盆腔淋巴囊肿的CT诊断

目的 分析盆腔淋巴囊肿的CT表现,探讨其形态学特征,并评价CT对盆腔淋巴囊肿的诊断价值.方法 收集盆腔恶性肿瘤术后发生盆腔淋巴囊肿的患者19例,所有病例均经穿刺或手术病理证实,回顾性分析其CT表现,并探讨其诊断价值.结果 19例患者共发现淋巴囊肿27个,病变发生在左侧盆腔9例,右侧3例,两侧均发生7例.27个病变发生在髂外血管旁17例(23个病变),髂内血管旁3例(4个病变),1例病变同时发生于髂内、外.CT表现为圆形、类圆形或管状水样密度影,囊壁薄而均匀,边界清,增强后囊肿壁轻度强化.囊肿直径1.8~5.0 cm,平均大小2.7 cm×2.1 cm,CT值4~40 HU,平均约24 HU.结论 CT能清楚显示盆腔淋巴囊肿的形态学特征,熟悉这些特征并结合病史对诊断及鉴别诊断有重要意义.     

妇科恶性肿瘤术后盆腔淋巴囊肿的CT、MRI诊断

目的 研究盆腔淋巴囊肿的影像特征.方法 回顾性分析经穿刺化验及临床随访证实的51例共68个淋巴囊肿的CT及MRI临床及影像资料.结果 68个囊肿均位于盆腹膜外髂血管旁,其中95.6％(65/68)位于髂外血管周围.位于髂外血管前缘或后缘及髂内血管前缘的囊肿98.0％(51/52)呈卵圆形,且位于髂外血管前缘者33.3％(13/39)见“桃尖征”.骑跨髂外血管内侧缘或外侧缘的多呈葫芦形、哑铃形、肾形、U形联通管状.囊肿边缘光滑清晰,囊液为水样密度或信号.CT增强囊壁轻度强化,囊壁显示欠清;MRI增强囊壁及囊内分隔呈中等度强化,囊壁均匀光滑,囊内容物无强化.结论 CT及MRI能清晰显示盆腔淋巴囊肿分布特点、形态学特征、典型的密度、信号及强化表现,结合妇科恶性肿瘤手术病史可对盆腔淋巴囊肿做出正确诊断.     

盆腔淋巴结清扫术后淋巴囊肿的CT诊断与临床价值

目的:探讨盆腔淋巴结清扫术后淋巴囊肿的CT诊断价值与临床应用价值.方法:回顾性分析12例CT及临床资料完整的淋巴囊肿病例,其中8例经穿刺或手术病理证实,4例为临床诊断.结果:12例共计囊肿20个,大小1.0cm×1.0cm～2.0cm×7.0cm,类圆形 13个,管状5个,葫芦状2个.CT表现为典型的囊肿征象,19个囊肿沿盆壁分布,并与髂外动脉、髂外静脉伴随走行,1例位于盆腔左前方.结论:淋巴囊肿具有囊肿典型的CT表现,其形态学特征、沿盆壁分布、伴随髂外动静脉走行的特点,具有重要的诊断价值及临床应用价值.     

椎管内肠源性囊肿的MRI诊断与鉴别诊断

目的 探讨椎管内肠源性囊肿的MRI特征性表现及其诊断和鉴别诊断的价值.资料与方法 回顾性分析14例经手术病理证实的椎管内肠源性囊肿的临床和MRI资料.所有病例均行MRI平扫,6例行MRI增强扫描.结果 11例位于髓外硬膜下,3例位于脊髓内.除1例表现为短T1、长T2信号,1例表现为等T1、长T2信号外,余12例病变平扫均表现为稍长或长T1、长T2信号,其中1l例信号均匀,l例信号不均.6例增强扫描,4例无强化,2例囊壁轻度强化.结论 MRI能够清晰显示椎管内肠源性囊肿的病变部位、大小、形态、信号强度等特征,对其诊断和鉴别诊断具有重要价值.     

海绵窦海绵状血管瘤的MRI诊断

目的 探讨海绵窦海绵状血管瘤的MRI表现,以提高诊断正确率.方法 收集经手术病理证实的海绵窦海绵状血管瘤9例,全部病例均行头颅MRI平扫及增强扫描.结果 MRI扫描病灶形态呈哑铃状或类圆形,边界清楚,T1WI 6例呈脑灰质信号,3例稍低于脑灰质信号,T2WI 9例均呈类似于脑脊液的均匀极高信号,T1WI增强扫描均匀显著强化8例,不均匀强化1例.结论 MRI对海绵窦海绵状血管瘤的诊断有重要价值.     

