3D动脉自旋标记、弥散张量成像联合常规MRI鉴别诊断颅内血管外皮细胞瘤与血管瘤型脑膜瘤

目的 观察3D动脉自旋标记（3D ASL）、弥散张量成像（DTI）联合常规MRI鉴别诊断颅内血管外皮细胞瘤（HPC）与血管瘤型脑膜瘤（AM）的价值。方法 回顾性分析经手术病理证实的15例HPC（HPC组）与11例AM（AM组），分析2组临床表现、MRI（包括平扫、增强、DTI、3D ASL）征象及功能成像参数差异。结果 HPC组平均脑血流量（CBF）及各向异性分数（FA）均低于AM组（t=-8.99，P<0.01；t=-3.66，P<0.01），表观弥散系数（ADC）高于AM组（t=2.61，P=0.02）；HPC组高灌注区和低灌注区CBF均低于AM组（t=-15.13，P<0.01；t=-8.30，P<0.01）；HPC组平均发病年龄低于AM组（t=-2.39，P=0.02），性别差异无统计学意义（χ²=1.69，P=0.19）；相比AM组，HPC组更易出现分叶征（χ²=9.09，P<0.01）及囊变坏死（χ²=9.38，P<0.01），HPC病灶T1WI以等高信号为主（χ²=27.78，P<0.01）、T2WI以等低信号为主（χ²=16.33，P<0.01），瘤周水肿程度轻（χ²=19.25，P<0.01），血管流空影更常见且更粗大（χ²=9.02，P=0.01），多与硬脑膜多为窄基底相连（χ²=28.54，P<0.01）而脑膜尾征少见（χ²=25.00，P<0.01）。结论 HPC与AM的MRI征象及各功能成像参数值存在一定差异，可为鉴别诊断提供参考。     

胰腺腺鳞癌与导管腺癌的影像特点及病理对照分

目的 分析总结胰腺腺鳞癌（adenosquamous carcinoma ASqC）的CT、MRI表现及病理特点，并与胰腺导管腺癌(Invasive ductal adenocarcinoma of pancreas，IDAC)进行对照，探讨其影像及病理的特征。方法 回顾性分析经手术病理证实胰腺ASqC 11例、IDAC 22例的CT、MRI影像及病理资料，将ASqC组的性别、年龄、术前CA199；病理中神经束受侵、淋巴结转移、脉管癌栓、ki67%、胰腺切缘受累情况；影像资料的位置、大小、形态、坏死、出血、钙化及CT、MR表现与导管腺癌组进行对照分析。结果 ASqC与IDAC两组在病变大小、形态、坏死、强化程度（期）、脉管癌栓、胰腺切缘受累情况方面差异显著，差异性有统计学意义（P〈0.05）。与IDAC相比，ASqC直径较大（53.86±23.28mm VS.28.38±9.12mm），直径大于30mm个数百分比为（81.82%VS.31.82%）；呈类圆分叶状较多（63.64%VS.18.18%），广泛的中央坏死明显（91%VS.31.82%）； 强化程度（期）延时期较明显（75%VS.27.27%）；脉管癌栓多见（45.45%VS.9.09%）。结论：ACqC多为类圆形或分叶状，体积较大并具有广泛的中央坏死区，弥散受限更明显；病变癌栓发生率较高，这些特征可以为ASqC的诊断提供参考。     

不同影像学检查方法对原发性甲状旁腺功能亢进症患者甲状旁腺病灶的定位诊断价值

目的 探讨不同影像学检查方法对原发性甲状旁腺功能亢进症（PHPT）的诊断价值。方法 回顾性分析经病理学检查证实的109例PHPT患者的临床资料,将其超声、MRI、CT、⁹⁹Tc^m-MIBI检查定位诊断结果与手术后病理学结果比较分析。结果 109例PHPT中,甲状旁腺癌11例（11/109,10.09%）,增生16例（16/109,14.67%）,甲状旁腺瘤82例（82/109,75.23%）,包括单发病灶74例（74/109,67.89%）,双侧腺瘤8例（8/109,7.34%）。腺瘤、增生、腺癌组病灶发生部位的差异有统计学意义（χ²=36.151,P<0.001）。⁹⁹Tc^m-MIBI、MRI、CT、超声术前检查定位的准确率分别为83.50%（81/97）、72.22%（13/18）、68.51%（37/54）、67.67%（67/99）,差异无统计学意义（χ²=4.826,P=0.185）;超声明显低于⁹⁹Tc^m-MIBI检查（χ²=6.638, P=0.001）,CT明显低于⁹⁹Tc^m-MIBI检查（χ²=4.562,P=0.033）,CT与MRI的定位诊断准确率差异无统计学意义（χ²=1.153,P=0.283）。对于术后病理诊断直径<1 cm的病变,⁹⁹Tc^m-MIBI、超声、CT、MRI术前检查定位的准确率分别为77.27%（17/22）、35.00%（7/20）、61.53%（8/13）、66.67%（2/3）,差异有统计学意义（χ²=7.881,P=0.049）,⁹⁹Tc^m-MIBI的定位准确率高于超声（χ²=7.664,P=0.006）,但与CT、MRI的差异无统计学意义（χ²=2.154,P=0.175）。结论 对PHPT进行定位诊断时,超声仍是首选检查,⁹⁹Tc^m-MIBI双时相显像的诊断价值最高。     

