胆囊腺肌症的发病机制与影像学诊断进展

胆囊腺肌症是一种相对少见且发病机制不明的疾病,该病缺乏特异性症状,常和胆囊炎、胆囊结石同时存在。胆囊腺肌症术前诊断困难,既往多发现于胆囊切除术后标本中。近年来国内外文献报道其有潜在恶变倾向,可能与胆囊癌的形成有关。随着对该病的深入研究及影像学技术的发展,目前对它的病因、发病机制有了进一步的了解,在影像学诊断方面有了进一步的提高。笔者就此主要对该病的发病机制及影像学诊断进行综述。     

糖尿病性舞蹈症影像分析

糖尿病性舞蹈症临床非常少见,本文报道6例经临床证实的糖尿病性舞蹈症患者的CT、MRI影像学表现,并结合文献,分析其影像学特点及形成机制,以提高对该病的认识,为临床对该病进行早期诊断及治疗提供影像学依据.     

弥漫硬化型甲状腺乳头状癌的影像学研究进展

弥漫硬化型甲状腺乳头状癌(DSVPTC)是甲状腺乳头状癌中的一种特殊罕见类型,其侵袭性强,转移早,预后差。该病发病率低,临床表现隐匿,较难触及甲状腺肿块,临床医师因缺乏对该病的认识和诊断经验,易漏误诊。对DSVPTC的影像学检查主要有超声、X射线、CT等,本文就DSVPTC的影像学表现进行综述。     

残余胆囊9例报告

目的探讨残余胆囊的发生、诊断、治疗以及预防。方法通过对9例残余胆囊患者的诊治,讨论其发病特点、临床症状、诊治方法以及预防措施。结果 9例患者均经影像学检查诊断且经再次手术治愈,随访12个月~5年无复发。结论根据临床表现和影像学检查该病能获得正确诊断,再次手术切除是治愈该病的最有效手段。     

贲门失弛缓症在多层螺旋CT中的影像表现

目的总结食管贲门失弛缓症的多层螺旋CT影像学资料,提高对该病的临床诊断准确性,减少检查的重复性。方法对临床证实的食管贲门失弛缓症的17例患者的多层螺旋CT资料进行回顾性分析,总结其影像学特点。结果食管贲门失弛缓症有较为特征性的CT表现。结论根据贲门弛缓症多层螺旋CT的表现,结合X线、食管镜等检查,能对该病进行准确的诊断。     

胰腺实性假乳头状瘤的CT特征及恶性征象研究

目的:探讨胰腺实性假乳头状瘤(SPNP)的影像学表现特征,提高影像学对该病的诊断正确率。方法:回顾性分析9例SPNP患者的影像学检查资料,观察肿瘤的大小、位置、囊实性、包膜情况、有无钙化和出血、病灶的强化方式、胰胆管是否扩张及肿瘤与邻近结构的关系,分析总结肿瘤的特征性表现。结果:9例全部为单发,男性2例,女性7例,4例位于体尾部,9例均为囊实性,但比例不一,增强扫描实性部分渐进性强化,囊性部分不强化。结论:SPNP的影像学表现有一定特殊的征象,放射科医师应进一步提高对该病的认知程度,以提高影像学对SPNP诊断的准确率。     

腹膜后Castleman 1例报告并文献复习

Castleman病（Castleman＇s disease,CD）是一种罕见的淋巴组织增生性疾病。该病病因不明,对本病影像学表观认识不足,临床上常诊断困难。本文对其影像学表现、病理学分型及临床总结如下,并结合文献进行分析,以提高对该病的影像学认识,以减少误诊率。     

食管囊肿

食管囊肿极少见 ,临床表现和影像学检查均无特异性 ,该病术前诊断困难 ,其最后确诊有赖于手术和病理。今有我院及外院手术病理确诊的食管囊肿 4例 ,就其影像学表现进行分析和对比 ,以期从影像学的角度提高认识 ,降低误诊率。例 1,女 ,2 7岁 ,以“进干硬食物哽咽7个月”而就诊 ,     

肾上腺髓质脂肪瘤的诊治（附13例报告）

目的分析和总结肾上腺髓质脂肪瘤的临床特征及其诊断和治疗原则。方法回顾性分析我院1997年至2009年收治的肾上腺髓质脂肪瘤13例,对其临床特征、影像学表现、诊断和治疗以及随访结果进行总结。结果 10例患者接受手术治疗,术后病理均证实为肾上腺髓质脂肪瘤,与影像学诊断结果高度一致。肿瘤大小与临床表现无明显相关性。术后无复发,预后良好。3例未手术者随访无临床症状,肿瘤亦无明显变化。结论影像学检查可以明确诊断,腹腔镜手术是治疗该病的金标准。该病预后良好,无复发。无症状患者可长期随访观察。     

