胰腺肿瘤的磁共振成像诊断——与CT、B超对比研究

目的：评价磁共振成像在胰腺肿瘤诊断的价值。方法：本文通过对２５例有手术病理的胰腺病变进行ＭＲ检查，采用自旋回波Ｔ１和Ｔ２加权像对病变进行判断，并与ＣＴ和Ｂ超对比分析。结果：这三种影像方法对胰腺癌的诊断准确率均为７２．７％。胰腺癌的ＭＲ表现，无论在Ｔ１还是Ｔ２加权像上其信号改变无特点，且７８％的胰腺癌信号强度与正常的肝组织和胰腺接近，故ＭＲ无法区别胰腺癌或胰腺其它病变。但在Ｔ１加权像上，由于ＭＲ的组织分辨率高，因而无论是显示胰周脂肪，肠系膜上动静脉有无受侵，还是肝门、脾门、脾静脉有无受侵均较ＣＴ显示更佳。结论：我们认为ＭＲ对于胰腺肿瘤的诊断尚需进一步探讨，但对于判断肿瘤侵犯的范围则有较大的应用价值     

实时超声对胰腺囊性病变的诊断价值

目的：评价超声对胰腺囊性病变的诊断价值。方法：对１７例经手术病理证实的胰腺囊性病变的声像图进行了分析。结果：胰腺肿瘤及假性囊肿的符合率分别为１００％及６７％，前者高于ＣＴ，后者与ＣＴ相似。结论：超声检查对此病的诊断很有价值。     

急性胰腺炎的CT诊断(附93例分析)

目的：评价急性胰腺炎的ＣＴ诊断价值,主要探讨ＣＴ增强扫描及术后复查的重要意义。材料与方法：９３例１２３次急性胰腺炎ＣＴ检查资料回顾分析。结果：９３例中,诊断急性水肿型胰腺炎５３例,急性坏死性胰腺炎４０例,合并胰腺出血２例,合并胰腺脓肿４例,合并假性囊肿８例。９３例中,３６例经手术治疗,其中２例术后死亡。其余５７例经保守治疗,９１例均治愈出院。结论：急性胰腺炎的诊断并不困难,重要的是对其正确的分型,以及早期发现胰腺的出血、坏死。急性胰腺炎手术前后的ＣＴ检查,尤其是ＣＴ增强扫描,不仅可肯定胰腺炎的诊断与类型,而且为临床提供合理的治疗方案及作出预后的判断。     

59例脑动静脉畸形的CT分析

目的：报道并分析脑动静脉畸形的ＣＴ表现,评价ＣＴ诊断脑动静脉畸形的价值。方法：５９例均经脑血管造影证实,２８例行手术治疗,其中２１例经病理证实,４４例作ＣＴ增强检查。结果：显示动静脉畸形本身的２６例,出血３３例,其中１２例同时显示动静脉畸形病变。结论：ＣＴ可准确地显示病变的并发症,还可显示病变本身或出现提示病变的征象,从而作出诊断或提示诊断。     

眼球突出的CT诊断

观察分析眼球突出的ＣＴ表现,探讨眼球突出的病因诊断,材料与方法,对１０５例经手术病理或临床证实的眼球突出的ＣＴ表现进行回顾性分析。结果：眼球突出不仅是眶内病变的常见表现,亦可继发生眶及眶周病变。可由内分泌,肿瘤,炎症及外伤等多种疾病引起。     

彩色多普勒超声诊断胰腺病变分析

目的：本应用彩色多普勒超声诊断胰腺病变。方法：分析38例经手术及病理证实的胰腺病变的超声图像特点。结果：在胰腺病变的诊断和鉴别方面，超声显像是一种重要的检查方法。其特点是不仅对胰腺的物理性质作出准确的判断，而且与临床最后诊断符合率达95％。结论：彩色多普勒超声是诊断胰腺病变的一种有效的方法。     

CT在骨肿瘤定性诊断中的价值(附70例分析)

目的：探讨ＣＴ在骨肿瘤定性诊断中的价值。材料和方法：回顾性分析７０例经手术、病理或临床证实的骨肿瘤ＣＴ资料,其中恶性肿瘤５０例,良性肿瘤和肿瘤样病变２０例,部分病例与平片资料进行对照。结果：在有平片资料的５６例骨肿瘤中,平片定性正确３８例,定性正确率６７９％,ＣＴ结合平片定性正确４９例,定性正确率８７５％。ＣＴ定性的价值在于：①病变检出率高。②显示病变内部结构和骨外软组织肿块清晰。③显示病变的膨胀性和皮质完整性佳。④增强扫描利于确定病变的成份和血供。结论：ＣＴ对骨肿瘤定性有其独到之处,与Ｘ线平片相结合能明显提高定性正确率。     

