INTRODUCTION:To explore the feasibility of applying computed tomography perfusion (CTP) imaging-guided mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion beyond the therapeutic time window.METHODS:The clinical data of acute cerebral infarction patients with large vessel occlusion who were beyond the therapeutic time window and admitted to Handan Central Hospital from January 2021 to March 2022 were retrospectively analyzed. All patients were assessed by the National Institutes of Health Stroke Scale (NIHSS) and were examined by one-stop CTP imaging. The preoperative onset time of the disease was more than 6 h. Fourteen patients underwent magnetic resonance imaging examination at the same time. Fifty-four patients were retrospectively divided into two groups based on the treatment methods: the mechanical thrombectomy group had 21 patients and the conservative treatment group had 33 patients. NIHSS scoring and computed tomography scan were performed before treatment, 6 h, 24 h, 7 days, and 30 days after treatment.RESULTS:The NIHSS scores of the patients with acute cerebral large vessel occlusion who underwent CTP imaging-guided mechanical thrombectomy at 6 h, 24 h, 7 days, and 30 days after treatment were compared with those of the conventional treatment group. The NIHSS score of the mechanical thrombectomy group was significantly better, and the difference was statistically significant (P < 0.05). In terms of the prognosis rate and expansion rate of infarct core volume, the patients of the mechanical thrombectomy group had a better prognosis, and the difference was statistically significant (P < 0.05). Artificial intelligence-assisted CTP diagnosis can facilitate the automatic evaluation of diseases and enable quick judgments that are independent of radiologists' evaluation, but it may pose a problem in the determination of infarct core volume (either being too high or too low).CONCLUSION:It is of great significance to apply CTP imaging in guiding the mechanical thrombectomy procedure in acute stroke patients with large vessel occlusion who are beyond the therapeutic time window.

目的 探讨CT双能量成像在肝细胞癌TACE术后疗效评估中的应用价值.方法 选取TACE术后4～6周复查的41例HCC患者,所有患者均行DSA及CT双能量肝脏增强扫描.从碘化油形态和伪影对常规混合能量和40～70 keV单能量的图像质量进行主观评分.以DSA检查结果为参照,统计不同图像有强化和无强化病变的数目,计算其灵敏度、特异度、准确率、阳性预测值及阴性预测值.测量有血供区和坏死区AP、PP NIC及能谱曲线斜率,对各参数进行统计学分析.结果 70 keV单能量图像质量最优,40 keV单能量图像对病变的显示能力最强.有血供区的能谱曲线走行较坏死区的陡直,两组间的AP、PP NIC及能谱曲线斜率差异均有统计学意义(P＜0.05).ROC曲线显示双能量CT定量参数在区分TACE术后有血供区和坏死区的比较均具有较高的诊断效能(AUC＞0.7).结论 CT双能量成像有助于诊断肝细胞癌TACE术后疗效,对后续的随访具有重要意义.

目的 探讨动态增强磁共振成像(DCE-MRI)及弥散加权成像(DWI)在乳腺肿瘤良恶性诊断及乳腺癌化疗效果评估中的应用价值.方法 收集2020年3月至2022年3月我院就诊的78例乳腺肿瘤患者,以病理检查结果为金标准,使用Kappa一致性检验评价DCE-MRI与DWI联合鉴别良恶性乳腺肿瘤的诊断效能;对穿刺活检确诊的乳腺癌患者行新辅助化疗(NAC),根据Miller分级将所有患者分为组织学显著反应(MHR)组和组织学非显著反应组(NMHR)组,比较两组化疗前后DCE-MRI定量参数和表观弥散系数(ADC)值变化.结果 78例乳腺肿瘤患者中,乳腺癌56例(51.25％),良性病变22例(48.75％);恶性肿瘤组ADC值显著低于良性肿瘤组(P＜0.05);ROC曲线分析结果显示,ADC值鉴别乳腺肿瘤良恶性的最佳临界值为1.20×10-3mm2/s;DCE-MRI的时间信号强度曲线(TIC)和DWI的ADC值联合诊断良恶性乳腺肿瘤与病理一致性较好(Kappa值=0.805).NAC前后MHR组和NMHR组容量转移常数(Ktrans)、速率常数(Kep)和ADC变化率比较均有显著差异(P＜0.05);DCE-MRI 联合 DWI 评估 NAC 效果的 AUC 为 0.845(95％CI:0.766～0.905),分别大于ΔADC、AKtrans单独评估的AUC(P＜0.05).结论 联合DCE-MRI和DWI的TIC、ADC联合诊断良恶性乳腺肿瘤效能高,而联合Ktrans和ADC变化率能较好地预测NAC疗效.

