多参数MRI鉴别腮腺单发Warthin瘤与多形性腺瘤的价值

目的　探讨多参数MRI鉴别腮腺单发Warthin瘤与多形性腺瘤的价值。方法　回顾性分析病理学证实的26例腮腺单发Warthin瘤、35例多形性腺瘤的MRI资料。评估常规MRI特征、ADC值、达峰时间（Tpeak）、流出率（WR）及时间信号强度曲线（TIC）类型。结果　Warthin瘤ADC值 [（0.89±0.22）×10-3 mm2/s]显著低于多形性腺瘤[（1.54±0.34）×10-3 mm2/s]（t =-8.60,P＜0.05）。两者Tpeak（t =-14.74）、WR（t =8.75）及TIC类型（χ2=61.00）的差异有统计学意义（P＜0.05）。以ADC值=1.24×10-3 mm2/s作为阈值,鉴别Warthin瘤与多形性腺瘤的敏感度为82.86%（29/35）,特异度为100%（26/26）,准确率为90.16%（55/61）。将ADC值与TIC类型进行线性拟合并绘制ROC,曲线下面积为0.996,敏感度为94.29%（33/35）,特异度为100%（26/26）,准确率为96.72%（59/61）。结论　多参数MRI可提高鉴别腮腺单发Warthin瘤与多形性腺瘤的效能。     

脉络膜血管瘤的MRI表现及动态增强研究

Objective To characterize the regular and the dynamic contrast enhancement MR imaging in choroidal hemangioma.Methods MR imaging findings of 30 cases (31eyes, 32 lesions) with choroidal hemangioma confirmed by follow-up results were retrospectively analyzed.Among them, postcontrasted T1-weighted imaging was performed in 30 patients and dynamic contrast enhancement scanning was performed in 26 cases.MRI findings and the time-intensity curve of dynamic contrast enhancement were analyzed.Results Among the 32 choroidal hemangiomas, 26 of them were at the temporal side of optic disc and 28 lesions were fusiform.Before enhancement, 23 lesions showed isointense T1-weighted signal and 31 lesions were isointense on T2-weighted imaging.All the lesions showed strong enhancement on postcontrast T1-weighted imaging, including 31 homogenously enhanced lesions and one heterogeneously enhanced lesion.Retinal detachments were found in 18 eyes.Fill-in sign were observed in 12 lesions during dynamic contrast enhancement.The time-intensity curve of dynamic contrast enhancement in 28 lesions suggested a pattern with rapid enhancement and slow washout, time to peak (91.00±25.27) s, slope ratio 3.03±1.13, the median of washout ratio 17.06%, enhancement ratio 2.87±0.79.Conclusion MRI showed a few features of the location, shape, signal characteristics, and enhancement pattern in choroidal hemangioma, which may contribut to diagnosis and treatment plan of this disease.     

先天性骨性外耳道发育畸形的CT表现及分类方法探讨

骨性外耳道发育不良是先天性外、中耳发育畸形的常见形式之一,CT表现较为复杂,目前认为骨性外耳道发育畸形分为以下3种类型:骨性外耳道闭锁、骨性外耳道狭窄和垂卣外耳道.     

葡萄膜转移瘤的MRI表现

目的探讨葡萄膜转移瘤的MRI表现特点。方法回顾性分析20例经病理或临床随访证实的葡萄膜转移瘤的MRI表现。1例仅行平扫，19例同时行平扫和增强扫描，其中4例行动态增强扫描。结果20例葡萄膜转移瘤中，位于虹膜和睫状体2例，18例位于脉络膜；2例表现为略长T1、等T2信号，9例表现为等T1、等T2信号，3例表现为等T1、略长T2信号，3例表现为等T1、略短T2信号，2例表现为略短T1、略短T2信号，1例表现为略短T1、略长T2信号；8例表现为眼球壁轻度增厚，3例呈新月形，7例呈梭形，2例呈结节状。19例呈中度至明显强化；行动态增强扫描的4例时间-信号强度曲线均呈速升、缓降型。伴有视网膜脱离11例和玻璃体信号异常2例。结论MRI能显示葡萄膜转移瘤的部位、形态、信号及强化特点，有助于葡萄膜转移瘤的诊断与鉴别诊断。     

促进我国头颈部影像学的发展(述评)

头颈部影像学研究自颅底至胸廓入口各种组织结构的影像学检查技术、诊断和鉴别诊断等内容,包括眼、耳、鼻、咽喉、口腔及颈部等部分,由于解剖复杂,涉及众多的血管、神经及其通道,因此临床表现常为多样性和复杂化.     

