MRI在直肠癌术前TNM分期中的应用价值

直肠癌术前准确的分期是切除术成功的关键。MRI是直肠癌术前分期诊断最重要的检查方法之一,通过MRI准确的术前分期,可以准确评估肿瘤浸润的深度和淋巴结转移,了解肿瘤与直肠系膜、直肠系膜筋膜的关系,在全直肠系膜切除术(TME)之前准确预测环状切缘(CRM),为临床诊断和治疗提供更多有价值的信息。就MRI应用于直肠癌术前TNM分期的研究进展进行综述。     

MRI纹理分析在直肠癌术前T分期中的应用价值

目的 评估MRI纹理分析在直肠癌术前T分期中的应用价值。方法 选取经手术及病理证实的61例直肠癌患者术前盆腔增强MRI图像资料,采用Omni-Kinetics软件,于轴位T₁WI、T₂WI及增强T₁WI上,在包含肿瘤实性成分最大的层面测量,软件自动生成直方图、形态学矩阵等4类纹理特征的纹理参数,比较pT₁-2期与pT3-4期直肠癌各参数的差异,并对有差异的参数绘制R0C曲线,评估其效能。结果 统计得到峰度、能量及熵值等37种纹理特征参数,其中在T₁WI序列上有峰度、熵等5个纹理特征在2组数据中差异有统计学意义(P<0.05),其中熵具有较高的鉴别效能,AUC值为0.765,最佳阈值为5.34,敏感度65.9%,特异度80%;在T₂WI序列上有最大强度、峰度等19个纹理特征参数差异有统计学意义(P<0.05),其中最大强度具有较高的鉴别效能,AUC值为0.788,最佳阈值为2.185,敏感度58.5%,特异度95%;在T₁W...     

水脂分离增强序列在3.0T磁共振直肠癌术前分期中的应用

目的:将水脂分离增强扫描序列应用于直肠癌磁共振术前分期检查,探讨其在直肠癌术前分期中的应用价值。方法:选择经肠镜活检证实为直肠癌患者46例,随机盲法均分为两组,一组序列采用常规序列及T1脂肪抑制增强扫描序列;另一组序列采用常规序列及水脂分离增强扫描序列,结果与病理分期对照,比较两组序列图像信噪比及T、N分期。结果:组一T分期总敏感度为74%,特异度为78%。N分期总敏感度为74%,特异度为74%;N0分期敏感度78.6%,特异度66.7%,准确率为78%;N1分期敏感度57%,特异度81%,准确率为71%;N2分期敏感度100%,特异度100%,准确率为100%。组二T分期总敏感度为83%、特异度为83%;N分期总敏感度91%,特异度为91%;N0分期敏感度94%,特异度83%,准确率为94%;N1分期敏感度75%,特异度95%,准确率为75%;N2分期敏感度100%,特异度94.5%,准确率为100%。结论:水脂分离序列可提高图像信噪比,脂相有助于提高N分期,此序列在直肠癌术前分期中具有一定的临床应用价值。     

MRI在子宫颈癌的诊断与分期中的应用价值

目的分析子宫颈癌的MR影像表现,并评价其诊断价值。方法74例经病理确诊的子宫颈癌患者于手术前均经盆腔轴位T1WI,T2WI,SPIR,矢状位T1WI,T2WI,增强扫描轴位及矢状位抑脂T1WI。根据肿瘤的位置、大小、信号特征、浸润范围、以及宫旁和盆壁的受累情况,将MRI所见进行影像学分期,并与国际妇产科联合会（FIGO）的分期结果相比较。结果子宫颈癌病变在末增强的T1WI上呈等信号,在T2WI上呈等信号或稍高信号,在T2WI上肿瘤与低信号的子宫颈基质和高信号的子宫颈内膜及子宫旁脂肪具有良好的对比,SPIR上肿瘤呈稍高信号,增强扫描肿瘤呈轻度强化或不明显强化,3D-动态MRI增强扫描肿瘤明显强化。MRI对子宫颈癌的定位诊断准确性为100％,分期准确性为91．88％。结论MRI具有很高的解剖分辨率,特别是采用3D-动态增强扫描,可为子宫颈癌的诊断与分期提供直接的解剖基础和客观依据。     

