急性胰腺炎腹膜后间隙受累的CT表现与临床严重程度的相关性分析

目的 探讨急性胰腺炎(acute pancreatitis,AP)腹膜后间隙受累的CT表现与临床严重程度的相关性.资料与方法 回顾性分析76例AP患者的临床和影像学资料,按照亚特兰大AP临床分类标准及AP腹膜后间隙扩散CT表现范围分级评分.分析腹膜后间隙扩散CT表现范围分级评分与临床严重程度分级评分的相关性.结果 76例中,肾旁前间隙、肾周间隙及肾旁后间隙受累发生率分别是49%(37/76)、25%(19/76)及26%(20/76).轻症AP 26例,其中肾旁前间隙受累19例,肾周间隙受累6例,肾旁后间隙受累1例;重症AP 50例,其中肾旁前间隙受累18例,肾周间隙受累13例,肾旁后间隙受累19例.腹膜后间隙扩散CT表现范围分级评分与临床严重程度呈显著正相关(r=0.547,P=0.000).结论 AP腹膜后间隙扩散CT表现范围分级评分与临床严重程度密切相关,影像学检查能够为AP的严重程度及预后提供重要的信息.     

急性胰腺炎腹膜后隙的CT炎性浸润程度与临床严重程度的相关性分析

目的 探讨急性胰腺炎腹膜后隙的CT炎性浸润程度与临床严重程度的相关性.资料与方法 回顾性分析118例急性胰腺炎CT表现,观察腹膜后隙的炎性浸润程度,与急性胰腺炎临床严重程度进行对比分析.结果 118例中,98例不同程度累及腹膜后隙,阳性率83.1%(98/118),肾旁前间隙、肾周『日J隙、肾旁后间隙总的受累率分别为83.1%(98/118)、62.7%(74/118)、31.4%(37/118).其中轻症急性胰腺炎44例,主要累及肾旁前间隙,腹膜后隙炎性浸润程度以0级和Ⅰ级为主,分别占45.5%(20/44)和47.7%(21/44);重.型急性胰腺炎33例,同时累及肾旁前间隙和肾周间隙,炎性浸润程度以Ⅱ级为主,占78.8%(26/33);重2型急性胰腺炎41例,同时累及肾旁前间隙、.肾周间隙和肾旁后间隙,炎性浸润程度均在Ⅱ级以上,并以Ⅲ级为主,占80.5%(33/41).腹膜后隙的炎性浸润程度与临床急性胰腺炎的严重程度呈显著正相关(r=0.7797,P=0.000).结论 腹膜后隙的CT炎性浸润程度,特别是肾旁后间隙的受累往往反映了急性胰腺炎的临床严重程度.     

急性胰腺炎扩散至肾周间隙的螺旋CT表现及其解剖基础

目的探讨急性胰腺炎(AP)扩散至肾周间隙的螺旋CT表现及其解剖学基础。方法回顾分析87例连续AP病例的螺旋CT增强扫描表现,着重观察肾周间隙是否受累以及其CT特征,并进行CT分级评分,观察肾周间隙受累与肾筋膜的毗邻关系。结果肾周间隙总的受累率为75%(65/87),其中B级50%(44/87),C级25%(21/87)。本组轻症AP24例,其中9例出现了肾周间隙受累;63例重症AP,56例出现了肾周间隙受累。肾周间隙内出现的水肿或积液通过肾周间隙内的桥隔与同侧水肿或积液的肾筋膜相连。结论AP累及肾周间隙时,轻者CT表现为肾周间隙内桥隔或脂肪水肿,重者可见蜂窝组织炎或积液。AP所致的炎性水肿或积液主要通过肾周间隙内的桥隔扩散或者破坏肾筋膜而进入肾周间隙。     

