非特异性间质性肺炎的影像诊断

目的探讨非特异性间质性肺炎(NSIP)的影像学表现,评价其临床应用价值。方法对22例NSIP(7例经开胸肺活检证实,15例临床综合诊断)的临床及影像资料进行回顾性分析。结果14例主要表现为单发或散在分布的斑片状、片状磨玻璃影,其中8例伴有小叶实变,9例小叶内间质轻度增厚,2例伴有轻微的细支气管扩张。6例既有片状磨玻璃影,同时伴有小叶内间质增厚及牵拉性细支气管扩张。2例NSIP患者主要表现为小叶内间质增厚、牵拉性细支气管扩张及局部肺结构的扭曲、破坏。22例NSIP病变中,19例分布于中、下肺的外周部,1例位于右上叶后段。结论NSIP的影像表现有一定的特征性,结合病史、症状、体征、肺功能及激素治疗情况等临床资料,可较大提高其诊断正确率。     

高分辨CT征象对特发性间质性肺炎的诊断价值及其ROC曲线评估

目的 探讨几种高分辨CT征象对特发性肺纤维化(IPF)、非特异性间质性肺炎(NSIP)、隐源性机化性肺炎(COP)的诊断和鉴别诊断价值.方法 回顾性分析46例经病理证实的特发性间质性肺炎患者HRCT表现,其中IPF 19例、NSIP 14例、COP 13例.男29例,女17例,年龄25～76岁,平均(49.98±10.37)岁.观察者在不知道诊断结果的前提下,选取5种可以量化的征象,评价其累及范围、分布特点,通过多因素分析评估其鉴别诊断价值,进而采用ROC曲线评估其诊断效能.结果 有助于IPF与NSIP、COP组鉴别的因素是细支气管扩张分布的范围(OR值为1.782),其对IPF的诊断准确度较高(Au为0.931),联合气腔实变影可以提高诊断效能(0.963);有助于NSIP与IPF、COP组鉴别的因素是细支气管扩张分布的范围(OR值为0.843),其对NSIP的诊断准确度为0.787;有助于COP与IPF、NSIP组鉴别的因素是气腔实变影分布范围(OR值为1.522)和细支气管扩张分布范围(OR值为0.781),联合2种征象可以提高诊断效能(0.923).结论 IPF、NSIP、COP均具有各自区别的特征性的HRCT表现.     

消化道间质瘤的影像学分析

目的探讨消化道间质瘤(GIST)的临床影像学特点。方法对21例病理证实的消化道间叶源性肿瘤的X线钡剂造影及CT影像表现及鉴别诊断进行回顾性分析。结果21例消化道间质瘤中发生于食管1例,胃15例,小肠3例及结肠2例。X线钡剂造影:6例显示黏膜变平、撑开或移位,8例表现为充盈缺损,2例显示为外压性改变。CT检查:腔内外生长之肿块密度均匀者12例,内见液化坏死区6例,肿瘤内钙化者2例。增强扫描肿块均有显著强化,17例肿瘤不均匀强化或外围性强化,3例较均匀强化。结论消化道间叶源性肿瘤中以GIST最常见,CT检查在术前诊断中有重要价值。     

胃肠道间质瘤的影像学表现

目的:分析胃肠道间质瘤的影像学表现。方法:对16例经病理学证实为胃肠道间质瘤患者进行不同的影像学检查。结果:16例原发胃肠道间质瘤中原发于胃10例,原发于十二指肠1例,发生于回盲部1例,发生于小肠2例,横结肠系膜1例,乙状结肠系膜1例。内生性生长者1例,外生性生长者11例,腔内外生长者1例。影像学判断GIST良恶性的符合率为81%(13/16)。结论:外生性生长是胃肠道间质瘤主要的生长方式,也是诊断的主要依据。CT是该病术前诊断及判断其生物学行为的主要工具。     

特发性间质性肺炎的HRCT诊断及新分类法解读

特发性间质性肺炎（Idiopathicinterstitialpneumonia,IIP）是一组在临床上相当重要且比较复杂的弥漫性肺部疾病,在这组疾病的诊疗过程中,影像学诊断起着极为重要的作用。因此,作为放射科医师,了解并熟悉这方面的知识,将有助于更好地服务于临床和患者,并在临床工作中承担更为重要的角色。     

