Investigations of fatal causes of chest pain: Case report and literature review

A case of fatal ascending aortic dissection (AAD) misdiagnosed as pulmonary embolism (PE) despite strong radiological evidence is described. The occurrence of this serious pathology is uncommon. Its prompt diagnosis and treatment are crucial. Anticoagulant therapy for pulmonary embolism should be withheld until acute aortic dissection is excluded definitively. A management approach to optimise the outcome of patients with chest pain in which ascending aortic dissection and/or pulmonary embolism are suspected is presented.     

颅内表皮样囊肿的影像学诊断

目的:分析颅内表皮样囊肿的CT和MRI表现。方法:对30例经手术及病理确诊的颅内表皮样囊肿的CT和MRI表现作回顾性分析,其中30例作MRI平扫与增强扫描;20例作CT平扫检查。结果:肿瘤位于桥前池及桥小脑角池18例,4例位于鞍上,2例位于鞍旁,5例位于第四脑室,1例位于小脑延髓池。肿瘤大小不等,形态不规则,轮廓光整或呈分叶状。CT平扫17例呈均匀低密度,2例呈稍不均匀低密度,CT值为-15～10Hu,1例呈高密度。MRI平扫28例T1加权像上肿瘤呈不均的低信号,T2加权像上呈不均匀高信号,部分病例在FLAIR图象上表现为不均匀高信号,与周围低信号的脑脊液分界清晰;2例表现为T1加权像上为高信号,T2加权像上为低信号。增强后,2例肿瘤边缘有轻微强化,其余肿瘤均无明显强化。结论:典型的颅内表皮样囊肿,通过CT和MRI检查可做出准确诊断,并可以与颅内其他疾病相鉴别;在鉴别诊断中,MRI优于CT。非典型的颅内高密度囊肿,必须CT和MRI相结合诊断,为准确的术前诊断提供更多的信息。     

Lymphangioma: Imaging diagnosis

Lymphangiomas are congenital malformations of the lymphatics that are curable by extirpation. Accurate delineation of lesion extension is important for pre-operative diagnosis, surgical planning, and assessing recurrence. The radiologic findings were retrospectively evaluated to determine the imaging appearance of these benign tumours. The plain radiographs, barium meal, ultrasound, CT, and MR images of 18 patients with one or more pathologically proved lymphangiomas were reviewed. Plain radiography and barium study showed masses displacing adjacent organs. Ultrasound examination showed uni- or multilocular cystic masses with smooth, thin or irregular, thick walls. Enhancement of the cyst wall was variable on CT and MR studies. The CT density of the fluid ranged from ?4 to 34 HU depending on the lipid content and the presence of haemorrhage. The cysts were isointense to muscle on T1 -weighted and hyperintense to fat on T2-weighted MR images. The MR imaging delineated the tumour lesion extension more clearly than ultrasound and CT scans. Ultrasound, CT, and MR imaging are valuable for evaluating lymphangiomas. Magnetic resonance imaging allows accurate determination of lesion extension.     

胰腺实性假乳头状瘤的影像学诊断与病理对照分析

[目的]分析胰腺实性假乳头状瘤（SPTP）的CT和MRI表现,并与病理结果对照分析。[方法]回顾性分析12例经手术和病理证实的S门P的I临床及CT和MRI表现．分析肿瘤的部位、大小、形态、密度、信号以及强化方式,并将CT与MRI表现与病理对照。[结果]SPTP好发于胰头,影像学表现为境界清楚的圆形或类圆形胰腺肿块,瘤体通常比较大。CT主要表现为囊实性混杂密度影,部分实性结构呈乳头状或壁结节样突起,增强后实性部分呈渐进性强化;MRI表现为肿块在T1WI、T2WI上呈不均匀混杂信号,可识别肿瘤内部的坏死囊变及出血等特异性征象,实性部分增强呈渐进性强化。[结论]胰腺实性假乳头状瘤影像学表现具有一定特征性,对其诊断具有重要指导意义。     

