Clinical and imaging features of Gorham disease:a report of eleven cases and review of literature / 中华放射学杂志

Objective To evaluate the clinical and radiological features of Gorham disease. Methods Clinical and radiological features of Gorham disease were retrospectively analyzed by reviewing the eleven cases from our hospital and the cases reported in the domestic literature in the past fifty years. The diagnoses of all these 11 patients were in accordance with the diagnostic criteria established by Wells and Gray et al. All patients had X?ray plain film, four had CT scan and five had MR examination, with one had additional contrast?enhanced MR examination. Results There were 7 males and 4 females, age ranged from 16 to 66 years with a median age of 32 years. There were six cases involving hand, one involving ulnar and radial bones, one involving acetabulum and three involving jaw bones. The main clinical manifestations were pain, swelling, limited activity, and focal muscular atrophy occurred in 7 cases. On X?ray plain films, the affected bone became thin and the cortexes were not smooth and became coarse in 6 cases. Local lucent area was seen in 5 cases and massive bone absorption was seen in 6 cases. The residual bones showed a tapering appearance in 1 case. Pathological fracture occurred in 1 case. On CT scans, the affected bone became thin and the cortexes became coarse in 4 cases. Local lucent area was seen in 1 case. Massive bone absorption was seen in 3 cases. The adjacent muscular atrophy and widened intermuscular fat space occurred in 2 cases (atrophic bone absorption). On MRI, normal signal intensity of bone marrow disappeared and demonstrated low signal on T1WI and high signal on T2WI. The signal could be homogeneous or heterogeneous. There were widespread strip and patchy high signal areas in the soft tissue around the absorption areas in 4 cases, which resembled the edema?like signal. In 1 case, there was irregular widespread soft tissue mass around the absorption areas with heterogeneous high signal on T2WI. The adjacent muscle showed atrophy, and the intermuscular fat space became wide. There were a total of 92 cases reported cases in the literature including our 11 cases. There were 63 males and 29 females. The onset age ranged from 10 to 40 years in 66/92(72%)cases. The lesion affected one bone in 24 cases, affected two or more bones in 68 cases, out of which 9 cases had single center distribution, 59 cases had multiple centers distribution. Pectoral girdle, pelvis, maxillofacial bones, and hand were the most common sites of involvement in decreasing order. Forty three cases had muscle atrophy and 8 cases had soft tissue mass. Conclusion Gorham disease should be considered when atrophic bone absorption in one bone or continuous bones occurs that does not match clinical symptoms, with soft tissue atrophy but no bone sclerosis or periosteal reaction in the osteolytic areas.

