椎管内硬膜外原发恶性淋巴瘤的MRI表现

目的 :分析椎管内硬膜外原发性恶性淋巴瘤MRI特点 ,以提高诊断正确性。材料和方法 :经手术病理证实的椎管内硬膜外原发性恶性淋巴瘤 6例 ,男 4例 ,女 2例 ;所有病例均有MR扫描及增强扫描。结果 :MR表现为长达数个椎体的椎管内硬膜外梭形占位 ,呈等T1或略短T1,长T2信号 ;与脊髓间可见低信号硬脊膜线 ,3例环绕脊髓生长 ,3例为偏于一侧 ,2例穿破低信号硬脊膜线侵蚀脊髓 ,1例沿神经根向椎管外生长 ;增强扫描 ,占位呈均质或略显混杂重度增强。结论 :MRI能全面观察肿块及脊髓情况 ,为临床诊断提供有力的影像学依据。     

急性硬脊膜外血肿的治疗

目的探讨急性硬脊膜外血肿的早期诊治与预后的关系。方法回顾性分析21例急性硬脊膜外血肿的诊断治疗情况。结果17例早期诊断并手术治疗脊髓功能恢复良好，4例诊断与手术较晚预后较差。结论急性硬脊膜外血肿早期诊断和及时手术治疗是患者预后的关键。     

硬脊膜外海绵状血管瘤MRI表现

目的评价硬脊膜外海绵状血管瘤MRI特征表现。方法回顾性分析3例经手术病理证实的硬脊膜外海绵状血管瘤的MR表现及文献复习。结果3例硬脊膜外海绵状血管瘤中,1例位于腰段椎管,2例位于胸段椎管,3例均发生于脊髓背侧,两端尖细,长轴与脊椎纵轴一致,相应平面的脊髓均受压推移;3例均表现为T2WI高信号,Gd-DTPA增强扫描呈均匀一致的明显强化。结论MRI检查是诊断此病的最佳无创检查方法。     

椎管内硬脊膜外海绵状血管瘤的MRI影像诊断

目的 探讨椎管内硬脊膜外海绵状血管瘤MRI影像特征及诊断价值。方法 选取经手术病理证实的4例椎管内硬脊膜外海绵状血管瘤患者MRI平扫及增强检查的影像资料,与病理相对照。结果 4例患者发生于中上段胸椎背侧硬膜外,3例为原发性,1例继发于椎体血管瘤; 4例肿瘤均为上下径较长、两端变尖的的梭形肿块,形似纺锤;病灶向前推移、半包绕脊髓,向外侧伪足样蔓延累及邻近的椎间孔; 4例增强后病灶明显强化,其中2例两端硬脊膜强化,形成“毛笔尖征”。结论 椎管内硬脊膜外海绵状血管瘤MRI影像表现具有特征性,为临床诊断及鉴别诊断提供了重要的信息。     

脊髓栓系综合征的MRI诊断

目的　探讨脊髓栓系综合征 (TCS)的MRI特点及诊断价值。方法　对 30例TCS患者的MRI资料进行了回顾性分析 ,所有病例均经手术病理证实。结果　 30例中 ,脊髓圆锥尖部位置均低于L2 椎体中部以下 ,脊髓受牵拉固定 ;单纯终丝粗大紧张 4例 ,约占 13%;脂肪堆积 13例 ,约占 43%;脊膜膨出 4例 ,约占 13%;脊膜脊髓膨出 3例 ,占 10 %;椎管内肿瘤 6例 ,占 2 0 %,其中神经纤维瘤 2例 ,皮样囊肿 2例 ,表皮样囊肿 1例 ,畸胎瘤 1例。结论　MRI的优良的软组织分辨率、多方位成像等优点 ,能明确显示脊髓圆锥的位置 ,形态及伴发畸形 ,对诊断TCS具有重要价值。     

