伴乳头溢液乳腺癌的乳腺导管造影表现与病理对照研究

目的:分析伴有乳头溢液乳腺癌的乳腺导管造影表现,并分析其病理基础,以提高诊断水平。方法:临床表现有乳头溢液并经手术、病理证实的乳腺癌23例,回顾性分析其乳腺导管造影的影像表现,并与手术病理结果进行对比分析。结果:23例中原位癌8例,浸润性导管癌10例(包括单纯癌6例、乳头状癌4例),导管癌早期浸润3例,乳头状瘤病恶变2例。病理上诊断早期癌13例(56.5%),其中8例临床未触及乳腺肿块。乳腺导管造影主要表现:导管内充盈缺损并伴有不同程度的导管扩张12例;乳腺肿瘤侵蚀导管形成潭湖征5例;溢液导管受乳腺肿块推挤,导管变形3例;导管持续显影、管壁不规则伴广泛微钙化灶1例。本组中乳腺导管造影诊断乳腺癌的符合率为82.6%。结论:乳腺导管造影对伴有乳头溢液乳腺癌的检出是一项安全、有效的检查方法,能准确观察到肿块与溢液导管的位置关系、溢液导管受侵蚀程度,而且还能检测出临床触诊阴性的早期乳腺癌。     

Diagnosis of papillomas of the breast: value of magnetic resonance mammography in comparison with galactography

The aim of this study was evaluation of MRI alone and in combination with mammography and galactography in the diagnosis of intraductal papillomas. From 1994 to 1998, a total of 48 women presenting with pathologic mammary secretion underwent galactography and magnetic resonance mammography (MRM). Thirty-five patients aged 16–71 years (average age 46 years) subsequently underwent surgery or diagnostic puncture and the histologic findings were compared with the results of the radiologic examination. Histology revealed papillomas in 16 cases. In 6 of these patients, there was associated malignant degeneration. Malignancy without associated papilloma was observed in 3 cases. Galactography displayed a sensitivity of 94 % and a specificity of 79 % with five false-positive findings and one false-negative finding in the recognition of intraductal papillomas. Malignant processes were detected by mammography/galactography in only one instance. Magnetic resonance mammography visualized pathologic contrast medium uptake in 8 of 9 cases of malignant disease (sensitivity 89 %). One patient with in situ ductal carcinoma escaped detection with MRM. Papillomas showed no or below-the-threshold-lying contrast uptakes with no specific sign suggestive of papilloma. Galactography in combination with mammography remains the primary diagnostic procedure in cases of pathologic mammary secretion or suspected papilloma. The addition of MRI permits exclusion of malignant disease with a high degree of certainty; thus, expectant management in individual cases with negative findings appears justified. Received: 18 November 1999; Revised: 20 March 2000; Accepted: 25 April 2000     

乳腺X线导管造影和染色定位对乳腺疾病的临床价值探讨

目的:探讨乳腺X线导管造影和染色定位的操作摄影技术要求及其X线特征。方法:回顾分析经手术切除和穿刺活检病理证实的60例乳腺疾病的乳腺导管造影和染色定位资料。结果:本组3例穿刺失败,57例导管造影成功,53例导管造影的影像诊断与手术及穿刺活检证实的结果相同。肿瘤性病变10例,非肿瘤性病变47例。38例术前行染色定位,术中使得病灶形态显示更为全面和直观。结论:导管造影和染色定位可对乳腺疾病的诊断、临床术前术中评估及手术方案的制订提供更全面、更有价值的信息。     

乳腺导管造影在溢液乳腺疾病诊断中的应用价值(附70例报告)

目的探讨乳腺导管造影在溢液乳腺疾病诊断中的应用价值。方法回顾性分析70例经手术及病理确诊的乳头溢液乳腺病的X线特点,结合临床及病理特征进行鉴别诊断。结果导管内乳头状瘤45例,导管癌5例,导管扩张症17例,导管增生伴炎症3例。结论乳腺导管造影在导管肿瘤良恶性的鉴别及导管炎性疾病的诊断中有极高的应用价值,可为临床提供准确的诊断和治疗依据。     

Percutaneous drainage of splenic abscesses: an effective and safe procedure.

