MR胸导管成像诊断右位胸导管的价值

目的 评价磁共振胸导管成像(MRTD)诊断右位胸导管的价值.方法 回顾性分析MRDT资料,总结右位胸导管的检出率并与核素淋巴显像及直接淋巴管造影、手术所见相对照.结果 连续1547例MRTD检查中共检出右位胸导管12例,检出率0.78%.其中1例合并全内脏反位,1例合并右位主动脉弓.12例患者均同时行核素淋巴显像,核素淋巴显影明确诊断4例.4例行直接淋巴管造影者均可见右位胸导管.7例接受右位胸导管粘连松解术.结论 MRTD可以无创性的诊断右位胸导管,为外科手术提供客观依据,其检出率及诊断准确性高于核素淋巴显像.     

淋巴管肌瘤病合并乳糜性胸、腹腔积液的影像学表现与手术对照

目的 探讨淋巴管肌瘤病(LAM)合并乳糜性胸、腹腔积液的影像学表现.方法 回顾性分析20例合并乳糜性胸、腹腔积液的LAM患者的直接淋巴管造影(DLG)及CT资料,其中15例行胸导管探查,18例行手术治疗.结果 20例LAM均合并不同程度的乳糜性胸腔积液,其中8例合并乳糜性腹腔积液.DLG显示20例LAM腹膜后及髂淋巴管均不同程度扩张,并5例向对侧返流.DLG直观显示14例胸导管出口受阻,其中13例行胸导管探查证实梗阻存在,并行胸导管梗阻解除术,1例胸、腹腔积液完全消失,12例减少或趋于稳定.6例胸导管部分于DLG未见明确显示,其中2例为胸导管结扎术后,1例行髂外淋巴管静脉吻合术后腹腔积液好转;其余4例中2例行胸导管探查证实出口受阻,行胸导管出口梗阻解除术后胸、腹腔积液减少;另2例未行胸导管探查,行髂外或下肢淋巴管静脉吻合术后腹腔积液减少.结论 DLG及CT成像可为LAM合并乳糜性胸、腹腔积液的诊断及治疗提供重要信息.     

非增强MR淋巴管成像在乳糜胸检测中的价值

乳糜胸是由于胸导管或其主要分支破裂或阻塞,使乳糜液潴留在胸膜腔内而形成.乳糜胸导致的乳糜液丢失可引起循环、呼吸、代谢、营养和免疫功能异常,严重威胁患者生命健康[1-2].目前,显示胸导管的技术主要是淋巴管造影及核素淋巴管显像[3],但这些技术具有对比剂不良反应、辐射损伤、检查时间较长及组织分辨率差等缺点[4].近年来,无创的非增强MR淋巴管成像技术在胸导管的显示方面展示出独特的价值[4-6],目前这些研究尚处于起步阶段,主要是针对胸导管解剖学及其变异的研究以及探讨一些腹部疾病对它的影响[5-8].而利用非增强MR淋巴管成像对乳糜胸进行检测目前笔者尚未见报道.因此利用MR淋巴管成像对6例各种原因导致的乳糜胸患者进行显像,探讨该技术在乳糜胸检测方面的价值.     

足背淋巴管造影时肺淋巴的显影

在常规双侧足背淋巴造影中肺淋巴不常显影,有报告在胸导管阻断或梗阻(常伴乳糜胸)下可发生肋间、肺或胸膜淋巴管逆行充盈。罕而在正常胸导管及无乳糜胸情况下见到肺淋巴管。作者报告2例正常胸导管于淋巴造影时肺淋巴管显影。例1为49岁女性,患宫颈鳞癌,每侧足注入8毫升Ethi-odol,淋巴造影片有异常,两侧髂区及左侧腹主     

