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肿瘤侵犯食管入口的影像学表现 总被引:3,自引:0,他引:3
目的:分析肿瘤侵犯食管入口(环咽)的X线、CT和MRI表现,探讨肿瘤侵犯食管人口的影像诊断标准。方法:回顾分析27例经临床、病理证实的侵犯食管入口病变的X线、CT和MRI表现。包括原发于食管环咽段的鳞癌4例,颈段食管癌侵犯食管入口5例,梨状窝癌侵犯食管入口7例,喉癌侵犯食管入口6例,甲状腺癌侵犯食管入口5例。结果:27例常规X线均见剂通过食管入口受阻,16例见食管入口狭窄、黏膜破坏等征象。23例经CT或MRI发现食管环咽段增厚伴杓状软骨破坏,或环-椎间距增大,14例MRI均发现肿块与食管入口的界限模糊、消失,7例CT发现杓状软骨破坏,6例甲状软骨破坏。结论:CT或MRI发现食管环咽段增厚伴杓-椎间距或环-椎间距增大,MRI发现肿块与食管入口的界限模糊、消失,X线吞钡检查食管入口狭窄、黏膜破坏等征象是食管入口受侵的特征性改变。 相似文献
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目的通过探讨巨食管症的影像表现,以提高对巨食管症的认识。方法回顾性分析1例巨食管症病人的影像资料并进行文献复习。结果病人颈椎MRI平扫检查提示气管后方椎体前方食管扩张,T1WI呈低信号,T2WI呈低信号。颈部、肺部CT平扫检查示食管全程显著扩张,扩张最宽处直径约7 cm,内见大量食糜,贲门部未见明显肿块,相邻气管及纵隔内结构受压推移,气管支气管狭窄,胃内见内容物,扩张尚可。服用钡餐后,腹部平扫CT示扩张的食管、胃内均见点状高密度钡剂显影。食管钡餐造影检查提示食管全程显著不均匀迂曲扩张,呈节段性囊样改变,钡剂下行缓慢,食管内见较多食物潴留及多个宽大液平,蠕动尚柔和,黏膜纹增粗,局部显示不清。结论巨食管症的影像表现具有特异性,熟悉巨食管症的影像表现有助于本病的诊断。 相似文献
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咽—食管连接肿瘤影像学 总被引:3,自引:0,他引:3
庄奇新 《中国医学计算机成像杂志》2001,7(2):77-82
咽-食管连接也可称为环咽,食管上括约肌,环后区,咽食管段或食管入口,它是由软骨,肌肉,肌膜和韧带组成,本文简要介绍了咽-食管连接的解剖,生理和影像学检查方法,包括常规X线,X线录像,CT和MRI,对原发于咽-食管连接的肿瘤以及侵犯咽-食管连接的颈段食管癌,下咽癌,喉癌和甲状腺癌的影像学表现作了介绍,咽-食管连接受肿瘤侵犯时,常规X线可发现钡剂通过咽-食管连接受阻,狭窄及黏膜破坏征象,CT和MRI能发现咽-食管连接处椎前软组织增厚,杓-椎间距-寰-椎间距或甲-椎间距增大,杓状软骨破坏等影像学表现。 相似文献
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目的 探讨先天性食管闭锁与食管气管瘘的X线、CT诊断价值.资料与方法 回顾性分析7例先天性食管闭锁与食管气管瘘的影像学表现,7例均行X线平片和食管造影,其中3例进行了CT检查.结果 7例中Ⅰ型2例、Ⅱ型1例、Ⅲ型4例(Ⅲa型1例,Ⅲb型3例).X线胸腹平片显示胃肠积气4例、吸入性肺炎6例及右上肺不张2例;食管造影显示近端呈盲端6例、近端食管气管瘘1例;CT检查显示远端食管气管瘘3例.结论 综合应用X线、CT检查对先天性食管闭锁与食管气管瘘的确诊及分型具有重要意义. 相似文献
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【摘要】目的:探讨扩散加权成像(DWI)及外周循环肿瘤细胞(CTCs)总数及各亚型数目与食管鳞癌病理分级之间的的相关性。方法:回顾性收集经活检证实为食管癌的患者,根据2017版美国国立综合癌症网络(NCCN)食管癌诊疗指南选择治疗方案及手术与否;入组术后病理诊断为鳞癌的68例患者,所有患者术前均行食管MRI扫描及CTCs检测,测量得到表观扩散系数(ADC)值、CTCs总数及各亚型数目。手术后病理标本分析得到肿瘤的病理分级(高、中、低分化)、局部浸润深度(T分期)、淋巴结转移情况(N分期)。采用统计学分析得到组间差异有统计学意义的有效参数。采用受试者操作特征(ROC)曲线、二元logistic回归分析及Z检验比较有效参数对低分化食管鳞癌的诊断效能。结果:食管鳞癌高分化5例、中分化43例、低分化20例。ADC值及CTCs各亚型数目在不同病理T分期、N分期间差异无统计学意义。不同病理分级间ADC值、间质型CTCs、CTCs总数间差异具有统计学意义(P均<0.05)。ADC值、间质型CTCs诊断低分化食管鳞癌的ROC曲线下面积分别为0.870、0.690(P均<0.05), ADC值诊断效能优于间质型CTCs(Z=2.25,P<0.05),CTCs总数诊断低分化食管鳞癌效能差(P>0.05)。ADC值联合间质型CTCs诊断低分化食管鳞癌的ROC曲线下面积为0.873。结论:ADC值及间质型CTCs与食管鳞癌病理分级有一定的相关性,两者均可以在一定程度反映食管鳞癌病理分化程度,两者结合预测低分化食管鳞癌价值更高。 相似文献
