肝内胆管癌影像学诊断

影像技术的快速发展，提高了对肝内胆管癌（ICC）的准确诊断和分期，从而为临床精准治疗ICC提供依据。超声检查是ICC的一线筛查手段，简便，经济，但缺乏特异性。CT及MRI目前仍是诊断ICC的主要影像学方法。MRI具有良好的软组织分辨率和多方位成像等优势，而磁共振胰胆管成像（MRCP）技术，可进一步明确肿瘤与周围胆管关系。MRI对ICC的判别准确性总体优于CT，但CT在显示肝内胆管结石相关的ICC方面较MRI更直观。PET-CT联合CT及MRI，可提高ICC的诊断准确性，并且可弥补了CT及MRI诊断ICC区域淋巴结转移和远处转移的不足。     

直肠癌侧方淋巴结转移影像学评估

直肠癌侧方淋巴结转移的诊断至关重要,直接影响侧方淋巴结清扫的选择,放化疗方案的制定,以及病人预后的判断。目前,临床常用的直肠癌侧方淋巴结转移影像学诊断方法包括MRI、直肠腔内超声（ERUS）、多排螺旋CT（MDCT）、弥散加权成像（DWI）、PET-CT以及影像组学。迄今,淋巴结转移的影像学诊断标准尚未达成完全一致。尽管淋巴结形态被应用于转移性淋巴结诊断,但受限于研究者间一致性差,尚未在临床得到广泛应用。DWI-MRI和PET-CT作为功能影像并未显著提高淋巴结诊断准确率。影像组学作为新的诊断方法已经被应用结直肠癌转移性淋巴结预测中。期待未来能够出现包括人工智能神经网络在内的更准确的方法用于术前诊断淋巴结。     

核磁共振、正电子发射扫描在感染性脊柱炎诊断中的应用价值研究

目的 探讨核磁共振(MRI)、18氟-氟代脱氧葡萄糖(18F-FDG)正电子发射断层扫描成像/计算机断层扫描成像(PET/CT)在感染性脊柱炎诊断中的应用价值.方法 回顾2001年1月～2019年12月期间在河北北方学院附属第一医院进行感染性脊柱炎筛查的100例患者的临床资料.所有受试者经组织病理学和细菌学检查,有明确的诊断结果,并接受MRI及18 F-FDG PET/CT检查.分析MRI、18 F-FDG PET/CT检查在感染性脊柱炎诊断中的意义.结果 MRI、18 F-FDG PET/CT检查均为感染性脊柱炎诊断结果的独立影响因素.ROC曲线分析结果显示,MRI、18 F-FDG PET/CT及联合预测因子在诊断感染性脊柱炎中的曲线下面积(AUC)分别为0.896、0.958、0.973,均有统计学意义(P<0.01).MRI与18F-FDG PET/CT联合检测在感染性脊柱炎诊断中的诊断效能最理想,准确度、敏感度、特异度分别为99.00％、100.00％、97.50％.结论 将MRI与18 F-FDG PET/CT联合检测感染性脊柱炎,能够明显提升诊断的准确率.     

背景抑制磁共振弥散成像在胃肠道肿瘤及转移淋巴结诊断中的应用

目的 探讨背景抑制磁共振弥散成像(DWIBS)在胃肠道肿瘤及转移淋巴结诊断中的价值.方法 对11例胃肠道肿瘤患者(6例胃癌、3例直肠癌、1例结肠癌和1例肛管癌)术前DWIBS结果进行分析.评价DWIBS对胃肠道原发肿瘤的诊断能力及转移淋巴结的显示效果.测量并比较胃癌患者转移淋巴结与非转移淋巴结表观弥散系数(ADC值).结果 11例患者中,DWIBS诊断正确7例,包括3例(3/6)胃癌,3例(3/3)直肠癌和1例肛管癌.DWIBS均能清楚的显示转移淋巴结.胃癌患者转移淋巴结平均ADC值为(0.83±0.25)×10-3 mm~2/s,非转移淋巴结平均ADC值为(1.61±0.29)×10~(-3)mm~2/s,两组间差异有统计学意义(t=-6.98,P<0.05).结论 DWIBS对胃癌原发灶的诊断能力有限,但对直肠癌、肛管癌原发灶和胃肠道肿瘤转移淋巴结的诊断有较高的临床应用价值.     

