脾肿瘤的CT诊断及鉴别诊断

目的探讨脾肿瘤CT表现和鉴别诊断价值。方法52例脾肿瘤均行CT平扫 增强检查,其中手术及穿刺活检病理证实27例,征象典型及病史明确25例。结果脾良性肿瘤18例,恶性肿瘤34例。良性肿瘤表现为脾脏内单发或多发,多数大小不等低密度结节病变,1例血管瘤为等密度。血管瘤及淋巴管瘤可显示点状或小片状钙化。增强扫描,血管瘤显示延迟均匀强化特点,淋巴管瘤内间隔可轻度强化。脾囊肿无强化。脾脏恶性肿瘤多较大,密度不均匀,增强扫描不均匀强化。脾淋巴瘤表现为脾肿大或多发结节样低密度病变,增强扫描强化不明显。结论CT是诊断脾肿瘤的主要检查方法,结合临床及B超检查,多可做出诊断。     

脾淋巴瘤的CT影像学特征

目的:探讨脾淋巴瘤的CT影像学特征,为临床分期、治疗和预后判断提供支持。材料和方法:回顾性分析经临床病理证实的16例脾淋巴瘤的CT图像,并做文献复习。结果:16例脾淋巴瘤中,弥漫浸润和粟粒结节型2例,CT表现为弥漫性脾大,密度正常或略低,较均匀强化;多发肿块型6例,表现为脾内多发结节状及类圆形低密度灶,密度均匀,轻度均匀强化;巨块型8例,表现为脾内单发巨大低密度肿块,不均匀强化。10例伴有脾外淋巴瘤表现。结论:脾淋巴瘤的CT表现有一定特征性,结合脾外病变对临床诊断与分期有一定意义。     

脾脏转移瘤的螺旋CT诊断

目的:探讨脾脏转移瘤的CT诊断价值。方法:采用西门子Somatom Plus4螺旋CT机扫描,15例脾转移瘤病例经手术、穿刺活检病理证实及临床上有明确原发灶随访证实。结果:15例转移瘤均表现为单发或多发低密度灶,囊肿型7例,结节型4例,巨块型4例。结论:病灶易囊样变为脾转移瘤常见的影像学表现,CT为目前诊断脾脏转移瘤的重要方法,但需结合临床分析才可做出明确诊断。     

脾脏原发性淋巴瘤的CT、MRI表现

目的 探讨脾脏原发性淋巴瘤(PSL)的CT、MRI表现。方法 选取并分析经手术病理证实的17例PSL的临床和CT、MRI表现，探讨其影像学特征。结果 17例PSL均为非霍奇金淋巴瘤，其中弥漫浸润型4例，表现为巨脾合并脾梗死；粟粒结节型2例，表现为脾脏多发小结节，最大直径<1.0 cm;多发结节型8例，表现为脾脏多个大小不等结节，直径从5.0～10.0 cm不等，增强后部分呈环形强化，部分轻度强化；孤立肿块型3例，表现为脾脏单发巨大肿块，直径>10.0 cm,增强后不均匀强化。结论 PSL的CT、MRI表现具有一定的特征，影像学检查对PSL的分期有一定帮助。     

脾脏疾病的CT,MRI诊断

脾脏的大体及断面解剖。２ ．脾脏的先天变异（ 位置、形态及数目） 。３ ．脾感染性疾病：脾脓肿,脾结核及脾包虫病。ＣＴ、ＭＲＩ 均表现病灶中心为低密度液化坏死区,边缘可见环行强化。病灶多发及钙化有助于脾结核的诊断。４ ．脾脏的囊性病变：主要包括脾囊肿、脾内假性胰腺囊肿及脾包虫病。ＣＴ、ＭＲＩ 像呈液性密度或信号,边缘光整。鉴别诊断需结合临床病史及包虫皮试。５ ．脾良性肿瘤：主要包括脾血管瘤,脾错构瘤和淋巴管瘤。以脾血管瘤最多见,较特征性的影像学表现为ＣＴ 增强扫描病灶明显强化,ＭＲＩ Ｔ１ Ｗ 像呈低信号或等信号,Ｔ２ Ｗ 像呈高信号。６ ．脾脏恶性肿瘤：常见有恶性淋巴瘤和转移瘤。恶性淋巴瘤ＣＴ 表现为脾肿大,脾内多发或单发低密度灶,边缘不规整。脾转移瘤表现多种多样,病灶可单发或多发,实性或囊性。ＭＲＩ呈稍长Ｔ１ 、Ｔ２ 信号。７ ．脾梗塞：常见于脾血管血栓、癌栓栓塞及肿瘤组织的包埋。典型梗塞形状为尖端指向脾门、内小外大的锥形。ＣＴ 增强扫描为低密度灶。ＭＲＩ 呈稍长Ｔ１、长Ｔ２ 信号。８ ．脾外伤包括三种：ａ 完全性破裂;ｂ 脾中心破裂;ｃ 包膜下破裂。ＣＴ、ＭＲＩ 可显示脾损伤裂口,还可区分新鲜、陈旧出血及腹腔积液等。     

