肝泡型包虫病肝内外转移及其与肝癌的鉴别诊断

目的:探讨肝泡型包虫病肝内外转移及与肝癌的鉴别诊断。方法:分析经手术病理证实的20例肝泡型包虫合并肝内外转移患者的影像学资料,并行卡松尼试验及实验室检查。结果:20例病例中,脑转移3例,肺转移4例,脑转移合并肺转移3例,行相关影像学检查可见肝内、颅脑、肺实性占位性病变,以上病例行卡松尼皮内过敏试验均为阳性,AFP、CEA、CA199值均在正常范围内。结论:肝泡型包虫病类似肝恶性肿瘤,可从肝脏转移或扩张至其他器官,行相关影像学检查、卡松尼皮内过敏试验、AFP、CEA、CA199测定可与肝脏原发肿瘤相鉴别。     

An incidental case of biliary fascioliasis with subtle clinical findings: US and MRCP findings

Background

Fascioliasis is a disease caused by the trematode Fasciola hepatica. Cholangitis is a common clinical manifestation. Although fascioliasis may show various radiological and clinical features, cases without biliary dilatation are rare.

Case report

We present unique ultrasound (US) and magnetic resonance cholangiopancreatography (MRCP) findings of a biliary fascioliasis case which doesn’t have biliary obstruction or cholestasis. Radiologically, curvilinear parasites compatible with juvenile and mature Fasciola hepatica within the gallbladder and common bile duct were found. The parasites appear as bright echogenic structures with no acoustic shadow on US and hypo-intense curvilinear lesions on T2 weighted MRCP images.

Conclusions

Imaging studies may significantly contribute to the diagnosis of patients with subtle clinical and laboratory findings, particularly in endemic regions.     

Early MRI findings in High Grade Glioma

Magnetic resonance imaging (MRI) is more sensitive than computerized tomography in the detection of many intracerebral lesions; however, the significance of some MRI findings may be unclear. Over four years, nine patients, aged 40–79 years, have been encountered whose initial MRI scans were negative or had minimal abnormalities and soon thereafter had high grade glioma. Initial MRI was performed in eight patients for new-onset seizures and one patient for a focal deficit. MRI was negative in four of the patients and mildly abnormal in five of the patients (small areas of increased T2 and/or minimal enhancement). The initial diagnoses usually included inconclusive differentials of stroke and infection with neoplasm less frequently considered. Radiographic progression leading to the diagnosis of high grade glioma became evident on repeat MRI in 1–8 months with six patients showing progression within three months. All patients underwent surgery and had histologic diagnosis of glioma. Although MRI is quite sensitive, four of the initial scans were negative with reasonable quality studies. Conversely, in five of the initial scans, the tumors were detected when so small that the radiographic findings were not typically diagnostic. Glioma must be considered as a possible cause of initial seizures or new neurologic deficits in adults with normal or minimally abnormal MRI. In this group, seizures were the overwhelming hallmark of presentation. In such a clinical situation, close follow-up with short interval repeat MRI should be performed.     

MRCP和CT在肝门部胆管癌术前分型中的价值

目的 探讨磁共振胰胆管成像(MRCP)和CT在肝门部胆管癌患者术前分型的价值.方法 对42例经病理学证实的肝门部胆管癌患者影像学资料进行回顾性分析,采用Bismuth-Corlette分型比较术前及术后结果.结果 MRCP和CT对肝门部胆管癌术前诊断准确率分别为93％、79％;MRCP和CT术前及术后分型差异无统计学意义(P＞0.05).结论 MRCP对肝门部胆管癌的术前分型准确率较CT高,对术前手术方式的选择有重要的参考价值.     

