磁共振成像导引经皮活检15例

目的：评价磁共振成像导引经皮活检的临床应用。方法：应用０５Ｔ磁共振成像扫描机作１５例经皮活检，其中１２例为胸部活检，２例为肝活检，１例为肾活检。用１９Ｇ抽吸穿刺针作活检。采用快速梯度回波和快速自旋回波技术扫描。结果：磁共振成像导引经皮活检刺中率为１００％，活检正确率８６７％。所有病例经皮活检无并发症出现。结论：磁共振成像导引经皮活检是一种安全、正确有效的诊断和鉴别诊断的方法。

Surgical Experience in the Management of 125 Patients with Thyroid Masses in Kashmir

Results of surgical treatment in 125 patients with thyroid masses who attended to a Unit of the Department of ENT, Head and Neck Surgery of Govt. Medical College associated SMHS Hospital Srinagar in the first decade of this century are presented. Age of the patients ranged from 17 to 68 years peaking in the fourth decade of life (Figure 1 and Figure 2). Near 85% of the patients with thyroid masses were female and most of the cases (76%) euthyroid at the time of presentation. Depending upon the expertise of the pathologist, the FNA cytology has a good role in the preoperative diagnosis of thyroid masses especially the malignant types (Figure 3 and Figure 4). The specificity of FNA cytology in detecting malignant thyroid tumors in this study was 100% and the sensitivity was 73.08%. The overall diagnostic accuracy was 83.20%. 45.60% of the thyroid masses proved on excision biopsy to be malignant of which papillary carcinoma continued to be the most common malignant thyroid tumor followed by the medullary, the follicular and the undifferentiated types. Radionuclide scanning gave equivocal results in distinguishing between the benign and the malignant thyroid nodules in this study, but it was useful in evaluating indeterminate cases of FNA cytology. Magnetic resonance imaging of neck was used as an adjunctive imaging modality in assessing the extent of the primary malignant thyroid lesion, its direct extra-thyroidal spread and regional nodal metastases (Figure 5 and Figure 6). Different surgical techniques utilized in dealing with the thyroid masses included partial thyroidectomies and total thyroidectomy with or without modified neck dissection and the results are discussed.

鼻咽镜和MRI及超声波引导穿刺检查在头颈部原发肿瘤诊断中的联合应用

目的 探讨多种检查方法在头颈部原发肿瘤诊断中的应用价值.方法 回顾性分析196例未确诊的头颈部肿物初诊患者,所有患者在完成详细的病史询问、仔细的临床体格检查及影像学检查后,对疑为肿瘤部位行活体组织病理检查（简称活检）或穿刺细胞学检查.结果 196例患者中除4例口咽周围肿块的患者行直接穿刺外,余192例均在超声波引导下穿刺.171例（87.2％）患者检出肿瘤细胞：其中通过原发肿瘤部位（鼻咽部）活检确诊31例,通过穿刺细胞学检查确诊106例,通过原发肿瘤部位（鼻咽部）活检和穿刺细胞学检查均确诊34例.140例（71.4％）穿刺细胞学检查见肿瘤细胞,咽后淋巴结、咽旁间隙和口咽周围肿块的肿瘤细胞检出率分别为71.1％ （123/173）,66.7％ （10/15）,87.5％ （7/8）.在获取病理细胞学诊断过程中无一例发生严重并发症.结论 间接鼻咽镜活检、MRI及超声波引导穿刺细胞学检查的相互结合,对肿瘤患者的早期诊断、早期治疗具有重要的临床价值.

1.5 T MR快速扫描在腹部疾病穿刺活检中的临床应用

目的探讨高场封闭式MR导向穿刺活检对诊断腹部不同疾病的临床应用价值。方法搜集高场MR导向穿刺活检的45例患者,其中肝脏8例,胰腺8例,肾脏9例,腹膜后10例,盆腔10例,对其穿刺活检结果与术后组织病理学诊断结果以及临床随访结果进行对照分析,并总结MR导向较其他导向设备活检的优势。结果45例患者在高场MR引导下顺利完成了穿刺,穿刺均一次性成功,手术均在局部麻醉下完成,术中患者耐受性良好,MR引导的穿刺活检均获得了足够的标本,且没有发生明显的并发症。穿刺结果与术后病理比较,总符合率为93.3%(42/45)。结论高场MR无电离辐射,具有较高的软组织分辨率,可任意方位断层成像,多个角度引导穿刺,故对于诊断腹部疾病简单、安全,取材准确可靠,准确率高。

高场封闭式MR导向穿刺活检的应用初探

目的探讨高场MR导向穿刺活检的临床应用价值。方法回顾性分析高场MR导向穿刺活检的62例患者,对穿刺针的使用、穿刺时间、穿刺部位等方面进行经验总结,并对其穿刺活检结果与术后组织病理学诊断结果以及临床随访结果进行对照分析。结果 62例患者活检中,52例(83.9%)在20 min内完成;38例(61.3%)使用非兼容性活检针。穿刺活检的部位包括胸部42例,腹部12例,骨关节8例。62例患者成功获得足够组织标本。最终确诊55例,7例不能确诊,穿刺活检患者总符合率为88.7%(55/62)。所有术者并发症中,出现针道及病灶周围出血8例(12.9%)。在42例肺部穿刺活检患者中,气胸3例(7.1%),其中1例行微创性胸腔闭式引流,术后少量咯血5例(11.9%),。未发现致命性并发症。结论高场MR导向活检是一种安全、方便、准确的方法,值得推广与应用。