软组织转移瘤影像学诊断

目的探讨软组织转移瘤的影像学表现特点。方法选择经病理证实的软组织转移瘤35例,分析其CT和MRI表现特点。结果 CT检查31例,其中平扫13例,增强扫描15例,平扫并增强扫描3例。MRI平扫3例。19个肌肉内转移瘤CT平扫表现为等密度或略低密度肿块,边界不清,密度均匀或不均匀,最大径1.2~25.3cm;4例(21.52%)表现为弥漫性肌肉肿胀,密度均匀,与炎症相似;3例肿块内可见成簇的颗粒状或无定形钙化。9个皮下组织转移瘤CT平扫表现为多发或单发结节状或团块状等或略低密度灶,最大径0.5~5.2cm,边界清;2个表现为皮下组织内饼状软组织密度灶,边界不规则。CT增强扫描,病灶呈均匀或不均匀轻中度强化;其中7例(33.33%)呈环形强化,病灶中心不强化。3例MRI平扫表现为等长T1,不均匀长T2异常信号;2例边界清楚,1例边界不清。结论软组织转移瘤不罕见,在软组织肿瘤诊断中应注意鉴别。     

脾脏炎性假瘤的影像学表现（附三例报告）

目的 报道3例脾脏炎性假瘤的影像学表现,以提高对本病的认识。方法 复习3例脾脏炎性假瘤的超声、CT扫描和1例MRI表现,并与病理表现进行对照。结果 B超表现为单发球形病变,回声不均匀、边界清楚,其中1例见环状强回声伴后方声影。3例CT平扫见脾内边界清楚的低密度肿块,1例见周边蛋壳样环状钙化;2例作增强扫描,1例静脉期略有增强,另1例延迟扫描病变强化程度与脾实质接近;1例又作MR平扫,T1、T2WI均以低信号为主。结论 脾脏炎性假瘤应列入脾单发肿物的鉴别诊断,其影像表现与肿块内纤维组织和炎性肉芽组织的多少有关。超声表现为边界清楚、回声不均的肿块;CT增强扫描以病变延迟强化为特点;MRT2WI常以低信号为主。     

脾脏窦岸细胞血管瘤的临床、病理及影像学表现

目的 总结脾脏窦岸细胞血管瘤的临床、病理及影像学表现,以提高对该病的认识.资料与方法 我院2007-07～2011-08收治经手术病理确诊的5例脾脏窦岸细胞血管瘤,总结其临床、病理和影像学表现.结果 5例患者中,2例合并恶性肿瘤;2例为多发,3例为单发.多发肿块直径0.5～3cm,单发肿块直径5.5～9.5cm.超声声像图上可表现为低、等、强回声,血流超声可有或无血流信号.CT平扫表现为等或低密度肿块,增强扫描多呈不均匀渐进式强化.1例患者11C-乙酸盐及18F-脱氧葡萄糖(FDG) PET/CT检查未见阳性发现.5例患者均行脾脏切除术.病理组织学上肿瘤由大小不等、互相吻合的血管性腔隙组成,腔隙被覆低柱状或立方形内皮细胞,无明显异型性.肿瘤细胞免疫表型CD31和CD68均阳性.结论 脾脏窦岸细胞血管瘤是一种脾脏特有的、罕见的良性血管性肿瘤,临床常无特异表现,增强CT表现可提示其血管性肿瘤特征,确诊依赖病理形态学和免疫组织化学检查.     