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目的:基于肝脏影像报告和数据系统(LI-RADS)2014版评分系统,探讨CT和 MRI对乙肝肝硬化基础上的肝细胞肝癌(HCC)的诊断价值。方法:本研究为多中心、个体内对照研究,搜集51例(54个 HCC 病灶)经病理证实的慢性乙型肝炎肝硬化合并HCC患者的病例资料,所有患者均行CT和MRI平扫及动态增强扫描(两项检查间隔时间不超过1个月)。由2位不同年资的放射科医师根据LI-RADS标准分别对所有入组病例的动态增强CT、平扫联合动态增强MRI两个阅片单元进行独立盲法读片,每位阅片者每个单元读片结束后需等待至少一个月方能进入下个读片单元。通过Kappa检验对两位阅片者间的评分一致性进行分析。结果:两位阅片者对51例 HCC 患者 CT 图像进行评价,LI-RADS评分分别为4.13±1.10和4.07±1.13,一致性中等(Kappa=0.550);而基于平扫联合动态增强 MRI,两位阅片者的LI-RADS评分分别为4.61±0.65和4.31±0.91,一致性一般(Kappa=0.398)。结论:针对 HCC 病灶,使用LI-RADS进行诊断评分时,动态增强CT的阅片者间一致性较好,优于平扫联合动态增强 MRI。 相似文献
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Li R Chen TW Wang LY Zhou L Li H Chen XL Li CP Zhang XM Xiao RH 《World journal of radiology》2012,4(4):179-185
AIM:To investigate contrast-enhanced computed tomography(CECT)for discriminating esophageal squamous cell carcinoma(ESCC)from normal esophagus and evaluating outcomes within tumors after chemoradiotherapy(CRT).METHODS:Sixty-four patients with surgical ESCC served as group A,and underwent thoracic contrastenhanced scan with 16-section multidetector row CT 1 wk before surgery.Thirty-five patients with advanced ESCC receiving 4-wk CRT and showing response to CRT served as group B,and underwent CT scans similar with group A 4 wk after completion of CRT.In group A,differences in CT attenuation values(in HU)between the preoperative ESCC and background normal esophageal wall(delta CT1),or between different background normal esophageal walls(delta CT2)were compared.Furthermore,delta CT1 between group A and B was also compared.RESULTS:In group A,mean delta CT1 was higher than delta CT2(23.86±10.59 HU vs 6.24±3.06 HU,P<0.05).When a delta CT1 of 10.025 HU was employed at a cut-off value to discriminate ESCC from normal esophagus,a sensitivity of 89.1%and specificity of 90.6%were achieved.Mean delta CT1 was lower in group B than in group A(9.25±10.86 vs 23.86 ±10.59,P<0.05),and a delta CT1 of 15.45 HU was obtained at a cut-off value to assess the CRT changes with a sensitivity of 76.6%and specificity of 77.1%.CONCLUSION:CECT might be a clinical technique for discriminating ESCC from normal esophagus,and evaluating outcome in the tumors treated with CRT. 相似文献
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目的:探讨食管癌术前CT检查的意义及价值。材料和方法:分析本院1993-1998年共140例经手术和病理证实的食管癌患者的资料。结果:CT检查能明确食管癌的大小、部位、形状、范围、有无局部外侵、与周围组织的关系,包括气管、支气管、降主动脉、胸主动脉以及淋巴结的转移。结论:CT检查在估计食管癌能否手术切除方面有重要作用。能协助制定手术的方式,且为治疗设计适宜的方案。 相似文献
