原发性腹膜后肿瘤的CT诊断价值（附27例分析）

目的 探讨原发性腹膜后肿瘤的CT表现.方法 对27例穿刺活检和手术后病理证实的原发性腹膜后肿瘤的CT表现进行分析.结果 对肿瘤的位置、大小、形态、密度、成份、边缘、与周围邻近组织的关系及增强扫描后CT的影像学资料进行分析,CT显示原发性腹膜后肿瘤的敏感性达100%,定位正确率为77.8%(21/27),良恶性定性诊断率为66.7%(18/27).结论 CT对原发性腹膜后肿瘤的定位及良恶性的判断有较高价值.     

腹膜后神经源性肿瘤CT征象与病理分类相关性分析

目的:分析腹膜后神经源性肿瘤的CT影像学征象与病理类型的相关性,提高对腹膜后神经源性肿瘤的影像学诊断和鉴别诊断。方法:对44例经手术、病理证实的腹膜后神经源性肿瘤的CT征象进行回顾性分析,并与手术后的病理结果进行对照、研究。结果:44例腹膜后神经源性肿瘤均位于从膈肌下至盆腔腹膜后间隙内。其中,良性36例,恶性8例;神经鞘瘤9例,神经纤维瘤9例,节细胞神经瘤17例,副神经节瘤5例,神经母细胞瘤4例;肿瘤生长在肝肾隐窝、脾肾隐窝及双侧肾上极区17例,腹主动脉及下腔静脉间或旁4例,肾前间隙及肾内缘12例,双侧腰大肌前缘及前外侧7例,骶骨前缘及盆腔内2例,其它部位2例;肿瘤外形呈圆形或类圆形30例,不规则形14例。结论:腹膜后神经源性肿瘤的CT征象有其一定的特征性,通过对病理类型与肿瘤CT征象的关系分析,能提高CT检查对腹膜后神经源性肿瘤的诊断并在临床有较好的应用。     

18F-FDG PET/CT在探查腹膜转移性肿瘤中的价值

目的:评价18F-FDG PET/CT探查腹膜转移瘤的价值。方法:39例有腹部原发恶性肿瘤手术史患者行PET/CT首次和延迟扫描,在PET/CT图像上记录病灶大小、分布,结果与常规CT比较。测量62个病灶和对照组32例腹部无病变患者的肠管SUVmax。所有病例经手术、病理、影像学和肿瘤标记物随访作出最后诊断。结果:最终确认39例中31例腹膜转移瘤,病灶均为结节状或沿腹膜条片状分布,多位于肝脏周围和盆腔腹膜,其他部位腹膜少见。PET/CT漏诊的4个病灶主要位于肝脏周围,1例因化疗不久病灶FDG低摄取而漏诊,因此敏感性为87.1%,特异性为87.1%。CT仅检出12例转移瘤。转移瘤SUVmax明显高于对照组肠管SUVmax(P=0.0000)。结论:18F-FDG PET/CT能够较CT更早、更多地检出腹膜转移瘤,病灶体积小、位于基础摄取较高的肝脏周围是漏诊主要原因,而结合原发肿瘤病史和肿瘤标记物检查有利于诊断。     

