BACKGROUND:Bladder cancer (BCa) with variant histology (VH) is aggressive, leading to poor prognosis and resistance to neoadjuvant treatment (NAT). Preoperative identification of VH may be important for informing treatment options. PURPOSE:To develop and validate a multiparametric MRI-based ensemble model to identify VH in BCa and explore its association with disease-free survival (DFS) and NAT response. STUDY TYPE:Retrospective. SUBJECTS:Six hundred twenty patients with pathologically confirmed BCa (median age, 65 years [IQR: 56, 73], 145 female) from four centers who underwent preoperative MRI, were divided into a training (n = 311), internal validation (n = 54) from Center 1, and three external validation datasets (n = 85, 68, and 102, respectively). Two additional cohorts, DFS (n = 75) and NAT (n = 69) cohorts, were collected from Center 1 to evaluate prognosis. FIELD STRENGTH/SEQUENCE:3T, non-fat suppressed T2-weighted imaging using fast spin echo, diffusion-weighted imaging using single-shot echo planar imaging, and T1-weighted dynamic contrast-enhanced sequence using 3D gradient echo sequence. ASSESSMENT:Habitat, radiomic, clinical, clinical-radiomic based, and the VHRisk Score (VHRiS) models were constructed for evaluating VH. The prognostic value of VHRiS for DFS and pathological complete response (pCR) rate was further evaluated. STATISTICAL TESTS:Mann-Whitney U test, t-test, ROC analysis (AUC), Kaplan-Meier curves, log-rank test, and SHapley Additive exPlanations (SHAP) analysis. RESULTS:The VHRiS model demonstrated favorable accuracy (AUCs: training, 0.971; internal validation, 0.895; external validation, 0.898-0.974). Low-risk patients (VHRiS ≥ 0.863) exhibited significantly longer DFS than high-risk patients (4.20 months vs. 3.08 months) in the DFS cohort (median follow-up period: 13.19 months [IQR: 6.54, 31.91]). They also showed a higher pCR rate than high-risk patients (64% vs. 33%) in the NAT cohort. DATA CONCLUSIONS:The VHRiS model may be a robust tool for identifying VH, and may offer a potential method for risk stratification and prognosis prediction in patients with BCa. LEVELS OF EVIDENCE:4. TECHNICAL EFFICACY STAGE:2.

Bladder cancer (BCa) is one of the most common malignancies in the world, which can be categorized into muscleinvasive (MIBC) and non-muscle-invasive (NMIBC). These two types of BCa must be treated differently, and thus it is essential to correctly distinguish MIBC and NMIBC patients preoperatively for adopting different treatment methods accordingly. Currently, the two types can be distinguished through MRI images by radiologists, but manual inspection is time and labor-consuming. Existing machine learning based methods attempt to free radiologists from manual inspection. However, they fail to take full advantage of image features and always require extra laborious refined manual labeling in addition to the classification labels. In this study, we propose a Tumor Staging and Localization Network (TSLNet) to perform preoperative non-invasive assessment of muscle invasion of BCa, which can automatically distinguish MIBC patients from NMIBC patients based on MRI T2-weighted images of BCa. The model adopts the weakly supervised learning method. Specifically, self-produced guidance is used as pixellevel segmentation pseudo labels for auxiliary supervision to extract basic features, and location-recognition based fine-grained image classification technology and inexact consistency labels are used for auxiliary supervision to extract fine-grained features. Moreover, the model can visualize the critical regions of the lesions, which can provide practical reference and a basis for clinicians' clinical diagnosis. Experimental results show that the model achieves high AUC, accuracy, specificity, sensitivity, and F1-score, which is comparable to experienced clinicians.

