肺内淋巴结的多层螺旋CT特征分析

目的 探讨肺内淋巴结的多层螺旋CT影像特征。方法 回顾性分析2014年1月—2017年6月经手术及病理检查确诊的15例肺内淋巴结患者的影像与临床资料。其中男6例,女9例;年龄38～69(55.6±10.03)岁。15例患者均行肺低剂量CT平扫及肺结节高分辨CT扫描,其中3例同时行增强检查。观察肺内淋巴结的位置、数目、大小、影像学特点及伴随病变。结果 15例多层螺旋CT检查共发现19枚肺内淋巴结,直径4～10(5.53±1.50)mm。14枚肺内淋巴结位于右肺,其中右上叶1枚,中叶5枚,下叶8枚;5枚肺内淋巴结位于左肺,均在下叶。15枚肺内淋巴结发生在肺外带或叶间胸膜附近,病灶距离相邻胸膜的垂直距离3～16 mm,平均9 mm;4枚紧贴胸膜下。17枚边界清晰、锐利,2枚部分边缘毛糙。17枚密度均匀,2枚密度不均,但未见钙化或囊变。轴位图像上11枚肺内淋巴结呈类圆形,2枚呈三角形,6枚呈不规则形。12枚肺内淋巴结在轴位或冠矢状面重建图像上可见一条或多条均匀致密线状影与病灶相连。3例3枚淋巴结CT增强扫描,2枚无明显强化,1枚表现为渐进性强化。4例同时伴发同侧原发肺癌。结论 肺内淋巴结的多层螺旋CT表现有一定的特征性,熟悉这些表现特点,多数可在术前做出明确诊断。     

Dry small pleural dissemination of adenocarcinoma of the lung preoperatively detected by PET/CT: a report of two cases

Dry pleural dissemination in non-small cell lung cancer, defined as solid pleural metastasis of lung cancer without pleural effusion, is a condition occurring in T4 lung cancer. Positron emission tomography (PET) has been reported to be useful for the diagnosis and staging of lung cancer. It has been reported that positive findings on PET scans of indeterminate pleural abnormalities at computed tomography (CT) are sensitive to malignancy. We encountered two cases of dry small pleural dissemination of adenocarcinoma of the lung preoperatively detected by PET/CT. A 75-year-old man and a 66-year-old man underwent CT scan, which demonstrated solitary tumor in the lung, an enlarged mediastinal lymph node, and a small pleural nodule less than 10 mm in size, all of which were positive findings on the fluorine 18 fluorodeoxyglucose (FDG) PET portion of an integrated PET/CT. Both patients underwent thoracoscopic biopsy of the dry pleural nodule revealing dissemination of adenocarcinoma of the lung (T4). Whereas histological thoracoscopic diagnosis remains mandatory before planning treatment, our cases may suggest that PET/CT will be useful as a screening modality for dry pleural dissemination of lung cancer.     

Inguinal lymph nodes: size,number, and other characteristics in asymptomatic patients by CT

Purpose

The purpose of this study was to establish normative data for the CT appearance of inguinal lymph nodes.

Materials and methods

After Institutional Review Board approval, search of the radiology information system identified 500 consecutive CT examinations of the pelvis. Patients were included if no lower extremity or perineum pathology, or history of malignancy at the time of CT examination, and a clinical note documenting no tumor at least 2 years after the CT. The final study group was 77 patients. CT examinations were retrospectively reviewed and bilateral inguinal lymph nodes were characterized by size (short axis and largest size in general), number, and presence of fat attenuation.

Results

The mean short-axis inguinal lymph node size was 5.4 mm (range 2.1–13.6 mm), measured at 8.8 mm two standard deviations above the mean. The mean number of superficial and deep inguinal lymph nodes was 10.7 (range 3–18) and 1.2 per patient (range 1–2), respectively. Superficial and deep inguinal nodes showed internal fat attenuation in 85 and 78 % of nodes, and were oval in shape in 95 and 78 %, respectively.

