快速多层面干扰梯度回波序列动态增强扫描在小肝癌诊断中的价值评估

目的 分析小肝癌（small hepatocellular carcinoma,SHCC）在自旋回波（SE）序列和快速多面干扰梯度回波（fast multiplanar spoiling recalled,FMPSPGR)序列动态增强扫描中的特征,比较再者对病灶检出敏感性,进一步探讨FMPSPGR在SHCC诊断中的价值。方法 58例SHCC病例行SE序列T1WI,T2WI和FMPSPGR动态增强,比较其检出敏感性和定性准确性,并做统计学处理。结果 58例共检出病灶72个,对SHCC的敏感性依次为FMPSPGR增强＞SE T2WI＞FMPSPGR平扫＞SE T1WI,FMPSPGR增强和后两者之间均有差异,而T2W少FMPSPGR平扫无差异,FMPSPGR平扫和T1WI也有差异,对病灶的定性准确性,FMPSPGR（平扫＋增强）＞SE（T1WI＋T2WI）,再者差异有显著性。结论 FMPSPGR序列在病灶检出和定性方面均优于SE序列,可基本取代之,两者结合可进一步提高敏感性和定性准确性。     

肝血管肉瘤的MRI表现

目的探讨原发性肝血管肉瘤（HAS）的MRI表现。方法回顾性分析第二军医大学东方肝胆医院2009至2011年经手术病理证实的3例HAS患者的临床、病理和术前MRI表现。结果3例HAS患者包括男性1例和女性2例,年龄35—71岁。所有病灶在MRI的TIWI和T2WI均表现为混合信号强度。所有病灶均存在肿瘤内出血、坏死。GD-DTPA增强扫描后动脉期病灶均为不均匀轻度强化,延迟期病灶表现为持续渐进增强而瘤中心无强化。结论当肝内肿瘤MRI表现为坏死、出血,增强后延迟期病灶渐进强化应考虑到HAS的可能。     

原发性肝细胞癌MRI延迟强化特点与病理组织不同纤维成分分布的关系

背景原发性肝细胞癌(hepatocellular carcinoma, HCC)是我国常见的恶性肿瘤之一,磁共振成像(magnetic resonanceimaging,MRI)技术在肿瘤疾病的诊断中具有很大的优势,其分辨率高,肿瘤中不同的纤维增强成分可能不同.因此,本研究旨在探讨原HCC的MRI延迟强化特征及不同纤维成分在组织病理学上的分布关系.目的观察HCC的MRI延迟强化特点与病理组织不同纤维成分分布的关系.方法选取2016-04/2019-05在浙江省义乌市中心医院诊治的56例原发性HCC患者为研究对象,均行MRI常规和增强检查,对2 min延迟期图像进行分析,评估病灶边缘及内部的强化程度,并测量MRI延迟期边缘环形强化厚度.并经手术病理取材,常规处理、切片后行HE染色,对不同纤维组织采用间苯二酚碱性品红法、Masson三色染色法及氢氧化银氨液浸染法特殊染色,分别观察纤维包膜的厚度及包膜内三种纤维的分布特点.结果 (1)病灶边缘:MRI延迟期边缘环形强化不同程度患者包膜厚度、包膜外炎性细胞浸润程度之间比较,差异无显著性(P0.05),而包膜内血管之间比较,差异具有显著性(P0.05). MRI信号特点:病灶包膜完整可见环形增强,包膜断续者可见半环形增强. 44个病灶环形强化厚度在纤维包膜厚度、包膜外炎性细胞浸润程度和包膜内血管数量病理特征之间比较,差异均有统计学意义(P0.05).(2)病灶内部:由于恶性肿瘤内部血管丰富,病灶内纤维组织含量相对较少,且在不同病灶中纤维组织分布差异较大. MRI信号特点:MRI延迟期内部强化不同程度患者炎性细胞浸润程度及胶原纤维、弹性纤维、网状纤维含量之间比较,差异均具有统计学意义(P0.05).结论原发性HCC边缘和内部增强MRI延迟期强化特点与纤维组织及炎性细胞浸润有关.     

