体素内不相干运动扩散加权磁共振成像在脑肿瘤鉴别诊断及术前分级中的临床应用

目的探讨多b值体素内不相干运动扩散加权磁共振成像(introvoxelincoherentmotion MR imaging,IVIM-MRI)定量参数在脑肿瘤鉴别诊断及术前分级中的临床价值。方法选择在我院治疗并实施磁共振检查的脑肿瘤患者64例,根据病理学检查结果确定肿瘤类别及病理分级,并据此对患者进行分组。结果在脑肿瘤鉴别诊断方面,良性肿瘤组患者ADC standard、D和D*值均显著高于恶性脑肿瘤患者(P<0.05);良性脑肿瘤患者f值显著低于恶性脑肿瘤患者(P<0.05);ADC standard的AUC最大,敏感性、特异性分别为97.4%,77.4%,同时D值的药时曲线下面积(AUC)敏感性、特异性均较高。在脑肿瘤术前分级方面,低级别脑胶质瘤组与高级别脑胶质瘤组患者ADC standard差异无统计学意义(P>0.05)。低级别脑胶质瘤组患者D、f和D*值均显著低于高级别脑胶质瘤(P<0.05);D*的AUC最大,对不同级别脑胶质瘤诊断的敏感度、特异度分别为94.7%,84.9%。结论单指数模型ADC值与多指数模型D值在脑肿瘤鉴别诊断中均具有较高的临床价值,且多指数模型D值还可用于脑肿瘤的术前分级。

CT增强延时扫描技术在肝脏肿瘤鉴别诊断中的应用效果

评价肝脏肿瘤鉴别诊断中应用CT增强延时扫描技术的临床效果。方法 以颜色球随机抽取法选取我院于2022年1月-2023年4月期间收治的患者88例,将其分为2组。参照组应用MRI,评估组应用CT增强延时扫描技术,对比诊断价值。结果 对比实验结果,相较于与参照组,评估组的诊断价值更高(P<0.05)。结论 CT增强延时扫描技术在肝脏肿瘤鉴别诊断中的运用效果确切,可进一步推广。

彩色多普勒超声检查在乳腺肿瘤诊断中的应用价值分析

目的 探讨彩色多普勒超声检查在乳腺肿瘤诊断中的临床应用价值。方法 51例疑似乳腺肿瘤患者,均行彩色多普勒超声检查,以病理检查结果为金标准,将超声检查结果与病理结果进行对比,分析彩色多普勒超声检查诊断乳腺肿瘤的准确率及声像图特点。结果 51例疑似乳腺肿瘤患者,经彩色多普勒超声检查检出无异常5例,乳腺肿瘤46例,乳腺肿瘤检出率为90.20%(46/51),其中恶性肿瘤12例,良性肿瘤34例。经手术组织活检病理检查检出正常乳腺组织1例,乳腺肿瘤50例,乳腺肿瘤检出率为98.04%(50/51),其中恶性肿瘤14例,良性肿瘤36例。彩色多普勒超声检查诊断的灵敏度为92.00%(46/50),特异度为100.00%(1/1),诊断准确率为92.16%(47/51)。36例病理检查确诊良性肿瘤患者的彩色多普勒超声检查诊断率为94.44%(34/36);14例病理检查确诊恶性肿瘤患者的彩色多普勒超声检查诊断率为85.71%(12/14)。50例病理检查确诊良恶性肿瘤的彩色多普勒超声检查诊断率为92.00%(46/50)。恶性乳腺肿瘤患者声像图表现中无包膜、有周边高回声环、形态不规则、后方回声衰减、有内部细点状钙化占比、血流阻力指数、搏动指数、收缩期峰值血流速度均显著高于良性乳腺肿瘤患者,血流信号差于良性乳腺肿瘤患者,对比有显著差异(P<0.05)。结论 应用彩色多普勒超声检查技术对乳腺肿瘤进行诊断鉴别,具有较高的诊断准确率及良恶性分辨率,对为患者采取早期针对性治疗具有积极的临床应用价值。