Conclusion

Inguinal lymph nodes in asymptomatic patients have a mean short axis of 5.4 mm, a short axis of 8.8 mm at two standard deviations above the mean, and are multiple and symmetric in size and number (4–20 per patient). Normal inguinal lymph nodes were commonly oval in shape and contained fat, although such findings may be absent in smaller lymph nodes.     

Focal organizing pneumonia: CT and pathologic findings

The purpose of this study was to describe the CT findings of focal organizing pneumonia and to compare the findings with pathology. CT findings of histologically proven focal organizing pneumonias in 26 consecutive patients were analyzed. In 17 patients who had undergone surgical resections, the findings were correlated with pathology. Focal organizing pneumonias appeared as a nodule (n= 13) or a mass (n=13), ranging from 9 mm to 66 mm in diameter. Ground-glass opacity was seen in 6/13 (46%) nodules and 6.5/13 (50%) masses (k=.48) with an extent ranging from 5% to 75% (mean, 16%). In 4/26 (15%) patients, the extent was more than 50% of the lesion. They showed smooth (n=4), lobulated (n=8), spiculated (n=1), or lobulated and spiculated margin (n=13). On correlative analysis, nodule or mass on CT consisted histologically of intraalveolar exudate or microabscess, chronic inflammatory cell infiltration, fibrotic nodules, and polypoid granulation tissue in the alveolar or bronchiolar spaces. Ground-glass opacity consisted of interstitial fibrosis and chronic inflammatory cell infiltration and intraalveolar polypoid granulation tissue. Focal organizing pneumonia may simulate a lung cancer with variable appearances on CT and the findings reflect underlying histopathology of the disease.     

抗中性粒细胞胞浆抗体相关性血管炎的胸部CT表现

目的:探讨抗中性粒细胞胞浆抗体(antineutrophil cytoplasmic antibodies,ANCA)相关性血管炎(ANCA-associated small vessel vasculitis,AASV)的胸部CT表现.方法:回顾性分析2012年1月至2016年12月在苏州大学附属第一医院经血清学确诊的25例AASV患者的胸部CT表现.结果:25例患者中,男11例,女14例,年龄32～79岁(平均62)岁,其中胞浆型抗中性粒细胞胞浆抗体(cytoplasm antineutrophil cytoplasmic antibodies,c-ANCA)阳性5例,核周型抗中性粒细胞胞浆抗体(peripheral antineutrophil cytoplasmic antibodies,p-ANCA)阳性20例.胸部CT主要表现为间质性肺炎19例,斑片状磨玻璃影10例,结节及肿块7例,胸膜增厚5例,肺气肿肺大疱4例,支气管扩张4例,支气管充气征3例,空洞3例,胸腔积液3例,蜂窝肺1例,纵膈淋巴结肿大1例.在主要的3个影像学表现中,p-ANCA阳性患者中间质性肺炎的比例较高,较c-ANCA阳性患者而言,差异具有统计学意义(P<0.05),而斑片状磨玻璃影、结节及肿块两者比较差异并无统计学意义(P>0.05).结论:AASV患者胸部CT表现多样,以间质性肺炎、斑片状磨玻璃影、结节及肿块为主,p-ANCA阳性患者更易合并间质性肺炎.     

肝内周围型胆管细胞癌的CT影像分析

目的回顾分析经病理证实的肝内周围型胆管细胞癌的CT影像表现,以提高术前诊断准确率。方法本组17例病例采用PQ-2000S单排螺旋CT平扫及三期增强扫描。结果CT平扫显示肿块呈不规则形态（13例）或类圆形（4例）,58.8%患者病灶呈低或稍低密度。增强扫描动脉期病灶无明显强化或边缘轻-中度强化,门静脉期及延迟扫描病灶强化逐渐明显,部分病例有逐渐填充趋势;肿块多合并肝内胆管扩张、肝门淋巴结肿大、附近肝叶萎缩等间接征象。结论肝内周围型胆管细胞癌CT扫描有较特征性影像表现,结合AFP等检查可与肝细胞癌和肝血管瘤等肝内其他占位病变相鉴别。     

