多发性对称性脂肪瘤病病例报告及文献回顾

多发性对称性脂肪瘤病(multiple symmetrical lipomatosis,MSL)是一种罕见的脂肪代谢异常疾病,多见于嗜酒的中年男性,主要表现为弥漫的、对称的、无包膜的脂肪组织沉积于颈、项、肩、上肢、上背等部位,手术是目前最有效的治疗方法。该文通过回顾1例多发性对称性脂肪瘤病的患者,并对国内外文献做一回顾性分析,对这一类疾病的流行病学、病因学、临床表现、诊断治疗及预后进行介绍。     

腮腺脂肪瘤的CT与MRI影像学表现

目的:探讨腮腺脂肪瘤的CT与MRI表现特点,并与病理结果对照,以提高对该病的认识.方法:回顾性分析经手术病理证实的16例腮腺脂肪瘤患者的CT与MRI资料(CT检查12例,MRI检查10例,其中有6例分别行CT、MRI检查).对肿瘤的部位、大小、形态、边界、内部密度(信号)、增强特点及病灶周围有无肿大淋巴结等进行分析,并...     

马德龙病1例报告

马德龙病又称为多发性对称性脂肪瘤病,是一类罕见的因脂肪代谢障碍引起的疾病,多发于30~60岁的中老年男性,主要病变特征是大量无包膜脂肪组织团块呈弥漫性、对称性聚积在颈、项、肩以及其他躯干部位的皮下组织内,目前对于该病国际上尚无标准有效的治疗方法。本文报告我科收治的1例马德龙病例,并基于现有文献资料,对马德龙病的病因、临床分型、特征性表现以及诊断、鉴别诊断和治疗等进行讨论。     

头颈部IgG4相关疾病CT影像学特点

目的 总结IgG4相关疾病头颈部CT影像学表现，分析其影像学特点，提高对该病的诊断水平。方法 回顾性研究2019年9月—2021年12月在山西医科大学第一医院口腔颌面外科诊治，并最终经组织病理学确诊的IgG4相关疾病患者的临床一般资料及CT资料，观察受累部位、病变特点等。结果 按照纳排标准共纳入20例患者，其中14例双侧颌下腺受累，6例单侧颌下腺受累，8例双侧腮腺受累，1例单侧腮腺受累，11例泪腺受累，3例甲状腺受累，此外笔者观察到95%(19例)患者头颈部受累腺体周围或颈部可见肿大淋巴结。CT影像中，唾液腺受累表现为腺体不同程度的弥散性肿大或腺体内存在实质性团块，在笔者收集的病例中，所有受累腺体的CT影像均未见明显钙化或囊性病变。泪腺受累多表现为双侧对称性肿大，密度均匀，部分患者可见眼外肌、眶下神经增粗受累。淋巴受累表现为单个或多个肿大淋巴结，边界清晰，无明显钙化及坏死液化影。甲状腺受累表现为腺体局部见低密度影像，形态不规则，与正常腺体边界欠佳。另外部分患者可观察到鼻旁腺、鼻腔黏膜及血管受累影像。结论 头颈部IgG4相关疾病在CT下具有一些体征性的表现，准确识别并判断这些CT表现有助...     

颞下颌关节盘锚固术中脂肪组织瓣转归的实验研究

目的：探讨颞下颌关节（temporomandibularioint，TMJ）盘锚固术中游离脂肪瓣的影像学变化及组织学转归。方法：选取3个月龄小型猪6只，术前拍摄TMJMRI。将左侧作为实验组．对其进行关节盘前附着松解．并切取耳前区脂肪瓣，移植到TMJ松解后的间隙内。右侧作为对照组，只进行关节盘前附着松解。术后即刻、3、6个月分别拍摄TMJMRI，观察脂肪组织的影像学变化。术后3、6个月各处死动物3只．取脂肪标本．测量脂肪组织的体积．并进行HE染色．观察其组织学变化。结果：MRI示移植的脂肪组织在术后3个月、6个月信号逐渐减弱，脂肪瓣体积在术后3个月减少到67．7％．术后6个月减少为42．6％。HE染色示术后3个月脂肪组织呈现慢性炎症反应．术后6个月可见新的脂肪小叶形成，小叶间纤维组织增生明显。结论：游离脂肪瓣移植6个月后，脂肪瓣部分存活，体积稳定，为TMJ外科临床应用游离脂肪瓣提供了理论支持。     

