磁共振扩散加权成像对结肠癌术后肝转移灶检出的临床研究

目的:探讨磁共振扩散加权成像对结直肠癌肝转移的诊断价值。方法:27例结直肠癌患者行肝脏磁共振扩散加权成像、非增强磁共振和多层CT检查。阅片前告知阅片者患者为结直肠癌术后,但不提供临床病史和既往影像学资料。结果:多层CT、非增强磁共振和扩散加权成像对肝转移灶的敏感度分别为72%(45/63)、76%(48/63)和93%(58/63),扩散加权成像对肝转移灶具有更高的敏感度且与多层CT和非增强MRI相比,差异有显著性意义。扩散加权成像对肝转移患者敏感度最高(82%),而多层CT和非增强MRI分别为77%和66%。结论:磁共振扩散加权成像对结直肠癌肝转移灶的检出率高于多层CT和非增强MRI。     

磁共振成像扩散加权成像联合肿瘤标记物对结直肠癌术前肝转移的早期诊断价值

目的 探究磁共振成像(MRI)扩散加权成像联合肿瘤标记物对结直肠癌术前肝转移的早期诊断价值.方法 选取我院于2019年1月至2020年5月收治的30例结直肠癌患者作为本次的研究对象,术前检测患者肿瘤标志物癌胚抗原(CEA)、糖类抗原(CA)125、CA19-9的水平,记录并分析患者的MRI扩散加权成像特点,评价单项和两...     

多模态磁共振技术对比评估结直肠癌肝转移的价值

目的对比评估常规MRI(T2WI)、DWI及动态增强磁共振(DCE-MRI)探查结直肠癌肝转移灶的价值。方法共32例患者行3.0T MRI腹部扫描,两名放射医师独立分析所有受检者肝脏的常规MRI序列(T2WI),DWI序列及DCEMRI序列,以手术病理、术中超声及治疗前后影像图像的综合评价作为金标准,评判各个序列探查肝转移灶的阅片间一致性,并两两比较各序列探查肝转移灶的敏感性、阳性预测值(PPV)及AUC面积(area under the ROC curve)。结果探查所有肝转移灶时,DWI及DCE-MRI序列均获得了很好的阅片者间一致性并明显高于T2WI,在探查直径小于1cm的肝转移灶时,DWI的阅片者间一致性明显高于DCE-MRI及T2WI序列;探查所有肝转移灶时,DWI及DCE-MRI序列的敏感性、PPV及AUC面积均高于T2WI;探查直径小于1cm的肝转移灶时,DWI的各参数均明显高于T2WI,敏感性及AUC高于DCE-MRI序列,DCE-MRI序列的阳性预测值及AUC高于T2WI序列。结论非增强DWI序列可以有效探查结直肠癌肝转移灶,且与增强DCE-MRI序列无明显差异;而在探查直径小于1cm的肝转移灶时,DWI序列的整体价值较其他序列更高。     

肝脏MR成像对CT发现有潜在治愈可能的结直肠癌肝转移病人的增值:扩散加权成像、钆塞酸增强MR成像以及这两种MR技术联合应用的前瞻性比较

<正>目的前瞻性比较扩散加权(DW)成像、钆塞酸增强MR成像、两种技术联合(联合MR成像)及CT在检测结直肠癌肝转移的诊断性能和评估MRI对CT发现有潜在治     

肝脏钆塞酸增强MRI与扩散加权成像上化疗后消失或残留的微小(≤5mm)结直肠癌肝转移灶是否需要局部治疗?

正摘要目的评价经化疗结直肠癌肝转移(CLM)病人钆塞酸增强MRI与扩散加权成像(DWI)上消失的结直肠癌肝转移(DLM)或残留微小(≤5 mm)的结直肠癌肝转移(RTCLM)     

无创性影像技术对于结直肠癌区域淋巴结侵犯术前评价的比较研究与病理对照

目的:评价多排螺旋计算机断层扫描(CT)、磁共振成像(MRI)、MRI结合扩散加权成像(DWI-MRI)在结直肠癌区域淋巴结侵犯中的作用.方法:35名原发结直肠癌患者,于术前进行MRI检查,其中25名患者同时进行CT检查.将CT、MRI、DWI-MRI对于肿瘤区域淋巴结侵犯的诊断结果与病理学结果进行对照,应用x2分析检验不同影像方法诊断的准确性.结果:CT、MRI和DWI-MRI淋巴结分期结果与组织病理学结果的整体符合率分别为56%、57.1%和74.3%.经x2分析,DWI-MRI诊断结果与病理学结果具有中等相关性,Kappa值为0.536(P＜0.05);CT和MRI诊断结果与病理学结果无明显相关性,Kappa值分别为0.138(P＞0.05)和0.150(P＞0.05).结论:DWI-MRI更为准确的预测结直肠癌区域淋巴结侵犯情况.     

