多级图像对比度放大技术在膝关节摄影中的应用

目的:分析评价膝关节摄影中多级图像对比度放大技术(MUSICA)参数设定的成像效果,为实际临床应用提供理论指导。方法:随机抽取膝关节侧位软拷贝图像70例,以骨皮质、骨小梁、肌间隙、髌上囊、皮下脂肪为比对目标,由三位观察者对其显示情况进行分析,并对结果进行统计分析。结果:MUSICA处于较小值(0～2)时,适合于软组织显示,但图像锐利度欠缺;处于较高值时(4～6)适合于观察骨皮质、小梁等细节信息,但较多地出现伪影,共25例;处于2～4时整体影像对比度适中,如实反映人体密度结构。结论:作图像处理时应将MUSICA为2～4设定为常规,实际应用通常情况下可以选择该处理方法,但应根据具体要求适当调整MUSICA参数值。     

强直性骶髂关节炎的42例CT诊断

目的：回顾性分析强直性脊柱炎的骶髂关节CT表现及诊断价值。方法：分析42例临床诊断为强直性脊柱炎的骶髂关节的CT征象,进行分级,并与临床分期对照。结果：临床早期CT级表现骶髂关节的面呈对称性或不对称受累,关节面毛糙。皮质白线消失．骨关节面皮质中断．关节面下小囊变。临床中期CT级,表现为骶髂关节面局呈锯齿状或毛刷状改变．关节面下小囊状骨质破坏及其周围增生硬化。关节间隙假性增宽或不规则狭窄,关节间隙内含气征。晚期CT级为临床稳定期,可见韧带钙化,关节骨性强直和关节间隙消失。明显骨质疏松,为临床稳定期。结论：CT能够清晰显示骶髂关节的细微结构．作出正确的分级诊断,为临床分级提供依据。     

拟定Ⅰ期强直性脊柱炎的影像学诊断

目的：拟定强直性脊柱炎(AS)的早期(I期)影像学诊断标准。方法：1463例骶髂关节CT检查中，正常284例，AS1179例，l期483例。并经过中西医结合治疗，以及治疗前后影像学对比观察。结果：正常骶髂关节：①关节面光整，骨皮质密度均匀．厚薄一致；②关节间隙宽度呈左右、上下对称一致；③紧靠关节面骨皮质的松质骨小梁清晰可辨。I期AS的影像学表现为：①髂骨侧关节面骨皮质模糊，浓密不均，部分骨皮质消失或完全消失；②髂骨侧紧靠骨皮质的松质骨小梁难以辨认；③关节间隙狭窄。I期AS经过中西医结合治疗后可完全痊愈，未经治疗的I期变为Ⅱ期，即关节面出现缺损。结论：拟定的I期AS影像学诊断经治疗前后的影像对比证明是正确的。     

颈胸交界区感染、积气性病变MDCT表现特征及其解剖、病理学基础

目的：明确颈胸交界区感染、积气病变的MDCT影像表现特点和规律,结合尸体断面解剖观察,探讨其影像学表现与解剖、病理学基础的相关性。方法：观察尸体断面标本11具（5例横断面、4例矢状面和2例冠状面）,主要观察颈胸交界区组织结构的位置、形态特征,并结合经临床或病理证实的颈胸交界区感染、积气性病变84例的MDCT表现特点及规律,阐明影像学表现与解剖、病理学的相关性。结果：ll例尸体断面解剖发现：咽后间隙、椎前间隙与上纵隔食管后间隙自然相通;椎前间隙向外下方经腋鞘与腋窝相连通;颈动脉鞘向下与上纵隔血管周围间隙相延续;颈部气管前间隙向下与上纵隔相通。84例患者的MDCT影像表现：咽后间隙感染可向下达后纵隔;椎前间隙感染可向下蔓延至后纵隔,向两侧蔓延至腋窝;颈动脉鞘感染可向下延伸至上纵隔;积气性病变可同时分布于纵隔、颈部、腋窝区。结论：MDCT能够详细反映颈胸交界区感染、积气病变的局部表现和向周围扩散的情况;尸体断面发现的解剖特点决定了此区域病灶的优势分布．     

