Sonography of hemorrhagic ovarian cysts

The sonographic appearance of hemorrhagic ovarian cysts (HOC) has received little attention aside from a recent report in adolescent girls. We reviewed the sonographic findings in 14 adults with 15 pathologically proven HOC to see whether there were any consistent sonographic findings that, along with the clinical history, might make possible the diagnosis. The majority (93%) of patients presented with the abrupt onset of lower abdominal or pelvic pain, and each, when clinically appropriate, had a negative serum pregnancy test. Sonographically, all of the masses were cystic except one. The cyst wall was thin and well defined in six cases and thick and irregular in eight. The majority (87%) had internal echoes. These echoes were scattered and low level or diffuse and homogeneous (27%) or complex and echogenic (53%) in nature. Two cysts had numerous septations, and another had a fluid--debris interface. If the pain subsides and the hematocrit remains stable, the premenopausal patient can be managed conservatively. Sonographic follow-up is recommended so that an underlying hemorrhagic ovarian cystic neoplasm can be excluded. This was present in three of our patients, two of whom were postmenopausal.     

Hepatosplenic brucelloma: clinical presentation and imaging features in six cases

Background We conducted a retrospective analysis of the clinical presentation and the computed tomographic (CT) and ultrasound (US) findings in six episodes of hepatosplenic brucelloma in five patients.Methods In four episodes, the diagnosis was based on clinical history, serology, and characteristic imaging findings. In the other two episodes in the same patient, the diagnosis was suspected after a biopsy was taken. CT was performed in all six cases and US in five.Results On US, brucellomas were iso- or hypoechogenic with the liver. Hyperechogenic masses were seen in one patient. Brucellomas were very poorly defined and contained small scattered cystic areas. All lesions showed central or marginal gross focal calcification, except multiple lesions in one patient. Contrast-enhanced CT showed predominantly solid masses with irregular borders and fine or thick enhancing trabeculations separating hypodense solid areas and/or small cystic areas. Two patients showed transdiaphragmatic lung invasion by brucelloma, a complication not previously published.Conclusion In regions where brucellosis is endemic, brucelloma should be included in the differential diagnosis if a hepatic or splenic mass with irregular borders and central or marginal gross focal calcification is detected, and contrast-enhanced CT shows enhancing trabeculations that separate hypodense solid areas and/or small liquid collections.     

小儿颈部囊性病变的高频超声诊断与鉴别诊断

目的：探讨小儿颈部囊性病变的高频超声表现特征。方法：搜集42例经手术病理证实的颈部囊性病变，均行超声检查，回顾性分析其超声特点。结果：甲状舌管囊肿19例（45．24％），颈淋巴管瘤15例（35．71％），鳃裂囊肿8例（19．05％）。颈部囊性病变各有其好发部位，且病变具有一定的超声特征。甲状舌管囊肿多见于颈中线附近、舌骨上下；淋巴管瘤多见于颈侧部、锁骨上，范围较广；腮裂囊肿多见于中上侧颈部。甲状舌管囊肿及鳃裂囊肿呈单房性，淋巴管瘤多为多房性。结论：超声检查可清晰显示病变的大小、形态和延伸范围，多数能定性诊断，对颈部囊性病变具有重要的诊断和鉴别诊断价值。     

Value of Near-Isovoxel Ultrasound for Evaluation of Ductal Communications with Pancreatic Cystic Lesions: Correlation with Magnetic Resonance Cholangiopancreatography

The aim of this study was to determine the value of near-isovoxel ultrasound (ISUS) using xMATRIX technology in assessment of ductal communications with pancreatic cystic lesions. Twenty patients with pancreatic cystic lesions (n = 21) on magnetic resonance cholangiopancreatography (MRCP), underwent 2-D ultrasound (US) and subsequent ISUS using a matrix probe. Two observers assessed the presence of ductal communications with pancreatic cystic lesions for all MRCP, 2-D US, and ISUS images with multi-planar reformation, using a 5-point confidence scale. Weighted-κ statistics and intra-class correlation coefficients were calculated. Inter-observer agreement for MRCP, 2-D US and ISUS was moderate, fair and moderate (0.475, 0.222 and 0.472), respectively. The intra-class correlation coefficients between ISUS and MRCP was higher than that between 2-D US and MRCP (0.8706 vs. 0.5353, observer 1; 0.7206 vs. 0.4818, observer 2, respectively). Correlation and inter-observer agreement were better with MRCP than with 2-D US. We conclude that ISUS may be useful in evaluating ductal communications with pancreatic cystic lesions.     

