毛细血管扩张型骨肉瘤的影像表现及其与病理的关系

目的:分析毛细血管扩张型骨肉瘤影像学表现与病理的关系,以提高诊断准确性.方法:回顾性分析经手术病理证实的毛细血管扩张型骨肉瘤9例,术前分别经X线平片、CT平扫、MR SE T1WI、T2WI和T1WI增强扫描,仔细复习影像征象并和手术病理作对照.结果:9例毛细血管扩张型骨肉瘤中,位于股骨5例,胫骨3例和髂骨1例.位于长管状骨者,5例位于干骺端,2例位于骨干,1例接近骨端.肿瘤直径6.3～11.8 cm.所有肿瘤均为溶骨性骨质破坏,破坏区呈椭圆形5例,不规则地图形4例.病灶呈囊状9例,7例病灶境界不清,7例病变见骨膜增生,伴软组织肿块8例,所有病例软组织肿块境界清楚.5例行CT检查,病灶密度低于肌肉或与肌肉相仿,CT显示骨膜增生及软组织肿块较平片清楚,增强扫描软组织明显强化.4例行MR检查,T1WI为混杂信号3例,低信号1例;T2WI为低、等和高信号混杂4例.T2WI 4例均可见明显囊状改变和液-液平面,均可见软组织成分,软组织构成囊壁和分隔,部分呈不规则肿块结节,T2WI软组织信号高于肌肉.结论:毛细血管扩张型骨肉瘤好发于长管状骨干骺端,呈卵圆形或地图样溶骨性破坏,容易呈多囊状坏死,但肿瘤内常见软组织成分,常伴骨膜增生和骨外软组织肿块,CT增强扫描和MR有助于显示病灶的软组织成分.     

原发性软骨肉瘤影像学表现与病理关系

目的:探讨软骨肉瘤的CT和MR及其增强表现,分析其病理基础.方法:回顾分析经手术病理证实的软骨肉瘤27例,术前分别或同时经X线平片、CT平扫和增强、MR SE T1WI、T2WI和T1WI增强扫描,复习影像学扫描结果并和手术病理作对照.结果:27例软骨肉瘤中,普通型22例,间充质型3例,去分化型2例.发病部位包括骨盆11例,管状骨10例,肋骨2例,胸骨1例,椎体1例,软组织1例,腹膜后1例.肿瘤直径4.5～23.0 cm,<5.0 cm 2例,5.0～10.0 cm 17例,>10.0 cm 8例.骨质破坏呈轻度膨胀性或溶骨性,密度等于或低于肌肉密度,钙化21例,扇贝状分叶边缘19例,骨膜增生3例.肿瘤CT值等于或低于肌肉;MR T1WI呈等低信号,T2WI为显著高信号,高信号内总见弓环状低信号分隔或低信号结节.CT和MR增强13例,小叶分隔呈环弓状进行性持续强化,小叶自身不强化.结论:扇贝状分叶边缘、弓环状钙化、T2WI显著高信号内存在弓环状低信号、弓环状进行性强化等构成各型软骨肉瘤的特异性影像学特征,对诊断具有重要价值.     

Managing Incidental Findings on Thoracic CT: Lung Findings. A White Paper of the ACR Incidental Findings Committee

The ACR Incidental Findings Committee presents recommendations for managing incidentally detected lung findings on thoracic CT. The Chest Subcommittee is composed of thoracic radiologists who endorsed and developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address commonly encountered incidental findings in the lungs and are not intended to be a comprehensive review of all pulmonary incidental findings. The goal is to improve the quality of care by providing guidance on management of incidentally detected thoracic findings.     

Ambiguous Findings on Radiographs

Findings with uncertain clinical significance are frequently encountered on radiographs. A structure or opacity visible on radiographs could be due to several causes ranging from artifact or external structure to malignancy or a life-threatening process. The approach that a radiologist chooses to address ambiguous findings can have a significant impact on a patient's health. In this article we discuss the causes and impact of ambiguous findings on radiographs. We also discuss the various strategies radiologists can adopt to maximize clinical value and, when needed, reach a definite diagnosis.     

淋巴管瘤的影像学表现

目的:探讨淋巴管瘤的影像学表现及其与病理的相关性.方法:经手术病理证实的淋巴管瘤26例,男15例,女11例,年龄1个月～68岁,平均19.4岁.7例行CT检查纳入研究,其中6例有平扫加增强扫描;1例行MRI检查;24例行超声检查.结果:CT上病灶均为囊性病变,密度均匀,边界较清楚,壁薄.2例病灶呈单房,5例病灶内可见分隔并形成多房,增强扫描囊壁及部分分隔强化,囊内未见强化.MRI上病变在T1WI上为低信号,T2WI上呈高信号,病变信号不均匀,边界欠清楚,其内见分隔.超声声像图上病灶均为囊实性低回声或无回声肿块影,其中10例病变回声不均质,14例探及条形分隔反射,其中3例分隔为蜂窝状、网状,3例边界不清;彩色多普勒血流成像探及囊内及分隔内血流7例.手术病理显示病变全部为囊性,可看到扩张的淋巴管,有些病灶内可见血管,并见一些纤维组织及脂肪组织成分.结论:淋巴管瘤有较为典型的影像学表现:囊性,薄壁肿块,密度较均匀,边界较清楚;病理与影像一致性好.     

