前列腺癌和良性前列腺增生磁共振灌注加权成像的应用价值

目的 探讨磁共振灌注加权成像对前列腺癌(PCa)和良性前列腺增生(BPH)的诊断和鉴别诊断价值.方法 收集行磁共振灌注加权成像检查的PCa患者23例、BPH患者22例及正常对照组8例,分别比较其前列腺灌注参数的差异,包括相对负性强化积分(rNEI)、相对平均达峰时间(rMTE)和相对最大下降斜率(rMSD).结果 外周带PCa组rNEI值高于BPH组外周带(t=11.64,P＜0.001)和正常外周带(t=11.79,P＜0.001);外周带PCa组rMTE值低于BPH组外周带(￡=3.50,P=0.002)和正常外周带(t=3.78,P=0.001).中央带PCa组rNEI值高于BPH组中央带(t=6.99,P＜0.001)和正常中央带(t=10.32,P＜0.001);BPH组中央带rMSD值高于中央带PCa组(t=2.30,P=0.027)和正常中央带(t=3.15.P=0.001).应用受试者工作特征曲线分析,rNEI对PCa具有诊断意义,选择最佳诊断阈值为6.44.敏感性为91.3%(21/23)、特异性为81.8%(18/22).结论 磁共振灌注加权成像的rNEI可作为鉴别PCa与BPH的有效指标.     

三维磁共振波谱成像对前列腺癌与BPH的鉴别价值

目的：评价三维磁共振波谱成像（Three dimensional MR spectroscopic imaging．3D-MRSD在MRI基础上联合应用对前列腺癌（PCa）和BPH的鉴别价值。方法：对37例疑为PCa的患者行MRI和3D—MRS检查．然后作10点或12点前列腺穿刺病理学检查,并将3DMRS检查结果与病理检查结果进行对照。结果：穿刺病理检查结果证实．37例患者中,BPH13例,PCa24例。BPH的枸橼酸盐（Citrate,Cit）峰位于2．6ppm．胆碱峰值位于3．2ppm．特征表现为Cit／Cho比值升高;PCa患者MRI＋3D-MRSl提示“PCa可疑”或“PCa”者共19例。符合度为79．2％,3D-MRSI特征为Cit峰明显降低．Cho峰显著升高,Cit／Cho比值降低。BPH组与PCa组Cit／Cho比值差异有统计学意义（P〈O．05）。结论：不配备直肠线圈的情形下．结合MRI的3D-MRSI检查对于前列腺良恶性肿瘤的患者可得到有诊断意义的波谱信息。病理对照研究显示3D-MRSI有助于鉴别肿瘤与其他疾病,与MRI结合能直观地显示肿瘤范围。     

3.0T MRI在前列腺良恶性病变诊断分析中的应用

前列腺良性增生(BPH)和前列腺癌(PCa)严重危害老年男性的健康,BPH常合并PCa,早期诊断对于选择有效的治疗方法十分重要.作者通过对26例前列腺良恶性病变患者的3.0T MRI资料进行分析,旨在探讨前列腺疾病在超高场强MRI平扫加增强扫描中的影像学表现.     

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.     

三维1H磁共振波谱分析在前列腺癌诊断与鉴别诊断中的应用价值

目的 探讨三维1H磁共振波谱分析(MRS)在前列腺癌(PCa)诊断与鉴别诊断中的应用价值.方法 采用1.5T高场强超导磁共振成像仪和直肠内线圈前列腺三维1H MRS检查前列腺疾病患者52例,其中PCa 17例、良性前列腺增生(BPH)35例,9例无泌尿系症状的志愿者作为对照组.前列腺波谱检查数据经工作站后处理得到前列腺代谢产物胆碱(Cho)、肌酸(Cr)和柠檬酸盐(Cit)的波峰谱线,以及Cho/Cit比值、(Cho+Cr)/Cit比值.结果 17例PCa患者病灶波谱分析显示Cit波峰明显降低或消失,Cho峰明显升高,Cr峰无明显变化,平均Cho/Cit比值为2.24±1.43,平均(Cho+Cr)/Cit比值为2.80±1.69.35例BPH患者病灶表现为较高的Cit峰,增生病灶区平均Cho/Cit比值为0.46±0.27,平均(Cho+Cr)/Cit比值为0.58±0.31.PCa与正常前列腺周围带、中央腺区和BPH病灶分别比较,平均Cho/Cit比值和平均(Cho+Cr)/Cit比值差异均有统计学意义.结论 PCa病灶内Cit和Cho含量出现明显变化,在波谱分析中呈现特征性波峰变化,在诊断和鉴别诊断PCa方面具有较高的诊断价值.     

