自身免疫性胰腺炎的影像学研究

目的 研究自身免疫性胰腺炎( autoimmune pancreatitis,AIP)的影像学表现及其临床价值.方法 回顾性研究14例经病理证实或肾上腺皮质激素规范治疗后随访证实的AIP患者临床资料,男13例,女1例,平均58.3岁.12例行CT检查,8例行MRI检查,其中6例同时行CT及MRI检查.结果 胰腺弥漫肿大者7例,局限肿块型5例,混合型2例.CT平扫病变呈等密度(5例)或稍低密度(7例),1例胰腺内及周边见多个囊性低密度灶,MRI病变T1WI序列信号均匀或稍不均匀降低,T2WI序列信号不同程度均匀或稍不均匀升高,DWI序列信号均升高.动态增强扫描,动脉期病变强化降低呈不均匀“雪花状”,后渐进性延迟强化.9例病变周围见“胶囊样”包壳.4例胰管形态不规则,5例胰管轻度扩张;9例胆总管下段管壁规则增厚伴明显强化及“鸟嘴样”管腔狭窄.4例病变周围血管受累,1例肝门区见2枚肿大淋巴结.2例增强后肾脏内见异常低密度灶.经肾上腺皮质激素规范治疗的10例患者随访影像学检查病变胰腺均有明显的好转及恢复.结论 AIP具有特征性的CT和MRI影像表现,对于AIP的诊断和鉴别诊断具有重要意义.     

【述评】自身免疫性胰腺炎典型影像学表现

自身免疫性胰腺炎（AIP）是一种特殊类型的慢性胰腺炎,临床并不少见,以往由于缺乏认识,多被误诊为胰腺癌。     

胰腺炎误诊胰腺癌CT及MRI征像分析

目的 从误诊为胰腺癌病例中寻找胰腺炎的影像特征。 方法 回顾性分析2001-2010年第二军医大学附属长征医院22例误诊为胰腺癌的胰腺炎CT、MRI影像学资料。 结果 误为局限性胰腺癌的胰腺炎有5种表现：胰腺局限性增大,胰腺内坏死、假性囊肿,胰腺不均匀脂肪沉积,继发于胰腺分裂的胰管潴留性扩张或胰管积血。误为弥漫性胰腺癌的胰腺炎有3种表现：胰腺弥漫肿大,胰腺广泛乏血供病变,胰腺周围没有渗出。误为胰腺外转移的胰腺炎有2种表现：胰旁假性囊肿、炎性结节误认为转移淋巴结,局部静脉血栓、动脉狭窄误认为血管侵犯。 结论 对表现不典型的胰腺癌均应想到胰腺炎或合并胰腺炎可能,应完整了解病史,仔细分析影像学特点和变化规律,密切随访。     

隆突性皮肤纤维肉瘤的MRI和CT表现

目的探讨隆突性皮肤纤维肉瘤（DFSP）的MRI与CT特征。方法回顾性分析11例经手术及病理证实的隆突性皮肤纤维肉瘤患者的MRI及CT资料。11例中,8例接受MR检查,其中5例接受增强扫描;4例接受CT扫描,其中1例同时接受增强扫描。结果10例DFSP位于皮下及皮下脂肪层,表现为边界清楚的椭圆形或分叶状肿块;1例位于左侧大腿中上段深部。DFSP在T1WI图像上主要为低至稍高信号,T2WI图像上呈稍高或高信号;CT平扫呈等密度。MR和CT增强扫描病灶均明昂强化。结论隆突件皮肤纤维肉瘤的MRI和CT嘉孤且右一宦特衍．右助千明确诊断．     

CT与MRI检查对自身免疫性胰腺炎的诊断价值

目的 探讨CT与MRI检查对自身免疫性胰腺炎（AIP）的诊断价值。方法 回顾性分析2011年 6月至2013年12月期间眉山市中医医院收治的14例AIP患者的临床和影像学资料。结果 CT和MRI检查示AIP患者的胰腺弥漫性肿大呈腊肠状,T1WI示胰腺实质信号明显减低,扩散加权成像（DWI）示胰腺实质信号明显增高;增强扫描后动脉期胰腺实质强化幅度明显降低,延迟期呈持续性延迟强化伴包膜征,胆总管胰腺段呈鸟嘴样狭窄。结论 AIP的影像学表现具有一定的特征性,结合临床表现及实验室检查可早期诊断,对选择治疗方案具有重要意义。     

自身免疫性胰腺炎的CT表现特征(附4例分析)

