Radiologic diagnosis of bone metastases

Radiological diagnosis of bone metastases comprises multifarious examinations of varying diagnostic value. The incidence and topography of osseous metastases, as well as the x-ray morphological pattern, are described and the ranking of the various radiological methods discussed in detail. The diagnostic procedure to be followed in osseous metastases is explained on the basis of clinical examples, and the value of the individual methods in assessing the therapeutic effect is subjected to critical evaluation.     

Brain metastases. Radiologic diagnosis and therapy

Brain metastasis is a sign of advanced malignant disease. The grave clinical symptoms demand an immediate and accurate diagnosis and effective palliation. Computer-assisted tomography with contrast enhancement is the most established diagnostic procedure, and the number and size of the metastases can be determined, as well as indirect signs of increased intracranial pressure. The treatment of choice for multiple brain metastases is whole-brain irradiation. The symptomatic responses range between 60% and 80%, with a median survival of about 5 months. Survival in individual cases however, is mainly influenced by the histology of the primary tumor, as well as the general condition of the patient and the progression of the extracerebral disease. Prophylactic brain irradiation in patients with small-cell lung cancer and a good response to chemotherapy significantly decreases the incidence of symptomatic metastases in patients and yields longer survival times. Larger treatment doses per fraction and simultaneous application of chemotherapy may enhance the risk of late neurological sequelae.     

Radiologic diagnosis of metastases in the lesser pelvis

Reviewing the literature and summarizing our own experience, the role of various imaging modalities concerning diagnosis of metastases to lymph nodes and organs in the pelvic cavity is discussed. Especially ultrasound, CT and lymphography are compared, the importance of fine-needle-aspiration is emphasized. Possible advantages of MRI are mentioned.     

Radiologic diagnosis of pneumoconioses

Radiology is extremely important in the diagnosis of occupational lung disease. Owing to its general availability and international comparability, the roentgenographic pa view of the chest obtained by the high-voltage technique is still the basis of the radiologic examination. Supplementary investigations are necessary for medical reasons, however, as well as for documentation of experts' certification. Valuable diagnostic information is supplied by oblique views of the thorax and by conventional X-ray tomography, though not by scintigraphic examinations or - up to now - by digital luminescence radiography. Ultrasound helps in the differentiation of free pleural fluid, organized pleural effusion, and pleural malignancy. In addition, computed tomography (CT) can be guided by ultrasound. CT has emerged as the method of choice for examination and for support of medical experts' certification of pneumoconiotic pleural disease, and high-resolution CT (HRCT) is also increasing used for examination of pneumoconiotic lung foci as well. Diagnostic accuracy in pneumoconiosis is further improved by shorter CT scanning times in combination with HRCT.     

乳腺癌骨转移的影像学诊断进展

乳腺癌是“嗜骨性癌肿”,极易伴发骨转移,由骨转移引发的骨相关事件可明显影响晚期乳腺癌患者的生存质量及预后转归。因此,早期、准确诊断骨转移对乳腺癌的临床分期及治疗计划制定具有决定作用,对预后改善亦有重要意义。该文综述了乳腺癌骨转移影像学诊断的研究进展,为临床早期诊断骨转移提供影像学依据。     

Radiological imaging for the diagnosis of bone metastases.

Primary neoplasms of the skeleton are rare, but metastatic involvement is, unfortunately, a common occurrence. This is particularly true for certain primary tumors. Skeletal metastases are clinically significant because of associated symptoms, complications such as pathological fracture and their profound significance for staging, treatment and prognosis. Detection of bone metastases is, thus, an important part of treatment planning. The frequency with which metastases are detected varies considerably with the type of primary tumor and with the methodology utilized for detection. Four main modalities are utilized clinically: plain film radiography, CT scan, nuclear imaging and magnetic resonance imaging. In this discussion, we will review literature on the radiology of skeletal metastases with respect to lesion detection, assessment of response to treatment and possible therapeutic implications. The bulk of the discussion will focus on MRI and nuclear studies since most of the recent advances have been made in these areas.     

