MR诊断（通用10篇）
MR诊断 篇1
骨巨细胞瘤又称破骨细胞瘤。为常见骨肿瘤在良性骨肿瘤中居第二位。好发于长管状骨骨端。现将我科两年来MR检查并经手术病理证实的11例骨巨细胞瘤做一回顾性分析, 以其进一步提高诊断水平。
1 材料与方法
男7例, 女4例。年龄16~48岁, 平均27岁。采用GEl.OT超导型扫描仪, 四肢扫描用体线圈, 平卧解剖位, FOV34~48cm, 取图时视病变部位需要再放大, 以示双侧肢体的可对比性;腰椎扫描用腰椎线圈, 自旋回波序列, 失状位T1MI, 快速自旋回波序列矢状位、冠状位、轴位T2WI, 层厚5mm, 0~0.6mm间隔扫描, 10例病人增强扫描, 肘静脉注射GD-DTPAO.1mmol/kg。
2 结果
11例骨巨细胞瘤发生于股骨远端8例, 胚骨上段2例, 腰椎1例。所有病例均为单发病灶, 直径5.6-10.8cm平均8cm左右, 7例良性病灶境界清晰。多有低信号包膜围绕, 病灶表现多结节状长Tl长T2信号影, 夹杂较少的不规则等、低信号影;4例恶性骨巨细胞瘤包膜不完整, 周围软组织受侵, 肿块多表现分叶状或多结节状, 在长骨骨端病灶表现偏心性、达关节软骨下骨, T1WI呈等、低信号影, T2WI呈等、高信号的囊实性混杂信号影, 坏死出血区多见, 范围不定, 囊性成分, 相互融合、大小不等, 囊壁薄, 囊液为长Tl长T2信号影, 信号欠均匀, 有出血时表现液-液平面, 上层为水样信号, 下层为等T1等T2信号影。囊壁和实性部分可轻、中度强化, 囊性部分无强化。骨质破坏似虫蚀状, 见分布不规则的粗大骨脊突入肿块内, 骨性分隔显示不清。
3讨论
骨巨细胞瘤又称为破骨细胞瘤、髓样瘤、出血性骨髓炎, 恶性者称为恶性巨细胞瘤。本病较常见。在良性骨肿瘤中居第2位, 临床上, 巨细胞瘤男女发病相仿, 75%以上发生于20~40岁成年人, 20岁以下和40以上少见, 10岁以下罕见, 肿瘤早期局限于骨内, 随肿瘤增大部分肿瘤可突破骨皮质发展到骨外, 80%的病变可侵犯骨性关节面。骨巨细胞瘤多为单发, 偶可多发10~15%可以恶变, 组织学上虽为良性, 但生物学特征具有局部侵袭性, 手术治疗的复发率达10~60%可发生肺和淋巴结的转移。
病理上根据单核瘤细胞和多核巨细胞的组织学特点, 可分为3 级:良性、组织活跃、恶性。但是组织学上的分级常不完全代表骨巨细胞瘤的生物学性质。
MRI可行不同加权和多种方位扫描, 有利于病变的观察。但是由于骨皮质及病灶内骨性分隔在TlWI、T2WI表现无信号影像, 诊断时不能一味强调MRI的重要性, 还需要结合X线和CT片, 综合多种影像信息, 才能提高诊断率, 很好的为临床服务。
本病呈囊状膨胀性不改变, 应与以下疾病鉴别: (1) 骨囊肿:发病年龄较小, 多在骨骺愈合之前。向周围膨胀性发展不如骨巨细胞明显, 囊长轴常平行于骨干。囊内少有典型泡沫状影。一般无临床症状常因病理骨折而就诊, 巨细胞瘤则常以疼痛为主要症状。 (2) 良性成骨细胞瘤发病年龄小, 多发生于骨骺愈合前, 肿瘤内常有钙化斑。 (3) 软骨瘤好发生于短管状骨。发生于长管状骨而无钙化者, 颇视巨细胞瘤, 鉴别困难。 (4) 溶骨性成骨肉瘤:二者发病部位不同, 一般骨肉瘤较少出骨膨胀, 仅为溶骨性破坏。也多无残留骨壳可见。
摘要：目的分析骨巨细胞瘤的MR表现及诊断价值。方法回顾性分析11例骨巨细胞瘤的MR表现, 全部病例经手术病理证实。结果骨巨细胞瘤发生于股骨远端8例, 胫骨上端2例, 腰椎1例。MR典型表现为多囊融合的囊实性占位。结论MR对骨巨细胞瘤有较高的诊断价值。
关键词：骨骼,骨巨细胞瘤,磁共振成像
MR诊断 篇2
Everyday I went to the pawnshop to make sure the guitar was still there. The owner looked like a vaguely degenerate antique dealer in a movie. He wore a vest.
Every morning I got up at five and made the half-hour walk to the temp service, a trailer set up in a gravel lot. The place looked like a used car dealership without any cars and the owner was a big thick guy named Purcell who was quick to let you know he was retired Navy. The whole set up was pretty shady. Pay was always in cash and you had to get there before dawn to get a job. Except for me the crowd was all Mexican, illegals I’m pretty sure. They stayed to themselves, so I’d stand alone while we waited for Purcell to show up and smoke and drink coffee and think about how I was going to smash the guitar over a low brick wall once I got it back. My father gave it to me when I was eighteen. One afternoon, 1979, when my high school let out he was in the parking lot sitting on the hood of an old Lincoln he’d parked sideways across five spaces. You couldn’t miss him any way you looked. He was dressed in the same outfit Hank Williams was buried in. I hadn’t heard from him for seven years.
I told my friends I was supposed to meet with a teacher and went back inside and hid in the bathroom—I figured if I waited long enough he’d leave. The janitor ran me out of there so I wouldn’t interfere with his drinking. I killed some time walking the halls, then fooling at my locker. Finally the assistant principal who was locking up made me leave.
He was still outside. It was deserted now. He smiled and waved.
“Thought that was you I saw,” he said. “Figured I’d wait.”
I nodded. I didn’t know what to say.
“I hear you’re getting ready to be a high school graduate,” he said.
I nodded again.
“That’s real good.” He cocked his head, looking at me and smiling. “Your grandma don’t mind your hair being that long?”
“She hasn’t said anything.”
“First time I came in with a duck tail she chased me with the scissors.” He took a pack of cigarettes from his inside coat pocket and rapped it on his knee and a single cigarette jumped halfway out, and if he hadn’t been my father that would’ve been cool as hell.
He wanted to go get a hamburger. The inside of the Lincoln smelled like a strip club at six AM. The radio was missing. I reminded him how to get to McKenna’s, a place that had curb service. After we got our drinks he poured part of his Coke out the window and filled it back up from a pint of bourbon he pulled from under the seat. He offered me the bottle but I shook my head.
“Don’t drink?” he asked.
I shrugged.
He nodded. “Don’t seem to talk, either.”
After seven years that crawled all over me. I turned away and stared out my window.
“Ah son,” he said, “I know, I know. I . . . well,” and then I heard his cup slosh. I was looking out at a station wagon where a woman was handing around soft serve cones to her kids. A little boy in the backseat was looking back at me.
“Your grandma tells me you’re playing now,” he said.
“Yeah.” I still didn’t look at him.
“What’re you doing?”
I was in a bad cover band that played sock hops and dances at country clubs. I’d been listening to Earl Klugh and Wes Montgomery, too, trying some of that out.
“Not much,” I said.
The boy pulled his nose up with his thumb and grinned. He had braces. His mother had on a green scarf.
“I guess you don’t go in for Bob Wills and such,” he said.
“No,” I said.
“Not many do anymore,” he said. “That’s why this car’s such a piece of shit.”
Then neither of us said anything. A long minute passed, then another. The little boy kept making faces between licks of his cone. Then the mother caught him. After a glance at me, she jerked him around by the collar.
I heard him splash bourbon into his cup again.
Then the car hop brought the tray with the food and hung it on his window and I felt like I could finally turn around.
“Anything else?” she asked. She was bleach blond and pudgy—I recognized her from school a couple years back but didn’t know her. She had on white jeans and a pink shirt with the tails tied into a knot below her breasts. When you looked at her all you saw was stomach.
“You all got any ice cream left in there?” he said.
“Sure,” she said.
“Then get you one and charge it on my ticket. Girl who looks sweet as cake needs some ice cream to go with her.”
She giggled.
“Or maybe you want a drink of this special Co’-Cola instead?” he asked.
She leered, looked left and then right. “Sure,” she said. He handed her the cup and she ducked her head and took a drink.
“When they let you off here?” he said.
“Not soon enough,” she said. “The horse’s ass that runs the place keeps us here half the night.”
“Well, we’re big boys,” he said. “We get to stay up late.”
I opened my door and got out. He looked around. “Hey, where you going?”
I shut the door. My eyes met the girl’s over the roof of the car, then I ducked my head in the window. “I’ve got to go,” I said. “I’ll see you,” and I started away from the car.
“Hey!” he yelled.
But I didn’t turn around. He yelled a couple more times but I kept going. When I was far enough away I looked back. The girl was still standing at the Lincoln.
