Investigation of acute lower gastrointestinal bleeding with 16‐ and 64‐slice multidetector CT†

We evaluated the usefulness of 16‐ and 64‐slice multidetector CT (MDCT) in the detection of a bleeding site in acute lower gastrointestinal tract (GIT) haemorrhage by conducting a retrospective study of cases of presumed acute lower GIT haemorrhage imaged with CT in two teaching hospitals in an 11‐month period. The patients underwent contrast enhanced CT using either a 16 or 64 MDCT. No oral contrast was used. One hundred milliliters of non‐ionic intravenous contrast agent was injected at 4.5 mL/s, followed by a 60 mL saline flush at 4 mL/s through a dual head injector. Images were acquired in arterial phase with or without non‐contrast and portal phase imaging with 16 × 1.5 mm or 64 × 0.625 mm collimation. Active bleeding was diagnosed by the presence of iodinated contrast extravasation into the bowel lumen on arterial phase images with attenuation greater than and distinct from the normal mucosal enhancement or focal pooling of increased attenuation contrast material within a bowel segment on portal‐venous images. Further management and final diagnosis was recorded. Fourteen patients and 15 studies were reviewed. CT detected and localized a presumed bleeding site or potential causative pathology in 12 (80%) of the patients. Seven of these were supported by other investigations or surgery, while five were not demonstrated by other modalities. Eight patients had mesenteric angiography, of which only four corroborated the site of bleeding. CT did not detect the bleeding site in three patients, of which two required further investigation and definitive treatment. We propose that MDCT serves a useful role as the initial rapid investigation to triage patients presenting with lower GIT bleeding for further investigation and management.     

多排CT对肝细胞癌动门脉分流诊断能力研究

目的 评价多排CT(MDCT)技术诊断肝细胞癌(HCC)合并动门脉分流(APS)的能力。方法 282例HCC接受MDCT肝动脉早期、晚期和门脉期薄层增强扫描和数字减影血管造影(DSA)检查。APS的诊断标准;(1)门脉主干和(或)1级分支增强早于肠系膜上静脉或脾静脉,或门脉主干和(或)1级分支显影密度大于肠系膜上静脉或脾静脉;(2)门脉2级及以下分支增强早于门脉主干,或门脉2级及以下分支显影密度大于门脉主干。采用双盲法分析、比较MDCT和DSA显示APS的结果。结果 全组有56例HCC合并APS。MDCT显示中央型APS 48例,其中重度41例,中度7例,有1例HCC病灶巨大,DSA未能显示合并的中度分流;轻度周围型APS7例,有2例因分流量小DSA未能显示。1例中度混合型APS MDCT和DSA均显示。结论 MDCT是一种简便、有效、非侵入性诊断HCC合并APS的新技术。     

多排螺旋CT在检测早期胃癌淋巴结转移中的临床价值评估

目的评估多排螺旋CT在检测早期胃癌术前淋巴结转移中的临床价值。方法使用多排螺旋CT评估77例早期胃癌患者的淋巴结转移情况,其中24例患者采用的多排螺旋CT层厚为2.5～5.0 mm,53例患者采用的层厚为7.5～10.0 mm。结果多排螺旋CT检测淋巴结转移的准确率为74.0%,而手术评估的准确率为54.5%。采用2.5～5.0 mm层厚的多排螺旋CT对淋巴结转移诊断的敏感度、特异度、阳性预测值和阴性预测值分别为75.0%、65.0%、30.0%和92.9%;采用7.5～10.0 mm层厚的多排螺旋CT对淋巴结转移诊断的敏感度、特异度、阳性预测值和阴性预测值分别为62.5%、82.2%、38.5%和92.5%;而相应手术的评估值分别为45.5%、63.6%、17.2%和87.2%。结论MDCT对淋巴结转移诊断的准确率较高,对早期胃癌淋巴结转移的检测有一定的临床价值。     

Usefulness of preoperative multidetector-row computed tomography in evaluating the extent of invasive lobular carcinoma in patients with or without neoadjuvant chemotherapy

