腹膜假性黏液瘤的 CT、MRI 表现

目的：探讨5例经病理证实的腹膜假性黏液瘤（PM P ）的C T 及M RI表现及病理组织学特征,提高对该病的诊断水平。方法回顾分析5例经腹腔穿刺或手术证实的PMP的CT、MRI资料并结合文献讨论,分析其CT、MRI表现及临床病理特点。结果5例中,1例为阑尾黏液腺癌,1例为急性阑尾炎术后2年,1例为无任何原发肿瘤,1例为十二指肠黏液腺癌,1例为双侧卵巢癌,C T、M RI表现为腹腔内分隔样囊性病变或／和腹膜弥漫性饼状“胶冻腹”改变,并1例肝、脾周围多发结节样、扇贝样压迹。结论腹部CT、MRI平扫＋增强可以显示PMP病灶部位、形态,有一定的特殊影像学表现。     

Appendiceal mucocele with pseudomyxoma peritonei mimicking ovarian tumor with peritoneal carcinomatosis

Appendiceal mucocele with unprompted pseudomyxoma peritonei is a rare malignant tumor, which is difficult to diagnose before surgery. We present a case of a 62-year-old woman, and subsequently discuss the clinical and imaging presentation of mucoceles. Findings on CT scan suggested 2 diagnoses: appendiceal mucocele with pseudomyxoma peritonei and malignant ovarian tumor with peritoneal carcinosis. MRI suggested the former diagnosis, showing a large tubular mass at the base of appendix with discontinuous wall, and no ovarian abnormality, which was confirmed by mini laparotomy and histological study of peritoneal thickened tissue. Treatment consisted of neoadjuvant chemotherapy, with a good response. This case shows the role of imaging in the preoperative diagnosis of appendicular mucoceles; CT scan and MRI, which are useful tools in identifying undetermined lesions of the appendix.     

Imaging of mucocoele of the appendix with emphasis on the CT findings: a report of 10 cases

AIM: Mucocoele of the appendix denotes an obstructive dilatation of the appendiceal lumen due to abnormal accumulation of mucus. It is sometimes associated with pseudomyxoma peritonei, which predicts a malignant origin. We present the CT findings and additional imaging studies of 10 patients with neoplastic appendiceal mucocoele and discuss the clinical implications. MATERIALS AND METHODS: Abdominal CT findings from 10 patients with appendiceal mucocoele were reviewed. Barium enema, US and MRI were additionally performed in three patients. There were five men and five women aged 45-80 years. Special attention was directed to the shape and nature of the mass, its relation to the caecum and the presence of ascites or peritoneal implants, as well as possible additional ovarian tumours in female patients. RESULTS: The mucocoele was an incidental finding in five patients. They were either spherical or elongated cystic lesions, attached to the wall of the caecum, six of them with mural calcification. Ascites were present in six patients and hypodense large peritoneal implants representing pseudomyxoma peritonei in four. Pathologically the series included five cases of cystadenoma (in one, a malignant pseudomyxoma peritonei subsequently developed), four cases of cystadenocarcinoma and one villous adenoma (this patient later developed pseudomyxoma peritonei). Pseudomyxoma peritonei was found in five cases. Three women had associated ovarian cystic tumour. CONCLUSION: The appearance of an appendiceal mucocoele is quite characteristic and can be diagnosed on CT. CT can also depict additional findings suggesting pseudomyxoma peritonei. In women with an appendiceal mucocoele the ovaries should be examined closely for cystic tumour and vice versa.     

Magnetic resonance imaging of pseudomyxoma peritonei

MRI findings in three cases of pseudomyxoma peritonei, in two cases associated with visceral invasion, are described. MR imaging using the same morphologic criteria as described in ultrasonography and CT suggested the diagnosis in all three cases. In T 1 weighted images (SE 400/28 ms) the hypointensity of signals of both implants and mucoid ascites was found to approach that of muscle tissue. In T 2 weighted images (SE 1600/40, 80, 120 ms), however, there was general hyperintensity of signals, which was more pronounced in mucoid ascites than in implants, and which approached signal intensities of water. Invasion of the viscera was very well depicted in all cases.     

