超声及超声引导下粗针穿刺活检诊断小腹部神经母细胞性肿瘤的价值

目的:探讨常规超声及超声引导下穿刺活检对小儿腹部神经母细胞性肿瘤的诊断价值。材料和方法:回顾性分析2000-01~2005-01的27例小儿腹部神经母细胞性肿瘤(节细胞瘤5例,节细胞神经母细胞瘤7例,神经母细胞瘤15例)的常规超声表现及14例超声引导下粗针穿刺活检的病理组织学结果。结果:18例超声准确判断肿瘤神经母细胞性来源(66.7%),9例分别误诊为肾母细胞瘤(3例)、其他神经来源的肿瘤(2例)、淋巴瘤(1例)和未能提出肿瘤可疑来源的3例。本组神经母细胞性肿瘤的超声表现为较大的低回声或混合回声包块(9.25±2.96 cm),形态不规则,23例可见散在的细小钙化灶,17例肿块包绕腹部大血管,节细胞瘤-节细胞神经母细胞瘤-神经母细胞瘤声像图有从均匀一致到弥漫不均的趋势;14例活检病例中,13例具体分型与术后病理相符,1例节细胞神经母细胞误诊为节细胞瘤。结论:常规超声对小儿腹部神经母细胞性肿瘤的诊断具有一定的帮助,而超声引导下多点的粗针穿刺活检能够明确肿瘤的分类和性质。     

儿童肾母细胞瘤的CT诊断和鉴别诊断

目的探讨CT在小儿肾母细胞瘤的诊断及鉴别诊断中的作用。方法回顾性分析经临床及病理证实的小儿肾母细胞瘤45例,肾透明细胞癌2例,肾横纹肌肉瘤1例。结合手术病理,了解其在CT上的表现特点。结果肾母细胞瘤表现为实性肿块34例（76%）、囊实性9例（20%）、囊性2例（4%）。肿瘤实质及囊壁有明显强化。7例（15.6%）肾或腔静脉内有癌栓形成。肾细胞癌表现与肾母细胞瘤相似。肾横纹肌肉瘤表现为肾中心囊实性肿块,内有线状钙化,有肾包膜下积液。结论肾母细胞瘤在恶性肾脏肿瘤中最常见,好发于肾实质,易侵犯肾盂肾盏,肿瘤常伴有出血、坏死、囊变,影像学上与肾细胞瘤很难鉴别。肾横纹肌肉瘤常好发于肾中心,包绕于瘤叶的线状钙化及包膜下积液为其特点。     

肾上腺少见神经源性肿瘤的临床病理特征与影像学表现

目的探讨几种少见的起源于肾上腺的神经源性肿瘤的临床病理特征及影像学表现,提高诊断水平。方法回顾性分析经病理证实的23例少见肾上腺神经源性肿瘤的临床病理特征及CT、MRI表现。结果 23例中,节细胞神经瘤12例,神经母细胞瘤5例,神经鞘瘤4例,节细胞神经母细胞瘤2例。其中,节细胞神经瘤多见于中青年男性,神经鞘瘤多见于中年人,神经母细胞瘤及节细胞神经母细胞瘤多见于儿童及青少年。各类肿瘤均有一定的CT、MRI表现特征,并与其病理学表现具有相关性,部分肿瘤表现相似需加以鉴别。结论了解肾上腺少见神经源性肿瘤的临床病理特征及CT、MRI特异性表现,有利于提高诊断能力并指导临床治疗。     

