Neurohypophyseal germinoma traced from its earliest stage via magnetic resonance imaging: case report.

BACKGROUND: We report a case in which magnetic resonance imaging (MRI) documented the formation of a neurohypophyseal germinoma from its earliest stage. CASE DESCRIPTION: A 9-year-old girl presented with polyuria, polydipsia, and growth retardation. Urinary and endocrinological examination indicated diabetes insipidus (DI) and growth hormone deficiency. No clear evidence of a mass in the hypothalamo-pituitary area was apparent on the first MRI scan. Follow-up MRIs and endocrinological examinations revealed that a tumor, arising from the stalk and posterior lobe of the pituitary gland, formed a mass and caused anterior pituitary function to deteriorate. Histologic diagnosis was germinoma based on open biopsy. CONCLUSION: Radiologic findings in this case indicated the primary site of this intrasellar germinoma to be the hypothalamo-neurohypophyseal region, designating this a "neurohypophyseal germinoma."     

Two cases of lymphocytic infundibuloneurohypophysitis

We report two cases of lymphocytic infundibuloneurohypophysitis (LIH). A 32-year-old male and a 13-year-old male were admitted to our hospital because of a sudden occurrence of the diabetes insipidus (DI). MRI of both patients showed the disappearance of hyperintensity of the posterior pituitary in T1WI, pituitary stalk swelling and enlargement of the pituitary gland, with homogeneous enhancement by gadolinium. We thereby diagnosed LIH, so neither patient was operated on, but both were followed-up conservatively. We reviewed 51 cases of LIH. The patient's ages ranged from 4 to 74 years (mean 45.4 years). Based on the initial symptoms, DI was found in all cases. Almost all these cases revealed characteristic MRI findings similar to those in our cases. The mean follow-up period was 3.1 years. The rate of disappearance of radiological abnormalities was 56.2%, but only 13.7% of DI improved. If we encounter a patient presenting with idiopathic DI whose MRI is strongly suggestive of LIH, and barring the necessity of an urgent operation, careful conservative treatment is advised.     

CT-myelography of cervical cord injury

We reported seven cases of acute cervical cord injuries who were examined by CT-Myelography (CTM) within 7 days after trauma. The presence or absence of spinal cord enlargement, the initial neurological status and the neurological prognosis of these patients were studied. The neurological status of each patient was graded by the method of Frankel who defined five grades from A to E according to the severity of neurological deficits. Seven patients were all males. The youngest was 18 and the oldest was 73 years old, with a mean age of 40.7 years. Follows up periods ranged from 7 to 23 months. Result: CTM revealed the enlargement of spinal cord in two cases, who had severe neurological deficits and were graded to A. No neurological improvements were obtained in these cases. Five cases without cord enlargement were graded to A in one patient, B in one patient and C in three patients. Four of these five patients improved neurologically. One grade C patient remained grade C. Complete block of subarachnoid space was observed in two out of seven cases. Cord enlargement was present in one of them. Another case of complete block improved from C to D. Conclusion: We consider the presence of cord enlargement which can be demonstrated by CTM well correlates the severity of the cord damage and presume poor neurological prognosis. Internal decompression, such as posterior longitudinal myelotomy may be recommended to the case of cord enlargement. When the cord enlargement is absent, improvement of neurological grade is expected although the initial neurological status shows severe deficits.     

Magnetic resonance imaging-guided biopsy of mammographically and clinically occult breast lesions

Background Breast magnetic resonance imaging (MRI) is a very sensitive technique for detection of breast cancer. We report on MRI-guided needle localization for biopsy of abnormalities seen only on MRI. Methods A retrospective review was performed of 231 patients with invasive breast cancer or ductal carcinoma-in-situ who had MRI as part of their evaluation and treatment at the University of Pennsylvania between 1992 and 1998. Clinical, radiological, and pathologic data were examined. Results MRI needle localization was performed in 41 (18%) patients. MRI needle localization was required for a finding of a mammographically or clinically occult lesion in 31 patients, better MRI definition of tumor in 5 patients, and surgeon’s choice in 5 patients. In all cases, MRI localization and excisional biopsy were successfully completed. Nineteen of 31 patients were found to have additional mammographically and clinically occult tumors. There were 12 (29%) falsepositive MRI scans. Conclusions MRI has a high sensitivity for detection of breast cancer; additional mammographically and clinically occult sites of tumor are detected in approximately 1 (15%) of 7 breast cancer patients. These otherwise occult sites of disease can be appropriately biopsied with MRI needle-localization techniques.     