Background:Lesion size is a major determinant of treatment strategies and predictor of clinical outcomes for osteochondral lesions of the talus (OLTs). Although magnetic resonance imaging (MRI) has been commonly used in the preoperative evaluation of OLTs, MRI has low reliability and usually overestimates or underestimates lesion size compared with intraoperative assessment. This study aims to determine whether the surface microscopy coil (SMC) can improve the accuracy of assessment of preoperative OLTs compared with conventional coil MRI, ankle joint special phased array coil (ASC).Methods:A total of 43 patients diagnosed with OLTs undertook preoperative MRI examination with both SMC and ASC were included in this prospective study from 2019 to 2022. The diameter of the lesion was measured in sagittal plane and coronal plane at its widest point and then the lesion area was calculated. Then MRI measurements were compared with arthroscopy or open-surgery measurements.Results:The mean lesion area measured with ASC was significantly greater than that measured intraoperatively (95.07±44.60 vs. 52.74±29.86 mm2, P<0.001), while there was no significant difference between lesion area measured in SMC and intraoperatively (55.28±36.06 vs. 52.74±29.86 mm2, P=0.576). Diameter measured in ASC was significantly greater than that measured intraoperatively in both coronal plane (8.95±2.48 vs. 6.67±1.81, P<0.001) and sagittal plane (13.12±3.76 vs. 9.58±3.98, P<0.001). No significant difference between lesion diameter measured in SMC and intraoperatively in both coronal plane (6.44±2.59 vs. 6.67±1.81, P=0.608) or sagittal plane (10.23±3.69 vs. 9.58±3.98, P=0.194). Compared with surgical assessment, 39 of 43 cases were consistent with SMC assessment while only 26 of 43 cases were consistent with ASC assessment (39/43 vs. 26/43, P=0.002).Conclusions:Diameter measured with SMC was much more accurate than ASC MRI. Compared with ASC MRI, the SMC had a much higher concordance rate between preoperative assessment and surgical assessment.

OBJECTIVES:To determine the morphologies and effect of the round window niche veil (RWNV) on local drug delivery efficacy and develop diagnostic criteria on high-resolution computed tomography (HRCT). METHODS:Patients diagnosed with otosclerosis, bilateral profound sensorineural hearing loss or vestibular schwannoma were enrolled from 2019 to 2022, receiving temporal bone HRCT scanning, and anatomic variations of RWMV were summarized intraoperative. For patients with vestibular schwannoma, 1 mL of dexamethasone solution (4 mg/mL) was administered via facial recess during operation, and samples of perilymph were collected to analyze. The diagnostic criteria of RWNV on HRCT were developed and verified. RESULTS:A total of 85 patients were enrolled. RWNV was observed in 54 cases intraoperatively with an incidence of 63.5% (95% CI, 52.9%-73.0%). The median perilymph concentrations were 4.86-fold higher in the group without RWNV than with RWNV (p < 0.0001). RWNV could be visualized on HRCT with a window width of 3500-4500 HU and a window level of 300-500 HU. The characteristic features were as follows: (1) a thin soft tissue shadow could be seen at the entrance of the round window niche (RWN); (2) it was visible in at least 2 consecutive layers along the upper margin of RWN from top to bottom; (3) it was discontinuous with the adjacent bone margin. The sensitivity and specificity of the diagnostic criteria were 77.8% and 93.6%, respectively. CONCLUSION:RWNV could reduce local dexamethasone diffusion efficacy to the inner ear, which could be diagnosed on HRCT and used as a predictor of local drug delivery efficacy to the inner ear. LEVEL OF EVIDENCE:3 Laryngoscope, 134:1396-1402, 2024.

目的 探讨黄色肉芽肿性胆囊炎的CT、MR影像学表现.方法 收集2017年1月至2021年8月中山大学孙逸仙纪念医院经病理证实的黄色肉芽肿性胆囊炎21例,回顾性分析其CT、MR影像表现.结果 共收集21例患者,其中男13例,女8例,年龄28～69岁,平均55岁.行CT增强扫描14例,行MR增强扫描13例,MR平扫3例,均行CT及MR扫描9例.胆囊壁增厚18例(86.00％),其中弥漫性、均匀性增厚9例(50.00％),弥漫性、不均匀性增厚4例(22.22％),局限性增厚5例(27.78％),胆囊壁无增厚3例(14.29％).肌层均匀强化者13例(72.22％),肌层不均匀强化者3例(16.67％).胆囊壁内结节8例(38.10％).胆囊黏膜线连续者18例(85.71％),中断者3例(14.29％).浸润邻近结构9例(42.86％),边界清楚者12例(57.15％).周围见肿大淋巴结4例(19.05％).合并胆囊或胆管结石的有15例(71.43％),其中导致胆道梗阻的有9例(60.00％).结论 胆囊壁增厚、胆囊肌层均匀强化、胆囊壁内结节及胆囊黏膜线连续是黄色肉芽肿性胆囊炎较有特征的影像学表现.

