乳腺良恶性肿块的钼靶X线征象分析

目的提高对乳腺疾病的钼靶X线征象认识。材料和方法良性病变60例(69个病灶),恶性病变51例(55个病灶),年龄13～72岁。患者均行乳腺钼靶X线摄影并经手术病理证实。结果良性病灶多为圆形、卵圆形,边缘规则,等密度、低密度或混合密度,80％的病灶可见完全或不完全的晕环。恶性病灶多为分叶形或不规则形,80%为高密度,20%为等密度,没有低密度和混合密度病灶。病灶边缘模糊,61％伴有钙化,39％患侧血管增粗扭曲紊乱。结论钼靶乳腺摄影是乳腺影象学检查的首选方法,95%以上的病变可望术前作出正确诊断。     

Cystic lesions of the breast: sonographic-pathologic correlation

PURPOSE: To understand the pathologic basis for sonographic features of cystic lesions of the breast and determine appropriate assessment and management recommendations for these lesions based on sonographic appearance. MATERIALS AND METHODS: From a database of 2,072 image-guided procedures performed from July 1995 through September 2001, 150 cystic lesions were identified. Diagnosis was established with fine-needle aspiration (n = 55), 14-gauge core-needle biopsy (n = 81), or both (n = 14). Excision was performed for all malignant (n = 18) and atypical (n = 2) lesions and for 11 benign lesions, which recurred or enlarged at follow-up. Imaging follow-up was available for 92 of 119 benign lesions. Targeted sonography was performed with high-frequency (10-MHz center frequency) transducers. Imaging and histopathologic, cytologic, and/or microbiologic findings were reviewed. Lesions were categorized as simple cysts, complicated cysts (imperceptible wall, acoustic enhancement, low-level echoes), clustered microcysts, cystic masses with a thick (perceptible) wall and/or thick (> or =0.5 mm) septations, intracystic or mixed cystic and solid masses (at least 50% cystic), or predominantly solid masses with eccentric cystic foci. RESULTS: Of 150 lesions, 16 were simple cysts aspirated for symptomatic relief. Of 38 lesions characterized as complicated cysts and one cyst with thin septations, none proved malignant, nor did any of 16 lesions characterized as clustered microcysts. Of 23 masses with thick indistinct walls or thick septations, seven proved malignant. Of 18 intracystic or mixed cystic and solid masses, four proved malignant. Of 38 predominantly solid masses with eccentric cystic foci, seven proved malignant. CONCLUSION: Symptomatic complicated cysts generally warrant aspiration. All clustered microcysts were benign, but further study is required. Cystic lesions with thick indistinct walls and/or thick septations (> or =0.5 mm), intracystic masses, and predominantly solid masses with eccentric cystic foci should be examined at biopsy; 18 of 79 of such complex cystic lesions proved malignant in this series.     

腮腺肿瘤的CT诊断价值

目的:探讨腮腺肿瘤的CT诊断价值。方法:回顾性分析经手术及病理证实的腮腺肿瘤20例,其中良性肿瘤12例,恶性肿瘤8例。结果:12例良性肿瘤中,形态规则、边界清晰者11例,边界不清者1例;其中8例行增强扫描,均表现为轻至中度强化,其中密度均匀者5例,密度不均者3例。8例恶性肿瘤中,形态不规则、边界不清并伴邻近组织器官受侵者7例,边界清楚、形态规则者1例;其中6例行增强扫描,均见不同程度强化,肿瘤密度均匀者1例,密度不均者5例,其中2例中心可见大片低密度坏死;8例恶性肿瘤中,4例合并颈部淋巴结肿大,3例面神经受累。结论:CT扫描对腮腺肿瘤的诊断及鉴别诊断具有重要价值。     

