核素三维显像诊断肝血管瘤

核素肝血池平面显像及断层显像诊断肝血管瘤的价值已早有报道 ,本文对比分析了肝血池平面图像、断层图像、透视三维立体图像诊断肝血管瘤的各项效能 ,旨在观察透视三维立体显像在诊断肝血管瘤中的应用价值。1　资料与方法1 1　临床资料　核素肝血池显像共 12 4例 ,男 78例 ,女 46例 ,年龄 18～ 79岁 ,平均 45岁。全部病例均在肝血池显像前后 1周内行Ｂ超检查 ,同时接受ＣＴ检查有 6 0例。经手术或随访并结合临床各项检查确诊为肝血管瘤 88例 ,原发性肝癌 2 3例 ,转移性肝癌 5例 ,其它肝占位病变 8例。1 2　方法　常规体内标记红细胞后 30ｍ…     

透视三维立体显像诊断肝血管瘤的价值

透视三维立体显像诊断肝血管瘤的价值欧阳巧洪文志道杨振华刘加昌腾小梅对７３例患者进行了肝血池平面显像、断层显像及透视三维立体显像，旨在观察透视三维立体显像在诊断肝血管瘤中的价值，现报道如下。一、资料与方法７３例患者中男４６例，女２７例，年龄１８～７９岁...     

缝扎法治疗肝海绵状血管瘤36例

我院1987年1月～1992年12月共收治≥5．0cm的肝海绵状血管瘤50例，采用缝扎法治疗36例，效果满意。临床资料一、一般情况本组36例，男性25例，女性11例。年龄24～64岁。肝右后叶12例，右前叶比例，左内叶6例，左外叶3例。维发24例，多发12例，共SO个血管瘤。最大瘤体直径10cm。36例均有L腹部胀痛不适，3例并有胆囊结石，术前均行B超检查，CT检查20例，肝血池扫描16例，肝动脉造影8例，均明确诊断。二、手术方法采用连续硬膜外麻醉，右上胶经腹直肌切口或右肋缘下新切口，入腹后先探查证实诊断，对合并胆囊结石老先常规切除胆囊。游离切断…     

全肝血流阻断无血切肝术切除巨大肝血管瘤一例

全肝血流阻断无血切肝术切除巨大肝血管瘤一例李捷雷，张宏义肝胆外科主题词肝肿瘤，血管癌，肝切除术患者女，４２岁。上腹部肿块４年，肿块占据整个上腹部，隆起于腹壁表面。术前经Ｂ超、ＣＴ、肝血池扫描诊断为：肝海绵状血管瘤。肝功能ＣｈｉｌｄＡ级。１９９６年１月...     

超声波断层不能识别的肝海绵状血管瘤

作者对超声波不能识别的2例肝海绵状血管瘤的原因加以探讨。1例肝左叶海绵状血管瘤,与邻近肝组织具有强度相同的回波,以致超声波无法识别。应用选择性腹腔动脉造影后,明确了本病的诊断。另1例是以慢性胰腺炎入院的患者,CT扫描显示肝右叶后部有一直径2.0cm的低密度区,增强CT显示了典型的海绵状血管瘤表现。作者发现肝海绵状血管瘤的回波强度与血管瘤的管腔直径有     

肺结节的不均匀灌注

目的 利用16及64层螺旋CT评价孤立性肺结节容积灌注是否均匀.方法 85例孤立性肺结节(直径≤4.0 cm,57例恶性结节,15例活动性炎症,13例良性结节)患者,在增强前、后采用16层(30例)及64层(55例)螺旋CT进行同层动态扫描.注入对比剂后11-41 s,每秒扫描1次;90 s扫描1次.16层螺旋CT扫描层厚:病灶直径3.0～4.0 cm时8.0 mm;2.0～3.0 cm时6.0 mm;1.5～2.0 cm时4.0 mm;1.0～1.5 cm时3.0 mm;<1.0 cm时2.0 mm(其中病灶直径3.0 cm时,层厚8.0 mm;2.0 cm时,6.0mm;1.5 cm时,4.0 mm).64层螺旋CT扫描层厚:病灶直径3.0～4.0 cm时5.0mm;<3.0 cm时2.5 mm.记录孤立肺结节增强前后各时相的CT值.分别计算肺结节3个中央有效层面强化值、灌注值、结节一主动脉强化值比、平均通过时间.使用均数间方差检验进行统计学分析.结果 3个中央层面强化CT值分别为(30.95±14.53)、(25.10±13.32)、(32.37±15.85)HU、灌注值分别为(33.01±21.35)、(23.70±12.87)、(29.00±15.47)ml·min-1·100 g-1,结节-主动脉强化值比分别为(13.58±6.41)%、(10.95±5.76)%、(13.64±6.20)%,平均通过时间分别为(11.61±5.74)、(11.97±3.55)、(13.44±3.74)s,差异均有统计学意义(F值分别为5.913、6.464、5.333、3.837,P值分别为0.003、0.002、0.005、0.023).平扫的CT值差异无统计学意义(F=0.032,P=0.968).结论 孤立肺结节容积灌注是不均匀的,推荐采用CT容积灌注成像的方式对孤立肺结节血流模式进行研究.     

