长管状骨非潜水性骨梗死影像学表现分析

目的:总结9例长管状骨非潜水性骨梗死的X线、CT、MRI表现,探讨各影像学检查方法对骨梗死的诊断价值。方法:9例患者均拍摄了X线平片,7例行CT检查,2例行MRI检查;2例手术活检。结果:9例长管状骨非潜水性骨梗死共累及13个部位,股骨下段7个,胫骨上段4个,胫骨下段2个。其中2个部位经手术活检病理证实。X线平片显示髓腔内不均匀性骨化;CT显示髓腔内呈地图样改变,周围环以硬化边;MRI在T1WI和T2WI上病变中心区出现高低不等的混杂信号。结论:X线平片可以满足中晚期骨梗死的诊断,CT检查可以进一步明确诊断。MRI检查对早期骨梗死的诊断具有较高的敏感性。     

动脉瘤样骨囊肿的影像学诊断

目的：探讨动脉瘤样骨囊肿（ABC）的影像学特点。资料与方法：回顾性分析23例经手术病理证实的ABC的影像学表现，23例均摄X线平片和CT平扫。4例行MRI检查。结果：23例ABC发生于长骨18例，骨盆5例。ABC平片表现常为偏心性膨胀性骨破坏；CT平扫可见膨胀的骨壳内缘呈清晰弧形压迹，其中骨壳完整12例，断缺11例。病灶密度不均，19例可见蜂房样低密度影或液－液平面，15例出现软组织肿块；4例MRI主要表现为T1WI呈等低信号，T2WI呈大小不一高信号囊腔或液－液平面，3例增强扫描，2例无明显强化，1例轻度强化，囊间隔在T1WI、T2WI及增强后均为低信号。结论：X线平片简便经济，但对内部结构的显示有一定限度，CT和MR对内部结构及软组织的显示明显优于前者，对ABC具有很高的诊断价值。     

多层螺旋CT与磁共振成像在细微及隐匿性骨折诊断中的应用

目的探讨多层螺旋CT(MSCT)与磁共振成像(MRI)在细微及隐匿性骨折中的诊断价值。方法对69例车祸伤后,常规X线、普通CT检查阴性,但怀疑有骨折或临床症状明显者行MSCT和MRI检查。结果 MSCT检查发现52例细微骨折,其中鼻骨骨折8例,颅底骨折9例,脊柱骨折6例,肋骨骨折10例、骨关节骨折19例;另17例MSCT检查未见骨折征象,再行MRI检查并诊断为隐匿性骨折,其中脊柱骨折5例,骨关节骨折12例。结论 MSCT检查能发现常规X线与普通CT未能发现的细微骨折,对特殊部位,如颅底、肋骨骨折诊断有明显优势,对骨折的类型、骨折线涉及范围有较准确的诊断;而MRI检查可显示不能被MSCT所发现的骨挫伤及隐匿性骨折。MSCT与MRI联合应用,可为骨折患者的临床治疗及交通事故的医疗鉴定提供可靠的依据。     

The role of spiral CT vs plain films in acute cervical spine trauma: a comparative study

Purpose: To compare the diagnostic yield of conventional radiographs versus helical computed tomography (CT) in screening acute trauma patients. Methods: We reviewed 604 trauma patients who presented to our level I trauma emergency room and underwent both conventional radiography and spiral CT of the cervical spine of. Results: Of the 604 patients, 30 (5.13 %) had fractures seen on helical CT, only 10 of which were diagnosed on conventional radiography. Conclusion: In the screening of acute trauma patients, conventional radiography is less sensitive in detecting fractures than helical CT. CT should therefore be considered as a standard modality choice in such cases.     

Juvenile spondylolysis: a comparative analysis of CT, SPECT and MRI

Objective To evaluate whether MRI correlates with CT and SPECT imaging for the diagnosis of juvenile spondylolysis, and to determine whether MRI can be used as an exclusive image modality.Design and patients Juveniles and young adults with a history of extension low back pain were evaluated by MRI, CT and SPECT imaging. All images were reviewed blindly. Correlative analyses included CT vs MRI for morphological grading and SPECT vs MRI for functional grading. Finally, an overall grading system compared MRI vs CT and SPECT combined. Statistical analysis was performed using the kappa statistic.Results Seventy-two patients (mean age 16 years) were recruited. Forty pars defects were identified in 22 patients (31%), of which 25 were chronic non-union, five acute complete defects and ten acute incomplete fractures. Kappa scores demonstrated a high level of agreement for all comparative analyses. MRI vs SPECT (kappa: 0.794), MRI vs CT (kappa: 0.829) and MRI vs CT/SPECT (kappa: 0.786). The main causes of discrepancy were between MRI and SPECT for the diagnosis of stress reaction in the absence of overt fracture, and distinguishing incomplete fractures from intact pars or complete defects.Conclusions MRI can be used as an effective and reliable first-line image modality for diagnosis of juvenile spondylolysis. However, localised CT is recommended as a supplementary examination in selected cases as a baseline for assessment of healing and for evaluation of indeterminate cases.     

