Mycetoma-like manifestations in invasive pulmonary aspergillosis

Invasive pulmonary aspergillosis is characterized by radiological signs allowing a correct diagnosis, including differentiation from pulmonary candidiasis, when they are associated with appropriate clinical symptoms (neutropenia and fever persisting despite broad-spectrum antibiotics). In particular the formation of a pulmonary mycetoma in a previously normal lung is one of these signs. Unlike a simple fungus ball (the saprophytic form of aspergillosis), the rounded density of invasive pulmonary aspergillosis consists of sequestrum of devitalized lung tissue owing to blood vessel invasion by Aspergillus hyphae. This morphologic phenomenon is demonstrated in the present case report and is discussed together with the other roentgenological signs of the invasive aspergillosis.     

系统性红斑狼疮累及中枢神经的CT与MRI诊断

本文总结9例系统性红斑狼疮(SLE)累及中枢神经系统的CT、MRI表现，并与其他原发和继发的中枢神经系统疾病的影像学表现相鉴别，从而得出较准确的影像诊断，协助临床进一检查和治疗。     

侵袭性肺曲菌病的CT表现

目的 探讨侵袭性肺曲菌病（ＩＰＡ）的ＣＴ表现。方法 经病理及临床证实的ＩＰＡ８例,均行常规ＣＴ扫描,２例４周后ＣＴ复查。结果 ＣＴ表现为肿块样浸润（３例）;炎症样病变（３例）;多发结节（２）。结论 ＩＰＡ的早期ＣＴ征象有肿块,多发结节,实变;ＣＴ“晕轮征”的出现强烈提示的早期诊断。     

神经精神性狼疮MRI检查的临床应用价值

目的：探讨神经精神性狼疮(NPSLE)MRI表现特点及其与临床的关系。方法：52例NPSLE患者在出现症状后1天～2个月内进行头部MR检查。另选取26例无神经系统症状的SLE患者和27例健康志愿者行MR检查并与NPSLE组比较。结果：NPSLE的MRI主要表现为斑点状和大片状脑炎样病变、出血、脑梗死和脑萎缩，额、顶叶和基底节区好发。表现为点状病灶的临床以精神障碍和头痛为主要表现，片状病灶以癫痫和偏瘫为主要表现。临床病情严重患者的片状病灶的发生率、病灶总面积较轻微组显著增高。片状的，边缘模糊的，T1WI等、略低信号，T2WI高信号的病灶变化迅速。结论：NPSLE的MRI检查有助于明确脑病性质及更准确的评估病情和预后，从而指导治疗和评价疗效。     

Discrimination between invasive pulmonary aspergillosis and pulmonary lymphoma using CT

Objective

The purpose was to assess the characteristic CT features of invasive pulmonary aspergillosis (IPA) and pulmonary lymphoma (PL) and to analyze the potential to distinguish the two entities using CT.

Methods

The CT images of 70 patients with either proven IPA (n = 35) or PL (n = 35) were evaluated retrospectively and independently by two radiologists (reader 1 [R1] and reader 2 [R2]), analyzing images for presence, number and characteristics of pulmonary nodules and masses, ground-glass opacities, consolidations and other interstitial changes.

Results

Interreader agreement was moderate (4/33 CT features), good (9/33) or excellent (20/33). Pulmonary nodules (P = 0.045 [R1], P = 0.001 [R2]), nodules with spiculated outer contours (P < 0.001 [R1], P = 0.001 [R2]), nodules with a halo sign (P < 0.001 [R1+R2]), nodules with homogeneous (P = 0.030 [R1], P = 0.006 [R2]) and inhomogeneous (P = 0.001 [R1], P < 0.001 [R2]) attenuation patterns, nodules with cavitation (P = 0.006 [R1], P = 0.003 [R2]) and wedge-shaped, pleural-based consolidations (P < 0.001 [R1 + R2]) occurred significantly more often in patients with IPA, while masses without a halo sign (P = 0.03 [R1], P = 0.01 [R2]), lobar consolidations with bronchogram (P = 0.02 [R1 + R2]) and consolidations with homogeneous attenuation patterns (P < 0.001 [R1 + R2]) were found significantly more frequent in PL-patients.

