Computed tomography of gastrointestinal leiomyosarcoma

Computed tomography (CT) was performed in 6 patients with gastrointestinal leiomyosarcoma. The characteristic CT findings were a large extraluminal mass, apparently mesenteric in location, with central areas of necrosis. These findings were present in 5 of the 6 patients. Enhancement of the rim of the tumor was seen in 2 of 3 patients who had scans before and after administration of intravenous contrast material. CT identified the site of origin of tumor in only 2 patients. The characteristic CT findings should suggest the diagnosis of gastrointestinal leiomyosarcoma.     

Echogenic focus in the gastrointestinal wall as a sign of ulceration

An ultrasound study carried out on 22 patients with ulcerated gastrointestinal lesions (20 adenocarcinomas and 2 peptic ulcers) showed, in all cases, an echogenic focus (EF) that was situated in the gastrointestinal wall. In order to find out the histopathologic significance of this focus and its location, an examination was made in vitro of 8 surgical specimens obtained from gastrectomies-6 from peptic and 2 from malignant ulcers. The specimens were immersed in a water bath using a 5-MHz transducer. A common finding in all the specimens was an EF similar to that seen in the clinical study and situated behind the crater of the ulcer. In this location the histopathologic findings demonstrated necrotic and inflammatory material in both the benign and malignant lesions.     

Ascariasis of the gastrointestinal tract

The radiographic findings and complications ofAscaris lumbricoides infection of the gastrointestinal tract are presented. Since the clinical symptoms of ascariasis are usually vague or nonspecific, the radiologist may be in a position to play a major role in the proper diagnosis of this disease.     

Multiple gastrointestinal tract diverticula

Simultaneous occurrence of gastrointestinal diverticula at multiple sites in a single patient is unusual. We report a patient with a Zenker's, a mid-esophageal, a gastric, and multiple colonic diverticula. The presence of multifocal gastrointestinal diverticula suggests as one possible etiology congenital weaknesses in the bowel wall, since esophageal manometry and histology of a resected diverticulum did not reveal any abnormalities other than gastroesophageal reflux.     

Gastrointestinal leiomyosarcoma — Unusual sites: Esophagus,colon and porta hepatis

This paper is based on a retrospective analysis of the radiologic findings of 6 newly proven cases of primary gastrointestinal leiomyosarcomas located in unusual sites. The radiographic and angiographic features of esophageal, colonic, and porta hepatis leiomyosarcomas are described and illustrated. General background information together with a brief review of the literature regarding these lesions are provided. The difficulties encountered in the preoperative diagnosis are explained by the protean and nonspecific clinical and radiographic features of many of these tumors. In addition, although myomatous tumors of the liver and porta hepatis are angiographically hypervascular, similar tumors of the colon are slight to moderately vascular, and tumors of the esophagus are avascular.     

Sonographic features of gastrointestinal leiomyosarcoma

Five cases of gastrointestinal leiomyosarcoma were studied by ultrasound. Sonographic features of a huge mass with a thick echogenic rim and central sonolucent cavitation were seen in four cases with presenting symptoms of an abdominal mass. In a fifth case necrotic metastasis was seen in the liver after removal of a leiomyosarcoma. Although not pathognomonic, such features should strongly suggest the diagnosis of leiomyosarcoma.     

Preliminary abdominal films for gastrointestinal examinations: How efficacious?

A prospective study to evaluate the efficacy of preliminary abdominal films for colon and upper gastrointestinal examinations was carried out on 733 patients. The preliminary film was found to be cost effective and useful in predicting adequacy of patient preparation for colon examinations but not for upper gastrointestinal studies. Significant diagnostic information that could potentially contribute to the patient's care was present in 8.4% of the cases. No contraindications to contrast examinations were found.     

Value of CT in localizing site of gastrointestinal hemorrhage following negative angiography

This case report of severe gastrointestinal (GI) bleeding demonstrates the utility of computed tomography (CT) in localizing such hemorrhages when all other diagnostic modalities have been exhausted. All previous studies in this case were nondiagnostic. However, abdominal CT performed without the benefit of oral contrast but immediately following negative angiography was useful in directing the surgeon to the region of hemorrhage by documenting the presence of focally dense intraluminal contrast within the small bowel loops.     

Sonography of hepatic echinococcal cysts

One hundred and fifty-one cases of hepatic echinococcal cysts were studied by gray-scale ultrasound. According to their echographic features, the cysts were categorized as follows: (a) discrete cysts (simple, suppurative, and calcified); (b) multiple cysts (linear and racemose); and (c) queer pear-shaped cysts. The spherical or oval shape and the regularity of the walls were common findings in all types of cysts except pear-shaped cysts. The criteria for diagnosis and clues to differentiation are discussed and illustrated.     

