儿童肺隔离症的影像学诊断(附11例报告)

目的分析儿童肺隔离症的影像学表现及评价诊断方法。材料与方法11例儿童中均摄胸部X线平片,其中支气管碘油造影、CT、B超检查各2例,主动脉造影1例。结果(1)胸部平片表现为肺实质肿块1例、囊性肿块7例、肺实变灶3例,肺门增大及肺组织结构异常8例;(2)支气管碘油造影的造影剂未进入病变区,支气管树移位2例;(3)CT示实质性及囊性肿块各1例,异常供血血管1例;(4)B超示肺内实质肿块1例,另1例囊性肿块受气体干扰术前未能作出诊断;(5)主动脉造影1例示降主动脉异常供血血管。结论胸部X线平片是最基本检查手段,可提供重要线索,但难以确诊;B超、CT检查有很高诊断价值,CT增强可显示异常的供血动脉;主动脉造影具有决定意义,但属有创伤检查,儿童难以接受;MR检查是公认的最佳方法。     

白塞病的胸部影像学表现

目的分析白塞病累及胸部的临床及影像学表现.材料和方法回顾性分析15例胸部受累白塞病患者的临床及影像表现.影像检查包括X线平片15例,CT 9例,MRI 3例,血管造影6例,肺V/Q显像3例,超声心动图或血管Doppler超声7例.3例患者具有影像随访资料.结果15例中,胸痛、咯血者6例,上腔静脉阻塞综合征4例,余5例无明显胸部症状.影像表现包括肺动脉血栓栓塞3例,肺动脉瘤2例,上腔静脉系统狭窄或闭塞4例,心脏受累4例以及胸腔积液、肺纹理增多等其它非特异表现.结论白塞病累及胸部的表现多样,X线平片常可提示诊断,应作为首选检查;CT和MRI是主要确诊手段;而血管造影应仅限于介入治疗.     

关于恶性胸膜间皮瘤X线诊断的讨论

目的：恶性胸膜间皮瘤在X线、CT检查中的特点。材料与方法：本病20例恶性胸膜间皮瘤患者均经过胸部平片检查及CT检查。结果：胸部X线平片表现为单发的肺内肿块4例，波浪状胸膜肥厚及多发胸膜结节8例。肺内转移及脑转移各1例，胸腔积液6例。结论：胸部X线平片和CT检查，在诊断恶性胸膜间皮瘤中具有相互补充作用。胸部X线平片仍是首选方法。CT在诊断胸部恶性间皮瘤肿瘤侵犯范围方面优干胸部X平片。因此合理的使用CT检查将会使恶性胸膜间皮瘤的诊断更准确。     

56例强直性脊柱炎的影像学分析

目的：分析强直性脊柱炎(AS)的影像学改变，提供早期诊断的依据。方法：56例AS病例全部做了X线平片和CT检查，其中32例进行了MRI检查，进行对比分析。结论：X线平片为首选方法，对早期病例CT扫描优于X线平片，MRI优于CT检查。     

滑膜血管瘤的影像诊断分析

目的 探讨滑膜血管瘤的影像学表现及临床诊断价值.资料与方法 回顾性分析经病理证实的16例(男9例,女7例)滑膜血管瘤患者资料,其中膝关节14例,肘关节1例,髋关节1例.X线平片检查13例,CT平扫1例,MRI平扫及增强扫描15例,血管造影1例.结果 X线平片可见软组织肿胀、静脉石、软组织肿块表现.CT表现为软组织肿胀及骨质侵蚀.血管造影见毛细血管期及静脉期对比剂滞留.MRI显示肿块T1 WI呈等低信号,T2WI呈"葡萄串"样高信号或不均匀等低信号,其内见条索状或网格状低信号分隔.MRI表现各异由病理组织成分不同所决定.结论 X线平片、CT、血管造影对滑膜血管瘤定性诊断价值有限,MRI 对滑膜血管瘤的定位及定性诊断具有重要价值,是术前诊断的首选方法,对治疗方案的选择具有指导作用.     