口腔颌面部恶性神经鞘瘤的影像学和病理学分析

目的:系统分析口腔颌面部恶性神经鞘瘤的影像学和病理学特征,提高对该疾病的认识。方法 :收集2005—2013年我院收治并经病理检查确诊的8例口腔颌面部恶性神经鞘瘤的病历资料,系统分析其CT和MRI影像学表现,以及组织病理学特征。结果:颌骨内恶性神经鞘瘤的CT检查表现出骨质破坏、牙根吸收等恶性肿瘤特征。而软组织恶性神经鞘瘤的MRI检查表现为边界不清,T1WI呈等信号、T2WI压脂像呈高信号,信号不均匀,有不均匀强化等特点。病理学上,Vimentin免疫组织化学染色在所有病例的恶性神经鞘瘤细胞中为强阳性,S-100和Ki-67表现为部分肿瘤细胞表达阳性。CD34在7例患者肿瘤细胞中表达为阴性。结论:CT和MRI影像学检查可帮助确定颌面部恶性神经鞘瘤的性质、范围、形态和破坏程度及与周围组织的关系。Vimentin、S-100和Ki-67免疫组织化学染色可用于肿瘤术后的确诊。     

口腔颌面部间隙感染的磁共振影像表现及其临床意义

目的:通过分析口腔颌面部间隙感染病例及其磁共振影像(magnetic resonance imaging,MRI)表现,探讨MRI在诊断口腔颌面部间隙感染中的意义。方法:回顾分析13例经临床证实的口腔颌面部间隙感染的MRI表现。包括咬肌间隙感染1例,翼下颌间隙感染1例,颞下间隙感染3例,舌下间隙感染1例,颊间隙感染1例,下颌下间隙感染1例,多间隙感染5例。并分析临床口腔颌面部间隙感染典型病例在应用MRI后的诊断结果和治疗方案设计。结果:蜂窝织炎在T1WI(T1 weighted imanging)呈等、低信号,T2WI(T2 weighted imanging)呈高信号;脓肿在T2WI上呈显著高信号,在增强T1WI上呈边界强化表现。MRI能够清楚地显示出软组织的肿胀,脂肪间隙的移位、缩减甚至消失。MRI能够正确指导口腔颌面部间隙感染复杂病例的诊断及治疗。结论:MRI可以清楚地显示口腔颌面部间隙的蜂窝织炎和脓肿,通过MRI可以了解病变发展的动态、程度和病变范围,从而对疾病做出正确的诊断,实施正确的治疗。     

rhBMP-2/DFDBA复合材料植入大鼠体内不同部位后血管再生的实验研究

目的：比较rhBMP-2／DFDBA复合材料和单纯DFDBA材料在大鼠体内血管及肌、肌、皮下和脂肪组织4个不同部位异位植入后的血管再生能力。方法：72只健康成年雄性Wistar大鼠，先根据植入材料不同分2组，即rhBMP-2／DFDBA复合材料（A组）和单纯DFDBA材料（B组），再按植入部位不同进一步分为4组，分别植入大鼠的背阔肌及血管（血管及肌组）、背阔肌（肌组）、背部皮下组织（皮下组）和腹部脂肪组织（脂肪组）4个不同部位。，于术后2、4、8周处死动物后进行大体观察、HE染色、血管内皮生长因子（VEGF）免疫组化染色观察及VEGF表达的图像分析。采用SPSS11．5统计软件包对数据进行t检验。结果：A组新生血管数量和VEGF的表达均高于B组。不同的植入部位．以血管及肌组新生毛细血管数量最多，VEGF表达最强，其次是肌组、皮下组，脂肪组最弱。结论：当加入外源性rhBMP-2时，rhBMP-2／DFDBA复合物可以表现出更强的血管再生能力；不同组织中，rhBMP-2／DFDBA复合植入物的血管再生能力有所不同，其中以血管及肌组织最强，肌组织和皮下组织次之，脂肪组织最弱，这可能由各组织的血流速率不同所引起。     