直接淋巴管造影对胸导管出口梗阻的诊断价值

目的 探讨直接淋巴管造影对胸导管出口梗阻的诊断价值.方法 回顾性分析124例临床表现为淋巴水肿、乳糜胸、乳糜腹、乳糜尿和小肠淋巴管扩张症等患者的直接淋巴管造影资料,并与颈部胸导管手术探查结果进行对照分析直接淋巴管造影对颈段胸导管的显示与胸导管手术探查情况进行对照,2名影像科医师在不知胸导管手术探查结果的情况下,阅读直接淋巴管造影后DSA造影结果,对手术侧颈干、锁骨下干、支气管纵隔干和胸导管末端入血梗阻的数值差异用Kappa值进行一致性分析.结果 124例中,直接淋巴管造影显示淋巴反流:左颈干80例,左锁骨下干75例,左支气管纵隔干30例.胸导管出口入血障碍118例,与颈部胸导管手术探查结果对比分析,符合率分别为89.9％(80/89)、92.6％(75/81)、90.9％ (30/33)和95.2％(118/124).直接淋巴管造影对颈段胸导管的显示与探查情况进行对照,2名影像科医师阅读直接淋巴管造影后DSA造影结果具有高度一致性(K=0.82,P＜0.05).另外,直接淋巴管造影显示腰干以下淋巴管不同程度迂曲、扩张和结构紊乱者114例(91.9％),无异常者仅10例(8.1％);乳糜池以下不同程度反流者92例(74.2％);肠干反流者16例(12.9％);向肾区反流者11例(8.9％);向心包反流者5例(4.0％).伴有阴道淋巴漏7例(5.6％),腹膜后淋巴漏2例(1.6％),胸腔淋巴漏3例(2.4％),气管淋巴漏1例(0.8％).结论 直接淋巴管造影与颈部胸导管手术探查在显示胸导管出口梗阻的各种征象方面具有较高的一致性,直接淋巴管造影可作为胸导管末段手术探查的重要依据.     

淋巴管肌瘤病的影像表现

目的：探讨淋巴管肌瘤病(LAM)的影像学诊断价值。方法 回顾性分析15例经临床和病理证实的LAM胸部X线平片、HRCT,腹部CT和直接淋巴管造影(DLG)及DLG后胸腹部CT扫描等影像资料。结果 15例中,X线胸片上未见异常1例,双肺纹理增多3例,弥漫性小蜂窝状影或网格状影11例,气胸2例,胸腔积液14例。胸部常规CT和HRCT扫描显示15例均具有典型LAM表现,均可见两肺散在囊状影或广泛密布的囊状影。按Avila等肺部疾病程度分级标准：Ⅰ级3例;Ⅱ级5例;Ⅲ级7例。腹部CT显示14例在腹膜后、盆腔可见囊性淋巴管瘤9例,淋巴管肌瘤13例,二者共同存在7例,并发肝脏脂肪瘤和血管平滑肌脂肪瘤、肾脏小错构瘤及子宫肌瘤各1例。DLG检查,除1例淋巴管梗阻部位在腰3水平外,其余14例均可见胸导管不同程度的狭窄、梗阻及颈干和（或）锁骨下干和（或）支气管纵隔干淋巴管反流。DLG术后CT,除3例未显示胸导管出口梗阻外,其余12例显示胸导管出口梗阻情况与DLG基本一致。结论 HRCT对肺淋巴管肌瘤(PLAM)的诊断具有特征性价值,CT可发现腹部LAM,DLG和DLG后MSCT对因LAM引起的胸导管或淋巴管干梗阻部位的显示具有价值,可为手术治疗提供一定的帮助。     

介入治疗乳糜漏60例的临床疗效分析

目的评价介入治疗乳糜漏的可行性、安全性、治疗效果, 以及个体化手术方式的选择。方法回顾性分析2019年6月至2022年1月郑州大学第一附属医院放射介入科收治的60例乳糜漏患者临床资料, 包括乳糜胸37例、乳糜腹10例、乳糜尿4例、乳糜胸合并乳糜腹5例、乳糜胸合并心包积液2例、盆腔乳糜性积液2例。所有患者均保守治疗失败。患者均先行淋巴管造影, 而后根据造影结果选择个体化手术方式。术后统计治疗效果和并发症, 并进行随访。结果淋巴造影成功55例, 5例患者乳糜池和胸导管未见显影, 造影成功率91.7%。单纯淋巴管造影23例、胸导管栓塞23例、乳糜池胸导管针刺毁损5例、直接淋巴管栓塞4例、胸导管球囊扩张成形5例。治疗后痊愈39例(65.0%)、有效14例(23.3%)、无效7例(11.7%), 总体有效率88.3%(53/60)。并发症发生率8.3%(5/60), 均为轻症并发症。失访患者4例, 完成随访者56例, 随访时长0.5～30个月, 中位随访时间为11个月。随访期间病情复发1例(2.0%, 1/49)、死亡8例。结论介入治疗乳糜漏安全、有效、并发症低。根据淋巴造影结果选择个体化手术方...     