磨玻璃密度肺腺癌内血管异常CT表现与病理亚型及磨玻璃分型的相关性

目的 分析磨玻璃密度（GGO）肺腺癌血管异常CT表现与病理亚型及磨玻璃分型的相关性。方法 收集经手术病理证实的50例GGO密度肺腺癌患者的影像学及病理资料,观察病灶内血管的走行及其异常表现（增粗、增多）,分析血管异常表现与病灶的病理亚型及磨玻璃分型的相关性。结果 共55个GGO肺腺癌病灶,浸润前病变5个,均无血管增粗,1个原位癌病灶仅出现血管增多;微浸润腺癌（MIA）16个,11个出现血管增粗,16个血管增多;浸润腺癌（IAC）34个,均有血管增粗及增多。浸润前病变、MIA、IAC 3个病理亚型血管增粗、血管增多的整体差异均有统计学意义（χ²=27.67、20.08,P均<0.05）,且病理亚型与血管增粗和血管增多均存在相关性（r=0.61、0.66,P均<0.01）。两两比较,浸润前病变、MIA、IAC血管增粗差异均有统计学意义（浸润前病变与MIA：χ²=9.19,P=0.01;浸润前病变与IAC：χ²=29.87,P<0.01;MIA与IAC：χ²=12.63,P<0.01）。两两比较,浸润前病变与MIA、浸润前病变与IAC血管增多差异均有统计学意义（χ²=15.45、20.79,P均<0.01）。55个GGO肺腺癌病灶中,25个为纯GGO（pGGO）,出现血管增粗17个,血管增多21个;30个为混杂GGO（mGGO）,出现血管增粗28个,血管增多30个。pGGO和mGGO肺腺癌血管增粗和血管增多的差异均有统计学意义（χ²=6.12、6.69,P均<0.05）。结论 GGO肺腺癌血管增粗及增多提示病变浸润性增加,血管增粗及增多均可单独出现。     

磁共振扩散张量成像鉴别诊断肝内胆管细胞癌与肝细胞癌

目的 探讨磁共振扩散张量成像（DTI）鉴别肝内胆管细胞癌（ICC）和肝细胞癌（HCC）的价值。方法 回顾性分析在我院接受肝脏MR检查并经病理证实的ICC 20例（ICC组）、HCC 32例（HCC组）。所有患者均接受1.5T MRI常规T1WI、T2WI、DWI及DTI序列扫描,观察病变影像学特征。由2名观察者独立测量两组病灶DTI的弥散系数（D）值、各向异性分数（FA）值及DWI的ADC值,分析其测量的一致性并进行组间比较。对有统计学差异的参数,绘制ROC曲线,分析诊断效能及阈值。结果 ICC组9例（9/20,45.00%）病灶边界清晰,HCC组15例（15/32,46.88%）边界清晰,差异无统计学意义（χ²=0.02,P=0.90）。ICC组11例（11/20,55.00%）可见邻近胆管扩张,高于HCC组（4/32,12.50%）,差异有统计学意义（χ²=10.83,P=0.001）。2名观察者测得的2组各参数结果一致性良好,相关系数值均大于0.90。ICC组FA值（0.45±0.16）高于HCC组（0.30±0.13）,差异有统计学意义（P=0.001）;2组的ADC值和D值差异均无统计学意义（P均>0.05）。FA值ROC曲线下面积为0.76,在界值为0.31时,鉴别诊断ICC与HCC的敏感度（85.0%）较高。结论 DTI的FA值对鉴别ICC与HCC有较高的诊断效能,可以为临床提供重要参考。     

