目的 对比观察胰腺腺鳞癌(ASqC)与胰腺浸润性导管腺癌(IDAC)的影像学及病理学表现.方法 回顾性分析经手术病理证实的11例ASqC(ASqC组)和22例IDAC(IDAC组)临床资料、CT、MRI表现及病理特征.比较分析2组影像学(病灶位置、大小、形态、中心坏死、强化峰值时间、胆管扩张、主胰管扩张)及病理表现(神经束受侵、淋巴结转移、脉管癌栓、Ki-67)的差异.结果 2组病灶CT所示直径、形态、中心坏死、强化峰值时间差异均有统计学意义(x2=7.34,6.82,10.25,5.57,P均＜0.05).MRI示2组病灶T1WI及动态增强信号无显著差异,但IDAC组病灶T2WI信号低于ASqC组.病理结果显示ASqC组出现脉管癌栓比例(5/11,45.45％)高于IDAC组(2/22,9.09％,x2=5.80,P=0.02).结论 ASqC与IDAC影像学及病理学表现具有一定特异性,结合临床有助于鉴别诊断.

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.

目的:分析腮腺常见良性肿瘤的临床表现及CT表现,以提高其术前诊断准确率.资料与方法:回顾性分析45例经手术病理证实为腮腺良性肿瘤患者的临床资料及CT影像资料,结合文献并总结其临床及影像学表现特征.结果:45例患者中,形态规则,多形性腺瘤24例(均为单发),基底细胞腺瘤6例(均为单发),腺淋巴瘤15例(单发5例,多发10例,双侧多发5例).10例腺淋巴瘤患者有长期吸烟史;多形性腺瘤表现为渐进性强化;基底细胞腺瘤表现为动脉期和静脉期显著强化,静脉期较动脉期稍减退;腺淋巴瘤表现为"快进快出",可有血管贴边征;三者增强方式不同,其强化差异有统计学意义(P<0.05).结论:腮腺常见良性肿瘤具有一定CT特征表现,结合患者临床表现,有利于提高其术前诊断准确率.

目的 探讨基于增强MRI参数的诺模图(nomogram)预测乳腺癌脉管侵犯的价值.方法 回顾性分析2016年1月～2018年12月中山大学孙逸仙纪念医院经活检病理证实的256例浸润性乳腺癌患者的常规MRI、DWI及DCE MRI的资料.根据术后病理检查结果确定肿瘤脉管侵犯情况,将256例患者按约2:1随机分为训练集(n=171)及验证集(n=85).采用LASSO回归筛选与乳腺癌脉管侵犯最相关的危险因素,构建诺模图预测模型,采用受试者工作特征曲线(ROC)分析模型的诊断效能,绘制诺模图校准曲线验证预测能力.结果 256例患者中,99例(38.7％)肿瘤侵犯脉管.经LASSO回归,8个MRI参数及HER-2为乳腺癌脉管侵犯的独立预测因素.训练集中,基于多参数模型的诺模图预测脉管侵犯的曲线下面积(AUC)为0.843,敏感度76.3％,特异度77.7％,符合率77.2％,阳性预测值为64.3％,阴性预测值为86.1％;验证集中,诺模图预测脉管侵犯的AUC为0.833,敏感度65.0％,特异度84.4％,符合率75.3％,阳性预测值为78.8％,阴性预测值为73.1％.诺模图校准曲线显示模型预测与真实结局之间具有良好吻合度.结论 本研究构建及验证的诺模图能有效预测乳腺癌脉管侵犯.