联合应用CT淋巴管成像与99mTc-DX淋巴显像在原发性乳糜性心包积液中的诊断价值

目的 探讨^99mTc-DX淋巴显像和CT淋巴管成像(CTL)联合应用在原发性乳糜性心包积液中的诊断价值。方法 回顾性分析经临床确诊的48例原发性乳糜性心包积液患者,所有患者均行^99mTc-DX淋巴显像和CTL。根据^99mTc-DX淋巴显像表现进行分型：Ⅰ型为异常浓聚型,表现为左颈静脉角处异常放射性浓聚,Ⅱ型为异位引流型,表现为右颈静脉角区对比剂持续性浓聚,伴或不伴有左颈静脉角放射性浓聚,Ⅲ型为未显影或一过性显影型,表现为左颈静脉角未显影或在检查过程中一过性显影。CTL的评价指标包括：(1)颈部、锁骨下区、胸导管末端、右淋巴导管末端及腋窝对比剂异常分布及反流;(2)胸部对比剂异常分布,包括胸深部(前纵隔、主肺动脉窗、气管及支气管周、隆突下、后纵隔、肺门、支气管血管束周围、心包等)对比剂异常分布,胸浅部(肋间、胸膜、横膈上)对比剂异常分布;(3)胸导管扩张是指胸导管最宽径>3 mm为扩张;(4)横膈下、同侧髂组、腰干对比剂异常分布,对侧髂组、对侧腰干反流,腹膜后对比剂异常分布。并将各组CTL表现进行统计学分析,P<...     

MSCT直接淋巴管造影在弥漫性淋巴管瘤病中的诊断价值

目的 探讨MSCT直接淋巴管造影(DLG)在弥漫性淋巴管瘤病中的诊断价值.方法 回顾性分析9例弥漫性淋巴管瘤病的影像学资料,5例行DLG及造影后胸、腹、盆部CT检查,余4例行CT检查.9例中3例行MRI检查.结果 9例中,8例累及脾,5例累及腋窝,5例累及颈部,5例累及腹腔及腹膜后,4例累及髂部及腹股沟,3例累及纵隔,3例累及腹壁,2例累及肺,1例累及肝,1例累及颅内硬膜下,CT表现为囊状低密度影,MRI表现为囊状长T1、长T2信号.8例累及骨,CT上表现为边界清楚的类圆形低密度影,MRI上表现为长T1、长T2信号.5例行DLG、造影后CT及胸导管探查示胸导管出口受阻,腹膜后淋巴管扩张迂曲.9例中有4例合并乳糜返流,1例合并锁骨上乳糜囊肿.结论 弥漫性淋巴管瘤病影像学表现具有特异性,MSCT DLG可明确显示淋巴管的异常,可为其病因诊断及合并乳糜返流性疾病的治疗提供直接信息.     

胸导管出口梗阻在 99Tc m-右旋糖酐淋巴显像中的影像特征

目的:通过 99Tc m-右旋糖酐(DX)淋巴显像与直接淋巴管造影(DLG)的比较,探讨 99Tc m-DX淋巴显像在胸导管出口(TDE)梗阻患者中的影像特征及价值。 方法:回顾性分析北京世纪坛医院2017年1月1日至2019年1月1日经胸导管末端手术探查证实的...     