Background  The present study was conducted to assess the clinical usefulness of multidetector-row CT (MDCT) in determining the extent of invasive lobular carcinoma (ILC) and especially the extent of residual tumor after neoadjuvant chemotherapy (NAC). Patients and methods  The subjects were 24 patients with primary ILC who underwent surgery without NAC and 17 patients with ILC who underwent surgery after NAC at National Cancer Center Hospital (NCCH) between April 1999 and December 2005. The extent of primary ILC was assessed by ultrasound, mammography, and MDCT before surgery, and the results obtained using each modality were compared with the results of pathological examination after surgery. In addition, the characteristic findings of ILC obtained by MDCT were assessed. Similarly, the extent of residual tumor after NAC was evaluated using ultrasound, mammography, and MDCT before surgery in the subjects who underwent NAC, and the results obtained by each modality were compared with the results of pathological examination after surgery. Results  The findings of primary ILC obtained by MDCT showed that the carcinoma was the non-localized type rather than the localized type in 63% of the subjects. In addition, with regard to the pattern of time-sequential contrast enhancement, the persistent pattern (in which tumor enhancement is strong in the late phase rather than in the early phase) was observed in 46% of the subjects, and the plateau pattern (in which contrast enhancement is weak in both the early phase and the late phase) was observed in 38% of the subjects. These trends were significant in the subjects who underwent NAC and in whom tumor enhancement could not be clearly observed by MDCT. Assessment of the extent of carcinoma showed that the diagnostic accuracy of MDCT was 79%, as compared with 71% for either ultrasound or mammography. Assessment of the extent of carcinoma after NAC also showed that the diagnostic accuracy of MDCT was 71%, as compared with 48% for ultrasound and 53% for mammography, indicating that MDCT provided the highest accuracy. It should be noted that for all modalities, the extent of ILC was not overestimated as compared with the tumor diameter measured during pathological examination. Conclusion  Assessment by MDCT showed that ILC tends to be diffuse, tumor enhancement tends to be very weak, and the rate of enhancement tends to be low. In addition, MDCT was found to be useful for determining the extent of carcinoma, and the diagnostic accuracy of MDCT, especially in determining the extent of carcinoma after NAC, was much higher than that of ultrasound or mammography.     

Ovarian Masses: Is Multi-detector Computed Tomography a Reliable Imaging Modality?

Background: Ovarian cancer continues to pose a major challenge to physicians and radiologists. It is thethird most common gynecologic malignancy and estimated to be fifth leading cancer cause of death in women,constituting 23% of all gynecological malignancies. Multi-detector computed tomography (MDCT) appears tooffer an excellent modality in diagnosing ovarian cancer based on combination of its availability, meticuloustechnique, efficacy and familiarity of radiologists and physicians. The aim of this study was to compute sensitivity,specificity, positive and negative predictive values and diagnostic accuracy of 64- slice MDCT in classifyingovarian masses; 95% confidence intervals were reported. Materials and Methods: We prospectively designeda cross-sectional analytical study to collect data from July 2010 to August 2011 from a tertiary care hospital inKarachi, Pakistan. A sample of 105 women aged between 15-80 years referred for 64-MDCT of abdomen andpelvis with clinical suspicion of malignant ovarian cancer, irrespective of stage of disease, were enrolled by nonprobabilitypurposive sampling. All patients who were already known cases of histologically proven ovariancarcinoma and having some contraindication to radiation or iodinated contrast media were excluded. Results:Our prospective study reports sensitivity, specificity; positive and negative predictive values with 95%CI andaccuracy were computed. Kappa was calculated to report agreement among the two radiologists. For readerA, MDCT was found to have 92% (0.83, 0.97) sensitivity and 86.7% (0.68, 0.96) specificity, while PPV and NPVwere 94.5% (0.86, 0.98) and 86.7% (0.63, 0.92), respectively. Accuracy reported by reader A was 90.5%. Forreader B, sensitivity, specificity, PPV and NPV were 94.6% (0.86, 0.98) 90% (0.72, 0.97) 96% (0.88, 0.99) and87.1% (0.69, 0.95) respectively. Accuracy computed by reader B was 93.3%. Excellent agreement was foundbetween the two radiologists with a significant kappa value of 0.887. Conclusion: Based on our study results,we conclude MDCT is a reliable imaging modality in diagnosis of ovarian masses accurately with insignificantinterobserver variability.     

Clinical value of multidetector row computed tomography in detecting lymph node metastasis of early gastric cancer.

