Tolosa-Hunt综合征的MRI表现及诊断价值

目的 探讨Tdosa—Hunt综合征的MR扫描方法、表现及其诊断价值。方法 17例Tolosa—Hunt综合征经临床随访确诊，分别行头颅扫描及海绵窦薄层扫描与增强扫描，并比较2种扫描方法对病变显示的情况。结果 17例海绵窦薄层扫描与增强扫描显示患侧海绵窦增宽，外缘光滑，T1WI和T2WI均呈等或稍低信号，增强后信号明显均匀强化；3例同时累及眶上裂，1例同时累及眶尖，3例同时累及眶尖及眶上裂；6例病变包绕颈内动脉海绵窦段，其中4例还表现颈内动脉局部变细。而采用头颅扫描方法，17例中仅11例显示海绵窦增宽及异常信号，其余6例未见异常；2例眶上裂及2例眶尖受累；2例颈内动脉海绵窦段变细。海绵窦薄层扫描对Tolosa—Hunt综合征的显示明显优于头颅扫描（X^2=417，P〈0.05）。结论 与头颅MR扫描相比，海绵窦MR薄层扫描与增强扫描可更好地显示病变的部位、信号表现和范围，有助于Tdosa—Hunt综合征的诊断、鉴别诊断及随访观察。     

MRI findings in the patients with the presumptive clinical diagnosis of Tolosa-Hunt syndrome

The aim of this study was to present our experience in MRI diagnosis of 23 patients with the clinical findings suggesting Tolosa-Hunt syndrome (THS). Cranial MRI studies of the patients with a clinical history of at least one episode of unilateral or bilateral orbital and periorbital pain, and associated paresis of one or more of third to sixth cranial nerves, were performed on a 1.5-T MRI scanner. Whereas 5 patients had the diagnosis of THS, paracavernous meningiomas in 4 patients, pituitary macroadenomas with cavernous sinus infiltration in 3 patients, Meckel's cave neurinoma in 1 patient, and suprasellar epidermoid in 1 patient were surgically proven MRI findings. Other pathological MRI findings were leptomeningeal metastases in 3 patients, granulomatous pachymeningitis sequelae in 2 patients, and aneurysm with compression on cavernous sinus in 1 patient. Three patients had normal MRI findings. The incidence of radiologically proven diagnosis of THS among the patients with the clinical findings suggesting THS seemed to be low in our study. In conclusion, MRI is the most valuable imaging technique to distinguish THS from other THS-like entities, and permits a precise assessment, management, and therapeutic planning of the underlying pathological conditions. Electronic Publication     

Tolosa-Hunt syndrome in a patient with systemic lupus erythematosus

We report a case of Tolosa-Hunt syndrome (THS) in a patient with systemic lupus erythematosus studied with MRI. Magnetic resonance showed enlargement of the cavernous sinus and compression of the carotid syphon by enhancing tissue. In particular, fat-suppressed T1-weighted images before and after contrast agent injection and MR angiography showed extension of the abnormal tissue to the apex of the orbit and narrowing of the internal carotid artery. A presumptive diagnosis of THS was made and steroid treatment was started with rapid relief of symptoms. Follow-up MR study after steroid therapy demonstrated sub-total resolution of the neuroradiological findings. Neuroradiological findings in THS are quite typical but they may be subtle; furthermore, the presence of a systemic disease may suggest secondary involvement of the cavernous sinus. Utilization of the appropriate MR techniques and follow-up exams may contribute to the diagnosis of THS even in the presence of other systemic diseases.     

Tolosa-Hunt syndrome,phlebographically controled after recovery

Summary A 27 year old patient, presenting clinically and phlebographically a Tolosa-Hunt syndrome was observed after recovery. Normal reappearance of a previously completely obstructed cavernous sinus was noted, leaving only a persisting irregularity of the superior ophthalmic vein.     

隐原性机化性肺炎的CT表现特点及激素治疗后改变

目的 回顾性分析隐原性机化性肺炎(COP)的系列CT表现特点及CT半定量分析激素治疗后的变化情况.方法 对经病理确诊的13例COP患者的临床、病理和影像学资料进行回顾性分析.CT病变评价采用半定量方法计算,并进行皮质激素治疗前后病变程度变化分析.结果 CT上所有患者均表现为两肺野多个肺叶受累,下叶分布为主,沿支气管或胸膜下分布,CT最主要的表现是磨玻璃影(13例)及斑片状实变影(12例),病变范围占全肺的比例分别为13％、10％.所有患者确诊前抗炎治疗效果不明显或无效,确诊后均给予糖皮质激素治疗,2例完全吸收,8例好转,1例无明显改变,2例病变进展,病变以磨玻璃影(10例)及网格影(5例)为主,实变影4例,病变平均范围分别为19％、2％、1％.结论 典型COP的CT表现具有特征性.经皮质激素治疗后复查CT大多数吸收或好转.病变半定量评价有助于临床医师更准确了解疾病的疗效.     

