胰管腺癌的放射学诊断和分期

诊断胰腺癌常用技术包括:超声、CT、ERCP、PTC、血管造影及FNAB(细针穿刺活检)。作者对各种检查方法进行了分析比较,认为:IBDCT(床动动态团注增强CT)是观察胰腺的最佳技术。胰腺癌主要CT表现为胰腺肿块和胰、胆管扩张,辅助征象包括:局部蔓延、相邻器官受侵、血管受累、转移及腹水;超声是疑为壶腹周围肿瘤或胰头癌所致梗阻性黄疸病人最常用的初检方法,胰     

肠道恶性淋巴瘤的CT及MRI分析

目的探讨肠道恶性淋巴瘤的CT和MRI表现及其诊断价值。资料与方法回顾性分析经手术、病理证实的23例肠道恶性淋巴瘤患者的临床及CT、MRI影像学资料;其中CT检查23例,MRI检查5例。结果23例病理组织学结果:均为非霍奇金恶性淋巴瘤,B细胞性淋巴瘤18例,黏膜相关淋巴组织淋巴瘤4例,T细胞淋巴瘤1例;其中肿块型9例(39.1%),浸润型10例(43.5%),溃疡型4例(17.4%)。23例共发现不连续肠道病变42个;肿瘤样病灶23个;肠壁呈向心性增厚病灶15个;肠壁呈不均匀增厚病灶5个。15例伴有腹腔淋巴结受累,胰头受侵1例,脾受侵1例。结论肠道恶性淋巴瘤的CT和MRI表现具有一定特征性,典型的影像学特点,结合临床可以做出正确诊断,并且有助于临床的分期及疗效评价。     

十二指肠恶性肿瘤的CT诊断与鉴别诊断

目的　探讨十二指肠恶性肿瘤的CT诊断与鉴别诊断。方法　回顾性分析 2 0例手术病理证实的十二指肠恶性肿瘤的CT平扫和增强资料。结果　原发十二指肠恶性肿瘤 8例 ,其中十二指肠腺癌 3例 ,恶性淋巴瘤 2例 ,恶性间质瘤 3例 ;十二指肠继发性恶性肿瘤 12例 ,其中壶腹癌 3例 ,胰头癌 8例 ,胰腺无功能性神经内分泌癌 1例。十二指肠腺癌CT表现为肠腔局限性不规则环状狭窄伴软组织肿块 ,增强扫描肿块有中度强化 ;恶性淋巴瘤的特点是长范围的肠壁增厚或肠腔外肿块 ,增强扫描肿块有轻度强化 ;恶性间质瘤的特点是巨大软组织肿块伴明显、不均匀强化 ,肠梗阻不明显。壶腹癌表现为十二指肠降部内侧壁的局限性肿块 ,增强有轻中度强化 ,伴肝内外胆管扩张 ;胰头癌累及十二指肠表现为十二指肠内侧壁凹凸不平 ,邻近的胰头部肿块 ,增强扫描不强化 ,伴肝内外胆管扩张 ;胰腺无功能性神经内分泌癌侵及十二指肠表现为胰头部巨大肿块伴明显强化 ,肝内外胆管不扩张 ,肿块与十二指肠分界不清。结论　CT检查对十二指肠恶性肿瘤有重要的诊断和鉴别诊断价值。     

CT在胰腺结核诊断中的价值

目的：探讨胰腺结核的CT征象及其诊断价值。资料与方法：回顾性分析14例胰腺结核的CT表现及临床资料。结果：胰腺结核表现为3型：（1）局灶型：9例，多位于胰头，表现为低密度肿块伴有周边或蜂房状强化；（2）多结节型：4例，胰腺内多发低密度病变，无强化或轻度强化，胰头病变明显，呈蜂房状强化；（3）弥漫型：1例，表现为胰腺弥漫性肿大，边缘模糊。胰腺结核常伴有胰外结核。胰周淋巴结肿大9例，7例增强，呈花环状或环形强化；肝脏受累3例，脾脏受累4例，表现为肝、脾实质内低密度无强化病灶；胆管梗阻、结核性腹膜炎各3例。结论：胰腺结核CT表现多样，包括胰腺局灶性低密度肿块、多发低密度结节或弥漫性胰腺肿大，但最常见的表现是胰腺内局灶性蜂房状强化的肿块。低密度的胰周和门静脉周围淋巴结肿大伴周边环形强化以及其他播散结核灶是支持胰腺结核诊断的重要辅助征象。     