AP侵及肾旁后间隙的CT表现及其解剖学基础

目的基于肾筋膜间平面的解剖概念,探讨肾筋膜外侧解剖附着分型为Ⅱ型的急性胰腺炎(AP)患者的肾旁后间隙扩散的CT表现及其受累的解剖途径。方法收集97例急性胰腺炎患者的临床和影像学资料。97例中,23例患者的一侧或双侧肾筋膜外侧附着解剖分型为Ⅱ型,且均有肾旁后间隙(PPRS)受累。回顾性分析23例中的PPRS受累的CT表现及其解剖学基础。结果 1)左侧PPRS和右侧PPRS受累分别为22例和9例;双侧PPRS受侵8例;2)PPRS受累表现为与同侧增厚的肾后筋膜后层和锥侧筋膜相连的条索影、斑片状影、条状积液,以及片团状积液影;3)PPRS受累的途径为:(1)肾旁前间隙的炎症先侵入肾后筋膜后层的筋膜间平面,再侵及PPRS;(2)肾旁前间隙的炎症直接通过增厚的肾后筋膜后层的薄弱处侵犯PPRS;(3)肾旁前间隙和/或肾前筋膜间平面的炎性积液向下进入锥下间隙,然后反折向上而侵犯PPRS。结论基于肾筋膜间平面的解剖,CT可良好显示肾筋膜外侧解剖附着分型为Ⅱ型的急性胰腺炎侵犯肾旁后间隙的解剖细节及其途径。     

急性胰腺炎的多层螺旋CT诊断

目的：探讨多层螺旋CT（MSCT）在急性胰腺炎（AP）诊断中的价值。方法：回顾性分析78例经手术病理及临床证实的AP患者的螺旋CT资料,全部病例均行CT平扫和增强扫描。结果：水肿性胰腺炎49例,出血坏死性29例。其中5例患者合并脓肿,4例死亡。按Balthazar分级：A级5例,B级19例,C级21例,D级18例,E级15例。左膈下脂肪浸润（LSFI）占急性出血坏死性胰腺炎的41.38%（12/29）。肾周间隙（PS）受累占急性出血坏死性胰腺炎的48.28%（14/29）,肾旁后间隙（PPS）受累占急性出血坏死性胰腺炎的44.83%（13/29）。结论：螺旋CT对AP具有定性诊断价值,Balthazar分级、胰腺坏死分型、LSFI、PS及PPS受累对急性出血坏死性胰腺炎的病情判断有很大价值。     

急性胰腺炎累及肾旁后间隙的螺旋CT表现及其解剖基础

目的探讨急性胰腺炎(AP)累及肾旁后间隙(PPS)的螺旋CT表现及其解剖基础。方法回顾分析87例连续AP病例螺旋CT增强表现，着重观察：PPS受累的CT特征及其转归情况；PPS受累与肾后筋膜及锥侧筋膜的关系。结果PPS总的受累率为47％(41／87)。从PPS受累的CT形态看，发生率为：A级53％(46／87)，B级24％(21／87)，C级23％(20／87)。从PPS受累的纵向范围看，发生率为：0级53％(46／87)，Ⅰ级22％(19／87)，Ⅱ级25％(22／87)。PPS内出现的积液直接与同侧肾旁前间隙或肾后筋膜间的积液相连。随访中，3例PPS内的假性囊肿在肾圆锥下方与肾旁前间隙内假性囊肿相通。结论AP累及PPS时，轻者CT表现为PPS内脂肪水肿，重者可见蜂窝织炎或积液。AP产生的肾旁前间隙积液可沿3条路径进入PPS。     

