患者女,34岁,因“左下腹胀痛2年”入院.查体:腹肌无强直,全腹未触及肿块.CT:左侧腹膜后肾上腺区约3.5 cm×2.3 cm×3.7 cm分叶状肿块(图1A),边界清,其内密度不均,周围及分隔可见钙化;增强扫描肿块呈渐进性延迟强化(CT值约69～89 HU,图1B),病灶与肾上腺外侧支分界欠清.行腹腔镜下左侧肾上腺肿物切除术.术后病理检查示肿块呈广泛玻璃样变,可见散在灶性淋巴细胞聚集,有包膜,包膜下残留少许肾上腺皮质细胞(图1C).病理诊断:(左肾上腺)韧带样纤维瘤.

The present study evaluated three-dimensional proton magnetic resonance spectroscopy (MRS) and diffusion-weighted imaging (DWI) features in differentiating incidental prostate carcinoma (IPCa) and benign prostate hyperplasia (BPH) in the central gland of the prostate. The clinical and imaging data of 9 patients with IPCa, 118 patients with BPH [including those with glandular hyperplasia (GH), stromal hyperplasia (SH) and mixed hyperplasia (MH)], were retrospectively analyzed. The mean (choline + creatine)/citrate (CC/C) value of 3D MRS, the apparent diffusion coefficient (ADC) value and the minimal ADC value of DWI were compared between carcinoma and non-carcinoma tissues. The mean CC/C values were 1.04±0.28, and 1.09±0.58 in IPCa and BPH, respectively (t=-0.205, P=0.838). No significant difference in CC/C values (χ2=2.595, P=0.458) could be detected between IPCa, GH, SH and MH groups. The ADC values of the central gland only differed between IPCa (1.48±0.18) ×10-3 and GH (1.60±0.16) ×10-3 mm2/sec (P=0.037). The minimal ADC values were similar between IPCa (1.15±0.10) ×10-3 and BPH (1.14±0.11) ×10-3 mm2/sec, no significant differences could be detected between IPCa and GH (P=0.930), IPCa and SH (P=0.192), and IPCa and MH (P=0.544). Although the ADC values of the central gland of the prostate differed between IPCa and GH, the findings of the present study therefore indicate that combining 3D MRS with DWI cannot potentially improve the detection of IPCa.

目的 采用 Meta分析评价扩散峰度成像(DKI)在乳腺良恶性病变鉴别诊断中的价值.方法 检索 Pubmed、Cochrane协作网、Cochrane图书馆、OVID、中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(CNKI)、万方数据知识服务平台、维普中文科技期刊数据库(VIP)自建库以来至 2017 年 3 月国内外公开发表的关于DKI在乳腺良恶性病变鉴别诊断中的价值的中英文文献.按照Cochrane协作网推荐的诊断试验纳入标准筛选文献,并对纳入研究进行质量评价后提取相关数据.采用 Review Manager 5.3 进行数据分析,合并诊断效应量标准化均数差值(SMD)、诊断比值比(DOR)及绘制汇总受试者工作特征曲线(SROC曲线),计算曲线下面积(AUC).结果 共纳入 7 篇文献,病灶 644 个,乳腺恶性病变的平均扩散峰度(MK)明显高于良性病变(SMD 1.66,95%CI 1.21~2.10;Z=7.31,P＜0.000 01),其中5 篇文献可提取敏感度、特异度、AUC及截点数据,汇总敏感度(SEN)、特异度(SPE)及DOR分为0.92(95%CI 0.88~0.94)、0.87(95%CI 0.81~0.91)、79.07(95%CI 43.35~144.22),AUC为0.956 2.结论 DKI定量参数 MK在乳腺良恶性病变鉴别诊断中有较可靠的应用价值.

