Imaging and classification of congenital cystic renal diseases

OBJECTIVE: The purpose of this clinical perspective is to describe a decision-tree approach to the finding of hyperechoic kidneys as signs of congenital renal cystic disease in fetuses and children. This approach takes into account the latest classification of inherited renal cystic diseases. The basis of the approach is a detailed sonographic analysis in addition to assessment of clinical data and the familial history. CONCLUSION: With the decision-tree approach, typical sonographic patterns can be described and used for accurate diagnosis of isolated renal cystic diseases and polymalformative syndromes. In some cases, however, the diagnosis is not achieved, and complementary examinations are needed.     

Imaging of cystic liver diseases

The high frequency of benign and asymptomatic liver cysts must not underevaluate the potential diagnostic difficulties of liver cystic diseases. Complicated liver cyst or cystic mass of various origin, such as developmental, neoplastic or inflammatory, are important to be recognized by the radiologist. The diagnostic approach is depending on the number of lesions and their dissemination. The presence of a wall, the internal structure of the lesion, particularly the MR signal and the proximity of the biliary tree are the main diagnostic criteria. Some less frequent but characteristic unusual features need to be memorized.     

囊性肾癌的影像分析

目的：讨论各种影像检查对囊性肾癌的诊断价值。方法：对经影像检查并得到病理证实的囊性肾癌15例进行分析,其中5例行静脉肾盂造影（IVP）,15例行B超及CT检查,14例同时行增强扫描,比较各种检查方法对囊性肾癌的检出率。结果：15例中,IVP检查诊断符合3例（60．0％）,B超诊断符合12例（80．0％）,CT扫描诊断符合13例（86．6％）。结论：联合影像学检查可提高囊性。肾癌的术前诊断率。     

Imaging of cystic diseases of the pancreas

Although the majority of cystic lesions of the pancreas seen in clinical practice represent postinflammatory pseudocysts, it is important for the radiologist to be knowledgeable of the wide spectrum of cystic masses of the pancreas and the variable prognoses they possess. As a result of similarities in the imaging features of these lesions, a definitive diagnosis is often not possible. By combining imaging features with clinical history, a reasonable differential diagnosis can be offered to the referring physician. In some cases, biopsy or fluid aspiration may be required prior to surgery. In a patient without the appropriate history of pancreatitis and the presence of a cystic pancreatic mass, it is incumbent upon the radiologist to offer alternative diagnoses of cystic neoplasms of the pancreas.     

Imaging of the rare cystic lung diseases

When discussing cystic lung diseases, a certain group of diseases tends to receive the majority of attention. Other less frequently discussed cystic lung diseases are also important causes of morbidity in patients. Etiologies include genetic syndromes, lymphoproliferative diseases, infections, exogenous exposures, and a developmental abnormality. This review article focuses on the clinical and imaging features of these other cystic lung diseases.     

复杂性肾囊性病变治疗方式研究

目的探讨复杂性肾囊性占位性病变的治疗方式的选择。方法选取陆军总医院泌尿外科自2010年4月至2014年12月收治的复杂性肾囊性病变患者15例,依据影像学检查行术前评估及手术探查,根据术中冰冻病理结果行手术治疗。结果本组15例患者均行手术治疗,其中,恶性病变9例,良性病变6例;肾根治性切除术7例,肾部分切除术8例。结论复杂性肾囊性占位病变术前常不能确定良恶性,需结合手术探查及术中冰冻病理结果决定行肾部分切除术或肾根治性切除术,尽量避免肾因良性病变切除,提高患者生活质量。     

