肾上腺淋巴瘤的超声诊断

目的探讨肾上腺淋巴瘤的超声声像图特点,评价超声对该病的诊断价值。资料与方法回顾性分析12例经病理证实的肾上腺淋巴瘤患者的超声表现,评估病变的大小、形态、边界、内部回声及血流情况。结果 12例患者中,9例为双侧受累,3例为单侧,共21个病灶。病灶大小3.1～12.7cm,平均(7.8±3.7)cm。肿块形态呈不规则形12个,呈椭圆形或类圆形7个,呈肾上腺弥漫性增厚表现2个,类似于肾上腺增生。肿块内部主要表现为低回声,内部回声均匀12个,回声不均匀9个,其中4个内部可见条状高回声,3个内部可见片状无回声区。肿块边界清晰16个,边界不清5个。彩色多普勒血流显像示大部分病灶血流信号稀少或无明显血流信号。结论肾上腺淋巴瘤超声声像图表现具有一定的特征性,超声检查有助于与肾上腺其他肿瘤鉴别。     

肝脏上皮样血管平滑肌脂肪瘤彩色多普勒超声特征分析

目的 探讨肝脏上皮样血管平滑肌脂肪瘤超声声像图特征。方法 选取我院经手术切除病理证实肝脏血管上皮细胞肿瘤12例患者资料，超声声像图特征及超声造影特征。结果 12例患者有14个病灶，肿瘤平均直径约(5.75±4.07) cm,以高回声为主71.4%(10/14),内部回声多数不均匀71.4%(10/14),高回声为主的病灶内可见边界清晰散在分布的小片状低回声区，病灶内可见点状或短线状强回声92.8%(13/14),多数病灶内可见点状或点条状血流信号57.1%(8/14),超声造影主要表现为病灶动脉期均呈快速高增强，门静脉期及延迟期缓慢消退呈等增强。结论 肝脏上皮样血管平滑肌脂肪瘤超声声像图及超声造影表现具有一定的特征性，对于超声准确诊断该病能够提供一定的帮助。     

高频超声对结节性甲状腺肿合并甲状腺微小癌的诊断价值

目的分析结节性甲状腺肿(NG)合并甲状腺微小癌(TMC)的超声声像图特点,以提高 TMC 的术前超声检出率.资料与方法回顾性分析经手术病理证实的64例 NG 合并 TMC 的超声声像图表现,并以同病例邻近癌灶且直径≤1cm 的 NG 结节作为对照.结果 TMC 与 NG 结节在形态、边界、回声强度、声晕、微小钙化、囊性变与血流分布等方面差异有统计学意义(P <0.01),回声均匀程度差异无统计学意义(P >0.05).颈部淋巴结肿大超声检出率为89.47%(17/19).结论 TMC 具有与 NG 结节不同的声像图特点,TMC 的灰阶超声特点为低回声、无声晕、有微小钙化、无囊性变等,彩色多普勒超声显示病灶内部血流信号丰富或无血流,周边少或无血流信号.在 NG 检查中重点观察≤1cm 的低回声结节,以及早发现 TMC.     

隆突性皮肤纤维肉瘤的超声表现

目的：分析隆突性皮肤纤维肉瘤（DFSP）的声像图表现,探讨超声对该病的诊断价值。方法：回顾性分析19例经病理诊断为DFSP的超声表现,结合文献资料,分析该病的声像图特点。结果：19例术前超声表现为位于皮下的单发结节,最大径1.7～6.0 cm,18例（94.7%）呈椭圆形,1例（5.3%）呈类圆形;2例（10.5%）可见小分叶,余病灶形态规则;所有病灶边界清楚,内部呈不均匀低回声,后方回声增强;病灶周边及内部均可见血流信号,1例（5.3%）为Ⅰ级血流,3例（15.8%）为Ⅱ级血流,15例（78.9%）为Ⅲ级血流,可测及低阻力动脉频谱,RI为0.46～0.68。术后病理表现为皮下单发结节,最大径2.2～8.0 cm,组织学表现倾向为DFSP。19例均未发现转移病灶。结论：DFSP的声像图表现具有一定的特征性,可作为临床诊断的参考依据。     

