目的:通过分析甲状腺相关眼病(TAO)患者糖皮质激素治疗前后眼眶内容物MRI各参数的变化,探讨MRI定量测量对TAO糖皮质激素治疗疗效评价的价值.方法:回顾性分析糖皮质激素治疗前后行眼眶3.0 T MRI检查的活动期TAO患者37例,根据患者主要症状、体征改善情况及临床活动度评分(CAS)变化分为有效组(23例)和无效组(14例),测量2组双眼治疗前后眼球突出度、眼球内侧脂肪厚度、眼外肌最大截面积、眼外肌与同侧颞肌的信号强度比(SIR眼外肌/颞肌),分析治疗前后各参数的变化与CAS变化的相关性.结果:有效组治疗前后SIR眼外肌/颞肌、CAS差异均有统计学意义(均P<0.001).Spearman相关性分析表明,有效组治疗前后SIR眼外肌/颞肌差值与CAS差值相关(r=0.801,P<0.001).ROC曲线分析表明,SIR眼外肌/颞肌治疗前后差值对疗效判断具有一定参考价值(AUC=0.898,P<0.001).结论:MRI定量测量SIR眼外肌/颞肌可评估激素治疗活动期TAO的效果,为临床疗效评价提供依据.

Objective:This study was performed to explore the application value of thoracic CT values on the bone mineral density (BMD) in adult Chinese women.Methods:A retrospective study was used in this work. A total of 287 adult female examiners (aged 21-84 years [mean=55.8±13.6 years]) were recruited from May 2020 to July 2021 at the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine. The participants underwent chest CT scan, and the images were reconstructed by standard algorithm. The BMD and CT attenuation values of the T 7-9 vertebral bodies were measured by quantitative CT (QCT) software and picture archiving and communication systems. The average BMD and CT attenuation values were calculated. The two measurements were also correlated. The BMD of the thoracic vertebra was converted into the BMD of the lumbar vertebra. Diagnosis results were obtained according to the Chinese guideline for the diagnosis criteria of osteoporosis by using QCT. Receiver operator characteristic curves were generated to analyze the sensitivity, specificity, and optimal threshold of the CT values in the diagnosis of osteoporosis (BMD <80 mg/cm 3) and normal (BMD >120 mg/cm 3) BMD. Results:BMDs of the T 7-9 vertebra were (125.17±47.42), (121.84±48.33), and (123.93±49.24) mg/cm 3, respectively, with an average value of (123.67±47.73) mg/cm 3. CT attenuation values of the T 7-9 vertebra were 157.48±56.97), (154.92±58.37), (and 158.03±60.02) HU, respectively, with an average value of (156.81±57.78) HU. CT values and average CT values of each vertebral body in T 7-9 were positively correlated with the BMD of the corresponding vertebral body ( r=0.946, 0.960, 0.956, and 0.968; all P values <0.001). Among the 287 examiners, 77 cases had osteoporosis, 102 cases had osteopenia, and 108 cases had normal BMD. The threshold of <116 HU was 98.6% sensitive and 92.2% specific for distinguishing osteoporosis from osteopenia and normal BMD, with area under curve (AUC) of 0.988 (95% credibility interval [ CI]: 0.997-0.999; P <0.001). The threshold of >170 HU was 100% sensitive and 96.1% specific for the recognition of normal BMD, with AUC of 0.997 (95% CI: 0.993-1.000; P <0.001). Conclusion:The CT attenuation value of the thoracic vertebra can predict the BMD and has a high diagnostic efficiency for BMD. The measurement of the mean thoracic CT value can be used as an adjunct to predict BMD in the high-risk population.

目的:研究胸椎定量CT(QCT)和双能X线吸收检测仪(DXA)对绝经后女性骨质疏松症的诊断差异,以及胸椎QCT在绝经后女性骨质疏松筛查中的价值.方法:选取2020年8月～2021年8月同时行胸部CT与腰椎及髋关节DXA检测的绝经后女性192例,获取胸7-9椎体QCT及腰1-4椎体和左髋关节DXA的BMD和T值,结合文献以胸7-9椎体QCT的平均BMD 90 mg/cm3和136 mg/cm3作为判定骨质疏松和骨量减少的阈值,比较胸椎QCT和双能DXA对绝经后女性骨质疏松症的检出率的差异并评估BMI对腰椎DXA的BMD及T值和胸椎QCT的BMD的影响.结果:192例绝经期女性的平均年龄为64.79岁,胸椎QCT对绝经后女性骨量减少以及骨质疏松症的检出率同腰椎DXA对其检出率有统计学差异(P<0.05),QCT和DXA完全符合者100例(52.08％),不符合者92例(47.92％),其中80例(41.67％)在DXA被低估;不同BMI对腰椎DXA的BMD及T值有统计学差异(P<0.05),而对胸椎QCT的BMD无统计学差异(P>0.05).结论:胸椎QCT对绝经后女性骨质疏松的检出率优于双能DXA,胸部CT检查联合胸椎QCT获得胸椎BMD可指导绝经后女性进行骨质疏松的筛查,在绝经后女性人群中对骨质疏松症的诊断具有重要价值.

