CT对喉癌的诊断价值

目的 评价CT平扫与增强扫描对喉癌的诊断能力。方法35例给手术病理证实的喉癌患者均经CT平扫，其中，15例又经对比增强扫描。对所有病例的CT表现进行了回顾性分析。结果在35例的CT像上，病变形态呈结节状见于12例，不规则形14例，菜花状5例，巨块形2例，以及未见明确肿块2例；病变部位在声门20例，声门上部6例，声门下部1例，以及贯声门8例；病变侵犯范围包括声带28例，会厌皱襞8例，会厌5例，会厌前间隙5例，以及梨状隐窝6例。10例伴发颈部淋巴结转移。在接受CT增强扫描的15例患者中，13例的肿块于增强后呈轻-中度强化。结论CT扫描可清晰显示肿块的形态位置、侵犯范围，以及颈部淋巴结的转移，因而，它能为喉癌的诊断与治疗提供重要信息。     

CT平扫与增强扫描对梗阻性黄疸的诊断价值

目的探讨CT对梗阻性黄疸的诊断价值。方法对38例经手术病理证实的梗阻性黄疸进行回顾性分析。其中，胆管癌9例，胰腺癌12例，胆总管结石16例，胆总管炎性狭窄1例。结果胆管癌中7例位于胆总管，2例位于肝门区胆管，均表现为梗阻上方胆管扩张。胰腺癌中8例表现为胰头增大，4例胰头增大不明显，增强扫描可见小结节状强化。胆总管结石中14例为阳性结石，表现为高密度影，2例为阴性结石，表现为低密度影。胆总管炎性狭窄1例，表现为肝内外胆管扩张，胆囊扩大，胆总管渐进性狭窄。结论CT除可以确定梗阻性黄疸的诊断以外，还能明确梗阻部位以及判断梗阻原因。     

Radiation therapy for patients with obstructive jaundice caused by carcinoma of the extrahepatic biliary system]

From February 1980 through September 1990, 92 patients with obstructive jaundice resulting from biliary tract cancer registered at Shikoku Cancer Center Hospital or Ehime University Hospital. Radiation therapy (RT) was used to treat 38 of these patients (30 with carcinoma of the extrahepatic bile duct, excluding ampulla of Vater, and eight patients with carcinoma of the gallbladder). Of 38 patients, 11 underwent intraoperative radiation therapy (IORT), and 27 were treated by external radiation therapy (ERT) alone. In contrast, 54 patients (39 with carcinoma of the extrahepatic bile duct and eight with carcinoma of the gallbladder) were not treated by RT. All jaundiced patients received external and/or internal biliary drainage of some kind. Among patients undergoing biliary drainage with a catheter, 21 patients who underwent RT (four with IORT) survived significantly longer than 19 patients who did not (generalized Wilcoxon test: p less than 0.05). There were no significant differences in survival between 7 patients with recanalization and 11 patients with no recanalization. Concerning the survival of laparotomized patients, excluding those with complete resection or perioperative death, eight patients treated with postoperative ERT survived longer than 12 patients who did not have postoperative ERT (not significantly). Eleven patients underwent IORT. A patient with unresectable carcinoma of the hilar bile duct survived 2 years and 3 months after a combination treatment of ERT and IOTR. In four of eight autopsied patients, radiation effects of Grade II were observed (Oboshi and Shimosato's evaluation system for the histological effects of radiation therapy). Our experience suggests that RT is effective in patients with obstructive jaundice caused by carcinoma of the biliary system.     

