中枢神经系统白血病CT诊断

目的:探讨中枢神经系统白血病的CT表现,提高诊断水平。方法:总结经临床脑脊液细胞学检查找到白血病细胞共计17例CT表现,其中急性淋巴细胞白血病10例,急性非淋巴细胞白血病7例。CT平扫17例,增强扫描13例。结果:CT表现为脑池、沟消失,脑皮层区低密度,增强扫描呈斑片状及脑回样强化3例。脑实质内呈结节状及肿块状高密度影,周围伴水肿14例,增强扫描呈明显均匀强化。结论:结合临床,CT对中枢神经系统白血病诊断有帮助。     

中枢神经系统白血病的CT及MRI主要表现

目的 分析经临床证实的11例中枢神经系统白血病的CT及MRI表现,探讨其影像学特征,增进对该病的认识,为临床诊断提供依据.方法 回顾性分析经临床证实的11例中枢神经系统白血病CT及MRI的影像学表现.其中4例CT平扫后行MRI平扫及增强扫描检查;其余7例直接行MRI平扫或平扫+增强扫描检查.结果 ①白血病浸润软脑膜5例,CT表现为脑沟、脑池消失,内可见条状低密度灶,对应MRI表现为T1WI呈低信号,T2WI/FLAIR呈高信号,脑回肿胀,DWI呈稍高信号,增强后明显强化;合并蛛网膜下腔出血1例.②脑实质浸润6例,单发肿块2例,余均为多发,MRI表现T1WI低信号,T2WI/FLAIR高信号,DWI高信号,无明显占位效应,增强后明显强化;其中3例合并出血.③硬脑膜受累1例,累及额部板障,CT表现为软组织密度灶,MRI表现为软组织信号灶,增强后明显强化.结论 中枢神经系统白血病影像学表现有一定的特征性,影像学检查尤其是MRI增强检查有助于对中枢神经系统白血病表现的认识,以及诊断及鉴别诊断.     

儿童非霍奇金淋巴瘤与白血病肾脏浸润的CT表现

目的：认识儿童非霍奇金淋巴瘤（NHL）及白血病肾脏浸润的各种CT表现。材料和方法：复习病理证实的42例儿童NHL的临床资料,选出其中12例肾脏浸润的病例,分析化疗前后的CT变化,所有病例均行常规胸腹部CT平扫加增强扫描;4例白血病B超提示肾脏浸润,然后行腹部CT平扫加增强扫描。结果：NHL肾脏浸润表现为两侧肾脏多发结节样改变9例,单侧单弛节浸润2例,单侧多结节1例;4例白血病肾脏浸润全部表现为两肾多结节样改变。结论：儿童NHL与白血病肾脏浸润CT表现极其相似,具有一定的特征性,CT能很好显示肾脏浸润情况,正确及时地诊断肾脏浸润有助于NHL的临床分期,也有助于NHL及白血病化疗前后的疗效观察。     

A case of adult T-cell leukemia with metastatic calcification

We report a case of adult T-cell leukemia with increased uptake in both lungs which was detected by a bone scan using 99mTc-MDP. This finding is thought to have been caused by the metastatic calcification which is associated with ectopic parathormone production.     

A case of adult T-cell leukemia with metastatic calcification

We report a case of adult T-cell leukemia with increased uptake in both lungs which was detected by a bone scan using ^99mTc-MDP. This finding is thought to have been caused by the metastatic calcification which is associated with ectopic parathormone production.     

"Preventive" cranial irradiation in acute lymphoblastic leukemia in childhood]

In accordance with the recommendations of Pinkel, 147 children with acute lymphoblastic leukemia were treated by a combined cytostatic and radiation therapy during a joint study between May 1971 and Jan. 1, 1974. After a primary cytostatical treatment which brought about a remission of 94% of the patients within four to six weeks, the cranial irradiation was performed, depending on age, with a focal dose of 1500 up to 2400 rd in the course of three or four weeks. Simultaneously, the patients were given methotrexate intrathecally which was followed, later on, by a long-term therapy with cytostatics. By means of this combined treatment, a three-year survival was obtained in 50% (8 of 16) and a complete remission in 44% (7 of 16). The prognosis is the same for boys as for girls. A less favorable prognosis concerns the patients with an initial leukocytosisf more than 50 000 leukocytes/mm3 of blood, an age of more than ten years, and leukemic cells already demonstrable in the cerebrospinal fluid.     