颅内静脉窦血栓形成60例临床表现和影像学特点

目的探讨颅内静脉窦血栓形成的临床表现和影像学特点以提高该病的诊断。方法对60例颅内静脉窦血栓形成患者的临床特点和影像学检查等客观资料进行总结,并结合文献对其临床特点、发病机制、诊断及鉴别诊断进行分析。结果本组患者多为急性、亚急性起病,临床表现复杂,多有头痛,可伴有恶心、呕吐、癫痫、偏瘫、视力障碍等症状。影像学既可表现为出血也可表现为缺血,49例（49/54）头颅MRV检查示颅内静脉窦血栓形成,27例患者头颅DSA检查均示一处或多处静脉窦狭窄、充盈缺损和显示不良。脑脊液多压力升高,脑电图可有轻度异常。予抗凝等对症支持治疗,预后良好。结论颅内静脉窦血栓形成临床表现复杂多变,头痛是其主要表现,影像学MRV及DSA检查有助于该病诊断,及时治疗预后良好。     

周围型胆管细胞性肝癌影像学诊断

胆管细胞性肝癌是肝脏常见的原发性恶性肿瘤之一，根据部位分为周围型和肝门型两类，本文综述了周围型胆管细胞性肝癌的临床表现、病因、病理学改变以及与之相关的影像学表现特征，并评价了各种影像学检查方法的价值。     

超声造影对肝内胆管细胞癌的诊断价值

目的探讨肝内胆管细胞癌的超声造影征象及临床应用价值.方法对3例病理证实的胆管细胞癌分别行常规超声及实时灰阶谐波超声造影检查,记录病灶的大小、回声、血流分布及分析超声造影各时相的特征.结果 3例病灶在二维声像图上没有特异性,彩色多普勒血流显像显示病灶均为少血供型,超声造影显示3例病灶均表现"快进快出"的超声造影增强模式,门脉相病灶呈低回声,周边可见高回声环.结论超声造影在本组肝内胆管细胞癌病例中表现出的共同特征,对病灶的诊断有一定帮助.     

Hilar cholangiocarcinoma: MRI/MRCP in staging and treatment planning

The role of MR imaging in hilar cholangiocarcinoma is to confirm/reach a diagnosis and to assess resectability. Hilar cholangiocarcinoma shows the same signal intensity pattern of peripheral tumors both on T1- and T2-weighted images. On magnetic resonance cholangiopancreatography (MRCP) images, hilar cholangiocarcinoma appears as a moderately irregular thickening of the bile duct wall (5 mm) with symmetric upstream dilation of the intrahepatic bile ducts. The aim of preoperative investigation in Klatskin tumors typically requires the evaluation of the level of biliary obstruction, the intrahepatic tumor spread, and the vascular involvement; it also needs to show any atrophy-hypertrophy complex. Because of its intrinsic high tissue contrast and multiplanar capability, MR imaging and MRCP are able to detect and preoperatively assess patients with cholangiocarcinoma, investigating all involved structures such as bile ducts, vessels and hepatic parenchyma. The main reason for surgical/imaging discrepancy is represented by the microscopic diffusion along the mucosa and in the perineural space.     

Staging of hilar cholangiocarcinoma with ultrasound

The preoperative assessment of the extent of biliary and vascular involvement by hilar cholangiocarcinoma is clinically important because resectability may be limited by tumor extension along the bile ducts into the hepatic parenchyma or to the adjacent hilar vessels. Thirty-five patients with hilar cholangiocarcinoma were studied with ultrasound, and the results were compared with operative findings and other diagnostic modalities. The level of intrahepatic biliary obstruction was determined in 100% of patients with ductal ectasia, and a tumor mass was shown in 37.1%. Imaging and Doppler ultrasound proved accurate in detecting the neoplastic involvement of the portal vein. Both correctly diagnosed portal occlusion and wall infiltration in 4 of 4 and 15 of 18 (83%) patients, respectively, without any false-positives. On the contrary, imaging ultrasound had poor sensitivity in detecting infiltration of the hepatic artery (43%) and metastases in regional lymph nodes (37%), liver (66%), and peritoneum (33%). In conclusion, ultrasound may be valuable in the preoperative staging of hilar cholangiocarcinoma, specially in predicting ductal and portal involvement. © 1995 John Wiley & Sons, Inc.     

