变应性真菌性鼻窦炎的CT诊断

目的 探讨变应性真菌性鼻窦炎的CT表现及其诊断价值。方法 回顾性分析12例经术后组织病理证实的变应性真菌性鼻窦炎，均经过CT检查。主要临床表现包括奶酪状黏涕、鼻阻塞感及鼻区痛。鼻内镜检查：12例受累侧鼻腔内均可见息肉、黏膜水肿，鼻窦腔内均见真菌分泌物。结果 变应性真菌性鼻窦炎累及半组鼻窦3例，累及全组鼻窦9例。CT平扫12例表现为鼻窦黏膜增厚；窦腔内充满软组织影，伴有不规则条状、匍行性或斑片状高密度影(软组织窗)，边界清楚，也可伴有云雾状高密度影(骨窗)，边界模糊；CT值80～110HU，平均92．5HU。11例鼻窦膨胀，窦壁骨质变形、变薄10例，8例窦壁骨质侵蚀。8例病变延伸到邻近结构，其中4例累及眼眶，2例累及颅内，2例同时累及眼眶和颅内。结论 半组或全组鼻窦充满软组织影，伴有多发典型的高密度影是诊断本病的特征性CT征象，根据此征象可能首先提出本病的诊断。CT不但可以准确显示病变累及的范围，也能够帮助与其他病变进行鉴别。     

CT管腔内密度衰减梯度联合无创血流储备分数对心肌缺血性损伤的诊断价值

目的 探讨并比较CT管腔内密度衰减梯度(TAG)、无创血流储备分数(FFR)及两者联合对心肌缺血性损伤的诊断效能。方法 回顾性纳入2019年1月至2020年7月来本院就诊同时行冠状动脉CT血管造影(CCTA)和冠状动脉造影(ICA)检查，临床资料完整的73例患者，共114支病变血管(心肌缺血性损伤组49支，无心肌缺血性损伤组65支);对比两组患者临床资料与影像学特征的差异，包括基线资料、病变血管数量、病变血管位置、CT-FFR值、TAG值，并建立TAG、CT-FFR及两者联合诊断心肌缺血性损伤模型。结果 心肌缺血性损伤组累及单支血管数量明显低于无心肌缺血损伤组，而同时累及三支血管数量明显高于后者(P<0.05)。在血管水平上，心肌缺血性损伤组不论是单支还是总体血管的CT-FFR和TAG值均明显小于无心肌缺血性损伤组(P<0.01)。在诊断效能上，CT-FFR诊断特异度明显优于TAG(87.7%vs.67.7%,P<0.017),TAG联合CT-FFR诊断特异度高于TAG(86.2%vs.67.7%,P<0.017);重要的是，两者联合诊断心肌缺血性损伤曲线下面积...     

门静脉高压性肠病研究进展

门静脉高压性肠病(PHE)是在门静脉高压(PH)患者中出现的肠黏膜毛细血管淤血、扩张，黏膜上皮细胞超微结构改变，以及异位静脉曲张等，其范围仅限于以血管改变为特征的肠道病变。PHE包括门静脉高压性小肠病及门静脉高压性结肠病(PHC)，是PH并发消化道出血的重要原因之一。PHE的发病机制尚不完全清楚，其组织病理学表现缺乏特异性，临床症状不典型，且病变解剖位置独特，导致其诊断具有一定难度。腹部CT、多层螺旋CT灌注成像、99mTc标记红细胞及单光子发射CT(SPECT)/CT等检查手段能提供一定的诊断信息并有助于指导后续治疗。本文从发病机制、组织病理学表现、临床表现、检查与诊断及治疗方法等方面总结PHE的研究进展，以加深临床医师对该疾病的认识。     

低恶度性腹膜囊性间皮瘤的临床与病理

收集１４例低度恶性腹膜囊性间皮瘤，结合有关文献对其临床表现、病理改变、诊断、治疗及预后进行分析。病变发生于大网膜或肠系膜处４例，盆腔处４例，腹膜后１例，胃肠浆膜面及肠系膜多处累及５例。主要症状为腹部不适或疼痛逐渐加重，５例有不完全性肠梗阻表现。多发囊性结节型４例，弥漫囊性结节型６例。     

低度恶性腹膜囊性间皮瘤的临床与病理

收集１４例低度恶性腹膜囊性间皮瘤，结合有关文献对其临床表现、病理改变、诊断、治疗及预后进行分析。病变发生于大网膜或肠系膜处４例，盆腔处４例，腹膜后１例，胃肠浆膜面及肠系膜多处累及５例。主要症状为腹部不适或疼痛逐渐加重，５例有不完全性肠梗阻表现。多发囊性结节型４例，弥漫囊性结节型６例。     

