儿童嗜酸性膀胱炎的临床及CT表现

目的分析儿童嗜酸性膀胱炎的临床及CT表现。方法对9例经病理证实的儿童嗜酸性膀胱炎（7例）及嗜酸性肉芽肿性膀胱炎（2例）的临床及CT表现进行研究。结果临床上均伴有血尿、膀胱刺激征、排尿困难和腹痛等症状。影像学上，4例表现为膀胱壁结节状或局限性增厚。其中2例为嗜酸性肉芽肿性膀胱炎，其余5例表现为膀胱壁弥漫性不均匀增厚。结论 嗜酸性膀胱炎的影像学及临床表现与膀胱肿瘤易于混淆，病变的活检定性对于作出正确诊断及制定相应治疗方案是必不可少的步骤。     

儿童嗜酸性膀胱炎的临床及CT表现

目的 探讨儿童嗜酸性膀胱炎的临床及CT表现。资料与方法 对4例经病理证实的儿童嗜酸性膀胱炎的临床及CT表现进行回顾性研究。结果 4例嗜酸性膀胱炎，2例表现为膀胱壁弥漫性不均匀增厚，2例为局限性结节状膀胱壁增厚。结论 嗜酸性膀胱炎的CT及临床表现与膀胱肿瘤易于混淆，病变的活检定性对于作出正确诊断及制定相应治疗方案是必不可少的步骤。     

Eosinophilic cystitis associated with eosinophilic enterocolitis: case reports and review of the literature

We report three cases of eosinophilic cystitis. Contrast-enhanced computed tomography (CT) revealed characteristic bladder wall thickening exceeding 10 mm, with preservation of the mucosal lining and intense, progressive contrast enhancement on sequential arterial and delayed scans. Eosinophilic cystitis might have been associated with eosinophilic infiltration in other organs, such as the gastrointestinal tracts and liver.Eosinophilic cystitis is a relatively rare form of bladder inflammation that affects both children and adults. Since Palubinskas [1] and Brown [2] first reported this condition independently in 1960, many additional cases in both adults and children have been described [3–5]. To our knowledge, however, eosinophilic cystitis that is associated with eosinophilic disease of the gastrointestinal tract is rare [1, 6]. We report three cases of eosinophilic cystitis associated with eosinophilic enterocolitis in whom no specific cause could be found and review the literature.     

Emphysematous cystitis in a patient presenting with paradoxical arterial embolism and intestinal mycobacteriosis without evidence of diabetes

We describe the case of a 72-year-old woman who displayed massive multiple intramural gas collections of the bladder wall as an incidental finding on CT. The patient presented with critical ischemia of the left leg caused by paradoxical arterial embolism, raised corpuscular sedimentation rate, anemia by gastrointestinal blood loss, hypoproteinemia, diarrhea, malabsorption, and exudative enteropathia caused by mycobacterial ileocolitis. The patient had no dysuria and there was no evidence of diabetes. The intramural gas collections of the bladder wall, as shown by CT, were compatible with emphysematous cystitis. Urine samples proved infection by a multi-resistant strain of E. coli. Emphysematous cystitis is a rare form of bladder infection that can be diagnosed by plain-film radiograms or CT. Received: 25 February 2000/Revised: 22 June 2000/Accepted: 28 June 2000     

Three-Dimensional Ultrasound-Based Navigation Combined with Preoperative CT During Abdominal Interventions: A Feasibility Study

Purpose: Three-dimensional (3D) intraoperative ultrasound may be easier to interpret when used in combination with less noisy preoperative image data such as CT. The purpose of this study was to evaluate the use of preoperative image data in a 3D ultrasound-based navigation system specially designed for minimally invasive abdominal surgery. A prototype system has been tested in patients with aortic aneurysms undergoing clinical assessment before and after abdominal aortic stent-graft implantation. Methods: All patients were first imaged by spiral CT followed by 3D ultrasound scanning. The CT volume was registered to the patient using fiducial markers. This enabled us to compare corresponding slices from 3D ultrasound and CT volumes. The accuracy of the patient registration was evaluated both using the external fiducial markers (artificial landmarks glued on the patients skin) and using intraoperative 3D ultrasound as a measure of the true positioning of anatomic landmarks inside the body. Results: The mean registration accuracy on the surface was found to be 7.1 mm, but increased to 13.0 mm for specific landmarks inside the body. CT and ultrasound gave supplementary information of surrounding structures and position of the patients anatomy. Fine-tuning the initial patient registration of the CT data with a multimodal CT to intraoperative 3D ultrasound registration (e.g., mutual information), as well as ensuring no movements between this registration and image guidance, may improve the registration accuracy. Conclusion: Preoperative CT in combination with 3D ultrasound might be helpful for guiding minimal invasive abdominal interventions.     

