遗传性多发性骨软骨瘤恶变的影像学表现

目的　探讨遗传性多发性骨软骨瘤恶变的影像学表现。方法　回顾分析 5例经临床、X线平片及CT检查 ,且手术病理证实为遗传性多发性骨软骨瘤恶变的影像学表现。结果　恶变发生在骨盆 2例 ,股骨 2例 ,骨盆及股骨 1例。主要X线表现为软骨帽不规则增厚、破坏或消失 ,钙化成堆 ,密度不均 ;基底部及骨干骨皮质溶骨性破坏 ,骨膜出现放射状骨针及Codman三角 ;软组织明显肿胀。CT表现为软骨帽钙化增多 ,骨质破坏 ;基底部及骨干骨皮质虫蚀样破坏 ;瘤内广泛的不规则钙化或环状钙化及骨化影 ,密度不均 ;放射状骨针及骨膜三角 ;软组织明显肿胀。结论　遗传性多发性骨软骨瘤恶变的影像学表现具有特征性。常规X线及CT检查是诊断本病的可靠方法 ,可早期发现恶变征象     

颌面部骨源性肿瘤与类肿瘤病变的CT表现

目的回顾性分析颌面部骨源性肿瘤与类肿瘤病变的CT表现,旨在提高对此类病变CT表现的认识.方法回顾颌面部骨源性肿瘤与类肿瘤病变20例,与病理对照,分析各类病变的影像学特点.结果恶性肿瘤8例,CT表现为不规则软组织肿物,其中骨肉瘤3例,明显溶骨性骨质破坏3例,肿物内均有瘤骨形成;软骨肉瘤3例,局部有骨质破坏,肿物内有钙化灶者2例,有瘤骨及瘤软骨形成者1例;尤文氏肉瘤1例,内见钙化;良性肿瘤及类肿瘤病变7例,为边缘规则肿物,未见钙化、瘤骨及骨膜反应.成釉细胞瘤5例,为边缘规则的分房状肿物、骨质膨胀性破坏4例,广泛侵犯1例.骨纤维异常增殖症4例,均为多骨膨胀性改变,其内骨结构紊乱,正常骨小梁消失.结论各类颌面部骨源性肿瘤与类肿瘤病变有不同的影像学特点.CT扫描对颌面部骨源性的肿瘤与类肿瘤病变定性诊断及侵犯范围的准确评估有重要意义.     

内生软骨瘤的X线和CT表现分析

目的探讨内生软骨瘤的X线和CT表现特点。方法对10例经手术和病理证实的内生软骨瘤的X线和CT表现进行讨论。并结合文献回顾性分析。结果与结论X线平片可见四肢长管状骨干骺端呈囊状膨胀性骨质破坏区，内有不同程度的钙化；CT对钙化有更好的分辩力，能很好地判断病灶与骨髓腔的分界和骨皮质的受累情况。     

长骨骨端囊样骨肿瘤及肿瘤样病变的CT分析

目的：探讨长骨骨端囊样骨肿瘤及肿瘤样病变的CT诊断价值。材料与方法：对资料完整曾行CT检查并经活检或手术病理证实的长骨骨端囊样骨肿瘤及肿瘤样病变45例进行回顾性分析。结果：45例中骨肿瘤29例,其中良性肿瘤24例,恶性5例,肿瘤样病变16例。良性肿瘤包括：巨细胞瘤12例,软骨母细胞瘤4例,骨样骨瘤,软骨粘液样纤维瘤各3例,内生软骨瘤及骨母细胞瘤各1例,恶性肿瘤包括：恶性巨细胞瘤、软骨肉瘤各2例,纤维肉瘤1例,肿瘤样病变包括：骨囊肿7例,骨纤维异常增殖症6例,动脉瘤样骨囊肿3例。发病部位包括骺板闭合前28例（其中骨骺4例,干骺端24例）闭合后骨端17例,主要CT表现为端囊样骨破坏,包括膨胀性改变34例伴皮质断裂13例,骨性包壳形成21例,瘤内钙化13例,液－液平2例,骨膜反应及软组织增厚（或肿块）分别为5例和4例,结论：CT能清晰显示X线平片不能显示的“囊”壁、“囊”内及周围结构的细微表现,因而具有重要的诊断价值。但因表现有重叠,定性诊断有一定限度。     

