髋部撞击的影像学评估

髋部撞击是引起髋关节或腹股沟疼痛的常见原因,可以导致髋关节内结构及周围组织的损伤,严重影响患者生活质量。髋部撞击根据发生撞击的部位可以分为股骨髋臼撞击和关节外撞击,后者主要包括棘下撞击、坐骨股骨撞击、髂腰肌撞击及大粗隆骨盆撞击等。了解各种髋部撞击的影像学特点,有助于早期诊断及早期治疗,对于改善预后有十分重要的意义。笔者对各种髋部撞击的影像学表现进行总结,希望提高广大放射科医师对该组疾病的认识。     

颅内脂肪瘤的磁共振表现

目的:分析颅内脂肪瘤MRI影像特点并探讨其发生机制.材料和方法:58例颅内脂肪瘤(2例手术证实,其余依据典型短T1中长T2和高质子密度的MR信号和抑脂时信号消失而诊断),男性28例,女性30例,年龄41.3(9～77)岁.均采用常规SE序列,T2WI加脂肪抑制,其中4例使用了T1WI脂肪抑制.结果:全部病灶均具有典型MR信号,与球后或皮下脂肪信号相同,并均无占位效应.中线脂肪瘤41例,合并发育异常9例.其中胼胝体区16例,包括巨块3例,弧线型12例,小点状1例;四叠体池、环池区域13例,小脑上池6例,窦汇区、蚓部、纵裂内、小脑半球间、鞍上池、跨枕大孔区各1例.非中线脂肪瘤15例.包括天幕池2例,桥小脑角池、侧裂池、侧脑室三角区各4例,及脑实质1例.多发2例,分别为2个和4个瘤体.结论:颅内脂肪瘤具有典型MR信号,中线部位尤其胼胝体区多见,并常见伴行的发育异常;非中线部位表现多样,形态各异,伴行发育异常少;少数可多发.胼胝体区脂肪瘤具有较强规律性,与胼胝体发生发育一致;非胼胝体区脂肪瘤与脑膜关系密切.     

侧脑室脑膜瘤的磁共振表现

目的：通过分析侧脑室脑膜瘤的磁共振特征,以提高诊断准确性。方法分析手术病理证实的27例侧脑室脑膜瘤的磁共振资料,总结其磁共振影像特点。结果25例位于侧脑室后角及三角区（其中19例位于左侧、6例位于右侧）、1例位于侧脑室体部、1例为多发。所有肿瘤M RI均表现为边界清楚的肿块影。22例肿瘤形态呈圆形（81．5％）,5例浅分叶（18．5％）,1例深分叶。信号均与脑灰质对比,T1 WI呈等高或稍低信号,T2 W/FLAIR呈等或稍高信号,与脑室外脑膜瘤信号基本一致。T1 WI增强扫描多数为明显强化,并显示肿块边缘与脉络丛相连。肿瘤病理类型：19例为纤维型、8例为上皮型。测ADC平均值分别为纤维型（0．89±0．12）×10-3mm2/s ,上皮型（0．95±0．18）×10-3mm2/s。结论侧脑室脑膜瘤具有一定的M RI征象,可以提高术前诊断的准确性。     

结节性硬化症的磁共振影像学表现

目的　分析结节性硬化症TSC的MRI表现。方法　 13例经临床证实的TSC病例 ,分析其头部MRI特征性改变。结果　MRI主要征象包括 :①室管膜下结节 :13例均发现病灶 ,T1WI发现 71个 ,T2 WI 39个 ,PDWI 5 6个 ;②皮层及皮层下结节 :11例有阳性发现 ,T2 WI和PDWI各发现 114个病灶 ,T1WI 72个 ;③脑白质异常信号 :5例发现白质病变 ,T2 WI和PDWI各发现 10个病灶 ,T1WI无明确显示 ;④室管膜下巨细胞星形细胞瘤 :仅 1例发现。结论　MRI对TSC的中枢神经系统改变敏感 ,是诊断此病的首选影像学检查方法 ,其中T1WI观察室管膜下结节敏感 ,T2 WI和PDWI观察皮层下及白质病变敏感     

Alzheimer病的早期磁共振表现

介绍了Alzheimer病在常规磁共振成像(MRI)、功能性磁共振(fMRI)及磁共振波谱成像(MRS)中的早期表现及鉴别诊断。     

Alzheimer病的早期磁共振表现

介绍了Alzheimer病在常规磁共振成像(MRI)、功能性磁共振(fMRI)及磁共振波谱成像(MRS)中的早期表现及鉴别诊断.     

