小儿睾丸内胚窦瘤的CT评价

目的评价CT扫描对诊断小儿睾丸内胚窦瘤的临床意义。方法 11例经手术病理证实的小儿睾丸内胚窦瘤患者均经CT平扫与增强扫描,随后,对全部患者的CT表现进行了回顾性分析。结果小儿睾丸内胚窦瘤CT平扫表现为睾丸内软组织肿块,边界不清,7例的肿瘤病灶表现为不均匀,其中2例瘤内可见小片状钙化,2例瘤内可见小片状低密度影;另4例的肿瘤病灶表现为密度均匀。增强扫描显示全部患者的肿瘤病灶呈明显片状、团块状强化,2例小片状低密度影处增强后无强化。结论 CT平扫与增强扫描在小儿睾丸内胚窦瘤的诊断中起重要作用,尤其结合血清甲胎蛋白测定可准确地将其与睾丸的其他肿瘤相鉴别。     

原发纵隔内胚窦瘤的CT诊断

目的:提高对纵隔内胚窦瘤CT表现的认识.方法:回顾性分析11例经手术病理证实的纵隔内胚窦瘤患者的临床和CT资料.结果:11例CT平扫均表现为纵隔内实性肿块,8例密度不均匀,3例密度较均匀.10例行CT增强扫描,表现为中度-高度不均匀强化,其中5例表现为周边部不规则线状及网状强化.结论:纵隔内胚窦瘤的CT表现虽具有恶性肿瘤的特点,但缺乏特异性,确诊有赖于病理学检查.     

原发性腹膜后肿瘤的CT表现：附40例分析

本文叙述４０例经手术病理证实的原发性腹膜后肿瘤的ＣＴ表现，指出ＣＴ能够清楚显示肿瘤的部位，大小，形态，范围，密度及与邻近结构的关系，同时，ＣＴ对于腹膜后肿瘤的鉴别诊断，作者提出了诊断的要点，旨在提高原发性腹膜后肿瘤的定性诊断。     

纵隔内胚窦瘤的MSCT表现及诊断价值

目的探讨纵隔内胚窦瘤(mediastinal endodermal sinus tumor,MEST)的多层螺旋CT(MSCT)表现,提高临床诊断水平。方法回顾性分析7例病理证实的纵隔内胚窦瘤的MSCT表现。结果 7例病例均位于前纵隔,其中前上纵隔4例,前中上纵隔3例;CT平扫显示肿块均为实性软组织肿块,边界不清;6例密度不均匀,5例肿块内部可见坏死囊变,2例可见不规则钙化;增强扫描肿块中度～高度不均匀强化;1例较大肿块内可见强化血管。结论纵隔内胚窦瘤CT表现具有一定的特征性,MSCT图像后处理有利于病变细微结构的显示,根据CT表现可以提示诊断并帮助确定手术方案和推测预后,但确诊需依靠病理学。     

Extracranial and extraspinal nerve sheath tumors: Computed tomographic evaluation

Summary Thirty-five patients with 37 peripheral nerve sheath tumors (NST) (16 schwannomas, 11 neurofibromas, 5 plexiform and 1 diffuse neurofibroma, and 4 malignant NST) were studied respectively. The benign NST usually appeared on CT as well-defined oval, spherical or fusiform masses, centered at the expected anatomic location of a cranial, spinal, autonomic or peripheral nerve with characteristic displacement of adjacent muscles and blood vessels. None of the schwannomas appeared homogeneously hypodense on IV enhanced CT, whereas close to half of neurofibromas and plexiform neurofibromas were so. This fact, which had not been reported in the past, may be related to differences in inherent vascularity and blood-nerve barrier (fenestrated blood vessels) between schwannomas and neurofibromas and may be a useful distinguishing CT feature. The most reliable, though not infallible criterion of malignant NST was poor definition of their margins. Ninety-two per cent of NST (34 out of 37) were diagnosed or included in a limited differential pre-operatively.     