卵巢良性和恶性肿瘤的超声鉴别诊断价值分析

目的:探讨卵巢良性和恶性肿瘤的超声鉴别诊断经验,进一步提高诊断水平。方法:收治卵巢肿瘤患者50例,均经手术或病理检查确诊。病理诊断良性肿瘤45例,恶性肿瘤5例,所有患者均采用彩色多普勒超声诊断仪进行检查。结果:本组患者50例,良性肿瘤45例(90.0%),其中卵泡膜纤维瘤1例,良性畸胎瘤1例,黏液性囊腺瘤2例,乳头状囊腺瘤5例,巧克力囊肿6例,单纯性浆液性囊腺瘤12例,炎性包块18例。恶性肿瘤5例(10.0%),其中宫内膜间质肉瘤1例,宫内膜样癌1例,黏液性囊腺癌1例,浆液性囊腺癌2例。良性肿瘤图像表现肿块包膜完整,边界清楚,形态规则,肿块内回声规则,阻力指数(RI)为0.67±0.13,均>0.4,搏动指数(PI)均>1.0,最大血流速度(PSV)均<15cm/秒,性肿瘤的超声图像表现为肿瘤边缘不整,欠清晰,结构紊乱,隔增厚不整齐,多呈乳头状突起,边界形态不规则,内部回声不均。阻力指数(RI)0.38±0.02,均<0.4,搏动指数(PI)均<1.0,最大血流速度(PSV)均>15cm/秒。结论:超声是鉴别卵巢肿瘤良恶性的重要检查方法之一,超声医生要根据肿瘤的形态、内部结构、边缘是否整齐等进行诊断,最大血流速度和搏动指数是区分恶性和良性肿瘤的重要依据。

肝血管良恶性肿瘤中采用放射技术进行诊断鉴别的效果

目的:分析肝血管良恶性肿瘤中采用放射技术进行诊断鉴别的效果。方法:选取2019年1月—2020年6月我院收治的肝血管肿瘤患者50例作为研究对象,对患者进行CT联合MRI的放射技术检查,对上诉患者进行良恶性肿瘤的鉴别诊断,以患者的病理诊断结果作为金标准,分析两种检查结果的效果。结果:放射技术检查结果与病理检查结果准确率、漏诊率以及误诊率的对比结果显示,差异不显著(P>0.05)。结论:对肝血管肿瘤患者采用放射技术进行良恶性肿瘤的鉴别诊断,其诊断准确率可以得到保证,为医生的临床诊断提供比较精准的依据,为患者的治疗打下良好的基础。

彩色多普勒超声与介入超声经皮穿刺活检术在乳腺肿瘤诊断中的应用价值

目的研究彩色多普勒超声与介入超声经皮穿刺活检术对乳腺肿瘤患者的诊断价值。方法80例乳腺肿瘤患者分别行常规彩色多普勒超声诊断以及介入超声经皮穿刺活检术诊断。观察并记录所有患者的手术病理结果,对比彩色多普勒超声及介入超声经皮穿刺活检术的灵敏度、特异度、阳性预测值及阴性预测值。结果80例乳腺肿瘤患者病理结果:良性肿瘤50例,恶性肿瘤30例。彩色多普勒超声诊断45例良性肿瘤,35例恶性肿瘤,其中真阳26例,假阳9例;真阴41例,假阴4例。介入超声经皮穿刺活检术诊断49例良性肿瘤,31例恶性肿瘤,其中真阳30例,假阳1例;真阴49例,假阴0例。介入超声经皮穿刺活检术的灵敏度、特异度、阴性预测值及阳性预测值分别为100.00%、98.00%、96.77%、100.00%,均高于彩色多普勒超声的86.67%、82.00%、74.29%、91.11%,差异具有统计学意义(P<0.05)。结论与常规彩色多普勒超声对比,介入超声经皮穿刺活检术对乳腺肿瘤的诊断价值更高,可在临床实践中推广应用。

超声弹性成像在腮腺混合瘤良恶性鉴别诊断中的应用价值

目的:探讨超声弹性成像对腮腺混合瘤良恶性鉴别诊断的应用价值。方法:对82例98个经病理证实的腮腺混合瘤结节术前行常规超声及超声弹性成像检查。结果:以超声弹性成像评分≥4分作为腮腺混合瘤恶性结节的诊断标准,超声弹性成像技术对腮腺混合瘤结节的良恶性鉴别诊断敏感性、特异性、准确性分别为84.6%、88.9%、87.8%,阳性预测值73.3%,阴性预测值94.1%。结论:超声弹性成像对腮腺混合瘤结节的良恶性鉴别诊断有较大的应用价值。

