Part Ib Diffusion-Weighted MRI nyob rau hauv lub genitourinary System
Jul 05, 2023
Abstract
Diffusion-weighted imaging (DWI) yog ib qho kev ua haujlwm tseem ceeb hauv Magnetic Resonance Imaging (MRI). DW ib ntus yog ua los ntawm kev tau txais cov duab ib txwm muaj piav qhia los ntawm lawv cov b-tus nqi, txhua tus nqi b sawv cev rau lub zog ntawm diffusion MR gradients tshwj xeeb rau qhov sib lawv liag. Los ntawm kev ua kom haum cov ntaub ntawv nrog cov qauv piav qhia txog kev txav ntawm cov dej hauv cov ntaub so ntswg, ib daim ntawv qhia pom meej diffusion coefficient (ADC) thiab tso cai rau kev ntsuam xyuas cov dej txav hauv cov ntaub so ntswg. Lub cellularity siab ntawm cov qog txwv tsis pub cov dej ntws tawm thiab txo tus nqi ntawm ADC hauv cov qog, uas ua rau lawv tshwm sim hypointense ntawm ADC maps. Lub luag haujlwm ntawm cov kab ke no tam sim no loj tshaj nws thawj qhov chaw kho mob hauv neuroimaging, uas yog txoj kev pab kuaj xyuas cov theem pib ntawm cerebral ischemic stroke. Cov ntawv thov txuas mus rau tag nrho lub cev duab rau ob qho tib si neoplastic thiab non-neoplastic kab mob. Qhov kev tshuaj xyuas no qhia txog kev sib koom ua ke ntawm DWI hauv kev kuaj mob genitourinary los ntawm kev qhia txog qhov kev siv nyob rau hauv poj niam lub plab, prostate, zais zis, noov, testis, thiab raum MRI. Nyob rau hauv gynecological imaging, DWI yog ib qho tseem ceeb ib theem zuj zus rau tus yam ntxwv ntawm lub ncauj tsev menyuam hlav thiab endometrial carcinomas, nrog rau kev sib txawv ntawm leiomyosarcoma thiab benign leiomyoma ntawm lub tsev menyuam. Nyob rau hauv zes qe menyuam epithelial neoplasms, DWI muab cov ntaub ntawv tseem ceeb rau cov yam ntxwv ntawm cov khoom sib xyaw ua ke hauv ntau hom ntawm zes qe menyuam. Hauv kev kuaj pom prostate, DWI tau dhau los ua ib feem tseem ceeb ntawm ntau qhov sib nqus sib nqus Resonance Imaging (mpMRI) txhawm rau kuaj mob qog noj ntshav. Prostate Imaging-Reporting and Data System (PI-RADS) tau qhab nia qhov tshwm sim ntawm cov qog prostate tseem ceeb tau ua rau muaj txiaj ntsig zoo. Nws txoj kev koom tes tau tsim mpMRI raws li qhov yuav tsum tau kuaj xyuas rau kev npaj ntawm prostate biopsies thiab radical prostatectomy. Ua raws li txoj hauv kev zoo sib xws, DWI tau suav nrog hauv cov txheej txheem multiparametric rau lub zais zis thiab lub testis. Hauv kev kuaj lub raum, DWI tsis tuaj yeem sib txawv ntawm cov qog nqaij hlav malignant thiab benign raum tab sis kuj yuav pab tau rau tus yam ntxwv ntawm cov qog nqaij hlav, suav nrog cov cell ntshiab thiab tsis-clear-cell carcinomas lossis low-fat angiomyolipomas. Ib qho kev vam meej tshaj plaws ntawm lub raum DWI yog kev kwv yees ntawm lub raum fibrosis hauv cov neeg mob raum mob ntev (CKD). Hauv kev xaus, DWI ua ib qho kev nce qib loj hauv genitourinary imaging nrog lub luag haujlwm tseem ceeb hauv kev txiav txim siab algorithms hauv poj niam lub plab thiab qog nqaij hlav prostate, tam sim no tso cai rau cov ntawv cog lus hauv lub raum duab lossis lub zais zis thiab testicular mpMRI.
Ntsiab lus
MRI ntawm genitourinary; nthuav dav; prostate; raum; poj niam pelvis; mob qog noj ntshav.