Evaluation of abdominal lymphoma by ultrasound

Ultrasonography was utilized in 13 patients with lymphoma of the bowel, the liver, spleen, and abdominal lymph nodes. The lymphomatous tumors were (except in one patient with Burkitt's lymphoma) ultrasonographically anechoic or hypoechoic and showed very good echo transmission. In 6 out of 13 patients, lymphography was negative, or there was no evidence of enlarged retroperitoneal lymph nodes by ultrasound or computed tomography. In these patients, abdominal lymphoma in other areas was shown by ultrasonography. After a base-line had been obtained, the therapeutic effect or progression of the tumor could be followed simply by ultrasound.     

原发性胃肠道恶性淋巴瘤内镜诊断应用分析

目的 总结分析原发性胃肠道恶性淋巴瘤(PGIML)的内镜下特征及诊断要点,进一步提高该病的诊断阳性率,为临床治疗提供依据。方法 回顾性分析2004-2009年诊治的67例PGIML患者的临床资料。结果 PGIML临床症状缺乏特异性。主要表现为腹痛、黑便、腹部包块。胃是最常见的发生部位,达55.8％(37/67)。黏膜表面呈肿块结节是PGIML最常见的内镜表现。内镜活检诊断PGIML的阳性率为68.7％ (46/67)。67例均为非霍奇金淋巴瘤。免疫分型以B细胞为主,为50例。30例为黏膜相关淋巴组织(MALT)淋巴瘤。结论 PGIML早期诊断较困难,可采取多种诊断手段综合诊断,手术治疗作用尚未肯定,还需进一步随访观察。     

多层螺旋CT半定量诊断高危险程度胃肠道间质瘤

目的 对比分析高危险程度与较低危险程度(包括极低、低、中等危险程度)胃肠道间质瘤(GISTs)的多层螺旋CT(MSCT)特征,探讨高危险程度GISTs的半定量诊断.方法 回顾分析46例GISTs患者(共51个病灶)的MSCT资料,对比分析高危险程度与较低危险程度GISTs的发生部位、大小、形状、边界、生长方式、平扫及增强扫描中的特征,并进行统计学分析,并进一步得出logistic回归方程.结果 高危险程度与较低危险程度GISTs在发生部位、大小、形状、边界、远处转移等方面差异有统计学意义.肿瘤的边界和大小与肿瘤的危险程度有明显相关性.高危险程度GISTs的半定量诊断方程为ln [P/(1-P)]=-2.612X_3+0.371X_5(X_3:肿瘤的边界;X_5:肿瘤的大小).结论 上述logistic回归方程可用以判断GISTs为高危险程度的几率,有助于诊断高危险程度GISTs.     

Digital radiography of the gastrointestinal tract

The gastrointestinal tract lends itself quite well to digital imaging. Since fluoroscopy is already employed, the images can easily be obtained in digital format and several manufacturers have now developed systems for commercial use. Because of the type of pathology as well as the inherent subject contrast, it would appear the resolution requirements for digital imaging of the gastrointestinal tract are less than in other organ systems. The necessary resolution level is already technically available and feasible without significant cost. Digital imaging also holds promise of at least a modest reduction in radiation dose to the patient, as well as a reduction in costs, although these factors are operator dependent. However, digital imaging provides a latitude in performing the examination that is not available with screenfilm systems. Finally, there is promise that by acquiring gastrointestinal images in digital format, manipulation of the images may help increase diagnostic accuracy by improving both technical and perceptive components of diagnosis. Not only will simple image manipulation be helpful but there is even potential for computer-assisted evaluation of gastrointestinal images.     

肝外胆管癌超声造影的诊断价值

目的观察肝外胆管癌的超声造影特点,探讨该技术对肝外胆管癌诊断及鉴别诊断的价值。方法对21例经手术病理或胆管造影证实的肝外胆管癌患者进行二维及彩色多普勒超声检查,并经静脉团注SonoVue造影剂,行超声造影检查,观察肿块强化开始时间、强化方式、持续时间等,同时采用爆破及造影剂捕捉功能,重复观察病灶内造影剂灌注及显示情况。结果注射造影剂后,肿块9~19s肿块开始显影,所有肿块均有强化,持续时间约10~20s。肿块强化开始时间晚于总胆管壁,消退早于后者。21例患者中有5例伴有结石,5例侵犯周围肝组织,二维超声均难以判断。超声造影可以准确鉴别肿块和结石,并且能够判断肿块的侵犯范围,与手术病理结果一致。结论超声造影能实时观察肝外胆管肿块的微血流灌注情况,对肝外胆管癌的定性诊断及与胆管结石的鉴别诊断有较高的临床应用价值。     

