继发性甲旁亢甲粗隆骨膜下骨吸收的X线观察

笔者采用指骨Ｘ线直接放大摄影来观察３０例甲粗隆的Ｘ线解剖和２４例肾性骨病甲粗隆骨膜下骨吸收的Ｘ线征象。认为甲粗降骨膜下骨吸收是肾性骨病继发性甲状旁腺机能亢进（甲旁亢）早期最敏感的Ｘ线征象。     

自制数字显示式放大摄影装置

Ｘ线放大摄影是利用几何投影原理或光学放大原理使Ｘ线照片影像放大的一种Ｘ线特殊检查方法,它可将细微病变放大而显示清楚。对如乳腺癌、石棉肺、佝偻病的早期腕关节改变［１］,氟骨症,肾病骨膜下骨吸收［２］等疾病早期诊断起到积极作用［３］。然而,目前国内使用的各类Ｘ线机中,常不配备放大摄影装置,给Ｘ线放大摄影带来诸多不便。为此,我们研制了数字显示式直接放大摄影装置。该装置移动灵活,操作简便,放大倍数精确可调。１　原理与结构Ｘ线片成像的放大倍数为Ｘ线源（焦点）到胶片的距离与患者检测部位到胶片的距离之比。当选…     

不同部位放大像与普通X线平片对照分析

目的．探讨放大像与普通Ｘ线平片对同一部位骨南病变的诊断效果。材料与方法：对２１０便（男１２０例、女９０例）既有Ｘ线平片又有放大像的病例所摄照片进行分析、对比。结果：放大像发现病变的阳性率为７２％；Ｘ线平片发现病变的阳性率为５９％。结论：当临床高度怀疑有骨质病变，常规Ｘ线平片表现为正常或怀疑异常时，应摄放大像以减少漏诊。     

眼内异物MRI临床应用研究

目的：通过分析４２例５５枚眼内异物的ＭＲＩ表现，并与ＣＴ和Ｘ线平片比较，探讨了ＭＲＩ对眼内异物的诊断价值。材料与方法：男３３例，女９例，年龄５～４５岁。５５枚眼内异物中非磁性异物５３枚，铁磁性异物２枚。每例均在术前１个月内完成Ｘ线平片、ＣＴ和ＭＲＩ检查。结果：（１）ＭＲＩ对５５枚眼内异物检出率（９４％）和ＣＴ（９１％）相仿（Ｐ＞０．２５），均明显高于Ｘ线平片（４２％）（Ｐ＜０．００５）；（２）ＭＲＩ对眼内异物相关并发症的显示优于ＣＴ，而其对巩膜异物的显示差于ＣＴ；（３）ＳＥ序列Ｔ２ＷＩ和ＰＤＷＩ（质子密度加权成像）是检出眼内异物的优选序列；（４）非磁性异物ＭＲＩ呈信号缺失区，无伪迹产生；而铁磁性异物产生大量伪迹，并可致眼部额外损伤。结论：ＭＲＩ是检出眼内非磁性异物的有效方法，特别适用于Ｘ线平片和ＣＴ不能显示的少数非金属异物。眼内铁磁性异物不适于ＭＲＩ。     

不同部位放大像与普通X线平片对照分析(附210例分析)

目的：探讨放大像与普通Ｘ线平片对同一部位骨质病变的诊断效果。材料与方法：对２１０例（男１２０例、女９０例）既有Ｘ线平片又有放大像的病例所摄照片进行分析、对比。结果：放大像发现病变的阳性率为７２％；Ｘ线平片发现病变的阳性率为５９％。结论：当临床高度怀疑有骨质病变，常规Ｘ线平片表现为正常或怀疑异常时，应摄放大像以减少漏诊。     

