功能影像学技术对乳腺癌诊断的价值

乳腺癌居女性恶性肿瘤发病的首位，是致死率较高的恶性肿瘤之一［1］。早发现、早诊断和早治疗直接影响乳腺癌患者治疗方案的选择和生存时间。乳腺病变的检出主要依靠乳腺影像技术，目前常用的乳腺影像技术是乳腺X线和乳腺超声，两种影像技术的应用发现了大量无症状和无体征的乳腺肿物。乳腺肿物术前诊断的关键是判断良恶性，目前常用的乳腺影像技术（超声和X线摄影）的共同特点是敏感度高、特异度较低，因此，提高影像技术对乳腺肿物的定性诊断一直是全球多个学科的研究热点。随着影像技术的快速发展，新技术层出不穷，功能影像学研究肿瘤微循环特征、肿瘤细胞和分子水平的代谢和功能变化，可望在乳腺癌的定性诊断和乳腺癌的早期诊断上获得突破。功能影像技术包括超声造影（contrast enhanced ultrasound，CEUS）、功能磁共振成像（function magnetic resonance imaging，fMRI）、正电子发射型计算机断层显像（position emission type computerized tomography，PET/CT）、热层析成像等。本文对乳腺癌多种功能影像技术临床研究及医学影像前沿技术的临床应用进行阐述。

AIM To review the evolution of gastrointestinal (GI) imageology in China over the past 50 years.METHODS The evolution of GI imageological equipment and techniques, published original articles of GIimageology in the Chinese Journal of Radiology, books of GI imageology in China, academic researcheswhich won the academic award of scientific and technological progress at the ministrial and national levelwere reviewed.RESULTS Within 50 years of GI imageology evolution, equipment of GI imageology were developed from200mA X-rays apparatus in the 50s to digital X-rays in the 90s. Technique of GI imaging was developed fromgeneral radiography in the 50s to digital radiography (DR), CT and MR virtual endoscopy of GI in the 90s.About 211 original articles were published in the Chinese Journal of Radiology on the GI imageology.Radiography and single contrast examination of disease were mainly described in the 50s and CT and MR andDR and interventional radiology in the 90s. Twelve books about GI imageology were published within the 50years, ranging from atlas of X-ray examination and diagnosis of GI by Chen Zhen-Lin to atlas of imagingdiagnosis of alimentary tract disease by Xie Jin-Xia. Three academic prizes of scientific and technologicalprogress were awarded by the Ministry of Health and the nation. The study of double contrast barium sulfateof Hua-Shan 2000 by Chen Gen-Fang et al acquired class 3 award of national invention in the 70s, andexperimental study and applications of double contrast radiography by Shang Ke-Zhong et al won class 3award of the Ministry of Health.CONCLUSION In keeping abreast with the development of world GI imageology, great achievements havebeen made in the study and development in GI imageology in China with its own features.

心脏磁共振成像评价心肌纤维化在扩张型心肌病患者预后判断中的价值

目的：利用造影剂增强的心脏磁共振成像（contrast-enhanced cardiac magnetic resonance imaging，CE-CMR）评价扩张型心肌病（dilated cardiomyopathy，DCM）患者心肌纤维化的特点及其在预后判断中的价值。
　　方法：入选了123名住院期间行CE-CMR检查的DCM患者（年龄45±12岁，男性98名），利用CMR的短轴电影成像评价左室舒张末径（left ventricular end-diastolic diameter，LVEDD）和左室射血分数（left ventricular ejection fraction，LVEF），利用心肌延迟钆增强成像（late gadolinium enhancement，LGE）评价心肌纤维化，利用24小时动态心电图（Holter）监测评价室速。中位随访时间为29（3~79）月，主要不良心脏事件（major adverse cardiac events，MACE）定义为全因死亡或室速。

磁共振成像技术在轻度认知障碍研究中的应用

阿尔茨海默病(AD)是一种中枢神经系统退行性疾病,主要表现为进行性认知障碍和记忆能力损害.其发病率随着年龄呈近似于指数式的增长.鉴于中晚期AD的治疗效果不佳,越来越多的研究者开始关注与痴呆紧密关联的前期智能衰退的轻度认知障碍(mild cognitive impairment,MCI)阶段,以期做到疾病的早期预警和防控.MCI在65岁以上人群的发病率为13%～19%,其中有超过50%的MCI患者在5年内进展为AD[1].

