动态增强MRI在诊断颈部淋巴结病变中的价值

目的:探讨动态增强MRI(DCE-MRI)在颈部良恶性淋巴结中的诊断价值。方法:采用GE1.5T磁共振扫描仪及颈部相控阵线圈对46例单侧或双侧颈部淋巴结肿大患者行MRI平扫、动态增强MRI检查,其中26例为恶性病变,20例为良性病变,均经手术及病理证实。分析比较良恶性淋巴结病变的MRI征象,计算病灶峰值增强率Emax,峰值时间Tmax,最大强化速率Slopemax,并根据病变最高强化区ROI测量值,绘制病灶的时间-信号强度曲线(SI-Time曲线)。结果:良性淋巴结多为椭圆形,淋巴结周围水肿,脂肪边缘模糊,与周围软组织界限不清,动态强化参数Emax为(168.23±117.89)%,Tmax为(70.17±8.75)s,Slopemax为(2.96±2.03)%/s;而恶性淋巴结则呈类圆形或球形,轮廓较清晰,动态强化参数Emax为(192.74±106.84)%,Tmax为(61.92±21.37)s,Slopemax为(3.37±1.83)%/s。良、恶性淋巴结病变动态增强MRI的峰值增强率Emax、峰值时间Tmax及最大强化速率Slopemax之间的差异无显著性意义(P>0.05)。时间-信号强度曲线类型良性淋巴结病变多表现为Ⅰ型,而恶性淋巴结病变多为Ⅲ型,Ⅱ型曲线均可见于良性和恶性淋巴结病变。结论:淋巴结MRI可提供病灶的形态学及血流动力学特征,有助于良、恶性淋巴结的诊断。     

边缘-中心向心强化率在肌骨系统良恶性肿块中的鉴别诊断价值

目的　探讨MRI动态增强参数边缘 中心向心强化率 (Rrim center)在肌骨系统良恶性肿块中的鉴别诊断价值。资料与方法　对 2 8例肌骨系统肿块 (良性 14例 ,恶性 14例 )采用GRASS序列作MRI动态增强扫描。计算Rrim center,分析其在良恶性肿块之间有无差异。通过描绘接受者操作特征 (ROC)曲线得出最佳评价指标。结果　恶性组Rrim center0 .6 2± 0 .2 2 (范围 0 .18～ 0 .92 ) ;良性组 0 .19± 0 .2 7(范围 - 0 .16～ 0 .84) ,两组间有极显著差异 (P <0 .0 0 1) ,以 0 .30为界 ,对肿块潜在恶性评估的敏感性、特异性、准确性分别为 81.3%、91.7%、85 .7%。结论　MRI动态增强参数Rrim center有助于肌骨系统良恶性肿块的鉴别诊断。     

磁共振成像动态增强技术鉴别青年乳腺癌的研究

目的探讨磁共振成像(MRI)动态增强技术对青年乳腺癌的诊断价值,以期提高青年乳腺癌的检出率。方法回顾分析58例经手术病理证实的青年女性乳腺疾病的MRI影像检查资料,包括恶性病变42个,良性病变27个。比较青年乳腺良恶性病变的MRI各种征象,包括形态学及血流动力学特点,计算病变的早期强化率,绘制时间-信号强度曲线,探讨这些指标的诊断价值。结果青年乳腺良性病变多呈类圆形或分叶状,边缘光整,无毛刺,边界清晰,强化均匀,时间-信号强度曲线多为Ⅰ型;恶性病变多呈不规则形结节或肿块,边缘不规则或呈星芒状,边界不清,强化不均匀,部分呈典型环形强化或填充型环形强化,时间-信号强度曲线多为Ⅲ型。早期强化率在青年良恶性病变之间的差异无统计学意义,时间-信号强度曲线类型分布则有统计学意义(P<0.05)。结论 MRI动态增强技术能满意地显示青年乳腺病变的形态学特征和增强的血流动力学特点,是诊断青年乳腺癌的有效方法。     

