Longitudinal tibial epiphyseal bracket in Nievergelt syndrome

A patient is described with lower extremity mesomelic dwarfism associated with bilateral congenital elbow, hip, and knee dislocations. Rhomboid-shaped tibiae and delayed ossification of the primary fibular ossification centers were demonstrated at birth. Plain films and magnetic resonance imaging revealed that the tibial deformities were due to the presence of longitudinal epiphyseal brackets. These brackets were observed at surgery and confirmed histologically. Recognition of the longitudinal epiphyseal bracket and its relationship to the tibial deformities seen in this patient with Nievergelt syndrome is important for planning surgical treatment.     

Benign clavicular lesions that may mimic malignancy

Nontraumatic lesions of the clavicle are infrequent. Of these, malignant tumors are more common than benign lesions. From January 1988 to January 1990, we examined 17 patients with benign lesions of the clavicle; in 8, the morphologic appearance of the lesion raised the possibility of malignancy in the differential diagnosis. The radiologic findings in these patients are presented. We propose that the unique shape and embryologic development of the clavicle may contribute to the atypical, aggressive presentation of some benign lesions in that bone.     

儿童腹部脏器外囊性病变的的CT诊断

目的:探讨CT对儿童腹部脏器外囊性病变的诊断价值。方法:回顾性分析35例经手术病理证实的儿童腹部脏器外囊性病变的CT表现。结果:淋巴管瘤11例,其中肠系膜淋巴管瘤7例,腹膜后淋巴管瘤4例,肿块形态不规则,囊壁菲薄,张力低,边缘清楚,其中8例可见线条状分隔,8例行增强扫描均未见强化。肠系膜囊肿8例,均为先天性肠系膜囊肿,形态较规则,边缘清晰锐利,囊壁薄而均匀,6例为单房,2例为多房,2例囊壁呈线状强化,6例囊壁无强化。大网膜囊肿4例,长径均大于6cm,病灶位于腹腔前方,紧贴前腹壁,形态不规则。肠重复畸形6例,均与肠管关系密切,4例呈管状,2例呈类圆形,4例囊壁可见强化。囊性畸胎瘤4例,3例位于腹膜后,1例位于骶尾部,2例囊壁可见线条状钙化。腹部脓肿2例,呈不规则液性密度区,囊壁较厚且厚薄不均,增强时明显强化。结论:CT对腹部脏器外囊性病变的形态特征、大小范围及与周围组织结构的关系显示清晰,能对大多数病变作出准确诊断。     

Benign bone-forming lesions: osteoma,osteoid osteoma,and osteoblastoma

The benign bone lesions — osteoma, osteoid osteoma, and osteoblastoma — are characterized as bone-forming because tumor cells produce osteoid or mature bone. Osteoma is a slow-growing lesion most commonly seen in the paranasal sinuses and in the calvaria. When it occurs in the long bones, it is invariably juxtacortical and may need to be differentiated from, among others, parosteal osteosarcoma, sessile osteochondroma, and a matured juxtacortical focus of myositis ossificans. Osteoid osteoma and osteoblastoma appear histologically very similar. Their clinical presentations and distribution in the skeleton, however, are distinct: osteoid osteoma is usually accompanied by nocturnal pain promptly relieved by salicylates; osteoblastoma arises predominantly in the axial skeleton, spinal lesions constituting one-third of reported cases. This review focuses on the application of the various imaging modalities in the diagnosis, differential diagnosis, and evaluation of these lesions. Their histopathology also is discussed, and their treatment briefly outlined.     

Percutaneous biopsy of thoracic lesions in children

Over the last 6 years, 15 percutaneous thoracic biopsies have been performed in 15 children. The peripheral nature of most of the lesions allowed ultrasound guidance in ten and needles larger than 21 gauge in ten. No pneumothorax developed. Of the 15, 12 biopsies were sufficient for final diagnosis; 3 required surgical biopsy for more definitive tissue typing.     

小脑占位性病变的MRI诊断

目的评价MRI对小脑占位性病变的诊断能力。方法经手术病理证实资料完整的小脑占位性病变26例，恶性肿瘤11例，良性占位性病变15例，均经MRI平扫与增强扫描检查。结果本组中MRI正确诊断良性病变12例，恶性病变9例，定位准确率96．1％，敏感性为81．8％，特异性80％，准确性80．8％，阳性预测值75％，阴性预测值85．7％。结论MRI对该区占位性病变的诊断和鉴别诊断有重要价值。     