AIMS: To evaluate the clinical value of multidetector row computed tomography (MDCT) as a pre-operative staging tool for lymph node metastasis in patients with early gastric cancer (EGC). METHODS: In 278 consecutive patients with EGC, lymph node metastasis was evaluated pre-operatively with MDCT at a slice thickness of 2.5mm (n=57), 5.0mm (n=188), or 7.5mm (n=33). RESULTS: Overall accuracy of nodal category from N0 to N3 was 86% for MDCT and 95% for operative assessment. Regarding accuracy in detecting at least one metastatic lymph node, area under curves (AUC) of receiver operating characteristics for 2.5, 5.0, and 7.5-mm slices and assessment during surgery were 0.87, 0.67 and 0.47, and 0.70, which were significantly different (P<0.0001). MDCT image with 2.5-mm could discriminate the presence of lymph node metastasis with diagnostic accuracy: sensitivity 80%; specificity 92%; positive predictive value (PPV) 50%; negative predictive value (NPV) 98%, whereas assessment during surgery was as follows: sensitivity 65%; specificity 98%; PPV 72%; and NPV 97%. CONCLUSIONS: These results suggest that pre-operative assessment with MDCT using thinner slices may detect at least one lymph node metastasis as accurately as assessment during surgery for patients with EGC.     

气管支气管树腺样囊性癌MSCT表现

  目的  观察分析气管支气管树腺样囊性癌（adenoid cystic carcinoma,ACC）的MSCT表现,以期提高对该病的认识。  方法  回顾性分析和总结天津医科大学肿瘤医院2004年4月至2013年4月经组织病理证实的19例原发气管支气管树腺样囊性癌的MSCT表现。  结果  19例中气管病变7例,段及以上支气管病变10例,周围型病变2例;腔内外生长型15例（79%）,腔内生长型2例（11%）。气管ACC有明显的沿气管黏膜下浸润延伸趋势,表现为气管壁弥漫环周增厚2例,移行状增厚3例;10例段及以上支气管ACC均表现为腔内外型肿物,8例病变相邻支气管腔内可见息肉样影隆起或突入,7例腔外部分大于腔内。13例增强检查中3例无强化,5例轻度强化,4例中度强化,1例明显强化。  结论  气管支气管树腺样囊性癌MSCT表现具有一定特点,CT可定性诊断,但明确诊断需依靠病理。      

Vessel probe CT protocol in the study of esophageal carcinoma: Can it improve preoperative T staging?

Aims

This study aims to compare transverse images and vessel probe (VP) in MPR mode reconstructions obtained by 16-row MDCT with the histological findings in the preoperative T staging of esophageal cancer.

Materials and methods

Thirty-one patients (23 M, 8 F, mean age 63.2) with endoscopic and histological diagnosis of esophageal carcinoma underwent CT examination. Esophageal lumen was distended by CO₂ and a biphasic technique with 35 s and 70 s delay was used after intravenous injection of contrast material. Transverse and VP in MPR mode images were evaluated and the following parameters were considered: presence and location of the tumor; esophageal wall thickness and enhancement; depth of visceral wall invasion; periesophageal fat morphology and infiltration of adjacent organs. Preoperative staging was performed and then it was compared with the histological findings considered as reference standard.

Results

Sensibility, negative predictive and accuracy values were 67%, 64% and 79% by using axial images for preoperative T staging, while the use of VP increased the previous values up to 83%, 78% and 89%, respectively.

Conclusions

In the preoperative staging of esophageal cancer, VP in MPR mode reconstructions obtained by 16-row MDCT increase the sensibility and diagnostic accuracy values in the T parameter evaluation compared with axial images.     

