目的 观察320排容积CT全脑灌注成像(CTP)在缺血性脑血管病变(ICVD)中的应用价值.方法 选取2017年1月—2018年12月72例拟诊ICVD病人,入院24 h内均行常规CT检查、320排容积CTP检查,获得脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)等灌注参数及动态CT血管成像图(4D-CTA),分析常规CT平扫、全脑CTP、4D-CTA结果.结果 72例病人CT平扫中43例未见明显异常,29例发现37个脑缺血病灶,全脑CTP灌注异常51例,共发现76个病灶;异常灌注区灌注参数CBF值低于健侧镜像区(P<0.05),MTT值、TTP值均高于健侧镜像区(P<0.05);4D-CTA图像提示59例存在不同程度血管狭窄或闭塞,其中轻度11例,中度18例,重度21例,闭塞9例;脑血管重度狭窄或闭塞灌注异常占比93.33％,高于脑血管无狭窄或轻中度狭窄的16.67％(P<0.05);颅内动脉、颈动脉狭窄程度与MTT、TTP呈正相关(P<0.05),与CBV、CBF无相关性(P>0.05).结论 320排容积CTP能同时获得常规CT扫描、全脑CTP、4D-CTA图像,全面显示脑缺血病灶、脑血流灌注参数及脑血管狭窄程度,为ICVD诊疗提供影像学依据.

目的 分析3.0T磁共振(MRI)多b值弥散加权成像(DWI)与动态增强(DCE)扫描对前列腺癌术前诊断价值.方法 选取本院2017年4月至2019年11月收治的82例穿刺活检疑似前列腺癌的患者作为研究对象,分析DCE-MRI与DWI检查诊断前列腺癌的敏感性、特异性、准确性,比较前列腺癌与前列腺增生不同b值的ADC值.结果 以病理学活检为"金标准",DCE-MRI联合DWI检查诊断前列腺癌的敏感性、特异性、准确性分别为93.33％、89.19％、91.46％,其敏感性与病理学比较无差异(P>0.05);前列腺癌不同b值的ADC值均小于前列腺增生,两者比较差异显著(P<0.05).结论 3.0T MRI多b值DWI与DCE-MRI在诊断前列腺癌中具有一定的临床应用价值,术前可有效鉴别诊断前列腺良恶性疾病,具有较高的诊断准确性.

目的 探讨小视野体素内不相干运动-扩散加权成像在前列腺癌与前列腺增生中的鉴别价值.方法 选取邯郸市中心医院2017年10月至2020年5月诊经病理证实的60例前列腺癌患者为A组,76例前列腺增生患者为B组,均行小视野MRI平扫及IVIM-DWI检查,分析A组与B组的ADC值、D值、D*值及f值之间的差异.结果 A组ADC值、D值、f值低于B组(P<0.01).A组D*值高于B组(P<0.01).结论 小视野IVIM-DWI能够反映前列腺组织水分子扩散运动及灌注信息,对鉴别前列腺癌与前列腺增生具有重要的价值.

目的 研究小视野体素内不相干运动(intravoxel incoherent motion,IVIM)技术成像量化参数与前列腺癌(prostate cancer,PC)病理特征的关系及联合诊断价值.方法 选取PC患者62例作为观察组,良性前列腺增生症患者62例作为对照组.比较2组一般资料、IVIM技术成像量化参数[伪扩散系数(pseudo diffusion coefficient,D *)、灌注分数(perfusion fraction,f)、扩散系数(diffusion coefficient,D)、表观扩散系数(apparent diffusion coefficient,ADC)],应用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析 IVIM 技术成像量化参数及联合诊断PC的价值,并比较不同病理特征患者IVIM技术成像量化参数,采用Spearman及Pearson分析IVIM技术成像量化参数与病理特征的相关性.结果 观察组D、ADC低于对照组(P＜0.05);2组D*、f差异无统计学意义(P＞0.05).ROC分析结果显示,D、ADC诊断PC的AUC值分别为0.800、0.773;D、ADC联合诊断PC的AUC值为0.865,返回预测概率Logit(p)作为独立检验变量,结果显示,联合诊断的AUC值大于单一参数单独检测(P＜0.05).不同2016版肾癌WHO泌尿课程/国际泌尿病理协会分级、D'Amico危险度、肿瘤T分期、Gleason评分患者D、ADC差异有统计学意义(P＜0.05);不同肿瘤大小、PSA水平患者D、ADC差异无统计学意义(P＞0.05).D、ADC与ISUP分级、Gleason评分、D'Amico危险度、肿瘤T分期呈负相关(P＜0.05).结论 IVIM技术成像量化参数中D、ADC诊断PC敏感度、特异度较高且参数值与病理特征关系密切,二者联合不仅可进一步提高诊断效能,还能为临床评价病理特征提供参考,便于治疗方案的制定.