Serous cystadenoma of the pancreas: imaging findings]

PURPOSE: To present the imaging findings of serous cystadenoma (SCA) and discuss the main problems of differential diagnosis with other cystic pancreatic lesions. MATERIALS AND METHODS: 55 cases of SCA were reviewed; all the lesions proved to be benign at pathology. 35 tumors were evaluated with Ultrasonography (US), 49 with Computed Tomography (CT), and 15 with Magnetic Resonance Imaging (MRI). RESULTS: Among the patients who underwent either demolitive (47) or derivative (3) interventions, two different morpho-structural patterns were identified: microcystic (37), and oligocystic (13). The diagnosis of SCA, possible in the presence of microcystic pattern, was achieved in 63% of cases by US (22/35), in 63% of cases by CT (31/49), and in 73% of cases by MRI (11/15). In 12 patients evaluated with all the imaging modalities, the combined information allowed a correct diagnosis in 10 cases (83%). The 13 oligocystic tumors were almost always undistinguishable from other cystic masses of the pancreas. CONCLUSIONS: The diagnosis of SCA can be considered certain if a microcystic pattern is detected. A correct diagnosis is not achievable in the presence of oligocystic architecture. MRI is the best imaging modality in characterizing this tumor.     

强直性脊柱炎髋关节改变的X线、CT和MRI对比研究

目的 探讨强直性脊柱炎(AS)髋关节受累的影像表现,比较X线平片、CT和MRI显示AS髋关节受累的敏感度.方法 对55例AS患者行骨盆X线平片和MR检查,其中29例行髋关节CT检查.MR平扫均包括冠状面T1WI、T2WI、STIR、附加水激励的三维稳态快速梯度回波序列(3D-BTFE-WATS),其中24例同时行脂肪抑制T1WI增强检查.分析患者的影像资料,应用x2检验对X线平片、CT和MRI显示AS髋关节受累改变的敏感度进行分析.结果 55例AS患者110侧髋关节中,X线平片和MRI显示异常分别为13侧和85侧;X线平片改变包括关节面下骨侵蚀破坏13侧、关节间隙变窄4侧、韧带骨赘5侧;MRI显示关节面下骨侵蚀破坏31侧、关节间隙变窄4侧、关节少量积液80侧、骨髓水肿32侧、脂肪沉积28侧、韧带附着点炎21侧,24例行MR增强检查患者中19例见双侧滑膜异常强化.CT检查29例共58侧髋关节,CT在显示X线平片和MRI所显示的骨破坏同时,发现X线平片未能显示的10侧骨破坏和MRI未显示的1侧骨破坏.X线平片、CT、MRI显示异常分别为10.3％ (6/58)、27.6％ (16/58)和77.6％ (45/58),MRI显示髋关节受累的敏感度优于X线平片和CT(x2值分别为53.22和29.08,P值均＜0.05).MRI除显示X线平片和CT所能显示的慢性骨结构改变外,还发现X线平片和CT未能显示的急性炎症改变.结论 MRI能显示X线平片和CT不能显示的AS髋关节受累的急性炎症改变,滑膜炎所致的少量积液和滑膜异常强化是髋关节受累最常见的MRI表现.     

Computed tomography and bone scintigraphy in the evaluation of tarsal coalition

Three cases of talocalcaneal coalition were evaluated with routine radiography, conventional tomography, 99mTc-MDP bone scintigraphy, and computed tomography (CT). Routine radiography was normal in 1 case and demonstrated secondary findings suggesting coalition in 2. Conventional tomography confirmed the coalition in 2 patients. In all 3 cases, the scintigrams demonstrated increased uptake in the region of the coalition. CT provided the most graphic depiction of the coalition site and also identified an associated lesion involving the posterior subtalar joint, not recognized on conventional tomography. Scintigraphy may be useful as a screening procedure and can provide important localizing information in difficult cases.     

