肝实质一过性异常强化：肿瘤与炎性病变对比研究

目的探讨不同肝脏病变间动态增强CT扫描肝实质一过性异常强化(THAE)的表现特征及临床意义。方法收集肝脏或腹部病变为肿瘤类和炎性病变并伴有动态CT扫描肝实质一过性异常强化征象病例43例,所有病例病变均由病理或临床资料证实。通过分组并对肝实质一过性异常强化征的形态、分布部位、强化特点等多方面进行对比分析。结果肿瘤组THAE征均呈楔形、不规则形或节段形,分布于病灶一侧或远离病灶,边界多清楚。炎症组引起的THPE多呈大叶、大片或斑片状,与炎性病灶相临或环绕炎性病灶分布,边界欠清。肿瘤组与炎性病变组对比,动态增强扫描时动脉期肝实质一过性异常强化征在形态和发生部位方面差异性具有统计学意义。结论不同病变伴有特征的动脉期肝实质一过性异常强化征的表现,对于肝内病变的定性和鉴别诊断有参考价值。     

颈动脉间隙及其占位性病变的影像研究

目的:探讨正常颈动脉间隙的影像特点及比较CT、MRI对颈动脉间隙占位性病变的诊断及鉴别诊断价值。方法:分析3例正常男性颈动脉间隙的影像特点;回顾15例经手术病理证实的颈动脉间隙占位性病变,CT检查11例,MRI检查4例。结果:颈部MRI轴位图像上可清楚显示颈深筋膜各间隙的形态和毗邻关系。神经鞘瘤可显示囊变和钙化,MRI显示T2WI呈明亮高信号为其特征。颈动脉体瘤增强后肿瘤显著强化。鳃裂囊肿有其相对固定的发病部位,增强扫描无强化。淋巴管瘤显示分层液面现象为其特征,MRI可显示瘤内脂肪、出血和纤维分隔等不同成分,对鉴别诊断有一定价值。不同来源的肿瘤与颈内、外动脉或颈总动脉和颈内静脉的位置关系有解剖上的相关性,有利于准确的定位和鉴别诊断。结论:颈深部疾病影像检查应首选MRI。根据病变所在的解剖平面、强化扫描特点及其与颈部血管的关系,CT和MRI对大部分颈动脉鞘病变有定性诊断及鉴别价值。     

不典型肝细胞癌的CT表现与分析

目的探讨原发性肝细胞癌(HCC)在螺旋CT扫描中的不典型表现及其产生原因。方法选择17例HCC患者,其中男性14例,女性3例;年龄29～71岁,平均年龄52岁。分析经手术病理组织证实的螺旋CT扫描中呈不典型表现的CT征像和病理学改变。结果17例共发现18个病灶为不典型表现,其中10个病灶在动脉期强化明显,门静脉期和延迟期为等密度或高密度;6个病灶在动脉期、门静脉期和延迟期均呈低密度;2个病灶动脉期病灶边缘有环形强化,门静脉期和延迟期仍有持续强化。结论肝癌在螺旋CT 3期增强扫描中有多种不典型表现,病灶的血液供应情况、病理学基础等是其常见原因。     

甲状腺癌的CT与US表现对比研究

目的对比术前甲状腺癌的CT与超声(Ultrasound,US)表现,评价两种检查方法对甲状腺癌的诊断价值.方法回顾性分析23例同期兼作CT与US检查的甲状腺癌的影像学表现,主要对原发病灶和颈部淋巴结转移进行对比分析,并与临床手术及病理对照.结果 23例甲状腺癌,CT与US两种检查方法在显示肿瘤病灶、形状不规则、密度/回声不均匀和边缘不清楚方面无显著性差异(p>0.05);US对肿瘤囊性、实性及混合性显示率高于CT;CT显示有6例肿瘤出现瘤周"半岛状"瘤结节、4例瘤周"残圈"征;CT检查6例肿瘤出现细颗粒状钙化,US检查4例出现细颗粒状钙化;在颈部淋巴结转移方面,CT检查显示率(60%)略低于US检查(70%).结论超声成像应作为甲状腺癌的首选检查方法,尤其在评价原发病灶及颈部转移性淋巴结方面;CT在肿瘤定性诊断方面具有一定特征性.两种检查手段结合起来,可提高甲状腺癌术前评估和诊断的准确性.     

