伴有脊柱后突的不可复性食管裂孔疝--胸部平片与CT、MRI对照观察

目的 加深对伴有脊柱后突的不可复性食管裂孔疝影像表现的认识,并探讨此类食管裂孔疝形成的机制。材料与方法 对照分析８例经钡餐造影确诊的伴有脊柱后突的不可复性食管裂孔疝的胸片与ＣＴ、ＭＲ影像表现。结果 ８例均为老年人,以女性居多,胸片与ＣＴ、ＭＲ影像表现均见疝囊在心脏之后呈肿块状,内含气体或气－液面,并有食管裂孔增宽、膈肌后份变平、后肋膈角变浅、贲门位于膈上而食管不短;均见脊柱胸腰段后突,该水平胸廓前     

膈肌脚及脚后间隙病变的CT与MRI诊断

目的分析膈肌脚及脚后间隙病变的CT及MRI表现,探讨其诊断与鉴别诊断。资料与方法回顾性分析267例经临床及病理证实的膈肌脚及脚后间隙病变患者的影像学资料。结果 270例病变中下腔静脉变异16例;奇静脉、半奇静脉曲张5例;主动脉夹层59例;腹主动脉动脉瘤15例;骨质增生20例;椎旁脓肿3例;淋巴结肿大76例;食管裂孔疝30例;食管破裂感染伴纵隔积气1例;神经母细胞瘤1例;畸胎瘤3例;肿瘤直接侵及41例。结论正确认识膈肌脚及脚后间隙解剖结构有助于脚后间隙病变的诊断。     

外伤性膈肌破裂后纵隔胰腺假性囊肿

小儿胰腺假性囊肿少见,而进入纵隔者更罕见,文献报道35例纵隔胰腺假性囊肿仅3例为小儿。一般通过食管裂孔或主动脉裂孔进入纵隔,罕有经胸肋三角(Morgagni′s孔)或膈肌者。作者报告1例胰腺假性囊肿经外伤性膈肌缺损处进入纵隔。8岁、男孩,因左胸痛、用力后呼吸困难、干咳入院。6个月前有腹部钝性创伤史。胸片左侧胸腔积液及膈疝(钡餐证实)。胃有轻度弧形的外来     

膈疝的X线诊断(附21例报告)

腹部脏器穿过横膈突入胸腔者称为膈疝。好发于膈肌的薄弱部分,如食管裂孔,胸骨后裂孔,胸膜裂孔,外伤性裂孔及横膈先天性缺损部分。此病X线表现复杂,容易误诊,现将我院经手术或X线检查证实的21例报告如下:     

膈肌和脚后间隙的CT表现

一、正常解剖、变异和CT表现 (一) 膈肌膈肌周围由三组肌性纤维组成:①胸骨部,②肋骨部和③腰部,中部为中央腱。膈肌有三个沟通胸腹腔的孔道:①主动脉裂孔,②食管裂孔和③下腔静脉裂孔。由于膈肌为圆顶形,CT横断层图像为同心环或卵圆环形,越向下扫描环越大,而围绕膈肌周围的肋膈窦和肺则逐渐减小,直至膈肌起点。膈肌环状轮廓以内为膈下,而轮廓以外则为胸腔。当肺充气良好则衬托出     

膈肌运动及血流动力学与下腔静脉膜性阻塞关系的研究

目的 探讨膈肌运动及血流冲击(右房反流血液与肝静脉血流)与下腔静脉膜性阻塞(MOVC)发病机制的关系.方法 通过20例尸体解剖,测量腔静脉膈肌裂孔横径与胸廓横径,并取膈肌腔静脉孔处下方肝静脉上方下腔静脉(A组)行组织学检查,观察该处下腔静脉(IVC)内膜厚度及I型胶原的沉积情况,并与肾静脉汇合处上方0.5 cm处下腔静脉(B组)的检查结果 进行对照分析,同时分析裂孔横径相对大小与A组结果 的相关性.结果 A组IVC内膜厚度及I型胶原面积均大于B组,两组间差异有统计学意义(P＜0.05),膈肌裂孔横径相对大小与A组结果 无明显相关性.结论 膈肌运动、血流冲击在MOVC发病过程中可能起重要作用,其中膈肌运动可能起关键作用.     

