3.0T MR在卵巢肿瘤诊断中的临床应用价值

目的分析3.0T MR鉴别诊断卵巢肿瘤患者的临床结果。方法对2012年5月至2015年5月我院收治的40例卵巢肿瘤患者的临床资料进行回顾性分析。结果40例患者中,37例患者的鉴别诊断符合手术病理结果,达到了92.5%的临床诊断符合率;15例患者为单纯性卵巢囊肿,8例患者为卵巢囊性畸胎瘤,6例患者为卵巢囊腺瘤,5例患者为卵巢子宫内膜异位囊肿,3例患者为卵巢囊腺癌,3例患者为卵巢冠囊肿,分别占总数的37.5%、20.0%、15.0%、12.5%、7.5%、7.5%。卵巢囊性畸胎瘤、黏液性囊腺瘤、浆液性囊腺瘤、卵巢冠囊肿的平均瘤体/囊肿直径分别为(12.5±3.3)cm、(10.5±3.5)cm、(10.2±3.3)cm、(14.3±3.4)cm。结论 MR能够有效鉴别诊断卵巢肿瘤。     

超声、MRI在筛查卵巢病变患者中的临床应用

目的 探讨超声、MRI在筛查卵巢病变患者中的临床应用价值。方法 回顾性分析我院2015年1月-2016年1月期间收治的经病理和手术证实的39例卵巢病变患者的临床、病理、超声、MRI检查资料。结果 术前14例行超声检查,25例行MRI扫描检查;超声诊断准确率为85.71%,MRI诊断准确率为88.00%;超声、MRI扫描检查准确率均较高,差异无统计学意义(P0.05)。超声造影显示卵巢浆液性乳头状囊腺癌患者卵巢可见呈椭圆形囊实混合型包块,内部无回声或有点状回声,有血流信号,盆腔内有积液;左右侧输卵管浆液性囊腺癌可见单右侧卵巢有实质性包块,内有强回声,血流信号较弱。MRI影像资料显示卵巢浆液性乳头状囊腺癌患者卵巢可见呈椭圆形囊实混合型包块,边界模糊,呈混杂信号,动态增强扫描可见囊壁厚薄不均及实性部分强化明显;左右侧输卵管浆液性囊腺癌患者单侧卵巢可见椭圆形或圆形实质性包块,T1WI呈低信号或低、等信号,D2WI呈不均匀高信号,动态增强扫描可见囊壁、囊内片状阴影及实性部分强化明显。结论 超声、MRI卵巢病变准确率较高,但仍有待提高;二者影像学表现有一定的特征性,均可较清晰显示病变特点,对卵巢病变的筛查及诊断具有重要的临床价值。     

MRI影像分析对膝关节病变的临床诊断价值探讨

目的研究探讨MRI影像分析对膝关节病变的临床诊断价值。方法从2013年1月至2015年1月在我科收治的膝关节病变患者中随机选取70例作为研究对象。对患者先行MRI检查(观察组),之后行X线片检查(对照组)。观察并对比两组的诊断符合率情况。结果观察组关节积液的检出率11.43%、软骨变薄15.71%、骨质缺损35.71%、半月板受损32.86%均分别显著高于对照组的1.43%、2.86%、10.00%、17.14%,差异均有统计学意义(P0.05)。观察组膝关节病变检出的敏感度84.29%、特异性91.43%均高于对照组的68.57%、75.71%,差异均有统计学意义(P0.05)。观察组对膝关节病变单病灶的检出率30.00%、多病灶检出率64.29%均高于对照组的14.29%、45.71%。观察组对膝关节病变漏诊率2.86%及误诊率0%均低于对照组的12.86%、18.57%。结论 MRI诊断膝关节病变敏感度、特异性较高,可对膝关节病变准确诊断,有利于提供正确治疗方案,改善预后,值得重视。     

Roll-in Experience from the Cardiovascular Outcomes with Renal Atherosclerotic Lesions (CORAL) Study

