磁共振弥散加权成像在肝脏恶性肿瘤诊断中的应用
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摘要
恶性肿瘤是严重危害人们健康和生命的常见疾病之一,早期、明确的诊断对治疗恶性肿瘤起着关键性的指导作用。影像学检查是诊断恶性肿瘤的重要手段,其结果往往直接影响到临床治疗方法的选择及预后的判断。目前的影像学检查(超声、X片、CT、MRI等)都是通过形态学的影像来实现的,无法反映肿瘤组织的微观变化,从而导致了治疗开展的滞后性和盲目性。近年来快速发展的MR功能成像突破了常规影像学检查只反映形态改变的限制,从人体组织器官的生物学、生理和生化代谢功能角度出发,获得动态的定量资料,从而在软组织肿瘤定性、判断肿瘤的恶性程度及术后疗效判定等方面逐渐显现出优势。而弥散加权成像(Diffusion-Weighted Imaging,DWI)是MR功能影像的一种,它可以通过检测活体组织内部水分子无规则的扩散运动,反映机体组织微观空间的组成变化和病理生理状态下各组织成分之间水分子交换的功能状况,从而为肿瘤的诊断提供更多的信息,进而更好的指导治疗,提高患者的生存质量和延长生存期。目前利用DWI及表观弥散系数(Apparent Diffusion Coefficient, ADC值)协助肿瘤诊断,较多地是应用于颅脑肿瘤、直肠肿瘤的研究。在鉴别肝脏良恶性肿瘤方面,国内外学者也进行了相对较多的研究,但对于鉴别不同病理类型的肝脏恶性肿瘤的研究鲜有报道。
目的:本实验通过应用磁共振弥散加权成像技术,探讨肝组织以及不同病理类型的肝脏恶性肿瘤病灶的平均ADC值、变化规律,从而为临床早期诊断肝脏恶性肿瘤提供有价值的依据。
方法:肝脏恶性肿瘤患者26例,男21例,女5例,中位年龄54岁(28～65岁),所有病例均经肝穿刺活检病理组织学检查证实。其中肝细胞癌14例,胆管细胞癌5例,肝转移癌7例。所有患者均在治疗前1天行常规MRI扫描(T1WI、T2WI)及弥散加权成像扫描(弥散敏感因子b值取50,400,1000)。在由相应层面DWI图像通过影像后处理工作站自动拟合而成的ADC图上,随机选取五个感兴趣区( region of interest, ROI),利用计算机软件直接测量肿瘤组织的表观弥散系数(ADC值),取其平均值。如1个病例有多个病灶,只选取病理结果所对应的病灶进行测量。感兴趣区为避免测量误差,注意避开瘤内原有坏死区、血管、胆管等部位。同样的方法获得肝组织的ADC值。应用配对样本T检验(Paired-Sample T Test ),对不同病理类型肝脏恶性肿瘤患者病灶与周围正常肝组织的ADC值进行比较,以P <0. 05认为差异有显著性意义;应用单因素方差分析,对不同病理类型肝脏恶性肿瘤病灶的ADC值进行组间两两比较,以P<0.05认为差异有显著性意义。
结果:
1图像的分析
当b=50、400、1000 s/mm2时,所见肝癌病灶在DWI图像上均为高信号或中高信号,提示DWI图像是显示病灶的敏感方法。
2 ADC值的比较
2.1不同类型肝癌病灶与周围肝组织的比较
在b值为50、400和1000 s/mm2时,肝细胞癌患者病灶平均ADC值是(0.85±0.13)×10-3mm2/s,肝组织的平均ADC值是(1.01±0.20)×10-3mm2/s,t=9.142,P=0.000<0.05,结果显示两者之间差异有统计学差异;胆管细胞癌患者病灶平均ADC值是(0.88±0.12)×10-3mm2/s,肝组织的平均ADC值是(0.96±0.20)×10-3mm2/s,t=6.880,P=0.003<0.05,结果显示两者之间有统计学差异;肝转移瘤患者病灶平均ADC值是(0.93±0.07)×10-3mm2/s,肝组织的平均ADC值是(0.98±0.20)×10-3mm2/s,t=2.998,P=0.037<0.05,结果显示两者之间有统计学差异;
2.2不同类型肝癌病灶之间的比较
肝细胞癌与肝转移瘤在同一b值下的ADC值之间差异具有统计学意义(P<0.05);胆管细胞癌与肝转移瘤在同一b值下的ADC值之间差异具有统计学意义(P<0.05);肝细胞性癌与胆管细胞癌在同一b值下的ADC值之间差异无统计学意义(P=0.276)。
结论:不同病理类型的肝脏恶性肿瘤在DWI中具有不同的特征,结合ADC值的量化特征,对肝脏恶性肿瘤的鉴别有一定的参考价值。通过对病灶的ADC值进行量化分析,能为肝脏恶性肿瘤的定性诊断提供重要依据。
Cancer is one of the common diseases which harm people's health and lives seriously. Early and clear diagnosis plays a critical role in guiding treatment of malignant tumor. Imaging examination is an important means for diagnosis of malignant tumors. The result is often a direct impact on the choice of clinical treatment and prognosis. The current imaging studies(ultrasound, X-ray, CT, MRI, etc.) through morphological image to achieve, which can not reflect micro-changes in tumor tissue. So developing the treatment is delayed and blindness. MR functional imaging break through the constraint of the conventional images and show up ascendancy in qualitation, the judgement of malignant degree and curative effect of tumors from biology, physiology and biochemistry. DWI is one of the MR functional imaging and show physiological and pathological changes through measuring the microscopic molecular movement of water in the tissues. This technique can provide more information for guiding the continued treatment plans and lasting life time. At present, most of the researches in diagnosis of tumor using DWI and ADC value is major of brain and rectal tumors. Many scholars has studied in differentiating benign and malignant tumors in liver through DWI, but the research of identification different pathological types of liver cancer using DWI and ADC is rare.
