孤立性肺结节的影像学研究进展

随着医学影像设备及技术的发展,孤立性肺结节的研究进入了形态学和功能学的研究阶段,这包括MSCT、MRI的动态增强和灌注成像以及PET/CT对组织代谢变化的研究,这些均有利于良、恶性肺结节的鉴别.就孤立性肺结节的影像学研究进展进行综述.     

孤立性肺结节的影像学研究进展

随着医学影像设备及技术的发展，孤立性肺结节的研究进入了形态学和功能学的研究阶段，这包括MSCT、MRI的动态增强和灌注成像以及PET／CT对组织代谢变化的研究，这些均有利于良、恶性肺结节的鉴别。就孤立性肺结节的影像学研究进展进行综述。     

PET/MRI在肺癌中的潜在临床应用价值

PET/MRI作为新出现的融合影像技术,其临床应用价值尚未得到充分证实。与CT相比,MRI具有软组织对比分辨力高、无辐射、多参数成像、能够提供更多功能信息的优势,PET与MRI的融合对于肺癌的潜在应用价值可能要优于PET/CT。简述不同的PET/MRI系统的设计,并从肺结节的检出、鉴别诊断、TNM分期、预后/早期疗效评价/肿瘤复发4个方面介绍PET/MRI在肺癌中的潜在临床价值。     

孤立性肺结节:一过性动态增强灌注区域CT检测、一过性动态增强MR成像和FDGPET/CT的比较

摘要目的前瞻性地比较动态灌注区域CT检测、动态MR成像以及应用18F FDG的PET/CT在孤立性肺结节诊断中的能力。材料与方法机构审查委员会批准了这项研究,每     

肺结节的影像学研究进展

肺结节是胸部的常见病变,也是近年来研究的热点和难点,随着现代医学影像学技术的发展,大大提高了肺结节的检出及定性诊断率。本文综述了传统X线检查、CT检查、MRI检查及PET成像技术诊断肺结节的优缺点,其中多层螺旋CT具有一定的优势。     

MRI在孤立性肺结节评估中的应用

低剂量螺旋CT扫描及多层螺旋CT的广泛应用,使得孤立性肺结节的偶然检出率增加。随着MR快速成像序列、动态增强MRI、功能MR成像以及计算机应用技术的发展,MRI对孤立性肺结节的评估越来越受到人们的重视。就MR成像在孤立性肺结节评估中的应用予以综述。     

MRI在孤立性肺结节评估中的应用

低剂量螺旋CT扫描及多层螺旋CT的广泛应用,使得孤立性肺结节的偶然检出率增加。随着MR快速成像序列、动态增强MRI、功能MR成像以及计算机应用技术的发展,MRI对孤立性肺结节的评估越来越受到人们的重视。就MR成像在孤立性肺结节评估中的应用予以综述。     

PET/MRI在胰腺肿瘤中的应用

PET/MRI是一种将PET和MRI融合的新型影像诊断技术,其整合了PET提供的人体生理代谢、分子信息和MRI提供的功能及解剖形态信息。相较于CT,MRI具有更高的软组织对比度,可多参数成像,且无辐射。PET/MRI在胰腺癌病灶检测、术前分期和预后评估方面优于PET/CT。~(68)Ga标记的生长抑素受体显像剂PET/MRI能够提高胰腺神经内分泌肿瘤的检测和诊断能力。新型显像剂的研发和应用能够提高胰腺肿瘤PET/MRI的特异性和精准性。就PET/MRI在胰腺癌的诊断、分期及疗效监测的应用价值及其对胰腺神经内分泌肿瘤的研究进展予以综述。     

