MSCT、MRCP及超声在胆道梗阻性疾病诊断中的价值

目的：探讨多层螺旋CT、MRCP及超声在胆道梗阻性疾病诊断中的应用价值，方法：收集经临床证实的胆道梗阻性疾病32例，行MSCT、MTCP及超声检查．结果进行对照分析。结果：32例胆道梗阻性疾病的诊断，超声总符台率78．1％，MSUF总符合率87．5％，MRCP总符合率78．1％。结论：MSCT诊断胆道梗阻性疾病的诊断符合率较MRCP、超声为高，可作为胆道梗阻性疾病的主要检查方法。     

磁共振胆道成像对胆道梗阻的诊断价值

磁共振胆道成像对胆道梗阻的诊断价值张联合陆之安宋建荣钱铭辉为了探讨磁共振胆道成像（ＭＲＣ）对胆道梗阻的诊断价值，我们对４４例胆道梗阻患者进行ＭＲＣ检查，现报告如下。一、材料与方法４４例胆道梗阻中男１９例，女２５例，年龄２７～８２岁，平均６２．６岁。胆...     

磁共振胆道造影在胆道梗阻定位和定性诊断中的价值

目的：通过ＭＲＩ胆道造影（ＭＲｃｈｏｌａｎｇｉｏｇｒａｐｈｙ，ＭＲＣ）与ＣＴ、ＵＳ、经皮穿刺胆道造影术（ＰＴＣ）或内窥镜逆行胰胆管造影术（ＥＲＣＰ）及手术、病理的对照研究，评价ＭＲＣ显示胆道梗阻部位，确定梗阻原因的能力。材料与方法：３０例梗阻性黄疸的患者在ＧＥＳｉｇｎａ１．５Ｔ超导系统上进行了ＭＲＣ检查，并与ＰＴＣ或ＥＲＣＰ、ＣＴ、ＵＳ、手术及病理对照。结果：本组资料中，ＭＲＣ显示胆道梗阻的部位准确性达１００％，优于有损伤性的ＰＴＣ或ＥＲＣＰ。ＭＲＣ确定梗阻原因的准确性达７０％，类似于ＰＴＣ或ＥＲＣＰ、ＣＴ、ＵＳ。结论：初步研究结果表明，无损伤性的ＭＲ胆道造影在梗阻性黄疸的定位和定性上具有很高的敏感性、准确性，对于梗阻性黄疸，特别是行ＥＲＣＰ失败和不宜行ＰＴＣ或ＥＲＣＰ的病人是最有效的替代方法。     

磁共振胰胆管成像对诊断胆胰系统疾病的临床应用价值

目的评价磁共振胰胆管成像(MRCP)技术在胆胰系统疾病诊断中的应用价值.方法68例患者进行了MRCP检查,其中正常对照组11例,各种胰胆管病变组57例.扫描使用ELSCINTSGR2.0T超导磁共振成像仪,体线圈及呼吸门控触发技术.平扫采用自旋回波(SE)常规成像;MRCP采用快速自旋回波(FSE)重T2加权像进行薄层扫描.所得图像用最大强度投影法(MIP)进行三维(3D)重建.结果MRCP能清晰显示胰胆管的解剖结构,对胆道梗阻程度和梗阻部位判断的确诊率达100%,梗阻原因的确诊率达91.2%.结论MRCP检查的成功率高,胰胆管解剖结构显示清晰,适应于各种胰胆管疾病的诊断,可作为该系统疾病诊断的首选方法     

磁共振胰胆管成像对恶性胆道梗阻的诊断价值

目的：评价磁共振胰胆管成像（MRCP）对恶性胆道梗阻性疾病的临床诊断价值，探讨肝外恶性胆道梗阻的MRCP、MRI诊断及鉴别诊断。方法：回顾性分析69例恶性胆道梗阻患者的MRI及MRCP表现，并与CT、US、直接胆道造影和手术病理结果对照。MRCP采用二维（2D）和／或三维（3D）屏气半傅立叶转换快速自旋回波（FASE）序列T2加权成像技术。结果：69例MRCP检查均一次成功，全部病例胰胆管显示满意，与直接胆道造影对照，二者所获图像极其相似。MRCP对恶性胆道梗阻定位诊断准确率为98．5％定性诊断准确率为95．6％。结论：MRCP对恶性胆道梗阻定位及定性诊断优于CT和US，是诊断恶性胆道梗阻的一种有效的非侵袭性的检查方法。     

MRCP,磁共振sSSh-SPAIR及BTFE-M2D序列对胆道结石的诊断价值

目的 对比分析MRCP,磁共振sSSh-SPAIR及BTFE-M2D序列在胆道结石诊断中的诊断价值.方法 分析98例经临床手术或ERCP证实的胆道结石的MRCP,磁共振sSSh-SPAIR及BTFE-M2D序列MRI表现.结果 98例病例中共有胆道结石192枚,其中MRCP发现结石87例(88.8%),检出结石158枚(82.3%);MRCP+sSSh-SPAIR发现结石94例(95.9%),检出结石172枚(89.6%);MRCP+sSSh-SPAIR+BTFE-M2D序列发现96例(98.0%),检出结石189枚(98.4%).结论 MRCP+sSSh-SPAIR+BTFE-M2D序列对胆道结石有较高的临床诊断价值.     