肺内支气管囊肿的CT表现

目的 探讨肺内支气管囊肿的CT表现特点。方法 回顾性分析57例经手术病理证实的支气管囊肿的CT表现。结果 57例肺内支气管囊肿,48例发生于单叶肺,3例累及一侧多叶肺,6例累及双肺多叶。21例CT表现为球灶型,19例呈空腔型,8例呈肿块样型,9例呈蜂窝型。13例含有曲菌球,5例囊壁发生钙化。15例见囊肿周围透亮度增高影,24例见周围条状实变影,4例见邻近肺组织节段性压缩不张,9例见近端引流支气管扩张积液。结论 大部分肺内支气管囊肿的CT表现具有特征性,有助于术前诊断。     

Choledochal cysts: Ultrasonographic findings and correlation with other imaging modalities

In the past, choledochal cysts had been infrequently diagnosed prior to surgical exploration for obstructive jaundice. However, with the advance of imaging modalities, preoperative diagnosis is usually apparent. We evaluated the radiological findings of choledochal cysts in 14 patients in whom ultrasonography (US) or computed tomography (CT) were mainly used for diagnosis. In addition, oral cholecystography, intravenous (IV) cholangiography, scintigraphy, and percutaneous transhepatic cholangiography were performed in some of them. The diagnosis was confirmed surgically in all patients. Ultrasonographic examinations were diagnostic in 13 of 14 patients. Preoperative specific diagnosis of choledochal cyst was possible with the demonstration of direct entrance of the extrahepatic bile ducts into the cyst in most cases. When US fails to show relation of cystic mass with biliary system, other imaging modalities can be used to clarify the findings.     

Chylous cyst of the mesentery: US and CT diagnosis

We report a case of mesenteric chylous cyst diagnosed preoperatively by ultrasonography (US) and computed tomography (CT). Both demonstrated a unilocular cystic mass with a fluid-fluid level. The CT number of the two components indicated fat density and water density and with shaking or positional changes, the contents displayed miscibility. The tumor changed its position during hospitalization. Both features are considered to be quite diagnostic of this condition.     

Small cystic lesions of the pancreas: clinical significance and findings at follow-up

Background Our purpose was to correlate the imaging findings of small cystic pancreatic lesions to the incidence of growth on follow-up imaging and their pathologic diagnoses. Methods CT images for 159 patients with cystic pancreatic lesions were retrospectively evaluated and lesions were assessed for size, number, connection to the main pancreatic duct (MPD), MPD dilatation, and any presence of loculation, wall irregularity, thick septations, or solid components. A total of 86 patients had follow-up imaging with time periods of less than 6 months (n = 21), 6–12 months (n = 22), 1–2 years (n = 14), and greater than 2 years (n = 29). Lesion histology was available in 20 patients. Results Lesions with pathologic correlation proved to be: side branch intraductal papillary mucinous neoplasm or tumor (IPMT) (n = 5), combined type IPMT (n = 4), nonmucinous cyst (n = 4), chronic pancreatitis (n = 2), and reactive atypia with nonmucinous fluid (n = 1), combined type IMPT with foci of adenocarcinoma (n = 1), mucinous adenocarcinoma (n = 2), and nonmucinous adenocarcinoma (n = 1). Lesions with solid components were significantly more likely to grow and be malignant (P < 0.05). The presence of MPD dilatation was more common in patients with combined type IPMTs or malignancies. No other factors were predictive of malignancy. Conclusions Solid components are predictive of malignancy, and MPD dilatation should prompt consideration of surgery. Other cystic lesions can be followed.     