目的 分析磁共振成像(MRI)联合扩散加权成像(DWI)对胃间质瘤与胃癌的鉴别价值.方法 回顾性分析经手术病理证实并行MRI联合DWI检查的65例胃癌患者及21例间质瘤患者的影像资料.对比分析胃间质瘤和胃癌在MRI联合DWI检查中的影像学表现及ADC值,绘制ROC曲线分析ADC值鉴别诊断胃间质瘤与胃癌的价值,采用Kappa检验评价MRI联合DWI检查中的ADC值诊断结果与手术病理检查结果的一致性.结果 86例研究对象中T2WI压脂、DWI图像上均呈不同程度的高信号,虽然胃癌的图像信号强度总体上略高于胃间质瘤,但二者征象特征并不易准确区分;此外,可见胃间质瘤多发于胃体、胃底,胃癌多发于胃窦.胃癌患者ADC值为(1.05×10-3±0.27×10-3)s/mm2,显著低于胃间质瘤患者ADC值[(1.43×10-3±0.21×10-3)s/mm2](t=5.891,P<0.05).ADC值鉴别诊断胃间质瘤与胃癌的曲线下面积为0.865,约登指数为0.688,临界值为1.26×10-3s/mm2,此时对应的敏感度为83.08%,特异性为85.71%,准确度为83.72%,误诊率为14.29%,漏诊率为16.92%,阳性预测值为94.74%,阴性预测值为62.07%.MRI联合DWI检查中的ADC值诊断结果与手术病理检查结果比较,Kappa值为0.609(P<0.05),说明一致性较高.结论 MRI联合DWI检查作为一种无创的影像学检查技术,有助于鉴别诊断胃间质瘤与胃癌,具有一定的临床应用价值.

目的:探讨高分辨率磁共振血管壁成像(HRMR-VWI)在椎动脉夹层诊断中的应用价值.方法:搜集 2例经临床证实为椎动脉夹层病人的临床及影像资料,均获取磁共振时间飞跃法磁共振血管成像(TOF-MRA)、快速自旋回波 T1 加权成像(T1WI)、快速自旋回波 T2加权成像(T2WI)、三维可变反转角快速自旋回波(3D-SPACE)、T1WI常规剂量增强扫描(CE-T1WI)成像,分析椎动脉夹层的临床特点及影像特征.结果:椎动脉夹层临床无明显特异性,HRMR-VWI既可显示血管腔结构,又可以清晰显示血管壁,典型影像学表现为明显强化的内膜瓣征、真假两腔的双腔征、高信号的壁内血肿及动脉瘤样扩张等.结论:椎动脉夹层具有独特的影像特征,HRMR-VWI成像技术对椎动脉夹层具有重要诊断价值.

患者 男,53岁.无意中发现左侧软腭肿物,无明显不适.查体:肿物表面光滑,质韧,无触痛及破溃.实验室检查:嗜酸性粒细胞计数1.81×109/L,嗜酸性粒细胞百分比31.4％.MRI检查显示左侧软腭团块状长T,长T2信号影,内见点条状T2低信号,DWI稍高信号(图1A～1C),增强扫描肿块明显强化,内见点状无强化(图1D,1E);左侧颈动脉鞘区见肿大淋巴结(图1F).MRI诊断考虑恶性病变.病理诊断:鳞状上皮下淋巴组织增生伴淋巴滤泡形成,伴大量嗜酸性粒细胞浸润,血管增生,符合Kimura病.