磁共振胰胆管成像在胰胆管疾病中的诊断价值

目的：探讨磁共振胰胆管成像（ＭＲ ｃｈｏｌａｎｇｉｏｇｒａｐｈｙ,ＭＲＣＰ）对胰胆管疾病的诊断价值。材料和方法：用ｆａｓｔ－ＡＳＥ序列完成了８２例ＭＲＣＰ检查,其中有６３例经手术病理证实,余为超声或ＣＴ证实,经二维（２Ｄ）及三维（３Ｄ）处理图像,后以最大信号投影重建图像。结果：全部检查均获得成功。良、恶性胰胆管疾病在ＭＲＣＰ图像上具有一定的特征性。ＭＲＣＰ定位及定性准确率分别为１００％及８６％。结论：ＭＲＣＰ是一种无创伤性的有效手段,能清楚显示正常或异常的胰胆管结构,定性和定位准确率高,能为临床提供十分有意义的诊断资料。     

超声与磁共振在乳腺疾病诊断中的价值对比研究

目的：探讨超声和磁共振扫描对乳腺疾病的诊断价值。方法：对乳腺疾病50例分别行超声检查及磁共振动态增强扫描,并与病理结果进行对比。结果：超声检查符合病理结果的准确率为93.5%;磁共振动态增强扫描检查符合病理结果的准确率为66.3%。磁共振检查的病理准确率虽不及超声,但敏感性较高。磁共振动态增强扫描能清晰显示病灶的形态、内部结构及血液供应情况,而超声对乳腺囊性病变、增生及肿物优于磁共振,磁共振对乳腺疾病血供,较小结节分布及周围组织关系的整体观优于超声。结论：超声和磁共振对乳腺疾病的诊断各有所长,如两者结合,可提高对乳腺疾病的诊断准确率。     

MRI与MRCP结合在胆管恶性梗阻性病变诊断中的应用价值

目的：探讨磁共振成像结合磁共振胰胆管成像技术对胆管恶性梗阻性病变的诊断价值。方法：收集30例经手术病理和临床治疗证实的胆管恶性梗阻性病例,回顾性分析其影像学表现。结果：30例患者MRI均表现为肝内外胆管不同程度阻塞性扩张。其中胆管癌23例,胆囊癌1例,肝细胞肝癌2例,转移瘤2例,壶腹癌2例。阻塞部位在肝内胆管部2例,肝门部10例,中部15例,壶腹部3例。所有病例均经临床或病理证实。结论：MRI与MRCP结合能显示胆管阻塞性扩张及阻塞部位,有较高的诊断价值。     

半傅立叶单次激发快速自旋回波序列单次屏气三维磁共振胆管成像

目的 前瞻性评价半傅立叶单次激发快速SE（HASTE）序列三维磁共振胆管成像（3D MRC）在胆管疾病诊断中的作用。方法 102例胆管疾病患者和20例正常成人行HASTE序列单次屏气3DＭＲＣ检查,对照分析患者的３D MRC表现与手术结果。结果 HASTE序列２D MRC能清晰显示各类胆管病变的形态改变。3D MRC诊断胆管炎的敏感性为90％,特异性与阳性预测值为100％,阴性预测值98％,诊断胆管结石的敏感性为90％,特异性99％,阳性预测值,阴性预测值均为96％,诊断胆管恶性梗阻的敏感性为90％,特异性97％,阳性预测值95％,阴性预测值94％,可显示胆总管癌和肝门胆管癌癌肿的位置,大小与侵犯范围,结论 HASTE序列3D MRC是诊断胆管病变的理想方法。     

