目的:评价超声(ultrasound,US)联合磁共振成像(magnetic resonance imaging,MRI)诊断胎儿胸腹部异常的价值.提出并探讨以染色体检查结果为基础的结构畸形评分(structural malformation score,SMS)的临床意义.方法:通过对2016年3月至2019年9月经US和MRI检查且符合纳入标准的77例胎儿进行回顾性研究,探讨US和MRI联合应用指征,计算US、MRI及US联合MRI检查的敏感性、特异性、阳性预测值、阴性预测值.采用受试者操作特征(receiver operating characteristics,ROC)曲线分析US、MRI联合诊断胎儿胸腹部异常的价值.通过计算染色体阳性病例百分率对胎儿胸腹部结构畸形进行风险等级评估.结果:①鉴别诊断和US应用的局限性是增加MRI联合检查的主要原因.②77例受检孕妇经随访证实正常胎儿(阴性)27例(35.1％)、异常胎儿(阳性)50例(64.9％).US检出阴性25例(32.5％)、阳性52例(67.5％);MRI检出阴性28例(36.4％)、阳性49例(63.6％).US联合MRI诊断的敏感性、特异性、阳性预测值、阴性预测分别为96.0％、92.6％、96.0％、92.6％,明显高于单一US或单一MRI检查.US诊断的ROC曲线下面积(area under the ROC curve,AUC)为0.792,MRI诊断的AUC为0.819,US联合MRI诊断的AUC为0.943.联合方案与单一US和单一MRI两两比较,差异有统计学意义(Z=2.23,P=-0.026;Z=1.97,P=-0.049).③根据染色体阳性病例百分率将SMS分为5个评分等级,即0≤1分＜25％,25％≤2分＜50％,50％≤3分＜75％,75％≤4分＜ 100％,100％评为5分.当4分≤SMS＜ 10分时,建议临床进行染色体或基因检测,当SMS≥10分时,建议临床必要时终止妊娠.结论:US、MRI联合诊断胎儿胸腹部异常的效能最优.准确的诊断和精确的评分对临床决策具有重要指导作用.

目的探索多参数MRI影像组学信号模型预测直肠癌(rectal cancer,RC)KRAS基因突变的价值.材料与方法回顾性分析深圳市人民医院2019年4月至2020年12月104例经病理证实且行术前MRI检查的直肠癌患者的临床病理资料和提取RC的多参数MRI影像组学特征.采用t检验、χ2检验或Mann-Whitney U检验分析临床病理特征和影像组学特征与KRAS基因突变的相关性,将有统计学意义的特征纳入LASSO回归模型进行特征选择和建立影像组学信号.采用受试者工作特征(receiver operating characteristic,ROC)的曲线下面积(area under the curve,AUC)评价影像组学信号对KRAS基因突变的预测效能.结果临床病理资料在有无KRAS基因突变间差别无统计学意义.321个影像组学特征中,单因素分析表明16个影像组学特征与KRAS基因突变有相关性.LASSO回归筛选出7个影像组学特征构建影像组学信号,在验证集和预测集中预测KRAS基因突变的AUC值分别为0.81(0.70～0.92)和0.77(0.63～0.91,P=0.60),其中ADC特征中一阶偏度的压缩系数最大为3.36.结论MRI影像组学特征可以作为预测KRAS基因突变的生物学标记,其中ADC特征中偏度的预测效能最好.

目的 探讨256排冠状动脉CT血管成像(CCTA)用于慢性阻塞性肺疾病(COPD)患者自由呼吸下检查的可行性.方法 回顾性分析自2017年1月至2019年10月收治的74例COPD患者和74例无屏气困难患者的临床资料.两组患者均行256排CCTA,其中,COPD患者在自由呼吸状态下完成,而无屏气困难患者则在标准屏气状态下完成.比较两组患者的辐射剂量相关指标(有效辐射剂量、容积CT剂量指数、剂量长度乘积)、图像质量可判读性指标(每位受试者、每支血管、每个节段)及冠状动脉图像质量评分.结果 两组患者的辐射剂量相关指标、图像质量可判读性指标及图像质量主观评分比较,差异均无统计学意义(P>0.05).结论 COPD患者在自由呼吸状态下行256排CCTA,图像质量和辐射剂量均与标准屏气状态接近.

