肝脏非典型性局灶性病变超声造影研究

目的 探讨超声造影对肝脏非典型性局灶病变的诊断价值.方法 对37例肝脏非典型性局灶病变进行超声造影并与手术病理或增强CT结果对照.结果 21例常规超声不能明确局灶病变存在,经超声造影,确定病灶存在15例,同时发现新病灶6例;排除局灶性病变6例;15例常规超声局灶性病变性质不能确定或与其他影像诊断有异议,经超声造影获得诊断.结论 超声造影可有效地反映肝脏病变的血流灌注特征,对非典型性局灶病变的确定和诊断有重要价值.     

超声造影对脂肪肝背景下肝脏单个低回声局灶性病变的鉴别诊断

目的探讨实时超声造影对脂肪肝背景下肝脏单个低回声局灶性病变的诊断价值。方法应用常规超声和超声造影对106例脂肪肝患者肝脏单个低回声局灶性病变进行分析,并与病理诊断进行比较。结果 106例脂肪肝背景下肝脏低回声病灶中,超声造影诊断原发肝癌28例,转移性肝癌16例,肝血管瘤27例,肝脓肿9例,肝腺瘤1例,肝局灶性结增生5例,非均匀性脂肪肝11例。超声造影的诊断准确率为91.5%,明显优于常规超声的64.2%。结论超声造影可以提高脂肪肝背景下肝脏低回声局灶性病变的诊断准确率,是鉴别诊断脂肪肝背景下肝低回声结节的有效方法。     

超声多模态成像鉴别肝脏局灶病变良恶性的价值

目的:研究多模态超声鉴别肝脏局灶性病变(focal Liver Lesions,FLLs)良恶性的价值.方法:纳入85例于我院发现FLLs的患者,对所有患者共150个FLLs行常规超声、超声造影(contrast-enhanced ultrasound,CEUS)、剪切波弹性成像(shearwave elastogra...     

超顺磁性氧化铁增强MRI对肝脏转移瘤与非实性良性肿瘤的鉴别意义

影像学检查在评价转移性肝肿瘤时常常难以区分实性转移瘤与非实性良性肿瘤 ,如血管瘤或囊肿 ,因为上述病变在T2加权像 (T2WI)上均为高信号。本研究将肿瘤在超顺磁性氧化铁 (SPIO)增强T2WI和重T1加权 (T1WI)梯度回波图像上的信号强度划分为几种类型 ,以此评价SPIO增强MRI区分实性转移瘤与非实性良性肿瘤的能力。材料和方法 :6 5例无肝硬化病变的肿瘤患者 ,CT增强检查或超声疑有病变而进一步行SPIO增强MRI检查。其中 33例 (男 2 5例 ,女 8例 )有 81个病灶 ,包括囊肿 4 2个、血管瘤 1 3个、转移瘤 2 6个。囊肿最大径 5～ 35mm(平…     

肝脏局灶性结节增生的诊断及治疗

目的　探讨肝脏局灶性结节增生的临床特点及诊治方法。方法　回顾性分析 15例经手术切除、病理学检查证实的肝脏局灶性结节增生患者的临床资料。结果　该病多发生于中青年 ,6例女性患者均无服用避孕药史 ,全组患者肝功能、AFP水平均正常 ,86.7% (13 / 15 )的患者血清乙型、丙型肝炎病毒指标水平正常 ;术前综合影像正确诊断率为 3 3 .3 % (5 / 15 ) ;13例为单发病灶 ,其余 2例各有 2个病灶。 11例行不规则肝切除术 ,4例行肝段切除术。 2例出现并发症 ,其中 1例为术后肝创面活动性出血 ,另1例为切口感染。结论　肝脏局灶性结节增生影像学表现有一定特征 ,综合临床及影像学检查能提高术前确诊率。确诊病例无需手术治疗 ;疑为肝腺瘤、恶性肿瘤以及病灶发展迅速者应行手术治疗。     

