静脉内平滑肌瘤的CT和MRI表现

目的探讨静脉内平滑肌瘤的影像学特征。方法回顾性分析5例病理证实为静脉内平滑肌瘤患者的临床资料和CT和MRI检查结果。结果 CT上肿瘤盆腔内部分呈不规则形块状或碎屑状,不均匀强化,伴静脉充盈缺损。全部5例肿瘤延伸至下腔静脉,3例经同侧或双侧髂静脉和髂总静脉至下腔静脉,另2例通过卵巢静脉、肾静脉延伸至下腔静脉,1例肿瘤局限于下腔静脉肝下段,4例扩展至右心房。MRI的特征是静脉内流空信号消失,代之以静脉内软组织信号。结论在子宫静脉、髂静脉或卵巢静脉内生长的蠕虫状肿块,可沿下腔静脉漂浮样延伸达心腔和肺动脉是静脉内平滑肌瘤病的显著特征。     

血管平滑肌瘤病影像学评估

目的 探讨血管平滑肌瘤病的影像学表现.资料与方法 分析6例手术病理证实的血管平滑肌瘤病的影像学表现.结果 5例肿瘤起自子宫端,1例局限在下腔静脉内.3例经下腔静脉延伸到右心房,其中1例经右心房到右心室.6例CT显示下腔静脉和/或卵巢静脉扩张,1例左肾静脉扩张.增强后表现为血管内和右心腔内充盈缺损,呈"血管内血管"征;肿瘤自身可呈不均匀强化.2例MRI显示腔静脉扩张,流空效应消失.结论 CT和MRI能提示血管平滑肌瘤病.     

子宫体外平滑肌瘤的CT、MRI影像表现(附57例分析)

目的探讨子宫体外特殊部位平滑肌瘤的CT、MRI影像学特点。方法回顾性分析57例经手术病理证实的子宫体外平滑肌瘤的术前CT、MRI影像学表现。结果子宫旁平滑肌瘤48例,发生于阔韧带、宫颈、膀胱、阴道、圆韧带、卵巢、输卵管、尿道、直肠旁间隙和盆壁,影像学表现为相应部位与子宫肌瘤特点相似的软组织肿物;腹膜后平滑肌瘤3例,表现为腹膜后、肾门水平密度均匀或不均匀的软组织肿物;腹膜播散性平滑肌瘤病2例,表现为腹膜及肠系膜多发边界清晰、密度均匀的软组织结节及肿物;良性转移性平滑肌瘤4例,为肺内多发大小不等的软组织结节,形态与恶性肿瘤肺转移无差异。结论子宫体外平滑肌瘤影像学表现尤其是MRI具有特点,合并子宫肌瘤或者既往有子宫肌瘤手术史,可提示诊断,但最终确诊仍需依赖手术病理。     

食管平滑肌瘤的影像学表现

目的：探讨食管平滑肌瘤的影像学诊断和鉴别诊断。方法：回顾性分析经手术病理证实24例食管平滑肌瘤的影像学表现。结果：常规食管X线钡餐造影示腔内型16例。表现为圆形或半圆形充盈缺损,腔外型8例,表现为局部轻度受压。其中21例行CT检查,显示圆形和椭圆形及马蹄型肿块,增强扫描呈均匀强化。16例行MR扫描显示肿块,矢状位和冠状位肿块与食管关系密切。结论：食管平滑肌瘤X线钡餐造影检查是首选检查方法,但有时定性诊断较难,CT与MRI扫描能确定肿瘤大小、范围、性质及与其他病变鉴别。     

