Use of magnetic resonance imaging for detecting clinically and mammographically occult ductal carcinoma in situ.

We report on two cases where breast magnetic resonance imaging examination changed clinical management. Breast magnetic resonance imaging is now recognised as an indispensable adjunctive examination to mammography and ultrasound. In each of the two cases described, breast magnetic resonance imaging revealed unsuspected, extensive, and mammographically and ultrasonologically occult, ductal carcinoma in situ. In each of these cases, planned breast conserving surgery was changed to mastectomy. The success of breast conservation treatment depends on removal of all tumour with clear margins at the time of surgery. Magnetic resonance imaging is now considered the most sensitive method for evaluating the extent of breast cancer. Breast magnetic resonance imaging has a very high sensitivity for invasive carcinoma (near 100%), and recent studies show its specificity in high-risk patients is between 93 and 99%. Magnetic resonance imaging may well be proven an important adjunctive examination in patients who have dense breasts or extensive fibrocystic change.     

眼耳鼻咽喉疾病CT和MR技术创新与应用——2011年度国家科学技术进步二等奖

针对眼耳鼻咽喉CT和磁共振成像(MR)存在的问题,项目组从检查技术创新入手,系统地研究了眼耳鼻咽喉解剖与生理、变异与临床以及疾病与征象之间的相互关系,建立CT和MR检查体系;以构建眼耳鼻咽喉疾病CT和MR数据库为核心,创建影像诊断评估体系,揭示常见病变特征和规律;提出并证实了颞骨血管沟骨壁缺损是搏动性耳鸣发生的重要机制;验证了先天复杂性斜视的"神经———肌肉异常支配"假说;由此全面提升了眼耳鼻咽喉疾病的诊治和科学认知水平。     

CT与MRI认知融合影像在经腹会阴直肠切除术后患者经会阴前列腺靶向穿刺中的应用

目的 探究磁共振融合CT引导下经会阴前列腺靶向穿刺技术在无肛门患者中的应用。方法 对2例APR术后检查发现血清PSA异常升高的患者行磁共振融合CT引导下前列腺靶向穿刺技术。穿刺前先对2名患者进行多参数前列腺MRI,操作者通过目视估测,判断目标病灶位置。随后穿刺者对目测所得病灶靶向穿刺,其中患者1还进行了12针系统性穿刺,穿刺所取得的前列腺组织送病理检查,以病理结果为最终诊断。结果 患者1病理提示良性前列腺组织;患者2病理提示前列腺腺癌,Gleason评分3+4=7。结论 磁共振融合CT引导下经会阴前列腺靶向穿刺技术在无肛门患者中的应用是可行的,但这一技术的敏感性与特异性则有赖于进一步研究。     

MRI诊断半月板损伤的试验性评价

目的:进一步评价磁共振成像技术(MRI)诊断半月板损伤的价值。方法:选择骨科疑诊为膝关节半月板损伤的患者118例,分别进行MRI和关节镜检查,采用诊断试验评价指标进行分析。结果:MRI和关节镜诊断结果无统计学差异(P=0.549);与关节镜相比,MRI诊断半月板损伤的一致率90.68%,敏感性90.14%,特异性91.49%,误诊率8.51%,漏诊率9.86%,证实损伤能力10.59,排除损伤能力0.11;ROC曲线位于左上角,远离机会线。结论:MRI对膝关节半月板损伤诊断与金标准(关节镜诊断)结果相当,已成为关节镜检查前必要的诊疗技术。     

Magnetic resonance whole body imaging at 3 Tesla: feasibility and findings in a cohort of asymptomatic medical doctors.