MR直方图预测结直肠癌肝转移化疗疗效

正摘要目的以实体瘤疗效评价标准(RECIST 1.1)为参考标准,探讨MRI直方图分析对预测结直肠癌肝转移病人化疗疗效的价值。方法 53例结直肠癌肝转移病人在化疗前进行常规MRI检查,包括扩散加权成像(b=0,500 s/mm~2)。将表观扩散系数(ADC)图、动脉期和门静脉期强化图中的最大转移灶兴趣区(ROI)以直方图形式显示,得到上述图像中最     

磁共振DWIBS在结直肠癌术后评估中的价值

目的 探讨磁共振背景抑制扩散加权成像(DWIBS)在结直肠癌术后评估中的价值.方法 对71例病理证实为结直肠癌并术后的患者均行常规MRI及DWIBS检查.回避囊变坏死区,测量病变区与邻近正常组织在常规MRI及DWIBS中的信号强度(SI)、背景噪声标准差(SD)及表观扩散系数(ADC)值,计算分别在T1WI、T2-STIR、DWIBS中病灶的对比噪声比.判断常规MRI及DWIBS在结直肠癌术后评估中的准确性、敏感性及特异性.结果 DWIBS对结直肠癌术后复发诊断的敏感性为100％,准确性为95％,ROC曲线下面积(AUC)为0.871(P＜0.05).复发组信号强度明显高于对照组(P＜0.05),ADC值明显小于对照组(P＜0.05).DWIBS对术后淋巴结转移诊断的敏感性为96.29％,AUC为0.934(P ＜0.05).最小淋巴结短径约0.5 cm.对术后肝转移的检出率为94％;＜1.0 cm小病灶,常规MR1序列检出率为61％ (51/84),DWIBS检出率为90％ (76/84).AUC为0.903(P＜0.05).结论 DWIBS对结直肠癌术后复发、淋巴结转移及以肝脏转移为主的远处转移的监测敏感性较高,是术后评估的有效方法.     

肺结节的检出--快速屏气MRI与多层螺旋CT对比研究

目的:通过两个独立阅片人阅片,评价两种磁共振(MRI)快速成像序列和螺旋CT对肺结节显示的敏感性和假阳性率。方法:所有30例患者均行螺旋CT或多层螺旋CT扫描,使用SiemensSonata1.5T磁共振扫描机行3D梯度回波(3D GRE:TR/TE/Flip=2.9ms/1.1ms/5°)和半傅立叶采集单次激发快速自旋回     

磁共振全身弥散成像对结直肠癌原发病灶筛查的价值

目的:探讨磁共振全身弥散成像(WB-DWI)对结直肠癌原发病灶筛查方面的价值.方法:对已经确诊的结直肠癌患者43例作为研究组,另随机选取健康人群10例,痔疮患者8例,息肉患者10例作为对照组,进行常规MRI及WB-DWI检查,进行常规MRI、WB-DWI、手术、病理资料对比研究分析.结果:结直肠癌在WB-DWI上表现为较高信号,与正常肠管相比,其DWI信号强度明显高于正常肠壁的信号强度(P＜0.05),其ADC值明显小于正常肠壁的ADC值(P＜0.05).WB-DWI最终正确诊断68例,3例假阳性诊断,0例假阴性诊断.WB-DWI对结直肠癌原发病灶检出的敏感性为100%(43/43),特异性为89%(25/28),诊断准确性为96%(68/71).结论:WB-DWI可以快速发现结直肠癌,对结直肠癌的全身筛查和早期诊断方面具有重要意义.     

