腮腺肿块的电子束CT平扫、腮腺造影CT和三维CT的对比研究

目的探索电子束CT平扫(EBCT)、腮腺造影CT和三维CT对腮腺肿块诊断的优缺点。材料与方法对43例腮腺肿块分别进行EBCT平扫、60％泛影葡胺腮腺造影CT扫描、腮腺造影图像应用四种方法进行三维重建,显示结果进行统计学分析和与手术病理结果对照分析。结果腮腺造影CT较EBCT平扫对腮腺肿块的显示更为准确,三维CT对腮腺内导管的显示较腮腺造影CT更为理想。容积显示法三维重建对腮腺内导管的显示较好,而表面显示法三维重建有利于显示病变与周围骨结构的关系。结论EBCT、腮腺造影和三维重建对腮腺肿块的诊断具有重要的应用价值。     

腮腺区肿块性病变的CT检查

本文分析了１５例腮腺区肿块性病变的ＣＴ表现，着重讨论了腮腺ＣＴ平扫，静脉团注射法增强，腮腺造影ＣＴ扫描的优缺点，腮腺良恶性肿块及腮腺内外肿块的诊断和鉴别诊断。     

腮腺肿瘤的CT诊断

目的：评价ＣＴ检查对腮腺肿瘤的诊断价值。方法：１６例腮腺肿瘤均经病理学确诊。８例ＣＴ平扫,其中４ 例加增强,另８例造影后ＣＴ扫描并作三维成像。肿瘤按ＣＴ表现分三类：Ⅰ　形态规则,边缘清楚;Ⅱ　形态不规则,边界模糊;Ⅲ　形态不规则,边界无法确定。结果：１６例中良性肿瘤９例,恶性７例;浅叶肿瘤９例,深叶４例,复发性肿瘤３ 例。Ⅰ类６ 例均为良性,病理上包膜完整,无粘连;Ⅱ类７ 例中良性３ 例,恶性４例,病理上包膜不完整或无包膜,有粘连;Ⅲ类３例均为恶性,病理上无包膜,邻近结构受侵犯。腮腺造影后ＣＴ扫描显示较ＣＴ平扫和增强清楚;三维成像可多方位显示,更直观。结论：ＣＴ检查有助于腮腺肿瘤的定位和定性诊断,腮腺造影后ＣＴ扫描优于普通ＣＴ,三维成像是一种有益的影像补充。     

60％泛影葡胺重症过敏8例报告

６０％泛影葡胺重症过敏８例报告北京酒仙桥医院ＣＴ室曹连义，朱风丽ＣＴ扫描中很多患者需要增强扫描，以帮助诊断。我科自１９８７—０３～１９９１—１２共计有８０００人次应用６０％泛影葡胺增强扫描，遇到８例重症过敏患者，现报告如下。一般资料１．１８例中男性５...     

腮腺混合瘤的CT分析

本文收集我院 1992～ 1998年行ＣＴ检查并经手术病理证实为腮腺混合瘤 41例 ,加以回顾性分析以归纳其ＣＴ表现。1　资料与方法1.1　资料　腮腺混合瘤 41例 ,男 3 1例 ,女 10例 ,年龄 3 0～ 65岁 ,平均 (4 7.5± 17.5 )岁。所有患者均以发现耳下方肿块就诊 ,病程 2 0ｄ～ 2年 ,体检于腮腺区触及质软或略硬肿块 ,无压痛 ,手术切除病理证实为腮腺混合瘤。1.2　方法　使用日本岛津 45 0 0 -ＴＦＣＴ扫描机 ,行ＣＲ图像平行肿块轴位定位 ,全部病例均行平扫及增强扫描 ,层厚 5ｍｍ ,层距 5ｍｍ ,扫描时间 2 .8ｓ。造影剂为 60 %泛影葡胺 5 0ｍｌ,…     

