Hepatic angiomyolipoma： Dynamic computed tomography features and clinical correlation

AIM： To study the dynamic computed tomography （CT） features of hepatic angiomyolipoma （AML） in patients with or without tuberous sclerosis complex （TSC）.
METHODS： The clinical information, CT findings and histopathological results of hepatic AML were analyzed retrospectively in 10 patients.
RESULTS： Hepatic AML was prone to occur in female patients （7/10）, and most of the patients （8/10） had no specific symptoms. All tumors presented as welldefined, unenveloped nodules in the liver. Six patients with sporadic hepatic AML had a solitary hepatic nodule with a definite fat component. Non-fat components of the hepatic lesions were enhanced earlier and persistently. Prominent central vessels were noted in the portal venous phase in three patients. In four patients with hepatic AML and TSC, most of the nodules were within the peripheral liver. Seven fatdeficient nodules were found with earlier contrast enhancement and rapid contrast material washout in two patients. Lymphangioleiomyomatosis was found in one patient.
CONCLUSION： Imaging features of hepatic AML are characteristic. Correct diagnosis preoperatively can be made in combination with clinical features.     

Diagnosis and treatment of hepatic angiomyolipoma in 26 cases

AIM: To summarize the experience of the diagnosis and treatment of hepatic angiomyolipoma (HAML).METHODS: The dinical, imaging and pathological features,and treatment strategies of 26 patients with HAML treated at the authors‘ institute between October 1998 and January 2003 were retrospectively analyzed. All the patients received liver resection and were followed up till the study.Immunohistochemical assays were performed with a panel of antibodies.RESULTS: There was an obvious female predominance(21:5), and most of the patients (18/26) had no symptoms.Heterogeneous high echo was found in ultrasonography and punctiform or filiform vascular distribution pattern was found in color Doppler-sonography in most of the lesions (21/26).All of the 5 lesions further enhanced with Levovist showed early and prolonged enhancement. At contrast-enhanced spiral CT, the soFt-tissue components of 24 lesions were markedly enhanced in the arterial phase and 18 lesion sremained enhanced in the portal venous phase. MR1 was performed in 9 patients, and showed hypointensity or hyperintensity on Tl-weighted images and heterogeneous hyperintensity on T2-weighted images. Histopathologically,all lesions were composed of adipose tissues, smooth muscle and blood vessels with different proportions. Most lesions showed positive immunohistochemical staining for HMB45 (26/26), A103 (24/26) and SMA (24/26). All of the 26 patients showed a benign course with no sign of recurrence.CONCLUSION: Preoperative radiological diagnosis of HAML is possible. The demonstration of intratumoral fat and central vessels is helpful in the diagnosis. HMB45, A103 and SMA are promising markers for pathologic diagnosis of HAML,and surgical resection is effective for the treatment of HAML.     

Solitary fibrous tumors in abdomen and pelvis:Imaging characteristics and radiologic-pathologic correlation

AIM:To describe the imaging features of solitary fibrous tumors(SFTs)in the abdomen and pelvis,and the clinical and pathologic correlations.METHODS:Fifteen patients with pathologically confirmed SFTs in the abdomen and pelvis were retrospectively studied with imaging techniques by two radiologists in consensus.Patients underwent unenhanced and contrast-enhanced imaging,as follows:3 with computed tomography(CT)and magnetic resonance imaging(MRI)examination,8 with CT examination only,and 4 with MRI examination only.Image characteristics such as size,shape,margin,attenuation or intensity,and pattern of enhancement were analyzed and correlated with the microscopic findings identified from surgical specimens.In addition,patient demographics,presentation,and outcomes were recorded.RESULTS:Of the 15 patients evaluated,local symptoms related to the mass were found in 11 cases at admission.The size of the mass ranged from 3.4 to 25.1cm(mean,11.5 cm).Nine cases were round or oval,6were lobulated,and 10 displaced adjacent organs.Unenhanced CT revealed a heterogeneous isodense mass in 7 cases,homogeneous isodense mass in 3 cases,and punctuated calcification in one case.On MRI,most of the lesions(6/7)were heterogeneous isointense and heterogeneous hyperintense on T1-weighted images and T2-weighted images,respectively.All tumors showed moderate to marked enhancement.Heterogeneous enhancement was revealed in 11 lesions,and 7of these had cysts,necrosis,or hemorrhage.Early nonuniform enhancement with a radial area that proved to be a fibrous component was observed in 4 lesions,which showed progressive enhancement in the venous and delayed phase.No statistical difference in the imaging findings was observed between the histologically benign and malignant lesions.Three patients had local recurrence or metastasis at follow-up.CONCLUSION:Abdominal and pelvic SFTs commonly appeared as large,solid,well-defined,hypervascular masses with variable degrees of necrosis or cystic change that often displaced adjacent structures.     