Joubert 综合征的MRI表现

Joubert 综合征是一种罕见的颅脑先天性发育畸形,国内外鲜见报道.现将本院诊治的6例Joubert 综合征的MRI表现报道如下,以提高对本病的认识. 1 资料与方法 1.1 一般资料 收集本院2008-08-2011-09收治的Joubert综合征患者6例,其中男2例,女4例,年龄5月~3岁,平均1.2岁.6例患者的临床表现不一,发育迟缓5例,反应差3例,双眼外展受限2例,竖头不稳1例,抽搐1例,伴有多指畸形1例.     

MRI findings in thoracic outlet syndrome

We discuss MRI findings in patients with thoracic outlet syndrome (TOS). A total of 100 neurovascular bundles were evaluated in the interscalene triangle (IS), costoclavicular (CC), and retropectoralis minor (RPM) spaces. To exclude neurogenic abnormality, MRIs of the cervical spine and brachial plexus (BPL) were obtained in neutral. To exclude compression on neurovascular bundles, sagittal T1W images were obtained vertical to the longitudinal axis of BPL from spinal cord to the medial part of the humerus, in abduction and neutral. To exclude vascular TOS, MR angiography (MRA) and venography (MRV) of the subclavian artery (SA) and vein (SV) in abduction were obtained. If there is compression on the vessels, MRA and MRV of the subclavian vessels were repeated in neutral. Seventy-one neurovascular bundles were found to be abnormal: 16 arterial-venous-neurogenic, 20 neurogenic, 1 arterial, 15 venous, 8 arterial-venous, 3 arterial-neurogenic, and 8 venous-neurogenic TOS. Overall, neurogenic TOS was noted in 69%, venous TOS in 66%, and arterial TOS in 39%. The neurovascular bundle was most commonly compressed in the CC, mostly secondary to position, and very rarely compressed in the RPM. The cause of TOS was congenital bone variations in 36%, congenital fibromuscular anomalies in 11%, and position in 53%. In 5%, there was unilateral brachial plexitis in addition to compression of the neurovascular bundle. Severe cervical spondylosis was noted in 14%, contributing to TOS symptoms. For evaluation of patients with TOS, visualization of the brachial plexus and cervical spine and dynamic evaluation of neurovascular bundles in the cervicothoracobrachial region are mandatory.     

Contrast-enhanced MRI in spinal arteriovenous malformations and fistulae before and after embolisation therapy

MRI was performed in six cases of spinal arteriovenous malformation (AVM) and arteriovenous fistula (AVF) before and after embolisation. Intramedullary and perimedullary AVMs showed marked vascular enhancement after embolisation. This was thought to reflect feeding vessel occlusion and correlated well with a favourable clinical outcome. In dural AVFs, contrast-enhanced studies were essential for the diagnosis, unenhanced images being nonspecific. After embolisation, enhancement of the spinal cord was reduced, although one case with a poor outcome showed persistent enhancement. Received: 20 June 1995 Accepted: 23 August 1995     

Vogt-小柳-原田综合征眼部MRI表现

目的 探讨Vngt-小柳-原田综合征(VKHS)的眼部MRI表现及其诊断价值.方法 对14例(男7例,女7例,年龄10～62岁)经临床确诊的VKHS患者的眼部MRI表现进行回顾性分析.结果 14例(28眼)在MRI均表现为视网膜.脉络膜复合体增厚,呈等T1、等T2信号.6例(12眼)伴有视网膜脱离,5例(10眼)伴有睫状体的异常增厚和强化,2例(4眼)伴有视神经炎.11例(22眼)行增强扫描,可见病变呈明显均匀强化.结论 MRI可很好地显示该病的眼部表现和累及范围,有助于VKHS的诊断及随访观察.     

