卵巢囊腺癌的CT表现及分期

目的探讨卵巢囊腺癌的CT表现特征及分期价值。方法经手术和病理证实的52例73个卵巢囊腺癌,对其CT表现进行分析,且对41例全腹扫描组进行肿瘤分期并与手术病理对照。结果73个肿瘤中Ⅰ型(囊性为主)肿瘤23个,占31.5%;Ⅱ型(囊实性)肿瘤32个,占43.8%;Ⅲ型(实性为主)肿瘤18个,占24.7%。而术前肿瘤分期准确率达82.9%,Ⅲ期准确率达90.9%。结论卵巢囊腺癌的CT表现具有多样性,表现典型者(Ⅰ型)可做出明确诊断,且CT检查对其术前分期的准确率较高,尤其对Ⅲ期患者。     

Uterine Intravenous Leiomyomatosis with Intracardiac Extension and Pulmonary Benign Metastases on FDG PET/CT: A Case Report

A 48-year-old woman presented with a 50-day history of irregular vaginal bleeding and lower abdominal pain. Ultrasound indicated an extremely large occupying lesion in the pelvic cavity that was highly suggestive of malignancy. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed to further assess the nature of pelvic abnormality. PET/CT images demonstrated a diffusely lobulated mass ranging from cervix up to the inferior pole of kidneys with mild FDG uptake. Simultaneously, multiple nodules in bilateral lungs and a hypodense lesion in the right ventricle were shown without FDG-avidity. Based on the imaging results, the presumptive diagnosis was uterine intravenous leiomyomatosis with intracardiac extension and pulmonary benign metastases, which was subsequently confirmed by MRI and the lesion biopsy.     

Integrated PET/CT in the preoperative staging of lung cancer: A prospective comparison of CT,PET and integrated PET/CT

Purpose

The purpose of this study was to evaluate the role of integrated PET/CT in the staging of lung cancer compared with CT alone or PET alone.

Materials and methods

Thirty-three patients underwent integrated PET/CT for the staging of lung cancer. The tumor, node and metastasis (TNM) stages were assessed with CT, PET and integrated PET–CT and compared with the surgical and pathological staging.

Results

CT correctly evaluated the (T) status in (64%) of the patients, PET in (59%) and PET/CT in (86%). CT correctly evaluated the (N) status in (73%) of the patients, PET in (76%), and PET/CT (88%) with accuracy, sensitivity, specificity, PPV and NPV were 73%, 78%, 71%, 50% and 94% for CT, 76%, 67%, 79%, 55% and 95% for PET and 88%, 89%, 88%, 73% and 100% for PET/CT respectively, and for (M) status were 91%, 86%, 92%, 75% and 96% for CT, 88%, 71%, 92%, 71% and 92% for PET and 97%, 100%, 96%, 88% and 100% for PET/CT respectively. Regarding the overall TNM staging CT correctly staged 24 patients. PET correctly staged 23 cases while PET/CT correctly staged 30 cases. A significant difference in the accuracy of overall tumor staging between PET/CT and CT (P = 0.0412) or PET (P = 0.0233).

Conclusion

The integrated PET/CT is superior to either CT or PET in the staging of lung cancer which has an important impact on selection of the appropriate treatment regimen.     

A Case Report: Cavitary Infarction Caused by Pulmonary Tumor Thrombotic Microangiopathy in a Patient with Pancreatic Intraductal Papillary Mucinous Neoplasm

Pulmonary tumor embolism is commonly discovered at autopsy, but is rarely suspected ante-mortem. Microangiopathy is an uncommon and distinct form of simple tumor pulmonary embolism. Here, we present a 52-year-old male with tumor thrombotic microangiopathy and pulmonary infarction, which might have originated from intraductal papillary mucinous tumor of the pancreas. Multiple wedge-shaped consolidations were found initially and aggravated with cavitation. These CT features of pulmonary infarction were pathologically confirmed to result from pulmonary tumor thrombotic microangiopathy.     

Pulmonary Actinomycosis Imitating Lung Cancer on 18F-FDG PET/CT: A Case Report and Literature Review

Here we report a case of 41-year-old man with a soft tissue density mass at right upper lung and palpable abscesses at right upper backside and right wrist. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography demonstrated a 7.8 × 5.0 cm mass with soft-tissue density in the upper lobe of the right lung with high metabolic activity. The infiltrative mass extended to adjacent chest wall soft tissue. Final diagnosis of pulmonary actinomycosis with multiple abscesses was made. The patient responded well to antibiotics treatment.     

