结节性筋膜炎的临床和CT诊断

目的：探讨结节性筋膜炎的CT表现。方法：对12例经手术病理证实为结节性筋膜炎患者的临床及CT 检查资料进行回顾性分析。结果：12例中病变位于上肢5例、下肢4例、颈部、腹壁和腰背部各1例,病灶最大径1．0～4．0 cm,11例为单发肿块,1例于腰背部可见2个肿块。主要CT表现：病灶均为实性软组织肿块,呈扁平状或椭圆形,与周围肌肉密度相比呈均匀等密度,增强扫描示肿块明显强化;肿块与周围脂肪层及邻近肌肉分界清晰10例,边界不清2例,其中1例颈部肿块侵及颌下腺及周围颈部肌群;8例可见“筋膜尾征”,未见肿块突破筋膜面向浅（深）侧侵犯。结论：结节性筋膜炎的CT表现有一定特征性,结合其临床表现,有助于结节性筋膜炎的诊断。     

结缔组织病肌筋膜炎的MR和CT表现与穿刺活检的对照研究

目的 了解结缔组织病肌筋膜病变的影像表现特点，以及MRI、CT的应用价值。方法 经临床诊断的结缔组织病22例，其中皮肌炎（DM）8例、多肌炎（PM）12例和嗜酸性筋膜炎2例。所有病例均完成大腿CT平扫、MR的T1WI、T2WI、频率预饱和反转恢复（SPIR）序列及CT导向经皮穿刺活组织检查。结果 穿刺活检、MRI和CT发现肌组织病变分别有17例、14例和5例，发现筋膜病变分别为5例、9例和9例。肌炎、肌萎缩、筋膜炎可单独或合并存在，肌炎（9例）呈现T1WI低信号和T2WI或SPIR高信号改变，肌萎缩（9例）呈T1WI、T2WI高信号以及肌间隙增宽。SPIR检出肌炎明显优于CT和T1WI，P＜0．05。DM（6／8）的发生率明显高于PM（3／12），P＜0．05。病情加重期肌炎（7／11）的发生率明显高于缓解期（2／11），P＜0．05。结论 MRI和CT能够客观地反映结缔组织病肌筋膜病变的类型、累及部位和病情变化特点。     

皮肌炎的MRI诊断

目的 探讨皮肌炎软组织病变的MRI表现及其临床应用价值.方法 回顾性分析28例经临床确诊皮肌炎患者的双侧大腿MRI表现,常规行快速自旋回波序列TSE-T1WI、T2WI及短时反转恢复序列STIR.结果 (1)本组28例双侧大腿病变基本呈双侧对称性分布,软组织形态结构未见破坏.炎性病灶在抑脂STIR序列上表现最为明显.(2)MRI提示肌炎者15例,筋膜炎者28例,皮下结缔组织炎者10例,上述三大主要异常表现间有不同程度合并;其它少见表现包括骨髓水肿4例、髌上囊积液4例、肌肉萎缩3例.(3)急性活动期患者5例,以弥漫性肌炎为主,同时合并筋膜炎和典型的皮下结缔组织炎;亚急性过渡期5例,肌炎、皮下结缔组织炎减轻,筋膜炎明显;慢性缓解期18例,以不同程度筋膜炎为主,可伴肌肉萎缩.结论 MRI可作为皮肌炎临床诊断、随访的重要手段.     

