颅内硬膜外积脓的影像诊断

目的　评估MR和CT对颅内硬膜外积脓的诊断价值。方法　对 4例颅内硬膜外积脓的CT和MR表现进行分析。结果　 2例额部 ;1例额顶部 ;1例后颅窝。 4例颅内硬膜外积脓处硬膜明显增厚 ,均匀强化 ,局部骨板侵蚀破坏变薄或增生。结论　CT和MR可以清楚显示颅内硬膜外积脓的形态学和病理学改变 ,因此CT和MR是诊断颅内硬膜外积脓最有价值的方法     

Subdural empyema in adult with recent SARS-CoV-2 positivity case report

Intracranial abscess, including subdural empyema, is a rare central nervous system infectious disease and diagnosis is often delayed due to patient presentation with non-specific neurologic findings. Here we report a 65-year-old male with a recent past medical history of SARS-CoV-2 infection who presented with three weeks of escalating headache in whom MRI imaging revealed a subdural empyema. He subsequently underwent two craniectomies, which resulted in eradication of the abscess and clinical improvement. This report highlights a potential link between SARS-CoV-2 infection and this patient''s development of subdural empyema, which has not been documented elsewhere in the literature.     

Prospective study of bone marrow infiltration in aggressive lymphoma by three independent methods: whole-body MRI, PET/CT and bone marrow biopsy

PURPOSE: Initial lymphoma staging requires bone marrow assessment in aggressive lymphomas. Bone marrow lymphoma infiltration is routinely assessed by bone marrow biopsy (BMB), considered as the "gold standard". The aim of this study was to compare the performance of BMB, whole-body MRI and PET/CT for evaluation of BM infiltration. METHODS: Patients with newly diagnosed aggressive lymphoma were evaluated by BMB, MRI and PET/CT. Two radiologists, two nuclear medicine physicians and one pathologist independently assessed the results of the three modalities. Bone was considered as involved if BM was positive or if PET/CT or MRI was positive and if there was a resolution of the abnormal image shown on PET/CT or MRI halfway or at the end of therapy. RESULTS: Both MRI and PET/CT detected bone marrow lesions in the 9/43 patients, but two patients with multiple lesions had more lesions detected by PET/CT compared to MRI. Among these nine patients, two with an iliac crest lesion detected by both MRI and PET/CT had bone marrow involvement with large-cell lymphoma on histological examination. The other seven patients had focal MRI and PET/CT lesions in areas other than the iliac crest, where the blind BMB was done. The other patients had bone marrow without large-cell lymphoma involvement. In all cases, after lymphoma therapy bone marrow involvement regressed on histological examination, PET and MRI. CONCLUSION: These preliminary results suggest that non-invasive morphological procedures could be superior to BMB for bone marrow assessment in aggressive lymphomas. Ongoing study is underway to validate these results.     

MRI of spinal bone marrow: part 2, T1-weighted imaging-based differential diagnosis

OBJECTIVE: The purpose of this article is to review the structure of bone marrow and the differential diagnosis of bone marrow pathology on the basis of T1-weighted MRI patterns. CONCLUSION: Bone marrow is an organ that is evaluated routinely during MRI of the spine, particularly lumbar spine evaluation. Thus, it is one of the most commonly performed MRI examinations. T1-weighted MRI is a fundamental sequence in evaluating spinal marrow, and an understanding of T1-weighted MR signal abnormalities is important for the practicing radiologist.     

Diagnostic value of MRI in comparison to scintigraphy, PET, MS-CT and PET/CT for the detection of metastases of bone

The initial localization of metastases in the bone in patients with solid tumors has a relatively good prognosis in comparison with visceral metastasization. The early detection of bone marrow metastases allows for a rapid initiation of therapy and a subsequent reduction in the morbidity rate. Modern MRI is superior to the 30-year-old skeletal scintigraphy and bone marrow scintigraphy with respect to sensitivity, specificity, as well as the extent of osteal metastasis. MRI provides substantial, therapy-relevant additional information. MSCT plays an important role in the management of cancer patients in clinical routine and gives an excellent survey of the axial skeleton by demonstrating osteolytic and osteoblastic metastases. Extensive comparative studies of MRI with 18F-FDG-PET and 18F-fluoride-PET have not yet been carried out. Whole body MRI is a very promising new staging method for the oncological diagnosis of solid tumors and the detection of osteal metastases. The adoption of 18F-FDG-PET and 18F-fluoride-PET FDG as well as the side by side PET-CT image fusion and the two in one PET/CT examinations appears to be slightly less sensitive to whole body MRI in the detection of osteal metastases. Larger, prospective multicenter studies are necessary to establish these as new, promising methods for the detection of osteal metastases.     