DWI和DCE-MRI鉴别诊断良恶性前列腺外周带T2WI局灶性低信号病变

目的探讨弥散加权成像(DWI)和动态对比增强MRI(DCE-MRI)鉴别诊断T2WI表现为外周带局灶性低信号的不同病理级别前列腺癌(PCa)与慢性前列腺炎(CP)的价值。方法36例PCa和15例CP经病理证实,且T2WI外周带均表现为局灶性结节样低信号,回顾性分析其ADC值和信号强度-时间(SI-T)曲线类型差异,并绘制ROC曲线评价其诊断效能。结果36例外周带局灶性PCa患者中,中高危PCa亚组20例,低危PCa亚组16例。除低危PCa亚组与CP组ADC值差异无统计学意义(P=0.079)外,其余两两比较ADC值差异均有统计学意义(P均<0.01)。中高危PCa亚组与CP组SI-T曲线类型差异有统计学意义(P=0.013),其余两两比较差异均无统计学意义(P均>0.05)。ADC值诊断外周带局灶性PCa的AUC为0.823[95%CI(0.708,0.938)];以0.94×10^-3mm²/s为最佳临界值,ADC诊断外周带局灶性PCa的敏感度为86.70%,特异度63.90%,准确率79.99%。结论DWI的ADC值有助于鉴别前列腺外周带良恶性局灶性病变,但对鉴别诊断前列腺非临床显著癌与CP无显著价值;DCE-MRI的SI-T曲线可鉴别前列腺临床显著癌与CP。     

良性前列腺增生的形态组织学及影像学研究进展

良性前列腺增生(BPH)是常见的男性老年病,近50多年来,我国BPH发生率迅速增长。增生前列腺的形态组织学常表现为体积增大,重量增加,增生部位主要位于移行区。国内外学者利用常规、特殊染色及计算机图像分析研究了增生前列腺的组织学特点。发现前列腺增生是以间质增生为主。影像学检查是诊断BPH重要的辅助方法,尤其是经直肠超声(TRUS)和磁共振成像(MRI)检查有助于增生前列腺的观察。     

COX-2、Ki-67联合检测对良恶性前列腺病变鉴别诊断的价值分析

目的 探讨环氧合酶-2(COX-2)、细胞增殖核抗原Ki-67(Ki-67)联合检测对良恶性前列腺病变的鉴别诊断价值。方法 选取2017年1月至2019年6月本院收治的168例良恶性前列腺病变患者,将其中83例前列腺癌(PCa)患者设为PCa组,85例良性前列腺病变患者[良性前列腺增生（BPH）患者40例、前列腺上皮内瘤(PIN)患者45例]设为BPH+PIN组。检测两组前列腺病变组织的COX-2、Ki-67表达水平;分析前列腺组织中的COX-2、Ki-67表达水平与PCa临床病理特征的关系;采用受试者工作特征（ROC）曲线评价前列腺病变组织COX-2、Ki-67 mRNA表达水平对PCa的诊断和鉴别价值。结果 PCa组患者的前列腺组织中COX-2、Ki-67 mRNA及蛋白阳性表达率水平均高于BPH+PIN组（均P<0.001）;PCa组患者的前列腺组织中COX-2、Ki-67表达水平与临床分期、远处转移、淋巴结转移、浸润深度、分化程度有明显相关性（均P<0.05）,与年龄、组织类型无相关性（均P>0.05）;前列腺病变组织的COX-2、Ki-67 mRNA诊断PCa的曲线下面积（AUC）分别为0.885、0.868,灵敏度分别为83.13%、78.31%,特异度分别为91.76%、92.94%;两者联合鉴别PCa的灵敏度（95.18%）高于两项单独检测,而特异度（90.59%）低于两项单独检测。结论 前列腺病变组织中的COX-2联合Ki-67对PCa具有较高的诊断价值,可提高诊断灵敏度,且具有较高准确度,有助于临床鉴别良恶性前列腺病变。     

前列腺癌的磁共振检查研究进展

磁共振成像(MRI)有良好的组织分辨率和三维成像的特点，是目前检测前列腺癌较好的影像学检查方法。SET2加权序列(SET2WI)为检出前列腺癌(PCa)的主要序列，PCa多发生于外周带，表现为周边高信号区内出现低信号病灶，但不具有特异性。由于BPH中央带及移行带的MRI信号与     