颅内海绵状血管瘤MR成象:病理证实的13例

颅内海绵状血管瘤是较少见的血管畸形,由于能被完全切除,故术前正确诊断甚为重要。作者报道了经病理证实的13例颅内海绵状血管瘤的MR表现。男7例,女6例,3～44岁(平均29岁)。病灶大小为1.2～4.0cm(平均2.7cm)。临床表现为癫痫5例、亚急性或急性神经功能障碍5例、渐     

10例疑难肝占位病变肝血池显像误诊分析

１０例疑难肝占位病变肝血池显像误诊分析刘琳，唐谨，曹秀华，郑容，陈盛祖肝血池显像能动态显示病灶的供血状况，但对一些疑难的肝占位病例，仍可能发生误诊．我们就有手术病理对照的１０例疑难肝占位病变的误诊原因，分析和讨论如下．资料与方法肝癌及肝血管瘤１２５例...     

核素血池显像对肢体和躯干肌肉血管瘤的诊断价值

核素血池显像对肢体和躯干肌肉血管瘤的诊断价值徐峰坡，董慎安，吴星红，张玮，江一民，李金泉，苏成海对１９８７年３月～１９９４年２月我院住院和门诊的１８２例软组织核素血池显像患者进行了回顾分析，旨在探讨核素血池显像对肌肉血管瘤的诊断价值．１８２例四肢、躯...     

肝断层及平面显像在肝占位性病变鉴别诊断中的意义──与B超、CT比较

本文对９２例临床可疑肝占位性病变患者进行了肝胶体及血池断层与平面显像，计算了肝血流灌注指数，并对照同期的病理及肝动脉造影资料，探讨了核素显像、ＣＴ及Ｂ超的诊断价值。研究表明，三种方法对肝癌及肝囊肿的诊断准确性无显著性差异（Ｐ＞０．０５），但断层显像对肝血管瘤的诊断（９３％）明显优于ＣＴ（８４％）和Ｂ超（８０％）；平面肝显像难以发现直径３ｃｍ以下的病变，对肝占位灶的检出率明显低于断层显像（Ｐ＜０．０５）。联合肝、胆道系统显像有助于降低假阳性率，其价值有待进一步探讨。     

Distinction between hemangioma of the liver and hepatocellular carcinoma: value of labeled RBC-SPECT scanning

The role of adding single-photon emission CT (SPECT) to 99mTc-labeled RBC imaging of the liver was evaluated by specifically focusing on the differentiation between hepatic hemangioma and hepatocellular carcinoma. Planar RBC imaging followed by blood-pool SPECT scanning was performed in 77 patients with a total of 108 hemangiomas and in 29 patients with a total of 46 hepatocellular carcinomas. All lesions were smaller than 5 cm in diameter. Thirty-six (33%) of 108 hemangiomas were detected by planar delayed RBC imaging, whereas 63 (58%) were detected by the delayed RBC-SPECT scan. The smallest hemangioma shown by delayed RBC-SPECT scanning was 1.4 cm in diameter, compared with 1.7 cm by planar RBC scanning. When confined to nodules larger than 1.4 cm in diameter, 42% of hemangiomas (36/85) were detected by planar delayed RBC imaging, whereas 74% (63/85) were detected by delayed RBC-SPECT. Increase in sensitivity was noted in nodules 2.1-4.0 cm in diameter. No hepatocellular carcinomas were shown by delayed RBC planar or SPECT scans. We concluded that with the addition of SPECT, the sensitivity of delayed RBC scans in the detection of small hemangiomas is considerably improved. Delayed RBC-SPECT scanning can be used to distinguish hemangioma from hepatocellular carcinoma.     

