椎管内原发性淋巴瘤的MRI表现

目的探讨MRI对椎管内原发性淋巴瘤诊断和鉴别诊断的价值。方法搜集经手术或穿刺病理证实的椎管内原发性淋巴瘤19例,行全身骨显像检查均未见确切骨转移征象,行骨髓穿刺检查均呈阴性,结合临床特征回顾性分析其MRI表现。结果 19例MRI表现为椎管内硬膜外软组织肿块,矢状面呈长条形,横断面呈半月形,14例向椎管外呈钻孔样生长。12例合并相邻椎骨骨质破坏,多位于椎弓附件区,其中8例软组织肿块范围大于骨质破坏范围,5例伴有压缩性骨折。软组织肿块信号均匀,边界清楚,以T1WI等信号、T2WI稍高信号为主,脂肪抑制序列呈高信号,增强后呈轻中度均匀或不均匀强化。骨质破坏为斑片状T1WI低信号,T2WI低或高信号,脂肪抑制序列呈高信号,结论椎管内原发性淋巴瘤MRI表现有一定的特征,把握这些特征有助于做出正确的诊断和鉴别诊断。     

原始神经外胚层肿瘤的CT、MRI表现

目的 探讨原始神经外胚层肿瘤 (PNET)的CT、MRI特征,提高对本病的认识.方法 回顾性分析经病理证实的17例PNET的CT、MRI表现.结果①中枢性PNET 4例,影像学上共同表现为幕上较大肿块,边界不清楚,内见囊变坏死区,密度或信号不均匀,囊变多位于周边部,未见钙化,瘤周水肿不明显.增强扫描实质部分不均匀强化.②外周性PNET 13例,软组织pPNET 11例,其中10例表现为较大软组织肿块,边界不清,密度不均匀,内可见囊变坏死区,未见钙化,增强扫描肿瘤实质不均匀强化;MRI T1WI为等、低混杂信号,T2WI为等、高混杂信号.10例中2例病变邻近骨见骨质破坏.椎管内软组织pNET 1例表现为椎管内髓外硬膜下肿块,T1WI为等信号,T2WI为高信号,增强扫描均匀强化,椎体及附件无骨质破坏.原发骨的pNET 2例,CT表现为明显骨质破坏和软组织肿块,未见骨膜反应、肿瘤骨和钙化;MRI T1WI为等信号,T2WI为高信号,增强扫描明显强化.所有病例免疫组化至少有一种神经元标记物阳性表达.结论 PNET缺乏典型的特异性影像学表现,但具有一定的影像学特点.CT和MR扫描能较好显示肿瘤的内部结构、明确肿瘤的范围,有助于本病的鉴别诊断以及手术评估.     

脊柱恶性外周神经鞘瘤的CT和MRI表现

目的分析脊柱恶性外周神经鞘瘤(malignant peripheral nerve sheath tumor,MPNST)的CT和MRI表现,提高术前对该病诊断的准确性。资料与方法回顾性分析12例经病理证实的脊柱MPNST的CT(n=10)和/或MRI(n=11)表现。结果 MPNST表现为类圆形(n=2)或不规则分叶状(n=10)肿块。3例未见明显骨质破坏,9例有邻近椎骨侵犯,主要侵犯神经孔相邻的椎弓根、椎板及相邻局部椎体,骨质破坏以溶骨性骨质破坏(n=8)为主,少数(n=1)为溶骨性骨质破坏与不规则瘤骨同时存在。CT平扫肿块呈等密度(n=4),等、低混杂密度(n=4)或等、高混杂密度(n=2)。MR T2WI和T1WI上均呈以长T2、长T1为主的混杂信号,内部可见片状T2WI高信号(n=8)或点、条状低信号(n=2)或簇状血管影(n=1)。增强扫描肿块多表现为不均匀强化,内部可见不强化坏死区。10例可见神经孔增宽;9例可见肿块与脊神经相连。结论 CT或MRI像上出现神经孔扩大、周围明显骨质破坏、增强扫描不均匀强化、内部有无强化坏死区的脊柱占位性病变,特别是肿块与脊神经相连时应考虑脊柱MPNST可能。     