咀嚼间隙疾病的MRI和CT诊断

目的：评价ＭＲＩ和ＣＴ对咀嚼间隙病变的诊断价值。材料和方法：回顾性分析４２例咀嚼间隙病变的ＭＲＩ和ＣＴ表现。除５例感染经抗炎治疗好转外，均经手术病理证实。结果：５例蜂窝织炎病变弥漫，累及间隙内脂肪、咀嚼肌和周围间隙及其皮下脂肪，无明确肿块和骨质破坏，ＭＲＩ和ＣＴ均具特征，１例炎性肉芽肿有明确肿块和骨质破坏，术前误诊；５例原发性肿瘤均有明确肿块、间隙内脂肪受压消失、翼内肌受压向后内移位和骨质受压或破坏，除软骨瘤外均缺乏组织学特征；３１例累及咀嚼间隙的继发性肿瘤ＭＲＩ和ＣＴ均能显示其侵入的途径和范围。结论：ＭＲＩ和ＣＴ对显示病变的范围、鉴别感染类型、判断肿瘤位置、性质和来源具有重要价值，可帮助临床制定治疗计划     

头颈区去神经性肌萎缩的CT与MRI表现及其临床意义

本文报告８例头颈区去神经性肌萎缩的ＣＴ和ＭＲＩ表现，旨在评价其临床意义，引起肌萎缩的原因包括颈静脉孔区肿瘤４例（颈静脉球瘤，转移瘤各２例），鼻咽癌２例，中颅凹区脑膜瘤１例，上颌窦囊腺癌转移至咽旁１例，ＣＴ和ＭＲＩ表现为特定的颅神经运动支支配区肌肉轮廓缩小，脂肪间隙增宽，病程较长者表现为受累肌群完全为脂肪组织取代；３例根据肌萎缩征象发现原发病变。作者认为：认识去神经性肌萎缩的ＣＴ，ＭＲＩ表现可避免误     

颅内多发原发性肿瘤的CT与MRI诊断

目的：报道１５例颅内多发原发性肿瘤的ＣＴ和ＭＲＩ表现，并评价ＣＴ与ＭＲＩ的诊断价值。方法：１５例颅内多发原发性肿瘤均行ＣＴ检查，其中４例行ＭＲＩ检查，均经手术病理证实。结果：多发胶质瘤４例，其中恶性室宫膜瘤３例，表现为脑室内及额顶叶脑实质内实质性肿块或囊性病变，多发星形细胞瘤１例，病变分别位于额叶及小脑蚓部；双侧听神经瘤及多发脑膜瘤各３例、ＣＴ和ＭＲＩ表现均较典型；脑膜瘤合并胶质瘤３例、脑膜瘤合并听神经瘤１例和垂体瘤合并胶质瘤１例。结论：结合肿瘤的ＣＴ和ＭＲＩ表现特点，可对大多数颅内多发原发性肿瘤作出正确诊断，ＭＲＩ对脑膜瘤的诊断优于ＣＴ。     

病毒性脑炎的CT、MRI诊断(附48例报告)

加深对病毒性脑炎ＣＴ、ＭＲＩ表现的认识,以提高临床对该病变诊断的准确性。材料与方法。回顾分析４８例病毒性脑炎（男２６例,女２２例,平均年龄３６岁）的临床及影像学资料,其中单纯疱疹病毒（ＨＳＶ）脑炎８例。经手术病理证实者１例。检查方法：ＣＴ检查２３例,ＭＲＩ检查１４例,同时经ＣＴ和ＭＲＩ检查者１１例。作ＣＴ和ＭＲＩ增强检查者共１２例。结果脑内有多发或单发病灶者４７例,主要位于皮层,皮层下脑侧脑室周围     