目的 探讨体素内不相干运动磁共振加权成像(IVIM-DWI)与动态增强磁共振(DCE-MRI)在前列腺疾病诊断中的联合应用价值.方法 前列腺疾病患者80例,术后病理诊断为前列腺癌34例(前列腺癌组,其中高分化4例、中分化12例、低分化18例)和良性前列腺增生46例(良性前列腺增生组),术前采用IVIM-DWI、DCE-MRI检查,测量IVIM-DWI参数真实的扩散系数(D)、伪扩散系数(D?)、灌注分数(f)以及DCE-MRI参数容量转移常数(Ktrans)、速率常数(Kep)、血管外细胞外间隙容积分数(Ve)、血管空间容积分数(Vp),另采用受试者工作特征曲线(ROC)分析IVIM-DWI联合DCE-MRI诊断前列腺疾病的价值.结果 与良性前列腺增生组比较,前列腺癌组D、f、Ve升高,D?、Ktrans、kep、Vp降低(P均<0.05).与低分化组比较,高分化者D?及中分化者D?、f、kep升高(P均<0.05);与中分化组比较,高分化者D?、kep升高,f降低(P均<0.05).IVIM-DWI联合DCE-MRI正确诊断前列腺癌33例、良性前列腺增生39例,诊断准确性为90.00％,AUC为0.909(95％CI为0.836～0.980),灵敏度为97.10％,特异度为84.80％.结论 IVIM-DWI联合DCE-MRI诊断前列腺疾病具有较高的灵敏度以及特异度,有助于初步评估前列腺疾病性质.

目的 探讨小视野体素内不相干运动(IVIM)扩散加权成像(DWI)在前列腺癌诊断中的应用价值.方法经穿刺活检病理证实为前列腺癌的患者20例,患者穿刺术前均进行多b值小视野DWI扫描,将扫描数据传至GE ADW4.5工作站,采用Functool MADC软件分析多b值DWI图像,完成IVIM数据与图像重建.根据前列腺组织穿刺活检结果确定肿瘤区及非肿瘤区.对多b值DWI图像进行后处理,得到肿瘤区及非肿瘤区的IVIM模型参数,包括ADC值、真实扩散系数(D)、灌注相关扩散系数(D*)和灌注分数(f).比较肿瘤区及非肿瘤区IVIM各参数的差异,采用受试者工作特征(ROC)曲线评价各参数诊断前列腺癌的效能.结果20例前列腺癌患者共获得可评估前列腺分区136个,其中肿瘤区60个、非肿瘤区76个.肿瘤区的ADC、D、f均小于非肿瘤区,肿瘤区D*大于非肿瘤区(P均<0.05).ADC、D、D*、f诊断前列腺癌的ROC曲线下面积分别为0.962、0.789、0.871、0.972.根据敏感度与特异度之和的最大值选定最佳诊断阈值,ADC诊断阈值为0.738×10-3 mm2/s,诊断的敏感度和特异度分别为86.8％、91.7％.D诊断阈值为0.488×10-3 mm2/s,诊断的敏感度和特异度分别为68.4％、83.3％.D*诊断阈值为6.835×10-3 mm2/s,诊断的敏感度和特异度分别为66.7％、100.0％.f诊断阈值为35.45％,诊断的敏感度和特异度分别为92.1％、90.0％.结论小视野IVIM DWI有助于诊断前列腺癌,其中D*及f可提供更多肿瘤相关信息,对前列腺癌的诊断效能较高.