布加综合征的CT和MRI诊断

布加综合征(BCS)是一种因肝静脉流出道阻塞而导致的少见病变,本文对BCSCT和MRI表现进行了综述,CT和MRI检查可以显示直接征象即静脉阻塞的部位和范围,对于肝内外的侧支血管、肝尾叶增大、肝脏不均匀强化、再生结节等静脉阻塞间接表现也能较好显示,认识这些表现有助于病变的早期诊断和选择合适的治疗方法。     

Madelung综合征的CT与MRI表现

目的 探讨Madelung综合征的CT与MRI表现特征.方法 搜集5例Madelung综合征患者,5例中Ⅰ型3例,Ⅱ型2例.5例患者均行CT检查,1例行CT增强扫描,2例行MR平扫.分析其临床特点及影像表现.结果 3例Ⅰ型Madelung综合征表现为躯干上部浅层皮下脂肪及颈深层脂肪增多,肿物弥漫分布于颈部、上胸及肩部,呈现"马颈圈"、"牛颈"样特征性表现;2例Ⅱ型表现为四肢近端、前胸壁皮下脂肪明显增厚,呈"大力水手"的特殊外观;5例患者均有腹直肌前方、腹股沟皮下脂肪增厚及阴囊内脂肪堆积.CT显示病变部位浅层皮下脂肪增多,CT值为-30～-70 HU;MR T1WI、T2WI及T2WI脂肪抑制序列均能显示增厚的脂肪组织,呈典型的短T1、长T2信号,在脂肪抑制序列上呈低信号,脂肪组织间有纤维组织分隔.结论 结合长期大量酗酒史,CT与MR检查对Madelung综合征可明确诊断,并明确病变范围及周围组织分界,对手术治疗方案提供有价值的信息.

Abstract：

Objective To determine the CT and MR findings of Madelung syndrome. MethodsFive cases of Madelung syndrome were collected in our hospital from February 2006 to June 2009, including 3 cases of typeⅠMadelung syndrome and 2 cases of typeⅡ Madelung syndrome. The 5 cases were all examined by CT, meanwhile 1 case by CT enhancement scanning and 2 cases by MR. The clinical characteristics and imaging manifestations were analyzed. Results CT and MR images in 3 patients of typeⅠMadelung syndrome displayed fat accumulation within the subcutaneous tissue of the upper trunk and deep layer tissue of neck. The diffuse masses were located around the neck, upper chest and shoulders, which were called "horse collar"and " buffalo humps". The other 2 cases of type Ⅱ Madelung syndrome displayed fat thickening within the subcutaneous tissue of the proximal extremities, anterior chest wall, showing special appearance of "vigorous sailor". All the 5 patients showed fat deposit within the subcutaneous tissue of the anterior rectus abdominis, inguina and fat accumulation within the scrotum. CT showed proliferated fat at the subcutaneous tissue of the involved regions. The CT value of proliferated fat were between -30 and -70 HU. The proliferated fat tissue all could be displayed on MR T1WI,T2WI and T2WI fat suppression sequence, with typical hypointensity on T1WI and hyperintensity on T2WI, hypointensity on fat-suppression sequence and fibrous septation presenting among fat tissue. Conclusion Combination with the history of long-term alcohol abuse, the Madelung syndrome could be diagnosed by CT and MR, which had great value in the surgical planning for identifying the extent of disease.     

A rare case of Tolosa-Hunt syndrome imaged with FDG PET/CT and MRI

We report on the imaging findings of Tolosa-Hunt syndrome in a 59-year-old patient. Clinical findings included periorbital pain, ptosis, disordered eye movements, and blurred vision. Treatment with intravenous administration of steroid resolved all symptoms. Currently, magnetic resonance imaging plays a key role in the diagnosis of Tolosa-Hunter syndrome for locating the inflammatory tissue and follow-up. This case of Tolosa-Hunter syndrome with representative (FDG PET/CT) images may imply that FDG PET/CT is a useful tool in detecting and monitoring of this disease.     

Ramsay Hunt综合征的MRI表现

目的　探讨RamsayHunt综合征的MRI表现及诊断价值。 方法　 5例临床确诊的单侧RamsayHunt综合征患者 ,男 3例 ,女 2例 ,年龄 2 9～ 5 4岁 ,行MR平扫及钆喷替酸葡甲胺 (Gd DTPA)增强检查 ,其中 3例增强前后对面神经颞骨内各节段分别测量信号强度。 5例均进行面神经各节段信号强度的双侧对比及增强前后对比。结果　 4例患侧面神经节段性异常强化 (双侧信号强度增强差值 >2 0或评分相差 1级或以上 ) ,1例双侧面神经强化无差别。膝状神经节 (4/ 4 )和迷路段(3/ 4 )的异常强化相对多见 ,内听道末段、鼓室段和乳突段各有 2例异常强化。结论　对于单侧患病者来说 ,只有患侧面神经节段性强化高于健侧相应节段才有诊断意义。RamsayHunt综合征较易累及迷路段和膝状神经节。Gd DTPA增强MRI能够客观地反映面神经的病变节段 ,有助于临床诊断及鉴别诊断 ,具有一定的临床实用价值。该项检查结果与临床表现的关系还需进一步研究。     

