B超、CT、ERCP对梗阻性黄疸的诊断价值

梗阻性黄疸是临床常见的体征可由多种疾病引起,造成胆管阻塞,出现胆汁淤积、黄疸。因此对梗阻性黄疸的定性和定位诊断显得十分重要,如何进一步提高诊断的准确性一直是影像学探讨的问题,评价B超、CT、经十二指肠镜胰胆管逆行造影(ERCP)三种方法对诊断梗阻性黄疸的报告较少,本对这三种方法的诊断价值进行了比较。     

胆总管下段梗阻性病变B超与CT诊断价值比较

目的：探讨B超与CT对胆总管下段梗阻性病变的诊断价值。方法：分析经手术及病理证实的胆总管下段梗阻性病变69例的B超及CT特征,并比较二者诊断结果。结果：B超与CT总的定位诊断准确率分别为85．5%和91．3％,总的定性诊断准确率分别为68．1%和73．9％,B超＋CT定性诊断准确率为94．2％。结论：对于胆道下段梗阻性病变,B超与CT具有同等定位诊断价值。对于不同病因的诊断,两者各有特点。B超和CT结合可提高定性诊断准确率。     

胰胆管疾病的ERCP影像诊断

目的评价内窥镜逆行胰胆管造影(ERCP)对胰胆管疾病的诊断价值。方法回顾性分析了经手术或病理及临床证实胰胆管疾病480例的ERCP表现,并与CT,MRI,MRCP,超声及透皮肝穿刺胆道造影(PTC)等检查方法进行对比。结果正常胰胆管75例,先天性胆管囊肿14例,胆系结石292例,奥狄括约肌狭窄症46例,壶腹癌、胆管癌52例,胰管癌4例,胰腺炎2例,胰管结石3例,胆道蛔虫症9例,肝内胆管发育变异2例,胆囊管异位开口6例,胆道-腹腔漏2例,十二指肠乳头旁憩室9例,十二指肠乳头开口于憩室内2例,肝移植后吻合口狭窄2例,肝移植后吻合口狭窄并胆漏1例,肝移植后肝外胆管条状结石2例。结论ERCP及MRCP检查同为诊断胰胆管疾病的“金标准”,但每种影像学方法均有其优缺点,应根据患者情况选择。ERCP虽有一定的创伤性,但检查同时可行内镜下乳头括约肌切开术(EST)等微创治疗。     

CT与B超诊断肾损伤的价值

随着近年来交通事故、治安问题和工伤事故的增加 ,肾损伤的发生率也明显升高。影像学检查在判断肾损伤情况及决定治疗措施方面愈显必要。但是 ,对于影像学在肾损伤诊断价值方面的评价研究却较少见。因此 ,本研究回顾分析了Ｂ超与ＣＴ肾损伤的影像诊断资料 ,以探讨其诊断价值。1     

肾癌的CT诊断与B超的对照

目的：研究肾癌对肾周组织侵犯征象，提高ＣＴ术前分期的诊断准确率。并为诊断肾癌合理选用ＣＴ、Ｂ超提供依据。材料与方法：总结６３例经手术、病理证实的肾癌对术前ＣＴ、Ｂ超的诊断准确率，部分肾周侵犯征象检出率进行对比分析。结果：ＣＴ、Ｂ的诊断准确率，部分肾周侵犯征象的检出率相似，但ＣＴ在肾周大血管侵犯及腹膜后淋巴结转移的检出率优于Ｂ超。结论：ＣＴ对肾癌的术前分期有明显优势。     

CT、B超诊断前列腺肉瘤二例

例 1　男 ,5 3岁。 2年前始有排尿困难 ,尿后滴沥伴小便次数增多 ,无血尿、腰酸、发热、尿路刺激等症状。 1年前大便次数增多 ,且不成形。胸膝位肛指检查距肛门约 6 0ｃｍ处附近的直肠内触及一软组织肿块 ,占据肠腔约 1/ 3,质中 ,肛指套带血。尿路平片 静脉尿路造影检查无异常发现。实验室检查 :尿常规及肝肾功能正常。癌胚抗原 (ＣＥＡ)15 μｇ/Ｌ ,前列腺酸性磷酸酶 (ＰＡＰ)1 1μｇ/Ｌ ,前列腺特异性抗原 (ＰＳＡ) <1 5μｇ/Ｌ。ＣＴ :前列腺形态饱满 ,体积增大 ,可见一梭形团块灶 ,向后突出 ,约5 6ｍｍ× 6 0ｍｍ× 5 0ｍｍ大小 ,边缘…     