[目的]总结胆囊神经内分泌肿瘤的CT与MRI影像学表现特征.[方法]回顾性分析2010年1月至2018年5月经手术病理证实的10例胆囊神经内分泌肿瘤的CT与MRI检查资料,其中6例仅行胆囊CT检查,3例仅行MRI检查,1例同时行CT与MRI检查.观察胆囊肿瘤的大小、形态、强化方式,是否合并肝转移、胆管与肝周转移、淋巴结转移、胆囊结石等情况.[结果]10例胆囊神经内分泌肿瘤,肿块T1最大径为39～120 mm,表现为广基底附着于胆囊壁,并突向胆囊腔内;其中7例CT表现为软组织密度不规则肿块;4例MRI上,肿瘤在T1加权成像为均匀等信号,T2加权成像为不均匀高信号,弥散加权成像上弥散受限.10例胆囊肿瘤增强后呈中度不均匀持续性强化.10例中,8例伴有肝转移,其中肝4、5段转移7例,其它肝段多发转移1例;6例侵犯胆管,3例侵犯肝门部脂肪;7例伴有肝门或腹膜后淋巴结转移;1例合并胆囊结石.[结论]胆囊神经内分泌肿瘤CT及MRI表现有一定特征性,多表现为胆囊部位的大肿块,易侵犯邻近的肝实质,沿胆囊颈、胆囊管蔓延,伴肝门、腹膜后淋巴结转移,并肝门部脂肪侵犯.

目的:总结双重病理(DP)所致颞叶癫痫(TLE)的边缘系统MRI影像学改变及特征.方法:对DP所致TLE 36例(左侧组20例,右侧组16例)与正常对照组(36例)进行多模态MR成像,分析两组边缘系统所在脑区T1WI灰质体积、指数化表观扩散系数(eADC)、脑血流量(CBF)差异,并进行统计学分析.结果:结构像及功能像均发现左侧、右侧TLE组边缘系统脑区与对照组差异具有统计学意义(FDR校正,P≤0.001),功能成像显示更广范围脑区分布,检出最明显异常为病侧海马及海马旁回、眶额皮质,其次为杏仁核、扣带回、内侧额上回,最后为额叶直回、丘脑,右侧组可累及对侧部分边缘系统脑区.结论:左、右侧DP所致TLE边缘系统损伤具有差异性,右侧组异常范围大于左侧.多模态MRI对边缘系统损伤评估具有重要价值.

Objective To analyze the relationships between pancreatic head-ampulla region tumors and pancreatic duodenal artery arch, in order to improve qualitative diagnosis of tumor tissue origin in this area. Methods A total of 36 cases of pancreatic head-ampulla region tumors which were scanned using multi-slice spiral CT before operation and confirmed by pathology were collected in our hospital from January 2009 to January 2018, including 10 cases of pancreatic head carcinoma, 8 cases of pancreatic neuroendocrine tumor, 2 cases of pancreatic head solid pseudopapillary tumor, 1 case of pancreatic head lymphoma, 8 cases of duodenal papillary carcinoma, 1 case of duodenal lymphoma, 1 case of duodenal stromal tumor and 5 cases of common bile duct carcinoma.The relationship between tumor tissue origin and pancreatic duodenal artery arch were analyzed retrospectively. Results Pancreatic head originated tumors pushed the pancreatic duodenal artery arch to the right, with vascular embedding.Common bile duct originated tumors pushed the pancreatic duodenal artery arch to the right, but without vascular embedding.Duodenal ampulla originated tumors pushed the pancreatic duodenal artery arch to the left and right, without vascular embedding. Conclusion The shift and embedding signs of pancreatic duodenal artery arch have improtant value in the CT differential diagnosis of tumors in the pancreatic head-ampulla region. Key words: Pancreatic head-ampulla region tumors; Pancreatic duodenal artery arch; Multi-slice spiral CT

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.

Objective To investigate the diagnostic value of multimodal MRI for dual pathology (DP)in temporal lobe epilepsy (TLE).Methods The methods of voxel based morphometry (VBM)and voxel based analysis (VBA)had been employed to study the difference between 36 patients (20 cases left group and 16 cases right group)with TLE caused by DP and 36 healthy subjects on the grey matter (GM)volume,exponential apparent diffusion coefficient (eADC)and cerebral blood flow (CBF)value.The corresponding statistical study had also been conducted.Results There were significant statistical differences (FDR correction,P=0.001)between healthy subj ects and patients on the GM volume,eADC and CBF value.Those values decreased with diseased laterality and wider range in functional imaging.These overlaying abnormal brain regions were located in the temporal pole (superior temporal gyrus), temporal pole (middle temporal gyrus),middle temporal gyrus,inferior temporal gyrus,fusiform gyrus,hippocampus and parahippocampal gyrus which represented in all examination results.Conclusion The combined findings of multimodal MRI can improve the localization ability of seizure focus in TLE,which caused by DP,before surgery.

