八例Askin瘤的影像诊断

目的研究Askin瘤的影像表现，提高对该病的认识及鉴别诊断能力。方法回顾性分析经病理证实的8例Askin瘤的影像表现。8例均行X线检查，7例行CT检查，1例行MR检查，4例行核素骨扫描。结果8例Askin瘤均表现为位于胸壁或胸腔的软组织肿物，其中左侧4例，右侧4例。6例大病灶密度不均匀，2例较小病灶内密度或信号均匀；CT扫描4例可见囊变、坏死区。CT、MRI、核素骨扫描共显示肋骨破坏6例，其中CT显示4例，MRI显示1例，核素骨扫描显示放射性核素浓集3例。胸腔积液6例。瘤肺交界面清楚1例，不清楚7例。8例病灶中均未见钙化。结论Askin瘤影像学表现为胸腔或胸壁的软组织肿物，但不具有特异性，对发生于儿童及青少年的胸壁肿物，应注意鉴别诊断。     

The significance of sinonasal radiodensities: ossification,calcification, or residual bone?

PURPOSETo determine whether very radiodense material within a sinonasal soft-tissue mass on CT can be differentiated as calcification, ossification, or residual bone.METHODSWe retrospectively described the radiodensities within 235 sinonasal soft-tissue masses as discrete, solitary or multiple, or as a diffuse process with either a well-defined or poorly defined margin. They were also classified as calcification, ossification, or residual bone. Findings were correlated with pathologic specimens.RESULTSResidual bone was underdiagnosed; calcification was overdiagnosed. A solitary discrete density was most likely to be calcification within an inflammatory mass. However, multiple discrete densities were as likely to be in a tumor as in an inflammatory lesion. If the process was diffuse with a well-defined margin, it was most likely to be a benign fibroosseous lesion. If the process was diffuse with a poorly defined margin, it was most likely to be a high-grade sarcoma. Densities within inverted papillomas were shown to be residual bone, not calcifications; densities within esthesioneuroblastomas were calcifications.CONCLUSIONRadiodensities may help in refining a CT diagnosis, but one may not know based on CT whether the density is a calcification, ossification, or residual bone.     

炎性肌纤维母细胞瘤4例分析并文献复习

目的分析炎性肌纤维母细胞瘤(infiammatory myofibroblastic tumor,IMT)的CT表现,以提高对该肿瘤的认识。方法回顾性分析经病理证实的4例IMT患者的影像学资料,其中男3例,女1例,年龄22～61岁,平均49岁。肺部2例,肾脏和脾各1例。术前4例均行CT检查,其中2例仅行CT平扫,另2例行CT平扫及增强扫描。结果 2例肺内IMT CT表现均为孤立性实质性病变,边缘可光滑,亦可不规则,密度均匀或不均匀,其中1例病变边缘可见线条状钙化。2例腹部实质性脏器病变分别位于肾脏和脾,CT表现为实性肿块,边缘清晰或不清晰,肿块内部出现钙化,增强后病变呈渐进性强化,但强化程度均低于周围正常组织。结论 IMT是一种少见肿瘤,CT检查能为临床诊断IMT提供有价值的信息。     

Early disappearance of calcification in posterior paraspinal muscles in a patient with rhabdomyolysis associated with neuroleptic malignant syndrome

We report computed tomography (CT) findings that demonstrated early disappearance of ectopic calcification in the bilateral posterior paraspinal muscles in a patient with rhabdomyolysis. A 37-year-old man with acute renal failure due to rhabdomyolysis caused by neuroleptic malignant syndrome underwent studies with CT and bone scintigraphy. First, bone scintigraphy showed high radiotracer uptake in bilateral posterior paraspinal muscles; then CT demonstrated ectopic calcification in those muscles. After 2.5 months, CT showed that the calcification had completely disappeared. Bone scintigraphy anticipated calcification, and CT demonstrated a unique course of early disappearance of the calcification.     

Imaging of tumoral calcinosis: new observations

Five patients with tumoral calcinosis were evaluated with radiography, bone scintigraphy, computed tomography (CT), and magnetic resonance (MR) imaging. The arthropathy of calcium pyrophosphate dihydrate deposition disease was seen in two of the patients and pseudoxanthoma elasticum-like syndrome in three. Identification of calcific particular masses on radiographs is characteristic of tumoral calcinosis. Marrow lesions could be identified as patchy areas of calcification (calcific myelitis) in long bones and the calvarium. Bone scintigraphy appears to be the best modality for detection of the masses and marrow lesions and for monitoring therapy. At CT the masses demonstrated a varied appearance, from small and solid to large and cystic. The marrow abnormality appears as an area of increased attenuation and spotty calcification that in the skull may be associated with dural and vascular calcifications. MR imaging of the particular masses was remarkable in that the masses displayed high signal intensity on T2-weighted images despite a large calcific component. Marrow lesions also showed increased signal intensity on T2-weighted images. When calcified particular masses are present the diagnosis is rarely in question. The diagnosis may be overlooked, however, when calcific myelitis is the only manifestation.     

