RS-EPI序列在前列腺肿瘤DWI中的临床应用价值

目的：通过比较前列腺肿瘤的分段读出平面回波成像（RS—EPI）和单次激发平面回波成像（SS-EPI）的影像表现,探讨RS-EPI在前列腺肿瘤诊断中的应用价值。方法：回顾性分析34例行3．0TMRISS-EPI和RS-EPI检查并经穿刺活检确诊为前列腺肿瘤患者的病例资料。由两位影像医生在不提供任何临床及MRI序列信息的情况下,针对扩散加权成像（DWI）图像的病灶显示清晰程度、几何变形、空间分辨力、诊断信心四个方面按5个等级（1～5分）进行独立评分,由第三位影像医生在工作站上半定量测量图像的信噪比（SNR）、对比度和对比噪声比（CNR）并进行统计学分析。结果：RS-EPI序列上病灶显示清晰程度（K=0．649,P〈0．001）、图像变形（K=0．599,P〈0．001）、空间分辨力（K=0．768,P〈0．001）、诊断信心（K=0．622,P〈0．001）等方面,两位医师的评分具有良好的一致性。SS-EPI序列上,病灶显示清晰程度（K=0．587,P〈0．001）、图像变形（K=0．554,P〈0．001）、空间分辨力（K=0．640,P〈0．001）、诊断信心（K=0．597,P〈0．001）等方面,两位医师的评分具有良好的一致性。RS-EPI和sS-EPI序列的平均分值如下：病灶显示清晰程度分别为4．56和3．85分,几何变形分别为4．34和3．28分,空间分辨力分别为4．41和2．84分,诊断信心分别为4．34和3.74分,SNR分别为173．49和234．78,对比度分别为6．29和7．23,CNR分别为144．98和202．13。结论：基于RS-EPI序列的高分辨力DWI与SS-EPI序列相比明显提高了图像质量,更有利于前列腺肿瘤的显示。     

情绪记忆中杏仁核和海马作用的fMRI

目的：通过行为学和功能磁共振成像方法,检测杏仁核和海马激活情况,探讨内侧颞叶结构参与情绪记忆增强效应的认知神经机制。方法：20例受试者,实验材料采用160帧彩色情景图片。实验过程分为编码和提取两个阶段,编码阶段要求受试者观看图片并记住,编码同时进行功能磁共振扫描,提取阶段将80帧旧图片和80帧新加入的图片随机呈现,要求受试者通过按键尽快且尽可能准确地判断新、旧图片,记录行为学成绩。采用SPM2分析软件对功能成像数据进行分析。结果：受试者对情绪图片的记一也成绩为（2．82±0．16）分,较中性图片的记忆成绩（1．75±0．18）分显著增强（t=3．73,P〈0．001）;功能成像显示,双侧杏仁核（左侧：r=0．49,P=0．028,右侧：r=0．66,P=0．001）和海马（左侧海马和海马旁回r=0．56,P=0．010,右侧海马r=0．70,P=0．001）与增强效应显著相关（类聚块阈值r〉0．44,P〈0．05）。结论：情绪增强效应主要与杏仁核和海马密切相关,提示内侧颞叶在情绪记忆中具有重要作用。     

不同图像采集和处理对^67Ga显像质量及病灶探查的影响

目的分析平面显像、非衰减校正（NAC）断层显像和CT衰减校正（AC）断层显像等^67Ga显像图像采集和处理模式对图像质量和病灶判断的影响。方法用美国GE Millennium^TM VG 5型SPECT／CT仪对31例活动期肺结节病患者行^67Ga平面显像、胸部NAC断层显像;并对断层图像行CTAC。图像分析：双盲法阅片,判断平面图像、AC和NAC断层图像的图像质量及病灶数;测量病变与周围正常组织的放射性计数,并测量其比值。采用SPSS10．0软件,行配对t检验和,检验。结果图像质量按照平面显像、NAC、AC顺序依次提高（χ^2=25．880,P〈0．001）。以活动期结节病患者SPECT／CT示放射性增高的肺门、纵隔淋巴结为“病灶”,平面显像发现“病灶”70个,漏诊“病灶”8个;NAC、AC断层图像均发现“病灶”78个。NAC图像中“病灶”的放射性计数明显低于AC图像中“病灶”的放射性计数（15．240±8．865和67．241±35．049,t=-17．230,P〈0．001）。和NAC图像比较,AC图像“病灶”与肺的放射性比值增高（t=-7．520,P〈0．001）,“病灶”与肝（t=3．298,P=0．001）及“病灶”与腰椎（t=7,032,P〈0．001）的比值降低。结论^67Ga平面显像因前后组织放射性分布叠加,可能导致漏诊。^67Ga NAC断层显像能够较为准确地确定病变淋巴结的三维位置,但图像计数率低、噪声较大。AC断层图像虽未能增加检出的病灶数,但能有效提高NAC计数率,改善图像质量。     