肝胆管结石合并肝胆管癌的临床分析

目的探讨肝胆管结石和肝胆管癌的关系以及肝胆管结石合并肝胆管癌的临床特点、诊断及治疗。方法回顾性分析6例肝胆管结石合并肝胆管癌患者的临床资料。结果 6例患者中,2例行内镜下逆行胆汁内引流及支架植入术,其余4例行开腹手术,其中3例行肝切除术。术后病理均提示为腺癌。结论肝胆管结石合并肝胆管癌的可能性大,临床医生应对长期肝胆管结石提高警惕,掌握肝胆管结石合并肝胆管癌的临床表现特征,重视对高危对象的定期复查。肝切除术是治疗肝胆管结石合并肝胆管癌的有效手段,一旦确诊,宜早期手术。     

Imaging features of hepatic sarcomatous carcinoma on computed tomography and gadoxetic acid-enhanced magnetic resonance imaging

Abdominal Radiology - To determine the imaging features of hepatic sarcomatous carcinoma including sarcomatous intrahepatic cholangiocarcinoma (S-ICC) and sarcomatous hepatocellular carcinoma...     

肝内胆管细胞癌超声造影与增强MRI表现对比分析

目的 分析肝内胆管细胞癌超声造影与增强MRI影像学表现特点.方法 8例经手术病理证实的肝内胆管细胞癌,术前行超声造影、增强MRI检查.结果 超声造影：动脉期5例周边环状高增强,1例整体均匀高增强,2例整体不均匀高增强;门脉期6例整体为低增强,2例内部呈低增强,周边仍见环状高增强;延迟期均呈低增强.增强MRI：动脉期8例环状高增强;门脉期及延迟期1例环状高增强,7例向心性增强.结论 肝内胆管细胞癌超声造影与增强MRI表现不同,可能与疾病的病理特点及两种造影剂在人体内的分布特点有关.     

磁共振成像在肝内胆管细胞癌的诊断及疗效评估中的研究进展

肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)是肝脏仅次于肝细胞癌(hepatocellular carcinoma,HCC)的第2位常见的原发性恶性肿瘤,近年来发病率呈上升趋势,发病隐匿,其恶性程度高,预后差。因磁共振成像(magnetic resonance imaging,MRI)有助于肝内胆管细胞癌的早期诊断及疗效评估,故越来越多地被用于ICC的临床实践中。本文对MRI在ICC诊断及疗效评估中的应用现状作一综述。     

MR imaging of intrahepatic cholangiocarcinoma

Background: The purpose of this study was to determine the magnetic resonance (MR) features of intrahepatic cholangiocarcinoma. Methods: MR imaging studies of seven cases of pathologically proven intrahepatic cholangiocarcinoma were retrospectively reviewed. Results: On MR images the tumors presented as a single mass (N = 5) or multiple nodules (N = 2), as welldelineated (N = 5) or ill-defined (N = 2), and as non-encapsulated (N = 7). Mean tumor diameter ranged from 6–14 cm (mean, 10 cm). On T1-weighted (TR/TE = 400–600/10–17 msec) images, the tumors were hypointense compared to the liver. The five tumors studied with dynamic MR imaging showed progressive centripetal filling-in after intravenous administration of a gadolinium chelate. On T2-weighted (TR/TE = 2000–2500/80–100 msec) images, all tumors were hyperintense compared to the liver; five were markedly hyperintense and two moderately hyperintense. Vascular encasement, bile duct dilatation within the tumor, and central scar were depicted on MR images in four, three, and two tumors respectively. Conclusion: The typical MR appearance of intrahepatic cholangiocarcinoma is a large well-delineated nonencapsulated tumor associated with intrahepatic venous encasement.     

Imaging spectrum of cholangiocarcinoma: role in diagnosis,staging, and posttreatment evaluation

Cholangiocarcinoma, a tumor of biliary epithelium, is increasing in incidence. The imaging appearance, behavior, and treatment of cholangiocarcinoma differ according to its location and morphology. Cholangiocarcinoma is usually classified as intrahepatic, perihilar, or distal. The three morphologies are mass-forming, periductal sclerosing, and intraductal growing. As surgical resection is the only cure, prompt diagnosis and accurate staging is crucial. In staging, vascular involvement, longitudinal spread, and lymphadenopathy are important to assess. The role of liver transplantation for unresectable peripheral cholangiocarcinoma will be discussed. Locoregional therapy can extend survival for those with unresectable intrahepatic tumors. The main risk factors predisposing to cholangiocarcinoma are parasitic infections, primary sclerosing cholangitis, choledochal cysts, and viral hepatitis. Several inflammatory conditions can mimic cholangiocarcinoma, including IgG4 disease, sclerosing cholangitis, Mirizzi’s syndrome, and recurrent pyogenic cholangitis. The role of PET in diagnosis and staging will also be discussed. Radiologists play a crucial role in diagnosis, staging, and treatment of this disease.