Role of ultrasound in assessment of early rheumatoid arthritis

This report reviews imaging methods used for diagnosis and monitoring of rheumatoid arthritis, with emphasis on the role of ultrasonography. Traditionally, conventional radiography has been useful in detecting and monitoring the extent of joint destruction in rheumatic disease. However, it is particularly difficult to detect pathological joint changes in the early stages. Magnetic resonance imaging is able to detect inflammation of the synovial membrane and erosions but is limited by cost and availability. Ultrasound has recently emerged as a useful and potentially reliable method for assessing the degree of joint inflammation and erosion in patients with early rheumatoid arthritis.     

Bilateral lipoma arborescens of the subdeltoid bursa

Lipoma arborescens is a rare cause of chronic monoarticular arthritis. It is most commonly seen in the knees, but only a few cases involving other joints, especially the subdeltoid bursa, have been described. To our knowledge, this is the first reported case of lipoma arborescens involving bilateral subdeltoid bursae. Although it is associated with joint effusion, synovial cysts and erosions, the presence of reactive bone formation has not been reported. Magnetic resonance imaging is a very effective method for the diagnosis of this rare condition because of its ability to do tissue characterization.     

鼻咽癌颅底骨质破坏放疗前后MRI评估

[目的]探讨磁共振(MRI)对鼻咽癌颅底骨侵犯的诊断价值。[方法]分析2003年7月至2004年12月35例颅底骨质破坏初诊鼻咽癌患者放疗前后MRI的变化。[结果]35例鼻咽癌患者放疗前均存在程度不等的颅底骨质破坏,MRI可见T1WI骨髓高信号消失及压脂增强后明显强化。经放射治疗,35例患者均呈放疗后状态。[结论]MR平扫及增强扫描图像对鼻咽癌TNM分期及疗效判断有重要价值。     

Magnetic-resonance-imaging of bone-marrow in lymphoma

Magnetic resonance imaging provides a non-invasive method of obtaining high resolution images of the bone marrow. The signal obtained is dependent on bone marrow cellularity and the proportions of haemopoietic tissue, fat, tumour and fibrous tissue present. MRI is a sensitive method of detecting bone marrow involvement in Hodgkin's disease and high grade non-Hodgkin's lymphoma and provides a complimentary tool to conventional bone marrow trephine biopsy in assessing bone marrow involvement.     

磁共振成像在宫颈癌疗效评价中的应用

磁共振成像（MRI）形成三维立体定位解剖成像。通过MRI对比肿瘤体积及信号强度变化,MRI在宫颈癌疗效评估方面有重要价值。随着影像学的发展,磁共振扩散加权成像（DWI）、磁共振波谱（MRS）能提供细胞水平的定性和定量信息,反应肿瘤细胞在治疗中的变化。MRI技术能早期预测局部晚期官颈癌新辅助化疗疗效,为患者个体化治疗提供重要依据。     

Magnetic Resonance Imaging in Patients with Bone Marrow Disorders

Magnetic resonance imaging (MRI) provides a non-invasive means to evaluate a large fraction of marrow in less than one hour. Marrow disorders produce non-specific changes in marrow signal intensities which primarily reflect changes in proportions of fat and cellular elements. The pattern of these signal changes narrows the differential diagnosis, and the combination of these features with the clinical context allows interpretations which are clinically useful in many ways. These include: I) the diagnosis of avascular necrosis (and its distinction from other causes of joint pain), 2) detection of osteomyelitis, 3) differential diagnosis of hypo-plastic disorders, 4) staging of lymphomas and myeloma, 5) selection of patients for autolo-gous bone marrow transplant, 6) objective measures of marrow response to therapy, 7) detection of leukemic transformation, and 8) improved detection of marrow disease (primary or secondary) in patients with otherwise unexplained bone pain.     

Multiples Myelom

Multiple myeloma first shows alterations in conventional X-ray images at later stages and can be seen as coarse strands of osteoporosis with infiltration of the vertebrae or localized osteolysis. The slice imaging technique does not suffer from overlapping images and smaller osteolytic changes can therefore be recognized earlier using computed tomography (CT). CT is also very well suited for detection of skeletal structures at risk for fractures. In the region of the long bones infiltration of the medullary cavity can be found with or without destruction of the cortical substance. Magnetic resonance imaging (MRI) is the most sensitive method to visualize manifestations of the bone marrow by multiple myeloma. The total vertebral column and the pelvis should always be imaged as these are the main locations of manifestations of multiple myeloma. If possible whole body MRI should be carried out because this is more sensitive than conventional X-rays and CT. MRI also is of value for the prognosis. The guidelines of the International Myeloma Foundation should be used for staging.     

