Objective:To explore the distribution of perihip stress in male marathon runners and normal volunteers during the gait cycle using finite element analysis.Methods:In November 2022, the hip joint CT image data of a male marathon runner and a male healthy volunteer was collected. The gait cycle was divided into 7 phases, including the foot to the ground, the early, middle, and late period of one-foot support, the toe push and extension period, and the beginning and end of the swing. A three-dimensional finite element model was constructed based on the gray value of CT and according to the individualized material attribute assigning scheme. The dynamic change of hip joint contact force during the gait cycle was applied to the load, and the biomechanical qualitative analysis of the model was carried out through the equivalent stress results. Based on qualitative analysis, the same 10 nodes on the front, middle, and back of the model acetabulum, the front, and back of the femoral head, and the neck of the femur were extracted as equivalent stress reference points, and the biomechanical quantitative analysis of the model was carried out.Results:During the gait cycle, according to the hip equivalent stress distribution diagram, the contact on the articular surface of the two subjects mainly occurred in the posterior upper part of the acetabulum and the posterior part of the femoral head and gradually moved outward and backward with the joint force during walking. From the point of view of the stress distribution nodes around the hip joint, the stress changes of the nodes in each part of the two subjects showed bimodal characteristics with the load inside the hip joint at each phase. The internal stress value of the hip joint showed a gradual upward trend from the foot to the ground, reached the maximum stress in the middle period of one-foot support, then decreased, and slightly increased in the toe push and extension period. Then, the stress values at the beginning and end of the swing gradually decreased until entering the next gait cycle. The stress values in the posterior acetabulum and posterior femoral head of the marathon runner were smaller than those of the healthy volunteer.Conclusion:The stress around the hip joint was different between marathon runner and healthy volunteer, but the stress distribution and transmission path were the same.

目的 探讨基于深度学习测量X线片髋关节外侧中心边缘(LCE)角和Sharp角评估髋关节发育不良的价值.方法 回顾性收集384例成人双髋关节正位数字化X线片.由2名影像科医师标注髋臼关键点和股骨轮廓用于模型训练,经十折交叉验证得到预测结果;以设定程序自动测量双侧髋关节LCE角和Sharp角,由上述医师于X线片中手动测量LCE角和Sharp角并诊断髋关节发育不良及交界性发育不良.对比手动测量与自动测量LCE角、Sharp角结果的差异;观察手动测量与自动测量的相关性;以组内相关系数(ICC)评估测量结果的一致性;采用受试者工作特征(ROC)曲线评估自动测量LCE角、Sharp角诊断髋关节发育不良的效能.结果 共测量768侧髋.手动测量与自动测量左侧LCE角、右侧LCE角、右侧Sharp角结果差异无统计学意义(P均>0.05),手动测量左侧Sharp角小于自动测量结果(P<0.05).对左、右侧LCE角及左、右侧Sharp角,手动测量与自动测量结果的ICC分别为0.944、0.904、0.890及0.887,r值分别为0.948、0.924、0.910及0.887(P均<0.05).共诊断73侧髋关节发育不良、93侧交界性髋关节发育不良.基于自动测量诊断髋关节发育不良的敏感度为87.67％(64/73),准确率为95.57％(734/768);诊断交界性发育不良的敏感度为66.67％(62/93),准确率为91.54％(703/768).自动测量LCE角(阈值为25.24°)和Sharp角(阈值为43.47°)诊断髋关节发育不良的曲线下面积(AUC)分别为0.928和0.906(P均<0.05).结论 基于深度学习自动测量X线片中双侧髋关节LCE角和Sharp角可诊断髋关节发育不良.

