肝癌患者多层螺旋CT多期扫描的影像特征及临床应用价值

目的:探讨多层螺旋CT对肝癌多期扫描的影像特征及其临床应用价值.方法:临床纳入原发性肝癌患者90例,随机分为研究组与对照组,每组45例.研究组采用多层螺旋CT进行动脉期、全肝静脉期、病灶平衡期扫描,对照组采用119]多层螺旋CT平扫.观察两种扫描方式在病灶显示率及病灶阳性诊断率等方面的差异.结果:研究组CT动脉期、静脉期、平衡期病灶显示率分别为95.56％、91.11％、95.56％,对照组CT平扫显示率为75.56％,研究组各期显示率均要明显高于对照组,差异均有显著性(P＜0.05);研究组诊断肝癌42例,诊断阳性率为93.33％,对照组诊断肝癌26例,诊断阳性率为57.78％,差异有显著性(P＜0.05);对不同类型肝癌诊断率方面,研究组对巨块型、结节型、弥漫型的诊断准确率分别为100.00％、93.10％、87.50％,对照组对巨块型、结节型、弥漫型的诊断准确率分别为100.00％、50.00％、20.00％,其中结节型、弥漫型诊断准确率两组差异有显著性(P＜0.05).结论:多层螺旋CT对肝癌进行多期扫描,能够为早期临床诊断肝癌提供更多的影像诊断信息,有助提高肝癌的早期诊断率.特别对于结节型、弥漫型等类型的肝癌早期诊断,能够提供更为可靠的诊断依据.     

CT/MR与PET/MR融合显像在神经胶质瘤靶区勾画中的应用进展

神经胶质瘤是最常见的中枢神经系统肿瘤之一,主要来源于神经系统间质细胞,呈弥漫性、浸润性生长,具有高发病率、术后高复发性、高病死率及低治愈率的特点。目前胶质瘤的治疗以手术治疗为主,辅以放射治疗、化学治疗等进行综合治疗。肿瘤靶区的准确勾画对于术后进行精准放疗具有很重大的意义,CT/MR融合显像较多被应用到神经胶质瘤的肿瘤靶区勾画。近年来,新型分子功能显像技术PET/MR在肿瘤中的应用越来越广泛,本文拟就CT/MR与PET/MR融合显像在神经胶质瘤靶区勾画上的应用进展及差异进行综述。     

Temporal lobe ganglioglioma in refractory epilepsy: CT and MR in three cases

MR was abnormal in both patients in which it was performed (including the patient with a normal CT examination). Lesions were hyperintense on T₂W inmages and iso-to-hypointense on T₁W images when compared to normal parenchyma. Regions of calcification were missed on standard spin-echo sequences.Continuous video EEG monitoring captured habitual partial seizures in all patients; focal onset correlated with tumor location in each instance. Intraoperative electrocorticography corroborated the EEG results. Two of three patients underwent gross total resection. Pathologic features were characteristic of ganglioglioma in all instances. All patients have been seizure-free postoperatively [mean follow-up: 16 months (range 13–18 months)] and without evidence of tumor recurrence.Although ganglioglioma is an unusual cause of refractory temporal lobe epilepsy, our short term follow-up suggests excellent outcome with both partial and gross total resection.     

CT/MR与PET/MR融合显像在神经胶质瘤靶区勾画中的应用进展北大核心CSCD

神经胶质瘤是最常见的中枢神经系统肿瘤之一,主要来源于神经系统间质细胞,呈弥漫性、浸润性生长,具有高发病率、术后高复发性、高病死率及低治愈率的特点。目前胶质瘤的治疗以手术治疗为主,辅以放射治疗、化学治疗等进行综合治疗。肿瘤靶区的准确勾画对于术后进行精准放疗具有很重大的意义,CT/MR融合显像较多被应用到神经胶质瘤的肿瘤靶区勾画。近年来,新型分子功能显像技术PET/MR在肿瘤中的应用越来越广泛,本文拟就CT/MR与PET/MR融合显像在神经胶质瘤靶区勾画上的应用进展及差异进行综述。     

A Correlative Study of CT, MR and Pathology in Rabbit Liver after Embolization by a China-Formulated Lipiodol Emulsion

