嵌合体对异种骨髓移植后急性移植物抗宿主病的预防作用

目的 探讨嵌合体对异种骨髓移植后急性移植物抗宿主病(aGVHD)的预防作用。方法 用亚致死量^60Coγ射线全身照射＋输注小鼠骨髓细胞＋腹腔注射环磷酰胺的方法,建立嵌合体大鼠模型,然后观察嵌合体对异种骨髓移植致小鼠aGVHD的预防作用。结果 移植小鼠均出现典型aGVHD症状,未用aGVHD预防方案即输注无嵌合体大鼠骨髓和脾细胞的移植小鼠(A组),死亡高峰在移植后10～12天。输注嵌合体大鼠细胞的移植BALB／C小鼠(B组),生存时间较A组和C组(输注嵌合体大鼠的C57BL／6小鼠)显著延长,aGVHD症状及病理表现明显减轻。结论 诱导出的嵌合体能有效预防异种骨髓移植后的aGVHD,减轻其症状和病理损害,延长平均生存时间,而且此预防作用具有特异性。     

Radiation protocols determine acute graft-versus-host disease incidence after allogeneic bone marrow transplantation in murine models

PURPOSE: Effects of radiation sources used for total body irradiation (TBI) on Graft-versus-Host Disease (GvHD) induction were examined. MATERIALS AND METHODS: In a T cell receptor (TCR) transgenic mouse model, single fraction TBI was performed with different radiation devices ((60)Cobalt; (137)Cesium; 6 MV linear accelerator), dose rates (0.85; 1.5; 2.9; 5 Gy/min) and total doses before allogeneic bone marrow transplantation (BMT). Recipients were observed for 120 days. Different tissues were examined histologically. RESULTS: Acute GvHD was induced by a dose rate of 0.85 Gy/min ((60)Cobalt) and a total dose of 9 Gy and injection of 5 x 10(5) lymph node cells plus 5 x 10(6) bone marrow cells. Similar results were obtained using 6 MV linear accelerator- (linac-) photons with a dose rate of 1.5 Gy/min and 0.85 Gy/min, a total dose of 9.5 Gy and injection of same cell numbers. TBI with (137)Cesium (dose rate: 2.5 Gy/min) did not lead reproducibly to lethal acute GvHD. CONCLUSIONS: Experimental TBI in murine models may induce different immunological responses, depending on total energy, total single dose and dose rate. GvHD might also be induced by TBI with low dose rates.     

Radiation protocols determine acute graft-versus-host disease incidence after allogeneic bone marrow transplantation in murine models

Purpose:?Effects of radiation sources used for total body irradiation (TBI) on Graft-versus-Host Disease (GvHD) induction were examined.

Materials and methods:?In a T cell receptor (TCR) transgenic mouse model, single fraction TBI was performed with different radiation devices (⁶⁰Cobalt; ¹³⁷Cesium; 6 MV linear accelerator), dose rates (0.85; 1.5; 2.9; 5 Gy/min) and total doses before allogeneic bone marrow transplantation (BMT). Recipients were observed for 120 days. Different tissues were examined histologically.

Results:?Acute GvHD was induced by a dose rate of 0.85 Gy/min (⁶⁰Cobalt) and a total dose of 9 Gy and injection of 5×10⁵ lymph node cells plus 5×10⁶ bone marrow cells. Similar results were obtained using 6 MV linear accelerator- (linac-) photons with a dose rate of 1.5 Gy/min and 0.85 Gy/min, a total dose of 9.5 Gy and injection of same cell numbers. TBI with ¹³⁷Cesium (dose rate: 2.5 Gy/min) did not lead reproducibly to lethal acute GvHD.

Conclusions:?Experimental TBI in murine models may induce different immunological responses, depending on total energy, total single dose and dose rate. GvHD might also be induced by TBI with low dose rates.     

CT and ultrasound features of metanephric adenoma in adults with pathologic correlation.