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PURPOSE: To determine the feasibility and usefulness of magnetic resonance imaging (MRI) for evaluating cardiovascular invasion of a thoracic mass by demonstrating the sliding motion between the mass and adjacent structures. MATERIALS AND METHODS: Twenty-six patients (17 males and nine females, mean age = 49 years) were included in this study. They all had thoracic masses with equivocal cardiovascular invasion on chest CT scan and/or MRI that were surgically confirmed. The pathologic diagnoses were teratoma/thymic tumor (N = 12), lung cancer (N = 9), and other thoracic tumor (N = 5). Conventional T1/T2, contrast-enhanced, and breathheld ECG-gated cine MRI using a steady-state free precession (SSFP) technique was performed. The results were compared to the surgical reports. RESULTS: The cine MR images showed the presence of sliding motion in 39 structures in 20 patients, which were surgically confirmed as not being invaded, and 15 structures in six patients with the absence of sliding motion noted as tumor invasion. Therefore, the accuracy of the cine MR images was 94.4% (51/54) for evaluating cardiovascular invasion of a thoracic mass. CONCLUSION: MRI can provide additional information and improve the accuracy of preoperative staging for predicting cardiovascular invasion of a thoracic mass by evaluating the sliding motion. 相似文献
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目的:分析肝硬化背景上肝细胞肝癌(HCC)的 MRI 动态增强表现,探讨2014版肝脏影像报告及数据系统(LI-RADS)所定义的各种征象在 MRI上的识别率。方法:2008年12月-2014年8月共54例乙肝肝硬化患者入组本多中心研究,所有患者均行 MRI平扫和增强扫描、且经病理诊断证实有 HCC。由两位阅片者对 MR 图像进行独立盲法读片,阅片方法遵循LI-RADS流程:对主要征象、次要征象进行评价(出现/未出现),计算2位阅片者对LI-RADS所定义的各种 MRI征象的识别率。通过Kappa检验来分析两位阅片者对征象识别的一致性。结果:两位阅片者对病灶的3个主要征象(动脉期高强化、“廓清”表现、“包膜”表现)的识别率依次分别为83.3%和85.2%、77.8%和64.8%、51.9%和61.1%,阅片者间的一致性(Kappa值)分别为0.791、0.512和0.589。对于次要征象,大部分征象均有一定的识别率,以T2 WI上稍高信号、扩散受限的识别率最高,分别为90.7%和87.0%、88.9%和90.7%,阅片者间的一致性(Kappa 值)分别为0.813和0.899。结论:基于LI-RADS的诊断标准,平扫及动态增强MR图像上乙肝肝硬化背景上的HCC病灶的主要征象能较多地被识别,且阅片者的一致性较好;次要征象中T2 WI稍高信号和扩散受限的识别率较高,阅片者间的一致性也非常好。 相似文献
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Staging of esophageal cancer: Computed tomography, magnetic resonance imaging, and endoscopic ultrasound 总被引:3,自引:0,他引:3