MRI在诊断多发性肌炎及皮肌炎中的应用

多发性肌炎和皮肌炎是临床上相对较常见的特发性炎性肌病。目前多发性肌炎/皮肌炎的诊断主要依据临床表现、肌电图、血清肌酶和肌肉活检,其中肌肉活检是确诊的依据。但在临床中,部分患者病变较局限,肌肉活检时不一定能取到病变肌肉,导致部分活检失败。     

小腿骨筋膜间隔综合征MRI表现及其诊断价值

目的　总结小腿骨筋膜间隔综合征 (ostealcompartmentsyndrome ,OCS)的MRI表现特点及其诊断价值。　方法　回顾分析 15例经临床证实的小腿OCS患者的临床及MRI资料。结果　 15例中表现为多个筋膜间室受累 14例 ;单室受累 1例。急性期MRI表现为受累肌肉高度水肿 ,T1WI为低信号、T2 WI为高信号 ,肌间隔结构模糊 ;亚急性期信号混杂。与肌肉水肿相比 ,肌肉坏死区在T1WI呈更低信号 ,T2 WI呈更高信号 ,而肌肉内出血在T1WI、T2 WI上均呈高信号 ;慢性期主要表现为受累肌肉萎缩、肌间隔脂肪增多和深筋膜增厚。　结论　小腿OCS的MRI表现具有一定特征性。MRI可帮助临床诊断可疑病例 ,明确病变部位、范围和程度 ,并帮助临床制定治疗计划     

结节性筋膜炎的CT和MRI表现

目的：探讨结节性筋膜炎的CT和MRI表现。方法：回顾性分析10例经病理证实的结节性筋膜炎的CT和MRI表现。结果：10例中4例位于上肢,4例位于下肢,2例位于腹壁。病灶均表现为单发实性软组织肿块（肌内型6例,肌间型2例,皮下型2例）,CT平扫示肿块密度稍低于肌肉密度,增强扫描有明显强化。MRI检查：病灶于T1WI呈等或稍低信号,T2WI呈不均匀高信号,其中1例病灶边缘可见囊变区,3例病灶中央可见低信号,增强扫描肿块呈均匀或不均匀中度一重度强化,边界清。结论：结节性筋膜炎的CT和MRI表现有一定特征性,两种方法均有助于本病的诊断及鉴别诊断。     

MRI在进行性肌营养不良中的应用价值

目的探讨进行性肌营养不良(progressive muscular dystrophy,PMD)的骨骼肌MRI表现与临床的相关性及其应用价值。资料与方法对22例经临床表现、血清肌酸激酶(CPK)、肌电图检查及开放式骨骼肌活检、组织及免疫病理学证实的PMD患者的临床及影像资料进行回顾性分析。结果各型肌病MRI受累肌肉分布特征为:杜兴型和贝克型为大腿前部肌群;肢带型2B型为大腿后部肌群;远端型中Welander型为大腿后部肌群及小腿前群、外侧群肌肉;Nonaka型为小腿前群、外侧群肌肉;Miyoshi型为小腿后部肌群;先天性为大、小腿后部肌群;强直性为大、小腿前、后肌群。MRI上的病变程度与病程无一致性关系。除假肥大型无肌肉水肿表现外,其余类型均有不同程度的肌肉水肿。结论 MRI表现提示不同的肌病类型有特定的分布,有助于临床鉴别某些类型的肌病。利用对脂肪沉积和水肿敏感的MRI序列,有助于理解肌病的病理过程,协助临床检查监测对治疗的反应。     

皮肤双重瘤1例

患者男性,31岁,农民。病理号：29514。因右大腿皮肤发黑粗糙1年,伴隆起性肿块7月就诊。外院活检病理诊断：皮肤组织慢性炎,皮下纤维组织瘤样增生。查体：右大腿中下段前有一突起性包块,表面皮肤见4．5cm×4cm范围的乳头状粗糙区,行手术切除,术中见肿块浸及皮肤全层达皮下肌筋膜。     