Nyem qhov no kom paub tias Cistanche yog dab tsi
Taw qhia
Nyob rau hauv ntau yam ntawm kev soj ntsuam imaging txoj kev, diffusion-weighted MR imaging (DWI) stands rau nws exceptional tus nqi rau cov neeg mob tswj raws li zoo raws li rau nws fascinating txheej txheem. Nrog rau qhov kev daws teeb meem spatial ze li 1 hli, Diffusion-Weighted (DW) sequences soj ntsuam kev txav dawb ntawm cov dej molecules hauv cov ntaub so ntswg ntawm qib micrometer, nrog rau kev nthuav dav ze li ib txhiab. Thawj thawj zaug hauv xyoo 1986 los ntawm Le Bihan li al. [1], DWI tau ntsib kev txhim kho loj tom qab kev ua qauv qhia ntawm nws lub peev xwm los kuaj pom lub paj hlwb ischemia ntev ua ntej lwm txoj hauv kev tsis yog [2,3]. Txawm hais tias cov txheej txheem ntawm cov dej tsis sib haum xeeb tom qab o ntawm cellular o yog ib feem nkag siab [4], kev siv DWI tau txuas ntxiv mus rau lwm yam kab mob. Raws li cov dej diffusion kuj tseem txo qis hauv cov qog vim yog lawv cov ntawv thov cellular tau txwv tsis pub dhau lub hlwb, muaj kev vam meej sai rau lwm qhov kev suav nrog cov txheej txheem gaverourinary.
Cov kab mob genitourinary feem ntau yog tshawb xyuas los ntawm ultrasound lossis axial xam tomography (CT) ua thawj kab kev ntsuas kev ntsuas txhawm rau txheeb xyuas cov tsos mob ntawm cov kab mob malignant lossis ua cov kab mob. Txawm li cas los xij, magnetic resonance imaging (MRI) tau tshwm sim los ua tus neeg tseem ceeb hauv kev kuaj mob thiab ua tus yam ntxwv ntawm cov kab mob qog thiab tsis qog, ib feem vim nws cov ntaub so ntswg zoo sib xws. MRI tsis tsuas yog muab kev daws teeb meem morphological dluab xwb tab sis kuj muab ntau yam ntaub ntawv ua haujlwm, xws li cov ntaub so ntswg oxygenation, perfusion, lossis diffusion. Ntawm cov txheej txheem kev ua haujlwm zoo no, DWI yeej cuam tshuam rau kev tswj cov neeg mob qog noj ntshav genitourinary feem ntau. Tshwj xeeb, DWI tau dhau los ua ib qho cuab yeej tseem ceeb hauv kev kuaj mob thiab ua rau muaj ntau yam qog nqaij hlav qog noj ntshav thiab prostatic. Thaum kawg, tau tsav los ntawm kev nce qib ntawm txoj kev ua pa ntawm txoj kev txo qis, DWI kuj tau ua tiav rau kev kuaj lub raum.
Dhau ntawm lub raum mob qog noj ntshav, DWI zoo nkaus li yog cov cuab yeej tawm tshiab uas yuav muaj feem cuam tshuam rau hauv kev tswj xyuas cov kab mob tsis muaj qog raum. Qhov kev ua haujlwm no yog txhawm rau tshuaj xyuas cov ntawv thov tam sim no nrog rau cov kev siv yav tom ntej ntawm DWI, nrog rau kev tsom mus rau poj niam lub plab, prostate, zais zis, noov, testis, thiab ob lub raum.
Cistanche tubulosa
Cov ntsiab lus ntawm Diffusion-Weighted MRI hauv Genitourinary System
Dej yog cov molecule ntau tshaj plaws hauv cov ntaub so ntswg. Txhua cov dej molecule dais ob lub hydrogen nuclear spin, uas yog lub cev qhov chaw ntawm MRI teeb liab nyob rau hauv feem ntau ntawm cov kev siv tshuaj kho mob. Cov dej molecules undergo chaotic perpetual microscopic motion, hu ua molecular diffusion, tshawb txog qhov muaj nyob rau hauv intra- thiab extracellular compartments. Nyob rau hauv lub xub ntiag ntawm ib tug muaj zog static magnetic teb, cov hydrogen nuclear spin pib tig ib ncig ntawm lub axis ntawm lub teb nyob rau hauv ib tug txheej txheem hu ua precession. Lub precession zaus yog ncaj qha proportionate rau lub amplitude ntawm static magnetic teb.
Tus paub zoo spin echo MR txheej txheem [5] yields intra-voxel refocusing ntawm spin los ntawm "lub sij hawm mirroring" tus neeg sib txawv nyob rau hauv precession frequencies. Cov zaus offsets tuaj yeem tshwm sim vim qhov tsis sib xws hauv cheeb tsam ntawm qhov chaw sib nqus zoo li qub lossis tuaj yeem ua rau muaj kev cuam tshuam los ntawm kev siv cov hlau nplaum gradient pulses. Spin echo refocusing yog qhov tsis zoo yog tias qhov pom kev sib tw tau ua rau muaj kev ntxhov siab, sib xws rau ib feem poob ntawm spin coherence thiab attenuation ntawm spin echo teeb liab siv [6]. Yog li ntawd, pom MRI teeb liab muaj cov ntaub ntawv hais txog kev txav ntawm cov dej molecular thiab tshwj xeeb, kev txwv tsis pub txav vim muaj ntau yam kev lom zem [4].