磁共振各序列在骨挫伤及骨转移诊断中的应用

目的:探讨磁共振各序列在骨挫伤及骨转移诊断中的应用价值。方法:对商丘市第一人民医院的45例骨挫伤及骨转移患者行磁共振检查,磁共振扫描前经CR或CT扫描。使用GESigna Contour 0.5T超导型扫描机,脊柱扫描使用脊柱线圈,膝关节扫描使用膝关节线圈,行矢状位、冠状位及横断扫描。扫描序列包括各序列。结果:所有45例接受磁共振检查的患者中,骨转移并骨损伤10例,膝关节骨挫伤合并半月板、韧带损伤22例,骨转移并伴有相邻椎体脊髓水肿13例。结论:对于骨挫伤及骨转移脂肪抑制序列T2WI检查好于TSET2WI及FL2DT2WI,与SET1WI相结合能够更敏感的发现骨挫伤及骨转移改变。     

Radiologic assessment of metastases to the thyroid gland

PURPOSE: We reviewed the radiologic and clinical data in patients with metastatic disease to the thyroid gland and assessed the role of radiologic techniques in this disorder. METHOD: The findings on US (n = 11), CT (n = 7), MRI (n = 6), palpation or US-guided fine needle aspiration (FNA) biopsy, and clinical records were reviewed in 11 cases of pathologically verified metastatic tumors of the thyroid gland. RESULTS: Five patients had palpable thyroid nodules and six had nonpalpable nodules discovered incidentally with imaging procedures. Three patients had no known malignancies at the time of diagnosis of thyroid tumors. Correct diagnosis was obtained in 10 of the 11 cases with FNA biopsy. Thyroid metastases were detected in all of the cases with US and MRI and six of the seven cases with CT. Thyroid metastases were solitary (n = 5) or multiple (n = 6), and about half of them measured <2 cm in diameter. These tumors typically had well defined margins and no calcification and sometimes had cystic portions. Multiple nodules within the same patient were radiologically quite similar to each other. On US, metastases appeared as hypoechoic or markedly hypoechoic areas without halo, on CT as low density areas, and on MRI as areas of varying signal intensities. Half of the metastases showed hypointensity on either T2-weighted images or gadolinium-enhanced T1-weighted images. The tumors involved lymph nodes in 10 cases and other remote organs in 5. Level I or II or parotid nodes were involved in six cases. CONCLUSION: These radiologic features may alert clinicians to a possibility of metastatic thyroid cancer. US combined with US-guided FNA biopsy is suitable for early diagnosis of metastases to the thyroid gland.     

髓母细胞瘤骨转移的MRI诊断及临床治疗

目的：探讨髓母细胞瘤骨转移的MRI诊断及临床治疗。方法：回顾性分析髓母细胞瘤术后骨转移病例4例,分别行脊柱、髋关节或股骨MRI扫描,根据MRI检查结果运用常规分割法放射治疗。结果：4例中脊柱转移2例,髂骨及股骨颈转移1例,股骨下段转移1例,均表现为骨质内块状T1WI低信号、T2WI高信号影;经局部放射治疗疼痛症状均得到明显缓解。结论：髓母细胞瘤可以发生骨转移,MRI检查能够明确转移的范围和数目,其主要治疗手段是局部放射治疗。     

骨转移瘤漏误诊的影像学分析

目的借鉴漏误诊病例的经验教训,提高对本病的影像诊断水平。方法回顾性分析18例经手术病理证实的影像漏误诊骨转移瘤。结果骨转移瘤病例以多发,溶骨为主。影像检查漏误诊分别为：X线8例,CT2例。结论X线、CT是检查骨转移瘤重要手段,但有一定限度,条件许可时应尽早做MRI检查,并做必要的鉴别诊断。     

子痫性脑病的影像学诊断

目的:探讨子痫性脑病的影像学表现。方法:回顾性分析9例子痫性脑病患者的临床和影像学表现。9例行MRI检查,6例行CT,且都行CT或MRI复查。结果:3例CT显示双侧额叶、顶叶及枕叶皮层及白质内对称性斑片状低密度影,3例未见异常。9例MRI显示病灶呈双侧对称性分布,多数病灶位于旁正中矢状位、顶枕叶脑实质内;病灶T1WI呈等或低信号,T2WI呈高信号;早期多无明显占位效应,严重者表现为脑室、脑池受压、变小或闭塞;增强扫描多数病灶无明显异常强化;经对症处理后复查示所有病变几乎完全吸收消失,临床症状也在2周~3月内部分改善或痊愈。结论:子痫性脑病有特征性影像学表现。正确认识子痫性脑病对早期诊断和治疗具有非常重要的意义。