Computed tomography in unilateral extremity swelling of unusual cause.

Computed tomography (CT) were used in the evaluation of unilateral soft tissue swelling of unusual cause. Three patients with unilateral myositis are described and the diagnostic information provided by the CT scan is discussed. A fourth patient with lymphedema praecox and unilateral extremity swelling is presented.     

24. The Fusion of Anatomic and Physiologic Tomographic Images to Enhance Accurate Interpretation

Purpose: Dedicated PET-(fluorine-18)-fluorodeoxyglucose (FDG) studies were interpreted with the corresponding anatomic images (MR or CT) using image fusion display to improve spatial accuracy for the interpreter and the referring physician.Methods: The image-fusion display system was designed in-house and allows manual alignment and display of one image volume as an overlay on the other which has improved accurate correlation of physiological and anatomical information for more than 50 patient studies.Results: A case of a patient with left foot recurrent melanoma is presented for which the PET scan showed a large focus of activity just lateral to the urinary bladder. Image fusion confirmed that the PET focus corresponded to an abnormal lymph node on the follow-up CT scan. In a case of bladder carcinoma which included bladder augmentation, altered surgical anatomy rendered interpretation of the FDG-PET images difficult. The fusion with the patient's CT scan allowed evaluation of the altered physiology due to the altered surgical anatomy which permitted accurate image interpretation. In a case of pelvic lymphoma, the FDG-PET scan showed intense activity adjacent to the acetabulum and possibly within it. Image fusion allowed accurate localization of the patient's primary lesion with the additional benefit of showing activity extending into the adjacent bone.Conclusion: Image fusion of tomographic, anatomic and physiologic information permits accurate lesion localization including separation of soft tissue from bone. The image-fusion technique facilitates image-guided biopsy by providing accurate anatomic localization.     

Imaging foreign glass and wooden bodies of the extremities with CT and MR

This paper reviews our recent experience imaging glass and wooden foreign bodies of the extremities with magnetic resonance (MR) and CT. In all five cases the foreign bodies were detected by CT or MR or both. Only two of the foreign bodies were detected by plain radiography. Computed tomography and MR provided additional information regarding the adjacent tendons, neurovascular bundles, and muscle groups. The surrounding inflammatory reactions were accurately compartmentalized, and the extent of the disease along anatomic pathways of potential spread was demarcated. Magnetic resonance was superior to CT in soft tissue contrast resolution. Magnetic resonance and CT are not necessary for a case of acute foreign body injuries, but in complicated cases CT and MR may not only diagnose a foreign body but also serve to guide the surgical approach and extent of exploration.     

Osseous hydatidosis of the pelvic girdle. Contribution of computerized tomography and ultrasonics. Apropos of 3 cases

Three cases of bone hydatidosis of pelvis with invasion of soft tissues provided data on the effectiveness of CT scan and ultrasound imaging for diagnosis, evaluation of extension and follow up surveillance of this affection. Two of the three patients treated medically were followed up by review CT scan and ultrasound examinations. The two techniques were found to be effective for detecting recurrence and for surveillance of hydatid lesions of soft tissues during medical therapy.     

鼻腔副鼻窦恶性肿瘤的CT诊断

目的探讨鼻腔副鼻窦CT检查方法和肿瘤的形态、密度、窦壁骨质破坏、周围脂肪层侵犯、窦腔外软组织肿块等征象在鼻腔副鼻窦恶性肿瘤中的诊断作用.材料与方法逐项对比观察分析经病理证实的鼻腔副鼻窦恶性肿瘤32例和良性肿物139例的CT表现.结果CT冠状位扫描显示15例恶性肿瘤破坏25个窦腔骨壁,20例腔外软组织肿块累及23个相邻部位.轴位扫描发现骨壁受累12例,有20个侧壁骨质显示破坏,15个腔外肿块累及18个相邻结构.恶性组和良性组突出于窦腔外的软组织肿块分别为71.9%和5.0%、窦壁骨质侵蚀性破坏59.4%和14.4%、窦腔周围脂肪层的侵犯消失56.3%和13.7%,而软组织肿块形态不规则和密度不均匀,两组间无显著差异.结论鼻腔副鼻窦腔外软组织肿块、侵蚀性骨质破坏和窦壁周围脂肪层的侵犯消失,是诊断鼻腔副鼻窦恶性肿瘤的可靠征象.冠状扫描观察解剖内容和病变侵犯范围优于轴位扫描.     