人附睾蛋白4在卵巢恶性肿瘤早期诊断中的作用

目的探讨人附睾蛋白4(HE4)检测在卵巢肿瘤鉴别诊断及疾病转归中的价值。方法用病例-对照研究方法,分别检测病例组术前以及健康对照组血清人附睾蛋白4和糖类抗原-125(CA125)的水平;用免疫组化方法比较各组的组织上HE4的表达情况,分析HE4分布特点,探讨HE4水平与卵巢癌病理分型的关系以及与肿瘤分期的关系。结果血清HE4水平在56.37 pmol·L-1时,HE4诊断卵巢恶性肿瘤的敏感度为80%,特异度为96%;HE4水平与病理分化呈负相关,而与临床分期呈正相关;HE4在恶性肿瘤组及交界性组表达阳性率明显高于卵巢良性肿瘤组、卵巢非赘生性病变组及其他妇科恶性肿瘤组。血清HE4水平与组织中的HE4表达情况呈正相关。结论 HE4诊断卵巢恶性肿瘤的敏感性和特异性均高于CA125,与CA125联合检测的敏感性最高,血清HE4及组织HE4水平均与卵巢恶性肿瘤病理分型及临床转归均密切关联。

颅内孤立性纤维瘤侵犯颈静脉孔1例并文献复习

颅内孤立性纤维瘤(ISFT)临床上较为罕见,侵犯颈静脉孔的ISFT更少见。该文报道侵犯颈静脉孔的ISFT 1例,对其病理学、影像学特征、术后复发和转移相关研究进展进行文献复习。

Preliminary Application of Perfusion Imaging in Neoplasm in the Brain and Body with Multi-slice Helical CT

Objective： To evaluate the clinical value of perfusion imaging in neoplasm in the brain and body with Multi-slice helical CT. Methods： Twenty-eight patients with neoplasm were subjected to perfusion imaging with multi-slice helical CT, including 22 patients with brain neoplasm and 6 patients with body neoplasm. At first, CT routine scan was preformed to localize central slices of neoplasm. Then perfusion imaging of 4 and identical slices in central slices of neoplasm was performed by using CT cine scan. Scanning images were transferred into ADW3.1 work-station to create and analyze perfusion images and parameters. Results： Perfusion parameters of cerebral neoplasm had a remarkable increase. But, CBF value of different cerebral neoplasms had partial overlap; CBV value was increased slightly; MTT value had no apparently clinical value; PS value was increased significantly, pituitary neoplasm〉meningoma〉cerebral glioma≈cerebral metastasis. PS value could reveal the characters of cerebral neoplasm and had apparently clinical value. Perfusion parameters of body neoplasms have a remarkable increase too. Body tumors were liable to be interfered by breath movement. Perfusion parameters were helpful to differentiation diagnosis of neoplasm in the brain and body. PS images of neoplasm in the brain and body were helpful to defining tumor outline and finding small tumor. Conclusion： MSCT perfusion imaging provided a precise and relative simple method to quantitatively estimate blood perfusion status in tumors in the brain and body. The technique can be easily implemented on clinical scanners.

Pancreatic carcinoma coexisting with chronic pancreatitis versus tumor-forming pancreatitis:Diagnostic utility of the time-signal intensity curve from dynamic contrast-enhanced MR imaging