I was hoping he’d be waiting outside the house when I got home. He wasn’t.
A week later a notice came from Martin’s Drugs saying I had a Trailways package. It was a cardboard box wrapped in brown butcher’s paper and tied with string, light to carry but about the size of Shakespeare’s coffin. When I got it home and opened it I found a new calfskin guitar case packed in newspaper and inside that was the Hummingbird. The guitar was in good shape, but the words Mr Good were scratched in tall letters on the back of the body. In the bottom of the case was a note:
Son
I wont you to have this a fine instrumint i bought it new in 1965. Maybe somday we can play together i can teech you some Bob wills. The only thing about it is i got no idee how the writing got on the back i woke up in a motel in oddessa tex 8 yeer ago and it was almost nite and their it was this is stil a good guitar.
Dad
I hadn’t heard from him since. If he was alive he’d be sixty-three, and the older I got the more I wished I could see him. We’d have something to talk about now that I’d made every mistake he had.
Once I was living with a psychologist and she started ribbing me after she saw how I took such good care of the Gibson. Better take Mr. Good to soccer practice, she’d say, or Mr. Good says he wants to order Chinese. If she hadn’t been so good-looking I wouldn’t have put up with her—she’d come home after counseling all day and make astrology charts on her clients and smoke pot. She finally drank enough coffee one morning to think to ask how I got the guitar. I told her the story about my dad.
“That’s cute,” she said.
I just stared at her.
“What is it?” she said.
I shook my head.
“No, what is it?” she asked, almost hysterical.
“Nothing,” I said. “Just looking at your hair.”
* * *
It was cold. I was in Purcell’s lot, smoking, drinking coffee, half-listening to the Spanish talk all around me. I had seven hundred dollars in my socks—after getting paid today I’d have enough to get the Gibson back, and after Monday and Tuesday I’d have enough to go back to Dallas—and then suddenly an angry shout came from behind the trailer, then another. The lot quickly fell silent. Then the Spanish started up again and most of the men walked over and looked behind the trailer but as soon they did they started leaving, some running, and in about two minutes the place was deserted except for me.
I kept watching the trailer, about fifteen yards away. Nothing. I couldn’t hear anything either but the hum of the arc lights. I didn’t know what to do. I was kind of scared, but I had to try to work that day, no matter what, so I decided to stay where I was and wait for Purcell to show up. I started to light another cigarette, then footsteps sounded on the gravel and a man staggered around the side of the trailer. He was clutching his side and when he saw me he said something in Spanish. He was big, at least three hundred pounds, and looked like a bear coming toward me. Then he just stopped and stood there. I could hear his breathing. He sank to his knees like a camel sitting down and fell over.
For about a hundred and fifty dollars I would’ve left. But there weren’t any philanthropists in the vicinity. I went over to him. He had rolled onto his back and when he saw me standing over him he started talking in Spanish. He had a rip in the side of his thin jacket and there were dark stains around it. I took off my denim coat and kneeled down, and when he saw what I was doing he moved his hands and let me use the coat as a compress. Some warm blood soaked into the denim, but not much. He seemed more panicked than anything. He just kept on jabbering.
Then I heard other voices. Two Mexicans were standing a few yards away, at the edge of the light.
“Habla ingles?” I called out.
“No much, no much,” the taller of the two said.
I got him to hold the jacket in place and right away he and the injured man started talking, arguing it sounded like. I ran the three blocks to the store where I made a point of buying my coffee every morning because I liked the way the clerk looked. I asked her to call 911.
“Sorry, the phone’s not public,” she said.
“Are you kidding?” I said.
She shook her head. “That’s the rule.”
“But a guy’s been knifed or something.”
She hesitated, then looked at her watch, a pink thing the size of a coaster. “My manager’s due here any minute now and he says you can’t let the phone thing get started or people’ll be asking to use it all the time.” She looked over my shoulder. “Could you move, please?”
I stepped over but stayed at the counter and an old black guy in a baseball cap moved up and gave her numbers for a lottery ticket.
“So you’re not going to call?” I said.
“No,” she said.
I went outside and picked up the receiver on the pay phone on the side of the building and put it to my ear even though I knew it was dead. I asked two people going into the store if they had cell phones—both shook their heads, though one had his in a holster on his belt. Then I ran back to the temp service because there wasn’t another payphone nearby and I didn’t know what else to do.
Purcell was there. He had his headlights directed onto the scene and he stood in their beams next to the injured man and the two Mexicans who were squatting over him. The shorter one, who I could now see was an older man, was crying.
“I can’t have this kind of helling going on here,” Purcell was saying.
“Mr. Purcell,” I said.
He jerked his head around and squinted into the headlights. “Hey, who’s there?” He recognized me. “So did you see what happened here?”
“No. I just tried to call an ambulance but I couldn’t find a phone.”
He waved like he was shooing a fly. “I checked him, he doesn’t need one. It’d be a waste of the taxpayers’ money. All he’s got is a little lard sliced off.” Then he put his hands on his hips and stared down at the man. He had on a white short sleeve shirt and a dark tie; I had never seen him in a coat, no matter the temperature. “Hey,” he said loudly and all three Mexicans looked up at him and he spoke to them in broken Spanish. The tall one holding my jacket answered.
According to Purcell’s translation: the two Mexicans who had stayed were from the same town in Mexico as the injured man, and the older one was his uncle or cousin or something. Two days ago the tall Mexican had heard that the injured man—who looked at least thirty—had gotten someone’s teenage daughter pregnant. The tall Mexican wasn’t sure who the girl was, but he’d heard there’d been a blow up with her father.
“I didn’t think there was anybody left who cared about that,” Purcell said. He took out a pack of Juicy Fruit and put a stick in his mouth. He stared down at the man, his face a brown study. I crossed my arms and hugged myself. I was freezing.
“This has implications,” Purcell said.
“We should probably call an ambulance,” I said.
“We might do that,” he said. “But we’ve got to move him off this property first.”
I didn’t say anything, but Purcell jerked his head around like I had.
“Just because this pussel-gut decides to tap some Mexican cheerleader, I should have to pay double and triple on my liability insurance? And as for the police,” he said, “what’d you think: Columbo’s gonna show up here at dawn?” He pulled a wallet-on-a-chain out of his back pocket and started speaking Spanish again. When he finished all three Mexicans nodded. The old one wiped his eyes with the back of his hand. Then Purcell took out two fifty-dollar bills and handed one to each of the two squatting men. They both spoke to the injured man, patted him on the shoulder, then stood up and left. Purcell bent over the injured man and slipped two bills into his pants pocket. He spoke to him and the man answered. Purcell replied, his voice angry. The man shook his head back and forth on the ground. Purcell started cursing in English. He turned to me, “Sack of shit says he can’t get up.”
“Huh,” I said.
Purcell gave the man a little kick in the hip and said something in Spanish. Then he grabbed the man’s arm and tried to haul him up. He didn’t budge. He was dead weight. Purcell dropped his arm. “All right,” he said, “you get his shoulders and I’ll get his legs,” and he stepped around the man to his feet. I didn’t move.
He waved. “Come on, let’s go.”
“That’s my coat there,” I pointed.
“Yeah? So?” he said.
“It’s ruined,” I said.
His expression deadened as he figured it out, which took about two seconds. He shook his head and cursed again. He took out his wallet and handed over a fifty.
“I need a hundred more,” I said.
If either of us had been smoking the whole block would’ve exploded. “Listen,” he said, “I wouldn’t be paying anybody anything if I could speak enough Spanish to make these tacos understand if they don’t do what I say I’ll tell the police whatever I want. But even though you’re a goddamn briar you understand me, don’t you?”
“The police might hassle me on your sayso,” I said, “but that’s about all they could do. And think about it. If I do end up talking to them, I’m such a briar I might let it slip how you run a straight cash business.”
He turned his back to me and started muttering. He stayed that way at least a half-minute. Then he turned back around holding out five twenties. His mouth was very tight.
Lifting the man was like picking up one end of a rowboat full of water, if you’ve ever done that. We carried him ten yards, rested, then went the last ten yards to the street. Purcell dropped the man’s feet and stayed bent over with his hands on his knees, huffing and puffing. He glanced up at me, then unhooked his key ring from his belt and tossed it and it hit the sidewalk right in front of me and I had to do a skip to keep it from hitting my feet. “Move my car up to the trailer,” he said.
I looked at the keys, then at him. “What?” I said.
“Do it, or I’ll tell the cops you robbed me.” He took his cell phone out of his back pocket.
“Why do you want me to do it?” I said.
“Just because I do,” he said.
“Forget you,” I said.
“All right,” he said and punched a button on the phone, and that’s when I thought of the seven hundred dollars in my socks and how great it would look on a guy without a coat.