动态增强MRI对软组织肿块良、恶性的鉴别诊断价值

目的 评价动态增强MRI对软组织肿块和肿瘤样病变的良、恶性的鉴别价值。方法 对30例经病理证实的软组织肿块进行动态增强扫描，其中恶性肿瘤11例，良性肿块19例。将感兴趣区(ROI)的信号强度绘制成时间-信号强度曲线(TIC)，并分别计算其0．5min斜率值。结果 30例软组织肿块的TIC分为3型，12例表现为I型曲线，其中10例为恶性肿瘤，2例为良性肿瘤；12例表现为Ⅱ型曲线，其中11例为良性肿块，1例为恶性肿瘤；6例表现为Ⅲ型曲线，均为良性肿块。11例恶性肿瘤中，10例病变的0．5min斜率值大于0．0057；19例良性肿块中，17例0．5min斜率小于0．0057；良、恶性肿瘤的TIC斜率值之间存在显著性差异，Logistic回归分析病变良、恶性和斜率值有相关性。以0．5min斜率值0．0057作为鉴别肿块良恶性的阈值，判断肿块良、恶性的敏感性为90．9%，特异性为89．4％，阳性预测值为83．3％，阴性预测值为94．4％。结论 动态增强MRI可以较准确地预测肿瘤病变的良、恶性。     

MRI动态增强扫描联合DWI对乳腺良恶性肿块的诊断价值

目的 :探究MRI动态增强扫描联合DWI对乳腺良恶性肿块的诊断价值。方法 :选择经手术或穿刺病理证实的乳腺肿块48例,测量病灶ADC值和动态增强曲线(DCE-TIC)并统计分析。结果:52个病灶中,良性肿瘤23例,恶性肿瘤29例。良性肿瘤的ADC值为(1.326±0.526)×10-3mm~2/s,恶性肿瘤为(1.202±0.060)×10-3mm~2/s,两者差异有统计学意义(P0.05)。良性肿瘤DCE-TIC表现为Ⅰ型4例,Ⅱ型16例,Ⅲ型3例;恶性肿瘤DCE-TIC表现为Ⅰ型0例,Ⅱ型5例,Ⅲ型24例,两者差异均有统计学意义(均P0.05)。表现为Ⅱ型曲线的良恶性肿块与表现为Ⅲ型曲线的肿块ADC值比较,差异有统计学意义(P0.05)。结论:MRI动态增强扫描联合DWI对乳腺良恶性肿块的诊断有重要价值,不同强化曲线类型的病灶可选择相应的ADC阈值进行判断。     

动态增强MRI鉴别乳腺良恶性病变的价值

目的：探讨动态增强MRI对乳腺良恶性病变的鉴别诊断价值。方法：对147例经手术病理证实的乳腺疾病患者行MRI平扫和动态增强检查。分析比较乳腺良恶性病变的MRI征象。包括形态学、内部信号及其动态增强特征等，计算病灶峰值增强率Emax，峰值时间Tmax，最大强化速率Slope max，并根据病变最高强化区ROI测量值，绘制病灶的时间-信号强度曲线。结果：147例患者共计病灶152个。其中恶性87个，良性65个。分析比较病变的形态学及动态增强表现，发现乳腺良性病变多呈类圆形或分叶状．边缘光整，无毛刺、边界多清晰，强化均匀或伴有内部分隔等，动态强化参数Emax多大于90％，Tmax多大于240s。Slopemax。多大于3％／s；恶性病变则多为不规则形。边缘可伴毛刺，与周围结构分界不清，强化不均匀，病灶常呈环形强化，导管样强化，Emax多大于90％，Tmax多大于240s。而Slopemax多大于3％／s。时间-信号曲线类型恶性病变多表现为Ⅱ或Ⅲ型，良性病变则多为Ⅰ或Ⅳ型。结论：乳腺MRI不仅提供了病灶丰富的形态学信息，而且还通过动态增强进一步揭示病变的血流动力学特征，从而有助于对乳腺病变作出准确的定性诊断，更有效地鉴别诊断乳腺良恶性病变。     