Computed tomography of cavernous sinus diseases

Summary We retrospectively analyzed CT scans of 21 cavernous sinus lesions in an attempt to discover CT findings helpful to the differential diagnosis. With the integration of various CT observations it was possible to categorize the lesions into inflammatory, vascular, benign neoplastic and malignant metastatic lesions with few exceptions. Four of 5 cases of septic cavernous sinus thrombophlebitis revealed unilateral or bilateral multiple irregular filling defects in the enhancing cavernous sinus with or without orbital inflammatory change. Four of 5 cases of carotid-cavernous fistula demonstrated unilateral or bilateral diffuse bulging and homogeneous enhancement of the cavernous sinus with obliteration of normal low densities of cranial nerves and gasserian ganglion. Dilatation and tortuosity of superior ophthalmic vein were also associated. Four of 5 cases of benign neoplastic lesion showed well-circumscribed enhancing masses confined to the cavernous sinus with pressure erosion or hyperostosis of adjacent bone. Five of 6 cases of malignant metastatic lesion showed changes suggesting malignancy such as destruction of adjacent bone or associated manifestations of intracranial spread. As compared with the axial scan, coronal scans proved to be more sensitive in detection of subtle cavernous sinus expansion, and superior in evaluation of intracavernous neural structures, relationships with the pituitary gland and changes in the skull base. Axial scans, however, were superior in detection of associated orbital and intracranial abnormalities. Scans in both projections are needed in the evaluation of most cavernous sinus diseases.     

电视胸腔镜手术治疗前纵隔肿瘤和囊肿103例

目的探讨电视胸腔镜手术治疗前纵隔肿瘤和囊肿的方法和价值。方法回顾分析1994年7月—2010年7月完全胸腔镜下或胸腔镜辅助下小切口切除前纵隔肿瘤和囊肿103例临床资料。其中完全胸腔镜切除66例,胸腔镜辅助小切口下切除37例。结果 103例均顺利完成手术,无并发症。手术时间平均(80±15)min。术中出血平均(100±35)ml。术后留置胸腔闭式引流平均(3.5±0.5)d。术后住院平均(7±0.8)d。术后病理诊断:纵隔畸胎瘤17例,胸腺瘤34例,胸腺增生6例,支气管囊肿11例,胸腺囊肿15例,心包囊肿4例,纵隔囊肿9例,胸腺脂肪瘤3例,甲状腺肿1例,纵隔囊性淋巴管瘤1例,淋巴组织瘤样增生1例,脂肪组织增生1例。术后均无并发症。88例随访1～5年,均无复发。结论电视胸腔镜手术切除前纵隔肿瘤和囊肿安全可靠,切除彻底,具有微创、恢复快及并发症少的特点。     

按像素量化CT值方法鉴别卵巢囊实性肿瘤的应用价值

目的 评价采用按像素量化CT值方法鉴别囊实性卵巢肿瘤良恶性的诊断价值.方法 回顾性收集本院39位患者41例卵巢囊实性肿瘤,经病理或随访证实良性27例,恶性14例.应用ImageJ软件在增强CT图像上沿肿瘤边界逐层勾画出感兴趣区(ROI),并提取ROI内各像素点的CT值.分别以20、25、30、35、40 HU为囊性及实性成分分界值,得到全病灶内囊性及实性成分的CT量化值,计算不同分界值时2组病例实性成分百分比、实性成分平均CT值及中位CT值. 结果 不同分界值时,恶性组实性成分平均CT值较良性组高(P<0.05).20、25、35、40 HU时,恶性组实性成分中位CT数值较良性组高(P<0.05).仅分界值为40 HU时,恶性组实性成分百分比较良性组高(0.67±0.25 vs 0.47±0.31).采用受试者工作特征(ROC)曲线区分卵巢肿瘤良恶性,当分界值为40 HU时,卵巢实性成分中位数值曲线下面积(AUC)最大(AUC=0.735).结论 将CT值按像素量化有助于确定囊/实性成分,40 HU是较好的分界值,并且所获实性成分百分比及实性部分CT值有助于良恶性病变鉴别.     