B超与CT检查对腰椎间盘突出症的诊断价值对比

为探讨Ｂ超与ＣＴ对腰椎间盘突出症的诊断价值 ,我们于 1990～ 2 0 0 0年对经手术证实的腰椎间盘突出症 178例的Ｂ超和ＣＴ的诊断价值进行对比 ,结论是Ｂ超的确诊率略高于ＣＴ。1　对象和方法1 1　对象　 178例中 ,男 119例 ,女 4 9例 ;年龄 18～ 66岁 ,平均 4 3岁。腰椎间盘膨出 98例 ,腰椎间盘突出 73例 ,黄韧带增厚 7例。1 2　方法　使用日本产Ａｌｋａｓｓｄ 2 56型Ｂ超仪和美国产尖端影像 2 4 10型双功能超声诊断仪 ,探头频率 3 5～ 5 0ｍＨｚ。患者取屈膝俯卧位 ,在腹与大腿之间夹一软垫 ,使腰椎部凸起呈“驼峰背” ,致使腰椎前纵韧…     

Multiple bile duct hamartomas simulating liver metastases on US and CT: case report

The radiological findings in multiple bile duct hamartomas (MBDH) are rare macroscopic manifestations of a more common microscopic entity. We present a patient in which the US and CT appearance simulated liver metastases. Final diagnosis was made by liver biopsy. Correspondence to: T. Sainte     

内窥镜逆行胰胆管造影加乳头切开术在胆管梗阻性疾病中的诊疗价值

目的:评价内窥镜下逆行胰胆管造影(ERCP)对胆管梗阻性疾病的诊断以及内窥镜下乳头括约肌切开术(EST)治疗胆总管结石的价值。方法:回顾性分析82例经手术、病理证实的ERCP表现以及62例胆总管结石的EST取石治疗。结果:本组82例,78例ERCP显示异常,其中胆管结石65例,胆管癌7例,胆管炎症狭窄3例,胆总管囊肿、胆道蛔虫、外科手术后胆总管瘘各1例。4例ERCP未显示病变,ERCP对胆管梗阻性疾病诊断正确率为95.1%(78/82)。ERCP指导EST行网篮、球篮和机械碎石网篮取石,取石60例,2例失败,取石成功率为96.8%(58/60)。结论:ERCP对胆管梗阻性疾病有较高的诊断价值,同时在EST网篮碎石、取石中具有重要的基础作用,可指导网篮取石及观察疗效。     

ERCP后CT扫描对阻塞性黄疸诊断价值的研究

目的 探讨ERCP后CT扫描的临床价值。材料与方法 34例阻塞性黄疸患者进一步作ERCP后CT扫描。方法为ERCP拔管后1－2小时行CT扫描。对比评价ERCP后CT扫描与单纯ERCP检查有无不同。结果 34例患者两种检查方法正确诊断19例,ERCP误诊或诊断不全面,由ERCP后CT扫描诊断正确13例,ERCP后CT扫描误诊或诊断不全面,由ERCP作出正确诊断1例,两种方法共同误诊1例。经配对χ^2检验,P＜0．05。结论 ERCP后CT扫描将ERCP和CT二者结合起来,可取长补短,提高诊断正确率,具有较高的临床价值。     

A case of malignant fibrous histiocytoma of the pancreas: computed tomography (CT) and ultrasound (US) appearance

The case of a 50-year-old female with a malignant fibrous histiocytoma of the pancreas is presented. This was diagnosed pre-operatively on ultrasound and computed tomography (CT).The lesion encircled the body and tail of the pancreas and appeared as a large inhomogeneous mass with polycyclic and well-defined margins. Contrast-enhanced CT examination showed marked but inhomogenous enhancement. the tomodensitometric characteristics plus the lack of lymphnodal or hepatic metastases indicated the sarcomatous nature of the mass before the surgical approach. Correspondence to: A. Vidiri     

Differentiation and diagnosis of benign and malignant testicular lesions using 18F-FDG PET/CT

ObjectivesThe purpose of this study was to evaluate the differential diagnostic value of ¹⁸F-fluorodeoxy glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) for benign and malignant testicular lesions.MethodsThe PET/CT scans of 53 patients with testicular lesions confirmed by biopsy or surgical pathology were retrospectively analyzed. There were 32 cases of malignant tumors and 21 cases of benign lesions. Differences in the maximum standardized uptake value (SUVmax) measurements and the SUVmax lesion/background ratios between benign and malignant lesions were analyzed. The diagnostic value of this PET/CT modality for the differential diagnosis of benign versus malignant testicular lesions was calculated.ResultsThe differences in the SUVmax measurements and the SUVmax lesion/background ratios between benign and malignant lesions were statistically significant (SUVmax: Z = −4.295, p = 0.000; SUVmax lesion/background ratio: Z = −5.219, p = 0.000); specifically, both of these indicators were higher in malignant lesions compared to benign lesions. An SUVmax of 3.75 was the optimal cutoff value to differentiate between benign and malignant testicular lesions. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of this PET/CT modality in the differential diagnosis of benign versus malignant testicular lesions were 90.6%, 80.9%, 86.8%, 87.9%, and 85.0%, respectively.Conclusions¹⁸F-FDG PET/CT can accurately identify benign and malignant testicular lesions.     