CT在儿童纵隔神经母细胞源性肿瘤诊断、分期及治疗方案选择中的应用

目的探讨CT在儿童纵隔神经母细胞源性肿瘤诊断、分期及治疗方案选择中的应用价值。方法回顾性分析经病理证实的29例儿童纵隔神经母细胞源性肿瘤的临床资料、CT表现及分期,并与病理结果进行对照分析。其中神经母细胞瘤(NB)20例,节细胞神经母细胞瘤(GNB)4例,节细胞神经瘤(GN)5例。平均发病年龄NB为(34.35±24.12)个月,GNB为(91.75±53.65)个月,GN为(67.40±68.00)个月。所有病例均行CT平扫及增强扫描。结果 CT平扫上,80.0%(16/20)NB、25.0%(1/4)GNB表现为密度不均匀,100.0%(5/5)GN密度均匀;80.0%(16/20)NB有不规则斑片状、点条状钙化,75.0%(3/4)GNB和80.0%(4/5)GN呈点状钙化。增强后75.0%(15/20)NB、50.0%(2/4)GNB呈不均匀强化,85.0%(17/20)NB和75.0%(3/4)GNB呈中度及明显强化,而100%(5/5)GN为均匀轻度强化。70.0%(14/20)NB、50.0%(2/4)GNB和40%(2/5)GN可见局部侵犯或远处转移。肿瘤分期中L_1期3例,L_2期15例,M期11例。随访中3例M期NB发生复发转移。肿瘤生物因子检测显示7例NB香草扁桃酸(VMA)升高,8例NB、1例GNB及1例GN的神经元特异性烯醇化酶(NSE)升高,6例NB的N-myc基因阳性。结论 CT在纵隔神经母细胞源性肿瘤的诊断、分期及治疗方案的选择中具有重要价值。     

儿童神经节成神经细胞瘤CT表现

儿童神经节成神经细胞瘤(又称节细胞成神经细胞瘤、节母细胞瘤，简称节母)是一种起源于交感神经系统较少见的恶性神经源性肿瘤。以往文献报道均认为它与成神经细胞瘤在病理和形态学均相似，但两者临床表现及预后明显不同。现将我院3例经手术与病理证实的节母细胞瘤临床表现及CT征象报告如下。     

多排螺旋CT在腹膜后神经源性肿瘤的分类及诊断中的价值

目的探讨腹膜后神经源性肿瘤的CT表现,以加深对其认识,提高术前诊断准确率。方法分析22例经手术病理证实的腹膜后神经源性肿瘤的CT表现特点。并结合文献进行分析、总结腹膜后神经源性肿瘤的影像学特点。全部病例均进行了CT平扫和增强扫描,其中交感神经源性肿瘤5例,神经鞘膜来源肿瘤7例,副节瘤10例。结果 22例腹膜后神经源性肿瘤均位于肾上腺区或沿交感神经链分布,其中交感神经节细胞来源的节细胞神经瘤3例,神经母细胞瘤及神经节神经母细胞瘤各1例;良性神经鞘瘤3例,恶性神经鞘瘤2例,神经纤维瘤2例,嗜铬细胞瘤4例,良性副节瘤4例,恶性副节瘤肿瘤2例。神经母细胞瘤和神经节神经母细胞瘤表现较具有特征性:平扫呈明显低密度,形态不规则,边界尚光整,增强扫描无明显强化或轻微强化;可见有较粗大无规则钙化及腹膜后大血管的包埋征象。副节瘤强化最显著,临床症状及实验室检查具有特征性,神经鞘来源的肿瘤形态差异较大,强化程度介于前两者之间。结论腹膜后神经源性肿瘤根据其好发部位、CT表现,结合患者发病年龄和临床资料,大多数在术前可作出较准确的诊断。     

小儿腹部肿瘤临床表现及二维与彩色多普勒超声诊断价值比较

目的 :探讨小儿腹部肿瘤临床表现及彩色多普勒超声诊断价值。方法 :选择2013年1月至2014年12月我院收治的49例腹部肿瘤患儿,均行彩色多普勒超声及二维超声检查,观察患儿的年龄分布、肿瘤类型,比较彩色多普勒超声与二维超声检查的确诊率。结果:本组49例中,肾母细胞瘤、神经母细胞瘤、卵巢畸胎瘤及肝母细胞瘤中男患儿居多,腹膜后畸胎瘤以女患儿居多;肾母细胞瘤、腹膜后畸胎瘤及肝母细胞瘤多见于婴幼儿,神经母细胞瘤与卵巢畸胎瘤则发病年龄偏大。彩色多普勒超声准确诊断48例,确诊率为97.96%;二维超声准确诊断37例,确诊率为75.51%,两者比较差异有统计学意义(P0.05)。结论:不同类型的小儿腹部肿瘤性别及年龄均存在差异,彩色多普勒超声检查可显著提高小儿腹部肿瘤的诊断准确率,值得临床推广。     

