大脑胶质瘤病的MRI及MRS研究

目的回顾性分析大脑胶质瘤病磁共振成像(MRI)及磁共振波谱(MRS)特点,以探讨其对本病诊断的临床价值。方法综合7例患者的临床表现、影像学特点及病理诊断,均符合大脑胶质瘤病诊断标准。常规行SE序列平扫及增强。其中3例行MRS研究,二维多体素、点分辨法(PRESS)、TE144ms。结果所有病例均侵犯2个脑叶或以上。病变区呈长T2、稍长T1异常信号,受累区脑组织肿胀,占位效应轻。增强扫描3例见小结节或片状强化,4例无明显强化。3例MRS表现均有不同程度NAA降低,Cho上升,Cho/Cr和Cho/NAA的比值上升。结论MRI是目前诊断大脑胶质瘤病的首选影像学方法,MRS对于鉴别诊断有较大价值。     

脊髓血管母细胞瘤的MR诊断

目的：探讨脊髓血管母细胞瘤的MRI表现及其鉴别诊断。方法：回顾性分析12例经手术和病理证实的脊髓血管母细胞瘤患者的临床和MRI资料。所有病例均行MRI平扫及增强扫描。结果：本组12例患者均经手术及病理证实。8例发生在颈段脊髓,3例发生于颈胸段脊髓,1例发生于胸段脊髓。其中1例呈多发,同时累及小脑半球和颈髓。肿瘤实质最大1.5cm,最小3mm,3例为局部囊变,9例为邻近脊髓空洞积水,2例伴有明显的水肿。累及范围为1个椎体区段至10个椎体区段。T1WI显示病变囊影呈脑脊液样低信号,结节与脊髓相比,呈等或略低信号。其中9例结节位于脊髓背侧,3例位于脊髓中央区域。9例囊肿及空洞积水周围的脊髓未见明显水肿存在。3例邻近脊髓水肿呈T1 W略低信号,T2 W呈较高信号。1例同时伴有小脑血管母细胞瘤。T2 WI囊性病变呈脑脊液样高信号,结节呈略高信号,囊肿周围水肿区呈较高信号,其中1例结节内见血管流空信号。T1WI增强扫描12例结节病灶及伴有小脑病灶的均显著增强。结论：脊髓血管母细胞瘤在MR图像上具有一定的形态及信号特点,对于术前正确诊断具有一定意义。     

大脑胶质瘤病的MRI及MRS研究(英文)

目的回顾性分析大脑胶质瘤病磁共振成像(MRI)及磁共振波谱(MRS)特点,以探讨其对本病诊断的临床价值。方法综合7例患者的临床表现、影像学特点及病理诊断,均符合大脑胶质瘤病诊断标准。常规行 SE 序列平扫及增强。其中3例行 MRS 研究,二维多体素、点分辨法(PRESS)、TE 144ms。结果所有病例均侵犯2个脑叶或以上。病变区呈长 T_2、稍长 T_1异常信号,受累区脑组织肿胀,占位效应轻。增强扫描3例见小结节或片状强化,4例无明显强化。3例 MRS 表现均有不同程度 NAA 降低,Cho 上升,Cho/Cr 和 Cho/NAA 的比值上升。结论 MRI 是目前诊断大脑胶质瘤病的首选影像学方法,MRS 对于鉴别诊断有较大价值。     

颅内血管母细胞瘤的临床研究

目的 探讨颅内血管母细胞瘤（HB）的临床特点及次全切除术后的综合疗效。方法 采用回顾性分析方法，对经手术完全切除的38例（手术组）及手术切除有残灶、术后辅以放疗的25例（综合治疗组）颅内血管母细胞瘤进行临床分析和疗效总结。主要临床症状为颅内压增高（35例）、小脑机能障碍（20例）及颅神经损害（8例）。52例病灶位于小脑，肿瘤病理组织学特点由毛细血管网和间质细胞构成。结果 综合治疗组5例复发，4例死于复发，22例非脑干区术后残留肿瘤照射剂量50～55Gy；其5、10和15年生存率分别为100％、92％和89％。手术组6例复发，3例死于复发；其5、10、15年生存率分别为97％、85％、79％。结论 颅内血管母细胞瘤好发于成人小脑部位，术后有残留者辅以放疗可能会减少复发。     

