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PurposeTo investigate whole-body magnetic resonance imaging in diagnosis of idiopathic inflammatory myopathy (IIM), and to guide clinical treatment.Materials and Methods Twenty-six patients clinically diagnosed IIM including 19 dermatomyositis and 7 polymyositis were analyzed retrospectively. Whole-body MRI was performed in all patients including whole-body coronal scan and axial scan of both sides of thigh. Short tau inversion recovery (STIR) sequences were used in the coronal scan and T1WI and fat-suppressed T2WI were performed in the axial scan. Ten healthy volunteers were recruited as control group. MRI findings were compared between the two groups.Results Whole body MRI showed that muscles were homogeneously low signal intensity in the control group. Imaging findings of the patients with IIM included muscle inflammation, fascitis, subcutaneous tissue edema, muscle atrophy and fatty infiltration. The most common distribution site of muscle inflammation of dermatomyositis patients was thigh (n=18), followed by gluteus (n=14), great psoas muscle (n=13), shoulder muscles (n=11), leg muscle (n=11), erector spinae (n=10) and neck muscles (n=9). Findings out of muscles included cavities in the both lungs, infarction in femurs and tibias, avascular necrosis of femoral head, adrenal mass and thyroid nodules. The most common distribution site of muscle inflammation of polymyositis was thigh (n=5), followed by gluteus (n=3), great psoas muscle (n=3), shoulder muscles (n=2), leg muscles (n=2), erector spinae (n=1) and neck muscles (n=1). Findings out of muscles included 1 case of infarction in femurs and tibias.Conclusion Whole-body MRI can not only comprehensively evaluate the activity of IIM but also detect complications such as bone infarction. It's a powerful tool for diagnosis, guiding treatment and monitoring of IIM.
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Objective To investigate the value of MR DWI in the detection of early acute sacroiliitis in patients with spondyloarthritis(SpA).Methods The data of sacroiliac joint MRI were retrospectively analyzed in fifty-nine patients with inflammatory low back pain and negative plain radiographs and/or CT.T1WI,T2WI,short tau inversion recovery (STIR) and DWI images were obtained in all cases.Contrast-enhanced T1WI with fat suppression (FST1WI) images were obtained in 28 patients and follow-up MRI examinations were performed during treatment in 7 cases.Acute inflammatory lesion was defined as hyperintense signal located in subchondral or periarticular regions on STIR images and or on enhanced FST1WI.Cases were divided into acute inflammation group and non-inflammation group.Comparison was performed among STIR,enhanced FST1WI and DWI in the detection of acute inflammation by using Chi-square test.Mean ADC value was obtained from normal and inflammatory areas in acute inflammation group and from subchondral bone marrow in non-inflammation group,and t test was used for comparison of ADC values.Results Acute inflammation existed in 38 cases (72 sacroiliac joints) and acute inflammatory lesions displayed as high signal on DWI in 35 cases (67 sacroiliac joints).STIR,enhanced FST1WI and DWI showed no significant difference in the detection of acute sacroilliitis (37/38,38/38,36/38,respectively;x2=0.16,P=0.923).ADC values measured from acute inflammatory areas were significantly higher than values measured from normal area in acute inflammation group [(1.087± 0.207)× 10-3 and (0.537±0.091) × 10-3mm2/s],and values measured from subchondral bone marrow in non-inflammation group [(0.487±0.112) × 10-3mm2/s],there were significant difference (t values were 14.971 and 12.289,P＜0.01).ADC values were similar between normal area in acute inflammation group and subchondral bone marrow in non inflammation group (t=1.874,P=0.066).ADC values were (1.018±0.266) × 10-3 and (0.706±0.164) ×10-3mm2/s before and after the treatment (t=5.312,P＜0.01).Conclusions DWI is a sensitive method to display acute inflammatory lesions in sacroiliac joints.ADC values can be effectively used to quantify inflammatory lesions in acute sacroilliitis as well as in the evaluation of efficacy of treatment.