MRI of ovarian masses

MRI provides exquisite views of the pelvic anatomy through its high spatial resolution and tissue contrast, and as such plays a key role in the work up of ovarian lesions, identifying features that distinguish benign and malignant lesions. In the case of primary tumors it enables local staging and detection of metastatic disease to help guide management options such as complex surgery or the consideration of neoadjuvant chemotherapy. Functional MRI techniques such as diffusion‐weighted MRI (DW‐MRI), dynamic contrast‐enhanced MRI (DCE‐MRI) and tumor‐selective molecular imaging are currently being evaluated as possible predictive and prognostic biomarkers in the context of ovarian malignancy, and may play a larger role in routine clinical practice in the future. Herein we provide an overview of the conventional and advanced MRI techniques used to characterize ovarian masses and of the role that MR plays in the staging, treatment selection and follow up of patients with ovarian cancer. J. Magn. Reson. Imaging 2013;37:265–281. © 2012 Wiley Periodicals, Inc.     

Localized pseudomyxoma peritonei in the female pelvis simulating ovarian carcinomatous peritonitis

Two cases of localized pseudomyxoma peritonei in the female pelvic cavity associated with a ruptured appendiceal mucocele and ovarian involvement that mimicked ovarian carcinomatous peritonitis were evaluated. Subtle omental irregularity adjacent to the cecum may suggest the hidden appendiceal origin reflecting localized carcinomatous peritonitis caused by the occult rupture of the mucocele. Mucinous fluid-like materials were localized in the pelvic cavity with scalloping of the uterus, which may be the diagnostic finding of pseudomyxoma peritonei.     

卵巢恶性肿瘤的MRI诊断与误诊原因分析

目的:通过分析卵巢恶性肿瘤的MRI征象,提高对卵巢恶性肿瘤的诊断水平。方法:搜集经手术病理证实的20例卵巢恶性肿瘤病例,其中卵巢上皮癌12例、卵巢恶性生殖细胞肿瘤2例、小细胞癌3例、淋巴瘤1例、转移瘤2例。所有病例均行MRI平扫及增强,回顾性分析其MRI征象。结果:卵巢恶性肿瘤MRI表现为肿块体积较大、形态不规则,与周围组织结构分界不清;肿块质地不均,其中囊性肿块4例,实性肿块4例,囊实性肿块12例,囊壁、壁结节和实性部分增强扫描均有明显强化。结论:不同病理类型卵巢恶性肿瘤的MRI表现有相似之处,分析其相关征象对卵巢恶性肿瘤的定性诊断具有重要意义。     

低度恶性肌纤维母细胞肉瘤的影像学分析

目的探讨低度恶性肌纤维母细胞肉瘤(LGMS)的影像特点及提高其影像诊断水平。方法回顾性分析8例经病理证实的LGMS的X线、CT、MRI表现。单种方法检查中,行X线平片检查1例,行CT及MRI检查各2例;3例行2种方法检查。结果 8例LGMS中,5例发生于软组织,3例发生在长骨;发生于软组织者,在CT上2例边界较清晰,2例可见大量不规则钙化影,3例行增强扫描,动脉期肿瘤均呈明显不均匀强化,仅有1例行静脉期扫描,肿瘤强化程度进一步增高,1例出现双肺转移,在MRI上,肿瘤呈长T1、长T2信号,增强扫描瘤体强化明显;发生于长骨者,在X线平片上呈斑片状、虫蚀样的溶骨性骨质破坏,未见硬化边、钙化及骨膜反应,在MRI上,肿瘤呈长T1、长T2信号,增强扫描肿瘤以外周强化明显,肿瘤中心区域未见强化。结论 LGMS发病率低,影像表现缺乏特征性,确诊需依靠病理检查。     

动脉瘤样骨囊肿的CT及MRI诊断(附21例报告)

目的分析动脉瘤样骨囊肿的CT及MR I表现,评价其影像学诊断价值。方法回顾分析21例经手术或穿刺证实的动脉瘤样骨囊肿的CT及MR I表现。结果病变在CT上有16例可见明显液-液平面,其上缘CT值低于下部,其中继发性动脉瘤样骨囊肿可见明显软组织肿块,而MR I图像上除1例继发性动脉瘤样骨囊肿未见明显液-液平面以外,其它20例均有明显液-液平面。且继发性动脉瘤样骨囊肿的软组织肿块显示得更加清楚。结论动脉瘤样骨囊肿大部分病例在CT和MR I上出现有液-液平面,具有一定特征性,但不是惟一性。     