相位对比磁共振成像在中脑导水管流动测量中的应用

脑脊液(cerebrospinal fluid,CSF)循环有人体第三循环之称.早期人们对CSF的研究都使用有创方法,这改变了CSF的生理环境,给研究带来一定困难[1] .1986-1987年,Feinberg和Mark[2]首次将PC-cine法用于测量CSF速度的活体研究,开创了MRI用于研究CSF循环领域.相位对比磁共振成像(phase contrast magnetic resonance imaging,PC-MRI)对低速流动敏感,近年来PC-MRI作为一种无创、准确的流体测量技术集中应用于脑室系统、蛛网膜下腔、椎管和中脑导水管CSF的流动研究,导水管存在较为稳定的流动模型,成为研究热点.

Objective To investigate the diagnostic value of brain magnetic resonance imaging in detecting central nervous system diseases among AIDS patients of different levels of T cells. Methods Total of 164 AIDS patients who did not receive antiviral treatment were divided into 2 groups according to their baseline CD4+T cell counts. Group A had CD4+T cell below or equal to 50 cells/μl (n=81) and group B had CD4+T cells over 50 cells/μl (n=83). All patients underwent brain MRI scan. Imaging analysis and the prevalence of the central nervous system disorders were compared between two groups. Results Among them 48 cases were found of abnormal brain MRI, group A was higher than group B (35.8%vs. 22.9%) although without statistical significance (P = 0.065). Altogether 48 cases were diagnosed as AIDS related central nervous system disorders based on clinical symptoms, signs and laboratory findings. The prevalence of CNS disorders was higher in group A than in group B (41.9%vs. 16.8%) with statistical significance (P<0.01). Conclusions The patients with CD4+T cell count less than or equal to 50 cells/μl had high prevalence of CNS diseases. Brain MRI plays an important role in the diagnosis and differentiation of CNS diseases in advanced AIDS patients. This study suggests patients with low CD4+T cell count (≤ 50/μl) should routinely undergo MRI examination.

腰椎间盘营养扩散途径的DCE-MRI研究进展

椎间盘退变是颈、腰椎病发生发展的根本原因，不同程度的影响患者的生活质量[1]。流行病学研究表明营养供应减少、细胞凋亡失衡、基质酶活性改变、生物力学机制及自身免疫反应等均可能是导致椎间盘退变的重要因素[2]，营养物质缺乏被认为是诸多因素中导致椎间盘退变的首要影响因素并被体外研究所证实[3]。当某些病因引起营养椎体的血液供应减少时，影响了髓核营养的输送，终导致椎间盘退变的发生。既往检测扩散途径的方法较多，但主要集中在离体研究上[4]，如何无创检测活体对于早期预防和干预治疗具有重要意义。磁共振成像(magneticresonanceimaging，MRI)应用于医学领域已有20多年历史，动态增强磁共振扫描(dynamiccontrastenhanced-MRI，DCE-MRI)通过MRI对比剂进入椎间盘的快慢及多少反映椎间盘的营养扩散过程，具有可重复、无创的优点，是一种新的分析椎间盘营养机制的方法，现将其机制进行综述。

