基于BI-RADS评估伴或不伴点状/圆形钙化的可疑恶性钙化分类研究

目的 基于第5版乳腺影像报告与数据系统（BI-RADS）,探讨各钙化分布中伴或不伴点状/圆形钙化的各种可疑钙化的分类。方法 回顾性分析经乳腺X线摄影检出可疑钙化或点状/圆形钙化并有病理活检结果的女性病人289例,平均（47.2±9.4）岁。将可疑钙化根据是否伴有点状/圆形钙化分为2组,即单纯可疑钙化（不伴有）组和混合可疑钙化（伴有）组。对处于不同钙化分布及形态下的2组可疑钙化的阳性预测值（PPV）及BI-RADS分类进行分析。2组钙化间PPV比较采用χ²检验或Fisher确切概率检验,2组钙化间恶性风险比较以优势比（OR）和95%可信区间（CI）表示。结果 35处点状/圆形钙化均为良性,为BI-RADS 2类。可疑钙化共254处,其中混合可疑钙化104处,单纯可疑钙化150处。混合可疑钙化在区域性、成簇、线样和段样分布中的PPV均低于单纯可疑钙化（均P<0.05）,且恶性风险也低于单纯可疑钙化（均OR<1.0）。区域性、成簇及段样分布中,混合细小多形性钙化的PPV均低于单纯细小多形性钙化（均P<0.05）,且恶性风险也均较单纯细小多形性钙化更低（均OR<1.0）。区域性分布中,混合及单纯无定形钙化均为BI-RADS 4A类;成簇分布和段样分布中,混合及单纯无定形钙化均为BI-RADS 4B类。区域性、成簇、段样分布中混合及单纯细小多形性钙化均为BI-RADS 4B类及4C类。结论 依据BI-RADS,更细化分析点状/圆形钙化对各钙化分布中各种可疑钙化的影响,对精准评估可疑钙化恶性风险具有更大帮助。     

Calcification in chronic maxillary sinusitis: comparison of CT findings with histopathologic results.

BACKGROUND AND PURPOSE: It is important to differentiate fungal from nonfungal sinusitis in order to determine the optimal treatment for chronic sinusitis. The purpose of this study was to describe the CT findings of calcifications in chronic fungal and nonfungal maxillary sinusitis. METHODS: Five hundred ten patients with pathologically proved chronic maxillary sinusitis were studied with unenhanced CT before undergoing sinonasal surgery. In 36 patients, the CT scans were reviewed retrospectively to ascertain the shape and location of intrasinus calcifications. RESULTS: Calcifications were found in 20 (51%) of 39 patients with fungal sinusitis and in 16 (3%) of 471 patients with nonfungal sinusitis. Direct histopathologic correlation was performed in two of 16 patients with nonfungal sinusitis who had intrasinus calcification. The location of intrasinus calcification was central in 95% of the patients with fungal sinusitis and peripheral in 81% of those with nonfungal sinusitis. Although calcifications with a nodular or linear shape were seen in both fungal and nonfungal sinusitis, fine punctate type calcifications were seen only in those with fungal sinusitis (50%) and round or eggshell type calcifications only in those with nonfungal sinusitis (19%). CONCLUSION: Intrasinus calcifications are different in location and shape between fungal and nonfungal maxillary sinusitis. Although intrasinus calcification is uncommon in nonfungal sinusitis, the CT finding of intrasinus calcification may be helpful for differentiating fungal from nonfungal maxillary sinusitis.     

Diffusely calcified renal cell carcinoma: CT features.

Calcifications of renal masses are common. They are usually dense, partial, small, punctate, and linear opacities. Diffuse calcification is an extremely rare feature of renal masses. Generally, calcified renal cell carcinomas are hypovascular, with calcifications in the interstitium, and they also contain fibrotic capsules, necrotic areas, or hyalinization. We recently observed a renal neoplasm with diffuse calcification on CT and intermediate vascularity on angiography, which was diagnosed histologically as renal cell carcinoma, clear cell type. Interestingly, there were numerous calcific deposits within the tumor cells.     

