MR扩散加权成像诊断非特殊型浸润性导管癌的价值

目的 探讨MR DWI诊断非特殊型浸润性导管癌的价值,寻找较合适的诊断界值.方法 回顾性分析经手术病理证实的69例乳腺非特殊型浸润性导管癌(69个病灶)和67例良性肿块患者(69个病灶)资料,所有患者均行MR平扫和DWI检查,分别测量乳腺癌病灶和其对侧正常乳腺、良性病灶和其对侧正常乳腺组织的ADC值,并采用独立样本t检验进行比较,通过绘制各组ADC值的ROC曲线,寻找各组病变间ADC值的最佳诊断界值.结果 非特殊型浸润性乳腺癌肿瘤的ADC值为(0.925 ±0.268)×10-3 mm2/s,对侧正常乳腺组织ADC值为(1.680±0.446)×10-3mm2/s,差异有统计学意义(t=12.08,P＜0.01);良性肿块的ADC值为(1.350±0.383)×10-3 mm2/s,对侧正常乳腺组织ADC值为(1.690±0.356)×10-3 mm2/s,差异有统计学意义(t=6.64,P＜0.01);良、恶性病变的ADC值差异也有统计学意义(t=7.56,P＜0.01).将非特殊型浸润性乳腺癌肿瘤和其对侧正常乳腺组织、良性肿块和其对侧正常乳腺组织、恶性和良性肿瘤所得ADC值绘制ROC曲线,曲线下面积分别为0.915、0.794和0.847.ADC值鉴别恶性肿瘤与其对侧正常组织、良性肿瘤与其对侧正常组织、恶性肿瘤与良性肿瘤之间的最佳ADC值界值分别为1.185×10-3、1.505×10-3、1.015×10-3mm2/s,诊断的敏感度和特异度分别为89.9％和85.5％、79.7％和63.5％、75.4％和87.0％.结论 MR DWI对诊断非特殊型浸润性导管癌具有较好的价值,鉴别其与良性病变的ADC界值为1.015×10-3mm2/s.     

不同扩散梯度因子值的乳腺MR扩散加权成像对比研究

目的 确定一个最佳的用于乳腺MR DWI的b值.方法 按照前瞻性设计,选取怀疑乳腺癌的乳腺可触性包块患者40例,术前行双侧乳腺MR和DWI扫描,b值分别取1000、800和600 s/mm2,肉眼判断DWI图像等级,采用单因素方差分析比较3组b值的DWI像信噪比和病灶ADC值,采用ROC曲线评价ADC值诊断价值.结果40例患者中乳腺癌26例,良性肿块14例,DWI显示36例,共42个病灶.3组b值下的DWI图像质量均较好,加例中视觉分级达A级的分别占75.0%(30例)、77.5%(31例)和77.5%(31例).3组b值DWI图像对病灶的检出能力相同.b=1000、800和600 s/mm2的信噪比平均值分别为63±22、82±27和96±29,3组间比较差异具有统计学意义(P<0.01).良性病变平均ADC值分别为(1.44±0.28)× 10-3、(1.50±0.32)×10-3和(1.52±0.29)×10-3mm2/s,3组间比较差异无统计学意义(P=0.725).恶性病变平均ADC值分别为(1.00±0.25)×10-3、(0.98±0.19)×10-3和(1.07±0.22)×10-3mm2/s,3组间比较差异也无统计学意义(P=0.358).3组b值的ADC值诊断乳腺良恶性病变的ROC曲线下面积分别为0.879、0.885和0.865;诊断良恶性病变的阈值分别为1.295×10-3、1.435×10-3和1.335×10-3mm2/s;诊断乳腺癌的敏感性分别为80.0%、92.0%和84.0%,特异性均为90.0%;阳性预测值分别为95.2%,95.8%和95.5%.结论综合图像信噪比和ADC值诊断价值,认为在乳腺DWI中,b=800 s/mm2是乳腺DWI成像的最佳b值.     

