膝关节挫伤的磁共振影像表现

目的：探讨磁共振短时的反转恢复序列(STIR)在膝关节骨挫伤中的临床应用。方法：通过32例膝关节外伤病例在常规SE序列、FSE序列和STIR序列中的影像表现,分析STIR序列的优越性。结果：32例共45个骨挫伤病灶,T1W发现38个(占84％),T2W发现37个(占82％),STIR序列病灶全部显示(100％)。结论：STIR序列对骨挫伤的敏感性较高,能显示微小的骨髓水肿,充血及骨小梁的微骨折及其周围的骨软骨、关节囊的细微变化,对膝关节外伤具有较高价值。     

彩色多普勒超声对腮腺腺淋巴瘤与多形性腺瘤的鉴别诊断价值探讨

目的:探讨高频彩色多普勒超声对腮腺腺淋巴瘤与多形性腺瘤的鉴别诊断价值。方法回顾性分析经手术病理确诊的腺淋巴瘤35例和多形性腺瘤28例的声像图特点。结果:两者的声像在肿瘤的大小、边缘、内部回声、彩色血流信号级别方面有显著差异。结论:分析腮腺肿瘤的超声声像学特点并结合临床信息可显著提高术前鉴别诊断效率。     

MRI检查在肝门部胆管癌诊断中的应用

目的:评价MR平扫、MRCP、DWI序列及MR动态增强扫描等不同MR检查方法对肝门部胆管癌的诊断价值。方法:回顾性分析经手术及病理证实的9例肝门部胆管癌在上述不同MRI检查方法中所显示的影像特征,提高对肝门部胆管癌的诊断认识。结论:肝门部胆管癌在MRI平扫上表现为边界不清的等、稍长T1信号稍高T2混杂信号团块,MRCP可明确显示肝门区肝管狭窄、截断征象,远侧肝管的显著扩张,DWI序列病灶表现为扩散受限稍高信号,MR动态增强扫描动脉期病变表现为不强化或轻度强化,程度不一的延迟强化较具特征性,同时增强MR对胆管壁和邻近肝实质的侵犯、血管侵犯以及肝门、腹膜后淋巴结转移有明显的诊断价值。合理选择上述多种MRI检查方法结合临床胆管癌相关抗原、CA19-9检测能对大多数肝门部胆管癌做出正确诊断,对疾病的诊断、分型、临床治疗路径选择具有重要价值。     

膝关节挫伤的磁共振影像表现

目的 :探讨磁共振短时的反转恢复序列 (STIR)在膝关节骨挫伤中的临床应用。方法 :通过 32例膝关节外伤病例在常规SE序列、FSE序列和STIR序列中的影像表现 ,分析STIR序列的优越性。结果 :32例共 45个骨挫伤病灶 ,T1W发现 38个 (占 84% ) ,T2W发现 37个 (占 82 % ) ,STIR序列病灶全部显示( 1 0 0 % )。结论 :STIR序列对骨挫伤的敏感性较高 ,能显示微小的骨髓水肿 ,充血及骨小梁的微骨折及其周围的骨软骨、关节囊的细微变化 ,对膝关节外伤具有较高价值。     

腮腺肿瘤加部分腮腺切除加面神经解剖术围术期患者的护理

腮腺肿瘤是涎腺肿瘤中发病率最高的一种,其中良性肿瘤约占2／3。恶性肿瘤占1／3。腮腺肿瘤80％发生于腮腺浅叶,良性肿瘤以混合瘤最多见,其次为腺淋巴瘤。良、恶性腮腺肿瘤均可发生于任何年龄。目前手术治疗仍是重要手段。     