患者 男,56岁.主因活动后心前区不适1年,间断发作近10天再次出现不适症状入院.体格检查:体温36.4℃,脉搏60次/min,血压145/95 mmHg.心前区无隆起,未见异常心尖搏动,心界向左下扩大,心尖部可闻及收缩期杂音.生化检验:尿酸460.0 μmol/L,甘油三脂2.09 mmol/L,白蛋白(澳甲酚绿法)37.8 g/L.心脏彩色超声诊断:节段性室壁运动异常,左心大,二尖瓣前叶关闭不全伴中量返流.

探讨鼻部复发性多形性腺瘤的临床病理特点、影像学表现及鉴别诊断.回顾性分析1例鼻部复发性多形性腺瘤的病例资料,结合相关文献进行学习.患者表现为鼻塞及左眼溢泪,副鼻窦MRI表现为左侧鼻腔内软组织肿块,其内信号混杂,边缘清,鼻腔肿物切除术后病理诊断为多形性腺瘤.术后随访4年,因视物模糊、鼻出血再次入院,CT表现为边界清、密度均匀的软组织肿块,MRI示肿块内部信号不均匀,增强扫描明显不均匀强化,术后病理诊断为多形性腺瘤复发.多形性腺瘤在术后易复发,因此术前通过影像学检查准确诊断该疾病,可以提醒术者选择合理的手术方式,扩大肿块切除范围,降低术后复发率.

Background: This study was to investigate the prevalence of preoperative rim enhancement, and its association with clinicopathological features, relapse, and survival profiles in Chinese basal-like breast cancer (BC) patients. Materials and Methods: The preoperative breast magnetic resonance imaging images of 145 basal-like BC patients who underwent surgical excision were obtained to determine rim enhancement. Besides, based on disease status and survival status during follow-up, the 1-year relapse rate/mortality, 3-year relapse rate/mortality, 5-year relapse rate/mortality were calculated; disease-free survival (DFS) and overall survival (OS) were determined. Results: There were 51 (35.2%) patients with rim enhancement and 94 (64.8%) patients without rim enhancement. Furthermore, rim enhancement was associated with larger tumor size and advanced T stage, whereas it did not associate with age, pathological differentiation, N stage, or TNM stage. In addition, rim enhancement was associated with higher 1-, 3-, and 5-year relapse rate and shorter DFS; meanwhile, rim enhancement was associated with increased 1-, 3-, and 5-year mortality rate and decreased OS. By multivariate Cox's regression analyses, rim enhancement, pathological differentiation, and N stage independently predicted reduced DFS; T stage independently predicted declined OS. Conclusion: Preoperative rim enhancement on MRI might be a possible noninvasive indicator for guiding personalized treatment strategies and improving prognosis in Chinese basal-like BC patients.

患儿 男,5 岁.因 1 周前无明显诱因出现右侧腹股沟区触痛,外院腹部彩色多普勒超声考虑右侧腹股沟皮下肿物,急诊入院.查体:腹平坦,未见胃肠型及蠕动波,腹软,右侧腹股沟区触痛,似可触及一范围约4 cm×2 cm肿物,无反跳痛及肌紧张,余腹部正常.腹部彩色多普勒超声:右侧腹股沟区不规则低回声,右侧腹股沟区多发淋巴结.CT扫描:右下腹阑尾增粗,其内可见"螺丝钉"样金属致密影(图 1,2),右侧腹股沟区可见囊状低密度影(图 3),周围脂肪间隙模糊.诊断:考虑阑尾"螺丝钉"异物,右侧腹股沟区脓肿可能性大.