Whole body diffusion weighted imaging pattern of normal bone marrow / 中华放射学杂志

Objective To analyze the pattern of normal bone marrow on whole body diffusionweighted imaging (WB-DWI) and its influence factors.MethodsA total of 98 healthy volunteers (male 47 and female 51). All volunteers underwent WB-DWI at 1.5 T MR scan. The ADC value,the signal intensity on DWI obtained with a b value of 800 s/mm2 ( SIDWI ),and the signal intensity on short time inversion recovery images ( SISTIR ) of thoracic vertebrae,lumber vertebrae,bilateral head of femur,bilateral neck of femur,bilateral superior segment of femur,bilateral inferior segment of femur,bilateral ilium,bilateral head of humerus,bilateral scapula were measured and compared with ANOVA test and StudentNewmar-Keuls test.The normal appearance of bone marrow on WB-DW[ was assessed. The relationship between the SIDwI and the ADC,and the SIDWI and the SISTIR of bone marrow were analyzed.The ADC of bone marrow between male and femaIe were compared. Spearman correlation analysis was performed for different age groups.Results( 1 ) Bone marrow signal intensity was different among 98 healthy volunteers.Bone marrow in 69 healthy volunteers (female 24,male 45 ) showed low to intermediate signal intensity,whereas in the remaining 29 healthy volunteers (female 27,male 2) showed high signal intensity.(2) The SIDWI of thoracic vertebrae ( median 44.54),lumber vertebrae ( median 35.01 ),head of femur ( median 13.61 ),neck of femur ( median 16.00),superior segment of femur ( median 21.45 ),ilium ( median 25.77),head of humerus (median 18.35),scapula (median 36.12) was positively correlated with the ADC [ (0.55 ±0.08) × l0-3,(0.53 ±0.08) × 10-3,(0.30 ± 0.10) × 10-3,(0.42 ± 0.16) × 10-3,(0.74±0.14) ×l0- 3,(0.49±0.10) ×10-3,(0.36±0.13) ×10-3,(0.49±0.11) × 10-3mm2/s]and the SISTIR ( median 61.81,64.99,53.27,69.08,73.10,66.35,73.16,79.81 ),r =0.513 and 0.695,0.741 and 0.764,0.443 and 0.489,0.641 and 0.656,0.510 and 0.648,0.475 and 0.715,0.366 and 0.446,0.437 and 0.739 ;P ＜ 0.01. (3) There was significant difference of the ADC of bone marrow in different bone,F =138.69,P ＜ 0.01. Student-Newman-Keuls test revealed that no significant difference was found in the ADC between thoracic vertebrae and lumbar vertebrae,ilium and scapula,head of humerus and inferior segment of femur ( P ＞ 0.05 ),and significant difference was found in the ADC values between the remaining two groups ( P ＜ 0.05 ). The bones associated with decreasing ADC values were superior segment of femur,thoracic vertebrae and lumber vertebrae,ilium and scapula,neck of femur,head of humerus,head of femur and inferior segment of femur. ( 4 ) The ADC values of bone marrow of female subjects in thoracic vertebrae [ (0.59 ±0.07) × 10-3 mm2/s],lumber vertebrae [ (0.58 ±0.06) × 10 -3 mm2/s],head of femur ( median 0.33 × 10 -3 mm2/s),neck of femur ( median 0.53 × 10 -3 mm2/s),superior segment of femur ( median 0.81 × 10-3 mm2/s),inferior segment of femur ( median 0.32 ×10-3 mm2/s),ilium [ (0.52 ± 0.09 ) × 10-3 mm2/s ],head of humerus (median 0.42 × 10-3 mm2/s),scapula [ (0.53 ± 0.09) × 10-3 mm2/s] were significantly higher than those of male subjects [ (0.51 ±0.07) × 10-3,(0.48 ±0.07) × 10-3,median 0.23 × 10-3,median 0.31 × 10-3,median 0.66 × 10-3,median 0.23 × 10-3,(0.46 ±0.10) × 10-3,median 0.27 × 10-3,(0.45 ±0.11 ) × 10 3mm2/s].(5)There was significant negative correlation between the ADC values of bone marrow and age in thoracic vertebrae,lumber vertebrae,head of femur,neck of femur,superior segment of femur,ilium,head of humerus for female subjects,r =-0.549, -0.629, -0.329, -0.524, -0.338, -0.548 and -0.416,respectively,P ＜ 0.05.There was no significant correlation between ADC values and age in inferior segment of femur and scapula for female subjects and all the regions for male subjects ( P ＞ 0.05 ).Conclusions The ADC and the SIsTIR of bone marrow correlates with the SIDW1.The ADC values of bone marrow is affected by age and sex,and is different for different bones.

Analysis of image findings in forty-one patients with primary lymphoma of the bone / 中华放射学杂志

