MRI平扫联合DWI对乳腺良恶性病变诊断价值分析

目的:探讨MRI平扫联合DWI对乳腺良恶性病变的诊断价值。材料与方法:对病理证实的70例患者MRI常规平扫、扩散加权成像(DWI)及表观扩散系数(ADC)值进行回顾性分析,所有病例均采用SET1WI、FSET2WI压脂序列、单次激发自旋平面-回波成像(SE-EPI)序列行DWI扫描,扩散敏感系数(b值)取1000s/mm2。结果:70例病变中,乳腺癌49例,乳腺腺瘤19例,积乳囊肿2例。MRI平扫诊断乳腺良恶性病变的敏感性为61.2%(30/49),特异性为19%(4/21),准确性为48.6%(34/70)。以病变信号对乳腺良恶性诊断检出率比较无统计学意义(P0.05)。以恶性病变平均ADC值95%可信区间的上界1.203×10-3mm2/s作为诊断良、恶性病变的界值,所得结果与病理结果比较,诊断敏感性为87.8%(43/49),特异性为85.7%(18/21),准确性为87.1%(61/70)。MRI平扫联合弥散加权成像ADC值综合诊断的敏感性为93.8%(46/49),特异性为90.5%(19/21),准确性为92.8%(65/70)。结论:DWI及ADC值是诊断和鉴别诊断乳腺良、恶性病变的有价值方法;MRI平扫结合DWI成像能明显提高乳腺良恶性病变诊断准确性。     

MRI在痰菌阴性不典型肺结核中的应用价值

目的探讨MRI在痰菌阴性不典型肺结核中的应用价值。方法回顾性收集痰菌阴性且误诊为肺癌的不典型肺结核病例23例,采用Philips 1.5 T MRI完成胸部常规序列、弥散加权成像(DWI)和动态增强序列,描述病灶的形态、大小及内部信号,测量弥散梯度(b)=600 s/mm2病变区的表观弥散系数(ADC)值,根据Schaefer分型将动态强化曲线分为流出型、平台型、渐进型和无强化型。分析结节或肿块样病变、空洞样病变、肿块合并肺实变样病变的影像特点。结果结节或肿块样病变以T1WI低信号,T2WI稍高信号为主,平均ADC值为1.44×10-3 mm2/s,动态强化曲线以平台型为主。空洞病变内部信号以T2WI低信号、DWI明显高信号而具有特征性,平均ADC值为0.67×10-3 mm2/s明显低于空洞壁。肿块合并肺实变MRI信号特点无特异性。结论 MRI对菌痰阴性肺结核具有一定诊断价值,可作为不典型肺结核的影像分析的重要补充。     

3.0T磁共振成像在乳腺良恶性病变中的诊断价值

目的探讨3.0T磁共振成像(3.0T MRI)在乳腺良恶性病变中的诊断价值。方法 66例患者共70个病灶纳入研究,同时期行乳腺MRI检查的女性健康体检者30例设为对照。采用3.0T磁共振弥散加权成像(MRI-DWI)行乳腺扫描,扩散敏感因子(b值)取50、450、850 s/mm2。观察病灶检出率及DWI影像表现。以病理诊断为金标准,计算诊断乳腺癌的敏感度、特异度、阳性预测值及阴性预测值。根据病理检查结果,将患者分为恶性病变组、良性病变组,以及健康对照组,观察不同b值下3组表观弥散系数(ADC)值差异。结果病灶检出率为94.29%(66/70),其中恶性病变46例,良性病变20例。b=50~850 s/mm2时,得ADC阈值为1.087×10-3mm2/s,诊断出假阳性6例,假阴性5例;b=50~450 s/mm2时,得ADC阈值为1.236×10-3mm2/s,诊断出假阳性9例,假阴性7例。b=50~850 s/mm2时对恶性肿瘤诊断的敏感性、特异性、阳性预测值均高于b=50~450 s/mm2,阴性预测值低于前者。不同b值时,恶性病变的ADC值低于良性病变,良恶性病变组ADC值均低于健康对照组,差异均具有显著性意义(P0.01)。结论 3.0T MRI-DWI可较好地检出并鉴别乳腺良恶性病变性质。     