The diagnostic value of CT for radiotherapy of cerebral tumors

Summary The paper deals with CT followup studies on 73 patients with cerebral tumors who received radiotherapy. The value of CT for the indication of radiotherapy, for followup therapy and for the demonstration of therapeutic success are discussed. Since the cerebral tumors become visualized by means of CT in their entire extent and can be differentiated from perifocal edema, the question arises whether radiotherapy should consist of higher doses in the future. It is also suggested that the clinical malignancy may be used to compare the behavior of cerebral tumors when there is no exact histological classification. The possible histopathological effects of radiotherapy (edema, necrosis) and their demonstration by CT are discussed.Supported by the Deutsche Forschungsgemeinschaft     

Computed tomography evaluation of fatty tumors of the somatic soft tissues: Clinical utility and radiologic-pathologic correlation

The role of computed tomography (CT) in the evaluation of fatty tumors of the somatic soft tissues was investigated. Six surgically proven cases of fatty tumors were studied preoperatively by CT and standard radiographic means — conventional radiographs, xeroradiography, and angiography. Our case material included a simple lipoma, two infiltrative lipomas, an angiolipoma, and two liposarcomas. The radiologic-pathologic correlation was evaluated with respect to the various imaging modalities. The unique tissue characteristics of fatty tumors makes them particularly adaptable to CT scanning. In addition to its ability to define accurately tissue densities, the facility of CT in depicting depth, size, and extent of the lesion in the axial plane was found to be most useful in the preoperative evaluation of our case metarial.     

Primary malignant lymphoma of the maxillary sinus: CT and MRI

We reviewed the CT and MRI of seven patients with primary malignant lymphoma of the maxillary sinus to find if there are characteristic imaging findings suggestive of the disease. The images were analysed for appearance, size, signal, internal characteristics, extent of tumour, bone change and lymph node enlargement. In two patients, the tumour first presented with mucosal thickening. In the remaining five, the tumours were an expansile mass 4–6 cm in diameter at the time of detection. Although it was difficult to distinguish tumour from mucosa or obstructed fluid on CT, T2-weighted MRI enabled us to separate tumour from normal mucosa or fluid. In two patients, the tumours were heterogeneous. Calcification and haemorrhage were observed in one patient. Periantral soft-tissue infiltration was always present, even when tumour appeared as slight mucosal thickening. Posterior extension was seen in all patients. Permeative and lytic bone destruction accompanied most cases of periantral soft-tissue infiltration; mixed destruction and sclerosis was also observed. Mucosal thickening with periantral soft-tissue infiltration may suggest malignant lymphoma of the maxillary sinus in its early form. Various types of bone change may accompany the periantral soft-tissue infiltration. Received: 25 January 1999 Accepted: 21 July 1999     

盆部内胚窦瘤临床表现及CT特征

目的探讨内胚窦瘤临床及CT表现特点,提高诊断正确率。方法回顾性分析经组织学证实为内胚窦瘤14例的临床与CT表现,所有病例采用美国PICKER ULTRAZ螺旋CT作平扫及增强扫描检查,抽血检查甲胎蛋白（AFP）。结果主要临床表现为盆部包块,AFP均有不同程度升高,CT检查发现瘤体主要位于盆部中轴线,体积较大,常向下腹部特别是向骶尾部突出,边界多不规整,密度不均匀,常见程度不同的坏死囊变区域,但所有病例均未见钙化灶,增强扫捕显示不均匀强化。结论内胚窦瘤CT表现有一定特点,结合AFP升高可以明确诊断,但要注意与横纹肌肉瘤、恶性畸胎瘤、神经母细胞瘤、淋巴肉瘤等鉴别。     

卵巢内胚窦瘤的B超和CT诊断

目的　探讨卵巢内胚窦瘤的B超和CT特征。方法　回顾分析 10例经手术和病理证实的卵巢内胚窦瘤的B超和CT资料 ,结合病理讨论其影像学特征。结果　 10例卵巢内胚窦瘤均作了B超检查 ,5例呈实质性回声像图 ,3例呈囊实性 ,2例呈囊性为主 ,实性部分血流丰富 ,局部可见蜂窝样改变。 10例中有 5例作了CT检查 ,边界大部分清楚光整 ,1例呈实质性肿块 ,内见较大不规则坏死区 ;2例呈囊实性 ,囊腔边缘不规则模糊 ;2例呈囊性为主 ,内见分隔。结论　卵巢内胚窦瘤的B超、CT表现有一定的特征性 ,尤其是CT ,结合年龄、血清AFP ,术前明确诊断是完全可能的     