Objective: In this experiment, we discuss the changes and significance of mean apparent diffusion coefficient(ADC) value in and provid valuable evidences for judgement effect of diagnoses of liver cancer in the early stage. Methods: 26 patients ( 21 male patients and 5 female patient, aged 28 to 65 years, mean 54 years) with liver malignant Tumor.All these were confirmed by pathological examination. 14 patients with hepatocellular carcinoma,5 patients with cholangiocellular carcinoma,7 patients with hepatatic metastatic neoplasms.Before treatment conventional MRI and DWI were performed in 26 patients, respectively. To choose five(region of interests, ROIs) in ADC map randomly and measure the ADC values of tumor tissue. If there are multiple lesions in a case, only selected the results corresponding to the pathological lesions to measure.ROIs get out of zone of necrosis, blood vessel, bile vessel in order to avoid error of measurement. The ADC values of liver were obtained in the same method. T2WI image were loaded in Argus browser and compute tumor volume through the software. To compare ADC values of patients with different pathological types of liver lesions and the surrounding normal liver tissue using Paired-Sample T Test. If P<0.05, the difference was significant. Application of single-factor analysis of variance, for different types of liver pathology of ADC values of malignant lesions in pairwise comparison between groups.If P<0.05, the difference was significant. Results:
2.1 Different types of liver lesions compared with the surrounding liver tissue
The average ADC value of tumor tissue of the patients with hepatocellular carcinomathe(0.85±0.13)×10-3mm2/s,if the value b denfined 50、400和1000 s/mm2. The average ADC value of liver tissue i(s1.01±0.20)×10-3mm2/s,t=9.142,P=0.000<0.05. The results showed that they had significant statistically between them. The average ADC value of tumor tissue of the patients with cholangiocellular carcinoma is (0.88±0.12)×10-3mm2/s, The average ADC value of liver tissue is (0.96±0.20)×10-3mm2/s,t=6.880,P=0.003<0.05. The results showed that they had significant statistically between them. The average ADC value of tumor tissue of the patients with hepatatic metastatic neoplasms is (0.93±0.07)×10-3mm2/s, The average ADC value of liver tissue i(s0.98±0.20)×10-3mm2/s,t=2.998,P=0.037<0.05. The results showed that they had significant statistically between them.