Conclusions

Those CT features can therefore be considered suggestive for either IPA or PL. However, in most cases the diagnosis cannot be made based on CT findings solely because no single feature gained a high sensitivity and specificity concomitantly. Furthermore, the logistic regression did not show a combination that was significantly better than the best univariate predictor.     

Cavitary pulmonary nodules in systemic lupus erythematosus.

Two cases of systemic lupus erythematosus with cavitary pulmonary nodules as a manifestation are presented. The literature concerning the radiographic manifestations of cardiopulmonary involvement in systemic lupus erythematosus is reviewed.     

Thin-section chest CT findings in systemic lupus erythematosus with antiphospholipid syndrome: a comparison with systemic lupus erythematosus without antiphospholipid syndrome

Purpose

To assess thin-section chest CT findings in systemic lupus erythematosus (SLE) with antiphospholipid syndrome (APS), in comparison with SLE without APS.

Materials and methods

We retrospectively reviewed the medical records and thin-section CT findings of 17 consecutive patients with an established diagnosis of SLE with APS, comparing with 37 consecutive SLE patients without APS, between 2004 and 2008, and patients who had other autoimmune disease, such as Sjögren syndrome, were excluded. No significant differences were seen between the two groups in age, gender, smoking habits, or history of steroid pulse and biological therapy. CT images of 2 mm thickness obtained with a 16- or 64-detector row CT were retrospectively evaluated by two radiologists in consensus on ultra high-resolution gray-scale monitors.

Results

The frequency of thin-section CT abnormalities was higher in SLE with APS group (82%) than in SLE without APS group (43%). Ground-glass opacity (59%), architectural distortion (47%), reticulation (41%), enlarged peripheral pulmonary artery (29%), and mosaic attenuation (29%) were significantly more common in the SLE with APS group than in the SLE without APS group (Fisher's exact test, p < 0.01).

Conclusion

SLE patients with APS have increased prevalence of thin-section chest CT abnormalities than those without APS.     

Abnormal brain diffusivity in patients with neuropsychiatric systemic lupus erythematosus

BACKGROUND AND PURPOSE: Neuroimaging techniques have increased our knowledge of the pathogenesis of neuropsychiatric systemic lupus erythematosus (NPSLE) and have been useful in supporting the diagnosis. Nevertheless, new imaging techniques are needed to unravel the exact pathogenesis and to provide diagnostic criteria for NPSLE. In this preliminary study, we investigated whether diffusion-weighted imaging (DWI) can depict cerebral abnormalities in patients with a history of NPSLE, and we assessed whether apparent diffusion coefficient (ADC) histograms in these patients differ from those of healthy control subjects. METHODS: Eleven female patients with a history of NPSLE (mean age [+/- SD], 35 years +/- 9) and 10 healthy control subjects (eight female, two male; mean age, 37 years +/- 16) underwent DWI. DWI and ADC images were assessed by means of visual inspection, and histograms were composed from the ADC images. From these, we derived a variety of parameters that quantitatively reflect the diffusivity of brain parenchyma. RESULTS: Visual inspection of ADC images and DWIs did not reveal any abnormalities in either patients with NPSLE or control subjects. In contrast, ADC histograms of the NPSLE group were, on average, significantly lower and broader, with a higher mean ADC value. CONCLUSION: The data suggest an increased general diffusivity in brain parenchyma of patients with NPSLE, probably based on loss of tissue integrity. In addition to increasing our battery of highly wanted diagnostic tools and our understanding of the pathogenesis of NPSLE, the present method seems to be useful in quantifying the disease burden, enabling monitoring in treatment trials and the study of disease progression.     

红斑狼疮性脑病的MRI诊断

目的：探讨红斑狼疮性脑病的MRI表现及其临床诊断价值。方法：回顾性分析17例系统性红斑狼疮性脑损害患者的MRI图像。全部病例均符合系统性红斑狼疮诊断，临床有神经、精神异常而行颅脑MRI检查。结果：红斑狼疮性脑病的加U检查阳性率为88．2％(15／17)。主要加U表现包括：弥漫性白质或灰质异常信号(13／17)；局灶性异常信号(2／17)；病灶无强化或边缘轻微强化；基底节脑梗塞；病灶边界清晰，周围无水肿带，亦无占位效应，全部病例无脑萎缩表现。结论：MRI检查可显示红斑狼疮性脑病患者脑内病变的位置、数目、大小、范围，对指导治疗及评价疗效有重要意义。     

