目的 分析磁共振成像(MRI)不同扫描序列对胎盘植入患者诊断及分级评估的价值.方法 选择2017 年3 月-2019年6月台州市第一人民医院妇产科收治的52例产前B超检查怀疑胎盘植入的孕妇为研究对象,采用1.5T MRI 系统对患者分别进行T2加权成像(T2WI)序列、单次激发平面回波成像(SSEPI)序列、单次激发快速自旋回波(SSFSE)序列扫描.以病理检查结果为金标准,观察不同类型胎盘植入3 种序列影像学图像,分析3 种序列MRI特征检出情况及对不同胎盘植入类型及分级的评估价值.结果 3种序列对胎盘信号不均、子宫肌层连续性中断、胎盘侵及子宫肌层、胎盘与子宫肌层间低信号带消失的检出率比较差异有统计学意义(均P＜0.05).T2WI、SSEP列、SSFSE诊断胎盘植入的灵敏度分别为25.00％(4/20)、80.00％(16/20)、90.00％(18/20),特异度分别为87.50％(28/32)、87.50％(28/32)、93.75％(30/32),阳性预测值分别为55.56％(4/9)、80.00％(16/20)、90.00％(18/20),阴性预测值分别为65.11％(28/43)、87.50％(28/32)、93.75％(30/32),诊断符合率分别为61.54％(32/52)、84.62％(44/52)、92.31％(48/52).T2WI与病理检查胎盘植入分级的符合率为65.00％(13/20),SSEPI 与病理检查胎盘植入分级的符合率为80.00％(16/20);SSFSE与病理检查胎盘植入分级的符合率为80.00％(16/20).结论 T2WI易造成伪影,SSEPI可对胎盘植入程度进行定量分析,SSFSE分辨率相对较高,三者联合应用可提高胎盘植入诊断率.

目的:分析Tourette综合征患儿症状严重程度与静息态功能磁共振脑低频振幅(ALFF)的关系.方法:选取台州市第一人民医院2017年2月至2018年4月所收治20例首发Tourette综合征患儿,均接受静息态功能磁共振扫描检查,分别在不同频段对脑ALFF值进行计算,探讨症状严重程度与脑ALFF值的相关性.结果:左额上回眶部、右额中回、左额中回眶部的症状严重程度评分与脑ALFF值表现为正相关(P<0.05);左距状沟、右距状沟及其周围皮质的症状严重程度评分与脑ALFF值表现为负相关(P<0.05).结论:Tourette综合征患儿的症状严重程度与特定区域脑功能活动异常存在显著相关性.

Objective:To investigate the expression of circ0008234 and miR-1205 in breast cancer and the oncology characteristics of CT.Methods:40 patients with breast cancer were collected as observational objects from Jan.2018 to Dec.2018 and 40 patients without breast cancer were selected as the control group. The expression levels of circ0008234 and miR-1205 of all patients were estimated by quantitative real-time polymerase chain reaction. Bioinformatics was used for the predictions of circ0008234 target miRNA. A dual-luciferase reporter assay was used to confirm the interaction between circ0008234 and miR-1205. All patients of the observation group were examined by multi-slice CT. CT images were analyzed through observing tumor size, shape, calcification area, lymph node metastasis and margin. The correlation between CT signs and the expression of circ0008234 and miR-1205 was further analyzed.Results:The levels of circ0008234 of observation group were significantly higher than those of the control group (2.23±0.86, 1.07±0.37, P=0.00) , but the expression levels of miR-1205 were lower than the control group (0.76±0.29, 1.04±0.29, P=0.00) . In the observation group, there were no significant differences in the expression of circ0008234 and miR-1205 among patients with different tumor marginal morphology and micro calcifications. However the expression of circ0008234 in patients with regular lump form were significantly higher than those in patients with inregular form (2.52±0.88, 1.91±0.74, P=0.025) , and the expression of miR-1205 were lower than those in patients with inregular form (0.66±0.30, 0.86±0.25, P=0.025) . In the observation group, the expression of circ0008234 in patients with mass diameter≥2 cm were significantly higher than those in patients with mass diameter<2 cm (2.59±0.95, 1.69±0.17, P=0.001) , but the expression of miR-1205 were lower than those in patients with mass diameter<2 cm (0.65±0.21, 0.92±0.33, P=0.003) . In the observation group, the expression of circ0008234 in patients with lymph node metastasis were higher than those without lymph node metastasis (2.55±1.09, 1.94±0.44, P=0.022) , but the expression of miR-1205 in patients with lymph node metastasis were lower than those without lymph node metastasis (0.65±0.26, 0.85±0.30, P=0.027) . miR-1205 was verified as a direct target of circ0008234 by luciferase assay. circ0008234 could negatively regulate the expression of miR-1205. Conclusion:There is a correlation between CT imaging signs and the expression of circ0008234 and miR-1205 in patients with breast cancer, which can provide more reference for the judgment of malignant degree and prognosis of patients with breast cancer.

