原发性腹膜后节细胞神经瘤影像分析

目的:分析腹膜后节细胞神经瘤的特征影像表现,提高其诊断准确率。方法:回顾性分析7例经手术病理证实的腹膜后节细胞神经瘤的影像表现。结果:所有肿块均边界清楚,其中3例呈铸型或嵌入生长,1例侵犯椎间孔;2例可见小斑点钙化;超声显示3例呈轻度不均匀性低回声,内可见条索状间隔回声;1例不均匀低回声内见血流信号。CT平扫呈均匀性低密度,CT增强扫描1例无明显强化;2例动脉期包膜轻度强化,其中1例无延迟强化,1例呈进行性延迟强化;2例动脉期包膜及间隔轻度强化,并见包膜及间隔轻度延迟强化。MRI T1WI呈均匀性低信号,T2WI呈不均匀性高信号,增强扫描后呈轻度强化。结论:CT、MRI诊断节细胞神经瘤优于超声;当其出现特征影像表现时,需要考虑节细胞神经瘤的诊断。     

纵隔包虫病CT及CMR表现并文献复习

目的 探讨纵隔包虫病的影像特点及鉴别诊断。 方法 回顾性分析1例经临床证实的纵隔包虫病CT和心脏MR表现并进行文献复习。 结果 CT平扫显示右侧冠状沟类圆形囊状稍低密度,密度均匀,局部壁钙化,右侧房室交界部及右冠状动脉近段受压推移。 心脏MR显示病灶T₁WI呈等信号,T₂WI黑血序列呈稍高信号,电影序列示右房、右室运动及三尖瓣开放受限,病灶随房室运动轻度抖动,T₁ mapping显示腔内信号均匀。静息首过灌注及延迟增强影像均显示病灶未见明显强化。 结论 纵隔包虫病较为罕见,诊断时应结合其流行病学史、CT和MRI的影像特点,临床工作中诊断纵隔囊性占位也应考虑到纵隔包虫病感染的可能。     

肺硬化性血管瘤的CT表现

目的探讨肺硬化性血管瘤(PSH)的多层螺旋CT表现特征,以提高对该病的认识。方法分析经手术或CT导引下穿刺病理证实的肺硬化性血管瘤20例,20例均做了64层螺旋CT检查,其中12例行增强扫描。结果肿瘤呈圆形7例,椭圆形9例,类三角形4例,肿瘤边缘清晰,3例病灶可见浅分叶。肿瘤密度欠均匀,9例病灶内部或边缘见点状钙化,3例病灶周边可见"含气裂隙征"。12例增强扫描,4例呈斑片样强化,7例肿瘤呈均匀一致性明显强化,1例无明显强化、病灶内部密度均匀,4例肿瘤边缘肺门侧见"贴边血管征"。结论多层螺旋CT层厚薄,图像的空间分辨率和增强扫描的时间分辨率高,可以显示病灶内部的细微钙化及增强特征,较普通CT确诊率明显提高。     

卵巢甲状腺肿超声与CT影像比较分析

目的探讨超声与CT对卵巢甲状腺肿的临床诊断价值。方法回顾性分析经手术和病理证实的11例卵巢甲状腺肿患者的超声与CT表现,并与病理检查结果行对照研究,对卵巢甲状腺肿的超声和CT诊断的准确率行统计学分析。结果 11例卵巢甲状腺肿病例中:1)发生于左侧卵巢者4例,发生于右侧卵巢者7例;2)单发囊性病灶1例,囊实性病灶10例;3)6例形态不规则,5例呈类圆形或椭圆形;4)超声显示单发囊性病灶回声均匀,囊实性病灶呈混杂回声,其中10例囊实性病灶均呈中高回声的不规则间隔及实性结节,7例呈多房、且各房回声不等,3例囊壁及间隔见强回声钙化,1例见高回声脂肪,4例彩色多普勒超声可探及实性成分及分隔的血流信号;5)CT显示单发囊性病灶密度高于水,10例囊实性病灶中7例呈多房、密度不等,7例囊壁及间隔见钙化,2例见脂肪密度,增强扫描9例实性成分明显强化,1例轻度强化,5例伴盆腔积液,1例伴胸腔积液。结论卵巢甲状腺肿的超声及CT表现具有一定特征性,认识其影像学特征对减少误诊具有重要意义。     