Imaging findings of biliary hamartomas

AIM: To evaluate the imaging findings of biliary hamartomas (von Meyenburg complexes, VMCs) and discuss the differential diagnosis with other related diseases. METHODS: Imaging findings of biliary hamartomas on ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), MR cholangiopancreatography (MRCP)and hepatobiliary scintigraphy were retrospectively analyzed in six patients. RESULTS: On ultrasound images, five of the six cases showed multiple small hyper- and hypo-echoic lesions with comet-tail echoes, especially when magnified by US with the usage of zoom function. In all the six cases, multiple tiny hypodense lesions less than 10 mm in diameter were revealed as scattered throughout the liver with no enhancement on CT. These tiny lesions were demonstrated to be hyper- and hypo-intensity on T2- and T1-weighed images, respectively, in three patients who underwent MRI examinations. MRCP was performed in two patients, and clearly showed multiple tiny irregular- and round-shaped hyper-intensity lesions. MRCP and hepatobiliary scintigraphy showed normal appearances of intra- and extra-hepatic bile ducts in two and one patients, respectively. CONCLUSION: Imaging modalities are useful in the diagnosis and differential diagnosis of VMCs. A correct diagnosis might be obtained when typical imaging findings are present even without a histological confirmation.     

腮腺腺淋巴瘤的CT表现及临床病理特征分析

正2020 were selected as the study subjects. All the patients underwent enhanced CT scanning,and their CT manifestations and pathological features were analyzed. Results A total of 76 lesions were found in the 54 patients,including unilateral single lesion in 36 cases,unilateral double lesions in 12 cases,bilateral single lesion in 5 cases(10 lesions),and bilateral multiple lesions in 1 case(6 lesions). The edges were clear in 63 lesions and fuzzy in 13 lesions. There were 74 lesions with cystic changes,52 lesions in the superficial lobe,14 in the deep lobe and 10 in the trans lobe. There were 60 lesions with upper-lower diameter being greater than anteroposterior diameter and left to right diameter. All of the 76 lesions were significantly enhanced in arterial phase,and the degree of enhancement in venous phase decreased. Fifty lesions showed “marginal vascular sign”after enhancement,and the vessels mainly came from the branches of posterior auricular artery and superficial temporal artery. Conclusion CT findings in patients with parotid adenolymphoma are mostly circularly shaped with uniform density and clear boundaries,accompanied by cystic changes with intact capsule. Enhanced scanning shows significant enhancement in arterial phase and     

Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

AIM： To evaluate the feasibility and efficacy of percutaneous radiofrequency ablation （RFA） of the feeding artery of hepatocellular carcinoma （HCC） in reducing the blood-flow-induced heat-sink effect of RFA.
METHODS： A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two groups. Seventy-one patients with 75 HCCs （average tumor size, 4.3 ± 1.1 cm） were included in group A, in which the feeding artery of HCC was identified by color Doppler flow imaging, and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery （PAA）] before routine RFA treatment of the tumor. Eighty-three patients with 102 HCC （average tumor size, 4.1 ± 1.0 cm） were included in group B, in which the tumors were treated routinely with RFA. Contrast-enhanced computed tomography was used as post-RFA imaging, when patients were followed-up for 1, 3 and 6 mo.
RESULTS： In group A, feeding arteries were blocked in 66 （88%） HCC lesions, and the size of arteries decreased in nine （12%）. The average number of punctures per HCC was 2.76 ± 1.12 in group A, and 3.36 ± 1.60 in group B （P = 0.01）. The tumor necrosis rate at 1 mo post-RFA was 90.67% （68/75 lesions） in group A and 90.20% （92/102 lesions） in group B. HCC recurrence rate at 6 mo post-RFA was 17.33% （13/75） in group A and 31.37% （32/102） in group B （P = 0.04）.
CONCLUSION： PAA blocked effectively the feeding artery of HCC. Combination of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC.     