软组织血管瘤的影像诊断

目的:研究软组织血管瘤的X线平片、CT 和MRI 征象,探讨CT 和MRI对该肿瘤的诊断价值。方法:对经手术病理或临床确诊的软组织血管瘤35例进行回顾性分析。所有病例均行X线平片、CT平扫和增强扫描。其中动态增强扫描8例,MRI检查15例。结果:海绵状血管瘤19例,蔓状血管瘤8例,毛细血管瘤3例,混合型血管瘤2 例,血管瘤病3例。CT平扫肿瘤呈结节状、分叶状、管状或团块状低密度病变。增强扫描后血管成分显著强化,可呈扭曲血管状,而非血管成分不强化或轻度强化。MRIT1WI上肿瘤呈略高信号或等信号,T2WI上呈显著高信号,其中夹杂不均匀信号,病理上代表了脂肪、纤维组织、平滑肌、血栓、静脉石和钙化。结论:CT和MRI对血管瘤均可作出定性诊断,但MRI在显示血管瘤内特征性的血管及血管成分间的脂肪纤维组织方面较CT优越。     

Imaging of ascariasis

Ascaris lumbricoides is one of the most common parasitic infestations of the gastrointestinal tract worldwide. During the intestinal phase of the disease, the adult worms usually remain clinically silent, sometimes causing a variety of non‐specific abdominal symptoms. When present in large numbers, the worms may get intertwined into a bolus, causing intestinal obstruction, volvulus or even perforation. Occasionally, the adult Ascaris worm may migrate into the Vater’s ampulla and enter the bile duct, gall bladder or pancreatic duct, leading to a variety of complications such as biliary colic, gallstone formation, cholecystitis, pyogenic cholangitis, liver abscess and pancreatitis. Imaging plays a significant role in showing the presence of worms and possible complications in intestinal as well as hepatobiliary ascariasis. This pictorial essay aims to illustrate various imaging features of ascariasis and its associated complications.     

Radiological Imaging in Patients with Esophageal Carcinoma

Diagnostic imaging is carried out in patients with esophageal carcinoma in order to decide on thetherapeutical procedure,to control therapy,to document complications and to assess concomitant diseases.Chest X-rays and esophagograms give a 2-dimensional view of the X-ray absorption in a-dimensionalexamination volumes,the diagnostic accuracy thus being limited by overshadowing.Because of the robustexamination technique,the broad availability and the low costs chest X-rays are usually used for short-termcontrols under therapy and follow-up.Esophagography is carried out in order to asses the exact locationand length of a known esophageal carcinoma prior to therapy and in order to assess peristaltic disturbancesand fistulas.CT and MRI provide tomographic images with a spatial resolution of up to 1 mm allowingthe reconstruction of high-resolution images not only in the transversal but also in any other plain.Thediagnostic accuracy of esophagography is comparatively high in T1-T3 stages (80%-90%).T1 and T2tumors cannot be diagnosed by CT and MRI,because both methods do not visualize the mucosa (unlikeesophagography and endoscopy) and the esophageal wall layers (unlike EUS).Infiltration depth tends tobe overestimated in T1 and T2 carcinomas and to be underestimated in T3 and T4 cancers.CT andMRI cannot detect metastases in normally sized lymph nodes and cannot accurately differentiate betweenbenign and malignant lymphadenopathy in enlarged nodes with a reported sensitivities and specifities of60% and 74%,respectively.However,further prospective studies using up to date CT and MR technologyare needed to assess the present diagnostic situation.CT and MRI do not only visualize the mediastinum,but also the lungs,the pleura and the skeleton as well as the neck and the abdomen thus providing acomprehensive overview of the TNM stage in 3 body regions.     

肝脏原发性平滑肌瘤影像学表现

Objective: To investigate the imaging features of primary hepatic leiomyoma. Methods: 3 patients of primary hepatic leiomyoma confirmed by pathology without immunodeficiency were retrospectively analyzed about CT and MRI findings, clinical and pathological correlation. 2 cases had routine CT scan, 2 cases had routine MRI. Results: 2 case CT scans showed low-density lesions, 2 cases MRI showed lesions with long T1 and long T2 signal. One case of uniform density and signal showed homogeneous enhancement; two cases showed uneven density and signal, of which one case was inhomogeneous enhancement. 3 cases presented pseudocapsule without hepatic cirrhosis and venous tumor thrombus. Pathology showed spindle tumor cell proliferation and capillary hyperplasia; one case showed central hyalinization and one case central liquefaction necrosis. Conclusion: Primary hepatic leiomyoma is a hypervascular tumor, and CT and MRI help in the diagnosis.     

