脑结核瘤的MRI诊断及其临床价值

目的：研究磁共振成像(MRI)对脑结核瘤的影像学诊断及其临床价值。方法：回顾性分析了12例经手术、病理或抗结核治疗随访证实为脑结核瘤病人的MRI及其临床资料。采用0．3T低场永磁型设备，行常规SET1WI、FSET2WI，其中11例行钆喷替酸葡甲胺(Gd-DTPA)增强扫描。10例行CT检查，其中6例行CT增强扫描。结果：本组12例共发现病灶32个，单发7例，多发5例，其中1例合并粟粒性结核瘤。将脑结核瘤的MRI表现不同分为2种类型。T1WI呈等或略高信号、T2WI呈等或略低信号，明显结节样强化或不均匀环状强化是脑结核瘤较具特征性的MRI表现，环内核心部分呈T2WI低信号对诊断更有价值。针对脑结核瘤的不同类型采取抗结核药物或手术切除等不同的治疗方法。结论：脑结核瘤有较特征性的删表现，并可指导临床采取不同的治疗方法。     

MRI对椎体结核诊断价值的评价

本文分析了22例椎体结核的MRI形态及信号特征,认为MRI能敏感地显示椎体结核引起的椎体、椎间隙和椎间盘的异常,并能清楚地判定冷脓肿和椎管内受侵的范围。指出MRI 是诊断椎体结核较为理想的影像学手段。     

脑结核瘤的MRI诊断价值研究

目的：研究MRI对脑结核瘤的影像学诊断价值。方法：回顾性分析18例经临床治疗或手术确诊脑结核瘤病人的MRI表现。采用1．5T超导型MRI机，行常规T1WIT2WI FLAIR序列扫描并Gd—DTPA增强检查。结果：本组18例中单发病灶2例，多发16例。其中粟粒性脑结核瘤2例（未计数），共发现病灶96个，分布干幕上60个，幕下30个，脑干6个。T1WI上呈等或略高信号，T2WI上呈等或略低信号，增强后呈明显结节状强化或环形强化是脑结核瘤较具特征性的MRI表现，中心部分T2WI低信号对诊断更有价值。结论：脑结核瘤的MRI表现具有特征性，对于临床正确诊断及治疗有较高价值。     

脊柱结核的MRI诊断

MRI组织分辨率高，能多方位、多参数成像。对脊柱结核的诊断及鉴别比X线平片、CT提供了更多信息。因此成为术前诊断及治疗随访的可靠方法。本文收集经手术病理或临床治疗证实的脊柱结核24例。分析其MRI表现，以提高对脊柱结核诊断水平。     

MRI在脊柱结核诊断中的应用价值

目的 探讨MRI在脊柱结核诊断中的价值. 资料与方法 对34例临床疑脊柱结核者,术前行X线平片、MRI平扫及增强检查,并分别与手术病理结果 对比. 结果 34例中,最终诊断结核者33例,另1例为慢性化脓性炎. 33例结核X线平片诊断正确24例(72.7%),MRI均正确诊断(100%);1例慢性化脓性炎平片及MRI 均误诊为结核. 结论 MRI可清楚显示脊柱结核的骨髓水肿、椎体破坏、椎旁脓肿、间盘受累和椎管内改变,诊断准确率高,评价细致全面,并且能早期诊断.     

中枢神经系统结核的MRI诊断

目的：分析中枢神经系统结核的MRI表现,探讨MRI的诊断价值。方法：收集我院自2006年9月-2008年5月的中枢神经系统结核121例,其中颅内结核111例、椎管内结核10例。对所有病例均作常规MRI平扫,静脉注射Gd-DTPA增强,并对其MRI表现作回顾性总结。结果：脑膜结核60例、脑实质结核33例、脑膜并脑实质结核18例,脊膜结核4例、结核性脊髓炎4例、脊膜并脊髓结核2例,合并脑梗死24例、脑积水22例,合并室管膜炎3例、硬膜下积液1例、脊髓空洞4例。结论：MRI是检查中枢神经系统结核的重要和可靠方法。     