目的 探讨胸椎(T7～T9)与腰椎(L1～L3)椎体骨密度(BMD)的差异与相关性,以及T7～T9 BMD诊断骨质疏松的最佳临界值.方法 测量同时行胸腹部CT检查的278例检查者的T7～T9和L1～L3椎体BMD数据,分析两者间的差异与相关性;并以L1+L2为诊断标准,通过受试者工作特征(ROC)曲线分析分别依据T7+T8、T7+T9、T8+T9诊断骨质疏松的最佳临界值.结果 不论男女,T7～T9和L1～L3椎体BMD均与年龄呈负相关.在T7～L3方向,6个椎体BMD呈逐渐减低趋势(P<0.05),且BMD均存在显著相关性(r=0.78～0.99,P<0.01).ROC曲线分析显示依据T7+T8、T7+T9、T8+T9诊断骨质疏松的最佳临界值分别为107 mg/cm3、106 mg/cm3、100 mg/cm3,对应的敏感度分别为87.5％、86.5％、85.4％,特异度分别为87.9％、87.9％、91.8％.结论 T7～T9 BMD均高于L1～L3,存在显著的正相关性.胸椎BMD诊断骨质疏松的参考值高于腰椎的诊断标准值,定量CT测量胸椎BMD诊断骨质疏松应依据胸椎的诊断阈值为参考.

目的:通过定量CT测量,评估受试者注射碘对比剂前后骨密度(BMD)的变化,分析碘对比剂对BMD测量的影响及其与年龄的关系.方法:回顾性分析2019年12月至2020年4月行腹部CT检查的138例患者影像资料,采用QCT测量腰1～腰3椎体平扫、动脉期、门脉期、延迟期的BMD值,计算3个椎体各期相平均BMD及增强前后BMD增加值(△BMD).以平扫BMD作为标准QCT-BMD,采用单因素方差分析比较增强前后各期相BMD的差异,采用两独立样本非参数检验比较老年组与非老年组间各期相△BMD的差异,Pearson相关分析评价增强后各期相与平扫BMD以及△BMD与年龄的相关性.结果:QCT-BMD与增强各期BMD差异有统计学意义(P=0.026、0.000、0.012,均＜0.05),门脉期与动脉期之间差异有统计学意义(P=0.034＜ 0.05),其余各期相间无统计学差异;门脉期及延迟期老年组与非老年组各期相△BMD比较有统计学差异(门脉期P=0.003＜ 0.05,延迟期P=0.009＜0.05).增强后动脉期、门脉期、延迟期与标准QCT-BMD均呈正相关(r=0.992、0.983、0.987,均P=0.000＜ 0.05);门脉期及延迟期△BMD与年龄呈正相关,r值分别为0.307 (P=0.001＜0.05)和0.269 (P=0.000＜0.05).结论:QCT测量增强扫描各期相与平扫之间BMD有较好的相关性,动脉期及延迟期较门脉期更好;门脉期及延迟期BMD增加值与年龄正相关;增强扫描各期相中,应以动脉期作为增强QCT-BMD测量的最佳期相.

目的:研究3.0T磁共振在乳腺癌患者疗效评价方面的应用.方法:研究对象来自我院2015年1月—2020年4月的乳腺癌患者42例,按疗效分为完全缓解组(20例)和非完全缓解组(22例),分析不同组别3.0T磁共振指标之间的差异,研究磁共振指标与患者疗效的相关性.结果:完全缓解组患者的强化率(Enhanced rate,En％)、平均最大强化速率(Slopemax)显著低于非完全缓解组,表观弥散系数(ADC)值显著高于非完全缓解组,差异存在统计学意义(P<0.05).疗效与影像学指标En％、Slopemax呈正相关,与ADC呈负相关(P<0.05).结论:影像学指标与疗效显著相关,在治疗中及时开展3.0T磁共振检查,对于患者的治疗具有积极的意义.

