肌肉病的磁共振影像学诊断

目的:探讨磁共振成像技术在肌肉病诊断中的作用.方法:回顾性研究54例经临床及病理确诊的肌肉病患者的大腿磁共振影像,分析病灶的信号与分布特点.结果:进行性肌营养不良以脂肪替代为主,其中肢带型肌营养不良有炎性水肿的表现.皮肌炎主要表现为炎性水肿.脂质沉积症与糖原贮积症形态特点相似,以斑片状脂肪替代为主.同时,不同疾病对大腿肌群的累及也具有一定的选择性.结论:不同肌肉病病灶具有一定的信号与分布特点,通过磁共振检查有助于疾病的诊断.     

New diagnostic methods of sarcoidosis in Hungary: labial biopsy and cardiac MRI

The two major challenges in the diagnostic procedure of sarcoidosis are the differential diagnosis and the determination of the extent of the disease. 1) The corner stone of differential diagnosis is the histological demonstration of non-caseating granulomas. Obtaining an appropriate sample for histological examination often requires invasive examinations. A minimal invasive sampling method, the labial biopsy, not yet practiced in Hungary is showed in the first part of this paper. 2) Cardiac involvement has great importance in the evaluation of the extent of the disease. MRI is the most accurate method available to date to demonstrate cardiac sarcoidosis. The first MRI proven cardiac sarcoidosis in the Hungarian medical literature is reported in the second part of the article.     

MRI findings in pituitary-hypothalamic axis Langerhans cell histiocytosis

Pituitary-hypothalamic axis Langerhans cell histiocytosis is an uncommon entity. It is a rare disease in adults. The CT and MR study provides us the best anatomo-topographic evaluation and determine the precise size of the lesion which are necessary to the treatment. We report a case of hypothalamic involvement by Langerhans cell histiocytosis accompanied by lesions in bone affecting a 31-year-old woman. The clinical, histiotological and CT/MR findings of histiocytosis X are described in this article.     

Three cases of alveolar soft part sarcoma and MRI findings

Three cases of alveolar soft part sarcoma were reported with characteristic MRI findings. On MRI findings, slightly higher signal intensity than muscles on T1 weighted image and remarkably high signal intensity on T2 weighted image were thought to be characteristic of alveolar soft part sarcoma.     

低磁场MRI在股四头肌肌腱损伤的诊断研究

目的：探讨股四头肌肌腱损伤低磁场MRI的应用价值。方法：回顾性分析26例临床随访证实股四头肌肌腱损伤磁场强度为0.35T的MRI影像资料。结果：髌骨附着点肌腱病18例,表现为髌骨附着点附近信号增高;韧带不同程度撕裂8例,均为部分性断裂,伴游离端回缩7例。MRI较好显示了伴发的膝关节其他损伤或退行性骨关节病。结论：MRI易于准确评价股四头肌肌腱损伤。     

内侧髌股韧带急性损伤的低场磁共振成像表现

目的：探讨内侧髌股韧带（MPFL）急性损伤的低场磁共振成像（MRI）表现特征。方法：回顾性分析临床证实的26例MPFL急性损伤患者的0.35TMRI影像资料。结果：26例患者均为单膝受累。MRI主要表现：MPFL区域信号增高（n=26）、韧带周围肿胀（n=11）、变细（n=11）、中断（n=4）,以轴位显示最佳。病变部位：股骨侧10例、髌骨侧14例、体部2例。伴发症：伴髌骨半脱位和（或）脱位13例,伴骨折和（或）骨挫伤22例,伴软骨损伤15例,其他韧带损伤14例,膝周肌损伤9例,滑膜囊及关节腔积液26例,膝关节退行性骨关节病12例,髌股关节先天性异常4例,滑膜病变7例等。结论：MRI是评价MPFL损伤及其伴发病变较佳的检查方法。     

胸腺脂肪变与成年人眼肌型重症肌无力的相关性研究

目的　探讨成年人眼肌型重症肌无力 (O -MG)的胸腺影像学变化特点。方法　对正在接受临床治疗的成年人O -MG患者 5 0例 ,男 1 8例 ,女 32例 ,年龄 2 0～ 5 5岁 ,进行磁共振成像 (MRI)检查 ,其中 1 6例增强扫描。对照组5 0例为相同年龄段非重症肌无力患者 (N -MG) ,其中 2 0例增强扫描。观察两组胸腺变化关系包括脂肪变、增生、占位效应等。结果　 (1 )胸腺脂肪变O -MG组 2 5例 ,对照组 8例。 (2 )胸腺增大 :O -MG组 4例 ,其中 2例含结节灶 ;对照组无一例增大。 (3)胸腺出现占位病灶仅见于O -MG组 5例。 (4)胸腺未发现异常 :O -MG组 1 6例 ,对照组 4 2例。 (5 )统计学处理显示 :胸腺脂肪变O -MG组与对照组比较差异有极显著性 (P <0 .0 0 1 ) ;胸腺的异常率比较 ,两组同样具有极显著性差异 (P <0 .0 0 1 )。结论　胸腺脂肪变是成年人O -MG患者常见和主要异常变化。MRI能提供胸腺形态和组织变化的客观信息 ,有助于临床治疗方式的选择和疗效观察。     

