成人型肺结核磁共振表现初步观察

探讨磁共振对肺结核的诊断价值。方法回顾分析５５例成人型肺结核磁共振和Ｘ线片表现。结果磁共振和胸片在反映肺结核浸润性、增殖性病理变化和空洞、结核瘤、干酪性肺炎病变类型方面无明显差别。浸润性、增殖性病灶及干酪性肺炎Ｔ１、Ｔ２加权像均呈中等信号，空洞呈低信号，结核瘤Ｔ２加权像多呈不均信号。结论磁共振毋须做为肺结核诊断常规手段     

超急性及急性脑梗塞的磁共振弥散成像

目的 评价磁共振弥散加权成像在老年人超急性、急性脑梗塞中的应用及与常规磁共振序列、CT之间的比较。方法共收集61例疑似超急性、急性脑梗塞患者（平均年龄70岁）,在发病24h内进行磁共振T1WI、T2WI、水抑制序列、弥散加权扫描以及CT扫描。结果 共有36例患者确诊为超急性或急性脑梗塞,弥散加权序列准确显示了35例,敏感性为97％、特异性为99％;水抑制序列加T2WI为56％、57％,CT为44％、48％。结论 弥散加权对于24h内超急性、急性期脑梗塞的显示明显优于常规磁共振序列及CT,并且可以很好地区分急性与慢性梗塞病灶。     

Magnetic resonance imaging of inflammatory lung disorders: preliminary studies in children

Magnetic resonance(MR) scans were performed on 14 children with a variety of inflammatory disorders of the lungs. MR successfully identified disease in all of the children and accurately localized the disease within the lung fields. In patients with pneumonia and lung abscesses the acute inflammation was associated with a marked increase in signal intensity on T2 when compared with T1 weighted images. One patient with an inflammatory pseudotumor demonstrated a smaller increase in signal intensity on T2 weighted images than was seen in acute pneumonia. Abscess cavities were well identified along with the wall thickness. In patients with diffuse lung disease (diffuse histoplasmosis, miliary tuberculosis, Letterer-Siwe disease, and allergic alveolitis), each disease appeared different on the MR images. These preliminary studies indicate that magnetic resonance imaging is effective for identifying pulmonary disease in children and may improve the radiologist's ability to differentiate pulmonary disorders.     

3．0TMRI磁敏感加权成像在老年人急性脑梗死伴出血的诊断价值

目的探讨3．0TMⅪ磁敏感加权成像在老年人急性脑梗死伴出血的诊断价值。方法对128例疑似急性脑梗死的老年患者全部进行常规MⅪ扫描、弥散加权（DWI）扫描及磁敏感加权（SWI）扫描。结合常规MRI、DWI、SWI检查图像,判断SWI在老年人急性脑梗死伴微出血的观测价值。结果本组128例临床疑似急性脑梗死的患者中,SWI发现急性脑梗死46例,其中伴出血19例;DWI发现急性脑梗死73例,其中伴出血的13例;常规MⅪ发现急性脑梗死67例,其中伴出血的12例。按大脑半球、小脑半球、脑干发病部位分类,SWI检出急性脑梗死伴微出血分别为14例、2例、3例;DWI检出急性脑梗死伴微出血分别为11例、1例、1例;常规MRI检出急性脑梗死伴微出血分别为9例、1例、2例。结论诊断急性脑梗死伴出血,SWI明显优于DWI及常规MRI,对脑干和小脑半球的急性脑梗死伴出血灶,由于接近颅底,SWI序列伪影干扰较大,病变显示效果欠佳。     

