鼓室球瘤的影像学表现

目的 探讨鼓室球瘤的影像学诊断价值。方法 回顾性分析10例经手术病理证实的鼓室球瘤的CT和MRI表现，总结其影像学表现特点及其诊断价值。结果 8例行颞骨高分辨率CT检查，2例行常规CT扫描；其中7例轴面及冠状面均能显示鼓室软组织结节影，3例示中耳乳突内充满了略低密度软组织影，CT仅诊断为慢性中耳乳突炎，漏诊了其内的鼓室球瘤，所有病例未见骨质破坏。行MR检查者8例，T2WI显示肿瘤为较高信号（6例）和高信号（2例），增强后以明显强化为特点；3例伴有慢性中耳乳突炎者，T2WI可区分肿瘤的较高信号和周围炎症的高信号，增强MRI亦能显示强化的肿瘤和不强化的周围炎症。结论 MRI对鼓室球瘤的显示优于CT，伴有中耳乳突炎时MRI优势更明显。     

脊索瘤的病理和影像学表现

脊索瘤属于原发性低度恶性的骨肿瘤,发生率约占原发恶性骨肿瘤的3%～4%,占原发恶性骨肿瘤的第4住.根据脊索瘤的组织学特征,可将起源于脊索的肿瘤及相关病变归纳为:脊索残余物和脊索瘤.脊索瘤一般包括经典型脊索瘤(typical chordoma)和软骨瘤样脊索瘤(chondroid chordoma),还有少见的未分化型脊索瘤(dedifferentiated chordoma)和周围型脊索瘤(parachordoma).本文综述了近年文献中有关脊索瘤发生学、流行病学、组织病理学及影像学表现.     

腹膜假性黏液瘤的影像学表现

目的探讨腹膜假性黏液瘤(PMP)的影像诊断。资料与方法经手术病理证实的PMP2例,术前均行超声、CT和MRI检查,其中1例行多层螺旋CT血管造影(MSCTA)检查。结果2例PMP超声表现为腹腔内多囊性肿块,内部回声不均;CT表现为网膜、肝脾周围、肠间多发低密度影,内部可见分隔,肝边呈“扇贝样”;1例可见病灶内点状及线状钙化,并见病灶沿胸腹腔间隙向后纵隔生长,MSCTA示肝外段门脉主干受侵变窄,MRI示病灶呈长T1、长T2改变。结论PMP在CT和MRI上病变部位和病变形态有其特殊影像学表现,术前影像学的评价有利于手术方案的制定。     

脊索瘤的影像学分析

目的：分析脊索瘤的影像学表现，探讨其影像学诊断价值。资料与方法：收集经手术病理证实的12例脊索瘤，所有病例均摄X线平片，其中CT检查8例，MRI检查4例。结果：骶尾部脊索瘤7例，表现为囊性膨胀性及溶骨性骨质破坏，骨壳完整或不完整，骨破坏区内可见散在分布的斑片状、斑点状钙化，周围可见软组织肿块；颅底部脊索瘤4例，表现为溶骨性膨胀性骨质破坏及软组织肿蚨，内可见囊变、出血及钙化灶；腰椎1例，表现为椎体溶骨性骨质破坏及软组织肿块，内可见斑点状钙化。MRI表现为病变呈不均匀长T1、长T2信号，增强扫描表现为不均匀“蜂窝样”强化。结论：通过影像学检查，并结合临床，大部分脊索瘤术前能够正确诊断；CT较X线平片能够更好的显示病变结构及邻近软组织改变；MRI能够精确显示病变范围及周围血管神经的关系，有助于制定合适的手术方案和预后的估计。     

肾上腺淋巴管瘤的影像学表现

目的 探讨肾上腺淋巴管瘤(AL)的影像学表现,提高对AL的术前诊断水平.方法 回顾性分析10例经术后病理证实为AL患者的临床病理及影像学资料.结果 AL为单房或多房囊性病灶,常累及单侧肾上腺,最大径约1.0～7.8 cm,边界清楚.CT平扫呈低密度,T1WI上呈低信号,T2WI上呈高信号.病灶内或囊壁常见钙化.6例可见...     