急性胰腺炎在腹膜后扩散的CT表现与肾筋膜减压平面的关系

目的 通过观察急性胰腺炎(acrte pancreatits,AP)在腹膜后间隙内扩散的CT表现提出肾筋膜减压平面并确定其范围.资料与方法 回顾分析61例AP患者的CT增强表现,着重观察AP在腹膜后扩散的CT表现,并分析其与肾筋膜减压平面的关系.结果 61例中,累及肾旁前间隙达113个,肾前筋膜间平面109个,锥侧筋膜间平面63个,肾后筋膜间平面29个,肾旁后间隙15个,肾周间隙81个.肾筋膜间平面包括肾前筋膜间平面、锥侧筋膜间平面以及肾后筋膜间平面,AP累及肾筋膜间平面的CT表现为肾筋膜增厚、模糊、边缘毛糙,中间可见"弧"形或"新月"形液体密度积聚区,肾筋膜间平面间相互交通.肾周间隙受累主要表现为桥隔增厚、边界模糊,桥隔水肿增厚呈条索影,桥隔积液或蜂窝组织炎表现为液体或软组织样密度,桥隔旁脂肪密度增高、呈"毛玻璃"样.结论 AP在腹膜后扩散通道清楚显示了肾筋膜减压平面形态;肾筋膜减压平面包括肾筋膜间平面和桥隔平面.     

肾周间隙积液的CT表现及解剖学基础

目的:结合肾周间隙的解剖学基础分析肾周间隙积液的CT表现。材料和方法:观察59例肾周间隙积液的分布及CT表现。结果:肾周间隙积液CT表现:肾窦水肿,肾被膜下积液,肾周间隙内桥隔增厚,肾周间隙脂肪层内斑片状影,肾被膜及肾前、肾后筋膜增厚,部分同时有圆锥侧筋膜增厚肿胀。右侧肾周间隙积液向上可至肝裸区。结论:CT能够清楚显示肾周间隙积液和肾筋膜的分隔作用,了解这些解剖结构,可合理地解释影像学征象及了解疾病扩展途径,为泌尿外科及介入治疗提供依据。     

急性胰腺炎累及肾周间隙的MRI研究

目的:研究急性胰腺炎(AP)向肾周间隙扩展的MRI表现,以及肾周间隙受累与AP严重程度的关系.方法:回顾性分析119例急性胰腺炎患者的MRI表现.每例AP患者在MRI上的严重程度用MRI严重程度指数(MRSI)进行分级,MRS10～2分为轻症,3～6分中症,7～10分为重症.在MRI上观察肾周间隙有无受累,并对受累程度分级:无受累记为0分,肾周间隙内条索状高信号记为1分,积液记为2分.分析肾周间隙受累程度与MRSI的相关性.结果:119例急性胰腺炎中,轻症急性胰腺炎例48例,中症59例,重症急性胰腺炎12例.73.95%(88/119)的AP患者在MRI上有肾周间隙受累,表现为肾周间隙内条索状、斑片状或大片状异常信号.其中轻症急性胰腺炎肾周间隙受累率47.92%(23/48),中症为91.52%(54/59),重症为91.67%(11/12).肾周间隙MRI评分为1分时在轻症为41.67%(20/48),中症及重症为19.72%(14/71)(χ~2=7.249,P=0.007);肾周间隙MRI评分为2分者轻症和中症共为42.06%(45/107),而在重症为75.00%(9/12)(χ~2=4.724,P=0.030).在MRI上肾周间隙受累的严重程度与MRSI成正相关(r=0.714,P=0.000).结论:在MRI上急性胰腺炎肾周间隙受累率高于文献报道的CT上的受累率,肾周间隙受累反映了AP的严重程度.     

儿童胰腺损伤的MSCT诊断

目的 探讨MSCT在儿童胰腺损伤的诊断价值.方法 回顾性分析经临床、实验室检查及CT明确诊断和手术探查(4例)及临床随访证实的18例闭合性腹部外伤致胰腺损伤患儿的CT表现并按损伤程度进行分级.结果 胰腺损伤CT表现的直接征象有:胰腺肿大(7例),胰腺实质裂伤(5例),实质裂伤伴胰管断裂(2例),胰腺内出血/积液(5例).间接征象有:胰周被膜和肾周筋膜增厚(6例),小网膜囊、胰周及肾旁间隙出血/积液(10例),胰周及腹膜后炎性反应(3例),胰周假性囊肿(10例).合并肝、肾及十二指肠损伤各1例,脾损伤2例.Ⅰ级7例,Ⅱ级6例,Ⅲ级3例,Ⅳ级2例.结论 结合临床及外伤病史,MSCT检查对儿童胰腺损伤能作出正确诊断并可作为首选方法.     