先天性肺静脉异位引流的双源CT与超声心动图对比研究

对比双源CT(DSCT)和超声心动图(TTE)对先天性肺静脉异位引流(APVC)诊断的价值,以探讨DSCT诊断APVC的优势。回顾性研究行DSCT检查的APVC 31例,其中行手术治疗16例,术前均行DSCT和TTE检查;而未行手术治疗15例,其中行TTE检查10例。统计分析异常静脉的数量、引流的解剖部位和途径,以及合并畸形。其中手术病例,还与手术结果对照。手术病例16例中,诊断异常肺静脉数量及引流部位与途径,DSCT的准确率分别为98%(49/50)、93.8%(15/16)、TTE准确率分别为80%(40/50)、56.3%(9/16),差异均有统计学意义(P<0.05);合并畸形,DSCT和TTE的准确率分别为89.1%(41/46)、78.3%(36/46),差异无统计学意义(P>0.05)。未手术病例15例,DSCT诊断为部分性肺静脉异位引流,但TTE诊断率仅40%(4/10)。因此,与TTE对比,DSCT在准确、全面诊断APVC方面具有明显优势,提示APVC患者术前应常规行DSCT检查。     

异位嗜铬细胞瘤的CT诊断价值

目的探讨异位嗜铬细胞瘤的CT诊断价值,指导临床手术,降低手术风险。方法回顾性分析10例异位嗜铬细胞瘤的临床资料及CT表现,并复习文献。结果10例异位嗜铬细胞瘤术前均进行CT平扫及增强检查,8例位于腹主动脉旁,1例位于膀胱,1例位于后纵隔。平扫肿瘤呈类圆形或椭圆形,伴有囊变、坏死及钙化密度常不均匀;动脉期明显强化,病灶内或周围见增粗迂曲血管影;实质期病灶强化程度稍下降或持续强化。结论 CT检查对异位嗜铬细胞瘤的定位、定性有重要价值,并对手术方案制定及术后的随访有重要意义。     

肝结核18例的CT诊断

目的 分析肝结核的CT表现,探讨肝结核的CT诊断和鉴别诊断.方法 回顾性分析18例有CT检查资料的肝结核,分析其影像学表现.结果 18例肝结核中有12例合并腹腔或肺结核,结节型肝结核4例,可表现为肝内局灶性类圆形或不规则形低密度区,增强扫描无强化或仅有周边轻度强化;粟粒型肝结核12例,CT表现为肝弥漫性肿大、密度减低或表现为肝肿大伴有多发性粟粒状低密度灶,增强扫描无明显强化.混合型肝结核2例,表现为低密度灶和钙化斑点并存,其它类型罕见.结论 粟粒型肝结核较小时CT常常难以显示,但肝肿大、肝CT值降低及无明显强化常见,结合结核病史或伴有其他脏器结核,应考虑到本病可能."粉末"状钙化具有肝结核的诊断价值,结节型肝结核和结核性胆管炎的CT表现有一定的特征性.     

