多排螺旋CT鉴别诊断黄色肉芽肿性胆囊炎和胆囊癌

目的 探讨多排螺旋CT(MDCT)鉴别诊断黄色肉芽肿性胆囊炎和胆囊癌的价值。方法 回顾性分析经手术病理证实的11例黄色肉芽肿性胆囊炎(XGC)和20例胆囊癌(GBC)的资料,所有患者术前均接受MDCT检查,并分析两种病变的CT征象。结果 胆囊壁的增厚方式、黏膜线情况、是否有壁内低密度结节和胆道梗阻在XGC和GBC患者间差异有统计学意义(P均<0.05)。XGC与GBC患者发生邻近肝脏及周围组织改变的病例数差异无统计学意义(P>0.05),但邻近组织改变的形式不同。结论 MDCT扫描可为鉴别诊断黄色肉芽肿性胆囊炎和胆囊癌提供客观依据。     

Gallbladder ectopia simulating pancreatic mass on CT

The authors present an unusual case of a highly mobile gallbladder which simulated a pancreatic mass on computed tomograms. Radiographic features of this interesting variant are illustrated.     

大肠癌多层螺旋CT诊断与临床病理分期的对照研究

目的:评估充气大肠螺旋CT扫描(AESCT)对大肠癌术前分期的诊断价值。方法:对45例经内窥镜活检证实的大肠癌病人,术前经肠道准备后行螺旋CT扫描,并进行术前Duke分期,然后与手术病理分期对照。结果:AESCT显示大肠癌的敏感性达100%;对大肠癌Duke分期的准确率为80%(36/45),较普通CT扫描50%的准确率有明显提高。结论:AESCT扫描对大肠癌的术前分期很有价值,尤其对判断局部浸润和远处转移的情况更为准确,是评估大肠癌术前分期的很有价值的方法。     

原发性胆囊癌与慢性化脓性胆囊炎的CT鉴别诊断

目的:探讨原发性胆囊与慢性化脓性胆囊炎的CT诊断及鉴别诊断。材料与方法:回顾性分析29例胆囊癌及12例慢性化脓性胆囊炎的临床表现及CT资料。结果:两组病例临床表现类似。CT显示胆囊癌的胆囊壁增厚6例,突入胆囊腔内肿块16例及肿块占据整个肿囊7例。肝内胆管扩张18例。病灶均有轻度至中度强化。慢性胆囊炎均表现胆囊增大,壁增厚;5例壁内存在低密度区;增强后明显强化。肝内胆管扩张1例。结论:CT显示胆囊癌主要表现为局部肿块及肝内胆管扩张;胆囊炎表现为胆囊壁增厚、边缘模糊,尤其CT可以发现壁内低密度小脓肿。     

黄色肉芽肿性胆囊炎的CT表现

目的探讨黄色肉芽肿性胆囊炎(XGC)的CT表现特点,提高对XGC的诊断水平.方法回顾性分析经手术病理证实的29例XGC的CT检查资料.结果术前诊断为胆囊癌15例,慢性结石性胆囊炎14例.29例均有不同程度的胆囊壁增厚,其中局限性胆囊壁增厚8例,弥漫性胆囊壁增厚21例;增厚的胆囊壁内见单发或多发低密度结节15例;伴发胆囊结石26例;肝-胆界面较清楚者24例,肝-胆界面不清者5例;增强后增厚的胆囊壁在动脉期仅有轻度强化,门脉期至延迟期强化逐渐明显,胆囊壁内低密度结节影强化不明显,增强后显示密度较高的黏膜线9例.结论增强后增厚的胆囊壁延迟强化,增厚的胆囊壁内低密度结节,胆囊轮廓及黏膜线的存在对本病诊断有意义.     

双胆囊畸形并慢性结石性胆囊炎1例

患者男,62岁.主因"反复右上腹痛2年余"入院,疼痛呈持续性,向背部放射,有时伴有剑突下疼痛,多次行胃镜检查均提示为浅表性胃炎,服用胃药后症状无明显好转.查体:皮肤及黏膜无黄染,腹软、右上腹轻压痛,无反跳痛,Murphy征(-).B超提示双胆囊,一个胆囊腔内见数个大小不等强回声伴声影.仰卧位CT示胆囊区域见大小不等的两个囊状影,囊壁较厚,小囊内可见高密度影.俯卧位CT示高密度影移向最低处.术前诊断:双胆囊,胆囊结石.后行胆囊切除术,术中证实为双胆囊,小胆囊内结石,两胆囊有各自的胆囊管分别与胆总管相通.     