Objective To compare the usefulness of contrast-enhanced T1 high resolution isotropic volume excitation (THRIVE) sequence and fat-saturated TSE sequence in detection of spinal metastases.Methods Thirty-one consecutive patients with spinal metastases were recruited.All patients received post-contrast TSE T1WI followed by a fat-suppressed THRIVE sequence.The number of lesions,SNR and CNR for both sequences,and the scoring of image quality concerning motion-artifact and tumor conspicuity were compared.Results Acquisition time of the post-contrast TSE T1W sequence and the THRIVE sequence was 2 min 55 s and 33 s,respectively.No significant difference was found in the number of lesions detected between the two sequences (Z=-0.816,P=0.414).The SNR (432.54±271.60) and CNR (233.27± 197.65) of the THRIVE sequence were significantly lower than the SNR (674.32±375.79) and CNR (312.38±207.49) of the TSE T1W sequence respectively (t=-4.366,-2.660,P＜0.001,0.012).Tumor conspicuity of the post-contrast TSE sequence was better than that of THRIVE sequence (Z=-4.082,P＜0.001),while the motion-artifact in TSE sequence was more severe (Z=2.291,P=0.022).Conclusion The post-contrast THRIVE sequence is capable of decreasing acquisition time and motion-artifact.Besides,its detected efficacy is equal to that of TSE sequence.There is practical possibility to replace the conventional post-contrast TSE T1WI sequence with the THRIVE sequence in the imaging of spinal metastases.

当作者根据设计好的课题,完成课题研究,收集、分析完数据,撰写好文章稿件后,接下来要考虑的是如何选择合适的期刊来进行投稿.发表论文是科研及临床工作者公开展示其研究成果的重要方式之一,是每位科研工作者及临床医生提高自己影响力的重要方式之一.在一份论文完成后,如何选择合适的期刊投稿,需要进行多方面的综合考虑.下面笔者将结合自身的投稿经验来简要介绍如何合理选择投稿期刊.

Objective To analyze the gray matter (GM) of temporal lobe epilepsy (TLE) caused by double pathology using voxel-based morphometry and surface-based morphology methods.Methods The GM volume,cortical thickness,and cortical surface area on three-dimensional T1-weighted BRAVO sequence of 36 patients with left (20) and 16 right (16) TLE from hippocampal sclerosis (HS) and focal cortical dysplasia (FCD) were compared with that of 30 healthy subjects.Results In patients with TLE,GM volume was reduced in the ipsilateral epileptogenic temporal lobe gyrus including hippocampus.In addition,the left thalamus and amygdala volume was significantly decreased in left TLE (P＜0.001).The temporal and extra-temporal lobe cortical thickness was increased in some of the patients whereas the surface area of the ipsilateral temporal lobe was significantly reduced in TLE (P＜ 0.01).Conclusion In TLE caused by HS and FCD,the ipsilateral epileptogenic temporal lobe regions including hippocampus showed reduction in GM volume and cortical surface area.

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.