Objective To analyze the imaging features of primary lymphoma of the bone,and discuss the special feature of the floating ice sign. Methods Forty-one cases of primary lymphoma of the bone in our unit from 1963.1-2009.6 were retrospectively studied. All 41 patients underwent X-ray examination, and 20 patients underwent CT examination, 12 patients underwent MR examination (3 cases simultaneously with enhancement).Results Involvement of the flat bone was seen in 12 cases. Vertebral column was affected in 8 cases, and 17 cases showed lesions in long bones and irregular bones were involved in 4 cases. The most common location was the femur(10, 24.4%), followed by the ilium(8, 19.5%). Lesions were found in the metaphyses of the long bone in 11 cases (64.7%). Floating ice sign was showed in the calcaneus of 2 patients and in the lumbar vertebra of 2 cases respectively, accounted for 9.8% of all cases. Slight bone destruction with soft tissue mass on CT image could be found in 12 cases, while obvious soft tissue mass was found in 9 cases. No periosteal reaction was found in 37 cases (90.2%). MRI examinations of 12 patients revealed soft tissue mass in 10 patients, and the extent of the lesion was larger in MR than CT. One case showed extensive bone destruction on MR but inconspicuous bone destruction on X-ray plain film and CT scan. Conclusion Slight bone destruction with conspicuous soft tissue mass, conspicuous bone destruction on MR but slight or inconspicuous bone destruction on X-ray film and CT,could strongly imply the diagnosis of primary lymphoma of the bone. Floating ice sign was a special imaging feature of primary lymphoma of the bone, which could be used as a clue for the diagnosis of lymphoma.

In vitro gene imaging by luciferase to detect the expression and effect of human tumor necrosis factor related apoptosis-inducing ligand in lung cancer A549 cells / 中华放射学杂志

Objective To detect the expression and effect of human tumor necrosis facctor related apoptosis-inducing ligand(hTRAIL)in vitro by using a novel double expressing adenoviral vector encoding hTRAIL and firefly lueiferase (luc) gene (Ad-hTRAIL-luc),in which luc wag used, as reporter gene.Methods A549 cells were transduced with the adenoviral vector encoding enhanced green fluorescent protein (EGFP) gene(Ad-EGFP)at variable multiplicity of infection(MOI).Adenoviral transducfion efficiency wag determined 48 h later.A549 cells were transduced with Ad-hTRAIL-luc at variable MOI.and the following tests were performed 48h later,respectively:the expressive ratio of hTRAIL and the apeptotic ratio of A549 cells were meagnred by flow eytometer;counts per minute(cpm)of luminescence were measurde by scintiUation counters. A549 cells were transduced with Ad-luc at variable MOI, and cpm of luminescence was measured by scintillation counters 48 h later. After A549 cells were transduced with AdhTRAIL-luc,the expressive ratio of hTRAIL,the apoptotic ratio of A549 cells and cpm of luminescence were analyzed by one-way ANOVA.The positive ratio of EGFP and cpm of luminescence (Ad-luc) were analyzed bv nonparametric ANOVA.Results After A549 cells were transfected with Ad-hTRAIL-luc,the expressive ratio of hTRAIL on the cell membrane of the groups were(2.37±0.04)/,(3.16±0.03)/,(3.64±0.03)/,(3.96±0.02)/,(4.24±0.02)/,(4.34±0.02)/ respectively,which showed significant difference between each other (P＜0.01);and the apoptotic ratio of A549 cells were (1.52±0.04)/,(2.93±0.02)/,(3.39±0.02)/,(3.64±0.02)/,(3.86±0.02)/,(4.08±0.02)/,(4.20±0.02)/,respectirely,and it showed significant difference between each other (P＜0.01);cpm of luminescence were 465 561±26 801,1 038 576±29 417,937 655±23 197,786 432±20 028,524 288±16 338,401 566±15 961,respectively,and it also showed significant difference between each other(P＜0.01).There was a positive relationship between the expressive ratio of hTRAIL and cell apoptotic ratio of A549 cells (r=0.984,P＜0.01).Conclusion The double expressing adenoviral vector Ad-hTRAIL-luc can transfer luc and hTRAIL gene to A549 cells efficiently,and the activity of luc may reflect the effect of hTRAIL as well as the expression of hTRAIL.

