髓外硬膜下肿瘤磁共振定性诊断

目的评价MRI对髓外硬膜下肿瘤的诊断价值.方法经手术、病理证实的髓外硬膜下肿瘤69例、83个瘤灶(其中1例转移癌为随访证实),回顾性分析其MRI表现.结果(1)神经源性肿瘤多为T1WI低信号、T2WI高信号,T1/T2得分比值为0.31±0.2,信号不均匀,可见肿瘤血管,增强扫描强化明显,但不均匀;(2)脊膜瘤T1WI多为等信号或稍低信号,T2WI多为等或稍高信号,T1/T2得分比值为0.85±0.19,信号较均匀,增强扫描强化均匀,增强效果不如神经源性肿瘤高,可见脊膜尾征;上述肿瘤的T1、T2、T1/T2得分比值及强化效果经统计学处理差异有显著性;(3)其它脂肪瘤MRI表现具有特征性;转移癌MRI表现可类似脊膜瘤.结论髓外硬膜下肿瘤的MRI诊断价值极高,定位诊断正确率为98.80%,定性诊断正确率为95.2%.     

小肝癌螺旋CT门脉期最大强化率与病理及免疫组化的研究

目的:对小肝细胞肝癌(SHCC)的螺旋CT多期扫描肿瘤门脉期强化程度与组织分级、p53、p21、CD34、VEGF表达的相关性进行多因素分析,试图以螺旋CT多期扫描的影像学评价SHCC的生物学特性,为SHCC的治疗和预后判断提供新的依据。方法:手术病理证实SHCC30例,共33个癌结节,术前均进行螺旋CT多期扫描,其中男26例,女4例。术后肿瘤行大体病理及其HE染色、免疫组化染色分析。结果:门脉期最大强化率高的肿瘤,CD34和p53多为高表达,VEGF多为低表达。三者的标准回归系数分别为0.2809,0.6042和-0.2590,其中p53最大,即p53与癌灶门脉期最大强化率的关系最密切;CD34和VEGF与癌灶门脉期最大强化率的相关性类似,但作用方向相反。结论:螺旋CT多期增强扫描可比较全面观察肿瘤,反映SHCC的生物学特性,且无创、快捷、可重复运用。根据SHCC的螺旋CT征象,可间接评价其相关基因的表达,为SHCC的治疗和预后判断提供新的有价值的依据。     

螺旋CT多期扫描在肝癌诊断中的应用

目的探讨肝癌螺旋CT多期扫描影像特征和临床应用价值.方法对诊断为肝癌的600例患者先行全肝CT平扫,其中308例不论肿瘤大小（包括114例结节型）先作病灶动脉期扫描,再作全肝静脉期扫描,最后进行病灶平衡期扫描.292例仅行动脉期及静脉期扫描.结果600例中409例为巨块型（占68.2%）,114例为结节型（占19%）,77例为弥漫型（占12.8%）.308例中CT平扫、动脉期、静脉期及平衡期病灶的显示率分别为89%、98%、92%、98%.结论螺旋多期扫描能获得肿瘤在各期增强征象,为肝癌的定性定量诊断提供更多的影像诊断信息;尤其在早期肝癌诊断,动脉期扫描可得到非常重要的诊断依据.     

急性缺血性脑卒中患者出血转化与血脂水平的关系

目的 探讨血脂水平对急性缺血性脑卒中出血转化(hemorrhagic transformation,HT)影响及其规律.方法 连续收录广西医科大学第一附院神经内科2009年1月至2010年12月期间确诊急性缺血性脑卒中病例.收录内容包括性别、起病年龄、既往病史、神经功能缺失严重程度、血压、血糖、血脂水平、缺血性脑卒中病因、梗死面积及部位.以上因素与HT关系采用非条件Logistic回归分析.结果 共纳入665例急性缺血性脑卒中病例,HT68例.大面积梗死、皮层梗死、空腹血糖、空腹血清总胆同醇水平、既往高血压史与HT有关:空腹血清总胆固醇水平每降低l mmol/L,HT发生率增高35.6%(OR:0.644;95%CI:0.456～0.908;P=0.012).结论 空腹血清总胆固醇水平与HT有关;随着空腹血清总胆同醇水平降低,HT发生率呈增高趋势.     

