周围型肝内胆管细胞癌的影像学表现与病理对照分析

目的探讨周围型肝内胆管细胞癌的影像学表现及病理基础。方法回顾性分析经手术及病理证实的周围型肝内胆管细胞癌25例,所有病例均行B超检查;21例行CT平扫和增强扫描;11例行MRI检查;9例行DSA检查。结果B超显示病灶15例为低回声,10例为略强或强回声,均匀或不均匀;CT平扫病灶均为低密度,边界不清,MRI表现为T1WI低信号,T2WI呈较高信号伴中心低信号,动态CT及MRI检查病灶多表现为渐进性的向心性强化;病灶局部肝包膜可有回缩,周围肝内胆管可有轻度扩张和结石;选择性动脉造影呈乏血管肿瘤改变,超选择性动脉造影显示动脉期肿瘤血管纤细、呈绒球状改变,实质期肿瘤染色明显,轮廓不清;病理表现镜下为低分化或未分化腺癌,血管分布稀少,癌巢之间为大量纤维结缔组织。结论周围型肝内胆管细胞癌的影像学表现有一定的特征性。     

胆管导管内乳头状黏液性肿瘤的影像表现和形态分型

目的 探讨胆管导管内乳头状黏液性肿瘤(IPMN-B)的CT、MRI特征及其形态分型.方法 回顾性分析经病理证实的IPMN-B患者18例,16例行CT平扫+增强扫描,13例行MR增强扫描,其中11例同时行CT和MR检查.观察分析其影像和病理表现,结合影像及病理表现将IPMN-B分为典型IPMN-B、囊性IPMN-B、无肿块型IPMN-B和侵袭性IPMN-B共4种类型,确定其分型.结果 典型IPMN-B 9例,表现为沿胆管壁的肿瘤灶,肿瘤上游、下游胆管均明显且广泛扩张.囊性IPMN-B5例,胆管呈动脉瘤样扩张,内可见单发或多发瘤灶.无肿块型IPMN-B 2例,胆管呈广泛明显扩张,未见明确肿瘤病灶,胆管壁光滑.侵袭性IPMN-B 2例,病灶所在节段胆管扩张,肿瘤突向胆管腔内使胆管壁呈锯齿状,伴随胆管外异常密度或信号灶.18例均有胆管扩张,其中16例可见扩张胆管内肿瘤病灶,2例未见明确瘤体显示,仅表现为胆管扩张.CT扫描可见肿瘤密度低于肝实质,并高于胆汁和胆管内黏液.MR T2WI可见肿瘤信号高于结石,并低于胆汁和黏液.DWI肿瘤均表现为高信号.增强扫描肿瘤呈轻中度强化,三期增强扫描可见肿瘤的密度或信号均低于肝实质.结论 IPMN-B的CT和MRI表现具有一定特征性并有助于分型.     

周围型肝内胆管细胞癌的CT诊断及鉴别

周围型肝内胆管细胞癌起源于肝内胆管的上皮细胞，是原发肝癌的少见类型。其影像、病理及临床表现均与肝细胞癌有所不同，为进一步提高周围型肝内胆管细胞癌的CT诊断及鉴别诊断水平，本文收集了近年来经手术病理证实的周围型肝内胆管细胞癌10例，着重分析其CT表现，找出CT特征，加深对此病的认识。     

周围型胆管细胞癌临床病理与CT及MR诊断研究

目的:对比研究肝内周围型胆管细胞癌的临床病理与CT及MRI表现。方法:回顾性分析经病理学证实的周围型胆管细胞癌39例,32例行CT平扫和动态增强扫描,11例行MRI扫描,其中4例同时做过CT和MRI检查。结果:肿瘤在CT、MRI上表现为类圆形软组织肿块(肿块型)、不规则形片状异常密度(信号)影(浸润生长型)和扩张胆管腔内结节样(或菜花样)软组织肿块,动态增强扫描早期呈轻度强化,以边缘为主,延迟后扫描病灶可无明显强化,或内部呈现片状、分隔状甚至均匀性强化。病理学上见肿瘤细胞呈高柱状、立方形或扁平形排列成腺管状,中间含有增生的纤维结缔组织,在不同类型肿瘤中两者含量和分布特点不同构成不同影像表现的病理学基础。结论:周围型胆管细胞癌的临床表现缺乏特异性,动态增强扫描是CT、MRI诊断和鉴别诊断要点,排列成腺管状的瘤细胞造成肿瘤早期强化,而增生的纤维结缔组织是形成肿瘤延迟强化的病理基础。     

