Early detection of skeletal metastasis is critical for accurate staging and optimal treatment. This paper briefly reviews our current understanding of the biological mechanisms through which tumours metastasise to bon...Early detection of skeletal metastasis is critical for accurate staging and optimal treatment. This paper briefly reviews our current understanding of the biological mechanisms through which tumours metastasise to bone and describes the available imaging methods to diagnose bone metastasis and monitor response to treatment. Among the various imaging modalities currently available for imaging skeletal metastasis, hybrid techniques whichfuse morphological and functional data are the most sensitive and specific, and positron emission tomography(PET)/computed tomography and PET/magnetic resonance imaging will almost certainly continue to evolve and become increasingly important in this regard.展开更多
Objective To evaluate the feasibility of whole body diffusion weighted imaging (DWI) in bone metastasis detection using bone scintigraphy as comparison. Methods Forty-five patients with malignancy history were enrolle...Objective To evaluate the feasibility of whole body diffusion weighted imaging (DWI) in bone metastasis detection using bone scintigraphy as comparison. Methods Forty-five patients with malignancy history were enrolled in our study. All the patients received the whole body DWI and bone scintigraphy scan within 1 week. The magnetic resonance (MR) examination was performed on 3.0T MR scanner using embedded body coil. The images were reviewed separately by two radiologists and two nuclear medicine physicians, who were blinded to the results of the other imaging modality. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the two techniques for detecting bone metastasis were analyzed. Results A total of 181 metastatic lesions in 77 regions of 34 patients were detected by whole body DWI, and 167 metastatic lesions in 76 regions of 31 patients were identified by bone scintigraphy. The patient-based sensitivity and PPV of whole body DWI and bone scintigraphy were similar (89.5% vs. 81.6%, 97.1% vs. 91.2%), whereas, the patient-based specificity and NPV of whole body DWI were obviously higher than those of bone scintigraphy (85.7% vs. 57.1%, 60.0% vs. 36.4%). Ten regions negative in scintigraphy but positive in whole body DWI, mainly located in spine, pelvis, and femur; nine regions only detected by scintigraphy, mainly located in skull, sternum, clavicle, and scapula. The region-based sensitivity and specificity of whole body DWI were slightly higher than those of bone scintigraphy (89.5% vs. 88.4%, 95.6% vs. 87.6%). Conclusion Whole body DWI reveals excellent concordance with bone scintigraphy regarding detection of bone metastasis, and the two techniques are complementary for each other.展开更多
Pancreatic neuroendocrine neoplasms(panNEN)are a heterogeneous group of tumors with differing pathological,genetic,and clinical features.Based on clinical findings,they may be categorized into functioning and nonfunct...Pancreatic neuroendocrine neoplasms(panNEN)are a heterogeneous group of tumors with differing pathological,genetic,and clinical features.Based on clinical findings,they may be categorized into functioning and nonfunctioning tumors.Adoption of the 2017 World Health Organization classification system,particularly its differentiation between grade 3,well-differentiated pancreatic neuroendocrine tumors(panNET)and grade 3,poorly-differentiated pancreatic neuroendocrine carcinomas(panNEC)has emphasized the role imaging plays in characterizing these lesions.Endoscopic ultrasound can help obtain biopsy specimen and assess tumor margins and local spread.Enhancement patterns on computed tomography(CT)and magnetic resonance imaging(MRI)may be used to classify panNEN.Contrast enhanced MRI and diffusion-weighted imaging have been reported to be useful for characterization of panNEN and quantifying metastatic burden.Current and emerging radiotracers have broadened the utility of functional imaging in evaluating panNEN.Fluorine-18 fluorodeoxyglucose positron emission tomography(PET)/CT and somatostatin receptor imaging such as Gallium-681,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid–octreotate PET/CT may be useful for improved identification of panNEN in comparison to anatomic modalities.These new techniques can also play a direct role in optimizing the selection of treatment for individuals and predicting tumor response based on somatostatin receptor expression.In addition,emerging methods of radiomics such as texture analysis may be a potential tool for staging and outcome prediction in panNEN,however further investigation is required before clinical implementation.展开更多
