MR乳腺线圈对腋窝淋巴结的评价

目的　研究正常与异常乳腺腋窝淋巴结的MRI表现 ,探讨MR乳腺线圈对术前乳腺癌腋窝淋巴结转移的评估。方法　应用MR乳腺线圈对 2 4例健康志愿者、2 3例乳腺良性疾病患者和 43例乳腺癌患者共 119个腋窝进行扫描 ,对比分析MRI片内各组腋窝淋巴结的形态、边缘、大小、数目和信号变化 ,并将乳腺癌组淋巴结表现与组织病理学结果进行对照。结果　 3 1.2 5 %的正常健康人腋窝可以检出淋巴结 ,乳腺良性疾病、乳腺癌腋窝淋巴结无转移者 (LN -)淋巴结的形态、边缘、大小、数目和信号变化与正常健康人无显著差异 ,乳腺癌腋窝淋巴结转移者 (LN + )淋巴结的形态、边缘、大小和强化方式与前三者有显著差异。结论　MRI是术前评估腋窝淋巴结状态的有效检查方法 ,为临床手术和治疗提供有价值的依据     

腋窝淋巴结分析在乳腺疾病诊断中的价值

目的 探讨乳腺X线摄影中腋窝淋巴结特点对于乳腺疾病诊断的价值.方法 对乳腺疾病患者行乳腺X线摄影检查,筛选出腋窝淋巴结显影者46例,其中乳腺癌20例,良性病变26例,比较显影淋巴结的位置、数目、大小、密度、形态.结果 26例乳腺良性疾病的腋窝淋巴结有16例单侧显影,10例双侧显影,数目2枚以上多发者15例,直径≥1 cm者13例,高密度6例,中等密度20例,所有淋巴结边缘均未见分叶改变;20例乳腺癌的腋窝淋巴结有12例为双侧显影,8例单侧显影,15例多发,直径≥1 cm者13例,高密度16例,边缘分叶状改变4例,实心圆12例.2组间的淋巴结在密度上有显著统计学差异,在位置、数目、大小上无统计学意义.同时在形态上乳腺癌的腋窝淋巴结以分叶和实变占明显优势.结论 腋窝淋巴结的密度和形态与乳腺疾病的良恶性有一定的相关性,可以作为2类疾病鉴别诊断的辅助指标.     

乳腺癌腋窝淋巴结的乳腺X线摄影评价

目的探讨乳腺X线摄影对判断乳腺癌腋窝淋巴结有无转移的价值。资料与方法搜集39例乳腺癌患者根治术后422枚腋窝淋巴结,用数字乳腺X线机对每例患者根治术后的腋窝淋巴结按大小顺序编号后行乳腺X线摄影,然后逐一行组织病理学检查,分析淋巴结的影像学表现并与其病理结果对照。结果转移淋巴结114枚,非转移淋巴结308枚。淋巴结长径≥12 mm时,两者分别为60枚、92枚;淋巴结短径≥8 mm时,两者分别为73枚、103枚;长×短径值≥130 mm2时,两者分别为66枚、52枚。两者类圆形分别为10枚、41枚;类椭圆形分别为42枚、133枚;不规则形分别为62枚、134枚。淋巴结内有脂肪密度者24枚、202枚;淋巴结有融合者分别为41枚、10枚。结论两组淋巴结在长径、短径、长×短径值、密度及有无融合方面经χ2检验差异有统计学意义,形状方面差异无统计学意义。乳腺X线摄影对判断乳腺癌腋窝淋巴有无结转移有一定价值。但在实际工作中,对临床指导意义有限。     

高频超声与X线钼靶对早期乳腺癌的诊断价值

目的 分析比较高频超声、X线钼靶单独及两者联合应用对早期乳腺癌的诊断价值.方法 体检发现乳腺包块、怀疑乳腺肿瘤的258例患者,行高频超声、X线钼靶的单独检查和联合检查,并行手术治疗.对照分析手术病理与影像学表现.结果 258例患者,手术病理证实早期乳腺恶性肿瘤135例,良性乳腺肿瘤123例.对于诊断早期乳腺癌,联合检查的敏感性优于单独的高频超声检查或X线钼靶检查(P<0.05),准确性优于X线钼靶检查(P<0.05),特异性、阳性预测值、阴性预测值、假阳性、假阴性等指标3组间均无显著差异(P均>0.05).对于早期乳腺癌患者,高频超声和X线钼靶相比,检出的钙化灶较少(18.3% vs 36.5%,P<0.01),能够发现更多的乳腺癌腋窝淋巴结转移(69.0% vs 33.3%,P<0.01).结论 高频超声与X线钼靶的单独和联合检查对于早期乳腺恶性肿瘤均为可靠的影像学诊断方法,联合应用诊断早期乳腺癌具有较高的敏感性和准确性.     

