非特异性肉芽肿性乳腺炎的影像学表现

目的 :探讨非特异性肉芽肿性乳腺炎(IGM)的X线、CT及MRI特征。方法 :回顾性分析53例经手术病理证实的IGM的X线、CT及MRI资料。结果:X线示15例病灶呈等或稍高于正常腺体密度肿块影;5例呈局限性致密影或结构扭曲;9例因腺体致密显示不清。CT示14例呈等或稍高于正常腺体密度肿块影,增强扫描明显强化;2例呈囊性改变,增强扫描边缘强化。MRI示T1WI呈等或稍高信号,T2WI呈不等高信号,增强扫描病变片状强化,信号高于正常腺体,部分病变伴脓肿形成,部分伴环形强化结节影,TIC呈多样性。X线、CT及MRI可见部分病例伴乳头内陷、局部皮肤增厚。结论:IGM乳腺X线表现特异性差,CT与MRI表现具有一定特异性,影像结合临床有助于准确诊断。     

下颌骨骨肉瘤影像学分析

目的:分析下颌骨骨肉瘤影像学表现,评价不同影像检查方法的优劣。方法:7例下颌骨肿块患者中均经X线和MRI检查,6例行CT并经手术病理证实为下颌骨骨肉瘤。所有病例的影像学特点和诊断价值均被分析比较。结果:X线检查有7例病变显示不清;6例呈棉絮状和不规则高密度,1例呈低密度,内有间隔;3例见骨膜反应呈“日光放射状”和“花边状”。CT平扫显示2例呈高密度,4例呈混合密度伴有骨皮质破坏、中断;5例见“日光放射状”骨膜反应;CT增强显示所有病例均有不均匀强化表现,4例伴有软组织肿块形成。平扫MRI显示5例病变T1WI上呈等、低信号,T2WI上呈高信号;2例在T1WI和T2WI上均呈等、低信号;增强MRI显示2例病灶轻度强化;2例呈边缘强化,其内强化不均。结论:CT和MRI均可清晰显示下颌骨骨肉瘤的形态和内部结构,MRI显示髓内病变范围方面优于CT。     

乳腺黏液腺癌钼靶X线与磁共振成像特点及诊断价值

目的探讨磁共振成像(MRI)及钼靶X线摄影检查对乳腺黏液腺癌的诊断价值。方法收集本院经手术病理证实的乳腺黏液腺癌12例,回顾性分析MRI成像、X线钼靶摄影及影像表现特点。结果单纯性8例,混合性4例。MRI表现:所有病例均表现为肿块,平扫T1WI为低信号或等低信号,T2WI为高信号或极高信号;动态增强扫描病灶呈渐进性明显强化,2例呈轻度强化;磁共振弥散加权成像(DWI)病灶呈高信号,表观扩散系数(ADC)值增高。X线表现:肿块9例,不规则团片状2例,结构扭曲变形1例,内有钙化1例。病灶均表现为高密度,边缘清7例,边缘不清5例,其中边缘毛刺3例。MRI准确率71%,X线准确率67%,MRI和X线敏感性均100%。结论乳腺黏液腺癌由于含有黏液成分,MRI和X线影像表现上有一定特征,对本病诊断有一定价值,MRI准确性高于X线,二者应相互结合。     

原发性肝类癌的CT及MRI表现

目的 探讨原发性肝类癌的CT及MRI表现.方法 回顾性分析2003年12月至2008年11月间11例经手术病理证实的原发性肝类癌患者资料.4例行CT检查,8例行MRI检查,分析其影像表现特征.结果 11例中肿瘤多发2例,表现为2个或2个以上的结节状病灶,其余9例均为单发.CT检查4例患者病灶均表现为平扫边界清楚低密度,中心可见不规则更低密度区;增强后动脉期病灶实质部分不均匀强化,中心更低密度区无强化,门静脉期及延迟期病灶边缘仍轻度强化,强化程度较动脉期减低,中心坏死区始终无强化.MRI 8例患者中7例T_1WI表现为边界清楚的不均匀低信号,T_2WI病灶呈高信号,中心可见不规则低信号;增强后动脉期病灶边缘不均匀强化,病灶中心可见不规则无强化低信号区,门静脉期及延迟期病灶边缘仍轻度强化,边缘显示不清,病灶中心无强化低信号区范围较动脉期缩小.1例患者T_1WI表现为边界清楚的囊状低信号影,囊内可见高信号,T_2WI病灶呈高信号;增强后动脉期病灶边缘不均匀强化,门静脉期及延迟期呈低信号.结论 平扫和动态增强CT扫描及MRI能反映原发性肝类癌的影像特点,具有一定特征性.     

