磁共振诊断男性假两性畸形1例

患者,社会性别女,17岁.因无月经来潮在当地医院未能明确诊断而来本院就诊.查体:一般情况好,心肺无异常,无月经史.妇科检查外生殖器呈女性,阴蒂较大,双侧腹股沟内可扪及活动度良好的包块.第二性征为女性,染色体核型(46,XY).MRI扫描横断位见左右腹股沟内侧各见一实性结节影,两者大小相似,约1.9 cm×1.9 cm×2.5 cm大小(图1).盆腔内未见子宫及附件影(图2).增强扫描后冠状位见双侧腹股沟实性结节有强化,可见阴道口(图3).MRI诊断:双侧隐睾,腹股型,结合临床考虑男性假两性畸形,阴茎发育不全.     

威廉斯综合征合并心血管畸形的影像诊断

目的 探讨威廉斯(Williams)综合征合并心血管畸形的影像诊断方法.方法 13例Williams综合征患者,均行体检、心电图、X线胸片及超声心动图检查.3例行电子束CT、8例行心血管造影检查.结果 12例患者因发现心脏杂音而就诊,1例因出生后紫绀而就诊.7例伴有"小精灵"面容同时合并轻度智力障碍,4例生长发育迟缓,所有患者均伴有主动脉瓣上狭窄,6例合并肺动脉狭窄,2例合并动脉导管未闭,2例合并重度肺动脉高压,1例合并完全型心内膜垫缺损.8例行心血管造影患者中,2例分别于造影即将结束时和造影完毕返回病房留观时发生心源性猝死.结论 心血管造影是诊断Williams综合征合并心血管畸形的金标准,但其为有创检查,有发生猝死的危险,可尝试用无创或少创的诊断方法替代心血管造影.     

X线与CT在成软骨细胞瘤诊断中的应用分析

目的 通过观察X线和CT扫描对成软骨细胞瘤的诊断情况,对比二者在成软骨细胞瘤诊断中的应用.方法 对我院2005年6月～2012年10月收治并拟诊断成软骨细胞瘤的50例患者进行X线和CT扫描检查来辅助诊断,并对比观察两组影像学检查方法的诊断结果.结果 X线检测表明成软骨细胞瘤呈局限性骨破坏,病程多呈圆形,CT扫描表明病灶有不同程度的分叶,呈半环形钙化,有清晰边界;通过病例检查确诊可知,X线的诊断敏感度为84.8％（39/46）、特异度为75.0％（3/4）,CT扫描的诊断敏感度是97.8％（45/46）,特异度100.0％（4/4）.两组检查手段的诊断敏感度均较高,差异无统计学意义（x2 =3.42,P＞0.05）,CT扫描的特异度显著高于X线,差异有统计学意义（x2=5.52,P＜0.05）.结论 X线和CT检查对成软骨细胞瘤的诊断均有重要价值,且各具优势,两者联合应用能够为临床诊断提供更多参考信息.     

X线球部畸形表现对球部溃疡的诊断价值(附218例分析)

我们将有完整记录的十二指肠球部溃疡218例的X线诊断和胃镜诊断进行分析比较,发现X线球部畸形表现对诊断球部溃疡是不可靠的,现报告如下。 一般资料 本组患者在进行胃镜检查前均有X线钡餐检查记录,相隔时间3天38例,4～5天161例,6～7天19例。男198例,女20例。年龄18～68岁,20～45岁154例。218例中X线诊断球部溃疡141例。其中以龛影表现者46例中经     

17α-羟化酶缺陷症合并男性女性化的影像学特征

【摘要】目的：探讨17α-羟化酶缺陷症合并男性女性化患者的影像学特征。方法：回顾性分析9例17α-羟化酶缺陷症合并男性女性化患者的临床及影像学资料,9例患者社会性别均为女性,年龄9~26岁。所有患者均进行肾上腺激素水平测定、染色体核型分析、双侧肾上腺和盆腔下腹部CT和/或MRI检查,14岁以上患者行X线骨龄测定。结果：9例患者染色体核型均为46XY,临床均表现为原发醛固酮增多症、ACTH水平增高、血尿皮质醇增高,成年患者性激素水平异常。影像学特征包括双侧肾上腺显著弥漫性增粗伴结节、生殖系统发育异常和骨骺闭合延迟。结论：双侧肾上腺显著弥漫性增粗伴结节、生殖系统发育异常和骨骺闭合延迟是17α-羟化酶缺陷合并男性女性化患者的特征性表现。     