Diagnosis of bacterial hepatic abscess by CT

BACKGROUND:Bacterial hepatic abscess usually is acute and progressive,often resulting in sepsis,impairment of liver function and disseminated intravascular coagulation. The mortality rate was as high as 80%in the past.For the purpose of early diagnosis and differential diagnosis of this disease,we probed the imaging manifestations and their characteristics in bacterial hepatic abscesses by CT scan. METHODS:Twenty-four lesions from 21 patients with bacterial hepatic abscesses that were confirmed by clinical features,puncture and culture were reviewed for CT manifestations.Fourteen patients were male and 7 were female,with an average age of 56.2 years.All lesions underwent CT plain scan and three-phase enhanced scan and 15 patients underwent delayed-phase imaging.Three senior radiologists read the films in accordance with a standard. RESULTS:Among 24 lesions,18(75%)were situated in the right liver with diameters of 1.4-9.3 cm(average 4.5 cm).Nineteen(79.2%)lesions were round or sub-round in shape,and 22(91.7%)had smooth,uninterrupted and sharp edges.All lesions showed low attenuation of less than 20 Hu.Twenty-two enhanced lesions(91.7%) had rim-shaped enhancement in the abscess wall,and 13(54.2%)showed single or double-ring signs.Eighteen (75%)displayed honeycomb-like,grid-like or strip-like enhancement.Eighteen(75%)were regionally enhanced in the surroundings or upper or lower layers.Only 2(8.3%) displayed a gas-liquid surface sign.CONCLUSIONS:The CT findings of bacterial hepatic abscess are usually typical,and the diagnosis of the abscess is not difficult.To precisely diagnose atypical cases,it is necessary to combine CT with clinical observations and follow-up.     

Macro-regenerative nodules in biliary atresia： CT/MRI findings and their pathological relations

AIM： To describe the radiological findings of a macro-regenerative nodule （MRN） in the liver of pretransplantation biliary atresia （BA） patients and to correlate it with histological findings.
METHODS： Between August 1990 and November 2007, 144 BA patients underwent liver transplantation （LT） at our institution. The pre-transplantation computer tomograghy （CT） and magnetic resonance imaging （MRI） findings were reviewed and correlated with the post-transplantation pathological findings.
RESULTS： Nine tumor lesions in 7 patients were diagnosed in explanted livers. The post-transplantation pathological findings showed that all the lesions were MRNs without malignant features. No small nodule was detected by either MRI or CT. Of the 8 detectable lesions, 6 （75%） were in the central part of the liver, 5 （63%） were larger than 5 cm, 5 （63%） had intratumor tubular structures, 3 （38%） showed enhancing fibrous septa, 3 （38%） had arterial enhancement in CT, one （13%） showed enhancement in MRI, and one （13%） had internal calcifications.
CONCLUSION： Although varied in radiological appearance, MRN can be differentiated from hepatocellular carcinoma （HCC） in most of BA patients awaiting LT. The presence of an arterial-enhancing nodule does not imply that LT is withheld solely on the basis of presumed malignancy by imaging studies. Liver biopsy may be required in aid of diagnostic imaging to exclude malignancy.     

Single-level dynamic spiral CT of hepatocellular carcinoma:Correlation between imaging features and density of tumor microvessels