腹膜后神经源性肿瘤的分类以及CT诊断和鉴别诊断

目的：本文探讨腹膜后不同神经源性肿瘤的影像学表现、血液动力学特征及其与病理的关系,以提高诊断准确性。方法：经手术病理证实的腹膜后神经源性肿瘤43例,12例术前经螺旋CT或多排螺旋CT平扫和增强扫描,31例经平扫、动脉期和门脉期扫描。注射流率2～3ml/s。复习CT扫描结果并和手术病理作回顾性对照分析。结果：43个病例中神经鞘膜来源肿瘤28例（良性神经鞘瘤19例,恶性神经鞘瘤7例,神经纤维瘤2例）;副神经节瘤9例（良性8例,恶性1例）;交感神经节细胞来源肿瘤6例（节细胞神经瘤2例,神经母细胞瘤4例）。神经鞘膜来源肿瘤由低密度的细胞稀疏区和中等密度的细胞密集区构成,两种结构强化程度不同;神经鞘瘤多呈圆形,神经纤维瘤呈丛状或不规则形;良性肿瘤境界清楚,恶性神经鞘瘤境界不清,可见晕样结构和毛刺。副神经节瘤实体部分密度偏高,密度与腹主动脉相仿,变性明显,强化显著;良性和恶性难以鉴别。交感神经节细胞来源肿瘤富含水分,形态不规则,密度低;节细胞神经瘤密度较均匀,境界清楚,容易铸型并形成伪足样突起,强化轻微;神经母细胞瘤密度不均匀,境界不清,容易包绕血管和脏器,钙化显著,分叶明显,呈不均匀轻中度强化。神经节神经母细胞瘤影像表现介于节细胞神经瘤和神经母细胞瘤之间。结论：腹膜后神经源性肿瘤包括神经鞘膜来源肿瘤,副神经节瘤和交感神经节细胞来源肿瘤。不同神经源性肿瘤的影像表现既有相似之处又存在区别,结合肿瘤的病理基础,突出其根本征象并与其他征象结合,有助于提高诊断的准确性。     

大脑皮层及皮层下肿瘤的MRI表现

目的研究大脑皮层及皮层下肿瘤的MRI表现。方法回顾性分析187例大脑皮层及皮层下肿瘤患者的术前常规MR图像,总结常见大脑皮层及皮层下病变的MRl表现及鉴别要点。结果 187例大脑皮层及皮层下肿瘤中少突星形细胞瘤80例,弥漫性星形细胞瘤22例,胚胎发育不良性神经上皮瘤(DNET)17例,胶质母细胞瘤14例,节细胞胶质瘤11例,少突胶质细胞瘤11例,间变性少突星形细胞瘤6例,间变性少突胶质细胞瘤4例,多形性黄色星形细胞瘤(PXA)4例,恶性淋巴瘤4例,室管膜瘤4例,间变性室管膜瘤3例,胶质肉瘤2例,幕上原始神经外胚层肿瘤(PNET)2例,神经节细胞瘤1例,转移瘤1例,间变性星形细胞瘤1例。结论大脑皮层及皮层下肿瘤MRI特征性表现有助于诊断与鉴别诊断。     

节细胞神经母细胞瘤的CT表现与病理对照研究

目的：探讨节细胞神经母细胞瘤（ GNB）的CT表现,并与病理对照研究。方法收集经手术及病理证实的经CT检查发现的节细胞神经母细胞瘤4例,分析CT表现。结果肿瘤位于肾上腺区2例,腹膜后1例,骶管内1例。病灶边界不清楚,形态不规则,明显侵犯周围器官,肿块包绕周围大血管,瘤体最大径均＞5 cm。CT上密度多表现为不均匀,伴钙化1例,增强扫描呈明显不均匀强化。结论节细胞神经母细胞瘤有一定的影像表现特征,CT可清晰显示肿瘤的形态及与邻近结构关系,肿瘤发现晚、体积大,主要分布在交感神经节链是节细胞神经母细胞瘤的特征表现,但确诊仍依靠病理检查。     