MR动态增强鉴别良恶性骨肿瘤及肿瘤样病变的价值

目的探讨磁共振动态增强时间-信号强度曲线(time-signal intensity curve,TIC)和动态强化参数早期动态增强的斜率值(Slope)、边缘-中心向心强化程度比(Rrim-center)在鉴别良、恶性骨肿瘤及肿瘤样病变的价值。资料与方法选择临床资料完整的骨肿瘤及肿瘤样病变患者61例行动态增强扫描,利用工作站配置的MeanCurve分析软件直接得到病变实质、邻近肌肉及相同层面的动脉TIC,测量指标包括TIC类型、Slope、Rrim-center。统计学分析结果以P<0.05为差异有统计学意义。结果 61例良恶性骨肿瘤TIC类型:23例良性骨肿瘤及肿瘤样病变中,I型0例,Ⅱ型7例(30.4%),Ⅲ型13例(56.5%),Ⅳ型3例(13.0%);38例恶性骨肿瘤中,I型11例(28.9%),Ⅱ型17例(44.7%),Ⅲ型10例(26.4%),Ⅳ型0例;良、恶性骨肿瘤TIC类型分布差异有统计学意义;TIC取I、Ⅱ型曲线为恶性诊断标准,诊断恶性肿瘤的敏感性为73.68%,特异性为69.57%,准确性为72.13%,阳性预测值为80%,阴性预测值为61.54%。动态增强参数比较,良性骨肿瘤Slope...     

MR动态增强扫描时间一信号强度曲线在骨骼肌肉系统肿瘤定性诊断中的价值

目的 探讨动态增强MRI时间一信号强度曲线(TIC)上升段最大斜率值和曲线类型在骨骼肌肉系统良、恶性肿瘤鉴别中的作用.方法 采用多时相增强快速采集梯度同波序列,对93例骨骼肌肉系统肿瘤进行MR动态增强扫描,在斜率图上选取ROI,经Functool软件后处理,得到TIC,并将曲线分为Ⅰ、Ⅱ、Ⅲ型,计算曲线上升段最大斜率值.以病理结果为金标准,对TIC类型在良、恶性肿瘤中的分布差异和曲线的上升斜率值进行χ2检验或t检验.结果 49例恶性肿瘤中,37例为I型曲线,12例为Ⅱ型曲线;44例良性肿瘤中,26例为Ⅰ型曲线,7例为Ⅱ型曲线,11例为Ⅲ型曲线,曲线类型在良、恶性肿瘤中的分布差异具有统计学意义(χ2:14.008,P<0.01).良、恶性肿瘤曲线上升斜率值分别为6.80±3.35和6.80±2.71,差异无统计学意义(t=0.008,P＞0.05).与形态学表现相结合,应用TIC类型对骨骼肌肉系统恶件肿瘤定性诊断的敏感度为100%,特异度为50%,阳性预测值为78%,阴性预测值为100%,准确度为82%.结论 TIC类型结合形态学表现,能够提高MRI对骨骼肌肉系统肿瘤良、恶性鉴别的能力.     

早期动态MRI增强斜率值在肌骨系统良恶性肿块中的鉴别诊断价值

目的　探讨早期动态增强斜率值 (Slope)在肌骨系统良恶性肿块中的鉴别诊断价值。方法　对 36例肌骨系统肿块 (良性18例 ,恶性 18例 ) ,采用GRASS序列行MRI动态增强扫描 ,绘制时间 -信号强度 (SI -Time)曲线 ,计算早期动态增强斜率值 (Slope)。分析其在良恶性肿块之间有无差异。绘制接受者操作特征 (ROC)曲线 ,得出最佳评价指标。采用Spearman等级相关分析法确定Slope与肿瘤组织微血管密度之间关系。结果　恶性组Slope值 ( 4.33± 2 .70 ) % /s(范围 0 .97%～ 10 .5 0 % /s) ,良性组 ( 1.46± 0 .97) % /s(范围 0 .37%～ 3.86% /s) ,2组间有极显著差异 (Ρ <0 .0 0 1) ,以 2 .0 % /s为界 ,Slope对肿块潜在恶性评估的敏感性、特异性、准确性分别为 83.3%、77.8%、80 .6%。Slope与肿瘤组织微血管密度之间呈线性正相关 (Ρ <0 .0 5 )。结论　早期动态增强斜率值(Slope)作为一种定量检测指标 ,对肌骨系统良恶性肿块的鉴别诊断具有重要价值。Slope反映了肿瘤组织的血管化程度及血流灌注情况     

