胸腹交界中线区域病变的MDCT表现及其解剖、病理学基础

为明确胸腹交界中线区域疾病多层螺旋CT(MDCT)表现及其解剖、病理基础,通过观察3例尸体横断面、3例矢状面标本胸腹交界中线区结构的位置、形态特点,并结合93例胸腹交界中线区域疾病的MDCT表现,阐明其影像学表现与解剖、病理学的相关性,发现断面尸体上,中线区域膈上有心包膜、心脏,膈下有镰状韧带、肝左叶,前方有胸壁,后方有胸后壁和附着于脊柱的膈肌脚,膈肌内从前向后依次有腔静脉孔、食管裂孔和主动脉裂孔。MDCT图像上,同时累及胸腹交界中线区域膈上、膈下疾病93例,包括门静脉高压侧支循环开放23例、主动脉夹层18例、下腔静脉病变8例、淋巴瘤9例和脊柱多椎体病变12例;食道胸下段癌合并上腹部淋巴结转移7例;食道下段-贲门癌9例;食管裂孔疝4例;后纵隔或腹膜后神经源性肿瘤3例。因此,胸腹交界中线区域解剖、病理特点影响该区域疾病的局部、扩散和相互通连的影像学表现特点。     

非何杰金氏淋巴瘤累及小网膜的CT特征

目的：探讨非何杰金氏淋巴瘤累及小网膜的多层螺旋CT表现特征.方法：回顾性分析20例CT扫描资料和临床资料完整的非何杰金氏淋巴瘤累及小网膜的病例,着重观察小网膜病变的CT表现特征.结果：（1）肝胃韧带淋巴结增大20例,均表现为均匀强化,并部分融合;增大淋巴结包绕胃小弯侧血管弓2例;（2）肝十二指肠韧带淋巴结增大20例,并部分融合;其中增大淋巴结均匀强化19例（95%）,增大淋巴结均匀强化合并坏死1例（5%）.包绕门静脉主干和/或肝动脉6例.（3）肝食管韧带和肝膈韧带淋巴结增大分别为13例和6例,均表现为均匀强化.结论：多层螺旋CT可全面显示非何杰金氏淋巴瘤累及小网膜的解剖细节及淋巴结的病理改变.     

肝胃韧带的断层和CT解剖

目的 :阐明肝胃韧带分隔网膜囊上隐窝 (SRLS)的意义及内侧胃膈韧带的存在。方法 :①观察肝的韧带的附着和相互移行情况及肝胃韧带、SRLS与左肝上后间隙、左肝上前间隙的通连关系。②观察腹部连续断层标本 (横断层和矢状断层 )。③腹部螺旋CT扫描。结果 :①通常教科书和文献所述的肝胃韧带实际上由肝膈韧带、肝食管韧带和肝胃韧带构成。②肝胃韧带位于静脉韧带裂内 ,后层在近胃小弯处反折至膈形成内侧胃膈韧带 ,并与内侧胃膈韧带分别作成SRLS的前界和左侧界。③肝胃隐窝与SRLS之间因隔以肝胃韧带而不相通。结论 :肝胃韧带和内侧胃膈韧带分别构成SRLS的前界和左侧界分隔SRLS ;一些教材所用的图 ,表达SRLS与左肝上后间隙相通的概念值得商榷。     

肝裸区及周围结构特点与临床应用研究进展

<正>肝裸区由肝右后叶表面右冠状韧带上层和下层之间无腹膜覆盖区及左冠状韧带前后两层未愈着处与膈肌之间的区域组成~([1,2]),其与周边结构可形成潜在的间隙。临床利用这些间隙进行精确、安全的肝叶、肝段切除。笔者整理了近年来肝裸区与周边结构的解剖学和组织学特点及其胚胎来源的文献,依次阐述各个间隙成年后的解剖特点、肝裸区与膈肌间不同层次的组织学组成、肝后下腔静脉引流血管分布规律、下腔静脉韧带的组织学特点及肝裸区与右肾上腺的联系。藉此为外科术中     

