1．5T 与3．0T MRI 弥散加权成像对腰椎间盘退变诊断价值的比较

目的：比较不同场强磁共振成像（ magnetic resonance imaging ,MRI）设备诊断腰椎间盘退变的价值。方法120例腰椎间盘退变患者的600个椎间盘,分别采用1？．5T和3．0T 超导磁共振仪扫描,测得椎间盘表观系数（ apparent diffusion coefficient ,ADC）值;依据Pfirrmann标准对腰椎间盘进行分级。结果1．5T MR椎间盘Pfirrmann分级：Ⅰ级31个,Ⅱ级94个,Ⅲ级86个,Ⅳ级78个,Ⅴ级11个;3．0T MR椎间盘Pfirrmann分级：Ⅰ级41个,Ⅱ级80个,Ⅲ级81个,Ⅳ级91个,Ⅴ级7个。不同级别椎间盘ADC值比较,1．5TMR的Ⅳ和Ⅴ级椎间盘ADC值均分别小于Ⅰ、Ⅱ和Ⅲ级,Ⅴ级椎间盘ADC 值明显低于Ⅳ级盘（ P ＜0．05）。3．0TMR组Ⅰ和Ⅱ级盘ADC值差异无统计学意义（ P ＞0．05）,其余椎间盘随分级增高,ADC值明显减低（ P ＜0．05）。同一级别椎间盘3．0TMR组ADC值明显低于1．5TMR组（ P ＜0．05）。同水平同级别椎间盘2组MR设备ADC值比较,L1／2的各级椎间盘,3．0TMR组ADC值明显小于1．5TMR（ P ＜0．05）;L2／3的Ⅱ和Ⅲ～Ⅴ级盘3．0 TMR组ADC值明显小于1．5TMR组（ P ＜0．05）;L3／4和L4／5的Ⅲ和Ⅳ～Ⅴ级盘3．0TMR组ADC值明显低于1．5TMR（ P ＜0．05）;L5／S1的Ⅰ～Ⅱ级、Ⅲ级和Ⅳ～Ⅴ级盘3．0TMR组ADC值明显低于1．5TMR组（ P ＜0．05）。结论 MR测得的ADC值可用于腰椎间盘退变评估,椎间盘Pfirrmann分级越高,其对应的ADC值越低;与1．5TMR设备比较,3．0TMR对诊断早期轻度腰椎间盘退变更加敏感。     

A Practice Improvement Education Program Using a Mentored Approach to Improve Nursing Facility Depression Care—Preliminary Data

Depression is common in nursing facility residents. Depression data obtained using the Minimum Data Set (MDS) 3.0 offer opportunities for improving diagnostic accuracy and care quality. How best to integrate MDS 3.0 and other data into quality improvement (QI) activity is untested. The objective was to increase nursing home (NH) capability in using QI processes and to improve depression assessment and management through focused mentorship and team building. This was a 6‐month intervention with five components: facilitated collection of MDS 3.0 nine‐item Patient Health Questionnaire (PHQ‐9) and medication data for diagnostic interpretation; education and modeling on QI approaches, team building, and nonpharmacological depression care; mentored team meetings; educational webinars; and technical assistance. PHQ‐9 and medication data were collected at baseline and 6 and 9 months. Progress was measured using team participation measures, attitude and care process self‐appraisal, mentor assessments, and resident depression outcomes. Five NHs established interprofessional teams that included nursing (44.1%), social work (20.6%), physicians (8.8%), and other disciplines (26.5%). Members participated in 61% of eight offered educational meetings (three onsite mentored team meetings and five webinars). Competency self‐ratings improved on four depression care measures (P = .05 to <.001). Mentors observed improvement in team process and enthusiasm during team meetings. For 336 residents with PHQ‐9 and medication data, depression scores did not change while medication use declined, from 37.2% of residents at baseline to 31.0% at 9 months (P < .001). This structured mentoring program improved care processes, achieved medication reductions, and was well received. Application to other NH‐prevalent syndromes is possible.     