目的:尝试配制一种应用于直肠/阴道腔内的短T 2效应MR I对比剂,旨在提高阴道和直肠MRI质量.方法:将右旋糖酐铁溶液与超声耦合剂按不同比例混合,配制成含铁浓度分别为0.125、0.375、0.625、1.250、1.875、2.500、3.125和3.750 mg/g共8种浓度的对比剂(实验组),以纯超声耦合剂和纯右旋糖酐铁溶液作为2个对照组.将3组混和均匀的物质分别注入不同的试管中进行3.0T MRI检查,扫描序列包括FSE T1 WI、FRFSE T2 WI和T2-mapping,其中T2-mapping序列重复扫描50次.测量8支试管的T2值.比较实验组不同铁浓度对比剂的T2值,筛选出最佳短T2效应的含铁浓度.结果:纯超声耦合剂和纯右旋糖酐铁溶液的T2值分别为(773.90±5.04)和(83.00±3.40)ms.实验组中8种含铁浓度的对比剂的T2值依次为(931.04±19.44)、(867.4±18.89)、(832.98±19.40)、(622.88±7.74)、(88.68±4.15)、(62.80±9.23)、(26.82±4.30)和(18.24±3.68)ms,各组间差异有统计学意义(F=53644.11,P<0.001).随着对比剂铁含量的增高,在T2 WI上的信号呈下降趋势;当铁含量为3.125 mg/g时,信号强度与无信号背景接近,同时其在T1 WI上的信号强度与纯超声耦合剂相当.结论:铁浓度为3.125 mg/g的右旋糖酐铁溶液与超声耦合剂的混合剂可作为直肠和阴道腔内较合适的短T2效应对比剂.

目的 探讨超声(US)联合磁共振成像(MRI)在胸腹部异常胎儿诊断中的价值.方法 回顾性研究2016年3月至2019年3月经MRI和US检查且符合纳入标准的49例孕妇资料,对比分析US和MRI在胸腹部异常胎儿诊断中的优势与不足.结果 1)超声应用的局限性是增加MRI联合检查的主要原因.2)49例孕妇共查出胎儿胸腹部异常56处,其中胸部异常9例,占比16.1％.腹部异常47例,包括消化系统异常9例,占比16.1％;泌尿生殖系统异常32例,占比57.1％;腹壁异常6例,占比10.7％.单一US诊断符合率为76.8％,单一MRI检查诊断符合率为82.1％.3)联合方案诊断符合率为94.6％,明显高于单一US及单一MRI检查诊断符合率,差异有统计学意义(χ2=7.29,P=0.006927518;χ2=4.26,P=0.038924029).结论 US联合MRI能够有效提升胸腹部异常胎儿的诊断符合率,对临床决策具有重要的指导意义.

目的 分析钆塞酸二钠增强MRI联合残余肝脏体积法在肝脏储备功能评估的应用价值.方法 选取肝脏局灶性病变患者100例,均拟行Gd-EOB-DTPA增强MRI检查,同时评估残余肝脏体积,对患者实施Child-Pugh分级,对不同Child-Pugh分级患者肝脏扫描情况、肝脏体积等进行分析,探索各指标间的相关性.结果 与Child-Pugh A级患者比,Child-Pugh B级患者ICG-R15、总胆红素水平明显升高,白蛋白水平明显降低(P＜0.05);Child-PughB级患者肝脏相对强化程度明显低于Child-Pugh A级患者(P＜0.05);经Spearman行相关性分析,肝脏相对强化程度和ICG-R15为负相关,ICG-R15和肝脏相对强化程度、肝脏相对强化程度×肝脏体积、肝脏相对强化程度×残余肝脏体积比率的相关性逐渐增强.结论 肝切除术前储备功能评估中,应用Gd-EOB-DTPA增强MRI联合残余肝脏体积评估法能够更准确的了解肝脏储备功能,为手术的实施做好准备.