外阴血管肌纤维母细胞瘤临床分析

目的：分析外阴血管肌纤维母细胞瘤的临床及病理特征、治疗及预后。方法收集7例外阴血管肌纤维母细胞瘤,总结其临床表现、病理特征、治疗及预后,并结合国内外相关文献分析其发病机制及临床特征。结果7例患者临床症状主要为逐渐增大的无痛性外阴肿物,病理大体标本境界清楚,组织学上呈密集血管区与少细胞的水肿区交替分布。手术治疗为主,预后良好。结论外阴血管肌纤维母细胞瘤罕见,术前易误诊,超声可辅助诊断,治疗首选手术,术后需长期随访。     

中枢神经系统血管母细胞瘤的蛋白质组学分析

背景与目的:中枢神经系统血管母细胞(centralnervoussystemhemangioblastoma,CNSHB)的治疗较难,至今病因不明。本研究应用蛋白质组学方法分析HB与正常脑组织的蛋白质表达谱的差异,分离鉴定与HB发病的蛋白质,为研究HB的组织学起源与发病机制提供依据。方法:收集5例血管母细胞瘤与5例正常脑组织标本。提取标本的总蛋白质。通过双向凝胶电泳(2-DE)分离蛋白,确定血管母细胞瘤与正常脑组织的差异表达蛋白质点。应用基质辅助激光解离-飞行时间质谱(MALDI-TOF-MS)鉴定并对鉴定蛋白质进行生物信息学分析。结果:通过双向凝胶电泳,建立了约含600个蛋白质点的血管母细胞瘤及正常脑组织的高分辨率蛋白质表达图谱。两者相比具有较高的同源性。应用ImageMaster2D图像分析软件共发现115个差异蛋白质点。经MALDI-TOF-MS分析后成功鉴定了87个蛋白质点共计47种蛋白质。其中HB组较正常对照组表达上调46个蛋白质点,下调41个蛋白质点。鉴定蛋白质的功能涉及转运、蛋白质折叠与代谢、三羧酸循环、细胞分化、干细胞相关蛋白质等数个方面。对鉴定所得蛋白质Vimentin、14-3-3蛋白进行免疫组化染色可重复本研究的结果。结论:中枢神经系统血管母细胞瘤可能是一种起源于间叶脑组织的肿瘤。其发生是一个多因子参与、多步骤的复杂过程。多种蛋白质如Vimentin及14-3-3蛋白参与了血管母细胞瘤的发病并起到重要的作用。     

常规MRI纹理分析鉴别脑胶质母细胞瘤和原发性中枢神经系统淋巴瘤的价值

背景与目的：影像组学是近年来研究的热点，可量化肿瘤异质性，广泛应用于病灶定性、临床分期、疗效评价及危险因素分层分析等。该研究旨在探讨常规磁共振成像（magnetic resonance imaging，MRI）影像学纹理分析对脑胶质母细胞瘤和原发性中枢神经系统淋巴瘤的鉴别诊断价值。方法：回顾性分析2012年6月—2017年7月在皖南医学院第一附属医院经术后病理学检查证实的35例脑胶质母细胞瘤及15例原发性中枢神经系统淋巴瘤患者临床及影像学资料。所有患者术前均接受常规MRI平扫，包括轴位T1WI、T₂WI和T2WI液体衰减反转恢复序列（T₂-weighted fluid-attenuated inversion recovery，T2-FLAIR）。利用MaZda软件于3个平扫序列上显示肿瘤病灶最大层面手动勾画感兴趣区（region of interest， ROI），提取并分析其纹理特征。结果：通过对大量的纹理特征进行统计筛选，灰度共生矩阵类参数中T1WI自相关、T1WI熵、T2WI均值、T2-FLAIR均值及T2-FLAIR熵在二者之间的差异有统计学意义。基于这些纹理参数构建多变量logistic回归分析，显示该模型受试者工作特征曲线（receiver operating characteristic curve，ROC）下面积为0.94。结论：常规MRI纹理分析可提供可靠、量化的客观依据，无需增强检查，有助于鉴别脑胶质母细胞瘤和原发性中枢神经系统淋巴瘤。     