小儿睾丸内胚窦瘤CT诊断

目的 评价CT在小儿睾丸内胚窦瘤诊断中的价值.方法 总结7例临床影像资料完整、经活检或手术病理证实的小儿睾丸内胚窦瘤的临床、CT表现.结果 肿瘤位于右侧阴囊5例,左侧阴囊2例.平扫肿瘤均表现为单发软组织肿块,边界不清,2例其内见低密度区;1例其内见点状钙化.增强扫描5例肿瘤呈多个结节状或片状明显强化,强化幅度达周围强化血管程度,同侧腹股沟淋巴结无肿大,腹膜后未见肿大淋巴结.AFP术前增高6例,术后增高1例.结论 小儿内胚窦瘤的CT表现具有一定特征性,结合血清AFP测定有助于小儿睾丸内胚窦瘤的定性诊断及术后随访.     

F-FDG-PET/CT of orofacial tumors, a value of whole-body imaging approach

Aim

Staging of head and neck tumors is one of the most difficult tasks in imaging techniques, due to the very complicated head and neck anatomy and serious problems with the differentiation of reactive enlarged lymph nodes and lymph nodes involved with metastases. The aim of the study was to evaluate the validity of the whole-body approach in the assessment of head and neck malignancies using ¹⁸F-FDG-PET/CT.

Materials and methods

The analysis of a group of 1750 consecutive whole-body procedures in all indications of ¹⁸F-FDG-PET/CT was made according to: the presence of orofacial tumors; their histology; findings concerning the spread outside head and neck region; and findings concerning the primary staging or restaging. The examinations of head and neck tumors were performed after intravenous application of the ¹⁸F-FDG and its accumulation for one hour. Drinking and speaking is restricted during this accumulation to prevent artificial muscle ¹⁸F-FDG uptake and to minimize false positive findings. In our hospital, high resolution PET is followed by the sub-millimeter isotropic acquisition of CT data after intravenous application of an iodinated contrast material. The acquisitions of head and neck region and trunk are performed separately to obtain optimal resolution in both regions.

Results

105 examinations of the orofacial tumors were performed on 87 patients in a group of 1750 consecutive PET/CT examinations. The ratio between primary staging and restaging was 3:7. The most frequent indications were carcinomas of the tongue (19 examinations) and carcinomas of the salivary glands (19 examinations). The metastatic spread of the tumor outside the region of the head and neck was noted in 12 cases.

Conclusion

Our findings of distant metastases confirmed the importance of the use of whole-body PET/CT in this indication.     

Coil migration into coronary sinus: A rare complication of percutaneous transhepatic obliteration of portal systemic collaterals

A 62-year-old woman underwent percutaneous transhepatic obliteration of a giant portal-systemic shunt. Just after inserting a coil into the shunt, it slipped through the giant shunt and migrated to the right atrium. CT showed coil migration into the coronary sinus.     

Use of CT in the evaluation of primary cardiac tumors

Two cases of primary cardiac sarcomas diagnosed with CT are presented. CT demonstrated the origin, extent, and potential pathology of the tumors. In both cases CT provided more specific information for diagnosis and treatment planning than the 2D echocardiography. The advantages of CT in the detection of cardiac tumors as well as its potential advantages over 2D echocardiography are also discussed.     

Differentiation of large (≥5 cm) gastrointestinal stromal tumors from benign subepithelial tumors in the stomach: Radiologists’ performance using CT

Purpose

To identify significant CT findings for the differentiation of large (≥5 cm) gastric gastrointestinal stromal tumors (GIST) from benign subepithelial tumors and to assess whether radiologists’ performance in differentiation is improved with knowledge of significant CT criteria.

