目的:探讨多参数磁共振成像(mpMRI)在鉴别颈部淋巴结良恶性中的应用价值.方法:选取在医院行MR检查初诊颈部淋巴结病变的34例患者,将其经手术、穿刺病理或随访证实的95枚颈部淋巴结依据淋巴结病理结果分为良性淋巴结组(51枚)和恶性淋巴结组(44枚).分析颈部良、恶性淋巴结MRI平扫影像特征、表观弥散系数(ADC)值及动态增强扫描时间-信号曲线类型、达峰时间等指标间的差异,绘制受试者工作特征(ROC)曲线,比较不同检查技术间的敏感性、特异性及ROC曲线下面积(AUC).结果:恶性淋巴结组淋巴结平均长径、短径均大于良性淋巴结组,差异有统计学意义(t=2.287,t=2.637;P<0.05);恶性淋巴结组平均ADC值低于良性淋巴结组,差异有统计学意义(t=2.702,P<0.05);颈部良性淋巴结时间-信号曲线多为B型,恶性淋巴结则以A型为主;颈部良性淋巴结组的平均达峰时间明显早于恶性淋巴结组,差异有统计学意义(t=40.983,P<0.05).mpMRI鉴别颈部淋巴结良、恶性的敏感性及特异性均高于弥散加权成像(DWI)、动态增强扫描序列.AUC的mpMRI>动态增强扫描>DWI成像,三者间差异有统计学意义(Z=5.247,P<0.001).结论:mpMRI能够提供更加全面的形态学及血流动力学等信息,综合分析能够提高颈部淋巴结定性诊断的准确性.

目的 分析三维非增强血管造影和斑块内出血成像(SNAP)序列上大脑中动脉(MCA)粥样硬化斑块的图像特征,并探讨其与临床症状的关系.资料与方法 回顾性分析76例动脉粥样硬化MCA狭窄患者的三维非增强血管造影、T1加权三维容积各向同性快速自旋回波序列和SNAP图像.根据患者有无急性脑血管事件发生分为症状组44例与无症状组32例.根据斑块主体的分布位置分为前壁、上壁、后壁及下壁斑块,比较两组患者斑块数目及位置差异,以及SNAP序列显示斑块内出血(IPH)的分布情况.结果 76例患者共发现位于MCA偏心斑块78处,症状组中IPH 33例(76.7％),明显多于无症状组的5例(14.3％),差异有统计学意义(P<0.001).症状组内分布在前、上、后、下壁斑块IPH例数分别为15例(83.3％)、14例(87.5％)、2例(50.0％)、2例(40.0％),症状组内前壁及上壁的IPH分布比率明显多于后壁及下壁(P<0.05),但前壁与上壁间IPH比较,差异无统计学意义(P>0.05).结论 MRI 3D SNAP序列可辅助评价症状性MCA粥样硬化性狭窄斑块易损特征,症状组IPH较无症状组更多见.

This study investigated the correlation between dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and intravoxel incoherent motion diffusion-weighted imaging (IVIM DWI) to differentiate thyroid nodules. Quantitative DCE-MRI parameters, including the transfer constant (K trans), rate constant (K ep) and volume fraction of the extracellular extravascular space (V e), were calculated. The diffusion coefficient (D), pseudo-diffusion coefficient (D* ), and perfusion fraction (f) were derived from biexponential fitting of IVIM DWI. A total of 38 nodules, including 22 malignant and 16 benign nodules, were analyzed. The K trans, K ep and V e for benign lesions were 1.32 ± 0.76 min-1, 6.44 ± 1.44 min-1, and 2.02 ± 0.89 min-1, respectively, and for malignant lesions, the values were 0.84 ± 0.30 min-1, 5.43 ± 1.38 min-1, and 1.71 ± 0.83 min-1, respectively (P = 0.027, 0.036, and 0.257, respectively). The D, f, and D* for benign lesions were 1.51 ± 0.52 mm2/s, 26.63 ± 8.75%, and 15.84 ± 8.71 mm2/s, respectively, and for malignant lesions, the values were 0.68 ± 0.17 mm2/s, 31.63 ± 10.72%, and 11.10 ± 4.21 mm2/s, respectively (P [< 0.0001, 0.135, 0.058], respectively). No significant correlations were found between IVIM DWI and DCE-MRI quantitative parameters (all P > 0.05). In benign nodules, a moderate inverse correlation was found between D and K ep (r = -0.54, P = 0.031). IVIM DWI shows no significant correlation with perfusion parameters derived from DCE-MRI; however, IVIM DWI combined with quantitative DCE-MRI may be a useful imaging tool for the assessment of thyroid nodules in clinical studies.