Central neurocytoma occurring in the thalamus: CT and MRI findings

A case of central neurocytoma occurring in the thalamus, confirmed by electron microscopy and immunohistochemistry, is reported. Computed tomography demonstrated a hypodense mass with an irregular margin arising from the right thalamus, extending into the lateral ventricle and crossing the midline. It contained areas of calcification and showed slight enhancement after contrast injection. On magnetic resonance imaging (MRI) scan, the tumour was hypointense to the brain in T1-weighted images and was heterogeneously hyperintense to the brain in T2-weighted images.     

Brain MRI findings in two cases with eclampsia

Neurological complications in patients with eclampsia are varied and include headache, visual disturbances, focal neurological deficits, altered mental status and coma. Occasionally, a focal neurological deficit includes a variety of visual disturbances. The pathophysiology of CNS abnormalities in patients with eclampsia is uncertain. Our cases, combined with a review of the literature, demonstrate that there is no correlation among severity of hypertension, parity, and location of lesions at initial magnetic resonance (MR) imaging findings or between the severity of hypertension and neurological symptoms. Two typical patterns are seen on MR images of patients with eclampsia. Lesions in the region of the posterior cerebral circulation are most common and are frequently associated with visual disturbances. Although there are lesions in the deep white matter or basal ganglia, a focal neurological deficit or alterations in mental status may not develop. This demonstrates the sensitivity of MR imaging in the detection of abnormalities in patients with eclampsia, even those without neurological deficits.     

MRI findings of cerebral cryptococcosis in immunocompetent patients

Worldwide, cerebral cryptococcal infections caused by cryptococcus neoformans are mostly found in immunocompromised patients, but less found in immunocompetent patients with fewer related imaging reports in literatures. This pictorial essay describes some important MR imaging features in arriving at diagnosis for cerebral cryptococcosis in immunocompetent patients by way of five illustrative cases with intact MRI data.     

磁共振肝胆特异性对比剂普美显Gd-EOB-DTPA的临床应用进展

新型肝细胞特异性对比剂普美显Gd-EOB-DTPA,具有非特异性细胞外对比剂的性质,能进一步特异性地被肝细胞所摄取,部分由胆道系统排泄。由于具有细胞特异性和独特的代谢特点,Gd-EOB-DTPA增强磁共振成像表现出良好的诊断效能,特别在肝脏局灶性病变的检出、鉴别诊断及指导临床等方面具有明显优势。     

卵黄囊瘤的CT及MRI表现

目的:探讨卵黄囊瘤CT及MRI的表现及在诊断中的应用价值。方法:回顾性分析2005年1月至2015年5月经病理证实的40例卵黄囊瘤的CT或MRI表现及临床特征。结果:发病年龄9个月~50岁,平均年龄12.7岁;其中男17例,女23例。肿瘤位于卵巢18例,睾丸12例,骶尾部6例,阴道2例,膈肌1例,腹股沟1例。影像学表现为类圆形或不规则形肿块,呈实性或囊实混合性,肿瘤最大径1.5~28cm。增强扫描实性部分明显不均匀强化,实性部分及囊壁内可见迂曲血管影。结论:卵黄囊瘤在CT及MRI存在特征性的影像学表现,结合发病年龄、AFP升高等临床特征,可以提高对该病的鉴别诊断。     