AIM: To evaluate the ability of the time-signal intensity curve (TIC) of the pancreas obtained from dynamic contrast-enhanced magnetic resonance imaging (MRI) for differentiation of focal pancreatic masses, especially pancreatic carcinoma coexisting with chronic pancreatitis and tumor-forming pancreatitis. METHODS: Forty-eight consecutive patients who underwent surgery for a focal pancreatic mass, including pancreatic ductal carcinoma (n = 33), tumor-forming pancreatitis (n = 8), and islet cell tumor (n = 7), were reviewed. Five pancreatic carcinomas coexisted with longstanding chronic pancreatitis. The pancreatic TICs were obtained from the pancreatic mass and the pancreatic parenchyma both proximal and distal to the mass lesion in each patient, prior to surgery, and were classified into 4 types according to the time to a peak: 25 s and 1, 2, and 3 min after the bolus injection of contrast material, namely, type-Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively, and were then compared to the corresponding histological pancreatic conditions. RESULTS: Pancreatic carcinomas demonstrated type-Ⅲ (n = 13) or Ⅳ (n = 20) TIC. Tumor-forming pancreatitis showed type-Ⅱ (n = 5) or Ⅲ (n = 3) TIC. All islet cell tumors revealed type-Ⅰ. The type-Ⅳ TIC was only recognized in pancreatic carcinoma, and the TIC of carcinoma always depicted the slowest rise to a peak among the 3 pancreatic TICs measured in each patient, even in patients with chronic pancreatitis.CONCLUSION: Pancreatic TIC from dynamic MRI provides reliable information for distinguishing pancreatic carcinoma from other pancreatic masses, and may enable us to avoid unnecessary pancreatic surgery and delays in making a correct diagnosis of pancreatic carcinoma, especially, in patients with longstanding chronic pancreatitis.

Radiofrequency ablation for incidentally identified primary intrahepatic cholangiocarcinoma

Cholangiocarcinoma is the second most common primary hepato-biliary malignancy. The majority of patients with primary hepatic tumors are not suitable candidates for resection, due to advanced stage of the disease at presentation, anatomic limitations and medical comorbidities. At present, radiofrequency ablation (RFA) may offer an alternative, feasible and safe therapy for selected patients with hepatic tumors, who are not otherwise candidates for hepatic resection. Herein, we present the case of successful RFA in a patient with a solitary, primary intrahepatic cholangiocarcinoma. The patient remained free of disease 24 mo after the procedure, and is still followed up. This is the first report of RFA application inthe treatment of primary intrahepatic cholangiocarcinoma.

Relationship between trefoil factor 1 expression and gastric mucosa injuries and gastric cancer

AIM:To determine whether trefoil factor 1 (TFF1) is associated with mucosa healing and carcinoma suppression, we assess the expression of trefoil factor 1 in normal and pathologic gastric mucosa. METHODS: TFF1 in normal and pathologic gastric mucosa was assessed by immunohistochemical method, and the average positive A was estimated by Motic Images Advanced 3.0 software. RESULTS: Increased TFF1 was detected in gastritis, gastric ulcer and duodenal ulcer compared with normal mucosa. The same result could be seen in multiple and compound ulcer compared with simple ulcer. There was no significant difference between gastric ulcer and duodenal ulcer, gastritis and simple ulcer respectively. Increased TFF1 was detected in the peripheral mucosa of the gastric adenocarcinoma compared with normal mucosa. The expression of TFF1 in gastric adenocarcinoma was related to the differentiation of adenocarcinoma. The lower the differentiation of adenocarcinoma, the weaker the expression of TFF1. There was no TFF1 expressed in low-differentiated adenocarcinoma. The expression of TFF1 in middle and highly differentiated adenocarcinoma was a little lower than that in normal mucosa. But there was no significant difference. No TFF1 was assessed in esophageal squamous carcinoma and peripheral tissue. There was no significant difference between male and female. CONCLUSION: The expression of TFF1 was higher in gastritis and peptic ulcer than that in normal mucosa, and was also higher in multiple and compound ulcer than in simple ulcer. It seems that TFF1 plays a role in gastric mucosa protection and epithelial restitution. Increased expression of TFF1 in peripheral tissue suggests that TFF1 is associated with mechanism of carcinoma suppression and differentiation. Decreased expression of TFF1 in carcinoma and its relativity to the differentiation suggests that TFF1 is related to gland and cell destruction of carcinoma.