肺原发性淋巴上皮样癌CT诊断及误诊分析

目的探讨肺原发性淋巴上皮样癌的CT表现并分析导致其误诊原因,以提高诊断的正确率。方法选择经手术和病理证实的肺原发性淋巴上皮样癌患者10例,其中男性3例,女性7例;年龄50~71岁,中位年龄60岁。回顾性分析全部患者的CT表现,所有病例均行CT平扫和增强扫描,术后病变组织送病理室行苏木精-伊红染色及免疫组织化学检测。结果中央型3例,周围型7例,均为单发病灶,最大直径约1.2~5.0 cm,发生于左肺上叶2例,左肺下叶3例,右肺中叶5例,4例已发生纵隔淋巴结转移。肿物多为浅分叶状,其中边界清晰7例,边缘可见短毛刺2例;形态不规则3例。平扫密度均匀6例;不均匀4例,1例内部可见点状钙化灶。增强扫描5例明显均匀强化,5例不均匀强化,2例可见无强化坏死区。术前1例误诊为巨淋巴结增生,2例误诊为炎性假瘤,所有病例均未能诊断为肺原发性淋巴上皮样癌。结论肺原发性淋巴上皮样癌少见且缺乏特征性CT征象,容易导致误诊,诊断肺原发性淋巴上皮样癌需首先排除鼻咽癌肺部转移。     

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。     

结直肠癌螺旋CT征象与肿瘤血管生成的关系

目的 探讨结直肠癌螺旋CT征象与肿瘤血管生成的关系.方法40例结直肠癌患者术前均行螺旋CT多期动态扫描,术后肿瘤标本采用免疫组化SP法染色,检测血管内皮生长因子(VEGF)、基质金属蛋白酶(MMP)2和nm23的表达并计数微血管密度(MVD).结果 螺旋CT判断结直肠癌肠外、肠壁浸润的准确率为92.5%.肠外、肠壁浸润组的转移率分别为67.9%和33.3%,差异有统计学意义(P<0.05).螺旋CT结直肠癌肠壁、肠外浸润组间的CT强化程度、MVD、VEGF和MMP-2的表达差异具有统计学意义(t值分别为7.73、2.85、2.44、2.05,P均<0.05).结直肠癌腹腔内转移与无转移组间的CT强化程度、MVD和nm23表达的差异亦有统计学意义(P均<0.05).结直肠癌肠壁浸润组及腹腔内转移组癌组织CT强化程度与MVD之间呈正相关(r=0.878,P<0.05).结论 螺旋CT扫描可准确反映结直肠癌肠外浸润、腹腔内转移情况.MVD和VEGF、MMP-2表达与结直肠癌浸润密切相关.nm23的失活可能是结直肠癌转移的因素.CT强化程度可反映肿瘤血管生成,有助对结直肠癌的浸润、转移进行估计.     

多层螺旋CT增强扫描显示肝静脉正常解剖及变异

目的采用多层螺旋CT增强扫描显示肝静脉正常解剖及变异情况,为活体肝移植及肝叶切除提供解剖学数据.方法100例行CT增强扫描,用肝静脉期(70s)采集数据,应用薄层横断面(1～2 mm)行多平面重组(MPR)、最大密度投影(MIP)法重建.对肝静脉的解剖和变异进行分型,并测量其直径,同时测量右后下肝静脉的直径和肝外段长度.结果100例中3大支肝静脉单独汇入下腔静脉占71%;肝左静脉和肝中静脉共干占29%.肝左静脉直径(6.8±1.8)mm;肝中静脉直径(6.7 1.7)mm;肝右静脉直径(7.9±2.5)mm;右后下肝静脉显示率83%(83/100),右后下肝静脉直径(4.1±1.5)mm;右后下肝静脉肝外段显示率59%(49/83),右后下肝静脉肝外段长度(4.0±1.8)mm.结论多层螺旋CT增强扫描MPR及MIP图像能很好地显示肝静脉正常解剖及变异情况.     

Correlation between radiologic features on contrast-enhanced CT and pathological tumor grades in pancreatic neuroendocrine neoplasms