患者男,22岁,主因"发现右上臂肿物6个月"入院。患者半年前右上臂被蚊虫叮咬后出现红肿,于局部皮下可扪及肿物,并缓慢增大突起于皮肤表面,无疼痛及瘙痒不适。否认局部外伤史。查体:右上臂可扪及一突起肿块,约3.0cm×2.0cm,质韧,肿块与皮肤粘连,无压痛,表面皮肤颜色无明显

Objective:To analyze the CT and MR characteristics of central nervous system (CNS) neuroblastomas and explore the diagnostic value of CT and MRI.Materials and Methods:CT and MR imaging features of 6 patients with CNS neuroblastomas confirmed by pathology were analyzed retrospectively.Results:Six patients were enrolled,5 patients were male and 1 female,their age ranged from 3-24 years old and the average age 13.8 years old.Among them,3 cases were above tentorium,temporal lobe (1),occipital lobe (1),parietal lobe (1).And 2 cases were below tentorium,fourth ventricle (1) and the pons (1),the rest 1 case was astride left cerebellum tentorium.Two cases were cystic-solid mass,4 cases were mainly solid mass.The solid part of tumor presented iso-or hypointense on T1WI,iso-or hyperintense on T2WI,and iso-or slightly hyperintense on T2 FLAIR,after contrast,2 cases with no obvious enhancement,and 4 cases with significant enhancement.The cystic part of tumor displayed hypointense on T1WI,hyperintense on T2WI,and hypointence on FLATR sequence.The tumor were well defined and peritumoral edema was not obvious.On CT,the tumor solid compontent showed iso-or hyperdensity,calcification may be seen,and the cystic compontent showed hypo-density.Conclusions:The imaging of CNS neuroblastoma has certain characteristics on CT and MRI.It may help to the diagnosis and differential diagnosis of the disease based on tumor location,boundary,signal (or density),edema,enhancement,etc.

Objective To evaluate the applying value of DKI in the grading of cerebral gliomas with Meta-analysis.Methods Published papers in Chinese and English literature on the use of DKI in the grading of cerebral gliomas were searched from Pubmed,Cochrane collaboration,Cochrane library,OVID,China bio-medicine Database,China National Knowledge Infrastructure (CNKI),Wanfang Chinese Periodical Database and VIP Database from inception to May 2016,and select according to the criteria of diagnostic recommendation by the Cochrane Method Group.Quality evaluation was performed for the eligible papers before data extraction.Statistical analysis was performed with software Meta-Disc 1.4,the magnitude of the diagnostic effect was calculated and a summary receiver operating characteristic (SROC) curve was drawn to obtain the area under curve.Results In total,5 studies with 265 lesions were considered for this analysis.The pooled sensitivity,specificity,Diagnostic odds ratio,positive likelihood ratio,negative likelihood ratio was 0.88 (95 ％ CI 0.81 ～0.93),0.87(95％ CI 0.81 ～0.91),52.49(95％ CI17.36 ～ 158.67),6.25 (95％ CI 3.17 ～ 12.32),0.16(95％ CI 0.08 ～ 0.36),respectively.The area under the curve of summary receiver operating characteristic was 0.9439.Conclusion Diffusion kurtosis imaging has high applicability in differentiating glioma grades.

Objective To assess the diagnostic value of coronary CTA (CCTA) combined myocardial CT perfusion imaging (CTP) in coronary artery disease (CAD) with Meta-analysis.Methods Chinese and English literatures evaluating CCTA combined CTP in diagnosis of CAD in PubMed,Wed of Science,Cochrane Library,China National Knowledge Infrastructure (CNKI) and Wanfang Periodical Database from inception to December 2016 were searched.The extraction was conducted according to the criteria for diagnostic recommended by Cochrane Method Group.The quality of included studies was assessed with quality assessment of diagnostic accuracy studies-2 instrument.The statistical analysis was performed by Meta-disc 1.4 software,the diagnosis efficacy was calculated and the symmetric receiver operating characteristic curves (SROC) was drawn to obtain the area under curve (AUC).Results Five studies involving a total of 611 vessels were included.The pooled sensitivity (SEN),specificity (SPE),diagnostic odds ratio (DOR),positive likelihood ratio (PLR),negative likelihood ratio (NLR) were 0.96 (95％CI [0.92,0.98]),0.91 (95％CI [0.88,0.94],206.14 (95％CI [100,424.94]),9.33 (95％CI [5.57,15.61]),0.06 (95％CI [0.03,0.13]),respectively.The AUC of SROC was 0.977.Conclusion CCTA combined CTP has significant value in diagnosis of CAD.