Hauv qhov nruab nrab dawb, qhov tshwm sim los nrhiav cov dej molecule tom qab lub sijhawm muab yog 3D isotropic Gaussian muaj nuj nqi, nrog rau qhov dav dav ntawm ib nrab siab tshaj plaws (FWHM) nce proportionally rau lub hauv paus square ntawm lub sij hawm soj ntsuam. Nyob rau hauv cov ntaub ntawv no, ib tug scalar tus nqi, qhov pom tseeb diffusion coefficient (ADC, mm2 ·s −1), yog txiav txim raws li ib tug ntsuas ntawm qhov diffusion qhov magnitude [7] thiab lub MRI teeb liab attenuation yog ib tug exponential muaj nuj nqi ntawm ib theem zuj zus gradient qhov hnyav. Lub zog ntawm cov hlau nplaum gradients yog lub npe siv tsab ntawv "b" ua raws li tus lej sib txawv uas sawv cev rau qhov amplitude thiab lub sijhawm ntawm cov ntawv thov gradients, qhia hauv SI base units ntawm s·mm-2. Cov khub ntawm b-tus nqi sib txawv ntawm 0–500 lossis 1000 s/mm2 rau lub plab thiab 0–200 thiab 1000 s/mm2 rau lub plab [8].
Hauv kev kuaj pom prostate, qhov tseem ceeb ntawm 0 thiab 2000 s / mm2, piv txwv li, b50, b500, b1000, b1500, thiab b2000. Diffusion-weighted sequences siv gradient tus nqi siab dua 1000 s / mm2 tuaj yeem raug xa mus rau siab (los yog ultra-high) b-tus nqi DW sequences thiab lawv qhov tseem ceeb hauv prostate MRI tau pom los ntawm ntau qhov kev tshawb fawb [9,10]. Nyob rau hauv lub xub ntiag ntawm xws li gradients, yog hais tias barrier-zoo li cov qauv txwv molecular txav nyob rau hauv ib cov ntaub so ntswg, lub siab MR teeb liab yuav raug khaws cia thiab cov ntaub so ntswg yuav tshwm sim txawv hyperintense ntawm DW dluab thiab hypointense ntawm ADC, xav txog qhov txo cov dej diffusion. Hauv txoj kev xav, txoj hauv kev yooj yim tshaj plaws los ntsuas ADC tsuas yog yuav tsum tau DWI kev yuav khoom rau ob qhov b-tus nqi thiab ib qho monoexponential haum, tab sis lwm cov qauv nyuaj tau tsim los piav qhia txog cov dej molecule hauv cov ntaub so ntswg. Cov qauv no tau raug tshawb xyuas tsuas yog hauv cov prostate thiab tau piav qhia nyob rau hauv seem nplooj siab.
Txij li thaum MRI tsis ncaj qha piv rau cov khoom, tab sis nws cov spatial zaus (tso rau hauv qhov chaw hu ua k-space) nws yog qhov tshwj xeeb tshaj yog rau kev txav. Cov ntaub so ntswg txav thaum lub sij hawm tau txais yields nruab nrab thiab tej zaum hnyav artifacts [11], piv txwv li, blurring, ghosting, thiab hloov cov ntaub so ntswg sib piv. Ntau yam kev txo qis tau raug tsim los kho kev txav thaum tau txais. Txoj kev yooj yim tshaj plaws kom tsis txhob ua pa tawm yog kom tau txais cov duab thaum ua pa tuav. Ib ntus synchronization ntawm MR teeb liab tau txais nrog cov lus tsa suab ntawm lub cev yog tom qab ntawd tau txais kev siv los yog synchronization rau ECG lossis ua pa waveforms. Cov txheej txheem ntau ntxiv muaj xws li taug qab cov ntaub so ntswg txoj hauj lwm los ntawm kev siv MR-raws li navigators rau yav tom ntej lossis rov qab ua kom raug cov lus tsa suab. Hauv qhov chaw kho mob, kev nrhiav tau ntawm lub raum zoo lossis cov duab pelvic DW hauv ib qho apnea tsis yog ib txwm ua tau. Yog li ntawd, cov tswv yim them nyiaj yuav tsum tau txhim kho cov duab zoo ntawm DWI thiab kom tsis txhob muaj qhov cuam tshuam ntawm cov macroscopic txav ntawm dej diffusion [12,13].