Percutaneous drainage of splenic abscesses has not yet become a common procedure due to the potential risk of bleeding and the danger of damage to neighbouring organs. We present our experience of percutaneous drainage in eight patients with splenic abscesses. Four patients were treated by therapeutic percutaneous needle aspiration of the fluid collection, and four by percutaneous trocar catheter insertion. All procedures were guided by ultrasound or computed tomography. The procedure was successful in all eight patients with no complications.     

肝外胆管癌X线和超声诊断的探讨

本文归纳了30例肝外胆管癌用PTC、ERCP、术中或术后“T”形管造影的X线征象:完全性阻塞端形态有杯口、截断、钝圆、尖削、不规则等;不完全阻塞端有菜花状、不规则、局限性狭窄等。低张钡餐检查对远段胆道病变,仍不失为简易有效的手段。US对肝内胆管扩张和结石的准确率很高,但胆总管下段病变受到限制。为了合理利用各种检查方法,设计了以US为第一步的筛选程序,在CT尚不普及的情况下是切实可行的。     

钼靶X线对检出早期乳腺癌中广泛的导管内成分的作用

目的　评价钼靶X线对检出广泛的导管内成分 (EIC)的作用 ,为临床治疗提供参考。方法　经钼靶X线检查 ,手术、病理证实的Ⅰ、Ⅱ期乳腺癌 340例 348个病灶 ,包括浸润性导管癌2 97个、导管原位癌伴微浸润 8个、黏液腺癌 2 1个和髓样癌 2 2个。观察钼靶X线表现 ,与病理有无EIC对照。结果　 (1)浸润性乳腺癌EIC阳性较EIC阴性在钼靶X线片上显示钙化病灶的比例高(6 6 4 %、2 0 4 % ,χ2 =75 2 9,P <0 0 0 1)。尤其当表现为单纯钙化时 ,这种差别就更明显 (2 1 1%、2 0 % ,χ2 =5 2 5 6 ,P <0 0 0 1)。 (2 ) 5 4 6 % (10 7个 )的单纯肿块和 19 4 % (38个 )的临床扪及肿块而钼靶X线阴性的较易出现在浸润性乳腺癌EIC阴性中 ,与分别为 2 5 0 % (38个 )和 5 9% (9个 )出现在EIC阳性病例的比较差异有非常显著意义 (两者 χ2 值分别为 30 84和 13 2 9,P值均 <0 0 0 1)。(3)结构扭曲伴或不伴钙化对判断EIC差异无显著意义 (χ2 =1 84 ,P >0 0 5 )。 (4)阳性预测值统计显示 ,单纯钙化和钙化灶最大径≥ 3cm预示着浸润性乳腺癌有 88 9%和 95 8%的可能为EIC阳性 ,肿块伴钙化为 6 7 8%。相反 ,钼靶X线片上显示为钙化颗粒 <10枚或钼靶X线片为阴性 ,而临床扪及肿块时对EIC阴性的阳性预测值分别为 96 6 %和 80 9%     

Thyroglossal duct cyst carcinoma: case report and review of the literature, with emphasis on CT findings

Carcinoma arising in a thyroglossal duct cyst (TDC) is rare. To the best of our knowledge, 155 cases have been reported, 12 of which were studied with CT. The diagnosis is established after surgical excision of the lesion but CT findings may raise the suspicion of malignancy. We present a case of TDC carcinoma and a review of the literature, with emphasis on CT findings. Received: 5 March 1999 Accepted: 20 October 1999     

胆管癌的PTC与T管造影的X线特征

本文分析３０例胆管癌的ＰＴＣ与Ｔ管造影的ｘ线表现：胆管癌的影像特征是病变梗阻部位呈不同程度凹凸不平，边缘不规则及管壁僵硬，肝门胆管或肝、胆总管呈向心性或偏心性狭窄的充盈缺损或左右肝管交汇处漏斗型影像或者其影像为杵状，圆钝或平削状。胰头癌的影像特征是胆总管呈手套手指状扩张征象，且呈挤压性扭曲改变。壶腹癌为胆总管末端呈鸟嘴样改变和不规则充盈缺损。     

Subcutaneous ports in the radiology suite: an effective and safe procedure for care in cancer patients