外周血和组织炎性细胞在鉴别PSA4～10ng/ml的前列腺癌和前列腺增生中的临床意义

目的:评价外周血和前列腺组织炎性细胞在鉴别前列腺特异性抗原(PSA)4～10 ng/ml的前列腺癌(PCa)和良性前列腺增生(BPH)中的临床意义。方法:回顾性分析我院2013年10月～2018年10月PSA水平4～10 ng/ml的PCa和BPH患者共45例,其中PCa组患者20例,BPH组患者25例。PCa组患者行前列腺癌根治术后病理确诊,BPH组患者行耻骨上经膀胱前列腺摘除术或经尿道前列腺电切术(TURP)后病理确诊。所有患者在行前列腺穿刺活检术前检测血常规,记录患者外周血中WBC、中性粒细胞、淋巴细胞和单核细胞计数,分析外周血淋巴细胞与单核细胞比率(LMR)、中性粒细胞与单核细胞比率(NMR)和中性粒细胞与淋巴细胞比率(NLR)等。同时收集患者术后病理石蜡切片,采用免疫组织化学(IHC)染色法检测前列腺组织中炎性细胞表达情况。结果:PCa组和BPH组患者外周血白细胞、中性粒细胞和淋巴细胞计数等指标比较差异无统计学意义。PCa组单核细胞计数明显低于BPH组,差异有统计学意义(P0.05)。两组LMR、NMR和NLR值比较差异无统计学意义。两组淋巴细胞和中性粒细胞表达比较差异无统计学意义,但BPH组单核细胞标志物CD14表达高于PCa组,差异有统计学意义(P0.05)。结论:检测外周血和组织中单核细胞计数有助于诊断PSA浓度4～10 ng/ml的PCa患者。     

Osteoarthritis--radiology imaging

Osteoarthritis is degenerative arthritis. On radiograms it is characterised with joint place narrowing, subchondral bone sclerosis, and formation of cystic and osteophitic changes.     

Recent advances in MR imaging: FLAIR imaging

Fluid-attenuated inversion recovery (FLAIR) imaging is a technique that increases the sensitivity of magnetic resonance imaging to detect central nervous system (CNS) diseases characterized by an increase in interstitial water content such as brain tumors, cerebral infarcts, and gliotic scars. A role for this technique in subarchnoid disease processes such as hemorrhage and epidermoid tumor is also being revealed.     

Patellofemoral imaging

Imaging of the patella and patellofemoral joint cannot be isolated from imaging of the knee anymore than the function of the patellofemoral joint can be separated from the function of the entire knee. Therefore, the current author will focus on imaging of the patellofemoral joint yet integrate this with the entire knee. Because radiographs and other imaging techniques are adjuncts to the history and physical examination, and specifically an extension of the physical examination, each view or technique must be selected thoughtfully to yield the most useful and accurate information possible. Imaging techniques range from relatively inexpensive to very costly, yet the amount of useful information may not show a positive correlation with the cost. Only by integrating the history, physical examination, and the best imaging techniques can the clinician locate the abnormality, determine its cause, and plan a proper course of treatment. Radiographic imaging of the patellofemoral joint requires attention to detail on the part of the technician and knowledge of these techniques on the part of the clinician who orders and interprets the results. Understanding these concepts will help achieve everyone's goal: high-quality and cost-effective orthopaedic care.     

Scrotal imaging

Color Doppler ultrasound has been the mainstay for the evaluation of the scrotum in a variety of clinical settings. However, ultrasonography results are not always accurate or conclusive. Despite the high cost and limited availability, magnetic resonance imaging with the dynamic contrast-enhanced subtraction technique provides accurate information on morphology as well as blood flow. Infrared scrotal thermography increases accuracy in the diagnosis of varicocele. This article attempts to summarize recent advances in scrotal imaging with regard to testicular and extratesticular disorders.     

Adrenal imaging

The problems inherent in visualizing the adrenal glands are illustrated by the variety of imaging modalities that have been employed. Although urography has been the basic screening examination, one can make a sound argument for CT as the procedure of choice in the evaluation of the patient with suspected adrenal pathology. Angiography, venous sampling, and radionuclide studies continue to have a role in selected problem cases. This article reviews the usefulness of available modalities in the context of the clinical evaluation of adrenal disease.     

1.5 T: intraoperative imaging beyond standard anatomic imaging

Intraoperative high-field MRI with integrated microscope-based neuronavigation is a safe and reliable technique providing immediate intraoperative quality control. Major indications are pituitary tumor, glioma, and epilepsy surgery. Intraoperative high-field MRI provides intraoperative anatomic images at high quality that are up to the standard of pre- and postoperative neuroradiologic imaging. Compared with previous low-field MRI systems used for intraoperative imaging, not only is the image quality is clearly superior but the imaging spectrum is much wider and the intraoperative work flow is improved. Furthermore, high-field MRI offers various modalities beyond standard anatomic imaging, such as magnetic resonance spectroscopy, diffusion tensor imaging, and functional MRI.     

Musculoskeletal imaging in progress: The EOS imaging system

The EOS 2D/3D radio-imaging device (Biospace med, France) can disclose a digital radiographic image of bones with a very low radiation dose. This in turn allows in obtaining a single image of a large field of view, as wide as the full skeleton. The simultaneous capturing of spatially paired AP and lateral X-ray images is also a specificity of EOS imaging, which further provides secondary 3D (volumic) reformation of skeletal images. The main indications of this new imaging technology are assessment and follow-up of balance disorders of the spine and of the lower limbs.