头颈部放疗后软组织损伤的CT表现

目的 :本文旨在观察和探讨头颈部肿瘤放疗后软组织损伤的CT表现 ,以提高对头颈部放射性损伤的影像学认识。方法 :对头颈部恶性肿瘤放疗后 70例作CT扫描观察 ,计 13 3次扫描 ,扫描 1次 3 8例 ,2次 15例 ,3次以上 17例。观察时间分为放疗后近期 ( 6个月以内 )、中期 ( 6～ 12个月 )和远期 ( 12个月以上 )。放疗剂量为 40～ 72Gy(单程放疗 )、14 0Gy(二程及二程以上放疗 )。全部病例均有放疗前CT图像对照。结果 :CT所见包括皮下脂肪层变薄 2 6例 ,皮肤增厚15例 ,皮肤凹陷 2 6例 ,肌肉萎缩 19例 ,颈深筋膜增厚 15例 ,皮下纤维性增生 18例 ,涎腺萎缩 19例 ,复发性肿瘤 18例。结论 :CT对头颈部软组织放射性损伤的表现和程度的判断是准确的 ,能为临床治疗提供参考依据     

MR多种成像序列在皮肌炎诊断中的应用

目的：探讨皮肌炎的MRI表现及不同MRI成像序列的诊断价值。方法：分析12例皮肌炎在不同MRI成像序列上的MRI表现，成像序列包括：SE T1WI、FSE T2WI、S11R、DWI与增强SE T1WI抑脂序列。结果：12例中，幼年性皮肌炎10例，3例表现为多发性肌炎，5例表现为多发性肌炎、肌筋膜炎，2例表现为肌筋膜炎、皮下结缔组织炎并钙质沉着和表皮损害。成人皮肌炎2例，表现为多发性肌炎、肌筋膜炎、皮下结缔组织炎。肌炎、肌筋膜炎、皮下结缔组织炎在，T1WI上呈等或低信号，T2WI、STIR、DWI上呈高信号，增强扫描可见点、片状轻至中度强化，软组织钙质沉着在所有序列上均呈结节状低信号。STIR与DWI序列对显示组织炎性病变最为敏感，病变区域ADC值与正常肌肉组织相比无显著差异。结论：MRI能反映皮肌炎不同病变阶段的各种异常病理改变及其动态变化，STIR与DWI对显示组织炎性病变优于其他成像序列，横断面扫描对显示病变位置及分布较好。     

皮肌炎的MRI诊断

目的：探讨皮肌炎在MRI上的表现及其诊断价值。方法：对经病理证实的20例皮肌炎早期阶段病例和25例活动期病例行MR SE序列T1WI,快速自旋回波序列（FSE）T2WI,以及短时反翻转恢复序列（STIR）扫描。结果：（1）多发性肌炎改变,26例在T1WI均无异常信号,在T2WI和STIR上表现为两侧对称性,小片状分布的稍高信号,肌束形态无明显异常,肌束界限清楚：19例在T1WI和T2WI上均无信号异常,在STIR上呈局限性小片状高信号。肌炎最常累及部位为臀肌和大腿下1／3的外侧肌群。（2）皮下结缔组织炎有18例均为活动期病例,是该疾病的较重的表现。（2）肌筋膜炎17例,早期和活动期均可出现。（4）表皮损害5例。伴肌萎缩7例,多为慢性病变。结论：皮肌炎在MRI上表现为多发性肌炎,肌筋膜炎,皮下结缔组织炎,后者是疾病较严重阶段的表现,最常累及的部位是臀肌和大腿下1／3的外侧肌群。MRI是诊断皮肌炎的有效的方法。STIR是诊断皮肌炎最敏感的序列。     

CT evaluation of gracilis myocutaneous vaginal reconstruction after pelvic exenteration

After pelvic exenteration for cancer, the gracilis muscles, skin, and subcutaneous fat from the inner aspect of both thighs may be raised as a pedicle flap and tunneled under the skin into the pelvic space to create a neovagina. We reviewed nine pelvic CT examinations in six patients to evaluate the CT appearance of this procedure and its complications. Five patients are alive and without complications. One patient died 6 months after surgery and had a small-bowel fistula to the neovagina. Normal CT findings included air in the vaginal canal in six of nine examinations, gracilis muscle atrophy in two patients who had early and late CT studies, and early separation of the anterior and posterior approximation of the flaps in one patient. Abnormal findings were seen in two patients: one had an abscess near the vaginal apex that was drained per vagina; the other had extraluminal air in the retropubic and subcutaneous fatty tissues due to a small-bowel fistula into the vagina.     