膈下间隙的冠状断层解剖学研究

目的　为膈下间隙病变的断层影像学诊断和外科治疗提供实用的形态学依据。　方法　在 30例成人尸体上腹部连续冠状断层标本和 2例尸体腹部磁共振冠状图像上 ,研究了膈下间隙的冠状断层解剖。　结果在冠状断层上 ,膈下间隙分为肝周间隙和脾周间隙 ;胃胰襞左部前缘和小网膜左部 (肝胃韧带 )后层之间的间隙构成网膜囊上、下隐窝间的唯一直接交通 ,其交通形式在冠状面上可分为 3型。胃膈韧带右层与小网膜的后层相续 ,左层与膈脾韧带右层及胃脾韧带后层相续 ,向下左、右层靠拢而续为胃胰襞左部。胃裸区居胃膈韧带的左、右层之间 ,其存在率为 10 0 %。脾裸区居膈脾韧带、胃脾韧带、脾肾韧带和脾结肠韧带之间 ,在脾肾韧带处最宽 ,脾裸区可分为脾门部和脾肾部 ,其最大值分别为 :2 6 4± 1 16cm ,4 16± 2 2 4cm。　结论　冠状断层是显示胃胰襞左部及网膜囊上、下隐窝间通连关系的优势断层。网膜囊上、下隐窝相通的约占观察总例数的 73 3%     

膈肌胸肋三角双相16层螺旋CT影像解剖研究

前瞻性收集连续性正常成年人100例,采用16层螺旋CT分别在深吸气末和深呼气末屏气扫描并行薄层多平面重建(multiplanar reformation,MPR)。在双相薄层断面CT图像上观察膈肌胸肋三角的显示情况及其形态表现特征,评价成年人正常膈肌胸肋三角显示率、形态及其影响因素。同时收集病变2例,观察其发生的部位、膈肌的连续性、膈肌缺损的大小及脏器疝入胸腔的表现。膈肌胸肋三角显示率与呼吸时相有关,在吸气相为43%,呼气相为32%,与年龄、性别、体重指数无关。膈肌胸肋三角形态表现单一,为尖向中心腱底向胸壁的三角形低密度影。膈肌胸肋三角疝表现为膈肌薄弱区连续性中断,腹腔脏器经缺损区疝入胸腔。MPR冠、矢状重建图像可直接观察破裂口并能测量其大小,疝入胸腔的脏器通过破裂口与腹腔脏器相连。多层螺旋CT,特别是MPR技术对显示膈肌正常薄弱区及其病变有较高的临床价值。双相螺旋CT提供了正常活体内膈肌运动的生理变化信息,成为研究正常膈肌解剖和生理的一个重要方法。     

胃周围间隙的三维断层解剖及在影像学的应用

目的探讨胃裸区和胃周围间隙的划分、形态学特征及其在影像学的应用意义。方法将65具成人尸体解剖观测胃裸区后膈下腹膜外间隙;46具成人尸体腹部连续断层标本,观测胃裸区后膈下腹膜外间隙出现平面、范围。选2例上腹部标本在胰尾处向肾旁前间隙内灌注红色乳胶,观察乳胶胰在周围的扩散和积聚情况。结果尸体解剖观测发现胃裸区位于食管腹段后方、邻近胃小弯侧胃的后壁无腹膜覆盖的区域,其出现率为100%。胃膈内侧韧带、胃膈外侧韧带和胃胰韧带勾画出胃裸区的范围,胃裸区与左膈之间的间隙为左侧膈下腹膜外间隙。胃周围间隙可划分为肝胃隐窝、网膜囊上隐窝、左侧膈下腹膜外间隙、网膜囊下隐窝、脾胃隐窝。左侧膈下腹膜外间隙与左肾旁前间隙相交通。结论(1)胃膈内侧韧带、胃膈外侧韧带和胃胰韧带勾画出胃裸区的范围,它们是划分胃周围间隙依据。(2)胃周围间隙可划分肝胃隐窝、网膜囊上隐窝、左侧膈下腹膜外间隙、网膜囊下隐窝、脾胃隐窝。(3)左侧膈下腹膜外间隙与左肾旁前间隙相通。     

甲状腺病变累及至上纵隔的MDCT表现特征及其解剖、病理学基础

为了明确甲状腺病变累及至上纵隔的多层螺旋CT(MDCT)影像表现特点及其解剖、病理学基础,回顾性收集经临床病理证实的累及至上纵隔的甲状腺病变49例(其中结节性甲状腺肿22例,甲状腺瘤13例,甲状腺癌14例),结合其解剖、病理学基础,分析其MDCT表现特征及优势解剖分布。结果发现甲状病变向下位于前上纵隔约占67.3%(33/49)、后上纵隔14.3%(7/49)、跨前后纵隔18.4%(9/49);不同性质病变有各自特征性的MDCT表现:结节性甲状腺肿以局限多发结节、肿块为主,约占77.3%(17/22);甲状腺腺瘤以单发肿块为主,约占92.3%(12/13);甲状腺癌以单发肿块为主,约占57.1%(8/14),9例合并有颈部和(或)纵隔淋巴结转移。因此,甲状腺病变累及至上纵隔,位于前上纵隔多见,后纵隔少见,其影像学表现及优势解剖分布与其解剖、病理基础密切相关。     

