影像学技术对转移性淋巴结的诊断价值

早期准确地评估肿瘤患者的淋巴结及难以解释的淋巴结病变,对选择合适的治疗计划及预后的判断至关重要。目前,淋巴结大小仍然是区别转移性和非转移性淋巴结的最常用的指标,但是其准确性不高,为了提高对淋巴结良恶性病变评估的准确性,需要找到一种新的显像方法,它并不仅仅局限于对淋巴结解剖上的评估,还可以在细胞水平对淋巴结生理和生化过程进行直观和定量评估。不同的影像学方法在评价局部淋巴结时具有各自的特点,随着分子影像学的发展,功能成像技术在淋巴结诊断方面占据着越来越重要的地位。该文旨在对诊断淋巴结转移的各种影像学技术做一综述。     

Chest and abdominal CT during extracorporeal membrane oxygenation: Clinical benefits in diagnosis and treatment

RATIONALE AND OBJECTIVE: This study aims to evaluate the clinical usefulness of thoracic and abdominal computed tomography (CT) as an adjunct to bedside diagnostic imaging in patients on extracorporeal membrane oxygenation (ECMO) therapy because of severe acute respiratory failure. MATERIALS AND METHODS: Imaging records for 118 consecutive thoracic and abdominal CT examinations performed in 63 patients (22 neonates, 15 children, and 26 adults) on ECMO therapy during an 8-year period were retrospectively reviewed. Reported CT findings were compared with concurrent bedside radiographs and ultrasounds. The clinical importance and effect on treatment of each CT finding was determined by reviewing the medical records. RESULTS: CT showed 30 clinically important complications in 20 different patients that directly impacted on the treatment, but were not diagnosed with bedside imaging. Of the 30 complications, 15 (50%) were surgically treated, 11 (37%) required percutaneous invasive procedures, and 4 (13%) were managed conservatively. Despite the serious complications, 13 of 20 patients (65%) survived. CONCLUSION: Both chest and abdominal CT have an important clinical role in patients on ECMO therapy because of acute respiratory failure, as a complement to bedside imaging, to exclude or show complications and expedite early invasive treatment, when needed.     

Vascular lesions of the renal sinus

The renal sinus contains within it the collecting system of the kidney as well as lymphatics, nerves, and renovascular structures. This area may be affected by a large variety of pathological conditions arising from the various tissues in this site. Vascular lesions of the renal sinus are uncommon and may present clinically with acute symptoms and on imaging as a mass lesion. Awareness of the different vascular lesions affecting this area is essential for establishing the correct diagnosis and for appropriate treatment. The role of computed tomography is emphasized because it is the most commonly used modality to evaluate acute abdominal conditions as well as suspected renal masses, and the diagnosis can usually be made without the need for additional imaging modalities.All departments affiliated to the Sackler School of Medicine, Tel Aviv University, Israel     

Current imaging strategies for the evaluation of uterine cervical cancer

Uterine cervical cancer still remains an important socioeconomic issue because it largely affects women of reproductive age.Prognosis is highly depended on extent of the disease at diagnosis and,therefore,accurate staging is crucial for optimal management.Cervical cancer is clinically staged,according to International Federation of Gynecology and Obstetrics guidelines,but,currently,there is increased use of cross sectional imaging modalities [computed tomography(CT),magnetic resonance imaging(MRI),positron emission tomography-CT(PET-CT)] for the study of important prognostic factors like tumor size,parametrial invasion,endocervical extension,pelvic side wall or adjacent/distal organs involvement and lymph node status.Imaging indications also include cervical cancer follow-up,evaluation of tumor response to treatment and selection of suitable candidates for less radical surgeries like radical trachelectomy for fertility preservation.The preferred imaging method for local cervical cancer evaluation is MRI;CT is equally effective for evaluation of extrauterine spread of the disease.PETCT shows high diagnostic performance for the detection of tumor relapse and metastatic lymph nodes.The aim of this review is to familiarize radiologists with the MRI appearance of cervical carcinoma and to discuss the indications of cross sectional imaging during the course of the disease in patients with cervical carcinoma.     

