脑胶质瘤磁共振扩散张量成像与病理对照研究

目的 探讨脑胶质瘤病理良恶性分级与磁共振扩散张量成像(diffusion tensor imaging, DTI)的相关性.方法 搜集本院脑胶质瘤手术病人32例,该组患者术前均进行了完整的磁共振常规检查及DTI扫描,对于每一例患者分别于瘤中心、瘤边缘、正常区域脑白质3个位置测各项指标部分各向异性(FA)值、ADC值,每一病人每一部位测3次.搜集其病理分级、Ki67增殖指数等病理结果,并与DTI各项值进行相关分析.结果 瘤中心、瘤边缘、周围正常组织各部位FA值、ADC值均存在着显著差异,不同级别肿瘤的瘤中心FA值(后简称FA值)有显著性差别,且FA值与肿瘤分级呈正相关,FA值与Ki67增殖指数呈现明显正相关,且Ki67增殖指数与肿瘤分级呈正相关,而ADC值与Ki67、肿瘤分级之间均无相关性.结论 DTI检查,尤其是FA值对脑胶质瘤良恶性分级评估具有一定价值.     

非小细胞肺癌PET/CT表现与病理特征之间的相关性分析

目的探讨非小细胞肺癌PET/CT与病理特征之间的相关性。方法回顾性分析55例经病理证实的非小细胞肺癌患者的PET/CT与病理学资料,将肿瘤的PET/CT指标SUVavg、SUVmax与肿瘤的Ki-67、EGFR表达水平、MVD之间做相关分析。结果非小细胞肺癌的SUVmax与Ki-67之间呈正相关(r=0.73,P0.05),与MVD之间呈正相关(r=0.58,P0.05)。低分化非小细胞肺癌SUVmax值、EGFR突变率分别为10.92±2.14、69.6%,均大于高分化组(P0.05)。结论非小细胞肺癌的PET/CT表现与肿瘤的病理学特征具有一定关联,可通过SUV值评估肿瘤的细胞增殖水平、微血管密度与EGFR突变情况。     

3.0T-MRI DWI在评价晚期肺癌同步放化疗疗效中的应用

目的探讨3.0T MRI弥散加权成像(DWI)在评价晚期肺癌同步放化疗疗效中的临床应用价值。方法对经穿刺病理证实的59例晚期肺癌患者进行3.0T-MRI DWI检查,测量肿瘤的表观弥散系数(apparent diffusion coefficient, ADC)值与肿瘤细胞密度(TCD)值,分析DWI对肺癌病灶的显示能力,比较肺癌ADC值与TCD之间的相关性。结果 59例肺癌病灶在DWI像上均呈明显高信号,癌肿平均ADC均值为(993±170)×10~(-6)mm~2/s,明显小于胸大肌ADC均值(1388±148)×10~(-6)mm~2/s,两者之间有显著差异(P0.001);非小细胞肺癌(NSCLC)与小细胞癌(SCLC)之间病灶ADC均值存在差异(P=0.0050.05);共取得45例TCD值,NSCLC与SCLC之间TCD存在差异(P=0.0470.05);肺癌病灶ADC值与病理TCD之间呈负相关(P=0.001,相关系数=-0.534)。结论通过DWI检查可以清晰的显示肺癌肿瘤累及区域,不仅有利于SCLC与NSCLC的鉴别诊断,并且能够间接地反映肿瘤TCD值,为临床监测肺癌治疗疗效和预后提供可靠的依据。     

PCNA和Ki-67在非小细胞肺癌组织中的表达及其临床意义

目的探讨PCNA和ki-67在非小细胞肺癌中的表达及意义。方法收集临床手术切除的非小细胞肺癌组织蜡块128例及正常肺组织32例,应用免疫组化检测组织中PCNA和Ki-67的表达,结合临床病理资料和随访资料进行回顾性研究。结果发现非小细胞肺癌组织中PCNA的表达和Ki-67表达均明显高于正常肺组织(P<0.01)。PCNA表达增高与肿瘤病理分级、分期增加以及淋巴结转移之间有相关性(P<0.01),但与肿瘤组织学分型无相关性(P>0.05)。PCNA表达与Ki-67表达之间呈显著正相关(P<0.01)。结论 PCNA及Ki-67高表达是影响患者预后的主要因素,两者的异常表达与肺癌的发生、发展及转移关系密切,对判断肺癌恶性程度及预后有重要参考价值。     