蝶鞍内囊肿的X线、CT、MRI诊断

目的:提高蝶鞍内囊肿的X线、CT、MRI诊断水平。材料和方法:回顾性分析15例经手术、病理证实的蝶鞍内囊肿的X线、CT、MRI表现。结果:X线平片发现蝶鞍改变7例(含5例X线体层摄影),6例未发现异常,2例行颈动脉血管造影,其中1例大脑前动脉水平段轻度弧形上抬,2例侧位片示颈动脉虹吸部稍张开。CT呈圆形或卵圆形低密度,准确诊断鞍内囊肿6例。MRI表现为蝶鞍内圆形或卵圆形长T1、长T2信号,准确诊断囊肿5例。结论:对蝶鞍内囊肿X线平片和脑血管造影无特异性,CT和MRI术前正确诊断率高。后者为首选的影像学诊断检查。     

年轻士兵腰椎间盘突出症影像学诊断对比分析

目的总结年轻士兵腰椎间盘突出症（LDH）的X线平片、CT及MRI特点,进一步探讨影像学对诊断LDH的价值。方法收集我院32例经临床及影像学确诊的年轻士兵LDH的临床资料,分析其腰椎X线平片、CT及MRI影像特点。结果 32例中,X线平片表现为椎间盘病变8例,CT表现为椎间盘突出29例,MRI均表现为椎间盘突出。结论年轻士兵LDH较轻,X线平片阳性表现少,结合症状、体征可起筛查作用,而CT、MRI检查具有确诊价值,可为临床确诊提供重要的参考依据。     

脊柱结核的影像学分析

目的　评价X线平片、CT、MRI在脊柱结核的诊断价值。方法　回顾 180例被手术或临床证实为脊柱结核病人的X线平片、CT、MRI ,根据影像学表现和临床分为A(X线平片正常 ,CT或MRI异常 ) ,B(X线平片、CT和MRI均异常 ) ,C(临床有神经症状 ) 3类。结果　依据分类 ,A类 40例 (4 0 / 180 ) ,病史短 ,<4月 ,累及椎体数目少 ,均为 1个。CT可清晰显示骨破坏。B类 70例 (70 / 180 ) ,病史较长 (5～ 12月 ) ,累及椎体数目多 (2～ 3个 )。CT可清晰显示椎体骨破坏的数目、范围及碎骨片在椎管内情况。MRI可显示椎体软组织肿胀及寒性脓肿的范围。C类 70例 (70 / 180 ) ,病史长 ,病史短者 ,破坏位于椎体后部。CT可清晰显示椎体骨破坏的数目、范围及碎骨片在椎管内情况。MRI可显示硬膜外脓肿及脊柱后凸对脊髓的压迫 ,脊髓变性情况 ,寒性肿胀的范围。结论　X线平片结合CT扫描可对脊柱结核进行全面细致的观察 ,对于有神经症状的病人应用MRI作为补充。     

急性创伤性膈疝影像学诊断

目的 探讨急性创伤性膈疝的影像学表现及诊断价值。材料与方法24例均行胸腹透视、拍胸部平片,其中10例做胃肠道造影检查,8例行CT扫描,对X线征象及CT表现进行对比分析。结果X线表现为膈上胃泡影11例,多个液气平面6例,膈上肿块5例,漏诊2例。CT发现膈上疝囊5例,膈上肿块2例,漏诊1例。结论多种影像学检查方法综合应用能提高创伤性膈疝的诊断率。     

脊柱多发性骨髓瘤影像学对比分析

目的:探讨脊柱多发性骨髓瘤(MM)的影像学表现及其临床价值。方法:回顾性分析27例经骨髓穿刺或活检病理证实的脊柱MM的临床特点及其X线、CT、MRI征象。结果:X线平片示11例骨质破坏伴骨质疏松,骨质疏松不伴骨质破坏9例,X线平片未见明显异常7例。CT示23例骨质破坏,其中15例为溶骨性,8例为穿凿样破坏;4例未见阳性征象。MRI示27例均发现骨髓信号异常。结论:脊柱MM的影像表现有一定特点。MRI在MM的诊断及鉴别诊断中明显优于X线平片和CT。     

Penetrating atherosclerotic ulcers of the descending thoracic aorta: evaluation with CT and distinction from aortic dissection.