系统性红斑狼疮脑病的磁共振影像表现

目的描述系统性红斑狼疮脑病的ＭＲＩ表现，探讨ＭＲＩ在本病中的诊断价值。方法符合系统性红斑狼疮诊断标准的女性患者１０例，年龄１５～５３岁，病史１～１０年。均表现为不同程度的神经或精神症状（其中９例符合神经精神性红斑狼疮）。在出现症状１～５个月内行头部ＭＲＩ扫描并结合临床资料对ＭＲＩ进行分析。结果本组ＭＲＩ显示为弥漫性白质或灰质异常信号６例（其中１例并发进行性多灶性白质脑病死亡）；局灶性异常信号２例，其中１例合并出血；２例显示为正常；全部病例均无脑萎缩表现。结论系统性红斑狼疮脑病的病因复杂，ＭＲＩ作为一种重要的检查方法，其主要作用不仅在于发现病变并确定诊断，而且在指导治疗及评价疗效方面有重要意义     

Radiographic findings in the hands in patients with systemic lupus erythematosus

Hand radiographs of 59 patients with systemic lupus erythematosus (SLE) were examined. Thirty-four revealed radiographic abnormalities, most commonly periarticular soft-tissue swelling or demineralization. Alignment abnormalities, acral sclerosis, avascular necrosis, soft-tissue calcification and terminal tuft resorption were also seen. All patients with periarticular calcification or terminal tuft resorption had Raynaud's phenomenon. Clinical indicators of disease activity (including low serum complement levels) did not correlate with the presence or severity of radiographic abnormalities. Patients with abnormal radiographs generally were older at the time of diagnosis than those with normal studies.     

CT features of systemic lupus erythematosus in patients with acute abdominal pain: emphasis on ischemic bowel disease

PURPOSE: To evaluate the computed tomographic (CT) features of systemic lupus erythematosus (SLE) in patients with acute abdominal pain. Special emphasis was placed on the analysis of ischemic bowel disease. MATERIALS AND METHODS: The authors retrospectively reviewed the images from 39 abdominal CT examinations performed in 33 patients with SLE and acute abdominal pain. Images were evaluated for bowel wall changes, mesenteric changes, fluid collection, retroperitoneal lymphadenopathy, peritoneal enhancement, and hepatomegaly as well as for changes in other abdominal organs. Ischemic bowel disease was diagnosed if at least three of the following signs were seen: bowel wall thickening, target sign, dilatation of intestinal segments, engorgement of mesenteric vessels, and increased attenuation of mesenteric fat. RESULTS: Thirty-one (79%) of the 39 examinations had CT findings diagnostic of ischemic bowel disease, including symmetric bowel wall thickening (n = 29), target sign (n = 26), and mesenteric vascular engorgement and haziness (n = 31). In 24 cases, bowel wall thickening was multifocal, with variable length, and did not appear to be confined to a single vascular territory. CONCLUSION: The most common CT finding in patients with SLE and acute abdominal pain is ischemic bowel disease. CT is useful for detecting the primary cause of gastrointestinal symptoms, planning treatment, and monitoring for infarction or perforation.     

系统性红斑狼疮胸部病变89例影像分析

系统性红斑狼疮（systemic lupus erythematosus,SLE）是一种临床表现有多系统损害症状的慢性系统性自身免疫病,其血清具有以抗核抗体为主的大量不同的自身抗体[1]。     

白血病肺部浸润的CT表现

目的：探讨白血病胸部浸润的CT表现，评价白血病肺部浸润的CT诊断价值。方法：回顾性分析我院确认的12例白血病患者的胸部白血病细胞浸润的CT(HRCT)表现。结果：白血症患者发生胸部浸润的CT表现多种多样，主要为小叶间隔增厚、外周支气管血管间质增厚、结节影，毛玻璃状改变，气腔实变等。这些表现与白血病细胞浸润肺的途径相一致，但不具特异性。结论：白血病患者出现胸部症状时，应考虑到肺浸润的可能，CT有助于肺浸润的诊断，但应与其他并发症如感染相鉴别。