胰腺内副脾误诊为神经内分泌肿瘤病例特点及误诊分析（附 10例报道）

目的 探讨胰腺内副脾患者的病例特点及误诊原因，以提高对该病的认识，减少误诊及不必要的手术。方法 回顾性收集术前诊断为胰腺神经内分泌肿瘤，经术后病理确诊为胰腺内副脾的患者10例(共12 个病灶)，分析其CT、MRI、Ga68-dotatatePET-CT图像、病理特点及临床资料。结果 10例患者中9例为单发，1例有3个病灶；12个病灶均位于胰尾、均与周围组织边界清晰、均为富血供结节；病灶最大径0.3~3 cm, 平均1.43 cm。MRI表现：T1W1均呈低信号，T2W1 8例呈高信号（80%），DWI 7例呈高信号（70%）；增强扫描动脉期6例呈均匀强化，只有 1例呈 “花斑样”不均匀强化。3例行Ga68-dotatatePET-CT检查的患者病灶均呈高代谢，SUVmax约为脾脏SUV的一半。结论 IPAS一般位于胰尾，病灶小于3cm，边界清晰；在MRI T1W1序列上呈低信号，T2W1及DWI多呈高信号，增强扫描动脉期很少见到典型的“花斑样”不均匀强化，静脉期及延迟期多为均匀强化，68Ga标记生长抑素受体PET/CT检查时可能会出现高代谢。     

MRIDWI在肝细胞肝癌TACE后疗效监测中的应用

目的探讨磁共振（MR／）弥散加权成像（DWI）在肝细胞肝癌（HCC）肝动脉栓塞化疗术（TACE）后疗效监测中的价值。方法对40例HCC患者于TACE前后行屏气状态下多个弥散梯度因子的DWI,选用固定参数组合自旋平面回波（SE-EPI）序列于屏气状态下测量瘤灶、邻近未累及肝实质区与背景噪声的信号强度（SI）,观察TACE术后碘油沉积情况及肿瘤表观弥散系数（ADC）值的变化趋势,判断肿瘤的残存及复发情况。将检查结果与CT增强扫描结果比较。结果随b值增加,肝脏DWI图像质量呈下降趋势。b值取600s／mm^2时,肿瘤组织与肝实质之间存在最佳对比度。TACE后肿瘤的ADC值普遍增大,多排CT和DWI检测肝复发灶的敏感性分别为28．12％（18／64）和43．75％（28／64）x^2=10．41,P〈0．05。结论DWI对HCC行TACE治疗后病灶转移复发的检出率高;在评价TACE效果中有重要价值。     

肝细胞癌自发性破裂出血的治疗对策选择（附30例报告）

目的探讨肝细胞癌（HCC）自发破裂出血患者在治疗对策上的选择。方法对本院2008年1月-2011年12月收治的30例HCC破裂出血患者的临床资料进行回顾性分析,其中行Ⅰ期手术9例,急诊经导管肝动脉化疗栓塞术（TACE）治疗21例,TACE治疗后再手术切除10例,其余11例均为单纯TACE治疗,从临床治疗效果进行评价分析。计数资料比较采用卡方检验或Fisher′s检验。结果21例经急诊TACE治疗者止血成功率为100%,其中10例患者TACE治疗后2~5周内进行Ⅱ期手术,术后病理证实均为HCC,术后3个月复查均未见腹腔肿瘤种植转移灶,术后1 年存活率70%（7/10）; 9例行Ⅰ期手术切除的患者中,围手术期内死亡2例,3个月内发生腹腔或切口种植转移者5例（5/7）,术后1 年存活率44.4%（4/9）;11例单纯TACE治疗患者术后1 年存活率为27.3%（3/11）。急诊TACE联合手术切除HCC破裂出血在提高抢救成功率、减少术后并发症及提高患者生存时间上均优于急诊手术切除及单纯的TACE治疗。结论HCC自发性破裂出血患者应首选急诊TACE治疗,再联合手术切除,可以明显提高抢救成功率和手术切除率,并可显著降低肿瘤腹腔种植转移率,延长患者生存时间。     