静息门控心肌显像评价冠心病患者CABG术后早期疗效

目的应用^99Tc^m-甲氧基异丁基异腈（MIBI）心肌灌注及心室显像评价冠状动脉旁路移植（CABG）术的近期疗效。方法对52例接受CABG术的患者于手术前1周、术后3～5周分别行静息心肌灌注及心室显像，采用QGSPECT专用软件程序定量分析整体及局部心室功能，并与超声心动图检查结果进行比较。结果①术后^99Tc^m-MIBI显像示左室射血分数（LVEF）提高（P〈0．05），左室舒张末期容积（EDV）、收缩末期容积（ESV）均明显减小（P〈0．001），与超声心动图检查示EDV、ESV变化结果符合。②手术前后LVEF改变值与整体室壁运动（WM）改变值（r=0．75，P〈0．01）及整体室壁收缩增厚率（WT）改变值（r=0．51，P〈0．01）均有良好相关性；手术前后整体-12,肌血流灌注值与整体WM值（r=0．54、0．36，P均〈0．01）及整体WT值（r=0．63、0．65，P均〈0．01）均有较好的相关性。③术后心肌显像剂相对摄取值提示前壁、间隔、下壁多节段心肌灌注明显改善（P〈0．05）。④术后显像提示前壁、间隔的WM降低（P〈0．05），下壁、前侧壁、下侧壁WM明显改善（P〈0．05），并与超声心动图结果基本符合；WT仅下侧壁明显改善（P〈0．05），在间隔无变化（P〉0．05）。结论CABG术后心肌显像的WM低估间隔室壁运动，高估侧壁运动；WT与心肌血流灌注在手术前后均有较好的相关性，可能更适用于评价CABG术后心功能。     

彩色多普勒超声对颈部淋巴结结核早期诊断中的价值

目的：探讨彩色多普勒超声在颈部淋巴结结核早期诊断中的临床应用价值。方法对100例颈部肿大淋巴结进行探查分析二维及彩色多普勒超声表现。结果结核性淋巴结组与非结核性淋巴结组比较,L/S比值明显高于非结核性淋巴结组,且差异具有统计学意义（ t ＝4．28, P ＜0．05）。对比两组的血流分型情况可以发现结核性淋巴结中央的血流分型中边缘型和边缘＋中央型所占比例明显低于非结核性淋巴结组,且差异具有统计学意义（x2＝4．21、3．99, P ＜0．05）。结论超声可清晰显示颈部病变,对颈部淋巴结结核可早期诊断。     

彩色多普勒血流显像对脑卒中高危人群视网膜中央动脉血流动力学的研究

目的：探讨脑卒中高危人群视网膜中央动脉血流动力学变化。方法：采用对照研究,对180例脑卒中高危人群（观察组）和71例健康人群（对照组）进行视网膜中央动脉彩色多普勒超声检查,检测视网膜中央动脉的血流频谱,测量收缩期最大峰值血流速度（PSV）、舒张末期血流速度（EDV）和血流阻力指数（RI）。结果：观察组视网膜中央动脉血流峰值流速及舒张末期流速较对照组明显缓慢,阻力指数明显增加。观察组和对照组视网膜中央动脉PSV分别为（10．97土1．93）和（12．50士1．21）cm／s,两组间差异有统计学意义（P〈0．001）;两组的EDV分别为（3．65士0．93）和（5．26士1．01）cm／s,两组间差异有统计学意义（P〈0．001）;两组的R1分别为0．67士0．07和0．58士0．06,两组间差异有统计学意义（P〈O．001）。结论：超声多谱勒血流显像可发现脑卒中高危人群视网膜中央动脉发生的血流动力学改变,可为脑卒中患者早期干预提供依据。     