3D-CT cystography of submucosal elevated lesion of the bladder: report of two cases

We report 2 cases of rare inflammatory disease of the bladder arising from the bladder submucosa: eosinophilic cystitis in a 33-year-old woman and inflammatory pseudotumor of the bladder in a 41-year-old man. 3D-CT cystography demonstrated submucosal tumorous lesions clearly and enabled the evaluation of mucosae of lesions especially showed the bridging fold-like appearance of the submucosal tumorous lesion in eosinophilic cystitis.     

Reinterpretation of radiological imaging in patients referred to a tertiary referral centre with a suspected pancreatic or hepatobiliary malignancy: impact on treatment strategy

Our objective was to determine the clinical importance of reinterpretation of radiological investigations performed in a referring hospital and the value of additional investigations in a referral centre. A panel of four experts retrospectively evaluated the technical quality of radiological investigations and made reinterpretation reports, of 78 patients referred with a suspected pancreatic or hepatobiliary malignancy. The value of additional radiological investigations performed in the referral centre was assessed. The quality of ultrasound and CT examinations was sufficient for reinterpretation in (36 of 69) 52% and (42 of 60) 70%, respectively. The reinterpretation reports of the ultrasound investigations were scored as "in accordance" in (30 of 36) 83%, as "minor discordance" in (3 of 36) 8% and as "major discordance" in (3 of 36) 8%. For CT proportions of (29 of 42) 69%, (8 of 42) 19% and (5 of 42) 12%, respectively, were found. Additional ultrasound (n=55) showed no additional findings in 16%, minor additional findings in 53% and major additional findings in 31% of cases. For additional spiral CT scan (n=47) results were of 21, 47 and, 32%, respectively. Reinterpretation of ultrasound and CT resulted in a change in treatment strategy for 7 patients (9%). Additional ultrasound or CT resulted in a change in treatment strategy for 24 patients (30%). Improved communication and reinterpretation of radiological investigations may reduce unnecessary referral. Electronic Publication     

A new ultrasound-based method for the assessment of torsional differences following closed intramedullary nailing of femoral fractures

Objective. A torsional difference of more than 15° is found in up to 30% of patients following closed intramedullary nailing of femoral fractures. The diagnosis is usually established postoperatively by computed tomography. A torsional deformity of more than 15° should be corrected by early derotation. In order to enable an intraoperative control and possible correction to avoid a second operation for the patient, a new ultrasound-based method suitable for the intraoperative setting has been developed, using the anterior condylar line as a distal reference line. Design and patients. In a prospective study the torsional difference after closed intramedullary nailing of femoral fractures was measured postoperatively by ultrasound in 32 patients and compared with standard CT readings. Results. Torsional differences measured by ultrasound and CT showed a high correlation (r=0.8) and a median difference of less than ±3°. Conclusions. By the introduction of the anterior condylar line as a distal reference line femoral torsion can accurately be assessed by ultrasound in a position required for intraoperative control and possible correction. Received: 8 January 1999 Accepted: 2 March 1999     

The value of computed tomography and ultrasound in cases of inflammatory aneurysms of the abdominal aorta

In a retrospective study 344 CT examinations of patients with suspected aneurysms of the abdominal aorta were evaluated with respect to the inflammatory character of the aneurysm. In 207 cases surgical therapy was conducted. In 144 of those 207 cases preoperative ultrasound examination results were also available. Frequency of inflammatory aneurysms, as classified by CT, was 10.2% (35/344) and in the subgroup of surgically treated aneurysms, 14.0% (29/207). Sensitivity and specifity of CT to realise the inflammatory type of aneurysm was 86.2% and 97.2%. The respective figures for ultrasound examinations on the basis of 144 surgically treated aneurysms were 26.1% and 100%. We conclude that even in cases of sonographically unequivocal abdominal aneurysms CT should be performed because ultrasound is not sufficiently sensitive to realise an inflammatory character of the aneurysm, which can have great impact on surgical strategy. Correspondence to: E. Rinast     

Diagnosing appendicitis with CT and ultrasound using prospective patient stratification by body mass index

