缩窄性心包炎的MRI诊断

目的 评价MRI检查缩窄性心包炎的诊断价值。材料与方法 回顾性分析临床证实的26例缩窄性心包炎MRI表现。结果 MRI发现24例心包有增厚,2例正常。增厚的心包T1WI上20例呈中等信号,4例为低信号。右心室腔呈管状狭窄者6例,右心室前壁僵、右心室腔呈三角形者13例,5例右心室略大。11例电影MRI均显示右心室受限。右房除2例外均有不同程度的增大,左房有4例增大,19例发现有上、下腔静脉扩张。结论 MRI能直接显示极大多数病例增厚的心包,并确定其部位和范围,对诊断缩窄性心包炎和与限制性心肌病鉴别有重要价值,可在某些诊断有争议的病例中选择性应用。     

缩窄性心包炎MRI诊断

目的 评价MRI对缩窄性心包炎的诊断价值.资料与方法 对12例经手术证实的缩窄性心包炎患者行心电门控自旋回波、MRI电影和对比剂延迟增强扫描,分析心包、心肌以及心腔形态结构和功能变化.30名正常人纳入对照组进行对比研究.结果 所有12例均有不同程度的心包增厚,平均心包厚度(5.08±1.73)mm,其中弥漫性增厚5例;不规则局限性增厚7例.左房轻度扩大,右房明显扩大,双室腔不大[左房前后径(36.20±10.96)mm,右房前后径(49.79±8.74)mm,P<0.05],下腔静脉扩张11例.所有病例右室腔均显示不同程度的受压变形,其中严重变形8例;MRI电影序列显示室间隔摆动10例,全部病例未见明显二尖瓣和三尖瓣关闭不全.对比剂延迟增强扫描仅1例出现心包强化.结论 MRI既能直接显示心包形态和厚度、继发性心房和下腔静脉扩张,又能动态观察到室间隔异常摆动,因此是诊断缩窄性心包炎的理想方法.     

缩窄性心包炎左心房功能的MRI评估

目的 利用常规的二腔心、四腔心及三腔心电影序列评价缩窄性心包炎(CPC)患者的左心房结构功能改变特点.方法 回顾性分析17例CPC病例,同时收集20例正常志愿者作为对照组,对比分析2组之间各个切面左心房内径,左心房最大容积,最小容积和左心房收缩前容积和左心房功能.结果 2组之间的左心房内径对比显示,CPC组的左心房二腔心长径,四腔心、三腔心前后径较正常组明显增大,左心房最大容积(LAVmax),左心房最小容积(LAVmin)以及左心房收缩前容积(LAVpr)显示CPC组的左心房在上述3个期相中明显更大,左心房功能评价指标中,CPC组的左心房射血分数(LAEF)较对照组明显减弱,CPC组的左心房主动射血分数(LAEFcon)及左心房被动射血分数(LAEFpa)都显示出明显下降,都具有统计学意义.结论 利用常规的心脏MR电影序列,可以对左心房的结构、功能改变进行详细的评价,有利于病情的评估.     

缩窄性心包炎的CT表现

作者分析了１６例缩窄性心包炎的ＣＴ表现，结合文献复习进行讨论，认为心包增厚（伴或不伴心包钙化），伴有室间隔扭曲成角和／或下腔静脉扩张者，可考虑为缩窄性心包炎，同时指出ＣＴ是鉴别缩窄性心包炎与限制型心肌病的最佳影像学技术之一。     

缩窄性心包炎的外科治疗

目的　探讨缩窄性心包炎的外科治疗方法。方法　 2 2例病人在气管插管 ,全麻状态下行心包松解术。结果　本组无手术死亡 ,远期随访满意。结论　切除心包应先左心、后右心 ,先流出道 ,后流入道 ,及恰当的围术期处理 ,对术后低心排的预防有重要作用。     

13例慢性缩窄性心包炎的手术治疗

目的：探讨１３例慢性缩窄性心包炎的手术时机,方法及围手术期常见并发症的处理。方法;术中切除缩窄增厚心包,术后给予强心,利尿,扩血和治疗降低心脏前后负荷。结果：出院时症状改善者９例,无改善者３例,加重１例,远期随访死亡２例。结论：病史长短与手术预后密切相关,一经确诊应立即手术：术中只要充分切除左室心尖及右室流出道缩窄增厚心包,即可获得较好疗效;     