超声造影在局灶性脂肪肝与肝脏良性肿瘤鉴别诊断中的应用价值

目的:探讨超声造影在局灶性脂肪肝与肝脏良性肿瘤鉴别诊断中的应用价值.方法:收集在我院手术或行肝脏穿刺组织病理检查确诊的肝脏良性肿瘤及局灶性脂肪肝共患者156例(156个主要病灶),均有完整病史、常规超声、超声造影检查,病理结果,回顾性分析超声及超声造影检查结果.结果:超声造影检查对局灶性脂肪肝与肝脏良性肿瘤诊断的灵敏度为82.61%、特异度为92.73%、阳性预测值为82.61%、诊断准确率为89.74%,明显高于常规超声检查的63.04%、82.73%、60.42%、76.92%,比较差异有统计学意义(P<0.05);局灶性脂肪肝的46个病灶表现为与肝组织同步增强及消退,肝血管瘤、肝脏腺瘤、肝局限性结节增生在动脉相、门脉相时表现各有不同.结论:超声造影用于局灶性脂肪肝及肝脏良性肿瘤诊断时灵敏度及特异度均明显高于常规超声检查,可根据动脉相及门脉相的表现对局灶性脂肪肝与肝脏良性肿瘤进行鉴别诊断.     

增强CT纹理参数对肝脏局灶性结节性增生与肝细胞肝癌的鉴别诊断价值

[目的]探讨增强CT纹理参数鉴别肝脏局灶性结节性增生(FNH)和肝细胞肝癌(HCC)的价值。[方法]回顾性分析25例FNH和30例HCC患者临床资料,所有患者均接受CT三期增强扫描,使用灰度直方图和灰度共生矩阵纹理分析法测定灰度平均值、峰度、偏度、能量、自相关、熵值和标准差,分析FNH与HCC组增强CT图像纹理参数ROC曲线中的AUC值、标准误、95%CI和P值,找到动脉期、门脉期和延迟期中同时满足AUC>0.5且P<0.05的有效参数;对有效参数进一步对比其在两组患者中不同增强期的表达情况。计算上述指标在各个增强期的截断点,计算其鉴别HCC的效能。[结果]①灰度平均值在三个增强期时AUC值均较其它纹理参数AUC值大,AUC>0.5且P<0.05。动脉期自相关、标准差AUC值均>0.5,且P<0.05;门脉期峰度、自相关AUC值均>0.5,且P<0.05。②动脉期,HCC组平均值、自相关、标准差均较FNH组低,P<0.05。门脉期,HCC组平均值、峰度、自相关均较门FNH组低,P<0.05。延迟期HCC组平均值较FNH组低,P<0.05。③平均值在动脉期<80.01时诊断HCC特异度为80.00%,灵敏度为76.67%;在门脉期<102.33诊断HCC特异度为88.00%,灵敏度为83.33%;在延迟期<81.02时诊断HCC特异度为84.00%,灵敏度为93.33%。自相关在动脉期<2.86×10^4诊断HCC特异度为88.00%,灵敏度为66.67%,在门脉期<2.30×10^4诊断HCC特异度为84.62%,灵敏度为53.33%,在延迟期无诊断价值。标准差在动脉期<12.02时诊断HCC特异度为84.00%,灵敏度为53.33%;峰度在门脉期<3.48诊断HCC特异度为52.00%,灵敏度为80.00%。[结论] CT纹理参数尤其是灰度平均值,在HCC与FNH区分上有较高效能,尤其是延迟期最佳。     

超声造影在肝脏局灶性病变诊断中的价值

Objective: By observing the pattern of the focal liver lesions (FLL) in different phases by real time contrast-enhanced ultrasound (CEUS), compared to enhanced CT, investigate the value of CEUS in diagnosing focal liver lesions. Methods: 35 patients with unconfirmed focal liver lesions were studied by contrast agent SonoVue and Technos DU 8 produced by Esaote company. Results: Among the 14 cases of hepatocellular carcinoma (HCC), 10 were typical, presented with early artery enhancement and immediate wash-out. The enhancement patterns of 6 livers metastasis were diverse, including peripheral or entire degree enhancement. The wash-out time in malignant tumors was earlier than other focal liver lesions (P＜0.05), appeared as hypoechoic in the portal phase or parenchyma phase. The 6 cases of hemangioma were enhanced centripetally nodular in artery phase and washed out after several minutes. The pattems of different lesions were similar compared to contrast-enhanced CT, without significant statistic differences. Conclusion: The contrast enhanced ultrasound technique can significantly improved the value of diagnosing focal liver lesions.     