脊索瘤的MRI表现

目的：探讨脊索瘤的MRI表现及其诊断价值。方法：回顾性分析17例经临床病理证实的脊索瘤的MRI表现。结果：颅底脊索瘤8例，骶尾部脊索瘤9例，邻近颅底及椎体骨质均有溶骨性破坏，伴硬膜外及骶前较大软组织肿块。17例中16例信号不均匀，T1WI呈低、等信号，T2WI呈明显高信号，MRI增强扫描后，肿瘤均有轻度或中度不均匀性强化。结论：T2WI显著高信号是脊索瘤的特征性MRI表现，有重要鉴别诊断意义，MRI反映肿瘤的部位、侵犯范围以及显示骨质破坏作用均优于CT。     

骨母细胞瘤的CT和MRI诊断(附12例报告)

目的探讨CT及MR对骨母细胞瘤的诊断价值,提高对本病的认识。方法回顾分析经病理学证实的12例骨母细胞瘤的临床、CT、MR I及病理学资料。结果(1)行CT检查6例,均表现为膨胀性溶骨性破坏区伴随不同程度的钙化或骨化,瘤灶边缘呈反应性骨硬化缘,边缘光整。(2)行MR I扫描10例(包括4例已做CT检查的病人),表现为膨胀性的骨改变,瘤灶信号混杂,内有分隔,T1W I呈略低或等信号,T2W I呈高信号9例,1例以低信号为主。其中8例瘤灶周边可见清楚的T1、T2低信号缘,2例邻近组织呈片状模糊高信号。(3)增强扫描均呈中度以上强化,内夹杂片状低信号不强化区。结论骨母细胞瘤有较为典型的CT表现,MR I表现缺乏特征性。     

Chondroblastoma and clear cell chondrosarcoma: radiological and MRI characteristics with histopathological correlation

OBJECTIVE: To analyze and compare the radiological and magnetic resonance imaging (MRI) appearances of chondroblastoma and clear cell chondrosarcoma with histopathological correlation. DESIGN AND PATIENTS: Twelve patients with histologically proven chondroblastoma and of another four patients with clear cell chondrosarcoma were investigated by radiographs and MRI (T1-, T2-weighted sequences, intravenous gadolinium application). Additionally, the clinical and radiologic data of seven cases of clear cell chondrosarcoma without available MRI were considered. The localization, calcification of tumor matrix, periosteal reaction, cortical bone and patterns of bone destruction were analyzed according to the Lodwick radiological grading system (LRGS). The signal intensity on T1- and T2-weighted sequences, characteristics of contrast enhancement, associated bone marrow edema, soft tissue reaction and joint involvement were evaluated. Histopathological specimens were available in all cases. RESULTS: The age of patients with chondroblastoma (range 15-59 years, mean 22.3 years) was lower than that of those with clear cell chondrosarcoma (range 19-61 years, mean 36.6 years), and the lesions were smaller in the chondroblastoma group (range 1-4 cm, mean 2.3 cm) than in patients with clear cell chondrosarcoma (range 3-7.5 cm, mean 5.2 cm). The chondroblastomas were more confined to the epiphysis (10/12) than the clear cell chondrosarcomas. All chondroblastomas and clear cell chondrosarcomas except one were classified as grade 1A or 1B according to the LRGS; one clear cell chondrosarcoma was judged as grade 2. Signal intensity of the tumors on MRI was very heterogeneous in both groups. High signal intensity on T2-weighted MR images in chondroblastoma mostly corresponded to areas with aneurysmal bone cyst components and in clear cell chondrosarcoma to islands of hyaline cartilage. Contrast enhancement occurred in all tumors and tended to be more intense with clear cell chondrosarcoma. Chondroblastoma was more frequently associated with bone marrow edema (11/12), periosteal reaction (10/12), soft tissue reaction (7/12) and synovitis (3/12). CONCLUSION: Chondroblastoma occurs in younger patients, is smaller than clear cell chondrosarcoma and is more confined to the epiphysis. The overlap of signal intensity and contrast enhancement patterns does not allow a reliable differentiation of the two tumors by MRI. Chondroblastomas are typically associated with bone marrow edema, periosteal reaction and soft tissue reaction.     