核磁检查在乳腺癌诊断中的应用价值研究

目的 探讨3.0核磁检查在乳腺癌诊断中的应用价值.方法 回顾性分析2011年2月-2013年6月该院门诊收治的90例疑似乳腺癌患者使用3.0核磁共振检查的临床资料.结果 90例疑似乳腺癌患者中肿物在2 cm以下的患者占36例,乳腺癌患者占18例,3.0核磁共振在术前的诊断中乳腺癌患者占16例,诊断符合率为88.9％,假阴性患者占2例;肿物在2 cm以上的患者占54例,乳腺癌患者占30例,3.0核磁共振在术前诊断为乳腺癌的患者占30例（100.0％）,假阳性患者占2例.结论 核磁检查作为一种新型的诊断技术,在乳腺癌诊断中的应用价值较高.     

3.0T磁共振不同序列检出妇科肿瘤盆腔淋巴结转移的比较

目的探讨3.0T磁共振(MRI)不同序列条件下,如何选择检出妇科肿瘤盆腔淋巴结转移的磁共振方法。方法选择符合入组条件的患者32例,于术前行常规T1加权序列（T₁WI）、T2加权序列（T₂WI）、增强扫描（T₁WI+C）、弥散加权成像（DWI）等序列检查,记录每例的盆腔检出淋巴结的组别分布及总淋巴结个数,与盆腔淋巴结清扫术记录对比,计算不同序列扫描对妇科肿瘤患者盆腔淋巴结转移的检出率并结合DWI序列扫描图分析分别以淋巴结短径及其表观弥散系数（ADC）阈值为判断标准时的阳性检出率。结果使用DWI序列对盆腔淋巴结转移检出率最高,为86.4%（51/59）,与DWI序列比较,T₁WI-MRI平扫、T₂WI-MRI平扫、T₁WI+C的检出率分别为61.0%（χ²=8.575,P＜0.05）、69.5%（χ²=3.996,P＜0.05）、72.9%（χ²=2.563,P＞0.05）,DWI序列的淋巴结转移检出率和增强扫描相仿。短径判断方法的检出率为81.4%,ADC阈值判断方法的检出率为89.8%,基于两种判断方法的检出率间差异无显著性（χ²=1.100,P＞0.05）。结论DWI序列扫描可以获得和增强扫描相似的检出率,优于常规T₁WI、T₂WI平扫,故推荐常规磁共振扫描时加扫DWI序列,其阳性判断方法可任意选用短径法和ADC阈值法。     

影像数据传输及存储的低成本实现

目的：依靠现有资源组建小型局域网,实现大型医用设备影像数据的传输和低成本存储。方法：基于TCP/IP和DICOM协议,建立Efilm workstation与各大型医用设备间的通讯,组建mini-PACS。结果：传输快速通畅,无数据丢失,实现了以光盘为介质存储影像数据,大大降低了成本,便于数据的导入、导出、再现、教学演示。结论：该方法简单可行,对中小医院具有一定的推广价值。     

PACS中MR序列定位线的绘制

根据核磁共振原理成像的MR设备,其扫描序列中的图像成像参数复杂,如何使临床医生定位当前MR图像切片在组织器官中的确切位置是个很重要的问题。基于DICOM3．0标准,结合PACS系统的应用,讨论TMR序列中定位线绘制的解决方法。     

门静脉三维动态增强在3．0T高场磁共振成像技术的应用

目的探讨三维动态增强磁共振门静脉成像（3DDCE—MRP）的技术方法。方法120例受检者采用3．0T磁共振检查仪以3D小角度激发序列进行容积扫描得到血管图像,戍像技术包括增强前后图像数据减影,最大信号强度投影（MIP）,多平面重建（MPR）及容积重建（VR）。结果116例门静脉图像质量达到诊断要求,4例图像模糊。结论高质量的门静脉3DDCE-MRP图像依赖于注药后最佳的延时扫描时间,合适的注射速率,注射总量,扫描序列及其参数．     