眼眶海绵状血管瘤的影像学诊断

目的:分析眼眶海绵状血管瘤的超声、CT及MRI征象,探讨各影像技术对海绵状血管瘤的诊断价值。方法:回顾性分析经手术病理证实的30例海绵状血管瘤患者的超声、CT及MRI影像学表现,并与手术结果对照。结果:超声显示海绵状血管瘤呈圆形或类圆形,内回声多且分布均匀,声衰减少,轻度可压缩性,内部缺乏血流信号;CT显示肿瘤位于肌锥内,边缘清楚,软组织密度,根据眶尖处是否存在透明三角区可判断是否向颅内蔓延,增强扫描呈渐进性强化征象;MRI能清楚显示肿瘤与眼外肌及视神经的关系。结论:超声能够揭示海绵状血管瘤的组织学特点,CT及MRI可对肿瘤准确定位,揭示病变与周围组织关系。选择超声与CT或超声与MRI相结合的检查方法可对海绵状血管瘤作出诊断。     

肾上腺节细胞神经瘤的影像学表现

目的探讨肾上腺节细胞神经瘤的影像学表现,以提高该病的诊断准确性.资料与方法回顾性分析15例经手术病理证实的肾上腺节细胞神经瘤的影像特点.结果15例肾上腺节细胞神经瘤中,11例行 CT 平扫及增强检查, CT 平扫8例呈均匀低密度,3例呈不均匀低密度;7例病灶内可见钙化,以散在点状或小斑块状钙化为主;增强扫描后2例病灶未见明显强化,9例病灶表现为不均匀轻、中度进行性强化,2例增强后可显示包膜.5例行 MRI 检查,病灶呈稍长 T1不均匀长 T2信号,反相位无信号减低,DWI 呈等低信号,4例增强后呈渐进性轻、中度强化,1例表现为较明显的不均匀团块状强化,4例T2WI 及增强后可显示完整包膜.结论肾上腺节细胞神经瘤一般表现为渐进性轻、中度强化,CT 可见散在点状钙化,MRI 可清晰显示包膜及内部组织成分,二者结合可对大多数病变作出正确的术前诊断.     

超声与CT对肾母细胞瘤诊断价值

目的:探讨肾母细胞瘤的超声和CT影像表现及诊断价值。方法:回顾性分析14例肾母细胞瘤的超声和CT表现,并与手术病理结果对照。结果:本组14例B超显示均为单侧病灶,瘤体形态呈圆形或类圆形,边界清楚,病灶呈实性者11例,囊实性者2例,囊性者1例,其中5例病灶内可见斑点状钙化,1例边缘呈环形钙化。CT平扫呈混杂密度,强化后瘤体呈不均匀强化;彩色多普勒血流显像(CDFI)均见数量不等的血流信号显示。结论:肾母细胞瘤的超声和CT影像表现具有一定的特征性,两者联合应用具有更高临床价值。     

节细胞神经瘤CT诊断

目的 :探讨节细胞神经瘤的CT诊断。方法 :回顾性分析 4例经手术病理证实的节细胞神经瘤的CT表现 ,并结合相关文献复习 ,讨论其影像特征。结果 :肿瘤位于脊柱旁或肾上腺区 ,直径均 >3 .5cm ,呈卵圆形 ,有完整包膜 ,呈较均匀低密度或欠均匀 ,多数病灶内可见点状高密度钙化。增强扫描呈轻度均匀或欠均匀强化。结论 :节细胞有一定的CT影像特点 ,CT能作出正确的定位及较准确的定性诊断     