Purpose: To determine the accuracy of CT and ultrasonography (US) in diagnosing appendicitis in adults stratified to either modality on the basis of body mass index (BMI), a measure of body habitus. Methods: Seventy-two adults with suspected appendicitis and demonstrating atypical clinical features were prospectively stratified to either appendiceal CT or US based on BMI. Patients with BMI < 30 underwent US and with BMI ≥ 30 underwent CT. Outcomes were determined by surgery, the medical record, and clinical follow-up after 3 months. Results: Of the 72 patients enrolled, 30 (24 women and 6 men) underwent CT and 42 (35 women and 7 men) underwent US. The average BMI was 34 ± 4 among patients who had CT and 24 ± 3 among patients who had US. Of the patients who had CT scans, 4 had positive scans for appendicitis and all of these were proven at surgery to have appendicitis. The remaining 26 patients had negative CT scans for appendicitis. Twenty-two of these were subsequently proven either by surgery or clinical follow-up not to have appendicitis, while 4 were lost to follow-up. This corresponds to a sensitivity, specificity, positive predictive value, and negative predictive value of 100 %. Twelve ultrasound examinations were positive for appendicitis. Nine of these patients had appendicitis proven at surgery, 1 had a perforated Meckel's diverticulum, and 2 did not have appendicitis after clinical follow-up. Twenty-seven patients had negative ultrasound exams for appendicitis. However, 6 of these had appendicitis proven at surgery, 17 did not have appendicitis, and 4 were lost to follow-up. Three patients had ultrasound exams that were equivocal for appendicitis; of these, 1 had appendicitis and 2 did not. For US, this corresponds to a sensitivity of 60 %, specificity of 85 %, PPV of 75 %, and NPV of 74 %. Conclusion: This study suggests that CT is an accurate method of evaluating adults with suspected appendicitis who have BMI ≥ 30. Stratifying patients with BMI < 30 to US did not reproduce the results already reported in the literature.     

Fetal trauma: brain imaging in four neonates

The purpose of this paper is to describe brain pathology in neonates after major traffic trauma in utero during the third trimester. Our patient cohort consisted of four neonates born by emergency cesarean section after car accident in the third trimester of pregnancy. The median gestational age (n=4) was 36 weeks (range: 30–38). Immediate post-natal and follow-up brain imaging consisted of cranial ultrasound (n=4), computed tomography (CT) (n=1) and post-mortem magnetic resonance imaging (MRI) (n=1). Pathology findings were correlated with the imaging findings (n=3). Cranial ultrasound demonstrated a huge subarachnoidal hemorrhage (n=1), subdural hematoma (n=1), brain edema with inversion of the diastolic flow (n=1) and severe ischemic changes (n=1). In one case, CT demonstrated the presence and extension of the subarachnoidal hemorrhage, a parietal fracture and a limited intraventricular hemorrhage. Cerebellar hemorrhage and a small cerebral frontal contusion were seen on post-mortem MRI in a child with a major subarachnoidal hemorrhage on ultrasound. None of these four children survived (three children died within 2 days and one child died after 1 month). Blunt abdominal trauma during pregnancy can cause fetal cranial injury. In our cases, skull fracture, intracranial hemorrhage and hypoxic-ischemic encephalopathy were encountered.     

Eosinophilic lung diseases: diagnostic accuracy of thin-section CT in 111 patients

PURPOSE: To determine whether various eosinophilic lung diseases can be differentiated by means of thin-section computed tomography (CT). MATERIALS AND METHODS: Thin-section CT scans in 111 patients with eosinophilic lung diseases-40 with chronic eosinophilic pneumonia, 16 with Churg-Strauss syndrome, 16 with allergic bronchopulmonary aspergillosis (ABPA), 13 with acute eosinophilic pneumonia, 12 with simple pulmonary eosinophilia, 11 with drug-induced eosinophilic pneumonia, and three with hypereosinophilic syndrome-were assessed independently by two observers. The observers recorded the abnormalities, diagnosis, and degree of confidence in the diagnosis. RESULTS: The two observers made a correct first-choice diagnosis on average in 61% of readings. The correct diagnosis was made in 78% of cases of chronic eosinophilic pneumonia; 81%, acute eosinophilic pneumonia; 44%, Churg-Strauss syndrome; 84%, ABPA; 17%, simple pulmonary eosinophilia; 27%, drug-induced eosinophilic pneumonia; and 33%, hypereosinophilic syndrome. The two observers made a correct diagnosis with a high degree of confidence in 36% of readings. There was moderate agreement between the observers for the correct diagnosis (kappa, 0.47) and for the correct diagnosis with a high degree of confidence (kappa, 0.59). CONCLUSION: Although eosinophilic lung diseases often can be differentiated by means of thin-section CT, correlation between CT findings and careful clinical evaluation are required for a definitive diagnosis.     