彩色多普勒检查甲状腺乳头状癌临床价值分析

目的 探讨甲状腺乳头状癌超声特征,并分析其超声表现与病变MVD的关系。方法 选择42例甲状腺乳头状癌患者进行超声学检查,并经病理证实。观察甲状腺乳头状癌的超声图像特征及多普勒超声特征。分析其血流动力学特征〔最大血流速度（Vmax）、搏动指数（Pulsation index,PI）及阻力指数（Resistance index,RI）〕与MVD的关系。结果 42例甲状腺乳头状癌患者单发37例,多发5例,平均径线（3.47±1.18）cm。边界不清34例、包膜不完整或未见包膜、回声不均匀31例、有钙化回声29例、伴有颈部淋巴结转移30例。平均MVD值为（65.54±19.21）个/HP。伴有淋巴结转移的甲状腺乳头状癌MVD值（71.34±21.21）个/HP,显著高于未合并淋巴结转移者的（55.45±18.56）个/HP（P〈0.05）。甲状腺乳头状癌多普勒超声参数Vmax值大于对照组,PI值低于对照组（P〈0.05）。甲状腺乳头状癌MVD计数与多普勒超声参数Vmax间存在显著正相关（r=4.35,P〈0.05）。结论 甲状腺乳头状癌超声学表现具有一定的特征,且MVD计数与多普勒超声参数Vmax间存在正相关。     

甲状腺功能亢进症患者SPECT脑血流灌注统计参数图分析

目的拟用SPECT脑血流灌注显像研究甲状腺功能亢进症（简称甲亢）患者脑血流改变模式,并分析可能相关因素。方法年龄、性别、文化程度相匹配的25例甲亢患者和22名健康对照者于静脉注射^99Tc^m-双半胱乙酯（ECD）1110MBq后30min行静息SPECT脑灌注显像。应用统计参数图5．0软件（SPM5）对甲亢和对照者脑灌注图像进行体素对体素的团体t检验（P〈0．05,校正）。应用基于TMairach图谱的脑功能自动提取法获取各个脑功能区的血流半定量值。血清FT3、FT4、高灵敏促甲状腺激素（sTSH）、甲状腺过氧化物酶抗体（TPOAb）、促甲状腺激素受体抗体（TRAb）浓度与脑灌注相关性应用单因素Pearson相关分析,病程与脑灌注相关性应用单因素Spearman相关分析。结果甲亢患者大脑边缘系统、额叶血流灌注减低。边缘系统血流减低的部位主要包括海马钩回、两侧海马旁回（后内嗅皮质、后旁嗅皮质、海马旁皮质、前扣带回、右侧颞下回）和左侧下丘脑及尾状核体（P〈0．05,校正）。额叶血流减低部位包括左侧前体感联合皮质、前运动皮质、额叶眼动区（t=5．87,P〈0．05,校正）。甲亢患者左侧舌回、后扣带回血流灌注与FL浓度呈负相关（r=-0．468,-0．417,P均〈0．05）。左侧舌回、两侧颞下回、右侧顶上小叶血流与FT4浓度呈负相关（r=-0．434,-0．418,-0．415,-0．459,P均〈0．05）,左侧乳头体、左侧壳核血流与FT4浓度呈正相关（r=0．419,0．412,P均〈0．05）。左侧岛叶血流与sTSH呈负相关,右侧听觉联合皮质血流与sTSH呈正相关（r=-0．504,0．429,P均〈0．05）。左侧颞中回、左侧角回血流与TRAb呈正相关（r=0．750,0．862,P均〈0．05）,右侧丘脑、右侧下丘脑、左侧前核、左侧腹侧核血流与TRAb呈负相关（r=-0．691,-0．835,-0．713,-0．759,P均〈0．05）;右侧前扣带回、右侧楔叶、右侧直回、右侧缘上回血流与TPOAb呈正相关（r=0．696,0．581,0．779,0．683,P均〈0．05）。甲亢患者中央后回、颞回、左侧缘上回、听觉联合皮质血流与病程呈正相关（r=0．502,0．457,0．524,0．440,P均〈0．05）。结论甲亢患者边缘系统、额叶脑血流减低,并与甲状腺激素、自身免疫抗体水平及病程相关。     