An evaluation of the flow cytometric nuclear DNA analysis of intrahepatic multinodular hepatocellular carcinoma for a diagnosis of their multicentricity

This study aims to evaluate the clinical significance of the nuclear DNA index (DI) for identification of multicentrically occurring (MC) hepatocellular carcinoma (HCC). In 14 multinodular HCC patients, the DI of 30 HCC specimens and 14 non-cancerous liver tissues were analyzed by flow cytometry. Histological studies of the 30 HCCs revealed MC in 6 cases and intrahepatic metastasis (IM) in 7 cases except for a histologically undetermined case who was found to be a hepatitis B virus (HBV) carrier, and the MC of this case was determined by a clonal study using the HBV integration pattern. In four of the seven specimens with MC HCC, the DI of all the intrahepatic tumors was 1.0 (diploid pattern), while the remaining three were different. On the other hand, five of the seven IM cases were identical (3 diploid and 2 aneuploid), one similar level (DI = 1.17 – 1.18) and one different (1.0 and 1.24). Moreover, in one IM case, the possibility of an alteration of the DI during the course of HCC development was investigated. Although the DI of the recurrent main tumor (DI = 1.17) of this case, which was identified as metastasis of the primary tumor by a clonal study, was also similar to that of subsequent metastatic lesions (DI = 1.18), the DI of the primary tumor was 1.0. These results indicate that DI analysis was not enough to make a differential diagnosis of the multicentric occurrence of HCC.     

Fibrolipomatous hamartoma of nerve. A clinicopathologic analysis of 26 cases

Nineteen cases of fibrolipomatous hamartoma of nerve without macrodactyly and seven cases with macrodactyly are discussed. Twenty-five involved the hand, wrist, palm, and finger, and one case involved the foot. Nineteen patients had isolated fibrofatty enlargement of nerve, while seven had macrodactyly in addition to the peripheral nerve changes. Involved nerves included the median nerve, ulnar nerve, an unidentified nerve near the elbow, and a nerve on the dorsum of the foot. Four of nine patients with neurologic symptoms of pain or paresthesias had physical findings compatible with compression neuropathy, and two others were described as having carpal tunnel syndrome. Most patients had been aware of a mass for several years. Microscopically, the lesion was characterized by fibrofatty enlargement of nerve with massive epineural and perineural fibrosis. In two of the cases with macrodactyly, the fibrofatty enlargement of the nerve was associated with overgrowth of bone and the surrounding subcutaneous tissues. In one case, the perineural fibrosis was associated with metaplastic bone. The histogenesis of fibrofatty overgrowth of nerve has been disputed. Mature fat cells have been described within the normal nerve sheath, and it is thought that proliferation of these cells leads to the fatty enlargement of the nerve and its coverings. The relationship of these neural changes to the development of macrodactyly remains controversial. Follow-up in 18 patients (69%) reveals a benign course following biopsy, limited excision, or division of the flexor retinaculum in the wrist.     

Breast MRI Wire-Guided Excisional Biopsy: Specimen Size as Compared to Mammogram Wire-Guided Excisional Biopsy and Implications for Use

Background Breast magnetic resonance imaging (MRI) has been implemented as a screening tool for early detection and as a diagnostic test in the management of breast cancer. Lesions identified by MRI but not amenable to conventional biopsy techniques require MRI wire-guided excisional biopsy (MRIbx). We hypothesized that more tissue would be resected with MRIbx compared to Mammobx. We also sought to evaluate factors that might predict the presence of breast cancer in patients undergoing MRIbx. Methods We reviewed consecutive cases of breast MRIbx from 2004 to 2006 performed by seven surgeons. MRI was performed in patients with either a synchronous breast cancer or significant risk factors. Lesions visualized only by MRI underwent diagnostic MRIbx. The control group was comprised of consecutive cases that underwent diagnostic Mammobx during the same time period. The volumes of tissue resected, overall and by pathologic outcome, were compared. Results Seventy-one patients, with a mean age of 48, underwent MRIbx. Eleven (15.5%) invasive breast cancers and eight cases (11.3%) of ductal carcinoma in situ (DCIS) were identified. The median volume of tissue resected was significantly greater than that in the Mammobx group (28.8 cm³ vs 21.1 cm³, respectively). DCIS-containing MRIbx specimens were significantly larger than benign or invasive cancer-containing specimens. There was no significant overall association between either the indication for MRIbx or the size of the MRI lesion and the frequency of cancer. Conclusions In patients undergoing breast MRIbx, 27% were found to have DCIS or invasive breast cancer. MRIbx was associated with significantly larger specimen volumes than Mammobx.     

