Radiographic study of acute gastric anisakiasis

The radiographic findings from 226 patients with acute gastric anisakiasis are reviewed. Suggestive but indeterminate findings such as coarse and broad gastric folds caused by mucosal edema were demonstrated in 224 patients (98%). In 179 patients (88%) mucosal edema was so extensive that it occupied more than half of the entire gastric wall. The most diagnostic radiographic finding, present in 139 patients, was the appearance of a threadlike filling defect about 3 cm in length, showing an anisakis larva itself. Careful demonstration of these radiographic findings is useful for the diagnosis of acute gastric anisakiasis.     

Calcified gastric carcinoma: CT findings

The computed tomographic (CT) findings of 13 cases of calcified gastric carcinoma were analyzed retrospectively. Eleven cases were confirmed as a mucinous adenocarcinoma by surgery (three cases), or endoscopic biopsy (eight cases). Two cases were diagnosed as adenocarcinoma by endoscopic biopsy. In all cases the calcifications were of the punctate or miliary shape and the size varied from 1–3 mm in diameter. The calcifications were located in the thickened gastric wall in all cases, and were seen in metastatic lesions such as lymph nodes and the liver in two cases. In 10 cases, some tumor portions showed lower attenuation number than that of the muscle on CT scans, and corresponded to mucin pool in tumor portions histologically. Twelve cases were in inoperable advanced stage.     

原发性小肠肿瘤X线及CT表现

目的分析原发性小肠肿瘤的X线及CT表现,探讨其诊断价值.方法回顾分析经手术病理证实的原发性小肠肿瘤28例的临床资料和小肠钡剂造影及CT表现.28例均行数字化小肠气钡追踪造影,2例行小肠灌肠造影,7例行多层螺旋CT扫描.结果原发性小肠肿瘤小肠气钡造影表现包括充盈缺损、管腔狭窄、黏膜破坏或受压、管壁僵硬、龛影、肠梗阻或肠套叠.CT扫描表现为软组织块影、管壁增厚及肠管受压或狭窄.结论原发性小肠肿瘤X线表现具有一定特征,结合临床表现可明确诊断,与CT检查相结合可提高诊断率.     

Amyloidosis of the gastric stump: Radiographic and CT findings

An unusual case of amyloid deposition in the wall of gastric pouch 15 years after surgery for peptic ulcer is presented. The radiographic and computed tomographic (CT) findings included marked thickening of the gastric wall associated with clusters of calcifications and ulcerated mucosa. These features are illustrated and the pertinent literature is briefly reviewed.     

胃癌浆膜面的不同CT表现及其诊断意义

目的探讨胃癌浆膜面不同CT表现类型以及据此判断浆膜有无侵犯的价值及临床意义。方法回顾性分析接受根治性切除的进展期胃癌患者141例,将胃癌浆膜面CT表现分为5种类型:光滑型(Ⅰ型)、光滑膨隆型(Ⅱ型)、毛糙型(Ⅲ型)、结节型(Ⅳ型)和血管包绕型(Ⅴ型)。光滑型诊为浆膜无侵犯,其余类型诊为浆膜侵犯。将CT和术中判断胃癌浆膜侵犯结果与病理相对照。结果 CT和术中判断胃癌浆膜有无侵犯的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为88.76%(79/89)、65.38%(34/52)、81.44%(79/97)、77.27%(34/44)、80.14%(113/141)和98.88%(88/89)、34.62%(18/52)、72.13%(88/122)、94.74%(18/19)、75.18%(106/141)。CT判断浆膜无侵犯的特异度高于术中判断(χ2=9.85,P<0.05)。术中判断浆膜侵犯的敏感度高于CT(χ2=7.85,P<0.05)。CT胃癌浆膜面光滑型、光滑膨隆型、毛糙型、结节型和血管包绕型浆膜侵犯率分别为22.73%(10/44)、46.15%(6/13)、83.61%(51/61)、85.71%(6/7)和100%(16/16),差异有统计学意义(χ2=42,P<0.001)。结论血管包绕型是CT诊断胃癌浆膜侵犯的可靠征象;CT浆膜面表现为光滑膨隆型时,判断胃癌浆膜侵犯要慎重。     

Computed tomographic features of two cases of acute gastric anisakiasis

Little is known about the detailed computed tomography (CT) features of acute gastric anisakiasis. Our two cases showed transiently swollen gastric folds comprised of the remarkably thickened contrast little-enhanced submucosal layer with little-thickened contrast-enhanced mucosal and muscular-serosal layers on multi-detector row CT. When CT demonstrates the swollen gastric folds in acute abdomen, acute gastric anisakiasis should be included in the differential diagnosis.     