PurposeTo describe the experience and results from the roll-in phase of the Cardiovascular Outcomes with Renal Atherosclerotic Lesions (CORAL) study.Materials and MethodsThe CORAL roll-in database was used to describe the baseline characteristics of the patients in the roll-in cohort, all of whom underwent renal artery stent placement; to evaluate CORAL site performance; to compare estimates of lesion (stenosis) severity made by site interventionalists with the central CORAL angiographic core laboratory readings; and to report outcomes after renal artery stent placement. During the roll-in phase, 239 patients (mean age, 70.2 y ± 9.0; 49% male) underwent renal artery stent procedures. Angiographic core laboratory analysis of renal arteriograms was done, and participants were followed at 1 month and 9 months.ResultsMajor angiographic complications were identified in 28 (13%) subjects. Kidney function remained unchanged at the short (2–4 weeks) follow-up interval. Improvement in systolic blood pressure with use of distal embolic protection devices (n = 161) did not show any clinical benefit over nonuse of such devices (n = 78) in this small series. At 9 months, there were significantly more endpoints reported by site in subjects with bilateral renal artery stenosis (P = .01) and prior history of stroke (P = .03).ConclusionsIn the roll-in phase of the CORAL study, a significant number of angiographic complications were identified. No effect was seen on estimated glomerular filtration rate after renal artery stent placement, but systolic blood pressure decreased significantly.     

DWI联合M RCP 在鉴别诊断壶腹周围病变良恶性中的价值

目的：探讨扩散加权成像（diffusion weighted imaging ,DWI）联合MRCP序列在鉴别导致胆管狭窄的壶腹周围病变的良恶性的应用价值。方法回顾性分析自2012年11月～2013年11月在我院怀疑壶腹部胆管狭窄,行常规MRI、MRCP及DWI检查的69例患者。经手术或ERCP活检病理证实,良性病变43例,恶性病变26例。由两名放射科资深医师首先参照常规MRI ,在MRCP和DWI图像基础上分别进行诊断,然后结合两者对壶腹周围病变进行再次评估,分别统计其恶性的可能性。两位资深医师的结果分别通过ROC曲线进行分析。结果2位医师分别通过M RCP和DWI对壶腹周围病变良恶性诊断的敏感度、特异度和准确度进行计算,M RCP分别为55．6％,86．9％,71．3％;53．5％,87．5％,70．9％;DWI分别为87．5％,62．5％,74．9％;89．4％,61．3％;76．3％。MRCP联合DWI图像后对病变诊断的准确度均得到提升,分别提高到81．2％和82．7％。结论 M RCP联合DWI可以提高对引起壶腹部胆管狭窄疾病的良恶性诊断的准确度。     

Abnormal subcortical deep-gray matter susceptibility-weighted imaging filtered phase measurements in patients with multiple sclerosis: a case-control study

Objective

To investigate abnormal phase on susceptibility-weighted imaging (SWI)-filtered phase images indicative of iron content, in subcortical deep-gray matter (SDGM) of multiple sclerosis (MS) patients and healthy controls (HC), and to explore its relationship with MRI outcomes.

Methods

169 relapsing-remitting (RR) and 64 secondary-progressive (SP) MS patients, and 126 age- and sex-matched HC were imaged on a 3 T scanner. Mean phase of the abnormal phase tissue (MP-APT), normal phase tissue volume (NPTV) and normalized volume were determined for total SDGM, caudate, putamen, globus pallidus, thalamus, pulvinar nucleus of thalamus (PVN), hippocampus, amygdala, nucleus accumbens, red nucleus and substantia nigra. 63 HC were used for establishment of normal reference phase values, while additional 63 HC were used for blinded comparisons with MS patients.

Results

Increased MP-APT, decreased normalized volume and decreased NPTV were detected in total SDGM, caudate, putamen, globus pallidus, thalamus and PVN in MS patients compared to HC (p < .0004). MS patients also showed decreased volume in hippocampus (< .0001) and decreased NPTV in the hippocampus, amygdala and accumbens (< .0004). SPMS patients had increased MP-APT, decreased volume and decreased NPTV in total SDGM, caudate and amygdala compared to RRMS (p < .005), while individual measure differences were also detected in putamen, thalamus, hippocampus and accumbens (p < .006). RRMS patients showed a significant relationship between increased MP-APT and increased lesion burden and more advanced brain atrophy (p < .004).