脾结核1例报告

病人　女,３３岁。不明原因突然感四肢麻木无力、双手指发麻,轻度头痛、恶心,同时感右侧腰痛,血压１７／１３ｋＰａ。Ｂ超：脾脏厚４．８ｃｍ,于其下极可见大小约５．５ｃｍ×５．０ｃｍ偏低回声肿块,边界清,内部回声欠均匀。诊断为脾脏实性占位,脾大。ＣＴ：上腹部ＣＴ平扫＋增强ＣＴ扫描。脾脏明显增大,平扫时显示有一约５ｃｍ×５ｃｍ大小略低密度影,边缘尚光整（图１）。注入６０％复方泛影葡胺８０ｍｌ（静脉快速注入）增强扫描显示脾脏内低密度病灶更加清晰,注射造影剂后延迟６′,１０′脾脏内低密度病灶略有缩小,但未被…     

纵隔巨大淋巴结增生的CT诊断（附四例报告）

巨大淋巴结增生是一种少见的淋巴结特发性增大的良性疾病，多发生在纵隔，常误诊为纵隔肿瘤。本研究的目的是提出本病的ＣＴ征象，以及纵隔肿瘤鉴别。经手术、病理证实的纵隔巨大淋巴结增生４例。ＣＴ平后用６０％泛影葡胺１００ｍｌ团注法行增强扫描。纵隔窗观察，窗宽３５０ＨＵ，窗位３５ＨＵ。本病平扫时显示为软组织肿块，呈圆形或椭圆形，边缘光整，密度均匀，钙化发生率低。     

高压注射器与手推泛影葡胺在CT增强扫描中副反应的对比研究

增强扫描是ＣＴ诊断技术中很重要的一个步骤,目前一般医院多采用静脉团注法,笔者通过对１３４９例应用高压注射器与９４０例应用手推泛影葡胺造影剂引起副反应进行对比分析。１材料与方法２２８９例病人的增强造影剂全部使用６０％泛影葡胺注射液,其中９４０例采用手推...     

恶性滋养叶细胞肿瘤子宫造影诊断价值

目的：研究７６％复方泛影葡胺子宫造影能否用于恶性滋养叶细胞肿瘤的诊断和疗效观察。方法：２４例恶性滋养叶细胞肿瘤病人在化疗前后共进行４２次复方泛影葡胺子宫造影，对造影征象及临床指标进行了对比观察。结果：恶性滋养叶细胞肿瘤其子宫造影片有特征性Ｘ线表现；Ｘ线片系列观察能反映子宫病灶的变化。结论：在恶性滋养叶细胞肿瘤的诊断和疗效观察中，７６％复方泛影葡胺子宫造影是一种安全、易行、实用的方法。     

数字减影支气管造影的临床应用

目的：利用数字减影技术改善碘支气管造影影像及副作用。材料和方法：应用数字减影支气管造影（ＤＳＢ）技术共检查３５例患者，其中１９例选用７６％泛影葡胺磺胺混悬液，１２例用２０％泛影葡胺、４例用稀释的优维显（Ｕｌｔｒａｖｉｓｔ）做造影剂。结果：３５例ＤＳＢ影像均达优质，但用低浓度泛影葡胺病例的术中术后不良反应明显低于高浓度泛影葡胺。根据ＤＳＢ影像诊断支气管扩张１１例，支气管炎５例，支扩并支气管炎１５例、肺结核１例、支气管狭窄２例、正常１例。结论：ＤＳＢ技术可明显降低碘水的使用浓度，减少副反应，而且图像优良、易于实施。     

CT 对腮腺区肿块的诊断价值

评价ＣＴ对腮腺肿瘤的诊断价值。方法８８例腮腺区肿瘤进行ＣＴ平扫,ＣＴ增强扫描和／或腮腺造影ＣＴ扫描。结果：７８例为腺内肿瘤,其中７例为恶性;１０例为腺肿瘤。对ＣＴ肋腺区肿瘤定位准确,能准确显示肿瘤的范围,大小,数目及浸润情况。     

Three-dimensional processing of ultrafast CT sialography for parotid masses.