Radiology of medullary chondrosarcoma: Preoperative treatment planning

We evaluated the radiologic studies of 30 medullary chondrosarcomas with respect to their accuracy in diagnosis and surgical staging. There were 30 sets of plain radiographs, 14 conventional tomograms, 26 radionuclide bone scans, 19 arteriograms, and 15 computed tomograms (CT). Plain radiographs provided most of the diagnostic information although many tumours looked benign. CT provided the most complete anatomic staging, including intra- and extraosseous tumor, and neurovascular involvement. However, it was difficult to be sure about subtle soft tissue invasion. Arteriography remained useful for evaluating major vessel involvement or cortical penetration when CT and conventional tomography were equivocal. Scintigrams disclosed increased uptake, usually corresponding to the true tumor extent; "extended uptake" beyond the tumor was uncommon. Conventional tomography has been largely replaced by CT, but was occasionally useful when the tumor was near the end of a bone.     

肝外胆管细胞癌的CT诊断

目的:分析肝外胆管细胞癌的CT表现,探讨其诊断价值。材料和方法:23例病理证实的肝外胆管癌均行螺旋CT动态增强检查和ERCP检查,分析其影像表现和诊断准确性。结果:CT诊断符合率78.3%(18/23),均表现为特征软组织肿块(直接征象)和肝内胆管及胆总管扩张(间接征象)。CT同时提供了较好的肿瘤分期诊断。ERCP诊断符合率91.3%(21/23),表现为肝内胆管均呈不同程度的扩张,肝外胆管狭窄、截断。CT结合ERCP后全部诊断正确,并提供详细信息。结论:肝外胆管细胞癌的螺旋CT检查有较好的诊断,结合ERCP可以获得更高的诊断准确率。     

18F-氟脱氧葡萄糖PET-CT在头颈部肿瘤临床诊治中的价值

PET-CT图像融合技术将CT解剖结构信息与PET功能代谢信息结合在一起,能更准确地显示肿瘤组织,18F-氟脱氧葡萄糖(18F-FDG)PET-CT在头颈部肿瘤明确原发灶、治疗前分期、监测治疗反应和复发、制定放疗计划等方面具有一定的临床价值。     

Incremental dynamic computed tomography: practical method of imaging the carotid bifurcation

A simple, practical method of applying incremental dynamic computed tomography (CT) to the imaging of 20 carotid bifurcations is described. The results are compared with those obtained by conventional carotid angiography and intravenous digital subtraction angiography (DSA). Conventional angiography provided additional information about the carotid bifurcation in only one of 14 cases, while incremental dynamic CT provided information not available from intravenous DSA in two of eight cases. Conventional brain CT is being used increasingly in the workup of patients with transient ischemic symptoms, and dynamic CT scanning at 3-mm increments requires only an extra 5 min of scanner time. The addition of incremental dynamic CT through the carotid bifurcation to the conventional brain CT scan procedure may obviate other screening tests before more definitive angiographic procedures.     

儿童纵隔神经母细胞瘤的影像学诊断

目的　探讨儿童纵隔神经母细胞瘤的影像学诊断价值及限度。方法　回顾性分析经手术、病理证实的 8例纵隔神经母细胞瘤的X线平片、B超及CT检查的影像学特征 ,比较它们的作用及限度。结果　X线平片 7例见后纵隔包块 ,提示神经源性肿瘤可能 ;B超 8例均可见纵隔包块 ,6例显示包块内血流丰富 ;CT检查均可见类圆形软组织包块 ,6例见密度混杂 ,内有团片状钙化影。结论　X线平片适于初步的定位诊断 ;B超更适合配合不佳儿童的初步检查 ,并可显示瘤内血供特征 ;CT则为最佳方法 ,不仅可作倾向性定性诊断 ,而且可显示与周围组织的解剖关系。     

Computed x-ray tomography in the study of 16 undifferentiated epitheliomas of the cavum nasopharyngeal type in children

CT scans were performed in 16 children with undifferentiated epitheliomas of the cavum nasopharyngis type. The CT scan provided the most precise data during initial investigations, especially clear information being obtained on any intra-orbital or intracranial extension, which may occur without clinical signs. The scan is also a valid method for determining efficacy during treatment, and for the early detection of recurrences.     