Diffusion-Weighted Imaging for the Left Hepatic Lobe has Higher Diagnostic Accuracy for Malignant Focal Liver Lesions

Background: This study was conducted to investigate whether apparent diffusion coefficient (ADC) measurements by dividing the liver into left and right hepatic lobes may be utilized to improve the accuracy of differential diagnosis of benign and malignant focal liver lesions. Materials and Methods: A total of 269 consecutive patients with 429 focal liver lesions were examined by 3-T magnetic resonance imaging that included diffusion-weighted imaging. For 58 patients with focal liver lesions of the same etiology in left and right hepatic lobes, ADCs of normal liver parenchyma and focal liver lesions were calculated and compared using the paired t-test. For all 269 patients, ADC cutoffs for focal liver lesions and diagnostic accuracy in the left hepatic lobe, right hepatic lobe and whole liver were evaluated by receiver operating characteristic curve analysis. Results:For the group of 58 patients, mean ADCs of normal liver parenchyma and focal liver lesions in the left hepatic lobe were significantly higher than those in the right hepatic lobe. For differentiating malignant lesions from benign lesions in all patients, the sensitivity and specificity were 92.6% and 92.0% in the left hepatic lobe, 94.4% and 94.4% in the right hepatic lobe, and 90.4% and 94.7% in the whole liver, respectively. The area under the curve of the right hepatic lobe, but not the left hepatic lobe, was higher than that of the whole liver. Conclusions: ADCs of normal liver parenchyma and focal liver lesions in the left hepatic lobe were significantly higher than those in the right hepatic lobe. Optimal ADC cutoff for focal liver lesions in the right hepatic lobe, but not in the left hepatic lobe, had higher diagnostic accuracy compared with that in the whole liver.     

Hepatic Adenoma and Focal Nodular Hyperplasia: A Diagnostic Dilemma

Focal Nodular Hyperplasia (FNH) and Hepatic Adenoma (HA) remain difficult diagnostic problems due to their variable imaging appearances. Five new cases are presented, illustrating this variability, and the current literature is reviewed. Ultrasonography is a sensitive modality for their detection but is otherwise non-specific. On computer tomegraphy, the presence of a scar suggests FNH, whilst haemorrhage suggests HA. However these features are seen in only a small number of cases. Radionuclide (colloid) scanning aids considerably in FNH but a definitive role has not been found in HA. Angiography is helpful, providing anatomical information, sometimes diagnostic (septated blush in FNH, hypovascular areas in HA) and able to discern benign from malignant lesions.     

MRI与 CT对原发性脑淋巴瘤的诊断价值分析

目的：探讨MRI与CT对原发性脑淋巴瘤的诊断价值。方法选取50例原发性的脑淋巴瘤患者作为观察组,选50例颅内发生转移的瘤患者作为对照组,行MRI和CT检查,比较患者的病灶分布、肿瘤囊变及坏死和水肿情况、信号特点及尖突症情况。结果患者病灶多分在深部的脑组织,呈区域性分布,瘤周围以中度水肿为主,较少出现囊变及坏死,T2W1主要为等或者低信号,尖突多呈阳性。结论 MRI和CT检查能够提高原发性淋巴瘤患者诊断率,有助于其早期诊断。     

磁共振改良DIXON定量技术在椎体转移瘤中的诊断价值

目的 探讨磁共振改良DIXON定量技术(mDIXON Quant)在椎体转移瘤中的诊断价值.方法 回顾性分析152例经病理确诊为恶性肿瘤并椎体转移患者的MRI图像.扫描序列包括T1WI、STIR、mDIXON Quant及T1 WI压脂增强.分析T1WI、FF图像在椎体转移瘤中的诊断效能;比较正常椎体与椎体转移瘤FF值...     