18F-FDG PET／CT棕色脂肪摄取的影像学规律和特点

目的分析和探讨^18F-FDGPET／CT检查中棕色脂肪组织（BAT）摄取的规律和特点。方法回顾性分析2011年7月～2012年6月间6759例次行^18F-FDGPET／CT全身检查的受检者图像,采用视觉和半定量法分析并记录各部位BAT^18F-FDG摄取的SUVmax,并采用统计学方法分析BAT^18F-FDG摄取的影像学特征。结果55例次（0．81％）有不同程度BAT摄取：显影主要出现在寒冷季节,女性比例（1．93oA）高于男性（O．59％）,平均年龄明显低于无BAT摄取者（P〈O．001）,但体重指数无显著性差异（P〉0．05）;特征性表现为对称性分布于颈部、锁骨上区、腋窝、脊柱两旁、纵隔血管间隙及肾周的摄取。BAT显影部位的数目与摄取的SUVmax呈正相关（r=0．41,P〈O．05）。结论BAT摄取具有一定的发生规律和特征表现,通过熟悉和掌握BAT图像特点,可减少PET／CT医师对BAT显影的误判。     

肺结核支气管播散的MSCT影像特征及其与血清总胆固醇浓度的关系

目的：探讨肺结核支气管播散的MSCT影像特征及其与血清总胆固醇浓度的关系。方法：回顾性分析69例伴有支气管播散的肺结核病例MSCT影像特征并统计其抗结核治疗前血清总胆固醇浓度。结果：空洞、腺泡实变融合更多出现于重度支气管播散（P〈O．001）,而树芽征少见于重度支气管播散（P〈0．001）。大片实变及支气管壁增厚在不同程度播散之间差异无显著性意义（P〉O．05）。中度、重度支气管播散血清总胆固醇浓度均低于正常对照组（t=-13．155,P〈O．001;t=-16．116,P〈0．001）;且重度支气管播散血清总胆固醇浓度低于中度支气管播散（t=4．474,P〈0．001）。结论：不同程度支气管播散肺结核影像学特征不同;血清总胆固醇浓度与肺结核支气管播散的影像学特征存在一定的相关性。     

Vascularity and grey-scale sonographic features of normal cervical lymph nodes: variations with nodal size

AIM: This study was undertaken to investigate variations in the vascularity and grey-scale sonographic features of cervical lymph nodes with their size. MATERIALS AND METHODS: High resolution grey-scale sonography and power Doppler sonography were performed in 1133 cervical nodes in 109 volunteers who had a sonographic examination of the neck. Standardized parameters were used in power Doppler sonography. RESULTS: About 90% of lymph nodes with a maximum transverse diameter greater than 5 mm showed vascularity and an echogenic hilus. Smaller nodes were less likely to show vascularity and an echogenic hilus. As the size of the lymph nodes increased, the intranodal blood flow velocity increased significantly (P < 0.05), whereas there was no significant variation in the vascular resistance(P> 0.05). CONCLUSIONS: The findings provide a baseline for grey-scale and power Doppler sonography of normal cervical lymph nodes. Sonologists will find varying vascularity and grey-scale appearances when encountering nodes of different sizes.Ying, M.et al. (2001). Clinical Radiology, 56, 416-419.     

