胸腺瘤的CT和平片分析

目的　探讨胸腺瘤的X线与CT诊断价值。方法　分析 30例经手术病理证实的胸腺瘤X线和CT表现 ,并与病理对照。结果　 18例非侵袭性胸腺瘤 ,胸片仅发现 15例 ,CT扫描 10例 ,均为前纵隔软组织肿块 ,边界清楚 ,密度均匀。 12例侵袭性胸腺瘤 ,肿瘤侵犯邻近器官 ,CT显示纵隔胸膜受侵 3例 ,心包受侵 2例 ,大血管结构受侵 2例 ,胸膜种植 3例 ,胸腔积液 2例 ,腹腔受侵和纵隔淋巴结转移各 1例 ;胸片仅能显示 1例肿瘤侵犯纵隔胸膜和 1例胸膜种植。结论　CT扫描在胸腺瘤的发现和判别侵袭性方面明显优于X线平片并且是可靠预测胸腺瘤侵袭性的检查方法。     

CT找寻原发肿瘤的价值

作者回顾了31例确诊的转移瘤,用CT找寻原发癌,大多数病例是腺癌。31例中18例从手术或尸检证实的,13例细胞学证实的。31例病人曾用胸部正、侧位、支气管镜、超声、胃肠检查、钡灌肠、胃镜、结肠镜、CT检查。CT层厚为8～4 mm,甚至2 mm,2/3病例用100～150ml非离子型造影剂困注。19例从肺尖至肾上腺,12例从肝到耻骨联合。以CT表现与常规X线检查对比。18例中16例在CT能检查的范围中,其中6例得出正确诊断。故CT能查出1/3的不引人注意的肿瘤如胸膜间皮瘤、胰腺肿瘤、肾上腺样癌。误诊的有:1例胸膜间皮瘤的范围很小,当做肿瘤引起的胸膜转移,1例是     

胸膜病变的CT诊断:着重纵隔胸膜

作者对比84例胸膜病变患者的CT与常规X线检查。其中恶性间皮瘤34例,胸膜转移瘤16例,良性胸膜病变34例。CT显示胸膜增厚81例,X线显示57例。纵隔胸膜病变CT显示48例,胸片显示21例。CT均比普通X线检查敏感(P<0.001)。恶性间皮瘤、转移瘤和良性感染性病变在注入造影剂后CT值增强25～40HU,平均为33HU,三者增强无明显差别。良性非感染疾病对比增强仅为0～15HU,与上述病变相比有显著性差异(P<0.001)。恶性胸膜病变一般为较大的不规则肿块,良性病变较小,边缘光滑。但仅根据胸膜厚度不能鉴别良恶     

人工气胸后肝脏顶部病变穿刺活检的初步应用

目的：探讨CT导向下人工气胸后行肝顶病变穿刺活检的可行性、安全性及诊断的准确性。方法：23例（男性17例女性6例）患者,经超声、CT或磁共振检查发现肝脏顶部病变,经CT导向下先行人工气胸,推移膈顶周围肺组织,使肝脏顶部病变充分暴露,然后经胸膜腔进针对肝脏病变活检,待检出组织满意后将人工气胸注入的洁净气体抽出。结果：本组共23例手术均顺利完成,术后观察2～5天,无1例出现病理性气胸、出血、感染等并发症。术后病理结果：14例为肝细胞癌,2例为胆管细胞癌,3例为肝内局灶性结节性增生,4例为肝内慢性炎症。结论：CT导向下人工气胸后行肝顶病变的穿刺活检是一种安全可行、定位准确的检查方法。     

23例肺转移瘤的影像学诊断

目的 提高对肺部转移性肿瘤的影像学诊断水平。方法 回顾性分析23例经临床病理证实为肺转移瘤的影像学特征。结果 将影像学表现分为五型：(1)单发结节型3例；(2)多发结节型15例；(3)粟粒结节型3例；(4)淋巴结肿大型4例；(5)胸膜转移型6例。结论 传统X线与胸部CT检查均为诊断肺转移瘤的主要方法，特别是后者对0．5cm以下病灶的检出率以及发现肺门、纵隔淋巴结肿大和胸膜转移效果更好。     

经皮肝动脉的门静脉造影诊断小肝肿瘤的价值

目的:评价经皮肝动脉的门静脉造影(CTAP)诊断小肝癌及肝内小转移瘤的价值。材料和方法:对12例经病理证实为肝癌或肝转移瘤患者进行CTAP检查,其中肝癌6例,肝转移瘤6例;比较CTAP与常规CT、DSA、碘油造影CT病变检出率。结果:CTAP发现的病灶23个,常规CT 12个,DSA 16个,碘油造影CT 23个。结论:CTAP对发现小肝肿瘤有重要作用,可成为患者介入治疗前的影像检查方法之一。     

