三维对比增强磁共振血管成像诊断胡桃夹综合征

目的探讨3D-CE MRA对胡桃夹综合征（NCS）的诊断价值。方法对4例NCS患者及对照组（30名3D-CEMRA表现正常者）的3D-CE MRA原始图像进行重建,测量数据并对照分析。结果所有研究对象左肾静脉（LKV）均跨过腹主动脉前方;对照组肠系膜上动脉（SMA）与腹主动脉间夹角为（84.50±13.60）°,SMA前行（13.40±5.10）mm转而下行,经过LKV层面SMA与腹主动脉间距离为（16.40±5.10）mm,LKV肾门前段与SMA、腹主动脉夹角段前后径比值为1.4。4例NCS患者的夹角明显变小（〈30°）,且SMA以较小角度发出后前行较短距离后即转向下行,SMA与腹主动脉间距离变小,SMA与腹主动脉夹角内LKV明显受压,LKV扩张段与狭窄段前后径平均比值为4.5,与对照组有明显差异。结论3D-CE MRA能显示腹主动脉、SMA与LKV三者之间关系,准确诊断NCS。     

肾移植术后输尿管并发症17例临床分析

目的 总结肾移植术后输尿管并发症的诊治经验.方法 回顾分析济南军区总医院诊治的17例肾移植术后输尿管并发症患者的临床资料.结果 17例患者伴有不同程度的少尿和局部肿胀不适等症状,实验室检查血清肌酐（Scr）升高,彩色多普勒超声（彩超）检查示移植肾积水、移植肾输尿管扩张,经磁共振水成像或计算机断层摄影术（CT）尿路成像明确诊断.其中输尿管膀胱吻合口狭窄15例,输尿管坏死2例.治疗经过：14例行开放性手术,包括行移植肾输尿管膀胱重新吻合术12例,移植肾输尿管-自体输尿管吻合1例,移植肾输尿管游离、重新放置输尿管支架管1例.3例行非开放性手术治疗,包括输尿管皮肤造瘘1例、腔内球囊导管扩张术1例、软膀胱镜下逆行输尿管支架管插管治疗1例.疗效：14例开放手术治疗患者与1例输尿管皮肤造瘘患者的移植肾肾盂与膀胱的连接部恢复通畅,移植肾功能均明显改善.另2例非开放手术治疗患者,包括1例腔内球囊导管扩张术及1例行软膀胱镜下逆行输尿管支架管插管术患者术后复发,行开放手术治疗.结论 彩超及磁共振成像水成像或CT尿路成像等影像学检查是确诊移植肾输尿管并发症的主要方法.肾移植术后输尿管并发症应以预防为主,确诊后视具体情况行开放性手术或非开放性手术治疗,开放手术治疗的疗效较佳.     

胡桃夹综合征并发IgA肾病临床分析

目的 了解胡桃夹综合征并发IgA肾病的临床特点及提高其相应诊治水平。 方法 回顾分析14例胡桃夹综合征并发IgA肾病患者（病例组）及同期36例单纯胡桃夹综合征患者（对照组）的临床资料。所有胡桃夹综合征病例均由彩色多普勒超声和磁共振血管成像（MRA）诊断;IgA肾病均由病理证实。记录两组实验室、影像学资料并进行t检验分析。 结果 两组患者性别、年龄、血压差异无统计学意义。病例组Scr值高于对照组[（81.2±21.3） μmol/L比（61.2±11.8） μmol/L,P < 0.01],尿蛋白量较多[（1.1±0.6） g/d比（0.3±0.2） g/d,P < 0.01],血尿更明显（尿红细胞计分2.3±0.9比1.5±1.3,P < 0.05）。彩色多普勒超声显示两组左肾静脉狭窄处及近肾门处血流速度和内径差异无统计学意义;磁共振血管成像提示两组患者肠系膜上动脉与腹主动脉之间的夹角差异无统计学意义。 结论 对持续存在血尿和蛋白尿、异常红细胞比例较高的胡桃夹综合征患者应考虑存在并发慢性肾炎特别是IgA肾病的可能,应及早行肾活检明确诊断。     

MRA 、IPVG及DUS在门静脉高压症血流动力学研究中的应用价值

目的 探讨磁共振血管造影（MRA）、间接门静脉造影（IPVG）、多普勒超声（DUS）在门静脉高压症血流动力学研究中的应用价值。方法 对38例肝硬变门静脉高压症患者进行MRA检查，检测门静脉系统解剖显像和血流量，分别与IPVG和DUS的结果进行比较。结果 MRA成像结果优于IPVG，能很好显示门静脉及其属支；对流速、流量的测定结果与DUS所测结果有正相关性。结论 MRA能较好显示门静脉系统解剖影像，并可测得流速、流量，应成为门静脉高压症血流动力学研究的首选方法。     

The role of ultrasonography in the detection of adrenal masses: Comparison with computed tomography and magnetic resonance imaging