OBJECTIVE To explore the MR characteristics following lipiodol retention in rabbit liver and to evaluate the sensitivity of CT (CT value ＞400 HU) and MR in displaying the hepatic degeneration and necrosis following embolization.METHODS Thirty-two rabbits were randomly divided into 3 groups. In the control group (n=8), 2 ml of normal saline was injected into the right branch of the portal vein. In the first experimental group(n=12), 4 ml of lipiodol emulsion was injected into the main portal vein. In the second experimental group (n= 12), 2 ml of lipiodol emulsion was injected into the right branch of the portal vein. CT and MR images were obtained before and after surgery in each group. The histopathologic condition was determined for all liver tissue specimens.RESULTS In the control group, CT and MR did not show any significant changes in the livers after surgery. After the operations in the experimental groups, the regional CT attenuation was 601 ±101 HU in the largest slice,which had no abnormal signals on T1WI and T2WI. In the first group, histologic examinations showed there were concentrated lipiodol droplets around the portal areas. In the second group, serious degeneration and necrosis in the right hepatic lobe occurred in 9 rabbits. T1Wl displayed homogenous or non-homogenous low signals and T2Wl mainly displayed a high signal.However, these pathologic changes did not appear on CT scanning due to high attenuation of the lipiodol.CONCLUSION There were no remarkable hepatic changes on MR in rabbits following good retention of the formulated lipiodol emulsion mixture of lipiodol and urografin(CT value ＞ 400 HU). MR displayed serious degeneration and necrosis of the liver following embolization.     

Pulmonary hydatid disease mimicking sequestration: Differentiation on magnetic resonance imaging

A case of hydatid disease of the lung proven by thoracotomy and histopathological evaluation is described. It was clinically and radiologically suggestive of a complicated pulmonary sequestration or non-resolving consolidation.     

CT强化与MR显像检测骨转移瘤的对比分析

目的:探讨CT强化与MR显像检测骨转移瘤的效果。方法:选择2009年5月至2013年1月在我院就诊的恶性肿瘤患者 110例,都进行骨骼部位的CT强化与MR显像检查,以病理结果为金标准判断诊断效果。结果:MR检查的骨转移瘤病灶数目明显高于CT强化检查(P<0.05)。脊柱与下肢带骨病变区的ADC值都明显高于邻近正常骨质,差异具有统计学意义(P<0.05)。CT诊断骨转移瘤的敏感度为71.7%,特异度为66.7%;而MR诊断骨转移瘤的敏感度为86.9%,特异度为66.7%。结论:相对于CT强化,MR显像可以早期诊断骨转移瘤,而结合ADC值定量测量,有利于病变的诊断。     

星形细胞肿瘤CT灌注成像参数与MVD的相关性

目的评价星形细胞肿瘤CTP参数与MVD之间的相关性。方法选择我院神经外科53例脑肿瘤患者,经手术和病理学证实为星形细胞肿瘤者纳入研究对象。CTP采用GE LightSpeed 64层螺旋CT机进行灌注扫描,在AW4.2P后处理工作站对原始数据进行后处理,测定肿瘤最大灌注区和对侧正常脑组织的CBF、CBV、MTT及PS值。手术获取脑肿瘤标本,进行组织病理学分级和MVD测定。结果高、低级别星形细胞肿瘤的CBF、CBV、PS和MVD值均显著高于相对应正常侧脑组织(P<0.01),而MTT值的差异无统计学意义(P>0.05)。AA-GBM组的CBF、CBV、PS及MVD值均显著高于LGA组(P<0.01),而MTT值差异无统计学意义(P>0.05)。星形细胞肿瘤CTP参数CBF、CBV、PS与MVD均有显著线性正相关(r＝0.819,0.862,0.776,P<0.01),以CBV值最强,而MTT与MVD无相关性(r＝-0.320, P>0.05)。结论CTP参数CBF、CBV及PS值对星形细胞肿瘤血管生成的评价具有很高的准确性。     

螺旋CT后处理技术在肺癌新分期中的临床价值

Objective:To evaluate the role of spiral CT imaging postprocessing techniques in preoperative TNM staging of lung cancer.Methods:106 patients with pathologically confirmed lung cancer received spiral CT examinations with a new revised TNM staging method of lung cancer which was taken as criterion of diagnosis.The images were reconstructed by using different postprecessing techniques such as MPR,MIP,SSD,VR,and their TNM staging capabilities were assessed by using postprocessing imaging and the results with axial CT images were compared.Results:In T staging,the accurate rates of axial CT images in T1-T4 staging were 77.3%,60.6%,60.7%,and 60.3% respectively; for postprocessing images,the accurate rates were 86.4%,90.9%,89.3%,and 87.0% respectively.In N staging,the accurate rates of axial CT images were 84.6%,68.1%,63.6%,and 64.2% in NO-N3 staging,respectively; but they were 92.3%,90.9%,90.9%,and 85.7% in postprocessing images,respectively.The postprocessing images were superior to axial CT images in T1-T3 and N1-N3 staging of lung cancer but there were no significant differences in T1 and NO staging.For metastasis,the postprocessing images may be helpful for the TNM staging of lung cancer.Conclusion:The postprocessing techniques of the spiral CT could improve the accurate rates of TNM staging of lung cancer,and represent a useful complement to the axial CT.     

