多层螺旋CT首过期灌注成像和肿瘤微血管密度在评价周围型肺癌TNM分期的临床价值

目的探讨多层螺旋CT首过期灌注强化指标和肿瘤微血管密度(MVD)在肺癌TNM分期的临床价值。资料与方法对32例周围型肺癌患者行CT灌注扫描,依据首过期肿块强化的时间-密度曲线(TDC)计算肿瘤的灌注强化指标,按病理结果分为:≤3 cm肺癌组和>3 cm、≤7 cm肺癌组,累及胸膜组和未累及胸膜组;有淋巴结转移组和无淋巴结转移组;TNM分期按Ⅰ~Ⅱ期和Ⅲ~Ⅳ期分两组,并对肿瘤MVD计数。各组观察指标的差异采用t检验或t’检验;将CT灌注强化指标分别与MVD做相关性分析;利用受试者工作特征(ROC)曲线分析MVD和CT灌注强化指标评价肺癌TNM分期的诊断效能。结果 (1)肿块的强化峰值(PH)、肿块与主动脉PH之比(M/A)、灌注值(PV)和MVD在肿块直径≤3 cm与>3 cm、≤7 cm之间[分别为(33.73±20.56)HU、(31.26±13.22)HU;(0.28±0.10)、(0.24±0.14);(1.58±0.83)ml.min-1.ml-1、(1.45±0.81)ml.min-1.ml-1;(73.00±15.03)个/0.74 mm2、(66.42±12.93)个/0.74 mm2]差异均无...     

儿童急性白血病四肢骨关节的影像研究

目的 探讨急性白血病儿童患者四肢骨关节的X线和MRI特点.方法 搜集以骨关节疼痛为主诉,经临床及骨髓穿刺确诊为急性白血病的13例患儿,对其疼痛部位均行X线平片检查,8例同时行MR检查,其中4例经过化疗达完全缓解后1周内行原疼痛部位的X线和MRI复查.对2种不同影像表现进行分析.结果 13例中,6例X线表现正常,7例共14处可见骨质异常:十骺端透亮带5处,骨膜反应3处,混杂密度骨质破坏1处,浸润性骨质改变3处,骨质疏松2处.MR检查8例共11处,6例共9处MRI表现为骨髓浸润、坏死,X线表现正常;2例共2处MRI表现为骨髓浸润,X线可见骨膜反应及干骺端透亮带.4例化疔达完全缓解后1周内复查,MRI显示骨髓浸润、坏死病灶范围缩小并T1WI骨髓信号不均匀增高,坏死灶呈较均匀长T1、长T2信号,边界清晰,双边征消失,相同病例治疗前后X线复查未见明显改变.结论 以骨关节痛为主诉的急性白血病患儿,MRI较X线能更早期、全面地检测到骨关节的病变,MRI可作为临床疗效监测的指标之一.

Abstract：

Objective To evaluate X-ray and MRI features of limbs in childhood acute leukemia.Methods Thirteen children with acute leukemia in our pediatric hematology ward were recruited.Allpatients were pathologically diagnosed by bone marrow aspiration and complained of bone or joint pain in the first visit.ConventionaI X-ray and MRI examinations of algesic sites were performed before clinical treatment and after complete remission.MR images were obtained with SE-T1WI,SE-T2WI and T2WI-fat suppressed sequences and symmetria bilateralis was requested while scanning.X-ray and MRI manifestations were evaluated and compared.Resuits All 13 patients had received X-ray examinations.Among them,6 had normal X-ray findings,whereas the other 7(14 sites)showed various abnormalities including radiolucent metaphyseal bands(5 sites),periosteal reaction(3 sites),osteapenia(2 sites),mixed lesions(lysissclerosis,1 site),and permeative pattern(3 sites).The number of patients for MRI examinations was 8(11 sites).Among them,6(9 sites)showed bone marrow infiluration and bone marrow necrosis accompanied by normal X-ray findings,another 2(2 sites)showed bone marrow infiltration associated with radiographic abnormalities of periosteal reaction and radiolucent metaphyseal bands.Four cases were followed up within 1 week when reached complete remission by chemotherapy.MR images features included reduced sizes of bone marrow infiltration lesions associated with increased signal intensity on T1WI,and disappearance of double-line sign on bone marrow necrosis accompanied by signal homogenization.However,the radiograph before and after treatment in the same cases did not differ significantly.Conclusions MRI was earlier and more comprehensive in showing limbs bone marrow abnormality than radiogram in acute leukemia children with chief complaint of osteoarticular pains.MRI might be one of indicators in following up therapeutic effect for AL children with osteoarticular disorder.     