对比观察炎性肺癌与渗出为主型肺结核CT表现

目的 对比观察炎性肺癌与渗出为主型肺结核的CT表现。方法 回顾性分析84例炎性肺癌（肺癌组）和93例渗出为主型肺结核（结核组），比较2组病变CT表现（实变数目、单发实变分布、实变影密度、实变影内充气支气管征和含气腔隙、实变影周围磨玻璃密度（GGO）、伴随结节影、胸腔积液及纵隔淋巴结是否肿大及钙化）的差异。结果 2组实变数目差异无统计学意义（χ²=0.30，P>0.05）。结核组单发实变影双肺分布大致相同，以上叶多见；肺癌组中以右肺及下叶多见。2组充气支气管征发生率差异无统计学意义（χ²=0.33，P>0.05）；肺癌组以枯枝型多见，结核组以青枝型多见（χ²=24.67，P<0.05）。结核组实变影中含气腔隙发生率高于肺癌组（χ²=10.13，P<0.05），含气腔隙内分隔多见于肺癌组（χ²=22.42，P<0.05）。相比结核组，肺癌组病灶密度多不均匀，GGO多见（χ²=5.27，20.43，P均<0.05）而伴随结节影少见（χ²=4.53，P<0.05）。结论 炎性肺癌与渗出为主型肺结核CT表现存在一定差异；实变影密度不均伴枯枝型充气支气管征及有分隔的含气腔隙、同时存在GGO时，需高度警惕炎性肺癌。     

MR脂肪抑制T2WI联合弥散加权成像与增强MRI鉴别乳腺黏液癌与黏液样纤维腺瘤

目的 对比观察MR脂肪抑制（FS）-T2WI （FS-T2WI）联合弥散加权成像（DWI）与增强MRI鉴别乳腺黏液癌（MBC）与乳腺黏液样纤维腺瘤（MFA）的价值。方法 回顾性分析经术后病理证实的14例MBC （MBC组）与22例乳腺MFA （MFA组）,比较组间FS-T2WI信号强度（SI）指数、DWI-表观弥散系数（ADC）、强化特点及时间信号强度曲线（TIC）等MRI表现差异。针对FS-T2WI联合DWI及增强MRI参数以二元logistic回归分析拟合回归方程,绘制受试者工作特征（ROC）曲线,计算曲线下面积（AUC）,评估2种回归方程鉴别MBC与乳腺MFA的效能。结果 组间FS-T2WI信号SI指数（Z=3.780,P<0.001）、DWI-ADC （t=4.230,P<0.001）、强化均匀与否（P=0.006）、早期强化方式（P<0.001）、强化填充方式（P<0.001）及TIC类型（P=0.001）差异均有统计学意义,延迟期强化方式差异无统计学意义（P=0.062）。基于FS-T2WI联合DWI参数建立回归方程如下：Logit （P）=－10.434+0.003×ADC+0.748×FS-T2WI SI指数;基于增强MRI参数建立回归方程Logit （P）=31.666+0.287×强化均匀与否-18.319×早期强化方式+19.945×强化填充方式-36.591×延迟期强化方式+20.225×TIC类型。上述2个回归方程鉴别MBC与乳腺MFA的AUC （Z=1.890,P=0.059）、敏感度（χ²=1.050,P=0.305）、特异度（χ²=1.100,P=0.294）和准确率（χ²=0.660,P=0.416）差异均无统计学意义。结论 FS-T2WI联合DWI可鉴别诊断MBC与乳腺MFA,其诊断效能与增强MRI相当。     

MRI鉴别诊断乳腺髓样癌与纤维腺瘤

目的 探讨MRI在乳腺髓样癌与纤维腺瘤鉴别诊断中的价值。方法 回顾性分析经病理证实的11例乳腺髓样癌（髓样癌组）及36例乳腺纤维腺瘤（纤维腺瘤组）资料,分析并比较2组MRI特征。结果 髓样癌组患者年龄大于纤维腺瘤组（t=2.791,P=0.008）。2组间病灶最大径、病灶内部强化特征、坏死及囊变征象、平扫T2WI病灶信号强度、DWI病灶信号强度及时间-信号强度曲线（TIC）类型差异均有统计学意义（P均< 0.05）,而病灶数目、形态、边缘差异均无统计学意义（P均> 0.05）。结论 MRI特征有助于鉴别诊断乳腺髓样癌与纤维腺瘤。     

