Cardiac sarcoidosis diagnosed by multimodality imaging

A 66‐year‐old woman presented with frequent premature ventricular contractions (PVC) and akinesis of the basal septum on echocardiography. Coronary angiography was normal. Cardiac magnetic resonance showed mid‐wall enhancement. Positron emission tomography showed a perfusion defect at the same location using 13N‐ammonia, but increased 18‐fluorodeoxyglucose uptake. These findings supported the diagnosis of cardiac sarcoidosis. High‐dose steroids initially reduced frequency of PVCs but had to be withdrawn due to severe side effects. An ICD was implanted. Our case demonstrates the utility of multimodality imaging to diagnose and guide management of this entity.     

Hepatic peribiliary cysts diagnosed by magnetic resonance cholangiography

Received: March 8, 2000 / Accepted: June 23, 2000     

Epithelioid angiomyolipoma of the liver： Cross-sectional imaging findings of 10 immunohistochemically-verified cases

AIM： To retrospectively evaluate the computed tomography （CT）/magnetic resonance imaging （MRI） imaging features of epithelioid angiomyolipoma of the liver （Epi-HAML）, with pathology as a reference. METHODS： The CT/MRI findings （number, diameter, lobar location, and appearance of lesions） in a series of 10 patients with 12 pathologically proven epithelioid angiomyolipomas of the liver were retrospectively analyzed. The imaging features, including attenuation/ signal intensity characteristics, presence of fat, hypervascular, outer rim, and vessels within lesion, were evaluated and compared with that of non-Epi- HAML in 11 patients （13 lesions）. The Fisher exact test was used to compare difference in probability of imaging features between the two types. RESULTS： For 21 patients, CT images of 15 patients and MR images of six patients were available. No patient underwent two examinations. For the 15 patients with a CT scan, all HAML lesions in the two groups （10 Epi-HAML and seven non-Epi-HAML） manifested as hypoattenuation. For the six patients with MRI, all lesions （two Epi-HAML and six non-Epi- HAML） were hypointense on TlWI （fat suppression） and hyperintense on T2WI. There were 10 non-Epi-HAML, but only two Epi-HAML lesions showed the presence of fat, which significantly different between the two types （P = 0.005）. On the dynamic contrast enhancement （DCE） imaging, eight Epi-HAML, and 13 non-Epi lesions manifested as hypervascular. Punctate or curved vessels were displayed in 10 Epi-HAML as well as in nine non- Epi lesions and outer rim enhancement could be found with eight Epi-HAML as well as six non-Epi lesions. CONCLUSION： Little or no presence of adipose tissue was found to be an imaging feature of Epi- HAML, compared with the non-Epi type. In addition, hypervascularity with opacification of central punctiform or filiform vessels on DCE would be a characteristic enhancement pattern for Epi-HAML.     

小脑分水岭梗死的临床和影像学分析

目的探讨小脑分水岭梗死患者血管病变特点。方法收集178例小脑梗死病例的临床表现及磁共振成像（MRI）、磁共振弥散加权成像（DWI）、磁共振血管造影（MRA）／CT血管造影（CTA）检查结果,按DWI上病灶部位分为小脑分水岭梗死和非分水岭梗死。根据MRA／CTA检查结果将椎一基底动脉狭窄部位分为四种类型：颅内段、颅外段、混合性和未发现狭窄,比较小脑分水岭梗死和非分水岭梗死患者血管病变的特点。结果178例患者中42例符合小脑分水岭梗死;小脑分水岭梗死患者起病时症状较轻,预后良好,但血管狭窄发生率为90．5％,高于小脑非分水岭梗死（74．3％）;颅内段、颅外段、混合性、未发现狭窄4种血管病变类型在小脑分水岭梗死患者中分别占14．3％,52．4％,23．8％,9．5％,在小脑非分水岭梗死中则分别为33．8％,16．2％,24.3％,25．7％。结论尽管小脑分水岭梗死患者有着更为良性的临床表现和预后,但大血管狭窄,尤其是椎动脉颅外段狭窄的发生率高,应早期进行血管内干预治疗。     