急性胰腺炎的CT诊断

目的：评价急性胰腺炎的ＣＴ诊断价值。主要探讨ＣＴ增强扫描及术后复查的重要意义。材料与方法：９３例１２３次急性胰腺炎ＣＴ检查资料回顾分析。结果：９３例中,诊断急性水肿型胰腺炎５３例,急性坏死性胰腺炎４０例,合并胰腺出血２例,合并胰腺脓肿４例,合并假性囊肿８例。９３例中,３６例经手术治疗,其中２例术后死亡。其余５７例经保守治疗,９１例均治愈出院。结论：急性胰腺炎的诊断并不困难,重要的是对其正确的分型,     

自身免疫性胰腺炎的CT表现研究

目的：研究自身免疫性胰腺炎（Autoimmune pancreatitis,AIP）的CT表现。方法：回顾性分析11例AIP患者的CT资料,11例均有CT平扫及动态增强扫描资料;分析病变胰腺的部位、形态及节段性AIP的病变胰腺与正常胰腺交界面（本文称作病变胰腺“前端”,前端与病变胰腺最大径之间称为“前段”）特征;定量分析AIP的平扫密度、动态增强扫描时病变胰腺强化模式,并与正常对照组（n=25）进行比较。结果：4例AIP表现为胰腺弥漫性肿大,7例表现为胰腺节段性肿大,病变胰腺长轴均与主胰管一致。7例节段性AIP中：病变前端细小、前段呈圆锥形2例;前端平直、前段呈梯形1例;前端呈圆弧形、前段呈“子弹头”状3例;另1例AIP一侧前段呈“子弹头”状,另一侧前段呈圆锥形。3例节段性AIP的大体外形呈纺缍形或梭形;3例节段性AIP病变胰腺边缘毛糙、中间段稍粗的长柱状;5例AIP呈腊肠状,其中1例为节段性AIP。平扫时11例AIP病变胰腺密度呈均匀的等偏低密度,动态增强扫描11例均呈渐进性强化,动脉期AIP组密度低于对照组,门脉期AIP组密度高于对照组。9例合并胰外病变或/和胰周结构直接侵犯。结论：AIP在CT上有特征性表现,动态增强扫描对其诊断具有重要意义,多数AIP病例可以通过CT检查确诊。     

梗阻性黄疸的CT诊断价值

目的：探讨ＣＴ对梗阻性黄疸的诊断价值。方法：分析４０例经手术和病理证实的梗阻性黄疸病例的ＣＴ表现。结果：①ＣＴ诊断梗阻性黄疸的符合率９５％。②梗阻性黄疽的病因最常见为结石,其次为胆道、胰腺肿瘤。结论：ＣＴ对扩张胆管的部位及病因有较高的诊断率,应作为梗阻性黄疸的首选方法。     

胰腺原发神经内分泌肿瘤MSCT表现

目的：探讨原发胰腺神经内分泌肿瘤的MSCT表现。方法回顾性分析11例经病理证实的胰腺原发神经内分泌肿瘤的CT表现,包括病灶位置、大小、密度、强化特点及与周围血管脏器及胆总管下段及胰管的关系等,是否有低血糖及黄疸等临床症状。结果11例经手术证实的神经内分泌肿瘤病灶（位于胰头4例、胰颈1例、胰体2例、胰尾4例）,病灶大小为1.5～10 cm,平均3.9 cm。11例病人中,功能性神经内分泌肿瘤5例,无功能性神经内分泌肿瘤6例。11例CT平扫检查时病灶呈等低密度,9例增强病人其中7例神经内分泌肿瘤动脉期及静脉期均呈显著强化,静脉期病灶强化程度较动脉期稍减低,与胰腺实质相类似,2例因肿瘤体积较大,内部缺血坏死区无明显强化。结论神经内分泌肿瘤的MSCT具有特征性表现,尤其是多期增强CT检查为鉴别诊断提供更多信息。通过对肿瘤强化方式、病灶与周围器官、组织的关系观察及病灶有无远处转移,对临床拟定合理的治疗方案提供有价值的参考标准,提高胰腺神经内分泌肿瘤的治愈率。     