Adjunctive diagnostic value of ultrasonography evaluation in patients with suspected ductal breast disease

PURPOSE: The purpose of this study was to evaluate the adjunctive diagnostic value of breast ultrasonography (US) in the study of benign ductal breast disease. MATERIALS AND METHODS: Fifty-two patients underwent US examinations for bloody nipple discharge, palpable retroareolar masses, retroareolar opacities or ductal pattern on mammography. US enabled visualisation of mammary-duct ectasia (simple or pseudocystic, retroareolar and/or peripheral) and focal masses (endoluminal or periductal, with ill-defined or regular margins). All patients with nipple discharge underwent cytological evaluation. After the US examination, all focal masses with ill-defined margins underwent fine-needle aspiration biopsy (FNAB), if necessary. The benign alterations were followed up. RESULTS: In 38/52 cases, US diagnosed mammary-duct ectasia and in 30/52 cases, the presence of focal masses (mean size 7 mm). In the nine women who underwent biopsy, histopathological evaluation diagnosed five solitary papillomas, one solitary papilloma with a focal area of ductal carcinoma in situ (DCIS), two multiple papillomas of the nipple and one papillomatosis. CONCLUSIONS: High-frequency US plays an important role in the detection of benign ductal disease both for the diagnosis and classification of focal masses and mammary-duct ectasia. US can be used as a complementary imaging method to galactography or as a valuable alternative when galactography is not available.     

CT scanning in traumatic and emergency patients

In emergency cases and traumatic head cases, CT scanning has completely changed the diagnostic method and angiography can in most cases be avoided. Not only can a proper diagnosis be set concerning intracranial bleedings or hematomas of different kinds but also additional information which earlier with help of angiography were not available can now be diagnosed. The article discusses the principles for using CT scanning as a diagnostic method in traumatic and emergency patients and discusses also the limitations and benefits with this method compared with angiography.     

恶病质病人CT增强扫描的方法和护理

1资料和方法 1.1观察对象 1999年3月～2003年3月中恶病质病人76例,男44例,女32例,年龄30～80岁,平均62岁.     

CT scanning in patients with opsomyoclonus: importance of nonenhanced scan

Children with neuroblastoma presenting with opsomyoclonus are a diagnostic dilemma; they may not have a palpable mass or elevated urine catecholamines and the neurologic manifestation often precedes the discovery of a primary tumor by several months. The delay in diagnosis probably reflects the difficulty in detecting small lesions. Even with high-resolution computed tomography (CT), difficulty was recently experienced in identifying small retroperitoneal lesions in three patients who presented with opsomyoclonus. Calcifications in these small neoplasms resembled contrast material within adjacent small-bowel loops that were not discernible until additional, unenhanced scans were obtained. It is recommended that the initial CT evaluation in patients presenting with opsomyoclonus be performed without bowel or intravenous contrast enhancement.     

Aneurysms of the portal venous system: ultrasonography and CT findings

Objective: The retrospective study of aneurysms of the portal venous system and their possible aetiology, using different imaging methods. Material and methods: Between 1992 and 1995 we collected 13 cases of portal vein aneurysm from 11 patients, eight of whom suffered portal hypertension (PH) secondary to hepatic cirrhosis. All were diagnosed by means of ultrasonography (155) and/or computed tomography (CT). The aneurysms were defined as fusiform expansions when in the main portal vein and its branches or as cystic lesions with internal flow when in the intrahepatic branches. Results: Ten of the aneurysms (76.9%) were in the extrahepatic portal venous system and three (23.1%) in intrahepatic branches. Of the extrahepatic aneurysms, the two most common locations were the main portal vein and the confluence of superior mesenteric and splenic veins (30.7% each site). The largest were generally those at the confluence (37.6±9.7 mm maximum diameter). Conclusion: Aneurysms in the portal system can be congenital or acquired. Although their aetiology is uncertain, we found a clear relation to PH syndrome; of 13 aneurysms in the study, eight were related to this disease. PH should be suspected in the evaluation of portal aneurysms.     