良性成骨细胞瘤的影像学表现

目的 分析良性成骨细胞瘤的影像学表现.方法 收集经手术病理证实的5例发生于脊椎外的良性成骨细胞瘤,其中男4例,女1例,年龄20～50岁,平均28岁.5例均摄有病变部位正侧位平片,3例有CT检查,1例有MR检查.结果 5例中,发生于跟骨者2例,距骨者1例,腓骨者1例,髌骨者1例.X线表现:2例呈局灶性骨质破坏,边界清晰;1例呈膨胀性改变,边缘有硬化,其内密度不均;1例略呈囊状膨胀性骨质破坏;1例病变呈溶骨性破坏,边界欠清.CT检查:2例病变呈均匀低密度,其内无钙化及骨化,无硬化边,增强扫描病变有中度强化,其中1例伴有病理性骨折;1例呈外生囊状膨胀性生长,有花边样硬化边,其内可见点、片状高密度影.MRI检查:病变主体位于骨皮质内,边界清晰,T1WI呈均匀低信号,T2WI呈等低信号,增强扫描明显强化.结论 脊椎以外成骨细胞瘤影像无明显特征性,容易误诊,CT对其影像学细节征象的显示有较大优势.     

耳硬化症CT表现

目的探讨耳硬化症的高分辨率CT(HRCT)表现及其应用价值。资料与方法回顾性分析2000年11月至2004年9月经手术证实的耳硬化症24例,均行水平位及冠状位HRCT扫描,层厚、层间距1mm,窗位700HU,窗宽4000HU。结果左耳13例,右耳12例CT显示前庭窗前方低密度影;左耳7例,右耳7例耳蜗周围可见低密度影;6例镫骨底板增厚,其中左侧3例,右侧3例;5例镫骨底板塌陷,左侧2例,右侧3例;4例前庭窗扩大,左侧2例,右侧2例;6例前庭窗狭窄,左侧2例,右侧4例。结论耳硬化症好发于年轻女性,病变累及耳囊各部,前庭窗前方近鼓岬处为好发部位,活动期表现为密度减低影,前庭窗状似“扩大”,底板“塌陷”,成熟期表现为前庭窗变窄,甚至封闭;耳蜗周围尤其环绕底转常可发现异常病灶,“斑点”状或“弧线”样,典型表现为“双环征”。CT可以清晰地显示病变范围及其程度,对明确诊断及随诊有很大帮助。     

急性呼吸窘迫综合征的X线表现(附26例报告)

目的分析急性呼吸窘迫综合征(ARDS)的X线及CT表现. 资料与方法 26例ARDS均行X线检查,其中18例有2～6次胸部X线检查,2例同时行CT扫描. 结果初次检查,正常7例,肺纹理增多8例,毛玻璃样表现11例,胸腔积液6例.复查显示随着检查时间不同,上述肺内表现逐渐演变,数周后可以转归为网格状肺纹理. 结论胸部X线片对于ARDS的诊断有很重要的价值,可用于ARDS的诊断及治疗后随访.     

节细胞神经瘤的CT表现

目的　探讨节细胞神经瘤的特征性CT表现。材料与方法　对 11例经病理证实的节细胞神经瘤的CT表现进行回顾性分析。结果　 8例位于右侧肾上腺 ,3例位于腹膜后 ,3例中 1例同时合并双侧肾上腺嗜铬细胞瘤。肿瘤最大直径 3～ 6cm ,平均4.4cm。呈椭圆形者 9例 ,2例呈圆形。肿瘤边界均清晰 ,无周围组织和血管侵犯征象。平扫呈均匀低密度 ,平均 2 7.8± 4.7HU ,内有点状钙化者 3例 ( 2 7% )。增强扫描有轻度强化 ,平均 3 6.3± 9.4HU。结论　节细胞神经瘤有一些特征性CT表现 ,但确诊仍依赖组织学检查。     