0.5 T MR单激发快速自旋回波在胆系梗阻性病变诊断中的应用

目的评估0.5 T MR单激发半傅立叶采集快速自旋回波胰胆管水成像(HASTE-MRCP)的定位及定性准确性,并与三维快速自旋回波胰胆管水成像(3D-TSE-MRCP)进行比较.方法所有95例病人均行HASTE-MRCP及结合呼吸门控的3D-TSE-MRCP检查及最大信号强度投影(MIP)(设备为Philips 0.5 T T5-NT 磁共振成像系统).分析95例患者的胆管解剖显示情况、病变显示情况并与手术结果比较.结果 HASTE-MRCP胆总管及1～3级胆管的显示率为100.0%,4～5级胆管为94.7%,胆囊为74.1%,胰管为63.2%;结石部位显示100.0%,恶性病变及术后狭窄显示率100.0%.与3D-TSE-MRCP比较,对4～5级胆管、胆囊颈及结石,尤其泥沙样结石的显示率更高,统计学上两者间差异有显著性意义(χ2 值分别为3.92、6.62、11.76 及29.93,P<0.05 或<0.01);对恶性病变及术后狭窄的显示率均为100.0%.结石主要表现为胆道内呈低信号的"充盈缺损";恶性病变则表现为截断及梗阻征象,并可显示软组织轮廓.结论 HASTE-MRCP是优秀的胰胆管超快速成像技术,在0.5 T MR 也能非常好的运用;比较结合呼吸门控的3D-TSE-MRCP ,HASTE-MRCP在重症病人成像或显示小结石及泥沙样结石上有明显优势,建议对急诊、重症及临床疑为结石的病人,首先考虑选择HASTE-MRCP技术.     

Common bile duct diameter in an asymptomatic population: A magnetic resonance imaging study

AIM: To measure the common bile duct (CBD) diameter by magnetic resonance cholangiopancreatography (MRCP) in a large asymptomatic population and analyze its some affecting factors.METHODS: This study included 862 asymptomatic subjects who underwent MRCP. The CBD diameter was measured at its widest visible portion on regular end-expiration MRCP for all subjects. Among these 862 subjects, 221 volunteers also underwent end-inspiration MRCP to study the effect of respiration on the CBD diameter. The age, sex, respiration, body length, body weight, body mass index (BMI), portal vein diameter (PVD), length of the extrahepatic duct and CBD, cystic junction radial orientation and location were recorded. The subjects were divided into 7 groups according to age. All of the above factors were compared with the CBD diameter on end-expiration MRCP.RESULTS: Among the 862 subjects, the CBD diameter was 4.13 ± 1.11 mm (range, 1.76-9.45 mm) and was correlated with age (r = 0.484; P < 0.05), with a dilation of 0.033 mm per year. The upper limit of the 95% reference range was 5.95 mm, resulting in a reasonable upper limit of 6 mm for the asymptomatic population. Respiration and other factors, including sex, body length, body weight, BMI, PVD, length of the extrahepatic duct and CBD, cystic junction radial orientation and location, were not related to the CBD diameter.CONCLUSION: We established a reference range for the CBD diameter on MRCP for an asymptomatic population. The CBD diameter is correlated with age. Respiration did not affect the non-dilated CBD diameter.     

MR胰胆管成像加常规扫描在鉴别胆道术后病变良恶性上的意义

目的　探讨MR胰胆管成像 (MRCP)加常规扫描在鉴别胆道术后病变良恶性上的意义。方法　对 61例胆道术后出现不明原因发热、黄疸、右上腹痛等症状患者进行MRCP检查 ,同时行MR平扫及增强扫描 ,2位医师使用 3种不同的序列组合 (MRCP、MRCP +平扫、MRCP +平扫 +增强扫描 )独立对病变的良、恶性作出诊断。诊断结果分别与手术、病理结果对照。结果　对病变良恶性的诊断 ,仅用MRCP ,医师 1诊断的敏感度、特异度、准确度分别为 42 1%、80 9%、68 9% ,医师 2分别为47 4%、85 7%、73 8%。使用MRCP +平扫 ,医师 1诊断的敏感度、特异度、准确度分别为 78 9%、92 9%、88 5 % ,医师 2分别为 78 9%、95 2 %、90 2 %。使用MRCP +平扫 +增强扫描 ,医师 1诊断的敏感度、特异度、准确度分别为 84 2 %、95 2 %、91 8% ,医师 2分别为 84 2 %、97 6%、93 4%。MRCP +平扫的ROC曲线Az值 (医师 1为 0 90 7,医师 2为 0 92 0 ) ,较MRCP的ROC曲线下的面积 (Az值 ) (医师 1为 0 682 ,医师 2为 0 714)显著增大 (P <0 0 5 ) ,MRCP +平扫 +增强扫描的ROC曲线Az值 (医师 1为0 948,医师 2为 0 944 )较MRCP +平扫的ROC曲线Az值增大 ,但无显著性差异 (P >0 0 5 )。结论MRCP加MR常规扫描有助于鉴别病变的良恶性 ,提高术后病变     

Evaluation of supraspinatus muscle tears by ultrasonography and magnetic resonance imaging in comparison with surgical findings

Objective

To evaluate the sensitivity, specificity and diagnostic accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) in evaluating suspected supraspinatus muscle injury compared with surgery.

Subjects and methods

One hundred patients underwent both US and MRI for their shoulders due to shoulder pain. Forty patients with non-improved symptoms underwent surgical exploration. We compared the sensitivity, specificity and accuracy of US and MRI for detection of supraspinatus pathology, using surgical findings as ‘gold standard’.