CT在甲状腺肿瘤鉴别诊断中的应用价值

目的探讨CT在甲状腺良恶性肿瘤诊断及鉴别诊断中的价值。方法经手术后组织病理学证实的39例良恶性甲状腺肿瘤患者,其中男性17例,女性22例,年龄33～78岁,平均年龄45．6岁。行颈部CT平扫8例．增强扫描31例。分析其良恶性甲状腺肿瘤的CT表现,并进行统计学处理。结果7例甲状腺腺瘤平扫时边界清晰．内部主体低密度且密度均匀;3例可见到完整或不完整的囊壁。4例结节性甲状腺肿局限型,低密度影。25例恶性甲状腺肿瘤平扫时成等密度或混杂密度,边界不清,增强扫描强化不均,并向邻近组织侵犯。结论有无对周围组织的浸润、包膜是否完整、边界是否清晰、轮廓是否规则、密度均匀与否及颈部淋巴结有无肿大等特点,对鉴别甲状腺肿瘤良恶性有很大作用。CT在甲状腺肿瘤的诊断和鉴别诊断中具有重要作用。     

肺纤毛黏液结节性乳头状肿瘤的高分辨CT影像表现

目的 探讨肺纤毛黏液结节性乳头状肿瘤(CMPT)的高分辨CT表现特点。方法 回顾分析2017年1月—2020年12月烟台山医院经手术病理证实的6例CMPT患者的临床、影像及病理学资料,其中男1例、女5例,年龄59～74(66.8±4.5)岁。6例患者均行肺低剂量CT及肺结节高分辨CT扫描。观察肿瘤的大小、位置、内部特征、病理特点以及肿瘤边缘距离最近脏层胸膜的距离。结果 6例CMPT患者肺部病灶均为孤立结节,肿瘤的最大径为4～11(7.7±2.4)mm。肿瘤位于左肺下叶3例、右肺下叶2例、右肺上叶1例,位于肺外带5例、叶间胸膜附近1例。肿瘤边缘距离邻近胸膜的最小距离为0～7 mm,平均3.7 mm。1例为实性结节,有分叶,密度不均匀,肿瘤内见斑片状低密度灶。5例表现为混合磨玻璃结节,其中1例瘤体边缘光整呈类圆形、密度均匀,4例形态不规则、瘤体边缘毛糙、病灶内可见斑片状低密度灶;2例肿瘤内见“空泡征”。病理检查显示,镜下肿瘤内均见大量黏液,并向相邻肺泡腔内不规则突出。结论 CMPT常表现为发生于周围肺的单发实性或磨玻璃结节,生长缓慢;肿瘤边缘多毛糙不规则且密度不均,而镜下肿瘤内大量黏液并向周围肺泡腔内突出可能是其病理基础。     

CT动态增强扫描中时间密度曲线及特征参数值对孤立性肺结节的诊断价值

目的:分析CT动态增强扫描中时间密度曲线及特征参数值对孤立性肺结节的诊断价值。方法:回顾性分析95例孤立性肺结节病变患者的临床资料,所有患者均行CT动态增强扫描检查及病理活检。依据病理结果,分析CT动态增强扫描的特异性、敏感性及准确性,并对不同类型孤立性肺结节时间密度曲线及特征参数值进行比较分析。结果:（1）95例孤立性肺结节病变患者中,恶性结节67例、良性结节14例,炎性结节14例;（2）CT动态增强扫描诊断孤立性肺结节病变性质的特异性为83.33%,敏感性为95.38%,准确性为91.58%;（3）恶性结节及炎症结节患者在CT动态增强扫描中各时间点的CT值均高于良性结节组（P<0.05）;在CT动态增强扫描300及480 s时,炎性结节组CT值较恶性结节组下降显著（P<0.05）;（4）恶性结节组及炎性结节组结节强化值（PH）、孤立性肺结节PH与主动脉PH之比均明显高于良性结节组（P<0.05）。结论:对孤立性肺结节病变患者行CT动态增强扫描,时间密度曲线及特征参数值可以为良、恶性孤立性肺结节提供一定的诊断依据。     

