Peripheral T‐cell lymphoma with unusual clinical presentation of rhabdomyolysis

Primary extranodal lymphoma is known to occur in nose, gastrointestinal tract, skin, bone, and central nervous system. However, it is extremely rare for primary lymphoma to arise in skeletal muscle. We report a case of a 32‐year‐old man who presented initially with fever and fatigue. He had a history of alcohol abuse. Laboratory studies and computerized tomography scan showed results consistent with rhabdomyolysis, but the cause of the rhabdomyolysis was undetermined. After biopsy of abdominal skeletal muscle with histologic examination and T‐cell receptor gamma chain gene rearrangement analysis, the diagnosis of peripheral T‐cell lymphoma was established. After two cycles of the cyclophosphamide, doxorubicin, vincristine, prednisone, and etoposide regimen, the patient's symptoms greatly improved. This is the third reported case of peripheral T‐cell lymphoma arising in skeletal muscle reported in the literature and which presented clinically with rhabdomyolysis. The alcohol abuse during the clinical course likely worsens the pathologic process of the rhabdomyolysis. Copyright © 2015 John Wiley & Sons, Ltd.     

Neurotized Free Muscle Flaps can Produce MRI Changes Mimicking Tumour Recurrence

Soft tissue sarcomas are investigated by magnetic resonance imaging (MRI) both for initial staging and follow-up. We describe the presence of increased signal on T2-weighted images caused by a neurotized muscle flap following reconstructive surgery. This raised concern about possible sarcoma recurrence that was not clinically evident. On post-operative imaging of sarcomas the presence of recurrent tumour is indicated by a mass and high signal intensity on T2-weighted images. However, high signal changes in skeletal muscle on T2-weighted images are not specific. In this case, the free functioning muscle transfer with neurotization of the flap mimicked recurrence on MR scan. High signal intensity on T2-weighted images in muscle is an indication of either a physiological change or a pathological condition and must be taken in context of the clinical picture.     

Atypical magnetic resonance imaging findings of craniopharyngioma

Three cases of craniopharyngiomas with atypical MRI findings are reported. The first patient had a nasopharyngeal craniopharyngioma. Its unusual location made diagnosis difficult. The second patient had a massive craniopharyngioma with extensive cystic expansion, involving the anterior, middle and posterior cranial fossae, and extending into the foramen magnum. The tumour of the third patient involved the suprasellar region with a large extension into the third ventricle, and demonstrated a predominantly high signal intensity on all T1‐weighted, proton‐weighted and T2‐weighted images. These patients further stressed the complexity of MRI findings in craniopharyngiomas.     

Long‐standing Morel‐Lavallée lesion in the proximal thigh: Ultrasound and MR findings with surgical and histopathological correlation

A 65‐year‐old man presented with a soft mass in his proximal right thigh. Ultrasonography showed a well‐defined anechoic lesion with slightly internal echoes. On MRI, the mass was hypointense and minimally hyperintense compared with muscle at T1 and hyperintense at T2, with a hypointense peripheral rim on both sequences. No signal loss was observed on T1‐weighted fat‐suppression MRI. The clinical setting, imaging findings and histopathological features were consistent with a long‐standing Morel‐Lavallée lesion.     

MRI of Lumbar and Sacral Plexus Nerve Sheath Tumours

Seven patients with peripheral nerve sheath tumours affecting the lumbo-sacral plexus were examined with MR imaging utilizing a 1.5T magnet and spin echo pulse sequences. The majority of tumours were homogeneous in signal intensity and isointense with adjacent muscle on T₁ weighted images and showed markedly increased signal intensity on T₂ weighted images with central areas of relatively low signal intensity. An attempt to obtain a pathological correlation with the areas of low signal on T₂ weighted images was unsuccessful. The use of Gadolinium DTPA in one patient resulted in irregular enhancement of both a neurogenic sarcoma and smaller neurofibromas. The multiplanar imaging capabilities, high soft tissue contrast, non-invasiveness, lack of ionizing radiation and the characteristic appearance of neural tumours makes MR ideal for imaging these lesions.     

Value of electrophysiologic tests for peripheral nerve neuromas

Management of a peripheral nerve neuroma can be improved by the use of electro-physiologic tests. The relative value of these tests and their possible applications are discussed in some detail. Nerve stimulation either preoperatively or at the operating table remains the simplest and best test for early regeneration. Electromyography can document denervation, although similar conclusions can usually be reached by a careful clinical examination. Nascent muscle action potentials or decreased numbers of fibrillations can be recorded by electromyography and sometimes herald return of function. Conduction velocity tests are most useful for neuropathies of nontraumatic origin, while muscle stimulation tests are of limited value because they tell the investigator little about the quantity or quality of reinnervation. Evoked nerve action potentials (NAP) can be recorded at the operating table and are helpful in documenting a partial lesion or relatively early regeneration.     