舌癌的CT诊断

目的：探讨舌癌的多层螺旋CT表现特征及诊断价值,评价CT检查在舌癌诊断中的应用价值。方法：回顾性分析经手术及病理证实的舌癌16例,其中男10例,女6例,年龄45-75岁,平均年龄51岁。16例均行CT平扫及增强CT扫描。对病变的部位、形状、密度及向周围浸润情况等几个方面进行回顾性分析。结果：16例病理类型均为鳞状细胞癌,舌体癌11例,舌根癌4例,全舌癌1例,14例伴有溃疡,侵犯肌层12例,侵犯口底4例,11例伴有颌下及颈部淋巴结多发转移。舌癌CT平扫表现为舌体及舌根边缘区稍低密度肿块13例,2例表现为等密度肿块,1例表现为稍高密度肿块,边界均模糊不清,内密度不均匀。CT增强扫描后肿块明显不均匀强化14例,环形强化2例,增强后肿块边界及轮廓显示清楚,呈分叶状,14例溃疡型肿块内见气体影,11例颌下及颈部间隙内可见多发肿大淋巴结,增强后明显不均匀强化。结论：CT检查对原发性舌癌的形态、大小、密度及周围结构侵犯以及颈部淋巴结转移等方面有重要的诊断价值,增强扫描对病灶显示尤为重要。     

颌骨对称性多发性畸形性骨炎1例报告并文献复习

目的：探讨罕见的颌骨畸形性骨炎的临床特点和诊疗方法。方法：结合一例对称性多发性畸形性骨炎病例资料，结合文献复习，进行总结。结果：颌骨畸形性骨炎临床表现为颌骨明显畸形，损害广泛；检测血碱性磷酸酶呈高水平状态；CT显示上下颌骨体积增大，呈广泛溶解和硬化共存影像，骨小梁排列紊乱。结论：畸形性骨炎在国内罕见，颌骨及全身大部分骨骼均可累及，有典型的生物学、影像学和临床特征，本病目前尚无法治愈。本例患者病变呈对称性和多发性，国内外罕见。     

融合CT和MRI数据构建颌面部3D数字化模型

目的 探索通过精确、高效配准CT和MRI数据,建立包含颌面部主要肌肉和骨骼组织的3D数字化模型.方法 对1名志愿者行颌面部螺旋CT及MRI扫描,数据分别导入Mimics 15.0中,在3个视窗,即横断面、矢状面、冠状面,分别调整两种数据至同一断层,以树脂球为配准点,至少5个点配准两组数据.再利用CT分割并重建颌骨和面部皮肤3D模型,利用MRI分割重建面部主要肌肉3D模型.结果 建立了包含3对咀嚼肌、12对表情肌、面部皮肤与颌骨组织的3D模型,配准模型具有较高的一致性和相对位置精度.结论实现了CT与MRI两种影像学数据的配准融合.     

Grey-scale sonography in assessment of cervical lymphadenopathy: review of sonographic appearances and features that may help a beginner

