腹膜后副神经节瘤CT诊断

目的:探讨腹膜后副神经节瘤的CT表现特征。方法:回顾性分析10例经手术病理证实的原发性腹膜后副神经节瘤CT资料,并与病理结果进行对照分析。结果:病灶均为单发,6例发生于腹主动脉左侧,4例发生于腹主动脉右侧,肿块直径均大于4cm,其内密度不均,中间均可见不规则低密度坏死区,其中4例可见斑片、点状及线状高密度钙化灶,8例增强扫描瘤体实质部分明显强化,3例可见瘤体内明显强化的纡曲扩张血管,坏死区不强化。8例病灶与周围组织边界清楚,2例侵犯周围组织。结论:原发性腹膜后副神经节瘤的CT表现具有一定特征性,CT检查有助于原发性腹膜后副神经节瘤的定位定性及明确肿瘤与周围组织结构的关系。     

CT、MR对腹膜后原发肿瘤诊断临床价值分析

目的 探讨CT、MR检查对腹膜后肿瘤的诊断价值.方法 对27例腹膜后原发肿瘤患者术前螺旋CT和/或MR进行回顾性分析,并与手术或病理活检的结果进行对照.结果 本组27例中,其中神经源性11例(神经鞘瘤4例,嗜铬细胞瘤3例,神经纤维瘤2例,副神经节瘤1例,神经内分泌瘤1例),淋巴瘤3例,恶性纤维组织细胞瘤3例,淋巴管瘤2例,成熟畸胎瘤2例,脂肪肉瘤2例,平滑肌肉瘤2例,脂肪瘤1例,表皮样囊肿1例.本研究正确诊断腹膜后肿瘤21例(84％),误诊6例.结论 正确识别CT和MR特征性表现对原发腹膜后肿瘤定位、正确诊断或缩窄诊断范围至关重要.     

小儿腹膜后神经节源性肿瘤的CT表现

目的描述26例腹膜后神经节源性肿瘤的CT表现,以提高对本病的认识.方法男18例,女8例.经手术、病理(24例)及临床骨穿(2例)证实.成神经细胞瘤、神经节成神经细胞瘤、神经节瘤分别为14、10、2例,平均年龄分别为1岁3个月、3岁6个月、6岁,其中神经节瘤2例分别合并白血病及恶性嗜铬细胞瘤.全部病例于术前作腹部CT平扫,其中14例同时作了增强扫描.术前作B超检查20例.结果(1)肿瘤约2.0cm×2.5cm×2.5cm～16cm×10cm×8cm大小,26例均位于腹膜后,位于一侧22例,位于中线上3例,2处多发1例.(2)肿物外形不规则20例,类圆形6例;边缘清楚14例,模糊12例.(3)25例肿瘤与肾脏对比呈等密度为主的混杂密度,1例为均匀低密度;23例肿瘤有不同形态钙化;增强扫描者12例肿瘤有不均匀增强,2例增强不明显.(4)腹膜后淋巴结肿大19例,肝转移3例,肿瘤包埋血管18例,下腔静脉内瘤栓1例,肿瘤侵入椎管3例.结论CT平扫可以提示腹膜后神经节源性肿瘤的诊断,增强扫描能够进一步明确肿瘤内部及其周围异常.     

CT征象分析对原发性腹膜后肿瘤鉴别诊断的价值

_目的：探讨特定 CT 征象对原发性腹膜后肿瘤（简称腹膜后肿瘤）鉴别诊断的价值。方法：回顾性分析经手术病理证实的79例腹膜后肿瘤的 MSCT 资料,确定对良恶性肿瘤鉴别有价值的征象,探讨生长方式、内部结构特点及增强表现对特定类型肿瘤的诊断价值。结果：67例（84．8％）定位诊断正确。32例（76．2％,32/42）良性肿瘤及35例（94．6％,35/37）恶性肿瘤定性诊断正确,提示恶性肿瘤有价值的征象包括病灶体积较大、浸润性生长、中重度强化、坏死、囊变及钙化。匍匐状生长对诊断淋巴管瘤及神经源性肿瘤的敏感度、特异度、阳性预测值（PPV）及阴性预测值（NPV）分别为75．0％、98．4％、92．3％、93．9％。脂肪密度对诊断脂肪肉瘤与畸胎瘤的敏感度、特异度、PPV 及 NPV 分别为85．0％、98．3％、94．4％、95．1％。水样密度对诊断淋巴管瘤与畸胎瘤的敏感度、特异度、PPV 及 NPV 分别为80．0％、93．2％、80．0％、93．2％。囊肿样表现对诊断淋巴管囊肿的敏感度、特异度、PPV 及 NPV 分别为100％、98．6％、90．0％、100％。钙化对诊断神经源性肿瘤及畸胎瘤的敏感度、特异度、PPV 及 NPV 分别为51．2％、87．5％、80．0％、64．8％。强化程度接近血管对诊断副神经节瘤的敏感度、特异度、PPV 及 NPV 分别为77．8％、98．6％、87．5％、97．2％。结论：CT 征象分析有助于腹膜后良恶性肿瘤的鉴别及特定肿瘤的诊断。     