Predicting Infected Bile Among Patients Undergoing Percutaneous Cholecystostomy

Purpose Patients may not achieve a clinical benefit after percutaneous cholecystostomy due to the inherent difficulty in identifying patients who truly have infected gallbladders. We attempted to identify imaging and biochemical parameters which would help to predict which patients have infected gallbladders.Methods A retrospective review was performed of 52 patients undergoing percutaneous cholecystostomy for clinical suspicion of acute cholecystitis in whom bile culture results were available. Multiple imaging and biochemical variables were examined alone and in combination as predictors of infected bile, using logistic regression.Results Of the 52 patients, 25 (48%) had infected bile. Organisms cultured included Enterococcus, Enterobacter, Klebsiella, Pseudomonas, E. coli, Citrobacter and Candida. No biochemical parameters were significantly predictive of infected bile; white blood cell count >15,000 was weakly associated with greater odds of infected bile (odds ratio 2.0, p=NS). The presence of gallstones, sludge, gallbladder wall thickening and pericholecystic fluid by ultrasound or CT were not predictive of infected bile, alone or in combination, although a trend was observed among patients with CT findings of acute cholecystitis toward a higher 30-day mortality. Radionuclide scans were performed in 31% of patients; all were positive and 66% of these patients had infected bile. Since no patient who underwent a radionuclide scan had a negative study, this variable could not be entered into the regression model due to collinearity.Conclusion No single CT or ultrasound imaging variable was predictive of infected bile, and only a weak association of white blood cell count with infected bile was seen. No other biochemical parameters had any association with infected bile. The ability of radionuclide scanning to predict infected bile was higher than that of ultrasound or CT. This study illustrates the continued challenge to identify bact-erial cholecystitis among patients referred for percutaneous cholecystostomy.     

Diffuse liver disease: MRI with Gd-DTPA versus CT and ultrasound

Twenty-nine patients with diffuse liver disease were examined by ultrasound, CT and MRI. MRI was performed using T1- and T2-weighted spin-echo sequences as well as fast gradient-echo-sequences. The paramagnetic contrast agent Gd-DTPA was applied intravenously (0.1 mmol/kg). in patients with hepatitis, MRI could be used in guiding liver biopsies as inflammatory changes were clearly delineated. CT and ultrasound were superior to MRI in the detection of focal or diffuse fatty degeneration. On the other hand MRI was more helpful in differentiating fatty changes and neoplasm. In liver cirrhosis, fibrotic changes were most clearly demonstrated by MRI. In patients suffering from hemochromatosis MRI offers advantages over CT and ultrasound in the diagnosis and follow up due to the paramagnetic properties of iron, resulting in a reduction in signal intensity. In patients with Wilson's disease a characteristic pattern of parenchymal changes was seen. Administration of Gd- DTPA contributes additional information about perfusion conditions in the liver parenchyma, however this information was not of diagnostic relevance in the cases we studied. Correspondence to: T.J. Vogl     

Comparison of computed tomography findings between bacteremic and non-bacteremic acute pyelonephritis due to Escherichia coli

AIM:To identify computed tomography(CT)findings that are associated with the presence of bacteremia in patients with acute pyelonephritis(APN)due to Escherichia coli(E.coli).METHODS:The clinical data and contrast-enhanced CT findings of 128 patients who were diagnosed with APN due to E.coli and showed renal abnormality on contrast-enhanced CT between January 2003 and November 2013 were retrospectively reviewed.The patients were divided into two groups according to the presence of bacteremia:The bacteremia group and the non-bacteremia group.The abnormality on contrast-enhanced CT were categorized into 5 renal and 4 extrarenal CT findings and compared between the two groups using the χ~2 test and multivariate logistic regression.RESULTS:Among the 128 patients,34 patients(26.6%)were classified into the bacteremia group and 94 patients(73.4%)into the non-bacteremia group.There was no statistically significant difference in gender between the two groups(P = 0.09),but the age of thepatients in the bacteremia group was higher than that of the patients in the non-bacteremia group(P < 0.01).Compared to the non-bacteremia group,1 renal CT finding such as urothelial thickening and 3 extrarenal CT findings such as diffuse peritoneal thickening,cystitis and pulmonary congestion were more frequently observed in the bacteremia group with statistical significance.The logistic regression analysis revealed that CT findings,including urothelial thickening,diffuse peritoneal thickening,cystitis and pulmonary congestion were suggested as the predictive CT findings of bacteremic APN.CONCLUSION:On CT,urothelial thickening,diffuse peritoneal thickening,cystitis,and pulmonary congestion are more frequently observed in patients with bacteremic APN due to E.coli.     