Txhawm rau txo qhov cuam tshuam ntawm lub cev txav mus ntxiv, DWI tau txais kev pom zoo los ntawm kev siv ib zaug txhaj tshuaj encoding schemes uas yog hu ua echo planar imaging (EPI). Hauv EPI, qhov pib excitation RF pulse ua rau MR teeb liab yog ua raws li cov qauv gradient thiab refocusing RF pulses uas npog k-chaw ntawm txhua daim. Lub k-chaw nyob rau hauv lub zaus domain ces hloov mus rau hauv ib daim duab uas siv cov lej ua haujlwm, Fourier hloov. EPI yog nquag mus rau geometric distortion thaum lub zos magnetic teb yog inhomogeneous thiab rau lwm yam complex artifacts, xws li imperfect saturation ntawm cov roj teeb liab. Ib qho kev daws teeb meem los kov yeej cov kev txwv no yog qhov segmentation ntawm k-chaw tsis tau ntawm tus nqi ntawm lub sijhawm nce ntxiv. Cov txheej txheem "Resolve" (REadout Segmentation Of Long Variable Echo-trains) txheej txheem [14] muaj qhov luv luv ntawm cov kab nyeem ntawv hauv k-qhov chaw uas tau muab faib ua ntau pawg sib luag, tsawg kawg peb. Cov yam ntxwv no tso cai rau txo qis lub sijhawm ncha thiab lub sijhawm hloov pauv zaus. Nyob rau hauv rov qab, cov txheej txheem muab cov duab sharper uas feem ntau tsis muaj distortion thiab siab spatial daws teeb meem, tso cai rau dav siv nyob rau hauv prostate thiab lub raum DWI.
Cistanche capsules
Diffusion-Weighted Poj Niam Pelvis Imaging
Magnetic resonance imaging yog ib qho kev qhia ntxiv uas feem ntau ua tom qab ultrasound. DWI yog qhov tseem ceeb thiab ua tiav hauv cov poj niam feem ntau cov kev tshawb fawb pelvic ntxiv rau cov pa morphologic T1- thiab T2-Weighted (T2W) sequences, raws li qhia hauv daim duab 1. DWI, ua ke nrog dynamic contrast-enhanced (DCE ) imaging, yog ib feem ntawm lub functional imaging apparatus uas nyob rau hauv tsis ntev los no lub sij hawm nce lub diagnostic kev ua tau zoo ntawm MRI nyob rau hauv lub teb ntawm gynecology oncology. Raws li DWI raug kev txom nyem los ntawm kev daws teeb meem tsis zoo, thiab yog li ntawd, tsawg dua lub ntsiab lus anatomical, nws yuav tsum tau siv rau hauv kev koom tes nrog morphologic T2W ib ntus [15]. DWI yog qhov tshwj xeeb tshaj yog nyob rau hauv kev ntsuam xyuas ntawm endometrial thiab mob qog noj ntshav, pab kom sib txawv ntawm benign thiab malignant uterine los yog zes qe menyuam lesions thiab ntsuam xyuas lub peritoneal qog extension ntawm gynecologic cancers [16].
Daim duab 1. Tus poj niam lub plab ib txwm muaj 26-xyoo nyob rau hauv lub dav hlau coronal. (A) T2W duab; (B) ADC daim ntawv qhia; (C) b-tus nqi=0 s/mm2 DW duab; (D) b-tus nqi=1000 s/mm2 DW duab. Peb pom qhov ploj ntawm cov teeb liab kua dej siab (raws li ib qho hauv lub zais zis) nrog nce b-tus nqi tab sis qhov kev pheej hmoo ntawm kev siv lub teeb liab siab ntawm siab b-tus nqi rau lub endometrium.
Feem ntau cov qog nqaij hlav ntawm lub ncauj tsev menyuam yog squamous cell carcinomas, paub tias muaj feem cuam tshuam nrog tib neeg papillomavirus (HPV) thiab ntau dua li adenocarcinomas ntawm lub ncauj tsev menyuam. Thaum qhov kev kuaj mob biopsy-pov thawj, lub luag haujlwm ntawm kev kuaj pom hauv kev mob qog noj ntshav yog. Lub International Federation of Obstetrics thiab Gynecology (FIGO) staging yog qhov tseem ceeb rau kev tswj xyuas oncological. Nws suav nrog carcinoma nyob rau hauv situ (Tis), carcinoma nyob rau hauv lub tsev menyuam (T1), carcinoma invading tshaj lub tsev menyuam (T2), carcinoma txuas mus rau pelvic phab ntsa thiab / los yog cuam tshuam rau sab thib peb ntawm qhov chaw mos (T3), thiab carcinoma invading. lub zais zis los yog qhov quav (T4). Pelvic MRI raug pom zoo rau qhov chaw hauv zos ntawm cov qog nqaij hlav hauv tsev menyuam raws li tau hais tseg hauv 2018 FIGO staging hloov tshiab [17].
