囊性胸腺瘤的临床及MRI特征

【摘要】目的：探讨囊性胸腺瘤的MRI特征,以提高其MRI诊断及鉴别诊断水平。方法：回顾性分析经组织病理学证实的17例囊性胸腺瘤的临床及MRI影像资料,其中男9例,女8例,年龄19~72岁,平均46岁。分析常规MRI特征（包括大小、形态、囊腔分隔、实性成分、包膜完整度、瘤周水肿等）及表观扩散系数（ADC）值。结果：组织病理学分型：A型胸腺瘤2例（11.8%）,AB型胸腺瘤2例（11.8%）,B1型胸腺瘤2例（11.8%）,B2型胸腺瘤8例（47.0%）,B3型胸腺瘤3例（17.6%）。肿瘤大小2.3~13.6cm,平均7.1cm;囊液呈T1WI低信号、T2WI高信号12例（70.6%）,T1WI高信号、T2WI高信号5例（29.4%）;囊壁或分隔均含有不同程度实性成分,其中单发附壁结节/肿块9例（52.9%）,多发附壁结节/肿块5例（29.4%）,弥漫性增厚伴结节/肿块3例（17.7%）;肿瘤实性成分ADC平均值1.32×10-3mm2/s。结论：囊性胸腺瘤多为B2型胸腺瘤,肿瘤多伴有不同程度实性成分。MRI对囊性胸腺瘤的诊断及鉴别诊断具有重要价值。     

MRI diagnosis of granulose cell tumor of the ovary

目的:探讨MRI对卵巢颗粒细胞瘤(GCTO)的诊断价值.方法:回顾性分析经手术与病理证实的20例GCTO患者的临床和MRI资料.所有病例均行MRI平扫及增强扫描.结果:20例术前MRI诊断正确16例(80％).MRI 平扫主要表现:子宫附件区边界清楚、形态较规整、包膜完整的囊性、囊实性、实性肿块.6例为囊性肿块,其中1例为单一大囊性肿块,多囊性肿块内见厚薄不一分隔,以较厚为主,囊内壁光滑,囊内容物T1WI呈等低信号,T2WI呈高信号;9例为囊实性肿块,T1WI呈等低混杂信号,T2WI呈混杂高信号,内有多发大小不等的囊性变,囊内壁光滑;5例为实性肿块,T1WI和T2WI高于同层肌肉信号.合并症:12例子宫增大,内膜增厚,3例合并子宫内膜癌(1例同时合并子宫肌瘤)、3例合并子宫肌瘤.增强扫描20例GCTO患者的肿瘤实性部分及囊壁均明显强化.结论:卵巢颗粒细胞瘤MRI表现具有一定的特征,能清晰显示其合并症,对其诊断及鉴别诊断具有重要的临床应用价值.     

卵巢良恶性肿瘤与MRI平扫及DWI影像表现的相关性研究

目的 探讨卵巢良恶性病变与其MRI平扫及DWI影像表现的相关性,提高定性诊断准确率.方法 回顾性分析48例经手术病理证实的卵巢占位病变的MRI平扫加DWI影像表现,纳入分析指标共9项,包括年龄、单/双侧、最大径、边界、囊壁/分隔、囊实性、T1WI及T2WI信号特征、表观扩散系数(ADC),进行单因素及多因素分析.结果 48例患者中良性34例,恶性14例,其中双侧者良性8例,恶性5例,占位病变共61个.(1)单因素分析结果显示:良、恶性病变的最大径、囊壁/分隔情况、囊实性成分比例、T2 WI信号均匀性及ADC值(b=600 s/mm2)差异有统计学意义(P＜0.05).(2)多因素分析结果显示:2组变量中上述5项影响因素曲线下面积(AUC)从大到小依次是:ADC值(0.881)＞囊壁/分隔(0.764)＞最大径(0.736)＞T2信号均匀性(0.710)＞囊实性(0.695),其中ADC值价值最大,其在b=600 s/mm2时临界值为1.53×10-3 mm2/s,小于界值,提示恶性.结论 MRI平扫加DWI在卵巢肿瘤良恶性的鉴别中具有重要价值,病变ADC值小于1.53×10-3mm2/s,囊壁/分隔厚且不均,病变较大、T2WI信号等或混杂,DWI呈高信号是恶性肿瘤的有力证据,同时结合临床病史,综合评估,为临床诊治提供可靠的信息和依据.     