乳腺乳头腺瘤的超声表现

目的:探讨乳腺乳头腺瘤的高频超声图像特征.材料和方法:回顾性分析7例经术后病理证实的乳腺乳头腺瘤的超声图像资料.在灰阶声像图上观察病灶形状、大小、边界、内部回声及后方回声.应用彩色多普勒血流成像(CDFI)观察病灶内部及周围血流分布和供应情况.结果:6例乳腺乳头腺瘤声像图表现为乳头内圆形或椭圆形低回声结节,境界清楚,后方回声增强,彩色多普勒显示结节内少量血流或边缘血流.1例位于左乳乳头后方低回声结节,边界清晰,周边见薄的包膜回声,彩色多普勒显示其内中等量的血流信号.结论:乳腺乳头腺瘤是一种少见的乳腺良性肿瘤,超声检查有助于乳腺乳头腺瘤的诊断及鉴别诊断.     

髂腰肌囊扩张高频彩超误诊分析及其临床意义

目的探讨髂腰肌囊扩张高频彩超声像图特征,了解髂腰肌囊扩张的解剖学特点,提高超声医师对此病的认识。方法回顾性分析高频彩色超声诊断经CT、MRI或超声引导下穿刺抽液术证实了的19例髂腰肌囊扩张的临床资料及高频彩超声像图资料。结果 19例髂腰肌囊扩张均被高频彩超误诊为腹股沟囊肿。19例病灶均为单发,其中17例病灶位于左侧腹股沟区,2例病灶位于右侧腹股沟区,病灶大小从1.5cm×1.0cm~4.8cm×2.3cm不等。声像图均表现为典型的囊肿声像图特征:扁椭圆形、水滴形或长茄形无回声区,边界清晰,内透声佳或欠佳,部分病灶内见纤细分隔,部分病灶可见与髋关节囊相连通,病灶内未见明显血流信号,部分病灶周边可见少量点状血流信号。结论髂腰肌囊扩张具有囊肿的共性,超声扫查的敏感性较高。超声医师掌握了髂腰肌囊扩张的解剖结构,可以直接诊断髂腰肌囊扩张,为临床诊治此病及疗效随访提供帮助。     

结节性筋膜炎的CT和MRI表现

目的：探讨结节性筋膜炎的CT和MRI表现。方法：回顾性分析10例经病理证实的结节性筋膜炎的CT和MRI表现。结果：10例中4例位于上肢,4例位于下肢,2例位于腹壁。病灶均表现为单发实性软组织肿块（肌内型6例,肌间型2例,皮下型2例）,CT平扫示肿块密度稍低于肌肉密度,增强扫描有明显强化。MRI检查：病灶于T1WI呈等或稍低信号,T2WI呈不均匀高信号,其中1例病灶边缘可见囊变区,3例病灶中央可见低信号,增强扫描肿块呈均匀或不均匀中度一重度强化,边界清。结论：结节性筋膜炎的CT和MRI表现有一定特征性,两种方法均有助于本病的诊断及鉴别诊断。     

腮腺类实性腺淋巴瘤的超声表现

目的探讨腮腺类实性腺淋巴瘤的超声表现,提高对本病的诊断水平。方法收集15例手术标本证实的腮腺腺淋巴瘤超声声像图资料,并分析病变的部位、大小、内部回声、后方回声、肿瘤血管情况。结果 15例皆为男性,平均年龄57岁。超声显示,15例腮腺腺淋巴瘤均位于腮腺浅叶,其中11例位于浅叶的下极。8例为椭圆型,3例为圆形,4例不规则型。15例边缘清晰。13例显示包膜,2例可疑显示。8例为低-等混杂回声,5例为低回声,2例为中等回声。7例内部回声较均匀,8例为不均匀。15例均表现病变后方回声增强。14例有CDFI资料,其中血流信号丰富者5例,血流信号中等者5例,血流信号稀疏者4例;血流分布在周边者6例,分布在内部者5例,周边及内部均显示者3例。结论腮腺类实性腺淋巴瘤的超声表现有一定的特征性,有助于其明确诊断。     