腮腺病变的CT诊断

目的探讨腮腺良、恶性病变的CT特点。方法回顾性分析52例经手术病理及临床证实的腮腺病变的CT表现,其中良性肿瘤29例,恶性肿瘤13例,结核4例,慢性腮腺炎6例。结果52例中,48例表现为腮腺内或腮腺区肿块,良性肿瘤形态规则,边界清楚,占82.8%(24/29);恶性肿瘤形态不规则,边界模糊不清,占76.9%(10/13);腮腺结核表现为密度不均、边界较模糊的结节或肿物,并有结节样钙化和腮腺周围淋巴结肿大,病灶及肿大淋巴结均呈环形强化;4例弥漫性炎症表现为一侧或双侧腮腺弥漫性肿大,密度增高;2例为局限炎症,呈形态不规则肿块状,边界不清。结论CT扫描对腮腺病变定位敏感性为100%,对各类腮腺病变的定性诊断有重要价值,增强扫描可提高其定性诊断率。     

Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy.

PURPOSE: To evaluate the use of stereotactic directional vacuum-assisted biopsy (SDVAB) in diagnosing and managing papillary lesions of the breast. MATERIALS AND METHODS: The authors retrospectively reviewed the mammographic and histopathologic findings of 26 cases in which papillary lesions were diagnosed at SDVAB. In all cases, subsequent surgical excision (n = 20) or long-term imaging follow-up (n = 6) was performed and correlated with findings at SDVAB. RESULTS: SDVAB of 26 lesions yielded tissue that was classified as benign in 12, atypical in six, and malignant in eight. Of the 12 lesions that were diagnosed as histologically benign at SDVAB, six were surgically excised. Of these six lesions, five yielded benign correlative results. The sixth lesion was thought to be discordant with the imaging findings, and was surgically excised and determined to be malignant. Of the six benign lesions that were not surgically sampled for biopsy, five decreased in size and one was not seen at radiographic follow-up. Of the six lesions diagnosed as atypical at SDVAB that were surgically excised, one was benign and five were atypical. None proved to be malignant. Of the eight lesions diagnosed as malignant at SDVAB, surgical excision demonstrated ductal carcinoma in situ in all eight; two also had foci of invasive carcinoma. CONCLUSION: Benign and malignant papillary lesions of the breast can be reliably diagnosed at SDVAB when the SDVAB results correlate with the imaging findings. However, the extent of malignant papillary disease may be underestimated at SDVAB; in our study, invasive carcinoma was later discovered in 25% of patients with this diagnosis.     

Role of supersonic shear wave imaging quantitative elastography (SSI) in differentiating benign and malignant solid breast masses

Purpose

To evaluate sensitivity and specificity of supersonic shear wave imaging quantitative elastography (SSI) for distinguishing benign and malignant solid breast masses.

Materials and methods

100 patients with small solid breast masses, were included. The lesions were classified according to the BIRADS (Breast Imaging and Reporting Data System) by SSI. Measurement of the kilopascals (kPa) in different areas of the examined region of interest (ROI) was performed. Ultrasound-guided Tru-cut needle biopsy with an 18-gauge needle was done in all cases.

Results

From the malignant lesions (according to histopathological data), 15% were classified as BIRADS 4 and 85% as BIRADS 5 by SSI. Of the benign lesions, 98%, were classified as BIRADS 3% and 2% as BIRADS 4. According to the histological data, 100% of the lesions with a score of 5 (by SSI) were malignant and 100% of the lesions with a score of 3 were benign. 10% of the lesions with a score of 4 were benign and 90% were malignant. The mean elasticity values were significantly higher for malignant lesions than for benign lesions.

Conclusions

SSI has high sensitivity and specificity in the differentiation of benign and malignant solid breast masses.     

