椎管内占位性病变的脊髓造影

目的对比分析脊髓造影、脊髓造影CT及MRI在椎管内占位性病变中的作用.方法对资料完整的64例椎管内占位性病变病人进行了脊髓造影、CTM、MRI影像学比较研究.脊髓造影采用常规脊髓造影和CTM相结合(以下称脊髓造影).CTM在常规脊髓造影后4～6h进行.MRI采用SE序列加GE序列.椎管内占位性病变的病灶检出率、定位和定性准确率做一统计和分析.结果脊髓造影CT与MRI的检出敏感性分别为88.6%,85.7%,定性准确率分别为66.2%,79.6%,定位准确率分别为90.6%,92.3%,病变检出率及定位准确率在造影与MRI之间无显著差异,而定性准确率存在显著差异(P＜0.05).结论脊髓造影CT与MRI结合将有利于椎管内病变的检出、定位及定性能力的提高.     

椎管内占位性病变脊髓造影诊断

椎管内占位性病变脊髓造影诊断西安医科大学第二临床医学院放射科代社教，张维信椎管内占位性病变并非少见，临床诊断亦不甚困难。但术前准确定位以及初步定性诊断就必须作脊髓造影。本文分析了２０例经手术病理证实的该类病变。目的在於提高对椎管内占位性病变定位及定性...     

《脊柱脊髓影像学》——一部完整的脊柱脊髓影像学教材

近一个世纪以来，脊柱的X线成像局限于骨性结构。虽然椎管造影、髓核造影、脊椎动脉造影等相继为椎管内病变、椎间盘病变、脊髓血管性病变的直接或间接诊断提供了可能性，然而由于都是损伤性检查，成像质量也不满意，临床应用受到一定的限制。直到CT、MRI的问世，使脊柱骨性结构的精确解剖定位和椎管内脊髓的直接成像成为现实，尤其是MRI，可任意平面成像以及对病变组织的高度敏感度，     

MRCP联合MRI在胰胆管梗阻性疾病中诊断的价值

目的:探讨MRCP联合MRI对胰胆管梗阻性疾患定位和定性诊断的价值.方法:对2000年9月～2007年9月842例梗阻性黄疸患者的MRCP及MRI的图像进行分析,并与CT、US、直接胆道造影和临床手术病理结果对照.结果:全部病例MRCP 检查均一次成功,其中320例行直接胆道造影,与MRCP 对照,二者所获图像极其相似.MRCP 对梗阻定位诊断准确率为96.79%,MRCP联合MRI可提高到100%;MRI对梗阻定性诊断准确率为89.19%,联合MRCP可提高至97.74%.CT对梗阻的定位、定性诊断率分别为78.61%,77.59%;US对梗阻的定位、定性诊断率分别为89.73%,82.47%.结论:MRCP联合MRI作为无创性检查技术,对胆胰管梗阻性疾病的定位与定性诊断准确率均高于CT及US;可作为胆系梗阻性病变诊断的首选检查.     

臂丛神经及神经根鞘撕裂伤的脊髓造影CT诊断与临床价值

目的 探讨脊髓造影CT(CTM)诊断臂丛神经撕裂伤的临床价值.方法 16例臂丛神经损伤患者行CTM.全部患者与临床手术探查对照,7例术前行电生理学检查.结果 本组共检出28个受损神经根,其中26个诊断准确,准确率为92.8%.神经根撕裂伤的主要征象是椎管内神经前、后支充盈缺损消失,间接征象为假性硬膜囊肿,脊髓移位与变形,神经根扭曲.结论 CTM对臂丛神经根损伤的诊断具有重要价值.     

骶部硬膜外囊肿的临床影像学表现与病理分析(18例报告及文献综述)

目的探讨骶部硬膜外囊肿的临床影像学与病理特点。方法本组18例均行腰骶部及骨盆X线平片检查,其中17例行CT扫描、11例行MRI检查、7例行脊髓造影、4例行脊髓造影CT(CTM)扫描,结合文献分析其影像学表现。结果本病临床误诊率为78%,X线诊断率17%,CT诊断率72%,MRI检查、脊髓造影、CTM扫描诊断率100%。18例均手术切除,病理报告为硬膜外囊肿,椎管内型13例、椎管外型3例及混合型2例。随访15~32个月,平均24个月,未发现症状加重和复发病例。结论骶部硬膜外囊肿为椎管内或椎管外通过颈口与蛛网膜下腔相通的硬膜外囊性肿物,临床和影像学具有特征性表现。     

