Intracavitary metastasis to the left ventricle: an angiocardiographic diagnosis.

A patient with an intracavitary metastasis to the outflow tract of the left ventricle diagnosed prior to the primary tumours is presented. It is unique in location, type and diagnosis. Metastatic disease of the heart is far more common than primary cardiac tumours and usually is diagnosed late in the course of the disease or at autopsy. Angiocardiography is the best method of diagnosing tumours of the heart and should be performed whenever such a diagnosis is considered.     

Lung metastasis of a meningioma

Case report of a 35-year-old male patient. 1976: operation for a falx-meningioma. 1981: meningioma recurrence and further intracranial meningiomas. Histology: 1976 and 1981 endotheliomatous meningioma: no signs of malignancy. Prior to the 2nd operation in 1981 a lung tumor was diagnosed for the first time. Histology of the lung tumor: endotheliomatous meningioma, same histology as in cerebral meningiomas.     

长骨骨干皮质型转移瘤的影像学诊断

目的探讨长骨骨干皮质型转移瘤的影像学表现特点。方法回顾性分析6例经临床及病理证实的位于长骨骨干的皮质型转移瘤的X线、CT及MRI检查资料。6例均摄患肢正侧位X线平片,其中CT检查2例,MR检查2例。结果 X线表现为长骨骨干骨皮质局限性偏心性骨质破坏,边界清晰。CT及MRI横断位示骨皮质呈"咬甜饼干"样骨质缺损,骨质破坏范围小于1/2周,边缘未见骨质增生、硬化,局部可见密度均匀的软组织肿块影,增强扫描强化明显。结论长骨骨干皮质型转移瘤具有一定的特征性影像学表现,结合其临床特点有助于诊断。     

单发肝脏转移性肿瘤的CT诊断及鉴别诊断

众所周知,肝脏是转移性肿瘤最好发的部位之一。对于多发肝脏转移性肿瘤影像诊断一般不难,但单发肝脏转移性肿瘤需要与原发性肝癌、肝脓肿、肝血管瘤等鉴别,对指导临床治疗有重要意义。笔者搜集了37例单发肝脏转移性肿瘤的CT资料,探讨其CT表现及鉴别诊断以期提高其诊断水平。     

侵及颈静脉孔区的原发性中耳癌的CT、MRI诊断

目的 探讨侵及颈静脉孔区的原发性中耳癌的CT、MRI特点.方法 回顾性分析7例经手术病理证实的侵及颈静脉孔区原发性中耳癌患者的CT、MRI资料,其中6例行高分辨率CT(HRCT)扫描,1例行常规CT增强扫描,7例均行MR平扫+增强.结果 HRCT显示鼓室、鼓窦、外耳道深部及颈静脉孔区软组织病灶伴不规则虫蚀样骨质破坏,涉及颈静脉孔(7例)、咽鼓管骨性段(7例)、面神经管(4例)、颈动脉管(4例)、外耳道前后壁(3例)、听小骨(2例)及前庭窗、水平半规管(1例)等结构的破坏.4例病变密度较均匀,CT值约30～55 HU,2例肿块内见少许小片状高密度影.1例CT增强显示中度较均匀强化.MR平扫示边界不清软组织肿块,与脑灰质相比,T1WI呈等、略低信号,T2WI呈等、略高信号,其中5例信号较均匀,2例肿块内见少许小片状T1WI、T2WI低信号灶,增强扫描5例呈中度较均匀强化,2例不均匀强化,内见小片状无强化区.MRI显示4例侵及颈内动脉,1例侵及乙状窦.结论 原发性中耳癌可广泛侵及颈静脉孔区,易造成误诊.HRCT可准确显示中耳癌骨质破坏特点及范围,咽鼓管骨性段破坏可帮助减少误诊;MRI能更清楚显示病变范围,肿瘤信号及强化方式有一定特点.     