Magnetic resonance in the diagnosis of bone infections

Skeletal infections represent a variety of clinical and pathological conditions in which both an early diagnosis and the precise evaluation of disease extent are very important in planning proper therapy. To determine MRI capabilities and limitations in the evaluation of skeletal infections 21 patients--12 with a clinical diagnosis of osteomyelitis of the lower limbs and 9 with a clinical diagnosis of spondyloscitis--were studied with this technique. All patients were examined with conventional X-rays; conventional tomography was performed in 3 cases, and CT in 6. Signal intensities and morphological aspects were then evaluated with MRI. MRI diagnoses were compared with surgical findings or clinical follow-up, after antibiotic therapy: 19 true-positives were observed, together with 1 true-negative, 1 false-positive, and no false-negatives. MRI findings were correlated with those of conventional radiology: MRI identified the lesions and their nature in 100% of cases, whereas conventional radiology did the same in 85% of cases; in 50% of cases only the latter was able to define the nature of the process. Four patients underwent MRI follow-up. MRI was highly sensitive in determining the presence of lesions in an early stage and in demonstrating lesion regression. Moreover, MRI was able to identify the complications occurring in some cases of osteomyelitis and spondyloscitis. In all cases MRI allowed the extent of the disease to be accurately determined and, in osteomyelitis of the lower limbs, it was extremely useful to differentiate soft-tissue infections from bone marrow involvement.     

The value of magnetic resonance imaging in the diagnosis of orbital floor fractures

The value of MRI in the diagnosis of acute orbital floor fractures has not been clearly defined. We therefore compared MR findings with CT findings in patients with orbital trauma. In 30 patients with isolated orbital trauma both coronal CT and coronal MRI were used to examine the orbits and the adjacent paranasal sinuses. Visualization of anatomical landmarks, the kind and extent of traumatic lesions, as well as artifacts were scored. The scores were compared using the Wilcoxon matched-pairs signed-rank test. Interexamination agreement between the two methods was calculated using a kappa analysis. All examinations had diagnostic quality: 30 fractures of the orbital floor (9 right and 21 left orbital floor fractures) were identified. In addition, CT showed fractures of the medial orbital wall in 19 patients (63.3%), of the lateral wall in 10 patients (33.3%), of the zygomatic arch in 2 patients (6.7%), and of the maxillary sinus in 4 patients (13.3%). Soft tissue herniation was shown in 13 patients (inferior rectus muscle twice, orbital fat in 11 cases). Magnetic resonance imaging demonstrated soft tissue herniation in 21 patients: muscle in 4, orbital fat in 17 cases. Magnetic resonance imaging is able to demonstrate orbital floor fractures as sensitively as CT, but CT is superior to MRI in showing small and associated fractures; therefore, CT remains in orbital fractures the imaging modality of choice. Magnetic resonance imaging is superior to CT in showing soft tissue herniations; therefore, MRI may have a role as an adjunct to CT if soft tissue entrapment remains unclear.     

The topicality and use of the radiological exam in gunshot wounds of the limbs. An assessment of 132 cases

INTRODUCTION: Gunshot wounds of limbs are frequent injuries especially in Western countries. They can be single or associated with other penetrating gunshot wounds, for instance to the chest, abdomen and skull. PURPOSE: We investigated the current role and usefulness of conventional radiography in the assessment of gunshot injuries to limbs because, despite major advances in diagnostic imaging, this method remains the examination of choice in this condition. We stress the valuable contribution of conventional radiography to detection of bone blow-out fractures, multifocal traumatic bone changes, bone and joint injuries, bullet retention, and finally subcutaneous emphysema. MATERIAL AND METHODS: We retrospectively reviewed 132 cases of firearm injuries of limbs submitted to radiography March 1996 to July 1999. All the patients were men ranging in age 17-66 years (mean: 35). Radiography followed a preliminary physical examination, and follow-ups were carried out in the following days after orthopedic reduction of bone fractures or surgery with metal osteosynthesis. Emergency CT was performed first when chest, abdomen, or skull were involved. RESULTS: The lower limbs were involved three times as much as the upper ones; the leg was most frequently involved (61%), followed by thigh (61%), forearm and hands (24%), and feet (15%). The right lower limb was wounded in 65% of cases, especially tibia (55 cases) and femur (46 cases). Spiral injuries to bone diaphysis were the most frequent ones, followed by mixed fractures caused by cortical bone sinking from bullet impact. Bullets were retained in 60% of cases; subcutaneous emphysema was found in 78% of cases and vascular injuries in 25 cases in relation to disarranged fractures. We observed 4 arteriovenous fistulas during 3 years' follow-up. DISCUSSION AND CONCLUSIONS: Gunshot wounds to the limbs need a different clinical, diagnostic and therapeutic approach than thoracoabdominal and skull injuries, which require immediate and quick diagnosis and emergency treatment. The cases with injury to a primary artery from open and splintered fractures require emergency surgical reconstruction with vascular anastomosis and reduction of compound fractures, to prevent necrosis and amputation. Conventional radiography does depict the bullet and its site, subcutaneous emphysema, blow-out fractures, and the location of bone splinters. This permits adequate emergency surgery and an efficacious orthopedic approach, as well as selection of the cases to be submitted to clinical monitoring.     

