静脉内平滑肌瘤彩色多普勒超声诊断价值探讨

目的探讨彩色多普勒超声对静脉内平滑肌瘤病的诊断价值。方法对9例静脉内平滑肌瘤病患者进行彩色多普勒超声检查,分析其声像图特征,并与临床外科手术进行对照。结果 9例患者中1例表现为子宫多发实性团块,8例均做过子宫切除术,均在盆腔内发现实性占位,彩色多普勒超声可清晰显示静脉内实性回声,内为动脉血流,超声可清晰显示其累及范围。结论静脉内平滑肌瘤病彩色多普勒超声具有一定的特征,可作为其首选的影像学检查方法。     

经阴道超声及宫腔造影对鉴别子宫内膜息肉与其他病变的意义

目的分析子宫内膜病变的声像图和血流特征,并评价经阴道彩色多普勒超声宫腔造影对子宫内膜息肉的诊断价值。方法采用经阴道彩色多普勒加宫腔造影,分别对19例子宫内膜息肉和32例子宫内膜其他病变之声像图、彩色血流及频谱表现进行对比,全部病例经宫腔镜及手术后的病理证实。结果经阴道彩色多普勒超声检诊子宫内膜息肉,清晰显示了内膜与黏膜下肌层之界限和息肉的病变边界,还显示了息肉蒂基底的彩色血流或黏膜下肌瘤周边彩色血流环,适时加做宫腔造影则更有益于对细小病变的诊断。结论经阴道彩色多普勒超声加做宫腔造影可大大提高对子宫内膜息肉与子宫内膜其他病的鉴别诊断水平。     

子宫内膜间质肉瘤超声误诊分析

目的：探讨子宫内膜间质肉瘤的超声表现并对其超声误诊原因进行分析.材料和方法：对14例经手术及病理证实的子宫内膜间质肉瘤患者声像图进行回顾性分析.结果：根据超声所见病变分为3型.Ⅰ型：宫腔型（n=8）,Ⅱ型：宫壁型（n=3）,Ⅲ型：宫腔及宫壁型（n=3）.6例（42.9%）误诊为子宫良性病变[子宫肌瘤（肌壁间或黏膜下）、子宫腺肌症合并腺肌瘤或肌瘤];4例（4/14）误诊为子宫内膜癌,4例诊断为子宫恶性肿瘤.结论：子宫内膜间质肉瘤声像图缺乏特异性是误诊的主要原因,不同分型声像图应与相应疾病进行鉴别,并结合临床资料,可以提高对该病的诊断符合率.     

药物性不全流产的超声表现分析

目的:探讨药物流产后宫内残留药物的二维声像图、彩色多普勒的超声表现。方法:对86例药物流产后阴道持续流血患者应用二维超声、彩色多普勒观察子宫大小,宫腔内回声及宫腔内血流情况,并用脉冲多普勒测量宫内残留物的阻力指数。结果:72例宫内残流物及8例宫内膜炎性改变的病例显示局灶性血流丰富区,呈低阻力型动脉血流频谱,RI<0.6;6例未探及有血流信号的病例为陈旧性血块。结论:二维声像图表现及彩色多普勒超声有助于判断残留物的性质,对药物性不全流产有准确的诊断及临床应用价值。     

经阴道彩色多普勒超声对子宫内膜病变的诊断价值

目的探讨经阴道彩色多普勒超声㈣CD）对子宫内膜病变的诊断价值。方法对140例不规则阴道出血的患者行阴道彩色多普勒超声检查,重点观察内膜厚度及内膜血流,与诊刮的内膜组织病理诊断对照。结果140例患者中,无子宫内膜病变的42例,良性病变95例,子宫内膜癌3例,三者声像图表现、血流显示、阻力指数（RI）均有明显差异。结论经阴道彩色多普勒超声是一种有效的诊断及鉴别诊断子宫内膜病变的检查方法。     

超声对乳腺叶状囊肉瘤的诊断价值

目的：探讨乳腺叶状囊肉瘤的声像图特点和超声诊断价值。方法：回顾分析12例经手术病理证实的乳腺叶状囊肉瘤的声像图表现；观察病变的部位、大小、形态、边界、内部与后方回声、有无液化和钙化；利用彩色多普勒超声观察肿块内部及周边的血流分布情况。结果：乳腺叶状囊肉瘤的二维声像图表现为：体积较大的分叶状肿块，边界多清晰、规则，内部以实性低回声为主，回声可不均匀，部分见有散在的无回声区，少有钙化，后方回声增强。所有肿块的内部和／或周边均可探及血流信号。彩色多普勒超声在判断肿瘤的病理分级方面价值有限。结论：超声对乳腺叶状囊肉瘤的定性诊断具有较高的临床应用价值。     