An Unusual 131I-Avid Adrenal Metastasis From Follicular Thyroid Carcinoma Identified by 131I-SPECT/CT

ABSTRACT: The adrenal gland is an uncommon site of metastasis from differentiated thyroid carcinoma, and I-avid adrenal metastatic lesions are even rarer. Here, we describe a 54-year-old woman with I-avid adrenal metastasis from follicular thyroid carcinoma identified using I whole-body scan (I-WBS) and I-SPECT/CT. I-SPECT/CT allowed superior localization of the equivocal I uptake in the I-WBS. It provides metabolic and anatomic information about a lesion, resulting in accurate localization and improved definition of I-WBS findings.     

MSCT尿路成像诊断泌尿系统疾病:与IVP检查的对比研究

目的:探讨多层螺旋CT尿路成像(MSCTU)技术对泌尿系病变的临床诊断价值,以及此技术相对IVU检查的优越性。方法:40例泌尿系病变患者分别行3期CT增强扫描、CT尿路成像及IVP检查,并进行对比分析。MSCTU后处理技术包括多平面重组(MPR)、曲面重组(CPR)、容积再现(VR)和最大密度投影(MIP)等。结果:40例CT检查(包括常规轴位扫描和重组图像)可清晰直观地显示病变的部位、性质、大小、形态、与周围组织的解剖关系以及继发改变,明显优于IVP。结论:MSCTU具有图像质量好、对病变检出率显著高于IVP检查的特点,结合原始横断面图像,基本可以取代IVP检查。     

侵及颈静脉孔区的原发性中耳癌的CT、MRI诊断

目的 探讨侵及颈静脉孔区的原发性中耳癌的CT、MRI特点.方法 回顾性分析7例经手术病理证实的侵及颈静脉孔区原发性中耳癌患者的CT、MRI资料,其中6例行高分辨率CT(HRCT)扫描,1例行常规CT增强扫描,7例均行MR平扫+增强.结果 HRCT显示鼓室、鼓窦、外耳道深部及颈静脉孔区软组织病灶伴不规则虫蚀样骨质破坏,涉及颈静脉孔(7例)、咽鼓管骨性段(7例)、面神经管(4例)、颈动脉管(4例)、外耳道前后壁(3例)、听小骨(2例)及前庭窗、水平半规管(1例)等结构的破坏.4例病变密度较均匀,CT值约30～55 HU,2例肿块内见少许小片状高密度影.1例CT增强显示中度较均匀强化.MR平扫示边界不清软组织肿块,与脑灰质相比,T1WI呈等、略低信号,T2WI呈等、略高信号,其中5例信号较均匀,2例肿块内见少许小片状T1WI、T2WI低信号灶,增强扫描5例呈中度较均匀强化,2例不均匀强化,内见小片状无强化区.MRI显示4例侵及颈内动脉,1例侵及乙状窦.结论 原发性中耳癌可广泛侵及颈静脉孔区,易造成误诊.HRCT可准确显示中耳癌骨质破坏特点及范围,咽鼓管骨性段破坏可帮助减少误诊;MRI能更清楚显示病变范围,肿瘤信号及强化方式有一定特点.     

Radiologic imaging of chronic sinusitis in the adult

The diagnosis of chronic sinusitis is based on clinical presentation, nasal endoscopy and CT scan. As a matter of fact, the CT scan of the paranasal sinuses is absolutely necessary to characterise the lesions, to visualise anatomic variations which are risk factors for the endoscopic surgery and to follow up treated and/or operated patients with recurrent symptoms. Nowadays, plain films of paranasal sinuses do not have any indication. MR Imaging may be indicated in selected cases of complicated sinusitis and of pseudotumors associated to sinusitis.     

