原发性肝癌术后复发的肝动脉造影表现和介入治疗

本文报告了40例原发性肝癌术后复发的肝动脉造影表现和介入治疗的结果。我们将造影表现归纳为三种类型:Ⅰ型(边缘复发型)11例占27.5%,Ⅱ型(肝内播散型)23例占57.5%,Ⅲ型(隐匿复发型)6例占15%。造影表现特点是:血供相对不丰富,肝瘤结节染色浅淡;病灶常呈多发性;小病灶(直径<2.0cm)多见。我们认为介入治疗对肝癌术后复发也是一种有效的治疗方法,并应该早期(术后2～4个月)进行。     

AFP检测与CT 增强扫描在评价肝癌复发中的相关性研究

目的：探讨甲胎蛋白（AFP）检测与CT增强扫描在评价肝癌治疗后复发的相关性,为判断肝癌治疗后是否复发寻找依据。方法102例肝癌治疗后复发患者,治疗后1．5～2月做AFP检测与CT增强扫描,分析其对肝癌复发判断的敏感性,及二者的相关性。其中行MR强化23例、PET‐CT 8例、肝动脉造影检查3例,一并进行分析。结果102例肝癌治疗后复发患者均于术后1．5～2月间做血液AFP检测和CT 增强扫描,AFP下降但是未降至正常或较前升高82例,AFP检测敏感性为80．39％（82／102）;CT强化扫描,病灶局部异常强化81例,敏感性为79．41％（81／102）;MR强化23例、PET‐CT 8例、肝动脉造影检查3例,敏感性分别为82．61％、87．5％、100％。结论 AFP检测与CT增强扫描均可评价肝癌治疗后是否复发,A FP检测更敏感,具有方便快捷的优势,应该作为首选的判定肝癌治疗后复发的依据,结合CT增强扫描可提高判断的准确性。     

原发性肝癌外科手术联合血管内介入治疗的意义

目的：探讨原发性肝癌外科联合血管内介入治疗的意义。方法：69例原发性肝癌患者,41例先行手术切除,术后行TAI或TACE;28例先行TACE,7天-1月内再行手术切除,术后1—6月内再行TAI或TACE治疗。结果：全组病例共行236次TM或TACE,最多者11次,最少者1次,平均3．4次。手术及介入治疗均成功,未出现并发症。先行手术组1～2个月造影残癌者9例（9／41）,2年内发现复发病灶18例。先行TACE组手术后近期未发现残余病灶,2年内肿瘤复发为7例。AFP术后降至正常或接近正常范围为56例,术后存活率为：半年100％,1年89．3％,2年68．0％,3年57．3％,5年43．8％。结论：术前行TACE有利于争取手术机会和手术根治,防止术后复发。介入治疗和手术结合是提高肝癌整体疗效及病人存活率的重要方法。     

CT引导下经皮肝穿刺微波治疗原发性肝癌后肝动脉造影表现

目的:探讨原发性肝癌微波治疗后的DSA表现及临床意义。方法:本组共12例原发性肝癌,均为单发病灶,肿瘤直径3.0～6.5cm(平均4.4cm),经皮肝穿刺微波治疗术后1～3个月内行肝总动脉及可疑区域供血动脉超选择性血管造影,同时对残留及复发灶进行栓塞治疗。结果:术后造影表现为微波治疗的肿瘤区多为无血管区,呈圆形或类圆形无染色或低密度染色区;治疗边缘区可见以下几种征象:肉芽形成(7例)、出血(3例)、边缘残留或复发(7例)和无异常造影征象(2例)。肝内异位复发灶(7例)造影表现同其原发肿瘤常见造影表现。本组12例造影发现原位边缘复发和/或肝内异位复发灶8例并全部完成栓塞治疗。结论:微波治疗区域的边缘征象的发现和鉴别是判断局部残留及复发的关键,DSA在疗效的观察及进一步综合治疗中有较高的临床价值。     