Introduction People living in highland areas may have factors that allow them to adapt to chronic hypoxia, but these physiological mechanisms remain unclear. This study aimed to investigate the brain mechanism in a cohort of adult residents of Tibet, a well-known plateau section in China, by observing differences in brain structure and function in non-plateau populations. Methods The study included 27 Tibetan and 27 non-plateau region residents who were matched in age, sex, and education. All participants underwent high-resolution three-dimensional T1 weighted imaging (3D-T1WI) and resting-state functional magnetic resonance imaging (rs-fMRI) scans on a 1.5 Tesla MR. Gray matter volumes and regional spontaneous neuronal activity (SNA) were calculated and compared between the two groups. Results When comparing gray matter in people living in high altitudes to those living in the flatlands, the results showed positive activation of gray matter in local brain regions (p < 0.05, false discovery rate (FDR) corrected), in the right postcentral [automated atomic labeling (aal)], left postcentral (aal), and right lingual (aal) regions. Comparing the people of high altitude vs. flat land in the brain function study (p < 0.05, FDR corrected), positive activation was found in the right superior motor area (aal) and left superior frontal (aal), and negative activation was found in the right precuneus (aal). Conclusion In high-altitude individuals, larger regional gray matter volumes and higher SNA may represent a compensatory mechanism to adapt to chronic hypoxia.

Background Preoperative diagnosis of pheochromocytoma (PHEO) accurately impacts preoperative preparation and surgical outcome in PHEO patients. Highly reliable model to diagnose PHEO is lacking. We aimed to develop a magnetic resonance imaging (MRI)-based radiomic-clinical model to distinguish PHEO from adrenal lesions. Methods In total, 305 patients with 309 adrenal lesions were included and divided into different sets. The least absolute shrinkage and selection operator (LASSO) regression model was used for data dimension reduction, feature selection, and radiomics signature building. In addition, a nomogram incorporating the obtained radiomics signature and selected clinical predictors was developed by using multivariable logistic regression analysis. The performance of the radiomic-clinical model was assessed with respect to its discrimination, calibration, and clinical usefulness. Results Seven radiomics features were selected among the 1301 features obtained as they could differentiate PHEOs from other adrenal lesions in the training (area under the curve [AUC], 0.887), internal validation (AUC, 0.880), and external validation cohorts (AUC, 0.807). Predictors contained in the individualized prediction nomogram included the radiomics signature and symptom number (symptoms include headache, palpitation, and diaphoresis). The training set yielded an AUC of 0.893 for the nomogram, which was confirmed in the internal and external validation sets with AUCs of 0.906 and 0.844, respectively. Decision curve analyses indicated the nomogram was clinically useful. In addition, 25 patients with 25 lesions were recruited for prospective validation, which yielded an AUC of 0.917 for the nomogram. Conclusion We propose a radiomic-based nomogram incorporating clinically useful signatures as an easy-to-use, predictive and individualized tool for PHEO diagnosis.

根据黄龙带水库大坝两期高精度三维激光大坝扫描点云数据,本文提出基于正态分布的点云数据配准算法、改进原始渐进加密三角网滤波算法,运用点到面形变量对比分析模式监测大坝形变量,并进行源程序开发,实现一体化监测点云数据的加工、对比分析及建模处理.通过结果验证显示:①改进后的算法效率高、精度优,适用于大坝点云数据处理和对比分析;②开发的点云数据一体化处理软件简单易用,能够精准反映坝体变形情况;③黄龙带坝体稳定,尚无安全隐患.

教师授课为主是医学影像学传统的教学模式.随着信息化网络化的发展,新的教学模式逐渐出现,尝试将慕课作为医学影像学教学的一种补充方式,按照医学影像学的系统分类,制作呼吸、循环、消化、骨骼、神经及泌尿生殖共六个系统的慕课小视频,内容以模仿临床实际工作为主线,串联基础医学、影像医学及临床诊断的思维,将视频放在指定的公共网络上,供学生选择合适的时间和方式进行自主学习,补充课堂授课的不足之处,加强学生对医学影像与临床的关系的认识,从而使学生对医学影像学的知识掌握更加全面,在今后的学习和工作中更好的运用医学影像的知识.

