食管癌术后复发的CT表现及其诊断价值

目的 :探讨食管癌术后复发的CT表现及其诊断价值。方法 :搜集经CT诊断并经临床或病理证实的食管癌术后复发病例 91例 ,分析其CT表现特点。结果 :吻合口复发 5 4例 ,部分伴周围组织浸润和纵隔淋巴结转移 ;胸腔胃复发11例 ,单纯纵隔淋巴结转移复发 2 6例。结论 :CT能准确显示食管癌术后复发及 /或纵隔淋巴结转移 ,周围结构受侵 ,脏器转移 ,为进一步治疗提供可靠资料。     

食管癌术后复发和转移的螺旋CT表现特点

目的　探讨食管癌术后复发和转移的优势解剖分布及其螺旋CT表现特点。方法　回顾性分析 50例食管癌术后的螺旋CT资料,总结肿瘤复发和转移的类型、解剖部位及其复发时间分布特点,并进行统计分析。结果　50例中共有 31例复发和转移。31例中,消化道复发 12例,包括吻合口复发 8例,食管残端复发 1例,残胃复发 3例;淋巴结转移 28例,以 2R区(11例)和 7+8区(11例)多见,两区以上淋巴结转移为 13例,腹主动脉周围淋巴结群转移 5例,锁骨上窝淋巴结转移 3例;双肺转移 8例,肝脏转移 7例,胰腺转移 1例; 31例复发和转移病例中,胸腔积液 6例, 1例为双侧, 5例为单侧 (术侧 )。复发和转移以术后 3个月 ~1年内多见(Ρ<0. 005)。结论　食管癌术后复发以吻合口为主要部位;淋巴结转移为主要转移途径,增大淋巴结优势分布于气管右旁和气管隆突下淋巴结。复发和转移常发生在术后 3个月~1年内。螺旋CT对食管癌术后复发和转移的诊断具有较高的应用价值。     

食管癌术后声带麻痹的CT表现及病因分析

目的 分析食管癌术后声带麻痹的CT表现及其与纵隔淋巴结转移的关系,提高对其影像学表现的认识.方法 回顾性分析临床诊断为食管癌术后并发声带麻痹的40例患者的CT资料.结果 声带麻痹CT表现:患侧杓会厌皱襞增厚、向前内侧移位,同侧梨状隐窝扩大34例 (85%);患侧声带萎缩外展,同侧喉室扩大31例 (77.5%);患侧杓状软骨向前内侧移位16例 (40%)等.38例(95%)患者发现纵隔淋巴结转移,4例(10%)患者发现吻合口复发.结论 CT检查为声带麻痹的确诊提供了重要依据,而且有助于明确引起声带麻痹的原因.     

胃管状成形重建在食管癌切除术中应用效果观察

目的：观察胃管状成形重建（管状胃）在食管癌切除术中的应用效果。方法：选择食管癌、贲门癌116例,随机分为管状胃组和胸腔胃组各58例,比较两组手术时间、术中出血量、术中术后输血量、术中清除淋巴结数量及住院时间,并观察术后吻合口瘘、胸胃综合征等并发症发生情况。结果：管状胃组手术时间、术中出血量、术中术后输血量均显著或非常显著少于胸腔胃组（P〈0.05,P〈0.01）;两组清除淋巴结数量及术后住院时间差异不显著（P〉0.05）。管状胃组发生颈部吻合口瘘1例,胸胃综合征1例;胸腔胃组发生颈部吻合口瘘1例,肺不张2例,肺部感染4例,胸胃综合征6例;死亡1例。结论：食管癌切除术中,胃管状成形重建食管术式优于胸腔胃术式。     

管状胃胃底成形术在食管癌切除中的应用

目的探讨管状胃胃底成形术在食管癌手术切除中临床应用的可行性。方法分析130例食管癌患者管状胃胃底成形术的手术效果。结果管状胃胃底成形术在预防食管癌手术后吻合口瘘、吻合口狭窄、抗反流、防止胸胃综合征、减少术后局部淋巴结复发与远处转移等方面疗效确切。结论食管癌患者手术中,管状胃胃底成形并纳入原食管床重建消化道,操作简单,安全可靠,值得推广。     