Concurrent COVID-19 and pneumocystis carinii pneumonia in a patient subsequently found to have underlying hairy cell leukemia

SARS-CoV-2 infection manifestation has great diversity and it becomes even greater while co-infection occurs or there is a serious underlying disease in an affected patient. In this case report, we present a case of a 71-year-old man who underwent a chest CT scan following the development of fever, weakness, and pulmonary symptoms. Chest CT scan showed segmental consolidation with centrilobular nodular infiltration, ground glass opacifications in the inferior segment of the left upper and lower lobes, and left lung pleural thickening which was atypical for either COVID-19 infection or pneumocystis carinii pneumonia but his SARS-CoV-2 PCR result was positive and he received COVID-19 treatment. His symptoms recurred after a few months with the same chest CT findings and subsequent bronchoalveolar lavage revealed the presence of pneumocystis carinii infection. Consequently, he received cotrimoxazole which caused improvement in symptoms, nonetheless splenomegaly and anemia remained in his clinical and laboratory investigation. Accordingly, bone marrow study and flow cytometry was done and confirmed the previously undiagnosed hairy cell leukemia. This case accentuates the fact that when we face atypical clinical or paraclinical features in a COVID-19 patient, we should explore for coinfection or unknown underlying diseases.     

Bone scan "flare" in patients irradiated to formerly false negative bone metastasis]

We discuss three cases irradiated to their bone metastases. 99mTc-MDP bone scan before irradiation showed normal uptake in the lesions. In all the cases, the irradiation therapy was effective, but focal increased uptake area corresponding to the site of bone metastasis was revealed by the follow-up bone scan one to three months after irradiation. We concluded that the change of tracer uptake was so-called flare in formerly false negative lesion. The cause of this phenomenon was considered either elevation of osteoblastic activity with control of tumor or progression of osteolysis until tumor got well-controlled.     

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.     

复方黄黛片诱导急性早幼粒细胞白血病细胞凋亡的研究

为探讨复方黄黛片治疗急性早幼粒细胞白血病 (APL)的作用机制 ,观察了 2 1例经复方黄黛片治疗的APL患者 ,取不同治疗阶段的患者骨髓细胞 ,用流式细胞仪检测APL骨髓细胞分化抗原 (CD33和CD1 1b)、细胞周期 ,以及与细胞凋亡相关的Fas和Apo2 .7蛋白的表达。结果显示 ,服用复方黄黛片治疗后 ,患者骨髓的APL细胞CD33表达明显下降 ,CD1 1b表达升高 ,对细胞周期的影响主要表现为G2 /M期的阻滞 ,服药后Fas蛋白及Apo2 .7蛋白表达增加。提示复方黄黛片对APL细胞有凋亡和分化的双重作用 ,且细胞凋亡可能与Fas和Apo2 .7蛋白有关     

Intraosseous petrous apex neuroma: CT findings

An avascular, contrast enhancing intraosseous petrous apex mass was discovered on CT in a patient with prior colonic carcinoma and acute myelocytic leukemia. A normal bone scan made metastasis unlikely and surgery revealed a neuroma. The differential diagnosis is discussed.     