Magnetic resonance imaging pattern variability in dysferlinopathy

The widespread use of magnetic resonance imaging (MRI) in the diagnosis of myopathies has made it possible to clarify the typical MRI pattern of dysferlinopathy. However, sufficient attention has not been given to the variability of MRI patterns in dysferlinopathy.Materials and methodsTwenty-five patients with the clinical manifestations of dysferlinopathy were examined. For all patients, creatine phosphokinase levels were measured and molecular genetics were examined. In two patients, immunohistochemical examinations of muscle biopsies were performed. MRI scanning was included T2 multi-slice multi-echo, T1 weighted, T2 weighted and Short Tau Inversion Recovery T2 weighted sequences. Quantitative and semi-quantitative evaluations of fatty replacement and swelling of the muscles were undertaken.ResultsVariability in the MRI patterns was lowest in the pelvis and leg muscles and highest in the thigh muscles. Three main types of MRI patterns were distinguished: posterior-dominant (80%), anterior-dominant (16%), and diffuse (4%). Among patients with the anterior-dominant pattern, the collagen-like variant (4%), proximal variant (4%) and pseudo-myositis (8%) were separately distinguished.ConclusionsAwareness of atypical MRI patterns in dysferlinopathy is important for increasing the efficiency of routine diagnostics and optimizing the search for causative gene mutations.Key words: dysferlinopathy, LGMDR2, LGMD2B, Miyoshi myopathy, MRI pattern, T2-MSME     

大面积脑梗死患者磁敏感加权成像的应用

目的应用磁敏感加权成像技术对大面积脑梗死患者脑微出血(CMB)的分析,探讨磁敏感加权成像对CMB诊断价值及CMB发生的相关因素,指导大面积脑梗死及其合并症的诊断及治疗。方法选取大面积脑梗死患者32例,其中CMB组27例,无CMB组5例。对患者行常规T_1WI、T_2WI、液体衰减反转恢复序列、磁共振弥散加权成像等序列检查。结果磁敏感加权成像对于大面积脑梗死CMB的识别明显优于常规MRI检查。CMB组既往脑梗死和高血压发病率明显高于无CMB组,差异有统计学意义(P<0.05,P<0.01)。既往脑梗死和高血压与CMB存在相关性。结论与常规MRI检查序列比较,磁敏感加权成像对大面积脑梗死后CMB的显示有明显的优越性,为临床早期评价大面积脑梗死患者有无继发CMB及严重程度提供信息。     

Case of nonspecific interstitial pneumonia associated with aortitis syndrome

A 32-year-old woman was admitted to our hospital because of fever and back pain. Two months previously, she had been given a diagnosis of bacterial pneumonia based on the same symptoms and recovered after antibiotic treatment. Chest CT scans on admission showed a consolidation and thickened pleura in the right lower lobe. Bronchoalveolar lavage fluids showed an alveolar hemorrhage. Lung biopsy specimens showed thickened pulmonary arteries and fibrotic nonspecific interstitial pneumonia (NSIP). Three years later, she was admitted with fever and pain of the left arm and aortitis syndrome was diagnosed. In this case of NSIP pattern associated with aortitis syndrome we speculate that repeated pulmonary infarction and alveolar hemorrhages caused the NSIP pattern.     

Chronic infiltrative lung diseases: value of gadolinium-enhanced MRI in the evaluation of disease activity--early report

STUDY OBJECTIVE: To determine the value of gadolinium-enhanced MRI in the assessment of disease activity in chronic infiltrative lung diseases (CILDs). DESIGN: Retrospective study. SETTING: University hospital. Materials and Methods: Twenty-five consecutive patients with CILD were studied. The following diseases were diagnosed: sarcoidosis (n = 10), bronchiolitis obliterans organizing pneumonia (n = 3), usual interstitial pneumonia (n = 4), radiation pneumonia (n = 2), desquamative interstitial pneumonia (n = 1), rheumatoid lung (n = 1), vasculitis (n = 1), alveolar proteinosis (n = 1), bronchioloalveolar carcinoma (n = 1), and chronic eosinophilic pneumonia (n = 1). In each patient, the disease activity was assessed by one or more of the following studies: BAL (n = 18), gallium-radioisotope lung scanning (n = 6), serum angiotensin-converting enzyme assay (n = 10), and open lung biopsy (n = 4). T1-weighted breath-hold MRI studies were obtained before and after IV injection of gadolinium. The MRI examinations were analyzed to assess the presence or absence of lesional enhancement. RESULTS: The presence of enhanced pulmonary lesions was seen in 14 patients. All of these patients had active disease. Of the 17 patients with active disease, 14 had enhanced lesions, and 3 had unenhanced lesions. Pulmonary lesions were not enhanced in any patients with inactive disease. The difference was statistically significant (Fisher Exact Test, p < 0.05). CONCLUSION: Gadolinium-enhanced MRI may prove to be a useful tool in assessing disease activity in CILDs.     

Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis

Objective

To compare the diagnostic utility of T1‐weighted and STIR magnetic resonance imaging (MRI) sequences in early spondylarthritis (SpA) using a standardized approach to the evaluation of sacroiliac (SI) joints, and to test whether systematic calibration of readers directed at recognition of abnormalities on T1‐weighted MRI would enhance diagnostic utility.

Methods

Six readers independently assessed T1‐weighted and STIR MRI scans of the SI joints from 187 subjects: 75 ankylosing spondylitis (AS) and 27 preradiographic inflammatory back pain (IBP) patients, and 26 mechanical back pain and 59 healthy volunteer controls ages ≤45 years. The exercise was repeated 6 months later on a random selection of 30 AS patients and 34 controls after calibration directed at lesions visible on T1‐weighted MRI. Specific MRI lesions were recorded according to standardized definitions. In addition to deciding on the presence/absence of SpA, readers were asked which MRI sequence and which type of lesion was the primary basis for their diagnostic conclusion.

Results

Structural lesions were detected in 98% of AS patients and 64% of IBP patients. A diagnosis of SpA was based on T1‐weighted or combined T1‐weighted/STIR sequences in 82% of AS patients and 41% of IBP patients. Calibration enhanced the diagnostic utility of MRI in the majority of readers, especially those considered less experienced; the mean positive and negative likelihood ratios (of 6 readers) were 14.5 and 0.08 precalibration, respectively, and 22.2 and 0.02 postcalibration, respectively.

Conclusion

Recognition of structural lesions on T1‐weighted MRI contributes significantly to its diagnostic utility in early SpA. Rheumatologist training directed at detection of lesions visible on T1‐weighted MRI enhances diagnostic utility.     

Acute onset of somnolence and amnesia due to cerebral infarction of bilateral thalamus accompanied with tuberculous meningitis: a case report

A 55-year-old man was admitted to our hospital because of somnolence and aspontaneity. He was hospitalized in the psychopathic ward under the initial diagnosis of depression. Chest X-ray showed infiltration in both upper lobe. Twelve days later, Mycobacterium tuberculosis was detected from his sputum and was confirmed by RT-PCR. Cerebrospinal fluid findings showed elevated ADA and mononuclear cells, suggesting the presence of tuberculous meningitis. However, the brain CT revealed no abnormal findings. By applying antituberculous treatment the pulmonary lesion improved but psychological symptoms remained. Three months later follow-up brain MRI was examined. Contrast enhanced granuloma was detected in the ambiens, suprasellar and quadrigeminal cisterns. A strong signal was seen in the left frontal thalamus and a weak enhanced lesion was detected in the right frontal thalamus on a T2 enhanced image. These lesions showed low intensity on a T1 enhanced image, suggesting cerebral infarction affecting the bilateral thalamus. Somnolence and memory disorder was due to cerebral infarction of the bilateral thalamus and tuberculous meningitis contributed to form the intracranial lesion. From the experience of this case, it is needed to consider cerebral infarction (especially the thalamus) due to tuberculous meningitis when we examine the patients with acute onset of psychological symptoms.     

Two cases of lung metastasis of malignant melanoma]

We report 2 cases of lung metastasis of malignant melanoma. Patient 1 was a 71-year-old woman who had undergone an operation for enucleation of her left eye 13 years earlier. Chest magnetic resonance imaging (MRI) demonstrated intermediate intensity including partially high intensity on T 1 weighted images, and high intensity including partially low intensity on T 2 weighted images. Microscopic findings from a transbronchial lung biopsy specimen disclosed melanotic melanoma. Patient 2 was a 54-year-old man who had undergone surgery for malignant melanoma in the left upper arm 4 years earlier. Chest MRI films demonstrated low intensity on T 1 weighted images, and high intensity on T 2 weighted images. Microscopic findings from specimens of the primary lesion in the left upper arm revealed melanotic melanoma, but the findings from the lower right lobectomy disclosed amelanotic melanoma. It has been reported that MRI is useful in the diagnosis of malignant melanoma, and that melanin content reflects MRI signal intensity. The MRI findings were consistent with the histopathologic findings in each of the 2 cases we reported.     

