点状接触钢板结合改良钢丝内固定治疗股骨假体周围骨折

对7例采用点状接触钢板结合改良钢丝内固定术治疗的股骨假体周围骨折患者的病例资料进行回顾性分析。7例骨折均为Vancouver分型的B1型,骨折均恢复良好,认为采用点状接触钢板结合改良钢丝内固定术治疗此类骨折是目前比较好的治疗方法。     

Assessment of extradural degenerative disease with Gd-DTPA-enhanced MR imaging: correlation with surgical and pathologic findings

To test whether gadolinium-DTPA-enhanced MR would increase the conspicuity of extradural degenerative disease in the previously unoperated patient, we prospectively studied a group of 30 patients with symptoms suggestive of disk disease. Surgical findings and pathologic correlations were used as an objective measure of accuracy. Gadolinium-DTPA increased the confidence of diagnosis at one of eight operated cervical levels (six patients) and changed the diagnosis from extradural degenerative disease to tumor in one patient. The mechanism of enhancement of the epidural space and peridiskal region appears to be related to accumulation of contrast material within the epidural venous plexus, as well as to epidural fibrosis associated with disk disruption and herniation. While the immediate clinical utility of gadolinium-DTPA for morphologic analysis seems limited to difficult cervical spine cases, the presence of enhancement as a marker of epidural fibrosis and attempted healing may prove to be of great importance in studying the natural history and basic pathophysiology of degenerative disk disease.     

Assessment of extradural degenerative disease with Gd-DTPA-enhanced MR imaging: correlation with surgical and pathologic findings

To test whether gadolinium-DTPA-enhanced MR would increase the conspicuity of extradural degenerative disease in the previously unoperated patient, we prospectively studied a group of 30 patients with symptoms suggestive of disk disease. Surgical findings and pathologic correlations were used as an objective measure of accuracy. Gadolinium-DTPA increased the confidence of diagnosis at one of eight operated cervical levels (six patients) and changed the diagnosis from extradural degenerative disease to tumor in one patient. The mechanism of enhancement of the epidural space and peridiskal region appears to be related to accumulation of contrast material within the epidural venous plexus, as well as to epidural fibrosis associated with disk disruption and herniation. While the immediate clinical utility of gadolinium-DTPA for morphologic analysis seems limited to difficult cervical spine cases, the presence of enhancement as a marker of epidural fibrosis and attempted healing may prove to be of great importance in studying the natural history and basic pathophysiology of degenerative disk disease.     

Epithelioid sarcoma: clinical,MR imaging and pathologic findings

OBJECTIVE: To report and describe the MR imaging features of eight new cases of this rare soft tissue sarcoma and correlate them with the clinical and histologic findings.DESIGN AND PATIENTS. Retrospective analysis was carried out for the MR imaging characteristics and histologic findings of eight patients with pathologically proven epithelioid sarcoma and the literature was reviewed. Findings were correlated in each case with the patient's clinical presentation and eventual outcome.RESULTS: The patients, whose primary tumors ranged from 2.5 cm to 19 cm in maximum dimension, were 1 to 90 years of age. Tumors involved the extremities ( n=5), the scalp ( n=2) and the paraspinal muscles ( n=1). Five tumors presented as well-defined, frequently painful, deeply situated masses and three as subcutaneous nodules or cutaneous ulcers with no palpable mass. Four patients had associated regional lymphadenopathy and one had distant metastases at diagnosis. MR imaging showed tumor infiltration of adjacent tissues in seven patients. Signal characteristics reflected varying degrees of cellularity, and the presence of necrosis, hemorrhage, fibrosis, hyalinization and inflammation. Bone marrow involvement was demonstrated in one patient. Clinical outcomes were generally poor.CONCLUSIONS: Epithelioid sarcoma is an aggressive soft tissue sarcoma with a varied clinical presentation, growth pattern, MR signal characteristics and histologic picture. The tumor favors the distal extremities and is commonly infiltrative and accompanied by enlarged regional lymph nodes. This neoplasm may present as an intramuscular mass but should also be suspected in patients with ulcerating cutaneous nodules with or without regional lymphadenopathy.     