多层螺旋CT、MRI单独及联合检查对原发性颅脑肿瘤的诊断价值

目的 探讨多层螺旋CT、MRI单独及联合检查对原发性颅脑肿瘤的诊断价值。方法 选取92例疑似原发性颅脑肿瘤患者,均接受多层螺旋CT、MRI检查,以术后病理检查结果为金标准,评估多层螺旋CT、MRI单独及联合检查对原发性颅脑肿瘤的诊断价值。结果 术后病理结果显示,92例患者中,原发性颅脑肿瘤62例,其他脑部疾病30例。多层螺旋CT、MRI联合检查诊断原发性颅脑肿瘤的灵敏度、特异度、准确度分别为98.39%、100%、98.91%;MRI检查诊断原发性颅脑肿瘤的灵敏度、特异度、准确度分别为93.55%、90.00%、92.39%;多层螺旋CT检查诊断原发性颅脑肿瘤的灵敏度、特异度、准确度分别为80.65%、76.67%、79.35%;多层螺旋CT、MRI联合检查诊断原发性颅脑肿瘤的灵敏度、特异度、准确度均高于二者单独检查。术后病理检查结果显示,62例确诊为原发性颅脑肿瘤中,星形脑胶质瘤35例,脑膜瘤14例,髓母细胞瘤6例,室管膜肿瘤7例。MRI检查诊断星形脑胶质瘤、脑膜瘤、髓母细胞瘤、室管膜肿瘤的结果与病理检查结果的一致性为优（Kappa=0.874）;多层螺旋CT检查诊断星形脑胶质瘤、脑...     

无脂肪的腹膜后脂肪肉瘤的 CT 和 MRI 表现

目的：探讨并分析影像学评价无脂肪的腹膜后脂肪肉瘤（lipid poor retroperitoneal liposarcomas, LPRL）的 CT 和 MRI 表现及其临床诊断、鉴别价值。方法回顾性分析21例经病理证实的无脂肪的腹膜后脂肪肉瘤患者的临床及 CT、MRI 影像学资料,并与病理和组织学表现对照分析。结果21例患者病变表现为腹膜后软组织肿物,大小为（12.5±8.0）cm,范围为1.9～21.0 cm。肿瘤边界清晰者12例,边界不清者9例。病变呈分叶状或形态不规则。肿瘤位于肾周间隙者12例,位于肾旁前间隙者6例,位于肾旁后间隙者3例。9例患者的肿瘤伴粗大血管影,11例伴分隔,7例伴坏死,4例伴钙化（粗大、散在、多发钙化）。该病有特征性的CT、MRI 表现,多表现为软组织实性肿物;平扫密度或信号不均匀,增强后实性部分不均匀强化,病变多伴坏死或分隔、血管影。结论 CT 及 MRI 对无脂肪的腹膜后脂肪肉瘤患者的临床诊断和鉴别有重要的参考价值。     

原发性小肠肿瘤的影像诊断(附26例报告)

目的　分析原发性小肠肿瘤的影像特点 ,探讨螺旋CT及DSA检查应用价值。方法　回顾分析 2 6例小肠原发性肿瘤的影像表现。 2 6例均行口服钡剂造影 ,11例超声检查 ,6例螺旋CT检查 ,4例DSA检查。结果　口服钡剂造影主要表现为充盈缺损、管腔狭窄 ,螺旋CT主要表现为肠壁增厚、软组织肿块 ,DSA主要表现为肿瘤染色、出血。CT诊断 6例 ,与病理相符 5例 ;DSA诊断 4例 ,与病理相符 3例。结论　小肠原发性肿瘤具有一定的影像特点 ,结合临床可提高诊断 ,螺旋CT与DSA检查明显提高肿瘤的定性诊断率。     

原发性小肠肿瘤的影像诊断（附26例报告）

目的：分析原发性小肠肿瘤的影像特点，探讨螺旋CT及DSA检查应用价值。方法：回顾分析26例小肠原发性肿瘤的影像表现。26例均行口服钡剂造影，11例超声检查，6例螺旋CT检查，4例DSA检查。结果：口服钡剂造影主要表现为充盈缺损、管腔狭窄，螺旋CT主要表现为肠壁增厚、软组织肿块，DSA主要表现为肿瘤染色、出血。CT诊断6例，与病理相符5例；DSA诊断4例，与病理相符3例。结论：小肠原发性肿瘤具有一定的影像特点，结合临床可提高诊断，螺旋CT与DSA检查明显提高肿瘤的定性诊断率。     