Penetrating atherosclerotic ulceration of the aorta is a poorly understood entity that clinically mimics classic aortic dissection but has imaging features that are distinctly different. In a review of 16 patients with penetrating atherosclerotic ulceration, patients were typically hypertensive (n = 14), and they experienced chest or back pain (n = 13). All patients had an abnormal chest radiograph, with diffuse (n = 14) or focal (n = 2) enlargement of the descending thoracic aorta. Features at contrast material-enhanced computed tomography (CT) included intramural hematoma (n = 16), focal ulcer (n = 15), displaced intimal calcification (n = 13), pleural and/or extrapleural fluid (n = 7), mediastinal fluid (n = 4), and a thick or enhancing aortic wall (n = 6). The chest radiograph and CT findings were compared in patients treated conservatively (n = 9) and surgically (n = 7). These findings did not correlate with the need for surgery. Eight of nine conservatively treated patients were asymptomatic after treatment with antihypertensive medication. Contiguous dynamic contrast-enhanced CT of the aorta enables distinction of ulceration from dissection, which is particularly important in the hemodynamically unstable patient because the surgical management of ulceration is more extensive than that for aortic dissection.     

胸部脂肪瘤的影像学诊断(附14例报告)

目的探讨胸部脂肪瘤的影像学表现及检查方法优选. 资料与方法搜集胸部脂肪瘤14例资料,包括肺脂肪瘤2例,胸壁脂肪瘤4例,纵隔脂肪瘤3例,胸腺脂肪瘤3例,横膈脂肪瘤1例,右心房脂肪瘤1例,全部病例均有胸部正侧位片,12例进行了CT检查,1例进行了MRI检查,对全部患者的影像学表现进行分析. 结果胸部正侧位片病灶发现率78.6%,漏诊原因与肿瘤密度过低,肿瘤沿胸壁深部肌间隙浸润生长或肿瘤位于平片上较隐蔽的部位有关.CT检查不仅可进行精确的定位诊断和分类诊断,而且能作出定性诊断,但应常规摄脂肪窗片.MRI对这类肿瘤最敏感,它对病变的发现、定位、分类诊断及定性诊断有决定性意义. 结论胸部正侧位片是胸部脂肪瘤的首选检查方法,但病变的分类诊断与定性诊断需依赖胸部CT与MRI,其中MRI是该类疾病的最佳检查方法.     

外伤性主动脉夹层的CT诊断(附2例报告)

目的：探讨外伤性主动脉夹层的早期CT表现。方法：回顾性分析在我院漏诊及确诊的外伤性主动脉夹层的CT表现。2例中1例行3次CT平扫,1例行CT平扫和增强扫描。结果：2例均为DeBakeyIU型主动脉夹层,1例3次CT平扫示降主动脉管腔进行性增宽,伴双侧胸腔积液;此例因漏诊,患者于2周后死亡。另1例CT平扫示降主动脉增粗,CT增强扫描明确诊断,主要表现为降主动脉扩张,可见真腔、假腔及内膜线;此例患者行支架植入术后,患者预后良好。结论：对于胸部外伤患者,CT平扫时应注意观察主动脉的直径,如果降主动脉增粗、尤其是进行性增粗时,应考虑主动脉夹层的可能。     

肺动静脉畸形的综合影像评价

目的 评价各种影像学检查手段诊断肺动静脉畸形的作用。材料与方法 回顾性分析11例肺动静脉畸形患者的各种影像学检查的表现、胸片、肺动静脉造影11例,CT平扫7例（增强4例）,MR扫描2例（PA、MRA）,并计算各种检查方法的敏感性。结果 肺动静脉造影发现病灶29个,病灶呈瘤样扩张的血管,有1条供血动脉和数条引流静脉,引流静脉和左房早期显影。胸片表现为肺内局限结节样影且有异常血管与肺门相连,其敏感性为79.3%(23/29）。CT表现为病灶密度均实,边界光整,并有典型的“血管蒂”征,增强扫描示病灶与肺动脉同步强化,多平面重建（MPR）有助于认识其相关血管,检查敏感性为94.4%(17/18）。MR扫描敏感性的80.8%(4/5）,对比增强肺动脉MR成像（CE MRA）可弥补常规序列的不足,有助于显示病变全貌,图像堪与肺动脉造影相比。结论 胸片可作为筛选方法,而肺动脉造影是诊断的“金标准”;CT可以提供与肺动脉造影相同的诊断信息,在某种程度上可取代肺动脉造影;MR特别是动态增强MRA不仅可以在形态上确认病灶,还可用以评价血流动力学改变和评估预后。胸片与CT是最佳的治疗后随访手段。     