螺旋CT对胰腺癌的诊断及术前评估

主要从胰腺癌病灶本身及邻近受累器官的CT表现、胰周血管受侵、胰周淋巴结及远处转移灶的CT表现等几方面总结了螺旋CT在胰腺癌的诊断及术前评估中所发挥的重要作用.其中着重强调了螺旋CT对判定胰腺癌可切除性的指导意义,并详细介绍了螺旋CT对胰周血管重建的研究.     

螺旋CT对胰腺癌的诊断及术前评估

主要从胰腺癌病灶本身及邻近受累器官的CT表现、胰周血管受侵、胰周淋巴结及远处转移灶的CT表现等几方面总结了螺旋CT在胰腺癌的诊断及术前评估中所发挥的重要作用。其中着重强调了螺旋CT对判定胰腺癌可切除性的指导意义，并详细介绍了螺旋CT对胰周血管重建的研究。     

急性胰腺炎的CT表现及其临床价值的探讨

目的:分析急性胰腺炎的CT表现,探讨其临床意义。方法:回顾性分析100例急性胰腺炎的CT表现,重点观察胰腺的受累情况,胰周及腹膜后间隙,特别是肾前筋膜的受累情况。结果:100例患者CT表现胰腺肿胀,胰周边界不清,结构不完整,实质内点状、小片状低密度区,胰管扩张,肾前筋膜受侵,尤其是左侧肾前筋膜。结论:CT检查对胰腺炎的诊断具有很高的准确性,通过急性胰腺炎的CT严重程度指数(CTSI)的评判,对临床的治疗及预后可提供真实而客观依据及有重要意义。     

胰腺癌:多排螺旋CT三期增强及曲面重建的评价

目的探讨多排螺旋CT三期扫描及曲面重建对胰腺癌显示与胰周血管侵犯评价的价值。方法对54例临床怀疑胰腺癌患者采用多排螺旋CT行薄层三期动态增强扫描,其中经手术或临床随访证实23例胰腺癌入选本研究,并采用胰腺期图像沿胰胆管以及胰周主要血管行曲面重建,分析肿瘤在三期图像上显示以及胰周血管受累情况。结果肿瘤于胰腺期图像上与胰腺实质密度差异最大,肿瘤-胰腺CT值差于动脉期、胰腺期及门脉期,分别为28.02±11.13,35.67±11.60和24.52±13.13,胰腺期高于动脉期和门脉期(p<0.01),而动脉期与门脉期差别无统计学意义(p>0.05)。曲面重建能直接显示肿瘤与周围解剖结构的关系以及血管受侵的情况。结合横断位图像,曲面重建共检出64条血管受侵,对6例手术患者血管无受累作出正确评价。结论多排螺旋CT动态增强胰腺期有利于肿瘤显示和胰周血管侵犯的评价。曲面重建可以直观显示肿瘤与周围结构的关系及血管受侵情况,并且能加强与临床医生间的信息传递。     

右半结肠癌的胰腺和胰腺周围淋巴结转移:12例CT所见

作者复习了12例右半结肠癌胰腺转移(不包括原发肿瘤直接浸润胰腺)的CT所见。男性8例,女性4例,年龄31～74岁。使用GE9800CT机,层厚1.5～10mm,层距5～10mm。原发肿瘤发生在盲肠3例,升结肠5例,横结肠4例。结肠癌确诊至发现胰腺转移的平均时间为32个月(6个月～14年)。有11例病理证实为结肠转移瘤,其中胰腺活组织检查3例,手术6例,胰周淋巴结抽吸活检2例,另1例有多部位转移,经腰_5椎体活检证实。CT表现如下,右半结肠癌转移累及胰腺者8例(占67％),胰腺周围结节状侵犯及胰实质受侵     