AIM:To investigate the correlation of enhancement featuresof hepatocellular carcinoma (HCC) revealed by single-leveldynamic spiral CT scanning (DSCT) with tumor microvesseldensity (MVD),and to determine the validity of DSCT inassessing in vivo tumor angiogenic activity of HCC.METHODS:Twenty six HCC patients were diagnosedhistopathologically.DSCT was performed for all patientsaccording to standard scanning protocol.Time-density curveswere generated,relevant curve parameters were measured,and gross enhancement morphology was analyzed.Operationwas performed to remove HCC lesions 1 to 2 weeks followingCT scan.Histopathological slides were carefully prepared forthe standard F_8RA immunohistochemical staining and tumormicrovessel counting.Enhancement imaging features of HCClesions were correlatively studied with tumor MVD and itsintra-tumor distribution characteristics.RESULTS:On DSCT images of HCC lesions,three patternsof time-density curve and three types of gross enhancementmorphology were recognized.Histomorphologically,thedistribution of positively stained tumor endothelial cells withintumor was categorized into 3 types.Curve parameters suchas peak enhancement value and contrast enhancement ratiowere significantly correlated with tumor tissue MVD (r=0.508and r=0.423,P<0.01 and P<0.05 respectively).Both thepattern of time-density curve and the gross enhancementmorphology of HCC lesions were also correlated with tumorMVD,and reflected the distributive features of tumormicrovessels within HCC lesions.Correlation between thelikelihood of intrahepatic metastasis of HCC lesions withdensely enhanced pseudocapsules and rich pseudocapsulartumor MVD was found.CONCLUSION:Enhancement imaging features of HCClesions on DSCT scanning are correlated with tumor MVD,and reflect the intra-tumor distribution characteristics of tumor microvessels.DSCT is valuable in assessing theangiogenic activity and tumor neovascularity of HCC patientsin vivo.     

Mangafodipir trisodium-enhanced magnetic resonance imaging for evaluation of pancreatic mass and mass-like lesions

AIM: To investigate the role of mangafodipir trisodium (MnDPDP) in focal pancreatic masses and mass-like lesions by evaluating contrast uptake features of the lesions and pancreatic parenchyma after contrast medium injection. METHODS: A total of 37 patients with pancreatic mass or mass-like lesions were examined by unenhanced and MnDPDP-enhanced magnetic resonance imaging (MRI). RESULTS: MRI was obtained 20-40 min after infusion of MnDPDP and homogeneous contrast enhancement was observed in normal pancreas parenchyma. In patients with atrophic pancreas there was no enhancement in pancreatic parenchyma on MnDPDP-enhanced MRI. In 37 patients with 41 pancreatic masses and mass-like lesions, contrast enhancement was observed at 5 lesions on MnDPDP enhanced MRI. Three of these 5 lesions were focal pancreatitis and the other 2 were adenocarcinoma. No contrast enhancement was determined in 36 pancreatic masses and mass-like lesions in 32 patients. CONCLUSION: MnDPDP contrast-enhanced MRI, especially in cases with no parenchyma atrophy, can distinguish focal pancreatic lesion margins. Information about the function of pancreatic parenchyma can be obtained out of tumor. MnDPDP facilitates staging of pancreatic tumors by detection of metastatic lesions in the liver. In addition, diminished heteregenous uptake of MnDPDP in patients with pancreatitis may be helpful in differential diagnosis.     

Solitary Necrotic Nodules of the Liver: Histology and Diagnosis With CT and MRI

Background

A solitary necrotic nodule (SNN) of the liver is an uncommon lesion, which is different from primary and metastatic liver cancers.

Objectives

To analyze the classification, CT and MR manifestation, and the pathological basis of solitary necrotic nodule of the liver (SNN) in order to evaluate CT and MRI as a diagnosing tool.

Patients and Methods

This study included 29 patients with liver SNNs, out of which 14 had no clinical symptoms and were discovered by routine ultrasound examinations, six were found by computed tomography (CT) due to abdominal illness, four had ovarian tumors, and five had gastrointestinal cancer surgeries, previously. Histologically, these SNNs can be divided into three subtypes, i.e., type I, pure coagulation necrosis (14 cases); type II, coagulation necrosis mixed with liquefaction necrosis (five cases); and type III, multi-nodular fusion (10 cases). CT and magnetic resonance imaging (MRI) patterns were shown to be associated with SNN histology. All patients were treated surgically with good prognosis.

Results

CT and MRI appearance and correlation with pathology types: three subtypes of lesions were hypo-density on both pre contrast and post contrast CT, 12 lesions were found the enhanced capsule and 1 lesion of multi- nodular fusion type showed septa enhancement. The lesions were hypo-intensity on T2WI and the lesions of type II showed as mixed hyperintensity on T2WI. The capsule showed delayed enhancement in all cases, and all lesions of multi- nodular fusion type showed delayed septa enhancement on MR images. 15 cases on CT were misdiagnosed and Four cases on MRI were misdiagnosed and the accuracy of CT and MRI were 48.3% and 86.2% respectively.