目的 应用Meta分析方法评价MSCT灌注成像鉴别诊断肺结节良恶性的价值.方法 检索Cochrane图书馆、Cochrane协作网、Pubmed、Web of science、中国知网及万方数据库中于2004年1月——2015年10月发表的有关CT灌注成像诊断肺结节的中英文文献,提取符合纳入标准的诊断试验数据.采用Meta disc 1.4分别汇总MSCT以不同灌注参数[血容量(BV)、表面通透性(PS)、BV+ PS]诊断恶性肺结节的敏感度、特异度及95％可信区间(CI),拟合工作特征曲线(SROC)并计算曲线下面积(AUC).结果 共纳入文献18篇,肺结节1221个,其中恶性结节780个,良性结节441个.依次以BV、PS、BV+ PS作为灌注诊断指标进行分析,其汇总敏感度分别为0.91[95％ CI(0.89,0.93)]、0.88[95％CI(0.85,0.90)]、0.91[95％ CI(0.88,0.93)],汇总特异度分别为0.77[95％ CI(0.73,0.81)]、0.83[95％ CI(0.79,0.86)]、0.91[95％CI(0.87,0.94)];相应AUC分别为0.92、0.93、0.97.结论 MSCT以BV、PS作为灌注诊断参数对鉴别肺结节良恶性具有较高的敏感度及特异度,当二者结合时诊断效能更高,可作为鉴别诊断的标准化灌注指标.

Objective To study the ratio changes of systemic circulation and pulmonary circulation blood flow of the lungs in normal subjects,and compare the perfusion parameters among the normal in a different district. This is done to explore the feasibility and superiority of low-dose CT pulmonary perfusion by using the 320-detector row dynamic volumetric CT. Methods A total of 20 patiens in our hospital were collected from 2014 May to 2015 January. A Toshiba 320-detector row dynamic volumetric CT scanner( Aquilion One,Japan Toshiba medical device company) was used for lung volumetric scan in this study and with scanning parameters of 80 k V,70 m A current,and AIDR image reconstruction. The volume data was processed with the image post-processing software,and 4 time-density curves were produced,meanwhile the time to peak( TTP) is recorded. In order to evaluate from the gravitational( ventral,middle,dorsal) and non-gravitational direction( upper,middle and lower),the regions of interest in the various places were selected,and finally the lung parenchyma pseudo color perfusion images were displayed,which revealed the pulmonary artery flow( PAF),bronchial artery flow( BAF) and perfusion index[PI = PAF /( PAF + BAF) ]. We selected each region to measure at three consecutive levels and respectively achieved average perfusion parameters( PAF,BAF,PI) in every region. The statistical analyses of the data obtained from above were performed to analyze the difference in perfusion of various regions in normal subjects from the gravitational and non-gravitational direction with the single-factor analysis of variance. Results The total radiation dose was 4. 02 m Sv per subject. There was visible difference in PAF in the direction of gravity in the normal lung parenchyma group( F = 13. 29,P = 0. 00),PAF was 123. 2 ± 32. 9,137. 1 ± 33. 6,158. 5 ± 38. 7 ml·min- 1·100ml- 1from ventral to dorsal respectively and there was a significant statistical difference between each other,but there was no obvious difference in BAF and PI. In the non-gravitational direction,PAF,BAF and PI all had a marked difference in total( P <0. 05),but if compared with each other,it displayed a significant statistical difference only between the upper and lower region( P < 0. 05) Conclusion The low dose of lung perfusion scanning by using 320-detector row dynamic volumetric CT scan can quantitatively assess the proportion of pulmonary and systemic circulation in normal subjects. About 98. 76%normal pulmonary parenchyma was supplied by the pulmonary artery,bronchial arterial blood was a very small percentage,and PAF and BAF in gravitational and non-gravitational direction were influenced by gravity and blood flow distribution.