消化道平滑肌类肿瘤的X线钡餐造影与CT诊断

目的：探讨胃肠道平滑肌类肿瘤的X线钡餐造影表现与CT特征以及平滑肌瘤与平滑肌肉瘤鉴别诊断中的一些问题。资料与方法。搜集经手术病理证实的胃肠道平滑肌类肿瘤15例，包括平滑肿瘤11例，平滑肌肉瘤4例，13例行胃肠道气钡双重造影检查，6例行螺旋CT平扫及双期增强扫描。结果：4例食管平滑肌瘤包括腔内型和腔外型各2例，X线钡餐造影表现为腔内充盈缺损和粘膜皱襞受压推移，3例边缘呈“屋檐征”，9例胃部平滑肌类肿瘤包括腔内型5型，腔外型和腔内外型各2例，X线钡餐造影表现为腔内充盈缺损，4例胃平滑肿瘤（4／7）有“桥”形皱襞形成，CT表现为腔内或腔内外软组织肿块影，1例胃平滑肌瘤密度均匀，2例平滑肌肉瘤密度不均匀，2例小肠平滑肌肉瘤均为腔内外型，CT扫描表现为小肠区多个不规则肿块，密度不均匀。结论：X线钡餐造影是胃肠道平滑肌类肿瘤基本的首选检查方法，CT作为重要的补充检查特别是对于腔外型和腔内外型病变，二者结合使用弥补了单一方法的不足，提高了对胃肠道平滑肌类肿瘤的诊断价值，并对平滑肌瘤和平滑肌肉瘤鉴别诊断有较大帮助。     

下腔静脉内平滑肌瘤病影像表现的四例资料分析

静脉内平滑肌瘤病(intravenous leiomyomatosis,IVL)是罕见的沿静脉血管生长的平滑肌瘤,起源于子宫静脉壁内的平滑肌细胞或子宫壁内的平滑肌瘤细胞,一般通过盆腔静脉或卵巢静脉向下腔静脉生长,并向右心房腔内延伸.     

良性转移的平滑肌瘤的CT表现

目的:探讨良性转移性平滑肌瘤的影像学表现。方法:回顾性分析12例子宫外平滑肌瘤的CT表现,并与病理结果进行对照分析。结果:所有病例均有子宫平滑肌瘤手术史。1例播散性腹膜平滑肌瘤病表现为肝脏、脾脏、腹膜及盆腔多发结节。1例静脉内平滑肌瘤病并发腹腹后转移,CT示髂静脉及下腔静脉扩张,增强扫描示腔内充盈缺损。3例腹膜后转移,表现为腹膜后单发囊实性结节或囊性结节,增强扫描示强化不均或囊壁强化。2例肺转移分别表现为多发囊性结节和囊实性肿块,增强后囊壁强化均匀或不均。4例寄生性平滑肌瘤表现为盆腔内与子宫相隔多发实性肿块,平扫呈等密度,强化均匀。1例腹壁平滑肌瘤表现为腹壁囊实性肿块,增强后强化不均匀。结论:有子宫平滑肌瘤手术病史的女性,出现局部病变或转移性病变时,应考虑到子宫平滑肌瘤转移可能。     

颅内海绵状血管瘤的CT、MRI与DSA对比研究

目的：探讨CT、MRI、DSA对颅内海绵状血管瘤的诊断价值。方法：经手术病理证实的颅内海绵状血管瘤27例(脑内型22例，脑外型5例)，其中9例行CT扫描，24例行MRI检查，10例行DSA检查．分别分析其影像学表现。结果：颅内海绵状血管瘤的CT表现为稍高密度影，MRI表现为混杂信号团块，DSA检查未见异常染色。结论：颅内海绵状血管瘤的MRI表现比较有特异性，综合CT、MRI和DSA所见有利于正确的诊断。     