The significance of sinonasal radiodensities: ossification,calcification, or residual bone?

PURPOSETo determine whether very radiodense material within a sinonasal soft-tissue mass on CT can be differentiated as calcification, ossification, or residual bone.METHODSWe retrospectively described the radiodensities within 235 sinonasal soft-tissue masses as discrete, solitary or multiple, or as a diffuse process with either a well-defined or poorly defined margin. They were also classified as calcification, ossification, or residual bone. Findings were correlated with pathologic specimens.RESULTSResidual bone was underdiagnosed; calcification was overdiagnosed. A solitary discrete density was most likely to be calcification within an inflammatory mass. However, multiple discrete densities were as likely to be in a tumor as in an inflammatory lesion. If the process was diffuse with a well-defined margin, it was most likely to be a benign fibroosseous lesion. If the process was diffuse with a poorly defined margin, it was most likely to be a high-grade sarcoma. Densities within inverted papillomas were shown to be residual bone, not calcifications; densities within esthesioneuroblastomas were calcifications.CONCLUSIONRadiodensities may help in refining a CT diagnosis, but one may not know based on CT whether the density is a calcification, ossification, or residual bone.     

Mammographic features of ductal carcinoma in situ (DCIS) present on previous mammography.

AIM: To review previous mammograms of women found later to have DCIS and identify features which may have been missed or misinterpreted as benign. METHODS: The previous mammograms of 50 women who developed DCIS were analysed. The mammographic features at diagnosis and on the prior mammograms were compared. RESULTS: 11 (22%) of the previous mammograms were in retrospect abnormal; 5 (45%) of these had previously been assessed for the abnormality. All showed microcalcification. The following features were commoner at diagnosis than on previous films; rod shaped calcification (64 vs. 27%, P = 0.03) and a ductal distribution of calcification (76 vs. 45%, P = 0.05). Predominantly punctate calcification (64 vs. 12%, P = 0.001) and less than 10 calcifications in the cluster (54 vs. 24%, P = 0.05) were more common on the previous films. No difference was found in the frequency of granular calcification, branching calcification, irregularity in density, size or shape of calcification between the two groups. CONCLUSION: Features of DCIS missed on previous mammography include small cluster size, less than 10 calcifications in the cluster, the absence of rod shaped calcifications, the absence of a ductal distribution and the presence of predominantly punctate calcification. Features frequently seen both at diagnosis and on previous films which might have allowed earlier diagnosis were granular calcifications which vary in size, density and shape in an irregularly shaped cluster. Focal clustered calcification deserves aggressive investigation.     

Extrapulmonary Pneumocystis carinii infection in AIDS: CT findings

Clinical and computed tomographic (CT) findings in three cases of extrapulmonary Pneumocystis carinii infection in patients with acquired immunodeficiency syndrome (AIDS) were reviewed. Proved sites of involvement included the spleen (n = 2), bone marrow (n = 1), liver (n = 1), and peritoneal and pleural fluid (n = 1). CT findings included focal low-attenuation splenic lesions that became progressively calcified in rimlike or punctate fashion; punctate calcifications in the liver, renal cortices, and adrenal glands; calcification of lymph nodes; and pleural and peritoneal effusions with subsequent calcifications of the pleural and peritoneal surfaces. Although rare both before and since the onset of the AIDS epidemic, extrapulmonary P carinii infection in AIDS patients has been reported with increasing frequency in recent years, and more cases with radiologic manifestations should be expected.     

Calcified renal stones and cyst calcifications in autosomal dominant polycystic kidney disease: clinical and CT study in 84 patients.

