多层螺旋CT后处理技术对肝癌动脉的显示价值

目的：探讨多层螺旋CT后处理技术对于肝癌动脉的显示价值。方法：173例肝癌患者中,男131例,女42例;年龄33～82岁。采用多层螺旋CT机进行增强扫描。将动脉期图像数据以多平面重建、最大密度投影及容积再现等模式对血管进行显示分析。曲面重组和曲面最大密度投影技术也被应用。结果：在评价肝动脉解剖识别方面,容积再现技术和最大密度投影显著优于多平面重建（P〈0．001）,且容积再现技术优于最大密度投影（P〈0．001）。在评价肿瘤病灶供血动脉方面,最大密度投影显著优于多平面重建和容积再现技术（P〈0．001）,且容积再现技术优于多平面重建（P〈0．05）。在评价肿瘤血管的连续性和血管形态方面,MIP优于VRT（P〈0．001）;MIP优于MPR（P〈0．001）;VRT优于MPR（P〈0．001）。结论：多层螺旋CT血管成像技术是一种重要的对肝癌供血动脉的评价方法。MIP为评价肝脏血管的最佳模式,有助于外科手术和介入治疗。     

多层螺旋CT对肾上腺嗜铬细胞瘤的诊断价值

目的探讨MSCT对肾上腺嗜铬细胞瘤的诊断价值。方法收集本院经手术和病理证实的32例肾上腺嗜铬细胞瘤患者的资料,其中男13例,女19例,年龄14~70岁,平均31岁。所有病例术前均行MSCT平扫和增强扫描(动脉期、静脉期),部分病例行MPR、MIP等后处理,回顾性分析其CT表现。结果本组32例共34个病灶,其中单发30例,多发2例;CT扫描显示,肿瘤呈较大的圆形或类圆形软组织肿块(平均直径4.8cm),边界清楚,平扫密度多不均匀,其中26例均伴有出血、坏死和囊变,增强扫描肿瘤多为不均匀明显强化,动静脉期肿瘤实性部分明显强化,低密度坏死囊变区始终未见强化。MPR及MIP等后处理能清晰显示肿瘤的大小、部位、形态、血供、内部情况及周围结构的关系。结论MSCT对肾上腺嗜铬细胞瘤的诊断具有重要价值,嗜铬细胞瘤的CT表现具有一定的特征性,结合MPR、MIP等后处理、临床资料和实验室检查,即可明确诊断。     

多层螺旋CT对双侧肾上腺疾病的诊断价值

目的探讨多层螺旋CT对双侧肾上腺疾病的临床诊断价值。资料与方法 34例双侧肾上腺疾病患者均行多层螺旋CT平扫,其中27例加行双期增强扫描,并行冠状面三维多平面重组(MPR)观察其影像学特征。结果 34例双侧肾上腺病变中,转移瘤20例,淋巴瘤4例,腺瘤3例,结核3例,嗜铬细胞瘤2例,皮质癌2例。转移瘤呈类圆形或不规则形,不均匀明显强化。淋巴瘤形态不规则,不均匀轻、中度强化。腺瘤边界清晰,平扫CT值<15 HU,中度强化。结核显示肾上腺弥漫性肿大、结核性肉芽肿形成及弥漫性钙化。嗜铬细胞瘤边界清晰,实性部分明显强化。皮质癌肿块较大,密度不均,强化明显但不均匀,可累及周围组织。结论多层螺旋CT是双侧肾上腺病变的首选检查方法。     

16层螺旋CT血管成像诊断脾动脉瘤的价值

目的：探讨多层螺旋CT血管成像（MSCTA）诊断脾动脉瘤的价值。材料和方法：回顾性分析经多层螺旋CT腹部检查发现的7例脾动脉瘤的MSCTA表现，血管成像方法为容积再现（VR）、表面覆盖显示法（SSD）、最大密度投影（MIP）及多平面重组（MPR）和曲面重组法（CPR）。结果：7例均发现脾动脉瘤，其中单发5例，多发2例。VR、SSD、MIP、MPR、CPR均可明确显示脾动脉瘤，但以VR为最佳。结论：多层螺旋CT血管成像是一种有效的无创性检查手段，能准确显示脾动脉瘤，可作为诊断和随访脾动脉瘤首选检查方法。     

