目的探讨单指数、双指数及拉伸指数DWI模型在肾乏脂肪性错构瘤与肾透明细胞癌鉴别诊断中应用价值。方法回顾性分析131例经病理证实为肾乏脂肪性错构瘤(27例)与透明细胞肾癌(104例)的临床资料,所有病人均在3.0 T MRI上接受多b值DWI检查(b值为0~1700 s/mm^2)。基于单指数模型计算出各向同性的表观扩散系数(ADC);应用双指数模型计算出假扩散系数(D_p),纯扩散系数(D_t)和灌注分数(f_p);应用拉伸指数模型计算出水分子扩散异质性指数(α)扩散分布系数(DDC)。所有扩散参数在乏脂肪性错构瘤与肾透明细胞癌两组中的比较采用Student’s t检验进行分析。同时采用ROC曲线及组内相关系数等方法比较诊断效能。结果肾乏脂肪性错构瘤组的ADC,Dt,α值显著低于肾透明细胞癌组,差异有统计学意义(P<0.001);虽然D_p,f_p及DDC值略高于肾透明细胞癌组,差异无统计学意义(P=0.136,0.090,0.424)。鉴别两类肿瘤,α(0.953)和D_t(0.964)的曲线下面积(AUC)都显著高于ADC(0860),D_p(0.605),f_p(0.596)及DDC(0.477)的AUC值(P<0.001)。结论与传统扩散参数相比,水分子扩散异质性指数(α)与D_t在鉴别乏脂肪性错构瘤与透明细胞肾癌可以提供更多信息并提高诊断敏感性与特异性。
Objective To evaluate the diagnostic value of three-dimensional multidetector-row computed tomogra- phy （MDCT） in detecting acquired renal arteriovenous malformation （RAVM） and to compare its perfor- mance with that of ultrasonography and digital subtraction angiography （DSA）. Methods The institutional review board approved this retrospective study and written informed consent was obtained from all patients before examination. All 14 patients with acquired RAVM underwent MDCT, including cortical and medullary phase enhancement angiography and three-dimensional （3D） reconstruc- tion. Five and nine patients were further examined and their diagnoses confirmed by DSA and surgery, respectively. The MDCT images, including 3D reconstructions, were analyzed for RAVM independently and in consensus by two observers using a workstation. Results Among the 14 patients with acquired RAVM, 12 with maximum lesion diameter 〉 10 mm, and one with a maximum lesion diameter between 5 and 10 ram, were correctly diagnosed with MDCT angiog- raphy. Among these patients, four diagnoses were confirmed by DSA. One patient with a lesion 5-10 mm in diameter was misdiagnosed with a renal aneurysm by MDCT angiography. The other one with the maxi- mum diameter of the lesion between 5 mm and 10 mm was misdiagnosed as renal aneurysm with MDCT angiography, which was diagnosed as renal arteriovenous malformation with DSA. Among 14 lesions in 14 patients, eight and six originated in the left and right kidney, respectively. Conclusion MDCT angiography can accurately diagnose RAVM and improve our understanding of the disease, which will allow clinicians to provide better care.
Qiuxia WangLiang ChenXuemei HuYao HuDaoyu HuZhen Li
Objective The aim of this study was to investigate the ability of intravoxel incoherent motion(IVIM) diffusion-weighted magnetic resonance imaging(MRI) to diagnose cervical cancer and to evaluate the response of uterine cervical cancer to radiochemotherapy(CRT).Methods This prospective study was approved by the institutional review board, and informed consent was obtained from all patients. A total of 23 patients with primary cervical cancer who were undergoing CRT and 16 age-matched healthy subjects were prospectively recruited for IVIM(b = 0–800 s/mm2) and standard pelvic MRI. Bi-exponential analysis was performed to derive f(perfusion fraction), D*(pseudo-diffusion coefficient), and D(true molecular diffusion coefficient) in cervical cancer(n = 23) and the normal cervix(n = 16). The apparent diffusion coefficient(standard ADC) was calculated. The independent-samples t-test and paired-samples t-test were used for comparisons.Results Pre-treatment cervical cancer had the lowest standard ADC(1.15 ± 0.13 × 10-3 mm2/s) and D(0.89 ± 0.10 × 10-3 mm2/s) values, and these were significantly different from the normal cervix and posttreatment cervical cancer(P = 0.00). The f(16.67 ± 5.85%) was lowest in pre-treatment cervical cancer and was significantly different from the normal cervix and post-treatment cervical cancer(p = 0.012 and 0.00, respectively). No difference was observed in D*.Conclusion IVIM is potentially promising for differentiating between the normal cervix and cervical cancer because pre-treated cervical cancer has low perfusion and diffusion IVIM characteristics. Further, the standard ADC, D, and f of cervical cancer showed a tendency to normalize after CRT; thus, IVIM may be useful for monitoring the response to CRT in cervical cancer.
Intestinal lymphangiectasia （IL） is an uncommon protein losing enteropathy, characterized by small intes- tinal mucosa or serosa lymphangiectasia and intestine lymph loss. Currently, IL is a very rare disease in children or adults, with typical clinical symptoms including hypoalbuminemia, absolute lymphocyte reduc- tion, ascites, edema, etc. We report a case of an adult with intestinal lymphatic ectasia accompanied by chylothorax and multiply arteriovenous malformations of the hip and lower extremity. CT and MRI revealed diffuse edema and thickening of the small intestine, accompanied by splenomegaly and pleural effusion. Extensive nodularity of lower ileum and the ileocecal region could be seen during intestinal endoscopy. Finally, small intestinal lamina propria lymphangiectasis was confirmed by pathological examination. To raise awareness of the disease, here we compare our case and those previously reported, and discuss the diaqnosis and manaqement of IL.