Thoracic duct scintigraphy by orally administered I-123 BMIPP: normal findings and a case report

PURPOSE: To investigate the use of orally administered iodine-123-labeled 15-(4-iodophenyl)-3(R,S)-methyl-pentadecanoic acid (I-123 BMIPP) for thoracic duct imaging in normal and pathologic states and to study the tracer distribution and dynamics in healthy participants. METHODS: The radiotracer was administered with solid (in three healthy persons and one patient) or liquid meals (in three other healthy persons). Solid meals contained relatively more fat content than did the liquid meal. Images were acquired to trace the passage of radiotracer from the intestine to the systemic venous circulation via the lymphatic route. Multiple static planar images were acquired in the anterior and posterior views. Blood samples were analyzed for radioactivity and serum triglyceride levels. RESULTS: In the healthy participants, I-123 BMIPP was absorbed from the intestine and reached the venous circulation through the thoracic duct. The thoracic part of the duct was visualized successfully in all healthy persons within 80 minutes. The radiotracer dynamics varied according to the type of meal administered. The patient had chylomediastinum and right chylothorax and underwent thoracic duct ligation. In the patient, marked stasis in the collateral lymphatic channels was seen, as was chylous leakage into the mediastinal space and right pleural cavity. Passage of tracer to the general venous circulation was delayed. A normal thoracic duct was not seen in this patient. CONCLUSIONS: Scintigraphy by orally administered I-123 BMIPP is a simple method to image the thoracic duct and to monitor its lesions. Meals with a higher fat content result in better BMIPP absorption and may be used as a standard method.     

Assessment of the lymphatic system in patients with diffuse lymphangiomatosis by magnetic resonance imaging

Objective

To assess the lymphatic system in patients with diffuse lymphangiomatosis by magnetic resonance imaging.

Materials and methods

15 patients with diffuse lymphangiomatosis were examined by magnetic resonance imaging. Three locations were examined: first, the lower leg and foot region; second, the upper leg and the knee region; and third, the pelvic with retroperitoneal and abdominal region. For magnetic resonance lymphangiography a T1-weighted 3D spoiled gradient-echo and a T2-weighted 3D-TSE sequence was used.

Results

The size of the genital lymphangiomas, which were revealed in all patients, varied between 5 and 83 mm. In 47% of the patients lymphangiomas were detected at the level of the lower legs, and in 87% of the patients at the level of the upper leg and retroperitoneum. Furthermore, lymphangiomas were seen in the inguinal and pelvic region in 100% and intraabdominally in 40% of the patients. The lymphangiomas extended into the abdominal wall in 93% of the examined patients. A chylous pleural effusion was revealed in 20% and a chylous ascites in 13% of patients. 93% of patients suffered due to the diffuse lymphangiomatous pathologies from a lymphedema of the lower extremities, while a generalized lymphedema of the trunk was found in 87% of the patients.

Conclusion

Magnetic resonance imaging is a safe and accurate minimal-invasive imaging modality for the evaluation of the lymphatic system in patients with diffuse lymphangiomatosis. Since the localization and extension of the lymphangiomas are important prognostic factors, it is crucial to perform a safe radiologic evaluation with a high resolution for the patient's therapeutic planning.     

Lymphangiography to Treat Postoperative Lymphatic Leakage: A Technical Review

In addition to imaging the lymphatics and detecting various types of lymphatic leakage, lymphangiography is a therapeutic option for patients with chylothorax, chylous ascites, and lymphatic fistula. Percutaneous thoracic duct embolization, transabdominal catheterization of the cisterna chyli or thoracic duct, and subsequent embolization of the thoracic duct is an alternative to surgical ligation of the thoracic duct. In this pictorial review, we present the detailed technique, clinical applications, and complications of lymphangiography and thoracic duct embolization.     

静脉性脑梗死MR影像特点

目的回顾总结静脉性脑梗死MRI及MRV影像表现,旨在提高影像诊断水平。方法对15例静脉性脑梗死的MR表现进行了回顾性分析,其中9例临床治疗后复查MR表现明显好转,临床症状明显改善。15例均行常规MRI平扫,其中9例同时进行MR增强及3DCE-MRV,6例行2DTOF MRV。结果 15例脑内多发病灶9例,单发病灶6例,其中2例脑梗死伴出血改变。15例中发生于额叶4例,顶叶6例,颞叶3例,枕叶1例,小脑1例。静脉栓塞部位11例为上矢状窦,1例直窦及左横窦,1例右侧横窦及乙状窦,2例皮层大脑浅静脉。9例行增强扫描,5例病灶内不规则强化,2例脑膜强化,3例无强化.7例MRV均显示栓塞的静脉血流信号丢失或缺损,3例出现异常静脉侧支或引流静脉异常扩张。结论静脉性脑梗死MR影像表现具有特征性,MRI结合MRV可以作为首选的无创检查方法,对静脉栓塞早期诊断和治疗有重要作用。     