乳腺恶性肿瘤的MRI表现及病理对照研究

目的:分析各种乳腺恶性肿瘤的MRI表现,并探讨其病理基础.材料和方法:对87名经手术病理证实的乳腺恶性肿瘤患者行MRI平扫和动态增强检查,分析比较不同病理类型乳腺恶性肿瘤的MRI特点.结果:通过分析比较87例不同病理类型乳腺恶性肿瘤的MRI表现及其时间-信号强度曲线类型,发现浸润性导管癌多呈星芒状或蟹足状肿块,边缘不规则或伴毛刺,边界不清,内部信号不均匀,增强多呈明显不均匀强化,或不规则环状强化,SI-Time曲线以Ⅲ型为主;导管原位癌常为局限于一个象限内的锲形分布不规则异常信号灶,内部信号不均匀,边界不清,增强后呈线样分支状强化,SI-Time曲线以Ⅱ、Ⅲ型为主;黏液腺癌多表现T2WI较高信号,增强后无明显强化或仅见轻度强化改变,SI-Time曲线以Ⅳ型为主;交界性分叶状肿瘤瘤体较大,边缘呈分叶状,有多结节融合样改变,增强后多呈均匀强化,部分内部可伴囊变;转移性乳腺癌为多发性明显强化的类圆形肿块,边缘光整;湿疹样癌多表现为乳头表面凹凸不平,增强后明显强化;乳腺淋巴瘤、髓样癌及腺样囊性癌等少见病变亦因其不同的病理基础而有其特征性的影像学表现.结论:乳腺恶性肿瘤因其不同的病理基础,表现出不同的MRI特征,正确认识将有助于对乳腺病变作出准确的定性诊断.     

Oral and oropharyngeal tumors

There is a large variability of tumors and tumor-like lesions, which are located in the oral cavity and oropharynx. But more than 90% of all tumors in this area are squamous cell carcinomas (SCCs). Other malignancies in this location are rare. About 10% of all oral and oropharyngeal tumors are benign. Congenital lesions, like vascular malformations, lingual thyroid or (epi-)dermoid cyst, usually become present in youth or childhood. Acquired lesions can be inflammatory (abscess) or neoplastic (pleomorphic adenoma and hemangioma). Preferred imaging in childhood are ultrasound and magnetic resonance imaging (MRI), while in adults usually computed tomography (CT) and MRI are more frequently used.     

原发性结外淋巴瘤在耳鼻及咽部的临床特点

目的 总结原发性结外淋巴瘤在耳、鼻及咽部的临床表现,以提高及时确诊率。方法 回顾性分析16例原发性结外淋巴瘤在耳、鼻及咽部的临床表现特点,特别是罕见的中耳淋巴瘤和少见的副鼻窦淋巴瘤的临床表现。结果 中耳淋巴瘤1例,以伴有疼痛的慢性分泌性中耳炎(传导性聋)、轻度面瘫为特点;扁桃体淋巴瘤7例,以咽异物感及单侧扁桃体肿大为特点;鼻及副鼻窦淋巴瘤2例,以血涕、鼻臭、下鼻甲黏膜粗糙,增厚为特点;鼻咽部淋巴瘤以血涕、头痛为特点;口咽部淋巴瘤以咽痛、发热、软腭溃疡、口臭为特点。结论 在发现耳、鼻及咽部病变时,掌握原发性结外淋巴瘤在耳、鼻及咽部的临床表现特点,及时行病理检查,是及时确诊的关键。     

乳腺癌术后肝转移癌的声像图特点

本文回顾性分析了１９８７－１１～１９９４－１１乳腺癌术后肝内占位性病变１２０例，其中９８例为转移癌，２２例为非均匀性脂肪肝、肝囊肿或血管瘤。采用针吸活检、诊断性化疗、综合影像学诊断及超声随访方法证实。乳腺癌术后出现脂肪肝的比例较高（４７％），肝转移伴脂肪肝者３５例（３６％），其声像图特点为内部呈低回声（６６％）及周围无低回声晕（６９％）；而不伴脂肪肝者６３例（６４％），其内部多呈等回声（５９％），常伴低回声晕（７６％）。脂肪肝的存在使肝脏回声衰减，可能导致占位显示不清而漏诊；脂肪肝的存在又往往使得一些占位病变表现不典型而误诊。当声像图不典型、鉴别诊断困难时，应做超声引导下穿刺活检予定性诊断。     