巨大胃间质肉瘤合并坏死误诊1例

胃间质肉瘤合并坏死临床较少见,易误诊,现报告如下。患者男,43岁。因腹部包块、黑便、呕吐2周入院。患者于3月前出现上腹部饱胀不适,疼痛且进食后加重,伴恶心、呕吐,近2周发现黑便,呈柏油样,并感头昏无力。查体:慢性病容,贫血貌,未见胃肠型及蠕动波,上腹部可扪及约8.0cm×9.0cm的质硬包块,边界不清,表面光滑,活动度差,压痛。实验室检查:血红蛋白3.0g,白细胞8.0×109/L,中性0.7,淋巴0.3,大便潜血实验( )。X线检查:胃体小弯贲门部下方有一向外开口,钡剂由此进入一大小约2.5cm×10.0cm的囊腔内,囊壁僵硬欠规整,食道下端及贲门拉长变形,呈细长…     

间质瘤影像学表现与病理学特点的对比研究

目的:通过分析胃肠道间质瘤(GIST)及胃肠道外间质瘤(EGIST)的影像学表现及病理学特点,提高对间质瘤的诊断及鉴别诊断水平。方法:回顾性分析35例经病理证实的GIST及EGIST的影像学和病理学资料。结果:①部位。GIST:食管3例,胃16例,回肠3例,十二指肠、结肠及直肠各1例,共25例;EGIST:腹膜后3例,前腹壁1例,肠系膜4例,腹股沟2例,共10例。②大小。GIST直径4.8～18.0cm,平均10.8cm;EGIST直径7.7～31.0cm,平均20.5cm。③影像学表现为肿瘤轮廓光整,与周围组织分界清晰,部分可见液化坏死,较小病灶常呈均匀强化,较大病灶呈不均匀、分隔状强化。④免疫组化表现为35例CD117或CD34均呈高表达,性质分属于低度、中度或高度恶性。结论:GIST及EGIST的影像学及病理学表现相似,为来源相同的肿瘤,但病理学特点不能完全评价间质瘤性质或危险度,而影像学可以提供更多的诊断信息,在间质瘤诊断、鉴别诊断及危险度预测中有重要的价值。     

胃肠道间质瘤的影像学表现

目的探讨胃肠道间质瘤(GIST)的影像学表现特点及其诊断价值。方法回顾分析41例经手术和病理证实的胃肠道间质瘤影像及临床资料。结果病灶位于胃20例,小肠5例,直肠3例,食管2例,消化道外11例。影像学检查恶性GIST共计27例,其中21例肿瘤直径>5cm,边界不清楚,19例与邻近结构有明显的粘连或直接侵犯周围组织,13例可见明显瘤内坏死、囊变,5例出现转移灶;良性14例,11例肿瘤直径<5cm,边界清楚,密度均匀,增强后均匀强化。结论胃肠道双对比造影检查易于发现腔内型和腔内外型胃肠道间质瘤。CT检查弥补了常规胃肠道造影和内窥镜检查的不足,对GIST的准确定位、良恶性的判断、指导临床治疗和估计预后有重要价值。     

周围型小肺癌影像学误诊原因分析

本文搜集1990年以来经手术，活检等病理证实而影像学误诊的周围型小肺癌48例，究其误诊原因回顾分析如下。     

胃肠间质瘤的CT影像分析

本文回顾性分析我院2001年9月~2007年4月经手术病理证实的31例胃肠间质瘤(GIST)的CT影像特点并与手术病理进行对照,旨在探讨CT在GIST术前诊断中的价值。1材料与方法1.1一般资料收集我院2001年9月~2007年4月行CT检查并经手术病理证实的胃肠间质瘤患者31例,其中男24例,女7例,男女     

成人麻疹病毒肺炎的影像表现

目的 探讨成人麻疹肺炎的胸部影像表现.方法 对163例成人麻疹患者行胸部X线平片检查,其中3例行MSCT扫描,共确诊10例成人麻疹肺炎患者.结果 10例肺炎患者中8例X线胸片异常,特征性表现为磨玻璃密度影(6例)和支气管增粗(2例);2例X线胸片正常者行MSCT检查.MSCT表现为双肺磨玻璃密度灶1例,右上叶呈肺小叶分布的磨玻璃密度灶2例.结论 了解麻疹肺炎的X线胸片和MSCT表现可以缩小鉴别诊断范围,首次X线胸片正常患者不能除外肺部受累.

Abstract：

Objective To illustrate the chest radiography and MSCT findings of measles pneumonia in adults. Methods One hundred and sixty three measles patients underwent chest radiography, MSCT was performed in 3 of them. Measles pneumonia was confirmed in 10 patients (6.13%). Results Eight of 10 patients had abnormal appearances in initial chest radiography. The characteristic chest radiographic findings were ground-glass opacities (n=6) and bronchial wall thickening (n=2). MSCT showed bilateral multiple ground-glass opacities in 1 patient,unilateral patchy ground-glass opacities with lobular distribution in the right upper lung in 2 patients. Conclusions Familiarizing with radiographic and MSCT appearances of measles pneumonia in adults is very important for the differential diagnosis and appropriate management of measles pneumonia. Normal initial chest radiography cannot exclude the involvement of the lungs.     