Fibrous nodules found at large-core needle biopsy of the breast: imaging features

PURPOSE: To describe the imaging and histologic features of large-core needle biopsy (LCNB) specimens of fibrous nodules. MATERIALS AND METHODS: Of 853 breast masses in which LCNB was performed, 38 (4%) revealed histologic findings of fibrous nodules. Repeat biopsy was performed in 16 lesions (surgical excision, 13 lesions; repeat LCNB, three lesions). The mammographic and ultrasonographic findings in these 16 cases, the histologic LCNB findings, and the repeat biopsy findings were retrospectively reviewed. RESULTS: Repeat biopsy findings confirmed the diagnosis of fibrous nodules in 15 of the 16 masses. In one mass, repeat LCNB findings showed a fibroadenoma. The imaging features of the fibrous nodules varied. Five nodules (33%) manifested as masses with indistinct margins; six (40%), as circumscribed masses. In four cases (27%), imaging suggested malignancy. None were calcified masses. An additional 22 masses had circumscribed or indistinct borders and were diagnosed with LCNB as fibrous nodules. None of these masses had suspicious findings, and repeat biopsy was not performed. CONCLUSION: Fibrous nodules usually manifest as masses with circumscribed or indistinct margins but can have findings suggestive of malignancy. LCNB can reveal histologic findings consistent with this diagnosis. In all masses in which repeat biopsy was performed, the diagnosis of a fibrous nodule was confirmed or another benign stromal lesion was diagnosed.     

The significance of new densities and microcalcification in the second round of breast screening

AIM: To assess the nature of new densities and microcalcifications in the second round of breast screening. MATERIALS AND METHODS: A total of 34 634 women were screened at our unit in the second round of the United Kingdom National Health Service Breast Screening Programme. Of those attending for the second time, 302 were recalled for further work-up of 311 new lesions. The lesions were divided into masses, microcalcifications, asymmetric densities and architectural distortions. Masses were classified according to margin and density, and microcalcifications according to morphology and distribution. RESULTS: Among women attending for the second time, the cancer detection rate was 0.45% (89 cancers). One hundred and eighty-eight new masses were identified: 53 well-defined (two malignant), 67 partially defined (six malignant), 54 ill-defined (18 malignant), and 14 spiculate (14 malignant). Well-defined masses were usually cysts, especially in women on hormone replacement therapy. Of 97 new microcalcifications, 71 were pleomorphic (28 malignant), 12 linear (one malignant), and 14 punctate (none malignant). Twenty-five new asymmetric densities were identified (five malignant). One of two architectural distortions was malignant. Malignancy was found in 21% of new masses, 30% of new microcalcification and 20% of asymmetric densities. CONCLUSION: Carcinoma was found in 24% of all new mammographic abnormalities appearing in a 3-year screening period. Spiculate and ill-defined masses, clustered pleomorphic microcalcification, and new asymmetric densities should be regarded with particular suspicion. The use of fine needle aspiration cytology in combination with imaging assessment may help to reduce the number of benign excisional biopsies for new mammographic lesions.     

女性盆腔肿块的MRI诊断与鉴别诊断

目的:探讨MRI在女性盆腔肿块中的诊断与鉴别诊断价值。方法:回顾性分析139个(75例)经术后病理证实的盆腔肿块的MRI征象。结果:MRI检出病灶共129个(129/139,92.8%),其中子宫病变67个(67/69,97.1%),卵巢病变62个(62/70,88.6%),2个子宫肌瘤、5个卵巢冠囊肿、3个黄体囊肿漏诊(10/139,7.2%)。MRI检出的129个病灶中,128个病灶部位均符合手术所见,准确性为99.2%。子宫病变主要表现为实质性肿块影或子宫内膜增厚;卵巢病变表现为囊性、囊实性或实性肿块影。MRI诊断为良性病变108个,恶性病变21个;病理诊断为良性病变116个,恶性病变23个,MRI诊断出恶性病变的灵敏度为91.3%(21/23),阳性预测值为100%。结论:MRI判断盆腔病灶的起源具有很高的准确性,在判断良恶性肿瘤方面亦具有较高的准确性,但是区分恶性肿瘤的细胞类型难度较大。     

Follow-up of palpable circumscribed noncalcified solid breast masses at mammography and US: can biopsy be averted?