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Objective To investigate the feasibility and accuracy of volumetric measurement of necrotic lesion using CT and MRI,and to assess the value of necrotic lesion volume in predicting collapse of the femoral head in patients with avascular necrosis of the femoral head(ANFH). Methods Comparison among CT,MRI and gross section was performed in 25 femoral heads of 18 patients who underwent total hip replacement for established ANFH.The volume of necrotic lesion was measured using fluid displacement.CT and MRI data were transferred to a computer to calculate the volume of necrotic lesion using software.One way ANOVA was used to compare the volumes of necrotic lesion measured by CT,MRI and gross section.A total of 62 patients (92 hips) who were diagnosed with ANFH but without collapse by CT were followed up 24 months.Student t-test was used to compare the ratio of the volumes of the necrotic lesion and entire femoral head in the hips with and without collapse and ROC curve analysis was carried out.Results CT and MRI coincided with gross section in the necrotic area,proliferative area and extralesional area.The volumes of the necrotic lesion measured by CT,MRI and gross section were ( 20.5 ± 5.2 ),( 21.4 ± 4.8 ),( 20.9 ± 5.2 ) cm3,respectively.There was no significant difference among the necrotic volumes measured by the three methods(F =0.185,P =0.831 ).In fifty-seven out of 92 hips,collapse of the femoral head occurred during the follow-up.The ratio of the volumes of the necrotic lesion and entire femoral head was higher in hips with collapse than in hips without collapse[ (34.5 ±9.3)％ vs.(23.4 ±8.4)％ ;t =5.749,P=0.000].The area under the ROC curve was 0.808. Conclusions The volume of the necrotic lesion plays an important role in the collapse of femoral head in patients with ANFH.Both CT and MRI can identify the shape and location of the necrotic lesion intuitively and stereospecifically and can determine the volume of the necrotic lesion accurately.
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Objective To study the imaging findings of hip involvement and to compare the sensitivity of radiography,CT,and MRI in the identification of hip involvement in patients with ankylosing spondylitis(AS).MethodsAnteroposterior radiography of the pelvis and MRI of hip were performed in 55 patients with AS.CT scan of hip was performed in 29 of 55 patients.T1-weighted,T2-weighted,short tau inversion recovery (STIR) and three dimensional balanced turbo field echo with water selective excitation (3D-BTFE-WATS) coronal sequences of hips were obtained in all patients,of which fat-saturated contrastenhanced T1-weighted sequence was performed in 24 patients.The imaging data of 55 patients were analyzed.The chi-square test was used to analyze the sensitivity in the identification of hip involvement among radiography,CT,and MRI.ResultsAmong 110 hips in all 55 patients,abnormal changes were detected in 13 hips by radiography,85 hips by MRI.The findings of radiography included bone erosions in 13 hips,joint space narrowing in 4 hips,syndesmophytes in 5 hips.MRI revealed bone erosive destruction in 31 hips,joint space narrowing in 4 hips,joint effusion in 80 hips,subchondral bone marrow edema in 32 hips,fat accumulation of bone marrow in 28 hips,enthesitis in 21 hips.Bilateral synovial enhancement was showed in 19 of 24 patients who underwent fat-saturated contrast-enhanced T1-weighted sequence.Of the 58 hip joints in 29 patients who underwent CT examination,not only did CT show all bone erosions detected by radiography and MRI,but CT revealed bone erosive destruction that were not identified by radiography in 10 hips and by MRI in 1 hip as well.Abnormal changes were detected in 10.3％ (6/58)by radiography,27.6％ (16/58) by CT,and 77.6％ (45/58) by MRI.The sensitivity of MRI in the identification of hip involvement is higher than that of radiography and CT ( x2 =53.22 and 29.08,P ＜ 0.05 ).In addition to chronic bone structural changes,MRI depicted acute inflammatory changes which could not be detected by radiography and CT.ConclusionsMRI can detect early acute inflammatory changes of hip joint that can not be showed by radiography and CT.Effusion of joint and synovial enhancement caused by synovitis are the most common MRI findings of the hip in patients with AS.