骶骨肿瘤的CT诊断

目的探讨骶骨肿瘤的CT表现特征。方法回顾性分析28例骶骨肿瘤的CT表现，包括转移瘤13例，脊索瘤4例，软骨肉瘤1例，原始神经外胚层肿瘤1例，骨巨细胞瘤3例，骨母细胞瘤1例，神经鞘瘤2例，囊肿3例（单纯性骨囊肿1例，蛛网膜囊肿2例）。结果骶骨肿瘤的CT表现包括病变的中心位置及范围，骶椎骨质破坏（恶性者多为溶骨性骨质破坏，良性者多呈膨胀性生长），残留骨嵴，软组织肿块，肿块内钙化，骶管、骶孔扩大等。良性肿瘤边界锐利，并多可见硬化边（除骨巨细胞瘤外），恶性者边界多不清晰，无硬化。增强后除囊肿性病变无强化外，其他均可见程度不等之强化。结论CT可清楚地显示肿瘤的部位、范围以及与周围组织关系，根据病灶不同的CT表现有可能在术前对多数骶骨肿瘤进行定性诊断。     

股骨上端骨和肿瘤样病变84例X线分析

目的：分析股骨上端骨肿瘤和肿瘤样病变的X线表现。材料与方法：回顾性分析84例经手术病理和临床证实的股骨上端骨肿瘤和肿瘤病变X线表现，结合文献进行讨论。结果：良性肿瘤31例，其中骨脂肪瘤7例，软骨母细胞瘤4例，外生骨疣、巨细胞瘤、骨母细胞瘤各3例，软骨黏液样纤维瘤、韧带纤维瘤、骨牙质瘤和骨血管瘤各2例，软骨瘤、非骨化性纤维瘤和巨细胞瘤伴动脉瘤样骨囊肿各1例。恶性肿瘤33例，其中转移瘤9例，软骨肉瘤7例，骨肉瘤、骨旁肉瘤、骨血管外皮瘤、骨横纹肌肉瘤和畸形骨炎恶变为骨肉瘤各2例，骨髓瘤、淋巴肉瘤、网状细胞肉瘤、尤文氏瘤、骨纤维肉瘤、腺泡状肉瘤和Burkitt氏瘤各1例肿瘤样病变20例，其中骨囊肿和骨纤维异常增症各9例，嗜酸性肉芽肿2例。84例中发生于粗隆下区29例，其中良性9例，恶性12例，肿瘤样病变8例；粗隆区32例，其中良性13例，恶性12例，肿瘤样病变7例；粗隆至头部均受累14例，其中良性5例，恶性6例，肿瘤样病变3例；颈部6例，其中良性2例，恶性3例，肿瘤样病变1例；头部3例，其中良性2例，肿瘤样病变1例。结论：股骨上端以转移瘤、骨囊肿、骨纤维异常增殖症、骨脂肪瘤和软骨肉瘤多见。良恶性肿瘤和肿瘤样病变均好发于粗隆区和粗隆下区。     

去分化软骨肉瘤45例DR、CT、MRI影像特征分析

目的:探讨去分化软骨肉瘤患者的DR、CT、MRI的影像学特征有哪些。方法:选取2005-2016年间经病理证实去分化软骨肉瘤患者45例,对其DR、CT、MRI影像资料进行回顾性分析以找寻能预判软骨肉瘤去分化转变的影像学特征。结果:42个病例的CT和MRI图像能发现骨皮质破坏,37个病例的CT图像能发现骨内软骨钙化,31个病例的DR图像能发现骨内膜扇贝型压迹。15个病例的DR图像,36个病例的CT图像及41个病例的MRI图像能发现去分化软骨肉瘤的双重形态影像学改变,即DR图像表现为以骨质破坏为主的伴有钙化的软组织肿瘤。而CT和MRI图像表现为骨内含有软骨成分的肿瘤旁可见一巨大的非钙化性软组织肿瘤。结论:根据去分化软骨肉瘤的影像学表现,比如双重形态学特征、骨皮质破坏、骨内膜扇贝型压迹,软骨基质的钙化这几个指标能提高对去分化软骨肉瘤的诊断准确率,为临床治疗提供准确和可靠依据。     