肝动脉解剖变异及多支供血在肝癌介入治疗中的临床意义

目的：研究肝动脉解剖变异和肝癌多支供血及临床意义。材料和方法：140例肝癌行介入治疗前常规腹腔动脉和肠系膜上动脉造影，邻近膈肌病灶加作选择性膈下动脉造影，分析造影图象。结果：肝动脉常见型113例（80．8％），变异27例（19．2％）。病灶单纯由肝动脉供血92例，48例存在除肝动脉外的多支血管供血。结论：熟悉肝癌的血供特点可指导术者方便快捷插入导管，发现除肝动脉外的供血动脉，并给予化疗栓塞以确保疗效。     

外生型肝癌的CT诊断(附7例分析)

目的：提高对外生型肝癌的认识和诊断。方法：回顾性分析７例（男５例，女２例，年龄３６～６６岁）经手术、病理或临床证实的外生型肝癌的ＣＴ表现。结果：根据肝内有无肿块将其分为单纯型（６例）和混合型（１例）。５例肿瘤突出于肝外有蒂与肝相连，２例肿瘤紧邻肝表面。病灶呈低密度，不均匀强化，其病理改变与肝内原发性肝癌一致。结论：外生型肝癌的诊断主要依据肿瘤有蒂与肝脏相连或紧邻肝表面，肿瘤相应的ＣＴ表现。血管造影及血ＡＦＰ检查对诊断有重要参考价值     

肝癌氩氦刀术后的DSA血管造影分析

目的 了解肝癌氩氦刀（ECS）术后的DSA影象特征。方法 本组对38例肝癌患者（原发性肝癌32例,转移性肝癌6例）作氩氦刀治疗,术后分别在7d左右、30～60d行肝动脉或超选择血管造影。结果 单个冰球覆盖的病灶呈圆形或类圆形,其中〈5cm以下的单发病灶,冰球覆盖较完全。冰球叠加覆盖的病灶形态多为不规则形。巨块型,弥漫结节状,治疗区内可见到病理血管和肿瘤染色。冰球覆盖遗漏区18个,肝动脉-静脉和肝动脉-门静脉瘘各4例,穿刺道出血5例,造影剂外溢6例。ECS治疗区域与周围组织有明显界限。ECS治疗术后并行肝动脉化疗栓塞术（TACE）治疗的病例复发率明显降低。结论 ①直径5cm以下的单发病灶,ECS治疗效果满意;②直径5cm以上的富血型肝癌病理血管对ECS不敏感;③巨块型,弥漫结节状,不规则状肝癌ECS治疗后遗漏区较多;④近肝包膜或肝门附近的病灶,ECS治疗时容易出现并发症;⑤ECS治疗术后7d左右行TACE可提高肝癌综合治疗效果。     

肝动脉解剖变异及其对肝癌介入治疗的临床意义

目的：研究肝动脉解剖变异及其对肝癌介入治疗的临床价值。方法：采用Ｓｅｌｄｉｎｇｅｒ经股动脉插管法或超选择性动脉插管法对１７３例肝癌患者行肝动脉造影，分析动脉期图像。结果：肝动脉典型分布１５０例（８６．７％），肝动脉变异２３例（１３．３％）。肝动脉异位自肠系膜上动脉最多见，占８．０９％，其次为肝总动脉变异，占４．０５％。与文献报道尚有差异。另外有２例肝动脉异位自右膈下动脉，尚未见文献报道。结论：肝动脉造影的操作顺序是先行腹主动脉造影，再行腹腔动脉和肠系膜上动脉造影，如无异常，上行至肝动脉系统选择性造影插管至靶血管，才能保证肝动脉插管准确性及肝癌治疗中动脉血管阻断的彻底性。     