椎管内肿瘤手术后的护理体会

椎管内肿瘤是指脊髓、神经根、脊膜和椎管壁组织的原发和继发性肿瘤，可分为硬脊膜外肿瘤、硬脊膜下脊髓外肿瘤及脊髓内肿瘤［1］。目前手术切除是治疗椎管内肿瘤的唯一有效方法，病情一旦确诊，应尽早手术。椎管内肿瘤部位深在，肿瘤切除手术需显露并切除部分椎板以开放椎管，加上脊髓组织娇嫩，手术难度较大，术后往往需要长期康复，容易发生多种并发症。因此，手术后的专业护理对于患者的病情康复和预后至关重要。回顾我科2010年1月~2012年12月共62例椎管内肿瘤患者，均接受手术治疗，术后经过精心护理，取得满意效果，现汇报如下。     

18F-FDG PET/CT在硬脊膜内转移诊断中的应用

目的 评价¹⁸F-FDG PET/CT在硬脊膜内转移诊断中的价值。资料与方法 回顾性分析2010年10月—2022年4月于江西省人民医院行¹⁸F-FDG PET/CT和MRI检查且确诊椎管内转移肿瘤患者的影像资料,对病灶代谢活性进行视觉分析,并测量最大标准化摄取值(SUVmax)。分析¹⁸F-FDG PET/CT诊断硬脊膜内转移的敏感度、特异度和准确度,并应用受试者工作特征曲线分析SUVmax诊断硬脊膜内转移的效能。结果 135例伴可疑椎管内转移症状的肿瘤患者中,硬脊膜内(软脊膜和髓内)转移18例,其他病变80例,脊髓无病变37例。18例硬脊膜内转移中,13例软脊膜转移,2例髓内转移,3例同时有软脊膜和髓内转移。转移表现为结节状(10例)或条片状(6例)¹⁸F-FDG摄取增高,对应CT上髓旁或髓内结节或脊髓肿胀。¹⁸F-FDG PET/CT比MRI发现了更多的病灶,包括亚厘米的病灶。基于患者,¹⁸F-FDG PET/CT诊断硬脊膜内转移的敏感度、特异度和准...     

硬脊膜动静脉瘘的MRI和DSA影像学特点及栓塞治疗

目的 探讨硬脊膜动静脉瘘的MRI和DSA影像学特点及血管内栓塞治疗方法。方法 12例硬脊膜动静脉瘘患者均行MRI和脊髓血管造影检查,4例行栓塞治疗。分析其MRI和血管造影表现。结果 12例硬脊膜动静脉瘘中,MRI屉示脊髓内弥漫性长T2信号影11例,脊髓斑片状强化2例,脊髓背侧异常血管影6例。脊髓血管造影均能显示其瘘口和引流静脉,并反映其病变范围、供血状况及特征。4例行栓塞治疗患者其临床症状均有改善。结论 脊髓血管造影是诊断硬脊膜动静脉瘘的主要确诊方法。MRI对确定诊断具有重要作用。血管内栓塞是一种有效的治疗方法。     

椎管内硬脊膜外蛛网膜囊肿的低场强MRI诊断

目的:探讨椎管内硬脊膜外蛛网膜囊肿的低场强MRI表现特征,提高对该病的认识。方法:回顾性分析12例经手术病理证实的硬脊膜外蛛网膜囊肿的临床及MRI表现特征,其中10例行Gd DTPA增强扫描,7例行X光平片或CT片检查。结果:本组病例发病于胸腰段8例,位于脊髓背侧9例,呈典型的椎管内硬脊膜外占位病变征象,囊肿的信号强度与脑脊液一致或相近,上、下缘与硬脊膜外脂肪毗邻,上或下方邻近硬脊膜的显示,可为硬脊膜外囊肿的定位诊断提供有力的佐证,囊肿与蛛网膜下腔相交通时,孔道区囊肿内可出现流空信号,可确定孔道的具体位置,为手术提供可靠可靠的依据。结论:MRI是目前评价椎管内硬脊膜外蛛网膜囊肿的定位和定性诊断最佳影像学方法和首选检查手段。     