腹部神经源性肿瘤CT分析34例

目的：探讨腹部神经源性肿瘤的CT特征，提高CT诊断能力，方法：分析34例手术病理证实的腹部神经源性肿瘤，其中神经鞘瘤16例，神经纤维瘤12例，节细胞神经瘤及神经母细胞瘤6例，良性18例，恶性16例，扫描方法以肿瘤为中心行CT平扫，28例增强扫描，层厚10mm。结果：腹部神经源性肿瘤大部分位于腹膜后及腹膜后脏器（23／34）占67．65％，其余11例来源于腹腔脏器和腹壁，良性神经源性瘤大多表现为圆形，类圆形组织密度影，边缘光滑，密度均匀，节细胞神经瘤可见斑点状钙化，增强扫描肿瘤大多表现为中度均匀或不均匀强化，恶性肿瘤体积大，形态不规则，边缘欠光滑，密度不均匀，有的肿瘤中心液化坏死或相互融合或侵蚀周围组织，结论：腹部神经源性肿瘤如果与大神经干走行无关，定性诊断较困难，肿瘤大小和密度不是区分良恶性神经源性肿瘤的特性表现，肿瘤边缘不光滑，形态不规则，并对周围组织的侵蚀破坏才是诊断恶性神经源性肿瘤的特征。     

炎性肌纤维母细胞瘤的MSCT和MRI诊断

目的：探讨炎性肌纤维母细胞瘤（IMT）的MSCT和MRI表现及其临床诊断价值。方法：回顾性分析经手术病理证实的15例IMT患者的CT和MRI表现,其中11例行CT检查,4例行MRI检查。结果：15例中病变发生于腹腔9例、鼻窦和鼻腔1例、肺部2例、左侧腮腺1例、肘关节及膝关节周围各1例。主要CT和MRI表现为肿块密度及信号不均匀,11例出现囊变、坏死,增强后肿块实性部分呈均匀或不均匀中度或明显强化,坏死、囊变区无明显强化,2例关节周围肿块可见包膜。病理示肿瘤由梭形细胞及炎症细胞组成,免疫组织化学染色肌源性蛋白阳性表达。结论：CT和MRI检查对IMT的定位和定性诊断及鉴别诊断具有一定价值,但IMT的确诊有赖于组织病理学及免疫组织化学检查。     

Color Doppler ultrasonography findings of bladder tumors: correlation with stage and histopathologic grade

PURPOSE: To describe color Doppler ultrasonography findings of bladder tumors and to investigate the correlation between these findings with stage and histopathological grade. MATERIAL AND METHODS: Twenty-four patients with bladder tumors were assessed with color Doppler ultrasonography for tumor size, presence of vascularity, vascular pattern, and spectral properties. All patients underwent surgery. Stage and histopathological grades of tumors were determined and compared with color Doppler ultrasonography findings. RESULTS: Presence of vascularity was related to tumor size (P<0.05) and color Doppler signal was detected when tumors reached 24 mm in size. There was no statistically significant relationship between tumor stage and histopathological grade with tumor size, presence and pattern of vascularity, and spectral color Doppler ultrasonography findings (P>0.05). CONCLUSION: The evaluation of vascularity in bladder tumors by color Doppler ultrasonography is not helpful in predicting tumor stage and histopathological grade before surgery.     

小儿生殖细胞瘤的CT诊断

目的分析小儿生殖细胞瘤的CT表现特点，提高CT诊断的准确性。资料与方法回顾性分析38例生殖细胞瘤的CT表现，并与手术及病理结果进行对照。结果多种组织成分组成的混杂密度占位18例，囊性或以囊性为主的占位12例，软组织密度或绝大部分为软组织密度的占位8例。其中良性28例，恶性10例。良性均为成熟畸胎瘤。恶性组中内胚窦瘤合并畸胎瘤3例；末成熟畸胎瘤、无性细胞瘤、内胚窦瘤各2例；卵巢绒毛膜癌1例。结论小儿生殖细胞瘤的CT表现具有各自的特点，CT诊断准确性较高，为首选的检查方法。     