不典型肾血管平滑肌脂肪瘤的多层CT诊断及误诊分析

目的:探讨不典型肾血管平滑肌脂肪瘤（ARAML）的多层CT（MDCT）表现及误诊原因。方法:分析经手术病理证实的19例ARAML误诊病例的MDCT资料,观察病灶边界、密度、强化特征及其多发、伴发病灶等,分析误诊原因。结果:18例边界清楚锐利,1例合并出血、周围见渗出;所有病例肾皮质均见不同程度缺损。乏脂肪或无脂肪16例:密度均匀10例,其中延时强化7例、强化呈“快进快出”3例;密度不均匀6例,其中瘤内出现“黑斑征”5例、瘤内合并出血1例。瘤内见粗大强化血管影1例。外生富脂肪型1例,无明显强化。多房囊性1例,囊壁及分隔明显强化。4例多发,其中1例为结节性硬化症并肺内、骨骼多发高密度结节改变;1例伴发肝血管平滑肌脂肪瘤。术前误诊为肾癌17例（包括多房囊性肾癌1例）,腹膜后脂肪肉瘤1例,肾转移瘤1例。结论:ARAML的MDCT表现为边界清楚锐利,增强扫描延时强化常见,伴或不伴一些特征性征象（“黑斑征”、粗大血管影、皮质缺损征等）。但少数表现极不典型者（如多房囊性、明显外生富脂性）易造成误诊。临床工作中需综合分析,仔细观察病灶及周围征象,尤其增强扫描及多平面重建有助于提高诊断正确性。     

MDCT动态增强扫描测量肝癌与膈肌交界面弓弦比对膈肌侵犯的诊断价值

目的 探讨MDCT动态增强扫描不同期相测量肝癌与膈肌交界面弓弦比对膈肌侵犯的诊断价值。方法 回顾性分析本院影像学检查提示癌灶与邻近膈肌关系密切的肝癌患者90例。经手术及病理检查证实53例无膈肌侵犯,37例有膈肌侵犯。分别测量3个期相（平扫、增强扫描动脉期及增强扫描静脉期）CT图像中的弓长（肝癌与膈肌交界面长度）、弦长（与弓长大致平行的肿瘤最大径线）,并计算弓弦比。通过分析3个期相所测弓弦比对肝癌膈肌侵犯的受试者工作特征（receiver operating characteristic,ROC）曲线,评价其诊断效能并确定诊断阈值。结果 无膈肌侵犯与膈肌侵犯在平扫、增强扫描动脉期及增强扫描静脉期所测弓弦比值的差异均有统计学意义（P均＜0.05）,ROC曲线示平扫、增强扫描动脉期及增强扫描静脉期的曲线下面积（area under the curve,AUC）分别为0.814、0.769、0.893,Z检验示增强扫描静脉期与平扫、增强扫描静脉期与增强扫描动脉期的AUC之间的差异均有统计学意义（P均＜0.05）。取增强扫描静脉期所测弓弦比的阈值为1.07时,其诊断膈肌侵犯的敏感性为89.2%,特异性为84.9%。结论 MDCT动态增强扫描静脉期图像测量肝癌与膈肌交界面弓弦比可以作为评估癌灶侵犯膈肌的一种简便而准确的方法。     

Serum vascular endothelial growth factor-C combined with multi-detector CT in the preoperative diagnosis of lymph node metastasis of gastric cancer

Aim: To investigate whether serum vascular endothelial growth factor‐C (SVEGF‐C) and multi‐detector computed tomography (MDCT) can predict lymph node metastasis (LNM) in gastric cancer (GC). Methods: The SVEGF‐C level of 80 patients with GC was examined by enzyme linked immunosorbent assay. An MDCT scan of the abdomen was performed. Kaplan – Meier survival analysis was used to analyse survival. Results: In patients with GC, a higher level of SVEGF‐C was found in the LNM group (650.9 ± 198.6 vs 451.0 ± 115.5 pg/mL, P = 0.000) and in patients with distant metastases (834.3 ± 80.0 pg/mL vs 557.9 ± 187.0 pg/mL, P = 0.000). With a cut‐off value of 542.5 pg/mL, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SVEGF‐C for predicating LNM were 82.8, 81.8, 82.5, 92.3 and 64.3%, respectively. MDCT could not be employed to detect the LNM. When SVEGF‐C associated with MDCT was employed to determine LNM in GC, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 91.4, 86.4, 90.0, 94.6 and 79.2%, respectively. No difference of SVEGF‐C level was found among N1, N2 and N3 groups (P > 0.05). The 5‐year overall survival was 47.5%. A shorter mean survival time were found in patients with SVEGF‐C >834.3 pg/ml (43.3 ± 2.8 months vs 67.4 ± 2.5 months, P = 0.000) and in patients who were MDCT‐positive (42.7 ± 3.8 months vs 60.8 ± 2.2 months, P = 0.0034). Conclusion: SVEGF‐C may be a biomarker for a preoperative diagnosis of LNM. In conjunction with MDCT, SVEGF‐C can improve the accuracy of a diagnosis of LNM in GC. A higher SVEGF‐C level and an MDCT‐positive finding could predict the poorer prognosis of GC.     

