【摘要】 目的 探讨磁共振动态增强扫描及磁共振弥散加权成像（diffusion weighted imaging，DWI）对肝癌经导管动脉内化学栓塞（transcatheter arterial chemoembolization，TACE）治疗后的肿瘤残余及复发的判断价值。 方法 2009年1月-2010年10月，对28例经证实的肝癌患者在TACE治疗前、治疗后3~7 d及治疗后1~2个月、3~6个月行磁共振动态增强及DWI扫描，动态测量表观弥散系数（apparent diffusion coefficient，ADC）值，与数字减影血管造影（digital substraction angiography，DSA）检查对照，评价动态增强扫描及DWI对肿瘤残留或复发的检出能力。〖HTH〗结果 对肿瘤残余及复发的显示，动态增强扫描灵敏度为90.0%，特异度为96.9%；DWI灵敏度为96.7%，特异度为93.8%；动态增强扫描与DWI相结合的灵感度为100.0%，特异度为99.5%；DSA灵敏度和特异度分别为96.7%、100.0%。TACE治疗前所有肿瘤实质的ADC值为（1.134±0.014）×10-3 mm2/s；TACE治疗后3~7 d ADC值为（1.162±0.016）×10-3 mm2/s；TACE治疗后1~2个月碘油沉积较好，无明显残余或复发病灶的ADC值为（1.175±0.015）×10-3 mm2/s，3~6个月后随访病灶ADC值为（1.179±0.017）×10-3 mm2/s；TACE治疗后1~2个月碘油沉积不完全或无明显沉积病灶ADC值为（1.147±0.016）×10-3 mm2/s，3~6个月后随访病灶实质平均ADC值（1.142±0.012）×10-3 mm2/s。 结论 将动脉增强扫描与DWI相结合可提高对TACE治疗后肝癌残余及复发判断的灵敏度及特异度；对肿瘤组织平均 ADC值的动态测量、观察可及早判断肿瘤复发的可能性。【Abstract】 Objective To evaluate the dynamic contrast-enhanced MRI and diffusion weighted imaging (DWI) in judging the remnant and recurrence on hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods Between January 2009 and October 2010, 28 patients with HCC underwent dynamic contrast-enhanced MRI and DWI before and after TACE 3-7 days, 1-2 months and 3-6 months, respectively, and the apparent diffusion coefficient (ADC) value of the tumor were also measured at above mentioned time points. The sensitivity and specificity of dynamic contrast-enhanced MRI and DWI in diagnosis of residual tumor and recurrent cancer was qualitatively evaluated by comparing with the DSA results. Results Compared with DSA, the sensitivity and specificity of dynamic contrast-enhanced MRI were 90.0% and 96.9% by revealing the remnant and recurrence of HCC, while the sensitivity and specificity of DWI were 96.7% and 93.8% respectively. Combining dynamic contrast-enhanced MRI and DWI the sensitivity and specificity were improved to 100.0% and 99.5%, respectively. The mean ADC value of tumor before and after 3-7 days of TACE were (1.134±0.014)×10-3 and (1.162±0.016)×10-3 mm2/s, respectively. The mean ADC value of tumor without and with remnant and recurrence after 1-2 months and 3-6 months follow up were (1.175±0.015)×10-3, and (1.179±0.017)×10-3 mm2/s; (1.147±0.016)×10-3 and (1.142±0.012)×10-3 mm2/s, respectively. Conclusions Combining dynamic contrast-enhanced MRI and DWI could improve the sensitivity and specificity to detect the remnant and recurrence of HCC after TACE. Measuring the ADC value during follow up of HCC patients after TACE could predict the probability of tumor recurrence.
【摘要】 目的 探讨MRI动态增强扫描在子宫内膜癌手术前诊断中的价值。 方法 回顾分析2008年2月-2010年3月38例经手术病理证实为子宫内膜癌患者的动态增强MRI检查资料，判断内膜癌子宫肌层和宫颈浸润情况，与病理结果对照，计算T2WI及动态增强序列诊断肌层及宫颈浸润的敏感度、特异度、准确度等，分析两种序列诊断准确度有无差异；计算内膜癌组织与子宫肌层在动态增强各期的对比信噪比，并分析其在各期间有无差异。 结果 动态增强序列诊断内膜癌肌层和宫颈受侵的敏感度、特异度、阳性预测值、阴性预测值分别为96.8%、85.7%、96.8%、85.7%和85.7%、91.7%、85.7%、91.7%；动态增强序列诊断内膜癌深肌层浸润的准确度为94.7%，显著高于T2WI诊断深肌层浸润的准确度78.9%（Plt;0.05）；平衡期内膜癌组织与子宫肌层的对比信噪比显著高于动脉期和静脉期（Plt;0.01）。 结论 MRI动态增强扫描能够在手术前准确的判断内膜癌肌层及宫颈浸润，有助于子宫内膜癌治疗方式的选择。【Abstract】 Objective To investigate the role of dynamic-enhanced MRI in the diagnosis of endometrial carcinoma. Methods Thirty-eight patients with endometrial carcinoma confirmed by surgicopathology undergone dynamic-enhanced MRI scans were analyzed retrospectively. The invasion in myometrium and uterine cervix were analyzed. The tumor and myometrium contrast-to-noise ratios during different phases of dynamic imaging were calculated. MR imaging findings were compared with pathologic findings. Sensitivity, specificity, diagnostic accuracy, positive and negative predictive values of MR imaging in depicting myometrial and cervical infiltration were calculated. Results Respective sensitivity, specificity, and positive and negative predictive values in assessing myometrial infiltration were 968%,85.7%,96.8%,85.7%;those for cervical infiltration were 85.7%,91.7%,85.7%,91.7%,respectively. The diagnostic accuracy (94.7%) of dynamic imaging in depicting deep myometrial infiltration were significantly higher than that of T2WI (78.9%) (Plt;0.05).There was a significant improvement in tumor and myometrium contrast-to-noise ratios during the equilibrium phase compared with the arterial and venous phases (Plt;0.01). Conclusion Dynamic-enhanced MRI is highly accurate in preoperative diagnosis of endometrial carcinoma, which will benefit for the treat of endometrial carcinoma.