原发性下腔静脉平滑肌肉瘤1例

患者男,66岁,右上腹部阵发性疼痛1年,伴有腰部放射痛.查体:右上腹轻度压痛,无肌紧张及反跳痛,未触及包块,腹部移动性浊音阴性,无腹壁静脉曲张,无下肢肿胀.实验室检查未见明显异常.CT:平扫约平肾门水平下腔静脉及其周围见团块样软组织密度影,约7.8 cm×6.2 cm×10.3 cm,CT值29～40 HU,与下腔静脉、十二指肠水平段及邻近腹主动脉分界欠清(图1A);增强扫描见下腔静脉限局性增粗,长约8.6 cm,局部可见7.5cm×5.6 cm软组织密度肿块影向腔内及腔外生长,实质明显不均匀强化,液化坏死部分末见强化;病变包绕部分腹主动脉,与右肾、右肾动脉、右侧输尿管、右侧腰大肌分界清楚,与十二指肠水平段紧邻(图1B、C),其远侧下腔静脉对比剂充盈欠佳.诊断为下腔静脉恶性肿瘤,行下腔静脉肿瘤切除+右侧肾脏切除术.术后病理诊断:下腔静脉平滑肌肉瘤(图2).免疫组化:Des(+),Ki-67(20十),SMA(+),Caldesmon(+),CD117(-).     

Sonography of the gastrointestinal tract.

OBJECTIVE: The purpose of this presentation is to provide an overview of sonographic manifestations of various gastrointestinal diseases. METHODS: Patients were scanned with an HDI 3000 or HDI 5000 system (Philips Medical Systems, Bothell, WA) with both a 2- to 5-MHz curvilinear transducer and a 5- to 12-MHz linear transducer. The patients were asked to fast from the previous night. For accurate visualization of the stomach, a cup of water was given to patients thought to have stomach or upper gastrointestinal disease. RESULTS: A satisfactory sonographic examination could be performed in all patients. CONCLUSIONS: With recent technical advances, the increasing use of sonography in initial evaluation of patients with abdominal pain may allow earlier detection of bowel disease.     

The minimum effective dose of glucagon in upper gastrointestinal radiography

The effect of small intravenous doses (0.025 and 0.05 mg) of glucagon was evaluated in 22 patients. All 12 patients given 0.05 mg demonstrated hypotonicity of the stomach and duodenum at 1 min and beginning return of peristalsis at 2 1/2 min. Subsequently, 100 patients with radiographically normal upper gastrointestinal examinations who received 0.05 mg of glucagon intravenously were compared to 100 patients with normal examinations without it. Comparison was made to determine the effect of glucagon on gastric mucosal coating and distention of the stomach and duodenum. In all areas of the stomach, mucosal coating was significantly improved in the glucagon group. There was also increased distention of the distal antrum, duodenal bulb, and duodenal loop. No adverse effects were reported. Because of the short duration of action of glucagon, the examination needs to be coordinated and done rapidly. The routine use of a small dose of glucagon increased the performance time slightly with small additional cost but was compensated for by the increased diagnostic quality of the examination.     

Biopsy of bowel wall pathology under ultrasound control

Primary lesions of bowel wall were biopsied transabdominally in 7 patients. Adequate material for histological diagnosis was obtained in all. In 3 patients previous biopsy performed at endoscopy had failed to establish a diagnosis. In 2 others the area biopsied, i.e., gallbladder, was inaccessible to endoscopy and confirmation would have otherwise required laparotomy. No complications occurred.     

胃肠道间质瘤的CT诊断与鉴别诊断

目的 探讨胃肠道间质瘤（GIST）的螺旋CT征象及其诊断、鉴别诊断价值.方法 回顾性分析28例经手术病理证实为GIST患者的螺旋CT资料,分析其CT征象与肿瘤恶性程度的相关性.结果 28例患者生物学危险度：极低度2例（7.1 %）,低度4例（14.3 %）,中度8例（28.6 %）,高度14例（50.0 %）.肿块的大小、边界、密度、侵犯和/或转移、坏死或出血与肿瘤的生物学危险性之间差异密切相关（P ＜ 0.05）,而肿瘤的形态、强化程度与危险性无统计学意义（P ＞ 0.05）.结论 GIST的CT表现具有一定特征,对GIST的鉴别诊断及术后随访有重要价值,并有助于判断肿瘤的生物学危险性.