白塞氏病的胸部CT表现

目的；探讨白塞氏病胸部ＣＴ表现。材料与方法；回顾性分析了１５例白塞氏病患者的胸部ＣＴ表现。结果：１５例中１１例胸部ＣＴ可见不同程度的异常改变，其中２例肺部肿块ＣＴ增强扫描为肺动脉瘤；１例上腔静脉狭窄血栓形成致胸壁侧支循环形成；１例肺动脉高压及肺间质病变；其他异常包括胸腔积液、胸膜增厚、肺灌注不良、肺间质病变及纵隔淋巴结肿大。结论：ＣＴ对白塞氏病患者胸部病变尤其是肺动脉脉瘤的诊断具有重要的价值。     

细支气管肺泡癌的CT诊断与误诊

目的 回顾性分析细支气管泡癌（ＢＡＣ）的ＣＴ表现的误诊原因,提高影像诊断准确率。材料与方法 ４２例经寅理证实的ＢＡＣ,根据ＣＴ表现分为结节型、实变型和多结节型,为２３．１６和３例,其中误诊１２例（２８．６％）。结合文献资料分析各型肺泡癌的ＣＴ征象。结果 结节型ＢＡＣ主要表现为：结节位于肺外围（９５．７％）,有分叶（９１．３％）、毛刺（６９．６％）、空泡征或支气管气相（６５．２％）、密度不均（６５．     

多层螺旋CT对周围肺动脉显示能力的研究

目的比较多层螺旋CT肺动脉造影不同层厚重建对周围肺动脉的显示能力. 资料与方法 21例无肺部疾患和血栓病史的患者行CT肺动脉造影检查,均用0.75 mm准直扫描,分别用0.75 mm/0.5 mm（层厚/层间距）（A组）、1.0 mm/0.6 mm（B组）、1.5 mm/1.0 mm（C组）重建,记录每例患者3种不同重建层厚对段肺动脉、亚段肺动脉、5级和6级肺动脉的显示情况及血管不能显示的原因. 结果 3组人均肺段动脉的显示率均为96.45%（19.29/20）;人均亚段动脉显示率分别为94.42%、93.44%、91.13%,3组间均无显著性差异;A、B、C组对第5级肺动脉的人均显示率分别为80.44%、73.47%、59.02%,A组与C组有显著性差异（P＜0.01）,B组与C组间有显著性差异（P＜0.05）;6级肺动脉3组人均显示率分别为33.75%、31.69%、23.56%,A组与C组有显著性差异（P＜0.01）.段肺动脉不能分析的主要原因是解剖变异（53.33%）和心脏搏动伪影（40%）;A、B组亚段肺动脉不能分析的主要原因是解剖变异和心脏搏动伪影,C组的主要原因是部分容积效应（43.84%）与A组比较有显著性差异（10.87%）（P=0.015）;3组对5级和6级肺动脉不能分析的主要原因均为部分容积效应. 结论多层螺旋CT肺动脉造影0.75 mm、1.0 mm、1.5 mm重建层厚对段肺动脉和亚段肺动脉均有很好的显示率,A、B组对5级肺动脉的显示率也较好.影响亚段肺动脉显示的主要原因是解剖变异和心脏搏动伪影.1.0 mm重建层厚可满足肺动脉的观察和图像处理的需要.     

周围型肺癌阻塞性病变的CT表现(附18例分析)

目的:确定深呼吸时相CT扫描对周围型肺癌诊断敏感性。材料与方法:18例周围型肺癌(13例经病理证实,5例由其它方法证实)和12例良性肺肿块对照者(炎性假瘤和结核球等)均经常规CT扫描,除2例炎性假瘤患者外,其余所有病人并经肿块部位及其上下一层的深呼吸时相CT扫描。结果:周围型肺癌深呼吸时相CT扫描所见的阻塞性病变计有4例肺不张,12例阻塞性肺炎(按其帮位进而可分为远离肿块的和邻近肿块的阻塞性肺炎),1例阻塞性肺气肿,以及1例肺静脉癌栓。周围型肺癌的这些CT表现,在良性肺肿块对照者中不复被看到。结论:深呼吸时相CT扫描所见的远离肿块的阻塞性肺炎及肿块外侧的阻塞性肺气肿,可被看作是周围型肺癌的特有表现而且是其早期诊断的依据。     