In this study, a finite element model of the hip joint of a marathon runner was established based on the method of assigning material properties by CT gray value, and the biomechanics of the hip joint were analyzed when standing on one foot. The results of the study demonstrated that the stress was concentrated in the arcuate line, the greater sciatic notch, the pubic comb, and the acetabular region in the pelvis model; in the femoral model, the stress was concentrated in the femoral head, medial side of femoral neck and femoral shaft. The stress is transmitted from the sacroiliac joint to the acetabular dome through the arcuate line, on one side of the femoral head, from the medial side of the femoral neck to the lower side of the lesser trochanter to the medial side of the femoral shaft, and on the other side from the upper side of the femoral neck to the lateral side of the femoral shaft. The maximum principal stress was distributed in the posterior superior of the acetabular roof (7.22 MPa) and the posterior superior of the femoral head (6.68 MPa). The displacement of the model was about 1 to 3 mm at the upper edge of the ilium, and gradually decreased along the femoral axis, and the displacement at the hip joint was about 0.1 to 0.3 mm.

1病例简介 男,22岁.主诉:左下腹肿物进行性增大8个月.体格检查:左侧腹股沟触及一无痛性肿块,质地硬,平卧后肿物未见缩小消失,牵拉睾丸后肿物无明显活动.彩色多普勒超声提示:左侧会阴部皮肤隆起处距体表0.9 cm探及略强回声,大小约5.0 cm×2.8 cm×4.4 cm,边界较清,形态规则.

搜索2011年—2020年Web of Science核心合集(WoSCC)数据库中关于深度学习在医学影像学研究领域中的应用的文献,以VOSviewer 1.6.13软件分析数据并构建知识图谱,评估该领域最具影响力的文献和科研热点.

Purpose A computer-aided system was used to semiautomatically measure Tönnis angle, Sharp angle, and center-edge (CE) angle using contours of the hip bones to establish an auxiliary measurement model for developmental screening or diagnosis of hip joint disorders. Methods We retrospectively analyzed bilateral hip x-rays for 124 patients (41 men and 83 women aged 20–70 years) who presented at the Affiliated Zhongshan Hospital of Dalian University in 2017 and 2018. All images were imported into a computer-aided detection system. After manually outlining hip bone contours, Tönnis angle, Sharp angle, and CE angle marker lines were automatically extracted, and the angles were measured and recorded. An imaging physician also manually measured all angles and recorded hip development, and Pearson correlation coefficients were used to compare computer-aided system measurements with imaging physician measurements. Accuracy for different angles was calculated, and the area under the receiver operating characteristic (AUROC) curve was used to represent the diagnostic efficiency of the computer-aided system. Results For Tönnis angle, Sharp angle, and CE angle, correlation coefficients were 0.902, 0.887, and 0.902, respectively; the accuracies of the computer-aided detection system were 89.1, 93.1, and 82.3%; and the AUROC curve values were 0.940, 0.956, and 0.948. Conclusion The measurements of Tönnis angle, Sharp angle, and CE angle using the semiautomatic system were highly correlated with the measurements of the imaging physician and can be used to assess hip joint development with high accuracy and diagnostic efficiency.

Background: Diagnosis of hip joint plays an important role in early screening of hip diseases such as coxarthritis, heterotopic ossification, osteonecrosis of the femoral head, etc. Early detection of hip dysplasia on X-ray films may probably conduce to early treatment of patients, which can help to cure patients or relieve their pain as much as possible. There has been no method or tool for automatic diagnosis of hip dysplasia till now. Results: A semi-automatic method for diagnosis of hip dysplasia is proposed. Considering the complexity of medical imaging, the contour of acetabulum, femoral head, and the upper side of thigh-bone are manually marked. Feature points are extracted according to marked contours. Traditional knowledge-driven diagnostic criteria is abandoned. Instead, a data-driven diagnostic model for hip dysplasia is presented. Angles including CE, sharp, and Tonnis angle which are commonly measured in clinical diagnosis, are automatically obtained. Samples, each of which consists of these three angle values, are used for clustering according to their densities in a descending order. A three-dimensional normal distribution derived from the cluster is built and regarded as the parametric model for diagnosis of hip dysplasia. Experiments on 143 X-ray films including 286 samples (i.e., 143 left and 143 right hip joints) demonstrate the effectiveness of our method. According to the method, a computer-aided diagnosis tool is developed for the convenience of clinicians, which can be downloaded at http://www.bio-nefu.com/HIPindex/. The data used to support the findings of this study are available from the corresponding authors upon request. Conclusions: This data-driven method provides a more objective measurement of the angles. Besides, it provides a new criterion for diagnosis of hip dysplasia other than doctors' experience deriving from knowledge-driven clinical manual, which actually corresponds to very different way for clinical diagnosis of hip dysplasia.

