肝内胆管囊腺癌磁共振诊断价值

目的探讨肝内胆管囊腺癌的磁共振征像及诊断价值。方法回顾性分析9例经病理证实的肝内胆管囊腺癌患者的临床及MR资料。结果 9例患者中伴分隔多房囊实性2例,单房囊实性7例。所有病灶均显示壁结节突入囊腔内,囊壁结节及分隔信号略有差异,但均表现为T1WI呈略低信号,T2WI略高信号。4例囊腔内并出血。增强扫描可见囊壁、囊内分隔及囊壁结节轻、中度强化。结论肝内胆管囊腺癌MRI有较特征性表现。肝内单房或多房分隔囊性异常信号,囊壁有壁结节或囊腔内有实性成分或囊内液性成分出血表现,支持肝内胆管囊腺癌的诊断。     

肾脏多房囊性病变的影像学表现

目的探讨肾脏多房性囊性病变的CT及MRI表现特征,提高对其诊断的准确性。方法回顾性分析经手术病理证实的多房囊性病变共28例,26例行CT平扫及增强扫描,10例行MRI扫描。结果总共28例,均为多房囊性病变,其中囊性肾癌18例,囊壁及分隔厚薄不均,5例可见壁结节,4例囊内见絮状悬浮物,17例增强扫描囊壁及囊内分隔呈快进快出强化,囊液未见强化。另外10例,多房囊性肾瘤4例、多房性肾囊肿5例、肾髓质囊肿病1例,其中7例囊壁及囊内分隔均匀,3例囊壁及分隔粗细不均,最厚处小于3mm,增强扫描5例囊壁及囊内分隔不同程度强化,5例囊壁及分隔未见强化,10例囊内均未见强化,未见壁结节。结论多房囊性肾癌与其它多房囊性病变的影像表现特征,有助于提高其术前诊断的准确率。     

肝脏单发性囊性转移瘤的影像学表现

目的探讨肝脏单发囊性转移瘤的CT和MRI表现。方法回顾分析14例肝脏单发囊性转移瘤的CT（5例）和MRI（9例）表现。结果肝左叶5例，右叶9例。2例包膜下转移瘤呈扁丘形，其余12例呈圆形或类圆形。肿瘤直径0．7～5．5cm，平均2．7cm。病灶表现为均匀薄壁型2例，均匀厚壁型2例，不均匀厚壁型7例和分隔型3例。病灶的囊壁和分隔CT平扫呈低密度，MRI T1WI呈低信号，MRI T2WI呈高信号、无钙化。12例有强化，3例延迟增强MR扫描呈现外周冲洗现象。病灶囊内部分为水样密度或信号、无强化，3例有液平。病灶通常不伴肝硬化、门静脉栓子以及胆道扩张，但有时同时显示肝外原发肿瘤或者腹部他处转移灶。结论肝脏单发囊性转移瘤具有一定的CT和MRI特征，了解这些特征有助于此类病变的诊断与鉴别诊断。     

肝脏囊性转移瘤的CT和MR征象的比较

目的:分析肝脏囊性转移瘤在CT和MR上的表现,比较CT和MR检查对囊性转移瘤的临床诊断价值.材料和方法:18例(共52个病灶)肝脏囊性转移瘤中10例行CT平扫和增强门脉期扫描.8例行MR T1WI和FMP-SPGR多期动态增强扫描.观察肿瘤的大小、形态、数目、囊壁和壁结节的强化情况.结果:2例为单发病灶外,其余均为多发病灶.病灶呈类圆形或椭圆形.CT上8例见到囊壁不规则增厚,其中6例可见向囊腔内突起的壁结节,1例内有分隔.2例薄壁且均匀的病灶误诊为肝囊肿.T1WI上,7例为低信号,1例为混杂信号.T2WI上,病灶均为明显高信号,2例信号均匀,6例信号不均匀,可见到壁结节为略低信号.增强动脉期所有病灶均无强化表现,门脉期和延迟期,可见到边缘环形强化和壁结节的强化.也有1例见到分隔.结论:CT和MR均可显示肝脏囊性转移瘤的特征,MR在显示病灶的出血、囊变、分隔和囊壁的情况等比CT更为敏感、可靠,在鉴别诊断方面价值更大.     