Pulmonary manifestations of Hodgkin's disease: radiographic and CT findings

The aim of this study was to assess the radiological and CT findings in patients with pulmonary Hodgkin's disease and to analyse to what extent CT provides more diagnostic information. In 37 patients with 41 episodes of pulmonary manifestation of Hodgkin's disease (histological diagnosis: 11, clinical diagnosis: 30) 39 radiographs and 33 CT scans were analysed by two readers in consensus. Pulmonary nodules were recorded in 77% of radiographs (CXR) and 88% of CT scans. Nodules were multiple in 67% (CXR) and 86% (CT) and bilateral in 43% (CXR) and 66% (CT) of cases, respectively. Nodule size ranged from 2 to 100 mm. Of the nodules, 83% at radiography and CT, respectively, were < or =30 mm, and again 83% at radiography and CT, respectively, were irregularly marginated. Diffuse infiltration with and without nodules was less common. With pulmonary manifestations at initial diagnosis of Hodgkin's disease there was always hilar or mediastinal lymphadenopathy. Of 20 episodes, in which radiograph and CT had been obtained within 8 days, CT demonstrated pulmonary involvement when chest radiography was normal in 3 cases and demonstrated more lesions in 12 cases. The typical appearance of pulmonary HD consisted of multiple, irregularly marginated pulmonary nodules. Diffuse infiltration was less common. Computed tomography was superior to radiography not only in characterization of lesions but could also demonstrate pulmonary involvement when the radiograph was normal and should, therefore, be used liberally in addition to radiography.     

Pulmonary Metastases of Alveolar Soft-Part Sarcoma: CT Findings in Three Patients

Alveolar soft-part sarcoma is a rare soft tissue sarcoma of young adults with unknown histogenesis, and the organ most frequently involved in metastasis is the lung. We report the CT findings of three patients of pulmonary metastases of alveolar soft-part sarcoma, which manifested as clearly enhanced pulmonary nodules or masses. On enhanced scans, some of the masses were seen to contain dilated and tortuous intratumoral vessels.     

肺结节CT影像评价

肺结节的鉴别诊断是肺部疾病诊断难点之一,如何有效地显示其特征是准确诊断的前提。用于肺结节检查的CT应用技术有多种,关键是薄层,特别以靶扫描技术最佳。应该主要从三方面显示肺结节的特征：（1）内部特征,包括形态、密度等;（2）结节－肺界面;（3）邻近结构改变。肺结节中以肺癌诊断最重要,肺癌的重要征象有分叶、毛刺和胸膜凹陷征等,动态增强扫描有其特征的时间－密度曲线。其他病变也各有其特点。     

多中心型Castleman病CT表现(附1例报告与文献复习)

目的　评价多中心型Castleman病 (CD)的CT表现。方法　回顾性分析 1例经淋巴结活检证实的多中心型CD患者的胸、腹部CT表现 ,并作文献复习。结果　患者具有全身症状 ,多克隆性高丙球蛋白血症 ,全身浅深淋巴结广泛肿大并增强扫描轻度强化 (约 2 0HU) ,肺实质出现特异性浸润 ,包括小叶中心性分布的弥漫小结节、磨玻璃灶、薄壁气囊、支气管血管束和小叶间隔增厚 ,与文献高度一致。结论　多中心型CD具有明显的临床全身症状、全身广泛的淋巴结肿大并轻中度强化 ,侵犯肺实质时病变有一定特点 ,典型表现可提示本病。     

Neurolymphomatosis on F-18 FDG PET/CT and MRI Findings: A Case Report

Neurolymphomatosis is a rare manifestation of malignant lymphoma. A 74-year-old man, in complete remission from diffuse large B cell lymphoma, presented with a loss of pain and temperature sensation in the left hemiface and left upper extremity, and motor weakness in the left upper and both lower extremities. Cerebrospinal fluid analysis and brain magnetic resonance imaging (MRI) findings were negative. Combined fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) revealed multiple linear hypermetabolic lesions along the mandibular branch of the left trigeminal nerve, left brachial plexus, right axillary nerve, right suprarenal plexus, right adrenal gland, right femoral nerve, and both sciatic nerves, which corresponded to the patient’s complex neurologic symptoms. C-spine and pelvic MRI revealed diffuse thickening with enhancement in the left brachial plexus and in the proximal portion of the left sciatic nerve, but negative findings for other sites identified by FDG-PET/CT. These findings suggest that FDG-PET/CT can detect peripheral nerve infiltration by malignant lymphoma earlier than MRI. Thus, if a patient with a history of lymphoma presents with neurologic symptoms, FDG-PET/CT should be performed to evaluate neurolymphomatosis.     