先天性脊柱裂与脊髓栓系综合征的手术治疗

目的　探讨先天性脊柱裂与脊髓栓系综合征的手术特点及治疗经验。方法　脊柱裂与脊髓栓系综合征是一种先天性疾病。本文总结了 1993年 9月～ 2 0 0 3年 2月收治的 5 2 8例先天性脊柱裂与脊髓栓系患者的显微手术情况。年龄 5个月～ 4 5岁 (平均 9岁) ,其中脊膜膨出 2 39例 (4 5 3% ) ,脊髓脊膜膨出 12 3例(2 3 3% ) ,脊柱裂伴脂肪瘤 10 7例 (2 0 3% ) ,隐性脊柱裂 5 9例 (11 2 % )。结果　在手术的 5 2 8例患者中 ,临床症状改善 32 2例 (6 1% ) ,无变化 194例 (36 7% ) ,症状加重 12例 (2 3% )。结论　对于脊柱裂手术 ,除了要去除局部硬脊膜囊及其他组织的压迫和松解脊髓栓系外 ,还应考虑病人的远期再粘连问题。     

显微手术和非显微手术治疗椎管内肿瘤100例的比较分析

目的比较非显微手术与显微手术治疗椎管内肿瘤的临床疗效及术后恢复情况。方法回顾性分析100例椎管内肿瘤患者的临床资料,对非显微手术组与显微手术组的治疗效果进行了比较分析。结果 A组(显微手术组)手术时间(3.9±0.8)h,出血量(414±87)ml,脑脊液漏发生2例(发生率4.0%),平均住院时间(13±3)d;B组(非显微手术组)手术时间(2.1±0.5)h,出血量(680±106)ml,脑脊液漏发生9例(发生率18.0%),平均住院时间(22±13)d。A组有47例患者肿瘤全切除(全切率94%),B组全切除肿瘤仅34例(全切率68%)。A组中疼痛患者有93.3%有所缓解;感觉障碍的患者有76.5%得到不同程度的缓解,2例加重;运动障碍的患者都得到不同程度的改善;尿潴留或尿失禁患者有86.7%得以缓解。B组中疼痛患者仅有63.6%症状有所缓解;感觉障碍的患者有54.2%得到不同程度的缓解;运动障碍的患者有55%得到不同程度的改善;尿潴留或尿失禁患者仅45.5%得以缓解。可见显微手术组各方面均优于非显微手术组(P<0.05)。术后随访时间为6个月~3年,平均随访时间28.3个月,随访率76%。A组随访患者术后未见并发症发生;B组随访患者术后肿瘤复发6例,继发性椎管狭窄5例。结论显微手术治疗椎管内肿瘤具有创伤小、安全性高等优点。显微手术是治疗椎管内肿瘤的有效方法。     

肝脓肿的CT表现

本文分析２６例肝脓肿（化脓性２４例、阿米巴２例）的ＣＴ表现。脓肿直径＜２０ｍｍ多发小脓肿７例，单发脓肿１４例，复杂多间隔脓肿５例。作者认为脓肿内积气、＂簇状征＂和＂双靶征＂为肝脓肿特征性表现。对延迟扫描在肝脓肿诊断和鉴别诊断中的作用进行了探讨。本研究表明ＣＴ诊断肝脓肿具有重要的临床价值。     