木村病的影像表现及文献复习

目的 探讨不同部位木村病的CT及MRI表现.方法 收集本院经病理证实19例木村病患者的CT和MRI行回顾性分析,并结合文献讨论.结果 19例木村病中累及头颈部16例、肺内1例、胸壁1例、肝脾受累1例.头颈部木村病CT表现为结节、团块及弥漫性密度异常,平扫与肌肉密度相似,T1WI呈等或稍低信号,T2WI呈高信号,CT和MRI增强扫描多为中度或明显强化.肺内及胸壁木村病表现为软组织肿块,增强扫描肺内病灶呈中度强化,胸壁病灶呈环形强化.肝脾同时受累木村病病灶呈散在结节状轻度强化灶.结论 木村病影像学表现缺乏特征性,需结合实验室检查及病理综合判断.     

Value of plain chest film in predicting traumatic aortic rupture

Plain chest film performed after blunt chest trauma showed blurring of the left pulmonary hilum in 53% of cases of traumatic aortic rupture (Group A, n = 15), and in no cases with negative aortography (Group B, n = 10). This sign can be explained by diffusion of mediastinal hemorrhage through the peri-bronchovascular connective tissue; the close relationship between aortic isthmus, the side of most frequent rupture, and the left pulmonary hilum is the anatomical basis for this asymmetrical finding. Review of all radiological alterations of the plain chest film shows a statistically significant difference between groups A and B only for mediastinal widening and aortic knob alterations (p less than 0.05). A combination of some findings due to aortic injury (mediastinal widening, aortic knob alterations, shift of trachea and left main bronchus, left apical cap, left hilar blurring, obscuring of descending aorta) was typical of aortic rupture when four or more signs were found (33%); these findings were absent only in patients with negative aortogram (8%). In the remaining cases (60%), the plain chest film showed two or three of these signs in both groups, making it impossible to differentiate between patients with and without aortic injury.     

Infected aortic aneurysms: imaging findings

PURPOSE: To determine the imaging characteristics of infected aortic aneurysms. MATERIALS AND METHODS: Review of records of patients with surgical and/or microbiologic proof of infected aortic aneurysm obtained over a 25-year period revealed 31 aneurysms in 29 patients. This study included 21 men and eight women (mean age, 70 years). One radiologist reviewed 28 computed tomographic (CT) studies (22 patients underwent CT once and three patients underwent CT twice), 12 arteriograms (12 patients underwent arteriography once), eight nuclear medicine studies (six patients underwent nuclear medicine imaging once and one patient underwent nuclear medicine imaging twice), and three magnetic resonance (MR) studies (three patients underwent MR imaging once). Features evaluated included aneurysm size, shape, and location; branch involvement; aortic wall calcification; gas; radiotracer uptake on nuclear medicine studies; and periaortic and associated findings. The location of infected aortic aneurysms was compared with that of arteriosclerotic aneurysms. RESULTS: Aneurysms were located in the ascending aorta (n = 2, 6%), descending thoracic aorta (n = 7, 23%), thoracoabdominal aorta (n = 6, 19%), paravisceral aorta (n = 2, 6%), juxtarenal aorta (n = 3, 10%), infrarenal aorta (n = 10, 32%), and renal artery (n = 1, 3%). Two patients had two infected aortic aneurysms. CT revealed 25 saccular (93%) and two fusiform (7%) aneurysms with a mean diameter at initial discovery of 5.4 cm (range, 1-11 cm). Paraaortic soft-tissue mass, stranding, and/or fluid was present in 13 (48%) of 27 aneurysms, and early periaortic edema with rapid aneurysm progression and development was present in three (100%) patients with sequential studies. Other findings included adjacent vertebral body destruction with psoas muscle abscess (n = 1, 4%), kidney infarct (n = 1, 4%), absence of calcification in the aortic wall (n = 2, 7%), and periaortic gas (n = 2, 7%). Angiography showed 13 saccular aneurysms with lobulated contour in 10 (77%). Nuclear medicine imaging showed increased activity consistent with infection in six (86%) of seven aneurysms. MR imaging showed three saccular aneurysms. Adjacent abnormal vertebral body marrow signal intensity was seen in one (33%) of three patients. CONCLUSION: Saccular aneurysms (especially those with lobulated contour) with rapid expansion or development and adjacent mass, stranding, and/or fluid in an unusual location are highly suspicious for an infected aneurysm.     