Results

Study included 40 patients (27 men and 13 women, age range from 20 to 68 years). US had sensitivity, specificity and accuracy of 92.3%, 92.6% and 92.5%, respectively in diagnosing partial thickness tears (PTT); 92.6%, 94% and 95%, respectively in diagnosing full thickness tears (FTT). MRI had sensitivity, specificity and accuracy of 84.6%, 92.6% and 90%, respectively in diagnosing partial thickness tears (PTT); 100%, 88.2% and 95%, respectively in diagnosing full thickness tears (FTT). There was no statistically significant difference between the two techniques on one hand and surgery on the other hand in detecting both PTT and FTT.

Conclusion

US and MRI yield high sensitivity, diagnostic accuracy in detecting FTT. Regarding PTT rotator cuff tears both tests were less sensitive.     

Lesions of the Achilles tendon: Evaluation with ultrasonography and magnetic resonance imaging

Purpose

This work aims at evaluating the role of ultrasonography and magnetic resonance imaging in the diagnosis of the lesions affecting Achilles tendon of the ankle joint.

Patients and methods

The study is a prospective study of 28 patients. Some of them are complaining of a posterior heel pain, stiffness & a limitation of movements, soft tissue thickness and swollen and ecchymotic ankle. Plain X-ray (anteroposterior and lateral views), ultrasound examination were performed for both ankles of all patients with the patients in a prone position, the Achilles tendon was examined from its musculotendinous junction to its calcaneal insertion in both longitudinal and transverse views. Finally, MRI was performed with the patients in supine position, the foot is dorsiflexed, axial and sagittal T1, T2-weighted images, STIR & proton density were done for all patients.

Results

Out of 28 patients that were examined, the final diagnosis included; eight cases of tendinopathy (five cases peritendinosis, and three cases tendinosis), 16 cases of partial thickness tear (as compared to arthroscope), and four cases of full thickness tear.

Conclusion

Ultrasound is an important complementary diagnostic tool in the diagnosis of lesions of Achilles tendon, it is as good as MRI in the diagnosis of tendinopathy and full thickness tear, however MRI is more superior in the diagnosis of partial thickness tear, and in the differentiation of the different types of tendinopathy.     

MRCP评价正常人胰胆管十二指肠连接部活动度

目的 :探讨动态MRCP反映胰胆管十二指肠连接部 (PPDJ)活动度的可能性。方法 :随机选择 2 0例健康志愿者 ,在 3 0min内间断重复进行 5次MRCP检查。测量左右肝管汇合点与十二指肠乳头间的距离和胆总管上下段间的夹角 ,以其在 5次MRCP上的最大值与最小值之差作为评价PPDJ活动度的指标 ,来反映胰胆管十二指肠连接部的柔韧度。结果 :正常人胰胆管十二指肠连接部具有一定的变化角度和变化范围 ,平均最大变化角及垂直方向最大位移分别为 (9.3±3 .8)°和 (0 .66± 0 .2 4)cm。结论 :正常人胰胆管十二指肠连接部具有一定活动度 ,MRCP能无创性显示其变化。     

胆系磁共振仿真内镜的临床应用评价

目的：评价磁共振仿真内镜（MRVE）对胆系梗阻性疾病的诊断价值。方法：47例胆系梗阻性病变的患者行MRVE检查。将快速自旋回波（FSE）和单次激发快速自旋回波（SSFSE）获得的二维T2WI数据传输至工作站，用导航软件显示胆管内腔。结果：MRVE清晰显示了胆管内解剖结构、梗阻部位和梗阻端的表面形态，FSE序列的MRVE和SS－FSE序列的MRVE对病变的定位准确率都为100％，检出病变的敏感性分别为92.2%和96.0%。结论：FSE序列的MRVE和SSFSE序列的MRVE都能显示胆系腔内结构。MRVE是对磁共振胆胰管造影（MRCP）技术的有益补充，但对胆系梗阻性病变诊断的特异性较性。     

ROC评价在影像诊断中的应用

目的:介绍一种在实际影像诊断中简单制作ROC曲线的方法,及其在诊断中的价值。方法:通过“利用ROC曲线评价CT和MR T1压脂序列和动态增强扫描在诊断胰腺小腺癌中的价值”介绍ROC曲线的制作过程,采用实际病例中的所需的病灶作为信号,而非病灶或其他所需鉴别的疾病病灶作为噪声代替传统模体中的人造小球。结果:计算得到了观察者观测信号的概率值Pdel,并做出了胰腺癌两种检查方法的ROC曲线。结论:ROC评价法在临床诊断中有很大的使用价值,利用病变作为信号或噪声,可以方便、准确的制作ROC曲线。