磁共振成像在宫颈癌疗效评价中的应用

磁共振成像（MRI）形成三维立体定位解剖成像。通过MRI对比肿瘤体积及信号强度变化,MRI在宫颈癌疗效评估方面有重要价值。随着影像学的发展,磁共振扩散加权成像（DWI）、磁共振波谱（MRS）能提供细胞水平的定性和定量信息,反应肿瘤细胞在治疗中的变化。MRI技术能早期预测局部晚期官颈癌新辅助化疗疗效,为患者个体化治疗提供重要依据。     

Symptomatic ossification of the posterior longitudinal ligament of the cervical spine: Pictorial essay

Symptomatic ossification of the posterior longitudinal ligament (OPLL) of the cervical spine is a rare but well‐documented condition. It is the causative factor in up to 5% of cases presenting with cervical radiculopathy or myelopathy. Computed tomography is the modality of choice in showing the distinctive characteristics and extent of the disease. Magnetic resonance imaging (MRI) is sensitive in detecting cord compression and its attendant complications. Cervical OPLL commonly affects those of middle and advanced age, and the condition is noted to be particularly common in Japanese, although other racial groups are also affected. A ‘mushroom’ or ‘hill’ shape on axial CT typifies OPLL. A sharp radiolucent line separating the posterior vertebral margin from the superficial component of the ossified ligament is a characteristic feature.     

Magnetic resonance evaluation of the labral capsular ligamentous complex: A pictorial review

Magnetic resonance imaging of the shoulder is a common imaging test, and in the course of routine evaluation it can provide accurate information regarding the labral capsular ligamentous complex (LCLC). Common patterns of labral injury include fraying, flap tears and labral distraction, which can be readily identified on both coronal and axial planes by paying attention to signal and morphological characteristics. Capsular and ligamentous pathology may be subtle, but is recognizable using a high-resolution technique that has differential contrast between native intra-articular fluid and the adjacent labrum and capsular restraints. Common patterns of capsular injury include a thickened, hyperintense capsule, sometimes with disruption and retraction. The inferior glenohumeral ligament is the primary stabilizer of the shoulder joint, and although failure of this structure is uncommon, the injury is easily identified. Shoulder instability is a common presentation, the diagnosis of which is dependent upon recognizing various injury patterns including Bankart lesions, reverse Bankart lesions, anterior labroligamentous periosteal sleeve avulsion (ALPSA) and failure of the inferior glenohumeral ligament.     

Development of an evidence‐based guideline for imaging in cervical spine trauma

Cervical spine trauma is a common reason for presentation to an emergency department. However, less than 5% of patients who have suffered possible neck injury actually have an injury requiring medical treatment. Nevertheless, the consequences, both for the patient and the doctor, of a missed injury are well recognized by emergency department medical staff. This results in the vast majority of these patients receiving some form of diagnostic imaging. We describe the development of an evidence‐based imaging guideline for use in the patient who has suffered cervical spine trauma. The guideline aims to help clinicians determine, at the bedside, when it is appropriate to use imaging and which imaging modality should be used first. Correct utilization of the guideline should lead to a reduction in the number of imaging tests required to reach a diagnosis without adverse patient outcomes.     

Magnetic resonance imaging anatomy of the anal canal

The anatomy of the anal canal is complex but well demonstrated by MRI. Understanding the anatomy is a prerequisite for determining the true site and the extent of pathology, especially for surgical workup. In this article, the MRI anatomy of the anal canal has been displayed using highlighted MRI images and line diagrams.     

Evolving standards of practice for cervical spine imaging in trauma: A retrospective review

Recently published works on radiology and emergency medicine suggest an increasing role for primary CT imaging of the cervical spine (C‐spine) in trauma, rather than plain X‐rays. This observational retrospective study of 406 patients was undertaken to examine current practice in a metropolitan teaching hospital setting and to define factors affecting the use of primary imaging for suspected C‐spine fracture. This study supports the increasing recognition of the limited accuracy and adequacy of plain films, especially among the more severely injured patients. It is suggested that intubated patients, patients with severe trauma or patients with Glasgow Coma Scale <13 have CT as a primary screening examination for suspected C‐spine fracture rather than X‐ray. Patients having head CT for suspected intracranial injury may also benefit from included C‐spine CT. The increasing usage of primary CT will increase overall imaging costs and resource utilization.     