彩超在喉部良性占位性病变诊断中的应用价值

目的:评价彩超对喉良性占位性病变的诊断价值。方法:对59例喉良性病变住院病人术前行彩色超声检查并与喉内镜及手术、病理对照。结果:彩超对声带息肉的检出率为100%,能较清晰显示喉部良性病变的大小、部位、内部回声及血流情况、病变范围及其与声带边缘的关系。结论:彩超对喉部良性病变有较高的诊断符合率,特别是对难以配合的儿童患者及其他常规检查难以配合的患者则是最佳检查方法,对临床选择喉显微手术方式具有指导意义。但是要求操作者必须手法娴熟且熟悉喉部解剖。     

磁共振质子波谱分析鉴别乳腺良恶性病变的应用研究

目的 研究磁共振波普分析在鉴别乳腺良、恶性病变的临床价值.方法 对50例2010年5月～2011年5月期间经我院检查怀疑为乳腺病变患者,并对其进行磁共振质子波谱检查.结果 50例患者中共有58个病灶通过病理得到了证实,其中恶性病灶占60.3％,良性病灶占39.7％;39个病灶在3.22～3.28ppm时出现了胆碱峰,19个病灶未出现胆碱峰,对乳腺良、恶性病变诊断中出现胆碱峰的情况经统计学分析均具有显著差异性(P＜0.01).结论 磁共振波普检查在鉴别乳腺良、恶性病变中有着肯定的应用价值.     

18F-FDG PET/CT对腹膜良恶性病变的鉴别诊断价值

目的 分析腹膜病变的18F-FDG PET/CT的代谢和形态特点,探讨18F-FDG PET/CT在腹膜良恶性病变鉴别诊断中的价值。方法 回顾性分析经18F-FDG PET/CT检查腹膜有病变的病人70例,男22例,女48例,平均年龄(58.20±13.18)岁。根据病理结果将病人分为恶性组(61例)和良性组(9例)。记录腹膜病变最大标准化摄取值(SUV_max),FDG代谢分布特征、大网膜挛缩、病灶大小及边界,测量腹水CT值、SUV_max及腹腔积液SUVmax/肝脏SUV_max的比值(即T/NT值)。2组间非正态分布的计量资料采用Mann-Whitney U检验进行比较,采用连续校正卡方检验或Fisher确切概率检验对计数资料进行差异性分析。结果 与良性组相比,恶性组大网膜更易出现挛缩,呈不规则状及条状改变(P<0.05),且大网膜及肠系膜FDG代谢摄取多呈局限性改变(均P<0.05);肿块样病变(>3 cm)只在恶性组中出现,大网膜、小网膜、肠系膜、盆腔腹膜的病灶中大结节(>5 mm)病变占比更...     

3.0T磁共振成像在甲状腺良恶性病变鉴别诊断中的价值研究

目的 探讨磁共振成像在甲状腺良恶性病变鉴别中的应用价值.方法 研究对象为2010年8月～2011年8月我院收治的甲状腺病变48例患者、54个病灶,经Philips 3.0T磁共振成像,比较分析T1WI、T2 WI、DWI(b值为150、300和500s/mm2)及动态增强中良性病灶及恶性病灶的MRI表现,并与病理对照.结果 T1 WI像良性病变呈等及略高信号,恶性病变为不均匀略高信号;T2 WI像良恶性病变均为略高信号,无统计学差异(P＞0.05);DWI成像(良性病变:b值为150时ADC值为2.489±0.442、b值为300时ADC值为1.974±0.369、b值为500时ADC值为1.649±0.445;恶性病变:b值为150时ADC值为1.733±0.326、b值为300时ADC值为1.399士0.258、b值为500时ADC值为1.214±0.302),具有统计学差异(P＜0.05).T1WI动态增强良性病变呈流出型强化曲线,恶性病变呈延迟性消退型曲线,具有一定特征性.结论 磁共振成像对甲状腺良恶性病变鉴别应用价值高,尤其是ADC值对良恶性病灶的鉴别意义较大.     