The Role of Magnetic Resonance Imaging in the Diagnosis and Monitoring of Myelodysplastic Syndromes or Leukemia

Magnetic resonance imaging (MRI) can provide valuable information about regions of the bone marrow which are inaccessible to biopsy. MRI also is unique in characterizing normal and abnormal bone marrow because of its ability to distinguish fat from other tissues. In patients with myelodysplastic syndromes (MDS) or leukemia, marrow MRI is an important tool for accurate diagnosis and monitoring and may function as an adjunct to bone marrow aspiration and biopsy. In clinical practice, defining the anatomic distribution and extent of marrow involvement by MRI is of advantage in the management of patients with MDS or leukemia.     

骨髓异常的磁共振成像及其临床应用研究

目的：探讨磁共振成像（magnetic reconance imaging,MRI) 在评价骨髓病变中的作用。方法：定性定量分析78例正常人群、44例骨髓病变患者（15例白血病、13例非霍奇金氏淋巴瘤、16例增生性贫血）的脊柱MRI汲骨髓穿刺、外周血检查资料，并将MRI定量资料与临床实验室检查资料进行相关性分析。全部病例均经骨髓穿刺或活检证实。结果：①白血病及淋巴瘤T1加权像（T1-weigted imaging,T1WI)低信号多于增生性贫血及正常人群（P＜0．05），T2加权像（T2-weigted imaging,T2WI)高信号多于增生性贫血及正常人群（P＜0．05）；正常人群、白血病、淋巴瘤强化无差异（P＞0．05）；白血病弥漫性浸润多于淋巴瘤（P＝0．000）。②T1WI白血病及淋巴瘤骨髓肌肉信号强度比（signal intensity ratio on T1WI,SIR1)低于增生性贫血及正常人群（P＜0．05）。③增生性贫血SIR1与粒细胞和红细胞之比呈正相关（P＝0．006），与骨髓中红细胞比例负相关（P＝0．008）；白血病SIR1与骨髓幼稚细胞比例负相关（P＝0．048）。结论：MRI可显示脊柱红骨髓的分布；MRI定性分析可区分良、恶性骨髓病变；定量分析SIR1诊断价值有限；SIR1可评价增生性贫血的贫血程度，粗略预测白血病的瘤负荷。     

Debilitating musculoskeletal pain and stiffness with letrozole and exemestane: associated tenosynovial changes on magnetic resonance imaging

Objective Arthralgia, skeletal and muscle pain have been reported in postmenopausal women under treatment with third generation aromatase inhibitors (AIs). However, the pathogenesis and anatomic correlate of musculoskeletal pains have not been thoroughly evaluated. Moreover, the impact of AI-induced musculoskeletal symptoms on normal daily functioning needs to be further explored. Patients and methods We examined 12 consecutive non-metastatic breast cancer patients who reported severe musculoskeletal pain under a third generation AI; 11 were on letrozole and 1 on exemestane. Clinical rheumatological examination and serum biochemistry were performed. Radiological evaluation of the hand/wrist joints were performed using ultrasound (US) and/or magnetic resonance imaging (MRI). Results The most common reported symptom was severe early morning stiffness and hand/wrist pain causing impaired ability to completely close/stretch the hand/fingers and to perform daily activities and work-related skills. Six patients had to discontinue treatment due to severe symptoms. Trigger finger and carpal tunnel syndrome were the most frequently reported clinical signs. US showed fluid in the tendon sheath surrounding the digital flexor tendons. On MRI, an enhancement and thickening of the tendon sheath was a constant finding in all 12 patients. Conclusions Musculoskeletal pains in breast cancer patients under third generation AIs can be severe, debilitating, and can limit compliance. Characteristic tenosynovial, and in some patients joint changes on US and MRI were observed in this series and have not been reported before.     