脑胶质瘤的~1H-MRS和MRI诊断(附20例分析)

 目的　探讨磁共振成像 (MRI)结合氢质子磁共振波谱 (1H MRS)以提高脑胶质瘤的诊断正确性。方法　对 2 0像MRI显示不典型胶质瘤表现者配合1H MRS检查 (测NAA、Cho、Cr、及Lac波 )进行综合诊断。结果　1H MRS显示肿块区NAA下降、Cho升高、Cr略下降或变化不明显。结论　MRI影像结合1H MRS分析 ,既能提高脑胶质瘤的诊断正确性 ,对临床选择导航、立体定向活检、γ 刀等治疗方案 ,具有重要的临床应用价值     

颅内血管母细胞瘤34例临床分析

目的:探讨颅内血管母细胞瘤的临床特点和诊治方法。方法:回顾性分析我院自1988~2005年间经手术和病理证实的34例颅内血管母细胞瘤患者的临床资料并复习相关文献。结果:本病的好发年龄在20~40岁,男性多于女性,绝大多数发生在小脑,多为囊结节型。本组所有患者的囊壁瘤结节和实质型肿瘤被完全切除。结论:颅内血管母细胞瘤是良性肿瘤,其诊断主要依靠CT和MRI检查。MRI对囊性血管母细胞瘤的诊断具有特异性。手术切除肿瘤是最佳选择,彻底切除肿瘤可获治愈。     

单发性脊髓血管母细胞瘤１例

血管母细胞瘤又称血管网织细胞瘤,发生于脊髓的极少。由于发病率低,临床对其认识有限。现报告1例经手术证实的单发性脊髓血管母细胞瘤的核磁共振表现。     

侵袭性垂体瘤的MRI诊断与影像学特征

目的:探讨MRI对侵袭性垂体瘤的诊断价值与影像特征.方法:回顾性分析经手术病理证实的36例侵袭性垂体瘤的临床资料及其MRI表现.结果:36例侵袭性垂体瘤均向鞍区多个方向生长致周围组织结构受侵,其中以海绵窦和颅底骨质侵犯为主要特征,表现为包绕颈动脉,鞍底受侵下陷,部分肿瘤突破鞍隔,突入蝶窦等,且常伴有坏死或囊变、出血.在T1WI上肿瘤呈低、等信号及混杂信号,T2WI肿瘤呈等信号或不均匀高信号.T1WI增强扫描后肿瘤多呈不均匀强化.结论:MRI检查可清楚显示侵袭性垂体瘤形态、大小、生长方式,以及肿瘤与周围组织的关系,对临床治疗方案的制定具有重要价值.     

Application of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)combined with magnetic resonance spectroscopy(MRS)in prostate cancer diagnosis

