强直性脊柱炎骶髂关节影像学分析：附24例骶髂关节平片,CT和MR…

目的：旨在评估强直性脊柱炎（ＡＳ）患者骶髂关节炎的ＭＲ影像特征，并比较Ｘ线平片、ＣＴ和ＭＲ影像在诊断骶髂关节炎中的作用。材料与方法：搜集２４例ＡＳ患者，分别行Ｘ线平片、ＣＴ和ＭＲＩ检查。增强前ＭＲ扫描序列包括ＳＥ Ｔ１ＷＩ、ＦＳＥ Ｔ２ＷＩ和梯度回波的准Ｔ２ＷＩ（ＧＲ Ｔ２＾＊ＷＩ）。增强后ＭＲ扫描序列参数与增强前ＳＥ Ｔ１ＷＩ相同。另选９例志愿者，行ＭＲ平扫检查。结果：８例志愿者１６个骶髂关节的     

早期强直性脊柱炎骶髂关节病变的X线、CT和MRI对比研究

目的 比较X线平片、CT和MRI在早期强直性脊柱炎(AS)骶髂关节病变中的诊断价值.方法 对53例临床拟诊为AS的患者行骶髂关节X线平片和MR检查,MR平扫均包括骶髂关节斜冠状面T1WI、T2WI、短时反转恢复序列(STIR)、附加水激励的三维稳态快速梯度回波序列(3D-BTFE-WATS),其中24例同时行脂肪抑制T1WI增强检查;25例患者同时行CT检查.分析患者的影像资料,应用x2检验对X线平片、CT和MRI显示骨侵蚀破坏敏感度进行统计学分析.结果 53例患者的106侧骶髂关节中,X线平片和MRI显示关节面下骨侵蚀病变分别为16侧和63侧;25例CT检查中显示26侧骶髂关节面下存在骨侵蚀破坏.CT和MRI显示骨侵蚀敏感度相近(x2=0.16,P＞o.05),两者均优于x线平片(x2值分别为14.44和17.36,P值均＜0.05),在所应用的MR序列中,3 D-BTFE-WATS显示骨侵蚀破坏最佳.MRI除显示AS骶髂关节慢性骨结构改变外,显示骨髓水肿 32例、滑膜增厚和(或)异常强化35例,脂肪沉积16例、韧带附着点炎15例、被膜炎9例和关节软骨破坏31例.结论 MRI能发现X线平片和CT不能显示的骨髓水肿和滑膜炎等急性炎性改变,早期诊断价值优于X线平片和CT.     

1047例骨转移瘤的影像学诊断

目的：分析１０４７例骨转移瘤Ｘ线、放射计算机体层摄影（ＥＣＴ）、ＣＴ及ＭＲＩ表现，并比较其敏感性及特异性。材料和方法：原发肿瘤主要为肺癌（２８．７５％），乳腺癌（１２．０３％）及鼻咽癌（５．０６％）等，２７．０３％来源不明。Ｘ线诊断９８８例，ＥＣＴ检查１２６例，ＣＴ扫描９７例，ＭＲＩ扫描４７例。结果：Ｘ线显示骨转移部位为脊椎、肋骨、四肢近段及颅骨。ＥＣＴ表现多骨多处浓集灶（８２．５４％）或单发浓集灶（１６．６７％），仅１例表现为稀疏病灶。ＭＲＩＴ１ＷＩ表现低信号（８０．８５％）或其他异常信号（１９．１５％）；Ｔ２ＷＩ呈高信号（６８．８５％）或其他异常信号（３１．１５％）。结论：ＭＲＩ及ＥＣＴ敏感性高于ＣＴ和Ｘ线。ＭＲＩ、ＣＴ及Ｘ线特异性高于ＥＣＴ。骨转移瘤首选ＥＣＴ并结合Ｘ线检查，必要时做ＣＴ或（和）ＭＲＩ检查。     

MRI多序列联合应用在强直性脊柱炎相关骶髂关节病变中的诊断价值

目的：探讨M RI在强直性脊柱炎相关骶髂关节病变的诊断价值。方法对23例临床怀疑为强直性脊柱炎患者的X线平片、C T及M R检查结果进行分析。结果23例患者中X线平片检查确诊的7例共9侧;C T检查明确11例18侧骶髂关节病变;M RI多序列检查23例患者中均表现为异常,特别是X线平片及C T不能显示的骨髓水肿、滑膜病变、脂肪沉积、肌腱附着点炎、被膜炎及关节软骨破坏。结论 M RI多序列联合应用能发现X线平片及C T 不能显示的AS的早期病变表现,为临床怀疑AS病变相关性骶髂关节炎的首选检查方法。     