垂体柄阻断综合征的临床特征及MRI诊断

目的 分析垂体柄阻断综合征的临床特点及MRI表现,提高对该病的认识和诊断水平.方法 收集23例垂体柄阻断综合征患者的临床资料及MRI图像,并对其进行分析总结.结果 23例垂体柄阻断综合征患者均存在生长发育异常,生长激素激发试验峰值均＜5μg/L.2例合并第二性征发育迟缓,1例合并第二性征缺如;3例合并尿崩症;2例伴肾上腺皮质功能减退;1例伴智力障碍.3例合并其他先天性发育畸形,1例伴胼胝体发育不良(体部及压部缺如);1例伴轻微Joubert综合征、Chiari畸形;1例伴视神经、视束萎缩,大脑镰发育不良.骨龄落后2～14岁不等.诊断年龄为3～24岁,其中18例(78.3％)诊断年龄≥10岁,提示明显诊断延迟.MRI检查均提示垂体柄缺如或中断、垂体后叶异位、垂体前叶萎缩或发育不良.结论 垂体柄阻断综合征以生长发育迟缓为主要临床表现,表现为腺垂体功能减退,同时可合并其他先天性发育畸形.其MRI表现具有特征性,联合实验室检查可明确诊断.     

多层螺旋CT三维重建应用于腰椎骨折诊断中临床价值分析

目的 探讨CT三维重建技术应用于腰椎骨折临床诊断中的应用价值.方法 回顾性62例腰椎骨折患者的临床资料、X线及螺旋CT表现,CT三维重建技术在诊断腰椎骨折中应用价值.结果 本组62例共计78个椎体骨折,其中单个椎体骨折者46例,多个椎体骨折者17例（2个椎体骨折例13,3个椎体骨折例2例）.与手术诊断情况进行诊断符合情况分析发现X线平片诊断腰椎骨折31例,诊断符合率为61.29％（38/62）;多层CT螺旋诊断腰椎骨折50例,诊断符合率达96.77％（60/62）,经统计学分析发现多层螺旋CT的诊断符合率明显高于X线平片,且差异具有统计学意义（x2=23.55,P＜0.05）.结论 X线与CT诊断胸腰椎骨折各有优缺点,X线检查普及性较高,但是诊断准确性低,多层螺旋CT三维重建技术可非常清晰地显示骨折情况,为临床医师准确的诊断及治疗方案、手术的选择和术后随访、疗效以及预后评估提供了很好的依据.     

胎儿三维磁共振成像技术的初步应用

目的：探讨三维磁共振成像（3D-MRI）技术在显示胎儿体表正常解剖和先天畸形方面的应用价值。方法：对40例18~37周的胎儿在超声检查后1~2d内行MRI检查,应用单次激发快速自旋回波序列（SSFSE）行胎儿轴面、矢状面和冠状面二维MRI（2D-MRI）,三维稳态进动快速成像（3D-FIESTA）序列MRI,均使用并行采集技术（ASSET）,在工作站对原始数据进行多平面重组（MPR）、容积重组（VR）和磁共振仿真内窥镜技术（MRVE）等三维图像后处理。将MRI和随访、尸检结果进行比较。结果：36例孕妇3D-MRI检查成功率为94.4%（34/36）,34例胎儿经随访和尸检证实46处畸形。胎儿体表先天畸形2D-MRI正确诊断37处,诊断符合率80.4%（37/46）;误诊1处,假阳性率为2.1%（1/46）;漏诊8处,漏诊率17.4%（8/46）。3D-MRI正确诊断43处,诊断符合率93.5%（43/46）;误诊1处,假阳性率2.1%（1/46）;漏诊2处,漏诊率为4.3%（2/46）。两种方法诊断胎儿体表先天畸形差异无统计学意义（χ2=2.40,P〉0.05）,但3D-MRI对于面部畸形如唇裂和其他复杂畸形如体蒂异常、骶尾部畸胎瘤、联体双胎等显示更直观清楚。结论：3D-MRI一次扫描可直观反映胎儿体表结构的表面特征、立体形态及相互间的位置关系,VR、MRVE对胎儿正常面部、外生殖器、脐带、肢体等的评价有较高价值,MPR可对兴趣区进行多角度观察。磁共振三维成像对显示胎儿正常体表结构和病变及产前咨询和围产期手术具有重要的临床价值。     