The purpose of the study is to present our experience and compare the results of the three types of ports used as a central venous access and performed in the radiology suite. Between March 1989 and November 1993 we performed 288 implantations (100 Implantofix Seldinger, 100 plastic Hickman port, and 88 stainless steel Port-a-cath) for chemotherapeutic treatment on the same number of patients diagnosed as having cancer. In all cases access was obtained via a subclavian vein (the left one in 185 cases and the right one in 103). All the system ports were implanted in the radiology suite. In all cases the procedure was successfully performed. Complications occurred in 26.3% of cases, most notably thrombosis in 13 cases (4.5%) and infection in 12 cases (4.1%). Duration of the port systems placement varied between 17 and 1467 days (a mean of 315 days). A total of 133 systems have been removed to date, 80 (60.%) due to termination of chemotherapy, and 53(40%) for treatment of complications. Significant differences (complications and port duration time) were not observed between the three types of reservoir used. Subcutaneous ports are safe, comfortable, and effective devices for central venous access. Correspondence to: M. A. de Gregorio     

乳腺单发乳头状瘤钼靶X线诊断（附42例报告）

目的：提高对乳腺单发乳头状瘤放射学诊断水平。材料与方法：作者回顾分析了４２例经病理证实的乳腺导管内单发乳头状瘤临床表现，钼靶平片及造影片表现。结果：３７例（８８％）有乳头分泌物。９５％（３５／３７）发生于中央大导管。２４％（１０／４２）平片有异常改变。造影表现：５４％（２０／３７）表现导管内充盈缺损，４１％（１５／３７）表现导管完全阻塞，４３％（１６／３７）有导管轻度扩张。结论：乳头溢液为导管内乳     

Bloody nipple discharge caused by an intraductal papilloma of the breast in an adolescent girl: A case report

Bloody nipple discharge in pediatric patients is rare and mostly associated with benign conditions.Despite the generally benign nature, a thorough investigation of the cause and treatment is required if a palpable lesion is present. Here, the author reports a case of bloody nipple discharge in an adolescent girl with no significant medical history. Breast ultrasound demonstrated a solid, oval-shaped, circumscribed mass in the left subareolar region that was categorized as category 4a according to the breast imaging reporting and data system (BI-RADS). An excisional biopsy and histological examination confirmed a diagnosis of intraductal papilloma. While intraductal papilloma is rare in the pediatric population, ultrasound evaluation and knowledge of characteristic findings are useful for noninvasive diagnostics and image-guided treatment planning.     

ERCP、CT、B超对胰胆管下段疾病的诊断准确性

目的 比较ERCP、CT、B超对胰胆管下段疾病的诊断准确性。方法 100例临床表现为梗阻性黄疸，反复上腹痛、恶心呕吐的患均经ERCP、CT及B超检查本组患经手术病理或活检证实为良性病变(胆总管结石)57例，恶性肿瘤31例，其中胆总管癌11例，胰头癌13例，以及壶腹癌8例。上述3种方法术前的定性诊断准确率均与手术病理结果对照。结果 对胆总管结石的定性诊断准确率：ERCP为98％(n=56)，CT为72％(n=41)，B超为61％(n=35)；对恶性肿瘤的定性诊断准确率：ERCP为97％(n=31)，CT为78％(n=25)，B超为63％(n=20）。结论 ERCP对胰胆管下段良恶性病变的定性诊断准确率明显高于CT和B超，但因CT与B超均属无创性操作且对某些恶性肿瘤也有较高的定性诊断准确率，因此在影像诊断中应考虑3项技术优势互补。     

乳腺导管原位癌的钼靶X线表现与病理对照研究

目的 分析乳腺导管原位癌（DCIS）的钼靶X线表现，并分析其与病理亚型间的相关性，为临床选择治疗方法提供参考。方法 经手术、病理证实的乳腺导管原位癌21例和原位癌伴微浸润8例，观察钼靶X线表现，并与病理分型、分级对照。结果 （1）单纯簇状微钙化表现20例， 经伴块影3例，单纯软组织块影表现4例，乳头内陷伴乳头后大导管增粗和钼靶表现阴性各1例。（2）23例钙化表现者，分布呈V形7例、圆形8例，、不规则形5例、某一象限内多个分散分布的小簇状钙化3例。（3）从乳头向深部的长条状肿块1例、圆形肿块3例。（4）线样分支状钙化易出现在粉刺型（7／9）高核级（6／9）DCIS中；颗粒点状钙化易出现在非粉刺型（11／12）低核级（11／12）DCIS中。2组差异有非常显著性意义，P＝0.002和P＝0.009（x^2检验，Fisher‘s精确算法）。结论 DCIS的钼靶X线表现有一定特征，与基于分子生物改变为基础的病理分型、分级密切相关，在一定程度上可为临床治疗方法的选择提供参考。     

Subarcuate artery and canal: an important anatomic variant

An aberrant subarcuate artery and its related canal are rare. The presence of this variation has a surgical significance, that is, risk of hemorrhage, if accidentally nicked. It is therefore important to be aware of this entity, and its relative anatomy, to avoid any untoward complication. We present a case of a 29-year-old man who presented with hearing loss after trauma. High-resolution computed tomographic scan of the temporal bone demonstrated an enlarged subarcuate canal.     