缩窄性心包炎76例误诊情况分析

缩窄性心包炎是指心脏被致密厚实的纤维化或钙化心包所包围,使心室舒张期充盈受限而产生的一系列循环障碍的病征。多继发于急性心包炎,起病缓慢、隐匿,临床表现多样且缺乏特异性,早期诊断困难。2009年1月-2013年1月,我院共收治缩窄性心包炎76例,其中早期误诊48例。现分析报告如下。     

MSCT诊断缩窄性心包炎的临床价值

目的:探讨MSCT诊断缩窄性心包炎的临床价值。方法:回顾性分析经临床确诊的缩窄性心包炎患者28例,所有患者行MSCT扫描,分析心包、心肌的形态变化。所有患者最后行心包剥离手术治疗。结果:28例缩窄性心包炎患者中,心包平均厚度6.46mm,心包不同程度增厚伴钙化22例,4例心包增厚不明显,仅于房室沟处局限性点状钙化,2例心包无增厚及钙化,仅表现为心包致密。20例心室不同程度变形,其中严重变形11例。28例均有下腔静脉扩张,心房增大18例,CT增强扫描清晰显示冠状动脉,2例心肌灌注异常。术中中心静脉压明显下降,其中19例心包弥漫性增厚、粘连、纤维环形成,3例弥漫性钙化,6例心包局限性增厚、粘连伴钙化、纤维环形成。结论:MSCT可显示心包增厚、钙化、血流动力学异常以及纤维缩窄环所导致的心室形态改变,增强扫描直观显示冠状动脉与钙化心包关系以及异常心肌灌注,是诊断缩窄性心包炎可靠方法。     

慢性缩窄性心包炎的影像学诊断

本文收集了我院自1988年-2003年间收治的34例慢性缩窄性心包炎，进行回顾性分析，着重讨论本病的影像学表现。旨在提高对本病的认识及时作出诊断以配合临床治疗。     

Radionuclide angiography and magnetic resonance imaging: complementary non-invasive methods in the diagnosis of constrictive pericarditis

Constrictive pericarditis presents with a suggestive clinical picture, and its diagnosis is based on a haemodynamic pattern revealing impaired ventricular filling. In this study of 15 patients with pure isolated constrictive pericarditis, we attempted to evaluate the diagnostic value of two non-invasive methods not usually employed in this indication: radionuclide angiography (RNA) and magnetic resonance imaging (MRI). Whilst RNA permits analysis of the functional pattern of the global and segmental left ventricular filling impairment, MRI allows measurement of the thickness of the pericardium. RNA revealed increased early diastolic filling as evidenced by a shorter one-third filling time (TFl/3;P<0.0001 with respect to a normal population), a higher peak filling rate (PFR;P<0.01) and its early occurrence (P<0.001), increased one-third and mid diastolic filling fractions (P<0.01), and the ratio of the PFR over the peak ejection rate (P<0.01). During late diastole, the atrial filling fraction decreased (NS). The patients with constrictive pericarditis also showed a decrease in the physiological filling asynchrony, as assessed by segmental evaluations. Seven patients underwent MRI. The pericardium was thickened in all the patients, varying from 6 to 14 mm (normal: 2.5±0.7 mm), without any systolo-diastolic variation. Pericardial thickening appeared as a dark low-intensity signal band, demonstrating the fibrocalcific nature of the pericardial contents. Sagittal and coronal cross-sections were particularly well-suited to show the non-uniformity of the pericardial thickening. These results indicate that RNA and MRI are complementary non-invasive methods, and can provide the functional and anatomical information required for the diagnosis of constrictive pericarditis.     

糖尿病足的MRI诊断价值

目的:探讨糖尿病足的MRI诊断价值.方法:回顾性分析经临床综合诊断证实的12例糖尿病足患者的MRI表现,对病变部位、软组织病变、骨关节病变进行评估.结果:大部分病变位于前足(9/12,占75.0％)和中足(4/12,占33.3％);12例患者均可见软组织肿胀、窦道形成、骨髓水肿及骨髓炎,部分伴脓肿形成(5/12,占41.7％);2例夏科氏关节伴骨髓炎并可见关节脱位及摇椅足形成.结论:MRI能够清楚地显示糖尿病足的骨关节及软组织病变情况,为临床诊疗提供良好的影像依据.     