咽旁间隙三维断层影像解剖学研究

目的　研究咽旁间隙及毗邻结构的断面解剖形态及其CT、MRI影像表现。材料与方法　在尸体头部左、右侧切取各边长度约 8.0cm的并包含咽旁间隙及毗邻结构在内的组织块 ,利用生物塑化技术将这些组织块制作成横、冠、矢 3个方位的连续薄层断层标本 (层厚 1.2mm) ,并与CT、MRI图像对照。结果　确定了咽旁间隙划分的具体方法 ,明确了茎突前间隙、茎突后间隙和咽后间隙各自的界限。MRI以其对软组织的高分辨率、多平面成像等特点 ,可较CT更好地显示咽旁间隙的软组织结构 ,但CT在显示颅底骨质及骨性通道等方面要明显优于MRI。结论　结合塑化薄片、CT及MRI图像以深入了解咽旁间隙及毗邻间隙的解剖是非常必要的。确定咽旁间隙的划分标准有助于对该区病变的影像诊断 ,帮助临床医生制定更恰当的治疗方案     

Madelung综合征的影像表现(附4例报告)

目的探讨Madelung综合征的CT与MRI表现特征。方法搜集4例Madelung综合征患者。2例患者行CT增强扫描,2例行MRI平扫。分析其临床特点及影像表现。结果 4例Madelung综合征患者均有长期大量饮酒史,表现为颈及肩背部浅层皮下脂肪及深层脂肪增多。CT显示病变部位增厚的脂肪组织,CT值为-100HU;MR T1WI、T2WI及T2WI脂肪抑制序列均能显示病变部位脂肪增多,呈短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。CT与MRI均能显示喉内及其周围结构脂肪组织浸润,双侧背阔肌、胸锁乳突肌缩小变薄,肌间隙稍增宽。结论 CT与MR检查对Madelung综合征可明确诊断,为临床治疗提供有价值的信息。     

强直性脊柱炎骶髂关节病变螺旋CT早期诊断的探索

目的:探讨螺旋CT对早期强直性脊柱炎骶髂关节病变的诊断价值。方法:对38例临床确诊为强直性脊柱炎的骶髂关节的螺旋CT征象及临床资料进行回顾性分析。结果:早期强直性脊柱炎骶髂关节病变的影像表现为髂骨侧关节面模糊,皮质部分或完全消失,近皮质部的松质骨增生硬化糜烂、密度不均呈"融雪状",骨小梁模糊,随病程延长可向骶骨侧与韧带部发展,关节内软组织肿胀等。结论:螺旋CT能够清晰显示骶髂关节的局部细微结构,对病变早期发现与分期更准确,应作为首选检查方法。     

急性胰腺炎并发症的CT研究及其解剖基础分析

目的：研究急性胰腺炎并发症的CT表现，并分析其解剖基础。材料和方法收集经临床证实的120例急性胰腺炎病例的CT资料，观察其并发症的CT表现，分析其解剖基础。结果：CT显示并发症为腹膜后和腹腔积液，肝、肿、肾、胃、肺等脏器损害及亚腹膜间隙受累。结论：急性胰腺炎并发症主要为多间隙积液及箩脏器受累。积液的分布与腹腔、腹膜后间隙的解剖结构及其相互通连情况密切相关，亚腹膜间隙是病变扩散的重要途径。     

CR影像后处理在肋骨骨折诊断中的应用

目的探讨CR图像后处理技术在肋骨骨折中的应用价值。方法对临床怀疑肋骨骨折512例患者的肋骨CR影像应用谐调处理与空间频率处理的方法进行技术处理。结果对季肋部与下部肋骨骨折单独调节谐调处理参数与单独调节空间频率处理参数及二者同时结合使用,所得影像可以满足临床诊断的需要,其临床诊断符合率分别为80.5%,81.5%,92.4%。结论应用CR的谐调处理和空间频率处理调整影像的对比度和锐利度,通过信息后处理来显示不同解剖部位的影像,在胸部可以得到满意的、适合诊断要求的照片。     