腔隙性脑梗死CT与MR表现对比研究

目的对比腔隙性脑梗死CT与MRI表现并探讨在腔隙性脑梗死诊断中的价值。方法对180例临床疑似腔隙性脑梗死患者在常规头颅CT、MRI的基础上行FLAIR、DWI和MRA检查,根据影像学结果进行对比分析,选择治疗方案。结果①MRI可以确诊疑似病例患者是负腔隙性脑梗死;②FLAIR可以发现早期脑缺血灶;③DWI可显示常规CT和MRI T1W1、T2W1不能显示的病灶（新鲜病灶）。④MRA显示血管闭塞的部位和狭窄程度。结论通过比较影像学早期诊断腔隙性脑梗死,显示梗死灶与靶血管的关系,早期临床体征可提供切实可行的影像学资料。     

Abnormal findings of magnetic resonance imaging (MRI) in patients with systemic lupus erythematosus involving the brain]

To elucidate the clinical significance of MRI on CNS-SLE, MRI and CT scans were performed in 35 patients with SLE, of 18 patients who had CNS manifestations at the time of MRI examinations. The investigations were also carried out with 17 patients without CNS-SLE. The rate of detection of abnormal findings on MRI in patients with CNS-SLE was 77.2% (14/18), which was high, as compared with the rate of those on CT scans (50%: 9/18). Especially, all of 4 patients with seizure and 3 patients with encephalopathy showed abnormal MRI findings, although respectively 50% and 33.3% of them had abnormal CT scan findings. MRI findings were classified into 4 groups as below: 1) Large focal are as of increased signal intensity at T2 weighted image. These were observed in 2 of 4 patients with seizure and 1 of 3 patients with encephalopathy, which were completely resolved after treatment. 2) Patchy subcortical foci of increased signal intensity at T2 weighted image. These were observed in 11 of 18 CNS-SLE and 7 of 17 without CNS-SLE, which were not detected by CT scan. 3) All of six patients with cerebral infarctions showed high signal intensity areas at T2 weighted image and low signal intensity areas at T1 weighted image. 4) Normal findings were observed in 4 of 18 CNS-SLE (22.2%). We concluded that MRI is useful for the evaluation of CNS-SLE and provides more information than CT scan.     

弥散加权磁共振与磁共振血管成像在急性脑梗死诊断中的临床应用

目的　评价弥散加权磁共振成像 (Diffusion -weightedimaging ,DWI)及磁共振血管成像 (MagneticReso nanceAngiography ,MRA)在脑梗死早期的临床应用价值。 方法　对 3 0例急性脑梗死患者行DWI和MRA检查 ,并与CT、常规MRI的结果进行分析比较。结果　在超早期及早期急性脑梗死中DWI可显示CT及T2 WI不能显示的病灶 ,对于T2 WI能显示的病灶DWI能更清楚、更全面的显示该病灶 ,MRA能快速发现血管病变的部位和程度。结论　DWI与MRA对急性脑梗死的早期诊断十分敏感 ,联合检查可同时显示脑实质和脑血管情况 ,为早期溶栓治疗提供了切实可行的影像学资料     

Magnetic resonance imaging of skeletal muscle involvement in limb restricted vasculitis

BACKGROUND: Limb restricted polyarteritis nodosa (PAN) and PAN-type diseases such as isolated vasculitis of skeletal muscle are localised vasculitides affecting the skin, muscles, or peripheral nerves, usually of the lower limbs. These diseases often present with non-specific clinical symptoms and normal laboratory values and electromyograms. The usefulness of magnetic resonance imaging (MRI) of skeletal muscle has been poorly investigated to date. OBJECTIVE: To describe the MRI findings in the legs of three patients with limb restricted vasculitides (two PAN, one isolated vasculitis of the skeletal muscle) with histologically established muscle involvement. METHODS: MRI was carried out on calf muscles and T(2) weighted images, unenhanced T(1) weighted images, and STIR sequences were obtained. RESULTS: Muscle damage resulted in oedema-like changes on MRI characterised by hyperintense signals in T(2) weighted and slow tau inversion recovery (STIR) sequences and normal unenhanced T(1) weighted sequences of one or several leg muscles. CONCLUSIONS: MRI should be considered a useful complementary examination that might facilitate the recognition of limb restricted vasculitides, and possibly indicate the site for muscle biopsy. It could also be useful in monitoring the course of the disease. Future studies should also evaluate MRI for systemic PAN or other systemic vasculitides with muscle involvement.     