CT和MRI对中晚期胆囊癌周围脏器侵袭和转移的诊断价值

目的评价CT及MRI在中晚期胆囊癌周围脏器侵袭和转移中的诊断价值。方法回顾性分析我院2003年3月至2010年6月期间收治的经手术病理证实的中晚期胆囊癌患者45例,所有患者术前均同时行CT和MRI检查。结果①在诊断胆囊癌方面,CT诊断符合率为93.33%(42/45),MRI诊断符合率为88.89%(40/45),二者比较差异无统计学意义(χ2=0.287 2,P>0.05)。②在诊断胆囊癌转移的敏感度方面,肝脏直接浸润和转移诊断方面CT为72.00%(18/25),MRI为92.00%(23/25);胆管受侵诊断方面CT为83.33%(5/6),MRI为100%(6/6);胰腺转移诊断方面CT为100%(3/3),MRI为100%(3/3);淋巴结转移诊断方面CT为70.00%(7/10),MRI为90.00%(9/10);腹膜、网膜转移诊断方面CT为33.33%(1/3),MRI为33.33%(1/3)。诊断胆囊癌转移的总诊断符合率CT为72.34%(34/47),MRI为89.36%(42/47),MRI明显高于CT(χ2=4.083 3,P<0.05)。结论 MRI在诊断胆囊癌方面与CT相当,但在诊断肿瘤侵犯邻近器官及转移方面MRI略优于CT。     

18F-脱氧葡萄糖正电子发射计算机断层显像CT检查在前列腺癌诊断和分期中的应用价值

目的 评价18F-脱氧葡萄糖(18F-FDG)正电子发射计算机断层显像CT检查(PET/CT)在前列腺癌诊断和分期中的应用价值.方法 经手术或穿刺活检病理证实为前列腺癌患者40例,年龄52 ～ 78岁,平均67岁.其中T24例,T316例,T420例.行18F-FDG PET/CT及99Tcm-MDPECT骨显像检查,统计PET/CT显像对前列腺癌原发灶、淋巴结转移及骨转移诊断的敏感性,对比分析PET/CT显像及99Tcm-MDPECT骨显像对骨转移的诊断效果.结果 40例患者中,18F-FDG PET/CT检查显示前列腺局部结节状放射性浓聚17例,对原发灶诊断敏感性为43％.17例淋巴结转移患者中CT检查发现8例,18F-FDG PET/CT检查发现15例,诊断敏感性为88％,其中5例患者因PET/CT检查改变了临床分期以及治疗方案.18F-FDG PET/CT对骨转移诊断的敏感性与99Tcm-MDP骨显像相近,但特异性(95％)和准确率(96％)均明显高于99Tcm-MDP骨显像,其中6例患者因PET/CT检查改变了临床分期,2例改变了治疗方案.结论 18F-FDG PET/CT对前列腺癌淋巴结转移和骨转移有较高诊断价值,对前列腺的分期具有特殊优势,可为临床医生制定治疗方案提供可靠依据.     

非小细胞肺癌术前纵隔淋巴结分期诊断的现状分析

非小细胞肺癌(non-small cell lung cancer,NSCLC)术前纵隔淋巴结分期可分为无创性影像学分期和有创性外科学分期。无创性分期技术对纵隔淋巴结术前分期效能较差。其中计算机断层成像(CT)提供了良好的解剖图像已作为常规检查,磁共振成像(MRI)与磁共振扩散加权成像(DWI)目前并未得到普遍应用,电子发射计算机体层显像-X线计算机体层成像(PET-CT)作为最准确的无创分期检查仍有较高的假阳性率及假阴性率。有创性分期技术对纵隔淋巴结分期安全有效。其中纵隔镜术目前作为纵隔淋巴结分期诊断的金标准,超声内镜针吸活检术及电视胸腔镜手术(VATS)亦在临床有效应用。ⅢA期肺癌诱导治疗后的纵隔淋巴结再分期较为困难,首选有创性分期方法。     

