MRI扩散加权成像表观扩散系数评估乳腺癌新辅助化疗疗效的价值

目的： 探讨MRI扩散加权成像表观扩散系数（ADC）的变化在预测乳腺癌新辅助化疗疗效中的价值。 方法： 回顾性分析2017年1月—2018年12月间收治的80例局部晚期乳腺癌患者临床资料。所有患者均行空芯针穿刺证实为乳腺癌并行新辅助化疗,在新辅助化疗第1周期前、手术前常规行乳腺MRI检查,记录新辅助治疗前与手术前肿瘤组织ADC值。分析肿瘤组织ADC值的变化（△ADC）与病理反应（MP分级）的关系,并通过ROC观察△ADC值判断新辅助化疗的效能。 结果： 全组患者中,新辅助化疗后病灶ADC值较化疗前增高（1.27×10-3 mm2/s vs. 0.98×10-3 mm2/s,P=0.000）;按类型分组分析显示,除三阴性乳腺癌ADC值化疗前后无统计学差异外（P>0.05）,其余类型的乳腺癌新辅助化疗后ADC值均较化疗前明显升高（均P<0.05）。组织学显著反应患者△ADC值明显大于组织学非显著反应患者（0.448×10-3 mm2/s vs. 0.209×10-3 mm2/s,P=0.004）。△ADC评价乳腺癌新辅助疗效的ROC曲线下面积为0.72,敏感度73.1%,特异度66.7%,当△ADC的截断值为0.239×10-3 mm2/s时,阳性预测值51.4%,阴性预测值83.7%,准确度68.8%。 结论： 在大多数乳腺癌中,ADC的变化对早期预测和评估新辅助化疗疗效有一定的价值。     

磁共振弥散加权成像信号强度评价透明细胞肾癌组织分化程度的价值

目的分析磁共振弥散加权成像（DWI）目测信号强度、量化信号强度（SI）值与透明细胞肾癌（CCRCC）的组织分化程度的关系,探讨DWI信号强度评价CCRCC的组织分化程度的价值。 方法回顾性收集经病理证实的CCRCC患者91例,并根据Fuhrman病理分级Ⅰ～Ⅳ级标准,分为高分化组（Ⅰ级和Ⅱ级,37例）、中分化组（Ⅲ级,32例）、低分化组（Ⅳ级,22例）,所有患者均行中腹部MR平扫、增强和DWI检查（1.5 T,b=800 sec/mm²),分别目测CCRCC的DWI信号强度、测量SI值,采用Kruskal-Wallis秩和检验比较CCRCC的DWI目测信号强度与组织分化程度差异;采用单因素方差比较CCRCC的SI值与组织分化程度的差异;采用Spearman等级相关检验分析CCRCC的组织分化程度与目测信号强度、SI值的相关性;并采用受试者工作特征ROC曲线评价CCRCC的SI值诊断高分化CCRCC、低分化CCRCC的效能。 结果91例CCRCC的DWI目测信号强度中,43.9%呈明显高信号,30.8%呈中等高信号,25.3%呈等/略高信号。明显高信号组与等/略高信号组的CCRCC的组织分化程度差异有统计学意义（P<0.05）。中等高信号组与等/略高信号组、中等高信号组与明显高信号组的CCRCC组织分化程度差异均无统计学意义（P>0.05）。CCRCC的DWI目测信号强度与组织分化程度呈中等的负相关（r_s=-0.552,P<0.05）。高分化CCRCC的SI值明显低于中、低分化CCRCC,中分化CCRCC的SI亦低于低分化CCRCC（P<0.05）。CCRCC的SI值与组织分化程度呈显著的负相关（r=-0.711,P<0.05）。受试者工作特征ROC曲线分析显示DWI的SI值诊断高分化CCRCC的最佳临界点值为273.7,相应的敏感度与特异度分别67.6%、98.2%;诊断低分化CCRCC的最佳临界点值为378.9,相应的敏感度与特异度分别91.3%、59.1%。 结论随DWI目测信号强度、SI值升高,CCRCC的组织分化程度降低。DWI目测信号强度及SI值预测CCRCC组织分化程度有一定的临床价值。     

