Echography in tuberculosis of the full abdominal viscera

109 cases of abdominal tuberculosis are reported and sonographic data are described in 25 cases with renal lesions, 30 cases with ganglionic lesions, 8 cases with hepatic lesions and 6 cases with splenic lesions. The lesions are not specific.     

Percutaneous vertebral biopsy through intact bone: a coaxial bone transgressing technique with 18 gauge needle

Advancement of radiologic technologies allows the detection of vertebral lesions at an earlier stage, thereby increasing the proportion of vertebral lesions that are surrounded by intact bone when they are detected. While biopsy guns are effective in obtaining good-quality tissue samples of osteolytic bone lesions, lesions that are covered by intact bone are not accessible with a biopsy gun. For percutaneous biopsy of osteolytic vertebral lesions, an intact-bone transgressing technique is described in which a simple, inexpensive and small-calibre (18-gauge) instrument is used to allow multiple passage of 20-gauge biopsy guns for effective tissue sampling. In this series consisting of metastatic and myeloproliferative lesions, the effectiveness and safety of this well-tolerated technique are demonstrated in thoracic and lumbar vertebrae.     

Prebiopsy localization of nonpalpable breast lesions

Invasive localization procedures are indicated preoperatively when breast lesions are nonpalpable. Several techniques are available for locating such lesions. In experience with 343 nonpalpable lesions, 27% of the biopsied lesions were malignant. Calcification was present in 51% of all lesions. A combination needle-hooked wire technique was used. Some problems were encountered, the most frequent being vasovagal reactions. The most serious problem was the failure to remove the located lesion in nine cases.     

Percutaneous biopsy of thoracic lesions: value of sonography for needle guidance

Fluoroscopy and CT are widely used to guide percutaneous needle biopsy of thoracic lesions. However, some lesions are not sufficiently visible on fluoroscopy and others are dangerous to access on CT without real-time monitoring. When these are the circumstances, sonographic guidance may be helpful. Real-time sonography was used to guide percutaneous needle biopsy in 124 patients with thoracic lesions. The indications for sonographic guidance included pulmonary, pleural, or mediastinal lesions in contact with the chest wall, including lesions near the heart or great vessels (n = 12); lesions in the apical region (n = 5); lesions in a juxtadiaphragmatic location (n = 6); small lung nodules adjacent to the chest wall (n = 16); and peripheral tumors with adjacent pleural effusion (n = 4). A diagnosis was made in 74 (90%) of 82 malignant lesions and in 24 (67%) of 36 benign lesions. Complications included pneumothorax (n = 5), hemoptysis (n = 1), and hemothorax (n = 1). The advantages of sonographic guidance are that the sonographic equipment is mobile and real-time monitoring makes the procedure safer. Its limitations are that it cannot be used when aerated lung or free air (pneumothorax) lies between the chest wall and the lesion and that cavitary lesions are difficult to sample by biopsy. Our results show that the use of sonographic guidance considerably expands the number of thoracic lesions amenable to percutaneous biopsy.     

Osteoid osteoma and osteoblastoma of the talus

Forty patients with osteoid osteoma or osteoblastoma of the talus are presented. Clinical and radiographic findings, histologic features, and therapy of these lesions are discussed. The body of the talus was involved in two patients, all other lesions being located in the neck of the bone. Subperiosteal lesions accounted for 75% of cases, and medullary lesions for 25%. Thirty of the 40 lesions were paraarticular. Five radiographic appearances in the talus are discussed: subperiosteal target lesions of the neck (54%); medullary lesions of the neck (20%); subperiosteal radiolucent lesions of the neck (13%); medullary lesions of the body (5%); and exostotic osteoid osteoma of the talar neck (3%).Supported by Grant No. 85.02793.44, Special Project Oncology, Italian National Council of Researchers     

Computed tomography of the intervertebral foramen

Summary 52 cases with pathologic lesions in the intervertebral foramen, studied with CT, are analyzed. The most frequent lesions are intraforaminal disc herniations. These are characterized by their hyperdensity in comparison to the dural sac (34 of 34 cases) and their broad contact with the intervertebral disc space (31 of 34 cases). Foraminal size and contour are usually normal. In contradistinction to disc herniations, benign tumors often show bone erosion of the pressure-type with enlargement of the foramen. Bone infiltration was seen only in malignant lesions and in the single case of Echinococcosis. Preoperative diagnosis of vascular lesions which present with foraminal enlargement is most important for the choice of the appropriate operative approach. Correct CT diagnosis of such vascular lesions is only possible with dynamic CT.     