Ultrasound examinations of the neck in 218 patients with confirmed cervical lymphadenopathy were reviewed. Lymph nodes were assessed for their size, shape, internal architecture, echogenicity, nodal border, posterior enhancement, and ancillary features (adjacent soft tissues oedema, and matting). The hilus is a linear, echogenic, non-shadowing structure containing nodal vessels, and is continuous with fat around the node. Coagulation necrosis is an ill-defined, rounded, non-shadowing echogenic area within a node. It is less echogenic than the hilus and is not continuous with the fat around the node. Calcification is a highly echogenic focus within the node, which may be dense or punctate echogenic foci. It is not continuous with the fat around the node. Dense intranodal calcification usually produces shadowing. However, fine punctate calcification may not have posterior shadowing though, if the transducer frequency is increased, it may show thin lines. Cystic necrosis is focal, often ill-defined echolucent area within the node. Echogenicity of lymph nodes is usually compared with the adjacent muscles, and is classified as hypoechogenicity, isoechogenicity, and hyperechogenicity. The nodal border is assessed for its sharpness. Posterior enhancement is when the structures posterior to the node look more echogenic than neighbouring areas. Oedema of soft tissues is an ill-defined, hypoechoic area around the node with loss of adjacent fascial planes. Nodes are considered matted when they are clumped or adherent to each other with no normal intervening soft tissue between them. Ultrasound features that help only in identifying abnormal nodes include size, shape, echogenic hilus, hypoechogenicity or isoechogenicity, echogeneity, coagulation necrosis, and a sharp nodal border. Ultrasound features that help to identify abnormal nodes as well as giving clues to the primary lesion include hyperechogenicity, intranodal calcification, intranodal cystic necrosis, ragged nodal border, posterior enhancement, adjacent soft tissue oedema, and matting.     

(iii) CT and MRI of hip replacements

Computed tomography (CT) and magnetic resonance imaging (MRI) are now useful imaging techniques in the evaluation of hip arthroplasty. The recognised problems of beam hardening in CT and magnetic susceptibility artefact in MRI have been significantly reduced.MRI is useful for assessing the peri-prosthetic soft tissues and in evaluation of the painful replacement with normal plain films.CT is better than plain films in evaluating bone stock around a hip replacement.     

Secondary post-traumatic enophthalmos: high-resolution magnetic resonance imaging compared with multislice computed tomography in postoperative orbital volume measurement.

PURPOSE: Multislice computed tomography (MSCT) was the modality of choice for orbital volume measurement. This first prospective study compares MSCT with high-resolution magnetic resonance imaging (MRI) combined with micro (MRImc) and headcoil (MRIhc) in volumetric evaluation of the postsurgical enophthalmic orbit. PATIENTS AND METHODS: Morphologic and dimensional changes of the orbit, eyebulb, and fat content were investigated 3 to 4 months after reconstruction of complex orbital fractures in 36 patients. Image analysis and volumetric assessment from 2-dimensional and 3-dimensional-MRImc and MRIhc were compared with MSCT. The volume segmentation algorithm operated on multispectral, 3-dimensional MR data acquired at isotropic proton density weighted acquisitions. RESULTS: CT and MRI volume data correlated significantly (P < .01). Enlargement of the posterior segment often resulted in orbital geometry change from conical to convex. Even cases of correct orbital reconstruction presented significant volume enlargement compared to the contralateral side (P < .01). The retro bulbar fat showed itself fragmented and was dislocated in the medial posterior region mostly. We found reduced sagittal eye projection, increased width of the orbital rim, and dislocation of the posteromedial orbital floor (P < .01). High correlation was detected between orbital volume increment and degree of enophthalmos (0.93 mm per 1 cm3 orbital volume enlargement diameter) (P < .01). CONCLUSIONS: As MRI orbital volume measurement permitted prediction of postsurgical enophthalmos, which is related to possible failure in orbital volume correction and reduction of the posterior medial bulge and not to fat content changes, it is suited for planning secondary correction.     

正常成人颞颌关节的CT和MRI影相分析

本文对10名正常成人双侧TMJ进行了CT扫描,其中3名作了MRI扫描。对所有CT片作了TMJ骨性结构的三维分析,观察了正常人髁状突和关节凹的形态类型,并发现双侧形态均为同型,双侧髁状突运动范围一致。同时,还用CT软组织窗位相(闪烁相)对关节盘进行了正中(牙合)位和尽力开口位的观察,并用MRI对其结果加以证实。本研究所得结果较其它方法准确,更具有可比性。因为本研究选用CT对双测TMJ进行同时扫描,消除了以往X光片需分侧和多种投照检查所造成的误差。     

Masticatory muscles. Part V. Geometry of the masticatory muscles and cranial morphology

Studies focussed on the interactions between masticatory function and the variation in craniofacial height have received an important impulse by the availability of non-invasive imaging techniques like CT and MRI. These techniques allow for in vivo determination of the cross-sectional area and spatial orientation of the human jaw muscles. In recent MRI studies it has been established that the jaw muscles of long-face subjects are up to 30% smaller than those of normal individuals, while the position of the muscles was fairly comparable in both groups. The maximum bite force of long-face subjects is roughly half that of normals. The observed variation of the in vivo data of normal and long-face jaw muscle geometry does explain only half of the difference in their average maximum bite force. The jaw muscles of long-face and normal subjects are presumably different with respect to their force generating capacity per unit of cross-sectional area, which may be attributed to a different muscle fiber type composition.     