颅内结核瘤的MRI诊断

目的 通过分析３２例脑结核瘤的ＭＲＩ表现，讨论了脑结核瘤的鉴别诊断。方法 回顾性分析了３２例经手术、病理或临床随访证实为脑结核瘤患者的ＭＲＩ表现。全部病例均获取自旋回波Ｔ１ＷＩ、自旋回波或快速自旋回波Ｔ２ＷＩ及钆喷替酸葡甲胺（Ｇｄ－ＤＴＰＡ）增强Ｔ１ＷＩ。结果 全部病例ＭＲＩ平扫均发现病灶，单发２５例（包括脑膜结核瘤１例），多发７例（其中粟粒性脑结核瘤１例），除１例粟粒性外，３１例患者共发现４６个     

前列腺脓肿的MRI诊断

目的:探讨前列腺脓肿的MRI诊断价值。方法:回顾性分析4例临床证实的前列腺脓肿的MRI表现。结果:单个脓肿2例,多发脓肿2例。脓肿T1WI呈稍低信号或低信号,T2WI呈高信号或较高信号。增强扫描脓肿壁薄环状明显强化2例,厚环状中等度强化2例,内见强化分隔,脓腔不强化。伴精囊腺肿大3例,精囊腺脓肿1例。向前列腺周围组织蔓延2例。结论:前列腺脓肿MRI表现具有特征性,容易发现小脓肿,并可以确定脓肿蔓延的范围。     

MRI和MRS对前列腺疾病的鉴别诊断价值

目的探讨MRI和MRS在前列腺疾病中的鉴别诊断价值。方法回顾分析经病理证实的22例患者的临床资料及MRI和MRS所见,其中包括前列腺良性增生(BPH)16例及前列腺癌(PC)6例。MRI观察前列腺大小、病变位置、信号特点和肿瘤侵犯程度,MRS观察枸橼酸盐(Cit)、胆碱复合物(Cho)和肌酸(Cr)的化学位移及(Cho Cr)/Cit比值。结果16例BPH中,前列腺弥漫性增大,T2W均示前列腺中央叶明显增大,其中13例表现为多个大小不等类圆形高和/或低信号结节,部分低信号结节周围可见低信号假包膜,外围带受压变窄。6例PC中5例均表现为T2W外周带中见低信号区,1例表现为中央叶前部较大低信号结节;2例位于包膜内,4例突破包膜侵犯精囊腺和血管神经束,其中1例伴有盆腔淋巴结肿大和骨盆骨转移。MRS上BPH患者Cit明显升高,Cho略升高,(Cho Cr)/Cit比值不高,平均0.60。PC患者,Cit明显下降,Cho明显升高,(Cho Cr)/Cit比值升高,平均2.51。分别对PC与BPH体素的2组代谢物比值进行比较,二者之间有显著的统计学差异(t=0.353,P<0.05)。结论MRI和MRS有助于PC和BPH的鉴别诊断。     

颅脑结核的MRI诊断

目的探讨颅脑结核的MRI表现及其诊断价值。方法对31例经临床证实的颅脑结核患者行MRI平扫及增强扫描并对其MRI表现进行回顾性分析。结果31例中,单发及多发脑实质结核者9例,单纯累及脑膜者16例,脑实质结核瘤形成合并脑膜受累者6例,脑膜受累者合并脑积水征象1d例。结论MRI通常能对颅脑结核作出明确诊断,尤其是增强扫描能为本病的定性诊断提供可靠依据。     