PURPOSE: The purpose of this work was to correlate the CT, ultrasound, and pathologic features of metanephric adenoma, a rare benign renal tumor in adults. METHOD: Retrospective review of medical records (1990-1997) revealed three adult female patients who had both preoperative imaging and nephrectomy with pathologic diagnosis of metanephric adenoma performed at our institution. CT (n = 3) and ultrasound (n = 2) features were reviewed in consensus by two radiologists and correlated with pathologic findings. RESULTS: In all three cases, the metanephric adenoma was of increased attenuation relative to adjacent renal parenchyma on unenhanced CT scans. No septa or calcifications were seen. Ultrasound images showed both tumors to be hyperechoic with enhanced through-transmission. CONCLUSION: The CT and ultrasound findings correlate with the pathologic features of a high nuclear-to-cytoplasmic ratio and psammomatous calcifications. In the adult population, it is unlikely that metanephric adenoma can be prospectively differentiated from renal cell carcinoma based on imaging features.     

Repopulation of marrow after transplantation: MR imaging with pathologic correlation

Sixty-seven magnetic resonance (MR) studies of the lumbar spine were performed in 15 patients with bone marrow transplants, and the appearance of marrow regeneration on MR images was correlated with results of bone marrow biopsy and pathologic examination. After transplantation, T1-weighted MR images of vertebral marrow showed a characteristic band pattern consisting of a peripheral zone of intermediate signal intensity and a central zone of bright signal intensity. Reciprocal changes were identified on short inversion time inversion recovery images. At histologic examination the central zone corresponded to fatty marrow; the peripheral zone corresponded to a zone of regenerating hematopoietic cells. Posttransplantation T1 and T2 relaxation times of the entire vertebral marrow were calculated from the spin-echo images; no statistically significant trends in relaxation times were noted. Knowledge of the normal MR pattern of marrow regeneration after transplantation may be useful in screening for residual marrow disease, determining marrow engraftment, and differentiating marrow repopulation with normal versus malignant cells.     

Gastrointestinal inflammation after bone marrow transplantation: graft-versus-host disease or opportunistic infection?

Gastrointestinal inflammation after allogeneic bone marrow transplantation may be due to acute graft-versus-host disease (GVHD) and/or superinfection with opportunistic organisms. Twenty-eight patients with barium studies suggesting gastrointestinal inflammation after bone marrow transplantation and either acute GVHD, viral infection, or both were studied to characterize the radiographic appearances of each disease and to determine whether acute GVHD could be distinguished from viral superinfection on the basis of radiographic findings. Thirteen patients had minimal or no acute GVHD, with viral infection proved in eight and strongly suspected in four others; the remaining patient was thought to have nonspecific inflammatory bowel disease. Five patients had pure acute GVHD, and 10 patients had viral enteritis superimposed on acute GVHD. Radiographic abnormalities were found in the gastrointestinal tract in both acute GVHD and viral infection and were more extensive than previously reported. Findings were similar in both entities, although gastric abnormalities were not seen in pure acute GVHD but only in viral infection, either alone or together with acute GVHD. Prolonged small bowel barium coating occurred in both viral infection and acute GVHD. Fold thickening evolved into fold effacement with a shaggy contour in two patients with viral infection. Colonic findings in all groups mimicked ulcerative colitis. Our data indicate that differentiation between acute GVHD and viral enteritis is not possible on the basis of radiographic findings alone. Both entities should be considered when gastrointestinal inflammation occurs after bone marrow transplantation.     

Gallium-67 uptake in the salivary glands in chronic graft-versus-host disease after bone marrow transplantation

Ga-67 citrate scans were performed in a 17-year-old female patient after bone marrow transplantation for acute lymphoblastic leukemia. Ga-67 accumulated in salivary glands in which chronic graft-versus-host disease (GVH) was demonstrated pathologically. Ga-67 scan may be a sensitive and noninvasive test for detecting and monitoring the Sicca syndrome induced by chronic GVH.     

