精细检查法诊断早期胃癌的价值

目的:探讨精细检查法诊断早期胃癌的价值。材料和方法:回顾性分析经手术病理证实的25例早期胃癌的经胃内分泌液清洗后进行低张气钡双对比造影X线征象。结果:X线诊断早期癌14例,进展期9例,胃溃疡2例。25例早期胃癌的X线表现为:隆起性病变呈息肉样突向胃腔10例;小凹陷性病变呈小的浅表龛影,轮廓不规则8例;大凹陷性病变呈大而扁的龛影6例;胃壁柔软度降低,轮廓线模糊,胃小区增大,出现大小不等的颗粒样阴影,胃小沟模糊紊乱,似石榴籽样1例;斑片状不规则的染钡区5例。结论:精细检查法有利于观察粘膜微细结构,对粘膜和粘膜下层的早期癌变有一定的诊断价值。     

超声显像诊断胃溃疡的价值

目的:研究超声显像诊断胃溃疡中的应用价值.材料和方法:32例临床初步诊断胃溃疡患者,先行超声显像检查,观察胃部结构,再行胃镜检查,两者结果进行比较.结果:胃溃疡的典型超声图像表现为胃内壁不同程度的凹陷,凹陷的边缘增厚呈低回声.本组病例32例胃溃疡患者胃镜全部检出,超声检出胃溃疡26例,总体符合率为81.3%.26例胃溃疡中,胃大弯部溃疡3例,胃小弯溃疡5例,胃角部溃疡18例,2例有明显凹陷的溃疡型胃癌全部检出,没有明显凹陷的2例溃疡型胃癌及4例较小胃溃疡漏诊.结论:超声对胃溃疡的诊断具有较高价值,但对较小的浅表溃疡仍存在漏诊.     

上消化道X线诊断——A良性凹陷性病变

前言凹陷性病变的基本X线表现是在正位像上有阳性造影剂滞留,侧位像上为边缘的突出。如果确定为凹陷性病变,其次要判断是为有粘膜缺损的病变或为无粘膜缺损的病变。如果有粘膜缺损则凹陷内部缺少正常的胃小区像,也有的凹陷内部无结构像,有的凹陷内部星凹凸不平改变。此外还能看到突出底部不规则,其移行部边缘屈曲,不规则等。再有粘膜皱襞集中,胃小弯短缩,胃呈“B”或“U”字型变形,则容易判断为有粘膜缺损的病变。如突出部的边缘轮廓光滑,且能见到突出部影     

内镜下尼龙绳套扎联合黏膜下剥离术治疗胃隆起性病变临床分析

目的探讨内镜下尼龙绳套扎联合黏膜下剥离术治疗胃隆起性病变的疗效及安全性。方法对25例经胃镜检查发现的胃隆起性病变常规行小探头超声内镜检查,明确病变位于粘膜层或粘膜下层,先行尼龙绳套扎,然后在尼龙绳上方行黏膜下剥离术,2～4周后内镜下复查创面愈合情况。结果25例全部一次性套扎并切除成功,术中发生渗血1例,尼龙绳脱落1例,无大出血及穿孔病例。分别于术后2～4周复查发现23例创面完全愈合,2例创面处浅溃疡。结论内镜下尼龙绳套扎联合黏膜下剥离术治疗胃隆起性病变是一种安全、有效、操作简便、经济的方法,值得临床广泛应用。     

食管、胃、肝同时性三重癌

近十年间,三重癌的报道约增加8倍,但为数仍较少。作者报道一例食管、胃、肝同时性三重癌。男,70岁,因进行性吞咽困难4个月入院。41岁时曾于广岛原子弹爆炸时受害(被害距离不详),生化检查除α-GTP 外均正常。X 线检查食道中段前壁长约6cm 充盈缺损,食管内窥镜检查距门齿25～30cm 处范围约3/4周径浅在性凹陷性病变,伴环堤征。并经活检诊断为食管中度分化型扁平上皮癌。胃小弯见浅的凹陷性病变,粘膜辐辏中断和融     

His角的观察在上消化道钡餐造影检查中的意义

X线钡餐造影是上消化道疾病常用的诊断方法之一．His角也称食管胃角．是由贲门上方3～4cm长的胃—食管前庭段的左侧壁与胃底形成的锐角切迹，食管-胃连接部一般是指食管下段、贲门及胃底区．包括邻近的横膈、韧带等结构，是某些上消化道疾病常见发生部位（如贲门癌等）。当此处发生病变时．组织结构上的改变可致His角改变。本文收集51例经病理确诊的胃-食管连接部病变的病例．并对其X线钡餐造影中His角的征象进行回顾性分析。     

