目的 探讨胸腺原发黏膜相关淋巴组织淋巴瘤(MALToma)的CT表现,以期提高对该病的认识.方法回顾性分析8例经病理证实的胸腺MALToma患者的临床及CT特征并复习相关文献.结果 8例患者中,5例为囊实性铸型生长肿块,内可见多发边界清晰的类圆形囊变区域,定义为"瑞士奶酪征",3例为实性类圆形小结节;增强后实性成分均中度至明显强化,平均强化幅度为35 HU.8例均无纵隔肿大淋巴结,无心脏大血管包绕或侵犯.7例合并干燥综合征.结论 胸腺MALToma的CT表现有一定的特征性,且多数伴有干燥综合征,结合患者临床病史有可能做出准确的术前诊断.

Objective:To explore CT imaging features related to disease-free survival (DFS) for gastric cancer (GC) patients with no clinical lymph node metastasis (cN0).Methods:From January 2005 to December 2018, 298 patients with GC were collected retrospectively in Peking University People′s Hospital. All the patients performed CT scanning before operation, and cT1-4N0M0 was defined by CT images. The clinical tumor stage (cT), extramural vessel invasion (EMVI), tumor morphological type, location and size were defined and recorded based on preoperative contrast-enhanced CT images. According to the pathological results, the patients were divided into pT1-2, pT3-4, pN0, and pN1-3 subgroups, with 148, 150, 135, and 163 cases, respectively. Progressive events and corresponding time were recorded during follow-up. DFS was defined as the time from radical operation to progressive events; if no progressive events occurred, DFS was defined as the time from radical operation to the last follow-up. The Kaplan-Meier curve and log-rank test were used to analyze the differences in cumulative DFS among patients with different CT imaging features, and Cox survival analysis was used to explore the independent CT imaging risk factors affecting DFS of cN0 patients. The log-rank test was used to test the effect of independent risk factors on cumulative DFS in different subgroups.Results:The follow-up time of enrolled patients was 36.0 (14.9, 59.3) months. The 3-year cumulative DFS rates of cT3-4 and cT1-2 GC patients were 61.2% and 85.6%, respectively, and the difference of DFS was statistically significant (χ 2=22.72, P<0.001). The 3-year cumulative DFS rate of EMVI-positive patients was 46.3%, which was lower than that of EMVI-negative patients (77.1%), and the difference was statistically significant (χ 2=21.34, P<0.001). There was no significant difference in 3-year cumulative DFS between different tumor locations and morphological types (χ 2=1.75, 1.73, P=0.189, 0.196). The difference in 3-year cumulative DFS between the tumor maximal diameter ≥3.4 cm and <3.4 cm groups was statistically significant (χ 2=17.58, P<0.001). On Cox survival analysis, cT (HR=5.203, P=0.001) and EMVI (HR=1.971, P=0.025) were independent risk factors for 3-year DFS in patients with cN0 GC. The results of subgroup analysis showed that the effect of EMVI on the 3-year DFS in pN0, pN1-3, pT1-2 and pT3-4 subgroups was statistically significant ( P<0.05). The effect of cT on the 3-year DFS was statistically significant in pN0, pN1-3, and pT1-2 subgroups ( P<0.05), but not in pT3-4 group (χ 2=2.58, P=0.108). Conclusion:cT and EMVI defined on preoperative CT examination are independently prognostic factors of 3-year DFS for patients with cN0 GC.

目的 通过MRI定量分析探讨2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)肝脂肪变性程度与铁含量的相关性.资料与方法 前瞻性纳入94例T2DM患者进行上腹部MRI检查,通过最小二乘估算法迭代水脂分离技术序列测量患者的肝脏质子密度脂肪分数(PDFF)和MRI弛豫率(R2*).以PDFF为NAFLD诊断"金标准"及脂肪变性严重程度划分标准,将T2DM分为伴有NAFLD组51例和不伴有NAFLD组43例,比较两组的R2*值,探讨肝R2*值与脂肪变性严重程度的关系,分析T2DM伴有NAFLD的危险因素.结果 T2DM伴有NAFLD组R2*值高于不伴有NAFLD组(t=3.355,P<0.01).随着脂肪变性程度的加重,R2*值升高(F=6.312,P<0.05).R2*值(OR=1.062,95％CI=1.007～1.121)、丙氨酸氨基转移酶(OR=1.044,95％CI=1.011～1.079)、体质量指数(OR=1.143,95％CI=1.010～1.293)是T2DM伴有NAFLD的独立危险因素(P均<0.05).结论 随着T2DM合并NAFLD肝脏脂肪变性程度的加重,肝脏铁含量增加;铁是T2DM伴有NAFLD的独立危险因素.

