腹部CT和MRI诊断腰疝

目的 分析腹部CT和MRI诊断腰疝的价值。方法 回顾性分析75例临床诊断腰疝患者,观察其CT及MRI表现。75例均接受CT平扫,其中65例接受CT增强检查,20例接受MRI平扫及增强检查。结果 75例中,CT共检出79处腰疝,MRI共检出21处腰疝（其中1例为双侧病变）,均表现为经腹后外侧壁缺损突出至腰背部的软组织肿块,邻近肌肉受压变薄/萎缩,其中75处（75/79,94.94%）为腰上三角疝,3处（3/79,3.80%）为腰下三角疝,1处（1/79,1.27%）为弥漫性腰疝。75例中,39例（39/75,52.00%）为右侧腰疝,32例（32/75,42.67%）为左侧、4例（4/75,5.33%）为双侧腰疝。疝囊平均最大径（3.83±1.82）cm;59个疝囊呈烧瓶样或椭圆形,20个类圆形或扁丘状;疝环平均最大径（2.13±1.22）cm;疝囊密度或信号因疝内容物不同而有所不同,66处（66/79,83.54%）疝内容物为脂肪组织,10处（10/79,12.66%）为结肠,2处（2/79,2.53%）为多脏器疝出,1处（1/79,1.27%）为肝脏。MRI均清楚显示病变处深筋膜缺损及肌层,而CT显示疝囊及疝环、观察相邻骨骼更佳。结论 腰疝CT及MRI表现具有一定特征性,二者相结合有利于提高术前诊断准确率。     

Preoperative radiographic diagnosis of a Spigelian hernia containing large and small bowel

A case is reported in which the preoperative diagnosis of a Spigelian hernia containing both large and small bowel was made by radiographic means. The anatomy, clinical findings, and radiologic picture of this condition are discussed.     

Ultrasonography and CT of abdominal and inguinal hernias

Forty-two patients with various abdominal wall hernias and five patients with inguinal hernias were studied with ultrasonography. Thirteen patients were studied by CT. Although hernias are usually apparent on physical examination, difficulty in diagnosis may be encountered in some patients. Ultrasonography and CT are not only capable of diagnosing hernia in such instances, they are also helpful in the clinical management of the patients by demonstrating the precise location and extent of the muscular defect. However, the hernia may simulate a mass or cyst in the ultrasonograph and CT scan and one should carefully demonstrate intraperitoneal communication through a muscular defect or a herniated bowl loop within the hernia in order to avoid misdiagnosis. Pseudohernias due to localized thinning or thickening of the rectus muscle were also observed in five patients.     

产前超声联合磁共振成像在单纯性腹股沟斜疝临床诊断中的应用

目的探讨超声与磁共振成像在胎儿腹股沟斜疝诊断中的临床应用价值。 方法对2003年2月至2015年2月在湖北省妇幼保健院产前超声检查的671 558例胎儿行系统超声检查,并对超声检出腹股沟斜疝和疑诊睾丸肿瘤的胎儿行磁共振成像（MRI）和出生后超声复查。与出生后临床、超声检查结果对照,对腹股沟斜疝胎儿的超声及磁共振图像特征进行分析。 结果3例胎儿单纯性腹股沟斜疝均发生在晚孕期,临床罕见（发生率0.4/万,3/671 558）,产前超声典型特征：（1）右侧阴囊增大,阴囊内见混合性肿块及蠕动的肠管回声。（2）单侧（左侧）睾丸可显示,阴茎可显示。磁共振成像示3例胎儿右侧腹股沟区腹壁连续性中断,疝囊内容物为肠管及网膜组织。出生后新生儿外科体检示3例男婴右侧阴囊大,疝入阴囊的包块可回纳,超声复查显示为腹股沟斜疝。与胎儿MRI及新生儿检查结果对照,产前超声正确诊断单纯性腹股沟斜疝2例,误诊为睾丸肿瘤1例;磁共振正确诊断单纯性腹股沟斜疝3例。 结论胎儿单纯性腹股沟斜疝有特征性超声表现,超声及MRI联合检查有助于正确诊断而减少漏误诊。     

CT diagnosis of paraduodenal hernia

The computed tomographic (CT) findings of a right and left paraduodenal hernia are described. In the right paraduodenal hernia the major findings consist of encapsulation of small bowel loops in the right mid-abdomen with looping of arterial and venous jejunal branches behind the superior mesenteric artery. The findings of the left paraduodenal hernia are less specific and involve encapsulation of bowel loops at or above the level of the ligament of Treitz with intermittent dilatation.     