Recent progress in image diagnosis of female pelvis

MRI has been employed most in the diagnosis of female pelvic lesions because of its excellent tissue contrast. The T 1-&T 2-weighted image is mainly used for the diagnosis, but very recently the diffusion weighted image has been introduced in clinical practice, with the advance of imaging methods. The diffusion weighted image has high sensitivity to malignancy, especially to dissemination and lymph node metastasis, but may have low specificity to differentiate malignant from benign lesions. Hence,despite the MRI advantage, the diagnosis has to be conducted based on both new and conventional images.     

Surrounding muscle edema detected by MRI is valuable for diagnosis of intramuscular myxoma

We recently experienced 4 cases of intramuscular myxoma and analyzed MRI findings, comparing them with histological ones. Results showed that all tumors were depicted with a homogeneous low signal intensity on T1-weighted images and a markedly high signal intensity on T2-weighted images, findings which are similar to those of cystic lesions like intramuscular ganglions. However, tumors were diffusely and finely enhanced on T1-weighted images with intravenous gadolinium administration. Three cases showed the characteristic fat rim and fat cap. A diffuse edematous lesion demonstrating intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images was also found in the adjacent muscle surrounding the tumor in 3 of 4 cases. In this lesion, tumor invasion, diffuse and severe muscle degeneration, blood and lymphatic congestion with exudates, and reactive adipose tissue formation were observed. The present results suggested that for the clinical diagnosis of intramuscular myxoma with MRI examination, the combination of three MRI signs such as homogeneous low signal intensity on T1-weighted mages, markedly high signal intensity on T2-weighted images, and an enhancement effect with contrast medium are important, but the fat rim or fat cap, and the surrounding muscle edema as detected by MRI are also characteristic and allow for a more firm diagnosis. We presume that the diffuse and severe muscle fiber degeneration induced by tumors may cause such specific surrounding muscle edema.     

颅内室管膜瘤的影像学诊断

目的：分析颅内室管膜瘤的CT、MRI表现。方法：回顾分析18例经手术病理证实的颅内室管膜瘤的CT、MR表现。结果：18例中，脑室系统14例，其中四脑室9例，三脑室1例，侧脑室4例，肿瘤为不规则形或类圆形，边界清楚，CT表现为混合密度肿块，部分可见斑点状钙化，MRI T1加权像为等信号或略低信号，B加权像为不均匀高信号，瘤周无水肿，增强扫描呈不均匀强化；脑实质4例，其中小脑1例、大脑3例均有囊变与瘤周水肿，其余多为实性肿块，肿瘤实质部分CT为等密度，易钙化，在T1加权像为略低信号，B加权像为略高信号，增强扫描实质部分呈轻-中度强化。结论：CT与MRI相结合，能更全面地为临床提供诊断、鉴别诊断及治疗所需要的信息，为治疗方法的选择提供可靠的依据。     

Ulnar nerve injuries of the hand producing intrinsic muscle denervation on magnetic resonance imaging

Muscle and nerve injuries in the hand may be difficult to detect and diagnose clinically. Two cases are reported in which magnetic resonance imaging showed ulnar nerve injury and intrinsic hand muscle denervation. The clinical, anatomical and radiological features of injury to the deep motor branch of the ulnar nerve and associated muscle denervation are discussed and illustrated.     

Renal lymphangiomatosis: A rare cause of bilateral nephromegaly

We report the ultrasound, excretory urography and MR findings in a young child with renal lymphangiomatosis who presented with gradually progressive bilateral flank swelling but who was otherwise asymptomatic. The typical perirenal and parapelvic cysts are visualized as hypoechoic lesions on sonography and hyperintense on T2‐weighted HASTE images. T1‐weighted image could not delineate the cysts clearly. The renal parenchyma was hyperechoic on sonography, and MRI showed reversal of the normal corticomedullary signal intensity, and confirmed the diagnosis by suggesting the non‐parenchymal origin of the cysts.     