Magnetic resonance imaging of traumatic transection of the optic chiasm

A case of traumatic transection of the optic chiasm diagnosed by magnetic resonance imaging is reported.     

Magnetic resonance imaging of lumbar vertebral apophyseal ring fractures

Posterior lumbar vertebral apophyseal ring fractures are described in three adolescents presenting with severe low back pain, spinal tenderness and lower limb neurological deficit. Magnetic resonance imaging showed severe L4/5 posterior disc protrusion in all three patients. The actual fracture fragment was visualized with difficulty on MRI alone. The diagnosis of apophyseal ring fracture was made by either radiography or CT. Computed tomography delineated the size, shape and site of the fracture fragment. Surgical confirmation was obtained in all cases. Posterior lumbar vertebral apophyseal ring fractures may be difficult to visualize on MR imaging. Careful review of radiographs, supplemented by targeted CT, is necessary for the correct diagnosis and management of this entity.     

Sequential magnetic resonance imaging of cervical cancer

BACKGROUND:

The objectives of this study were to investigate outcome prediction by measuring absolute tumor volume and regression ratios using serial magnetic resonance imaging (MRI) during radiation therapy (RT) for cervical cancer and to develop algorithms capable of identifying patients at risk of a poor therapeutic outcome.

METHODS:

Eighty patients with stage IB2 through IVA cervical cancer underwent 4 MRI scans: before RT (MRI1), during RT at 2 to 2.5 weeks (MRI2) at 4 to 5 weeks (MRI3), and 1 to 2 months after RT (MRI4). The median follow‐up was 6.2 years (range, 0.2‐9.4 years). Tumor volumes at MRI1, MRI2, MRI3, and MRI4 (V₁, V₂, V₃, and V₄, respectively) and tumor regression ratios (V₂/V₁, V₃/V₁, and V₄/V₁) were measured by 3‐dimensional volumetry. Predictive metrics based on tumor volume/regression parameters were correlated with ultimate clinical outcomes, including tumor local recurrence (LR) and dying of disease (DOD). Predictive power was evaluated using the Mann‐Whitney test, sensitivity/specificity analyses, and Kaplan‐Meier analyses.

RESULTS:

Both tumor volume and regression ratio were strongly correlated with LR (P = .06, P = 5 × 10^?4, P = 1 × 10^?6, and P = 2 × 10^?8 for V₁, V₂, V₃, and V₄, respectively; and P = 7 × 10^?5, P = 1 × 10^?6, and P = 1 × 10^?8 for V₂/V₁, V₃/V₁, and V₄/V₁, respectively) and DOD (P = .015, P = .004, P = .001, and P = 3 × 10^?4 for V₁, V₂, V₃, and V₄, respectively; and P = .03, P = .009, and P = 3 × 10^?4 for V₂/V₁, V₃/V₁, and V₄/V₁, respectively). Algorithms that combined tumor volumes and regression ratios improved predictive power (sensitivity, 61%‐89%; specificity, 79%‐100%). The strongest predictor, pre‐RT volume and regression ratio at MRI3 (V₁ > 40 cm³ and V₃/V₁ > 20%, respectively), achieved 89% sensitivity, 87% specificity, and 88% accuracy for LR and achieved 54% sensitivity, 83% specificity, and 73% accuracy for DOD.

CONCLUSIONS:

The current results suggested that tumor volume/regression parameters obtained during primary therapy are useful in predicting LR and DOD. Both tumor volume and regression ratio provided important information as early outcome predictors that may guide early intervention for patients with cervical cancer who are at high risk of treatment failure. Cancer 2010. © 2010 American Cancer Society.     