Objective The aim of the study was to investigate the application of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)combined with magnetic resonance spectroscopy(MRS)in prostate cancer diagnosis.Methods In the outpatient department of our hospital(Sichuan Cancer Hospital,Chengdu,China),60 patients diagnosed with prostate disease were selected randomly and included in a prostate cancer group,60 patients with benign prostatic hyperplasia were included in a proliferation group,and 60 healthy subjects were included in a control group,from January 2013 to January 2017.Using Siemens Avanto 1.5 T high-field superconducting MRI for DCE-MRI and MRS scans,after the MRS scan was completed,we used the workstation spectroscopy tab spectral analysis,and eventually obtained the crest lines of the prostate metabolites choline(Cho),creatine(Cr),citrate(Cit),and the values of Cho/Cit,and(Cho+Cr)/Cit.Results Participants who had undergone 21-s,1-min,and 2-min dynamic contrast-enhanced MR revealed significant variations among the three groups.The spectral analysis of the three groups revealed a significant variation as well.DCE-MRI and MRS combined had a sensitivity of 89.67%,specificity of 95.78%,and accuracy of 94.34%.Conclusion DCE-MRI combined with MRS is of great value in the diagnosis of prostate cancer.     

Magnetic Resonance Imaging (MRI) Appearances of Syringohydromyelia

Magnetic resonance imaging (MRI) examination of the spinal cord is now a first-line in vestigation for the evaluation of suspected syringohydromyelia. It is an accurate, non-invasive means of detecting cavities within the spinal cord and for assessing spinal cord size and the position of the cerebellar tonsils. It has considerable advantages over post-myelographic computerised tomography (CT). The current study discusses our initial experience of thirteen surgically proven cases of syringomyelia with special reference to appearances on T 1 and T2 weighted images and a discussion of the apparently confusing appearances of the cavities on the T2 weighted images.     

磁共振成像在肺癌放射治疗中的应用价值

目的　探讨磁共振成像 (MRI)在肺癌放射治疗中的应用价值。方法　 37例经病理证实的肺癌行MRI检查 ,并与同期X线胸片或CT比较。结果　MRI对确定肺门纵隔淋巴结转移、肿瘤对肺门纵隔大血管侵犯优于CT和X线平片 ;MRI可辨别肺癌放疗后纤维化抑或肿瘤复发 ,区分肺门癌块与阻塞性肺不张 ;MRI和CT可检查出X线胸片难以显示隐匿部位的较小病灶。结论　MRI在肺癌的放射治疗中有一定的应用价值。     

少见类型脑膜瘤的影像学特点及误诊分析

目的:对不典型脑膜瘤患者的临床及影像学特点进行分析,提高其术前诊断正确率.方法:回顾性分析21例经病理证实或术前误诊为脑膜瘤病例的影像及临床资料.结果:21例病变中,15例脑膜瘤术前被误诊为胶质瘤7例,室管膜瘤、血管外皮细胞瘤及听神经瘤各2例,PNET及颅骨肿瘤各1例;其中13例病灶呈单发且信号不均,12例呈不均匀轻度强化,8例可见脑膜尾征,2例多灶性脑膜瘤同时累及胼胝体.其他病变被误诊为脑膜瘤者6例,分别为脑血管畸形伴出血、朗格汉斯细胞增生症、海绵状血管瘤、颅咽管瘤、胶质母细胞瘤及血管周细胞瘤各1例.结论:在准确定位的前提下,加深对发生于少见部位及特殊病理类型脑膜瘤的认识,可有效减低术前误诊率.     

1HMRS对脑转移瘤的诊断价值

目的：探讨氢质子磁共振波谱（proton magnetic resonance spectroscopy,1 H MRS）对脑转移瘤的诊断价值。方法：收集术后病理或临床证实脑转移瘤32例。所有患者MRS前均行MR平扫及增强扫描。3．0T MR多体素波谱（TE 144ms）扫描,分别于肿瘤实质、瘤周水肿及正常脑实质取感兴趣区（VOI）,测量代谢物浓度,计算Cho／Cr、NAA／Cr、Cho／NAA值,比较肿瘤实质与正常脑实质、瘤周水肿与正常脑实质代谢物比值的差异,采用配对t检验。观察肿瘤实质是否出现1．3ppm脂峰（Lip）及可流动脂质。结果：肿瘤实质与正常脑实质代谢物比较,Cho／Cr增高、NAA／Cr降低、Cho／NAA增高,差异有统计学意义（P均＜0．05）。瘤周水肿与正常脑实质代谢物比较,Cho／Cr略有增高,NAA／Cr 略有降低,差异无统计学意义（P均＞0．05）;Cho／NAA 增高,差异有统计学意义（P＜0．05）。32例中24例出现Lip,出现率75％,15例出现可流动脂质,出现率46．9％。结论：脑转移瘤的MRS具有一定特征,脂峰及可流动脂质的出现有助于脑转移瘤的诊断。     