子宫内膜间质肉瘤的影像表现

目的:总结分析子宫内膜间质肉瘤的影像表现。方法:回顾性分析20例经手术及病理证实的子宫内膜间质肉瘤患者的临床及影像资料,并与病理结果对照分析。结果:20例子宫内膜间质肉瘤均经病理证实,其中低级别子宫内膜间质肉瘤11例,低级别子宫内膜间质肉瘤局部伴性索间质样分化1例,高级别子宫内膜间质肉瘤6例,低级别混合性子宫内膜间质-平滑肌肿瘤1例,未分化子宫内膜肉瘤1例。20例均为单发,其中腔内生长型6例,肌层肿块型7例,肌层浸润型3例,浆膜下型3例,宫外型1例。病灶最大径为(6.18±1.34)cm;类圆形14例,形态不规则6例;边界清晰8例,边界不清12例。12例出现卵石征,8例可见黏液样变区域,1例呈环岛征改变,7例肿块周围及内部见多发蚯蚓状、螺旋状强化血管影,6例瘤周可见T 2WI线状低信号轮廓,6例瘤周可见T 2WI结节状或蠕虫状稍高信号。增强扫描20例肿块实性成分呈渐进性、持续性强化,其中15例强化程度与子宫肌层相仿或高于肌层,5例强化程度低于肌层。结论:子宫内膜间质肉瘤的影像表现具有一定特征性,能为该病的诊断提供依据。     

经阴道彩色多普勒超声对子宫内膜病变的诊断价值

目的探讨经阴道彩色多普勒超声（TVCD）对子宫内膜病变的诊断价值。方法对140例不规则阴道出血的患者行阴道彩色多普勒超声检查,重点观察内膜厚度及内膜血流,与诊刮的内膜组织病理诊断对照。结果140例患者中,无子宫内膜病变的42例,良性病变95例,子宫内膜癌3例,三者声像图表现、血流显示、阻力指数（RI）均有明显差异。结论经阴道彩色多普勒超声是一种有效的诊断及鉴别诊断子宫内膜病变的检查方法。     

高频彩色多普勒超声诊断与鉴别诊断阴囊肿块的价值

目的:探讨彩色多普勒超声对阴囊肿块的诊断与鉴别诊断价值.材料和方法:对34例阴囊肿块行彩色多普勒超声检查,恶性病变23 例,良性病变11例,分析恶性病变及良性病变的超声声像图特征.结果:恶性病变声像图特征是睾丸形态失常,体积增大,肿瘤呈低回声(15/23)或不均匀混合回声(8/23),边界不清楚,CDFI显示肿块周边和内部血流丰富,呈条状或树枝状血流.良性病变声像图特征是睾丸大小形态常正常,病变多呈低回声,边界清楚,形态规整,CDFI显示病变内血流信号较少(8/11)或无血流信号(3/11).超声对阴囊肿块性质的诊断准确率88.2%(30/34),与手术和穿刺病理结果无显著性差异(P＞0.05).结论:彩色多普勒超声对阴囊肿块诊断与鉴别诊断有较高的临床应用价值.     

乳腺叶状肿瘤的超声诊断(附33例分析)

目的探讨乳腺叶状肿瘤的声像图特点和超声诊断价值,以提高诊断水平。方法回顾分析33例经手术病理证实的乳腺叶状肿瘤患者,观察其超声的声像图表现:病变的部位、大小、形态、边界、内部回声与后方回声、有无液化和钙化,利用彩色多普勒超声观察肿块内部及周边的血流分布情况。结果 33例乳腺叶状肿瘤中,良性12例,交界性12例,恶性9例。乳腺叶状肿瘤的二维声像图表现:体积较大的分叶状肿块,边界清晰、规则,内部以实性低回声为主,回声大部分均匀,部分可见散在的无回声区,无或少有钙化,后方回声增强,所有肿块的内部和/或周边均可探及血流信号。结论超声对乳腺叶状肿瘤的定性诊断具有较高的临床应用价值。     