Prostatic Cancer: Diagnosis and Differentiation by Dynamic Contrast-Enhanced MRI

To assess the role of dynamic contrast-enhanced MRI (DCE-MRI) in thediagnosis and differentiation of prostatic cancer (PC). Methods: Five volunteers, 36 patients withbenign prostatic hyperplasia (BPH) and 13 patients with biopsy-proven prostate cancer underwentconventional MRI, DCE-MRI and delayed enhancement MRI. The value of the signal intensity in DCE-MRIwas measured and calculated to draw the time-signal intensity curve of the normal peripheral zone(PZ), the prostate cancer and the benign prostatic hyperplasia. Results: In DCE-MRI, the normalperipheral zone was enhanced mildly and slowly and the peak value was located in late phase. Theenhancement of the lesions in 36 patients with the benign prostatic hyperplasia was obvious in earlyphase and strengthened gradually, and then turned to decrease in late phase after peak value. Thelesions in 9 of 13 cases with prostate cancer were enhanced obviously in early phase and washed outrapidly, and the peak value was located in early phase, but the peak value was in mediate and latephase in the other 4 cases with diffuse lesion in the prostate on T_2WI. Conclusion: In DCE-MRI, theenhancement patterns of the normal peripheral zone, the prostate cancer and the benign prostatichyperplasia were significantly different. DCE-MRI was very useful in the diagnosis anddifferentiation of prostate cancer.

Pancreatic tuberculosis masquerading as pancreatic serous cystadenoma

Solitary pancreatic involvement of tuberculosis is rare, especially in an immunocompetent individual, and it may be misdiagnosed as pancreatic cystic neoplasms. Pancreatic cystic neoplasms are being identified in increasing numbers, probably because of the frequent use of radiology and advances in endoscopic techniques. However, they are composed of a variety of neoplasms with a wide range of malignant potential, and it is often difficult to differentiate pancreatic tuberculosis mimicking cystic neoplasms from benign or malignant pancreatic cystic neoplasms. Non-surgical diagnosis of pancreatic tuberculosis is inconclusive and continues to be a challenge in many cases. If so, then laparotomy should be employed to establish the diagnosis. Therefore, pancreatic tuberculosis should be kept in mind during the differential diagnosis of solitary cystic masses in the pancreas. We report a patient who had solitary pancreatic tuberculosis masquerading as pancreatic serous cystadenoma.

Usefulness of DWI in the evaluation of pulmonary isolated lesions

Objective： The aim of our study was to investigate the value of Diffusion-weighted MR imaging （DWl） for evaluating differential diagnosis of pulmonary isolated lesions. Methods： Twenty-seven consecutive patients enrolled in this study, all of whom underwent single direction DWl examinations and received a histologic and clinical diagnosis. Diffusion factor B value was 300, 500, 800 s/mm2, respectively. DWl images of twenty cases could be satisfied to measurement and diagnosis and success rate was percent 74. Among these, lung tuberculoma 5 cases, harmatoma 3 cases, peripheral lung cancer 12 cases. The apparent diffusion coefficient （ADC） values of the lesions were measured. Statistical analyses were performed with the independent samples t test for comparing difference of ADC values between malignant nodules and benign nodules at different 8 value. Results： DWI images of twenty cases could be satisfied and its success rate was percent 74. When B value was 300 s/mm2, ADC values of malignant nodules and benign nodules were 0.002192±0.0006091 mm2/s, 0.002454 ± 0.0007892 mm2/s, respectively, and P = 0.442. When B value was 500 s/mm2, ADC value of malignant nodules and benign nodules were 0.002065 ± 0.0006769 mm2/s, 0.002871± 0.0007746 mm2/s, respectively, and P = 0.033. When B value was 800 s/mm2, ADC value of malignant nodules and benign nodules were 0.001646 ± 0.0004292 mm2/s, 0.002651 ＋ 0.0008041 mm2/s, respectively, and P = 0.009. There were the most different between malignant nodules and benign nodules at B value 800 and statistical significance. Conclusion： Lung DWl imaging is helpful to diagnosis and differential diagnosis between malignant and benign isolated nodules. The ADC value of benign lesions was statistically higher than that of malignant tumors.

PRELIMINARY APPLICATION OF COLOR DOPPLER FLOW IMAGING IN THE LOCALIZATION OF PARATHYROID ADENOMAS

From December 1991 to April 1993, we performed color Doppler flow imaging (CDFI) in 11 patients with parathyroid adenoma, and all cases were confirmed by operation and pathology. In all the parathyroid adenomas,vessels were clearly revealed at the periphery of the upper pole and/or anterior periphery, where arterial signals were elicited. These arteries had branches into the adenomas and originated from inferior thyroid arteries on the same side in most cases. The internal flow signals were increased markedly as compared to normal thyroid, and high-velocity arterial signals were detected. Because of the thyroid' s rich blood supply and landmark peripheral vessels, CDFI can distinguish parathyroid foci from thyroid nodules, lymph nodes, and normal tissues and provide a sound basis for the diagnosis of small parathyroid foci.

