外生型肝细胞癌及肝血管瘤的CT诊断

目的：探讨外生型肝细胞癌及肝血管瘤的CT表现。方法：回顾性分析7例外生型肝细胞癌及3例外生型肝血管瘤的CT和临床资料,10例均经手术、病理或临床证实。结果：外生型肝细胞癌根据肝内有无肿块将其分为单纯型（4例）和混合型（3例）。2例肿块突出肝外,有蒂与肝相连,5例肿块紧邻肝表面。7例肿块平扫均呈低密度,动脉期不均匀强化,门脉期病变密度降低或呈低密度;其中2例出现动静脉短路征象,2例出现肿瘤周围部分肝实质一过性增强,4例出现门静脉癌栓,3例有肝硬化表现。外生型肝血管瘤中,2例为海绵状血管瘤,病灶平扫呈低密度,增强扫描动脉期肿块边缘强化,门脉期强化范围扩大;1例为纤维性血管瘤,表现为门脉期不均匀强化。结论：CT是诊断外生型肝细胞癌和肝血管瘤的有价值的影像学手段。     

胆管细胞型肝癌的CT诊断

目的：探讨胆管细胞型肝癌ＣＴ增强扫描征象的诊断价值及其病理基础。材料与方法：２８例经手术病理证实的胆管细胞型肝癌术前均做了ＣＴ平扫，２８例中２７例做了常规ＣＴ增强扫描，其中７例于病灶最大层面加做单层的“两快一长”增强扫描。２８例中８例手术切除的完整标本做了１０ｍｍ层厚的全标本ＣＴ多层扫描，并进行标本ＣＴ、术前ＣＴ与标本对应切面的对照研究。取材１０３个病理点切片，观察不同ＣＴ征象的病理改变。结果：发现病灶内部有两种基本ＣＴ征象：（１）延迟强化区；（２）无强化区。病理上延迟强化区是大量纤维组织伴少量散在的腺癌组织；无强化区则是凝固性坏死或同时含有大量粘液的存活癌组织。结论：胆管细胞型肝癌病灶内的延迟强化区和无强化区的ＣＴ表现，在与肝细胞型肝癌等多种常见肝肿瘤的鉴别中有重要价值。     

外生型肝癌

外生型肝癌是指肿块主要向肝外生长，仅以蒂与肝脏相连，而肿块本身几乎不累及肝脏实质。外生型肝癌是肝癌的一种特殊类型，极为罕见，在国内尚未见报道。现将我们2例经手术病理证实的外生型肝癌的CT及动脉造影表现报告如下。     

胃平滑肌肿瘤的螺旋CT诊断

目的：探讨胃平滑肌肿瘤的螺旋ＣＴ表现、鉴别诊断及检查技术。材料与方法：采用充分口服温开水（或０．５￣１．０％的泛影葡胺）、低张和及时扫描的ＣＴ检查方法,分析２１例经手术病理证帝胃平滑肌肿瘤的螺旋ＣＴ表现。结果：１２例有肌瘤ＣＴ表现多为圆形或椭圆形软组织肿块。与胃壁广基底或带蒂相连,直径多在５ｃｍ以内。除瘤灶内有散在钙化或中央呈低密度各１例外,其余肿块密度均匀,强化均一。９例平滑肌肉瘤ＣＴ表现为椭圆     

肝癌肝动脉化疗栓塞后肿瘤发展的CT研究

目的：评价肝癌肝动脉碘油抗癌药化疗栓塞后肿瘤发展的ＣＴ表现并探讨其有关因素。方法：搜集４５例栓后ＣＴ复查发现肿瘤发展的病例进行分析。结果：４５例栓后肿瘤发展的ＣＴ表现如下：（１）原瘤灶边缘局部发展１５例（３３．３％ ）;（２）肿瘤整个增大发展９例（２０％ ）;（３）肝内其它部分出现１例（２．２％ ）;（４）原瘤灶边缘部及肝内他处出现１６例（３５．６％ ）;（５）肿瘤整个增大发展伴肝内他处出现４ 例（９％ ）。结论：可通过观察栓后肿瘤边缘部碘油潴留形态判断疗效及栓后肿瘤生长情况。     