肺硬化性血管瘤的CT诊断

目的：分析肺硬化性血管瘤的CT表现,以提高诊断水平。方法：回顾分析9例经病理证实的肺硬化性血管瘤的CT表现。结果：典型病灶7例,CT显示圆形或椭圆形的结节或肿块影,直径10～50mm,其中30mm以下6例,50mm1例;该7例病灶边缘均较规则,无分叶及毛刺;7例中6例病灶密度均匀,1例病灶直径50mm,密度欠均匀,CT值20～43HU;2例病灶可见粗点状钙化;2例加增强扫描,均呈明显均匀强化,CT值增加大于50HU。不典型病灶2例,CT显示病灶中心见结节影,边缘欠规则,周围见斑片影,斑片影边缘较规则,结节影与周围斑片影相连;结节周围见＂空气新月征＂;1例加增强扫描,结节无明显强化。结论：肺硬化性血管瘤的CT表现有一定特征性,认真分析影像表现,有助于术前诊断。     

原发性甲状腺淋巴瘤影像表现及误诊分析

目的探讨原发性甲状腺淋巴瘤(PTL)的影像表现,以期进一步提高PTL的诊断准确率。方法回顾性分析经手术病理证实的6例PTL患者的影像表现,其中5例行CT平扫及增强扫描,1例同时行MRI平扫及全身~(18)F-FDG PET/CT检查。结果 6例患者均以发现颈部肿物就诊,病理证实均为非霍奇金淋巴瘤,其中3例合并有桥本甲状腺炎。病灶侵及甲状腺一侧叶4例,侵及甲状腺双侧叶及峡部1例,侵及甲状腺单侧叶及峡部1例。CT表现为单发结节型2例,多发结节型1例,弥漫肿大型3例。CT平扫6例病灶均呈稍低密度,5例密度大致均匀,1例病灶内可见钙化。增强扫描5例病灶呈均匀、轻中度强化。2例出现颈部淋巴结转移。MRI病灶T_1WI呈等信号,T_2WI呈稍高信号,DWI呈高信号。PET/CT病灶表现为高代谢。6例患者术前全部误诊。结论 PTL容易误诊,其影像表现具有一定特征性,结合临床资料,有助于提高诊断准确性,其最终确诊仍需依靠病理学检查。     

Hepatic hemangioma presenting atypical radiologic findings: a case report

A 69-year-old woman was referred to our hospital due to a liver tumor that was incidentally noted on ultrasound (US). US revealed a pedunculated mass of 5 cm in diameter, with a heterogeneous echo pattern. On arterial phase dynamic contrast-enhanced computed tomography (CT), a tiny enhancing dot in the upper aspect of the mass was seen; whereas, the main portion of the lesion appeared as hypoattenuating. The tumor was of low intensity on T1-weighted magnetic resonance (MR) images, and showed slightly heterogeneous high intensity on T2-weighted MR images. The most characteristic feature of the tumor was its exophytic appearance. On post-gadolinium hepatic arterial dominant-phase MR images, the tumor showed nodular enhancement centrally, with progressive spread of enhancement on later images. Angiography showed dilatation of the right posterior inferior branch of the hepatic artery and C-shaped opacification. Since we could not rule out malignancy for these nonspecific radiologic findings, a partial resection of the liver was carried out, resulting in a pathological diagnosis of hepatic hemangioma. This hemangioma had marked hyalinization and fibrosis, causing a heterogeneous appearance on MR images. The tumor presented an exophytic appearance, which caused some diagnostic confusion.     