无静脉预饱和3D-TOF-MRA诊断脑动静脉畸形的临床应用

目的：评估3.0T MRI机无静脉预饱和三维时飞法MR血管成像（non-S-3D-TOF-MRA）在脑动静脉畸形（AVM）诊断中的临床应用价值。方法：回顾性分析40例临床疑似AVM患者进行无静脉预饱和3D-TOF-MRA、有静脉预饱和（S）3D-TOF-MRA、3D-PC-MRA及数字减影血管造影（DSA）检查的影像显示效果。结果：与DSA金标准相比,检出AVM瘤灶及显示供血动脉及引流静脉及汇入静脉窦non-S-3D-TOF-MRA、S-3D-TOF-MRA与DSA完全一致（100%）。结论：无静脉预饱和3D-TOF-MRA可全面准确地诊断AVM。     

实验猪胸部正位CR合理曝光条件研究

目的探讨计算机X线摄影(computed radiography,CR)的合理曝光条件。材料与方法以10mAs、20mAs、40mAs档,分别从50～150kV、步长为2kV对实验猪胸部进行系列曝光,用剂量计记录每次曝光的入射点的入射X线剂量、肺野和纵隔处的透射X线剂量,得到三个序列的X线剂量与kV的关系数据,绘制入射剂量、透射剂量与kV的关系图,然后用相同的步骤进行系列胸部正位CR摄影,以噪声不影响观察为前提,找出曝光量最低的CR图像及其对应的合理曝光剂量,分析合理曝光剂量与曝光条件的关系。结果(1)合理曝光条件对透射剂量有很强的依从关系,不管如何改变kV和mAs的组合,合理透射剂量均是一个相对的恒定值,三个序列间合理剂量差异性比较均无统计学意义(P>0.05);(2)合理曝光剂量相对应的入射剂量,低mAs高kV组合要比高mAs低kV组合的入射剂量低,三个序列间差异比较具有统计学意义(P<0.01);(3)入射点剂量与mAs呈正相关。结论(1)对于CR来说,透射剂量是合理曝光条件唯一考量的参数;(2)提高kV对降低患者辐射剂量有意义。     

眼眶淋巴瘤的影像学特征与病理对比分析

目的 分析眼眶淋巴瘤(orbital lymphoma)的CT及MRI表现特征,探讨其影像学诊断的价值.方法 回顾分析9例淋巴瘤患者的CT及MRI所见,并与病理结果相对照,其中7例行CT扫描,4例行MRI扫描.结果 均为单侧发病,其中右眶7例,左眶2例;部位以隔前眶周、外上象限多见;其中2例为局限性肿块影,呈条索状或结节状,边界清楚,密度(信号)均匀,其余为弥漫性肿块,多沿肌锥外间隙及眼环向眶内呈"铸型"浸润生长,与周围组织关系紧密.增强扫描病灶呈中度及以上均匀强化.结论 眼眶淋巴瘤的CT、MRI表现具有一定的特征性,尤其是MRI检查能准确定位及一定程度的定性,有助于临床治疗.     

磁共振扩散加权成像与慢性乙型肝炎肝功能的相关性研究

目的 探讨磁共振扩散加权成像评价慢性乙型肝炎病人肝功能的应用价值.方法 对30例正常志愿者及30例慢性肝病病人行肝脏磁共振扩散加权成像,测量并比较正常组与病例组间肝实质表观扩散系数(apparent diffusion coefficient,ADC)值,分析ADC值与肝功能终末期肝病模型(model for end-stage liver disease,MELD)评分的相关性.结果 病例组ADC值较正常组降低(P<0.01),b=800 s/mm2时,ADC值与MELD评分有显著性负相关,r=-0.68,P<0.01.结论 肝实质ADC值与MELD评分显著性负相关,对慢性乙型肝炎肝功能的评估有较高的临床应用价值.     