多排螺旋CT在检测肠系膜淋巴结中的应用及其意义

目的以健康人群为研究对象,探讨肠系膜淋巴结在薄层螺旋CT图像上的分布特点及其临床意义。方法选择60例健康体检者,其中男性35例,女性25例;年龄26～67岁,平均年龄55岁。用Siemens Definition AS 128层螺旋CT进行腹部扫描,成像参数:120 kV,280 mA,128 i×0.6 mm,0.5 s/r,螺距0.6,扫描层厚、层间距均为8 mm。由3名放射学工作者应用同一图像贮存和传输系统(PACS)工作站阅读所有CT图像,记录所有短轴大于3 mm的肠系膜淋巴结的大小、数目及位置(肠系膜根部、周边肠系膜或右下腹肠系膜区)。结果有54例检测到短轴直径大于3 mm肠系膜淋巴结,其中12例(22.2%)检测到10个以上淋巴结,31例(57.4%)检测到5个以上淋巴结,其余11例(20.4%)检测到5个以下淋巴结。同时所有体检者都检测到多个短轴直径小于3 mm的肠系膜淋巴结,短轴直径多为2 mm左右。在所有检测到的淋巴结中,最大淋巴结直径范围为5.4～9.2 mm,平均直径范围为3.5～6.5 mm。54例中,肠系膜根部发现较多淋巴结者25例(46.3%),右下腹肠系膜区22例(40.7%),肠系膜周边部7例(13.0%)。结论128层螺旋CT能检出更多、更小的肠系膜淋巴结。这些淋巴结直径可小于3 mm。在健康人群中发现这些淋巴结,无临床意义,不需要进一步的影像学检查及临床治疗。     

肾上腺神经节瘤的CT表现

目的探讨肾上腺神经节瘤的CT表现特点及其诊断价值。方法回顾性分析16例患者的临床病理及影像学资料。7例患者行CT平扫,9例行CT平扫加增强;15例经手术病理证实,1例经穿刺活检证实为肾上腺神经节瘤。结果16例患者CT扫描可见2例肿物为囊实性,14例为实性;5例肿物内伴有钙化;平扫CT值介于20～40 HU左右;9例增强扫描后,5例轻度延迟强化,4例强化不明显。结论肾上腺节细胞神经瘤CT扫描具有特征性,CT扫描对正确诊断肾上腺神经节瘤具有重要价值。     

基于机器学习的鼻咽癌转移淋巴结鉴别模型

目的:研究使用机器学习与影像组学建立用于鼻咽癌CT图像中鉴别转移淋巴结的模型。方法:选择50例鼻咽癌患者初诊CT平扫及静脉灌注增强图像及18F-FGD-PET图像,患者均经病理及PET检查证实为鼻咽癌伴局部淋巴结转移。手动勾画患者CT图像中体积＞1 cm3的淋巴结,由18F-FGD-PET图像中对应区域SUVmax＞2.5及现行影像学标准作为转移与否的分类标准。研究中共获得143枚淋巴结,其中转移淋巴结103枚。使用机器学习方法对上述分类结果进行训练,其中列入训练组淋巴结100枚,验证组43枚,分组方式为随机分组以避免特定的分组方式造成的系统误差。结果:机器学习过程中获得由淋巴结体积、最大横截面短轴及数个影像组学特征构建模型,模型对转移淋巴结的鉴别准确率可达86%。特征选择结果得出:最大横截面直径、平均宽度、灰度强度能量、像素数量、频度、形态密实度等可作为诊断转移淋巴结的重要特征。结论:研究中建立的鉴别模型可在CT图像中实现辅助诊断转移淋巴结,为影像检查中快速判定鼻咽癌患者淋巴结是否转移提供一种新思路,有利于个体化放疗中靶区的精准勾画。     

