3.0T核磁共振成像LAVA动态增强在乳腺良恶性病变的诊断价值

目的研究3.0T核磁共振成像LAVA动态增强对乳腺恶性肿瘤的鉴别价值,为治疗提供依据。方法选择2013-02—2016-03间收治的36例乳腺良恶性病变患者为观察对象。采用SIMENS 3.0T超导MRI对患者进行平扫及LAVA动态增强扫描,与术后病理穿刺检测结果进行比较。计算动态增强的灵敏度、特异度、准确度。结果乳腺癌患者LAVA动态增强曲线呈早期信号快速上升,中晚期信号强度逐渐降低表现。患者动态增强曲线呈逐渐上升改变。3.0TMRI平扫显示乳腺良恶性病变信号无统计学意义,LAVA显示良恶性肿瘤形态差异明显。良性肿瘤表现为Ⅰ型曲线,诊断的特异度较高(97.3%),恶性肿瘤表现为Ⅲ型曲线,诊断准确度较高(83.2%)。结论 3.0T核磁共振成像LAVA动态增强序列,可以清晰显示乳腺良恶性病变的形态、边缘,具有较高诊断价值。     

乳腺触觉成像诊断乳腺疾病临床价值研究

目的 探讨乳腺触觉成像（palpation imaging,PI）对乳腺疾病的诊断价值。方法 对2010年10月至2011年3月在上海交通大学医学院附属瑞金医院乳腺外科就诊的151例病人共计213个病灶,行PI、B超、钼靶及磁共振成像（MRI）检查,各检查方法独立进行。以病理诊断为金标准,通过受试者工作特征曲线（ROC曲线）评估PI对乳房病灶的诊断价值,并比较不同方法诊断结果的差异。结果 PI对病灶的良恶性具有较好的诊断价值（AUC=0.832,95%CI：0.766～0.898,P<0.001）,敏感度为87.0%,显著高于钼靶（63.5%,P=0.005）,与B超（87.0%）及MRI（94.0%）相比差异无统计学意义。PI的特异度及准确率为69.8%与74.2%,与钼靶相比差异无统计学意义（80.5%,P=0.041,未达到调整后检验水准α’ =0.0083;75.4%,P=0.778）,但显著低于B超（86.2%,P<0.001;86.4%,P=0.002）及MRI（85.7%,P=0.005;88.7%,P<0.001）。结论 PI对于乳房疾病具有良好的诊断价值,有望成为乳腺疾病现有辅助检查外的又一种重要检查方法。     

MRI动态增强联合DWI对乳腺良恶性病变的鉴别

目的:探讨MRI动态增强时间-信号强度曲线(TIC)联合扩散加权成像(DWI)对乳腺良恶性病变的鉴别诊断价值。方法:收集经手术病理证实的43例(51个病灶)乳腺病变患者的MRT1WI、T2WI、DWI(b值=800s/mm2)和MRI动态增强扫描资料,对病灶信号强度、ADC值和增强幅度、TIC进行回顾性分析。结果:43例51个病灶中,TICI型曲线,良性19个,恶性1个;II型曲线,良性4个,恶性7个;III型曲线,良性2个,恶性12个;IV型曲线,6个病灶均为良性病变。病灶的ADC值>1.22×10-3mm2/s的30个(其中良性27个,恶性3个);ADC值≤1.22×10-3mm2/s的21个(其中恶性17个,良性4个)。结论:MRI动态增强TIC联合DWI对乳腺病变的诊断有较高的敏感性和特异性,TIC类型和ADC值对乳腺病变的良恶性鉴别具有重要价值。     

动态增强MRI定性诊断乳腺导管上皮非典型增生

目的 观察动态增强MRI（DCE-MRI）定性诊断乳腺导管上皮非典型增生（ADH）的价值。方法 回顾性分析经穿刺活检或局部切除组织活检诊断的64例乳腺单发ADH患者,以手术病理结果为金标准,比较恶性与良性病变患者临床资料及乳腺X线、DCE-MRI征象,分析DCE-MRI预测乳腺恶性ADH的效能。结果 64例乳腺单发ADH中,28例为恶性（恶性组）,36例非恶性（非恶性组）,组间活检方式、病灶最大径、MRI示乳腺实质背景强化（BPE）、乳腺X线表现差异均有统计学意义（P均<0.1）;将上述因素纳入Logistic多因素回归分析,结果显示仅BPE为乳腺恶性ADH的独立影响因素[OR=7.550,95%CI（1.575,36.197）,P=0.011]。DCE-MRI诊断BI-RADS 4A及以下者27例,其中3例为恶性;4A类以上（4B及4C）37例,25例为恶性,诊断敏感度89.29%（25/28）,特异度66.67%（24/36）,阳性预测值67.57%（25/37）,阴性预测值88.89%（24/27）。结论 DCE-MRI可用于定性诊断乳腺ADH;其所示中重度BPE为术后病理恶性的正相关因素。     