脑实质内海绵状血管瘤的影像学诊断

目的：探讨脑实质内海绵状血管瘤(CA)的CT、MRI、MRA认和DSA表现并比较四种影像学检查方法的诊断价值。方法：回顾性分析20例CA的影像学表现，其中15例经手术病理证实，5例经影像学及临床随访证实。20例进行CT和MRI平扫、MRA认，13例行CT增强扫描，15例行MRI增强扫描，12例行DSA检查。结果：CA可发生于脑内任何部位．以单发多见(17／20，占85％)。20例CA检出25个病灶。CT和MRI平扫均发现所有病灶。CA的CT平扫均表现为高密度或稍高密度；13例CT增强扫描发现15个病灶，其中10个病灶无强化，5个病灶轻度强化。CA的MRI平扫表现为T1WI呈等或低信号12个，高信号8个，混杂信号5个；T2WI全部病灶均表现为高低混杂信号，23个病灶周围伴有低信号环，2个病灶周围有水肿带，无占位效应；15例MRI增强扫描发现17个病灶，其中7个病灶出现瘤体血管床轻中度强化，2个病灶边缘强化，8个病灶无强化。20例CA行3D TOF MRA认均未见异常血管影。12例行全脑DSA检查未见供血动脉与引流静脉。4例表现为毛细血管期或静脉窦期富血管性病变。结论：CA具有较典型的影像学表现．CT和MRI平扫对明确诊断具有重要意义，且MRI优于CT；CA的CT和MRI增强扫描无特征性表现；MRA和DSA对诊断CA价值有限。     

女性盆腔囊实性病变的CT诊断

目的:探讨女性盆腔囊实性病变的CT特征,为鉴别诊断提供依据。方法:回顾性分析有完整的CT、临床及病理资料的女性盆腔囊实性病变116例。结果:病变直接来源于妇科器官(子宫及附件)108例,妇科器官外的8例。其中良性74例,恶性42例。囊实性病变CT平扫表现为高低不一的混杂密度,增强后实性部分强化明显,囊性部分无强化。结论:CT对女性盆腔囊实性病变的定位准确率高,密切结合临床病史对定性诊断亦具有重要价值。     

联合MRI常规与弥散成像判断多发性硬化斑块的病理基础

目的：研究MRI常规与弥散成像（DWI，DTI）联合应用，在判定多发性硬化斑块病理基础中的价值。材料和方法：对14例脑部多发性硬化病例进行联合MRI常规及弥散加权（DWI）、弥散张量成像（DTI）。其中1例为继发进展型（SP型），13例为好转－复发型（RR型）。首次发作期（急性斑块）成像者5例，缓解期（慢性斑块）成像者9例。分析常规MRI T1WI、T2WI及DWI、DTI成像后所获得的ADC图、FA图上的信号改变，量化分析DTI成像中的平均D值及各向异性指数AI值。结果：急性与慢性MS斑块MRI表现明显不同。急性MS斑块较大，斑块内信号不均匀，大致可以分为两部分：中心为数毫米至2cm不等的圆形或卵圆形异常信号影，呈T1WI低、T2WI高信号，推测病理为脱髓鞘或轴索丢失。周围为片状不规则形T1WI略低、T2WI略高信号影，考虑为水肿。发作MS斑块DWI可呈现高信号，e指数ADC图亦可呈现高信号，但范围后者明显小于前者。斑块中心平均D值升高、AI值明显下降，周围ADC值亦升高，但不如前者明显，AI值无明显改变，支持常规MRI关于斑块病理的推测。慢性MS斑块较小，多呈小片状或宽条状分布于侧脑室旁，T1WI呈略低信号、T2WI高信号。DWI呈近等信号、e指数ADC图呈等或略低信号。斑块平均D值不同程度升高，AI值下降，提示为脱髓鞘或轴索丢失，而无水肿存在。结论：联合MRI常规与弥散成像可以判断多发性硬化斑块的病理，从而进一步加深了对MS斑块病理的认识。     

Ultrasonography of intra-abdominal cystic lesions in the newborn

Intra-abdominal cystic lesions are increasingly recognized in the newborn because of the advent of routine antenatal ultrasonography. As these lesions are often asymptomatic or non-specific in clinical presentation in the newborn, imaging by ultrasonography has an important role in diagnosis. We present a pictorial review of the commonly encountered intra-abdominal cystic lesions in the newborn, with emphasis on ultrasonographic features that can aid differentiation between the various lesions.     