氩氦刀治疗肝细胞癌早期疗效的MRI评价

目的探讨氩氦刀冷冻消融术治疗肝细胞癌(hepatocellular carcinoma,HCC)早期疗效的MRI特征。方法应用氩氦刀治疗53例HCC患者的59个病灶,并回顾性分析治疗前后的MRI图像,评价早期疗效,探讨肿瘤完全坏死和残留的MRI特点。结果治疗后59个病灶中41个(69.5%)完全坏死,18个(30.5%)肿瘤残留。术后3～7d(A组)、4～6周(B组)及12～15周(C组)复查MRI评估疗效,疗效评估诊断(完全坏死/肿瘤残留)分别为36/23、39/20、40/19,3组疗效评估结果一致。氩氦刀治疗后早期(A组)T1加权像(T1weightedimage,T1WI)消融区低信号、瘤结节高信号及瘤周0.5cm消融边界为肿瘤坏死完全的可靠征象,T2加权像(T1weightedimage,T2WI)消融区呈环形且厚度均匀的高信号为炎性反应。T2WI消融区局灶性高信号及增强扫描不规则强化仍是诊断肿瘤残留的"金标准"。结论 MRI评价氩氦刀治疗HCC的早期疗效具有及时、准确、特异性高、无辐射的优点,术后3～7d即可进行早期评价。T1WI具有较高的诊断价值,T2WI信号及增强扫描仍是评价疗效的关键。     

高强度聚焦超声联合肝动脉化疗栓塞术治疗中晚期原发性肝癌的临床研究

目的通过应用高强度聚焦超声（HIFU）联合肝动脉化疗栓塞术（TACE）治疗原发性肝癌（HCC）的临床疗效。探讨其治疗原发性肝癌的价值。方法对2001年4月至2002年12月79例原发性肝癌患者,其中46例接受单独HIFU治疗,20例HIFU治疗前曾行经皮肝动脉栓塞化疗（TACE）治疗,13例行TACE单独治疗。对这些患者的资料进行临床分析。结果治疗后HCC患者临床症状减轻、血清AFP水平呈不同程度的下降（P〈0.05）。病灶缩小、血供减少或消失。局部无并发症出现,心肾功能正常,但肝脏酶谱有一过性升高。HIFU治疗后肿物回声有不同程度增强。HIFU治疗后CT或MRI呈典型的凝固性坏死表现。HIFU联合TACE治疗有效率为70%（14/20）,优于单纯HIFU组的41%（19/46）,优于单纯TACE组的31%（4/13）,组间比较有显著性差异（P〈0.05）。HIFU治疗组与TACE治疗组3、6个月及1年、2年生存率比较,无明显差异。结论 HIFU治疗原发性肝癌具有一定疗效。HIFU联合TACE治疗原发性肝癌是有效和可行的,两者具有协同作用。将为临床非侵入性治疗肝脏肿瘤提供一个可考虑的新的局部治疗手段。     