MRI测量颈髓延髓角对颅底凹陷症的术前诊断及术后评估价值

目的：通过测量对比颅底凹陷症患者术前、术后以及正常人群颈髓延髓角的大小,探讨颈髓延髓角对颅底凹陷症患者术前诊断及术后评估价值。方法搜集我院2005年1月～2013年1月明确诊断并手术的颅底凹陷症患者63例,以及同期行M RI检查显示无颅颈结合部病变者40例,测量并比较颅底凹陷症患者术前、术后及对照组颈髓延髓角的大小。结果63例颅底凹陷症中有42例行术前及术后M RI检查,21例仅行术前M RI检查,63例颅底凹陷症患者术前平均颈髓延髓角为（138．0±11．2）°,42例术后平均颈髓延髓角为（156．3±8．7）,40例正常对照组明确平均颈髓延髓角为（154．9±7．7）°,颅底凹陷症患者术前颈髓延髓角明显小于正常对照组及术后患者, P ＜0．05,术后患者颈髓延髓角与正常对照组无显著性差异, P ＞0．05。结论颈髓延髓角可以作为诊断颅底凹陷症及术后评估的重要指标。     

结肠造影对结肠癌浸润深度诊断的现状

作者就101例无蒂型早期结肠癌和12例直径2cm以下的小进展癌结肠造影的正、侧位片与手术标本及组织学所见进行了比较,讨论了X线上判断浸润深度的可能性。结肠无蒂型隆起性病变,正位可借表面有无凹陷或极轻微的凹陷鉴别良恶性,一旦达到较深程度的凹陷,就可以作出癌肿浸润深度达粘膜下层以下的诊断。隆起性病变在侧位象上,借     

胃类癌的X线诊断探讨（附6例报告）

本文报告6例胃类癌，3例分别位于胃体，胃窦及幽门大弯侧，2例在胃小弯角切迹区，1例位于胃底贲门部，其中4例伴有溃疡形成，全部病例均经X线，手术和病理证实，现结合文献分析，讨论如下。     

胃嗜酸性肉芽肿2列报告

１　病例报告例１　男,６５岁,主诉为左上腹疼３月,加重１ｄ。疼痛呈阵发性加剧伴返酸、呕吐。体检：左上腹轻压疼,余未见异常。Ｘ线钡餐示：胃小弯角切迹处可见大小约３ｃｍ×３ｃｍ充盈缺损区,中央可见大小约１．５ｃｍ×２ｃｍ钡斑,周围粘膜肿胀,局部蠕动减弱,有僵硬感（图１）。意见：胃角溃疡型胃癌可能,建议镜检。胃镜示：胃角中央近后壁可见约１．５ｃｍ×２ｃｍ凹陷,底不平,表面污苔覆盖,周围粘膜高低不平,肿胀,质脆易出血。手术所见：胃小弯可见约３ｃｍ×３ｃｍ×２ｃｍ肿块、质硬,中央可见约１．５ｃｍ×２ｃｍ溃…     

胃癌手术前CT扫描的意义

本文选择经气钡双重造影、纤维胃镜、活检及病理学确诊的胃癌14例,术前行CT簿层或重叠扫描.有6例术前扫描无淋巴结转移和邻近脏器侵润而手术,有8例因有淋巴结转移或向邻近脏器扩散而不能手术只有接受化疗.CT扫描能准确测出胃壁厚度(正常5～7mm,平均5mm),并能显示癌瘤向邻近脏器扩散的情况.对胃癌术前估计可切除性及术后是否转移CT扫描都是有价值的.     

Radiologic examination in gastric cancer. A retrospective study of 188 patients

The accuracy in the diagnosis of gastric cancer was investigated in 188 histologically proven cases, including 12 cases of early gastric cancer. One hundred and sixty-five of 167 patients (99%) were recorded radiologically as having a gastric lesion. The initial diagnosis was carcinoma in 144 patients (86%), and benign lesion in 21 cases (13%). In 2 cases (1%) no abnormalities were seen. In 3 out of 9 patients with a partial gastrectomy (33%) an incorrect diagnosis was made. In 11 of 12 patients with early gastric cancer the radiologic examination revealed abnormal findings, but 7 of these were incorrectly interpreted as benign. A retrospective analysis of the radiologic examination in which no malignancies were reported showed that inadequacy of the examination technique and misinterpretation of radiologic signs of malignancy were the main causes of failure in diagnosing of malignancy. The rate of misinterpretation of malignancy as a benign lesion (13%) justifies the endoscopic control of every radiologically detected abnormality. The high sensitivity in detecting a lesion indicates, however, that a biphasic radiologic examination is a safe screening method in gastric cancer. Endoscopy with biopsy showed a lesion in 156 out of 160 patients (98%), but in 11 of these (7%) the initial examination did not yield histologic proof of malignancy. In 4 patients (2%) no abnormalities were observed by endoscopists. One hundred and forty-nine patients were examined with both radiology and endoscopy with biopsy. A malignant lesion with recognition of its malignant character was defined in 144 cases (97%).     