眼内异物MRI临床应用研究

目的：通过分析４２例５５枚眼内异物的ＭＲＩ表现，并与ＣＴ和Ｘ线平片比较，探讨了ＭＲＩ对眼内异物的诊断价值。材料与方法：男３３例，女９例，年龄５～４５岁。５５枚眼内异物中非磁性异物５３枚，铁磁性异物２枚。每例均在术前１个月内完成Ｘ线平片、ＣＴ和ＭＲＩ检查。结果：（１）ＭＲＩ对５５枚眼内异物检出率（９４％）和ＣＴ（９１％）相仿（Ｐ＞０．２５），均明显高于Ｘ线平片（４２％）（Ｐ＜０．００５）；（２）ＭＲＩ对眼内异物相关并发症的显示优于ＣＴ，而其对巩膜异物的显示差于ＣＴ；（３）ＳＥ序列Ｔ２ＷＩ和ＰＤＷＩ（质子密度加权成像）是检出眼内异物的优选序列；（４）非磁性异物ＭＲＩ呈信号缺失区，无伪迹产生；而铁磁性异物产生大量伪迹，并可致眼部额外损伤。结论：ＭＲＩ是检出眼内非磁性异物的有效方法，特别适用于Ｘ线平片和ＣＴ不能显示的少数非金属异物。眼内铁磁性异物不适于ＭＲＩ。     

手类风湿性关节炎Gd—DTPA磁共振增强的意义

手类风湿性关节炎ＧｄＤＴＰＡ磁共振增强的意义许建荣杨世埙高晓敏何鸿渊朱珠华靳激扬乔瑞华王皖手类风湿性关节炎（ｒｈｅｕｍａｔｏｉｄＡｒｔｈｒｉｔｉｓ，ＲＡ）影像学检查传统应用Ｘ线摄片方法，近年来逐步采用ＭＲＩ检查，文献〔１〕报道ＳＥＴ２ＷＩ像检出Ｒ...     

骶髂关节MRI检查在强直性脊柱炎诊断中的应用

目的 探讨强直性脊柱炎(AS)早期骶髂关节MRI表现及其对本病的诊断价值.方法 收集68例确诊的AS患者的临床资料和骨盆X线平片及双侧骶髂关节MR扫描结果,进行对比分析.结果 68例AS患者中X线检出率54.41%,其中单侧骶髂关节发病11例,双侧骶髂关节发病26例.Ⅰ～Ⅱ级病变X线的检出率分别为21.05%、27.27%,MRI检出率分别为78.95%和81.82%(P＜0.001).Ⅰ～Ⅱ级AS患者MRI可见关节软骨增厚、信号异常,滑膜信号异常,以及骨髓水肿;对Ⅲ、Ⅳ级病变2种方法检出率相似(P＞0.05).结论 MRI能够发现AS患者骶髂关节的早期病变,为AS的早期诊断提供依据.     

强直性脊柱炎致骶髂关节炎的X线与CT诊断

目的 评估X线对强直性脊柱炎患者骶髂关节炎的诊断价值。方法 对临床表现为缓慢加重的腰骶部及双髋部疼痛、压痛及活动受限者68例，进行脊柱正侧位或加摄斜位X线片。其中，6例临床怀疑骶髂并节病变者又经CT检查。结果 单侧骶髂关节改变为28例，双侧骶髂关节改变40例。怀疑骶髂关节病变6例，轻度骶髂关节炎34例，中度骶髂关节炎20例，重度骶髂关节炎8例。68例中59例HLA—B27抗原阳性。结论 X线正位加左、右斜位平片能对大部分骶髂关节炎作出诊断，尤其是左、右斜位更有利于观察骶髂关节病变。对于骶髂关节炎的早期诊断，CT优于X线平片。     