恶性黑色素瘤的CT诊断

目的分析恶性黑色素瘤的CT表现,探讨CT诊断的价值。资料与方法回顾分析20例经手术病理证实的恶性黑色素瘤的CT表现。结果鼻腔及鼻窦中的9例肿瘤CT表现均为单侧无钙化软组织肿块,部分伴邻近结构侵犯;眼球2例表现为球内高密度占位;颅内1例为类圆形等密度灶,增强扫描强化明显;上颌骨、咽部、硬腭病灶为不规则软组织肿块;转移4例具备转移瘤特点。结论CT对恶性黑色素瘤的定性有一定限度,但可清晰显示病变范围、部位、侵犯及骨质破坏情况,对临床确定治疗方案及判断预后有重要作用。     

Concentration of Tc-99m MDP in ovarian carcinoma and its soft tissue metastases

A patient with ovarian carcinoma was evaluated for skeletal metastasis with a routine whole body bone scan. Although no bone metastases were visualized, there was dramatic accumulation of tracer in the soft tissues of the abdomen. CT revealed calcifying soft tissue metastases on the liver surface, the bowel serosa, and in the pelvis corresponding to the abnormal areas of Tc-99m MDP uptake. Tumor necrosis and ongoing calcification within the metastatic sites are possible explanations for this unusual soft tissue concentration of the bone-seeking radiopharmaceutical. In patients with metastatic ovarian carcinoma, careful review of extraosseous regions on bone scan images may provide valuable diagnostic information.     

胸部螺旋CT技术参数的最佳选择及应用

本文目的在于通过对螺旋ＣＴ及常规ＣＴ影像进行对比。取得肺成像的最佳螺旋ＣＴ扫描条件。作者对钨丝模型、低对比模型、空气干燥膨胀肺标本在相同ｋＶ、ｍＡｓ条件下进行不同层厚、不同重建算法、不同螺距的螺旋ＣＴ扫描及常规ＣＴ扫描，分析两种扫描成像的分辨率差异，支气管及血管的可见度及噪音。结果显示薄层、超高分辨、高分辨重建算法时影像分辨率高。厚层、标准、软组织重建算法时两种扫描方式影像略有差异。作者还对３２例     

Radiology of giant cell tumors of bone: Computed tomography,arthro-tomography,and scintigraphy

Radiologic studies of 50 giant cell tumors of bone in 48 patients were useful in assessing the anatomic extent for planning surgical treatment. Contrast-enhanced computed tomography (CT) provided the most useful and complete evaluation, including soft tissue extent and relationship to major vessels. Angiography was useful when the extraosseous extent and vascular relationships were not entirely clear on CT. Arthro-tomography was the best way to evaluate tumor invasion through subchondral cortex and articular cartilage. Reactive soft tissues, with edema and hyperemia, were difficult to distinguish from tumor tissue on CT and angiograms. Bone scintigrams often showed intense uptake beyond the true tumor limits.     

MRI of the floor of the mouth, tongue and orohypopharynx

Magnetic resonance is the imaging modality of choice for studies of the orohypopharynx, floor of the mouth, or tongue base. The superiority of MRI soft tissue contrast can demonstrate intra- and extraorgan spread of tumor beyond that of CT. Use of T1- and T2-weighted pulse sequences allows better discrimination of pathologic masses from fat or muscle than does CT. Multiplanar capabilities allow ease of examination in the preferred planes. Various sequences or planes of imaging may be chosen to tailor the examination to the anatomic region of interest. The use of Gd-DTPA with T1-weighted images should further improve diagnostic precision of tumor location and extension and may replace the need for the longer T2-weighted sequences. Gadolinium may help differentiate tumor recurrence from fibrosis in the post-radiation patient. New improvements in surface coil technology, motion and flow compensation imaging strategies, faster scan times, and spatial resolution will further advance MRI as the modality of choice for assessment of oropharyngeal, mouth, and tongue soft tissue masses.