Pulmonary BALT lymphoma successfully treated with eight cycles weekly rituximab: report of first case and F-18 FDG PET/CT images

Extra marginal-zone lymphomas of the lung is a very rare tumor and it originates from bronchial-associated lymphoid tissue. A 68-yr-old woman presented with productive cough and dyspnea. A thorax computed tomography scan showed a 9 × 10 cm in size mass in the left lung and pleural effusion in the lower lobe of left lung. Positron emission tomography/computed tomography (PET/CT) revealed intense uptake foci at the upper and middle sites of left lung and slight uptake foci at the mediastinal lymph nodes which showed malignant involvement. After bronchoscopic biopsy, the diagnosis of pulmonary bronchial-associated lymphoid tissue (BALT) lymphoma was confirmed. At the end of the eight cycles weekly rituximab treatment, complete response was obtained by PET/CT findings. It is concluded that extended rituximab schedule is more effective and it would be beneficial to investigate the use of PET/CT in the diagnosis and evaluating of the treatment response of pulmonary BALT lymphoma.     

Calcified Pulmonary Nodules Identified in a 350-Year-Old-Joseon Mummy: the First Report on Ancient Pulmonary Tuberculosis from Archaeologically Obtained Pre-modern Korean Samples

We found calcified pulmonary nodules in a middle-aged female mummy discovered from 350-yr-old Joseon tomb of Korea. In the CT scan, we found six radiopaque nodules in right lung, through the levels of thoracic vertebrae 1 to 6. We also found presumptive pleural adhesions in right thoracic cavity of CT images. We re-confirmed radiological findings by our post-factum dissection on the same mummy. By the differential diagnosis, we speculate that the radiopaque calcification nodules and associated pleural adhesion could have been caused by tuberculosis. This is the first-ever report on the pulmonary tuberculosis identified in archaeologically obtained, pre-modern Korean samples.     

Structure,blood supply,and lymphatic vessels of the sheep's visceral pleura

We investigated the morphology of the visceral pleura of 36 sheep, using macroscopic, histologic, and ultrastructural approaches to quantify regional pleural thickness, blood supply, and lymphatic drainage, including the pulmonary ligament and hilar lymphatic distributions. Pleural thickness increased caudally and dorsally, such that the costal pleura of the caudal lobes had a mean minimum pleural thickness of 83 μm. The blood supply to the entire visceral pleura came exclusively from the bronchial arteries. Lymph vessels formed an extensive plexus throughout the serous membrane of all lobes. Trunk lymphatics (> 100 μm diameter) had a density of about 2/cm of pleural length on all lobar surfaces except for the cranial and middle lobes, where their density on the costal surfaces was ≤ 1/cm. Pleural trunk lymphatics coursed to the pulmonary ligaments and to the hilum on their way to regional lymph nodes. At the hilum they anastomose with intrapulmonary lymphatic trunks. The principal lymph nodes to receive pulmonary lymph were the caudal mediastinal node and tracheobronchial nodes. The visceral pleura of sheep is thick, showing considerable regional diversity in morphology.     

Pulmonary nodule registration in serial CT scans based on rib anatomy and nodule template matching