急性尿路梗阻及尿路梗阻性肾周围炎的影像学研究

目的：分析急性尿路梗阻的原因及由尿路梗阻引起的肾周围炎的 CT、MR 影像表现,评价 CT、MR 对尿路梗阻及尿路梗阻性肾周围炎的诊断价值。方法分析72例急性尿路梗阻的原因及尿路梗阻性肾周围炎 CT、MR 表现,着重探讨 CT、MR 在输尿管结石及肾周围炎诊断中各自的优势。结果70例(72个部位)输尿管结石患者中,CT 诊断结石准确率为100%,MR 诊断结石准确率为59.7%;72例肾周围炎患者中,MR 对肾周软组织内积液的显示明显优于 CT。结论CT、MR 在尿路梗阻及尿路梗阻性肾周围炎诊断中各有优势,CT 对输尿管结石的诊断有明显的优势,MR 对肾周围炎诊断有明显优势。     

Bone metastases: evaluation of acuity of lesions using dynamic gadolinium-chelate enhancement, preliminary results

Purpose:

To evaluate whether enhancement on serial dynamic gadolinium‐enhanced abdominal–pelvic MR imaging (DCE‐MRI) can determine the acuity of bone metastases.

Materials and Methods:

Twenty consecutive patients who underwent abdominal–pelvic DCE‐MRI for evaluation/staging of a proven cancer and had bone metastases were included. Two radiologists analyzed in consensus 59 DCE‐MRIs of these patients. Region of interest measurements were performed in up to three lesions on noncontrast T1‐weighted, serial hepatic arterial dominant phase (HADP), early hepatic venous phase (EHVF), and interstitial phase (IP) postgadolinium images, and the percentage enhancement of 134 lesions was calculated. The coordinator separately and retrospectively sorted the lesions into three groups based on the imaging and clinical information: acute/active, subacute, and chronic metastases.

Results:

The mean percentage enhancement of the bone metastases classified as acute/active, subacute, and chronic in the HADP, EHVP and IP were respectively (%): 134, 107, 99; 87, 86, 87; and 39, 65, 73. In the HADP, acute/active lesions enhanced significantly more than both subacute (1.53‐fold) and chronic (3.4‐fold) lesions (P < 0.01). Time intensity curves were significantly different between these three entities as well.

Conclusion:

The enhancement on arterial phase images and the time–intensity curves were different for acute/active, subacute, and chronic bone metastases. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

MR characteristics of acute cholangitis

Purpose: To describe the MR appearance of acute cholangitis and discuss the role of MR imaging as a diagnostic method in this disease.Material and Methods: Of 60 patients with clinical acute cholangitis, 12 were examined with MR before endoscopic retrograde pancreatography (ERCP). A retrospective review was performed of MR and ERCP findings. The MR findings registered were presence of biliary duct dilatation, intraluminal filling defects due to stones or sludge, bands of mucosal oedema of the biliary ducts, intra- and retroperitoneal oedema/fluid, and definition of the cause of obstruction, e.g. stones, stenosis or tumour was made.Results: Acute cholangitis was related to obstruction from choledocholithiasis (n=8), pancreatic cancer (n=1), benign biliary duct stricture (n=1), papillary stenosis (n=1) and without evidence of an obstructing cause (n=1). One patient had an acute obstructive suppurative (toxic) cholangitis.Conclusion: MR imaging has a role in the non-invasive radiographic arsenal of techniques to confirm or exclude the diagnosis of acute cholangitis, especially in older patients where the clinical symptoms may be vague.     

Sequential CT in monitoring experimental lung transplant.