外周神经鞘膜肿瘤的高频超声检查

目的 探讨神经鞘瘤与神经纤维瘤的声像图特征及两者间的鉴别要点,以及恶性神经鞘瘤与良性神经鞘瘤的鉴别方法.方法 高频超声检查27例经病理证实的外周神经鞘瘤患者,观察其病变大小、形态、边界、内部回声,并注意观察病变与周围组织关系,观察病变内彩色多普勒血流情况.结果 ①21例神经鞘瘤均边界清晰,7例圆形,14例椭圆性;15例有包膜,6例无包膜;所有肿瘤均为低回声,后方回声均增强;肿瘤内均有血流信号,1例为血流信号丰富;有6例可见瘤体与神经相连,具体表现为神经干在接近瘤体时内部结构紊乱或消失、回声减低并逐渐增粗连于肿瘤的两端.②5例孤立性神经纤维瘤均是单发结节,边界清晰,4例椭圆形,1例圆形,肿瘤均为低回声;3例有包膜,2例无包膜,后方回声增强,肿瘤内均有血流信号;2例与神经相连.③恶性神经鞘瘤仅发现1例,肿瘤较大,约7.0 cm,位于颈部,形状不规则,边界不清,未见明显包膜,未见与神经相连,其内可见丰富血流信号.结论 ①高频超声可发现肿瘤与神经相连,可作出病变为神经鞘瘤的正确诊断.②高频超声可明确病变范围与周围组织的关系.③部分肿瘤可根据声像图表现明确诊断;部分肿瘤缺乏特征性声像图表现,须在超声引导下穿刺活检,以便明确诊断.     

高频彩色多普勒超声诊断与鉴别诊断阴囊肿块的价值

目的:探讨彩色多普勒超声对阴囊肿块的诊断与鉴别诊断价值.材料和方法:对34例阴囊肿块行彩色多普勒超声检查,恶性病变23 例,良性病变11例,分析恶性病变及良性病变的超声声像图特征.结果:恶性病变声像图特征是睾丸形态失常,体积增大,肿瘤呈低回声(15/23)或不均匀混合回声(8/23),边界不清楚,CDFI显示肿块周边和内部血流丰富,呈条状或树枝状血流.良性病变声像图特征是睾丸大小形态常正常,病变多呈低回声,边界清楚,形态规整,CDFI显示病变内血流信号较少(8/11)或无血流信号(3/11).超声对阴囊肿块性质的诊断准确率88.2%(30/34),与手术和穿刺病理结果无显著性差异(P＞0.05).结论:彩色多普勒超声对阴囊肿块诊断与鉴别诊断有较高的临床应用价值.     

结节性筋膜炎的影像表现

目的 分析结节性筋膜炎(NF)的CT及MRI表现,以提高影像诊断水平.方法 回顾性分析经手术病理证实的9例NF的影像表现,其中4例行CT检查,5例行MR检查.结果 9例NF中,5例位于下肢,2例位于腹壁,2例位于外耳道.病灶最大直径为1.1～9.5 cm,平均(3.7±0.3)cm.所有病灶均表现为单发实性软组织肿块,CT平扫显示肿块密度与肌肉密度相仿;病灶在MR T_1WI呈等低信号,在T_2WI呈混杂高信号,增强扫描肿块呈均匀或不均匀中、重度强化.结论 CT及MR检查能为临床诊断及鉴别诊断NF提供有价值的信息.     

MRI characteristics of nodular fasciitis of the musculoskeletal system

Objective

To evaluate MRI imaging appearances of nodular fasciitis in a pathologic-proven series of 29 patients.

Materials and methods

Review of the orthopedic oncology and pathology databases yielded 51 cases of histologically proven nodular fasciitis. MR imaging was available in 29 patients. Three musculoskeletal radiologists retrospectively reviewed all cases in consensus. Imaging features evaluated included location in the body, size, compartmental localization, relationship to fascia, signal characteristics, enhancement pattern, transcompartmental extension, and osseous and intra-articular involvement.