Background There is a growing need for a reproducible and effective imaging method for the quantitative differentiation of benign from malignant thyroid nodules. This study aimed to investigate the performances of intravoxel incoherent motion (IVIM) parameters and the apparent diffusion coefficient (ADC) in differentiating malignant from benign thyroid nodules derived from the most repeatable region of interest (ROI) delineation. Methods Forty-three patients with 46 pathologically confirmed thyroid nodules underwent diffusion-weighted imaging (DWI) with 8 b values. Two observers measured the intravoxel incoherent motion (IVIM) parameters ( D , f and D* ) and the apparent diffusion coefficient (ADC), ADC 600 and ADC 990 values using whole-lesion (W-L) ROI and IVIM parameters using single-section (S-S) ROI delineation. The intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to evaluate the intra- and interobserver variability. The diagnostic performance of these parameters was evaluated by generating receiver operating characteristic (ROC) curves. Results The ICC values of all IVIM with W-L ROI delineation were higher than those with S-S ROI delineation, and excellent intra- and interobserver reproducibility was obtained. According to the Bland-Altman plots, the 95% limits of agreement of the IVIM parameters determined by the W-L ROIs revealed smaller absolute intra- and interobserver variability than those determined by S-S ROIs. The D and ADC 600 values obtained from the W-L ROIs were the most powerful parameters in differentiating benign from the malignant nodules [area under the ROC curve = 0.962 and 0.970, P = 0.771]. Conclusions The W-L ROI of the thyroid was considered an effective method for obtaining IVIM measurements with excellent reproducibility for differentiating benign from malignant nodules.

目的 探讨非增强MR淋巴成像(MRL)与直接淋巴管造影(DLG)术后CT对定位诊断乳糜尿患者淋巴管-泌尿系瘘道与胸导管异常的价值.方法 回顾性分析24例乳糜尿患者MRL及DLG后CT资料,观察MRL所示肾淋巴管及其他腹膜后淋巴管扩张、胸导管扩张和胸导管周围纡曲淋巴管,DLG后CT所示肾淋巴管和泌尿系对比剂反流、髂干和胸导管出口区淋巴管对比剂反流,判断淋巴管-泌尿系瘘道位置和胸导管梗阻相关征象.结果 MRL显示19例(19/24,79.17％)淋巴管-泌尿系瘘道,位于双肾2例,左肾6例,右肾10例,膀胱1例.DLG后CT显示24例淋巴管-泌尿系瘘道,位于双肾6例,左肾7例,右肾10例,膀胱1例.MRL与DLG术后CT的一致性中等(Kappa=0.601,P＜0.001),判断单侧肾脏水平淋巴管-泌尿系瘘差异有统计学意义(x2 =22.463,P＜0.001),MRL敏感度68.97％,特异度100％.2例DLG及术后CT对比剂未达胸导管颈段,MRL显示其中1例颈段胸导管.MRL发现2例DLG术后CT漏诊的合并单侧双肾盂输尿管畸形.结论 MRL可作为无创显示乳糜尿患者淋巴管-泌尿系瘘道的初步检查方法;联合DLG术后CT能为评估淋巴管-泌尿系瘘及胸导管梗阻提供更多信息.

