腹部促纤维结缔组织增生性小圆细胞瘤CT表现及病理对照

目的：探讨腹部促结缔组织增生性小圆细胞肿瘤（DSRCT）的CT表现。方法：回顾性分析经病理证实的8例DSRCT患者的CT表现,8例患者均行CT增强扫描,并对其CT表现与病理学进行对照分析。结果：3例DSRCT单发,5例多发;病变主要位于膀胱后方（n=5）及肠系膜间隙（n=5）;CT表现为腹、盆腔内分叶状或结节状低密度肿块;可见坏死区（n=3）及钙化灶（n=4）;增强扫描均表现为不均匀强化,平扫、增强扫描动脉期及静脉期肿块的平均CT值各为38.9 HU5、6.1 HU6、2.5 HU。8例肿瘤病理特点均表现为瘤组织呈片状或巢状弥漫浸润性生长,中间由宽厚的纤维结缔组织分隔,3例可见瘤内坏死。结论：DSRCT的CT表现与病理之间存在一定的相关性,CT有助于DSRCT的诊断、分期及定位活检。     

腹盆部促纤维组织增生性小圆细胞瘤的CT表现

目的探讨腹盆部促纤维组织增生性小圆细胞瘤(desmoplastic small round cell tumor,DSRCT)的影像表现,以提高对该肿瘤的认识及诊断水平。方法对6例经手术、活检病理证实的腹盆部DSRCT的影像表现进行回顾性分析。结果 6例CT表现为单个或多个较大肿瘤内可见坏死、囊变区,6例均可见多少不等钙化灶;增强扫描3例肿瘤实质部分呈轻至中度强化,3例明显强化,可见多发条状明显强化血管影。结论腹盆部DSRCT的CT表现有一定特征性,当青少年患者腹盆部出现多发大小不等肿块,内密度多不均匀,增强扫描肿瘤呈轻至中度强化,可提示DSRCT的诊断,确诊仍需进行病理及免疫组织化学检查。     

腹盆腔促纤维组织增生性小圆细胞瘤的CT表现及文献复习

目的探讨腹盆腔促纤维组织增生性小圆细胞瘤(desmoplastic small round cell tumor,DSRCT)的CT表现。方法回顾性分析5例DSRCT的典型病例,并结合相关文献复习,探讨其CT表现。结果 4例表现为腹盆部多发大小不等的肿块,最大的肿块呈囊实性,位于小肠系膜,无明显钙化;1例表现为双侧卵巢巨大类椭圆形囊实性肿块,密度不均匀,边界不清,周围见转移灶。5例患者肿瘤标记物CA125分别为172.20 U/ml,158.40 U/ml,126.70 U/ml,117.60 U/ml,96.90 U/ml(正常值<35 U/ml)。结论 DSRCT CT表现多样,结合实验室检查对早期诊断有一定价值。     

促结缔组织增生性小圆细胞肿瘤的CT特征及鉴别诊断

目的:总结分析促结缔组织增生性小圆细胞肿瘤(DSRCT)的特征性CT表现，提高鉴别诊断能力。方法:回顾性分析经病理证实的14例DSRCT患者的临床及CT表现，总结病变CT特点(肿块位置、密度、强化特点，腹膜、腹水及脏器受侵等)。结果:14例DSRCT患者中，男11例(78.5%),女3例(21.4%),年龄9～42岁，平均(21.1±29.8)岁。肿块位于盆腔(膀胱后方)者12例(85.7%);增强扫描14例(100%)肿块均呈持续强化；腹膜增厚者14例(100%),其中结节样、肿块样增厚10例(71.4%),絮状、饼状增厚9例(64.3%);10例(71.4%)合并少量腹水；8例(57.1%)发生腹腔腹膜后淋巴结转移，共10例(71.4%)发生远处转移(肝、肺、骨转移)。结论:DSRCT好发于青年男性，盆腔肿块并持续强化、少量腹水、腹膜增厚为其特征性CT表现，可与淋巴瘤腹膜侵犯、腹膜转移等相鉴别。     