肝癌射频治疗后的血管造影表现

目的　了解肝癌射频治疗后的DSA征象 ,为评价肝癌射频治疗的疗效和选择理想的术后影像学随访手段提供参考。资料与方法　本组共 8例 ,原发性肝癌 7例 ,转移性肝癌 1例 ;6例为单发病灶 ,2例各为 2个病灶 (1例为原发 ,1例为转移 ) ;肿瘤直径 3～ 7.5cm(平均 4 .3cm)。肝总动脉及可疑区域供血动脉超选择性造影。结果　DSA表现 :射频治疗的肿瘤区多为圆形或类圆形无染色的低密度区 ;边缘区可见以下几种征象 :(1)局部染色 ;(2 )肝动脉门静脉瘘 ;(3)边缘区出血 ;(4 )边缘复发 ;(5 )无异常造影征象。肝内异位复发灶造影表现同其原发肿瘤常见造影表现。本组 7例造影发现原位边缘复发和 /或肝内异位复发灶。结论　发现和鉴别射频治疗区域的边缘征象是判断局部复发的关键。 (1)肉芽组织染色为治疗区边缘常见征象 ,多见于治疗后 1个月内。 (2 )局部肝动脉门静脉瘘是射频治疗的并发症 ,常因局部肝动脉灌注不足和门静脉异常灌注 ,掩盖局部复发征象。 (3)边缘出血与局部复发的鉴别要点在于 :前者为片状染色 ,时相更早 ,门静脉显影后仍有对比剂存留 ;边缘复发多为结节状 ,分布不均 ,突出于治疗轮廓以外。 (4 )射频治疗 3个月后 ,原肿瘤病灶边缘应无异常血管征象 ,若有染色应考虑复发。DSA在检出 <1cm的边缘结节复发和肝     

不同参数数字减影血管造影对肝恶性肿瘤的临床价值分析

目的 研究不同参数数字减影血管造影对肝恶性肿瘤诊断的临床价值.方法 选择经临床诊断的原发性肝癌患者160例,转移性肝癌40例,分别进行肝总动脉常规造影(RA)及肝总动脉长时间低流率造影(LTLRA),对造影图像进行分析评价,对造影表现、检出病灶进行统计学处理.结果 原发性肝癌造影血供表现为:肝总动脉增粗、肝动脉受侵、抱球征、肿瘤血管、肿瘤染色、肝动脉-门静脉瘘、肝动脉-肝静脉瘘等,其中以肿瘤染色和肿瘤血管出现率最高;转移性肝癌主要表现为肿瘤血管、肿瘤染色,不同大小的病灶血供表现各不相同.原发性肝癌的病灶检出,LTLRA组较RA组检出病灶多95个,检出率提高15.10%,2组比较,有显著性差异(P＜0.05).转移性肝癌的病灶检出,LTLRA组较RA组检出病灶多76个,检出率提高33.33%,2组比较,有显著性差异(P＜0.05).结论 和RA比较,LTLRA可明显提高病灶检出率,特别是对于转移性肝癌的病灶.     

Effect of joint position and ligament tension on the MR signal intensity of the cruciate ligaments of the knee

Six cadaveric lower extremities were imaged with T1-weighted spin-echo pulse sequences with the knees extended and flexed to 90°. Magnetic resonance signal intensities of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were compared. Changing from extension to flexion resulted in decreased signal intensity in six of six ACLs and five of six PCLs. Two of the knees were then imaged with and without tension applied to the ACL. Both specimens showed a decrease in signal intensity with tension, followed by an increase in signal intensity with release of the tension. Finally, in three of the limbs the ACL was surgically reconstructed and then imaged with and without tension applied to the tension graft. Signal intensity decreased with tension and increased with release of the tension in all three specimens. Thus, joint position and changes in ligament tension affect the signal intensity of the ACL and PCL, generally resulting in a signal intensity decrease with tension.     

CT Arthrography and Virtual Arthroscopy in the Diagnosis of the Anterior Cruciate Ligament and Meniscal Abnormalities of the Knee Joint

Objective

To determine the diagnostic accuracy of CT arthrography and virtual arthroscopy in the diagnosis of anterior cruciate ligament and meniscus pathology.

Materials and Methods

Thirty-eight consecutive patients who underwent CT arthrography and arthroscopy of the knee were included in this study. The ages of the patients ranged from 19 to 52 years and all of the patients were male. Sagittal, coronal, transverse and oblique coronal multiplanar reconstruction images were reformatted from CT arthrography. Virtual arthroscopy was performed from 6 standard views using a volume rendering technique. Three radiologists analyzed the MPR images and two orthopedic surgeons analyzed the virtual arthroscopic images.

