子宫粘膜下肌瘤的MRI、超声及宫腔镜对照研究

目的：综合研究子宫粘膜下肌瘤（subumcosal myoma of uterus）的 MRⅠ、超声及宫腔镜对照价值.方法：采取回顾性地研究方法,选取在我院2015年2月-2016年2月收治的子宫粘膜下肌瘤患者临床资料45例作为研究对象,采取 MRⅠ、超声等检查方法,将宫腔镜以及相关手术病理结果作为对照.采用 SPSS20.0统计学软件进行统计学分析45例子宫粘膜下肌瘤患者的 MRⅠ、超声及宫腔镜诊断符合率.结果：MRⅠ 检查：术前有44例患者确诊为子宫粘膜下肌瘤,MRⅠ 诊断符合率为97.78%（44/45）,MRⅠ 诊断44例子宫粘膜下肌瘤患者中有2例0型、29例 Ⅰ 型、13例 Ⅱ 型;阴道超声检查：40例确诊为子宫粘膜下肌瘤,阴道超声诊断符合率为88.89%（40/45）,阴道超声诊断40例子宫粘膜下肌瘤患者中有2例0型、18例 Ⅰ 型、20例 Ⅱ 型;宫腔镜以及手术病理结果为：子宫粘膜下肌瘤中有10例0型、20例Ⅰ 型、15例 Ⅱ 型;MRⅠ、超声在 Ⅰ 型子宫粘膜下肌瘤患者中的诊断有统计学意义（P〈0.05）.结论：子宫粘膜下肌瘤的 MRⅠ 分型结果与病理结果密切相关,对确定子宫粘膜下肌瘤患者分型具有较高的应用价值.

MRI、超声及X线在乳腺癌术前诊断中的应用

目的:研究分析在实施乳腺癌手术前诊断采用MRI、超声及X线检查对后期治疗的应用指导及效果。方法:将我院2017年5月—2018年5月的90例乳腺癌手术患者作为本次的重点参考目标进行研究,将患者随机分为参照组、观察组及实验组各30例。参照组在手术前进行X线检查,观察组在手术前对患者实施超声检查,实验组患者实施MRT检查。结果:三组患者采用不同的检查方法后,乳腺癌确诊率及病症检查率分别为参照组70%、观察组90%、实验组96.66%。三个小组之间差异明显(P <0.05)。结论:MRI检查对患者术前确诊率及诊断后能够为治疗提供良好的指导,MRI检查可在临床中广泛应用。

Characterization of focal liver lesions with SonoVue~-enhanced sonography: International multicenter-study in comparison to CT and MRI

AIM： To evaluate in a multicenter study whether the sonographic characterization of focal liver lesions can be improved using SonoVue-enhancement; and to compare this method with computed tomography （CT） and magnetic resonance imaging （MRI）. METHODS： One hundred and thirty four patients withone focal liver lesion detected in baseline ultrasound （US） were examined with conventional US, contrastenhanced US （n = 134）, contrast-enhanced CT （n = 115） and/or dynamic contrast-enhanced MRI （n = 70）. The lesions were classified as malignant, benign or indeterminate and the type of lesion was determined. The final diagnosis based on the combined information of all imaging examinations, clinical information and histology （n = 32） was used. Comparisons were made to see whether the addition of contrast-enhanced US led to the improvement of the characterization of doubtful focal liver lesions.RESULTS： In comparison with unenhanced US, SonoVue markedly improves sensitivity and specificity for the characterization （malignant/benign） of focal liver lesions. In comparison with CT and/or dynamic MRI, SonoVue -enhanced sonography applied for characterization of focal liver lesions was 30.2% more sensitive in the recognition of malignancy and 16.1% more specific in the exclusion of malignancy and overall 22.9% more accurate. In the subgroup with confirmative histology available （n = 30）, sensitivity was 95.5% （CEUS）, 72.2% （CT） and 81.8% （MRI）, and specificity was 75.0% （CEUS）, 37.5% （CT） and 42.9% （MRI）. The sensitivity and specificity of CEUS for the identification of focal nodular hyperplasia （FNH） and hemangiomas was 100% and 87%, resulting in an accuracy of 94.5%.CONCLUSION： SonoVue-enhanced sonography emerges as the most sensitive, ost specific and thus most accurate imaging modality for the characterization of focal liver lesions.