Conclusions

In conclusion, CT and MRI are useful tools for SNN diagnosis.     

MRI长时间延迟增强扫描诊断肝脏孤立性坏死性结节价值研究*

目的 探讨磁共振成像（MRI）长时间延迟增强扫描诊断肝脏孤立性坏死性结节（SNNL）的价值。方法 2013年5月~2018年5月我院就诊的17例SNNL患者和15例肝脏恶性肿瘤患者（其中10例为肝细胞癌和5例为肝转移癌）,所有患者均行常规CT/MRI增强扫描及MRI多期长时间延迟至120 min扫描,分别比较两组病灶影像学特征,如病灶密度、强化类型,探讨长时间延迟扫描在鉴别SNNL与肝脏恶性肿瘤中的作用。结果 在SNNL患者,CT和MRI共检出17个病灶,均位于肝右叶,且均为单发病灶,直径为（2.1±0.4） cm;在10例HCC患者,MRI检查发现11个病灶,位于肝右叶者8个,位于肝左叶者3个。单发病灶9例,多发病灶1例,直径为 （5.4±1.6） cm;在5例肝脏转移癌患者中,共检出12个病灶,位于肝右叶者9个,位于肝左叶者3个,直径为 （3.1±0.9）cm;在SNNL病灶中有4个病灶在T2WI上表现为“靶征”,与肝转移癌病灶的影像学表现类似;在延迟期（DP）3/5 min扫描,HCC和肝转移癌病灶边缘多呈中度-重度环形强化,SNNL病灶边缘强化水平随着延迟时间延长而逐渐增强。在DP 1 h时,17个病灶均表现为中度-重度环形强化,病灶中心无强化,而肝脏恶性肿瘤病变边缘强化均已消失。结论 MRI 长时间延迟增强扫描能有效区分SNNL与肝脏恶性肿瘤,主要表现为在延迟扫描时呈病灶边缘和间隔环形强化,且病变中心无强化。     

先天性支气管囊肿CT及MRI诊断价值

目的探讨先天性支气管源性囊肿(bronchogenic cysts, BC)的计算机断层扫描(computerized tomography, CT)及磁共振成像(magnetic resonance imaging, MRI)诊断。 方法回顾性分析经手术病理证实的23例BC患者的CT及MRI表现和临床资料。 结果纵隔内11例，其中前纵隔4例，中纵隔3例，后纵隔4例，均为单发，呈类圆形，边缘光滑，密度均匀；其中一例合并出血和感染，平扫表现为稍高密度影、CT值约为50～60 HU，增强扫描可见轻度强化；其余纵隔型BC均表现为平扫低密度影，CT值约为10～30 HU，增强扫描未见明显强化。肺内10例，均为单发类圆形或椭圆形病灶，其中3例为含气囊腔，7例为囊性低密度影，增强扫描未见明显强化。颅内2例，位于左侧额部，MRI表现为椭圆形T1WI低信号，T2WI高信号影，一例其后份可见片状T1WI、T2WI稍高信号影，增强扫描均未见强化。 结论支气管囊肿的CT及MRI表现有一定的相对特征性，结合临床综合分析可提高诊断正确率。     

Imaging findings of biliary hamartomas

AIM: To evaluate the imaging findings of biliary hamartomas (von Meyenburg complexes, VMCs) and discuss the differential diagnosis with other related diseases.METHODS: Imaging findings of biliary hamartomas on ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), MR cholangiopancreatography (MRCP)and hepatobiliary scintigraphy were retrospectively analyzed in six patients.RESULTS: On ultrasound images, five of the six cases showed multiple small hyper- and hypo-echoic lesions with comet-tail echoes, especially when magnified by US with the usage of zoom function. In all the six cases,multiple tiny hypodense lesions less than 10 mm in diameter were revealed as scattered throughout the liver with no enhancement on CT. These tiny lesions were demonstrated to be hyper- and hypo-intensity on T2- and TI-weighed images, respectively, in three patients who underwent MRI examinations. MRCP was performed in two patients, and clearly showed multiple tiny irregular- and round-shaped hyper-intensity lesions.MRCP and hepatobiliary scintigraphy showed normal appearances of intra- and extra-hepatic bile ducts in two and one patients, respectively.CONCLUSION: Imaging modalities are useful in the diagnosis and differential diagnosis of VMCs. A correct diagnosis might be obtained when typical imaging findings are present even without a histological confirmation.     

