骨原发性淋巴瘤影像分析

目的 分析原发性骨淋巴瘤(PLB)及"浮冰征"的影像表现和病理基础.方法 回顾性分析经病理证实且临床资料齐全的41例PLB患者的临床与影像特征.41例全部行X线检查,20例行CT检查,12例行MR检查(3例同时行增强扫描).结果 41例PLB中位于扁骨12例,脊柱8例,长骨17例,其他不规则骨4例.发病最多的部位是股骨(10例,24.4%),其次为髂骨(8例,19.5%).长骨病变位于骨干干骺处者11例.41例中无骨膜反应者37例(90.2%).CT显示骨质破坏轻微而出现软组织肿块者12例,伴有明显软组织肿块者9例,出现"浮冰征"者4例.12例MR检查结果中,10例显示软组织肿块,MRI显示病变范围全部大于CT所显示病变范围,其中1例MRI显示大范围骨质异常,但平片及CT显示骨质破坏不明显.结论 (1)骨质破坏轻而软组织肿块明显,或MRI显示骨质异常范围明显超过平片及CT所见,或MRI显示骨质异常而平片及CT显示骨质破坏较轻或未见明显骨质破坏者提示PLB.(2)"浮冰征"是PLB较为特殊的一种征象,其出现对淋巴瘤的诊断具有一定提示意义.

Abstract：

Objective To analyze the imaging features of primary lymphoma of the bone,and discuss the special feature of the "floating ice sign". Methods Forty-one cases of primary lymphoma of the bone in our unit from 1963.1-2009.6 were retrospectively studied. All 41 patients underwent X-ray examination, and 20 patients underwent CT examination, 12 patients underwent MR examination (3 cases simultaneously with enhancement).Results Involvement of the flat bone was seen in 12 cases. Vertebral column was affected in 8 cases, and 17 cases showed lesions in long bones and irregular bones were involved in 4 cases. The most common location was the femur(10, 24.4%), followed by the ilium(8, 19.5%). Lesions were found in the metaphyses of the long bone in 11 cases (64.7%). "Floating ice sign" was showed in the calcaneus of 2 patients and in the lumbar vertebra of 2 cases respectively, accounted for 9.8% of all cases. Slight bone destruction with soft tissue mass on CT image could be found in 12 cases, while obvious soft tissue mass was found in 9 cases. No periosteal reaction was found in 37 cases (90.2%). MRI examinations of 12 patients revealed soft tissue mass in 10 patients, and the extent of the lesion was larger in MR than CT. One case showed extensive bone destruction on MR but inconspicuous bone destruction on X-ray plain film and CT scan. Conclusion Slight bone destruction with conspicuous soft tissue mass, conspicuous bone destruction on MR but slight or inconspicuous bone destruction on X-ray film and CT,could strongly imply the diagnosis of primary lymphoma of the bone. "Floating ice sign" was a special imaging feature of primary lymphoma of the bone, which could be used as a clue for the diagnosis of lymphoma.     

长骨血管瘤的影像诊断

目的 分析长骨血管瘤的影像特征,旨在提高其诊断水平.方法 回顾性分析经手术病理证实的18例长骨血管瘤患者的X线平片(14例)、CT(9例)及MRI(6例).结果 18例长骨血管瘤中髓型10例、骨膜型5例、皮质内型3例.X线表现:髓型8例,其中3例表现为典型的蜂窝状,3例为溶骨性病灶周围骨质硬化明显,单纯溶骨、毛玻璃样密度各1例;骨膜型3例,表现为骨皮质增厚、硬化;皮质内型3例,表现为边界清晰的溶骨性病灶.CT表现:髓型6例,表现为溶骨膨胀型病灶5例,其中3例可见薄厚不一的硬化边,蜂窝状骨嵴影2例,骨皮质呈筛孔状1例,垂直于骨皮质的放射状骨膜增生2例;毛玻璃样密度1例.2例骨膜型表现为骨皮质均匀增厚1例,不规则骨膜增厚1例,局部髓腔狭窄消失.1例皮质内病变表现为病灶呈均匀软组织密度,局部皮质膨胀、增厚.MRI表现:2例显示髓腔内斑片状T1WI稍低信号,T2WI均呈稍高信号,边界清晰;1例T1WI及T2WI均呈等或稍低信号,病灶与正常组织分界不清;1例显示病灶突破局部骨皮质,肿物向外突出,外突肿物及相连髓腔部分T1WI呈稍低信号,T2WI呈高信号;2例显示骨膜增厚,其中1例呈等信号,1例无信号;2例周围肌肉组织内可见不均匀斑片状长T2信号,T1WI与肌肉组织呈等信号.结论 长骨血管瘤的囊性蜂窝状X线表现较为特征型;CT及MRI有助于长骨血管瘤的诊断.