食管癌的影像学表现

Diagnostic imaging is carried out in patients with esophageal carcinoma in order to decide on the therapeutical procedure, to control therapy, to document complications and to assess concomitant diseases.Chest X-rays and esophagograms give a 2-dimensional view of the X-ray absorption ill 3-dimensional examination volumes, the diagnostic accuracy thus being limited by overshadowing. Because of the robust examination technique, the broad availability and the low costs chest X-rays are usually used for short-term controls under therapy and follow-up. Esophagography is carried out in order to asses the exact location and length of a known esophageal carcinoma prior to therapy and in order to assess peristaltic disturbances and fistulas. CT and MRI provide tomographic images with a spatial resolution of up to 1mm^3 allowing the reconstruction of high-resolution images not only in the transversal but also in any other plain. The diagnostic accuracy of esophagography is comparatively high in T1 T3 stages (80%-90%). T1 and T2 tumors cannot be diagnosed by CT and MRI, because both methods do not visualize the mucosa(unlike esophagography and endoscopy) and the esophageal wall layers (unlike EUS). Infiltration depth tends to be overestimated in T1 and T2 carcinomas and to be underestimated in T3 and T4 cancers. CT and MRI cannot detect metastases in normally sized lymph nodes and cannot accurately differelltiate between benign and malignant lymphadenopathy in enlarged nodes with a reported sensitivities and spccifities of 60% and 74%, respectively. However, further prospective studies using up to date CT and NIR technology are needed to assess the present diagnostic situation. CT and MRI do not only visualize the inediastinum,but also the lungs, the pleura and the skeleton as well as the neck and the abdomen thus providing a comprehensive overview of the TNM stage in 3 body regions.     

鼻咽癌颈静脉孔侵犯的影像学表现及临床分析

[目的]探讨鼻咽癌颈静脉孔侵犯的临床和影像学特征及临床意义。[方法]回顾性分析8例初治和4例复发鼻咽癌伴颈静脉孔侵犯者的临床表现、CT及MRI特征。[结果]12例中,5例表现为Ⅸ￣Ⅺ颅神经均麻痹的颈静脉孔综合征,7例仅表现为Ⅸ颅神经麻痹。12例,有10例合并舌下神经管受累,3例有一侧的胸锁乳突肌及斜方肌萎缩,2例有一侧舌肌萎缩。CT及MRI显示鼻咽癌颈静脉孔侵犯主要有3种途径,分别为:①鼻咽病变通过茎突后间隙直接蔓延(4例,包括1例茎突后间隙复发);②转移淋巴结直接侵犯(4例,其中2例为咽后淋巴结转移,2例为颈动脉鞘淋巴结复发);③颈静脉孔骨性结构直接破坏(4例,其中1例为单纯颈静脉孔复发)。[结论]鼻咽癌可通过直接蔓延、咽后和颈动脉鞘区转移淋巴结侵犯及骨质直接破坏侵犯颈静脉孔,临床上出现Ⅸ￣Ⅺ颅神经一支或多支均麻痹。CT和MRI,尤其是MRI对于病变的诊断、病变范围的确定和放射治疗计划的制定有非常大的作用。     

A Review of Imaging Practice in Bone and Soft Tissue Lesions

Thirty six consectutive bone and soft tissue lesions which were referred to the Bone Transplantation Service between January 1987 and June 1989 were reviewed with respect to the information provided by pre-operative CT, MR and plain X-ray and the final histopathologic diagnosis. The ability of CT and MR to demonstrate cortical destruction, periosteal reaction, a soft tissue mass and soft tissue calcification was scored on a scale of one (low suspicion of abnormality) to four (definite abnormality) in each case. Of the thirty six cases reviewed there were twenty-two histologically confirmed tumours with all of the above three imaging modalities available for comparison. In each of these tumours MR was found to provide an equal or more accurate assessment of soft tissue extent. On a scale of 1 to 4 the average point scores were 3.6 and 2.6 for MR and CT respectively. Little difference was shown between CT and MR with respect to medullary involvement (4.0 points vs. 3.9) and cortical destruction (2.5 points vs. 2.7). CT (3.7 points) was more sensitive than MR (1.2 points) in detecting fine soft tissue calcification. In only five cases did the radiology report correctly nominate the histologic diagnosis and thus the role of imaging was more valuable in staging than diagnosis. For this reason a management oriented report should include comment regarding cortical destruction, the intramedullary extent of tumour and the extent of soft tissue involvement. MR is recommended in the investigation of all suspected malignant soft tissue or bone tumours.     