Stress MR imaging for evaluation of popliteal artery entrapment

The popliteal artery entrapment (PAE) syndrome has been recognized as a cause of arterial occlusion in young people. It is the result of an anomaly of the relationship between the popliteal artery and the gastrocnemius muscle. Eight young healthy volunteers (16 legs) and six patients (10 legs) with suspected PAE underwent magnetic resonance (MR) imaging. Gradient-echo images were obtained in axial planes with the leg at rest and during active plantar flexion against resistance. Imaging at rest allowed identification of PAE signs in only one leg, which had an anomalous medial course of the popliteal artery. In the other cases, only the stress technique was able to show signal loss in the popliteal artery due to muscular compression (two legs) or the presence of accessory muscle slip around the vessel (two legs), as confirmed at surgery. MR imaging is therefore a useful technique for the diagnosis of PAE because of its capability of combining information obtainable with other modalities.     

MR imaging of muscle and tender points in fibromyalgia

Fibromyalgia is a syndrome manifested by chronic, diffuse muscu-loskeletal aching and soreness, palpable muscle tender points, and other symptoms. Standardized clinical diagnostic criteria have recently been developed. Skeletal muscle has been postulated as the end organ in this disease. Biochemical, histologic, electromyographic, and conventional radiographic studies have demonstrated no definitive abnormality. This study sought to establish whether magnetic resonance (MR) imaging could demonstrate any abnormality in these patients. Eighteen patients were entered in the study, 14 of whom were able to complete their examinations. T1 -weighted, T2-weighted, gradient-echo, and STIR (short-tau inversion-recovery) sequences were performed in all patients, with selected patients examined with T1weighted, gadopentetate dimeglu-mine-enhanced sequences. The trapezius and suboccipital regions were imaged in patients who, clinically, had active fibro-myalgia. No abnormalities could be detected. The authors conclude that the conventional MR imaging used in this study was unable to depict any primary skeletal muscle abnormality in fibromyalgia.     

Controversies in cervical spine imaging in trauma patients

No area of emergency radiology has generated as much discussion in recent years as the subject of cervical spine imaging for trauma patients. This review will be in three parts. The first will examine the indications for cervical imaging and will focus on those factors that make patients at high risk or low risk for cervical injury. The second part will discuss the merits of radiography and computed tomography as the main screening diagnostic examination. In addition to the roles of each modality in the evaluation process, such factors as efficacy of diagnosis, time (duration) of study, and cost will be discussed. Finally, the third part will explore the methods currently employed to clear the cervical spine in comatose patients.Presented at the Annual Meeting of the American Society of Emergency Radiology, Las Vegas, Nevada, 22–25 October, 2003     

Uterine contractions: Possible diagnostic pitfall at MR imaging

A total of 206 nongravid patients with various gynecologic problems underwent pelvic magnetic resonance (MR) examinations that included both sagittal T2-weighted and contrast agent–enhanced T1-weighted images. MR images were retrospectively reviewed to identify changes in endometrial configuration on serial images obtained during the same MR examination. In 20 MR examinations (all in women of reproductive age), endometrial distortion due to myometrial bulging was noted on T2-weighted or contrast-enhanced T1-weighted images. It was absent on other MR images obtained at different times. Myometrial bulging exhibited low signal intensity in 18 examinations. The finding resembled adenomyosis or leiomyoma on T2-weighted or contrast-enhanced T1-weighted images. These results evidence the presence of transient myometrial bulging and transient low-intensity myometrium in the nongravid uterus. This phenomenon is thought to represent uterine contraction. Clinicians should be aware of the potential presence of transient low-signal-intensity myometrial bulging that could present diagnostic problems in the normal uterus.     

Brodie Abscess: MR imaging appearance in 10 patients

The magnetic resonance (MR) imaging features of Brodie abscess have not yet been fully evaluated. Ten patients with Brodie abscess, eight of long bone and two of vertebra, were studied with MR imaging. Long bone abscess had a characteristic “target” appearance with four layers: (a) a center with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR (short-inversion-time inversion recovery) images, (b) an inner ring isointense to muscle on T1-weighted images and with high signal intensity on T2-weighted and STIR images, (c) an outer ring hypoin-tense on all images, and (d) a peripheral halo hypointense on T1-weighted images. In six of eight cases, a soft-tissue mass was found. The two vertebral abscesses had a less specific appearance, with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR images. Only the peripheral halo was clearly identified in both cases.     