Schmid氏型干骺端软骨发育不良1例

干骺端软骨发育不良较为罕见 ,笔者曾诊断Schmid氏型 1例 ,现总结分析如下。1　病历简介患者 ,男 ,5岁。走路不稳 3年 ,伴左踝畸形来院就诊。否认外伤及手术史 ,父母非近亲结婚。体检 :无前额突出及鼻梁凹陷 ,胸廓对称 ,神经系统未发现阳性特征 ,脊柱无侧弯。双膝、双踝关节增粗并双踝内翻畸形 ,双下肢短缩。实验室检查 :碱性磷酸酶及酸性磷酸酶 ,钠、钾、氯、钙均未发现异常。细胞遗传学检查 :46XY ,无异常 ,染色体检查无异常。X线检查 :全身长管状骨干骺端、双侧肩峰及锁骨肩侧端均示密度减低 ,并有不规则透亮区和散在的钙化点。肱骨近…     

Application of 320-detector row computed tomography in the diagnosis of congenital heart diseases

目的:探讨320排CT对先天性心脏病的临床诊断价值.方法:回顾性分析15例先天性心脏病患者的320排CT扫描资料,并与经胸超声心动图(TTE)及手术结果进行对照研究.结果:15例经手术证实的心内外结构异常共72个,其中心内结构异常27个,心外结构异常45个.320排CT、TTE对心内畸形的诊断符合率分别为96.3％(26/27)和92.6％(25/27),差异无显著性意义(x2=2.982,P＞0.05).320排CT对心脏大血管连接部位畸形及心外大血管畸形的诊断符合率[100％(45/45)]明显高于TTE[53.3％(24/45)],差异有显著性意义(x2=31.28,P＜0.05).320排CT及TTE对先心病总的诊断符合率分别为98.6％和68.0％,差异有显著性意义(x2=28.09,P＜0.05).结论:320排CT对心外大血管结构异常的检出显著优于TTE,对心内结构异常的检出也有良好的效果,320排CT结合TTE可显著提高对小儿先心病的诊断准确性.     

Gleichzeitige Darstellung von EsD,DIA, GLO und UDPGP in einem Stärkeblock

Zusammenfassung Es wird über die gleichzeitige Darstellung von 4 Enzymsystemen aus menschlichen Hoden berichtet. GLO- und Diaphorase-Typen waren sehr gut reproduzierbar. Das gilt prinzipiell auch für EsD; dabei sollte eine Inkubationszeit von 2–3 min nicht überschritten werden, weil sich die Untergrundfluoreszenz zunehmend intensiviert. Von der UDPGP wurden 2 differente Muster angezeigt; jedoch gelang ihr Nachweis nicht regelmäßig.     

Frequenzen von Gm 1, 2, 3, 5, 10, 21 und Km 1, 3 in Portugal und Schleswig-Holstein

Zusammenfassung Es wurden 1000 Schleswig-Holsteiner und erstmalig 562 Portugiesen auf die Gm-Faktoren 1, 2, 3, 5, 10 und 21 sowie die Km-Faktoren 1 und 3 untersucht und die Phänotypen mit ihren Genfrequenzen für diese Kollektive bestimmt. Die Frequenzergebnisse wurden miteinander verglichen und Unterschiede herausgestellt.Ausführliche Darstellung siehe Dissertation Zippel, Lübeck (1981)     