Objective To evaluate the values of whole body diffusion weighted imaging （DWI） in screenmg pnmary unknown tumor in patients with metastases. Methods Totally, 34 patients with metastases of primary unknown tumors w...Objective To evaluate the values of whole body diffusion weighted imaging （DWI） in screenmg pnmary unknown tumor in patients with metastases. Methods Totally, 34 patients with metastases of primary unknown tumors were scanned with whole body DWI, and conventional magnetic resonance （MR） imaging was performed if suspected lesions were detected. All the metastases including 27 cases of osseous metastases, 2 brain metastases, 2 liver metastases, 1 pulmonary multiple metastasis, 1 neck metastasis and 1 malignant ascites, were diagnosed by computed tomography, single photon emission computed tomography, or MR imaging. For the proven primary tumors diagnosed by biopsy or pathology of surgical specimens, apparent diffusion coefficient （ADC） values of the primary and metastatic lesions were measured respectively. The sensitivity and specificity of this technique for screening primary tumors were cvaluated. Results We found 24 cases with suspected primary lesions, in which 23 lesions were proved to be primary tumors, and 1 was proved to be benign lesion. And no definite primary lesion was found in 10 cases on whole body DWI, but in which 1 case was diagnosed with primary tumor by biopsy later, and the other 9 cases remained unknown within follow-up of over halfa year. The difference was not significant in ADC values between primary and metastatic lesions （P〉0.05）. The sensitivity and specificity of whole body DWI for searching primary tumors was 95.8% and 90.0%, respectively. Conclusion Combined with conventional MR scanning, whole body DWI can help to search primary lesions of patients with metastases.展开更多
Ten intracranial gliomas cases, that had postoperative intracranial dissemination, underwent magnetic resonance imaging （MRI） examinations, including T1 weighted imaging, fat-suppressed T1 weighted imaging, T2 weigh...Ten intracranial gliomas cases, that had postoperative intracranial dissemination, underwent magnetic resonance imaging （MRI） examinations, including T1 weighted imaging, fat-suppressed T1 weighted imaging, T2 weighted imaging and fluid attenuated inversion recovery （FLAIR）. Results showed that tumor metastasis had occurred via the cerebrospinal fluid, the brain white matter fibers and the surgical access site alone. On the plain MRI scans, 1/7 cases were linearly thickened with isointensity and 5/7 cases exhibited nodular foci on T1 weighted imaging; the cerebral sulci and cisterns in 2/7 cases had become shallow and five cases had nodular foci on T2 weighted imaging. FLAIR imaging revealed that the cerebral sulci and cisterns in 2/7 cases had become shallow and that six cases had affected nodular foci. The contrast-enhanced MRI scans revealed linear thickening in seven cases, nodules in seven cases, similarities to ＂mould-like＂ signs in six cases and hydrocephalus in six cases. These findings suggested that MRI with different sequences can diagnose glioma metastasis.展开更多
Objective. To investigate the magnetic resonance (MR) features of meningeal carcinomatosis, and to improve the ability in understanding and diagnosing meningeal carcinomatosis by MR findings.Methods. Eleven cases with...Objective. To investigate the magnetic resonance (MR) features of meningeal carcinomatosis, and to improve the ability in understanding and diagnosing meningeal carcinomatosis by MR findings.Methods. Eleven cases with proven meningeal carcinomatosis were studied by conventional and Gd - DTPA enhanced MR imaging. The enhancement patterns and features, as well as the types of meningeal involvement, were retrospectively analyzed.Results. Conventional MR imaging showed no evident meningeal abnormalities. After the administration of Gd - DTPA, abnormal pia mater enhancement was detected in 9 cases, demonstrating as the continuous, thin, and lineal high signal intensity on the brain surface that could descend into the sulci. The abnormal pial enhancement occurred on the cortical surfaces of cerebellum, brainstem, and cerebrum. No abnormal enhancement in the subarach-noid space was found. Abnormal dura - arachnoid enhancement was seen in 3 cases, showing as the continuous, thick, and curvilineal high signal intensity over the convexities or in the tentorium without extension into the cortical sulci. Cerebral dura - arachnoid involvement was found in all 3 cases and one of them also showed abnormal enhancement in cerebellar dura - arachnoid and tentorium. Of the 11 cases, 9 with pial involvement had abnormal cerebrospinal fluid (CSF) results, 2 involving only the dura - arachnoid had normal CSF results.Conclusion. Meningeal carcinomatosis could be well demonstrated by Gd - DTPA enhanced MR imaging, and its type could be differentiated by the enhancement features. Combined with the clinical information, Gd - enhanced MR imaging may lead to the diagnosis and guide the therapy of meningeal carcinomatosis.展开更多