To compare detection rates of adrenal tumors by ultrasonography,computed tomography and magnetic resonance image, we studied 61patients with adrenal tumor, who underwent adrenalectomy. In 45(73.8%) of the 61 patients, adrenal tumor was detected by ultrasonography. However, computed tomography and magnetic resonance imaging could detect all adrenal tumors. All adrenal tumors measuring more than 3.0 cm in diameter were detected by ultrasonography, computed tomography and magnetic resonance image. When adrenal tumors were smaller than 3.0 cm, however,ultrasonography, computed tomography and magnetic resonance imaging correctly found adrenal tumors in 30 (65.2%) and 46(100.0%) of 46 patients and 30 (100.0%) of 30 patients,respectively. These facts suggest that ultrasonography seems to be an effective diagnostic procedure for the prevention of overlooking adrenal tumors larger than 3.0 cm. This revised version was published online in September 2006 with corrections to the Cover Date.     

门静脉高压症诊治中磁共振血管成像与间接门静脉造影和多普勒超声对照研究

目的:将磁共振血管造影术(MRA)与间接门静脉造影术(IPVG)和多普勒超声检查(DUS)对门静脉系统解剖影像学及血流动力学的检查结果进行比较,探讨MRA在门静脉高压症诊治中的应用价值。方法:于38例肝硬化门静脉高压症病人和12例非肝硬化病人对照组进行3D-DCEMRA和2D-PCMR检查,检测门静脉系统解剖的显像和血流量,分别与IPVG和DUS的结果进行比较。结果:MRA能很好显示门静脉系统的各属支,成像结果优于IPVG。对门静脉系统各血管流速、流量的测定与DUS有良好的相关性。结论:MRA能较好显示门静脉系统的解剖影像,并可测得血流动力学资料,可成为门静脉高压症血流动力学研究的首选方法。     

肾脏混合性上皮-间质肿瘤二例报告

本文报道2例老年女性肾脏混合性上皮-间质肿瘤患者。病例均行根治性肾切除术且经病理证实,术后分别随访10个月和18个月,均无复发和转移。通过描述其临床资料及影像学表现,以进一步提高对本病的认识。     

肝静脉阻塞型Budd-Chiari综合征的静脉造影 与MR、多普勒超声对比研究

目的 评价静脉造影、MR、多普勒超声对肝静脉阻塞型Budd—Chiari综合征的诊断价值。方法 回顾性分析35例肝静脉阻塞型Budd—Chiari综合征的静脉造影、MR、多普勒超声表现，比较三种检查方法显示该组病例肝脏形态、肝静脉、肝内侧支血管情况。结果 MR显示肝脏特别是尾叶体积增大，肝脏信号不均，显示有肝内侧支血管。多普勒超声显示肝静脉狭窄或阻塞，显示有肝内侧支血管，显示有肝外侧支血管如脐静脉重开。正确全面的静脉造影可以确诊肝静脉阻塞、并可显示下腔静脉狭窄等间接征象。结论 MRI对显示肝脏形态、阻塞部位性质较为敏感，多普勒超声则对显示肝静脉狭窄或阻塞、肝内侧支血管有优势，有助于该病的临床初筛，静脉造影作为Budd—Chiari综合征介入治疗的重要步骤，诊断意义重大。静脉造影与MR、多普勒超声相互补充有助于本病的正确诊断具备指导意义。     

Radiologic Features of Sinonasal Tumors

Imaging evaluation of sinonasal tumors is most often conducted with computed tomography, which excels at identifying the effects of these masses on adjacent osseous structures, and magnetic resonance imaging that is ideal for distinguishing pathologic masses from mucosal thickening and fluid that are common in the sinonasal spaces and depicting extension into the surrounding soft tissues, orbits, and intracranial compartment. Accordingly, the two studies are complementary exams and both are commonly utilized in the assessment of these masses. Less commonly, positron emission tomography can provide additional metabolic evaluation of potential metastatic disease in patients with malignant disease. While these imaging modalities are excellent for the portrayal of an abnormality, there is considerable overlap in the imaging appearance of these tumors and specific imaging manifestations linked to a particular tumor are frequently lacking. Therefore, while the mass may be readily identified, narrowing the differential diagnosis to a single specific entity is rare. Nevertheless, cross-sectional imaging plays an essential role in patient management and valuable guidance for successful biopsy or surgical resection in virtually all cases. This review emphasizes essential imaging manifestations that correlate with sinonasal tumors in general and highlight certain features that may implicate a specific disease process.     

Imaging in vascular disease

Accurate imaging and interpretation of the vascular system is fundamental to the management of patients with vascular disease. It assumes particular importance when considering evidence-based intervention for carotid and aneurysmal disease. This article introduces the basic principles, advantages and limitations of imaging used to assess patients with vascular disease. The roles of duplex ultrasonography (DUS), magnetic resonance imaging (MRI), computed tomography (CT) and digital subtraction angiography (DSA) in the vascular patient are reviewed.     