The criteria for diagnosis of lung rejection remain controversial. In this study early changes in lung rejection were characterized using sequential CT with the aim of developing a sensitive and safe monitoring method, which would also provide specific information on graft status. Twenty-one experimental single lung transplants (SLTs) in piglets, including unmodified rejections, immunosuppressed recipients, and autogenic reimplants, were scanned using CT on days 3, 5, 7, 10, 14, 22 up to 134 days after operation. In addition to morphological analysis, bilateral densitometric CT measurements of the peripheral lung parenchyma were used to evaluate the intensity of interstitial infiltration of lung grafts. Altogether 67 postoperative CT studies were carried out. Simultaneous transbronchial/thoracic biopsies were undertaken. The mean follow-up time was 28 days (range 0-134 days). The experience obtained was then used in relation to SLT in a male patient for chronic obstructive pulmonary disease. All piglets had a typical hilar reimplantation response, which disappeared in 10-20 days. Two distinct patterns of radiological acute rejection were found. Increasing peripheral alveolar infiltrates reflected early massive rejection in untreated animals. In immunosuppressed animals, after the initial reimplantation response, acute rejection was detected as densitometrically measured diffuse interstitial infiltration over the whole graft. Local findings, like focal infections, were seen later in the lingula and basal portions of the graft. In the SLT patient, density changes preceded clinical rejection episodes, which responded to steroid therapy. In the experimental study, the lung graft was compared to normal contralateral lung. In the SLT patient, however, this was not possible, and, therefore, the subsequent repeated CT studies formed the basis of clinical follow-up. Sequential imaging and densitometric measurements allowed objective estimation of diffuse interstitial infiltration relating to rejection.     

Predicting cerebral ischemic infarct volume with diffusion and perfusion MR imaging

BACKGROUND AND PURPOSE: Diffusion and perfusion MR imaging have proved useful in the assessment of acute stroke. We evaluated the utility of these techniques in detecting acute ischemic infarction and in predicting final infarct size. METHODS: Diffusion and hemodynamic images were obtained in 134 patients within a mean of 12.3 hours of onset of acute ischemic stroke symptoms. We retrospectively reviewed patient radiology reports to determine the presence or absence of lesion identification on initial diffusion- (DW) and perfusion-weighted (PW) images. Radiologists were not blinded to the initial clinical assessment. For determination of sensitivity and specificity, the final discharge diagnosis was used as the criterion standard. Neurologists were not blinded to the DW or PW imaging findings. In 81 patients, acute lesions were compared with final infarct volumes. RESULTS: Sensitivities of DW imaging and cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) perfusion parameters were 94%, 74%, 84%, and 84%, respectively. Specificities of DW imaging, CBV, CBF, and MTT were 96%, 100%, 96%, and 96%, respectively. Results were similar in 93 patients imaged within 12 hours. In 81 patients with follow-up, regression analysis yielded r(2) = 0.9, slope = 1.24 for DW imaging; r(2) = 0.84, slope = 1.22 for CBV; r(2) = 0.35, slope = 0.44 for CBF; and r(2) = 0.22, slope = 0.32 for MTT, versus follow-up volume. A DW-CBV mismatch predicted additional lesion growth, whereas DW-CBF and DW-MTT mismatches did not. Results were similar in 60 patients imaged within 12 hours. CONCLUSION: Diffusion and hemodynamic images are sensitive and specific for detecting acute infarction. DW imaging and CBV best predict final infarct volume. DW-CBV mismatch predicts lesion growth into the CBV abnormality. CBF and MTT help identify additional tissue with altered perfusion but have lower correlation with final volume.     

The value of diffusion-weighted imaging for prediction of lasting deficit in acute stroke: an analysis of 134 patients with acute neurologic deficits

Acute stroke is one of the three major causes of death and disability in the United States. Now that new, and possibly effective therapy is becoming available, accurate, rapid diagnosis is important to provide timely treatment, while avoiding the risk of complications from unnecessary intervention. Our objective was to test the hypothesis that use of echo-planar (EPI) diffusion-weighted imaging (DWI) is more accurate than conventional T₂ weighted MRI in predicting progression to stroke in patients with acute ischemic neurologic deficits. We studied 134 patients presenting with acute neurologic deficits to a community hospital emergency room with both conventional MRI and DWI within 72 h of the onset of the acute deficit. We found DWI significantly more sensitive to permanent neurologic deficit at discharge (sensitivity 0.81) than conventional MRI (sensitivity 0.41). When available, DWI should be considered for routine use in patients being imaged for acute stroke. Received: 21 January 2000 Accepted: 7 October 2000     

