不同MR脉冲序列在乳腺癌中的应用

MRI经历了从结构成像到功能成像,从单纯T1WI、T2WI序列到多脉冲序列成像的发展过程。利用多个MR脉冲序列成像可获得乳腺癌病变的定性、定量信息,在乳腺癌的早期诊断、生物学评价、疗效和预后评估等方面可发挥重要作用,但其也存在敏感性高而特异性相对较低且费用较高的问题。就乳腺癌MRI的应用现状、存在的问题及前景进行综述。     

神经纤维瘤病I型的MRI研究

目的：回顾神经纤维瘤病I型（NF1）患者MRI表现，分析MR扫描序列及其诊断价值，以建立合适的MR成像方案，为NF1影像诊断提供有价值的依据。方法：对30例临床确诊为NF1患者采用本组MR成像方案进行扫描，主要包括：轴面SE序列T2WI；平扫矢状面SE脉冲序列T1WI；增强轴面或矢状面SE脉冲序列T1WI；轴面或冠状面液体衰减反转恢复（FLAIR）序列，同时分析病变的发病部位、数目、形态、信号的变化和病变的强化情况等。结果：MRI可见下列3种表现：（1）多发性脑内错构瘤：30例中25例在SE脉冲序列T2WI和FlAIR脉冲序列见高信号病灶，病灶主要位于苍白球、小脑和脑干。另外，25例中20例可见海马回、海马旁回等区晕状高信号改变。（2）视通道或下丘脑胶质瘤：视神经、视交叉增粗、扭曲；视交叉或下丘脑肿块，SE脉冲序列T2WI和FlAIR序列表现为不规则分叶状混杂信号肿块，在增强SE脉冲序列T1WI有明显不规则强化。（3）脊柱多发性神经纤维瘤：SE脉冲序列T2WI和脂肪抑制短时反转恢复（STIR）序列显示高信号沿脊神经分布的多发性肿瘤。结论：MRI能够作为1种 常规的影像检查方法对NF1患者进行诊断和追踪。本组MR成像方案能较好地显示NF1的多发性或多灶性病变。     

STIR快速反转恢复脉冲序列技术在膝关节半月板撕裂伤中的应用

MRI具有极佳的软组织对比,可用多序列、多参数成像来评价膝关节的软组织和半月板、骨及软骨结构,因而较常规X线平片、CT及其他影像技术有明显优越性。急性或反复创伤和进行性退变可导致半月板撕裂伤,常规采用T1WI、T2WI和PDWI检查序列。笔者通过临床观察发现采用STIR反转恢复脉冲序列对膝关节半月板损伤的诊断有很高的清晰度和临床应用价值,现报告如下。     

MRI多序列扫描在诊断乳腺癌中应用研究

目的探讨MRI多序列扫描在乳腺癌诊断中的应用价值。方法回顾性分析2013年1月至2016年5月青海红十字医院收治的150例乳腺肿瘤患者的临床资料,所有患者入院后均完成3.0T MRI T1加权成像(T1WI)、抑脂T2加权成像(T2WI)、扩散加权成像(DWI)、动态增强成像(DCE)、氢质子波谱成像(1H-MRS)扫描,以手术病理作为金标准,分析MRI多序列扫描对乳腺癌的诊断价值。结果 MRI平扫确诊乳腺癌100例,乳腺良性病变38例;DCE-MRI确诊乳腺癌97例,良性乳腺病变40例;DWI确诊乳腺癌82例,乳腺良性病变33例;1H-MRS确诊乳腺癌69例,确诊乳腺良性病变45例;其中,DCE诊断乳腺癌敏感度、特异性、准确率为95.1%、83.3%、89.3%,常规平扫为88.2%、79.2%、85.3%,DWI为80.4%、68.8%、76.7%,1H-MRS为64.7%、93.8%、74.0%。结论 MRI平扫、DWI、DCE序列对乳腺癌诊断综合价值高,尤其以DCE扫描诊断优势更高。     

MR不同脉冲序列成像诊断胆囊腺肌瘤病的价值

目的分析35例胆囊腺肌瘤病患者的MRI表现,比较不同脉冲序列显示Rokitansky Aschoff窦(RAS)能力的差异。方法经组织学证实诊断的35例胆囊腺肌瘤病患者(男19例,女16例,年龄32～72岁,平均52岁)均进行了MR常规T1WI、常规T2WI、3mm薄层T2WI及MR胰胆管成像(MRCP)。2名高年资放射科医生共同分析MRI,观察胆囊壁增厚情况及RAS信号表现,并与病理所见对照。根据5级评分标准,对RAS可信度达到4和5级的MRI脉冲序列进行统计学分析,比较不同脉冲序列显示RAS能力的差异。结果35例患者的胆囊壁均明显增厚,厚度范围5～12mm,平均7mm。其中包括局限型胆囊腺肌瘤病16例,节段型12例,弥漫型7例。RAS表现为病变胆囊壁内数量不等、大小不一的点状异常信号,其大小2～7mm,平均4mm。在T2WI和MRCP上,RAS呈点状高信号;在T1WI,RAS可呈低、高或等信号。RAS显示率在3mm薄层T2WI、常规T2WI、MRCP、T1WI依次为100%、60%、60%、26%(χ2=40.88,P<0.01)。结论3mm薄层T2WI显示RAS效果最佳。     