四肢骨松质内混合型骨瘤发生率非常低,文献少有报道.骨瘤主要发生于颅盖骨、面部骨骼的皮质,少数发生于松质.四肢骨髓腔内混合型骨瘤罕见,易误诊为其他骨质病变.现将台州市第一人民医院1例进行报告.

目的 探讨弥散加权成像及动态增强扫描对老年早期强直性脊柱炎骶髂关节的评价价值.方法 选择老年早期强直性脊柱炎患者60例作为强直性脊柱炎组,老年健康体检者60例作为对照组.强直性脊柱炎组和对照组进行弥散加权成像及动态增强扫描.结果 强直性脊柱炎组骶侧和髂侧表观弥散系数(ADC)值均明显高于对照组(P<0.05).强直性脊柱炎组和对照组骶侧和髂侧时间-强度曲线(TIC)类型比较差异有统计学意义(P<0.05),强直性脊柱炎组骶侧和髂侧TIC以Ⅱ型为主,对照组骶侧和髂侧TIC以Ⅲ型为主.强直性脊柱炎组骶髂关节达峰时间(TTP)、信号增强比率(SER)、最大上升斜率(MSI)、峰值信号强度(SIpeak)均明显高于对照组(均P<0.05).ADC、TTP、SER、MSI、SIpeak诊断强直性脊柱炎的最大曲线下面积(AUC)分别为0.82、0.74、0.79、0.71、0.84,灵敏度分别为85.46％、67.83％、74.21％、68.42％、81.26％,特异度分别为72.13％、71.23％、67.58％、73.45％、77.43％.结论 弥散加权成像及动态增强扫描对老年早期强直性脊柱炎骶髂关节改变有一定的诊断价值,SIpeak的诊断效能最高.

目的：探讨64排螺旋CT低剂量扫描在肺孤立小结节的良恶性病变的鉴别与诊断价值。方法对收治的肺孤立性小结节病变56例患者进行64排螺旋CT低剂量扫描复查，并与穿刺活检或手术病理确诊结果进行对比研究。结果64排螺旋CT低剂量扫描对肺孤立性小结节病变的良、恶性鉴别诊断的敏感性为93．10％，特异性为88．46％，准确性为90．91％。恶性病变患者的CT影像学表现与良性病变比较存在明显差异，其中恶性病变患者的边缘大部分呈现不规则或分叶，而良性病变患者的边缘则呈现清楚的状态，且差异具有统计学意义。另外，良性病变患者的内部结构表现为钙化的例数明显多于恶性病变患者，且差异具有统计学意义。炎性结节组和恶性结节组患者在动态增强扫描期间，在各时间点的CT值均明显高于良性结节组，且差异具有统计学意义。对比炎性结节组和恶性结节组的不同时间点动态增强CT值可以发现炎性结节组在30s、90s、180s的动态增强CT值均升高，但是两组无差异（ P ＞0．05）；而在300s和480s，炎性结节组的动态增强CT值明显下降，而恶性结节组则下降不明显，而且炎性结节组在300 s和480 s的动态增强CT值明显低于恶性结节组，且差异具有统计学意义）。结论64排螺旋CT低剂量扫描可以为鉴别和诊断良、恶性肺孤立性小结节病变提供有利证据。

目的 比较核磁共振成像(MRI)与CT在鼻咽癌诊断中的应用价值.方法 选取鼻咽癌患者60例,均行鼻咽部MRI和CT检查,并对患者进行鼻内镜下取材病理检查确诊.依据病理组织活检和临床随访分别对MRI与CT的诊断效果进行评价,比较其检查的灵敏度、特异性和准确度.结果 MRI与CT对鼻咽癌T分期检查结果一致者45例(75.0％),对N分期诊断一致者54例(90.0％),对临床分期诊断检查结果一致者55例(91.7％).在鼻咽癌转移淋巴的检查中,CT检查的效果均明显优于MRI检查.而且CT与MRI检查对头长肌、咽旁间隙、颈动脉鞘等病灶部位的检出率差异均有统计学意义(x2=10.23、9.41、6.82,均P＜0.05),MRI检查效果优于CT.结论 MRI与CT在诊断鼻咽癌时有各自的优缺点.CT检查有利于评价淋巴转移情况并给出关于肿瘤的准确数据,MRI检查有助于发现鼻咽癌原发灶.应用时应将两者结合应用,可以提高诊断的准确度。

