腹膜后纤维化的CT诊断

研究腹膜后纤维化的CT表现。分析经临床病理证实的9例腹膜后纤维化的CT表现,其中男性4例、女性5例,平均年龄53．7岁;特发性6例,继发性3例。9例均行CT平扫及增强检查。9例中CT平扫表现为腹膜后间隙或盆后间隙的低密度、不均匀密度或等密度弥漫性浸润病变4例,不规则肿块样病变5例,增强检查病变显示不同程度强化,多数病例伴有肾盂及输尿管扩张积水。因此,CT能很好显示腹膜后纤维化病变的各种表现,腹膜后间隙出现弥漫浸润性或不规则肿块样病变,并合并肾盂及输尿管扩张积水时应考虑到本病诊断。     

Posteriorly situated retroperitoneal colon: A study using CT and MRI

In a patient with symptoms attributable to lumbar spine disease, computed tomography (CT) demonstrated the descending colon lying in an exceptionally posteromedial position. The colon, within the retroperitoneal fat, passed between the psoas major and quadratus lumborum muscles, thereby abutting the normal left L4 ventral ramus lateral to the L5 pedicle. Although it remains debatable whether this curious anatomical arrangement was responsible for this patient's symptoms, the case prompted us to see how often the colon was situated so posteromedially. Among 33 consecutive patients whose abdominal CT images were analyzed, this close anatomical relationship was seen in only one patient; it was not seen in any of 50 randomly selected patients undergoing magnetic resonance imaging (MRI) of the lumbar spine. As judged by CT measurements, the average position of the most posteromedial portion of the descending colon lies 5 mm anterolateral to a plane joining the anterolateral margins of the psoas major, quadratus lumborum, and iliacus muscles and 54 mm from the ventral ramus. © 1993 Wiley-Liss, Inc.     

Intrapulmonary cystic lymphangioma in a 2-month-old infant.

Lymphangioma is an abnormal collection of lymphatics that are developmentally isolated from the normal lymphatic system. Lymphangioma rarely presents as a solitary pulmonary lesion. We report a rare case of intrapulmonary cystic lymphangioma involving the upper lobe of the right lung, which presented with dyspnea in a 2-month-old infant. High-resolution computed tomography (HRCT) of the chest demonstrated a well-circumscribed, multiseptate, cystic lesion in the upper lobe of the right lung, mimicking the feature of type I congenital cystic adenomatoid mal-formation. The tumor was removed by bilobectomy of the upper and middle lobes of the right lung, and its pathologic examination confirmed the diagnosis of an intra-pulmonary cystic lymphangioma.     

继发于恶性肿瘤的腹膜后纤维化临床和影像学特征分析

 摘要： 目的 探讨继发于恶性肿瘤的腹膜后纤维化（RPF, Retroperitoneal Fibrosis）的临床和影像学特征。 方法 分析我院1992年7月~2010年1月各科住院的RPF患者共106例,以其中继发于恶性肿瘤的8例RPF为研究对象,收集患者的临床资料并进行规律随访。 结果 8例恶性RPF中男性5例,女性3例,平均年龄59.6岁。原发肿瘤中生殖系统肿瘤4例,消化系统肿瘤2例,血液系统肿瘤及恶性神经鞘瘤各1例,其中1例同时患胃癌和膀胱癌。恶性RPF的临床症状与良性者比较并无特异,诊断主要依据影像学和病理。恶性RPF计算机X射线断层造影（CT）的特点：通常范围更广泛,肿物体积更大,包绕的腹主动脉、下腔静脉可发生背离脊柱方向的移位,输尿管可能发生向外侧移位;肿物边缘多呈结节或分叶状;肿物的中心多偏向髂血管方向。CT还可评价疗效和提示预后,病理学为最终确诊依据。 结论 恶性RPF临床症状无特异性,但影像学表现有一定特征,有鉴别诊断意义。     

Imaging of articular pathology: MRI,CT, arthrography

The purpose of this review article is to present the advantages and limitations of magnetic resonance imaging (MRI), computed tomography (CT) and arthrography for evaluating articular pathology. Techniques, patient selection, indications and contraindications for each modality are reviewed. MRI provides superior soft tissue contrast and image plane selection, making it the ideal technique for most articular abnormalities. However, obese patients and patients with certain electrical or metallic implants cannot be examined with MRI. CT provides superior detail for fine cortical bone and subtle calcifications, but lacks the soft tissue contrast provided by MRI. Arthrography is an invasive technique with minimal risk of allergy to contrast material or infection. This technique permits accurate measurement of capsular volume, allows for fluid aspiration for laboratory studies and permits injection of anesthetic and/or steroid compounds for purposes of treatment or confirming the site of the patient's pain. Magnetic resonance imaging, computed tomography and arthrography are useful techniques for evaluating articular pathology. Careful review of the clinical symptoms and patient's condition is necessary to select the most appropriate technique. Clin. Anat. 10:1–13, 1997 © 1997 Wiley-Liss, Inc.     