Cistanche extract
Ntxiv rau qhov morphologic T2W sequences, DWI yog siv los ntsuam xyuas lub zos txuas ntxiv ntawm cov qog nqaij hlav cancer thiab sib npaug rau qhov sib piv-txhim kho MRI [18]. Lub T2W axial oblique dav hlau perpendicular mus rau lub axis ntev ntawm lub ncauj tsev menyuam yog ib qho tseem ceeb hauv kev ntsuam xyuas parametrial ntxeem tau (theem IIB) thiab tuaj yeem koom ua ke nrog tus nqi siab b-tus nqi DW ib ntus txhawm rau txhim kho qog nqaij hlav delineation [19], raws li pom hauv daim duab 2. Cervical carcinomas yog tus cwj pwm los ntawm hypercellularity uas ua rau muaj teeb liab siab (SI) ntawm siab b-tus nqi (1000 s/mm2) DW cov duab thiab qhov qis qis qis qis (SI) ntawm daim ntawv qhia ADC piv rau lub ncauj tsev menyuam ib txwm muaj stroma [16]. Txog tam sim no, tsis muaj ADC txiav tawm tus nqi tau raug lees paub los kwv yees qhov muaj qhov tsis zoo, feem ntau yog vim muaj kev sib koom ua ke ntawm tus nqi ADC suav thiab qhov ntau ntawm b-tus nqi siv rau kev suav [16]. Hauv cov ntsiab lus ntawm kev soj ntsuam tom qab siv hluav taws xob hauv zos thiab kev kho cov tshuaj tua kab mob, DWI yog siv los sib txawv ntawm cov kab mob seem thiab cov fibrosis hauv zos [20], nrog rau txhawm rau kuaj cov qog rov ua dua [21]. DWI kuj tseem tuaj yeem siv los ua biomarker rau kev soj ntsuam qog cov lus teb [22,23]. Hauv kev tshawb xyuas meta-tshaj tawm tsis ntev los no ntawm kev siv cov kev txawj ntse (AI) hauv cov qog nqaij hlav qog noj ntshav, mob qog noj ntshav hauv tsev menyuam tau raug rau ntau cov kev tshawb fawb (34 los ntawm 71) feem ntau tsom mus rau qhov muaj txiaj ntsig ntawm kev kuaj pom [24]. Raws li tag nrho cov MR sequences tau siv los ua ke hauv AI, nws tseem nyuaj rau kev nthuav dav cov txiaj ntsig tshwj xeeb ntawm DWI hauv hom dub lub thawv no.
Daim duab 2. MR duab ntawm 66- poj niam muaj hnub nyoog uas muaj tus kab mob khees xaws ncauj tsev menyuam. (A) Sagittal T2W duab; (B) axial T2W duab perpendicular rau lub ncauj tsev menyuam axis. Cervical cancer thiab nws qhov txuas ntxiv tshwm sim raws li qhov sib txawv T2W cheeb tsam ( xub) los ntawm qhov qub stroma thiab txoj cai parametrium, (C) siab b-tus nqi (b=1000} s / mm2) thiab (D) fusion dluab ntawm T2W thiab siab b-tus nqi sequences rau kev soj ntsuam zoo dua ntawm tus kab mob carcinoma txuas ntxiv.
Endometrial carcinoma yog hom kab mob gynecological ntau tshaj plaws hauv cov teb chaws tsim, hais txog cov poj niam hnub nyoog 50 xyoo. Raws li Bokhman cais. tion (25], Hom I endometrial qog tseem hu ua endometrioid carcinoma yog hom mob qog noj ntshav ntau tshaj plaws, nrog rau cov txiaj ntsig zoo tshaj plaws. Raws li FIGO kev faib tawm, theem I ntawm cov qog yog txwv rau lub cev ntawm lub tsev menyuam, thiab theem ll yog txhais los ntawm kev txuas ntxiv los ntawm lub ncauj tsev menyuam stroma. Qhov chaw mos parametrium, thiab / los yog hauv pem teb pelvic, los yog nthuav tawm para-aortic lymphadenopathy thaum theem IV yog txhais los ntawm kev ncua ntawm cov qog mus rau lub zais zis los yog lub plab los yog muaj cov metastases nyob deb.
MRI nyob rau hauv endometrial cancer yog ua rau theem ntawm tus kab mob. Kev cuam tshuam tsawg dua 50 feem pua ntawm cov myometrium kom cais theem la thiab Ib yog ua raws li lub dav hlau morphologic T2W perpendicular mus rau cov kab noj hniav endometrial. Kev mob qog noj ntshav endometrial feem ntau yog hyperintense rau myometrium tab sis tuaj yeem nyuaj rau kev sib txawv ntawm cov ntaub so ntswg nyob ib puag ncig raws li qhia hauv daim duab 3. Ntawm DWI mob qog noj ntshav qhia txog kev txwv tsis pub muaj qhov siab b-1000 teeb liab thiab qis ADC qhov tseem ceeb piv rau lub cev endometrium thiab nyob sib ze myometrium. Qhov sib ntxiv ntawm DWI rau T2W imaging zoo txhim kho cov theem ntawm endometrial cancer (26,27]. Nws yog qhov tseem ceeb tshaj rau cov neeg mob uas lub raum tsis ua haujlwm uas tsis tuaj yeem tau txais txiaj ntsig los ntawm kev tswj hwm gadolinium, thiab yog li ntawd, los ntawm kev sib piv-txhim kho MRI, txawm li cas los xij, kev sib xyaw ntawm DWI thiab qhov sib piv-txhim kho MRI tseem yog txoj hauv kev zoo tshaj plaws los kwv yees myometrial ntxeem tau, raws li kev txhawb nqa los ntawm kev kawm tsis ntev los no ntawm kev kawm tshuab (28)DWI kuj tseem pab tau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau ntawm DWI nrog qis ADC qhov tseem ceeb nyob rau hauv lub endometrial kab noj hniav sib haum mus rau secretory thiab hyperplastic endometrium los yog ntshav thaum lub sij hawm poj niam voj voog uas yog yooj yim pom los ntawm nws cov teeb liab siab ntawm T1W FatSat sequences (8].