目的:研究多层螺旋CT(MDCT)增强扫描对慢性肾盂肾炎的诊断价值。方法:病例组:2008年3月至2009年3月经我院诊治的慢性肾盂肾炎患者30例,均行MDCT增强扫描及静脉肾盂造影(IVP)检查,两者间隔时间不超过1周;对照组:同期无肾脏疾患,无尿路感染史,因其他原因来做腹部CT增强扫描的患者25例。由两名不同年资的腹部影像医师对拟定的征象进行观察、评价。结果:两医师对本组病例的诊断一致性极佳K=0.812,Plt;0.05)。病例组30例,双肾病变14例,单肾病变16例。单肾病变中,左肾12例,右肾4例。MDCT增强扫描显示肾盏轻度变形2例(6.7%),肾盏裸露18例(60.0%),实质凹陷征23例(76.7%),肾盂轻度扩张积水21例(70.0%),肾盂壁增厚、强化21例(70.0%),肾功能减退15例(50.0%)。5例(16.7%)仅表现为肾盂壁增厚、强化。MDCT增强扫描与IVP对肾实质凹陷征,肾盂壁增厚、强化及肾盏轻度变形的显示率有统计学差异(Plt;0.05)。结论:MDCT增强扫描能清晰地显示慢性肾盂肾炎的病理变化。与IVP比较,它能提供更多肾实质的信息,对判定慢性肾盂肾炎所造成的肾脏损害程度及疾病预后具有很高的价值,不过对肾盏轻度变形的显示有赖于延迟扫描。
ObjectiveTo compare the effectiveness of magnetic resonance spectroscopy (MRS) and Dynamic Contrast-enhancement (DCE-MRI) with 1.5 T MR scanner in diagnosing prostate cancer. MethodsFrom April 2011 to December 2012, based on the results of biopsy, we measured 216 regions of interest (ROIs) in images of MRS and DCE-MRI, comprised of 131 ROIs from cancer zone and 85 ROIs from non-cancer zone. The data were analyzed with statistical methods, including receiver operating characteristic (ROC) curve. ResultsThere were significant differences between the malignant group and the benign group (P<0.05) in Cit integral, Cho integral, CC/Cit ratio, the type of time-signal intensity curve, initial value, enhancement rate and ratio of enhancement. According to ROC curve, the area under curve (AUC) of CC/Cit and enhancement rate was 0.853 and 0.719, respectively. AUC of time to peak, time difference, enhancement rate and Cit integral was lower than 0.400. The optimal operating point (OOP) of CC/Cit was 0.775, with a specificity of 0.85 and a sensitivity of 0.79, and the AUC was 0.853. The OOP of the ratio of enhancement was 60.89, with a specificity of 0.66 and a sensitivity of 0.71, and the AUC was 0.719. ConclusionMRS is more sensitive and specific than DCE-MRI to diagnose prostate cancer when an 1.5 T MR scanner is used. On the other hand, MRS is susceptible to interference, but DCE-MRI can make up for these deficiencies.
Objective To explore the differential diagnosis significance of 3.0T MRI united-sequences examination in the diagnosis of benign and malignant breast lesions. Methods A total of 67 breast lesions of 59 patients were collected prospectively, which be treated at the Sichuan Provincial People’s Hospital during July 2015 to January 2017. All patients were underwent bilateral breast 3.0T magnetic resonance plain scan, diffusion weighted imaging, and dynamic enhanced scan successively before surgical operation. Analysis of morphological features of the benign and malignant breast lesions, the time-signal intensity curve (TIC), the apparent diffusion coefficient (ADC), and the combination diagnosis of them were performed. Results Of all 59 patients, 67 lesions were confirmed by histopathology, including 18 benign lesions and 49 malignant lesions. The morphological features (including margin, shape, border, and evenness), the types of TIC of dynamic enhancement, and ADC value between the benign lesions and malignant lesions were statistically significant (P<0.05). The sensitivity and specificity of Fischer scoring system was 89.8% (44/49) and 61.1% (11/18) respectively. The sensitivity and specificity of TIC types was 83.7% (41/49) and 77.8% (14/18) respectively. The diagnostic threshold of ADC value was 1.012×10–3 mm2/s, with the sensitivity and specificity for the diagnosis was 91.8% (45/49) and 83.3% (15/18) respectively. The sensitivity and specificity of the combination of Fischer scoring system and TIC type for diagnosis between benign and malignant breast lesions was 95.9% (47/49) and 72.2% (13/18) respectively. The sensitivity and specificity of the combination of Fischer scoring system, TIC type, and ADC value for benign and malignant breast lesions was 98.0% (48/49) and 83.3% (15/18) respectively. Conclusion The combination of Fischer scoring system, TIC type, and diffusion-weighted imaging for the differential diagnosis between benign lesions and malignant lesions was more effective than single imaging method.