结直肠癌的MRI初步研究

目的 探讨MRI对结直肠癌检查的可行性及其价值。方法 对38例经临床拟诊为结直肠癌患者行MR检查,检查前经直肠灌水300—1000ml。分别行轴面平扫,轴面、矢状面和冠状面3个平面增强扫描及水成像。结果 38例中经手术病理证实的结直肠癌31例,5例表现为腔内局限性软组织肿块,26例表现为肠壁不规则增厚,肠腔环形狭窄环绕肠腔1周或部分,平扫T1WI上呈等信号,T2WI上30例呈略高信号,1例呈明显高信号;钆喷替酸葡甲胺(Gd—DTPA)增强扫描病灶均明显强化。5例平扫SE序列T1WI上病灶周围脂肪间隙内见斑片状低信号。增强后病变段肠壁外缘光滑12例,不光滑或有结节影向外突出19例。结直肠水成像满意的24例中显示为病变部位肠腔内不规则充盈缺损14例,10例病变远侧端呈“袖口征”及“截断征”,近侧端未显示。MRI可以正确识别31例经病理证实的结直肠癌中的30例和7例非结直肠癌中的4例,诊断的敏感度、特异度和准确度分别为96．8％、57．1％和89．5%。MRI对结直肠癌T分期的准确度为83．9％(26／31),其中对T1～2期为75．0％(9／12)、对13期为88．2％(15／17)、对T4期为100％(2／2)。结论 MRI可以从整体上显示结直肠癌的纵向和横向侵犯,可以较准确地判断肿瘤在肠壁的浸润深度,水成像最大信号强度投影(MIP)重建可部分替代钡灌肠检查,为制定临床治疗方案提供有益的指导。     

Intramedullary and extramedullary fat globules on magnetic resonance imaging as a diagnostic sign for osteomyelitis

We retrospectively studied the frequency of persistent foci of fat signal on magnetic resonance (MR) imaging in osteomyelitis to assess its frequency, cause and diagnostic value. The radiographs and MR scans of 100 patients with a final diagnosis of osteomyelitis referred to a specialist orthopaedic oncology service with the presumptive diagnosis of a bone tumour were reviewed. The MR signal and morphological characteristics were recorded with particular attention to the presence of persistent fat signal within the infected area, which was classified as diffuse or focal. Seventeen cases were classified on radiographic grounds as acute, 63 as subacute and 20 as chronic osteomyelitis. In the acute group 12 (70%) showed replacement of the marrow with fluid containing residual fatty signal, diffuse in seven and focal in five cases. Two cases showed predominantly fatty marrow with very early marrow oedema and three cases (18%) showed replacement of marrow fat with fluid and no residual fatty foci. None of the subacute group showed foci of fatty signal and two cases of inactive sclerosing osyeomyelitis in the chronic group showed restoration of normal marrow. Persistent fatty signal within the bone as well as soft tissues on MR imaging is a frequent finding in acute osteomyelitis. Radiological–pathological correlation suggests that the increasing intramedullary pressure leads to septic necrosis with death of the lipocytes and release of free fatty globules. This characteristic, but not pathognomonic, MR finding supports the diagnosis of osteomyelitis and may help to exclude the presence of a tumour.     

烟雾病的MRI、MRA诊断价值

 目的探讨MRI、MRA对烟雾病(Moyamoya病)的诊断价值.方法对11例Moyamoya病患者行MRI和MRA检查,MRI包括横轴位和矢状位T1WI、T2WI、FLAIR;MRA采用3D TOF法,3例行增强MRA.结果MRI表现为:(1)Moyamoya血管:双侧3例,单侧8例;(2)脑梗死和脑软化灶11例;(3)局部脑萎缩3例.MRA表现为3例双侧颈内动脉狭窄,双侧大脑中、前动脉闭塞,大脑后动脉形成异常血管网;6例右侧颈内动脉、大脑中动脉狭窄;2例左侧颈内动脉、大脑中动脉狭窄.结论MRI能良好的显示脑内病变,MRA能较完整的显示异常血管,MRI与MRA相结合可作为烟雾病诊断的首选检查方法.     