Detection of colorectal liver metastases: a prospective multicenter trial comparing unenhanced MRI, MnDPDP-enhanced MRI, and spiral CT

The aim of this study was to compare unenhanced MRI, MnDPDP-enhanced MRI, and spiral CT in the detection of hepatic colorectal metastases. Forty-four patients with hepatic colorectal metastases were examined with unenhanced and MnDPDP-enhanced MRI and with unenhanced and contrast-enhanced spiral CT. The MR examination protocol included baseline T1-weighted spin-echo (SE), T1-weighted gradient-recalled-echo (GRE), and T2-weighted fast-SE sequences; and T1-weighted SE and T1-weighted GRE sequences obtained 30–60 min after administration of 0.5 µmol/kg (0.5 ml/kg) mangafodipir trisodium (MnDPDP). Images were interpreted by three blinded readers. Findings at CT and MRI were compared with those at intraoperative US, which were used as term of reference. Intraoperative US detected 128 metastases. In a lesion-by-lesion analysis, the overall detection rate was 71% (91 of 128) for spiral CT, 72% (92 of 128) for unenhanced MRI, and 90% (115 of 128) for MnDPDP-enhanced MRI. MnDPDP-enhanced MRI was more sensitive than either unenhanced MRI (p<0.0001) or spiral CT (p=0.0007). In a patient-by-patient analysis, agreement with gold standard was higher for MnDPDP-enhanced MRI (33 of 44 cases) than for spiral CT (22 of 44 cases, p=0.0023) and unenhanced MRI (21 of 44 cases, p=0.0013). MnDPDP-enhanced MRI is superior to unenhanced MRI and spiral CT in the detection of hepatic colorectal metastases.     

Detection of liver metastasis: is diffusion-weighted imaging needed in Gd-EOB-DTPA-enhanced MR imaging for evaluation of colorectal liver metastases?

Purpose

We compared diagnostic ability for detecting hepatic metastases between gadolinium ethoxy benzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) on a 1.5-T system, and determined whether DWI is necessary in Gd-EOB-DTPA-enhanced MRI for diagnosing colorectal liver metastases.

Materials and methods

We assessed 29 consecutive prospectively enrolled patients with suspected metachronous colorectal liver metastases; all patients underwent surgery and had preoperative Gd-EOB-DTPA-enhanced MRI. Overall detection rate, sensitivity for detecting metastases and benign lesions, positive predictive value, and diagnostic accuracy (Az value) were compared among three image sets [unenhanced MRI (DWI set), Gd-EOB-DTPA-enhanced MRI excluding DWI (EOB set), and combined set].

Results

Gd-EOB-DTPA-enhanced MRI yielded better overall detection rate (77.8?C79.0?%) and sensitivity (87.1?C89.4?%) for detecting metastases than the DWI set (55.9?% and 64.7?%, respectively) for one observer (P?<?0.001). No statistically significant difference was seen between the EOB and combined sets, although several metastases were newly detected on additional DWI.

Conclusions

Gd-EOB-DTPA-enhanced MRI yielded a better overall detection rate and higher sensitivity for detecting metastases compared with unenhanced MRI. Additional DWI may be able to reduce oversight of lesions in Gd-EOB-DTPA-enhanced 1.5-T MRI for detecting colorectal liver metastases.     

Diagnostic accuracy of portal-phase CT and MRI with mangafodipir trisodium in detecting liver metastases from colorectal carcinoma

AIM: To compare the diagnostic accuracy of single section spiral computed tomography (CT) and magnetic resonance imaging (MRI) with tissue-specific contrast agent mangafodipir trisodium (MnDPDP) in the detection of colorectal liver metastases. MATERIAL AND METHODS: One hundred and twenty-five consecutive patients undergoing surgery for primary and/or metastatic disease were evaluated using CT (5 mm collimation and reconstruction interval, pitch 2), two-dimensional fast spoiled gradient echo (2D FSPGR) T1 and single shot fast-spin echo (SSFSE) T2 weighted breath-hold MRI sequences, performed before and after intravenous administration of MnDPDP. The reference standards were intraoperative ultrasound and histology. RESULTS: The per-patient accuracy of CT was 72.8 versus 78.4% for unenhanced MRI (p = 0.071) and 82.4% for MnDPDP-enhanced MRI (p = 0.005). MnDPDP-enhanced MRI appeared to be more accurate than unenhanced MRI but this was not significant (p = 0.059). The sensitivity of CT was 48.4% versus 58.1% for unenhanced MRI (p = 0.083) and 66.1% for MnDPDP-enhanced MRI (p = 0.004). The difference in specificity between procedures was not significant. The per-lesion sensitivity was 71.7, 74.9 and 82.7% for CT, unenhanced MRI, and MnDPDP-enhanced MRI, respectively; the positive predictive value of the procedures was respectively 84.0, 96.0 and 95.8%. MnDPDP-enhanced MRI provided a high level diagnostic confidence in 92.5% of the cases versus 82.5% for both unenhanced MRI and CT. The kappa value for inter-observer variability was >0.75 for all procedures. CONCLUSIONS: The diagnostic accuracy and sensitivity of MnDPDP-enhanced MRI is significantly higher than single section spiral CT in the detection of colorectal cancer liver metastases; no significant difference in diagnostic accuracy was observed between unenhanced MRI and MnDPDP-enhanced MRI.     

