螺旋CT双期扫描诊断嗜铬细胞瘤的价值

目的 探讨螺旋CT(SCT)双期扫描诊断嗜铬细胞瘤的影像价值.方法 搜集经手术和病理证实的 19 例嗜铬细胞瘤患者术前SCT平扫、双期扫描影像资料.结果 18/19例肾上腺嗜铬细胞瘤为单侧发病,发生肾上腺15例,肾上腺外4例.肿块较大,瘤界较清晰,16例出现坏死和囊变,1例出现钙化.增强双期扫描肿瘤实体部分明显强化.结论 SCT双期扫描肾上腺嗜铬细胞瘤的定位和定性诊断有重要价值.     

嗜铬细胞瘤的CT诊断

目的 探讨CT对嗜铬细胞瘤的诊断价值. 资料与方法 分析经手术病理证实的嗜铬细胞瘤20例CT征象. 结果 嗜铬细胞瘤多是单侧发病(19/20),发生于肾上腺者16例,异位者4例.肿块较大,边界清楚,多为类圆形或椭圆形(19例).肿块内密度多不均,出血、坏死常见(10/17),钙化较少见,增强扫描可见病变实质不均匀强化. 结论 CT不但能发现较小的肿瘤,还可以定位诊断,以及显示肿瘤与周围组织结构、血管的关系,有助于手术方案的选择和术后随访.     

多层螺旋CT对肾上腺嗜铬细胞瘤的诊断价值

目的探讨MSCT对肾上腺嗜铬细胞瘤的诊断价值。方法收集本院经手术和病理证实的32例肾上腺嗜铬细胞瘤患者的资料,其中男13例,女19例,年龄14~70岁,平均31岁。所有病例术前均行MSCT平扫和增强扫描(动脉期、静脉期),部分病例行MPR、MIP等后处理,回顾性分析其CT表现。结果本组32例共34个病灶,其中单发30例,多发2例;CT扫描显示,肿瘤呈较大的圆形或类圆形软组织肿块(平均直径4.8cm),边界清楚,平扫密度多不均匀,其中26例均伴有出血、坏死和囊变,增强扫描肿瘤多为不均匀明显强化,动静脉期肿瘤实性部分明显强化,低密度坏死囊变区始终未见强化。MPR及MIP等后处理能清晰显示肿瘤的大小、部位、形态、血供、内部情况及周围结构的关系。结论MSCT对肾上腺嗜铬细胞瘤的诊断具有重要价值,嗜铬细胞瘤的CT表现具有一定的特征性,结合MPR、MIP等后处理、临床资料和实验室检查,即可明确诊断。     

嗜铬细胞瘤的CT、MR诊断价值分析

目的探讨嗜铬细胞瘤的CT、MR诊断价值。方法收集6例经手术病理证实的嗜铬细胞瘤临床资料,术前均行CT、MRI扫描,回顾性分析其CT、MR征象。结果 6例均位于肾上腺区,无位于肾上腺外异位嗜铬细胞瘤,1例恶性嗜铬细胞瘤。嗜铬细胞瘤呈较大的类圆形或不规则形肿块,CT平扫呈软组织密度,T1WI信号强度类似肝实质,T2WI信号较高,肿瘤实体部分多明显强化,易发生坏死、囊变。结论嗜铬细胞瘤的CT、MRI表现具有一定特征,CT、MRI检查可较好地显示肿瘤部位、形态、大小、与周围结构的关系,结合临床表现多可明确诊断。     