Hepatic leiomyosarcomas: CT features with pathologic correlation

The purpose of this study was to determine the computed tomographic (CT) features of hepatic leiomyosarcoma and to correlate them with pathologic findings. CT examinations of 15 patients with pathologically proven leiomyosarcoma of the liver were retrospectively reviewed. Three patients had primary leiomyosarcoma of the liver and 12 patients had 43 distinct hepatic metastases originating from a primary gastrointestinal (n = 8), uterine (n = 2) or retroperitoneal (n = 2) leiomyosarcoma. In the 11 patients who had partial hepatic resection or surgical biopsy of their tumors, a correlation was made between CT imaging and pathologic findings. Primary leiomyosarcomas showed heterogeneous enhancement; two displayed internal and peripheral enhancement, and one showed peripheral enhancement with a pseudocystic pattern (i.e. enhancing thick wall with internal nonenhancing low attenuation area). Leiomyosarcomas metastatic to the liver were homogeneous, showing no or moderate enhancement (10 of 43 metastases, 23%) or heterogeneous and predominantly peripheral enhancement (33 of 43 metastases, 77%). A pseudocystic pattern was seen in 13 of the 43 metastases (30%). Homogeneous tumors were made of smooth fibrous-like tissue without area of necrosis. Heterogeneous tumors contained varying degrees of necrosis and hemorrhage or gelatinous tissue. We found that primary and secondary hepatic leiomyosarcomas of the liver can exhibit different features. A pseudocystic pattern is uncommon. Furthermore, purely cystic tumors were not seen in our series.     

Computed tomography of gastrointestinal inflammation after bone marrow transplantation

Overwhelming secretory diarrhea can be a major complication after bone marrow transplantation, associated usually with acute graft-versus-host disease (AGVHD). Radiographic evaluation may be hampered by nausea, vomiting, or debilitation. Computed tomography (CT) in seven such patients demonstrated diffuse wall thickening in the small intestine, colon, and/or mesentery. In two cases, prolonged adherence of oral contrast material to the luminal surface resulted in bizarre patterns of coating. In two others, a layer of low attenuation within the thickened wall produced a target appearance consistent with submucosal edema or hemorrhage. Small bowel dilatation and fold enlargement was the only finding in one patient. The role that superinfection of the gastrointestinal tract with opportunistic organisms can play in this immunocompromised group of patients is less well established. In this group of patients, the findings were due to AGVHD in two, AGVHD and viral enteritis in two, and viral enteritis alone in three. CT may be an alternative to routine contrast studies in assessing the extent of gastrointestinal tract involvement after bone marrow transplantation. Neither contrast studies nor CT were able to differentiate between AGVHD and viral enteritis.     

Anorectal gastrointestinal stromal tumors: CT and MR imaging features with clinical and pathologic correlation

OBJECTIVE: The purpose of this study was to describe the imaging features of anorectal gastrointestinal stromal tumors with clinical and pathologic correlation. CONCLUSION: Anorectal gastrointestinal stromal tumors are mesenchymal neoplasms that typically arise in the muscularis propria of the intestinal wall. The cross-sectional imaging appearance is that of a well-defined mural mass that may have an exophytic component and may invade adjacent structures. A prominent intraluminal component is a rare feature.     

异基因骨髓移植小鼠GVHD模型的建立

目的:建立异基因骨髓移植小鼠移植物抗宿主病(GVHD)模型.方法:将供体C57BL/6雄性小鼠骨髓细胞和脾细胞按不同细胞数混合,输入接受照射后的受鼠雌性BALB/c小鼠,观察受鼠的一般情况、生存期、组织病理学和嵌合体检查.结果:给予5×106个以上的供者脾细胞的各组小鼠都发生了急性GVHD,但小鼠GVHD出现的时间不同.结论:成功地建立了异基因骨髓移植小鼠GVHD模型,输入5×106-5×107个供鼠脾细胞均适用于小鼠GVHD防治的研究,可以根据实验需要选择供鼠脾细胞的数量.     