Right-side aortic arch with aneurysm of aberrant left subclavian artery: MR imaging appearance.

Reports of aneurysms of the subclavian artery in both normal and anomalous aortic arches have been rare. The authors describe a patient with a right-side aortic arch and an aneurysm of the aberrant left subclavian artery, which, to the authors' knowledge, is a previously unreported association. At presentation, the aneurysm appeared as a calcified left superior mediastinal mass. Magnetic resonance imaging enabled preoperative diagnosis and guided surgical planning.     

MR angiography of congenital heart disease: Value of segmented two-dimensional inflow technique and maximum-intensity-projection display

Magnetic resonance (MR) angiography of the cardiovascular system was evaluated in 41 patients with congenital heart disease by using a two-dimensional (2D) inflow technique based on a magnetization-prepared gradient-echo pulse sequence with segmented k-space data acquisition and electrocardiographic gating at 0.5 T. Inversion and saturation prepulses were used to suppress stationary tissue and enhance intravascular signal. Presaturation slabs were applied where certain vascular structures had to be suppressed. Sequence parameters were optimized by evaluating signal intensity and contrast characteristics for various flip angles and inversion and saturation delay times. The heart and intrathoracic vasculature were encompassed with 40–50 overlapping sections. Both 2D angiograms and maximum-intensity-projection images were evaluated. Combining data sets acquired in the sagittal and transverse orientations provided the most satisfactory information about the pulmonary arteries. The highest signal-to-noise ratios were obtained with a flip angle of 65° and short prepulse delay times. Two-dimensional MR angiography can provide useful diagnostic information but requires a thorough understanding of in-plane and hemodynamically induced signal intensity changes.     

Adrenal tissue characterization with 0.5-T MR imaging: Value of T2*-weighted images

The authors investigated the value of magnetic resonance (MR) imaging at 0.5 T for distinguishing adrenal adenomas from adrenal metastases. The series included 23 adrenal adenomas (18 nonhyperfunctioning, five hyperfunctioning) and 23 adrenal metastases from various organs. Adrenal tumor–liver signal intensity ratios on T1-, T2-, and T2*-weighted images were calculated for adrenal tissue characterization. Adrenal adenomas were more precisely distinguished from adrenal metastases on T2*-weighted images (21 of 23, 91%) than on T2-weighted images (15 of 23, 65%). T1-weighted images were not useful for this distinction. In conclusion, T2*-weighted images were better than routine T2-weighted images for distinguishing adrenal adenomas from adrenal metastases. It can be postulated that the total signal intensity of adrenal adenomas, which contain some fat components, decreased on T2*-weighted images because of an out-of-phase effect.     

Dynamic contrast-enhanced MR imaging assessment of vascularized free fibular grafts

Magnetic resonance (MR) imaging may be a noninvasive method for assessing perfusion of vascularized bone grafts placed for treatment of avascular necrosis. One proximal femur of seven beagles was devascularized, with insertion of a vascularized fibular graft. MR imaging at 1 week (seven dogs) and 6 weeks (five dogs) after surgery included pre- and postcontrast spin-echo sequences, unenhanced twodimensional time-of-flight (TOF) vascular imaging, and dynamic gradient-echo imaging during infusion of gadolinium. Relative signal intensity values of selected regions obtained from the dynamic gradientecho images were plotted as percent enhancement versus time. In the operated hip, MR imaging did not show enhancement in six of seven femoral heads and greater trochanters at 1 week after surgery, with similar results after 6 weeks. MR imaging of fibular grafts 6 weeks after surgery showed an initial rapid increase in enhancement and a subsequent slower increase in five of five dogs, although no enhancement was seen in six of seven dogs at 1 week. These findings contrasted with a rapid initial increase in enhancement followed by slow decline in non-operated hips. Two-dimensional TOP imaging did not show the vascular pedicle of the graft in any dog. Findings of radionuclide bone scanning performed 1 week after surgery were consistent with devascularization of the operated femur and fibular graft. However, tetracycline distribution and histologic findings confirmed the viability of five of five grafts within the devascularized femurs 6 weeks after surgery. Thus, dynamic contrast-enhanced MR imaging at 6 weeks after surgery is valuable for assessing vascular bone graft perfusion, while similar imaging at 1 week may suggest otherwise.