OBJECTIVES:To evaluate the value of multiparameter MRI (mp-MRI) including conventional MRI image features, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) in differentiating borderline from malignant ovarian epithelial tumors (OETs). METHODS:Forty-three patients with borderline OETs (BOETs) and 119 patients with malignant OETs (MOETs) who underwent mp-MRI examinations for pre-treatment assessment were respectively enrolled. Conventional MRI features (eg, tumor shape, configuration, signal intensity [SI] on T1WI and T2WI) were retrospectively analyzed. Apparent diffusion coefficient (ADC), and DCE-MRI derived parameters (rel-enhancement [RELENH], time to peak [TTP], wash-in-rate [WIR], and wash-out-rate [WOR]) were evaluated. Independent samples t-test, Mann-Whitney U test, χ2 test, multivariate logistic regression analysis, binary logistic regression, and receiver operating characteristic (ROC) curve analyses were employed as appropriate. RESULTS:BOETs group showed significantly lower age than MOETs group (P < .001). Multivariate logistic regression analysis indicated that tumor configuration was the independent imaging features associated with MOETs (P < .001). BOETs group showed significantly higher ADC value than MOETs group (P < .001). Among DCE-MRI derived parameters, MOETs group showed significantly shorter TTP than BOETs (P = .014). ROC analyses indicated that a combination of age ≥ 43.5 years old + non-cystic predominant type + ADC ≤ 1.05 × 10-3 mm2/s + TTP ≤ 238.87 s showed the highest efficiency (AUC, 0.930; sensitivity, 84.9%; specificity, 86.0%) in diagnosing MOETs, which was significantly higher than that of age (P = .002), configuration (P < .001), ADC (P = .027), and TTP (P < .001) alone. CONCLUSIONS:mp-MRI might be effective in differentiating MOETs from BOETs. ADVANCES IN KNOWLEDGE:The study which combining conventional MRI, DWI, and DCE-MRI for differentiating BOETs from MOETs is still lacked until now. What is more, the study may be more accurate for the differentiation of borderline malignancy or low-grade malignant potential tumors.

ObjectivesThe main objective of this study was to identify the key predictors and construct a nomogram that can be used to predict the overall survival of individuals with non-endometrioid endometrial cancer.MethodsA total of 2686 non-endometrioid endometrial cancer patients confirmed between 1988 and 2018 were selected from the Surveillance, Epidemiology, and End Results database. They were divided into a training cohort and an internal validation cohort. Independent risk factors were chosen by Cox regression analyses. A predictive nomogram model for overall survival was constructed based on above factors. A Chinese cohort of 41 patients was collected to be an external validation cohort.ResultsEight variables were estimated as independent predictors for overall survival. A nomogram was established using these factors. The C-index for predicting the overall survival of patients with non-endometrioid endometrial cancer from the nomogram was 0.734, 0.700, and 0.767 in training, internal, and external validation cohort, respectively. Calibration plots and decision curve analysis showed that the nomogram was valuable for further clinical application.ConclusionWe constructed a nomogram which can be used as an effective tool to predict the 3- and 5-year overall survival of Non-endometrioid endometrial cancer patients.

该文报道1例新生儿先天性马蹄肺合并胸主动脉扭曲畸形的多层螺旋CT表现。患儿生后紫绀，呼吸急促。CT表现为在脊柱前方心影后方两下肺峡部肺组织相连，伴左肺发育不良，完全性肺静脉异位引流，永存左上腔静脉，主动脉弓发育不良，降主动脉走行迂曲、延长，动脉导管走行迂曲。