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.     

肝胆管囊腺瘤的影像学表现

目的 探讨肝胆管囊腺瘤CT、MRI及B超表现,提高其诊断准确率.方法 回顾性分析9例经病理证实的肝胆管囊腺瘤患者,螺旋CT检查7例,MRI检查4例,B超检查5例.结果 7例患者CT平扫表现为多房囊性病变,囊内可见线状分隔,囊壁均匀增厚,壁光滑;MRI检查4例患者中,病变T1WI呈低信号多房囊性占位,T2WI病灶呈高信号为主混杂信号,囊内分隔呈低信号,增强后动脉期囊壁及分隔轻度强化,门脉期及延迟期继续强化.B超检查5例患者表现为肝内无回声暗区,边界清楚,内见多条强回声带,可见分隔或乳头状隆起.结论 平扫加动态增强CT、MRI及B超能够特征性反映肝胆管囊腺瘤的影像学特点,提高该疾病的诊断准确率.     

小儿淋巴管瘤的CT和MRI诊断

目的 探讨儿童淋巴管瘤的CT和MRI表现及其诊断价值.方法 回顾性分析经手术病理证实的43例淋巴管瘤的CT和MRI影像资料,CT检查37例,MRI检查6例.结果 病变发生于颈部21例,其中同时累及纵隔和/或腋窝6例;肠系膜7例;腹膜后7例;大网膜3例;胸腹壁3例;四肢2例.主要表现为:(1) 边缘清楚或不清楚的单房性(n=5)或多房囊性(n=38)薄壁肿块;(2) 沿疏松组织间隙生长(n=22);(3) 5例出血者瘤内密度增高,其中2例可见液-液平面;(4) 2例合并感染者,囊壁增厚;(5)增强扫描囊壁及分隔轻度强化,囊内不强化;(6) T2WI均呈高信号影,T1WI呈低信号或等信号影,合并出血者T1WI呈高信号影.结论 淋巴管瘤的CT、MRI表现具有特征性,对临床治疗有重要价值.     

囊性肾癌的影像学分析

目的：提高对囊性肾癌的影像学诊断水平。方法：回顾性分析18例经手术病理证实的囊性肾癌的超声、CT及MRI的影像学表现。结果：囊性肾癌在超声、CT及MRI的影像学表现的主要特点为囊壁厚、可有不规则分隔，可有壁结节、不规则钙化，边缘不清晰，囊性占位性病变彩色多普勒检查囊壁或分隔上有明显的血流信号。CT增强扫描后囊壁、壁结节及分隔强化。MR检查T1WI像呈近似等信号，T2WI像呈稍高信号的囊壁及分隔，增强表现其囊壁及分隔信号增强。结论：囊性肾癌在超声、CT及MRI的检查上有一定的特征性的表现，对不典型者应行引导下穿刺活检。     

肝内胆管囊腺肿瘤的影像诊断及临床研究

目的:总结肝内胆管囊腺瘤和囊腺癌的CT、MRI表现及临床特征,评价其影像诊断价值。方法:回顾性分析2005年-2011年9例经手术及病理证实的肝内胆管囊腺肿瘤的CT、MRI表现及临床资料。结果:手术病理证实有7例囊腺癌,2例囊腺瘤;9例均行多层螺旋CT平扫及增强扫描,其中2例行MRI平扫及增强。7例位于肝脏左叶,1例位于右叶,1例位于尾叶;病灶直径为1.5～20cm,平均6.7cm;5例囊腺癌及2例囊腺瘤呈分叶状多房分隔,2例病灶呈单房囊性病灶;其中6例见乳头状壁结节,1例囊内合并出血;增强后9例实性成分(包括壁结节)及分隔强化。2例行MRI扫描者1例表现为壁结节呈T1、T2等信号,囊液为短T1、长T2信号,1例为长T1、长T2信号。结论:CT及MRI显示肝内囊性多房分隔或单房囊性肿块,囊内成分混杂,乳头状壁结节突出于囊壁或实性成分漂浮于囊内;增强后实性成分、壁结节、囊壁及分隔不同程度强化,高度提示胆管囊腺瘤/癌的可能,对于临床治疗提供指导。     