多排螺旋CT低张力动态增强扫描在进展期胃癌术前评估中的价值

目的 探讨多排螺旋CT（MDCT）低张力动态增强扫描对进展期胃癌术前评估的价值.方法 对43例进展期胃癌患者行MDCT低张力动态增强扫描,判断肿瘤诊断及分期,预测手术可切除性,并与病理学结果进行比较.结果 本组43例行手术治疗,其中36例行手术切除,7例行肠胃吻合术.MDCT术前T分期总体符合率为76.7％（33/43）,术前N分期总体符合率为74.4％（32/43）.胃壁厚度与浆膜浸润密切相关（x 2=20.1709,P＜ 0.001）.结论 MDCT低张力动态增强扫描能够较全面、准确地反应进展期胃癌T、N分期,能够为胃癌术前诊断和治疗提供指导.     

套细胞淋巴瘤的多层螺旋CT影像学表现及其在分期中的应用价值

目的探讨多层螺旋CT(multidetector computed tomography,MDCT)中套细胞淋巴瘤(mantle cell lymphoma,MCL)的影像学表现,以及在分期中的应用价值。方法回顾性分析23例MCL患者初诊及随诊MDCT图像,以病理和临床诊断作为金标准。结果 MCL患者23例,多表现为全身多区域淋巴结受侵(91.3%,21/23).各区域内肿大淋巴结可呈融合状,亦可呈孤立状,CT增强扫描呈中等、均匀强化。与金标准比较,MDCT检出区域淋巴结受侵的敏感性为82.1%,特异性为75.2%,MDCT对受侵淋巴结区域检出的一致性适中(Kappa值为0.410)。MDCT检出结外受侵10例(52.6%,10/19),包括肺受侵2例、脾受侵6例、扁桃体受侵3例、肠道受侵2例、乳腺受侵1例,其敏感性为75.4%,特异性为91.6%。与临床分期对照.23例患者中MDCT分期Ⅰ期1例(4.3%),Ⅱ期2例(8.7%),Ⅲ期13例(56.5%),Ⅳ期7例(30.5%).其分期准确率为73.9%(17/23)除4例因骨髓受侵将Ⅳ期低估为Ⅲ期外,将Ⅰ期高估为Ⅱ期1例,将Ⅲ期低估为Ⅱ期1例。结论 MDCT对MCL全身淋巴结受侵区域的检出具有较高的敏感性,分期准确率较高;除骨髓外,MDCT对结外受侵器官的检出敏感性亦较好。     

C.T. Demonstration of Thrombosis of the Portal Venous System

Thrombosis involving all or part of the portal venous system was demonstrated by C.T. in three patients. Predisposing factors were sigmoid colectomy for adenocarcinoma, appen-diceal abscess and splenectomy for splenic arterio-venous malformation, respectively. Fresh thrombus appeared as high density intraluminal content on noncontrast enhanced scans. Older thrombus appeared as low density intraluminal content surrounded by a high density venous wall on contrast enhanced scans. One patient developed a cavernoma of the portal vein demonstrated by C.T. and porto-graphy. In another patient; bowel infarction with bowel wall thickening and intra-mural gas was demonstrated. Although the diagnosis can be made on non-contrast enhanced scans in the acute phase and by using the bolus intravenous technique for contrast enhanced scans for older thrombus, optimal demonstration of the presence of thrombus and clear definition of the extent of thrombosis requires a dynamic scanning technique during rapid intravenous infusion of contrast.     