Improved detection of small cavernous hemangiomas of the liver with high-resolution three-headed SPECT.

The purpose of this study was to review our experience with 99mTc-red blood cell scintigraphy for diagnosis of cavernous hemangiomas of the liver using a new three-headed, high-resolution dedicated SPECT system. Of 19 patients referred with a total of 38 lesions seen on CT, US, or MRI, 14 patients had 24 lesions that were hemangioma-positive with SPECT (all true-positives). Six of these 14 patients also had 9 hemangioma-negative lesions; all were less than or equal to 1.3 cm in size and false-negative. The remaining five patients had hemangioma-negative lesions only (1 false-negative, 4 true-negatives). Two hemangiomas were seen by SPECT that were not detected by CT, US, or MR. The sensitivity for hemangiomas greater than or equal to 1.4 cm. was 100% (20/20). The sensitivity was 33% for lesions 0.9-1.3 cm, and 20% for lesions less than or equal to 0.8 cm. The smallest hemangioma detected was 0.5 cm. These results show a definite improvement in sensitivity with high-resolution triple-headed SPECT over previously reported results using single-headed SPECT. High-resolution SPECT has improved our ability to detect small cavernous hemangiomas of the liver.     

Planar and SPECT Tc-99m red blood cell imaging in hepatic cavernous hemangiomas and other hepatic lesions

The utility of Tc-99m RBC imaging in the diagnosis of hepatic cavernous hemangiomas has been established. Of the 25 patients with various focal hepatic lesions evaluated, 16 were diagnosed as having hemangiomas: eight proven by surgery, two proven by angiography, and six proven by maintaining a stable clinical course ranging from 6 to 12 months with normal follow-up liver function tests. Although fourteen of these were detected by planar imaging, two were detected by SPECT only. Two patients with large hemangiomas had false-negative scans, whereas the remaining seven patients had other liver lesions.     

Definitive diagnosis of hepatic hemangiomas: MR imaging versus Tc-99m-labeled red blood cell SPECT

Thirty-seven patients with 69 suspected hemangiomas found by means of computed tomography (CT) and/or ultrasound were studied with both 0.5-T magnetic resonance (MR) imaging and single photon emission CT (SPECT) with technetium-99m-labeled red blood cells. Using a criterion of "perfusion-blood pool mismatch," SPECT readers diagnosed 50 of 64 hemangiomas and all five "nonhemangiomas" (sensitivity, 78% [95% confidence interval, 0.664 - 0.864]; accuracy, 80% [0.69 - 0.877]). Qualitative analysis of lesion signal intensity on T2-weighted spin-echo MR images allowed readers to diagnose 58 of 64 hemangiomas and four of five nonhemangiomas (sensitivity, 91% [0.814 - 0.96]; accuracy, 90% [0.807 - 0.951]). Because of the significantly higher cost of MR imaging and its inability to categorically differentiate hemangiomas from hypervascular metastases, the authors consider SPECT to be the method of choice for diagnosing hepatic hemangiomas. MR imaging should be reserved for the diagnosis of lesions smaller than 2.0 cm and for those 2.5 cm and smaller adjacent to the heart or major hepatic vessels; in such cases MR imaging was found superior to SPECT.     

The role of Tc-99m RBC scintigraphy in the differential diagnosis of orbital cavernous hemangioma

The cavernous hemangioma is the most common benign orbital tumor in adults. Its presentation is during the forth to fifth decades with a slowly progressive unilateral proptosis. Intraconal cavernous hemangiomas may be difficult to differentiate from other intraconal lesions such as schwannomas, meningiomas and hemangiopericytomas. We report a case of orbital cavernous hemangioma diagnosed by Tc-99m RBC scintigraphy. Tc-99m RBC scintigraphy revealed a typical scintigraphic pattern in which there is intense focally increased uptake on the delayed image. We conclude that Tc-99m RBC scintigraphy can be a useful method in the differential diagnosis of orbital cavernous hemangioma as in hepatic hemangioma.     

Features of hepatic cavernous hemangioma on planar and SPECT Tc-99m-labeled red blood cell scintigraphy.