MSCT双期增强扫描鉴别肾上腺无功能嗜铬细胞瘤与腺瘤

目的 分析肾上腺无功能嗜铬细胞瘤和腺瘤的CT表现,为诊断与鉴别诊断提供参考.方法 回顾性分析经病理证实的肾上腺无功能嗜铬细胞瘤17例、腺瘤31例,对2组病例的影像表现进行统计分析,包括肿瘤大小、形态、密度、强化程度、是否见肿瘤血管及坏死囊变等.结果 嗜铬细胞瘤最大直径平均(52.2±20.2) mm,腺瘤最大直径平均(27.8±17.6) mm,差异有统计学意义(P<0.05).肿瘤实质部分平扫、动脉期、静脉期平均CT值嗜铬细胞瘤均高于腺瘤(均P<0.05).17例嗜铬细胞瘤,14例(82.4%)可在动脉期于肿瘤周围或肿瘤内见到肿瘤血管,12例(70.6%)可见坏死囊变,肿瘤边缘均未见环形或弧线样强化;31例腺瘤,3例(9.7%)见肿瘤血管,2例(6.5%)见坏死囊变,10例(32.3%)见环形或弧线样强化;差异均有统计学意义(均P<0.05).结论 肾上腺无功能嗜铬细胞瘤与腺瘤均具有特征性影像表现,MSCT双期增强扫描可为临床诊断和治疗提供帮助,增强扫描动脉期是否可见肿瘤血管是两者的鉴别点之一.     

异位嗜铬细胞瘤MSCT诊断价值分析

目的探讨MSCT检查在诊断异位嗜铬细胞瘤中的临床价值。方法收集异位嗜铬细胞瘤的24例CT检查与病理资料。结果将患者的术后病理检查结果作为金标准进行对照分析,MSCT检查共明确诊断22例,诊断准确率为(91.67%)。经MSCT检查显示,本组24例患者的肿瘤均表现为卵圆形或类圆形样,大多数患者的病灶边界均相对比较清晰。最小的病灶处于膀胱,面积约1.3cm×1.6cm,最大的病灶处于后腹膜,面积约8.1cm×10.3cm。大部分患者的CT平扫密度不均,可见囊性低密度区域,实性病灶的CT平均值约为(42.41±3.62)HU,增强扫描显示全部病灶的实性成分均有明显强化,CT平均值为(104.6±6.7)HU,而液化坏死区域则没有强化。双期增强扫描中门脉期时患者的CT值又会进一步上升,且特点比较显著。结论 MSCT能够清晰的显示患者肿瘤的位置、大小、形态及结构。     

CT对嗜铬细胞瘤诊断价值的探讨

本文分析 24例经病理证实的嗜铬细胞瘤CT表现,并与B超手术结果进行了对照,旨在探讨 CT对该病定位、定性诊断价值和对临床治疗的指导作用。24例中,男11例,女13例。起源于肾上腺的肿瘤19例,异位嗜铬细胞瘤5例。CT扫描发现嗜铬细胞瘤具有一些特点:肿块一般较大、密度多不均匀、可伴有液化、坏死、钙化或囊变,增强时肿瘤实质明显强化,而坏死区无或略有强化。结果表明,CT对该病的定位率（95.8％）、定性率（87.5％）均高于B超（定位率83.3％,定性率62.5％）,提示CT是目前嗜铬细胞瘤影像诊断的主要方法。根据肿瘤的CT特点并结合典型的临床表现和生化异常,可进一步提高对嗜铬细胞瘤的诊断率。     

嗜铬细胞瘤的CT诊断

目的:探讨嗜铬细胞瘤的CT表现,提高CT诊断的准确性。方法:搜集经手术和病理证实的17例嗜铬细胞瘤患者的资料,所有病例术前均作超声、CT检查。结果:瘤体呈较大(平均瘤径6.1cm)的类圆形肿块,瘤界清晰,平扫密度多不均匀,10例出现坏死和囊变,肿瘤实体部分多明显强化。结论:嗜铬细胞瘤CT表现具有一定特征,CT可清楚显示肿瘤的部位、形态、大小、瘤内成份及与周围结构的关系,结合临床表现多可明确诊断。     

膀胱异位嗜铬细胞瘤的MSCT诊断

目的 讨论膀胱异位嗜铬细胞瘤MSCT表现.方法 对8例资料完整、经手术证实膀胱异位嗜铬细胞瘤的CT图像进行回顾性分析.结果 8例肿块均为单发,分别位于膀胱三角区(2例)、顶部(2例)、前壁(1例)、后壁(3例),2例位于粘膜下,6例位于膀胱肌层.病灶平扫呈均匀低密度,无囊变,1例可见环形钙化,增强扫描动脉期明显均匀强化,动脉期与平扫病灶CT值相差＞40HU,门脉期与动脉期CT值相差为15HU左右.结论 膀胱异位嗜铬细胞瘤在MSCT有其特征性表现,术前可以明确诊断.     