64排螺旋CT在直肠癌术前分期的诊断价值

目的：评价64排螺旋CT进行直肠癌术前分期的准确性及诊断价值。方法：纳入51例经手术病理检查证实为直肠癌,并在术前行全腹CT扫描的患者,分析CT影像在确定肿瘤侵犯范围、淋巴结转移及远处转移方面的特点,并与病理结果进行对比。结果：64排螺旋CT对直肠癌T分期、N分期、M分期的准确度分别为84．3％（43／51）,84．3％（43／51）,98．0％（50／51）,对直肠癌TNM分期总准确度为74．5％（38／51）。结论：利用64排螺旋CT腹部平扫技术,能够较为准确地进行直肠癌术前分期,有助于临床选择恰当的手术方案和制定有效的综合治疗措施。     

进展期胃癌64排螺旋CT三期增强影像强化特点与组织学分型相关性的研究

目的探讨进展期胃癌病灶强化程度及强化方式与组织学分型的关系。方法进展期胃癌共121例,术前行64层螺旋CT三期增强扫描,应用轴位图像结合VR、MPR和MIP重建,研究CT图像上病灶的强化程度及强化方式,并将结果与术后病理所示胃癌组织学分型比较分析。结果病灶强化程度与病理类型之间的关系为：腺癌中度强化为主（n=57,61．3％）,黏液腺癌轻度强化为主（n=7,46．7％）,印戒细胞癌明显强化为主（n=8,61．5％）。病灶强化方式主要为：腺癌均匀强化（n=58,62．4％）,黏液腺癌内层强化明显（n=13,86．7％）,印戒细胞癌内层强化明显（n=7,58．3％）。结论进展期胃癌MSCT三期增强扫描病灶强化程度与病灶强化方式与胃癌组织学分型密切相关,在病理诊断前正确识别各类型的胃癌,将有助于治疗方案的制定和优化,对于观察肿瘤的生物学行为以及治疗疗效的判定具有重要意义。     

Treatment of roentgenographically occult endobronchial carcinoma with external beam radiotherapy and intraluminal low-dose-rate brachytherapy: second report

PURPOSE: To evaluate the efficacy and toxicity of treatment with external beam radiotherapy and intraluminal low-dose-rate brachytherapy for roentgenographically occult endobronchial carcinoma (ROEC). METHOD AND MATERIALS: A total of 79 lesions (71 cases) of ROEC were treated with external beam radiotherapy and intraluminal low-dose-rate brachytherapy from July 1991 to December 1998. Of these lesions, 68 (64 cases) were treated with our standard dose (external beam radiotherapy of 40 Gy and intraluminal low-dose-rate brachytherapy of 25 Gy) and are the subject of this report. All 64 patients were males, and their ages ranged from 55 to 80 (median, 68) years. The histologic diagnosis was squamous cell carcinoma in all patients. RESULTS: In all cases, the scheduled treatment was carried out within 2 months. Follow-up period ranged from 4 to 91 (median, 44) months from the beginning of this treatment. Acute toxicity was tolerable. Grade 2 radiation pneumonitis was observed in 4 cases, and there was no case of greater than Grade 2 radiation fibrosis. Nineteen cases of bronchial stenosis and 23 cases of bronchial obstruction were observed on follow-up bronchoscopy. However, no Grade 2 or greater deterioration of respiratory function due to radiotherapy, prolonged symptoms, or fatal toxicity was observed. Nine patients suffered recurrence, 5 of whom were rescued by surgery and external beam radiotherapy, and 4 of whom died of disease. The 5-year cause-specific survival, overall-survival, and disease-free rate were 96.1%, 72.3%, and 87.3%, respectively. CONCLUSION: Combined treatment with external beam radiotherapy and intraluminal low-dose-rate brachytherapy is effective and results in acceptable complications for ROEC.     

磨玻璃密度结节肺腺癌MDCT表现

目的：探讨磨玻璃密度结节肺腺癌的多排螺旋CT（ MDCT）的影像表现。方法：分析经病理证实的磨玻璃密度结节（ GGNs）肺腺癌31例的完整MDCT资料,经多方位重建和多窗位处理,对GGNs的形态（圆形或类圆形、不规则形）,瘤肺界面（清楚毛糙、模糊无界）,边缘形态（短密毛刺、浅分叶、尖角征）,内部结构（实性成分、支气管充气征、空泡征）,邻近结构改变（胸膜凹陷征、血管集束征）及强化幅值深入分析。结果：瘤体圆形与卵圆形29例、瘤肺界面清楚27例,分叶征19例,毛刺征14例,胸膜凹陷征13例,空泡征11例,血管集束征8例,支气管充气征7例,GGNs内实性成分强化幅值大于20Hu 15例。结论：仔细识别磨玻璃密度结节肺腺癌MDCT征象细节对提高GGNs肺腺癌诊断及其鉴别诊断有较好的应用价值。     