脊柱溶骨性转移瘤的CT诊断

目的　分析脊柱溶骨性转移瘤的CT表现 ,探讨CT对该病的诊断及鉴别诊断价值。方法　分析 46例 72个椎骨溶骨性转移瘤的CT表现 ,并与其中 2 8例的X线平片结果进行比较。结果　 46例脊柱溶骨性转移瘤的 72个转移椎骨中 ,椎体破坏 45例共 74个病灶 ,椎弓根破坏 2 2例 ,累及横突 15例 ,椎板和棘突 (受累 )各 11例。微转移病灶集中在椎体 ( 4 5 /4 9)。CT发现骨破坏、椎管受累及椎旁软组织肿块分别为 10 0 %、67.85 %及 71.4% ,而X线对三者的发现率仅为 5 3 .6%、14 .3 %及 3 2 .1%。结论　脊柱转移瘤首先侵犯椎体 ,椎体转移瘤是椎弓根、椎板、横突和棘突破坏的基础。CT扫描在发现和评估病变方面较X线平片检查敏感     

恶性胸膜间皮瘤的CT评价

目的：主要分析恶性胸膜问皮瘤的CT征象，评价CT对本病的诊断价值。方法：回顾性分析12例经组织学证实的恶性胸膜问皮瘤的CT征象。结果：10例弥漫性恶性胸膜问皮瘤患者中，8例胸膜增厚大于10mm，占67％，胸膜增厚呈结节或肿块状7例，占58％，环状胸膜增厚6例，占50％，纵隔胸膜及叶间膜受侵8例，占67％，8例有半侧胸腔体积缩小，2例表现为单发结节，4例有纵隔淋巴结转移，1例有远处转移，侵犯颈椎。结论：CT在确定恶性胸膜间皮瘤的侵犯范围和程度方面具有重要作用，但本病的最终确诊仍需要病理组织学的证实。     

连续CT血管造影检查直肠结肠癌肝脏转移

作者前瞻性研究了30例连续CT血管造影技术(CCTA)在检查直肠结肠癌肝脏转移方面的价值。女性16例,男性14例,年龄40～73岁,将导管置于肝动脉,每一层面在CT扫描前3s内注射10～20ml造影剂,同一层面连续24s扫描,层厚10mm,同样方法连续检查10～18层,平均13层,以术中US和手术探查作为参照标准比较术前US、常规CT和CCTA三种方法,所有的实质性病变(不管是高密度还是低密度)或动脉期边界清晰环状强化病变均认为是转移灶。肝表面触诊结合术中US发现16例病人有44处肝转移灶,14例无转移,无术中US时可发现38处,CCTA发现了其中的43处,其敏感性(98%)和准确性(81%)明显高于US(52%,63%)和常规CT(52%,58%);此外CCTA对显示直径<1cm的病灶和完整显示3个以上的多病灶方面也有价值;然而,CCTA有较高的     

弥漫性胸膜病变的CT鉴别诊断

作者分析了74例证实为弥漫性胸膜病变的CT表现,39例恶性,35例良性,患者年龄为23～78岁,男53例,女21例,其中包括间皮瘤11例,转移瘤24例,淋巴瘤3例,石棉肺16例,脓胸9例,纤维胸8例,放线菌病2例。发现在良恶性胸膜病变的鉴别诊断中下列征象提示恶性:(1)环状胸膜增厚;(2)结节状胸膜增厚;(3)壁层胸膜增厚超过1cm;(4)纵隔胸膜受累。这些征象的     

Radiofrequency ablation of 40 lung neoplasms: preliminary results

OBJECTIVE: Radiofrequency thermal ablation is a minimally invasive treatment widely used for treatment of liver neoplasms and has also been tested on other types of tumor. Few studies have been published regarding the use of radiofrequency thermal ablation in the treatment of lung neoplasms. This study was performed to evaluate the technical feasibility, the safety, and the efficacy of lung radiofrequency thermal ablation. SUBJECTS AND METHODS: Between February 2002 and March 2003, 18 subjects with unresectable lung neoplasms, four of whom had primary neoplasms and 14 of whom had metastatic neoplasms, underwent lung radiofrequency ablation. The technique was performed percutaneously using a monopolar cooled-tip electrode needle under CT guidance with the patient under general anesthesia. Patients had no more than three nodules with a total diameter of 10 cm and no evidence of extrathoracic disease. A total of 40 nodules were treated in 24 therapeutic sessions. After treatment, patients underwent follow-up every 3 months by CT and nuclear MRI with gadolinium for a median time of 8 months (range, 2-14 months). RESULTS: No evidence of local relapse was discovered in 94.4% of subjects. The treatment was safe and well tolerated. Complications encountered included massive pneumothorax, which occurred in one subject, requiring pleural drainage. Other complications were moderate pneumothorax (also requiring pleural drainage), cough, fever, slight dyspnea, and pain, but these complications were short in duration and successfully treated. CONCLUSION: Radiofrequency thermal ablation is a promising technique in the treatment of patients with lung neoplasms and has been found to be both safe and technically feasible.     