子宫内膜间质肉瘤的MRI表现

目的:探讨子宫内膜间质肉瘤的MRI表现特点。方法:回顾性分析7例经手术及病理证实的子宫内膜间质肉瘤患者的临床和MRI资料。所有病例均行MRI平扫。结果:本组7例患者子宫体积均增大。6例病变位于宫腔内,呈息肉状突向宫腔或弥漫性填充宫腔;1例位于子宫肌壁间,类似囊性变性子宫肌瘤。2例囊实混合性占位,5例实性占位。7例ESS病变直径范围为2.5cm-15cm,平均8.8cm。肿瘤在MRI平扫上5例T1WI 呈等信号或低信号,T2WI呈稍高信号;2例T1WI呈等及低信号,T2WI呈稍高为主的混杂信号,伴有出血或坏死囊变,其中1例位于子宫肌壁间。6例可见向子宫肌层侵润性生长,子宫T2WI结合带低信号中断或消失,其中1例可见宫颈、双侧输卵管壁、卵巢及膀胱受侵,1例子宫肌层及宫旁可见扭曲条点状流空信号影。4例合并少量盆腔积液,2例合并子宫肌瘤,1例合并卵巢滤泡囊肿,3例合并增殖期子宫内膜。病理示低度恶性ESS 6例,未分化ESS 1例。结论:子宫内膜间质肉瘤好发于宫腔内,也可见于子宫肌壁间,多向子宫肌层浸润性生长,于T1WI呈等或低信号,T2WI呈稍高信号,伴出血或坏死囊变时呈T2WI稍高信号为主的混杂信号,其在MRI上具有一定的信号特点,能为该病的诊断提供帮助。     

Adhesive capsulitis: contrast-enhanced shoulder MRI findings

Purpose: Evaluation of contrast‐enhanced magnetic resonance imaging (CE‐MRI) findings in cases clinically diagnosed as adhesive capsulitis (AC). Methods: CE‐MRI images of 12 cases diagnosed as AC (13 shoulder joints) and nine control cases were retrospectively evaluated. AC diagnosis was established based on the history and clinical symptoms. MR signal intensity changes in the axillary pouch, rotator interval, biceps anchor and anterior–posterior capsules were analysed with regard to the presence of abnormal soft tissue and contrast enhancement. Capsular and synovial thickening were measured in the axillary recess and rotator interval on coronal oblique CE T1‐weighted images. Patient and control groups were compared by Fisher's exact and McNemar tests in terms of signal intensity changes and contrast enhancement in the described areas. Results: Comparison of the group with AC and the control group regarding intensity changes showed a statistically significant difference in the axillary pouch (P < 0.001). No significant difference was found in the rotator interval, biceps anchor and anterior–posterior capsules (P > 0.05). Comparison of AC and control groups in terms of contrast enhancement revealed statistically significant differences in the axillary pouch, rotator interval, biceps anchor and anterior–posterior capsules (P < 0.001). A significant difference was determined between the AC and control groups with regard to thickening in axillary pouch and rotator interval (P < 0.001). Conclusion: CE studies are useful for diagnosis of AC as it demonstrates thickening of specific soft‐tissue areas like joint capsule and synovium.     

Haemolysis,elevated liver enzymes and low platelets syndrome: Ultrasound and magnetic resonance imaging findings in the liver

We describe the imaging findings of the HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome in a gravid 36‐year‐old‐woman who presented at 19.5 weeks gestation with severe right upper quadrant pain. Ultrasound findings suggested a focal hyperechoic liver lesion suggesting pregnancy‐related hepatopathy prior to development of biochemical signs of HELLP syndrome. Within 3 days, the patient developed characteristic clinical and laboratory evidence of the HELLP syndrome. MR imaging at this time demonstrated localized hepatic ischaemia, further strengthening the diagnosis of HELLP syndrome.     

Evaluation of MRI T1-based treatment monitoring during laser-induced thermotherapy of liver metastases for necrotic size prediction

Purpose: The aim of this study was to evaluate the accuracy of real-time magnetic resonance imaging (MRI) T1-based treatment monitoring for predicting volume of lesions induced by laser-induced thermotherapy (LITT) of liver metastases.

Materials and methods: This prospective study was approved by the institutional review board and informed consent from all included patients was obtained. In 151 patients, 237 liver metastases were ablated during 372 LITT procedures. 1.5T MRI treatment monitoring was performed based on longitudinal relaxation time (T1) using fast low-angle shot (FLASH) sequences. Patients underwent additional contrast-enhanced MRI directly after LITT, 24?h after the procedure and during follow-up at 3, 6 and 12 months. The amount of energy necessary to induce a defined necrotic area was investigated within the various liver segments.