螺旋CT和MRI检查对子宫颈癌的诊断价值

目的 探讨螺旋CT和MRI检查对子宫颈癌的诊断价值.方法 比较70例宫颈癌患者行螺旋CT和MRI检查的结果,分析螺旋CT、MRI以及螺旋CT联合MRI对子宫颈癌的诊断及分期效果.结果 螺旋CT与MRI对子宫颈癌的诊断率明显低于螺旋CT+MRI联合诊断,差异有统计学意义(P＜0.05);螺旋CT对子宫颈癌Ⅰ期、Ⅱ期的诊断率明显低于MRI,有统计学差异(P＜0.05);螺旋CT对病灶直径≤3 cm的子宫颈癌诊断灵敏度、特异性均明显低于MRI和螺旋CT+MRI联合诊断(P＜0.05);螺旋CT对病灶直径＞3 cm的子宫颈癌诊断灵敏度、特异性以及准确率与MRI相近,差异无统计学意义(P＞0.05);螺旋CT与MRI对病灶直径≤3 cm和直径＞3 cm的子宫颈癌诊断准确率均明显低于螺旋CT+MRI联合诊断,有统计学差异(P＜0.05).结论 MRI对子宫颈癌诊断的准确率优于螺旋CT,尤其表现在对病灶直径≤3 cm的宫颈癌诊断中,但二者联合诊断效果更佳.     

Sentinel lymph node localization and staging with a low-dose of superparamagnetic iron oxide (SPIO) enhanced MRI and magnetometer in patients with cutaneous melanoma of the extremity - The MAGMEN feasibility study

BackgroundIn patients with melanoma, sentinel lymph node (SLN) status is pivotal for treatment decisions. Current routine for SLN detection combines Technetium^99m (Tc⁹⁹) lymphoscintigraphy and blue dye (BD). The primary aim of this study was to examine the feasibility of using a low dose of superparamagnetic iron oxide (SPIO) injected intracutaneously to detect and identify the SLN, and the secondary aim was to investigate if a low dose of SPIO would enable a preoperative MRI-evaluation of SLN status.MethodsPatients with melanoma of the extremities were eligible. Before surgery, a baseline MRI of the nodal basin was followed by an injection of a low dose (0.02–0.5 mL) of SPIO and then a second MRI (SPIO-MRI). Tc⁹⁹ and BD was used in parallel and all nodes with a superparamagnetic and/or radioactive signal were harvested and analyzed.ResultsFifteen patients were included and the SLNB procedure was successful in all patients (27 SLNs removed). All superparamagnetic SLNs were visualized by MRI corresponding to the same nodes on scintigraphy. Micrometastatic deposits were identified in four SLNs taken from three patients, and SPIO-MRI correctly predicted two of the metastases. There was an association between MRI artefacts in the lymph node and the dose SPIO given.DiscussionIt is feasible to detect SLN in patients with melanoma using a low dose of SPIO injected intracutaneously compared with the standard dual technique. A low dose of SPIO reduces the lymph node MRI artefacts, opening up for a non-invasive assessment of SLN status in patients with cancer.     

CT和 MRI对卵巢癌的诊断价值比较

目的：比较CT与MRI对于卵巢癌的诊断价值。方法对56例卵巢癌患者术前同时进行CT和MRI检查,并评估术后复发及转移情况。结果在对卵巢癌的临床诊断中,CT准确率为82．1％,MRI准确率为94．6％。在对卵巢癌的定性诊断中,CT准确率为71．4％,MRI准确率为87．5％。在对卵巢癌的分期诊断中,CT准确率为73．2％,MRI准确率为89．3％。在对卵巢癌侵袭和转移的诊断中,CT总的准确率为49．2％,MRI总的准确率为84．1％。结论对卵巢癌的诊断,MRI明显优于CT。     

超声造影对166例肝脏占位性病变的诊断价值

[目的]探讨超声造影对肝脏占位性病变的诊断价值。[方法]166例肝脏占位性病变患者共182个结节分别行常规超声和超声造影检查,比较两者诊断的准确率。[结果]超声造影明确诊断148例共163个结节,诊断准确率为89.6%（163/182）;常规超声明确诊断102例共115个结节,诊断准确率为63.2%（115/182）,两者诊断准确率比较差异具有统计学意义（P〈0.01）。[结论]超声造影为不同类型的肝脏占位性病变提供了重要的诊断依据,提高了超声影像学的诊断准确率。