Tuberculosis versus non-Hodgkin's lymphomas involving small bowel mesentery:Evaluation with contrast-enhanced computed tomography

AIM: To evaluate the specific computed tomography (CT) imaging criteria for differentiating tuberculosis involving the small bowel mesenteric lymph nodes from lymphomas. METHODS: We retrospectively reviewed the anatomic distribution,CT enhancement patterns of lymphoma in 18 patients with mesenteric tuberculosis and 22 with untreated non-Hodgkin’s lymphomas (NHL) involving small bowel mesentery (SBM). Of the 18 patients with tuberculosis,9 had purely mesenteric tuberculous lymphadenopathy (TL),and 9 had mesenteric TL accompanied with tuberculous mesenteritis (TLM). RESULTS: CT showed that tuberculosis and NHL mainly affected lymph nodes in the body and root of SBM. Homogeneously enhanced lymph nodes in the body and root of SBM were found more often in the NHL (P < 0.05). Homogeneously mixed peripheral enhanced lymph nodes in the body of SBM were found more often in mesenteric TL and TLM (P < 0.05). Peripheral enhanced lymph nodes in the root of SBM were found more often in mesenteric TL and TLM (P < 0.01). "Sandwich sign" in the root of SBM was observed more often in NHL (P < 0.05). CONCLUSION: Anatomic lymph node distribution,sandwich sign and specific enhancement patterns of lymphadenopathy in SBM on CT images can be used in differentiating between tuberculosis and untreated NHL involving SBM.

Tuberculous abscess in hepatoduodenal ligament: Evaluation with contrast-enhanced computed tomography

Two patients with tuberculous abscess in the hepatoduodenal ligament were studied. Both patients underwent contrast-enhanced computed tomography (CT) scan. The abscess showed a low density with an irregular thick wall in the hepatoduodenal ligament on CT images, the margin was poorly defined. Contrastenhanced CT images showed the contrast-enhanced thick wall, homogeneous and peripheral-enhanced lymph nodes. Although features of the tuberculous abscess in the hepatoduodenal ligament could be conspicuously shown with contrast-enhanced CT, further experience is needed to evaluate the potential value of CT in detecting early tuberculous abscess in relation to other entities in the hepatoduodenal ligament.

Trabecular bone deterioration at the greater trochanter ol mice with unilateral obstructive nephropathy

Our previous study showed the early molecular responses of bone in response to obstructive nephropathy in a unilateral ureteral obstruction （UUO） mouse model. Here, we addressed the changes in trabecular bone properties at greater trochanter, the proximal and the distal metaphysis of femur in UUO mice. The male mice were subjected to UUO （n= 10） or sham operation （n= 10）. All mice were killed on day 7 after the surgical operation. The micro-computed tomography （micro-CT） analysis for different femoral trabecular bone sites demonstrated pathological alterations of trabecular bone mass and micro-networks at greater trochanter as shown by decreases in bone mineral density/bone volume （P〈O.05） and trabecular number （P〈O.05） and increases in trabecular separation （P〈O.01） and bone surface/bone volume （P〈O.05） in UUO mice. The present study demonstrates that UUO-induced unilateral obstructivenephropathy has markedly detrimental effects on the trabecular trochanter of the femur.

Roles of radiograph, magnetic resonance imaging, three- dimensional computed tomography in early diagnosis of femoro-acetabular impingement in 17 cases

Objective： To evaluate the roles of radiograph, magnetic resonance imaging （MRI）, three-dimensional computed tomography （3-D CT） in early diagnosis of femoro-acetabular impingement （FAI） in 17 cases. Methods： Plain radiographs of the pelvis, 3-D CT, and MRI of the hip were made on 17 patients with groin pain, which was worse with prolonged sitting （i.e. hip flexion）. There was no history of trauma or childhood hip disorders in the patients who did not complain of any other joint problems or neurologic symptoms. All patients had positive anterior or posterior impingement test. Plain radiographs included an antero-posterior （AP） view of the hip and a cross table lateral view with slight internal rotation of the hip. CT scan was performed with the Lightspeed 16 row spiral （General Electric Company, USA） at 1.25 mm slice reconstruction. MRI scan was performed on the Siemens Avanto （Siemens Company, Germany）1.5T supraconduction magnetic resonance meter. The CT and MRI scans were taken from 1 cm above the acetabulum to the lesser trochanter in 5 series. Results： The plain radiographs of the pelvis showed that among the 17 patients, 12 （70.59%） had ＂Cam＂ change of the femoral head, 6 （35.29%） had positive ＂cross-over＂ sign, and 17 （100%） had positive ＂Pincer＂ change of the acetabulum. The 16 row spiral CT noncontrast enhanced scan and 3-D reconstruction could discover minus femoral offset and ossification and osteophyte of the acetabulum labrum in all the 17 cases （100%）. The MRI noncontrast enhanced scan could discover more fluid in the hip joint in 15 cases （88.33%）, subchondral ossification in 3 cases （17.6%）, and labrum tears in 3 cases （17.6%）. Conclusions： Plain radiographs can provide the initial mainstay for the diagnosis of FAI, 3-D CT can tell us the femoral offset, while MRI can show labrum tears in the very early stage of FAI. Basically, X-ray examination is enough for the early diagnosis of FAI, but 3-D CT and MRI may be useful for the treatment.