森林冠层和林窗的结构及其时空变化是理解森林生态系统格局、动态变化过程的重要基础.在当前生物多样性监测倍受关注的契机下,如何以合适的手段准确描述林窗面积、分布等特征,并与森林固定样地监测数据有效地结合,更好地回答群落构建的理论问题,使森林群落物种多样性维持机制得到更全面的认识,是目前亟待解决的问题.以鼎湖山南亚热带常绿阔叶林20 hm2固定监测样地为研究对象,基于不同遥感影像提取方法对其林窗和林冠表层数据进行提取分析.结果 表明:基于监督分类的提取方法适合RGB波段航片林窗的提取,在林窗分类中,应首先确定林窗高度、边界木与最小面积,不同分类方法差异主要表现在林冠分类中,林窗分类生产者精度和用户精度表现都较为一致.无人机航拍识别率受地形因素影响较大,在地形复杂林地应按坡度分区域进行飞行以降低误差.相对于地面调查,MD4-1000无人机航片的林窗识别率为98.7％;大疆Phantom4无人机航片的林窗识别率为72.3％,影像后期处理数据量小,同样适用于森林林窗定量研究,符合生态学、林业等从业人员对大型样地林窗长期监测的要求.无人机航拍南亚热带森林物种识别难度较大,基于MD4-1000无人机搭载的高分辨率相机,在地势平缓区域优选的4 hm2样地中可识别林冠表层物种数17种,共2 706个个体.搭载高分辨率无人机在降低飞行高度的基础上可进行部分物种识别.应用无人机近地面遥感对森林固定样地进行林冠监测,可为后期群落构建研究提供数据基础,有望从新的研究角度探讨森林群落物种多样性维持机制.

BackgroundBladder cancer (BCa) can be divided into muscle‐invasive BCa (MIBC) and non−muscle‐invasive BCa (NMIBC). Whether the tumor infiltrates the detrusor muscle is a critical determinant of disease management in patients with BCa. However, the current preoperative diagnostic accuracy of muscular invasiveness is less than satisfactory. The authors report a radiomic‐clinical nomogram for the individualized preoperative differentiation of MIBC from NMIBC.MethodsIn total, 2602 radiomics features were extracted from whole bladder tumors and the basal part of the lesions on T2‐weighted magnetic resonance imaging. Then, a radiomics signature was constructed using the least absolute shrinkage and selection operator algorithm in the training set (n = 130). Furthermore, a radiomic‐clinical nomogram was developed incorporating the radiomics signature and selected clinical predictors based on a multivariable logistic regression analysis. The performance of the nomogram (discrimination, calibration, and clinical usefulness) was assessed and validated in an independent validation set (n = 69).ResultsThe radiomics signature, consisting of 23 selected features, showed good discrimination in the training and validation sets (area under the curve [AUC], 0.913 and 0.874, respectively). Incorporating the radiomics signature and magnetic resonance imaging‐determined tumor size, the radiomic‐clinical nomogram showed favorable calibration and discrimination in the training set with an AUC of 0.922, which was confirmed in the validation set (AUC, 0.876). Decision curve analysis and net reclassification improvement and integrated discrimination improvement indices (net reclassification improvement, 0.338, integrated discrimination improvement, 0.385) demonstrated the clinical usefulness of the nomogram.ConclusionsThe proposed noninvasive radiomic‐clinical nomogram can increase the accuracy of preoperatively discriminating MIBC from NMIBC, which may aid in clinical decision making and improve patient prognosis.

针对水产养殖过程监管中,地域广阔、养殖信息采集工作量大等造成的养殖过程监管、溯源的困难,提出二维码与GPS和GIS结合的养殖过程信息采集技术,设计了包含鱼塘编码、操作类型编码和具体操作编码的养殖操作信息采集二维码,研究了带地理坐标的鱼塘编码方法.以白蕉海鲈为例,研发了白蕉海鲈养殖过程监管信息采集系统.示范应用表明,该技术简化了操作人员的录入工作,提高了信息采集的真实性;实现了养殖基地、鱼塘等信息的可视化管理,提升了养殖过程监管信息化水平.

