儿童结核性腹膜炎的MSCT诊断价值

目的 分析儿童结核性腹膜炎的多层螺旋CT(MSCT)表现,探讨CT诊断及鉴别诊断价值。方法 回顾性分析经临床和/或病理证实的18例儿童结核性腹膜炎（TBP）的MSCT影像表现特点。观察腹膜结构（壁腹膜、大网膜、肠系膜）增厚情况、有无腹腔积液、有无其他系统（腹腔淋巴结、实质脏器或腹外系统）的异常改变。应用宝石能谱成像（GSI）综合分析平台将能谱CT检查获得的影像数据重建出相应的动、静脉期碘（水）基图,进一步分析其能谱曲线特点。结果 CT对TBP的检出率为94.4%(17/18)。TBP的CT影像主要表现为壁腹膜光滑均匀增厚（13例）、大网膜污垢样改变（12例）、肠系膜污垢样改变（16例）、腹腔积液（18例）及腹腔淋巴结肿大（15例）,且以上多种表现常同时出现。18例TBP均未累及腹部实质脏器;14例伴有肺部改变,5例合并结核性脑膜炎。网膜、淋巴结及肠系膜组织的能谱曲线随着不同能量的衰减趋势基本趋于一致,以增厚网膜的强化程度最高。结论 儿童TBP的MSCT表现具有一定特征性,结合临床资料有助于提高病变的诊断准确性。CT能谱曲线可以提供有价值的半定量信息,可作为传统CT检查的补充,为其诊断提...     

多层螺旋CT对结核性腹膜炎的诊断价值

目的:探讨多层螺旋CT对结核性腹膜炎的诊断价值。方法:回顾性分析22例有CT扫描资料的结核性腹膜炎病例,其中经手术病理证实5例,经腹腔穿刺和/(或)经临床综合指标及抗结核治疗随访显效而诊断者17例,重点观察结核性腹膜炎累及腹膜腔、腹膜下间隙及腹膜后间隙的CT表现特征。结果:结核性腹膜炎螺旋CT的主要表现有:①壁腹膜光滑、增厚19例(86.4%),其中均匀增厚17例,局部不规则增厚2例,12例增厚的腹膜有轻度强化;②大网膜增厚16例(72.7%),表现为污迹样增厚10例,结节样增厚4例,饼状增厚2例;③肠系膜受累15例(68.2%),其中10例合并小结节影;④淋巴结增大12例(54.5%),其中6例显示环状强化(27.2%);⑤腹腔积液20例(90.9%),其中11例为少量积液。结论:多层螺旋CT表现具有特征性,对临床诊断具有重要价值。     

结核性腹膜炎的CT特征探讨

目的：探讨结核性腹膜炎的CT表现特征，提高对本病CT征象表现的认识。方法：回顾性分析18例结核性腹膜炎病例的CT资料，其中经手术病理证实4例，经腹腔穿刺和经临床综合指标及抗结核治疗随访显效而诊断者14倒，主要观察结恢性腹膜炎引起的壁腹膜，大网膜、肠系膜、腹水及淋巴结增大的CT表现特征。结果：（1）壁腹膜增厚16例（89％），其中光滑均匀增厚15倒，局部不规则增厚1例，10例增厚的腹膜有明显强化。（2）大网膜增厚16例（89％），表现为污迹样增厚10例，结节样增厚4例，饼状增厚2例．（3）肠系膜受累12例（60％），其中4例合并小结节。（4）腹水12例（60％），其中9例为少量腹水．（5）淋巴结增大12例（60％）．其中5例显示环行强化．结论：结核性腹膜炎的CT主要表现有均匀性腹膜增厚并强化，大网膜污迹样增厚、肠系膜受累及腹水、腹腔淋巴结增大等。     

结核性腹膜炎的螺旋CT特征探讨

目的 :探讨结核性腹膜炎的螺旋CT表现特征。方法 :回顾性分析 3 2例有CT扫描资料的结核性腹膜炎病例 ,其中经手术病理证实 5例 ,经腹腔穿刺和 /或经临床综合指标及抗结核治疗随访显效而诊断者 2 7例。重点观察结核性腹膜炎累及腹膜腔、腹膜下间隙及腹膜后间隙的CT表现特征。结果 :①壁腹膜光滑、增厚 2 9例 ( 90 .6% ) ,其中均匀增厚 2 6例 ,局部不规则增厚 3例 ,18例增厚的腹膜有明显强化 ;②腹腔积液 3 0例 ( 93 .7% ) ,其中 15例为少量积液 ;③大网膜增厚 2 3例 ( 71.9% ) ,表现为污迹样增厚 14例 ,结节样增厚 6例 ,饼状增厚 3例 ;④肠系膜受累 2 2例 ( 68.8% ) ,其中 13例合并小结节影 ;⑤淋巴结增大 18例 ( 5 6.2 % ) ,其中 8例显示环状强化。结论 :结核性腹膜炎螺旋CT的主要表现有少量腹腔积液、均匀性腹膜增厚并强化、大网膜污迹样增厚、肠系膜受累及腹腔淋巴结增大 ,增强扫描时肿大的淋巴结呈环状强化等。     