In diagnosis of pleural effusion and pneumothorax in the intensive care unit patients: Can chest us replace bedside plain radiography?

Aim

To compare the role of chest US and bedside plain chest radiography in the evaluation of intensive care patients having pleural effusion and pneumothorax. Chest computed tomography has been used as an ideal standard.

Tumor invasion of the chest wall and mediastinum in lung cancer: evaluation with pneumothorax CT

For preoperative evaluation of chest wall and mediastinal invasion by lung cancer, computed tomography (CT), combined with artificial pneumothorax (pneumothorax CT), was performed in 43 patients with lung cancer in whom conventional CT scans showed that the mass was contiguous to the chest wall (n = 30) and/or mediastinum (n = 25) but without evidence of definite tumor invasion. Invasion was diagnosed on the basis of whether an air space existed between the mass and the adjacent structures. In three patients pneumothorax was not produced. After the procedure, four patients developed symptomatic pneumothorax, and one, subcutaneous emphysema. Comparison of diagnoses based on findings at pneumothorax CT, surgery, and pathologic examination showed that pneumothorax CT is 100% accurate for chest wall invasion and 76% accurate for mediastinal invasion. The authors conclude that this procedure is helpful in accurate evaluation of the T criterion in lung cancer, especially for patients in whom findings at conventional CT suggest tumor invasion of the chest wall and mediastinum.     

人工液胸辅助超声引导微波消融治疗肝癌的临床应用价值

 目的 探讨人工液胸在辅助超声引导经皮微波消融治疗近膈顶肝癌的临床应用价值。方法 回顾性研究2011-01至2013-12行人工液胸操作辅助超声引导微波消融治疗肝癌的患者115例临床资料,年龄35～82岁,对人工液胸操作的可行性、有效性和安全性指标进行评估。结果 人工液胸操作成功率97.4%(112/115),滴注的生理盐水量为500～1500 ml,平均(962.9±219.4)ml。操作成功的112例患者中110例完成了肝癌的超声引导微波消融治疗,操作有效率98.2%。本组病例术中和术后未出现与人工液胸操作有关的严重并发症,轻微并发症包括疼痛、咳嗽等。结论 人工液胸技术具有良好的可行性,可以安全有效地用于辅助超声引导经皮微波消融治疗近膈顶肝癌,扩大了适应证范围。     

CT导向下125I粒子植入治疗肝门区肝癌

目的评价CT导向下125I粒子植入治疗肝门区肝癌及淋巴结的临床价值.方法本组病例32例,其中肝门区肝细胞癌(HCC)8例,肝门区胆管癌(HC)12例,肝转移瘤6例,肝门区淋巴结转移6例.14例侵犯肝门胆管致肝内胆管扩张,22例合并肝硬化.全部病例经CT、MRI检查或病理穿刺活检证实.病灶平均直径为4.2 cm.采用TPS计算布源,在CT导向下将125I粒子植入瘤灶内,采用0.6～0.9 mCi活度的12I粒子相隔1.0～1.5 cm平面播植.结果2例死于远处转移,3例死于肝功能衰竭,全组中位生存时间10个月.2个月后CT复查,完全缓解(CR)2例;部分缓解(PR)20例;无变化(NC)5例;进展(pD)5例.总有效率(CR+PR)68.8%.2个月随访过程中发现7颗粒子在肝脏内游走,3颗粒子迁徙至肺内;1例出现气胸,肺压缩在30%以下,白细胞轻度下降1例.未见大出血、胆汁瘘、肠瘘、肠出血等严重并发症.结论CT导向下放射性粒子植入治疗肝门区肿瘤及淋巴结创伤小,并发症发生率低,生活质量改善明显,近期效果好,是治疗中晚期肝门区肿瘤及淋巴结的简单、安全、有效的方法.     

Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors?

