肺动静脉瘘的影像学诊断

目的:探讨肺动静脉瘘不同影像学方法的诊断价值。材料与方法:9例肺动静脉瘘分别作了心血管造影、核磁共振及CT检查及心脏超声。结果:9例中6例为局限性的肺动静脉瘘,3例为弥漫性的肺动静脉瘘,3例中2例有肝脏疾病史。结论:肺动静脉瘘心血管造影为主要的诊断手段,但对毛细血管床前型的弥漫性肺动静脉瘘诊断有局限性,MRI、CT对局限性的肺动静脉瘘的诊断有帮助,心脏超声有助于毛细血管床前型的弥漫性肺动静脉瘘诊断。     

Imaging diagnosis of acute pulmonary embolism

Pulmonary embolism represents a major public healthcare problem and it also imposes frequent clinical diagnostic issues. Despite the availability of the D-dimer tests, imaging remains the mainstay for its diagnosis. Computed tomography pulmonary angiography (CTPA) is now the most widely used diagnostic test and its utility has been well validated in a large number of trials. Nuclear medicine techniques, which are also well established, are now used significantly less frequently. Magnetic resonance pulmonary angiography is developing as an alternative to CTPA in patients who have contraindications to iodinated contrast media. Catheter pulmonary angiography remains the gold standard, although it is being used increasingly less frequently. In this article, we review the current knowledge on the imaging diagnosis of acute pulmonary embolism with special emphasis on the noninvasive techniques.     

Lipomatous hypertrophy of the interatrial septum in a patient with carcinoma: a case report of the importance of multi-modality imaging

Introduction: Lipomatous hypertrophy of the interatrial cardiac septum is a benign disorder. In rare cases, the disorder can cause obstruction of atrial inflow, causing symptoms of heart failure, or cardiac arrhythmias resulting from the involvement of the atrial wall and atrioventricular conduction pathways. Case presentation: We present a case of a Caucasian 66‐year‐old man with urothelial carcinoma where transthoracic echocardiolography showed a mass in the basal part of the interatrial septum. After injection of echo contrast, it was suggested that the structure was vascularized, thus implying tumour. Transoesophageal echocardiography and cardiac magnetic resonance imaging gave the correct diagnosis of lipomatous hypertrophy. It was then discovered that the patient had been referred to a computed tomography (CT) earlier, but no mention of the mass was found in the report from the examination. Re‐evaluation of the images showed a clearly visible mass indicative of fatty tissue. Conclusion: This case report highlights the importance of multi‐modality imaging when the findings are not concordant. Moreover, this case report also highlights the importance of careful examination of the heart on routine CT scans, something that is often overlooked by the radiologists. In this case, the CT scan clearly indicated the diagnosis of lipomatous hypertrophy of the interatrial septum and thus could have prevented the subsequent imaging cascade.     

多模态磁共振成像在脑胶质瘤分级诊断及预后评估中的研究进展

脑胶质瘤是中枢神经系统中常见的恶性肿瘤,其具有弥漫性浸润生长的特点,在治疗的过程中具有较大的难度,肿瘤恶性程度高,容易复发、预后较差。多模态磁共振成像技术多用于肿瘤术前的初步诊断,在胶质瘤分级判断以及预测预后方面具有重要的价值。本文就扩散加权磁共振成像、弥散张量磁共振成像、动态磁敏感对比灌注加权成像、动态对比增强磁共振成像、动脉自旋标记成像和磁共振波谱成像等几种多模态磁共振成像技术在脑胶质瘤术前分级诊断及预后评估方面的研究进展进行综述。     

急性心肌炎多模态影像学诊疗进展

急性心肌炎(AM)临床表现多变,早期明确诊断对临床决策与预后评估具有重要意义。作为无创诊断AM的主要工具,超声心动图、MRI及PET可从形态、功能及分子水平显示心肌损伤,在其风险分层和临床管理中发挥关键作用。本文就多模态影像学用于诊断与治疗AM进展进行综述。     

The role of multimodality imaging in the diagnosis of left ventricular noncompaction