MRI动态增强及重建在乳腺病变诊断中的应用

目的分析50例乳腺病变MRI表现,说明MR在乳腺病变诊断中的补充作用.材料与方法对50例乳腺病变的MR表现进行回顾性研究,并与术后病理结果相比较.结果50例乳腺病变中,恶性病变18例:分别为浸润性导管癌14例(左乳10例,右乳4例),左乳浸润性导管癌术后复发1例,右乳浸润性小叶癌1例,左乳导管内癌1例,右乳粘液癌1例.良性病变22例:分别为乳腺病伴(或不伴)纤维腺瘤10例,纤维(囊性)乳腺病9例.左乳导管内乳头状瘤1例,左乳分叶状肿瘤1例,双乳错构瘤1例.乳腺感染性病变4例.脂肪坏死2例.乳腺外伤后改变1例.双乳假体术后3例.结论MR作为乳腺病变检查的一种重要补充方法,对病变多方位的显示,具有无射线损伤,广阔的视野,良好的软组织对比度等优势,结合动态增强曲线及重建,在病变诊断及临床治疗中有重要价值.     

影像学检查在乳腺良性疾病诊断中的合理应用及价值

影像学检查对乳腺良性疾病的诊断及治疗效果评估有重要意义。目前临床常用的乳腺影像学检查方法包括超声、X线摄影及MRI检查,临床工作中应重视这三种检查方法的合理结合,以降低乳腺疾病的假阳性率,提高良性病变诊断的准确率,减少不必要的手术风险。     

食管肿瘤行核磁共振检查的临床价值

对２６例食管癌、３例食管平滑肌瘤，２例食用这平滑肌肉瘤病人术前行核磁共振（ＭＲＩ）扫描并与手术及病理对照研究。结果表明ＭＲＩ的扫描估价食管肿瘤外侵程度不十分准确，判定肿瘤切除可能性不可靠，对纵隔及食管旁淋巴结检邮率低，不能鉴别食管肿瘤的良或恶性。因此，ＭＲＩ检查对食管肿瘤病人选择治疗方案帮助不大。     

3.0T动态增强核磁共振成像技术对老年前列腺癌患者的临床诊断意义

目的 探究DCE-MRI对老年前列腺癌患者的临床诊断意义。方法 选择2016年1月至2017年1月于本院收治的45例前列腺癌（prostate cancer,PC）及前列腺增生患者（PC 30例,前列腺增生15例）。行MRI及DCE-MRI检查,并与病理结果比较。比较中央腺体非癌区、外周带非癌区以及前列腺癌区比较容积转运常数（K^trans）值、速率常数（K_^ep）值、血管外细胞外容积分数（V_e）值,并将PC组按Gleason评分进行分组。结果 中央腺体非癌区K^trans值、K_ep值、V_e值与外周带非癌区、前列腺癌区、组间差异具有统计学意义（P<0.05）;Gleason不同评分患者K^trans、V_e组间差异具有统计学意义（P<0.05）;前列腺患者癌区Ktrans与Gleason评分成正相关（r=0.654,P<0.05）。结论 3.0T动态增强核磁共振成像技术对老年前列腺癌患者的诊断提供了客观依据。     

磁共振成像对乳腺钙化灶的诊断价值

目的:探讨磁共振成像(magnetic resonance imaging,MRI)对超声检查阴性乳腺钙化灶的诊断价值。方法:回顾性分析2011年1月至2014年3月209例因乳腺X线检查发现226个BI-RADS 4-5级钙化灶(超声检查阴性)而接受活检病人的MRI检查表现,并与病理结果对比分析。226个钙化灶中,42个为恶性,184个为良性。结果:对于超声检查阴性钙化灶恶性的判断,乳腺X线检查和MRI的灵敏度分别为69.0%和85.7%(P=0.068),特异度分别为64.7%和88.0%(P     