脑脂肪栓塞的MRI及CT诊断

目的 总结脑脂肪栓塞(CFE)的临床及MRI及CT的影像特点。方法 分析3例急性CFE的临床表现、影像特点。结果 (1)3例均为长骨骨折，在外伤后或骨折固定、复位数小时后突发精神状态改变。(2)醒状昏迷是主要临床表现。(3)3例患者MRI能明确显示病灶，1例CT显示了病灶。(4)MRI、CT显示脑内病灶均呈基本对称性分布，为边缘模糊的点、片状长T1、长T2信号，CT呈低密度。病灶均累及脑干、分水岭区脑白质、基底节区、胼胝体压部。2例病灶累及小脑。(5)1例患者发病康复治疗3个月后MRI复查示脑内病灶完全消失。结论 急性脑脂肪栓塞的临床及MRI、CT影像改变具有特征性，MRI在病灶显示上优于CT。     

复发性多软骨炎10例诊治体会

复发性多软骨炎（RP）是一种少见的、累及全身多处软骨的自身免疫性疾病。病变可侵犯包括耳鼻咽喉、气管支气管、关节及心血管等全身重要器官的软骨结构及其结缔组织，可造成多系统功能紊乱。其临床表现多种多样，具有慢性、复发性、多软骨性及萎缩性特点，起病隐袭，极易误诊，早期诊断、及时治疗有利于控制症状。     

静脉性脑梗死的临床及影像分析

目的提高对静脉性脑梗死的临床及影像学表现的认识。方法回顾性分析21例静脉性脑梗死患者的临床及影像学表现。结果患者存在颅内静脉血栓高危因素的14例,主要为口服避孕药、中耳乳突炎、产褥期等;临床表现为头疼、呕吐、癫痫、肢体功能障碍、失语、视物模糊等;脑实质病变位于大脑皮层下及皮层区19例(双侧6例、累及小脑2例),丘脑2例,17例为出血性梗死;15例血栓累及多个静脉窦。结论静脉性脑梗死临床表现缺乏特异性,当发现非常规分布的脑梗死、出血,结合血栓高危因素等应想到静脉性脑梗死可能,及时的MRV/CTV检查有助于诊断。     

皮层下动脉硬化性脑病156例CT诊断体会

皮层下动脉硬化性脑病 (Ｓｕｂｃｏｒｔｉｃａｌａｒｔｅｒｉｏｓｃｌｅｒｏｔｉｃｅｎ ｃｅｐｈａｌｏｐａｔｈｙ ,ＳＡＥ)又称Ｂｉｎｓｗａｎｇｅｒ氏病。病变主要累及脑白质 ,灰质一般不受侵犯或轻度受累。近来文献突出了本病的不少见性[1～ 7] ,同时还强调了ＣＴ特别是磁共振 (ＭＲ)影像能够明确显示本病的基本病理所见—脱髓鞘病变的大小及部位。甚至有区别其它脱髓鞘病变的可能性。作者回顾性分析了 1 5 6例ＳＡＥ的ＣＴ诊断 ,结合临床表现 ,就本病的诊断及相应的鉴别诊断作一讨论。1　一般资料自 1 994年 3月～ 1 997年 2月共检出皮…     

超声与内窥镜在胆源性胰腺炎中的应用

胆系病变(结石)是引发急性胰腺炎的主要原因。超声和内窥镜技术(包括US，EUS，ERCP，CTVE，MRVE)能有效地发现、诊断和去除胆系病变，从而对胆源性胰腺炎的预防、诊治及评估其发病、演变、恶化、复发等都有着重要作用。     

Successful Recovery of a Fulminant Form of Acute Disseminated Encephalomyelitis (ADEM) with Intravenous Steroids

Abstract Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory demyelinating disease of the central nervous system mostly associated with a preceding infection or vaccination. It is characterized by multifocal white matter lesions on neuroimaging. A patient is described who developed a fulminant form of ADEM after a bacterial skin infection. Despite poor prognostic factors and extensive white matter lesions, the patient recovered dramatically under high-dose administration of steroids.     

Cranial computed tomography in acute disseminated encephalomyelitis

Summary Acute disseminated encephalomyelitis (ADEM) is an uncommon inflammatory disorder of the nervous system. The appearance of ADEM on cranial CT scans has rarely been reported. The author reports seven cases in two instititions during a period of seven years. Only four of the seven patients had hypodense lesions in the white matter and six patients showed spotty, nodular, or gyral enhancement after contrast injections. The enhancement resolved with steroid therapy, leaving some persistent hypoattenuated areas even after 10 months follow-up, these findings support the dual components of the pathogenesis of ADEM. The vasculitic component may be responsive to steroids, nevertheless the demyelinating or necrotic areas may not, and the latter may be responsible for the sequelae of ADEM.This work has been in part presented on the 7th AOCN on September 1987, in Bali, Indonesia     

Delayed MR imaging changes in acute disseminated encephalomyelitis.