巨大淋巴结增生症的影像学诊断

目的:研究巨大淋巴结增生症(Castleman Disease)的CT和MR影像表现特点,以提高对本病的认识,提高诊断准确率。方法:收集我院自1995年1月~2012年10月间,经手术病理证实的19例巨大淋巴结增生症,患者均接受CT或MRI平扫及增强扫描检查。其中,男7例,女12例,年龄19~62岁,平均43.4岁。结果:19个病例中14例病灶位于胸部(胸腔或纵隔),2例位于颈部,3例位于腹膜后区,局限型16例,弥漫型3例。CT检查采用CT动态增强扫描技术,局限型病灶在动脉期可见明显强化,强化程度近似主动脉,弥漫型病灶在动脉期表现为中等程度强化,两者在延迟期均表现为持续强化。MR扫描:4例表现为T1WI低信号,1例为中等信号,T2WI均呈高信号,动态增强扫描病灶的强化方式与CT基本一致。结论:颈部、胸部或腹膜后区的富血供病变,在CT及MRI增强扫描动脉期表现明显强化,延迟期持续强化,应高度怀疑巨大淋巴结增生症的可能性。     

MR 弥散加权成像对鉴别诊断良恶性椎体压缩性骨折的临床价值研究

目的：探讨MR弥散加权成像(DWI)鉴别诊断良恶性椎体压缩性骨折的临床价值。方法：对57 例经临床或病理证实的椎体 良恶性压缩性骨折患者行矢状位T1WI、T2WI、T2WI/FS 及DWI扫描,研究其在常规序列和DWI序列上的表现,将常规MR 序列 和DWI序列检出率进行比较,测量正常椎体及病变椎体的表观弥散系数(ADC)值,并进行统计学分析。结果：(1)MR 常规序列和 DWI序列(b=500s/mm2)表现：良性椎体压缩性骨折呈长T1 长或等T2 改变,T2WI/FS 呈高信号,DWI 可以呈高信号、等信号及低 信号;恶性椎体压缩性骨折呈长T1 长T2 信号,大部分病灶T2WI/FS 及DWI呈高信号,少数变现为低信号;(2)MR 常规序列和 DWI 序列(b=500s/mm2)病灶检出率的比较：T1WI、T2WI/FS 及DWI序列病灶检出率均高于T2WI 序列,其间的差别有显著性意 义(P<0.01),T1WI、T2WI/FS 及DWI序列病灶检出率之间无显著性差异(P>0.01);(3)ADC 值比较：在DWI(b=500 s/mm2)上,良性组 ADC 值为(2.03± 0.83)× 10-3mm2/s,恶性组ADC 值为(1.37 ± 0.75)× 10-3mm2/s,正常组ADC值为(0.36± 0.21)× 10-3mm2/s,成像条 件相同时,良性组高于恶性组,两组间有明显的统计学意义(P<0.05)。结论：DWI可较好的反映椎体的弥散特征,ADC值作为量化 指标可对良恶性椎体压缩性骨折进行可靠鉴别。     

MR弥散加权成像对鉴别诊断良恶性椎体压缩性骨折的临床价值研究

目的：探讨MR弥散加权成像（DWI）鉴别诊断良恶性椎体压缩性骨折的临床价值。方法：对57例经临床或病理证实的椎体良恶性压缩性骨折患者行矢状位T1M、T2WI、T2WI／FS及DWI扫描,研究其在常规序列和DWI序列上的表现,将常规MR序列和DWI序列检出率进行比较,测量正常椎体及病变椎体的表观弥散系数（ADC）值,并进行统计学分析。结果：（1）MR常规序列和DWI序列（b=500s／mm2）表现：良性椎体压缩性骨折呈长T1长或等T2改变,T2WI／FS呈高信号,DWI可以呈高信号、等信号及低信号;恶性椎体压缩性骨折呈长T1长T2信号,大部分病灶T2WUFS及DWI呈高信号,少数变现为低信号;（2）MR常规序列和DWI序列（b=500s／mm2）病灶检出率的比较：T1WI、T2WI／FS及DWI序列病灶检出率均高于T2WI序列,其间的差别有显著性意义（P〈0．01）,T1WI、T2WI／FS及DWI序列病灶检出率之间无显著性差异（P〉0．01）;（3）ADC值比较：在DWI（b=500s／mm2）上,良性组ADC值为（2．03±0．83）×10^3mm^2/s,恶性组ADC值为（1．37±0．75）×10^-3mm^2/s,正常组ADC值为（0．36±0．21）×10^-3mm^2／s,成像条件相同时,良性组高于恶性组,两组间有明显的统计学意义（P〈0．05）。结论：DWI可较好的反映椎体的弥散特征,ADC值作为量化指标可对良恶性椎体压缩性骨折进行可靠鉴别。     