An automated method is being developed in order to identify corresponding nodules in serial thoracic CT scans for interval change analysis. The method uses the rib centerlines as the reference for initial nodule registration. A spatially adaptive rib segmentation method first locates the regions where the ribs join the spine, which define the starting locations for rib tracking. Each rib is tracked and locally segmented by expectation-maximization. The ribs are automatically labeled, and the centerlines are estimated using skeletonization. For a given nodule in the source scan, the closest three ribs are identified. A three-dimensional (3D) rigid affine transformation guided by simplex optimization aligns the centerlines of each of the three rib pairs in the source and target CT volumes. Automatically defined control points along the centerlines of the three ribs in the source scan and the registered ribs in the target scan are used to guide an initial registration using a second 3D rigid affine transformation. A search volume of interest (VOI) is then located in the target scan. Nodule candidate locations within the search VOI are identified as regions with high Hessian responses. The initial registration is refined by searching for the maximum cross-correlation between the nodule template from the source scan and the candidate locations. The method was evaluated on 48 CT scans from 20 patients. Experienced radiologists identified 101 pairs of corresponding nodules. Three metrics were used for performance evaluation. The first metric was the Euclidean distance between the nodule centers identified by the radiologist and the computer registration, the second metric was a volume overlap measure between the nodule VOIs identified by the radiologist and the computer registration, and the third metric was the hit rate, which measures the fraction of nodules whose centroid computed by the computer registration in the target scan falls within the VOI identified by the radiologist. The average Euclidean distance error was 2.7 +/- 3.3 mm. Only two pairs had an error larger than 10 mm. The average volume overlap measure was 0.71 +/- 0.24. Eighty-three of the 101 pairs had ratios larger than 0.5, and only two pairs had no overlap. The final hit rate was 93/101.     

The role of computerized tomography in the diagnosis of regional metastases of cancer of the esophagus and the proximal part of the stomach]

Computed tomography (CT) findings were compared with operative ones for 50 patients with esophageal and proximal gastric cancer. In diagnosis of metastases to the upper abdominal and retroperitoneal lymph nodes ST sensitivity reached 93.3%, specificity 85% and accuracy 90.3%. The best diagnostic results were obtained in detection of metastases to the nodes of the celiac trunk branch and paraaortal fat (94.2%). Lower CT resolution appeared in diagnosis of perigastric node metastatic involvement in the primary tumor location in the proximal stomach.     

胃壁及胃周异位胰腺的CT影像学研究

目的研究人胃壁异位胰腺及胃周异位胰腺的CT影像学特征,为CT诊断异位胰腺提供理论基础。方法回顾性分析40例经术后病理证实的胃部异位胰腺CT资料,其中21例进行了增强CT扫描。于PACS系统上进行图像分析。结果胃壁异位胰腺24例,病灶多数位于胃窦部或胃大弯侧或混合型,表现为圆形、卵圆形或不规则形的粘膜下病变,可伴有中央脐凹征或囊性变,表面粘膜增厚或破溃。Ct增强后表现为高于、类似或低于正常胰腺的强化方式。胃周脂肪内异位胰腺16例,10例为多发病灶。胃周脂肪内异位胰腺均表现为圆形或椭圆形小结节,境界清楚,强化程度类似于周围淋巴结。结论胃壁异位胰腺CT表现有其特征性,可为临床诊断提供影像学依据,胃周异位胰腺应注意与胃周淋巴结鉴别。     

CT预测肌层浸润性膀胱尿路上皮癌盆腔淋巴结转移的回顾性研究

目的　探讨CT预测肌层浸润性膀胱尿路上皮癌（muscle-invasive bladder urothelial carcinoma,MIBUC）伴盆腔淋巴结转移的可行性。 方法　回顾性分析接受根治性全膀胱切除术加盆腔淋巴结清扫术的40例MIBUC患者的临床和影像学资料,对比分析CT检查的盆腔淋巴结情况与病理诊断结果之间的相关性。 结果　（1）以病理诊断结果为标准,CT检查发现MIBUC伴盆腔淋巴结转移的准确率为90%,灵敏度为75%,特异度为93.8%;（2）临床分期为T1、T2、T3、T4期的MIBUC患者,其盆腔淋巴结转移的发生率分别为0、9.1%、45.5%、100%。 结论　（1）CT影像学检查可较好地预测MIBUC是否伴盆腔淋巴结转移;（2）随着MIBUC临床分期的进展,盆腔淋巴结转移的发生率相应增高（P<0.05）。