Results: The total amount of energy applied during LITT varied from 6.12–225.32?kJ (mean 48.96?kJ). Ablation in liver segments 5 (2.12?kJ/cm³) and 8 (2.16?kJ/cm³) required the highest energy. The overall pre-ablative metastasis volume ranged from 0.5–51.94?cm³ (mean 1.99?cm³, SD 25.49?cm³) while the volume measured in the last available T1 image varied from 0.78–120?cm³ (mean 26.25?cm³, SD 25.66?cm³). Volumes measured via MRI T1-based treatment monitoring showed a stronger correlation with necrosis 24?h after LITT (r?=?0.933, p?r?=?0.888, p?Conclusions: Real-time MRI T1-based treatment monitoring during LITT of liver metastases allows for precise estimation of the resulting lesion volume and improves control of the energy necessary during ablation.     

Prostatosymphyseal fistula and osteomyelitis pubis following transurethral resection of the prostate: CT and MRI findings

We present a very rare case of osteomyelitis pubis in a 75‐year‐old male patient due to a prostatosymphyseal fistula, which constituted a few weeks after trans‐urethral resection of the prostate. The patient had a previous history of prostatic carcinoma treated by radiotherapy, which may have played a role in the development of the fistula. Computed tomography with excretory phase and magnetic resonance imaging were performed and enabled to make the final diagnosis.     

MRI findings in deep infiltrating endometriosis: A pictorial essay

Endometriosis is an important gynaecological disorder which can impact significantly on an individual's quality of life and has major implications on fertility. Deep infiltrating endometriosis is a severe form of endometriosis which can cause obliteration of anatomic compartments. Laparoscopy remains the gold standard for diagnosis of endometriosis, although is an invasive procedure that has the potential to be hindered by obliterative disease. Ultrasound is often employed as the first‐line imaging modality when endometriosis is suspected, however, MRI is more accurate in assessment of complex disease. Pre‐operative MRI is highly specific in the diagnosis of endometriosis and characterization of disease extent, and plays a key role in guiding surgical management. MRI findings in deep infiltrating endometriosis are described.     

MRI对肝动脉栓塞化疗治疗肝癌近期疗效随访的价值

[目的]评估MRI对经肝动脉栓塞化疗（transcatheter arterial chemoembolization,TACE）治疗肝癌近期疗效随访的价值。[方法]回顾性分析肝癌手术切除后复发22例患者（36个病灶）经TACE治疗后的MRI表现。[结果]MRI可正确判断22例患者（36个病灶）肝癌在TACE治疗后的近期疗效。随访1年,肿瘤完全凝固坏死32个,残留癌灶4个,2例患者在TACE治疗后1～3个月出现复发。[结论]MRI能准确评估TACE治疗肝癌的近期疗效。     

Three-dimensional movement of a liver tumor detected by high-speed magnetic resonance imaging

Objective: Three-dimensional (3D) movement of a spherical liver tumor during respiration was investigated with magnetic resonance imaging (MRI) using a high-speed sequence.

Methods: A marker was placed on the surface of the patient as a reference of distance. Repetition time (TR) was 7.7 ms, echo time (TE) was 4.2 ms, flip angle was 20°, section thickness was 8 mm, and a 256×128 matrix was used. The acquisition time was 1.0 s followed by an interval of 0.5 s. The 20 tumor contours extracted during 30 s were superimposed on sagittal and coronal MR images.

Results: The maximum value of tumor edge location was 3.9 cm in the cranio–caudal direction, 2.3 cm in the ventro–dorsal direction, and 3.1 cm in the lateral direction. The mean length of tumor displacement observed was 2.1 cm in the cranio–caudal direction, 0.8 cm in the ventro–dorsal and 0.9 cm in the left–right direction, respectively. The locus of the center of the tumor contour in the sagittal cross section was inclined at 23° and in the coronal cross section was inclined at 18° to the cranio–caudal axis of body.