Experimental study of dynamic diffusion tensor imaging in spinal cord of goats under persistent compression / 中华放射学杂志

Objective To explore the dynamic changes of diffusion tensor imaging(DTI) in spinal cord of goats with persistent compression injury. Methods Eighteen goats weighted 20--25 kg were divided into three groups with completely random design: A, B and C. A balloon catheter was inserted into the epidural space at C3-4 level via intervertabral foramen for each goat. The balloon was inflated by injection of variable volumes of saline in group A and B 10 days following operation. The volume of saline was 0. 3 ml in group A and 0. 2 ml in group B,respectively. The compression sustained for 40 days. Group C served as uncompressed control without injection of saline. The locomotor rating score was applied to each group. Conventional MRI and DTI were performed. The apparent diffusion coefficient (ADC)and fractional anisotropy (FA) values were measured. Histopathological assessments of the compressed spinal cord were performed 50 days following operation with light microscope and transmission electron microscopy. Results Before operation, the locomotor rating score was 5, the ADC value was ( 1.23 ± 0. 05 ) × 10-3 mm2/s and the FA value was (0. 72 ± 0. 05 ) each group. Of six goats in Group A, the locomotor rating score severely decreased and reached( 1.5±0. 4)on the 40 th day after compression. The ADC value at compression site decreased soon and reached the minimum (0. 75±0. 04) × 10-3mm2/s on the 5 th day after compression. Then the ADC value increased gradually, restored normal on the 10 th day or so, then became markedly higher than normal and reached( 1.61±0. 05) × 10-3mm2/s on the 40 th day. The FA value at compression site decreased soon, reached(0. 54±0. 04)on the 1st day, then decreased gradually and reached(0. 43 ± 0.05) on the 40 th day. It appeared high signal intensity on T2WI on the 10 th day. In Group B, the locomotor rating score was moderately decreased and reached(3.4±0. 5 )on the 40 th day. The ADC value at compression site decreased slightly firstly, reached( 1.08±0. 04) × 10-3mm2/s on the 1st day, restored normal on the 20 th day or so, then increased gradually, became higher than normal and reached ( 1.27 ± 0. 05) × 10-3mm2/s on the 40 th day. The FA value increased slightly firstly, reached (0. 78±0. 05 )on the 1st day, then decreased gradually, restored normal on the 15 th day or so, became lower than normal and reached(0. 67±0. 05) on the 40 th day. There was no abnormality on conventional MRI. In Group C, the locomotor rating score, ADC value and FA value remained unchanged. There was no abnormality on conventional MRI. There were dynamic changes over time of the ADC value and FA value in Group A and B, which was more marked in Group A than that in Group B ( repeated measurements analysis of variance, F=426. 7 for the ADC value and F =7895.2 for the FA value, P < 0. 01 ). Histopathologically, swelling and degeneration of axons and neurons as well as the disarrangement of myelin sheathes could be seen. The pathological changes were more marked in Group A than in Group B. In Group C, no abnormality could be seen. Conclusion There are dynamic changes of DTI in cervical spinal cord with compressive injury that correlated with the degree and duration of compression. The ADC value decreased firstly, restored normal and then increased. The FA value increased firstly, restored normal and then decreased in mild compression while solely decreased in serious compression.

The role of apparent diffusion coefficient in the differentiation between benign and malignant bone tumors / 中华放射学杂志

Objective To explore the role of apparent diffusion coefficient (ADC) value of diffusion-weighted imaging (DWI) in the differentiation between benign and malignant bone tumors. Methods Echo planar imaging DWI was performed in 18 patients with benign tumor or tumorous lesion and 26 patients with malignant tumor of bone. Three b-values (0, 500 and 1000 s/mm2) were applied. The lowest, highest, and whole ADC values were measured for each lesion, respectively. Results The lowest ADC values of benign bone tumor[ mean( 1.28±0. 49) ×10-3mm2/s ] were significantly higher than that of malignant tumor [ mean ( 0. 92±0. 35 )×10-3mm2/s, t = 2. 839, P < 0. 01 ]. The whole ADC values of benign bone tumor [ mean (1.62±0. 51 ) ×10-3mm2/s] were significantly higher than that of malignant tumor [ mean ( 1.21±0. 36) ×10-3mm2/s, t = 3. 092, P < 0. 01 ]. However, there were much overlapping between benign and malignant bone tumor in the lowest and whole ADC values. There was no significant difference for the highest ADC values between benign [. Mean ( 2. 02±0. 55 )×10-3mm2/s] and malignant bone tumor[ mean( 1.71±0. 65 ) ×10-3mm2/s, t = 1. 669, P > 0. 05 ]. Excluding cases of bone cyst and aneurismal bone cyst, the lowest, highest, and whole ADC values of benign bone tumor was (1.11± 0. 31 )×10-3mm2/s, ( 1.88±0. 49)×10-3mm2/s, and( 1.45±0. 35 )×10-3mm2/s, respectively. There was no significant difference for the lowest, highest, or whole ADC values between benign and malignant bone tumor (t = 1. 728, 0. 964, and 2. 012, respectively, P > 0. 05). Conclusion ADC value is useless for the differentiation between benign and malignant bone tumors.