MR乳腺线圈对腋窝淋巴结的评价

目的　研究正常与异常乳腺腋窝淋巴结的MRI表现 ,探讨MR乳腺线圈对术前乳腺癌腋窝淋巴结转移的评估。方法　应用MR乳腺线圈对 2 4例健康志愿者、2 3例乳腺良性疾病患者和 43例乳腺癌患者共 119个腋窝进行扫描 ,对比分析MRI片内各组腋窝淋巴结的形态、边缘、大小、数目和信号变化 ,并将乳腺癌组淋巴结表现与组织病理学结果进行对照。结果　 3 1.2 5 %的正常健康人腋窝可以检出淋巴结 ,乳腺良性疾病、乳腺癌腋窝淋巴结无转移者 (LN -)淋巴结的形态、边缘、大小、数目和信号变化与正常健康人无显著差异 ,乳腺癌腋窝淋巴结转移者 (LN + )淋巴结的形态、边缘、大小和强化方式与前三者有显著差异。结论　MRI是术前评估腋窝淋巴结状态的有效检查方法 ,为临床手术和治疗提供有价值的依据     

Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma

OBJECTIVE: This study compares dynamic helical CT with dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. SUBJECTS AND METHODS: Women with biopsy-proven cervical carcinoma prospectively underwent dynamic helical CT and MR imaging before surgery. A metastatic node on CT and MR imaging was defined as a rounded soft-tissue structure greater than 10 mm in maximal axial diameter or a node with central necrosis. Imaging results were compared with pathology, and receiver operating characteristic curves for size and shape were plotted on a hemipelvis basis. Nodal density and signal intensity on CT and MR images, respectively, were reviewed for differences between benign and malignant disease. RESULTS: A total of 949 lymph nodes were found at pathology in 76 hemipelves in 43 women, of which 69 lymph nodes (7%) in 17 hemipelves (22%) were metastatic. Sensitivity, specificity, positive and negative predictive values, and accuracy of helical CT and MR imaging in the diagnosis of lymph node metastasis on a hemipelvis basis was 64.7%, 96.6%, 84.6%, 90.5%, and 89.5% and 70.6%, 89.8%, 66. 7%, 91.4%, and 85.5%, respectively. Receiver operating characteristic curves for helical CT and MR imaging gave cutoff values of 9 and 12 mm in maximal axial diameter, respectively, in the prediction of metastasis. Central necrosis had a positive predictive value of 100% in the diagnosis of metastasis. Signal intensity on MR imaging and density-enhancement pattern on CT in patients with metastatic nodes did not differ from those in patients with negative nodes. CONCLUSION: Helical CT and MR imaging show similar accuracy in the evaluation of pelvic lymph nodes in patients with cervical carcinoma. Central necrosis is useful in the diagnosis of metastasis in pelvic lymph nodes in cervical cancer.     

颈部恶性淋巴结肿大的高频及彩色多普勒超声表现

目的：用高频彩色普勒超声观察颈部恶性肿大淋巴结的形状、大小、短长径之比（Ｓ／Ｌ）、内部回声及血流信号，并评价其临床诊断价值。材料和方法：经病理证实的颈部恶性肿大淋巴结２００例，并以７０例良性肿大淋巴结对照。结果：恶性肿大淋巴结即恶性原发性肿大淋巴结（ＰＥＬＮ）及转移性肿大淋巴结（ＭＥＬＮ）多为类圆形，Ｓ／Ｌ＞０．５，回声均减低。二者内部血流信号丰富度不同，ＰＥＬＮ多为Ⅱ－Ⅲ级，ＭＥＬＮ多为Ⅰ－Ⅱ级（Ｐ＜０．０１），具有显著性差异。收缩期最高流速、舒张期最低流速及阻力指数在二者鉴别中无显著差异（Ｐ＞０．０５）。良性肿大淋巴结多扁园形回声较高，内部血流信号甚少，多为０－Ⅰ级，Ｓ／Ｌ＜０．５。结论：高频彩色多普勒显像对颈部肿大淋巴结的诊断及鉴别诊断有重要价值     

Intracapsular osteoid osteoma of the proximal femur: findings on plain film and CT

