肌肉血管瘤的X线诊断：附100例分析

作者复习了１３年来诊治的肌肉血管瘤１００例，发现海绵状血管瘤８９例，蔓状血管瘤１１例。描述了两种血管瘤Ｘ线表现特点，讨论了海绵状血管瘤和蔓状血管瘤的正确概念。提出了不同的血管瘤应选择不同的造影方法。肯定了Ｘ线检查是诊断肌肉血管瘤的主要手段，并对手术治疗帮助很大。     

磁敏感加权成像对四肢软组织海绵状血管瘤临床应用初探

目的:探讨磁敏感加权成像在四肢软组织海绵状血管瘤的影像学表现特征及其应用价值。方法:分析11例经手术及病理证实的四肢软组织海绵状血管瘤常规MR表现及SWI表现。结果:MR表现分为:①局限肿块型7例,T1WI呈等或稍高信号,4例T2WI呈高信号;3例T2WI呈高、低混杂信号;②弥漫蔓藤型4例,T1WI呈等或稍高信号,T2WI及T2WI脂肪抑制呈高信号或高、低混杂信号。SWI表现:①肿瘤显示:4例局限肿块型呈较均匀稍高信号,3例局限肿块型及4例弥漫蔓藤型呈混杂信号或低信号为主,其间混杂条索状高信号;②静脉引流血管显示:4例局限肿块型为低回流型,3例局限肿块型及4例弥漫蔓藤型为高回流型;③肿瘤钙化与出血的鉴别:5例肿瘤钙化相位图以低信号为主,周边环以高信号;7例出血灶信号与之相反。结论:SWI序列可以客观的反映软组织海绵状血管瘤的构成成分,较常规序列可以提供更多的信息,为临床诊断及治疗方案的选择提供有重要的价值。     

FDG PET for giant cavernous hemangioma: important clue to differentiate from a malignant vascular tumor in the liver

Giant cavernous hemangioma of the liver sometimes has a very inhomogeneous appearance with intratumoral degeneration on computed tomography or magnetic resonance imaging, and may mimic a malignant hepatic tumor, including angiosarcoma. There are many reports about F-18 fluorodeoxyglucose (FDG) uptake of angiosarcoma; however, knowledge regarding positron emission tomography findings with FDG for giant hepatic cavernous hemangioma is still limited. We herein present 2 cases of giant hepatic cavernous hemangioma in which low FDG uptake was considered helpful to differentiate from malignant hepatic tumor.     

Diagnosis of coexistent hepatic tumors of different kinds: a challenge from CT and MR imaging

Three cases of multiple, different liver tumors in the same patient were examined with CT and MR imaging. Two patients with coexistent hepatocellular carcinoma and cavernous hemangioma were correctly diagnosed by the following characteristic findings on dynamic CT and/or MR images; spreading and markedly prolonged enhancement in cavernous hemangioma, and the presence of capsule and/or transient diffuse enhancement in hepatocellular carcinoma. The third case of hepatocellular carcinoma and cholangiocarcinoma showed typical findings of hepatocellular carcinoma in one tumor and unusual complex enhancement in the other. CT and MR imaging may enable correct diagnosis to be made even in patients with multiple liver tumors of different kinds.     

Congenital fistula from ectopic accessory parotid gland: diagnosis with CT sialography and CT fistulography.

We report a case of congenital fistula from ectopic accessory parotid gland to the cheek demonstrated by CT sialography and CT fistulography. The right parotid gland was abnormally located lateral to masseter muscle. The fistula was arising from an ectopic accessory parotid gland with ectopic duct positioned anterior to masseter muscle. CT sialography and CT fistulography were very helpful in the diagnosis and surgical planning.     