Evaluation of gall bladder carcinoma with dynamic magnetic resonance imaging and magnetic resonance cholangiopancreatography

The objective of this study is to evaluate the efficacy of dynamic MRI with magnetic resonance cholangiopancreatography (MRCP) in the preoperative assessment of gall bladder carcinoma. Magnetic resonance imaging and MRCP were carried out in 15 patients with gall bladder carcinoma before surgery and the imaging findings correlated with surgical and pathological findings. Gall bladder carcinoma manifested as focal or diffuse wall thickening in 73% (11/15) and as a mass replacing the gall bladder in 27% (4/15). All tumours showed enhancement in the early phase, which persisted into the delayed phase. The sensitivity and specificity of MRI with MRCP in detecting hepatic invasion, lymph node metastasis and bile duct invasion was 87.5 and 86%, 60 and 90%, and 80 and 100%, respectively. Magnetic resonance imaging correctly diagnosed duodenal invasion in only 50% and in none of the two patients with peritoneal metastasis. In conclusion, dynamic MRI with MRCP is an accurate and a reliable method of showing gall bladder carcinoma and in assessing its local and regional extent as part of preoperative assessment.     

Magnetic resonance imaging of thickened pituitary stalk proceeding to Langerhans cell histiocytosis in a child

Magnetic resonance imaging has shown isolated pituitary stalk thickening in certain cases of idiopathic or secondary central diabetes insipidus (DI) due to infiltrative processes. We present a 4‐year‐old boy who was initially diagnosed as having central DI. The MRI showed isolated pituitary stalk thickening with prominent homogeneous contrast enhancement. The remaining findings on MRI were within normal limits. The patient's personal and family history and laboratory and clinical findings were unremarkable; therefore, he was initially diagnosed as having idiopathic DI. Since central DI and isolated pituitary stalk thickening may be considered to be the first manifestations of Langerhans cell histiocytosis, we decided to follow up the patient. After 5 months, following the initial diagnosis, on skeletal X‐ray survey, the patient did indeed develop multiple lytic skull lesions which, on biopsy, were histologically typical bone lesions of Langerhans cell histiocytosis.     

Primary Leptomeningeal Sarcomatosis; A Pathology Proven Case with Challenging MRI and Clinical Findings

A 20-year-old male patient admitted with intractable seizures and progressive dementia is presented. Magnetic resonance imaging (MRI) examinations revealed diffuse leptomeningeal thickening, enhancement especially in the basal cisterns and multiple cystic formations in the brain stem, temporal lobes and basal ganglia. The pathologic examination from the right temporal lobe was consistent with leptomeningeal sarcoma. Marked regression of the symptoms and MRI lesions were detected following radiotherapy.     

Early diagnosis of spinal-epidural metastasis by magnetic resonance imaging

Sixteen patients with various types of cancer who developed pain along the axial spine were prospectively studied by magnetic resonance imaging (MRI). The studies were performed with a Fonar Beta-3000 (Fonar Co., Melville, NY) permanent magnet operating at 0.3 Tesla (T). Detailed neurologic examinations were followed by bone x-rays, bone scans, and MRI. In 12 patients there were focal neurologic findings. Bone x-rays and bone scans were diagnostic for metastatic disease in 10 cases; MRIs were consistent with metastatic spinal-epidural disease in all 16 patients. Magnetic resonance imaging revealed bone involvement in three patients whose x-rays and bone scans were both negative indicating a higher degree of sensitivity. In six patients thecal compression was obvious on MRI; in three of these previous myelograms had been interpreted as negative. These early results suggest that MRI can serve as a useful tool for diagnosing early spinal-epidural metastases.     

18F-FDG PET-CT与磁共振成像在评估淋巴瘤骨髓浸润中的价值

淋巴瘤是血液系统常见的恶性肿瘤之一,淋巴瘤是否有骨髓浸润在淋巴瘤的诊断、分期、尤其化疗早期疗效评估方面具有重要的价值.目前临床上仍主要依据骨髓穿刺活组织检查诊断淋巴瘤骨髓浸润,但常因取材的局限性出现假阴性,延误治疗.近年影像技术日益发展、完善,为淋巴瘤骨髓浸润提供了新的检测手段,提高了诊断的敏感性和特异性.文章对磁共振成像(MRI)、18F-FDG PET-CT这两种新的影像检查方法在淋巴瘤骨髓浸润方面的研究作一综述.     

Bone marrow infiltration in hairy cell leukemia after interferon therapy detected by magnetic resonance imaging

Magnetic resonance imaging (MRI) can detect bone marrow infiltration by neoplastic cells in many hematological malignancies. We studied 10 patients affected by hairy cell leukemia (HCL) and treated with interferon (IFN) with both MRI and bone marrow biopsy. T1-weighted MR scans of femurs and pelvis proved to be effective to score hairy cell infiltration, while less information was obtained from the study of the lumbar vertebral column. A good correlation (<10% difference) was noted between biopsy and MRI in over 90% of cases. MR scans showed, in general, a higher grade of infiltration. MR scan, however, can be useful for monitoring the course of HCL and the response to the treatment. Moreover, MRI evaluating a large amount of tissue, can detect a nodular type of infiltration which can be missed in biopsy specimens.     