乳腺肿块的钼靶X线诊断与病理基础分析

目的:探讨乳腺良恶性肿块的钼钯X线表现及诊断价值。方法:对经病理证实为乳腺恶性肿块32例和良性肿块20例患者的钼靶X线表现进行回顾性分析。结果:对肿块大小、形态、边缘、钙化、血运、腋窝淋巴结等情况进行综合分析,恶性肿块表现:X线测量值小于临床触诊值26例(81.3%),形态不规则27例(84.4%),边缘不清26例(81.3%),毛刺征21例(65.6%),簇状微钙化18例(56.3%),血运增多11例(34.4%),同侧腋窝淋巴结肿大12例(37.5%);良性肿块表现:X线测量值近似临床触诊值17例(85.0%),形态规则13例(65.0%),边缘清楚17例(85.0%),毛刺征2例(10.0%),粗大钙化3例(15.0%),血运增多2例(10%),同侧腋窝淋巴结肿大2例(10.0%)。结论:钼靶X线对乳腺良恶性肿块的鉴别诊断有重要的应用价值。     

乳腺癌X线特征与VEGF—C表达及肿瘤腋窝淋巴结转移的相关性研究

目的 研究乳腺癌X线征象与肿瘤组织血管内皮生长因子 C( VEGF C)表达及腋窝淋巴结转移的相关性. 资料与方法 分析105例乳腺癌及腋窝淋巴结的X线征象,利用免疫组织化学染色检测标本中VEGF C的表达水平,分析乳腺癌某些X线征象与VEGF C表达及腋窝淋巴结转移的关系. 结果 VEGF C的过表达与腋窝淋巴结转移密切相关(P＜0.05);乳腺癌X线征象中:肿瘤≥2 cm、边缘有"毛刺征"及血管影增多、增粗组中VEGF C阳性表达率及腋窝淋巴结转移率分别较＜2 cm、无"毛刺征"和血管影正常组高(P＜0.05);转移性腋窝淋巴结主要表现为"门"结构消失及实质厚度不均匀(P＜0.05)等. 结论 通过乳腺癌的X线征象可以评价其组织中VEGF C的表达水平及腋窝淋巴结的状态,乳腺癌腋窝淋巴结转移主要表现为淋巴结结构的改变,当腋窝淋巴结发生实变、实质厚度不均时,可疑为转移性淋巴结.X线对判断乳腺癌腋窝淋巴结转移有明显优势.     

原发性乳腺淋巴瘤的影像表现

目的 探讨乳腺X线摄影、超声检查和磁共振成像(MRI)联合的多模态影像模式对原发性乳腺淋巴瘤的诊断价值。方法 选取14例经手术或病理证实的原发性乳腺淋巴瘤的影像资料，分析和总结其乳腺X线摄影、超声检查和MRI的特征性表现。结果 14例患者中13例为单侧乳腺单发病灶，1例为双侧乳腺多发病灶，9例伴腋窝肿大淋巴结。9例患者行乳腺X线摄影检查，均未见毛刺征及钙化，7例表现为肿块影，边缘模糊或部分模糊，1例表现为非对称致密，1例病灶未能显示。13例患者行超声检查，均表现为以低回声为主的高低混杂回声，无后方回声衰减，边缘清晰，质地较软，彩色多普勒可见内部或周边丰富血流信号。7例患者行MRI检查，表现为T₁WI低信号，抑脂T₂WI高信号或稍高信号，信号较均匀，动态增强早期明显均匀强化，DWI明显高信号，ADC值(0.36～0.74)×10^-3mm²/s。肿瘤最大径为1.5cm～14.5cm，中位直径为5cm。结论 原发性乳腺淋巴瘤的超声和MRI表现具有相对特异性，乳腺X线摄影表现缺乏特异性，且常常低估其恶性程度...     

