腹膜后纤维化的综合影像诊断

目的 探讨腹膜后纤维化(RPF)的影像学表现及其诊断价值。方法 回顾分析经临床病理证实的9例：RPF的IVP、B超、CT及MRI表现。结果 RPF的影像学表现为腹膜后弥漫性斑块或肿块及腹膜后脏器的浸润，多伴有肾盂输尿管扩张。结论 CT和MRI能全面反映腹膜后病变的各种表现，并能进行分期及疗效监测。综合分析各种影像学检查有助于RPF的诊断。     

多房囊性肾癌的CT、MRI表现及鉴别诊断

目的:分析多房囊性肾癌的影像学表现,以提高对此病的认识及正确诊断率.方法:回顾性的分析病理证实的9例多房囊性肾癌患者的CT/MRI图像,其中1例患者为双侧多房囊性肾癌.结果:10个病灶,均边界清楚.8个病灶囊壁局部增厚,2个囊壁菲薄.3个病灶间隔菲薄,4个间隔增厚不均匀,3个间隔增厚并有结节.增强扫描囊壁及分隔均不同程度强化.2个病灶见囊壁和/或间隔钙化.Bosniak分级ⅡF级3个,Ⅲ级7个.结论:多房囊性肾癌多表现为多房囊性肿物,边界清楚,囊壁可有局部增厚,间隔粗细不均,附壁及间隔结节直径小于5mm.需要与肾囊肿及肾癌囊性变鉴别,表现典型者可作出正确诊断.     

正常和良性增生前列腺的高场强磁共振成像特征

目的总结正常前列腺的磁共振成像（ＭＲＩ）特征和随增龄的变化，探讨老年人良性前列腺增生的ＭＲＩ特征及其与临床的对应关系。方法结合３例尸体前列腺ＭＲＩ进行病理对照，分析２３例正常、５０例老年人良性增生前列腺的高场强ＭＲ成像。结果４０岁组至６０岁组的正常前列腺整体各径线以及内部各带径线均值差异无显著性，而Ⅰ、Ⅱ、Ⅲ度增生各组间各径线均值差异有显著性。前列腺每增大１度，其各径线均值增加５～８ｍｍ。结论正常前列腺，从４０岁组至６０岁组不随年龄增长而增大，临床分度与增生前列腺的大小相关，前列腺周围静脉丛与前列腺大小及年龄无关。并提供以下分度参考值：正常前列腺最大横径≤４５ｍｍ，而≥５５ｍｍ为Ⅲ度增生，横径在４６～５４ｍｍ之间为Ⅰ～Ⅱ度增生。     

急性重症胰腺炎的CT诊断

急性重症胰腺炎是一种严重急腹症,如不能及时正确诊断,将会影响治疗的恰当与否,导致严重后果。急性重症胰腺炎,有时体征不典型,血、尿淀粉酶的增高也可不显著、难以与其他急腹症鉴别。既使临床诊断为急性胰腺炎,对胰腺病变的严重程度也不易准确判断。X线腹部平片及B型超声波对胰腺的检查由于肠     

胸腺上皮肿瘤的临床CT表现与术后存活时间的关系

目的 分析胸腺上皮肿瘤的临床和CT表现与患者术后存活时间的相关性.方法 回顾性复习91例经手术病理证实,并作了WHO病理分类的胸腺上皮肿瘤的CT表现.根据肿瘤大小、形态、边缘、密度、强化程度、纵隔淋巴结、有无大血管侵犯及肺内或胸膜转移灶,并结合是否伴发重症肌无力、WHO病理分类等,评价各因素对患者预后的影响.用Kaplan-Meier 法计算总生存率,Log rank 检验用于评价各因素间的差异,Cox回归比例风险模型用于多因素分析影响存活的预后因素,χ2检验用于分析CT表现与WHO分类的关系.结果 91例中因非肿瘤因素病死2例,其余89例中病死13例,5年总生存率为84.3%(75例).89例共有病灶91个,在CT表现上肿瘤≥ 5cm、边缘分叶、密度不均匀、出现血管侵犯、纵隔淋巴结肿大及有远处转移者存活时间较短,5年生存率分别为72.7%、77.3%、76.7%、73.8%、30.0%、68.8%.多因素分析显示肿瘤大小、患者是否合并重症肌无力和是否出现纵隔肿大淋巴结是影响预后的独立影响因素,其偏回归系数(B)分别为0.378、-1.756和1.853,P值分别为0.002,0.009和0.025.CT表现与WHO分类的比较结果和单因素分析结果一致,WHO病理分类不同,则肿瘤的大小、边缘、血管侵犯情况、纵隔淋巴结肿大以及是否有远处转移差异有统计学意义(x2值分别为6.598、5.737、18.307、8.465、15.608,P值均＜0.05).结论 CT表现可以提示肿瘤的生物学特性,肿瘤大小和有无纵隔淋巴结肿大是影响患者存活时间的主要因素,而伴发重症肌无力多提示肿瘤级别较低,患者存活时间相对较长.