Objective: To investigate the potential of superparamagnetic iron oxide particles (SPIO) in MR imaging for the differentiation between hyperplastic and metastatic lymph node. Methods: Animal models of malignant lymph ...Objective: To investigate the potential of superparamagnetic iron oxide particles (SPIO) in MR imaging for the differentiation between hyperplastic and metastatic lymph node. Methods: Animal models of malignant lymph node metastasis were established in 6 New-Zealand rabbits by a unilateral intra-muscular injection of VX2 carcinoma cells, and models of hyperplastic lymph nodes were induced in another 6 rabbits by a unilateral intra-muscular injection of egg yolk emulsion. MR images of the lymph nodes were obtained before and 12 h after interstitial injection of SPIO. Image results were analyzed and compared with pathological findings. Results: On unenhanced images, the signal intensity of hyperplastic and metastatic lymph nodes did not differ significantly. After administration of SPIO, the signal intensity of both hyperplastic and metastatic lymph nodes remained unchanged on T1-weighted SE images. On T2-weighted SE images, the signal intensity of hyperplastic lymph nodes decreased heterogeneously, while that of all metastatic ones remained unchanged. On T2-weighted GRE images, the signal intensity of hyperplastic lymph nodes decreased significantly and homogeneously, while that of 4 metastatic ones remained unchanged and that of the rest 2 decreased heterogeneously. Conclusion: SPIO-enhanced MR imaging may enable the differentiation between the hyperplastic and metastatic lymph nodes.展开更多
患者女,56岁,因“双侧甲状腺乳头状癌”接受“甲状腺全切术+颈部淋巴结清扫术”后1月余;检出糖尿病3个月。查体:颈前见横向手术瘢痕,余未见明显异常。实验室检查:促甲状腺素(thyroid stimulating hormone,TSH)92.72μIU/ml,血清刺激性...患者女,56岁,因“双侧甲状腺乳头状癌”接受“甲状腺全切术+颈部淋巴结清扫术”后1月余;检出糖尿病3个月。查体:颈前见横向手术瘢痕,余未见明显异常。实验室检查:促甲状腺素(thyroid stimulating hormone,TSH)92.72μIU/ml,血清刺激性甲状腺球蛋白(thyroglobulin,Tg)>479ng/ml。行^(131)I清除残余甲状腺组织(简称清甲)治疗后全身显像(^(131)I post therapy whole body scan,Rx-WBS)见颈部多发淋巴结及双肺多发结节^(131)I浓聚。展开更多
文摘Early detection of skeletal metastasis is critical for accurate staging and optimal treatment. This paper briefly reviews our current understanding of the biological mechanisms through which tumours metastasise to bone and describes the available imaging methods to diagnose bone metastasis and monitor response to treatment. Among the various imaging modalities currently available for imaging skeletal metastasis, hybrid techniques whichfuse morphological and functional data are the most sensitive and specific, and positron emission tomography(PET)/computed tomography and PET/magnetic resonance imaging will almost certainly continue to evolve and become increasingly important in this regard.
文摘Objective To evaluate the feasibility of whole body diffusion weighted imaging (DWI) in bone metastasis detection using bone scintigraphy as comparison. Methods Forty-five patients with malignancy history were enrolled in our study. All the patients received the whole body DWI and bone scintigraphy scan within 1 week. The magnetic resonance (MR) examination was performed on 3.0T MR scanner using embedded body coil. The images were reviewed separately by two radiologists and two nuclear medicine physicians, who were blinded to the results of the other imaging modality. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the two techniques for detecting bone metastasis were analyzed. Results A total of 181 metastatic lesions in 77 regions of 34 patients were detected by whole body DWI, and 167 metastatic lesions in 76 regions of 31 patients were identified by bone scintigraphy. The patient-based sensitivity and PPV of whole body DWI and bone scintigraphy were similar (89.5% vs. 81.6%, 97.1% vs. 91.2%), whereas, the patient-based specificity and NPV of whole body DWI were obviously higher than those of bone scintigraphy (85.7% vs. 57.1%, 60.0% vs. 36.4%). Ten regions negative in scintigraphy but positive in whole body DWI, mainly located in spine, pelvis, and femur; nine regions only detected by scintigraphy, mainly located in skull, sternum, clavicle, and scapula. The region-based sensitivity and specificity of whole body DWI were slightly higher than those of bone scintigraphy (89.5% vs. 88.4%, 95.6% vs. 87.6%). Conclusion Whole body DWI reveals excellent concordance with bone scintigraphy regarding detection of bone metastasis, and the two techniques are complementary for each other.