腹部促结缔组织增生性小圆细胞肿瘤的CT、MRI表现

目的 探讨腹部促结缔组织增生性小圆细胞肿瘤(desmoplastic small round cell tumor,DSRCT)的CT、MRI表现.资料与方法 回顾性分析经病理证实的7例DSRCT患者的临床及影像学资料,7例中单发2例,多发5例;病灶直径＞10 cm者5例.7例均行CT检查,2例在1周内行MRI.结果 腹、盆腔内可见分叶状或结节状低密度肿块,其内有小片状坏死,5例可见斑点状钙化;增强扫描2例轻度强化,5例中度强化;病灶与浆膜面关系密切,对周围组织及血管呈推移、包绕、侵犯倾向,但无明显起源关系,5例病灶内可见分隔状强化血管影.2例伴腔积液;2例肝转移、骨转移;3例淋巴结转移.MR T1WI上呈等低信号,T2WI呈稍高信号,其内可见更高信号的囊变坏死区.结论 CT和MRI表现为腹、盆腔内巨大结节状或分叶状肿块,特别是位于膀胱后方或子宫直肠区域,与周围器官无明显起源关系,广泛腹膜、网膜种植,肿瘤呈不均匀低密度,内见斑点状钙化及小片状坏死,腹腔积液少见,增强扫描呈轻、中度强化,可考虑DSRCT的可能.     

阑尾低级别黏液性肿瘤的CT表现

【摘要】目的：探讨阑尾低级别黏液性肿瘤（LAMN）的CT表现。方法：回顾性分析经手术/穿刺病理证实的24例LAMN患者的影像及临床资料，总结其CT特征。15例行CT增强扫描，9例同时行CT平扫及增强扫描。结果：24例中21例表现为右髂窝、盆腔或结肠旁沟囊性肿块，3例呈右髂窝条状含气腔漂浮于液体中，其中2例形成腹盆腔巨大多房囊性病变。LAMN均表现为囊壁不均匀增厚且不光滑，病变长径/短径为1.60±0.56，囊壁厚度为（3.80±1.53）mm。囊性肿块CT值为（17.21±6.59）HU，高于膀胱内液体密度。9例边界局部欠清。7例囊壁连续性中断，9例见囊壁下薄层分隔影或囊壁“双边样”改变，19例囊壁钙化。10例腹盆腔积液，7例腹膜假黏液瘤（PMP）。囊壁轻度强化，周围未见淋巴结转移。结论：LAMN的CT表现有一定特征性，结合临床可做出较准确的诊断。     

小儿腹盆腔横纹肌肉瘤的CT表现与病理对比研究

目的探讨小儿腹盆腔横纹肌肉瘤(RMS)的CT表现特征及与病理学分型的相关性,提高其诊断水平。方法对10例经手术或活检病理证实的小儿腹盆腔RMS的临床病理资料及CT影像表现进行回顾性分析。结果 6例腹腔及腹膜后RMS,5例CT表现为腹盆腔边界清楚巨大软组织肿块,最大径12~19cm,1例为边界不清多发结节状团块融合;平扫6例密度均低于肌肉,4例均匀,2例内部可见不规则片状更低密度坏死区;增强后动脉期5例肿块内部可见迂曲肿瘤血管,静脉期6例均为肿瘤内部不均匀片絮状强化。4例膀胱RMS CT均表现为膀胱腔内低于肌肉密度葡萄簇状软组织肿块,膀胱壁不规则增厚,增强后肿块中度均匀强化,并可显示膀胱壁以黏膜下层增厚为主,其中2例合并膀胱外盆腔肿块。10例病理类型均为胚胎性RMS,其中4例起源于膀胱的RMS分属葡萄簇状亚型,余6例为梭形细胞型。结论小儿腹盆腔RMS CT表现有一定的特征性,并可初步反映其病理分型。     

腹盆腔炎性肌纤维细胞瘤CT表现与临床病理特征

目的 探讨腹盆腔炎性肌纤维细胞瘤(IMT)的CT表现及临床病理学特征。方法 选取经手术病理证实的9例IMT,分析临床特征及影像学表现。结果 9例IMT患者中CT平扫4例密度均匀，呈等密度影；3例呈等低混杂密度影，伴有囊变坏死，1例病灶边缘伴线样钙化影。CT增强6例动脉期呈轻至中度强化，静脉期呈现持续性强化，2例动脉期可见小血管强化影；1例动脉期呈中度以上强化，静脉期持续性强化。4例病灶内实性部分呈结节、片絮状强化伴不同程度的黏液变性区，2例呈环形强化。5例肿瘤边界清晰，4例肿瘤边缘不规则，可见范围不等的小片状或晕状渗出模糊影。4例病灶周边脏器不同程度受压、移位；2例肝脏转移、腹盆腔转移及腹壁侵犯。随访9例均无瘤生存，2例复发均手术切除。结论 腹盆腔IMT的CT表现具有多样性，其影像学表现在一定程度上可反映病理学特征。     

