X线胸片与CT诊断1cm左右周围型小肺癌

目的：探讨Ｘ线胸片与ＣＴ对１ｃｍ左右周围型小肺癌的诊断价值。资料与方法：回顾性分析经病理证实的１７例直径在１ｃｍ左右的周围型小肺癌的Ｘ线胸片资料与其中１１例ＣＴ资料。结果：胸片上分叶征２例，胸膜凹陷征１例。有系列Ｘ线胸片者见病变逐渐增大或从无到有。ＣＴ片病灶显示边缘清楚较整齐者７例，毛刺征３例，分叶征７例，血管集束征９例，空泡征或支气管充气征４例，胸膜凹陷征３例，空洞２例。结论：Ｘ线胸片是检出１ｃｍ左右周围型小肺癌的主要方法，但不能定性；ＣＴ是诊断１ｃｍ左右小肺癌的较好方法，但也有一定限度；二者结合可提高诊断准确率。     

X线胸片与CT诊断1ck左右周围型小肺癌

探讨Ｘ线胸片与ＣＴ以１ｃｍ左右周围型小肺癌的诊断价值。资料与方法：回顾性分析经病理证实的１７例直径在１ｃｍ左右的周围型小肺癌的Ｘ线胸片资料与其中１１例ＣＴ资料。胸片上分叶征２例，胸膜凹陷征１例。有系列Ｘ线胸片者见病变逐渐增大或无到有。     

肺泡癌的X线表现及误诊分析

目的：肺泡癌的Ｘ线表现多种多样，易误诊，为提高认识，探讨其Ｘ线特点。方法：收集两家医院１９７３－１０～１９９６－０２经病理证实的肺泡癌７４例，均有两次以上胸片，此外，ＣＴ４１例，分层２７例。结果：首次胸片误诊３８例（５１．４％），四周内复查或作ＣＴ后纠正诊断９例（１２％），根据影像表现分为五型：１．粟粒型；２．多发结节型；３．≤３ｃｍ单发结节型，４．３～５．７ｃｍ块状型；５．肺炎型。上述各型误诊由高到低依次为肺炎型、单发结节型、粟粒型、多发结节型。结论：各型Ｘ线表现有其特点，全面分析，及时复查，可望提高诊断正确率。     

直径＜3cm肺部结节的CT引导经皮穿刺活检

目的：评价肺小结节ＣＴ导引经皮穿刺术的准确性、并发症及应用价值。材料与方法：选择１９９１年８月至１９９８年５月的１９０例经皮肺穿刺术患者中肺部结节直径〈３．０ｃｍ并经病理或随访证实的５０例（５０个结节）,共做了５８次穿刺,均做细胞学和组织学检查。病灶直径最小０．５ｃｍ（平均２．４ｃｍ）。结果：５０例中恶性肿瘤３４例（原发性支气管肺癌２７例,转移癌７例）,穿刺确诊３０例,２３例穿刺与手术病理一致,７     

乳腺浸润性导管癌的早期X线诊断(附22例报告)

目的：为进一步提高早期浸润性导管癌的 Ｘ 线诊断水平。方法：作者总结了经手术病理证实２２ 例女性直径＜ ２ ｃ ｍ 早期浸润性导管癌症的 Ｘ 线表现。结果：２２ 例中,８ 例呈肿瘤结节,３ 例出现恶性钙化,５ 例局部结构紊乱,４ 例出现小灶致密影,２ 例表现为条索状改变,３ 例显示为星芒征。结论：对上述诸多特殊表现的认识,在浸润性导管癌的早期诊断中具有重要价值。     

肺结核性空洞与癌性空洞的CT表现与临床分析

目的探讨肺结核性空洞与肺癌性空洞CT表现。方法分析经病理及临床证实的肺结核性空洞29例及肺癌性空洞31例CT表现及临床资料。结果癌性空洞一般为厚壁,内缘凹凸不平,有壁结节,分叶及胸膜凹陷征多见;而肺结核空洞以薄壁相对多见,周围常有卫星灶。厚壁空洞出现壁结节伴有胸膜凹陷征高度提示肺癌,而薄壁空洞,洞壁厚薄较均匀,周围伴有卫星灶者以肺结核最常见。结论 CT对鉴别肺癌性空洞和肺结核性空洞有较高的价值。     

