小儿盆腔及泌尿生殖系横纹肌肉瘤的影像诊断

目的探讨儿童盆腔及泌尿生殖系横纹肌肉瘤(RMS)的尿路造影和CT表现及其诊断价值。资料与方法回顾性分析20例经手术及活检病理证实的原发于盆腔及泌尿生殖系RMS的影像学资料。其中10例经静脉肾盂造影(IVP)检查,3例经膀胱尿道造影(VCUG)检查,10例经CT检查,1例经MRI检查。结果8例膀胱RMS的IVP、CT表现为膀胱内葡萄状充盈缺损,膀胱颈部与耻骨联合间距增宽,VCUG可见肿物延伸至后尿道;4例前列腺RMS表现为后尿道肿物压迫膀胱颈部并使其抬高、环绕尿道的盆底部包块。6例盆腔RMS IVP及CT表现为盆腔包块,压迫膀胱移位、变形,膀胱壁轻度浸润不规则,输尿管下段浸润者可有轻度输尿管及肾盂积水。1例尿道RMS表现为尿道内充盈缺损,1例阴道RMS,IVP表现为膀胱颈部充盈缺损。结论IVP及VCUG能明确诊断原发于膀胱、前列腺、尿道的RMS及上尿路继发病变;CT及MR可进一步了解起自阴道、前列腺、盆腔的RMS及其与周围器官的关系。     

小儿盆腔及泌尿生殖系统横纹肌肉瘤超声诊断及病理分析

目的:探讨超声检查在儿童盆腔及泌尿生殖系统横纹肌肉瘤的诊断价值及病理类型分析.方法:对30例原发盆腔及泌尿生殖系统横纹肌肉瘤的超声检查结果结合病理类型进行分析.结果:膀胱横纹肌肉瘤11例,1例为葡萄簇型,其余10例均为胚胎性.前列腺横纹肌肉瘤3例,3例病理结果均为胚胎性.阴道横纹肌肉瘤1例,病理结果为葡萄簇型.盆腔横纹肌肉瘤15例,2例为腺泡状,其余13例均为胚胎性.本组盆腔及泌尿生殖系统横纹肌肉瘤超声基本表现为肿瘤边缘清楚,无包膜回声,形态规则或不规则形,内部为基本均质的低回声,部分肿瘤内部可见液化坏死.结论:超声检查可作为盆腔及泌尿生殖系统横纹肌肉瘤影像学检查的首选方法.     

盆腔横纹肌肉瘤的超声诊断

目的：探讨儿童盆腔横纹肌肉瘤的超声特点。方法：回顾性分析12例儿童盆腔横纹肌肉瘤的超声表现。结果：膀胱横纹肌肉瘤7例，前列腺横纹肌肉瘤3例，阴道横纹肌肉瘤2例，超声表现均为边缘清晰、形态规则的实质性肿块，其中5例出现部分液化。结论：盆腔横纹肌肉瘤无包膜，边缘清晰，肿瘤内部常发生坏死液化。     

小儿膀胱胚胎性横纹肌肉瘤一例报道及文献复习

目的 探讨小儿膀胱横纹肌肉瘤(rhabdomyosarcoma,RMS )的影像表现.资料与方法 对1例小儿膀胱RMS的临床及影像资料进行分析,并结合文献进行复习.结果 患儿RMS位于膀胱颈及尿道内口,并沿尿道侵犯前列腺,肿块呈"葡萄簇"状,CT平扫密度均匀,低于腹壁肌肉,未见坏死及钙化,增强扫描肿块逐渐强化,边缘呈持续明显强化,邻近膀胱壁稍增厚.多平面重组(MPR)清晰显示肿块形态及侵犯范围.结论 小儿膀胱RMS影像表现具有一定的特征性,结合患儿年龄及临床特征可做出正确诊断.     

小儿腹盆腔横纹肌肉瘤的CT表现与病理对比研究

目的探讨小儿腹盆腔横纹肌肉瘤(RMS)的CT表现特征及与病理学分型的相关性,提高其诊断水平。方法对10例经手术或活检病理证实的小儿腹盆腔RMS的临床病理资料及CT影像表现进行回顾性分析。结果 6例腹腔及腹膜后RMS,5例CT表现为腹盆腔边界清楚巨大软组织肿块,最大径12~19cm,1例为边界不清多发结节状团块融合;平扫6例密度均低于肌肉,4例均匀,2例内部可见不规则片状更低密度坏死区;增强后动脉期5例肿块内部可见迂曲肿瘤血管,静脉期6例均为肿瘤内部不均匀片絮状强化。4例膀胱RMS CT均表现为膀胱腔内低于肌肉密度葡萄簇状软组织肿块,膀胱壁不规则增厚,增强后肿块中度均匀强化,并可显示膀胱壁以黏膜下层增厚为主,其中2例合并膀胱外盆腔肿块。10例病理类型均为胚胎性RMS,其中4例起源于膀胱的RMS分属葡萄簇状亚型,余6例为梭形细胞型。结论小儿腹盆腔RMS CT表现有一定的特征性,并可初步反映其病理分型。     