Qualitative and localized diagnosis methods for colorectal cancer liver metastases (CRLM) including CT enhanced scanning, magnetic resonance imaging, PET-CT, and intraoperative ultrasound contrast. With the continuous increasing of high-level research evidence, combined with diffusion-weighted imaging and gadolinium disodium and other hepatocyte-specific contrast agents, MRI imaging has gradually become the most accurate diagnostic method for CRLM. In addition to CRLM morphological information provided by CT, MRI and ultrasound, PET-CT supplements tumor metabolic information and improves the diagnostic specificity. In addition, ultrasound contrast and intraoperative ultrasound contrast should not be underestimated for the choice of CRLM surgical strategy.

低位直肠癌治疗的目标是降低局部复发率和延长生存期,同时尽可能保留括约肌结构和功能.由于肿瘤与周围结构间隙狭窄而导致手术切缘阳性,将增加低位直肠癌病人局部复发率.MRI通过分析低位直肠癌与周围结构的关系,可预测环周切缘是否为阳性.根据MRI检查结果调整手术切面,有助于降低手术切缘病理阳性率和局部复发率;同时,应用MRI判断切缘阴性而采用单纯手术方式,也可避免新辅助放化疗的毒副反应.然而,治疗策略中的手术方式选择并未达成共识,其原因之一是缺乏低位直肠癌手术定义和规范.高分辨率MRI可通过判断低位直肠癌下缘与肛直肠环上缘的纵向位置关系,以及低位直肠癌向肠壁外浸润深度的横向位置关系,协助确定手术方式,精准选择病人进行适宜的手术,增加了保留括约肌结构和功能的机会.在手术不断精细化和局部化的趋势下,通过新辅助治疗或完全新辅助放化疗实现完全临床缓解后采用“等待观察”的非手术策略,有望成为保留器官及其功能的重要治疗方案之一.目前,病人的选择和完全临床缓解的判断尚处于研究中.

Objective: To evaluate the practice of video imaging training for internal clinical interns through the use of the Picture Archiving and Communicating System (PACS) and the "Interactive" teaching method, and to evaluate the application of the PACS system to medical imaging teaching training. The feasibility and advantages. Methods: A total of 40 medical students in the fifth year of the clinical long-term study system of Peking University People' s Hospital were selected as subjects. Divided into 2 groups for each 2 hours of chest imaging training. The main content of the training is the discovery and qualitative diagnosis of pulmonary nodules. The training methods are teacher-led teaching and interactive teaching. Both are done in the PACS system. After the training, a questionnaire survey was conducted to understand the impact of interactive teaching methods based on PACS on teaching effectiveness. Results: The results of questionnaires from 40 trainees of internal medical interns showed that the use of PACS for chest imaging can help to understand the anatomy of chest CT images, help to find lesions, and perform sign analysis. Compared with the guiding pedagogy, trainees showed a more positive attitude toward interactive teaching methods, especially for self-directed learning. Trained students believe that interactive teaching methods are more effective. Conclusion: The combination of PACS system and interactive teaching methods, as a novel and effective teaching method, has achieved initial results in chest imaging training.