The car was a Cadillac in name only. The last time it looked good Eddie Murphy was funny. I slid under the wheel, but didn’t close the door so the rooflight would stay on and I could find things. The seat was too far up for me to fit my feet to the pedals, so I reached down to find the lever and my hand hit a bottle under the seat. It was a half-pint of Jack Daniels and all that was empty was the neck. I unscrewed the cap, bent over like I’d dropped the keys and took a drink, then sat up again. The glove box was missing its door, a cigar with an inch of dead ash was in the ashtray, a single porno playing card was in the passenger seat, a woman who looked like she was waiting for surgery to begin. I turned the card over: seven of clubs. I bent over and took another drink. I was thinking of the last time I saw my father—one of these old boats always did that.
I discovered the seat wouldn’t move, so I managed to get situated with my legs splayed out on either side of the steering wheel. I shut the door, then pulled the car up in front of the trailer and cut the engine and the lights. I stuck the half-pint down the front of my pants. Then I looked in the rearview mirror: Purcell was still at the curb, under a streetlight, standing over the injured man talking and gesturing. It looked like he was haranguing a corpse.
I leaned over to get at my pants pocket and took out the hundred and fifty and put it on the dash behind the steering wheel. I just couldn’t abide the idea of having to think of Purcell everytime I played the Gibson. I would’ve rather seen it in the hands of Campfire Girls.
The pawn shop opened a half-hour before the liquor stores. I’d been waiting in a coffee shop across the street. I had the Gibson’s empty calfskin case and a Epiphone in its case. I was going to pawn the Epi which would give me the last fifty I needed to get the Gibson back, plus another sixty or seventy. That much would get me to Shreveport, and I figured I knew enough people in Dallas I could find someone who’d drive out and get me.
I went in the pawn shop, the bell ringing over my head, and right away I noticed the Gibson wasn’t on its stand in the line of guitars that sat on a high shelf in the back. Holding the two cases I suddenly felt like an idiot in a Norman Rockwell painting. The empty one felt light enough to throw through the display window.
The owner was still wearing his pea coat and was at the back of the long shotgun room behind a line of jewelry cases to my left. He came up front.
“It’s gone,” he said. “Girl bought it last night not long after you came in.”
I set down the guitar cases.
“She paid cash so I don’t know who she was,” he said.
I asked him what she looked like.
“I wouldn’t kick her out of bed for eating crackers,” he said.
I kept looking at him. I couldn’t believe he had said that. Then he gave a police blotter description of the girl—young, long brown hair, skinny, pale, wearing jeans and a green jacket, said he wouldn’t call her pretty exactly. I asked him, if she came back in, to give her my name and the place where I roomed and to tell her I’d pay to get the Gibson back. I said I’d pay him, too, for doing that.
“Once I tell her, you got no reason to pay me,” he said.
“That’s true,” I said.
“A twenty ought to take care of it,” he said.
I felt so beat I didn’t argue. I squatted down and lifted my pants leg to get at my sock. The bell rang and a guy in a dirty overcoat and came in and set down a kit bag and started pulling out barber tools. I stood up and the owner took my twenty. I picked up my guitar cases and left.
Walking down the street, freezing, I realized I could take the money I had and buy a coat and a bus ticket and be back in Dallas by midnight or I could stay in Cincinnati and buy a coat and try to find the Gibson. I thought about it three seconds and decided to stay.
I can play guitar pretty well. And I’ve spent twenty years worth of afternoons in libraries killing time before gigs so I know the difference between Augustine of Hippo and all the other Augustines and I know that even if we do come up with a unified field theory it isn’t going to change a damn thing. But other than that, I wouldn’t take my own advice about anything.
MR诊断 篇3
【关键词】女性盆腔恶性肿瘤；CT和MR诊断；评价
下面本文选取我院2013年03月至2014年03月收治的20例女性盆腔恶性肿瘤患者，患者全部进行CT检测，之后患者还做了MR诊断检测，对患者的CT和MR诊断结果进行评价，现总结如下。
1 资料与方法
1.1 临床资料
本次试验选用的20例患者均为2013年3月至2014年3月在我院进行治疗的女性盆腔恶性肿瘤患者。其中患者年龄31到80岁之间，平均年龄58.31±5.54岁。患者的主要临床症状表现为阴道出现不规则出血情况、腹痛以及盆腔肿块等[ 1 ]。
1.2 诊断方法
本次试验的20例女性盆腔恶性肿瘤患者，患者全部进行CT检测，主要就是患者进行GE8层螺旋CT全盆腔平扫以及CT增强扫描诊断，之后患者还做了MR诊断检测，也就是磁共振扫描检测，扫描序列为S：T2WI T1WI，IRFSE，C：T2WI，IRFSE T：T2WI[2]。对患者的CT和MR诊断结果进行评价。
2 结果
2.1 本次试验的20例女性盆腔恶性肿瘤患者的CT和MR诊断结果分析
通过对本次试验的20例女性盆腔恶性肿瘤患者的CT和MR诊断结果进行分析，我们发现20例女性盆腔恶性肿瘤患者中，其中9例患者是宫颈癌，5例患者是子宫内膜癌，4例患者是卵巢原发恶性肿瘤，2例患者是卵巢转移瘤。
2.2 影像学表现
9例患者是宫颈癌首次诊断，其中4例患者为内生型病例，MR诊断表现为宫颈体积出现不规则的增大，同时观察到了圆形团状的影像，信号不均匀，主要是稍长的T2、T1信号为主要信号分布[3]。剩下的5例患者首次动态增强扫描诊断显示患者的早期肿瘤强化比较明显，信号高于正常的宫颈组织，之后信号开始下降，增强晚期的信号低于正常宫颈组织的信号检测结果。5例患者是子宫内膜癌，经过CT检测以后，发现患者的子宫体积扩大，同时3例患者宫腔内形成了积液的影像，经过MR诊断后，发现患者的子宫内膜出席那了不规则的变厚，同时动脉期轻度得到强化，静脉期强化更加的明显，子宫侧壁受累。MR诊断表现为T1WI为高信号，T2WI的信号和肌层组织比较相似，同时3例患者宫腔内形成了积液的影像。4例患者是卵巢原发恶性肿瘤，其中2例患者出现了大网膜扁平状或者是圆形团状的软组织肿块，密度不均匀，边界不规则。同时在CT诊断检测结果中显示患者的盆腔肠周围形成了多个钙化的灶区，表明发生了钙化性转移。剩下的2例患者显示外淋巴结增大，同时肝脏内部发生了多发性灶区转移，表面发生了淋巴结转移。2例患者是卵巢转移瘤，在CT诊断检测结果中显示患者出现了密度不均的肿块影像，同时内部发现血管影像，大量腹水影像形成[4]。
3 讨论
女性宫颈癌的诊断过程中，主要就是依据宫颈的涂片和镜检结果来对其进行检查和诊断。本文通过对患者进行CT和MR诊断，发现其检测结果各有优势。
本文选取我院2013年3月至2014年3月收治的20例女性盆腔恶性肿瘤患者，患者全部进行CT检测，之后患者还做了MR诊断检测，对患者的CT和MR诊断结果进行评价，结果表明20例女性盆腔恶性肿瘤患者中，其中9例患者是宫颈癌，5例患者是子宫内膜癌，4例患者是卵巢原发恶性肿瘤，2例患者是卵巢转移瘤。在卵巢原发恶性肿瘤患者的诊断过程中，其中2例患者出现了大网膜扁平状或者是圆形团状的软组织肿块，密度不均匀，边界不规则。同时在CT诊断检测结果中显示患者的盆腔肠周围形成了多个钙化的灶区，表明发生了钙化性转移。剩下的2例患者显示外淋巴结增大，同时肝脏内部发生了多发性灶区转移，表面发生了淋巴结转移。
在其他类肿瘤的诊断过程中，CT和MR诊断都表现出了各自的诊断优势。这说明MR诊断对于女性盆腔恶性肿瘤患者的临床诊断检测效果非常好，在肿瘤的定位、定性诊断过程中优于CT检测，但是CT检测在对女性盆腔恶性肿瘤化作的钙化性转移方面又存在着比较明显的优势，因此临床使用CT和MR诊断肿瘤的过程中，需要根据其用途来选择适合的诊断方法。
参考文献
[1]张宝国.女性盆腔恶性肿瘤的CT和MR诊断和评价[J].中国伤残医学，2014，22（3）：178-179.
[2]鲍海龙，赵希鹏，李伟霞，栗海龙.女性盆腔结核与盆腔恶性肿瘤的CT鉴别诊断[J].青海医学院学报，2010，31（3）：208-211.
[3]唐建华，张开华，周梅玲，阎伟伟，蒋玉莺.多发性脾肿瘤的CT和MR诊断[J].实用全科医学，2008，6（4）：415-417.
