乳腺MRI分割与基于光线投影的三维重建

目的乳腺MRI(magnetic resonance imaging)序列成像连续、位置固定,但二维图像无法提供便于观察的肿块的深度与外形信息,为此提出乳腺及其肿块分割与三维重建方法。方法首先利用最大类间方差法与区域生长法提取乳腺外轮廓,然后选用基于梯度和能量信息的水平集方法准确分割乳腺肿块,并对分割结果采用基于包围盒的光线投影算法进行体绘制。结果对患者的多组MRI序列进行分割实验并对几种分割算法进行客观评价,三维重建实验得到乳腺与肿块的立体图像以供医生观察。结论分区处理的水平集分割与基于光线投影的三维重建为医生提供更加形象的立体视觉效果,不仅有助于对肿块病变程度的诊断,而且能帮助外科医生在保乳手术中准确判断开刀位置。     

MRI在高泌乳素血症患者中的应用价值

目的：探讨高泌乳血症患者垂体的变化情况。方法对26例临床诊断为高泌乳血症的患者行鞍区MR扫描,并对检查结果进行分析。结果26例患者中垂体巨腺瘤11例,微腺瘤7例,未见明显异常改变8例。病变呈等T1、稍长T2信号,增强扫描病变明显强化。结论经鞍区MR检查可以基本肯定或排除垂体高泌乳素腺瘤的诊断,为临床治疗提供依据。     

乳腺超声检查中BI-RADS分级诊断标准对乳腺原位癌的诊断价值

目的 探究应用BI-RADS分级诊断标准来诊断乳腺原位癌的超声诊断价值,以提升超声工作者对规范乳腺诊断标准认识和运用,提高彩色多普勒超声对乳腺原位癌的诊断能力。方法 选取2015年5月~2018年5月在我院通过手术及病理结果证实为乳腺原位癌的患者37例,系统回顾了根据病灶所显示出的不同声像图特征,综合分析采用BI-RADS超声分级诊断,探讨误诊主要原因。结果 37例乳腺原位癌病例中,超声诊断准确率为75.36%（28/37）,4例未定,5例误诊,其中1例误诊为导管内乳头状瘤,1例误诊为导管浸润癌,1例误诊为导管局部扩张,2例误诊为瘤样增生。结论 彩色多普勒超声诊断仪采用BI-RADS分级诊断方法,较大提高了乳腺原位癌的检出率,联合其它辅助检查可明显提高检出率,在指导临床对患者乳腺疾病的评估起到重要作用。     

超声、钼靶、MRI及肿瘤标志物联合检测在乳腺癌诊断中的价值研究

目的 探讨乳腺癌在彩色多普勒超声、乳腺钼靶和乳腺MRI上的表现及乳腺癌肿瘤标志物CA15-3的表达水平,比较超声、钼靶和MRI及CA15-3在早期乳腺癌诊断中的应用价值.方法 回顾性分析2014年3月至2016年3月在唐山市人民医院收治的92例乳腺癌患者,比较术前超声、钼靶、MRI、CA15-3及联合检查与术后病理诊断的符合情况.结果 MRI的确诊率明显地高于超声和钼靶,两者间差异有统计学意义(x2=3.761,P＜0.050;x2 =3.513,P＜0.05),钼靶也明显高于超声,两者间差异有统计学意义(x2 =5.312,P＜0.05).CA15-3与MRI差异无统计学意义.超声检查漏诊及误诊率明显高于钼靶、MRI、CA15-3.超声、钼靶和MRI三种影像学检查联合血清CA15-3水平检测正确诊断86例,诊断正确率为93.5％.结论 乳腺癌较容易漏诊,疑难病例定性困难,超声、钼靶、MRI及肿瘤标志物联合检测可以有效提高乳腺癌诊断的灵敏度和正确率,减少漏诊率.     