Comparative analysis of CT and pathological findings of peripheral nerve sheath tumors

Objective: To improve the qualitative diagnosis of peripheral nerve sheath tumors by computed tomography (CT). Methods: CT findings of 64 cases of pathologically confirmed nerve sheath tumors were compared with the pathological findings of the tumors. Results: Low density of the tumors shown in plain CT images was related to dominating reticular structure in the tumor as found pathologically. Tumors with intact capsule found by pathological findings were shown with smooth margin in CT images. Inhomogeneous density and enhancement of the tumors in CT images was related to tumor necrosis, liquefaction and cystic degeneration, and inhomogeneous enhancement also involved the reticular structure. Conclusion: Nerve sheath tumors are characterized by distribution along the nerves, lower density than that of muscles in plain CT images, and inhomogeneous enhancement in enhanced CT, which can help differentiate nerve sheath tumors from other soft tissue tumors. When nerve sheath tumors lack distinctive CT features, the diagnoses have to depend on their pathological findings.

The Application of HE4 in Diagnosis of Gynecological Pelvic Malignant Tumor

OBJECTIVE To investigate the value of human epididymis geneproduct 4 (HE4) in differential diagnosis of gynecological pelvictumors.METHODS The level of serum HE4 in 132 women wasdetermined. These women were divided into three groups, i.e.,46 women with good health being classified as the normal control(NC) group, and based on clinicopathological results, the other 86with pelvic masses being classified into groups of benign (n = 56)and malignant lesions (n = 30), respectively.RESULTS The range of serum HE4 in the NC group was(23.5～46.0) pmol/L, with an average value of (34.1 ± 5.6) pmol/L;the range of serum HE4 in the benign lesion group was (30.1～58.9)pmol/L, with an average value of (39.1 ± 7.2) pmol/L; the range ofserum HE4 in the group of malignancy was (31.2～1430.0) pmol/L,and the average value was (248.7 ± 364.5) pmol/L. The level ofHE4 in the malignant lesion group was significantly higher thanthat in the other 2 groups, with a statistical difference, P < 0.001.The diagnostic index reached maximum (0.847) when the serumHE4 was at 51.6 pmol/L, and the sensitivity and specificity of HE4were 86.7% and 98.0%, respectively. The area under the receiver-operator characteristic curve (ROC) was 0.935 (95% CI 0.832～1.037,P = 0.000). The consistency checking Kappa value of HE4 in thediagnosis of pelvic malignant tumors was 0.867, P = 0.000.CONCLUSION The determination of serum HE4 is a goodindicator in differential diagnosis of benign and malignant ovariantumors.

Clinicopathological analysis of solitary fibrous tumor

Objective:The aim of this study was to investigate the clinicopathologic characteristics,diagnosis and differential diagnosis,molecular genetics,treatment and prognosis of solitary fibrous tumor(SFT).Methods:The clinicopathological manifestations were analyzed retrospectively in 22 patients with surgically confirmed SFT.Results:There were 12 male patients and 10 female patients,with the age range 33-67(mean 48.62) years.The SFTs originated from different from parts of the body,including 13 in the chest,2 in the lungs,3 in the abdomen,1 in the lumbosacral area,2 in the pelvis,and 1 in the left shoulder.There were 19 benign and 3 malignant tumors.Major clinical presentations were local masses and compression symptoms.Microscopy:the tumor was composed of areas of alternating hypercellularity and hypocellularity.The tumor cells were spindle to short-spindle shaped and arranged in fascicular or storiform pattern and hemangiopericytoma-like structure was presented.Immunohistochemically,Vimentin positive rate was 100%(22/22),Bcl-2 positive rate was 95.5%(21/22),CD99 positive rate was 86.4%(19/22),CD34 positive rate was 81.8(18/22),focally positive for P53,as well as negative CK,S100 and Desmin.Ki67 labelling index was 2%-30%.Conclusion:SFT is a rare tumor which may be found in various parts of human body.SFT mostly is a benign tumor,but a few could be malignant.Its diagnosis mainly rely on its morphologic features and immunohistochemical profiles.The major treatment is to completely resect it by operation and long-term clinical follow-up is necessary.