结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

A report of two cases

A set of related medical disorders that lack a proper classification system and diagnostic criteria is like a society without laws. The result is incoherence at best, chaos at worst. For this reason, the International Classification of Headache Disorders (ICHD) is arguably the single most important breakthrough in headache medicine over the last 50 years. The ICHD identifies and categorizes more than a hundred different kinds of headache in a logical, hierarchal system. Even more important, it has provided explicit diagnostic criteria for all of the headache disorders listed. The ICHD quickly became universally accepted, and criticism of the classification has been minor relative to that directed at other disease classification systems. Over the 20 years following publication of the first edition of the ICHD, headache research has rapidly accelerated despite sparse allocation of resources to that effort. In summary, the ICHD has attained widespread acceptance at the international level and has substantially facilitated both clinical research and clinical care in the field of headache medicine.

International Classification of Headache Disorders

Foundations of Clinical Research: Applications to Practice, 2nd Edition, Leslie Gross Portney, Mary P. Watkins. Prentice Hall, Upper Saddle River, NJ (2000), 752 pages. $60

Among the various disorders manifesting dementia, gait disturbance, and urinary incontinence in the elderly population, idiopathic normal pressure hydrocephalus (iNPH) is becoming of great importance. After the publication of the first edition of the Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus in 2004 (the English version was published in 2008), clinical awareness of iNPH has risen dramatically, and the number of shunt surgeries has increased rapidly across Japan. Clinical and basic research on iNPH has increased significantly, and more high-level evidence has since been generated. The second edition of the Japanese Guidelines was thus published in July 2011, to provide a series of timely evidence-based recommendations related to iNPH. The revision of the Guidelines has been undertaken by a multidisciplinary expert working group of the Japanese Society of Normal Pressure Hydrocephalus in conjunction with the Japanese Ministry of Health, Labour and Welfare research project on "Studies on the epidemiology, pathophysiology, and treatment of normal pressure hydrocephalus." This English version of the second edition of the Guidelines was made to share these ideas with the international community and to promote international research on iNPH.

Guidelines for management of idiopathic normal pressure hydrocephalus: second edition.

The aim of this study was to describe the magnetic resonance imaging (MRI) findings in patients with ischiofemoral impingement (IFI) and to evaluate the reliability of these MRI findings. Seventy hips of 50 patients with hip pain and quadratus femoris muscle (QFM) edema and 38 hips of 30 control cases were included in the study. The QFM edema and fatty replacement were assessed visually. Ischiofemoral space (IFS), quadratus femoris space (QFS), inclination angle (IA), hamstring tendon area (HTA), and total quadratus femoris muscle volume (TQFMV) measurements were performed independently by two musculoskeletal radiologists. The intra- and interobserver reliabilities were obtained for quantitative variables. IFS, QFS, and TQFMV values of the patient group were significantly lower than those of controls (P < 0.001). HTA and IA measurements of the patient group were also significantly higher than in controls (P < 0.05). The QFM fatty replacement grades were significantly higher in the patient group than in the control group (P < 0.001). Inter- and intra-observer reliabilities were strong for all continuous variables. Clinicians and radiologists should be aware of IFI in patients with hip or groin pain, and MRI should be obtained for the presence of the QFM edema/fatty replacement, narrowing of the IFS-QFS, and other features that may help in the clinical diagnosis of IFI for the proper diagnosis and treatment of the disease.

Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability.

The aim of this prospective study was to evaluate the value of unenhanced (three-dimensional constructive interference in steady state (3D-CISS)) and contrast-enhanced MR cisternography (CE-MRC) in detecting the localisation of cerebrospinal fluid (CSF) leak in patients with rhinorrhoea. 17 patients with active or suspected CSF rhinorrhoea were included in the study. 3D-CISS sequences in coronal and sagittal planes and fat-suppressed T1-weighted spin-echo sequences in three planes before and after intrathecal contrast media administration were obtained. Images were obtained of the cribriform plate and sphenoid sinus. In addition, high-resolution CT (HRCT) was performed in order to evaluate the bony elements. The leak was present in 9/17 patients with 3D-CISS and 10/17 patients with CE-MRC. The leak from the cribriform plate to the nasal cavity in six patients and from the sphenoid sinus in four patients was nicely shown by CE-MRC. Eight of those patients were surgically treated, but spontaneous regression of the symptoms in two precluded any intervention. The leak localisations shown with CE-MRC were fully compatible with surgical results. The sensitivities of HRCT, 3D-CISS and CE-MRC for showing CSF leakage were 88%, 76% and 100%, respectively. In conclusion, 3D-CISS is a non-invasive and reliable technique, and should be the first-choice method to localise CSF leak. CE-MRC is helpful in conditions when there is no leak or in complicated cases with a positive beta2-transferrin measurement.

/pdf/the-contribution-of-3d-ciss-and-contrast-enhanced-mr-2jdeeghxzl.pdf

The contribution of 3D-CISS and contrast-enhanced MR cisternography in detecting cerebrospinal fluid leak in patients with rhinorrhoea

CE-MRC has been in use for the past 15 years and was reported to be a useful method in the evaluation of CSF disorders and hydrocephalus. The use of CE-MRC in conjunction with other MR imaging techniques has been shown to be effective in selected cases for the evaluation of several disorders of cerebrospinal system. CE-MRC has certain advantages over other cisternographic studies with fewer side effects if performed properly. Although intrathecal Gd administration is not widely accepted yet, several recent studies have reported the safety of small-dose intrathecal gadolinium injection. In this review, we describe CE-MRC and review recent applications in several clinical conditions.

http://www.ajnr.org/content/ajnr/34/1/14.full.pdf

Intrathecal Gadolinium-Enhanced MR Cisternography: A Comprehensive Review

MRI is not only beneficial in the diagnosis of cerebrospinal fluid (CSF)-related diseases, but also aids in planning the management and post-surgery follow-up of the patients. With recent advances in MRI systems, there are many newly developed sequences and techniques that rapidly enable evaluation of CSF-related disorders with greater accuracy. For a better assessment of this group of disorders, radiologists should follow the developments closely and should be able to apply them when necessary. In this pictorial review, the role of MRI in the evaluation of hydrocephalus, CSF diversion techniques, and other CSF disorders is illustrated. Teaching Points
 • The 3D-SPACE seems to be most efficient technique for evaluation of hydrocephalus and ventriculostomy. • In complex cases, PC-MRI, 3D-heavily T2W, and/or CE-MRC images may prevent false results of 3D-SPACE. • MRI is beneficial in the diagnosis and management of hydrocephalus and other CSF-related diseases.

/pdf/evaluation-of-hydrocephalus-and-other-cerebrospinal-fluid-51yxq6od31.pdf

Evaluation of hydrocephalus and other cerebrospinal fluid disorders with MRI: An update

Introduction
In the current study, we aimed to compare the diagnostic efficacies of phase-contrast magnetic resonance imaging (PC-MRI) and three-dimensional constructive interference in steady-state (3D-CISS) sequence over detection of aqueductal stenosis (AS) on the basis of contrast-enhanced magnetic resonance cisternography (MRC).

Oktay Algin

Papers

Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability.

The contribution of 3D-CISS and contrast-enhanced MR cisternography in detecting cerebrospinal fluid leak in patients with rhinorrhoea

Intrathecal Gadolinium-Enhanced MR Cisternography: A Comprehensive Review

Evaluation of hydrocephalus and other cerebrospinal fluid disorders with MRI: An update

Phase-contrast MRI and 3D-CISS versus contrast-enhanced MR cisternography on the evaluation of the aqueductal stenosis