超声引导下周边型肺肿块穿刺活检方法学及安全性分析

目的进一步评价超声引导下经皮肺穿刺方法学及临床应用价值,探讨如何减少并发症的发生及提高取材结果的阳性率。方法对978例影像学检查显示的肺周边型肿块需明确诊断者行超声引导下经皮肺肿块穿刺活检术。结果 978例病人937例确诊,活检确诊率95.8%。病理诊断结果:恶性肿瘤714例,其中鳞癌306例,腺癌215例,未分化癌118例,恶性淋巴瘤4例,恶性间皮瘤3例,肺泡癌30例,转移癌23例,其它恶性肿瘤15例;良性病变223例,其中结核82例,肺脓肿35例,炎性假瘤101例,错构瘤5例;未能确诊者41例。并发气胸13例,咯血8例,并发症发生率为2.15%。结论超声引导下经皮肺穿刺是一种安全简便的鉴别诊断方法,可以有效提高周边型肿块的诊断准确率。     

彩色多普勒超声对乳腺良、恶性肿块的诊断价值

目的探讨彩色多普勒超声对乳腺良、恶性肿块的诊断价值。方法选择我院经手术病理组织活检确诊的90例乳腺肿块患者,分析其彩色多普勒图像表现,比较良、恶性肿块的形态、内部回声、钙化、后方衰减及有无CDFI等情况,并比较血流Vmax值、Vmin值及RI值。结果彩色多普勒超声显示,良、恶性肿块的形态、内部回声、钙化、后方衰减及有无CDFI等方面均有差异（P〈0．05）,血流Vmax值、Vmin值及RI值参数比较差异亦有统计学意义（P〈0．05）。结论彩色超声在鉴别典型的乳腺良、恶性肿块方面具有一定的价值,但仍存在一些不典型肿块,其声像图特征会存在重叠的现象。因此,还要结合必要的临床资料进行诊断和鉴别诊断。     

DWI及DCE-MRI在良恶性骨病鉴别诊断中的应用

目的   探讨磁共振扩散加权成像（DWI）及MR动态增强成像（DCE-MRI）在良恶性骨病鉴别诊断中的应用价值。方法   47例骨病患者（良性18例,恶性29例）行DWI检查,其中36例（良性14例,恶性22例）再行DCE-MRI检查。分别于DWI和动态增强图像上测量ADC值、信号增强幅度（SEE）、早期动态增强斜率值(Slope值),判断TIC曲线类型,采用受试者操作特征（ROC）曲线选择良恶性病变鉴别诊断的阈值,计算各参数对病变潜在恶性估计的敏感度、特异度和准确度。结果   ① 47例病例中,良恶性两组病变的ADC值分别为（171.15±46.96）×10-5mm2/s、（100.14±26.47）×10-5mm2/s（P＜0.05）;以113.3×10-5mm2/s为阈值,ADC值对病变潜在恶性评估的准确性为86.4%;② 36例病例中,TIC曲线呈Ⅲ型者24例,恶性22例（91.67%）,良性2例（8.33%）;呈Ⅱ型者5例,Ⅰ型者7例,均为良性病变。若以Ⅲ型为恶性病变,Ⅰ、Ⅱ型均视为良性病变为诊断标准,则TIC类型对病变潜在恶性评估的准确性为94.3%;③ 良恶性两组间SEE、Slope值分别为227.96±172.08、325.6±125.86（P＞0.05）;（0.97±0.67）%/s、（2.53±0.91）%/s（P＜0.05）。Slope值对病变潜在恶性估计的准确性为91.4%。结论  ①  DCE MRI比DWI更有助于鉴别骨骼系统病变良恶性,以TIC类型准确性最高,最有价值;② 良恶性病变间ADC值有一定交叉,DCE MRI存在重叠,联合应用DCE-MRI与DWI,会提高诊断的准确性和特异性。     

实时超声弹性成像在鉴别乳腺肿块中的诊断价值

目的探讨实时超声弹性成像技术在鉴别乳腺肿块中的诊断价值。方法应用实时超声弹性成像技术对58例患者共66个肿块行术前超声检查,测量肿块组织与周围组织弹性应变率的比值．以3．08为界点判断肿块的良恶性,所有病灶均经手术病理证实。结果66个肿块中,良性45个,恶性21个,良性肿块弹性应变率比值为（1．88±1．29）,恶性肿块的弹性应变率比值为（5．79±5．36）,两者的差异有统计学意义（P〈0．01）。以3．08为界点判断肿块的良恶性、诊断恶性肿块的敏感性95．2％,特异性88．9％,准确性90．9％。结论实时超声弹性成像技术对鉴别乳腺肿块的良恶性有较高的诊断价值。     

下肢软组织肿块的影像诊断及鉴别

[目的]分析下肢软组织肿块的影像表现特点,以提高对其诊断和鉴别诊断水平.[方法]回顾性分析经手术和病理证实的71例下肢软组织肿块的临床及影像学表现,男44例,女27例,年龄36 ～ 78岁,平均56岁;病程:2周～21年;CT检查28例,MRI检查43例;重点回顾肿块的部位、数目、大小、形态特征、密度或信号强度及与周围组织关系.[结果]神经鞘瘤20例,腱鞘囊肿8例、滑膜囊肿8例,肌肉内血管瘤4例,脂肪瘤7例,脂肪肉瘤5例,血肿及血肿伴机化11例,粘液瘤3例、纤维瘤病2例、恶性纤维组织细胞瘤2例、增生性肌炎1例;下肢软组织肿块的CT特点是低密度肿块为主,MRI表现各异.[结论]大多数下肢软组织肿块的影像表现具有特征性,正确认识其影像表现及结合临床病史,有助于提高该病的诊断和鉴别诊断水平.     

