【摘要】 目的 评价螺旋CT对原发性膀胱移行细胞癌（TCC）分期的准确性。 方法 对2000年9月-2009年9月诊治的73例原发性TCC患者，手术前行螺旋CT临床分期与手术后病理分期进行比较。 结果 TCC患者手术前螺旋CT临床分期与手术后病理分期相符率为90.5%。7例分期不符的患者中，4例螺旋CT分期低于病理分期，3例高于病理分期。 结论 螺旋CT对TCC的手术前临床分期较准确；螺旋CT分期误差产生的主要原因是不能确定肿大的淋巴结是否是癌转移。【Abstract】 Objective To investigate the value of contrast helical CT in Neopl-asm staging in patients with transitional cell carcinoma (TCC) of bladder. Methods Total 73 patients with TCC of bladder treated from september 2000 to September 2009 was analysed to compare preoperative helical CT examination with postoperative pathological diagnosis. Results The coincident staging of helical CT and pathological finding of TCC of bladder was found to be 90.5%. In the remaining seven patients, four patients were of overstaging and three patients were of understaging respectively. Conclusion The early enhancing phase of helical CT is helpful in the evaluation of the staging in patients with TCC of bladder.The cause of incorrecting staging by preoperative CT was usualy due to the difficulty in determing if lymph nodemetastasis occurs.
目的 探讨囊性脑膜瘤的磁共振表现、表观弥散系数（ADC）图的影像特点、ADC值与病理分级的关系及ADC值对判断不同病理亚型脑膜瘤的价值。 方法 回顾性分析2003年3月－2007年12月18例经病理证实的囊性脑膜瘤患者的磁共振表现，其中男8例，女10例，平均年龄45.6岁。在ADC图上分别测量肿瘤实质、瘤周水肿、囊变区的平均ADC值（均取4～6个区域，取平均值），比较不同病理亚型、不同病理分级的肿瘤实质、瘤周水肿、囊变区的ADC值差异是否有统计学意义。 结果 良恶性脑膜瘤肿瘤实质ADC值差异无统计学意义（P＞0.05）；囊性脑膜瘤各亚型间的肿瘤实质、瘤周水肿的ADC值差异无统计学意义（P＞0.05）；肿瘤实质、囊变区与瘤周水肿平均ADC值相比差异均有统计学意义（P＜0.05）。 结论 ADC值可区分肿瘤实质、囊变区及瘤周水肿，但对脑膜瘤亚型及良恶性的甄别需结合常规MRI与增强的征象。Objective To explore the MRI imaging manifestation, features of apparent diffusion coefficient (ADC) map and the relationships among ADC value, pathologic grading and pathologic subtype of cystic meningioma. Methods The clinical data of 18 patients (8 males and 10 females, with an average age of 45.6 years) with cystic meningiomas confirmed by pathologically examination were retrospectively analyzed. The ADC values of tumor parenchyma, peritumoral edema, cystic regions and the contralateral normal brain of the tumor parenchyma were measured and analyzed.The ADC value of the tumor parenchyma, peritumoral edema, cystic region were measured and then compared with the pathological findings. P value of less than 0.05 was considered as having a statistically significant difference. Results There was no significant difference in ADC values between benign and malignant meningioma and also among the tumor parenchyma, periedema and cystic region in different pathological subtypes. The difference in ADC values amongst tumor parenchyma, peritumoral edema and cystic region were statistically significant (P＜0.05). Conclusions Although ADC quantitative measurement allows the differentiation of the tumor parenchyma, cystic region and peri-edema, it is need to combined with conventional MR examination to assess tumor malignancy as well as grading in cystic meningioma.