椎间盘退变的磁共振弥散加权成像研究

目的运用磁共振弥散加权成像技术定量分析椎间盘退变,以期对椎间盘早期退变进行定量诊断。方法88例对象430个椎间盘纳入研究（排除磁敏感性伪影较重的10个椎间盘）,行PM分级后经GE 1．5T超导MRI对腰椎行常规（矢状面T1加权、12加权和横断面T2加权）和矢状面弥散加权成像（diffusion weightedi maging,DWI）。其中脊柱常规扫描采用快速自旋回波（fast spin echo,FSE）脉冲序列,弥散成像采用平面回波成像（echo—planar imaging,EPI）脉冲序列。根据正中矢状面他加权像椎间盘形态及信号变化,在ADW4．2后处理工作站使用Function tool图像处理软件对图像进行后处理,在DWI矢状面上分别对腰椎椎间盘手动画出感兴趣区并测量其信号强度与表观弥散系数（apparent diffusion coefficient,ADC）值。结果430个椎间盘纳入DWI研究,PM分级Ⅰ级0个,Ⅱ级166个;Ⅲ级146个;Ⅳ级69个;Ⅴ级49个。经Kruskal—Wallis秩和检验,ADC值与PM分级有相关性（P〈0．05）。以ADC=1．05×10-3mm2／s作为评价椎间盘状态定量指标,其灵敏度为73．48％,特异度为75．30％。结论磁共振弥散加权成像可定量评价椎间盘退变程度。     

磁共振DTI表观扩散系数、各向异性分数与腰骶丛脊神经根受压的关系

目的 分析磁共振(magnetic resonance,MR)弥散张量成像(diffusion tensor imaging,DTI)的表观扩散系数(apparent diffusion coefficient,ADC)、各向异性分数(fractional anisotropy,FA)与腰骶丛脊神经根受压的关系.方法 ...     

腰椎骨质疏松的MRI表现

目的　分析腰椎骨质疏松的MRI征像。方法　选择X线及CT扫描证实为骨质疏松的病例 ,进行SE序列MRI扫描 ,就其MRI征像进行分析。结果　 5例轻微骨质疏松MRI信号无明显改变 ,2 5例明显骨质疏松病例MRISET1W信号明显增高。同时MRI还显示了疏松性骨折、有无终板疝形成及腰椎不同程度退行性变。结论　MRI在骨质疏松影像诊断中具有潜在优势 ,但有一定限度。     

磁共振成像扩散加权成像技术在鉴别原发性胆囊癌和肝细胞癌中的价值

目的 探讨MRI扩散加权成像(DWI)技术对侵犯肝脏的原发性胆囊癌和侵犯胆囊的原发性肝细胞癌进行鉴别诊断的价值.方法 回顾性分析2009年1月至2010年10月解放军总医院收治的11例原发性胆囊癌和19例原发性肝细胞癌患者的临床资料.采用MRI DWI技术对两种疾病进行鉴别诊断.选择扩散敏感梯度场参数(b值)为800 s/mm2时进行扫描,绘制受试者工作特征曲线(ROC),比较原发性肝细胞癌和原发性胆囊癌的表观弥散系数(ADC)阈值.利用独立样本t检验比较两组ADC值之间的差异.结果 30例患者共30个肿瘤,所有肿瘤在DWI图像上呈高信号,T1WI呈稍低信号,T2WI呈稍高信号,原发性胆囊癌累及肝脏的边界欠清楚.11例原发性胆囊癌患者的肿瘤主要位于胆囊窝区,其中10例累及肝脏,平均ADC值为(0.89±0.14)mm2/s;19例原发性肝细胞癌患者中,15例肿瘤位于肝右叶,4例肿瘤位于肝左叶,平均ADC值为(1.04±0.18)mm2/s,两者ADC值比较,差异有统计学意义(t=2.425,P＜0.05).ROC曲线下面积为0.756(95%CI:0.577～0.935),当阈值为0.96 mm2/s时,敏感性为68.4%,特异性为81.8%.结论 b值为800 s/mm2时,原发性胆囊癌的ADC值低于原发性肝细胞癌,有利于两种疾病的鉴别诊断.