鼻腔和鼻旁窦平滑肌肉瘤的影像学表现(附5例报告)

目的：分析鼻腔鼻旁窦平滑肌肉瘤的CT与MRI表现，评价其临床价值。资料与方法：回顾分析经病理证实的鼻腔鼻旁窦平滑肌肉瘤5例，均行CT检查，其中2例加增强扫描；MRI检查2例，均为平扫加增强扫描。结果：肿瘤原发于鼻腔2例，上颌窦1例，1例肿瘤范围广已无法确定其原发部位，还有1例为鼻咽癌放射治疗14年的右后鼻孔－鼻咽区的复发肿瘤，肿瘤涉及范围包括鼻腔、筛窦、鼻咽部、眼眶、翼腭窝、颞下窝、咽部间隙、硬腭甚至口咽侧壁、中颅窝等。该类肿瘤呈浸润性生长及局部较广泛骨质破坏，无1例发生钙化及颈淋巴结转移。肿块在CT上3例呈较均匀的中等密度，2例密度不均；MRI T1WI呈无效中等信号，T2WI表现为略不均匀的中等到稍高信号，注射对比剂后肿瘤轻度强化或仅有部分强化。结论：鼻部平滑肌肉瘤表现为较广泛浸润性生长及骨质破坏，无钙化。CT能较好地显示肿瘤涉及范围及骨质破坏情况；MRI在区别肿瘤与周围炎性等病变方面较清楚。     

儿童骨骼尤文肉瘤的影像学诊断和鉴别诊断

目的 探讨儿童骨骼尤文肉瘤在X线平片、CT和MRI上的影像学征象，以提高对其诊断和鉴别诊断能力。资料与方法 回顾性分析经临床病理证实的儿童骨骼尤文肉瘤11例，其中X线平片检查7例，单行MRI扫描2例，单行CT扫描4例，同时行MRI及CT扫描者4例。结果 11例尤文肉瘤中发生于骨盆4例，股骨3例，胫骨、肋骨、趾骨和脊柱各1例，其中胫骨和髂骨各1例术后出现颅骨转移。X线平片上6例表现为虫蚀状或溶骨性破坏，2例病灶略呈膨胀性改变，骨皮质破坏伴单层、多层或放射状骨膜反应，邻近软组织层次欠清；发生于肋骨的1例以硬化为主，CT像上髓腔密度增高，骨质鼠咬状或斑片状破坏伴骨皮质裂隙状或不规则破坏；2例骨皮质呈膨胀、变薄、中断，周围见不完整的层状骨膜反应及较大软组织肿块；MRI上表现为大片长T1长T2信号的骨质破坏和巨大的软组织肿块；1例肿块呈跨关节生长。结论 X线平片、CT和MPI在骨尤文肉瘤的评估方面有重要作用。X线平片可有助于肿瘤的定性和定位；MRI平扫T1WI像及短反转时间反转恢复技术(STIR)能清晰显示肿瘤的范围，在显示肿瘤对骨骺及邻近软组织的侵犯方面尤为敏感；CT在显示骨及骨皮质破坏等方面优于MRI。     

背部弹力纤维瘤的 CT 和 MRI 诊断

目的：探讨背部弹力纤维瘤(EFD)的 CT 和 MRI 表现及其诊断价值,提高对 EFD 的认识。方法回顾性分析经手术病理证实的20例(36个病灶)EFD 患者的 CT 或 MRI 图像,其中12例行胸部 CT 平扫,4例行胸部 MRI 平扫,4例行肩部 MRI 平扫,分析其 CT 及 MRI 表现特点。结果①EFD 发病部位均位于肩胛骨内侧前锯肌与胸壁间的脂肪间隙内,表现为扁平椭圆状或半圆形的软组织肿块,与肌肉密度(信号)相似,内均见沿病灶长轴分布的脂肪密度(信号)间隔;病灶边缘不规整,病灶外侧与前锯肌和肩胛骨交界部分界不清,脂肪间隙消失。②EFD 男女性发病率、单双侧发病率及左右侧病灶大小差异均有统计学意义(P <0.05),其中女性发病率及双侧发病率较高,以右侧病灶较大。结论①EFD 发病部位固定,影像学表现特殊,CT 及 MRI 检查可明确诊断。②肩胛骨与胸壁之间的机械性摩擦可能是肿瘤生长的协同因素。