静脉注射钆类对比剂对乳腺正常腺体及肿瘤组织MR扩散加权成像的影响

目的 探讨乳腺MR DWI质量及正常腺体与癌组织的ADC值是否受到钆类对比剂增强扫描的影响.方法 对25例已经针吸穿刺或粗针活检病理证实为乳腺癌的患者在静脉注射Gd-DTPA前、后行DWI扣描,将R01分别置于癌灶及正常腺体,应用配对t检验及非参数检验比较b值=0及1000 s/mm2时增强前后图像中癌灶和正常腺体的信噪比(SNR)、对比噪声比(CNR)及ADC值的变化.结果 增强前、后癌灶的SNR(34.56±11.34和33.60±14.34)与正常腺体的SNR(9.88±3.16和10.42±4.18)以及图像CNR(24.16±9.05和22.26±10.05)的差异无统计学意义(P癌灶SNR=0.70,P正常腺体SNR=0.11;PCNR=0.17);增强前后癌灶的ADC值分别为(0.96±0.13)×10-3和(0.95±0.14)×10-3mm2/s,正常腺体分别为(1.90±0.47)×10-3 和(1.91±0.61)×10-3mm2/s,两者在增强后ADC值与其增强前差异均无统计学意义(P=0.20和0.97).结论 乳腺痛组织和正常腺体DWI的质量及ADC测量值不会受到Gd-DTPA的影响,故在乳腺MR扫描中,DWI可以在增强扫描后进行.     

非恶性乳腺病变:动态增强MRI假阳性的良性和高风险亚型病变的ADC值

目的评价常规乳腺MRI中表现为假阳性的非恶性乳腺病变的扩散加权成像(DWI)特点。材料与方法本回顾性研究符合HIPAA要求,获得单位伦理委员会批准,无需知情同意书。回顾分析乳腺动态增强MRI及乳腺影像报告和数据系统为4或5类,但最终活检证明为非恶性的病变。共收集165例女性的175个非恶性乳腺病变。计算每个病变DWI(b=0、600s/mm2)的ADC值,比较不同亚型的病变与ADC值1.81×10-3mm2/s的阈值(先前研究证明敏感度达100%)。结果 81例(46%)病灶的ADC值大于预设的阈值。平均ADC值大于阈值的最常见病变是纤维腺瘤[(1.94±0.38)×10-3mm2/s,n=30],局灶性纤维化[(1.84±0.48)×10-3mm2/s,n=19],正常组织[(1.81±0.47)×10-3mm2/s,n=13],乳腺大汗腺化生[(2.01±0.38)×10-3mm2/s,n=13],普通导管增生[(1.83±0.49)×10-3mm2/s,n=12]和炎症[(1.95±0.46)×10-3mm2/s,n=10]。不典型导管增生[(1.48±0.36)×10-3mm2/s,n=23]是ADC值低于阈值的最常见乳腺病变亚型。所有非恶性病变的淋巴结均表现为最低的ADC值[(1.28±0.23)×10-3mm2/s,n=4]。高风险病变(不典型导管增生和小叶内瘤)的ADC值明显低于其他良性病变(P<0.0001),是ADC值低于阈值的最常见病变。结论联合应用ADC值和动态增强MR成像评价病变的特性,能减少乳腺MR检查中的假阳性,避免不必要的活检数量。DWI具有鉴别高风险与其他非恶性病变的能力,从而能够进一步提高病人的治疗效果。原文载于Radiology,2012,265(3):696-706.     

乳腺良恶性病变的3.0T磁共振扩散加权成像鉴别诊断及b值优化

目的:探讨3.0T扩散加权成像(DWI)在乳腺良恶性病变鉴别诊断中的诊断价值并对b值使用进行优化。方法:34例患者共20个良性和16个恶性乳腺病灶纳入研究,同期20例正常乳腺受检者列为对照组。采用3.0T MR行乳腺DWI成像检查,b值分别取0,750 s/mm2,1000 s/mm2,1250 s/mm2。比较不同b值DWI图像质量,测量病灶的对比噪声比(CNR)以及表观扩散系数(ADC)值,以病理诊断为金标准,计算诊断乳腺癌的敏感度、特异度及准确性,绘制受试者工作特征曲线(ROC)并进行比较。结果:不同b值时DWI图像主观质量评分没有统计学差异(F=3.02,P=0.0516>0.05)。b=750 s/mm2时病灶的CNR明显优于b=1000s/mm2及1250s/mm2时(P值为0.004及0.000),而b=1000s/mm2与1250s/mm2之间没有统计学差异(P=0.800>0.05)。相同b值时,正常乳腺组织的平均ADC值>乳腺良性病变>乳腺恶性病变(P均=0.000)。以各b值恶性病变平均ADC值95%可信区间的上限作为界定乳腺癌ADC的阈值,则b=750 s/mm2、1000 s/mm2、1250s/mm2时,ADC阈值分别为1.33×10-3mm2/s、1.25×10-3mm2/s、1.16×10-3mm2/s。以上述阈值判断乳腺癌的敏感度、特异度及准确性分别为81.25%、87.5%、85.71%,81.25%、77.5%、78.57%及81.25%、82.5%、82.14%。三个b值的ROC曲线下面积无显著性差异(P=0.1925>0.05)。结论:乳腺的3.0T DWI中,以b=750s/mm2时病灶CNR最高,值得推荐应用。应用DWI鉴别乳腺良恶性病变时,需要结合ADC值判断。     