大转子疼痛综合征的MRI表现

目的:探讨大转子疼痛综合征(GTPS)患者的MRI表现.方法:回顾性分析2018年1月-2020年4月在本院经临床诊断为GTPS的20例患者的临床及MRI资料.MRI扫描序列主要有冠状面和横轴面T1WI、T2WI和STIR序列.结果:20例患者累及26髋.主要MRI表现:臀中肌或臀小肌肌腱增厚或信号增高(n=9);臀中...     

大动脉炎血管壁的磁共振表现特点

目的：分析大动脉炎血管壁的MR表现特征及其临床应用价值。方法：32例临床确诊为大动脉炎的患者接受了MR检查,其中处于病情活动期20例,非活动期12例。分析并比较了两组患者受累动脉管壁的MR表现特征。结果：所有受累动脉的血管壁均不同程度的环形增厚。活动期组患者的管壁厚度较非活动期组患者明显增厚[（4．6±0．4）mm vs（3．4±0．6）mm,P〈0．01];比较两组增厚的血管壁形态,管壁呈“多环征”（分别为89／100和25／60）、内层明显强化（分别为66／100和24／60）、血管外界模糊不清（分别为72／100和20／60）等征象,经Х^2检验差异均有统计学意义（P〈0．01）。结论：大动脉炎血管壁的MR主要征象是管壁增厚及其信号改变。MRI能观察血管壁精细的形态学变化,对大动脉炎管腔狭窄前的早期诊断以及活动性判断具有重要价值。     

膝关节骨关节炎的磁共振成像

目的：探讨膝关节骨关节炎患者运用MRI发现膝关节各结构病变的价值以及与疼痛症状之间的关系。方法：搜集本院已确诊或拟诊为膝关节骨关节炎的患者28例（男12例,女16例,平均年龄61.4岁）共31个膝关节为研究对象,运用主诉疼痛分级法对疼痛程度进行分级。运用1.5T磁共振仪对上述膝关节行多序列扫描,观察各研究对象磁共振图像中各种病变的出现率。运用统计软件（SPSS13.0;SPSS,Chicago,Ⅲ）分别计算本研究对象中上述关节各种结构病变的出现率,并行多组独立样本间Fisher精确检验比较不同疼痛程度患者组间出现上述征象的差别,以P〈0.05为差异有显著性意义。结果：所有31例膝关节骨关节炎患者中磁共振成像显示关节软骨异常、半月板异常、前交叉韧带异常、软骨下骨骨髓水肿样改变、骨赘形成、滑膜增厚、关节积液的出现率分别为37.1%、32.3%、38.7%、45.2%、100%、15.1%和67.7%。其中轻、重度疼痛患者两组间有无关节积液及关节积液Ⅰ级和Ⅱ级的出现率差异均有显著性意义（P=0.004,0.001）。结论：磁共振可对膝关节骨关节炎患者行全关节各结构的评价,能很好地显示关节多方面的病理改变。患者的疼痛症状与关节积液有关。     

血管周围间隙的磁共振成像表现

血管周围间隙包绕在经蛛网膜下腔进入脑实质的小血管壁周围,小的血管周围间隙见于任何年龄,随着年龄增长血管周围间隙呈增多增大趋势。肉眼观察血管周围间隙在MRI的各种成像序列上与脑脊液信号一致。扩大的血管周围间隙常分布于三个特征性的部位:Ⅰ型血管周围间隙见于豆纹动脉经前穿支进入基底节处;Ⅱ型血管周围间隙分布于脑的穿髓动脉进入大脑凸面并延伸至皮质下白质处;Ⅲ型血管周围间隙见于脑干。偶尔血管周围间隙表现不典型,可能很大,集中于一侧大脑半球,甚至产生占位效应。根据血管周围间隙的发生部位和MRI信号特征可与多种病变相鉴别。     

The hip abductors at MR imaging

Imaging of the hip abductors plays an increasing role for the evaluation of greater trochanteric pain in patients with and without total hip arthroplasty. This review article addresses the anatomy of the hip abductors and their intervening bursae. It highlights different possible imaging appearances such as tendinopathy or partial and full thickness tears of the gluteal tendons. Muscle atrophy or fatty degeneration of the gluteal muscles is an important reason for limping. Inflammatory diseases such as hydroxyapatite crystal deposition disease or spondylarthritis have to be considered. Knowledge of these different entities is important to achieve optimal treatment and outcomes.     