脑疝CT、MRI诊断

脑疝是临床上颅内占位性病变引起的最严重并发症之一,死亡率极高。CT、MRI对早期脑疝可做出明确诊断,为临床提供可靠依据及充足时间,指导制定治疗方案,使患者得到及时救治,降低死亡率及致残率。本文着重介绍CT、MRI诊断小脑幕裂孔疝及枕骨大孔疝的研究进展。     

Dynamic ultrasound with postural change facilitated the detection of an incisional hernia in a case with negative MRI findings

Incisional hernias commonly develop after abdominal surgeries with a lower incidence in patients receiving laparoscopy. Diagnosis through a non-surgical approach is usually made by computed tomography or magnetic resonance images (MRI) but both image modalities require patients to be examined in a supine position. We reported a case noticing a mass over her right lower abdomen after a laparoscopic liver segmentectomy with negative findings of hernia on MRI. A hernia sac was found by ultrasound with the patient being standing, highlighting the utility of dynamic ultrasound with postural change in investigation of incisional hernias.     

Cecal hernia into the lesser sac

Two cases of cecal herniation through the foramen of Winslow into the lesser sac are presented. This unusual and potentially life-threatening form of internal herniation can be diagnosed radiographically on plain abdominal radiographs and barium studies by identifying the cecum lying posterior and medial to the stomach in association with the absence of the cecum in the right lower quadrant of the abdomen. One of the described cases is unique in that the patient was asymptomatic relative to the internal hernia. The other case clearly demonstrates the importance of increased intra-abdominal pressure as a causative factor in foramen of Winslow hernia.     

Sliding appendiceal inguinal hernia: preoperative sonographic diagnosis

We report the case of a 3-month-old boy with a right-sided sliding appendiceal inguinal hernia that was diagnosed preoperatively with sonography. Surgery was performed, and intraoperative and histopathologic evaluations also revealed changes in the appendix that could have led to complications if left untreated. The infant's recovery was uneventful, and he was discharged on the second day after surgery. This condition is usually diagnosed intraoperatively, and to the best of our knowledge, this is only the second report in the English-language medical literature in which such a case was correctly diagnosed preoperatively with sonography. In our case, the early sonographic diagnosis led to early intervention and the avoidance of potential complications.     

Congenital diaphragmatic hernia: Presentations and problems in the adult

Three cases of congenital diaphragmatic hernia in the adult are reported. Strangulation of the large bowel was the presenting feature in 1 case and pancreatitis in another. The abnormality was discovered as a coincidental finding in a third case. The incidence, presentations, and diagnosis of this uncommon condition are discussed.     

US in pubalgia

There is considerable confusion over the word “pubalgia” with regard to the definition and the etiological causes of this condition. The term pubalgia should be used to indicate disabling pain affecting the pubic region in people who practise sports. Pubalgia affects 10% of those who practise sports and it is particularly prevalent in football players. According to the literature, about 40% of cases of pubalgia are caused by overuse of the symphysis pubis with progressive lesions affecting the rectus abdominal muscles, adductors (rectal-adductor syndrome) and the symphysis itself (osteitis pubis and joint injury). An initial study of the tendons is carried out by ultrasound (US) whereas magnetic resonance imaging (MRI) should be performed to study the bones and joints.Another 40% of cases of pubalgia are caused by "sports hernia" defined as anteroinferior abdominal wall insufficiency. These alterations can only be identified at dynamic US examination.About 20% of cases of pubalgia are caused by diseases of the neighboring structures or joints such as diseases of the hip, iliopsoas, hamstring, sacred iliac or nerves, or by urogenital diseases.     