The primary strategy for low rectal cancers is curative operation.In results of anatomic characteristics,low rectal cancers treated with abdominoperineal excision (APE) have a higher rate of margin involvement compared with tumours elsewhere in the rectum.It is necessary to analyze the relationship between low rectal cancer and surrounding structures and organs before operation.High-resolution magnetic resonance imaging (MRI) can be used to assess risk factors related with margin involvement,including tumor extended to full thickness of the muscularis propria/internal sphincter,extends into the intersphincteric plane,or extends into the external sphincter or ＜ 1 mm from levator ani,anterior quarter invasion,extramural vascular invasion,and less than 4cm from anal verge.Risk factors can be used to correct surgical management to minimize the rate of margin involvement.Local control rate of rectal cancer has been improved after neoadjuvant chemoradiation and even pathological completed response (pCR) has been demonstrated in a significant minority.If the patients with clinical completed response to neoadjuvant chemoradiation can be demonstrated by clinical and medical imaging findings,a nonoperative management (NOM) strategy has been pursued to preserve sphincter function and avoid complications induced by surgery.MRI could be used to assess completed response of rectal cancer to neoadjuvant chemoradiotherapy.The Future research must focus on the integration of morphological and functional imaging with clinical data and molecular biomarkers.

Objective To investigate the accuracy of high-resolution magnetic resonance imaging (MRI) in diagnosis of the lymph nodes metastases (LNMs) and stage of rectal cancer (RC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 65 patients with RC who were admitted to the Peking University People's Hospital between April 2014 and April 2016 were collected.The results of postoperative pathological examination:of 65 patients with RC,24 had positive LNMs and 41 had negative LNMs;N0,N1 and N2 were respectively detected in 41,14 and 10 patients.Imaging data were captured using 3.0-Tesla MRI and body phased-array coil.Diagnostic criteria for LNMs of RC:criterion 1:irregular lymph node boundaries and signal characteristics were not considered;criterion 2:heterogeneous signal of lymph nodes and boundary characteristics were not considered;criterion 3:irregular lymph node boundaries and / or heterogeneous signal of lymph nodes.The American Joint Committee on Cancer (AJCC) cancer staging manual (7th edition) have established the N staging scheme for RC.Lymph nodes distribution according to the rectal lymphatic drainage:D1was located in fascia of the mesorectum;D1a above the level of tumor;D1b at the level of tumor;D1c under the level of tumor;D2 around the superior rectal artery and root of inferior mesenteric artery;D3 on the side of pelvic cavity.Observation indicators:(1) Efficiency and comparison of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria (postoperative pathological result as a gold standard).(2) Efficiency and comparison of N stage of RC diagnosed by high-resolution MRIaccording to the 3 criteria (postoperative pathological result as a gold standard).(3) Efficiency of LNMs of RC diagnosed by high-resolution MRI according to the maximum short diameter of lymph nodes:① maximum short diameter distribution of positive and negative LNMs of RC;②sensitivity,specificity,accuracy and consistency of LNMs diagnosed using different maximum short diameter of lymph nodes as a threshold (postoperative pathological result as a gold standard);③ comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes with highest diagnostic accuracy as a threshold and using the 3 criteria;④ sensitivity,specificity,accuracy and consistency (postoperative pathological result as a gold standard) of LNMs diagnosed using maximum short diameter of lymph nodes with highest diagnostic accuracy as a threshold combined with the highest efficiency in the (1),and its comparison in accuracy of LNMs with highest diagnostic accuracy as a threshold.(4) Distribution of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria.(5) Follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' postoperative survival up to October 2016.The sensitivity,specificity,accuracy and comparison of ratio were respectively done by the chi-square test.Kappa test was used for consistency,tκ ≤ 0.40was used as low consistency,0.40＜κ≤0.60 as moderate consistency,0.60＜κ≤0.80 as higher consistency,and κ＞ 0.80 very high consistency.Results (1) Efficiency and comparison of LNMs of RC diagnosed by highresolution MRIaccording to the 3 criteria:accuracies of LNMs of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were respectively 93.8％,87.7％ and 90.8％,showing very.high,higher and very high consistencies compared with postoperative pathological results (κ =0.87,0.74,0.81,P＜0.05),and with no statistically significant difference in diagnostic accuracy among them (x2=1.495,P＞0.05).(2) Efficiency and comparison of N stage of RC diagnosed by high-resolution MRI according to the 3 criteria:accuracies of N stage of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were respectively 87.7％,83.1％ and 84.6％,showing the same higher consistencies compared with postoperative pathological result (κ =0.77,0.68,0.72,P＜0.05),and with no statistically significant difference in N stage among them (x2=0.567,P＞0.05).(3) Efficiency of LNMs of RC diagnosed by high-resolution MRI according to the maximum short diameter of lymph nodes:① maximum short diameter distribution of positive and negative LNMs of RC:maximum short diameter ranges were respectively 3-18 mm in positive LNMs and 1-9 mm in negative LNMs,and maximum short diameter ＜3 mm and ≥ 10 mm were respectively negative and positive LNMs.② Efficiency of LNMs of RC diagnosed using different maximum short diameter of lymph nodes as a threshold:diagnostic accuracy of 70.8％was the highest when maximum short diameter ＞7 mm was used as a standard of positive LNMs,showing a low consistency compared with postoperative pathological result (κ =0.29,P＜0.05).③ Comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes ＞7 mm as a threshold and using the 3 criteria:there was a statistically significant difference among them (x2 =15.637,P＜0.05);accuracies of LNMs of RC diagnosed by high-resolution MRI according to the criterion 1,2 and 3 were higher than that diagnosed using maximum short diameter of lymph nodes ＞7 mm as a threshold (x2 =10.354,5.656,6.923,P＜0.05).④Comparison of accuracy of LNMs diagnosed using maximum short diameter of lymph nodes ＞7 mm combined with the criterion 3 as a threshold and using maximum short diameter ＞7 mm as a threshold:the criterion 3 was used as a threshold because there was no statistically significant difference in diagnostic accuracy among the 3 criteria (P＞ 0.05).Diagnostic accuracy was 78.5％ when maximum short diameter ＞7 mm combined with the criterion 3 as a threshold,showing a low consistency compared with postoperative pathological result (κ =0.36,P＜0.05),with no statistically significant difference in diagnostic accuracy compared with maximum short diameter ＞ 7 mm as a threshold (x2=0.154,P＞0.05).(4) Distribution of LNMs of RC diagnosed by high-resolution MRI according to the 3 criteria:positive LNMs of RC diagnosed by high-resolution MRI located mostly in D1 (76.1％-83.1％)and D1b(77.8％-81.4％).(5) Follow-up situations:of 65 patients,54 were followed up for 6-25 months,with a median time of 14 months.During the follow-up,7 patients had distant metastases and 47 had tumor-free survival.Conclusions There are higher accuracies of LNMs and N stage of RC diagnosed using preoperative highresolution MRI.Diagnostic accuracy of LNMs of RC cannot be improved when characteristics of lymph node morphology and size are used as a diagnostic standard.The positive LNMs of RC locate mostly in D1 and Dib.