2.2 comparison with the different types of liver cancer
The average ADC value in Hepatocellular carcinoma and liver metastases have significant statistically at the same value b.
Conclusion:Different pathological types of liver cancer have different feature at different DWI. It is helpful for Identification in liver malignant tumors. through quantitative analysis of the ADC values, it can Provide an important basis for Qualitative diagnosis of liver cancer.
目的:本实验通过应用磁共振弥散加权成像技术,探讨肝组织以及不同病理类型的肝脏恶性肿瘤病灶的平均ADC值、变化规律,从而为临床早期诊断肝脏恶性肿瘤提供有价值的依据。
方法:肝脏恶性肿瘤患者26例,男21例,女5例,中位年龄54岁(28～65岁),所有病例均经肝穿刺活检病理组织学检查证实。其中肝细胞癌14例,胆管细胞癌5例,肝转移癌7例。所有患者均在治疗前1天行常规MRI扫描(T1WI、T2WI)及弥散加权成像扫描(弥散敏感因子b值取50,400,1000)。在由相应层面DWI图像通过影像后处理工作站自动拟合而成的ADC图上,随机选取五个感兴趣区( region of interest, ROI),利用计算机软件直接测量肿瘤组织的表观弥散系数(ADC值),取其平均值。如1个病例有多个病灶,只选取病理结果所对应的病灶进行测量。感兴趣区为避免测量误差,注意避开瘤内原有坏死区、血管、胆管等部位。同样的方法获得肝组织的ADC值。应用配对样本T检验(Paired-Sample T Test ),对不同病理类型肝脏恶性肿瘤患者病灶与周围正常肝组织的ADC值进行比较,以P <0. 05认为差异有显著性意义;应用单因素方差分析,对不同病理类型肝脏恶性肿瘤病灶的ADC值进行组间两两比较,以P<0.05认为差异有显著性意义。
结果:
1图像的分析
当b=50、400、1000 s/mm2时,所见肝癌病灶在DWI图像上均为高信号或中高信号,提示DWI图像是显示病灶的敏感方法。
2 ADC值的比较
2.1不同类型肝癌病灶与周围肝组织的比较
在b值为50、400和1000 s/mm2时,肝细胞癌患者病灶平均ADC值是(0.85±0.13)×10-3mm2/s,肝组织的平均ADC值是(1.01±0.20)×10-3mm2/s,t=9.142,P=0.000<0.05,结果显示两者之间差异有统计学差异;胆管细胞癌患者病灶平均ADC值是(0.88±0.12)×10-3mm2/s,肝组织的平均ADC值是(0.96±0.20)×10-3mm2/s,t=6.880,P=0.003<0.05,结果显示两者之间有统计学差异;肝转移瘤患者病灶平均ADC值是(0.93±0.07)×10-3mm2/s,肝组织的平均ADC值是(0.98±0.20)×10-3mm2/s,t=2.998,P=0.037<0.05,结果显示两者之间有统计学差异;
2.2不同类型肝癌病灶之间的比较
肝细胞癌与肝转移瘤在同一b值下的ADC值之间差异具有统计学意义(P<0.05);胆管细胞癌与肝转移瘤在同一b值下的ADC值之间差异具有统计学意义(P<0.05);肝细胞性癌与胆管细胞癌在同一b值下的ADC值之间差异无统计学意义(P=0.276)。
结论:不同病理类型的肝脏恶性肿瘤在DWI中具有不同的特征,结合ADC值的量化特征,对肝脏恶性肿瘤的鉴别有一定的参考价值。通过对病灶的ADC值进行量化分析,能为肝脏恶性肿瘤的定性诊断提供重要依据。
Cancer is one of the common diseases which harm people's health and lives seriously. Early and clear diagnosis plays a critical role in guiding treatment of malignant tumor. Imaging examination is an important means for diagnosis of malignant tumors. The result is often a direct impact on the choice of clinical treatment and prognosis. The current imaging studies(ultrasound, X-ray, CT, MRI, etc.) through morphological image to achieve, which can not reflect micro-changes in tumor tissue. So developing the treatment is delayed and blindness. MR functional imaging break through the constraint of the conventional images and show up ascendancy in qualitation, the judgement of malignant degree and curative effect of tumors from biology, physiology and biochemistry. DWI is one of the MR functional imaging and show physiological and pathological changes through measuring the microscopic molecular movement of water in the tissues. This technique can provide more information for guiding the continued treatment plans and lasting life time. At present, most of the researches in diagnosis of tumor using DWI and ADC value is major of brain and rectal tumors. Many scholars has studied in differentiating benign and malignant tumors in liver through DWI, but the research of identification different pathological types of liver cancer using DWI and ADC is rare.