Fibromatosis ovárica: “signo de la guirnalda negra”

The main objective in the imaging differential diagnosis of an ovarian mass is to establish whether it is cystic or solid; solid lesions are less common. Ovarian fibromatosis is a benign disease of the ovary that is rarely included in the differential diagnosis of solid ovarian lesions. Characteristic features of masses that have a fibrous component are low signal in T1-weighted MRI sequences and especially in T2-weighted MRI sequences. The presence of peripheral fibrotic tissue around the residual ovarian tissue is specific to ovarian fibromatosis; on MRI, this results in marked hypointensity on T2-weighted images that has been dubbed the “black garland sign”. This sign, together with slight peripheral enhancement after the administration of contrast material and the preservation of the ovarian architecture, facilitates the diagnosis, making it possible to avoid unnecessary surgical interventions.     

腱鞘巨细胞瘤MRI影像学特征与病理对照分析

目的探讨腱鞘巨细胞瘤(GCTTS)的MRI影像学特征并与病理对照,提高对GCTTS的诊断水平。方法回顾性分析经手术病理证实的38例GCTTS患者的临床资料、MRI影像学资料及病理资料。结果38例患者中局限型23例,弥漫型15例;MRI表现23例局限型GCTTS,表现为类圆形软组织肿块,边界清晰,邻近骨质未见明显异常,与骨骼肌信号相比,T1WI序列11例呈等信号,7例呈等或低信号,5例呈低信号,T2WI-FS序列17例呈高或低混杂信号,6例呈低信号。15例弥漫型GTCCS,其中6例弥漫型为术后复发,表现为关节旁多发形态欠规则软组织肿块,与周围肌腱、血管、韧带分界不清,邻近骨质未见明显异常,与骨骼肌信号相比,T1WI序列呈等或低信号,T2WI-FS序列呈高低混杂信号。镜下见较多组织细胞样单核细胞、多核巨细胞,并见散在泡沫细胞及含铁血黄素沉积。结论GCTTS具有一定特征性的MRI影像表现,反映病理改变,结合临床症状和体征,可帮助临床医生提高诊断正确率。     

Chronic colonic perforation in pseudomyxoma peritonei

Pseudomyxoma peritonei (PP) produces abundant mucoid material from the rupture of low grade ovarian or appendiceal mucinous tumours. The unique pattern of cancer dissemination and intraperitoneal mucous re-distribution makes it a distinct clinical condition. It has diverse presentations, mainly as a result of narrowing of the gastrointestinal tract and entrapment of other viscera by gelatinous mucoid material. Imaging is helpful, but not diagnostic of this condition. We report a patient with pseudomyxoma perotonei who had perforation at the recto-sigmoid junction into a large mucinous cyst adjacent to the sigmoid colon. The patient improved clinically with conservative management, with persisting communication and no adverse symptoms reported at 4 months follow-up.     

儿童纵隔神经母细胞瘤的CT与MRI诊断

目的 探讨儿童纵隔神经母细胞瘤的CT与MRI表现及其诊断价值.方法 回顾性分析21例经病理证实的儿童纵隔神经母细胞瘤的CT和MRI表现.19例行CT检查,8例行MRI检查.结果 20例肿瘤位于后纵隔,呈椭圆形或不规则形软组织肿块,突向肺野,边界较清楚.CT平扫示肿瘤密度较均匀12例,密度不均匀7例,15例肿瘤内伴有钙化.13例行增强检查,7例均匀强化,6例不均匀强化.8例MRI检查T1WI示肿瘤呈等或稍低信号,与胸壁肌肉相近,T2 WI呈不均匀稍高信号,3例肿瘤内伴出血、囊变呈混杂信号.结论 儿童患者,CT或MRI检查发现后纵隔肿物,特别是其内伴钙化者,诊断时应首先考虑神经母细胞瘤.     