眶颅沟通性病变的CT和MRI研究

目的 研究、探讨眶颅沟通性病变的沟通路径、CT和MRI表现及其影像学特征。方法 51例患者,男28例,女23例,年龄2－68岁,平均41岁,为手术病理和随访结果证实。51例均行 CT扫描,45例行MR扫描,CT和MR增强扫描各44例。结果 通过眶上裂或视神经管沟通的颅眶沟通笥病变31例,占60.8％。其中9例通过视神经管沟通,包括4例视神经和视交叉胶质瘤、3例视神经鞘脑膜瘤,以及2例视网膜母细胞瘤侵犯视神经和视交叉;通过眶上裂沟通者,包括5例脑膜瘤、4例神经源性肿瘤、2例Tolosa-Hunt综合征、3例炎性假瘤、1例眼眶和海绵窦皮样囊肿,以及7例鼻咽癌同时侵犯海绵窦和眼眶,通过眶骨穿支血管间隙沟通的病变或骨质破坏缺损区沟通的眶颅沟通性病变20例,占39.2％,包括5例眶骨扁平性脑膜瘤、10例眶壁转移瘤、1例眶壁软骨肉瘤侵犯筛窦、额窦和额叶、3例泪腺囊腺癌侵犯颅内和1例额底脑膜瘤侵犯眼眶。结论 CT和MRI,尤其是使用脂肪抑制技术和增强扫描的T1WI能明确显示眶颅沟通性病变的沟通路径和病变特征,为制订治疗方案和手术入路提供重要和直接的依据。     

儿童肝母细胞瘤的CT、MRI诊断

目的:提高对肝母细胞瘤(HB)的临床及CT、MRI的认识.方法:回顾性分析有完整临床资料和病理资料证实的54例HB,分析其CT、MRI征象,探讨CT、MRI对HB的诊断价值.结果:39例行CT检查,12例行MRI检查,3例行CT及MRI检查.均表现为肝脏占位性病变,CT平扫时为等低密度,21例伴有钙化,增强后肿瘤不均匀强化.MRI表现为肿瘤在T1WI中为等低信号,T2WI为等高信号,增强后不均匀强化.结论:CT、MRI是HB最有价值的影像学检查方法,对病灶的定位及定性较为准确,具有一定的特异性.     

经皮射频消融治疗膈下肝癌

目的评价CT引导下冷循环射频消融治疗膈下肝癌的可行性和疗效。方法20例肝癌患者共25个膈下病灶在CT引导下行冷循环射频消融治疗,术后复查增强CT或增强MR,观察病灶坏死情况。结果18个病灶完全坏死,病灶完全坏死率72%,其余7个病灶大部分坏死,无严重并发症。结论CT引导下冷循环射频消融术治疗膈下肝癌安全、有效。     

翼腭窝神经鞘瘤的CT和MRI诊断

目的 分析翼腭窝神经鞘瘤的CT和MRI表现. 资料与方法 回顾性分析12例经组织学证实的翼腭窝神经鞘瘤的影像学资料. 结果 12例神经鞘瘤均为单侧发病,病变以翼腭窝为中心生长并向其通道及周围间隙蔓延,边界清楚,呈卵圆形8例,梭形4例.CT表现:翼腭窝扩大,相应骨质受压变薄、移位及吸收;平扫显示10例病变密度均匀,另2例病变内可见低密度区,5例行CT增强扫描,其中3例病变显示不均匀强化.MRI表现:与脑实质比较,T1WI均呈等信号;T2WI呈等信号9例,高信号3例,10例病灶内可见点、片状高信号,其中5例并可见结节状高信号;增强后不均匀强化,T2WI上所见的高信号区均未见明显强化,其他区域中度或显著强化. 结论 根据典型的骨质及信号改变,可提示本病诊断.     

Portal flow into the liver through veins at the site of biliary-enteric anastomosis

The aim of this study was to establish the role played by jejunal veins in hepatopetal flow after biliary-enteric anastomosis and to evaluate the helical CT features of hepatopetal flow through the anastomosis. We retrospectively analyzed helical CT images of the liver in 31 patients with biliary-enteric anastomosis who underwent hepatic angiography with (n=13) or without (n=18) CT arterial portography within 2 weeks of the CT examination during the last 4 years. Arterial portography showed hepatopetal flow through small vessels located (communicating veins) between the elevated jejunal veins and the intrahepatic portal branches in two (9%) of 22 patients with a normal portal system. Helical CT showed focal parenchymal enhancement around the anastomosis in these two patients. All nine patients with extrahepatic portal vein occlusion (100%) had hepatopetal flow through the anastomosis, and four of the nine had decreased portal flow. CT revealed small communicating veins in two of these four patients. In five patients with normal portal perfusion despite extrahepatic portal vein occlusion, CT detected dilated communicating veins and elevated jejunal veins. The presence of communicating veins and/or focal parenchymal enhancement around the anastomosis indicates hepatopetal flow through the elevated jejunal veins.     