Value of Multiparametric MRI in the Work-up of Prostate Cancer

The role of magnetic resonance imaging (MRI) in prostate cancer evaluation is controversial and likely underestimated. Technological advances over the past 5 years have demonstrated that multiparametric MRI, including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI, can evaluate the actual tumor burden of a newly diagnosed prostate cancer more accurately than sextant biopsy protocols. Tumor risk, defined by the D’Amico criteria, hence can be re-evaluated by multiparametric MRI. As a result, there is increasing evidence that MRI before repeat or even initial biopsy can accurately select patients who require immediate biopsies and those in whom biopsy could be deferred. Also, a relationship between apparent diffusion coefficient (ADC), calculated from DWI, and Gleason score was found. Thus, MRI before biopsy helps to detect high-grade tumors to target biopsies within areas of low ADC values. To achieve good targeting accuracy, transrectal ultrasound (TRUS)-MRI image registration is necessary. Three-dimensional deformable registration is sufficiently accurate to match TRUS and MRI volumes with a topographic precision of 1 mm. Real-time MRI-guided biopsy is another technique under evaluation. Both approaches will allow for increasing acceptance of focal therapies, should these techniques be validated in the future.     

Correlation of DNA index and BrdU labeling index with clinicopathological factors in colorectal carcinoma]

We studied the usefulness of the DNA index (DI) and bromodeoxyuridine (BrdU) labeling index (BLI) using fresh material from 71 patients with colorectal carcinoma. We compared the DI and BLI of the biopsy specimens with those of the resected specimens from 17 patients. These DI and BLI values were evaluated by flow cytometry. Neither DNA ploidy nor DI was correlated with other clinicopathologic factors. Intratumoral DI heterogeneity (DIH) was found in 33.8% (24/71) of tumors. Lymph node metastases were observed more often in cases with DIH than without DIH. The incidence of DIH was correlated with histologic stage. BLIs were higher in well-differentiated adenocarcinoma than in moderately and poorly differentiated adenocarcinoma. BLIs were not correlated with histologic stage. A significant correlation was observed between DI and BLI (r = 0.47, p less than 0.001). In cases without DIH, there was a good correlation between the DI values of the biopsy and resected specimens (r = 0.99, p less than 0.001). A significant correlation was also found between the BLI values of the two types of specimens (r = 0.69, p = 0.002). These results suggested that 4 biopsy specimens were adequate to estimate DI and BLI by FCM, and that DI and BLI values determined by FCM could facilitate the design of treatment regimens for preoperative patients.     

Mechanisms of the bronchoconstrictor effects of deep inspiration in asthmatic patients.

A single deep inspiration (DI) is commonly followed by transient airflow obstruction in asthmatic patients. In some patients, however, DI results in a sustained response which suggests that more than one mechanism may be responsible. We have studied the characteristics of the response to repeated DI, and their modificatiion by various pharmacological agents, by measuring specific airway resistance (sRaw) in ten subjects who showed reproducible and consistent increases in sRaw after DI. Two types of reaction were observed: type A (n = 8) had an immediate maximum and usually short persistence; type B (n = 2) had a delayed maximum with a progressive increase. In type A reactions repetition of DI showed different patterns of response--either a reproducible reaction to each DI or a plateau effect. In type B reactions the response spontaneously increased with repeated DI. Type A responses to DI were inhibited completely by a beta-adrenergic stimulant (BAS), largely by an anticholinergic drug (AC, ipratropium bromide), but in no case by disodium cromoglycate (DSCG). Type B responses were inhibited completely by BAS, largely by DSCG, and partially by AC. These findings suggest that the response to DI is due to bronchoconstriction, which in type A reactions is of reflex origin, vagally mediated, and is due in part or wholly to mediator-release in type B reactions.     