患者男,40岁,反复咳嗽两年余,加重伴发热2天入院.肺呼吸功能检查:轻度阻塞性通气功能障碍.X线胸片检查:未见明显异常.CT检查:右侧中间段支气管见一类圆形软组织肿块,跨支气管壁生长,部分突入气管腔内,病灶呈宽基底与管壁相连,邻近管壁不均匀增厚,肿块大小约1.8 cm×1.2 cm×2.1 cm,边界清晰(图1A),平扫CT值约71 HU(图1B),增强扫描呈不均匀明显强化,动脉期CT值约185 HU(图1C),CT诊断为血管源性肿瘤,血管周细胞瘤可能.

患儿男,2岁,因发现右眼肿物1个月、渐进性增大8天入院.查体:右侧眼眶外侧壁扪及一肿块,质软,边缘光滑.CT平扫:右侧额颞部占位、破坏邻近额骨及右侧眼眶外侧壁.MRI:右侧眼眶外侧壁膨胀性分叶状肿块,大小4.61 cm×3.22 cm×3.61 cm,周围见低信号环,T1WI呈等、低信号,T2WI呈多房囊实性混杂信号,囊内可见液-液平面(图1A、1B),增强扫描示囊壁和实性部分强化,囊内容物未见强化(图1C).

Atherosclerosis (AS)is a chronic inflammatory autoimmune disease,AS is closely related to the innate im-munity and adaptive immunity.Toll-like receptors (TLRs)are pathogen pattern recognition receptors that recognize bac-terial and viral products,and other pathogens,and then activate immune response.Toll-like receptor 9 is an important member of the TLR family.TLR9 has been identified as the important receptor in innate immunity for CpG DNA from bacterias and virus,and is closely related to the occurrence of atherosclerosis development.Collective evidence suggests that TLR9 is closely related to the occurrence and development of atherosclerosis including endothelial damage and foam cell formation.However,other studies found that TLR9 has potential protective effect in the process of AS.This paper summarizes the latest evidence in research on the role of TLR9 in AS,and briefly demonstrates the relationship between TLR9 and dendritic cell,autophagy,and then TLR9 as a potential target for the treatment of atherosclerosis provides a new train of thought.

AbstractObjective:To summarize the CT and MRI findings and differential diagnosis of chordoid glioma in the third ventricle and to explore the diagnostic value of imaging examination.Materials and Methods: Three patients (two males and one females; range, 7-34 years) with chordoid glioma in the third ventricle conifrmed by biopsy pathology were enrolled. The symptoms, imaging findings and pathology were retrospectively analyzed, and then a review of the literature was performed. Results:The symptoms were usually obstructive hydrocephalus, progressive headache, neuroendocrine symptoms. All the three tumors located in the third ventricle. The tumor usually represented as a large, well-circumscribed ovoid and hypodense lesion on CT. No cystic or necrotic changes were found. Only one case had peripheral calcification, as hyperdense on CT. On MRI, the lesions all showed homogeneous hypointensity on T1-weighted image and hyperintensity on T2-weighted image. Two cases showed heterogenously enhancement, while the other one showed homogeneously enhancement. Microscopically, the tumor cells arranged in clusters or scattered in a mucinous background. Tumor cell nucleus were round, oval or offset, chromatin were granulated or nubby, the nuclei were small and hyperchromatic, nuclear fission were rare. Necrosis was not identified, new blood vessels showed proliferation. Immunohistochemically, tumor cells were stained positively for GFAP and vimentin.Conclusion:There are several characteristic CT and MRI findings of chordoid glioma in the third ventricle. The diagnosis can be made when combining image ifndings with clinical ifndings. The ifnal diagnosis should be conifrmed by histopathology and immunohistochemical staining.