颅脑肿瘤的MR诊断及应用价值 篇4
1 材料与方法
我院自MR投入使用以来共收集颅内肿瘤57例, 其中, 男性24例, 女性33例, 年龄19~87岁, 平均年龄48岁。全部病例经我院或外院手术病理证实, 资料结果真实可靠。临床表现主要取决于肿瘤的部位, 较常见表现多为头疼, 抽风及颅内压增高表现。MR采用安科公司OPFN MARK3000, 10.3T开放式永磁型磁共振成像系统, 成像距256×256, 常规行横断面T1, T2及FLATR。矢状冠状T1加权。层厚为5~10mm部分病例行GD-DTRA增强, 作横断矢状、冠状T1加权扫描。
2 结果
57例患者中, 胶质瘤15例, 脑膜瘤8例, 垂体瘤8例, 生殖细胞瘤2例, 血管母细胞瘤2例, 颅咽管瘤1例, 畸胎瘤1例, 转移瘤20例。 (1) 胶质瘤15例, 其中星形细胞瘤12例, 少枝胶质细胞瘤3例, 病变位于额叶3例, 颞叶7例, 顶叶5例, 信号T1多为低, 少数为稍高或杂信号, T2多数为高或杂信号, 绝大多数瘤周有水肿带, 有程度不一的占位效应, 增强扫描见不同程度的强化。 (2) 脑膜瘤8例, 脑镰旁2例, 顶部2例, 枕部2例, 额部1例, 侧裂1例。T1为等或稍低信号, T2为稍高信号。多呈球形, 边缘清, 信号较均匀, 明显均匀性强化。 (3) 垂体瘤8例, 女性7例, 男性1例, 2例表现为肢端肥大症, 3例表现为高泌乳素血症, 1例有视力改变。病变于冠状位、矢状位显示清楚, 多呈T1T2等信号, 内有少的囊变区, 呈长T1长T2信号, 有明显的增强。 (4) 生殖细胞瘤2例, 均为青年男性, 一例为松果体区和鞍区两部位同时发病, , 另1例病变仅位于鞍区, 临床表现均为尿崩。 (5) 血管细胞瘤2例, 1例位于小脑半球, 1例位于延髓。表现为较大的囊性病变和较小的壁结节, 增强扫描见壁结节明显强化, 囊内容物无强化。 (6) 颅咽管瘤1例, 位于鞍上区, 成囊实性肿块, 信号杂囊性部分为长T1长T2实性部分为等信号。 (7) 转移瘤20例, 发病平均偏大, 42~80岁。多发15例, 单发5例, 肺肿瘤转移12例, 食道癌转移2例, 上颌窦癌转移1例。单发者病灶较大, 3~5cm, 多发者病灶较小, 形态多呈境界清, 类圆形实性或者单环囊状影, 位于小脑者有囊内物质沉积。形成液性平面。
3 讨论
颅内肿瘤是神经外科中最常见的疾病之一, 分原发性和继发性两大类。原发性颅内肿瘤可发生于脑组织、脑膜、颅神经、垂体、血管残余胚胎组织等。常见的有神经胶质瘤、脑膜瘤、神经鞘瘤、松果体区肿瘤、鞍区肿瘤、血管内细胞瘤、生殖细胞瘤等。继发性肿瘤指身体其他部位的恶性肿瘤转移至颅内形成转移瘤。
MR诊断颅内肿瘤依靠以下几个反面: (1) 部位。 (2) 形态。 (3) 信号特点。 (4) 周围水肿。 (5) 增强情况。确定肿瘤发生部位至关重要, 有些肿瘤具有特定的发病部位, 例如垂体瘤在脑垂体、, 颅咽管瘤好发鞍区, 生殖细胞瘤位于中线结构松果体及鞍区听神经瘤好发于桥小脑角区, 脑膜瘤好发于大脑凸面, 脑镰旁贴近硬脑膜处等。CT对于脑顶部、底部、鞍区、低位脑干显示较差, 而MR可多成像。利用冠、矢状位无观察死角, 对这些部位病变显示非常清晰, 例如:MR对于鞍区肿瘤显示具有非常大的优势。颅内肿瘤多数为类圆形即各个方向经线大致相同, 良性肿瘤往往边缘光整, 恶性肿瘤边缘不清楚, 不规则常提示肿瘤对周围组织侵润。多数肿瘤由于细胞内或细胞外自由水增多, 呈长T1长T2信号, MR信号变化多样复杂, 一般不作为定性依据。信号有的异性的有黑色素瘤, 为短T1短T2信号。另外, 像颅咽管瘤、脂肪瘤、畸胎瘤、错构瘤等因含脂肪T1可呈高信号。利用FLAIR序列, MR可清晰区分瘤体及周围水肿。MR显示水肿较CT敏感, 瘤周水肿是血管源性水肿, 反映血脑屏障破坏, 水肿成度反映血脑屏障破坏程度, 由此, 水肿程度与恶性程度呈正相关。对于脑内肿瘤强化程度反映血脑屏障破坏程度即恶性程度越高强化越显著, 脑外肿瘤由于无血脑屏障, 无论良恶性都强化明显。
MR的软组织分辨率较高, 可显示垂体脑干等部位的细微病变。MR的成像除传统的轴位外还有冠矢状位成像, 消除了观察死角, 对于垂体小脑幕区病变观察明显强于CT。对于脑内外, 脑室内外病变区别变得简单准确。可以说MR对于病变的定位是相当准确的。由于血管有流空现象, 在不用造影剂的情况下可观察肿瘤的血供情况, 借助于增强扫描有利于病变的定性。总之, MR具有多方面的优点。被认为是诊断颅内肿瘤的最佳检查方式。
英语老师——mr李 篇5
他教我们英语，也是我们的班主任，他的啰嗦，谁都受不了他的啰嗦，谁都很无奈，他的课简直就像是班会课，扯上扯下，明明是英语课却成了一节啰嗦了，天呐，该烦死了，英语书什么时候才会翻开第一页，什么时候才能减少他的啰嗦，什么时候他才能转入正题上英语课……
他以为我们都还只是一群无知的三岁小孩，每天教我们一年级的道理，居然花了一个星期教我们写字母，这折磨，真的是命中注定啊，课程上的比乌龟走路还慢，这是什么人啊，我真的“刮目相看”了，“厉害厉害!”。当然，他的课挺搞笑的，我比较喜欢英语，所以我就一拍即合，可是我没想到，他竟然一直保持着那高傲冷慢的教课速度，每节课都说不会扯其他。
谁知道才刚刚说完，他随口就开始讲与课堂无关的，服了服了，我服了，他居然那么让我们出乎意料，我受不了了，不行，我不能这样听他讲课，不然我就等于空坐等时间呐，他的每节课，我都不想听，甚至不想看到他那“讨厌的脸”，看到他，我就想躲远点，假装看不见……
MR诊断 篇6
1 MRI诊断
介入治疗前需要准确显示胆道扩张程度及梗阻的部位, MR在这方面要优于超声和CT。同时, MR也是一种无创性的检查, 它能同时显示胆管情况及胆管周围实质脏器情况[2]。另外, MRCP技术的运用可以清晰显示三级胆管的全貌, 临床上对梗阻性黄疸的定位、定性诊断具有很高的价值。
1.1 常规MRI检查方法
MR检查前要求患者禁食4~6h, 检查前30min口服5%甘露醇水溶液约1000m L充盈胃肠道。检查所用的扫描程序有自旋回波 (SE) 、反转复原 (IR) 、相位对比 (PC) 、部分饱和 (PS) 、梯度回波 (GE) 以及化学位移 (CS) 等, 最常用的是SE程序。一般先作冠状面T1加权成像 (T1WI) , 定出横断面扫描的范围, 再作横断面T1WI和和T2加权成像 (T2WI) 。T1WI对软组织分辨率高, 能清楚地显示腹部的解剖结构及其毗邻关系和发现肝内病灶。T2WI尤其是长TR、多回波的SE程序主要用于定性诊断。对于临床高度怀疑有肝脏病变的病例可进一步行MRI增强扫描[3]。扫描范围从膈上1cm至肝脏下缘1cm, 以避免因呼吸运动导致肝脏上下移动而造成的遗漏。
1.2 MRCP技术
MRCP即磁共振胰胆管造影, 是一种非介入性胆胰管成像技术, 利用重T2加权使含水器管显影。当TR>3000ms, TE>150ms进行上腹部扫描时, 富有极高质子密度并处于静止状态的胆汗、胰液呈高信号, 而肝胰实质器官则因较低的质子密度 (较短T2弛豫) 而呈低信号, 形成黑色的背景而衬托出清晰的胆胰管结构, 2D SSFSE-MRCP是一种单次激发快速自旋回波技术, 采用单次激发采集、快速采集弛豫增强技术, 能在一次屏气2s完成扫描, 就用超长回波链 (200Ms左右) 能更好地显示胰胆管, 获得5mm薄层的连续图像, 形成良好的胆管树, 减少人为因素的干扰, 不会产生图像错位伪影, 可任意选择成像平面, 避免长时间屏气的痛苦等。3D MRCP彩用FRFSE (快速恢复自旋回波序列) T2WI, 单块薄层定位、呼吸门控下冠状面扫描, 然后行MIP、SSD重组图像。