MRI长时间延迟增强扫描诊断肝脏孤立性坏死性结节价值研究*

目的 探讨磁共振成像（MRI）长时间延迟增强扫描诊断肝脏孤立性坏死性结节（SNNL）的价值。方法 2013年5月~2018年5月我院就诊的17例SNNL患者和15例肝脏恶性肿瘤患者（其中10例为肝细胞癌和5例为肝转移癌）,所有患者均行常规CT/MRI增强扫描及MRI多期长时间延迟至120 min扫描,分别比较两组病灶影像学特征,如病灶密度、强化类型,探讨长时间延迟扫描在鉴别SNNL与肝脏恶性肿瘤中的作用。结果 在SNNL患者,CT和MRI共检出17个病灶,均位于肝右叶,且均为单发病灶,直径为（2.1±0.4） cm;在10例HCC患者,MRI检查发现11个病灶,位于肝右叶者8个,位于肝左叶者3个。单发病灶9例,多发病灶1例,直径为 （5.4±1.6） cm;在5例肝脏转移癌患者中,共检出12个病灶,位于肝右叶者9个,位于肝左叶者3个,直径为 （3.1±0.9）cm;在SNNL病灶中有4个病灶在T2WI上表现为“靶征”,与肝转移癌病灶的影像学表现类似;在延迟期（DP）3/5 min扫描,HCC和肝转移癌病灶边缘多呈中度-重度环形强化,SNNL病灶边缘强化水平随着延迟时间延长而逐渐增强。在DP 1 h时,17个病灶均表现为中度-重度环形强化,病灶中心无强化,而肝脏恶性肿瘤病变边缘强化均已消失。结论 MRI 长时间延迟增强扫描能有效区分SNNL与肝脏恶性肿瘤,主要表现为在延迟扫描时呈病灶边缘和间隔环形强化,且病变中心无强化。     

CT引导经导管动脉化疗栓塞治疗肝细胞癌

目的探讨CT引导经导管动脉化疗栓塞（transcatheter arerial chemoembolization,TACE）治疗肝细胞癌（hepatocellular carcinoma,HCC）的初步疗效,分析局部复发的危险因素。方法对32例患者的34个HCC病灶进行了CT引导TACE治疗。结果32例中26例实现局部控制,6例出现局部复发。采用Logistic回归分析发现,TACE治疗后中央型HCC病灶是局部复发的危险因素（P=0．0408）。结论CT引导TACE是治疗小HCC的好方法,其局部控制率高、复发率低。中央型HCC是TACE术后局部复发的危险因素。     

Role and limitation of FMPSPGR dynamic contrast scanning in the follow—up of patients with hepatocellular carcinoma treated by TACE

AIM：To evaluate the role and limitation of fast multiplanar spoiled gradient-recalled(FMPSPGR)MRdynamiccontrast scanning in the follow-up of patients with HCCtreated by transarterial chemoembolization(TACE).METHODS:Twenty-two patients with 24HCClesions confirmed by biopsy or surgical resection underwent MR imaging in 4-9wks after TACEwith a superconducting 1.5TMR scanner,including SE T1WI,T2WIand FMPSPGR dynamic contrast scanning.The signal intensities of all lesions on SET1WI,T2WIand the enhancement patterns on FMPSPGRdynamic contrast scanning were observed,and the comparison was made between MRI findings and pathological results in all the casese.RESULTS:Of the 24lesions,the signal intensities were various on SET1WIand T2WI.OnT1WI,13lesions appeared as hyperintense,4 lesions were isointense and the other 7lesions were hypointensese,Histologically.Hyperintense lesions showed on T1WI were viable tumor or hemorrhage;isointensities were coagulative necrosis or inflammatory infiltration;hypointensities were tumor,liquified necrosis,coagulative necrosis or inflammatory infiltration.OnT2WI,15lesions appeared as hyperintense,3lesions were isointense and the other 6lesions were hypointensese,Hyperintense lesions shower on T2WI were residuals of viable tumor,hemorrhage,liquefied necrosis or inflammatory infiltration;isointense lesions were residuals of viable tumor or inflammatory infiltration;hypointense lesions were coagulative necrosis.On FMPSPGR dynamic contrast scanning,18 of the 24lesions enhanced on early-phase dynamic scanning corresponding to residuals of viable tumor and the other 6lesions had no enhancement at this phase because complete necrosis were seen in the histologic examination.On delayed-phase dynamic scanning,6lesions had permanent enhancement appeared as inhomogeneous hyperintensity and both residuals of viable tumor and inflammatory infiltration were found by histologic examination,18 lesions were hypointense at this phase and 8of them coexisted with peripheral ring-like enhancement of the lesions resulting from viable tumors or inflammatory infiltration.CONCLUSION:FMPSPGR MR dynamic contrast scanning can reflect the pathologic changes of HCCtreated by TACE.Especially.early-phase dynamic scanning can evaluate accurately residuals of viable tumor and necrosis in HCClesions.FMPSPGR dynamic contrast scanning is useful in the follow-up of patients with HCC treated by TACEcombined with SET1WIand T2WI,but is is difficult to differentiate peripheral viable tumors from inflammatory infiltration.     