PET/CT鉴别诊断孤立性肺结节的优势与限度

目的：探讨PET/CT在孤立性肺结节（SPNs）鉴别诊断中的价值。方法：经病理证实的58例SPNs均行PET/CT扫描,结合结节的PET的代谢特点及CT的形态学特点综合判定SPNs的性质。结果：恶性SPNs的最大标准摄取值SUVmax（均值7.03±4.75）明显高于良性SPNs（均值2.06±1.06）,差异有统计学意义（t=6.40,P〈0.001）。PET/CT诊断恶性SPNs的敏感度、符合率、阴性预测值（100%、96.6%、100%）均较单独利用CT（88.2%、87.9%、50.0%）和单独利用PET（86.3%、84.5%、41.7%）高。结论：PET/CT可以提高诊断孤立肺结节的敏感度、符合率及阴性预测值。     

18F-FDG PET/CT联合肺动脉灌注成像指数在单发肺结节中的应用价值

目的探讨18F-FDG PET/CT联合320容积CT双入口灌注成像(DI-CTP)肺动脉灌注指数(PPI)对单发性肺结节的鉴别诊断价值。方法搜集经病理证实40例单发性肺结节患者的18F-FDG PET/CT及320排CT灌注成像影像资料(恶性结节24例、良性结节16例),PET/CT以结节18F-FDG摄取值SUV≥2.5为诊断恶性结节阈值,18F-FDG PET/CT联合PPI则在SUV≥2.5诊断阈值的基础上综合PPI<50%判定,并分析SUV与PP均值在良恶性结节间差异性及相关性。结果PET/CT联合PPI正确诊断38例,其中恶性结节22例、良性结节16例,误诊2例。18F-FDG PET/CT联合PPI诊断肺单发结节的敏感性91.6%,特异性100%,准确性95.0%;18F-PDG摄取值SUV在良、恶性结间差异无统计学意义(t=1.66,P>0.05),而PPI均值在良、恶性结节间差异有统计学意义(t=-3.14,P<0.01);SUV与PPI间相关性无统计学意义(r=0.20,P>0.05)。结论18F-FDG PET/CT联合PPI可以提高诊断肺单发肺结节敏感性、特异性和准确性,减少误诊率。     

Physiologic and pathologic calcifications and ossifications in the face and neck

The aim was to give a systematic presentation of physiologic and pathologic calcifications and ossifications in the face and neck with a special emphasis on clinical relevance. In a sometimes subacute setting one should recognize specific calcifications which often lead to important diagnoses such as fungal sinusitis or sclerosing labyrinthitis. In a more chronic situation intraocular calcifications in small children are pathognomonic for retinoblastoma. Juxtatumoral sclerosis of the laryngeal cartilage in laryngopharyngeal carcinoma is usually caused by tumor infiltration of the cartilage resulting in a higher tumor stage and, this way, has a major impact on the therapeutical strategy. Calcified lymph nodes are mainly unspecific but can be the result of tuberculosis or metastases of thyroid cancer. Cross-sectional imaging methods, most of all computed tomography, are ideally suited to reveal head and neck calcifications and ossifications, especially those which are clinically relevant.     

Head and neck infection and inflammation

This article discusses the imaging manifestations of infectious and inflammatory conditions of the head and neck. Special attention is paid to the sites, routes of spread, and complications of neck infections. Because the clinical signs and symptoms and the complications of these conditions are often determined by the precise anatomic site involved, anatomic considerations are stressed. Familiarity with the fascial layers, spaces of the neck, and the contents of each space is helpful for this discussion. The fascial layers of the neck are important barriers to infection, and once infection is established, the fascial layers play a part in directing its spread.     

Staging and surgical management of pancreatic and biliary cancer and inflammation

Management of benign and malignant diseases of the pancreas, liver, and biliary tract has made remarkable progress in the last two decades. Advances in minimally invasive surgery, interventional radiology, and diagnostic and therapeutic endoscopy have changed the treatment of common diseases such as cholelithiasis and more serious diseases such as pancreatic adenocarcinoma. Advances in biliary tract and pancreatic surgery have paralleled the advances in ultrasonographic imaging, CT, and MR imaging. This article outlines the surgeon's perspective on radiologic imaging and preoperative staging of benign and malignant biliary and pancreatic disease.     