早期周围型肺癌的X线与CT诊断分析

目的:分析早期周围型肺癌的X线与CT征像特点,探讨X线与CT检查在早期周围型肺癌诊断中的作用。方法:对65例直径<3cm,经手术病理证实的周围型肺癌的X线胸片及CT扫描征象进行回顾性分析。对两种检查方法的定性准确率进行统计学检验。结果:分叶征、毛刺征、空气支气管征、血管集束征及胸膜凹陷征为早期周围型肺癌的基本征象。对病灶的定性诊断CT扫描明显优于普通X线检查(x=5.47 P<0.025)。结论:胸部X线检查是发现病变的基本首选方法,发现病变后进行CT扫描对早期周围型肺癌的确诊有重要意义,熟悉并掌握早期周围型肺癌的基本X线及CT征象是提高肺癌早期诊断水平的关键。     

胃肠道肿瘤CT影像学诊断与鉴别诊断

目的探讨CT增强薄层扫描与CT普通扫描诊断和鉴别诊断胃肠道肿瘤的临床效果。方法回顾性分析2011年1月至2013年6月间我院疑似的胃肠道恶性肿瘤患者138例,比较CT增强薄层扫描融合图像、CT图像和病理检查的符合率。结果 138例疑似胃肠道肿瘤患者,病理检查确诊102例,CT增强薄层扫描重建融合图像确诊符合率为92.2%(94/102),CT图像确诊符合率为83.3%(85/102),差异有统计学意义(P<0.05)。病理检查组织周围浸润患者78例,CT增强薄层扫描诊断组织周围浸润符合率为91.0%(71/78),CT图像诊断组织周围浸润符合率为75.6%(59/78),差异有统计学意义(P<0.05)。CT增强薄层扫描诊断淋巴结转移患者符合率为92.9%(52/56),CT图像诊断淋巴结转移患者符合率为75.0%(42/56),差异有统计学意义(P<0.05)。除N0期外,CT增强薄层扫描与CT普通扫描在肿瘤TNM分期诊断符合率差异均有统计学意义(P<0.05)。结论 CT增强薄层扫描诊断胃肠道肿瘤准确率高,特异性强,且对判断肿瘤分期具有临床意义。     

腹膜后原发性巨大肿瘤的CT诊断

作者报告９例经手术病理诊断的腹膜后原发性巨大肿瘤的ＣＴ表现，结合文献讨论了腹膜后肿瘤ＣＴ定位诊断以及与腹膜后脏器肿瘤定位的鉴别，认为ＣＴ检查可为临床治疗提供较可靠的参考依据。     

腹膜后巨大脂肪肉瘤1例并文献复习

目的 探讨腹膜后脂肪肉瘤的诊断和治疗,提高少见病例的诊疗水平。方法 回顾江汉大学附属医院收治的1例腹膜后巨大脂肪肉瘤患者的临床资料,结合文献讨论腹膜后脂肪肉瘤的临床特点以及诊断、治疗方法。结果 患者经影像学诊断后行左侧腹膜后肿瘤切除+左肾部分切除术,术后病理提示腹膜后脂肪肉瘤,手术顺利,术后随访20个月,未见肿瘤复发及转移。结论 腹膜后脂肪肉瘤临床少见,无特异性临床表现,CT有助于该病的诊断,手术是首选的治疗方法。     

Multiple Retroperitoneal Schwannomas Mimicking Adrenal Tumors

Schwannomas are benign tumors mostly arising from the head and neck. Retroperitoneal schwannomas are rare. Here we report the case of a 68-year-old woman with multiple retroperitoneal schwannomas. An abdominal computed tomography (CT) scan showed 1 non-enhancing mass with a low-density area, 4.6 cm in diameter, in the left adrenal region and another non-enhancing mass with a low-density area, 2.9 cm in diameter, in the para-aortic region. The patient had regularly undergone CT scans for malignant tumor screening in maintenance dialysis patients. Retrospectively, the 2 tumors had existed in the same regions in previous CT scans and had gradually increased in size. The tumors were completely resected. Pathological diagnosis of both tumors was schwannoma. When a CT scan shows a slowly growing retroperitoneal tumor with a low-density area, schwannoma should be considered. If the tumor increases in size, complete resection should be performed for pathological diagnosis.Key Words: Retroperitoneal schwannoma, Computed tomography scanning, Adrenal tumor     