髋关节滑膜肉瘤的影像学表现

目的：分析髋关节滑膜肉瘤的影像学特点,提高诊断的准确性。方法：髋关节周围软组织滑膜肉瘤患者6例,其中4例行DR（digital radiography）拍片,1例行CT检查,6例患者均行MRI（underwent magnetic resonancei maging）检查。回顾分析相关影像学资料,总结其影像学特点。结果：DR表现为髋关节不规则骨质破坏。CT表现为髋关节周围密度不均匀软组织肿块,内中可见斑点状钙化影,邻近骨质不规则破坏。MRI表现为髋关节周围软组织肿块,边界不清;T1WI呈低信号,T2WI呈高、低混杂信号,脂肪抑制序列T2WI呈混杂高信号。结论：发现髋关节周围软组织肿块并邻近骨质不规则破坏,要考虑滑膜肉瘤的可能性。DR、CT、MRI三者相结合有助于髋关节滑膜肉瘤的诊断。     

腱鞘巨细胞瘤的影像学表现

目的分析和总结腱鞘巨细胞瘤(GCTTS)的影像学表现。方法分析20例GCTTS患者X线、CT、MRI影像及病理资料,所有患者经病理或手术证实。10例行X线检查,9例行CT平扫检查,4例同时行增强检查,2例同时行关节CT造影检查,19例行MRI平扫。结果7例X线平片骨质破坏,2例仅见关节周围软组织肿胀,骨质见硬化边,关节间隙正常,均未见钙化及骨膜反应。CT平扫关节周围等密度肿块,密度不均匀,边缘不清楚;8例见明显骨质破坏;1例骨质可见硬化边,均未见钙化及骨膜反应。关节CT造影及增强扫描肿块呈中度至明显的不均匀强化。T1WI 14例与骨骼肌信号对比呈等信号,内见斑点状低信号,5例呈稍低信号;T2WI与骨骼肌信号对比13例呈混杂信号,内见线条状低信号,6例呈高信号。结论GCTTS的影像表现有一定的特点,X线、CT显示邻近骨质压迫吸收、侵蚀性改变,MRI能够反映GCTTS内部的双低信号特征。     

软组织恶性外周神经鞘瘤的临床及MRI表现

目的 分析软组织恶性外周神经鞘瘤(MPNST)患者的临床及MRI表现,提高术前对其诊断的准确性.方法 回顾性分析14例经病理证实的软组织MPNST患者的临床及MRI表现. 结果 14例MPNST患者临床均表现为伴压痛或触痛的局部肿块,其中1例伴有神经纤维瘤病I型.MRI多表现为位于肌肉层(6/14)的单发(11/14)肿块,呈类圆形(9/14)或不规则形(5/14),边缘多欠光整(10/14),有不完整包膜(8/14),最大径平均10.3 cm.T1 WI、T2 WI脂肪抑制边缘以等信号为主,内部可见不规则坏死区,周围软组织可见水肿改变(10/14),增强扫描多呈明显不均匀强化(10/14).结论 软组织MPNST的临床与MRI表现有一定特征,对提高其术前诊断准确性有一定的意义.     

外周型原始神经外胚层肿瘤的CT和MRI表现

目的 分析外周型原始神经外胚层肿瘤(pPNET)的临床特点和CT、MRI表现,以提高对本病的认识.方法 回顾分析17例经病理证实的pPNET的临床表现和CT、MRI征象.7例行CT检查,11例行MRI检查.结果 17例pPNET男女比例相当,男8例,女9例,年龄4～74岁,中位年龄18岁;临床表现局部疼痛,位于浅表者触及包块,局部功能活动受限,少数肢体感觉障碍.发病部位分别位于鼻咽部1例、纵隔2例、肩胛区3例、腹部1例、肾脏1例、耻骨2例、髂骨1例、椎管内及股骨各3例.软组织pPNET的CT表现为边界不清的软组织肿块,密度不均匀伴坏死、囊变,无钙化,增强后明显不均匀强化.骨pPNET的MRI表现为溶骨性骨质破坏伴巨大软组织肿块.发生于椎管内的pPNET的MRI表现为与脊髓分界清晰的软组织肿块,通过椎间孔向外生长.肿块在T1WI上呈低或等信号改变,T2WI上呈等或高信号改变,脂肪抑制呈高信号.结论 外周型PNET影像表现缺乏特征性,但其临床发病具有一定特点,根据影像学表现和临床资料可提出诊断.CT和MRI检查在鉴别诊断、制定手术计划、评判肿瘤转移和复发方面有很大的作用.     