OBJECTIVES: To evaluate the feasibility of whole body imaging using a 3 Tesla magnetic resonance scanner without a contrast agent, and to study the prevalence of abnormal findings among a cohort of asymptomatic doctors. DESIGN: Prospective study. SETTING: Private hospital, Hong Kong. PARTICIPANTS: A total of 132 asymptomatic medical doctors (111 men, 21 women), with a mean age of 56 (range, 38-82) years, volunteered for the study. They underwent corresponding whole body imaging at our hospital between October 2005 and February 2006. Imaging involved a 3 Tesla magnetic resonance scanner with 32 channels, parallel imaging, Total Imaging Matrix technology, a maximum gradient amplitude of 40 mT/m and a slew rate of 200 mT/m/ms (Magnetom Tim Trio, Siemens Medical Solution, Erlangen, Germany). The use of matrix coils enabled coverage of the whole body. No contrast agent was used. MAIN OUTCOME MEASURES: Detection of abnormalities in asymptomatic, apparently healthy adults. RESULTS: All examinations were completed successfully. The mean scan time per subject was 33 (standard deviation, 4) minutes. All subjects tolerated the examination well and overall imaging quality was satisfactory. A total of 124 (94%) subjects had positive findings, of whom 24 (18%) had further workup. Five (4%) subjects were found to have tumours, of which two (1.5%) were proven malignant. Our cancer detection rate was comparable to that of other reported whole body screening studies using contrast magnetic resonance imaging and positron emission tomography. CONCLUSION: We demonstrated the feasibility of performing whole body imaging in 30 minutes, using 32-channel magnetic resonance imaging at 3 Tesla without a contrast agent or any ionising radiation.     

胆胰管内超声内镜对胰腺疾病的诊断价值

目的评估胆胰管内超声内镜检查(IDUS)在胰腺疾病中的诊断价值。方法回顾分析2005年2月至2010年2月间行IDUS的63例胰腺疾病患者的影像学资料,IDUS均在经内镜逆行胰胆管造影(ERCP)时用经导丝的UMG20-29R腔内超声探头扫查胰腺。比较IDUS与CT、MRI、超声内镜(EUS)及腹部B超等5种方法在诊断胰腺疾病中的区别,以进一步评估IDUS在胰腺疾病的临床诊断中的应用价值。结果 IDUS对慢性胰腺炎(23例)、胰腺癌(10例)、导管内乳头状黏液瘤(IPMT,25例)、胰腺囊腺瘤(4例)的诊断准确率和Kappa检测值分别为93.7%(59/63),0.854;100.0%(63/63),1.00;90.5%(57/63),0.898以及96.8%(61/63),0.848。IDUS诊断准确率和Kappa检测值均优于其他4种方法 ,并且对1例胰腺囊腺癌也做出正确的术前诊断。结论 IDUS对胰腺疾病的诊断有较高的应用价值。     

Confluent focal nodular hyperplasia mimicking liver cancer: Value of liver-specific contrast-enhanced MRI for diagnosis

Focal nodular hyperplasia is the second most common benign hepatic tumor. Unlike adenoma as well as the malignant neoplasms, focal nodular hyperplasia can often be managed successfully without surgery. Use of liver-specific contrast-enhanced magnetic resonance imaging allows clinicians to confirm the diagnosis noninvasively in some patients, allowing select patients to avoid surgery. We report a case of a patient who presented with the rare profile of multiple, confluent lesions that were diagnosed, using magnetic resonance imaging with gadolinium-dimeglumine, as focal nodular hyperplasia. This complicated case was managed successfully and noninvasively based on algorithm found in the recent literature that allows patients to avoid unnecessary surgery.     

儿童体表淋巴管瘤的磁共振影像诊断

目的探讨儿童体表淋巴管瘤的磁共振影像学表现,评价磁共振影像诊断在儿童体表淋巴管瘤的价值,提高对淋巴管瘤的影像诊断水平。方法回顾性分析2014年1月～2018年12月年经手术或穿刺病理证实的的儿童体表淋巴管瘤42例的磁共振影像。结果单纯囊性淋巴管瘤26例,海绵状淋巴管瘤9例,血管淋巴管瘤7例。40例均表现为多房囊性结构,2例表现为单囊结构;18例病例可见液液平面;7例见血管穿行征;4例可见血管挤压征;20例表现为混杂信号,22例表现为长T1长T2信号;颈部及腋下大部分淋巴管瘤呈侵袭性生长,四肢及头皮肿物呈爬行性生长。结论儿童体表淋巴管瘤磁共振影像具有一定的特征,磁共振对儿童淋巴管瘤的诊断有重要的价值,能准确判断病灶的范围,对临床手术评估及内科治疗具有重要的意义。     

钼靶X线、彩色多普勒超声和磁共振检查在乳腺癌保乳手术上的应用研究

目的 探讨钼靶X线、彩色多普勒超声和磁共振检查在乳腺癌保乳手术上的应用情况. 方法 选取本院2010-01～2011-12间收治的经病理检查证实的乳腺癌患者,这些患者全部选择保乳手术治疗,并在手术前均进行了钼靶X线、彩色多普勒超声和磁共振检查,观察这三种影像学检查和术后病理检查结果的符合率情况.结果 钼靶X线检出率76.32％,诊断准确率为55.26％;彩色多普勒超声检出率86.84％,诊断准确率为78.95％;磁共振检出率100％,诊断准确率为100％.结论 三种影像学检查方式都具有一定的优势,但是磁共振方法的优势最高,应作为保乳手术前常规影像学检查项目.     