Solitary Necrotic Nodules of the Liver: Histology and Diagnosis With CT and MRI

Background

A solitary necrotic nodule (SNN) of the liver is an uncommon lesion, which is different from primary and metastatic liver cancers.

Objectives

To analyze the classification, CT and MR manifestation, and the pathological basis of solitary necrotic nodule of the liver (SNN) in order to evaluate CT and MRI as a diagnosing tool.

Patients and Methods

This study included 29 patients with liver SNNs, out of which 14 had no clinical symptoms and were discovered by routine ultrasound examinations, six were found by computed tomography (CT) due to abdominal illness, four had ovarian tumors, and five had gastrointestinal cancer surgeries, previously. Histologically, these SNNs can be divided into three subtypes, i.e., type I, pure coagulation necrosis (14 cases); type II, coagulation necrosis mixed with liquefaction necrosis (five cases); and type III, multi-nodular fusion (10 cases). CT and magnetic resonance imaging (MRI) patterns were shown to be associated with SNN histology. All patients were treated surgically with good prognosis.

Results

CT and MRI appearance and correlation with pathology types: three subtypes of lesions were hypo-density on both pre contrast and post contrast CT, 12 lesions were found the enhanced capsule and 1 lesion of multi- nodular fusion type showed septa enhancement. The lesions were hypo-intensity on T2WI and the lesions of type II showed as mixed hyperintensity on T2WI. The capsule showed delayed enhancement in all cases, and all lesions of multi- nodular fusion type showed delayed septa enhancement on MR images. 15 cases on CT were misdiagnosed and Four cases on MRI were misdiagnosed and the accuracy of CT and MRI were 48.3% and 86.2% respectively.

Conclusions

In conclusion, CT and MRI are useful tools for SNN diagnosis.     

Radiological and pathological correlation of lung malignant tumors treated with percutaneous radiofrequency ablation

Radiological and histological correlation was evaluated in patients with malignant tumors of the lung that underwent radiofrequency ablation (RFA). One of the patients had a primary lung tumor and another patient had three metastatic lung tumors. RFA was performed under computed tomography (CT) fluoroscopic guidance. CT showed ground glass shadows around the tumoral lesions immediately after RFA, but one week later homogenous opacification without tumoral enhancement was noted. Two months after RFA, most lesions showed cystic changes without activity on FDG-PET. Histological evaluation showed massive coagulation necrosis throughout the tumor and some viable cells at the peripheral areas in all lesions. Although RFA is a promising therapeutic approach for malignant lung tumors, some viable cells may persist in peripheral areas of the tumor.     

Solitary fibrous tumors in abdomen and pelvis:Imaging characteristics and radiologic-pathologic correlation