边缘型肝胆管癌的螺旋CT双期增强扫描研究

目的:研究边缘型肝胆管癌螺旋CT双期扫描的表现特点。材料与方法:29例边缘型肝胆管癌患者,分别于注药后30s,65s获得肝动脉及门静脉双期图像,所有病例均经手术或穿刺活检证实。结果:所有肿块均呈边缘不规则的低或略高密度灶,CT值14～41Hu。增强CT表现:肝动脉相及门静脉相可见菲薄、不连续的环形轻度强化,在双时相间变化不明显,且在低密度肿块内部可见轻度不规则的强化区,绝大部分瘤体可不强化或仅轻度强化。结论:边缘型肝胆管癌的特征性CT表现是:瘤体较大,密度较低,边缘不规则。增强扫描于肝动脉相及门静脉相可见菲薄、不连续的环形轻度强化,在双时相间变化不明显,且在低密度肿块内部可见轻度不规则的强化区。     

肾癌的CT诊断及分期与病理对照的研究

目的:探讨螺旋CT对肾癌的诊断与影像分期的价值。材料与方法:回顾性分析65例肾癌的CT征象,将其术前影像诊断结果与手术病理分期进行比较。结果:CT影像分期与手术病理分期准确率分别为:I期87.5%,II期85%,IIIa期50%,IIIb期83.3%,IIIc期87.5%,IVa期75%,IVb期100%。结论:螺旋CT为肾癌术前诊断与术前分期提供重要的指导意义。     

胆囊癌的CT与B超诊断价值

目的探讨和比较CT、B超对胆囊癌的诊断价值。方法回顾分析42例经手术病理证实的胆囊癌CT、B超影像和临床资料,就其CT和B超的影像表现、强化方式、周围组织结构的关系、有无转移等进行对比分析。结果42例胆囊癌中CT诊断胆囊癌31例(占74%),B超26例(占62%)。结论CT对胆囊癌的诊断优于B超,并可对肿瘤对周围结构侵犯评估及病变的治疗方案的制定有重要价值。超声因无损伤、可反复、不同体位的检查等优点可作为胆囊病变的筛查方法。     

基于多层螺旋CT简易评分模型鉴别局灶型食管癌与食管平滑肌瘤

目的 观察多层螺旋CT（MSCT）简易评分模型鉴别局灶型食管癌与食管平滑肌瘤的效能。方法 对46例局灶型食管癌和21例食管平滑肌瘤患者术前均行胸部增强CT检查,观察二者病变位置、密度、大小、病灶MPR最长径/轴位最厚厚度比值、强化程度及方式、瘤-空气界面、瘤周脂肪间隙及肿大淋巴结;对存在差异的CT征象进行Logistic回归分析,建立简易评分模型,采用受试者工作特征曲线（ROC）其鉴别诊断效能。结果 二者肿瘤MPR最长径/轴位最大截面厚度比值[优势比（OR）=0.154,95% CI（0.033,0.722））、肿瘤增强CT值[OR=0.928,95% CI（0.866,0.994）]及瘤-空气界面[OR=0.028,95% CI（0.004,0.184）]存在显著差异（P均<0.05）。据此建立简易评分模型,肿瘤增强CT值>65.5 HU赋值1分,肿瘤MPR最长径/轴位最大截面厚度比值>1.61为2分,瘤-空气界面不光滑为4分,以2.5分为最佳阈值,≥ 2.5分诊断为局灶型食管癌,简易评分模型曲线下面积（AUC）为0.945[95% CI（0.891,0.999）],其鉴别诊断效能优于单一特征（P<0.05）。结论 MSCT简易评分模型有助于鉴别局灶型食管癌与食管平滑肌瘤,可显著提高诊断效能。     

Ultrasonographic findings in acute acalculous cholecystitis

Acute acalculous cholecystitis (AAC) is usually seen as a complication of major surgery or trauma. Although this entity is well-known in the surgical literature, little has been written about it in the radiologic literature. A review of patient records from 1975 through 1982 revealed 16 patients with pathologically confirmed AAC on whom at least 1 sonographic study had been performed. Thickening of the gallbladder wall, a subserosal halo of edema, pericholecystic abscess, and marked gallbladder distention were consistent findings in AAC. In the proper clinical setting, these otherwise nonspecific findings allow a prompt and accurate diagnosis.     

慢性胆囊炎与胆结石形成关系的超声研究

目的 探讨慢性胆囊炎与胆结石形成的关系.方法 慢性胆囊炎、胆结石患者及正常人各20例采用超声法进行脂餐前后胆囊容积及排空率的测定.结果 结石组较对照组脂餐前、餐后各期胆囊容积增大,排空率降低(P＜0.05).慢性胆囊炎组餐后胆容积及排空率与对照组无显著性差异(P＞0.05),但空腹容积显著增大(P＜0.05).结论 慢性胆囊炎患者存在胆囊运动功能异常,这种异常可能是胆囊结石形成的原因之一.     

Computed tomography as the method of choice in the diagnosis of emphysematous cholecystitis

Computed tomographic (CT) findings in 4 cases of acute emphysematous cholecystitis are described. The use of CT in the diagnosis of this condition is discussed in relation to the use of sonography and plain radiography.     