MR imaging and MR cholangiopancreatography in the preoperative evaluation of hilar cholangiocarcinoma: correlation with surgical and pathologic findings

The primary aim was to evaluate delayed contrast-enhanced MRI in depicting perineural spread of hilar cholangiocarcinoma (CCC) and consequently to determine the capability of MRI/MRCP for staging CCC. Fifteen patients that underwent MRI/MRCP and surgical treatment were retrospectively included. Two radiologists evaluated MR images to assess delayed periductal enhancement, extent of bile duct stenosis, liver parenchymal and vascular involvement and presence of liver atrophy. An agreement between delayed enhancement of the bile duct walls and perineural neoplastic spread showed a very good correlation factor (0.93). The overall accuracy in detecting biliary neoplastic invasion was higher for delayed T1-weighted images (93.3%) than for the MRCP images (80%), and T1-delayed image increased the MR accuracy in assessing the neoplastic resectability (p < 0.05). MRI correctly predicted vascular involvement in 73% and liver involvement in 80% of the cases. The number of overall correctly assessed patients with regard to resectability was 11 true positive, 1 false positive and 3 true negative. The combination of MRI/MRCP is a reliable diagnostic method for staging hilar cholangiocarcinomas. Delayed periductal enhancement is accurate in the evaluation of neoplastic perineural spread, and it can improve diagnostic accuracy to identify resectable and unresectable tumours.     

肝门部胆管癌术前MRI及MRCP评价:手术及病理的相关性研究

本研究目的主要是评价延迟对比增强MRI在显示肝门部胆管癌的神经周围扩散,进而评价MRI/MRCP对肝门部胆管癌的肿瘤分期能力。回顾性分析15例外科手     

CT and MR imaging findings of xanthogranulomatous cholecystitis: correlation with pathologic findings

The aim of this study was to evaluate CT and MRI findings in xanthogranulomatous cholecystitis (XGC) and to correlate the imaging findings with various pathologic parameters. The study included 13 patients with histopathologically confirmed XGC. The CT (n=13) and MRI (n=5) obtained in these patients were evaluated retrospectively. On CT, low-attenuation areas in the wall of XGC correlated with foam and inflammatory cells or necrosis and/or abscess in XGC. Areas of iso- to slightly high signal intensity on T2-weighted images, showing slight enhancement at early phase and strong enhancement at last phase on dynamic study, corresponded with areas of abundant xanthogranulomas. Areas with very high signal intensity on T2-weighted images without enhancement corresponded with necrosis and/or abscesses. Luminal surface enhancement (LSE) of gallbladder wall represented preservation of the epithelial layer. The early-enhanced areas of the liver bed on dynamic CT and MR images corresponded with accumulation of inflammatory cells and abundant fibrosis. Our results indicate that CT and MRI findings correlate well with the histopathologic findings of XGC.     

MR imaging of soft-tissue hemangiomas: correlation with pathologic findings

Soft-tissue hemangiomas have been described in MR imaging, but a histopathologic correlation to better understand the MR appearance has not been reported. Five patients with intramuscular soft-tissue hemangiomas were imaged in orthogonal planes on a 1.5-T system with spin-echo (SE) short-TR/TE sequences (600/20) and long-TR/TE sequences (2500/20-80). Complete intact surgical specimens were obtained, and gross and histopathologic findings were compared with MR findings. A striated-septated configuration with a high signal intensity on long-SE sequences (TE greater than 75 msec) correlated with endothelial-lined vascular channels separated by fibrous and/or fatty linear strands. An awareness of the morphologic MR pattern of soft-tissue hemangiomas may aid in recognition of these lesions.     

Breast and axillary tissue MR imaging: correlation of signal intensities and relaxation times with pathologic findings

We tested a variety of inversion-recovery (IR) and spin-echo (SE) sequences by imaging the breast masses of 22 patients before surgery and 23 tissue specimens with magnetic resonance (MR) imaging at 0.6 T to determine the most effective pulse sequences to evaluate breast disease. An SE pulse sequence using a long repetition time (TR) of 1,600 msec and a long echo time (TE) of 90 msec was found to be the most sensitive in depicting carcinoma in the excised tissue specimens, with all of the carcinomas (n = 15) demonstrating irregular areas of higher signal intensity (SI) than that of the adjacent fat. However, only five of 11 breast carcinomas present in the preoperative patients produced a higher SI than that produced by fat on the same T2-weighted sequence. Five of the remaining six carcinomas in the preoperative patients appeared as localized distortions of fibroductular architecture on both T2-weighted SE and IR sequences. In axillary tissue specimens, both metastatic carcinoma and hyperplastic lymph nodes produced a high SI on T2-weighted SE sequences. However, metastatic carcinoma had a significantly longer T2 relaxation time than did hyperplastic lymph nodes.     

