颅内胶质瘤和转移瘤的磁共振波谱和弥散成像研究

目的:探讨颅内胶质瘤和转移瘤肿瘤强化区域和肿瘤周围区域的1H-MRS和弥散成像特点及其对于鉴别诊断的意义。方法:34例颅内肿瘤患者(其中低级别胶质瘤Ⅰ～Ⅱ级10例,高级别胶质瘤Ⅲ～Ⅳ级13例,转移瘤11例)均行常规MRI,DWI,多体素MRS检查。DWI的观察指标是ADC值;MRS主要观察的代谢物有:氮-乙酰天门冬氨酸(NAA),胆碱复合物(Cho),肌酸(Cr/PCr),计算NAA/Cr,Cho/Cr,NAA/Cho比值。采用SPSS10.0软件进行统计学比较。结果:①DWI的检查结果:低级别胶质瘤肿瘤强化区域的ADC值较另外两者高,且有统计学意义;高级别胶质瘤肿瘤周围区域的ADC值最低,与另外两者有显著差异。其余之间没有统计学意义;②MRS的检查结果:高级别胶质瘤和转移瘤肿瘤强化区域各比值之间没有显著差异(P>0.05),且二者与低级别胶质瘤相比有显著差异性(P<0.05);高级别胶质瘤肿瘤周围组织出现NAA/Cr与NAA/Cho降低,Cho/Cr升高,且与转移瘤和低级别胶质瘤肿瘤周围组织相比均有显著差异性(P<0.05)。结论:结合肿瘤强化区域与肿瘤周围区域的磁共振波谱和DWI可以对胶质瘤和转移瘤起到鉴别诊断作用。     

3.0T 1H-MRS在颅内常见肿瘤中的应用研究

目的 探讨3.0 T氢质子磁共振波谱(1H-MRS)对颅内常见肿瘤诊断、鉴别诊断、评价治疗效果及在胶质瘤分级中的价值.资料与方法选取经手术病理或临床确诊的69例颅内肿瘤患者.采用GE Signa EXCITE HD3.0T超导型MR扫描仪对所有患者行颅脑常规MRI扫描和二维多体素序列扫描.采用Functool软件包后处理,分别测定病变实质、病变周围及健侧相应区域的胆碱(Cho)/肌酸(Cr)、Cho/N-乙酰天门冬氨酸(NAA)、NAA/Cr比值及肌醇(MI)值的变化,并对结果进行统计学分析.结果 (1)实质区:低级别胶质瘤的Cho/Cr值与高级别胶质瘤、转移瘤及脑膜瘤间差异有统计学意义(P＜0.01);低级别胶质瘤与高级别胶质瘤、脑膜瘤的Cho/NAA比值分别比较有统计学意义(P＜0.05),转移瘤与高级别胶质瘤、脑膜瘤的Cho/NAA比值分别比较有统计学意义(P＜0.05);低级别胶质瘤NAA/Cr比值与高级别胶质瘤、转移瘤分别比较有统计学意义(P＜0.05),转移瘤与脑膜瘤比较有统计学意义(P＜0.05);低级别胶质瘤的MI值与高级别胶质瘤、转移瘤及脑膜瘤分别比较有统计学意义(P＜0.05).(2)瘤周水肿区:高级别胶质瘤Cho/Cr比值与另外三者比较差异有统计学意义(P＜0.05),低级别胶质瘤Cho/Cr比值与转移瘤、脑膜瘤分别比较差异有统计学意义(P＜0.01);低级别胶质瘤Cho/NAA比值与转移瘤、脑膜瘤分别比较差异有统计学意义(P＜0.05),高级别胶质瘤与转移瘤、脑膜瘤分别比较有统计学意义;低级别胶质瘤与高级别胶质瘤NAA/Cr比值差异有统计学意义(P＜0.05);各肿瘤瘤周水肿区MI值比较无统计学意义(P＞0.05).结论 1H-MRS在鉴别诊断颅内肿瘤中有重要价值,可较准确显示肿瘤瘤周浸润情况,结合其他影像征象对胶质瘤分级诊断亦有重要价值.     