乳腺超声光散射成像联合血清CA15-3、CEA检测在乳腺肿瘤中的诊断价值

目的 探究乳腺超声光散射成像与血清糖链抗原(CA15-3)、癌胚抗原(CEA)联合检测对乳腺肿瘤诊断的临床价值.方法 回顾性分析2014年1月至2016年1月我院收治的200例经术后病理学确诊为乳腺肿瘤患者的临床资料,其中乳腺癌、乳腺良性肿瘤患者各100例,另选取同期来我院进行体检的健康妇女50例作为对照组,对其临床资料进行回顾性分析.均采用超声光散射乳腺断层成像系统对总血红蛋白水平进行测量,同时采用化学发光免疫法对血清肿瘤标志物(CEA、CA15-3)水平进行检测.分析并比较三者联合检测与单一检测对乳腺肿瘤诊断的价值.结果 乳腺癌组的MHC测定值及血清CEA、CA15-3水平均高于乳腺良性肿瘤组及对照组,各项指标组间比较差异具有统计学意义(P<0.05);OPTIMUS联合血清CEA及CA15-3水平检测在乳腺癌中的检出阳性率最高,明显高于OPTIMUS、CEA及CA15-3三者的单独检测,差异具有统计学意义(P<0.05);OPTIMUS联合血清CEA、CA15-3水平检测诊断乳腺癌的灵敏度、准确率及阴性预测值分别为92.0%、94.0%、92.3%,均明显高于三者的单独检测,组间比较差异具有统计学意义(P<0.05).结论 乳腺超声光散射成像联合血清糖链抗原、癌胚抗原检测在乳腺肿瘤的诊断中具有重要的临床价值,可提高诊断灵敏度及准确率,值得在临床推广应用.     

脊柱原发骨质疏松性压缩骨折MRI特征及诊断价值

目的　分析脊柱原发性骨质疏松性压缩骨折MRI特点及其诊断价值 .方法　回顾性分析经X线诊断、临床证实的 4 8例脊椎原发骨质疏松性压缩骨折的MRI表现 .结果　共 82个椎体表现为压缩变形 ,其中凹陷形 4 1个 ,楔形 31个 ,扁平形 10个 .矢状位T1WI5 2个椎体表现不同类型的低信号 ,30个椎体未见异常信号 .结论　脊柱原发骨质疏松性骨折的MRI表现较具特征性 ,是临床诊断的一种可靠的检查手段 ,能准确地与恶性肿瘤所致的椎体病理性骨折鉴别     

MiR-21对乳腺癌诊断价值的Meta分析

目的应用Meta分析的方法评价microRNA-21(miR-21)在乳腺癌患者诊断中的价值。方法检索1990年至2018年在Pubmed、Embase、Medline等英文数据库及1990年至2018年在中国知网、万方及维普数据库收录的所有有关miR-21用于乳腺癌诊断的研究文献,根据纳入与排除标准筛选文献,提取原始有效数据后,利用Med-Disc1.4进行统计分析。结果共有11篇文献纳入相关临床研究,11个独立的病例对照研究,其中包含乳腺癌患者761例,健康对照组652例。miR-21用于诊断乳腺癌的合并灵敏度和特异性分别为0.66(95%CI0.63~0.70)和0.82(95%CI0.79~0.82),阳性似然比和阴性似然比分别为4.12(95%CI2.60~6.52)和0.33(95%CI0.21~0.52);其DOR为13.31(95%CI5.59~31.68);SROC-AUC为0.898。亚组分析显示miR-21对于血清标本和非亚洲人的诊断优势高于非血清标本和亚洲人。结论评价结果提示miR-21在乳腺癌诊断中有一定的精确性,可作为重要的参考指标。     

CT与MRI诊断股骨头坏死的价值研究

目的 对比CT检查与MRI检查对股骨头坏死的诊断价值。方法 选取2016年5月~2018年5月医院门诊收治的78例股骨头坏死患者作为研究对象,依据检查方式不同将患者分为对照组38例和观察组40例。对照组患者行双侧股骨头 CT检查,观察组患者行MRI检查,比较两组的诊断结果。结果 观察组患者确诊率高于对照组（97.50% vs 78.95%）,差异有统计学意义（P＜0.05）;观察组患者Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期的诊断率均高于对照组,其实Ⅰ期、Ⅳ期比较,差异有统计学意义（P均＜0.05),Ⅱ期、Ⅲ期比较,差异无统计学意义（P＞0.05）。结论 MRI检查对股骨头坏死患者的诊断准确率较高,优于CT 检查,可用于临床早期诊断中。     

Diagnostic Value of Silver-Stained Interphasic Nucleolar Organizer Regions in Breast Tumors

Seventy-six specimens of normal breast tissue and benign and malignant breast lesions were studied to assess the mean area occupied by silver-stained proteins of the nucleolar organizer regions (MNORA) of the nucleolus. The assessment was performed with a computer-assisted image analyzer. The results indicate that only 30% of malignant lesions have a MNORA value greater than that of normal breast tissue or benign lesions. On the other hand, MNORA values of ductal carcinoma in situ were significantly greater than those of epitheliosis (papillomatosis). MNORA values were also significantly different in grade I and grade III invasive ductal carcinomas, the latter exhibiting the highest MNORA values of all the cases observed. Evaluation of MNORA values may therefore help in differentiating benign epithelial proliferations from ductal carcinomas in situ. Furthermore, because there is evidence that MNORA values are indicative of the cell duplication rate, MNORA values may ultimately be considered an objective prognostic parameter in addition to grading for invasive ductal carcinomas.     