Objective: In this experiment, we discuss the changes and significance of mean apparent diffusion coefficient(ADC) value in and provid valuable evidences for judgement effect of diagnoses of liver cancer in the early stage. Methods: 26 patients ( 21 male patients and 5 female patient, aged 28 to 65 years, mean 54 years) with liver malignant Tumor.All these were confirmed by pathological examination. 14 patients with hepatocellular carcinoma,5 patients with cholangiocellular carcinoma,7 patients with hepatatic metastatic neoplasms.Before treatment conventional MRI and DWI were performed in 26 patients, respectively. To choose five(region of interests, ROIs) in ADC map randomly and measure the ADC values of tumor tissue. If there are multiple lesions in a case, only selected the results corresponding to the pathological lesions to measure.ROIs get out of zone of necrosis, blood vessel, bile vessel in order to avoid error of measurement. The ADC values of liver were obtained in the same method. T2WI image were loaded in Argus browser and compute tumor volume through the software. To compare ADC values of patients with different pathological types of liver lesions and the surrounding normal liver tissue using Paired-Sample T Test. If P<0.05, the difference was significant. Application of single-factor analysis of variance, for different types of liver pathology of ADC values of malignant lesions in pairwise comparison between groups.If P<0.05, the difference was significant. Results:
2.1 Different types of liver lesions compared with the surrounding liver tissue
The average ADC value of tumor tissue of the patients with hepatocellular carcinomathe(0.85±0.13)×10-3mm2/s,if the value b denfined 50、400和1000 s/mm2. The average ADC value of liver tissue i(s1.01±0.20)×10-3mm2/s,t=9.142,P=0.000<0.05. The results showed that they had significant statistically between them. The average ADC value of tumor tissue of the patients with cholangiocellular carcinoma is (0.88±0.12)×10-3mm2/s, The average ADC value of liver tissue is (0.96±0.20)×10-3mm2/s,t=6.880,P=0.003<0.05. The results showed that they had significant statistically between them. The average ADC value of tumor tissue of the patients with hepatatic metastatic neoplasms is (0.93±0.07)×10-3mm2/s, The average ADC value of liver tissue i(s0.98±0.20)×10-3mm2/s,t=2.998,P=0.037<0.05. The results showed that they had significant statistically between them.
2.2 comparison with the different types of liver cancer
The average ADC value in Hepatocellular carcinoma and liver metastases have significant statistically at the same value b.
Conclusion:Different pathological types of liver cancer have different feature at different DWI. It is helpful for Identification in liver malignant tumors. through quantitative analysis of the ADC values, it can Provide an important basis for Qualitative diagnosis of liver cancer.