Imaging of retroperitoneal ganglioneuroma

The aim of this study was to describe the radiological appearance of retroperitoneal ganglioneuroma. We retrospectively reviewed seven cases of histologically proven retroperitoneal ganglioneuroma. Ultrasound and enhanced CT were obtained in all cases, and MRI in three cases. The masses were well-circumscribed, ranged in size from 5 x 3 x 3 to 10 x 6 x 4 cm. In three cases close relationships between the tumor mass and major blood vessels were noted, resulting in vessel displacement or surrounding, but without compression or occlusion. On ultrasound examination the tumor showed a heterogeneous solid echostructure. Non-enhanced CT showed homogeneous or mildly heterogeneous low attenuation, and a punctate calcification was seen in one case. Contrast uptake was absent (n = 1) or delayed (n = 6). Progressive but incomplete enhancement was observed in three cases. On MRI, T2-weighted images showed a high signal intensity. Dynamic studies depicted the same enhancement pattern as described on CT. Ganglioneuroma is a rare tumor which should nevertheless be included in differential diagnosis of retroperitoneal masses when presenting as a well-delimited tumor with possible tendency to surround or displace major blood vessels, low density on non-enhanced CT, and delayed progressive enhancement on CT and MRI.     

原发性腹膜后节细胞神经瘤影像分析

目的:分析腹膜后节细胞神经瘤的特征影像表现,提高其诊断准确率。方法:回顾性分析7例经手术病理证实的腹膜后节细胞神经瘤的影像表现。结果:所有肿块均边界清楚,其中3例呈铸型或嵌入生长,1例侵犯椎间孔;2例可见小斑点钙化;超声显示3例呈轻度不均匀性低回声,内可见条索状间隔回声;1例不均匀低回声内见血流信号。CT平扫呈均匀性低密度,CT增强扫描1例无明显强化;2例动脉期包膜轻度强化,其中1例无延迟强化,1例呈进行性延迟强化;2例动脉期包膜及间隔轻度强化,并见包膜及间隔轻度延迟强化。MRI T1WI呈均匀性低信号,T2WI呈不均匀性高信号,增强扫描后呈轻度强化。结论:CT、MRI诊断节细胞神经瘤优于超声;当其出现特征影像表现时,需要考虑节细胞神经瘤的诊断。     

螺旋CT对原发性腹膜后肿瘤的诊断价值

目的：探讨螺旋CT对原发性腹膜后肿瘤的诊断价值及其临床意义。方法：20例经手术病理证实的原发性腹膜后肿瘤术前均行螺旋CT检查，其中8例经工作站行多平面重建(MPR)与三维重建技术处理回顾性分析其CT征象。结果：腹膜后恶性肿瘤15例，病灶平均直径较大，CT表现为形态不规则，密度不均匀，有远处转移、毗邻大血管被包绕或被侵犯，并常侵犯邻近的组织器官。腹膜后良性肿瘤5例，其表现与恶性者大致相反。结论：螺旋CT对原发性腹膜后肿瘤能精确地进行定位诊断；其CT表现除对分化好的脂肪类肿瘤与非何杰金淋巴瘤进行定性诊断外，对于其他肿瘤为非特异性。     

腹腔和腹膜后巨大肿瘤的CT诊断

目的：评价CT对腹腔和腹膜后肿瘤的诊断价值。材料和方法：回顾性分析经手术、病理证实的原发于腹脏腹源腔器外和腹膜后巨大肿瘤14例的CT表现。结果；CT对上述肿瘤的定位正确率为78．5％，良恶性鉴别的正确率为85．7％。结论：CT值可确定囊性、实性和囊实性；强化表现与肿瘤组织学有关，对部分肿瘤能揭示组织学来源；肿瘤大小对良恶性鉴别帮助不大。     