血管前置超声与磁共振成像的诊断研究

目的 探讨产前超声与磁共振成像（MRI，Magnetic Resonance Imaging）在血管前置方面的临床诊断价值。方法 回顾分析6例血管前置病例的产前超声诊断与磁共振图像，评价其临床价值。结果 6例均行产前超声（4例经腹及经会阴检查，2例经腹及经阴道检查），其后行磁共振成像检查，并一致诊断为血管前置，术后均得到证实。结论 超声及磁共振成像均能良好地显示宫颈内口处的前置血管，产前超声在结合彩色多普勒及经会阴、经阴道的检查可使诊断率大大增加。     

胰腺十二指肠损伤影像学诊断

胰十二指肠损伤在临床上较罕见,损伤的早期诊断和治疗与预后密切相关。但胰十二指肠损伤病人临床表现多不典型,早期诊断难度大,影像学检查在其中扮演了重要角色。目前常用的影像学检查手段包括CT、腹部超声、磁共振胰胆管成像（MRCP）及内镜逆行胰胆管造影（ERCP）,其中多排CT（MDCT）是首选的影像学检查手段。     

结直肠癌肝转移影像学评估及意义

应用影像学方法及时准确诊断肝脏转移瘤后,由多学科综合治疗协作组讨论制定个体化治疗方案,病人总生存期可能会得到显著提高。多排螺旋CT（MDCT）是临床常规使用的结直肠癌肝转移瘤筛选和确诊方法。正电子发射断层显像/X线计算机体层扫描（PET/CT）主要用于诊断肝脏及肝脏以外的其他器官转移瘤。相比较而言,多参数磁共振成像（MRI）并用肝脏细胞特异造影剂是诊断结直肠癌肝转移瘤的优选影像学检查方法,特别是对于直径<10 mm的肝脏转移瘤及脂肪肝背景下肝脏转移瘤诊断准确性明显高于MDCT以及PET/CT。术中超声（IOUS）微泡造影是诊断肝脏转移瘤的有益补充,临床可能因其新发现肿瘤而改变手术决策。影像学检查依据实体肿瘤疗效评价（RECIST）和世界卫生组织（WHO）标准对肿瘤大小及数目进行判断,是评价结直肠癌肝转移化疗效果的重要手段。而且,PET/CT、扩散加权MRI以及动态增强MRI通过判断肿瘤代谢、细胞密度及血管灌注特征能够早期监测肿瘤化疗效果,并预测病人生存期。     

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??Imageology features and assessment of gallbladder carcinoma HUANG Sui-qiao. Department of Radiation, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
Abstract There are many imaging methods in detecting gallbladder carcinoma. Ultrasonography is the most common imaging method now, but the applications of CT and MRI are increased gradually and shown very important in diagnosing gallbladder carcinoma in clinical practice. 18F-FDG PET-CT has very high specificity and can be used in diagnosing difficult cases. It is not difficult for diagnosing typical gallbladder carcinoma, but it is not easy to diagnose early stage of gallbladder carcinoma. The applications of CDFI, contrast-enhanced ultrasound, dynamic CT and MRI scanning, DWIBS technique and 18F-FDG PET-CT will hopefully increase correct diagnosing level for early stage of gallbladder carcinoma. CT and MRI are better in demonstrating invasion of near structures and lymph node involvement due to gallbladder carcinoma. But lymph node involvement can easily get missed diagnosis just based on the size of lymph node. The shortages would be improved by 18F-FDG PET-CT and DWIBS technique.     