乳腺血管肉瘤的MRI及X线表现(附2例报告并文献复习)

目的 探讨乳腺血管肉瘤的MRI与X线表现并结合文献探讨其诊断价值.资料与方法 搜集经手术病理证实的2例乳腺血管肉瘤患者的MRI与X线检查资料,并结合相关文献进行回顾性分析.结果 X线表现:1例为右乳腺外上侧局限团片状致密影,密度中等程度增高,后缘与胸大肌分界欠清晰;另1例为左乳腺外下侧高密度肿物,边缘略分叶,部分边界清晰,部分边界浸润,未见毛刺,肿物周围血管较对侧丰富,2例均未见明显钙化,脂肪层未见混浊,皮肤未见增厚,腋下均未发现肿大淋巴结.MRI上2例均表现为T22WI上呈高信号、T1WI上呈低信号肿块,扩散加权成像(DWI)上呈高信号,表观扩散系数(ADC)值减低,其中1例肿瘤内的含血液区在T1WI上表现为点状或片状不规则高信号区,肿物周围血供丰富,脂肪层混浊.动态增强扫描肿瘤大部分有早期强化(增强后1min内),并有延迟强化(增强后5min后).结论 X线诊断乳腺血管肉瘤无特异性,结合MRI可提高乳腺血管肉瘤的检出率,尤其动态增强MRI对其定性诊断有重要价值.     

出血坏死性鼻息肉的CT和MRI诊断

目的 探讨出血坏死性鼻息肉的CT和MRI表现.方法 回顾性分析17例经病理证实的出血坏死性鼻息肉的影像资料.其中14例行CT检查,16例行MR检查,15例同时行MR增强检查.结果 17例病变均以上颌窦口为中心向鼻腔及上颌窦内生长,边缘清晰,16例形态不规整,呈浅分叶状,仅1例呈卵圆形.CT表现:14例病变表现为密度不均匀的软组织肿块影,2例分别在病变周边及内部见到条形及结节状高密度影,邻近骨质均呈压迫、吸收改变,局部骨质不连续,以上颌窦内壁最常见.MRI表现:16例病变内部在T_1WI上为低信号(与脑灰质相比),T_2WI上为高信号,14例同时伴有线样的低信号分隔;15例病变周边可见到T_1WI为等信号、T_2WI为低信号的不规则环形影围绕;15例行增强检查的病变呈不均匀性明显强化,强化部分形态各异,10例内部为多发结节状强化,4例为斑片状强化,1例强化外观似叶片状,而T_2WI上的低信号环不强化.4例病变的鼻腔侧周边可见边缘清楚的囊状液体信号影,向前至鼻前庭,向后达后鼻孔区,增强后不强化.11例行动态增强扫描,其中7例时间-信号强度曲线(TIC)呈持续上升型;4例呈速升缓降型.结论 MRT_2WI上内部的不均匀高信号为低信号围绕以及增强后结节状、斑片状的强化特征均是出血坏死性鼻息肉特异的MRI表现,而CT有助于判断病变性质,明确诊断有一定困难,MRI应是出血坏死性鼻息肉的首选检查方法.     

MRI及CT对软组织海绵状、蔓状血管瘤的诊断价值

目的 :探讨软组织海绵状血管瘤 (CH)、蔓状血管瘤 (RH)的MRI、CT表现及诊断价值。方法 :回顾性总结经手术及病理证实 2 1例CH及 14例RH的MRI和CT表现。结果 :CH在MRI上呈团块或不规则状 ,边界清楚 ,血窦呈不均匀等T1长T2 信号 ,瘤内纤维、脂肪组织呈花边、条状分隔或串珠样短T2 信号 ;CT示肿瘤密度不均 ,有分隔 ,呈中等度强化。RH形态不规则、边界欠清 ,MRT1WI及T2 WI可见其内管状流空血管影 ;CT示瘤内见结节状、蚓状等、高密度影 ,部分有钙化、静脉石 ,增强扫描呈结节状、条状明显强化。结论 :CH和RH影像表现具有相对特征性 ;CT有利于显示瘤内钙化、静脉石 ,MRI则可反映瘤内脉管及非血管组织成分 ,对定性诊断有重要的价值。     