Invited. Hepatitis,cirrhosis, and hepatoma

Virus hepatitis and liver cirrhosis are found at high incidence in Asia, and they require not only biochemical examination of blood but also subsequent imaging, because they are often complicated by hepatocellular carcinoma (HCC). It is, therefore, very important to know the specific appearances of hepatitis, liver cirrhosis, and HCC when we diagnose these diffuse liver diseases. Liver necrosis due to severe hepatitis is seen as high intensity on T2-weighted spin echo images. Regeneration is seen as low intensity on T2-weighted images. Morphologic and pathologic changes of cirrhotic liver are well demonstrated by MR imaging techniques. Fibrotic septum with inflammatory cell infiltration or rich pseudo bile duct show high intensity on T2-weighted images, and regenerating nodules shows low intensity. Gradient echo images show regenerating nodules with iron deposition as low-intensity nodules due to susceptibility artifact. MRI also has the potential to evaluate function of diffuse liver disease, cirrhosis, and hepatitis. MRI can visualize and diagnose HCC objectively. Dynamic MRI is very useful for diagnosing HCC. It is also applied for evaluation of effect after transcatheter arterial chemoembolization, because it shows enhancement only in the viable region at an arterial phase. MRI is less invasive and is thus an extremely important form of liver imaging.     

Renal Colic Imaging: Myths,Recent Trends,and Controversies

There has been a substantial increase in the utilization of imaging, particularly of multi-detector computed tomography (MDCT), for the evaluation of patients with suspected urolithiasis over the past 2 decades. While the diagnostic accuracy of computed tomography (CT) for urolithiasis is excellent, it has also resulted in substantial medical expenditures and increased ionizing radiation exposure. This is especially concerning in patients with known nephrolithiasis and in younger patients. This pictorial review will focus on recent trends and controversies in imaging of patients with suspected urolithiasis, including the current roles of ultrasound (US), MDCT, and magnetic resonance imaging, the estimated radiation dose from MDCT and dose reduction strategies, as well as imaging of suspected renal colic in pregnant patients. The current epidemiological, clinical, and practice management literature will be appraised.     

Accuracy and precision of MR velocity mapping in measurement of stenotic cross-sectional area,flow rate,and pressure gradient

Reliability of magnetic resonance (MR) velocity mapping to assess severity of stenosis was assessed in vitro. Steady flow at different flow rates through five stenoses with a central orifice area ranging from 17 to 176 mm² was measured with velocity mapping performed perpendicular to the stenotic jet. Besides determination of the stenotic cross-sectional area and flow rate, the pressure gradient was calculated with the modified Bernoulli equation and compared with manometer measurements. Cross-sectional areas were measured with an accuracy of ?76%, a precision of ?91%, and an error of ?19 mm². Flow rates had an accuracy of ?72%, a precision of ?94%, and an error of ?1.4 L/min. The modification of the Bernoulli equation limited its reliability to stenoses with areas of 35-113 mm². Pressure gradients were calculated with an accuracy of ?80%, a precision of ?88%, and an error of ?15 mm Hg. The method was applied in a single patient with aortic stenosis and gave estimates that agreed with those obtained by heart catheterization.     

Software-annotated, digitally photographed, and printed MR images: suitability for publication

RATIONALE AND OBJECTIVES: The authors performed this study to evaluate whether digitally photographed, computer-annotated MR images produced by clinical radiologists and printed with an inexpensive photo printer are suitable for publication. MATERIALS AND METHODS: Laser prints of 20 magnetic resonance images of the brain were photographed with a 3-megapixel digital camera and annotated with arrows, arrowheads, and asterisks by using graphics software that incorporates vector support. Then, 5 x 7-inch glossy prints with white borders were made by using an inexpensive photo printer. These prints were compared with those produced of the same 20 images by members of the medical center's graphics department with professional scanning and printing equipment and annotated with conventional rub-on symbols. Eight radiologists evaluated image and annotation quality and overall suitability for publication. RESULTS: In all three categories, the images produced by radiologists outscored those produced by the graphics department. CONCLUSION: Digitally photographed, software-annotated MR images printed with an inexpensive photo printer are suitable for publication.     