Evaluation of focal hepatic masses: a comparative study of MRI and CT

We evaluated suspected hepatic lesions in 30 patients using both nongated spin-echo magnetic resonance imaging (MRI) on a 0.35 T superconducting magnet and contrast-enhanced dynamic incremental computed tomography (CT). In the 27 patients with focal lesions, both modalities detected abnormalities in 26 patients. Liver lesions were equally well demonstrated using MRI and CT in 15 patients, better demonstrated by CT in 11 patients, and better demonstrated by MRI in 1 patient. Small lesions (<2 cm) were much better demonstrated using CT than MRI; this was significant when knowledge of the precise extent of disease was necessary for planning surgical therapy or for evaluating response to chemotherapy. Five patients had significant extrahepatic disease detected by CT; MRI identified extrahepatic abnormalities in only 2 of these 5 patients. We conclude that at the current time CT is more useful than nongated spin-echo MRI in the evaluation of suspected hepatic masses.     

Sonographic findings in Richter's hernia

Richter's hernia can present as a diagnostic challenge because of its usually small size and eccentric bowel wall involvement with limited luminal compromise. This article describes a case of Richter's hernia in the femoral canal and illustrates its sonographic features.     

Characteristic findings of hepatocellular carcinoma: An evaluation with comparative study of US,CT, and MRI

The sensitivity, specificity, and accuracy of ultrasonography (US), dynamic incremented computed tomography (CT) with delayed phase imaging, and magnetic resonance imaging (MRI) with or without Gd-DTPA were studied for detecting the characteristic appearances of hepatocellular carcinomas (HCC): fibrous capsules, fibrous septa, and mosaic appearances. Results were prospectively evaluated in 30 patients who subsequently underwent hepatic lobectomies or segmentectomies. Pathologic evaluations of the resected liver specimens demonstrated fibrous capsules in 20 tumors (66.7%), fibrous septa in 13 tumors (43.3%), and mosaic appearances in 19 tumors (63.3%). The accuracies for fibrous capsules were 71.4% (20 of 28) for US, 81.5% (22 of 27) for CT, and 92.3% (24 of 26) for MRI. The accuracies for fibrous septa were 57.1% (16 of 28) for US, 59.3% (16 of 27) for CT, and 73.1% (19 of 26) for MRI. The accuracies for mosaic appearances were 71.4% (20 of 28) for US, 51.9% (14 of 27) for CT, and 69.2% (18 of 26) for MRI. Gd-DTPA administrated MRI showed higher accuracies than did conventional MRI for all manifestations. In conclusion, the fibrous capsules of HCCs were readily detected by CT and MRI. Gd-DTPA administration demonstrated an advantage in clarifying fibrous capsules, as well as fibrous septa and mosaic appearances.     

MRI of fetal abdominal abnormalities

Although ultrasonography is the method of choice for evaluating the fetus, magnetic resonance imaging (MRI) complements ultrasonography in the accurate diagnosis of fetal abnormalities. The advantages of MRI include excellent tissue contrast, a large field of view, and relative operator independence. To date, most studies on fetal MRI have focused on the fetal central nervous system and thoracic disorders. However, our experience suggests that MRI can be helpful even in evaluating fetal abdominal disorders. This pictorial essay illustrates the various MRI appearances of fetal abdominal abnormalities and discusses the indications and advantages of fetal MRI.     

软组织侵袭性纤维瘤病的影像表现及其病理对照分析

目的分析侵袭性纤维瘤病(AF)的CT及MRI影像学特点及与病理的关系,提高对该病的认识和诊断水平。材料与方法回顾性分析14例经手术病理证实的AF(12例原发,2例复发)的临床资料和影像表现,并与术后病理进行对照分析。结果 CT平扫,4例病灶呈稍高密度,8例呈等密度,2例呈稍低密度;边界清晰3例,模糊9例;增强病灶均呈明显强化,未见包膜。MRI 检查,4例病灶局限于单一肌肉,10 例累及多块肌肉;3例肿瘤境界清楚、有不完整包膜,11例境界不清、无包膜、边缘呈爪状生长;与肌肉比较,病灶平扫T1WI呈等信号4例、呈低信号10例,T2WI均呈高信号;增强检查病灶呈明显不均匀强化。结论 MRI信号的差异主要反映了病灶的组织学成分的不同,MRI 比CT更精确地显示病灶的形态、范围及其与周围结构关系。     