乳腺X线摄影与超声检查对乳腺黏液腺癌诊断价值的比较

目的 探讨X线摄影与超声检查对乳腺黏液腺癌的诊断价值.方法 回顾性收集本院先后行术前X线检查和超声检查,手术治疗并经病理学证实的黏液腺癌22例患者.结果 22例病例中,15例为单纯型黏液腺癌,7例为混合型黏液腺癌;乳腺X线诊断为癌灶者共13例,诊断正确率59.09%,超声诊断癌灶者20例,诊断准确率为90.90%,明显高于X线(P=0.039).结论 乳腺黏液腺癌在乳腺X线及超声影像上有一定特征性表现,但由于其病理学特性的限制,乳腺X线对其诊断的准确性低于超声检查.     

MRI评价乳腺癌腋窝淋巴结转移的价值

目的：探讨 MRI评估乳腺癌腋窝淋巴结转移的应用价值。方法对60例乳腺癌患者进行术前 MRI检查,评价乳腺内肿瘤最大径、瘤体最大信号增强率(SERmax )及同侧腋窝淋巴结的大小、形态、边缘、信号强度和强化方式,并与术后同侧腋窝淋巴结状态进行对照分析。结果60例乳腺癌患者 MRI显示28例同侧腋窝淋巴结有转移,病理证实22例腋窝淋巴结有转移。MRI 检出腋窝淋巴结转移的灵敏度、特异度、准确率为90.91%、78.95%、83.33%。57例同时行超声检查,超声检查诊断淋巴结转移的灵敏度、特异度、准确率分别为59.09%、94.29%、80.70%。腋窝淋巴结转移组淋巴结大小(1.20±0.59)cm,无转移组淋巴结大小(0.85±0.24)cm,2组间腋窝淋巴结大小差异有统计学意义(t=3.258,P=0.001<0.05)。腋窝淋巴结无转移与有转移组间乳腺内肿瘤 SERmax值差异有统计学意义(t=4.167,P=0.000<0.05),转移组 SERmax值大于无转移组。转移性淋巴结多表现为形态不规则,边缘不规整,信号强度及强化不均匀。结论乳腺 MRI能在检出乳腺癌的同时全面评价腋窝淋巴结,是术前评估腋窝淋巴结状态的有效检查方法。     

乳腺非霍奇金淋巴瘤X线摄影及CT表现

目的分析8例乳腺NHL的影像学表现,提高对本病影像学表现的认识。方法回顾性分析经病理证实的8例患者X线摄影及CT资料,乳腺为首发部位者5例。非首发部位者3例。X线摄影及CT增强扫描各4例,超声检查5例。结果 X线摄片4例均表现为单发结节或肿块,大小为25～60mm。肿块边界清楚3例。边缘不清楚者1例。增强CT扫描4例中,3例表现为一侧乳腺密度弥漫性增高,皮肤增厚,伴皮下脂肪层消失或部分消失及乳后间隙模糊。1例则显示乳腺单发肿块,40mm×45mm大小,前缘清楚,后缘部分模糊。增强扫描4例中病灶均可见不均匀轻度强化。所有病例未见毛刺或微细钙化。结论乳腺NHL影像学表现缺乏特异性,最终依赖病理组织学检查。若乳腺影像学检查发现结节、肿块或一侧乳腺密度普遍增高,伴皮肤增厚又无钙化及毛刺等表现时,应考虑乳腺淋巴瘤可能,及时行穿刺或切除活检,有利于临床选择适宜治疗方案。     

小乳癌的数字化乳腺摄影与超声成像对比研究

目的探讨数字化乳腺摄影与彩色多普勒超声对小乳癌及腋淋巴结转移的诊断价值。方法60例≤2.0cm(包括未形成肿块的早期乳腺癌)乳腺结节的数字化影像和超声资料分别由影像和超声医师用双盲法分析,定性诊断,并与病理对照。结果60例中,乳腺癌36例,良性病变24例;发现腋淋巴结96个,45个有转移。数字化摄影和超声在诊断小乳癌的敏感性、准确性及腋淋巴结转移的敏感性方面,二者差异显著(P(0.05);对直径≤1.0cm的病灶,数字化摄影的准确性明显高于超声(P(0.05)。结论对小乳癌及其腋淋巴结的定性诊断方面,数字化摄影为首选,二者结合有利于发现更早期的乳腺癌。     

Value of FNAC in abnormal axillary lymph nodes with non specific mammograms

Objective

This study aimed to evaluate the role of fine-needle aspiration cytology (FNAC) in the diagnosis of abnormal axillary lymph nodes identified in patients with nonspecific mammographic findings.