胃肠道平滑肌类肿瘤的气钡双重造影与CT诊断对照研究

目的通过对胃肠道平滑肌类肿瘤的气钡双重造影与CT诊断对照研究分析，探讨胃肠道平滑肌瘤与平滑肌肉瘤的诊断及鉴别诊断中的一些问题。资料与方法收集经手术病理证实的胃肠道平滑肌类肿瘤20例，包括平滑肌瘤14例，平滑肌肉瘤6例。20例均行胃肠道气钡双重造影检查，10例行螺旋CT平扫及双期增强扫描。结果6例食管平滑肌瘤包括腔内型和腔外型各3例，气钡双重造影表现为腔内充盈缺损和黏膜皱襞受压推移，4例边缘呈“屋檐征”。11例胃部平滑肌类肿瘤包括腔内型7例，腔外型和腔内外型各2例，气钡双重造影表现为腔内充盈缺损，CT表现为腔内或腔内外软组织块影。3例小肠平滑肌肉瘤包括腔内型1例及腔内外型2例，CT表现为小肠区多个不规则肿块，密度不均匀。结论气钡双重造影是胃肠道平滑肌类肿瘤基本的首选检查方法，CT作为重要的补充检查特别是对于腔外型和腔内外型病变，二者结合使用弥补了单一方法的不足，提高了对胃肠道平滑肌类肿瘤的诊断价值，并对平滑肌瘤和平滑肌肉瘤鉴别诊断有较大帮助。     

胃肠道间质瘤的影像学诊断

目的:探讨CT、MRI和DSA对胃肠道间质瘤(GIST)的诊断价值。方法:对经病理证实的19例GIST的影像学表现进行回顾性分析。其中17例行CT检查(1例同时行MRI,另1例合并肝转移瘤者同时行DSA),2例行DSA检查。结果:19例中肿瘤发生于胃6例,小肠10例,直肠2例,小肠系膜1例;恶性17例,潜在恶性2例;最大径小于5 cm者 4例。CT表现(17例):肿瘤向腔外生长12例,呈分叶状14例,肿瘤内有多发低密度区12例,肿瘤呈中度或明显强化16 例。MRI表现(1例):肿瘤于T1WI呈等、低信号,T2WI呈高信号为主的混杂信号,双期增强扫描示肿瘤静脉期强化较动脉期显著。DSA表现(3例):肿瘤血管丰富,供血动脉增粗,引流静脉提前显影。结论:CT、MRI是GIST的主要影像学检查方法,肿瘤有分叶或多灶性坏死征象可提示恶性或潜在恶性诊断,对于小于5 cm GIST的良恶性判断,该征象可能有更大价值。DSA对GIST的诊断有一定价值。     

电子束CT诊断主动脉-肺动脉间隔缺损的价值

目的评价电子束CT（EBCT）对主动脉．肺动脉间隔缺损（APSD）及其合并畸形的诊断价值。方法7例APSD患者，年龄1～13岁。均行X线平片、超声心动图及EBCT检查。心电门控EBCT血管造影采用270mg I／ml非离子型对比剂碘海醇，层厚1．5～3．0mm。其中3例行心血管造影检查，2例有手术对照。将同一患者的各项影像学检查结果及手术所见进行比较并分析。结果7例主-肺动脉间隔缺损EBCT全部诊断，2例经手术证实；3例经心血管造影检查证实；超声心动图仅检出2例。同时，EBCT检查示4例合并右肺动脉起源异常、主动脉弓离断；5例合并动脉导管未闭，均经手术和（或）造影证实；超声心动图检查漏诊右肺动脉起源异常2例，漏诊主动脉弓离断2例；心血管造影漏诊动脉导管未闭1例。结论X线平片、超声心动图、心血管造影及EBCT综合影像诊断是必要的，作为无创性检查方法，EBCT在主动脉-肺动脉间隔缺损及其合并畸形诊断有重要价值。     

Tumors of the cardiac valves: imaging findings in magnetic resonance imaging, electron beam computed tomography, and echocardiography

We describe the findings from various cross-sectional imaging modalities in patients with cardiac valve adherent masses. The techniques are discussed, and imaging findings are compared with the results of cardiac surgery. All three patients had neurological symptoms and/or cardiac murmurs. Transthoracic and/or transesophageal echocardiography revealed the cardiac mass in all three. For differentiation of thrombus and cardiac neoplasm magnetic resonance imaging (MRI) was also performed in all three patients and electron-beam computed tomography (EBCT) in two. Fast segmented cine gradient-echo MRI techniques provided mass depiction in all patients, while T1-weighted spin-echo imaging failed in mass detection in one patient. None of the patients showed evidence of valve regurgitation or stenosis in flow sensitive cine MRI. EBCT excluded mass calcifications in both patients and reliably demonstrated the valve attached lesions. Although echocardiography is the modality of choice in evaluating cardiac masses and especially valve attached masses, MRI and EBCT provide additional information about tissue characteristics and allows an excellent overview of the cardiac and paracardiac morphology. Fast segmented cine gradient-echo MRI is especially able to depict even small tumors attached to rapidly moving cardiac valves, and valve competence can be easily assessed within the same examination. Received: 17 December 1998; Revision received: 1 June 1999; Accepted: 10 August 1999     