胆道、胰头区的CT诊断:肿瘤发现率的研究

作者分析110例经手术、病理、血管造影证实的胆道、胰头区肿瘤的CT 表现。其中向此区淋巴结转移的24例,胆管癌38例,胰头癌34例,十二指肠乳头癌14例。比较发现淋巴结转移的手术和CT结果,CT 发现率为58%。3厘米以上的淋巴结均可发现,2厘米以下的92%不被发现,集合淋巴结63%可查出。肝胆胰区肿瘤较大时,难与肿大的淋巴结分开。胃癌时胰头后部淋巴结转移与胰头癌的CT 表现很相似,但前者出现的胰体、胰尾部萎缩及胰管、胆管扩张较胰头癌少见,可作为二者的鉴别点。50%胆管癌能由CT 发现。胆管癌依胆瘤部     

肾淋巴瘤的CT诊断

目的 探讨CT对肾淋巴瘤的诊断价值。材料与方法 回顾性分析6例经病理证实的肾淋巴瘤的CT表现。结果 肾淋巴瘤的CT表现可分为多发肿物型、弥漫增大型和肾周肿物型。结论 肾淋巴瘤常是全身性淋巴瘤的一部分,其CT表现常与其他实质性脏器一致。     

脾脏淋巴瘤的CT表现

分析脾脏淋巴瘤的ＣＴ表现，评估ＣＴ诊断价值，材料与方法，回顾性分析１１例病理证实的脾脏淋巴瘤的ＣＴ平扫和增强资料，结果脾脏淋巴瘤的ＣＴ表现分３型：（１）脾脏均匀增大型；（２）单个或多个结节型；（３）弥漫浸润型。     

肺黏膜相关淋巴组织淋巴瘤的CT诊断

目的 研究肺黏膜相关淋巴组织(MALT)淋巴瘤的CT表现,提高对该病的认识及鉴别诊断能力.方法 回顾性分析经病理证实的12例MALT淋巴瘤的CT表现,影像观察指标为病灶的数量、分布、形态、密度及伴随征象.结果 12例MALT淋巴瘤中共检出肺实变、肺肿块、肺结节、磨玻璃样病灶32个,病灶单发2例,多发10例;多发病例中单肺多发2例,双肺多发8例.肺实变10例共21个病灶,其内均可见支气管充气征,1例2个病灶内见支气管扩张;肺肿块或结节影3例共5个病灶,3个病灶内可见支气管充气征;磨玻璃样改变2例共6个病灶;1例伴纵隔及肺门淋巴结肿大.结论 MALT淋巴瘤CT上常表现为双肺多发、含有支气管充气征的肺实变、肿块、结节样或磨玻璃样改变;上述影像表现及相对缓慢的病变过程提示MALT淋巴瘤的诊断.     

多层螺旋CT对原发性肾上腺淋巴瘤的诊断价值(附4例报告并文献复习)

目的探讨原发性肾上腺淋巴瘤的CT表现。资料与方法回顾性分析4例确诊为原发性肾上腺淋巴瘤患者的CT影像学资料。结果 4例中双侧病灶3例,单侧病灶1例,共计7侧病灶;瘤体较大,长径5.6～7.8cm,平均6.3 cm;边界清晰6侧,边界不清1侧;肾上腺明显增粗伴局部肿块4侧,肾上腺轮廓消失、呈不规则形3侧;CT平扫密度均匀6侧,密度不均匀1侧;行双期增强扫描,均匀强化5侧,不均匀强化2侧,其中1侧病灶内见不规则无强化区。结论原发性肾上腺淋巴瘤的CT表现具有一定特征性,据此可提示诊断。     

胰腺结核的CT表现

目的 探讨胰腺结核的CT表现及其诊断价值。方法 8例胰腺结核中,6例经手术病理证实,2例经穿刺活检证实,CT常规平扫加增强扫描。结果 多发结节型 胰腺结核1例,表现为肿大的胰腺内布满结节状低密度灶,仅结节灶边缘轻度强化。局灶 腺结核7例,均累及胰头部。局部软组织肿块4例,其中2例伴有多发斑点状钙化灶,1例呈蜂窝状强化;囊性肿块2例,其中1例囊壁有多发斑点状钙化灶,另1例为多房囊性病灶。胰头部团块状钙化灶1例。8例胰腺结核中4例有腹内胰外表现,包括腹内淋巴结结核、结核性腹膜炎,以及肝、脾结核。结论 胰腺结核CT表现呈多样化,但有一定特征性,伴有多发斑点状钙化灶或呈蜂窝状强化的胰腺肿块,可提示胰腺结核的诊断;与胰腺结核共存的腹内结核特别是特征性淋巴结结核有助于该病的诊断。     