Role of axillary lymph node ultrasound and large core biopsy in the preoperative assessment of patients selected for sentinel node biopsy

PURPOSE: The aim of this study was to evaluate the diagnostic accuracy of axillary lymph node sonography, if necessary in combination with US-guided large core biopsy, in the preoperative evaluation of breast cancer patients scheduled for quadrantectomy and sentinel lymph node excision. MATERIALS AND METHODS: From July 2001 to December 2002, we evaluated 117 breast cancer patients with ultrasound and, where indicated, FNAB. Breast lesions had diameters between 4 and 26 mm (mean diameter 11 mm). Fifteen (13%) of the 117 patients were excluded from the series as they did not fulfil the criteria for preliminary sonography of the axilla: in 9 patients fewer than 4 nodes were detected and in 6 patients the breast lesions were intraoperatively found to be benign. Eleven patients (10.7 %) with sonographically suspicious axillary nodes were sampled by US-guided core biopsy using a 14 or 16 Gauge Tru-Cut needle. RESULTS: The ultrasound study aims to evaluate the dimensions and morphology of the breast lesion as well as detect and assess at least 4 axillary nodes. These were evaluated for hilar and cortical thickening and ratio between the sinus diameter and the total longitudinal diameter. Lymph nodes with hilar diameters equal to or greater than 50% of the longitudinal diameter were considered normal. Of the 102 patients evaluated, 77 (75.7%) had normal axillary nodes according to the US criteria adopted. Negativity was confirmed by histology in 56 cases (72.7%, true negative); 21 (27.3%, false negative) were found to be positive, in contrast with the sonographic appearance. The false negative cases were due to lymph node micrometastasis which probably did not cause morphologic alterations perceptible at ultrasound. The remaining 25 patients (24.5%) had axillary lymph nodes classified as suspicious. In 13 cases of (52%, true positive) there was agreement with histology, whereas in 12 cases (48%, false positive) the US suspicion was not confirmed at surgery. The most important sonographic alteration was the gradual reduction in hilar echogenicity (seen in 100% metastatic nodes); conversely, hilar denting or irregularities, as well as dimensional criteria, proved to be poorly specific. CONCLUSIONS: The sonographic assessment of axillary and internal mammary chain nodes, possibly in addition to core biopsy, improves the preoperative evaluation of breast cancer patients scheduled for conservative surgery of the breast (quadrantectomy) and the axilla (sentinel node biopsy). US findings suspicious for metastatic involvement of axillary lymph nodes should be considered as an exclusion criterion for sentinel node biopsy. A more widespread use of axillary node biopsy and an accurate sonographic evaluation of the excised lymph node increase the specificity of the procedure, allowing a better correlation between sonographic findings and definitive histology.     

淋巴结反应性增生的CT诊断

目的分析淋巴结反应性增生的CT表现及CT的诊断价值。方法回顾性分析13例经手术及病理证实的淋巴结反应性增生的CT表现。结果13例淋巴结反应性增生中,单独侵犯颈外侧淋巴结7例,同时侵犯颈外侧区及面淋巴结、颏下淋巴结各2例,1例侵犯腋窝及腹股沟淋巴结,1例为颈、腋、纵隔、腹膜后区和腹股沟淋巴结同时肿大。肿大淋巴结短径最小0.6 cm,最大2.6 cm,平均1.6 cm。肿大淋巴结孤立存在12例,仅1例有融合。1例因相互融合而密度不均,12例密度均匀并有明显强化,增强后CT值增加19.1~113.2 HU,平均59.1 HU。结论淋巴结反应性增生的CT表现有一定的特征性,CT检查对该病的定性诊断与鉴别诊断具有重要价值。     

腋窝淋巴结移植的应用解剖

目的通过对腋窝淋巴结血供的研究,探索腋窝淋巴结移植的可行性。方法用15具(30侧)成人灌注乳胶的尸体,观察了腋窝各群淋巴结的血供及数量,测量了营养各群淋巴结的血管口径和血管干长。结果外侧群淋巴结数量为(3.16±1.72)个,血供属多源性且不恒定;前群淋巴结数量为(3.83±1.79)个,营养血管主要为胸外侧动脉的分支,其外径(1.04±0.42)mm,干长(29.5±12.25)mm;后群淋巴结数量为(2.38±0.97)个,血管来源于肩胛下动脉的淋巴结支,其外径为(0.78±0.32)mm,干长(18.78±8.67)mm;中央群淋巴结数量为(4.05±1.95)个,血管来源于腋动脉的分支,其外径均在1 mm以下,干长20 mm以上;尖群淋巴结数量为(2.82±1.96)个,营养血管为胸肩峰动脉的分支,外径为(0.79±0.29)mm,干长(10.60±4.13)mm。结论腋窝淋巴前群为吻合血管淋巴结移植的理想供区。     

Breast MRI for evaluating patients with metastatic axillary lymph node and initially negative mammography and sonography.