医学影像学传统的教学模式是以灌输式教育为主,不利于医学人才创新素质的培养.现代医学影像学发展迅速,需不断改进教学方法,需要扎实扎好基础知识和影像分析能力,以及创新思维能力的培养.TBL教学法创设出了和谐、宽松的课堂气氛,激发学生思维的积极性.创新思维的培养是素质教育的客观要求、课堂改革的重要目标.TBL结合创新思维教学在医学影像学本科生教学中的应用及评估是一种全新、独特的教学方法,能提升教学方式的改革,在更高层次上提高学生的医学影像学认知能力;增进学生对医学影像学的学习兴趣;培养学生的团队合作和人际交往能力.综合评估模式在今后医学影像学课程教学实施过程不断完善,相信会有较好的应用性.

Background: Preoperative lymph node (LN) status is important for the treatment of bladder cancer (BCa). However, a proportion of patients are at high risk for inaccurate clinical nodal staging by current methods. Here, we report an accurate magnetic resonance imaging (MRI)-based radiomics signature for the individual preoperative prediction of LN metastasis in BCa. Methods: In total, 103 eligible BCa patients were divided into a training set (n=69) and a validation set (n=34). And 718 radiomics features were extracted from the cancerous volumes of interest (VOIs) on T2-weighted MRI images. A radiomics signature was constructed using the least absolute shrinkage and selection operator (LASSO) algorithm in the training set, whose performance was assessed and then validated in the validation set. Stratified analyses were also performed. Based on the multivariable logistic regression analysis, a radiomics nomogram was developed incorporating the radiomics signature and selected clinical predictors. Discrimination, calibration and clinical usefulness of the nomogram were assessed. Findings: Consisting of 9 selected features, the radiomics signature showed a favorable discriminatory ability in the training set with an AUC of 0.9005, which was confirmed in the validation set with an AUC of 0.8447. Encouragingly, the radiomics signature also showed good discrimination in the MRI-reported LN negative (cN0) subgroup (AUC, 0.8406). The nomogram, consisting of the radiomics signature and the MRI-reported LN status, showed good calibration and discrimination in the training and validation sets (AUC, 0.9118 and 0.8902, respectively). The decision curve analysis indicated that the nomogram was clinically useful. Interpretation: The MRI-based radiomics nomogram has the potential to be used as a non-invasive tool for individualized preoperative prediction of LN metastasis in BCa. External validation is further required prior to clinical implementation. (c) 2018 The Authors. Published by Elsevier B.V.