CT对脾脏转移瘤的诊断价值(附10例报告)

目的探讨CT对脾脏转移瘤的诊断价值。方法回顾性分析经病理证实或随访证实的10例脾脏转移瘤的CT表现。结果 10例转移瘤均表现为单发或多发低密度灶,粟粒型1例,囊肿型4例,结节型3例,巨块型2例。结论脾脏转移瘤的CT表现具有一定特征,结合临床资料可明确诊断。     

肿瘤样钙质沉着症的临床和影像学分析

目的:探讨肿瘤样钙质沉着症的临床及影像学表现,提高本病的影像诊断水平.方法:回顾性分析6例经手术病理证实的肿瘤样钙质沉着症的临床及影像学资料.6例均行X线平片检查,2例行MRI检查.结果:6例患者主要临床表现为关节附近无痛性肿块,多发肿块2例,单发肿块4例.主要X线表现为关节周围团块状软组织钙化.MRI表现:T1WI上呈结节状不均匀低信号,T2WI上呈不均匀高信号.X线和MRI均显示邻近关节结构正常.结论:肿瘤样钙质沉着症的典型影像学表现为不侵及关节的软组织内多发钙化性肿块,平片和MRI有助于本病的诊断和鉴别诊断.     

肝脏原发性平滑肌瘤的影像表现

目的探讨肝脏原发性平滑肌瘤的影像特征。方法回顾性分析经病理证实的3例无免疫缺陷的肝脏原发性平滑肌瘤患者CT和MRI表现，及其与临床、病理间的联系。2例行CT检查，2例行MR检查。结果2例CT检查者病灶呈低密度，2例MRI检查者病灶呈长T1、长T2信号。1例密度和信号均匀，呈明显均匀强化；2例不均匀，1例增强后不均匀强化。3例均有假包膜征，无肝硬化和静脉瘤栓。病理示梭形肿瘤细胞增殖，毛细血管增生；1例伴中心玻璃样变，1例伴中心液化坏死。结论肝脏原发性平滑肌瘤是富血管性有假包膜的肿瘤，CT和MR检查对诊断有一定帮助。     

Magnetic resonance imaging of soft-tissue tumors of the extremities: A practical approach

Diagnosis of extremity soft-tissue tumors can be challenging. Characteristics of tumor margins can help precisely identify locally aggressive or non-aggressive behavior for surgical planning, but cannot differentiate benign from malignant lesions. Most malignant tumors can have inhomogeneous signals on T2-weighted images. Although a uniform signal on T2-weighted images can be a reliable indication of a benign lesion, a well-defined mass with homogeneous internal signal intensity does not definitively identify a benign lesion. Some common and distinctive soft-tissue lesions can have specific clinical and imaging features allowing a diagnosis without biopsy. These are known as determinate lesions. This illustrative report presents a diagnostic guide for extremity soft-tissue tumors based on tissue signal and morphological characteristics on magnetic resonance images. It is important for clinicians to be familiar with the imaging characteristics of common determinate lesions.     

恶性肿瘤脾转移15例临床分析

目的：通过临床病例分析了解脾脏转移癌的形态及临床特点。方法：总结15例恶性肿瘤脾转移病例．对脾转移发生的中位时间、临床表现及影像学特点进行分析。结果脾转移距原发病灶的中位发生时间为38.2个月,临床表现无特异性,影像学特点为脾实质内单发或多发结节。结论:脾转移可发生于几乎全身各种恶性肿瘤,病史和影像学检查是诊断的重要依据。     

29例脾转移瘤的CT征象分析

目的：研究碑转移瘤的CT诊断。方法：临床病理证实的29例脾转移瘤CT进行平扫与增强扫描,结果：单发16例,多发13例,其中单发或多发圆形,类圆形低密度灶13例,不规则形6例,大囊样低密度区5例,弥漫粟粒样病灶1例,脾门菜花样肿块4例,25例同时存在多脏器转称,结论：脾转移瘤的CT表现多样化,与其他多种脾病变需要鉴别CT为发现脾转移瘤较好的检查方法。     

脾脏肿瘤的CT诊断

目的：详细论述脾脏肿瘤的CT诊断及鉴别诊断。材料和方法：收集21例脾脏肿瘤患者的腹部CT平扫及增强检查资料，分析脾脏大小．轮廓、病灶数目，密度，边界等多种表现。结果：转移瘤的脾脏多为均匀性增大，病灶多发，边界欠清．靶心样强化具特征性。原发性淋巴瘤的脾脏常为不均匀性增大，病灶边界不清．边缘地图样强化具特征性．血管肉瘤绝大多数可发生囊变，增强时囊变区不增强。错构瘤可见钙化，脂肪，具特征性．多发肿瘤以转移瘤及淋巴瘤常见，而单发肿瘤以良性肿瘤多见。少数为转移瘤。结论：尽管脾脏肿瘤性病变较少见，但根据CT平扫及增强的特征性表现，大多数肿瘤可作出正确诊断。     