小儿纵隔肿瘤和囊肿的CT诊断

分析小儿纵隔肿瘤和囊肿的ＣＴ表现并探讨ＣＴ诊断的价值。方法回顾性总结５８例经手术,病理证实的小儿纵隔肿瘤和囊肿的ＣＴ表现,包括神经源性肿瘤２５例,恶性淋巴瘤１５例,肠源性囊肿６例,胸腺瘤３例,畸胎瘤,脂肪瘤,支气管囊肿各２例。结论ＣＴ检查可清楚显示小儿纵隔肿瘤的囊肿的大小,形态,密度,范围,以及与纵隔大血管,气管,食管的关系。诊断小儿纵隔肿瘤和肿行ＣＴ检查是最有效的方法之一。     

Nonspecific interstitial pneumonia: histologic correlation with high-resolution CT in 29 patients

Purpose

To determine the pathological correlation with various high-resolution CT (HRCT) findings in cases with nonspecific interstitial pneumonia (NSIP), paying special attention to pathological subgroups.

Material and methods

The study involved 29 patients diagnosed with NSIP by surgical lung biopsy. A total of 54 specimens were obtained and grouped according to Katzenstein's classification (groups 1–3) for NSIP. Two observers then evaluated the HRCT findings for every biopsy site and classified the findings according to the main pattern evident into the following four radiologic pattern groups: A, ground-glass attenuation and fine reticulation; B, ground-glass and coarse reticulation; C, consolidation and D, ground-glass attenuation and consolidation.

Results

The pathological pattern was NSIP group 1 in 6 patients, group 2 in 22 and group 3 in 25, while 1 specimen was normal. The main HRCT pattern was pattern A in 15 specimens, B in 8, C in 9 and D in 21. Although there were no significant correlation between HRCT patterns and histological subgroups (Chi-square test, p = 0.07), pattern C was more frequently seen in group 2 (7 of 9) and pattern A was more common in group 3 (11 of 15). HRCT pattern A corresponded pathologically to areas of thickened alveolar septa with temporal uniformity. Pattern B correlated with areas with airspace enlargement/emphysema or dilation of small airways superimposed on thickened alveolar septa. Pattern C was pathologically associated with areas of severe thickened alveolar septa, mucin stasis in the small airways and intraluminal organization.

Conclusion

The pathological backgrounds of the same CT findings in patients with NSIP varied among all pathological subgroups. Areas of ground-glass attenuation and air-space consolidation did not always correspond to reversible pathological findings.     

甲型H1N1流感合并肺炎的影像表现

目的 探讨甲型H1N1流感合并肺炎的影像表现.方法 分析确诊的甲型H1N1流感合并肺炎患者51例,均摄床旁X线胸片,44例同期行胸部CT检查.按肺内病变程度将所有患者分为轻度、中度、重度3型.结果 轻度患者4例,表现为肺内局限片状阴影;中度33例,肺内片状阴影超过2个肺野,其中双侧病变30例,单侧病变3例;重度14例,肺内广泛分布片状及磨玻璃密度阴影,可以合并间质改变,其中2例合并感染,成人呼吸窘迫综合征(ARDS)6例,并发皮下气肿1例.结论 甲型H1N1流感合并肺炎以片状影及磨玻璃密度阴影为主,可见间质病变,合并感染后影像表现多样,部分患者可进展为ARDS.     

CT和MRI对甲状旁腺腺瘤的诊断价值

报告甲状旁腺腺瘤的ＣＴ和ＭＲＩ检查方法及其表现,评估并比较这两种检查方法对甲状旁腺腺瘤的诊断价值。方法４５例共４５个病理证实的甲状旁腺腺瘤术前进行了ＣＴ和ＭＲＩ检查,其中ＣＴ检查４３例,ＭＲＩ检查７例。结果ＣＴ正确诊断出３７个腺瘤,２７个位于气管－食管旁沟内,１０个为异位腺瘤。     

Usual interstitial pneumonia and nonspecific interstitial pneumonia: correlation between CT findings at the site of biopsy with pathological diagnoses

Objectives

The aim of this study was to correlate high-resolution CT (HRCT) findings at the site of biopsy with the whole lung CT and pathologic diagnoses in usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP).

Methods

The study included 35 patients (25 UIP and 10 NSIP) diagnosed both pathologically and clinically. 81 surgical biopsy specimens (54 UIP, and 27 NSIP) and extracted areas corresponding to biopsy sites on HRCT were analyzed. CT interpretations were compared with pathological diagnoses in both extracted images and the whole lung. Concordant and discordant cases in multiple extracted images were divided and analyzed. Then the whole cases were categorized by including or not at least one UIP diagnosis of extracted images and evaluated.