MSCT动态增强扫描在嗜铬细胞瘤中的诊断价值

<正> 典型嗜铬细胞瘤具有明确的临床表现、实验室检查指标增高,临床诊断不难。CT检查主要是定位诊断;而隐匿型和无功能型嗜铬细胞瘤因无临床症状,CT检查不仅具有定位诊断价值,而且具有重要的定性诊断价值,有助于临床手术方案的选择。本文收集我院2002～2008年18例经手术病理证实的嗜铬细胞瘤的临床资料及MSCT表现,分析探讨MSCT动态增强扫描对嗜铬细胞瘤的定位、定性诊断价值。     

肾螺旋CT平扫与增强延时扫描对肾损伤的诊断

目的探讨螺旋CT平扫与增强延时扫描对肾损伤的诊断价值。方法57例肾损伤患者外伤后30min～3d均经螺旋CT平扫,其中,23例又经增强延时扫描,回顾分析其CT表现特点。结果Ⅰ型肾挫伤（肾内血肿）25例,Ⅱ型肾包膜下血肿11例．Ⅲ型严重肾损伤（肾撕裂或肾断裂）15例,Ⅳ型肾例血肿6例。23例肾损伤CT增强扫描和延时扫描不仅显示了平扫所见,而且,还硅示了肾集合系统损伤导致尿外液渗9例。结论肾螺旋CT平扫与增强延时扫描能显示肾损伤的的部位、范围、类型以及合并其他的损伤,并能指导怖床治疗。     

CT diagnosis of renal artery injury caused by blunt abdominal trauma

Controversy exists about the sensitivity of CT in the diagnosis of occlusion of the renal artery or one of its branches after blunt abdominal trauma. We report 10 cases in which contrast-enhanced CT was used to diagnose correctly either main (seven cases) or segmental (three cases) posttraumatic renal artery occlusion. The abnormality was proved angiographically and/or surgically in all cases. CT showed the absence of a nephrogram in the devascularized portion of the kidney in all 10 cases. A pyelogram was not shown on CT in the seven patients in whom the main renal artery was occluded, but was present in the three patients who had segmental arterial lesions. Termination of enhancement within the affected artery (renal artery cutoff sign) was observed in one patient, and a thin, peripheral rim of cortical enhancement in an otherwise unenhanced renal segment (rim sign) was observed in three patients. Retroperitoneal hematoma with renal displacement was present in nine patients. Our experience suggests that the absence of a nephrogram on contrast-enhanced CT scans is a useful sign of main or segmental renal arterial occlusion in patients with blunt abdominal trauma.     

Value of CT in determining the need for angiography when findings of mediastinal hemorrhage on chest radiographs are equivocal

The role of CT in determining the need for angiography in patients with possible thoracic vascular injury resulting from blunt trauma is controversial. During a 24-month period, we prospectively evaluated the results of CT to screen 90 patients with a history of decelerating thoracic trauma for evidence of mediastinal hemorrhage or great vessel abnormality. All patients either had equivocally abnormal mediastinal contours on chest radiographs (64%) or had technically suboptimal chest radiographs owing to body habitus or restriction to the supine projection (36%). Patients with unequivocal signs of mediastinal hemorrhage on chest radiographs underwent immediate arteriography without prior CT. Thoracic CT was interpreted as normal in 63 (77%) patients and no further imaging was performed. Five patients had technically suboptimal CT studies, and CT scans were interpreted as equivocal in six. These 11 patients had normal arteriograms. Sixteen CT scans (18%) demonstrated evidence of mediastinal hemorrhage and/or great vessel contour abnormality. Four (27%) of 15 patients who underwent arteriography had injury to the great vessels. One patient refused to undergo angiography. In 11 patients with CT evidence of mediastinal hemorrhage, major vascular injury was not seen on arteriography. These results suggest a valuable role for CT in determining the need for arteriography to detect potential great vessel injury in patients with blunt decelerating thoracic trauma and equivocally abnormal mediastinal contours on chest radiographs.     