常规MRI和1H-MRS在职业性锰暴露致中枢神经损害中的应用价值

Objective MRI and MR hydrogen proton spectroscopy (1H-MRS) were used to detect the abnormal signal and alteration of metabolites, in order to explore the efficacy of these method in evaluating the damages of central nervous system (CNS) induced by occupational manganese exposure.Methods Eighteen workers exposed to manganese without any manganism symptoms, 12 workers with slightly chronic manganese poisoning, and 19 healthy workers were scanned using routine MRI sequence and 1H-MRS.The blood manganese concentration was also collected for each subject.On cerebral axial T1 WI,the signal intensities of ipsilateral globus pallidus and frontal white matter were measured in the visually brightest area (try to select the signal homogeneous region), and the globus pallidus index (PI) was then calculated.The 1H-MRS data was calculated to get the values of the peak height of N-acetylaspartate (NAA), choline (Cho), inositol (mI) and creatine (Cr) and the ratios of NAA/Cr, Cho/Cr, and mL/Cr were also calculated.One way ANOVA was used to compare the values of PI, NAA/Cr, Cho/Cr, mI/Cr and MnB among the three groups, and the correlations between PI and the time span of manganese exposure or blood manganese concentration were analyzed by Pearson correlation analysis.Eight workers exposed to manganese were followed up one year, and their PI , NAA/Cr before and after follow-up were compared by t test.Results Fourteen of 18 cases exposed to manganese without any manganism symptoms showed symmetrically high intensity signal on T1 WI, while the T2 WI were normal.No high signal intensity was observed on T1WI in any of the healthy workers or manganese poisoning workers.We found that the average PI in manganese exposed group (1.16 ±0.09) was significantly higher (F =24.79 ,P =0.O00)than those of the poisoning ( 1.05 ± 0.07 ) and control groups ( 1.01 ± 0.05 ).The blood manganese concentration in manganese exposed group, the poisoning group and the control group were (0.051 ±0.024), (0.047 ±0.018 ), ( 0.043 ± 0.020 ) μg/ml respectively, which was not significantly different ( F = O.623, P =0.541 ) and did not exceed the upper limit of normal reference value ( < 0.10 μg/ml ).There was a significantly correlation between PI and the time span of manganese exposure ( r = 0.67, P = 0.002 ),however, there was no correlation between PI and blood manganese concentration ( r = 0.20, P = 0.427 ).Furthermore, the NAA/Cr ratio decreased variously in the manganese poisoning group ( 1.22 ± 0.07 ) which was significantly lower( F = 4.120, P = 0.023 ) than those of the poisoning( 1.33 ± 0.13 ) and control groups ( 1.31 ±0.13).No statistical significanees were found in the ratios of Cho/Cr and mI/Cr among these three groups(P>0.05).No obvious changes of the PI and NAA/Cr were found in the 8 manganese exposed workers after 1 year follow-up.Conclusion Manganese exposure could lead to the high intensity signal on T1 WI, therefore the increased PI may be the biomarkers of central nerve system damages caused by the occupational manganese exposure.     

组织四维动态增强磁共振成像灌注参数与肝癌微血管密度相关性研究

目的 探讨组织四维动态增强(tissue 4 dimensional-dynamic contrast enhanced,T4D-DCE)磁共振成像(MRI)灌注参数在评估原发性肝癌(primary liver cancer,PLC)微血管密度(microvessel density,MVD)中的价值.方法 51例PLC患者行T4D-DCE MRI成像,并用Tissue-4D软件分析病灶和正常肝组织的灌注参数:转运常数(Ktrans)、血管外细胞外间隙体积百分比(Ve)、速率常数(Kep),将病灶灌注参数和正常肝组织灌注参数的比值作为病灶相对灌注参数与病理结果进行对比.结果 各灌注参数与PLC病理等级均无相关性(P＞0.05).Ktrans病灶、Ktrans相对、Kep相对与MVD均存在正相关(r=0533、0.791、0.717,P＜0.001).结论 T4D-DCE能直观反映PLC的血流灌注信息,在诊断PLC及评估PLC微循环特征中具有重要参考价值.