Comparison of reference points in different methods of temporomandibular joint imaging

PurposeConventional radiography is a well-established method for imaging of the temporomandibular joint (TMJ) structures. However, the dental computer tomography becomes more important for the visualization of teeth in the jaw-bone. The applicability of dental computer tomography for the visualization of the TMJ it not yet been proven. The aim of the study was to identify TMJ structures using reference points with the magnetic resonance imaging (MRI) and the computed tomography (CT).MethodsIn order to compare the visualization and measurement of the TMJ a total of eight human cadaver heads was examined with CT and MRI and analysed using reference points.ResultsIn both imaging techniques the selected reference points and distances are well definable and allow objective evaluation of anatomical structures. The CT images display a clearly better contrast to noise ratio than the MR images. The distance measurement of different width and length showed significant correlation of both images techniques.ConclusionsIn TMJ diagnostics, maximum information could be obtained using both imaging techniques together due to synergistic effects.     

胎儿水囊状淋巴管瘤的产前诊断及预后分析

目的探讨胎儿囊性淋巴瘤（cystic hygroma，CH）的产前诊断及妊娠期的处置。方法回顾性分析2006年1月～2008年4月间我院35例胎儿CH产前超声声像、介入性羊膜腔穿刺查胎儿染色体及TORCH感染情况、胎儿病理。结果发生在颈背部者33例，腋窝2例。足月分娩6例并存活，引产29例（包括死胎2例）。染色体核型分析异常者共19例，占58%，其中Turner′s综合征最常见，共11例，占33%；Down′s综合征5例，占15%；Trisomy182例，占6%；Tri-somy131例，占3%。结论超声及介入性羊膜腔穿刺查胎儿染色体在早期诊断及处置胎儿CH起决定性作用，胎儿CH与Turner综合征等染色体异常相关。     

腹膜后恶性纤维组织细胞瘤的 MSCT 表现及诊断价值简

目的分析腹膜后恶性纤维组织细胞瘤（MFH）的多层螺旋CT（MSCT）表现,探讨MSCT对该病的诊断价值。方法经手术病理证实的15例腹膜后MFH患者,其中男性11例,女性4例：年龄21～79岁,平均年龄46.5岁。回顾性分析其临床及MSCT表现.并与病理组织学改变相对照。结果15例腹膜后MFH主要临床表现为腹部肿块和疼痛。15例MSCT平扫表现为腹膜后软组织肿块.肿瘤呈圆形或类圆形10例。不规则形5例,肿瘤平均直径为12.5cm,瘤内坏死9例,出血7例,钙化6例。增强扫描肿瘤不均匀强化,13例见分隔状强化。组织学上呈明显多形性,其中车辐状一多形型MFH 11例,巨细胞型MFH 3例,炎症型MFH 1例。结论腹膜后MFH的MSCT表现具有一定特征,对其诊断及鉴别诊断有重要价值。     

后踝撞击综合征MRI和CT诊断价值分析

【摘要】目的:研究电子计算机断层扫描（CT）和磁共振成像（MRI）对后踝撞击综合征的诊断价值。方法:回顾性分析疑似后踝撞击综合征患者80例,均实施关节镜下手术治疗,且在术前进行CT和MRI检查。观察CT和MRI对后踝撞击综合征诊断情况,并对两种诊断方式一致性及诊断效能进行分析。结果:80例患者中经关节镜确诊后踝撞击综合征诊患者70例（87.50%）,其中CT诊断后踝撞击综合征患者51例（63.75%）,MRI诊断后踝撞击综合征患者65例（81.25%）,两种方式诊断率差异有统计学意义（P<0.05）。两组诊断方式特异度和阳性预测值均为100%,其中MRI灵敏度、准确性、阴性预测值均优于CT（P<0.05）。CT诊断结果与关节镜手术结果具有一致性（Kappa>0.4）,MRI诊断结果与关节镜手术结果一致性较好（Kappa>0.7）。结论:后踝撞击综合征术前辅助检查使用MRI诊断准确率、诊断效能及一致性均优于CT,临床应用价值较高。     

Acceptance Test of a Commercially Available Software for Automatic Image Registration of Computed Tomography (CT), Magnetic Resonance Imaging (MRI) And 99mTc-methoxyisobutylisonitrile (MIBI) Single-Photon Emission Computed Tomography (SPECT) Brain Images

