16层螺旋CTU诊断老年原发性肾盂和输尿管移行细胞癌

目的: 探讨16层螺旋CT尿路造影(CTU)技术诊断老年原发性肾盂和输尿管移行细胞癌的价值.材料和方法: 回顾性分析42例老年人CTU检查和经手术病理证实的13例原发性输尿管与3例肾盂移行细胞癌的CTU影像特点,年龄69～82岁,病例均采用10mm层厚和层间距行腹盆部CT增强扫描,并获得原始图像,图像经1.25mm层厚和50%的重叠处理后传送至工作站进行图像后处理.结果: 42例CTU成功率93%,16层螺旋CTU能够清晰显示尿路肿瘤的大小、形态、范围和与其周围组织结构的关系,螺旋CT扫描结果与术中所见一致.结论: 16排螺旋CTU具有扫描速度快、憋气时间短、侵袭性小的特点,同时可多平面、多方位、立体地显示尿路病变,特别适用于老年性尿路疾病的诊断和筛选.     

多层螺旋CT在肺结核诊断和鉴别诊断中的临床应用价值

目的探讨多层螺旋CT在肺结核诊断和鉴别诊断中的临床应用价值。方法收集选取2009年7月～2012年7月收治的68例经多层螺旋CT诊断为肺结核,后经痰检、活检及临床治愈明确证实为肺结核的患者。所有患者均行胸片、多层螺旋CT扫描,其中39例患者做了增强CT扫描。分析研究多层螺旋CT在肺结核诊断和鉴别诊断中的临床应用价值。结果多层螺旋CT能够发现常规CT和胸片无法发现的肺结核征象。结论多层螺旋CT在肺结核的诊断和鉴别诊断中,能够显示处肺结核的各种重要CT征象,并做出正确的诊断,具有重要的临床意义。     

肾盂输尿管移行细胞癌的螺旋CT诊断

目的 评价螺旋CT扫描及三维重建技术对肾盂输尿管移行细胞癌的诊断与鉴别诊断以及临床意义。资料与方法 对27例经临床证实的肾盂输尿管移行细胞癌CT表现、特点进行回顾性分析,所有病例均常规进行平扫,肾皮质期、实质期及排泄期增强扫描,并进行多平面重建（MPR）、曲面重建（CMPR）及容积重建（VR）、最大密度投影（MIP）和仿真内镜（VE）等重组及三维重建。结果 术前CT对25例肾盂输尿管移行上皮癌做出正确诊断。诊断准确率92．59％,对肿瘤分期准确率84％。三维重建有助于明确病变范围、肿块与周围组织的关系,使得病灶形态显示更为全面和直观。结论 螺旋CT扫描及三维重建对于肾盂输尿管移行上皮癌的诊断、鉴别诊断和肿瘤分期有较高的准确性,可为临床制订治疗方案提供依据。     

肾细胞癌的多层螺旋CT诊断及鉴别诊断

目的:分析肾细胞癌的CT表现,提高其诊断和鉴别诊断水平。材料和方法:回顾性分析经手术和病理证实的21例肾细胞癌的多层螺旋CT表现。结果:实性肾癌18例,增强扫描皮质期13例呈明显增强,5例呈轻中度增强,囊性肾癌3例,增强后皮质期囊壁、壁结节、囊内分隔明显增强。实质期及肾盂期增强迅速减退,呈快进快退改变。术前正确诊断率和分期正确率分别为90.5%和80.9%。结论:肾细胞癌多层螺旋CT表现有一定的特征性,大多数能正确诊断。     

酷似肾盂结石的肾盂癌一例

患者　男 ,81岁。因反复血尿 11个月加重 14天入院。 11个月前无诱因出现血尿 ,运动后加重伴血块。自发病以来无畏冷发热 ,无尿频、尿急、尿痛 ,亦无腰痛症状。查体 :一般情况可 ,无特殊发现。实验室检查 :尿ＲＢＣ 15～ 2 0个 /ＨＰ ,ＷＢＣ 0～1个 /ＨＰ。腹部平片及ＩＶＰ见右肾盂内有一直径约 3 .0ｃｍ大小致密影 ,考虑为肾盂结石。ＣＴ平扫 :右肾盂内见一约 3 .0ｃｍ×2 .0ｃｍ× 2 .0ｃｍ边缘光滑的高密度结节影充满右肾盂 ,ＣＴ值10 8ＨＵ ,诊断为肾盂结石 (附图 )。手术所见 :右肾无增大 ,但肾盂扩张 ,其内充满肿物 ,遂切除右肾。术…     

