SAPHO综合征临床及影像学表现

目的：探讨滑膜炎、痤疮、脓疱疮、骨肥厚、骨炎综合征(SAPHO综合征)的临床和影像学表现。资料与方法：报道了5例SAPHO综合征并复习文献。结果：SAPHO综合征有骨关节病变和皮肤病变。骨关节病变表现为骨肥厚、硬化和关节炎，好发部位是前上胸壁、脊柱、骨盆等，胸肋锁骨区的改变最有特征性。皮肤病变表现为脓疱疮和重症痤疮。结论：放射科医师应提高对SAPHO综合征的认识，并与其他疾病进行鉴别。     

脊椎慢性布氏菌病影像学表现

目的:探讨脊椎慢性布氏菌病影像表现。方法:回顾性分析10例脊椎慢性布氏菌病患者的影像学表现。结果:脊椎慢性布氏菌患者的影像学表现:①椎体破坏同时伴有增生硬化;②破坏的椎体前上角缺如、碎裂,局部可见游离的碎骨块;③椎间隙狭窄;④可同时累及多个椎体;⑤未见椎旁或腰大肌脓肿。结论:椎体破坏、硬化、椎间隙狭窄、无椎旁脓肿并结合患者来自牧区,应考虑布氏菌病的可能,确诊则依赖实验室检查。     

Vertebral involvement in SAPHO syndrome: MRI findings

We report on the MRI findings in the vertebrae and surrounding soft tissues in two patients with the SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis). The MRI findings include abnormal bone marrow signal, either focal or diffuse, of the vertebral bodies and posterior elements; hyperintense paravertebral soft tissue swelling and abnormal signal of the intervertebral discs. These changes are consistent with discitis and osteitis. Received: 27 July 1998 Revision requested: 14 October 1998 Revision received: 23 November 1998 Accepted: 24 November 1998     

Klippel-Trenaunay综合征的影像表现分析

Klippel-Trenaunay综合征(静脉畸形骨肥大综合征)是一种较少见的血管类型的疾病,自1962年国内最先由李鹤鸣报道3例病例之后,陆续有相关病例的个案报道及一些有关的病例分析[1～4] ,不少外科医师及放射科医生由于对于该病认识不足,易造成误诊。本文通过对证实为K -T综合征的6例病例的X线及血管造影影像进行分析并结合相关文献对该病进行总结及分析。1　材料与方法对6例K -T综合征病例的X线及血管造影进行影像学分析,其中男4例,女2例,年龄16～40岁。发病部位均为下肢,发病于股骨2例,发病于胫骨4例,其中有1例患者其祖父亦有类似病变(已死亡…     

Giant Vertebral Notochordal Rest: Magnetic Resonance and Diffusion Weighted Imaging Findings

A giant vertebral notochordal rest is a newly described, benign entity that is easily confused with a vertebral chordoma. As microscopic notochordal rests are rarely found in adult autopsies, the finding of a macroscopic vertebral lesion is a new entity with only seven previously presented cases. We report here radiological findings, including diffusion weighted images, of a patient with a giant notochordal remnant confined to the L5 vertebra, with an emphasis on its distinction from a chordoma.     

严重急性呼吸综合征的影像学表现

目的 探讨严重急性呼吸综合征(SARS)的影像表现特征和发展规律。资料与方法 对22例临床确诊为SARS患者的影像资料进行观察，就其肺部病变发生的时间、部位、性质和病变进展情况进行分析。结果 本组患者中，出现临床症状l-4天影像表现为阳性者18例，占82％；5—8天影像上为阳性者4例，占13％。多数患者的病灶首先发生在下肺野。进展期病变发展迅速，常累及多部位及双肺，不以肺叶或肺段分布。好转期一般在治疗后的8-12天。结论 SARS的主要影像表现为：(1)病变主要发生在肺的外围；(2)多部位受累，下肺野多于上肺野；(3)影像表现与临床症状有时不符；(4)病变变化迅速；(5)CT比胸片能早l-3天发现早期病变。熟悉SARS的影像学表现，密切结合临床和实验室检查是可以做出明确诊断的。     

脑后部可逆性脑病综合征的MRI表现

目的 探讨脑后部可逆性脑病综合征(posterior reversible eneephalopathy syndrome,PRES)的MRI征象.方法 搜集经临床、影像确诊的PRES病例6例,结合文献分析其脑部MRI征象.结果 6例均见双侧枕顶叶病变,同时有双侧额叶病变3例,双侧颞叶病变2例,双侧小脑半球病变1例.病变主要位于皮质区,脑回状,为长T1长T2信号,FLAIR像上呈高信号.双侧大致对称.以T2WI像上和FLAIR像上显示为明显.6例均经积极治疗后症状均消失,2例MBI复查病变消失或减少.结论 PRES的MRI表现具有一定特征性,结合临床可确定诊断.     