Imaging of cystic lesions

Cystic neck masses are varied in their histology and embryogenesis. Because neural, vascular, and lipomatous lesions may all appear cystic, a multimodality imaging approach can help identify these potential mimics. Developmental neck cysts include thyroglossal duct, thymic, and branchial cleft cysts, and teratomatous lesions or lymphangiomas. Although laryngoceles are acquired lesions, congenital anomalies (e.g., abnormally long saccules) may play a role in their formation. Lesion location is at least as important a determinant as morphology in formulating the differential diagnosis of a cystic neck mass. Midline cystic lesions are most commonly thyroglossal duct cysts, although dermoid tumors are also frequently midline. Squamous cell carcinoma metastatic to anterior triangle lymph nodes (Fig. 17), and cystic, necrotic schwanommas, can mimic the typical appearance of an infected second branchial cleft cyst. Posterior triangle lymphadenopathy and lipomatous lesions may resemble cystic hygromas. Cystic-appearing masses in the carotid space include neurogenic tumors, vascular thromboses, and carotid chain lymphadenopathy. Neural-based lesions typically occur posterolateral to the carotid artery. Necrotic lymphadenopathy may be suggested by lesion multiplicity, or by the presence of ancillary features, such as systemic symptoms, or the existence of a primary tumor. It must be emphasized that the primary role of the radiologist in head and neck imaging is to help stage disease and guide surgery. Despite clinical and radiographic analysis, the diagnosis of many lesions ultimately depends on image-guided or excisional biopsy.     

囊性肾癌的超声、CT及MR影像学诊断

囊性肾癌(cysticrenal cell carcinoma,CRCC)是肾癌的一种少见类型,在病理上肿瘤细胞核分裂和肿瘤分期均较低,预后较好。其临床表现缺乏特异性,超声、CT及MR影像学表现与一般肾癌不同。目前对于囊性肾癌的术前诊断,CT和MRI扫描仍为主要检查手段。囊液密度或信号、囊壁及分隔厚薄和附壁结节、钙化、病灶与肾组织分界、假包膜及增强扫描表现等是影像诊断中观察的重点。其CT、MRI表现具有一定特征,表现典型者可做出明确诊断。     

Renal cystic diseases

Renal cystic disease comprises a mixed group of heritable, developmental, and acquired disorders. Because of their diverse etiology, histology, and clinical presentation, no single scheme of classification has gained acceptance. Conditions include autosomal dominant polycystic kidney disease, acquired renal cystic disease, medullary sponge kidney, autosomal recessive polycystic kidney disease, multicystic dysplastic kidney, medullary cystic disease, tuberous sclerosis, cysts of the renal sinus, and von Hippel-Lindau's disease. An awareness of the pathology of each cystic disease is helpful in the understanding of the corresponding radiological images. Imaging techniques used in evaluating renal cystic disease include intravenous urography, sonography, CT, MRI, nuclear medicine, and renal angiography. Many types of cystic disease show similar imaging features. Meticulous attention to subtle radiological findings is therefore essential for reaching a correct diagnosis. Imaging features requiring analysis include whether the cysts are unilateral or bilateral, renal size and functional status, cyst distribution in the kidneys, and the presence of hemorrhagic and calcified renal cysts, solid renal masses, renal sinus cysts, and cysts in adjacent organs. Radiological findings should be carefully correlated with clinical features such as patient age, family history, symptoms, physical findings, and renal functional status before a diagnosis is attempted. Received 10 October 1996; Revision received 30 January 1997; Accepted 4 February 1997     

多房性囊性肾瘤的影像学表现

<正> 多房性囊性肾瘤是一种较少见的肾脏囊性病变,国内外文献报道较少。笔者回顾性分析2例多房性囊性肾瘤的CT表现,同时复习相关文献,以总结其影像表现。1 临床资料例1:女,41岁,体检发现左肾病变,查体未见明显异常。实验室检查:血、尿常规及肝、肾功能均无异常。     

Unilateral renal cystic disease

Unilateral renal cystic disease (URCD) is a distinct entity that is one of the renal cystic diseases. URCD consists of a cluster of multiple cysts in part or most of one kidney with no association of cystic disease in the contralateral kidney. URCD is a nonfamilial, nonprogressive disorder and is not related with autosomal dominant polycystic kidney disease (ADPKD). We report a case of URCD with six-year CT follow-up. Confinement of the cystic disease to one kidney with an absence of cysts in other organs such as liver or pancreas distinguish URCD from ADPKD. Absence of an encapsulated mass and intervening normal renal parenchyma between the cysts can differentiate URCD from cystic renal tumors.     