目的探讨自身免疫性胰腺炎(AIP)的CT表现特征。方法收集4例经临床、实验室检查和类固醇激素治疗有效的AIP患者的CT资料。CT检查包括平扫、双期(动脉期和门静脉期)增强扫描,在CT图像上观察胰腺的形态、大小、质地、强化程度、胰管、胰腺边缘、胰周及腹膜后各间隙等情况并分析AIP的CT表现特征。结果3例AIP表现为胰腺弥漫性肿大,1例为胰头的局限性肿大;病变区域胰腺实质在动脉期强化减弱但出现明显的延时强化;2例在胰腺病变区周围环绕包膜样结构;2例伴胆总管胰头段狭窄,1例ERCP显示胰管不规则狭窄;经类固醇激素治疗后,CT复查显示胰腺情况明显好转。结论AIP的CT表现具有一定的特征性。     

自身免疫性胰腺炎

自身免疫性胰腺炎（autoimmune pancreatitis,AIP）是一种少见而特殊的慢性胰腺炎。尽管Sarles领导的法国科学团队于1961年发表了第1篇关于自身免疫对胰腺影响的报道,但直到1995年AIP这个概念才为人所知。2001年,Hamano等里程碑式地阐述了AIP与免疫球蛋白（immunoglobulin,Ig）G4抗体的关系,     

自身免疫性胰腺炎诊治进展

自身免疫性胰腺炎(autoimmune pancreatitis,AIP)是一种特殊类型的慢性胰腺炎症。该病临床上少见,发病率约占慢性胰腺炎的4%～6%[1],临床表现多样,极易与胰腺癌混淆而误诊误治。1发病机制迄今为止AIP的发病机制仍不清楚。综合文献报道,可能的机制包括以下几点。1.1免疫因素免疫介导的发病机制一直以来是AIP基础研究的重点,大量文献已证实,AIP病人大多有高球蛋白     

自身免疫性胰腺炎

1965年，Sarles等报道了1例特殊的慢性胰腺炎，其病因并非是常见的酒精性，伴有高γ球蛋白血症，提示其病因与自身免疫有关。此后，相继报道一部分慢性胰腺炎的发病机制可能与自身免疫有关。近10年来，发现了相似的慢性胰腺炎病例，但不伴随全身自身免疫疾病，称之为自身免疫相关性胰腺炎，1995年，Yoshida等。将其命名为自身免疫性胰腺炎（autoimmune pancreatitis，AIP）。AIP已越来越多地受到了国外学者的重视，报道的病例数逐年上升。我国报道的病例不多，对其重视程度尚待进一步提高。     

自身免疫性胰腺炎影像学诊断误诊分析

自身免疫性胰腺炎（AIP）表现为胰腺弥漫性增大及主胰管不规则性狭窄。然而部分AIP由于缺乏典型影像学表现给诊断带来一定困难。     

Contrast enhanced computed tomography and magnetic resonance imaging in the diagnosis of recurrent disc herniation

Summary A positive result of re-operation in patients with recurrent symptoms after lumbar disc surgery is likely only if a new disc herniation is present. An improved ability to differentiate between recurrent disc herniation and scar tissue by contrast enhanced CT and MRI is suggested in earlier studies.In a prospective study 29 patients were selected for operation for suspected recurrent disc herniation. The inclusion of the patients was based on clinical symptoms and signs and myelography or non-enhanced CT. All patients were examined by CT and MRI both with and without intravenous contrast pre-operatively. The examinations were evaluated blind on a five point scale and statistical analysed by a regret function.Intravenous contrast improved the diagnostic power of both CT and MRI. MRI was superior to CT in both non-enhanced and enhanced examinations. MRI with intravenous contrast enhancement is proposed as the primary examination in patients with suspected recurrent disc herniation.     

Imaging characteristics of papillary renal cell carcinoma by computed tomography scan and magnetic resonance imaging

AIM: To analyse the differences in the patterns between clear and papillary renal cell carcinomas using magnetic resonance imaging (MRI) and dual-phase helical computed tomography (CT). METHODS: We examined seven patients with papillary renal cell carcinoma, and six with clear cell carcinoma. The highest attenuation value of tumors in the corticomedullary phase (CMP) and the excretory phase (EP) was measured using the observer-defined region of interest (ROI). MRI consisted of T1-weighted and T2-weighted spin-echo imaging. RESULTS: All five tumors except for one with papillary renal cell carcinoma showed homogenous hypointensity, but all six tumors with clear cell carcinoma showed heterogeneous hyperintensity on their T2-weighted images. In the CMP, the mean CT numbers of the papillary renal cell carcinomas were significantly lower than those of the clear cell carcinomas. The mean enhancement of the papillary renal cell carcinomas in the CMP and the EP was significantly lower than that of the clear renal cell carcinomas. The mean CT numbers of the clear cell carcinomas in the CMP were markedly increased from those on the unenhanced CT; those in the EP were decreased gradually. But the mean CT numbers of the papillary renal cell carcinomas in the EP were still slightly more increased than those in the CMP. The enhancement patterns of the papillary renal cell carcinomas in the CMP and the EP were homogenous, but those of the clear cell carcinomas were heterogeneous. CONCLUSIONS: We can speculate the differential diagnosis from clear to papillary renal cell carcinoma using MRI and dual-phase helical CT.     