PURPOSE: To determine whether palpable noncalcified solid breast masses with benign morphology at mammography and ultrasonography (US) can be managed similarly to nonpalpable probably benign lesions (Breast Imaging Reporting and Data System [BI-RADS] category 3)-that is, with periodic imaging surveillance-and to determine whether biopsy can be averted in these lesions. MATERIALS AND METHODS: No institutional review board approval or patient consent was required. This retrospective analysis, based on final imaging reports, included 152 patients (age range, 28-77 years; mean age, 48.3 years) with 157 palpable noncalcified solid masses that were classified as probably benign at initial mammography and US. Of 152 patients, 108 underwent follow-up with mammography and US (6-month intervals for 2 years, then 12-month intervals). The remaining 44 patients underwent surgical or needle biopsy after initial imaging. Lesions were analyzed at initial and follow-up examinations. Statistical analysis included Student t test and corresponding exact 95% confidence intervals. RESULTS: In 108 patients who underwent follow-up only, 112 lesions were palpable. In 102 (94.4%) of 108 patients, masses remained stable during follow-up. Lesions were followed for at least 2 years (mean, 4.1 years; range, 2-7 years). In six (5.6%) patients, palpable lesions increased in size during follow-up; these lesions were benign at subsequent open biopsy. No breast carcinoma was diagnosed in the 44 patients with 45 palpable lesions who underwent biopsy after initial imaging. Of 157 lesions, no malignant tumors were observed (exact one-sided 95% confidence interval: 0%, 1.95%). CONCLUSION: The data strongly suggest that palpable noncalcified solid breast masses with benign morphology at mammography and US can be managed similarly to nonpalpable BI-RADS category 3 lesions, with short-term follow-up (6-month intervals for 2 years). More data, based on a larger series, are required to determine whether this conclusion is correct.     

Solid splenic masses: evaluation with 18F-FDG PET/CT.

Our objective was to assess the role of (18)F-FDG PET/CT in the evaluation of solid splenic masses in patients with a known malignancy and in incidentally found lesions in patients without known malignancy. METHODS: Two groups of patients were assessed: (a) 68 patients with known malignancy and a focal lesion on PET or a solid mass on CT portions of the PET/CT study; and (b) 20 patients with solid splenic masses on conventional imaging without known malignancy. The standard of reference was histology (n = 16) or imaging and clinical follow-up (n = 72). The lesion size, the presence of a single versus multiple splenic lesions, and the intensity of (18)F-FDG uptake expressed as a standardized uptake value (SUV) were recorded. The ratio of the SUV in the splenic lesion to the background normal splenic uptake was also calculated. These parameters were compared between benign and malignant lesions within each of the 2 groups of patients and between the 2 groups. RESULTS: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of (18)F-FDG PET/CT in differentiating benign from malignant solid splenic lesions in patients with and without malignant disease were 100%, 100%, 100%, and 100% versus 100%, 83%, 80%, and 100%, respectively. In patients with known malignant disease, an SUV threshold of 2.3 correctly differentiated benign from malignant lesions with the sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%, respectively. In patients without known malignant disease, false-positive results were due to granulomatous diseases (n = 2). CONCLUSION: (18)F-FDG PET can reliably discriminate between benign and malignant solid splenic masses in patients with known (18)F-FDG-avid malignancy. It also appears to have a high NPV in patients with solid splenic masses, without known malignant disease. (18)F-FDG-avid splenic masses in patients without a known malignancy should be further evaluated as, in our series, 80% of them were malignant.     

Role of ultrasound in the assessment of benignity and malignancy of parotid masses