ObjectivesTo explore the prognostic value of magnetic resonance image compilation (MAGiC) in the quantitative assessment of neonatal hypoglycemic encephalopathy (HE). MethodsA total of 75 neonatal HE patients who underwent synthetic MRI were included in this retrospective study. Perinatal clinical data were collected. T1, T2 and proton density (PD) values were measured in the white matter of the frontal lobe, parietal lobe, temporal lobe and occipital lobe, centrum semiovale, periventricular white matter, thalamus, lenticular nucleus, caudate nucleus, corpus callosum and cerebellum, which were generated by MAGiC. The patients were divided into two groups (group A: normal and mild developmental disability; group B: severe developmental disability) according to the score of Bayley Scales of Infant Development (Bayley III) at 9-12 months of age. Student's t test, Wilcoxon test, and Fisher's test were performed to compare data across the two groups. Multivariate logistic regression was used to identify the predictors of poor prognosis, and receiver operating characteristic (ROC) curves were created to evaluate the diagnostic accuracy. ResultsT1 and T2 values of the parietal lobe, occipital lobe, center semiovale, periventricular white matter, thalamus, and corpus callosum were higher in group B than in group A (p < 0.05). PD values of the occipital lobe, center semiovale, thalamus, and corpus callosum were higher in group B than in group A (p < 0.05). Multivariate logistic regression analysis showed that the duration of hypoglycemia, neonatal behavioral neurological assessment (NBNA) scores, T1 and T2 values of the occipital lobe, and T1 values of the corpus callosum and thalamus were independent predictors of severe HE (OR > 1, p < 0.05). The T2 values of the occipital lobe showed the best diagnostic performance, with an AUC value of 0.844, sensitivity of 83.02%, and specificity of 88.16%. Furthermore, the combination of MAGiC quantitative values and perinatal clinical features can improve the AUC (AUC = 0.923) compared with the use of MAGiC or perinatal clinical features alone. ConclusionThe quantitative values of MAGiC can predict the prognosis of HE early, and the prediction efficiency is further optimized after being combined with clinical features.

目的 探讨常规MRI联合扩散加权成像(DWI)及表观扩散系数(ADC)在早产儿局灶性脑白质损伤(PWML)诊断中的应用价值.方法 回顾性分析81例PWML患儿资料,按年龄分为早期组(1～7天)、中期组(8～30天)及晚期组(1～3个月),每组各27例.观察各组PWML患者MRI影像特点,包括T1WI、T2WI、T2-FLAIR、DWI及ADC图像,运用Pearson卡方检验比较每组间各序列对于PWML检出能力有无差异,采用两独立样本t检验比较各组病灶平均表观扩散系数(ADCmean)值有无统计学差异,并应用受试者工作特征(ROC)曲线评估ADCmean值在早期组与中、晚期组鉴别中的诊断效能.结果 PWML形态包括点状、片样、簇状及线状,且各期均以点状病灶为主.T1WI高信号、T2WI低信号、T2-FLAIR高信号、DWI高信号及ADC低信号.各期均为T1 WI检出数最多,T2WI及T2-FLAIR病灶检出数对比T1WI差异无统计学意义(P＞0.05),DWI病灶数对比T1WI差异有统计学意义(P＜0.05),三组ADCmean值差异有统计学意义(P＜0.05),早期组与中、晚期组ADCmean值对比曲线下面积(AUC)=0.808(95％ CI:0.729～0.864,P＜0.001),临界值为1.09×10-3mm2/s,敏感度84.91％,特异度60.87％.结论 MRI对PWML诊断具有重要价值,T1 WI检出效能最强,而DWI对早期脑白质损伤更为敏感,DWI及ADCmean值可能是评估PWML治疗效果及预后的有效方法,ADCmean＞1.09×10-3 mm2/s可作为PWML治疗效果及积极预后的评价指标.

目的 观察依据术前MRI所示子宫内膜癌(EC)浸润肌层深度联合原发灶体积预测其淋巴结转移的价值.方法 回顾性分析255例经术后病理确诊的EC患者,以盆腔MRI评估EC浸润肌层深度(浸及深肌层或浅肌层),并测量原发灶体积.采用单因素及多因素logistic回归分析筛选EC淋巴结转移的独立预测因素,并建立联合模型回归方程;绘制各参数及联合模型的受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估其预测EC淋巴结转移的效能.结果 255例中,EC浸及深肌层91例、浅肌层164例;25例淋巴结转移、230例无淋巴结转移.术前MRI显示EC浸润肌层深度及原发灶体积是淋巴结转移的独立预测因素(P均＜0.05),以之构建联合模型回归方程,即Logit(P)=-3.73+0.02×原发灶体积+2.06×MRI浸润肌层深度,以之预测EC淋巴结转移的AUC为0.83,高于单一 EC浸润肌层深度及原发灶体积(AUC=0.77、0.78,Z=2.61、2.27,P均＜0.05).结论 术前根据MRI所示EC浸润肌层深度联合原发灶体积可预测淋巴结转移.