The sonographic evaluation of lymph nodes is based primarily on evaluation of their shape and size. Recently, however, the availability of high-frequency transducers has made consideration of internal structure possible. An important objective is to determine whether node enlargement is due to inflammatory or neoplastic processes. To determine the accuracy of sonography for this purpose, we obtained in vitro sonograms of 53 enlarged lymph nodes excised from 41 patients during surgery for neoplastic or nonneoplastic disease. The sonograms were obtained with 7.5- and 10-MHz transducers. They were interpreted by a radiologist who was unaware of the clinical diagnosis. The nodes were subsequently processed for anatomohistologic study; findings were compared side by side. In 26 of the 53 nodes, sonograms showed an identifiable central echogenic line, which on histologic specimen corresponded to the internal part of the medulla where the lymphatic sinuses converge. All these nodes were benign. Two other nodes had an echogenic internal structure not resembling the normal hilum; in one case this was caused by metastatic disease and in the other by fibrosis. Sonograms of the remaining 25 nodes showed no detectable hilar structure; 21 were involved by a tumor and four had diffuse fatty replacement. Our results suggest that the sonographic finding of a central echogenic line is a valid criterion of benignity. Absence of this finding may be due to factors other than neoplastic disease, such as fatty replacement.     

Dual-modal computer-assisted evaluation of axillary lymph node metastasis in breast cancer patients on both real-time elastography and B-mode ultrasound

PurposeTo propose a computer-assisted method for quantifying the hardness of an axillary lymph node on real-time elastography (RTE) and its morphology on B-mode ultrasound; and to combine the dual-modal features for differentiation of metastatic and benign axillary lymph nodes in breast cancer patients.Materials and methodsA total of 161 axillary lymph nodes (benign, n = 69; metastatic, n = 92) from 158 patients with breast cancer were examined with both B-mode ultrasound and RTE. With computer assistance, five morphological features describing the hilum, size, shape, and echogenic uniformity of a lymph node were extracted from B-mode, and three hardness features were extracted from RTE. Single-modal and dual-modal features were used to classify benign and metastatic nodes with two computerized classification approaches, i.e., a scoring approach and a support vector machine (SVM) approach. The computerized approaches were also compared with a visual evaluation approach.ResultsAll features exhibited significant differences between benign and metastatic nodes (p < 0.001), with the highest area under the receiver operating characteristic curve (AUC) of 0.803 and the highest accuracy (ACC) of 75.2% for a single feature. The SVM on dual-modal features achieved the largest AUC (0.895) and ACC (85.7%) among all methods, exceeding the scoring (AUC = 0.881; ACC = 83.6%) and the visual evaluation methods (AUC = 0.830; ACC = 84.5%). With the leave-one-out cross validation, the SVM on dual-modal features still obtained an ACC as high as 84.5%.ConclusionDual-modal features can be extracted from RTE and B-mode ultrasound with computer assistance, which are valuable for discrimination between benign and metastatic lymph nodes. The SVM on dual-modal features outperforms the scoring and visual evaluation methods, as well as all methods using single-modal features. The computer-assisted dual-modal evaluation of lymph nodes could be potentially used in daily clinical practice for assessing axillary metastasis in breast cancer patients.     

An overview of neck node sonography

RATIONALE AND OBJECTIVES: Gray scale and power Doppler sonography are commonly used to evaluate cervical lymph nodes. This study was undertaken to identify which of the features used in ultrasound of cervical lymph nodes is readily applicable in routine clinical practice. METHODS: Two hundred and eight-six patients diagnosed with cervical lymphadenopathy were included in the study. The largest node in each patient was included in the study and the nature of the node was assessed by fine-needle aspiration cytology. Lymph nodes were assessed for their gray scale and Doppler sonographic features. RESULTS: Metastatic, lymphomatous, and tuberculous nodes were round (63-94%) and without echogenic hilus (57-91%). Sharp borders were found in metastatic and lymphomatous nodes (56-100%), but uncommon in tuberculosis (49%). Capsular or mixed vascularity is common in metastatic, lymphomatous, and tuberculous nodes but not found in reactive nodes. Except metastatic nodes from papillary carcinoma of the thyroid that showed low resistance, metastatic nodes had a higher vascular resistance than reactive nodes. Micronodular echo pattern is common in lymphomatous nodes. Hyperechogenicity and punctate calcification are typical features for metastatic nodes from papillary carcinoma of the thyroid. Intranodal cystic necrosis, adjacent soft tissue edema, matting and displaced hilar vascularity are common features in tuberculosis. CONCLUSIONS: Using gray scale and power Doppler sonography, metastatic, lymphomatous, and tuberculous nodes can be differentiated from reactive nodes. Metastatic nodes from papillary carcinoma, lymphoma, and tuberculosis can be identified. However, it is difficult to differentiate metastatic nodes from squamous cell carcinomas, nasopharyngeal carcinoma, and infraclavicular carcinomas, and differentiate metastatic nodes (nonthyroid primary) from tuberculous lymphadenitis.     