Objecetive To investigate the ability of extramural vascular invasion(EMVI) in predicting 3-years disease-free survival(3yr DFS)of patients with colon cancer. Methods Between February 2009 and December 2013, patients who had histologically proven primary colon cancer and underwent curative resection were included in this retrospective study. EMVI was defined as tumor tissue in adjacent vessels beyond colon wall on MDCT. DFS was defined as the time from the date of curative resection to the date of local recurrence,and/or distant disease,or tumor-related death. Univariate and multivariate analysis were conducted to identify prognostic factors associated with 3yr DFS. Kaplan-Meier analyses were used to compare 3yr DFS. Cox’s proportional hazards models were used to measure the impact of confounding variables on survival rates. Chi-square test was used to analyze the difference of recurrent/metastatic rate. Results In final,90 patients were included in this study that were identified as stageⅢpatients by pathology based on American Joint Committee on Cancer (AJCC). Multivariate analysis showed that elevated serum CA19-9(HR=2.229,95%CI 1.040-4.776,P=0.039)and EMVI positive(HR=3.266,95%CI 1.648-7.173,P=0.003) were identified as independent predictors of 3yr DFS in stageⅢcolon cancer. Cumulative 3-year DFS were 52.8%and 81.5%(95%CI 1.648-7.173)for EMVI positive and negative patients,and 55.6%and 76.6%(95%CI 1.040-4.776)for elevated serum CA19-9 and normal serum CA19-9,significances were seen (P<0.05). Compared with ctEMVI positive combined with elevated serum CA19-9,3yr recurrent/metastatic rate of ctEMVI negative combined with normal serum CA19-9 was lowerer significantly (10.5%vs. 54.5%,P<0.05).Conclusion EMVI detected with ceMDCT, and elevated serum CA19-9 level could be used as independent predictors of 3yr DFS in patients with stageⅢ colon cancer.