Purpose Previous research has found that women with second pregnancy may have an increased risk of cognitive dysfunction. This study aims to investigate the intrinsic functional connectivity (FC) pattern of the DMN anchored on posterior cingulate cortex (PCC) in postpartum women, especially the parous women using resting-state functional magnetic resonance imaging (rs-fMRI). Methods Twenty parous women, 26 primiparous women, and 30 nulliparous women were included for rs-fMRI scan. They were age and education well matched. A seed based FC method was conducted to reveal FC patterns with other brain regions using a region of interest in the PCC. The relationships between FC patterns and cognitive performance were further detected. Results Relative to primiparous women, parous women had significantly decreased FC primarily between the PCC and the right middle frontal gyrus and right parahippocampal gyrus. The decreased FC to the right parahippocampal gyrus in parous women was positively associated with the reduced DST scores (rho = 0.524, p = 0.031). Moreover, parous women compared with nulliparous women showed significantly decreased FC between the PCC and the left superior frontal gyrus and left middle frontal gyrus. The reduced FC to the left superior frontal gyrus in parous women was also positively associated with the lower DST scores (rho = 0.550, p = 0.022). Conclusion Our result highlights that women with second pregnancy revealed decreased FC between the DMN regions with the parahippocampal gyrus and prefrontal cortex, which was correlated with specific impaired cognitive function. This study may provide new insights into the neuropathological mechanisms of postpartum cognitive impairment and enhance our understanding of the neurobiological aspects during postpartum period.

Currently, there are no effective approaches for differentiating ovarian fibrothecoma (OF) from broad ligament myoma (BLM). This retrospective study aimed to construct a nomogram prediction model based on MRI to differentiate OF from BLM. The quantitative and qualitative MRI features of 41 OFs and 51 BLMs were compared. Three models were established based on the combination of these features. The ability of the models to differentiate between the two cancers was assessed by ROC analysis. A nomogram based on the best model was constructed for clinical application. The three models showed good performance in differentiating between OF and BLM. The areas under the curve (AUC) of the models based on quantitative and qualitative variables were 0.88 (95% CI: 0.79–0.96) and 0.85 (95% CI: 0.76–0.93), respectively. The combined model designed from the significant variables exhibited the best diagnostic performance with the highest AUC of 0.92 (95% CI: 0.86–0.98). Calibration of the nomogram showed that the predicted probability matched the actual probability well. Analysis of the decision curve demonstrated that the nomogram was clinically useful. Relative T1 value, stone paving sign, enhancement patterns, and ascites were identified as valuable predictors for identifying OF or BLM. The MRI-based nomogram can serve as a preoperative tool to differentiate OF from BLM.

本文报道1例原发性外阴肌上皮癌，患者女，37岁，以近半年会阴无痛性肿物逐渐增大为主要临床表现。MRI示会阴部形态不规则肿物，边缘光整，T 1WI呈等信号，T 2WI呈不均匀高信号，DWI呈高信号，增强扫描病灶强化不均匀，与阴蒂分界欠清，动态增强时间-信号强度曲线呈平台型，晚期轻度流出。术后随访24个月肿瘤无复发。