引文
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13 Van Rijswijk CS, Kunz P, Hogendoorn PC, et al. Diffusion- weighted MRI in the characterization of soft-tissue tumors. JMRI, 2002, 15: 302-307
14 Sinha S, Lucas-Quesada FA, Sinha U, et al. In vivo diffusion- weighted MRI of the breast: potential for lesion characterize- ation.J Magn Reson Imaging, 2002, 15: 693-704
15韩鸿宾,王俭,谢敬霞,等.高扩散敏感系数扩散加权像异常高信号疾病的鉴别诊断[J].中华放射学杂志,2002, 36 (9): 812-816
16 Meyer JR, Gutierrez A, Mock B, et al. High-b-value diffusion-weighted MR imaging of suspected brain infarction [J]. AJNR, 2000, 21(10): 1821-1829
17 Gibbs P, Tozer DJ, Liney GP, et al. Comparison of quant- itative T2 mapping and diffusion-weighted imaging in the normal and pathologic prostate [J]. Magn Reson Imaging, 2001, 46(6): 1054-1058
18张毅,郭顺林,雷军强,等.磁共振扩散加权成像在肝癌介入治疗前后应用的初步研究[J].中国介入影像与治疗学, 2006, 3(3):182-185
19 Chen S,Ikawa F, Kurisu K, et al. Quantitative MR evaluation of intracranial epidermoid tumors by fast fluid-attenuated inversion recovery imaging and echo-plannar diffusion- weighted imaging [J]. AJNR, 2001, 22: 1089-1096
20 Duong TQ,Ackermann JH,Ying HS,et al.Evaluation of extra and intracellular apparent diffusion in normal and globally ischemic rat brain via 19 FNMR[J].Magn Reson Med,1998,40 ( 28 ) :12
21 Nasu,Kuroki Y,Nawano,et al. Hepaticmetastases: diffusion-weighted sensitivity–encoding versus SPI O2 enhanced MR imaging[J].Radiology,2006,261 ( 61 ) :122
22 Koh DM,Riddell A,Husband JE et al.Colorectal livermetastases:e valuation using MnDPDP enhanced MR imaging and breath hold single-shot echo-planar diffusion-weighted MR imaging[J].Eur Radiol,2005, ( 58 ) :144
23 Moteki T,Ishizaka H,Horikoshi H,et al.Differentiation between hemangiomas and hepatocellular carcinomas with the apparent diffusion coefficient calculated from turboFLASH MR images[J].JMagn Reson Imaging,1995,5(2):187-191
24 Ichikawa T,Haradome H,Hachiya J,et al.Diffusion-weighted MR imaging with a single-shot echoplanar sequence:detection and characterization of focal hepatic lesions[J].AJR Am J Roentgenol,1998,170(2):397-402
25 Kim T,Murakami T,Takahashi S,et al.Diffusion-weighted single-shot echoplanar MR imaging for liver disease[J]. AJR Am J Roentgenol, 1999,173(2):393-398
26 SUN Xi-jie,LIANG Wen,QUAN Xian-yue,et al.Quantitative study of mangnetic resonace imaging in focal hepatic lesions less than 3cm[J]. Journal of Hepatobiliary Surgery,2005,13(2):112-115[孙希杰,梁文,全显跃,等.3cm以下肝脏常见病变的磁共振成像的量化研究[J].肝胆外科杂志,2005,13(2):112-115]
27 ZHANG Yue-lang,SUN Xing-wang,QIANG Yong-qian Clinical application of abdominal diffusion weighted MR imaging[J].Journal of Practical Radiology,2005,21(3):313-315[张月浪,孙兴旺,强永乾.腹部磁共振扩散加权成像的临床应用[J].实用放射学杂志,2005,21(3):313-315]
28郭勇,王辅林,夏明,等.乳腺肿瘤表观弥散系数与组织细胞密度相关性研究[J].中国医学影像学杂志,2002,10 ( 4 ) :412