关节软骨磁共振成像的研究进展

关节软骨损伤是临床常见病，可以导致关节疼痛、积液和功能障碍，严重者可致残。外伤、骨性关节炎( osteoarthritis，OA )、剥脱性骨软骨炎等原因均可造成关节软骨的损伤，并且一旦损伤极难修复。在长期大量运动的人群和老年人中，关节软骨的退变、损伤几乎都不同程度的存在。早期的软骨损伤易被忽视，临床诊断也缺乏特异性。关节镜虽是关节软骨损伤诊断的“金标准”，但有创伤、视野小、有盲区、无法显示软骨下骨损伤程度等局限；常规X线、CT检查无法直观显示关节软骨。MRI凭借其多方位、多序列、多参数成像及组织分辨率高、对比度好等诸多优势，不仅能无创性地观察软骨损伤的部位、范围、程度、软骨表面的病理变化，而且能准确观察软骨内部、软骨下骨及骨髓的病变情况，被公认为目前评价软骨损伤的佳无创检查方法[1]。尤其是近年来定量磁共振成像技术的快速发展，使得关节软骨无创性检查从形态学发展到了分子生化水平，为早期关节软骨损伤的检测以及修复效果的评估提供了更多行之有效的技术手段[2]。但在临床工作中，对于关节软骨的 MRI 序列选择及优化组合、软骨损伤在不同 MRI 序列中的表现和诊断等方面尚无统一标准[3]。

肌骨影像学发展方向

1895年，德国物理学家伦琴( Roentgen )发现 X线，当时照的第一张人体 X线片就是他夫人的手。由于人体骨骼含钙多，密度高，与周围组织对比明显，因此非常适合 X线成像。从常规 X线摄片，到 CT、MRI，再到 PET-CT、PET-MRI以及分子影像学，100多年来，医学影像学已成为骨科必不可少的检查方法，在各种骨科疾病的诊断、治疗和随访中发挥着不可替代的作用。医学影像学科包括放射学和核医学，为骨科的发展提供了基础，同时骨科的发展也促进了医学影像学成像技术的进步。如今影像学的发展日新月异，我们认为以下几个方面是未来发展的方向。

磁共振导航系统引导下氩氦刀冷冻治疗肺癌

对于不能及不愿进行开放性手术治疗的肺癌患者,氩氦刀经皮穿刺治疗为患者提供了又一条可选择的治疗途径.已有报道多数是在CT引导下经皮穿刺或与开放性手术联合治疗.2007年4月～2008年6月,我院在介入性磁共振治疗系统(interventional magnetic resonance imaging,IMRI)引导下对肺癌进行氩氦刀经皮穿刺微创治疗,效果满意,现报道如下.

“磁共振与超声(MRI-US)融合成像在产前诊断中的应用研究”的点评

1 原文题目及摘要MRI and ultrasound fusion imaging for prenatal diagnosisObjective A combination of magnetic resonance imaging (MRI) images with real time highresolution ultrasound known as fusion imaging may improve prenatal examination.This study was undertaken to evaluate the feasibility of using fusion of MRI and ultrasound (US) in prenatal imaging.

磁共振技术对新生儿青紫型先天性心脏病的诊断意义

近年来,随着心脏外科的发展,儿童先天性心脏病(简称先心病)的手术年龄越来越小,对于某些先心病如完全性大动脉转位等,在新生儿期手术治疗的效果远比新生儿期后手术治疗效果要好.新生儿先心病外科手术要求术前精确地显示心脏畸形的形态,这就对新生儿心脏影像诊断提出了很高的要求.超声心动图是新生儿心脏影像检查的首选方法,能很好地显示心内结构异常,但对于心外大血管异常和复杂性先心病有时还需要其他影像检查方法作为补充.心血管造影、多层螺旋CT、电子束CT和磁共振检查都能补充超声心动图的不足,但前3种检查方法患儿均需接受较大量的放射线,尤其新生儿对射线敏感,应尽量避免,而且心血管造影还是创伤性检查,有一定的风险.磁共振作为一种无射线的非创伤性检查方法,适用于新生儿[1,2].但新生儿心脏磁共振在检查技术、注意事项、病种特点和诊断要点等方面不仅与成人有很大的差别,与一般儿童也有一定的不同.本文主要介绍我院在新生儿心脏病磁共振检查方面,特别是新生儿青紫型先心病磁共振诊断的初步经验.