腹盆腔恶性淋巴瘤的少见CT表现

目的 探讨腹盆腔恶性淋巴瘤的少见CT表现.资料与方法 分析13例经病理证实的腹盆腔恶性淋巴瘤患者的CT表现,男9例,女4例,年龄25-74岁.非霍奇金淋巴瘤12例,霍奇金淋巴瘤1例.全部病例术前或治疗前均做CT平扫及增强检查.结果 腹盆腔恶性淋巴瘤的少见CT表现有:(1)腹膜炎样改变(3/13);(2)腹腔或腹膜后肿块合并坏死灶(5/13);(3)大量腹腔积液(2/13);(4)单发或单侧腹腔脏器浸润(3/13).结论 CT表现不典型的腹盆腔恶性淋巴瘤,术前易被误诊,需综合CT表现及临床资料作出诊断.     

盆腔腹膜外间隙神经源性肿瘤的CT诊断

目的探讨盆腔腹膜外间隙神经源性肿瘤的螺旋CT表现特征。方法回顾性分析经手术病理证实的盆腔腹膜外间隙神经源性肿瘤9例。9例均行螺旋CT平扫和增强扫描。结果神经鞘瘤3例(其中恶性1例),神经纤维瘤4例,神经母细胞瘤和节细胞性神经瘤各1例;肿瘤位于直肠腹膜外间隙6例,膀胱腹膜外间隙3例;CT表现为体积较大,形态规则或不规则,边界清楚或局部不清楚,密度不均匀,内可见囊变区和钙化灶,增强扫描呈边缘强化或瘤体不均匀强化。结论螺旋CT对盆腔腹膜外间隙神经源性肿瘤的诊断有一定价值。     

Oral and oropharyngeal tumors

There is a large variability of tumors and tumor-like lesions, which are located in the oral cavity and oropharynx. But more than 90% of all tumors in this area are squamous cell carcinomas (SCCs). Other malignancies in this location are rare. About 10% of all oral and oropharyngeal tumors are benign. Congenital lesions, like vascular malformations, lingual thyroid or (epi-)dermoid cyst, usually become present in youth or childhood. Acquired lesions can be inflammatory (abscess) or neoplastic (pleomorphic adenoma and hemangioma). Preferred imaging in childhood are ultrasound and magnetic resonance imaging (MRI), while in adults usually computed tomography (CT) and MRI are more frequently used.     

原发性结外淋巴瘤在耳鼻及咽部的临床特点

目的 总结原发性结外淋巴瘤在耳、鼻及咽部的临床表现,以提高及时确诊率。方法 回顾性分析16例原发性结外淋巴瘤在耳、鼻及咽部的临床表现特点,特别是罕见的中耳淋巴瘤和少见的副鼻窦淋巴瘤的临床表现。结果 中耳淋巴瘤1例,以伴有疼痛的慢性分泌性中耳炎(传导性聋)、轻度面瘫为特点;扁桃体淋巴瘤7例,以咽异物感及单侧扁桃体肿大为特点;鼻及副鼻窦淋巴瘤2例,以血涕、鼻臭、下鼻甲黏膜粗糙,增厚为特点;鼻咽部淋巴瘤以血涕、头痛为特点;口咽部淋巴瘤以咽痛、发热、软腭溃疡、口臭为特点。结论 在发现耳、鼻及咽部病变时,掌握原发性结外淋巴瘤在耳、鼻及咽部的临床表现特点,及时行病理检查,是及时确诊的关键。     