意外胆囊癌的诊治进展

胆囊癌是最常见的胆道恶性肿瘤,早期诊断困难,手术切除率低,预后差.随着腹腔镜技术的普及,腹腔镜胆囊切除术中出现意外胆囊癌的几率逐渐增大.高龄、结石病史长等胆囊癌高危因素与意外胆囊癌相关.术中操作、人工气腹等原因可导致肿瘤的种植转移.不同分期的胆囊癌应采用不同的手术方式,肿瘤的分期是最重要的预后因子.本文综述了其临床特征、预后及诊断和治疗的最新进展.     

胆囊癌侵犯胃肠道的螺旋CT诊断(附8例分析)

目的探讨胆囊癌侵犯胃肠道的螺旋CT表现，以提高对本病的认识。方法回顾性分析我院1998年儿月至2004年8月期间8例经手术和病理证实伴有胃肠道侵犯的胆囊癌患者的CT表现。8例均行CT平扫及增强双期扫描。并于扫描前饮入对比剂使上消化道充盈。结果8例中有2例胃窦受侵。6例十二指肠受侵，3例结肠肝曲受侵。术前CT诊断较为肯定的有2例胃窦和4例十二指肠受侵，表现为胆囊与受侵器官之间脂肪间隙不清、受侵处胃肠壁增厚、肿块形成、管腔狭窄等征象；对3例结肠肝曲受侵CT均不能肯定诊断。结论CT对判断胆囊癌是否侵犯胃和十二指肠有一定作用。但是对结肠肝曲受侵较难准确诊断。     

腹腔镜胆囊切除术后常规病理检查的必要性探讨

目的:探讨腹腔镜胆囊切除术(LC)后胆囊常规病理检查的必要性。方法:搜集华西医院病理科5年间的全部胆囊病理报告,找出其中LC术后意外胆囊癌患者,并分析其临床资料。结果:LC术后意外胆囊癌的发生率约为0.28%(36/12 969),88.9%(32/36)为腺癌,58.3%(21/36)为原位癌和早期胆囊癌(T1a和T1b)。结合术前影像学检查,术中通过观察及胆囊标本触摸,成功辨认出34例(94.4%)意外胆囊癌患者存在的可疑病变,遗漏1例原位癌和1例T1a期患者。结论:绝大多数意外胆囊癌患者均可在术中发现可疑病变,极少数肿瘤处于极早期无法发现者,单纯的胆囊切除已达有效治疗。因此,LC术后常规的行胆囊病理检查的必要性有待商榷。     

Renal Cell Carcinoma with Gallbladder Metastasis

The nature of polypoid masses within the gallbladder is difficult to define preoperatively. Tumors larger than 1 cm in size are strongly related to malignancy, but they are not always primary tumors of the gallbladder. We present a patient who underwent radical surgery for renal cell carcinoma and the preoperative finding of a polypoid mass within the gallbladder turned out to be a metastatic lesion.     

对胆囊结石导致胆囊癌发病的认识

胆囊癌不易早期诊断,预后差,其发病机制尚不明确。胆囊结石病与胆囊癌的发生具有一定相关性,胆石通过胆囊黏膜的机械性刺激、细菌感染、胆汁中的毒素等因素诱发胆囊黏膜癌变。胆石病相关的易感基因与胆囊癌发生也具有相关性。合理处理胆石病,是预防胆囊癌发生的重要措施。     

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??Gallbladder stones and gallbladder carcinoma JIANG Zhao-yan, HAN Tian-quan, ZHANG Sheng-dao. Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Surgery,Shanghai 200025, China
Corresponding author: HAN Tian-quan, E-mail: digsurgrj@yahoo.com.cn
Abstract Gallbladder carcinoma is difficult to be early diagnosed leading to poor prognosis. The pathogenesis of gallbladder carcinoma is not clear. Cholelithiasis is shown to be associated with gallbladder carcinoma. Mechanical irritation, bacterial infection, xenobiotic in the bile may induce the carcinogenesis of gallbladder epithelium. Several risk genes associated with gallstone disease are also shown to be related with gallbladder carcinoma. Proper treatment of gallstone disease may provide a protective role in prevention of gallbladder carcinoma.     