BACKGROUND:The objective of this meta-analysis was to evaluate the clinical usefulness of K, Kep, and Ve values in the differential diagnosis of prostate cancer (PCa) and noncancerous tissue in the peripheral zone (PZ) and central gland (CG). METHODS:A search was conducted of the PubMed, MEDLINE, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases from January 2000 to October 2015 using the search terms "prostate cancer," " dynamic contrast-enhanced (DCE)," "magnetic resonance imaging," "K," "Kep," and "Ve." Studies were selected and included according to strict eligibility criteria. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were used to compare K, Kep, and Ve values between PCa and noncancerous tissue. RESULTS:Fourteen studies representing 484 patients highly suspicious for prostate adenocarcinoma were selected for the meta-analysis. We found that K values measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) were significantly higher in PCa tissue than in noncancerous tissue in the PZ (SMD 1.57, 95% CI 0.98-2.16; z = 5.21, P <0.00001) and CG (SMD 1.19, 95% CI 0.46-1.91; z = 3.21, P = 0.001). Kep values measured by DCE-MRI were significantly higher in PCa than in noncancerous tissue in the PZ (SMD 1.41, 95% CI 0.92-1.91; z = 5.59, P < 0.00001) and CG (SMD 1.57, 95% CI 0.69-2.46; z = 3.49, P = 0.0005). Ve values generated by DCE-MRI were slightly higher in PCa than in noncancerous tissue in the PZ (SMD 0.72, 95% CI 0.17-1.27; z = 2.58, P = 0.010), but sensitivity analysis found that the Ve value was unstable for differentiation between PCa and noncancerous PZ tissue. However, there was no significant difference in the Ve value between PCa and noncancerous CG tissue (SMD -0.29, 95% CI -1.18, 0.59; z = 0.65, P = 0.51). CONCLUSION:Our meta-analysis shows that K and Kep were the most reliable parameters for differentiating PCa from noncancerous tissue and were critical for evaluation of the internal structure of cancer. The Ve value was not helpful for distinguishing PCa from noncancerous CG tissue; its ability to distinguish between PCa and noncancerous PZ tissue remains uncertain.

The morbidity and mortality of lung cancer is high.Early detection,diagnosis and treatment can improve the prognosis obviously.Nowadays,with the developments of CT hardware and software,the low-dose spiral/helical computed tomography(LDCT)have made great advances in lung cancer detecting.The lung owns high natural contrast,which can get a satisfying image and enhance the detection rate by adjusting the CT scanning parameters and optimizing the imaging methods,while reducing the radiation dose as much as possible.Besides the effects of scanning,the size,density and location of nodules are also the factors of affecting detection rate.Research progresses of low-dose chest CT detecting pulmonary cancer were reviewed in this article.

Diffusion tensor imaging (DTI) was used to measure the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) value in amyotrophic lateral sclerosis (ALS) patients to determine their diagnostic value. 69 ALS patients and 23 healthy controls were scanned with DTI sequence in 3.0T MR, and FA and ADC values in 18 regions were evaluated. Compared with the controls, the ADC values of patients in bilateral centrum semiovale, deep frontal and parietal white matter were significantly increased (P < 0.05), while the FA values in cerebral peduncle, posterior limb of internal capsule (PLIC), corona radiata, centrumsemiovale, bilateral deep frontal white matter, the genu and the splenium of the corpus callosum were significantly decreased (P < 0.05). When the FA cut-off value was set to ≤ 0.6860 for the cerebral peduncle, sensitivity (SE) and specificity (SP) of ALS were 95.7% and 83.9% respectively. When the cut-off value was set to ≤ 0.7085 for PLIC, SE and SP were 95.7% and 85.7% respectively. When the cut-off value was set to ≤ 0.6950 for corona radiata, SE and SP were 100.0% and 95.7%, respectively. DTI can be used to quantitatively evaluate injury in ALS patients.

患儿男,7岁,阵发性头痛半个月,伴喷射状呕吐,呕吐后头痛缓解,伴双下肢乏力、行走不稳.查体:闭目难立征(+),余阴性.CT:4脑室见一稍高密度肿块影,约4.2 cm×3.8 cm,内见小点状钙化灶.MRI:4脑室可见一占位,T1WI呈低信号,T2WI呈等高信号,肿块内见散在T1WI更低信号、T2WI高信号影,周围水肿不明显,双侧侧脑室及3脑室积水扩张(图1A、1B),增强扫描肿块呈明显不均匀强化(图1C).DWI肿块为稍高信号.

