our experience with MRI screening in a large population of women with a family history of breast cancer. Methods We retrospectively reviewed the Memorial Sloan–Kettering breast cancer surveillance program prospective database from April 1999 to July 2006. Patients with a family history of breast cancer and at least 1 year follow-up were identified. All patients were offered biannual clinical breast examination (CBE) and annual mammography (MMG). MRI screening was performed at the discretion of the physician and patient. Results Family history profiles revealed 1,019 eligible patients; median follow-up was 5.0 years. MRI screening was performed in 374 (37%) patients resulting in a total of 976 MRIs during the study period. Cancer was detected in 9/374 patients (2%) undergoing MRI screening. Seven cancers were detected by MRI only, for a cancer detection rate of 0.7% (7/976) for screening MRI. When stratified by family risk profile, the positive predictive value (PPV) of MRI was higher (13%) in those patients with the strongest family histories and lower (6%) in patients with less significant family histories. Conclusions MRI screening can be a useful adjunct to CBE and MMG in patients with high-risk family histories of breast cancer, yet it has low yield in patients with lower-risk family histories. These data suggest that MRI screening should be reserved for those at highest risk. Patrick I. Borgen is currently affiliated with Maimonides Cancer Center, Brooklyn, NY, USA.     

进展期胃癌MRI影像分析

目的总结分析进展期胃癌MRI影像特点,以进一步提高其影像诊断水平。方法回顾性分析8例志愿者和30例经手术切除病理检查证实的进展期胃癌患者的MRI平扫及动态增强扫描图像。结果进展期胃癌胃壁呈不均匀增厚,T1WI呈等或稍低信号,T2WI多呈等或稍高信号,累及浆膜者浆膜面模糊、毛糙,部分于T1WI反相位可见病灶处胃壁与胃周脂肪间低信号带中断,侵及邻近器官者胃周脂肪间隙模糊、消失;动态增强扫描病灶呈明显强化,表现为不规则强化和分层强化两种类型。结论当胃壁不均匀增厚并信号异常,胃周脂肪间隙模糊、消失,增强扫描出现不规则强化或分层强化时对进展期胃癌临床诊断具有较大的参考价值。     

Differential Diagnosis of Primary Benign and Malignant Retroperitoneal Tumors

Background:
Clinical differential diagnosis between malignant and benign tumors is important in order to select a therapeutic strategy for a primary retroperitoneal tumor.
Methods:
The clinical findings and radiological features of 25 patients with primary retroperitoneal tumors were retrospectively evaluated to find those signs that might contribute to the preoperative distinction between benign and malignant tumors.
Results:
Of 25 primary retroperitoneal tumors, 15 were benign. This may reflect the increased number of incidentally found small benign tumors. There were significant associations between the presence of symptoms and malignancy (P< 0.05), between irregular margins on imaging and malignancy (P< 0.05) and between the absence of calcification and malignancy (P< 0.05). Malignant tumors were significantly larger than benign tumors (11.45 ± 1.90 cm vs. 5.31 ± 0.43 cm). A retroperitoneal tumor scoring system was developed to distinguish primary retroperitoneal benign tumors from their malignant counterparts based on the: 1) maximum diameter equal to or larger than 5.5 cm, 2) presence of symptoms, 3) absence of calcification, 4) presence of irregular margins, and 5) presence of cystic degeneration or necrosis. A significant correlation was found between the incidence of malignant tumors and the total retroperitoneal tumor score (P < 0.05).
Conclusion:
This study suggests that the size of tumor, the presence of symptoms, irregular margins, and the absence of calcification may be valuable predictors of primary retroperitoneal malignant tumor.     

Results of MRI Screening for Breast Cancer in High-Risk Patients with LCIS and Atypical Hyperplasia

Background Magnetic resonance imaging (MRI) can detect breast cancer in high-risk patients, but is associated with a significant false-positive rate resulting in unnecessary breast biopsies. More data are needed to define the role of MRI screening for specific high-risk groups. We describe our experience with MRI screening in patients with atypical hyperplasia (AH) and lobular carcinoma in situ (LCIS). Methods We retrospectively reviewed data from our high-risk screening program prospective database for the period from April 1999 (when screening MRI was first performed at our institution) to July 2005. Patients with AH or LCIS demonstrated on previous surgical biopsy were identified. All patients underwent yearly mammography and twice yearly clinical breast examination. Additional screening MRI was performed at the discretion of the physician and patient. Results We identified 378 patients; 126 had AH and 252 had LCIS. Of these, 182 (48%) underwent one or more screening MRIs (mean, 2.6 MRIs; range, 1–8) during this period, whereas 196 (52%) did not. Those who had MRIs were younger (P < 0.001) with stronger family histories of breast cancer (P = 0.02). In MRI-screened patients, 55 biopsies were recommended in 46/182 (25%) patients, with 46/55 (84%) biopsies based on MRI findings alone. Cancer was detected in 6/46 (13%) MRI-generated biopsies. None of the six cancers detected on MRI were seen on recent mammogram. All six cancers were detected in five patients (one with bilateral breast cancer) with LCIS; none were detected by MRI in the AH group. Thus, cancer was detected in 5/135 (4%) of patients with LCIS undergoing MRI. The yield of MRI screening overall was cancer detection in 6/46 (13%) biopsies, 5/182 (3%) MRI-screened patients and 5/478 (1%) total MRIs done. In two additional MRI-screened patients, cancer was detected by a palpable mass in one, and on prophylactic surgery in the other and missed by all recent imaging studies. For 196 non-MRI-screened patients, 21 (11%) underwent 22 biopsies during the same period. Eight of 22 (36%) biopsies yielded cancer in seven patients. All MRI-detected cancers were stage 0–I, whereas all non-MRI cancers were stage I–II. Conclusion Patients with AH and LCIS selected to undergo MRI screening were younger with stronger family histories of breast cancer. MRI screening generated more biopsies for a large proportion of patients, and facilitated detection of cancer in only a small highly selected group of patients with LCIS.