儿童骨肌原始神经外胚层肿瘤的CT和MRI表现

【摘要】 目的：探讨儿童骨肌来源外周性原始神经外胚层肿瘤（pPNETs）的CT和MRI影像学特点。方法：回顾性分析经我院病理证实的14例骨肌来源pPNETs患儿的CT及MRI影像学表现。其中男8例,女6例;年龄21个月~13岁,中位年龄9岁。10例行CT扫描,其中5例行CT增强扫描;6例行MRI检查,其中5例同时行MRI增强扫描。结果：本组14例中骨来源和软组织来源各7例,位于胸壁4例、肩胛骨、下肢、脊柱旁区和头部各2例、骨盆1例。骨来源pPNETs的CT表现为溶骨性为主的骨质破坏伴有周围软组织肿块,直径3~8cm,边界多模糊不清,增强后呈不均匀强化;主要MRI表现为T1WI上受累骨结构内见稍低信号,T2WI上呈高信号,骨皮质低信号不连续,周围可见囊实性肿块、呈明显不均匀强化。软组织来源的pPNETs CT表现为软组织密度肿块,内部可有低密度坏死区、钙化少见,肿块通常较大,直径5~15cm,增强扫描肿瘤内可见片絮状强化或不均匀轻度强化,邻近骨性结构可受累;主要MRI表现为T1WI上骨质破坏区多呈等信号或稍低信号,T2WI上多呈不均匀等信号及高信号,增强扫描呈不均匀明显强化,其内囊变坏死区无明显强化,周围骨性结构受累时呈略长T1、长T2信号。结论：儿童骨肌来源pPNET的影像学表现特异性不强,但在临床诊断儿童骨骼肌肉来源的恶性肿瘤时需要注意与本病进行鉴别诊断,CT和MRI不仅可以显示肿瘤的范围,同时对肿瘤可切除性的判断以及治疗效果的监测也很有帮助。     

骶骨骨巨细胞瘤X线、CT及MRI表现

目的分析骶骨骨巨细胞瘤(GCT)的X线、CT和MRI表现特点,探讨三种影像检查方法的临床应用价值。资料与方法 21例骶骨GCT均经手术病理证实,所有病例均行X线、CT和MRI检查,分析骶骨GCT的X线平片、CT、MRI表现特点,将影像学表现与手术病理结果进行对照,并经双盲法分析确认。结果 21例中,X线和CT显示囊性膨胀性骨质破坏18例,溶骨性骨质破坏15例,骨包壳不完整14例,MRI显示骨质破坏10例。X线显示侵犯骶髂关节及髂骨5例,CT显示16例,MRI显示11例。CT平扫显示软组织肿块12例,CT增强显示16例,MRI显示16例,其中巨大囊实性软组织肿块12例,10例可见液平面,病灶周围可见软组织水肿及骨髓水肿。骨质破坏在MR SE T1WI上呈等低信号,T2WI呈等信号。骨包壳在MRI上表现为低信号,X线和CT上表现为硬化环。软组织肿块实性部分在T1WI为等信号,T2WI及短时反转恢复(STIR)呈等高信号。囊性部分在T1WI为低信号,T2WI及STIR呈等高信号。软组织水肿及骨髓水肿在T2WI及STIR呈高信号。CT和MRI增强软组织肿块实性部分明显强化,囊性部分不强化。结论 X线、CT和MRI从不...     