【摘要】 目的 探讨磁共振动态增强扫描及磁共振弥散加权成像（diffusion weighted imaging，DWI）对肝癌经导管动脉内化学栓塞（transcatheter arterial chemoembolization，TACE）治疗后的肿瘤残余及复发的判断价值。 方法 2009年1月-2010年10月，对28例经证实的肝癌患者在TACE治疗前、治疗后3~7 d及治疗后1~2个月、3~6个月行磁共振动态增强及DWI扫描，动态测量表观弥散系数（apparent diffusion coefficient，ADC）值，与数字减影血管造影（digital substraction angiography，DSA）检查对照，评价动态增强扫描及DWI对肿瘤残留或复发的检出能力。〖HTH〗结果 对肿瘤残余及复发的显示，动态增强扫描灵敏度为90.0%，特异度为96.9%；DWI灵敏度为96.7%，特异度为93.8%；动态增强扫描与DWI相结合的灵感度为100.0%，特异度为99.5%；DSA灵敏度和特异度分别为96.7%、100.0%。TACE治疗前所有肿瘤实质的ADC值为（1.134±0.014）×10-3 mm2/s；TACE治疗后3~7 d ADC值为（1.162±0.016）×10-3 mm2/s；TACE治疗后1~2个月碘油沉积较好，无明显残余或复发病灶的ADC值为（1.175±0.015）×10-3 mm2/s，3~6个月后随访病灶ADC值为（1.179±0.017）×10-3 mm2/s；TACE治疗后1~2个月碘油沉积不完全或无明显沉积病灶ADC值为（1.147±0.016）×10-3 mm2/s，3~6个月后随访病灶实质平均ADC值（1.142±0.012）×10-3 mm2/s。 结论 将动脉增强扫描与DWI相结合可提高对TACE治疗后肝癌残余及复发判断的灵敏度及特异度；对肿瘤组织平均 ADC值的动态测量、观察可及早判断肿瘤复发的可能性。【Abstract】 Objective To evaluate the dynamic contrast-enhanced MRI and diffusion weighted imaging (DWI) in judging the remnant and recurrence on hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods Between January 2009 and October 2010, 28 patients with HCC underwent dynamic contrast-enhanced MRI and DWI before and after TACE 3-7 days, 1-2 months and 3-6 months, respectively, and the apparent diffusion coefficient (ADC) value of the tumor were also measured at above mentioned time points. The sensitivity and specificity of dynamic contrast-enhanced MRI and DWI in diagnosis of residual tumor and recurrent cancer was qualitatively evaluated by comparing with the DSA results. Results Compared with DSA, the sensitivity and specificity of dynamic contrast-enhanced MRI were 90.0% and 96.9% by revealing the remnant and recurrence of HCC, while the sensitivity and specificity of DWI were 96.7% and 93.8% respectively. Combining dynamic contrast-enhanced MRI and DWI the sensitivity and specificity were improved to 100.0% and 99.5%, respectively. The mean ADC value of tumor before and after 3-7 days of TACE were (1.134±0.014)×10-3 and (1.162±0.016)×10-3 mm2/s, respectively. The mean ADC value of tumor without and with remnant and recurrence after 1-2 months and 3-6 months follow up were (1.175±0.015)×10-3, and (1.179±0.017)×10-3 mm2/s; (1.147±0.016)×10-3 and (1.142±0.012)×10-3 mm2/s, respectively. Conclusions Combining dynamic contrast-enhanced MRI and DWI could improve the sensitivity and specificity to detect the remnant and recurrence of HCC after TACE. Measuring the ADC value during follow up of HCC patients after TACE could predict the probability of tumor recurrence.
目的 探讨脑胶质瘤术后不同时期的MRI增强表现，客观分析其术后的手术切除程度。 方法 2009年2月－2012年10月32例脑胶质瘤患者均在术后1 d～2周进行第1次MRI平扫及增强扫描（其中21例在术后3 d内进行检查），术后1～3个月随访复查21例，术后6～12个月随访复查18例，术后1～3年MRI随访16例。分析不同时期的MRI平扫及增强表现，以期发现正确评价手术切除程度的指标。 结果 术后3 d内行MRI增强检查仅有4例出现反应性强化，肿瘤残余有7例，结合其影像学表现可较准确地区分术后反应性强化及肿瘤残余。 结论 胶质瘤术后早期（3 d内）进行MRI增强检查可准确评价肿瘤术后切除程度，便于制订下一步治疗计划。
目的 探讨64排螺旋CT血管探针技术在评价肾动脉狭窄中的价值。 方法 回顾分析2010年4月－2012年1月51例行64排螺旋CT肾动脉血管成像且肾动脉狭窄患者的临床资料，对双侧肾动脉行血管探针重组，分析血管狭窄的原因，以及累及范围、狭窄程度。 结果 51例患者双侧肾动脉共105支（3支副肾动脉），其中管腔正常肾动脉27支，管腔有狭窄肾动脉78支。管腔狭窄者中，肾动脉斑块血管共65支，累及范围主要为局限性，以混合性及轻度狭窄为主；肾动脉夹层4支，累及范围主要为节段性，假腔内无对比剂，真腔轻中度狭窄为主；肾动脉肿瘤包绕共有9支，累及范围主要为节段性，腔轻度狭窄为主。 结论 64排螺旋CT血管成像清晰显示肾动脉，血管探针技术分析血管快速、可靠，能准确评价肾动脉狭窄，对指导临床治疗具有重要的意义。