Left ventricular noncompaction (LVNC) is a heterogeneous entity and, in reality, a likely spectrum of disease which is clinically associated with arrhythmia, thromboembolic complications and sudden cardiac death. With the emergence of cardiac MRI (cMRI), the phenotype is increasingly more prevalent, resulting in clinical uncertainty regarding prognosis and management. The currently accepted hypothesis suggests an early embryonic arrest of the normal, sequential myocardial compaction process. LVNC is observed in isolation or in association with congenital heart disease, neuromuscular disease or a vast array of genetic cardiomyopathies. Definition of the entity varies among international society guidelines with differences both within and between imaging modalities, predominantly echocardiography and cMRI. Long-term prognostic data are emerging but due to the intrinsic variability in reported prevalence, selection bias and lack of pathological to prognostic correlation, there are many uncertainties regarding clinical management. This review seeks to clarify the role of multimodality imaging in diagnosis and management of the disease. We discuss the sensitivity and specificity of the current diagnostic criteria, as well as the nuances in diagnosis using the available imaging modalities.     

儿童急性斜颈的罕少见病因及影像诊断

目的 探讨儿童急性斜颈的罕少见病因、检查方法及影像学表现。材料与方法 收集本院30例临床诊治罕少见病因引起的急性斜颈病例,回顾分析颈椎正位及张口位片、颈部或头颅CT及MRI扫描的影像表现及诊断。 结果 所有患儿出现急性斜颈伴颈部疼痛,有外伤病史8例,发热7例,双上肢活动障碍1例。影像学诊断颈椎骨折3例,儿童钙化性椎间盘病9例,咽部脓肿5例,四脑室区肿瘤7例,颈椎管内硬膜外血肿、川崎病、咽部淋巴结炎、颈椎郎格罕氏细胞组织细胞增生症、颈椎骨母细胞瘤及食道异物各1例。 结论：儿童急性斜颈并非某种疾病特异性表现,诊治时应选择合适的影像方法,积极寻找病因,以减少误漏诊的发生。     

SPECT/CT肺灌注显像评价肺动脉球囊扩张成形术治疗慢性血栓栓塞性肺动脉高压效果

目的 以SPECT/CT肺灌注显像评价肺动脉球囊扩张成形术（BPA）治疗慢性血栓栓塞性肺动脉高压（CTEPH）的疗效。方法 对18例CTEPH患者分别于BPA前及其后1~3个月内行SPECT/CT肺灌注显像，以经导管肺动脉造影为标准，评价BPA前、后SPECT/CT探测肺段灌注缺损及灌注改善情况。结果 SPECT/CT肺灌注显像在BPA前探测肺段灌注缺损的敏感度、特异度、准确率、阳性预测值（PPV）及阴性预测值（NPV）分别为90.42%（302/334）、99.05%（418/422）、95.24%（720/756）、98.69%（302/306）及92.89%（418/450）；BPA后探测灌注改善的敏感度、特异度、准确率、PPV和NPV分别为77.78%（56/72）、80.00%（24/30）、78.43%（80/102）、90.32%（56/62）及60.00%（24/40）。结论 SPECT/CT肺灌注显像用于评价BPA治疗CTEPH后肺段灌注及改善具有较好临床价值。     

Isolated partial right lower lobe pulmonary venous drainage into the right atrium as a cause of pulmonary hypertension in a middle-aged woman

Partial anomalous pulmonary venous connection is a rare congenital disease characterized by drainage of one or several pulmonary veins into the systemic venous system. It is extremely rare as an isolated anomaly. We report the case of a middle-aged woman with isolated drainage of an enormously enlarged right lower pulmonary vein into the right atrium with significant left-to-right shunt, severe right ventricular enlargement, and pulmonary hypertension.     

Multimodality imaging for the diagnosis and assessment of aortic stenosis severity

Introduction: Aortic stenosis (AS) is the most common cause of valvular heart disease. Imaging plays a major role in the diagnosis and evaluation of AS severity.

Areas covered: The present review focuses on new emerging concepts in AS by stressing the substantial value of imaging into the understanding of the complex pathophysiology and management of AS.

Expert commentary: Though, standard 2D echocardiography is often diagnostic multi-modality imaging can be required in patients with doubtful results or to refine the evaluation of AS.     