目的 探讨MRI动脉自旋标记(ASL)技术对高级别胶质瘤术后放化疗患者假性进展与复发的诊断价值.方法 应用3.0T MR对32例术后和放化疗后的随访MR中发现新的异常强化灶的高级别胶质瘤患者进行2D pASL检查.患者基于随后的病理分析或临床放射学随访被分为假性进展组(n=7)和胶质瘤复发组(n=25).使用Wilcocon秩和检验比较两组之间的损伤灌注参数值rCBF.ROC曲线评估rCBF在复发假性进展中的诊断性能.结果 对比增强病变中,假性进展组的rCBF显着低于胶质瘤复发组[(1.45±0.25)对(3.16±0.14)Z=-3.739,P=0.000].rCBF在假性进展诊断中ROC曲线下面积为0.765 (95％置信区间:0.597-0.932),灵敏度为0.647,特异性为0.733.结论 ASL有助于区分治疗后常规随访MRI的新发展增强病变的高级别胶质瘤患者的假性进展和复发.

目的 分析颈部动脉血管影像学检查中应用磁共振时间分辨对比剂动态成像(TRICKS)技术的临床价值.方法 选取2016年7月-2018年6月就诊的颈动脉粥样硬化病变疑似患者112例,均经由磁共振时间分辨对比剂动态成像技术及DSA检查,以DSA检查为金标准,分析两种检查间应用价值差异.结果 112例均成功完成TRICKS、DSA检查;其中112例患者经TRICKS技术检出332处颈动脉狭窄,经DSA检出血管狭窄处236处;TRICKS与DSA颈总动脉狭窄相符率119.57％(55/46)、颈动脉交叉狭窄相符率201.69％(119/59)、颈内动脉狭窄相符率(158/131);经DSA检出正常颈动脉40支,轻度狭窄30支,中度狭窄69支,重度狭窄26支,完全闭塞6支;TRICKS与DSA检出相符情况127.50％ (51/40)、193.33％(58/30)、128.99％(89/69)、115.54％ (29/26)、100.00％ (6/6).结论 TRICKS技术能够清晰反应颈动脉狭窄位置及严重程度,在颈部动脉血管成像中的应用价值良好.

Objective: To investigate the alterations of the volumes and 3D shapes of fifteen subcortical nucleus in patients with post-stroke depression (PSD) and to explore the pathogenesis regularity and mechanism of early PSD. Methods: From 2015 to 2017, a total of 28 patients with PSD and 18 stroke patients without depression (PSND), 13 patients with depression (De) and 11 cases of healthy volunteers (NC) were enrolled to perform 3.0 T high resolution MRI.Computer automatic segmentation and vertex analysis were used to segment and measure the volume of bilateral nucleus accumbens, caudate nucleus, putamen, globus pallidus, thalamus, hippocampus, mygdale and brainstem. Results: The volume of bilateral nucleus accumbens and bilateral thalamus, left pallidum were different among groups with statistical difference (P<0.05). The nucleus volume of the PSD group was (415±128) mm(3) (L-Nac)/(303±90) mm(3) (R-Nac), (7 590±867) mm(3) (L-Th)/(7 459±905) mm(3) (R-Th), (1 675±328) mm(3) (L-Pa), which was smaller than that of PSND group (433±100) mm(3) /(307±88) mm(3), (7 999±961) mm(3) /(7 753± 955) mm(3), (1 790±286) mm(3) and other groups.The nuclei with significantly statistical differences between inter-group were found in following: between PSD group and NC group, right accumbens and bilateral thalamus (P<0.01); between PSD group and De group, right accumbens and right thalamus (P<0.001), left accumbens, left pallidum and left thalamus (P<0.01); between PSND group and NC group, right accumbens (P<0.05); between PSND group and De group, right accumbens (P<0.001), left accumbens and right thalamus (P<0.05). Significant differences in morphology changes of nuclei (P<0.05) by F test mainly located on the top and tail of right accumbens, the anterior and middle body of right caudate nucleus, the most part of bilateral thalamus, the ventromedial body of bilateral hippocampus, the anterior and body of left caudate nucleus, especially in left thalamus. Conclusion: PSD has abnormal volume and morphological structure of subcortical nuclei, which supports the role of subcortical structures changes in the pathophysiology and pathogenesis of early PSD.