胸腺瘤的MRI表现

目的 分析胸腺瘤的MRI表现。方法 收集经病理证实并有完整影像学资料的29例胸腺瘤患者,分析平扫、DWI及增强扫描MRI表现,并根据病理结果分为低危组（n=18）和高危组（n=11）,分析其影像学表现的差异。结果 肿瘤均为单发,28例病灶位于前纵隔,1例位于左锁骨上窝;21例肿瘤形态不规则,21例与邻近结构分界清楚。24例病灶T2WI呈高/稍高信号;20例T1WI呈低—中等信号;9例病变内有囊变坏死,7例可见分隔,1例可见液平;全部病灶DWI呈均匀或混杂信号。9例病灶增强扫描轻度强化,11例中度强化,9例明显强化。低危组与高危组ADC值差异无统计学意义（P=0.42）。结论 胸腺瘤常规MRI及DWI表现有一定特征性,有助于术前诊断胸腺瘤。     

MRI鉴别诊断表现为磨玻璃结节的早期浸润性肺腺癌

目的 探讨MRI鉴别诊断表现为磨玻璃结节的早期浸润性肺腺癌的价值。方法 回顾性分析34例表现为肺部磨玻璃结节的肺腺癌患者的MRI资料,根据病理结果将其分为非浸润性腺癌组（包括不典型腺瘤样增生、原位腺癌和微浸润性腺癌,n=15）和浸润性腺癌组（n=19）。测量并比较2组病变的最大径、T2WI信号强度和ADC值,绘制ROC曲线,评价其鉴别诊断浸润性腺癌的效能。结果 非浸润性腺癌组病变最大径小于浸润性腺癌组[（9.91±2.63）mm vs（13.12±2.71）mm,P<0.01]。非浸润性腺癌组病变T2WI信号强度低于浸润性腺癌组（92.97±8.33 vs 113.57±22.88,P<0.01）。非浸润性腺癌组病变ADC值低于浸润性腺癌组[（0.98±0.22）×10^-3 mm²/s vs（1.34±0.31）×10^-3 mm²/s,P=0.01]。ROC曲线分析结果显示,病变最大径诊断浸润性腺癌与非浸润性腺癌的AUC为0.791,临界值为11.52 mm,敏感度为73.72%,特异度为73.33%。结论 病变最大径、T2WI信号强度、ADC值对鉴别诊断表现为磨玻璃结节的浸润性与非浸润性肺腺癌具有一定价值。     

Duplex ventral pancreas

Complete duplication of the ventral pancreatic ductal system in 2 patients is reported. Both patients, during evaluation for recurrent abdominal pain, underwent endoscopic retrograde cholangiopancreatography that revealed typical changes of chronic pancreatitis and pseudocysts confined to 1 ductal system with the other ductal system completely normal. Both ductal systems filled with contrast medium via a common opening at the major papilla. A rudimentary minor papilla was present, but cannulations were unsuccessful. This unusual anomaly of the ventral pancreas with its embryologic basis, diagnosis, and clinical implications is discussed.     

Lymphoepithelial cyst of the pancreas

Lymphoepithelial cyst of the pancreas is a rare lesion which may mimic a pancreatic pseudocyst or mucinous cystic neoplasm. To our knowledge, this lesion has never been reported in the radiologic literature. We present a patient with lymphoepithelial cyst of the pancreas, and we discuss the radiographic and pathologic findings.     

Agenesis and pseudo-agenesis of the dorsal pancreas

Agenesis of the dorsal pancreatic anlage is a very unusual congenital anomaly. The case reported appears to be accompanied by hypertrophy of the ventral gland. Atrophy of the pancreas following an episode of acute pancreatitis is also very unusual. When the atrophy spares the uncinate process, it may also resemble agenesis of the dorsal gland.     

Cystic central necrosis of transplanted pancreas

The computed tomographic (CT) findings in pancreas transplant rejection have been reported to include graft swelling and inhomogeneity. We report a patient with transplant rejection in whom the preoperative CT examination and specimen radiographs revealed large cystic structures within the pancreas. Cystic central necrosis has previously been reported in patients with pancreatitis, but here it is associated with transplant rejection.     

Intraductal papillary carcinoma of the pancreas

We report a case of intraductal papillary adenocarcinoma of the distal pancreatic duct. Although a rare subgroup of exocrine pancreatic tumors, their diagnosis is an important one in view of their favorable prognosis with pancreatectomy. Because of the established behavior of villous tumors of the colon, to which they are similar histologically, these tumors should be resected, even if biopsy shows benign disease. Patients should be followed radiologically for recurrence or the development of new adenoma following resection.     

Ectopic pancreas: Usual and unusual features

Nine patients with ectopic pancreas in the stomach (8 patients) and duodenum (1 patient) were studied both radiographically and endoscopically. Correct diagnosis was made by radiography in six cases and by endoscopy in seven cases. Masses radiographically larger than 3 cm in diameter were seen in three patients. The incorrect radiographic diagnoses were related to the presence of a large mass in one patient and to the complications of severe bleeding and gastric outlet obstruction in the other two. Endoscopy and radiography are complementary modalities in the diagnosis of ectopic pancreas.     