Percutaneous Embolization of a Chylous Leak from Thoracic Duct Injury in a Child

Postoperative chylous leak may result from thoracic duct injury during surgical procedures in the chest or neck and can be successfully treated with percutaneous embolization. We report the case of a child with persistent chylothorax and chyloperitoneum following multivisceral transplantation, which was performed due to unresectable inflammatory myofibroblastic tumor of the retroperitoneum. Intranodal lymphangiography was used to demonstrate the site of chylous leak from the lower segment of the thoracic duct and the leak resolved within days following percutaneous embolization of the thoracic duct.     

Experience of 4 years with open MR defecography: pictorial review of anorectal anatomy and disease.

Functional disorders of the pelvic floor are a common clinical problem. Diagnosis and treatment of these disorders, which frequently manifest with nonspecific symptoms such as constipation or incontinence, remain difficult. Fluoroscopic x-ray defecography has been shown to aid in detection of functional and morphologic abnormalities of the anorectal region. With the advent of open-configuration magnetic resonance (MR) imaging systems, MR defecography with the patient in a vertical position became possible. MR defecography permits analysis of the anorectal angle, the opening of the anal canal, the function of the puborectal muscle, and the descent of the pelvic floor during defecation. Good demonstration of the rectal wall permits visualization of intussusceptions and rectoceles. Excellent demonstration of the perirectal soft tissues allows assessment of spastic pelvic floor syndrome and descending perineum syndrome and visualization of enteroceles. MR defecography with an open-configuration magnet allows accurate assessment of anorectal morphology and function in relation to surrounding structures without exposing the patient to harmful ionizing radiation.     

胸膜外孤立性纤维瘤CT和MR表现

目的 探讨胸膜外孤立性纤维瘤(ESFT)的CT和MR表现. 资料与方法 回顾性分析7例经病理证实的ESFT的CT和MR表现. 结果 发生在眼眶和腹膜后各2例,胸椎管内髓外硬膜下、盆腔和睾丸各1例.CT表现为圆形或卵圆形肿块,边界较清楚,4例密度均匀,3例密度不均匀.T1WI呈低或等信号,T2WI呈低信号.增强后肿瘤实质区均明显强化. 结论 影像学表现为孤立性肿块、边界清楚、T2WI有低信号区提示本病.     

Value of MRI in three patients with major vascular injuries after laparoscopic cholecystectomy

The aim of this study was to describe three cases of major vascular injuries after laparoscopic cholecystectomy depicted on magnetic resonance (MR) examination. Three female patients (mean age, 32 years; range, 22–39 years) were studied with clinical suspicion of bilio-vascular injuries after laparoscopic cholecystectomy. All MR examinations were performed within 24 h after the laparoscopic procedure. MR imaging was evaluated for major vascular injuries involving the arterial and portal venous system, for bile duct discontinuity, presence or absence of biliary dilation, stricture, excision injury, free fluid and collections. In the first patient, a type-IV Bismuth injury with associated intrahepatic bile ducts dilation was observed. Contrast-enhanced MR revealed lack of enhancement in the right hepatic lobe due to occlusion of the right hepatic artery and the right portal branch. This patient underwent right hepatectomy with hepatico-jejunostomy. In the other two cases, no visualization of the right hepatic artery and the right portal branch was observed on MR angiography. In the first case, the patient underwent right hepatectomy; in the second case, because of stable liver condition, the patient was managed conservatively. MR imaging combined with MR angiography and MR cholangiography can be performed emergently in patients with suspicion of bilio-vascular injury after laparoscopic cholecystectomy allowing the simultaneous evaluation of the biliary tree and the hepatic vascular supply that is essential for adequate treatment planning.