Objective To assess paraspinal muscles fat infiltration by using Dixon MR imaging and investigate the relationship of fat infiltration with age.Methods Two radiologists measured signal intensity (SI) of right side paraspinal muscles by manual drawn ROI on fat and water images of Dixon sequence twice independently in 135 patients. The fat signal fraction (FSF) of paraspinal muscles was calculated. ICCs were used to evaluate inter- and intra-observers reliability. The relationship between FSF of paraspinal muscles and age was assessed using ANCOVA with adjustment of gender.Results FSF of paraspinal muscles increased with age. After adjusting gender, the association between FSF of paraspinal muscles and age was statistical significant (P=0.016). Inter- and intra-observer reliability was excellent with ICC of 0.83 and 0.86, respectively.Conclusion Dixon MR imaging can be used to monitor degeneration of paraspinal muscles with aging with excellent reliability.

目的 描述布鲁杆菌性脊柱炎的MRI表现及文献复习,旨在提高非疫区的放射诊断医师对本病的认识水平,指导临床及时采用正确的诊疗手段.方法 回顾性分析经临床证实的5例布鲁杆菌性脊柱炎的MRI表现,结合文献比较布鲁杆菌性脊柱炎的MRI表现与脊柱结核和Modic 1型终板的鉴别诊断要点.结果 5例患者均累及腰椎,其中1例为单发病灶,其余4例为多发,2例伴有椎旁软组织受累.椎体受累表现为骨髓炎改变,但椎体结构保持完整.椎旁软组织受累表现为多发小脓肿和周围水肿样改变.这些征象有一定的特征性,结合临床,有助于与脊柱结核和Modic 1型终板进行鉴别.结论 布鲁杆菌性脊柱炎的MRI表现有一定特征性,如椎体结构完整的骨髓炎及轻度的椎旁软组织改变,结合临床资料,MRI可以作出提示性诊断.

Objective To explore the comparison and application value of ultrasound and MRI in fetal heart malformation screening.Methods In the first stage,39 cases of diagnosis fetus cardiac malformation by ultrasound to proceed MRI scan,templates of sonographic graph was used to create the corresponding MRI standards fault graph,the image acquisition success rate was calculated and compared.In the second stage,selection of 57 cases of fetal cardiac malformations suspected cases,with standard sectional drawing or fault graph based,proceed respectively ultrasound,MRI and the combination of the two methods,the results and follow-up results were analyzed,the accuracy of diagnosis of fetal cardiac abnormalities were compared. Results In the first stage,of 39 cases of cardiac malformation,38 cases received standard ultrasonography and the success rate of images was 97.44%.According to the standard ultrasonography template,32 cases were successfully created using MRI to create the standard section map.The success rate of the image was 82.05%,and the difference was statistically significant(χ2=5.014,P<0.05). The second stage for 57 cases of suspected cardiac malformation fetus,the coincidence rate of ultrasound combined with MRI in the diagnosis of fetal cardiac malformations was 98.24%,which was higher than that of ultrasound and MRI(85.96% and 70.18%), the difference had statistical significance(χ2=3 . 95 , P<0 . 05 ,χ2=14 . 21 , P<0 . 01). The diagnostic compliance rate of MRI was significantly lower than that of ultrasound,and the difference was statistically significant(χ2=4.15,P<0.05).Conclusion The coincidence rate of the combination of ultrasound and MRI is significantly higher than that of ultrasound or MRI,which can effectively improve the detection rate and accuracy of fetal cardiac deformity screening.