文摘Pancreatic neuroendocrine neoplasms(panNEN)are a heterogeneous group of tumors with differing pathological,genetic,and clinical features.Based on clinical findings,they may be categorized into functioning and nonfunctioning tumors.Adoption of the 2017 World Health Organization classification system,particularly its differentiation between grade 3,well-differentiated pancreatic neuroendocrine tumors(panNET)and grade 3,poorly-differentiated pancreatic neuroendocrine carcinomas(panNEC)has emphasized the role imaging plays in characterizing these lesions.Endoscopic ultrasound can help obtain biopsy specimen and assess tumor margins and local spread.Enhancement patterns on computed tomography(CT)and magnetic resonance imaging(MRI)may be used to classify panNEN.Contrast enhanced MRI and diffusion-weighted imaging have been reported to be useful for characterization of panNEN and quantifying metastatic burden.Current and emerging radiotracers have broadened the utility of functional imaging in evaluating panNEN.Fluorine-18 fluorodeoxyglucose positron emission tomography(PET)/CT and somatostatin receptor imaging such as Gallium-681,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid–octreotate PET/CT may be useful for improved identification of panNEN in comparison to anatomic modalities.These new techniques can also play a direct role in optimizing the selection of treatment for individuals and predicting tumor response based on somatostatin receptor expression.In addition,emerging methods of radiomics such as texture analysis may be a potential tool for staging and outcome prediction in panNEN,however further investigation is required before clinical implementation.
文摘Objective To evaluate the values of whole body diffusion weighted imaging （DWI） in screenmg pnmary unknown tumor in patients with metastases. Methods Totally, 34 patients with metastases of primary unknown tumors were scanned with whole body DWI, and conventional magnetic resonance （MR） imaging was performed if suspected lesions were detected. All the metastases including 27 cases of osseous metastases, 2 brain metastases, 2 liver metastases, 1 pulmonary multiple metastasis, 1 neck metastasis and 1 malignant ascites, were diagnosed by computed tomography, single photon emission computed tomography, or MR imaging. For the proven primary tumors diagnosed by biopsy or pathology of surgical specimens, apparent diffusion coefficient （ADC） values of the primary and metastatic lesions were measured respectively. The sensitivity and specificity of this technique for screening primary tumors were cvaluated. Results We found 24 cases with suspected primary lesions, in which 23 lesions were proved to be primary tumors, and 1 was proved to be benign lesion. And no definite primary lesion was found in 10 cases on whole body DWI, but in which 1 case was diagnosed with primary tumor by biopsy later, and the other 9 cases remained unknown within follow-up of over halfa year. The difference was not significant in ADC values between primary and metastatic lesions （P〉0.05）. The sensitivity and specificity of whole body DWI for searching primary tumors was 95.8% and 90.0%, respectively. Conclusion Combined with conventional MR scanning, whole body DWI can help to search primary lesions of patients with metastases.