螺旋CT表现遮盖法及多平面重组对骨病变的诊断价值

目的：探讨螺旋ＣＴ三维（３Ｄ）表面遮盖法（ＳＳＤ）和多平面重组（ＭＰＲ）立体和多方位显示骨病变,比较与常规ＣＴ的优缺点。材料与方法：选择３０例典型病例,均经临床或手术病理证实。全部数据输入工作站进行图像处理。结果：ＳＳＤ很好地立体展现了骨病变,ＭＰＲ可从任意平面观察并能进行位置调整。结论：ＳＳＤ和ＭＰＲ在影像显示上有独特的优势,可立体或任意平面观察病变,改变了影像思维方式,有助于影像与实际解剖相结合。     

Imaging of acute injuries of the articular surfaces (chondral, osteochondral and subchondral fractures)

Fractures involving the articulating surfaces of bone are a common cause of chronic disability after joint injury. Acute fractures of the articular surface typically run parallel to the surface and are confined to the cartilage and/or the immediate subchondral cancellous bone. They should be distinguished from vertical or oblique bone fractures with intra-articular extension. This article reviews the mechanism of acute articular surface injuries, as well as their incidence, clinical presentation, radiologic appearance and treatment. A classification is presented based on direct inspection (arthroscopy) and imaging (especially MRI), emphasizing the distinction between lesions with intact (subchondral impaction and subchondral bone bruises) and disrupted (chondral, osteochondral lesions) cartilage. Hyaline cartilage, subchondral bone plate and subchondral cancellous bone are to be considered an anatomic unit. Subchondral articular surface lesions, osteochondral fractures and solely chondral fractures are different manifestations of impaction injuries that affect the articulating surface. Of the noninvasive imaging modalities, conventional radiography and MRI provide the most relevant information. The appropriate use of short tau inversion recovery, T1-weighted and T2-weighted (turbo) spin-echo as well as gradient-echo sequences, enables MRI to classify the various acute articular surface lesions with great accuracy and provides therapeutic guidance. Received: 5 April 1999 Revision requested: 6 May 1999 Revision received: 21 June 1999 Accepted: 12 July 1999     

骨斑点症的影像学表现(附6例报告及文献复习)

目的:提高对骨斑点症的影像学认识.方法:对6例患者均行全身骨X线检查,4例行CT与MRI检查.结果:6例患者发病均较广泛并双侧对称,病灶呈大小不等的圆形,类圆形硬化结节.大部分病灶位于骨松质内,并与骨小梁走行一致,少部分位于骨皮质内.相邻关节软骨无异常改变.结论:骨斑点症X线、CT、MRI表现均具有特异征象,可明确诊断.     

L形钢板加螺钉骨栓髂骨植骨治疗股骨髁部粉碎骨折

目的：股骨髁部粉碎骨折保守治疗效果差,采用手术复位内固定以利恢复膝关节功能。方法：2005～2009年采用L形钢板和螺钉骨栓髂骨植骨内固定治疗股骨髁粉碎骨折52例。术中先用螺丝固定内处髁,然后用L形钢板固定髁和股骨干。结果：所有骨折愈合,骨折解剖复位47例。随访1～3.5年,总优良率88.5%。结论：股骨髁部粉碎骨折应早期手术。采用L形钢板和螺钉内固定能达到解剖复位,坚强固定,早期功能锻炼,有利膝关节功能恢复。     

Histomorphometry of primate's iliac bones following head-down tilting and "dry" immersion]

Histomorphometry of the iliac bone in Macaca mulatta males was performed in experiments with 30-d head-down tilting (HDT, n = 6) and 8-10-d "dry" immersion (DI, n = 6). The iliac crest was sampled two weeks before DI or a month prior to HDT, and immediately after completion of the experiments. HDT was shown to provoke osteopenia in the bone spongy manifested by losses in the volume of spongiosa, number of trabeculae, and growth of the space in-between. Osteoids were noted to gain volume and thickness, whereas the osteoclast resorption surface was not altered The iliac spongiosa deviations following DI were qualitatively similar to those after HDT but more marked as evidenced by reduction in such integral parameter as the spongy volume. Analysis of the data and their comparison with iliac bones taken from the space-flown primates suggest that DI can be viewed as another, besides HDT, ground-based model of microgravity effects on the spongy bone. Exposure in DI was less durable and yet caused qualitatively same atrophy of the iliac spongiosa as HDT though a bit more significant.     

