盆腔脂肪增多症的影像学诊断(附4例分析)

目的提高对盆腔脂肪增多症的认识及诊断水平.材料和方法总结分析4例经手术及病理证实的盆腔脂肪增多症的X线、CT和MRI表现.结果术中见膀胱、直肠、前列腺等脏器受压后移位、变形与影像学表现一致.结论影像学检查是诊断本病的主要方法和依据.     

四例盆腔脂肪增多症的影像表现

目的分析4例盆腔脂肪增多症（PL）的影像和临床表现特点，以期提高对本病的认识。方法搜集经临床和病理证实的4例盆腔脂肪增多症的影像资料，4例均行CT、超声和静脉尿路造影（IVU）或膀胱造影检查，1例行MRI检查，1例行钡灌肠造影，3例行膀胱镜检查。结果4例盆腔脂肪增多症患者的腹部X线片、CT、IVU与钡灌肠造影均可见“骨盆透明”征；肾盂和输尿管上段有不同程度扩张积水，输尿管下段狭窄；膀胱抬高呈“梨”形；直肠和乙状结肠向上及外侧推挤移位；3例病理诊断伴有腺性或腺囊性膀胱炎。结论分析PL的影像特点，结合临床表现，可以诊断PL。     

盆腔脂肪增多症的影像学表现(附六例分析)

目的 报道６例盆腔脂肪增多症的影像表现。方法 ６例患者分别应用多种方法检查,手术证实４例,随访２例。结果 ＣＴ检查６例,示盆腔内大量低密度影并膀胱变形,５例输尿管及肾盂扩张;Ｂ超检查６例,示盆腔内大量强回声光团,膀胱变形,５例肾盂、输尿管扩张;ＭＲ检查３例,示盆腔内大量短Ｔ１、短Ｔ２信号,膀胱变形并肾盂、输尿管扩张;Ｘ线平片４例,显示盆部透亮度增加;静脉肾盂造影４例,示输尿管扩张移位、肾盂积水;钡     

超声对盆腔脂肪增多症的诊断价值

盆腔脂肪增多症是一种病因不明的以盆腔内脂肪组织异常增多及盆腔脏器受压为特征的少见良性疾病。1959年En-gles首次对该病进行了描述,1968年Fogg将本病命名为盆腔脂肪增多症。本研究收集了我院从1995年到2010年共5例利用超声诊断的并均经CT和手术病理证实的盆腔脂肪增多症病例,对其超声声像图做进一步的分析,以探讨利用超声对盆腔脂肪增多症的诊断价值。     

盆腔脂肪增多症一例

盆腔脂肪增多症是一种原因未明的罕见良性疾病.由Engels于1959年最早报道,1968年由Fogg和Smyth正式命名[1].本文报道1例具有全面影像学资料并经手术证实的盆腔脂肪增多症.     

彩色多普勒超声检查盆腔脂肪增多症5例

盆腔脂肪增多症是一种原因不明的良性罕见疾病,缺乏典型临床症状,诊断主要依靠影像学检查,CT、MRI对其诊断率较高.随着超声诊断技术的不断发展和对该病认识的提高,超声对盆腔脂肪增多症的诊断优势越来越突出.1992～2008年我院收治了5例盆腔脂肪增多症患者,对其声像学及临床资料进行总结.     

颈部脂肪增多症1例

男，59岁，因自觉颈部不适2年来诊，初起感颈部较前增粗，后逐渐明显，视诊可见了患者下颈部隆起，皮肤表面光滑，色泽正常，触诊颈部软组织增厚，边界不清，无触痛，未及确切肿块，皮温不高。无家族史，无遗传性疾病。B超显示双侧颈部肌间隙内弥漫强回声团，界限不清晰，内部回声均匀。     