CTU简易评分对肾实质浸润性肾盂癌与肾盂浸润性肾细胞癌鉴别诊断的临床研究

目的：分析肾实质浸润性肾盂尿路上皮癌（肾盂癌）与肾盂浸润性肾细胞癌在计算机体层成像尿路造影（computed tomography urography,CTU）中的影像学表现,提高术前诊断的准确度。方法：回顾并分析术后明确诊断的78例肾盂癌与肾细胞癌的患者资料,手术前所有的患者在首都医科大学附属北京友谊医院行640层螺旋CT平扫及3期增强扫描。研究指标包括性别、年龄、是否有血尿及CTU中肿瘤的特征[肿瘤部位、肿瘤长径、平扫及增强各期强化程度、是否伴有肾积水、肿瘤轮廓外凸、肾脏体积增大、肾盂（盏）内可强化的充盈缺损、结石]。比较两组间各项指标的差异,对差异有统计学意义的指标采用logistic回归分析,筛选独立危险因素,建立简易评分模型,采用受试者工作特征（receiver operating characteristic,ROC）曲线计算评分系统诊断效能。结果：两组患者在平扫及增强各期强化程度、是否肾积水、肿瘤轮廓外凸、肾脏体积增大、肾盂（盏）内肿物、血尿、结石方面差异均有统计学意义（P<0.05）,其中肾积水、肾脏体积增大、肾盂（盏）内肿物、血尿、结石指标为肾盂癌的独立危险因素...     

螺旋CT对肾癌的诊断价值

肾癌又称肾细胞癌，其临床治疗主要为根治性肾癌切除术。对于早期发现的患者，手术治疗效果和预后较好。而早期正确的诊断具有重要的临床意义。随着螺旋CT的应用，肾癌的早期诊断病例逐渐增多。定性诊断准确性也不断提高。笔者搜集近年来螺旋CT检查，并经过手术病理证实的肾癌患者15例作总结如下。     

Noninvasive method using multidetector CT for calculating the relative blood supply ratio of duplicated renal arteries in renal donors

Purpose The aim of this study was to evaluate the correlation between the renal artery cross-sectional area measured by multidetector computed tomography (MDCT) and the nephrogram area calculated by renal arteriography in potential living renal donors with duplicated renal arteries. Materials and methods Medical records of 18 patients with duplicated renal arteries who underwent both MDCT angiography and renal arteriography between 2001 and 2003 were retrospectively reviewed. All 20 kidneys were evaluated. Renal artery cross-sectional areas were measured using the workstation to which the CT data were transferred; the nephrogram areas on the digitized angiographic images were calculated using public domain software. Bland-Altman analysis was performed to compare the cross-sectional area ratio of the accessory arteries to the main renal arteries, with the ratios obtained from the nephrogram areas calculated from the arteriograms. Results The mean cross-sectional areas of the accessory and main renal arteries were 6.78 and 20.9 mm², respectively. The ratio of the nephrogram areas calculated from the arteriograms ranged from 0.094 to 0.809. Bland-Altman analysis showed no significant difference. Conclusion It is possible to predict the supply volume of accessory renal arteries by measuring the cross-sectional area of the accessory and main renal arteries in potential living renal donors. This article was presented at the 2004 Japan Radiological Society meeting.     

Value of dynamic multidetector CT in different grades of hepatocellular carcinoma

Purpose

To evaluate dynamic multidetector CT (MDCT) in assessment of grades of hepatocellular carcinoma (HCC).

Patients and methods

Forty patients of HCC were assessed. Enhancement patterns were correlated with pathological grades.

Results

Three enhancement patterns were:

1.

Hyperattenuating lesions in portal venous phase.

2.

Hypoattenuating lesions in all phases.

3.

Hyperattenuating lesions in arterial phase.

Conclusion

Arterial and portal biphasic imaging was the most informative in assessment of tumor grades. High grade lesions were hyperattenuating in arterial phase.At initial evaluation, triphasic imaging is advisable, while in diagnosed cases and on follow up, biphasic imaging could be satisfactory.     