Objective To observe the CT and MRI results of solitary fibrous tumors(SFT) in the abdomen and pelvis, analyze their characteristic imaging, and improve the accuracy of diagnosis and understanding of the disease.Methods Retrospective analysis of 18 cases confirmed by pathology from January 2008 to June 2017[9 men, 9 women, age 41–71(53.0±10.6) years old] through imaging findings and clinical and pathological data of patients with pelvic SFT. Among the 18 patients, 13 received dynamic CT and 5 received dynamic MRI. The tumor size(maximum diameter), morphology, density or signal, dynamic enhancement characteristics, arterial tumor vessels, and tumors were mainly analyzed.Fisher's exact test was conducted to examine the relationship between tumor size, boundary, and morphology of benign and malignant tumors. The differences among the three characteristics in malignant tumors were determined by Fisher' s test.Results① Characteristics of CT imaging: The maximum diameter of tumor lesions in the 13 patients with CT was(2.7–23.4) cm, and the mean diameter was(10.53±6.21) cm. Among the 13 cases, 8 were lobulated and 7 exhibited cystic degeneration. One patient showed calcification. Furthermore, 11 cases of nonuniform enhancement by dynamic enhancement was observed. Delayed enhancement was observed in 8 cases. Mild to moderate enhancement was observed in 2 cases. In 10 cases, pointy and linear enhancement of vessels could be seen at the arterial stage, and in 8 cases, tortuous vessels were observed around the lesions. The maximum diameter of the lesions was (10.0–13.4) cm and the mean diameter was(11.93±3.21) cm.② Characteristics of MRI: The lesion boundaries of 5 patients were clear, and the lesions were lobulated in 4 of 5 patients. In T2 weighted imaging, cystic changes were observed in 3 patients. In 4 cases, scarlike or flaky low-signal areas were found in the lesions, 1 case showed uniform isobaemic signals, and 5 cases presented empty vascular shadows. Moreover, 4 cases indicated an obvious uneven enhancement. Delayed enhancement was observed in 4 cases, and uniform enhancement was observed in 1 case. In 5 cases, vessels were strengthened in the lesion at the arterial stage.③ Pathology results showed that among the 18 SFT cases, 7 were malignant and 11 were benign. For the malignant SFT, 5 of 7 cases exceeded the average diameter[(10.88±5.62) cm], whereas for the benign SFT, only 2 of 11 cases exceeded the mean. The maximum diameter was different between the benign and malignant lesions(χ2=5.103,P=0.039), showing statistical significance.Conclusions Although radiological findings on abdomino-pelvic SFT vary between dynamic contrast enhanced CT and MRI, a hypervascular mass with delayed enhancement is the imaging feature. Peripheral tortuous vessels and filiform vessels in the lesion may reinforce the diagnosis. The low signal of T2 weighted imaging in MRI also has a certain diagnostic value.

目的:研究甲状腺乳头状癌与结节性甲状腺肿CT成像特点的对比.方法:本次研究选取的研究对象为2016年7月12日-2017年7月20日期间本院接收的甲状腺乳头状癌50例和结节性甲状腺肿患者30例,回顾性分析两组患者的甲状腺和肿瘤体积、CT成像特点.结果:甲状腺乳头状癌患者、结节性甲状腺肿患者之间比较左叶[(35.50±48.76)cm3、(64.38±178.75)cm3)]和右叶腺体体积[(37.31±41.27)cm3、(58.66±150.27)cm3]、结节体积[(51.03±136.84)cm3、(22.83±39.88)cm3]存在较大差异(P<0.05);且甲状腺乳头状癌患者、结节性甲状腺肿患者的结节形态、边界、与腺体关系、晕圈、钙化、内部特点、分界等成像特点存在较大差异(P<0.05).甲状腺乳头状癌具有结节不规则、与周围组织边界模糊、多处于腺体被膜外、病灶内呈低密度阴影、伴有晕圈和钙化、呈不均匀的乳头状强化;而结节性甲状腺肿的临床主要表现为甲状腺结节形态规则且呈弥漫性肿大、多发结节,边界清晰且边缘无包膜,伴有出血和钙化情况.结论:在甲状腺乳头状癌患者、结节性甲状腺肿的诊断中采用CT扫描能够有效进行鉴别诊断,提供有效信息以供术前诊断和临床进行参考,便于制定针对性的治疗方案,临床应用价值高.

目的：探讨肛门直肠周围脓肿的MR表现与诊断价值。材料与方法：16例肛周脓肿患者，行MR平扫检查，检查结果与手术对照。结果肛周脓肿6例，肛瘘9例，还有1例误诊为肛周脓肿，检查结果与手术结果基本一致。结果：在T1WI图像上，肛周脓肿表现为条状及片状低信号，T2WI图像上，瘘管及肛周脓肿表现为条状及片状高信号，DWI呈高信号。结论：MR是一种既快速又无损伤、且具有相当高准确性的肛周脓肿检查方法，能给外科手术提供所需的解剖和病理资料。

Objective:To analyze the clinical manifestations of multiple myeloma and the images of whole-body magnetic resonance,to explore the relationship between MRI stage and clinical stage.Methods:15 multiple myeloma patients enrolled.Histological proof of multiple myeloma was obtained in all cases.Fisher exact test is used to analyze MRI stage and clinical stage.Results:The most common clinical manifestations of multiple myeloma are bone pain,fatigue,anemia,and hepatosplenomegaly and superficial lymphadenopathy.15 cases were classified as normal type(4 cases),diffuse type(3 cases),focal type(3 cases),mixed type(4 cases) and "salt and pepper" type(1 case).Conclusion:Multiple myeloma's clinical manifestations is divergent,the most common is bone pain.Whole-body MR has good image effects and evaluation value for multiple myeloma.And,there is no statistical significant difference between MRI stage and clinical stage.