Progredienter Querschnitt bei einem somnolenten Kind

A somnolent small girl with septic symptoms and a progressive paraplegia was initially treated as having meningitis with complications. Subsequently it was discovered through magnetic resonance imaging (MRI) that she was suffering from spinal epidural empyema due to a staphylococcal superinfection on the basis of tuberculous vertebral osteomyelitis. Lacking surgical facilities therapy was carried out by the anesthesia department using multilevel epidural punctures and drainage. This article discusses the agreement of MRI findings with the interventional findings and the clinical features and shows the leading diagnostic role of MRI throughout the clinical course.     

Diagnostic efficacy of bone scintigraphy, magnetic resonance imaging, and positron emission tomography in bone metastases of myxoid liposarcoma

Myxoid liposarcomas (MLS) have a tendency to metastasize to unusual sites. We report an unusual case of bone metastases not detected by bone scan and neither by fluorodeoxyglucose positron emission tomography (PET-FDG) and successfully identified with magnetic resonance imaging (MRI) in a patient with metachronic MLS. Histopathological examination of the primary tumor evidenced a tumor with unfavorable prognostic markers, and the biopsy of an iliac bone lesion confirmed the diagnosis of metastatic disease. On histological grounds, the tumor showed features of a more differentiated neoplasm without foci of round cells or necrosis in the latter. MRI allowed the identification of disseminated disease compared to computed tomography (CT) and PET scans. Thus, because of the heterogeneous histological features of MLS and the biological behavior of the disease, a combined approach of FDGPET-CT and MRI, may allow a more accurate staging of soft tissue sarcomas.     

Intracranial dural empyema

Intracranial dural empyema is a neurosurgical emergency with potentially devastating complications. The prognosis is adversely affected by delay in diagnosis. Modern imaging techniques, especially contrast enhanced CT and MRI, have improved the speed and accuracy of radiological diagnosis of this condition, with an associated reduction in mortality. Despite this, there may still be a delay in diagnosis, partly owing to the subtlety of early radiological signs, especially on unenhanced CT. We present cases that illustrate some of the radiological manifestations, complications and potential pitfalls in diagnosis.     

骨梗死的磁共振成像诊断

目的探讨骨梗死的磁共振成像（MRI）表现及其特点,以提高陔病的诊断水平。方法回顷性分析经病理证实或临床随访确诊15例骨梗死的MRI影像特点。结果15例患者总共累及21个部位．股骨下端8个,胫骨上端7个,胫骨下端2个,肱骨上端1个,桡骨下端1个,距骨2个。12例患者MRI表现符合急性骨梗死,2例符合亚急性骨梗死,1例符合慢性骨梗死。21个部位的病变均示松质骨内类圆形或不规则边界清楚的地图状改变。结论MRI是诊断骨梗死最有效方法,不仅能显示早期骨梗死的各种征象,在亚急性期及慢性期MRI均具有特征性表现．且为无创件诊断．是评估骨椰死的最件榆杏片洪     

MRI of spinal bone marrow: part I, techniques and normal age-related appearances

OBJECTIVE: This article reviews MRI protocols, including routine and nonroutine pulse sequences as well as the normal MRI appearance of spinal marrow and expected age-related changes. CONCLUSION: Routine MRI of the spine provides useful evaluation of the spinal bone marrow, but nonroutine MRI pulse sequences are increasingly being used to evaluate bone marrow pathology. An understanding of MRI pulse sequences and the normal and age-related appearances of bone marrow is important for the practicing radiologist.     