颅内海绵状血管瘤的CT和MRI诊断

目的:探讨脑内与脑外海绵状血管瘤的CT和MRI表现及诊断价值.方法:搜集45例颅内海绵状血管瘤的CT和MRI影像资料进行分析,MRI检查45例,CT检查30例,其中脑内型海绵状血管瘤42例,脑外型海绵状血管瘤3例,均经手术病理证实.结果:脑内型海绵状血管瘤可位于脑内任何部位,单发病灶多见,无明显占位效应,周围无或轻度水肿.CT检查的全部病例呈稍高及混杂密度影27例,增强扫描大都无强化;MRI检查T2 WI表现为"桑葚状"混杂高信号,周围有云絮状低信号环,增强后病灶仅少数轻度强化.脑外型病灶位于中颅窝鞍旁,MRI呈类似哑铃形或类圆形较均匀的稍长T1明显长T2信号,增强扫描呈明显均匀强化.结论:脑内与脑外型海绵状血管瘤的CT和MRI表现具有一定特征,MRI优于CT像,特别是MRI的T2 WI像有助于明确诊断.     

小儿肝母细胞瘤的CT、MRI诊断及其临床应用价值

目的提高对小儿肝母细胞瘤(HB)CT、MRI表现的认识和诊断水平,评价其临床应用价值.材料和方法37例经手术病理证实的HB,行CT/MRI检查并分析其表现.结果CT表现29例表现为单发类圆形低密度肿块、26例边界清、16例包膜完整、7例可见钙化和瘤内出血6例,增强扫描不均匀增强.MRI表现20例表现为光滑类圆形肿块、T1WI呈低信号、T2WI呈高信号,5例瘤内出血,T1WI、T2WI均为高信号.结论小儿 HB的CT、MRI表现有特征性,对其早期诊断和预后判定具有重要价值.     

儿童腹部钝性损伤致十二指肠肠壁血肿CT和MRI表现

目的探讨儿童腹部钝性损伤十二指肠致肠壁血肿CT和MRI特征。方法回顾性分析经手术或临床证实的8例十二指肠壁血肿CT和MRI资料。结果病灶均单发,肠腔内7例,肠腔外1例,呈管状型或类圆形,边缘清楚6例,模糊2例,位于单一肠段4例,多个肠段4例。CT扫描病灶呈等高密度包块,密度不均匀,典型者可见"融冰征"和(或)"空气裂隙征";MRI扫描病灶T1WI呈稍高或混杂信号,T2WI呈低或等高信号,增强扫描病灶内均无强化,其中血肿壁强化3例。结论儿童腹部钝性损伤致十二指肠肠壁血肿影像学表现特殊,CT、MRI平扫及增强扫描检查对病灶的显示具有优越性,有助于肠壁血肿的早期诊断和治疗。     

MRI analysis of tumor-like encephalitis

目的:探讨肿瘤样脑炎的MRI表现.方法:回顾性分析本院10例肿瘤样脑炎患者的MRI资料,所有病例均行MRI平扫及增强检查.结果:肿瘤样脑炎平扫呈长T1、长T2不均匀信号,边界欠清晰,周围有水肿带,灰白质同时受累,占位征象较轻.增强扫描4例呈单发结节或环形伴核心样明显强化,6例为单发或多发偏心结节状明显强化,有5例(5/10)伴邻近脑膜线状强化、其中2例(2/10)同时有脑回状强化.结论:肿瘤样脑炎MRI平扫表现缺乏特征性,增强扫描表现有一定特征性,充分认识其MRI表现并结合临床对肿瘤样脑炎的诊断及鉴别诊断有重要意义.     

髂腰肌囊扩张的MRI诊断

目的探讨髂腰肌囊扩张的MRI表现特征。方法回顾性分析经B超导引下穿刺抽吸和/或经手术病理或临床随访证实的具有典型MRI表现的13例髂腰肌囊扩张病人的MRI表现。结果13例扩张髂腰肌囊均发生于单侧,右侧5例,左侧8例,出现于全部或部分髋臼层面上,上下范围最大径线约为7.0cm。为圆形、卵圆形、倒水滴状或不规则分房状囊性肿物,位于髋关节囊前方,髂外或股动静脉外后方和髂腰肌(腱)内侧。MRT1WI呈低、等信号,T2WI呈水样高信号,T2WI+脂肪抑制呈明显高信号,平扫囊壁难以辨认。5例做增强扫描,3例囊壁呈线样均匀轻-中度强化,1例囊壁未见强化,1例呈厚薄不均不规则明显分房状强化,为单纯性化脓性滑膜炎病人。13例中,2例为单纯性滑膜炎症,11例伴髋关节病变。结论MRI对髂腰肌囊扩张的诊断具有重要意义。     

Deep pelvic endometriosis: accuracy of pelvic MRI completed by MR colonography

Purpose

This study assessed the diagnostic accuracy of pelvic magnetic resonance (MR) imaging completed by MR colonography for the preoperative evaluation of deep pelvic endometriosis in patients undergoing laparoscopic surgery.