Diagnostic value of multidetector computed tomography for renal sinus fat invasion in renal cell carcinoma patients

Objective

Although renal sinus fat invasion has prognostic significance in patients with renal cell carcinomas (RCCs), there are no previous studies about the value of multidetector computed tomography (MDCT) about this issue in the current literature.

Materials and methods

A total of 863 consecutive patients (renal sinus fat invasion in 110 patients (12.7%)) from single institutions with surgically-confirmed renal cell carcinoma who underwent MDCT between 2010 and 2012 were included in this study. The area under the curves (AUCs) of the receiver operating characteristic (ROC) analysis was used to compare diagnostic performance. Reference standard was pathologic examination. Weighted κ statistics were used to measure the level of interobserver agreement. Multivariate logistic regression model was used to find the predictors for renal sinus fat invasion. Image analysis was first performed with axial-only CT images. A second analysis was then performed with both axial and coronal CT images. A qualitative analysis was then conducted by two reviewers who reached consensus regarding tumor size, decreased perfusion, tumor margin, vessel displacement, and lymph node metastasis. The reference standard was pathologic evaluation.

Results

The AUCs of the ROC analysis were 0.881 and 0.922 for axial-only images and 0.889 and 0.902 for combined images in both readers. The AUC of tumor size was 0.884, a similar value to that of the reviewers. In multivariate analysis, tumor size, a linear-nodular or nodular type of fat infiltration, and an irregular tumor margin were independent predicting factors for perinephric fat invasion.

Conclusion

MDCT shows relatively high diagnostic performance in detecting perinephric fat invasion of RCC but suffers from a relatively low PPV related to low prevalence of renal sinus fat invasion. Applying tumor size alone we could get similar diagnostic performance to those of radiologists. Tumor size, fat infiltration with a nodular appearance, and an irregular tumor margin were predictors for perinephric invasion.     

多层螺旋CT诊断肾外肾盂(附47例报告)

目的 研究肾外肾盂的CT表现和鉴别诊断,加强对肾外肾盂的认识,避免误诊发生.方法 回顾分析47例肾外型肾盂的CT轴位平扫、增强扫描及三维重建表现.结果 在CT轴位平扫、增强扫描及三维重建中表现为在肾窦外囊样水密度影,CT增强时对比剂均匀充盈,三维重建显示更直观.其中双侧29例,单侧18例.结论 多层螺旋CT诊断肾外肾盂更为准确可靠.     

Solid-pseudopapillary neoplasm of the pancreas: spectrum of findings on multidetector CT

Solid-pseudopapillary neoplasms of the pancreas are uncommon and usually occur in young women. They are generally large, encapsulated masses with mixture of solid, cystic, and hemorrhagic components. Some cases have atypical features; for example, they can form a small predominantly solid mass and produce dilatation of the main pancreatic duct. In this article we discuss and illustrate the spectrum of the appearances of this distinctive neoplasm on multidetector CT.     

Advances of multidetector computed tomography in the characterization and staging of renal cell carcinoma

Renal cell carcinoma (RCC) accounts for approximately 90%-95% of kidney tumors. With the widespread use of cross-sectional imaging modalities, more than half of RCCs are detected incidentally, often diagnosed at an early stage. This may allow the planning of more conservative treatment strategies. Computed tomography (CT) is considered the examination of choice for the detection and staging of RCC. Multidetector CT (MDCT) with the improvement of spatial resolution and the ability to obtain multiphase imaging, multiplanar and three-dimensional reconstructions in any desired plane brought about further improvement in the evaluation of RCC. Differentiation of RCC from benign renal tumors based on MDCT features is improved. Tumor enhancement characteristics on MDCT have been found closely to correlate with the histologic subtype of RCC, the nuclear grade and the cytogenetic characteristics of clear cell RCC. Important information, including tumor size, localization, and organ involvement, presence and extent of venous thrombus, possible invasion of adjacent organs or lymph nodes, and presence of distant metastases are provided by MDCT examination. The preoperative evaluation of patients with RCC was improved by depicting the presence or absence of renal pseudocapsule and by assessing the possible neoplastic infiltration of the perirenal fat tissue and/or renal sinus fat compartment.     