不典型脑转移瘤的CT诊断

脑转移瘤是颅内常见的占位病变，约占脑肿瘤的30％-40％，典型的脑转移瘤CT较易诊断；本文收集7例CT平扫病灶呈高密度、无水肿带、无占位效应，增强扫描病灶无强化，称为不典型脑转移瘤。     

不典型脑转移瘤的CT诊断

目的 分析脑转移瘤的CT特征，提高对不典型脑转移瘤的认识。方法 回顾性分析了214例脑转移瘤的CT资料。结果 脑转移瘤的典型CT表现是大脑皮层或皮层下（86.02%）多发的（73.83%）均匀结节（40.42%）或环形结节（32.53%），增强扫描后不同程度强化（98.80%),瘤周水肿明显。病灶也可见于基底节（2.65%）、小脑（8.67%）、室管膜下（1.45%）、丘脑（0.48%）和脑干（0.24%）。病灶也可呈直径超过3cm的均匀肿块（4.10%）或环形肿块（12.53%），也可呈单纯囊肿型（2.89%）、囊壁结节型（2.17%）或不规则多囊状（5.54%）。结论 不典型性脑转移瘤的CT诊断除了仔细观察病灶的影像细节外，积极寻找原发肿瘤显得格外重要。     

低场强MRI对脊椎转移瘤的诊断及鉴别诊断

目的:为了提高脊椎转移瘤诊断及其与其他椎体病变的鉴别诊断水平。方法:回顾性分析经病理证实的转移瘤79例和误诊病例15例的MRI特点,归纳其影像表现的差异。结果:79例转移瘤中,累及椎体125个,多为跳跃式分布;累及附件骨92个,占73.6%;椎体破坏变形81个,占64.8%;椎间盘均无变化;有软组织肿块22例(17.6%),软组织肿块常以破坏区为中心生长。T1WI均呈低信号,T2WI信号改变可以多种多样。结论:MRI检查在诊断脊椎转移瘤及与其他脊椎病变的鉴别诊断中更敏感、更具特异性。     

Coronarography in the diagnosis of left atrial thrombosis

Thrombosis of left atrium is frequent in the patients with mitral defect. Systemic embolism that generates by separated thrombus parts is a possible complication during the disease. Echocardiography is routinely used in the diagnosis of left atrial thrombosis. On the basis of angiographic experience, we have set the hypothesis: coronary angiography has a great sensitivity, but small specificity in the diagnosis of left atrial thrombosis. The presence of thrombus in left atrium was analyzed in 60 operated patients with mitral valve disease. During the surgery, thrombus was found in 13, and not found in 47 patients. Coronary angiography was preoperatively performed in all patients. In 9 out of 13 patients with intraoperatively observed left atrial thrombus, thrombus was also found by angiography. In 47 patients thrombus was found neither intraoperatively, and in 45 nor by angiography. The sensitivity of angiography in the diagnosis of left atrial thrombosis is 69%, specificity is 97%, and the accuracy is 90%. Positive index of anticipation is 81%, and negative index of anticipation is 91%.     

MRI诊断脑转移瘤的价值

目的 探讨MRI诊断脑转移瘤的价值。方法 分析36例脑转移瘤患的临床及MRI资料，全部病例均行非增强及增强MRI检查。结果 多发颅脑转移瘤29例，其中3例为弥漫性脑转移瘤。单发脑转移瘤7例。脑转移瘤发生在幕上21例，幕下4例，幕上及幕下均有11例。4例伴有邻近脑膜受累。非增强MRI病灶上多数为长T1长T2信号，增强MRI上病灶均有强化，以环状强化为多见。增强MRI比非增强MRI发现转移瘤病灶将近高1倍。结论 增强扫描是MRI诊断脑转移瘤所必须的。结合临床病史和MRI特征，对大多数病例可做出准确诊断。     

增强MR及DWI在脑转移瘤诊断应用

目的：探讨增强MR及DWI在脑转移瘤诊断应用价值。方法：回顾分析70例明确诊断为脑转移瘤病例,全部病例均进行MRI增强检查,其中44例同时行DWI检查,分别测定肿瘤实质、坏死囊变区、瘤周水肿及正常脑实质ADC值。结果：增强MRI共发现病灶525个,强化类型为结节状强化（289）、环状强化（198）、片状强化（13）和环斑片状强化（25）。转移瘤病灶部位ADC值：实质区（1．136±0．320）X10一、囊变坏死区（2．166±0．492）×10^-3、周围水肿区（1．587±0．228）×10^-3和正常脑实质区（0．802±0．148）×10^-3,这四者间ADC值差异显著性。结论：增强MRI检查能够准确反应脑转移瘤分布、大小、形态及周围组织受累情况,并能检出更多MRI平扫所不能显示微小病灶,DWI检查及ADC值能反应脑转移瘤组织微观结构变化,对于脑转移瘤诊断起到一定辅助诊断作用。     