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26 Nasu,Kuroki Y,Nawano,et al. Hepaticmetastases: diffusion-weighted sensitivity–encoding versus SPI O2 enhanced MR imaging[J].Radiology,2006,261 ( 61 ) :122
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1 Chen TY, Lai PH, Ho J T, et al. Magnetic resonance imaging and diffusion-weighted images of cystic meningioma correla- ting with histopathology. Journal of Clinical Imaging, 2004, 28(1): 10-19
2 Desmond PM, Lovell AC, Rawlinson AA, et al. The value of apparent diffusion coefficient maps in early cerebral ischemia. Am J Neuroradiol, 2001, 22 (7): 1260-1267
3 Kim T, Murakami T, Takahashi S, et al. Diffusion-weighted single-shot echoplanar MR imaging for liver disease. AJR, 1999, 173(2): 393-398
4于德新,李传福,张晓明,等. 3.0T磁共振弥散成像对肝脏恶性局灶性病变诊断的价值.山东大学学报(医学版),2006,44(S):496-500
5 Annet L, Peeters F, Abarca-Quinones J, et al. Assessment of diffusion-weighted MR imaging in liver fibrosis. J Magn Reson Imaging, 2007, 25(1): 122-128
6 Byun WM, Shin SO, Chang Y, et al. Diffusion-weighted MR imaging of metastatic disease of the spine: assessment of response to therapy. AJNR, 2002, 23(6): 906-912
7 Thoeny HC,De Keyzer F,Vandecaveye V,et al.Effect of vascular targetting agent in rat tumor model:dynamic contrast-enhanced versus diffusion-weighted MR imaging[J].Radiology,2005,237 ( 21 ) :492
8 Lang P,Wendland MF,Saeed M,et al.Osteogenic sarcoma:noninvasive in vivo assessment of tumor necrosis with diffusion-weighted MR imaging[J].Radiology,1998,206 ( 15 ) :227
9 Hollingswort h KG, Lomas DJ. Influence of perfusion on hepatic MR diffusion measurement [J]. NMR Biomed, 2006,19(2)∶231
10 Le Bihan D, Breton E, Lallemand D, et al. MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders[J]. Radiology, 1986, 161(2): 401-407
11 Sotak CH. Nuclear magnetic resonance (NMR) measurement of the apparent diffusion coefficient (ADC) of tissue water and its relationship to cell volume changes in pathological states. Neurochem Int, 2004, 45: 569-582
12 Einarsdottir H, Karlsson M, Wejde J, et al. Diffuison- weighted MRI of soft tissue tumours. Eur Radiol, 2004, 14: 959-963
13 Van Rijswijk CS, Kunz P, Hogendoorn PC, et al. Diffusion- weighted MRI in the characterization of soft-tissue tumors. JMRI, 2002, 15: 302-307
14 Sinha S, Lucas-Quesada FA, Sinha U, et al. In vivo diffusion- weighted MRI of the breast: potential for lesion characterize- ation.J Magn Reson Imaging, 2002, 15: 693-704
15韩鸿宾,王俭,谢敬霞,等.高扩散敏感系数扩散加权像异常高信号疾病的鉴别诊断[J].中华放射学杂志,2002, 36 (9): 812-816
16 Meyer JR, Gutierrez A, Mock B, et al. High-b-value diffusion-weighted MR imaging of suspected brain infarction [J]. AJNR, 2000, 21(10): 1821-1829
17 Gibbs P, Tozer DJ, Liney GP, et al. Comparison of quant- itative T2 mapping and diffusion-weighted imaging in the normal and pathologic prostate [J]. Magn Reson Imaging, 2001, 46(6): 1054-1058
18张毅,郭顺林,雷军强,等.磁共振扩散加权成像在肝癌介入治疗前后应用的初步研究[J].中国介入影像与治疗学, 2006, 3(3):182-185