MSCT在腹膜后副神经节瘤诊断中的应用价值

目的：探讨多层螺旋CT （MSCT）在腹膜后副神经节瘤诊断中的应用价值,提高对该病的认识。方法回顾性分析我院2003年5月～2012年4月经手术病理证实为腹膜后副神经节瘤的13例患者CT 资料。所有患者均行M SC T增强扫描及三维后处理重建。以手术结果为标准,分析CT 检查显示腹膜后副神经节瘤的准确性。结果13例患者中,11例单发,2例多发,共计16个病灶。病灶均位于腹主动脉周围,呈椭圆形或圆形,平扫肿瘤呈等或略低密度,密度不均匀,2例病灶边缘钙化。增强扫描病灶不均匀明显强化,可见坏死和囊变区,7例瘤内或瘤周可见明显强化的迂曲血管影。CT增强扫描及三维重建在病灶大小、形态、位置、供血动脉及与周围组织关系的显示上与手术结果一致。结论腹膜后副神经节瘤的CT表现具有一定特异性,MSCT增强扫描及三维重建在腹膜后副神经节瘤的诊断中有重要价值。     

原发性腹膜后脂肪肉瘤的CT诊断与鉴别诊断

目的探讨原发性腹膜后脂肪肉瘤的cT表现及鉴别诊断要点。方法回顾性分析经手术病理证实的32例原发性腹膜后脂肪肉瘤的CT资料,32例均行CT平扫及增强扫描。结果①肿瘤大小约8～30cm,肿瘤的形态绝大多数不规则,所有肿瘤均位于腹膜后间隙。②32例脂肪肉瘤中,20例肿块中含有典型的脂肪成分,其cT值为-20—130Hu。增强扫描时肿块内的脂肪成分无强化,软组织成分轻度强化。结论cT在原发性腹膜后脂肪肉瘤的定位诊断以及判断肿瘤与邻近器官的关系方面具有十分重要的价值,而且对高分化型脂肪肉瘤或含脂肪的其他类型脂肪肉瘤能够明确诊断。     

肝硬化门脉高压腹膜后静脉曲张CT表现

目的：分析肝硬化门脉高压腹膜后静脉曲张CT表现，探讨其临床应用价值。方法：搜集门脉高压腹膜后静脉曲张患者24例，其中14例行3mm薄层容积扫描，最大强度投影法重建。结果：腹膜后Retzius静脉丛9例，CT增强示胰腺、十二指肠及升、降结肠周围蚯蚓或粗管状增强血管影；脾肾侧支开放14例，表现为脾门及左肾静脉之间柱状或转告愉状强化影，其中5例曲张静脉向肾后区域延伸；椎旁静脉曲张6例，表现为腰静脉、腰升静脉扩大增粗，并与椎管内静脉丛相通。结论：CT增强扫描对腹膜后静脉曲张诊断有鉴别诊断具有重要价值，MIP血管成像立体显示脾肾侧支开放有椎旁静脉曲张，对于肝性脑病预测具有一定临床意义。     

FDG-PET/CT findings of autoimmune pancreatitis associated with idiopathic retroperitoneal fibrosis

We report the fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) findings of autoimmune pancreatitis (AIP) associated with idiopathic retroperitoneal fibrosis. A 69-year-old male patient was admitted to our hospital with obstructive jaundice. Six months prior to this admission, he was treated with steroid therapy for retroperitoneal fibrosis. Laboratory data showed that elevated T-bil, C-reactive protein, amylase and immunoglobulin 4, and antinuclear antibodies were positive. Clinical history, laboratory data, CT image, and magnetic resonance imaging led to a diagnosis of autoimmune pancreatitis. To investigate the inflammatory activity, FDG-PET/CT was undertaken. FDG-PET/CT demonstrated diffuse intense FDG uptake in the enlarged pancreas and diffuse mild uptake in the region of the abdominal aorta-bilateral iliac arteries. A dilated right renal pelvis and upper ureter, corresponding to hydronephrosis probably caused by retroperitoneal fibrosis, were shown. An FDG-PET/CT was useful to evaluate inflammatory activity and morphological imaging, and supported our diagnosis of AIP and retroperitoneal fibrosis.     