下肢缺血的影像学评估及新进展

下肢缺血的诊断和治疗依赖于精确的影像学评估。传统影像学评估主要包括双相超声、动脉内数字减影血管造影、计算机断层扫描血管造影和磁共振血管造影。它们都主要针对肢体缺血病变的血管解剖结构进行评估。近年来一些针对缺血区域血流灌注情况评估的影像学方法逐渐被应用在外周动脉疾病的诊断和指导治疗中,包括激光多普勒血流仪、高光谱成像、吲哚氰绿血管造影等。改善的传统成像技术与新兴的灌注影像学方法为下肢缺血的诊断和治疗提供了新的思路,两者结合具有重要的临床价值。     

The role of imaging techniques in the management of multiple myeloma

Bone disease is the major feature of multiple myeloma (MM). Imaging is required for correct staging, in the follow‐up after treatment and, as recently highlighted, is predictor of prognosis. In the near future, whole‐body X‐Ray may be replaced by more sensitive techniques, such as whole‐body low‐dose computerized tomography (CT). Magnetic resonance imaging (MRI) is the gold standard method for assessing bone marrow infiltration of the spine, predicting the risk of vertebral fracture and distinguishing between benign and malignant osteoporosis. Positron emission tomography (PET) with CT (PET/CT) provides important information about the extent of whole‐body disease, including soft tissue masses, and is the best tool to distinguish between active or inactive disease after therapy. Both MRI and PET/CT are predictors of clinical outcome. A prospective use of these newer imaging techniques in both clinical trials and clinical practice may help optimize MM management in the near future.     

Hepatic sarcoidosis associated with chronic hepatitis C

Received: November 18, 2000 / Accepted: April 13, 2001     

A discrepant finding between magnetic resonance imaging and other imaging modalities suggests a microcystic serous cystadenoma of the pancreas

Summary Background. Serous cystadenoma of the pancreas is generally considered as having no malignant potential. Thus, of clinical importance is a differential diagnosis of this neoplasm from other solid tumors that are often malignant. Results. We report a case of microcystic serous cystadenoma of the pancreas. Abdominal ultrasonography, computed tomography, and endoscopic ultrasonography showed a solid mass in the body of the pancreas with a diameter of 15 mm, but magnetic resonance imaging revealed it as a unilocular cystic lesion. Histological examinations on the surgically resected tissue specimen showed a honeycombed tumor with innumerable tiny cysts appearing grossly as a solid mass. The discrepant finding between magnetic resonance imaging and other imaging modalities observed in this case is suggestive of and might be specific to microcystic serous cystadenoma of the pancreas. Conclusions. Magnetic resonance imaging is a mandatory modality to identify pancreatic serous cystadenoma that contains no visible cystic compartments on computed tomography and ultrasonography.     

磁共振弥散加权成像对肾癌与肾血管平滑肌脂肪瘤的诊断价值

目的探讨磁共振弥散加权成像对肾癌和肾血管平滑肌脂肪瘤的诊断价值。方法选取85例肾肿瘤患者（包括肾癌54例,肾血管平滑肌脂肪瘤31例）,术前行常规MRI平扫检查及弥散加权成像,并在取b值为800 s/mm2时直接测量肾脏肿瘤实性部分的平均表观弥散系数（ADC）值。结果 54例肾癌肿瘤实性部分在弥散加权成像上表现为高信号;31例肾血管平滑肌脂肪瘤表现为边界清楚的混杂信号,其中软组织部分呈等、稍高信号,脂肪部分呈低信号。在b值取800 s/mm2时,肾癌、血管平滑肌脂肪瘤的ADC值比较差异具有统计学意义（P〈0.05）。结论通过弥散加权成像及ADC值,可以更多了解肿瘤的内部结构,有助于肾脏良恶性肿瘤的诊断和鉴别诊断。     