Results

There were 15 male and 14 female patients. Mean age was 33 years (range, 16–59 years). Lesions ranged in size from 1.6 to 9 cm with 84 % of lesions measuring less than 4 cm. Twenty-three lesions were located in the upper arm or shoulder girdle. Nine lesions were subcutaneous in location, nine were intra-muscular, and 11 were inter-muscular. Lesions were consistently ovoid in shape with broad fascial contact. They exhibited internal homogenous low T1 and heterogeneous intermediate T2 signal with surrounding edema and slightly inhomogeneous enhancement. Twelve lesions exhibited central non-enhancing areas. Trans-compartmental spread was demonstrated in nine lesions. Osseous changes were seen in five cases and included extrinsic cortical saucerization, medullary edema, and transcortical osseous invasion. Two lesions demonstrated intra-articular extension.

Conclusions

MR imaging features of nodular fasciitis are generally non-specific and can be mistaken for a soft tissue sarcoma. This series, the largest MRI series of musculoskeletal cases in the literature, confirms the predilection of nodular fasciitis for the upper extremity in young adults but also demonstrates that aggressive imaging features such as transcompartmental spread, and osseous and intra-articular involvement may be seen in association with this benign soft tissue lesion.     

Nodular fasciitis in the head and neck: CT and MR imaging findings

BACKGROUND AND PURPOSE: The purpose of this study was to describe the CT and MR imaging findings of nodular fasciitis occurring in the head and neck region. METHODS: CT (n = 6) and MR (n = 4) images obtained from 7 patients (3 men and 4 women; mean age, 19.4 years; age range, 1-48 years) with surgically confirmed nodular fasciitis in the head and neck were retrospectively reviewed. All patients presented with a palpable mass in the head and neck that was noticed 1-3 months earlier: 5 in the face, one in the occipital scalp, and the remaining one in the supraclavicular fossa. We investigated the CT and MR imaging characteristics with emphasis on the location, size, internal content, margin, enhancement pattern, and signal intensity of the lesion. RESULTS: All lesions appeared as a discrete mass on imaging, ranging from 1.0 cm to 4.6 cm in diameter (mean, 2.2 cm). Six lesions, all of which appeared benign, were located in the subcutaneous tissue superficial to the deep cervical fascia. The remaining lesion was located deep to the temporalis muscle and showed an aggressive imaging appearance, markedly eroding the bony orbit and skull. Five lesions were solid, and 2 lesions were partly or completely cystic in appearance. Five lesions were well defined, whereas 2 lesions were ill defined. Four of 5 solid lesions showed moderate to marked diffuse enhancement, whereas the remaining lesion demonstrated mild enhancement. Two cystic lesions showed peripheral, nodular, or rim-like enhancement. Compared with muscle, both solid lesions had isointense signal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images, whereas the signal intensity of the solid portions of the deep-seated, partly cystic lesion was isointense on both T1-weighted and T2-weighted images. CONCLUSION: Although rare, nodular fasciitis occurs as a discrete solid or cystic mass in the head and neck, depending on the predominant stromal components. When one sees a head and neck mass with a superficial location and moderate to marked enhancement on CT and MR imaging, nodular fasciitis should be included in the differential diagnosis, especially in patients with a recently developed, rapidly growing mass and a history of recent trauma.     

Sonography of plantar fibromatosis

OBJECTIVE: Plantar fibromatosis is a rare benign fibroproliferative disorder of the plantar fascia that can be evaluated on sonography. Our study details the sonographic appearances of plantar fibromatosis. MATERIALS AND METHODS: We conducted a retrospective review of the clinical presentation, sonographic appearances, and clinical progress in 14 patients (range, 35-85 years; mean age, 53.1 years;) with plantar fibromatosis. Sonography was performed using either a 13-5-MHz multidimensional or 12.5-MHz linear array transducer. The location, sonographic appearances, and size of the plantar fibromatosis nodules were noted and correlated with symptom duration and clinical outcome. RESULTS: A total of 25 fibromatosis nodules in 19 feet were examined. On sonography, plantar fibromatosis was seen as a discrete fusiform nodular thickening of the plantar fascia, separate from the calcaneal insertion. Approximately one third (36%) of lesions were bilateral, and one quarter (26%) were multiple. All lesions were located either medially (60%) or centrally (40%) in the fascia. Most were hypoechoic (76%), were well defined (64%), and showed no acoustic enhancement (80%) or intrinsic vascularity (92%). No correlation was found between the echogenicity and size of plantar fibromatosis nodules or duration of symptoms (p < 0.01). One quarter of the affected feet had coexistent thickening of the plantar fascia at the calcaneal insertion with no related symptoms. CONCLUSION: Although the sonographic appearances of plantar fibromatosis vary, the appearances are characteristic enough to allow a specific diagnosis to be made. No clear relationship was found among the sonographic appearances, duration of symptoms, or clinical outcome.     