眼肌麻痹的CT和MRI研究

目的 回顾性分析眼肌麻痹患者的CT和MRI资料,探讨引起眼肌麻痹的病变发生特点及最佳扫描方案.方法 搜集1376例因眼肌麻痹为主要症状行CT和(或)MRI患者的资料,计算总阳性率及各病变的构成比,比较分析不同检查方法及序列显示海绵窦炎症等病变的情况.统计学分析采用多配对样本的Friedman检验,两两比较采用Wilcoxon检验.结果 影像检查的总阳性率为91.9%(1264/1376),同时行CT和MRI的50例中,MRI阳性率(92.0%,46/50)高于CT(48.0%,24/50)(Z=-4.8,P＜0.01).引起眼肌麻痹的病变:海绵窦区病变552例,占43.7%;眼外肌病变518例,占41.0%;颅眶沟通性病变108例,占8.5%;其他病变86例,占6.8%.对行MRI的283例海绵窦炎症,5种MRI序列显示率差异有统计学意义(χ2=1047.1,P＜0.01);横断薄层T1WI[(2.71±0.69)分]优于横断厚层T2WI[(1.67±0.64)分],横断薄层增强T1WI[(3.92±0.27)分]优于横断厚层T2WI,横断薄层增强T1WI优于横断薄层T1WI,横断薄层增强T1WI优于冠状薄层T1WI[(3.10±0.39)分],冠状薄层T1WI优于横断薄层T1WI,冠状薄层T1WI优于横断厚层T2WI,冠状薄层增强T1WI[(3.95±0.22)分]优于横断薄层T1WI,冠状薄层增强T1WI优于横断厚层T2WI,冠状薄层增强T1WI优于冠状薄层T1WI(P值均＜0.01).对动眼神经和外展神经病变,增强MRI阳性率(100%,39/39)高于平扫(82.1%,32/39)(Z=-2.1,P＜0.05).结论 CT和MRI可显示引起眼肌麻痹的病变,MRI是眼肌麻痹患者的最佳影像检查方法.

Abstract：

Objective To analyze the diseases responsible for ophthalmoplegia and determine the optimal technique identifying the lesions. Methods CT and MR imaging findings of 1376 patients with ophthalmoplegia were analyzed. The total positive rate and ratio of the diseases causing ophthalmoplegia were calculated. The efficiency of various methods and sequences was compared in the evaluation of cavernous sinus inflammation and other lesions. Multi-paired samples Friedman test was used to compare five kinds of images from different methods and sequences, and Wilcoxon test was used to compare between every two kinds of images. Results The total positive rate was 91.9% (1264/1376). In 50 patients who underwent both CT and MRI, the positive rate of MRI (92. 0% ,46/50) was higher than that of CT (48.0% ,24/50)(Z = -4. 8, P ＜ 0. 01). There were 552 cases (43.7%) of cavernous sinus lesions, 518 cases (41.0%)of extraocular muscle diseases, 108 cases (8. 5%) of cranio-orbital communicating lesions and 86 patients (6. 8%) of other lesions. The five kinds of images from various methods and sequences had significant difference in the detection of 283 cavernous sinus inflammation (χ2 = 1047. 1, P ＜ 0. 01) cases. Transverse T1WI with thin slice thickness[(2. 71 ± 0. 69)scores]was better than that with thick slice thickness [(1.67 ± 0. 64) scores], contrast transverse T1 WI with thin slice thickness[(3.92 ± 0. 27) scores]was better than transverse T2WI with thick slice thickness, transverse T1WI and coronal T1 WI with thin slice thickness[(3. 10 ± 0. 39) scores]. Coronal T1 WI with thin slice thickness was better than transverse T1 WI with thin slice thickness and transverse T2WI, and the contrast coronal T1WI with thin slice thickness [(3.95 ± 0. 22) scores]was better than transverse T, WI with thin slice thickness, transverse T2 WI and coronal T1WI (P ＜0. 01 separately). The positive rate of enhanced MRI (100% ,39/39) was higher than that of nonenhanced MRI (82. 1% ,32/39) (Z = - 2. 1, P ＜ 0. 05). Conclusion CT and MRI can show the lesions responsible for ophthalmoplegia. MRI is the best examination method in displaying these lesions.     