Comparison of MRI (including SS SE-EPI and SPIO-enhanced MRI) and FDG-PET/CT for the detection of colorectal liver metastases

Fluoro-18-deoxyglucose positron emission tomography computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI), including unenhanced single-shot spin-echo echo planar imaging (SS SE-EPI) and small paramagnetic iron oxide (SPIO) enhancement, were compared prospectively for detecting colorectal liver metastases. Twenty-four consecutive patients suspected for metastases underwent MRI and FDG-PET/CT. Fourteen patients (58%) had previously received chemotherapy, including seven patients whose chemotherapy was still continuing to within 1 month of the PET/CT study. The mean interval between PET/CT and MRI was 10.2 ± 5.2 days. Histopathology (n = 18) or follow-up imaging (n = 6) were used as reference. Seventy-seven metastases were detected. In nine patients, MRI and PET/CT gave concordant results. Sensitivities for unenhanced SS SE-EPI, MRI without SS SE-EPI and FDG-PET/CT were, respectively, 100% (p = 9 × 10⁻¹⁰ vs PET, p = 8 × 10⁻³ vs MRI without SS SE-EPI), 90% (p = 2 × 10⁻⁷ vs PET) and 60%. PET/CT sensitivity dropped significantly with decreasing size, from 100% in lesions larger than 20 mm (identical to MRI), over 54% in lesions between 10 and 20 mm (p = 3 × 10⁵ versus unenhanced SS SE-EPI), to 32% in lesions under 10 mm (p = 6 × 10⁻⁵ versus unenhanced SS SE-EPI). Positive predictive value of PET was 100% (identical to MRI). MRI, particularly unenhanced SS SE-EPI, has good sensitivity and positive predictive value for detecting liver metastases from colorectal carcinoma. Its sensitivity is better than that of FDG-PET/CT, especially for small lesions.     

18F-FDG PET/CT与PET/MRI在结直肠癌肝转移诊断中的比较分析

目的:比较 18F-氟脱氧葡萄糖（FDG） PET/CT与PET/MRI显像对结直肠癌肝转移的诊断价值。 方法:回顾性分析2018年9月至2019年9月于宁波明州医院行全身 18F-FDG PET/CT显像及上腹部 18F-FDG PET/MRI显像,并疑似有结直肠癌肝转移...     

Comparison of gadoxetic acid-enhanced dynamic imaging and diffusion-weighted imaging for the preoperative evaluation of colorectal liver metastases

Purpose:

To retrospectively compare the diagnostic accuracy for the detection of colorectal liver metastases between gadoxetic acid‐enhanced MRI (EOB‐MRI) and diffusion‐weighted imaging (DWI) on 3.0 Tesla (T) system, and then to determine whether a combination of the two techniques may improve the diagnostic performance.

Materials and Methods:

Forty‐seven patients underwent MR imaging at 3.0T, including DWI (DWI set) and dynamic and hepatobiliary phase EOB‐MRI (EOB set) for the preoperative evaluation of colorectal liver metastases. All suspicious metastases were confirmed by hepatic surgery. Two blinded readers independently reviewed three different image sets, which consisted of DWI set, EOB set, and combined set. The accuracy was assessed by the area (Az) under the alternative‐free response receiver operating characteristic curve, and the sensitivity and positive predictive value (PPV) were calculated.

Results:

We found a total of 78 confirmed colorectal liver metastases in 42 of 47 patients. Each reader noted higher diagnostic accuracy of combined set of EOB‐MRI and DWI than DWI set and EOB set, without statistical significance. Regardless of the size of colorectal liver metastasis, each reader detected significantly more metastases on combined set than on DWI set, and PPV was significantly higher with DWI set than with EOB set or with combined set for one reader.