肝胆管囊腺癌的MRI表现

目的:探讨肝胆管囊腺癌(HBCAC)的MRI表现,提高肝胆管囊腺癌的诊断准确性.方法:回顾性分析9例经病理证实的肝胆管囊腺癌的MRI表现,所有患者均行MR平均和三期动态增强扫描.结果:9例中单囊性病灶8例,多囊性病灶1例.T1WI上6例表现为囊状低信号影,囊内分隔和囊壁厚薄不均,可见壁结节或乳头状突起;3例囊壁光滑,囊内呈稍高信号影,可见结节状软组织信号影.T2WI上病灶以高信号为主,囊内分隔、壁结节及软组织呈低信号.增强扫描动脉期示囊内分隔、壁结节和软组织明显强化,门脉期及延迟期强化仍较明显.结论:平扫及动态增强MRI能较好反映肝胆管囊腺癌的影像学特点,对本病的诊断及鉴别诊断有重要价值.     

成人囊性肾瘤的CT表现

目的分析囊性肾瘤的CT影像学特征。资料与方法回顾性分析经临床病理证实的6例囊性肾瘤的CT资料,并与病理和组织学表现对照分析。结果 6例均为单发,2例发生于左侧,4例发生于右侧。6例均表现为边界清晰,多房,囊性肿块,囊液CT值高于水。1例病灶内呈稍高密度,CT值为33 HU,后经病理证实为出血,增强扫描囊液无强化。1例CT表现为分隔不清,1例出现少许点状、条状钙化。结论肾脏囊性肾瘤影像学表现为边界清晰、多囊性病变、囊液CT值高于水,分隔较纤细,未见明显壁结节,分隔及囊性部分均无明显强化。     

多房性囊性肾瘤的影像学表现与病理对照

目的 提高对多房性囊性肾瘤的影像学的认识。资料与方法 报告2例经手术病理证实，且临床与影像学资料完整的多房性囊性肾瘤。分析其B超、IVU、CT、MRI检查所见征象，并与手术、病理所见对照，结合文献复习，对多房性囊性肾瘤作深入讨论。结果 影像学表现为肾区单发、多房性囊性病灶；囊肿边界清楚，与肾盏不相通，肾脏被挤压变薄，未受累区的肾脏正常；囊内容均匀或不均匀；囊间隔的密度比正常肾实质低，分隔完全且厚薄不一，可强化，但强化程度不及正常的肾组织。术后病理证实为多房性囊性肾瘤。结论 CT、MRI最能反映多房性囊性肾瘤的病理基础，是术前诊断该病的最佳方法。术前完善的影像学检查对该病的治疗方案及预后至关重要。     

Multilocular cystic nephroma: MR imaging appearance with current techniques,including gadolinium enhancement

The purpose of the study was to define the MRI appearance of multilocular cystic nephroma (MLCN), using current MR techniques, including gadolinium (Gd)-enhanced sequences. Seven patients with MLCN underwent MR imaging with the following sequences: T1-weighted spin echo with fat suppression (TIFS, five patients), T1-weighted spoiled gradient echo (SGE, seven patients), T2-weighted fast spin echo (two patients), and Gd-enhanced TIFS (seven patients) and SGE (seven patients). MLCN was histologically proven by resection of the mass in six patients and by observation of typical imaging features with stability in appearance over a 6-month period in one patient. Lesion morphology and signal intensity (SI) features were retrospectively evaluated. MRI features of MLCN included a solitary cystic lesion with thin internal septations in six patients and a cluster of closely grouped cysts similar in size in one patient. Individual cystic spaces demonstrated SI, varying from low to high on T1-weighted images in three patients and demonstrated low-to-intermediate SI in four patients. Herniation of the lesions into the renal collecting system and thin enhancing septa were demonstrated in all patients. A complex cystic renal lesion with enhancing septa and herniation into the renal collecting system are the characteristic MR findings of MLCN. The direct multiplanar capability of MR may optimally show the relationship of MLCN to the renal pelvis and, thus, facilitate correct diagnosis.     