对比分析颅底软骨肉瘤与脊索瘤CT和MRI征象

目的 对比分析颅底软骨肉瘤与脊索瘤CT和MRI征象。方法 回顾性分析经病理证实的7例颅底软骨肉瘤和18例脊索瘤患者的CT和MRI资料。结果 颅底软骨肉瘤与脊索瘤好发部位相似,以斜坡中线区多见,少数位于前、后颅窝底;其CT和MRI有共性征象：均伴颅底膨胀性或溶骨性骨质破坏,T2WI以明显高信号为主,增强后多呈"花瓣样"或"蜂房样"明显不均匀强化。5例软骨肉瘤可见明显粗大钙化,密度较高且边缘锐利,4例DWI呈低信号;16例脊索瘤无明显钙化或见细小条状残留骨嵴,仅2例DWI呈低信号。结论 颅底软骨肉瘤与脊索瘤的CT和MRI征象有一定共性,肿瘤内钙化特点及DWI信号强度对鉴别诊断有一定价值。     

软骨肉瘤的影像学诊断

目的 探讨不同分型软骨肉瘤的影像学表现。方法 回顾性分析手术病理证实的26例软骨肉瘤的影像学资料。结果 ①普通髓腔型:X线平片检查6例,表现为溶骨与硬化混合的外观,位于长管状骨者可见骨内膜的扇贝样改变。CT检查8例,7例示膨胀性骨质破坏,5例钙化明显,3例钙化轻微。MR检查9例,T1WI为等、低信号,T2WI 8例呈明显高信号,其中6例可见低信号分隔。②间叶型:X线平片检查2例,1例肿瘤位于骨内,呈轻度膨胀性改变,1例位于骨外,病灶密集钙化。CT检查7例,6例位于骨骼系统外,4例钙化明显,1例钙化局限,1例未见明显钙化。MR检查5例,4例骨外型T2信号特点取决于瘤体内钙化的形态及范围,或呈胡椒面样表现或表现为高信号包绕低信号。③去分化型:CT 检查3例,均示钙化,2例尚可见絮状成骨样改变。MR检查2例,T2WI上均为高低混杂信号。④皮质旁型:X线平片检查2例,1例可见相应部位异常钙化。CT检查3例,均显示分叶状外形的软组织肿块贴近骨皮质,2例见基质轻微钙化。MR检查3例,2例可见髓腔侵犯。增强扫描普通髓腔型及皮质旁型呈边缘及间隔强化,间叶型呈弥漫性强化,去分化型则同时可见边缘强化及弥漫性强化。结论 普通髓腔型软骨肉瘤影像学表现较具特征性。结合钙化特点、信号特征及增强后表现可提示诊断间叶型及去分化型软骨肉瘤。     

盆壁肿瘤的多层螺旋CT诊断

目的 通过对盆壁肿瘤的多层螺旋CT表现的分析,提高对其CT诊断的认识.方法 回顾性分析20例盆壁肿瘤的多层螺旋CT表现,其中转移瘤10例,神经源性肿瘤5例(其中神经鞘瘤2例,神经纤维瘤1例,神经纤维瘤病2例),软骨肉瘤2例,脊索瘤1例,骨巨细胞瘤1例,骨软骨瘤1例.结果 盆壁肿瘤的主要征象包括骨质破坏、软组织肿块,转移...     