MRCP具有无创性、能反复应用和无需对比剂等优点, 能较好地反映胆胰管解剖关系和病理变化, 图像质量接近ERCP;结合源图像和常规MRI图像可提供比CT、ERCP更多对诊断有价值的资料, 有助于制定合理的手术方案, 并且适用于不同病情的各类病例。MRCP检查不仅可显示梗阻的部位和梗阻的程度, 还可以显示梗阻周围的软组织的情况。胆肠吻合后、胃毕Ⅱ式吻合术后以及急性胰腺炎的患者均能行MRCP检查, 特别是在ERCP检查失败的病例, MRCP是最好的选择, 可以作为首选的替代方法。
MRCP的局限性在于空间分辨力的限制, 不能清楚显示胰管的分支, 对轻度狭窄及微小结石不能显示, 由于高信号的液体掩盖, 对胆总管末段与胰管汇合处分辨不清, 胆管狭窄长度往往因十二指肠降段不显影而不能判断。因此, 对3D源图像及MIP、SSD重组图像的观察十分重要[4]。
1.3 MRI表现特点
MRI检查发现病变主要是利用正常肝脏形态、大小变化、肝叶间的比例以及肝组织和病变组织间的信号差来确定。在恶性梗阻性黄疸中, 胆管癌是最常见的病因, 它是起源于肝内毛细胆管的上皮细胞, 根据其起源不同可以分为肝内胆管细胞癌和肝门部胆管细胞癌[5]。
1.3.1 肝内胆管细胞癌
北京大学深圳医院医学影像科 (518036)
临床上一般将肝内胆管细胞癌归类于肝癌, 肿瘤多发生在肝左叶, 也可合并有肝内胆管结石。在MRI上平扫T1WI常为低信号, T2WI常为略高信号, 且信号不均, 肿瘤边缘不清, 无包膜征象。增强扫描早期轻度至中度强化。其MRI表现特点为:多见于肝左叶, 信号较低的肿块, MRI上均呈边缘强化和延迟强化, 病灶远端的肝内胆管扩张, 常合并有肝内胆管结石。它与肝细胞癌 (HCC) 相比, 强化程度稍弱, 且通常表现为边缘强化。
1.3.2 肝门部胆管癌
指发生在左右肝管与肝总管汇合处2cm内的胆管癌, 是胆管癌中最常见的一种, 占胆管癌总发病率的40%~50%。正常左右肝管及上段肝总管的内径较小, 生长在肝门胆管的肿瘤易导致梗阻, 因此进行性加重的黄疸常常是肝门胆管癌患者的首发症状。根据Bismuth-Corlette分型分为4型:Ⅰ型肿瘤累及肝总管近段, 未侵犯汇合处;Ⅱ型肿瘤累及肝总管近段和汇合处, 但未侵犯左右肝管;Ⅲ型肿瘤累及肝总管近段和汇合处同时侵犯一侧肝内胆管, 可分2个亚型, Ⅲa型即肿瘤累及肝总管近段和汇合处同时侵犯右肝管;Ⅲb型为同时侵犯左肝管;Ⅳ型肿瘤累及肝总管近段和汇合处, 同时侵犯左、右肝管。T1WI上表现为低信号肿块, T2WI上分化较好的腺癌表现为高信号肿块, 而硬腺癌含有大量纤维组织, 则呈略高信号。可显示肝内胆管扩张, MRCP更为清晰。由于肝门部位动脉及门静脉具有特殊的无信号表现, 因此MRI对于肿瘤侵犯或推移血管的显示优于CT。其MRI表现特点为:肝内胆管明显扩张, 而肝外胆管无明显扩张, 肝门部不规则肿块。T1WI低信号, T2WI高信号。增强扫描表现为不同程度的强化。
2 介入治疗
经皮肝穿刺置管引流术 (PTCD) 及经皮经肝胆道支架置入术是指在PTCD后经PTCD管扩张胆道狭窄并置入支架以解决胆汁引流问题。目前多采用B超引导下穿刺, 在梗阻上方放置引流, 如果能通过狭窄, 则可以行内引流, 如放置支架。介入治疗可通过引流改善黄疸引起的各种症状, 从而提高患者的生存质量, 为进一步治疗创造条件[6]。对于晚期不能行根治手术的病例, PTCD+金属支架置入术已成为重要手段。其具有创伤小、恢复快、相对安全、可重复性强的特点, 目前应用较多[7]。另外, 通过经皮穿刺途径进行穿刺活检可进一步提高活检的成功率与准确率[8]。
2.1 胆道梗阻的分型与介入治疗
根据梗阻的部位大致可分为肝内型、肝门区以及壶腹区。肝门区的肿瘤主要运用Bismuth-Corlette分类方法 (见前述) 。对于Ⅰ型患者, 经一侧肝内胆管入路进行引流即可;Ⅱ型患者需要双侧肝内胆管引流;对于Ⅲ型患者需要经受累对侧胆管引流;Ⅳ型患者可引流扩张较明显的肝内胆管, 而对于肝内广泛受侵者则不应该行介入治疗。对于累及左右肝管分叉的患者, 在引流区域上仍有争论。有学者认为, 引流30%的区域就能起到减黄的效果;也有学者认为需要双侧引流才能引流充分, 且能避免未引流区域出现胆管炎[9]。而对于肝内肿瘤引起的恶性胆道梗阻, 国内很多学者称为高位的恶性梗阻, 即恶性肿瘤引起的肝总管以上的胆道阻塞性病变, 主要病因有肝门区肝细胞癌、肝门型胆管细胞癌、胆囊癌及其他组织肿瘤肝门淋巴结转移。对于高位的恶性梗阻单纯的采用胆总管支架内引流是不够的, 还需最大限度的建立肝内梗阻胆管外引流通道, 这是保证治疗效果的关键[10]。
2.2 胆道支架置入
经皮经肝或经内镜的支架置入治疗恶性梗阻性黄疸, 有效地恢复和维持了正常的胆道生理, 避免因外引流导致胆汁流失, 已成为无法手术切除的恶性胆道梗阻患者的标准的减黄治疗方案。支架置入的相对禁忌证:有胆道手术史、多段狭窄或闭塞、胆道系统活动性炎症、肝脏慢性疾病、凝血功能障碍、对对比剂过敏及预期生存期少于3个月者。支架置入前先行胆道穿刺引流, 引流2~5d后再行支架置入, 这样有利于支架置入后的稳定、减少移位。支架置入前若有必要时可先行球囊扩张。支架应覆盖狭窄段近端及远端各2cm长度。置入后1~3d再次行经皮经肝胆道造影, 确认支架内通畅[11]。支架再狭窄的时间大约为3个月。所以也有的学者认为, 由于支架再狭窄机率较高, 有学者建议保留经皮肝穿刺的通道, 以便于因再狭窄而进行再次介入治疗[12]。
2.3 介入术后并发症及预后
介入治疗是一种创伤性治疗, 加上恶性梗阻性黄疸患者大多数体质较弱, 肝功能及凝血机制差, 因此容易出现并发症。常见并发症有: (1) 出血:包括腹腔出血、胆道出血、穿刺道出血。原因是穿刺损伤肝包膜、肿瘤表面溃烂、肝动脉、门静脉分支损伤且与胆管想通、肋间动脉穿破等。置入支架后由于支架的局部压迫止血作用出血率可减低。 (2) 感染:由于对比剂过量注入造成胆管内压升高使感染的胆汁逆行入血所致;而恶性胆道梗阻患者术前即有25%~50%合并胆道感染。因此术前术后需要足量敏感抗生素治疗, 并尽量控制对比剂用量。 (3) 肝功能损害:多为一过性, 一般经过术前术后护肝治疗2~3d即可恢复, 如果转氨酶持续升高则需考虑肿瘤引起的肝细胞损害[13]。
恶性胆道梗阻的平均生存期为3个月, 经介入治疗胆道支架置入治疗后的平均生存期可延长至5个月[14]。有资料显示, CA199对于预后有重要意义, CA199>300U/m L的患者的平均生存期低于CA199值<300U/m L的患者[15]。
摘要：恶性梗阻性黄疸是临床常见病, 手术切除率低、预后差。经皮经肝胆道引流和支架置入为主的介入治疗由于其操作简单、并发症少、成功率高, 且能显著改善生活质量并延长生存期, 已成为目前姑息性治疗恶性梗阻性黄疸的首选方法。术前的MR检查尤其是MRCP技术的运用对梗阻性黄疸的定位、定性诊断有很高的价值。
MR诊断 篇7
1 资料与方法
收集我院2007年8月至2012年7月经手术及病理证实的女性盆腔囊性包块70例。年龄15~69岁, 平均39.5岁。其主要临床症状为腹部包块、月经异常、下腹隐痛等。囊性病变定义为CT及MR图像上囊性区占病灶的2/3以上。