威廉斯综合征合并心血管畸形的影像诊断

目的 探讨威廉斯(Williams)综合征合并心血管畸形的影像诊断方法.方法 13例Williams综合征患者,均行体检、心电图、X线胸片及超声心动图检查.3例行电子束CT、8例行心血管造影检查.结果 12例患者因发现心脏杂音而就诊,1例因出生后紫绀而就诊.7例伴有"小精灵"面容同时合并轻度智力障碍,4例生长发育迟缓,所有患者均伴有主动脉瓣上狭窄,6例合并肺动脉狭窄,2例合并动脉导管未闭,2例合并重度肺动脉高压,1例合并完全型心内膜垫缺损.8例行心血管造影患者中,2例分别于造影即将结束时和造影完毕返回病房留观时发生心源性猝死.结论 心血管造影是诊断Williams综合征合并心血管畸形的金标准,但其为有创检查,有发生猝死的危险,可尝试用无创或少创的诊断方法替代心血管造影.     

Uterine artery embolization (UAE) for diffuse leiomyomatosis of the uterus: clinical and imaging results

Purpose

The aim of the current study was to evaluate the efficacy of uterine artery embolization (UAE) in the management of diffuse uterine leiomyomatosis with mid-term follow-up.

Materials and methods

All patients who underwent UAE between 2008 and 2010 for symptomatic fibroids were analyzed. Among 360 cases, a total of 7 patients with diffuse uterine leiomyomatosis diagnosed based on MRI were included in this retrospective study. Patient ages ranged from 29 to 38 (mean 32.7) years. The median follow-up period was 16 (range; 6–31) months. The embolic agent was non-spherical polyvinyl alcohol particles. All patients underwent follow-up MRI at 3 months after UAE. Uterine volumes were calculated using MRI. Menorrhagia symptom changes were assessed at mid-term follow-up.

Results

There were no technical failures to catheterize the uterine artery and no adverse events requiring therapy after UAE. Contrast-enhanced MRI showed complete necrosis of the leiomyomatous nodules in 5 patients (71%) 3 months after embolization. Two patients (28%) showed mostly leiomyomatous nodules that were necrotized, some of which were still viable. All 7 patients with menorrhagia had improvement of symptoms at the mid-term follow-up. The initial mean uterine volume was 601.30 ± 533.92 cm³ and was decreased to a mean of 278.81 ± 202.70 cm³ at 3 months follow-up, for a mean uterus volume reduction rate of 50.1% (p < 0.05). One patient became pregnant 5 months after UAE treatment.

Conclusion

UAE was a highly effective treatment for diffuse uterine leiomyomatosis with mid-term durability and may be a valuable alternative to hysterectomy.     

原发性肺动脉肿瘤的影像学诊断

目的：探讨原发性肺动脉肿瘤临床及影像学特点。方法：对3例经手术、病理证实的原发性肺动脉肿瘤（良性间叶细胞瘤、恶性间叶细胞瘤及纤维肉瘤各1例）进行回顾性分析。3例均经胸部X线平片、电子束CT（EBCT）、核素肺灌注显像、超声心动图及肺动脉造影进行检查。结果：2例EBCT检查作出正确诊断，其中1例其他影像学检查均考虑肺动脉栓塞；另1例所有影像学检查均误诊为肺动脉栓塞。结论：原发肺动脉肿瘤非常少见，临床无特异性，诊断困难。X线平片、CT及肺动脉造影均有其相应的征象，但均为非特异性，综合影像学检查是必要的。     