Magnetic resonance imaging of the craniocervical junction in rheumatoid arthritis: value,limitations, indications

The cervical spine is the second most common location for manifestation of rheumatoid arthritis (RA). Symptoms are typically related to involvement of the craniocervical junction. Unfortunately, conventional radiographic examination is often unable to demonstrate that RA is the cause of such symptoms. Magnetic resonance imaging (MRI) provides an unique opportunity to visualize nerves, connective tissue, and bone in all planes without the use of contrast agents. These features suggest that MRI could provide important information related to RA of the cervical spine. The possibilities and limitations of MRI were therefore evaluated in 60 patients with cervical RA. The main objective of this study was to correlate symptoms and clinical findings with MRI results to establish indications for this imaging procedure.     

Malignancy associated with chronic empyema: radiologic assessment

Radiologic findings of six cases of malignancy associated with chronic empyema 5-39 years in duration were reviewed. Pathologic examination confirmed three B-cell non-Hodgkin lymphomas, one round-cell sarcoma, one mesothelioma, and one adenocarcinoma. Retrospective findings on plain chest radiographs suggested the occurrence of malignancy: increased radiopacity in the thoracic cavity, soft-tissue bulgings and/or unsharpness of fat planes in the chest walls, destruction of bone near the empyema, and extensive medial deviation of the calcified pleurae. Computed tomography delineated masses with soft-tissue attenuation more clearly than radiography in all cases. Magnetic resonance images of three cases were informative because empyema cavities were surrounded by low-intensity rims, and two of them showed a signal intensity different from that of necrotic tumors. Scintigraphy revealed increased uptake of gallium in all cases. Ultrasonography was useful for biopsy guidance. Every radiologist should know this entity in observation of chest radiographs obtained in patients with chronic empyema, and further radiologic assessment and aggressive biopsy are recommended if malignancy is suspected.     

Magnetic resonance imaging of trabecular and cortical bone in mice: comparison of high resolution in vivo and ex vivo MR images with corresponding histology

Measurements of bone morphometry and remodeling have been shown to reflect bone strength and can be used to diagnose degenerative bone disease. In this study, in vivo and ex vivo magnetic resonance imaging (MRI) techniques to assess trabecular and cortical bone properties have been compared to each other and to histology as a novel means for the quantification of bone. Femurs of C57Bl/6 mice were examined both in vivo and ex vivo on an 11.7 T MRI scanner, followed by histologic processing and morphometry. A thresholding analysis technique was applied to the MRI images to generate contour lines and to delineate the boundaries between bone and marrow. Using MRI, an optimal correlation with histology was obtained with an in vivo longitudinal sectioned short echo time gradient-echo versus an in vivo long echo time spin-echo sequence or an ex vivo pulse sequence. Gradient-echo images were acquired with a maximum in-plane resolution of 35 microm. Our results demonstrated that in both the in vivo and ex vivo data sets, the percent area of marrow increases and percent area of trabecular bone and cortical bone thickness decreases moving from the epiphyseal growth plate to the diaphysis. These changes, observed with MRI, correlate with the histological data. Investigations using in vivo MRI gradient-echo sequences consistently gave the best correlation with histology. Our quantitative evaluation using both ex vivo and in vivo MRI was found to be an effective means to visualize non-invasively the normal variation in trabecular and cortical bone as compared to a histological "gold standard" The experiments validated in vivo MRI as a potential high resolution technique for investigating both soft tissue, such as marrow, and bone without radiation exposure.     

骨挫伤的MRI诊断价值

目的探讨骨挫伤的MRI影像表现及MRI在骨挫伤影像诊断中的价值.方法回顾性分析34例骨挫伤和3例隐匿性骨折病例的X线平片、CT及MRI影像资料,分析骨挫伤的MRI影像表现,评估X线平片、CT及MRI在骨挫伤影像诊断中的作用.结果全部病例的X线平片均未见异常.CT能有效显示3例隐匿性骨折的部位和形态,但34例骨挫伤病例CT均未能予以诊断.3例CT诊断为隐匿性骨折的病例MRI诊断为骨挫伤而未能显示骨折的存在.MRI能有效显示不同部位骨挫伤的病变部位、范围及形态,在SE序列上骨挫伤的典型MRI表现为不规则片状T1WI低信号、T2WI高信号的异常信号改变,骨皮质及骨轮廓不发生变化.结论在X线平片、CT及MRI三种影像检查方法中,MRI是唯一能有效诊断骨挫伤的检查方法,但MRI不能明确区别骨挫伤和未分离、移位的隐匿性骨折.     