Hepatic schwannoma:Imaging findings on CT,MRI and contrast-enhanced ultrasonography

A primary benign schwannoma of the liver is extremely rare and is difficult to preoperatively discriminate from a malignant tumor.We compared the imaging and pathological findings,and examined the possibility of preoperatively diagnosing a benign liver schwannoma.A 72-year-old woman was admitted to our hospital because of a 4.6-cm mass in the liver.A malignant tumor was suspected,and a right hepatectomy was performed.After this,the diagnosis of a primary benign schwannoma of the liver was made through pathological examination.Contrast-enhanced ultrasonography(CEUS) with Sonazoid showed minute blood flows into the septum and solid areas of the tumor in the vascular phase;most likely due to increased arterial flow associated with infiltration of chronic inflammatory cells.In the postvascular phase,CEUS showed contrast defect of cystic areas and delayed enhancement of solid areas;most likely due to aggregation of siderophores.Because discriminating between a benign and malignant schwannoma of the liver is difficult,surgery is generally recommended.However,the two key findings from CEUS may be useful in discriminating ancient schwannoma by recognizing the hemorrhage involved in the secondary degeneration and aggregation of siderophores.

乳腺X线摄影,超声及MRI诊断乳腺癌的临床价值

探讨乳腺癌的临床诊断中乳腺X线摄影、超声、MRI的应用价值。方法:选取2019年4月~2020年6月在我院接受检查的270例乳腺病变患者作为观察对象,其中200例行乳腺X线摄影检查、50例行超声检查、20例行MRI检查,分析检查结果。结果:MRI诊断的灵敏度、特异度、PPV、NPV、准确度与AUC均显著高于乳腺X线摄影与超声检查,差异具有统计学意义(P<0.05)。结论:在临床鉴别、诊断良恶性乳腺病变中,MRI具有较高的灵敏度和准确度,可为医生提供客观、真实的参考数据,值得推广。

Endoscopic ultrasound and magnetic resonance imaging for re-staging rectal cancer after radiotherapy

AIM： To compare the sensitivity and specificity of two imaging techniques, endoscopic ultrasound （EUS） and magnetic resonance imaging （MRI）, in patients with rectal cancer after neoadjuvant chemoradiation therapy. And we compared EUS and MRI data with histological findings from surgical specimens. METHODS： Thirty-nine consecutive patients （51.3% Male; mean age： 68.2 ＋ 8.9 years） with histologically confirmed distal rectal cancer were examined for staging. All patients underwent EUS and MRI imaging before and after neoadjuvant chemoradiation therapy. RESULTS： After neoadjuvant chemoradiation, EUS and MRI correctly classified 46% （18/39） and 44% （17/39） of patients, respectively, in line with their histological T stage （P 〉 0.05）. These proportions were higher for both techniques when nodal involvement was considered： 69% （27/39） and 62% （24/39）. When patients were sorted into T and N subgroups, the diagnostic accuracy of EUS was better than MRI for patients with T0-T2 （44% vs 33%, P 〉 0.05） and NO disease （87% vs 52%, P = 0.013）. However, MRI was more accurate than EUS in T and N staging for patients with more advanced disease after radiotherapy, though these differences did not reach statistical significance. CONCLUSION： EUS and MRI are accurate imaging techniques for staging rectal cancer, However, after neoadjuvant RT-CT, the role of both methods in the assessment of residual rectal tumors remains uncertain.

Transrectal ultrasound and magnetic resonance imaging measurement of extramural tumor spread in rectal cancer