Magnetic resonance imaging signal characteristics in hydatid cysts

The MRI features of hydatid cysts were retrospectively studied in 12 patients to look for specific signal characteristics. Twelve patients in the series included eight with abdominal, two with abdominal‐pelvic, one with a sacral and one with a lung hydatid cyst. The T1‐, T2‐ and proton density (PD)‐weighted images of spin‐echo sequence were used for imaging. The signal characteristics of the hydatid parent cyst capsule and fluid, daughter cyst fluid, detached germinal membrane and surrounding soft tissue reaction were noted. Observations revealed that the capsule is best seen on T2‐ and PD‐weighted images. The daughter cysts are best demonstrated on T1‐weighted images, whereas the difference in the signal intensities of parent cyst and daughter cyst fluid is better demonstrated on T2‐weighted and T1‐weighted images, and the detached germinal membrane is best seen on T2‐ and PD‐weighted images. The signal characteristics of hydatid cyst morphology can help distinguish it from other entities.     

Current status of body MR imaging: fast MR imaging and diffusion-weighted imaging

The recent technical advances in fast MR imaging have greatly enhanced the clinical value of MR imaging of the body. Advances in T₁-weighted images have enabled the acquisition of dynamic contrast-enhanced MR imaging, which is currently central to hepatic MR imaging for detection and characterization of liver tumors and is also useful for the evaluation of myometrial invasion in uterine cor-pus cancer. Advances in rapid T₂-weighted MR imaging with single-shot fast spin-echo images have enabled MR cholangiopancreatography and MR urography. Application of respiratory triggering can also provide T₂-weighted images of high quality. Cine MR imaging utilizing ultrafast MR sequences enables the assessment of the respiratory motion of the lung for evaluating thoracic wall invasion by tumors. Diffusion-weighted images can provide excellent tissue contrast based on molecular diffusion and have the potential to demonstrate malignant tumors. Quantitative measurement of apparent diffusion coefficient values may also be valuable in distinguishing malignancies from benign lesions.     

HASTE MRCP and MRI findings in alveolar echinococcosis of the liver

Alveolar echinococcosis is a rare mass‐producing inflammatory process of the liver. Experience with MRI, and particularly magnetic resonance cholangiopancreatography (MRCP), demonstrates that features of this disease are limited. The HASTE (half‐Fourier acquisition single‐shot turbo spin echo) MRCP and MRI findings of alveolar echinococcosis of the liver are presented in this report. HASTE MRCP was used to define the biliary system and the biliary system–mass relationship. It was found that results were comparable with those of invasive techniques such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography.     

Vertebral hydatid disease

Hydatid disease affecting the bones is a rare condition, its incidence ranging from 0.5-2% of all cases of hydatidosis. The bones most often involved are the vertebrae (44%). A 22-year-old man presented to the hospital with low back pain. A CT scan revealed intracanal and paravertebral cystic lesions at the level of L5-S1 with destruction of the corpus and lamina, and sacral foramen invasion. An operation was performed and histopathological findings confirmed the diagnosis. In countries where hydatidosis is endemic, the possibility of the disease must be borne in mind.     

64排螺旋CT灌注成像技术在直肠癌术前评估中的应用价值

目的探讨CT灌注成像的各项参数对直肠癌的术前评估价值。方法选经根治性手术治疗且病理证实的30例直肠癌患者为研究对象,所有患者于术前行CT灌注成像扫描,准确记录血容量(blood volume,BV)、强化峰值(peak enhancement image,PEI)、强化峰值达到时间即达峰时间(time to peak,TTP)、血流量(perfusion,PF),并在术后确定pTNM分期,并对TNM分期中各CT灌注参数值进行统计学比较。结果直肠癌组织中的PF、BV明显高于正常组织,差异有统计学意义(均P<0.01),而PEI、TTP的差异无统计学意义(均P>0.05)。在T分期的各组中,PF、TTP、BV的差别有统计学意义(均P<0.01),而PEI的差异无统计学意义(P>0.05);在淋巴结是否转移的分组中,无淋巴结转移组的PF、BV要高于有淋巴结转移组,差异有统计学意义(均P<0.05),TTP及PEI则无统计学差异(均P>0.05)。在是否远处转移各分组中,同时肝转移组的PEI、PF要低于无远处转移组,差异有统计学意义(均P<0.05),TTP、BV则无统计学差异(均P>0.05);肿瘤的分化程度分组中,分化程度越高,其PF、TTP渐次升高,差异有统计学意义(均P<0.05);靶淋巴结灌注的表现为转移淋巴结的PF要多于反应性增生的淋巴结(P=0.000 1),而TTP、BV、PEI无统计学意义(均P>0.05)。结论直肠癌患者CT灌注成像中的各项参数对直肠癌进行术前分期有一定的应用价值,可以使术前分期更加准确,进而采取更合理的治疗策略。     