3.0MR 高分辨磁敏感加权成像对颅脑弥漫性轴索损伤的诊断价值

目的:探讨3.0TMR高分辨磁敏感加权成像(SWI)序列对颅脑弥漫性轴索损伤(DAI)的诊断价值。方法:选择临床诊断为DAI的30例患者行SWI及常规序列扫描,观察患者病灶等,对比SWI与常规MR序列对DAI病灶形态、分布、数目显示的敏感性,并分析与哥拉斯哥昏迷(GCS)评分及预后的相关性。结果:130例DAI患者SWI序列平均病灶个数为22.83个,明显高于T1WI、T2WI、T2flair序列的1.5个、2.13个、4.1个,比较差异有统计学意义(X2=11.44,P<0.05);2SWI序列皮髓质交界区、白质区、基底节、脑干、小脑、胼胝体DAI病灶呈边界清晰、大小不等点状、片状、串珠状、条状、团状不均低信号;3GCS分值越高DAI平均病灶数目越少,两者呈明显负相关(r=-0.715,P<0.05);4痊愈、好转、死亡患者DAI平均病灶数目、脑中线累及率依次增高,比较差异有统计学意义(F=9.29,X2=13.52,P<0.05)。结论:3.0TMR高分辨SWI序列对DTI的敏感性优于常规序列,病灶数目与GCS评分具有相关性,能够较好地预测患者预后情况。     

头颈部木村病的CT、MRI影像学表现

目的:探讨头颈部木村病的CT、MRI的影像学表现。方法:对6例经手术或活检病理证实的头颈部木村病的CT及MRI影像学表现进行回顾性分析。结果:本组6例以中青年男性患者多见,病灶位于耳周2例、颊面部1例、颌下区1例,腮腺区1例、头皮下1例,均表现为无痛性肿块。3例CT表现为单侧或双侧、单发或多发等或略高密度软组织肿块,密度均或不均,边缘清楚或局部欠清,伴邻近皮下组织受累;增强扫描病灶表现为不同程度强化。3例MRI表现为对比邻近肌肉信号,病灶在T1WI上为等、稍高信号,在T2WI上为高信号,大部分病灶中等至明显强化。本组6例病变均伴有周围多发淋巴结肿大及实验室检查外周血嗜酸性粒细胞增多,可伴病侧局部皮下脂肪层萎缩。结论:头颈部木村病的CT、MRI影像表现有一定特征性,结合临床病史及实验室检查,可提高木村病的诊断准确率。     

Magnetic resonance image and blood manganese concentration as indices for manganese content in the brain of rats

Neurological disorders similar to parkinsonian syndrome and signal hyperintensity in brain on T₁-weighted magnetic resonance (MR) images have been reported in patients receiving long-term total parenteral nutrition (TPN). These symptoms have been associated with manganese (Mn) depositions in brain. Although alterations of signal intensity on T₁-weighted MR images in brain and of Mn concentration in blood are theoretically considered good indices for estimating Mn deposition in brain, precise correlations between these parameters have not been demonstrated as yet. Male Sprague-Dawley rats received TPN with 10-fold the clinical dose of the trace element preparation (TE-5) for 7 d. At 0, 2, 4, 6, and 8 wk post-TPN, the cortex, striatum, midbrain, and cerebellum were evaluated by MR images, and Mn concentration in blood and Mn content in these brain sites were measured by atomic absorption spectrometry. Immediately after TPN termination, signal hyperintensity in brain sites and elevated Mn content in blood and brain sites were observed. These values recovered at 4 wk post-TPN. A positive correlation was observed between either the signal intensity in certain brain sites or Mn content in blood and the relevant brain sites. Our observations suggest that the Mn concentration in blood and signal intensity in the brain sites on T₁-weighted MR images are reliable indices for monitoring Mn contents in brain.     