淋巴瘤肺浸润的CT表现和病理对比

目的：探讨淋巴瘤肺浸润的特征性CT表现和病理学特征,以提高对本病的认识。方法：回顾性分析23例经病理证实的淋巴瘤肺浸润的CT影像资料,并与组织病理学和手术结果比较。结果：23例淋巴瘤中霍奇金淋巴瘤5例,非霍奇金淋巴瘤18例。单发病灶7例,多发病灶16例。肺叶肺段型9例,结节肿块型8例,混合型6例。CT病理对比研究显示支气管充气征（14/23,60.87%）、CT血管造影征（12/23,52.17%）、磨玻璃结节（3/23,13.04%）,跨叶病灶（4/23,17.39%）为较具特征性的征象,对诊断意义较大。结论：淋巴瘤肺浸润CT表现具有一定的特征性,对淋巴瘤肺浸润的诊断具有一定的临床价值。     

Early and late-onset acute GvHD following hematopoietic cell transplantation: CT features of gastrointestinal involvement with clinical and pathological correlation

Objective

With the introduction of non-myeloablative hematopoietic cell transplantation, acute graft-versus-host-disease (GvHD) is frequently observed beyond the traditional 100 days cut-off.The aim of this study was to describe and compare CT features of gastrointestinal early and late-onset GvHD and to correlate findings with clinical and pathology grading.

Subjects and methods

Abdominal CT scans were obtained in 20 patients with early and 15 with late-onset GvHD. Examinations were assessed for intestinal and extraintestinal abnormalities and findings compared between the two subgroups of GvHD. Distinct CT abnormalities as well as a CT-score integrating multiple pathologies were correlated with gut, clinical or pathology grading.

Results

Frequent intestinal abnormalities included wall thickening, abnormal enhancement, and excessive fluid-filling (94%, 89%, and 94%). 86% of patients showed concomitant small and large bowel involvement. A discontinuous distribution was observed in 54%. Bile tract abnormality was the most common extra-intestinal finding (74%).The distribution of pathologies was equal between subgroups of early or late-onset disease.Wall thickening and mucosal attenuation in non-enhanced scans were significantly related to clinical and pathology scores (P ≤ 0.018). Number of abnormal segments, small bowel dilatation, engorgement of the vasa recta, mesenteric fat stranding and ascites were linked to clinical grading (P ≤ 0.019). A CT-score integrating multiple abnormalities was correlated to gut, overall clinical and pathology grading (r = 0.64, 0.57, 0.50).

Conclusion

CT morphology of acute GvHD is independent of its time of onset and, thus, facilitates differential diagnosis of late-onset acute GvHD. Correlation of CT morphology with clinical and pathological grading is important in terms of prognosis and may help guiding the therapeutic approach.     

Independent predictors of acute appendicitis on CT with pathologic correlation

RATIONALE AND OBJECTIVES: To assess computed tomographic (CT) signs that have been described in published studies for the diagnosis of appendicitis to identify independent findings that predict appendicitis. METHODS AND MATERIALS: A retrospective database search identified 67 patients with a CT scan of the abdomen/pelvis and pathologic evaluation of the appendix, including 41 with appendicitis and 26 with a normal appendix on pathologic examination. Each computed tomogram was re-evaluated by three independent, blinded observers who evaluated appendix diameter, enhancement of the appendix, thickening of the appendix, presence of an appendicolith, infiltration of peri-appendiceal fat, focal cecal thickening, local lymphadenopathy, fluid collections, non-appendiceal bowel thickening, non-periappendiceal infiltration of fat, and comparison of peri-appendiceal fat infiltration to thickening of adjacent bowel loops. RESULTS: Mean diameter of the normal appendix (6.7 +/- 2.2 mm) was significantly lower than that of the inflamed appendix (12.1 +/- 4.3 mm; P < .001). Significant univariate predictors of appendicitis included appendix diameter >8 mm (odds ratio [OR] 34.8), enhancement of the appendix (OR 4.4), thickening of the appendix (OR 4.3), infiltration of peri-appendiceal fat (OR 5.5), focal cecal thickening (OR 5.1), non-appendiceal bowel thickening (OR 0.4), and non-periappendiceal infiltration of fat (OR = 0.3). Of these variables, only appendix diameter and enhancement of the appendix were significant independent predictors of appendicitis on multivariate analysis. An overall diagnostic impression based on all secondary signs was less accurate than a diagnosis based on appendix diameter alone (receiver-operating characteristic analysis: Az = 0.80 vs. Az = 0.91, P = .02). Sensitivity/specificity of appendix diameter was 84%/87% using a cutoff between 8 and 9 mm and 97%/48% using a cutoff between 6 and 7 mm. CONCLUSION: Appendix diameter is the best single diagnostic criterion for appendicitis on CT scan. A cutoff between 8 and 9 mm provided the best balance of sensitivity/specificity in our study population, whereas a cutoff between 6 and 7 mm improved sensitivity at the expense of specificity. The presence of appendiceal enhancement provided additional diagnostic information, but other secondary signs of appendicitis did not improve diagnostic accuracy.     