强直性脊柱炎的临床,CT,ECT诊断与比较

报告１１０例强直性脊柱炎（ＡＳ）的临床、Ｘ线平片及ＣＴ表现，并与其中２４例发射计算机体层（ＥＣＴ）全身骨显像及骨与邻近软组织核素比值进行了对照分析。结果表明，骶髂关节和髋关节骨与邻近软组织核素比值高者，临床上均有明显的下背疼痛和僵硬（Ｐ＜０．０５），核素比值与Ｘ线平片及ＣＴ显示骨的侵蚀和硬化呈正相关（ｒ＝０．５３～０．６６，Ｐ＜０．０５；ｒ＝０．４０～０．５３，Ｐ＜０．０５），与强直呈负相关（ｒ＝－０．４２～－０．４７，Ｐ＜０．０５）。随着骨侵蚀和硬化的增加，骨与软组织核素比值亦相应升高，而强直加重时比值反而减小。ＥＣＴ骨与软组织核素比值测定不仅能预示ＡＳ的活动，而且可以确定病变的部位和范围尤其对全身有多处病变者其敏感性和检出率明显高于ＣＴ及Ｘ线平片。作者认为ＥＣＴ骨与软组织核素比值测定对ＡＳ的早期诊断是一个有价值的检查方法。     

0.1 mm超微焦点放大摄影诊断未触及肿块的乳腺癌

目的研究０．１ｍｍ超微焦点钼靶Ｘ线放大摄影对临床未触及肿块的乳腺癌的诊断价值。方法３５例乳腺癌病例均经手术病理证实，所有病例术前临床均未触及肿块。所有病例术前都进行了普通钼靶摄影（以下简称普通摄影）与０．１ｍｍ超微焦点钼靶Ｘ线放大摄影（以下简称放大摄影），并选择检出率及分辨率为观察指标。结果放大摄影的图像质量明显优于普通摄影，且在统计学上有非常显著性差异。结论应把放大摄影列为检查未触及肿块而临床或普通钼靶摄影疑诊乳腺癌病例的常规手段。     

微焦点高千伏放大摄影应用价值的研究

作者对２３１例常规Ｘ线摄影难以确诊的病例行微焦点高干伏放大摄影（摄影焦点０．３ｍｍ、放大率２倍），并作对照研究。其中胸部１５２例，骨骼７９例；共３１１个部位，２６种病变。研究结果表明，本法在显示病变的微细结构方面明显优于常规片。该方法集微焦点、高千伏和放大摄影的技术优势于一体，可显著提高成像质量，提高人体生理视阈和肉眼的能见度，为Ｘ线诊断提供敏感而可靠的病理改变信息。并可减少病人的照射量，延长Ｘ线     

超声显像及X线造影在胃癌诊断中的对照研究

本文对６０例经手术及／或胃镜病理证实的中后期胃癌进行了超声显像与Ｘ线双对比造影的对照研究。结果表明：Ｘ线对中后期胃癌检出的阳性率（９５％）显著高于超声（８１．７％）（Ｐ＜０．０５），诊断正确率（９３．３％）同样显著高于超声（７１．６％）（Ｐ＜０．０５）。对转移病例的检出，超声（８８％）却显著高于Ｘ线（１２％）（Ｐ＜０．０５），超声对胃癌浸润程度的评定亦远较Ｘ线为优。超声显像不应作为诊断胃癌的首选方法。     

计算机摄影（CR）在鼻骨骨折检查中的临床价值

目的：探讨CR在鼻骨骨折检查中的作用及其临床价值。方法：回顾分析35例鼻骨外伤患者鼻骨侧位CR照片。结果：35例鼻骨CR摄片，发现鼻骨骨折12例（占34．28％）；鼻骨未见异常23例（占65．72％）。结论：利用计算机X线摄影（CR）的空间频率处理（边缘增强处理）和谐调处理结合应用（低对比处理和较强空间频率处理的结合）以及对图像放大后等处理功能，能清晰显示全鼻骨侧位像。在条件允许的情况下，尽量利用CR摄影替代普通X线平片检查，可减少漏诊、误诊的发生。     

Quantitative microfocal radiography of children with renal osteodystrophy; comparison with laboratory and histological findings

High definition microfocal radiography permitted the quantitative assessment of the radiographic features of renal osteodystrophy in the phalanges of 11 children in stable chronic renal failure, treated with phosphate binders for 1 year. The most consistent feature was subperiosteal cortical resorption, expressed as a ratio total length of resorbed subperiosteal bone/total length subperiosteal bone x 100. It was found that the extent of resorbed bone was significantly greater in the middle phalanx and on the ulnar surface of the phalanges. The radiological findings over the duration of the disease were compared with laboratory assessments and bone histomorphometry. The extent of the percentage of subperiosteal resorption at base line and its change during the study period correlated significantly with the level of serum parathyroid hormone levels and its change over the same period. No other significant correlations were found between radiographic features and laboratory assessments or with bone histomorphometry.     