Status of musculoskeletal injury articles published in the major journals of radiology in China and comparison with abroad during the last decade / 中华放射学杂志

Objective To investigate the status of musculoskeletal articles and musculoskeletal injury articles published in the major journals of radiology in China and compare with abroad during the last decade.Methods Statistic analysis and comparison were done with musculoskeletal injury articles published in the major journals of radiology in China and abroad.The number,category,exam methods,study region and study contents were analyzed respectively.The journals in China included Chinese Journal of Radiology,Journal of Clinical Radiology and Journal of Practical Radiology.The journals at abroad included Radiology,the American Journal of Roentgenology(AJR),the British Journal of Radiology(BJR)and Skeletal Radiology.Results The rate of musculoskeletal articles among the treatise articles was 13.O%(827/6352)in China and 10.4%(900/8659)in three kinds of compressive jonrnals at abroad.The rate of musculoskeletal injury articles in musculoskeletal articles was 21.5%(178/827)in China and 10.8%(97/900)abroad.Among the review articles,the rate was 9.9%(73/741)and 13.7%(10/73)in China.respectively,while that was 4.3%(34/783)and 23.5%(8/34),respectively abroad.Among the case reports,the rate was 17.0%(675/3971)and 3.4%(23/675)in China respectively,while that was 8.8%(177/2019)and 14.7%(26/177),respectively abroad.The rate of exam methods which onlv used X-ray plain film in injury articles was 11.7%(26/222),mainly CT was 42.8%(95/222)and mainly MR was27%(60/222)in China,while that was10.9%(32/295),9.8%(29/295)and 32.5%(96/295),respectively in four kinds of journals at abroad.The combination examination was 16.2%(36/222)in China and 42.0%(124/295)at abroad respectively,The other was 2.3%(5/222)in China and 4.8%(14/295)at abroad.As for the study region,the rate of vertebrate column was 22.5%(50/222).knee joint was 21.1%(47/222),cranial and facial bones was 15.3%(34/222),hip joint was 7.2%(16/222).thoracic region was 6.8%(15/222),foot and ankle was 4.5%(10/222),hand and wrist was 4.1%(9/222),respectively,while that was 14.6%(43/295),14.6%(43/295),1.7%(5/295).6.4%(19/295),3.7%(11/295),12.9%(38/295)and 7.5%(22/295)at abroad,respectively.As for the study contents,the rate of bone was 64.9%(144/222),articular capsule and ligament was 8.6%(19/222),cartilage and osteoepiphysis was 7.7%(17/222),dislocation with or without fracture was 5.8%(13/222),menisci was 5.4%(12/222),combination study was 4.0%(9/222)and the other was 3.6%(8/222),respectively,while that was 62.4%(184/295),24.1%(71/295),4.7%(14/295),0.3%(1/295),2.7%(8/295),2.4%(7/295)and 3.4%(10/295)at abroad,respectively,The number of experimental articles in Chinese Journal of Radiology was 7,while that of Radiology was 29.Conclusion The rate of article on bone and bone injury was lower in all articles.Emphasize should be laid on experimental research and non-bone musculoskeletal injury in china.