三叉神经瘤的影像学诊断

目的：提高三叉神经瘤的影像诊断和鉴别诊断水平。方法：经手术病理证实的17例三叉神经瘤，分析其MRI、CT及DSA表现。结果：肿瘤表现①中颅窝6例，肿瘤瘤体小，多为实性无囊变。后颅窝4例，瘤体大有囊变、坏死。跨颅窝3例，典型的哑铃状；②MRI T1WI肿瘤呈稍低信号或低、等混杂信号，T2WI呈高信号及高、等混合信号，CT平扫为低或混合密度。增强呈均匀性或环状、结节状强化。DSA示肿瘤多血供，斑点状染色；③三叉神经根增粗及功能异常，常伴岩骨、颅底骨质吸收、破坏。结论：MRI、CT是三叉神经瘤理想的影像学检查方法，MRI优于CT，定性困难者，结合DSA易做出诊断。     

淋巴管瘤影像学诊断

目的:探讨淋巴管瘤的影像学表现,评价影像学的诊断价值.方法:回顾性分析31例经手术及病理证实的淋巴管瘤影像学资料.结果:根据所合淋巴管扩张程度不同,组织学上将其分为3型:囊性淋巴管瘤18例、海绵状淋巴管瘤11例和血管瘤淋巴管瘤2例.结论:CT和MRI检查可清晰显示淋巴管瘤的大小、形态和范围,具有重要的诊断价值,MRI在...     

颈椎脊索瘤影像学表现及鉴别诊断

目的:探讨颈椎脊索瘤的特征性CT和MRI表现.方法:回顾性分析经病理确诊的11例颈椎脊索瘤的影像学表现.结果:7例位于C2,2例位于C4,位于C5和C6各1例;CT显示椎体呈溶骨性(6例)或混合性(5例)骨质破坏,位于C6的1例肿瘤伴左侧横突骨破坏;5例可见点状钙化,3例可见残存骨嵴;4例椎旁可见软组织肿块,6例肿瘤侵犯至椎管内;MRI显示肿瘤T1WI呈低信号(5例)、等信号(4例)或混杂信号(2例);T2WI呈混杂信号(5例)、高信号(5例)或低信号(1例),9例肿瘤内部可见低信号纤维分隔;10例行增强扫描,其中8例呈明显不均匀强化,2例呈轻中度强化.术前仅4例诊断正确.结论:颈椎脊索瘤CT和MRI表现具有一定特征性,对术前正确诊断有重要提示意义.     

Charcot关节的影像学表现分析

目的 分析Charcot关节的X线、CT及MRI影像学特征.方法 搜集Charcot关节24例,男11例,女13例.24例均行X线检查,9例行CT检查,5例行MR检查,3种检查都进行者2例.结果 24例Charcot关节分为增生型(12例)和吸收型(12例).X线及CT表现:增生型受累关节骨质增生硬化,伴有骨赘形成,关节周围软组织肿胀;吸收型受累关节骨端吸收、消失,关节周围软组织肿胀,可见游离碎骨片影,可有关节半脱位或脱位.MRI也反映了相同的影像学表现,在MRI增强扫描,肥厚关节囊及其周围软组织均明显强化,其内缘边界清楚.结论 Charcot关节的影像学表现具有特征性.     

颈动脉体瘤影像学表现分析

目的 探讨颈动脉体瘤影像学表现及诊断价值.方法 33例颈动脉体瘤均经手术病理证实,均行X线平片及超声检查,其中28例经血管造影、20例行CT、16例行MRI和10例行MRA检查.回顾性分析颈动脉体瘤的各种影像学表现,评价其临床价值.结果 各种检查均可显示肿瘤部位及其形态,颈动脉体瘤的B型超声特点为中等偏低实质回声,＞3 cm的肿瘤可见管道结构,但肿瘤上缘观察欠清,2例行彩色多普勒超声显示瘤内网状血管.CT增强显示为富血管肿瘤,其中1例肿瘤均匀强化,颈内、外动脉密度与瘤体等同难以分辨.MRI的特点为瘤内见流空的血管影像,明确显示颈内、外动脉分离.MRA能良好显示肿瘤与颈总动脉及其分叉的关系.血管造影可明确显示供血动脉.结论 B超、CT和MRI对颈动脉体瘤的诊断各具一定的特征性.     