Intussusception due to intestinal anisakiasis: Report of a case

This report describes our experience of intussusception due to intestinal anisakiasis which was treated by laparoscopy-assisted surgery. The unique sonographic findings of this complication were a pseudokidney sign and a target sign with an edema of Kerckrings folds in the intussusceptum. Surgeons should know about intussusception as a rare complication of intestinal anisakiasis. Sonography, computed tomography and laparoscopy are helpful in diagnosing and treating this complication.     

Heterotopic gastric mucosa in the gallbladder: sonographic and CT findings

We present computed tomographic (CT) and sonographic findings of heterotopic gastric mucosa incidentally found in a 63-year-old male. CT showed a slightly high density area in the gallbladder, which was intermediately enhanced early after bolus injection of contrast medium. Ultrasonography showed an echogenic sessile polyp. Histologically, the tumor consisted of gastric fundic glands containing parietal cells and chief cells.     

胃神经鞘瘤和间质瘤的多排CT表现及对照研究

目的:探讨胃神经鞘瘤(GS)的CT表现,并与胃间质瘤(GST)进行对照分析,以提高诊断正确率.材料与方法:选取经手术病理证实的GS 19例及GST 76例,回顾性分析其临床特征及CT表现,并对两者的CT表现进行比较.CT影像资料由两名具有丰富经验的高年资放射科医师评估,评估内容包括肿瘤大小、形态、生长方式、增强模式、强化程度、肿瘤内部出血、钙化及坏死囊变.统计学分析采用单因素方差分析、LSD检验和卡方检验.结果:极低风险度GST的最大直径小于GS(P=0.04),低、中风险度间质瘤最大直径与胃肠道神经鞘瘤的最大直径没有统计学意义(P=0.98,P=0.23),高风险度间质瘤的最大直径大于GS(P=0.01).GS(18/19)和极低(16/16)、低风险(28/34)及中风险(11/13)GST多呈圆形或卵圆形,而高风险GST(8/13)多呈分叶状或不规则形.极低风险GST腔内生长较多见(12/16).GS(18/19)和极低危险度(15/16)GST肿瘤内部均匀强化.低(26/34)、中等(11/13)及高危险度GST(13/13)中等或明显强化较GS(9/19)多见.GS(1/18)内部的坏死囊变较低(11/34)、中等(6/13)及高危险度(11/13)间质瘤少见(P=0.01).结论:胃肠道神经鞘瘤CT上多表现为圆形、卵圆形的肿块,增强后呈轻度均匀强化,肿瘤内部坏死囊变、钙化、出血现象较少见,与高危险度GST影像学表现差异较大,但与极低、低、中危险度GST较难区别.     

胃间质瘤CT征象与病理及预后的关系

目的探讨螺旋CT对胃间质瘤的诊断价值。方法回顾性分析胃间质瘤43例,所有病例分别行CT平扫及三期增强扫描。所有病例均经病理免疫组化证实,如CD117,CD34,SMA-100及DESMIN。结果GST的大小、形态和均匀与不均匀的强化方式同恶性程度相关(P<0.05),与生长方式不相关(P>0.05);对比分析表明,病理为恶性、高度恶性及5年内复发、转移的CT征象大多表现为>5cm、不均匀强化、腔内/外生长;17例既向腔内生长又向腔外生长的胃间质瘤患者中,16例病理证实为恶性,有5例在3年内出现复发;5例GST呈间隔状强化,病理结果均为恶性,2例在3年内复发。结论瘤体直径大于5cm、不均匀强化、腔内/外生长和浸润与转移提示GST预后不良。     