Vascular compression caused by solitary osteochondroma: useful diagnostic methods of magnetic resonance angiography and Doppler ultrasonography

 Osteochondroma is a common benign bone tumor that sometimes causes vascular complications when the lesion is situated near the knee. Venous complications are seen less frequently. We report two cases of solitary osteochondroma that arose in the distal femur. The patients were an 11-year-old boy and a 16-year-old boy, both of whom were suffering from bone protuberance and lower leg swelling due to congestion. In both patients, magnetic resonance imaging (MRI) revealed dilated popliteal veins at a site distal from the tumors or superficial veins. MR angiography (MRA) showed compressed popliteal arteries, and Doppler ultrasonography revealed weaker blood flow in the dorsalis pedis arteries in the lower leg with the tumor than in the other lower leg. The former patient complained of pain due to swelling in the lower leg, and for this reason the patient underwent resection of the tumor. After resection, both the swelling and the pain were decreased, and Doppler ultrasonography also revealed normal blood flow in the artery. The latter patient had swelling, but no pain, in the lower leg, and accordingly this patient has been followed carefully without resection, since there is always the possibility of irreversible vascular damage caused by osteochondroma, such as arterial or venous occlusion. We present two patients with osteochondroma, both of whom suffered from swelling of the lower leg due to venous compression by the tumor. In both cases, MRI and MRA were useful to show the presence of vascular compression. Doppler ultrasonography could also reveal the blood flow disturbance objectively, even in current osteochondroma cases in which there were no arterial symptoms. Received: November 26, 2001 / Accepted: March 7, 2002     

Magnetic resonance imaging of vertebral osteoblastoma: A report of two cases

Two patients with vertebral osteoblastoma evaluated with computed tomography and magnetic resonance imaging are presented. A literature review revealed that cases of osteoblastoma originating within the vertebral body are exceedingly rare.     

Imaging of acute pancreatitis and its complications. Part 1: Acute pancreatitis

Acute pancreatitis is an acute inflammatory disease of the pancreas that may also involve surrounding tissues or remote organs. The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Generally, imaging is recommended to confirm the clinical diagnosis, investigate the etiology, and grade the extend and severity of the acute pancreatitis. Ultrasound is the first-line imaging modality in most centers for the confirmation of the diagnosis of acute pancreatitis and the ruling out of other causes of acute abdomen, but it has limitations in the acute clinical settting. Computed tomography not only establishes the diagnosis of acute pancreatitis, but also enables to stage severity of the disease. Magnetic resonance imaging has earned an ever more important role in the diagnosis of acute pancreatitis. It is especially useful for imaging of patients with iodine allergies, characterizing collections and assessment of an abnormal or disconnected pancreatic duct. The purpose of this review article is to present an overview of the acute pancreatitis, clarify confusing terminology, underline the role of ultrasound, computed tomography and magnetic resonance imaging according to the proper clinical context and compare the advantages and limitations of each modality.     

Percutaneous discography: comparison of low-dose CT, fluoroscopy and MRI in the diagnosis of lumbar disc disruption

Aim: To compare the diagnostic accuracy of low-dose computed tomography (CT), magnetic resonance imaging (MRI) and fluoroscopy in percutaneous discography in patients scheduled for lumbar spondylodesis. Material and methods: Within a prospective pilot study, 18 disc segments of 11 patients with radicular or pseudoradicular pain prior to anteroposterior spondylodesis were evaluated. After injection of a mixture of non-ionic iodine-containing contrast agent and gadolinium-based contrast medium into the disc spaces, all patients underwent conventional fluoroscopy, as well as low-dose CT and MRI. The occurrence of memory pain during contrast injection was recorded. CT, MRI and fluoroscopic images were analyzed independently by two readers blinded to the clinical findings. Results: There was 100% agreement between CT and MRI discography in the detection, localization and grading of degenerative changes. In contrast, conventional fluoroscopy identified only 9 of the 12 abnormal segments. Memory pain following puncture was identified in 3 of the 12 affected segments. Summary: Low-dose CT and MRI discography have a similar accuracy in the assessment of disc disruption and they are superior to fluoroscopic discography.     

Imaging in vascular disease

Accurate imaging and interpretation of the vascular system is fundamental to the management of patients with vascular disease. This is especially important when considering evidence-based intervention for carotid and aneurysmal disease. This article introduces basic principles, advantages and limitations of imaging modalities frequently used to assess patients with vascular disease. The roles of duplex ultrasonography (DUS), computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) in the vascular patient are reviewed.     

胰腺囊性病变的影像学表现

随着CT和MRI检查新技术的发展,胰腺囊性病变逐渐被临床医师认识和了解.胰腺囊性肿瘤和假性囊肿的鉴别是诊断的重点.胰腺假性囊肿患者一般具有急慢性胰腺炎病史,而胰腺囊性肿瘤没有胰腺炎病史.部分胰腺囊性肿瘤缺乏影像学特征性,在临床上常常难以鉴别.胰腺囊性病变按照CT和MRI检查的特点分为单囊性病变、微囊性病变、大囊性病变和囊实性病变.这一分型系统有助于诊断和鉴别诊断,并可以指导治疗方案和判断预后,具有重要的临床价值.