Computed tomography aspects of cerebral toxoplasmosis in AIDS

We followed by CT 19 AIDS patients with cerebral toxoplasmosis. Diagnosis of cerebral toxoplasmosis was assessed on radiological and clinical basis, including the therapeutic response. CT allowed to confirm brain lesions (40 lesions in 19 patients) and to follow the evolution with treatment. Analysis of the CT features of these brain lesions permits to define some characteristic findings, though not pathognomonic. These lesions share common characteristics with other granulomatous diseases or with brain abscesses. The most frequently observed features are: target lesions (74%) with contrast enhancement (95%), frequently multiple (53%), associated with a hypodense area of oedema (100%), and responsible for a mass effect (79%). Under treatment, we observed improvement in 89%, resulting either in complete disappearance of the lesions (16%), disappearance of one or more contrast enhancing (46%) or hypodense (6%) areas, or volumetric regression of the hypodensities (50%). We conclude that CT is a good first-step examination for the detection and follow-up of cerebral toxoplasmosis in AIDS patients. MRI, a method with a higher sensitivity but still less accessible, may be considered at the present time as a second-step examination for those patients with solitary lesions on CT, or for symptomatic patients with normal CT.     

CT and MRI: prognostic tools in patients with AIDS and neurological deficits

Summary To determine the prognostic value of CT and MRI in AIDS we studied the survival of patients with neurological involvement, in relation to the initial imaging results. Twenty-six initial CT and 15 MRI examinations of 41 patients were reviewed for the presence of cerebral atrophy and/or focal lesions. The mean survival time of patients with initially normal imaging was longer (700±89 days) than that of patients with isolated cerebral atrophy (326±65) or isolated focal lesions (202±97). The shortest survival (78±44 days) was found in patients with both cerebral atrophy and focal lesions. The risk of death in patients with focal lesions alone 6.4 times higher, and in patients with both changes 19.3 times higher than in patients with initially normal imaging. Cerebral imaging with CT and/or MRI thus allows identification of AIDS-related cerebral changes and may contribute to assessment of prognosis.     

Small (<or= 2 cm) hepatic lesions in colorectal cancer patients: detection and characterization on mangafodipir trisodium-enhanced MRI

OBJECTIVE: The purpose of this study was to evaluate whether mangafodipir trisodium (MnDPDP)-enhanced MRI improves the detection and characterization of small ( 2.0 cm). The differences between MnDPDP-enhanced MRI and helical CT with regard to the detection rates for hepatic lesions and metastases and with regard to the false-positive rates for hepatic metastases were analyzed using the McNemar test. The performances of MnDPDP-enhanced MRI and helical CT in indicating metastases of focal liver lesions were analyzed using receiver operating characteristic curves. RESULTS: No statistically significant differences were seen between MnDPDP-enhanced MRI and helical CT in the detection of all hepatic lesions (p = 0.383) and small lesions (p = 0.210). However, concerning the differentiation between benign and metastatic lesions, MnDPDP-enhanced MRI was superior to helical CT both for all hepatic lesions (p = 0.023) and for small lesions (p = 0.015), and remained better when the analyses were restricted to patients with histopathologic confirmation (p = 0.023 for both). MnDPDP-enhanced MRI changed the diagnosis of hepatic metastasis in nine (13.0%) of 69 patients. Of 12 metastases that were found on MnDPDP-enhanced MRI and missed on helical CT, 11 lesions (91.7%) were small. MnDPDP-enhanced MRI showed a significantly greater detection rate than helical CT for small hepatic metastases (p = 0.022). MnDPDP-enhanced MRI was better when the analyses were restricted to patients with histopathologic confirmation (p = 0.043). CONCLUSION: Although MnDPDP-enhanced MRI is equal to helical CT in detection of both all hepatic lesions and small lesions in patients with colorectal carcinoma, it is superior to CT in characterization of the lesions.