碘油栓塞兔肝脏的MRI研究

目的：研究肝脏中碘油ＣＴ值在４００ＨＵ时，对ＭＲ信号的影响。方法：３２只家兔随机分为三组，对照组８只，经门静脉右支注入生理盐水２ｍｌ；实验１组１２只，经门静脉主干注入碘油乳剂４ｍｌ；实验２组１２只，经门静脉右支注入碘油乳剂２ｍｌ。结果：实验组术后肝脏最大层面区域ＣＴ值６０１±１０１ＨＵ（Ｘ±Ｓ），术后即刻ＭＲ检查，其Ｔ１ＷＩ和Ｔ２ＷＩ均较术前无改变。病理切片见大量碘油脂滴围绕在汇管区周围。实验２组中，９只（２５％）家兔因门静脉栓塞肝组织发生严重变性、坏死后，Ｔ１ＷＩ呈低信号影或混杂信号影，Ｔ２ＷＩ以高信号影为主。ＣＴ则由于碘油高密度的存在，不能反映这种组织学改变。结论：达到肝癌治疗目的的碘油乳剂用量对肝脏ＭＲ信号无影响。在碘油存在状态下，ＭＲ能够显示肝脏严重变性、坏死的组织学变化，为ＭＲＩ随访肝癌介入治疗效果提供了理论依据。     

膝关节正常关节软骨及软骨缺损的多序列MR成像比较

目的：筛选ＭＲＩ评价关节软骨的最佳成像序列。材料和方法：应用五种不同ＭＲ序列，包括ＴｌＷＩ、ＰＤＷＩ、Ｔ２ＷＩ、ＳＴＩＲ和３Ｄ－ＧＥ，对６位健康志愿者的正常膝关节和１２个用外科方法制作的直径ｌｍｍ—６ｍｍ的软骨缺损的膝关节标本进行成像比较。结果：与ＳＥ和ＳＴＩＲ序列相比，３Ｄ－ＧＥ序列可作连续薄层扫描，具有高信噪比、高分辨率、良好的组织对比及成像时间短等优点，能清楚显示软骨的厚度及轮廓，并可检出直径小至２ｍｍ的软骨缺损。结论：３Ｄ－ＧＥ序列是检查关节软骨病变的最佳序列，若辅以ＴｌＷＩ和ＳＴＩＲ成像，有利于关节软骨与关节液和脂肪组织的区分，可进一步提高ＭＲ诊断关节软骨病变的准确性     

Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis accompanying ankylosing spondylitis

Objective. To compare magnetic resonance (MR) imaging, computed tomography (CT), and radiography in the detection of sacroiliitis accompanying ankylosing spondylitis (AS). Design and subjects. Nine volunteers and 24 patients were recruited. Radiography, CT, and MR imaging were completed within a 1-week period in 24 patients with AS. In precontrast MR examination, spin-echo T1, fast spin-echo T2, and gradient echo with rephasing T2* images were obtained without fat saturation using a 0.3-T imager for all volunteers and patients. Postcontrast MR examination was performed using the same precontrast SE T1 sequence for patients with AS. Results and conclusions. MR imaging directly showed the normal cartilage in all 16 sacroiliac joints of the 8 volunteers. In the 24 patients with AS, cartilage abnormalities were observed in 42 sacroiliac joints. More diagnoses of sacroiliitis were made using MR and CT imaging than using radiography (P<0.001). Therefore, low-field-strength MR can be useful in detecting early sacroiliitis in patients with AS. MR imaging was able to reveal early cartilage changes and bone marrow edema, which could not be found by either CT or radiography.     

Sacroiliitis: MR imaging findings

Magnetic resonance (MR) imaging was performed in seven asymptomatic volunteers and 17 patients with clinical and radiologic evidence of sacroiliitis. MR imaging findings were compared with those at computed tomography (CT) to determine the MR imaging appearance of the sacroiliac joint when normal and in sacroiliitis. The normal articulation was well depicted with MR imaging. Findings of sacroiliitis were identified in 20 sacroiliac joints (12 patients). MR imaging findings characteristic of sacroiliitis included abnormal cartilage signal intensity (95% of joints) and erosions (75% of joints) on T1-weighted images. Areas of increased intensity in the articulation (80% of joints) or in erosions (60% of joints) were seen on T2-weighted images. MR imaging was superior to CT for evaluation of cartilage and detection of erosions. Four sacroiliac joints (20%) and two patients (17%) with MR imaging findings of sacroiliitis were negative at CT. The authors conclude that MR imaging is a valuable method for detecting sacroiliitis, particularly when results of other imaging techniques are inconclusive.     