肝内周围型胆管细胞癌的MRI诊断

目的探讨MRI对肝内周围型胆管细胞癌（IHPCC）的诊断及鉴别诊断价值。方法回顾性分析经手术病理证实的IHPCC 28例,分别作MRI平扫和动态增强扫描。结果在MRI图像上,IHPCC主要表现为分叶状或不规则形、混杂密度或信号、无包膜的软组织肿块;动态增强扫描肿瘤呈＂慢进慢出＂表现,动脉期肿瘤以边缘轻～中度强化为主,延迟扫描出现从周边到中心的向心性、延迟强化;其他征象包括瘤内见扩张的胆管8例,病灶周围或远端胆管扩张20例,包膜回缩征象12例,局部肝萎缩8例,肝门后或腹膜后淋巴结转移10例,均无门静脉癌栓形成。结论 IHPCC的MRI表现具有一定的特征性,可为IHPCC的诊断及鉴别诊断提供重要的依据;MRI新技术的应用更能反映肿瘤的病理特征。     

原发性肝内周围型胆管细胞癌MRI诊断

目的 探讨MRI在原发性肝内周围型胆管细胞癌(IHPCC)中的诊断与鉴别诊断价值.方法 收集经手术/穿刺活检病理证实的IHPCC 12例,所有病例均做了MRI平扫和动脉期、门脉期、延迟期增强扫描,分析记录IHPCC MRI平扫及多期动态增强扫描表现.结果 共计17枚IHPCC瘤灶,其中12枚瘤灶T2WI信号特点为周围稍高、中央等低、边缘模糊,其余5枚瘤灶呈长T2信号.动脉期2枚瘤灶不强化,其余15枚瘤灶均为周围轻度环状强化,门脉期和延迟期17枚IHPCC瘤灶均呈向心性充填;12例IHPCC均正确诊断.结论 IHPCC 的MRI影像表现较具有特征性,对该瘤的诊断具有重要价值.     

周围型肝内胆管细胞癌的CT表现与病理学基础相关性分析

目的:探讨周围型肝内胆管细胞癌的CT表现与病理学基础,提高对周围型胆管细胞癌的认识。方法:回顾性分析12例经病理证实为周围型胆管细胞癌患者的临床病理与CT扫描资料。结果:CT平扫12例均为类圆形或不规则形低密度灶,边界不清;病灶周围肝内胆管扩张5例;局部肝包膜回缩征象4例。增强扫描:动脉期与静脉期病灶无强化或轻度强化,延迟后病灶内部呈片状、分隔状或均匀强化。病理表现镜下为低分化或未分化腺癌,血管分布稀少,癌巢之间为大量纤维结缔组织。结论:周围型肝内胆管细胞癌的CT表现具有一定的特征性,其病理学基础有助于理解CT征象。     

周围型肝内胆管细胞癌的磁共振诊断

目的 :评价磁共振 (MRI)平扫及联合动态增强MRI对周围型肝内胆管细胞癌 (PCC)的诊断价值。方法 :回顾性分析 15例经手术病理证实的周围型肝内胆管细胞癌的MRI平扫及动态增强表现。结果 :全部病灶显示满意。参考平扫胆管扩张情况定性诊断符合率为 3 3 .3 % ,联合动态增强定性符合率提高至 86.7%。结论 :MRI平扫能较好显示病灶和胆管扩张情况 ,平扫联合动态增强检查可提高对PCC的定性符合率。     

肝内周围型胆管细胞癌的螺旋CT诊断

目的:探讨肝内周围型胆管细胞癌的临床、病理及螺旋CT表现特征,提高肝内周围型胆管细胞癌的CT诊断准确率。方法:回顾性分析经病理证实的17例肝内周围型胆管细胞癌的螺旋CT表现。结果:17例肝内周围型胆管细胞癌,肿瘤位于左叶9例,右叶5例,左右叶同时累及3例;肿瘤大小2.5cm×3.0cm~9cm×11cm,其中15例肿块直径大于5cm;肿瘤形态呈分叶状、片状或不规则状12例,类圆形5例;肿瘤边缘清楚4例,13例边缘不清。螺旋CT特征为:病灶以低密度为主的不规则肿块,内可见囊性更低密度区;病灶以边缘轻至中度强化为主,出现特征性的从周边到中心的向心性强化、延迟强化,呈“慢进慢出”表现;病灶周围肝内胆管轻度扩张;局部肝萎缩,肝包膜凹陷征。结论:肝内周围型胆管细胞癌的CT表现有一定的特征性,对于与肝内其它常见病变的鉴别诊断有重要价值。     

肝内周围型胆管细胞癌的螺旋CT征象分析

肝内胆管癌即从肝左右管合流部(肝门部)至末梢的胆管上皮细胞发生的癌.组织学表现为腺样分化或伴有黏液分泌,富于纤维性间质,比肝细胞癌硬.根据其发生部位分为末梢型胆管癌(肝内周围型胆管细胞癌)及肝门部胆管癌.     

Peripheral neurofibromatosis

Neurofibromatosis or von Recklinghausen disease usually is a readily diagnosed entity, characterized by typical cutaneous lesions and a strong family history. In a variant of the usual disease, peripheral neurofibromatosis, these stigmata may be absent and accurate diagnosis may be elusive. We present a patient without diagnostic cutaneous lesions in whom the diagnosis of neurofibromatosis was initially suggested by computed tomography because of numerous masses in the distribution of peripheral nerves.     