目的:探讨单一节段腰椎间盘突出症患者髓核摘除手术前后受压神经根弥散张量成像(DTI)相关参数(FA值和ADC值)变化及其与病程的相关性.方法:对25例接受经皮椎间孔镜髓核摘除术(PTED)的单一节段腰椎间盘突出症患者进行术前及术后3月两次DTI扫描,测量手术前后患侧及健侧神经根FA和ADC值;记录每位患者的病程并分析DTI相关参数和病程的相关性.结果:术前患侧神经根FA值较健侧减低(P=0.000);术后患侧FA值较术前升高(P=0.000)、较健侧仍减低(P=0.038).术后患侧ADC值低于术前(P=0.019),术前及术后患侧及健侧神经根ADC值均未见统计学差异(P＞0.05).手术前后患侧神经根FA值的差值与病程呈显著负相关(r=-0.751,P=0.000).结论:DTI可能是评价腰椎间盘突出症患者术后神经根微观结构改变的重要工具,对临床可能会具有指导意义.

目的 探索心脏磁共振成像(CMR)评估特发性肺动脉高压(IPAH)患者右心导管(RHC)指标的简便方法.方法 对25例IPAH患者行CMR及RHC检查.使用自主开发的计算机软件在心尖四腔心层面测量并计算右心室腔7个水平舒张末期和收缩末期室间隔至右心室游离壁距离的变化值(SFDC),自心尖向心底方向分别命名为SFDC1～ SFDC7,测量并计算三尖瓣环收缩期位移(TAPSE).分析SFDC1～ SFDC7、TAPSE及SFDC1 ～ SFDC7和TAPSE的乘积分别与RHC测算的右心室心输出量(RVCO)、右心室心脏指数(RVCI)、右心室心搏指数(RVSI)、肺动脉平均压(PAMP)、肺血管阻力(PVR)倒数1/PVR的相关性.结果 所有CMR参数与PAMP均没有相关性(P＞0.05).SFDC5×TAPSE与其他RHC参数相关性最高(r分别为0.86、0.81、0.78、0.74,P＜0.001).TAPSE与RVSI呈中度相关(r=0.50,P=0.01).结论 CMR右心室SFDC5×TAPSE也许可以简便并准确地评估IPAH患者部分RHC指标.

BackgroundIntravoxel incoherent motion (IVIM) parameters derived from iZOOM diffusion-weighted imaging (DWI) can be used to quantitatively identify malignant thyroid nodules. However, the criteria are not standardized. PurposeTo determine IVIM parameter values derived from iZOOM DWI that can differentiate malignant from benign thyroid nodules. Material and MethodsForty-two patients with 46 pathologically confirmed thyroid nodules. All patients underwent preoperative examinations with conventional and iZOOM DWI. A three-dimensional region of interest was drawn on multiple slices to cover the entire nodule. IVIM parameters (D, pure diffusion; f, perfusion fraction; and D*, pseudodiffusion) were measured. The IVIM parameters of the malignant and benign thyroid nodules were compared using independent samples t-tests, a multiple logistic regression, and receiver operating characteristic (ROC) curve analysis. ResultsD, D*, and f exhibited good reproducibility. The D and f values in the malignant nodules (D = [0.72 ± 0.14] × 10−3 mm2/s, [29.94 ± 7.36] %) were significantly lower than those in benign nodules (D = [1.23 ± 0.35] × 10−3 mm2/s, [36.00 ± 8.35] %). The D value achieved the highest area under curve (0.939). The optimal cut-off value for D was 0.87 × 10−3 mm2/s (sensitivity = 95.83%, specificity = 90.91%, positive predictive value [PPV] = 92.00%, negative predictive value [NPV] = 95.24%, and accuracy rate = 93.48%). The area under ROC curve (AUC) of D combined with the f value did not significantly differ from that of D. ConclusionIVIM parameter D derived from iZOOM DWI may be helpful in differentiating malignant from benign thyroid nodules.