急性髓细胞性白血病组织学分型与颅骨骨髓MRI分型的对照分析

目的 分析急性髓细胞性白血病（AML）颅骨骨髓MRI分型与组织学分型的关系,并探讨MRI分型的临床价值。 方法 回顾性纳入30例经骨髓细胞学检查证实为AML的病人,男19例,女11例,中位年龄46.0岁。AML组织学分型为：M1型1例,M2型14例,M3型4例,M4型6例,M5型4例,M6型1例。30例病人治疗前均行头部MRI平扫,其中13例同时行增强扫描。由2名医师分析颅骨骨髓MRI影像特征并进行分型。采用Pearson卡方检验比较不同MRI分型的AML组织学分型差异,并分析2种分型的相关性。采用Kappa检验分析2名医师阅片结果的一致性。 结果 AML颅骨骨髓MRI主要表现为T₁WI上颅骨骨髓信号减低,增强扫描显示颅骨板障周边信号明显强化。依据MRI特征将颅骨骨髓分为5型：a型5例,b型7例,c型7例,d型9例,e型2例。不同MRI分型的AML组织学分型间差异有统计学意义（P<0.05）。其中,a型中白血病M2型的占比较高（60.00%）,b型中白血病M4型占比较高（57.14%）,d型中白血病M2型占比较高（77.78%）。颅骨骨髓MRI分型与AML组织学分型呈中度相关（Cramer’s V=0.490,P=0.045）。2名医师对M1、M2、M3、M5、M6型中颅骨骨髓MRI分型的一致性均较好（均κ≥0.75）,对M4型中颅骨骨髓MRI 分型的一致性中等（0.4≤κ<0.75）。 结论 颅骨骨髓MRI分型特征可作为评估AML部分组织学分型的有效辅助手段,为临床治疗决策提供依据。     

Bone scintigraphy with 99mTc-MDP in a patient with acute lymphoblastic leukemia initially diagnosed of Still's disease

We present a 43-year-old male, who was admitted with the diagnosis of Adult-onset Still's disease, after several months of arthralgias, febricula and loss of weight. Chest x-ray, abdominal ultrasonography, chest, abdomen and pelvic CT scan and bone scintigraphy were performed. Scintigraphic findings oriented to the performance of a bone marrow biopsy with diagnosis of acute lymphoblastic leukemia.     

Diffuse hepatic and splenic uptake of Tc-99m methylene diphosphonate on bone scintigraphy after intravenous administration of gadolinium-containing MRI contrast

Three patients with known lung cancer came on different days to our department to have a bone scan to evaluate possible osseous metastatic disease. The bone scan images showed increased Tc-99m methylene diphosphonate (Tc-99m MDP) activity in the liver and to a lesser degree in the spleen, whereas bone scan images from other patients on the same days showed no abnormal activity in the liver or spleen. On the same day, shortly before the bone scan, all 3 patients had a magnetic resonance imaging scan with an intravenous injection of Magnevist (Gadolinium-DTPA), which was not previously known to cause an altered Tc-99m MDP distribution. In the follow-up bone scans performed within 1 week of the initial bone scintigraphy, images from none of these 3 patients showed abnormal liver or spleen activity. The findings indicated that the increased Tc-99m MDP activity in the liver and spleen in the early studies was indeed an effect of Gadolinium-containing magnetic resonance imaging contrast. This effect was further confirmed by an animal experiment.     

Gallium-67 uptake in the salivary glands in chronic graft-versus-host disease after bone marrow transplantation

Ga-67 citrate scans were performed in a 17-year-old female patient after bone marrow transplantation for acute lymphoblastic leukemia. Ga-67 accumulated in salivary glands in which chronic graft-versus-host disease (GVH) was demonstrated pathologically. Ga-67 scan may be a sensitive and noninvasive test for detecting and monitoring the Sicca syndrome induced by chronic GVH.     

Physical property of emission data in simultaneous emission/transmission acquisition: evaluation for clinical application

PURPOSE: Although simultaneous emission transmission acquisition (SET) is the ideal method for positron emission tomography (PET) because the same patient position can be used for both emission and transmission scans, the quality of PET images is subject to interference by the cross-contamination of each data. In recent years, segmented attenuation correction of transmission data has made it possible to exclude the contamination from emission data. In the present study using a phantom, the physical property of emission data in SET acquisition was evaluated in comparison with that in separate scan. METHODS: We measured scatter fraction, scatter projection, % random, and noise equivalent count rate in the sinogram. Next, we determined the acquisition time of the SET scan to obtain the same coefficient of variation as the separate scan in reconstructed images. RESULTS: In the evaluation of the strength of the line source, the physical property of emission data in the SET scan seemed inferior to that in separate scan, and SET scanning was not effective enough to reduce the acquisition time of PET examinations. CONCLUSION: SET scanning has the advantage that the same patient position can be used for emission and transmission data; however, further studies may be necessary to apply it to clinical examinations.     