Cerebellar infarction; the findings of CT, MRI and cerebral angiography

The findings of CT, MRI and cerebral angiography were analysed in 18 cases with cerebellar infarction, of which 10 were men and 8 women. The areas of infarction were as follows; PICA in 9 cases, SCA in 8 cases, AICA and diffuse type in one case each. One case had two lesions. CT showed low density areas in 15 cases after 24 hours of the onset, but an abnormality was not demonstrated in one case which had an infarction of PICA area. MRI showed a high-intensity lesion on T2 weighted image during the first and tenth day after the onset, while a low-intensity lesion on T1 weighted image and high-intensity lesion on T2 weighted image were demonstrated after seventh day. MRI revealed the area of infarction better than CT. Vertebral angiography and DSA showed narrowing or poor visualization of the cerebellar arteries in 5 cases but this finding was not shown in 3 cases which were examined by IVDSA.     

Welder’s lung and brain MRI findings in manganese-exposed welders

Background:Biomarkers of manganese (Mn) exposure and manganism are poorly understood. Blood Mn levels are often used to assess exposure, while brain Mn accumulation may be demonstrated by pallidal hyperintensity at magnetic resonance imaging (MRI). Mn-containing electrodes used in manual metal arc welding may be associated with the welder’s lungs.Methods:A cross-sectional study was set up to compare T1 intensity in basal ganglia at MRI and Mn blood levels in subjects with or without pneumoconiosis. Clinical, radiological, pulmonary function and laboratory parameters were assessed among 154 welders referred to our hospital for suspected pulmonary pathology.Results:The study group included 123 male welders with pneumoconiosis (79.9%) and 31 welders without pulmonary damage (20.1%). The cases without pneumoconiosis were younger (38.5±6.6 vs 42.1±7.1, p=0.012). Cases with pneumoconiosis had blood lower Mn levels [13.5 (10-21)] as compared to those without pneumoconiosis [18.5 (7.8-34)], p=0.035. In the same groups, the cases with high blood Mn levels were 49 (39.8%) and 18 (58.1%) p=0.052, respectively. Brain MRI hyperintensity was found in 86 (55.8%) subjects with welder’s lung 63 (51.2%) but also in 23 (74.2%) individuals without welder’s lung. MRI hyperintensity in basal ganglia was significantly related to high blood Mn (p<0.005).Conclusion:This is the first study evaluating blood Mn levels of welders and their correlation with pulmonary and neurological effects. In Mn-exposed welders, poor working conditions may be associated with exposure fibrogenic fumes leading to chronic lung diseases and hyperintensity in brain MRI suggesting Mn accumulation.     

Naso-sinusienne sarcoidosis

BACKGROUND: Sarcoidosis is an ubiquity disease, which can infiltrate all tissues. The cutaneous and ophthalmologic thoracic localizations are most frequent. The nasosinusienne localisation is rare. AIM: The authors report their observations of 4 patients: 2 men and 2 women with a mean age 47.5 years (42-56). Theses cases was diagnosed and treated between january 1998 and December 2003 in the ENT service of the Habib Thameur hospital. CASES: The diagnosis was related to a nasal or a sinuses biopsy. The assessment of extension was negative in 3 cases. The corticoid treatment in local pulverization was sufficient in 2 cases. The corticoid treatment by systematic way was necessary among 2 patients. Favourable out look was obtained in all the cases. The naso sinusienne localization is rare, it is exceptionally isolated. The clinical and radiological symptoms are not specifics. Principal element of the diagnosis is the directed biopsy, easy in this localization.     

Pancreatic sarcoidosis

Pancreatic involvement in sarco?dosis is exceptional. We report a case of pancreatic sarco?dosis diagnosed during the etiologic work-up done for a pancreatic mass associated to a polyadenopathy. Under corticotherapy evolution is favorable with regression of the pancreatic lesions.     

Rheumatologic manifestations of sarcoidosis

Sarcoidosis is a systemic granulomatous disease of unknown etiology. It has various clinical features. The most commonly affected organs are the lung, the lymph nodes, the eyes and the skin. Involvement of the musculoskeletal system is far less common and may be inaugural. Articular involvement is dominated by Lofgren syndrome and acute polyarthritis. Abarticular manifestations are often confounded with arthritis. Bone locations are dominated by sarcoidosis dactylitis and osteolysis. Muscular involvement is often unknown and can appear as 3 clinical features: spread form, myositique form or pseudotumoral form. Calcium balance disturbances are dominated by hypercalcemia which is often asymptomatique, but sometimes it reveal the sarcoidosis. Treatment of rheumatologic disorders often involves non steroidal antiinflammatory drugs, corticosteroids and methotrexate. Biological therapies such as the anti-TNFa and the anti-CD20 were showed to be effective in some case reports of severe and refractory disease.     

结节病的研究进展

结节病是一种原因不明的肉芽肿性疾病,通常累及肺部,临床表现多种多样、预后差异极大.确诊依赖于组织学中发现非干酪性肉芽肿,支气管镜检查是获取病理组织的最常用方法.肺纤维化、肺功能受损和肺动脉高压是临床预后不良的危险因素.糖皮质激素是最常用的一线治疗,免疫抑制剂通常作为糖皮质激素的替代方案,TNFα拮抗剂通常用于难治性结节病患者.