肾上腺肿瘤MR扩散加权成像表现与细胞密度相关性的初步研究

目的探讨肾上腺肿瘤MR扩散加权成像（DWI）表现,分析良、恶性肿瘤表观扩散系数（ADC）值之间的差异及ADC值与肿瘤细胞密度的相关性。资料与方法采用屏气单次激发自旋回波-回波平面成像．扩散加权成像（SE-EPI-DWI）技术,分别选取3个不同b值检查4｜D例47个肾上腺肿瘤,其中恶性肿瘤18个,良性肿瘤29个;观察DWI表现,比较ADC值差异,并进行受试者工作特征曲线（ROC）分析,以选取肾上腺肿瘤DWI最佳成像b值和ADC值诊断阈值;对其中27个手术切除的肿瘤,在光镜下计数肿瘤细胞密度,并分析其与ADC值相关性。结果b值的大小影响DWI上肿瘤显示及其信号强度;肾上腺良、恶性肿瘤均可表现为均匀的高信号或不均匀高信号,并与肿瘤的类型及囊变、坏死程度有关,其间ADC值差异有统计学意义。经ROC曲线分析,肾上腺肿瘤DWI最佳成像b值为800s／mm^2,以ADC≥1．21×10^-3mm^2／s为阚值,诊断肾上腺良性肿瘤的敏感性为79％、特异性为72％。肾上腺肿瘤ADC值与其细胞密度负相关,以b值取800s／mm^2时相关性最强（r=-0．723,P〈0．01）。结论DWI对肾上腺肿瘤性质鉴别具有价值,是对常规MR检查的有益补充;测量肿瘤ADC值有可能为在体鉴别肾上腺肿瘤性质和病理分级提供新方法。     

表观扩散系数对非小细胞肺癌早期放化疗疗效的评估

目的 探讨表观扩散系数(ADC)值对非小细胞肺癌放化疗疗效的早期监测的应用价值.方法 收集32例经病理证实的非小细胞肺癌患者,分别于治疗前、治疗后第7天、治疗后第42天行常规MRI和DWI检查.根据治疗后第42天肿瘤体积的变化,分为有效组和无效组.有效组14例,无效组18例.结果 2组治疗后第7天肿瘤体积均无明显变化.有效组治疗后第7天ADC值有明显升高(F=12.34,P<0.01),而无效组无明显升高(P>0.05).用治疗后第7天肿瘤平均ADC值升高程度12.8%作为评价非小细胞肺癌治疗疗效的指标,诊断的敏感性为82.3%,特异性为77.8%.结论 ADC值可以对非小细胞肺癌放化疗疗效做出早期监测.     

DWI在不同肺癌类型中的鉴别诊断

目的探讨扩散加权成像(DWI)在不同肺癌类型中的诊断价值。方法选取2016年3月~2017年3月我院收治的肺癌患者58例,所有患者均行DWI扫描,扩散敏感因子b值取500s/mm^2,比较不同类型肺癌的表观扩散系数(ADC)。结果58例患者中,中央型肺癌19例,周围型肺癌39例;小细胞肺癌(SCLC)11例,非小细胞肺癌(NSCLC)47例,其中NSCLC包括腺癌32例,鳞癌15例;肺癌实性部分在T1WI呈等信号或稍低信号,在T2WI抑脂呈高或不均匀高信号;腺癌及鳞癌在DWI呈等或高信号,ADC呈低或偏低信号;SCLC在DWI呈高信号,ADC呈偏低信号;中央型肺癌ADC值与周围型肺癌比较,差异无统计学意义(P>0.05);NSCLC患者ADC值明显高于SCLC患者(P<0.05),腺癌ADC值明显高于鳞癌(P<0.05);DWI诊断不同病理类型肺癌的AUC为0.848。结论当b值为500s/mm^2时,DWI在腺癌、鳞癌、SCLC鉴别诊断中具有一定价值。     