颈部淋巴结结核的CT诊断和鉴别诊断

目的:分析颈部淋巴结核的CT表现,探讨CT诊断价值及鉴别诊断。方法:对22例颈部肿块行CT平扫及增强扫描。全部病例均经病理证实。其中15例为颈部淋巴结结核,女9例,男6例,年龄20～38岁。4例为颈部淋巴结转移瘤;3例为颈部淋巴瘤。结果:颈部淋巴结结核病变好发部位为颈静脉链下、中组及颈后三角淋巴结与淋巴性肿瘤有区别。根据颈部淋巴结核CT扫描的形态,密度及周围脂肪间隙的情况,可反映颈部淋巴结结核的病理改变。结论:CT在颈部淋巴结结核的诊断方面有着重要的价值,不仅可以明确病变的部位、数目、大小、形态特征及周围情况,尚可以反映其病理改变。     

Coagulation necrosis in malignant mediastinal nodes on endoscopic ultrasound: a new endosonographic sign

AIMS: Endoscopic ultrasound (EUS) can be used to assess mediastinal lymph nodes, and EUS-guided transoesophageal fine needle aspiration (EUS-FNA) can provide a tissue diagnosis. Previous studies suggest that a uniformly hypoechoic echotexture is a feature of malignant nodes, and echogenic structures within nodes are due to the normal hilum. Ill-defined, non-shadowing echogenic areas within malignant lymph nodes have been termed coagulation necrosis (CN) on neck ultrasound. The purpose of this study is to determine whether CN can be detected on EUS and be used as a predictive sign for malignancy in mediastinal lymph nodes. METHODS: A total of 36 individuals who underwent EUS-FNA of mediastinal lymph nodes were initially included. A radiologist experienced in neck ultrasound, and blinded to the final diagnosis, reviewed hard-copy films for CN. Comparison was made with the EUS-FNA result and the final diagnosis. RESULTS: Four patients were excluded because their films were deemed inadequate for retrospective diagnosis. The remaining 32 patients were all included, and 11 showed CN. Of the 11 cases, 10 had malignant cytology on EUS-FNA; and in the remaining case follow-up indicated a false-negative EUS-FNA. Of the 21 subjects with no CN, the final diagnosis was malignant in 12 and non-malignant in 9 cases. No participant with a final benign diagnosis had CN. CONCLUSION: Echogenic structures within mediastinal lymph nodes on EUS are not necessarily due to the normal hilum. Careful analysis of the intranodal echo pattern may reveal CN. CN can be used as a predictive sign of malignancy and EUS-FNA should be targeted towards these nodes.     

'Pseudocystic' appearance of non-Hodgkin's lymphomatous nodes: an infrequent finding with high-resolution transducers

AIMS: A pseudo-cystic appearance and posterior enhancement are previously reported to be diagnostic sonographic features of lymph node involvement in non-Hodgkin's lymphoma. This study was undertaken to determine whether these ultrasonic features remain with the use of high-resolution transducers.MATERIAL AND METHODS: A review of ultrasound examinations in 32 patients with proven lymphomatous cervical lymphadenopathy (27 non-Hodgkin's lymphoma, five Hodgkin's disease) was performed. A total of 95 lymph nodes were assessed for size, shape, posterior enhancement and internal architecture. All examinations were performed with the same high-resolution transducer and by the same sonologist.RESULTS: Lymphomatous nodes (irrespective of type) are frequently heterogeneous (68-86%), have a micronodular pattern (63-69%) and less commonly demonstrate posterior enhancement (9-26%).CONCLUSION: Using a high-resolution ultrasonic transducer, cervical nodes involved with lymphoma (irrespective of type) commonly demonstrate a heterogeneous micronodular pattern. The pseudocystic appearance of nodes with posterior enhancement in non-Hodgkin's nodes is seen infrequently.