脉络膜裂囊肿的影像学诊断

背景与目的：脑部脉络膜裂囊肿属神经上皮性囊肿,临床上不常见。本文通过探讨脉络膜裂囊肿的影像学表现,以期提高对本病的诊断及鉴别诊断水平。方法：回顾性分析20例CT和MRI诊断为脉络膜裂囊肿患者的临床及影像学资料。患者均行CT和MRI检查,其中增强扫描5例。结果：20例患者均为单发病灶．其中右侧13例,左侧7例,病灶均位于两侧脉络膜裂区。CT表现为圆形或类圆形、边缘光滑的脑脊液样低密度灶、增强扫描无强化。MRI检查表现为长T1长T2脑脊液样信号灶,FLAIR为低信号,在各扫描序列中完全与脑脊液信号同步,病灶周围脑实质无明显异常表现。结论：正确认识脉络膜裂囊肿的影像学表现．可避免误诊。CT和MRI均可检出脉络膜裂囊肿,但单纯CT检出定位困难,MRI多方位扫描可作出明确诊断并能够与其他囊性病变相鉴别。     

直肠神经内分泌肿瘤的影像学分析

目的 分析新病理分级下直肠神经内分泌肿瘤(neuroendocrine neoplasm,NEN)的影像学表现,提高对直肠NEN的术前诊断率.方法 收集2010-03-01-2014-03-31经手术病理确诊、有完整影像学资料的直肠NEN患者37例,分析直肠NEN的影像学表现及不同级别间影像学表现差异.结果 37例直肠NEN均为无功能性.参照WHO 2010年消化系统肿瘤分类和2010年中国病理学诊断共识,G1级32例,G2级1例,G3级4例,单发多见(33/37).G1～G2级33例,长径均＜2.0 cm(平均1.0 cm,G2级1例长径为5 cm),边界清楚,增强均为明显强化;其中30例为黏膜面息肉样或结节隆起型病变,31例黏膜表面光滑,1例出现淋巴结转移,均未见肝转移.G3级4例,病变长径均＞2.0 cm(平均6.4cm),均侵犯肠管1/2周以上或呈环周性生长,侵犯浆膜外或纤维膜外,边界不清楚,黏膜表面不规则,增强扫描明显强化;其中3例出现淋巴结转移,1例出现肝转移.结论 增强扫描明显强化是直肠神经内分泌肿瘤的影像特征,低级别(G1、G2级)病灶长径小,形态规则,远处转移少见,而高级别(G3级)病变长径大,侵袭性生长特点明显.     

10例肝脏淋巴瘤的影像学表现分析

目的：探讨肝脏淋巴瘤的影像学特点。方法回顾性分析10例初诊未治的肝脏淋巴瘤患者的临床表现、病理类型与影像学表现。结果10例均为B细胞型非霍奇金淋巴瘤（4例原发性,6例继发性）,表现为单发肿块型4例,多发结节型4例,浸润型2例。3例CT平扫呈均匀低密度,6例CT增强扫描呈轻度强化,强化程度低于正常肝实质。4例MRI平扫者,T1WI呈低信号,T2WI及脂肪抑制序列呈均匀中高信号,2例DWI扫描呈明显扩散受限,2例行MR增强扫描呈轻度强化。4例有血管穿行肿瘤但无明显受侵征象。7例伴有肝脏区域淋巴结侵犯。原发肝脏淋巴瘤的影像表现与继发性相仿。结论肝脏淋巴瘤的影像表现可多种多样,多数呈密度/信号均匀,增强后呈轻度强化,血管于肿瘤内穿行而无受侵是肝脏淋巴瘤的较为特征性表现。     

跨中、后颅窝轴外肿瘤及肿瘤样病变的影像学诊断

目的提高对跨中、后颅窝轴外肿瘤及肿瘤样病变的影像学认识。方法60例经病理证实的跨中、后颅窝轴外肿瘤及肿瘤样病变按位置分为中央型和外侧型，后者又分中颅窝型、后颅窝型及骑跨型，分析各型构成情况及影像学特征。结果中央型12例，脊索瘤5例，垂体瘤3例，鼻咽癌2例，颅咽管瘤、脑膜瘤各1例。外侧型48例，三叉神经肿瘤14例，脑膜瘤12例，表皮样囊肿11例，硬膜型海绵状血管瘤4例，皮样囊肿、转移瘤各2例，血管外皮瘤、颈静球脉瘤、鼻咽癌各1例。多数病变可根据影像学特点做出诊断并明确范围。结论按位置特征对跨中、后颅窝轴外肿瘤及肿瘤样病变分型，有助于定性诊断及范围描述，有较高的临床应用价值。     