MRI对卵巢颗粒细胞瘤的诊断价值

目的:探讨MRI对卵巢颗粒细胞瘤(GCTO)的诊断价值。方法:回顾性分析经手术与病理证实的20例GC-TO患者的临床和MRI资料。所有病例均行MRI平扫及增强扫描。结果:20例术前MRI诊断正确16例(80%)。MRI平扫主要表现:子宫附件区边界清楚、形态较规整、包膜完整的囊性、囊实性、实性肿块。6例为囊性肿块,其中1例为单一大囊性肿块,多囊性肿块内见厚薄不一分隔,以较厚为主,囊内壁光滑,囊内容物T1WI呈等低信号,T2WI呈高信号;9例为囊实性肿块,T1WI呈等低混杂信号,T2WI呈混杂高信号,内有多发大小不等的囊性变,囊内壁光滑;5例为实性肿块,T1WI和T2WI高于同层肌肉信号。合并症:12例子宫增大,内膜增厚,3例合并子宫内膜癌(1例同时合并子宫肌瘤)、3例合并子宫肌瘤。增强扫描20例GCTO患者的肿瘤实性部分及囊壁均明显强化。结论:卵巢颗粒细胞瘤MRI表现具有一定的特征,能清晰显示其合并症,对其诊断及鉴别诊断具有重要的临床应用价值。     

肝脏黏液性囊性肿瘤的MRI特征及分型

目的：探讨肝脏黏液性囊性肿瘤的MRI特征及分型。方法：回顾性分析复旦大学附属中山医院和日照市人民医院2010年6月至2023年1月经病理证实的55例肝脏黏液性囊性肿瘤患者的资料,图像分析包括病灶的位置、边界、数目、大小、形态、有无分隔、壁结节、有无胆管扩张、囊壁及囊腔在T1WI、T2WI、DWI及ADC图像上的信号特征,病灶的囊壁、分隔及壁结节的强化特点,根据形态学特点分为微囊型、寡囊型、混合型3组,分析3组病灶的MRI特征差异有无统计学意义。结果：55例患者中有55个病灶,所有病灶均为单发,微囊型6例,寡囊型20例,混合型29例,病灶大小为1.6～23 (8.8±4.7)cm;3组间在病灶大小、有无壁结节的比较差异有统计学意义（P<0.05）,在年龄、性别、有无临床症状、形态、病灶位置、边界、实验室指标、有无浸润性、囊液信号、有无分隔、壁结节强化方式及壁结节是否扩散受限、囊腔数量及上游胆管有无扩张的比较差异无统计学意义（P>0.05）。结论：不同类型的肝脏黏液性囊性肿瘤的MRI表现有一定的特征,MRI有助于该病的诊断与鉴别诊断。     

卵巢性索间质肿瘤的低场MR诊断

目的 探讨卵巢性索间质肿瘤(OSCST)的低场MRI表现,提高对该病的诊断水平.方法 回顾性分析经手术病理证实的13例OSCST的临床、MR影像资料.结果 8例实性肿块,6例卵泡膜细胞瘤,2例纤维瘤,T1WI呈等低信号,T2WI低信号中夹杂条索状、片絮状高信号,5例轻度强化、1例明显强化、1例纤维瘤不强化.5例颗粒细胞瘤,表现囊实性肿块,囊壁及分隔粗厚、光滑,T1WI呈等信号,T2WI呈稍高信号;囊性部分呈长T1、长T2信号;肿块实质、囊壁及分隔明显强化.本组正确诊断10例(76.9%),误诊阔韧带肌瘤2例、胃肠间质瘤1例.结论 OSCST在低场MRI上表现具有一定特征性,对该病具有一定的诊断价值.     