Abstract：

Objective To explore the imaing features of hemangioma in the long bone and improve the diagnostic level of this disease. Methods The X-ray(14 cases), CT(9 cases) and MRI(6 cases)findings of 18 patientswith histologically proven hemangioma in the long bone after surgery were retrospectively reviewed. Results Ten tumors occurred in medullary cavity or bone end(medullary type),6 on the surface of bone (periosteal type) and 3 in cortex (intracortical type). X-ray findings: among 8 cases of medullary type, 3 showed honeycomb appearance, 3 lytic areas with sclerotic borders, one purely osteolyticchanges, and 1 frosted glass; 3 cases of periosteal type showed sclerosis and thickening of the underlying cortex; 3 cases of intracortical type showed well-defined osteolytic foci. CT findings: among 6 cases of medullary type, 5 appeared as expansile lytic lesion with uneven selerotic rim (3 cases)orhoneycomb appearance (2 cases), 1 cribriform appearance in the cortical bone, 2 periostealnew bone formation in vertical radiation pattern; 1 ground-glass appearance; among 2 cases of periosteal typeone showed regular cortical thickening, and the other irregular periosteal proliferation with marrowing of medullarycavity; 1 case of intracorticaltype showed density similar to that of soft tissue, with cortical thickening and expansion . MRI findings: 2 apeared as well-defined lesions with low signal intensity on T1WI and high signal intensity on T2WI; 1 appeared as ill-defined lesion with low to intermediate signal intensity on T1 WI and T2 WI. One showed breakthrogh of cortex and formation of soft tissue mass with low signal intensity on T1 WI and high signal on T2WI. Two showed thickening of periosteumwith intermediate signal intensity in one of them and very low signal intensity in the other. Two showed abnormal signal intensity in surrounding muscles, which was high on T2 WI and intermediate on T1 WI. Conclusions The soap-bubble or honeycomb appearance is the typical radiographic finding of hemangioma in long bone. CT and MRI can provide useful information for the diagnosis of hemangioma in long bone.     

儿童戈谢病骨骼影像特征分析

目的 探讨儿童戈谢病骨骼病变的X线平片及MRI表现特点.方法 109例戈谢病患儿均行常规脊柱正、侧位及双股骨正位X线检查,同时行骨盆止位检查18例,左腕正位检查14例;14例患儿同时行股骨MR平扫.MR扫描序列为标准T1WI、T2WI、T2压脂像冠状面及矢状而扫描.综合分析其影像特点.结果 骨骼异常X线征象包括:长骨干骺端烧瓶样畸形89例(81.7%)、骨质稀疏91例(83.5%)、长骨十骺端密度不同程度的减低86例(78.9%)、骨皮质变薄69例(63.3%)、溶骨性破坏31例(28.4%)、骨硬化12例(11.0%)、骨囊性病变16例(14.7%),病理性骨折26例(23.9%),其中椎体压缩性骨折24处、股骨颈陈旧性骨折5处、脊柱弧形后凸3例、股骨头碎裂变形4例、髋关节脱位4例.,14例股骨MRI显示,T1WI及T2WI骨髓内均可见异常信号,分别表现为T1WI、T2WI信号减低4例;在T2WI及压脂像信号广泛减低的基础上出现限局性高信号或混杂信号10例.结论 儿童戈谢病骨骼病变的影像表现有一定特征性,对临床诊治及观察疗效具有较大的帮助.

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Objective To discuss the imaging features of skeletal changes in children with Gaucher disease on X-ray and MRI images.Methods One hundred and nine children with Gaucher disease were enrolled in this study.They all received routine X-ray for spine with anterior-posterior(A-P)and lateral view and bilateral femurs with A-P view.Among them.18 patients received X-ray for pelvic with A-P view.14 patients received X-ray for left wrist with A-P view.and 14 patients received MRI scan for femur.The MRI scan included T1-weighted imaging,T2-weighted imaging and fat-suppressed T2-weighted imaging with short tau inversion recovery(STIR)sequence.The imaging features of the X-ray and MRI images were analyzed retrospectively.Results The most common feature is osteoporosis,which presented in 91 cases (83.5%).Besides this,decreased density of metaphysis occurred in 86 cases(78.9%).erlenmeyer flask deformity of metaphysis occurred in 89 patients(81.7%),thinner cortex occurred in 69 cases(63.3%),osteolytic destruction occurred in 31 cases(28.4%).pathological fractures occurred in 26 cases (23.9%),osteosclerosis occurred in 12 cases(11.0%).cystic degeneration of bone occurred in 16 cases (14.7%),and dislocation of the hip occurred in 4 cases.All 14 patients received MRI presented abnormal signals.Among them,4 patients presented low signal intensity both on T1-weighted and T2-weighted images in bone marrow;the other ten presented high signal intensity mixed in low signal intensity areas on T2-weighted and fat-suppressed T2-weighted images.Conclusions The imaging features of skeletal changes in children with Gaucher disease are of some characteristics,which could provide useful information for the clinical treatment.     