Abstract：

Objective To investigate the value of diffusion-weighted magnetic resonance imaging in the differential diagnosis of primary gallbladder cancer with liver invasion and primary hepatocellular carcinoma (HCC) with gallbladder invasion. Methods From January 2009 to October 2010, 11 patients with primary gallbladder cancer and 19 patients with primary HCC were admitted to the PLA General Hospital. The clinical data of the 30 patients were retrospectively analyzed. All patients underwent diffusion-weighted magnetic resonance imaging with b value of 800 s/mm2, and the receiver operating curve (ROC) was drawn. The apparent diffusion coefficient (ADC) values of the patients with gallbladder cancer and HCC were compared by independent sample t test. Results Thirty tumors were detected in the 30 patients. All tumors showed high signal on DWI, slightly low signal on T1 WI and slightly high signal on T2 WI. The foci of 11 patients with primary gallbladder cancer were at the gallbladder fossa, and 10 of them had liver involvement. The mean ADC value of the 11 patients was (0.89 ±0. 14)mm2/s. Of the 19 patients with primary HCC, the foci of 15 patients were at the right lobe of liver, and 4were at the left lobe. The mean ADC value of the 19 patients was (1.04 ±0.18)mm2/s. There was a significant difference in the ADC value between patients with primary gallbladder cancer and those with primary HCC ( t =2.425, P＜0. 05). The area under the ROC was 0. 756 (95% confidence interval: 0.577-0. 935), and the sensitivity and specificity were 68.4% and 81.8%, respectively, when the threshold value was 0.96 mm2/s.Conclusion The ADC value of patients with primary gallbladder cancer is lower than those with primary HCC when the b value is 800 s/mm2, which is helpful in the differential diagnosis of primary gallbladder cancer and primary HCC.     

磁共振成像扩散加权成像技术在鉴别原发性胆囊癌和肝细胞癌中的价值

Objective To investigate the value of diffusion-weighted magnetic resonance imaging in the differential diagnosis of primary gallbladder cancer with liver invasion and primary hepatocellular carcinoma (HCC) with gallbladder invasion. Methods From January 2009 to October 2010, 11 patients with primary gallbladder cancer and 19 patients with primary HCC were admitted to the PLA General Hospital. The clinical data of the 30 patients were retrospectively analyzed. All patients underwent diffusion-weighted magnetic resonance imaging with b value of 800 s/mm2, and the receiver operating curve (ROC) was drawn. The apparent diffusion coefficient (ADC) values of the patients with gallbladder cancer and HCC were compared by independent sample t test. Results Thirty tumors were detected in the 30 patients. All tumors showed high signal on DWI, slightly low signal on T1 WI and slightly high signal on T2 WI. The foci of 11 patients with primary gallbladder cancer were at the gallbladder fossa, and 10 of them had liver involvement. The mean ADC value of the 11 patients was (0.89 ±0. 14)mm2/s. Of the 19 patients with primary HCC, the foci of 15 patients were at the right lobe of liver, and 4were at the left lobe. The mean ADC value of the 19 patients was (1.04 ±0.18)mm2/s. There was a significant difference in the ADC value between patients with primary gallbladder cancer and those with primary HCC ( t =2.425, P＜0. 05). The area under the ROC was 0. 756 (95% confidence interval: 0.577-0. 935), and the sensitivity and specificity were 68.4% and 81.8%, respectively, when the threshold value was 0.96 mm2/s.Conclusion The ADC value of patients with primary gallbladder cancer is lower than those with primary HCC when the b value is 800 s/mm2, which is helpful in the differential diagnosis of primary gallbladder cancer and primary HCC.     

3.0T磁共振扩散加权成像诊断肾血管 平滑肌脂肪瘤

目的探讨MR扩散加权成像（DWI）及相应的表观扩散系数（ADC）对肾血管平滑肌脂肪瘤（AML）的诊断价值。方法收集经手术病理证实的肾脏AML患者15例,其中典型AML 10例,不典型AML 5例;正常对照组15名,对病变区域行DWI及常规MRI,测量b=50～1000 s/mm^2时肾脏AML及正常对照组的ADC值。结果肾脏典型AML、不典型AML及正常对照组的ADC值（×10^-3mm^2/s）分别为（0.87±0.08）、（1.55±0.34）、（1.82±0.18）,差异有统计学意义（P〈0.05）。结论3.0T磁共振DWI及ADC值测定可为诊断肾脏AML提供帮助。     