Imaging Findings in Auto-Atticotomy

BACKGROUND AND PURPOSE:An acquired attic cholesteatoma may spontaneously drain externally into the external auditory canal, leaving a cavity in the attic with the shape of the original cholesteatoma but now filled with air, a phenomenon referred to as “nature''s atticotomy” or auto-atticotomy. We describe and quantify the CT appearance of the auto-atticotomy cavity as it pertains to the appearance of the scutum and the lateral attic wall.MATERIALS AND METHODS:Twenty-one patients with erosion of the scutum and loss of the lower attic wall on MDCT were identified during a 5-year span. Images were assessed for measureable widening of the space between the ossicles and the lower lateral attic wall in the axial and coronal planes. Three measurements of the lateral attic were made on the axial images. Findings were compared with the same measurements in 20 control subjects.RESULTS:The 21 patients had a characteristic blunting of the scutum with loss of the lower lateral attic wall and widening of the lateral attic, consistent with an auto-atticotomy. There was a statistically significant (P < .001) widening of the lateral attic dimensions in the axial plane in the patients with auto-atticotomy.CONCLUSIONS:Spontaneously evacuated cholesteatoma may mimic a surgical atticotomy on MDCT. Scutal erosion and attic enlargement with a smoothly contoured bony remodeling of the lower lateral attic wall in a patient with no history of surgery suggest that a cholesteatoma was previously present and spontaneously drained.

An atticotomy is a surgical approach through the external auditory canal to the attic of the middle ear, whereby the scutum and the lower lateral wall of the attic are surgically removed for access. An auto-atticotomy (also called “nature''s atticotomy”) refers to an enlarged lateral attic with absence of the scutum and lower lateral wall of the attic in a patient without a history of surgery.^1–3 This entity results from a deep retraction pocket or a cholesteatoma that has eroded the bone and then spontaneously drained into the external auditory canal. The wall of the original cholesteatoma remains, and so the air-filled defect is lined by keratinizing squamous epithelium. The appearance of an atticotomy and an auto-atticotomy is similar on CT. The purpose of this article was to describe the findings of auto-atticotomy on multidetector CT of the temporal bone.     

Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings. A White Paper of the ACR Incidental Findings Committee

The ACR Incidental Findings Committee presents recommendations for managing incidentally detected mediastinal and cardiovascular findings found on CT. The Chest Subcommittee was composed of thoracic radiologists who developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address the most commonly encountered mediastinal and cardiovascular incidental findings and are not intended to be a comprehensive review of all incidental findings associated with these compartments. Our goal is to improve the quality of care by providing guidance on how to manage incidentally detected thoracic findings.     

MR Imaging Findings of the Intraspinal Meningeal Melanocytoma: Correlation with Histopathologic Findings

SUMMARY: Our aim was to better understand and improve the accuracy of the preoperative diagnosis of intraspinal MM by a combined analysis of MR imaging and pathologic findings. All 5 patients had undergone unenhanced and contrast-enhanced MR imaging examinations. All tumor samples had immunohistochemical reactions to HMB-45, vimentin, S-100, EMA, and Leu-7 antibodies. All 5 cases were located in the intradural extramedullary compartment. Two cases had multifocal lesions, and 3 cases were solitary. Two cases showed homogeneously strong enhancement, and 3 cases showed moderate enhancement on contrast-enhanced T1WI. The tumor cells had positive reactions to HMB-45, vimentin, and S-100 antibodies. MR imaging plays an important role in the detection and diagnosis of intraspinal MM. Final diagnosis should be based on histopathology and IHC examinations.     

极性成胶质细胞瘤的CT表现（附15例分析）

极性成胶质细胞瘤海风了，术前定性诊断困难，报道１５例旨在提高对该病的认识。回顾性分析１５例经手术病理证实的极性成胶质细胞瘤的ＣＴ表现。幕上１２例，幕下３例；平扫１５例中１４例表现为低密度区或多房状低密度区，边界不清，有明显灶周水肿及占位效应；１例呈边界清楚的囊状低密度区。     

腹腔脓肿的CT表现

目的：旨在进一步提高对腹腔脓肿CT表现的认识。材料和方法：经手术证实的腹腔脓肿15例，回顾性分析腹腔脓肿的CT表现。结果：11例中央呈均匀低密度影及由低密度影勾画出的壁，占73％；内壁光，外壁毛糙分别为8例、10例，分别占72％、90％，增强后壁强化程度明显高于软组织。腔内含气影7例，占46％。脓肿邻近脏器界面显示模糊10例，占66％。腹腔脂肪呈索条状、片状、网格状密度增高9例，占60％。腹壁炎性改变4例，占26％。结论：CT可对腹腔脓肿作出正确诊断，但早期腹腔脓肿，应追踪观察有无脓壁形成，有助于脓肿的诊断。     

Ductographic Findings of Breast Cancer

Ductography has become the gold standard for the evaluation of patients exhibiting pathologic nipple discharges. In nine patients (age range, 29-67 years; median age, 51 years) with invasive (n=5) or intraductal (n=4) cancer, ductographic findings were recorded, then correlated with mammographic and sonographic findings. Common ductographic findings included complete ductal obstruction, multiple irregular filling defects in the nondilated peripheral ducts, ductal wall irregularities, periductal contrast extravasation, and ductal displacement. Faint microcalcifications or ill-defined masses, which were not opacified by contrast material, were often discovered adjacent to ductal abnormalities. Mammographically and sonographically occult diffusely spreading intraductal cancers often manifested as pathologic nipple discharge. In such cases, meticulous ductographic examinations and interpretations were crucial in order not to miss breast cancers.     