Invasion of laryngeal cartilage by cancer: comparison of CT and MR imaging

Forty-two patients with laryngeal carcinomas were examined with computed tomography (CT) and magnetic resonance (MR) imaging. The accuracy of both CT and MR imaging in the depiction of cartilage invasion was evaluated in 16 patients by comparing findings at CT and MR with pathologic findings. Calcified cartilage that has been invaded by cancer is frequently seen on CT scans as having an intact contour. Tumor approaching nonossified cartilage may simulate cartilage invasion. On T1-weighted MR images, invaded marrow of ossified cartilage is of intermediate signal intensity, allowing it to be differentiated from normal bone marrow. On proton-density images, tumor is of increased signal intensity, which allows it to be differentiated from nonossified cartilage. In our experience, the specificities of CT and MR imaging were approximately equal (91% and 88%, respectively), but CT had a considerably lower sensitivity than MR (46% vs. 89%). Gross movement artifacts, which resulted in nondiagnostic images, occurred in 16% of the MR examinations. MR imaging is recommended as the modality of choice in the diagnosis of cartilage invasion.     

MR imaging of the larynx at 1.5 T

The normal magnetic resonance (MR) anatomy of the larynx at high field strength (1.5 T) was studied in 2 normal excised larynges and 62 subjects without laryngopharyngeal disease. The two normal excised larynges were imaged using a 1.5 T MR scanner with a 3 in diameter circular surface coil and a GE 9800 CT scanner. The larynges were sectioned transversely and the MR and CT images compared to gross and histologic sections. Unossified hyaline cartilage was intermediate in signal intensity on T1-weighted and proton density images and low in intensity on T2-weighted images. The signal intensity from ossified cartilage was determined by the amount of fatty marrow and was high in intensity on T1-weighted and proton density images and low to intermediate in intensity on T2-weighted images. A chemical shift artifact from high intensity fatty marrow obscured the calcified or ossified cortex of the major laryngeal cartilages along the frequency encoding axis. The epiglottic cartilage demonstrated an intermediate signal intensity on T1-weighted images and higher intensity on proton density and T2-weighted images. The intralaryngeal muscles were well demonstrated as low intensity structures. The conus elasticus and the vocal ligaments were not recognized as distinct structures. However, the quadrangular membrane and a previously undescribed membrane separating the preepiglottic and paralaryngeal spaces were shown on MR as low intensity linear structures. In the 62 subjects, MR at 1.5 T proved excellent for demonstrating the anatomical details of the major laryngeal cartilages, extra- and intralaryngeal muscles, ligaments, and soft tissues including the vocal cords, false vocal cords, laryngeal ventricles, aryepiglottic folds, preepiglottic space, and paralaryngeal spaces. Visibility and intensity of muscles, ligaments, and soft tissues did not depend on age or sex. The intensity pattern of the thyroid and cricoid cartilages demonstrated wide variations in the same sex and age groups, depending on the degree of ossification. However, they did show more high intensity foci in older men than in younger women. Magnetic resonance showed better contrast resolution and finer detail than CT scans in the same subjects. Magnetic resonance imaging at 1.5 T, with either a saddle-shaped neck surface coil or a 3 in diameter circular surface coil, provides high contrast and high spatial resolution images and could be useful for the diagnosis of lesions of the larynx.(ABSTRACT TRUNCATED AT 400 WORDS)     

Juvenile rheumatoid arthritis: assessment with MR imaging

Thirty-three joints of the appendicular skeleton in 15 children with juvenile rheumatoid arthritis were examined with magnetic resonance (MR) imaging to determine if it could demonstrate synovial hypertrophy and status of the articular cartilage. Presumed synovial hypertrophy was seen in 13 joints as masses of varying sizes of low to intermediate signal intensity on T1- and T2-weighted images; sometimes foci of increased signal intensity, most likely due to fluid or inflammation, were seen on T2-weighted images. Probable abnormal articular cartilage was detected in ten joints, and MR imaging also demonstrated epiphyseal overgrowth, bone erosions, joint effusions, and joint space narrowing. Because MR imaging appears to provide an objective method of evaluating both synovial hypertrophy and status of articular cartilage, it may prove to be useful in monitoring progression of juvenile rheumatoid arthritis and response to therapy.     