腰椎间盘弥散加权成像研究进展

弥散加权成像（DWI）是一种无创性评价腰椎间盘内分子弥散及相应微环境变化的研究方法。通常利用平面回波DWI序列进行成像,以正中矢状位测量表观弥散系数（AIW）来评价腰椎间盘内分子弥散及相应微环境变化。不同年龄人群正常椎间盘中,接近头部腰椎间盘的ADC值均比接近尾部者高,髓核与纤维环相比,分子各向弥散更为均匀一致。研究发现,ADC随着腰椎间盘中黏多糖、水及胶原的降解而下降。在退行性变腰椎间盘中,越接近骶尾部的ADC值越低,但是否可通过ADC来区分退行性变的程度,目前尚无定论。随着磁共振成像硬件和序列技术的改进,DWI技术有望对椎间盘组织结构进行无创性量化评估。     

腰痛患者腰椎3.0T MR弥散加权成像腰椎间盘表观弥散系数与椎间盘退变分级的相关性

【摘要】 目的：分析腰痛患者腰椎3.0T MR弥散加权成像（diffusion weighted image,DWI）椎间盘的表观弥散系数（apparent diffusion coefficient,ADC）与椎间盘退变形态学分级的相关性。方法：2012年6月~2012年11月对60例腰痛患者行腰椎3.0T MR T2加权成像（T2 weighted image, T2WI）和DWI扫描。男30例,女30例,年龄19～66岁,平均42.5±11.9岁。在MR常规T2WI序列上对腰椎间盘按Pfirrmann标准进行形态学分级,在矢状面ADC图上对正中层面椎间盘进行ADC值测量。对腰椎间盘ADC值与Pfirrmann分级之间的相关性采用Spearman相关分析,并对椎间盘不同Pfirrmann分级的ADC值进行单因素方差分析,如有差异进一步进行LDS法两两检验。结果： 腰椎间盘Pfirrmann分级为Ⅰ级45个（15%）,Ⅱ级61个（20.3%）,Ⅲ级74个（24.7%）,Ⅳ级113个（37.7%）,Ⅴ级7个（2.3%）。Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ级椎间盘的ADC值分别为1.73±0.21、1.74±0.15、1.62±0.24、1.23±0.37、0.81±0.32（10-3mm2/s）。腰椎间盘不同Pfirrmann分级的ADC值有显著性差异（F=56.9,P=0.000）,不同分级间差异进一步行LDS法两两检验,Ⅰ级的ADC值与Ⅱ级比较无显著性差异（P＞0.05）,Ⅲ级、Ⅳ级、Ⅴ级分别与Ⅰ级、Ⅱ级比较均有显著性差异（P＜0.05）,Ⅲ级、Ⅳ级、Ⅴ级之间两两比较均有显著性差异（P＜0.05）。腰椎间盘ADC值与其Pfirrmann分级呈明显负相关（r=-0.624,P=0.000）。结论： 腰痛患者腰椎3.0T MR DWI腰椎间盘的ADC值与椎间盘退变分级呈负相关。     

不同致密度乳腺腺体的表观弥散系数与月经周期的关系

目的探讨不同致密度正常乳腺腺体的ADC值与月经周期的关系。方法将50名(100侧乳腺)女性志愿者按腺体致密度分为致密型(40侧)、中间型(36侧)、脂肪型(24侧),分别在月经期、增殖期及分泌期行T2WI-TIRM、DWI检查,并对各期乳腺腺体的ADC值进行测量,采用单因素方差分析、配对t检验比较各月经周期中不同腺体类型的ADC值及同一腺体类型在不同月经周期ADC值的差异。结果月经期时致密型、中间型及脂肪型腺体的ADC值分别为(2.08±0.07)×10-3 mm2/s、(2.09±0.09)×10-3 mm2/s、(1.90±0.35)×10-3 mm2/s;增殖期时各类腺体的ADC值分别为(1.97±0.16)×10-3 mm2/s、(2.00±0.17)×10-3 mm2/s、(1.81±0.54)×10-3 mm2/s;分泌期时各类腺体的ADC值分别为(2.01±0.08)×10-3 mm2/s、(2.02±0.05)×10-3 mm2/s、(1.82±0.21)×10-3 mm2/s;各腺体类型在月经期ADC值与增殖期及分泌期差异均有统计学意义(P均0.05),各月经周期脂肪型腺体的ADC值与致密型及中间型腺体ADC值差异均有统计学意义(P均0.01)。结论进行乳腺DWI检查时应考虑腺体致密度及月经周期对乳腺的影响,尽量选择月经结束后1周内完成。     

