强直性脊柱炎影像学诊断

强直性脊柱炎(ankylosing spondylitis,AS)是一种全身性慢性进行性炎症性疾病,主要侵犯中轴骨关节及脊柱旁韧带组织,最后发生脊柱强直。为了提高诊断水平,为临床提供更准确的诊断,笔者收集了近年来45例确诊AS的病例进行分析对比,现总结如下。1临床资料本组45例,其中男42例,女3例;

MRI引导下乳腺定位活检术应用效能探讨

目的:细化分析仅在MRI下显示的乳腺病灶的影像学特征以减少不必要的MRI引导下定位活检。方法:75例(共75个病灶)经MRI穿刺定位活检病理证实乳腺病患者,女性,平均年龄44.4±11.0岁,其中13例为恶性病变,62例为良性病变,所有病例穿刺术前均行常规3.0T MRI检查、且BI-RADS分级达4级。根据Fischer评分标准对穿刺术前病灶MRI影像特征进行回顾性分析,将病灶评分与病理结果进行对照,并运用受试者操作特征曲线(ROC)评价其诊断的准确度。结果:Fischer评分标准的曲线下面积(AUC)为0.802(95%CI:0.694~0.885),表现出较高诊断效能。ROC分析当取cut-off值为≤3时,可在不遗漏恶性病灶的情况下减少21例(33.8%)不必要的活检。结论:对于仅在MRI上显示的可疑病灶,运用Fischer评分标准进行进一步评估,能在一定程度上减少不必要的MRI引导下定位活检术。

非手术治疗1242例腰椎间盘突出症的临床报告

我们从１９９１～１９９７年应用自行研制的“全自动电脑控制牵引推拿法”治疗腰椎间盘突出症１２４２例，取得了比较好的效果，报导如下。资料与方法１２４２例病人全部为住院病人，男９３８例，女３０４例；年龄２６～５９岁，平均４２．２岁；病程最短１２天，最长２．...

创伤性膈疝15例诊治体会

①目的探讨创伤性膈疝的诊断及其治疗方法。②方法回顾性分析创伤性膈疝15例的临床资料。③结果术前确诊1O例,治愈14例,死亡1例。④结论临床经验不足是导致创伤性膈疝误诊、漏诊的主要原因。X线和CT检查在膈疝的诊断中有重要的作用。创伤性膈疝一经确诊,应立即手术治疗。

腰椎滑脱合并极外侧型椎间盘突出症的诊断与治疗

目的总结腰椎滑脱合并极外侧型椎间盘突出症的影像学检查结果、临床特征和手术治疗效果。方法对本院既往收治的10例腰椎滑脱合并极外侧型椎间盘突出患者的影像学检查结果、临床特征和手术治疗效果进行了回顾性分析。结果所有患者经9~32个月随访,平均(20.4±4.5)月,其中治疗优秀9例,良好1例,可0例,差0例,总优良率90.0%。结论腰椎滑脱合并极外侧型椎间盘突出症患者的病情需要综合分析,明确诊断,选择适宜的手术方案进行治疗,在去除极外侧型腰椎间盘突出症的同时恢复滑脱的腰椎,到达解除症状的目的。

Rapid progression of hepatocellular carcinoma after Radiofrequency Ablation

AIM:To report the results of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in cirrhotic patients and to describe the treatment related complications (mainly the rapid intrahepatic neoplastic progression). METHODS:Eighty-seven consecutive cirrhotic patients with 104 HCC (mean diameter 3.9 cm,1.3 SD) were submitted to RFA between January 1998 and June 2003.In all cases RFA was performed with percutaneous approach under ultrasound guidance using expandable electrode needles. Treatment efficacy (necrosis and recurrence) was estimated with dual phase computed tomography (CT) and alpha- fetoprotein (AFP)level. RESULTS:Complete necrosis rate after single or multiple treatment was 100%,87.7% and 57.1% in HCC smaller than 3 cm,between 3 and 5 cm and larger than 5 cm respectively (P=0.02).Seventeen lesions of 88(19.3%) developed local recurrence after complete necrosis during a mean follow up of 19.2 mo.There were no treatment-related deaths in 130 procedures and major complications occurred in 8 patients (6.1%).In 4 patients,although complete local necrosis was achieved,we observed rapid intrahepatic neoplastic progression after treatment.Risk factors for rapid neoplastic progression were high preoperative AFP values and location of the tumor near segmental portal branches. CONCLUSION:RFA is an effective treatment for hepatocellular carcinoma smaller than 5 cm with complete necrosis in more than 80% of lesions.Patients with elevated AFP levels and tumors located near the main portal branch are at risk for rapid neoplastic progression after RFA.Further studies are necessary to evaluate the incidence and pathogenesis of this underestimated complication.