高分辨率MRI显示直肠周围筋膜结构

目的观察直肠周围筋膜高分辨率MRI成像表现。方法对50名正常志愿者行盆腔MRI常规T1WI、T2WI及高分辨率T2WI扫描,观察直肠周围筋膜结构,比较各序列对直肠周围筋膜的显示情况。结果高分辨率T2WI序列对前、后、左、右方直肠系膜筋膜显示率分别98%、100%、94%、90%;对Denonvilliers筋膜、骶前筋膜及腹膜返折显示率分别为58%、54%、70%。高分辨率T2WI对前、左、右方筋膜、Denonvilliers筋膜及腹膜返折的显示率明显高于盆腔常规T1WI、T2WI(P均0.05);对后方直肠系膜筋膜、骶前筋膜显示率略高于常规T1WI、T2WI,但差异无统计学意义(P均0.05)。结论高分辨率T2WI显示直肠周围筋膜结构优于盆腔常规MRI序列。     

法洛四联症的MRI诊断研究

目的评价MRI 对TOF的诊断价值.方法对20例临床疑诊为TOF患者进行MRI检查,分析其心内畸形和合并心外畸形的MRI表现.并与UCG表现进行比较.结果全部病例经手术证实,MRI能检出TOF心内畸形和合并心外畸形,统计学显示TOF心内畸形的MRI和USG检出率χ2值为1.03～2.01,P＞0.05,表明两种检查技术无显著差异;对合并心外畸形的显示,MRI明显优于UCG(χ2 = 52.27,P＜0.001). 结论 MRI有诸多的成像优势,能充分满足临床的诊断需求,是一种非常有用的检查技术.     

脑星形细胞肿瘤的MR灌注成像和病理分级对照研究

目的研究MR灌注成像(PWI)在脑星形细胞肿瘤术前分级中的应用价值.方法对28例脑星形细胞肿瘤病人行MR PWI,低级别星形细胞瘤9例,间变型星形细胞瘤12例,胶质母细胞瘤7例.依次行常规MRI及MR PWI,首先得到信号强度-时间曲线,并合成相对脑血流容积(rCBV)图,计算出最大rCBV比率.结果三组最大rCBV比率分别为(3.23±0.97), (5.23±0.33),(6.09±0.70),三组之间比较均有显著性差异.结论 MR PWI能有效地在术前评价星形细胞肿瘤的病理级别.     

腹部炎性肌纤维母细胞瘤的CT表现与病理对照分析

目的 对照分析腹部炎性肌纤维母细胞瘤(IMT)的CT表现与病理结果,旨在提高其影像诊断水平.方法 经手术病理证实的10例腹部IMT,术前均经CT检查,对照术后病理结果总结分析肿瘤的生长方式、形态、密度以及CT增强表现.结果 发生于肝脏2例,腹腔3例,脾脏、十二指肠降部上段、胃窦部、胆囊、膀胱各1例.CT表现为囊性肿块2例,囊实混合型3例,实性肿块5例.增强扫描实性部分呈均匀或不均匀轻中度或明显强化,囊性部分不强化,囊实混合型其内见不规则样、片状、花环状、分隔样强化,病灶与周围组织分界清晰.结论 腹部IMT的CT表现特点对诊断及鉴别诊断可提供有价值的信息,但确诊需依赖病理组织学和免疫组织化学检查.     

儿童胸膜肺母细胞瘤五例的CT表现

肺母细胞瘤(pulmonary blastoma,PB),又称肺胚瘤,是一种罕见的肺部原发性恶性肿瘤,好发于肺周围部.按发病年龄分为成人型和儿童型,2种类型在组织学、遗传学、临床表现及预后上明显不同,因此有学者提出胸膜肺母细胞瘤的新概念(pleuropulmonary blastoma,PPB)[1].目前国内外文献报道的肺母细胞瘤较少,而儿童更少.笔者回顾性分析手术病理证实的5例PPB患儿的CT影像,结合临床资料,总结其CT影像特点,旨在为临床诊断提供帮助.     

慢性乙型肝炎的磁共振弥散加权成像初步研究

慢性乙型肝炎是临床上常见的慢性肝病之一,常常导致肝功能严重损害.磁共振弥散加权成像(diffusion weighted imaging,DWI)应用于慢性乙型肝炎的研究国内外报道不多.该技术具有无创伤性、成像快及测量准确稳定的特点,我们采用该技术分析了慢性乙型肝炎患者肝实质ADC值的变化,旨在探讨磁共振弥散加权成像在慢性乙型肝炎的临床诊治和疗效判断中的应用价值.