A follow-up study by MRI and enhanced-MRI in a case of cerebral tuberculosis]

We report a case of cerebral tuberculosis following miliary tuberculosis. A 54-year-old man was admitted to our hospital in October 1990 because of fever and general fatigue. Chest x-ray film on admission showed diffuse granular shadows in both lungs. Tubercle bacilli were seen in the sputum (Gaffky 5) by the Ziehl Neelsen's staining, and anti-tuberculous therapy was quickly started. But a few days after admission, the disturbance of consciousness, neck stiffness, and headache appeared. The examination of cerebrospinal fluid disclosed that leucocytes was increased in number, and that ADA was elevated to 14.6 IU/l. Tubercle bacilli were detected from cerebrospinal fluid by culture. Although CT scan of the brain was normal at first week of admission, brain CT at eighth week of admission showed several nodulus enhanced with contrast medium. The findings were confirmed by T2 weighted magnetic resonance images (MRI) as high intense areas. Although T1 weighted MRI showed isointensity of the gray matter, T1 weighted MRI enhanced by Gd-DTPA revealed abnormal enhancement. At twenty-ninth week of admission CT showed no abnormality even by contrast enhancement, but enhanced T1 weighted MRI revealed a small lesion with enhancement which was not shown by CT. MRI enhanced by Gd-DTPA was more useful for evaluating cerebral tuberculosis than brain CT.     

Long-term prognosis of patients with initial cerebral thrombosis and the MRI findings]

To clarify the relationship between long-term prognosis of patients with stroke and their MRI findings, 103 patients with initial cerebral thrombosis, who survived more than three months after the ictus, were studied for five years. The mean age of 98 patients (T group), who were followed up completely, was 73.1 years-old and 65 were men. The age-matched controls consisted of two groups: 65 subjects, who had hypertension and/or diabetes without a history of stroke (R group), and 85 subjects, who had any hypertension, diabetes and stroke (N group). MRI findings were divided into six categories: 1) types of causative lesion, 2) grades of periventricular hyperintensity (none, rims/caps, patchy, diffuse PVH), 3) number of spotty lesions, 4) presence of silent infarction. 5) ventricular dilatation, and 6) extents of brain atrophy. Types of causative lesion were subdivided into 3 subtypes; infarction of the perforating artery territory (P type), infarction of the cortical artery territory (C type), and brainstem infarction (B type). The presence of vascular risks and dementia, and the extent of activity of daily living (ADL) were assessed. The P, C, and B types were identified by MRI in 46, 36, and 16 of the T group, respectively. Motor impairment, dementia, and an ADL status of complete dependence at discharge were also seen in 84, 44, and 22, respectively. In the T group, 33 patients died during five years, which resulted in a cumulative mortality rate of 33.7% and an annual mortality rate of 8.2%. Based on log-rank analysis, the survival rate of the T group revealed was significantly lower than those of the R and N groups. The recurrent rate in the T group (annual stroke recurrence rate was 4.0%) was higher than in the R and N groups, but stroke recurrence was not the cause of death and two thirds of deaths were due to aspiration pneumonia and/or asphyxia. Cox hazard regression analysis for death due to respiratory diseases showed that the hazard ratios of infarction, patchy PVH, and more than 4 spotty lesions were 8.87 (p < .001), 0.31 (p = .058), and 0.44 (p = .098), respectively. Compared to the survival group, rates of complete dependence in ADL, dementia, and brain atrophy were significantly higher in the death group with low incidences of the P type and patchy PVH, which indicated small vessel disease. These findings suggested that in patients with cerebral thrombosis, even in the chronic phase, care should be taken to prevent pneumonia and/or asphyxia due to bulbar palsy. Furthermore, no MRI findings were distinct predictors of long-term prognosis, although infarction based on the small vessel disease had rather good outcome in terms of respiratory disease.     