Objective To investigate the predictive value of diffusion-weighted (DW) magnetic resonance imaging (MRI) for invasiveness of hilar cholangiocarcinoma (HC).Methods The retrospective casecontrol study was conducted.The clinicopathological data of 65 HC patients who were admitted to the Sun Yat-sen Memorial Hospital from January 2012 to November 2017 were collected.Patients received DW MRI before treatment,and 2 senior imaging doctors analyzed imaging data and measured the apparent diffusion coefficient (ADC) for the primary lesions of HC.Observation indicators:(1) MRI situations of HC;(2) relationship between ADC and clinicopathological factors;(3) receiver operator characteristic (ROC) curve analysis;(4) treatment and follow-up situations.According to patients' conditions,treatment plans were done within 2 weeks after MRI and patients underwent radical resection of HC.Follow-up using telephone interview was performed to detect tumor recurrence up to December 2017.Measurement data with normal distribution were represented as (x)±s,and comparisons between group and among group were respectively analyzed using the t test and one-way ANOVA.Spearman's rank correlation was performed to analyze the relationship between ADC and clinicopathological factors.ROC curves assessed the diagnostic efficiency of ADC.Results (1) MRI situations of HC:MRI and magnetic resonanced cholangio-pancreatography (MRCP) in 65 patients showed varying degrees of soft rattan-like dilations of intrahepatic bile ducts and truncation signs of bile tracts in hepatic port.Of 65 patients,tumors in 23,7 and 35 patients were respectively pedunculated type,polypoid type and infiltrating type.The pedunculated-type lesions of 23 patients presented as low signal on T1WI and slightly high signal on T2WI;after enhanced scans of MRI,pedunculated-type lesions of 7 patients demonstrated moderate homogenous enhancement in 3 patients,ring-like enhancement with internal liquefaction necrosis in 10 patients and moderate heterogeneous enhancement in 10 patients,respectively.The polypoid-type lesions presented as low signal on T1WI and high signal on T2WI,and moderate homogenous enhancement by enhanced scans of MRI.There were varying degrees of bile duct wall thickness and irregular nodules in the infiltrating-type lesions of 35 patients,showing moderate enhancement by enhanced scans of MRI.All the lesions of 65 patients using DW MRI demonstrated restricted diffusion,showing a clear boundary between lesions and normal surrounding bile ducts or liver tissues;heterogeneous enhancement lesions by MRI scans presented as heterogeneously high signal on DWI and heterogeneously low signal on ADC map,and necrotic area of lesions showed low signal on DWI;homogenous enhancement by MRI scans presented as homogenously high signal on DWI and homogenously low signal on ADC map.(2) Relationship between ADC and clinicopathological factors:ADC was respectively (1.382±0.165)× 10-3 mm2/s,(1.343±0.138)× 10-3 mm2/s,(1.291-±0.226)×10-3 mm2/s,(1.111±0.243)×10-3 mm2/s in stage Ⅰ,Ⅱ,Ⅲ and Ⅳ (TNM staging) and (1.441± 0.355) × 10-3 mm2/s,(1.226 ± 0.177) × 10-3 mm2/s,(1.061 ± 0.228) × 10-3 mm2/s in highdifferentiated,moderate-differentiated and low-differentiated tumors (pathological grading) and (1.403±0.176)× 10-3 mm2/s,(1.121±0.238)× 10-3 mm2/s in Ki-67 score ≤ 10％ and ＞ 10％ and (1.115±0.241)× 10-3 mm2/s,(1.347±0.174)× 10-3 mm2/s in HC patients with and without lymph node metastasis,with statistically significant differences in the above indicators (F =4.158,9.866,t =11.607,13.464,P＜0.05).Results of Spearman's rank correlation analysis showed that ADC had a negative correlation with TNM staging,pathological grading and Ki-67 score (r=-0.532,-0.522,-0.409,P＜0.05).(3) ROC curve analysis:using 1.225×10-3 mm2/s as a critical value of ADC,the sensitivity and specificity of ADC in the diagnosis of stage Ⅰ-Ⅱ HC and stage Ⅲ-Ⅳ HC were 70.5％ and 81.0％,and area under ROC curve was 0.705 (95％CI:0.62-0.84,P＜0.05).Using 1.100×10-3 mm2/s as a critical value of ADC,the sensitivity and specificity of ADC in the diagnosis of lowdifferentiated HC and moderate-and high-differentiated HC were 88.2％ and 64.3％,and area under ROC curve was 0.814 [95％ confidence interval (CI):0.69-0.90,P＜0.05].Using 1.243×10-3 mm2/s as a critical value of ADC,the sensitivity and specificity of ADC in the diagnosis of Ki-67 score ≤ 10％ and ＞ 10％ were 66.7％ and 75.0％,and area under ROC curve was 0.783 (95％CI:0.62-0.90,P＜0.05).Using 1.222×10-3 mm2/s as a critical value of ADC,the sensitivity and specificity of ADC in the diagnosis of lymph node metastasis were 91.3％ and 71.4％,and area under ROC curve was 0.873 (95％CI:0.76-0.94,P＜0.05).(4) Treatment and followup situations:65 patients underwent successful radical resection of HC.Thirty-three patients were followed up for 1-24 months.Of 33 patients,5 had tumor recurrence within 6 months postoperatively,including 4 with ADC ＜ 1.100× 10-3 mm2/s,13 had tumor recurrence after 6 months postoperatively,and 15 didn't have tumor recurrence or metastasis,including 1 with ADC ＜ 1.100× 10-3 mm2/s.Conclusions There are different ADC in differentTNM staging,pathological grading,Ki-67 score and with or without lymph node metastasis of HC.ADC of DWMRI can be used as a preoperative imaging predictor for invasiveness of HC.