Gd-EOB-DTPA对多b值肝脏DWI中表观弥散系数值的影响

目的 通过行肝脏多b值弥散加权成像（DWI）,观察注射钆塞酸二钠（Gd-EOB-DTPA）前、后不同时相表观弥散系数（ADC）值的变化,探讨增强后行DWI的可行性。方法 收集行Gd-EOB-DTPA肝脏增强的受检者126例,其中,例行体检的健康志愿者30名,肝脏病变患者96例（原发性肝癌25例、转移性肝癌20例、肝血管瘤28例、肝囊肿23例）,均经临床或病理证实。在Philips Achieva 1.5T双梯度超导MR成像系统上,行同相与正反相T1加权像闭气轴位平扫及轴位呼吸门控DWI。通过肘静脉向受检者注射0.025 mmol/kg Gd-EOB-DTPA,行动脉期、静脉期、3 min期、10 min期、20 min期、30 min期闭气轴位T1加权高分辨率各向同性容积激发序列（THRIVE）扫描,在5 min期,行轴位T2加权像脂肪抑制呼吸门控扫描,在15 min期,行轴位呼吸门控DWI后,接着行冠状位T2加权闭气扫描,在25 min期,行轴位呼吸门控DWI。平扫期、15 min期、25 min期的DWI参数完全一致,为单次激发自旋回波-平面回波成像（SE-EPI）序列,b值依次取0、50、300、600 s/mm2,扫描时间196 s。在EWS工作站上,通过ADC分析函数生成平扫期、15 min期、25 min期在b=50、300、600 s/mm2时的ADC图,测出正常肝脏、原发性肝癌、转移性肝癌、肝血管瘤、肝囊肿的ADC值,对同一b值下同一疾病在平扫期、15 min期及25 min期的ADC值进行t检验,分析是否存在统计学差异。结果 同一b值下同一疾病的ADC值在平扫期时最大,随着Gd-EOB-DTPA的注入,ADC值开始下降,然后上升,到了25 min期,ADC值与平扫期时基本一致,15 min期的ADC值最低,平扫期、15 min期、25 min期的ADC值差异无统计学意义（t=0.25~1.29,P均>0.05）。同一疾病同一时相的DWI中,随着b值的增加,ADC值不断下降,b值越小,ADC值越大。结论 静脉注射Gd-EOB-DTPA后,肝脏ADC值下降十分有限,增强后行DWI是可行的。     

Discordant 99mTc sulfur colloid and 67Ga-citrate scintigrams in Aspergillus splenic abscesses

A 43-year-old man with acute undifferentiated leukemia developed high fever and stomatitis followed by severe abdominal pain after completion of a first course of chemotherapy. A ^99mTc-sulfur colloid (SC) scan showed multiple, irregular defects in an enlarged spleen. A ⁶⁷Ga-citrate scan showed uniform tracer distribution except for a large defect in the upper portion of the spleen. The size of the spleen in the ⁶⁷Ga-scan was much larger than in the SC scan. At surgery an abscess cavity was found between the spleen and the greater gastric curvature with multiple smaller abscesses on the splenic capsule and throughout the splenic parcnchyma. A hematoma was present in the upper pole of the spleen. The disparate splenic size and seemingly discordant distribution patterns of tracer in the ^99mTc- and ⁶⁷Ga-scans were fully explained by histopathological study of the surgically resected spleen.     

Precision of dual photon absorptiometry measurements

One of the important uses of bone absorptiometry is to examine the rate of bone mineral change in order to evaluate therapy and to identify individuals who need therapy. Generally, this involves comparing the difference between two scans obtained months to years apart. This study investigates the precision of dual photon absorptiometry using a human torso phantom, normal subjects, and abnormal patients. These studies showed that bone mineral calculated as g/cm2 was more precise than g/cm. Reanalysis of the same scan by the same individual produced an average error equivalent to that produced by scanning and analyzing the same subject on multiple occasions. Interobserver analysis error was essentially equal to the intraobserver error. In order to obtain maximum precision, care must be taken that the integrated area of a repeat scan is identical to the previous scan. Our findings indicate that to be confident (95%) of a real change between two scans a difference of at least 5.6% must be measured.