Magnetic Resonance Imaging of Retropharyngeal Lymphadenopathy in Nasopharyngeal Carcinoma

OBJECTIVE The aim of our study was to document the patterns of RLN spread by using MRI. METHODS The MR images of 294 patients with newly diagnosed NPC were reviewed retrospectively. Criteria for metastatic lymph nodes included： shortest axial diameter, nodal necrosis, extracapsular spread, and a contrast enhancing rim. RESULTS RLN involvement was detected in 190 （64.6%） patients. A significantly higher incidence of metastatic RLNs was observed in patients with involvement of the oropharynx, nasal cavity, pre-styloid parapharyngeal space, post-styloid parapharyngeal space, levator muscle of the velum palatini, and tensor muscle of the velum palatine. Patients with level Ⅱ,Ⅲ, and Ⅴ node involvement also had a higher incidence of metastatic RLNs. Of the 231 patients who had metastatic RLNs or cervical lymph nodes, 43 （18.6%） had only metastatic RLNs, 41 （17.7%） had only metastatic cervical lymph nodes, and 147 （63.6%） exhibited an involvement of both the RLNs and cervical lymph nodes. The difference between the incidence of RLN involvements （82.3%） and the incidence of cervical lymph node involvement （81.4%） was very small. CONCLUSION Metastatic RLNs are significantly associated with early stage primary tumor involvement and supper cervical lymph node metastasis in NPC.     

Magnetic resonance imaging of the ankle: Pathology of the lateral and posterior compartments

Magnetic resonance imaging (MRI) is the gold standard for imaging the tendons and the ligaments of the ankle. MRI combines excellent tissue contrast and accurate anatomic delineation of joint structures. In the first article of this series, we discussed a compartmental approach to the interpretation of ankle pathology focusing on the anterior and medial compartments. This article will complete the MR review of the ankle, with a focus on the lateral and posterior compartments of the ankle.     

Magnetic resonance imaging of the ankle: Pathology of the anterior and medial compartments

Magnetic resonance imaging (MRI) is the gold standard for imaging the tendons and the ligaments of the ankle. MRI combines excellent tissue contrast and accurate anatomic delineation of joint structures. In this pictorial essay, the first of two parts, we delineate the ankle into anatomic compartments and use this as a template for describing pathology in each compartment.     

Magnetic resonance imaging of ankle tendons and ligaments: Part I – Anatomy

Magnetic resonance imaging is an excellent technique for imaging the tendons and the ligaments of the ankle. Owing to the advantage of detailed demonstration of soft‐tissue structures and capability for multiplanar demonstration of the ankle ligaments and tendons, MRI has been increasingly used in the evaluation of the ligamentous and the tendon injuries of the ankle. Knowledge of normal anatomy and of MRI appearances are essential to recognize pathological appearances. In this pictorial essay, the first of a three part series, we review the normal MRI appearances of the ankle tendons and ligaments. The anterior, lateral and medial tendon groups, the Achilles tendon and the lateral, the syndesmotic and the medial ligament groups are described and illustrated. Anatomy of the sinus tarsi is also described. Tendon and ligament pathology will be illustrated in the second part of the series, and imaging approach to ankle injuries will be outlined in the final part of this series.     

磁共振扩散加权成像参数与宫颈癌组织学特点的相关性

目的:探讨与研究磁共振(MR)扩散加权成像(DWI)参数与宫颈癌组织学特点的相关性.方法:采用回顾性研究方法,2012年9月到2016年1月选择在我院住院诊治的宫颈癌病例84例作为观察组,同期选择由于其他原因进行宫颈检查的女性患者84例作为对照组,两组都给予常规MRI平扫及DWI检查,记录与调查宫颈癌组织学特点与DWI 参数 ADC值,同时进行相关性分析.结果:两组MRI影像学图像均满足诊断及测量要求,未见明显伪影和变形;观察组在T1WI上呈等信号,在T2WI上呈稍高或高信号,DWI上表现为边界清晰的高信号肿块.当MRI DWI b值为1 000 s/mm2时,观察组与对照组的ADC值分别为(0.89±0.15)×10-3mm2/s和(1.50±0.23)×10-3mm2/s,观察组明显少于对照组(P<0.05).ADC值在宫颈癌患者的不同临床分期、淋巴结转移和分化程度中对比都有统计学意义(P<0.05);Pearson相关系数显示宫颈癌患者的ADC值与临床分期、淋巴结转移与分化程度也呈现明显负相关性(P<0.05).结论:MRI诊断宫颈癌有很好的成像质量,且 DWI成像参数ADC值明显降低,与宫颈癌的组织学特点有很好的相关性,能有效反映宫颈癌的病变状况.     