Magnetic resonance imaging signal characteristics in hydatid cysts

The MRI features of hydatid cysts were retrospectively studied in 12 patients to look for specific signal characteristics. Twelve patients in the series included eight with abdominal, two with abdominal‐pelvic, one with a sacral and one with a lung hydatid cyst. The T1‐, T2‐ and proton density (PD)‐weighted images of spin‐echo sequence were used for imaging. The signal characteristics of the hydatid parent cyst capsule and fluid, daughter cyst fluid, detached germinal membrane and surrounding soft tissue reaction were noted. Observations revealed that the capsule is best seen on T2‐ and PD‐weighted images. The daughter cysts are best demonstrated on T1‐weighted images, whereas the difference in the signal intensities of parent cyst and daughter cyst fluid is better demonstrated on T2‐weighted and T1‐weighted images, and the detached germinal membrane is best seen on T2‐ and PD‐weighted images. The signal characteristics of hydatid cyst morphology can help distinguish it from other entities.     

Neuromuscular complications of cancer diagnosis and treatment

Neuromuscular disorders are a common cause of morbidity in patients with cancer.They can be a direct effect of the primary malignancy, a paraneoplastic effect, or a treatment complication. Malignant neoplasms may infiltrate or compress nerve roots, plexi, and peripheral nerves, causing various sensory and motor symptoms. Electrodiagnostic testing, cerebrospinal fluid analysis, and neuroimaging are helpful in confirming the diagnosis.Treatment for neuropathies of neoplastic origin involves irradiation and chemotherapy, which may improve pain, but usually does not improve neurologic function. Paraneoplastic syndromes are rare and sometimes result from production of autoantibodies directed against neural antigens present in tumor tissues.They commonly precede any symptoms related to the cancer itself, and discovery of such syndromes necessitates a thorough investigation to look for an occult neoplasm. Treatment of the underlying cancer occasionally improves neurologic function. Both brachial and lumbosacral plexopathies may represent a complication of radiotherapy. Electrodiagnostic tests particularly are helpful; these diagnostics demonstrate the presence of myokymic discharges, which are suggestive of radiation injury. Many chemotherapeutic agents may cause peripheral neurotoxicity and associated acute and chronic peripheral neuropathies, particularly if given to patients with preexisting hereditary or acquired neuropathies.These side effects are a limiting factor in cancer treatment. Other potential neuromuscular problems related to cancer include side effects of steroids and other immunosuppressants, effects secondary to bone marrow transplantation, and infections. Early recognition and management of these disorders will improve patient outcome and quality of life.     

CT and MRI features in Bipolaris fungal sinusitis

Bipolaris is an increasingly recognized cause of fungal sinusitis. Reports of imaging features are sparse. Our purpose was to review the imaging features in patients with Bipolaris fungal sinusitis. A review of our data showed seven patients with culture‐proven Bipolaris fungal sinusitis. Computed tomography of the paranasal sinuses in all the patients and MRI in five patients were analysed for the location, nature, extent of the disease and density/signal characteristics on CT/MRI. The sphenoid and posterior ethmoid sinuses were most often involved (six of seven), followed by the anterior ethmoid sinus (five of seven), frontal sinus (four of seven) and maxillary sinus (three of seven) involvement. Five of seven cases had bilateral disease. Secretions were seen to fill the sinus and were expansile in nature in six of seven cases. Bony erosion was noted in all the patients. Air–fluid levels and bony sclerosis were rarely seen. Computed tomography showed central hyperdensity in all the cases. In the corresponding MR images (n = 5), the sinus contents appeared hyperintense on T1‐weighted images and hypointense on T2‐weighted images. Extension into the nasal cavity was found in six of seven cases. Five of seven cases had intracranial (extradural) spread. Intraorbital extension was seen in three of seven cases, with associated optic nerve compression in two. All the patients responded to surgical debridement, and systemic antifungal therapy was not required. Bipolaris fungal sinusitis typically presents with an allergic fungal sinusitis picture with expansile sinus opacification and bony erosions. There is central hyperdensity on CT scan, which appears hyperintense on T1‐weighted and hypointense on T2‐weighted MR images.     

鼻咽癌引起的咀嚼肌失神经支配的MRI特征

鼻咽癌（NPC）病人的咀嚼肌一旦失神经支配（DMM）就会在MRI上呈T2延长（高信号）,静脉造影后明显增强,还可有肌肉萎缩和脂肪性变。DMM的出现,强烈提示下颌神经（Ⅴ3）有NPC浸润,故应努力搜寻。除非在Ⅴ3径路上包括卵圆孔,三叉神经池（即Meckel氏小腔）,或海绵窦无新的、日渐增大的NPC累及灶,才可对放疗过的病人考虑为Ⅴ3放射损伤所致。NPC如果向侧方扩展侵入DMM,则该被侵的DMM的MRI信号即转变成为NPC的信号。     

