小儿先天性肺囊性腺瘤样畸形的临床及影像学表现分析

目的通过对小儿先天性肺囊性腺瘤样畸形（CCAM）的临床特征、发病机制及鉴别诊断的分析,探讨患儿CCAM的影像学特点,以提高对该病的影像学认识。方法回顾性分析2011年3月-2013年3月3例经手术、病理证实CCAM患儿的临床资料、胸部CT影像学特点,复习相关文献,并对3例患儿随访2年。结果3例CCAM患儿均累及单侧单一肺叶,且位于下叶,其中左肺下叶2例,右肺下叶1例;2例可见多个含气大囊,1例见多发蜂窝样小囊。依照Stocker组织病理学分型,3例患儿中Ⅰ型2例,Ⅱ型1例。手术证实病变均为单侧,并侵犯一个肺叶,不与支气管相通。所有患儿治愈出院,术后随访2年结果显示恢复良好,无复发。结论影像学检查为发现和诊断CCAM的主要依据,其CT表现具有特征性,根据CT表现可推测其病理分型,熟悉其临床及CT特征有助于提高对该病的诊断。     

Joubert综合征及相关疾病的产前及产后影像学研究

目的：探讨胎儿及家系患儿Joubert综合征及相关疾病（JSRD）超声、磁共振成像（MRI）影像特征。方法对2013年4至8月在南方医科大学附属深圳市妇幼保健院产前筛查的脑积水胎儿行超声、MRI及基因检查,对引产胎儿标本行尸体解剖检查;对家系6岁JSRD患儿进行体格检查、脑电图及MRI检查。结合临床、影像学检查及尸检结果进行综合分析。结果 JSRD胎儿及家系患儿检查结果：（1）超声声像图示胎儿小脑蚓部发育不良形成的“裂隙征”、脑积水、左侧脑室宽约2.3 cm。（2）颅脑MRI示胎儿及家系患儿均显示中脑水平“臼齿征”及小脑蚓部发育不良形成的“裂隙征”。（3）基因检测：胎儿脐带血及患儿外周血基因检测均表现为染色体4p15.32上的CC2D2A基因突变。（4）引产胎儿尸体解剖示小脑蚓部发育不良,两侧小脑半球向中线靠拢。（5）临床检查：家系患儿视听反应欠佳、抬头不稳、头眼协调欠佳、上眼睑抬举乏力,哭时口角左歪、智力运动发育落后,走路不稳。（6）脑电图检查：家系患儿枕部大脑皮质异常放电以3-4 Hz为主;睡眠背景欠佳,额区尖波频发,右侧为著。结论产前颅脑MRI显示“臼齿征”可提示JSRD;超声显示小脑蚓部发育不良出现“裂隙征”可为诊断JSRD提供一定线索,但“裂隙征”在中孕早期特异性不强。产后依据临床及影像学“臼齿征”、“裂隙征”、“蝙蝠翼征”等特征性超声表现较易诊断JSRD。     

先天性胆管囊状扩张症的影像学诊断(重点讨论CT诊断)

本文对２５例先天性胆管囊状扩张症根据ＣＴ表现分为三种类型：１）肝内型；２）肝外型；３）混合型。肝内型具有特征性ＣＴ表现为扩张呈囊状的胆管将门静脉分支包绕，在增强ＣＴ或胆道造影ＣＴ均可显示出“中心圆点。征象。肝外型囊壁见突出腔内结节时为癌变征象。ＣＴ对本病的显示准确率达１００％。对照其它影像检查方法，作者认为：超声对本病也有重要诊断价值；Ｘ线胆道造影诊断价值不大；ＥＲＣＰ和ＰＴＣ为痛苦性检查方法，提     

胃囊性病变的影像学鉴别

本文搜集手术病理证实的发生于胃部的多种囊性病变（胃憩室,胃重复畸形,异位胰腺囊肿,胃肠间质瘤囊变）,胃周易误诊为胃来源的囊性病变（肝左叶囊肿、胰腺假性囊肿）,以及文献报道的胃壁脓肿。回顾上述病例的临床资料,针对其影像学表现,对胃的囊性病变的影像学特征进行归纳和小结,同时结合临床表现、病理改变对胃囊性疾病进行阐述,以期提高对胃囊性病变的认识。     