Although renal calculi and cyst calcifications occur commonly in patients with autosomal dominant polycystic kidney disease (ADPKD), their true frequency is unknown because it is difficult to distinguish between the two with excretory urography and sonography. A detailed analysis of renal calcifications in ADPKD based on CT findings has not been performed. Accordingly, we retrospectively evaluated clinical and CT findings in 84 patients with ADPKD to determine the frequency of calculi and cyst calcifications, the relationship of these abnormalities to symptoms, and possible factors in their pathogenesis. Of the 84 patients, 53 had both IV contrast-enhanced and unenhanced CT scans and 31 had unenhanced scans only. We examined unenhanced CT scans of all 84 patients for renal calcifications. However, we classified renal calcifications into stones and cyst calcifications in only the 53 patients, because it is often difficult to distinguish between the two when only unenhanced scans are available. Of 84 patients, 18 (21%) had passed renal calculi or had stones treated surgically and 42 (50%) had renal calcifications on CT. Of the 53 patients who had both enhanced and unenhanced CT scans, 19 (36%) had renal calculi on CT. Patients with stones had significantly higher frequencies of previous flank pain (68% vs 35%) and of urinary tract infections (63% vs 18%) than did those without calculi. Cyst calcifications occurred in 13 (25%) of 53 patients and were probably a consequence of cyst hemorrhage. Cyst calcifications were found significantly more often in older patients with larger kidneys and worse renal function. We conclude that renal stones have a high rate of occurrence among patients with ADPKD and are a significant cause of morbidity in this disorder. Cyst calcification is also common in patients with ADPKD, particularly those with more advanced cystic disease.     

MR imaging of calcified intracranial lesions

Fifty calcified intracranial lesions diagnosed with computed tomography (CT) were evaluated with magnetic resonance (MR) using a spin-echo sequence. MR images demonstrated 41 of 50 lesions seen as calcified on CT scans, among them 29 of 30 cerebral neoplasms and all ten arteriovenous malformations. The presence of calcification was suspected prospectively in about 60% of calcified lesions but was also suspected in 45% of uncalcified lesions (reviewed as control cases). No fine calcifications and only 25% of punctate calcifications were disclosed on MR images. In the nine lesions undetected by MR, calcification was the only abnormal CT finding. The findings of calcification on MR images were nonspecific, ranging from signal void or signal dampening on all sequences to no alteration of signal intensity. The most common finding of calcification was a focus of signal diminution, rather than signal void, as commonly reported.     

Calcification of the trochlear apparatus of the orbit: CT appearance and association with diabetes and age.

OBJECTIVE. Calcification can sometimes be observed on CT scans in the region of the trochlear apparatus of the orbit, the cartilaginous structure through which the superior oblique tendon and its sheath pass. We evaluated associations of trochlear calcifications with age and diabetes. MATERIALS AND METHODS. We retrospectively reviewed CT scans of the orbit in 159 patients to identify the presence of trochlear calcifications. The presence or absence of diabetes, duration of diabetes, type of therapy, and presence or absence of neuropathy were determined from medical charts of 139 patients. We calculated the odds ratio of detecting a trochlear calcification and used logistic regression to evaluate the associations of age, sex, and diabetes with trochlear calcification. RESULTS. Trochlear calcifications were present in seven of the 24 diabetic patients and in 10 of the 115 nondiabetic patients. The odds ratio for detecting trochlear calcifications in diabetic vs nondiabetic patients was 4.3 (p < .01). Logistic regression showed univariate associations with trochlear calcification for both increasing age (p < .001) and diabetes mellitus (p < .01). The effect of diabetes on the prevalence of trochlear calcifications was seen predominantly in those less than 40 years old (odds ratio = 24.0, p = .014). Sex, duration of diabetes, insulin dependence, and neuropathy were not significantly associated with an increase in trochlear calcifications. CONCLUSION. The results show that a trochlear calcification seen on CT is a benign condition that may serve as a marker for diabetes in young patients. Trochlear calcifications are observed frequently (25-30%) in persons more than 50 years old. When it is present in patients younger than 40 years, it is strongly associated with diabetes.     