Definitive palliation for neoplastic colonic obstruction using enteral stents:Personal case-series with literature review

Acute colonic obstruction due to malignancies is an emergency that requires surgical treatment.Elderly patients or inoperable tumors require intestinal decompression that is a simple colostomy in almost all cases.This“manoeuvre” leads the patient to a percentage of moRality/morbidity and to a bad quality of life due to acceptance of stoma.The introduction of enteral metal stent inserted endoscopically has,in our opinion,provided a new way to obtaining the definitive palliation of inoperable colo-rectal cancer with a simple method.We reported our case-series and we analyzed the current literature and costs of treatments.

Imaging findings of biliary hamartomas

AIM： To evaluate the imaging findings of biliary hamartomas （yon Meyenburg complexes, VMCs） and discuss the differential diagnosis with other related diseases. METHODS： Imaging findings of biliary hamartomas on ultrasonography （US）, computed tomography （C-T）, magnetic resonance imaging （MRI）, MR cholangiopancreatography （MRCP）and hepatobiliary scintigraphy were retrospectively analyzed in six patients. RESULTS： On ultrasound images, five of the six cases showed multiple small hyper- and hypo-echoic lesions with comet-tail echoes, especially when magnified by US with the usage of zoom function. In all the six cases, multiple tiny hypodense lesions less than 10 mm in diameter were revealed as scattered throughout the liver with no enhancement on CT. These tiny lesions were demonstrated to be hyper- and hypo-intensity on T2- and TI-weighed images, respectively, in three patients who underwent MRI examinations. MRCP was performed in two patients, and clearly showed multiple tiny irregular- and round-shaped hyper-intensity lesions. MRCP and hepatobiliary scintigraphy showed normal appearances of intra- and extra-hepatic bile ducts in two and one patients, respectively. CONCLUSION： Imaging modalities are useful in the diagnosis and differential diagnosis of VMCs. A correct diagnosis might be obtained when typical imaging findings are present even without a histological confirmation.

Giant hepatobiliary cystadenoma in a male with obvious convex papillate

Hepatobiliary cystadenoma that is most often found in is an uncommon lesion middle-aged women and difficult to diagnose preoperatively. Here, we report a case of giant hepatobiliary cystadenoma in a male patient with obvious convex papillate. On the basis of imaging examinations, the patient was diagnosed as hepatobiliary cystadenoma prior to operation. Left hepatectomy was performed and the patient was symptom-free during a 6-too follow-up period, suggesting that imaging examination is the major diagnostic method of hepatobiliary cystadenoma, and operation is its best treatment modality.

A case of enterolith small bowel obstruction and jejunal diverticulosis

We reported a case of 79-year old woman with known large bowel diverticulosis presenting with small bowel obstruction due to stone impaction - found on plain abdominal X-ray.Contrast studies demonstrated small bowel diverticulosis.At laparotomy, the gall bladder was normal with no stones and no abnormal communication with small bowel - excluding the possibility of a gallstone ileus. Analysis of the stone revealed a composition of bile pigments and calcium oxalate.This was a rare case of small bowel obstruction due to enterolith formation - made distinctive by calcification (previously unreported in the proximal small bowel).

A patient with spinal metastasis from hepatocellular carcinoma discovered from neurological findings

Although spinal tumors are uncommon, they may reduce survival or cause serious functional disorders in the extremities. Metastatic spinal tumors from malignant tumors can induce symptoms of spinal cord compression, such as paraplegia, quadriplegia, and vesicorectal disturbance, which are aggravated with progression of the diseases and time. We report a patient with hepatocellular carcinoma (HCC) who was suspected of having spinal lesions based on neurological findings, and a metastatic spinal tumor was found by imaging examination. Assuming that metastasis had occurred at the time lumbar pain developed, the patient reached the level of gait disturbance within only 4 mo, showing a rapid advancement of symptoms. If early diagnosis had been possible, treatment could be performed before acute myelopathy progressed to complete paralysis. We speculate that the terminal stage of HCC is not only liver failure associated with intrahepatic lesions but also metastasis to other regions, treatment for individual pathologies therefore, will be needed, which constitutes an important issue.