Inflammatory pseudotumor of the liver: Radiologic diagnosis

To determine the characteristic radiologic findings of inflammatory pseudotumor of the liver, various imagings of ten patients (11 lesions) with proven diagnoses of inflammatory pseudotumor were reviewed. Radiologic examinations, i.e., computed tomography (CT; 11 lesions), ultrasonography (11 lesions), magnetic resonance imaging (MRI; 6 lesions), angiography (10 lesions), CT during arterio-portography (CTAP; 3 lesions), and gallium-67 scans (9 lesions) were analyzed for their utility in diagnosis. No inflammatory pseudotumor showed a fibrous capsule around the lesion. Ten of the 11 lesions were poorly demarcated on most of the imagings, and all 11 lesions showed delayed and/or prolonged enhancement on CT or MRI. Arterio-portal shunting was observed in 4 lesions after contrast material administration on CT or angiography. Central lesions with suspiciously high fibrotic tissue content were demonstrated in 5 lesions on CT or MRI. Major vessels coursing in the lesions were demonstrated in 4 lesions by CT, MRI, and CTAP. Inflammatory pseudotumor of the liver should be included in the differential diagnosis in patients with hepatic masses, even if the patients are asymptomatic. If radiologic examinations suggest inflammatory pseudotumor, percutaneous biopsies should be performed so that unnecessary surgery can be avoided.     

自身免疫性胰腺炎的CT和MRI影像学征象

目的 探讨自身免疫性胰腺炎(autoimmune pancreatitis,AIP)的CT及MRI影像学表现特征.方法 回顾性分析14例经组织学和(或)类固醇激素治疗证实的AIP患者的CT及MRI资料.10例行CT检查,7例行MRI检查(其中3例同时做CT和MRI检查).结果 11例AIP表现为胰腺弥漫性肿大,3例为胰腺局限性肿大.10例CT平扫见胰腺病变区密度均降低,5例显示节段性胰管,5例见胆总管胰头段狭窄;7例在胰腺病变区周围可见环绕包膜样结构;动态增强后出现延迟均匀强化.7例MRI的抑脂T1WI显示胰腺病变后信号均匀降低(3例)或不均匀降低(4例),抑脂T2WI信号均匀增高(3例)或不均匀增高(4例);4例MRI显示胰管,MRCP见1例胰头部胰管局限性狭窄,2例胰管节段性狭窄;5例MRI见胆总管胰头段狭窄,MRCP见3例胆总管胰头段呈鸟嘴样狭窄;6例见胰腺病变区周围环绕包膜样结构.14例AIP均未见胰腺实质钙化,胰管均未见明显扩张(＞3 mm).结论 AIP的CT、MRI表现具有特征性,主要为胰腺呈腊肠样改变,胰周出现包膜样结构,胰管弥漫性或局限性狭窄,胆总管胰头段炎性狭窄.     

脑静脉窦蛛网膜颗粒的CT和MRI诊断

目的 探讨脑静脉窦内蛛网膜颗粒的CT和MRI影像特点。方法 8例脑静脉窦内蛛网膜颗粒患者行MRI检查，其中7例行CT扫描，对影像进行回顾性分析，总结其特征性征象。结果 8例患者中，脑静脉窦内蛛网膜颗粒共有9个，其中6个位于横窦，3个位于上矢状窦。病灶在CT影像中均表现为低密度影，其中3个有钙化灶。9个Tl加权像为低信号，1、2加权像为高信号，7个液体衰减反转恢复序列上为低信号；4个增强后可见轻度或中度强化，以及充盈缺损；4个MR静脉造影影像呈附壁状充盈缺损征象。结论 CT和MRl影像是诊断脑静脉窦内蛛网膜颗粒的有效方法，特别是MRl影像能显示其特征性信号改变及与静脉窦的关系，对诊断更有意义。     