侵袭性骨母细胞瘤影像学分析

目的探讨侵袭性骨母细胞瘤的影像表现及提高其影像诊断水平。资料与方法回顾性分析9例经病理证实的侵袭性骨母细胞瘤患者的X线、CT、MRI表现。8例行X线平片检查,4例行CT检查,6例行MRI检查。结果 9例侵袭性骨母细胞瘤中,6例表现为斑片状、虫蚀样的溶骨性骨质破坏,3例呈膨胀性骨质破坏,3例可见短小液-液平面,3例可见斑点状及絮状钙化影,1例可见硬化边,2例可见葱皮状骨膜反应,9例均可见明显软组织肿块。结论综合分析侵袭性骨母细胞瘤影像学资料能够提高对其诊断的准确性。     

淋巴管瘤的影像学表现

目的:探讨淋巴管瘤的影像学表现及其与病理的相关性.方法:经手术病理证实的淋巴管瘤26例,男15例,女11例,年龄1个月～68岁,平均19.4岁.7例行CT检查纳入研究,其中6例有平扫加增强扫描;1例行MRI检查;24例行超声检查.结果:CT上病灶均为囊性病变,密度均匀,边界较清楚,壁薄.2例病灶呈单房,5例病灶内可见分隔并形成多房,增强扫描囊壁及部分分隔强化,囊内未见强化.MRI上病变在T1WI上为低信号,T2WI上呈高信号,病变信号不均匀,边界欠清楚,其内见分隔.超声声像图上病灶均为囊实性低回声或无回声肿块影,其中10例病变回声不均质,14例探及条形分隔反射,其中3例分隔为蜂窝状、网状,3例边界不清;彩色多普勒血流成像探及囊内及分隔内血流7例.手术病理显示病变全部为囊性,可看到扩张的淋巴管,有些病灶内可见血管,并见一些纤维组织及脂肪组织成分.结论:淋巴管瘤有较为典型的影像学表现:囊性,薄壁肿块,密度较均匀,边界较清楚;病理与影像一致性好.     

Imaging Findings in Auto-Atticotomy

BACKGROUND AND PURPOSE:An acquired attic cholesteatoma may spontaneously drain externally into the external auditory canal, leaving a cavity in the attic with the shape of the original cholesteatoma but now filled with air, a phenomenon referred to as “nature''s atticotomy” or auto-atticotomy. We describe and quantify the CT appearance of the auto-atticotomy cavity as it pertains to the appearance of the scutum and the lateral attic wall.MATERIALS AND METHODS:Twenty-one patients with erosion of the scutum and loss of the lower attic wall on MDCT were identified during a 5-year span. Images were assessed for measureable widening of the space between the ossicles and the lower lateral attic wall in the axial and coronal planes. Three measurements of the lateral attic were made on the axial images. Findings were compared with the same measurements in 20 control subjects.RESULTS:The 21 patients had a characteristic blunting of the scutum with loss of the lower lateral attic wall and widening of the lateral attic, consistent with an auto-atticotomy. There was a statistically significant (P < .001) widening of the lateral attic dimensions in the axial plane in the patients with auto-atticotomy.CONCLUSIONS:Spontaneously evacuated cholesteatoma may mimic a surgical atticotomy on MDCT. Scutal erosion and attic enlargement with a smoothly contoured bony remodeling of the lower lateral attic wall in a patient with no history of surgery suggest that a cholesteatoma was previously present and spontaneously drained.

An atticotomy is a surgical approach through the external auditory canal to the attic of the middle ear, whereby the scutum and the lower lateral wall of the attic are surgically removed for access. An auto-atticotomy (also called “nature''s atticotomy”) refers to an enlarged lateral attic with absence of the scutum and lower lateral wall of the attic in a patient without a history of surgery.^1–3 This entity results from a deep retraction pocket or a cholesteatoma that has eroded the bone and then spontaneously drained into the external auditory canal. The wall of the original cholesteatoma remains, and so the air-filled defect is lined by keratinizing squamous epithelium. The appearance of an atticotomy and an auto-atticotomy is similar on CT. The purpose of this article was to describe the findings of auto-atticotomy on multidetector CT of the temporal bone.     