Endosonography with linear array instead of endoscopic retrograde cholangiography as the diagnostic tool in patients with moderate suspicion of common bile duct stones

AIM: To evaluate the diagnostic efficiency of endoscopic ultrasound (EUS) as the main imaging modality in patients with moderate suspicion of common bile duct stones (CBDS).METHODS: 55 patients with moderate clinical suspicion of CBDS were prospectively included to the study and evaluated with EUS. This study was done in single blind method in the clinical and biochemical data of patients. EUS was done with echo-endoscope Pentax FG 32-UA (f=5-7,5 MHz) and Hitachi EUB 405 ultrasound machine. Patients diagnosed with CBDS by EUS were excluded from this study and treated with ERC. All the other patients were included to the follow up study obtained by mail every 6 months for clinical evaluation (need of ERC or surgery).RESULTS: CBDS was found in 4 patients by EUS. Diagnosis was confirmed in all cases on ERC. The remaining 51 patients without CBDS on EUS were followed up for 6-26 months (meanly 13 months) There were: 40 women, 42cholecystectomized patients, aged: 55 (mean). Biochemical values (mean values) were as follows: bilirubin: 14,9 μmol.L-1,alkaline phosphatase: 95 IU.L-,1 γ-GTP: 131 IU.L-1, ALT: 50IU.L-1, AST: 49 IU.L-1, Only 1 patient was lost for follow up.In the remaining 50 patients with follow up, there was only 1 (2 %) patient with persistent biliary symptoms in whom CBDS was finally diagnosed by ERC with ES. All other patients remained symptoms free on follow up and did not require ERC or biliary surgery.CONCLUSION: Vast majority of patients with moderate suspicion of CBDS and no stones on EUS with linear array can avoid invasive evaluation of biliary tree with ERC.

Hepatic schwannoma:Imaging findings on CT,MRI and contrast-enhanced ultrasonography

A primary benign schwannoma of the liver is extremely rare and is difficult to preoperatively discriminate from a malignant tumor.We compared the imaging and pathological findings,and examined the possibility of preoperatively diagnosing a benign liver schwannoma.A 72-year-old woman was admitted to our hospital because of a 4.6-cm mass in the liver.A malignant tumor was suspected,and a right hepatectomy was performed.After this,the diagnosis of a primary benign schwannoma of the liver was made through pathological examination.Contrast-enhanced ultrasonography(CEUS) with Sonazoid showed minute blood flows into the septum and solid areas of the tumor in the vascular phase;most likely due to increased arterial flow associated with infiltration of chronic inflammatory cells.In the postvascular phase,CEUS showed contrast defect of cystic areas and delayed enhancement of solid areas;most likely due to aggregation of siderophores.Because discriminating between a benign and malignant schwannoma of the liver is difficult,surgery is generally recommended.However,the two key findings from CEUS may be useful in discriminating ancient schwannoma by recognizing the hemorrhage involved in the secondary degeneration and aggregation of siderophores.

Signet-ring cell carcinoma of ampulla of Vater:Contrast-enhanced ultrasound findings

Signet-ring cell carcinoma(SRCC) of ampulla of Vater is extremely uncommon,and less than 15 cases have been reported so far in literature.It mainly occurs in elderly people(median age 57 years).We report a rare case of SRCC of the ampulla of Vater in a 38-year-old woman who presented with a small tumor at the Vater,discovered by the contrast-enhanced ultrasound(CEUS).Histopathological examination showed prominent signet-ring features.We also describe the imaging features of SRCC of ampulla of Vater in CEUS.

Effects of Huo Nao Fang in 60 Cases of Ischemic Apoplexy

To observe the therapeutic effects of the prescription of Huo Nao Fang (活脑方) on ischemic apoplexy,120 patients were divided into a treatment group and a control group, with 60 in each group, the formertreated with Huo Nao Fang while the latter with western medicine. The nervous function and bloodrheology were tested before and after treatment for both groups, and the effects of Huo Nao Fang wereevaluated. The results showed that the total effective rate was 91.7% in the treatment group and 61.6% inthe control group, with a significant difference (P＜0.01) between the two groups. The treatment group wassuperior to the control group in improving blood rheology, reducing blood lipid and restoring the nervousfunction (P＜0.05).

DIAGNOSIS AND TREATMENT OF MEDIASTINAL NEUROGENIC TUMORS--REPORT OF 110 CASES

Object.To study the clinical manifestations,diagnostic methods,surgical management ,and prognosis of various neurogenic mediastinal tumors.Method.One hundred and ten cases of neurogenic tumors of mediastinum were reviewed and retro-spectively analyzed.Results.Operative or hospitalization death happened in2cases,complications occurred in8cases,mostly were Horner’s syndrome or recurrent nerve paralysis.During the follow?up,there were2recur-rences in102benign tumors,and4cases of neurofibrosarcoma or malignant neurilemmoma died within3years postoperatively.Conclusion.Most mediastinal neurogenic tumors are benign.It is enough to establish diagnosis by chest X?ray and CT scan.There are different features in the clinical manifestations,diagnosing methods,and surgical management for the dumbbell tumors.Minimal invasive surgery and video?assisted thora-coscopy surgery(VATS)have a special value in treatment of the selected neurogenic mediastinal tumors.Benign neurogenic tumors rarely recur after complete resection,whereas malignant neurogenic tumors have poor prognosis.