The longest survivor and first potential cure of an advanced cholangiocarcinoma by ex vivo resection and autotransplantation: a case report and review of the literature

Bismuth type IV hilar cholangiocarcinoma (CC) carries a poor prognosis; however, ex vivo liver resection and autotransplantation (Atx) is theoretically a treatment option. There are only five previously reported cases of this procedure for hilar CC in the English literature, and most of them died early in the postoperative period. The only reported survivor died of tumor recurrence at 13 months. We are reporting a patient who has survived for 17 months without any sign of tumor recurrence. This probably represents the world's first cure for CC using this technique. This patient is a 26-year-old woman with a Bismuth Type IV CC. Portal vein involvement at the confluence was shown on angiogram, and in situ resection was deemed impossible. Ex vivo resection of segments five, six, seven, eight, and part of segment four was performed followed by a partial liver Atx. The pathology specimen demonstrated CC with clear margins. MRI and CT examinations done over the subsequent 17 months showed no evidence of recurrence. In conclusion ex vivo liver resection and Atx can be a viable option for cure among highly selected patients with CC.     

Radiologic features of granulomatous mastitis

Granulomatous mastitis (GM) is a recognized, but an uncommon cause of breast mass. Awareness of this condition is important, because it can clinically as well as radiologically mimic breast carcinoma. In this study, we present the imaging features of a series of 10 cases with proved diagnosis of granulomatous mastitis with emphasis on magnetic resonance (MR) findings. All those patients who were histologically proven to have GM of the breast were analyzed. Their files were reviewed and data recorded for demographic, clinical presentation and imaging appearances. The imaging features of the lesions by mammography, ultrasound, and magnetic resonance imaging were analyzed. Of the 305 patients who were surgically treated, 10 (3%) cases proved to have GM. All the patients were females with age ranging from 27 to 53 years (average 38 years and median age 36 years). Guided core biopsy was performed in all cases for confirmation of diagnosis followed by either excision biopsy (in five cases) or lumpectomy (in five cases). The final histopathologic results were chronic granulomatous inflammation consistent with tuberculosis in four cases and GM with acute inflammation, but unknown etiology in four cases and GM due to duct ectasia in two cases. GM, a rare breast condition, should be considered in the differential diagnosis of patients with a breast mass associated with inflammatory change. Routine breast imaging with US, MG, or MRI, the condition from malignant lesions and biopsy, still remains the only method of definite diagnosis.     

Surgical resection of focal cortical dysplasias in the central region

BACKGROUND AND PURPOSE: Taylor-type focal cortical dysplasias (TTFCD) represent a particular pathological entity responsible for severe drug-resistant epilepsy of extratemporal location. Epilepsy can be surgically cured if complete removal of the lesion can be performed. However, identification on imaging may be difficult and negative standard MRIs are not rare. The frequent location of TTFCD in the central region restrains the possibilities of complete resection. We report a series of patients operated on for intractable epilepsy associated with TTFCD in the central area. PATIENTS AND METHODS: Between 2000 and 2006, of 34 consecutive patients with TTFCD, 17 had a lesion located in the central area. MRI was considered normal in eight, although in five a subtle gyral abnormality was disclosed on further analysis. A (18)FDG PET scan performed in 16 cases demonstrated focal hypometabolism in 15 that correlated with abnormalities on MRI when visible. SEEG performed in 13 cases revealed typical abnormalities for TTFCD in 10 cases. At resection, cortical and subcortical stimulations of the dysplastic cortex did not elicit a motor response. RESULTS: Postoperative motor or sensory deficit was observed in 13 patients--severe in four--which subsequently resolved completely in seven. Six patients had a minor permanent, motor or sensory deficit. Four patients were reoperated for seizure recurrence and residual dysplastic tissue was found at reoperation in three cases. Average postoperative follow-up was 3.7 years. Sixteen patients (94%) were in Engel Class I (65% in Class IA). CONCLUSION: This study suggests that surgical resection of central region TTFCD may be associated with favorable seizure outcome and no or minor functional permanent disability. In cases of seizure relapse, reoperation can be performed without further permanent deficit and lead to seizure-free outcome. Future techniques for intraoperative detection of these lesions could optimize their complete resection in functional areas.     

Pseudolymphomatous folliculitis: a clinicopathologic study of 15 cases of cutaneous pseudolymphoma with follicular invasion.