颅内原发性黑色素瘤的影像学诊断

目的：探讨颅内黑色素瘤的影像学特点。方法：回顾性分析5例经手术病理及临床证实的颅内原发性黑色素瘤的CT和MR影像学表现。结果：CT表现为类圆形高密度影4例,低密度影1例。增强扫描肿瘤出现不均匀强化。MR检查,4例T1WI肿瘤表现为高信号,1例T1wI肿瘤表现为不均匀低信号;5例增强扫描肿瘤明显增强。结论：MRI有助于颅内黑色素瘤的诊断,在一定程度上可以区分原发性和转移性黑色素瘤。     

A case of metastatic leptomeningeal carcinomatosis from early gastric carcinoma

Intramuscular myxoma is a rare benign soft tissue tumor which may be mistaken for other benign and low-grade malignant myxoid neoplasms. We present the case of a 63-year-old woman with an asymptomatic intramuscular myxoma discovered incidentally on a whole-body F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography. PET images showed a mild FDG uptake (maximum standardized uptake value, 1.78) in the left gluteus maximus. Subsequent magnetic resonance (MR) imaging revealed a well-defined ovoid mass with homogenous low signal intensity on T1-weighted sequences and markedly high signal intensity on T2-weighted sequences. Contrast-enhanced MR images showed heterogeneous enhancement throughout the mass. The diagnosis of intramuscular myxoma was confirmed on histopathology after surgical excision of the tumor. The patient had no local recurrence at one year follow-up. Our case suggests that intramuscular myxoma should be considered in the differential diagnosis of an oval-shaped intramuscular soft tissue mass with a mild FDG uptake.     

The Utility of Gadoxetic Acid-Enhanced MR Imaging to Characterize Atypical Cirrhotic Nodules Detected on Dynamic CT Images

Purpose

To evaluate whether gadoxetic acid (Gd-EOB-DTPA)-enhanced MR images of tumors taken during the hepatocyte-specific phase can aid in the differentiation between hepatocellular carcinoma (HCC) and dysplastic nodules (DNs) in patients with atypical cirrhotic nodules detected on dynamic CT images.

Materials and Methods

Seventy-one patients with 112 nodules showing atypical dynamic enhancement on CT images underwent gadoxetic acid-enhanced MR imaging (MRI) studies. Using a reference standard, we determined that 33 of the nodules were DNs and that 79 were true HCCs. Tumor size, signal intensity on precontrast T1-weighted images (T1WI) and T2WI, and the pattern of dynamic enhancement on MR images taken in the hepatocyte-phase were determined.

Results

There were significant differences in tumor size, hyperintensity on T2WI, hypointensity on T1WI, typical HCC enhancement pattern on dynamic MR images, or hypointensity on hepatocyte-phase images between DNs and HCC. The sensitivity and specificity were 60.8% and 87.9% for T2WI, 38.0% and 87.9% for T1WI, 17.7% and 100% for dynamic MR imaging, 83.5% and 84.9% for hepatocyte-phase imaging, and 60.8% and 87.9% for tumor size (threshold of 1.7 cm).

Conclusion

Gd-EOB-DTPA-enhanced hepatocyte-phase imaging is recommended for patients at high risk of HCC who present with atypical lesions on dynamic CT images.     

The safe face lift with bony anatomic landmarks to elevate the SMAS

The risk for facial nerve injury has been reported to be increased with the inclusion of superficial musculoaponeurotic system (SMAS) elevation as compared with a skin-only face lift. The facial nerve courses through the parotid gland. The SMAS is elevated superficial to the parotid gland. However, in elevating the SMAS anterior to the parotid gland, the facial nerve is at risk of injury where its branches emerge from the anterior edge of the parotid gland. The purpose of this study was to identify bony anatomic landmarks to predict the location of the anterior edge of the parotid gland to avoid injury to the facial nerve branches as they exit the parotid gland. The authors dissected 20 cadaver face halves to determine bony landmarks-the masseteric tuberosity and the inferior lateral orbital rim-to predict the location of the anterior parotid edge. Then they measured the anterior edge of the parotid gland in relation to the vector formed between these two bony landmarks. They identified and measured the most anterior portion of the parotid gland in relation to this vector. Then the most posterior aspect of the parotid gland in relation to this vector was measured. In the 20 dissections, the authors found the most anterior portion of the parotid gland to be 2.7 +/- 1.0 mm anterior to the vector from the inferior lateral orbital rim to the masseteric tuberosity. The most posterior part of the anterior edge of the parotid gland in relation to this vector was found to be 1.0 +/- 1.5 mm posterior to this vector. The parotid gland measured an average of 38.8 +/- 3.5 mm in width from the tragus to the anterior parotid edge. In elevating the SMAS with a face lift, the facial nerve branches can be predicted to exit the anterior edge of the parotid gland, which can be located 38.8 mm anterior to the tragus and near the vector from the inferior lateral orbital wall to the masseteric tuberosity.     