Materials and methods

A total of 143 patients (mean age 34.3±5.1 years) with a clinical suspicion of deep pelvic endometriosis were assessed by pelvic MR and MR colonography. All patients underwent laparoscopic surgery 3–10 weeks after the MR examination. The presence, location, number and extent of endometriotic lesions were evaluated. Data obtained with MR were compared with surgical findings. MR sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and diagnostic accuracy values were calculated for each site by considering the laparoscopic and histological findings as the reference standard.

Results

Laparoscopy confirmed the presence of endometriosis in 119/143 patients (83%); in 76/119 (64%) deep pelvic endometriosis was diagnosed, whereas in the remaining 43/119 (36%), superficial peritoneal implants and endometriomas were found. In 32/119 (27%) patients, intestinal lesions were detected. MR had sensitivity, specificity, PPV, NPV and diagnostic accuracy values of 67–100%, 85–100%, 83–100%, 84–100% and 84–100%, respectively, in recognising lesions located in different pelvic sites.

Conslucions

MR imaging combined with colonography is a highly accurate tool for characterising deep endometriotic lesions in patients scheduled for laparoscopic surgery. In particular, MR colonography has very high accuracy in detecting colorectal involvement.     

CT of pelvic fractures

Although magnetic resonance imaging has become the dominant modality for cross-sectional musculo-skeletal imaging, the widespread availability, speed, and versatility of computed tomography (CT) continue to make it a mainstay of emergency room (ER) diagnostic imaging. Pelvic ring and acetabular fractures occur as the result of significant trauma secondary to either a motor vehicle accident or a high-velocity fall. These injuries are correlated with significant morbidity and mortality, both from the complications of pelvic ring fractures and from commonly associated injuries. The most commonly used classification of pelvic and acetabular fractures has been based on conventional radiographs that are, in the majority of cases, sufficient to determine the type of injury. However, because of the complexity of pelvic and acetabular fractures, precise pathological anatomy is not easily demonstrated by routine radiographs and in many cases details of fractures are not visible. Moreover, the insufficient co-operation of the patient or the difficulty of maintaining special positions can be overcome by using computed tomography. Spiral computed tomography provides information regarding the extent of the fractures and is complementary to radiography for ascertaining the spatial arrangement of fracture fragments. Spiral computed tomography is an effective tool for understanding complex fracture patterns, particularly when combined with multi-planar reconstruction two-dimensional (MPR 2D) reformatted images or three-dimensional images (3D) images. Including these techniques of reconstruction in routine pelvic imaging protocols can change management in a significant number of cases. Subtle fractures, particularly those oriented in the axial plane, are better seen on MPR images or 3D volume-rendered images. Complex injuries can be better demonstrated with 3D volume-rendered images, and complicated spatial information about the relative positions of fracture fragments can be easily demonstrated to the orthopaedic surgeons. The use of intravenous (i.v.) contrast material allows simultaneous evaluation of osseous and vascular structures within the affected area. Postoperative studies in patients with orthopaedic hardware also benefit from volume-rendered imaging. Volume rendering eliminates most streak artifact and produces high-quality images on which the relationships among hardware, bones, and bone fragments are well demonstrated.     

Emergent postpartum pelvic sonography

This article describes the variable appearance of the normal postpartum uterus and reviews complications which can occur in the postpartum period, with particular emphasis on the sonographic findings. Postpartum complications are a common presentation to the emergency department. The majority of these patients present with secondary postpartum hemorrhage. Additional symptoms of pain or clinical findings of pyrexia and leukocytosis confound the clinical scenario and necessitate further evaluation with imaging. Ultrasonography is the mainstay in the initial imaging evaluation of the postpartum patient, with occasional progression to CT, MR, or angiography. We sought to provide a brief review of the literature, with pictorial review of key imaging findings, with a focus on ultrasonography. We provide a pictorial and brief literature review, with case examples from our institution, of key postpartum complications. Ultrasonography is an important component of evaluation in postpartum patients, particularly those with hemorrhage or other complication.