The role of gallium-67 scan in defining the extent of disease in an endemic deep mycosis,paracoccidioidomycosis: a predominantly multifocal disease

The tools currently used to evaluate the extent of paracoccidioidomycosis (PCM) may be of limited value in detecting subclinical lesions. The aim of this study was to verify the role of gallium-67 whole-body scan in evaluating the extent of disease of 65 patients with active PCM. The (67)Ga scan findings were compared with the results of clinical evaluation, chest radiography and/or high-resolution computed tomography (CT), abdominal ultrasound (US) or CT, laryngoscopy, CT or magnetic resonance imaging (MRI) of the head, and technetium-99m methylene diphosphonate bone scan, obtained before treatment. Clinically unsuspected lesions were detected by imaging procedures in 21 patients (32%), mainly in the lungs (n=11), adrenals (n=6), and superficial (n=3) and deep lymph nodes (n=14). (67)Ga scan detected 100% of the cases with subclinical involvement in the lungs. Scintigraphy was superior to chest radiography in demonstrating lung disease (94% vs 81%). The lymphatic lesions were demonstrated by (67)Ga scan in all the clinically suspected cases and in nearly all unsuspected cases, and also revealed more extensive involvement than was clinically suspected in many of them. There was good agreement between (67)Ga scan and the other imaging procedures for the initial detection of thoracic and abdominal lymph nodes and bone involvement. (67)Ga imaging detected most cases of laryngopharyngeal disease with active inflammatory lesions found at indirect laryngoscopy. On the other hand, (67)Ga scan failed to demonstrate most of the adrenal and CNS lesions detected by abdominal US/CT and head CT/MRI. In conclusion, (67)Ga imaging is a useful tool for evaluating the location and extent of suspected and unsuspected lesions in PCM. It could serve as a screening method before the use of other diagnostic procedures, particularly in the detection of lung, superficial and deep lymph node and bone involvement.     

Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films--bowel obstruction, pneumoperitoneum, and the search of ureteral calculi--are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain.     

Multidetector CT angiography of renal vasculature: normal anatomy and variants

Knowledge of the variations in renal vascular anatomy is important before laparoscopic donor or partial nephrectomy and vascular reconstruction for renal artery stenosis or abdominal aortic aneurysm. Recently, multidetector computed tomographic (MDCT) angiography has become a principal imaging investigation for assessment of the renal vasculature and has challenged the role of conventional angiography. It is an excellent imaging technique because it is a fast and non-invasive tool that provides highly accurate and detailed evaluation of normal renal vascular anatomy and variants. The number, size and course of the renal arteries and veins are easily identified by MDCT angiography. The purpose of this pictorial essay is to illustrate MDCT angiographic appearance of normal anatomy and common variants of the renal vasculature.     

Detection of pelvic lymph node metastases in gynecologic malignancy: a comparison of CT, MR imaging, and positron emission tomography.

OBJECTIVE: Accurate assessment of lymph node status before treatment is critical in the treatment of gynecologic cancers because the 5-year survival and treatment of women is influenced by lymph node involvement. The aims of this study were to investigate the ability of X-ray CT, MR imaging, and (18)F-FDG positron emission tomography (PET) to detect pelvic lymph node metastases by comparing imaging with histopathologic findings after lymph node dissection. MATERIALS AND METHODS: Eighteen patients with gynecologic cancers were studied by all three imaging methods before surgery. The images were initially reviewed with routine diagnostic conditions and then, subsequently, by two observers who were unaware of the clinical and histopathologic findings of the patients. The nodal sites were split into upper (aortic to common iliac bifurcations) and lower (common iliac bifurcations to inguinal ligament) iliac chains. All observers' results were statistically analyzed with specificity, sensitivity, positive and negative predictive values, Fisher's exact test (individual observers) or chi-square test (combined observers), and Cohen's kappa test. RESULTS: Eight of 18 patients had lymph node metastases at histology. Findings of all three modalities agreed in full in only one patient. CT correctly revealed 10 node-negative patients, whereas MR imaging was correct in eight of these patients. (18)F-FDG PET correctly depicted one patient with lymph nodes negative for tumor. CT was the most specific imaging modality (97.0%), with MR imaging and PET rendering values of 90.7% and 77.3%, respectively, but sensitivity of all modalities was low (CT, 48.1%; MR imaging, 53.7%; PET, 24.5%). Observer agreement for each modality was good; kappa values among all observers were 0.88 for CT, 0.85 for MR imaging, and 0.72 for PET. CONCLUSION: CT is the most specific modality for detecting lymph nodes positive for tumor in gynecologic cancers, whereas MR imaging is the most sensitive. The poor results of PET in the pelvis are attributed to urinary (18)F-FDG in the ureters or bladder, which may mask or imitate lymph node metastases.     