肝结核的CT表现

目的：报告７例肝结核并结合有关文献讨论肝结核的ＣＴ表现。材料和方法：报告的７例患者均经手术或肝穿病理证实。男３例，女４例；年龄２４～５８岁（平均５０岁）。其中包括粟粒型肝结核、结节型肝结核和结核性胆管炎三个病理类型。结果：（１）粟粒型肝结核ＣＴ表现为肝脏弥漫性肿大、密度减低或表现为肝脏肿大伴有多发性粟粒状低密度灶，增强扫描无明显强化。（２）结节型肝结核可表现为肝内局灶性低密度区，增强扫描可有周边性强化；亦可表现为肝内结节状混杂密度灶，其特点是病灶中心密度高，尤其是伴有“粉末”状钙化，周围密度低，增强扫描有轻至中度的环形强化。（３）结核性胆管炎罕见，沿胆管壁走行的钙化、管型结石可能是本病的特点。结论：粟粒型肝结核ＣＴ表现缺乏特征性，除非有结核病史或伴有其他脏器结核，否则ＣＴ不能做出正确诊断。结节型肝结核和结核性胆管炎的ＣＴ表现有一定的特征性，可提示肝结核的诊断。     

恶性脑膜瘤CT与病理对照分析及CT诊断

复习了２０例资料完整经手术和病理证实的恶性脑膜瘤，综合分析其ＣＴ表现为：（１）肿瘤外形不规则，有分叶结节状凸起，边界不清；（２）肿瘤内低密度区及脑膜瘤的非均一强化或环状强化；（３）明显的瘤周水肿；（４）肿瘤侵犯颅骨及颅外软组织。讨论了恶性脑膜瘤的ＣＴ表现与病理组织学关系以及诊断与鉴别诊断。     

螺旋CT诊断外生型肝癌的价值

目的 分析外生型肝癌的临床特点及螺旋CT表现,探讨螺旋CT诊断外生型肝癌的价值.方法 对本院2004-01-2009-06期间收治的17例经病理证实的外生型肝癌行螺旋CT平扫加双期增强扫描,回顾性分析外生型肝癌的临床特点及螺旋CT表现.结果 HBsAg阳性者14/17例,AFP(+)者 13/17例,合并肝硬化的占58.82%(10/17),肝功能Child分级14/17例为A级.综合观察CT轴位及多平面重组(MPR)图像,13/17例外生型肝癌有蒂,其基底与相应肝叶或肝段相连,2/17例与邻近肝叶分界不清但无明确瘤蒂,只有2例与肝脏呈分离状态.CT增强扫描病变呈"速升速降"型强化的占88.24%(15/17),有2/17为轻度欠均匀强化.通过轴位、MPR以及最大密度投影(MIP)图像,可观察到15/17例外生型肝癌有肝动脉供血,另有2例可见胃十二指肠动脉的分支参与供血.结论 外生型肝癌有明显的临床及CT表现特征.     

PTC在成人先天性胆管囊肿诊断中的价值

目的 评价ＰＴＣ对成人先天性胆管囊肿的诊断价值。方法 收集１５例经Ｂ超、ＰＴＣ检查疑患先天性胆管囊肿的患者,部分ＣＴ检查。全部经手术和病理证实。结果 按Ｔｏｄａｎｉ五分法手术证实（１）１型：肝外胆管囊肿１０例,表现为肝外胆管呈漏斗状或梭形扩张。（２）４型：３例。表现为肝内外胆管多发梭形或柱扩张,胆胰共同管过长,大于１０ｍｍ。（３）５型：即Ｃａｒｏｌｉ氏病２例,表现为肝叶内胆管多发大小不一囊状或“分     