Objective The aim of the study was to evaluate the reliability of whole-body MRI(WBMRI)in detecting osseous metastases.Methods Thirty patients verified with malignant tumor by histology were enrolled.All the patients underwent WB-MRI and bone scintigraphy(BS)with a two week interval.Clinical information,conventional MRI and CT images,and follow-up data were collected as gold standard for the diagnosis of bone metastases.The data of 30 patients and 270 segments as study unit respectively were analyzed.The sensitivity and specificity between WB-MRI and BS were compared with McNemar test.Resuits Bone metastases were confirmed in 27 of 30 patients by gold standard.Twenty-five patients with bone metastases were detected by WB-MRI and no false-positive cases.Twenty-seven patients with bone metastases were Nund by BS but having two false-positive oases.With patients as study unit,the diagnostic sensitivity of WB-MRI and BS were both 92.6%(25/27)and the specificity were 100%(3/3)and 33.3%(1/3),respectively.The area under ROC curve of WB-MRI and BS were 0.9630 and 0.6296,respectively(P>0.05).With segments as study unit,119 bone metastases segments were confirmed.The diagnostic sensitivity of WB-MRI and BS were 90.8%(108/119)and 70.6%(84/119)(P<0.01),while the specificity were 98.0%(148/151)and 90.7%(137/151),respectively(P<0.01).The area under ROC curve of WB-MRI and BS were 0.9438 and 0.8066.The former was obviously higher than the latter(P<0.01).Meauwhile.by WB-MRI,3 cases coexisting with brain metastases,4 cases with lung metastases,and 4 cases with hepatic metastases were found.Conclusion WB-MRI was a good tool for screening osseous metastases.

Objective:To evaluate the skeletal muscle mitochondrial function using in vivo dynamic phosphorus magnetic resonance spectroscopy(31P-MRS) on clinical 3T MR system.Methods:31P-MRS was acquired from skeletal muscles in 20 healthy volunteers,spectra were analyzed using matlab software.Concentration of inorganic phosphate(Pi),phosphocreatine(PCr) and adenosine triphosphate(ATP) of every state were measured from area under the peak separately.Concentration of adenosine diphosphate(ADP) and intracellular pH value were calculated from the biochemistry reaction equilibrium.Results:During exercise,PCr concentration decreased,Pi,Pi/PCr and ADP values increased,in recovery state.Concentration of every phosphate compound come back to the resting state gradually.Conclusion:3 T high field intensity dynamic phosphorus magnetic resonance spectroscopy technique can reflect skeletal muscle mitochondrial function in vivo and provide valuable information to evaluate muscle functional imaging,thereby representing an ideal solution to research muscles related diseases.

Objective To quantitively evaluate the value of computed tomography(CT)obstruction index described by Qanadli et al in monitoring the effect of pulmonary embolism(PE)treated by thrombolysis and(or) anticoagulation.Materials and Methods Fifty-five consecutive patient with PE by computed tomography angiography(CTA)at the initial time(T0)were selected.All patients were treated with thrombolysis and(or)anticoagulation.CTA was performed again as the follow-up evaluation(T1)with the mean interval time 1-6 weeks after therapy.Qanadli obstruction index was calculated at both T0 and T1.Therapeutic effect was evaluated with oxygen saturation(Sat.O2)and pulmonary artery pressure(PAP)using spearman method.Results The improvements of Sat.O2 and PAP immediately occurred in 51 of 55 patients after thrombolysis and(or)anticoagulation therapy.Qanadli obstruction index in the 51 patients decreased from(45.09±18.22)% to(10.86±10.29)% at T0 and T1 respectively with statistically significant difference(P0.001).No statistical significant difference of Qanadli obstruction index between T0 and T1(P=0.080)was found in the rest four patients without improvement of Sat.O2 and PAP.Significant correlations existed between Qanadli obstruction index and Sat.O2(r=0.934),as well as CT obstruction index and PAP(r=0.813).Conclusion Qanadli obstruction index is an accurate,convenient and repeatable tool in quantitively evaluating therapeutic effects of pulmonary embolism(PE)with management of thrombolysis and(or)anticoagulation.