We report the clinical, histopathologic, and immunohistologic features of 15 cases of pseudolymphomatous folliculitis (PLF). The patients comprised seven males and eight females (mean age, 38.6 years; age range, 2-67 years). All patients had dome-shaped or flat-elevated nodules suggestive of cutaneous lymphoid hyperplasias (CLHs). The lesions were solitary in all 15 cases, except in one case with duplex lesions. All lesions were located on the face and measured less than 1.5 cm. In 14 cases with one lesion each, five lesions showed rapid regression after incisional biopsy, whereas the remaining nine underwent excisional biopsy. In the case with duplex lesions, one regressed spontaneously after excisional biopsy of the other. Histopathologically, all PLFs showed dense lymphocytic infiltrates from the dermis to the subcutis simulating cutaneous lymphomas. The walls of hair follicles in all cases were enlarged and irregularly deformed with their epithelium blurred by lymphocytic infiltrates; we called this change "activation" of hair follicles. In nine cases, many atypical lymphocytes were intermingled; three of these cases had been misdiagnosed as cutaneous T-cell lymphoma at other institutions. Immunohistologically, 10 and 5 cases showed predominantly B cells and predominantly T cells, respectively. Remarkably, all lesions showed increased numbers of perifollicular histiocytes expressing anti-S-100 protein and CD1a, and seven lesions showed histiocytes in aggregates. We conclude that PLF is a subset of CLH with characteristic clinical and pathologic features showing perifollicular clustering of T-cell-associated dendritic cells with activation of pilosebaceous units. PLF is an entity to be differentiated from malignant lymphomas and other cutaneous pseudolymphomas.     

Intraoperative imaging using a mobile computed tomography scanner.

OBJECTIVE: The radicality of tumour removal in patients suffering from glioma is discussed to be an important factor for longer survival times. Therefore intraoperative imaging modalities like magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound (US) are tested in many neurosurgical facilities for clinical use. In our department a mobile CT for intraoperative applications is used for this purpose since 1999. The handling and useful application of the mobile CT scanner as well as results without intraoperative imaging are discussed. MATERIAL AND METHODS: 470 CT scans with the mobile CT were accomplished, including 270 cases of neuronavigation planning, 76 cases of intraoperative scans, 48 cases of postoperative scans, 69 CT scans for stereotactic biopsy planning and control as well as 3 cases of emergency scanning in trauma patients and 4 spine applications. The results of the intraoperative CT scans are compared with those of the postoperative MRI scans. Additionally 87 patients with glioma were evaluated. These patients underwent surgery without intraoperative imaging. RESULTS: In 27 out of 43 patients with glioma residual tumour was detected with intraoperative CT. In 13 cases the surgery was resumed to complete resection, in 14 cases the operation was not continued due to close vicinity to eloquent areas or difficulties in image interpretation. In 44 cases the results of intraoperative CT and postoperative MRI were compared. In 6 cases the MRI demonstrated residual tumour in contrast to the results of the CT scans. In 3 cases the tumour removal could have been more complete (6.8 %). In 87 cases glioma surgery was performed without intraoperative CT. In 6 cases a more complete tumour removal could have been performed (6.9 %) according to the results of postoperative MRI. CONCLUSION: Intraoperative imaging with a mobile CT scanner is a good method for detection of residual tumour. The CT scanner can be integrated in an operative setting without problems. Although intraoperative imaging can be helpful in some selected cases, most of the neurosurgical procedures can be well performed with proper neuronavigation planning.     

The value of perineal punch biopsy in estimating the histological grade of carcinoma of the prostate

The degree of accuracy of the histological grade of carcinoma of the prostate obtained by perineal punch biopsy was analyzed by comparing the histological findings with those of radical prostatectomy specimens. Biopsy specimens of 97 of 100 patients who underwent radical prostatectomy between 1969 and 1979 were reevaluated. In 43% of the cases, perineal punch biopsy revealed a uniform architectural pattern, which was classified as well-differentiated adenocarcinoma in 21 cases and poorly differentiated adenocarcinoma in 22 cases. However, of the 21 cases determined by biopsy to be uniformly well-differentiated adenocarcinomas, only seven (33.3%) were confirmed by evaluation of the radical prostatectomy specimens. A uniform, poorly differentiated adenocarcinoma was ultimately found in only five operative specimens of the 22 patients with this preoperative diagnosis. As one case clearly demonstrated, multifocal origin of carcinoma of the prostate is the main source of the frequently occurring error encountered with perineal punch biopsy in determining the grade of differentiation.     