后方韧带复合体损伤情况在评价胸腰椎肿瘤致病理性骨折中的作用

目的 通过分析胸腰椎肿瘤致病理性骨折患者的后方韧带复合体(PLC)损伤情况,研究其在胸腰椎肿瘤致病理性骨折损伤程度、骨折分型、损伤评分、后凸畸形及神经功能损伤中的作用.方法 选取胸腰椎肿瘤致病理性骨折患者90例,根据PLC损伤程度将患者分为PLC完整组和PLC损伤组.通过评判两组患者的骨折分型、损伤评分、后凸畸形及神经功能损伤情况,研究各指标与PLC损伤的关系.结果 PLC损伤组的载荷分享评分(LSC)和胸腰椎损伤严重程度评分(TLICS)均高于PLC完整组(P<0.01),Cobb角度大于PLC完整组(P<0.01).PLC损伤组患者的Denis分型和AO分型均较PLC完整组严重.PLC损伤组和PLC完整组的神经功能不全比例分别为88.89%、60.00%,差异有统计学意义(P<0.01).结论 胸腰椎肿瘤致病理性骨折与PLC损伤情况关系密切.     

Magnetic resonance imaging anatomy of the prostate and periprostatic area: a guide for radiotherapists.

Magnetic resonance imaging (MRI) offers superb soft tissue contrast on T2-weighted images and allows direct multiplanar image acquisition. It can show the internal prostatic anatomy, prostatic margins, and the extent of prostatic tumors in much more detail than computed tomography (CT) images. The present article reviews some key prostatic and periprostatic radiologic landmarks that can be helpful for the radiotherapist using T2-weighted MRI as an adjunct to CT in treatment planning for prostate cancer.     

舌鳞癌颈淋巴结转移的MRI诊断

背景与目的明确有无颈部淋巴结转移对舌癌的治疗与预后评价意义重大,单纯触诊诊断淋巴结转移的准确率难以令人满意,MRI越来越多地用于颈部淋巴结转移的评价。本研究旨在分析舌鳞癌颈淋巴结转移的MRI特点及规律,探讨MRI在诊断舌鳞癌颈部淋巴结转移中的作用。方法对92例舌鳞癌患者共448个颈部淋巴结区进行MRI鄄病理对照分析。结果448个淋巴结区中,166区(37.1%)病理为淋巴结转移,其中Ⅱ区最常受累,Ⅰ、Ⅱ区MRI诊断的假阳性率及假阴性率均较高。舌体鳞癌颈部淋巴结各区转移率与舌根鳞癌比较无统计学差异。76个淋巴结区有明确的淋巴结中央坏死,病理证实均为转移淋巴结。包膜外侵犯34区,MRI上淋巴结边缘不规则,周围脂肪带模糊、不完整,其中2例包绕颈内动脉。以淋巴结最小直径≥8mm,或中央坏死作为MRI诊断转移淋巴结的标准,敏感性79.5%,特异性90.4%,准确性86.4%。结论舌鳞癌颈部淋巴结转移以Ⅱ区最高,淋巴结的大小、有无中央坏死及边缘是否规则可作为MRI诊断的主要依据。MRI对于Ⅲ、Ⅳ及Ⅴ区诊断的淋巴结转移诊断准确性高,但对Ⅰ、Ⅱ区淋巴结转移诊断价值有限。     

Sarcoidosis of the thoracic and lumbar spine: Imaging findings with an emphasis on magnetic resonance imaging

Vertebral sarcoidosis is exceedingly rare with only a few cases reported in the published literature. The case of a 40‐year‐old man with vertebral sarcoidosis is presented, emphasizing the role of MRI and biopsy in confirming the diagnosis. A brief review of the published literature is also presented.     

Magnetic resonance imaging of head and neck tumors

Magnetic resonance imaging has revolutionized the imaging of head and neck malignancies and is now rapidly replacing computed tomography as the study of choice in the majority of lesions in the head, neck, larynx, hypopharynx, oropharynx, paranasal sinuses, paranasopharynx, and skull base. CT scanning can be used in the same region; however, inflammation obtained in CT is not as clearly demonstrated and in some situations, such as malignancies of the tongue, the lesions may be missed entirely. There are still occasional difficult clinical problems when the two studies are complementary, but this situation will definitely be rare.