Follicular thyroid carcinoma: metastasis to the sternum, 13 years after total thyroidectomy

Primary and metastatic malignancies of the sternum are uncommon. Secondary lesions to the sternum occur more commonly in patients with lung and breast cancer, and only a few cases of sternal metastasis arising from a follicular thyroid carcinoma have been reported in the literature. Rarely, metastases to the sternum present in the guise of primary sternal tumours may be treated surgically with that diagnosis in mind. We describe a case of a sternal mass treated by radical surgery, which ultimately proved to be a solitary metastasis from a follicular carcinoma of the thyroid, appearing 13 years after total thyroidectomy and radioactive iodine therapy. Late metastatic thyroid carcinoma to the sternum should be kept in mind in the differential diagnosis of sternal lesions. For patients with thyroid carcinoma and sternal metastasis, we recommend surgical resection of the metastasis, not only as a curative or palliative measure but also to maximise the effect of subsequent radioiodine treatment.     

CT findings in metastatic ovarian tumors from gastrointestinal tract neoplasms (Krukenberg tumors)

The computed tomographic (CT) findings are reviewed in 7 patients with metastatic ovarian tumors from gastrointestinal tract neoplasms (Krukenberg tumors). All patients presented mixed ovarian masses. In 6 cases the masses were mainly cystic, with internal septa and focal or uniform enlargement of the cyst wall. In the seventh patient the ovarian mass appeared on the CT as mainly solid. The size of the neoplasm varied between 5 and 46 cm. Ascites was only seen in 1 case and in another the existence of a primary tumor in the sigmoid colon was demonstrated. In our cases the CT signs of ovarian metastasis were indistinguishable from primary tumors of the ovary.     

Sonographically guided core needle biopsy of soft tissue neoplasms

PURPOSE: This study was conducted to evaluate the usefulness of sonography (US)-guided needle biopsy in the diagnosis of soft tissue masses. PATIENTS AND METHODS: Thirty-seven patients with a mean age of 49 years were enrolled in the study. The size of the biopsy needle was selected according to the kind of tumor suspected (ie, primary or metastatic). In patients with suspected metastases, smaller biopsy needles were used; in patients with suspected primary tumors, larger needles were used so that larger specimens could be obtained. Prebiopsy color Doppler sonography (CDUS) was routinely used to guide the cutting needle to areas of the lesion showing sufficient vascularity. From 3 to 6 cores were obtained, depending on their quality. We compared the diagnoses yielded by the core biopsy and the final histopathologic analysis of the resected tumor by classifying the results as "concordant" or "discordant." RESULTS: A total of 37 tumors were examined. Final diagnoses were 24 malignant tumors (6 metastases and 18 primary tumors) and 13 benign tumors. The lesions were diagnosed correctly as either benign or malignant in 35 of the 36 cases for which needle biopsy specimens were adequate, with only 1 misdiagnosis. The diagnoses were concordant in 33 cases (17 primary malignant tumors, 6 metastatic tumors, and 10 benign tumors) and were discordant diagnosis in the other 4 cases (1 primary malignant tumor and 3 benign tumors). No complications were attributable to the needle biopsy. CONCLUSIONS: US-guided percutaneous core needle biopsy of soft tissue neoplasms is an easy, safe, and useful procedure. It can be considered a first-line procedure for the acquisition of tissue specimens adequate for histopathologic diagnosis.     

多排螺旋CT增强扫描对脾脏肿瘤的诊断价值

【目的】探讨多排螺旋CT增强扫描对脾脏肿瘤的诊断及鉴别诊断价值。【方法】收集30例经病理和临床证实的脾脏肿瘤的CT资料,其中转移瘤14例,原发淋巴瘤8例,血管瘤5例,错构瘤1例,血管内皮肉瘤1例,淋巴管瘤1例。所有病例均做CT平扫及动态增强扫描。【结果】螺旋CT增强扫描对脾脏肿瘤检出率高,对病变太小、形态、密度及脾周围组织器官的显示准确。【结论】螺旋CT增强扫描对脾脏肿瘤的定性诊断具有较高的价值。     