CSF flow studies of intracranial cysts and cyst-like lesions achieved using reversed fast imaging with steady-state precession MR sequences

BACKGROUND AND PURPOSE: Differentiating between intracranial cysts or cyst-like structures and communicating or noncommunicating cysts is often not possible with cranial CT or nonfunctional MR imaging. We evaluated a retrospective ECG-gated fast imaging with steady-state precession (PSIF) MR sequence with optional cine mode to differentiate cystic masses from enlarged CSF spaces and to determine the accuracy of detecting communication between cysts and neighboring CSF spaces. METHODS: Fourteen patients with intracranial cystic masses underwent CSF flow studies with an ungated and a retrospective ECG-gated cine-mode PSIF sequence in addition to spin-echo imaging. Findings were evaluated retrospectively by using a five-point rating scale and without knowledge of clinical or other imaging findings. Results were compared with intraoperative findings or with results of intrathecal contrast studies. RESULTS: Eighteen arachnoid cysts and one enlarged cisterna magna were diagnosed. Improved differentiation between cysts and enlarged CSF spaces was obtained with cine-mode PSIF imaging in six lesions (six patients). Increased diagnostic certainty as to communication between cysts and CSF spaces was obtained in 18 cysts (13 patients). Diagnoses were verified by membranectomy in five lesions, by CT cisternography in five lesions, and indirectly by shunting in one cystic lesion. In one case, MR diagnosis was not confirmed by CT cisternography. CONCLUSION: Cine-mode MR imaging with a retrospective ECG-gated flow-sensitive PSIF sequence contributed to the certainty of communication between arachnoid cysts and neighboring CSF spaces with an accuracy of 90%, using surgical findings or intrathecal contrast studies as reference. Differentiation between intracranial cysts and enlargement of CSF spaces and other cystic masses was improved in 25% of cases.     

Tumorähnliche Läsion des Pankreas bei chronischer Pankreatitis

OBJECTIVE: The aim of this study was to describe the imaging findings for inflammatory pseudotumors in patients with chronic pancreatitis as detected in computed tomography (CT). MATERIALS AND METHODS: In this retrospective study 20 patients with chronic pancreatitis were included, who underwent an abdominal CT scan. In all patients the diagnosis was confirmed by surgery and histopathology. Imaging findings which have previously been described as typical for chronic pancreatitis and for inflammatory pseudotumors were assessed by two radiologists in consensus. Values of tissue density (HU) at CT were measured within the lesions and in the surrounding pancreatic tissue. RESULTS: In 90% of patients with histologically proven chronic pancreatitis, CT showed corresponding indicative findings. In 10 patients the resected specimen revealed an inflammatory pseudotumor, which was located in all cases within the pancreatic head. Using CT these 10 patients presented with calcifications within the lesion in 50% of the cases, an irregular dilatation of the main pancreatic duct in 90%, a "double duct sign" in 70%, an interrupted main pancreatic duct in the area of the lesion in 50%, a "duct penetrating sign" in 30%, an infiltration of adjacent structures in 10% and pathologically enlarged lymph nodes in 100% of the cases. In the venous contrasting phase six tumors were hypodense and four isodense compared to the surrounding pancreatic tissue. In six patients biphasic CT was performed and the mean difference in attenuation between inflammatory pseudotumors and surrounding parenchyma was significantly higher in the pancreatic phase than in the venous phase. DISCUSSION: Differentiation between inflammatory pseudotumors and adenocarcinoma remains difficult or even impossible. Typical signs indicative of an adenocarcinoma of the pancreatic head, such as dilatation of the common bile duct and/or the main pancreatic duct as well as enlarged lymph nodes, were also found in patients with inflammatory pseudotumors. Inflammatory pseudotumors showed low contrast between lesions and parenchyma in the venous phase and calcifications within the solid part of the tumor.     