动态对比增强MRI在鼻咽癌中的应用进展

鼻咽癌(NPC)是鼻咽部最常见恶性肿瘤,其发生发展与血管生成密切相关。动态对比增强MRI(DCE-MRI)能定量反映病灶内的血流灌注及血管通透性,从形态学和功能学角度准确评估肿瘤恶性程度,有助于指导临床选择治疗方案。本文对DCE-MRI在NPC中的应用进展进行综述。     

Preoperative assessment of breast cancer: Multireader comparison of contrast-enhanced MRI versus the combination of unenhanced MRI and digital breast tomosynthesis

PurposeTo compare the sensitivity for breast cancer (BC) and BC size estimation of preoperative contrast-enhanced magnetic resonance imaging (CEMRI) versus combined unenhanced magnetic resonance imaging (UMRI) and digital breast tomosynthesis (DBT).Patients and methodsWe retrospectively included 56 women who underwent DBT and preoperative 1.5 T CEMRI between January 2016–February 2017. Three readers with 2–10 years of experience in CEMRI and DBT, blinded to pathology, independently reviewed CEMRI (diffusion-weighted imaging [DWI], T2-weighted imaging, pre- and post-contrast T1-weighted imaging) and a combination of UMRI (DWI and pre-contrast T1-weighted imaging) and DBT. We calculated per-lesion sensitivity of CEMRI and UMRI + DBT, and the agreement between CEMRI, UMRI and DBT versus pathology in assessing cancer size (Bland-Altman analysis). Logistic regression was performed to assess features predictive of cancer missing.ResultsWe included 70 lesions (64% invasive BC, 36% ductal carcinoma in situ or invasive BC with in situ component). UMRI + DBT showed lower sensitivity (86–89%) than CEMRI (94–100%), with a significant difference for the most experienced reader only (p = 0.008). False-positives were fewer with UMRI + DBT (4–5) than with CEMRI (18–25), regardless of the reader (p = 0.001–0.005). For lesion size, UMRI showed closer limits of agreement with pathology than CEMRI or DBT. Cancer size ≤1 cm was the only independent predictor for cancer missing for both imaging strategies (Odds ratio 8.62 for CEMRI and 19.16 for UMRI + DBT).ConclusionsUMRI + DBT showed comparable sensitivity and less false-positives than CEMRI in the preoperative assessment of BC. UMRI was the most accurate tool to assess cancer size.     

Routine screening for local recurrence following breast-conserving therapy for cancer with dynamic contrast-enhanced magnetic resonance imaging of the breast

Background: Dynamic contrast-enhanced magnetic resonance imaging (MRI) of the breast is highly sensitive for the diagnosis of primary breast malignancy. We investigated the clinical application of dedicated dynamic breast MR for routine screening for local recurrence following breast-conserving therapy. Methods: Patients underwent a single dynamic MR of the breast routinely in the period 1 to 2 years following treatment, or earlier if recurrence was suspected. A biopsy was performed if there was suspicion of recurrence on MR. Results: One hundred and five patients with a median age of 58 years (range 50 to 65 years) were recruited for the study. Sixteen biopsies were performed and nine recurrences were confirmed histologically. Patients not undergoing biopsy have been followed up for a median of 341 days (range 168 to 451 days) following the MR. The sensitivity for clinical examination, mammography, examination combined with mammography, and MRI alone for the detection of recurrent cancer were 89%, 67%, 100%, and 100%, respectively, and the specificity was 76%, 85%, 67%, and 93%. Conclusion: Combined clinical examination and mammography are as sensitive as dedicated dynamic MR of the breast for the detection of locoregional recurrence, but breast MRI is associated with a far greater specificity. Therefore, dedicated dynamic breast MRI should be used when there is clinical or mammographic suspicion of recurrence to confirm or refute its presence.Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997.     