胰腺囊性病变CT的良恶性鉴别诊断研究

目的：采用螺旋CT系统分析探讨胰腺囊性病变的影像学表现及特征,以资鉴别诊断。材料与方法：回顾性分析33例经手术及病理证实的胰腺囊性病变CT平扫加增强特点,对发病部位、大小、形态和囊性病变内部及周边强化特点、结合患者年龄、性别及临床表现,作为鉴别诊断的依据。结果：本组研究中,先天性囊肿1例,假性囊肿26例,浆液性囊腺瘤3例,黏液性囊腺瘤2例,胰腺癌囊变1例。假性囊肿壁薄,无强化,良性囊腺瘤壁较厚、光整,其内可见分隔及壁结节,囊壁及壁结节轻到中度强化,恶性壁厚薄不均,中度强化并边界模糊。结论：胰腺假性囊肿为最好发的囊性病变,囊性肿瘤具有较特征性CT表现,通过CT平扫加增强可对囊性病变的良恶性作出较为准确的判断。     

胰腺导管内乳头状黏液性肿瘤的MSCT和MRCP诊断

目的 探讨胰腺导管内乳头状黏液性肿瘤 （IPMN）的MSCT和MRCP影像学表现.方法 对26例经内镜或手术病理证实的IPMT患者的CT和MRCP表现进行回顾性分析.结果 分支胰管型IPMN12 例,表现为单发囊性病变或葡萄串样多发囊性病变伴腔内分隔或结节样突起;主胰管型 IPMN 5 例,表现为主胰管扩张伴管壁结节样突起;混合型IPMN 9例,表现为主胰管扩张和囊性病变合并存在.9例手术病理结果为腺瘤1例,交界性肿瘤2例,腺癌6例.结论 MSCT和MRCP对发现和诊断胰腺 IPMN具有较高价值.     

CT virtual pancreatoscopy: a new method for diagnosing intraductal papillary mucinous neoplasm (IPMN) of the pancreas

Background We sought to validate computed tomographic virtual pancreatoscopy (CT-VP) created by multidetector row CT (MD-CT) in the clinical diagnosis of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Methods Five cases of pancreatic IPMNs were included in this study. A nasopancreatic drainage tube was inserted and the pancreatic duct was filled with contrast medium, after which an upper abdominal scan was performed by MD-CT. CT-VP and three-dimensional (3D) CT pancreatographic images were created using a workstation and compared with images by conventional diagnostic techniques. All cases were evaluated by endoscopic retrograde pancreatography (ERP) and three cases of main duct type were assessed by intraoperative real pancreatoscopy (RP). Results In the main duct cases, papillary projections in the main pancreatic duct and branch orifices were clearly detected by CT-VP. These lesions and structures were confirmed by intraoperative RP, and the CT-VP images were clearer than RP images. In branch cases, a surface-rendering method allowed protruding lesions to be clearly detected in the dilated branches. Conclusion Compared with conventional ERP or RP, CT-VP and 3D-CT pancreatographic images were finer in quality, and the procedures were less invasive, faster, and less expensive. The potential shown by CT-VP with 3D-CT pancreatography in the clinical diagnosis of pancreatic IPMNs suggests that this approach may replace ERP in the near future.     

肝泡球蚴病CT与病理对照研究

目的：研究肝泡球蚴病ＣＴ表现与病理改变之间的关系。进一步明确ＣＴ描述的病理学意义及诊断价值。材料与方法：结合１５个患者的１６个病理标本对照观察,分析肝泡球蚴病患者的ＣＴ资料。结果：（Ｆ１）肝泡球蚴病灶内无血供结构,虽含大量密集小囊泡,但ＣＴ主要表现为实性低密度且无强化。（２）伴随钙化最为常见,钙化的范围、分布和异形并存具有特点;（３０液化腔为病灶液化坏死所致,腔内容物ＣＴ值接近水;（４）小囊变灶病     

胰腺损伤的影像学诊断

目的 探讨多层螺旋CT及MRI检查在评价胰腺损伤中的价值.方法 回顾性分析经手术和临床随访证实的10例闭合性腹部外伤致胰腺损伤的CT/MRI表现.男6例,女4例,年龄5～52岁,平均年龄(27.60±12.34)岁.CT检查7例,MRI检查5例,其中2例分别进行了CT和MRI检查.结果胰腺损伤CT/MRI表现为胰腺肿大(CT 5例,MR 2例);胰腺断裂(CT 5例,MR 4例);主胰管断裂(CT 1例,MR 4例);胰腺内/胰周出血(CT 3例,MR 1例);胰腺裂伤(CT 2例,MR 1例);胰周改变 胰周被膜和肾周筋膜增厚以及胰周、肾旁间隙广泛积液(CT 6例,MR 5例);假性囊肿形成(CT 4例,MR 2例);合并腹部其他脏器损伤CT显示肝、肾损伤各1例,脾损伤2例,MR显示脾损伤1例.结论 多层螺旋CT和MRI在胰腺损伤的诊断中有重要价值.     