OBJECTIVES: This study aimed to investigate the value of ultrasound in the identification of benign and malignant parotid masses. Methods: Data of 189 patients with parotid gland masses undergoing ultrasound-guided fine-needle aspiration (FNA), core biopsy or surgery were reviewed retrospectively and the presumed sonographic diagnoses were compared with the histopathology. The sensitivity, specificity and accuracy of sonographic diagnoses were assessed and the sonographic characteristics of those lesions, including shape, margin, echogenicity, echotexture and vascularization, were studied. Results: Of the 189 patients, the final pathological diagnosis included 18 malignant tumours and 171 benign masses; the presumed sonographic diagnoses showed 165 cases as benign and probably benign masses (11 cases were confirmed malignant, 154 cases benign) and 24 cases were diagnosed as probably malignant and malignant masses (7 cases were confirmed malignant, 17 cases benign). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasound for the diagnosis of parotid gland masses were 38.9%, 90.1%, 29.2%, 93.3% and 85.2%, respectively, and accuracy for malignant masses was 20%. The sonographic characteristics of parotid masses between benign and malignant lesions had no significant differences. The parotid gland masses in this study included pleomorphic adenoma, Warthin's tumour, retention cyst, haemangiomas, chronic granuloma, lymphoma, fibrolipoma, abscess, basal cell adenoma, oncocytoma, lymphatic tuberculosis, myoepithelioma, neurilemmoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, alveolar soft part sarcoma and retinal blastoma (metastasis). CONCLUSIONS: It is challenging to use sonography for differentiating between benign and malignant parotid gland masses. To make a definite diagnosis, ultrasound-guided FNA or core biopsy is advocated.     

胃肠道间质瘤的X线和CT表现

目的:分析胃肠道间质瘤的钡餐造影和CT表现,探讨其诊断价值。方法:回顾分析31例经手术病理证实的胃肠道间质瘤钡餐造影和CT表现,其中经数字化胃肠钡餐造影15例,多层螺旋CT检查16例。结果:本组胃肠道间质瘤中,胃部16例,小肠14例,直肠1例。恶性20例,良性10例,交界性1例。良性肿块直径均小于5cm10例(10/10),恶性肿块直径大于5cm17例(17/20),小于5cm3例(3/20)。钡餐造影表现为胃肠黏膜皱襞推压变平或破坏13例(13/15),偏侧性充盈缺损或肠壁不清、缺失、肠腔狭窄14例(14/15),病变区可见溃疡形成,位于腔外或部分腔外6例(6/15)。CT均可见软组织块影(16例),位于腔内或腔外,呈圆形或分叶、不规则形。良性密度均匀,呈均匀性强化,恶性密度大部分欠均匀,肿块内可见低密度坏死灶11例,明显不均匀强化,胃间质瘤肿块内可见钙化影5例。结论:钡餐造影和CT是诊断胃肠道间质瘤的主要手段。偏侧性腔壁不清或缺失以及肠腔狭窄,黏膜皱襞推压变平或消失,肿块内的钙化及腔外钡斑或溃疡是其诊断重要的征象,CT在诊断和鉴别良、恶性上有更大优势。     

Differentiation between small benign and malignant adrenal masses with dynamic incremented CT

Contrast-enhanced dynamic incremented CT scans in 37 patients with 44 small adrenal masses (28 benign and 16 malignant) were reviewed by two observers unaware of the histologic diagnosis to determine if applying morphologic criteria could help differentiate small benign adrenal masses from malignant adrenal masses. Only lesions smaller than 5 cm with diagnoses confirmed by histology (12 masses) or follow-up (32 masses) were included. Features evaluated to suggest a benign diagnosis were homogeneous low attenuation, possibly with punctate contrast enhancement; an enlarged gland (adrenal configuration maintained); a thin or absent rim; round or oval shape with sharp margins; and diffusely homogeneous attenuation about equal to or greater than that of muscle. Features studied to suggest a malignant diagnosis were a thick enhancing rim, invasion of adjacent structures, irregular or poorly defined margins, and inhomogeneous attenuation. Both observers' diagnoses of benign vs malignant lesions with CT criteria were highly statistically significant. The positive predictive value of a benign diagnosis was 100% for both observers and of a malignant diagnosis was 82% and 62% for the two observers. Evaluated singly, all but three diagnostic criteria were statistically significant in differentiating lesions for both observers; the other three criteria were present in a smaller percentage of patients, but nevertheless had positive predictive values for benignancy of 89-100%. We conclude that experienced observers who use CT criteria can often discriminate accurately between benign and malignant small adrenal masses and, in particular, minimize the number of false-negative diagnoses of adrenal metastases. If these results are confirmed and refined by prospective studies, aggressive diagnostic evaluation can be eliminated in some patients with benign adrenal lesions.     