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。     

多层螺旋CT肝静脉成像后处理技术

目的：探讨多层螺旋CT肝静脉成像技术及后处理方法。方法：20例患者行肝脏动脉期、门静脉期及肝静脉期3期扫描,肝静脉期图像分别行1mm及2mm层厚重建,图像重叠60%,分别对两组薄层图像行最大密度投影（MIP）、多平面重组（MPR）、遮蔽表面显示（SSD）和容积再现（VR）,比较各种后处理技术显示肝静脉的优缺点。结果：所有病例均清晰显示第二肝门的肝左、肝中及肝右静脉,20例中有18例显示第三肝门静脉属支,另2例在第二肝门以下未见明显肝静脉引流入下腔静脉。1mm重建层厚较2mm重建层厚对微小肝静脉的显示更好,图像质量好。4种后处理方法中轴面薄层MIP显示的引流静脉数目最多,冠状面MPR对第二肝门及第三肝门的解剖关系显示最好。VR及SSD对门静脉系、第二肝门及第三肝门各静脉属支立体结构关系显示最好。结论：多层螺旋CT肝静脉成像可显示主要肝静脉,1mm重建层厚,60%影像重叠后的重建图像质量较好,各种重组技术相结合可清晰、立体显示门静脉系、第二肝门及第三肝门的结构。     

64层螺旋CT门静脉三维重组对门静脉高压侧支循环的研究及临床应用

目的：评价64层螺旋CT门静脉三维重组对门静脉高压侧支循环的诊断价值及临床应用。方法：正常者20例,肝硬化患者39例,行64层螺旋CT门静脉造影,容积数据采用最大密度投影（MIP）、容积再现法（VR）、表面遮盖法（SSD）、多平面重组（MPR）三维重组,观察门静脉高压肝内门静脉、属支及侧支循环的影像学特征。结果：64层螺旋CT门静脉三维重组能准确显示侧支循环分布范围、初步评估病变程度,门静脉高压症组门静脉属支管径显著大于正常组（P=0.000）,64层螺旋CT诊断食管胃底静脉曲张与胃镜诊断有高度一致性。结论：64层螺旋CT门静脉三维重组能够多角度、立体观察侧支循环情况,对预测其并发症、手术方案的制定具有重要的指导意义。     

多层螺旋CT诊断原发性输尿管癌

目的：探讨多层螺旋CT在原发性输尿管癌诊断中的价值。方法：16例原发性输尿管癌患者行多层螺旋CT扫描,并在工作站行多平面重组（MPR）、曲面重组（CPR）,分析原发性输尿管癌的多层螺旋CT表现,并与手术病理结果对照。结果：16例原发性输尿管癌CT平扫表现为病变段输尿管壁增厚或结节状软组织密度影,MPR、CPR显示更清晰。增强扫描动脉期、静脉期病变持续强化,接近肾实质强化。延迟期强化程度减退,低于肾实质强化。病变以上输尿管不同程度扩张。结论：多层螺旋CT诊断原发性输尿管癌具有重要价值。     

多层螺旋CT对肠扭转的诊断价值

目的探讨多层螺旋CT(MSCT)对肠扭转的诊断价值。方法收集急腹症MSCT双期增强扫描病例80例,其中10例患者图像经多平面重组(MPR)及肠系膜血管最大密度投影(MIP)处理,诊断为肠扭转。结果MSCT诊断10例肠扭转,主要征象有肠系膜血管“漩涡征”10例,肠管“漩涡征”5例,靶环征或双晕征5例,肠系膜上动脉、静脉(SMA、SMV)换位征3例,鸟喙征4例,SMV血栓形成2例,腹水征10例。诊断均经手术证实。结论MSCT双期增强扫描及多平面重组(MPR)与肠系膜血管最大密度投影(MIP)对肠扭转的诊断有重要价值。     

多层螺旋CT血管成像诊断颈内动脉海绵窦瘘的临床价值

目的探讨多层螺旋CT血管成像对颈内动脉海绵窦瘘诊断的临床价值. 资料与方法对13例颈内动脉海绵窦瘘患者进行多层螺旋CT三维成像,并对不同成像方式进行比较. 结果所有病例均显示海绵窦扩张,与眶上静脉沟通,并呈多条迂曲血管影或多结节样强化,以多平面重建（MPR）和曲面重建（CMPR）显示最清楚.容积再现（VR）、表面遮盖显示（SSD）和最大密度投影（MIP）显示空间结构好,5例仿真内镜（VE）显示海绵窦呈“镂空”状改变（38.5%）,MPR和加厚MIP可以不同程度显示海绵窦引流静脉的扩张. 结论多层螺旋CT血管成像对颈内动脉海绵窦瘘具有较高的诊断价值.     