定量动态增强MRI在宫颈癌诊断、分型和分期中的价值

【摘要】目的：探讨定量动态增强磁共振成像（DCE-MRI）在宫颈癌诊断、分型、分期中的价值。方法：选取宫颈癌患者68例为宫颈癌组,同时选取因卵巢或膀胱类疾病行定量DCE-MRI检查的患者30例为健康宫颈组。比较健康宫颈组与宫颈癌组间相关定量DCE-MRI参数水平的差异;比较宫颈癌不同病理分型、不同分期患者间相关定量DCE-MRI参数水平的差异;分析宫颈癌患者分期与定量DCE-MRI参数水平间的相关性。结果：宫颈癌组织的Ktrans为（0.329±0.134）mm-1,Kep为（0.603±0.121）mm-1,Ve为（0.613±0.142）,显著高于健康宫颈组织的Ktrans（0.036±0.017）mm-1、Kep（0.195±0.109）mm-1、Ve（0.301±0.157）,差异均有统计学意义（P＜0.05）;Ktrans、Kep、Ve的组内相关系数分别为0.76、0.68、0.41,提示测量结果较为稳定。腺癌患者的Ktrans为（0.301±0.126）mm-1,Kep为（0.542±0.168）mm-1,显著高于鳞癌患者的Ktrans（0.506±0.139）mm-1、Kep（0.716±0.194）mm-1,差异均有统计学意义（P＜0.05）;鳞癌患者的VE为（0.571±0.142）,与腺癌患者的Ve（0.652±0.136）相比差异无统计学意义（P＞0.05）。宫颈癌Ⅰ期患者的Ktrans为（0.209±0.116）mm-1,Kep为（0.461±0.198）mm-1,Ve为（0.468±0.124）;宫颈癌Ⅱ期患者的Ktrans为（0.329±0.124）mm-1,Kep为（0.572±0.185）mm-1,Ve为（0.592±0.163）;宫颈癌Ⅲ期患者的Ktrans为（0.397±0.138）mm-1,Kep为（0.662±0.174）mm-1,Ve为（0.608±0.152）;不同分期患者的Ktrans、Kep水平差异有统计学意义（P＜0.05）,Ktrans、Kep水平随着患者的分期增加而逐渐增大;不同分期患者的Ve水平也随着患者的分期增加而增大,但差异无统计学意义（P＞0.05）。结论：定量DCE-MRI参数可辅助临床进行宫颈癌的诊断及分期评估,对临床制定更为合理的治疗干预方案具有重要意义。     

磁共振扩散加权成像及动态增强扫描在宫颈癌分期中的应用

【摘要】目的：探讨常规MRI联合扩散加权成像（DWI）和动态增强（DCE）MRI在宫颈癌诊断及分期中的价值。方法：35例经手术病理或活检证实的宫颈癌患者按临床治疗方式分为手术组（20例）和非手术组（15例）,以病理及临床分期为参照,评估常规MRI联合DWI、DCE-MRI（多模态MRI）对宫颈癌的分期诊断准确性。结果：手术组中常规MRI和多模态MRI对宫颈癌分期诊断符合率分别为 80%（16/20）和95%（19/20）。术后病理证实盆腔淋巴结转移4例,MRI检出3例。非手术组中多模态MRI分期与临床分期符合率为67%（10/15)。结论：常规MRI联合DWI和DCE-MRI可提高对宫颈癌分期的准确性,有助于宫颈癌治疗方案的制定。     

MRI在直肠癌术前T分期中的误判分析

目的:探讨MRI在直肠癌术前T分期中的常见误判原因。方法:选择32例经手术病理证实的直肠癌患者,术前均行MRI检查,MRI序列包括常规T1WI、T2WI及STIR。分析直肠癌患者MRI分期,并对照患者术后病理学分期,评估其一致性。结果:直肠癌的术前MRI分期与术后病理学分期的一致性较好(Kappa=0.64,P<0.001)。MRI术前分期误判率为25%,其中,4例pT2期(病理分期为T2期)过度分期为T3期;3例pT3期(病理分期为T3期)低分期为T2期,1例pT3期过度分期为T4期。结论:在直肠癌MRI术前T分期中,正确认识常见误判原因有利于临床治疗方案的制定。     

直肠癌T分期高分辨MRI技术应用及其病理对照研究

目的:探讨高分辨磁共振成像(HR-MRI)TSE T2WI在直肠癌术前T分期中的临床应用价值.方法:67例经病理证实的直肠癌患者行MRI检查.常规行横断面及矢状面TSE T2WI,斜横断面T2WI HR-MRI检查,并将MRI检查结果与手术病理结果进行对照分析.结果:MRI判断直肠癌T分期总的诊断符合率为85.1%,MRI判断≤T2期直肠癌的敏感度、特异度及诊断符合率分别为70%、97.9%和89.6%,T3期分别为90.5%、76%和85.1%,而T4期分别为100%、95.2%和95.5%.结论:HR-MRI能较准确地对直肠癌进行术前分期,有助于术前手术和治疗方案的制定.     