AIM： To evaluate the agreement between transrectal ultrasound （TRUS） and magnetic resonance imaging （MRI） in classification of ≥ T3 rectal tumors. METHODS： From January 2010 to January 2012, 86 consecutive patients with ≥ T3 tumors were included in this study. The mean age of the patients was 66.4 years （range： 26-91 years）. The tumors were all ≥ T3 on TRUS. The sub-classification was defined by the penetration of the rectal wall： a： 0 to 1 mm; b： 1-5 mm, c： 6-15; d： 〉 15 mm. Early tumors as ab （≤ 5 ram） and advanced tumors as cd （〉 5 mm）. All patients underwent TRUS using a 6.5 MHz transrectal transducer. The MRI was performed with a 1.5 T Phil- ips unit. The TRUS findings were blinded to the radiol- ogist performing the interpretation of the MRI images and measuring the depth of extramural tumor spread RESULTS： TRUS found 51 patients to have an early ≥ T3 tumors and 35 to have an advanced tumor, where- as MRI categorized 48 as early ≥ T3 tumors and 38 as advanced tumors. No patients with tumors classified as advanced by TRUS were found to be early on MRI. The kappa value in classifying early versus advanced T3 rectal tumors was 0.93 （95% CI： 0.85-1.00）. We found a kappa value of 0.74 （95% CI： 0.63-0.86） for the total sub-classification between the two methods. The mean maximal tumor outgrowth measured by TRUS, 5.5 mm ± 5.63 mm and on MRI, 6.3 mm ±6.18 mm, P = 0.004. In 19 of the 86 patients the following CT scan or surgery revealed distant metastases; of the 51 patients in the ultrasound ab group three （5.9%） had metastases, whereas 16 （45.7%） of 35 in the cd group harbored distant metastases, P = 0.00002. The odds ratio of having distant metastases in the ultra- sound cd group compared to the ab group was 13.5 （95% CI： 3.5-51.6）, P = 0.00002. The mean maximal ultrasound measured outgrowth was 4.3 mm （95% CI： 3.2-5.5 mm） in patients without distant metastases, while the mean maximal outgrowth was 9.5 mm （95% CI： 6.2-12.8 ram） in the patients with metastases, P = 0.00004. Using the MRI classification three （6.3%） of 48 in the MRI ab group had distant metastases, while 16 （42.1%） of the 38 in the MRI cd group, P = 0.00004. The MRI odds ratio was 10.9 （95% CI： 2.9-41.4）, P = 0.00008. The mean maximal MRI measured out- growth was 4.9 mm （95% CI： 3.7-6.1 turn） in patients without distant metastases, while the mean maximal outgrowth was 11.5 mm （95% CI： 7.8-15.2 mm） in the patients with metastases, P = 0.000006. CONCLUSION： There is good agreement between TRUS and MRI in the pretreatment sub-classification of ≥ T3 tumors. Distant metastases are more frequent in the advanced group.

Basket pattern blood flow signals discovered in a case of splenic hamartoma by power Doppler ultrasonography

We present the gray-scale ultrasonography （GSUS）, power Doppler ultrasonography （PDUS）, abdominal computed tomography （CT）, and magnetic resonance imaging （MRI） findings for a case of splenic hamartoma in a 27-year-old man, showing a φ 50 mm homogeneous, iso- and hypo-echoic splenic mass with evidence of a small plural cystic lesion. This splenic hamartoma showed increased vascularity on power Doppler sonograms. PDUS showed multiple circular blood flow signals inside the mass （i.e. a basket pattern）, which was consistent with the small plural cystic lesion shown by GSUS. Spectral analysis also confirmed arterial and venous flow. CT scans showed that the mass had lowdensity relative to the normal spleen and MRI showed that the mass was isodense, relative to the normal spleen. Therefore, CT and MRI are not useful for the diagnosis of splenic hamartoma. Ultrasonography can be used to diagnose splenic hamartoma without administration of a contrast matedal and therefore is an indispensable method for the diagnosis of splenic hamartoma.

肝癌局部消融治疗规范的专家共识

局部消融治疗是在影像技术的引导下对肿瘤靶向定位,用物理或化学的方法杀死肿瘤细胞;影像引导技术包括超声、CT和MRI;治疗途径有经皮、经腹腔镜手术和经开腹手术三种.局部消融治疗的特点：一是直接作用于肿瘤,具有高效快速的优势;二是治疗范围局限于肿瘤及其周围组织,对机体影响小,可以反复应用.局部消融治疗在过去20年左右发展迅速,已经成为继手术切除、介入治疗后的第三大肝癌治疗手段,而且由于其疗效确切,特别是在小肝癌的治疗方面,射频消融治疗的疗效与手术切除相近,因此,被认为是小肝癌的根治性治疗手段之一.