盆腔脂肪增多症合并腺性膀胱炎1例

<正>病人,男,48岁。因排尿不畅、尿不尽感半年入院。查体:体质量80 kg,身高1.72 cm,体质量指数27.0 kg/m~2,腹型较饱满,无压痛、叩击痛及反跳痛。膀胱造影示:膀胱底部抬高,膀胱容积缩小,颈部拉长,呈倒葫芦状(见图1)。CT平扫示:盆腔内直肠及膀胱周围可见大量脂肪组织堆积,膀胱精囊角变大,直肠及乙状结肠肠腔变窄,膀胱变     

盆腔脂肪增多症合并腺性膀胱炎的MRI诊断(附3例分析)

目的:提高对盆腔脂肪增多症合并腺性膀胱炎的认识与诊断水平,了解盆腔脂肪增多症、腺性膀胱炎的影像特点与临床表现以及两者发病的相关性。方法:分析3例盆腔脂肪增多症合并腺性膀胱炎的临床表现、MRI、MRU及病理特点,并分析对比参考文献。结果:盆腔脂肪增多症合并腺性膀胱炎的MRI、MRU具有一定特点,两者常常伴随发病,同时腺性膀胱炎易演变为膀胱癌。结论:根据MRI、MRU与临床特点的综合分析,MRI能够正确诊断盆腔脂肪增多症合并腺性膀胱炎,由于腺性膀胱炎易演变为膀胱癌,因此,对于盆腔脂肪增多症合并腺性膀胱炎的患者应高度重视,密切随诊复查。     

Measuring diagnostic accuracy of imaging parameters in pelvic lipomatosis

Objectives

To study whether the individual radiological findings can help predict diagnosis of pelvic lipomatosis (PL) or, specifically appreciate its progression.

Methods

Data from 32 clinically proven cases of PL and 25 controls were collected. Two reviewers were recruited for a blinded evaluation, image features were recorded in terms of: (1) bladder shape; (2) bladder-rectosigmoid morphological indexes including ratio of superior–inferior to anterior–posterior length of bladder (SI/AP), angle between anterior and posterior wall (AAP), relative length of posterior urethra (rLPU), angle between bladder and seminal vesicle (ABS) and rectosigmoid morphological index (RMI); (3) secondary complications. Results were evaluated by an unpaired t test and ROC analysis.

Results

The sensitivity and specificity were 40.6% and 100% for pear and banana-shaped bladder, 62.5% and 100% for SI/AP, 40.6% and 100% for AAP, 62.5% and 100% for ABS, 78.1% and 72% for rLPU, 59.4% and 96% for RMI, respectively. These radiological findings partially correlated with the severity of disease weighted by hydronephrosis and treatment grade. Image analysis demonstrated high prevalence of glandular cystitis (100%) and hydronephrosis (73.4%).

Conclusion

We conclude that PL is a progressive disease involving multiple pelvic organs with high prevalence of intractable cystitis and hydronephrosis. The imaging characteristics can help predict diagnosis and, specifically appreciate progression.     

Replacement lipomatosis related to renal tuberculosis: imaging findings in one case

Replacement lipomatosis of the kidney in a case of long-standing renal tuberculosis is reported. The radiologic and pathologic findings are described and the differential diagnosis is discussed. A hypothesis is given to explain the association of renal tuberculosis and replacement lipomatosis of the kidney.     

食管胃吻合口-胸腔瘘的影像学诊断和介入治疗

目的：探讨食管胃吻合口-胸腔瘘的影像学特征及其介入治疗方法。方法：回顾性分析6例具有完整临床资料的食管胃吻合口-胸腔瘘的口服碘水造影及CT表现；透视下，置入蘑菇状覆膜内支架封堵瘘口。结果：6例口服碘水造影显示对比剂均经吻合口溢入胸腔；6例螺旋CT检查，其中5例显示吻合口与胸腔相通，1例瘘口小而未显示。全部病例顺利置入内支架，既完全封堵了瘘口，又解决了进食问题。结论：根据口服碘水造影和螺旋CT征象可以诊断食管胃吻合口-胸腔瘘，置入蘑菇状覆膜内支架封堵瘘口操作简单、安全、近期疗效明显，是一项值得推广的新技术。     