联合应用MR波谱分析与扩散加权成像定量指标行前列腺癌定量诊断

目的 以前列腺六分区为基础,量化分析并验证MRS与DWI两种功能成像的定量指标在联合诊断前列腺癌时的权重大小.方法 搜集2006年2月至2007年7月间前列腺MR检查数据库中患者资料,并以接受前列腺MR检查的不同时间段,将入选前列腺检查患者分为2组,分别用于定量分析和验证结果,第1组为从2006年2月至12月期间、第2组为从2007年1月至7月期间的患者.每例患者在行常规MRI后,均进行MRS和DWI检查,测量MRS可用体素的(胆碱+肌酸)/枸橼酸盐(CC/C)值和分区内最小ADC值(ADC_(mini)).以CC/C≥0.911作为阳性体素标准,计算前列腺MRS六分区内阳性体素比(PVR).采用聚类分析中的线性判别,计算第1组分区内PVR和ADC_(mini)合用时各自所占的权重.将第2组分区内PVR和ADC_(mini)代入公式,采用ROC分析比较单独及联合诊断的诊断效能.结果 第1组和第2组均有40例患者,非前列腺癌加例,前列腺癌20例.由第1组病例得出的联合诊断线性判别公式为DWI和MRS联合诊断的非标准化线性判别值(D)=3.264×ADC_(mini)-0.205×PVR-4.407,分区内PVR和ADC_(mini)的曲线下面积(Az)分别为0.769和0.910,联合诊断的Az为0.909.第2组病例分区内PVR和ADC_(mini)的Az分别为0.838和0.912,联合诊断的Az为0.915.2组的联合诊断效能与单独使用DWI的诊断效能差异均无统计学意义(X~2值分别为0.32和1.50,P值均＞0.05).结论 DWI对前列腺癌的诊断效能高于MRS,联用2种功能参数不能明显提高总体的诊断效能.     

MR弹力成像在前列腺疾病诊断中的初步临床研究

目的 探讨3.0T MR弹力成像(MRE)在前列腺疾病诊断中的临床价值,评估前列腺癌和前列腺良性病变的弹性及黏滞度.方法 应用MRE评估由组织活检病理证实的8例前列腺癌患者的12个癌灶以及10例前列腺炎患者的14个病灶的平均弹性和黏滞度.MRE通过在耻骨联合上放置传导器,并向前列腺发射低频(100 Hz)纵向机械波实现,所得相位图像经重组获得弹力图.采用t检验比较前列腺癌和前列腺炎的平均弹性和黏滞度,并采用Pearson法分析前列腺癌的弹性和Gleason评分的相关性.结果 前列腺癌的弹性和黏滞度分别为(6.55±0.47)kPa和(6.56±0.99)Pa·s,前列腺炎分别为(1.99±0.66)kPa和(2.13±0.21)Pa·s,差异有统计学意义(t值分别为19.392和16.372,P＜0.01).8例前列腺癌患者中,Gleason评分为5分者2例,6分者3例,7分者2例,8分者1例,每组平均弹性值分别为5.83、6.02、7.45和8.05 kPa,Gleason评分与前列腺癌组织的弹性值呈正相关(r=0.913,P＜0.01).结论 MRE能够用于探查前列腺癌和前列腺良性病变的硬度,是有发展前景的临床诊断前列腺癌的影像方法.     

Proton MR spectroscopy of the prostate

PURPOSE: To summarize current technical and biochemical aspects and clinical applications of proton magnetic resonance spectroscopy (MRS) of the human prostate in vivo. MATERIAL AND METHODS: Pertinent radiological and biochemical literature was searched and retrieved via electronic media (medline, pubmed. Basic concepts of MRS of the prostate and its clinical applications were extracted. RESULTS: Clinical MRS is usually based on point resolved spectroscopy (PRESS) or spin echo (SE) sequences, along with outer volume suppression of signals from outside of the prostate. MRS of the prostate detects indicator lines of citrate, choline, and creatine. While healthy prostate tissue demonstrates high levels of citrate and low levels of choline that marks cell wall turnover, prostate cancer utilizes citrate for energy metabolism and shows high levels of choline. The ratio of (choline+creatine)/citrate distinguishes between healthy tissue and prostate cancer. Particularly when combined with magnetic resonance (MR) imaging, three-dimensional MRS imaging (3D-CSI, or 3D-MRSI) detects and localizes prostate cancer in the entire prostate with high sensitivity and specificity. Combined MR imaging and 3D-MRSI exceed the sensitivity and specificity of sextant biopsy of the prostate. When MRS and MR imaging agree on prostate cancer presence, the positive predictive value is about 80-90%. Distinction between healthy tissue and prostate cancer principally is maintained after various therapeutic treatments, including hormone ablation therapy, radiation therapy, and cryotherapy of the prostate. CONCLUSIONS: Since it is non-invasive, reliable, radiation-free, and essentially repeatable, combined MR imaging and 3D-MRSI of the prostate lends itself to the planning of biopsy and therapy, and to post-therapeutic follow-up. For broad clinical acceptance, it will be necessary to facilitate MRS examinations and their evaluation and make MRS available to a wider range of institutions.     