弥散加权磁共振在脑梗死诊断中的作用

目的　探讨弥散加权磁共振 (DWI)在脑梗死急性期诊断中的作用。方法　以急性期脑梗死 3 6例为研究对象 ,在平均发病 71h进行摄影。分别进行T1WI、T2 WI、FLAIR影像以及应用EPI法进行DWI摄影。结果　在发病 2 4h内摄影的病例中 ( 10例 ) ,T1WI检出病灶 2例 ,T2 WI检出病灶 4例 ,FLAIR法检出病灶 6例 ,而DWI法则检出全部病灶。另外 ,在 14例多发性脑梗死中 12例以及PVH高度的 10例中 ,用通常的方法确定原发病灶困难 ,而在DWI则清楚地显示。结论　MRDWI对急性期脑梗死病灶的检出率有较高的准确性 ,不仅有利于超急性期的诊断 ,在确定原发病灶上亦具十分重要意义     

Postmortem unenhanced magnetic resonance imaging of myocardial infarction in correlation to histological infarction age characterization.

AIMS: Postmortem magnetic resonance (MRI) imaging is currently evaluated as alternative to traditional autopsy and myocardial infarction plays a key role therein. The aim of this study is to determine the suitability of postmortem MRI in infarction age staging. METHODS AND RESULTS: In eight human forensic corpses presenting with a total of 11 myocardial infarcted areas, short-axis, transversal, and longitudinal long-axis images (T1, T2, stir, flair) were acquired in situ on a 1.5 T system. During subsequent autopsy, the section technique was adapted to short-axis images. Histological investigations were performed along the entire circumference of the left ventricle to correlate the signal alteration in MR to the histological appearance. Two peracute infarctions were not detected in MRI and autopsy. Four acute infarcted areas presented with decreased signal in necrotic centres and increased signal in marginal myocardial regions (T2-weighted). T1-weighted images showed local hyperintensities when intramyocardial haemorrhage occurred. Four cases showed subacute infarctions with hyperintense regions in T2-weighted images and no signal alteration in T1-weighted images. Four chronic myocardial infarctions showed distinctively decreased signals in all applied sequences. CONCLUSION: Postmortem MRI demonstrates myocardial infarction in situ and allows for an infarction age estimation based on the signal behaviour.     

A case report of right atrial epithelioid hemangioendothelioma with multiple pulmonary metastases

Cardiac epithelioid hemangioendothelioma (EHE) is a very rare tumour of endothelial origin with the lung and liver as the most easily metastatic organs. We describe herein a patient with hemoptysis, severe anaemia, and diffuse pulmonary nodules with halo signs that represented metastasis of cardiac EHE; these radiologic manifestations are relatively uncommon. During the initial workup for the patient’s pulmonary nodules, echocardiography missed the cardiac mass. However, positron emission tomography‐computed tomography revealed increased fluorodeoxyglucose intake in the right atrial wall, and cardiac magnetic resonance imaging (MRI) revealed an irregular nodule with normal T1‐weighted signal intensity and hyperintense T2‐weighted signal intensity. Enhanced abdominal computed tomography (CT) revealed micronodular liver metastases. Video‐assisted thoracic surgery was performed to make a definitive diagnosis. Immunohistochemistry staining proved the diagnosis of EHE with positive results for cluster of differentiation (CD) 34, CD31, erythroblast transformation‐specific‐related gene and Ki‐67. The patient started chemotherapy with docetaxel (75 mg/m²) and gemcitabine (900 mg/m²), but this failed to control his disease and he died from an opportunistic infection related to his immunocompromised status 5 months later. For the work out process of bilateral diffuse pulmonary nodules suspicious for cardiac origin, especially with atrial deviation, echocardiography alone is not sufficient to exclude atrial origin. Cardiac CT or MRI might be a better choice.