Diagnosis of arterioportal shunts in cases of hepatocellular carcinoma using multidetector CT: Impact on clinical management

Purpose

To study the ability of multidetector CT (MDCT) to diagnose arterioportal shunts (APS) associated with hepatocellular carcinoma (HCC) and its impact on further management of the patient.

Patients and methods

252 Patients with HCC were examined by triphasic MDCT scanning. Images were analyzed for the presence, locations, types and degrees of APS, being with or without thrombosis. Digital subtraction angiographies (DSA) were performed for 22 patients as a part of further therapeutic management.

Results

MDCT revealed APS in 37 patients including 20 central, 9 peripheral and 8 mixed. According to the degree we had 13 severe, 15 moderate and 9 mild APS. 18 patients had associated portal venous thrombosis. During DSA examinations; APS were demonstrated in 19 out of 22 as 3 mild and peripheral shunts were faint and missed. Embolization of the shunt was performed in 17 patients prior to injection of the cytotoxic drug-lipiodol mixture. In one patient the APS was closed to improve the hepatic status without further chemotherapy and in one patient the shunt was ignored and not closed.

Conclusion

Good understanding of MDCT findings of APS complicating HCC contributes to the diagnosis and improves the therapeutic outcome of the chemoembolization procedures.     

Local staging of endometrial carcinoma: role of multidetector CT

The purpose was to evaluate the accuracy of multidetector CT (MDCT) on a 16-row CT scanner in local staging of endometrial carcinoma and more specifically in the assessment of the depth of myometrial invasion and presence of cervical infiltration. This prospective study includes 21 women with newly diagnosed endometrial carcinoma. All CT examinations were performed on a 16-row CT scanner, and the protocol included scanning of the abdomen after intravenous administration of iodinated contrast material, during the portal phase, using a detector collimation of 16×0.75 mm and a pitch of 1.2. Sagittal, parasagittal and oblique reformatted images were evaluated for the depth of myometrial invasion, whether superficial or deep, and the presence of cervical infiltration. Imaging findings were correlated with the histopathologic results. The sensitivity, specificity and accuracy of MDCT in evaluating myometrial invasion were 100%, 80% and 95%, respectively, and for assessing cervical infiltration were 78%, 83% and 81%, respectively. In conclusion, MDCT on a 16-row CT scanner proved accurate in local staging of endometrial carcinoma.     

肿瘤体积与CT动态增强特征在肾盂癌鉴别诊断中的应用

目的通过对不同类型肾盂癌的肿瘤体积、CT平扫及增强各期CT值变化特点的定量分析,为肾盂癌的准确诊断提供定量客观依据。方法回顾性收集并经手术病理证实的22例肾盂癌患者及25例肾透明细胞癌(肾癌)的术前增强CT影像资料,采用ITK-SNAP软件获取病灶各期的体积、CT值等数据进行统计学对比分析。结果肾盂癌肿瘤小于肾癌肿瘤的体积(中位体积分别为5.87cm 3、8.11cm 3),P<0.05;平扫期肾盂癌肿瘤CT值大于肾癌〔平均值分别为(34.59±7.01)HU、(30.28±5.95)HU〕,P<0.05;皮质期、实质期肾盂癌肿瘤CT值(中位CT值分别为61.50HU、66.00HU)小于肾癌(81.00HU、74.00HU),P<0.05,分泌期两者CT值〔平均值分别为(58.07±11.60)HU、(65.53±15.11)HU〕,P>0.05。肿块浸润肾实质型肾盂癌的体积<侵犯肾盂的肾癌〔平均值分别为(25.22±34.85)cm 3、(119.44±69.28)cm 3〕,P<0.05,两者的平扫期、皮质期、实质期及分泌期肿瘤CT值差异均无统计学意义(P>0.05)。结论肾盂癌的体积显著小于肾癌,CT增强具有轻中度延迟强化的特征,可以为肾盂癌的准确诊断提供客观依据。     