Peroxidase activity in traumatic skin lesions

Summary Peroxidase activity was determined in experimental compression-excoriation lesions and incision wounds of rat skin after different periods of vital time. The peroxidase enzyme was extracted from the tissues by homogenization in 0.5% cetyltrimethylammoniumbromide, and the enzyme activity was measured from the supernatant by o-dianisidine-H₂O₂ assay. In the blood of the rats a mean activity of approx. 5.26±1.11 U/g dry weight was observed. In the control specimens of the skin the activity was very low and generally below the detection limit of the methods used. In 30-min-old compression-excoriation lesions the mean peroxidase activity was 0.38±0.21 U/g dry weight. In lesions older than 30 min the activity started to increase rapidly. In 4-h-old compression-excoriation lesions it was 10 times higher than the 30-min level and was 40 times higher in 12-h-old lesions and 70–100 times higher in 1–3-day-old compression-excoriation lesions, respectively. In 30-min-old incision wounds the mean peroxidase activity was 0.65±0.37 U/g dry weight. The increase of the activity compared with the 30-min level was even faster in the incision wounds: in 4-h-old wounds the mean activity was 50 times higher, in 12-h-old wounds 200 times higher and in those of 1–5 days it was several hundreds of times higher. Compression-excoriation lesions made after death showed activity similar to the control specimens. Postmortem autolysis at +22°C resulted in a loss of the enzyme activity in 1-day-old compression-excoriation lesions so that after 3 days approx. 80% remained, and after 5 and 7 days approx. 40% was present. After 3 days of autolysis at +4°C, nearly 100% of the activity remained and approx. 90% was present after 5 and 7 days of autolysis. Increased peroxidase activity was also detectable in human vital excoriations in the specimens which were taken in autopsies several days postmortem.     

Diagnostic value of apparent diffusion coefficient to differentiate benign from malignant vertebral bone marrow lesions

Background

Vertebral collapse is a common problem due to benign bone marrow lesions, trauma or malignant process. The diagnosis is often correctly predicted from characteristic imaging appearance. Some vertebral collapses have atypical imaging appearance that may cause diagnostic confusion.

Aim

To evaluate the value of the ADC obtained in DW-MR sequences for the differentiation between benign and malignant bone marrow lesions.

Patients

Sixty patients were included in this study, referred from Neurosurgery and Radiotherapy Departments and proved to have vertebral compression based on conventional MR imaging.

Results

The ADC value resulted in statistically significant characterization between (osteoporotic and post-traumatic collapse) and (malignant vertebral collapse) (P < 0.0001) while there was no statistically significant findings between infective spondylodiscitis and malignant vertebral collapse (P > 0.05). The sensitivity, specificity, PPV, NPD of DWI and ADC values in differentiating benign from malignant vertebral collapse were 100%, 83.3%, 60% and 100% respectively.

Conclusions

ADC values are a useful complementary MRI tool to characterize bone marrow lesions, in order to distinguish acute benign fractures from malignant or infectious bone marrow lesions. However, ADC values are not valuable in order to differentiate malignancy from infection with diagnostic overlap in the subacute traumatic vertebral collapse.     

Benign communicating hydrocephalus in children

Summary A review was performed of the computed tomograms (CTs) of 500 children which had been reported as showing widening of the supratentorial subarachnoid spaces with normal cerebral substance. On the basis of this a radiological diagnosis of cerebral atrophy had been made in all but five, who were said to have megalencephaly. From these, the children with large or abnormally enlarging heads, but normal or only slightly enlarged ventricles, were selected; there were 40 such cases (8%). The clinical condition either improved or remained stable over a period of 2 years; in the majority the scan abnormality regressed (22.5%) or remained static (67.5%). In three cases there was slight progression of the CT changes before stabilisation, but only one case developed classical communicating hydrocephalus necessitating a shunt procedure. This condition is a generally benign and mild form of communicating hydrocephalus, for which an aetiological factor was apparent in about two-thirds of the cases studied.     

Bilateral reversible thalamic lesions on computed tomography

Summary Bilateral approximately symmetrical hypodense areas located in the thalamus were encountered in two patients who recovered clinically. Regression of the lesions could be observed on CT. The clinical symptoms corresponded to the thalamic location. Since these two patients recovered, no autopsy material is available to prove the nature of the causative lesion, although the etiology is most probably inflammatory.     

Polyostotic fibrous dysplasia (McCune-Albright) with rare multiple epiphyseal lesions in association with aneurysmal bone cyst and pathologic fracture

Fibrous dysplasia, including McCune-Albright syndrome, is a genetic, non-inheritable benign bone disorder that may involve a single or multiple bone, typically occurring in the diaphysis or the metaphysis of long bones. In very rare instances polyostotic fibrous dysplasia present involvement of the epiphysis in long bones. Aneurysmal bone cysts are benign, expansile, lytic bone lesions formed by cystic cavities containing blood, that may occur de novo or secondary to other lesions of bone, including fibrous dysplasia. We report a case of an 18-year-old female with polyostotic fibrous dysplasia (McCune-Albright syndrome) with diaphyseal and unusual multiple foci of epiphyseal involvement of long bones as well as in the patella, and a simultaneous aneurysmal bone cyst of the left femoral neck with pathologic fracture. This is the first report of a simultaneous aneurysmal bone cyst in a patient with polyostotic fibrous dysplasia (McCune-Albright syndrome) with involvement of diaphysis and epiphysis of long bones, highlighting that fibrous dysplasia should be included in the differential diagnosis of polyostotic tumors involving the diaphysis as well as the epiphysis. In patients with polyostotic fibrous dysplasia there should be an active search for lesions in the epiphysis.     