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Objective To compare X-ray,CT,and MRI in detection of abnormal sacroiliac joint changes in patients with early stage of ankylosing spondylitis (AS).Methods Fifty-three patients with clinical suspected early stage of AS underwent X-ray and MRI scan.MR scan sequences for the sacroiliac joints consisted of T1-weighted,T2-weighted,short time inversion recovery (STIR) and three dimensional balance turbo field echo with water selective excitation (3D-BTFE-WATS) in all patients.In 24 of the patients,fat-saturated contrast-enhanced T1-weighted was used.Twenty-five of 53 patients underwent CT scan.The Chi-square test was used to analyse the uniformity of bone erosions detected by X-ray,CT,and MRI.Results Of the 106 sacroiliac joints in 53 patients,16 sacroiliac joints with bone erosions were detected by X-ray and 63 sacroiliac joints by MRI.Of the 50 sacroiliac joints in 25 patients,26 sacroiliac joints with bone erosions were found by CT.With regard to the detection of bone erosions,there was no difference between CT and MRI (x2 =0.16,P ＞0.05 ) and there was significant difference between CT and X-ray or MRI and X-ray ( x2 =14.44 and 17.36,P ＜ 0.05 ).3D-BTFE-WATS was better than other sequences in detection of bone erosions.Acute inflammatory changes were determined by MRI,which included subchondral bone marrow edema in 32 patients,synovitis in 35 patients,fat depositions in 16 patients,enthesitis in 15 patients,capsulitis in 9 patients,and cartilaginous disruption in 31 patients.Conclusions MRI can detect acute inflammatory changes that can not display by X-ray and CT.Compared with radiography and CT,MRI is more useful in detection of abnormal sacroiliac joint changes in patients with early stage of AS.
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Objective To explore the relationship between the osteonecrotic volume (lesion size), angle and the index of necrotic extent on the femoral head. Methods Fifty-one hips in 39 patients with non-traumatic avascular osteonecrosis on the femoral head were divided into 12 equal segments from the head to the neck junction (a turning point of the spherical curve of the head) with whole hip displacement, each with 30 degrees on a coronal plane of weight-bearing surface. The osteonecrotic angle of the arc of each necrotic segment from the center of the femoral head was measured at the point of one- to 12-o'clock on imaging of two dimensional reconstruction of computerized tomography (CT) scans and anteroposterior and lateral radiographs. Necrotic volume on each segment of the femoral head was calculated with fluid displacement method. The index of osteonecrotic extent on the femoral head was calculated using direct anatomical measurements. Results Osteoneerotic volume on the femoral head at the point of 12- to one-o'clock on coronal plane was (74. 5 ± 7.4)% of the sphere equivalent of the whole femoral head, which was positively correlated to its necrotic angle [ (41.9±8. 3) degrees] at the point of one-o'clock on the plane, with a coefficient of correlation of 0. 843, and that at the point of one- to two-o'clock on the plane was (73.7 ±0. 4) %, which was positively correlated to its necrotic angle [ (41.9 ± 1.8) degrees] at the point of two-o'clock, with a coefficient of correlation of 0. 543. Osteonecrotic volume on the point of 11- to 12-o'cleck was (83.6±8.6)%, and the necrotic angle at the point of 12-o'clock was (44. 9±3.9) degrees, which were positively correlated each other, with a coefficient of correlation of 0. 701 (P <0. 01 ). Osteonecrotic volume on the femoral head was positively correlated to its necrotic angle , modified index of necrotic extent, index of necrotic extent and Kerboul conjugated necrotic angle, with coefficients of correlation of 0. 798, 0. 701, 0. 377 and 0. 398 ( P < 0. 01 ), respectively, at the point of one o' clock. Conclusions Measurements of osteonecrotic volume was positively correlated to the index of necrotic extent and necrotic angle on the femoral head, respectively. Necrotic angle on the plane at 30-degree of the trochanter on the femoral head can well reflect its necrotic volume.
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Objective To prospectively assess the therapeutic procedure and outcome of MR-guided percutaneous sclerotherapy in patients with venous vascular malformations of the extremities. Methods Fifty-seven percutaneous sclerotherapy treatments were performed under MR guidance in 28 patients with venous vascular malformation. Assessment was conducted to analyze (1) individual success of therapy, (2) improvement of clinical symptoms, ( 3 ) occurrence of complications, (4) volume changes at follow-up examinations, (5) contrast-to -noise ration (CNR) changes. Paired-t test was used to compare the volume and CNR of pre- and postintervention. Results All MR-guided percutaneous sclerotherapy were performed successfully and without serious complications. Individual predominant symptoms were improved, especially about the pain and functional impairment. The mean lesion volumes of pre- and post-intervention were (56. 8 ± 11.7 ) cm3 and ( 27.0 ± 7.2 ) cm3 respectively, which showed significant difference ( t = 8. 90, P < 0. 01 ). The percentage of volume shrinkage ranged from 28. 5% to 74. 4% [ mean ( 54. 4 ± 5. 3 ) % ]. The CNR of the pre and post-interventional images were 21.9 ± 2. 0 and 8.4 ± 0. 9 respectively. There was significant difference(t = 21.76, P < 0.01 ) between them, and the percentages of CNR decrease were 40.0% to 78. 0% [ the mean(61.0 ± 3.6)%]. Conclusion MR-guided sclerotherapy of venous vascular malformations of the extremities is a safe and efficient technique.