MRI findings after successful vertebroplasty

BACKGROUND AND PURPOSE: Recurrent or residual back pain after vertebroplasty (VP) is common, and many patients with these symptoms are evaluated by MRI. The purpose of this report is to describe post-treatment MRI findings after successful VP. METHODS: We identified all patients who underwent VP at our institution and later presented with back pain and had a spine MRI. From these patients, we identified a cohort with uncomplicated procedures, in whom back pain at the site of the VP was not the dominant pain source at follow-up. Using the pre- and postoperative MRIs and the VP conventional radiographs, we assessed such features as interval height loss and changes in marrow edema in treated vertebrae. RESULTS: Thirty patients (51 treated vertebrae) met our clinical criteria for uncomplicated VP. Nine (18%) of 51 vertebrae lost additional height after the procedure. Neither patient demographics nor variables associated with the procedure itself, including volume of cement injected, correlated with additional height loss after VP. Moderate or severe marrow edema was demonstrated in 62% of vertebrae on preoperative MRI and in 33% of vertebrae on follow-up MRI. Twenty-one percent of vertebrae had new areas of marrow edema on follow-up. Twenty-two percent of vertebrae imaged >6 months after VP had moderate or severe edema. CONCLUSION: Progressive and persistent edema and interval height loss after successful VP are common and should not be interpreted as sufficient evidence of ongoing pathology at the treated vertebral level.     

Dynamic MR imaging in Tolosa-Hunt syndrome

OBJECTIVE: To evaluate the cavernous sinuses with dynamic magnetic resonance (MR) imaging in patients with Tolosa-Hunt syndrome (THS). METHODS: The sellar and parasellar regions of five patients with THS and 12 control subjects were examined with dynamic MR (1.5 T) imaging in the coronal plane. Dynamic images were obtained with spin-echo (SE) sequences in three patients, and with fast spin-echo (FSE) sequences in two patients and control subjects. Conventional MR images of the cranium including sellar and parasellar regions were also obtained on T1-weighted pre- and post-contrast SE, and T2-weighted FSE sequences in the coronal plane. RESULTS: MR images revealed affected cavernous sinus with bulged convex lateral wall in three patients and concave lateral wall in two patients. In all control subjects, cavernous sinuses were observed with concave lateral wall. The signal intensity on T1- and T2-weighted images and contrast enhancement on post-contrast images of the affected cavernous sinuses in patients were similar to those of the unaffected cavernous sinuses in patients and control subjects. The dynamic images in all patients disclosed small areas adjacent to the cranial nerve filling-defects within the enhanced venous spaces of the affected cavernous sinus, which showed slow and gradual enhancement from the early to the late dynamic images. No such gradually enhancing area was observed in control subjects except one. The follow-up dynamic MR images after corticosteroid therapy revealed complete resolution of the gradually enhancing areas in the previously affected cavernous sinus. CONCLUSION: Dynamic MR imaging may facilitate the diagnosis of THS.     

尺骨撞击综合征的MRI表现

目的 分析尺骨撞击综合征引发的月骨和三角骨缺生坏死的ＭＲＩ表现,以确定定其像学特征。方法 对２３例尺侧腕痛病例行Ｘ线测量及ＭＲＩ检查。结果 尺骨阳性变异范围在１～３．８ｍｍ,平均２．１ｍｍ,阴性变异范围０．５～２．２ｍｍ,平均１．８ｍｍ。尺骨阳性变异１３例,伴月骨和三角骨坏死９例,阴性变异６例,伴月骨地不死２例;中性变异４例,伴月骨和三角骨坏死２例,ＭＲＩ示坏死区位于月骨尺侧部分近端和三角骨腰部。     

Stewart-Treves 综合征的 MRI 表现

目的：探讨 MRI 对 Stewart-Treves 综合征(STS)的诊断价值。方法回顾性分析48枚 STS 肿物的 MRI 表现,并与病理结果对照分析。结果48枚肿物均为实性,直径≥4 mm,根据 D2-40、CD31的表达结果将 STS 分为2型,STS-Ⅰ型(即血管肉瘤)47枚结节肿物,MRI 表现：T1 WI 呈稍低信号,T2 WI 呈稍高信号,与同层肌肉比较,结节信号明显增高,增强检查呈明显强化、且均匀。STS-Ⅱb 型(混合型淋巴管肉瘤)1枚肿块样肿物;MRI 表现：T1 WI、T2 WI 序列均呈高低混杂信号,以高信号为主,强化程度较低且不均匀。结论MR 能显示 STS 特征性信号表现,结合患者肢体慢性淋巴水肿病史,可以提高术前正确诊断率。