肾透明细胞癌与肾乳头状癌、嫌色细胞癌MRI表现的对照研究

目的 探讨MR动态增强扫描对肾癌亚型的鉴别诊断价值.方法 搜集77例经病理证实的肾癌患者资料,其中透明细胞癌(CCRCC)55例,乳头状癌(PRCC)14例,嫌色细胞癌(CRCC)8例,回顾性分析各亚型肿瘤患者MR平扫及动态增强扫描表现并与病理对照,根据肿瘤及肾皮质增强前后的皮质期、实质期及延迟期信号变化,分别进行百分比测量、肿瘤-肾皮质增强指数计算,并采用单因素方差分析和LSD法进行比较.结果 CRCC多数信号均匀(7/8);CCRCC及PRCC多数信号不均(分别为51/55和13/14)、常见坏死(36/55和7/14),PRCC最常见出血(9/14)及囊变(9/14).动态增强各期CCRCC强化程度最高,强化模式呈"快进快退",CRCC轻至中度强化,PRCC强化最轻,两者均呈渐进性延迟强化.CCRCC、PRCC及CRCC皮质期信号变化分别为(296.15±60.27)%、(79.70±18.84)%和(119.56±40.76)%,实质期分别为(236.33±58.31)%、(122.81±27.35)%和(163.06±33.91)%,延迟期分别为(216.83±46.72)%、(117.55±20.63)%和(179.72±32.89)%;三者皮质期的肿瘤-皮质增强指数分别为1.26±0.34、0.33±0.12及0.54±0.10,实质期分别为0.92±0.23、0.41±0.23及0.62±0.15,延迟期分别为0.76±0.14、0.35±0.11及0.69±0.12,各亚型增强各期的信号变化(F值分别为940.931、124.515、38.194,P值均＜0.01)、肿瘤-皮质增强指数(F值分别为798.625、78.308、73.699,P值均＜0.01)差异均有统计学意义.3种亚型的MRI表现与病理学所见基本相符.结论 CCRCC、PRCC及CRCC的MRI动态增强有一定特征性的表现,与其病理特点密切相关,在肾癌亚型的鉴别诊断上有着较高的临床应用价值.

Abstract：

Objective To investigate the differential diagnostic features of subtypes of renal cell carcinoma(RCC) using dynamic contrast-enhanced MRI(DCE-MRI).Methods The MRI appearances of 77 RCCs, including 55 clear cell RCCs(CCRCC),14 papillary RCCs(PRCC) and 8 chromophobe RCCs(CRCC), were retrospectively analyzed and compared with findings of pathology. DCE-MRI was conducted in each case after intravenous administration of contrast agent. Region of interest measurements (cortical, nephrographic and delayed Phases) of signals within tumor and uninvolved renal cortex were used to calculate percentage signal intensity change and tumor-to-cortex enhancement index, and the data was analyzed by AVONA and t test. Results On unenhanced and enhanced MRI, most CRCCs showed homogeneous signal(7/8). CCRCC and PRCC often show inhomogenous signal with necrosis(36/55, 7/14). Hemorrhage and cystic degeneration were often found in PRCC (9/14). On the cortical, nephrographic and delayed phase images, CCRCCs showed greater signal intensity change[(296.15±60.27)%, (236.33±58.31)% and (216.83±46.72)%,respectively than PRCCs (79.70±18.84)%, (122.81±27.35)% and (117.55±20.63)%, respectively], and CRCCs showed intermediate change [(119.56±40.76)%, (163.06±33.91)% and (179.72±32.89)%, respectively].A phenomenon of quick staining and quick fainting was observed in CCRCCs. Both of CRCCs and PRCCs showed delayed enhancement. The tumor-to-cortex enhancement index at the cortical, nephrographic and delayed phases was highest for CCRCCs (1.26±0.34, 0.92±0.23 and 0.76±0.14, respectively), lowest for PRCCs (0.33±0.12, 0.41±0.23 and 0.35±0.11, respectively), and intermediate for CRCCs (0.54±0.10, 0.62±0.15 and 0.69±0.12, respectively,P＜0.01). The degree of enhancement was significantly different among the 3 subtypes at the every contrast enhanced phase (F=940.931, 124.515 and 38.194, P＜0.01), so was the tumor-to-cortex enhancement index(F=798.625,78.308 and 73.699, P＜0.01). There was a good consistency between MR appearances of the 3 RCC subtypes and pathological characteristics. Conclusion DCE-MRI could distinctly show imaging features of CCRCC, PRCC and CRCC, which were related to their pathological characteristics, and these features were helpful in predicting a specific subtype of RCC.