3.0 T MRI上深筋膜完整性对于下肢软组织肿瘤良、恶性鉴别的价值

目的 分析3.0 T MRI上深筋膜形态改变对于鉴别下肢软组织肿瘤良、恶性的价值.方法 回顾分析40例患者共41个经病理证实的下肢软组织肿瘤的3.0 T MRI表现.将肿瘤按主体与深筋膜的关系分为位于皮下浅层深筋膜外侧、深筋膜内侧、筋膜鞘间隙内、肌肉内的4组肿瘤,分析肿瘤与深筋膜的关系及深筋膜的形态学改变.将深筋膜外侧及内侧组肿瘤归为浅在肿瘤,筋膜鞘间隙及肌肉内肿瘤归为深部肿瘤,分别对其筋膜完整及筋膜破坏肿瘤的最大径进行Mann-Whitney U检验.结果 深筋膜外侧肿瘤7个,深筋膜内侧肿瘤8个,筋膜鞘间隙内肿瘤10个,肌肉内肿瘤16个.良性肿瘤16个,MRI显示深筋膜均完整,筋膜鞘间脂肪间隙存在;恶性肿瘤25个,其中23个见深筋膜破坏征象,包括筋膜中断处被肿瘤取代,肿瘤穿透筋膜生长;筋膜鞘间结构破坏,肌肉层次模糊,2例恶性肿瘤深筋膜完整.浅在肿瘤中,深筋膜完整者及破坏者肿瘤最大径的中位数±四分位数区间分别为(5.0±3.8)cm和(5.7±6.9)cm,两者差异无统计学意义(T=47.5,P>0.05).深部肿瘤中,深筋膜完整者及破坏者最大径的中位数±四分位数区间分别为(4.6±1.9)cm和(13.6±6.5)cm,两者差异有统计学意义(T=62.5,P<0.01).以深筋膜破坏指征诊断恶性软组织肿瘤,敏感度为92.0%(23/25),特异度为100%(16/16),准确度为95.1%(39/41).结论 在3.0 T MRI上显示深筋膜的破坏征象有助于恶性软组织肿瘤的诊断.     

结节性甲状腺肿的螺旋CT表现与病理学对照分析

目的 总结结节性甲状腺肿(NG)的螺旋CT表现及病理基础,提高术前诊断准确率.方法回顾性分析经手术病理证实的34例NG患者的螺旋CT表现,并与其病理结果对照分析.结果 NG患者甲状腺密度低于正常甲状腺密度,单发NG与多发NG甲状腺的密度无统计学差异.病灶多为多发,呈圆形或类圆形,大小不等,病灶边缘光整(28/34) ,病灶密度低于周围甲状腺组织,大部分病灶内密度较均匀(27/34),中心性坏死常出现在较大病灶(直径＞3.0 cm)内(5/34).增强后病灶实体部分CT值增加(47.1±42.2) HU,但强化程度低于周围甲状腺组织.病灶内钙化(6/34)多呈小点状、斑块状或蛋壳状.病理表现为单发或多发囊实性或实性结节,包膜不连续,部分(5/13)患者影像学表现为单发NG,病理表现为多发.CT表现为弥漫性的NG有3例,病理证实均为恶性.结论 NG的螺旋CT表现具有一定特征性,综合判断可提高CT诊断的准确率.     