CT and EUS are complimentary modalitiesthat allow accurate esophageal cancer staging. To prevent unnecessary surgical interventions, patients should undergo selective imaging tests before curative resection is attempted or palliative protocols are implemented (Fig 6). An acceptable strategy for evaluating a newly diagnosed esophageal cancer patient begins with a CT of the mediastinum and abdomen. If distant metastases (such as liver lesions) are detected, or definite local organ invasion is found (such as invasion of the trachea, bronchus, or pericardium), no further imaging tests are required, and palliative therapy should be initiated. If CT imaging is inconclusive or negative for metastases or frank local invasion, an EUS examination should be performed to define the extent of local invasion and regional lymph node metastases. Chemotherapy and radiation therapy should be considered in patients with T3, T4, and/or N1 disease. Shorter imaging times and improved contrast agents should further improve the accuracy and utility of CT and MRI. Additional technical advances, including a wider range of scanning frequencies, Doppler, and thinner scopes, should improve the application of EUS. 相似文献
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目的 探讨可切除性胸段食管鳞状细胞癌不同T分期病人胸腹部转移淋巴结CT表现及分布特征。材料与方法 回顾性分析川北医学院附属医院329例经术后病理证实为胸段食管鳞状细胞癌,同时伴淋巴结转移的病人临床及影像资料,其中男225例,女104例,年龄38~82岁,平均(55.8±9.2)岁。根据原发肿瘤是否浸润肌层将病人分为2组(pT1及pT2-3)。通过观察多层螺旋CT颈胸腹部淋巴结大小、密度及强化方式等综合判断淋巴结转移,采用Kappa检验对转移淋巴结的影像及病理学结果进行一致性评估,同时观察不同T分期病人转移淋巴结优势分布区域。结果 329例食管鳞状细胞癌病人中,pT1病人51例(51/329,15.5%),pT2-3病人278例(278/329,84.4%)。MSCT共发现转移淋巴结967枚,其诊断胸段食管鳞状细胞癌转移淋巴结与病理结果的一致性较好(κ=0.708)。胸段食管癌病人最常发生淋巴结转移的区域为上纵隔及胃周区域。pT1组病人中,原发肿瘤位于胸上段最常见淋巴结转移区域为上纵隔区,位于胸中、下段最易发生胃周区域淋巴结转移,中下纵隔及腹腔区域转移较少。pT2-3组中,胸上中段及下段食管癌最常见淋巴结转移区域分别为上纵隔区及胃周区,而中、下纵隔淋巴结转移率较pT1组明显增加(P<0.05)。结论 多层螺旋CT扫描对评估胸段食管癌淋巴结转移有较高的准确性,且食管癌不同T分期病人的淋巴结转移区域有明显差别。 相似文献
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Aortobronchial fistula is a rare condition characterized by the development of a communication between the aorta and a branch of the bronchial tree that results from processes that arise within the aorta, in the tissues of the mediastinum, or in the adjacent thoracic organs. Three cases are reported to demonstrate characteristic features. Case 1: An 82-year-old woman was found collapsed with blood clot in her mouth. At autopsy an atherosclerotic thoracic aortic aneurysm was found which had eroded into the underlying left main bronchus with filling of the larynx, trachea and main bronchi with fluid blood. There was no evidence of dissection. Case 2: A 30-year-old woman collapsed and died. At