AIM:To describe the imaging features of solitary fibrous tumors(SFTs)in the abdomen and pelvis,and the clinical and pathologic correlations.METHODS:Fifteen patients with pathologically confirmed SFTs in the abdomen and pelvis were retrospectively studied with imaging techniques by two radiologists in consensus.Patients underwent unenhanced and contrast-enhanced imaging,as follows:3 with computed tomography(CT)and magnetic resonance imaging(MRI)examination,8 with CT examination only,and 4 with MRI examination only.Image characteristics such as size,shape,margin,attenuation or intensity,and pattern of enhancement were analyzed and correlated with the microscopic findings identified from surgical specimens.In addition,patient demographics,presentation,and outcomes were recorded.RESULTS:Of the 15 patients evaluated,local symptoms related to the mass were found in 11 cases at admission.The size of the mass ranged from 3.4 to 25.1cm(mean,11.5 cm).Nine cases were round or oval,6were lobulated,and 10 displaced adjacent organs.Unenhanced CT revealed a heterogeneous isodense mass in 7 cases,homogeneous isodense mass in 3 cases,and punctuated calcification in one case.On MRI,most of the lesions(6/7)were heterogeneous isointense and heterogeneous hyperintense on T1-weighted images and T2-weighted images,respectively.All tumors showed moderate to marked enhancement.Heterogeneous enhancement was revealed in 11 lesions,and 7of these had cysts,necrosis,or hemorrhage.Early nonuniform enhancement with a radial area that proved to be a fibrous component was observed in 4 lesions,which showed progressive enhancement in the venous and delayed phase.No statistical difference in the imaging findings was observed between the histologically benign and malignant lesions.Three patients had local recurrence or metastasis at follow-up.CONCLUSION:Abdominal and pelvic SFTs commonly appeared as large,solid,well-defined,hypervascular masses with variable degrees of necrosis or cystic change that often displaced adjacent structures.     

Histopathological changes after microwave coagulation therapy for patients with hepatocellular carcinoma: review of 15 explanted livers

OBJECTIVES: Microwave coagulation therapy (MCT) is a well established local ablation technique for hepatocellular carcinoma (HCC). However, pathological changes in liver tissue after this therapy have not been well described. We examined the histological changes of HCC after MCT observed in explanted livers in relation to CT findings. METHODS: A total of 15 patients with 18 lesions of HCC underwent MCT and subsequent liver transplantation. Explanted livers were examined macro- and microscopically, and an evaluation of mitochondrial activity of ablated tissue was accomplished by using succinic dehydrogenase (SDH) stain in frozen sections. RESULTS: Of the 18 lesions, 16 were ablated completely and another two had residual tumor. The size of the ablated areas on CT scan corresponded to the macroscopic findings. Histologically the area of ablation was rimmed by a palisading, histiocytic, giant cell, inflammatory reaction associated with fibrotic bands. Coagulative necrosis with faded nuclei and eosinophilic cytoplasm were the predominant findings in the ablated areas. There were also areas in which the tumor cells had cytoplasmic eosinophilia, but nuclei were present and the cells seemed to be viable. On the SDH stain of frozen tissue taken from the edge of the ablated area, SDH activity was negative in both necrotic and nonnecrotic ablated areas. CONCLUSIONS: Most of the treated areas after microwave ablation develop coagulative necrosis accompanied by a foreign body-like inflammatory reaction and fibrosis. Pathologists need to be aware that after this form of therapy, portions of the tumor maintain their native morphological features as if the area is fixed, but their cellular activity is destroyed.     

Histopathological findings after ultraselective transcatheter arterial chemoembolization for hepatocellular carcinoma

Aim:  To evaluate the histopathologic findings in the surgical specimen of hepatocelluar carcinoma after transcatheter arterial chemoembolization (TACE) at the most distal portion of the sub-subsegmental artery of the liver (ultraselective TACE).
Methods:  Histolopathologic findings from nine tumors with a mean diameter of 3.1 cm ± 1.7 from patients who underwent hepatectomy after ultraselective TACE were evaluated, especially with regard to the relationship between peritumoral liver parenchymal necrosis and portal vein visualization during TACE. Portal vein visualization was classified into three grades by a spot digital radiograph obtained just after TACE: 0, no obvious portal vein visualization; 1, visualization of the portal vein adjacent to the tumor; and 2, visualization in the whole embolized area or extending into the surrounding non-embolized areas. Unenhanced computed tomography (CT) was obtained 1 week later and surgical resection was performed 37 ± 6.3 days after ultraselective TACE.
Results:  Portal vein visualization during TACE was classed as grade 1 in 5 tumors and grade 2 in 4. Histopathologically, complete tumor necrosis was observed in 7 tumors (77.8%). In 2 tumors (1 of grade 1, the other grade 2), a small viable portion or viable daughter nodule was seen. Macroscopic parenchymal necrosis adjacent to the tumor was observed in all 4 grade 2 tumors including gas-containing areas on CT obtained 1 week after TACE.
Conclusions:  Ultraselective TACE induces not only complete tumor necrosis but also peritumoral parenchymal necrosis, similar to that after radiofrequency ablation, when the portal veins are markedly visualized during the TACE procedure.     