Abdominal ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) have been used in the clinical diagnosis and management of nonalcoholic fatty liver disease (NAFLD). This article elaborates on the advantages and limitations of US, CT, and MRI in the evaluation of NAFLD. Compared with conventional imaging examinations, multi-parametric quantitative MRI allows for comprehensive and objective evaluation of NAFLD. Proton density fat fraction (PDFF) is considered the gold standard for the diagnosis of fatty liver disease and has been applied in clinical research. Independent clinical studies in adults and children have confirmed the practicability, reliability, and transformative quality of PDFF using various MRI scanning systems and software. Magnetic resonance elastography is used to evaluate the degree of liver fibrosis and is not affected by hepatic steatosis. In patients with NAFLD, MRI can measure hepatic fat deposition and fibrosis in a single examination and, to a certain degree, it can replace liver biopsy.

Objective To investigate the association between extramural vascular invasion (EMVI) detected by multi-detectors computed tomography (MDCT) with contrast enhanced (ceMDCT) and clinicopathologic characteristics in patients with colon cancer.Methods Between February 2009 and December 2013,patients with histologically proven primary colon cancer and undergoing curative resection were included in this retrospective study.According to American Joint Committee on Cancer TNM staging system,patients of stage Ⅱ and Ⅲ were included in this study.EMVI status detected by MDCT (ctEMVI) was defined according to the EMVI scores.Chi-square test was used to analyze the association between clinicopathologic characteristics and ctEMVI.Results 165 stage Ⅱ and stage Ⅲ patients were included in this study as confirmed by pathology based on AJCC.Positive ctEMVI was demonstrated in 51 patients (34.5％,51/165).There were significant association between positive ctEMVI and age ＜ 65 years (x2 =4.810,P =0.031),ceMDCT defined tumor stage (x2 =17.911,P =0.000),ceMDCT defined metastatic lymph node (x2 =5.436,P =0.022),tumor size≥5 cm (x2 =3.799,P =0.036) and pathological T stage (x2 =13.346,P =0.001).Conclusions EMVI,detected by ceMDCT,is significantly associated with age,tumor size and T staging in colon cancer.

Assessment of lymph node status in patients with rectal cancer is important before operation and neoadjuvant treatment because it has an influence on definition of operative plan, strategy of chemoradiotherapy and prognosis of the patients with rectal cancer. The imaging modalities that can be used to assess lymph node status include magnetic resonance imaging (MRI), endorectal ultrasonography (ERUS), multi-row detector computer tomography (MDCT), and PET-CT. The existing imaging criteria for metastatic lymph nodes in rectal cancer have not been reached. Combined with morphologic and functional imaging characteristics can be accurately predict metastatic lymph nodes. Based on the size of lymph node, the accuracy of rectal cancer N stage defined by imaging modality is poor. If the border and signal intensity of lymph nodes are used to predict the metastasis, the sensitivity and specificity can be significantly improved. However, the reproducibility needs an improvement because of limitation in imaging quality and difference in ability of imaging interpretation. In comparison, ultra small superparamagnetic iron oxide MRI (USPIO-MRI) has relatively higher reproducibility in definition of the metastatic lymph nodes while it is not permitted as an imaging tool used in clinical practice. In addition, USPIO-MRI has been used to evaluate the lymph node response to chemotherapy. As functional imaging tool, DW-MRI has high sensitivity in detection of lymph nodes, while the specificity is low. In contrast, PET-CT has lower sensitivity because of the limitation in imaging resolution, which can not find the small metastatic lymph nodes. ERUS and high resolution MRI have similar ability in distinguishing metastatic and benign nodes within mesorectum. While MRI and DW-MRI have greater diagnostic view than ERUS, thus they can effectively screen and diagnose the pelvic lateral lymph nodes and rectal upper arteriovenous lymph nodes. MDCT is the better choice in screening chest and abdominal metastatic lymph nodes compared with other modalities. The proper selection of imaging modality or combination of multi-modalities is necessary for special purpose in clinical practice.