于扫描前晚无渣饮食, 扫描时保持膀胱适度充盈。CT检查使用西门子SOMATOM Plus4螺旋CT机, 晚上21时口服3%~5%碘海醇稀释液500mL, 扫描前3h再次口服3%~5%碘海醇稀释液500mL, 行平扫及增强扫描, 层厚、层距10mm, 必要时行薄层扫描 (层厚、层距均为3mm) , 增强对比剂为碘海醇, 剂量80~100m L, 速率2.5~3.0m L/s。MR检查使用Philips Achieva 1.5T超导磁共振机, 多序列 (T2WI, T2W-SPIR, T1W-TFE-IP) 多轴位 (TRA、COR、SAG) 平扫并增强扫描, 对比剂使用马根维显GD-DTPA, 剂量0.2mmol/kg, 总量15~20m L, 使用高压注射器静脉推注, 速率3m L/s。扫描范围从耻骨联合下缘至髂棘区域, 个别病灶巨大者扫描至整个病灶为止。
2 结果
本文70例患者, 良性包块64例, 恶性包块6例。卵巢源性66例, 子宫源性3例, 其他来源1例。CT/MR诊断定位准确67例 (95.7%) , 定性准确54例 (77.1%) 。
本文中盆腔囊性包块来源于卵巢的有66例, 占病例总数的94.3%。卵巢囊肿29例, 其中单纯性浆液性囊肿16例, 黄体囊肿2例, 呈圆形或卵圆形薄壁囊性包块;巧克力囊肿11例, 其中单侧8例, 多房8例, 囊壁薄, 囊内出血2例, 1例囊内见子囊。卵巢囊腺瘤15例, 浆液性6例, 均为单侧, 大小33~151mm, 平均74mm, 单房者5例, 多房1例, 分隔薄, 3例见壁结节;黏液性9例, 大小41~196mm, 平均97mm, 均为多房, 囊壁厚薄不均匀, 6例见壁结节, 增强后均明显强化, 其中1例为交界性, 并双侧发病。卵巢囊腺癌共3例, 浆液性囊腺癌2例, 黏液性囊腺癌1例, 均为单侧, 多房病灶, 有壁结节, 囊壁、分隔厚薄不均匀, 增强后强化明显, 边界欠清, 合并有盆腔积液, 1例盆腔、腹股沟见淋巴结肿大, 1例并发大网膜转移。卵巢囊性畸胎瘤12例, 圆形或类圆形, 10例为单侧, 2例为双侧发病, 3例多发, 分界清, 11例见脂肪密度, 8例见斑片状或壳样钙化。其中1例为多房囊性密度, 未见脂肪及钙化, 误诊为囊腺瘤。盆腔囊性感染性包块5例, 其中卵巢脓肿合并输卵管积脓2例;盆腔包裹性脓肿3例, 均为厚壁多房, 囊内密度较高, 周围脂肪间隙模糊, 伴盆腔积液。卵巢转移瘤1例, 囊壁厚薄不均, 强化明显, 边界不清, 伴有盆腔积液。卵巢内膜样腺癌1例, 厚壁囊性包块, 可见壁结节, 边界不清。
来源于子宫的有3例, 占总病例的4.1%, 其中子宫肌瘤囊变2例, 1例为黏膜下肌瘤囊变, 1例为浆膜下肌瘤囊变。子宫梗阻1例, 宫腔积液, 壁厚均匀, 边界清晰, 合并双子宫畸形。来源于腹膜的恶性间皮瘤1例, 占总病例的1.4%, 分叶状厚壁囊性包块, 边界欠清, 囊壁、分隔明显强化。
3 讨论
3.1 女性盆腔囊性包块的定位诊断
螺旋CT检查具有速度快、时间分辨率及空间分辨率较高的优势, 而MR检查可以直接做出横断面、冠状面、矢状面及根据解剖位置灵活运用各种斜轴位图像, 经细致观察, 对包块的定位诊断一般不难, 本文病例的定位诊断准确率达95.7%。囊性包块是女性盆腔最常见的病变, 而卵巢来源的囊性包块又占女性盆腔囊性包块的绝大部分, 因此鉴别包块来源卵巢与否具有非常重要的意义。如包块体积较小或位置较典型时, 根据其螺旋CT及MR直接征像, 其定位相对简单。但如包块体积巨大时, 病变占据大部分中下腹, 甚至达横膈下, 周围组织受压, 解剖位置失常, 定位诊断尤为困难, 这就需要结合其他征象来判断来源于卵巢与否。
卵巢一般位于子宫底的后外侧, 但移动性大。卵巢主要由卵巢动脉供血经卵巢静脉回流, 当其发生肿瘤, 同侧的卵巢静脉可增粗, 当观察到正常或增粗的卵巢静脉进入肿瘤中 (即“卵巢血管蒂征”) 常提示卵巢来源性肿块。有文献报道, 通过卵巢血管来判断起源, 其准确率可达91%[1,2]。值得注意的是, 输卵管也是由卵巢血管供血, 故输卵管来源的包块 (如输卵管积脓) 亦易与卵巢来源的包块混淆, 导致误诊为卵巢肿瘤。除了卵巢来源的囊性包块, 子宫来源的囊性包块亦较常见, 结合病史, 观察CT及MR图像, 其定位较易。对于其他在非生殖系统来源的囊性包块的定位则需观察到与来源器官的关系方可明确, MR检查提供的多序列多轴位扫描, 对此帮助极大。
3.2 女性盆腔囊性包块的诊断及鉴别诊断
3.2.1 卵巢囊肿在卵巢包块中最为多见, 包括生理性囊肿 (功能性囊
肿) 和病理性囊肿, 病理性囊肿又以单纯性浆液性囊肿和巧克力囊肿常见。生理性囊肿和单纯性浆液性囊肿典型表现为边缘光整, 境界清晰, 呈圆形或类圆形的囊性包块, 大小不一, 囊肿密度/信号较匀一, 与水接近, 包膜完整, 有薄壁, 内无间隔、无软组织成分;部分囊肿并不如上述典型, 部分灶壁局限增厚及出现细线样间隔。巧克力囊肿表现为不同时期出血密度/信号影, 因囊内反复出血, 压力增高, 囊壁破裂出血, 致使周围组织粘连和囊腔外新的血液聚积, 形成相互粘连的多房性囊肿[3]。因有反复出血, 所以可见液-液分层现象。CT上出现局限性高密度区或MR上出现慢性血肿信号的子囊, 表现为子囊内呈同心圆状的T1WI及T2WI高低混杂信号, 极具有特征, 诊断亦较容易;当完全为陈旧性出血时, CT及MR表现均无显著特征, 但结合临床有周期性痛经并进行性加重表现, 亦可较明确诊断。
3.2.2 卵巢囊腺瘤/囊腺癌:
卵巢囊腺瘤是最常见的卵巢肿瘤, 典型的浆液性囊腺瘤通常为单侧, 直径一般<10cm, 壁薄而规则, 单房多见[4], 本组6例病例中5例为单房, 占83.3%, 部分病灶内见纤细分隔或片条状钙化灶, 囊内呈水样密度/信号 (长T1长T2信号) ;黏液性囊腺瘤直径一般>10cm, 囊壁分隔厚而规则, 常为多房, 本组9例病例均为多房, 最大直径约为196mm, 平均直径97mm, 间隔厚, 可达4mm, 囊内为稠厚的胶冻状黏液, 因此CT值较浆液性囊腺瘤组高, 本组病例约18~46Hu, 而MR图像上, T1WI及T2WI上囊内液体信号均比浆液性囊腺瘤组高, 且各囊之间信号不均匀。恶性者囊壁及分隔厚薄不均匀, 可见实性成分及壁结节, 强化较为显著, 而这些影像表现在良性病灶中亦可出现, 这是二者的鉴别难点。当实性成分较多, 并浸润周围组织, 盆腹腔淋巴结转移, 远处器官转移, 盆腔大量积液时, 常常提示为恶性肿瘤。
3.2.3 卵巢囊性畸胎瘤, 亦称为皮样囊肿, 通常由2个或3个胚层组织构成, 可有上皮、神经组织、毛发、脂肪、骨骼等。
其螺旋CT及MR表现常为边界清晰的混杂密度/信号囊性包块, 内含脂肪、钙化或软组织成分, 部分病灶形成特征性的脂肪-液体平面。如包块中均为液体, 未见脂肪、钙化, 此时与盆腔其他囊性病变鉴别较难, 需经术后病理才能确诊。本组1例曾误诊为囊腺瘤。
3.2.4 囊性感染性包块
卵巢输卵管来源或非卵巢输卵管来源。其螺旋CT及MR表现可为带分房的脓腔, 囊壁厚, 强化明显, 病灶周围脂肪间隙模糊不清。本组5例中2例为卵巢输卵管来源, 3例为盆腔脓肿。其中1例卵巢脓肿合并输卵管积脓术前曾误诊为卵巢囊腺瘤, 误诊主要原因是没有密切结合临床病史, 对该病影像表现认识不足, 回顾性分析其MR图像, 见输卵管扩张迂曲, 管壁增厚, 强化明显, 而输卵管近端窄小, 末端膨大, 呈喇叭状, 此具有特征性[5], 结合患者有下腹痛, 白细胞升高等临床表现可明确诊断。
3.2.5 卵巢转移瘤, 常称为库肯勃 (Krukenberg) 瘤。
双侧或单侧卵巢包块, 壁厚薄不均, 增强后明显强化, 常有腹水, 结合病史诊断不难, 本例患者来源于结肠癌。
3.2.6 卵巢内膜样癌占所有卵巢上皮性癌的23.