目的 比较进食高蛋白高脂肪食物与空腹状态下MR胸导管成像(MRTD)图像质量的差异.方法 将70例继发性下肢淋巴水肿患者随机分为空腹组和高蛋白高脂肪组,分别应用重T2W水成像技术进行MRTD.将所获得的胸导管图像分成腹段、胸段下1/2、胸段上1/2、颈段,分别进行图像质量评分(0～2分),记录2组患者胸导管各段评分情况,并计算每幅图像4个节段总评分.采用秩和检验比较2组间各段评分差异,以独立样本t检验比较2组总评分.结果 2组胸导管显示满意率(4段总评分≥4分)均为97.14％(34/35),高蛋白高脂肪组和空腹组平均评分分别为(6.37±1.37)分和(6.43±1.40)分(t=0.17,P=0.86).2组间胸段下1/2、胸段上1/2和颈段评分差异均无统计学意义(P=0.28、0.40、0.05),腹段差异有统计学意义(P-0.01).结论 空腹或高蛋白高脂肪饮食于MR胸导管整体显示无差异,高蛋白高脂肪饮食对MRTD显示胸导管腹段效果更佳.

Objective To evaluate the value of MRI in diagnosing primary hyperparathyroidism(PHPT), and analyze different results of multiple imaging modalities in the diagnosis of parathyroid lesion.Method Totally 32 PHPT lesions in 30 patients with surgery resection were analyzed retrospectively. There were 28 cases with MRI scan (with or without enhancement); 29 cases with 99mTc-MIBI dual-phase SPECT scan, 28 cases with ultrasonographical exam; 27 cases with combination of MRI and 99mTc-MIBI dual-phase SPECT examination. Using pathological results as the gold standard, the accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappavalue of the three imaging modalities.Result There were 28 cases of parathyroid adenoma (30 lesions); 2 cases of parathyroid hyperplasia (2 lesions). The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, Kappavalue: MRI were 94.69％, 83.33％, 98.80％, 96.15％, 94.25％, 0.858;99mTc-MIBI dual-phase SPECT were 94.87％, 86.21％, 97.73％, 92.59％, 95.56％, 0.859; ultrasonography were 89.38％, 70.00％, 96.39％, 87.50％, 89.89％, 0.709; combination of MRI and 99mTc-MIBI dual-phase SPECT examination were 99.08％, 96.55％, 100.00％, 100.00％, 98.77％, 0.976.Conclusion MRI is an effective tool for diagnosis of PHPT. Combination of MRI and 99mTc-MIBI dual-phase SPECT examination can provide better diagnostic accuracy of PHPT.

目的 应用MR相位对比成像评价永存三叉动脉(PTA)合并一侧颈内动脉发育不良患者PTA内血流状态.方法 对2009年4月至2015年11月发现的5例PTA合并单侧颈内动脉发育不良患者行磁共振相位对比法电影成像(CinePC)检查,采用Q-Flow测量PTA血流方向、平均流速及平均流量.结果 PTA合并一侧颈内动脉发育不良时的其血流方向与单纯PTA相反,表现为由后循环经PTA至颈内动脉闭塞侧大脑前循环;PTA平均流速(9.77 ±0.92) cm/s,平均流量(0.82 ±0.41) ml/s.结论 当合并一侧颈内动脉发育不良时PTA内血流方向会发生反转,由后循环向前循环供血,MR相位对比技术可以无创性地对这一血流变化进行定性、定量观察.

Objective To investigate the feasibility of the MR staging by volume index in the secondary unilateral lower limb lymphedema.Methods All 64 lower limb lymphedema cases were analyzed retrospectively in our hospital.Patients were enrolled into 4 groups according to the stages of International Society of Lymphology(ISL).Then all cases were scanned by mDIXON sequence. Data including volume,body mass index(BMI)and volume index(index=volume/BMI)were calculated and analyzed statistically.Results The analytical results of volume in ISL stages showed that there was no difference in stage Ⅰ and stage 0,stage Ⅱ respectively,but was significantly different between stage 0 and stage Ⅱ,between stage Ⅲ and stage 0,stage Ⅰ,stage Ⅱ respectively.The analytical results of the volume index in ISL stages showed the significant difference between any ISL groups.Moreover,positive linear correc-tion was found between the volume index and ISL stage(r=0.825).The clinical suggested index range:stage 0 was 8.0-9.6×104;stage Ⅰ was 9 .6-13 .0 × 104;stage Ⅱ was 13 .0-18 .0 × 104;stage Ⅲ was more than 18 .0 × 104 .Conclusion For the staging and evaluation of lower limb lymphedema,the new index is better than the volume.It could be established as a new,simple and quick measurable method.