动态增强磁共振成像在评估女性乳房乳头乳晕血供的应用

目的探究动态增强磁共振成像(DCE-MRI)用于评估女性乳房乳头乳晕血供特点的可行性,为乳房整形手术提供乳头乳晕的血供参考。方法从2012年3月至2019年10月华中科技大学同济医学院附属同济医院影像数据库中收集女性乳腺DCE-MRI图像资料,选择未发现肿物的正常乳房的DCE-MRI图像进行研究。在西门子工作站将患者乳腺DCE-MRI图像通过图像减影获取乳房血管图像,分别对轴位、冠状位和矢状位的最大密度投影(MIP)图像进行评估,结合三维MIP图像识别所有供应乳头乳晕的血管。乳头乳晕的血供被划分为内上、内侧、内下、外上、外侧、外下、中央、上方和下方9个象限,对各个象限血管进行统计和分析,并测量血管至乳房皮肤表面投影的最大距离。采用SPSS 19.0软件进行统计分析,通过卡方检验分别比较左侧与右侧乳房的乳头乳晕复合体(NAC)血供象限分布构成比。计算血管到皮肤距离的平均值、标准差及95%置信区间,通过方差分析比较各象限血管至皮肤距离的差异。P<0.05为差异具有统计学意义。结果共收集到245例患者490只女性乳房DCE-MRI图像,其中97例患者97只乳房发现有乳腺肿物,其余393只为正常乳房(97例单侧乳房、148例双侧乳房),将其作为研究对象。患者年龄23~72岁,平均43.7岁。393只乳房(左侧200只、右侧193只)共发现有637条(左侧311条、右侧326条)乳头乳晕供应血管。在637条血管中,内上象限269条(42.2%),外上180条 (28.3%),内侧57条(8.9%),下方37条(5.8%),中央30条(4.7%),内下25条(3.9%),外下25条(3.9%),上方11条(1.7%),外侧3条(0.5%)。卡方检验表明左侧乳房和右侧乳房在NAC血供象限分布构成比差异无统计学意义(χ2 =6.4,P=0.602)。除中央象限血管以外,所有血管到皮肤表面投影最大距离的平均值为0.91 cm, 95%置信区间为0.86~0.96 cm。方差分析表明各象限供血血管到皮肤投影的最大距离,差异有统计学意义(F=11.4,P<0.001)。结论 DCE-MRI可以清晰地显示乳头乳晕的血供来源。乳头乳晕血供主要来源于内上象限和外上象限的血管,血管在皮下约1 cm深度走行。     

三阴性乳腺癌的MRI研究进展

目的三阴性乳腺癌(TNBC)具有特殊的生物学行为及临床病理学特征,临床缺乏有效治疗方法,预后较差。目前MRI是诊断乳腺癌的最准确的影像学方法。MRI有助于诊断TNBC、制订治疗方案与预后评估,并能加深对其生物学行为的理解。TNBC的MRI特征包括较大的单发病灶,边缘光滑,T2WI呈高信号,增强后环形强化;而动态对比增强MRI(DCE-MRI)、DWI及MRS对于TNBC的临床应用价值有待更深入研究。     

分子分型及动态增强磁共振成像对乳腺癌新辅助治疗疗效的预测和评价

目的 前瞻性研究分子分型及动态增强MRI对乳腺癌新辅助治疗疗效的预测和评价价值.方法 选择2010年1月至2011年12月实施新辅助治疗并完成R0切除手术的79例乳腺癌患者,均为女性,年龄28 ～67岁,中位年龄48岁;其中Luminal A型6例,Luminal B型42例,HER-2阳性型14例,三阴型17例.研究入组患者动态增强MRI评价与病理疗效评价间的关系,分析分子分型及动态增强MRI对新辅助治疗疗效的预测和评价作用.结果 新辅助治疗临床有效率为83.5％(66/79),病理有效率为79.7％(63/79).79例患者中27例获得病理完全缓解(34.2％),其中Luminal B型12例(28.6％,12/42),HER-2阳性型5例(5/14),三阴型10例(10/17).分子分型与病理完全缓解具有统计学相关性(P =0.039).动态增强MRI临床疗效评价与病理疗效评价间有统计学相关性(r =0.432,P=0.000).结论 分子分型对乳腺癌新辅助治疗疗效具有预测价值,动态增强MRI检查与新辅助治疗后组织病理疗效评价具有相关性,有助于新辅助治疗疗效评价.     