胎儿先天性肺囊腺瘤畸形与肺隔离症的产前超声诊断与预后分析

目的探讨胎儿先天性肺囊腺瘤畸形和肺隔离症病变的声像图特点与其预后。方法对于我院就诊的孕妇进行产前超声检查,诊断23例胎儿存在先天性肺囊腺瘤畸形和肺隔离症病灶,对其声像图进行回顾性分析,并对其追踪随访。结果超声诊断为先天性肺囊腺瘤畸形和肺隔离症的23例,病灶最大径15~72mm,平均(30.3±13.6)mm,胎儿病灶体积与头围比值为0.02~1.54,致胎儿心脏受压位移的病灶8例;均未合并其他器官异常,无全身水肿、胸腔或腹腔积液、羊水过多等征象。继续妊娠的19例胎儿均为足月活产,2例终止妊娠,2例失访。结论胎儿先天性肺囊腺瘤畸形和肺隔离症预后良好,产前超声探查病灶血供来源是鉴别二者的重要依据。     

Clinical Utility of Fetal Short-Lag Spatial Coherence Imaging

In this study, we evaluate the clinical utility of fetal short-lag spatial coherence (SLSC) imaging. Previous work has documented significant improvements in image quality with fetal SLSC imaging as quantified by measurements of contrast and contrast-to-noise ratio (CNR). The objective of this study was to examine whether this improved technical efficacy is indicative of the clinical utility of SLSC imaging. Eighteen healthy volunteers in their first and second trimesters of pregnancy were scanned using a modified Siemens SC2000 clinical scanner. Raw channel data were acquired for routinely examined fetal organs and used to generate fully matched raw and post-processed harmonic B-mode and SLSC image sequences, which were subsequently optimized for dynamic range and other imaging parameters by a blinded sonographer. Optimized videos were reviewed in matched B-mode and SLSC pairs by three blinded clinicians who scored each video based on overall quality, target conspicuity and border definition. SLSC imaging was highly favored over conventional imaging with SLSC scoring equal to (28.2 ± 10.5%) or higher than (63.9 ± 12.9%) B-mode for video pairs across all examined structures and processing conditions. Multivariate modeling revealed that SLSC imaging is a significant predictor of improved image quality with p?≤?0.002. Expert-user scores for image quality support the application of SLSC in fetal ultrasound imaging.     

Volume contrast imaging: A new approach to identify fetal thoracic structures.

OBJECTIVE: To assess the potential of volume contrast imaging for evaluation of fetal intrathoracic structures. METHODS: Volume contrast imaging is a new ultrasonographic method that increases the contrast between tissues. It consists of a 5- to 10-mm-thick slice-shaped volume image projected on a 2-dimensional screen. The rendering process applied on the slice smoothens the speckle pattern of the image by filling up the gaps with tissue information from the adjacent layers. To evaluate the potential of volume contrast imaging for enhancing the contrast between fetal lungs and surrounding tissues, we compared the ability of volume contrast imaging and conventional ultrasonography to image the fetal thymus in 50 controls. We also applied volume contrast imaging to prenatal imaging of 6 thoracic abnormalities (2 left congenital diaphragmatic hernias, 1 right diaphragmatic hernia, 2 congenital adenomatoid lung malformations, and 1 lung sequestration). RESULTS: In controls, the thymus was identified in all cases by volume contrast imaging and in 42 cases (84%) by conventional 2-dimensional ultrasonography. Clear images of macrocystic and microcystic congenital adenomatoid malformations were obtained by volume contrast imaging, which provided precise contouring of the lesions. In cases with congenital diaphragmatic hernias, volume contrast imaging provided clear images of the limits of the lungs ipsilateral to the hernia. CONCLUSIONS: Volume contrast imaging may enhance the contrast between fetal lungs and surrounding organs and can be applied to prenatal imaging of intrathoracic structures in cases with thoracic fetal abnormalities.     

Usefulness of prenatal magnetic resonance imaging in differential diagnosis of fetal congenital cystic adenomatoid malformation and bronchopulmonary sequestration