MR弥散、灌注、波谱成像在单发脑转移瘤与恶性胶质瘤鉴别诊断中的价值

目的探讨磁共振弥散加权成像(DWI)、灌注加权成像(PWI)和1H波谱(1H-MRS)检查在单发脑转移瘤与恶性胶质瘤鉴别诊断中的应用价值。方法对术前进行了磁共振DWI、PWI和MRS检查并经病理证实的18例单发脑转移瘤和16例恶性胶质瘤进行回顾性分析,测量各病灶瘤体区、瘤周区及对照区的ADC、rCBV及Cho/Cr、Cho/NAA、NAA/Cr值,并计算rADC及rrCBV。结果瘤灶区rADCT单发脑转移瘤与恶性胶质瘤之间没有统计学差异(P>0.05),瘤周区rADCP脑转移瘤高于恶性胶质瘤,分别为1.98±0.69及1.43±0.31(P<0.05);瘤灶区rrCBVT和瘤周区rrCBVP转移瘤均低于恶性胶质瘤,分别为1.07±0.62、2.68±1.22(P<0.05)和0.38±0.23、1.11±0.61(P<0.05);瘤灶区Cho/Cr、Cho/NAA、NAA/Cr值脑转移瘤与恶性胶质瘤之间差异均无统计学意义;瘤周区胶质瘤Cho峰高于脑转移瘤,Cho/Cr和Cho/NAA值均高于脑转移瘤,分别为2.25±0.75、1.91±0.40和1.31±0.15、0.96±0.32(P<0.05和P<0.0...     

MRS和DTI对放疗前后脑胶质瘤瘤周水肿的观察与分析

目的:应用MRS和DTI观察脑胶质瘤放疗前、后肿瘤周围水肿区变化。方法:31例病理诊断明确的脑胶质瘤术后患者,分别在放疗前、后行MRI平扫+增强+MRS+DTI检查。分析肿瘤瘤周水肿区代谢物比值的变化[胆碱(Cho)/肌酐(Cr)、Cho/N-乙酰天门冬氨酸(NAA)、NAA/Cr]及部分各向异性(fractional anisotropy,FA)值、ADC值变化。结果:放疗后瘤周水肿区Cho/Cr、Cho/NAA、NAA/Cr值较放疗前下降,其中Cho/Cr差异有统计学意义(P<0.05),Cho/NAA、NAA/Cr值差异无统计学意义(P>0.05);瘤周水肿区域放疗后FA值升高(P>0.05),ADC值下降(P<0.05)。结论:MRS及DTI能显示肿瘤水肿区放疗后的早期变化,较早反映放疗效果。     

氢质子磁共振波谱鉴别孤立脑转移瘤与高级别脑胶质瘤的临床应用价值

目的探讨孤立脑转移瘤与高级别脑胶质瘤的MRI、1H-MRS的临床应用价值。方法经手术病理证实的高级别脑胶质瘤(Ⅲ、Ⅳ级脑胶质瘤)25例及孤立脑转移瘤20例,术前均行常规MRI及1H-MRS检查。从病变部位、信号强度、水肿程度、强化形态及出血与否等方面评价孤立脑转移瘤和高级别脑胶质瘤的常规MRI表现;检测肿瘤组织、瘤周组织区和对侧正常脑组织对照区NAA、Cho和Cr的变化,计算出NAA/Cho、NAA/Cr和Cho/Cr的比值。结果(1)孤立脑转移瘤和高级别脑胶质瘤的常规MRI各种表现中仅病变部位和水肿程度在两者间存在差别,P值分别为0.009、0.046;(2)高级别脑胶质瘤和孤立脑转移瘤的肿瘤组织的NAA/Cr和NAA/Cho比值存在显著性差异(P<0.01),但Cho/Cr比值无显著性差异(P>0.05);(3)高级别脑胶质瘤和孤立脑转移瘤的瘤周组织的Cho/Cr比值存在显著性差异(P<0.05),但NAA/Cr和NAA/Cho比值无显著性差异(P>0.05)。结论常规MRI结合1H-MRS表现可望提高鉴别高级别脑胶质瘤和孤立脑转移瘤的可能性。     