ADRENAL INCIDENTALOMAS:ANALYSIS OF 126 CASES

Purpose.To evaluate the diagnosis and treatment of adrenal incidentalomas.Methods.One hundred and twenty-six patients with incidentalomas were analyzed,among them98underwent operation.Results.Eighty-eight of the adrenal incidentalomas were discovered by ultrasound.Of all the types of adrenal incidentalomas,52(41.3%)of them were adenomas;43(34.1%)were hypersecretory adrenal tumors,including29pheochromocytomas,9primary aldosteronisms ,1adrenogenitol syndrome combined with adrenal adenoma ,2Cushing’s syndrome combined with adenomas and2Cushing’s syndrome com-bined with nodular hyperplasias.All nonhypersecretory adrenal adenomas were under6cm,and all a-drenal carcinomas were above6cm.Conclusions.To search for hypersecretory adrenal tumors and to detect malignant adrenal tumors are quite essential in the process of diagnosing adrenal incidentalomas.For nonhypersecretory adrenal adeno-mas,the size of tumor is the most important index in determining whether the tumor is benign or malig-nant and whether the tumor needs to be treated with operation.

ENDOVASCULAR EMBOLIZATION TREATMENT OF CEREBRAL ARTERIOVENOUS MALFORMATIONS（REPORT OF 54 CASES）

For further reaseach on endovascular embolization treatment of AVMs, 54 patients with AVMs treated with embolization were observed. It was found that embolization was an effective procedure for the treatment of AVMs. Combined treatment of AVMs with presurgical embolization and direct surgery could reduce the comphcations resulting from large and high flow AVMs with lone surgical removal.

Value of CT scan in the diagnosis of primary large bowel lymphoma

Objective: To study the CT imaging of primary large bowel lymphoma and evaluate the value of CT scan. Methods: CT reports of 8 patients with proven primary large bowel lymphoma were retrospectively reviewed. Plain CT scans were done on all patients, enhanced CT scans simultaneously with 5-10 mm section thickness, and 5-10 mm table increments in 6 cases. Results: Primary involved sites were on the cecum (n=3), the ascending colon (n=2), and the rectum (n=1). The tumor was found in multiple areas of the large bowel in 2 cases. CT appearance fell into 3 typical patterns in our study. The first was focal mass type in 2 cases, with one combined with intussusception and retroperitoneal adenopathy; the second was segmental annular involvement type in 3 cases, with one of them combined with mesenteric adenopathy; the last was diffuse involvement type in 2 cases. Multiple nodules were seen in the rectum in 1 case. Conclusion: CT was found to be accurate in detecting the primary sites and complications of lymphoma, and evaluating invasion of adjacent structures; Focal mass type, segmental annular involvement type and diffuse involvement type are the main patterns of CT features in the primary large bowel lymphoma; The features revealed by CT scan are suggestive of primary large bowel lymphoma in some cases.

CT and MR imaging of Spongiform leukoencephalopathy after heroin vapor inhalation: analysis of 13 cases

Objective: To study the CT and MR imaging features of spongiform leukoencephalopathy after heroin vapor inhalation. Method,: The CT and MR imaging features and pathologic findings of 13 patients with heroin-induced spongiform leukoencephalopathy were analyzed. Results: CT scanning and MRI of all the patients showed diffuse, symmetric lesion in the cerebellar and cerebral white matter, and the cerebellum was invariably involved in all cases. Symmetric round or butterfly-like lesions lateral to the midline of the cerebellum with clear border was the most distinct feature in CT and MRI examination. The lesions were not found in the anterior limbs of the internal capsules. CT scanning showed low-density changes while MRI TIWI imaging presented low-signal and T2WI high-signal lesions without space-occupying mass. The pathologic findings showed spongiform degeneration of the white matter in the central nervous system, but necrotic lesions were not observed. Conclusions: Spongiform leukoencephalopathy should be considered when acute. cerebellar signs are present in patients who admitted a history of heroin inhalation. The CT and MRI manifestation of this disease is typical and the diagnosis can thus be made.