超早期颅内血肿微创钻孔引流术治疗高血压基底节区脑出血

目的总结超早期颅内血肿微创引流术治疗高血压基底区节脑出血的经验。方法对我院88例高血压基底节区脑出血患者在超早期采用颅内血肿微创钻孔引流术清除血肿。对其临床资料进行回顾分析。结果本组患者均于术后24h后复查头颅CT,其中血肿清除量〉90%者21例,50%～70%者44例,〈50%者23例,再出血4例。对患者进行6个月随访,按日常生活能力分级法（ADL）评测：Ⅰ级10例,占11.3%;Ⅱ级25例,占28.4%;Ⅲ级41例,占46.6%;Ⅳ级12例,占13.6%;Ⅴ级0例。效果良好率86.3%。结论超早期颅内血肿微创钻孔引流术治疗高血压基底节区脑出血,具有创伤小、解除血肿占位效应好、术后再出血率低、并发症和致残率低、功能恢复快等优点,值得推广应用。     

Spinal epidural abscess with gadolinium-enhanced MRI: serial follow-up studies and clinical correlations

We reviewed serial MRI with and without gadolinium-DTPA in eight patients with spinal epidural abscess and correlated the findings and the clinical manifestations. In four patients, diffuse abscesses spanned four vertebral bodies or more; the others had focal abscesses associated with osteomyelitis and/or diskitis. In three of the four patients with diffuse abscesses, MRI (NCMRI) showed diffuse encasement of the subarachnoid space. Contrast-enhanced MRI (CEMRI) demonstrated linear enhancement surrounding unenhanced pus. In the four patients with focal abscesses, CEMR delineated the inflammatory process more clearly than NCMR. On follow-up studies, decrease in abscess size and better visualization of the subarachnoid space correlated with clinical improvement in both diffuse and focal abscesses. Despite clinical improvement, contrast enhancement persisted in the disk or epidural space of three patients, and was thought to represent chronic granulomatous change or postsurgical scar. CEMR is very valvable for the initial diagnosis of an epidural abscess, particularly if it involves lengthy segments. During follow-up, CEMR can document responses to therapy, and provide information for determining appropriate treatment.     

Sweet syndrome with osseous and splenic involvement: A case report

Sweet syndrome is an uncommon inflammatory skin condition. Here we present a case of Sweet syndrome in a young woman with rare extracutaneous manifestations, including bone and splenic fluid collections, with marked improvement following treatment with systemic corticosteroids. The patient was subsequently diagnosed with Crohn''s disease which can be seen in the setting of Sweet syndrome. Sterile abscesses should be considered in patients with a clinical diagnosis of Sweet syndrome and focal symptomatology.     

Suburban amebiasis: the diagnostic aspects via computed tomography and echography and the percutaneous treatment of amebic liver abscesses

INTRODUCTION: Liver is the most common site of extraintestinal amebiasis and hepatic abscesses are the most frequent symptom, occurring in 3-9% of patients with amebic infection. Several studies have shown that drug treatment is more efficacious when combined with percutaneous drainage of the abscess, yielding quicker recovery and a positive body response. We report our US and CT findings in 16 patients with amebic abscesses, 12 of whom lived in a temperate peripheral area north-east of Naples. All patients had a clinical-diagnostic condition that we called "suburban amebiasis". Finally we report our personal experience with the US-guided therapeutic drainage of amebic abscesses with repeated cavity washings, which is important for positive parasitology. MATERIAL AND METHODS: We retrospectively reviewed the findings of 16 patients (11 men and 5 women; age range 36-78 years; mean 52) with amebic abscesses of liver examined with US and CT. US with a 3.5 MHz transducer was the technique of choice in all patients. 94% of liver abscesses and some extraintestinal complications were easily shown with this technique. CT angiography was then performed to detail and clarify US findings. Abscesses over 4 cm in diameter were submitted to US-guided percutaneous treatment which permitted abscess drainage, the collection of material for parasitology and repeated cavity washings. RESULTS: US showed multiple liver abscesses in 12 patients, which were multiseptate and formed by multiple hypo-/hyperechoic microabscesses in 4 of them. Four non-European patients had a single abscess, which is typical of tropical endemic forms. CT showed the amebic abscesses as hypodense roundish masses with clear-cut outline most often localized in the right lobe in the 12 multiple cases. After percutaneous drainage 13/16 patients (81%) reported less pain in the right hypochondrium and had a lower temperature; their hospitalization was also shorter. DISCUSSION AND CONCLUSIONS: Combined US and CT assessment facilitated the diagnosis of amebiasis and its differentiation from pyogenic abscess and hepatoma. The combination of US-guided drainage and drug treatment provides better results than either treatment alone and quicker improvement of patient conditions, with fewer extraintestinal complications. Percutaneous drainage should be used in abscesses bigger than 4-5 cm, those with questionable clinical-laboratory findings and finally those failing to respond to drug treatment alone. Positive parasitology of abscess content is related to repeated cavity washings after percutaneous drainage, likely because peripheral layers are much richer in amebae.     

