Anatomy, pathology, and MRI findings in the sports hernia

"Sports hernia" is a frequently used term on athletic injury reports and in the sportscasting media, but its true definition remains elusive in the medical literature. Magnetic resonance imaging (MRI) is a useful tool in the evaluation of clinical athletic pubalgia, yet specific pathologies associated with this commonly encountered syndrome are poorly described in the imaging literature. In this article we review the musculoskeletal anatomy of the pubic region as well as several reproducible patterns of pathology on MRI we have encountered in patients with a clinical diagnosis of sports hernia.     

Central neurocytoma: clinical, pathological and neuroradiological findings

AIM: To evaluate the clinical, pathological and neuroradiological features of intraventricular central neurocytoma in six patients. MATERIALS AND METHODS: Six patients were imaged using non-enhanced and contrast-enhanced magnetic resonance imaging (MRI); three of them were also examined using non-enhanced computed tomography (CT). Two radiologists read the images retrospectively. The imaging data were studied with regard to location, size, margin, signal intensity, enhancement characteristics and presence of calcifications. Clinical data (i.e. presenting signs and symptoms, physical findings and medical histories) were collected and histopathological and immunohistochemical studies were performed by two pathologists. RESULTS: All lesions were located in the lateral ventricles. Three tumors were confined to the left side, one to the right side and two cases involved both lateral ventricles. The growth of central neurocytoma was of close spatial relation to the septum pellucidum. On MRI, most of the cases showed a heterogeneous hypointensity on T1-weighted images and hyperintensity on T2-weighted images or FLAIR with a well-defined margin. The presence of cystic components, necroses and calcifications caused these internal heterogeneities. After intravenous administration of gadolinium (Gd-DTPA) all tumours showed a heterogeneous enhancement. CT provided additional information by distinguishing intratumoural calcifications in all three evaluated cases. Immunohistochemical analysis showed positive synaptophysin staining in all cases and positive neuron-specific enolase staining in four cases. In three cases a small proportion of the tumour cells could be labelled with antibodies to glial fibrillary acid protein (GFAP). CONCLUSION: Central neurocytoma should be considered when the following conditions occur: young patients with lesions in the lateral ventricle, which contain calcifications and show some enhancement. This is especially applicable for tumours involving both lateral ventricles with symmetrical growth around the centre of septum pellucidum or for unilateral ventricular tumors with a wide base attachment to the septum pellucidum.     

Arthroscopy of the knee without pathological findings

From 1983 to 1990, 82 knee arthroscopies (8.2%) carried out in our patients found nothing pathological. Sixty-four percent of these patients were active in sports, but trauma was noted in 32% of the cases only. Football and other ball games, skiing, and track and field athletics were the main causes. Twenty-six percent of the patients had undergone previous surgery in the affected knee. At a mean of 4.6 years postoperatively, clinical and radiological re-assessment was conducted so as to compare our pre- and intraoperative findings with the further course of events. We found that 48.2% of the patients were symptom-free after the diagnostic arthroscopy, 37.5% had persistent discomfort and 14.3% had a recurrence of discomfort after 6 months to 2 years. The objective measurement score (Zarins Rowe score), at 47.5 out of 50 points, was better than the subjective score, at 40 out of 50 points. Our diagnoses had to be changed retrospectively: meniscal lesions were diagnosed too frequently, while chondropathia patellae and instability were often missed. Additionally, complaints could be related to abnormal axis, limited range of motion of the hip or knee, leg length inequality and hypermobility. Being unable to verify a presumed intra-articular lesion arthroscopically is frustrating for both doctor and patient. Our data suggest that meniscal signs should be looked at more critically and emphasise the need for a complete evaluation of the whole locomotor system.     