Ribbing disease: radiographic and biochemical characterization,lack of response to pamidronate

Ribbing disease is a rare form of sclerosing dysplasia characterized by benign endosteal and periosteal bone growth confined to the diaphyses of the long bones, usually the tibiae and femora. The onset is usually after puberty and the most common presentation is pain that is usually self-limited, but may progress. The etiology and optimal treatment for the disease are unknown. We present the case of a 39-year-old Hispanic man with clinical and radiological manifestations of Ribbing disease. Radiographs and CT imaging demonstrated typical cortical thickening in the mid-diaphyses of the tibiae bilaterally that correlated with intense tracer uptake on (99m)Tc-MDP bone scans. MRI demonstrated cortical thickening and abnormal marrow signal consistent with marrow edema. Bone marrow edema may explain the pain frequently associated with the disease. Multiple serum and urine markers of bone metabolism were within normal limits. In an effort to ameliorate pain, the patient was treated with the bisphosphonate, pamidronate. In spite of treatment, pain increased, requiring additional and larger doses of analgesics. Serial radiographs, CT, bone scans, and MRI all demonstrated disease progression with pamidronate treatment. In this report we present for the first time the finding of bone marrow edema with MRI as well as disease progression during intravenous pamidronate treatment.     

中耳炎颅内及颅底并发症的MRI表现

目的 探讨慢性中耳炎颅内及颅底并发症的MRI特点,以提高对该病诊断的准确性. 资料与方法 搜集经临床和MRI证实的有颅内及颅底并发症的慢性中耳炎11例患者资料,对中耳炎的扩散特点和MRI表现进行回顾性分析. 结果 中耳炎并发症中,硬脑膜炎11例,岩尖炎4例,颞叶脓肿6例,硬膜下脓肿3例,迷路炎1例. 结论 MRI可以清楚显示中耳乳突的炎症,并可清晰显示炎症在颅内的扩散情况,是判断中耳炎颅内并发症及其范围的首选检查方法.     

Prostate cancer imaging: what surgeons, radiation oncologists, and medical oncologists want to know

OBJECTIVE: The purpose of this article is to discuss the information that is important to note in imaging reports of patients with prostate cancer. CONCLUSION: Accurate staging through imaging is an integral part of prostate cancer management. Ultrasound, CT, bone scanning, and MRI are used for prostate cancer patients to assess the primary tumor, lymph node status, and bone metastasis. Accurate reporting of images is crucial for effective cancer treatment.     

3 Tesla MRI in diagnosis and follow up of children with pneumonia

PurposeTo investigate the utilization of 3-Tesla (3 T) magnetic resonance imaging (MRI) in detection of pulmonary abnormalities in children with pneumonia.Materials and methodsForty-seven children with pneumonia prospectively underwent 3 T thoracic MRI and posteroanterior (PA) chest radiography (CR). Of these, 15 patients also underwent contrast-enhanced thorax computed tomography (CT) or high-resolution CT (HRCT). The MRI protocol included axial and coronal T2-weighted spectral presaturation with inversion recovery (SPIR) Multivane-XD and axial echo-planar diffusion-weighted imaging (EPI DWI) with respiratory gating. Kappa statistics, Cochran Q, and McNemar tests were used to investigate the results.ResultsAgreement between CR and MRI was substantial in detecting consolidation/infiltration (k = 0.64), peribronchial thickening (k = 0.64), and bronchiectasis (k = 1); moderate in detecting cavity (k = 0.54) and pleural effusion (k = 0.44); and fair in detecting empyema (0.32) and bilateral involvement of lungs (k = 0.23). MRI was superior to CR in detecting bilateral involvement (p < 0.001), lymph node (p < 0.001), pleural effusion (p < 0.001), and empyema (p = 0.003). MRI detected all the consolidation/infiltration also detected on CT imaging. A kappa test showed moderate agreement between MRI and CT in detecting pleural effusion and ground-glass opacity (GGO), and substantial or almost perfect agreement for all other pathologies. No statistically significant difference was observed between MRI and CT for detecting pneumonia-associated pathologies by the McNemar test.ConclusionThoracic 3 T MRI is an accurate and effective technique for evaluating children with pneumonia. MRI detected more pathologies than CR and had similar results to those of thorax CT.     