腱鞘巨细胞瘤的影像学分析

目的 分析腱鞘巨细胞瘤(giant cell tumor of tendon sheath,GCTTS)的影像学表现以增加对该病的影像学认识,提高影像诊断的准确率.方法 收集2009年9月～2012年11月14例经手术病理组织证实的GCTTS患者X线、CT、MRI影像进行回顾性分析.其中14例行X线平片检查,6例行CT平扫检查,8例行MRI平扫及增强扫描.结果 X线平片显示局部稍高密度软组织肿块影,邻近骨质未见明显异常或轻度侵蚀破坏;CT表现为关节周围肌间隙内局限性软组织肿块,部分呈分叶状,明显跨关节生长,无明显钙化征象及骨膜反应;MRI表现为病灶在T1WI多呈较低信号,内可见条片状更低信号影,T2WI呈高低混杂信号,增强后强化明显,病灶与邻近肌腱关系密切,局部骨皮质可受侵.结论 腱鞘巨细胞瘤的影像学表现具有一定的特征性.     

Imaging of metastases to the liver

Metastatic disease to the liver is an important disease from the diagnostic, prognostic and therapeutic points of view. Different imaging modalities, such as US, CT, scintigraphy, and MRI, have been used for detection, characterization, therapy planning, and follow-up of this disease with variable degrees of success and failure. This review handles the problems which face the different imaging modalities in diagnosis of liver metastases in view of the pathological background of the disease. It also discusses the indications, strong points, and shortcomings of each of the imaging modalities in diagnosis of metastases, and surveys the recent efforts done to improve their performance through the optimization of quality control and in the innovations in the field of contrast agents. Finally, a protocol is suggested for the clinical management of patients with liver metastases to optimize cost-effectiveness of the imaging modalities in this era of multimodality approach in diagnostic imaging. Correspondence to: D. Mathieu     

Radiofrequency ablation treatment for renal cell carcinoma: early clinical experience

OBJECTIVE: To evaluate the early clinical experience associated with radiofrequency (RF) ablation in patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: The RF ablation treatment was performed on 17 tumors from 16 patients (mean age, 60.5 years; range, 43-73 years) with RCC. The treatment indications were localized, solid renal mass, comorbidities, high operation risk, and refusal to perform surgery. All tumors were treated by a percutaneous CT (n = 10), followed by an US-guided (n = 2), laparoscopy-assisted US (n = 2), and an open (n = 2) RF ablation. Furthermore, patients underwent a follow-up CT at one day, one week, one month, three and six months, and then every six months from the onset of treatment. We evaluated the technical success, technical effectiveness, ablation zone, benign periablation enhancement, irregular peripheral enhancement, and complications. RESULTS: All 17 exophytic tumors (mean size, 2.2 cm; range, 1.1-5.0 cm) were completely ablated. Technical success and effectiveness was achieved in all cases and the mean follow-up period was 23.8 months (range, 17-33 months). A local recurrence was not detected in any of the cases; however, five patients developed complications as a result of treatment, including hematuria (n = 2), mild thermal injury of the psoas muscle (n = 1), mild hydronephrosis (n = 1), and fistula formation (n = 1). CONCLUSION: The RF ablation is an alternative treatment for exophytic RCCs and represents a promising treatment for some patients with small RCCs.     

Intradural spinal tumors: current classification and MRI features

The differential diagnosis of intradural spinal tumors is primarily based on location, but the clinical presentation, age, and gender of the patient are also important factors in determining the diagnosis. This comprehensive review focuses on the current classification, clinical symptoms, and MRI features of the more common intradural extramedullary and intramedullary neoplastic lesions. This review does not include extradural lesions.     

Computed tomography of intra- and juxtasellar lesions

Summary During the first two years with the 160×160 matrix EMI scanner at Rigshospitalet, Copenhagen 108 consecutive patients referred with the suspicion of intra- or juxtasellar tumor were subjected to 166 computed tomography (CT) examinations. The X-ray attenuation and contrast enhancement patterns of the various lesions were analyzed. In general, it was difficult to correlate these parameters with the histopathological features. Arachnoid cysts, however, had typical low preinjection attenuation and no contrast enhancement. Chromophobe and eosinophilic pituitary adenomas rarely contained calcium and only in minute amounts, hardly visible on the polaroid pictures. Craniopharyngiomas and low grade suprasellar gliomas frequently contained large calcifications. Grade I gliomas, when located in the optic nerves or hypothalamus, showed significantly higher contrast enhancement than elsewhere in the brain. Three purely intrasellar adenomas were demonstrated with CT only. The diagnostic accuracy of CT was compared to that of carotid angiography, PEG and plain skull films in the lesions verified by initial operation (n=32). CT gave the highest accuracy of the four methods, but the accuracy of CT differed statistically only from that of carotid angiography.     