先天性肺静脉异位连接的电子束CT诊断

目的 探讨电子束ＣＴ对肺静脉异位连接的诊断价值。方法 对１４例ＥＢＣＴ诊断的肺静脉异位连接进行回顾性分析。ＥＢＣＴ检查采用增强单层容积扫描,层厚为３ｍｍ,扫描时间为１００毫秒,所用对比剂为非离子型碘对比剂。所有患者均行表面阴影显示法进行三维重建。所有病例均行超声心动图检查。其中８例行心血管造影检查,有２例尚有手术病理对照。结果ＥＢＣＴ诊断完全型肺静脉异位连接１０例,其中心上型６例,心脏型４例;心血     

Intravenous leiomyomatosis of the uterus extending through the inferior vena cava into the right cardiac cavities

Intravenous leiomyomatosis (IVL) is a rare neoplastic condition characterised by nodular masses of histologically benign smooth muscle growing within veins. In most cases, the disease is confined to the pelvic veins, but involvement may extend to the inferior vena cava (IVC) and right heart chamber. We present an unusual case of uterine leiomyoma that progressed along the IVC into the right atrium (RA) and right ventricle (RV). Various radiology modalities are available for the preoperative diagnosis of IVL. She was operated successfully through the first step of two-stage approach, failed to be resuscitated because of brain death secondary to severe right heart failure.     

Osteosarcoma of the lumbosacral spine invading the central venous pathways,right-sided cardiac chambers,and pulmonary artery

We report an unusual case of lumbosacral osteogenic sarcoma with cauda equina syndrome and invasion into the central venous and cardiac system. A 41-year-old Hispanic man presented to the emergency department complaining of severe low back pain, cauda equina syndrome, bilateral lower extremity edema, and an extra heart sound on physical examination. CT of the lumbosacral spine done in the emergency department demonstrated a sclerotic lesion in the sacrum with cortical destruction, extension into the spinal canal and a bulky soft tissue mass containing calcifications. Supplemental MRI demonstrated marrow replacement of L4, L5, and the sacrum, soft tissue extension of the tumor, and invasion iliac veins extending into the IVC; however, the full extent of the intravascular tumor was not seen on this examination. Surgical laminectomy and biopsy of the spinal tumor provided the diagnosis of osteogenic sarcoma. A transthoracic echocardiogram was performed while the patient was recovering due to nonsustained ventricular tachycardia, which showed an echogenic mass within the right atrium and ventricle. CT pulmonary angiogram confirmed the echocardiogram showing a tumor extending through the pulmonary valve into the main pulmonary artery. The patient underwent en bloc resection of the tumor from the venous and cardiac systems. Histologic examination of the tumor confirmed osteogenic sarcoma. While vertebral osteogenic sarcoma is uncommon, invasion of the spinal canal is common in these tumors. However, tumor extending into the central venous and cardiac system is rare. The previously reported cases of central venous and cardiac involvement have been related to distant metastases or primary cardiac osteosarcomas. There is only one other reported case of direct extension into the venous system by an iliac bone osteosarcoma in an adolescent; however, the tumor did not extend into the pulmonary circulation.     

原发性非黏液瘤性良性心脏心包肿瘤的影像学评价

目的分析原发性非黏液瘤性良性心脏心包肿瘤的影像学特征,评估几种常用的影像学诊断方法的主要优势及局限性。资料与方法搜集1979年1月～2004年3月间经手术及病理证实的原发性非黏液瘤性良性心脏心包肿瘤44例,其中接受电子束CT(EBCT)检查者20例,MRI检查者16例。结果X线平片示异常31例;超声心动图(UCG)定位诊断正确31例;EBCT和MRI定位诊断全部正确,其中EBCT定性准确9例(脂肪瘤4例,淋巴管瘤和心包囊肿各2例,血管瘤1例),MRI定性准确9例(脂肪瘤5例,纤维瘤和囊肿各2例)。结论X线胸片适合作为常规检查,UCG可作为首选初查且对心腔或心包腔内的肿瘤诊断准确率高,结合MRI高度的软组织分辨率和EBCT优良的空间、时间分辨率,可对大部分良性肿瘤进行组织学推断。