Hip pain in adults: MR imaging appearance of common causes

To determine the exact origin of hip pain can be challenging. Symptoms apparently originating from the hip may arise from the pelvis, the sacroiliac joint, the lumbar spine, periarticular structures such as muscles and bursae, or from unexpected sites such as the abdominal wall, the genitourinary tract, or the retroperitoneal space. This article reviews the differential diagnosis of hip pain arising from the hip and surrounding structures and the role of different imaging methods with emphasis on magnetic resonance imaging where most recent advances have occurred.     

Evaluation of radial-sequence imaging in detecting acetabular labral tears at hip MR arthrography

Objective In recent years, radial imaging has been advocated for improved visualization of the acetabular labrum in magnetic resonance arthrography of the hip. The purpose of this study was to investigate whether radial imaging demonstrates labral tears not visible on standard imaging planes. Methods Fifty-four consecutive magnetic resonance (MR) arthrograms of the hip that included radial imaging over 2 years were retrospectively analyzed by two radiologists. Standard imaging planes and radial imaging were reviewed for identification of labral tears in four specific areas of the labrum: anterosuperior, posterosuperior, anteroinferior, and posteroinferior. The standard imaging sequences include fat-saturated spin-echo T1-weighted images in the coronal and oblique axial planes, non-fat-saturated T1-weighted images in the coronal and sagittal planes, and T2-weighted sequence in the axial plane. Radial imaging was performed as previously described using fat-saturated T1-weighted sequences. Results Using standard imaging planes, 50 anterosuperior, 31 posterosuperior, 10 anteroinferior, and 9 posteroinferior labral tears were detected in 54 MR arthrograms of the hip. Using radial sequences alone, 44 anterosuperior, 25 posterosuperior, 9 anteroinferior, and 5 posteroinferior labral tears were detected. In all four areas of the labrum, the radial imaging did not show any labral tear not seen on standard imaging planes. Discussion In MR arthrography of the hip, radial imaging did not reveal any additional labral tears. Standard imaging planes sufficiently demonstrate all acetabular labral tears.     

Chronic medial knee pain without history of prior trauma: correlation of pain at rest and during exercise using bone scintigraphy and MR imaging

Objective  The objective of this study was to correlate chronic medial knee pain at rest and during exercise with bone scintigraphic uptake, bone marrow edema pattern (BMEP), cartilage lesions, meniscal tears, and collateral ligament pathologies on magnetic resonance MR imaging (MRI). Materials and methods  Fifty consecutive patients with chronic medial knee pain seen at our institute were included in our study. Pain level at rest and during exercise was assessed using a visual analog scale (VAS). On MR images, BMEP volume was measured, and the integrity of femoro-tibial cartilage, medial meniscus, and medial collateral ligament (MCL) were assessed. Semiquantitative scintigraphic tracer uptake was measured. Multivariate linear regression analysis was performed. Results  At the day of examination, 40 patients reported medial knee pain at rest, 49 when climbing stairs (at rest mean VAS 33 mm, range 0–80 mm; climbing stairs mean VAS, 60 mm, range 20–100 mm). Bone scintigraphy showed increased tracer uptake in 36 patients (uptake factor, average 3.7, range 2.4–18.0). MRI showed BMEP in 31 studies (mean volume, 4,070 mm³; range, 1,200–39,200 mm³). All patients with BMEP had abnormal bone scintigraphy. Ten percent of patients with pain at rest and 8% of patients with pain during exercise showed no BMEP but tracer uptake in scintigraphy. Tracer uptake and signal change around MCL predicted pain at rest significantly (tracer uptake p = 0.004; MCL signal changes p = 0.002). Only MCL signal changes predicted pain during exercise significantly (p = 0.001). Conclusion  In chronic medial knee pain, increased tracer uptake in bone scintigraphy is more sensitive for medial knee pain than BMEP on MRI. Pain levels at rest and during exercise correlate with signal changes in and around the MCL.     

Physical impairments in longstanding hip and groin pain: Cross-sectional comparison of patients with hip-related pain or non-hip-related groin pain and healthy controls

ObjectivesTo compare physical impairments between patients with hip-related pain and those with non-hip-related groin pain, and to compare both patient groups with healthy controls.DesignCross-sectional.ParticipantsEighty-one hip and groin pain patients were consecutively included and categorized into having hip-related pain or non-hip-related groin pain. Twenty-eight healthy controls were recruited.SettingsTertiary care.Main outcome measuresAll participants performed physical impairment testing including hip ROM, muscle function, and functional tasks. An analysis of covariates was used for analysis between patients groups and controls.ResultsPatients with hip-related pain showed reduced hip ROM in internal rotation compared to patients with non-hip-related groin pain and controls (p ≤ 0.026, d −0.65; −0.97). No differences in muscle function or performance in functional tasks were observed between patients with hip-related pain and those with non-hip-related groin pain (p ≥ 0.136, d 0.00; 0.68). Both patient groups had worse muscle function and worse performance in functional tasks compared to controls (p ≤ 0.048, d −0.67; −1.83).ConclusionsBoth patients with and without hip-related pain had worse muscle function and worse performance in functional tasks compared to matched controls but no differences were observed between the patient groups. Only patients with hip-related pain had reduced ROM in internal rotation.     