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Objective To analyze the MRI characters of hemodialysis-related osteoarthropathy in long-term dialysis recipients, and to evaluate the diagnostic value of X-ray, CT, and MRI on hemodialysis-related osteoarthropathy. Methods The shoulders, hips, wrists and lumbar vertebraes of 32 patients underwent X-ray and CT examinations. Twenty-six of them received MRI examinations. Results In X-ray of 32 patients, 28 appeared osteoporosis, 11 showed bone resorption, 6 had cystic lesions, 11 had bone sclerosis, 1 had joint swelling, and 19 had soft tissue calcification. In CT of 32 patients, 32 appeared osteoporosis, 9 showed bone resorption, 12 had cystic lesions, 11 had bone sclerosis, 3 had joint swelling, and 19 had soft tissue calcification. In MRI of 26 patients, 6 appeared osteoporosis, 2 showed bone resorption, 14 showed cystic lesions, 5 had bone sclerosis, 15 had joint swelling, and 1 showed soft tissue calcification. Conclusions X-rays plain film is the first choice for the diagnosis of hemadialysis-related osteopathy, and MRI is the first choice for the diagnosis of hemedialysis-related arthropathy. CT and MRI is pretty useful in the diagnosis of hemodialysis-related osteoarthropathy.
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Objective To evaluate CT-guided pereutaneous biopsy and fine needle aspiration in diagnosing malignant musculoskeletal tumors. Methods CT-guided percutaneous biopsy and fine needle aspiration was performed in 106 cases with suspected musculoskeletal tumor. The pathological results obtained from biopsy specimens were compared with clinical final pathological diagnoses. Results All 106 cases were finally diagnosed as suffering from malignant musculoskeletal tumors, which were proved by operation and incisional biopsy. Of 106 cases receiving CT-guided percutaneous biopsy and needle aspiration, the pathologic diagnosis obtained from this procedure was consistent with the clinical final pathological diagnosis in 89 and was "negative" in 17, with an accuracy rate of 84.0%. Conclusion CT-guided percutaneous biopsy and fine needle aspiration is a safe, simple and effective technique for the diagnosis of malignant musculoskeletal tumors, Incisional biopsy may be necessary when this procedure gives "negative" result.
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Objective To evaluate CT-guided percutaneous biopsy and fine needle aspiration in diagnosing malignant musculoskeletal tumors.Methods CT-guided percutaneous biopsy and fine needle aspiration was performed in 106 cases with suspected musculoskeletal tumor.The pathological results obtained from biopsy specimens were compared with clinical final pathological diagnoses.Results All 106 cases were finally diagnosed as suffering from malignant musculoskeletal tumors,which were proved by operation and incisional biopsy.Of 106 cases receiving CT-guided percutaneous biopsy and needle aspiration,the pathologic diagnosis obtained from this procedure was consistent with the clinical final pathological diagnosis in 89 and was "negative" in 17,with an accuracy rate of 84.0%.Conclusion CT-guided percutaneous biopsy and fine needle aspiration is a safe,simple and effective technique for the diagnosis of malignant musculoskeletal tumors.Incisional biopsy may be necessary when this procedure gives "negative" result.