Assessment of the vascularization of neuroendocrine tumors by stimulated acoustic emission of SH U 508A ultrasound contrast agent and color or power Doppler sonography

RATIONALE AND OBJECTIVES: To assess the vascularization of neuroendocrine tumors by stimulated acoustic emission (SAE) of SH U 508A during the blood pool phase in comparison with contrast-enhanced Doppler sonography. METHODS: Thirty-six patients with neuroendocrine tumors received contrast-enhanced Doppler sonography and 21, an additional SAE. To classify tumor perfusion on Doppler sonography, a 4-step rating score was introduced: (1) no vessels (hypoperfusion); (2) one feeding or central vessel (hypoperfusion); (3) some vessels (hyperperfusion); and (4) disseminated vessels (hyperperfusion). In 36 patients, 1 pancreatic primary tumor, 33 liver metastases, 1 splenic metastasis, and 1 lymph node metastasis were examined. Results were correlated with biphasic spiral CT (n = 35) and angiography (n = 2). RESULTS: Arterial-phase CT and digital subtraction angiography revealed 18 hyper- and 18 hypoperfused lesions. Contrast-enhanced Doppler correctly classified 15 of 18 patients (83%) with hyperperfused lesions as well as 16 of 18 (89%) hypoperfused tumors by applying the rating score. SAE correctly identified 4 of 9 hyperperfused lesions (44%), 2 were isoperfused compared with normal liver tissue (22%), and 3 were hypoperfused (33%). Of 12 hypoperfused lesions, 11 were classified correctly (92%), and 1 showed isoperfusion. Hence, the positive and negative predictive values for SAE were 80% and 69%, respectively. For contrast-enhanced Doppler sonography, positive and negative predictive values were 88% and 84%, respectively. CONCLUSIONS: Blood pool SAE failed to determine subtle tumor perfusion correctly. The rating score for contrast-enhanced Doppler sonography characterized tumor perfusion with high accuracy. The use of a contrast agent significantly improved perfusion characterization.     

Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: radiologic-pathologic correlation.

Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma are tumors of the sympathetic nervous system that arise from primitive sympathogonia and are referred to collectively as neuroblastic tumors. They arise wherever sympathetic tissue exists and may be seen in the neck, posterior mediastinum, adrenal gland, retroperitoneum, and pelvis. The three tumors differ in their degree of cellular and extracellular maturation; immature tumors tend to be aggressive and occur in younger patients (median age, just under 2 years), whereas mature tumors occur in older children (median age, approximately 7 years) and tend to behave in a benign fashion. The most benign tumor is the ganglioneuroma, which is composed of gangliocytes and mature stroma. Ganglioneuroblastoma is composed of both mature gangliocytes and immature neuroblasts and has intermediate malignant potential. Neuroblastoma is the most immature, undifferentiated, and malignant tumor of the three. Neuroblastoma, however, may have a relatively benign course, even when metastatic. Thus, these neuroblastic tumors vary widely in their biologic behavior. Features such as DNA content, tumor proto-oncogenes, and catecholamine synthesis influence prognosis, and their presence or absence aids in categorizing patients as high, intermediate, or low risk. Treatment consists of surgery and, usually, chemotherapy. Despite recent advances in treatment, including bone marrow transplantation, neuroblastoma remains a relatively lethal tumor, accounting for 10% of pediatric cancers but 15% of cancer deaths in children.     

Malignant microvasculature in abdominal tumors in children: detection with Doppler US.

Malignant tumors produce a network of microscopic, thin-walled vessels that invade the host and provide the blood supply essential for growth. This network, situated at the periphery of malignant tumors, gives rise to characteristic, high-velocity Doppler shifts at ultrasound (US) scanning and was sought in 54 children with abdominal masses. Characteristic high-frequency Doppler signals (greater than 2.5 kHz) were found in 27 of 35 malignant tumors. These signals disappeared during successful chemotherapy in three children with neuroblastoma in whom the signals had been documented initially. The signals were absent in three other children, who had undergone clinically successful therapy, and were present in two children with rapidly progressing tumors despite chemotherapy. In 14 children, none of the benign tumors showed high-frequency Doppler shifts. The search for malignant neovasculature with Doppler US scanning may provide insight into tumor behavior. The Doppler US examination, a noninvasive adjunct to routine US, may become useful at both the time of diagnosis of a mass and afterward to assess the effect of chemotherapy.     