Ultrasonography and computerized tomography in the diagnosis of renal metastasis

The US and CT findings of renal metastases are described in a series of 26 patients. US findings were round or oval masses ranging in diameter from 1.5 cm to 8 cm (mean: 4.2 cm); in only 21.2% of cases lesion diameters were less than or equal to 3 cm. In most patients (84.8%) the metastatic lesions were hypo-isoechoic, while in the extant cases they were either mildly hyperechoic or inhomogeneous. CT findings were round masses with variable diameters (1 cm to 8 cm; mean: 2.7 cm); in most cases (86.4%) lesions diameters were less than or equal to 3 cm. The latter finding was in significant disagreement with US results. CT densities were within the soft-tissue range, and always hypodense if compared to normal renal parenchyma in contrast-enhanced scans. Few cases of perirenal metastases were observed. US sensitivity was only 57%, much lower than that of CT; the latter method yielded no false negatives. CT showed metastatic lesions in patients with normal US findings; in 2 cases a greater number of lesions was detected with CT than with US. Our results are in substantial agreement with literature data, as far as US and CT findings are concerned; however, a lower incidence of bilateral cases was observed in our series than in previous reports. Our results support the primary role of CT in the detection of renal metastases thanks to its high sensitivity and to its allowing the simultaneous evaluation of other organs.     

Periosteal chondrosarcoma invading the medullary cavity

 We present a case of periosteal chondrosarcoma of the femur, in which a tumor invaded the medullary cavity and the lesion was clearly demonstrated only on MRI. To the best of our knowledge, there have been no previous reports of an intramedullary lesion caused by periosteal chondrosarcoma demonstrated on MRI.     

Lung metastases--limitations and possibilities of radiologic diagnosis

The different sensitivities of chest radiograph, full-lung tomography and computed tomography (CT) are determining factors in the diagnosis of pulmonary metastases. Pathogenesis and pathologic-anatomical morphology explain the radiological findings. Knowledge of spontaneous or therapy-induced changes and "sterilized" metastases is important for follow-up studies. The precise densitometry in CT improves the assessment of degree of a pulmonary disk-shaped lesion. Histological diagnosis may be obtained by fluoroscopically guided percutaneous thin-needle biopsy.     

CT diagnosis of intrasplenic metastasis from ovarian carcinoma

Intrasplenic metastases from ovarian carcinoma cannot be always demonstrated intraoperatively. CT is the most important imaging modality of choice for staging and follow-up ovarian cancer; in this study we searched CT appearances of intrasplenic metastases from ovarian carcinoma. We retrospectively reviewed imaging histories of the patients with ovarian cancer from the radiology information system, and found 12 patients with intrasplenic metastasis. All patients underwent abdominal CT with 16-MDCT. We searched number, density and maximum diameters of splenic metastasis. The growing rate of three lesions, which were followed up by CT, was calculated. Serum cancer antigen (CA) 125 levels were noted. We also evaluated clinical history and pathology reports of all patients. Splenic metastases, solitary or multiple, were detected most frequently during the follow-up (1-14 years after initial diagnosis) and most were associated with other sites of recurrence. The diameters of lesions ranged from 4 to 85mm. All lesions appeared hypodense except for one lesion with dense calcification. Densities of lesions ranged from 12 to 208 Hounsfield units (mean, 49±51HU). Most lesions appeared as solid well-defined nodules; however some lesions had lobulated and irregular contours with an infiltrative pattern. The growing rates of three lesions were 0.72mm/month, 1.75mm/month and 2.70mm/month. Eight patients had elevated serum CA 125 levels (40-1256U/mL). We concluded that CT can demonstrate intraparenchymal and infiltrative splenic metastasis in patients with ovarian cancer even in the absence of increased CA 125 levels.