Cervical spine: postmortem assessment of accident injuries--comparison of radiographic, MR imaging, anatomic, and pathologic findings.

PURPOSE: To assess the ability of postmortem radiography and magnetic resonance (MR) imaging to depict occult cervical spine injuries as compared with anatomic and pathologic findings. MATERIALS AND METHODS: The cervical spines of 10 adult accident victims underwent radiography and MR imaging, with T1-weighted, fast spin-echo T2-weighted, and four gradient-echo pulse sequences. The frozen specimens were cut into 3-mm-thick slices (sagittal plane) and photographed, and microfocus radiographs were obtained. Imaging findings were compared with the anatomic and pathologic findings. RESULTS: Eight of the 10 specimens had 28 posttraumatic lesions: three fractures (two missed at the initial MR imaging reading), 10 facet joint capsule lesions with bleeding, five soft-tissue and ligament lesions, eight disk lesions, and two spinal cord lesions. Radiography depicted one lesion (4%). Two partial ruptures of the anterior annulus fibrosus were depicted at only MR imaging. Initially, 11 of 28 lesions were detected on MR images; retrospectively, 17 of 28 lesions were correlated with anatomic findings. CONCLUSION: Soft-tissue and intervertebral disk and ligament injuries account for 89% (25 of 28) of posttraumatic cervical spine lesions detected on postmortem images. Occult lesions, including apophyseal joint injuries, were found in clinically noninjured cervical spines. MR imaging was limited in the depiction of discrete lesions when T1-weighted non-fat-saturated, fast spin-echo T2-weighted, and gradient-echo pulse sequences were used.     

Cirrhotic nodules: association between MR imaging signal intensity and intranodular blood supply

PURPOSE: To retrospectively determine whether there is a relationship between the intranodular blood supply evaluated at computed tomography (CT) during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) and the magnetic resonance (MR) imaging signal intensity of nodules associated with cirrhosis. MATERIALS AND METHODS: Neither institutional review board approval nor informed consent was required for retrospective reviews of medical records and images. One hundred fourteen hepatocellular nodules 10 mm or greater in largest diameter in 58 patients (39 men, 19 women; mean age, 61 years) with cirrhosis were evaluated at CTAP, CTHA, and MR imaging. The CTAP and CTHA nodule findings were divided into three main types: Type A nodules were isoattenuating at CTAP and hypoattenuating at CTHA; type B nodules, slightly hypoattenuating at CTAP and hypoattenuating at CTHA; and type C nodules, strongly hypoattenuating at CTAP and hyperattenuating at CTHA. The relationships between the CTAP and CTHA findings and the MR imaging signal intensity among these nodules were analyzed by using the chi(2) test. RESULTS: On T1-weighted MR images, 27 (63%) of 43 type A nodules were hyperintense, nine (39%) of 23 type B nodules were isointense, and 19 (48%) of 40 type C nodules were hypointense; differences were not significant. On T2-weighted MR images, 31 (72%) of 43 type A nodules were hypointense (P < .05), 12 (52%) of 23 type B nodules were isointense, and 34 (85%) of 40 type C nodules were hyperintense (P < .05). CONCLUSION: There was a significant association between intranodular blood supply and nodule signal intensity on T2-weighted MR images. However, study findings did not show whether the blood itself (ie, blood volume or blood flow amount) directly influenced the signal intensity.     