Distal Embolization After Stenting of the Vertebral Artery: Diffusion-Weighted Magnetic Resonance Imaging Findings

Purpose We retrospectively evaluated our experience with stenting of the vertebral artery in an effort to determine the risk of distal embolization associated with the procedure. Methods Between June 2000 and May 2005, 35 patients with 38 stenting procedures for atherosclerotic disease of the vertebral origin in our institution were identified. The average age of the patients was 60.3 years (range 32–76 years). Sixteen of these patients (with 18 stents) had MR imaging of the brain with diffusion-weighted imaging and an apparent diffusion coefficient map within 2 days before and after procedure. Results On seven of the 16 postprocedural diffusion-weighted MR images, a total of 57 new hyperintensities were visible. All these lesions were focal in nature. One patient demonstrated a new diffusion-weighted imaging abnormality in the anterior circulation without MR evidence of posterior circulation ischemia. Six of 16 patients had a total of 25 new lesions in the vertebrobasilar circulation in postprocedural diffusion-weighted MR images. One patient in this group was excluded from the final analysis because the procedure was complicated by basilar rupture during tandem stent deployment in the basilar artery. Hence, new diffusion-weighted imaging abnormalities were noted in the vertebrobasilar territory in 5 of 15 patients after 17 stenting procedures, giving a 29% rate of diffusion-weighted imaging abnormalities per procedure. No patient with bilateral stenting had new diffusion-weighted imaging abnormalities. Conclusion Stenting of stenoses of the vertebral artery origin may be associated with a significant risk of asymptomatic distal embolization. Angiography, placement of the guiding catheter, inflation of the stent balloon, and crossing the lesion with guidewires or balloon catheters may potentially cause distal embolization. Further studies to evaluate measures to increase the safety of vertebral artery stenting, such as the use of distal protection devices or short-term postprocedural anticoagulation, should be considered for patients with clear indications for this procedure.     

SAPHO综合征的CT特征

目的 探讨SAPHO综合征的CT特征.方法 回顾性分析42例SAPHO综合征患者CT表现及临床资料,所有病例行MSCT薄层扫描,6例行X线检查.结果 42例患者发病部位主要在胸骨、锁骨胸骨端、第一前肋及肋软骨、胸锁关节及胸肋关节,表现为骨质硬化肥厚,关节面破坏、关节间隙变窄,晚期以骨关节肥厚融合为主.对称性30例,非对称性12例,且均以右侧为重.皮肤受损40例,皮肤与骨关节同时发病11例,病程半年～30年不等.结论 SAPHO综合征具有固定发病部位及特征性影像学表现,MSCT扫描及其后处理技术是其最合理影像学检查方法.     

原发腹膜后肿瘤累及邻近脏器的CT，MRI表现及其临床意义

目的探讨腹膜后肿瘤累及邻近脏器的影像学表现,为手术治疗提供依据.材料和方法总结分析46例邻近脏器受累的腹膜后肿瘤患者的术前CT、MRI资料.结果恶性肿瘤患者32例,良性14例,肿瘤邻近脏器受累与肿瘤的良恶性无关.肾脏是最常受侵的脏器.下列征象提示可能需将受累肾脏切除;肿瘤生长穿通Gerota筋膜,与肾脏连接面大于肾周长的1/3以上;肿瘤压迫造成肾和肾蒂移位;肿瘤包裹肾门结构;肿瘤侵及输尿管,导致肾盂严重积水等.肿瘤累及腔静脉多于动脉.常规CT和MRI增强检查,可准确显示脏器受累的征象.结论肾脏和腔静脉最易受到腹膜后肿瘤的侵及;规范CT、MRI检查能够清楚显示脏器受累的征象.     

可逆性后部脑病综合征的影像学表现及诊断

目的 探讨可逆性后部脑病综合征(PRES)的影像学特点及诊断价值.资料与方法 回顾性分析15例PRES患者的临床和影像学资料,其中子痫或先兆子痫7例;原发性高血压1例;肾性高血压2例;肾移植及骨髓干细胞移植后3例,其中2例移植后使用环孢素A治疗;系统性红斑狼疮1例;行全脑血管造影使用非离子型对比剂诱发1例.结果 PRES的CT表现主要以顶枕叶白质呈低密度改变为特征,增强后无强化.顶叶、枕叶及额叶同时见低密度7例;顶叶及枕叶同时见低密度5例,其中2例有出血;顶叶、枕叶、额叶及基底节区或小脑白质同时见低密度2例;单纯枕叶见低密度1例.MRI对于诊断病变有无、病灶范围及皮层受累比CT更敏感.顶叶、枕叶、额叶及基底节区或小脑白质广泛低密度者疗效不佳;顶叶、枕叶及额叶低密度者与单纯枕叶低密度者全部恢复良好,呈可逆性改变.经过积极治疗,先兆子痫与子痫、原发性高血压、药物毒性所致PRES恢复良好.结论 结合PRES的影像学特点,了解其临床表现、病因及用药情况,综合分析,有利于早期做出诊断,提高治愈率.     