扩散加权成像鉴别肺恶性肿瘤与实性良性病变的初步研究

目的探讨扩散加权成像(diffusion-weighted imaging,DWI)对肺恶性肿瘤与实性良性病变的鉴别诊断价值。资料与方法62例肺内恶性肿瘤和实性良性病变(共66个病灶)行常规MRI和DWI检查,b值为500s/mm2,观察病变区DWI信号特点并测量其表观扩散系数(apparent diffusion coefficient,ADC)值。结果不同病变组DWI信号虽有一定特点,但不具特征性。恶性病变组和良性病变组ADC值分别为(1.256±0.320)×10-3mm2/s、(1.648±0.416)×10-3mm2/s,两者差异有统计学意义(t=-3.637,P=0.001),ADC值鉴别肺内良恶性病变的最佳诊断阈值为1.400×10-3mm2/s,敏感性和特异性分别为83.3%和74.1%;小细胞肺癌ADC值为(1.064±0.196)×10-3mm2/s,非小细胞肺癌ADC值为(1.321±0.335)×10-3mm2/s,两者差异亦有统计学意义(t=2.967,P=0.007);原发性肺癌ADC值为(1.255±0.328)×10-3mm2/s,肺转移瘤ADC值为(1.263±0.280)×...     

乳腺疾病的MRI扩散加权成像量化分析

目的 探讨MR扩散加权成像(DWI)对乳腺疾病的诊断价值.方法 58例共计 62个乳腺病灶(均经病理证实)及10例20个正常乳腺进行常规MR扫描及DWI检查.DWI采用单次激发平面回波(EPI)技术,b值为1000 s/mm2.以病理结果为金标准,动态增强减影图像为参照,比较正常乳腺组织、乳腺良性及恶性病变平均表观扩散系数(ADC)值的差异,分析平均ADC值与乳腺良恶性病变的相关性,同时评价DWI在预测乳腺恶性病变中的效能.结果 正常乳腺、良性病变、恶性病变的平均ADC值分别为(1.882±0.119)、(1.307±0.196)、(0.941±0.164)×10-3 mm2/s,差异有统计学意义(F=213.5, P<0.01).浸润性导管癌的平均ADC值低于导管原位癌(U=60.0,P<0.05),而乳腺腺病与纤维腺瘤的平均ADC值无显著差异(U=42.0,P=0.38).同时平均ADC值与乳腺良恶性病变呈负性相关(r=-0.715,P<0.01).利用平均ADC值对乳腺病变是否为乳腺癌进行诊断试验,ROC曲线下面积(Az)值为0.924,最佳临界点为1.065 × 10-3 mm2/s,此时诊断的敏感性为78.95%(30/38),特异性为87.50%(21/24),准确性为82.26%(51/62).结论 DWI量化分析ADC值有助于乳腺疾病的诊断及鉴别诊断.     