Daim duab 3. MR duab ntawm endometrial carcinoma nyob rau hauv ib tug 93- poj niam hnub nyoog. (A) Sagittal T2W duab nyob rau hauv lub endometrial kab noj hniav nrog extension nyob rau hauv lub myometrium me dua 50 feem pua ntawm nws thickness. (B) ADC daim ntawv qhia qhia txwv tsis pub muaj kev sib kis hauv cov kab mob endometrial pom raws li thaj chaw tsaus nti ( xub) nyob rau hauv kev tawm tsam nrog (C) siab teeb liab ( xub) ntawm cov duab b-tus nqi siab (b=1000 s/mm?). (D) tom qab txhaj tshuaj ntawm gadolinium T1W daim duab qhia tau hais tias endometrial carcinoma ( xub) nrog kev txhim kho tsawg dua li cov leeg myometrium.
Leiomyosarcomas yog cov qog nqaij hlav tsis tshua muaj ntawm lub tsev menyuam thiab suav nrog tsawg dua 10 feem pua ntawm cov qog nqaij hlav hauv tsev menyuam. Qhov sib txawv ntawm benign leiomyoma thiab leiomyosarcoma yog qhov tseem ceeb rau kev tswj kev phais ntawm cov kab mob no. MRI thiab tshwj xeeb tshaj yog DWl ua lub luag haujlwm tseem ceeb hauv kev ua tus cwj pwm thiab kev tswj cov qog nqaij hlav. Ntxiv rau qhov tshwj xeeb morphologic ntawm leiomyosarcoma, xws li T2 teeb liab nruab nrab, nodularborders, thiab hemorrhagic Cheebtsam, "T2 qhov tsaus ntuj thiab hauv nruab nrab qhov tsis zoo (291DW-raws li tsis yog lwm yam tseem ceeb rau kev sib txawv ntawm benign leiomyoma los ntawm leiomyosarcoma. , uterine leiomyosarcoma feem ntau qhia tau hais tias tsis tshua muaj ADC qhov tseem ceeb thiab nce cov teeb liab siv rau siab b-tus nqi DW cov duab piv rau cov myometrium li qub (15]. Hauv meta-kev tshuaj ntsuam ntawm Virarkar et al. uas suav nrog 795 tus neeg mob los ntawm yim kev tshawb fawb, ADC qhov tseem ceeb tau nce. qis dua hauv leiomyosarcoma dua li hauv leiomyomas (30]. Nyob rau hauv ib qho kev tshawb nrhiav tsis ntev los no-tswj rov qab, Wahab li al. tau npaj ib qho kev kuaj mob kom paub qhov txawv ntawm leiomyomas los ntawm uterine sarcomas raws li muaj cov lymphadenopathy siab dua SI ntawm cov duab b-tus nqi siab nyob rau hauv pawg. txheeb ze rau endometrium thiab ADC tus nqi qis dua 0.905 x 10-3 mm?/s 31]. Qhov sib txawv ntawm qhov rhiab heev thiab qhov tshwj xeeb ntawm cov algorithm no los faib cov uterine masses yog 97 feem pua thiab 99 feem pua hauv kev cob qhia ntawm 156 tus neeg mob, 88 feem pua thiab 100 feem pua hauv thawj qhov kev lees paub ntawm 42 tus neeg mob, thiab 83 feem pua thiab 97 feem pua hauv qhov kev lees paub thib ob ntawm 59 tus neeg mob. Focally los yog thoob ntiaj teb txo T2W Sland DWI-raws li SI qis dua lub endometrium tso cai rau peb kom ntseeg siab kuaj xyuas qhov loj li benign [31]. Txawm li cas los xij, qhov kev cia siab no yuav tsum muaj kev lees paub ntxiv los ntawm cov kev tshawb fawb multicentric yav tom ntej.