3T磁共振血管成像对糖尿病下肢大血管病变的诊断价值

 目的 评价3T磁共振血管成像（3.0-Telsa magnetic resonance angiography,3T MRA）对糖尿病患者下肢动脉病变（peripheral artery disease,PAD）的诊断价值。方法 根据大血管彩超结果,对下肢血管狭窄>50%的46例2型糖尿病患者做3T MRA检查,并用数字减影血管造影（digital subtraction angiography,DSA）作为对照,评价其对髂总、股、小腿和足动脉等4段血管病变诊断的意义。结果 3T MRA能完整显示整个下肢PAD,对踝以上动脉血管病变显像清晰,且病变分布广泛、远端重于近端、呈多节段性狭阻。3T MRA显示的股动脉、小腿动脉的狭窄>50%病变节段数与DSA无明显差异（P=0.965,P=0.846）,但其诊断的足部动脉狭阻节段数明显多于DSA（P=0.006）。3T MRA诊断狭窄>50%的动脉病变的敏感度和特异度分别为:股动脉皆为100%,小腿动脉为95.62%和100%,足动脉为100%和72.22%。两种方法诊断不同节段动脉病变的κ值依次为：股动脉1.000（P<0.001）,小腿动脉0.949（P<0.001）,足部动脉0.635（P<0.05）。结论 3T MRA可清楚显示糖尿病患者踝以上的动脉病变,对股及小腿动脉病变的诊断价值与DSA类似,但对足部动脉可能有夸大效应。     

In vivo magnetic resonance spectroscopy of gynaecological tumours at 3.0 Tesla

Background  Magnetic resonance spectroscopy (MRS) uses the same hardware as MR imaging and allows us to analyse the biochemistry of tissues in vivo . Published data for gynaecological lesions are limited and are largely based on MRS carried out at the lower magnetic field strength of 1.5 Tesla (T).
Objective  The purpose of this study was to determine whether in vivo proton MRS could be performed at the higher magnetic field strength of 3 T to characterise the spectra of a variety of benign and malignant gynaecological lesions.
Design  Prospective, non-randomised study.
Setting  MRI department within a tertiary referral centre for gynaecological cancers.
Sample  All women with a pelvic mass under going 3T MRI.
Methods  We carried out MRS on nonrandomised women undergoing routine 3 T MRI within our MRI department during investigation for gynaecological lesions from February 2006 to April 2008. Only those women for whom histopathological data were available were included.
Main outcome measures  The presence of choline detected by in vivo 3T MRS.
Results  Eighty-seven women underwent MRS, 57 of whom had newly diagnosed neoplasms. MRS data for 39 of these new women (18 were excluded because of technical errors or missing data) were used to detect the presence of choline, an indicator of basement membrane turnover. Overall, choline was present in 13 of the 14 ovarian cancers, 8 of the 11 cervical tumours and all 4 of the uterine cancers. There was no statistical significant difference between choline levels in various lesion types ( P = 0.735) or between benign and malignant disease ( P = 0.550).
Conclusions  In vivo MRS can be performed at 3 T to provide biochemical information on pelvic lesions. The way in which this information can be utilised is less clear but may be incorporated into monitoring tissue response in cancer treatments.     

Influence of high magnetic field strengths and parallel acquisition strategies on image quality in cardiac 2D CINE magnetic resonance imaging: comparison of 1.5 T vs. 3.0 T

The aim of this paper is to examine signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and image quality of cardiac CINE imaging at 1.5 T and 3.0 T. Twenty volunteers underwent cardiac magnetic resonance imaging (MRI) examinations using a 1.5-T and a 3.0-T scanner. Three different sets of breath-held, electrocardiogram-gated (ECG) CINE imaging techniques were employed, including: (1) unaccelerated SSFP (steady state free precession), (2) accelerated SSFP imaging and (3) gradient-echo-based myocardial tagging. Two-dimensional CINE SSFP at 3.0 T revealed an SNR improvement of 103% and a CNR increase of 19% as compared to the results obtained at 1.5 T. The SNR reduction in accelerated 2D CINE SSFP imaging was larger at 1.5 T (37%) compared to 3.0 T (26%). The mean SNR and CNR increase at 3.0 T obtained for the tagging sequence was 88% and 187%, respectively. At 3.0 T, the duration of the saturation bands persisted throughout the entire cardiac cycle. For comparison, the saturation bands were significantly diminished at 1.5 T during end-diastole. For 2D CINE SSFP imaging, no significant difference in the left ventricular volumetry and in the overall image quality was obtained. For myocardial tagging, image quality was significantly improved at 3.0 T. The SNR reduction in accelerated SSFP imaging was overcompensated by the increase in the baseline SNR at 3.0 T and did not result in any image quality degradation. For cardiac tagging techniques, 3.0 T was highly beneficial, which holds the promise to improve its diagnostic value.