Popliteal cysts: a reassessment using magnetic resonance imaging

The advent of magnetic resonance imaging (MRI) prompted the reevaluation of the incidence of popliteal cyst and its associated injuries. We reviewed more than 1000 consecutive MRI examinations of the knee performed on patients referred for evaluation of internal derangement. We report a 5% incidence of popliteal cyst, which is lower than has previously been determined. We believe that the reported higher incidence was due to arthrographic distention of normal, collapsed bursae. The strong association between popliteal cyst and tear of the medial meniscus is confirmed. We report for the first time to our knowledge the 13% association between popliteal cyst and complete tear of the anterior cruciate ligament.     

儿童心肌病的磁共振特征

目的:分析儿童心肌病磁共振的临床影像学特点.方法:回顾性搜集我院64例临床诊断儿童心肌病患者,其中心内膜弹力纤维增生症(EFE)26例,肥厚型心肌病(HCM)14例,扩张型心肌病(DCM) 16例,限制型心肌病(RCM)4例,致心律失常性右室心肌病(ARVC)2例,心肌致密化不全(NVM)2例.采用1.5T磁共振扫描,不能配合的患儿用0.5 mL/kg水合氯醛镇静.所有患儿行黑血快速自旋回波(TSE)、亮血平衡稳态自由进动梯度回波(balanced SSFP)电影,26例行快速自旋回波心肌延迟增强,28例行相位敏感反转恢复(PSIR)心肌延迟增强扫描.结果:26例EFE均有左室心腔扩大,9例伴心肌变薄;16例心肌收缩运动幅度减低;左房增大7例;左室肌小梁增多增厚13例;瓣膜返流18例;心包积液7例,胸腔积液4例.14例HCM共有66个左室节段心肌增厚,室间隔的增厚14例,共累及45个节段,左室游离壁增厚12例,共累及21个节段.1例右室心尖部受累.左室内乳头肌异常4例.左室肌小梁增多增厚6例.16例DCM均有心腔扩大,左室心肌变薄,左房左室同时显著增大12例,8例为全心增大,仅左室增大2例.13例患者心室壁收缩运动幅度均明显减低.左室游离壁肌小梁增粗增厚11例.瓣膜返流13例.心包积液9例,胸腔积液7例.4例RCM,均为双心室受累,舒张运动受限,心室腔大小正常,双侧心房明显扩张,6例瓣膜返流.下腔静脉扩张4例.心包积液3例.2例ARVC,MRI均可见右室流出道扩张,局部室壁变薄,“手风琴征”阳性.2例NVM,左室心内膜及肌小梁明显增厚,交叉呈网,相邻心肌变薄,NC/C约3.1～7.5.6例延迟强化,HCM 1例,EFE 2例,DCM 3例.结论:儿童心肌病的临床表现多样化,多伴有心功能异常,磁共振影像学表现有一定的特点,两者密切结合可以作出诊断.     

脑肿瘤磁共振波谱成像检查中的质量控制

目的探讨脑肿瘤磁共振波谱学检查技术及图像质量影响因素。方法分析137例接受磁共振波谱学检查的脑肿瘤患者的影像学资料。结果优质的图像使检查更易行可靠,更有助于影像诊断。结论检查技术参数的合理选择有助于提高影像质量,是质量控制的关键。     

宫颈癌功能磁共振成像研究进展

宫颈癌是女性生殖系统最常见的恶性肿瘤,早期诊断和治疗是防治的关键。MR成像尤其是功能MR成像技术在宫颈癌的早期诊断、生物学评价、疗效和预后评估等方面具有明显的优势。综述宫颈癌的功能MRI研究进展,重点分析各种功能成像技术的临床应用价值及其不足,以期为临床工作中根据具体情况和技术条件选择和组合多种功能MRI技术提供有益提示,从而提高宫颈癌的诊断准确率。     

Application of magnetic resonance imaging in cervical spondylotic myelopathy

Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction and is caused by static or dynamic repeated compression of the spinal cord resulting from degenerative arthritis of the cervical spine and some biological injuries to the cervical spine. The T2 signal change on conventional magnetic resonance imaging (MRI) is most commonly associated with neurological deficits. Diffusion tensor imaging and MR spectroscopy show altered microstructure and biochemistry that reflect patient-specific pathogenesis and can be used to predict neurological outcome and response to intervention. Functional MRI can help to assess the neurological functional recovery after decompression surgery for CSM.