复发性食管癌:食管切除术后的CT估价

作者复习了58例食管癌切除术后的患者,男49例,女9例,年龄37～79岁。术后临床疑有肿瘤复发的病人在1～78个月内均作了CT检查,最后的CT观察用于评估,最早的CT作为对照。对每个CT扫描均作了如下估价:①胃内软组织肿块,弥散的胃壁增厚(>2cm)或局部增厚。②胃外软组织肿块和/或纵隔淋巴结增大。③腹腔淋巴结肿大。④远处转移。如果CT发现上述任何一种表现,就表明已有复发。如     

多层螺旋CT对可切除性胸段食管鳞状细胞癌 淋巴结转移规律的研究

目的 探讨可切除性胸段食管鳞状细胞癌不同T分期病人胸腹部转移淋巴结CT表现及分布特征。材料与方法 回顾性分析川北医学院附属医院329例经术后病理证实为胸段食管鳞状细胞癌，同时伴淋巴结转移的病人临床及影像资料，其中男225例，女104例，年龄38~82岁，平均（55.8±9.2）岁。根据原发肿瘤是否浸润肌层将病人分为2组（pT1及pT2-3）。通过观察多层螺旋CT颈胸腹部淋巴结大小、密度及强化方式等综合判断淋巴结转移，采用Kappa检验对转移淋巴结的影像及病理学结果进行一致性评估，同时观察不同T分期病人转移淋巴结优势分布区域。结果 329例食管鳞状细胞癌病人中，pT1病人51例（51/329，15.5%），pT2-3病人278例（278/329，84.4%）。MSCT共发现转移淋巴结967枚，其诊断胸段食管鳞状细胞癌转移淋巴结与病理结果的一致性较好（κ=0.708）。胸段食管癌病人最常发生淋巴结转移的区域为上纵隔及胃周区域。pT1组病人中，原发肿瘤位于胸上段最常见淋巴结转移区域为上纵隔区，位于胸中、下段最易发生胃周区域淋巴结转移，中下纵隔及腹腔区域转移较少。pT2-3组中，胸上中段及下段食管癌最常见淋巴结转移区域分别为上纵隔区及胃周区，而中、下纵隔淋巴结转移率较pT1组明显增加（P<0.05）。结论 多层螺旋CT扫描对评估胸段食管癌淋巴结转移有较高的准确性，且食管癌不同T分期病人的淋巴结转移区域有明显差别。     

胸段食管癌三野根治术后放疗靶区的临床研究

目的 探讨胸段食管癌三野根治术后患者进行预防性放疗不同照射野范围的毒副作用及其对预后的影响。方法 选择我院行颈、胸、腹三野联合根治术的胸段食管鳞癌患者213例。用配对法分为3组：术后放疗“T”型大野组70例,术后放疗“T”型小野组70例和单纯手术组73例。“T”型大野组照射野的范围包括双锁骨上区、纵隔、贲门旁胃左动脉淋巴结引流区、吻合口及原食管瘤床。“T”型小野组照射野的范围包括双锁骨上区、中上纵隔淋巴结引流区、吻合口及原食管瘤床。于术后3～4周开始放疗,中位总剂量54 Gy,分27次,每次2Gy,5次/周,5.4周完成。结果 术后放疗大野组恶心、食欲不振、胸腔胃溃疡出血及非癌性心包胸腔积液的毒副作用明显重于小野组,大野组有6例死于非癌性心包胸腔积液,3例死于胸腔胃溃疡出血;小野组仅1例死于胸腔胃溃疡出血,两组比较差异有统计学意义（P＜0.05）。术后有淋巴结转移者放疗大野组、小野组和手术组5年生存率分别为36.8%、43.9%、23.6%（P＜0.05）;而无淋巴结转移者分别为54.7%、68.9%、47.3%（P＞0.05）;3组区域淋巴结转移复发率分别为15.7%、15.7%、41.1%,大小野组比较差异无统计学意义（P＞0.05）,但与手术组比较差异有统计学意义（P＜0.05）;3组血行转移率分别为22.9%、17.1%、19.2%（P＞0.05）.结论 食管癌术后放疗小野照射可提高局部控制率及生存率,而且毒副作用轻,患者能够耐受。建议胸段食管癌三野根治术后预防性照射靶区包括双锁骨上区、中上纵隔淋巴结引流区及原食管瘤床。     

食管胃吻合口-纵隔-左主支气管瘘介入治疗一例

报道1例特殊类型的食管胃吻合口瘘患者,该患者食管癌术后出现食管胃吻合口瘘,通过纵隔原食管床形成窦道,直接与左主支气管交通.现将治疗过程及体会报道如下.     