结核性腹膜炎的多层螺旋CT表现

目的 探讨多层螺旋CT对结核性腹膜炎的诊断价值.方法 回顾性分析22例有CT扫描资料的结核性腹膜炎病例,其中经手术病理证实5例,经腹腔穿刺和/或经临床综合指标及抗结核治疗随访显效而诊断者17例.主要观察:腹膜、网膜、系膜及淋巴结改变和腹水.结果 结核性腹膜炎螺旋CT的主要表现有:①壁腹膜光滑、增厚19例(86.4%),其中均匀增厚17例,局部不规则增厚2例,12例增厚的腹膜有明显强化;②大网膜增厚16例(72.7%),表现为污迹样增厚10例,结节样增厚4例,饼状增厚2例;③肠系膜受累15例(68.2%),其中10例合并小结节影;④淋巴结增大12例(54.5%),其中6例显示环状强化(27.2%);⑤腹腔积液20例(90.9%),其中10例为少量积液.结论 结核性腹膜炎的多层螺旋CT表现具有特征性,对临床诊断具有重要价值.     

腹腔结核的CT表现

目的评价CT诊断腹腔结核的价值。方法回顾性分析经手术病理或抗痨治疗确诊的腹腔结核16例CT表现,其中男8例,女8例。年龄20～66岁,平均36.4岁。结果腹腔淋巴结肿大(n=11),肠系膜肿块(n=6),腹水(n=6,多为限制性),网膜增厚(n=7),肠壁增厚(n=6),胸水(n=2),胰腺结节(n=1)。腹腔淋巴结肿大(以肠系膜、胰周淋巴结为主),主要表现为因中央干酪样坏死而呈环形或多房样强化,并有部分淋巴结钙化,且腹腔淋巴结受累程度明显重于腹膜后间隙淋巴结。结核性腹膜炎时腹水密度较高,系膜、网膜上有斑片状及结节状病灶,肠曲粘连固定。结论密切结合临床、实验室检查及CT表现,有望提高腹腔结核诊断准确性。     

结核性腹膜炎的CT表现

目的:探讨结核性腹膜炎的CT表现特点。方法:回顾性分析12例经手术病理证实或抗痨治疗效果显著而确诊的结核性腹膜炎的CT征象。结果:渗出型和粘连型分别以腹水、腹膜增厚为主要表现,干酪型则主要表现为分房状肿块,增强扫描时房壁环形强化,三种类型均可伴有不同程度的网膜、肠系膜、肠壁的增厚混浊和腹水。结论:腹部CT平扫加增强扫描有助于结核性腹膜炎的诊断。     

失代偿期肝硬化结肠和腹膜水肿的CT表现

目的研究失代偿期肝硬化患者结肠和腹膜水肿的CT表现.材料和方法共44例被确诊为失代偿期肝硬化的连续性病例,且排除了可引起腹膜增厚的其他疾病.分析以下CT表现(1)结肠壁增厚(＞ 6mm);(2)腹膜和腹膜后组织水肿,即相应部位脂肪层内有絮状密度增高.结果13例结肠壁增厚(30%),其中单纯右半结肠壁增厚7例,合并横结肠壁增厚5例,全结肠壁增厚的仅1例.腹膜增厚36例(82%),其中单纯肠系膜增厚的13例,合并网膜增厚的23例.腹膜后组织水肿13例(30%),均合并有肠系膜和/或网膜的增厚.结论结肠和腹膜水肿,是失代偿期肝硬化常见的CT表现.     

腹膜转移瘤的CT表现及转移途径分析

目的 :探讨腹膜转移瘤的CT表现及转移途径。方法:回顾性分析36例腹膜转移瘤的CT表现,并与病理结果对照。结果:腹膜转移瘤可表现为不同程度的腹水,肠系膜、大网膜及腹膜上的污垢、结节、饼状增厚,腹腔囊状肿块,小肠壁的增厚及肠管的移位。肠系膜、大网膜及腹膜成污垢状、结节状改变较为普通。结论:通过对腹膜转移瘤的分析,可提示部分不明原因的原发肿瘤。     