颅脑肿瘤强化周围区域的多体素氢质子波谱研究

目的　探讨在体氢质子MR波谱 (1H MRS)在颅脑肿瘤强化周围区域即T2 W图像上呈高信号区域的代谢物改变特点及其鉴别诊断意义。方法　经病理学证实的颅脑肿瘤 5 1例 (男 2 3例 ,女 2 8例 ) ,年龄 16～ 78岁 ,包括胶质瘤 2 4例、脑转移瘤 15例和脑膜瘤 12例。使用 1 5TMR成像仪 ,MRS使用点分辨波谱分析法 (PRESS)序列 ,TR 10 0 0ms ,TE 14 4ms,多体素相位矩阵 ,完成扫描后用随机软件包FuncTool进行分析 ,检测肿瘤强化、强化周围和正常参照区域的代谢物浓度 ,比较不同肿瘤、不同区域N 乙酰天门冬氨酸 (NAA)、胆碱 (Cho)和肌酐 (Cr)等代谢物比值平均值变化情况。结果　肿瘤强化区NAA/Cho和Cho/Cho(正常 ,n)平均值与正常参照区比较均有显著性意义 (P <0 0 5 ) ,但胶质瘤与转移瘤及与脑膜瘤之间变化情况相近 ,差异均无显著性意义 (P >0 0 5 )。肿瘤强化周围区域胶质瘤、转移瘤和脑膜瘤的NAA/Cho值分别为 0 89± 0 31,1 31± 0 4 4和 1 32± 0 15 ;NAA/Cr值分别为 1 5 4± 0 4 5 ,1 78± 0 5 2和 1 87± 0 39;Cho/Cho(n)为 1 4 7± 0 5 8,1 0 1± 0 4 7和 0 96± 0 32 ;Cho/Cr(n)为 1 75± 0 75 ,1 13± 0 5 4和 1 2 1± 0 4 6。胶质瘤与转移瘤和脑膜瘤肿瘤强化周围区域的NAA/Cho、Cho/Cho(n)、     

增强后多体素1H-MRS在颅脑肿瘤诊断中的应用

目的 探讨增强后多体素氢质子磁共振波谱(1H-MRS)对颅内常见肿瘤的鉴别诊断价值. 资料与方法 49例颅内常见肿瘤患者行增强后多体素1H-MRS检查,其中胶质瘤16例,单发转移瘤19例,脑膜瘤14例.测量计算3种肿瘤强化区、强化边缘区及对侧正常脑组织的代谢物比值:胆碱/肌酸(Cho/Cr)、N-乙酰天门冬氨酸/胆碱(NAA/Cho)、胆碱/对侧正常脑组织肌酸(Cho/Cr-n)和胆碱/对侧正常脑组织胆碱(rCho),并进行比较分析. 结果 单发转移瘤与胶质瘤、单发转移瘤与脑膜瘤以及胶质瘤与脑膜瘤强化边缘区之间NAA/Cho比值分别为2.4434±1.636、0.4762±0.278、1.0416±0.240,Cho/Cr-n比值分别为0.5444±0.457、1.0919±0.328、1.1597±0.342,rCho 比值分别为0.5405±0.497、1.1761±0.423、1.3436±0.566,Cho/Cr比值分别为0.9105±0.414、1.6208±0.230、1.0489±0.260;转移瘤与脑膜瘤间除Cho/Cr外差异均有显著统计学意义(P＜0.01),胶质瘤与脑膜瘤之间除Cho/Cr(P＜0.01)外差异均无统计学意义(P＞0.05).强化区之间三者NAA/Cho比值分别为0.4550±0.240、0.2436±0.220、0.1415±0.112,Cho/Cr-n比值分别为0.9149±0.294、1.5182±0.935、1.8115±0.804,rCho 比值分别为0.9129±0.304、1.5426±0.808、1.7464±0.504,Cho/Cr比值分别为4.3527±2.509、3.1709±2.197、4.9518±3.716;转移瘤与胶质瘤、脑膜瘤比较除Cho/Cr外差异均有显著统计学意义(P＜0.01),而胶质瘤与脑膜瘤之间差异均无统计学意义(P＞0.05). 结论 增强后多体素1H-MRS对脑肿瘤的鉴别诊断有重要的临床应用价值.     

高级别星形细胞瘤与脑单发转移瘤的1H MRS鉴别

目的 :探讨活体1 HMRS对高级别星形细胞瘤和单发转移瘤的鉴别诊断价值。方法 :搜集行1 HMRS检查的高级别星形细胞瘤 2 5例 (包括间变型星形细胞瘤 11例 ,胶质母细胞瘤 14例 ) ,单发转移瘤 10例。比较两组肿瘤强化区及肿瘤周围区之间Cho/Cr、NAA/Cr及Lac/Cr值。结果 :2 5例高级别星形细胞瘤与 10例单发转移瘤强化区的Cho/Cr分别为 5 .770 0± 1.82 12及 4.45 0 0± 2 .42 5 0 ,NAA/Cr分别为 0 .9476± 0 .5 0 2 6及 1.185 0± 0 .5 63 7,Lac/Cr分别为 2 .4684± 1.710 5及 3 .2 110± 2 .70 77,两组之间差异均无显著性意义 (P >0 .0 5 )。而肿瘤瘤周区的Cho/Cr分别为 2 .3 3 0 0± 1.2 10 0及1.0 75 0± 0 .2 5 41,差异具有显著性意义 (P <0 .0 0 1) ;NAA/Cr及Lac/Cr之间差异无显著性意义。结论 :应用1 HMRS检测肿瘤周围区代谢水平的高低可作为鉴别高级别星形细胞瘤和单发转移瘤的补充手段     