5%[6], 大多数来自卵巢表面生发上皮的化生, 少部分来源于子宫内膜异位囊肿恶变。CT及MR表现无特征性, 可为厚壁囊性包块, 可见壁结节, 边界不清。诊断多依靠病理, 本例就误诊为囊腺癌。
3.2.7 子宫肌瘤囊变
黏膜下、肌壁间肌瘤囊变诊断较为简单, 浆膜下肌瘤囊变螺旋CT表现为紧邻子宫或带蒂与子宫相连的混杂密度包块, 边界清楚, 可见包膜, 增强后实性部分可和子宫壁同步强化。浆膜下肌瘤大部分囊变时, 与附件囊性肿瘤鉴别较难, 此时行MR检查, 其多轴位扫描有助于明确诊断。
3.2.8 子宫梗阻
阴道、宫颈发育异常致子宫内积液, 表现为厚壁囊性包块, 壁厚均匀强化明显, 边缘清晰, 可合并双子宫畸形, 连续观察影像资料不难诊断。
3.2.9 囊性间皮瘤
为低度恶性肿瘤, 有局部复发的倾向。发生于腹膜时, 表现为分叶状囊性包块, 大小从数毫米~6cm不等, 囊内密度/信号与水接近, 依靠病理学检查可作出诊断。女性盆腔囊性包块类型多种多样, 其表现多有类似, 定性诊断较为困难, 螺旋CT及MR扫描能较好显示病灶内部特征及其与周围结构的关系, 而根据信号的不同, MR扫描更能推测病灶的结构成分, 做出准确的定位及定性诊断, 为临床提供必要的影像资料。
参考文献
[1]Asayama Y, Yoshimitsu K, Aibe H, et al.MDCT of the gonadal veins in females with large pelvic masses:value in differentiating ovarian versus uterine origin[J].AJR, 2006, 186 (2) :440.
[2]Lee JH, Jeong YK, Park JK, et al.“Ovarian vascular pedicle”sign revealing organ origin of a pelvic mass lesion on helical CT[J].AJR, 2003, 181 (1) :131-137.
[3]戴敏方, 赵英, 张洁, 等.卵巢病变的MR诊断 (附100例分析) [J].放射学实践, 2005, 20 (8) :686-689.
[4]周康荣.腹部CT[M].上海:上海医科大学出版社, 2013:316.
[5]季冬, 赵泽华.多层螺旋CT对女性盆腔囊性病变的鉴别诊断[J].上海医学影像杂志, 2008, 17 (4) 295-298.
MR诊断 篇8
1 资料与方法
1.1 一般资料
本文研究对象均选自2013年3月~2014年3月开封市中心医院放射科采集的48例有完整MR检查资料的卵巢囊性病变病例进行临床研究。所有入选病例均经手术病理证实为卵巢囊性病变, 年龄27~66岁, 平均年龄 (40.1±3.8) 岁;病例中37例有明显的临床症状, 如:下腹部坠胀、不适感, 腹部按压发现包块等症状;11例无明显症状, 均在常规体检中发现。
1.2 鉴别诊断方法
本文临床诊断设备均选用Philips Gyros can Acs-NT 1.5T超导磁共振扫描仪。入室后患者采取平卧体位, 叮嘱患者检查前保持膀胱适度充盈, 扫描范围从脐部至耻骨之间。在扫描中行常规轴位、矢状位的GRE T1WI、TSE T2WI及脂肪抑制技术, 同时根据患者病情增扫冠状位。扫描仪参数设置:T1WI:TR设定为110~170 ms, TE设定为12 ms, 翻转角度为70°;T2WI:TR设定为3000~5000 ms, TE设定为96~120 ms;扫描层厚设定为5~8 mm, 层间隔设定为1.0 mm, 扫描矩阵为320×256, 扫描影像采集次数2~3次, 影像视野为23 cm×23 cm。本文48例患者中41例患者给予静脉注射1 mmol/kg钆喷酸葡胺注射液后行增强扫描。
MR检查结果均由2名具有MR专业资质的医师进行阅片。入选标准为卵巢囊性病变的病灶内液性成分>80%为准, 同时观察、分析、记录患者卵巢病灶部位的MR信号、大小、形态等其他影像学征象, 并根据阅片结果确定病变的性质, 最后将诊断结果与手术病理资料进行对比。
2 结果
2.1 MR诊断与手术病理比较情况
本文入选的48例卵巢囊性病变患者的MR临床诊断与手术病理结果进行对比, 鉴别诊断符合手术病理结果者45例, 临床诊断符合率为93.75%。
2.2 卵巢囊性病变MR表现
(1) 单纯性卵巢囊肿者18例。MR显示囊肿呈圆形, 界线清晰, 包膜完整, 囊肿内的MR信号均匀; (2) 卵巢囊性畸胎瘤者10例。MR显示瘤体直径为5~20 cm, 且可清晰显示短T1、长T2脂肪信号影像, 瘤体形态主要为类圆形、豆粒或者条带状; (3) 卵巢囊腺瘤者7例。其中黏液性囊腺瘤者3例, 瘤体直径为20~30 cm, 多房, 各个小房的MR信号均有一定差异性, 小房分隔比较纤细且呈蜂窝状。浆液性囊腺瘤者4例, 此类病症一定为单发或者多发, MR检查显示病灶的T1信号偏低, T2信号偏高, 瘤体壁较薄, 瘤体直径大概为8~12 cm; (4) 卵巢子宫内膜异位囊肿者6例。MR显示囊肿呈椭圆形, 囊肿壁厚薄不同, 部分患者囊肿表现出复杂性多房结构, 囊体大小不同, MR信号混杂。 (5) 卵巢囊腺癌者3例。MR显示病灶轮廓比较清晰, T1、T2信号不均匀且混杂, 瘤体壁厚薄不均匀, 呈大小不一的乳头状结构, 瘤体周围分界模糊。 (6) 卵巢冠囊肿者4例。MR显示囊肿形态以椭圆形、圆形为主, 囊肿直径为10~18 cm, 有明显的液体信号影。
3 讨论
卵巢囊性病变在妇科疾病中属于比较常见的多发病, 由于引起病变的病因比较多, 因此临床鉴别诊断难度比较大。随着现代医疗技术的快速发展, MR技术被广泛应用于临床疑难疾病鉴别诊断, 该技术可以实现多方位成像, 尤其对软组织病变的对比度较好, 因此在卵巢囊性病变中可实现高准确度的定位、定性鉴别, 并清晰显示病灶部位内部的结构、正常组织解剖结构等内容, 对于卵巢囊性病变为临床鉴别、诊断及临床治疗等提供重要的临床参考依据[2]。
本文临床研究结果显示, 48例卵巢囊性病变患者的MR临床诊断与手术病理结果进行对比, 诊断准确者45例, 临床诊断符合率为93.75%。由此可知, 在卵巢囊性病变鉴别诊断中, MR可清晰显示囊性肿块形态、大小、边缘以及内部结构等, 为医师提供清晰影像资料, 有利于对囊性病变进行准确定位、定性, 并为制定针对性的手术治疗方案提供重要参考依据。
摘要：目的 探讨MR检查对卵巢囊性病变诊断和鉴别诊断的临床效果及应用价值。方法 回顾性分析48例卵巢囊性病变患者临床及影像资料, 并将MR诊断结果与手术病理资料进行对比。结果 MR诊断与手术病理结果进行对比, 诊断准确者45例, 临床诊断符合率为93.75%。结论 临床研究证实, 临床对卵巢囊性病变进行诊断时需结合临床症状综合分析MR影像细节, 从而提升临床诊断的准确率。
关键词：卵巢囊性病变,MR检查,诊断,鉴别
参考文献
[1]乐杰.妇产科学.第7版.北京:人民卫生出版社, 2011:283-285.