MR扩散加权成像在评价前列腺癌内分泌治疗中的应用价值

目的探讨内分泌治疗前后前列腺外周带癌区和非癌区的表观扩散系数（ADC）值的变化情况。方法对经手术病理或穿刺活检证实的14例前列腺癌和18例内分泌治疗6个月以上的前列腺癌患者行MR扩散加权成像（DWI）。依病理结果，将前列腺6分区归类为癌区和非癌区，测量每个分区的ADC值，同时测量每例膀胱、闭孔内肌的ADC值，对2组的结果进行比较。结果未治疗组14例癌区和非癌区的ADC值分别为（1．22±0．25）×10^-3、（1．59±0．19）×10^-3mm^2／s，差异有统计学意义（t=7．03，P〈0．01）。经内分泌治疗后的18例癌区的ADC值升高至（1．46±0．30）×10^-3mm^2／s，非癌区的ADC值为（1．59±0．24）×10^-3mm^2／s，癌区和非癌区之间ADC值差异有统计学意义（t=2．46，P〈0．05）。两组癌区之间ADC值差异有统计学意义（t=4．66，P〈0．01），非癌区、膀胱、闭孔内肌的ADC值差异无统计学意义（t值分别为0．06、0．48、1．64，P值均〉0．05）。结论ADC值用于判断前列腺癌内分泌治疗效果有应用前景。     

MR灌注成像在前列腺疾病诊断中作用的初步探讨

目的探讨MR灌注成像在前列腺良恶性病变中的初步应用,评价血管内皮生长因子(VEGF)和微血管密度(MVD)与MR灌注成像各指标的关系。方法对临床诊断为前列腺疾病的70例患者,其中良性前列腺增生(BPH)42例,前列腺癌(PCa)28例,进行MR灌注成像,并对标本进行免疫组织化学检测;分析病变的灌注曲线最大线性斜率(SSmax)、T2*弛豫率(△R2* peak)与免疫组织化学检查结果(VEGF、MVD)的相关性。结果(1)BPH组增生结节灌注曲线的SSmax及△R2*peak分别为:33．5±3．1、1．5±0．1;PCa组癌灶灌注曲线的SSmax及△R2*peak分别为:58．4±4．7、3．1±0．5,两者之间差异有统计学意义(t值分别为2．13、2．29,P值均<0．05);PCa组高、中、低分化腺癌的SSmax分别为:52．3±3．4、56．4±4．3、60．7±5．2,差异有统计学意义(F=132．04,P< 0．05),△R2*peak分别为:2．9±0．4、3．1±0．5、3．2±0．7,差异有统计学意义(F=114．82,P<0．05)。(2)BPH组VEGF阳性9例,MVD值为22．76±6．54;PCa组VEGF阳性为24例,MVD值为71．38±9．17;PCa的VEGF和MVD的表达水平明显高于BPH患者(X2=27．86,P<0．01;t=20．4,P< 0．01),PCa、BPH的VEGF表达与MVD表达呈正相关性(P<0．01);灌注加权成像(PWI)参数SSmax、△R2*peak与VEGF、MVD具有相关性(P<0．01)。结论PWI的有关指标(SSmax、△R2*peak)与MVD和VEGF的表达水平相关,有可能为前列腺疾病良恶性的鉴别提供信息。     

Characterization of time-enhancement curves of benign and malignant prostate tissue at dynamic MR imaging