结核性肾盂肾炎的CT表现

目的:探讨结核性肾盂肾炎的CT表现及其特征。材料和方法:回顾性分析32例经手术病理、生化检测或临床治疗证实的结核性肾盂肾炎的CT表现。结果:结核性肾炎CT表现为肾实质内局灶或多发类圆形或扇形稍低密度影,增强扫描不增强。结核性肾盂炎CT表现为肾盂及部分肾大盏变形、充盈缺损及积水征。结论:肾脏CT平扫并增强扫描是诊断结核性肾盂肾炎的重要手段,正确认识结核性肾盂肾炎的CT表现及其影像特征可减少误诊。     

脊柱结核的CT诊断

目的探讨脊柱结核的CT表现及脊柱结核CT检查的重要意义。方法对30例临床和病理确诊的脊柱结核病例的CT表现进行回顾性分析。结果脊柱结核的CT表现包括:(1)椎体及附件不规则虫蚀样和囊状骨质破坏。(2)沙砾样和斑片样死骨形成。(3)椎间盘坏死及椎间隙狭窄、消失。(4)椎旁脓肿、纵隔脓肿、腰大肌脓肿。(5)椎体后部的骨质破坏产生的碎骨片和坏死物质可进入椎管压迫硬膜囊和神经根。(6)椎体塌陷呈楔形。结论CT对脊柱结核的诊断和鉴别诊断有重要价值,尤其脊柱结核对椎体附件和椎管的累及范围、程度可清楚地显示,对指导手术治疗和判断预后有重要意义。     

脑血管母细胞瘤的MRI表现

目的: 探讨不同类型脑血管母细胞瘤的MRI表现.材料和方法: 回顾性分析10例经手术证实为脑血管母细胞瘤的MRI表现.结果: 发生在幕下小脑的9例中,大囊小结节型6例,实质型、单纯囊型及混合型各1例,幕上大脑半球1例,呈大囊小结节型.结论: MRI平扫及增强扫描能较全面地显示各种类型脑血管母细胞瘤的特点.     

支气管扩张症的多层螺旋CT表现

目的 探讨支气管扩张症的多层螺旋CT表现. 资料与方法 回顾性分析29例经手术证实和临床确诊的支气管扩张症的多层螺旋CT表现. 结果 29例MPR均显示扩张的支气管,其中柱状型11例,囊状型5例,静脉曲张型3例,混合型10例.行仿真内镜的21例中,15例显示支气管黏膜炎症、管腔内黏液栓、血块、环状软骨不完整及管腔扩张.采用肺透明技术重建的29例中,7例显示扩张的支气管. 结论 MSCT能对支气管扩张症做出较全面的评估.     

MR Imaging Findings of Clonorchiasis

Objective

The purpose of this study was to evaluate the MR spectrum and MR cholangiographic imaging findings of clonorchiasis.

Materials and Methods

We reviewed 26 patients with confirmed clonorchiasis by either stool tests (n=24) or surgery (n=2). MR imaging was performed on a 1.5 T system (GE Medical Systems, Milwaukee, WI) with a torso coil. Axial T1- and T2-weighted, gadolinium-enhanced dynamic images and MR cholangiography were obtained. Image analyses were used to identify abnormalities of the intrahepatic and extrahepatic bile ducts and the presence of hepatobiliary malignancy. All MR examinations were reviewed by the consensus of two abdominal radiologists.

Results

Intrahepatic bile duct abnormalities were seen in 23 (89%) of the 26 patients. The most common finding was mild dilatation of the intrahepatic bile duct which was found in 21 (81%). "Too many intrahepatic ducts" were found in 16(62%), wall enhancement and thickening in 21 (81%) and filling defects and ductal stricture in the intrahepatic bile duct in 6 (24%) and 3 (12%) patients, respectively. Extrahepatic ductal dilation was found in 5 (19%) and 9 (35%) revealed hepatobiliary malignancy.

Conclusion

MR imaging revealed various findings of clonorchiasis, including dilatation, wall enhancement, stricture of the intrahepatic ducts and filling defect within the intrahepatic bile duct.