Diagnostic accuracy of ultrasound in acute cholecystitis

This work attempts to assess the diagnostic accuracy of ultrasound for acute cholecystitis in 98 clinically suspected patients from the emergency unit in whom at least 3 of 6 relevant criteria are present. Gallbladder distention to 5 cm or more transversely or in the anterior-posterior axis (criterion 1) was present in 64 patients; thickening of the gallbladder wall of at least 5 mm (criterion 2) in 95; cholelithiasis (criterion 3) in 86; sonolucent halo in the gallbladder wall (criterion 4) in 40; sonolucent fluid band surrounding the gallbladder (criterion 5) in 27; and intraluminal echogenic mass with no posterior acoustic shadow (criterion 6) in 35. A diagnostic accuracy index, corrected for chance, was statistically and clinically more relevant with 3 as the minimum number of criteria for the ultrasonic diagnosis of acute cholecystitis.     

Cholescintigraphy for acute cholecystitis: False positive results caused by chronic cholecystitis

We investigated the effect of the severity of chronic cholecystitis on the incidence of false positive cholescintigrams in the diagnosis of acute cholecystitis. In a 4-year period 66 patients underwent cholescintigraphy (without evidence of significant hepatocellular disease or biliary tract obstruction) followed within 6 days by surgical removal of the gallbladder. At histopathology the gallbladders were categorized as normal, acute cholecystitis, or chronic cholecystitis. In addition, the severity of chronic cholecystitis was graded on a three-point scale. Using nonvisualization of the gallbladder for up to 4 h as the criterion for acute cholecystitis, the sensitivity and specificity for acute cholecystitis were 97 and 66%, respectively. Of the 35 gallbladders without acute cholecystitis, 4 were normal and the rest had various grades of chronic cholecystitis. The incidence of false positive studies increased with the severity of chronic cholecystitis (p<0.05). In addition, there were no false positive studies among the normal gallbladders and all gallbladders with grade three chronic cholecystitis gave false positive results. The data suggests that the severity of chronic cholecystitis affects the likelihood of obtaining false positive results with cholescintigraphy in the diagnosis of acute cholecystitis.     

结直肠癌64层螺旋CT灌注成像参数测定的可重复性研究

目的对结直肠癌64层螺旋CT灌注成像参数测定的可重复性进行评价。方法对33例结直肠癌患者进行64层螺旋CT灌注成像研究。重复测量灌注参数血流量（BF）、血容量（BV）、平均通过时间（MTT）、表面通透性（PS），比较各参数在同一观察者内及不同观察者间测定的可重复性。结果同一观察者不同时间测定的各参数均值相近，无统计学差异（P〉0．05）；不同观察者所测定的各参数均值也无显著性差别（P〉0．05）。结论结直肠癌64层螺旋CT灌注成像具有快速、无创、可重复性较好等特点，可用于评价结直肠癌的血流灌注状况。     

黄色肉芽肿性胆囊炎CT和病理特征

【目的】探讨黄色肉芽肿性胆囊炎（XGC）的CT和病理特征。【方法】回顾性分析经手术病理证实的13例XGC患者的CT影像学和病理学资料。【结果】13例XGC均表现为胆囊壁不同程度增厚,增强扫描增厚的胆囊壁轻一中度强化,n例增厚的胆囊壁内见条片状、结节状低密度影,增强扫描低密度影均无明显强化;7例囊内壁光整,黏膜线连续;6例黏膜面毛糙,不完整;13例胆囊内见均见结石,4例累及肝脏,5例与周围肠管粘连、分界不清;13例病理特点均表现为胆囊壁特征性的黄色肉芽肿结构,主要为泡沫样组织细胞,大量纤维组织增生,伴有淋巴细胞和浆细胞浸润,6例黏膜糜烂、渍疡形成。【结论】XGC的CT表现及病理具有一定的特征性,CT检查有助于XGC的诊断。     

早期子宫颈癌术后复发或转移的CT诊断

目的：探讨早期子宫颈癌术后复发或转移的典型和不典型CT征象。方法：收集125例早期子宫颈癌术后复发或转移病例，所有病例均接受螺旋CT增强扫描，对其CT表现进行回顾性分析。结果：局部复发23例，其中病变位于阴道残端9例，位于手术床区8例，位于盆壁5例，位于前腹壁1例，均表现为不规则形肿物，有明确坏死12例；淋巴结转移79例，其中只有淋巴结转移54例，同时合并有局部复发者6例，同时合并有远处转移10例，三者同时并存9例。远处器官转移23例，其中肝脏转移11例，肺转移6例，肾上腺转移3例，骨转移2例，腹膜复发1例。结论：淋巴结转移是早期子宫颈癌术后复发或转移的最常见的表现形式，CT可检出复发或转移病灶，并能显示病灶形态和范围，对于诊断和确定肿瘤范围有较大价值。