Magnetic resonance imaging for diagnosis and follow-up of genitourinary,pelvic, and perineal rhabdomyosarcoma

Magnetic resonance (MR) imaging, ultrasound, and computed tomography (CT) were performed for diagnosis and follow-up of rhabdomyosarcoma (RMS) arising from the genitourinary tract in five children, pelvic musculature in one, and the perineum in three others. MR imaging performed at 1.0 T included the following: spin-density-, T1-, and T2-weighted images in all nine patients; gadopentatate dimeglumine (Gd-DTPA)-enhanced T1-weighted images in five; and short TI inversion recovery (STIR) images in two children. Longitudinal T1-weighted images were of additional help in localizing the primary tumor at diagnosis and detecting local spread. Residual or recurrent disease within the bladder was best detected by spin-density images. Gd-DTPA enhancement improved contrast in two studies, but paramagnetic artifacts obscured intravesical lesions in three other studies. STIR images disclosed pelvic and retroperitoneal lymphadenopathy. MR imaging is recommended as the key method of diagnosis and follow-up of pelvic RMS.     

骨盆骨折旋转移位的影像学测量与诊断

目的 测量半骨盆在矢状位上旋转移位,为判断骨盆在三维平面上的旋转移位建立基础,从而为骨盆骨折闭合复位提供指导. 方法 根据骨盆解剖结构及术前或术中骨盆正位X线影像学资料,建立合理的数学模型,通过影像学特定点、线的测量,计算半骨盆矢状面旋转程度.选取不伴骨性结构异常的尸体骨盆标本10具,用铅线对每具标本双侧髂前上棘及耻骨联合前缘进行标记.模拟矢状位半骨盆旋转移位,摄改良的骨盆正位X线片.使用影像测量软件对影像学资料进行测量与计算,通过统计学分析,验证课题所提出方法的可行性和准确性. 结果 测量同一骨盆双侧髂前上棘至同侧耻骨联合前缘的连线距离,左右两侧连线长度差异无统计学意义(P＞0.05).对测量计算得出的旋转侧半骨盆矢状面旋转的角度与实验设计中的20°进行比较,差异无统计学意义(P＞0.05). 结论 通过骨盆解剖形态和影像学特征的研究,提出了改良骨盆正位,通过X线片特定点、线的测量计算获得骨盆空间移位的量化指标,能够指导复位操作及复位效果的判断,有助于骨盆骨折移位的闭合复位.     

Lumbosacral epidural lipomatosis: MRI grading

Lumbosacral epidural lipomatosis (LEL) is characterized by excessive deposition of epidural fat (EF). The purpose of our retrospective study was to quantify normal and pathologic amounts of EF in order to develop a reproducible MRI grading of LEL. In this study of 2528 patients (1095 men and 1433 women; age range 18–84 years, mean age 47.3 years) we performed a retrospective analysis of MRI exams. We obtained four linear measurements at the axial plane parallel and tangent to the superior end plate of S1 vertebral body: antero-posterior diameter of dural sac (A-Pd DuS), A-Pd of EF, located ventrally and dorsally to the DuS, and A-Pd of the spinal canal (Spi C). We calculated (a) DuS/EF index and (b) EF/Spi C index. We developed the following MRI grading of LEL: normal, grade 0: DuS/EF index ≥1.5, EF/Spi C index ≤40%; LEL grade I: DuS/EF index 1.49–1, EF/Spi C index 41–50% (mild EF overgrowth); LEL grade II: DuS/EF index 0.99–0.34, EF/Spi C index 51–74% (moderate EF overgrowth); LEL grade III: DuS/EF index ≤0.33, EF/Spi C index ≥75% (severe EF overgrowth). The MRI exams were evaluated independently by three readers. Intra- and interobserver reliabilities were obtained by calculating Kappa statistics. The MRI grading showed the following distribution: grade 0, 2003 patients (79.2%); LEL grade I, 308 patients (12.2%); LEL grade II, 165 patients (6.5%); and LEL grade III, 52 patients (2.1%). The kappa coefficients for intra- and interobserver agreement in a four-grade classification system were substantial to excellent: intraobserver, kappa range 0.79 [95% confidence interval (CI), 0.65–0.93] to 0.82 (95% CI, 0.70–0.95); interobserver, kappa range 0.76 (95% CI, 0.62–0.91) to 0.85 (95% CI, 0.73–0.97). In LEL grade I, there were no symptomatic cases due to fat hypertrophy. LEL grade II was symptomatic in only 24 cases (14.5%). In LEL grade III, all cases were symptomatic. A subgroup of 22 patients (42.3%) showed other substantial spinal pathologies (e.g., disk herniation). By means of simple reproducible measurements and indexes MRI grading enables a distinction between mild, moderate, and severe EF hypertrophy. Kappa statistics indicate that LEL can be reliably classified into a four-grade system by experienced observers.     