Accurate evaluation of lymph node metastasis in bladder cancer (BCa) is important for disease staging, treatment selection, and prognosis prediction. In this study, we aimed to evaluate the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) for metastatic lymph nodes in BCa and establish criteria of imaging diagnosis.

膀胱癌是泌尿系统最常见的恶性肿瘤,易发生复发、转移.相对于淋巴结转移阴性的患者,淋巴结转移阳性的患者复发、转移概率更高,而且往往是致死性的.准确预测淋巴结转移与否对于患者治疗策略的选择具有重要指导意义.目前诊断淋巴结转移的金标准为术后病理,术前主要依靠影像学,但是准确性不太理想.本文就膀胱癌盆腔淋巴结转移的影像学诊断方法,包括CT、MRI及PET/CT、SPECT/CT及前哨淋巴结显像等作一综述.

Adenoid cystic carcinoma (ACC) of the breast is a rare tumor comprising <0.1% of all breast malignancies. The present study reports the case of a 66-year-old woman who underwent multiple imaging techniques, including mammography, ultrasonography and magnetic resonance imaging (MRI). The patient reported gradual enlargement of a mass in the left breast. Mammography identified a high-density, irregular mass, with nipple retraction. Ultrasonography revealed an irregular, complex cystic and solid mass with an unclear margin in the subareolar region. The internal vascularity was seen on Doppler examination. The lesion on MRI was also mixed cystic and solid, with an irregular shape and irregular margins. The solid part of the lesion appeared heterogeneously isointense on T1-weighted imaging (WI) and a slightly high signal on T2WI, and exhibited internal septations with a low signal on T2WI. Following injection of contrast agent, the enhancement of the solid part was rapid and heterogeneous. The cystic parts of lesion appeared as high-signal on T1WI and T2WI. The tumor infiltrated the left nipple and adjacent skin. The patient underwent a left modified radical mastectomy with axillary lymph node dissection. The pathological examination confirmed the tumor as ACC of the left breast. The axillary lymph nodes were negative for tumor metastasis. Therefore, the differential diagnosis of mixed cystic and solid breast masses with unclear margins and internal septations on T2WI exhibiting delayed enhancement, must include ACC.

Objective: To investigate the clinical significance of Gd-EOB-DTPA to predict and evaluate the liver function. Materials and Methods: Gd-EOB-DTPA-enhanced MR images of 98 patients were conducted on a 3.0 Tesla MRI. The values of relative enhancement ratio (rER) and Child-Pugh scores were calculated. Serologic testing was obtained within 7 days before and after MRI. The comparison between different Child-Pugh groups was accomplished by One-Way ANOVA. Spearman rank correlation was applied to analyze the relationship between the rER values and serologic results. Results:The results showed statistical differences among rER values of different Child-Pugh groups and normal group (P<0.05). The mean values are respectively 2.281±0.275, 2.092±0.474,1.824±0.246, 1.711±0.433. Comparative analysis between every two groups was applied and the results showed that normal and Child-Pugh B, normal and Child-Pugh C, Child-Pugh A and Child-Pugh B indicated statistical significance. The linear regression analysis showed that P value between rERs and values of TBIL, ALT, AST, PT, PTA, PA, ChE were less than 0.05, which was significant statistically. Conclusions: The rER values of EOBMRI could be used to evaluate liver function and to identify mild, moderate liver damage significantly. It got the most intimate relation with prothrombin activity and prealbumin.

肝功能是肝脏外科术前评估及预后判断的一项重要指标.临床常用的肝功能评估方法准确性不高,不能完全满足目前精准外科的要求.随着影像技术及对比剂的发展,利用肝特异性对比剂磁共振(magnetic resonance imaging,MRI)增强扫描获得全肝甚至肝段的肝功能成为可能.本文简述了目前肝功能的评价方法及其不足之处,阐述了肝细胞特异性MRI对比剂的原理,及应用其进行肝功能评估的各种方法及最新进展.基于肝特异性对比剂的MRI有望在不久的将来能够成为术前评价肝功能的新定量方法,达到肝脏精准外科对肝功能评估的精确要求.