肺癌CT动态增强参数与预后因子的相关性研究

目的 初步探讨CT动态增强参数与肺癌预后因子的相关性.资料与方法对24例肺癌进行CT动态增强扫描,分别计算肺癌的强化率、强化斜率、1200 s廓清率及1200 s廓清率线性斜率等强化参数;并用免疫组织化学方法分析病理标本中的癌胚抗原(CEA)、Ki67、c-erbB-2和p53等表达,采用非参数统计中的Spearman等级相关分析评价肺癌动态增强参数与各预后因子间的相关性.结果 24例肺癌平扫CT值为(42.0±5.3)HU,强化值为(42.2 ±17.6)HU,强化率为(103.9±48.1)%,平均达峰时间为(135.2±191.7)s,1200 s廓清值为(19.2 ±15.6)HU,1200 s廓清率为(21.3 ±12.8)%,对比剂流入斜率为(2.1±2.1)%/s,1200 s流出斜率为(0.0214±0.0155)%/s;CEA阳性表达19例(19/24,79.2%),Ki67阳性表达13例(13/23,56.5%),c-erbB-2阳性表达15例(15/21,71.4%),p53阳性表达20例(20/23,87.0%).经统计学分析,强化值与p53表达有相关性(r=0.419,P=0.047＜0.05).结论 肺癌的CT强化参数与预后因子有一定的相关性,一定程度上能反映其预后.     

DWI对低位直肠癌术前T分期的评估价值及与Ki-67表达的相关性

目的探讨弥散加权成像(DWI)所得ADC值对低位直肠癌术前T分期的评估价值及与Ki-67表达的相关性。方法回顾性分析87例经手术病理证实为低位直肠癌患者的资料。所有患者在术前两周内完成MRI检查,并获得ADC值。分析ADC值与手术病理T分期的相关性。应用免疫组化检测肿瘤标本的Ki-67表达,分析ADC值与Ki-67增殖指数之间的相关性。结果所有直肠癌病灶ADC值范围为(0.6-1.2)×10~(-3)mm~2/s,肿瘤组织Ki-67增殖指数平均为(55.3±20.2)%;肿瘤ADC值与病理T分期呈负相关(r=-0.68,P0.01);ADC值与Ki-67增殖指数也呈负相关(r=-0.63,P0.01)。结论 ADC值与低位直肠癌术前T分期具有较好的相关性,对肿瘤的生物学行为判定有较高的价值,可以作为直肠癌侵袭性的潜在影像生物标记。     

乳腺浸润性导管癌组织AIB1与Ki67表达及相关性研究

目的：探讨乳腺癌扩增性抗原1（AIB1）及增殖细胞核抗原（Ki67）蛋白在乳腺浸润性导管癌（IDC）中的表达及二者相关性。方法采用免疫组织化学SP法检测100例乳腺IDC组织石蜡标本中AIB1及Ki67蛋白的表达情况。结果 AIB1及Ki67蛋白阳性表达率分别为75．00％和80．00％。它们的表达均与腋窝淋巴结转移、病理组织学分级、临床分期关系密切（P＜0．05）,而均与患者年龄无关（P＞0．05）;AIB1表达与肿瘤大小无关（P＞0．05）,而Ki67表达与肿瘤大小有关（P＜0．05）;多因素Logistic回归分析显示,组织学分级是影响AIB1及Ki67阳性表达最主要因素,P值均＜0．05;在80例Ki67蛋白阳性表达的乳腺IDC中有68例同时表达AIB1,AIB1与Ki67的表达呈正相关（P＜0．05）。结论 AIB1及Ki67蛋白可能是乳腺IDC患者的不良预后因素;二者可能共同促进乳腺癌细胞增殖、侵袭及转移,联合检测可能有助于更准确地判断乳腺IDC的预后。     

脑肿瘤的表观弥散系数与Ki-67标记指数的相关性——基于立体定向活检的初步研究

目的:评价反应脑肿瘤细胞增殖情况的Ki-67标记指数与经MR弥散加权影像计算出的表观弥散系数(ADC)值的相关性,探讨后者用于肿瘤诊断的病理基础。方法:15例脑肿瘤患者在进行立体定向活检之前接受了MR弥散成像检查。利用Spearman相关分析法评价了经立体定向活检术所取脑肿瘤组织的细胞增殖抗原Ki-67标记指数与MRI对应感兴趣区的ADC值的相关性。结果:脑肿瘤组织的Ki-67标记指数与ADC值呈显著负相关(r=-0.856,P<0.001)。结论:ADC值通过反应Ki-67标记指数可用于评价脑肿瘤的细胞增殖情况。     

The value of apparent diffusion coefficient in the assessment of cervical cancer

Objectives

To evaluate the potential value of apparent diffusion coefficient (ADC) measurement in the assessment of cervical cancer.