Shoulder erosions in renal osteodystrophy

The radiographic manifestations of renal osteodystrophy may be articular as well as osseous. The latter are well recognized, i.e., subperiosteal and subchondral bony resorption. Recently attention has been directed to the occurrence of an erosive arthritis of the hands and wrists in hyperparathyroidism. The authors present six patients with humeral head erosions, all of whom were on chronic long-term hemodialysis. These intra-articular erosions occurred at the bare area of the humeral head and thus represent an erosive arthritis and therefore can be distinguished from the usual sites of subchondral and subperiosteal bony resorption seen in hyperparathyroidism.     

The hand of the patient under periodic hemodialysis treatment. Comparative radiographic and xeroradiographic aspects

Renal osteodystrophy is the skeletal response to long-standing chronic renal disease. The radiographic features include hyperparathyroidism (osteitis fibrosa cystica), rickets or osteomalacia, osteoporosis, osteosclerosis and soft tissue and vascular calcifications. Many investigators have verified that changes in the phalanges of the hand are the most sensitive indicator of renal osteodystrophy, especially subperiosteal bone resorption. The hands of 50 chronic dialysis patients were evaluated for at least one year for tuftal resorption (acro-osteolysis), subperiosteal and intracortical bone resorption, and periosteal new bone formation (periosteal neostosis), using fine detail radiography and optical magnification. At last control, only in a group of 17 subjects (34%), xeroradiography of the hand was also performed. Results indicate the importance of the use of fine detail radiography in the early diagnosis of renal osteodystrophy and that serial radiography of the hand is a proper method of evaluating progressive bone resorption. In addition, a significant difference (p less than 0.05) is demonstrated between xeroradiography and radiography to evaluate periosteal neostosis.     

Early diagnosis of acute osteomyelitis in children by high-resolution and power Doppler sonography

Aim of the work

Our study purpose is to evaluate the diagnostic values of high-resolution and power Doppler sonography in early diagnosis of acute osteomyelitis using surgery, aspiration cytology, and follow up as a standard.

Patients and methods

Twenty seven children (below age 18 years) with symptoms suggesting acute osteomyelitis were included in our series. Plain radiograph was done to each patient followed by gray-scale and power Doppler sonography.

Results

Twenty five patients (92.6%) were finally diagnosed to have osteomyelitis. Twenty three patients (85.2%) were confirmed by surgery, while two patients (7.4%) were diagnosed by ultrasound guided aspiration of pus. Five sonographic signs could be detected in the disease: (1) deep soft-tissue swelling was the earliest sign which could be seen in the first day of symptoms; (2) periosteal elevation and a thin layer of subperiosteal fluid, which could be progressed to form a subperiosteal abscess (4–6 days). (3) Cortical erosion, which was commonly present in those who had had symptoms for more than a week. (4) Concurrent septic arthritis was evident in 7 patients (25.9%). (5) Increased flow within or around periosteum in power Doppler predicts subsequent subperiosteal abscess formation and failure of antibiotic therapy necessitating surgical intervention with a high sensitivity and positive predictive values reaching 100%

Conclusion

High resolution and power Doppler sonography were found to be very sensitive and highly specific in diagnosis of acute osteomyelitis in pediatrics with clinical suspicion of the disease and negative or equivocal plain radiographs.     

Metaphyseal sclerosis in patients with chronic renal failure

We reviewed radiographs of the hands and wrists of 33 patients with immature skeletons and chronic renal disease. Various radiographic manifestations of renal osteodystrophy were seen, including osteopenia in 23 patients (70%), subperiosteal resorption in 20 (61%), distal tuft resorption in 14 (42%), sclerosis of vertebral bodies in 2 (6%), and soft-tissue calcification in 1 (3%). We also noted that 13 patients (39%) exhibited metaphyseal sclerosis adjacent to the growth plates. Five of these 13 showed persistent sclerosis years after the growth plates had fused. None of the patients showed other radiographic changes of rickets, and there was no correlation between the serum calcium, phosphorus, or aluminum levels and the presence of metaphyseal sclerosis. Neither was there any association with the underlying cause of renal failure, method of treatment, presence of a transplant, or type of dialysis. We view this finding as another manifestation of renal osteodystrophy. The importance of distinguishing it from other sclerotic lesions is discussed.     