脊椎骨巨细胞瘤CT、MRI表现与病理分级对照分析

目的：探讨发生在脊椎的骨巨细胞瘤（giant cell tumor of bone ,GCT）CT、MRI表现并与病理分级对照,以提高对相关影像征象的认识。方法回顾性分析13例经手术病理证实的脊柱骨巨细胞瘤,探讨C T、M RI表现特点并与病理分级进行对照,其中C T检查10例、M RI检查11例。结果病变位于颈椎1例,胸椎3例,腰椎3例,骶椎6例,病理分级Ⅰ级3例,Ⅱ级8例,Ⅲ级2例,Ⅱ级以上占76．9％（10/13）。11例见突入椎管的软组织肿块,Ⅰ级2例、Ⅱ级7例、Ⅲ级2例,Ⅱ级以上占81．8％（9/11）。3例有骨嵴,病理分级为Ⅰ～Ⅲ级各1例。11例为椎体及附件同时受累,Ⅰ级1例、Ⅱ级8例、Ⅲ级2例,Ⅱ级以上占90．9％（10/11）;双侧附件受累6例,其中Ⅰ级1例、Ⅱ级5例,Ⅱ级以上占83．3％（5/6）。结论脊椎骨巨细胞瘤以Ⅱ和Ⅲ级多见,椎管内软组织肿块、肿瘤同时累及附件、骨质破坏的方式、是否伴有骨质硬化、钙化和瘤骨等征象有助于脊椎GC T的诊断和肿瘤级别的判断,对指导临床治疗具有指导意义。     

MRT des Bronchialkarzinoms

Compared to computed tomography (CT), magnetic resonance imaging (MRI) only plays a minor role for the imaging of lung cancer. Among the reasons are technical limitations, such as longer acquisition times or inferior spatial resolution, as well as unfavourable tissue characteristics which cause a low signal-to-noise ratio of the lung parenchyma. However, MRI is a valuable tool for staging lung cancer and may in some cases even be considered the method of choice. The following review illustrates the role of MRI for the diagnosis of lung cancer using current MR-techniques. In particular, the potential of MRI for TNM-staging, new technical developments (e. g. parallel MRI), and the application of functional MRI of the chest are described.     

卵巢蒂扭转的MRI表现

目的：探讨M RI在诊断卵巢蒂扭转中的应用价值。方法回顾性分析13例经手术病理证实的卵巢蒂扭转患者的M RI表现特点,提高对本病的认识。结果本组13例中,原发性卵巢蒂扭转3例;继发性卵巢蒂扭转10例：卵巢单纯性囊肿5例,卵巢巧克力囊肿2例,卵巢浆液性囊性腺纤维瘤、卵巢卵泡膜纤维瘤及卵巢畸胎瘤各1例。M RI均表现为盆腹腔区异常信号肿块。肿块局部与一侧宫角及附件相连12例,另1例为2月婴儿,子宫显示不清。扭转的卵巢蒂呈典型结节征（或漩涡征）5例,悬挂征4例,三角征4例。合并盆腔积液6例,妊娠1例,子宫肌瘤1例,对侧卵巢巧克力囊肿1例。结论卵巢蒂扭转的M RI表现具有一定特征,是超声等检查的有益补充。     

MRI of injuries to the first interosseous cuneometatarsal (Lisfranc) ligament

Objective  The objective of this study was to assess the utility of MRI in diagnosing injury to the first interosseous cuneometatarsal (Lisfranc) ligament and to additionally determine the associated patterns of traumatic soft tissue and osseous injury. Materials and methods  Fifteen patients (16 feet) who were referred for MRI evaluation of the Lisfranc ligament, and had operative exploration or examination under anesthesia, were included for analysis. Standard non-contrast MRI foot imaging was performed in all cases. Evaluation of the following components was performed: the dorsal and plantar bundles of the Lisfranc ligament, the plantar tarsal metatarsal ligaments, soft tissue edema and fluid, and bone marrow edema and fractures. Surgical reports were regarded as the reference standard in all cases. Results  Seven of 10 cases of grade 3 Lisfranc ligament injuries at surgery were correctly graded at MRI. No cases of surgically proven complete Lisfranc ligament tears (grade 3) were interpreted as normal at MRI. All Lisfranc ligament sprains (grade 2 or 3) at surgery were detected at MRI. Two of six cases reported as grade 1 injuries at MRI were normal at surgery. No cases of surgically proven normal or sprained Lisfranc ligaments were interpreted as grade 3 tears on MRI. Four of six of our cases of normal or sprained Lisfranc ligaments demonstrated fractures; while the minority of complete Lisfranc ligament tears (3/10) contained fractures. Conclusion  MRI is reasonably accurate at detecting traumatic injury to the Lisfranc ligament. However, in clinically suspected cases of traumatic Lisfranc ligament injury, true positive rate for sprain is low.