Our objectives were to determine time-enhancement curves of prostate cancer, peripheral zone, and adenoma at gadolinium-enhanced MR imaging, and to determine if a high-spatial/low-temporal dynamic imaging could be accurate in depicting prostate cancer, or if a higher temporal resolution (and a lower spatial resolution) should be favored. Thirty-nine patients with prostate cancer underwent MR imaging before radical prostatectomy by using T1- and T2-weighted axial images and a single-slice dynamic gadolinium-enhanced sequence (40 images; one image per 6 s; injection of 20 ml at 2 ml/s). After analysis of the pathologic specimens, four region-of-interest (ROI) cursors (cancer, peripheral zone, adenoma, and muscle) were retrospectively placed on dynamic images. Time-enhancement curves of the ROIs were obtained. The theoretical accuracy of a 30-s dynamic multislice MR sequence in depicting cancer within peripheral zone and adenoma (ROC curves) was calculated from these curves. On average, prostate cancer enhanced more and earlier than peripheral zone and adenoma, but there were great interindividual variations. For start delays ranging from 12 to 84 s, the areas under the ROC curves ranged from 0.602 to 0.698 for the depiction of cancer within adenoma and from 0.614 to 0.827 for the depiction of cancer within peripheral zone. The best results were obtained with a 36-s start delay. In conclusion, we found a 30-s scanning window which seems to allow a good depiction of cancer within peripheral zone. Because of largely overlapping enhancement patterns, cancer will probably not be depicted within adenoma by dynamic imaging, at least by using low temporal resolution. Electronic Publication     

MR波谱成像对前列腺癌分化程度预估价值的初步研究

目的 初步探讨MRS检查的(胆碱+肌酸)/枸橼酸盐[(Cho+ Cr)/Cit,CC/C]值对前列腺癌分化程度及Gleason评分的预估作用.方法 回顾性分析行前列腺癌根治术后的5枚标本,将每枚标本按照MRS检查中最大横径兴趣层面剖开、取层,将层内每一兴趣区的CC/C值和病理切片的Gleason评分结果进行对照,通过绘制散点图及Spearman相关分析探讨二者的相关性,再根据CC/C值分别进行中高分化前列腺癌组(Gleason评分≤7分)及低分化癌组(Gleason评分＞7分)的ROC曲线下面积的假设检验,计算最佳诊断阈值(Cutoff值).结果 共取得有效病理诊断结果90个,其中有癌区70个,无癌区20个.MRS检查共得到CC/C值90个,以CC/C值＞0.86为确定癌标准,诊断前列腺癌区65个,与病理结果对照诊断正确区域59个;诊断无癌区25个,与病理结果对照诊断正确区域14个.经Spearman相关分析,CC/C值与对应区的Gleason评分呈正相关(r=0.746,P=0.000).中高分化前列腺癌组中,以ROC曲线下面积计算Cutoff值的假设检验无统计学意义(P＞0.05);低分化癌组中,以ROC曲线下面积确定CC/C值为0.948最佳诊断阈值,敏感性为81.4％,特异性为75.0％,经Spearman分析低分化癌组中的Gleason评分与CC/C值亦呈正相关(r=0.605,P=0.000),提示CC/C值与低分化前列腺癌的分化程度具有相关性,当CC/C值大于0.948多为低分化癌,Gleason评分多＞7分.结论 CC/C值与Gleason评分呈正相关,MRS检查可用于预估前列腺癌的分化程度.     

T2WI低信号的前列腺外周带病变的MR诊断研究

目的：探讨磁共振T2加权相（T2WI）表现为低信号的前列腺外周带病变的诊断研究。方法：对83例前列腺外周带病变,其中前列腺炎症25例、前列腺腺癌45例、前列腺增生10例、纤维化病灶3例,进行T1WI、T2WI、DWI扫描,其中55例进行了增强扫描,分析前列腺外周带病变的信号表现。所有病例均经手术或穿刺活检病理证实。同时分析83例患者的PSA值。结果：前列腺外周带炎症T2WI的低信号影大部呈斑片状,无占位效应,增强后时间-信号曲线呈平台型,DWI呈稍高信号,ADC值稍减低,血PSA值处于正常值上限附近;前列腺外周带癌灶T2WI的低信号影以结节状为主,增强后时间-信号曲线呈速升速降型,DWI呈明显高信号影,ADC值明显降低,血PSA值明显增高;前列腺外周带良性前列腺增生T2WI的低信号呈斑片状或结节状,增强后早期无明显强化,后期不均匀强化,DWI呈稍高或高信号,ADC值稍低,介于腺癌与炎症之间,常可见中央带增生表现,血PSA值稍高;前列腺外周带纤维化病灶T2WI的低信号呈斑条状,界清,DWI呈低信号,增强后无强化,血PSA值正常。结论：前列腺外周带的炎症、腺癌、增生、纤维化病灶T2WI均可表现为低信号,增强扫描及DWI检查,ADC值测量,并结合PSA值,有较大诊断价值。     