Imaging in plague

An 8-year-old boy presented with elevated temperature, malaise, hepatoslpenomegaly, mesenteric adenitis, and septic shock. Cultures of biopsied abdominal lymph nodes as well as the blood grew Yersinia pestes. The boy's condition improved after two weeks of chloramphenicol and cefotaxime (Claforan). Two days after stopping intravenous antibiotic therapy, the patient again became febrile and complained of abdominal pain. Abdominal imaging with ¹¹¹In-labeled leukocytes did not show any abnormalities, however, ⁶⁷Ga-citrate scintigraphy demonstrated an abnormal focus of increased radiopharmaceutical uptake within a confluence of necrosed lymph nodes within the right upper quadrant of the abdomen. In addition, abnormal ⁶⁷Ga-uptake was seen within the left hip region. Correlative imaging with computed tomography is also presented.     

Multi-detector computed tomography of acute abdomen

Acute abdominal pain is one of the most common causes for referrals to the emergency department. The sudden onset of severe abdominal pain characterising the acute abdomen requires rapid and accurate identification of a potentially life-threatening abdominal pathology to provide a timely referral to the appropriate physician. While the physical examination and laboratory investigations are often non-specific, computed tomography (CT) has evolved as the first-line imaging modality in patients with an acute abdomen. Because the new multi-detector CT (MDCT) scanner generations provide increased speed, greater volume coverage and thinner slices, the acceptance of CT for abdominal imaging has increased rapidly. The goal of this article is to discuss the role of MDCT in the diagnostic work-up of acute abdominal pain.     

Patología aórtica no urgente: diagnóstico clínico-radiológico de la aortitis

Aortitis is a pathological term designating inflammation of the aortic wall, regardless of its cause. The clinical presentation of aortitis is nonspecific and variable. Symptoms include abdominal pain, fever, and weight loss; acute phase reactants may also be elevated. Aortitis can be caused by a wide spectrum of entities, including from infectious processes to autoimmune diseases (Takayasu arteritis and giant cell arteritis are among the most common of these causing aortitis), and the prognosis and treatment of these entities vary widely. Various imaging techniques can be used to evaluate the lumen and wall of the aorta (such as multidetector computed tomography, magnetic resonance imaging, angiography, or PET-CT). This review focuses on the most common diseases that cause aortitis and on the clinical and radiological findings that are most useful for diagnosing and treating this condition appropriately.     

Computed tomography in abdominal tuberculosis.

The diagnosis of abdominal tuberculosis is often difficult because of its protean clinical manifestations and non-specific laboratory investigations. In the abdomen, tuberculosis may affect the intestinal tract, lymph nodes, peritoneum and solid viscera in varying combinations. CT, with its ability to provide a comprehensive overview of abdominal structures, is the imaging modality of choice for evaluation of such patients. This pictorial review illustrates the spectrum of CT appearances of abdominal tuberculosis which includes intestinal, lymph nodal, peritoneal, mesenteric, hepatic, splenic and pancreatic disease.     