卵巢内膜样腺癌的MRI表现

目的:探讨卵巢内膜样腺癌(OEC)的MRI表现,提高对该病的认识.方法:回顾性分析经手术和病理证实的20例OEC的MRI表现,观察肿瘤的部位、形态、大小、肿块质地、壁结节、信号强度、强化程度、腹膜种植灶、腹水、同时伴发子宫内膜癌的双原发癌(DPC)、子宫内膜息肉、子宫内膜异位症及临床分期等情况.结果:20例OEC共22个病灶,单侧发病18例(90％),双侧2例(10％),DPC 10例(50％).13个(59％)病灶呈卵圆形,最大径约(11.2±5.1) cm(3.7～22.5 cm).病灶呈囊性为主伴壁结节15个(68％),囊实性病灶5个(23％),实性病灶2个(9％).囊液T1 WI呈均匀等或高信号者17例(85％),T2 WI呈均匀高信号者15例(75％),DWI呈低信号者10例(63％,10/16).实性成分T1 WI均呈等信号,19个(86％,19/22)病灶T2 WI呈不均匀高信号,14个(82％,14/17)病灶DWI呈高信号.出现卵圆形病灶、囊性为主伴壁结节、囊液T1WI呈均匀等或高信号时,诊断OEC的准确率分别为59％、68％和85％,联合上述3种征象诊断OEC的准确率为91％.结论:OEC的MRI表现有一定特征性,结合DWI有助于OEC的诊断.     

卵巢颗粒细胞瘤的MRI诊断

目的 分析卵巢颗粒细胞瘤的MRI特征。资料与方法 回顾性分析15例卵巢颗粒细胞瘤的MRI特征，并与手术及病理对照研究。结果 15例中，囊实性肿块8例，内有多发大小不等的囊性变，囊内壁光滑，囊内容物MRT1WI呈等低混杂信号，T2WI呈混杂高信号，囊与套间有厚壁分隔；实性肿块3例，T1WI及T2WI信号均高于肌肉；单一较大的囊性病灶4例。13例子宫均匀增大，内膜增厚，1例并有子宫内膜癌。结论 诊断卵巢颗粒细胞瘤的可靠依据为：(1)肿瘤内多发囊变，间有厚壁分隔，囊内壁光滑；(2)合并子宫体积增大，内膜增生。     

子宫附件良性囊性病变的MRI诊断

目的:探讨女性附件良性囊性病变的MRI表现特点,提高其诊断及鉴别诊断水平。方法:搜集我院近三年来经手术及病理证实的110例附件区良性囊性病灶,对其MRI表现作回顾性分析,讨论其MRI表现特点。结果:110例附件良性囊性病灶中,卵巢囊性病变最多,占所有病例的89%(98/110)。其中单纯性囊肿28例(25%,28/110),卵巢囊腺瘤27例(25%,27/110),畸胎瘤22例(20%,22/110),子宫内膜异位囊肿15例(14%,15/110),占所有病例的84%(92/110)。28例单纯性囊肿信号均匀,其中26例(93%,26/28)T1WI呈低信号,T2WI呈高信号。27例卵巢囊腺瘤中,24例可见分隔,2例可见壁结节。22例囊性畸胎瘤中21例可见明显脂质信号。所有15例子宫内膜异位囊肿T1WI和T2WI均呈高信号,部分病灶内可见液液分层。结论:大多数女性附件良性可性病变的MRI表现特征性较明显,可明确诊断。     

小儿淋巴管瘤的CT和MRI诊断

目的 探讨儿童淋巴管瘤的CT和MRI表现及其诊断价值.方法 回顾性分析经手术病理证实的43例淋巴管瘤的CT和MRI影像资料,CT检查37例,MRI检查6例.结果 病变发生于颈部21例,其中同时累及纵隔和/或腋窝6例;肠系膜7例;腹膜后7例;大网膜3例;胸腹壁3例;四肢2例.主要表现为:(1) 边缘清楚或不清楚的单房性(n=5)或多房囊性(n=38)薄壁肿块;(2) 沿疏松组织间隙生长(n=22);(3) 5例出血者瘤内密度增高,其中2例可见液-液平面;(4) 2例合并感染者,囊壁增厚;(5)增强扫描囊壁及分隔轻度强化,囊内不强化;(6) T2WI均呈高信号影,T1WI呈低信号或等信号影,合并出血者T1WI呈高信号影.结论 淋巴管瘤的CT、MRI表现具有特征性,对临床治疗有重要价值.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.