成人白血病中枢神经系统并发症的CT与MRI表现

目的 探讨成人白血病中枢神经系统并发症(CNSCL)的CT和MRI表现及其诊断价值.方法 回顾性分析18例经临床及手术病理证实的成人CNSCL的CT和MRI表现,其中急性淋巴细胞白血病7例,急性非淋巴细胞白血病10例,慢性粒单细胞白血病1例.CT平扫11例,其中增强1例;MR平扫16例,其中增强11例.结果 颅内受累14例:(1)颅内出血7例,其中脑内血肿4例,脑内血肿合并微出血1例,微出血2例.脑内血肿均为多发病灶.CT表现为团状高密度影;MRI表现为T1WI低信号或高低混杂信号,T2WI高信号或等高信号伴环状低信号环,病灶呈环形强化或无明显强化.脑微出血在磁敏感加权成像(SWI)上表现为多发斑点状及小条状低信号,其病灶检出率明显优于CT及MRI其他常规序列检查;7例中,伴脑梗死及蛛网膜下腔出血各1例.(2)颅内肿块5例:其中左额部内板下梭形病灶或跨颅板肿块2例,T1WI呈低信号,T2WI呈高低混杂信号,并有明显均匀强化,均见脑膜尾征;鞍区肿块1例,CT示鞍区高密度影,MRI示鞍区T1WI稍低信号,T2WI高信号,有不均匀强化;右侧脑室体旁肿块1例,T1WI、T2WI均呈等信号,有明显均匀强化.左额顶叶壁厚囊性肿块1例,呈环形强化.(3)梗阻性脑积水1例,表现为中脑导水管以上脑室系统扩张.(4)脑膜病变1例,MRI表现为广泛脑膜增厚伴明显均匀强化.椎管内病变4例:其中胸腰椎左侧椎旁软组织肿块2例,侵犯椎管内,伴邻近肋骨骨质破坏1例;椎管内肿块1例,表现为胸椎管后方梭形T1WI等高信号,T2WI等低信号灶,无明显强化;胸髓信号异常1例,表现为胸髓条状T2WI及液体衰减反转恢复(FLAIR)序列高信号影.结论 成人CNSCL影像表现多种多样,CT与MRI对该病的诊断价值相辅相成;白血病患者疑脑内病变者,建议常规使用SWI检查,以尽早发现脑微出血,降低脑内血肿发生的风险.

Abstract：

Objective To evaluate the CT and MRI findings and their diagnostic value of central nervous system complications of leukemia (CNSCL). Methods The CT and MRI findings of 18 adult patients with CNSCL proved by clinical features or pathology were retrospectively analyzed. Among 18 cases,7 were acute lymphocytic leukemia, 10 acute non-lymphocytic leukemia and 1 chronic myelomonocytic leukemia. Eleven cases underwent plain CT scan with one of them also receiving contrast-enhanced CT scan enhancement, 16 cases underwent plain MR scan with 11 of them receiving contrast-enhanced MR scan.Results Intracranial lesions in 14 cases: (1)intracranial hemorrhage was found in 7 cases, including intracerebral hematoma in 4 cases, micro-haemorrhage in 2 cases, and intracerebral hematoma accompanying by multiple intracerebral micro-haemorrhage foci in 1 case. All cases with intracerebral hematoma showed multiple lesions, which demonstrated high-density on CT images, and low or mixed signal on T1 WI, high- or intermediate signal with low-signal rim on T2 WI and ring enhancement or no evident enhancement. Microhaemorrhage manifested as multiple mini-mottling and strip hypointense foci on susceptibility weighted imaging, on which the detection rate of micro-haemorrhage foci was much higher than that on CT and other sequences of MRI. Among the 7 cases, one also had cerebral infarction and one subarachnoid hemorrhage.(2) Intracranial mass was found in 5 cases, among which two appeared as masses under or bestride cranium in the left frontal region with hypointensity on T1 WI, mixed signal on T2WI, strong homogeneous enhancement and dural tail sign;one showed a mass in saddle area, with high density on CT, slightly low signal on T1WI, high signal on T2WI and heterogeneous enhancement; one case displayed a mass near lateral ventricle with iso-intensity on T1 WI and T2WI and strong homogeneous enhancement; and one case manifested as cystic mass in the left fronto-apical lobe, with thick wall and ring enhancement (3)Obstructive hydrocephalus was found in 1 case, manifesting dilation of ventricles above the aquaeductus mesencephali. (4) Meningopathy was found in 1 case, manifesting diffuse thickening of meninges with strong homogeneous enhancement on MRI. Pathological changes of spinal canal was found in 4 cases among which two showed para-spinal mass involving vertebral canal and causing bone destruction of adjacent ribs; one case showed fusiform mass posterior to vertebral canal with high and intermediate signal on T1 WI and low and iso-signal on T2WI without enhancement; one showed zonale leison in thoracic cord with high signal on T2WI and fluid attenuated inversion recovery. Conclusion The radiologic manifestations of adult CNSCL are various and the role of CT and MRI for the diagnosis of CNSCL may complement each other. SWI is suggested as routine examination for patients of leukemia, in whom intracerebral lesions were suspected in order to find micro-haemorrhage as early as possible and reduce the risk of intracerebral hematoma occurrence.     