髋关节色素沉着绒毛结节性滑膜炎的MRI诊断

目的：探讨髋关节色素沉着绒毛结节性滑膜炎的MRI表现。方法：对8例髋关节PVNS患者行常规MRI检查,结合术后病理结果进行对照分析。结果：8例MRI均显示滑膜不同程度肿胀、增厚以及关节间隙软组织肿胀,增生的滑膜组织于T1WI上呈等信号～低信号,T2WI上呈低信号夹杂混杂信号。结论：PVNS的MRI表现具有一定的特征性,MRI可显示病变的范围和程度,能准确反映关节内外受侵情况,对本病的临床诊治具有较高价值。     

MR imaging findings in transient osteoporosis of the hip

Purpose: The authors sought to describe the magnetic resonance (MR) imaging findings including perfusion imaging, in association with the course of acute bone marrow oedema syndrome (aBMEs), in a group of patients with acute hip pain and a final diagnosis of transient osteoporosis of the hip (TOH). Materials and methods: From 217 patients referred with a probable diagnosis of avascular necrosis (AVN) of the femoral head, we identified 42 patients who had clinical and radiographic findings not relevant to AVN. MR imaging examinations were performed on a 1.0T scanner. Perfusion imaging was performed in 20 patients. The bone marrow oedema (BME) was classified in four stages. In addition, the presence or absence of oedema in the subchondral area and the presence of other subchondral lesions were recorded. Acetabular bone marrow was also assessed for the presence of oedema. The quantitative measurements included: maximum size of the effusion, percentage of enhancement (PE) and time of peak enhancement of abnormal marrow compared to the first pass, on the perfusion images. Results: Osteopenia was present on plain radiographs in 87% of cases. The most common pattern of BME was extending to the femoral head and neck. Acetabulum was involved in 16.6%. In 22.6% the BME spared the subchondral region of the femoral head. There were two cases (4.7%) with subchondral changes. A joint effusion was noted in 33 of the 42 patients. On perfusion imaging, a delayed peak enhancement was noted in 20 patients between 40 and 65 s after the first pass of contrast. No patient had any evidence of femoral head collapse or change in sphericity on follow-up MRI. None of the patients developed avascular necrosis in a time frame of 18 months from the onset of the acute hip pain. Conclusion: The aBMEs MR imaging pattern varies and is most commonly appearing on X-rays as osteopenia. Absence of subcondral lesions, delayed peak enhancement of the abnormal marrow on perfusion images, and sparing of subchondral zone from marrow oedema are MR imaging findings highly correlated to TOH.     

MR imaging after sports-induced hip dislocations. Report of three cases

The MR findings in 3 patients who had sustained a posterior dislocation of the hip during sports activities are reported.     

Pediatric hip pain

This presentation deals with acute hip pain problems in children. These include: fractures, avulsion injuries, infection and inflammation, aseptic necrosis, slipped capital femoral epiphysis, and tumor and tumor-like conditions. Emphasis is on plain film findings and how not to miss them in their subtle forms. Electronic Publication     

Sports-related groin pain: evaluation with MR imaging

Our purpose was to assess the role of MRI in evaluating themusculoskeletal system in athletes with chronic pain laterally in the groin of unknown etiology. Magnetic resonance imaging (MRI) of the pubic ring was performed in 11 young athletes (soc cer players) with long-standing groin n pain. MR findings were: compared with plain films and isotope examination (bone scan Tc 99M). Abnormal MRI findings included a broadend andirregular symphysis witha characteristics pattern of low signal intensity on T1W and high signal intensity on T2W images localized in the superior pubic ramus at a distance from the symphasis. Positive findings wer also observed on plain films and on nuclear medicine studies. However, the imaging findings in the superior pubic ramus of the symphysis was located considerably more laterally on MRI. MRI is :a valuable method for evaluating discrete and ambiguous pelvic pain in athletes. particularly for identifying concomitant changes in the superior ramus, which may give rise to long-standing localized laterally in the groin.