肝内胆管细胞癌CT表现

目的：通过对肝内胆管细胞癌的ＣＴ表现与手术病理对照分析以提高ＣＴ对其的诊断水平。材料和方法：１８例肝内胆管细胞癌，１例为乳头状粘液腺癌，１７例为中或低分化腺癌。所有病例术前均经Ｅｒｉｃｓｓｏｎ２４００ＣＴ机，层厚１ｃｍ及层距１ｃｍ作平扫及团注增强扫描。结果：１８例中７例为中央型，１１例为周围型。所有病例ＣＴ平扫见肿瘤边缘均不甚清晰，其中１７例肿瘤组织呈不均匀低密度，１例有点片状高密度影混杂为乳头状胆管细胞粘液腺癌的特征表现。肝内胆管细胞癌为中央型者，两侧胆管均扩大，增强后，由于肿瘤边缘的显示，肿瘤大小遂似有缩小，而最具有特征性的表现是肿瘤内可见线状征，本组病例均有此种表现。周围型均有局部肝包膜回缩表现。结论：肝内胆管细胞癌的ＣＴ表现对正确诊断有一定价值，特别是增强后肿瘤内出现的特殊线状征更具有病理影像诊断的意义。     

螺旋CT肝双期扫描在外生性肝癌诊断中的临床应用

目的：探讨螺旋CT肝双期扫描对外生性肝癌的诊断价值。方法：回顾性分析了7例外生性肝癌螺旋CT肝双期扫描的CT表现。结果：7例外生性肝癌与肝脏相连，3例有明显蒂部，2例肝右叶外生性肝癌向下至右侧盆腔内，6例其内可见CT“密度更低区”，3例压迫胃体及胃窦。螺旋CT肝动脉期6例肿瘤内可见不规则纡曲强化血管影。5例门静脉期肿瘤呈低密度；2例门静脉期部分肿瘤组织强化，密度增高。结论：螺旋CT肝双期扫描对外生性肝癌诊断有较高的临床价值。     

Diagnosis of coexistent hepatic tumors of different kinds: a challenge from CT and MR imaging

Three cases of multiple, different liver tumors in the same patient were examined with CT and MR imaging. Two patients with coexistent hepatocellular carcinoma and cavernous hemangioma were correctly diagnosed by the following characteristic findings on dynamic CT and/or MR images; spreading and markedly prolonged enhancement in cavernous hemangioma, and the presence of capsule and/or transient diffuse enhancement in hepatocellular carcinoma. The third case of hepatocellular carcinoma and cholangiocarcinoma showed typical findings of hepatocellular carcinoma in one tumor and unusual complex enhancement in the other. CT and MR imaging may enable correct diagnosis to be made even in patients with multiple liver tumors of different kinds.     

累及咽旁间隙的肿物的影像学特征

目的：分析累及咽旁间隙肿物的影像学特征。材料与方法：总结分析了１９例经手术病理证实的累及咽旁间隙肿物的ＭＲＩ、ＣＴ、ＭＲＡ和ＤＳＡ表现。包括腮裂囊肿４例、颈静脉球瘤３例、颈动脉体瘤４例、神经鞘瘤３例、鼻咽癌侵入咽旁间隙５例。１５例行ＭＲＩ检查、９例行ＣＴ扫描、３例行ＭＲＡ检查、５例行ＤＳＡ检查。结果：ＭＲＩ对肿块的大小、形态、位置、与周围组织的关系及继发改变能清晰显示，并可见具有特征性的副神经节瘤瘤内纡曲、匍行的低信号血管影。颈静脉球瘤的ＣＴ特征性表现是颈静脉孔的扩大和骨质破坏。ＭＲＡ和ＤＳＡ对肿瘤血管的显示十分清楚。结论：ＭＲＩ对累及咽旁间隙肿物的诊断优于ＣＴ，若能结合ＣＴ、ＤＳＡ、ＭＲＡ等其他影像学技术，能更准确地评估病变的部位和性质。     