Daim duab 4. MR cov duab ntawm leiomyosarcoma nyob rau hauv ib tug 54- poj niam hnub nyoog. (A) voluminous leiomyosarcoma nrog ib tug intermediary 2W teeb liab thiab irregular ciam teb ( xub xub). Ib feem ntawm cov leiomyosarcoma qhia txog kev txwv tsis pub muaj kev txwv tsis pub muaj (B) ADC qhov tseem ceeb thiab cov teeb liab siab ntawm (C) b-1000 sequenceD) tom qab txhaj tshuaj ntawm gadolinium T1 W ib ntus qhia qhov tsis muaj kev txhim kho hauv nruab nrab raws li qhov nruab nrab necrosis. Tag nrho cov nta yog cov yam ntxwv ntawm malignancy nyob rau hauv ib tug leiomyoma.
Cov qog zes qe menyuam feem ntau yog hom mob qog noj ntshav (95 feem pua), suav nrog cov qog nqaij hlav qog nqaij hlav thiab cov qog nqaij hlav. Ob pawg lwm yam muaj xws li poj niam txiv neej-cord stromal qog thiab cov kab mob qog nqaij hlav. Cov qog nqaij hlav zes qe menyuam yog qhov ua rau tuag taus ntawm tag nrho cov qog nqaij hlav hauv gynecological nrog qhov kev ntsuas pom los ntawm qhov pib theem thaum kuaj pom. Yog li ntawd, tus cwj pwm meej yog qhov tseem ceeb los muab kev txiav txim siab ntawm tus neeg mob qhov kev mob tshwm sim. Thawj qhov kev kuaj mob feem ntau ua tiav los ntawm kev kuaj ultrasound thaum MRI khaws cia rau qhov tsis paub meej.
Cov zes qe menyuam feem ntau qhia siab SI ntawm ob qho tib si b-tus nqi sequences thiab cov ntaub ntawv ADC sib raug, sib xws rau qhov hu ua "T2 ci-through" nyhuv. DWI yog qhov tseem ceeb rau tus cwj pwm ntawm cov khoom tsis txaus ntseeg nyob rau hauv heterogeneous complex zes qe menyuam, txheeb xyuas cov ntsiab lus ntawm cov cellularity siab hauv cov qog nqaij hlav qog nqaij hlav cancer (32 raws li European Society of Urogenital Radiology (ESUR) tam sim no cov lus pom zoo (33Illustraative MR dluab ntawm adenocarcinoma tuaj yeem pom hauv Daim duab 5. Kev sib koom ua ke ntawm qhov siab b-tus nqi DWI thiab cov duab morphologic T2W yog qhov ua tau zoo heev rau lub hom phiaj no.Qhov kab mob adnexal tuaj yeem raug cais raws li benign thaum nws cov khoom tivthaiv yog hypointense ntawm ob lub siab b-tus nqi DWI thiab cov duab T2W. (dark/dub" lesion) (34]. Txawm li cas los xij, DWI ib leeg tsis txaus los ntsuas qhov malignancy ntawm cov qog zes qe menyuam, raws li qee qhov mob benign, xws li mature cystic teratomas, endometriomas, lossis functional hemorrhagic cysts tuaj yeem ua rau muaj kev cuam tshuam tsis zoo ( 16,32,35]. Dynamic contrast-enhanced MRI sequences yog qhov tseem ceeb rau kev soj ntsuam ntxiv qhov tshwm sim ntawm malignancy.
Daim duab 5. Histologically proven sab laug zes qe menyuam adenocarcinoma nyob rau hauv ib tug poj niam muaj hnub nyoog 64-xyoo. (A) T2Whyperintense heterogeneous sab laug adnexal loj ntawm lub tsev menyuam (*). Tissular bilobed sab laug adnexal huab hwm coj nrog rau qhov qis (B) ADC qhov tseem ceeb thiab siab (C) b-1000 teeb liab raws li qhov kev txwv tsis pub muaj nyob hauv qhov txhab (C). Tom qab txhaj tshuaj ntawm gadolinium (D) T1W ib ntus nrog fat-sa turation qhia txog kev txhim kho heterogeneous ( xub xub).