目的 观察M RI鉴别诊断卵巢浆液性交界性肿瘤(SBOT)与浆液性囊腺瘤(SC)的价值.方法 回顾性分析经手术病理证实的30例SBOT和40例SC,对比其术前MRI表现.结果 30例SBO T共39个病灶,21例累及单侧、9例累及双侧卵巢;T1WI中25个病灶呈低信号、9个呈稍高信号、5个呈混杂信号,T2WI中均呈高信号,其中4例7个病灶为实性.40例SC共43个病灶,37例累及单侧、3例累及双侧卵巢;T1WI中37个病灶呈低信号、6个呈稍高信号,T2WI均呈高信号.SBO T与SC累及侧别、分房数目、囊壁或分隔厚度差异均有统计学意义(P均<0.05),病灶最大径差异无统计学意义(P>0.05).39个SBOT病灶中,31个可见囊内壁结节,增强后轻-中度强化,时间-信号曲线呈上升型或平台型;43个SC病灶中,11个可见囊内壁结节,增强后轻度强化,时间-信号曲线呈上升型.SBOT与SC壁结节最大径、表观弥散系数(ADC)、最大增强幅度(MRE)、最大增强斜率(MaxSlope)差异均有统计学意义(P均<0.05),壁结节数目差异无统计学意义(P>0.05).结论 SBOT、SC的MRI表现不同,有助于鉴别诊断.

To conduct multiparametric magnetic resonance imaging (MRI)-derived radiomics based on multi-scale tumor region for predicting disease-free survival (DFS) in early-stage squamous cervical cancer (ESSCC). A total of 191 ESSCC patients (training cohort, n = 135; validation cohort, n = 56) from March 2016 to September 2019 were retrospectively recruited. Radiomics features were derived from the T2-weighted imaging (T2WI), contrast-enhanced T1-weighted imaging (CET1WI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) map for each patient. DFS-related radiomics features were selected in 3 target tumor volumes (VOIentire, VOI+5 mm, and VOI−5 mm) to build 3 rad-scores using the least absolute shrinkage and selection operator (LASSO) Cox regression analysis. Logistic regression was applied to build combined model incorporating rad-scores with clinical risk factors and compared with clinical model alone. Kaplan–Meier analysis was used to further validate prognostic value of selected clinical and radiomics characteristics. Three radiomics scores all showed favorable performances in DFS prediction. Rad-score (VOI+5 mm) performed best with a C-index of 0.750 in the training set and 0.839 in the validation set. Combined model was constructed by incorporating age categorized by 55, Federation of Gynecology and Obstetrics (Figo) stage, and lymphovascular space invasion with rad-score (VOI+5 mm). Combined model performed better than clinical model in DFS prediction in both the training set (C-index 0.815 vs 0.709; p = 0.024) and the validation set (C-index 0.866 vs 0.719; p = 0.001). Multiparametric MRI-derived radiomics based on multi-scale tumor region can aid in the prediction of DFS for ESSCC patients, thereby facilitating clinical decision-making. • Three radiomics scores based on multi-scale tumor region all showed favorable performances in DFS prediction. Rad-score (VOI+5 mm) performed best with favorable C-index values. • Combined model incorporating multiparametric MRI-based radiomics with clinical risk factors performed significantly better in DFS prediction than the clinical model. • Combined model presented as a nomogram can be easily used to predict survival, thereby facilitating clinical decision-making.

目的 分析乳腺癌动态对比增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)参数、表观扩散系数(apparent diffusion coefficient,ADC)与病理分子预后标记物的相关性.材料与方法 回顾性分析我院106例乳腺癌患者临床资料,分别比较雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、细胞增殖抗原Ki67及雄激素受体(androgen receptor,AR)阳性表达与阴性表达者DCE-MRI参数、ADC差异,并分析DCE-MRI参数、ADC与ER、PR、Ki67、AR表达的相关性.结果 经Spearman秩相关检验,发现ER、PR及AR阳性表达与直径、边缘毛刺呈显著负相关(P<0.05),AR表达阳性表达还与达峰时间(time to peak,TTP)、ADC值呈显著正相关(P<0.05);Ki67阳性表达与直径、边缘毛刺呈显著正相关(P<0.05),与TTP、ADC值呈显著负相关(P<0.05).结论 DCE-MRI形态学参数及TTP、ADC值与乳腺癌分子生物学标记物具有一定相关性,对判断乳腺癌预后有利.