Calcifications in the portal venous system: comparison of plain films, sonography, and CT.

We describe 10 patients with long-standing portal hypertension and calcifications in the splenoportal and mesenteric venous systems or collateral vessels. The patients were examined with abdominal plain films (n = 10), sonography (n = 10), and CT (n = 9). Calcium was seen on CT scans in nine cases, on sonograms in seven, and on abdominal plain films in five. Calcifications appeared to be located in the wall of the vein in all cases. Sites of detection included the main portal, splenic, superior mesenteric, coronary, and peripancreatic veins. CT was more sensitive than sonography, and both were more sensitive than plain films, in showing portal venous calcification. Detection of such calcifications may influence surgical or percutaneous therapy of portal hypertension.     

Scleral calcifications in hyperparathyroidism: demonstration by computed tomography

Scleral calcifications were demonstrated roentgenographically in two patients with known hyperparathyroidism and clinically normal eyes. In one of these patients, scleral calcification was evident both on plain films and with computed tomography (CT). In the second patient, a solitary plaque of calcified sclera was visible only by CT. Histopathologic examination of the eyes of a third hyperparathyroid patient who died during surgery demonstrated calcium plaques in the posterior sclera consistent with the CT appearance of the sclera in the other patients.     

Bone metastasis of hepatocarcinoma. Review of the literature, radiologic pictures and personal caseload]

Prognosis of patients affected with hepatocellular carcinoma (HCC) has been improved by the modern imaging techniques allowing an early diagnosis and by the value of the therapeutic protocols employed. Staging has also become more and more important. Bone metastases from HCC are reportedly rare. The authors observed a 5.5% incidence in 90 cases of hepatocarcinoma. The metastases were demonstrated by radiography, CT, and nuclear scintigraphy, in patients with skeletal pain. The plain film appearance of skeletal metastases from HCC was osteolytic in all cases; no surrounding sclerosis was seen. CT scans demonstrated the destructive nature of these lesions, which were associated with bulky soft-tissue masses. Metastases exhibited increased radiotracer (99mTc-MDP) uptake at bone scintigraphy. The authors believe that bone scintigraphy should be included in the staging protocols of the HCCs which need a potentially curative therapy.     

99Tcm-MDP SPECT/CT显像用于骨肉瘤肺转移的诊断

目的：观察骨肉瘤肺转移的发生率,评价99Tcm-MDP SPECT/CT显像中的骨显像与胸部CT对肺转移的检出效能及其影响因素。方法178例骨肉瘤患者使用SPECT/CT行全身骨显像的同时获得胸部CT,以诊断有无肺转移发生。通过回顾性分析,将影像学诊断结果与最终临床诊断进行对照,计算肺转移的发生率;评价骨显像和胸部CT对肺转移的检出效能;分析转移灶钙化对骨显像检出率的影响;分析血清碱性磷酸酶（ALP）水平在有肺转移与无肺转移者之间、转移灶有钙化与无钙化者之间以及转移灶骨显像阳性与阴性者之间的差异。结果178例患者肺转移的发生率为24．2%;骨显像与胸部CT对其诊断的灵敏度分别为44．2%和100%;特异度分别为100%和89．6%;骨显像对有钙化转移灶的检出率显著高于无钙化转移灶（χ2=8．4,P＜0．01）;患者血清ALP水平与肺转移的发生相关,但与病灶内有无钙化以及病灶是否在骨显像中呈阳性无关。结论骨肉瘤患者肺转移的发生率较高,使用SPECT/CT同时行全身骨显像和胸部CT检查对其检出具有较高诊断价值,尤其适用于血清ALP升高的患者。     