BACKGROUND AND PURPOSE: White matter lesions on MR images obtained from patients with acute disseminated encephalomyelitis (ADEM) have been reported to appear shortly after symptom onset, and their resolution has been claimed to parallel recovery. To elucidate the temporal evolution of these lesions and to associate the changes on MR images to the patients' clinical condition, we performed serial MR imaging on patients with ADEM. METHODS: Several consecutive T2-weighted and fluid-attenuated inversion recovery scans were obtained from four previously healthy adult patients with ADEM within the first days after the onset of symptoms and again during the recovery period. MR imaging was done first on a weekly to biweekly basis and later at 1- to 2-month intervals for up to 8 months. RESULTS: MR scans of three of these patients did not show any specific abnormalities until several weeks after the onset of the disease. As the lesions later appeared, their number increased during the recovery period. CONCLUSION: MR imaging performed during the first days after the onset of the disease may not reveal any pathologic findings. The appearance of the ADEM-associated MR imaging changes may be associated with recovery rather than decline. It remains to be studied whether the new MR imaging techniques reveal the lesions associated with ADEM faster than the conventional T2-weighted imaging.     

Acute disseminated encephalomyelitis and multiple sclerosis: magnetic resonance imaging differentiation

The study was undertaken to compare the MR imaging features of acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) in a country with a high prevalence of ADEM. Magnetic resonance scans from 33 patients diagnosed clinically with MS (14 patients) or ADEM (19 patients) were reviewed concurrently by two radiologists blinded to the clinical diagnosis. The size, site, morphology and pattern of brain and spinal cord involvement were recorded and the MR imaging diagnosis was compared with the clinical diagnosis. The MR imaging findings matched with the clinical diagnosis in 11 of 14 patients with MS (sensitivity = 78.6%), and with the clinical diagnosis in 15 of 18 patients with ADEM (sensitivity = 78.9%). Three patients had non-specific findings and in a further three patients discordant imaging features were present. One patient with imaging features typical of Balo's concentric sclerosis was diagnosed clinically as suffering from ADEM. In a country with a high prevalence of ADEM, the majority of patients with ADEM and MS can be differentiated on MR imaging.     

Acute disseminated encephalomyelitis (ADEM) or ADEM-like inflammatory changes in a heart-lung transplant recipient: a case report

Acute disseminated encephalomyelitis (ADEM) is a white matter inflammatory disease which usually follows a viral infection or pharmaceutical intervention. We describe a case of presumed ADEM in a heart/lung transplant patient, the etiology of which cannot be elucidated. The fascinating aspect is the mode of clinical presentation and the rapid resolution of radiologic abnormalities. Histologic examination of the brain is provided in an attempt to elucidate the radiographic abnormalities.     

老年急性播散性脑脊髓炎15例临床表现及影像学特征

 目的 探讨老年急性播散性脑脊髓炎(ADEM)临床与影像特征。方法 回顾性分析2013-03至2019-01解放军总医院第六医学中心神经内科15例住院老年ADEM患者的临床资料、实验室资料及影像资料。结果 男6例,女9例,年龄60~77岁,其中急性、亚急性起病分别为5例、10例;2例存在前驱诱因;首发症状:头痛与偏瘫各4例,截瘫2例,面部抽动、复视、嗜睡、腹痛和视力障碍各1例;13例头颅MR影像可见病灶。本研究中的老年ADEM患者影像表现与文献报道的儿童及中青年ADEM的头颅MRI影像相比较,并无明显差别,但本研究中部分病灶影像呈假瘤样,与中枢神经系统瘤样炎性脱髓鞘病相叠加;4/6例神经传导速度异常,高于既往文献报道中儿童和中青年ADEM患者周围神经损害发生率;随访末期,遗留中重度神经功能障碍或者死亡8例,预后较既往文献报道中儿童和中青年ADEM患者差。结论 老年ADEM前驱症候较少、起病较缓、首发症状多不典型、多累及周围神经,易误诊,预后相对较差。     

Acute onset anarthria in a 7-year-old patient as a presentation of acute disseminated encephalomyelitis: A rare clinical and radiological entity

Acute disseminated encephalomyelitis (ADEM), also called post-infectious encephalomyelitis, is defined as an immune-mediated inflammatory and demyelinating event that involves the central nervous system. It usually follows an infectious episode or an active immunization several weeks prior the disease onset. ADEM is typically presented with an encephalopathy associated to focal neurological signs. Cerebrospinal fluid analysis is usually nonspecific, showing signs of central nervous system inflammation with negative viral and bacterial cultures. The diagnosis is based on clinical and MRI findings. Patients with ADEM respond well to anti-inflammatory and immunosuppressive agents, with high-dose of intravenous steroids administered as first-line treatment. Herein, we present the case of a 7-year-old male patient diagnosed of acute disseminated encephalomyelitis most likely secondary to a viral upper respiratory tract infection. It is a unique case, as the inaugurating sign is an acute onset anarthria. The patient responded favorably to the first-line therapy with an almost full recovery within the first week of treatment.     