双螺旋CT增强扫描对外伤性肾损伤的诊断价值

目的:探讨CT增强扫描在对伤性肾损伤诊断中的应用价值。材料和方法:回顾性分析28例肾损伤的CT平扫及增强扫描表现。结果:28例中,平扫能确诊肾损伤20例、可疑肾损伤5例、未见异常3例,敏感性89.2%、特异性71.4%;CT增强扫描后,全部确诊为肾损伤,敏感性100%、特异性100%。结论:CT增强扫描在外伤性肾损伤的诊断中具有重要的作用,能明显提高诊断准确率。     

CT scanning of children with blunt abdominal trauma – is oral contrast useful?

Purpose: To determine the usefulness of oral contrast in CT scanning of children with blunt abdominal trauma by comparing scans performed with and without oral contrast. Methods: CT scans of 273 children with abdominal trauma and 40 without trauma were reviewed. Results: Of the trauma patients, 116 (43 %) were scanned with oral contrast, 157 (57 %) without. Among the children who underwent laparotomy, CT scanning identified 6 of 6 organ injuries in those scanned with oral contrast and 11 of 12 in those scanned without. CT scanning identified all bowel injuries. The pancreatic body and tail were significantly better visualized in scans with oral contrast. Detection of pancreatic or liver injury was not, however, significantly different in the two groups. Opacification of the bowel by contrast was significantly better in elective than in trauma patients. Conclusion: There was no difference in detection of injuries between children scanned with and without oral contrast.     

Small bowel rupture after blunt trauma: Computed tomographic signs and their sensitivity

The purpose of this study is to describe the characteristic computed tomographic (CT) signs of small bowel perforation after blunt abdominal trauma and to evaluate their sensitivity. Nineteen preoperative CT scans were obtained from 16 patients with surgically proven small bowel rupture secondary to blunt abdominal trauma. Only the CT findings described in the original CT reports were used. Eleven of 19 CT scans (58 %) had findings that were unequivocal for bowel rupture (i.e., extraluminal air and/or extravasation of oral contrast medium). Seven CT scans (37 %) had findings that were suggestive of severe small bowel injury (i.e., focal small bowel wall thickening and/or free peritoneal fluid without other accompanying organ injuries). In all, 95 % of cases of small bowel rupture had either pathognomonic or suggestive CT findings. One CT scan did not demonstrate small bowel wall thickening, although a hemoperitoneum was present. CT is a sensitive method for suggesting severe small bowel injury and rupture secondary to blunt abdominal trauma.     

Blunt abdominal trauma: utility of 5-minute delayed CT with a reduced radiation dose

PURPOSE: To retrospectively evaluate the utility of 5-minute delayed computed tomography (CT) of the abdomen and pelvis by using a reduced radiation dose in patients with blunt abdominal trauma. MATERIALS AND METHODS: Institutional review board consent was obtained, and written informed consent was waived. The study was HIPAA compliant. A total of 662 patients (497 men, 165 women; mean age, 40.5 years; range, 18-94 years) were identified who were evaluated with CT after blunt abdominal trauma during a 1-year period. Delayed CT scans were acquired 5 minutes after intravenous contrast material injection by using a decreased tube current of 100 mAs. Injury was identified in 106 patients. Two radiologists blinded to initial CT scan interpretation reviewed these cases to determine the quality and utility of delayed scans. Disagreement was settled by consensus. Delayed scans were considered useful when they aided in (a) characterizing initial CT findings, (b) identifying findings not present at initial CT, (c) excluding injury suggested at initial CT, and (d) increasing reader confidence with regard to initial CT findings. RESULTS: All delayed scans were diagnostic. Delayed scans were useful in 27% (12 of 44) of patients with solid organ injury, 5.9% (one of 17) of patients with bowel or mesenteric injury, 4.5% (one of 22) of patients with pelvic fractures, and in none of the patients with free fluid only. Overall, delayed CT was useful in 2.1% (14 of 662) of all patients (95% confidence interval: 1.0, 3.2) referred for evaluation following blunt abdominal trauma. Utility increased to 13.2% (14 of 106) (95% confidence interval: 6.8, 19.7) in the group of patients with injury or suspected of having injury after initial CT. CONCLUSION: If delayed CT scans are acquired when patients with blunt abdominal trauma are evaluated, selective, rather than routine, acquisition is recommended and a reduced radiation dose seems adequate.     