Nuclear magnetic resonance imaging of the adrenal gland: a preliminary report

Nuclear magnetic resonance (NMR) imaging characteristics of the normal and abnormal adrenal gland were evaluated and compared with findings on computed tomography (CT). Forty-two patients were examined: 36 had normal adrenal glands and 6 had adrenal disease (3 metastatic lesions, 1 pheochromocytoma, and 2 cortical hyperplasia). NMR clearly showed all 42 left adrenals (100%) and 36 right adrenals (86%). In some patients, it appeared to differentiate the adrenal cortex from the medulla. The ability of NMR to detect adrenal disease was similar to that of CT in 6 cases examined. CT demonstrated superior spatial resolution in most cases, but NMR provided superior soft-tissue contrast. Since NMR does not involve ionizing radiation and provides excellent soft-tissue differentiation without contrast material, it has advantages over CT and appears to be a promising modality for imaging of the adrenal gland.     

肾上腺疾病的影像诊断与鉴别诊断

目的：提高对肾上腺疾病的影像诊断水平,方法：收集1993年1月－1999年9月经MRI检查的151例疑继发性高血压病人中有完整住院资料的46例临床,MRI,CT,B超及实验室结果,按病因分为肾上腺腺病（11例）,嗜铬细胞瘤（11例）,皮质腺癌（7例）,肾上腺增生（17例）共4组,结果：（1）大小：腺瘤体积小（原发性醛固酮增多症小于3cm,柯兴综合征小于5cm),嗜铬细胞瘤大于3cm,增生0．6－3．5cm.（2）质地：腺瘤和增生质地均匀,呈等T1,等T2信号,CT值15－25H嗜铬细胞瘤和腺癌易出血坏死液化。（3）实验室检查,原醛通常高钠低钾血症,嗜铬细胞瘤和腺癌患者尿中VMA可呈阳性,（4）肾上腺增生大小,形态及生化结果多种多样。结论：影像检查有利于明上腺疾病的检出,结合临床及实验室检查可提高病变的定性诊断。     

Pheochromocytoma in multiple endocrine neoplasia type 2A: positive 123I MIBG with negative CT and equivocal 131I MIBG imaging

An 123I metaiodobenzylguanidine (MIBG) planar image showed abnormal uptake in the left adrenal gland and thyroid in a 24-year-old woman with multiple endocrine neoplasia type 2A. 131I MIBG showed abnormal uptake in the thyroid but not in the adrenal gland. Abdominal CT with 2-mm thin slices demonstrated a normal adrenal gland. Postoperative pathologic findings were consistent with medullary carcinoma in both thyroid lobes and a small 1-mm pheochromocytoma in the left adrenal gland. 123I MIBG could clearly show the small pheochromocytoma, which was negative in thin-slice CT and equivocal in 131I MIBG.     

Changing role of imaging-guided percutaneous biopsy of adrenal masses: evaluation of 50 adrenal biopsies