超声造影与增强CT在胆囊疾病诊断中的对比分析

目的:比较超声造影(contrast-enhanced ultrasound,CEUS)和CT增强(contrast-enhanced helicalcomputedtomography,CECT)检查在胆囊占位性病变诊断中血流灌注过程中的的特点,探讨其在胆囊占位性病变诊断中的价值。方法:对比分析78例胆囊占位性病变的超声造影和增强CT在不同时相的增强及灌注特征。结果:超声造影和增强CT具有相似的表现。但对于小于5 mm的病变,超声造影的检出率高于增强CT,78例胆囊占位性病变中,胆囊癌35例,胆囊息肉29例,局限性胆囊腺肌增生症14例,增强CT准确率分别为84.35%,89.63%和80.13%,超声造影准确率分别为83.12%,93.79%和79.72%。结论:增强CT和超声造影检查均有助于胆囊疾病诊断,两者结合可提高胆囊疾病的诊断符合率。     

脊髓造影与CTM诊断腰椎间盘突出影像对比(附200例报告)

目的评价脊髓造影与CTM在诊断腰椎间盘突出症方面的影像价值.方法200例临床诊断为腰椎间盘突出症患者均先行脊髓造影后,又行CTM检查.结果经手术证实,脊髓造影诊断符合率为86%;CTM诊断符合率为98.5%.结论CTM检查诊断腰椎间盘突出症的准确率较脊髓造影高.     

高位胆道梗阻的CT与MRI、MRCP诊断价值

目的　探讨CT、MRI和MRCP对高位胆道梗阻的临床诊断价值。方法　对 12例高位梗阻 (恶性 11例 ,良性 1例 )进行了常规MRI、2DFSE序列MRCP检查 ,其中 10例恶性病变进行了CT检查 (平扫 7例 ,增强 3例 )。结果　CT、MRI和MRCP对高位梗阻定位诊断准确率分别为 90 %、92 %和 10 0 % ,定性诊断准确率分别为 80 %、83%和 6 7% ,MRI +MRCP定性诊断准确率提高到 92 %。10例恶性梗阻CT检查显示肿物 5例 ,胆总管环形增厚 3例。 12例MRI扫描显示肿物 8例 ,肝内转移 2例。MRCP显示梗阻近端形态较为特征 ,截断状以肝癌多见 ,锥状以胆管癌和转移癌多见 ,漏斗状见于良性病变。MRCP显示多发狭窄的长度和范围。结论　CT和MRI对高位梗阻具有同样重要的定性诊断价值。MRCP确定病变部位和范围具有独特的价值。MRI和MRCP结合可提高定位和定性诊断正确率     

幕下占位性病变的CT和MRI诊断

目的：探讨幕下占位性病变的CT和MRI表现及特征，提高对幕下占位性病变的定性诊断水平。方法：回顾性分析我院37例经临床和／或手术、病理证实的幕下占位性病变的CT和MRI和MRI表现，本组CT定位、定性准确率为79％、69％；MRI为96％、90％。结论：CT和MRI对该区占位性病变的诊断和鉴别诊断有重要价值。表现。结果：37例中星形细胞瘤6例，脑膜瘤6例，听神经瘤5例，转移瘤5例，髓母细胞脑瘤4例，血管母细胞脑瘤4例，蛛网膜囊肿3例，室管膜瘤及动脉瘤、三叉神经瘤、胆脂瘤各1例、幕下占位性病变中脑内病变22例，脑外病变15例，该区占位性病变大部分有特征性的CT     

CT脊髓造影诊断椎管内占位病变的意义

The value of omnipaque myelography and CT myelography in 77 cases of intraspinal space-occupying lesions (51 extramedullary and 26 intramedullary confirmed by operation) was reviewed. In 69 cases the preoperative diagnosis was accurate, but not in the other 8 cases. It is not advisable according to the authors' experience to have both myelography and postmyelography CT scan done for all intraspinal space-occupying lesions. For most of the extramedullary tumors, myelography alone proved to be adequate. For intramedullary lesions the information obtained from myelography was inconclusive and postmyelography CT scan as a supplementary procedure was necessary.     