螺旋CT与MRI评价鼻咽癌颅底侵犯

背景与目的：随着螺旋CT与MRI的普遍应用,研究哪种方法对鼻咽癌发生颅底侵犯的诊断更有价值,是临床上亟待解决的问题。本研究拟探讨用CT与MRI诊断鼻咽癌颅底侵犯的价值。方法：选取1993年8月--2001年9月经病理证实为鼻咽癌的患者6l例,全组患者治疗前均行螺旋CT及MRI检查。此外,螺旋CT薄层扫描三维重建8例。CT扫描采用Elscient CT Twin Flash,常规横断面平扫,部分加冠状面扫描,13例加增强扫描。MRI扫描采用Philips T5-Ⅱ型0.5 Tesla超导成像系统,标准头部正交线圈。常规SE序列,扫描方向为横断面、矢状面和冠状面,扫描范围由鞍上池至第二颈椎下缘水平,6l例中55例患者进行增强扫描。结果：CT发现颅底骨质侵犯17例,MRI扫描发现颅底侵犯26例,其中6例MRI扫描发现斜坡、翼突基底部和蝶骨基底部早期的骨髓浸润,而CT检查未见有这些部位的骨质破坏,另外3例MRI见肿瘤沿三叉神经向颅内侵犯,而CT未见明确的卵圆孔破坏。结论：CT与MRI均可显示鼻咽癌通过破坏骨质侵犯颅底,也可以通过自然孔道进入颅内。MRI较CT对颅底骨质破坏的检出更敏感,MRI可以发现肿瘤沿三叉神经向颅内侵犯,而卵圆孔没有骨质破坏。MRI较CT可以更准确地界定肿瘤的侵犯范围;螺旋CT薄层三维重建,可以较为直观地显示病灶。     

MRI findings of large low-grade angiosarcoma of the breast with subsequent bone metastases: a case report

We describe the magnetic resonance imaging (MRI) findings of 13 cm-sized low-grade angiosarcoma of the breast that occurred in a 23-year-old woman. Magnetic resonance examination revealed an ill-defined mass with marked high-signal intensity on T2-weighted images and persistent heterogeneous enhancement. Thirty months later she developed bone metastases, incidentally found on an MRI performed to evaluate the pelvis. There were well-defined bone lesions with high-signal intensity on T2-weighted images and persistent contrast enhancement on delayed phases. The metastases were not detected on previous computed tomography and fluoro-deoxyglucose positron emission tomography scans because the lesions were subtle osteoblastic type with a low proliferative index.     

Magnetic resonance imaging in the evaluation of treatment-related central nervous system damage

Neurologic and neuropsychologic treatment related sequelae are increasingly encountered in children with cancer, but conventional means of neurologic investigation are insensitive to the presence and extent of damage. Magnetic resonance imaging (MRI) has shown brain damage not demonstrable by other means of investigation. For this reason, 11 children with cancer and with nontumor-related neurologic dysfunction were studied on a 1.5 Tesla MRI unit. All had concurrent computed tomography (CT). MRI abnormalities were seen in all (100%) patients. In 10 of 11 patients, abnormalities were of greater extent on MRI than on CT. White matter changes were frequently seen on MRI without corresponding CT abnormality. Those patients with the most severe forms of neurologic compromise had the most extensive changes on MRI. Focal neurologic findings correlated well with regions of focal signal change. Milder forms of neurologic compromise occurred in patients with definite, but less extensive, periventricular and/or subcortical change on MRI. MRI is more sensitive than CT in demonstrating treatment-related neurologic damage in children with cancer, and the type of change seen on MRI seems to correlate well with the type and severity of neurologic dysfunction present.     

Epidural extramedullary haemopoiesis in thalassaemia

Intrathoracic extramedullary haematopoiesis is a rare condition. Involvement of the spinal epidural space with haematopoietic tissue is rather unusual. A 31‐year‐old‐man with a known diagnosis of β‐thalassaemia was referred with focal back pain. Magnetic resonance imaging revealed diffuse bone‐marrow changes, thoracic paraspinal masses and lobulated epidural masses, suggesting extramedullary haemopoiesis. The patient was treated with radiotherapy and blood transfusions. Follow‐up MRI was performed for evaluation efficacy of the treatment.