MR imaging of thymoma--comparison with CT, operative, and pathological findings]

Twenty-six patients with thymoma, who had magnetic resonance (MR) imaging and computed tomography (CT) before surgery, were studied. Twenty-six thymomas were classified into 11 non-invasive thymomas (Masaoka's clinical stage I) and 15 invasive thymomas (stage II, III, and IV). On MR imaging compared with histological findings, low signal intensity rim of the tumor was corresponded to fibrous capsule of the tumor, and linear and/or reticular low signal intensity lines in the tumor were corresponded to the fibrous septae dividing thymoma into lobules. The detectability of these findings by MR imaging was superior to that by CT. Margin of the tumor was smooth in non-invasive thymoma rather than invasive thymoma. The diagnostic accuracy of invasion to vessel, and pleura or lung on MR imaging and CT was compared with operative and histological findings. MR imaging was same as CT in its ability to detect tumoral invasion to vessel, and slightly superior to pleura or lung. In conclusion MR images clearly show the findings corresponding to pathologic specimens, and MR imaging combining with CT is useful to differentiate non-invasive thymoma to invasive thymoma.     

富于淋巴浆细胞型脑膜瘤的MRI与病理分析

目的 探讨脑膜瘤亚型富于淋巴浆细胞型的MRI表现特征.方法 回顾性分析7例经手术病理证实的富于淋巴浆细胞型脑膜瘤的影像资料及病理资料,结合相关文献进行对比分析.结果 7例富于淋巴浆细胞型脑膜瘤均为单发病灶,6例病灶沿脑膜匍匐性生长,5例未形成具体瘤结节,2例为不规则分叶状;7例病灶均界限不清,瘤周水肿明显,邻近脑组织不同程度受累.MR平扫T1WI 7例均呈等、略低信号,T2WI 5例呈等、略高信号,2例呈等、略低信号;增强扫描见7例病灶均有显著强化效应,6例脑膜广泛不均匀增厚.病理示细胞丰富,成分多样,见大量淋巴细胞、浆细胞浸润,可见多少不等的梭形瘤细胞及典型脑膜上皮细胞区域.结论 富于淋巴浆细胞型脑膜瘤影像表现不同于常见脑膜瘤,具有一定的影像表现特征,有助于该肿瘤的诊断和鉴别.     

The choledochocele: correlation of radiological, clinical and pathological findings.

Two cases of choledochocele are presented and 14 cases in the literature reviewed. Choledochocele is defined as a herniation of the common bile duct into the duodenum. This entity is distinguishable radiographically from duodenal diverticulum and duodenal duplication cyst by filling during cholangiography but not during upper gastrointestinal series. The duodenal diverticulum fills on upper gastrointestinal series but not on cholangiography. The duplication cyst will not fill with either method.     

Lymphoepithelial cyst of the pancreas: radiological and pathological findings

We report a case of a rare lymphoepithelial cyst of the body of the pancreas that developed in a woman complaining of constipation for 15 years. Ultrasonography revealed a homogeneous isoechoic lesion, while CT demonstrated a polycystic homogeneous mass with central scar and calcification. Cytological investigation of a CT-guided biopsy permitted diagnosis of lymphoepithelial cyst. The patient was operated on and had an uneventful recovery. The histological finding was of a cyst wall lined with keratinised squamous epithelium surrounded by lymphoid tissue with reactive follicular hyperplasia. The radiological findings and differential diagnosis are discussed. Correspondence to: D. Regge     