肺腺棘细胞癌的 X 线分析

目的：探讨肺腺棘细胞癌的Ｘ线表现并与肺鳞癌、肺腺癌进行比较。方法：报告的５０例患者均经手术及病理证实，全部有胸部正侧位平片，男４３例，女７例，年龄３５～６８岁（平均５５．７岁）。结果：作者根据Ｘ线表现将其分为二型：（１）周围型（包括肺段型）３７例，肿块直径多大于３ｃｍ（７９．４％）。（２）中心型１３例，其中１例为气管肿瘤，以肺门肿块及肺不张为主要表现。结论：肺腺棘细胞癌以周围型多见，其Ｘ线表现介于周围型肺鳞癌和肺腺癌之间的一些特点。     

周围型肺癌与肺结核空洞的CT鉴别诊断

目的:研究周围型肺癌空洞与肺结核空洞的CT表现,提高其鉴别诊断水平.材料和方法:回顾性分析周围型肺癌空洞46例和肺结核空洞32例的CT表现.结果:癌性空洞一般为厚壁,内缘凹凸不平,有壁结节,分叶及胸膜凹陷征多见;而肺结核空洞以薄壁相对多见,周围常有卫星灶.厚壁空洞出现壁结节伴有胸膜凹陷征高度提示肺癌,而薄壁空洞,洞壁厚薄较均匀,周围伴有卫星灶者以肺结核最常见.结论:CT可清楚地显示空洞壁的状况及病灶本身的特点,是肺部空洞鉴别诊断的最佳影像学检查方法.     

支气管动脉化疗药物灌注治疗晚期肺癌32例

１９８９年以来，我院对不能手术的晚期肺癌 ３２例，进行了选择性支气管动脉大剂量化疗药物联合灌注治疗（ＢＡＩ），收到较好效果。１临床资料１．１一般情况本组３２例，男２１例，女１１例；年龄２９～６８岁，平均５２岁。均经病理或细胞学检查证实诊断，其中鳞癌１９例，腺癌７例，小细胞未分化癌４例，不明组织类型２例。根据支气管动脉造影，依癌体内血管多少，分为多血管型和少血管型。本组多血管型２３例，少血管型 ９例。按 ＴＮＭ分期，Ⅲ期 １８例，Ⅳ期１４例，均无手术指证。肿瘤为３ ｃｍ×５ｃｍ～１０ｃｍ ×１２ｃｍ。合…     

肺错构瘤的影像诊断

目的：探讨肺错构瘤的影像诊断问题。方法：回顾性分析经手术病理证实的２６例肺错构瘤，所有病人均有Ｘ线平片，１１例体层及６例ＣＴ检查。并同４５例结核球和９８例周围性肺癌进行对照研究。结果：肺错构瘤的主要Ｘ线征象：中央型３例为叶支气管内或肺门区肿物，周围型２３例均为圆形或椭圆形肿块，病灶平均直径２．２ｃｍ，多数边缘光整，３５％病灶有钙化，以斑点状或环状多见。本病与结核球、肺癌在病灶的大小、边缘及密度等均有不同之处。本病ＣＴ表现病灶内常可显示钙化和脂肪。结论：传统Ｘ线对周围性错构瘤的诊断及其与结核球、周围性肺癌的鉴别很有帮助。ＣＴ检查可补充平片、体层之不足，可显示病灶内钙化或／和脂肪特征。     