少见部位软骨母细胞瘤的影像诊断

目的:探讨少见部位软骨母细胞瘤的影像学表现及其临床诊断价值。方法:回顾性分析经病理证实的7例少见部位软骨母细胞瘤患者的病例资料。肿瘤位于距骨2例、跟骨2例、髌骨、坐骨结节及耻骨下支各1例。行X线平片检查7例,CT平扫4例,MRI平扫及增强检查4例。结果:X线平片示膨胀性骨质破坏5例,囊状骨质破坏1例,灶周硬化3例,病灶内小斑片状钙化1例;平片漏诊1例。4例CT均显示膨胀性骨质破坏,灶周硬化,病灶内斑点状或小斑片状钙化。MRI上病变呈膨胀性骨质破坏3例,囊状骨质破坏1例,4例病灶信号均混杂,灶周均可见低信号线状影及明显的骨髓水肿。结论:少见部位软骨母细胞瘤具有膨胀性骨质破坏及灶周骨髓水肿明显的特点,平片、CT和MRI三种检查方法联合应用对本病的诊断及鉴别诊断有重要价值。     

Multiple pulmonary nodules detected by computed tomography: diagnostic implications

Prior to the advent of CT, the radiographic demonstration of multiple nonmiliary lung nodules usually indicated the presence of metastases or, less likely, granulomas. The increased sensitivity of CT at detecting small parenchymal pulmonary densities is accompanied by loss of specificity, creating uncertainty as to the significance of nodules detected at CT in any individual patient. During a 1 year period we reviewed all CT scans in our institution demonstrating three or more focal lung densities, noting these parameters: number of densities, maximum lesion size, presence of calcification as determined visually, and lesion morphology (linear or nodular). Of 137 patients with three or more focal lung densities at CT, nodule diagnosis was established on pathologic or clinical grounds in 114. Metastases accounted for 73%, with primary colon and lung malignancies and lymphoma the most common causes. Malignant nodules were statistically significantly larger, more numerous, and more rounded, whereas calcification was significantly associated with benign disease. However, no single criterion or combination of criteria was foolproof. Based on our results, we offer recommendations for further evaluation of nodules in several common clinical settings.     

反射性交感神经营养不良的影像学诊断

目的探讨反射性交感神经营养不良(RSD)影像学诊断的意义。方法收集并分析5例反射性交感神经营养不良的临床和影像学特点。结果全部患者均在外伤后起病,均有错位疼痛、局部水肿和感觉过敏等临床表现。X线平片和CT检查均可发现病变部位的斑片状骨质疏松,CT检查优于平片。4例患者行骨扫描检查发现病变部位均有放射性异常浓集影。1例早期患者行MR I检查,能发现在平片中不易发现的骨侵蚀。结论平片和CT扫描显示的斑片状骨质疏松是本病最具特征性的影像学表现,骨扫描和MR I有助于本病的早期诊断。     

Diffuse, intense lung uptake on a bone scan: a case report

PURPOSE: Clinical and scintigraphic findings are described in a patient with unexpected diffuse lung uptake on bone scan after a heroin overdose. METHODS: The patient's Tc-99m MDP bone scan is reviewed along with the pertinent clinical history and laboratory findings. RESULTS: Marked diffuse and symmetric lung uptake is present on bone scintigraphy in a patient with a history of acute renal failure and a markedly elevated calcium-phosphate product but normal renal function and laboratory values at the time of the examination. CONCLUSIONS: The incidental observation of metastatic calcification by bone scintigraphy is important, because it may aid in the diagnosis of a previously unsuggested elevated calcium-phosphate product, renal failure, or both. Furthermore, the intensity of tracer localization on bone tracer-specific imaging may help evaluate the activity of the metastatic calcification process.     

影像学检查诊断早期反射性交感神经营养不良的意义

目的 :探讨影像学检查在早期反射性交感神经营养不良 (RSD)诊断中的意义。材料和方法 :回顾性分析 3例早期RSD患者的临床和影像学检查特点。结果 :全部患者全身骨扫描检查发现受累肢体有明显的放射性异常浓集。 1例患者MRI检查可发现在平片中不易发觉的骨侵蚀。结论 :骨扫描和MRI有助于RSD的早期诊断 ,且优于X线平片和CT平扫。     

转移性骨肿瘤漏误诊原因的影像学分析

目的 分析转移性骨肿瘤漏、误诊的原因,提高对该病影像诊断水平。材料与方法 回顾分析资料完整的转移性骨肿瘤１０５例,其原发肿瘤主要为肺癌、前列腺癌、消化道癌及乳等。所有病例均摄Ｘ线平片,其中ＣＴ检查３１例,ＭＲ检查２１例,ＥＣＴ检查３４例。结果 骨转移瘤以多发、溶骨型为主。初次影像检查漏、误诊分别为：Ｘ线平片３５例,ＣＴ５例,ＭＲ及ＥＣＴ各１例。结论 影像检查首选ＥＣＴ和Ｘ线平片,有条件时最好作ＣＴ     