前列腺肉瘤1例

患者 男,59岁.因排便排尿困难就诊.一般状况良好,直肠指检:前列腺明显增大,质软.应用PHIIIPS iu22行超声检查:患者肝胆胰脾肾未见异常,膀胱充盈良好,壁光滑,内透声好,前列腺区见一低回声,形态与前列腺相似(图1),大小约11.4cm×8.5cm,向膀胱内凸出,表面光滑,内回声不均匀,见多个无回声,实质内见少许血流信号.PW测:Vmax:0.14m/s,RI:0.72(图2).超声诊断:盆腔内实性占位性病变,考虑前列腺肿瘤(前列腺肉瘤?).切除术后病理诊断:前列腺肉瘤(图3).     

胃肠间质瘤误诊卵巢肿瘤1例

<正>病人,女,32岁。1个月前无意中触及下腹部包块,在当地医院查超声提示盆腔囊实性包块、盆腔积液。我院门诊复查妇科超声:子宫前方可见约12.3 cm×9.1 cm囊实性包块,其内见不规则偏强回声及液性暗区,透声差。内可探及丰富血流信号。双侧卵巢显示不清。提示:盆腔囊实性包块。妇科检查:子宫前方偏左侧附件区可扪及一约13 cm×12 cm大小包块,边界欠清,活动欠佳,无压     

前列腺横纹肌肉瘤的影像学表现分析(附3例报道并文献复习)

目的 探讨前列腺横纹肌肉瘤的影像学表现.资料与方法 回顾性分析3例前列腺横纹肌肉瘤患者的临床及影像学资料并作文献复习.结果 3例表现为前列腺明显增大,伴软组织肿块形成,CT和MR增强后均有明显强化,肿瘤内部有不规则坏死区.DSA造影可见新生肿瘤血管和明显的肿瘤染色征.对盆腔邻近组织、结构仅1例主要表现为膀胱受压,其余均表现为不同程度侵犯,膀胱和精囊腺是极易受侵犯的器官.1例发生肺和盆腔转移.结论 前列腺横纹肌肉瘤常见于青少年,CT和MR能显示前列腺肉瘤的表现以及对邻近结构的侵犯情况.     

膀胱平滑肌瘤二例

膀胱平滑肌瘤很少见,国内外仅为个案报道［１～４］,现报告２例。例１女,３７岁。外院超声发现盆腔肿物１个月,以膀胱肿物性质待定入院。查体（－）。Ｂ超：阴道前见约５．０ｃｍ×４．７ｃｍ低回声团,内回声欠均,肿物压迫右侧膀胱壁,与尿道关系不清。提示：盆底实...     

完全性重复肾畸形并上位输尿管异位开口伴重度积水1例

正患者女,26岁。因下腹胀痛于外院就诊。外院超声所见:子宫切面形态正常,子宫后方见一大小约42. 1mm×17. 6mm条形无回声区,边界清,内可见光带分隔; CDFI:上述无回声区内未见彩色血流信号。超声提示:盆腔囊性包块,输卵管积水待排。患者妇科抗炎治疗2个月后,疼痛未见减轻,隧来我院就诊:常规行妇科阴道超声所见:膀胱左侧与之紧邻可见一迂曲扩张的管状回声,内径约1. 8cm,向下扫查为一细管样回声与之相连,似开口于后尿道与阴道之间(图1),并向会阴部的体表走行。继而采用经腹超声扫查,     

儿童盆腔横纹肌肉瘤CT 表现

目的：探讨儿童盆腔横纹肌肉瘤的CT影像学表现特征。方法回顾性分析9例经病理证实的儿童盆腔横纹肌肉瘤的CT表现,包括肿块的部位、形态、大小、密度、强化方式及强化程度。结果9例中病变主要位于膀胱直肠隐窝8例,后腹膜1例,均表现为巨大不规则软组织肿块,其中8例肿块边界欠清呈分叶状,1例边界清楚有包膜。肿块内可见偏心性带状、团状低密度区,2例肿瘤内混杂出血。肿块易侵犯邻近组织,周围均未见明确肿大淋巴结。CT增强扫描病灶动脉期均表现为轻中度不均匀强化,边缘强化程度较其中心强化明显,静脉期、延迟期呈持续性强化。结论发生于盆腔的儿童RM S在C T影像学表现中有一定的特征性和临床鉴别诊断意义。     

多层螺旋CT尿路成像在泌尿生殖瘘中的诊断价值

目的 探讨泌尿生殖瘘的多层螺旋CT尿路成像(multi-slice spiral CT urography,MSCTU)表现.资料与方法 搜集4例经手术证实泌尿生殖瘘病人的临床及影像资料,详细分析其MSCTU特征.结果 4例泌尿阴道瘘均表现为阴道不同程度扩张,其内充满水样密度影.3例膀胱阴道瘘表现为膀胱与阴道间存在窦道性交通,对比剂自膀胱流入阴道.MSCTU显示1例输尿管阴道瘘的输尿管内对比剂注入阴道.结论 MSCTU是目前诊断泌尿生殖瘘的最佳手段,可为制定手术计划提供更多的信息.     