氢质子磁共振波谱在足月新生儿缺氧缺血性脑病诊断中的价值

氢质子磁共振波谱(1H magnetic resonance imaging,1H MRS)可以在活体上早期、无创检测脑内代谢产物,了解新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)患儿脑内代谢的变化.本研究采用1H MRS研究足月新生儿缺氧缺血性脑病代谢产物的变化,评估1H MRS在足月新生儿HIE中的应用价值.

Functional magnetic resonance imaging studies have shown that the insular cortex has a signif-icant role in pain identiifcation and information integration, while the default mode network is associated with cognitive and memory-related aspects of pain perception. However, changes in the functional connectivity between the default mode network and insula during pain remain unclear. This study used 3.0 T functional magnetic resonance imaging scans in 12 healthy sub-jects aged 24.8 ± 3.3 years to compare the differences in the functional activity and connectivity of the insula and default mode network between the baseline and pain condition induced by intramuscular injection of hypertonic saline. Compared with the baseline, the insula was more functionally connected with the medial prefrontal and lateral temporal cortices, whereas there was lower connectivity with the posterior cingulate cortex, precuneus and inferior parietal lobule in the pain condition. In addition, compared with baseline, the anterior cingulate cortex exhibited greater connectivity with the posterior insula, but lower connectivity with the anterior insula, during the pain condition. These data indicate that experimental low back pain led to dysfunction in the connectivity between the insula and default mode network resulting from an impairment of the regions of the brain related to cognition and emotion, suggesting the impor-tance of the interaction between these regions in pain processing.

The aim of this study was to evaluate the resolution of brain lesions in patients with Wilson’s disease during the long-term chelating therapy using magnetic resonance imaging and a possible signiifcance of the time latency between the initial symptoms of the disease and the introduction of this therapy. Initial magnetic resonance examination was performed in 37 patients with proven neurological form of Wilson’s disease with cerebellar, parkinsonian and dystonic presentation. Magnetic resonance reexamination was done 5.7 ± 1.3 years later in 14 patients. Patients were divided into: group A, where chelating therapy was initiated < 24 months from the ifrst symp-toms and group B, where the therapy started≥ 24 months after the initial symptoms. Symmetry of the lesions was seen in 100% of patients. There was a signiifcant difference between groups A and B regarding complete resolution of brain stem and putaminal lesions (P= 0.005 andP=0.024, respectively). If the correct diagnosis and adequate treatment are not established less than 24 months after onset of the symptoms, irreversible lesions in the brain parenchyma could be ex-pected. Signal abnormalities on magnetic resonance imaging might therefore, at least in the early stages, represent reversible myelinolisis or cytotoxic edema associated with copper toxicity.

To attain the volumetric information of the optic radiation in normal human brains, we per-formed diffusion tensor imaging examination in 13 healthy volunteers. Simultaneously, we used a brain normalization method to reduce individual brain variation and increase the accuracy of volumetric information analysis. In addition, tractography-based group mapping method was also used to investigate the probability and distribution of the optic radiation pathways. Our results showed that the measured optic radiation ifber tract volume was a range of about 0.16%and that the fractional anisotropy value was about 0.53. Moreover, the optic radiation probability ifber pathway that was determined with diffusion tensor tractography-based group mapping was able to detect the location relatively accurately. We believe that our methods and results are help-ful in the study of optic radiation ifber tract information.

Global aphasia without hemiparesis is a striking stroke syndrome involving language impairment without the typically manifested contralateral hemiparesis, which is usually seen in patients with global aphasia following large left perisylvian lesions. The objective of this study is to elucidate the speciifc areas for lesion localization of global aphasia without hemiparesis by retrospectively studying the brain magnetic resonance images of six patients with global aphasia without hemi-paresis to deifne global aphasia without hemiparesis-related stroke lesions before overlapping the images to visualize the most overlapped area. Talairach coordinates for the most overlapped areas were converted to corresponding anatomical regions. Lesions where the images of more than three patients overlapped were considered significant. The overlapped global aphasia without hemiparesis related stroke lesions of six patients revealed that the signiifcantly involved anatomi-cal lesions were as follows:frontal lobe, sub-gyral, sub-lobar, extra-nuclear, corpus callosum, and inferior frontal gyrus, while caudate, claustrum, middle frontal gyrus, limbic lobe, temporal lobe, superior temporal gyrus, uncus, anterior cingulate, parahippocampal, amygdala, and subcallosal gyrus were seen less signiifcantly involved. This study is the ifrst to demonstrate the heteroge-neous anatomical involvement in global aphasia without hemiparesis by overlapping of the brain magnetic resonance images.