全数字化X线乳腺钼靶、MRI对乳腺癌的诊断价值探讨

目的探讨全数字化x线乳腺钼靶、MRI检查对乳腺癌的诊断价值。方法回顾性分析35例经手术证实的乳腺癌患者的全数字化x线乳腺钼靶及MRI检查资料,分析其影像学特征,并统计对比钼靶、MRI联合和单独应用的诊断准确率。结果全数字化x线乳腺钼靶表现：单发肿块22例,其中分叶20例,毛刺12例,钙化6例,不规则浸润13例,皮肤增厚、皮下水肿4例,肿大淋巴结10例。MRI表现：形状不规则或分叶,边缘不规则毛刺,T1WI相平扫呈低信号,与周围正常腺体无法区分;T2WI呈不均匀等高信号,边缘欠清,周围见长短毛刺征,增强后明显强化,表现为均匀、不均匀及边缘强化。MRI检查诊断准确率（30／35,85．71％）高于全数字化x线乳腺钼靶检查（22／35,62．85％）,X2=4．786,P=0．029。联合应用诊断准确率（34／35,97．14％）高于两者单独应用,差异有统计学意义（P〈0．05）。结论乳腺癌全数字化x线乳腺钼靶、MRI表现具有一定的特征性,两者联合应用有助于提高乳腺癌具有特征性的诊断正确率。     

Increased ipsilateral whole breast vascularity as measured by contrast-enhanced magnetic resonance imaging in patients with breast cancer

BACKGROUND: Tumor-induced neovessel formation identified by gadolinium-enhanced magnetic resonance imaging (MRI) is a commonly used marker for breast malignancy. The purpose of this study was to assess possible differences in whole-breast vascularity as measured by contrast-enhanced MRI in the ipsilateral and contralateral breasts of patients with unilateral breast malignancies. METHODS: Gadolinium-enhanced MRI of the breast using a Siemens 1.0-T scanner with dedicated breast coil was performed on 22 consecutive patients with histologically confirmed unilateral breast carcinoma. Whole-breast vascularity of the breast containing the carcinoma was estimated as increased, decreased, or similar compared with the contralateral unaffected breast. Breast vascularity was then correlated to clinical factors including tumor size, histology, multifocality, nodal involvement, and patient age and menopausal status. RESULTS: Twenty patients had infiltrating carcinomas, and 2 patients had ductal carcinoma in situ. Four were multifocal. Fifteen of 22 patients demonstrated clear evidence of increased whole-breast vascularity in the ipsilateral breast containing the primary breast cancer compared with the contralateral breast. Although there was no clear correlation between the presence of increased whole-breast vascularity in the cancer-bearing breast with tumor size, histology, grade, mammographic appearance, or patient age and menopausal status, increased vascularity was present in 3 of 4 patients with multifocal disease and in 4 of 5 patients with metastatic disease in the axillary nodes. CONCLUSIONS: Measurable increases in whole-breast vascularity can be identified by contrast-enhanced MRI and appear with increased frequency in the cancer-bearing breast. These findings suggest that factors other than tumor size and histology may influence development of macroscopic vessels during tumor progression and may be indicative of angiogenic tumor biology.     

乳腺癌分子亚型与MRI表现的相关性

目的探讨不同分子亚型乳腺癌与MRI表现的相关性。方法回顾性分析121例经手术病理证实的乳腺癌患者,根据雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体(HER-2)表达状态,将乳腺癌分为HER-2过表达型、Luminal A型、Luminal B型和三阴性型,观察不同亚型乳腺癌MRI表现及其与分子亚型的相关性。结果 4种分子亚型乳腺癌T1WI多呈稍低信号[HER-2过表达型:68.00%(17/25),Luminal A型:66.67%(38/57),Luminal B型:76.19%(16/21),三阴性型55.56%(10/18)];HER-2过表达型多呈非肿块样强化[84.00%(21/25)],Luminal A型多呈不均匀强化[75.44%(43/57)],Luminal B型和三阴性型多呈环形强化[52.38%(11/21)、83.33%(15/18)];HER-2过表达型、Luminal B型和三阴性型时间-信号强度曲线多为廓清型[76.00%(19/25)、80.95%(17/21)和77.78%(14/18)],LuminalA型多为平台型[82.46%(47/57)];HER-2过表达型、Luminal B型和三阴性型多有伴随征象[80.00%(20/25)、76.19%(16/21)、66.67%(12/18)],Luminal A型49.12%(28/57)有伴随征象。乳腺癌增强MRI强化方式与分子亚型呈高度相关(C=0.737,P0.001),时间-信号强度曲线类型与分子亚型呈中度相关(C=0.567,P0.001)。结论乳腺癌分子亚型与MRI表现具有一定相关性,可通过MRI特征初步判断乳腺癌分子亚型。     

Diagnostic value and safety of dynamic MRI of contralateral breast and axilla in subjects with tissue expander

Introduction

To verify the diagnostic value of contrast-enhanced breast and axillary MRI in patients with tissue expander labeled as “MR-unsafe” and to confirm its safety.