MR Imaging Findings of Clonorchiasis

Objective

The purpose of this study was to evaluate the MR spectrum and MR cholangiographic imaging findings of clonorchiasis.

Materials and Methods

We reviewed 26 patients with confirmed clonorchiasis by either stool tests (n=24) or surgery (n=2). MR imaging was performed on a 1.5 T system (GE Medical Systems, Milwaukee, WI) with a torso coil. Axial T1- and T2-weighted, gadolinium-enhanced dynamic images and MR cholangiography were obtained. Image analyses were used to identify abnormalities of the intrahepatic and extrahepatic bile ducts and the presence of hepatobiliary malignancy. All MR examinations were reviewed by the consensus of two abdominal radiologists.

Results

Intrahepatic bile duct abnormalities were seen in 23 (89%) of the 26 patients. The most common finding was mild dilatation of the intrahepatic bile duct which was found in 21 (81%). "Too many intrahepatic ducts" were found in 16(62%), wall enhancement and thickening in 21 (81%) and filling defects and ductal stricture in the intrahepatic bile duct in 6 (24%) and 3 (12%) patients, respectively. Extrahepatic ductal dilation was found in 5 (19%) and 9 (35%) revealed hepatobiliary malignancy.

Conclusion

MR imaging revealed various findings of clonorchiasis, including dilatation, wall enhancement, stricture of the intrahepatic ducts and filling defect within the intrahepatic bile duct.     

毛细血管扩张型骨肉瘤的影像表现及其与病理的关系

目的:分析毛细血管扩张型骨肉瘤影像学表现与病理的关系,以提高诊断准确性.方法:回顾性分析经手术病理证实的毛细血管扩张型骨肉瘤9例,术前分别经X线平片、CT平扫、MR SE T1WI、T2WI和T1WI增强扫描,仔细复习影像征象并和手术病理作对照.结果:9例毛细血管扩张型骨肉瘤中,位于股骨5例,胫骨3例和髂骨1例.位于长管状骨者,5例位于干骺端,2例位于骨干,1例接近骨端.肿瘤直径6.3～11.8 cm.所有肿瘤均为溶骨性骨质破坏,破坏区呈椭圆形5例,不规则地图形4例.病灶呈囊状9例,7例病灶境界不清,7例病变见骨膜增生,伴软组织肿块8例,所有病例软组织肿块境界清楚.5例行CT检查,病灶密度低于肌肉或与肌肉相仿,CT显示骨膜增生及软组织肿块较平片清楚,增强扫描软组织明显强化.4例行MR检查,T1WI为混杂信号3例,低信号1例;T2WI为低、等和高信号混杂4例.T2WI 4例均可见明显囊状改变和液-液平面,均可见软组织成分,软组织构成囊壁和分隔,部分呈不规则肿块结节,T2WI软组织信号高于肌肉.结论:毛细血管扩张型骨肉瘤好发于长管状骨干骺端,呈卵圆形或地图样溶骨性破坏,容易呈多囊状坏死,但肿瘤内常见软组织成分,常伴骨膜增生和骨外软组织肿块,CT增强扫描和MR有助于显示病灶的软组织成分.     

亨廷顿病的影像学表现

目的 报道亨廷顿病的影像学表现. 资料与方法 分析1例经基因检测证实的亨廷顿病患者CT、MRI、氢质子磁共振波谱(1H-MRS)、正电子发射体层成像(PET/CT)影像学表现,并复习文献. 结果 头颅CT及MRI提示双侧尾状核萎缩,侧脑室前角扩大.尾状核头部最大直径、壳核最大直径值减低、双尾状核比率和双额角比率值增高.1H-MRS出现异常乳酸峰并提示基底节区N-乙酰天门冬氨酸/肌酸值减低,胆碱复合物/肌酸值增高.PET/CT示双侧基底节代谢减低. 结论 1H-MRS代谢异常及PET/CT基底节区代谢减低有助于诊断亨廷顿病.     