增强CT联合纹理分析对于胰腺导管内乳头状黏液性肿瘤恶性潜能的预测价值

目的:探讨增强CT图像的纹理分析对胰腺导管内乳头状黏液性肿瘤(Intraductal papillary mucinous neoplasm,IPMN)恶性潜能的预测价值.方法:回顾性收集2010年1月-2019年12月经手术病理证实为分支胰管型IPMN(Branch duct IPMN,BD-IPMN)或混合型IPM...     

多排CT在胰腺内分泌肿瘤诊断中的应用价值

目的 探讨多排CT在胰腺内分泌肿瘤的诊断及区分功能性与非功能性胰腺内分泌肿瘤中的应用价值.方法 回顾性分析经临床和手术病理证实的21例胰腺内分泌肿瘤(功能性16例,非功能性5例)的CT表现,21例均行CT平扫及三期动态增强扫描.结果 21例均为单发,除2例CT平扫及增强均未显示外,其余19例4例发生在胰头、钩突,在胰颈2例,在胰体、胰尾13例;平扫呈等密度(12例)低(4例)及混杂密度(3例);三期动态增强扫描,动脉期明显强化(16例),门脉期持续强化(13例)或呈等密度(3例).结论 胰腺内分泌肿瘤有较为典型的多排CT表现,结合有特征性的影像学表现能够为术前诊断提供依据.     

肝脏炎性假瘤的动态增强CT及MR扫描(附17例分析)

目的:探讨肝脏炎性假瘤的CT、MR表现特点及其诊断价值。材料与方法:回顾性分析17例肝脏炎性假瘤的临床资料及CT、MR动态增强扫描表现,对其影像表现和病理学检查结果进行对照。结果:17例患者共发现20个病灶。CT动态增强扫描显示肝脏炎性假瘤的强化方式多样,其中动脉期呈轻微强化(4例)或无强化(7例);门脉期及延迟扫描常有一定程度强化,常见强化形式为边缘环状强化(7例)或中心点状强化(3例)或偏心状强化(1例)。MR平扫T1WI显示病灶为低信号、略低信号或等信号,T2WI为等信号或高信号。团注Gd-DTPA后,病灶的强化形式与CT动态增强表现相似。结论:肝脏炎性假瘤的强化方式反映了其病理学特征,CT、MR动态增强扫描对其鉴别诊断有重要的价值。     

Pancreatic duct evaluation: accuracy of portal venous phase 64 MDCT

Background  Many patients presenting with nonspecific signs and symptoms often receive CT scans using general protocols, not optimized to evaluate for pancreatic pathology. Therefore the purpose of this study was to evaluate portal venous phase 64 multi-row detector CT (MDCT) scans for detecting pancreatic duct strictures, stones, pancreas divisum, and communication between pancreatic ducts and cystic pancreatic lesions. Methods  Institutional review board approval with waived informed consent was obtained for this HIPAA-compliant study. We included all patients that underwent abdominal, portal venous phase, intravenous contrast-enhanced 64 MDCT scans between 6/7/05 and 5/01/07 and MR cholangiopancreatography (MRCP) or endoscopic retrograde pancreatography (ERCP) within 2 months of the CT. This yielded 93 patients (42 males, 51 females) with a mean age of 59 years. In addition to CT, 75 patients underwent MRCP and 37 patients underwent ERCP. Two radiologists independently evaluated the CT images, including multiplanar and minimum intensity pixel projection reformations, for pancreatic duct strictures, stones, pancreas divisum, or cystic pancreatic lesions. The latter were classified as communicating or not communicating with the pancreatic ducts. Findings on ERCP or MRCP were used to calculate diagnostic performance parameters. Results  On standard of reference examinations, 15 (16%) of the 93 patients had a pancreatic duct stricture. The sensitivity and the specificity for Observer 1 were 87% and 100%, respectively; for Observer 2, 100% and 100%, respectively. Six (6%) of the 93 patients had main pancreatic duct stones. The sensitivity and the specificity for Observer 1 were 83% and 100%, respectively; for Observer 2, 100% and 99%, respectively. Five (5%) patients had pancreas divisum; Observer 1 correctly identified four and Observer 2 correctly identified three cases. Eleven (12%) patients had cystic pancreatic lesions. Observer 1 correctly determined whether or not there was communication between the cystic pancreatic lesion and the pancreatic duct in ten cases; Observer 2 correctly made this determination in nine cases. Conclusion  Portal venous phase 64 MDCT images are moderately sensitive and highly specific for detecting pancreatic duct stricture, stones, and pancreas divisum and moderately accurate for detecting communication between pancreatic ducts and cystic pancreatic lesions.