CT引导下经皮穿刺适形冷冻消融治疗肺癌的临床分析

目的 探讨CT引导监测,经皮穿刺适形冷冻治疗肺癌的安全性、疗效和可行性.方法 研究对象为肺癌患者,纳入标准:(1)肺功能差、年龄大不能耐受开胸者;(2)周围型肺癌累及胸膜及胸壁肿瘤而无法彻底切除者;(3)肺癌通过临床综合治疗病灶缩小稳定,但不能消失者;(4)局限性肺癌,有手术切除适应证,但患者拒绝手术治疗者.排除标准:(1)双侧或单侧多发病灶患者;(2)肿块靠近纵隔大血管,预计穿刺途径不可避免地会伤及大血管者;(3)严重肺功能低下,肺最大通气容积<39%;(4)重度咳嗽,反复出现呼吸困难,不能配合治疗者;(5)肿瘤晚期、明显恶病质及出血倾向者.根据以上标准入选66例共76个病灶进行了冷冻消融,病灶最大径为1.5～16.0 cm,全部病灶按照肿瘤体积行17 G冷冻探针穿刺适形冷冻.肿瘤最大径<3.0 cm者采取双针"夹击"冷冻;肿瘤直径3.0～5.0 cm者采取多针穿刺适形冷冻;肿瘤最大径>5.0 cm者采取瘤内穿刺适形布针,针距<1.5 cm.患者术后随访6个月至2年.疗效评价采用CT增强扫描,观察病灶大小及强化情况.结果 本组18例肿瘤最大径<3.0 cm,术中CT复查显示冷冻范围超过病灶边缘1.0 cm以上,病灶局部密度减低,紧邻病灶周围可见窄带状透亮环绕,其外围肺组织密度增高,呈磨玻璃样环绕病灶形成靶征;术后1、3个月复查显示,病灶及邻近肺组织无强化;6个月后复查,扫描局部可见纤维条索影;7例随访时间达2年,其中5例肿瘤无复发和转移,1例术后1年发现纵隔淋巴结肿大,1例出现肿瘤骨转移.22例肿瘤最大径在3.0～5.0 cm之间,术后即刻CT复查显示,冷冻冰球覆盖全部病灶,病灶边缘的分叶和毛刺等恶性肿瘤征象消失,病灶体积轻度增大;术后1、3个月复查实性病灶逐渐缩小;9例患者随访达2年,其中4例肿瘤无复发,3例肿瘤稳定,2例出现其他部位转移.26例肿瘤最大径>5.0 cm,术中复查,冰球覆盖病灶体积70%～90%,周围肺组织无冷冻损伤改变.26例患者术后进行了放、化疗等综合治疗,随访6个月,9例病灶体积缩小,11例病灶稳定,6例病灶进展伴身体其他部位转移.本组患者术中3例出现咳血;术后26例痰中带血丝,19例出现气胸,其中5例行胸腔闭式引流,气体完全吸收,拔管时间平均为5 d.结论 CT引导监测,经皮穿刺适形冷冻治疗肺癌疗效肯定,是一种可行的微创方法.     

肺炎性肿块的CT诊断及鉴别诊断

目的探讨肺内炎性肿块的CT表现.材料和方法回顾性分析我院经手术切除、CT导引下穿刺活检及临床追踪证实的肺内炎性肿块38例(47个病灶)的CT表现.结果病灶位于肺外围、贴近胸膜面伴胸膜肥厚占80.9%;呈不规则形,三角形或锥形,尖端指向肺门或病灶长轴与支气管肺树一致占74.596;块内见气泡/蜂窝状边缘占76.6%.结论肺炎性肿块的CT表现有一定的特点,可以与肺癌鉴别.     

巨大子宫肌瘤的CT、MRI特征性分析

目的:探讨CT、MRI在巨大子宫肌瘤的诊断价值及巨大子宫肌瘤的CT、MRI特征。方法:回顾性总结18例经手术病理证实的巨大子宫肌瘤患者的CT和MRI表现,并将CT和MRI表现与手术病理结果进行对照。结果:肿瘤直径在15～20 Cm者8例,20～25cm者6例,25 cm以上者4例。11例位于浆膜下,7例位于肌壁间,黏膜下型无。12例CT检查5例为实性肿块,边界较清晰,平扫密度均匀,与子宫肌密度相当或偏低,7例为混杂密度灶,内可见玻璃样变性及坏死、囊变或黏液样变性,增强扫描实质部分明显强化,原低密度区不强化,1例为囊性低密度,增强扫描囊壁强化,其内无强化;6例MRI表现为肿块包膜完整,与周围脏器分界清晰,T_1WI为等或略低信号,T_2WI为中等信号,其内可见不规则高信号,注射Gd-DTPA后肿块明显强化,其内见不规则不强化灶,显示包膜更清晰,无强化。结论:CT、MRI可显示巨大子宫肌瘤较具特征的征象,特别是MRI有较好的软组织分辨力,可多方位成像,加上脂肪抑制技术,有利于显示肿块的成分与包膜,对诊断有较大的帮助。     

CT screening for lung cancer: prevalence and incidence of mediastinal masses

PURPOSE: To determine the frequency and natural course of mediastinal masses in asymptomatic people at high risk for lung cancer who were undergoing computed tomographic (CT) screening. MATERIALS AND METHODS: Informed consent and institutional review board approval for this HIPAA-compliant study were obtained at each participating institution. All documented mediastinal masses among the 9263 baseline and 11 126 annual repeat screenings performed in the Early Lung Cancer Action Project (ELCAP) and its successor project, the New York ELCAP, were identified. Two radiologists confirmed all cases, identified the location and measured the diameter (average of length and width) of each mass, and reviewed all subsequent CT and clinical and surgical results. The prevalence and incidence of mediastinal masses were then determined. RESULTS: Of the 9263 individuals, 71 had a mediastinal mass seen at baseline screening (prevalence of 0.77%). Of the 71 masses, 41 were thymic, 16 were thyroidal, two were esophageal cancers, six were tracheal-esophageal diverticula, and six were other masses. Among the 11 126 annual repeat screenings, only one new mediastinal mass was identified (incidence of 0.01%). This suggests a long average duration for mediastinal masses in asymptomatic people. Among the 41 thymic masses, five were larger than 3.0 cm in diameter, and all five were resected; of these five, one was a thymic carcinoma and four were noninvasive thymomas. Of the remaining 36 thymic masses, 25 were evaluated at follow-up CT 1 year later: Five had increased in diameter, two had decreased, and 18 remained unchanged. All 16 thyroid masses were due to goiter; none of these were changed at follow-up CT 1 year later. CONCLUSION: Mediastinal masses found in the context of CT screening for lung cancer in asymptomatic people should be approached in a "conservative" manner; this includes thymic masses smaller than 3 cm in diameter, as most of these remain unchanged or even decrease in size.     

