Computed tomography and ultrasound in parapneumonic effusions and empyema

AIM: Imaging of pleural empyema by ultrasound (US) or computed tomography (CT) is used to confirm the diagnosis and facilitate drainage. However, the information gained from US and CT may also have prognostic significance. The aim of the present study was to determine if CT and US appearances correlated with the severity of infection as determined by established microbiological and biochemical indicators, and to establish whether either technique could predict those patients who will fail drainage and require surgery. MATERIALS AND METHODS: Fifty patients with parapneumonic effusions were assessed. All had thoracic CT and the results of thoracic US were available in 36 patients. Imaging features were compared to the stage of the effusion and clinical outcome. RESULTS: At US, 7/36 (19%) pleural collections were anechoic, 5/36 (14%) were hyperechoic without septae and 24/36 (67%) were hyperechoic with septae. There was no relationship between US appearances and the presence of pus, the effusion stage or the need for surgical treatment. On CT pleural enhancement was seen in all patients. There was evidence of pleural thickening in 46/50 (92%) and thickening of extrapleural fat in 38/50 (76%). There was a trend for mean pleural thickness to increase with an increasing stage of pleural infection. However, a wide range of appearances were seen and overall the thickness of pleural/extrapleural tissues was not significantly related to the stage of effusion or to the requirement for surgery. CONCLUSIONS: Although US and CT have established roles in the investigation of parapneumonic effusions, neither technique reliably identifies the stage of pleural infection or predicts those patients who subsequently require surgical intervention after failed management by chest tube drainage and intrapleural fibrinolytics. Kearney, S. E. (2000). Clinical Radiology 55, 542-547.     

腹腔内纱布团影像表现的实验研究

目的 通过动物试验探讨遗留腹内的纱布团在Ｂ超、ＣＴ及ＭＲ影像检查中的表现及随滞留腹内时间改变的变化规律,找出特征性表现,提出诊断标准。方法 ８只大白兔在无菌操作下剖腹手术,放入纱布团,于术后当日、１～７周分别行Ｂ超、ＣＴ及ＭＲＩ的平扫与增强扫描,并与剖腹手术所见进行比较,同时行病理组织学检查。结果 遗留腹内的纱布团立即被大网膜及邻近肠管粘连包裹,自肠管与纱布团粘连处向四周逐渐扩展生成纤维结缔组织包     

Adrenal myelolipoma: CT and ultrasound findings

The computed tomographic (CT) and ultrasound (US) appearances of 5 adrenal myelolipomas in 4 patients are reported. The component tissues of a myelolipoma determine its CT and US appearance. A myelolipoma consisting primarily of fat has a characteristic CT and US appearance. A myelolipoma also containing macroscopic quantities of nonfatty material (blood, calcium, or myeloid tissue) may have a nonspecific CT or US appearance if fat is not identified in the lesion. In equivocal cases, needle biopsy may be used to establish the diagnosis of myelolipoma.     

Morphologic aspects of hepatic abscesses at computed tomography and ultrasound

The morphologic criteria of hepatic abscesses as demonstrated at computed tomography (CT) and ultrasound (US) were investigated in 27 patients and the diagnostic efficiency of both methods evaluated. Different appearances of hepatic abscess at CT and US were observed and investigated. No specific morphologic signs could be defined, since malignant neoplasms may show similar findings. Therefore, fine needle aspiration of possible hepatic abscesses should be performed to provide specific and bacteriologic diagnosis. US is an accurate method to evaluate patients with possible hepatic abscess. However, CT should be preferred in critically ill patients and postoperatively, since the diagnostic accuracy of CT is not limited by bowel gas, sutures and drainage tubes.     

小肾癌的CT研究

目的：探讨小肾癌的ＣＴ检出和定性能力。方法：应用ＣＴ和ＵＳ，对１４例手术证实的小肾癌进行观察，分析小肾癌的影像表现，评价其检出率。结果：１４例小肾癌，ＵＳ检出１２例，ＣＴ检出１４例，定性正确ＣＴ１４例，ＵＳ８例。结论：正确的ＣＴ检查是提高小肾癌检出和定性的有效方法     

Computed tomographic and ultrasound appearances of focal spared areas in fatty infiltration of the liver

Computed tomography (CT) and ultrasound (US) appearances of diffuse and focal fatty infiltration of the liver (FIL) are well recognized. We have recently seen 10 cases with "fat spared" areas in FIL presenting as pseudo tumours of the liver. Characteristic appearances of fat free areas in FIL which help differentiate these areas from other focal liver lesions include (i) location in the medial segment of the left lobe of the liver, (ii) absence of mass effect on surrounding vessels and liver tissue, and (iii) presence of typical changes of FIL elsewhere in the liver on CT or US examination.     