多房囊性肾细胞癌的CT分析

目的:探讨多房性囊性肾细胞癌的CT表现特点及诊断价值。方法:回顾性分析13例经手术病理证实的多房性囊性肾细胞癌患者的CT图像及相关临床资料。结果:病变位于右肾8例,左肾5例。病灶直径4~25cm,平均13cm。病灶由多个囊腔和分隔构成,5例伴附壁结节,2例见囊壁钙化,增强后囊壁、分隔和壁结节可有强化。结论:多房囊性肾细胞癌的CT表现有一定特征性。CT在多房性囊性肾细胞癌的诊断中具有重要作用,但在鉴别时仍有一定难度。     

原发性肾脏罕少见良性肿瘤的CT、MRI 表现与临床病理分析

目的：分析和探讨肾脏罕少见良性肿瘤的 CT、MRI 影像学表现及临床病理分析,提高肾脏罕少见良性肿瘤的诊断准确性。方法回顾性分析本院9例经手术及病理证实的肾脏罕少见良性肿瘤的 CT 及 MRI 影像学资料,分析其影像学特点和病理特征。结果入组病例分别为混合型上皮间质肿瘤(MESTK),囊性肾瘤(CN),平滑肌瘤(RL),嗜酸细胞腺瘤(RO)。病变分布情况：6例位于左肾,3例位于右肾。瘤体大小：长径2.5~8.9 cm,平均5.7 cm;短径2.5~8.4 cm,平均4.9 cm。形态：类圆形或椭圆形(n=7),不规则形(n=2)。9例病灶突出于肾轮廓外。MESTK 呈多囊性病变,增强扫描囊性成分未见明确强化,囊壁及粗间隔可见强化。CN 呈囊性病灶,平扫可见斑片状钙化,增强扫描囊性成分未见明确强化,病灶可见强化分隔影。RL 的 CT 和 MRI 平扫密度/信号不均匀,可见斑片状坏死;病灶增强扫描皮质期及髓质期明显强化,延迟期强化程度减退。RO 1例 MRI 平扫 T1 WI 呈不均匀低信号;T2 WI 呈不均匀高信号;CT 病灶密度欠均匀,平扫以等密度为主;增强扫描皮质期、髓质期病变呈明显不均匀强化,排泄期强化程度下降,中心瘢痕可见轻度延迟强化。结论肾脏罕少见良性肿瘤具有一定的 CT、MRI 影像学特点,结合其临床病理特点,可以提高肾脏罕少见恶性肿瘤的诊断和鉴别诊断。     

Cystic tumors of the kidney in adults: radio-histopathologic correlations

The purpose of this study is to provide an updated pathologic-radiologic classification of cystic renal tumors and to assess imaging diagnostic capabilities. Eighty seven cases of cystic renal tumors explored with multimodality imaging (ultrasonography, CT, MRI, arteriography) and with histopathologic correlation are reported. The most common cystic carcinomas were multilocular cystic renal cell carcinoma (33%) and the pseudocystic necrotic carcinoma (31%), which usually belong to category IV. Less common cystic carcinomas were unilocular cystic renal cell carcinoma (6%) and renal cyst wall carcinoma (6%). The association of thin septa and large locules are suggestive findings for multilocular cystic nephroma, but such criteria are not specific enough to recognize benign multilocular cystic nephroma and to exclude multilocular cystic renal cell carcinoma. Since carcinomatous degeneration may occur within the wall of such tumors, especially in von Hippel Lindau disease, surgery is still required. The results of our study corroborate the Bosniak classification of cystic renal masses: no tumors belonged to the category I or II, all cystic masses which belonged to the category IV were malignant tumors, category III included benign and malignant tumors.     

Cystic renal tumors: US and CT findings

Cystic renal tumors represent a variety of lesions in which both solid and liquid components coexist. These lesions may be either benign or malignant and include the multilocular cystic nephroma (MCN), the renal cell carcinoma (RCC), and the papillary adenocarcinoma (PAC). The MCN is a rare neoplasm formed of multiple loculated cystic masses divided by septa. The tumor is benign, although there are some rare reports of malignant cases. The RCC and the PAC may appear with cystic patterns. This is rather uncommon for the RCC, which inside has a unilocular or multilocular cystic appearance, if the necrotic component is large. PAC is an infrequent renal tumor, which has a greater tendency to appear as a large mass with a unilocular large cystic space. The ultrasonography (US) and computed tomographic (CT) features of 27 cystic tumors are presented. Both US and CT allowed the recognition of the cystic components, the septa, and the vegetations. The two imaging techniques made it possible to distinguish the tumors into “unilocular” and “multilocular” masses: the former correspond to RCC and PAC, the latter to MCN and RCC. CT added some information on calcified or partially calcified tumors. CT more than US enabled the differentiation between the malignant RCC and the benign MCN for which conservative surgery may be indicated. The two techniques did not allow the differentiation between RCC and PAC, which has different prognostic behavior.     