膝骨关节炎软骨下骨髓水肿样及囊样病变与软骨病损的相关性研究

目的:探讨膝骨关节炎软骨下骨髓水肿样及囊样病变与关节软骨缺失的关系。方法:683例膝关节骨关节炎患者纳入研究,其中126例135个膝关节进行了随访,随访期限为12~30个月。采用半定量积分系统WORMS分析膝关节骨髓水肿样和囊样病变的分布及邻近关节软骨状况。以骨髓病变稳定组作为参照,采用逻辑回归分析同一分区软骨下骨髓病损与软骨缺损之间的关系。结果:不伴有明显关节软骨病损的各分区其软骨下骨质病变发生率有明显差异,以胫骨中部分区较高。随访对照研究显示骨髓病变与软骨病损具有明显相关性,新发骨髓病灶相较稳定病灶的局部关节软骨病损的风险更为明显(OR=3.9),基期及随访期未见骨髓病变的病例组软骨病损风险远小于病灶稳定不变组(OR=0.1)。结论:膝关节承重部位相对易于发生软骨下骨髓病损,软骨下骨髓水肿样病变及囊样变与同一区域软骨病损明显相关。     

Evolution of CT findings in hepatic hematoma

This report evaluates the CT findings of posttraumatic, intrahepatic lesions in 10 patients. The change in appearance of the lesions on follow-up examinations, in the absence of surgical intervention, is described. Similar lesions were produced in dogs and are compared with the human lesions and with hematomas in nonhepatic tissue.     

Cysts and cystic lesions of the mandible: clinical and radiologic-histopathologic review.

Many lesions that occur in the mandible have a cystlike radiographic appearance. These lesions are often difficult to differentiate on the basis of their radiographic features alone. Mandibular lesions may be odontogenic or nonodontogenic. Among odontogenic lesions without mineralization, ameloblastomas, odontogenic keratocysts, and dentigerous cysts can all appear as well-defined, unilocular, well-corticated, lucent lesions that are often associated with the crowns of impacted or unerupted teeth. Most radicular cysts appear as round or pear-shaped, unilocular, lucent lesions in the periapical region. Among odontogenic lesions with mineralization, complex odontomas contain multiple masses of dental tissue and compound odontomas contain multiple teeth or toothlike structures. Odontogenic myxomas are characterized by lytic osseous changes of varying size, which may be demarcated and expansile or exhibit ill-defined borders. Nonodontogenic lesions that mimic odontogenic lesions include benign fibro-osseous lesions (conventional or juvenile ossifying fibroma, focal or periapical cemento-osseous dysplasia, florid osseous dysplasia), traumatic bone cyst, lingual salivary gland inclusion defect, central giant cell granuloma, brown tumor of hyperparathyroidism, arteriovenous malformation, and mucoepidermoid carcinoma. The clinical and radiographic features of these mandibular lesions help establish a differential diagnosis, although microscopic tissue evaluation is generally necessary to accurately identify the lesion.     

X-ray computed tomography in the surveillance of the course of acute pancreatitis. Values of a new classification of inflammatory lesions]

378 tomodensitometric investigations were performed in cases of acute pancreatitis. The evolution of inflammatory lesions were analyzed with special attention to tissue aggressive inflammation in order to recognize early signs of gravity on CAT scans. Pancreatic lesions less than 15 mm in diameter called "hypodense islets-1" are compatible with oedematous lesions while lesions greater than 15 mm in diameter ("hypodense islets-2") are characteristic of developing necrosis. Tissue aggressive inflammatory lesions were classified in five grades retrospectively and showed that the incidence of abcesses was greater in grade II (76.5%) than in grade I lesions (11.75%).     

Common and less-common renal masses and masslike conditions

As an increasing number of imaging examinations are performed, a greater number of incidental renal lesions are detected. Apart from the usual cysts and solid renal cell carcinomas, a variety of unusual benign and malignant renal lesions exist. Imaging is invaluable in characterizing these lesions and is confirmatory in some benign lesions. Renal cell carcinoma remains the diagnosis of exclusion; however, assessment of the imaging pattern in the appropriate clinical context can improve diagnostic accuracy. The objective of this article is to familiarize the radiologist with the imaging appearance of unusual non-neoplastic and neoplastic lesions and correlate with histopathologic studies when available.     

Bleeding scrotal vascular lesions: interventional management with transcatheter embolization

Vascular lesions of the scrotum are uncommon; the most common among them are varicocele lesions. The other vascular lesions that may involve the scrotum are hemangioma, lymphangioma, and arteriovenous malformations, which are exceedingly rare. The imaging modalities useful in the diagnosis and management of scrotal vascular lesions are grayscale sonography, color Doppler sonography, magnetic resonance imaging, magnetic resonance angiography, and digital subtraction angiography. We present two cases of scrotal vascular lesions involving the extratesticular scrotal soft tissues. Patients presented with bleeding and were treated by radiological interventional technique. We emphasize the importance of superselective catheterization and distal embolization.     