Appearances of choroidal osteomas with diagnostic imaging.

The diagnostic imaging appearances of three choroidal osteomas (osseous choristomas) are presented. This rare, benign choroidal tumour is being recognized with increasing frequency, and is important to remember in the differential diagnosis of any unusual mass in the ocular fundus lest it be mistaken for a more sinister lesion. All three osteomas were demonstrated by ocular ultrasound (US), fluorescein angiography (FA) and computed tomography (CT) but none by plain radiography. None of the lesions was visible on magnetic resonance imaging (MRI); the reason for this is probably the bony nature of the tumours. The appearances of choroidal osteomas on US, FA, plain radiography and CT are discussed. To our knowledge this is the first report of a series of choroidal osteomas investigated by MR.     

Ovarian teratomas: tumor types and imaging characteristics.

Ovarian teratomas include mature cystic teratomas (dermoid cysts), immature teratomas, and monodermal teratomas (eg, struma ovarii, carcinoid tumors, neural tumors). Most mature cystic teratomas can be diagnosed at ultrasonography (US) but may have a variety of appearances, characterized by echogenic sebaceous material and calcification. At computed tomography (CT), fat attenuation within a cyst is diagnostic. At magnetic resonance (MR) imaging, the sebaceous component is specifically identified with fat-saturation techniques. The US appearances of immature teratoma are nonspecific, although the tumors are typically heterogeneous, partially solid lesions, usually with scattered calcifications. At CT and MR imaging, immature teratomas characteristically have a large, irregular solid component containing coarse calcifications. Small foci of fat help identify these tumors. The US features of struma ovarii are also nonspecific, but a heterogeneous, predominantly solid mass may be seen. On T1- and T2-weighted images, the cystic spaces demonstrate both high and low signal intensity. Familiarity with the US, CT, and MR imaging features of ovarian teratomas can aid in differentiation and diagnosis.     

Epithelioid hemangioendothelioma of spleen with intrasplenic metastasis: ultrasound and computed-tomography appearance.

The US and CT appearances of epithelioid hemangioendothelioma of the spleen with intrasplenic metastasis have not been previously reported. We described a 29-yr-old female with such a disease. Abdominal US study revealed a large mass in the upper pole and multiple small nodules in the rest of the spleen. CT scan also showed similar lesions of hypodensity which were not apparently enhanced by contrast medium.     

门静脉海绵样变性的螺旋CT诊断

目的：探讨门静脉海绵样变性(CTPV)的CT表现，以提高对本病的认识方法回顾性分析经数字减影血管造影、手术或US证实的CTPV 25例。25例均行CT平扫及双期增强扫描。结果：CTPV螺旋CT表现：a)门静脉狭窄和阻塞；b)门脉走行区结构紊乱，正常结构消失，出现迂曲扩张血管样结构，门静脉期明显强化；c)在动脉期可见周围肝实质短暂灌注异常，表现为局部或带状高密度。结论：CTPV螺旋CT双期扫描具有一定的特征性表现，正确诊断有赖于结合临床资料和影像学征象的综合分析。     

CT对卵巢良性囊性畸胎瘤的诊断价值(附21例分析)

目的：探讨卵巢良性囊性畸胎瘤的CT表面特点及其诊断价值。方法：分析21例经手术病理证实的卵巢成熟性囊性畸胎瘤的CT及B超资料，讨论CT表现特点与病理的关系。结果：21例囊性畸胎瘤均显示脂肪密度区。11个“浮球征”，9个脂液平面，10个囊壁钙化呈点状、条块状，4个分房间隔内钙化，2个囊内骨化影和软组织混杂密度影,3个未见钙化影。5例发生蒂扭转。结论：CT能显示良性囊性畸胎瘤的特殊表现，反映其病理特点。     