Imaging rheumatic diseases

Currently, more than 100 rheumatic diseases affect nearly 46 million Americans. Some of the most common rheumatic diseases include rheumatoid arthritis, osteoarthritis, lupus, psoriatic arthritis, ankylosing spondylitis, gout, and Sj?gren syndrome. Rheumatic diseases are characterized by inflammation and lack of function in the joints and connective tissue. Early diagnosis and treatment of rheumatic disease is paramount in preventing damage and disability. Many radiologic modalities are used for diagnosing and monitoring these diseases, but for many, radiography remains the gold standard. Furthermore, imaging biomarkers may play an important role in diagnosis and treatment of rheumatic diseases in the future.     

Imaging of cardiopulmonary diseases

Clear physiologic adaptations to endurance and resistance training occur in the myocardium. These morphologic changes have been identified primarily by echocardiography. In the evaluation of the symptomatic athlete, imaging is a valuable tool. To differentiate athletic hypertrophy from hypertrophic cardiomyopathy, echocardiography, or MRI may be used, although the latter may be superior in the accurate assessment of wall thickness. Either imaging modality may be used to differentiate athletic dilatation from dilated cardiomyopathy in which systolic dysfunction always accompanies the dilatation. To exclude anomalous coronary arteries, either MRI or CT is a reasonable examination, although the latter requires x-ray exposure and iodinated contrast dye. Chest radiograph continues to be the standard imaging modality for athletic lung disease, whereas fluoroscopy and laryngoscopy are useful for identifying vocal cord dysfunction. Knowledge of the utility of these different imaging modalities is crucial to the practitioner of sports medicine.     

Imaging of prion diseases

Prion diseases are caused by self-replicating proteins that induce lethal neurodegenerative disorders. In the last decade, the understanding of the different clinical, pathological, and neuroimaging phenotypes of this group of disorders has evolved paralleling the advances in prion molecular biology. From an imaging standpoint, the implementation of diffusion-weighted imaging in routine practice has markedly facilitated the detection of prion diseases, especially Creutzfeldt-Jakob. Less frequent prion-related disorders, including genetic diseases, may also benefit from progresses in the field of quantitative diffusion-weighted imaging, MR spectroscopy or molecular imaging. Herein, we present a review of the neuroimaging features of the prion disorders known to affect humans emphasizing the important contribution of MRI in the diagnosis of this group of disorders.     

囊性胸腺瘤和囊性畸胎瘤的影像学特征及鉴别诊断

目的 探讨囊性胸腺瘤和囊性畸胎瘤的影像学特征, 以提高两者的诊断正确率。 方法 回顾性分析经手术后病理证实的18例囊性胸腺瘤和12例囊性畸胎瘤患者的X线及CT影像学表现, 所有患者均行X线检查和CT平扫+增强扫描。 结果 肿瘤主要局限在前上纵隔或部分延伸至前中纵隔, 而且大多数肿瘤多偏向一侧。囊性胸腺瘤有明显分叶, 肿瘤几乎囊变, 部分可见小壁结节, 邻近血管结构多受推移, 部分病灶可压迫肺组织; 部分肿瘤可继发胸部改变如胸腔积液等。畸胎瘤基本上都含有囊变, 但肿瘤内未见明显骨性及脂性成分, 肿瘤内密度不均匀, 肿瘤并不是完全囊变。 结论 囊性胸腺瘤与囊性畸胎瘤各自具有一定的病理学及影像学特征, 根据其影像特征并结合其临床表现, 能对两者进行鉴别诊断。     

Imaging of pericardial diseases

Traditionally echocardiography has been the method of choice for the evaluation of pericardial and cardiac lesions. However, computed tomography (CT) and magnetic resonance imaging (MRI) provide a large field of view and excellent images of anatomy not available with echocardiography. In addition, CT and MRI demonstrate high soft-tissue contrast as well as the exact localization of a lesion. Currently, CT and MRI are the preferred techniques for the recognition and characterization of pericardial disorders. In this review, the characteristic imaging appearances of a variety of pericardial diseases are discussed.