Materials and methods

One-hundred twenty patients with pathologically proven large (≥5 cm) GISTs (n = 99), schwannomas (n = 16), and leiomyomas (n = 5) who underwent CT were enrolled. Two radiologists (A and B) retrospectively reviewed their CT images in consensus for the location, size, degree and pattern of enhancement, contour, growth pattern and the presence of calcification, necrosis, surface ulceration, or enlarged lymph nodes. CT findings considered significant for differentiation were determined using uni- and multivariate statistical analyses. Thereafter, two successive review sessions for the differentiation of GIST from non-GIST were independently performed by two other reviewers (C and D) with different expertise of 2 and 9 years using a 5-point confidence scale. At the first session, reviewers interpreted CT images without knowledge of significant CT findings. At the second session, the results of statistical analyses were provided to the reviewers. To assess improvement in radiologists’ performance, a pairwise comparison of receiver operating curves (ROC) was performed.

Results

Heterogeneous enhancement, presence of necrosis, absence of lymph nodes, and mean size of ≥6 cm were found to be significant for differentiating GIST from schwannoma (P < 0.05). Non-cardial location, heterogeneous enhancement, and presence of necrosis were differential CT features of GIST from leiomyoma (P < 0.05). Multivariate analyses indicated that absence of enlarged LNs was the only statistically significant variable for GIST differentiating from schwannoma. The area under the curve of both reviewers obtained using ROC significantly increased from 0.682 and 0.613 to 0.903 and 0.904, respectively, with information of the significant CT findings differentiating GISTs from non-GISTs (P < 0.001).

Conclusion

Non-cardial location, heterogeneous enhancement, presence of necrosis, larger lesion size, and absence of lymphadenopathy are highly suggestive CT findings for large GISTs in differentiation from schwannomas or leiomyomas. Regardless of radiologists’ expertise, diagnostic performance in differentiation can be significantly improved with knowledge of these CT findings.     

肾上腺髓样脂肪瘤的CT诊断（附11例分析）

目的 探讨肾上腺髓样脂肪瘤的影像学特征及鉴别诊断.方法 回顾性分析11例经手术病理证实的肾上腺髓样脂肪瘤的CT表现.结果 CT扫描显示肾上腺区混杂密度（含脂肪组织）肿块,2例钙化,1例出血,11例增强扫描无明显强化.结论 肾上腺髓样脂肪瘤CT表现具有特征性,对于实性及巨大肿块应寻找其内脂肪成分以利于诊断及鉴别诊断.     

Differentiation between tuberculosis and primary tumors in the adrenal gland: evaluation with contrast-enhanced CT

The aim of the present study is to determine imaging criteria for differentiating tuberculosis from primary tumors in the adrenal gland on contrast-enhanced CT. Non-contrast and contrast-enhanced CT features in 108 patients with adrenal tuberculosis (n=34) and primary tumor (n=74) were retrospectively assessed for the location, size, calcification and enhancement patterns. The primary tumors included 41 adenomas, 11 pheochromocytomas, 4 carcinomas, 3 lymphomas, 6 myelolipomas, 6 ganglioneuromas, 2 neurilemmomas and 1 ganglioneuroblastoma. Biochemical investigation was performed for all patients. Of the tuberculosis cases, 31 (91%) invaded with bilateral involvement, while 7 (9%) of the primary tumors invaded with bilateral involvement (P<0.001). Tuberculosis often showed calcification (20 of 34; 59%), whereas primary tumors infrequently showed calcification (6 of 74; 8%; P<0.001). Low attenuation in the center with peripheral rim enhancement was more commonly seen in tuberculosis (16 of 34; 47%) than in primary tumors (7 of 74; 9%; P<0.001). In the determination of tuberculosis, the highest sensitivity (91%) and accuracy (91%) were obtained with bilateral involvement, and the highest specificity (99%) was obtained with the contour preserved. In the determination of primary tumors using a combination of having unilateral involvement and being mass-like, the outcome was a sensitivity of 91%, specificity of 94% and accuracy of 92%. CT findings can differentiate tuberculosis from a primary tumor of the adrenal glands with high sensitivity and an acceptable specificity when combined with the endocrinological examination.