Methods

One hundred twelve patients with cervical cancer and 67 control subjects underwent diffusion-weighted imaging (DWI) in addition to routine MR imaging at 3.0-T MRI before therapy. All ADCs were calculated from b?=?0, 600 s/mm² and b?=?0, 1,000 s/mm².

Results

The ADCs of cervical cancer were significantly lower than those of normal cervix for both ADC maps. There was a statistically significant difference between the ADCs of well-/moderately differentiated (G1/2) tumours and poorly differentiated (G3) tumours, between the ADCs of squamous cell carcinoma and adenocarcinoma, between the pretherapy ADCs of tumour recurrence or metastasis and tumour free patients after radical hysterectomy for both ADC maps. There was no significant difference among the ADCs of cervical cancer when divided by other features (FIGO, lymph node status, tumour size and age groups) for both ADC maps.

Conclusion

ADC values were reliable for differentiating cervical cancer from normal cervix with high diagnostic accuracy. The ADCs can be used to indicate the degree and histological type of cervical cancer, although there is some overlap. G3 tumours and lower ADCs may indicate poor prognosis. The diagnostic accuracy was equal for both ADC maps.

Key Points

? Diffusion-weighted magnetic resonance imaging provides new information about cervical cancer ? Apparent diffusion coefficient values can differentiate cervical cancer from normal cervical tissue ? Pretherapy ADCs can also predict the prognosis for patients who have undergone radical hysterectomy ? ADCs can help indicate the degree and histological type of cervical cancer ? Patients with G3 tumours and lower ADCs may benefit from preoperative chemoradiation     

Lung carcinoma: diffusion-weighted mr imaging--preliminary evaluation with apparent diffusion coefficient

PURPOSE: To prospectively evaluate diffusion-weighted (DW) magnetic resonance (MR) imaging with a split acquisition of fast spin-echo signals for diffusion imaging (SPLICE) sequence for tissue characterization of lung carcinomas by using apparent diffusion coefficients (ADCs). Materials and METHODS: An institutional review board approved this study; informed consent was obtained from patients. Thirty patients (nine women, 21 men; mean age, 68.0 years) with lung carcinoma underwent DW MR imaging with the SPLICE sequence. ADC of each lung carcinoma was calculated from DW MR images obtained with low and high b values. ADCs of lung carcinomas were statistically compared among histologic types. Nine surgically excised lung carcinomas were evaluated for correlation between ADCs and tumor cellularities. Analysis of variance was used to determine changes in ADCs and histologic lung carcinoma types. Spearman rank correlation was calculated between ADCs and tumor cellularities. RESULTS: ADCs for lung carcinomas were 1.63 x 10(-3) mm(2)/sec +/- 0.5 (mean +/- standard deviation) for squamous cell carcinoma, 2.12 x 10(-3) mm(2)/sec +/- 0.6 for adenocarcinoma, 1.30 x 10(-3) mm(2)/sec +/- 0.4 for large-cell carcinoma, and 2.09 x 10(-3) mm(2)/sec +/- 0.3 for small-cell carcinoma. ADC of adenocarcinoma was significantly higher than that of squamous cell carcinoma and large-cell carcinoma (P < .05). ADCs were 1.59 x 10(-3) mm(2)/sec +/- 0.5 and 1.70 x 10(-3) mm(2)/sec +/- 0.4 for moderately and poorly differentiated squamous cell carcinoma, respectively. ADCs were 2.52 x 10(-3) mm(2)/sec +/- 0.4 and 1.44 x 10(-3) mm(2)/sec +/- 0.3 for well- and poorly differentiated adenocarcinoma, respectively. ADC of well-differentiated adenocarcinoma was significantly higher than that of moderately and poorly differentiated squamous cell carcinoma and poorly differentiated adenocarcinoma (P < .05). With the Spearman rank test, ADCs of lung carcinomas correlated well with tumor cellularities (Spearman coefficient, -0.75; P < .02). CONCLUSION: ADCs of lung carcinomas overlap, but ADCs of well-differentiated adenocarcinoma appear to be higher than those of other histologic lung carcinoma types.     