腹膜后副神经节瘤的临床及CT表现与病理对照研究

目的:探讨腹膜后副神经节瘤的临床表现及CT诊断价值。方法:回顾性分析有完整病历及CT资料、经手术病理证实的腹膜后副神经节瘤27例,将临床及CT表现与病理学结果进行对照分析。结果:临床表现:有高血压症状10例,无高血压症状但术中出现血压波动6例,无高血压及术中血压波动11例。CT表现:肿瘤多位于腹中线大血管周围(19个病灶),并多大于5cm(21个病灶),增强CT表现为实性、明显强化,常伴有囊变或坏死。临床表现与病理对照:嗜铬性副神经节瘤16例,有高血压症状10例,另外6例术中有血压波动;非嗜铬性副神经节瘤11例,无任何症状6例,腹部包块4例,血尿1例。CT表现与病理对照:良性肿瘤边缘光整,病灶内囊变区内壁光整,边界清楚;恶性肿瘤形态不规则,"囊变区"不规则,边界不清楚。CT诊断正确率为88.9%,误诊11.1%。结论:临床症状结合增强CT表现在术前对大多数腹膜后副神经节瘤能做出正确诊断。     

Fungal pulmonary infections after bone marrow transplantation: evaluation with radiography and CT

The authors reviewed 55 pairs of chest radiographs and computed tomographic (CT) studies obtained in 33 febrile bone marrow transplant (BMT) recipients. The images were read separately, without knowledge of the clinical diagnosis. Twenty-one episodes of fungal infection were documented. One chest radiograph showed a pneumonia-like opacity, and 17 showed nodular opacities, five with cavitation. In 20 of 21 episodes, CT showed nodules with cavitation (n = 7), halo (n = 4), hazy margin (n = 5), air bronchogram (n = 2), cluster of fluffy nodules (n = 1), or sharp margin (n = 1). In none of the nine bacteremic episodes, however, were there opacities on chest radiographs or CT studies. CT studies demonstrating complicated nodules in febrile BMT patients strongly suggest a fungal infection, whereas negative CT studies suggest bacteremia or non-filamentous fungal infection of nonpulmonary origin. CT appears to add useful information to radiographic analysis during the assessment of febrile episodes in BMT patients, especially when invasive diagnostic procedures pose a high risk.     

Cytomegalovirus pneumonia after bone marrow transplantation: high resolution CT findings

Cytomegalovirus (CMV) pneumonia is one of the most common pulmonary complications after bone marrow transplantation (BMT). We describe the high resolution CT (HRCT) findings of 13 patients with CMV pneumonia diagnosed after allogenic BMT. The study included 13 consecutive patients who developed CMV pneumonia after BMT and who had HRCT of the chest performed within 24 h of the onset of symptoms. HRCT scans were reviewed by two radiologists who assessed pattern and distribution of findings. There were nine male and four female patients, ranging from 9 years to 56 years of age (mean age 33 years). BMT was performed for treatment of chronic myelogenous leukaemia (54%), severe aplastic anaemia (23%), acute myelogenous leukaemia (15%) and Fanconi's anaemia (8%). The time elapsed until diagnosis ranged from +18 days to +405 days (median of 54 days, mean +81.6 days). The predominant patterns of abnormality on HRCT scans were ground-glass opacities (69%), small centrilobular nodules (69%) and air-space opacities (54%). The abnormalities were distributed in the central and peripheral zones of the lungs in six cases, only in the periphery in four cases, and only in the central zone in three cases. In all cases the lung lesions were bilateral, and asymmetry was observed in seven cases. The authors conclude that the most common HRCT findings in patients with CMV pneumonia after BMT consist of bilateral asymmetric ground-glass, air-space opacities and small centrilobular nodules.     