急性肾上腺损伤的CT诊断

目的评价急性肾上腺损伤的CT诊断。方法260例腹部钝挫伤病例中经急诊CT检查诊断并CT随访证实肾上腺损伤12例，男11例，女1例，年龄12～55岁。伤后5h内行CT平扫及增强扫描。结果12例均为肾上腺单侧损伤，其中，右侧10例，左侧2例。11例CT表现为肾上腺区卵圆形肿块影，增强扫描肾上腺肢呈连续弧线状强化8例，肾上腺肢强化不连续且有中断现象3例。1例表现为肾上腺区不规则肿块，边界不清，肾上腺仅见部分残肢强化。结论CT是诊断急性肾上腺损伤的有效技术，依据肾上腺肢强化的表现，可推测损伤的程度。     

Evaluation of abdominal trauma by computed tomography

Computed tomography (CT) was used in the evaluation of 100 patients suffering abdominal trauma. The type of trauma was blunt in 78 patients, penetrating in eight, and iatrogenic in 14. Forty per cent of cases had normal CT scans, while 60% showed substantial abdominal or retroperitoneal injuries. Surgery, clinical follow-up, and repeated radiologic examinations confirmed the accuracy of CT, and there were no cases in which medical or surgical management was inappropriately guided by CT. A wide variety of injuries was detected, including 19 splenic, eight hepatic, six pancreatic, 13 renal, 13 retroperitoneal or abdominal wall, and one intraperitoneal. CT has major advantages over plain radiography, radionuclide imaging, and angiography in assessment of trauma-induced injuries.     

Repeat computed tomography scans among inter-facility transferred major trauma patients in Oklahoma, 2009–2015

Purpose

Computed tomography (CT) scans play a vital role in the diagnosis and evaluation of trauma patients. Repeat CT scans occurred often among transferred trauma patients. The objective was to describe CT use and identify patient- and hospital-level factors associated with repeat CT scans among inter-facility transferred major trauma patients.

Methods

A retrospective cohort study was conducted using data extracted from the Oklahoma State Trauma Registry between 2009 and 2015. Both bivariate and multivariate analyses were employed to assess the factors associated with repeat CT scans.

Results

During the 7-year study period, 8678 major trauma patients were transferred between acute-care hospitals in Oklahoma. Among them, 4311 patients had at least one repeat CT scan. Head CT scans were the most commonly performed as well as repeated. Bivariate analysis showed that differences in repeat CT scans were associated with age, injury type, injury severity score, head injury severity, revised trauma score, payer source, transport mode to referring facilities, and facility levels at the 5% level. Multivariate analysis showed the odds of repeat CT scans were higher for adult and geriatric patients, patients with blunt injuries, severely injured patients, patients with severe head injuries, patients with a good revised trauma score, patients discharged alive, and mode to referring facilities.

Conclusions

Our study demonstrated that inter-facility transfers within an organized rural trauma system often underwent repeat CT scans. The large proportion of patients with multiple and repeated CT scans should underline the importance of trauma systems evaluating the necessity of CT scans, image-sharing capability, and obtaining appropriate scans in order to optimize use. Overall, reducing unnecessary CT scans should be an essential part of trauma care quality improvement efforts.