Epiphysenfugenverletzungen der distalen Tibia Sinnvolle Mehrinformation durch die MRT?

Plain film radiography often underestimates the extent of injury in children with epiphyseal fracture. Especially Salter-Harris V fractures (crush fracture of the epiphyseal plate) are often primarily not detected. MRI of the ankle was performed in 10 children aged 9-17 (mean 14) years with suspected epiphyseal injury using 1.0-T Magnetom Expert. The fractures were classified according to the Salter-Harris-Rang-Odgen classification and compared with the results of plain radiography. In one case MRI could exclude epiphyseal injury; in four cases the MRI findings changed the therapeutic management. The visualisation of the fracture in three orthogonal planes and the possibility of detection of cartilage and ligamentous injury in MR imaging makes this method superior to conventional radiography and CT. With respect to radiation exposure MRI instead of CT should be used for the diagnosis of epiphyseal injuries in children.     

Dental vertical root fractures: value of CT in detection

PURPOSE: To determine the value of computed tomography (CT) in the diagnosis of dental vertical root fractures relative to the value of conventional dental radiography. MATERIALS AND METHODS: Thirty-seven patients with 42 teeth in which vertical root fracture was clinically suspected underwent dental radiography and axial CT. Two radiologists evaluated the images independently and by consensus for a fracture line. The results were compared with intraoperative findings. RESULTS: Twenty-eight of the 42 teeth were proved intraoperatively to be fractured. The sensitivity and specificity averaged for the two reviewers in the assessment of vertical fractures were 23% and 70%, respectively, with dental radiography and 100% and 100%, respectively, with CT. Consensus reading showed sensitivities of 25% for dental radiography and 75% for CT. Eight (reviewer A) or nine (reviewer B) false-negative CT findings were encountered in cases in which metallic artifacts obscured parts of the root and in cases in which the root was very small in diameter. Interobserver agreement was 95% for dental radiography and 93% for CT. CONCLUSION: CT is superior to dental radiography in the detection of dental vertical root fractures.     

Magnetic resonance imaging of para-acetabular insufficiency fractures in patients with malignancy

AIM: To describe the characteristic magnetic resonance imaging (MRI) findings of para-acetabular insufficiency fractures in patients with malignancy, and compare the MRI appearance of these fractures with that of metastatic bone disease. MATERIALS AND METHODS: MRI examinations were reviewed in 16 patients with a known malignant tumour and severe hip pain that raised the possibility of local recurrence or metastatic disease. Six patients had received pelvic irradiation, and three patients were receiving steroid medication. RESULTS: The total number of fractures detected was 21: a solitary fracture was present in 11 patients and five patients had bilateral para-acetabular fractures. Two patients had associated sacral insufficiency fractures, and one of them had stress fractures involving both acetabular columns. Conventional radiography allowed the diagnosis of 14 (67%) fractures; six (28%) radiographic examinations were negative; and one (5%) examination was equivocal for fracture. Available scintigraphic and computed tomography (CT) studies revealed typical findings of fracture. Using MRI, insufficiency fractures appeared as linear regions of low signal intensity on T1- and T2-weighted images. Marked marrow oedema was evident in all cases. Fractures characteristically were parallel to the superior acetabulum in a curvilinear fashion in 18 (86%) instances, and were oblique in three (14%) instances. The fractures demonstrated considerable enhancement after intravenous gadolinium administration. No associated soft tissue masses were documented. CONCLUSION: Para-acetabular insufficiency fractures are a cause of hip pain, which may mimic skeletal metastasis in the patient with malignancy and pelvic irradiation. Recognition of the characteristic MRI findings of these fractures can preclude misdiagnosis and unnecessary bone biopsy.     