HRCT扫描结合MSCT动态增强扫描在肺内孤立性结节的诊断价值

目的：评价HRCT扫描结合MSCT动态增强扫描在诊断肺内孤立性结节（SPNs）的价值。方法：收集直径小于3cm的肺内孤立性结节患者48例,其中周围型肺癌28例,单发转移瘤5例,肺炎性假瘤5例,结核瘤4例,肺血管瘤2例,支气管肺腺瘤2例、肺错构瘤2例。48例患者均先行常规胸部CT扫描,然后对兴趣区行HRCT扫描,然后行胸部动态增强扫描,并测量其CT值增强幅度。结果：HRCT扫描结合MSCT动态增强扫描诊断肺内孤立性小结节的正确率为90%,HRCT扫描可以更好显示病灶边缘特征及内部结构,动态增强扫描可见肺内恶性结节大多均匀增强,且增强CT值大于20HU,平均增强CT值为35HU。良性结节多周边增强,且增强CT值小于10HU。结论：根据SPNs的HRCT基本形态特征,并结合MSCT动态增强扫描强化特征有助于肺内孤立性结节的定性诊断,提高术前诊断正确率。     

不典型颅内海绵状血管瘤的CT、MRI诊断初探

目的 探讨颅内海绵状血管瘤(ICA)的CT和MRI不典型表现.资料与方法 回顾性分析经手术病理证实的不典型ICA9例,男5例,女4例,年龄11～72岁,平均35岁.所有病例均行MRI平扫及增强检查,其中4例行CT扫描.结果 9例均位于脑内.病灶最大径平均值5.5cm.行CT检查的4例中,2例表现为等、高密度,2例表现为等、低密度;3例病灶内可见钙化.9例T1WI和T2WI呈混杂信号,周围低信号环4例,囊实性病灶5例,囊内见液平面3例,其中囊变伴附壁结节4例,6例出现明显灶周水肿.增强扫描8例呈明显不均匀强化,1例无明显强化.结论 发现瘤体巨大伴有囊性变、瘤体占位效应、病变多种形式的强化等ICA不典型的CT和MRI征象时,应考虑ICA的诊断.     

Magnetic resonance imaging characteristics with pathological correlation of cavernous malformation in cavernous sinus

OBJECTIVE: To analyze extracerebral cavernous malformation located in the cavernous sinus and correlate their magnetic resonance imaging (MRI) features to pathological findings. MATERIALS AND METHODS: Nineteen patients (5 men and 14 women; mean age, 50.6 years; range, 32-71 years) with surgically verified cavernous malformations in the cavernous sinus were reviewed. MRI including T1-weighted, T2-weighted, and postcontrasted T1-weighted imaging was carried out in all instances with a 1.5-T superconductive system (Signa; General Electric Medical Systems, Milwaukee, WI). RESULTS: All these lesions measured from 2.5 cm to 6 cm (average, 4.3 cm) with 13 lesions located to the right side and 6 to the left side. Magnetic resonance images showed that 18 cases were hypointense to white matter on T1-weighted images with only one case showed mixed hypointensity and hyperintensity. On T2-weighted images, 17 cases showed marked homogeneous hyperintensity, 1 case showed marked hyperintensity with some signal void structures and 1 with mixed intensity. Marked homogeneous enhancement after contrast material administration was found in 7 cases, and the remaining 12 showed marked heterogeneous enhancement. Pathologically, these lesions can be classified as type A, type B, and type C. Type A was sponge-like with intact pseudocapsule; type B was mulberry-like with the pseudocapsule incomplete or absent; and type C was composed of both mulberry-like composition and sponge-like composition. Lesions with homogeneous contrast enhancement on MRI correlated with type A pathological findings, whereas those with heterogeneous enhancement correlated with type B and type C pathological findings. Asymmetrical dumbbell-shaped masses of 13 cases involving the sellar and round masses of 6 cases with 2 protruding into the sellar were found. All of the cavernous malformations displaced the adjacent temporal lobe without adjacent brain edema. The internal carotid arteries were displaced or encased in all cases. CONCLUSIONS: If a well-demarcated, homogeneous high signal intensity lesion on T2-weighted images with a dumbbell configuration involving both parasellar and sellar regions with marked heterogeneous or homogeneous enhancement is found, the diagnosis of cavernous sinus cavernous malformation should be entertained.     