Accuracy of diagnostic imaging as determined by delayed operative intervention for advanced neuroblastoma

Current treatment of newly diagnosed widespread neuroblastoma may include chemotherapy, delayed surgical resection, marrow ablative chemoradiotherapy, and bone marrow transplantation. Diagnostic imaging (DI) with computerized tomography (CT) or magnetic resonance imaging (MRI) has been used to determine response to therapy and timing of delayed resection. We assessed the accuracy of DI in 25 patients (26 total cases) treated over 21 months. Tumor size and location were estimated prior to surgical resection by DI, and the sensitivity and specificity of these studies were determined from operative findings. DI consisted of CT (15), MRI (8), and MRI and CT (3). Discordance between DI and operative findings was found in ten patients (38%). This included three errors of sensitivity (12%), including two false-positives and one false-negative. Seven errors of specificity were noted; they included a positive scan with no viable tumor identified (3), much more extensive disease (3), or less extensive disease (1). Viable tumor was identified in 18 cases, and in 11 patients, complete resection of macroscopic tumor at the primary site was carried out. Ten of 13 patients operated on within 5 months of beginning chemotherapy were rendered grossly free of neuroblastoma at the primary site after surgery. Eight of 12 patients operated on 6 months or longer after starting chemotherapy were rendered grossly free of tumor at the primary site. Bone marrow transplantation was performed in 21 patients, ten of whom are alive with a median follow up of 20 months. Survival was similar for patients who underwent surgical resection at less than or equal to 5 v greater than 6 months after starting chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Nuclear magnetic resonance imaging: its diagnostic value in patients with congenital vascular malformations of the limbs

Congenital vascular malformations (CVMs) of the limb include simple and cavernous hemangiomas, microarteriovenous and macroarteriovenous fistulas, venous angiomas, and mixed CVMs. In differentiating these lesions, Doppler waveform analysis, labeled microsphere studies, arteriography, closed-space phlebography, and contrast-enhanced CT scans have all been advocated, but each has significant limitations. This article evaluates the ability of magnetic resonance imaging (MRI) in characterizing CVMs. Limb CVMs were evaluated by MRI in eight patients: four in the upper and four in the lower extremity. Before MRI, seven of the patients had arteriography, five had phlebography, and five had Doppler waveform analysis. MRI showed a highly cellular network with little arteriovenous flow in five patients. In four of these, arteriography and phlebography confirmed the presence of a predominantly venous or microfistulous anomaly. In the other three patients, MRI demonstrated high-flow arterial and venous channels and were confirmed by arteriography to have macrofistulous arteriovenous malformations. In all eight patients, MRI revealed the anatomic location and the longitudinal and transverse extent of the vascular malformation as well as their relationships with contiguous muscle groups, bones, and vessels. We conclude that CVMs of the limbs can be characterized accurately with MRI, with the anatomic extent, degree of cellularity, and flow characteristics readily gauged. Because MRI provides the same basic information supplied by angiography and the noninvasive laboratory and assesses anatomic extent and cellularity, it serves well as the primary diagnostic test for suspected CVMs, particularly in infants and children in whom competitive tests pose additional limitations.     

肝内门静脉周围间隙增宽的CT诊断及临床意义

目的探讨肝内门静脉间隙增宽的CT表现及其常见相关疾病。方法回顾性分析16例肝内门静脉间隙增宽患者的CT及临床资料,总结门静脉间隙增宽的CT表现、分布特点及相关基础疾病类型。结果肝内门静脉间隙增宽表现为增强扫描门脉期门静脉左右支及其分支周围低密度影,肝左叶及有叶门静脉后支周围表现为“轨道征”,右叶门静脉前支周围表现为“晕环征”。16例门静脉间隙增宽中慢性活动性肝炎6例,心功能不全5例,外伤2例,晚期胃癌化疗后1例,骨髓移植术后1例,尿毒症1例。结论肝内门静脉间隙增宽可见于多种疾病,其表现及分布特点具有特征性,是一种重要的CT征象。     

Clinical manifestations of aqueductal stenosis in adults.

The authors review 17 cases of aqueductal stenosis in adults and describe five modes of clinical presentation. The average duration of symptoms was 6 years. Dementia was infrequent. Skull x-ray films frequently demonstrated some degree of cranial enlargement and signs of chronic increased intracranial pressure. Characteristic alterations of the sella included elongation of the anterior wall and flattening, erosion, and anterior displacement of the dorsum. Aqueductal configurations as defined by ventriculography and pneumoencephalography in all cases, and the angiographic findings in seven cases are described. Most of the patients improved substantially after shunt insertion. The clinical findings suggested that aqueductal narrowing and associated hydrocephalus had been present in most of these patients since early life.