Objective Toinvestigatethevalueof3.0T MRreducedfield-of-view (rFOV)IVIM-DWIondistinguishingprostate cancerandprostatehypertrophy.Methods 30patientswithpathologicallyprovenprostatecancerand38patientswithprostatehypertrophy accordingtotheresultsofbiopsywereanalyzedretrospectively,whounderwent3.0T MRrFOV multipleb-valueDWIscanpreoperatively.The DWIscanwasperformedusing11b-valuesof0,30,50,100,150,200,400,800,1000,1500and2000s/mm2.ADC,slowdiffusion coefficient(D),fastdiffusioncoefficient(D?)andperfusionfraction(f)weremeasuredoncancerousfociandprostatehyperplasiafoci.Allofthe datawereanalyzed.Results TheADC,D,D?andfvaluesoftheprostatecancerwere(0.61±0.12)×10-3 mm2/s,(0.41±0.08)×10-3 mm2/s, (88.0±40.3)×10-3mm2/s,289.3%±29.4%,respectively,and(09.0±01.7)×10-3mm2/s,(05.4±01.3)×10-3mm2/s,(46.1±15.3)×10-3 mm2/s, 474.3%±10.85%,respectively,forprostatehypertrophy.Thedifferencesamongthefourparameterswerestatisticallysignificant(P<0.05).The areasofADC,D,D?andfvaluesunderROCcurvestodistinguishbetweenprostatecancerandprostatehypertrophywere09.32,08.27,01.58,0.976, respectively.Conclusion 3.0T MRrFOVIVIM-DWIcanreflectthetruewaterdiffusion motionandperfusionintheprostate,and maycontributetothedifferentialdiagnosisofprostatecancerandbenignprostatehyperplasia.

Objective To investigate the value of quantitative analysis parameters of dynamic contrast-enhanced MRI (DCE-MRI) in distinguishing low or high grade prostate cancer.Methods Data of DCE-MRI in 26 patients with prostate cancer confirmed by surgical pathology following radical prostatectomy were retrospectively analyzed.These patients were divided into low grade prostate cancer (n=10) group or high grade prostate cancer group (n=16).The parameters,including transport constant (K trans),rat constant (Kep) and extravascular extracellular volume fraction (Vc.) were measured and compared between the two groups.ROC curve was used to determine the efficacy of the parameters in distinguishing low or high grade prostate cancer.The correlation between the parameters and Gleason score were assessed.Results Ktrans,Kep and Ve values in the low grade prostate cancer group was (0.22± 0.07)/min,(1.24 ± 0.57)/min and 0.21±0.08 respectively,and (0.36±0.10)/min,(1.82±0.66)/min,0.21±0.10 respectively in the high grade prostate cancer group.The differences of K trans and Kep were statistically significant between the two groups (both P＜0.05),while of Vc.was not statistically significant (P=0.994).The area under ROC curves of K trans and keapvalues for distinguishing low or high grade prostate cancers was 0.872 and 0.737,respectively.No correlation was found between any parameters nor Gleason scores (all P＞0.05).Conclusion K trans and Kep,the quantitative analysis parameters of DCE-MRI,contribute to the differential diagnosis of low and high grade prostate cancer.