高分辨力DWI-RESOLVE序列在直肠癌术前T分期中的价值

【摘要】目的：探讨高分辨力DWI-RESOLVE序列在直肠癌术前T分期中的价值。方法：回顾性分析经术后病理证实的40例直肠腺癌患者的病例资料,按照病灶是否突破固有肌层分为未突破组(A组)和突破组(B组),A组包括T1期和T2期,共17例,B组包括T3期和T4期,共23例。全部患者均行RESOLVE序列扫描（b值=0、1000s/mm2）。两位医师独立分析图像并测量感兴趣区的ADC值;采用组内相关系数（ICC）分析两位医师测量结果的一致性。根据病理结果描绘受试者工作特性（ROC）曲线,计算曲线下面积、最佳诊断阈值、敏感度和特异度。 结果:A组的平均ADC值为（1.230±0.160）×10-3mm2/s（医师1）和（1.200±0.166）×10-3mm2/s（医师2）,高于B组的平均ADC值［（0.973±0.216）×10-3mm2/s（医师1）和（0.948±0.181）×10-3mm2/s （医师2）］,两组间的ADC值差异有统计学意义（医师1：t=4.129,P<0.001;医师2：t=4.503,P<0.001）。两位医师ADC值测量结果的ICC为0.947。医师1的曲线下面积为0.820（95% CI:0.666～0.923）,敏感度为60.87%,特异度为94.12%,诊断阈值为0.98×10-3mm2/s;医师2的曲线下面积为0.855（95% CI:0.708～0.946）,敏感度为78.26%,特异度为76.47%,诊断阈值为1.07×10-3mm2/s。结论：高分辨力DWI-RESOLVE序列对于术前判断直肠癌是否突破固有肌层（T2期和T3期的鉴别）具有较高的参考价值。     

MRI常规序列结合DWI在直肠癌术前分期中的价值

目的:探讨1.5T MR常规序列结合DWI在直肠癌诊断中的价值。方法:回顾性分析23例直肠癌患者,对其MRI表现、手术、病理资料进行对比研究,分析MRI常规序列结合DWI在直肠癌诊断,T、N分期,术前放化疗效果评估等方面的应用价值。结果:MRI常规序列结合DWI是直肠癌诊断,T、N分期,术前放化疗效果评估的有效方法。结论:MRI常规序列是直肠癌诊断,T、N分期的主要方法;DWI具有疗效评估、辅助诊断的重要作用,是常规序列的必要补充。     

MR evaluation of the parotid gland using STIR and Gadolinium-enhanced imaging

The purpose of this study was to determine the efficiency of the STIR sequence in teh pre-operative assessment of salivary gland lesions, and to evaluate whether administration of intravenous contrast medium provided any additonal information. Nineteen patients with presumed parotid lesions were imaged using T₁-weighted soin-echo and STIR sequences and nine patients also had Gadolinium-DTPA (Gd-DTPA) enhancement. The pathological nature of all lesions was confirmed by cytological or histological examination. T₁-weighted spin-echo images were most useful for visualising anatomical structures and identifying the course of the facial nerve. Internal strcuture of tumours was best displayed with gladolinium enhanced images. Margination and conspicuity of lesions was optimal with STIR, which also achieved a minimal resolution of lesions of 4 × 6 mm diameter. Gd-DTPA enhancement of small lesions was sometimes misleading as they became obscured by surrounding enhancing glandular tissue or overlying fat. It is concluded that the combination is adequate to display anatomy and pathology with accuracy in both extensive ans subtle salivary gland disease. Gd-DTPA did not add to the diagnostic information already obtained by T1 and STIR imaging despite clearer demonstration of tumour architecture. Correspondence to: R. Chaudhuri     

Preoperative local staging of rectal cancer with endorectal MR imaging: comparison with histopathologic findings

The purpose of this prospective study was to assess the accuracy of endorectal MR imaging in the preoperative local staging of rectal cancers. In 20 cases, we correlated endorectal MR imaging findings with postoperative histopathologic staging according to TNM classification. The accuracy of endorectal MR for determining the T stage of rectal cancer was 85%. The sensitivity and specificity for detecting lymph node metastases were 90.9% and 55.5%, respectively.     