乳腺癌不同分子亚型的临床特征、治疗方案及其预后存在明显差异,早期准确预测乳腺癌分子亚型对指导临床治疗、改善预后至关重要.医学成像可以多角度预测乳腺癌分子亚型,其中超声弹性成像、超声增强检查、动态增强MRI、扩散加权成像、MR波谱成像、正电子发射体层成像等功能成像更能从分子水平预测其分子亚型.就多模态功能成像与乳腺癌分子亚型的相关性研究进展予以综述.

背景:动态增强MRI作为一种无创性检测方法,目前在肿瘤领域运用广泛,可进行肿瘤良恶性的鉴别、肿瘤级别的分级以及预后的预测与评估等.近年其在骨关节领域的运用研究逐渐成为热点,可用于骨髓血流灌注的测定、骨组织活性的评估、骨灌注异常的早期发现以及关节炎性病变血运的评估等.目的:总结动态增强MRI的技术概况及其目前在骨关节方面的应用进展.方法:英文检索式为“(bone OR joint) AND (dynamic contrast-enhanced MRI) OR dynamic contrast-enhanced magnetic resonance imaging)”,中文检索式为“(骨OR关节)AND动态增强磁共振”“(骨OR关节)AND动态增强MRI”“(骨OR关节)AND DCE-MRI”,由第一作者检索1984至2019年PubMed、Springerlink以及中国期刊全文数据库(CNKI),查阅近年动态增强MRI在骨关节方面应用的相关文献,最终保留55篇文献进行总结分析.结果 与结论:①目前动态增强MRI成像技术及数据处理尚未标准化,在骨关节主要采用T1WI成像,可行定性、半定量及全定量分析;②定性分析及半定量分析操作简便,量化指标明确,能客观地描述曲线形态,但不能反映组织间、血管内的对比剂浓度,且容易受扫描参数序列的影响,无法检测组织药物代谢动力学信息;而定量分析能获得组织内亚结构间的对比剂浓度变化并生成参数,评估组织的微血管生成及其功能;③动态增强MRI可无创性评估骨关节的微循环灌注,对许多骨关节疾病发病机制的探讨、诊断及鉴别诊断、预后预测、疗效评估以及治疗方式的选择都有一定参考价值.