Contrast-enhanced computed tomography (CT) contributes to the increasing detection of pancreatic neuroendocrine neoplasms (PNENs). Nevertheless, its value for differentiating pathological tumor grades is not well recognized. In this report, we have conducted a retrospective study on the relationship between the 2017 World Health Organization (WHO) classification and CT imaging features in 94 patients. Most of the investigated features eventually provided statistically significant indicators for discerning PNENs G3 from PNENs G1/G2, including tumor size, shape, margin, heterogeneity, intratumoral blood vessels, vascular invasion, enhancement pattern in both contrast phases, enhancement degree in both phases, tumor-to-pancreas contrast ratio in both phases, common bile duct dilatation, lymph node metastases, and liver metastases. Ill-defined tumor margin was an independent predictor for PNENs G3 with the highest area under the curve (AUC) of 0.906 in the multivariable logistic regression and receiver operating characteristic curve analysis. The portal enhancement ratio (PER) was shown the highest AUC of 0.855 in terms of quantitative features. Our data suggest that the traditional contrast-enhanced CT still plays a vital role in differentiation of tumor grades and heterogeneity analysis prior to treatment.     

Automatic detection and classification of hypodense hepatic lesions on contrast-enhanced venous-phase CT

The objective of this work was to develop and validate algorithms for detection and classification of hypodense hepatic lesions, specifically cysts, hemangiomas, and metastases from CT scans in the portal venous phase of enhancement. Fifty-six CT sections from 51 patients were used as representative of common hypodense liver lesions, including 22 simple cysts, 11 hemangiomas, 22 metastases, and 1 image containing both a cyst and a hemangioma. The detection algorithm uses intensity-based histogram methods to find central lesions, followed by liver contour refinement to identify peripheral lesions. The classification algorithm operates on the focal lesions identified during detection, and includes shape-based segmentation, edge pixel weighting, and lesion texture filtering. Support vector machines are then used to perform a pair-wise lesion classification. For the detection algorithm, 80% lesion sensitivity was achieved at approximately 0.3 false positives (FP) per slice for central lesions, and 0.5 FP per slice for peripheral lesions, giving a total of 0.8 FP per section. For 90% sensitivity, the total number of FP rises to about 2.2 per section. The pair-wise classification yielded good discrimination between cysts and metastases (at 95% sensitivity for detection of metastases, only about 5% of cysts are incorrectly classified as metastases), perfect discrimination between hemangiomas and cysts, and was least accurate in discriminating between hemangiomas and metastases (at 90% sensitivity for detection of hemangiomas, about 28% of metastases were incorrectly classified as hemangiomas). Initial implementations of our algorithms are promising for automating liver lesion detection and classification.     

胸部炎性肌纤维母细胞瘤的CT及MRI评价

目的 探讨胸部炎性肌纤维母细胞瘤(IMT)的CT和MRI表现,提高其影像学诊断水平.方法 回顾性分析2005年2月至2009年11月广州医学院第一附属医院及中山大学附属肿瘤医院住院并经手术病理证实的13例胸部IMT的影像学表现.结果 13例病灶中,肺5例,纵膈2例,食道上段1例,右侧胸壁2例,左侧胸壁2例,气管1例.肺IMT 1例为中央型,4例为周围型,为边缘清楚或不清的单发肿块.肺外IMT均表现为大小不一的单个实性软组织肿块,密度均匀或不均匀.2例病灶内出现斑点状钙化,1例胸壁IMT伴肋骨破坏.MR表现为T1WI呈稍低信号,T2WI呈不均匀高信号.结论 CT、MRI检查可清晰显示IMT的大小、形态及与周围组织的关系,对选择手术方案及评价治疗效果有重要参考价值.     

肝脏炎性假瘤与炎性假瘤样滤泡树突状细胞肿瘤的病理学诊断

目的探讨肝脏炎性假瘤及肝脏炎性假瘤样滤泡树突状细胞肿瘤的临床病理学特征及诊断、鉴别诊断要点。方法对肝脏炎性假瘤及肝脏炎性假瘤样滤泡树突状细胞肿瘤各1例进行临床病理分析、免疫组织化学染色及EBV-encoded RNA（EBER）原位杂交检测。结果肝脏炎性假瘤的临床症状包括右上腹不适或疼痛、发热、肝肿大、体重减轻等。大体肿瘤呈实性,境界清楚;镜下肿瘤细胞呈梭形,波浪状排列,其间可见大量淋巴细胞及浆细胞浸润以及散在分布的大的多形性细胞。核仁明显。肝脏炎性假瘤样树突状细胞肿瘤的临床症状、影像学表现及镜下表现均与肝脏炎性假瘤十分相似。但肿瘤细胞边界不清,胞质嗜酸性,除R—S样细胞外,还可见到不少形态怪异的巨细胞,且免疫表型CD21、CD35阳性。EBER（EBV—encoded RNA原位杂交）阳性。结论肝脏炎性假瘤样滤泡树突状细胞肿瘤是罕见的肿瘤,诊断时需注意与肝脏梭形细胞肿瘤甚至霍奇金淋巴瘤鉴别,树突状细胞免疫标记CD21、CD35阳性,特别是EBER原位杂交阳性有助于诊断。     