外周性原始神经外胚层瘤的影像表现

目的:探讨外周性原始神经外胚层肿瘤的影像学表现.方法:回顾性分析经病理证实的12例外周性神经外胚层瘤的影像学资料.9例行CT扫描,4例行MR扫描,其中1例行DSA检查.结果:胸壁软组织5例,右肺下叶1例,肱骨2例,股骨1例,胫骨1例,脊椎2例.胸壁软组织的pPNETs CT平扫表现为大而边界欠清的软组织肿块,内见坏死,无钙化,增强后明显不均匀强化.右肺下叶的pPNETs CT平扫表现为分叶状肿块,内见少量出血,边界清晰,增强后明显强化.长骨pPNETs表现为溶骨性骨质破坏伴巨大软组织肿块,无钙化,无骨膜反应.T1WI上表现为等或低信号,T2 WI上表现为不均匀高信号,增强后明显强化.脊椎pPNETs表现为椎体或附件骨质破坏伴软组织肿块,不累及椎间盘,其中1例骶骨pPNETs DSA检查示肿瘤由髂内动脉供血和大量新生血管.结论:CT和MRI均能很好地显示pPNETs的内部结构、病变范围、有无侵犯毗邻组织器官或远处转移.DSA可明确肿瘤供血动脉和反映新生肿瘤血管丰富的特点,可作为一种补充检查方法.确诊仍需依靠病理和免疫组化检查.     

Subependymoma of the lateral ventricle: a case report

We report a case of subependymoma of the right lateral ventricle in a 59-year-old man. CT revealed a mass lesion in the right lateral ventricle. No calcification was seen in the tumor, and the right lateral ventricle was dilated dominantly by the tumor. The tumor showed intermediate intensity on T1-weighted MR images and high intensity on T2-weighted MR images. On contrast study, the tumor showed heterogeneous enhancement. We suspected this to be a case of central neurocytoma, and surgical resection was performed. The histological diagnosis was subependymoma, but we considered it difficult to differentiate from astrocytoma, central neurocytoma, and ependymoma.     

Marked 99mTc-PYP myocardial accumulation immediately after reperfusion in a patient with acute myocardial infarction

We reported a case of a 72-year-old man with chest pain. An electrocardiogram showed ST segment elevation in I, II, III, aVL, aVF and V1-6 leads. 99mTc-tetrofosmin myocardial SPECT showed defect in the anterior, septal, apical and inferior walls. Coronary angiography showed 99% stenosis of the proximal right coronary artery and total occlusion of the midsegment of the left anterior descending coronary artery. Therefore, direct PTCA was performed for each lesion to achieve reperfusion. We didnt's see reperfusion injury during PTCA of the left coronary artery. On the other side, we saw severe reperfusion injury, such as slow-flow, arrhythmia and falling blood pressure during PTCA of the right coronary artery. After four hours, 99mTc-PYP myocardial SPECT showed marked uptake in the apical and inferior walls, and mild uptake in the anterior and posterior walls. After three days, severely-reduced uptake of 99mTc-PYP in the apex was noted, and mild uptake in the mid-portion of the anterior wall and the mid-portion of the inferior wall. Though reperfusion injury was seen, three was mild myocardial uptake of 99mTc-PYP in the area of the right coronary artery. On the other side, despite no reperfusion injury, there showed marked uptake during the acute phase and defect during the subacute phase in the area of the left coronary artery. Wall motion of the left ventricle was normal in the area of the right coronary artery and akinesis was seen on the left. These findings suggest that 99mTc-tetrofosmin and 99mTc-PYP myocardial SPECT are useful for visualization of reperfusion injury during the acute phase and for estimation of function during the chronic phase, better even than electrocardiogram or coronary angiography.     

多期双流速注射对比剂-盐水混合物在64层螺旋CT冠状动脉造影中的应用

目的 初步探索多期双流速注射对比剂-盐水混合物在64层螺旋CT冠状动脉造影中的应用价值.资料与方法 24例患者进行64层螺旋CT冠状动脉造影成像.其中,12例(A组)在团注对比剂后应用生理盐水,12例(B组)在团注对比剂后应用对比剂-盐水混合物(比例为60∶40).由2名有经验的放射科医师分别测量两组升主动脉根部、降主动脉、主肺动脉及右心室的CT值,评价冠状动脉的显示、右心室的均匀性及左心室室壁的显示.结果 经Kappa检验,两名医师均有良好的组内、组间一致性(K＞0.75).经独立样本t检验,两组升主动脉根部和降主动脉的平均CT值差异无统计学意义(P＞0.05);两组主肺动脉和右心室的平均CT值差异有统计学意义(P＜0.05).经配对秩和检验,在冠状动脉的显示和右心室的均匀性方面,两组差异无统计学意义(P＞0.05);在左心室室壁的显示方面,两组差异有统计学意义(P＜0.05).结论 在CT冠状动脉造影检查中,团注对比剂后应用对比剂-盐水混合物可以更好地显示右心室心腔和左心室室壁,而不影响冠状动脉的成像效果.     