游离型椎间盘突出的综合影像诊断

目的:探讨诊断本病的MRI特点与病理学关系及最佳影像学手段,以提高本病的综合影像诊断水平。方法:回顾性分析23例游离型椎间盘突出的CT和MRI表现特点。CT组16例,MRI组23例,同时行CT及MRI检查16例。结果:16例CT表现为椎管内硬膜囊前高密度影边缘较清,4例显示游离碎片与椎间盘呈细窄颈相连。MRI组中,7例为T1WI、T2WI均呈低信号(与脊髓相比)边缘清;13例T1WI呈等信号,T2WI上呈低或稍高信号,稍高信号位于周围,低信号位于中心部分,边缘欠清;3例T1WI呈稍高信号,T2WI上呈等信号。12例增强扫描中,7例于周边见轻度强化,中央无强化,3例无明显对比强化,2例呈均匀轻度强化。结论:游离型椎间盘突出的影像学诊断以MRI为最佳,MRI信号特征能充分反映其病理的改变,仔细分析平扫信号特点即可明确的诊断。     

头颈部血管瘤及血管畸形的CT、MRI诊断

目的:分析头颈部血管瘤及血管畸形的CT、MRI表现,探讨其诊断及鉴别诊断价值。方法:搜集经手术病理或DSA证实,临床及影像资料完整的47例头颈部血管瘤或血管畸形病例的资料,对其进行回顾性分析。CT检查33例,MRI检查14例。结果:海绵状血管瘤21例,T1WI呈均匀等或低信号,T2WI呈高信号,增强扫描呈中等不均匀强化并可见纡曲血管强化;CT平扫呈不均匀等密度、囊状低密度,3例可见圆点状静脉石,增强扫描轻至中等度强化,其中6例见线条状粗大纡曲血管影。蔓状血管瘤23例,病变弥漫,无明显边界。T1WI呈等信号,T2WI呈不均匀高信号,其内见粗大的流空血管影及低信号静脉石,增强扫描明显不均匀强化;CT平扫等密度,见高密度圆点状静脉石,增强明显强化,可见蚯蚓状粗大血管团。淋巴管瘤3例,边界清楚,平扫为低密度,增强扫描无明显强化。结论:CT及MRI可较好显示头颈部血管畸形,蔓状血管瘤为动静脉畸形或高流速血管畸形,影像见粗大纡曲的血管影。低流速的静脉畸形、淋巴管畸形须与头颈部其它囊性病变鉴别。     

骨梗死的X线、CT和MRI诊断

目的探讨骨梗死的影像学表现.材料和方法对10例累及28处骨骼的骨梗死患者行X线、CT及MRI检查,将骨梗死分为早、中、晚期,分析其影像学特征.结果病变主要累及股骨下段和胫骨上段,多双侧发病.骨梗死早、中期X线、CT表现为阴性和局部的骨质疏松及斑点状钙化,MRI表现为病变中心T1WI呈等或稍低信号,T2WI呈等或稍高信号,病灶边缘呈典型的地图样改变.晚期X线及CT呈不规则状、蜿蜒状骨质硬化,MRI T1WI及T2WI均呈低信号.结论MRI检查是诊断早、中期骨梗死最有效的方法,优于X线平片和CT;在晚期,X线平片和CT、MRI均有特征性表现,三者相结合可提高诊断准确率.     

Granulomatous mastitis: changing clinical and imaging features with image-guided biopsy correlation

Objectives

To review clinical presentation, revisit patient demographics and imaging findings in granulomatous mastitis and determine the optimal biopsy method for diagnosis.

Methods

A retrospective study was performed to review the clinical presentation, imaging findings and biopsy methods in patients with granulomatous mastitis. Twenty-seven patients with pathology-proven granulomatous mastitis were included.

Results

The average age at presentation was 38.0 years (range, 21–73 years). Seven patients were between 48 and 73 years old. Twenty-four patients presented with symptoms and three patients were asymptomatic. Nineteen patients were imaged with mammography demonstrating mammographically occult lesions as the predominant finding. Twenty-six patients were imaged with ultrasound and the most common finding was a mass lesion. Pathological diagnosis was made by image-guided biopsy in 44 % of patients. The imaging features of granulomatous mastitis on mammography are infrequently described.