腺性膀胱炎的CT诊断

目的 探讨腺性膀胱炎的CT表现及鉴别诊断要点。材料与方法 搜集7例经病理证实的腺性膀胱炎的CT资料,全部病例均作CT平扫及增强检查,结果 CT能清晰明示腺性膀胱炎病变的大小、形态、密度及膀胱周围组织情况。腺性膀胱炎病变范围可比较局限,部分伴有囊变且病灶增强效果不明显。结论 腺性膀胱炎在CT图像上有某些特征性表现并能与膀胱癌作鉴别诊断。CT对腺性膀胱炎有较高诊断价值。     

Comparison of CT,MRI and FDG-PET in response prediction of patients with locally advanced rectal cancer after multimodal preoperative therapy: Is there a benefit in using functional imaging?

The aim of this study was to compare CT, MRI and FDG-PET in the prediction of outcome of neoadjuvant radiochemotherapy in patients with locally advanced primary rectal cancer. A total of 23 patients with T3/4 rectal cancer underwent a preoperative radiochemotherapy combined with regional hyperthermia. Staging was performed using four-slice CT (n=23), 1.5-T MRI (n=10), and ¹⁸F-FDG-PET (n=23) before and 2–4 weeks after completion of neoadjuvant treatment. Response criteria were a change in T category and tumour volume for CT and MRI and a change in glucose uptake (standard uptake value) within the tumour for FDG-PET. Imaging results were compared with those of pretherapy endorectal ultrasound and histopathological findings. Histopathology showed a response to neoadjuvant therapy in 13 patients whereas 10 patients were classified as nonresponders. The mean SUV reduction in responders (60±14%) was significantly higher than in nonresponders (37±31%; P=0.030). The sensitivity and specificity of FDG-PET in identifying response was 100% (CT 54%, MRI 71%) and 60% (CT 80%, MRT 67%). Positive and negative predictive values were 77% (CT 78%, MRI 83%) and 100% (CT 57%, MRI 50%) (PET P=0.002, CT P=0.197, MRI P=0.500). These results suggest that FDG-PET is superior to CT and MRI in predicting response to preoperative multimodal treatment of locally advanced primary rectal cancer.     

A case of malignant fibrous histiocytoma of the pancreas: computed tomography (CT) and ultrasound (US) appearance

The case of a 50-year-old female with a malignant fibrous histiocytoma of the pancreas is presented. This was diagnosed pre-operatively on ultrasound and computed tomography (CT).The lesion encircled the body and tail of the pancreas and appeared as a large inhomogeneous mass with polycyclic and well-defined margins. Contrast-enhanced CT examination showed marked but inhomogenous enhancement. the tomodensitometric characteristics plus the lack of lymphnodal or hepatic metastases indicated the sarcomatous nature of the mass before the surgical approach. Correspondence to: A. Vidiri     

腺性膀胱炎的超声诊断及分型价值探讨

目的：探讨彩色多普勒超声对腺性膀胱炎的诊断及其分型的价值。方法：回顾性分析经膀胱镜或手术病理证实的58例腺性膀胱炎的声像图表现,从病灶范围、部位、内部回声等指标做综合分析。结果-58例腺性膀胱炎声像图表现分为四种类型：草坪状增厚型,本组35例,占60．34％;结节隆起型,本组10例,占17．24％;弥漫增厚型,本组9例,占15．51％;混合型,本组4例,占6．89％。经与手术病理对照,超声定位诊断符合率为100％,定性诊断符合率为89．66％。结论：腺性膀胱炎声像图有其特征性表现,超声检查应为其诊断的首选检查方法。     

腺性膀胱炎的临床与多层螺旋CT表现

目的 探讨腺性膀胱炎的临床和CT诊断特点. 方法 对12例经膀胱镜及病理确诊为腺性膀胱炎患者的临床、膀胱镜和CT表现进行回顾性分析,并复习相关文献. 结果 12例患者的临床表现为血尿8例,尿频、尿急和尿痛3例,排尿困难1例.病变好发于膀胱三角区、颈部和输尿管开口周围.其中3例CT检查未见异常,膀胱壁局限增厚7例,其范围约为1.6～5.5 cm,另1例表现为膀胱壁广泛增厚.平扫病灶为等密度,增强后仅轻度强化,CT值平均增加13.1 HU.结论 腺性膀胱炎的CT表现具有一定特征,但CT检查无异常者不能排除腺性膀胱炎的诊断.