Hypereosinophilic Syndrome: CT Findings in Patients with Hepatic Lobar or Segmental Involvement

Objective

The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved.

Materials and Methods

Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation.

Results

CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis.

Conclusion

Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis.     

脊椎骨嗜酸性肉芽肿的影像学表现(附10例分析)

目的　为了提高对脊椎骨嗜酸性肉芽肿的认识。方法　回顾分析 10例手术病理证实的脊椎嗜酸性肉芽肿的X线、CT及MRI的表现。结果　椎体呈溶骨性破坏 7例 ,囊性破坏 3例 ,椎间隙不同程度变窄或消失 ,部分椎弓及椎旁软组织受累。结论　椎体破坏与椎弓受累、椎间隙改变及椎旁软组织肿块不成比例 ,破坏区内可残存小骨碎片而无死骨存在等 ,可作为脊椎骨嗜酸性肉芽肿的主要特征表现     

脊柱嗜酸性肉芽肿的MRI表现

目的探讨脊柱嗜酸性肉芽肿的MRI表现. 资料与方法搜集经手术病理证实的脊柱嗜酸性肉芽肿患者12例,所有病例均进行了X线平片及MRI检查,重点分析其MRI表现. 结果发生于颈椎3例,胸椎7例,腰椎2例.12例椎体均呈不规则性破坏,MRI表现为楔形或盘状改变,12例中2例椎间隙轻度变窄,2例椎旁软组织肿胀,1例椎弓根及椎板受累;所有病例于T1WI呈低或等信号,T2WI呈高信号,脂肪抑制序列STIR呈高信号改变,增强扫描呈均匀性强化. 结论 MRI能准确显示病变范围、结构及邻近组织改变,大部分病例根据临床及MRI表现,可作出正确诊断,但确诊仍需依靠病理活检.     

MR椎管造影的影像学表现

目的：报道椎管常见病变的ＭＲ椎管造影表现。材料与方法：ＭＲ为Ｓｉｅｍｅｎｓ Ｍａｇｎｅｔｏｎ Ｉｍｐａｃｔ１．０Ｔ超导扫描机,所用的扫描序列为脂肪抑制重Ｔ２ＳＥ序列。重建方法为均数重建法和最大信号强度投影（ＭＩＰ）法。结果：５０例ＭＲ椎管造影,２５例正常ＭＲ椎管造影都能清楚地显示硬膜囊、神经根、神经根鞘袖和椎旁静脉丛。２０例椎间盘突出症中轻度者３例,中度１７例,轻度表现为硬膜囊周围的静脉丛信号缺损     

Budd—Chiari综合征的MRI

目的：探讨Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的ＭＲＩ和ＭＲＡ表现及其诊断价值。材料和方法：回顾性分析５例经腔静脉造影证实的Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的ＭＲＩ和ＭＲＡ表现,并与腔静脉造影进行比较。结果：ＭＲＩ和ＭＲＡ表现如下：１、肝肿大,３例慢性者尾叶增大;２、肝静脉未显示,肝内血管呈逗点状;３、下腔静脉狭窄、阻塞和狭窄阻塞后扩张及血流信号异常,与腔静脉造影比较,ＭＲＩ和ＭＲＡ显示狭窄和阻塞的形态不够确切;４、肝外侧枝血管形成。结论：ＭＲＩ对Ｂｕｄｄ－Ｃｈｉａｒｉ综合征具有特征性的诊断价值,但不能取代腔静脉造影。     

肺错构瘤的影像学诊断

目的 探讨肺错构瘤的X线、CT及正电子发射体层成像(PET-CT)表现及其诊断价值.资料与方法 回顾性分析20例经手术病理证实的肺错构瘤的影像学资料.结果 左肺8例,右肺12例.除1例出现浅分叶外,其余病灶均表现为边界清楚的类圆形结节影,均为单发病灶.7例胸片病灶表现为边界清楚的结节影,1例见环状钙化;13例CT均表现为边界清楚的结节影,8例可见周围血管受压推移,10例薄层扫描可见病灶内脂肪,增强扫描病变呈轻度强化;2例在PET-CT上未见显影剂浓聚.结论 胸片有助于错构瘤的检出,薄层CT平扫及增强对其诊断价值较高.