Madelung综合征的CT与MRI表现

目的 探讨Madelung综合征的CT与MRI表现特征.方法 搜集5例Madelung综合征患者,5例中Ⅰ型3例,Ⅱ型2例.5例患者均行CT检查,1例行CT增强扫描,2例行MR平扫.分析其临床特点及影像表现.结果 3例Ⅰ型Madelung综合征表现为躯干上部浅层皮下脂肪及颈深层脂肪增多,肿物弥漫分布于颈部、上胸及肩部,呈现"马颈圈"、"牛颈"样特征性表现;2例Ⅱ型表现为四肢近端、前胸壁皮下脂肪明显增厚,呈"大力水手"的特殊外观;5例患者均有腹直肌前方、腹股沟皮下脂肪增厚及阴囊内脂肪堆积.CT显示病变部位浅层皮下脂肪增多,CT值为-30～-70 HU;MR T1WI、T2WI及T2WI脂肪抑制序列均能显示增厚的脂肪组织,呈典型的短T1、长T2信号,在脂肪抑制序列上呈低信号,脂肪组织间有纤维组织分隔.结论 结合长期大量酗酒史,CT与MR检查对Madelung综合征可明确诊断,并明确病变范围及周围组织分界,对手术治疗方案提供有价值的信息.

Abstract：

Objective To determine the CT and MR findings of Madelung syndrome. MethodsFive cases of Madelung syndrome were collected in our hospital from February 2006 to June 2009, including 3 cases of typeⅠMadelung syndrome and 2 cases of typeⅡ Madelung syndrome. The 5 cases were all examined by CT, meanwhile 1 case by CT enhancement scanning and 2 cases by MR. The clinical characteristics and imaging manifestations were analyzed. Results CT and MR images in 3 patients of typeⅠMadelung syndrome displayed fat accumulation within the subcutaneous tissue of the upper trunk and deep layer tissue of neck. The diffuse masses were located around the neck, upper chest and shoulders, which were called "horse collar"and " buffalo humps". The other 2 cases of type Ⅱ Madelung syndrome displayed fat thickening within the subcutaneous tissue of the proximal extremities, anterior chest wall, showing special appearance of "vigorous sailor". All the 5 patients showed fat deposit within the subcutaneous tissue of the anterior rectus abdominis, inguina and fat accumulation within the scrotum. CT showed proliferated fat at the subcutaneous tissue of the involved regions. The CT value of proliferated fat were between -30 and -70 HU. The proliferated fat tissue all could be displayed on MR T1WI,T2WI and T2WI fat suppression sequence, with typical hypointensity on T1WI and hyperintensity on T2WI, hypointensity on fat-suppression sequence and fibrous septation presenting among fat tissue. Conclusion Combination with the history of long-term alcohol abuse, the Madelung syndrome could be diagnosed by CT and MR, which had great value in the surgical planning for identifying the extent of disease.     

Kimura病的CT、MRI表现

Objective To study the imaging features of Kimura disease to improve diagnostic ability prior to surgery.Methods The clinical manifestations and CT and MR findings of 11 patients with histologically confirmed Kimura disease were retrospectively analyzed.All 11 tumors originated from (or involved)the parotid region in 7 cases, the maxillofacial region in 2 cases, the palate in one case and the groin in one case.Clinically, the lesions showed asymptomatic tumors with the mean clinical course over 2 years.The increase of cosinophilic granulocyte was found in all 11 cases.Results On CT and MRI,5 patients were single masses and others were muhi-nodular masses.The smallest lesion was 6 mm×3 mm,and the largest lesion was 60 mm × 34 mm.The lesions were almost ill-defined in the subcutaneous tissue,especially 10 locating underlying superficialfascia in head and neck.On CT,the lesions showed homogeneous hypodense to the muscle in 9 patients.The lesions appeared isointeuse signal or slightly hypointense on MR T1WI and slightly hyperinteuse on T2WI in 3 patients.All lesions revealed moderate or marked, and homogeneous or inhomngeneous enhancement.Regional lymph nodes (eight cases in the maxillofacial region and one in the groin) enlarged without necrosis and fusion, and with marked enhancement.Conclusion The clinical and imaging findings of Kimura disease have some characteristics, the diagnosis can be made combined with the laboratory examination.     