前列腺癌的MR波谱成像中体线圈与直肠内线圈的比较

目的 比较体线圈(BODY)与直肠内线圈(ERC)MRS对前列腺癌的定性诊断效能,探讨BODY MRS临床应用的可行性.方法 12例取得穿刺病理结果的前列腺外周带癌患者,其中6例为前列腺癌,6例除外了前列腺癌.12例全部完成BODY MRS检查,其中7例同时完成ERC MRS检查.以六分区法对照穿刺结果进行MRS定量分析,分别测量每个区域内癌与非癌区(胆碱+肌酸)/枸橼酸盐[(Cho+Cre)/Cit]的比值,并采用Wilcoxon符号等级检验进行比较,计算BODY MRS对前列腺癌的诊断准确性.结果 (1)癌区与非癌区体素(Cho+Cre)/Cit比较:BODY组(7例)癌区体素比值中位数1.744(0.295～7.998),非癌区中位数0.412(0.112～2.113),两者差异有统计学意义(Z=-9.159,P＜0.01).ERC组(7例)癌区体素比值中位数为1.975(0.479～7.998),非癌区中位数为0.400(0.104～2.232),两者差异有统计学意义(Z=-9.200,P＜0.01).BODY与ERC组间比较:癌区体素组间比较差异无统计学意义(Z=-0.105,P＞0.05),非癌区体素组间比较差异无统计学意义(Z=-0.692,P＞0.05).(2)ROC分析:7例BODY与ERC组曲线下面积(Az值)分别为0.931、0.935,两者比较差异无统计学意义(P=0.851);应用BODY MRS 12例患者组Az值为0.935,敏感度、特异度分别为82.2%和88.2%.结论 BODY与ERC的MRS对前列腺外周带癌定性诊断效能接近,临床应用具有可行性.     

The value of endorectal MR imaging to predict positive biopsies in clinically intermediate-risk prostate cancer patients

The aim of this study was to assess the effectiveness of endorectal MR imaging in predicting the positive biopsy results in patients with clinically intermediate risk for prostate cancer. We performed a prospective endorectal MR imaging study with 81 patients at intermediate risk to detect prostate cancer between January 1997 and December 1998. Intermediate risk was defined as: prostatic specific antigen (PSA) levels between 4 and 10 ng/ml or PSA levels in the range of 10–20 ng/ml but negative digital rectal examination (DRE) or PSA levels progressively higher (0.75 ng/ml year^–1). A transrectal sextant biopsy was performed after the endorectal MR exam, and also of the area of suspicion detected by MR imaging. The accuracies were measured, both singly for MR imaging and combined for PSA level and DRE, by calculating the area index of the receiver operating characteristics (ROC) curve. Cancer was detected in 23 patients (28 %). Overall sensitivity and specificity of endorectal MRI was 70 and 76 %, respectively. Accuracy was 71 % estimated from the area under the ROC curve for the total patient group and 84 % for the group of patients with PSA level between 10–20 ng/ml. Positive biopsy rate (PBR) was 63 % for the group with PSA 10–20 ng/ml and a positive MR imaging, and 15 % with a negative MR exam. The PBR was 43 % for the group with PSA 4–10 ng/ml and a positive MR study, and 13 % with a negative MR imaging examination. We would have avoided 63 % of negative biopsies, while missing 30 % of cancers for the total group of patients. Endorectal MR imaging was not a sufficient predictor of positive biopsies for patients clinically at intermediate risk for prostate cancer. Although we should not avoid performing systematic biopsies in patients with endorectal MR imaging negative results, as it will miss a significant number of cancers, selected patients with a PSA levels between 10–20 ng/ml or clinical-biopsy disagreement might benefit from endorectal MR imaging. Received: 8 February 2000/Revised: 7 July 2000/Accepted: 10 July 2000