螺旋CT扫描及重建技术在气道异物诊断中的价值

气道异物是呼吸道常见急重症之一,如不及时诊治会导致一系列严重并发症,甚至可危及生命。由于手术具有风险性和创伤性,这就要求医生的术前诊断必须十分明确。多层螺旋CT薄层重建后处理技术可直接显示气管及支气管异物的形态、大小,同时可在后处理图像上直接测量异物大     

高频超声和CT诊断甲状腺乳头状癌合并钙化的临床价值

目的探讨高频超声和CT诊断甲状腺乳头癌钙化的共同的影像学特征。方法通过回顾分析发现经过手术甲状腺肿瘤并伴钙化84例,其中病理证实34例甲状腺乳头状癌的影像学资料。根据乳头状癌的钙化形态(沙粒样;弧形;蛋壳样),大小(微钙化2mm;粗钙化2mm),位置(肿块内部;周边),数目(孤立;2个;弥漫性)等进行详细对比。以50例合并钙化的良性结节的超声和CT图像为参考组。结果超声发现甲状腺乳头状癌沙粒样钙化(22例)弧形钙化(5例)蛋壳样钙化(2例);微钙化(22例)粗钙化(12例);肿块内部(25例)周边(3例);弥漫性钙化(25例)数目小于3个(7例)孤立性钙化(2例)。B超和CT诊断弥漫性沙粒样钙化(67.65%)最多见,孤立性弧形钙化(20.59%)次之,蛋壳样钙化(5.88%),囊内钙化(5.88%)。结论确定B超和CT钙化模式共同影像学特征,提高甲状腺乳头状癌诊断率和鉴别诊断有一定临床价值。     

老年患者CT增强扫描的观察与护理配合

随着多层螺旋CT的广泛应用,检查项目逐渐增加,CT增强时用高压注射器注射对比剂的速率不断提高.老年患者机体耐受力差、不良反应多,应引起护理人员重视.本文对240例不同年龄段的老年患者行CT强化护理的经验总结如下.     

颈部钝伤齿突侧块间隙不对称CT扫描的价值

目的 :研究颈部钝伤齿突侧块间隙 (LADS)不对称患者功能位CT扫描时寰枢椎旋转角度 ,为临床有关疾病的诊断治疗提供帮助。方法 :3 0例正常人和 2 5例患者行中立位CT扫描 ,然后行左、右旋转 2 5°～ 45°功能位扫描 ,测量功能位寰枢椎相对旋转角度。结果 :3 0例正常人寰椎相对于枢椎的旋转角度大于 8°。 2 5例受伤者中 19例寰椎相对于枢椎的旋转角度大于 8° ,其余 1周后CT复查均大于 8° ,枢椎的运动弧度正常时应小于寰椎的 5 0 %。结论 :张口位平片显示LADS间隙不对称而临床无其他症状者无需进一步检查或治疗。而临床伴有旋转固定症状者 ,需用功能位CT扫描。     

Comparative diagnostic evaluation with MR cholangiopancreatography, ultrasonography and CT in patients with pancreatobiliary disease

Purpose

The aim of this study was to directly compare the results of magnetic resonance cholangiopancreatography (MRCP) with those of ultrasonography (US) and multislice computed tomography (MSCT) in the diagnosis of pancreaticobiliary diseases.

Materials and methods

A total of 70 patients (41 men, 29 women) aged 22-89 years were studied either before (n=59) or after cholecystectomy (n=11) for biliary lithiasis. Clinical signs and symptoms were jaundice (n=15), abdominal pain (n=37) and proven biliary lithiasis (n=18). MRCP was performed in all patients, whereas abdominal US was performed in 55 (group 1) and MSCT in 37 (group 2) patients. A regional evaluation of the main structures of the pancreaticobiliary system was performed: gallbladder and cystic duct, intra- and extrahepatic bile ducts and main pancreatic duct. Histology (n=27), biopsy (n=5), endoscopic retrograde cholangiopancreatography (ERCP) (n=28) and/or clinical-imaging follow-up (n=10) were considered standards of reference. In particular, patients were classified as showing benign (n=47) or malignant (n=12) lesions or normal biliary anatomy (n=11).