Imaging of sacroiliitis in early seronegative spondylarthropathy. Assessment of abnormalities by MR in comparison with radiography and CT

PURPOSE: To analyze the type and frequency of abnormalities of the sacroiliac joint (SIJ) in early seronegative spondylarthropathy (SpA) by MR in comparison with CT and radiography, assess the most appropriate MR sequences to be used, and introduce a new way of grading MR abnormalities of the SIJ. MATERIAL AND METHODS: The SIJs of 41 patients with early SpA (median duration of inflammatory low back pain of 19 months) were evaluated by MR imaging using STIR, T1, T2, and T1 fat saturated (FS) sequences before and after i.v. Gd contrast medium followed by staging of abnormalities. The findings were compared with those obtained by CT and radiography. RESULTS: MR and CT had equal efficacy superior to radiography in staging of erosions and osseous sclerosis. Only MR allowed visualization and grading of active inflammatory changes in the subchondral bone and surrounding ligaments in addition to bone marrow fatty accumulations. T2-weighted sequences did not contribute to assessment of sacroiliitis. CONCLUSION: MR of the SIJs is reliable in its visualization of joint erosions in early SpA and allows differentiation between active and chronic sacroiliitis. We recommend the following sequences: semicoronal T1 and both semicoronal and semiaxial STIR. If these images are normal, the examination can be finished; otherwise additional semicoronal T1 FS before and after i.v. contrast has to be performed as well as semiaxial post-contrast T1 FS.     

A revisit of MRI analysis for synovial sarcoma

We evaluated magnetic resonance imaging (MRI) findings of synovial sarcomas in 22 patients, and the most common MRI findings were oval and well-defined nodular masses with heterogeneous intermediate signal intensity (SI) on T1 weighted images (WI), high SI on T2-WI and heterogeneous contrast enhancement. A cystic component was seen in 77%, intratumoral hemorrhage in 73%, and calcification in three monophasic sarcomas. Metastases were noted in lung (mostly biphasic type), lymph node, and bone. Posttreatment changes revealed diffusely increased S1 on T2-W1 and slightly diffuse contrast enhancement with feathery appearance. Morphology and MR signal characteristics assist in synovial sarcoma management.     

Rhabdomyosarcoma of the petrous ridge. CT and MR imaging in an atypical case with multiple cranial nerve palsy.

The CT and MR findings are reported in a case of biopsy proven rhabdomyosarcoma of the skull base. The tumor presumably originated in a pneumatized petrous ridge and had an atypical presentation of multiple cranial nerve palsy. The lesion exhibited a soft tissue density and a nonexpansile bone destruction on unenhanced CT. On MR imaging the lesion showed homogeneous intermediate signal intensity on T1 weighted images and a high signal intensity on proton density and T2 weighted images. The scanty literature on CT and MR features of rhabdomyosarcoma of the head and neck is reviewed.     

MRI联合DWI在强直性脊柱炎诊断中的价值

目的探讨MRI联合DWI对强直性脊柱炎(AS)的诊断价值。资料与方法搜集经修订纽约标准确诊的31例AS病例和25例正常对照组,两组均行两侧骶髂关节常规MRI横断位和冠状位抑脂T2WI、T1WI联合SE/EPI扩散加权成像(DWI)横断位扫描(b值0,600 s/mm2),观察两组骶髂关节的信号改变,测量表观扩散系数(ADC)值并作统计学检验。结果 31例病例组中的24例双侧或单侧骶髂关节面下骨质抑脂T2WI呈高信号,29例DWI呈高信号,25例对照组骶髂关节面下骨质T2WI、DWI均呈等信号,测量ADC值,病变组为(0.993±0.169)×10-3mm2/s,对照组为(0.649±0.395)×10-3mm2/s,病变组ADC值明显高于对照组(t=4.14,P<0.001),两者间差异有统计学意义。结论 MRI联合DWI对AS早期诊断有重要的临床价值。     

Hemophilic arthropathy: assessment with MR imaging

Fifteen patients with hemophilia, 14 of whom had hemophilic arthropathy, were examined with magnetic resonance (MR) imaging to determine if it could be used to assess hemophilic arthropathy, especially synovial hypertrophy and the status of the articular cartilage. Thirty-five joints of the appendicular skeleton were imaged. Four joints in two patients were clinically normal. Synovial hypertrophy was detected in 28 joints and appeared as areas of low to intermediate signal intensity on T1- and T2-weighted images, with foci of increased signal intensity on T2-weighted images (presumed to be due to areas of fluid or inflammation) in 16 joints. Abnormal articular cartilage was demonstrated in 26 joints; bone lesions, fluid collections, and joint space narrowing could also be seen. MR imaging appears to be useful in depicting the components of hemophilic arthropathy.