胃黏膜相关淋巴组织淋巴瘤CT表现与病理类型之间相关性分析

目的 :分析54例胃黏膜相关淋巴组织(mucosa-associated lymphoid tissue,MALT)淋巴瘤的CT表现,以及其与病理的相关性。方法:回顾性分析经手术病理证实胃MALT淋巴瘤54例。根据MALT淋巴瘤的病理分级,分为高度恶性淋巴瘤(21例)和低度恶性淋巴瘤(33例),对2组CT结果进行比较。结果:54例中,弥漫性或节段性胃壁增厚36例(66.7%),淋巴结肿大21例(38.9%),溃疡13例(24.1%),胃壁肿块2例(3.7%)。14例(25.9%)无任何异常,均为低度恶性组。高度恶性组在CT上的异常(100%)比低度恶性组异常发生率(51%)高。高度恶性组胃壁增厚程度比低度恶性组高(71%、14%,重度或中度)(P0.01)。淋巴结肿大高度恶性组占66.7%(14/21),低度恶性组为21.2%(7/33),2组差异有统计学意义(P0.05)。胃溃疡在高度恶性组中的发生率为57.1%(12/21),在低度恶性组中为3.0%(1/33),2组差异有统计学意义(P0.001)。胃肿块形成仅在高度恶性组中发现2例。结论:2组胃MALT淋巴瘤的CT表现,均为胃壁增厚,淋巴结肿大,在影像学表现有重叠。胃壁增厚较明显、更弥漫及溃疡提示高度恶性MALT淋巴瘤。     

结节性甲状腺肿的MR表现与病理对照

目的 探讨MR对结节性甲状腺肿(NG)的诊断价值.方法 回顾性分析55例NG患者的MR表现,观察结节的大小、数量、形态、边缘、信号类型、强化方式,结果与手术病理对照.结果 55例NG共见110个结节,其中单个结节19例(34.5%),多个结节36例(占65.5%);边界清晰、规则101个(91.8%),边缘模糊、不规则9个(8.2%);实性结节64个(58.2%),囊性结节46个(41.8%);结节 有4种信号类型:(1)T1WI等或稍高信号、T2WI高信号58个(52.7%);(2)T1WI和T2WI均高信 号37个(33.6%);(3)T1WI稍低、等或高信号、T2WI低信号9个(8.2%);(4)T1WI和T2WI均等信号6个(4.5%);绝大多数实性结节强化明显,幅度高于背景甲状腺;囊性结节呈周围环形强化、壁结节明显强化和囊内不强化.结论 NG在MR像上具有一定的形态学和信号特征,了解其MR表现有助于明确诊断.     

Castleman病的CT表现及病理分析

目的：探讨Castleman病（CD）的CT表现特征,以提高该病的诊断准确率。方法：收集经病理证实的10例CD,结合病理分析其CT表现特征。结果：10例中局限型CD 8例,病理均为透明血管型,均为单发,其中颈部2例,腹膜后肾脏前上方1例,前上纵隔2例,后纵隔1例,右肺门旁1例,右侧盆腔入口腰大肌旁1例,最大径3.3～8.5 cm（平均6.1 cm）;均呈圆形、类圆形或椭圆形肿块,7例密度均匀,1例密度不均,2例伴斑点状、条状钙化,6例边界清晰,2例部分边界与邻近结构欠清;增强扫描6例中,5例明显强化,1例中度强化,4例均匀强化,2例不均匀强化,4例病灶周围见强化血管影。多中心型CD 2例,1例双侧腋窝、腹膜后及双侧腹股沟多发增大淋巴结,增强扫描淋巴结呈均匀轻中度强化,病理为透明血管型;1例双侧肺门及纵隔多发增大淋巴结,病理为浆细胞型。结论：典型的CD常为局限型,病理上多为透明血管型,其CT表现具有显著特征性,有较高的诊断价值;不典型的CD仍需病理确诊。     