Extracerebral cavernous hemangioma of the cavernous sinus: diagnosis with MR imaging and labeled red cell blood pool scintigraphy

We present the case of a 64-year-old man with a presumed diagnosis of extracerebral cavernous hemangioma involving the cavernous sinus. The diagnosis was made on the basis of labeled red cell blood pool scintigraphy findings in conjunction with those of MR imaging. This lesion was not altered in appearance at 6-year follow-up MR imaging. We also present the labeled red cell blood pool scintigraphy findings obtained in three other patients with similar-appearing cavernous sinus lesions at MR imaging who underwent subsequent biopsy; histologic findings confirmed chondrosarcoma, chordoma, and meningioma, respectively.     

小角度激发快速梯度回波序列在脑内海绵状血管瘤诊断中的价值

目的探讨小角度激发快速梯度回波（fast low angle shot,FLASH）序列成像在脑内海绵状血管瘤诊断中的应用价值。方法搜集并分析14例脑内海绵状血管瘤患者影像资料,MR检查包括进行常规自旋回波T1WI（SE-T1WI）、快速自旋回波T2WI（FSE-T2WI）、液体衰减翻转恢复（FLAIR）序列、FLASH序列及Gd-DTPA增强扫描,将FLASH图像与常规序列图像进行对比。结果 14例海绵状血管瘤中,常规序列显示病灶21个,FLASH显示35个,明显多于常规序列,且显示更清楚。结论 FLASH序列成像对脑内海绵状血管瘤检出有高度敏感性,在脑内海绵状血管瘤的诊断中有重要价值。     

眼眶海绵状血管瘤的影像学表现及其意义

目的 研究眼眶海绵状血管瘤的ＣＴ和ＭＲＩ征象,并着重探讨海绵状血管瘤的特异性征象即“渐进性强化”,及其在诊断和鉴别诊断海绵状血管瘤中的价值。方法 对经手术病理证实的眼眶海绵状血管瘤５８例进行回顾性分析。所有病例均行Ｂ超检查,其中ＣＴ检查４８例,ＣＴ增强扫描４３例,动态增强扫描１０例;ＭＲＩ检查２７例,动态增强扫描２４例。结果 ＣＴ增强后３６例（８３．７％）显示不同程度的片状强化,１０例ＣＴ动态增强     

The masseter: an enigmatic muscle]

PURPOSE: To try and explain the frequency of pathologic processes involving the masseter muscle. MATERIALS AND METHODS: Anatomical and histological evaluation of the masseter muscle and its partial continuity with the medial pterygoid muscle. Retrospective evaluation of 21 cases of pathology of the masseter muscle imaged by CT and/or MRI. RESULTS: Two main groups of pathology are identified: benign masseter hypertrophy and hemodynamically inactive vascular malformations. Other etiologies are quite varied. Some are secondary to processes involving the nearby mandible and parotid gland. Others, including tumors, involved the masseter muscle in a non specific fashion. CT and especially MRI were quite valuable with accurate diagnosis in 17/21 cases, two of which with the help of clinical data. CONCLUSION: The main question regarding the preferential involvement of the masseter muscle over nearby muscles remains unanswered.     

Fluid-fluid levels in cavernous hemangioma of soft tissue

Five cases of cavernous hemangioma with fluid-fluid levels on magnetic resonance imaging and/or computed tomography are reported. The signal characteristics were those of blood and histological analysis of the fluid-fluid levels showed that they were blood-filled cavities in the tumor. Although this finding itself is not specific, it may help in confirming the diagnosis of cavernous hemangioma.     