PURPOSE: To study factors that may influence pneumothorax and chest tube placement rate, especially needle dwell time and pleural puncture angle. MATERIALS AND METHODS: In 159 patients, 160 coaxial computed tomography (CT)-guided lung biopsies were performed. Dwell time, the time between pleural puncture and needle removal, was calculated. The smallest angle of the needle with the pleura ("needle-pleural angle") was measured. These and other variables were correlated with pneumothorax and chest tube rates. RESULTS: One hundred fifty biopsies were included. There were 58 (39%) pneumothoraces (14 noted only at CT), with eight (5%) biopsies resulting in chest tube placement. Longer dwell times (mean, 29 minutes; range, 12-66 minutes) did not correlate with pneumothoraces (P =.81). Smaller needle-pleural angles (< 80 degrees) [corrected], decreased forced expiratory volume in 1 second to vital capacity ratio (<50%), lateral pleural puncture, and lesions along fissures were associated with higher [corrected] pneumothorax rates (P <.05). Emphysema along the needle path, pulmonary function tests showing ventilatory obstruction, and lesions along fissures predisposed patients to chest tube placement (P <.05). Pleural thickening and prior surgery were associated with lower pneumothorax rates (P <.05). CONCLUSION: Longer dwell times do not correlate with pneumothorax and should not influence the decision to obtain more biopsy samples. A shallow pleural puncture angle may increase the pneumothorax rate.     

Thoracic tumors treated with CT-guided radiofrequency ablation: initial experience

PURPOSE: To determine the effectiveness of computed tomography (CT)-guided radiofrequency (RF) ablation of malignant thoracic tumors. MATERIALS AND METHODS: CT-guided RF ablations of 99 malignant thoracic tumors (3-80 mm in largest diameter; mean, 19.5 mm) were performed in 35 patients in 54 sessions. Ablation was performed with an RF generator by using a single internally cooled electrode. Tumors were both primary (three lesions) and secondary (pulmonary or pleural metastases, 96 lesions). Follow-up was 1-17 months (mean, 7.1 months). Follow-up CT and histopathologic examinations were evaluated. Univariate analysis was performed with the Fisher exact test, and Welch t test was used to evaluate differences between group means. P <.05 represented a significant difference. The maximal diameter of each residual tumor or local recurrence or the proportion of primary lesions of pulmonary metastatic tumors with recurrence after RF ablation were analyzed. Complications, management, and outcomes of the complications were recorded. RESULTS: The appearance of each ablation zone, including the target tumor and surrounding normal lung parenchyma, showed involution at follow-up CT. Local recurrence was demonstrated histopathologically or radiologically in nine tumors. The other 90 tumors showed no growth progression at follow-up CT. Probable complete coagulation necrosis obtained with initial RF ablation was achieved in 91% (90 of 99) of the tumors. The mean maximal diameter of the nine tumors (19.6 mm +/- 7.7 [SD]) was not significantly different (P =.994) from that of the other 90 tumors (19.5 mm +/- 13.0). Primary lesions of those nine metastatic tumors varied and did not demonstrate a specific tendency. Complications included pneumothorax, fever higher than 37.5 degrees C, hemoptysis, cough, pleural effusion, abscess formation, and hemothorax. The overall complication rate was 76% (41 of 54 sessions). CONCLUSION: RF ablation seems to be a promising treatment for malignant thoracic tumors.     

Chest wall invasion by lung cancer: limitations of CT evaluation

Thirty-three patients with peripheral pulmonary malignancies contiguous with a pleural surface were evaluated for chest wall invasion by computed tomography (CT). CT criteria included pleural thickening adjacent to the tumor, encroachment on or increased density of the extrapleural fat, asymmetry of the extrapleural soft tissues adjacent to the tumor, apparent mass invading the chest wall, and rib destruction. The CT scans were classified as positive, negative, or equivocal for invasion, and a decision matrix was constructed comparing CT results with pathologic data. The sensitivity of CT was 38%, specificity was 40%, and accuracy was 39% for evaluation of invasion if equivocal CT results were counted as radiologic errors. CT scanning has low accuracy in assessing chest wall invasion in patients with peripheral lung cancers.     

Value of ultrasound in diagnosis of pneumothorax: a prospective study

Transthoracic ultrasound (US) is useful in the evaluation of a wide range of peripheral parenchymal, pleural, and chest wall diseases. Furthermore, it is increasingly used to guide interventional procedures of the chest and pleural space. The role of chest US in the diagnosis of pneumothorax has been established, but comparison with lung computed tomography (CT) scanning has not yet been completely performed. The purpose of this study is to prospectively compare the accuracy of US with that of chest radiography in the detection of pneumothorax, with CT as the reference standard. One hundred ninety-seven patients who were evaluated by spiral chest CT scan for various clinical indications were prospectively evaluated. Ultrasonography was performed by a radiologist, blinded to the chest CT findings. Sensitivity, specificity, and accuracy of ultrasound in the detection of pneumothorax were then compared with chest CT scan. CT scan showed pneumothorax in 92 patients. Sonography and plain X-ray of the chest revealed 74 and 56 cases of pneumothorax, respectively. Statistical analysis disclosed the US to be 80.4 % sensitive and 89 % specific in the detection of pneumothorax with an overall accuracy of 85 %. In this study, US was more sensitive than chest radiography in the detection of pneumothorax. The results of this study suggest that thoracic US, when performed by trained individuals, can be helpful for the detection of pneumothorax.