外生性肝癌的血供特点及介入治疗

目的探讨外生性肝癌血供特点及经肿瘤供血动脉化疗栓塞术的疗效。方法5例外生性肝癌经股动脉插管,肿瘤供血动脉造影、化疗栓塞治疗,用榄香烯350 mg肿瘤血管内热灌注化疗和顺铂60～80 mg加碘油8～15 ml乳剂及明胶海绵化疗栓塞。结果5例患者共行10次经血管途径的化疗栓塞术。造影显示肿瘤供血动脉以肝外血管为主,肝动脉部分参与供血。5例患者术后瘤体缩小30%～50%,4例AFP下降。结论外生性肝癌有不同于肝内肝癌的血供特点,经肿瘤供血动脉化疗栓塞术对外生性肝癌同样有效,是可供选择的治疗方法之一。     

Radiologists' performance in the diagnosis of liver tumors with central scars by using specific CT criteria

PURPOSE: To determine the performance of radiologists with differing levels of expertise in the diagnosis of the most common types of liver tumors with central scars (ie, focal nodular hyperplasia [FNH], fibrolamellar hepatocellular carcinoma [HCC], and large hepatic hemangioma) by using specific computed tomographic (CT) findings. MATERIALS AND METHODS: Review of medical records at the University of Pittsburgh Medical Center identified patients with a total of 64 liver tumors that had central scars-including 29 cases of FNH, 20 fibrolamellar HCCs, and 15 large (>3.5 cm in diameter) hemangiomas-and with CT scans available for review. Retrospective review of these scans was performed individually by six radiologists who were blinded to the diagnosis, including two faculty abdominal radiologists, one abdominal imaging fellow, and three radiology residents. Individual performance was evaluated by means of receiver operating characteristic analysis, and interobserver agreement was measured by using the Cronbach alpha. Individual CT findings that may allow differentiation of tumor types were identified with the Kruskal-Wallis test. RESULTS: CT allowed good to excellent interobserver agreement in the diagnosis of tumor type and in recognition of differential findings among the three types. The individual accuracy of diagnosis was very good, with the average area under the receiver operating characteristic curve ranging from 0.81 to 0.90. Although the faculty radiologists performed the best, the differences in performance between the subgroups of readers and the levels of confidence in diagnosis were not statistically significant. The diagnosis of fibrolamellar HCC was the most accurate and had the highest sensitivity, followed by FNH and large hemangioma. Clinical and CT findings that were found to be statistically significant in differentiating tumor types were patient age and sex, tumor size larger than 10 cm, width of tumor scars, invasion of vessels, nodular centripetal enhancement, marked hyperattenuation on arterial phase images, lymphadenopathy, heterogeneity, extrahepatic metastases, surface lobulation, calcification, and isoattenuation with liver tissue on portal venous phase images. CONCLUSION: CT allows accurate differentiation of the most common types of liver tumors with central scars, including FNH, fibrolamellar HCC, and large hemangioma.     

Small cell carcinoma of the lung: CT findings of parenchymal lesions

PURPOSE: The purpose of this study was to describe the CT findings of small cell carcinoma of the lung. MATERIALS AND METHODS: CT findings were retrospectively reviewed in 38 patients (34 men, 4 women; aged 46-73 years) with pathologically proven small cell carcinoma. RESULTS: Tumors were located centrally in 23 cases (61%) and peripherally in 15 cases (39%). Twenty-seven patients had a bulky central mass with encasement of the great vessels or extrinsic compression of the airway (22 central tumors, 5 peripheral tumors). Six patients had peripheral lesions without adenopathy. Five peripheral small cell carcinomas demonstrated peribronchial thickening adjacent to the primary tumor. CONCLUSION: The first sign of small cell carcinoma most typically is a bulky central mass that represents metastasis to the hilar and/or mediastinal lymph nodes. Although no findings specific to peripheral small cell carcinoma are available, small cell carcinoma originating from the peripheral lung parenchyma should be included in the differential diagnosis when peribronchial thickening is associated with the tumor.     