Objective To evaluate the effect of magnetic resonance thoracic ductography (MRTD)in the diagnosis of right thoracic duct.Methods MRTD data were analyzed retrospective,and the detection rate of right thoracic duct was summarized and compared with that of lymphoscintigraphy,direct lymphangiography and operation.Results 12 cases of right thoracic duct were detected in 1547 cases of MRTD.The detection rate was 0.78%,in which 1 case was complied with total internal organs inversion,and 1 case with right aortic arch.Lymphoscintigraphy were performed in all 12 cases and right thoracic duct were detected in 4 cases.Direct lymphangiography were performed in 4 cases and right thoracic duct were observed in all of them.7 cases of them received right lum-bar duct adhesiolysis.Conclusion MRTD is a noninvasive method for diagnosis of right thoracic duct,which providing useful guid-ance for surgical operation.Its detection rate and diagnostic accuracy are higher than those of lymphoscintigraphy.

Objective To evaluate the accuracy and reproducibility of the cardiac magnetic resonance (CMR) imagingderived left ventricular septal-to-free wall curvature ratio by CAD drawing software for prediction of the right ventricular systolic pressure (RVSP) in patients with idiopathic pulmonary arterial hypertension (IPAH).Methods Twenty patients with IPAH confirmed by right-side heart catheterization (RHC) underwent CMR imaging.Two doctors measured interventricular septal curvature (CIVS) and left ventricular free wall curvature (CFW) at end systole by using a third-party CAD drawing software and derived the curvature ratio (CIVS/CFW).Pressure rise of IVS (dPIVS) and pressure rise of FW (dPFW) derived from RHC and systemic systolic blood pressure was used to derive the dP ratio (dPIVS/dPFW).Interobserver and intraobserver curvature ratio measurements agreement was assessed by using Bland-Altman analyses.Linear regression analysis was performed to assess the relationship between curvature ratio and dP ratio.A regression equation was derived.By using this equation,the RVSP was computed in every patient,and the agreement between CMR-and RHC-derived RVSPs was assessed by using Bland-Altman analysis.Results A direct linear correlation between curvature ratio and dP ratio was observed (r =0.93).Bland-Altman analysis revealed moderate agreement between CMR-and RHC-derived RVSPs (mean difference =7.8 ± 12.1 mm Hg).Conclusion CMR-derived curvature ratio by CAD drawing software was a simple,fast,accurate and reproducible index for estimation of RVSP in patients with IPAH.

目的 初步探讨乳腺癌根治术后上肢继发性淋巴水肿的MR表现.方法 回顾性分析本院收治的116例(其中3例为双乳切除,共119侧上肢)女性乳腺癌术后上肢继发性淋巴水肿病例,均行MR检查.结果 根据临床Campisi分期,总结相应的MR表现.Campisi Ⅰ期:患肢皮下软组织内MR表现均为细线征或细网格征.CampisiⅡ期:患肢皮下软组织内MR表现为网格征及平行带征(以浅部及中部分布为主),其中7例内可见条带征.CampisiⅢ期:患肢皮下软组织内MR表现为粗网格征及平行带征、条带征(以中部及深部分布为著),其中9例可见淋巴湖征.CampisiⅣ期:患肢皮下软组织内MR表现为淋巴湖征和深筋膜侧的条带征,其中2例内可见新月征.结论 MR可以作为一种评价和诊断乳腺癌术后上肢继发性淋巴水肿的影像学方法.