下颌骨髁状突骨折的CT诊断

通过对比下颌骨髁状突骨折患者的普通Ｘ线和ＣＴ检查结果，着重提出ＣＴ诊断下颌骨髁状突骨折的方法及重要意义。     

几种影像方法对脊柱转移瘤诊断的比较

目的 :分析 93例脊柱转移瘤的MRI、ECT、SCT、X线平片征象 ,以提高脊柱转移瘤的早期诊断率。方法 :回顾性分析 93例经手术病理或随访证实的脊柱转移瘤的MRI、ECT、SCT、X线平片表现。结果 :93例脊柱转移瘤共发现2 79个椎骨异常、184处椎管受累、12 0处椎旁软组织肿块、12 0处椎体病理性骨折。MRIT1 WI表现为低信号 73 .3 %( 198/2 70 ) ,T2 WI表现为高信号 62 .2 %( 168/2 70 ) ,FS T2 WI表现为高信号 85 .2 %( 2 3 0 /2 70 ) ;ECT检出的 2 61处病灶表现为多处放射性浓聚或单发放射性浓聚 ;CT检出 184处病灶表现为局限性或大片骨质破坏 ;X线平片检出的 92处表现为骨质破坏。结论 :MRI及ECT敏感性高于SCT和X线平片 ,MRI、SCT、X线平片特异性高于ECT ;MRI是诊断脊柱转移瘤一种高敏感性和特异性的方法 ,优于ECT、SCT、X线平片 ;脊柱转移瘤首选ECT并结合X线检查 ,必要时SCT或 /和MRI检查。     

骨肉瘤的X线、CT及MRI比较分析(附61例分析)

目的:探讨原发性骨肉瘤的X线、CT和MRI表现及诊断价值.方法:经穿刺或手术病理证实的61例骨肉瘤患者,52例行X线检查,39例行CT检查,55例行MRI检查,其中23例行MRI动态增强检查.回顾性分析其影像学表现并与病理学表现进行对照分析.结果:本组61例骨肉瘤中成骨型13例,溶骨型21例,混合型27例.52例X线检...     

骨内脂肪瘤的影像学诊断

目的:讨论骨内脂肪瘤的发病机制、临床特征、影像表现、诊断及鉴别诊断.方法:回顾性分析经手术病理证实的11例骨内脂肪瘤的临床及影像资料,11例均行X线、CT检查,2例行MRI检查.结果:X线平片表现边界清晰的不规则形透亮区,可伴硬化缘.CT上病灶为类圆形或不规则形的脂肪密度区,CT值-55～-120 HU,病灶边界不规则,伴有厚薄不一的硬化缘,5个病灶中心可见结节状钙化灶.MRI表现为T1WI高信号,T2WI稍高信号,脂肪抑制序列病灶信号受抑变低,边缘见长T1短T2信号,其内见线条状长T1短T2信号的纤维分隔及长T1长T2的液性囊腔.结论:结合发病年龄、病变部位、临床症状和影像学表现,对本病可作出正确的术前诊断,可避免不必要的穿刺活检和CT、MRI的重复检查.     

CT evaluation of chondroblastoma

Chondroblastoma is a rare benign primary bone tumor with generally characteristic plain radiographic features. In some cases, however, the benign nature and the extent of the lesion may not be appreciated using conventional radiography. We report the CT findings of chondroblastoma in three patients. In one patient CT clearly defined cortical destruction, which was not well visualized on plain radiography or conventional tomography. In a second patient CT showed a sclerotic rim absent on plain radiography; this suggested the benign nature of the lesion. Other advantages and potential pitfalls of CT in evaluating chondroblastoma are discussed.     

关节积脂血征的影像学表现

目的：分析外伤所致关节积脂血征的X线、CT和MRI表现,总结其影像学特征表现。方法：回顾性分析46例关节积脂血征的X线、CT和MRI特点,其中膝关节32例、髋关节4例、肩关节4例、踝关节5例及肘关节1例。结果：仅4例在X线上有特征性表现,CT或MRI上46例关节积脂血征患者均有关节内骨折,关节积脂血征CT和MRI表现为关节囊内单液-液平面或双液-液平面,单液-液平面及双液-液平面的不同成份在CT和MRI上密度和信号不同,但上层均为脂肪。结论：关节积脂血征在CT和MRI上具有特征性表现,可做出明确诊断,关节积脂血征均与关节内骨折并存,可作为关节内骨折的可靠间接征象。