胃恶性肿瘤术前CT诊断价值（附15例分析）

目的本文旨在探讨胃恶性肿物的CT表现及其术前诊断价值。方法选取纤维胃镜及活检病理证实15例胃恶性肿瘤作CT薄层及重叠扫描。结果 15例中,胃癌9例,胃恶性溃疡1例,胃底癌4例,胃恶性淋巴瘤1例。其中7例胃癌及1例胃恶性淋巴瘤无任何肿瘤转移及外侵征象,作了手术切除,术中发现与术前CT检查相符,7例已有肝转移及胃外侵,不宜手术治疗。结论 CT是胃恶性肿瘤手术前评估最有效方法,应作为外科术前常规。     

螺旋CT扫描三维重建的临床应用价值探讨(附53例)

目的:探讨螺旋CT扫描三维成像技术在临床疾病中的应用价值。方法:对于53例病人行螺旋CT薄层扫描,重叠重建(层厚3～5 m m ,间隔1～2.5 m m ),然后通过软件功能行三维重建(three- dim ensionalreconstruction,3D)。通过旋转三维图像从最佳角度来观察病变的立体形态及其周围结构关系。结果:外伤31 例,肿瘤6例,感染5 例,骨关节退行性变5例,先天畸形4 例,胆囊息肉1例,正常结肠1例。结论:螺旋CT扫描三维重建(3DCT)可作为横轴图像和二维重建图像的重要补充,它可更直观地显示病变的立体形态。对于骨外科、口腔颌面外科手术前制定治疗计划和术前、术后对比均有重要的指导作用     

胃平滑肌肿瘤的影像学诊断

目的：探讨胃平滑肌肿瘤的影像学诊断价值和限度。材料和方法：经手术病理或(和)活检证实的胃平滑肌瘤17例，平滑肌肉瘤21例。回顾性分析其影像学表现特征。结果：平滑肌肿瘤X线诊断的准确性为74．1％(20／27)。腔内型15例，表现为圆形或卵圆形向腔内突出的肿块，并伴溃疡形成(9／15)。腔外型7例，为胃壁的受压变形；混合型5例，兼有上述两型表现。CT定性诊断为86．4％(19／22)，定位诊断为95．5％(21／22)，10例平滑肌瘤直径多在5cm内(80％)，表现为圆形或椭圆形软组织肿块，境界清楚，密度多均匀(80％)，明显强化。12例平滑肌肉瘤中表现为不规则分叶状肿块者11例(91．7％)，倾向于腔外或偏心性生长，肿块内不规则低密度坏死区(83．3％)，实质明显不均匀强化。肿块直径多大于5cm(83．3％)。结论：CT扫描在胃平滑肌肿瘤的诊断及鉴别诊断上有重要价值，明显优于钡餐检查。     

钼靶X线定位穿刺留置导丝活检对乳腺微小病灶的诊断价值

目的探讨乳腺X线定位穿刺留置导丝活检术对乳腺微小病灶的诊断价值。方法回顾分析临床触诊阴性而乳腺钼靶X线片显示的微小病灶28例,采用乳腺钼靶X线定位下穿刺,留置导丝于微小病灶区,引导手术将病灶切除活检。结果28例微小病灶均一次性定位成功,定位满意率93%,手术切除完整。病理检查:恶性病变9例,其中浸润性导管癌5例,导管内癌伴早期浸润1例,导管内癌2例,髓样癌1例;良性病变19例。结论乳腺钼靶X线定位穿刺留置导丝活检术,定位准确,诊断明确,能确定乳腺微小病灶的性质,是目前诊断早期乳腺癌的有效方法。     

原因不明胃肠道出血的DSA

目的：进一步提高消化道出血的诊断率，探讨ＤＳＡ的应用价值。材料和方法：对３０例原因不明胃肠道出血病例行选择性腹腔动脉和肠系膜上、下动脉造影。在常规ＰＵＣＫ快速摄片后，再行ＤＳＡ，比较两种方法所见。结果：３０例中２４例发现病理血管，检出病变，检出率为８０％。其中肿瘤６例（胃肠平滑肌瘤或肉瘤５例，腺瘤１例），血管病变１１例（ＡＶＭ６例，小肠毛细血管扩张症４症，胃底静脉曲张１例）；炎症性病变６例（麦克尔憩室２例，胆道出血１例，胃溃疡或糜烂３例）和十二指肠粘膜异位１例。ＤＳＡ较常规血管造影片显示病变更清楚，血管结构更仔细。２例小肠毛细血管扩张症在常规血管造影片上仅见小血管密集，紊乱，而ＤＳＡ则能清楚显示病变肠段较正常肠段染色异常增浓，因此术前得以确诊。本组资料显示ＤＳＡ对于提高胃肠道出血的病变检出率和诊断正确率很有价值。１例小肠毛细血管扩张症出血第一次检查阴性。一周后采用山莨菪碱药物血管造影，ＰＵＣＫ及ＤＳＡ见造影剂外溢及肠管异常染色而得到诊断。结论：胃肠道出血的血管造影检查结合应用ＤＳＡ，可进一步提高病变检出率和诊断正确率。     