OBJECTIVE: Prior series of percutaneous imaging-guided biopsies of adrenal masses before the advent of dedicated CT and MRI of the adrenal glands have shown that 40-57% of adrenal masses biopsied were adenomas-benign lesions requiring no further evaluation or treatment. This study was performed to assess the effect of dedicated adrenal imaging with CT and MRI on the rate of percutaneous imaging-guided biopsies of adrenal masses. MATERIALS AND METHODS: We reviewed 50 consecutive adrenal mass biopsies performed during a 48-month period. The patient demographics, technique of biopsy, pathology results, and results of any prior dedicated adrenal imaging with MRI or CT protocols were noted. RESULTS: Only six (12%) of 50 biopsies were adenomas. Five of these six cases were preceded by dedicated adrenal CT or MRI. Thirty-five cases were metastatic disease, four were adrenal cortical carcinoma, three were pheochromocytoma, and two biopsies were nondiagnostic. Overall, 20 of 50 cases were preceded by a dedicated adrenal CT or MRI examination to exclude an adenoma; in 21 of the remaining 30 cases, the imaging characteristics before biopsy were inconsistent with the potential diagnosis of an adenoma and dedicated adrenal CT or MRI was not recommended. CONCLUSION: The number of adrenal adenomas biopsied has declined markedly with the introduction of dedicated adrenal CT and MRI for adrenal adenomas. Percutaneous imaging-guided biopsy is useful in confirming the presence and nature of suspected metastatic deposits to the adrenal gland and in diagnosing or excluding adrenal adenomas in patients with equivocal imaging characteristics.     

~(99)Tc~m-HTOC和~(131)Ⅰ-MIBG显像诊断嗜铬细胞瘤的比较

目的比较和评价~(99)Tc~m-奥曲肽(HTOC)和~(131)Ⅱ-间碘苄胍(MIBG)显像诊断嗜铬细胞瘤的临床价值。方法 28例临床疑嗜铬细胞瘤患者先后进行~(99)Tc~m-HTOC 和~(131)Ⅰ-MIBG 全身显像,如全身显像发现异位病灶则加做同机 CT 融合检查。结果 28例中最终证实为嗜铬细胞瘤者19例,18例经手术或活组织病理检查证实,1例经生化和其他影像学检查证实。28例患者中9例~(99)Tc~m-HTOC 和~(131)Ⅰ-MIBG 显像均阳性,病灶位于心脏1例、腹主动脉旁3例、肾上腺3例,恶性多发病灶2例;恶性多发患者~(99)Tc~m-HTOC 显像发现的病灶多于~(131)Ⅰ-MIBG。~(99)Tc~m-HTOC 显像阳性而~(131)I-MIBG 显像阴性患者共5例,病灶位于心脏3例,恶性多发病灶2例。~(99)Tc~m-HTOC 显像阴性而~(131)Ⅰ-MIBG 显像阳性4例,病灶均位于肾上腺。两种显像均阴性10例,1例为嗜铬细胞瘤伴囊性变,其他9例均除外嗜铬细胞瘤。~(99)Tc~m-HTOC 和~(131)Ⅰ-MIBG 显像的灵敏度、特异性、准确性分别为73.7%、100%、82.1%和68.4%、100%、78.5%。~(99)Tc~m-HTOC 显像对异位于心脏的嗜铬细胞瘤和恶性多发病灶的诊断明显优于~(131)I-MIBG,但对肾上腺来源的嗜铬细胞瘤的检出不如~(131)Ⅰ-MIBG。结论 ~(131)Ⅰ-MIBG 显像仍是诊断嗜铬细胞瘤的首选检查,但结果阴性时需进行~(99)Tc~m-HTOC 显像.     

Role of multidetector row computed tomography in the assessment of adrenal gland injuries

OBJECTIVE: To determine the prevalence of adrenal injuries in a group of patients submitted to multidetector row CT evaluation after blunt trauma and to assess the impact of CT findings on clinical management decisions. MATERIALS AND METHOD: During a 4-year period, 2026 emergency CT examinations were performed in the setting of major blunt trauma. A total of 82 patients were retrospectively identified as having adrenal gland traumatic lesions. At multidetector row CT the following findings were considered specific of adrenal injury: round or oval hematoma expanding the adrenal gland, irregular hemorrhage obliterating the gland, uniform adrenal gland swelling, active extravasation of contrast material from the adrenal vessels and adrenal gland rupture. Associated CT findings were: stranding of the periadrenal fat, diffuse hemorrhage in the adjacent retroperitoneum and compression of the adrenal gland by adjacent traumatic lesions. RESULTS: We identified 82 patients (46 males and 36 females, age ranging from 15 to 86 years) with adrenal injuries. The right adrenal gland was injured in 60/82 patients, while the left adrenal gland was injured in 21 cases; in 1 patient bilateral adrenal gland traumatic lesions occurred. In 76 patients with non-isolated adrenal injuries concomitant injuries to the liver (49 cases), ipsilateral kidney (18 cases) and spleen (9 cases) were observed. Round or oval hematoma expanding the adrenal gland (61 cases), irregular hemorrhage obliterating the gland (14 cases), stranding of the periadrenal fat (9 cases) and diffuse hemorrhage in the adjacent retroperitoneum (8 cases) were the more frequent findings detected at CT. Six patients underwent surgical intervention for the presence of major injuries to the spleen (three cases), to the liver (one), to the right kidney (one), to the left kidney (one). Seventy-six patients were conservatively treated. CONCLUSION: Blunt adrenal injuries typically present as part of a multiorgan trauma. Familiarity with characteristic CT findings of adrenal trauma is essential for the radiologist to avoid misdiagnosis.     