A case of a small-sized cavernous hemangioma in the right ventricle - an incidental finding

A cardiac cavernous hemangioma is a rare, primary, benign tumor that is usually diagnosed in young or middle-aged patients. In this article, we report the case of a 71-year-old male patient whose doctors incidentally discovered a heart tumor on his transthoracic echocardiography. Triple-phase computed tomography (CT) (pre-contrast, arterial and portal venous) missed the lesion, and magnetic resonance imaging (MRI) revealed a small, oval tumor attached to the wall of the right ventricle. The tumor was successfully removed surgically, and the patient recovered after 2 weeks. A histopathological examination resulted in the diagnosis of a benign cavernous hemangioma.     

慢性心力衰竭的CT表现

目的:探讨慢性心力衰竭的CT表现。材料和方法:回顾性分析28例慢性心力衰竭的CT表现。结果:左心室增大16例、右心室增大8例、左心房增大6例、右心房增大4例,左、右心房增大3例,肺水肿24例、胸腔积液25例、肺动脉扩张3例、升主动脉扩张5例和冠状动脉钙化7例。左心衰CT示肺水肿、左心室扩大和胸腔积液。右心衰CT示右心室扩大、主肺动脉扩张和胸腔积液。全心衰竭CT示左右心室扩大,肺水肿和双侧胸腔积液。结论:CT可显示心脏各房室扩大、大动脉扩张、肺水肿、胸腔和心包积液以及冠状动脉钙化,为诊断原发心脏疾病及慢性心力衰竭提供重要依据。     

Evaluation of cardiac morphology, function, and perfusion at low radiation dose before mitral valve surgery

A low-dose cardiac CT examination for preoperative assessment of coronary artery disease and mitral valve annulus dimensions in 79-year-old female with mitral valve regurgitation, consisting of a prospectively ECG-triggered high-pitch first-pass perfusion scan under adenosine stress and a sequential scan at rest enabled the diagnosis of occlusion of the right coronary artery and high-grade stenosis of the left circumflex artery, reversible perfusion defects of the inferoseptal and inferolateral walls and a persistent inferior wall perfusion defect associated with inferior wall thinning and akinesia. All findings were confirmed with catheter coronary angiography and cardiac magnetic resonance imaging. Because of the diagnosis of peri-infarct ischemia, the patient underwent aortocoronary bypass grafting in addition to mitral valve reconstruction. CT allowed for comprehensive preoperative assessment of cardiac morphology, function, and perfusion at a low cumulative radiation dose of 4.3 mSv.     

加注生理盐水对16层螺旋CT冠状动脉成像作用的探讨

目的:探讨加注生理盐水对16层螺旋CT冠状动脉成像的作用。方法:60例患者被随机分成两组,1组:注入对比剂欧乃派克120ml;2组:注入对比剂欧乃派克100ml及生理盐水40ml。所有患者均行16层螺旋CT冠状动脉增强扫描,分别测量左、右冠状动脉开口层面升主动脉、肺动脉及上腔静脉的CT值,测量左冠状动脉主干、左前降支、左回旋支及右冠状动脉的CT值,并用统计学软件SPSS分析。结果:升主动脉CT值1组显著低于2组,上腔静脉CT值1组显著高于2组。肺动脉CT值在左、右冠状动脉开口层面1组均高于2组,但差异在右冠状动脉开口层面有显著性意义,在左冠状动脉开口层面无显著性意义。各支冠状动脉CT值1组均显著低于2组。结论:加注生理盐水可以节省对比剂,降低上腔静脉及右心的密度,增加升主动脉的密度,便于更好地显示冠状动脉。