Value of whole breast magnetic resonance elastography added to MRI for lesion characterization

The purpose of this work was to assess the diagnostic value of magnetic resonance elastography (MRE) in addition to MRI to differentiate malignant from benign breast tumors, and the feasibility of performing MRE on the whole breast. MRE quantified biomechanical properties within the entire breast (50 slices) using an 11 min acquisition protocol at an isotropic image acquisition resolution of 2 × 2 × 2 mm³. Fifty patients were included. Finally, 43 patients (median age 52) with a suspect breast lesion detected by mammography and/or ultrasound were examined by MRI and MRE at 1.5 T. The viscoelastic parameters, i.e. elasticity (G_d), viscosity (G_l), the magnitude of the complex shear modulus , and the phase angle , were measured via MRE and correlated with MRI Breast Imaging—Reporting and Data System (BI‐RADS) score, histological type, and histological grade. Stroma component and angiogenesis were also correlated with viscoelastic properties. In the 43 lesions, G_d decreased and y increased with the MRI BI‐RADS score (p_Gd = 0.02, p_y = 0.002), whereas (G_l) and y were increased in malignant lesions (p_Gl = 0.045, p_y = 0.0004). The area under the curve increased from 0.84 for MRI BI‐RADS alone to 0.92 with the MRI BI‐RADS and y (AUC increase +0.08; 95% CI (?0.003; 0.16)). Lesion characterization using the y parameter increased the diagnostic accuracy. The phase angle y was found to have a significant role (p = 0.01) in predicting malignancy independently of the MRI BI‐RADS. Interestingly, histological analysis showed no correlation between viscoelastic parameters and percentage and type of stroma, CD34 quantification of vessels, or histological grade. The combination of MRE and MRI improves the diagnostic accuracy for breast lesions in the studied cohort. In particular, the phase angle y was found to have a significant role in predicting malignancy in addition to BI‐RADS.     

核素功能显像及MRI形态检查对眼脉络膜黑色素瘤的影像诊断价值

目的 通过观察眼脉络膜黑色素瘤的核素功能性显像及MRI形态学成像表现,探讨二者对脉络膜黑色素瘤的诊断价值.方法 回顾性分析28例（28只眼）经眼超声和（或）彩色超声多普勒血流成像、CT、眼底血管造影及临床评价等综合诊断为脉络膜黑色素瘤患者资料（男11例,女17例,平均年龄为44.3±13.8岁）,所有患者均行过核素功能性显像及MRI形态学检查.结果 核素功能性显像示病变部位最大计数/枕骨平均计数（Tmax/0avg）与对侧最大计数/枕骨平均计数（Nmax/Oavg）之间差异有统计学意义（t=4.134,P＜0.01）,病变部位平均计数/枕骨平均计数（Tavg/0avg）与对侧平均计数/枕骨平均计数（Navg/Oavg）之间差异同样有统计学意义（t=4.620,P＜0.01）.有78.57％（22/28）患者存在整合素高表达.MRI显示支持诊断20例.结论 核素功能性显像及MRI形态学检查联合应用是目前对于此类疾病最佳的诊断方法.     

Computerized Breast Mass Detection Using Multi-Scale Hessian-Based Analysis for Dynamic Contrast-Enhanced MRI

This study aimed to investigate a computer-aided system for detecting breast masses using dynamic contrast-enhanced magnetic resonance imaging for clinical use. Detection performance of the system was analyzed on 61 biopsy-confirmed lesions (21 benign and 40 malignant lesions) in 34 women. The breast region was determined using the demons deformable algorithm. After the suspicious tissues were identified by kinetic feature (area under the curve) and the fuzzy c-means clustering method, all breast masses were detected based on the rotation-invariant and multi-scale blob characteristics. Subsequently, the masses were further distinguished from other detected non-tumor regions (false positives). Free-response operating characteristics (FROC) curve and detection rate were used to evaluate the detection performance. Using the combined features, including blob, enhancement, morphologic, and texture features with 10-fold cross validation, the mass detection rate was 100 % (61/61) with 15.15 false positives per case and 91.80 % (56/61) with 4.56 false positives per case. In conclusion, the proposed computer-aided detection system can help radiologists reduce inter-observer variability and the cost associated with detection of suspicious lesions from a large number of images. Our results illustrated that breast masses can be efficiently detected and that enhancement and morphologic characteristics were useful for reducing non-tumor regions.     