Desmoplastic small round cell tumor: imaging findings associated with clinicopathologic features

PURPOSE: To describe imaging findings of desmoplastic small round cell tumor (DSCRT) and to clarify the relation between radiologic appearances and clinicopathologic features. MATERIALS AND METHODS: CT scans and MRI examinations of four male patients with histologically confirmed DSCRT (mean age = 20 years) were retrospectively analyzed. RESULTS: The common imaging finding was multiple peritoneal masses with regular contour situated within mesentery. Tumors showed central low attenuation in 75% of patients on nonenhanced CT. All tumors showed inhomogeneous enhancement on CT. Small foci of punctate calcification were identified in a part of the tumor in all patients. Bone metastases were identified on enhanced CT in two patients 2 and 8 months after diagnosis, respectively. Pleural dissemination was identified in all patients, and one patient had double-sided dissemination. T2-weighted MRI showed inhomogeneous high signal intensity, and small cysts were identified in two patients. Fluid-fluid levels were identified in six tumors on T2-weighted images, which suggested the presence of hemorrhage. Tumors had inhomogeneous signal intensity low or isointense relative to skeletal muscle on T1-weighted images. Two lesions exhibited inhomogeneous enhancement with central low intensity consistent with necrosis. CONCLUSION: Imaging studies can depict disseminated characteristics and disease extent during the clinical course of DSRCT.     

小脑桥脑角听神经瘤的CT诊断：附204例分析

The CT findings of 207 acoustic neuroma in cerebellopontine angle from 204 cases verified by operation and pathology were analysed. The following characteristics are found helpful to determine the nature of the tumor: (1) on plain scan the tumor either presents as a homogeneous isodense or slightly hypodense lesion, or as a hypodense and isodense mixed density lesion. (2) The margin of the lesion is not well defined before contrast enhancement, and it becomes clearly marginated with smooth or lobulated contour after enhancement. (3) The enhancement of a solid tumor is homogeneous or slightly inhomogeneous, but in a tumor with cystic change the enhancement is inhomogeneous or ring-like (single ring or multiple rings). (4) The center of tumor growth is located at the inner outlet of internal auditory canal. (5) The tumor attaches to the petrous bone with an acute angle. (6) The internal auditory canal is enlarged or eroded. In the differential diagnosis, usually meningioma should be considered, if the tumor is solid; and cholesteatoma and arachnoid cyst should be ruled out, if the tumor is mainly cystic.     

A desmoid-type fibromatosis in the retroperitoneum of the gastro-pancreatic region that was resected with a distal pancreatomy: a case report

An 80-year-old man was referred to our hospital because of epigastric pain. Abdominal computed tomography revealed a well-defined circular intra-abdominal mass in the gastro-pancreatic region measuring 15 mm in diameter. After 6 months, the mass lesion was growing with mild enhancement, and weaker enhancement was found in the lower half of the mass on contrast-enhanced computed tomography. The mass lesion touched the stomach, whereas adipose tissue appeared to intervene between the mass and pancreas. On magnetic resonance imaging, the well-defined mass lesion had isointensity to muscle on T1-weighted imaging, slight hyperintensity to muscle on T2-weighted imaging, which indicated a rich fibrous tumor. Under general anesthesia, the patient underwent open surgery. Intraoperatively, the tumor was separated from the stomach and firmly attached to the pancreas. Therefore, we performed a distal pancreatomy with splenic resection. Pathological diagnosis was desmoid-type fibromatosis in the retroperitoneum, and the tumor margin was attached to the pancreas, splenic artery, and splenic vein. Since there are few reports of desmoid-type fibromatosis occurring in the retroperitoneum of the gastropancreatic region, it is difficult to distinguish from other soft tissue tumors and to identify the tumor origin. Close observation by radiological re-valuation was a useful option. Magnetic resonance imaging signals and an enhanced pattern may help distinguish a desmoid-type fibromatosis from other soft tissue tumors. A desmoid-type fibromatosis that is well-defined in radiological findings may infiltrate the surrounding organs with gross or pathological analyses.