3.0 T MRI不同脉冲序列对胰腺疾病的诊断价值

目的 探讨MRI检查不同脉冲序列对胰腺病变的诊断价值。方法 对87例临床怀疑胰腺病变的病人应用3.0 T MR设备进行检查,扫描序列包括双回波T1WI（同相位与反相位成像）、脂肪抑制T1WI（T1WI+FS）、脂肪抑制T2WI (T2WI+FS)、磁共振胆胰管水成像（MRCP）、快速多层面扰相梯度回波(FSPGR)动态增强扫描。由2名放射科医师分析不同脉冲序列的MRI所见。结果 正常胰腺15例,急性胰腺炎27例,慢性胰腺炎30例,胰腺癌15例。T1WI+FS显示胰腺形态与信号最佳,正常胰腺呈稍高信号。在双回波T1WI上,胰腺与周围组织对比度降低。胰腺病变在T1WI上表现为低信号50例,T2WI+FS显示胰周渗出性病变34例。MRCP显示胰管扩张35例,胆管扩张20例,双管征9例。快速扰相梯度回波（FSPGR）动态增强显示胰腺癌13例,肿块在动脉期表现为相对低信号,延迟期轻度强化,周围血管受侵2例。结论 合理应用MR扫描序列有助于提高胰腺病变的诊断效能。     

乳腺癌的MRI成像技术及其诊断价值

目的:探讨乳腺癌的MRI特征表现,分析各种MR成像技术的临床应用价值和存在的不足.方法:38例乳腺癌患者术前均经MRI平扫、DWI、动态增强及1H-MRS检查,回顾性分析乳腺癌的MRI表现,并分析各种乳腺MR成像技术的应用价值及存在的不足.结果:在平扫T1WI、压脂T2WI乳腺癌多表现为等或低信号;DWI中b=0时病灶呈明显高信号,随b值增加病灶信号强度依次降低;以形状不规则、毛刺征、环形强化、早期增强率≥70%和Ⅱ型或Ⅲ型曲线作为诊断乳腺癌标准,其敏感度分别为65%、67.5%、80%、95%和95%;1H-MRS显示乳腺癌出现明显升高的Cho峰,Cho/Cr升高,基于Cho峰的出现诊断乳腺癌的敏感度为77.5%.结论:乳腺癌MRI病灶形态学、动态增强特点具有特征性,DW和1H-MRS检查具有重要的辅助诊断价值,但是部分良、恶性病灶的表现存在部分重叠,对乳腺导管原位癌的诊断MRI无明显优势.     

嗜铬细胞瘤的MRI检查

目的　探讨MRI检查对嗜铬细胞瘤的诊断价值 ,并确定嗜铬细胞瘤MRI检查的最佳成像序列。材料与方法　 12例嗜铬细胞瘤 (肾上腺 10例 ,腹主动脉旁 2例 )术前行MRI增强前后检查 ,包括 7种序列。结果　嗜铬细胞瘤呈较大 (平均瘤径 5 .3cm±2 .0cm)的类圆形或卵圆形肿块。T1WI信号强度类似肝实质 ,T2 WI信号较高 ,易发生坏死、囊变 ( 7/12 ) ,肿瘤实体部分多明显强化。结论　嗜铬细胞瘤的MRI表现具有一定特征 ,结合临床表现多可明确诊断。MRI检查最佳成像序列是增强前T2 WI脂肪抑制序列、T1WI以及增强后T1WI脂肪抑制序列。化学位移反相位检查有助于鉴别诊断。     

先天性气管食管瘘一例

目的:对原发性乳腺癌的准确分期对临床确定治疗方案有重要意义。目前的全身MRI机能在一次检查中完成局部和远处分期。因此,我们设计了一种准确的检查方案并前瞻性的评价其诊断准确性。方法:连续65例乳腺癌患者行术前MRI检查(1.5T)。使用双侧乳腺成像技术(横轴面:动态增强扫描GRE T1WI;TSE T2WI;扫描时间10min)无需重新定位、一站     

MRI对T3与T4a期胃腺癌的诊断和鉴别诊断价值

【摘要】目的：探讨MRI多序列成像对T3、T4a期胃腺癌的诊断与鉴别诊断价值。方法：回顾性搜集2013年9月-2020年5月本院术前确诊并行磁共振检查的57例T3、T4a期胃腺癌患者的MRI影像资料及临床资料,并对照术后病理分期分析MRI的诊断效能。运用Logistic回归分析临床特征、相关抗原、多序列MRI特征对于T3与T4a期胃腺癌的鉴别诊断价值,绘制ROC曲线评价其鉴别诊断效能。结果：联合T1WI、T2WI的分期诊断符合率为78.9%;T1WI、T2WI联合T1WI增强的分期诊断符合率为82.4%,T1WI、T2WI联合DWI的分期诊断符合率为94.7%;T1WI、T2WI、DWI、T1WI增强四者联合的分期诊断符合率为96.5% 。Logistic回归分析结果显示：病灶的ADCmin、T1WI增强扫描胃壁浆膜面毛糙模糊对T3、T4a期胃腺癌最具鉴别诊断价值。结论：MR多序列成像能够准确鉴别T3与T4a期胃腺癌,尤其是病灶ADCmin、T1WI增强扫描胃壁浆膜面毛糙模糊具有重要意义。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

人体中的镭-226、镭-228、钋-210、铅-210

本文报道了广东阳江高本底地区6名、对照地区8名人尸体的骨²²⁶Ra、²²⁶Ra的浓度以及部分居民内脏器官中。²¹⁰Po、²¹⁰Pb的浓度。结果轰明阳江高本底地区和对照地区居民骨镭-226、镭-228的浓度分别为29.9pCi/kg, 26.9pCi/kgl 8.7pCi/kg, 8.2pCi/kg.由此估算出阳江高本底地区屠民骨中²²⁶Ra、²²⁸Ra的负薄璧及对骨衬、骨髓所产生的剂量当量分别为对照地区民民的3.4倍, 3.3倍。两地区居民内脏器官中^{210Po、210Pb的测定分析铡数较少但仍看出, 高本底地区均明显高于对照地区.}