跨中、后颅窝轴外肿瘤及肿瘤样病变的影像学诊断(英文)

目的提高对跨中、后颅窝轴外肿瘤及肿瘤样病变的影像学认识。方法 60例经病理证实的跨中、后颅窝轴外肿瘤及肿瘤样病变按位置分为中央型和外侧型,后者又分中颅窝型、后颅窝型及骑跨型,分析各型构成情况及影像学特征。结果中央型12例,脊索瘤5例,垂体瘤3例,鼻咽癌2例,颅咽管瘤、脑膜瘤各1例。外侧型48例,三叉神经肿瘤14例,脑膜瘤12例,表皮样囊肿11例,硬膜型海绵状血管瘤4例,皮样囊肿、转移瘤各2例,血管外皮瘤、颈静球脉瘤、鼻咽癌各1例。多数病变可根据影像学特点做出诊断并明确范围。结论按位置特征对跨中、后颅窝轴外肿瘤及肿瘤样病变分型,有助于定性诊断及范围描述,有较高的临床应用价值。     

Imaging features of primary pulmonary liposarcoma

Primary liposarcoma of the lung is extremely rare. We report a 28‐year‐old pregnant woman who complained of dyspnoea during the third trimester. Chest radiography, thoracic ultrasound, CT and MRI showed a huge heterogeneous tumour involving all the left lung and the mediastinum. The tumour was composed of soft tissue, and fatty and cystic components with calcifications. Diagnosis was made on core biopsy under CT guidance. Surgical excision was performed but unfortunately the patient died during the operation.     

Imaging findings of renal cell carcinoma

There are many imaging modalities used in the diagnosis of renal cell carcinoma, the most common cancer of the kidney, which accounts for approximately 2–3% of adult malignancies. Early detection of this tumor with the correct diagnostic approach using various cross-sectional imaging is very important, as are the clinical and laboratory findings. Familiarity with the spectrum of imaging findings of renal cell carcinoma will enable clinicians to consider appropriate treatment for patients and eliminate unnecessary further imaging studies.     

Assessment of abdominal aortic aneurysm with magnetic resonance imaging

Pre-operative imaging of abdominal aortic aneurysms (AAA) is important in determining suitability for operation and operative approach. Ultrasound imaging is an excellent screening modality but is relatively poor at identifying renal arteries and the extent of iliac involvement. Computed tomography scanning with intravenous contrast and arteriography are invasive modalities that are associated with a small risk. Magnetic resonance imaging (MRI) offers the potential of accurate anatomical definition without use of contrast agents and passage of an intra-arterial catheter. Eight patients who had their AAA evaluated with MRI are reported. All had renal arteries accurately defined, intraaneurysmal thrombosis was well delineated, and iliac extension was correctly identified in four cases. The initial experience has been most encouraging and the authors consider that MRI may become the investigation of choice for pre-operative AAA assessment.     

Cushing's disease: Pituitary imaging

Fourteen patients with adrenocorticotropic hormone (ACTH)-dependent hypercortisolism underwent pituitary scanning with computed axial tomography (CT) and magnetic resonance imaging (MRI). Computed tomography revealed pituitary macroadenomas in two patients, pituitary hyperplasia in one and a suspicion of pituitary microadenoma in one. Thirteen patients underwent MRI. One with a macroadenoma diagnosed on CT did not undergo MRI. The MRI revealed a pituitary macroadenoma in one, microadenoma in three and hyperplasia in two cases. Magnetic resonance imaging following gadolinium diethylene triamine penta acetic acid (gd-DTPA) enhancement revealed four more pituitary microadenomas. All patients who had pituitary adenomas (micro and macro) and hyperplasia underwent trans-sphenoidal pituitary surgery. One of the two patients, who had an enlarged pituitary on imaging but no demonstrable adenoma, was found to have a microadenoma at surgery. Patients with ACTH-dependent hypercortisolism should undergo MRI of the pituitary gland to identify/localize corticotroph pituitary adenomas. The study should include gd-DTPA enhancement in cases where the scan is normal.