Abstract：

Objective To describe the CT manifestations of thymic epithelial tumor and explore the correlation between CT findings and post-operative tumor-related survival time. Methods Ninety-one patients who underwent CT scan before operation were reviewed retrospectively. All cases had operation and were classified according to the WHO classification. The size, contour, shape, density and enhancement of the tumors on CT were assessed. Presence of mediastinal lymphadenopathy, great vessel invasion, metastasis to the lung or plural, myasthenia gravis (MG) were also analyzed. The survival rate was obtained using the Kaplan-Meier method. The Cox model was applied to determine the factors affecting the tumor-related survivals. Chi square test was used to analyze the relationship between CT findings and WHO classification. Results Two patients were excluded because of dying of myocardial infarction and colon cancer. The total 5-year survival rate was 84.3%(n=75). Eighty-nine patients had total 91 tumors. Tumors with diameter larger than 5 cm, lobular contour, heterogenous density, and presence of great vessel invasion, mediastinal lymphadenopathy, and metastasis were adverse factors which could significantly affect the survival time. Five-year survival rates of these factors were 72.7%, 77.3%, 76.7%, 73.8%, 30.0%, and 68.8%, respectively. Presence of MG was a favorable factor which also significantly affected the survival time (P＜0.05). While the shape and enhancement of the tumors and the age, gender of the patients did not significantly affect the survival time (P＞0.05). The result of the Cox multivariate analysis was consistent with that of the Log-rank test. For different WHO classification, there were significant different among the size or contour of the tumors, presence of great vessel invasion, mediastinal lymphadenopathy, and metastasis (x2 value were 6.598, 5.737, 18.307, 8.465, and 15.608, respectively P＜0.05). Conclusions CT findings may be served as predictors of clinical prognosis of the thymic epithelial tumors. Adverse factors for survival time are the size of the tumors and presence of mediastinal lymphadenopathy, while MG is a favorable factor for survival time.     

脾病变的CT诊断

脾脏疾病较少见,我院1980年10月～1989年12月9年期间腹部CT扫描发现有脾阳性所见并经证实者76例,为探讨CT对脾病变的诊断价值,进行以下分析。     

胃十二指肠平滑肌肿瘤的CT诊断

本文报导9例胃十二指肠平滑肌肿瘤,分析其CT表现与病理对照。CT检查补充了胃(肠)外型平滑肌肿瘤钡餐检查的不足,准确地显示出病变范围及有无其他器官的侵犯。胃外生型肿瘤可见肿块与胃壁有一段相连而胃外肿瘤则无。良恶性平滑肌肿瘤的CT表现有所不同。良性者肿块小,圆形、椭圆形或分叶状,密度均匀,静注造影剂后有均匀增强。恶性者肿块大,不规则分叶状,主要向腔外生长,常发生坏死,呈密度不均匀的低密度区,肿块与胃壁相连,对比增强后有边缘性增强。     

CT、MRI对鉴别Ⅰ、Ⅱ型乳头状肾细胞癌的价值

目的 比较和分析Ⅰ、Ⅱ型乳头状肾细胞癌(PRCC) CT及MRI影像表现,探讨对其亚型鉴别的可能.方法 回顾分析30例经病理证实分型的PRCC的CT或/和MRI表现,包括肿瘤大小、形态、边缘、生长方式、钙化、出血、密度均匀性、肿瘤双期增强CT值、皮质期肿瘤与正常肾皮质CT值比值、实质期肿瘤与正常肾实质CT值比值、MRI信号表现等情况,比较Ⅰ、Ⅱ型PRCC的影像学表现差异.结果 PRCC两亚型影像表现中的肿瘤形状、边缘、大小、生长方式、密度均匀性、双期增强CT值、皮质期肿瘤与正常肾皮质CT值比值、实质期肿瘤与正常肾髓质CT值比值均有显著统计学差异.区分两亚型的肿瘤增强双期CT值界值分别为67HU、77HU,皮质期肿瘤与正常肾皮质CT值比值、实质期肿瘤与正常肾髓质CT值比值的界值分别为0.38、0.39,而在两型MRI的信号表现上无明显差异.结论 Ⅰ、Ⅱ型乳头状肾细胞癌影像表现存在一定差异,有助于术前鉴别诊断.     

胸腺囊肿的CT、MRI诊断

目的:总结胸腺囊肿的CT和MRI影像表现。材料和方法:回顾分析12例胸腺囊肿的胸部平片、CT和MRI表现并与手术病理对照。结果:12例胸腺囊肿直径1~12cm,平均3.6cm;圆形或类圆形10例,长圆或圆柱形2例;位于前上纵隔9例,前下纵隔1例,从主动脉弓至横膈2例;边缘光整12例;境界清楚9例,与心脏大血管或心包联系紧密3例;未突出纵隔轮廓5例,突出纵隔轮廓7例;薄壁10例,厚壁2例;单房11例,多房1例;均匀水样密度9例,接近肌肉密度3例;7例增强扫描囊内容物均无增强。结论:大多数胸腺囊肿根据其CT和MRI表现,术前可作出正确诊断,并与其他纵隔囊性肿块相鉴别。