BACKGROUNDCongenital cystic adenomatoid malformation (CCAM) and bronchopulmonary sequestration (BPS) are the most common lung diseases in fetuses. There are differences in the prognosis and treatment of CCAM and BPS, and the clinical diagnosis and treatment plan is usually prepared prior to birth. Therefore, it is quite necessary to make a clear diagnosis before delivery. CCAM and BPS have similar imaging features, and the differentiation mainly relies on the difference in supply vessels. However, it is hard to distinguish them due to invisible supplying vessels on some images.AIMTo explore the application value of magnetic resonance imaging (MRI) in the differential diagnosis of fetal CCAM and BPS.METHODSData analysis for 32 fetuses with CCAM and 14 with BPS diagnosed by prenatal MRI at Huzhou Maternal and Child Health Care Hospital and Anhui Provincial Children’s Hospital from January 2017 to January 2020 was performed to observe the source blood vessels of lesions and their direction. Pathological confirmation was completed through CT examination and/or operations after birth. RESULTSAfter birth, 31 cases after birth were confirmed to be CCAM, and 15 were confirmed to be BPS. The CCAM group consisted of 21 macrocystic cases and 10 microcystic cases. In 18 cases, blood vessels were visible in lesions. Blood supply of the pulmonary artery could be traced in eight cases, and in 10 cases, only vessels running from the midline to the lateral down direction were observed. No lesions were found in four macrocystic cases and one microcystic case with CCAM through CT after birth; two were misdiagnosed by MRI, and three were misdiagnosed by prenatal ultrasonography. The BPS group consisted of 12 intralobar cases and three extralobar cases. Blood vessels were visible in lesions of nine cases, in four of which, the systemic circulation blood supply could be traced, and in five of which, only vessels running from the midline to the lateral up direction were observed. Three were misdiagnosed by MRI, and four were misdiagnosed by prenatal ultrasonography. CONCLUSIONCCAM and BPS can be clearly diagnosed based on the origin of blood vessels, and correct diagnosis can be made according to the difference in the direction of the blood vessels, but it is hard distinguish microcystic CCAM and BPS without supplying vessels. In some CCAM cases, mainly the macrocystic ones, the lesions may disappear after birth.     

Imaging Features of Paratesticular Masses

In this pictorial essay, we review the sonographic and other imaging findings of paratesticular masses in correlation with the pathologic findings. The examples include benign and malignant tumors and also non‐neoplastic mass lesions of the paratesticular structures. Diagnostic sonographic findings of these mass lesions as well as correlative findings of other imaging methods are presented.     

Advances in Molecular Imaging: Plaque Imaging

Recent advances in nuclear plaque imaging aim to achieve noninvasive identification of vulnerable atherosclerotic plaques using positron emission tomography (PET) with ¹⁸F-fluorodexoyglucose (FDG) and novel tracers targeting molecular markers of inflammation and other active metabolic processes. Nuclear imaging of atherosclerosis has been demonstrated in multiple vascular beds, including the carotid, aorta, peripheral and coronary arteries—but significant challenges remain, especially for coronary imaging. The advantage of PET over other molecular imaging modalities is its superior sensitivity, however, low spatial resolution means that images must be co-registered with computed tomography (CT) or magnetic resonance imaging (MRI) for precise anatomical localization of the PET signal. Such hybrid techniques provide the best hope for early detection of prospective culprit lesions—which may, in the coronary vasculature, appear falsely low-risk using conventional coronary angiography or stress imaging. Current hot topics in nuclear plaque imaging include the use of FDG-PET for therapeutic monitoring in drug development, identification of imaging biomarkers to evaluate cardiovascular risk, and the development of novel tracers against an array of biologically important markers of atherosclerosis. The purpose of this article is to review these recent advances in nuclear plaque imaging.     

VCI-C平面及三维超声重建对胎儿显性脊柱裂诊断价值的探讨

目的 探讨容积对比成像(Volume Contrast Imaging，VCI)-C平面及三维超声重建对胎儿显性脊柱裂的临床应用价值。方法对6例患显性脊柱裂的胎儿进行二维超声普通切面、VCI-C平面及三维超声重建，并对相关图像进行了分析。结果 本组6例胎儿显性脊柱裂二维超声普通切面声像图特征明显，定性诊断率高．达100％，但其声像图由于本身的技术特点而存在一定的不足，如图像空间立体感不强，逼真度差；VCI-C平面能显示与普通二维超声声束相垂直的声像图特征，其显像深度可在一定范围内任意调节，能从另一视角观察胎儿显性脊柱裂的声像图表现，声像图较逼真；三维超声重建在对胎儿显性脊柱裂的应用中优点为图像形象逼真，空间立体感强，缺点在于受二维超声声像图质量等多因素影响大；VCI-C平面超声成像结合三维超声重建信息量大，可以进行任意角度的图像后处理，获得了大量的超声信息。结论 VCI-C平面超声成像能在普通二维图像的基础上从另一视角观察胎儿显性脊柱裂的声像图，且图像形象逼真，空间立体感强，VCI-C平面超声成像与三维超声重建能在普通二维超声诊断胎儿显性脊柱裂的基础上提供更多的诊断信息。     