This note describes a method to characterize the performances of image fusion software (Syntegra) with respect to accuracy and robustness. Computed tomography (CT), magnetic resonance imaging (MRI), and single-photon emission computed tomography (SPECT) studies were acquired from two phantoms and 10 patients. Image registration was performed independently by two couples composed of one radiotherapist and one physicist by means of superposition of anatomic landmarks. Each couple performed jointly and saved the registration. The two solutions were averaged to obtain the gold standard registration. A new set of estimators was defined to identify translation and rotation errors in the coordinate axes, independently from point position in image field of view (FOV). Algorithms evaluated were local correlation (LC) for CT-MRI, normalized mutual information (MI) for CT-MRI, and CT-SPECT registrations. To evaluate accuracy, estimator values were compared to limiting values for the algorithms employed, both in phantoms and in patients. To evaluate robustness, different alignments between images taken from a sample patient were produced and registration errors determined. LC algorithm resulted accurate in CT-MRI registrations in phantoms, but exceeded limiting values in 3 of 10 patients. MI algorithm resulted accurate in CT-MRI and CT-SPECT registrations in phantoms; limiting values were exceeded in one case in CT-MRI and never reached in CT-SPECT registrations. Thus, the evaluation of robustness was restricted to the algorithm of MI both for CT-MRI and CT-SPECT registrations. The algorithm of MI proved to be robust: limiting values were not exceeded with translation perturbations up to 2.5 cm, rotation perturbations up to 10° and roto-translational perturbation up to 3 cm and 5°.     

Solitary intrapulmonary cystic lymphangioma in an infant: a case report with literature review

Lymphangioma rarely presents as a solitary pulmonary lesion. We encountered a case of solitary cystic lymphangioma and present its clinicopathologic and immunohistochemical findings. A 2-month-old boy was referred to the hospital after developing a persistent cough. Chest X-ray showed a large cyst in the right lung. Under the preoperative diagnosis of bronchogenic cyst, he underwent right lower lobectomy at the age of 11 months. The resected specimen contained a 5.5-cm septate cystic lesion. Microscopically, the lesion consisted of a large cystic space and interconnected slit-like spaces surrounding bronchovascular islands. The cyst was lined by a monolayer of flat cells with focal multinucleated giant cells. Immunohistochemically, the cells lining the cystic lesion were positive for D2-40, Prox1, CD34, and CD31, and weakly positive for VEGFR-3, but were negative for AE1/3, HMB45, VEGF-A, VFGF-C, VEGFR-1. Differential diagnoses included lobar or interstitial emphysema, bronchogenic cyst, congenital pulmonary airway malformation and alveolar adenoma. D2-40 and Prox1 were useful in differentiation and in determining the extent of the lesion. A review of the literature found only 15 cases of solitary pulmonary lymphangioma. In younger patients, the lesions tend to occupy more of the lung. Focal giant cell reaction has not been described in the reported papers.     

Tomographical anatomy of the pelvis,pelvic floor,and related structures

The sectional anatomy of the pelvic floor was studied in plastinated sections of adult pelves by computed tomography and by magnetic resonance imaging. In sectional anatomy, the levator ani is composed of three portions that can be clearly distinguished by their planes of cleavage and by the course of their fiber bundles. No muscular connections are found between the levator ani portions and the pelvic organs. The fascia of the levator ani is always interposed between the muscle and the pelvic organs. The sectional anatomy of the sphincter ani externus reveals a subdivision into a subcutaneous and a deep portion. Although the puborectalis portion of the levator ani and the deep portion of the sphincter ani externus are more or less continuous, in sectional anatomy they can be distinguished due to their different origins and attachments. Clin. Anat. 10:223–230, 1997. © 1997 Wiley-Liss Inc.     

基于深度学习的跨模态医学图像转换

运用深度学习的方法基于脑部CT扫描图像合成相应的MRI。将28例患者进行颅脑CT和MRI扫描得到的CT和MRI的断层图像进行刚性配准,随机选取20例患者的图像输入U-Net卷积神经网络进行训练,利用训练好的网络对未参与训练的8例患者的CT图像进行预测,得到合成的MRI。研究结果显示:通过对合成的MRI进行定量分析,利用基于L2损失函数构建的U-Net网络合成MRI效果良好,平均绝对平均误差（MAE）为47.81,平均结构相似性指数（SSIM）为0.91。本研究表明可以利用深度学习方法对CT图像进行转换,获得合成MRI,现阶段可以达到扩充MRI医学图像数据库的目的,随着合成图像精度的提高,可以用于帮助诊断等临床应用。     