Macrocystic pancreatic lesions: differentiation of benign from premalignant and malignant cysts by CT

Objective

To assess useful CT features for differentiating benign from premalignant and malignant macrocystic pancreatic lesions.

Methods

Seventy-four patients with pathologically proven macrocystic pancreatic lesions were enrolled: 17 benign cysts (macrocystic serous cystadenoma, n = 12; congenital cyst; n = 5) and 57 premalignant and malignant cysts (mucinous cystic neoplasm, n = 28; intraductal papillary mucinous neoplasm of branch duct type, n = 20; tumor with cystic change, n = 9). Size, location, shape (lobulated, round or oval, or complex cystic with tubular cyst), wall thickness (thin, ≤1 mm; thick, >1 mm), internal surface (smooth or irregular), and other findings were analyzed with multiphasic CT with thin-section (2.5-3 mm) images. CT features between two groups were compared using univariate and multivariate stepwise logistic regression analyses.

Results

On univariate analysis, the differences for the shape (p = 0.007), wall thickness (p = 0.011), and internal surface (p = 0.012) between benign and premalignant and malignant cysts were significant. A lobulated shape, a thin wall and a smooth internal surface were more frequent in benign cysts, whereas a round or oval shape or a complex cystic shape with tubular cyst, a thick wall and an irregular internal surface were more frequent in premalignant and malignant cysts. On multivariate analysis, the shape (p = 0.002) and wall thickness (p = 0.025) were significant CT features for differentiating benign from premalignant and malignant cysts.

Conclusion

Shape and wall thickness are the main CT features for differentiating benign from premalignant and malignant macrocystic pancreatic lesions.     

双源CT双能量扫描对肺良恶性病变的鉴别诊断

目的:探讨双源CT双能量扫描对鉴别诊断肺部良恶性肿块的价值.方法:选取72例肺肿块患者为研究对象,其中40例肺癌患者为观察组,32例炎性病变患者为对照组,72例患者均行双源CT双能量扫描,比较不同病变容积平均CT值、容积CT剂量指数值、平均容积CT增强值、容积CT净增值以及在不同keV下CT值衰减曲线,并计算不同标准化碘含量(NIC)阈值下CT检查的敏感度.结果:①观察组肿块体积、容积平均CT值、容积CT剂量指数值、平均容积CT增强值、容积CT净增值明显高于对照组,差异均有统计学意义(P＜0.05);②不同keV下腺癌和鳞癌CT值明显低于炎性病变,差异均有统计学意义(P＜0.05),但腺癌与鳞癌之间差异无统计学意义(P＞0.05);三组病变CT值曲线斜率分别为(-1.07±0.51)、(-1.12±0.41)及(-2.18±0.52),腺癌与鳞癌之间差异无统计学意义(P＞0.05),但均大于炎性病变(P＜0.05);③观察组NIC值为(0.273±0.089) mg/mL,明显低于对照组(0.417±0.107) mg/mL,差异有统计学意义(P＜0.05),对其进行ROC曲线分析得出NIC取值0.408 mg/mL时,双源CT鉴别诊断良恶性病变的敏感度为0.862,特异度为0.626,曲线下面积为0.757,差异有统计学意义(P＜0.05).结论:应用双源CT双能量扫描能对肺部良恶性病变在体积上进行鉴别,并且能通过不同keV CT值曲线斜率对肺部良恶性病变进行鉴别.     

Thyroglossal duct cyst carcinoma: case report and review of the literature, with emphasis on CT findings

Carcinoma arising in a thyroglossal duct cyst (TDC) is rare. To the best of our knowledge, 155 cases have been reported, 12 of which were studied with CT. The diagnosis is established after surgical excision of the lesion but CT findings may raise the suspicion of malignancy. We present a case of TDC carcinoma and a review of the literature, with emphasis on CT findings. Received: 5 March 1999 Accepted: 20 October 1999     

MRI, CT, US and ERCP in the evaluation of bile duct hamartomas (von Meyenburg complex): a case report

A case of multiple bile duct hamartomas (von Meyenburg complex) of the liver accompanied by exudative and in part necrotizing pancreatitis is presented. Magnetic resonance imaging (fat suppressed, T2-weighted images with prolonged echo time) could exclude diffuse tumor infiltration of the liver, which had not been possible with CT, sonography, or ERCP. To our knowledge, no comparable case has been reported. Received 15 September 1997; Revision received 5 January 1998; Accepted 4 February 1998