多发嗜铬细胞瘤的CT诊断价值

目的:分析多发嗜铬细胞瘤的影像学表现及动态增强特征,以提高其诊断准确性。方法:经手术病理证实的多发嗜铬细胞瘤9例,其中双侧肾上腺嗜铬细胞瘤7例,Von Hippel-Lindau病1例,腹膜后副神经节瘤并膀胱嗜铬细胞瘤1例。术前经螺旋CT和多层螺旋CT平扫、动脉期(30s)和门脉期(70～80s)扫描。对比剂采用欧乃派克或优维显,注射流率3ml/s。仔细复习CT扫描结果并与手术病理作回顾性对照分析。结果:9例嗜铬细胞瘤共18个病灶中,双侧肾上腺嗜铬细胞瘤7例,双侧肾上腺嗜铬细胞瘤并胰腺神经内分泌瘤和肾细胞肾癌1例(Von Hippel-Lindau病),腹膜后副神经节瘤并膀胱恶性嗜铬细胞瘤1例。良性病灶13个,恶性病灶5个。肿瘤呈圆形或椭圆形15个,不规则形3个。直径3.2～13.7cm,平均5.6cm。病灶直径<5.0cm3个,5.0～10.0cm13个,>10cm2个。肿瘤实质成分平扫CT值为34.2～53.0HU,平均42.7HU;动脉期CT值63.7～91.5HU,平均80.7HU;门脉期CT值75.1～126.4HU,平均98.1HU。8例双侧肾上腺嗜铬细胞瘤16个病灶中,6例两侧病灶大小、形态、密度、动态增强强化程度和强化方式相仿,2例两侧大小不同,坏死、囊变不同,但动态增强强化程度和强化方式相仿。结论:多发嗜铬细胞瘤包括双侧肾上腺嗜铬细胞瘤、副神经节瘤和脏器嗜铬细胞瘤,多位于双侧肾上腺,CT表现与肾上腺嗜铬细胞瘤相仿,同一病例不同肿瘤的大小、形态、坏死囊变、动态增强强化方式和强化程度相仿,少数肿瘤大小不同,坏死囊变存在差异。     

肺硬化性血管瘤的影像征象与病理分析

目的 探讨肺硬化性血管瘤的影像学表现及病理学特征.资料与方法 回顾性分析10例经病理确诊为肺硬化性血管瘤患者的胸片及CT图像,并对其影像表现与病理组织学特征进行分析.结果 10例患者均行胸片检查,9例单发,1例多发(3个病灶),共12个病灶.其中7例行CT平扫及增强扫描,共9个病灶.平片上病灶短径平均为(1.8±0.6) cm,未见钙化、毛刺、空洞等征象.CT病灶位于胸膜下,大小为1.7cm×1.9cm,5例可见浅分叶,2例可见小块状钙化灶,3例见周围血管包绕征,4例可见周围有肺气肿带包绕,所有结节均未见毛刺、空洞及空泡征,无胸膜牵拉征,肺门纵隔无淋巴结增大,无胸腔积液.平扫CT均值为(45.6±10.0) Hu,增强后可见不均匀强化,有明显强化区及未强化区,主要与病理组织成分相关;强化区域CT均值为(105.6±12.7) Hu,绝对增强均值为(60.0±13.8) Hu.病理上均包含血管瘤样区、乳头区、实变区和硬化区,按不同比例混合存在.免疫组化显示:Vim(+++),CK(++),EMA(+),部分CD34、NSE(+).结论 肺硬化性血管瘤影像学表现较具特征性,术前若作出正确诊断,多数患者可避免手术.     

Nodular fasciitis: MRI appearance and literature review

OBJECTIVE: To describe the MRI features of nodular fasciitis and to review the clinical, MRI and histologic aspects of the tumor. DESIGN AND PATIENTS: Three patients with biopsy-proven nodular fasciitis were selected for a retrospective study. A literature review was also carried out. RESULTS AND CONCLUSIONS: All the lesions appeared slightly hyperintense to skeletal muscle on T1-weighted images, and hyperintense on T2-weighted images with fat saturation [either frequency saturation or Short TI Inversion Recovery (STIR) sequences]. Two enhanced homogeneously after intravenous gadolinium, whereas the third showed heterogeneous enhancement with a nonenhancing area. Despite the difference in enhancing patterns, the histologic appearances of these lesions were similar. Our study shows that the MRI appearance of nodular fasciitis may not be related to the location of lesion. It is thought that the age of nodular fasciitis may reflect its gross morphology, and it is possible that the MRI and histologic appearances could correlate with the age of the lesion, but it would require a larger series to evaluate this concept.