CT引导下纵隔穿刺引流15 d治愈纵隔内食管胃吻合口瘘1例报告

根据食管癌的病理学和淋巴结转移规律 ,近年来 ,多数学者主张胸段食管癌均应行食管次全切除 ,颈部吻合食管重建术。颈部重建术吻合口瘘的发生率较胸内吻合瘘略高 ,其感染灶比较表浅局限 ,经引流换药治疗后多能在短期内愈合 ,很少危及生命。但是 ,一旦吻合口瘘入纵隔内 ,形成纵隔或胸腔内感染 ,处理不当则十分凶险 ,与胸内瘘相似 ,以往文献报道死亡率可达 61%以上[1] 。 2 0 0 3 -0 1我院发生该类瘘 1例 ,在CT引导下穿刺、引流、内外冲洗治疗及生物蛋白胶的应用 ,15d治愈 ,治疗效果满意 ,报告如下。1　临床资料患者　男 ,5 8岁 ,食管中段…     

纵隔型肺癌的CT及MR表现分析

目的 探讨纵隔型肺癌CT及MRI诊断能力.方法 回顾分析15例经纤支镜、穿刺活检及手术病理证实为纵隔型肺癌的CT及MRI影像资料,15例全部行CT平扫,其中11例增强扫描,3例行MR平扫与增强扫描.分析CT及MRI图像上肿块的位置、大小、形态、边缘及其与纵隔和肺的关系.结果 15例纵隔型肺癌为单发肿块,5例小细胞型肺癌,8例鳞癌、腺癌及腺鳞癌各1例.肿块均位于纵隔胸膜下,与纵隔呈宽基底相贴,大多呈类圆形或椭圆形.边缘分叶12例,毛刺9例.肿块位于上纵隔8例,中纵隔5例,下纵隔2例.其中前中纵隔区12例,后纵隔3例.肿块与肿大淋巴结融合7例.癌肿邻近相应支气管变窄或闭塞9例.4例有胸廓骨转移性骨质破坏.结论 纵隔型肺癌易误诊,仔细分析CT及MRI表现,结合临床可作出较准确的诊断.     

甲状腺癌淋巴结转移的CT表现

目的：评价甲状腺癌淋巴结转移的CT特点。方法：回顾性分析经手术及病理诊断的108例甲状腺癌淋巴结转移的CT表现。结果：108例中，颈上中深组淋巴结转移76例，颈下深组及锁骨上窝86例，气管食管沟52例，纵隔17例。84例乳头状癌中，16例淋巴结密度与正常甲状腺相似，24例有囊性变，其中18例淋巴结囊内有明显强化的乳头状结节，11例有细颗粒状钙化，24例滤泡癌，髓样癌，透明细胞癌中，17例淋巴结明显强化，17例与甲状腺原发或复发肿瘤密度一致，密度均匀或不均匀。结论：甲状腺癌转移淋巴结好发部位为颈静脉链周围，气管食管沟及纵隔；淋巴结明显强化，与正常甲状腺密度一致，囊性变，囊壁内明显强化的乳头状结节及细颗粒状钙化为甲状腺乳头状癌的特征性改变，淋巴结明显强化，与甲状腺肿瘤密度一致为滤泡癌，髓样癌，透明细胞癌转移淋巴结的特点。     

Staging of esophageal carcinoma: comparison of results with endoscopic sonography and CT

We compared the results of endoscopic sonography and CT in the preoperative staging of 46 patients with esophageal carcinoma studied prospectively. All patients had surgery and 44 had pathologic examination of the mediastinal and celiac lymph nodes. The results of CT and endoscopic sonography were compared with surgical and pathologic findings. A total of 51 tumors were found in 46 patients. Sonographic estimation of tumor extension through the different layers of the esophagus was correct in 37 (73%) of all 51 tumors and in 22 (85%) of the 26 tumors in which the examination was complete. The echoendoscope (13-mm diameter) could not pass through the tumor in 23 cases (50%). Infiltration to adjacent organs was found in 15 cases at surgery. In four of these 15, the extension was detected by CT; in seven of the 15 cases, it was detected by sonography. False-negative determination of tumor extension occurred with endoscopic sonography in patients with stenotic tumor. There were no false-positive results with either CT or endoscopic sonography. For detection of mediastinal lymph-node involvement, the sensitivity of CT was 48%. The sensitivity of sonography was 50% if metastatic nodes unexplored by sonography were included, or 84% if only cases in which stenosis was passed were considered. Statistical comparison revealed that sonography was superior to CT for the detection of metastases to lymph nodes. CT and endoscopic sonography provide complementary information. When the echoendoscope can be maneuvered past the tumor, sonography can be used accurately to define extension through the layers of the esophagus, extension to the adjacent organs, and involvement of the lymph nodes. When the tumor cannot be passed by the echoendoscope, CT is superior to sonography for detection of mediastinal extension.     