Conclusion:

EOB‐MRI was more useful for the detection of colorectal liver metastases, while DWI was more useful for their characterization. The combination of EOB‐MRI and DWI showed significantly higher accuracy and sensitivity for the preoperative detection of small colorectal liver metastases than DWI. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

MRI and PET/CT of patients with bone metastases from breast carcinoma

3.0Tesla magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was compared with combined 18F-fluorodeoxyglucose positron emission tomography and computed tomography (PET/CT) in patients with suspected bone metastases from breast cancer. A prospective clinical study was performed in 13 female breast cancer patients (mean age 61years; range 45-85 years). The spine was imaged in the sagittal plane with T1-weighted (T1), short tau inversion recovery (STIR), and T2-weighted fat-saturated (T2) sequences. The pelvis was imaged similarly in the coronal plane. Axial DWI was performed from the skull base to the mid-thigh. MRI and PET/CT were performed in all patients at a maximum interval of 10 working days and at least 14 days after chemotherapy. MRI was reviewed by two radiologists, and their consensus on potential metastases in 27 predefined locations was recorded. The predefined locations were the vertebral bodies (24), the left (1) and right (1) pelvic bones, and the sacral bone (1). The PET/CT was reviewed by a radiologists and a nuclear medicine physician. MRI detected 59 of the 60 active metastases found with our gold standard modality PET/CT. T1 had the highest sensitivity (98%) but rather low specificity (77%), but with the addition of STIR and DWI, the specificity increased to 95%. The additional metastases detected with MRI most likely represented postherapeutic residual scars without active tumour. In conclusion, 3.0Tesla MRI with T1, STIR, and DWI is useful for the clinical evaluation of bone metastases from breast cancer and compares well to PET/CT.     

Detection of hypovascular hepatic metastases at triple-phase helical CT: sensitivity of phases and comparison with surgical and histopathologic findings

PURPOSE: To compare the respective sensitivities of unenhanced, arterial-dominant, and portal-dominant phase helical computed tomography (CT) in the preoperative depiction of hypovascular hepatic metastases by using intraoperative ultrasonographic (US) and histopathologic findings as the standard of reference. MATERIALS AND METHODS: In this prospective study, 32 patients with 59 surgically and histopathologically proved hypovascular hepatic metastases underwent triple-phase helical CT of the liver, which included unenhanced, arterial-dominant, and portal-dominant phase scanning. Images from each phase were separately analyzed by three readers, and disagreements were resolved with consensus readings. The findings on CT images were compared with intraoperative US and histopathologic findings on a lesion-by-lesion basis to determine the sensitivity of each imaging phase. Statistical review of the lesion-by-lesion analysis was performed by using the Wilcoxon rank sum test. RESULTS: Among 59 hepatic metastases, unenhanced, arterial-dominant, and portal-dominant phase helical CT imaging depicted 39 (66.1%; 95% CI: 53.3%, 76.8%), 44 (74.5%; 95% CI: 62.2%, 83.9%), and 54 (91.5%; 95% CI: 81.6%, 96.3%) metastases, respectively. Portal-dominant phase imaging depicted significantly more hypovascular hepatic metastases than did unenhanced (P <.001) or arterial-dominant (P <.01) phase imaging (Wilcoxon test). CONCLUSION: Preoperative use of triple-phase helical CT in patients with hypovascular hepatic metastases may not be warranted. Portal-dominant phase helical CT imaging allows depiction of significantly more hypovascular hepatic metastases than does imaging during any of the other phases.     

Comparison of unenhanced and contrast-enhanced spiral CT for assessing interval change in patients with colorectal liver metastases

RATIONALE AND OBJECTIVES: The purpose of this study was to determine whether the interval change in hepatic colorectal metastases as assessed with serial computed tomographic (CT) scans without contrast material enhancement differs from that as assessed using serial, portal dominant phase, contrast-enhanced CT scans. MATERIALS AND METHODS: Unenhanced and contrast-enhanced abdominal CT scans were obtained in 28 patients. Three radiologists separately reviewed serial unenhanced and contrast-enhanced studies to assess the interval change in liver metastases. These radiologists recorded total number of lesions, bidimensional measurements of the largest lesions (as many as three), and overall impressions regarding the interval change (none, worse, or better). RESULTS: Among the 84 judgments (28 patients x 3 radiologists), comparisons of unenhanced and contrast-enhanced CT studies were concordant in 60 assessments (71%). Nineteen (23%) showed mild disagreement. Of these, contrast-enhanced CT studies demonstrated disease stability when unenhanced CT studies demonstrated otherwise in 11 judgments, whereas unenhanced CT studies demonstrated stability when contrast-enhanced CT studies demonstrated otherwise in eight assessments. Furthermore, of the five marked disagreements, two resulted from a conclusion of interval improvement on unenhanced CT studies and a conclusion of interval worsening on contrast-enhanced CT studies, whereas three demonstrated the opposite. Neither set of serial CT studies systematically resulted in under- or overestimation of disease progression (McNemar Q test, P < .25). CONCLUSION: The authors found no consistent pattern to demonstrate that serial unenhanced or contrast-enhanced CT studies resulted in over- or underestimation of disease progression.