长骨骨干骨肉瘤X线、CT及MRI表现

目的 分析长骨骨干骨肉瘤X线、CT和MRI表现,探讨有关的临床特点和鉴别诊断.方法 28例长骨骨干骨肉瘤患者,均经手术与病理证实,其中病变位于股骨干18例、腓骨干4例、肱骨干4例、胫骨干2例.所有患者均行X线、CT和MR检查,对其影像学表现与手术病理结果进行对照,并由双盲法分析确认.结果 28例中,X线和CT显示广泛骨质破坏16例,骨膜反应22例.X线显示软组织肿块18例,肿瘤骨和瘤样钙化12例.CT平扫显示软组织肿块22例,增强扫描显示软组织肿块24例,肿瘤骨和瘤样钙化16例.MRI显示骨质破坏和骨膜反应10例,软组织肿块26例,其周围可见软组织水肿及骨髓水肿.骨膜反应在SE T1WI上呈等低信号,T2WI呈等信号.软组织肿块在T1WI为等信号,T2WI及STIR呈等高信号.软组织水肿及骨髓水肿在T2WI及STIR呈高信号.MRI增强检查显示病灶均呈不均匀强化,骨髓水肿和软组织肿块均见强化.结论 X线、CT和MRI从不同方面反映长骨骨干骨肉瘤的影像病理特点,其发病率低,骨破坏范围大,无病理性骨折.成骨型骨干骨肉瘤较易诊断,溶骨型应与Ewing瘤、恶性巨细胞瘤等鉴别.

Abstract：

Objective To explore the findings of diaphysial osteosarcoma in long bone on X-ray,CT and MRI, and discuss their clinical features and manifestations for differential diagnosis. Methods Twenty-eight cases with diaphysial osteosarcoma in long bone proved by surgery and pathology were reviewed retrospectively. Eighteen tumors were located in the femur, 4 in fibula, 4 in humerus and 2 in tibia. All of the patients were examined by X-ray, CT and MRI. The imaging manifestations on X-ray, CT and MRI were analyzed, and the relationship of the imaging features with the pathological types was also observed. The imaging signs were correlated with the pathologic findings with a double blind method. Results Of the 28 cases, there were 16 cases with large bone destruction, 22 cases with periosteal reaction on X-ray and CT. On X-ray, 18 cases showed soft tissue mass and 12 cases with neoplastic bone and tumor calcification.While on CT, 22 cases showed soft tissue mass on plain scan and 2 more cases displayed soft tissue mass after the injection of contrast mediun. Sixteen cases showed neoplastic bone and tumor calcification on CT.On MRI, there were 10 cases with bone destruction and periosteal reaction with iso- and hypo-intense on T1WI and iso- signals on T2WI. Twenty-six cases showed soft tissue edema and bone marrow on MRI. The soft mass were iso-signals on T1 WI and iso-hyperintense signals on T2 WI or STIR. The soft tissue edema was found hyperintense signals on T2WI or STIR. The lesions had heterogeneous enhancement especially in bone marrow with edema and adjcent soft tissue. Conclusion The X-ray, CT and MRI can reflect the pathological changes of diaphysial osteosarcoma in long bone from different aspects. Lower incidence, large bone destruction and no pathological fracture were the features of diaphysial osteosarcoma. The osteogenic type is diagnosed easily, but the osteolytic lesion should be differentiated from Ewing sarcoma, malignant giant cell tumor of bone and so on.     

骨显像、X线、CT及MRI对骨转移瘤的诊断价值

目的：探讨骨显像(ECT)、X线、CT及MRI对转移性骨肿瘤的诊断价值及漏诊、误诊原因。方法：全组168例均行ECT及X线检查，CT检查68例，MRI检查66例。原发肿瘤为肺癌(32．1％)，乳腺癌(26．8％)，前列腺癌(19％)，鼻咽癌(4．2％)和甲状腺癌(3．6％)等。结果：ECT阳性率88％，X线阳性率57％，CT阳性率65％，MRI阳性率88％。相同扫描野，ECT比X线多检出162个病灶，比CT多56个，比MRI少15个病灶。结论：MRI与ECT均有较高的敏感性，MRI的特异性高。骨转移应首选ECT并结合X线检查，必要时直接做MRI。