Pheochromocytoma: detection by unenhanced CT

During a 2 1/2-year period, 10 patients with suspected pheochromocytoma were evaluated by unenhanced computed tomography (CT). Six adrenal masses, one hyperplastic adrenal gland, and two extraadrenal retroperitoneal masses were detected in seven patients; CT of the adrenals and retroperitoneum was normal in three patients. Scintigraphy with iodine-131 metaiodobenzylguanidine (131I-MIBG) was performed in nine of the 10 patients and corroborated the CT findings in all cases. In the three patients with normal CT and 131I-MIBG scintigraphic findings, follow-up assays of serum catecholamines were normal. In six of the seven patients with abnormal CT scans, surgical and pathologic confirmation was obtained; one patient was lost to follow-up after her CT scan. Unenhanced CT is recommended as the initial localizing procedure in patients with suspected pheochromocytoma, thereby avoiding the small but finite risk of hypertensive crisis associated with intravenous injection of urographic contrast medium.     

肾上腺转移瘤与非功能性肿瘤的CT鉴别诊断

目的探讨肾上腺转移瘤与非功能性肿瘤的CT鉴别诊断价值.资料与方法回顾分析46例经病理或临床随访证实的肾上腺非功能性肿瘤的CT及临床资料.结果转移瘤26例37个瘤灶中肺癌占17例(65%),28个瘤灶(76%)直径＞3 cm,多呈不规则或分叶状,可有出血、坏死、压迫或侵犯周围结构,31个瘤灶(84%)平扫CT值及强化程度＞20 HU.非功能性腺瘤12例呈类圆形,边界清楚,密度均匀,8例直径＜3 cm,5例瘤侧残存正常肾上腺,9例平扫及强化程度＜20 HU,其中4例出现负CT值.5例肾上腺皮质癌平均直径6.8 cm,边界不清,密度改变与转移瘤相似.3例嗜铬细胞瘤大小、形态、密度及边缘情况与转移瘤极为相似.结论转移瘤与非功能性腺瘤平扫密度、强化程度及是否瘤侧残存腺体均有显著性差异(P＜0.001),较易鉴别;与无功能性皮质腺癌、嗜铬细胞瘤鉴别较困难.     

嗜铬细胞瘤的CT诊断

目的 探讨CT对嗜铬细胞瘤的诊断价值. 资料与方法 分析经手术病理证实的嗜铬细胞瘤20例CT征象. 结果 嗜铬细胞瘤多是单侧发病(19/20),发生于肾上腺者16例,异位者4例.肿块较大,边界清楚,多为类圆形或椭圆形(19例).肿块内密度多不均,出血、坏死常见(10/17),钙化较少见,增强扫描可见病变实质不均匀强化. 结论 CT不但能发现较小的肿瘤,还可以定位诊断,以及显示肿瘤与周围组织结构、血管的关系,有助于手术方案的选择和术后随访.     

MR demonstration of a cystic pheochromocytoma

Cystic pheochromocytoma is a rare tumor of the adrenal gland that can pose a diagnostic challenge. We report a case of a 14 year-old boy who had an adrenal lesion that appeared cystic by both sonography and CT, but that demonstrated hemorrhage into the lesion at MR Imaging, and proved to be a cystic pheochromocytoma. We emphasize the importance of considering the diagnosis of pheochromocytoma when faced with a cystic lesion of the adrenal gland.