18F-FDG PET-CT显像在预测肺癌淋巴结分期中的价值

目的:探究18F-FDG PET-CT显像在肺癌患者淋巴结分期中的预测价值。方法:以35例经手术病理证实为肺癌患者的PET-CT资料及临床资料为研究对象。在PET-CT原发灶及纵隔淋巴结各区最浓聚的部位勾画感兴趣区,得出SUVmax.以淋巴结转移进行分组,采用t检验、Wilcoxon rank-sum检验及四格表资料的Fisher确切概率法分析组间淋巴结SUVmax、淋巴结与原发灶SUVmax的比值(SUVratio)及临床特征的差异。用ROC曲线对PET/CT的预测价值进行分析。结果:患者年龄、性别、吸烟史、组织类型与肺门、纵隔淋巴结转移无显著相关(P>0.05)。转移淋巴结的SUVmax较非转移淋巴结显著升高,差异有统计学意义(P<0.05),而淋巴结的SUVratio与淋巴结转移无明显相关(P>0.05)。取淋巴结SUVmax的最佳阈值,假阴性患者中的肺癌原发灶SUVmax偏低,假阳性患者比假阴性患者中的吸烟率高,但不具有显著统计学意义(P>0.05)。结论:淋巴结SUVmax可以为临床判断淋巴结转移提供定量指标。结合患者的临床病理特征判断淋巴结的转移可能从--定程度上减少假阳性率及假阴性率。     

Diagnostic performance of PET/CT in differentiation of malignant and benign non-solid solitary pulmonary nodules

OBJECTIVE: To evaluate whether [F-18] fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) can distinguish benign from malignant solitary pulmonary nodules (SPNs) with non-solid components. METHODS: [F-18] FDG-PET/CT scans were performed on 53 consecutive patients (30 men, 23 women; mean age 65 years) who had SPNs with non-solid components identified by CT screening for lung cancer. All patients underwent surgical resection, and all lesions were pathologically proved. Visual score, maximal, and mean standardized uptake value (SUV), and maximal and mean lesion-to-normal tissue count density ratio (LNR) were calculated in all lesions. In addition, clinical characteristics, laboratory test results, and CT findings were assessed. RESULTS: Benign SPNs with non-solid components had a higher uptake on [F-18] FDG-PET/CT. Visual score, maximal and mean SUV, and maximal and mean LNR were significantly higher in the benign when compared with the malignant SPNs (P < 0.001). When the cutoff of 1.5 was assigned for maximal SUV, the diagnostic performance of [F-18] FDG-PET/CT in predicting benign SPN revealed 100.0% sensitivity, 96.4% specificity, and 100.0% accuracy. CONCLUSIONS: [F-18] FDG-PET/CT is useful for the differential diagnosis of SPNs with non-solid components.     

Role of respiratory-gated PET/CT for pancreatic tumors: A preliminary result

Purpose

The aim of this study is to ascertain role of respiratory-gated PET/CT for accurate diagnosis of pancreatic tumors.

Materials and methods

Prior to clinical study, the phantom study was performed to evaluate the impact of respiratory motion on lesion quantification. Twenty-two patients (mean age 65 years) with pancreatic tumors were enrolled. Pathological diagnoses by surgical specimens consisted of pancreatic cancer (n = 15) and benign intraductal papillary mucinous neoplasm (IPMN, n = 7). Whole-body scan of non-respiratory-gated PET/CT was performed at first, and subsequent respiratory-gated PET/CT for one bed position was performed. All PET/CT studies were performed prior to surgery. The SUV max obtained by non-respiratory-gated PET/CT and respiratory-gated PET/CT, and percent difference in SUVmax (%SUVmax) were compared.

Results

The profile curve of 5 respiratory bin image was most similar to that of static image. The third bin of 5 respiratory bin image showed highest FWHM (24.0 mm) and FWTM (32.7 mm). The mean SUVmax of pancreatic cancer was similar to that of benign IPMN on non-respiratory-gated PET/CT (p = 0.05), whereas significant difference was found between two groups on respiratory-gated PET/CT (p = 0.016). The mean %SUV of pancreatic cancer was greater than that of benign IPMN (p < 0.0001). Identification of the primary tumor in pancreatic head (n = 13, 59%) was improved by using respiratory-gated PET/CT because of minimal affection of physiological accumulation in duodenum.

Conclusion

Respiratory-gated PET/CT is a feasible technique for evaluation of pancreatic tumors and allows more accurate identification of pancreatic tumors compared with non-respiratory-gated PET/CT.