血管介入栓塞在经髂腹股沟入路手术治疗骨盆不稳定骨折中的应用

目的:探讨血管介入栓塞技术在止血和减少术中出血联合早期经髂腹股沟入路切开复位内固定治疗骨盆不稳定骨折中的应用价值。方法:对27例不稳定骨盆骨折患者急症行血管介入栓塞患侧髂内动脉,术后5~8 d行髂腹股沟入路切开复位内固定术。结果:全部患者均一次性栓塞成功,平均止血时间为8 min,无一例再出血。手术平均时间150 min,术中平均输血250 ml。无感染、血管神经损伤等手术并发症。术后随访6~24月,骨折均愈合,Majeed骨折评价:优14例,良8例,可5例。结论:血管介入栓塞在骨盆不稳定骨折治疗中可以有效控制骨盆骨折出血,同时较少后期手术中的出血;髂腹股沟入路骨折复位直观,操作方便,在骨盆不稳定骨折手术中值得推广。     

双侧髂内动脉栓塞在骨盆肿瘤化疗栓塞中的临床应用

目的 :探讨双侧髂内动脉栓塞在骨盆肿瘤化疗栓塞中的临床应用价值。方法 :对 2 3例骨盆肿瘤患者采用Co bra或Yashiro导管进行超选择插管 ,找出肿瘤的所有供血动脉 ,然后根据血供进行超选择性灌注化疗 ,并用明胶海绵随机对其中 11例患者进行所有肿瘤供血动脉的选择性栓塞 (单纯栓塞组 ) ;对其中 12例患者除进行所有肿瘤供血动脉的选择性栓塞外 ,还对双侧髂内动脉主干进行栓塞 (双侧髂内动脉栓塞组 ) ,栓塞后 2 4～ 4 8h由同一组医生进行手术 ,计算术中出血量与手术时间。结果 :双侧髂内动脉栓塞组手术中暴露肿瘤的出血量为 80± 2 6 6 3ml,术中总出血量为 775± 2 35 97ml,手术时间为 16 4 17± 2 6 4 4min ;单纯栓塞组上述指标分别为 2 0 0± 4 8 5 8ml、176 3 6 4± 390 5 7ml、2 2 8 18± 37 37min。双侧髂内动脉栓塞组明显少于单纯栓塞组 (P <0 0 0 1)。手术中术野更清楚 ,易剥离 ,出血少 ,缩短手术时间。术后随访 6～ 18个月未见肿瘤复发和转移。结论 :双侧髂内动脉栓塞法能有效减少骨盆肿瘤的术中出血 ,利于肿瘤彻底切除 ,结合化疗能减少肿瘤复发或转移 ,是一种有价值的术前辅助性治疗方法