Results

The sensitivity and specificity of CT arthrography for the diagnosis of anterior cruciate ligament abnormalities were 87.5%-100% and 93.3-96.7%, respectively, and those for meniscus abnormalities were 91.7%-100% and 98.1%, respectively. The sensitivity and specificity of virtual arthroscopy for the diagnosis of anterior cruciate ligament abnormalities were 87.5% and 83.3-90%, respectively, and those for meniscus abnormalities were 83.3%-87.5% and 96.1-98.1%, respectively.

Conclusion

CT arthrography and virtual arthroscopy showed good diagnostic accuracy for anterior cruciate ligament and meniscal abnormalities.     

Percutaneous needle biopsy of the spine

The purpose of this review article is to provide a brief overview of the recent literature on the two main types of percutaneous biopsy methods done in the spinal column: fine needle aspiration biopsy (FNAB) and core needle biopsy (CNB). FNAB is the process of obtaining a sample of cells and bits of tissue for examination by applying suction through a fine needle attached to a syringe. Core needle biopsy involves extracting a cylindrical sample of tissue using a large, hollow needle. The decision for needle biopsy is a joint effort between the clinician, pathologist, radiologist, surgeon, and patient. Specific techniques and approaches with varying needle systems are described for each spinal region. Percutaneous image-guided spine biopsy is a safe and effective procedure. It is the procedure of choice in definitive diagnosis of pathologic lesions of the spine.     

MR imaging of disorders of the brachial plexus

The authors evaluated 64 consecutive patients with suspected brachial plexus (BP) abnormalities of diverse cause with magnetic resonance (MR) imaging, using the body coil and a standardized protocol. Of the 43 patients for whom follow-up was available, 25 were suspected of having neoplastic involvement of the BP, nine had sustained injuries, and nine presented with BP symptoms of uncertain cause. MR imaging was 63% sensitive, 100% specific, and 77% accurate in demonstrating the abnormality in this diverse patient population. When patients with neoplastic and traumatic disorders were considered separately, sensitivity increased to 81%, accuracy to 88%, and specificity remained unchanged. In the patients with a clinical diagnosis of idiopathic or viral plexitis, the MR imaging findings were normal, serving to exclude other structural abnormalities. It is concluded that MR imaging is valuable in the assessment of a wide range of BP disorders.     

Three-dimensional MR visualization of the intracisternal course of the cranial nerves V-VIII by virtual cisternoscopy

Purpose:
A post-processing protocol for 3D visualization of the cranial nerves V-VIII along their intracisternal course is presented. Material and Methods:
Six healthy volunteers underwent MR imaging (1.5 T) to obtain high-resolution heavily T2-weighted data sets (3DFT CISS) with isotropic voxels (0.5 mm³). The data sets were post-processed by using volume rendering software in order to visualize the intracisternal courses of the cranial nerves V-VIII as well as their root entry zones. The data acquisition and post-processing protocol was then applied in 14 patients with a suspected neural compression syndrome according to the clinical findings as well as cross-sectional images and evaluated with respect to image quality and diagnostic value by two neuroradiologists, using a five-point scale. Results:
Virtual cisternoscopy allowed a comprehensive intracisternal 3D visualization of the affected cranial nerves in 12/14 patients. The mean post-processing time amounted to 13.1/5.6/13.7 min for the cranial nerves V/VI/VII and VIII. The mean score for image quality was 4.2, that for diagnostic value 4.1. 2D and/or 3D reference images were indispensable for appreciating the spatial information provided by virtual cisternoscopy. Conclusion:
The data acquisition and post-processing protocol presented here allows comprehensive and standardized intracisternal 3D visualization of the cranial nerves V-VIII in a routine setting as a complementary imaging procedure.     

Trauma of the chest

Trauma to the chest may cause a wide range of injuries including fractures of the thoracic skeleton, contusion or laceration of pulmonary parenchyma, damage to the tracheobronchial tree, diaphragmatic rupture or cardiac contusion. Conditions affecting primarily extrathoracic sites may have indirect effects on the lungs causing adult respiratory distress syndrome or fat embolism. Laceration of the aorta is the typical and likewise most life threatening complication of massive blunt chest trauma necessitating immediate diagnosis and repair.Conventional radiography rather than cross-sectional imaging is the mainstay in diagnosing thoracic trauma. During the critical phase with often concomitant shock, pelvic and spinal injuries tailored radiographic views or even upright chest radiographs are impractical. The severely traumatized patient is usually radiographed in the supine position and suboptimal roentgenograms may have to be accepted for several reasons. It is well documented that many abnormalities detected on CT were not apparent on conventional radiographs, but CT is reserved for hemodynamical stable patients. Nevertheless certain situations like aortic rupture require further evaluation by CT and aortography.The value of conventional radiography, CT, MRI and aortography in chest trauma is reviewed and typical radiographic findings are presented.     