根据磁共振T2加权影像特征预测乳腺癌组织学分级

组织学分级是乳腺癌的重要预后指标。探讨磁共振(MRI)T2加权影像特征与乳腺癌组织学分级的关联性, 可为术前预测乳腺癌组织学分级提供有意义的参考作用。回顾性分析167例术前行MRI检查并经病理诊断为浸润性乳腺癌患者, 其中组织学分级Ⅱ级和Ⅲ级的分别为72例和95例。利用计算机半自动方法, 分割患者乳腺磁共振T2加权影像的病灶区域, 并对其提取包括纹理特征和形态特征的40维影像特征。采用留一法交叉验证方法(LOOCV), 通过统计学方法分析比较影像特征在组织分级Ⅱ级和Ⅲ级组间的差异, 并设计多变量分类预测模型。绘制受试者工作特征曲线(ROC), 并计算对应曲线下的面积(AUC);计算敏感性、特异性、F1-Measure等指标, 对预测模型进行综合评估。对每一维特征进行单变量逻辑回归分析, 在低分级和高分级组间进行统计检验分析(t检验)。形态特征中最优单特征为病灶半径, AUC值为0.742(P<0.05);纹理特征中最优特征为大面积高灰度级增强, AUC值为0.742(P<0.05)。设计多元逻辑回归(MLR)、支持向量机(SVM)、多任务学习(MTL)等3种分类器, 预测乳腺癌组织学分级, 其AUC值分别为0.767±0.036、0.772±0.036和0.771±0.037, 对应特异性分别为0.667、0.653、0.708, 灵敏度分别为0.747、0.737、0.684。研究表明, 乳腺癌的T2加权影像特征在一定程度上反映其组织学分级, 对乳腺癌的预后判断具有潜在价值。     

3D printing of MRI compatible components: Why every MRI research group should have a low-budget 3D printer

PurposeTo evaluate low budget 3D printing technology to create MRI compatible components.Material and methodsA 3D printer is used to create customized MRI compatible components, a loop-coil platform and a multipart mouse fixation. The mouse fixation is custom fit for a dedicated coil and facilitates head fixation with bite bar, anesthetic gas supply and biomonitoring sensors. The mouse fixation was tested in a clinical 3T scanner.ResultsAll parts were successfully printed and proved MR compatible. Both design and printing were accomplished within a few days and the final print results were functional with well defined details and accurate dimensions (Δ <  0.4 mm). MR images of the mouse head clearly showed reduced motion artifacts, ghosting and signal loss when using the fixation.ConclusionsWe have demonstrated that a low budget 3D printer can be used to quickly progress from a concept to a functional device at very low production cost. While 3D printing technology does impose some restrictions on model geometry, additive printing technology can create objects with complex internal structures that can otherwise not be created by using lathe technology. Thus, we consider a 3D printer a valuable asset for MRI research groups.     

Clinical Significance of Microcalcifications Detection in Invasive Breast Carcinoma

Background

Recently, a lot of cases with microcalcifications of the breast are pointed by the images of mammography (MG), because breast screening using MG become common. Although MG is a gold standard modality for detecting microcalcifications, images of ultrasonography (US) are now feasible to detect microcalcifications with recent improvements to ultrasound diagnostic devices. In this report, we analyzed clinical significance of microcalcifications detected with US images in invasive breast carcinoma.

Methods

Eighty-eight patients with invasive breast carcinoma who underwent MG and US before surgery at the Division of Breast and Endocrine Surgery of Tottori University Hospital between January 2012 and August 2013. After reviewing US images, the association between the presence of echogenic spots that indicate microcalcifications and images of MG or pathological findings was assessed.

Results

Patients without microcalcifications on US images were significantly more likely to have the Luminal A subtype and a lower nuclear grading. Conversely, patients with microcalcifications on US images were significantly more likely to have higher level of MIB-1 index, lymphovascular invasion, comedonecrosis and lymph node metastasis. The rate of detecting microcalcifications on US images was relatively good, with 81.8% of sensitivity, 94.5% of specificity and 89.8% of diagnostic accuracy. Among the calcifications detected by MG images, detected rate of calcifications with US images was higher in necrotic type (92.6%) than secretory type (33.3%).