PURPOSETo evaluate the diagnostic potential of three-dimensional image processing of ultrafast CT sialography in comparison with conventional CT sialography in patients with parotid masses.METHODSIn nine patients, CT sialography was done with three-dimensional image processing. The visibility of anatomic details and pathologic findings, derived from three-dimensional images, were graded numerically by three observers and compared with the findings obtained from conventional CT sialograms. Histopathologic specimens were obtained in all cases.RESULTSUltrafast CT images showed no motion artifact. Three-dimensional CT sialography offered significant improvement in demonstration of ductal anatomy (2.5 +/- 0.2 versus 1.5 +/- 0.1, respectively) and ductal pathology (2.6 +/- 0.1 versus 1.1 +/- 0.2, respectively) over conventional CT sialography. In two cases, the therapeutic regimen was altered substantially.CONCLUSIONUltrafast CT three-dimensional sialography has the potential to allow more precise presurgical planning and contributes to the diagnosis and therapy planning of parotid masses, especially in patients in whom MR image quality is degraded by motion artifact.     

Sialography, echography and computerized tomography in the study of the parotid region

The diagnostic accuracy of sialography and ultrasonography (US) in the evaluation of parotid masses is evaluated. Furthermore the role of computed tomography (CT) in this pathology is discussed. In the personal experience US proved to be the best method in the recognition of a parotid tumor while sialography was superior in defining the intra or extraparotid site. The two investigations showed the same accuracy in the definition of benign or malignant nature of the mass. Therefore we consider US the only investigation in most instances; sialography could be performed when the site of the lesion is uncertain or an inflammatory lesion is suspected. CT is never the first investigation; its use is limited to a low number of cases, mainly for the evaluation of large masses and when the association US-sialography does not allow a sure diagnosis.     

Retrospective study of the effectiveness of high-resolution ultrasound compared with sialography in the diagnosis of Sjogren's syndrome

OBJECTIVE: This report aimed to evaluate the effectiveness of high-resolution ultrasound compared with conventional sialography in the diagnosis of Sj?gren's syndrome (SS) and to establish whether less invasive ultrasound could replace sialography as a diagnostic investigation. METHOD: Clinical records and examination results of 105 consecutive subjects investigated contemporaneously by ultrasound and sialography of the parotid glands for SS were reviewed retrospectively. Results were compared against the final diagnosis established on the basis of revised international classification criteria for SS. 45 subjects were excluded from the study due to incomplete records. Of 60 remaining subjects under investigation for SS, 45 were confirmed (36 primary SS, 9 secondary SS), the remaining 15 subjects being proven not to have the condition. RESULTS: Ultrasound showed a decreased and heterogeneous honeycomb pattern of parotid gland reflectivity in patients with SS, while sialography demonstrated a punctate pattern of sialectasis. Sensitivity, specificity and accuracy for ultrasound were 84.44%, 73% and 81.6%, respectively, and for conventional sialography were 77.77%, 86.66% and 80%, respectively. The diagnostic difference between the two investigations approached significance (P = 0.074). By combining both imaging modalities, sensitivity increased to 91% with 60% specificity and 83.3% accuracy. There was no significant difference between investigations when diagnosing primary vs secondary SS. CONCLUSION: High-resolution ultrasound is a useful, non-invasive and more sensitive alternative to sialography as a diagnostic test in patients with suspected SS. Accuracy may be increased by supplementing ultrasound with sialography.     

Evaluation of the parotid gland. Comparison of sialography, non-contrast computed tomography, and CT sialography

Sialography, non-contrast computed tomography (NCCT), and CT sialography (CTS) were compared in 40 patients with parotid disease. While NCCT and CTS proved to be superior to sialography in most cases, with NCCT being as good as CTS for demonstration of parotid masses, sialography was preferred over both NCCT and CTS for evaluation of inflammatory disease. The role of percutaneous needle aspiration is discussed, and protocols for evaluation of both parotid masses and inflammatory disease are presented.     