原发性骨骼淋巴瘤的影像学诊断

目的:分析13例骨骼淋巴瘤的影像学特征以探讨其影像学的诊断价值。材料和方法:13例经手术病理证实的骨骼淋巴瘤病例,术前均经平片检查,其中CT检查10例,MR检查9例。结果:4例何杰金淋巴瘤和9例非何杰金淋巴瘤分别累及脊柱6例,长管状骨5例,骨盆2例,病变主要累及脊柱的椎体和长管状骨的骨干,骨质改变为溶骨型9例(69%)和混合型4例(31%),骨质破坏以浸润性虫噬状骨质破坏为主;骨皮质破坏11例,但皮质破坏的程度总是很轻微;骨膜成骨3例(23%),软组织肿块形成7例(54%)。软组织肿块CT表现为低密度或等密度,境界清楚;骨骼MRI T1WI低信号9例,T2WI显示为略低信号2例,等信号2例,高信号5例;软组织肿块的MR信号变化少,T1WI略低于肌肉,T2WI总是略高于肌肉,MR动态增强扫描为轻~中等程度强化。结论:骨骼淋巴瘤影像学特征:①明显的浸润性虫噬状骨质破坏,而骨皮质破坏轻微,骨膜反应少见;②软组织肿块T2WI信号略高,且信号相对均匀。平片、CT和MRI等影像学检查可以作出诊断。     

恶性外耳道炎影像学表现及预后

目的分析恶性外耳道炎(MEO)的影像学表现及其预后。方法回顾性分析13例经病理确诊的MEO患者的临床及影像学资料。结果 MEO主要临床症状包括耳痛(13/13,100%)、外耳道流脓(10/13,76.92%)及听力下降(5/13,38.46%)。HRCT主要表现为外耳道和中耳鼓室内异常软组织影及周围骨质受累,13例(13/13,100%)外耳道和10例(10/13,76.92%)中耳鼓室见异常软组织影,7例(7/13,53.85%)颞骨鼓部、9例(9/13,69.23%)岩鼓裂、7例(7/13,53.85%)茎突、6例(6/13,46.15%)乳突、3例(3/13,23.08%)下颌骨髁突、3例(3/13,23.08%)颈静脉孔见溶骨性骨质破坏。MRI表现为外耳道和中耳鼓室及周围软组织受累,8例(8/8,100%)外耳道、7例(7/8,87.50%)中耳鼓室、8例(8/8,100%)乳突、7例(7/8,87.50%)颞下颌关节、7例(7/8,87.50%)颞下窝、8例(8/8,100%)咽旁间隙、5例(5/8,62.50%)腮腺平扫可见异常软组织信号,增强后明显强化;其中7例颅内侵犯...     

Chronic thromboembolic pulmonary hypertension from the perspective of patients with pulmonary embolism

Summary

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but feared long‐term complication of acute pulmonary embolism (PE), although CTEPH may occur in patients with no history of symptomatic venous thromboembolism. It represents the most severe presentation of the so‐called ‘post‐PE syndrome’, a phenomenon of permanent functional limitations after PE caused by deconditioning after PE or ventilatory or circulatory impairment as a result of unresolved pulmonary artery thrombi. Because the post‐PE syndrome may occur in up to 50% of PE survivors, and CTEPH tends to have an insidious and non‐specific clinical presentation, CTEPH is often not diagnosed or diagnosed after a very long delay. Once the diagnosis is confirmed, the treatment of choice is pulmonary endarterectomy which effectively lowers the pulmonary vascular resistance and normalizes resting pulmonary artery pressures, leading to recovery of the right ventricle. When pulmonary endarterectomy is not technically feasible, balloon pulmonary angioplasty may be a potential acceptable alternative. Also, medical treatment may help to improve patient's symptoms and hemodynamics. Current studies are focusing on strategies for earlier CTEPH diagnosis after acute PE, as well as the most optimal treatment of inoperable patients. This review will focus on the epidemiology, risk factors, diagnosis and treatment of CTEPH from the perspective of the PE patient.

     

心脏黏液瘤多模态成像特点及诊断模式

目的 探究心脏黏液瘤(CM)多模态成像特点及其多模态诊断模式.方法 回顾性研究2016年7月至2019年8月在阜外医院行二维经胸超声心动图检查初诊为CM的178例患者,以病理结果为金标准,将研究对象分为CM组和非CM组,根据超声心动图特点将CM组划分为典型CM组和非典型CM组.分析归纳各组患者的临床特征,二维经胸超声心...     