目的:探讨新生儿坏死性小肠结肠炎(NEC)腹部X线征象与临床分期、转归的相关性.方法:收集139例NEC腹部X线平片、临床资料,比较Ⅱ期、Ⅲ期NEC腹部X线征象差异,分析NEC腹部X线征象与治疗方式的关系.结果:NEC Ⅰ期21例,Ⅱ期106例,Ⅲ期12例;内科治愈或好转117例,外科手术22例.Ⅱ期NEC肠管扩张、门静脉积气、气腹阳性率均低于Ⅲ期,差异有统计学意义(P＜0.05).内科治疗组NEC肠管扩张、肠壁积气、门静脉积气、气腹阳性率均低于外科手术组,差异有统计学意义(P＜0.05),logistic回归提示,肠管扩张(x1)、气腹(x4)与是否需要外科手术治疗关系最密切,拟合方程:y=2.354x1+3.094x4-6.187.结论:X线平片中肠管扩张、门静脉积气、气腹征象对NEC病情进展有提示作用,肠管扩张、气腹征象与外科手术选择关系最密切.

目的 评价产前MRI诊断胎儿侧脑室前角旁囊肿的价值,并随访观察胎儿转归.方法 回顾性分析44胎侧脑室前角旁囊肿胎儿,并跟踪随访观察其MRI特征及妊娠结局.结果 44胎中,23胎Ⅰ型、11胎Ⅱ型及10胎Ⅲ型侧脑室前角旁囊肿;T1WI见侧脑室前角旁类圆形/椭圆形、条形低信号,T2WI呈高信号,边界清晰;其中22胎合并其他颅内、外畸形.3种类型囊肿位置(单/双侧)差异无统计学意义(P＞0.05),Ⅰ型与Ⅱ型、Ⅱ型与Ⅲ型囊肿性质(单/双囊)差异具有统计学意义(P均＜0.0167);左、右侧囊肿最长径差异均具有统计学意义(P均＜0.05).其中19例出生后复查MRI,4例囊性病灶消失,8例病灶较胎儿期缩小,7例无明显改变.结论 产前MRI可为胎儿侧脑室前角旁囊肿产前咨询及出生后早期干预提供依据;侧脑室前角旁囊肿胎儿预后与其类型、大小及伴发畸形密切相关.

目的 提出一种基于偏场校正的概率模糊C均值(BCPFCM)改进算法,并应用于脑部MRI图像分割.方法 采用BrainWeb数据库中2幅人工合成图像和20幅脑部MRI图像进行仿真实验.第一步,构建MRI图像信息模型,并分离出偏场图像.第二步,采用像素加权隶属度和加权一致性测度解决难以分类的邻域空间异质性像素.第三步,构建基于模糊C均值算法、BCPFCM改进算法目标函数.采用误分类率和Tanimoto指数,比较不同算法图像分割结果.结果 BCPFCM改进算法能准确检测高低频条带与像素灰度不均等偏场信息,并完整分割出人工合成图像与脑部MRI图像各功能分区.基于BCPFCM改进算法的人工合成图像分割精度为100％;含40％灰度不均偏场的脑部MRI图像误分类率为5.74％,含1％～5％水平噪声图像误分类率为6.85％～14.34％.基于BCPFCM改进算法分割所得白质、灰质和脑脊液Tanimoto指数分别为0.75±0.03、0.79±0.04和0.39±0.01.结论 BCPFCM改进算法分割精度高、鲁棒性强,是一种可行的脑部MRI图像分割算法.

目的 观察MRI对诊断罕见部位异位妊娠(EP)的价值.方法 回顾性分析14例经临床或病理诊断的EP患者,观察妊娠物位置、大小、形态及MRI信号特征等,并与手术病理结果对照.结果 14例中,2例右侧残角子宫妊娠,5例宫角妊娠,3例输卵管间质部妊娠,2例宫颈妊娠,1例腹膜后直肠侧间隙妊娠,1例子宫肌壁间妊娠.MRI定位诊断EP结果与手术病理所见相符.结论 MRI可用于定位诊断罕见部位EP.

目的 探讨产后妇女大脑默认网络的功能连接与产后认知功能下降之间的相关性.方法 从21例产后妇女和21例年龄和教育程度相匹配的未生育女性中获得rs-fMRI扫描数据.选择后扣带回作为种子点区域以检测功能连接,然后确定这些变化是否与特定的认知表现相关.结果 与未生育女性相比,产后妇女的后扣带回和左内侧前额叶之间的功能连接显著降低.在校正年龄和教育程度后,后扣带回和左内侧前额叶皮层之间的功能连接减少与产后妇女较差的画钟测验(CDT)评分呈正相关(r=0.697,P=0.001).结论 产后妇女默认网络区域内的静息态功能连接减少,与产后妇女认知功能受损有关,说明默认网络可以反映产后妇女的认知功能情况,将为产后期潜在的神经病理学机制提供新的见解.