儿童急性播散性脑脊髓炎与临床孤立综合征的临床及影像学比较研究

目的探讨急性播散性脑脊髓炎(acute disseminated encephalomyelitis,ADEM)与临床孤立综合征(clini-cally isolated syndrome,CIS)的鉴别诊断要点。资料与方法搜集39例患儿首发中枢神经系统脱髓鞘病变时的临床及影像学资料。其中CIS 18例,包括女13例,男5例;ADEM共21例,其中女8例,男13例。平均随访时间4.2年,最短随访时间为2年。由一名儿科神经医师对CIS及ADEM的临床表现进行了归类总结。由一名资深神经影像学医师对患者ADEM及CIS头颅MRI表现进行分析,内容包括病灶的位置、大小、形态。对计数资料采用Fisher精确检验,对计量资料进行非参数Mann-Whitney U检验。分别应用几种CIS的诊断标准对患儿进行评价,比较分析每种标准诊断的特异性、敏感性、阳性预测值及阴性预测值。结果 39例儿童ADEM与CIS患者中,ADEM发病年龄小,平均约(6.14±3.41)岁;CIS平均发病年龄(10.05±2.87)岁,两者之间差异有统计学意义(P=0.000);ADEM临床表现以发热和运动障碍为主,分别占76%和71%,高于CIS的33%和22%(P=0.011,0.004)。而CIS中视力障碍及脑脊液寡克隆带阳性出现率分别占50%和61%,与ADEM的0%和24%比较,差异具有统计学意义(P=0.000,0.025)。随访中儿童ADEM的改良的Rankin量表评分不如CIS。影像学特征中,与CIS比较,中央白质病变及脑萎缩在ADEM中表现更为明显,分别占100%和38%(P=0.001,0.023);ADEM病灶分布相对对称。CIS的视神经及脊髓病变出现率分别为22%、17%,ADEM未出现此类病变(P=0.037,P=0.089)。"黑洞"在CIS中具有显著特异性,与ADEM比较差异具有统计学意义(P=0.037)。Callen诊断MS的标准敏感性最高,为87%。KIDMUS(2个均满足)MS诊断标准及Callen的鉴别MS与ADEM标准特异性均较高,分别为92%和90%。KID-MUS敏感性最差,为33%。Barkhof的成人MS标准在儿童中敏感性及特异性均较低,分别为22%和57%。结论临床及影像学特征的结合,可以帮助早期诊断与鉴别ADEM与CIS。在诊断CIS时应该用Callen诊断MS标准为主,而鉴别ADEM和CIS时可以用Callen的鉴别标准。     

Quantitative proton MR spectroscopic imaging in acute disseminated encephalomyelitis.

Serial MR imaging and quantitative proton MR spectroscopic imaging (MRSI) findings of a 4-year-old boy with acute disseminated encephalomyelitis (ADEM) are reported. Over a 2-month period characterized by an initial illness and two relapses, each with full recovery, MR imaging exhibited the appearance and disappearance of multifocal lesions throughout the CNS that correlated only partly with the neurologic impairment. During one relapse, MRSI revealed low levels of N-acetylaspartate (NAA) within the regions of prolonged T2 signal intensity. All other metabolites were normal. At follow-up, the MR imaging and MRSI abnormalities had fully resolved. MRSI might play an important role in the diagnosis of ADEM, as well as in the elucidation of underlying pathophysiologic processes in this poorly defined disorder of children. This case demonstrates that reduced levels of NAA are not always associated with neuronal loss, irreversible tissue damage, or poor neurologic outcome.     

急性播散性脑脊髓炎的MRI表现与临床分析

目的 :探讨急性播散性脑脊髓炎 (ADEM)脑部MRI及临床表现、病程、预后间的关系。方法 :回顾性分析 43例的MRI表现及临床资料 ,按病灶大小、数目分组 ,分析病灶大小、数目与临床表现、病程及预后间的关系。结果 :双侧脑室周围及额、颞、顶、枕白质区见多发、不对称长T1长T2 信号灶 ,部分T1WI为等信号。 18例见环形强化 ,3例轻度至中度占位效应。病灶大小与临床分级组间差异有显著性意义 (P <0 .0 5 ) ;病灶大小与病程、预后无明显相关性 ;病灶数目与临床分级、病程均无明显相关性。结论 :综合分析ADEM的脑部MRI表现 ,可在一定程度上为临床诊断、病情评估、治疗监测及评估预后提供依据。