肝癌自发性破裂出血的MRI诊断

目的：探讨肝癌自发性破裂出血的MRI图像特征。方法：对6例经手术或肝动脉血管造影确诊为原发性肝癌破裂出血患者的MR图像进行回顾性分析,总结其临床特点及MRI图像特征。结果：6例患者均行MR平扫及增强扫描,肝被膜下出血4例,腹腔内出血2例。出血表现为T1WI呈高或等信号,T2WI呈高或低信号,5例可清晰显示肿瘤破口。结论：MR诊断肝癌自发性破裂出血及时、准确,T1WI及延迟扫描冠状位图像对诊断有定性意义。     

MR Angiography,MR Imaging and Proton MR Spectroscopy In-Vivo Assessment of Skeletal Muscle Ischemia in Diabetic Rats

To prospectively evaluate the feasibility of using magnetic resonance (MR) techniques for in-vivo assessing a rat diabetic model of limb ischemia. Unilateral hind limb ischemia was induced by ligation of the iliac-femoral artery in male streptozotocin-treated and non-diabetic control rats. Four weeks after ligation, rats underwent MR Angiography (MRA), T₁-weighted and Short Time Inversion Recovery (STIR) sequences and muscle Proton MR Spectroscopy (¹H-MRS) on both hind limbs. After MR examinations, immunoblotting and immunofluorescence analysis were performed. MRA showed a signal void due to flow discontinuation distal to the artery ligation. T₁-weighted and STIR images showed, respectively, the presence of tissue swelling (p = 0.018 for non-diabetic; p = 0.027 for diabetic rats) and signal hyperintensity in tissue affected by occlusion. Mean total creatine/water for the occluded limb was significantly lower than for the non-occluded limbs in both non-diabetic (5.46×10⁻⁴ vs 1.14×10⁻³, p = 0.028) and diabetic rats (1.37×10⁻⁴ vs 1.10×10⁻³; p = 0.018). MR Imaging and ¹H-MRS changes were more pronounced in diabetic than in non-diabetic occluded limbs (p = 0.032). MR findings were confirmed by using histological findings. Combined MR techniques can be used to demonstrate the presence of structural and metabolic changes produced by iliac-femoral artery occlusion in rat diabetic model of limb ischemia.     

Transplantation of Mesenchymal Cells Improves Peripheral Limb Ischemia in Diabetic Rats

Adipose tissue-derived mesenchymal stromal cells (ADSCs) are a prominent cellular source for regenerative medicine. We tested whether transplantation of ADSCs into the ischemic muscular tissue of diabetic animals would attenuate impaired cell metabolism and microcirculatory function. We induced unilateral hind limb ischemia in male streptozotocin-treated rats and nondiabetic controls. One day after femoral artery ligation, six rats per group were intramuscularly injected allogeneic ADSCs (10⁶–10⁷–10⁸ cells/mL); or conditioned media from ADSC cultures (CM); or saline; or allogeneic fibroblasts (10⁷ cells/mL); or nonconditioned medium. Rats underwent magnetic resonance angiography; short time inversion recovery (STIR) edema-weighed imaging; proton MR spectroscopy (¹H-MRS); immunoblotting and immunofluorescence on both hind limbs for 4 weeks. T₁-weighted and STIR images showed tissue swelling and signal hyperintensity, respectively, in the ischemic tissue. The mean total ratio of creatine/water for the occluded limbs was significantly lower than for the nonoccluded limbs in both nondiabetic and diabetic rats. ADSC and CM groups had greater recovery of tCr/water in ischemic limbs in both diabetic and nondiabetic rats, with increased expression of α-sarcomeric actinin, vascular endothelial growth factor and hepatocyte growth factor, as well as increased vessel density. ADSCs improve ischemic muscle metabolism and increase neovasculogenesis in diabetic rats.     