Results

In group 1, the results of MRCP and US were concordant in the majority (92%) of cases; however, statistically significant discordance (p<0.01) was found in the evaluation of the extrahepatic ducts, with nine cases (16%) of middle-distal common bile duct stones being detected on MRCP only. In group 2, the results of MRCP and MSCT were also concordant in most cases (87%). However, findings were significantly discordant when the intra- and extrahepatic ducts were analysed, with seven (19%) and six (16%) cases, respectively, of lithiasis being detected on MRCP only (p<0.01 for both).

Conclusions

The results of our study confirm the diagnostic potential of MRCP in the study of the pancreaticobiliary duct system. In particular, the comparison between MRCP and US and MSCT indicates the superiority of MRCP in evaluating bile ducts and detecting stones in the common bile duct.     

CT and pathologic assessment of prospective nodal staging in patients with ductal adenocarcinoma of the head of the pancreas

OBJECTIVE: The aim of our study was to compare the assessment of peripancreatic lymph nodes using CT with the gold standard of detailed histopathologic assessment of resected specimens in patients with pancreatic ductal adenocarcinoma. SUBJECTS AND METHODS: Sixty-two patients with presumed pancreatic carcinoma were prospectively studied with dual-phase contrast-enhanced helical CT, and images were interpreted in consensus by three radiologists. Complete surgical resection was performed in 28 patients. A detailed nodal classification system was used for radiologic, surgical, and pathologic staging in the nine patients whose final diagnosis at histology was pancreatic ductal adenocarcinoma. RESULTS: Forty lymph nodes were prospectively identified on CT in these nine patients. Two of 23 nodes (9%) measuring less than 5 mm in the short-axis diameter were malignant, four of 11 nodes (36%) measuring 5-10 mm were malignant, and one of six nodes (17%) larger than 10 mm was malignant. Using a short-axis diameter of greater than 10 mm as the criterion for nodal involvement, we found a sensitivity of 14% (1/7) and a specificity of 85% (28/33), with a positive predictive value of 17% (1/6), a negative predictive value of 82% (28/34), and an overall accuracy of 73% (29/40). Ovoid nodal shape, clustering of nodes, and the absence of a fatty hilum were not useful predictors of malignancy on CT. CONCLUSION: In resectable pancreatic ductal adenocarcinoma, CT is not accurate overall for the prediction of nodal involvement. In a patient with presumed pancreatic carcinoma that is considered to be resectable, the depiction on CT of peripancreatic nodes should not prevent attempted curative resection.     

Multislice CT cholangiography without biliary contrast agent: technique and initial clinical results in the assessment of patients with biliary obstruction

Our objective was to describe our technique for multislice CT cholangiography without cholangiographic contrast agent, and to present our preliminary clinical results. Thirty-seven patients with suspected biliary obstruction were studied. A multislice CT unit was used with the following technical parameters: 2.5-mm collimation; 7.5-mm/s table speed; pitch 6; 0.8-s rotation time; 300 mA; 120 kVp; 18- to 24-s scan time; scan volume ranging from the hepatic dome to below the pancreatic head; 70-s delay after injection of 150 ml of iodinated contrast agent at 4 ml/s. No biliary contrast material was given; oral iodinated contrast agent was administered to opacify bowel loops. Axial, multiplanar reformatted, and minimum intensity projection images were evaluated. The CT findings were compared with the gold standard techniques: endoscopic retrograde cholangiography (ERCP) in 30 patients, percutaneous transhepatic cholangiography in 5, and intraoperative cholangiography in 2. In 5 patients with ampullary lesions biopsy was made during ERCP, 9 underwent surgery, and 11 US-guided fine-needle aspiration. Bile ducts appeared hypodense within the surrounding enhanced structures. Regarding the site of obstruction, agreement between multislice CT and conventional cholangiography was observed in all cases. One patient presented negative findings on both CT and ERCP. In 31 of 36 (86%) patients, multislice CT cholangiography without cholangiographic contrast agent correctly assessed the cause of bile duct obstruction. Multislice CT cholangiography without cholangiographic contrast agent seems to be a promising diagnostic tool in the assessment of patients with bile duct obstruction. Electronic Publication