Adenocarcinomas arising from primary retroperitoneal mature teratomas: CT and MR imaging

An adenocarcinoma arising from mature teratoma is one form of teratoma with malignant transformation. It is extremely rare but highly malignant. The authors report two patients with adenocarcinomas arising from primary retroperitoneal teratomas. The CT and MRI findings of the tumors are presented with emphasis on imaging features implying the presence of malignant transformation and differing from those of pure benign mature teratoma. Correct diagnosis of the presence of malignant transformation from a benign mature teratoma can be made as early as possible by awareness of the imaging features.     

儿童CT检查中扫描参数的优化

目的 了解儿童CT检查扫描条件选择及其所致辐射剂量的相关性,以期通过适当调节mAs、扫描长度等参数,降低儿童CT检查患者受照剂量。方法 比较江苏省7家医院不同年龄组（<1岁、1~5岁、6~10岁和11~15岁）儿童头颅、胸部、腹部多排螺旋CT检查主要扫描参数的差异。选用相同的检查参数在TM160剂量模体上测量CTDI₁₀₀,计算DLP,并通过经验加权因子,估算出不同部位检查的有效剂量（E）。对mAs、扫描长度和DLP进行多元线性回归分析,比较两家典型医院由于选择扫描条件不同所导致的剂量差异。结果 儿童头颅、胸部、腹部CT检查所致患者的有效剂量均值分别为2.46、5.69、11.86 mSv,各部位检查DLP与mAs、扫描长度均呈正相关（r=0.81、0.81、0.92,P<0.05）。较高的mAs选择,致使本研究各年龄组儿童胸腹部CT检查有效剂量是德国Galanski等研究的1.2~3.0倍;B医院各年龄组腹部检查选择了较高的扫描长度,以致其所致有效剂量均高于本研究均值。结论 建议通过合理优化儿童不同部位CT检查mAs、扫描长度等扫描参数,降低受检者所受辐射风险。     

多层螺旋CT诊断原发性腹膜后肿瘤的研究

原发性腹膜后肿瘤，因其位置隐蔽，早期临床上缺乏特异症状和体征，多数患者就诊时，肿瘤已相当大，需与腹膜后继发性肿瘤，腹膜后器官的肿瘤以及腹腔肿瘤等特别，本文收集16例资料完整的原发性腹膜后肿瘤，结合文献，复习其CT表现特点，以提高诊断水平。     

Retroperitoneal neoplasms within the perirenal space in infants and children: Differentiation of renal and non-renal origin in enhanced CT images

Purpose

To retrospectively demonstrate the specific CT findings of retroperitoneal neoplasms to diagnosis and differential diagnosis renal and non-renal tumors within the perirenal space in infants and children.

Materials and methods

We retrospectively reviewed the clinical data and CT images of 42 consecutive patients with surgically and pathologically proven retroperitoneal neoplasms within the perirenal space. The patients were divided into renal tumors group (n = 16) and non-renal tumors group (n = 26). The former included nephroblastoma (n = 15) and renal lymphoma (n = 1), while the latter included neuroblastoma (n = 12), retroperitoneal teratoma (n = 6), adrenal ganglioneuroma (n = 4), retroperitoneal lymphoma (n = 2), ectopic pheochromocytoma (n = 1) and adrenal cortical carcinoma (n = 1). The clinical information of these patients and the major CT imaging findings which were related to lesion localization in the two groups were compared and statistically analyzed using Pearson Chi-Square Test and Risk Estimate.