囊性肾癌的超声诊断特征及误诊原因分析

目的探讨囊性肾癌(cystic renal cell carcinoma,CRCC)的超声诊断特征及误诊原因。方法回顾性分析我院经手术病理检查证实的CRCC 17例的临床及超声检查资料。结果超声检查结果显示17例肿瘤直径1.7~16.0(8.2±0.5)cm;多囊性病变10例,单囊性病变6例,左侧肾单囊性、右侧肾多囊性病变1例。13例诊断为CRCC,4例误诊为肾囊肿,误诊率23.53%。4例误诊病例中3例为较大囊性癌,超声检查显示囊壁规则且较薄,囊壁未见结节性病变,囊腔内为均匀性低回声,囊壁及囊腔均未探及明确血流回声;1例为多囊性肾癌,囊间分隔及囊壁规整且较薄,仅分隔与囊壁交界处的壁稍增厚,彩色多普勒未查及明确血流信号。结论超声检查可为临床早期诊断CRCC提供重要影像学依据。     

胰腺浆液性囊腺瘤MSCT表现与病理特征

目的:探讨胰腺浆液性囊腺瘤MSCT表现和病理特征。方法:回顾性分析经手术及病理证实的43例胰腺浆液性囊腺瘤的MSCT表现,观察病灶部位、大小、囊腔类型、中央瘢痕、钙化及强化特点等。结果:43例胰腺浆液性囊腺瘤中,浆液性微囊型囊腺瘤34例,浆液性寡囊型囊腺瘤9例。34例浆液性微囊型囊腺瘤的囊直径平均为(4.2±0.5)cm,其中多囊蜂窝型29例,囊内见多发厚薄不均的蜂窝状分隔,其囊隔厚度为0.03~0.2 cm;多囊海绵型5例,瘤内呈海绵状囊实混杂密度,囊隔显示不清。34例微囊型囊腺瘤内有中央星芒状纤维瘢痕14例,放射状或砂砾状和囊壁上斑点状钙化14例,上游胰管扩张4例。9例浆液性寡囊型囊腺瘤中单囊型4例,呈圆形或卵圆形,囊直径平均为(3.1±3)cm;多囊型5例,边缘呈分叶状,由数个小囊构成,囊壁薄而光滑、均匀,其囊壁厚度<0.1 cm。增强扫描表现:微囊型囊腺瘤中囊内分隔、中央星芒状纤维瘢痕及实性成分多呈轻中度强化,囊内分隔及实性成分越多,强化越明显,中央纤维瘢痕多呈延迟强化;寡囊型囊腺瘤囊内无强化,仅囊壁、囊隔呈轻度强化。结论:胰腺浆液性囊腺瘤CT表现具有一定特征性。微囊型囊腺瘤CT平扫呈蜂窝状或海绵状,瘤中央见星芒状纤维瘢痕及放射状钙化,增强扫描见囊壁、分隔及实性部分呈轻中度或显著强化,中央纤维瘢痕呈延迟强化;寡囊型囊腺瘤由单个或数个大囊组成,无中央纤维瘢痕及钙化,增强扫描见囊壁、囊隔呈轻度强化。     

Prenatal sonographic findings of duodenal duplication: Case report

We report a rare case of duodenal duplication cyst that was suspected prenatally. Routine prenatal sonography (US) at 19 weeks' gestation showed an abdominal cystic mass on the left side of the abdomen. Follow‐up US examinations showed a partial “double‐wall” sign, highly suggestive of enteric duplication, and changes in cyst size and wall thickness. Postnatal US examination suggested enteric duplication cyst. A laparotomy revealed a duodenal cyst that was completely resected. The antenatal US findings associated with this condition, the accuracy of its antenatal diagnosis, and its differential diagnosis are discussed. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 41 :1–5, 2013     