MR-DWI对非哺乳期乳腺炎与非肿块强化乳腺恶性肿瘤的鉴别诊断

目的：探讨 MR-DWI 及其表观弥散系数（ADC）值对乳腺炎性病变与非肿块样强化乳腺恶性肿瘤鉴别诊断价值。方法：回顾性分析2013年1月-2014年2月经手术或穿刺活检病理确诊的乳腺炎性病变患者共32例与同时期非肿块样强化的乳腺恶性病变45例的乳腺 MR-DWI 表现及 ADC 值。32例炎性病变中12例为超声引导下穿刺活检病理证实,20例行手术病理证实,恶性病变均行手术治疗,获得组织病理结果证实。分析所有患者的术前 MRI 表现,包括 DWI图像中病变形态、信号表现,并测定 ADC 值,以探讨 MR-DWI 对乳腺炎性病变与非肿块强化恶性病变的鉴别诊断价值。结果：32例乳腺炎性病变 DWI 上全部检出,其中23例含脓肿或微脓肿病例,DWI 均可见不均匀高信号,部分可见显著高信号灶,边界清晰。与乳腺恶性肿瘤相比乳腺炎病例较多表现为 DWI 及 STIR 均呈高信号（P ＜0．01）;乳腺恶性肿瘤病例较乳腺炎病例多表现为 DWI 高信号、STIR 稍低信号（P ＜0．01）。32例乳腺炎病例的周围炎性渗出或增生肉芽组织ADC 值为（1．48±0．21）×10-3 mm2/s,其中23例含脓腔或微脓腔的乳腺炎性病变,其显著高信号脓腔的 ADC 值为（0．91±0．19）×10-3 mm2/s。45例乳腺恶性肿瘤实性成分的 ADC 值为（1．15±0．23）×10-3 mm2/s。结论：MR-DWI 联合 STIR 及 ADC 值对于非哺乳期乳腺炎性病变与非肿块样强化的乳腺恶性病变的鉴别诊断具有较大价值。     

MR扩散加权成像对前列腺癌的诊断价值

目的 探讨磁共振扩散加权成像(DWI)在前列腺癌的诊断及鉴别诊断中的应用价值.资料与方法 40例前列腺疾病中17例前列腺癌及23例前列腺增生.所有病例行MR DWI扫描,b值为800 s/mm2.分析各病例的DWI和表观扩散系数(ADC)图表现,并分别测量癌区、前列腺增生组织以及膀胱内尿液的ADC值,统计分析组间是否存在差异.结果 17例前列腺癌中15例在DWI上呈明显高信号,ADC图呈低信号,能直观显示肿瘤的范围.前列腺癌组织的平均ADC值为(1.03±0.32)×10-3 mm2/s,前列腺增生组织的平均ADC值为(1.62±0.16)×10-3 mm2/s,两者之间有统计学意义(P=0.002);前列腺癌与前列腺增生的膀胱内尿液的平均ADC值分别为(3.24±0.30)×10-3 mm2/s、(3.25±0.29)×10-3 mm2/s,两者之间无统计学意义(P=0.834).结论 DWI可显示前列腺癌的位置和侵犯范围;根据DWI信号特点以及ADC值可以提高前列腺癌的诊断准确率,对前列腺癌与前列腺增生具有较高的鉴别诊断价值.     

MR背景抑制扩散加权成像在乳腺癌的应用

目的 探讨MR扩散加权成像(DWI)结合短时间反转恢复回波成像(STIR-EPI)背景抑制(BS)技术在乳腺癌成像的技术参数及其可行性.方法 回顾性分析26例乳腺癌的MR DWIBS测得各组织的表观扩散系数(ADC),利用三维最大强度投影(3D-MIP)重组及黑白反转技术,观察病变显示效果.观察乳腺痛DWI及DWIBS两种方法的显示率.对乳腺各组织的ADC值进行随机区组设计的方差分析,在乳腺癌与良性病变ADC值的比较中,采用t检验.对两种成像方法乳腺癌的显示率进行配对资料X2检验.结果 在扩散敏感因子(b)=800 mm2/s的图像中,乳腺癌多表现为高信号,其ADC值分别为:肿瘤实质(0.93±0.25)×10-3 mm2/s、瘤内坏死灶(2.06±0.17)×10-3 mm2/s、正常腺体(1.92±0.23)×10-3 mm2/s、转移性淋巴结(1.10 ± 0.14)×10-3mm2/s,各种组织间两两比较,差异具有统计学意义(P值均＜0.01).DWIBS经MIP重组及黑白反转技术,病变周围组织信号被抑制,得到类正电子发射体层成像(PET)图像.在乳腺癌中,DWIBS对肿瘤实质(92.3/)及转移性淋巴结(88.4/)的显示率要高于DWI序列(分别为57.6/和42.3/),差异有统计学意义(x2值分别为8.307、12.235,P均＜0.05).乳腺癌与良性病变ADC值分别为(1.092±0·17)×10-3和(2.154±0.53)×10-3mm2/s,差异有统计学意义(t=8.626,P＜0.05).结论 MRDWIBS在显示病灶方面有一定优势,应用DWI结合ADC值对乳腺癌的诊断具有临床应用前景.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）