Retroperitoneal malignant fibrous histiocytoma--report of a case

A 52-year-old man with a three-month history of left epigastralgia and body weight loss was referred to us for a possible abdominal tumor in March 1984. Retroperitoneal malignant tumor was suspected by ERCP, angiography, US, and CT. At laparotomy, a child's-head-sized retroperitoneal tumor, which weighed 1,800 g, was resected. Pathological examination revealed the diagnosis of retroperitoneal malignant fibrous histiocytoma (MFH). He died because of recurrence in the retroperitoneum six months after the operation. We selected 26 Japanese cases of retroperitoneal MFH and discussed their clinical findings and prognosis.     

易误诊为腹膜后脂肪肉瘤的肾血管平滑肌脂肪瘤的CT征象分析北大核心

目的:探讨外生性肾血管平滑肌脂肪瘤(angiomyolipoma,AML)的CT影像学特点及误诊原因,以提高本病的认识及诊断。方法:回顾性分析经手术病理证实为15例外生性肾AML和23例腹膜后脂肪肉瘤患者,分析其CT图像资料及术前误诊原因。结果:AML女性患者占比较脂肪肉瘤高(P=0.008),发病年龄较脂肪肉瘤小(P=0.006),最大径小于脂肪肉瘤(P<0.001)。肾皮质缺损、肾动脉分支供血、瘤内可见粗大扭曲血管影、肿瘤血管延伸至肾实质(肾实质血管蒂征)、瘤内出血主要见于外生性肾AML(P<0.05)。肾脏移位和肿瘤内出现非脂肪成分异常强化结节则主要见于腹膜后脂肪肉瘤(P<0.05)。发病位置、伴发其他含脂肪成分病灶在二者之间差异无统计学意义。结论:外生性肾AML常见于中青年女性,可能具有部分与腹膜后脂肪肉瘤相同或相似的影像学特征,在诊断中还需对肿瘤形态学细节进行仔细分析以发现其特征性CT征象,并结合临床资料综合诊断,以减少误诊。     

Retroperitoneal sarcomas

Opinion statement The approach to the management of retroperitoneal tumors begins with a complete history and physical examination. Imaging of the abdomen and pelvis by computed tomography (CT) provides both an imaging modality and a method by which to obtain tissue for diagnosis. Because a histologic diagnosis is essential in treatment planning, adequate tissue can usually be obtained by a CT-guided core biopsy. If the diagnosis is sarcoma, additional tests necessary for staging include plain chest radiography and evaluation of the liver by either CT scan or magnetic resonance imaging (MRI). The treatment options for primary retroperitoneal sarcomas include chemotherapy, radiation therapy, surgery, or a combination of these modalities; therefore, a multidisciplinary group best manages treatment planning. Primary radiation therapy for cure is seldom effective for retroperitoneal sarcomas but can provide palliation in select cases. Systemic chemotherapy for chemosensitive lesions, such as poorly differentiated liposarcoma, malignant fibrous histiocytoma (MFH), synovial cell sarcoma, and primitive neuroectodermal tumors (PNET), can be useful when used in a neoadjuvant manner. Consequently, surgical resection continues to be the mainstay of treatment for retroperitoneal sarcomas and requires en bloc resection of the primary tumor. Frequently this includes adjacent organs such as colon, small bowel, kidney, adrenal, and pancreas. Postoperative adjuvant therapy with chemotherapy or radiation has not been proven to be of any additional benefit. Overall treatment results are predominantly influenced by tumor stage, grade, size, and margins of surgical resection. Follow-up CT scans at 6-month intervals and surgical resection of recurrences can be valuable.     