Kimura病的CT、MRI表现

Objective To study the imaging features of Kimura disease to improve diagnostic ability prior to surgery.Methods The clinical manifestations and CT and MR findings of 11 patients with histologically confirmed Kimura disease were retrospectively analyzed.All 11 tumors originated from (or involved)the parotid region in 7 cases, the maxillofacial region in 2 cases, the palate in one case and the groin in one case.Clinically, the lesions showed asymptomatic tumors with the mean clinical course over 2 years.The increase of cosinophilic granulocyte was found in all 11 cases.Results On CT and MRI,5 patients were single masses and others were muhi-nodular masses.The smallest lesion was 6 mm×3 mm,and the largest lesion was 60 mm × 34 mm.The lesions were almost ill-defined in the subcutaneous tissue,especially 10 locating underlying superficialfascia in head and neck.On CT,the lesions showed homogeneous hypodense to the muscle in 9 patients.The lesions appeared isointeuse signal or slightly hypointense on MR T1WI and slightly hyperinteuse on T2WI in 3 patients.All lesions revealed moderate or marked, and homogeneous or inhomngeneous enhancement.Regional lymph nodes (eight cases in the maxillofacial region and one in the groin) enlarged without necrosis and fusion, and with marked enhancement.Conclusion The clinical and imaging findings of Kimura disease have some characteristics, the diagnosis can be made combined with the laboratory examination.     

儿童急性白血病四肢骨关节的影像研究

目的 探讨急性白血病儿童患者四肢骨关节的X线和MRI特点.方法 搜集以骨关节疼痛为主诉,经临床及骨髓穿刺确诊为急性白血病的13例患儿,对其疼痛部位均行X线平片检查,8例同时行MR检查,其中4例经过化疗达完全缓解后1周内行原疼痛部位的X线和MRI复查.对2种不同影像表现进行分析.结果 13例中,6例X线表现正常,7例共14处可见骨质异常:十骺端透亮带5处,骨膜反应3处,混杂密度骨质破坏1处,浸润性骨质改变3处,骨质疏松2处.MR检查8例共11处,6例共9处MRI表现为骨髓浸润、坏死,X线表现正常;2例共2处MRI表现为骨髓浸润,X线可见骨膜反应及干骺端透亮带.4例化疔达完全缓解后1周内复查,MRI显示骨髓浸润、坏死病灶范围缩小并T1WI骨髓信号不均匀增高,坏死灶呈较均匀长T1、长T2信号,边界清晰,双边征消失,相同病例治疗前后X线复查未见明显改变.结论 以骨关节痛为主诉的急性白血病患儿,MRI较X线能更早期、全面地检测到骨关节的病变,MRI可作为临床疗效监测的指标之一.

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Objective To evaluate X-ray and MRI features of limbs in childhood acute leukemia.Methods Thirteen children with acute leukemia in our pediatric hematology ward were recruited.Allpatients were pathologically diagnosed by bone marrow aspiration and complained of bone or joint pain in the first visit.ConventionaI X-ray and MRI examinations of algesic sites were performed before clinical treatment and after complete remission.MR images were obtained with SE-T1WI,SE-T2WI and T2WI-fat suppressed sequences and symmetria bilateralis was requested while scanning.X-ray and MRI manifestations were evaluated and compared.Resuits All 13 patients had received X-ray examinations.Among them,6 had normal X-ray findings,whereas the other 7(14 sites)showed various abnormalities including radiolucent metaphyseal bands(5 sites),periosteal reaction(3 sites),osteapenia(2 sites),mixed lesions(lysissclerosis,1 site),and permeative pattern(3 sites).The number of patients for MRI examinations was 8(11 sites).Among them,6(9 sites)showed bone marrow infiluration and bone marrow necrosis accompanied by normal X-ray findings,another 2(2 sites)showed bone marrow infiltration associated with radiographic abnormalities of periosteal reaction and radiolucent metaphyseal bands.Four cases were followed up within 1 week when reached complete remission by chemotherapy.MR images features included reduced sizes of bone marrow infiltration lesions associated with increased signal intensity on T1WI,and disappearance of double-line sign on bone marrow necrosis accompanied by signal homogenization.However,the radiograph before and after treatment in the same cases did not differ significantly.Conclusions MRI was earlier and more comprehensive in showing limbs bone marrow abnormality than radiogram in acute leukemia children with chief complaint of osteoarticular pains.MRI might be one of indicators in following up therapeutic effect for AL children with osteoarticular disorder.     