髋关节置换术后股骨假体周围Vancouver B型骨折的治疗

目的研究全髋关节置换术后股骨假体周围VancouverB型骨折的治疗效果。方法股骨假体柄周围骨折10例，其中Vancouver分类B1型3例，B2型2例，B3型5例。B1型骨折行切开复位，异体皮质骨板移植加钢丝环扎治疗；B2型骨折行切开复位，钢丝或线缆固定，加长股骨柄翻修；B3型骨折行切开复位，加长股骨柄翻修，异体皮质骨板移植加钢丝环扎固定。全部患者均得到随访，时间8～36个月，平均27个月，采用Harris髋关节功能评分和X线片对治疗结果进行评价。骨折愈合，患肢恢复行走功能为治疗成功，而骨折未愈合、假体松动、发生感染等并发症需要再次手术治疗者为治疗失败。结果10例患者骨折全部愈合，假体无松动、感染等并发症，治疗成功率100％。9例患者自由行走，1例需要助行器帮助。最后一次随访，Harris评分平均为83分。移植骨板与宿主骨骨性愈合，股骨皮质厚度增加3～5mm。结论假体稳定性和局部骨骼条件是影响VancouverB型骨折治疗效果的重要因素，针对髋关节置换术后假体柄周围VancouverB型骨折不同亚型采用不同的治疗方法能够取得很好的疗效。同种异体皮质骨板移植重建股骨假体周围骨折，不但能提供固定支撑作用，而且可促进骨折愈合，增加局部骨量和改善骨强度，显示出较好的优越性。     

MR imaging of uterine carcinoma: correlation with clinical and pathologic findings

Thirteen patients with clinical stages I and II endometrial carcinoma were examined with magnetic resonance (MR) imaging before surgery. Depth of invasion and stage of disease were assessed, and the results were compared with those from MR images of the surgical specimens and pathologic findings. Staging with MR imaging was accurate in 11 of 13 patients (85%). Our results agree with previous reports that MR imaging is an accurate, noninvasive method of assessing depth of myometrial invasion and cervical involvement. We anticipate that MR imaging will have an increasing role in treatment of patients with endometrial carcinoma.     

Brachial plexus: correlation of MR imaging with CT and pathologic findings

Thirty-two patients with symptoms referable to the brachial plexus were evaluated with magnetic resonance (MR) imaging. Sixteen patients had undergone concurrent computed tomography (CT). MR imaging demonstrated normal findings in 16, 12 neoplasms, three cases of trauma, and one case of possible neural edema. Of the 16 patients with normal findings on MR images, eight had CT scans that were also normal. In one patient, MR images showed that the "mass" seen on CT was actually a tortuous blood vessel. In six of the 12 cases of neoplasm in which CT scans were available, MR imaging revealed more extensive disease. In the other six cases of tumor, MR imaging provided sufficient clinical information to obviate the need for CT or any other imaging modality. MR imaging provided definitive diagnoses in the three cases of trauma without further imaging. In one patient with paresthesia, MR imaging showed high signal intensity of the nerves on T2-weighted images, which was compatible with neural edema. A concurrent CT scan was normal.     

Primary sclerosing cholangitis: MR imaging findings with pathologic correlation.

OBJECTIVE: The purpose of this study was to evaluate MR imaging findings of primary sclerosing cholangitis, to compare them with histopathologic findings, and to determine if these findings help differentiate primary sclerosing cholangitis from other disorders that result in end-stage liver disease. MATERIALS AND METHODS: MR imaging was performed in 40 patients (27 men, 13 women; age range, 13-72 years; mean, 47 years) with primary sclerosing cholangitis over a 9-year period. In 16 patients who underwent orthotopic hepatic transplantation and in seven patients who underwent needle biopsy, correlation was made between MR imaging and pathologic findings. RESULTS: Focal signal changes in the liver parenchyma were seen on T2-weighted images as peripheral wedge-shaped zones of increased signal intensity in 29 patients (72%), as a reticular pattern in 15 patients (38%), and as periportal edema in 16 patients (40%). Lobar atrophy involved the right lobe in three patients (8%) and the left lobe in 11 patients (28%); hypertrophy of the caudate lobe was seen in nine patients (23%). Features of portal hypertension were seen in 14 patients (35%). Histologic assessment showed zones of segmental atrophy and scarring on the periphery of the liver. CONCLUSION: Peripheral wedge-shaped areas of high T2 signal intensity and dilatation of bile ducts are characteristic MR features of primary sclerosing cholangitis. Pathologic correlation suggests that these features may be related to underlying perfusion changes and bile duct inflammation in patients with primary sclerosing cholangitis.