Gross hematuria: a complication of intrapelvic cement intrusion in total hip replacement.

Four patients with gross hematuria and dysuria following intrusion of methylmethacrylate into the pelvic cavity after total hip replacement are described. This is a rare, benign complication which generally occurs 7-14 days after surgery and subsides promptly with symptomatic treatment. The diagnosis can be made on a simple radiography of the pelvis which shows the radiopaque cement as a mass intruding with the pelvic cavity. On the urogram it frequently abuts against or produces an extrinsic impression on the urinary bladder. This complication is very likely a result of the exothermal reaction during polymerization of the methylmethacrylate.     

Magnetic resonance imaging for diagnosis and follow-up of genitourinary, pelvic, and perineal rhabdomyosarcoma.

Magnetic resonance (MR) imaging, ultrasound, and computed tomography (CT) were performed for diagnosis and follow-up of rhabdomyosarcoma (RMS) arising from the genitourinary tract in five children, pelvic musculature in one, and the perineum in three others. MR imaging performed at 1.0 T included the following: spin-density-, T1-, and T2-weighted images in all nine patients; gadopentatate dimeglumine (Gd-DTPA)-enhanced T1-weighted images in five; and short TI inversion recovery (STIR) images in two children. Longitudinal T1-weighted images were of additional help in localizing the primary tumor at diagnosis and detecting local spread. Residual or recurrent disease within the bladder was best detected by spin-density images. Gd-DTPA enhancement improved contrast in two studies, but paramagnetic artifacts obscured intravesical lesions in three other studies. STIR images disclosed pelvic and retroperitoneal lymphadenopathy. MR imaging is recommended as the key method of diagnosis and follow-up of pelvic RMS.     

Magnetic resonance imaging for diagnosis and follow-up of genitourinary,pelvic, and perineal rhabdomyosarcoma

Magnetic resonance (MR) imaging, ultrasound, and computed tomography (CT) were performed for diagnosis and follow-up of rhabdomyosarcoma (RMS) arising from the genitourinary tract in five children, pelvic musculature in one, and the perineum in three others. MR imaging performed at 1.0 T included the following: spin-density-, T1-, and T2-weighted images in all nine patients; gadopentatate dimeglumine (Gd-DTPA)-enhanced T1-weighted images in five; and short TI inversion recovery (STIR) images in two children. Longitudinal T1-weighted images were of additional help in localizing the primary tumor at diagnosis and detecting local spread. Residual or recurrent disease within the bladder was best detected by spin-density images. Gd-DTPA enhancement improved contrast in two studies, but paramagnetic artifacts obscured intravesical lesions in three other studies. STIR images disclosed pelvic and retroperitoneal lymphadenopathy. MR imaging is recommended as the key method of diagnosis and follow-up of pelvic RMS.     

儿童后尿道瓣膜造影诊断及球囊治疗

目的 采用逆行性膀胱造影和排泄尿道造影,显示后尿道瓣膜及并发的尿路梗阻征象。从而做出影像学诊断。将球囊导管插入后尿道扩张、疏通后尿道膜性梗阻。方法 应用以上方法诊断后尿道瓣膜１６例,患儿年龄３个月～４岁,平均年龄２岁６个月。本组病例中３例经造影诊断后行外科手术治疗,１３例采用后尿道球囊治疗。１６例患儿均有出生后排尿困难、尿线不连贯、滴沥状临床特点。结果 １２例造影中直接显示后尿道瓣膜负影,全部病例     

MR imaging of the female pelvic floor in the supine and upright positions

The goal of this study was to determine whether a .5-T open configuration magnet system could be used to evaluate the female pelvic floor support structures and their functional changes in the upright and supine positions. We evaluated five normal volunteers with full bladders in the supine and sitting positions. Multiple measurements were obtained, including distance between symphysis and urethra, bladder neck to fixed pubococcygeal line, and posterior urethrovesical angle. The pelvic floor was evaluated for integrity of the urethra, vagina, and supporting ligaments. High quality, interpretable images were obtained for all five patients in both positions. Most of the pelvic floor structures were stable, with the exception of the posterior urethrovesical angle, which increased in the sitting position. We conclude that the vertically open configuration magnet system shows promise for evaluation of the female pelvic floor, including urinary stress incontinence and prolapse.     

Imaging the pediatric prostate

The prostate gland is not often the target of imaging in children but may be imaged during investigation of symptoms related to the lower genitourinary tract such as hematuria, urinary retention, dysuria, and incontinence or during an evaluation for suspected congenital anomalies. Ultrasound and voiding cystourethrography are useful for initial evaluation of congenital and neoplastic disorders of the prostate. MR imaging and CT are useful in delineating more detailed anatomy before surgical planning and in determining the organ of origin in a patient who has a large pelvic mass.