Application of magnetic resonance imaging and ultrasonography to preoperative evaluation of masseteric hypertrophy

A case of unilateral masseteric hypertrophy in a 30-year-old man is described. Preoperative evaluation was performed by magnetic resonance imaging (MRI), computed tomography (CT) and ultrasonography (USG). MRI could delineate not only the border between medial and lateral layers of the masseter but also delineate the hypertrophic portion. MRI also provided more information in respect of the masseter muscle as well as the other masticatory muscles and the surrounding tissues than CT. USG was useful because of its real-time processing, especially in this case where facial asymmetry was emphasized during mastication. We resected the medial lower-half of the masseter intraorally based on these imagings and obtained a successful result.     

Comparison of jaw-muscle bite-force cross-sections obtained by means of magnetic resonance imaging and high-resolution CT scanning

Cross-sectional areas of the jaw muscles were determined by means of magnetic resonance imaging (MRI) in 12 healthy adult male subjects. These findings were compared with the cross-sectional areas of the jaw muscles of the same subjects, obtained by means of computer tomography (CT) in a previous study (Weijs and Hillen, 1985). Significant correlations (r greater than 0.7) were found between the CT and MRI cross-sections of the masseter, medial pterygoid, and temporalis muscles. The low correlation between the CT and MRI cross-sections of the lateral pterygoid muscle could be explained by the different imaging techniques (slice thickness) of MRI and CT scanning. CT and MRI cross-sectional areas of the masseter and medial pterygoid muscle (but not the temporalis muscle) showed highly positive and significant correlations with the maximal voluntary bite force. In living subjects, the cross-sections of the masseter and medial pterygoid muscles can be visualized with CT and MRI. Compared with CT, MRI has some advantages, such as the absence of adverse effects (no radiation) and the excellent soft-tissue imaging. Furthermore, a series of frontal, horizontal, sagittal, and angulated MRI scans can be made without modification of the patient's position, facilitating reconstruction of the jaw muscles.     

基于光谱CT的钙抑制技术评估颞下颌关节紊乱病患者关节盘位置

目的探索钙抑制光谱CT技术在评估颞下颌关节盘位置及测量关节盘后带厚度中的应用。方法对2019年2至7月解放军总医院海南医院放射科门诊就诊的23例颞下颌关节紊乱病患者[平均年龄23岁(12~62岁),男性14例,女性9例]行MRI斜矢状位、斜冠状位质子密度加权成像及光谱CT扫描,共纳入可评估关节45侧,依扫描设备分为MRI测量组及钙抑制光谱CT测量组。采用钙抑制算法对光谱CT进行去钙处理,并重建斜矢状位及冠状位钙抑制光谱CT图像。基于斜矢状位及冠状位图像评估关节盘位置,基于斜矢状位图像测量关节盘后带最大厚度。结果45侧颞下颌关节盘位置在MRI图像及钙抑制光谱CT图像上基本一致。MRI测量组与钙抑制光谱CT测量组所测后带厚度的组内相关系数为0.843(0.712,0.914),Bland-Altman图分析MRI与钙抑制光谱CT测量关节盘后带厚度的差值点[95.6%(43/45)]位于95%一致性界限内。Wilcoxon配对检验提示MRI测量组[2.57(1.76,3.65)mm]与钙抑制光谱CT测量组[2.67(1.74,4.56)mm]差异无统计学意义(P=0.07)。结论钙抑制光谱CT成像可以准确评估关节盘位置及关节盘后带厚度。