肝脏影像学检查在土三七引起的肝小静脉闭塞性疾病中的诊断价值

目的探讨肝脏影像学改变在肝小静脉闭塞性疾病(HVOD)患者诊断中的价值。方法对45例HVOD患者临床表现、肝脏影像学检查及肝穿刺组织学变化进行分析。结果 45例患者肝脏超声检查有28例患者可见"斑片状"或"豹纹状"低回声区;CT检查均有"地图状"密度改变,肝脏MRI T1WI均呈大片状低信号,T2WI信号呈略高信号,增强后呈"地图状"不均匀强化。肝脏超声诊断HVOD符合率62.2%(28/45);肝脏CT、MRI诊断HVOD符合率100%,二者差异有统计学意义(χ2=15.06,P<0.05)。21例作肝组织穿刺确诊的HVOD患者,检查均显示肝脏有"地图状"的高、低密度改变。结论肝脏CT、MRI诊断HVOD较肝脏超声检查有更高敏感性和特异性。肝脏CT、MRI可替代肝穿刺组织学检查诊断HVOD。     

成人烟雾病16例临床和影像学特点研究

目的探讨成人烟雾病(MMD)的临床和影像学特征。方法回顾性总结2006年1—12月在山东大学齐鲁医院经脑血管造影证实的16例成人MMD患者的临床及影像学特征。结果 16例患者平均年龄为(40.8±9.8)岁;15例(93.75%)以缺血性脑血管病为首发症状;1例(6.25%)以非典型血管病为首发症状;无脑出血患者。颅内有梗死灶或出血性梗死灶者12例(85.7%);双侧颈内动脉(ICA)末端、大脑中动脉(MCA)和(或)大脑前动脉(ACA)起始部狭窄或闭塞、伴有脑底部异常血管网及侧支循环形成的13例(92.9%);仅表现为脑动脉硬化者1例(7.1%)。双侧ICA末端及ACA、MCA起始部不同程度狭窄或闭塞者10例(62.5%);单侧血管病变者6例(37.5%);可见不同程度的侧支循环形成者15例(93.8%);烟雾状血管形成者13例(81.2%)。结论成人MMD患者的临床表现以缺血性症状为主,发病年龄高峰在40岁左右。影像学特征为双侧ICA狭窄或闭塞,伴有MCA或ACA的狭窄或闭塞,颅底有不同程度异常增生的血管网。对于青壮年反复出现脑梗死者,应考虑MMD的可能并及早行MRA或DSA检查。     

Comparison of angiography,CT arteriography and MR imaging in assessment of liver metastases treated by percutaneous transcatheter intraarterial chemotherapy

Abstract: The purpose of this study was to compare results of digital subtraction angiography (DSA), computed tomographic arteriography (CTA), and magnetic resonance imaging (MRI) in the assessment of patients with liver metastases subjected to percutaneous transcatheter intra-arterial chemotherapy. Forty-four patients with liver metastases treated by cyclic percutaneous transcatheter intra-arterial chemotherapy were examined before each cycle by an imaging protocol consisting of DSA and CTA. MRI was added to this protocol in 18 patients. DSA and CTA equally detected thrombosis of the catheter or arteries distal to the catheter tip in 16 examinations. DSA detected arterial reflux in 15 examinations, while CTA detected only one case of reflux. CTA was superior to DSA in demonstrating perfusion abnormalities and superior to MRI in detecting metastases. CT was the only method that demonstrated intratu-moral calcification. In conclusion, in patients with liver metastases subjected to percutaneous transcatheter intra-arterial chemotherapy, DSA is the best method for detection of arterial reflux, whereas CTA is the best method for detection of metastases and demonstration of perfusion abnormalities.     

Comprehensive assessment of a post-coronary bypass graft patient with cardiovascular magnetic resonance imaging and multi-detector computed tomography

Coronary bypass graft surgery (CABG) is a revascularization procedure which reduces myocardial ischemia and cardiovascular morbidity and mortality in selected patients;however, up to 40% of saphanous vein grafts may degenerate over 10 years. Although coronary angiography is the gold standard to detect graft patency and native vessel disease, sometimes it is difficult to locate the grafts resulting in increased exposure to radiation and contrast administration. This case highlights the utility of cardiac computerized tomography and magnetic resonance imaging to provide comprehensive noninvasive assessment in a patient post CABG.(J Geriatr Cardiol 2007;4:244-247.)     