应用多层螺旋CT观察胸骨肌的发生率和解剖特点

目的:采用多层螺旋CT(MDCT)研究普通人群中胸骨肌的出现率及解剖特点.方法:回顾性分析5000例无前胸壁疾患成人胸部MDCT轴位图像,统计胸骨肌出现率,单、双侧出现率及性别差异,并进一步分析其位置,形态,起、止及大小等解剖特点.结果:5000例成人中胸骨肌出现率为5.8%,男性(6.7%)高于女性(4.3%).单、双侧分别为195、95例.单侧195例中左、右侧分别为71例、124例,单、双侧出现率男女性别差异无统计学意义.在CT轴位上胸骨肌位于胸骨两侧,胸大肌浅面,其断面呈扁平状或结节状,重建图上呈上下纵向走行扁梭形或条带状,部分可呈内上向外下走行.胸骨肌上缘起自第5肋软骨水平以上,附着于肋软骨、胸大肌、胸骨柄及体部、胸锁乳突肌肌腱,下缘止于第3～7肋软骨水平,附着于腹外斜肌腱、胸肌筋膜、肋软骨、胸骨体及剑突.胸骨肌形态变异大,平均长度(7.01±2.69)cm,平均厚度(0 50±0.20)cm,平均宽度(2.10±1.21)cm.结论:胸骨肌在正常人群中有较高出现率,MDCT轴位与三维重建结合能很好地显示其解剖特点.     

支气管肺隔离症1例

患者男性 ,6 7岁 ,因刺激性咳嗽 1个月、痰中带血 1周入院 ,起病缓慢 ,逐渐加重 ,查体未见其它阳性体征。X线示 :右下肺外野高密度块影 ,与周围边界模糊 ,4 2cm× 2 5cm ,主动脉迂曲增厚 ,右侧膈面毛糙 ,肋膈角模糊。CT示 :右上肺前外侧段结节影 ,形态不规则 ,边缘不光滑 ,密度均匀 ,周围可见小毛刺 ,向外侧与侧胸壁粘连 ,纵隔稍向左移位 ,考虑为周围性肺癌。术中见病变位于右肺下叶基底段 ,4 0cm× 1 8cm× 1 5cm ,肺门及纵隔未见肿大淋巴结 ,右肺表面可见多个直径 0 5～ 0 8cm的肺大泡 ,包块上端有部分组织与右上肺相连 ,右侧缘有…     

MDCT of abdominal wall lumbar hernias: anatomical review, pathologic findings and differential diagnosis

Purpose

To review the anatomical landmarks of the abdominal wall lumbar region and its normal appearance on multidetector computed tomography (MDCT) and to briefly describe the MDCT features of lumbar hernias.

Methods

We performed a retrospective search of the imaging report database from November 2007 to October 2011. We retrieved the clinical data and MDCT studies of patients suffering from abdominal wall lumbar hernias. We reviewed the imaging features of abdominal lumbar hernias and compared those with the normal appearance of the lumbar region in asymptomatic individuals.

Results

We classified lumbar wall hernias as diffuse, superior (or Grynfelt–Lesshaft) and inferior (or Petit) lumbar hernias. We briefly describe the imaging features of each subtype and review the anatomy and MDCT appearance of normal lumbar region.

Conclusions

Currently available MDCT provides an excellent opportunity for reviewing the normal anatomy of the wall lumbar region and may be considered a useful modality for evaluating lumbar hernias.     

特发性肺纤维化的16层螺旋CT表现特征及其解剖、病理基础

为明确特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)的16层螺旋CT表现特征、合并症及其解剖的优势分布。对临床病理证实的IPF38例行16层螺旋CT检查,其中26例追加薄层CT扫描。观察IPF的CT征像和合并症,评价其CT征像在解剖中优势分布。其中蜂窝肺14例(36.8%),10例(71.4%)主要分布于中下肺的外带、以双肺下叶基底段显著,4例(28.6%)呈弥漫性分布,11例(78.6%)病程在3年以上。小叶内间质增厚16例(42.1%)、小叶间隔增厚20例(52.6%)及支气管血管束增粗9例(23.7%),分别优势分布于中下肺的外带、双肺下叶基底段,双肺下叶及右肺中叶中内带。磨玻璃样密度影15例(39.5%),优势分布于肺的外带,主要以双肺下叶基底段显著;其中10例(66.7%)病程在1年以下。结果表明IPF的16层螺旋CT征象能反映其病理变化,在解剖分布上有明显特点。     

The demonstration of the number, course, and the location of nutrient artery canals of the femur by multidetector computed tomography

Purpose

The aim of this study was to evaluate the number, course, width and location of nutrient artery canals of the femur by using multidetector computed tomography (MDCT).