原发性肾上腺皮质癌的CT诊断

目的：总结肾上腺皮质癌的ＣＴ表现。材料与方法：分析２０例经手术病理证实的临床和ＣＴ资料。结果：功能性肿瘤占３０％。１例双侧性肿瘤。肿瘤大小范围６～１５ｃｍ，６个＜６ｃｍ。ＣＴ表现为肿瘤中心呈低密度的出血与坏死（１６例），钙化（４例），不规则增强（１５例），低密度的肿瘤周围环绕实质性的增强环（４例），轮廓不规则（１１例），边缘模糊（９例）。肿瘤可以直接侵犯邻近器官或转移到肝、淋巴结、胰腺、小肠和骨。结论：ＣＴ能提示肾上腺皮质癌的恶性性质。     

MR-guided laser-induced thermotherapy in recurrent extrahepatic abdominal tumors

The aim of this study was to evaluate the feasibility of MR-guided laser-induced thermotherapy (LITT) for treatment of recurrent extrahepatic abdominal tumors. In 11 patients (6 women and 5 men; mean age 53 years, age range 29-67 years) with 14 lesions the following tumors were treated in this study: paravertebral recurrence of hypernephroma (n=1); recurrence of uterus carcinoma (n=1); recurrence of chondrosarcoma of the pubic bone (n=1); presacral recurrence of rectal carcinoma (n=1); recurrent anal cancer (n=1); metastases in the abdominal wall (n=1); and lymph node metastases from colorectal cancer (n=8). A total of 27 laser applications were performed. A fast low-angle shot 2D sequence (TR/TE/flip angle=102 ms/8 ms/70 degrees ) was used for nearly real-time monitoring during treatment. All patients had no other treatment option. Seventeen LITT sessions were performed using a conventional laser system with a mean laser power of 5.2 W (range 4.5-5.7 W), and 10 LITT session were performed using a power laser system with a mean laser power of 28.0 W. In 10 lesions total destruction could be achieved. In the remaining recurrent tumors, significant reduction of tumor volume by 60-80% was obtained. All patients tolerated the procedure well under local anesthesia. No complications occurred during treatment. Laser-induced thermotherapy is a practicable, minimally invasive, well-tolerated technique that can produce large areas of necrosis within recurrent tumors, substantially reducing active tumor volume if not resulting in outright destruction of tumor.     

兔VX2移植性肝癌模型的制作及影像学评价

目的:探讨开腹注射法制作兔VX2移植性肝癌模型的特点及超声、CT在监测VX2肝癌中的价值。方法:将兔VX2瘤组织块加细胞悬液经开腹注入45只新西兰大白兔的肝左、肝右或肝中叶内,接种后的不同时期行彩超、CT平扫和双期增强扫描。结果:45只兔中40只接种成功,原位成瘤率为88.8%,其中肝脏单发结节者25只(62.5%),多发结节者15只(37.5%),原位成瘤伴异位种植者9只。CT平扫示病灶为低或等密度。增强扫描动脉期有明显强化高密度,门脉期为低密度,肿瘤边缘强化;第2周CT检查阳性率为46.7%,第3周为90.0%,不同时期检出率差异有统计学意义(x~2=4.26,P<0.05)。超声上肿瘤表现为低回声伴声晕,彩色多谱勒可见肿块周边血供丰富;超声检查第2周阳性率为40.0%,第3周为80.0%,不同时期检出率差异有统计学意义(x~2=4.33,P<0.05)。结论:经开腹注射法制作兔肝癌模型是一种简单、易行的方法,但易发生异位种植和多发结节。彩超和CT平扫及增强扫描均是准确、可靠的监测方法。