原发性肝、胆囊神经内分泌癌的影像学表现

目的 回顾原发性肝、胆囊神经内分泌癌(PHGNC)影像学表现及临床症状。方法 患者5例，男1例，女4例。长期腹泻4例，药物难以控制，其中伴腹痛2例；肿瘤出血，导致肝破裂1例。超声检查5例，CT检查4例，肝动脉造影检查3例。肿瘤发生在肝脏3例，发生在肝脏及胆囊1例，发生在胆囊1例。手术证实3例、活检及尸检证实各1例。结果 肝内多发肿瘤3例，单发肿瘤1例。超声表现：肝内不均匀强回声肿块2例，不均匀低回声肿块1例，内有一些小液化区，瘤体彩色血流丰富；肝内以囊性为主的巨大囊实性肿块1例；1例胆囊肿瘤表现为胆囊壁隆起性结节，无特异性征象。CT表现：肝脏内不均匀密度肿块，增强扫描肿瘤轻度强化，瘤内有一些小液化区。肝动脉造影表现：肿瘤实体部分血流丰富，瘤体明显染色；巨大囊实性肿瘤表现为瘤内无血管，周围血管受压。结论 肝神经内分泌癌影像学表现为肝内不均质肿块，内部血流丰富，肿瘤明显染色；肿瘤巨大时可发生出血、坏死、囊性变；肿瘤易发生肝内转移；肿瘤预后差。胆囊神经内分泌癌表现为胆囊壁隆起性病变，无特异性征象。患者常有腹泻、腹痛症状。     

Gynecologic causes of acute pelvic pain: spectrum of CT findings.

Although ultrasound (US) is the primary imaging modality of choice in the radiologic evaluation of the female patient with acute pelvic pain, the role of computed tomography (CT) in the evaluation of abdominal and pelvic pain continues to expand. CT may be performed if a gynecologic disorder is not initially suspected, if US findings are equivocal, or if the abnormality extends beyond the field of view achievable with the endovaginal probe and further characterization of pelvic disease is required. Many gynecologic disorders that cause acute pelvic pain (eg, uterine disorders, ovarian disorders, endometriosis, pelvic inflammatory disease, postoperative or postpartum complications) demonstrate characteristic CT findings. Familiarity with these CT appearances is important: It will allow the radiologist to guide appropriate treatment of affected patients and may eliminate the need for further imaging evaluation.     

腹腔内纱布团的影像表现

目的：探讨腹腔内纱布团的各种影像表现特征及其病理基础。材料和方法：２例患者经Ｂ超、ＣＴ及ＭＲＩ检查并经手术证实；进行了纱布团的水槽试验及１例动物试验。结果：纱布团在超声检查时表现为呈弧形强回声带后伴宽阔干净声影的肿块，在ＣＴ与ＭＲＩ平扫时表现为软组织密度与信号的肿块；位于腹腔内的纱布团当其周围有纤维结缔组织包膜形成后，超声检查尤其是高频探头探查于纱布团弧形强回声带外侧还可见薄层低回声带与其外侧的强回声带。ＣＴ及ＭＲＩ增强扫描可见包膜增强而纱布团内部无增强。结论：腹腔内遗留的纱布团在超声、ＣＴ和ＭＲＩ检查中都有一定的特征性表现，超声结合ＣＴ或ＭＲＩ的平扫及增强扫描可做出明确的诊断。     

Hemangiopericytoma of the greater omentum: US and CT appearance

The US, Doppler and CT appearances in a patient with hemangiopericytoma of the greater omentum are presented. Ultrasound revealed a solid mass with heterogenous echo pattern, well-defined margins and marked vascularity with low impedance flow (mean resistive index 0.42). The tumour was mobile. It was detected below the left kidney at the first US examination and had migrated into the pelvis 14 days later. At CT the tumour demonstrated strong but brief peripheral enhancement and a central hypodense s scar. Correspondence to: M. Bertolotto     