四肢软组织海绵状血管瘤的MRI分析

目的：分析四肢软组织海绵状血管瘤的MRI表现特征,旨在提高其诊治水平。方法：回顾性分析19例经病理证实的四肢软组织海绵状血管瘤的MRI表现。结果：发病部位：上肢5例,下肢14例;MRI表现主要分为三型,①局限团块型11例,6例位于肌肉间隙,5例位于皮下疏松组织内,T1WI表现为中等或略高信号,T2WI8例出现典型团块周围的＂铁环征＂,3例明亮高信号内见条形低信号分隔类似囊性病变表现;②弥漫蔓藤型6例,均位于皮肤表层或皮下疏松组织内,表现为弥散分布的迂曲的蔓藤状,T1WI呈等略高信号,T2WI呈明亮高信号,一般无血管流空现象;③混合型2例,均位于皮下疏松组织内,同时具有上述两种类型的影像表现;各型增强扫描均有明显强化。结论：四肢软组织海绵状血管瘤的MRI表现有一定的特征性,MRI对临床定位、诊断及治疗方案的选择有重要价值。     

脑血管畸形的MRI及MRA诊断

目的：研究脑动静脉畸形与海绵状血管瘤的ＭＲＩ及ＭＲＡ特征，评价不同的成像方法对脑血管畸形的诊断价值。材料与方法：对２１例脑动静脉畸形及６例海绵状血管瘤分别作了常规ＭＲ成像及ＭＲ血管成像，ＭＲＩ采用ＳＥＴ１和Ｔｕｒｂｏ ＳＥ Ｔ２加权序列，ＭＲＡ采用２Ｄ－ＦＬＡＳＨ及３Ｄ－ＦＩＳＰ序列，６例海绵状血管瘤ＭＲＡ仅使用２Ｄ－ＦＬＡＳＨ序列。所有成像以环形激化头线圈在１．０Ｔ ＭＲ仪上完成。结果：Ｔ１及Ｔ     

Thyroid hemangioma: a case report with a review of the literature

A 53-year-old man was found serendipitously to have increased blood-pool uptake in the right lobe of the thyroid during a radionuclide ventriculography study for left ventricular function. Primary thyroid hemangioma is a rare condition, with only two cases reported in the literature. Secondary hemangioma may occur as a result of fine-needle aspiration. This technique may cause hematoma formation, which generally resolves normally, but on rare occasions it can lead to cavernous hemangioma formation. In patients with a thyroid swelling who have a cold nodule on a thyroid scan and only blood on repeated fine-needle aspiration, Tc-99m erythrocyte blood-pool imaging may be performed to diagnose hemangioma.     

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.     

Cavernous hemangioma of the liver: detection with single-photon emission computed tomography

The roles of single-photon emission computed tomography (SPECT) and planar imaging with technetium-99m-labeled red blood cells in the diagnosis of cavernous hemangioma of the liver were evaluated. The study group consisted of 26 consecutive patients referred for evaluation of liver lesions. A total of 23 cavernous hemangiomas were found, all of which showed decreased or normal flow and delayed uptake of the radiotracer. SPECT demonstrated 13 hemangiomas that were not detected with planar imaging; both modalities demonstrated the other ten lesions. Lesions that were not cavernous hemangiomas showed either normal (n = 6) or increased (n = 4) flow; none had delayed increased uptake on either planar or SPECT images. SPECT with labeled red blood cells is an accurate method for the detection of cavernous hemangiomas of the liver and is more sensitive than planar imaging in depicting small lesions.     

Are bilateral cavernous hemangiomas of the orbit rare entities? The role of MRI in a retrospective study

Cavernous hemangioma is a benign orbital extraocular vascular lesion consisting of large dilated venous channels with fibrous, well-delineated capsule and hemosiderin deposition. Cavernous hemangioma is considered to be almost always unilateral and bilateral cases have been rarely described.

The aim of our study is to evaluate imaging characteristics of cavernous hemangioma and evaluate the prevalence of bilateral cases.

We studied 14 patients with cavernous hemangioma of the orbit with surgical confirmation. MRI was performed on a 1.5-T unit before and after contrast agent administration. Each MR examination had been retrospectively evaluated in order to define signal patterns, dimensions, location and other main imaging characteristics. In 3 out of the 14 cases studied (21.4%) bilateral cavernous hemangiomas were found. Thirteen masses appeared isointense on T1, two were hypointense, and two heterogeneous. On T2, 12 were hyperintense, 3 were heterogeneous, 1 isointense, and 1 hypointense. Contrast enhancement was inhomogeneous in 5, homogeneous and intense in 12 cases. The size ranged from 3 mm up to 21 mm (average 14.57). In four patients also CT scan without contrast administration of the orbits was performed.