PURPOSE: To determine the value and diagnostic accuracy of planar and SPECT Tc-99m-labeled red blood cell (Tc-99m RBC) scintigraphy in the investigation of suspected hepatic cavernous hemangioma as found on ultrasound. PATIENTS AND METHODS: One hundred patients, 89 women (89%) and 11 men (11%), between 22 and 67 years old (mean age, 38 years) were evaluated for liver masses found on abdominal ultrasound. All the patients had previous Tc-99m RBC scintigraphy. The size of the lesions ranged from 1 to 9 cm. The final diagnosis was reached through cytologic biopsy, or histopathologic tests (or all of these). RESULTS: One hundred thirty lesions were found. With regard to the distribution of the lesions, 116 (89%) were single; 14 (3%) were multiple, with 118 (91%) in the right lobe and 12 (9%) in the left lobe; 83 (64%) were posterior; and 47 (36%) were anterior. With respect to the pattern of radioactivity fill-in, 86 (66%) lesions were typical and 44 (34%) were atypical. The results of Tc-99m RBC scintigraphy showed sensitivity, specificity, and positive and negative predictive and accuracy values of 97%, 83%, 98%, 77%, and 96% respectively. The use of SPECT improved the sensitivity value by 11% for lesions of 1 to 2 cm. CONCLUSIONS: Tc-99m RBC scintigraphy is the noninvasive technique most helpful in the diagnosis of hepatic hemangioma, especially in those at risk for lesion rupture or bleeding. SPECT should be performed whenever planar imaging fails to show the lesion by 2 hours. The use of ultrasound should precede scintigraphy for two important reasons: the size and the location of the lesion. Location of the lesion (anterior or posterior) is important for optimal gamma camera acquisition parameters. Lesions less than 1 cm are cannot be detected because they are beyond the limit of spatial resolution of the gamma camera we used.     

Scintigraphic and ultrasound features of giant hemangiomas of the liver

Giant hemangiomas of the liver are clinically distinct from smaller and more innocent hemangiomas as they are more prone to complications. On imaging with ultrasound, they can also be readily confused with hepatoma, metastatic disease, or focal nodular hyperplasia. Nine giant hemangiomas (maximal diameter greater than 8 cm) were studied by scintigraphy and ultrasound. In all instances, the fill-in of the lesion on [99mTc]RBC scintigraphy indicated the diagnosis of hemangioma, adding specificity to the screening sonographic study. The pattern of fill-in on scintigraphy also appeared to be size dependent with lesions less than 11 cm in diameter equilibrating uniformly, while larger abnormalities intensified in centripetal fashion.     

Cavernous hemangioma. Why is peripheral filling at scintigraphy so rare?

Peripheral filling at dynamic CT occurs frequently with cavernous hemangiomas, yet this phenomenon is a rare finding on Tc-99m RBC imaging. A case of peripheral filling of a cavernous hemangioma with scintigraphy is reported and the rationale for its infrequent occurrence is discussed.     

Cavernous hemangioma of the liver: detection with single-photon emission computed tomography

The roles of single-photon emission computed tomography (SPECT) and planar imaging with technetium-99m-labeled red blood cells in the diagnosis of cavernous hemangioma of the liver were evaluated. The study group consisted of 26 consecutive patients referred for evaluation of liver lesions. A total of 23 cavernous hemangiomas were found, all of which showed decreased or normal flow and delayed uptake of the radiotracer. SPECT demonstrated 13 hemangiomas that were not detected with planar imaging; both modalities demonstrated the other ten lesions. Lesions that were not cavernous hemangiomas showed either normal (n = 6) or increased (n = 4) flow; none had delayed increased uptake on either planar or SPECT images. SPECT with labeled red blood cells is an accurate method for the detection of cavernous hemangiomas of the liver and is more sensitive than planar imaging in depicting small lesions.     

Nuclear magnetic resonance imaging of liver hemangiomas

Nine patients with cavernous hemangioma of the liver were examined by nuclear magnetic resonance imaging (MRI) with a 0.5 T superconductive magnet. Spin-echo technique was used with varying time to echo (TE) and repetition times (TR). Results were compared with 99mTc red blood cell (RBC) scintigraphy, computed tomography (CT), echography, and arteriography. Four illustrated cases are reported. It was possible to establish a pattern for MRI characteristics of cavernous hemangiomas; rounded or smooth lobulated shape, marked increase in T1 and T2 values as compared with normal liver values. It is concluded that, although more experience is necessary to compare the specificity with that of ultrasound and CT, MRI proved to be very sensitive for the diagnosis of liver hemangioma, especially in the case of small ones which may be missed by 99mTc-labeled RBC scintigraphy.