多形性黄色星形细胞瘤影像学表现与病理学分析

目的探讨多形性黄色星形细胞瘤(PXA)的影像学及病理学表现.方法回顾性分析2003-2011年间共12例经手术病理证实的 PXA 病人组织病理学、免疫组织化学和影像学资料.12例病人均行 MRI 平扫及增强检查,其中5例行 CT 平扫,2例行 CT 平扫和增强扫描.结果12例病人病理组织学均可见不同程度囊变,瘤细胞呈明显多形性,肿瘤中有淋巴组织浸润,少有坏死,核分裂少或无.其中10例表达 CD34.12例病人肿瘤均为单发,位于幕上.MRI 平扫时实性部分 T1WI 呈等信号或稍低信号,T2WI 为等信号或稍高信号;囊性部分 T1WI呈低信号,T2WI 呈高信号.MR 增强扫描时肿瘤实性部分和壁结节明显强化.5例病人进行 CT 平扫,3例表现为低密度囊性病变伴等密度结节,2例呈低密度囊性病变,未见明显结节影;增强扫描可见明显的强化结节.结论 PXA具有一定的影像和病理学特征,综合对比分析可以确定诊断.     

The cathartic colon: pathological findings and radiological/pathological correlation.

Cathartic colon has been described radiologically, but the pathological characteristics have not been reported. The authors describe a case in which radiological/pathological correlation was possible, with emphasis on the pathology of the colon. The disease simulates chronic ulcerative colitis radiologically and pathologically.     

Comparison of thin-section CT and pathological findings in small solid-density type pulmonary adenocarcinoma: Prognostic factors from CT findings

Objective

We divided pulmonary adenocarcinoma of ≤20 mm into air-containing and solid-density types based on a percentage reduction of the maximum tumor diameter in the mediastinal window image compared to the area in the lung window image on thin-section (TS) CT of ≥50% (air-containing type) and <50% (solid-density type). No relapse occurred in patients with air-containing type. The prognosis of solid-density type may be poor even when the tumor size is 20 mm or smaller. We investigated whether CT findings for these tumors could serve as prognostic factors.

Methods

The subjects were 105 patients with solid-density type pulmonary adenocarcinoma that was identified on TSCT and found to have a diameter of 20 mm or smaller after surgical resection during the period from April 1997 to November 2004. Notches, air bronchogram, pleural retraction, spiculation, venous involvement, and ground glass opacity were examined on TSCT, and their associations with pathological findings (i.e., pleural invasion, lymphatic permeation, vascular invasion, lymph node metastasis, and Noguchi's classification) and relapse were investigated using chi-square test and Cox proportional hazards model.

Results

The incidence of relapse was significantly higher in cases with notches. The incidence of notches increased with tumor growth and notches were frequent in Noguchi type D tumors, reflecting poorly differentiated adenocarcinoma. Lymphatic permeation and type D cases were independent factors associated with a poor prognosis using Cox proportional hazards model.

Conclusions

TSCT findings may be useful for prediction of the prognosis of solid-density type pulmonary adenocarcinoma.     

CT and MRI findings of calcified spinal meningiomas: correlation with pathological findings

Objective

This study was designed to present characteristic CT and MR findings of calcified spinal meningiomas that correlate with pathological findings and to assess the efficacy of CT for the detection of calcifications within a mass in comparison to MRI.

Materials and methods

Between 1998 and 2009, 10 out of 11 patients who had pathologically confirmed psammomatous meningiomas showed gross calcifications on CT images and were included in this study. On CT scans of the 10 patients, the distribution pattern, morphology and number of calcifications within masses were evaluated. MRI was performed in seven patients and signal intensities of masses were assessed. The pathological results analyzed semi-quantitatively were compared with the density or the size of calcifications within a mass as seen on a CT scan.

Results

Seven of 10 masses were located at the thoracic spine level. Eight masses had intradural locations. The other two masses had extradural locations. Four masses were completely calcified based on standard radiographs and CT. Symptoms duration, the size of the mass and size or number of calcifications within a mass had no correlation. The location, size, and distribution pattern of calcifications within masses were variable. On MR images, signal intensity of calcified tumor varied on all imaging sequences. All the masses enhanced after injection of intravenous contrast material.

Conclusion

A calcified meningioma should be first suggested when extradural or intradural masses located in the spine contain calcifications regardless of the size or pattern as depicted on CT, especially in the presence of enhancement as seen on MR images.