中枢神经细胞瘤的影像诊断与鉴别诊断

目的探讨中枢神经细胞瘤(CNC)的MRI和CT表现.方法对6例(男4例,女2例,年龄14～46岁,平均30岁)经手术病理证实的CNC的MRI、CT影像表现进行回顾性分析.结果 6例肿瘤均位于双侧侧脑室透明隔和/或第三脑室近Monro孔处;左侧侧脑室4例,右侧侧脑室2例.肿瘤呈不规则形(2例呈类圆形),密度不均、边缘清晰; MR T1WI以等信号为主,混有少量高信号及点状低信号,T2WI信号强度与皮层灰质比较为不均匀等到高混合信号,增强后不均匀低到中等强化.瘤体内常见囊变、钙化、出血.CT表现为肿块呈不均匀高密度影,4例(66.7%)可见不规则状钙化,边缘清晰. 结论 CNC的MRI、CT表现具有一定特点.     

肺炎型肺癌的诊断及鉴别诊断

目的探讨肺炎型肺癌的诊断及鉴别诊断。方法回顾性分析32例肺炎型肺癌的临床、影像学及病理表现,探讨其诊断要点。结果32例肺炎型肺癌中咳嗽、咳痰30例,发热20例,热型不一,胸闷气短14例,2例无明显症状体检发现。肿瘤大小2．1～11．7cm,肺周边部24例,肺门部8例,病理示细支气管肺泡癌16例,腺癌12例,腺鳞癌2例,小细胞癌2例。结论肺炎型肺癌多位于肺周边部,易误诊为肺炎,以细支气管肺泡癌、腺癌多见,抗炎治疗无效,需病理确诊,主要以手术治疗。     

乳腺乳头状病变的诊断与鉴别诊断

乳腺乳头状病变的诊断与鉴别诊断是日常病理诊断工作中经常遇到的问题.本文对导管内乳头状病变及特殊类型乳头状癌的诊断及鉴别诊断进行了较为详细的论述.     

MSCT对肝内胆管细胞癌的诊断与鉴别诊断

目的：探讨肝内胆管细胞癌的CT表现及其鉴别诊断，提高对肝内胆管细胞癌的认识。方法：收集本院两年来18例经病理证实的肝内胆管细胞癌的CT表现进行回顾性分析。结果：所有病例CT平扫时均表现为低密度病灶，伴肝叶萎缩或局部肝脏轮廓凹陷的有8例，局部外围胆管扩张的有11例，实验室检查CA-199升高的有12例，延迟（8~10 min）扫描病灶均有进一步强化。所有病例均无乙肝病史、无弥漫性肝硬化或门静脉癌栓形成。结论：因为肝内胆管细胞癌的病理基础与其他肝内肿瘤有着质的区别，CT表现也较为特殊，所以MSCT的平扫及多期动态增强扫描对其诊断有着非常重要的意义。     

克雅病的诊断与鉴别诊断进展

克雅病(Creutzfeldt-Jakob disease,CJD)又称皮质-纹状体-脊髓变性、亚急性海绵状脑病或传递性海绵状脑病,1920年Creutzfeldt和1921年Jakob首次报道该病。近年研究发现CJD是由朊病毒蛋白     

Unroofing the diagnosis

Unroofed coronary sinus is a rare congenital cardiac anomaly in which a communication occurs between the coronary sinus and the left atrium due to the partial or complete absence of roof of the coronary sinus. Its diagnosis is important to prevent pulmonary hypertension and brain abscess or cerebral emboli. We report a case of a symptomatic 35-year-old man in which no atrial septal defects were visualized by transesophageal echocardiography but MRI permitted the diagnosis of this rare cardiac anomaly and assessment of shunt severity.     

侵袭性葡萄胎的MRI诊断与鉴别诊断

侵袭性葡萄胎的MRI诊断在妊娠滋养层疾病的影像学诊断研究中鲜见报道.本文回顾分析本院收治的13例经病理证实的侵袭性葡萄胎患者的MRI资料,旨在提高对该病MRI表现的认识.     

Making the diagnosis of asthma

Diagnostic tests can only increase or decrease the probability of the asthma diagnosis, so a thorough history is very important. In patients with asthma-like symptoms, spirometric evidence of airway obstruction plus a large bronchodilator response makes asthma much more likely. However, normal spirometry is common in patients with mild asthma who are not symptomatic at the time of testing, and patients with poorly controlled asthma may lack substantial bronchodilator response. Inhalation challenge test often helps confirm asthma in patients with normal spirometry. Adult smokers with intermittent respiratory symptoms may have either asthma or chronic obstructive pulmonary disease (COPD). Normal post-bronchodilator spirometry rules out COPD. In patients with airway obstruction, a low diffusing capacity of the lung for carbon monoxide increases the probability of COPD and makes asthma much less likely. A high exhaled nitric oxide level makes allergic asthma more likely. Response to inhaled corticosteroids makes asthma more likely and COPD less likely.     