Ki67、EGFR在三阴性及非三阴性乳腺癌中的表达与相关性分析

目的对比Ki67、EGFR在三阴性乳腺癌（triple-negative breast cancer,TNBC）及非三阴性乳腺癌（non triple-negative breast cancer,NTNBC）中的表达,探讨Ki67与EGFR基因表达的相关性。方法免疫组织化学法检测513例乳腺癌标本中Ki67及EGFR的表达,对比两者在TNBC和NTNBC中的区别,应用Spearman法分析Ki67与EGFR基因表达的相关性。结果 TNBC组织中Ki67阳性表达率（94.32%）明显高于NTNBC（80.47%）,差异有统计学意义（P〈0.05）。TNBC组织中EGFR表达率（68.18%）明显高于NTNBC（11.76%）,差异有统计学意义（P〈0.05）。结论 Ki67和EGFR在TNBC中均表达升高,但两者无相关性,两者均对乳腺癌预后判断有重要意义。     

不同b值DWI对宫颈癌放化疗疗效的评估价值

目的 探讨不同b值弥散加权成像（DWI,diffusion-weighted imaging）对宫颈癌放化疗疗效的评估价值.方法 48名接受全程放化疗治疗的宫颈癌患者分别在治疗前、治疗2周后、治疗4周后及治疗结束后进行盆腔常规MRI及DWI扫描,每次扫描均测量肿瘤的ADC值,所有ADC值均由b=0,600s/mm^2和b=0,1000s/mm^2两组ADC图得出.根据治疗结束后的结果将患者划分为完全有效组（CR）、部分有效组（PR）及无效组（SD）,并根据ROC曲线比较两组ADC图评估宫颈癌放化疗疗效的价值.结果 治疗2周及4周后CR组的ADC值提高百分比在两组ADC图中均高于RP及SD组;治疗结束后,CR组的ADC值在两组ADC图中均高于RP及SD组;其中治疗4周后及治疗结束后高b值组（b=0,1000s/mm^2）区分CR组与PR/SD组的能力高于低b值组（b=0,600s/mm^2） （P＜0.05）;低b值组所测数据的标准差均大于高b值组.结论 高b值DWI评估宫颈癌放化疗疗效的整体价值高于低b值DWI,且数值更为稳定.     

小b值扩散加权成像对乳腺癌的诊断价值

目的:探讨小b值扩散加权成像(DWI)在诊断乳腺癌中的价值.方法:采用Philips 1.5T磁共振扫描仪对48例乳腺疾病患者行常规SE序列扫描、单次激发自旋回波-回波平面成像(SE-EPI)序列DWI及动态增强扫描.48例患者共检出53个病灶,其中良性肿瘤29个,恶性肿瘤24个,均经手术及病理证实;选择健康志愿者20...     

Diffusion-weighted MR imaging of the normal fetal lung

To quantify apparent diffusion coefficient (ADC) changes in fetuses with normal lungs and to determine whether ADC can be used in the assessment of fetal lung development. In 53 pregnancies (20–37th weeks of gestation), we measured ADC on diffusion-weighted imaging (DWI) in the apical, middle, and basal thirds of the right lung. ADCs were correlated with gestational age. Differences between the ADCs were assessed. Fetal lung volumes were measured on T2-weighted sequences and correlated with ADCs and with age. ADCs were 2.13 ± 0.44 μm²/ms (mean ± SD) in the apex, 1.99 ± 0.42 μm²/ms (mean ± SD) in the middle third, and 1.91 ± 0.41 μm²/ms (mean ± SD) in the lung base. Neither the individual ADC values nor average ADC values showed a significant correlation with gestational age or with lung volumes. Average ADCs decreased significantly from the lung apex toward the base. Individual ADCs showed little absolute change and heterogeneity. Lung volumes increased significantly during gestation. We have not been able to identify a pattern of changes in the ADC values that correlate with lung maturation. Furthermore, the individual, gravity-related ADC changes are subject to substantial variability and show nonuniform behavior. ADC can therefore not be used as an indicator of lung maturity.     