Computed tomography-based fat and muscle characteristics are associated with mortality after transcatheter aortic valve replacement

BackgroundComputed tomography (CT)-based fat and muscle measures are associated with outcome in large populations. We tested if muscle and fat characteristics are associated with long-term outcomes after TAVR.MethodsWe included 403 clinical CTs performed prior to TAVR at our center between 2008 and 2016, measuring area (cm²) and density (Hounsfield units, HU) of both psoas muscles (PM), subcutaneous adipose (SAT), and visceral adipose tissue (VAT). Area measures were indexed to height, log-transformed and both area and density were standardized for analysis. We assessed the association of each measure with all-cause mortality (adjusted for age, sex, body mass index (BMI), and the Society of Thoracic Surgeons (STS) risk score.ResultsOf the 403 individuals (83 ± 8 years; 52% female), 167 (41.4%) died during a median follow-up of 458 days (interquartile range IQR 297–840). Fat measures were feasible and rapid. Fat area was available in 242 (60%) patients with an adequate field of view. Individuals with the lowest PM area, SAT area or VAT area exhibited the highest hazard of mortality. In addition, greater SAT density was associated with a higher mortality hazard (adjusted HR per standard deviation increase in density = 1.35, 95%CI 1.10–1.67, P = 0.005).ConclusionRapid CT-based tissue characterization is feasible in patients referred for TAVR. Decreased PM area and increased SAT density are associated with long-term mortality after TAVR, even after accounting for age, sex, BMI, and STS score. Further studies are necessary to interrogate sex-specific relationships between CT tissue metrics and mortality and whether CT measures are incremental to well-established frailty metrics.     

胸膜外脂肪增厚在诊断中的意义

目的 了解胸膜外脂肪（ＥＰＦ）在判断病变性质上的意义。方法 １６６例有胸膜和（或）邻近肺部病变患者作了ＣＴ扫描,对见到ＥＰＦ者记录其厚度,测量ＣＴ值,同时测量其前胸壁下皮下脂肪ＣＴ值加以比较。     

MR and CT appearance of nodular fasciitis

Nodular fasciitis is a common soft-tissue tumor that remains almost unreported in the radiology literature. We retrospectively reviewed all available imaging studies on three patients with nodular fasciitis studied by MR at our institution. The lesions were round to oval in configuration, ranging in size from 1 to 4.5 cm. Two were intramuscular and one was subcutaneous in location. Both intramuscular lesions were poorly defined on CT, with a tissue attenuation less than that of skeletal muscle. The single subcutaneous lesion was well defined by surrounding fat. Conversely, all lesions were well defined on MR, although the appearance was otherwise nonspecific and varied according to the histology of the lesion. Both intramuscular lesions were mucoid or cellular and were hyperintense to skeletal muscle on T1-weighted and hyper-intense to fat on T2-weighted spin-echo (SE) MR images. The subcutaneous lesion was fibrous and markedly hypointense to skeletal muscle on all SE pulse sequences. Findings on three-phase bone scan, arteriography, and ultrasound are discussed. Because there are no unique radiologic findings in nodular fasciitis, this entity must be included in the preoperative differential diagnosis of small soft-tissue masses occurring in the extremities of young adults.     