Diagnostic Imaging of Early Gallbladder Cancer: Retrospective Study of 53 Cases

To diagnose early gallbladder carcinoma is difficult but essential to improve the survival of the patients with this cancer. Fifty-three early gallbladder cancers were macroscopically divided into protruding and flat types. The diagnostic devises [ultrasonography (US), computed tomography (CT), and drip infusion cholangiography (DIC)] were compared for their ability of early detection. The specimens were examined cytologically for diagnosis during operation and the p53 protein was investigated. Thirty-three cases were of the protruding type, eighteen of the flat type, and two unclassified. Carcinoma tended to be missed when gallstones were present. Preoperative diagnosis of the flat type was difficult. Tumor location did not always correlate with the preoperative diagnosis. Of the misdiagnosed cases of the protruding type, half were missed with US and CT and were not visualized clearly by DIC. Among the flat type cancers, only three had no abnormal findings by diagnostic imaging. Cytologic examination was effective, and p53 was expressed only in early carcinoma, not in adenoma or dysplasia. Even in the presence of gallstones or cholecystitis, any abnormal findings should make one suspicious of gallbladder cancer. Cytology and p53 expression may be useful for the intraoperative diagnosis, and a combination of diagnostic methods is important.     

Gallbladder metastasis from hepatocellular carcinoma: Report of a case and review of literature

INTRODUCTIONThe incidence of metastasis of hepatocellular carcinoma (HCC) to the gallbladder is low. Here, we report a case of HCC with metastasis to the gallbladder and discuss the pattern of spread and the treatment.PRESENTATION OF CASEA 74-year-old man was diagnosed with advanced hepatocellular carcinoma. Computed tomography and magnetic resonance imaging demonstrated a tumor in the right lobe of the liver with a thrombus in the bifurcation of the portal vein. Because intraoperative ultrasonography showed portal vein tumor thrombosis from the main tumor reaching the umbilical portion, we performed only a cholecystectomy for the elimination of postoperative cholecystitis. Pathological examination showed gallbladder vein tumor thrombosis from poorly differentiated hepatocellular carcinoma.DISCUSSIONA preoperative diagnosis of metastatic HCC to the gallbladder is difficult because there are no specific findings in the imaging tests. Cancer cells in the liver were thought to migrate to the gallbladder via the connection between the portal system and the cholecystic veins, and grow in the lumen of the veins in our case. The survival rate, in all reported cases including the present case, was increased in patients who underwent radical resection, compared to patients who underwent palliative surgery.CONCLUSIONThe resection of metastatic HCC to the gallbladder might appear to prolong survival.     

Actual Recurrence Patterns and Risk Factors Influencing Recurrence After Curative Resection with Stage II Gallbladder Carcinoma

Despite the advances in imaging techniques, most patients can only be diagnosed at advanced stage: The prognosis is very poor. Recent studies showed that aggressive radical resection for advanced gallbladder carcinoma can give an acceptable prognosis. However, recurrence frequently remains the main problem after curative resection of advanced gallbladder carcinoma. The aim of this study was to identify the patterns and risk factors of recurrence after curative resection for stage II gallbladder carcinoma. Between January 1991 and December 2003, 100 patients received radical curative resection for gallbladder carcinoma at Yonsei University Medical Center. Of these, 77 were defined with stage II gallbladder carcinoma according to the Union Internationale Contre Le Cancer classification (sixth edition). Of the 77 patients, 67 were reviewed for the predictors of tumor recurrence. Among the 67 patients, 38 (56.7%) suffered a recurrence. The mean length to the recurrence was 21.1 +/- 26.7 months, with the most common site being the intraabdominal organs: liver and aortocaval lymph nodes. Infiltrating and poorly differentiated types were identified as independent prognostic factors of recurrence after curative resection for stage II gallbladder carcinoma and it suggests that large multicenter randomized control trials are necessary to clarify the role of adjuvant chemotherapy in these patients.