Evaluation of the role of magnetic resonance myelography in lumbar spine imaging

The purpose of our study was to evaluate the accuracy of MR myelography in depicting disc herniation in the lumbar spine when compared with conventional MRI in patients presenting with clinical evidence of disc herniation. One hundred patients referred for conventional MR imaging of the lumbar spine also had coronal MR (TR 9000 ms, TE 272 ms eff, NEX 3, echo train length 32) myelography performed. Three experienced observers compared magnetic resonance myelography (MRM) with conventional lumbar spine MR using the following variables: visibility of thecal sac and nerve roots, and the presence, location and severity of disc herniation. Disc protrusions were seen at 110 disc space levels on conventional MR images as opposed to 93 on MRM. However, only 72 % of lesions seen on conventional MR were diagnosed by MRM. Similarly, only 63.8 % of nerve root compression abnormalities seen at conventional MR were visualized when compared with conventional MRM. The sensitivity, specificity and accuracy of MRM when compared with conventional MR was 72, 93 and 85 %, respectively. The MRM technique yields images that resemble conventional myelography and may be used to help confirm abnormalities seen on conventional MR in selected cases; however, the large number of false-positive and false-negative examinations indicates that caution should be used in interpreting MRM images. Received: 16 February 1998; Revision received: 25 May 1998; Accepted: 30 September 1998     

MR myelography of the cervical spine.

In previous studies, magnetic resonance (MR) myelography was not effective in the cervical region. However, effective cervical MR myelography is possible with a modified fast spin-echo sequence (8,000/360 [repetition time msec/effective echo time msec], four signals averaged, echo train length of 24). In a clinical study of this protocol, MR myelography was performed as an additional sequence following conventional MR imaging; composite images were obtained with a maximum-intensity projection algorithm. The MR myelographic sequence added only 8.5 minutes to the total imaging time and yielded information not provided by MR imaging in 13% of patients. MR myelography was especially valuable in demonstrating abnormal intraspinal vascularity and in guiding patient treatment by providing detailed preoperative information about intradural masses and posttraumatic and postoperative diverticulum and meningocele. This MR myelographic technique is a useful adjunct to MR imaging, especially in cases in which the more detailed information provided will be helpful in the analysis of complex intraspinal disease.     

髓核突出椎管造影、CT、MRI比较研究

笔者分析了经手术病理证实的34例患者44个部位髓核突出,术前皆行非离子型水溶性造影剂椎管造影、CT和MRI检查,结果三者确诊率分别为84.1％,93.2％和93.2％。结合对冰冻腰段标本的解剖及镜下组织学研究,作者重点讨论:(1)髓核突出三种影像检查的优缺点,(2)髓核突出好发于腰4～5及旁中央型的解剖学基础,(3)髓核突出与腰腿痛的关系。认为MRI为首选方法,既可查出纤维环破裂又能确定后纵韧带是否完整,为选择手术或经皮切吸方法提供关键依据。     

Short review of CT in the study of some intraspinal diseases

Summary We present our experience of the usefulness of high definition computed tomography (HDCT) in 30 cases of isolated intraspinal pathology (12 extramedullary and 18 intramedullary cases). The results are assesed in comparison to myelography.     

Accidental introduction of contrast medium into the cervical spinal cord

Summary The density of metrizamide injected accidentally into the spinal cord during cervical CT myelography was measured with CT scanning and compared with a series of dilutions of metrizamide scanned with a special phantom. The test suggests that the metrizamide is diluted rapidly in the spinal canal, and in an accidental intraspinal injection of metrizamide, it is not the contrast medium itself but the mechanical effect of the introduction of a volume of fluid that causes the neurological symptoms.     

Emergency magnetic resonance examination of patients with spinal cord symptoms

Eighteen consecutive patients with spinal cord symptoms of sudden or relatively sudden onset were examined with magnetic resonance imaging (MRI). The examinations were performed on a 0.3 tesla permanent/resistive imaging system using solenoidal surface coils. MRI revealed epidural tumour in five patients, intramedullary tumour in one, epidural abscess in one, myelitis in two, spontaneous intraspinal epidural haematoma in two, disc herniation in two, traumatic lesions in four and no abnormality in one patient. MRI was found to be capable of non-invasively and painlessly detecting and exactly defining the extent of intraspinal and paraspinal lesions. In some cases the nature of the lesion could be inferred from specific signal characteristics, which is a unique property of MRI. The results strongly suggest that MRI is superior to myelography and other imaging methods and should be regarded as the examination of choice in the emergency examination of patients with spinal cord symptoms.     

Two-dimensional MRI at 1.5 and 0.5 T versus CT myelography in the diagnosis of cervical radiculopathy

A prospective comparison was made of standard two-dimensional MRI sequences, at both high and midfield strength, with CT myelography in 23 patients with cervical spondylosis. MRI is adequate for assessment of cord compression, where high field strength is superior to midfield strength. MRI using 4-mm sections is inadequate for presurgical assessment of root compression. It remains to be proven whether thin-section white-CSF volume sequences or gadolinium-enhanced volume studies can replace CT myelography.