急性粟粒性肺结核的CT及病理对照研究

目的 探讨急性粟粒性肺结核(AMPT)的CT表现特征及病理基础.方法 回顾性分析25例AMPT的CT表现,并对人类免疫缺陷病毒(HIV)阳性和阴性组各种CT征象的发生率行双侧确切概率法χ2检验.HIV阴性组2例尸检全肺标本行冠状面HRCT扫描,并切割成10 mm厚度肺标本薄片,选取结节丰富区制作冠状面大切片(80～150 μm)和5 μm组织切片,将CT与病理所见进行对照观察;对其中1例HRCT和病理显示微结节在肺小叶的分布行x2检验.结果 25例AMPT患者中HIV 阳性11例,阴性14例.HRCT扫描发现所有AMPT患者两肺均随机分布着弥漫微结节,磨玻璃密度(GGO,17例)是主要的伴发征象.结节融合、肺实变仅出现在HIV阳性患者中(分别为5和6例),阴性患者无一例.分析2例尸检病例,结节以小叶中心与小叶周边之间肺组织分布最多(分别为792和560个),病理证实位于肺泡间隔;其中1例HRCT显示结节在肺小叶内的分布(1060个微结节)与病理所见(864个结节)差异无统计学意义(x2=2.814,P＞0.05).AMPT合并急性呼吸窘迫综合征(ARDS)于HRCT上表现为弥漫GGO,病理基础为肺水肿、炎症及肺泡透明膜.结论 AMPT的CT表现有一定特征,呈血行分布结节;肺内出现弥漫GGO需警惕合并ARDS.

Abstract：

Objective To elucidate the CT characteristics and pathology of acute miliary pulmonary tuberculosis (AMPT). Methods The CT features of AMPT in 25 cases were analyzed retrospectively, and the CT features in HIV-seronegative and HIV-seropositive patients were compared by 2-sided exact propability Chi-square test. Two lung specimens were inflated and fixed by Heitzman's method. HRCT scans, gross specimen section (80-150 μm) and histologic section (5 μm) were performed on dry lung specimens and CT-pathologic correlation was conducted. The distribution of micronodules in the secondary lobule on HRCT and pathology in one specimen was evaluated by Chi-square test. Results Twenty five patients with AMPT were included in this study, including 11 HIV-seropositive patients and 14 HIV-seronegative patients. HRCT showed diffuse micronodules randomly distributed throughout both lungs in 25 patients, and ground-glass opacity (17 patients)was the predominant complicated finding. Coalescence of nodules and consolidation in HIV-seropositive patients (5 and 6 patients) were markedly higher than that in HIV-seronegative patients (none). In lung specimens, most nodules located in the lung parenchyma between the central bronchovascular bundle and the perilobular structures (792 and 560 nodules), which located in the interlobular septum pathologically. The distribution of micronodules in the secondary lobule showed on HRCT (1060 nodules)and pathology(864 nodules) was not significantly difference(x2=2.814,P＞0.05). HRCT showed ground-glass opacities when ARDS occured, which were pulmonary edema,inflammation and hyaline membrane on alveolar wall pathologically. Conclusions The HRCT characteristic of nodule distribution in AMPT is random. ARDS should be suspected when diffuse ground-glass opacities appear on HRCT.     

Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation

OBJECTIVE: The CT and MRI features of ovarian torsion are illustrated with gross pathologic correlation. Ovarian enlargement with or without an underlying mass is the finding most frequently associated with torsion, but it is nonspecific. A twisted pedicle, although not often detected on imaging, is pathognomonic when seen. Subacute ovarian hemorrhage and abnormal enhancement is usually seen, and both features show characteristic patterns on CT and MRI. Ipsilateral uterine deviation can also be seen. CONCLUSION: Diagnostic pitfalls that may mimic ovarian torsion and observations for discriminating them are discussed.