Results

The diagnoses in extracted sites significantly correlated with pathological diagnoses (p = 0.047). There were significant differences in the concordances of extracted images compared with the diagnosis of whole lung and pathology (p = 0.008, 0.003, respectively). All 7 cases that were not concordant were diagnosed as radiological UIP with whole lung CT. The cases with at least one UIP diagnosis of extracted CT images were diagnosed as UIP in pathology more frequently (18 in 25) (p = 0.007).

Conclusions

Radiological UIP in whole CT had more frequently discordant diagnoses from multiple extracted images than NSIP. And there were more cases in pathological UIP that included at least one UIP diagnosis of extracted images compared with pathological NSIP.     

传染性非典型肺炎的影像学表现

目的:探讨传染性非典型肺炎的影像学表现。方法:收集2002年12月～2003年5月符合诊断标准的传染性非典型肺炎74例,其中46例曾做报道。所有病例均行胸部摄片,67例住院期间每隔1～2d摄胸片1次,9例行胸部CT扫描。回顾性分析所有病例的一般临床资料和影像学表现。结果:病变累及单侧肺50例(67.57％,50/74),以双下肺为多,占39例;病变累及双侧肺24例(32.43％,24/74),以同时累及右下肺和左下肺为多,占16例。肺部病变表现为多形态改变占28例,以肺部同时出现淡薄片状、云絮状及点片状影多见,占11例;单形态改变45例,以双肺纹理增多增粗、纹理间散在点片状影多见,占24例。67例有完整资料的住院患者影像学表现变化模式具有多样性,以进展～逐渐吸收模式多见,占42例;2例出现实变;5例出现胸膜增厚及胸腔积液。67例中有3例在住院后期出现条索状影,2例复查后条索影吸收好转。所有病例纵隔均未见明显肿大淋巴结。结论:传染性非典型肺炎多出现于单侧下肺,可表现为单形态或多形态,主要形态有点片状影、淡薄片状影、磨玻璃影、云絮状影、网状影及实变;病变的发展变化过程具有多样化。     

甲型H1N1流感肺炎63例影像分析

目的:探讨甲型H1N1流感肺炎的胸部影像学表现。方法:收集63例甲型H1N1流感肺炎患者的X线及CT资料,回顾性分析其影像学特征。结果:63例甲型H1N1流感肺炎胸部X线表现为:肺实质性病变48例(76.19%),实质间质混合性病变15例(23.81%),弥漫性病变14例(22.22%)。其中单侧肺受累16例(25.40%),双侧受累47例(74.60%);肺部多发散在病变49例(77.78%),局限性病变14例(22.22%),其中表现为斑片状影25例(39.68%)。结论:双肺受累、病变为多发散在斑片状阴影,部分呈磨玻璃样征合并实变是甲型H1N1流感肺炎的主要影像学表现。     

电子束CT在先天性单心室畸形诊断中的应用

将单心室的心血管造影与电子束ＣＴ检查结果进行对照研究，探讨ＥＢＣＴ在单心室诊断中的价值。方法２１例经临床及心电图，Ｘ线平片，超声心动图检查后拟诊为单心室的病人，分别行心血管造影检查与ＦＢＣＴ检查。采用节段分析法，用双盲法分别对每例的两种检查从８个解剖要点进行分析，对照，并把两种检查方法的优缺点进行比较。     

少见部位软骨母细胞瘤的影像诊断

目的:探讨少见部位软骨母细胞瘤的影像学表现及其临床诊断价值。方法:回顾性分析经病理证实的7例少见部位软骨母细胞瘤患者的病例资料。肿瘤位于距骨2例、跟骨2例、髌骨、坐骨结节及耻骨下支各1例。行X线平片检查7例,CT平扫4例,MRI平扫及增强检查4例。结果:X线平片示膨胀性骨质破坏5例,囊状骨质破坏1例,灶周硬化3例,病灶内小斑片状钙化1例;平片漏诊1例。4例CT均显示膨胀性骨质破坏,灶周硬化,病灶内斑点状或小斑片状钙化。MRI上病变呈膨胀性骨质破坏3例,囊状骨质破坏1例,4例病灶信号均混杂,灶周均可见低信号线状影及明显的骨髓水肿。结论:少见部位软骨母细胞瘤具有膨胀性骨质破坏及灶周骨髓水肿明显的特点,平片、CT和MRI三种检查方法联合应用对本病的诊断及鉴别诊断有重要价值。