Conclusion: In conclusion, 3D movement of a spherical liver tumor was detected using rapid MRI sequential examinations. Magnetic resonance imaging has a potential to improve the accuracy of the planning target volume of a liver tumor.     

The relationship between cardiac and liver iron evaluated by MR imaging in haematological malignancies and chronic liver disease

Although iron overload is clinically significant, only limited data have been published on iron overload in haematological diseases. We investigated cardiac and liver iron accumulation by magnetic resonance imaging (MRI) in a cohort of 87 subjects who did not receive chelation, including 59 haematological patients. M-HIC (MRI-based hepatic iron concentration, normal values <36 μmol/g) is a non-invasive, liver biopsy-calibrated method to analyse iron concentration. This method, calibrated to R2 (transverse relaxation rate), was used as a reference standard (M-HIC(R2)). Transfusions and ferritin were evaluated. Mean M-HIC(R2) and cardiac R^* of all patients were 142 μmol/g (95% CI, 114–170) and 36.4 1/s (95% CI, 34.2–38.5), respectively. M-HIC(R2) was higher in haematological patients than in patients with chronic liver disease or normal controls (P<0.001). Clearly elevated cardiac R2^* was found in two myelodysplastic syndrome (MDS) patients with severe liver iron overload. A poor correlation was found between liver and cardiac iron (n=82, r=0.322, P=0.003), in contrast to a stronger correlation in MDS (n=7, r=0.905, P=0.005). In addition to transfusions, MDS seemed to be an independent factor in iron accumulation. In conclusion, the risk for cardiac iron overload in haematological diseases other than MDS is very low, despite the frequently found liver iron overload.     

Diagnostic accuracy of diffusion-weighted MRI for identifying hepatocellular carcinoma with liver explant correlation

Background: The goal of this study was to use liver explant correlation to assess the diagnostic accuracy of diffusion‐weighted (DW)‐MRI for hepatocellular carcinoma (HCC). Materials and methods: Thirty‐seven patients were retrospectively identified who had undergone liver transplantation and had preoperative, respiratory‐triggered, single‐shot echo‐planar DW‐MRI. Two independent blinded observers evaluated the DW‐MRI images for HCC and comparison was made with the explanted specimens. Results: By pathology, 29 HCCs (mean largest diameter 2.0 cm; range 0.7–4.0 cm) were identified in 20 patients. Sensitivity and specificity for reader 1 were 55 and 92%, and for reader 2 were 45 and 100%. There was ‘substantial’ inter‐observer agreement (kappa = 0.64). Conclusion: DW‐MR is not sensitive enough for HCC to be used as a stand‐alone sequence, although its high specificity suggests that it is likely valuable as a component of a liver MRI protocol.     

Practice MRI: Reducing the need for sedation and general anaesthesia in children undergoing MRI

The aim of this study was to evaluate the effectiveness of a practice magnetic resonance unit, in preparing children to undergo magnetic resonance procedures without general anaesthesia (GA) or sedation. The records of children who attended the practice MRI between February 2002 and April 2004 were retrospectively reviewed. Each record was assessed as to whether the child had passed or failed the practice MRI intervention. Those children who were considered to have passed and were proceeded to a clinical non‐GA MRI had the report of the clinical scan reviewed. If the scan had been reported as non‐diagnostic because of movement artefact it was classified as a failed scan, otherwise it was considered a pass. One hundred and thirty‐four children undertook a practice MRI (age range 4.1–16.1 years, median age 7.7 years, 47% boys) and 120/134 (90%) passed the practice session. In all, 117/120 (98%) subsequently had a clinical non‐GA MRI and 110/117 (94%) passed (median age 7.8 years, 47% boys). Preparation is a safe and effective method to reduce the need for sedation and GA in children undergoing a clinical MRI scan. It provides a positive medical experience for children, parents and staff, and results in cost savings for the hospital.