A reduction in gray matter volume is common in patients with chronic back pain, and different types of pain are associated with gray matter abnormalities in distinct brain regions. To examine ences in brain morphology in patients with low back pain or neck and upper back pain, we gated changes in gray matter volume in chronic back pain patients having different sites of pain using voxel-based morphometry. A reduction in cortical gray matter volume was found primarily in the left postcentral gyrus and in the left precuneus and bilateral cuneal cortex of patients with low back pain. In these patients, there was an increase in subcortical gray matter volume in the bilateral putamen and accumbens, right pal idum, right caudate nucleus, and left amygdala. In upper back pain patients, reduced cortical gray matter volume was found in the left precentral and left tral cortices. Our findings suggest that regional gray matter volume abnormalities in low back pain patients are more extensive than in upper back pain patients. Subcortical gray matter volume in-creases are found only in patients with low back pain.

Aquaporin-4 regulates water molecule channels and is important in tissue regulation and water transportation in the brain. Upregulation of aquaporin-4 expression is closely related to cel-lular edema after early cerebral infarction. Cellular edema and aquaporin-4 expression can be determined by measuring cerebral infarct area and apparent diffusion coefficient using diffu-sion-weighted imaging (DWI). We examined the effects of silencing aquaporin-4 on cerebral infarction. Rat models of cerebral infarction were established by occlusion of the right middle cerebral artery and siRNA-aquaporin-4 was immediately injectedvia the right basal ganglia. In control animals, the area of high signal intensity and relative apparent diffusion coefifcient value on T2-weighted imaging (T2WI) and DWI gradually increased within 0.5–6 hours after cerebral infarction. After aquaporin-4 gene silencing, the area of high signal intensity on T2WI and DWI reduced, relative apparent diffusion coefifcient value was increased, and cellular edema was ob-viously alleviated. At 6 hours after cerebral infarction, the apparent diffusion coefifcient value was similar between treatment and model groups, but angioedema was still obvious in the treat-ment group. These results indicate that aquaporin-4 gene silencing can effectively relieve cellular edema after early cerebral infarction; and when conducted accurately and on time, the diffusion coefifcient value and the area of high signal intensity on T2WI and DWI can relfect therapeutic effects of aquaporin-4 gene silencing on cellular edema.

Acupuncture can induce changes in the brain. However, the majority of studies to date have focused on a single acupoint at a time. In the present study, we observed activity changes in the brains of healthy volunteers before and after acupuncture atTaichong (LR3) andTaixi (KI3) using resting-state functional magnetic resonance imaging. Fifteen healthy volunteers underwent resting-state functional magnetic resonance imaging of the brain 15 minutes before acupuncture, then received acupuncture atTaichong andTaixi using the nail-pressing needle insertion method, after which the needle was retained in place for 30 minutes. Fifteen minutes after withdrawal of the needle, the volunteers underwent a further session of resting-state functional magnetic res-onance imaging, which revealed that the amplitude of low-frequency lfuctuation, a measure of spontaneous neuronal activity, increased mainly in the cerebral occipital lobe and middle occipital gyrus (Brodmann area 18/19), inferior occipital gyrus (Brodmann area 18) and cuneus (Brodmann area 18), but decreased mainly in the gyrus rectus of the frontal lobe (Brodmann area 11), inferi-or frontal gyrus (Brodmann area 44) and the center of the posterior lobe of the cerebellum. The present ifndings indicate that acupuncture atTaichong andTaixi speciifcally promote blood lfow and activation in the brain areas related to vision, emotion and cognition, and inhibit brain areas related to emotion, attention, phonological and semantic processing, and memory.