急性腹痛就诊的系统性红斑狼疮相关性肠病MSCT表现

目的:研究以急性腹痛就诊的系统性红斑狼疮(SLE)相关性肠病MSCT表现.方法:搜集2009年3月-2012年9月以急性腹痛入院并确诊为SLE者11例.所有患者均行MSCT双期增强扫描并对扫描图像进行图像后处理,由两位经验丰富的临床放射科医师观察双期增强扫描的轴面及后处理图像,研究SLE相关性肠病MSCT表现.结果:肠管:肠壁肿胀、增厚者10例(10/11),肠管表现为“靶征”和“双晕征”8例(8/11),肠壁囊样积气症1例(1/11).肠管扩张9例(9/11),积气及积液者1例.肠系膜:肠系膜局部脂肪密度升高者9例(9/11),肠系膜血管增多、充血增粗者6例(6/11),肠系膜呈“梳状征”6例.胸水7例,腹腔积液10例,肠系膜及腹膜后淋巴结增多8例,双肾积水2例,膀胱壁增厚1例,SLE药物性肝损害1例.结论:SLE相关性肠病主要表现为肠壁和肠系膜改变.     

Stress MR imaging for evaluation of popliteal artery entrapment

The popliteal artery entrapment (PAE) syndrome has been recognized as a cause of arterial occlusion in young people. It is the result of an anomaly of the relationship between the popliteal artery and the gastrocnemius muscle. Eight young healthy volunteers (16 legs) and six patients (10 legs) with suspected PAE underwent magnetic resonance (MR) imaging. Gradient-echo images were obtained in axial planes with the leg at rest and during active plantar flexion against resistance. Imaging at rest allowed identification of PAE signs in only one leg, which had an anomalous medial course of the popliteal artery. In the other cases, only the stress technique was able to show signal loss in the popliteal artery due to muscular compression (two legs) or the presence of accessory muscle slip around the vessel (two legs), as confirmed at surgery. MR imaging is therefore a useful technique for the diagnosis of PAE because of its capability of combining information obtainable with other modalities.     

MR imaging of muscle and tender points in fibromyalgia

Fibromyalgia is a syndrome manifested by chronic, diffuse muscu-loskeletal aching and soreness, palpable muscle tender points, and other symptoms. Standardized clinical diagnostic criteria have recently been developed. Skeletal muscle has been postulated as the end organ in this disease. Biochemical, histologic, electromyographic, and conventional radiographic studies have demonstrated no definitive abnormality. This study sought to establish whether magnetic resonance (MR) imaging could demonstrate any abnormality in these patients. Eighteen patients were entered in the study, 14 of whom were able to complete their examinations. T1 -weighted, T2-weighted, gradient-echo, and STIR (short-tau inversion-recovery) sequences were performed in all patients, with selected patients examined with T1weighted, gadopentetate dimeglu-mine-enhanced sequences. The trapezius and suboccipital regions were imaged in patients who, clinically, had active fibro-myalgia. No abnormalities could be detected. The authors conclude that the conventional MR imaging used in this study was unable to depict any primary skeletal muscle abnormality in fibromyalgia.     

Uterine contractions: Possible diagnostic pitfall at MR imaging

A total of 206 nongravid patients with various gynecologic problems underwent pelvic magnetic resonance (MR) examinations that included both sagittal T2-weighted and contrast agent–enhanced T1-weighted images. MR images were retrospectively reviewed to identify changes in endometrial configuration on serial images obtained during the same MR examination. In 20 MR examinations (all in women of reproductive age), endometrial distortion due to myometrial bulging was noted on T2-weighted or contrast-enhanced T1-weighted images. It was absent on other MR images obtained at different times. Myometrial bulging exhibited low signal intensity in 18 examinations. The finding resembled adenomyosis or leiomyoma on T2-weighted or contrast-enhanced T1-weighted images. These results evidence the presence of transient myometrial bulging and transient low-intensity myometrium in the nongravid uterus. This phenomenon is thought to represent uterine contraction. Clinicians should be aware of the potential presence of transient low-signal-intensity myometrial bulging that could present diagnostic problems in the normal uterus.     

Controversies in cervical spine imaging in trauma patients

No area of emergency radiology has generated as much discussion in recent years as the subject of cervical spine imaging for trauma patients. This review will be in three parts. The first will examine the indications for cervical imaging and will focus on those factors that make patients at high risk or low risk for cervical injury. The second part will discuss the merits of radiography and computed tomography as the main screening diagnostic examination. In addition to the roles of each modality in the evaluation process, such factors as efficacy of diagnosis, time (duration) of study, and cost will be discussed. Finally, the third part will explore the methods currently employed to clear the cervical spine in comatose patients.Presented at the Annual Meeting of the American Society of Emergency Radiology, Las Vegas, Nevada, 22–25 October, 2003     

Brodie Abscess: MR imaging appearance in 10 patients

The magnetic resonance (MR) imaging features of Brodie abscess have not yet been fully evaluated. Ten patients with Brodie abscess, eight of long bone and two of vertebra, were studied with MR imaging. Long bone abscess had a characteristic “target” appearance with four layers: (a) a center with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR (short-inversion-time inversion recovery) images, (b) an inner ring isointense to muscle on T1-weighted images and with high signal intensity on T2-weighted and STIR images, (c) an outer ring hypoin-tense on all images, and (d) a peripheral halo hypointense on T1-weighted images. In six of eight cases, a soft-tissue mass was found. The two vertebral abscesses had a less specific appearance, with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR images. Only the peripheral halo was clearly identified in both cases.     