Bilateral cavernous hemangioma appears to be more frequent than as predicted by the literature. In our opinion the main reason of this incongruence is related to technological advances. Our results could also be related to carelessness of radiologists to inspect the other orbit for possible concomitant lesions, and thus invites to major attention in exploring both orbits for eventual bilateral lesions.     

Dumbbell-shaped epidural capillary hemangioma

We report a case of a purely epidural capillary hemangioma of the thoracic spine with foraminal extension. Epidural hemangiomas are rare; only a few cases of dumbbell-shaped ones have been reported, and all were cavernous. MR imaging showed characteristic findings of a capillary hemangioma, which are also consistent with other epidural lesions such as neuromas or meningiomas.     

海绵状血管瘤常规MRI和SWI影像对比分析

目的 对比分析海绵状血管瘤（CCM）常规MRI和磁敏感加权成像（SWI）的影像学特点,提高对CCM的影像学表现的认识.方法 回顾分析2010年8月~2012年8月我院诊断的CCM患者23例病例资料,采用Siemens Tim Tro3.0T超导磁共振系统进行扫描,分别从CCM的形态学表现、CCM出血表现及钙化方面,对比分析MRI和SWI的影像学表现.结果 23例中,常规MRI发现病灶22个,表现为＂桑葚＂状或＂爆米花＂样高、低混杂信号;发现钙化灶5个,出血灶13个.SWI发现病灶60个,其中钙化灶28个,出血灶32个,35个表现为完全低信号,47个可见＂铁环征＂,此外SWI还能显示CCM另一特征：周围引流小静脉.结论 常规MRI＋SWI是诊断CCM首选方法,能较好地反映其病理学特点,为临床诊断、治疗提供有力依据.     

MRI误诊的椎体海绵状血管瘤18F-FDG PET/CT显像一例

笔者报道了一例双下肢乏力4月余，加重伴疼痛、活动受限一周的病例。MRI显示病灶累及胸3椎体、椎体附件和周围组织，并延伸到椎管内硬脊膜，增强后病变明显强化，MRI因病变范围广且增强后明显强化，考虑为恶性肿瘤。而18F-FDG PET低代谢结合CT点状、栅栏状钙化灶和椎体骨质无破坏，考虑为海绵状血管瘤；且术后病理因病灶内见异常血管聚集成丛状，血管腔内有大量红细胞，诊断为海绵状血管瘤。文献复习加深了对椎体海绵状血管瘤的认识，其可累及椎体、椎体附件，甚至延伸到椎管内和（或）周围组织。海绵状血管瘤是一种血管畸形，MRI增强后呈明显强化，但是PET显像则呈低代谢。当MRI显示病变范围广伴明显强化，而椎体无骨质破坏，怀疑恶性肿瘤时，应结合PET/CT对诸如海绵状血管瘤等良性病变进行鉴别诊断。     

The role of Tc-99m RBC scintigraphy in the differential diagnosis of orbital cavernous hemangioma

The cavernous hemangioma is the most common benign orbital tumor in adults. Its presentation is during the forth to fifth decades with a slowly progressive unilateral proptosis. Intraconal cavernous hemangiomas may be difficult to differentiate from other intraconal lesions such as schwannomas, meningiomas and hemangiopericytomas. We report a case of orbital cavernous hemangioma diagnosed by Tc-99m RBC scintigraphy. Tc-99m RBC scintigraphy revealed a typical scintigraphic pattern in which there is intense focally increased uptake on the delayed image. We conclude that Tc-99m RBC scintigraphy can be a useful method in the differential diagnosis of orbital cavernous hemangioma as in hepatic hemangioma.