Lymph node calcification in malignant lymphoma. Presentation of nine cases and a review of the literature

Lymph node calcification in malignant lymphoma is an uncommon radiologic finding. Eight cases are added to the 61 cases of lymph node calcification following radiation therapy for Hodgkin's disease, assembled from the literature. The typical radiographic appearance of punctate calcifications, usually found in the upper mediastinum, at times together with egg-shell type calcification, is confirmed. The mean time before appearance of calcification was 3 years after initial treatment. The calcification seems to be associated with a good prognosis and long-term survival. In addition, the radiologic and clinical findings in a patient with non-Hodgkin's lymphoma who developed calcifications in the involved area after treatment are presented.     

Arterial calcifications of the hand: normal aging and the course in chronic dialysis patients

Normally, arterial calcifications in the hand progress from proximal to distal and do not reach the fingers by the 8th decade. In patients on maintenance dialysis arterial calcifications begin earlier and do not progress with age. The most severe arterial calcifications occur in patients with renal failure caused by diabetic nephropathy. Prognostically arterial calcifications in the finger-metacarpal region are an unfavourable sign.     

Cervical paraspinal calcification in collagen vascular diseases

Although soft-tissue calcification is common in collagen vascular disease, paraspinal calcification in the cervical spine has not been described before. We studied five women with large, lobulated, predominantly homogeneous calcific masses centered on synovial articulations in the neck. Changes consisting of either osteolysis or erosions were evident. All patients had radiculopathy, focal pain, or stiffness. In two patients, the presence of hydroxyapatite crystals was confirmed on biopsy. Symptomatic cervical paraspinal calcifications in patients with collagen vascular disease cause large soft-tissue masses that mimic tumoral calcinosis.     

Calcified masses of the kidney. Apropos of 58 cases

Case reports were analyzed of patients with calcified renal masses observed in the department since 1968. Of the 65 radiologic reports reviewed, 7 were rejected since the course since diagnosis was unknown. Of the 58 case reports studied, 34 were of masses of certain diagnosis, 12 undetermined, 7 of masses in polycystic kidneys, 3 in tuberculous kidneys and 3 probably calcified hematomas. Analysis involved only those masses of proven diagnosis. Results confirmed the absence of specificity in favor of the cyst of peripheral character of calcifications: 33% of these masses were cancers. The existence of tissue calcification is synonymous of a solid mass, nearly always malignant (92% of cases). For peripherally calcified masses, arteriography was not sufficient to affirm benign nature of lesions, most of these masses having a particularly poorly vascularized or even avascular appearance. In these cases angiotensin was of special interest. Ultrasound imaging proved to be a reliable and perfectly sensitive examination. The presence of calcifications rarely interfered with study of tumoral contents. CT scan imaging and puncture biopsy were also perfectly sensitive and reliable examinations. Because of the high frequency of cancers in masses with peripheral calcification, all these masses should be surgically explored or at least punctured. Although a "benign" CT scan image appears sufficient to affirm the benign nature, this still requires more ample confirmation.     

The radiologic and clinical aspects of calcified hypernephroma.

The radiologic, pathologic, and clinical findings were reviewed in 18 patients with calcified hypernephroma and 6 with calcified benign renal lesions. Our results suggest: (a) that the pattern of calcification in a renal parenchymal lesion is of little assistance in diagnosis; in this series, many hypernephromas had peripheral curvilinear calcifications, and most benign renal lesions had internal amorphous calcifications; (b) that no distinct angiographic pattern exists in calcified hypernephroma, and a spectrum ranging from avascular to hypervascular may be identified; and (c) that these tumors may behave more benignly than uncalcified hypernephroma (5-year survival 78%).     

Pleural calcification: a type of "metastatic calcification" in chronic renal failure

Pulmonary calcifications associated with chronic renal failure are rare conditions. However, a few such cases have been reported in the literature, and they were regarded as a sign of secondary hyperparathyroidism. Pleural calcification induced by secondary hyperparathyroidism has not been reported in the literature. We report four cases of slow-growing pleural calcification which are considered to have been induced by hyperparathyroidism, in patients undergoing maintenance haemodialysis for chronic renal failure. CT scan was useful for the detection of calcified lesions in the pleura.     