Conclusions

Our study demonstrates that granulomatous mastitis can occur in postmenopausal or asymptomatic patients, although previously reported exclusively in young women with palpable findings. Presentation on mammography as calcifications requiring mammographically guided vacuum-assisted biopsy has not been previously described. The diagnosis of granulomatous mastitis can easily be made by image-guided biopsy and surgical excision should be reserved for definitive treatment.

Key Points

? Characterizes radiographic appearance of granulomatous mastitis in postmenopausal or asymptomatic patients. ? Granulomatous mastitis can present exclusively as calcifications on mammography. ? The diagnosis of granulomatous mastitis is made by image-guided biopsy techniques.     

Imaging findings in idiopathic granulomatous mastitis. A review with emphasis on magnetic resonance imaging

OBJECTIVE: To describe magnetic resonance (MR) imaging features of patients with a histologic diagnosis of idiopathic granulomatous mastitis (IGM). METHODS: Dynamic contrast-enhanced MR imaging was performed with a 1.5-T MR unit. Postprocessing of images included subtraction and calculation of time-intensity curves of the enhancing regions at several points in all patients. RESULTS: In addition to granulomatous inflammation, biopsy slides of 5 patients demonstrated abscess formation without a specific organism (aseptic abscess). One patient had a fibrotic tissue component. Magnetic resonance imaging findings were heterogeneously enhancing areas with (n = 5) and without (n = 1) multiple ring-like enhanced abscesses and a circumscribed lesion with heterogeneous contrast enhancement (n = 1). Time-intensity curves showed a benign pattern in all but 1 patient. CONCLUSION: Idiopathic granulomatous mastitis has a number of appearances on MR imaging. Magnetic resonance imaging with measurement of time-signal intensity curves may support the findings of ultrasonography and mammography in distinguishing benign inflammatory breast disorders from malignant ones; however, biopsy still remains the only method of definite diagnosis.     

Granulomatous mastitis: radiological findings

Purpose: To evaluate the radiological, ultrasonographic, and magnetic resonance imaging (MRI) findings of idiopathic granulomatous mastitis.

Material and Methods: Between April 2002 and June 2005, the mammography, ultrasound, color Doppler ultrasound, nonenhanced MR, and dynamic MR findings of nine patients with the preliminary clinical diagnosis of malignancy and the final diagnosis of granulomatous mastitis were evaluated.

Results: On mammography, asymmetrical focal densities with no distinct margins, ill-defined masses with spiculated contours, and bilateral multiple ill-defined nodules were seen. On ultrasound, in four patients a discrete, heterogenous hypoechoic mass, in two patients multiple abscesses, in one patient bilateral multiple central hypo peripheral hyperechoic lesions, in two patients heterogeneous hypo- and hyperechoic areas together with parenchymal distortion, and in one patient irregular hypoechoic masses with tubular extensions and abscess cavities were seen. Five of the lesions were vascular on color Doppler ultrasound. On MR mammography, the most frequent finding was focal or diffuse asymmetrical signal intensity changes that were hypointense on T1W images and hyperintense on T2W images, without significant mass effect. Nodular lesions were also seen. On dynamic contrast-enhanced mammography, mass-like enhancement, ring-like enhancement, and nodular enhancement were seen. The time-intensity curves differed from patient to patient and from lesion to lesion.

Conclusion: The imaging findings of idiopathic granulomatous mastitis have a wide spectrum, and they are inconclusive for differentiating malignant and benign lesions.     

Granulomatous mastitis: imaging findings with histopathologic correlation

OBJECTIVE: The purpose of this study is to evaluate the mammographic and ultrasonographic characteristics of granulomatous mastitis and to correlate the imaging features with the histologic findings. MATERIALS-METHODS: 15 patients with diagnosis of idiopathic granulomatous mastitis were examined with mammography and ultrasonography. The clinical, pathologic and imaging features were retrospectively reviewed and correlated in all patients. RESULTS: Mammographic examination showed an asymmetric density with no distinct margins in 8 patients and an ill-defined mass in 3 patients. In 4 cases, no abnormal finding was detected on the mammography. Sonographic examination demonstrated an irregular mass with tubular connections in 5 patients, single or multiple hypoechoic tubular/nodular structures in 6, and focally or segmentally decreased parenchymal echogenity with acoustic shadowing in 4 patients. The imaging findings suggested a malignant tumor in 7 patients, while an inflammatory process or intraductal papilloma was considered in the differential diagnosis of the other patients. CONCLUSION: Granulomatous mastitis usually presents with clinical findings mimicking a carcinoma. The most common mammographic appearance of the lesion is an asymmetrically increased density, which is not characteristic for this entity. Sonographic patterns of the disease are varied and appear to relate to the histologic features. Findings include a mass-like appearance, tubular/nodular hypoechoic structures and focal decreased parenchmal echogenicity with acoustic shadowing. With awareness of the findings granulomatous mastitis can be considered in the differential diagnosis.     