MRI of sarcoidosis patients with musculoskeletal symptoms

OBJECTIVE: Our objective was to determine MRI findings in sarcoidosis patients with musculoskeletal symptoms. CONCLUSION: In sarcoidosis patients with musculoskeletal complaints, MRI reveals marrow and soft-tissue lesions that are occult or underestimated on radiographs. Axial and large-bone lesions may resemble osseous metastases on MRI. Most lesions detected are nonspecific in appearance, except nodular muscle lesions. MRI reveals features suggesting the diagnosis, but with standard protocols, no pathognomonic MRI features were determined.     

Improved identification of intracortical lesions in multiple sclerosis with phase-sensitive inversion recovery in combination with fast double inversion recovery MR imaging

BACKGROUND AND PURPOSE: Accurate detection and classification of purely intracortical lesions in multiple sclerosis (MS) are important in understanding their role in disease progression and impact on the clinical manifestations of the disease. However, detection of these lesions with conventional MR imaging remains a challenge. Although double inversion recovery (DIR) has been shown to improve the sensitivity of the detection of cortical lesions, this sequence has low signal-to-noise ratio (SNR), poor delineation of lesion borders, and is prone to image artifacts. We demonstrate that intracortical lesions can be identified and classified with greater confidence by the combination of DIR with phase-sensitive inversion recovery (PSIR) images. MATERIALS AND METHODS: A total of 16 subjects with MS were included in this study. DIR, PSIR, and fluid-attenuated inversion recovery (FLAIR) images were acquired and inspected by 3 experts, with identification of lesions by consensus. PSIR and DIR images were jointly used to classify lesions as purely intracortical, mixed gray-white matter, and juxtacortical. The difference in the number of lesions detected in each category was compared between combined PSIR and DIR and conventional FLAIR. RESULTS: PSIR consistently allowed a clearer classification and delineation of lesions. Combined PSIR and DIR images showed a 337% improvement in the total number of lesions detected compared with FLAIR alone. Detection of intracortical lesions was improved by 417% compared with FLAIR. Detection of mixed gray-white matter and juxtacortical lesions was improved by 396% and 130%, respectively, compared with FLAIR. CONCLUSION: Reliable detection and classification of intracortical lesions in MS are greatly improved by combined use of PSIR and DIR.     

Extramedullary intradural spinal tumors: a pictorial review

Defining the location of tumors and mass lesions of the spine in relation to the spinal cord and the dura is of the utmost importance as certain types of lesions tend to occur in certain locations. The differential diagnostic considerations will vary according to location of the mass lesion as will the treatment and prognosis of these various lesions. The category of extramedullary intradural masses includes a variety of lesions from meningiomas and nerve sheath tumors (neurofibromas, schwannomas) to less common tumors (hemangiopericytoma), metastases, benign tumors (lipoma, dermoid, epidermoid), inflammatory disorders (arachnoid adhesions, sarcoidosis), vascular lesions (spinal-dural arteriovenous fistula), and cystic lesions (perineural or Tarlov cysts). Characteristic magnetic resonance imaging findings are helpful for localization and characterization of these lesions before treatment, as well as for follow-up after treatment. We present a pictorial review of the various extramedullary intradural lesions of the spine, with pathologic correlation. We discuss imaging features that are typical for the various entities and describe various therapeutic options that are important considerations for surgical treatment of these lesions.     

Cystic angiomatosis of bone with sclerotic changes mimicking osteoblastic metastases

Five unusual cases of cystic angiomatosis of bone which presented with the radiologic appearance of osteoblastic lesions are reported. Three patients were female (ages 37, 41, and 65 years) and two were male (ages 24 and 66 years). Although cystic angiomatosis of bone usually produces widespread osteolytic lesions with a honeycombed appearance in the skeletal system, multiple osteoblastic lesions mimicking metastatic osteoblastic carcinoma are sometimes seen. This radiological presentation has not been well emphasized in previous reports. Histologically, in addition to the angiomatous lesions, both mature thickened lamellar bone trabeculae and immature trabeculae of woven bone were found. In one of our patients, increasing density of the osteoblastic lesions was noted over time. One previous study has suggested that the age of the lesions of cystic angiomatosis is related to radiographic density. It is important to recognize this uncommon variant of cystic angiomatosis and to include this entity among the radiologic differential diagnoses when multiple osteoblastic lesions are encountered.