24例脑肿瘤病人三维脑电地形图与CT、MRI的对照研究

目的：对比研究脑肿瘤患者三维脑电地形图（３Ｄ）和二维脑电地形图（２Ｄ）的变化及临床应用价值。方法：以ＣＴ、ＭＲＩ结果对照，对２４例脑肿瘤患者进行３Ｄ、２Ｄ和常规ＥＥＧ对比分析。结果：与影像学检查一致、基本一致和不一致者：３Ｄ分别为１４、５和５例，２Ｄ为５、１３和６例，ＥＥＧ为９、９和６例。结论：３Ｄ和ＥＥＧ检查结果与影像学一致率高于２Ｄ。２Ｄ的根本缺陷是采用平面圆代表立体的大脑，不能准确显示病变与范围     

基于64排螺旋CT的肝右静脉的应用解剖

目的: 为右叶部分活体肝移植提供有关肝右静脉的活体形态学资料,探讨64排螺旋CT(64-MSCT)显示肝静脉的价值.方法: 利用100例无肝病成人病例,行64-MSCT增强扫描,采集肝静脉期数据,对肝静脉进行三维重建,测量肝右静脉相关数据进行统计分析.结果: 可以清晰显示肝静脉主干及其4级以上属支;肝右静脉开口部位60.0%位于下腔静脉肝后段上份9点位,肝右静脉外科干长(13.01±6.10)mm,其主干距汇入下腔静脉处1、 2、 3、 4cm及主干汇合起始部上壁距肝膈面的距离分别为(13.23±6.79)、 (24.73±8.20)、 (32.63±7.76)、 (39.03±7.24)和(30.68±10.20)mm;肝右静脉Ⅰ型、Ⅱ型分别占71.0%和29.0%,其主干属支汇合形式呈树状者、2支型者和单独1支型者分别占83.0%、 11.0%和6.0%.结论: 国人肝右叶静脉回流多数以肝右静脉为主, 64-MSCT增强扫描可为活体肝移植提供精确的肝静脉走行.     

A dynamic and static study of hepatic arterioles and hepatic sphincters

The purpose of this investigation was to demonstrate the cytology of the sphincters of hepatic sinusoids, to elucidate further the pathway by which arterial blood is distributed to the sinusoids, and to study the hormonal and local regulation of arterial and portal venous blood flow through the sinusoids. The sphincters were found to consist of reticulo-endothelial cells and were the primary site for the regulation of blood flow through the sinusoids. By contracting independently or in unison the flow of blood was regulated through individual sinusoids, through sinusoids supplying a portion of a lobule, or through sinusoids supplying a whole lobule. When the sphincter cells contracted, their nuclear region bulged into the lumen, thereby occluding it. Hepatic arterioles were found to wind around adjacent portal venules with an average curvature of 42° and communicated with sinusoids via arterio-sinus twigs. No structural arterio-portal anastomoses were observed; however, functional “arterioportal anastomoses” were formed by short twigs which terminated in sinusoids near their origins. No branches were found to terminate near central venules. The data suggest that the local regulation of blood flow through the hepatic sinusoids is mediated by vasodilator metabolites (adenosine and/or potassium) released from hypoxic hepatic cells as a result of the rapid glycogenolysis that accompanies hepatic cellular hypoxia.