腹膜后神经源性肿瘤的CT诊断

目的:分析腹膜后神经源性肿瘤的CT表现,提高对良、恶性腹膜后神经源性肿瘤的鉴别诊断能力。方法:对23例经手术病理证实的腹膜后神经源性肿瘤的CT征象进行回顾性分析。结果:良性13例、恶性10例。13例良性神经源肿瘤CT大多表现为圆形、类圆形软组织肿块,密度均匀,轮廓光滑,其中神经鞘瘤和节细胞神经瘤可见斑点状钙化。10例恶性神经源性肿瘤,CT显示瘤体大而不规则,混杂密度,边缘不光滑,肿瘤可液化坏死、融合或侵蚀周围组织。CT增强扫描肿瘤表现为均匀或不均匀强化。CT对其良、恶性的诊断符合率为78%,组织类型诊断符合率为60.9%。结论:腹膜后神经源性肿瘤的好发部位有一定特征性,结合CT表现有助于良、恶性的鉴别,但对病理组织类型诊断有局限。     

Deep-seated thoracic and abdominal masses: usefulness of ultrasound and computed tomography guidance in fine needle aspiration cytology diagnosis

Fine needle aspiration cytology (FNAC) was performed under ultrasound and CT guidance in 120 cases. These included abdominal masses (85 cases) and thoracic masses (35 cases) biopsied over a two and a half year period (March 1996 to September 1998). The aim of this study was to assess the contribution of clinico-imaging evaluation and image-guided FNAC to the management of patients with deep-seated mass lesions. Aspirations in the abdomen were performed from various anatomic sites such as liver (56 cases), lymph nodes (18 cases), gastrointestinal tract (three cases), pancreas (six cases), and kidney (two cases). In the thorax, biopsy was performed in the lung (19 cases) and mediastinum (13 cases). In 112 cases (93.4%) FNAC was diagnostic. Of the lesions that were successfully aspirated, 85% were < or = 5 cm in size. No major complication was encountered. All the successful aspirates could be defined as malignant or non-malignant, but tissue differentiation was possible in 63.7% of malignant lesions and 53.8% of benign lesions. Combined clinical and imaging evaluation for malignancy showed 80% sensitivity and 59% specificity. Although clinicoradiological parameters themselves have certain limitations in diagnosing benign versus malignant lesions, in conjunction with guided FNA they are very accurate and safe in diagnosing deep-seated mass lesions in the thorax and in the abdomen. However, the role of FNA in tissue differentiation of solid lesions such as lymphoma requires further study.     

MRI to differentiate benign from malignant soft-tissue tumours of the extremities: a simplified systematic imaging approach using depth, size and heterogeneity of signal intensity

Objective Differentiating between malignant and benign lesions on the basis of MR images depends on the experience of the radiologist. For non-experts, we aimed to develop a simplified systematic MRI approach that uses depth, size and heterogeneity on T(2) weighted MR images (T(2)WI) to differentiate between malignant and benign lesions, and evaluated its diagnostic accuracy. Methods MR images of 266 patients with histologically proven soft-tissue tumours of the extremities (102 malignant, 164 benign) were analysed according to depth (superficial or deep), size (<50, ≥50 mm) and signal intensity (homogeneous or heterogeneous) on T(2)WI, to determine the ability of each to predict benign and malignant tumours. These three parameters were categorised into systematic combinations of different orders of application, and each combination was assessed for its ability to differentiate between benign and malignant lesions. Results Univariate analysis showed that depth, size and heterogeneity on T(2)WI differed significantly between benign and malignant masses (p<0.0001 each). Multiple logistic regression analysis, however, showed that depth was not helpful in distinguishing benign from malignant lesions. The systematic combination of signal intensity, size and depth, in that order, was superior to other combinations, resulting in higher diagnostic values for malignancy, with a sensitivity of 64%, a specificity of 85%, a positive predictive value of 32%, a negative predictive value of 59% and an accuracy of 77%. Conclusion A simplified systematic imaging approach, in the order signal intensity, size and depth, would be a reference to distinguish between benign and malignant soft-tissue tumours for non-experts.     