Objective To observe the bone marrow signals of acetabulum and proximal femur of asymptomatic non?professional marathoners by 3.0 T magnetic resonance imaging (MRI) T1WI, and evaluate the bone marrow transformation, so as to obtain the effect of Marathon exercise on bone marrow composition and function. Methods The study group was randomly selected to participate in and complete the whole marathon at least once a year in the past two years. The training mileage of long?distance running was not less than 1 600 kilometers per year. There were no symptoms such as hip pain. There were no abnormalities in hip joint physical examination. The age of 22?53 years old. A total of 31 and 62 hips were evaluated. The control group was randomly selected 29 healthy persons (58 hip joints), aged 23?53 years, without hip pain and regular exercise. All subjects underwent hip joint MRI scan, and the hip joint MRI showed normal. At least 12 hours before MR scan, he did not engage in long?distance running or other sports. The bone marrow signal intensity of acetabulum and proximal femur in T1WI was compared with that of surrounding muscles and fat. The signal intensity was graded from low to high and evaluated by grade. The research group was divided into two groups according to the training years of marathon (running age). The running age of group A was more than 4 years and group B was less than 4 years. The distribution of bone marrow signal in proximal femur was also evaluated by a more intuitive 3?4 classification method. Mann?Whitney U test was used for statistical analysis. Results Bone marrow signal grading evaluation showed that there were significant differences in bone marrow signal grade distribution between the two groups (Z=-6.828, -4.779, -3.046,-5.266,-3.490,-5.053, P<0.05). In the study group, there were 14, 28 hips and 168 parts in group A, 17, 34 hips and 204 parts in group B, bone marrow signals were graded. There were significant differences in acetabulum, femoral neck and upper femoral shaft bone (Z=-2.202, -2.214, -2.730, P<0.05), but no significant differences in femoral head, trochanter and trochanter bone (Z=-0.886,-1.642,-0.711, P>0.05). To evaluate the classification of bone marrow signals in proximal femur, 62 cases of bone marrow signals in the study group were classified as follows: 10 cases with type 1a, 24 cases with type 1b, 17 cases with type 2 and 11 cases with type 3. In the control group, 58 cases of bone marrow signals in proximal femur were classified as follows: 2 cases with type 1a, 13 cases with type 1b, 26 cases with type 2 and 17 cases with type 3. There were significant differences between the two groups (Z=-4.003, P<0.05). Conclusion The T1WI signal intensity of asymptomatic non?professional marathoners′acetabulum and proximal femur bone marrow is lower than that of non?marathoners; the T1WI signal intensity of acetabulum, femoral neck and upper femoral shaft bone marrow of the elderly runners is lower; that is, marathon exercise has certain influence on the bone marrow signal of acetabulum and proximal femur, that is, the change of bone marrow signal in weight?bearing area has a certain phase with the amount of exercise.

背景:异位骨化为全髋关节置换后常见的并发症之一,多无明显临床症状,但较严重的异位骨化可引起患者术后疼痛及关节活动度减低.异位骨化的发病机制尚不完全清楚,有多种因素可以增加异位骨化的发生率.由于目前临床上尚无有效的非手术方法治疗成熟的异位骨化,故对于异位骨化的早期诊断尤为重要.目的:总结目前全髋关节置换后异位骨化的相关研究进展.方法:第一作者以“total hip arthroplasty,heterotopic ossification”为英文检索词,以“全髋关节置换术,并发症,异位骨化”为中文检索词,通过PubMed、Springerlink英文数据库及CNKI中国期刊全文数据库检索2008至2018年间的相关文献.初检得到相关英文文献278篇,中文文献97篇,筛选后纳入53篇进行分析总结.结果 与讨论:①目前对于异位骨化的发病机制尚不完全清楚,与全身及局部因素均有关;②异位骨化的危险因素分为可变因素及不可变因素,通常认为年龄、男性、强直性脊柱炎、既往髋部手术史、髋关节强直等因素可增加异位骨化的发生率;③异位骨化的确诊主要依靠影像学检查,不同时期异位骨化的影像学表现有所不同,且不同的影像学检查方法对于异位骨化检测的敏感性和特异度也有区别;④异位骨化的危险因素仍存在很多不同结论,且没有公认的最佳影像学检查方法,但众多研究及分析结果可为临床预防及诊断全髋关节置换后异位骨化提供相应依据.