Sialography and CT-sialography in the diagnosis of parotid masses

Parotid masses were evaluated by sialography and CT-sialography in 22 patients. Nineteen were benign tumors and one a metastasis. All were identified by CT. Two patients with sialoadenitis were misinterpreted at CT. All benign tumors appeared as lobulated, sharply marginated masses, embedded in displaced glandular parenchyma. The metastasis was lobulated, irregular and located within the gland. With sialography, 17 tumors were identified and 3 small superficial tumors overlooked. Both patients with sialoadenitis were diagnosed by sialography. CT-sialography is recommended in patients with suggested parotid masses, and sialography in suggested inflammatory disease.     

A comparative study of the effective radiation doses from cone beam computed tomography and plain radiography for sialography

Objectives

As a first step in developing a protocol for multidimensional sialography using cone beam CT (CBCT), the objective of this study was to compare the effective radiation doses from sialography of the parotid and submandibular glands using plain radiography and CBCT.

Methods

The effective doses were calculated from dose measurements made at 25 selected locations in the head and neck of a radiation analogue dosimeter (RANDO) phantom, using International Commission on Radiological Protection 2007 tissue weighting factors.

Results

The effective dose (E) changed in relationship to changes in CBCT field of view (FOV), peak kilovoltage (kVp) and milliamperage (mA). Specifically, E decreased from a maximum of 932 μSv (30 cm FOV, 120 kVp, 15 mA) to 60 μSv (15 cm FOV, 80 kVp, 10 mA) for a parotid gland study and to 148 μSv (15 cm FOV, 80 kVp, 10 mA) for a submandibular study. The collective series of plain radiographs made during sialography of the parotid and submandibular glands yielded effective doses of 65 μSv and 156 μSv, respectively. The plain parotid gland series included one panoramic, two anterior–posterior skull and four lateral skull radiographs, whereas the submandibular gland series included one panoramic, one standard mandibular occlusal and four lateral skull radiographs.

Conclusion

The effective doses from CBCT examinations centred on the parotid and submandibular glands were similar to those calculated for plain radiograph sialography when a 15 cm FOV was chosen in combination with exposure conditions of 80 kVp and 10 mA.     

Sialolithiasis and salivary ductal stenosis: diagnostic accuracy of MR sialography with a three-dimensional extended-phase conjugate-symmetry rapid spin-echo sequence

PURPOSE: To evaluate the accuracy of magnetic resonance (MR) sialography in detecting salivary glandular calculi and ductal stenoses. MATERIALS AND METHODS: In a prospective study, 64 salivary glands in 61 consecutive patients with acute or recurrent parotid or submandibular glandular swelling were examined by using three-dimensional (3D) extended-phase conjugate-symmetry rapid spin-echo (EXPRESS) MR imaging. Transverse and sagittal-oblique source images and maximum intensity projection images were obtained. All MR images were analyzed independently by two radiologists, without knowledge of the final diagnosis. The reference standard was conventional sialography, ultrasonography (US), and sialendoscopy with or without surgery in 31 glands and was conventional sialography and US in 33 glands. RESULTS: Final diagnoses included sialolithiasis (n = 23), sialolithiasis and stenosis (n = 9), stenosis without lithiasis (n = 11), early Sj?gren syndrome without ductal stenosis (n = 2), ductal displacement (n = 3), and normal salivary glands (n = 16). The sensitivity, specificity, and positive and negative predictive values of MR sialography to detect calculi were 91%, 94%-97%, 93%-97%, and 91%, respectively. False-negative readings occurred due to calculi with a diameter of 2-3 mm in nondilated salivary ducts. Ductal stenosis was assessed, with a sensitivity of 100%, specificity of 93%-98%, positive predictive value of 87%-95%, and negative predictive value of 100%. Interobserver agreement was very good (kappa = 0.85-0.97). CONCLUSION: MR sialography with 3D EXPRESS imaging enables reliable prediction of salivary gland calculi and stenoses.