脑胶质瘤周围区的^1H-MRS研究

目的应用多体素氢质子磁共振波谱(1H-MRS)探讨胶质瘤周围区脑代谢改变的特点,评价多体素1H-MRS在胶质瘤周围区的应用价值.方法23例病理证实的脑胶质瘤病人分为低级别组(WHO Ⅰ～Ⅱ级)13例和高级别组(WHOⅢ～Ⅳ级)10例.所有病例术前均行多体素1H-MRS检查,测量肿瘤实质区、周围区及对侧正常脑组织区代谢产物的相对定量,进行统计学比较.结果多体素1H-MRS显示高级别胶质瘤的周围区与实质区NAA/Cr、Cho/Cr、NAA/Cho值差异有统计学意义(P值均为0.00).高级别胶质瘤周围区与对侧正常脑组织区NAA/Cr、Cho/Cr、NAA/Cho、Glx/Cr值差异均有统计学意义(P值均为0.00);低级别胶质瘤周围区与实质区NAA/Cr、Cho/Cr、NAA/Cho值差异均有统计学意义(P值均为0.00);低级别胶质瘤周围区与对侧正常脑组织区Cho/Cr、NAA/Cho值差异均有统计学意义(P值分别为0.02、0.00);高级别与低级别胶质瘤实质区NAA/Cr、NAA/Cho、Cho/Cr、Glx/Cr值差异均有统计学意义(P值分别为0.00、0.00、0.03、0.00);高级别与低级别胶质瘤周嗣区NAA/Cr、NAA/Cho、Cho/Cr、Glx/Cr值差异均有统计学意义(P值均为0.00).结论脑胶质瘤周围区代谢物的改变反映了肿瘤向瘤周组织浸润,对确定胶质瘤的分级及预测侵袭性病变的浸润范围有帮助.     

2D CSI1H-MRS对不同类别脑肿瘤的鉴别诊断

目的 探讨二维化学位移氢质子磁共振波谱(2D CSI1H-MRS)对胶质瘤、转移瘤、脑膜瘤的鉴别诊断价值.资料与方法 回顾性分析经临床诊断或经手术病理证实的90例患者的MRI及MRS资料,包括胶质瘤45例,转移瘤23例,脑膜瘤22例.计算瘤体及瘤周水肿区的Cho、Cr、NAA的浓度及Cho/Cr、NAA/Cr、NAA/Cho的比值.结果 (1)胶质瘤、转移瘤、脑膜瘤瘤体区的NAA/Cho分别为0.41±0.19、0.56±0.15、0.15±0.07,三组差异均有统计学意义(P＜0.05);(2)胶质瘤、转移瘤、脑膜瘤瘤周水肿区的Cho浓度分别为0.40 ±0.16、0.26±0.09、0.13±0.07,3组差异均有显著统计学意义(P＜0.01),胶质瘤显著高于其他两者,当取Cho＞0.45时,MRS区分胶质瘤的特异性、敏感性、阳性预测值、阴性预测值分别为83%、94%、77.3%、85.7%.结论 2D CSI1H-MRS对胶质瘤、转移瘤、脑膜瘤的鉴别诊断有重要意义.     

Physiologic and pathologic calcifications and ossifications in the face and neck

The aim was to give a systematic presentation of physiologic and pathologic calcifications and ossifications in the face and neck with a special emphasis on clinical relevance. In a sometimes subacute setting one should recognize specific calcifications which often lead to important diagnoses such as fungal sinusitis or sclerosing labyrinthitis. In a more chronic situation intraocular calcifications in small children are pathognomonic for retinoblastoma. Juxtatumoral sclerosis of the laryngeal cartilage in laryngopharyngeal carcinoma is usually caused by tumor infiltration of the cartilage resulting in a higher tumor stage and, this way, has a major impact on the therapeutical strategy. Calcified lymph nodes are mainly unspecific but can be the result of tuberculosis or metastases of thyroid cancer. Cross-sectional imaging methods, most of all computed tomography, are ideally suited to reveal head and neck calcifications and ossifications, especially those which are clinically relevant.     

Staging and surgical management of pancreatic and biliary cancer and inflammation

Management of benign and malignant diseases of the pancreas, liver, and biliary tract has made remarkable progress in the last two decades. Advances in minimally invasive surgery, interventional radiology, and diagnostic and therapeutic endoscopy have changed the treatment of common diseases such as cholelithiasis and more serious diseases such as pancreatic adenocarcinoma. Advances in biliary tract and pancreatic surgery have paralleled the advances in ultrasonographic imaging, CT, and MR imaging. This article outlines the surgeon's perspective on radiologic imaging and preoperative staging of benign and malignant biliary and pancreatic disease.     