肾脏上皮样血管平滑肌脂肪瘤的MDCT和MRI表现及其与病理的关系

目的：探讨肾脏上皮样血管平滑肌脂肪瘤（EAML）的MDCT和MRI表现及其诊断价值。方法：对13例经病理证实的肾脏EAMI。患者的MDCT和MRI资料进行回顾性分析,并与手术病理结果对照。9例行CT平扫和动态增强扫描,3例行MRI平扫和动态增强扫描,1例同时行MDCT和MRI检查。结果：13例中8例肿瘤呈实质性,5例呈囊实性。CT平扫示7例病灶呈等密度或高密度,3例呈稍低密度。MRI平扫T1WI上4例病灶以低信号为主,抑脂T2WI上呈低信号或等信号,其中3例信号明显不均匀。CT和MRI增强扫描皮髓交界期示9例病灶呈中等至明显强化,4例轻度强化;实质期示病灶呈持续强化9例,强化程度减退4例,11例病灶强化明显不均匀。仅1例EAML可见少许脂肪信号,6例瘤周可见假包膜显影、较厚且绝大多数完整,9例瘤内可见血管影,4例伴有出血。结论：肾脏EAML的CT和MRI表现具有一定的特征性,特别是T2WI上病灶呈低信号、增强后中等至明显不均匀持续强化、假包膜较厚且完整以及瘤内血管影的显示,有助于提高对EAML的影像诊断准确性。     

骨内脂肪瘤的影像学诊断

目的:讨论骨内脂肪瘤的发病机制、临床特征、影像表现、诊断及鉴别诊断.方法:回顾性分析经手术病理证实的11例骨内脂肪瘤的临床及影像资料,11例均行X线、CT检查,2例行MRI检查.结果:X线平片表现边界清晰的不规则形透亮区,可伴硬化缘.CT上病灶为类圆形或不规则形的脂肪密度区,CT值-55～-120 HU,病灶边界不规则,伴有厚薄不一的硬化缘,5个病灶中心可见结节状钙化灶.MRI表现为T1WI高信号,T2WI稍高信号,脂肪抑制序列病灶信号受抑变低,边缘见长T1短T2信号,其内见线条状长T1短T2信号的纤维分隔及长T1长T2的液性囊腔.结论:结合发病年龄、病变部位、临床症状和影像学表现,对本病可作出正确的术前诊断,可避免不必要的穿刺活检和CT、MRI的重复检查.     

多形性黄色星形细胞瘤影像学表现与病理学分析

目的探讨多形性黄色星形细胞瘤(PXA)的影像学及病理学表现.方法回顾性分析2003-2011年间共12例经手术病理证实的 PXA 病人组织病理学、免疫组织化学和影像学资料.12例病人均行 MRI 平扫及增强检查,其中5例行 CT 平扫,2例行 CT 平扫和增强扫描.结果12例病人病理组织学均可见不同程度囊变,瘤细胞呈明显多形性,肿瘤中有淋巴组织浸润,少有坏死,核分裂少或无.其中10例表达 CD34.12例病人肿瘤均为单发,位于幕上.MRI 平扫时实性部分 T1WI 呈等信号或稍低信号,T2WI 为等信号或稍高信号;囊性部分 T1WI呈低信号,T2WI 呈高信号.MR 增强扫描时肿瘤实性部分和壁结节明显强化.5例病人进行 CT 平扫,3例表现为低密度囊性病变伴等密度结节,2例呈低密度囊性病变,未见明显结节影;增强扫描可见明显的强化结节.结论 PXA具有一定的影像和病理学特征,综合对比分析可以确定诊断.