Assessment of the clinical utility of the rim and comet-tail signs in differentiating ureteral stones from phleboliths.

OBJECTIVE: This study was designed to assess interobserver variability in identifying the rim and comet-tail signs and to determine the clinical utility of these signs in determining whether or not the calcifications with which they are associated represent ureteral calculi. MATERIALS AND METHODS: Two radiologists and a radiology resident, unaware of the final diagnosis, reviewed preselected helical CT images from renal stone examinations in patients with 65 indeterminate pelvic calcifications. Assessment of calcifications for rim or comet-tail signs was performed independently of an assessment for the following five secondary signs of urinary tract obstruction: caliectasis, pelviectasis, ureterectasis, perinephric stranding, and renal enlargement. Agreement in identifying rim and comet-tail signs was assessed by obtaining kappa statistics. The utility the of rim or comet-tail signs in determining whether ureterolithiasis was present in patients in whom perinephric stranding and ureterectasis were present or absent was determined. The frequency with which one or more of each of the five assessed secondary signs was identified ipsilateral to a calcification having rim or comet-tail signs was also tabulated. RESULTS: Kappa values for interobserver agreement ranged from 0.49 to 0.73. In only one patient was a rim sign detected in the absence of ureterectasis and perinephric stranding. Reviewers identified at least three of the five assessed secondary signs ipsilateral to calcifications showing a rim sign in all but one patient (by each radiologist) and four patients (by the resident). When three or more secondary signs of obstruction were seen ipsilateral to a calcification having a comet-tail sign, in all but one instance, this was because the calcification was a ureteral calculus or because there was a separate ipsilateral ureteral calculus. CONCLUSION: In many instances, observers did not agree about whether the rim and comet-tail signs were present. The rim sign was observed in the absence of any secondary signs of urinary tract obstruction in only one (1.5%) of the 65 patients in our series (95% confidence interval, 0-5.3%). The comet-tail sign, when accompanied by secondary signs of obstruction, should indicate that an ipsilateral ureteral stone is present and not the reverse.     

Metastatic calcification of floor of the mouth secondary to chronic renal failure—report of a rare case with atypical presentation

Soft-tissue calcification is always pathological. Metastatic calcification is calcification of soft tissues owing to hyperphosphataemia with or without hypercalcaemia. Metastatic calcification of oral cavity is extremely rare. A case report of metastatic calcification of the floor of the mouth with atypical radiologic and clinical picture is presented here along with a review of earlier reports. A chance finding of the granular oral mucosa on palpation led to a radiographic examination revealing granular calcifications of the floor of the mouth. Blood chemistry and hormone analysis revealed chronic renal failure and hyperparathyroidism. A diagnosis of metastatic calcification secondary to renal failure was made and the treatment was aimed at correcting the renal failure without any intervention for the asymptomatic calcifications. Key differences between the present case and other cases reported in the literature are outlined.     

The prevalence of carotid artery calcification on the panoramic radiographs of patients with renal disease

OBJECTIVES: To determine the prevalence of carotid calcification on dental panoramic radiographs in end-stage renal disease (ESRD) patients on haemodialysis and renal transplant recipients. METHODS: Panoramic radiographs of 69 adult patients with renal disease (34 with haemodialysis and 35 with renal transplantations) (age range 17-74 years; mean age 39.45 years) and 50 controls (age-match, free of systemic disease) were examined on panoramic radiographs for any unusual radiopacity adjacent to or just below the intervertebral space between C3 and C4. Patients with such calcifications were referred to ultrasound examination. Using Chi-squared tests, calcification prevalence rates were statistically compared. RESULTS: The statistical difference between renal disease patients and control group was significant (chi2 = 17.91, P < 0.001). On comparison of haemodialysis patients and renal transplant recipients with controls, statistical difference (P=0.007) was found to be significant. CONCLUSION: Carotid artery calcification was higher in haemodialysis patients and renal transplant recipients. These patients with such calcifications should be referred for further evaluation and treatment of carotid arteries, coronary arteries and vascular risk factors.     