1.5 T MRI不同b值DWI在乳腺疾病诊断中的应用价值

【目的】探讨1.5 T磁共振成像(MRI)不同b值弥散加权成像(DWI)在乳腺疾病诊断中的应用价值。【方法】回顾性分析2018年2月至2020年2月西安市人民医院(西安第四医院)大差市院区行1.5 T MRI检查的84例女性乳腺疾病患者的临床资料,其中良性病变30例(良性组),恶性病变54例(恶性组)。观察常规MRI及DWI成像表现,分析两组不同b值下ADC值变化情况,判断不同b值下ADC值对乳腺良恶性病变的诊断效能。【结果】30例良性病变患者中,18例T_(2)WI压脂序列呈高信号,12例呈稍高信号;26例病灶边缘清晰,4个边缘不清;23例DWI上呈均匀稍高信号。54例恶性病变患者中,49例T_(2)WI压脂序列呈高信号,5例呈稍高信号;3例病灶边缘清晰,51例病灶边缘不清,周围可见毛刺或分叶状改变;5例DWI上呈均匀稍高信号,其余49例均呈明显高信号。当b值为1000 s/mm^(2)、1500 s/mm^(2)时,良性组ADC值均显著高于恶性组(P<0.05)。ROC曲线结果显示,不同b值(1000 s/mm^(2)、1500 s/mm^(2))下ADC值对乳腺良恶性病变均有一定诊断效能,曲线下面积分别为0.839、0.783。【结论】1.5 T MRI不同b值DWI对乳腺良恶性病变均有一定诊断效能,而b值为1000 s/mm^(2)时对乳腺良恶性病变的诊断效能最高。     

多模态磁共振成像技术在乳腺病变诊断中的应用

目的探讨乳腺MR T1WI动态增强扫描结合DWI、T2*WI首过灌注成像在乳腺病变诊断中的意义。方法分析56例乳腺病变患者的T1WI动态增强时间-信号强度曲线(TIC)、ADC值及T2*WI首过灌注成像TIC,评估单一方法诊断与三者联合诊断的效能。结果将T1WI动态增强TIC为流出型的病变诊断为恶性,诊断的敏感性为87.0%,特异性为66.7%。弥散敏感系数(b)=1 000 s/mm2时,以ADC<1.18×10-3 mm2/s作为诊断乳腺恶性病变的阈值,ROC曲线下面积为0.859,敏感性为85.7%、特异性为83.3%。以T2*WI首过灌注最大信号强度下降率20%作为诊断恶性病变的阈值,敏感性为83.3%,特异性为92.9%。T1WI动态增强扫描、ADC值、T2*WI首过灌注成像及三者联合应用的诊断正确预测百分比分别为79.3%、79.3%、87.9%及89.7%。结论 T1WI动态增强扫描结合DWI、T2*WI首过灌注成像有助于乳腺良恶性病变的定性诊断。     

多发性硬化弥散加权成像

目的研究脑部多发性硬化(multiple sclerosis,MS)病灶、表现正常脑白质及正常志愿者脑白质表观弥散系数(apparent diffusion coefficient,ADC)值的差异.方法对37例正常志愿者和46例MS患者进行弥散加权成像检查,分别测量T1WI低信号病灶、T1WI等信号病灶、额叶表现正常脑白质及正常志愿者额叶白质平均ADC值,比较其有无统计学差异.结果各感兴趣区平均ADC值分别为T1加权像低信号病灶1.384×10-3 mm2/s;T1加权像等信号病灶0.977×10-3 mm2/s;额叶表现正常脑白质0.762×10-3 mm2/s;正常志愿者额叶白质0.744×10-3 mm2/s.上述各组两两比较均存在显著性差异(P＜0.01).结论弥散加权成像可以分辨出MS病灶,并能够检测出MS患者表现正常脑白质的弥散异常.     

磁共振弥散加权成像在椎体良恶性病变鉴别诊断中的应用

目的探讨磁共振弥散加权成像在椎体良恶性病变鉴别诊断中的应用价值。方法 30例病人76个病变椎体,行常规T1WI、T2WI、STIR、DWI和T1WI增强扫描(部分病人)检查。椎体良性病变10例18个病灶(n=18),其中血管瘤8例12个病灶,结核性病变2例6个病灶;椎体恶性病变20例共58个病灶:其中肺癌转移12例35个病灶,肠癌转移4例13病灶,乳癌转移4例10个病灶。分析病变椎体的MRI影像学特征,包括形态特征、DWI信号改变,并定量测定病变椎体感兴趣区(ROI)的ADC值,进行统计学分析。结果良恶性病灶在DWI序列上的信号多数为高信号,无统计学差异,椎体良性病变ADC值为(2.029±0.814)×10-4mm2/s,椎体恶性病变病灶ADC值为(1.129±0.725)×10-4mm2/s,两者ADC值比较有显著的统计学差异(P<0.05)。结论椎体良恶性病变在DWI上的信号变化对鉴别诊断中假阴性和假阳性的概率较高,ADC值的测定对鉴别诊断有较大帮助。     