Results

The mean diameter of tumors was 9.82 ± 6.13 cm (n = 42 range: 2.3-32 cm). The demographic data and chief clinical symptoms between the renal tumor group and the non-renal tumor group showed no statistically significant differences (P > 0.05). 30.8% (8/26) of non-renal tumor patients presented elevated urinary vanillylmandelic acid (VMA) level, while no patient showed elevated VMA in renal tumor group (P < 0.05). Some CT imaging signs of the renal tumors including “crescent sign” (odds ratio, OR = 52), “beak sign” (OR = 84), “embedded organ sign” (OR = 84), and “prominent feeding artery sign” (OR = 36) showed significantly higher incidence when compared to the non-renal tumors (P < 0.001). The sign of “renal displacement and renal axis rotation” (OR = 0.059) was seen in 23 of 26 (88.5%) non-renal tumors, but in only 5 of 16 (31.3%) renal tumors (P < 0.001). The sign of “extra-renal central plane of tumor” (OR = 0.038) was displayed in 24 of 26 (92.3%) non-renal tumors, but in only 5 of 16 (31.3%) renal tumors (P < 0.001). The CT findings such as “pseudocapsule” (OR = 38.5), “necrosis and cystic change” (OR = 11.2), “vascularity” (OR = 16.867), “distant metastasis” (OR = 5.96), and “inferior vena cava tumor thrombus” which were thought to be characteristic of renal tumors were observed with significant higher incidence in renal tumors group than in the non-renal tumors group (P < 0.05); while CT signs of “irregular mass” (OR = 0.045) and “intratumoral calcifications” (OR = 0.065) were observed with lower incidence in renal tumors group than in the non-renal tumors group (P < 0.05).

Conclusion

The “crescent sign”, “beak sign”, “embedded kidney sign” and “renal arteries feeding” are the most specific CT signs suggestive of renal tumors and distinguish them from non-renal origin tumors within the perirenal space. Other CT signs, such as “pseudocapsule”, “hypervascular tumors” and “Inferior vena cava tumor thrombus”, when present, tumors of renal origin are strongly suggested. On the other hand, CT signs of “irregular mass”, “intratumoral calcifications”, and associated elevated urinary vanillylmandelic acid strongly suggest the non-renal tumors.     

螺旋CT对原发性腹膜后肿瘤的诊断价值

原发性腹膜后肿瘤(primary retroperitoneal neoplasm,PRN)临床少见,因临床症状无特征性,生长范围广泛,部位深在,依赖临床定性诊断有相当难度,而影像学检查对诊断有重要的意义。收集我院23例经手术病理证实的原发性腹膜后肿瘤的螺旋CT资料,分析其表现,旨在提高对腹膜后肿瘤的诊断水平。1材料与方法本组23例中,男17例,女6例,年龄24~57岁。临床症状:全部因腹部包块、腹痛就诊。采用GE Hispeed NX-I螺旋扫描机,扫描条件120~140kV,250~280mA,矩阵512×512,Pitch:1,层厚间隔为5mm或10mm。本组病例全部进行平扫,20例作了增强扫描,增强均用团…     

原发性腹膜后良性肿瘤的CT分析(附10例报告)

目的:总结分析10例原发性腹膜后良性肿瘤的CT表现。方法:对本组10例原发性腹膜后良性肿瘤进行CT平扫,其中5例行CT增强检查,全部病例均经病理证实。观察10例肿瘤的位置、大小、形态、密度、边缘、与周围组织的关系及增强后改变并归纳其不同CT表现。结果:在肿瘤的形态、密度、边缘情况、与周围组织关系及增强后改变等方面,不同类型的肿瘤CT表现有着明显的差异。结论:根据不同的原发性腹膜后良性肿瘤的不同CT特征,部分肿瘤可以做出定性诊断。CT检查是诊断原发性腹膜后良性肿瘤的重要方法。     

电子束CT双期扫描定量估价胰腺增强程度

目的：定量估价电子束ＣＴ双期扫描胰腺的增强程度。材料和方法：１１０例可疑胰腺病变者（２６～７２岁）均行电子束ＣＴ检查。其中胰腺癌１５例，胰腺炎３例，胰腺外伤２例，正常胰腺９０例。应用高压注射器以３．５ｍｌ／秒（８０ｍｌ）和１０ｍｌ／秒（２０ｍｌ）速度注射Ｕｌｔｒａｖｉｓｔ１００ｍｌ，在注射造影剂后１８～２０秒和５５～６０秒，应用ＳＶＳ０．３秒序列扫描胰腺２０层，层厚６ｍｍ。于动静脉期测量胰腺头、体、尾ＣＴ值。结果：在动脉期胰腺增强的ＣＴ值为１０１Ｈｕ±８（标准差），静脉期为８１Ｈｕ±５。其中６１例（５５％）动脉期较静脉期ＣＴ值增高２０Ｈｕ以上；３８例（３４％）增高１０Ｈｕ以上；１１例（１０％）动脉期ＣＴ值低于静脉期。结论：胰腺动脉期扫描较静脉期可提供更详细的解剖结构，可更清楚显示胰腺癌对胰周的浸润，可提高检测胰腺内小病灶的准确性。