基于双稀疏字典的医学图像融合算法及在脑血管疾病诊断中的应用

目的通过图像融合方法结合解剖和功能医学图像以提供更多有用的信息并辅助医生诊断。方法利用稀疏表示能很好地反映图像特征的优势。首先,选取医院脑梗死和脑出血的CT和MRI的临床图像,采用双稀疏字典算法得到稀疏字典,再通过结合空间域信息的最大选择法作为融合规则对其进行融合,并与基于主成分分析(principal component analysis,PCA)和离散小波变换(discrete wavelet transform,DWT)方法的图像融合结果在主观方面以及客观方面的QAB/F和Piella指标上进行比较。结果本文提出的方法所获得的融合图像主观评价优于另外两种方法。QAB/F和Piella的均值分别为0.9139和0.7213,客观评价指标也优于另外两种方法。结论基于双稀疏字典的图像融合算法得到的融合图像更清晰,对比度更高,并且特征保留效果更好,有助于医生的诊断。     

MRI与MSCTA诊断胰腺癌胰周血管侵犯的价值比较

目的:研究磁共振成像（MRI）与多层螺旋电子计算机断层扫描血管造影（MSCTA）诊断胰腺癌胰周血管侵犯的应用 价值。方法:选择86例胰腺癌患者,根据手术结果发现其中胰周血管侵犯63例,无血管侵犯23例,所有患者均进行MRI与 MSCTA检测。统计两种方式检查胰周血管受侵犯的诊断效能、对不同等级血管侵犯检出率、对不同类型血管侵犯情况检出 率。结果:MSCTA的灵敏度及特异度分别为96.83%、91.30%,MRI为85.71%、86.96%,差异无统计学意义（P>0.05）;MSCTA 诊断准确度为95.35%,高于MRI的86.05%（P<0.05）;MSCTA对1、2、3、4级血管侵犯与手术结果比较符合率分别为94.29%、 98.04%、96.36%、95.83%,MRI分别为88.57%、92.16%、92.73%,87.50%,差异无统计学意义（P>0.05）;两种检测方式对不同 类型血管侵犯检出率无明显差异（P>0.05）。结论:MSCTA检测胰腺癌胰周血管侵犯准确率更高。     

The role of computed tomography and magnetic resonance imaging in the investigation of natural death

Public distaste for the traditional autopsy combined with disquiet about the variable quality of the coroner’s post-mortem have led to increasing pressure to find a less invasive alternative. There have been previous studies using computed tomography (CT) and magnetic resonance imaging (MRI) to determine cause of death but there is very little evidence of the accuracy or reproducibility of these techniques in non-forensic cases. In 2006 the Department of Health funded a validation study of post-mortem imaging in adults which is due to report this year. Preliminary results suggest that, if a confident imaging (MR and CT) diagnosis of the cause of death is made, the major error rate is close to that of clinical death certificates. There are major weaknesses in diagnosis of coronary heart disease and pulmonary thromboemboli on imaging. These weaknesses will need to be overcome if imaging is to replace the invasive post-mortem or systematic errors in mortality statistics will result.     

Tomographical anatomy of the pelvis,visceral pelvic connective tissue,and its compartments

The sectional anatomy of the pelvic connective tissue was studied in plastinated sections of fetal and adult pelves, by computed tomography and by magnetic resonance imaging. The comparative study of the different specimens shows that the pelvic connective tissue consists of three compartments: a presacral compartment, a perirectal compartment, and a paravisceral compartment. The content and the borders of the compartments are described. Furthermore the pelvic fasciae and the pelvic ligaments are studied within the different specimens. A thin pelvic visceral fascia can only be found around the perirectal compartment. In tomographical anatomy the so called supportive ligaments of the uterus are only composed of the round ligaments and the sacrouterine ligaments. © 1995 WiIey-Liss, Inc.     

CT and multimodal imaging findings of primary orbital Ewing's sarcoma involving the middle cranial fossa: a case report

This report details the CT and MR imaging findings of a primary orbital Ewing's sarcoma case involving the middle cranial fossa in a 13-year old boy. CT showed an ill-circumscribed homogeneous soft-tissue density mass with needle-like bone reaction. On MRI, the mass showed homogeneous iso-intensity on T1WI, heterogeneous hyperintensity on T2WI, and marked homogeneous enhancement. Meanwhile, the mass was hyper-intense on DWI, and ADC value was 575×10-6 mm2/s. The mass showed as high rCBV and rCBF, prolonged MTT based on DCSPWI, and wash-out pattern of TIC derived from the DCE-MRI. Our case suggests that functional MRI modalities, including DWI, DSC-PWI or DCE-MR, could provide additional information for differential diagnoses. Both CT and MRI should be performed and comprehensively analyzed for limiting differential diagnoses, determining lesion extension and facilitating operative approach.     

PET/MRI仪器研发的历史和现状

PET/MRI仪器研发是过去15年多模态分子影像仪器研发的热点。本文首先介绍PET和MRI成像的特点及PET/MRI多模态成像的优势;其次介绍PET/MRI仪器的早期研发历史;随后着重介绍几个重要的磁兼容小动物原型系统和商用临床PET/MRI系统;最后介绍PET/MRI仪器研发近期进展,对今后PET/MRI仪器研发和应用研究进行展望。