Lub luag haujlwm tseem ceeb ntawm DWI hauv kev ua tus cwj pwm ntawm cov qog ntawm zes qe menyuam tau pom zoo hauv kev qhia tsis ntev los no ntawm Ovarian-Adnexal Reporting thiab Data System (O-RADS)-MRI scoring system, kev siv zog thoob ntiaj teb los txhim kho tus qauv ntawm adnexal MRI cov ntaub ntawv (36 , 37]. T2W cov duab thiab DWI txaus los sib txawv cov kab mob uas muaj cov ntsiab lus tseem ceeb hauv cov xwm txheej zoo (O-RADS-MRI 2) thiab siab dua (O-RADS-MRI3 txog 5), raws li cov qauv txhim kho ntawm homogenously hypointense lesions ntawm T2W thiab DWimages tsis cuam tshuam rau O-RADS-MRI kev faib tawm (37]. Cov qhab nia ntawm O-RADS-MRI raug tsim los ntawm qhov kev cia siab, ntau qhov kev tshawb fawb hauv 1194 cov poj niam nrog kev kuaj mob histologic thiab {{20} Cov txiaj ntsig kev pheej hmoo ua rau muaj qhov tseeb tag nrho ntawm 92 feem pua, rhiab heev ntawm 93 feem pua, qhov tshwj xeeb ntawm 91 feem pua, tus nqi kwv yees zoo ntawm 71 feem pua, thiab tus nqi kwv yees tsis zoo ntawm 98 feem pua. kev pom zoo zoo ntawm cov menyuam yaus thiab cov neeg nyeem paub txog, raws li tau lees paub los ntawm kappa-cov qhab nia ntawm 0.784 [36]. O-RADS-MRI validation thiab kev txais neeg kho mob tau zoo siab [38,39] thiab yuav raug txhim kho ntxiv thaum muaj kev pom zoo rau kev tswj xyuas muaj [40].
Cistanche ntxiv
Qee qhov pitfalls nyob rau hauv kev ntsuam xyuas ntawm diffusion-weighted dluab yuav tsum tau zam. Raws li tau hais dhau los, T2 ci-dhau los ntawm, pom tias muaj kev mob siab ntxiv mus thoob plaws b-tus nqi siab thiab ADC cov duab, yog ib qho ntawm lawv. Tsis yog tag nrho cov qauv nrog cov teeb liab siab ntawm kev nthuav dav yog mob qog noj ntshav thiab ib qho yuav tsum paub tias cov ntaub so ntswg noj qab haus huv tuaj yeem ua rau qis ADC qhov tseem ceeb thiab cov teeb liab siab ntawm cov duab b-value: ib txwm endometrium, plob tsis so tswj, ob lub raum, spleen, thiab lymph nodes [41,42] . Lwm cov txheej txheem, xws li qhov loj me, qhov sib txawv, thiab cov txiaj ntsig ADC tsawg heev tuaj yeem pab ua kom cov qog ntshav qab zib txawv txav los ntawm ib txwm muaj. Lub cev endometrium nyob rau hauv cov poj niam ntawm lub hnub nyoog yug me nyuam kuj tseem tuaj yeem pom muaj kev txwv tsis pub muaj kev cuam tshuam vim yog cov ntaub so ntswg ntawm cov cell ceev. Hauv qhov teeb meem no, kev ntsuam xyuas ntau ntawm cov ntaub so ntswg ntawm ADC daim ntawv qhia yuav tsum tau nrhiav, raws li cov qog endometrial tam sim no nrog cov txiaj ntsig ADC qis dua piv rau cov ntaub so ntswg uas nyob ib sab [15,16].
Hauv kev xaus, DWI yog qhov tseem ceeb los txiav txim siab qhov mob ntawm lub plab pelvic thiab ntsuam xyuas lawv qhov txuas ntxiv. Nws yog ib qho tseem ceeb ua ntu zus uas yuav tsum yog ib feem ntawm txhua qhov kev kuaj mob pelvic MRI. Kev soj ntsuam ntawm cov kab ke no yuav tsum siv ob qho tib si b-values sequences thiab ADC daim ntawv qhia kom tsis txhob muaj kev txhais lus tsis raug thiab yuav tsum muab piv rau cov teeb liab ntawm cov qauv uas nyob ib sab hauv lub plab mog. Nws yuav tsum tau soj ntsuam ua ke nrog cov morphologic T2W, T1W, thiab gadolinium-based sequences kom tsis txhob misdiagnosing ib co benign pelvic lesions li malignant.
Cov ntaub ntawv
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Thomas De Perrot 1, Christine Sadjo Zoua 1, Carl G. Glessgen 1, Diomidis Botsikas 1, Lena Berchtold 2, Rares Salomir 1, Sophie De Seigneux 2, Harriet C. Thoeny 3 thiab Jean-Paul Vallée 1
1 Division of Radiology, Geneva University Hospitals thiab University of Geneva, 1205 Geneva, Switzerland; christine.sadjo@hcuge.ch (CSZ); carl.glessgen@hcuge.ch (CGG); diomidis.botsikas@hcuge.ch (DB); raresvincent.salomir@hcuge.ch (RS); jean-paul.vallee@hcuge.ch (J.-PV)
2 Division of Nephrology, Geneva University Hospitals, 1205 Geneva, Switzerland; lena.berchtold@hcuge.ch (LB); sophie.deseigneux@hcuge.ch (SDS)
3 Division of Radiology, Hôpital Cantonal Fribourgois, 1752 Villars-sur-Glâne, Switzerland; harriet.thoeny@h-fr.ch ib