三尖瓣闭锁的影象诊断

总结１０例三尖瓣闭锁，分析Ｘ线平片，超声心动图及心血管造影表现。着重对三尖瓣闭锁理分型，各种影像学检查的诊断价值进行讨论。提出一些较有特异性的征象。认为平片结合临床可对少血型三在瓣闭锁作出初步诊断；二维超声可提供较多诊断信息；ＭＲＩ尚待开发应用；最后确诊有赖心血管造影，强调右房及左室造影的重要性。     

Fetal echocardiography—applications and limitations

Fetal echocardiography has been a useful technique for demonstrating the anatomy of the developing human heart. M-mode echocardiography may be used to provide rhythm diagnosis in the absence of high-fidelity transabdominal fetal electrocardiograms. The information so generated may be applied to plan the management of pregnancy and delivery in a population at “high risk” for structural or functional heart disease and may provide the impetus for developing in utero treatment programs. For this reason, a high degree of sensitivity and specificity must be asked of the technique and of the personnel performing the examination. “Major” malformations which impart marked hemodynamic and structural alterations on the fetal heart may be reliably diagnosed. Diseases which must be identified on the basis of direct recognition of subtle abnormalities of structure, with little impact on fetal flow patterns (e.g. mild semilunar valve stenosis of perimembranous ventricular septal defect) have been more problematic. Before effective screening and treatment programs for the fetal heart can be developed, a cooperative effort between cardiologists and perinatologists is essential in order to gain facility with imaging as well as familiarity with the natural history of these conditions.     

Prenatal Imaging of Fetal Lung Lesions: Magnetic Resonance Imaging Complements Ultrasound

Prenatal ultrasound has been used for 30 to 40 years in the evaluation of the fetus. In the 1980s, magnetic resonance imaging (MRI), given its high soft tissue detail, was introduced as an alternative method for fetal evaluation. Initially, MRI of pregnancy was limited to assessing maternal complications, as the fetal detail was poor because of motion on long acquisition times. However, in the 1990s, with the advent of short imaging sequences, fetal MRI rapidly established itself as a technique of diagnostic value. In this article, the authors present a case review of a fetus with a lung lesion, demonstrating the value of this modality.     

原发性干燥综合征继发肺淀粉样变性影像学表现以及文献复习

目的 结合回顾文献分析原发性干燥综合征（pSS）继发肺淀粉样变性（PA）的CT及¹⁸F-FDG PET/CT表现。方法 回顾性收集4例经病理证实的pSS继发PA患者,均接受胸部CT检查,其中1例接受全身¹⁸F-FDG PET/CT检查;结合文献分析pSS继发PA的CT及¹⁸F-FDG PET/CT表现。结果 4例胸部CT均表现为双肺多发结节或团块,病灶最大径3~36 mm、中位最大径13 mm,CT值15~410 HU、中位CT值65 HU,部分伴钙化（3/4）;并均见肺囊腔样病变（4/4）。¹⁸F-FDG PET/CT示部分结节¹⁸F-FDG摄取轻度升高。结论 pSS继发PA的CT表现具有一定特征性;结合¹⁸F-FDG PET/CT有助于与肿瘤性病变相鉴别。     

多形性黄色星形细胞瘤的影像表现

目的：探讨多形性黄色星形细胞瘤（PXA）的影像特征。方法：回顾性分析经手术病理证实的12例PXA的影像表现,其中10例行MR检查,2例同时行CT及MR检查。结果：12例患者共有13枚病灶,颞叶6枚,颞叶为主累及多个脑叶4枚,岛叶2枚,额叶1枚。13枚病灶中囊实性5枚,囊伴结节型6枚,实性结节2枚。增强后实性区及壁结节有明显强化,囊伴结节型病灶囊壁均不强化。13枚病灶中2枚出现邻近软脑膜强化,1枚有钙化。6枚行DWI检查的病灶中,表观弥散系数（ADC）值均高于对侧相应正常区,其中2例WHO Ⅲ级PXA的ADC值及相对表观弥散系数（rADC）值明显低于另外4例WHO Ⅱ级PXA。2枚行1H-MRS检查的病灶中,实性部分Cho峰升高,NAA峰下降,Cho/NAA值为0.84、1.06,1例出现Lac峰。结论：PXA的影像表现有一定特征性,认识这些特征并结合MR多种功能成像技术,有助于正确诊断。     