目的 探讨基于冠状动脉CTA的血流储备分数(FFRCT)评估心肌缺血的准确性.方法 检索2004年1月-2015年2月Pubmed、Cochrane图书馆、Embase、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据知识资源系统关于FFRCT在评估心肌缺血准确性方面的文献,对符合纳入条件的文献行进一步质量评估以及异质性检验.汇总敏感度和特异度,通过汇总工作特征曲线(SROC)和曲线下面积(AUC)评价采用FFRCT诊断心肌缺血的临床价值.结果 共纳入4篇文献,质量分级均为A级.纳入研究的总患者数为662例,血管1117条.FFRCT在患者及血管水平汇总后的敏感度分别为0.90(95％CI 0.85～0.93)和0.83(95％CI 0.78～0.87);特异度分别为0.72(95％CI 0.67～0.76)和0.78(95％CI 0.75～0.81);诊断比值比(DOR)分别为24.34(95％CI 10.84～54.65)和21.09(95％CI 7.51～59.24),AUC分别为0.9415、0.9140.结论 FFRCT能有效提高冠状动脉CTA对心肌缺血的诊断准确性.

患者女,29岁,因右腰部疼痛半月余,于当地医院就诊,CT检查考虑“右肾出血”,予止血、镇痛后症状缓解,但仍触痛明显,为进一步治疗收入我院.查体:右肾区压痛(+),叩痛(+),可触及包块,输尿管全程无压痛.CT:右肾中份实质内可见类圆形肿块向外突出,大小约4.2 cm×5.5 cm×4.5 cm,密度不均,边界较清,CT值约38 HU,增强呈持续不均匀强化,动脉期CT值约50 HU,静脉期CT值约70 HU,肿块周围可见密度不均匀低密度影环绕,增强扫描未见强化,正常肾实质受压变形(图1A～1C).行右肾切除术,术中见右肾体积增大,与周围组织粘连,无法暴露肾蒂,包膜下可见出血.

BACKGROUND Histologic studies have demonstrated that lipid content and its spatial distribution is related to plaque vulnerability. However, in vivo imaging is still limited. Photoacoustic imaging may provide novel in vivo insights into these lipid-rich plaques.OBJECTIVES This study sought to examine whether intravascular photoacoustic tomography (IVPAT) allows localization and quantification of lipid content in atherosclerotic plaques.METHODS Rabbits fed with a high-fat/high-cholesterol diet served as the atherosclerotic model. Catheter-based IVPAT was used to evaluate pixel-based lipid relative concentration (LRC) of the vessel wall. The aorta of 4 groups of rabbits (n = 12) were examined ex vivo with IVPAT after 0, 5, 10, and 15 weeks of a high-fat diet, respectively. Six rabbits underwent 3-dimensional (3D) IVPAT after 20 weeks of the high-fat diet. Three rabbits were examined in vivo using IVPAT without interruption of blood flow. Concentration-based lipid map and quantitative index were calculated. For subsequent histologic correlation, all specimens were evaluated with Oil Red O staining.RESULTS Cross-sectional LRC maps allowed visualization of concentration and depth information of lipid content in the atherosclerotic plaques. Lipid accumulation within plaque, assessed by the maximum LRC, mean LRC, and high lipid content area correlated to duration of a high-fat diet. Three-dimensional LRC maps enabled overall evaluation of focal plaques in an intact explanted aorta including spatial and structural features. In vivo-obtained LRC maps accurately showed the structure of lipid core with high contrast. Ex vivo and in vivo IVPAT results were highly consistent with histological results.CONCLUSIONS In an animal model, IVPAT allowed characterization of spatial and quantitative features of lipid-rich plaques. (C) 2014 by the American College of Cardiology Foundation