66例颈部淋巴结结核的CT征象分析

目的 探讨颈部淋巴结结核的CT征象特点。方法 搜集2015年8月至2017年8月苏州市第五人民医院诊治的66例经手术切除并经病理学证实的颈部淋巴结结核患者,回顾性分析上述患者CT表现资料。其中,男28例(42.4%),女38例(57.6%),年龄15~75岁,平均年龄(31.7±12.9)岁。对66例患者的发病部位、CT分型及征象进行总结分析。结果 66例颈部淋巴结结核患者中,多发者65例(98.5%),单发者1例(1.5%);双侧发病39例(59.1%),单侧发病27例(40.9%)。淋巴结分布于多个分区者59例(89.4%),分布于单个分区者7例(10.6%);淋巴结常见的分布区域依次为,Ⅱb区35例(53.0%),Ⅰa区30例(45.5%),Ⅰb区30例(45.5%),Ⅳb区26例(39.4%),Ⅱa区23例(34.8%),Ⅲ区22例(33.3%),Ⅳa区18例(27.3%)。淋巴结CT分型及征象为:均匀强化型(Ⅰ型)49例(74.2%),表现为结核结节及肉芽肿形成;包膜强化型(Ⅱ型)24例(36.4%),表现为淋巴结干酪样坏死,包膜强化,中心低密度区无强化;边缘强化型(Ⅲ型)34例(51.5%),表现为淋巴结包膜坏死,有分隔,边缘强化,中心低密度区无强化,周围脂肪间隙消失;不均匀强化型(或融合型;Ⅳ型)44例(66.7%),其中并发窦道形成8例(12.1%),表现为淋巴结干酪样坏死破溃侵犯周围组织,不均匀边缘强化,淋巴结正常结构消失,周围脂肪间隙消失,可见窦道。60例(90.9%)患者主发病灶均出现不同程度的周围组织侵犯。结论 颈部淋巴结结核具有多分区、多分型、多种CT征象显现同时存在的特点,CT增强扫描可以很好地显示病变形态和反映病理学改变,具有较高的诊断价值。     

Multifocal autoimmune pancreatitis: A retrospective study in a single tertiary center of 26 patients with a 20-year literature review

BACKGROUNDMultifocal-type autoimmune pancreatitis (AIP), sometimes forming multiple pancreatic masses, is frequently misdiagnosed as pancreatic malignancy in routine clinical practice. It is critical to know the imaging features of multifocal-type AIP to prevent misdiagnosis and unnecessary surgery. To the best of our knowledge, there have been no studies evaluating the value of diffusionweighted imaging (DWI), axial fat-suppressed T1 weighted image (T1WI), and dynamic contrast enhanced-computed tomography (DCE-CT) in detecting the lesions of multifocal-type AIP.AIMTo clarify the exact prevalence and radiological findings of multifocal AIP in our cohorts and compare the sensitivity of DWI, axial fat-suppressed T1WI, and DCE-CT for detecting AIP lesions. We also compared radiological features between multifocal AIP and pancreatic ductal adenocarcinoma with several key imaging landmarks.METHODSTwenty-six patients with proven multifocal AIP were retrospectively included. Two blinded independent radiologists rated their confidence level in detecting the lesions on a 5-point scale and assessed the diagnostic performance of DWI, axial fat-suppressed T1WI, and DCE-CT. CT and magnetic resonance imaging of multifocal AIP were systematically reviewed for typical imaging findings and compared with the key imaging features of pancreatic ductal adenocarcinoma.RESULTSAmong 118 patients with AIP, 26 (22.0%) had multiple lesions (56 lesions). Ulcerative colitis was associated with multifocal AIP in 7.7% (2/26) of patients, and Crohn’s disease was present in 15.3% (4/26) of patients. In multifocal AIP, multiple lesions, delayed homogeneous enhancement, multifocal strictures of the main pancreatic duct, capsule-like rim, lower apparent diffusion coefficient values, and elevated serum Ig4 level were observed significantly more frequently than pancreatic ductal adenocarcinoma, whereas the presence of capsule-like rim in multifocal-type AIP was lower in frequency than total AIP. Of these lesions of multifocal AIP, DWI detected 89.3% (50/56) and 82.1% (46/56) by the senior and junior radiologist, respectively.CONCLUSIONMultifocal AIP is not as rare as previously thought and was seen in 22.0% of our patients. The diagnostic performance of DWI for detecting multifocal AIP was best followed by axial fat-suppressed T1WI and DCE-CT.