细针吸取细胞学检查在临床病理诊断中的应用

目的 探讨细针吸取细胞学检查在体表以及经体表可触及肿物的诊断价值.方法 对158例行细针吸取细胞学检查患者的结果与组织学诊断结果进行对照.结果 68例恶性肿瘤的敏感性为(63/68)92.6%,90例良性病变的特异性为(85/90)94.4%,148例获得正确诊断,10例病变虽未明确诊断,但均未因诊断意见不一致造成过度...     

Lymphomatoid Granulomatosis: CT and FDG-PET Findings

Objective

Lymphomatoid granulomatosis (LG) is a rare, aggressive extranodal Epstein-Barr virus (EBV)-positive B-cell lymphoproliferative disease. The purpose of our study was to analyze the CT and fluorodeoxyglucose positron emission tomography (FDG-PET) findings of pulmonary LG.

Materials and Methods

Between 2000 and 2009, four patients with pathologically proven pulmonary LG and chest CT were identified. Two of these patients also had FDG-PET. Imaging features of LG on CT and PET were reviewed.

Results

Pulmonary nodules or masses with peribronchovascular, subpleural, and lower lung zonal preponderance were present in all patients. Central low attenuation (4 of 4 patients), ground-glass halo (3 of 4 patients), and peripheral enhancement (4 of 4 patients) were observed in these nodules and masses. An air-bronchogram and cavitation were seen in three of four patients. FDG-PET scans demonstrated avid FDG uptake in the pulmonary nodules and masses.

Conclusion

Pulmonary LG presents with nodules and masses with a lymphatic distribution, as would be expected for a lymphoproliferative disease. However, central low attenuation, ground-glass halo and peripheral enhancement of the nodules/masses are likely related to the angioinvasive nature of this disease. Peripheral enhancement and ground-glass halo, in particular, are valuable characteristic not previously reported that can help radiologists suggest the diagnosis of pulmonary LG.     

Sacrococcygeal Masses Other Than Meningomyelocele

This series comprises of a variety of sacrococcygeal masses other than meningomyelocele that presented to the department of pediatric surgery of Medical College Kolkata over last 10 years. In this series, 23 cases of sacrococcygeal masses are included. Barring meningomyelocele, teratoma constitutes a major group of cases. It also includes few other interesting and atypical masses such as presacral dermoid, degenerated nerve fiber, fibrofatty tissue, rhabdomyosarcoma, etc. This is an endeavor to enlighten ourselves so that the diagnosis and management of unfamiliar sacrococcygeal masses can be done.     

彩色多普勒超声在浅表软组织肿块诊断中的意义

目的:讨论彩色多普勒超声在浅表软组织肿块诊断中的意义。方法:选择118例经彩色多普勒超声诊断为浅表软组织肿块的患者,观察其肿块特征及血流信号,并与病理结果进行比较。结果:彩色多普勒超声诊断恶性肿瘤的敏感度为92.31%,特异度为96.97%,阳性预测值为96.00%,阴性预测值为94.12%,整体诊断符合率达到94.92%。边缘不规则、内部散在大小光团、后方回声衰减是恶性肿瘤的主要特征,良、恶性肿瘤间各声像学特征所占比例差异有统计学意义(χ2分别为25.67、27.44、25.09,P均<0.01)。恶性肿瘤患者收缩期血流阻力指数(RI)显著高于良性肿瘤,差异有统计学意义(P<0.05)。结论:彩色多普勒超声用于浅表软组织肿块的诊断,诊断符合率较高,成像清晰,具有重要的应用价值。     

Radiological evaluation of palpable breast masses during pregnancy and lactation

Objective

To evaluate the role of different imaging modalities in the diagnosis of palpable breast masses during pregnancy and lactation.

Materials and methods

Forty eight patients with palpable breast masses during pregnancy and lactation were evaluated by Ultrasound. When Ultrasound revealed a benign lesion as cyst no further diagnostic evaluation was necessary. On the other hand, when Ultrasound demonstrated a suspicious lesion, mammography, MRI and or biopsy was performed.

Results

Ultrasound showed a well defined lesion with the criteria of benignity categorized as BI-RADS 2 in 25 cases, 20 cases as BI-RADS 3, 2 cases as BI-RADS 4 and one as BI-RADS 5. One of the 2 cases classified as BI-RADS 4 was completely obscured on mammography. According to Goettinger score, MRI categorized 4 lesions in lactating patients as 1 intermediate and 3 suspicious. Tru-cut biopsy and US guided aspiration established the pathological diagnosis in 23 cases.

Conclusion

The majority of pregnancy-associated breast masses are benign; still, a thorough evaluation of any lesion is required, in order to rule out malignancy. US constitutes the most appropriate radiologic method for evaluating breast disorders in women during pregnancy and lactation. US has a greater sensitivity than mammography in this issue. MRI is not recommended during pregnancy and shows limitation in the lactating period. MRI breast should be used for undetermined cases and for staging malignancy. When the imaging results are suspicious and for grading malignancy, biopsy should be performed to obtain a pathologic diagnosis.