Pelvic hemangiopericytoma: the role of diffusion weighted imaging in targeting the biopsy site and in monitoring the tumour response to radiotherapy

BACKGROUND: Despite advances in imaging, the accurate characterization of soft tissue tumours remains a challenging task. Furthermore, the interpretation of post treatment changes and evaluation of tumour response to therapy is another complicating issue regarding soft tissue tumour imaging. CASE REPORT.: Herein, a patient with a pelvic hemangiopericytoma, by whom different diagnostic imaging methods were used, is presented. CONCLUSIONS: Diffusion weighted imaging (DWI) might provid useful information in guiding biopsy and enabled monitoring of the radiation therapy results.     

椎管内肠源性囊肿的MR表现

目的：探讨椎管内肠源性囊肿的MRI表现及其鉴别诊断。方法：回顾性分析12例经手术和病理证实的椎管内肠源性囊肿的临床和MRI资料。所有病例均行MRI平扫,8例行MRI增强扫描。结果：12例均位于椎管内髓外硬膜下脊髓腹侧,4例病变位于颈段,5例位于颈胸段交界处,3例位于上段胸椎。T1WI图像上,10例囊肿呈低信号,其中4例与脑脊液信号相似,为均质低信号,6例略高于脑脊液信号;2例呈与脊髓等信号。T2WI图像上,囊肿均呈高信号,其中5例与脑脊液信号相似,呈均质高信号,7例呈明显高于脑脊液信号。8例行MR增强扫描,囊壁及囊液均未见强化。结论：肠源性囊肿在MR图像上具有一定的形态及信号特点,对于术前正确诊断具有一定意义。     

Neurohydatidosis

Early and non‐invasive evaluation of hydatid infestation of brain and spine is of paramount importance, especially in endemic areas. We present a spectrum of imaging findings in neurohydatidosis with a brief review of literature.     

正常肝脏CT灌注成像与肝脏储备功能对照研究

目的通过对正常肝脏CT灌注成像与肝脏储备功能对照研究,确定准确的正常肝脏CT灌注值。方法选择无任何肝脏疾病的志愿者20例,采用Philips16排螺旋CT机,选择肝门层面为中心,包括肝门静脉、腹主动脉和脾脏在内进行CT灌注扫描,通过设备附带软件分别计算肝脏的灌注值;利用吲哚氰绿实验进行肝脏储备功能检测。结果20例平均肝脏CT灌注值肝动脉灌注量（HAP）=0.18±0.08 ml/min.ml,门静脉灌注量（HPP）=0.98±0.33 ml/min.ml,总肝灌注量（TLP）=1.1±0.12 ml/min.ml,肝动脉灌注指数（HAI）=19.2%,门静脉灌注指数（PVI）=80.8%;平均15 min吲哚氰绿潴留率（ICGR15）=1.8%。结论肝脏CT灌注成像能反映肝脏的血流动力学变化,可作为影像学评估肝脏储备功能的重要指标。     

Updates in hepatic oncology imaging

The utilization of advanced imaging modalities play an important role in the detection and differentiation of benign and malignant hepatic lesions. Imaging characteristics of hepatic tumors can sometimes be atypical, often leading to diagnostic challenges. Recent technical improvements in contrast enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI) have helped to better characterize hepatic lesions. For example, contrast agents used in US can now better delineate liver lesions, while the ability to reliably produce multiplanar and 3-D reconstructions through the use of MDCT provides an additional advantage in the context of therapeutic decision making for patients with hepatic lesions. In addition, modern MR that includes the use of biliary excreted contrast material, various post-processing techniques like multiplanar reformation (MPR), as well as volume rendering (VR) allow detailed evaluation of the biliary tract, hepatic vasculature, and better characterization of hepatic tumors. As the imaging technologies available continue to evolve and advance, understanding how to effectively utilize these modalities is key to clinical practice. We herein provide a review of the various hepatic oncologic imaging modalities with a focus on how advancements and novel techniques within the different fields may be utilized in the diagnosis, treatment and management of different benign and malignant hepatic lesions.