多层螺旋CT对食管鱼刺异物的诊断价值

Objective To investigate the detection rate and diagnostic value of multi-slice spiral CT scan in detecting fish bone impaction in the esophagus.Methods Experimental group: 30 fresh water fish bones from three variety classes were divided into three groups with length of(23.36±0.15), (28.51±0.07) and (30.89±0.10) mm, and diameter of (4.49±0.31), (1.78±0.09) and (0.49±0.07) mm.The fish bones were put into esophagus models in three different types including parallel, perpendicular and oblique.MSCT with axial scan combined with three dimensional reconstruction technique and plain X-ray film (CR and DR) were used to examine the model.The relations of the number and rate of fish bones were compared between MSCT and X-ray film.Clinical group: MSCT imaging were performed in 20 cases proved by esophageal endoscope or clinical operation, among which 11 cases received plain X-ray film (CR and DR), 15 cases received Barium-soaked cotton and 17 cases received endoscope.Paired Chi-square test was used to compare the differences of detection of fishbone by the different ways.Results In experimental group: All the 90 cases(100%) fish bones of three different species were clearly revealed on MSCT image; only 60 cases(66.7%) fish bones were revealed by plain X-ray film(CR and DR).The number and rate of fish bones detected by MSCT was higher than that of plain X-ray film (CR and DR) (X2=28.03, P < 0.01).In clinical group: 20 cases were made right diagnosis by MSCT, and the location and size of fish bone in the esophagus, the surrounding and complications of esophagus could be clearly demonstrated on MSCT image.Two cases detected by plain X-ray film(CR and DR) ;9 cases detected by Barium-soaked cotton;14 cases detected by endoscopy.The number and rate of fish bones detected by MSCT was higher than that of plain Xray film (CR and DR) (X2=7.11, P < 0.05) and Barium-soaked cotton (X2=4.17, P < 0.05).Conclusions The sensitivity and detection rate of fish bone with MSCT was high and could evaluate the surrounding and complications of the esophagus.MSCT could be used as the first examination of impacted fish bones in the esophagus.     

多层螺旋CT对食管鱼刺异物的诊断价值

Objective To investigate the detection rate and diagnostic value of multi-slice spiral CT scan in detecting fish bone impaction in the esophagus.Methods Experimental group: 30 fresh water fish bones from three variety classes were divided into three groups with length of(23.36±0.15), (28.51±0.07) and (30.89±0.10) mm, and diameter of (4.49±0.31), (1.78±0.09) and (0.49±0.07) mm.The fish bones were put into esophagus models in three different types including parallel, perpendicular and oblique.MSCT with axial scan combined with three dimensional reconstruction technique and plain X-ray film (CR and DR) were used to examine the model.The relations of the number and rate of fish bones were compared between MSCT and X-ray film.Clinical group: MSCT imaging were performed in 20 cases proved by esophageal endoscope or clinical operation, among which 11 cases received plain X-ray film (CR and DR), 15 cases received Barium-soaked cotton and 17 cases received endoscope.Paired Chi-square test was used to compare the differences of detection of fishbone by the different ways.Results In experimental group: All the 90 cases(100%) fish bones of three different species were clearly revealed on MSCT image; only 60 cases(66.7%) fish bones were revealed by plain X-ray film(CR and DR).The number and rate of fish bones detected by MSCT was higher than that of plain X-ray film (CR and DR) (X2=28.03, P < 0.01).In clinical group: 20 cases were made right diagnosis by MSCT, and the location and size of fish bone in the esophagus, the surrounding and complications of esophagus could be clearly demonstrated on MSCT image.Two cases detected by plain X-ray film(CR and DR) ;9 cases detected by Barium-soaked cotton;14 cases detected by endoscopy.The number and rate of fish bones detected by MSCT was higher than that of plain Xray film (CR and DR) (X2=7.11, P < 0.05) and Barium-soaked cotton (X2=4.17, P < 0.05).Conclusions The sensitivity and detection rate of fish bone with MSCT was high and could evaluate the surrounding and complications of the esophagus.MSCT could be used as the first examination of impacted fish bones in the esophagus.     

软骨母细胞瘤MRI及X线平片和CT的表现特征

目的 研究软骨母细胞瘤的影像表现,探讨其MRI与X线平片、CT征象的对应关系.方法 分析16例经手术、病理证实的良性软骨母细胞瘤的影像资料,总结其MRI表现与X线平片、CT征象的对应关系.结果 16例软骨母细胞瘤均位于骨骺,大小为0.9 cm×0.8 cm×1.0 cm～4.8 cm×4.3 cm×5.1 cm,呈不同程度的分叶状.在T1WI上以等、低信号为主,T2WI上呈混杂信号,CT上为软组织密度,内见钙化和更低密度区.边缘呈长T1、短T2信号,在CT上表现为硬化边.MRI可见病灶周围有骨髓水肿,在X线和CT上表现为骨质硬化区.病灶邻近软组织肿胀.MRI显示骨膜异常9例,8例与病灶不相邻;X线和(或)CT显示骨膜新生骨6例.MRI显示关节积液12例,CT显示6例.MRI上病灶均呈不均匀强化,骨髓水肿、骨膜反应和软组织肿胀均见强化.软骨母细胞瘤在扩散加权成像(DWI)上呈等、高信号,在MR平扫中的等T1、等T2成分和长T1、长T2成分,以及骨髓水肿、骨膜反应和软组织肿胀在DWI上均呈高信号.结论 MRI和X线平片、CT从不同方面反映软骨母细胞瘤的病理改变,联合应用不同检查手段可更全面显示软骨母细胞瘤的特点.     