Magnetic resonance imaging of pyomyositis

Pyomyositis is a relatively rare entity in temperate climates. Because of its rarity and its nonspecific clinical and radiographic findings, pyomyositis may be misdiagnosed and may cause severe morbidity and mortality. We present magnetic resonance imaging findings in two cases of pyomyositis. Magnetic resonance imaging was helpful in differentiating other pathological processes from pyomyositis, outlining the extent of involvement, and localizing the fluid collection.     

Gorham-Stout disease of costo-vertebral localization: radiographic, scintigraphic, computed tomography, and magnetic resonance imaging findings

Gorham-Stout disease is a clinical, radiographic, and histological entity characterized by progressive osteolysis as a result of a histologically benign vascular proliferation involving bone. We present a case involving the cervical and thoracic spine and the osseous thorax, with attention to the clinical, radiographic, scintigraphic, computed tomography, and magnetic resonance imaging findings. These subjects are discussed in the light of the literature.     

Magnetic resonance imaging features of inflammatory breast metastasis from gastric signet-ring cell carcinoma

This report presents a rare case of inflammatory breast metastasis from gastric signet-ring cell carcinoma. The clinical and radiologic findings were similar to those of primary inflammatory carcinoma or acute mastitis. Further, ultrasonography showed diffuse skin thickening and a diffuse infiltrative hypoechoic lesion with marked posterior acoustic shadowing in the left breast. Similarly, magnetic resonance imaging showed diffuse skin thickening/enhancement and a diffuse non-mass-like enhancement in the left breast and to a lesser degree in the right breast.     

Normal and abnormal meningeal enhancement: MRI features

The authors describe normal imaging of the meninges and meningeal spaces and MR (magnetic resonance) imaging findings in tumoral and nontumoral diseases. Dural or/and pial enhancement may be related to tumoral, infectious or granulomatous diseases.     

Two cases of pediatric bone disease (eosinophilic granuloma and Brodie's abscess) showing similar scintigraphic and radiographic findings

Two 9-year-old patients with femoral bone lesions were referred to the authors' institution within a few days of each other. Both showed similar radiographic, magnetic resonance imaging, and scintigraphic findings. The radiographs showed osteolytic lesions in the right femoral diaphyses, and gadolinium-DTPA-enhanced magnetic resonance imaging revealed inhomogeneous enhancement. Tc-99m HMDP showed marked linear accumulation with relatively low central uptake in the right femoral shafts, and TI-201 scintigraphy showed considerable uptake corresponding to the area seen with Tc-99m HMDP. Histologic analysis confirmed eosinophilic granuloma in the first patient and Brodie's abscess in the second. The radiographic and scintigraphic findings in Brodie's abscess may be similar to those in eosinophilic granuloma.     

Granulomatous spinal infections: MR imaging

The value of magnetic resonance (MR) imaging in evaluating granulomatous spinal infection was retrospectively assessed in 81 patients with proved disease; 27 were reexamined after administration of gadolinium diethylenetriaminepentaacetic acid, and 25 underwent follow-up studies. Blinded interpretations were correlated with clinical, microbiologic, and surgical findings. MR imaging enabled prediction of the presence of neurologic complications in 93% of patients and diagnosis of the type of infection in 94%, and correlated well with surgical findings in 24 of 27 patients. Vertebral intraosseous abscesses, meningeal involvement, subligamentous spread, and paraspinal abscess location were best identified on contrast-enhanced studies and were seen most frequently in tuberculous spondylitis. High signal intensity on T1-weighted images of previously affected vertebrae suggested healing and correlated well with symptoms. The authors conclude that MR imaging may be useful as the method of first choice for the initial assessment and posttherapy follow-up of patients with granulomatous spinal infection.