A simple model for anatomic bone scanning studies.

A simple anatomic model for studying the scintigraphic appearance of various skeletal structures is described. The technique makes use of the fact that technitium pyrophosphate uptake in bone occurs by chemisorption to the surface of crystals in the bone matrix. By soaking clean bones in solutions of technetium pyrophosphate they can be rendered radioactive and subsequently studied by various imaging techniques.     

Magnetic resonance arthrography indications and technique (I). Upper limb

Magnetic resonance (MR) is the most effective imaging technique in the diagnosis of articular pathology. MR arthrography (MRA), with intra-articular injection of diluted gadolinium or physiological saline solution has become more common in recent years. The intra-articular fluid facilitates the detection of articular pathology by delineating the articular structures, separating adjacent anatomic structures, and filling potential spaces that originate in or communicate with the joint. MRA provides additional information about the integrity of the articular structures, especially cartilage, fibrocartilage, and ligaments. MRA has proven especially useful in the shoulder, where most of the studies have been centered. The detection of subtle lesions of the capsule/labrum complex is fundamental for presurgical evaluation. MRA can be used to complement conventional MR imaging in some cases and in others it is the initial technique of choice. Indirect MRA with intravenous gadolinium administration is based on the enhancement of articular fluid caused by diffusion from the synovial space to the articular space. This technique offers better results in articulations with less capacity for distension, such as the wrist, ankle, hand, and foot. This first part of two-part article reviews the current role of MRA in the upper limb. Special emphasis is placed on the shoulder joint, where its usefulness has been most clearly established. The usefulness of this technique in other joints is also described, reviewing the most important anatomic aspects, techniques and applications.     

MR fat suppression technique in the evaluation of normal structures of the knee

The chopper fat suppression (CFS) pulse sequence, which is a phase sensitive implementation of the Dixon fat suppression method and the spin echo (SE) pulse sequence, was used in the evaluation of anatomic structures of the normal knee using 48 sets of imaging sequences in six volunteers using a repetition time/echo time combination of 1,500/30, 60 ms. A demonstration of the CFS technique in 10 patients with suspected knee pathology is also presented. A semiquantitative grading scale was established to rate anatomic visualization and used to compare CFS and SE pulse sequence techniques. The results in normal subjects demonstrate that hyaline cartilage is significantly better visualized by fat suppression pulse sequence than by conventional SE pulse sequence in the coronal and sagittal planes of imaging (p less than 0.001). The preliminary results from patients studies suggest that CFS imaging may be useful in the evaluation of meniscal tears, in the differentiation of hyaline cartilage from joint fluid, and in the detection of both soft tissue and bone injuries.     

Extra-osseous fat fluid level: a specific sign for osteomyelitis

Osteomyelitis may pose as a diagnostic dilemma on various imaging modalities and may be confused with neoplasms and other pathology. Although a rare finding, extra-osseous fat fluid level, especially when associated with spongy bone destruction, can be considered a specific sign of osteomyelitis. Previously, only two cases of extra-osseous fat fluid level in osteomyelitis have been reported, one on computed tomography (CT) and the other on magnetic resonance imaging (MRI). The former was a case of septic arthritis with intra-articular fat fluid level. A case of osteomyelitis is presented with the demonstration of extra-osseous fat fluid level. Our case is unique in providing exquisite CT and MRI correlation.     

Mimics of bone and soft tissue neoplasms

Many benign nonneoplastic entities can mimic bone and soft tissue tumors on imaging examinations. Distinguishing between neoplastic and nonneoplastic entities depends on history and physical examination findings and imaging findings, and is an important early step in the patient's overall workup and treatment plan. This article describes some of the pseudotumors seen on imaging studies in our orthopedic oncology clinic, as well as mimics of bone and soft tissue neoplasms described in the medical literature. Tumor mimics resulting from anatomic and developmental variants, trauma, infection and inflammation, osteonecrosis and myonecrosis, articular and juxta-articular conditions, and miscellaneous causes are discussed.