贲门癌的CT诊断价值

目的：探讨贲门癌的CT诊断价值。方法：收集本院1999年-2002年间经手术病理和／或内窥镜活检证实的贲门癌69例，对其CT图像进行回顾性分析。结果：贲门部腔内肿块43例，浅表溃疡46例，侵及食道下段19例，周围组织受累13例，远处转移19例，淋巴结肿大42例。结论：CT可显示贲门癌的大小、形态、范围，判定有无周围浸润、有无淋巴结及其他脏器转移，对指导制定手术方案有较大的价值。     

Computed tomography for staging esophageal and gastroesophageal cancer: reevaluation

A reevaluation of computed tomography (CT) for staging carcinoma of the esophagus and gastroesophageal junction was performed in 76 patients. For comparison 26 patients without carcinoma of the esophagus with a normal mediastinum at surgery were included in the evaluation. Four radiologists evaluated the CT scans without knowledge of the diagnosis. After determining if there was an adequate amount of fat, they were asked to evaluate each case for the presence or absence of local invasion and distant metastases. The radiologists correctly identified all 26 normal patients. Eighteen of the 76 carcinoma patients had a paucity of fat, but only six were thought to have truly indeterminate scans. CT correctly identified 40 of the 44 esophageal carcinoma patients with mediastinal invasion and 11 of the 15 patients without invasion (accuracy 88%). CT correctly identified 15 of 19 patients with distant abdominal metastases and 28 of 30 patients without metastases (accuracy 88%). CT was only 50% accurate in predicting the presence or absence of invasion in the 12 patients with gastroesophageal junction tumors and only 58% accurate in predicting distant metastases. CT correctly staged 46 (94%) of 49 patients with esophageal carcinoma but only five (42%) of 12 patients with gastroesophageal junction tumors. These results confirm that CT should be used as a major staging method in all patients with esophageal carcinoma.     

CT evaluation of mediastinal lymph nodes in lung cancer: influence of the lobar site of the primary neoplasm

Previous reports have shown differences in the ability of CT to detect mediastinal lymph nodes, depending on the precise mediastinal location of the nodes. Poorest correlation between findings on CT and findings at autopsy has been described for left-sided lymph nodes, particularly those in the left peribronchial region (American Thoracic Society node station 10L), suggesting that cancers of the left lung might be less well staged by CT than cancers of the right lung. The relationship between the accuracy of mediastinal lymph node staging and the location of the primary lung cancer was examined in a retrospective study. In 103 patients with non-small-cell bronchogenic carcinoma who had preoperative CT evaluation of the mediastinum, the accuracy of preoperative staging was 81% for tumors of the right lung (70 patients) and 97% for tumors of the left lung (33 patients). The conclusion is that cancers of the left lung are staged at least as accurately as cancers of the right lung, despite the fact that left-sided mediastinal nodes are depicted more poorly on CT. Subcarinal and crossover (contralateral) nodal metastases and a low prevalence of metastasis involving only region 10L were the most important factors minimizing staging differences based on the site of the primary tumor.     

Metastatic prostatic carcinoma presenting as an anterior mediastinal mass on gallium imaging.

A great majority of mediastinal lymph node metastases originate from primary neoplasms within the thorax. Mediastinal metastases from other malignancies are not infrequently encountered but are uncommon from a prostatic primary site. Since prostatic metastases may mimic lymphomatous nodes, it is important to be aware that mediastinal adenopathy occurring in a patient with prostatic carcinoma may be caused by metastases from that site rather than from lymphoma, or be secondary to some unknown primary malignancy elsewhere in the body. The author presents a case of metastatic prostatic carcinoma in the anterior mediastinum that was detected on Ga-67 citrate imaging and confirmed on a CT scan.     