Methods

Sixty-six adult (35 right and 31 left) dry femurs were included in this study and scanned by MDCT. Nutrient artery canals were evaluated on the multi-planar reformatted and volume rendered images which were reproduced on the basis of axial images.

Results

The median value of nutrient artery canals was two (minimum 1 and maximum 6). We determined that there was a negative correlation between the number of nutrient canals and the canal diameters. The outer ostia of the nutrient artery canals were most frequently located at the middle third segment of femoral diaphysis (65%). While the vast majority of the canals were showing upward courses (95%), only a few canals were having transverse (3%) or downward (2%) courses. Most encountered location of outer ostia of the canals according to linea aspera was the medial lip of the linea aspera (44%). Various variations were demonstrated in the number, course, and location of nutrient artery canals using MDCT.

Conclusions

In conclusion, the knowledge of the topographic features of the nutrient artery canals may be useful in various clinical implications such as bone grafting or radiologic evaluation for the fracture lines.     

Bilateral symmetric junctional infarctions of the cerebellum: a case report

The advances in neuroimaging have improved clinicoanatomic correlations in patients with stroke. Junctional infarct is a distinct term, used to describe border zone infarcts of the posterior fossa. We presented computed tomography (CT) and magnetic resonance imaging (MRI) findings in a rare case of bilateral symmetrical junctional infarcts between the superior cerebellar artery (SCA) and posterior inferior cerebellar artery (PICA) territories. In addition to precise knowledge of arterial territories required to achieve accurate localization of ischemic lesions on CT and MRI, the radiologist must also be aware of radiologic features and geographic territories of cerebellar arteries and their junctional infarctions.     

Prevalence and variance of the sternalis muscle: a study in the Chinese population using multi-detector CT

Objective

To analyze the prevalence, anatomical features, as well as variance of the sternalis muscle in the Chinese population using multi-detector computed tomography (MDCT).

Methods

We retrospectively reviewed 6,000 adult axial MDCT images to determine the overall and gender prevalence of the sternalis muscles. We also analyzed the side prevalence and anatomical features, including shape, size, location and course.

Results

The sternalis muscle was present in 347 (5.8 %) of 6,000 adults. This muscle was more common in males (6.0 %, 187/3091) than in females (5.5 %, 160/2909). Among the 347 adults, 118 (34.0 %) had bilateral sternalis muscles; 148 (42.7 %) had right sternalis muscles; and 81 (23.3 %) had left sternalis muscles. The sternalis muscle was either flat or nodular and located superficial to the major pectoral muscles on CT axial transverse images. According to the muscle morphology and course, we classified sternalis muscles as three different types and nine subtypes. The muscles appeared with a single head and single belly in 58.5 %, double or multiple heads in 18.1 %, and double or multiple bellies in 23.4 %. The mean length, width and thickness were 111.1 ± 33.0, 17.7 ± 9.9 and 4.1 ± 1.7 mm measured on MDCT.

Conclusion

The sternalis muscle was highly prevalent in normal Chinese adults. MDCT is an effective method to demonstrate this muscle in vivo.     

Using multidetector-row CT for the diagnosis of afferent loop syndrome following gastroenterostomy reconstruction

Purpose

To assess the clinical manifestations and multidetector-row computed tomography (MDCT) findings of afferent loop syndrome (ALS) and to determine the role of MDCT on treatment decisions.

Materials and Methods

From January 2004 to December 2008, 1,100 patients had undergone gastroenterostomy reconstruction in our institution. Of these, 22 (2%) patients were diagnosed as ALS after surgery that included Roux-en-Y gastroenterotomy (n=9), Billroth-II gastrojejunostomy (n=7), and Whipple''s operation (n=6). Clinical manifestations and MDCT features of these patients were recorded and statistically analyzed. The presumed etiologies of obstruction shown on the MDCT were correlated with clinical information and confirmed by surgery or endoscopic biopsy.

Results

The most common clinical symptom was acute abdominal pain, presenting in 18 patients (82%). We found that a fluid-filled C-shaped afferent loop in combination with valvulae conniventes projecting into the lumen was the most common MDCT features of ALS. Malignant causes of ALS, such as local recurrence and carcinomatosis, are the most common etiologies of obstruction. These etiologies and associated complications can be predicted 100% by MDCT.

Conclusion

Our results suggest that MDCT is a reliable modality for assessing the etiologies of ALS and guiding treatment decisions.     