应用影像学方法及时准确诊断肝脏转移瘤后,由多学科综合治疗协作组讨论制定个体化治疗方案,病人总生存期可能会得到显著提高.多排螺旋CT(MDCT)是临床常规使用的结直肠癌肝转移瘤筛选和确诊方法.正电子发射断层显像/X线计算机体层扫描(PET/CT)主要用于诊断肝脏及肝脏以外的其他器官转移瘤.相比较而言,多参数磁共振成像(MRI)并用肝脏细胞特异造影剂是诊断结直肠癌肝转移瘤的优选影像学检查方法,特别是对于直径＜10mm的肝脏转移瘤及脂肪肝背景下肝脏转移瘤诊断准确性明显高于MDCT以及PET/CT.术中超声(IOUS)微泡造影是诊断肝脏转移瘤的有益补充,临床可能因其新发现肿瘤而改变手术决策.影像学检查依据实体肿瘤疗效评价(RECIST)和世界卫生组织(WHO)标准对肿瘤大小及数目进行判断,是评价结直肠癌肝转移化疗效果的重要手段.而且,PET/CT、扩散加权MRI以及动态增强MRI通过判断肿瘤代谢、细胞密度及血管灌注特征能够早期监测肿瘤化疗效果,并预测病人生存期.

目的 评价非低张条件下,腹部增强CT对胃壁分层结构的显示,并分析其影响因素.方法 回顾性分析非低张条件下,正常胃壁增强CT图像.主要影像学评价征象为胃壁分层结构,同时观察胃充盈度、胃腔充盈介质、部位及伪影等情况.应用卡方检验及Logistic回归检验,分析影响胃壁分层结构显示的相关因素.结果 非低张条件下,增强CT对胃壁分层结构的显示率为82％.经过Logistic回归分析,充盈程度2分、胃窦部、水作为胃腔充盈介质,此3个因素为胃壁分层结构显示的独立相关因素(OR值分别为1.749,1.714及1.791;P值分别为0.000 8,0.000 2及＜0.000 1).结论 非低张条件下,水适度充盈胃腔可提高增强CT对胃壁分层结构的显示率,进而满足对胃壁病变浸润深度判断的要求.

Objective To evaluate preoperative staging by multidetector computed tomography (MDCT) for nonperitonealized colon cancer.Methods From January 2009 to December 2014,97 staging Ⅱ A nonperitonealized colon cancer patients at the Department of General Surgery,Peking University People's Hospital were enrolled in the study.Radiological T staging was evaluated through preoperative MDCT and statistical analysis was performed to evaluate the prognosis of different stages.Results There were 1 case of T2 stage,33 cases of T3 stage and 63 cases of T4 stage.Patients with radiological T3 and T4stages had significantly different survivals (x2 =9.174,P =0.002).According to the imaging standards,tumor invasion depth (extramural tumor depth,EMD) was estimated as 13 cases of EMD ＜ 1 mm,31 cases of1 mm≤EMD≤5 mm,39 cases of 5 mm＜EMD＜15 mm,14 cases ofEMD＞15 mm.The 3 year's disease-free survival was significantly different between groups of EMD 1-5 mm and 5-15 mm (x2 =4.549,P =0.033).The 5-year overall survival was also significantly different (x2 =10.315,P =0.001).Multi-variate analysis showed radiological T staging (RR =5.919,95％ CI:1.301-26.933,P =0.021) and EMD (RR =8.001,95％ CI:1.657-38.664,P =0.010) were independent prognostic factors.Conclusions MDCT can make pre-operative staging for the nonperitonealized colon cancer and this radiological T staging and EMD are independent poor prognostic factors in colonic neoplasms.