Conclusions

Abnormal phase, indicative of higher iron content was significantly increased in MS patients compared to HC, and was related to more severe lesion burden and brain atrophy.     

液基细胞学检查在健康女性宫颈病变筛查中的意义

目的评价液基薄层细胞学检查（Thinprep cytologic test TCT）在健康妇女宫颈病变筛查中的诊断价值。方法用特制宫颈刷采集宫颈细胞标本,连同宫颈刷放入专用的细胞保存液中,采用TCT技术制片。按照Bechesda报告系统（Bechesda System for Reporting Cervical Cytologr TBS）进行诊断,并对低度鳞状上皮内病变（LSIL）以上病变行阴道镜活检,做病理对照。结果8487人共检出阳性病例189例,其中非典型鳞状细胞,意义不明确（ASC—US）174例占2．05％、低度鳞状上皮内病变（LSIL）13例占0．15％、高度鳞状上皮内病变（HSIL）2例0．02％。LSIL、HSIL与病理诊断符合率占84．6％、100％。结论液积薄层细胞学检查与病理活检有较高的符合率,提高了异常细胞特别是宫颈病变的检出率。     

Bone and brain metastases from ampullary adenocarcinoma

Ampullary carcinoma is the second most common cancer of the peri-ampullary area after pancreatic carcinoma and metastasizes mostly intra-abdominally and to the liver. Extra-abdominal metastases are less frequent. In this report we describe the case of a patient with resected adenocarcinoma of the ampulla of Vater who developed skeletal metastases in the lower extremity and brain metastases. We briefly discuss aspects of this comparatively rare gastrointestinal malignancy.     

Evaluation of true diffusion, perfusion factor, and apparent diffusion coefficient in non-necrotic liver metastases and uncomplicated liver hemangiomas using black-blood echo planar imaging

Purpose

To assess the added value of true diffusion (D), perfusion factor (f) and apparent diffusion coefficient at low b-values (ADC_low) for differentiation between liver metastases and hemangiomas based on respiratory-triggered high-resolution Black-Blood Single-Shot SpinEcho Echo Planar Imaging (BB SS SE-EPI).

Materials and methods

Twenty-five patients suspected for malignant colorectal liver lesions were included in this study. A total of 106 lesions were examined. Different b-value images were compared for lesion conspicuity, image quality and artifacts using rank order statistic (RIDIT) and Student's t-test. D, f, and ADC_low values were calculated. Pearson correlation coefficient is used for comparison of interobserver variability.

Results

Best lesion conspicuity (p < 0.05) was achieved with BB SS SE-EPI (b = 0 and 10 s/mm²); best image quality (p < 0.05) with b = 10 s/mm². Image artifacts were lowest (p < 0.05) with b = 0 s/mm². Over the whole sample, D in metastases (D_met) was significantly (p < 0.05) lower than D in hemangiomas (D_hem); f and ADC_low of metastases (f_met, respectively, ADC_low met) were significantly (p < 0.05) higher than f and ADC_low of hemangiomas (f_hem, respectively, ADC_low hem). All Pearson correlations were statistically significant at a 0.01 level.

Conclusions

This preliminary study shows the potential of BB SS SE-EPI as a useful technique to aid in differentiating between liver metastasis and hemangioma. The calculation of D, f and ADC_low provides useful additional information for differentiating metastases from hemangiomas.     

蝶窦、蝶鞍穿刺的诊断和治疗作用

目的 总结蝶窦、蝶鞍穿刺在蝶窦、鞍区和侵及此两部位的中颅窝底病变的诊断和治疗作用。方法 分别采用X线荧光屏下定位穿刺、直接穿刺和、鼻内镜引导下定位穿刺三种方式,对62例蝶窦、鞍区和中颅窝底病变进行穿刺活检,并对其中4例行敏感抗生素穿刺冲洗治疗。结果 62例全部明确了病变的性质,其中25例达到治疗目的。结论 鼻内镜引导下穿刺应是目前蝶窦、鞍区和侵及此两部位的中颅窝底病变穿刺定位首选方法。