螺旋CT与高频超声诊断甲状腺癌价值的对比研究

目的: 分析甲状腺癌的螺旋CT (spiral CT, SCT)与高频超声(high-frequency ultrasound, US)表现,评价两者对甲状腺癌的诊断价值.材料和方法: 回顾性分析49例同期螺旋CT与高频US检查的甲状腺癌的表现,主要对原发病灶和颈部转移淋巴结进行对比分析,并与手术及病理结果对照.结果: 49例甲状腺癌,共58个原发病灶,螺旋CT与高频US均显示肿瘤病灶,形状不规则、密度/回声不均匀和边缘不清楚,两者无显著性差异(P>0.05). 螺旋CT显示16个瘤周"半岛状"瘤结节,11个瘤周"残圈"征.螺旋CT检出13个病灶微钙化,高频US检出22个病灶微钙化,两者无显著性差异(P>0.05).对颈部转移淋巴结,螺旋CT显示率84%(31/37),高频US显示率86%(32/37).结论: 高频超声应作为甲状腺癌的首选和重要检查方法,螺旋CT在评价甲状腺癌的原发灶、颈部转移淋巴结方面有一定特征性,两者结合起来,可提高甲状腺癌术前评估和诊断的准确性.     

Recognizing the CT Manifestations of Gynecologic Conditions Encountered in the Emergency Department

Women commonly present to the emergency room with subacute or acute symptoms of gynecologic origin. Although a pelvic exam and ultrasound (US) are the preferred initial diagnostic tools for gynecologic entities, a CT is often the first line imaging modality in the emergency department. We will provide a review of normal uterine enhancement and normal pregnancy related findings, and then familiarize radiologists with the CT appearances of gynecologic entities classically described on ultrasound that may present to the emergency department.     

儿童肺隔离症的影像学诊断(附11例报告)

目的分析儿童肺隔离症的影像学表现及评价诊断方法。材料与方法11例儿童中均摄胸部X线平片,其中支气管碘油造影、CT、B超检查各2例,主动脉造影1例。结果(1)胸部平片表现为肺实质肿块1例、囊性肿块7例、肺实变灶3例,肺门增大及肺组织结构异常8例;(2)支气管碘油造影的造影剂未进入病变区,支气管树移位2例;(3)CT示实质性及囊性肿块各1例,异常供血血管1例;(4)B超示肺内实质肿块1例,另1例囊性肿块受气体干扰术前未能作出诊断;(5)主动脉造影1例示降主动脉异常供血血管。结论胸部X线平片是最基本检查手段,可提供重要线索,但难以确诊;B超、CT检查有很高诊断价值,CT增强可显示异常的供血动脉;主动脉造影具有决定意义,但属有创伤检查,儿童难以接受;MR检查是公认的最佳方法。     

超声诊断肾细胞癌的价值并与CT对照

目的:评价彩色多普勒超声及灰阶超声诊断肾细胞癌的价值.材料和方法:回顾性分析31例手术病理证实为肾细胞癌的肾脏肿瘤的超声表现及超声定性诊断,并与CT诊断对比.结果:超声定性诊断与术后病理符合率83.9%(26/31),彩色多普勒超声表现为抱球型和丰富血流型的肾脏肿瘤,术前均定性诊断正确(21/21).而对于少血流型肿瘤,均未提出正确的定性诊断.超声及CT对于肾细胞癌定性诊断的符合率无差异(P＞0.05).结论:超声诊断肾细胞癌有很高的价值,尤其对血供丰富的肾肿瘤意义更大,可作为肾细胞癌患者术前首选检查方法.     

Detecting postsurgical recurrent hepatocellular carcinoma with multiphasic helical computed tomography: intrahepatic metastasis or multicentric occurrence?

OBJECTIVE: The aim of this study was to assess the computed tomography (CT) patterns of postoperative recurrent hepatocellular carcinoma (HCC). METHODS: Of 84 patients with histologically proven HCC by hepatectomies, multiphasic helical CT demonstrated 54 HCC lesions of intrahepatic recurrence in 31 (37%) patients. The initial and final appearances of HCC on hepatic arterial phase images were retrospectively determined by the serial CT scans, which were compared with appearances of primary HCC. RESULTS: The initial appearances of 54 recurrent HCCs were identical to the appearances of primary HCC in 41 (76%) lesions. Serial changes from the initial appearance to the final appearance of recurrent HCC were observed in 10 (42%) of 24 lesions. The 13 discordant lesions and the 10 lesions with altered lesion vascularity in our series implied that at least 43% were of multicentric occurrence. CONCLUSION: More than 40% of postoperative recurrent HCCs show intranodular hemodynamic changes. The incompatibility between CT findings of primary and recurrent HCCs implies that these tumors contain nodules of multicentric occurrence.