Objective: To investigate the relationship between vertebral endplate Modical changes and adjacent intervertebral disc degeneration. Materials and Methods: Lumbar structure and quantitative MR images of 66 patients were retrospectively analyzed. Disc degeneration was semi-quantitatively assessed using Pfirrmann grading system and quantitatively assessed using T2 and T2* values. Association between Pfirrmann scores, T2 and T2* values of intervertebral discs with adjacent endplate Modic changes was analyzed. Results: Nineteen intervertebral discs with adjacent endplate Modic changes were detected in fourteen patients (14/66, 21.2%), which included 2 discs with Modic type 1 changes and 17 discs with type 2 changes. Pfirrmann scores of the discs adjacent to normal endplates, Modic type 1 endplates and Modic type 2 endplates were 2.40±0.96、4±1.41 and 4.12±1.27, respectively. T2 values were (95.38±51.88) ms, (70.50±36.06) ms and (58.65± 38.47) ms. T2* values were (34.43±19.16) ms, (24.00±1.41) ms and (28.65±23.00) ms. The differences of disc Pfirrmann scores, T2 and T2* values among different endplate changes were statistical significant with P values of 0.000, 0.000 and 0.023, respectively. Comparing to discs adjacent to normal endplates, discs adjacent to Modic type 2 endplates had severe degeneration with increased Pfirrmann scores and decreased T2 and T2* values. The differences were statistical significant (P values were 0.000, 0.000 and 0.006, respectively). Conclusions: Modic changes of vertebral endplate are associated with adjacent intervertebral disc degeneration. Both of them should be regarded as a facet of the "whole-organ" pathologic conditions in the procession of spinal degeneration.

Objective To evaluate the value of magnetic resonance imaging ( MR ) in evaluating the tumor response to neoadjuvant chemotherapy (NAC) in breast cancer.Methods During Oct.2011 and Oct.2015, 60 patients with pathologically confirmed breast cancer, 25~70 years old, were enrolled into this study.All patients received 2~4 cycles of NAC, surgical treatment was performed 3 to 4 weeks after the end of NAC .MRI were made before and after NAC .The response to NAC were evaluated based on the response evaluation criteria in solid tumors ( RECIST ) , pathological examination and MRI analysis .Results The effective rate of NAC evaluated by MRI (clinical evaluation) was 73.3% (44/60), while it was 78.3% (47/60) evaluated by pathological examination (pathological evalua-tion).There was significant correlation between clinical evaluation and pathological evaluation (P<0.05).There were significant differ-ences in MRI related parameter, including tumor volume, tumor size and ADC before and after NAC (P<0.05).The type of TIC after NAC showed a tendency shift type Ⅲto typeⅠcompared with it before NAC, and the differences were statistically siginificant (P<0.05). Conclusion MRI could accurately assess the changes in tumor volume and biological activity after NAC , and therefore it is useful for evaluating response to neoadjuvant chemotherapy in breast cancer patients .

目的 探讨三维双回波稳态水激发(3D-DESSwe)序列在面神经成像中的临床应用价值.方法 采用3.0T MR 3D-DESSwe序列对18例健康志愿者行面神经扫描,对原始图像行多平面重组(MPR)及薄层最大密度投影(MIP)重建,观察并参照格氏解剖学图谱对图像进行评价分析,由2位阅片者采用5分法(1～5分,由高到低)对图像质量和面神经显示情况进行评估.结果 所有志愿者顺利完成扫描,双侧面神经全程均获得显示,面神经与周围组织结构对比明显,所得图像评分16个1分,2个2分,并显示颅外段(腮腺段面神经)分支.结论 3D-DESSwe序列可以清晰显示面神经全长,并可显示颅外段分支.