3.0T磁共振多序列成像对鉴别胰头癌与胰头肿块型慢性胰腺炎的应用价值

目的：探讨磁共振多序列成像对鉴别胰头癌与胰头肿块型慢性胰腺炎的临床价值及意义。方法：对已确诊的16例胰头癌患者和5例胰头肿块型慢性胰腺炎患者的磁共振多序列成像MR进行回顾性分析。主要征象包括：①肿块信号及形态学特点;②胰管及胆管扩张情况;③动态增强的特征;④胰周及大血管受累情况;⑤邻近器官受累与淋巴结肿大情况。检查方法包括：平扫T1WI＋FST2WI＋FS,MRCP,3D—VIBE动态增强扫描。结果：1）肿块形态信号异常：胰头癌与胰头肿块型胰头慢性胰腺炎的信号有较多重叠,在TlwI上均表现为相对低信号,T2WI表现为不均匀稍高、相等或低信号。2）胰管与胆管的异常：胰头癌表现为胰管扩张至肿块处突然截断12例,胆总管突然截断10例,“双管征”10例。胰头肿块型慢性胰腺炎胰管扩张3例,2例为串珠样扩张,扩张的胰管可贯通病灶区,胆总管5例均扩张,远端呈短锥形狭窄3例,鼠尾样狭窄2例。3）3D—VIBE强化特征分析结果：随着时间的延长胰头癌强化程度和强化百分率较胰头肿块型慢性胰腺炎明显减低。4）胰周大血管受累情况：胰头癌肿块与血管分界不清者8例,部分包绕血管6例完全包绕血管6例;胰头肿块型慢性胰腺炎1例与血管分界不清,1例部分被包绕。5）邻近器官受累与淋巴结肿大情况：胰头癌有7例淋巴结肿大主要分布在胰周及腹主动脉旁,胰头肿块型慢性胰腺炎,未见明显肿大淋巴结,有四例肾周筋膜增厚,两例肾前筋膜增厚。结论：磁共振多序列成像的联合使用及征象分析,有助于鉴别胰头癌与胰头肿块型慢性胰腺炎。     

Aberrant Resting-State Corticostriatal Functional Connectivity in Cirrhotic Patients with Hyperintense Globus Pallidus on T1-Weighted MR Imaging

Neurobiological and neuroimaging studies have emphasized the structural and functional alterations in the striatum of cirrhotic patients, but alterations in the functional connections between the striatum and other brain regions have not yet been explored. Of note, manganese accumulation in the nervous system, frequently reflected by hyperintensity at the bilateral globus pallidus (GP) on T1-weighted imaging, has been considered a factor affecting the striatal and cortical functions in hepatic decompensation. We employed resting-state functional magnetic resonance imaging to analyze the temporal correlation between the striatum and the remaining brain regions using seed-based correlation analyses. The two-sample t-test was conducted to detect the differences in corticostriatal connectivity between 44 cirrhotic patients with hyperintensity at the bilateral GP and 20 healthy controls. Decreased connectivity of the caudate was detected in the anterior/middle cingulate gyrus, and increased connectivity of the caudate was found in the left motor cortex. A reduction in functional connectivity was found between the putamen and several regions, including the anterior cingulate gyrus, right insular lobe, inferior frontal gyrus, left parahippocampal gyrus, and anterior lobe of the right cerebellum; increased connectivity was detected between the putamen and right middle temporal gyrus. There were significant correlations between the corticostriatal connectivity and neuropsychological performances in the patient group, but not between the striatal connectivity and GP signal intensity. These alterations in the corticostriatal functional connectivity suggested the abnormalities in the intrinsic brain functional organiztion among the cirrhotic patients with manganese deposition, and may be associated with development of metabolic encephalopathy. The manganese deposition in nervous system, however, can not be an independent factor predicting the resting-state brain dysfunction in real time.