副鼻窦恶性肿瘤的影像学诊断

目的:探讨副鼻窦恶性肿瘤的影像学表现,提高影像诊断水平。方法:回顾性分析我院诊断的副鼻窦恶性肿瘤42例。均行X线和CT检查,加冠状位CT扫描24例,行MRI检查7例,均经手术病理证实。结果:上颌窦源性22例,筛窦8例,蝶窦2例,另10例因肿瘤较大、侵犯范围广而无法判断来源。鳞癌28例,腺癌9例,纤维肉瘤4例,脂肪肉瘤1例。结论:X线对副鼻窦病变的诊断具有筛查作用,CT是明确诊断副鼻窦恶性肿瘤的主要方法,MRI对副鼻窦恶性肿瘤诊断与鉴别诊断具有重要意义。     

多灶性骨肉瘤的影像学诊断分析

目的:分析15例多灶性骨肉瘤的影像学和临床诊断特点。方法:对15例经手术后病理证实的多灶性骨肉瘤的X线、CT、MRI、SPECT影像学资料和临床诊断特点进行回顾性分析评估。结果:多灶性骨肉瘤的发病率为6.85%,SPECT对多灶性骨肉瘤的显示率为92.31%。同时性多灶性骨肉瘤多发于青少年,异时性多灶性多发于成年人。结论:多灶性骨肉瘤的影像学特点主要呈成骨性改变,CT、MRI、SPECT扩展和加深了对多灶性骨肉瘤的认识,为临床诊断提供了全面、准确的影像学资料。     

医学影像学在诊断先天性联体畸形中的价值

目的：探讨医学影像学在诊断先天性联体畸形中的价值，以便做好分离术前准备。材料与方法：收集我院两例联体婴儿的消化道造影、CT、MRI、核医学等影像学资料，分析各自特异性表现。结果：联体婴儿1肝脏相连，心包有轻度的粘连，相连的肝脏没有大血管交通，其代谢、功能正常，各自具有完整独立的胆道系统、消化系统、泌尿系统。联体婴儿2心脏、肝脏相连,其它部位没有相连。结论：联体婴儿的影像学资料比较全面地反映了相连脏器的相连程度及其血管沟通和代谢、功能情况，能够较准确地指导分离手术方案的制定,医学影像检查的综合应用是联体畸形分离术成功的重要保障。     

Noninvasive cardiac imaging in the evaluation of suspected acute coronary syndromes

Optimal management of patients presenting with chest pain to the emergency department is a major challenge, both in terms of a diagnostic dilemma and consumption of resources. The triage of such patients can be aided vastly by the appropriate use of noninvasive imaging. Noninvasive imaging modalities such as echocardiogram, radionuclide perfusion studies, positron emission tomography, cardiac magnetic resonance imaging and computed tomography have all been demonstrated to have favorable diagnostic and prognostic value, with an enhanced sensitivity to detect acute ischemia. A normal noninvasive evaluation in the appropriate clinical setting presents a strong argument against acute ischemia as an etiology of the chest pain. Randomized trials of both rest and stress imaging in the emergency department have confirmed a reduction in unnecessary hospitalizations and cost savings without compromising the safety of the patient. Cardiac magnetic resonance and computed tomography would provide an insight into subendocardial ischemia, the detection of which has previously been difficult, using single-photon emission tomography and echocardiography. In this review, novel hot-spot imaging modalities are discussed including infarct-avid imaging agents and ischemia-avid imaging agents, thus elucidating the pathophysiology of reperfusion-induced cell death. These agents represent work in evolution and are likely to be used routinely in the future as understanding of coronary syndromes and coronary artery disease becomes clearer.     

Metastatic melanoma of the left ventricle: Cardiac imaging in the diagnosis and surgical approach

A mass lesion occupying the left ventricle was noted on a screening CT scan in a 42-year-old man with a history of malignant melanoma. Subsequent echocardiography and cardiac MR imaging provided further hemodynamic and anatomic characterization of the lesion. These studies were also essential in guiding the proper surgical approach to allow extensive resection of the large mass without disrupting cardiac structures and function. The unique clinical aspects of this case are the unusual location for a lone cardiac metastasis of melanoma and the asymptomatic presentation despite the large size of the tumor and its apparent obstruction of ventricular outflow. The clinical and imaging features of this patients threatening cardiac lesion are presented.