Primary central nervous system lymphoma: CT and pathologic correlation

CT findings of 15 patients with histologically proven primary central nervous system (CNS) lymphoma were reviewed with pathologic correlation in order to evaluate variable CT patterns. There were a total of 32 lesions. Of the 15 patients studied, seven had acquired immunodeficiency syndrome (AIDS), all diagnosed within the past 3 years. The CT observations of eight non-AIDS patients were consistent with findings reported previously. Most of the lymphomatous lesions were either hyper- or isodense, round or oval masses with homogeneous contrast enhancement and variable surrounding edema. Pathologic examination showed tightly packed preserved lymphoma cells without necrosis. In AIDS patients, rim or ring enhancement of lymphoma, indistinguishable from brain abscess, was frequently seen. Histologic examination consistently showed extensive tumor necrosis with preservation of viable tumor cells at the periphery. A third and infrequent CT pattern was multiple infiltrative nonnodular solid enhancement with extensive edema. Pathologic correlation showed infiltrating viable tumor cells without necrosis. The rim- or ring-enhancing brain lesion seen in AIDS patients can either be an abscess or a primary lymphoma; proper tissue collection is essential for correct diagnosis and appropriate treatment.     

儿童非霍奇金淋巴瘤与白血病肾脏浸润的CT表现

目的：认识儿童非霍奇金淋巴瘤（NHL）及白血病肾脏浸润的各种CT表现。材料和方法：复习病理证实的42例儿童NHL的临床资料,选出其中12例肾脏浸润的病例,分析化疗前后的CT变化,所有病例均行常规胸腹部CT平扫加增强扫描;4例白血病B超提示肾脏浸润,然后行腹部CT平扫加增强扫描。结果：NHL肾脏浸润表现为两侧肾脏多发结节样改变9例,单侧单弛节浸润2例,单侧多结节1例;4例白血病肾脏浸润全部表现为两肾多结节样改变。结论：儿童NHL与白血病肾脏浸润CT表现极其相似,具有一定的特征性,CT能很好显示肾脏浸润情况,正确及时地诊断肾脏浸润有助于NHL的临床分期,也有助于NHL及白血病化疗前后的疗效观察。     

Mesenchymal tumors of the pancreas: computed tomography patterns

PURPOSE: To report the CT patterns of pancreatic mesenchymal lesions and to investigate the capabilities and limitations of this technique in terms of characterization. MATERIAL AND METHODS: We selected the CT examinations of 23 patients from all CT examinations of the pancreas performed from 1986 to 1998. The patients were 10 to 85 years old and all lesions but two (1 lipoma and 1 lymphoma) had pathologic confirmation. Two lymphangiomas, 2 lipomas, 4 Schwannomas (SCH), 1 plexiform neurofibroma, 1 cystic teratoma, 1 pancreatoblastoma, 9 non-Hodgkin's lymphomas (NHL), 1 undifferentiated sarcoma and 2 leiomyosarcomas were diagnosed. RESULTS: Lipomas had typically homogeneous negative HU values, and NHL a homogeneous hypodense pattern with mild contrast enhancement, with no necrosis or calcifications in both diffuse and nodular forms; SCH had variable appearance, with water/slightly negative HU numbers or highly enhanced patterns with a central necrotic core depending on the main Antoni A or B histology. Lymphangiomas appeared as complex cysts, with thin and regular or calcified walls and intracystic septa, while the plexiform neurofibroma had near-water homogeneous density with mild contrast enhancement and an infiltrating growth pattern. Our teratoma had multiple calcifications, mucinous and lipid components. The pancreatoblastoma, sarcomas, and leiomyosarcomas exhibited no specific findings. CONCLUSIONS: In selected cases, CT can provide virtually diagnostic information (lipoma and teratoma), or at least highly suggestive findings (NHL, plexiform neurofibroma, lymphangioma). Moreover, knowledge of the variable morphostructural patterns of mesenchymal histotypes (SCH, sarcoma etc.) permits to include them in the differential diagnosis of pancreatic masses.