Effect of using endorectal coil in preoperative staging of rectal carcinomas by pelvic MR imaging

PURPOSE: To assess the accuracy of magnetic resonance imaging with pelvic phased-array and endorectal coils prospectively, and evaluate if endorectal coil provides any additional information to high resolution pelvic MR imaging in rectal carcinoma staging. MATERIALS AND METHODS: Preoperative MRI of 25 patients with rectal carcinoma was performed with pelvic phased-array coil alone, and with both phased-array coil and endorectal coil placed. Staging was made by evaluating images obtained by using both coils prospectively, and correlated with histopathologic staging. The images were then assessed separately, and compared to each other retrospectively. RESULTS: Two and 3 of the 5 histopathologically proved T1 tumors were staged correctly on MRI with pelvic phased-array coil alone and after the endorectal coil placement, respectively. Histopathologically identified five T2 tumors were staged correctly as T2 in 4 of the cases, 1 was understaged and 10 of 14 patients who had T3 tumor were staged as T3, 4 of them were understaged as T2 on both techniques. Specificity, sensitivity and accuracy rates for staging of T3 tumors were found as 71%, 100% and 84%, respectively, for each technique. Sensitivity and positive predictive value of N staging were both 88% on both techniques. CONCLUSION: Pelvic MR imaging after the placement of endorectal coil in addition to the phase-array coil was not superior to the imaging with phased-array coil alone in T staging of rectal carcinomas and the latter achieved better visualization of the lymph nodes by means of larger field of view.     

棒球运动员肩关节损伤的MR影像特征

棒球运动中投手的投掷动作常可导致不同程度的肩关节损伤,棒球投掷运动造成的肩关节损伤主要有肩袖撕裂、肱二头肌腱病变、肩关节不稳、肩峰下撞击综合征和内部撞击综合征.结合肩关节稳定结构及其在棒球运动中的特点,对不同类型肩关节损伤的MR影像表现进行分析,综合评述肩关节损伤常见病变特征及MRI表现.     

Local staging of rectal cancer: the current role of MRI

With the advent of powerful gradient coil systems and high-resolution surface coils, magnetic resonance imaging (MRI) has recently extended its role in the staging of rectal cancer. MRI is superior to endorectal ultrasound, the most widely used staging modality in patients with rectal tumors, in that it visualizes not only the intestinal wall but also the surrounding pelvic anatomy. The crucial advantage of MRI is not that it enables exact T-staging but precise evaluation of the topographic relationship of a tumor to the mesorectal fascia. This fascia is the most important anatomic landmark for the feasibility of total mesorectal excision, which has evolved into the standard operative procedure for the resection of cancer located in the middle or lower third of the rectum. MRI is currently the only imaging modality that is highly accurate in predicting whether or not it is likely that a tumor-free margin can be achieved and thus provides important information for planning of an effective therapeutic strategy, especially in patients with advanced rectal cancer.     

COPD 病人的MR 肺功能成像进展

慢性阻塞性肺疾病(COPD)是以气道受阻及肺实质破坏导致的气流不可逆性受限为特征的疾病.掌握COPD 病人局部肺组织的通气和灌注异常及其与肺结构的关系,是理解其病理生理改变的关键.目前,CT 薄层容积扫描是首选的无创性评估方法,但其仅能反映形态学的变化.随着MR 功能成像的发展,其在肺实质成像中应用已取得重要进展.就MRI 肺灌注及通气成像在COPD 病人的应用进展作一综述.     

磁共振快速成像技术在肺癌分期中的应用

目的:探讨MRI快速成像序列在肺癌分期中的成像质量及其临床应用价值。方法:36例肺癌患者,分别行MRI快速序列成像及CT增强扫描。分析快速序列的伪影,与CT对比分析肿瘤与胸部邻近结构的关系、淋巴结肿大情况。结果:HASTE各项伪影评分均为0,FLASH伪影也低于常规序列。FLASH和true FISP无呼吸伪影,但搏动伪影高于常规序列。与CT对比,在显示胸部邻近结构侵犯方面,HASTE效果可靠,FLASHt、rueFISP因不同程度受伪影影响而效果次之。HASTE和FLASH均可显示纵隔肿大淋巴结。结论:HASTE无伪影,可作为肺癌MRI分期的首选快速成像序列,FLASH则主要用于冠状位成像,trueFISP可以选择应用。     

Magnetic resonance imaging staging of nasopharyngeal carcinoma in the head and neck

Magnetic resonance imaging (MRI) is the modality of choice for staging nasopharyngeal carcinoma in the head and neck. This article will review the patterns of primary and nodal spread on MRI with reference to the latest 7th edition of the International Union Against Cancer/American Joint Committee on Cancer staging system.