Asymmetric-Echo,Short TE,Retrospectively gated MR imaging of the heart and pulmonary vessels

Although retrospectively cardiac-gated (cine) magnetic resonance imaging has shown promise for large-vessel pulmonary vascular imaging, it has not been able to depict the peripheral pulmonary vasculature, where signal is dephased because of susceptibility and/or motion artifacts. The authors developed a cine pulse sequence that uses asymmetric echoes and radio-frequency envelopes to achieve reduced gradient moments and a short TE, thereby reducing signal losses due to disordered flow and susceptibility effects. The effects of TE (2.8–12 msec) and the degree of echo symmetry as measured by the echo symmetry fraction (ESF) (0.6–1.0) are considered in the pulmonary vasculature and the heart. In pulmonary vessels, the signal-to-noise ratio nearly doubled as TE was decreased from 12 to 2.8 msec, but there was only about a 15% difference as the ESF decreased from 1.0 to 0.6, consistent with T2* losses dominating gradient moment dephasing. At a TE of 2.8 msec, the sequence improves visualization of pulmonary vessels and may be helpful for diagnosing pulmonary emboll. In the heart, however, the contrast-to-noise ratio between blood and cardiac tissue decreased by 30% as TE decreased from 12 to 2.8 msec and was not affected by changes in ESF. Flow artifacts in the cardiac blood pool, including those that can aid in diagnosis (eg, signal loss due to “jet” flow), are much less pronounced when a small ESF and short TE are used, making this sequence less attractive for investigation of cardiac flow irregularities. The reduced flow artifacts in this case, however, permit excellent depiction of gross cardiac anatomy.     

Comparison of Ultrasound,CT, and MR Imaging in the Evaluation of Candidates for TIPS

To compare ultrasound (US), CT, and MRI in the evaluation of hepatic vascular anatomy, portal and splenic venous flow, and collateral pathways (varices and spontaneous shunts) in candidates for transjugular intrahepatic portosystemic shunting (TIPS), 17 patients with history of refractory variceal bleeding or intractable ascites underwent duplex US, contrast-enhanced CT, and MRI before TIPS. The appearance of portal and hepatic anatomy was graded from 1 (not visible) to 4 (excellent visualization) independently by four radiologists. Presence and direction of portal and splenic venous flow, and presence and location of varices and spontaneous portosystemic shunts were also assessed. Results and effects of interobserver variation were assessed for significance using Friedman's ANOVA and Wilcoxon's signed-rank test. MRI yielded higher scores than CT or US for hepatic veins (P <.0001) and inferior vena cava (P <.0001). MRI and CT scored better than US for portal vein branches (P =.012) and splenic vein (P =.0038). All tests demonstrated the main portal vein well, with no statistically significant difference. US and MRI were more sensitive than CT for detecting portal vein flow and direction (US 76%, CT 0%, MRI 82%). MRI was most sensitive for splenic vein flow and direction (US 41%, CT 0%. MRI 76%). CT and MRI were more sensitive than US in detecting varices (US 5%, CT 50%, MRI 58%) and spontaneous shunts (US 13%, CT 75%, MRI 75%). Interobserver variation did not influence results significantly P =.3691). MRI provides the most useful information and may be the preferred single imaging test prior to TIPS.     

Intraarterial ethanol as a long-term occlusive agent in renal,hepatic, and gastrosplenic arteries of pigs

The renal, hepatic, or gastrosplenic arteries of eleven juvenile pigs were selectively injected intraarterially with 95% ethanol to evaluate its efficacy as an agent for use in permanent occlusion and infarction of the vascular bed supplied by the injected artery. A dose of 2.2 cc/5 kg (1 cc/5 lb) of 95% ethanol was injected over 30–45 sec. The animals were then killed at 1 to 91 days and all pigs demonstrated tissue infarction and vascular occlusion. Our results confirm that ethanol is an effective agent for the infarction of organs and that complications can result if catheter placement is not precise and normal tissue is inadvertently perfused.