autopsy, coarctation of the thoracic aorta was found with a saccular aneurysm distal to this which was joined to the left main bronchus by a mass of necrotic tissue. The bronchus contained a cast of blood; blood was also present within the trachea and within the distal airways of the left lung. Case 3: A six-year-old girl collapsed with massive airway haemorrhage following bronchoscopy. At autopsy coarctation of the thoracic aorta was identified with a saccular aneurysm distal to this. A transverse tear of the thinned aneurysm wall communicated with a mass of necrotic friable tissue that extended through the wall of the left main bronchus. Distal airways were filled with fluid blood. All three deaths were due to haemorrhage from aortobronchial fistulas. The pathogenesis of aortobronchial fistulas involves a variety of mechanical, infective and neoplastic processes. Many cases will not be diagnosed until autopsy examination is performed. 相似文献
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目的 研究SPECT/CT肺灌注显像中肺段横断面、矢状面及冠状面的精确定位方法.方法 分析12名健康成人的肺灌注断层图像、CT图像及二者的融合图像,按CT解剖命名标准对肺灌注横断面、矢状面及冠状面图像上肺段进行划分.即右肺10段:上叶尖段、后段、前段,中叶外侧段、内侧段,下叶背段、内基底段、前基底段、外基底段、后基底段;左肺8段:上叶尖后段、前段、上舌段、下舌段,下叶背段、前内基底段、外基底段、后基底段,并总结3个层面肺段分布的特点.结果 确定了左右肺在横断面、矢状面及冠状面上的典型层面及各个肺段的主要分布特点:(1)横断面双肺由肺尖至肺底选取11个层面:胸锁关节层面及以上,主动脉弓上缘层面,主动脉弓层面,奇静脉弓层面或气管杈层面,右肺上叶支气管层面或左肺动脉层面,左肺上叶支气管层面或右肺动脉层面,中叶或舌叶支气管层面,底干支气管层面,下肺静脉层面,上下底段静脉层面,底段静脉层面;(2)双肺由内向外分别选取6个层面,左肺:左肺门层面,左主支气管杈层面,左肺动脉叶间部层面,心尖层面,心尖左侧第一层面,心尖左侧第二层面;右肺:右肺门层面,中间支气管杈层面,叶间动脉层面,叶间动脉分杈层面或右心房右侧第一层面,右心房右侧第二层面,右心房右侧第三层面向外;(3)冠状面双肺由前向后选取7个层面:胸锁关节层面,升主动脉层面,肺动脉杈层面,气管杈层面,中间支气管层面,底段总静脉层面,胸主动脉层面.结论 按该研究方法划分肺段,可为肺灌注断层图像中肺段的精确定位提供参考依据. 相似文献
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SPECT/CT肺灌注显像中肺段精确定位方法的研究 总被引:1,自引:0,他引:1
目的 研究SPECT/CT肺灌注显像中肺段横断面、矢状面及冠状面的精确定位方法.方法 分析12名健康成人的肺灌注断层图像、CT图像及二者的融合图像,按CT解剖命名标准对肺灌注横断面、矢状面及冠状面图像上肺段进行划分.即右肺10段:上叶尖段、后段、前段,中叶外侧段、内侧段,下叶背段、内基底段、前基底段、外基底段、后基底段 左肺8段:上叶尖后段、前段、上舌段、下舌段,下叶背段、前内基底段、外基底段、后基底段,并总结3个层面肺段分布的特点.结果 确定了左右肺在横断面、矢状面及冠状面上的典型层面及各个肺段的主要分布特点:(1)横断面双肺由肺尖至肺底选取11个层面:胸锁关节层面及以上,主动脉弓上缘层面,主动脉弓层面,奇静脉弓层面或气管杈层面,右肺上叶支气管层面或左肺动脉层面,左肺上叶支气管层面或右肺动脉层面,中叶或舌叶支气管层面,底干支气管层面,下肺静脉层面,上下底段静脉层面,底段静脉层面 (2)双肺由内向外分别选取6个层面,左肺:左肺门层面,左主支气管杈层面,左肺动脉叶间部层面,心尖层面,心尖左侧第一层面,心尖左侧第二层面 右肺:右肺门层面,中间支气管杈层面,叶间动脉层面,叶间动脉分杈层面或右心房右侧第一层面,右心房右侧第二层面,右心房右侧第三层面向外 (3)冠状面双肺由前向后选取7个层面:胸锁关节层面,升主动脉层面,肺动脉杈层面,气管杈层面,中间支气管层面,底段总静脉层面,胸主动脉层面.结论 按该研究方法划分肺段,可为肺灌注断层图像中肺段的精确定位提供参考依据. 相似文献