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.

患者女性,64岁.因阴道排液,发现宫腔积液入院.查体:脉搏:70次/min,呼吸:19次/min,血压:120/78 mmHg,心脏各瓣膜听诊区未闻及杂音.心电图:1)窦性心律;2)下壁异常q波;3)TII、III、aVF、V5～V6低平.彩色多普勒提示先天性心脏病:1)左侧三房心(右肺静脉及左上肺静脉开口副房,左下肺静脉开口真房);2)三尖瓣少量返流;3)左室舒张功能减低.

选取123例癫痫患者作为研究组,同期69例健康体检者作为对照组,均行三维动脉自旋标记技术(3D-ASL)灌注成像与静息态功能MRI(rs-FMRI)检查,研究二者在癫痫病诊断及鉴别中的价值.结果发现,研究组全面发作脑血流量(CBF)、低频振幅(ALFF)＜部分发作和对照组,全面发作血清脑源性神经细胞营养因子(BDNF)、胰岛素样生长因子-1(IGF-1)水平、认知功能(MMSE)评分＜部分发作＜对照组,血清神经肽Y(NPY)＞部分发作＞对照组(P＜0.05),且癫痫患者CBF、ALFF与BDNF、IGF-1、MMSE呈正相关,与NPY呈负相关.CBF与ALFF联合在诊断癫痫发作、鉴别不同癫痫发作类型方面均具有较高应用价值.说明3D-ASL灌注成像及rs-FM-RI在癫痫发作诊断及鉴别不同癫痫发作类型方面应用价值较高.

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.

选取我院108例癫痫发作患者作为研究组,同期82例健康体检者设为对照组,均接受3D-ASL灌注成像检查和血清同型半胱氨酸(Hcy)、神经肽(NPY)水平检测.结果发现,研究组患者平均脑血流量(CBF)和简易智能精神状态检查量表(MMSE)评分低于对照组,血清Hcy、NPY水平高于对照组(P＜0.05);癫痫发作患者CBF、Hcy、NPY与发作类型、脑电图特征存在一定相关性(P＜0.05);患者病程、发作频率、发作类型、痫性放电、发作持续时间、用药种类、癫痫持续状态史、受教育程度、Hcy、NPY、CBF均是癫痫认知障碍的重要影响因素(P＜0.05).可见,早期共同检测3D-ASL灌注成像、血清Hcy、NPY,可为癫痫的临床诊治、病情程度评估、预后改善提供循证指导.

目的 探讨脾脏炎性假瘤样滤泡树突细胞瘤的CT、MRI特征,以提高对该病的认识.方法 选取分析5例经手术病理证实的脾脏炎性假瘤样滤泡树突细胞瘤的CT、MRI表现,与术后病理结果比较、并复习相关文献,总结脾脏炎性假瘤样滤泡树突细胞瘤的CT、MRI影像学特征.结果 5例炎性假瘤样滤泡树突细胞瘤表现为类圆形单发肿块,肿块较大,直径5～11 cm,边界清晰,密度、信号欠均匀,5例肿块均有坏死,3例合并中央瘢痕,增强扫描动脉期显示病灶边缘强化,门静脉期病灶呈渐进性持续强化并向中央填充,坏死无强化,中央瘢痕延迟强化.结论 脾脏炎性假瘤样滤泡树突细胞瘤的中央瘢痕,增强扫描具有渐进性、持续性强化的特点,具有一定影像学特征,确诊需镜检及免疫组织化学检查.