Transection of the pancreas demonstrated by ultrasound and computed tomography

The early occurrence of peritoneal signs and hyperamylasemia in a 14-year-old boy, who had fallen off his horse, urged us to perform a sonographic and computed tomographic study of the upper abdomen. Both examinations showed a complete pancreatic rupture. Distal pancreatectomy led to a rapid and uneventful recovery.     

胰腺浆液性囊腺瘤MSCT表现与病理特征

目的:探讨胰腺浆液性囊腺瘤MSCT表现和病理特征。方法:回顾性分析经手术及病理证实的43例胰腺浆液性囊腺瘤的MSCT表现,观察病灶部位、大小、囊腔类型、中央瘢痕、钙化及强化特点等。结果:43例胰腺浆液性囊腺瘤中,浆液性微囊型囊腺瘤34例,浆液性寡囊型囊腺瘤9例。34例浆液性微囊型囊腺瘤的囊直径平均为(4.2±0.5)cm,其中多囊蜂窝型29例,囊内见多发厚薄不均的蜂窝状分隔,其囊隔厚度为0.03~0.2 cm;多囊海绵型5例,瘤内呈海绵状囊实混杂密度,囊隔显示不清。34例微囊型囊腺瘤内有中央星芒状纤维瘢痕14例,放射状或砂砾状和囊壁上斑点状钙化14例,上游胰管扩张4例。9例浆液性寡囊型囊腺瘤中单囊型4例,呈圆形或卵圆形,囊直径平均为(3.1±3)cm;多囊型5例,边缘呈分叶状,由数个小囊构成,囊壁薄而光滑、均匀,其囊壁厚度<0.1 cm。增强扫描表现:微囊型囊腺瘤中囊内分隔、中央星芒状纤维瘢痕及实性成分多呈轻中度强化,囊内分隔及实性成分越多,强化越明显,中央纤维瘢痕多呈延迟强化;寡囊型囊腺瘤囊内无强化,仅囊壁、囊隔呈轻度强化。结论:胰腺浆液性囊腺瘤CT表现具有一定特征性。微囊型囊腺瘤CT平扫呈蜂窝状或海绵状,瘤中央见星芒状纤维瘢痕及放射状钙化,增强扫描见囊壁、分隔及实性部分呈轻中度或显著强化,中央纤维瘢痕呈延迟强化;寡囊型囊腺瘤由单个或数个大囊组成,无中央纤维瘢痕及钙化,增强扫描见囊壁、囊隔呈轻度强化。     

Magnetic resonance imaging of the pancreas with gadolinium-DTPA

Gadolinium (Gd)-DTPA was evaluated as a contrast agent for magnetic resonance (MR) imaging of the pancreas at 1.5T. Twenty-five patients were imaged with identical gradient-echo (GE) (TR 47, TE 13, 80° pulse angle) and spinecho (SE) (TR 300, TE 15) MR sequences prior to and following an intravenous bolus of 0.1 mmol/kg Gd-DTPA. Marked pancreatic enhancement was demonstrated on dynamic sequential breath-hold GE images obtained immediately following the Gd-DTPA bolus (116% mean enhancement over pre-Gd-DTPA images). Enhancement decreased but persisted on the SE images obtained approximately 5 and 15 min following the Gd-DTPA bolus (65 and 60% mean enhancement, respectively). Five of the patients had a pancreatic mass. In these five patients, the enhancement of pancreatic tissue resulted in improved conspicuity of the mass. These initial results suggest that pancreatic enhancement occurs following an intravenous bolus of Gd-DTPA and has the potential to improve MR visualization of pancreatic masses.     

Cystic tumors of the pancreas: Evaluation by ultrasonography and computed tomography

The personal series of 30 cystic tumors of the pancreas [12 serous cystic tumors (SCT) and 18 mucinous cystic tumors (MCT)] is presented. All neoplasms were evaluated with ultrasonography (US) 28 of 30 with computed tomography (CT); the tumoral histotype could be correctly defined in 73% of cases (seven of 12 SCT and 15 of 18 MCT). Percutaneous fine-needle aspiration (FNA) with diagnostic aims (preparation of cytological smears and/or biochemical assays) was performed in only 10 of 30 cases, yielding a 100% sensitivity; on the whole, the combined use of imaging modalities and FNA allowed correct characterization of the cystic tumors in 27 of 30 cases (90%). The usefulness of a precise diagnostic workup of these neoplasms is emphasized, due to their prognostic and therapeutic outcome.