MR诊断 篇9
关键词：肺癌脑转移,MRI,平面扫描,增强扫描
肺癌脑转移是脑转移瘤中最为常见的一种, 以中老年患者为高发, 多呈现出脑卒中样的症状, 容易在早期临床诊断中发生漏诊及误诊, 临床上认为MRI是早期诊断肺癌脑转移有效方法。本文通过观察分析肺癌脑转移的MR表现与诊断方法, 总结其临床应用价值如下。
1资料与方法
1.1 一般资料
选取我院2007年12月至2010年12月151例肺癌脑转移的患者, 男121例, 女30例, 年龄在38～76岁, 平均年龄为 (57.5±0.6) 岁, 均通过手术病理证实, 主要临床表现为失语、肢体瘫痪、呕吐、头痛、部分无神经系统性症状。分别进行MRI平面及增强扫描, 对其临床病历资料进行回顾性分析。
1.2 检查方法
采用的是GE Signa 1.5T MR扫描仪, 8通道头颅线圈, 横断位T1 FLAIR (IR-FSE TR 2300 ms, TE 22 ms) 、T2W (SE-EPI TR 5000 ms TE 77 ms) 及DWI (采取单次激发SE-EPI序列, B值 1000 s/mm2) , 层厚7 mm, 间隔2 mm, FOV24×24, Nex 2, 增强后横断位及矢状位T1 FLAIR设置的参数同平面扫描[1]。所用对比剂为钆噴酸葡胺 (Gd-DTPA) , 剂量为0.2 mmol/kg, 静脉注射。
1.3 统计学方法
本组检查结果的数据经卡方软件V1.61版本检验, 以P<0.05为有统计学意义。
2结果
151例肺癌脑转移患者的MR表现为单发的有43例 (28.5%) , 其中包括未分化癌3例 (2.0%) 、腺癌13例 (8.6%) 、鳞癌27例 (17.9%) , 多发的有108例 (71.5%) , 病灶数目均≥3个;最大转移灶的直径在3～51 mm, 其中直径在5 mm以内的有13例 (8.6%) , 在10 mm以内的有37例 (24.5%) ;转移灶的分布以顶叶出现的频率最高, 有107例 (70.9%) , 额叶和颞叶次之, 分别为84例 (55.6%) 和74例 (49.0%) , 其余为枕叶64例 (42.4%) 、小脑60例 (39.7%) 、基底节区13例 (8.6%) 、胼胝体10例 (6.6%) 、颅骨7例 (4.6%) 、脑干7例 (4.65) ;转移瘤的形态以圆形/类圆形为主, 有128例 (84.8%) 其中直径≤20 mm的转移瘤形态皆为圆形, 其余转移瘤多呈现不规则形态;检查可见瘤周重度水肿有10例 (6.6%) 、中度水肿有74例 (49.0%) 、轻度水肿有27例 (17.9%) 、无瘤周水肿有40例 (26.5%) ;瘤内出血有23例 (15.2%) , 其中腺癌占10例 (6.6%) 、鳞癌占13例 (8.6%) ;出现重度占位性征象有13例 (8.6%) 、中度有44例 (29.1%) 、轻度有40例 (26.5%) 、无出现占位性征象有54例 (35.8%) 。
采取MRI平扫, 结果如下:T1WI中显示为低信号有60例 (39.7%) 、等信号有44例 (29.1%) 、混杂信号有47例 (31.2%) , T2WI中显示为高信号有117例 (77.5%) 、等信号有34例 (22.5%) ;采取MRI增强扫描, 结果如下:重度强化27例 (17.9%) 、中度强化104例 (68.9%) 、轻度强化20例 (13.2%) ;T1WI和T2WI平扫均无发现病灶27例 (17.9%) , 增强扫描均发现病灶, 两种扫描病灶发现率比较存在明显差异 (χ2=19.66, P<0.05) , 具有统计学意义。
3讨论
过去的文献中报道[2], 肺癌脑转移的MR表现一般满足:呈多发性的病灶居多, 髓交界区和幕上皮为高发部位;多见为小病灶, 通常合并病灶周围明显的脑水肿;进行MR增强扫描时可见有均匀的或环形的强化影像;临床认为转移瘤的信号大小、改变、坏死、出血情况及和占位的征象等表现均非其特征性表现。通常认为MRI用于诊断颅内病变具有较好的敏感性, 大部分患者能的转移瘤能通过平扫进行诊断, 本文通过经过平扫发现的病灶有124例, 占82.1%。但也会由于单发或者是多发的病例中出现瘤体的体积小比例较大, 导致瘤灶没有发生水肿现象的比例较高, 使阴性率增高;同时由于使用增强扫描时多数会使用双倍的造影剂, 因此增强扫描对于转移灶的显像会更清晰, 能发现平扫中无法清晰显示的病灶, 并且达85%的患者能发现病灶数目比平扫中显示要多。临床上认为增强扫描对诊断肺癌脑转移有不可替代的重要作用, 应作为检查肺癌脑转移的常规手段。
综上所述, MRI是诊断肺癌脑转移最为直接、有效的手段, 其中增强扫描能进一步显示出肺癌脑转移的病灶, 能为临床诊疗提供科学的依据。
参考文献
[1]刘年生, 张勇军, 唐海云.肺癌脑转移的MRI诊断价值.临床和实验医学杂志, 2007, 6 (1) :91-93.
MR诊断 篇10
1资料与方法
1.1一般资料:选取2014年4月至2015年4月来我院诊治的低颅压综合征患者30例, 其中男21例, 女9例;年龄28~67岁, 平均年龄为 (38.11±1.97) 岁。所有患者均经低颅压综合征诊断标准进行确诊, 且均行头颅MR平扫以及增强扫描, 行侧卧位腰穿刺后测得脑脊液压力低于60 mm Hg, 排除合并其他内科疾病患者以及其他神经系统疾病患者。该30例患者中11例为亚急性起病者, 19例为急性起病者;5例为继发性的低颅压综合征, 25例为原发性的低颅压综合征;13例伴有双颞侧疼痛, 8例单颞侧疼痛, 3例顶部疼痛, 6例枕部疼痛, 2例前额疼痛, 9例伴有头晕, 10例伴有恶心呕吐, 6例颈背痛、颈抵抗, 3例站立不稳, 1例耳鸣, 1例全身乏力, 2例病理征阳性。所有患者的一般资料间的差异无统计学意义 (P>0.05) , 具有可比性[2]。
1.2方法:本组30例患者均行侧卧位腰穿, 测得脑脊液压力低于60 mm Hg, 其中28例患者的性状为无色透明, 2例患者则为淡黄色;所有患者的脑脊液中红细胞数和白细胞数均为0/HP, 氯化物和糖的含量均正常, 脑脊液细菌涂片检查亦正常, 有6例患者的脑脊液蛋白含量略有增高。所有患者均行头颅MR平扫及增强扫描, 轴位T1FLAIR, T2FLAIR, T2WI, 厚度是5.0 mm, 间隔是0.5 mm, 矩阵是288×384, FOV=230, Gd-DTPA作为增强扫描的对比剂, 使用剂量控制在0.1 m L/kg, 增强扫描行矢状位、横断位和冠状位扫描, 有些疼痛严重的患者要进行脊柱平扫和增强扫描[3]。
1.3统计学分析:应用SPSS13.0统计学软件进行数据处理。
2结果
本组研究的30例患者的MR均表现为弥漫性硬脑膜增厚, 特征表现为等长T1信号以及等长T2信号, FLAIR均呈弥漫性硬脑膜均匀高信号, 增强扫描结果显示硬脑膜发生均匀强化。其中呈现脑下垂征象的有15例, 临床表现为桥前池变窄、小脑扁桃体下疝以及中脑发生下移, 伴有硬膜下积液的有10例, 伴有硬膜下血肿的有5例。对本组的30例患者均采取平卧休息、去枕, 静脉滴注、扩血管以及改善脑循环等治疗措施, 其中对患有硬膜下血肿的5例患者行硬膜下血肿清除手术。该30例患者最终均痊愈出院。
3讨论
低颅压综合征从发现之初到目前为止, 尚无法完全阐明其诱发病因和发病机制。随着现代医疗技术的不断发展和对该病研究的不断深入, 目前临床上共阐述了三种发病机制, 包括脑脉络血管舒缩功能紊乱造成脑脊液分泌减少, 脑膜出现撕裂口导致脑脊液从此处发生渗漏以及蛛网膜颗粒吸收偏多。原发性的低颅压综合征诱发原因尚不明确, 继发性的低颅压综合征目前明确了几种诱发病因, 包括脑室及脊髓腔的过度引流、腰穿、脊髓神经根撕裂、严重脱水、颅脑手术后、全身感染、休克以及全身中毒等。患有该病的部分患者在发病前受过明显的不良心理刺激, 因此推测这种不良刺激可能影响了大脑皮质、大脑深部核区或大脑-交感神经-儿茶酚胺系统、下丘脑-垂体-肾上腺皮质系统等, 造成脉络丛血管发生痉挛。随着核磁技术的发展, 特别是磁共振增强扫描技术的广泛应用[4], MR在低颅压综合征的诊断和鉴别方面发挥了重要作用, 为早期的干预治疗提供了科学的依据。
本组研究的30例患者的MR均表现为弥漫性硬脑膜增厚, 特征表现为等长T1信号以及等长T2信号, FLAIR均呈弥漫性硬脑膜均匀高信号, 增强扫描结果显示硬脑膜发生均匀强化。其中呈现脑下垂征象的有15例, 临床表现为桥前池变窄、小脑扁桃体下疝以及中脑发生下移, 伴有硬膜下积液的有10例, 伴有硬膜下血肿的有5例。低颅压综合征患者的MR均表现为硬脑膜增强异常, 双侧脑膜对称性、弥漫性增强和增厚, 且强化连续增厚, 无结节, 但其强化的程度明显低于海绵窦, 强化范围小于脑表面积的50%, 且连续增强不超过3 cm。另一个常见的临床特征为脑组织移位, 主要发生于中线附近。
综上所述, MR应用于低颅压综合征的诊断及征象研究, 具有较高的鉴别诊断价值, 值得在临床上大力推广应用。
参考文献
[1]张存美, 王光彬, 武乐斌.低颅压综合征的MR诊断及征象分析[J].实用放射学杂志, 2014, 30 (3) :12-14.
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