乳腺癌术后肝转移癌的声像图特点

本文回顾性分析了１９８７－１１～１９９４－１１乳腺癌术后肝内占位性病变１２０例，其中９８例为转移癌，２２例为非均匀性脂肪肝、肝囊肿或血管瘤。采用针吸活检、诊断性化疗、综合影像学诊断及超声随访方法证实。乳腺癌术后出现脂肪肝的比例较高（４７％），肝转移伴脂肪肝者３５例（３６％），其声像图特点为内部呈低回声（６６％）及周围无低回声晕（６９％）；而不伴脂肪肝者６３例（６４％），其内部多呈等回声（５９％），常伴低回声晕（７６％）。脂肪肝的存在使肝脏回声衰减，可能导致占位显示不清而漏诊；脂肪肝的存在又往往使得一些占位病变表现不典型而误诊。当声像图不典型、鉴别诊断困难时，应做超声引导下穿刺活检予定性诊断。     

FDG PET/CT and Mediastinal Nodal Metastasis Detection in Stage T1 Non-Small Cell Lung Cancer: Prognostic Implications

Objective

We aimed to compare the prognoses of patients with pathologically true negative (P-TN) N2 and PET/CT false negative (FN) results in stage T1 non-small cell lung cancer (NSCLC).

Materials and Methods

Our institutional review board approved this retrospective study with a waiver of informed consent. The study included 184 patients (124 men and 60 women; mean age, 59 years) with stage T1 NSCLC who underwent an integrated PET/CT and surgery. After estimating the efficacy of PET/CT for detecting N2 disease, we determined and compared disease-free survival (DFS) rates in three groups (P-TN [n = 161], PET/CT FN [n = 12], and PET/CT true positive [TP, n = 11]) using the Kaplan-Meier analysis and log-rank test.

Results

Pathologic N2 disease was observed in 23 (12%) patients. PET/CT had an N2 disease detection sensitivity of 48% (11 of 23 patients), a specificity of 95% (153 of 161), and an accuracy of 89% (164 of 184). The 3-year DFS rate in the PET/CT FN group (31%, 95% confidence interval [CI]; 13.6-48.0%) was similar to that of the TP group (16%, 95% CI; 1.7-29.5%) (p = 0.649), but both groups had significantly shorter DFS rates than the P-TN group (77%, 95% CI; 72.0-81.2%) (p < 0.001).

Conclusion

The PET/CT shows a high specificity, but low sensitivity for detecting N2 disease in stage T1 NSCLC. Patients with PET/CT FN N2 disease have survival rates similar to PET/CT TP N2 disease patients, which are both substantially shorter than the survival rate of P-TN patients.     

Lung metastases

The lungs are among the most prominent target organs for metastatic disease. Most frequently, lung metastases originate from cancers of the head and neck, breast, stomach, pancreas, kidney, bladder, the male and female genitourinary tract, and sarcomas. Plain chest radiography is typically the modality used for detection and therapeutic monitoring; however, the use of CT for these purposes is becoming more frequent. Currently, spiral CT appears to be the most sensitive imaging technique in the identification of metastases, because it detects a higher number of pulmonary nodules compared to other techniques. Pulmonary metastatic disease manifests itself by the presence of pulmonary nodules, lymphangitic carcinomatosis, endobronchial tumors, and pleural involvement. Nevertheless, the differential diagnosis is an important consideration, particularly in patients with solitary pulmonary nodules, systemic disorders, and signs or symptoms indicative of infection. The role of the radiologist involves the identification of metastatic disease, monitoring of response to therapy, and the use of invasive procedures when the differential diagnosis indicates the need for biopsy and histopathologic proof. The radiologist must be aware of the impact of his diagnosis on patient management and should be familiar with oncologic strategies as well as the terminology used to characterize tumor response. In future, the role of imaging may further expand due to the increased sensitivity in lesion detection, increased specificity in lesion (tissue) characterization using MR imaging, and reduced radiation exposure. Correspondence to: Christian J. Herold     

Follow-up Results After Negative Findings on Unenhanced Hepatic MR Imaging for Hepatic Metastasis from Rectal Cancer

Objective

To assess the follow-up results after negative findings on unenhanced hepatic MR imaging in rectal cancer patients who have undergone locally curative surgery.