MR imaging characteristics of noncancerous lesions of the prostate.

Radical prostatectomy specimens from 53 men with clinical stage A or B prostate cancer were retrospectively reviewed and compared with correlative axial T2-weighted magnetic resonance (MR) images obtained just before surgery. Non-cancerous lesions were evaluated for signal intensity and location. Focal high-signal-intensity areas (n = 72) were present in 81% of patients. The 26% of lesions seen in the central gland all correlated with cystic atrophy. Of the 53 lesions seen in the peripheral prostate, 47 (89%) were cystic atrophy without associated cancer, four (7.5%) cystic atrophy with cancer, and two (3.8%) focal inflammation. Focal low-signal-intensity areas (n = 42) were present in 60% of patients. Of the 31% of lesions in the central prostate, one-fifth correlated with benign prostatic hyperplasia (BPH) and four-fifths with fibrous tissue. Of the 69% of peripheral lesions, 83% corresponded to fibrous tissue, 10% to BPH, and 7% to normal tissue. Mixed lesions (n = 42) were present in 64% of patients; 86% of these were located centrally and 14% peripherally. All mixed central lesions were BPH; the peripheral lesions were areas of combined cystic atrophy and fibrosis. BPH of low or mixed signal intensity can extend into the peripheral prostate and mimic cancer. High-intensity cystic atrophy associated with cancer can mimic normal tissue.     

Some borderlands of the cervical spine

The complexity of the structure of the cervical spine as well superimposition by the parts of adjacent vertebrae, as well as other structures may cause some abnormalities to be overlooked. Among those abnormalities are, the short sagittal diameter, neoplasm in the cancellous part of the vertebral bodies, spurs in the apophyseal joints, trauma, infection and others.     

Evaluation of the cervical spine in the obtunded patient

Assessment of cervical spine stability in the posttraumatic obtunded patient can be difficult to accomplish with currently available imaging modalities. Dynamic fluoroscopy during passive flexion and extension has been proposed by some authors as a method for the evaluation of cervical spine stability. We present our experience with dynamic fluoroscopy, the general opinions of multiple trauma centers, and alternative methods for evaluating cervical spine stability in the obtunded patient. The potential risks and problems associated with each method are discussed.     

Localized proton MR spectroscopy of the brain in children

Small-voxel (3.0–8.0 cm³), magnetic resonance (MR) imaging–guided proton MR spectroscopy was performed in 54 patients (aged 6 days to 19 years) with intracranial masses (n = 16), neurodegenerative disorders (n = 34), and other neurologic diseases (n = 4) and in 23 age-matched control subjects without brain disease. A combined short TE (18 msec) stimulatedecho acquisition mode (STEAM) and long TE (135 and/or 270 msec) spin-echo point-resolved spatially localized spectroscopy (PRESS) protocol, using designed radio-frequency pulses, was performed at 1.5 T. STEAM spectra revealed short T2 and/or strongly coupled metabolites; prominent resonances were obtained from N-acetyl aspartate (NAA), choline-containing compounds (Cho), and total creatine (tCr). Lactate was well resolved with the long TE PRESS sequence. Intracranial tumors were readily differentiated from cerebrospinal fluid (CSF) collections. All tumors showed low NAA, high Cho, and reduced tCr levels. Neurodegenerative disorders showed low or absent NAA levels and enhanced mobile lipid, glutamate and glutamine, and inositol levels, consistent with neuronal loss, gliosis, demyelination, and amino acid neuro-toxicity. Preliminary experience indicates that proton MR spectroscopy can contribute in the evaluation of central nervous system abnormalities of infants and children.