腹腔结核的CT表现

目的评价CT诊断腹腔结核的价值。方法回顾性分析经手术病理或抗痨治疗确诊的腹腔结核16例CT表现,其中男8例,女8例。年龄20～66岁,平均36.4岁。结果腹腔淋巴结肿大(n=11),肠系膜肿块(n=6),腹水(n=6,多为限制性),网膜增厚(n=7),肠壁增厚(n=6),胸水(n=2),胰腺结节(n=1)。腹腔淋巴结肿大(以肠系膜、胰周淋巴结为主),主要表现为因中央干酪样坏死而呈环形或多房样强化,并有部分淋巴结钙化,且腹腔淋巴结受累程度明显重于腹膜后间隙淋巴结。结核性腹膜炎时腹水密度较高,系膜、网膜上有斑片状及结节状病灶,肠曲粘连固定。结论密切结合临床、实验室检查及CT表现,有望提高腹腔结核诊断准确性。     

Hepatosplenic antracosilicosis: a rare cause of splenic calcifications

A case of a 62-year-old man with known longstanding pulmonary antracosilicosis, with associated hepatosplenic antracosilicosis, is presented. A CT scan of the upper abdomen revealed multiple calcifications within the spleen, and to a lesser degree within the subcapsular region of the liver, as well as "egg-shell" calcifications of abdominal lymph nodes, most noticeable at the splenic hilum. Although histopathologically not proven, the similar appearance of the calcified hepatosplenic nodules to the small round calcifications scattered throughout the lungs, as well as the typical "egg-shell" morphology of the calcified abdominal lymph nodes, should raise the suspicion of hepatosplenic antracosilicosis.     

Experimentelle und klinische Ansätze zur Lymphknotenbildgebung

Exact assessment of lymph nodes is crucial to tumor staging, choice of therapy and in predicting the outcome. Although imaging plays a central role in the evaluation of lymph nodes, current imaging methods have low sensitivity and specificity primarily because they rely on insensitive morphological criteria or because they have low special resolution. Because of this diagnostic dilemma invasive, expansive and uncomfortable diagnostic techniques and/or unnecessary aggressive therapies are still in use. This brief overview is intended to summarize current imaging strategies and to give an outlook on experimental and clinical strategies in lymph node imaging in cancer.     

Role of 18F-FDG PET/CT in pre and post treatment evaluation in head and neck carcinoma

Head and neck cancer (HNC) ranks as the 6^th most common cancer worldwide, with the vast majority being head and neck squamous cell carcinoma (HNSCC). The majority of patients present with complicated locally advanced disease (typically stage III and IV) requiring multidisciplinary treatment plans with combinations of surgery, radiation therapy and chemotherapy. Tumor staging is critical to decide therapeutic planning. Multiple challenges include accurate tumor localization with precise delineation of tumor volume, cervical lymph node staging, detection of distant metastasis as well as ruling out synchronous second primary tumors. Some patients present with cervical lymph node metastasis without obvious primary tumors on clinical examination or conventional cross sectional imaging. Treatment planning includes surgery, radiation, chemotherapy or combinations that could significantly alter the anatomy and physiology of this complex head and neck region, making assessment of treatment response and detection of residual/ recurrent tumor very difficult by clinical evaluation and computed tomography (CT) or magnetic resonance imaging (MRI). ¹⁸F-2-fluoro-2-deoxy-D-glucose positron emission tomography/CT (¹⁸F-FDG PET/CT) has been widely used to assess HNC for more than a decade with high diagnostic accuracy especially in detection of initial distant metastasis and evaluation of treatment response. There are some limitations that are unique to PET/CT including artifacts, lower soft tissue contrast and resolution as compared to MRI, false positivity in post-treatment phase due to inflammation and granulation tissues, etc. The aim of this article is to review the roles of PET/CT in both pre and post treatment management of HNSCC including its limitations that radiologists must know. Accurate PET/CT interpretation is the crucial initial step that leads to appropriate tumor staging and treatment planning.     