Evaluation of usefulness of bone SPECT for lumbar spondylolysis

The purpose of this study was to evaluate the usefulness of 99mTc-MDP SPECT (bone SPECT) for lumbar spondylolysis. We analyzed 11 cases with 17 lesions. All cases were compared using plain radiography, computed tomography (CT), planar bone scintigraphy (PBS), and bone SPECT. Four lesions that showed a wide defect on CT were negative on bone SPECT and may have been chronic lesions. Thirteen lesions that were positive on bone SPECT were narrow or showed no defect on CT and may have been early lesions. Two cases showed no defect on CT but were positive on bone SPECT, and one of them progressed to bilateral spondylolysis after one year. This may have been a very early lesion. Thus bone SPECT is useful for the diagnosis of lumbar spondylolysis, especially in its early stage.     

Spontaneous fracture of the sacrum due to "insufficiency". An overlooked cause of low lumbago in elderly women

A case of insufficiency fracture of the sacrum is reported. These fractures usually occur in elderly women and are secondary to various conditions, mainly postmenopausal or steroid-induced osteoporosis and radiation therapy. They are often overlooked or confused clinically and radiographically with metastatic disease. Findings on plain films are often subtle. Radionuclide bone scan shows a characteristic H or butterfly shaped pattern of increased uptake in the sacral alae. The diagnosis is confirmed by conventional tomograms or CT which show the fracture always surrounded by prominent sclerosis.     

Extraosseus uptake of F-18 fluoride in the primary malignancy and cerebral metastasis in a case of non-small-cell lung cancer

A 68-year-old man with history of heavy smoking was admitted for increasing falls during the past 4 weeks. Chest x-ray revealed a right upper lobe mass. Biopsy demonstrated poorly differentiated non-small-cell carcinoma. F-18 fluoride positron emission tomography/computer tomography (PET/CT) was performed to evaluate bone metastasis. Review of the sectional PET images demonstrated extraosseous fluoride uptake in the primary lung mass, as well as ring-shaped fluoride uptake in the cerebral metastatic lesion. Neither of these lesions demonstrated calcifications on CT images. The patient received radiation treatment of the brain metastasis after F-18 fluoride PET/CT study.     

胰腺结核的CT表现

目的 探讨胰腺结核的CT表现及其诊断价值。方法 8例胰腺结核中,6例经手术病理证实,2例经穿刺活检证实,CT常规平扫加增强扫描。结果 多发结节型 胰腺结核1例,表现为肿大的胰腺内布满结节状低密度灶,仅结节灶边缘轻度强化。局灶 腺结核7例,均累及胰头部。局部软组织肿块4例,其中2例伴有多发斑点状钙化灶,1例呈蜂窝状强化;囊性肿块2例,其中1例囊壁有多发斑点状钙化灶,另1例为多房囊性病灶。胰头部团块状钙化灶1例。8例胰腺结核中4例有腹内胰外表现,包括腹内淋巴结结核、结核性腹膜炎,以及肝、脾结核。结论 胰腺结核CT表现呈多样化,但有一定特征性,伴有多发斑点状钙化灶或呈蜂窝状强化的胰腺肿块,可提示胰腺结核的诊断;与胰腺结核共存的腹内结核特别是特征性淋巴结结核有助于该病的诊断。     

Unilateral pulmonary metastases from Ewing's sarcoma shown in a technetium-99m-methylene-diphosphonate bone scan

A 32-year-old man with a history of painful swelling of the right ankle underwent bone scintigraphy, which showed increased uptake in the right ankle and also unexpected diffuse uptake throughout the right hemithorax. A single photon emission tomography scan performed after the intravenous injection of 740 MBq of technetium-99m methylene-diphosphonate ((99m)Tc-MDP) showed abnormal uptake throughout the right lung. Computed tomography (CT) revealed a large mass in the right lower lobe. CT-guided biopsy of this mass led to a diagnosis of metastatic Ewing's sarcoma. Although lung uptake on bone scans has been noted in various occasions (such as: pulmonary alveolar microlithiasis, Pneumocystis carinii pneumonia, and various tumoral lesions), increased uptake of (99m)Tc-MDP in lung metastases of Ewing's sarcoma has not been reported according to our knowledge until now. We report such a case.