3.0T磁共振弹力成像在继发性颅内肿瘤中的应用分析

目的 探讨3.0T磁共振弹力成像在继发性颅内肿瘤中的应用价值.方法 选取我院2011年1月～2013年1月收治的脑肿瘤患者87例,均为脑转移瘤,将所有患者分别通过3.0T磁共振弹力成像和普通MRI进行诊断,然后手术或者活检进行病理诊断,比较3.0T磁共振与普通MRI对于颅内转移瘤检测的准确性.结果 3.0T磁共振弹力成像与病理诊断的相符率明显高于普通MRI,其对于恶性级别的判断也优于普通MRI（P＜0.05）.结论 3.0T磁共振弹力成像可以对继发性脑肿瘤做出准确的判定,对于指导临床治疗具有重要作用.     

心源性脑栓塞100例临床分析

目的：分析心源性脑栓塞（cardiogenic cerebral embolism,CCE）的病因及影像学特点。方法：对100例心源性脑栓塞患者既往史、临床表现、心电图、超声心动图、CT、MRI进行分析。结果：心房纤颤84例,占84%;风湿性心脏瓣膜病伴心房纤颤21例,占21%;非风湿性心脏瓣膜病伴心房纤颤63例,占63%;头颅磁共振检查提示大面积脑梗死76例占76%,合并出血性梗死23例,占23%。结论：心房纤颤是引起心源性脑栓塞的最常见原因,其中大多数为非瓣膜病性心房纤颤,心源性脑栓塞约76%为大面积梗死,而且病灶累及多叶,易发生出血性梗死。     

A classic diagnosis with a new 'spin'

We describe a case of pericardial constriction following viral pericarditis and illustrate the use of cardiac magnetic resonance imaging in the diagnostic process. The advantages of cardiac magnetic resonance in the investigation of pericardial disease are briefly explained.     

论核磁共振全身弥散成像技术在临床诊断中应用优势

目的:探讨核磁共振新技术全身弥散成像(WB-DWI)在临床诊断中的应用优势。方法:通过对核磁共振全身弥散成像技术原理的阐述,分析此项新的成像技术的优势。结果:核磁共振全身弥散成像技术有易行、便捷、高敏感、无辐射等优点,对于全身肿瘤筛查有很高的敏感性,检查费用相对较低。结论:磁共振全身弥散成像方法简单,对全身肿瘤的筛查具有较高的临床应用价值。     

Precoccygeal epidermal inclusion cyst presenting as coccygodynia

Although there are numerous aetiologies for coccygodynia described in the medical literature, precoccygeal epidermal inclusion cyst presenting as a coccygodynia has not been reported. We report a 30-year-old woman with intractable coccygodynia. Magnetic resonance imaging showed a circumscribed precoccygeal cystic lesion. The removed cyst was pearly-white in appearance and contained cheesy material. Histological evaluation established the diagnosis of epidermal inclusion cyst with mild nonspecific inflammation. The patient became asymptomatic and remained so at two years follow-up. This report suggests that precoccygeal epidermal inclusion cyst should be considered as one of the differential diagnosis of coccygodynia. Our experience suggests that patients with intractable coccygodynia should have a magnetic resonance imaging to rule out treatable causes of coccygodynia.     

Profile of compressive myelopathy as evaluated by magnetic resonance imaging

To evaluate spectrum of diseases causing compressive myelopathy and accuracy of magnetic resonance imaging in diagnosing these conditions, a total of 69 clinically diagnosed cases of compressive myelopathy were evaluated by magnetic resonance imaging and results were tabulated. Caries spine was the commonest condition (24.6%) followed by metastasis spine (17.4%), ossified posterior longitudinal ligament (7.8%), primary bone tumours, nerve sheath tumours, intramedullary tumours and rare conditions like epidural abscess, spontaneous epidural haematoma, subdural haematoma, epidural lipomatosis, etc. Sensitivity, specificity and accuracy for diagnosing caries by magnetic resonance imaging was found to be 94%, 98% and 97% while that of metastasis spine was 91%, 98% and 97% respectively. Magnetic resonance imaging is the modality of choice for diagnosing compressive myelopathy.     