Imaging findings of ruptured abdominal and pelvic tumors

A variety of abdominal and pelvic tumors can present with rupture leading to hemoperitoneum/hemoretroperitoneum or peritonitis. Imaging plays an important role in the diagnosis of hemorrhage or peritonitis as well as in the detection of ruptured tumors or organs. In this article, we illustrate the imaging findings of ruptured tumors arising in the abdominal and pelvic organs while excluding those of ruptured tumors arising in the stomach and intestines. It is important for the radiologists to understand the mechanisms involved in tumor rupture and recognize the imaging features of ruptured tumors according to the organs involved because this will permit the exact diagnosis of ruptured tumors, thereby facilitating prompt and effective treatment.     

Primary pancreatic lymphoma-diagnosed on computed tomography: A rare case report.

Primary pancreatic lymphoma is a rare disease. It comprises less than 0.5 % of pancreatic neoplasm and 0.1% of malignant lymphoma. It should be differentiated from pancreatic adenocarcinoma because management differs. At computed tomography, 2 types of morphology of primary pancreatic lymphoma have been described- a localized well-circumscribed tumoral form and another diffuse enlargement infiltrating or replacing most of the pancreatic gland. Here, we are presenting computed tomography (CT) imaging features of a case of primary pancreatic lymphoma in a 27 year old female who presented with a complaint of abdominal pain radiating to the back for 3 months and yellowish discoloration of sclera and skin for the last 15 days. In contrast-enhanced computed tomography an exophytic homogenously hypoenhancing mass arising from head and neck region of pancreas was seen. Involvement of common bile duct (CBD) and duodenum was there. The main pancreatic duct was not dilated. Common hepatic artery was encased by mass without arterial luminal narrowing or distortion. Diagnosis of primary pancreatic lymphoma was suggested on basis of imaging findings and further confirmed with fine-needle aspiration cytology.     

Gynecologic pathology on multidetector CT: a pictorial review

The purpose of this pictorial essay is to review the imaging appearance of the spectrum of gynecologic pathology that may be visualized by multidetector computed tomography (CT). Although ultrasound and magnetic resonance imaging remain the primary imaging modalities for evaluating female patients with suspected obstetric and gynecologic pathology, CT is frequently performed as the initial imaging modality in the evaluation of abdominal and pelvic pain of unknown etiology. Pelvic pain in women due to a gynecologic condition may also mimic numerous other conditions such as appendicitis and diverticulitis, resulting in initial evaluation by CT—particularly in the emergency setting. The radiologist should, therefore, be familiar with the spectrum of gynecologic and obstetric pathology that may be present on a CT evaluation of the abdomen and pelvis regardless of the study indication, particularly because CT is often the most readily available imaging modality in the emergency setting on a 24/7 basis.     

Nuclear imaging in detection and monitoring of cardiotoxicity

Cardiotoxicity as a result of cancer treatment is a novel and serious public health issue that has a significant impact on a cancer patient’s management and outcome. The coexistence of cancer and cardiac disease in the same patient is more common because of aging population and improvements in the efficacy of antitumor agents. Left ventricular dysfunction is the most typical manifestation and can lead to heart failure. Left ventricular ejection fraction measurement by echocardiography and multigated radionuclide angiography is the most common diagnostic approach to detect cardiac damage, but it identifies a late manifestation of myocardial injury. Early non-invasive imaging techniques are needed for the diagnosis and monitoring of cardiotoxic effects. Although echocardiography and cardiac magnetic resonance are the most commonly used imaging techniques for cardiotoxicity assessment, greater attention is focused on new nuclear cardiologic techniques, which can identify high-risk patients in the early stage and visualize the pathophysiologic process at the tissue level before clinical manifestation. The aim of this review is to summarize the role of nuclear imaging techniques in the non-invasive detection of myocardial damage related to antineoplastic therapy at the reversible stage, focusing on the current role and future perspectives of nuclear imaging techniques and molecular radiotracers in detection and monitoring of cardiotoxicity.