目的 探讨卵巢(囊)腺纤维瘤的MRI特征,以提高该病的诊断水平.方法 回顾性分析18例经手术证实的卵巢腺纤维瘤(OAF)及卵巢囊腺纤维瘤(OCAF)患者的临床特征及MRI表现.结果 18例患者共19个肿瘤,双侧卵巢1例,单侧17例(左侧卵巢9例和右侧卵巢8例).最大肿瘤长径17 cm,最小肿瘤直径0.6 cm.OAF 5例,其中1例OAF合并畸胎瘤的碰撞瘤.OCAF 13例,单囊7例和多囊6例,包括浆液性10例、黏液性1例及内膜样2例.囊性部分无强化,实性部分及囊壁结节呈T2 WI低信号,轻度强化,动态增强呈缓慢流入型.无盆腔积液及淋巴结转移.结论 卵巢(囊)腺纤维瘤具有复杂的MRI表现.不同比例的囊腔与纤维间质是肿瘤的影像学基础,"蜂窝征"及"地毯征"是该组肿瘤较可靠的MRI特征.

BackgroundPrimary coenzyme Q10 deficiency refers to a group of diseases characterised by reduced levels of coenzyme Q10 in related tissues or cultured cells associated with the 9 genes involved in the biosynthesis of coenzyme Q10. A biallelic pathogenic variant of COQ8A gene causes the occurrence of the primary coenzyme Q10 deficiency type 4. The objective of this study was to investigate the genetic cause of muscle weakness in a proband who had a negative DMD gene test for Becker muscular dystrophy.MethodsThe DNA of the proband was sequenced using whole exome sequencing. With the help of the Human Phenotype Ontology (HPO), the range of related candidate pathogenic genes has been reduced to a certain extent based on “muscle weakness” (HP:0001324). In addition, family linkage analysis, phenotypic-genotype check and protein structure modeling were used to explore the genetic cause of the proband.ResultsThe compound heterozygous variant c.836A > C (p.Gln279Pro) and c.1228C > T (p.Arg410Ter) in the COQ8A gene was identified in the proband. According to the 2015 American College of Medical Genetics and Genomics (ACMG) standards and guidelines for the interpretation of sequence variants, the novel variant c.836A > C could be classified as “likely pathogenic” for the proband.ConclusionThe p.Gln279Pro was detected in the KxGQ motif and the QKE triplet of the COQ8A protein, whose structures were crucial for the structure and function of the COQ8A protein associated with the biosynthesis of coenzyme Q10 and the proband's clinical symptoms were relatively milder than those previously reported.

目的:探究Ki67与MR在宫颈癌根治术后宫颈癌淋巴结转移中评估价值的对比.方法:选择2016年1月至2018年1月于我院接受宫颈癌根治术的151例宫颈癌患者,分别对其实施Ki67检测及MRI检测,以病理学检测结果为金标准,计算两种检测方式对宫颈癌淋巴结转移评估的准确度、敏感度、特异度、阳性预测值及阴性预测值,并进行对比分析.结果:检测评估发现,MRI对宫颈癌淋巴结转移评估准确度为31.79％,灵敏度为46.75％,特异度为16.22％,阳性预测值为36.73％,阴性预测值为22.64％.Ki67检测对宫颈癌淋巴结转移评估准确度为42.38％,灵敏度为52.56％,特异度为31.51％,阳性预测值为45.05％,阴性预测值为38.33％.两种检测方式对比显示Ki67对宫颈癌淋巴结转移具有更高的诊断准确度.结论:3相比于MRI检测,Ki67对宫颈癌淋巴结转移具有更高的诊断准确度、特异度和阴性预测值,分析其原因与MRI检测受个体因素影响更大有关.