FDG PET/CT and Mediastinal Nodal Metastasis Detection in Stage T1 Non-Small Cell Lung Cancer: Prognostic Implications

Objective

We aimed to compare the prognoses of patients with pathologically true negative (P-TN) N2 and PET/CT false negative (FN) results in stage T1 non-small cell lung cancer (NSCLC).

Materials and Methods

Our institutional review board approved this retrospective study with a waiver of informed consent. The study included 184 patients (124 men and 60 women; mean age, 59 years) with stage T1 NSCLC who underwent an integrated PET/CT and surgery. After estimating the efficacy of PET/CT for detecting N2 disease, we determined and compared disease-free survival (DFS) rates in three groups (P-TN [n = 161], PET/CT FN [n = 12], and PET/CT true positive [TP, n = 11]) using the Kaplan-Meier analysis and log-rank test.

Results

Pathologic N2 disease was observed in 23 (12%) patients. PET/CT had an N2 disease detection sensitivity of 48% (11 of 23 patients), a specificity of 95% (153 of 161), and an accuracy of 89% (164 of 184). The 3-year DFS rate in the PET/CT FN group (31%, 95% confidence interval [CI]; 13.6-48.0%) was similar to that of the TP group (16%, 95% CI; 1.7-29.5%) (p = 0.649), but both groups had significantly shorter DFS rates than the P-TN group (77%, 95% CI; 72.0-81.2%) (p < 0.001).

Conclusion

The PET/CT shows a high specificity, but low sensitivity for detecting N2 disease in stage T1 NSCLC. Patients with PET/CT FN N2 disease have survival rates similar to PET/CT TP N2 disease patients, which are both substantially shorter than the survival rate of P-TN patients.     

Lung metastases

The lungs are among the most prominent target organs for metastatic disease. Most frequently, lung metastases originate from cancers of the head and neck, breast, stomach, pancreas, kidney, bladder, the male and female genitourinary tract, and sarcomas. Plain chest radiography is typically the modality used for detection and therapeutic monitoring; however, the use of CT for these purposes is becoming more frequent. Currently, spiral CT appears to be the most sensitive imaging technique in the identification of metastases, because it detects a higher number of pulmonary nodules compared to other techniques. Pulmonary metastatic disease manifests itself by the presence of pulmonary nodules, lymphangitic carcinomatosis, endobronchial tumors, and pleural involvement. Nevertheless, the differential diagnosis is an important consideration, particularly in patients with solitary pulmonary nodules, systemic disorders, and signs or symptoms indicative of infection. The role of the radiologist involves the identification of metastatic disease, monitoring of response to therapy, and the use of invasive procedures when the differential diagnosis indicates the need for biopsy and histopathologic proof. The radiologist must be aware of the impact of his diagnosis on patient management and should be familiar with oncologic strategies as well as the terminology used to characterize tumor response. In future, the role of imaging may further expand due to the increased sensitivity in lesion detection, increased specificity in lesion (tissue) characterization using MR imaging, and reduced radiation exposure. Correspondence to: Christian J. Herold     

Follow-up Results After Negative Findings on Unenhanced Hepatic MR Imaging for Hepatic Metastasis from Rectal Cancer

Objective

To assess the follow-up results after negative findings on unenhanced hepatic MR imaging in rectal cancer patients who have undergone locally curative surgery.