Bile duct disease: Prospective comparison of ERCP,CT, and fat suppression MRI

The authors compared computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP), techniques commonly used to study the biliary tree, with pre- and post-Gd-DTPA breath-hold fast low angle shot (FLASH) and fat suppressed spin-echo in 28 consecutive patients with bile duct abnormalities detected on ERCP, including 11 patients with malignant disease and 17 patients with benign disease. ERCP, CT, and magnetic resonance (MR) images were prospectively interpreted in a blinded fashion and reviewed by consensus. ERCP characterized all cases of malignant disease by the presence of a narrowed bile duct lumen with irregular margins. CT and MRI detected all cases of malignant disease and characterized nine of 11 as malignant. In seven of these cases, CT and MRI showed thickening of extrahepatic bile duct walls >5 mm. MRI images showed intrahepatic-enhancing periportal tissue in four cases, which was not seen on CT images, and which was biopsyproven tumor extension. Benign disease was characterized on ERCP images by the demonstration of smooth tapered narrowings in 16 cases, whereas on CT and MR images it was characterized by mild to moderate dilatation of the intrahepatic bile ducts and wall thickness < 5 mm in 13 cases. Overall ERCP correctly characterized 27 cases as benign or malignant and CT and MRI both characterized 25. The results of this study show a trend that ERCP is superior to CT and MRI for characterizing bile duct disease.     

Impact of contrast enhanced MRI on lymphocyte DNA damage and serum visfatin level

Objectives

Nephrogenic systemic fibrosis is a novel clinical entity encountered in subjects undergoing contrast enhanced magnetic resonance imaging (MRI). The aim of the present study is to evaluate the impact of contrast enhanced MRI exposure on lymphocyte DNA damage and serum levels of visfatin.

Design and methods

Twenty-eight subjects undergoing contrast enhanced hypophysial MRI with omniscan® were included in the study. Blood samples were drawn before MRI, after non-contrast MRI and after contrast enhanced MRI from each subject. Lymphocyte DNA damage was analyzed by the alkaline comet assay, whereas serum visfatin level was assessed with enzyme immuno assay.

Results

Both lymphocyte DNA damage and serum visfatin levels were statistically significantly increased in samples withdrawn after contrast enhanced MRI compared to samples withdrawn after non-contrast enhanced MRI and baseline samples (ANOVA p < 0.001, for both).

Conclusions

Findings of the present study revealed that the contrast enhanced MRI is associated with increased lymphocyte DNA damage and increased serum visfatin level.     

Ultrasound,CT, and MRI comparison in primary and secondary tumors of the liver

Thirty-five patients with surgically removed or percutaneous biopsy-proven tumors were examined by ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). This retrospective study describes the appearance of the primary tumors and m'etastases and compares the sensitivity and specificity of the 3 imaging methods.Ultrasound, CT, and MRI examinations as well as clinical, operative, and/or histologic data were available for all 35 patients. Paramagnetic contrast agent gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) was used in 23 patients and a short TI inversion recovery MRI sequence was used in 23 patients, in addition to various spin echo MRI sequences. Thirteen patients were examined using both Gd-DTPA and the short TI inversion recovery sequence. Our comparative study-based on the following criteria: detection, size, location of the tumor, and portal vein involvement and bile duct dilatation — demonstrated an advantage of MRI over ultrasound in 16 of 35 cases, equal results in 17 of 35 cases and a disadvantage of MRI compared to ultrasound in 2 of 35 cases. With the identical criteria, MRI proved to be more informative than CT in 10 of 35 cases, equal in 21 of 35 cases, and less informative in 4 of 35 cases.     

腹壁巨大切口疝行网片修补术患者的护理

目的总结腹壁巨大切口疝行网片修补术患者的围手术期护理。方法对18例腹壁巨大切口疝患者，术前进行详细评估、心理护理、呼吸功能训练、控制慢性疾病及肠道准备。术后密切观察患者呼吸、切口情况，防止腹内压增加，做好出院指导。结果18例患者中，切口Ⅰ期愈合16例，Ⅱ期愈合2例，平均住院13．5天，均痊愈出院，随访1～3年，无复发。结论做好充分的心理护理、术前准备及术后精心护理，是促进腹壁巨大切口疝网片修补术患者康复，同时也是减少并发症及术后复发的重要措施。