肺腺癌实性结节肿瘤间质与多排螺旋CT早期增强间的关系研究

Objective: To evaluate correlations between proportion and distribution of tumor stroma and MDCT early phase enhancement character in solid lung adenocarcinoma, and compare with microvessel density and histological subtypes.Methods: Thirty-one patients with lung adenocarcinoma shown as solid solitary pulmonary nodules underwent routine contrast-enhanced MDCT followed by surgical resections. CT character included net enhancement and distribution of enhancement. The largest cut surface of tumor specimens were stained by hematoxylin and eosin. About 25 fields of view of each specimen were scanned as digitized pictures at low magnification. Semi-auto segmentation software was used to calculate mean stroma proportion. Pearson correlation coefficient was used to represent the relationships between extent of tumor enhancement, proportion of tumor stroma and MVD respectively. Fisher's exact test was used to analyze statistical differences in degree of CT enhancement among groups of different histological subtypes. Results: Proportion of invasive tumor stroma (13.2%-54.5%, mean 26.2 ± 8.8%) was correlated positively with net enhancement (8-60.8 HU, mean 31.2 ± 13.6 HU; r =0.483, P= 0.006) which was more than MVD. 58.1% cases showed homogenous enhancement, 32.3% cases showed peripheral inhomogenous enhancement, 3.2% cases showed central inhomogenous enhancement, 3.2% cases showed asymmetrical inhomogenous enhancement, and 3.2% cases showed no enhancement. 58.1% cases' stroma showed mixed distribution,35.5% cases showed peripheral distribution, 3.2% cases showed central distribution, and 3.2% cases showed asymmetrical distribution. Significantly more adenocarcinomas classified with "net enhancement ＞ 20 HU" were found in the acinar group than in the solid with mucin subtype (P = 0.005). Conclusion: Extent of CT enhancement reflects underlying not only the tumor angiogenesis but also stroma proliferation in solid small lung adenocarcinoma. Tumor stroma proportion could reflect the histopathologic basis of small lung adenocarcinoma's CT enhancement substantially than MVD. Distribution between enhancement and tumor stroma have good correspondence. Most of acinar adenocarcinomas have higher degree of CT net enhancement than solid with mucin adenocarcinomas.     

胰腺实性-假乳头状瘤的CT表现及手术可行性评价

探讨胰腺实性-假乳头状瘤的CT特征,以提高术前诊断准确性并为手术和预后评估提供依据。方法: 回顾性分析经手术病理证实的胰腺实性-假乳头状瘤20例,男2例,女18例,年龄12～73岁,平均年龄（30.3±16.2）岁,所有病例均行CT平扫及多期动态增强检查,分析肿瘤的CT表现,并与术中实际情况进行对照。结果:CT平扫:20例肿物均表现为较大的胰腺肿块,其中13例明显突出于胰腺轮廓外;肿块呈类圆形、椭圆形或分叶状,边缘较清楚;13例为囊实性,3例为囊性,4例为实性;其中9例肿物内可见钙化。14例肿块位于胰头,其中4例胰管轻度扩张,1例明显扩张,均未见胆管扩张。1例伴肝转移。CT增强:3例囊性肿物的囊壁及分隔可见强化;17例实性及囊实性肿物的实性部分平扫为等密度或较低密度,增强后均有强化,动脉期强化程度均较低,平均CT值（51.45±10.63）HU,静脉期和实质期强化程度较动脉期提高,平均CT值分别约（82.05±22.04）HU和（81.83±19.86）HU,并与动脉期差别均有统计学意义（t1=-7.34,P=0.000和t2=-7.36,P=0.000）,但静脉期和实质期强化CT值无差别（t3=-0.15,P=0.880）。所有20例肿瘤均已行手术切除,其中包括肝转移灶。结论:结合患者年龄、性别和临床表现特点,CT检查多能对胰腺实性-假乳头状瘤做出正确诊断,鉴于肿瘤多为低度恶性或良性,一般均可行手术切除。