囊性肾癌的影像学诊断

目的 提高囊性肾癌的影像学诊断水平。方法 对15例囊性肾癌病人的B超、CT检查和治疗结果进行回顾性分析。结果 15例患者经健康体查B超发现肾囊性病变12例，因其他疾病而发现3例。初次B超拟诊囊性肾癌8例、单纯性肾囊肿7例。螺旋CT扫描全部病灶为囊性病变，增强扫描后囊壁内侧面不规则密度增高或结节样密度改变。全部病人经手术治疗，病理检查为肾细胞癌。结论 对于肾脏的囊性病变，如果B超或CT检查不能确立为单纯性囊肿，临床上应考虑为囊性肾癌并积极处理。     

乳腺原发性鳞状细胞癌的临床、病理及超声特征

目的总结乳腺原发性鳞状细胞癌临床超声及病理特征。 方法对7例1995年1月至2014年12月北京协和医院临床收治并经超声及手术病理检查证实为乳腺原发性鳞状细胞癌患者的临床、病理及超声声像图特征进行总结分析。 结果7例乳腺原发性鳞状细胞癌患者8个乳腺原发灶中单发6例,多发1例;大小7.0～60.0 mm,平均大小（34.0±19.6）mm;其中6个呈实性低回声,2个呈囊实性混合回声;8个原发灶形态均不规则、边界模糊;2个出现点状及条状钙化。彩色多普勒血流成像示7个原发灶血流丰富（Ⅱ或Ⅲ级）,1个原发灶未见血流（0级）。术后病理大体标本示8个乳腺肿物中实性6个,颜色灰白,质中,边界不清;2个肿物内部分呈囊腔样。1例70岁老年患者乳腺癌根治术后胸壁多次复发,超声显示胸壁复发灶呈厚壁无回声;2个胸壁复发灶大体标本示肿物均呈囊腔,囊壁厚,镜检示纤维脂肪及骨胳肌组织内见鳞状细胞癌浸润。 结论乳腺原发性鳞状细胞癌病灶较大,超声显示肿瘤内部较多囊性成分和丰富血流,对诊断乳腺原发性鳞状细胞癌有帮助。     

脾脏包虫病的影像学表现

目的:提高对脾包虫病影像学表现的认识.方法:回顾性分析8例经手术病理证实的脾包虫病的临床,CT和超声资料,探讨其影像学表现特点及诊断.结果:本组8例脾脏包虫的CT表现为单纯囊肿4例,内囊分离1例,多子囊2例,实质钙化1例,其中6例可见致密清晰的囊壁,囊内为水样低密谋,增强扫描病变区未见增强,4例作了超声检查,其中3例显示双层囊壁,囊内为无回声液性暗区,本组中同时伴有肝包虫病者6例,结论:脾包虫病虽然光见,但其影像学表现有一定特点,在脾脏囊性病变的鉴别诊断中不应忽视.     

超声造影在良性囊性肾占位中的应用

目的 分析超声造影在肾脏良性囊性占位中的表现,探讨其应用价值.方法 对24例24个经手术病理证实为肾脏良性囊性占位患者的常规超声及超声造影声像图进行回顾性分析.常规超声观察囊性占位大小、回声、边界、有无彩色血流信号.超声造影观察病灶囊壁、分隔及实质成分等内部结构的增强表现.结果 本组24个囊性肾占位经手术和病理证实单纯性囊肿11个,复杂性囊肿5个(其中4个伴出血或感染),肾实质和肾盂炎症5个,肾脏血肿2个和肾盏憩室1个.24个囊性病变最大直径范围2.1～19.4 cm,其中<3.0 cm 7个.常规超声显示囊性肿块8个,囊实性肿块16个,其中内见分隔12个,钙化6个,囊壁增厚或实质成分4个.5个病灶囊壁或分隔上发现彩色血流信号,19个未显示彩色血流信号.超声造影后15例见病灶增强,其中7个表现为少分隔规则增强,5个囊壁增强,3个蜂窝状增强,另9例未见增强.结论 囊性肾占位无增强、囊壁增强或少分隔规则增强应考虑良性病变,超声造影对诊断有较大的帮助.     