OBJECTIVE: We wanted to investigate the ability of breast MR imaging to identify the primary malignancy in patients with axillary lymph node metastases and initially negative mammography and sonography, and we correlated those results with the conventional imaging. MATERIALS AND METHODS: From September 2001 to April 2006, 12 patients with axillary lymph node metastases and initially negative mammography and sonography underwent breast MR imaging to identify occult breast carcinoma. We analyzed the findings of the MR imaging, the MR-correlated mammography and the second-look sonography. We followed up both the MR-positive and MR-negative patients. RESULTS: MR imaging detected occult breast carcinoma in 10 of 12 (83%) patients. Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively). In nine out of 10 patients, the MR-correlated mammography and second-look sonography localized lesions that were not detected on the initial exam. All the non-MR-correlated sonographic abnormalities were benign. CONCLUSION: Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes. Localization of the lesions through MR-correlated mammography and second-look sonography is practically feasible in most cases.     

Mammographic features of hidradenitis suppurativa axillaris

The mammographic features of hidradenitis suppurativa axillaris, a common clinical entity, are described for the first time in this report. Lucent axillary masses with a small central density appear to be a pathognomonic radiographic finding. Other entities seen on mammography such as lipomas, lucent galactoceles, traumatic oil cysts, axillary hibernomas and benign lymph nodes, should not be confused with hidradenitis suppurative axillaris.     

基于CT增强图像的影像组学模型评估乳腺癌腋窝淋巴结转移

目的:探讨基于CT增强图像的影像组学在评估乳腺癌腋窝淋巴结转移方面的临床应用价值.方法:回顾性分析402例乳腺癌患者(共825枚短径≥5 mm腋窝淋巴结)的CT增强图像.在每个淋巴结的最大层面勾画ROI,使用AK软件提取淋巴结的纹理特征.对两位医师分别提取的100个淋巴结的纹理特征进行一致性分析.分别采用单因素方差分析...     

Computed tomographic features of appendiceal serositis in pelvic inflammatory disease: comparison with pathological findings

OBJECTIVE: The purpose of this study was to describe the computed tomographic (CT) features of the appendiceal serositis in women with pelvic inflammatory disease and to compare these with the pathological findings. METHODS: Appendiceal serositis was pathologically evaluated in patients with pelvic inflammatory disease who underwent surgery within 3 days of computed tomography. On retrospective review of CT findings, each appendix was evaluated for the following characteristics: location relative to the cecum, maximal diameter, morphology of wall thickening, contrast enhancement, and presence of appendicolith and cecal wall thickening. The presence of fatty infiltration of the periappendiceal fat, mesentery, and omentum was evaluated. The presence of pelvic abscess or ascites, lymph nodes, and paralytic ileus was noted. RESULTS: On pathological review, 10 patients were shown to have appendiceal serositis: mild serositis in 3 patients, moderate in 4, and severe in 3. The maximal appendiceal diameter ranged from 5.4 to 8.9 mm (mean diameter, 7.1 +/- 0.9 mm). Diffuse wall thickening with collapsed lumen was detected in 6 patients. Focal wall thickening with intraluminal gas bubbles or an air-fluid level was detected in 4 cases. Peripheral rim enhancement of the appendix was detected in 3 patients with focal wall-thickened appendix. There was no association between the feature of appendiceal wall thickening and the pathological severity of serositis. Mesenteric fatty infiltration was detected in 5 patients and omental fatty infiltration in 3 patients. Fatty infiltration of the mesentery and omentum was more commonly presented in patients with severe serositis. Pelvic abscesses, including pyosalpinx, were detected in 7 patients; a small amount of free fluid was seen in 8 patients. CONCLUSIONS: The CT findings of appendiceal serositis are diffuse or focal wall thickening without severe distension, common association with mesenteric fatty infiltration, and pelvic abscesses.