肾脏孤立性纤维瘤的CT特征

目的 探讨肾脏孤立性纤维瘤(SFT)的CT特征.方法 回顾性分析经手术病理证实的6例肾脏SFI的临床、CT影像表现.结果 6例均为单发肿块,呈类圆形或椭圆形,长径3.2～12.4 cm.6例三期增强扫描,5例肿瘤密度均低于周围正常肾皮质,1例前两期强化后等于或高于肾皮质,最高强化在排泄期或实质期各3例.4例三期强化密度均匀,3例皮质期、实质期及排泄期分别呈轻、中、重度强化,呈“渐进持续”型强化;1例呈“快进快退”型强化,表现皮质期显著强化,实质期强化密度迅速增高,排泄期强化骤降.2例不均匀强化,呈“慢进慢出”型强化,表现为皮质期至实质期强化缓慢增高,排泄期缓慢下降,低密度囊变区始终未见强化.5例动脉期肿块内见点、条状小血管影.4例密度及强化均匀者病理为良性,2例密度及强化不均匀或多发点状钙化者病理为恶性.结论 肾SFF三期强化后肿瘤密度大多数低于周围正常肾皮质,最高强化在排泄期或实质期,强化方式多种多样,在CT上较具有特征性,具有较高的诊断价值.     

Tumefactive demyelinating lesions

We studied 21 cases of pathologically confirmed tumefactive demyelinating lesions and reviewed the spectrum of tumefactive demyelinating lesions in the literature. Radiological features and clinical data were reviewed to characterize the lesions as consistent with a known demyelinating disease, most notably multiple sclerosis. Atypical clinical or radiological features (other than tumefaction) were noted. Most lesions were part of a clinical and/or radiological picture consistent with multiple sclerosis. No case strongly suggestive of variants or related diseases, such as Schilder's disease or Balo's concentric sclerosis, were found. There was one case suggestive of acute disseminated encephalomyelitis. Features which help distinguish the lesions from tumour are discussed.     

Bone involvement pattern in hypervascular lesions

The pattern of the focal bone lesion which consists partly or wholly of rounded holes with comparatively smooth edges is discussed.Twenty-two bone lesions were studied by angiography. The hypervascular pattern occurred in five cases of widely different histology, all with strong intraosseous hypervascularity. Different pathogenic mechanisms in the creation of this pattern are discussed. It is probably the result of both destructive and reparative processes in the bone.     

多层螺旋CT多平面重组对孤立性肺结节征象检出的价值

目的:比较多层螺旋CT多平面重组(MPR)对孤立性肺结节(SPNs)征象的显示,探讨各种征象对SPNs良恶性的诊断价值.方法:搜集51例进行多层螺旋CT扫描的SPNs (直径≤4 cm)及其完整的临床病理资料.对SPNs的征象(深分叶征、棘状突起征、胸膜凹陷征、胸膜切迹征、阳性支气管征、空泡征、毛刺征)行MPR,评价MPR对SPNs的前5种征象的显示.计算7种征象在恶性结节组检出率及出现频率.结果:MPR检出5种征象的数目明显多于轴面扫描所检出的数目,检出具有5种征象的结节数目明显多于轴面扫描检出该征象的结节数目,差异具有显著性意义(P＜0.05).在恶性结节中出现频率由多到少的征象依次为深分叶征、阳性支气管征、胸膜凹陷征、棘状突起征、胸膜切迹征、毛刺征、空泡征.7种征象在良、恶性结节组的检出百分比中最能提示恶性的征象依次为胸膜切迹征、深分叶征、胸膜凹陷征、毛刺征、阳性支气管征、棘状突起征、空泡征.结论:应用多层螺旋CT薄层扫描,对SPNs行MPR,能明显提高SPNs的征象检出率,获得更多有价值的诊断信息,深分叶征、胸膜切迹征是最有诊断价值的恶性征象.     

胸膜孤立性纤维性肿瘤的CT表现

目的:探讨胸膜孤立性纤维性肿瘤的CT表现.方法:回顾性分析经病理证实的6例胸膜孤立性纤维性肿瘤的CT表现,其中手术切除3例,穿刺活检3例.结果:5例表现为胸膜下结节或肿块,密度均匀、边界清楚,肿块可有分叶,相邻肋骨可受侵,增强扫描示肿块均匀强化;1例占据一侧胸腔,其内可见斑点状坏死和钙化,增强扫描呈明显不均匀强化,并可见明显强化的曲线状血管影.结论:孤立性纤维性肿瘤的CT表现有一定特征性,可与其它胸膜和肺肿瘤相鉴别.