Imaging in rheumatoid arthritis – status and recent advances for magnetic resonance imaging, ultrasonography, computed tomography and conventional radiography

Within the field of imaging in RA, large and exciting advances have been made during the last decade. Although X-ray is still the most widely used tool for monitoring disease progression, other methods offer clear advantages through more sensitive depiction of inflammatory and destructive disease manifestations. MRI and US are increasingly used in RA trials and practice. MRI can visualize all the features involved in inflammation and damage in RA patients, and have documented independent prognostic value and superior sensitivity to change compared with conventional methods. US offers sensitive assessment of joint damage and, particularly, inflammation, and can be used by practising rheumatologists as part of the clinical examination. CT provides high-resolution images of erosion, and may have potential for sensitive monitoring of erosive progression.Overall, these new imaging modalities already provide important benefits for the clinician, including: more sensitive detection of early disease manifestations; more sensitive monitoring of responses to therapeutic agents, including improved assessment of whether optimal disease control (remission) has been achieved; and improved prognostication. Many questions concerning the optimal use of these new imaging modalities require further research efforts, but as technical advances are still progressing rapidly, the clinical and research applications of these modern imaging modalities are also expected to increase markedly during the next decade.Imaging could be useful in practice for the following:

A. In routine clinical practice

• to establish a diagnosis of RA (ACR 1987 criteria): X-ray

• to assist with the diagnostic workout in suspected, but not definite, inflammatory joint disease and early, unclassified inflammatory joint disease (by detection of presence/absence of synovitis, enthesitis, bone erosions etc.): MRI, US

• to monitor structural joint damage: X-ray, MRI

• to monitor disease activity: MRI, US

• to assist with the prognostic stratification of patients with early RA: X-ray, MRI

• to help define the presence or absence of true remission: MRI, US

• to guide aspirations and injections in joints, bursae and tendon sheaths: US

B. In research

• to assess structural joint damage in phase III/IV RA trials: X-ray, MRI

• to assess the anti-inflammatory effectiveness of a new compound (‘proof of concept' studies): MRI, US

• for pretrial selection of the patients most likely to progress (‘enrichment'): X-ray, MRI

For the individual imaging modalities, further exploration of:

• clinical value of differential diagnosis in early and in early suspected, but not certain, inflammatory joint disease: MRI, US

• clinical value of monitoring disease activity by imaging: MRI, US

• defining imaging remission and/or an imaging ‘acceptable state’: MRI, US

• clinical value of monitoring joint damage by imaging: MRI, US, CT

• benefit of and optimal methods for using modern imaging in clinical trials: MRI, US, CT

• development and testing of new technical methods: US (e.g. three-dimensional, new transducers), MRI (e.g. 3 Tesla imaging, whole-body MRI), X-ray (e.g. software for automated image interpretation)

Small angiomyolipoma of the liver diagnosed by fine-needle aspiration biopsy under ultrasound guidance

The first reported case of small hepatic angiomyolipoma to be diagnosed by fine-needle aspiration biopsy (FNAB) is described. A 53 year old man presented with a tumour in segment VI of the liver measuring 0.9 × 0.8 cm. The tumour was hyperechoic on ultrasound examination, showed relatively low density (+ 33 Hounsfield units) on computed tomography (CT), and was hypervascular on angiography. Computed tomography during arterial portography demonstrated a perfusion defect. Magnetic resonance imaging (MRI) revealed high intensity by both T1- and T2-weighted imaging. Diagnosis could not be obtained by these imaging modalities, but it was established successfully by FNAB under ultrasound guidance. Histologically, the tumour was an angiomyolipoma made up of three components: blood vessels, smooth muscle and fatty tissue. Surgery is unnecessary for this benign condition, and the patient has been followed up. Ten months later, the patient is currently doing well without growth of the hepatic angiomyolipoma.     

Cross‐sectional imaging for assessing intestinal fibrosis in Crohn's disease

More than 30% of patients with Crohn's disease (CD) develop fibrotic strictures in the bowel as the disease progresses. Excessive deposition of extracellular matrix components in the submucosa and smooth muscle hypertrophy or hyperplasia are the main features of fibrosis in CD. Cross‐sectional imaging technology provides a wealth of information on the anatomy, histological composition, and physiological function of the bowel, allowing for a non‐invasive and complete evaluation of associated abnormalities. This review summarizes recent advances in and the potential technologies of cross‐sectional imaging for assessing intestinal fibrosis in CD, including ultrasound imaging, computed tomography, and magnetic resonance imaging.