Fatty metamorphosis in hepatocellular carcinoma: radiologic features in 10 cases

We describe the sonographic, CT and angiographic findings in 10 cases of hepatocellular carcinoma in which extensive fatty metamorphosis occurred within the tumors. Fatty change was diffuse in smaller tumors (less than 3.5 cm) and focal in larger tumors (greater than 3.5 cm). Fatty metamorphosis characteristically caused a low-attenuation area on CT (less than -10 H) and a highly echogenic area on sonography. The sonographic appearance of small hepatocellular carcinomas with fatty metamorphosis was identical to the findings in cavernous hemangioma or focal fatty change of the liver. CT correctly revealed the presence of fat in these hepatocellular carcinomas. In these cases, hepatic arteriography showed no tumor stain; however, CT arteriography (dynamic CT during injection of contrast medium into the hepatic artery) was useful in showing the tumor, its capsule, and its internal septa. In the diagnosis of large hepatocellular carcinoma, the presence of intratumoral fat is not likely to be problematic, but small tumors that are diffusely infiltrated by fat must be distinguished from such benign conditions as focal fatty change, lipoma, and angiomyolipoma.     

Preoperative detection of pancreatic insulinomas on multiphasic helical CT

OBJECTIVE: The objective was to analyze enhancement characteristics of insulinomas and to determine the ability of multiphase CT to localize these tumors. MATERIALS AND METHODS: Prospective interpretations of multiphase helical CT scans were reviewed in 30 patients who had insulinomas resected over a 5-year period. CT scans were retrospectively reviewed to determine enhancement characteristics, tumor conspicuity in each phase of enhancement, and potential causes for false-negative findings. RESULTS: Sixty-three percent (19/30) of tumors were identified on CT prospectively. An additional six tumors were visualized in retrospect, allowing characterization of 25 (83%) of 30 tumors. Most tumors were hyperdense on at least one phase (n = 19), three tumors were hypoattenuating, and three were isodense and pedunculated. Insulinomas were most conspicuous on the early phase in 15 patients and in the portal venous phase in three. All tumors that underwent pancreatic phase imaging were seen (13/13), whereas three of 18 arterial and six of 25 portal venous phase findings were inconclusive for tumor. In the six examinations with false-negative findings in which the tumor could be seen in retrospect, two tumors were isodense and pedunculated, three were in close proximity to vessels, and one had a cystic appearance. CONCLUSION: Multiphasic CT has a moderate sensitivity in the detection of insulinomas. Most tumors are more conspicuous on the earlier phases of enhancement. The pancreatic phase may be more useful than the arterial phase. Potential sources of false-negative results include tumors adjacent to vessels, pedunculated morphology, or nonhyperattenuating lesions.     

外生型肝癌的CT和DSA诊断

目的:探讨外生型肝癌的临床表现、CT表现、DSA供血特点。材料和方法:将26例资料完整外生型肝癌的CT表现与其中8例DSA资料、6例手术资料进行回顾性对照分析。结果:26例中23例主诉有上腹疼痛或隐痛,腹胀、乏力,其中4例主要因腹块就诊,4例有突然剧烈腹痛史,3例体检发现。AFP>500ng/ml20例,23例两对半2-3项异常。CT动脉期23例中20例见肿瘤强化征象;静脉期23例中18例肿瘤呈相对低密度,5例肿瘤密度呈相对增高强化。直径>5cm瘤内有低密度坏死区,门脉主干及分支未见癌栓,26例中24例有肝硬化、脾肿大。8例DSA示肿瘤血供丰富,主要由肝动脉供血,其中2例<5cm肿瘤全部为肝动脉供血并显示蒂;5例>10cm肿瘤80%(4/5)有肝外动脉参与供血,其中左叶4例中3例有胃网膜右动脉参与供血。6例手术病例中2例有蒂,所有病例肝外瘤体均有包膜,4例有陈旧性破裂出血并被膈肌或网膜包裹粘连。结论:外生型肝癌有明显的临床及CT、DSA征象特点,运用这些特点能提高外生性肝癌的诊断正确率。