Objective To correlate T2 and T2* value of intervertebral disc (IVD) with Pfirrmann grades of IVD degeneration in patients with low back pain, in order to identify whether T2 and T2* value can be imaging biomarkers for quantitative assessment of IVD degeneration.Methods Sixty-six patients with low back pain underwent conventional structure imaging and quantitative imaging (T2 and T2* mapping) of lumber IVD using 3 Tesla MR system. Pfirrmann grades were performed by two diagnostic radiologists in concensus on the basis of the sagittal T2-weighted images. T2 and T2* values of IVD were measured by one diagnostic radiologist through manual drawing region-of-interest (ROI) on midsagittal T2 and T2* maps to cover the nucleus pulposus and inner annulus fibrosus. The correlation between Pfirrmann grades and the two quantitative parameters of IVD was assessed by Pearson correlation test. The difference in T2 and T2* values of contiguous Pfirrmann grades were compared using t test.Results T2 and T2* values of IVD were of negative correlation to Pfirrmann grades with correlation coefficients of -0.612 and -0.354 (P<0.001), respectively. Except grades Ⅳ andⅤ, T2 and T2* values of contiguous Pfirrmann grades showed statistical significant differences.Conclusion T2 and T2* values of IVD could be potential imaging biomarkers for quantitative assessment of IVD degeneration, which might be helpful of early diagnosis and objective evaluation of degeneration. For the end stage degeneration, the decrease of T2 and T2* values is slow down, and morphological changes become obvious.

特发性婴儿动脉钙化症（idiopathic infantile arterial calcification, IIAC）是一种以心脏瓣膜、大中动脉内弹力层广泛钙化为特征的罕见遗传性疾病。因心脏功能衰竭，85%的患儿在宫内或出生后6个月内死亡[1-2]。国内外文献报道不足200例[3]，其中产前诊断的病例只15例[1,4-14]。国内于1994年首次报道[15]，目前仅报道5例[15-19]，均为产后尸体解剖或出生后由儿科诊断发现。近期深圳市人民医院收治1例经产前诊断的IIAC病例，现报道如下。

目的 胸片普查延迟诊断的周围型小肺癌早期x线表现及动态变化特点.方法 回顾性分析15例胸部X线摄片延迟诊断的周围型小肺癌的影像学特征.将本组病例按检出前和检出时病灶形态、大小、密度和边缘进行了对比.结果 回顾性分析延迟诊断的15例患者初次胸片均有异常改变,包括:1)微结节伴有纹理聚集3例.2)灶状浸润7例.3)不规则结节状5例.检出时全部病灶均发展成(20.7±9.1)mm结节.从初次显现至病灶检出相距时间为8～47个月,平均16.3个月,倍增时间为35～233 d.结论 周围型小肺癌胸片较容易漏诊,认识其早期表现、动态比较观察以往胸片和及早行建议胸部CT扫描有助于降低小肺癌的延迟诊断率.

Objective To investigate the relationship between apparent diffusion coefficient (ADC)value of rectal adenocarcinoma on DWI and its pathological grading.Methods The ADC values of 46 rectal adenocarcinomas were measured and compared with their histopathological grades.Results The 46 rectal adenocarcinomas included well differentiated adenocarcinomas in 14,moderate-ly differentiated ones in 20,and poorly differentiated ones in 12.The ADC values of well,moderately and poorly differentiated ade-nocarcinomas were (1.125±0.103)×10 -3 mm2/s,(1.030±0.098)×10 -3 mm2/s and (0.922±0.091)×10 -3 mm2/s,respective-ly,exhibiting a statistical difference (χ2 =1 7.35 1,P =0.000).Mann-Whitney U test showed that difference in ADC value between different histopathological grades was statistically significant.Conclusion ADC value of rectal adenocarcinoma can be used as a bio-marker for cell grading to guide treatment decision and prognosis assessment.