肾上腺创伤的CT表现

目的 探讨肾上腺损伤(AGT)的CT表现特征.方法 回顾性分析1712例因腹部钝伤行CT检查的患者中AGT患者的CT检查结果.结果 1712例中,共发现AGT 29例(1.7%),右侧损伤23例,左侧3例,双侧3例,共32个病灶.主要CT表现:(1)肾上腺血肿:22例25个病灶,呈孤立立圆形或卵圆形肿块,平扫为高密度或混杂密度,三期动态增强扫描均无强化,肿块周围见推移张开的肾上腺肢体,呈弧形线状明显强化.(2)肾上腺肿胀:4例,表现为受损部肾上腺肢体肿胀,体积增大.(3)肾上腺弥漫性出血:3例,肾上腺被出血包埋,正常肾上腺结构消失.1例伴对比剂外溢,手术证实为肾上腺碎裂伴活动性出血.伴随征象主要包括伤侧肾上腺周围条纹状出血浸润影,膈肌脚增粗等.合并其他胸腹部脏器损伤25例.结论 AGT具有特征性CT表现,采用合理扫描技术并正确认识AGT的CT征象有助于避免漏诊和误诊.     

CT appearance of small renal angiomyolipoma

Twenty-six small renal angiomyolipomas (AML) in 21-patients, detected incidentally by ultrasonography, were evaluated with CT. Conventional CT findings of AML were classified into three types by the degree of the fatty areas in the mass. Type 1 is a mainly fat density mass like a lipoma observed in 7 lesions (26.9%). Type 2 is a fatty mass intermixed with areas of tissue density and found in 15 lesions (57.7%). Type 3 is a mass without fatty portion and observed in 4 lesions (15.4%). These latter lesions were indistinguishable from renal cell carcinoma on CT. It is important to diagnose a small lesion of the kidney as AML correctly for proper treatment.     

皮下脂膜炎样T细胞淋巴瘤18F-FDGPET/CT影像分析并文献复习(附4例报道)

目的 总结皮下脂膜炎样T细胞淋巴瘤（SPTCL）的18F-FDG PET/CT影像学特点,探讨18F-FDG PET/CT在SPTCL中的应用价值。 方法 回顾性分析4例经病理证实的SPTCL患者的影像学表现,观察病灶的形态、分布范围、代谢信息,结合其临床、病理特点复习相关文献。 结果 4例患者的18F-FDG PET/CT影像学表现:病灶形态不规则,密度增高,相应部位18F-FDG摄取增高。病变累及范围广泛,面颈（2例）、躯干（4例）、四肢（4例）、腹膜和盆腔脂肪组织（2例）均可受累。半定量分析结果:皮下脂肪病灶最大标准化摄取值为3.5~14.6。 结论 SPTCL病变分布广泛,18F-FDG摄取差异较大,但18F-FDG PET/CT显像有利于整体评估SPTCL患者病情,在疗效监测方面具有重要作用。      

Madelung综合征累及头颈部的CT诊断

目的：探讨CT对Madelung综合征累及头颈部的诊断价值。方法：回顾性分析24例Madelung综合征累及头颈部患者的CT表现,全部病例均行CT平扫,15例行增强扫描,18例采用2D多平面重组（MPR）和3D容积再现（VR）技术进行图像后处理。结果：24例均显示脂肪组织对称分布,无包膜,边界不清。男性患者病变主要分布于下枕部、后颈部及上背部皮下间隙、胸锁乳突肌及斜方肌深面、椎旁肌间隙、颈前区、腮腺区、面颊部、颈后三角区和锁骨上区;女性患者病变主要累及后颈部皮下间隙。部分病例见肌肉、腺体、大血管、上气道和消化道受压。此外,CT扫描发现头颈部偶发病变5例,包括会厌癌、真菌性上颌窦炎、枕大池蛛网膜囊肿、腮腺Warthin瘤和锁骨上血管畸形各1例。结论：CT是评价Madelung综合征累及头颈部的有效手段,结合2DMPR和3DVR重组技术,可准确显示脂肪组织的分布情况,病灶与肌肉、腺体和大血管的关系以及上气道和消化道受压的程度等,同时可发现头颈部其它偶发病变,对本病的诊断和治疗具有重要价值。