Conventional galactography and MR contrast galactography for diagnosing nipple discharge: preliminary results

OBJECTIVE: We wanted to compare the clinical usefulness of conventional galactography and MR contrast galactography for diagnosing patients with nipple discharge. MATERIALS AND METHODS: Both conventional galactography and MR contrast galactography were performed prospectively in 16 patients. Gadopentate dimeglumine (0.1 ml) was mixed with non-ionic contrast medium (0.9 ml) to obtain a resultant volume of 1 ml and this was used for both examinations. Following conventional galactography, MR contrast galactography was performed after direct injection of contrast media into the duct. RESULTS: Conventional galactography and MR contrast galactography were concordant in 13 (81%) of 16 patients; the results were normal in five, ductal dilatation was noted in four and intraductal filling defects were noted in four. The remaining three (19%) patients demonstrated discordant findings on the two examinations. While conventional galactography revealed filling defects, the MR contrast galactography results were normal in two patients. The third patient had kinks-stricture on conventional galactography and MR contrast galactography showed ductal dilatation. This suggested there were false positive results for the three patients' conventional galactography, and all the three patients with discordant results underwent surgery and the histopathologic evaluation showed fibrocystic changes. CONCLUSION: MR contrast galactography may be used as an alternative imaging modality for making the diagnosis of pathologic nipple discharge. However, statistically supported studies with large pools of subjects for comparing the galactography and MR contrast galactography results are needed to confirm our findings.     

放射性粒子植入的生物有效剂量计算及其临床应用

目的 建立计算放射性粒子植入治疗生物有效剂量（BED）和2 Gy分割生物等效剂量（EQD2）的模型。方法 引入根据L-Q模型建立的外照射BED计算公式和持续低剂量照射BED计算公式。结合BED公式,根据EQD2的定义,建立持续低剂量率照射（放射性粒子植入治疗）的EQD2计算公式。总结常见组织的α/β值和见于文献报道正常组织的T_r1/2值,利用实际值,进一步简化EDQ2计算公式,提出早反应组织和晚反应组织的EDQ2计算经验公式,并命名为王-彭经验公式。对于早反应组织,EQD2≈10D/12（王-彭公式 1）;对于晚反应组织,EQD2≈D/2（王-彭公式 2）。进一步举例说明本文所建立公式在临床上的应用,包括原发性肺癌、食管癌锁骨上淋巴结转移和宫颈癌腹膜后淋巴结转移。结果 根据王-彭经验公式,肿瘤临近的晚反应组织的EQD2仅约为肿瘤组织受量的一半,故而放射性粒子植入治疗"天然地"从生物等效剂量上对晚反应的组织进行了保护。通过实际计算,发现早反应组织的经验公式较为精确,而晚反应组织的经验公式精确度略差,只能做粗略估计。结论 本研究引入的BED计算公式和据此建立的一系列EQD2计算公式以及王-彭经验公式,在理论上可行,可用于放射性粒子植入治疗的物理剂量与外照射剂量之间的换算和叠加。但是使用公式时应谨慎,注意预设条件,慎重解读计算得出的结果。     

Choroid plexus papilloma of the third ventricle: angiography, preoperative embolization, and histology

We report a unique case of choroid plexus papilloma of the third ventricle in an 8-month-old girl in which preoperative embolization played a salient role in management. Initial surgery was aborted due to excessive bleeding. Cerebral angiography demonstrated enlarged posterior choroidal arteries feeding the tumor, and intense, persistent tumor staining. These vessels were effectively embolized to stasis with polyvinyl alcohol particles. The patient underwent a second craniotomy and complete resection of the tumor with minimal blood loss. Postsurgical histology showed postembolization iatrogenic intratumoral necrosis. Received: 17 July 2000 Accepted: 25 September 2000