骨肉瘤的X线、CT及MRI比较分析(附61例分析)

目的:探讨原发性骨肉瘤的X线、CT和MRI表现及诊断价值.方法:经穿刺或手术病理证实的61例骨肉瘤患者,52例行X线检查,39例行CT检查,55例行MRI检查,其中23例行MRI动态增强检查.回顾性分析其影像学表现并与病理学表现进行对照分析.结果:本组61例骨肉瘤中成骨型13例,溶骨型21例,混合型27例.52例X线检...     

软组织恶性纤维组织细胞瘤的临床影像学诊断

目的:回顾性分析26例恶性纤维组织细胞瘤(MFH)的临床影像学表现,讨论其影像学诊断。方法:搜集经手术病理及免疫组化证实的MFH 26例,男15例,女11例,40岁21例,占80.77%。病史3个月~5年。7例摄有X线平片。CT平扫17例,增强扫描8例。MR平扫15例,增强扫描8例。病灶大多位于大腿、小腿、前臂和臀部。23例位于深部软组织,3例位于表浅软组织。结果:21例(80.77%)呈不规则长圆形或长条形软组织肿块,直径5cm。3例X线平片表现为软组织肿块伴邻近骨质侵蚀性破坏,2例伴有骨膜增生。CT平扫多呈等、低或略低密度,仅1例高密度。CT增强均表现为明显不均匀强化,病灶边界均不清,累及邻近肌肉。CT上2个病灶内可见弧形钙化,其病灶直径均5.0cm。13例可见邻近骨骼破坏或骨膜增生。MR平扫15例,T1WI多呈等或低信号,合并出血4例。T2WI多呈高信号或混杂信号,10例病灶周围可见片状水肿信号。MR增强扫描8例,均呈明显不均匀强化,2例边界清楚,邻近肌肉受压推移,12例边界不清,邻近肌肉侵犯。6例可见邻近骨骼受侵。结论:发生于中老年人,位于下肢、前臂深部软组织的巨大肿块,尤其是呈长圆形分叶状或不规则长条状软组织肿块,边界不清,伴有邻近骨质破坏或骨膜反应,增强扫描呈明显不均匀强化者,应首先考虑恶性纤维组织细胞瘤。     

成软骨细胞瘤影像学诊断

目的 探讨成软骨细胞瘤影像学表现特点。资料与方法 分析22例经手术病理或穿刺活检证实的成软骨细胞瘤资料,总结其X线平片、CT和MRI表现。结果 胫骨上端18例,股骨下端2例,肱骨上端2例。表现为骨骺区分叶状骨质破坏区,内见钙化和更低密度区;MR T1WI以低信号为主,T2WI上信号混杂,扩散加权成像（DWI）上呈等高信号。硬化边厚薄不一。病灶周围在X线和CT上见高密度骨质硬化区,MRI表现为骨髓水肿。骨膜反应常不与病灶相邻,MRI上为长T1、短T2信号,与皮质间见条状高信号。邻近软组织肿胀,部分患者见关节积液。MRI上病灶可呈环状或较均匀强化,骨髓水肿、骨膜反应和软组织肿胀均强化。结论 成软骨细胞瘤影像学表现较有特征性,结合X线平片、CT和MRI能做出正确诊断。     

骨和累及骨的外周性原始神经外胚层瘤的临床病理与影像学表现

目的探讨骨和累及骨的外周性原始神经外胚层瘤(pPNETs)的临床病理与影像学表现。资料与方法7例中6例有X线检查、2例有CT检查、4例有MR检查,分析其临床病理和影像学特点。结果6例X线片上均呈溶骨性骨质破坏,其中2例病变区存在骨质硬化,5例合并软组织肿块,均未见骨膜反应。2例CT像上均为溶骨性骨质破坏合并软组织肿块形成,软组织内未见钙化或骨化。MRI检查4例中有3例病变在T1WI呈中等信号,1例在T1WI呈低信号,4例在T2WI上均呈中、高信号,信号不均匀,增强扫描呈中度不均匀强化。4例均合并软组织肿块,其中3例有囊变坏死区。结论影像学上骨内病变呈溶骨性破坏,可伴有病变区的骨质硬化而一般无骨膜反应,并伴有较大软组织肿块者应考虑到pPNETs的可能。     