Multimodal imaging of esophagus and cardia cancer before and after treatment

PURPOSE: Prognosis and treatment of esophagus and cardia cancer (ECC) depend on the precision with which the disease is staged according to the American Joint Committee of Cancer (AJCC) criteria. Imaging modalities normally used in clinical staging are esophagography, esophagoscopy, endoscopic ultrasound (EUS), computed tomography (CT) and positron emission tomography- CT fusion (CT-PET). The combination of these methods is crucial in determining not only the right diagnosis but also the stage and follow-up after multimodal treatment. The purpose of our investigation was to define the role of each imaging modality in determining the most appropriate treatment options in patients with ECC. MATERIALS AND METHODS: Fifty-six patients with ECC diagnosed by X-ray of the upper digestive tract, endoscopy and biopsy were staged using EUS, chest and abdomen CT scan, and CT-PET. Thirty-four patients in stage II and 18 patients in stage III underwent surgery after neoadjuvant chemotherapy; four patients in stage IV were treated with the positioning of an endoprosthesis after chemoradiotherapy. In the 52 patients who had surgery, follow-up included digestive tract X-ray, endoscopy and CT of the chest and abdomen every 6-8 months for the first 3 years. CT-PET was only performed in patients with a clinical suspicion of recurrence and/or CT findings suspicious of persistent disease (12 cases). RESULTS: In all 56 patients, endoscopy, EUS, CT and CT-PET in combination were crucial in determining the site of disease, locoregional extent and depth of esophageal wall penetration (T), and any involvement of the mediastinal lymph nodes (N1), extrathoracic lymph nodes (M1) or hepatic metastases. In the locoregional staging of ECC before chemotherapy, we were able to differentiate T2-T3 from T4 in 40 patients; T4 disease was found in 12 potentially resectable cases. We were able to distinguish N0 from N1 in 12 patients. In four cases, the presence of small lymph node and/or liver metastases prompted positioning of an endoprosthesis. The specificity of CT in detecting small lymph nodes in the mediastinum was less than 50% while for CT-PET, it was more than 80%; EUS revealed sensitivity higher than 90% but a low specificity in seven cases. Only CT-PET revealed metastatic subdiaphragmatic lymph nodes (diameter <15 mm) in three cases. Presurgical restaging of the 18 patients (stage III) who had chemotherapy was based on endoscopy, EUS, CT of the chest and abdomen and CT-PET (only in suspected cases) and was compatible with surgery. Anastomotic recurrence was diagnosed in 16 patients by endoscopy with associated biopsy; any intramediastinal spread from anastomotic recurrences was evaluated by chest CT, and CT-PET in suspected cases. CONCLUSIONS: X-ray of the upper digestive tract and chest and abdomen CT scan are useful in preliminary evaluation of ECC. Endoscopy is particularly indicated for evaluating tumour morphology, taking biopsies for a histological diagnosis and the early diagnosis of anastomotic recurrences. EUS is indicated mainly for evaluating T stage before and after chemotherapy or chemoradiotherapy. CT-PET is extremely useful in identifying small mediastinal metastatic lymph nodes (N1) or extrathoracic lymph nodes (M1) and hepatic metastases (相似文献   

甲状腺癌的CT和MRI诊断

评价ＣＴ和ＭＲＩ对甲状腺癌的诊断价值。材料和方法：回顾分析临床、病理证实的５０例甲状腺癌：３８例进行ＣＴ扫描,２８例作ＭＲＩ检查,其中１６例兼作ＣＴ和ＭＲＩ检查。结果：肿瘤内出血６例（１２％）、相邻结构受侵１１例（２２％）、颈部淋巴结转移１５例（３０％）、甲状腺内囊变２６例（５２％）和钙化２４例（４８％）,对甲状腺的定性诊断有重要价值。ＣＴ对甲状腺癌内钙化的发现明显优于ＭＲＩ,对肿瘤侵犯相邻结构的显示与ＭＲＩ相仿。ＭＲＩ对肿瘤内囊变,出血和颈部淋巴结转移的发现优于ＣＴ。结论：在甲状腺癌的定性诊断上,ＭＲＩ优于ＣＴ,但若能将两者相结合,能更准确地作出甲状腺癌的诊断。