NMR imaging of congenital intracranial germinal layer neoplasms

Summary NMR images in five patients with surgically proved, congenital germinal layer intracranial neoplasms (two dermoid and three epidermoid tumors) were reviewed. The dermoids were typically midline (suprasellar or parapineal) masses with sharply-defined margins. Relaxation times were variable, but if fat was present, T₁ was decreased, and T₂ was increased. The epidermoids were off the midline (cerebellopontine angle, temporal lobe, frontal lobe) masses with generally long T₁ and T₂ relaxation times. Obstructive hydrocephaly was noted in one patient, and tumor to ventricular communication was demonstrated in another.     

Computer tomography in the diagnosis of cerebellopontine angle tumours

Summary 53 patients clinically suspected of having a cerebellopontine angle (CPA) lesion were examined by computer tomography (CT) with 160 x 160 matrix EMI scanner. 17 cases (32%) had tumour positive CT, of which 12 were neurinomas and 1 meningioma. 1 CT suggestive of a CPA lesion was false positive and 1 unoperated case is probably a false negative CT. Three of the eleven verified neurinomas (27%) were of the medial type originating in the angle cistern. One neurinoma protruding 1 cm into the cistern showed no contrast enhancement. 2 CT scans (3.8%) were unsatisfactory due to movements and the large size of the head. CT is valuable for the investigation of CPA pathology and the diagnostic efficiency compares favourably to other neuroradiological procedures.     

原发性卵巢恶性肿瘤与卵巢转移瘤的CT诊断与鉴别诊断

目的　分析原发性卵巢恶性肿瘤与卵巢转移瘤的CT影像学特征及其诊断与鉴别诊断。方法　回顾分析自 1999-04~2003-11的 31例经手术或病理证实的卵巢原发恶性肿瘤和转移瘤的CT影像表现,重点观察肿瘤部位、内部密度、分隔、瘤壁、囊内外赘生物、软组织成分以及腹水,腹膜、网膜种植及淋巴结转移。比较原发性卵巢恶性肿瘤与卵巢转移瘤各自特点及两者之间的鉴别点。结果　24例卵巢原发恶性肿瘤中双侧占 13例,其中Ⅱa型 3例;Ⅱb型 11例;Ⅱc型 7例;Ⅲ型 3例。卵巢转移瘤Ⅱa型 6例;Ⅱc型 1例。结论　原发性卵巢恶性肿瘤以Ⅱb及Ⅱc型多见,转移瘤以Ⅱa型多见。转移灶好发于右侧网膜、腹膜及肝脏。转移瘤肿瘤实性部分呈树枝状或丝网状改变为其特征性改变。     

Primary tumors of the patella

This study reports 42 cases of histologically proven and radiographically correlated primary patellar tumors. Despite diverse histologic diagnoses, the radiographic appearances of benign as opposed to malignant patellar neoplasms are essentially indistinguishable. Although the literature suggests that giant cell tumor is the most frequent benign tumor of the patella, the most common benign neoplasm in this series is chondroblastoma (16 cases). Only four primary malignant lesions were encountered, three cases of lymphoma and one case of hemangioendothelioma. Since 38 (90%) of the 42 cases were benign, a benign etiology should be strongly favored, notwithstanding the radiographic appearance, whenever a primary patellar tumor is encountered.The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.     

肾与肾上腺肿瘤的血管造影鉴别诊断

回顾性分析32例肾与肾上腺肿瘤的血管造影表现，9例肾上腺肿瘤均显示为纤维的网状肿瘤血管；23例肾肿瘤中21例表现为粗大的新生肿瘤血管，依据肿瘤的供养动脉起源及肿瘤血管特征几乎总能对肿瘤的脏器起源作出正确判断，文中讨论了相关血管解剖，造影技术要领以及血管造影鉴别诊断的要点。