Utility of second-look ultrasound in the management of incidental enhancing lesions detected by breast MR imaging

Purpose

To assess the utility of second-look ultrasound (US) for identifying and characterising incidental enhancing lesions detected by breast magnetic resonance imaging (MRI).

Materials and methods

From among 655 consecutive breast MRI studies, 62 lesions (MRI visible, nonpalpable, occult at first-look US and mammography) were recommended for second-look US. MRI enhancement of lesions was mass-like in 59 cases (95%) and non-mass-like in three (5%). Forty-two lesions (68%) were ??10 mm; only three lesions (5%) were >20 mm. Of all lesions, the Breast Imaging Reporting and Data System (BI-RADS) MRI category was highly suggestive of malignancy in six cases (10%), suspicious abnormality in 33 (53%) and probably benign in 23 (37%). The correlation between MRI lesion appearance, lesion size, histopathology findings and detection rate at second-look US were analysed. The reference standard was histopathology and/or follow-up (range 18?C24 months). Statistical analysis was performed with the Fisher exact test.

Results

Second-look US identified 44 out of 62 (71%) lesions depicted at MRI. The detection rate at second-look US was higher for mass-like MRI lesions (75%) than nonmass-like lesions (0%), for lesion size >10mm (90%) and for BI-RADS 4 lesions (88%). Second-look US-guided biopsy detected 12 out of 17 (71%) malignant lesions. There was no correlation between the likelihood of carcinoma and the presence of a sonographic correlate.

Conclusions

Second-look US is a reliable problemsolving tool in identifying and characterising most incidental MRI findings. It contributes to accurately selecting the cases in which MRI-guided biopsy is required.     

Underestimation of breast cancer with II-gauge vacuum suction biopsy

OBJECTIVE. The purpose of this study was to determine the mammographic and histologic features of cancerous lesions underestimated using 11-gauge vacuum suction biopsy. MATERIALS AND METHODS. Retrospective review of 11-gauge vacuum suction biopsy was performed to identify lesions diagnosed as atypical ductal hyperplasia or carcinoma. The histology of the core and surgical specimens was compared. Of 158 cases of cancer, underestimation occurred in 15 (9.5%). The mammographic and histologic features were assessed. RESULTS. Of 15 underestimated cases, six were atypical ductal hyperplasia that proved to be cancer (5 ductal carcinoma in situ and 1 invasive) and nine were ductal carcinoma in situ that proved to have invasion. The underestimation rate for calcifications was 16.3% (14/86) and for masses was 1.6% (1/64) (p = 0.007). Most (5/6) underestimated atypical ductal hyperplasia cases were reported as "markedly atypical," and four of nine underestimated ductal carcinoma in situ cases were reported as "possible invasion." No significant difference was seen in the number of core specimens obtained or the sizes of the lesions for underestimated cases versus accurately diagnosed cases. The percentage of calcifications retrieved was significantly different (p = 0.017). No underestimations were found among cases in which the entire mammographic lesion was removed at vacuum suction biopsy. CONCLUSION. The cancer underestimation rate with vacuum suction biopsy was 9.5%. The underestimation rate for calcifications (16.3%) was significantly higher than that for masses (1.6%) (p = 0.007). The percentage of the lesion removed was an important factor in reducing underestimation, as reflected by the percentage of calcifications retrieved and the instances of complete resolution of the lesion seen on mammography.     

X线导向经皮胸部穿刺针吸活检(附401例报告)

目的：评价Ｘ线导向经皮穿刺针吸活检术对胸部病变的诊断价值。方法：对４０１例胸部肿块或结节进行了４５１人次Ｘ线导向经皮穿刺针吸活检术。结果：穿刺针吸标本细胞学或细菌学检查阳性３５６例（８８．８％），阴性４５例（１１．２％）。经手术病理、随访或治疗等证实，真正阳性３５６例，真正阴性４例，诊断正确率为８９．８％，假阴性４１例，误诊率为１０．２％。穿刺活检术后发生气胸４１例（１０．２％），少量咯血３３例（８．２％），无大出血或大量咯血者，亦无死亡病例。结论：Ｘ线导向经皮穿刺针吸活检对胸部肿块或结节是一种简单实用且比较安全的获取诊断资料的检查方法。