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Objective To evaluate the feasibility, safety, and efficacy of CT-guided permanent iodine-125 implantation for malignant tumors.Methods Thirteen lesions in 10 consecutive patients with malignant tumor were treated with CT-guided iodine-125 permanent implantation brachytherapy, of which four cases were primary unresectable carcinoma and six cases were metastases. There were 4 males and (6 females,) the mean age was 56.9 years (range 54 to 62 years). Based on the CT imaging within two weeks before the implantation of the seeds, a computer-based treatment planning system was used to determine the optimal seed distribution. Subsequent CT-guided needle placement and seed implantation were carried out. Post-implant CT scans were performed immediately and five to ten months after the implantation in all cases to assess seed distribution, complication, and curative effect. Results CT-guided iodine-125 permanent implantation was accomplished smoothly in all cases. This technique offered a better seed placement. The number of seeds implanted in one lesion was 1 to 44 (mean 18.6). No acute complications and late toxicity related to the implantation were observed. Pain relief was obtained in all four patients (100%) presenting with pain. Follow-up CT demonstrated that 3 of 13 lesions disappeared completely, eight lesions diminished, and the remaining 2 lesions had no significant change in size. Mean lesion size of pre-implant and post-implant were 3.15 cm and 2.06 cm, respectively (t=5.127, P
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Objective To evaluate MR imaging of transient osteoporosis.Methods MR imaging of transient osteoporosis in eight patients was retrospectively reviewed.In all eight patients,routine scanning was performed in axial and coronal planes,including T_1-weighted and T_2-wighted images.Of the eight patients,five were male and three were female,with the age ranging from 12 to 70 years.Neither of the women was pregnant when they visited our hospital.Results The bilateral hips were affected in seven patients,the left shoulder in one.The MR images demonstrated low signal intensity in all eight patients on T_1WI,and normal signal intensity (2 cases),medium-high signal intensity (3 cases),or high signal intensity (3 cases) on T_2WI.The bone marrow edema (BME) pattern involved the acetabulum (one hip),both the femoral head in 5 hips,the femoral neck and the intertrochanteric region through the upper femur in 7 hips,and the upper humerus in one.A small joint effusion was observed in six hips on T_2WI.Conclusion MRI is useful in defining the location and extent of transient osteoporosis.
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Objective To evaluate MR imaging of peripheral nerve tumors of the lower extremity. Methods MR imaging of peripheral nerve tumors of the lower extremity in five cases proved by surgery and pathology were retrospectively reviewed. In all patients, routine scanning was performed in axial, coronal, and sagittal planes, including T 1-weighted and T 2-weighted images. In two patients (schwannomas), T 1WI were obtained following intravenous injection of Gd-DTPA. Results There were four schwannomas (three benign and one malignant) and one malignant neurofibroma. Tumors arose at the following sites: leg ( n =2), popliteal region ( n =1), thigh ( n =1), and femoral region ( n =1). On T 1WI, tumors generally showed isointensity (two benign schwannomas) or lower-medium signal intensity to adjacent muscle with minimal inhomogeneity (one benign schwannoma, one malignant schwannoma, and one malignant neurofibroma). On T 2WI, tumors demonstrated inhomogeneous high signal intensity in all five patients. The target sign with peripheral hyperintense rim and central low intensity was see in two benign schwannomas on T 2WI. Conclusion MRI is useful in defining the location and extent of a lesion and in assisting the surgical planning. The target pattern appears to be a useful sign in the diagnosis of peripheral nerve tumors.
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Objective To evaluate the influence of lesion size and depth on the diagnostic accuracy and the rate of pneumothorax in patients undergone CT-guided transthoracic aspiration biopsy for pulmonary lesions.Methods CT-guided percutaneous transthoracic biopsy was performed in 398 patients that had surgical resection or clinical follow-up.According to lesion size,lesions were divided into≤2 cm,2～4 cm and ≥4 cm.Lesion depth was measured from the pleura surface to the edge of the lesion.This depth was classified in three categories:≤1 cm,1～3 cm and ≥3 cm.Comparison of the diagnostic accuracy and the frequency of pneumothorax in different size and depth of lesion was performed.Results(1)The overall diagnostic accuracy of CT-guided percutaneous needle aspiration biopsy was 83.2%(331/398).Pneumothorax occurred in 58(14.6%)of 398 biopsy;(2)The diagnostic accurate rate in different size of lesion was 73.3%(44/60),81.5%(176/216)and 91.0%(111/122)respectively,?2=9.91,P0.05.The occurred rate of pneumothorax in different depth lesion was 2.8%(4/141),14.8%(21/142)and 28.7%(33/115),?2=34.03,P
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Objective To explore the safety and efficacy of minimally invasive percutaneous nephrolithotomy (MPCNL) for pediatric upper urinary tract calculi. Methods We retrospectively reviewed the clinical data of 35 pediatric patients with upper urinary tract stones treated by MPCNL in our hospital. The series consists of 29 boys and 6 girls with a mean age of 8.5 years (4 to 13 years). Among the 35 cases,7 children had proximal ureteral stones and 28 showed renal stones; 2 of the patients were complicated with ureteropelvic junction obstruction (UPJ). Results Totally 31 (88.6%) of the 35 cases were cured by MPCNL. The one-session success rate was 87.1% (27/31),and two-session success rate was 75% (3/4). Four patients were converted to open surgery because of UPJ-caused ureteral stenosis under the level of the calculi or failure in percutaneous renal puncture. Conclusion MPCNL is safe and effective for renal calculi and proximal ureteral calculi in children.