MR扩散加权成像在眼眶良恶性肿块鉴别诊断中的应用

目的 分析眶内良恶性肿块的扩散加权成像(DWI)特征,评价表观扩散系数(ADC)值对其诊断价值.方法 对77例眶内肿块进行常规MRI及DWI,其中良性肿块55例,恶性肿块22例.扩散敏感系数(b)值=0、1000 s/mm2,测量病变对侧颞叶脑白质感兴趣区DWI信号,获得相应的肿块区ADC(ADCM)值、病变对侧颞叶脑白质ADC(ADCw)值,计算二者比值(ADCR).以不同ADCM值及ADCR作为临界点区分眶内良恶性肿块绘制出受试者工作特征曲线(ROC).结果 眶内良性肿块ADCM值及ADCR分别为(1.56±0.75)×10-3mm2/s、1.85±0.91;恶性肿块ADCM值及ADCR分别为(1.09±0.42)×10-3mm2/s、1.28±0.53;良性肿块ADCM值及ADCR显著高于恶性肿块(t值分别为2.803、2.735,P值均＜0.01).以不同ADCM值、ADCR作为临界点判断眶内良恶性肿块绘制ROC,曲线下面积均为0.71±0.07.以ADCM值为1.05×10-3mm2/s作为判断眶内良恶性肿块的决定值,灵敏度、特异度和准确率分别为59.1%(13/22)、78.2%(43/55)和72.7%(56/77);以ADCR为1.24作为决定值,灵敏度、特异度和准确率分别为59.1%(13/22)、76.4%(42/55)和71.4%(55/77).结论 DWI可揭示眼眶肿块的扩散特征,ADC值对于良恶性肿块的鉴别诊断具有辅助诊断价值.     

脉络膜血管瘤的MRI表现及动态增强研究

Objective To characterize the regular and the dynamic contrast enhancement MR imaging in choroidal hemangioma.Methods MR imaging findings of 30 cases (31eyes, 32 lesions) with choroidal hemangioma confirmed by follow-up results were retrospectively analyzed.Among them, postcontrasted T1-weighted imaging was performed in 30 patients and dynamic contrast enhancement scanning was performed in 26 cases.MRI findings and the time-intensity curve of dynamic contrast enhancement were analyzed.Results Among the 32 choroidal hemangiomas, 26 of them were at the temporal side of optic disc and 28 lesions were fusiform.Before enhancement, 23 lesions showed isointense T1-weighted signal and 31 lesions were isointense on T2-weighted imaging.All the lesions showed strong enhancement on postcontrast T1-weighted imaging, including 31 homogenously enhanced lesions and one heterogeneously enhanced lesion.Retinal detachments were found in 18 eyes.Fill-in sign were observed in 12 lesions during dynamic contrast enhancement.The time-intensity curve of dynamic contrast enhancement in 28 lesions suggested a pattern with rapid enhancement and slow washout, time to peak (91.00±25.27) s, slope ratio 3.03±1.13, the median of washout ratio 17.06%, enhancement ratio 2.87±0.79.Conclusion MRI showed a few features of the location, shape, signal characteristics, and enhancement pattern in choroidal hemangioma, which may contribut to diagnosis and treatment plan of this disease.     

脉络膜血管瘤的MRI表现及动态增强研究

Objective To characterize the regular and the dynamic contrast enhancement MR imaging in choroidal hemangioma.Methods MR imaging findings of 30 cases (31eyes, 32 lesions) with choroidal hemangioma confirmed by follow-up results were retrospectively analyzed.Among them, postcontrasted T1-weighted imaging was performed in 30 patients and dynamic contrast enhancement scanning was performed in 26 cases.MRI findings and the time-intensity curve of dynamic contrast enhancement were analyzed.Results Among the 32 choroidal hemangiomas, 26 of them were at the temporal side of optic disc and 28 lesions were fusiform.Before enhancement, 23 lesions showed isointense T1-weighted signal and 31 lesions were isointense on T2-weighted imaging.All the lesions showed strong enhancement on postcontrast T1-weighted imaging, including 31 homogenously enhanced lesions and one heterogeneously enhanced lesion.Retinal detachments were found in 18 eyes.Fill-in sign were observed in 12 lesions during dynamic contrast enhancement.The time-intensity curve of dynamic contrast enhancement in 28 lesions suggested a pattern with rapid enhancement and slow washout, time to peak (91.00±25.27) s, slope ratio 3.03±1.13, the median of washout ratio 17.06%, enhancement ratio 2.87±0.79.Conclusion MRI showed a few features of the location, shape, signal characteristics, and enhancement pattern in choroidal hemangioma, which may contribut to diagnosis and treatment plan of this disease.