Head and neck infection and inflammation

This article discusses the imaging manifestations of infectious and inflammatory conditions of the head and neck. Special attention is paid to the sites, routes of spread, and complications of neck infections. Because the clinical signs and symptoms and the complications of these conditions are often determined by the precise anatomic site involved, anatomic considerations are stressed. Familiarity with the fascial layers, spaces of the neck, and the contents of each space is helpful for this discussion. The fascial layers of the neck are important barriers to infection, and once infection is established, the fascial layers play a part in directing its spread.     

细胞自噬与肿瘤发生发展

自噬是真核生物中一种高度保守的胞内降解途径.其主要通过溶酶体或液泡进行饥饿状态下的营养动员,清除受损蛋白质、细胞器和胞内病原体.自噬主要包括巨自噬、分子伴侣介导自噬(CMA)和微自噬.自噬已被证实与多种人类疾病相关,其在肿瘤发生发展中具有重要意义.近年研究中,对于自噬和肿瘤关系有了进一步的认识,该文就自噬分子机制、调控通路以及与肿瘤发生发展关系的研究进展作一综述.     

The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings

Thyroid imaging approach is based on the preliminary clinical evaluation. Lesions that are smaller than 2 cm should be assessed with US, which is capable of discriminating masses as small as 2 mm and distinguishing solid from cystic nodules. US-guided FNAB provides tissue for cytologic examination of thyroid nodules. CT and MR imaging are indicated for larger tumors (greater than 3 cm diameter) that extend outside the gland to adjoining structures, including the mediastinum, and retropharyngeal region. Metastatic lymph nodes in the neck and invasion of the aerodigestive tract are also in the realm of CT and MR imaging. Thyroid nodules are categorized on scintigraphy as hot or cold nodules. Hot nodules are rarely malignant, whereas cold nodules have an incidence of 10% to 20% of malignancy. Calcifications (amorphous, globular, nodular, and linear) occur in adenomas and carcinomas and have no differential diagnostic features except for psammomatous calcifications, which are a pathognomonic finding in papillary carcinomas and a small percentage of medullary carcinomas. Papillary carcinoma is the most common malignant tumor (80%) followed by follicular (20% to 25%); medullary (5%); undifferentiated; anaplastic carcinomas (< 5%); lymphoma (5%); and metastases. Lymph node metastases are common in papillary carcinoma, 50% at presentation, and less common in follicular carcinomas. The metastatic nodes in papillary carcinoma may enhance markedly (hypervascular); show increased signal intensity on T1-weighted images (increased thyroglobulin content or hemorrhage); and reveal punctate calcifications. Localized invasion of the larynx, trachea, and esophagus occurs predominantly in papillary and follicular carcinomas; the incidence is less than 5%. Ectopic thyroid tissue may be encountered in the tongue (foramen cecum); along the midline between posterior tongue and isthmus of thyroid gland; lateral neck; mediastinum; and oral cavity. Goiter and malignant tumors, notably papillary carcinoma, may develop in ectopic thyroid tissue. Carcinomas may also arise in thyroglossal duct cysts, which develop from duct remnants between the foramen cecum and thyroid isthmus. Infectious disease of the thyroid gland is not common and the CT and MR imaging findings are similar as described under neck infection. Other types of inflammatory disorders including Hashimoto's thyroiditis, granulomatous thyroiditis, and Riedel's struma display no specific imaging features. Imaging studies may, however, be indicated to confirm a suspected clinical diagnosis and assess compromise of the airway (Riedel's struma). HPT is a clinical diagnosis in which hypercalcemia is the most important finding. Parathyroid hyperplasia, adenoma, and carcinoma represent underlying lesions. To relieve the patient's symptoms surgical extirpation is indicated. The surgical success rate without imaging is 95%. The indications for imaging studies vary but it is generally agreed that reoperation after a previous failed surgical attempt and suspicion of an ectopic parathyroid adenoma should be investigated by imaging. These consist of US, nuclear medicine studies, CT and MR imaging. US and technetium sestamibi scanning have the highest accuracy rate for localizing an adenomatous gland at and near the thyroid gland. Ectopic adenomas, particularly if they are located in the mediastinum, are preferrably investigated with CT and MR imaging with gadolinium and fat suppression. Carcinomas and parathyroid cysts are optimally evaluated by CT and MR imaging. On MR imaging adenomas are low in signal intensity on T1-weighted images, high in signal intensity on T2-weighted images, and enhance post introduction of gadolinium.