Clinical and imaging features of distended scapulothoracic bursitis: spontaneously regressed pseudotumoral lesion

OBJECTIVE: To describe clinical and imaging findings of distended scapulothoracic bursitis without scapular snapping, which is often confused with a soft tissue tumor. METHODS: Nine patients (6 male, 3 female; age range: 50-73 years; mean age = 67 years) with distended scapulothoracic bursitis diagnosed by clinical and magnetic resonance (MR) imaging findings were studied. The results of a histologic examination were available in 1 case. RESULTS: All patients presented with painless palpable masses below the scapula, and the initial diagnoses were soft tissue tumors. On MR images, the lesions were 5.5 to 12 cm in maximum diameter (mean = 7.7 cm) and well-demarcated cystic masses situated in the subscapular region between the serratus anterior and the chest wall. There was no solid portion on the cyst walls. The findings of hemorrhage within the bursae were present in all cases. Every mass regressed in size spontaneously after a few to several weeks, and no lesions revealed any malignant findings of sarcomas. CONCLUSIONS: Distended scapulothoracic bursae without scapular snapping resemble soft tissue tumors. They have some specific MR findings; therefore, precise recognition of these findings is important to avoid misdiagnoses and unnecessary treatments.     

CT引导下经皮穿刺微波消融治疗老年人巨块型肺癌的疗效

 目的 探讨CT引导下经皮穿刺微波消融治疗老年人巨块型肺癌的疗效。方法 选择2013-03至2015-03在CT引导下经皮微波消融治疗26例不能手术切除的巨块型肺癌患者,所有病例诊断均经术前穿刺病理证实,其中鳞癌18例,腺癌7例,腺鳞癌1例。术后即刻、3、6、12个月复查增强CT,评价肿瘤体积缩小及坏死情况,分别于术前与术后1个月采用KPS评分评价患者生存质量,随访时间为12个月。结果 26例32次微波手术均获得成功,其中6例于术后1周行二次微波消融手术。微波消融治疗结束后即刻行CT增强扫描,其中CA 5例(19.2%),PA19例(73.1%),SD 2例(7.7%),总体有效率为92.3%。所有患者瘤体负荷显著减轻,治疗前KPS评分为78.23±11.54,治疗后1个月KPS评分为85.13±10.22(t=-2.282,P＜0.05);消融术前肿瘤最大径为(10.4±1.3)cm,消融术后3、6、12个月肿瘤最大径分别为(7.6±2.4)cm、(6.2±2.8)cm 和(5.7±2.5)cm,与术前比较,差异有统计学意义(F=21.482,P＜0.05)。结论 CT引导下经皮穿刺微波消融治疗老年人巨块型肺癌是一种安全、微创、减瘤效果显著的介入方法,其远期疗效和对患者生存期的影响还有待进一步研究。     

卵巢囊性腺纤维瘤MR特征及病理分析

目的：探讨卵巢囊性腺纤维瘤的MRI表现特征及病理学基础,提高对该疾病的诊断准确性。方法收集并回顾性分析14例经手术病理证实的卵巢囊性腺纤维瘤患者MRI资料,所有患者术前均行MR平扫及增强扫描。重点对病变内部结构、信号特征及增强表现进行分析归纳,明确其具有诊断价值的图像特征。结果本组13例病灶为单侧发病,1例为双侧发病。病灶最大径为3．4-14．8cm,平均约8．15cm;8例呈囊性（多囊者6例,单囊者2例）,5例呈囊实性,1例呈实性。8例囊性病变于MRI-T2WI囊壁及分隔呈低信号;囊实性病灶实性成份主要表现为低信号,其中并见多发小囊样高信号灶,其中2例形成较典型的“黑色海绵征”。MR增强扫描所有病灶实性成份及囊壁均呈中度或明显强化效应。结论卵巢囊性腺纤维瘤多为单侧发病,主要呈多囊性表现;肿瘤中实性成份及囊壁T2WI呈低信号,增强扫描呈轻中度强化。“黑色海绵征”是其较典型的特征表现。