目的 探讨全髋关节置换术(THA)后异位骨化(HO)X线表现及其发生的危险因素,为预防及减轻其程度提供依据.方法 回顾性分析356例(385髋)患者全髋关节置换术后异位骨化的发生情况,以双髋关节正位X线片为诊断依据,通过影像学表现,有异位骨化的180髋作为研究组,按Brooker分级记录;无异位骨化的205髋作为对照组.对两组患者的年龄、性别、人工关节材料、手术时长、术中出血量、切口长度及术后应用非甾体类抗炎药(NSAIDs)时间进行单因素分析,并对有统计学意义的因素行多因素Logistics回归分析,得出与异位骨化发生及分级的相关性.结果 单因素分析显示,患者的性别、年龄、术中出血量及术后应用NSAIDs时间均为全髋关节置换术后异位骨化的影响因素(P<0.05).多因素Logistic回归分析结果显示,患者的性别、年龄及术后应用NSAIDs时间均为全髋关节置换术后异位骨化的独立危险因素(P<0.01).异位骨化在46.8％(180/385)的患者中形成.其中,BrookerⅠ级为119髋(66.1％),Ⅱ级为48髋(26.7％),Ⅲ级为12髋(6.7％),Ⅳ级为1髋(0.6％).引入brooker分级,将性别、年龄、术后应用NSAIDs时间与异位骨化的等级进行Spearman相关分析,结果显示,异位骨化的发生与患者性别(r=0.178,P<0.01)、年龄(r=0.152,P<0.01)呈正相关,与术后应用NSAIDs时间呈负相关(r=-0.153,P<0.01).结论 异位骨化是全髋关节置换术后的常见并发症.年龄大、男性会增加异位骨化的发生,术后应用NSAIDs可预防和减少异位骨化的发生.

患者 女,27岁.10年前发现右小腿下端外侧一突起肿物,逐渐增大,活动时略疼痛,近3个月肿物增长明显,疼痛加剧.临床触诊肿物呈长条形,质软,囊性感,有少许活动度,且有压痛感,局部皮肤色泽正常,行走略受限.MRI平扫显示右侧腓骨长短肌内可见条片状T1WI等信号、T2WI高信号为主混杂信号影,T2 stir呈不均匀高信号影,周围可见低信号,边界尚清,邻近腓骨长短肌受压推挤,周围软组织略肿胀(图1,2).MRI增强显示病灶呈渐进性明显强化,强化程度与同层血管相似,其内可见条片状不强化区,周围似可见供血血管(图3,4).MRI诊断为右小腿血管瘤.

病例资料 患者,女,45 岁,发现右乳肿物 7 个月,无乳头溢液、无压痛. 查体:右乳房增大,外上象限触及大小约6.0 cm×5.0 cm 肿块,边界不清,质韧. 影像检查: 双乳钼靶 X 线: 右乳外上象限见大小约6.2 cm×5.0 cm 卵圆形等纤维腺体密度影,局部界欠清,内未见钙化,提示 BI-RADS 3 类,双侧腋窝未见肿大淋巴结影(图1a,1b). 超声检查:右乳外上象限结构紊乱,回声增强,局部腺体明显增厚,内可见扩张导管,内部及周边未探及血流信号(图2a,2b).乳腺MRI 平扫+增强:右乳外上象限见大小约6.5 cm×4.6 cm 卵圆形异常信号影,界限清晰, T2抑脂呈等高信号(图3a),T1WI 呈混杂稍低信号(图3b),动态增强扫描(DCE-MRI)病变延迟缓慢强化(图 3c),右乳血管较丰富、略增粗(图 3d),DWI 呈稍高信号(图 3e), ADC 图等高信号(图 3f),时间-信号强度曲线为缓慢持续上升型(Ⅰ型) (图3g ). 患者行右侧乳房单纯切除术,术后5 年随访,未出现复发及转移.

目的 通过动态增强磁共振(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)评价股骨头坏死高危人群股骨头微循环灌注的变化及正常人群股骨头内血流灌注的异质性,为超早期股骨头坏死提供影像学依据.材料与方法 共选取50人60例股骨头,实验组为30例高危股骨头,对照组为30例正常股骨头,两组均行髋部DCE-MRI扫描,在股骨头负重区(前上方)、非负重区(下方)及股骨头中心区分别选取感兴趣区(region of interest,ROI),绘制百分比时间信号曲线(time-intensity curve,TIC),读取TIC上首次峰值(fEmax)、最高信号强度(Emax)、达峰时间(time to peak,TTP)参数,通过独立样本t检验比较股骨头坏死高危人群股骨头不同ROI与正常股骨头相应区域ROI灌注参数的差异;股骨头负重区与非负重区及股骨头中心ROI灌注参数差异的比较采用方差分析.结果 实验组与对照组负重区fEmax、Emax差异有统计学意义(P<0.05),实验组与对照组非负重区TTP差异有统计学意义(P<0.05),实验组与对照组股骨头中心区fEmax、Emax、TTP差异有统计学意义(P<0.05).对照组内负重区、中心区fEmax、Emax大于非负重区fEmax、Emax,且差异有统计学意义(P<0.01),对照组内不同ROI间TTP差异无统计学意义(P>0.05).结论 股骨头坏死高危患者比正常人股骨头血流灌注低;正常人群中股骨头负重区与非负重区血流灌注具有异质性,负重区血流灌注较多.此外,高危人群股骨头血流灌注量小于健康人,灌注时间较正常股骨头长,存在血流瘀滞现象.因此,DCE-MRI可应用于指导临床进行早期预防股骨头坏死发生.