The role of ultrasonography in the detection of adrenal masses: Comparison with computed tomography and magnetic resonance imaging

To compare detection rates of adrenal tumors by ultrasonography,computed tomography and magnetic resonance image, we studied 61patients with adrenal tumor, who underwent adrenalectomy. In 45(73.8%) of the 61 patients, adrenal tumor was detected by ultrasonography. However, computed tomography and magnetic resonance imaging could detect all adrenal tumors. All adrenal tumors measuring more than 3.0 cm in diameter were detected by ultrasonography, computed tomography and magnetic resonance image. When adrenal tumors were smaller than 3.0 cm, however,ultrasonography, computed tomography and magnetic resonance imaging correctly found adrenal tumors in 30 (65.2%) and 46(100.0%) of 46 patients and 30 (100.0%) of 30 patients,respectively. These facts suggest that ultrasonography seems to be an effective diagnostic procedure for the prevention of overlooking adrenal tumors larger than 3.0 cm. This revised version was published online in September 2006 with corrections to the Cover Date.     

Spoke-wheel-like enhancement as an important imaging finding of chromophobe cell renal carcinoma: A retrospective analysis on computed tomography and magnetic resonance imaging studies

AIM: Little information has been reported with regard to the radiological features of chromophobe cell renal carcinomas (CCRC). The aim of the present study was to identify imaging characteristics which lead to the histological diagnosis of CCRC. METHODS: The imaging findings of computed tomography (CT) and magnetic resonance imaging (MRI) were retrospectively analyzed in 11 patients with CCRC operated on at Tokyo Women's Medical University, Tokyo, Japan. RESULTS: None of the factors studied were significant in distinguishing the two variants, typical and eosinophilic variants. Enhanced CT scans showed a spoke-wheel-like enhancement with a central scar in 3 patients (27%). The radiological patterns were classified into two groups. Seven patients (64%) showed pattern 1 in which: (i) a hypodense to isodense enhancement compared to the renal medulla in the corticomedullary phase during dynamic CT; (ii) an isodense mass compared to the renal medulla in unenhanced CT scan; and (iii) a lobulated appearance were typically observed. Four patients (36%) showed pattern 2 that seemed to be similar to the features of clear cell carcinoma, having an alveolar structure including a hyperdense enhancement in the corticomedullary phase and an inhomogeneous appearance. A spoke-wheel-like enhancement was observed only in patients with pattern 1, and was more clearly demonstrated in larger tumors. CONCLUSIONS: The CT and MRI findings in CCRC patients were not uniform, but it was noted that a spoke-wheel-like enhancement with a central stellate scar, which might have been mistaken for oncocytoma, was one of important findings of CCRC. Tumors demonstrating a spoke-wheel-like enhancement with a central scar should be carefully managed, because they could be malignant.     

A prospective comparison between multidetector-row computed tomography and magnetic resonance imaging in the preoperative evaluation of rectal carcinoma

BACKGROUND: Multidetector-row computed tomography (MDCT, or multislice CT) is a new modality with four detectors, which makes examination time shorter and produces higher resolution and multiplanar reformation of the images. Its diagnostic role in patients with rectal carcinoma has not been determined. METHODS: Twenty-one patients with rectal carcinoma were preoperatively examined by both MDCT and magnetic resonance imaging (MRI). Diagnostic accuracies of both modalities were compared regarding depth of tumor invasion and lymph node metastasis based on the pathologic findings. RESULTS: Both examinations detected all tumors. Regarding depth of tumor invasion, the concordance was 95.2% (20 of 21) for MDCT and 100% (21 of 21) for MRI. Regarding lymph node metastasis, the overall accuracy was 61.9% for MDCT and 70.0% for MRI. CONCLUSIONS: Multidetector-row computed tomography was equal to MRI in the preoperative local staging of rectal carcinoma.     

Femoroacetabular impingement with chronic acetabular rim fracture - 3D computed tomography, 3D magnetic resonance imaging and arthroscopic correlation

Femoroacetabular impingement is uncommonly associated with a large rim fragment of bone along the superolateral acetabulum. We report an unusual case of femoroacetabular impingement (FAI) with chronic acetabular rim fracture. Radiographic, 3D computed tomography, 3D magnetic resonance imaging and arthroscopy correlation is presented with discussion of relative advantages and disadvantages of various modalities in the context of FAI.