Clinical applications of diffusion magnetic resonance imaging of the lumbar foraminal nerve root entrapment

Diffusion-weighted imaging (DWI) can provide valuable structural information about tissues that may be useful for clinical applications in evaluating lumbar foraminal nerve root entrapment. Our purpose was to visualize the lumbar nerve root and to analyze its morphology, and to measure its apparent diffusion coefficient (ADC) in healthy volunteers and patients with lumbar foraminal stenosis using 1.5-T magnetic resonance imaging. Fourteen patients with lumbar foraminal stenosis and 14 healthy volunteers were studied. Regions of interest were placed at the fourth and fifth lumbar root at dorsal root ganglia and distal spinal nerves (at L4 and L5) and the first sacral root and distal spinal nerve (S1) on DWI to quantify mean ADC values. The anatomic parameters of the spinal nerve roots can also be determined by neurography. In patients, mean ADC values were significantly higher in entrapped roots and distal spinal nerve than in intact ones. Neurography also showed abnormalities such as nerve indentation, swelling and running transversely in their course through the foramen. In all patients, leg pain was ameliorated after selective decompression (n = 9) or nerve block (n = 5). We demonstrated the first use of DWI and neurography of human lumbar nerves to visualize and quantitatively evaluate lumbar nerve entrapment with foraminal stenosis. We believe that DWI is a potential tool for diagnosis of lumbar nerve entrapment.     

Differentiation between hepatic alveolar echinococcosis and primary hepatic malignancy with diffusion-weighted magnetic resonance imaging

Purpose

To determine the value of diffusion-weighted magnetic resonance imaging (DW-MRI) in discriminating between hepatic alveolar echinococcosis (AE) and hepatocellular carcinoma and intrahepatic cholangiocarcinoma.

表观弥散系数在前列腺良恶性病变中的应用

目的探讨表观弥散系数在前列腺良恶性病变中的鉴别诊断价值。方法收集笔者所在医院27例前列腺癌、16例前列腺炎以及32例良性前列腺增生患者的MR资料。测量病灶ADC值,对所得数值进行统计学分析。结果 b值为800s/mm2时,前列腺癌灶ADC值为（0.82±0.16）×10-3mm2/s,与炎症及前列腺增生结节比较,均有统计学意义（P〈0.05）。以0.84s/mm2作为诊断前列腺癌阈值,其敏感度为84.21%、特异度为86.54%、准确性为85.92%、阳性预测值为70.37%、阴性预测值为93.75%（Kappa=0.67,P〈0.01）。结论 ADC值测量在前列腺疾病鉴别诊断中具有重要作用。     

Correlation between apparent diffusion coefficient value on diffusion-weighted MR imaging and Gleason score in prostate cancer

Objectives

To investigate whether diffusion-weighted imaging (DWI) apparent diffusion coefficient (ADC) correlates with prostate cancer aggressiveness and further to compare the diagnostic performance of ADC and normalized ADC (nADC: normalized to non-tumor tissue).