病例资料 患者,女,56岁,因发热3 d,上腹部疼痛1 d入院.3d 前无明显诱因出现发热,伴咳嗽、咳痰.1d 前无明显诱因出现右上腹部及剑突下疼痛, 呈持续性胀痛,伴恶心、呕吐、心悸、发热,测体温 38.3℃,伴肩背部放射痛.近2 个月来体重下降6 kg.查体:右上腹及剑突下压痛,无反跳痛、肌紧张,墨菲征可疑阳性. 既往胆囊结石病史多年,未行进一步检查. 其父有胰腺癌病史,其母有肺癌病史.实验室检查:白细胞计数(WBC):27.5×109/L 粒细胞百分比(Neu％):87.1％;肿瘤标志物如甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原(CA125、CA19-9)均阴性.

BACKGROUND:Research on the changes to knee structures in asymptomatic amateur ice hockey players (AAIHPs) has been limited. We aimed to assess the performance of the knees in AAIHPs using 3.0-T magnetic resonance imaging (MRI).METHODS:A total of 71 asymptomatic knees (32 AAIHPs and 39 age- and sex-matched controls) were imaged using a 3.0-T MRI scanner at the Affiliated Zhongshan Hospital of Dalian University in April 2017. Two experienced musculoskeletal radiologists were blinded to assess all MRI findings, including bursae around the knee, bone marrow edema (BME), meniscal signal changes, and articular cartilage and ligament damage. Any disagreements were resolved by a third professor of musculoskeletal radiology. Categorical variables were compared using the Chi-square test and continuous variables using the Student's t-test or Mann-Whitney U-test.RESULTS:The most common finding was fluid-filled bursae surrounding the knee. In the AAIHP group, which totaled 32 knees and 416 bursae, 155 (37%) fluid-filled bursae were present. In the control group, there were a total of 39 knees and 507 bursae, and 91 (18%) fluid-filled bursae were present. There was a significant difference in the number of fluid-filled bursae between the two groups (P < 0.05). However, in AAIHPs, the prevalence of meniscal signal changes (16 knees, 50%) was higher than in the control group (2 knees, 5%; P < 0.001). Importantly, 15 of the 19 were grade II signals. Other changes were only found in AAIHPs. Articular cartilage lesions were detected in 47% of their knees, predominantly at the patellofemoral joint, and BME was found in 34% of their knees.CONCLUSION:The MRI findings of knees in AAIHPs mainly manifested as self-protection reaction, and proper ice hockey exercise could be advocated.