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Objective To study the effects of human bronchial epithelial cells (BEAS-2B cells ) coculture together with human eosinophils on intercellular adhesion molecule (ICAM-1) expression on BEAS-2B cell surface.Methods BEAS-2B cells cocultured contact with eosinophils for 4 h and 12 h,total RNA was extracted and ICAM-1 gene in BEAS-2B cells were analyzed by reverse transcription polymerase chain reaction (RT-PCR); ICAM-1 protein on BEAS-2B cell surface was assayed by fluorescent antibody in flow cytometry.Results ICAM-1 gene expression in BEAS-2B cells was upregulated and ICAM-1 protein on BEAS-2B cell surface increased by coculture with eosinophils.Conclusion Coculture of BEAS-2B cells and eosinophils might induce BEAS-2B cells to express ICAM-1.
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Objective To investigate the factors influencing the diagnostic accuracy in CT-guided percutaneous transthoracic aspiration biopsy of lung lesions. Methods CT-guided percutaneous transthoracic biopsy was performed in 435 patients with surgical pathologic confirmation or clinical follow-up.Univariant statistical analysis and multivariant stepwise Logistic regression analysis were used to study the influence of lesion-related factors(benignancy or malignancy,size,location,depth,presence of cavity),procedure factors(laser-guidence,position of patient) and patient-related factors(sex,age,presence of emphysema);with the accuracy of the diagnosis. Results ① 289 lesions were diagnosed as malignant ones and 146 as benign ones.The accuracy of CT-guided biopsy was(83.4%)(363/435).Univariant analysis showed that the diagnostic accuracies for malignant and benign lesions were(88.9%)(257/289) and(72.6%)(106/146),respectively(?~2=(18.71),P=(0.00002)).Laser-group was superior to non-laser group((88.4%) versus(80.9%),respectively,?~2=(4.00),P=(0.0456)).Mean diameters of lesions in correct diagnostic group and non-correct diagnostic group were(3.78)?(1.64) cm and(3.02)?(1.26) cm,respectively((F=)(13.79),P=(0.0002)).②Multivariant stepwise Logistic regression analysis showed that among the various factors influencing the final benign or malignant diagnoses(Wald ?~2=(14.01),P=(0.0002)) and using laser-guidence(Wald ?~2=(3.92),P=(0.0477)) were significantly associated with the diagnostic accuracy. Conclusions Final correct diagnoses(benign,malignant) are closely related to the application of laser-guidence for determining the diagnostic accuracy in CT-guided transcutaneous thoracic needle aspiration biopsy.
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Objective To investigate nontraumatic avascular necrotic of the femoral head with different etiology whether or not having similar MRI and pathologic findings.Methods MRI features of nontraumatic avascular necrosis of the femoral head caused by differant etiology in 98 patients(152 hips) were retrospectively analysed.The causes of osteonecrosis of the femoral head included steroid-induced in 49 patients(86 hips),alcoholic in 18 patients(25 hips) and idiopathic cause in 31 patients(41hips).Gross section and pathologic examinations were performed on 34 femoral heads obtained after total hip replacement from 25 patients.Results Osteonecrosis of the femoral head with different etiology occurred at the anterior superior part of femoral head.The necrotic zones both on pathological gross section and MRI were consisted of cartilage,necrotic focus,proliferative zone and normal bony zones along the lesions.The proliferative zone surrounded necrotic area was low signal intensity on both T1WI and T2WI.There was correlations between localized MRI signal behavior and specific histopathologic features of femoral head osteonecrosis.Conclusion Nontraumatic osteonecrosis of the femoral heads associated with different etiology have similar characteristics on both MRI and pathology