Conclusion

This study suggest that microcalcifications of tumors detected by US images could serve as an useful prediction to evaluate the degree of malignancy for patients with invasive breast carcinoma.     

血清CA15-3和超声、CT、MRI检查对乳腺癌诊断价值的比较

目的：探讨了三种非创伤性影像检查方法,超声（US）、X线计算机断层摄影技术（CT）和磁共振成像（MRI）及血清CA15-3水平在乳腺癌诊断中的敏感性和准确性,以提高对乳腺癌早期诊断的方法。方法：回顾分析,比较38例乳腺癌患者的US、CT和MRI及CA15-3的优缺点。结果：乳腺癌的确诊率US为76.3%,CT为84.2%,MRI为93.8%,CA15-3为68.4%。US对乳腺癌的早期检出率较高,但确诊率较低。CT和MRI对乳腺癌的确诊率较高,血清CA15-3的确诊率较低。结论：US、CT、MRI和血清CA15-3各有其优点,合理的综合应用可提高对乳腺癌的早期诊断。     

Breast cancer screening in women at high risk using MRI

A series of prospective comparative studies have demonstrated that MRI has approximately twice the sensitivity of X‐ray mammography for screening women at high familial risk of breast cancer. In these studies, lesions have often been detected at an early stage, with disease being small and predominantly node negative. The diagnostic features in relation to risk and the biological behaviour of disease with risk category and age are being evaluated. The results of these studies have resulted in revised recommendations for screening for women at high risk of breast cancer. In this article, the results of the UK Magnetic Resonance Imaging in Breast Cancer Screening (MARIBS) study of MRI screening are described, and compared with results from other studies. Risk factors identifying women who would benefit from MRI screening are discussed, MRI measurement methods are described, and the results of studies evaluating MRI and mammographic lesions in different risk groups are reviewed. Recommendations for screening women at high risk of breast cancer published by the American Cancer Society and from the National Institute for Health and Clinical Excellence (NICE) in the UK are summarised. Copyright © 2008 John Wiley & Sons, Ltd.     

Treatment Response Evaluation of Breast Cancer after Neoadjuvant Chemotherapy and Usefulness of the Imaging Parameters of MRI and PET/CT

This study was aimed to evaluate the ability of imaging parameters measured on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted MRI (DWI) and positron emission tomography/computed tomography (PET/CT) to serve as response markers in breast cancer after neoadjuvant chemotherapy (NAC). In 20 patients with breast cancer, DCE-MRI and DWI using a 3 T scanner and PET/CT were performed before and after NAC. DCE-MRI was analyzed using an automatic computer-aided detection program (MR-CAD). The response imaging parameters were compared with the pathologic response. The areas under the curve (AUCs) for DCE-MRI using MR-CAD analysis, DWI and PET/CT were 0.77, 0.59 and 0.76, respectively. The combination of all parameters measured by MR-CAD showed the highest diagnostic performance and accuracy (AUC = 0.77, accuracy = 90%). The combined use of the parameters of PET/CT with DCE-MRI or DWI showed a trend toward improved specificity and negative predictive value (100%, 100%, accuracy = 87.5%). The use of DCE-MRI using MR-CAD parameters indicated better diagnostic performance in predicting the final pathological response compared with DWI and PET/CT, although no statistically significant difference was observed. The combined use of PET/CT with DCE-MRI or DWI may improve the specificity for predicting a pathological response.

Graphical Abstract

     

血清CA15-3与CEA,SF联检对乳腺癌的诊断价值

目的:比较肿瘤标志物—CA15-3单项检测及其与CEA、SF联检对乳腺癌的诊断价值。方法:选择 乳腺癌患者66例,乳腺良性疾病患者63例,用CLIA法测其血清CA15-3、CEA、SF含量,与正常组比较。结 果:在乳腺癌组中,CA15-3 CEA SF、CA15-3 SF阳性率分别为81.8%、74.2%,均明显高于CA15-3单 项检测阳性率(54.5%)(P<0.01,P<0.05);在乳腺癌组的无转移组中,CA15-3 CEA SF联检阳性率为 74.4%,明显高于CA15-3单项检测阳性率(46.5%)(P<0.01)。各组中,其余各种联检阳性率比较均无明显 差别(P>0.05)。结论:血清CA15-3 CEA SF联检可以明显提高乳腺癌特别是无转移乳腺癌的检出率,是 诊断早期乳腺癌较好的实验室检测组合项目。