Ultrasonography in the comprehensive diagnosis and evaluation of treatment effectiveness in retroperitoneal neuroblastoma in children

Neuroblastoma and ganglioneuroblastoma of adrenal (17) and extra-organ (60) origin and retroperitoneal extra-organ neoplasia (18), infrequent in childhood, were identified in 109 children referred to the Institute's Clinic with diagnosis of retroperitoneal tumor. Ultrasound characteristics of retroperitoneal tumors of the sympathetic nervous system and predictive value of ultrasound for involvement of adjacent organs and vessels were defined and classified. Similar criteria for differential diagnosis between retroperitoneal neuro- and ganglioblastoma and rare pediatric retroperitoneal tumors were worked out. Dynamics of evidence in the course of conservative treatment of tumors and the role of ultrasound tomography in evaluating retroperitoneal neuroblastoma were established. Predictive value of sonography, computed tomography and angiography in certain applications was compared.     

A retroperitoneal leiomyosarcoma--a case of non-concurrent double cancers with kidney cancer

A retroperitoneal leiomyosarcoma in a 50-year-old man is reported. A laparotomy was performed on Dec. 17, 1987 and the tumor, weighing 120 g, was completely excised. The patient was followed up and has stayed healthy (1 year after operation). Although CT ultrasonography and arteriography are helpful in the diagnosis of retroperitoneal tumors, it is felt that a histological examination is indispensable for a qualitative assessment of the lesion. Surgical excision constitutes the fundamental treatment for a retroperitoneal leiomyosarcoma. However, the prognosis is usually poor and depends on successful radical surgery. This case involved non-concurrent double cancers with a retroperitoneal leiomyosarcoma and a kidney cancer.     

射频消融治疗腹膜后和盆腔恶性肿瘤

[目的]探讨射频消融治疗腹膜后和盆腔恶性肿瘤的疗效和安全性.[方法]腹膜后和盆腔恶性肿瘤患者9例,均为单发病灶.其中原发性肾上腺梭形细胞瘤术后复发1例,软骨肉瘤术后腹膜后转移2例,肺癌、恶性胸腺瘤术后1例,胰腺癌腹膜后转移1例,直肠癌和子宫颈癌术后盆腔转移各1例.CT引导下进行射频消融术.[结果]腹膜后和盆腔肿块射频消融术共19次,平均2.1次.9例患者临床症状不同程度减轻或消失,临床缓解率100%.增强CT复查完全热凝固坏死4例,不完全坏死3例,部分坏死2例.患者术中较好地耐受治疗,术后未发生严重并发症.[结论]射频消融治疗腹膜后和盆腔恶性肿瘤安全,对直径小于6cm的肿瘤疗效确切.     

混合现实技术在腹膜后神经鞘瘤手术中的应用价值

目的:探讨混合现实技术在腹膜后神经鞘瘤手术治疗中的临床疗效与应用价值。方法:回顾性分析2021年1月至2022年4月于我院收治的19例腹膜后神经鞘瘤患者的临床资料，其中男5例，女14例，年龄（42.4±13.2）（20～72）岁，肿瘤最大径为（6.65±2.82）（3.1～11.7）cm。所有患者术前均行肿瘤部位增强三维重建CT扫描，通过混合现实技术对肿瘤的大小、周围解剖关系进行分析，并统计手术失血量及手术时长。同时对手术后的病例进行随访观察。结果:19例患者均行腹膜外入路手术，其中5例患者行经腹直肌外缘切口入路手术，8例行经髂腹股沟切口入路手术，5例行经骶尾部弧形切口入路手术，1例行经腹骶前后联合入路手术。所有患者按照术前方案完整切除肿瘤，肿瘤周围血管神经均保护完好，手术时间（86.3±39.8）（30～182）min，术中失血量（266.8±413.9）（30～1 500）mL。术后3例出现并发症，包括下肢疼痛和排尿异常。全部病例获得随访，随访时间(8.0±3.7)（3～14）个月，随访期内病例未见复发。结论:手术切除是腹膜后神经鞘瘤的首选治疗方式，术前应选择合适手术入路。混合现实技术可用于腹膜后神经鞘瘤的诊疗过程，有助于手术的精准操作。