细胞自噬与肿瘤发生发展

自噬是真核生物中一种高度保守的胞内降解途径.其主要通过溶酶体或液泡进行饥饿状态下的营养动员,清除受损蛋白质、细胞器和胞内病原体.自噬主要包括巨自噬、分子伴侣介导自噬(CMA)和微自噬.自噬已被证实与多种人类疾病相关,其在肿瘤发生发展中具有重要意义.近年研究中,对于自噬和肿瘤关系有了进一步的认识,该文就自噬分子机制、调控...     

The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings

Thyroid imaging approach is based on the preliminary clinical evaluation. Lesions that are smaller than 2 cm should be assessed with US, which is capable of discriminating masses as small as 2 mm and distinguishing solid from cystic nodules. US-guided FNAB provides tissue for cytologic examination of thyroid nodules. CT and MR imaging are indicated for larger tumors (greater than 3 cm diameter) that extend outside the gland to adjoining structures, including the mediastinum, and retropharyngeal region. Metastatic lymph nodes in the neck and invasion of the aerodigestive tract are also in the realm of CT and MR imaging. Thyroid nodules are categorized on scintigraphy as hot or cold nodules. Hot nodules are rarely malignant, whereas cold nodules have an incidence of 10% to 20% of malignancy. Calcifications (amorphous, globular, nodular, and linear) occur in adenomas and carcinomas and have no differential diagnostic features except for psammomatous calcifications, which are a pathognomonic finding in papillary carcinomas and a small percentage of medullary carcinomas. Papillary carcinoma is the most common malignant tumor (80%) followed by follicular (20% to 25%); medullary (5%); undifferentiated; anaplastic carcinomas (< 5%); lymphoma (5%); and metastases. Lymph node metastases are common in papillary carcinoma, 50% at presentation, and less common in follicular carcinomas. The metastatic nodes in papillary carcinoma may enhance markedly (hypervascular); show increased signal intensity on T1-weighted images (increased thyroglobulin content or hemorrhage); and reveal punctate calcifications. Localized invasion of the larynx, trachea, and esophagus occurs predominantly in papillary and follicular carcinomas; the incidence is less than 5%. Ectopic thyroid tissue may be encountered in the tongue (foramen cecum); along the midline between posterior tongue and isthmus of thyroid gland; lateral neck; mediastinum; and oral cavity. Goiter and malignant tumors, notably papillary carcinoma, may develop in ectopic thyroid tissue. Carcinomas may also arise in thyroglossal duct cysts, which develop from duct remnants between the foramen cecum and thyroid isthmus. Infectious disease of the thyroid gland is not common and the CT and MR imaging findings are similar as described under neck infection. Other types of inflammatory disorders including Hashimoto's thyroiditis, granulomatous thyroiditis, and Riedel's struma display no specific imaging features. Imaging studies may, however, be indicated to confirm a suspected clinical diagnosis and assess compromise of the airway (Riedel's struma). HPT is a clinical diagnosis in which hypercalcemia is the most important finding. Parathyroid hyperplasia, adenoma, and carcinoma represent underlying lesions. To relieve the patient's symptoms surgical extirpation is indicated. The surgical success rate without imaging is 95%. The indications for imaging studies vary but it is generally agreed that reoperation after a previous failed surgical attempt and suspicion of an ectopic parathyroid adenoma should be investigated by imaging. These consist of US, nuclear medicine studies, CT and MR imaging. US and technetium sestamibi scanning have the highest accuracy rate for localizing an adenomatous gland at and near the thyroid gland. Ectopic adenomas, particularly if they are located in the mediastinum, are preferrably investigated with CT and MR imaging with gadolinium and fat suppression. Carcinomas and parathyroid cysts are optimally evaluated by CT and MR imaging. On MR imaging adenomas are low in signal intensity on T1-weighted images, high in signal intensity on T2-weighted images, and enhance post introduction of gadolinium.