Establishment of orthotopic transplantation model of human bladder cancer and detection by MRI

Objective： To establish an orthotopic bladder cancer model bearing human bladder cancer for experimental research, and monitor tumor progression by magnetic resonance imaging （MRI）. Methods： The mucosa was mechanically damaged transurethrally under direct vision, and then human bladder cancer cell line T24 was inoculated into the bladders of BALB/c nude mice to establish orthotopic bladder cancer model. To find a suitable concentration of Gd-DTPA for this research. MRI was performed weekly to assess tumor growth, using Gd-DTPA as contrast agent. The pathologic morphology of the bladders and other specimens were observed with HE stain. Results： All the 25 mice developed bladder cancer after inoculation. The best concentration of Gd-DTPA was 1.408 mg/mL. On MRI, no change in the bladders was observed on day 7 after inoculation, filling defect in the bladders, accordant to actual tumor size, was detected on days 14, 21 and 28. Pathologic examination showed that tumor grew in the mucosa or superficial muscle of bladder on day 7, confined in muscle layer on days 14-28, and invaded serosa on day 35. Conclusion： Transurethrally damaged bladder mucosa under direct vision and instilled bladder cancer cell T24, we successfully established an orthotopic bladder cancer model. Tumor growth simulated the progression of human bladder cancer approximately. MRI was a reliable way for dynamic detection of murine orthotopic bladder tumor.     

The Role of Surveillance Magnetic Resonance Imaging (MRI) Scanning in Detecting Recurrent Brain Tumors in Asymptomatic Children

BACKGROUND: There is controversy regarding the utility of routine surveillance scanning for asymptomatic children with brain tumors. Although the role of CT or magnetic resonance imaging (MRI) scanning in this setting has been examined in several studies, none have focused on children followed exclusively by MRI. The purpose of this study was to determine how often recurrent brain tumors are detected by routine MRI surveillance in asymptomatic children. METHODS: The medical records of all children with brain tumors treated at Children's Hospital at Strong from 1990-1999 were reviewed. Recurrence was defined as an increase in size of the tumor on MRI scan. Astrocytomas and gangliogliomas were classified as low-grade tumors; high-grade astrocytomas, medulloblastomas, and ependymomas were classified as high-grade tumors. RESULTS: Of the 112 evaluable children with brain tumors during this time period, 46 (41%) suffered an MRI-documented recurrence. Of these 46 patients, 13 (28%) had low-grade tumors and 33 (72%) had high-grade tumors. Twenty-seven of the 46 recurrences (59%) occurred in asymptomatic children. Ten of the 13 children (77%) with recurrent low-grade tumors were asymptomatic compared to 17 of 33 children (52%) with recurrent high-grade tumors (p = 0.18). The median survival from time of recurrence for the symptomatic children was seven months, while the median survival from time of recurrence for the asymptomatic children has not yet been reached (p = 0.025). When the analysis was confined to children with high-grade tumors, there was no difference in median survival from the time of recurrence for symptomatic versus asymptomatic children (5 mo. versus 7 mo.) (p = 0.25). The frequency of detection of recurrences by surveillance scanning in asymptomatic children was 4.2% (one recurrence detected per 24 surveillence MRI scans). CONCLUSION: The majority of recurrent brain tumors are detected by MRI surveillence in asymptomatic children. However, asymptomatic recurrences were detected in only a small proportion of surveillance scans and had no impact on survival in children with high-grade tumors.