Materials and Methods

From all pertinent imaging reports and medical records, we selected 255 patients who had negative results on unenhanced hepatic MR imaging. When selecting patients who had undergone curative resection, the following patients were excluded from the study: 1) patients in whom extrahepatic metastases were detected on preoperative staging work-ups, 2) patients in whom the surgery was judged to be non-curative due to peritoneal seeding or local aggressiveness. Cases with follow-up periods of less than 18 months were also excluded, as these cases were considered insufficient to confirm the negative outcomes. Thus, a total of 149 patients were ultimately enrolled in our study. The follow-up results of unenhanced MR imagings were assessed according to the assumption that the newly developed hepatic metastases had been false-negative lesions on preoperative MR image.

Results

During a median follow-up period of 29.3 months, 25 hepatic metastases were detected in 13 patients (8.7%), which indicated a negative predictive value of 91.3%.

Conclusion

Unenhanced hepatic MR imaging provides a high negative predictive value with regard to the detection of hepatic metastasis in the preoperative evaluation of rectal cancer.     

Carcinosarcoma of the Liver: A Case Report

Primary hepatic carcinosarcoma is a rare tumor comprised of a mixture of carcinomatous and sarcomatous elements. Less than 20 adequately documented cases have been reported, however the imaging features of two cases were briefly described. We present here a case of carcinosarcoma of the liver in a 46-year-old woman, which was confirmed based on pathology. Imaging showed a large mass with large necrotic portions, small cystic portions, calcifications and bone formations.     

高场MRI对喉及下咽癌术前分期价值的评价

目的评价高场MRI（1.5T）在喉、下咽癌术前分期中的价值。方法对36例喉、下咽癌患者的MRI资料进行回顾性分期，并与临床分期及手术病理分期相对照。结果MRI对各期喉、下咽癌的准确率分别是T192%，T286%，T386%，T4100%。临床分期准确率分别是T1100%，T286%，T357%，T422%。MRI和临床分期总准确率分别是92%，69%。二者之间有显著性差异。结论高场MRI通过不同加权像的对比和从多角度准确显示肿瘤的部位形态及浸润范围，因而显著性提高喉、下咽癌术前分期的准确性。     

腹腔镜手术治疗子宫恶性肿瘤的应用价值

目的 研究腹腔镜下广泛全子宫切除术、盆腔淋巴结切除术治疗早期子宫恶性肿瘤的应用价值.方法 回顾性分析34例经腹腔镜和30例开腹手术治疗的临床Ⅰ～Ⅱ期子宫恶性肿瘤患者的临床资料,比较两组的手术时间、术中出血量、并发症、术后恢复情况及淋巴结切除数目等.结果 两组的手术时间、并发症发生率无显著性差异.腹腔镜组的术中出血量为247.13±127.62ml,明显少于同期开腹手术者(904.51±428.37ml,P＜0.01).腹腔镜组淋巴结切除数为23.2±5.8个,多于开腹组淋巴结切除数(16.5±3.8,P＜0.01).术后胃肠功能恢复时间,腹腔镜组为26.4±8.3h,开腹组为54.6±13.5h,两组间有显著性差异(P＜0.01).术后随访11个月两组均未见复发病例.结论 腹腔镜下广泛全子宫切除术、盆腔淋巴结切除术获得满意的效果,近期疗效肯定,远期疗效尚需进一步随访分析.     

MR Imaging of papillary renal neoplasms: potential application for characterization of small renal masses

The purpose of our study was to evaluate the role of MRI in demonstrating the precise nature of papillary renal tumors (P RCC) and its potential application to select patients for partial surgery. Ninety-seven tumors less than or equal to 3 cm in size [55 papillary renal cell carcinoma - 42 clear cell renal carcinoma (CC RCC)] were preoperatively evaluated by MRI. Imaging findings were assessed with a special focus on the aspect of the tumoral process. Correlations were performed with pathologic staging after surgery. At pathology, 92 tumors were established to be staged p T1 and 5 were p T3 ( 3 cases of CC RCC and 2 cases of P RCC). Ninety-four percent of papillary tumors exhibited low signal intensity with homogeneous pattern on T2-weighted images. All clear cell carcinoma were hyperintense and heterogeneous on T2-weighted sequence. Enhancement was lower and delayed in the papillary type in comparison with the clear cell type. MRI is accurate enough to predict the ‘histologic‘ nature of papillary renal carcinoma. It is an additional argument to propose that the tumor can be removed by partial surgery.