钆布醇延迟增强磁共振成像在脑转移瘤检测中的价值

目的:探讨磁共振钆布醇20 min延迟增强扫描检测脑转移瘤病灶的价值。方法:分析27例因原发肿瘤怀疑脑转移而行MRI钆布醇增强即时扫描和20 min延迟增强扫描患者的临床资料,比较两次增强扫描所显示的病灶数目、病灶检出率与病灶最大直径的关系、病灶与周围脑组织的对比、病灶与对侧脑白质的对比噪声比。结果:27例怀疑脑转移患者中,14例两次增强扫描发现脑转移灶。20 min延时扫描比即时增强多检出了13个病灶,多检出的病灶直径均小于1 cm,其中10个小于5 mm。两次增强扫描病灶与周围脑组织的对比、病灶与对侧脑白质的对比噪声比无明显差异(P均0.05)。结论:钆布醇延迟增强扫描能检测更多脑转移灶,尤其是小转移灶。     

Imaging of talar dome chondral and osteochondral lesions

Talar dome chondral and osteochondral lesions are a common cause of ankle pain and subjective instability. The goal of imaging these lesions is primarily their detection, demonstration of their position and extent, including status of the chondral surface, demonstration of any associated chondral delamination, assessment of the integrity of the subchondral plate, and assessment of the cancellous subchondral bone for bone marrow edema like signal, sclerosis, cystic change, and for the presence of an unstable osteochondral fragment. Although plain radiography, computerized tomography, and bone scan may be helpful in the detection and characterization of these lesions, magnetic resonance imaging is the only imaging modality that will provide a comprehensive assessment of all these issues. Technical aspects of plain radiography, computerized tomography, and magnetic resonance imaging are discussed, and imaging findings are presented.     

Imaging of adnexal masses in pregnancy.

OBJECTIVE: To illustrate the imaging appearances of a variety of adnexal masses in pregnancy. METHODS: Cases of adnexal masses in pregnancy were chosen to illustrate the appearance on ultrasonography and magnetic resonance imaging. RESULTS: Adnexal masses in pregnancy have a wide spectrum of imaging characteristics and clinical manifestations. Sonography is important in diagnosing, monitoring, and determining the malignant potential of these masses. Common adnexal lesions seen in pregnancy include simple cysts, hemorrhagic cysts, leiomyomas, and hyperstimulated ovaries in patients who have undergone assisted fertility. Uncommon adnexal lesions specific to pregnancy include hyperreactio luteinalis, theca lutein cysts with moles, and luteomas. Adnexal masses associated with pain include ovarian torsion and heterotopic pregnancy. Adnexal lesions that are found incidentally include teratomas, endometriomas, hydrosalpinx, cystadenomas, and cystadenocarcinomas. When the diagnosis of the adnexal mass cannot be made on the basis of sonographic appearance alone, magnetic resonance imaging may help. CONCLUSIONS: Familiarity with the clinicopathologic and sonographic features of common and uncommon adnexal masses in pregnancy is important for diagnosis and treatment.     

Evaluation of the Development of the Fetal Anal Sphincter with Tomography Ultrasonography Imaging

The aim of the study described here was to examine the potential of tomography ultrasonography imaging (TUI) in evaluation of the fetal anal sphincter. In this prospective cross-sectional study of the fetal anal sphincter with TUI, 326 singleton pregnancies (mean age = 28 y, range: 22–38 y) were scanned at 19–40 wk of gestation. The fetal anal region and ischium were revealed in 320 of 326 patients (98.2%). The normal fetal anal sphincter diameter and ischial space reached maximums of 15 and 39 mm, respectively. The normal fetal anal sphincter diameter and the ischial space were plotted as a function of gestational age (GA) on a linear curve, and the regression equations for normal fetal anal sphincter diameter and ischial space as a function of GA in weeks were obtained. A scatterplot was also created that revealed a significant positive relationship between normal fetal anal sphincter diameter and ischial space. On the basis of these criteria, imperforate anus was diagnosed in one fetus. Ultrasonographic assessment of the fetal anal sphincter and the ischium with TUI is feasible. The reference values reported in this article may be useful in prenatal diagnosis of fetal anal sphincter abnormalities.