目的 探讨乳腺磁共振简易序列(BMRI-AP)筛选乳腺癌的临床可行性.方法 收集2010年5月至2014年12月北京大学人民医院214例经钼靶或超声怀疑乳腺单发结节的女性病人行BMRI检查.以术后病理学检查为金标准,比较BMRI-AP和全扫描序列(BMRI-FDP)筛选乳腺癌的敏感度、特异度、阳性预测值及阴性预测值.结果 BMRI-AP及BMRI-FDP检查及阅读时间分别为5 min,45s及25min,1200s,均检出全部119例乳腺癌.BMRI-AP诊断乳腺癌敏感度(97.5％)及阴性预测值(95.9％)高于BMRI-FDPF(95.8％和94.0％),但差异无统计学意义(P=0.72和P=0.72).尽管BMRI-AP诊断乳腺癌特异度(73.7％)和阳性预测值(82.3％)低于BMRI-FDP(82.1％和87.0％),但同样差异无统计学意义(P=0.22和P=0.32).结论 BMRI-AP与BMRI-FDP相比,诊断乳腺癌的敏感度及特异度相似,但检查和阅片时间却显著缩短.BMRI-AP是临床可行筛选乳腺癌的影像学方法.

Objective The purpose of this study was to identify the prevalence and structure of radiology residents teaching skill and assess the satisfaction and benefits provided by the development program for teaching skills.Methods Study participants were radiology residence with membership in the Beijing Standardized Residents Development Program in Radiology.A 2 hours development program related with teaching skill was provided by residency program directors in Peking University Radiology Department.Questionnaire before and after the training program were set respectively.Results Based on questionnaire after training program,all participants satisfied with training program and agreed that it was didactic programs on their teaching skills.All residents made medical course by case study one by one each week as their reports after training.In addition,3 residents were provided opportunities to have a medical course for medical students and got the feedback from tutors and students.Conclusions As an essential part of resident training program,the course associated with teaching skills for the radiological residents provided benefit for the progression competency.

Objective To evaluate clinical features of primary and secondary hyperparathyroidism in perioperative period in term of the changes of PTH level,blood calcium and blood phosphates as a judge of the effect.Methods Clinical data of 24 hyperparathyroidism cases admitted from August 2010 to January 2013 to the Department of Gastrointestinal Surgery,Peking University People's Hospital were retrospectively analyzed.Results The lesion detect rate performed by the professional B ultrasound examiners was 97.56％ (40/41).The ioPTH value in all 24 cases decreased rapidly within 15 minutes after parathyroidectomy to 11％ at average compared to those at the beginning of operation.In the next 72 hours,PTH level continuously decreased in the secondary hyperparathyroidism patients,however,began to rise in 24 hours after the operation in the primary hyperparathyroidism patients.With the decrease of PTH,the blood phosphates level in the secondary hyperparathyroidism patients went into normal range in about 6 hours after operation,blood calcium level dropped to normal range in about 6 hours postoperatively in primary hyperparathyroidism patients.Conclusions The lesion determination rate of B ultrasound performed by professional examiners is higher than that of other examination methods.ioPTH measurement is an important means to judge the effect of surgical resection in the operation,but in cases of secondary hyperparathyroidism 50％ decrease of original ioPTH value is enough to judge complete parathyroidectomy only in combination with preoperative imaging results.

患者女,43岁,体检发现右肾占位1月余.患者无血尿、腰部疼痛不适,无尿频、尿急、尿痛.B超示右肾下极低回声,约8.3 cm×7.3 cm×6.0 cm,边界清楚,形态规则,存在彩色血流信号,肾门处肾静脉血流通畅.CT:平扫示右肾下极皮质内软组织肿块,向肾外突出,约6.2 cm×5.6 cm×5.4 cm,边界清楚,类圆形,混杂密度,平扫CT值14～39 HU,增强扫描不均匀强化,动脉期CT值25～56 HU,静脉期CT值39～86 HU;双肾皮质存在多发实性结节,均突出于肾皮质外,直径均小于1 cm;右肾门水平肾盂旁见2个软组织团块,约7.4 cm×6.7 cm、3.1 cm×1.6 cm,边界清楚,平均CT值约21 HU,增强扫描不均匀强化,动脉期、静脉期CT值分别为11～52 HU、13～44 HU;双侧髂骨、肋骨、椎体及附件多发的点片状成骨性骨质破坏.