Objective Application of reduced field-of-view diffusion weighted imaging (rFOV DWI) with renal clear carcino-ma, to investigate the utility of the apparent diffusion coef-ficient ( ADC) in distinguishing Fuhrman grading of renal clear cell car-cinoma RCCC .Methods 33 patients with pathologically proven RCCC who underwent preoperative MRI , including diffusion-weighted imaging with b values of 0 and 800 s/mm2 respectively , were retrospectively assessed .All of the RCCC were divided into four (Ⅰ~Ⅳ) grades according to the Fuhrman classification system , which grades Ⅰ~Ⅱwere considering of low-level group , grades Ⅲ~Ⅳwere considering of high-lever group.The utility of ADC for detecting high-grade RCCC was assessed using receiv-er operating characteristic ( ROC ) analysis .Results ADCs were significantly lower among high-grade than among low-grade ccRCC ( t =5.18 , P <0.001 ) .The area under the ROC curve for identifying high-grade ccRCC using ADC was 0.923 , with optimal thresholds , sensitivity, and specificity as follows:1.26 ×10ˉ3 mm2/s, 81.0%, 100%.There were no significance differ-ence between grade Ⅲ and Ⅳ ( t =-1.22;P =0.09 ) .And there were significance differences between grade Ⅰ and Ⅱ, grade ⅠandⅢgrade, gradeⅠand Ⅳgrade,ⅡandⅢgrade level,ⅡandⅣgrade level ( P≤0.001).Conclusion The ADC of rFOV DWI has high diagnostic efficiency in distinguishing Fuhrman grading of ccRCCC .

目的：比较小视野（rFOV）与常规弥散加权成像（DWI）对肾透明细胞癌的成像质量，探讨小视野弥散加权成像（rFOV DWI）在肾透明细胞癌诊断中的应用价值。方法收集经病理检查确诊的肾透明细胞癌患者25例，病理分级按Fuhrman核分级法分为低级别（Ⅰ、Ⅱ级）13例、高级别（Ⅲ、Ⅳ级）12例。均行rFOV DWI及常规DWI扫描，比较两种序列图像质量分级及表观扩散系数（ADC）值，比较两种序列对不同病理级别组织成像的ADC值，进行受试者工作特征（ROC）曲线分析两种序列对不同病理级别肾透明细胞癌的诊断效能。结果 rFOV DWI序列图像质量分级高于常规DWI序列图像（P＜0．01）。rFOV DWI序列的ADC值低于常规DWI（P＜0．05）。常规DWI低级别组与高级别组透明细胞癌ADC值差异具有统计学意义（P＜0．01），rFOV DWI低级别组与高级别组透明细胞癌ADC值差异亦具有统计学意义（P＜0．01）。常规DWI序列对不同级别透明细胞癌的ROC曲线下面积为0．920，最优阈值、灵敏性、特异性分别为1．28×10－3 mm2／s、76．9％、100％；rFOV DWI序列分别为0．965、1．06×10－3 mm2／s、100％、83．3％。结论 rFOV DWI序列较常规DWI序列的图像质量明显提高，且对肾透明细胞癌的分级具有较高的诊断效能。

目的 比较正常肾脏的常规视野( cFOV)和小视野( rFOV) 弥散加权成像( DWI)检测结果. 方法 选取51例(男30例、女21例)肾脏检查结果正常者,分别行cFOV DWI(360 mm ×360 mm)、rFOV1 (320 mm ×260 mm)和rFOV2(280 mm ×200 mm)DWI检查,比较3种序列的图像质量、肾皮质和髓质ADC值差异及不同性别肾皮髓质ADC值差异. 结果 DWI图像质量以rFOV1 最高,与cFOV和rFOV2 比较,P均<0.01. b值为0和1 000 ×10 -3 s/mm2 时,cFOV DWI右肾皮、髓质平均ADC值分别为2.178 ×10 -3、1.987 ×10 -3 mm2/s,rFOVl DWI为2.035 × 10 -3、1.831 ×10 -3 mm2/s,rFOV2 DWI 为1.879 ×10 -3、1.674 ×10 -3 mm2/s;肾皮质和髓质ADC值比较,P均<0.001. 不同性别三种序列肾脏皮髓质的ADC值比较均无统计学差异. 结论 正常肾脏肾皮质的ADC值高于髓质;与cFOV比较,rFOV DWI图像质量高、图像失真少.