Electron microscopic study of the interaction of axons and glia at the site of anastomosis between the optic nerve and cellular or acellular sciatic nerve grafts

Summary The interactions between retinal ganglion cell (RGC) axons and glia at the site of optic nerve section and at the junctional zone between optic nerve and cellular or acellular peripheral nerve (PN) grafts have been studied electron microscopically. After transection, RGC axons, accompanied by processes of astrocyte cytoplasm, grew out from the proximal optic nerve stump into the scar tissue that developed between proximal and distal stumps. However, axons failed to cross the scar, and none entered the distal stump. By 3 days post lesion (DPL), bundles of RGC axons, accompanied by astrocytes and oligodendrocytes, grew out from the proximal optic nerve stump into the junctional zone between optic nerve and either type of PN graft. The bundles of RGC axons and growth cones that grew towards acellular PN grafts degenerated within 10–20 DPL; by 30 DPL a small number of axons persisted within the end of the proximal optic nerve stump. No axons were seen within the acellular PN grafts. These results suggest that reactive axonal sprouting, axon outgrowth and glial migration from the proximal optic nerve stump are events that occur during an acute response to injury, and that they are independent of the presence of Schwann cells. However, it would appear that few axons entered either scar or junctional zone unless accompanied by glia. There was little evidence that axon outgrowth was laminin-dependent.The bundles that grew towards cellular PN grafts encountered cells that we have identified as Schwann cells within the junctional zone: the axons in these bundles survived and entered the cellular grafts. Schwann cells migrated into the junctional zone from the cellular PN graft. It is probable that Schwann cells facilitated RGC axon entry into the graft directly by both cell contact and the secretion of neuronotrophic factors, and indirectly by modifying the CNS glia in the junctional zone.     

Response of axons and glia at the site of anastomosis between the optic nerve and cellular or acellular sciatic nerve grafts

Summary Axonal and glial reactions at the site of optic nerve section and at the junctional zone between optic nerve and normal or acellular peripheral nerve grafts have been studied. Following optic nerve section, no axons grew into the distal optic nerve stump. Similarly, no axons invaded the acellular peripheral nerve grafts, although in both instances fibres did regenerate into the junctional zone and a few remained there at least until 30 days post lesion (dpl, the duration of the experiments). Axons regenerated into normal peripheral nerve grafts by 3–5 dpl and by 10 dpl large numbers had penetrated deeply into the grafts. The glial response to injury appeared similar in both groups of grafted animals. Astrocytes and oligodendrocytes grew out into the junctional zone over the 5–7 day period and invaded the margins of the cellular grafts by 10 dpl. They did not penetrate the acellular nerves or distal optic nerve stumps. We were unable to determine whether Schwann cells invaded the junctional zone from the normal peripheral nerve grafts. Schwann cells are both GFAP⁺ and Vim⁺, especially when reacting after injury, and Lam^– when not associated with axons: it is therefore possible that Schwann cells from the cellular grafts contributed to the population of GFAP⁺, Vim⁺ cells in the junctional zone of the cellular grafts. Anti-laminin immuno-reactivity persisted in the basal lamina tubes of both the normal and acellular peripheral nerve grafts. Thus, the failure of axon regeneration into acellular peripheral nerve grafts can be correlated with the absence of Schwann cells and does not appear to be related to the presence of laminin.     

Macro-optical color assessment of the pulmonary airways with subsequent three-dimensional multidetector-x-ray-computed-tomography assisted display

Bronchial diseases alter the color and structural characteristics of the pulmonary mucosa through changes in blood flow, epithelial thickening, and abnormal cell growth. Current analysis of these subtle changes includes visual interpretation of the airway color and topography through bronchoscopy procedures, and quantitative multidetector-x-ray-computed-tomography (MDCT)-based structural analysis, each affording valuable insights to the health of the lungs. The fusion of the bronchoscopy and MDCT image data promises to provide a synergistic data set exhibiting both mucosal color and topography crucial to fostering an understanding of airway structure and function. A real-time airway color analysis imaging system is developed and utilized to perform pulmonary mucosal color assessment in healthy volunteers with subsequent comparative studies performed in example disease states. Our results indicate that macro-optical digital bronchoscopes with appropriate image analysis may have a significant impact on understanding bronchial diseases. To ensure the correct interpretation of scene content, which is critical in the assessment of airway topography, we are developing methods of extracting 3-D structure from 2-D bronchoscope images utilizing MDCT imaging techniques. The resulting 3-D true-color images of the pulmonary mucosa facilitate the combination of mucosal color and topography analysis as well as region of interest localization within the airway tree.