MR imaging in intracystic hemorrhage of simple hepatic cysts

Intracystic hemorrhage of simple hepatic cysts is one of the most frequent complications. Ul-trasonography (US) and computed tomography (CT) may show abnormal findings and mimic other diseases. We describe magnetic resonance (MR) imaging in four patients with intracystic hemorrhage confirmed by surgery or percutaneous aspiration. In all cases the lesions were hyperintense on both T1- and T2-weighted sequences. In three of the four cases the signal was heterogeneous on T1-weighted sequences. Two cases of a thickened wall and one case of a fluid-fluid level were also observed. We suggest that MR imaging may be helpful to differentiate intracystic hemorrhage from other cystic lesions by showing high signal on T1- and T2-weighted sequences.     

超声显像在颌骨囊性病变中的临床应用

目的：探讨超声显像在颌骨囊性病变中的特征及诊断价值,方法：29例颌骨囊性病变的患者,术前均经超检查,术后病理对照。结果：1．超声能显法颌骨骨皮质破坏的范围,最小病变检出范围为0．3cm;2．超声能显示含牙囊肿有光点密集的特点,可见囊内含牙声像;3．超声能显示囊内不均质的变化;4．超声不能显示颌骨囊壁 破坏及牙根吸收的特点。论：超声显像在颌骨囊性病变诊断中有重要的临床价值。     

肾脏不典型囊性病变的Bosniak分级CT评价

目的探讨依据Bosniak分级标准用CT评价肾脏不典型囊性病变的诊断及处理。方法由两位放射诊断医生通过协商按Bosniak分级标准对65个病灶进行分类,并与临床随访和手术结果比较,计算该标准对是否需要手术切除判断的敏感性、特异性、准确性及阳性预测值、阴性预测值。结果本组病变中,按Bosniak分级标准诊断为Ⅱ级34个,ⅡF7个,Ⅲ级15个,Ⅳ级9个。对是否需要手术治疗的判断敏感性、特异性、准确性、阳性预测值和阴性预测值分别是83．3％、92．7％、89．2％、87．0％和90．5％。结论按Bosniak分级标准的CT表现,能准确地将需手术治疗的肾脏不典型囊性病变与仅需随访的病变加以区分。     

多房囊肿型肾细胞癌的超声表现与病理对照研究

目的探讨多房囊肿型肾细胞癌的超声表现及其诊断意义。方法回顾性分析11例经临床病理证实为多房囊肿型肾细胞癌患者的超声资料,并将其与手术病理进行对比。结果11例患者超声检查均表现为边界清楚的多房囊性肿物,囊内液体表现为无回声或低回声区,依据液体性质和/或有无实性成分的不同,一些小囊中有高低回声混杂的区域。11例患者中4例患者由于囊内有出血,囊内容物可见部分略高回声,1例纤维分隔上有营养不良性钙化,11例分隔上均未见结节,5例肿物内可见部分实质样成分,但比例小于10%。8例患者囊内分隔及瘤体内缘发现短线状或条状彩色血流。所有患者超声表现与病理学结果密切相关。结论多房囊肿型肾细胞癌在超声检查中的特征表现,对其诊断及鉴别诊断具有重要的临床意义。     

腹膜腔囊性病灶的CT诊断及临床意义

目的探讨腹膜腔囊性病灶的CT诊断及应用价值。方法对照分析20例腹膜腔囊性病灶的CT表现和手术、病理结果。结果3例腹膜腔单纯性浆液或黏液性的囊肿,CT均表现为边界清晰的囊性包块,4例囊腺瘤或囊腺癌可见增厚的囊壁和结节,3例肠系膜上的囊性肿瘤呈蔓藤飘浮状。3例腹膜腔假性黏液瘤在肝脏前、后间隙和结肠下间隙见多个有分隔状囊性肿块。2例腹膜腔囊性间皮瘤局限于下腹腔,壁稍厚,有强化。5例腹膜腔血肿均有外伤史,表现为上腹部器管间隙内边缘清晰的囊性包块。结论CT能清晰地显示腹膜腔囊性病灶的部位、形态、范围,对临床诊断和治疗有重要价值。