基金the National Natural Science Foundation of China, No. 300570539Major Subject of Shanghai Science and Technology Commission, No.07jc14032+2 种基金074119504Doctoral Innovation Fund of Shanghai Jiao Tong University School of Medicine, No. BXJ201043Nano Specialized Research Fund of Shanghai Science and Technology Commission, No. 1052nm05800
文摘Ten intracranial gliomas cases, that had postoperative intracranial dissemination, underwent magnetic resonance imaging （MRI） examinations, including T1 weighted imaging, fat-suppressed T1 weighted imaging, T2 weighted imaging and fluid attenuated inversion recovery （FLAIR）. Results showed that tumor metastasis had occurred via the cerebrospinal fluid, the brain white matter fibers and the surgical access site alone. On the plain MRI scans, 1/7 cases were linearly thickened with isointensity and 5/7 cases exhibited nodular foci on T1 weighted imaging; the cerebral sulci and cisterns in 2/7 cases had become shallow and five cases had nodular foci on T2 weighted imaging. FLAIR imaging revealed that the cerebral sulci and cisterns in 2/7 cases had become shallow and that six cases had affected nodular foci. The contrast-enhanced MRI scans revealed linear thickening in seven cases, nodules in seven cases, similarities to ＂mould-like＂ signs in six cases and hydrocephalus in six cases. These findings suggested that MRI with different sequences can diagnose glioma metastasis.
文摘Objective. To investigate the magnetic resonance (MR) features of meningeal carcinomatosis, and to improve the ability in understanding and diagnosing meningeal carcinomatosis by MR findings.Methods. Eleven cases with proven meningeal carcinomatosis were studied by conventional and Gd - DTPA enhanced MR imaging. The enhancement patterns and features, as well as the types of meningeal involvement, were retrospectively analyzed.Results. Conventional MR imaging showed no evident meningeal abnormalities. After the administration of Gd - DTPA, abnormal pia mater enhancement was detected in 9 cases, demonstrating as the continuous, thin, and lineal high signal intensity on the brain surface that could descend into the sulci. The abnormal pial enhancement occurred on the cortical surfaces of cerebellum, brainstem, and cerebrum. No abnormal enhancement in the subarach-noid space was found. Abnormal dura - arachnoid enhancement was seen in 3 cases, showing as the continuous, thick, and curvilineal high signal intensity over the convexities or in the tentorium without extension into the cortical sulci. Cerebral dura - arachnoid involvement was found in all 3 cases and one of them also showed abnormal enhancement in cerebellar dura - arachnoid and tentorium. Of the 11 cases, 9 with pial involvement had abnormal cerebrospinal fluid (CSF) results, 2 involving only the dura - arachnoid had normal CSF results.Conclusion. Meningeal carcinomatosis could be well demonstrated by Gd - DTPA enhanced MR imaging, and its type could be differentiated by the enhancement features. Combined with the clinical information, Gd - enhanced MR imaging may lead to the diagnosis and guide the therapy of meningeal carcinomatosis.
文摘Objective: To investigate the potential of superparamagnetic iron oxide particles (SPIO) in MR imaging for the differentiation between hyperplastic and metastatic lymph node. Methods: Animal models of malignant lymph node metastasis were established in 6 New-Zealand rabbits by a unilateral intra-muscular injection of VX2 carcinoma cells, and models of hyperplastic lymph nodes were induced in another 6 rabbits by a unilateral intra-muscular injection of egg yolk emulsion. MR images of the lymph nodes were obtained before and 12 h after interstitial injection of SPIO. Image results were analyzed and compared with pathological findings. Results: On unenhanced images, the signal intensity of hyperplastic and metastatic lymph nodes did not differ significantly. After administration of SPIO, the signal intensity of both hyperplastic and metastatic lymph nodes remained unchanged on T1-weighted SE images. On T2-weighted SE images, the signal intensity of hyperplastic lymph nodes decreased heterogeneously, while that of all metastatic ones remained unchanged. On T2-weighted GRE images, the signal intensity of hyperplastic lymph nodes decreased significantly and homogeneously, while that of 4 metastatic ones remained unchanged and that of the rest 2 decreased heterogeneously. Conclusion: SPIO-enhanced MR imaging may enable the differentiation between the hyperplastic and metastatic lymph nodes.
文摘患者女,56岁,因“双侧甲状腺乳头状癌”接受“甲状腺全切术+颈部淋巴结清扫术”后1月余;检出糖尿病3个月。查体:颈前见横向手术瘢痕,余未见明显异常。实验室检查:促甲状腺素(thyroid stimulating hormone,TSH)92.72μIU/ml,血清刺激性甲状腺球蛋白(thyroglobulin,Tg)>479ng/ml。行^(131)I清除残余甲状腺组织(简称清甲)治疗后全身显像(^(131)I post therapy whole body scan,Rx-WBS)见颈部多发淋巴结及双肺多发结节^(131)I浓聚。