Diffusion-weighted MR imaging in pancreatic endocrine tumors correlated with histopathologic characteristics

Purpose:

To retrospectively assess apparent diffusion coefficients (ADCs) of different subtypes of pancreatic endocrine tumors based on the World Health Organization (WHO) classification system and analyze the potentially responsible histopathologic characteristics.

Materials and Methods:

Following Institutional Review Board (IRB) approval, 18 patients with surgical pathology‐proven pancreatic endocrine tumors were evaluated. Tumors were subcategorized based on the WHO grading classification into well‐differentiated tumors with benign and uncertain behavior and endocrine carcinomas with well and poor differentiation. ADCs were measured on diffusion‐weighted (DW) images and compared using Student's t‐test and one‐way analysis of variance. The correlation between ADCs, tumor cellularity, Ki‐67 labeling index (an index of cell growth), and extracellular fibrosis were analyzed.

Results:

A difference was demonstrated in mean ADCs between well‐differentiated endocrine tumors (1.75 ± 0.53) and endocrine carcinomas (1.00 ± 0.19 × 10^?3mm²/sec) (P < 0.01). After excluding the three well‐differentiated endocrine tumors with benign behavior and marked fibrosis, a significant inverse correlation between ADC values and cellularity of endocrine tumors was observed. An inverse correlation was seen between Ki‐67 labeling index and ADC values (r = ?0.70; P < 0.01).

Conclusion:

Tumor cellularity and/or extracellular fibrosis may account for various ADCs in pancreatic endocrine tumors. ADC correlates well with the Ki‐67 labeling index and may help predict growth of endocrine tumors. J. Magn. Reson. Imaging 2011;33:1071–1079. © 2011 Wiley‐Liss, Inc.

     

磁共振扩散加权成像早期预测肺癌化疗疗效的价值

目的：评价磁共振扩散加权成像（DWI）对肺癌化疗疗效的早期预测价值。方法：对30例经病理证实的肺癌患者,在化疗前及第一周期化疗后进行MRI检查,包括常规T1wI,T2 wI及DWI检查。根据第二周期化疗后肿瘤最大径退缩率,按RECIST标准将患者分为治疗有效组和无效组,比较两组中肿瘤的表观扩散系数（ADC值）和最大径的差异,分析ADC值变化率的受试者工作特征曲线（ROc）,获得预测治疗有效的ADC值变化率临界值（cut—offvalue）。结果：第一周期化疗后,有效组化疗前后病灶的平均ADC值的差异有统计学意义（P值d0．001）;有效组和无效组中肿瘤ADC值的差异有统计学意义（P-0．031）;肿瘤最大径在两组间的差异无统计学意义（P-0．210）。以ADC值升高8．5％作为ADC值变化率诊断分界点,预测治疗获得PR的敏感度为85．7％,特异度为72．9％。结论：ADC值可以对肺癌化疗疗效进行早期监测。     

绝经前女性正常宫颈组织的表观弥散系数值研究

目的探讨不同年龄段绝经前女性正常宫颈组织在不同生理周期的表观弥散系数值（apparent diffusion coef ficient,,ADC）变化。方法将82名健康女性按年龄段分成3组（A组27例,20～29岁;B组28例,30～39岁;C组27例,40～49岁）,采用3．0TMRl分别于增殖中期及分泌中期行2次盆腔MR检查,研究不同结构区、年龄段及生理周期的宫颈ADC值的变化。结果子宫3层结构的ADC值两两比较差异均有统计学意义（肌层最高,黏膜层居中,结合带最低）,宫颈黏膜层及结合带的ADC值在分泌中期均低于增殖中期,而肌层的ADC值在不同周期问差异不明显,宫颈每层结构在同一周期的各年龄组之间无明显差异,宫颈粘膜层在增殖中期的ADC值更为稳定。结论不同结构区及生理周期会对正常宫颈组织的ADC值产生影响,当利用ADC值探测早期宫颈癌、监测疗效及鉴别肿瘤早期复发时应考虑这些因素,绝经前女性应在增殖期行盆腔MR扫描。