Objective To investigate the association between cerebral ischemia symptoms and carotid stenosis measured by multi-detector-row CT angiography(MDCTA) and to identify a reliable carotid stenosis threshold that was associated with cerebral ischemia symptoms.Methods 230 patients were studied for suspected carotid artery stenosis by using MDCTA and cerebral ischemia symptoms were recorded.In each patient,carotid artery stenosis was quantified and categories of atherosclerotic plaque were recorded using MDCTA.A ROC curve was calculated to identify a specific carotid stenosis threshold for the prediction of symptoms.Multivariate logistic regression analysis was used to estimate the strength of association between cerebral ischemia symptoms and carotid stenosis,categories of atherosclerotic plaque and other factors.Results Diameter of carotid artery in patients with symptoms was smaller than that of patients without symptoms.The ROC curve indicated that a threshold of 1.6 mm stenosis was associated with cerebral ischemia symptoms,with a sensitivity of 0.734,a specificity of 0.638,and AUC of 0.720.Multiple logistic regression analysis confirmed that symptoms were associated with increased luminal stenosis and with the presence of soft plaques.Conclusion Luminal stenosis identified by MDCTA is a reliable predictor for cerebral ischemia symptoms.The results suggest an association between luminal stenosis,soft plaques and the presence of cerebral ischemia symptoms.MDCTA is worthy to apply further for prevention and treatment of stroke.

<正>前列腺癌(prostate cancer)在老年男性中的发病率逐年增高[1],随病情的发展,癌肿常侵犯邻近组织器官,并可以引起广泛的骨骼转移,严重影响了患者的生存时间和生活质量,早期、准确的诊断对患者预后有十分重要的意义。在设备不断更新和技术快速进步的基础上,磁共振功能成像迅速发展,扩散加权成像(diffusion weighed imaging,DWI)就是其中常用的一种[2]。笔者通过对比分析前列腺癌、前列腺增

目的:分析总结了19例错构瘤的CT表现,以提高肾错构瘤的CT诊断率.方法:双肾常规平扫增强,层厚5mm,螺距1.5∶1,可疑小病灶拆薄后重建处理.结果:含脂肪组织较多的肿瘤14例;少脂或无脂肿瘤5例.拆薄后重建发现两例病灶未能发现的脂肪成分,一例可疑小病灶证实为病变.结论:含脂较多的错构瘤有典型的CT表现,诊断容易.少脂或无脂的错构瘤及细小病灶经拆薄重建后能提高诊断率.

后重建成像是近几年伴螺旋CT开发的新技术,是对传统放射、普通CT技术的重要补充.怎样正确运用螺旋CT的重建技术,使正常解剖结构及异常病灶显示更清晰,减少假阳性、假阴性是我们放射工作者的共同心愿.我科从2003年1月引进8排螺旋CT至2005年1月对数百名患者进行螺旋扫描并进行重建,在此作者谈谈自己工作中的经验体会,与同道进行交流,希望可以进一步提高螺旋CT的应用效能.

Objective:To compare valued of CT and MRI in the diagnosis of acoustic neuroma.Methods:To analyze retrospectively CT and MR manifestations of acoustic neuroma of 26 cases proved by surgery and pathology.Results:On MR,acoustic neuroma presented mass lesion.The lesion appeared hypointense or isointense on T 1WI and hyperintense or heterogenerous signal intensity on T 2WI.The parenchymal part of the lesion and the widening acoustic nerve were seen obvious contrast enhance and showed apple stem shape.On CT,the lesion showed equal or low density in cerebellopontine angle.The ipsilateral opening of internal auditory meatus showed enlargement with thin scaning.Conclusion:On CT,the opening of interal auditory meatus could be displayed with direct manner but easily neglected in common scanning.On MR,the advantages of multiplaner imaging without bone artifact were valuable to the display of acoustic neuroma body and ipsilateral auditery nerve widening.the acoustic neuroma was characterized by the sign of apple stemon postcontrast image.