影响影像引导下芯针穿刺骨骼软组织病变诊断率因素的探讨

目的评价病变特征及技术因素对影像引导下芯针穿刺(CNB)骨骼软组织病变诊断率的影响。材料与方法本研究为前瞻性研究。

Incremental value of magnetic resonance neurography of Lumbosacral plexus over non-contributory lumbar spine magnetic resonance imaging in radiculopathy: A prospective study

AIM: To test the incremental value of 3T magnetic resonance neurography(MRN) in a series of unilateral radiculopathy patients with non-contributory magnetic resonance imaging(MRI).METHODS: Ten subjects(3 men,7 women; mean age54 year and range 22-74 year) with unilateral lumbar radiculopathy and with previous non-contributory lumbar spine MRI underwent lumbosacral(LS) plexus MRN over a period of one year. Lumbar spine MRI performed as part of the MRN LS protocol as well as bilateral L4-S1 nerves,sciatic,femoral and lateral femoral cutaneous nerves were evaluated in each subject for neuropathy findings on both anatomic(nerve signal,course and caliber alterations) and diffusion tensor imaging(DTI)tensor maps(nerve signal and caliber alterations).Minimum fractional anisotropy(FA) and mean apparent diffusion coeffcient(ADC) of L4-S2 nerve roots,sciatic and femoral nerves were recorded.RESULTS: All anatomic studies and 80% of DTI imaging received a good-excellent imaging quality grading. In a blinded evaluation,all 10 examinations demonstrated neural and/or neuromuscular abnormality corresponding to the site of radiculopathy. A number of contributory neuropathy findings including double crush syndrome were observed. On DTI tensor maps,nerve signal and caliber alterations were more conspicuous. Although individual differences were observed among neuropathic appearing nerve(lower FA and increased ADC) as compared to its contralateral counterpart,there were no significant mean differences on statistical comparison of LS plexus nerves,femoral and sciatic nerves(P > 0.05).CONCLUSION: MRN of LS plexus is useful modality for the evaluation of patients with non-contributory MRI of lumbar spine as it can incrementally delineate the etiology and provide direct objective and non-invasive evidence of neuromuscular pathology.

3T magnetic resonance neurography of pudendal nerve with cadaveric dissection correlation

AIM: To evaluate the pudendal nerve segments that could be identified on magnetic resonance neurography(MRN) before and after surgical marking of different nerve segments.METHODS: The hypothesis for this study was that pudendal nerve and its branches would be more easily seen after the surgical nerve marking. Institutional board approval was obtained. One male and one female cadaver pelvis were obtained from the anatomy board and were scanned using 3 Tesla MRI scanner using MR neurography sequences. All possible pudendal nerve branches were identified. The cadavers were then sent to the autopsy lab and were surgically dissected by a peripheral nerve surgeon and an anatomist to identify the pudendal nerve branches. Radiological markers were placed along the course of the pudendal nerve and its branches. The cadavers were then closed and rescanned using the same MRN protocol as the premarking scan. The remaining pudendal nerve branches were attempted to be identified using the radiological markers. All scans were read by an experienced musculoskeletal radiologist.RESULTS: The pre-marking MR Neurography scans clearly showed the pudendal nerve at its exit from the lumbosacral plexus in the sciatic notch, at the level of the ischial spine and in the Alcock's Canal in both cadavers. Additionally, the right hemorrhoidal branch could be identified in the male pelvis cadaver. The perineal and distal genital branches could not be identified. On post-marking scans, the markers were used as identifiable structures. The location of the perineal branch, the hemorroidal branch and the dorsal nerve to penis(in male cadaver)/clitoris(in female cadaver) could be seen. However, the visualization of these branches was suboptimal. The contralateral corresponding nerves were poorly seen despite marking on the surgical side. The nerve was best seen on axial T1W and T2W SPAIR images. The proximal segment could be seen well on 3D DW PSIF sequence. T2W SPACE was not very useful in visualization of this small nerve or its branches.CONCLUSION: Proximal pudendal nerve is easily seen on MR neurography, however it is not possible to identify distal branches of the pudendal nerve even after surgical marking.

Incidental vertebral compression fractures in imaging studies:Lessons not learned by radiologists

AIM:To assess radiologists reporting rates of incidental vertebral compression fractures in imaging studies. METHODS:We performed a review of the current literature on the prevalence and reporting rates of incidental vertebral compression fractures in radiologic examinations. RESULTS:The bibliographic search revealed 12 studies:7 studies using conventional radiology and 5 using multidetector computed tomography(MDCT).The lossof height cut-off to define a vertebral fracture varied from 15%to 25%.Fracture prevalence was high (mean 21.1%;range 9.5%-35%)in both radiographic and MDCT studies(mean 21.6%and 20.2%,respectively).Reporting rates were low with a mean value of 27.4%(range 0%-66.3%)and were significantly lower in MDCT than in radiographic studies(mean 8.1%vs 41.1%).Notably,recent studies showed lower reporting rates than older studies. CONCLUSION:Many scientific studies have confirmed a high prevalence of vertebral compression fractures as incidental findings on imaging studies.However,the underreporting of these fractures,as determined in our study,may negatively affect patient care.

腰椎MRI表现的可靠性

目的 研究腰椎非椎间盘轮廓改变的退行性变的MRI表现在观察者本身及不同观察者之间的定性差异。方法该回顾性研究获审查委员会批准，符合HIPAA法案。从脊柱病人预后研究试验中随机选择了111例MRI可解释的病例，其年龄为18～87岁，平均（53±16）岁。4位读片者按特定的标准独立地评价这些病例，至少1个月后对其中的40例样本的MRI检查再次评价。

Intraosseous Lipoma with Subsequent Esophageal Carcinoma Metastasis

Background: This case report describes a well documented proximal femoral metadiaphysis intraosseous lipoma which later developed metastasis from a new esophageal cancer. Metastatic disease to benign conditions is a rare finding. To the best of our knowledge, this is the first reported case of metastatic disease to an intraosseous lipoma. Case Description: The metastatic deposit was initially detected by plain-film radiography, performed to evaluate new onset right hip pain, as possible new cortical breakthrough with irregularity in the site of previously known proximal right femur intraosseous lipoma. Concurrent follow-up PET/CT study showed a new hypermetabolic focus within the known intraosseous lipoma indicating a new metastasis that was confirmed with an MRI as a new enhancing mass within the preexisting intraosseous lipoma. Subsequently, an MRI-guided biopsy and eventually surgical excision was performed providing the histological samples for radiologic-pathologic correlation. Purpose and Clinical Relevance: Clinicians need to be aware that unusual, complex patterns within benign lesions may be a reflection of unexpected conditions, such as insufficiency injury, malignant transformation and secondary metastatic disease, as exemplified by our case report.