19 Chen S,Ikawa F, Kurisu K, et al. Quantitative MR evaluation of intracranial epidermoid tumors by fast fluid-attenuated inversion recovery imaging and echo-plannar diffusion- weighted imaging [J]. AJNR, 2001, 22: 1089-1096
20 Duong TQ,Ackermann JH,Ying HS,et al.Evaluation of extra and intracellular apparent diffusion in normal and globally ischemic rat brain via 19 FNMR[J].Magn Reson Med,1998,40 ( 28 ) :12
21 Nasu,Kuroki Y,Nawano,et al. Hepaticmetastases: diffusion-weighted sensitivity–encoding versus SPI O2 enhanced MR imaging[J].Radiology,2006,261 ( 61 ) :122
22 Koh DM,Riddell A,Husband JE et al.Colorectal livermetastases:e valuation using MnDPDP enhanced MR imaging and breath hold single-shot echo-planar diffusion-weighted MR imaging[J].Eur Radiol,2005, ( 58 ) :144
23 Moteki T,Ishizaka H,Horikoshi H,et al.Differentiation between hemangiomas and hepatocellular carcinomas with the apparent diffusion coefficient calculated from turboFLASH MR images[J].JMagn Reson Imaging,1995,5(2):187-191
24 Ichikawa T,Haradome H,Hachiya J,et al.Diffusion-weighted MR imaging with a single-shot echoplanar sequence:detection and characterization of focal hepatic lesions[J].AJR Am J Roentgenol,1998,170(2):397-402
25 Kim T,Murakami T,Takahashi S,et al.Diffusion-weighted single-shot echoplanar MR imaging for liver disease[J]. AJR Am J Roentgenol, 1999,173(2):393-398
26 SUN Xi-jie,LIANG Wen,QUAN Xian-yue,et al.Quantitative study of mangnetic resonace imaging in focal hepatic lesions less than 3cm[J]. Journal of Hepatobiliary Surgery,2005,13(2):112-115[孙希杰,梁文,全显跃,等.3cm以下肝脏常见病变的磁共振成像的量化研究[J].肝胆外科杂志,2005,13(2):112-115]
27 ZHANG Yue-lang,SUN Xing-wang,QIANG Yong-qian Clinical application of abdominal diffusion weighted MR imaging[J].Journal of Practical Radiology,2005,21(3):313-315[张月浪,孙兴旺,强永乾.腹部磁共振扩散加权成像的临床应用[J].实用放射学杂志,2005,21(3):313-315]
28郭勇,王辅林,夏明,等.乳腺肿瘤表观弥散系数与组织细胞密度相关性研究[J].中国医学影像学杂志,2002,10 ( 4 ) :412
29 Chan JH,Peh WC,Tsui EY,et al.Acute vertebral body compression fractures;discrimination between benign and malignant causes using apparent diffusion coefficients.Br J Radiol,2002,75(891):207-214
30 Sorkin A,McClure M,Huang F,et al.Interaction of EGF receptor and Grb2 in living cells visualized by fluorescence resonance energy transfer(FRET) microscopy[J]. CurrBiol,2000,10 ( 21 ) :1395
31 Petit SJ,Chayen NE,Pease JE.Site-directed mutagenesis of the chemokine receptor CXCR6 suggests a novel paradigm for interactions with the ligand CXCL16[J]. Eur J Immunol,2008,38 ( 8 ) :2337
32 Hein L,Meinel L,Pratt R,et al.Intracellular trafficking of angiotensin II and its A T1 and A T2 receptors:evidence for selective sorting of receptor and ligand[J]. Mol Endocrinol,1997,11 ( 9 ) :1266
33 Charo IF, Ransohoff RM. The many roles of chemokines and chemokine receptors in inflammation[J].N Engl J Med,2006,354 ( 6 ) :610