Materials and Methods

From all pertinent imaging reports and medical records, we selected 255 patients who had negative results on unenhanced hepatic MR imaging. When selecting patients who had undergone curative resection, the following patients were excluded from the study: 1) patients in whom extrahepatic metastases were detected on preoperative staging work-ups, 2) patients in whom the surgery was judged to be non-curative due to peritoneal seeding or local aggressiveness. Cases with follow-up periods of less than 18 months were also excluded, as these cases were considered insufficient to confirm the negative outcomes. Thus, a total of 149 patients were ultimately enrolled in our study. The follow-up results of unenhanced MR imagings were assessed according to the assumption that the newly developed hepatic metastases had been false-negative lesions on preoperative MR image.

Results

During a median follow-up period of 29.3 months, 25 hepatic metastases were detected in 13 patients (8.7%), which indicated a negative predictive value of 91.3%.

Conclusion

Unenhanced hepatic MR imaging provides a high negative predictive value with regard to the detection of hepatic metastasis in the preoperative evaluation of rectal cancer.     

Carcinosarcoma of the Liver: A Case Report

Primary hepatic carcinosarcoma is a rare tumor comprised of a mixture of carcinomatous and sarcomatous elements. Less than 20 adequately documented cases have been reported, however the imaging features of two cases were briefly described. We present here a case of carcinosarcoma of the liver in a 46-year-old woman, which was confirmed based on pathology. Imaging showed a large mass with large necrotic portions, small cystic portions, calcifications and bone formations.     

高场MRI对喉及下咽癌术前分期价值的评价

目的评价高场MRI（1.5T）在喉、下咽癌术前分期中的价值。方法对36例喉、下咽癌患者的MRI资料进行回顾性分期，并与临床分期及手术病理分期相对照。结果MRI对各期喉、下咽癌的准确率分别是T192%，T286%，T386%，T4100%。临床分期准确率分别是T1100%，T286%，T357%，T422%。MRI和临床分期总准确率分别是92%，69%。二者之间有显著性差异。结论高场MRI通过不同加权像的对比和从多角度准确显示肿瘤的部位形态及浸润范围，因而显著性提高喉、下咽癌术前分期的准确性。     

腹腔镜手术治疗子宫恶性肿瘤的应用价值

目的 研究腹腔镜下广泛全子宫切除术、盆腔淋巴结切除术治疗早期子宫恶性肿瘤的应用价值.方法 回顾性分析34例经腹腔镜和30例开腹手术治疗的临床Ⅰ～Ⅱ期子宫恶性肿瘤患者的临床资料,比较两组的手术时间、术中出血量、并发症、术后恢复情况及淋巴结切除数目等.结果 两组的手术时间、并发症发生率无显著性差异.腹腔镜组的术中出血量为247.13±127.62ml,明显少于同期开腹手术者(904.51±428.37ml,P＜0.01).腹腔镜组淋巴结切除数为23.2±5.8个,多于开腹组淋巴结切除数(16.5±3.8,P＜0.01).术后胃肠功能恢复时间,腹腔镜组为26.4±8.3h,开腹组为54.6±13.5h,两组间有显著性差异(P＜0.01).术后随访11个月两组均未见复发病例.结论 腹腔镜下广泛全子宫切除术、盆腔淋巴结切除术获得满意的效果,近期疗效肯定,远期疗效尚需进一步随访分析.     

MR Imaging of papillary renal neoplasms: potential application for characterization of small renal masses

The purpose of our study was to evaluate the role of MRI in demonstrating the precise nature of papillary renal tumors (P RCC) and its potential application to select patients for partial surgery. Ninety-seven tumors less than or equal to 3 cm in size [55 papillary renal cell carcinoma - 42 clear cell renal carcinoma (CC RCC)] were preoperatively evaluated by MRI. Imaging findings were assessed with a special focus on the aspect of the tumoral process. Correlations were performed with pathologic staging after surgery. At pathology, 92 tumors were established to be staged p T1 and 5 were p T3 ( 3 cases of CC RCC and 2 cases of P RCC). Ninety-four percent of papillary tumors exhibited low signal intensity with homogeneous pattern on T2-weighted images. All clear cell carcinoma were hyperintense and heterogeneous on T2-weighted sequence. Enhancement was lower and delayed in the papillary type in comparison with the clear cell type. MRI is accurate enough to predict the ‘histologic‘ nature of papillary renal carcinoma. It is an additional argument to propose that the tumor can be removed by partial surgery.