Tolosa–Hunt syndrome: MRI appearances

A review of MRI findings in seven patients with Tolosa–Hunt syndrome was carried out. Seven patients presented with unilateral painful ophthalmoplegia. Magnetic resonance imaging studies were carried out to evaluate the cavernous sinuses and orbits. Coronal fast spin‐echo T2‐weighted images and fat‐saturated T1‐weighted coronal and transverse images with and without contrast enhancement were obtained for the cavernous sinuses and orbits. All patients showed focal‐enhancing masses expanding the ipsilateral cavernous sinus. In one patient the mass was extending to the orbital apex and intraorbitally. All patients recovered on corticosteroid therapy and resolution of the masses was documented on follow‐up MRI studies in five patients. One patient had a relapse of symptoms after discontinuing therapy. Magnetic resonance imaging studies of the cavernous sinus and orbital apex show high sensitivity for the detection and follow up of inflammatory mass lesions in Tolosa–Hunt syndrome. Magnetic resonance imaging should be the initial screening study in these patients.     

颅底软骨瘤及软骨肉瘤的影像学诊断7例报告

 目的　分析颅底软骨瘤及软骨肉瘤的影像学表现,提高诊断水平。方法　7例经头颅X线平片配合CT、脑血管造影、MRI检查,经手术病理证实。结果　1.头颅X线片和CT：鞍区团絮状高密度钙化肿块2例,低密度钙化1例,等密度、高密度4例,强化后不均匀增强5例。2.脑血管造影：颈内动脉、大脑中动脉、大脑前动脉受压移位,无肿瘤血管染色2例;3.MRI：MRI T1WI像不均匀低信号及不均匀增强,T2WI像不均匀高信号4例,手术病理诊断：软骨瘤6例,软骨肉瘤1例。结论　头颅X线片和CT对鞍旁颅中窝大量钙化的软骨瘤容易诊断。对不典型者,应配合MRI或DSA脑血管造影检查有助于正确诊断。     

Neuromuscular hamartoma

A rare case of neuromuscular hamartoma, a benign tumor composed of well-differentiated skeletal muscle and nerve fibers, is described and compared with four previously reported cases. The tumor arose in the major peripheral nerves. Three of the five tumors were congenital tumors. A biopsy is essential in establishing the diagnosis. However, the tumor may be left alone if it cannot be separated from the nerve with ease, since spontaneous regression has been documented.     

鼻咽癌放射治疗后脑脊髓损伤的临床和影像学诊断

目的　探讨鼻咽癌患者放射治疗后脑脊髓放射性损伤的临床和影像学诊断。方法　对 32例鼻咽癌放射治疗脑脊髓放射性损伤患者的临床表现、CT及MRI表现进行回顾性分析。结果　 32例中共发现 4 5个损伤病灶 ,颞叶 30个 (占脑损伤病灶的 70 % ) ,脑干 13个 ,颈段脊髓 2个。其中 6例放射性颞叶损伤无临床症状。CT对颞叶放射性损伤的检出率为 87% ,对脑干损伤的检出率仅 2 9%。放射性颞叶损伤在CT图象上主要表现为指状低密度。MRI检查T1WI图象上放射性脑脊髓损伤均表现为低或等信号 ,T2 WI图象上为高信号或混合信号 ,颞叶损伤可伴有周围指状分布水肿信号 ,86 %病灶有增强效应 ,中间有不增强区。结论　放射性脑脊髓损伤的临床表现无特征性 ,亦可无症状 ,CT及MRI表现具有一定的特征性 ,结合病史可做出诊断。MRI在诊断脑干、脊膜损伤上优于CT。     

关节内原发恶性肿瘤九例报告

目的：报告9例关节内原发恶性肿瘤病例,探讨合理的诊断方法及治疗方案。方法2001年8月至2011年7月共收治关节内原发恶性肿瘤的9例,其中男6例、女3例,年龄21～76岁、平均43.8岁。7例滑膜肉瘤（均为膝关节）,1例脂肪肉瘤（膝关节）,1例恶性弥漫性巨细胞瘤（髋关节）。回顾其临床表现、影像特点、诊断途径、手术方式,评价术后关节功能、并发症及转归。结果9例入院前均有关节疼痛,MRI典型表现为T1加权像低信号,T2加权像高信号或混杂信号伴明显强化,均接受手术治疗,术后平均随访27.5（12～60）个月,中位随访27个月,4例最终行截肢术,另5例保肢治疗后功能良好。结论关节内原发恶性肿瘤发病率极低;易误诊为良性病变。本组病例以膝关节滑膜肉瘤多见;术前需活检明确诊断,根据病理结果制订治疗方案（行新辅助化疗或术后放化疗）,患者能有良好的预后。根据MRI评估关节受累情况,需设计良好的外科切除边界;获得有效的肿瘤切除。