脊髓血管母细胞瘤的影像学诊断及治疗

目的探讨脊髓血管母细胞瘤的诊断与治疗方法。方法分析22例脊髓血管母细胞瘤的MRI、DSA的影像学特点,总结栓塞、手术的操作技巧和治疗结果。结果脊髓血管母细胞瘤MRI表现为边界清楚的实性占位、增强后明显均匀强化。DSA表现为边界清楚,圆形或椭圆形高密度影,有明确供血动脉及引流静脉。本组病例直接手术6例,栓塞后手术16例。肿瘤均经手术全部切除,术后功能完全恢复正常12例,加重3例,7例无明显变化。结论MRI和DSA对脊髓血管母细胞瘤的诊断具有特异性,手术治疗是治疗脊髓血管网织细胞瘤的首选方法,栓塞可以降低血管母细胞瘤的血液供应,提高治愈率。     

Perforated appendix presenting with severe diarrhea. Findings on barium-enema examination

Severe diarrhea and marked lower abdominal cramps are unusual manifestations of appendicitis. The authors performed a barium-enema examination (BE) on 9 pediatric patients who were ultimately shown to have a perforated appendix and pelvic abscesses. In 8 cases, the atypical symptoms initially led to an incorrect clinical diagnosis. In all 9, the BE demonstrated extensive inflammatory changes of the rectosigmoid colon, caused by the surrounding pelvic infection. Recognizing this clinical and radiographic association could lead to earlier diagnosis and treatment.     

外生型肝癌的诊断及介入治疗

目的:研究外生型肝癌的诊断及介入治疗的方法。方法:11例外生型肝癌根据临床表现、AFP、CT、肝动脉造影及病理诊断确诊;11例均采用肝动脉灌注化疗及栓塞术,其中2例同时采用无水酒精注射治疗。结果:11例外生型肝癌介入治疗均成功无严重并发症发生。结论:外生型肝癌的诊断主要依靠临床表现、AFP、CT、肝动脉造影及病理进行综合诊断;外生型肝癌的介入治疗是一种有效的治疗方法。     

Acute spinal cord injury: MR imaging at 1.5 T

Thirty-seven magnetic resonance (MR) imaging studies were performed with a 1.5-T magnet and surface coils in 27 patients with suspected spinal cord injuries. Imaging was performed 1 day to 6 weeks after injury. Cord abnormalities were seen with MR in 19 patients, while skeletal and/or ligamentous injuries were seen in 21 (78%). Three types of MR signal patterns were seen in association with cord injuries. Acute intraspinal hemorrhage was seen in five patients with cord injuries and demonstrated decreased signal intensity on T2-weighted images obtained within 24 hours of injury. Cord edema and contusion had high signal intensity on T2-weighted images and were observed in 12 cases with cord injury. Neurologic recovery, determined in 16 patients, was insignificant in patients with intraspinal hemorrhage; however, patients with cord edema or contusion recovered significant neurologic function. MR at 1.5 T is extremely useful in the diagnosis of acute cord injury and also demonstrates potential in predicting neurologic recovery.