Prediction of traumatic avascular necrosis of the femoral head by single photon emission computerized tomography and computerized tomography： an experimental study in dogs

Objective： To evaluate the femoral head perfusion and to predict the traumatic avascular necrosis （AVN） of the femoral head by single photon emission computerized tomography and computerized tomography （SPECT/CT）. Methods： Totally 18 adult beagle dogs were divided randomly into three equal-sized （n=6） groups. Subsequently different degrees of ischemia model were developed by de- stroying blood vessels of the femoral head. The left hip received sham operation as normal control and the right hip underwent blood interruption. In Group A, the ligamentum teres was cut off. In Group B, the marrow cavity of the right femoral neck was destroyed while in Group C, the soft tis- sues at the base of the femoral neck were stripped in addition to the resection of the ligamentum teres and destruction of the marrow cavity. Three hours after surgery, SPECT/ CT was performed. Laser Doppler Flowmetry （LDF） measurements were also obtained at three different time points （before operation, immediately and three hours after operation） in order to assess the change process of blood supply to the femoral head. Results： SPECT/CT showed no significant difference in the radionuclide uptake between the right and left femo- ral heads in Group A （t=-0.09,P=-0.94） and Group B （t= 0.52, P=0.62）. However, in Group C, it was 261±62 for the right femoral head, only 12% of that in the left femoral head. LDF measurements indicated that the femoral head perfusion was decreased from （45.0±3.3） PU to （39.1±3.7） PU in Group A, from （44.0±2.7） PU to （34.3±2.6） PU in Group B, and from （47.3±2.1） PU to （4.96±0.6） PU in Group C immediately after operation. However, the perfusion was restored and returned to normal values three hours after operation except in Group C. Conclusion： SPECT/CT could assess the perfusion of the femoral head semiquantitatively, which might be useful in predicting the development of traumatic AVN.

Neoplasm-like abdominal nonhematogenous disseminated tuberculous lymphadenopathy: CT evaluation of 12 cases and literature review

AIM: To assess the diagnostic value of computed tomography (CT) imaging in screening for abdominal nonhematogenous disseminated tuberculous lymphadenopathy (TL). METHODS: The CT scans of 12 patients with abdominal nonhematogenous disseminated TL suggestive of neoplasm were retrospectively analyzed in this review. The final diagnoses were confirmed by lymph node pathology for seven patients and by laparoscopic surgery for five patients. All of the patients were treated at our institution between April 1995 and August 2009. RESULTS: The sites of involvement were the periportal (n = 6), peripancreatic (n = 3), periaortic (n = 3), and mesenteric (n = 2) regions. On the plain CT scan, the lymphadenopathy showed a heterogeneous isodensity or hypodensity in 11 patients and a low density in one patient. Peripheral enhancement was observed on the dynamic contrast-enhanced CT scans for all patients. In two cases, scans were more revealing during the portal venous and delayed phases. CONCLUSION: Abdominal lymphadenopathy with predominant peripheral rim-like enhancement on the dynamic contrast-enhanced CT scan may suggest a diagnosis of TL.

股骨大粗隆结核的影像学表现

目的探讨股骨大粗隆结核的影像学表现。方法回顾性分析经临床、病理证实的28例股骨大粗隆结核的影像学资料。结果28例患者均是单侧股骨大粗隆受累，包括滑囊型4例，中心型3例，边缘型21例。X线表现：中心型主要表现粗隆部骨质密度增高，骨质破坏，粗隆或股骨颈增粗、变形，边缘型表现粗隆边缘骨质毛糙，骨质硬化、破坏，临近软组织肿胀，钙化等。CT表现：主要表现为粗隆区骨质破坏、溃烂，或脓腔及死骨形成，临近软组织肿胀或脓肿形成，及软组织内散在钙化。MRI表现：主要表现大粗隆区骨质破坏，呈稍长或长T1长T2信号，T_2W脂肪抑制像：明显高信号，软组织肿胀、渗出，或寒性脓肿形成，或伴有低信号钙化灶。结论股骨大粗隆结核的发病部位、临床及影像学表现具有一定特征性。X线平片和CT对骨质破坏、硬化及死骨和钙化灶观察有一定价值，对早期滑囊型病变诊断MRI检查更有价值。