Nonmalignant papillary lesions of the breast at US-guided directional vacuum-assisted removal: a preliminary report

This study was conducted to assess the accuracy of US-guided directional vacuum-assisted removal (US-DVAR) in evaluating nonmalignant papillary breast lesions. This retrospective study was approved by the institutional review board at our institution; patient consent was not required. We reviewed the clinical and pathology findings from a total of 39 papillary lesions diagnosed at vacuum-assisted removal in 37 patients (age range, 26-60 years; mean age, 44.5 years). Over the follow-up period, we evaluated whether any histologic upgrade occurred and whether or not residual lesions were detected on follow-up imaging. US-DVAR of 39 lesions yielded tissue that was classified as benign in 35 and atypical in 4. Of the 35 lesions that were diagnosed as histologically benign at US-DVAR, 2 were surgically excised. Both of them yielded benign results. Of the 33 benign lesions that were not surgically excised, 28 (85%) were not seen at radiographic follow-up. Of the four lesions diagnosed as atypical at US-DVAR that were surgically excised, all the four were benign. None proved to be malignant. The upgrade rate was 0.0% (95% confidence interval, 0-9%). Among our patients, diagnosis by US-DVAR of benign papillary lesions proved to be accurate, and benign papillary lesions at US-DVAR did not need to be surgically excised for accurate diagnosis.     

盆部原发肿瘤CT表现特征及其解剖学基础

目的分析盆部原发肿瘤CT增强表现特征，探讨产生各种影像表现的病理学和解剖学基础。方法回顾性分析14例经病理学证实的盆部原发肿瘤CT增强表现，包括病灶大小、密度、边缘、强化特征，肿块所在的解剖部位及其与邻近组织器官和间隙的关系等。结果良性肿瘤3例，恶性肿瘤11例。肿块位于盆腹膜腔和腹膜外间隙各6例，盆腹膜腔和腹膜外间隙同时受累2例。CT增强表现为实质性8例，囊实性6例；均匀强化3例，不均匀强化11例。肿块周围脂肪间隙清晰和受侵犯各7例。4例病灶内出现钙化，其中良性畸胎瘤2例，恶性畸胎瘤和类癌各1例。结论CT增强扫描能准确判断盆部原发肿瘤的解剖位置及其与邻近解剖结构的毗邻关系，初步判断肿瘤的良恶性，对畸胎瘤能做出比较明确的定性诊断。     

Calcified masses of the kidney. Apropos of 58 cases

Case reports were analyzed of patients with calcified renal masses observed in the department since 1968. Of the 65 radiologic reports reviewed, 7 were rejected since the course since diagnosis was unknown. Of the 58 case reports studied, 34 were of masses of certain diagnosis, 12 undetermined, 7 of masses in polycystic kidneys, 3 in tuberculous kidneys and 3 probably calcified hematomas. Analysis involved only those masses of proven diagnosis. Results confirmed the absence of specificity in favor of the cyst of peripheral character of calcifications: 33% of these masses were cancers. The existence of tissue calcification is synonymous of a solid mass, nearly always malignant (92% of cases). For peripherally calcified masses, arteriography was not sufficient to affirm benign nature of lesions, most of these masses having a particularly poorly vascularized or even avascular appearance. In these cases angiotensin was of special interest. Ultrasound imaging proved to be a reliable and perfectly sensitive examination. The presence of calcifications rarely interfered with study of tumoral contents. CT scan imaging and puncture biopsy were also perfectly sensitive and reliable examinations. Because of the high frequency of cancers in masses with peripheral calcification, all these masses should be surgically explored or at least punctured. Although a "benign" CT scan image appears sufficient to affirm the benign nature, this still requires more ample confirmation.