小肠肿瘤的CT诊断

目的：探讨小肠肿瘤的CT表现以及良恶性的鉴别,材料和方法：回顾性分析20例经手术或活检病理证实的小肠肿瘤的CT表现。结果：良性肿瘤6例,腺瘤、脂肪瘤各1例;恶性肿瘤14例,腺癌5例,淋巴瘤4例,平滑肌肉瘤4例,转移瘤1例,结论：CT对小肠肿瘤的诊断特异性较高,有一定的临床价值。     

腹膜后恶性间叶瘤的CT诊断

目的 探讨腹膜后恶性间叶瘤的CT特点。方法 回顾分析经病理证实的腹膜后恶性间叶瘤4例CT资料。结果 腹膜后单发巨大不均质软组织肿物3例，均伴有大块状钙化，1例瘤内有脂肪密度。多发块状、结节软组织肿物1例，密度均匀。肿瘤复发2例，瘤床复发1例，广泛腹膜种植转移l例。复发灶内均有点状及块状钙化。所有瘤灶的软组织成分增强扫描均有轻一中度强化。结论 肿瘤呈单发巨大不均质软组织肿块，内有大块状不规则钙化及脂肪密度区，应为腹膜后恶性问叶瘤的典型表现。复发肿瘤表现同原发病变。肿瘤呈软组织密度时不能与其他问叶组织肿瘤区别。腹腔种植转移时应与卵巢癌有钙化的种植转移瘤鉴别。     

甲状腺肿瘤的CT诊断与鉴别诊断（附32例报告）

本文回顾性分析了32例甲状腺肿瘤的CT表现,包括甲状腺瘤10例,甲状腺囊肿5例,甲状腺癌17例,重点讨论CT对各种甲状腺肿瘤的诊断及鉴别诊断价值,提出良恶性病变的鉴别要点有,1.病灶大小及形态;2.病灶边界情况;3.病灶密度(包括钙化和囊变、是否均匀、强化后表现等);4.病灶对周围组织结构的浸润及转移情况。认为甲状腺恶性肿瘤的钙化率远远高于良性,但其钙化形式对鉴别诊断帮助不大。     

Computed tomography of the sternum

The author presents his experience with computed tomography (CT) in the diagnosis of sternal anomalies. The normal anatomy of the sternum and the peristernal soft tissues are described. The embryology, pertinent to the understanding of congenital sternal anomalies, is reviewed. The technique used to image the sternum is briefly explained. Variants of the sternum, traumatic changes, iatrogenic alterations, inflammation, and neoplastic lesions are illustrated. It is concluded that CT offers definite advantages in the evaluation of presumed sternal pathology and should be the examination of choice in the appropriate clinical setting.     

卵巢肿瘤及瘤样病变的CT鉴别诊断

目的:提高卵巢肿瘤及瘤样病变的术前CT定性诊断准确性。材料与方法:56例经手术及病理证实的卵巢肿瘤病变,对其CT表现进行分析,并与病理结果进行对照。结果:卵巢良、恶性肿瘤的CT诊断准确性均为89%,其中畸胎瘤达93%,卵巢区炎性包块的准确性为73%。结论:CT对于卵巢畸胎瘤的诊断及卵巢良恶性肿瘤的鉴别诊断价值值得肯定,对于各类囊肿及炎性包块作定性诊断时应密切结合临床。     

转移性胃癌的CT表现

目的：回顾分析４例转移性胃癌患者的ＣＴ资料,讨论转移性胃癌的诊断和鉴别诊断问题,旨在提高ＣＴ对转移性胃癌的认识。方法：回顾分析１９８４～１９９９年间,４例经手术和病理证实的转移性胃癌患者的临床、ＧＩ和ＣＴ资料。结果：原发癌中,小肠腺癌１例,结肠癌１例,肝癌２例,其中,肝细胞肝癌和胆管细胞型肝癌各１例,胃的转移瘤位于胃体１例,胃窦１例,胃窦及胃体部２例,孤立型肿块１例,弥温浸润型３例,结论：转移性胃癌是非常少见的消化道肿瘤,提高ＣＴ对该肿瘤的认识,提供临床更多的信息,对病人术前治疗计划的制定和预后的判断,预防意外的消化道穿孔和出血的发生有重要的参考价值。