女性年龄相关的腰椎骨量与骨骼大小的关系及对诊断骨质疏松的影响

目的探讨腰椎骨量(面积骨密度和体积骨密度)与年龄和骨骼骨面积(BA)大小之间的关系,及腰椎骨骼大小对评价骨量和诊断骨质疏松(OP)的影响。方法采用QDR-4500A型扇形束双能X线吸收法骨密度仪,测量5585例年龄5～96岁的女性正位腰椎BA、骨矿含量(BMC)、面积骨密度(aBMD)及估算体积骨密度(vBMD)。结果腰椎aBMD和vBMD的峰值BMD(x珋±s)分别为0.9884±0.1064g/cm2和0.1310±0.0128g/cm3。在所有年龄阶段aBMD随年龄的变化率显著大于vBMD。腰椎BA与BMC、aBMD和vBMD均呈显著正相关,其中BA与BMC的相关系数最大(r=0.706,P=0.000),与aBMD的相关系数次之(r=0.394,P=0.000),与vBMD的相关系数最小(r=0.141,P=0.000)。年龄≥40岁(平均52.7±9.58岁)的受试者(n=4012)腰椎BA按四分位数分成Q1、Q2、Q3和Q4组,4个组之间的BA、BMC和aBMD的平均值均有显著性差异。采用aBMD诊断OP,4个组的OP检出率分别为Q1=33.6%、Q2=17.9%、Q3=13.3%和Q4=8.39%,呈显著性梯次降低;与总体组比较,Q1组的患病风险增加126%,Q2、Q3和Q4组的患病风险分别降低3%、31%和59%。采用vBMD诊断OP,4个组的OP检出率分别为Q1=27.4%、Q2=18.3%、Q3=15.9%和Q4=14.0%,其梯次差异显著低于aBMD;与总体组比较,Q1组的患病风险增加62%,Q2、Q3和Q4组的患病风险分别降低4%、19%和30%。Q1组aBMD的OP检出率显著高于vBMD,Q4组aBMD的OP检出率显著低于vBMD。在椎体最小的Q1组,aBMD(OR=2.26)的患病风险比vBMD(OR=1.62)大约高64%,在椎体最大的Q4组,aBMD(OR=0.41)的患病风险比vBMD(OR=0.70)大约低29%。结论该研究揭示腰椎vBMD并不能完全消除骨骼大小对评价骨量和诊断OP的影响。在腰椎椎体较小的受试者,aBMD诊断OP的敏感性高于vBMD;在椎体较大的受试者,vBMD诊断OP的敏感性则高于aBMD。     

3．0T磁共振背景抑制弥散加权成像对直肠癌淋巴结转移的诊断价值

目的评估3．0T磁共振背景抑制弥散加权成像（DWIBS）对直肠癌转移性淋巴结的诊断价值。方法35例直肠癌患者术前行常规MRI加弥散加权成像（DWI）检查．手术行直肠癌切除加淋巴结清扫术。对照术后病理结果,确定转移性和非转移性淋巴结,测量淋巴结的表观弥散系数（ADC）值以及长、短径,并绘制受试者工作特征（ROC）曲线来评估淋巴结ADC值及长、短径对转移性淋巴结的鉴别诊断价值。结果35例直肠癌患者共获取部位明确的淋巴结151枚．其中转移性淋巴结65枚,非转移性淋巴结86枚。其ADC值分别为[（0．86±0．14）×10^-3]和[（0．94±0．16）×10^-3]mm^2／s,长径分别为（9．78±3．13）和（7．90±1．77）mm,短径分别为（7．65±2．00）和（6．45±1．19）mm,两者比较差异均有统计学意义（均P〈0．01）。ADC值、淋巴结长径、短径判断淋巴结是否转移的ROC曲线下面积分别为0．648、0．706、0．692,取最佳分界值[分别为（1．05×10^-3]mm^2／s、7．95mm、5．90mm]．三者的敏感性和特异性分别为93．8％和30．2％、75．4％和61．6％、90．8％和38．4％。结论3．0T磁共振DWIBS的ADC值的定量测量能够反映病灶的弥散受限程度．直肠癌转移性淋巴结的诊断需要ADC值、淋巴结径线测量的综合评价。     

双能X线骨密度测定腰椎和股骨颈对诊断骨质疏松检出率的比较

目的探讨双能X线吸收法测量腰椎及股骨颈两个不同部位骨密度对骨质疏松诊断的检出率,寻找灵敏度高、更经济实用的筛查骨质疏松的有效方法方法 2011年1月至2012年12月在我院妇科及老年病科住院的女性患者共732人,分别测量腰椎及股骨颈的骨密度T值,进行SPSS统计研究。结果对同一人群通过股骨颈和腰椎不同部位检测发现骨质疏松的检出率分别为25.4%,32.0%;严重骨质疏松的检出率分别为9.0%,27.9%;两者之间差异有统计学意义(P=0.001),腰椎骨密度测量对骨质疏松诊断检出率明显优于股骨颈。根据4个年龄组的股骨颈和腰椎的骨密度T值比较差异均有统计学意义(P均0.01)。结论采用双能X线骨密度测定对诊断骨质疏松腰椎明显优于股骨颈。