MRI多参数成像技术在前列腺癌患者诊断中的应用

目的探讨MRI多参数成像技术在前列腺癌(PCA)患者诊断中的应用价值。方法选取2015年3月至2017年4月我院对前列腺病灶行MRI扫描患者60例为研究对象,其中30例经手术或病理证实为前列腺癌,余下30例为前列腺增生,另选取30例健康志愿者为对照组,分析前列腺癌、前列腺增生患者T2加权成像(T2WI)、弥散加权成像(DWI)、动态增强(DCE)表现,比较前列腺癌组、前列腺增生组在b=50s/mm2及b=800s/mm2处DWI信号强度值与表观弥散系数(ADC),对比三组感兴趣区转运常数(Ktrans)、血管外细胞外间隙体积百分数(Ve)、速率常数(Kep)等参数,并分析T2WI、DWI、DCE单独或联合诊断前列腺癌的ROC曲线下面积(AUC)及效能。结果前列腺癌在T2WI上主要呈斑片状、结节状低信号,DWI上见斑片状或结节状高信号,DCE上呈Ⅱ、Ⅲ型曲线;前列腺癌组在b=50s/mm2及b=800s/mm2处信号强度值(90.34±1.67)、(103.29±1.68)及ADC值(101.10±1.67)均低于前列腺增生组、对照组(P0.05);前列腺癌组DCE上Ktrans(0.34±0.03)min-1、Ve(0.23±0.06)min-1、Kep值(0.72±0.05)大于前列腺增生组、对照组(P0.05);MRI各参数成像技术中T2WI+DWI诊断前列腺癌的AUC值、灵敏度、准确度较高、特异度最高,分别为0.891、90.90%、77.48%、82.21%。结论 MRI各参数技术应用于前列腺癌中具有较高诊断价值,尤其是T2WI联合DWI可明显提高诊断效能,值得在临床推广应用。     

3.0T MRI术前诊断子宫内膜癌肌层浸润的价值

目的:探讨和评价3.0T MRI常规序列结合弥散加权成像(DWI)术前判断子宫内膜癌肌层浸润的准确率及其临床应用价值.方法:术前对50例病理证实为子宫内膜癌的患者行3.0T MRI检查,由2位放射科医师分别采用T2加权成像(T2WI)、DWI、动态对比增强(DCE)、T2WI与DWI(T2WI-DWI)融合图像(b=1 000 s/mm2)分析肿瘤肌层浸润深度,并与手术病理对照.结果:医师对T2WI-DWI融合图像的阅片一致性好(K=0.904),且在肌层浸润深度方面与病理检查结果有较好的相关性(r=0.923,P＜0.001).T2WI-DWI融合图像对于肿瘤浸润子宫肌层的判断明显优于T2WI、DCE、DWI图像(P均＜0.05).T2WI-DWI融合图像和DCE图像对于肿瘤浸润子宫深肌层判断均优于T2WI和DWI图像(P均＜0.05).T2WI-DWI、DCE诊断肿瘤浸润子宫深肌层灵敏度、特异度和准确率分别为91%、97%、96%和100%、95%、95%,而两者判断肿瘤浸润子宫深肌层方面差异无统计学意义(P＞0.05).肿瘤的平均表观弥散系数(ADC)值为0.92×10-3mm2/s,其与肿瘤侵犯肌层的深度间无明显相关性(r=-0.18,P=0.32).结论:T2WI与高b值DWI融合图像对于术前诊断子宫内膜癌肌层浸润能提供准确信息.T2WI与高b值DWI融合图像和DCE图像均可作为优选序列来用于判断子宫内膜癌深肌层的浸润情况.     

磁共振弥散成像与表观弥散系数(ADC)在脑脓肿诊断中的应用

目的:探讨磁共振弥散成像与表观弥散系数(ADC)在脑脓肿诊断中的应用价值。材料与方法:5例临床证实为脑脓肿的病人行磁共振常规SE序列检查及弥散加权成像(DWI),获取ADC图,测定病灶兴趣区的ADC值,3例行MR增强扫描。结果:5个病例常规SE序列扫描共发现8个病灶,7个病灶腔内内容物在T1WI上为低信号,在T2WI上为高信号,在DWI上4个表现为高信号,3个表现为低信号,1个病灶脓腔内出现液-液平面,上半部在T2WI上为高信号,在DWI上为低信号,下半部在T2WI上为等信号,DWI上为高信号,各脓肿腔内容物在DWI上为高信号的区域平均ADC值为(1.15±0.116)×10-3mm2/s,低信号区域平均ADC值为(2.55±0.143)×10-3mm2/s。3例增强扫描T1WI上病灶表现为环形强化。结论:脑脓肿在DWI上可表现为高信号或低信号,信号高低及ADC值高低和脑脓肿病理形成过程有关,脓肿形成早期在DWI上呈高信号,低ADC值的特点有利于与肿瘤坏死或囊变肿瘤作鉴别。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.