原发性软骨肉瘤影像学表现与病理关系

目的:探讨软骨肉瘤的CT和MR及其增强表现,分析其病理基础.方法:回顾分析经手术病理证实的软骨肉瘤27例,术前分别或同时经X线平片、CT平扫和增强、MR SE T1WI、T2WI和T1WI增强扫描,复习影像学扫描结果并和手术病理作对照.结果:27例软骨肉瘤中,普通型22例,间充质型3例,去分化型2例.发病部位包括骨盆11例,管状骨10例,肋骨2例,胸骨1例,椎体1例,软组织1例,腹膜后1例.肿瘤直径4.5～23.0 cm,<5.0 cm 2例,5.0～10.0 cm 17例,>10.0 cm 8例.骨质破坏呈轻度膨胀性或溶骨性,密度等于或低于肌肉密度,钙化21例,扇贝状分叶边缘19例,骨膜增生3例.肿瘤CT值等于或低于肌肉;MR T1WI呈等低信号,T2WI为显著高信号,高信号内总见弓环状低信号分隔或低信号结节.CT和MR增强13例,小叶分隔呈环弓状进行性持续强化,小叶自身不强化.结论:扇贝状分叶边缘、弓环状钙化、T2WI显著高信号内存在弓环状低信号、弓环状进行性强化等构成各型软骨肉瘤的特异性影像学特征,对诊断具有重要价值.     

肝胆管囊腺瘤的影像学表现

目的 探讨肝胆管囊腺瘤CT、MRI及B超表现,提高其诊断准确率.方法 回顾性分析9例经病理证实的肝胆管囊腺瘤患者,螺旋CT检查7例,MRI检查4例,B超检查5例.结果 7例患者CT平扫表现为多房囊性病变,囊内可见线状分隔,囊壁均匀增厚,壁光滑;MRI检查4例患者中,病变T1WI呈低信号多房囊性占位,T2WI病灶呈高信号为主混杂信号,囊内分隔呈低信号,增强后动脉期囊壁及分隔轻度强化,门脉期及延迟期继续强化.B超检查5例患者表现为肝内无回声暗区,边界清楚,内见多条强回声带,可见分隔或乳头状隆起.结论 平扫加动态增强CT、MRI及B超能够特征性反映肝胆管囊腺瘤的影像学特点,提高该疾病的诊断准确率.     

颅内髓上皮瘤的影像学表现

目的 总结颅内髓上皮瘤的影像学表现特点.资料与方法 分析1例婴儿原发性侧脑室内髓上皮瘤的MRI表现及病理资料,结合文献,对这一罕见疾病的CT及MRI表现、组织病理学表现及临床诊断等进行探讨.结果 MRI示肿瘤位于左侧侧脑室内,体积较大且不规则,信号亦不均匀,增强扫描实性部分明显强化,病理学表现支持髓上皮瘤的诊断,部分呈脉络丛乳头状瘤改变.结论 该病例为罕见的原发性侧脑室内髓上皮瘤,其影像学表现具有多样性,要在术前明确该病的诊断存在一定困难,最终确诊离不开病理及免疫组化结果等.     

滑膜肉瘤的影像学表现

目的探讨滑膜肉瘤的影像学特征,提高诊断的准确性。方法回顾性分析病理确诊的13例滑膜肉瘤的临床及影像学资料。结果①大部分滑膜肉瘤邻近关节,尤其下肢大关节。②X线平片上多表现为直径>5cm的中等密度的肿块,部分有钙化。③CT上多表现为略低于肌肉密度的肿块,边界清楚或不清楚,内部密度欠均匀。④磁共振T2WI/STIR像肿瘤内多呈稍高信号的“卵石”状结节,其间有低信号间隔,增强后结节不强化或轻度强化,间隔明显强化。结论滑膜肉瘤的一些影像学特点,尤其MRI特点对其诊断有较强的参考价值。