Peripheral arteries

Peripheral arterial disease is a main cause of morbidity in industrialised countries. It chiefly affects older people. The most common causes are atherosclerosis and vasodilatatory abnormalities. In the presence of unexplained leg symptoms, peripheral arterial disease can be diagnosed or ruled out by non-invasive diagnostic methods such as history, clinical examination and the measurement of ankle and brachial artery pressure by Doppler ultrasound, as well as by calculating the ankle brachial index. Colour coded duplex sonography, computer tomography angiography, magnetic resonance angiography and arteriography are the imaging modalities used. Current diagnostic strategies are analysed for the different peripheral artery diseases.     

Peripheral MR angiography

Atherosclerotic disease of the lower extremities is a common disorder in western society. Its debilitating nature calls for accurate diagnosis and treatment. The gold standard for diagnosing this disease by depiction of vessel morphology is X-ray angiography (either conventional or digital subtraction angiography). However, the invasive nature of this technique and the possible harmful effects of iodinated contrast agents have led to the idea that non-invasive MR angiography might be a good alternative for acquiring information about vessel morphology. Most extensively studied was time-of-flight MR angiography. Although first results with this technique were encouraging, it is now apparent that time-of-flight MR angiography is hampered by the virtue of which it exists, since blood flow not only generates vessel-to-background contrast, but is also the cause of disturbing artifacts. However, with the introduction of minimally invasive contrast-enhanced MR angiography, using gadolinium chelates to reduce the T1 of blood, image quality has improved dramatically. Moreover, using contrast-enhanced MR angiography, high-resolution three-dimensional data about the entire peripheral vascular tree can be obtained within several minutes, which might make MR angiography a true competitor of X-ray angiography as a diagnostic tool in the clinical work-up of a patient with complaints of peripheral atherosclerosis. The purpose of this article is to explain working mechanisms and usefulness of both time-of-flight and contrast-enhanced MR angiography. Received: 28 August 1998; Revised: 7 December 1998; Accepted: 9 February 1999     

Peripheral middle lobe syndrome

Classically, the middle lobe syndrome has been described as being caused by a central obstruction. Clinical records and radiologic findings were reviewed in 129 patients examined between 1955-1981 who had chronic disease in the right middle lobe and/or lingula. Fifty-eight patients (45%) had no evidence of a central obstructive lesion. The majority were middle-aged women with histories of chronic cough and chest pain. Bronchoscopic and radiologic evaluation served to exclude central lesions. Surgical confirmation was available in 38 patients. Pathologic study showed varying degrees of chronic inflammation, pneumonia, and bronchiectasis. Surgical results were excellent in isolated disease. Chronic atelectasis and pneumonitis of the right middle lobe and/or lingula do not always imply central obstruction. A lack of collateral ventilation is a plausible theory to explain the pathophysiology in such patients.     

MRA在周围软组织血管瘤和血管畸形中的应用

目的探讨MRA在周围软组织血管瘤和血管畸形中的应用价值。方法回顾性分析61例血管瘤和血管畸形动脉、静脉磁共振血管成像表现。结果13例血管瘤中7例病灶内出现增多且逐渐变细的细小动脉,2例合并有动-静脉瘘形成,6例病灶内未见血管显示。48例血管畸形中35例病变区动、静脉显影,1例仅见动脉显影。动脉成像23例表现为动脉受压变细,5例可见动脉畸形。静脉成像25例显示浅静脉畸形,其中13例合并深静脉畸形,2例仅显示深、浅静脉增多、增粗。8例动、静脉成像均可见动-静脉瘘形成。12例病变区未见血管显影。结论MRA对周围软组织血管瘤和血管畸形的诊断和鉴别有重要价值。     

血管内超声溶解外周动脉血栓的研究

目的 评价血管内超声溶栓治疗急性外周动脉血栓形成的疗效。材料与方法 ２４例患者经血管造影证实，股浅动脉血栓形成２１例，Ｇｕｏ动脉血栓形成２例，肱动脉血栓形成１例。对下肢动脉血栓采用对侧或同侧股动脉穿刺，插入超声导管溶栓；对上肢动脉血栓采用股动脉穿刺，插入超声导管至上肢动脉深栓。２４例患者均进行４～６分钟血管内超声溶栓治疗。结果 ２４例治疗后即刻造影显示血管内超声成功溶解了动脉内血栓，有１例治疗２４     

Peripheral angioplasty balloon technology

Changes in balloon and catheter technology have led to the development of smaller, more flexible, and less traumatic balloon dilatation systems. The physical principles that govern balloon angioplasty and the current status of balloon materials and catheter designs will be reviewed. A compilation of various angioplasty catheters is also summarized.