幕上高灌注原发性中枢神经系统淋巴瘤一例

报道高灌注幕上原发性中枢神经系统淋巴瘤1例。CT表现为双侧半卵圆中心对称性类圆形高密度病变,周边可见大片状水肿。磁共振成像表现为稍长及等T1、稍长及长T2信号影,扩散加权成像病变呈高信号影,表观扩散系数值高于邻近正常脑实质,增强扫描病变明显均匀强化,右侧病变内可见斑片状无强化影,磁共振灌注成像表现为明显高灌注。     

Assessmrent of iron overload in thalassaemic patients by magnetic resonance imaging: a pilot study

The patients of thalassaemia major need repeated blood transfusion which leads to excess iron deposition in various organs like liver, heart, pituitary etc. This iron accumulation causes various complications and ultimately organs' failure. There is no non-invasive, standard and reliable method to know the status of iron overload in various organs of the body. This paper attempts to use magnetic resonance imaging to know the liver iron overload in 8 thalassaemic patients as a pilot study. Eight children suffering with thalassaemia and 3 controls who were the normal siblings of the patient group underwent magnetic resonance imaging of the abdomen using spin-echo T, weighted sequence. Blood serum ferritin levels in the patients' group were also determined on the same day of magnetic resonance imaging examination. It was observed that the ratio of magnetic resonance imaging signal intensity (in spin-echo T1 weighted image) in paraspinous muscle to liver was significantly different in normal control (0.65) compared to that in thalassaemia patients (2.1 to 11.4 depending upon extent of iron deposition). The magnetic resonance signal intensity ratio correlated with the blood serum ferritin level of patients (p = 0.01) which is generally taken as indirect measure of body iron burden. Spin-echo sequence is the simplest imaging sequence and it increases the chance of its routine use. The study concludes that magnetic resonance imaging has good potential to quantify the liver iron deposition non-invasively and may denote the efficacy of iron-chelation therapy which is used to reduce the body iron burden in these patients.     

磁共振检查对脑静脉窦血栓行诊断试验相关性的评价

目的 探讨磁共振检查对脑静脉窦血栓行诊断试验评价的相关性。方法 收集2011年7月至2017年12月榆林市第一医院疑似脑静脉窦血栓形成的患者63例为研究对象,在磁共振成像和磁共振静脉血管成像检查后一周内行数字减影血管造影,统计出MRI与DSA、MRV与DSA、MRI联合MRV与DSA诊断脑静脉窦血栓的情况,列出22四格表计算出各项诊断试验指标,进行对比分析,得出结论。结果 MRI联合MRV诊断脑静脉窦血栓形成的灵敏度、特异度、约登指数、符合率、阳性预测值、阴性预测值、阳性似然比、Kappa值在诊断脑静脉窦血栓的三个方面是最高的以及阴性似然比最低。结论 磁共振检查可以较好地诊断脑静脉窦血栓形成,在一定程度上可取代DSA诊断脑静脉窦血栓形成。     

Vascular diaphragmatic hernia in a patient with cirrhosis first case report

We report the case of an adult patient recently diagnosed with cirrhosis. The ultrasound evaluation described a multinodular inhomogeneous liver, requiring a magnetic resonance imaging scan for further characterization. The performed magnetic resonance imaging examination confirmed the diagnosis of cirrhosis associated with portal hypertension and detected a vascular left transdiaphragmatic hernia. Although various types of diaphragmatic hernias have been described - congenital or acquired - to the best of our knowledge, this type of pathology has never been reported.     

对比剂增强的磁共振显像对心肌梗死后坏死心肌的检测

目的评价对比剂增强的磁共振显像(CE-MRI)对急性和陈旧性心肌梗死后坏死心肌检测的准确性。方法采用导管介入球囊封堵冠脉的方法制作9头苏中猪心肌梗死模型,随机分为两组(急性心梗组和陈旧性心梗组),分别于术后3 d和3周行CE-MRI和病理学检查。结果两组猪心脏磁共振检查均见心肌的延迟增强显像。病理TTC染色证实,延迟增强区系坏死心肌。结论CE-MRI能够较准确地判断急性和陈旧性心肌梗死后坏死心肌及其范围。