Objective: To investigate the role of whole-brain volume computed tomography (CT) perfusion in assessing early ischemic cerebrovascular diseases. Materials and Methods: Seventy-two patients with early ischemic cerebrovascular diseases who had undergone routine CT scan and 320-row volume CT whole-brain perfusion imaging within 8 h after admission were retrospectively enrolled in this one-center case-sectional study. The perfusion parameters of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and dynamic CT angiogram (4D-CTA) were obtained and analyzed. Results: Among 72 patients, 29 cases with 37 cerebral ischemic lesions were found in plain CT scan, whereas 51 cases with 76 lesions were found in whole-brain CT perfusion, with 30.6% more patients being detected. The CBF value was significantly lower in the abnormal than normal corresponding perfusion area in the healthy hemisphere (P<0.05), while the MTT and TTP values were significantly higher in the abnormal than the normal corresponding area (P<0.05). 4D-CTA image suggested that 59 cases had different degrees of stenosis or occlusion, including 11 mild, 18 moderate, 21 severe, and 9 occlusive cases. Four-D-CTA imaging could detect significantly (P<0.05) more patients with abnormal perfusion in severe cerebral vascular stenosis or occlusion than those with no, mild or moderate stenosis (93.33% vs. 16.67%) (P<0.05). The stenosis of intracranial and carotid arteries was positively correlated with MTT and TTP values (P<0.05). Conclusion: Whole-brain volume CT angiography can comprehensively display early cerebral ischemic lesions, cerebral blood perfusion status, and cerebral vascular stenosis, providing valuable information for early detection of ischemic cerebral diseases and appropriate treatment planning.

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.

Objective The present study investigated the predictive value of each perfusion parameter of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) in CT perfusion (CTP) imaging for the prognosis of endovascular treatment at the time of admission in patients with acute ischemic stroke in the anterior circulation. Patients and Methods The imaging data of 62 patients with acute ischemic stroke in the anterior circulation with an onset time of 6 h or less were retrospectively analyzed. All patients underwent the one-stop whole-brain dynamic volume four-dimensional (4D) CT angiography (CTA)-CTP and cranial magnetic resonance imaging (MRI) within seven days after treatment. The patients were divided into better and worse prognosis groups according to their clinical symptoms, combined with an MRI-ASPECTS score of ≤ 6 within seven days after treatment. The observed perfusion parameters included cerebral blood flow (CBF)-ASPECTS, cerebral blood volume (CBV)-ASPECTS, mean transit time (MTT)-ASPECTS, and time to peak (TTP)-ASPECTS. The difference in ASPECTS scores involving the CTP parameter, as well as diagnostic power, was compared between the two groups of patients. Results All CTP-ASPECTS scores negatively correlated with clinical prognosis. The higher the CTP-ASPECTS scores preceding treatment in patients with ischemic stroke in the anterior circulation, the better the prognosis. There were statistically significant differences in the scores of CBF-ASPECTS and CBV-ASPECTS between the two groups (P < 0.05). Receiver operating curve (ROC) analysis showed that the parameter with the largest area under the curve (AUC) was the CBF-ASPECTS score (P = 0.003), with a sensitivity of 90.9%, a specificity of 59.1%, and an AUC of 0.806, which was the most valuable prognostic predictor. Conclusion The CBF-ASPECTS score presented significant value as a primary indicator for predicting the outcome of endovascular treatment in patients with acute ischemic stroke in the anterior circulation, and it had good application prospects in clinical practice.

剖宫产瘢痕妊娠（CSP）指孕囊或绒毛/胎盘种植于子宫下段剖宫产瘢痕部位的异位妊娠 [1] ,临床上较少见,近年由于全球范围内剖宫产率上升,导致CSP发生率升高。CSP患者如盲目行药物流产或清宫手术可导致孕妇大出血、子宫破裂、弥散性血管内凝血、甚至需要切除子宫,直接影响患者生育能力,甚至危及生命等严重后果,因此,早期正确诊断非常重要。MRI具有高的软组织分辨率及无电离辐射的优点,目前广泛应用于孕产妇的疾病诊断。本文回顾性分析24例经病理诊断的CSP患者的MRI资料,探讨CSP早期表现,旨在提高诊断水平。