AbstractObjective:To investigate the CT and MRI features of hepatic hilar cholangiocarcinoma with simultaneous bile duct stones.Materials and Methods: Fifty-four patients with hilar cholangiocarcinoma confirmed by surgical or biopsy pathology were enrolled. Thirty-four males and twenty females with ages between 28 and 86 years old (median age 61 years old), All patients were divided into two groups according to the presence of absence of bile duct stones as detected by MRI or CT. Among 54 patients with hilar cholangiocarcinoma, eleven patients had bile duct stones (group A), the remaining 43 cases had no bile duct stones (group B). Tumor shape, Bismuth-Corlette type, atrophy of liver lobe and postoperative recurrence were retrospectively analyzed and compared between the two groups.Results:For tumor shape, inifltrative type was found in 3 patients (27.3%) vs. 32 patients (74.4%), mass type in 5 patients (45.4%) vs. 8 patients (18.6%), polypoid type in 3 patients (27.3%) vs. 3 patients (7.0%) respectively in group A and group B. Signiifcant difference was found in tumor shape between the two groups (P<0.05). As for Bismuth-Corlette type, there were 2 cases (18.2%) of type I, 1 case (9.1%) of type II, 4 cases (36.3%) of type IIIa, 2 cases (18.2%) of type IIIb, 2 cases (18.2%) of type IV in group A; and 3 cases (7.0%) of type I, 14 cases (32.6%) of type II, 6 cases (14.0%) of type IIIa, 10 cases (23.2%) of type IIIb, 10 cases (23.2%) of type IV in group B. No signiifcant difference was found in Bismuth-Corlette type between the two groups (P>0.05). There were 2 recurrent cases (18.2%) in group A while 8 recurrent cases (18.6%) in group B. There were 4 cases (36.3%) with liver lobe atrophy in group A and 15 cases (34.9%) with liver lobe atrophy in group B. No signiifcant differences were found in postoperative recurrence and liver lobe atrophy between the two groups (P>0.05). Conclusion:Hepatic hilar cholangiocarcinomas accompanied with bile duct stones most often manifest as mass type or polypoid type. Hepatic hilar cholangiocarcinomas accompanied with bile duct stones or not represent similarly in respect of Bismuth-Corlette type, postoperative recurrence and liver lobe atrophy.

《礼记·中庸》有云：“凡事预则立，不预则废”。基金项目不是“雪中送炭”，基本都是“锦上添花”，需要众多的申请者进行竞争来获取。因此，平时围绕基金项目的申请，应从多方面进行准备，比如发表经同行评议的论文，特别是在国际公认刊物上发表论文，还有科技奖项、发明专利及编写著作等，这些和基金项目申请成功互相促进、互相帮助，形成级联放大的正反馈效应。当我们具备了申请基金的相关基础后，如何将完整的学术理论思想与具体的研究计划严谨、巧妙地呈现出来，则需要较强的专业及科研知识储备。然而，对于申请科研基金来说，仅具备理论基础显然是不够的，拥有创新性的选题、严谨缜密的实验设计及规范、良好的基金写作方法，并掌握一定写作技巧，将会显著提高基金申请的命中率。

本组共10例，男4例，女6例，年龄18～42（27.52±7.13）岁。全组病例符合地贫诊断标准［1］：家族史、长期溶血性贫血、血红蛋白电泳实验、基因检测确诊9例β型，1例α型。通过多种化验室检查、手术及活检病理、长期影像随访监测等［2］判定髓外造血灶，并完全排除其它原发性疾病。影像检查方法：10例DR、CT平扫(2例增强)检查，5例MR （2例增强）检查。影像设备为西门子AXIOM Aristos VX DR机，PHILIPS Bril-liance 120层螺旋CT，GE Signa EXCITE HD 1.5T超导型磁共振扫描仪。胸部CT扫描：螺距0.798，扫描电压120kV，管电流200mA，重建层厚3mm，层距1.5mm。腹部CT扫描：螺距1.014，扫描电压120kV，管电流200mA，重建层厚3mm，层距3mm，增强扫描，高压注射器团注优维显80ml，注射速度3.0ml/s，行动脉期、静脉期、延迟期扫描。颅脑MR 扫描：SE T1WI 轴位、FSE T2WI 轴位+矢状位、FSE FLAIR 轴位、SE-EPI DWI轴位。脊柱MR扫描：frFSET2WI矢状位、轴位、冠状位及抑脂矢状位、FSE T1WI矢状位。腹部MR扫描：FSPGR T1WI、DWI 轴位、FRFSET2WI 及抑脂轴位+冠状位、FSPGR T1WI三方位增强，经肘静脉注入钆喷酸葡胺（Gd-DTPA），用量0.1mmol/kg体重，速率2ml/s，行动脉期、静脉期、延迟期扫描。图像分析：靶向分布情况、外形、数目、大小、密度/信号、强化幅度、进程变化，邻近结构受累情况。两名副主任医师以上资深医师双盲法阅片，有分歧时，商讨后达成一致印象。