A roentgenologic study of cortical bone resorption in chronic renal failure

Periosteal, intracortical, and endosteal resorptive changes were evaluated in both hands and the proximal radius in 161 chronic renal-failure patients by microradioscopy, radiographic morphometry, and photodensitometry. These changes were compared to abnormalities found in skeletal surveys. A combination of microradioscopy and morphometry of hand bones was sufficiently sensitive for early detection of bone loss in renal osteodystrophy in 61% of the patients. Intracortical resorption in metacarpals appeared to be a sign of more advanced renal osteodystrophy than subperiosteal resorption in phalanges. Photodensitometric findings in the radius generally agreed with microradioscopic and morphometric findings in hand bones.     

The spectrum of radiographic findings in primary hyperparathyroidism

The aim of this study was to assess the spectrum of radiographic findings in primary hyperparathyroidism (PHPT). The study group consisted of 16 women and 7 men whose Ca levels were at least two or three times higher than normal. The average age was 55.3 in women and 49.4 in men. We detected carcinoma in 1, hyperplasia in 1, multiple adenomas in 4, single adenoma in 17 patients. The most common finding in the skeletal system was the decreased bone mineral density (BMD) and the complete loss of the lamina durae dentium. BMD was found lower in women than in men. This result attributed the increased number of postmenopausal patients in our study group. The second most common finding in our study group was subperiosteal bone resorption. Brown tumors (BTs) were located at maxilla in one, widespread in one, mandibula in two, long tubular bones in four patients. Renal stone disease was found in five, spastic colon in two, gastric ulcer in one, mitral valve calcification in one patients. We demonstrated no pathologic changes consistent with PHPT in remaining seven patients.     

Osteoid osteoma and osteoblastoma of the talus

Forty patients with osteoid osteoma or osteoblastoma of the talus are presented. Clinical and radiographic findings, histologic features, and therapy of these lesions are discussed. The body of the talus was involved in two patients, all other lesions being located in the neck of the bone. Subperiosteal lesions accounted for 75% of cases, and medullary lesions for 25%. Thirty of the 40 lesions were paraarticular. Five radiographic appearances in the talus are discussed: subperiosteal target lesions of the neck (54%); medullary lesions of the neck (20%); subperiosteal radiolucent lesions of the neck (13%); medullary lesions of the body (5%); and exostotic osteoid osteoma of the talar neck (3%).Supported by Grant No. 85.02793.44, Special Project Oncology, Italian National Council of Researchers     

The reflex sympathetic dystrophy syndrome. A comprehensive analysis using fine-detail radiography, photon absorptiometry, and bone and joint scintigraphy.

Nine patients with reflex sympathetic dystrophy were examined. Clinical manifestations suggesting arthropathy were supported by radiographic demonstration of juxta-articular and subchondral bone erosions and by radionuclide demonstration of increased activity localized in the joint regions. Aggressive demineralization was demonstrated by fine-detail radiography and consisted of endosteal and intracortical excavation and subperiosteal and trabecular bone resorption. A one-third reduction in bone mineral was confirmed by quantitative analyses. Newer modalities of study have aided in the documentation of arthropathy in reflex sympathetic dystrophy and have helped in defining the patterns of aggressive bone resorption.     

Behavior and significance of phalangeal bone changes in uremic patients under periodic hemodialysis treatment

Bone damage in hand phalanges has been evaluated with reference to age and duration of hemodialysis (on the basis of 248 radiological observations), in 93 cases with chronic renal failure (age: 20-59 years). These patients were on regular dialytic treatment (RDT) from 1 to 138 months. 72% of the patients underwent several periodic (annual) controls using the mammographic technique. The radiologic evaluations have been arranged into groups according to age. Skeletal damage was more evident when RDT was prolonged. Bone damage increases with age in the first 48 months; afterwards, on the contrary, bone changes were more evident in middle aged patients. At the beginning of RDT, acroosteolysis was the most important change always present. Both subperiosteal and intracortical resorption are more evident increasing age and duration of RDT. Radiological changes give a clear picture of the possible histo-morphologic pattern that characterizes uremic osteodystrophy.