Echo-guided percutaneous treatment of chronic calcific tendinitis of the shoulder

PURPOSE: We report on our personal technique and the results of US-guided percutaneous treatment of chronic calcific tendinitis. MATERIAL AND METHODS: January 1997 to March 1999, seventy patients with known chronic calcific supraspinatus tendinitis were submitted to the US-guided treatment. All patients had undergone plain radiography, US, and physical and psychiatric examination. Plain radiography and aspiration biopsy demonstrated hard and radiopaque calcification in 59 patients and soft and faintly milky calcification in 11 cases; calcification diameter ranged 6-30 mm. US showed tendon thickening, with bulging of the outer tendon surface; 10 patients also had moderate dilatation of the subacromial bursa. Psychiatric examination revealed chronic pain exacerbated at night, which was always associated with motion impairment. The selection criteria for treatment were calcification diameter > 6 mm, integrity of the tendon, and chronic pain. After superficial planes were anesthetized, a 16 G needle was positioned inside the calcification under US guidance and the calcific deposits were fragmented and aspirated. Then, 0.5-1 mL triamcinolone acetonide (40 mg) was injected in the soft tissues or subacromial bursa. RESULTS: Pain resolution and recovery of the full range of motion were seen in 42 patients (60%), and mild functional impairment was seen in 7 cases (10%), while 2 patients (2%) were unchanged. Post-treatment plain radiography showed calcification disappearance in 41 patients (58.5%) and debulking in 29 (41.5%); the calcifications were significantly debulked (> 60%) in 27 patients (38.5%). However, calcification diameter was substantially unchanged in 2 patients (3%) and there remained tendon bulging; in these patients clinical symptoms did not improve. No rotator cuff tears or new tendon calcifications were found in any of our patients even at 19-28 months' follow-up. DISCUSSION: The US-guided technique always allowed easy location of calcific deposits and complete aspiration of all soft calcifications. Splintering of hard calcifications helped migration of residual deposits to vascularized soft tissues, which accelerated the--frequently complete--resorption process. We privileged extensive and prolonged fragmentation of the calcifications using a single needle, versus the technique using a second needle, saline lavage and aspiration of residual deposits. CONCLUSION: US-guided percutaneous treatment with aspiration and splintering of chronic calcific supraspinatus tendinitis is a conservative, simple, well-tolerated procedure which can be considered the method of choice after the failure of medical treatment.     

Mammographic predictors of the presence and size of invasive carcinomas associated with malignant microcalcification lesions without a mass

OBJECTIVE: Our objective was to determine the degree with which mammographic features predict the presence and size of invasive carcinomas associated with malignant mammographic microcalcification lesions without a mass. MATERIALS AND METHODS: Mammographic features were correlated with pathologic features in 304 consecutive breast carcinomas manifested by mammographic calcifications only in a prospective evaluation. RESULTS: Mammographic calcifications associated with breast carcinoma had the final pathologic diagnoses of pure ductal carcinoma in situ (DCIS) in 65% of patients, DCIS with a focus of invasion in 32%, and invasive carcinoma only in 4%. Invasive foci were more likely associated with mammographic calcification size of 11 mm and greater (40%, 77/194) compared with 1-10 mm (26%, 29/110; p = 0.019). Invasive foci were also more likely associated with linear calcifications (44%, 55/126) compared with granular calcifications (29%, 51/178; p = 0.007). The frequency of invasion did not increase with calcification extents greater than 10 mm. The frequency of invasion ranged from 22% for less than or equal to 5-mm granular calcifications to 45% for linear calcifications of 11 mm and greater. Only 11% of cancers characterized by fine granular calcifications were associated with invasion as compared with 32% of those with coarse and mixed granular calcifications (p = 0.002). CONCLUSION: Mammographic calcification features of malignant lesions cannot predict the absence of invasion with greater than 90% predictive value or predict the presence of invasion with greater than 45% predictive value. Increased extent of calcifications greater than 10 mm was not associated with greater likelihood of invasion.