Objective : To investigate the method and clinical application of 64-slice spiral computed tomography angiography of the anterior inferior cerebellar artery. Methods : 20 patients planned to surgery in the area of cerebellopontine angle underwent 64-slice spiral CT angiography. The obtained thin-slice images were reformatted by using maximum intensity projection,curved planar reformation and volume rendering to evaluate anterior inferior cerebellar arteries. The visibility and morphological features of the anterior inferior cerebellar arteries were assessed.Results: 38 anterior inferior cerebellar arteries in 20 patients were visualized and all the 38 arteries arose from basilar artery. The mean diameter at starting point of the anterior inferior cerebellar arteries were measured as(1.19±0.66)mm, 86.8% of them penetrates between the ventral side of facial nerve and auditory nerve. Conclusion : 64-slice spiral CT angiography could accurately demonstrate the origin, caliber, course, morphological features of the anterior inferior cerebellar artery,so it’s helpful in discovering morphological features or abnormalities of anterior inferior cerebellar artery, offering us early and accurate clinical diagnosis and treatment guidance.

AbstractQuantitative dynamic contrast-enhanced MR imaging (dynamic contrast-enhanced MRI, DCE-MRI) using fast T1-weighted imaging is considered as a functional tool to non-invasively assess the microcirculation features of normal or diseased tissues. It can be used to assess tissue perfusion and microvessel permeability by means of qualitative, semi-quantitative and quantitative method. With inclusion of arterial input function and tissue concentration of contrast agents used, quantitative DCE-MRI is superior to either qualitative or semi-quantitative method with respect to accurate evaluation of tissue perfusion and microvessel permeability; and can avoid inconsistent analysis results between different researchers caused by individual scanning protocols used. Thus quantitative DCE-MRI is not only favorable to achieve an early diagnosis and improve accuracy of the differential diagnosis of various disease entities, but also helpful for implementation of a multicenter randomized control clinical trials to obtain evidence medicine data. To date, some obstacles are still present in DCE-MRI, such as the standardization of scanning protocols and data computation, particularly the application of appropriate hemodynamic models. Advanced software specialized designed for quantitative DCE-MRI can provide a standard and convenient platform for data analysis. With the help of such favorable platform, the progress of clinical application of DCE-MRI would be promoted and its application ifeld would be extended.

随着人工关节技术、手术方法的不断发展及临床医师对关节解剖及生物力学等方面认识的不断深入,人工关节置换术已成为临床上广泛应用的新技术,在关节创伤、关节炎、肿瘤、骨坏死、严重关节畸形等多种疾病的治疗方面发挥着重要的作用,显著提高了患者的生活质量.然而,人工关节置换术手术失败、置换术后发生多种并发症(如感染、假体松动、脱位、断裂),术后继发退行性变等多种问题并不少见,直接影响着人工关节置换术的治疗效果.如何使人工关节置换术更安全、有效,最大程度恢复患肢关节功能、减少术后并发症及翻修率是临床医师迫切期望解决的问题.这其中,人工关节精准的术前评估及设计起着关键的作用.

目的:探讨磁共振钆布醇20 min延迟增强扫描检测脑转移瘤病灶的价值.方法:分析27例因原发肿瘤怀疑脑转移而行MRI钆布醇增强即时扫描和20 min延迟增强扫描患者的临床资料,比较两次增强扫描所显示的病灶数目、病灶检出率与病灶最大直径的关系、病灶与周围脑组织的对比、病灶与对侧脑白质的对比噪声比.结果:27例怀疑脑转移患者中,14例两次增强扫描发现脑转移灶.20 min延时扫描比即时增强多检出了13个病灶,多检出的病灶直径均小于1 cm,其中10个小于5 mm.两次增强扫描病灶与周围脑组织的对比、病灶与对侧脑白质的对比噪声比无明显差异(P均＞ 0.05).结论:钆布醇延迟增强扫描能检测更多脑转移灶,尤其是小转移灶.