Characterization of focal hepatic lesions with SPIO—enhanced MRI

AIM: To evaluate the value of superparamagnetic iron oxide (SPIO) enhanced MRI in characterizing focal hepatic lesions. METHODS: Forty-three patients (32 men,11 women, mean age 51 years, age range 25-74 years) with previously identified focal hepatic lesions were enrolled into this study. All the patients underwent plain, Gd-DTPA enhanced MRI and the SPIO enhanced MRI 1-7 d later. The surgico-pathologic diagnosis was aestablished in 31 cases and the diagnosis in other 12 cases was made on the basis of clinical findings and biochemical tests. The signal changes of lesions were analyzed and the CNRs of lesion-to-liver were measured before and after SPIO enhancement. The data were analyzed by paired t test. RESULTS: Focal hepatic lesions included primary hepatocellular carcinoma (HCC,n=22), hemangioma (n=5), cyst (n=4), metastases (n=5), cirrhotic nodule (n=4), focal nodular hyperplasia (FNH, n=5) and other miscellaneous lesions (n=6). After SPIO enhancement HCC demonstrated iso- or slight hyperintensity on T1WI and moderate hyperintersity on T2WI, hemangioma showed moderate hyperintensity on T1WI and obvious hyperintensity on T2WI, the SI of cyst had no change either on T1WI or on T2WI, cirrhotic nodules revealed iso-intensity on T2WI, and the SI of FNH decreased significantly on T2WI. No specific manifestations were found in the other 6 miscellaneous lesions after SPIO enhancement. CONCLUSION: SPIO enhanced-MRI can improve the characterization confidence for diagnosis of focal hepatic lesions.     

Preoperative diagnosis of gastric cancer using 2‐D magnetic resonance imaging with 3‐D reconstruction techniques

OBJECTIVE: To investigate the clinical value of 2‐D magnetic resonance imaging (MRI) with 3‐D reconstruction techniques for the preoperative diagnosis and TNM‐staging of gastric cancer. METHODS: Using a Philips Gyroscan NT 1.0T superconductive unit, MRI using the water‐filling method was performed in 15 patients with suspected gastric cancers. The 2‐D MRI sequences included TSE‐T1WI, TSE‐T2WI and fat suppression (SPIR). The source images of magnetic resonance hydrography (heavily TSE‐T2WI sequence) were reconstructed using the Philips EasyVision viewing workstation. Four 3‐D postprocessing algorithms, including maximum intensity projection, surface shaded viewing, volume rendering and virtual endoscopy, were performed and compared with the results of a barium study and endoscopy. All 15 patients with 16 gastric cancers had their diagnosis confirmed by postoperative pathological findings. RESULTS: 2‐D MRI and 3‐D reconstruction images were successfully obtained for all 15 patients. The maximum intensity projection, surface shaded viewing, and volume rendering images corresponded to the upper gastrointestinal series findings, and the virtual endoscopy images corresponded to the gastroscopic views. In 16 gastric lesions, MRI correctly diagnosed 14 (87.5%) advanced gastric cancers, and the tumor location, size and classification were also accurately identified. The accuracy of MRI for determining the preoperative TNM stage was 64.3% (9/14), and there was significant correlation between these results and those from the histopathological studies (P < 0.01). Based on T, N and M factors, the staging accuracy of MRI was 71.4% (10/14), 57.1% (8/14) and 85.7% (12/14), respectively. CONCLUSIONS: 2‐D MRI with 3‐D reconstruction is an effective method for the preoperative diagnosis and TNM staging of gastric cancer. However, the detection of early cancers or benign lesions and N‐staging should be further studied.