脾脏CT表现用于预测进展期胃腺癌分化程度

目的 观察脾脏CT表现用于预测进展期胃腺癌分化程度的价值。方法 回顾性分析182例经术后病理证实的进展期胃腺癌患者,根据病理结果将其分为低分化组(n=89)及中-高分化组(n=93),比较2组临床资料,以及肿瘤及脾脏CT表现。采用多因素logistic回归分析筛选进展期胃腺癌分化程度的独立影响因素;绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估各单一独立影响因素及其联合预测进展期胃腺癌分化程度的效能。结果 组间患者年龄、性别、肿瘤厚度、肿瘤最长径、Borrmann分型、cT分期、cN状态、cTNM分期及动脉期脾脏CT值差异均有统计学意义(P均＜0.05)。多因素logistic回归分析显示,患者年龄、性别、Borrmann分型、cT分期、cTNM分期及动脉期脾脏CT值均为进展期胃腺癌分化程度的独立影响因素(P均＜0.05);以之单一及联合预测进展期胃腺癌分化程度的AUC分别为0.639、0.577、0.621、0.690、0.714、0.606及0.861。结论 脾脏CT表现有助于预测进展期胃腺癌分化程度,动脉期脾脏CT值为有效预测指标;联合临床及肿瘤CT特征可进一步提高预测效能。     

Afferent loop obstruction after gastric cancer surgery: helical CT findings

Background: We reviewed the computed tomographic (CT) findings of afferent loop obstruction and assessed the value of helical CT in determining the underlying cause.Methods: Helical CT scans of 18 patients (12 men and six women; age range = 35–67, mean age = 50 years) with afferent loop obstruction were reviewed. All patients had gastric cancer. Ten patients had undergone radical subtotal gastrectomy with Billroth II gastrojejunostomy, and eight had undergone total gastrectomy with Roux-en-Y esophagojejunostomy. CT images were analyzed retrospectively, and the presumed cause of obstruction on CT was compared with surgical findings (n = 8) and clinical courses (n = 10).Results: Local recurrence (n = 15), peritoneal seeding (n = 1), internal hernia (n = 1), and adhesion (n = 1) were the presumed causes of obstruction on CT. In all eight patients who underwent a second operation, the cause of afferent loop obstruction was correctly suggested on CT (local recurrence in six patients and adhesion and internal hernia in one patient). In 10 patients who were not re-explored, the clinical findings or biopsy indicated recurrent tumor as suggested on CT.Conclusion: Recurrent tumors and other potential causes of afferent loop obstruction can be correctly predicted with CT in most cases.     

Unusual cause of gastric outlet obstruction: CT findings in Bouveret's syndrome

We have described an 81-year-old woman with symptoms of gastric outlet obstruction in whom upper gastrointestinal endoscopy showed an extrinsic mass compressing the superior aspect of the postbulbar duodenum. This was confirmed by an upper gastrointestinal series, and CT revealed migration of a known, previously asymptomatic gallstone through the duodenal wall, forming a cholecystoduodenal fistula.     

Foodborne anisakiasis and allergy

Human anisakiasis, a disease caused by Anisakis spp. (Nematoda), is often associated with clinical signs that are similar to those associated with bacterial or viral gastroenteritis. With the globalisation of the seafood industry, the risk of humans acquiring anisakiasis in developed countries appears to be underestimated. The importance of this disease is not only in its initial manifestation, which can often become chronic if the immune response does not eliminate the worm, but, importantly, in its subsequent sensitisation of the human patient. This sensitisation to Anisakis-derived allergens can put the patient at risk of an allergic exacerbation upon secondary exposure. This article reviews some aspects of this food-borne disease and explains its link to chronic, allergic conditions in humans.     

对比胃与小肠间质瘤多层螺旋CT征象及病理学特点

目的 对比观察胃间质瘤与小肠间质瘤多层螺旋CT(MSCT)征象及病理学特点.方法 回顾性分析经病理学确诊的165例胃间质瘤(GST组)与37例小肠间质瘤(SIST组),对比观察其CT征象及病理学特点.结果 GST组与SIST组肿瘤生长方式及形态差异均有统计学意义(P均＜0.05).GST组中95.76％(158/165...     

Sonographic findings of intestinal tuberculosis

Sonograms in 41 patients with intestinal tuberculosis were analyzed. The sonographic findings of intestinal tuberculosis were thickening of the wall in the ileum, cecum, or ascending colon (or in more than one of these). We detected the wall thickening in 38 cases by sonography (detection rate, 93%). The ileum was the most frequent site of involvement. The patterns of bowel wall thickening were diffuse in 30 cases and focal in eight cases and were concentric in 28 cases and eccentric in six cases. The associated findings were ascites, lymphadenopathy, omental cake, and cecal spasm in order of decreasing frequency. The sonographic findings are not specific for the diagnosis of intestinal tuberculosis, but when noted in the appropriate clinical situation would be of great help in the diagnosis of intestinal tuberculosis.