MR鼻泪管成像的临床应用

目的 探讨MR鼻泪管成像技术和诊断价值.方法 对8名健康志愿者(16侧正常泪道)和17例泪溢患者(32侧泪溢泪道)进行MR检查,检查前向双侧结膜囊滴入无菌盐水,扫描序列为MR三维快速反转自旋回波泪道成像(3D-FRFSE MRD)序列,泪溢患者还加做了横断面及冠状面快速回复快速自旋回波T2WI序列.在MRI后3 d内对泪溢患者进行泪道内镜检查,并将MRD结果与内镜所见对照分析.结果 16侧正常泪道中有8侧泪囊及鼻泪管全程显影.32侧有泪溢症状的泪道经内镜证实为鼻泪管慢性炎症改变,黏膜增厚呈灰红色,阻塞处为灰白色无弹性的膜状物附着.泪溢组3D-FRFSE MRD序列判断的阻塞部位与内镜的符合率为78%(25/32),表现为阻塞部位以上的泪道呈含水的高信号,其以下的泪道不显影.泪溢侧的鼻泪管在FRFSE T2wI序列上均有阳性改变,阻塞部位以上的泪囊和(或)鼻泪管腔内可见长T2液体信号充填,其以下的管腔内可见等或稍长T2的软组织信号影充填,管壁黏膜增厚.结论 鼻泪管滴注无菌盐水后MRI可以显示正常鼻泪管,而且具有对鼻泪管阻塞定位、定性的诊断价值.     

Radiological diagnosis of acute stroke. Comparison of conventional MR imaging, echo-planar diffusion-weighted imaging, and spin-echo diffusion-weighted imaging.

PURPOSE: To compare conventional MR imaging, echo-planar diffusion-weighted imaging (EP-DWI) and spin-echo diffusion-weighted imaging (SE)-DWI at radiological diagnosis of acute stroke. MATERIAL AND METHODS: Twenty-seven patients (30-85 years old) were examined. Clinical examination was performed before MR imaging. All MR examinations were assessed by an experienced neuroradiologist blinded to clinical findings. RESULTS: In EP-DWI, every patient had a lesion corresponding to the clinical findings. EP-DWI was used as the gold standard. In conventional PD+T2 imaging, 23/59 focal lesions were interpreted as acute, which was false in 11 lesions, and 36/59 lesions were considered to be old, 6 were in fact acute. Nine acute lesions were only detected retrospectively and 12 acute lesions were not detected at all on PD+T2. SE-DWI including the apparent diffusion coefficient correlated fairly well with EP-DWI but the procedure was impractical. CONCLUSION: EP-DWI is reliable for diagnosis of early ischemic stroke, while SE-DWI performs reasonably well. Conventional PD+T2 imaging is not reliable for diagnosis of early ischemia.     

Urological and medical complications of renal transplant

Medical complications from renal transplant (acute tubular necrosis, acute rejection, chronic rejection) are mainly imaged with Doppler ultrasound to first exclude vascular or urological causes for renal function impairment. Once these causes are excluded, imaging features are nonspecific and imaging is mainly used for follow-up and biopsy remains essential. Urological complications include postsurgical collections, urinary fistulas, obstructive uropathy, vesicoureteric reflux, infections and malignancies. Imaging plays a leading role in the diagnostic and therapeutic management of these complications.     

儿童主动脉梗阻性病变的磁共振诊断

目的：报道93例儿童梗阻性主动脉病变并评价其磁共振成像技术。方法：主要采用造影增强磁共振血管成像术(CEMRA)诊断儿童梗阻性主动脉病变。结果：93例中，主动脉缩窄67例，主动脉弓离断l6例，主动脉瓣上狭窄2例，大动脉炎8例。男62例，女3l例。82例经手术或心血管造影检查证实磁共振诊断正确率为97．5％。结论：造影增强磁共振血管成像术是很好的儿童梗阻性主动脉病变诊断手段。