阑尾炎的超声诊断及漏误诊原因分析

目的 探讨阑尾炎的超声诊断价值及漏误诊原因.方法 回顾性分析经手术病理确诊的69例阑尾炎患者的超声声像图,分析阑尾炎超声漏误诊原因.结果 69例阑尾炎,超声诊断符合率92.75%(64/69).其中单纯性阑尾炎17.39%(12/69),化脓性阑尾炎37.68%(26/69),坏疽性及穿孔性阑尾炎14.49%(10/69),阑尾周围脓肿7.24%(5/69),慢性阑尾炎急性发作4.35%(3/69),超声间接征象提示急性阑尾炎11.59%(8/69),漏诊2例,误诊3例.结论 超声对阑尾炎有较高的诊断价值.检查医师的技术、仪器质量、患者病情的复杂性及多样性是阑尾炎漏诊误诊的主要原因.     

MR diagnosis of the liver

By recent technical development magnetic resonance tomography has brought about essential improvements also for the diagnostics of the liver. For detecting focal lesions the diagnostic value of MRT is equal or superior to CT. For tumour screening at medium magnetic field strengths T1-weighted sequences with short repetition and echo times and multiple averaging of images are indicated. After detection of a pathologic tumourous condition a T2-weighted sequence allows the further differentiation of tissues. Hemangioma, the most frequent hepatic tumour, can be differentiated with high accuracy and non-invasively by MRT. Sonography will keep its place in screening, because of the high numbers of available devices and its low costs. Cystic lesions are better detected and the biliary ducts and be evaluated rapidly and at lower costs than with MR and CT. Gadolinium-DTPA as paramagnetic contrast medium is advised for demonstrating perfusion of hepatic tumours. Ferrites, small ferromagnetic iron particles, may open a new age of tumour screening.     

卵巢癌的CT诊断与鉴别诊断

目的探讨卵巢癌及误诊为卵巢癌病变的CT征象,提高卵巢癌诊断及鉴别诊断的水平。方法病理证实47例盆腔肿块,其中卵巢癌42例,8例误诊;5例其他病变误诊为卵巢癌。所有病例均做平扫加增强扫描,回顾性分析其CT征象。结果①本组卵巢癌92.4%表现为盆腔或盆腹腔肿块,肿块呈囊实性、囊性、实性;增强扫描后,肿块间隔及实性成分明显强化;7.6%盆腹腔未见肿块,仅表现为腹水、网膜增厚。约57.2%有腹水。约19.0%肿块出现钙化。②盆腔脓肿或结核CT表现与囊性卵巢癌相似,但囊壁和间隔规则,未见壁结节;囊内积气为较特征的征象。③巧克力囊肿出血较新鲜以及浆膜下子宫肌瘤坏死囊变,平扫均呈囊实性肿块,增强扫描后,前者实性成分无强化,后者实性成分强化不明显。结论CT增强扫描,能清楚地显示肿块内部及其与周围器官的情况,不同病变强化形式不同对于不典型卵巢癌的CT诊断与鉴别诊断很有帮助,从而提高卵巢癌的诊断水平。     

CT诊断与鉴别诊断胸部局限性巨大淋巴结增生症

目的 探讨胸部局限性巨大淋巴结增生症(LCD)的CT表现及其诊断、鉴别诊断.方法 收集经手术病理证实的10例纵隔及肺门淋巴结LCD患者.以临床综合诊断或病理证实的影像不典型的纵隔及肺门区的团块状病变患者为对照组,包括肺门区类癌14例、纵隔及肺门区淋巴结核21例、胸腺瘤15例、神经源性肿瘤9例、结节病12例、淋巴瘤15例及肺癌淋巴结转移25例.观察肿块影像及增强扫描强化特点.结果 10例LCD患者中,7例位于纵隔及2例位于左肺门淋巴结的病灶为透明血管型,1例位于右肺门淋巴结的病灶为混合型.CT平扫10例LCD均表现为结节及球形软组织密度影,边界清晰,5例病灶内见分支、条状及斑片状低密度影,1例可见分支、片状钙化.LCD病灶强化方式:1例右肺门混合型病灶呈中度强化,其余病灶均呈明显强化并呈快进慢出型动态强化方式.9例明显强化病灶中4例病灶可见较粗大的滋养血管.9例透明血管型LCD与纵隔及肺门区常见实性结节样病变CT值比较:LCD最大增强CT值明显高于胸腺瘤、纵隔淋巴结结核、神经源性肿瘤、肺门区支气管腔外类癌,明显低于支气管腔内类癌CT值(P均＜0.05).结论 胸部透明血管型LCD的CT影像具有一定特征,动态增强扫描对诊断及鉴别诊断具有特征性意义.