骨嗜酸性肉芽肿的影像学分析

目的 探讨骨嗜酸性肉芽肿的影像学表现，资料与方法 回顾分析经病理证实的骨嗜酸性肉芽肿18例，其中X线平片检查16例，CT检查10例，MRI检查4例。结果 颅骨6例，表现为圆形。类圆形骨质破坏伴颅板内外软组织肿块；脊椎5例，椎体不规则破坏，边缘硬化，楔形变，椎旁软组织肿块。严重者椎体压缩呈盘状；肋骨2例，穿凿样或膨胀性骨质破坏；肩胛骨1例，斑片状骨质破坏伴周围广泛增生，有骨膜反应；股骨4例，膨胀性或溶骨性骨质破坏伴骨膜反应。MRI表现，T1WI呈低或等信号，STIR高信号，增强明显强化，18例中正确诊断12例，诊断准确率66.7%。结论 通过影像学检查，并结合临床，大部分骨嗜酸性肉芽肿术前能够正确诊断。CT较X线平片能更好的显示病变结构及邻近软组织的改变。MRI能够精确显示病变的范围。     

足跗骨软骨母细胞瘤的影像学表现

目的:总结分析足跗骨软骨母细胞瘤的影像学表现。方法:回顾性分析经临床病理证实的发生于足跗骨的5例软骨母细胞瘤的X线、CT及MRI表现。结果:5例均单发,2例位于跟骨,2例位于距骨,1例位于舟骨。X线主要表现为圆形或卵圆形透亮影,边界清楚,5例均可见病灶边缘硬化带形成,病灶内未见明显钙化。CT扫描显示肿瘤呈膨胀性生长,骨质破坏区边界锐利、硬化,灶周软组织肿胀,未见骨膜反应及软组织肿块,增强扫描呈轻度不均匀强化。MRI可见病灶形态呈分叶状,呈长、稍长T1信号,混杂T2信号,伴有灶周骨髓水肿及关节腔积液,灶周软组织水肿,增强扫描亦呈轻度不均匀强化。结论:足跗骨软骨母细胞瘤较少见,其影像学表现具有一定特征性。     

骨良性肿瘤与肿瘤样病变的MR诊断

目的：探讨磁共振在骨良性肿瘤与肿瘤样病变诊断中的价值。材料和方法：搜集骨良性肿瘤与肿瘤样病变３４例，分析其磁共振表现。全部病例均做磁共振检查。采用常规ＳＥ序列，Ｔ１Ｗ及Ｔ２Ｗ成像。其中２０例同时做了脂肪抑制成像。结果：磁共振诊断正确率为９４．１％（３２／３４）。磁共振征象包括：骨质破坏（３０／３４）；软组织肿块（３／３４）；关节侵犯（１／３４）；骨壳（１０／３４）；硬化缘（１７／３４）；钙化（３／３４）；骨间隔（７／３４）；囊变坏死（８／３４）；出血（７／３４）；软组织水肿（３／３４）；髓腔水肿（３／３４）；关节积液（３／３４）。结论：磁共振是骨良性肿瘤与肿瘤样病变的有效辅助诊断方法。磁共振与平片、ＣＴ相结合有利于提高定性诊断正确率。     

骨外周性原始神经外胚层瘤的影像学表现

目的探讨骨外周性原始神经外胚层瘤(pPNETs)的临床和影像学表现。方法分析10例骨pPNETs的临床和X线、CT及MR影像资料。结果pPNETs多以局部疼痛(9例)伴肿块(7例)为主诉。X线示溶骨性骨质破坏8例，伴有不规则硬化和轻度膨胀的溶骨性骨质破坏1例，未见异常1例；7例见软组织肿块；均未见骨膜反应。7例CT扫描中，边界不清的溶骨性骨质破坏6例。伴有不规则硬化和轻度膨胀的溶骨性骨质破坏1例，均有软组织肿块形成，2例伴有细小的点状钙化，均未见骨膜反应；10例MR扫描中，9例在T1WI呈等信号，1例呈中等偏高信号；在T2WI和短时反转恢复(STIR)序列，8例呈不均匀中、高信号，2例呈均匀高信号；均见明显软组织肿块形成；4个疗程化疗以后，肿瘤有明显缩小。结论骨pPNETs以溶骨性骨质破坏伴明显的软组织肿块、无骨膜反应为主要表现，缺乏特征性，但影像学检查有助于了解病变的范围、治疗措施的制定和治疗效果的评价。     

Periosteal Osteosarcoma Arising from the Rib and Scapula: Imaging Features in Two Cases

Periosteal osteosarcoma is an extremely rare chondroblastic osteosarcoma in the flat bone. There were authors reporting of two cases of periosteal osteosarcoma in the highly unusual sites. One of them arose from the rib, in a 17-year-old male, which appeared as a hypodense juxtacortical mass with periosteal reaction on CT. The other one arose from the scapula, in a 17-year-old female, which showed the intermediate signal intensity (SI) on T1-weighted image (WI), heterogeneous high SI on T2WI, and rim-enhancement on contrast-enhanced T1WI with cortical destruction on MRI.