目的 利用MRI测量退变性中央型腰椎管狭窄(LSS)硬膜囊横截面积(CSA),研究其与神经根沉降征(NRS)相关性,探讨NRS对LSS的诊断价值.方法 选择2017年4月至12月于大连大学附属中山医院就诊经MRI诊断中央型LSS患者500例,其中男性189例,女性311例;年龄45～80岁,平均年龄62.83岁;临床主要表现为腰腿痛、下肢无力、下肢麻木及间歇性跛行等症状.根据最小CSA分组,并获取每组内所有狭窄节段NRS的阳性病例,计算其阳性率.运用SPSS 20.0统计学软件行统计学分析,获得NRS阳性发生率与CSA间的相关性及退变性ISS在不同腰椎节段中的分布特点.结果 500例患者中1 038个狭窄节段共43.0％病变节段位于L4～5节段,39.1％位于L3～4节段,17.9％位于L2～3节段;其中NRS阳性组550个狭窄节段,NRS阴性组488个狭窄节段.阳性NRS在L2～3、I3～4、L4～5节段的分布差异有统计学意义(x2=8.688,P＜0.05);经两两比较得NRS阳性率在L3～4,L～5节段的分布差异有统计学意义(P＜0.05),I4～5节段的NRS阳性率高于L3～4节段.LSS轻度狭窄中NRS阳性103例,NRS阴性332例;LSS中度狭窄中NRS阳性147例,NRS阴性122例ASS重度狭窄中NRS阳性300例,NRS阴性34例;NRS阳性率与最小CSA的变化呈显著的负相关(r=-0.940,P＜0.05),CSA越小,阳性NRS的发生率越高.LSS组中NRS阳性率,单节段＜双节段＜多节段,差异有统计学意义(X2=65.612,P＜0.05).结论 退变性中央型LSS中NRS阳性与CSA具有显著相关性,NRS阳性可提示椎管狭窄,并可以作为临床评估和量化LSS的一种辅助方法.

目的:探讨动态增强磁共振(DCE-MRI)参考区域模型与扩散加权成像(DWI)对Luminal-A型乳腺癌(LABC)和Luminal-B型乳腺癌(LBBC)分型的诊断价值及与生物标志物Ki-67表达的相关性.方法:回顾性分析2016年12月-2017年6月本院经手术病理及免疫组化结果为luminal型乳腺癌102例.采用Siemens 3.0 T超导MRI扫描仪,行MR常规乳腺扫描、DCE-MRI及DWI扫描,获取病变表观扩散系数(ADC)值,运用后处理软件(Omni-Kinetics)测量灌注参数(Ktrans和Kep),分析其相关性;采用受试者工作特征曲线(ROC)评估Ktrans值联合ADC值对luminal型乳腺癌分型的诊断价值.结果:LABC与LBBC的平均Ktrans和ADC值差异有统计学意义(P=0.002、0.000),Kep值差异无统计学意义(P=0.875).Ktrans值与Ki-67表达呈正相关(r=0.369,P=0.001＜0.05),而ADC值与Ki-67表达呈负相关(r=-0.465,P=0.000＜0.05),Kep值与Ki-67表达无相关性(P=0.392＞0.05).ROC曲线分析,当Ktrans和ADC值的阈值分别取0.724/min和0.853×10 3mm2/s时,鉴别LABC与LBBC的敏感度分别为74.5％、63.3％,特异度分别为63.3％、76.6％,ROC曲线下面积(AUC)分别为0.689、0.741,联合Ktrans和ADC值的敏感度、特异度、AUC分别为71.0％、71.0％、0.777.结论:Ktrans值及ADC值与Ki-67表达有明显相关性;DCE-MRI参考区域模型(Ktrans值)和DWI(ADC值)有助于luminal型乳腺癌的鉴别诊断,且两者联合对luminal型乳腺癌的诊断效能高于单独使用.

患者 女,57岁.10 d前无明显诱因出现上腹部持续性胀痛,3 d前腹痛、腹胀症状加重,疼痛剧烈,伴有恶心、呕吐恶臭胃内容物,停止排气,排少量便,颜色深,无鲜血便.查体:腹膨隆,腹软,脐周压痛阳性,无反跳痛及肌紧张,莫菲征弱阳性.血液检查:血红蛋白55 g/L,总蛋白71.4 g/L,白蛋白27.3 g/L.患者有类风湿关节炎病史20余年,一直服用非甾体类抗炎药(non-steroidal anti-inflammatory drugs, NSAIDs),10余年前左侧股骨头坏死,3年前右侧股骨头坏死,10余年前行阑尾切除术.