Dynamic contrast-enhanced MR imaging assessment of vascularized free fibular grafts

Magnetic resonance (MR) imaging may be a noninvasive method for assessing perfusion of vascularized bone grafts placed for treatment of avascular necrosis. One proximal femur of seven beagles was devascularized, with insertion of a vascularized fibular graft. MR imaging at 1 week (seven dogs) and 6 weeks (five dogs) after surgery included pre- and postcontrast spin-echo sequences, unenhanced twodimensional time-of-flight (TOF) vascular imaging, and dynamic gradient-echo imaging during infusion of gadolinium. Relative signal intensity values of selected regions obtained from the dynamic gradientecho images were plotted as percent enhancement versus time. In the operated hip, MR imaging did not show enhancement in six of seven femoral heads and greater trochanters at 1 week after surgery, with similar results after 6 weeks. MR imaging of fibular grafts 6 weeks after surgery showed an initial rapid increase in enhancement and a subsequent slower increase in five of five dogs, although no enhancement was seen in six of seven dogs at 1 week. These findings contrasted with a rapid initial increase in enhancement followed by slow decline in non-operated hips. Two-dimensional TOP imaging did not show the vascular pedicle of the graft in any dog. Findings of radionuclide bone scanning performed 1 week after surgery were consistent with devascularization of the operated femur and fibular graft. However, tetracycline distribution and histologic findings confirmed the viability of five of five grafts within the devascularized femurs 6 weeks after surgery. Thus, dynamic contrast-enhanced MR imaging at 6 weeks after surgery is valuable for assessing vascular bone graft perfusion, while similar imaging at 1 week may suggest otherwise.     

Right-side aortic arch with aneurysm of aberrant left subclavian artery: MR imaging appearance.

Reports of aneurysms of the subclavian artery in both normal and anomalous aortic arches have been rare. The authors describe a patient with a right-side aortic arch and an aneurysm of the aberrant left subclavian artery, which, to the authors' knowledge, is a previously unreported association. At presentation, the aneurysm appeared as a calcified left superior mediastinal mass. Magnetic resonance imaging enabled preoperative diagnosis and guided surgical planning.     

Adrenal tissue characterization with 0.5-T MR imaging: Value of T2*-weighted images

The authors investigated the value of magnetic resonance (MR) imaging at 0.5 T for distinguishing adrenal adenomas from adrenal metastases. The series included 23 adrenal adenomas (18 nonhyperfunctioning, five hyperfunctioning) and 23 adrenal metastases from various organs. Adrenal tumor–liver signal intensity ratios on T1-, T2-, and T2*-weighted images were calculated for adrenal tissue characterization. Adrenal adenomas were more precisely distinguished from adrenal metastases on T2*-weighted images (21 of 23, 91%) than on T2-weighted images (15 of 23, 65%). T1-weighted images were not useful for this distinction. In conclusion, T2*-weighted images were better than routine T2-weighted images for distinguishing adrenal adenomas from adrenal metastases. It can be postulated that the total signal intensity of adrenal adenomas, which contain some fat components, decreased on T2*-weighted images because of an out-of-phase effect.     

MR angiography of congenital heart disease: Value of segmented two-dimensional inflow technique and maximum-intensity-projection display

Magnetic resonance (MR) angiography of the cardiovascular system was evaluated in 41 patients with congenital heart disease by using a two-dimensional (2D) inflow technique based on a magnetization-prepared gradient-echo pulse sequence with segmented k-space data acquisition and electrocardiographic gating at 0.5 T. Inversion and saturation prepulses were used to suppress stationary tissue and enhance intravascular signal. Presaturation slabs were applied where certain vascular structures had to be suppressed. Sequence parameters were optimized by evaluating signal intensity and contrast characteristics for various flip angles and inversion and saturation delay times. The heart and intrathoracic vasculature were encompassed with 40–50 overlapping sections. Both 2D angiograms and maximum-intensity-projection images were evaluated. Combining data sets acquired in the sagittal and transverse orientations provided the most satisfactory information about the pulmonary arteries. The highest signal-to-noise ratios were obtained with a flip angle of 65° and short prepulse delay times. Two-dimensional MR angiography can provide useful diagnostic information but requires a thorough understanding of in-plane and hemodynamically induced signal intensity changes.