Computed tomography of musculoskeletal disorders.

The utility of computed tomography (CT) in evaluation of musculoskeletal disorders was assessed in 55 selected patients. CT provided unique information leading to a correct diagnosis in 45% of cases. In 78% the extent of a lesion was more clearly defined than on conventional imaging procedures, and in the same percentage the CT findings were used to plan optimal therapy. CT was most useful in demonstrating absence of a suspected mass lesion and in defining the full extent of a lesion involving the soft tissues.     

侵袭性血管黏液瘤的影像诊断(附3例报告并文献复习)

目的探讨侵袭性血管黏液瘤(AAM)的影像学表现。方法回顾性分析3例经手术病理证实为AAM患者的临床和影像学资料,3例患者均行CT检查,其中1例行MR I检查。结果3例患者均表现为盆腔、会阴或外阴部的软组织肿块,境界清晰,肿块推移但并不浸润邻近结构,其中2例CT增强扫描及MR I的T2W I显示肿块内特征性“旋涡状”和“分层样”结构,且1例复发病灶具有与原发灶相似的影像学表现。3例患者中1例表现为病灶内小囊状低密度。结论AAM的CT和MR I表现具有相对特征性,且MR I较CT更具临床应用价值。     

Elastofibroma: MR and CT appearance with radiologic-pathologic correlation.

OBJECTIVE. The purpose of our study was to determine the MR and CT appearances of elastofibroma and correlate the imaging features with the underlying pathologic findings. MATERIALS AND METHODS. We reviewed retrospectively the MR and CT findings in five cases of elastofibroma. All patients had a soft-tissue mass; one patient also complained of pain. The mean age of the patients was 71 years (range, 63-79 years). Four lesions occurred in the subscapular region, and one occurred in the thigh. In addition, we reviewed and compared the demographic data of 72 histologically proved cases for which we had archival data. RESULTS. Three of four lesions evaluated with spin-echo MR imaging were approximately isointense with skeletal muscle and contained areas with a signal intensity similar to that of fat; these corresponded to areas of dense collagen and interspersed fat, respectively. In the fourth case, the MR appearance was nonspecific. In one case, MR imaging with gadopentetate dimeglumine showed areas with and without enhancement. Three of four lesions evaluated with CT had variable margins, with tissue attenuation similar to that of the adjacent soft tissue as well as scattered areas of decreased attenuation, suggesting fat within the lesion. In one case, the lesion was well defined and relatively homogeneous with an attenuation less than that of skeletal muscle. CONCLUSION. The MR and CT features of elastofibroma are different from those of most other soft-tissue tumors, reflecting entrapped fat within a predominantly fibrous mass. Although these features are not pathognomonic, their presence in a subscapular lesion in an older patient suggests a presumptive diagnosis of elastofibroma.     

Diagnostic imaging of gastrointestinal leiomyosarcoma. Experience with 12 cases

PURPOSE: Gastrointestinal (GI) leiomyosarcoma is an uncommon malignant cancer arising in the smooth muscle of the alimentary tract. It is known for its widely variable patterns and aspecific symptoms and signs preventing correct clinical assessment in the majority of cases. We will illustrate the key role of diagnostic imaging in the detection and staging of this lesion, describing the most suggestive imaging findings for the correct diagnosis. MATERIAL AND METHODS: January, 1990, to June, 1998, we examined 12 patients with GI leiomyosarcoma; they were 10 men and 2 women whose age ranged 42 to 85 years (mean: 63.7 years). Four lesions were found in the stomach, 3 in the jejunum and ileum, and 2 in the rectum. Due to the difficult clinical assessment of this type of lesion and to the development of emergency conditions, we could plan no diagnostic protocol in advance; thus, the most suitable diagnostic imaging approach was decided on the spot for studying the supposedly involved GI portions. Double contrast studies, US, CT and endoscopy were performed and each patient underwent at least two examinations. RESULTS: Barium contrast studies were performed in 9 patients: the lesion was detected in 7 cases and tumor site and extent were defined in 5, while the double contrast study of the colon allowed to exclude large bowel involvement in 2 ileal tumors. In all 9 cases US and US-guided endoscopy permitted better assessment of extra-luminal spread and involvement of adjacent organs. CT, which is essential to staging, provided useful information suggesting the lesion nature: a round, inhomogeneous mass in continuity with the intestinal wall, with irregular margins, peripheral enhancement after i.v. injection of contrast material and a central necrotic area. Histology confirmed CT diagnosis in 7/9 cases while an aspecific diagnosis of large retroperitoneal and abdominal lesion was made in 2 cases. CT did not allow to define the origin of 2 large exophytic lesions in the stomach and jejunum and missed peritoneal metastases in 3 cases. CONCLUSIONS: Although the aspecific and quite variable clinical patterns make it extremely difficult to plan a correct diagnostic protocol, in our experience all diagnostic imaging techniques played a fundamental role in identifying and staging alimentary tract leiomyosarcoma. Particularly, CT showed high sensitivity and specificity in characterizing and staging this lesion but exhibited rather poor sensitivity in recognizing peritoneal spread.     

小儿肝脏未分化性胚胎性肉瘤的CT观察

目的 分析总结小儿肝脏未分化性胚胎性肉瘤的CT表现特点,以提高对本病的认识,从而能够早期诊断、积极治疗。方法 回顾性分析6例未分化性胚胎性肉瘤（UES）的临床、病理及影像特征,并结合文献加以讨论。6例患儿行腹部平扫,5例并行增强扫描。结果 平扫显示病灶边界清楚,3例病变为单囊,3例为多房囊腔,内有厚薄不均的分隔。囊性区内可见少许不规则软组织密度影,位于囊腔边缘或分隔周围。1例于病灶边缘见针尖钙化。增强后,可见肿瘤有一致密的,即病理上的纤维假包膜。实性部分轻度强化,囊性区不强化。4例超声图像表现为混合回声的实性包块内可见大小不等的无回声区。6例均经病理证实。结论 CT多表现为单囊或多囊性病灶,边界清楚,内有不同程度的实性部分,可见强化边。而超声图像则多表现为实性为主,其不一致性亦为本病的重要特点。     

X-ray computed tomography in purulent pleurisy

Complementary CT scan imaging during investigation of 18 cases of empyema showed it to be an essential examination, since it established the diagnosis in all cases, determined possible extension of the infectious process and possible causal lesion, defined the most effective approach for percutaneous drainage and evaluated efficacy of the later.     

Epithelial-myoepithelial carcinoma of the parotid gland.

We describe an unusual salivary neoplasm, an epithelial-myoepithelial carcinoma (EMEC) of the parotid gland, that occurred in a 64-year-old man. A CT scan showed a fairly well defined heterogeneous lesion with smooth margins and slight enhancement. MR images showed a lesion with intermediate T1-weighted signal intensity and a relatively high T2-weighted signal intensity. Although the imaging characteristics of EMEC on both CT and MR studies are nonspecific, clinicians and radiologists must be aware of its high local recurrence rate, which has been reported to approach 50% in some series, and thus the need for periodic postoperative imaging to detect early recurrence.     

副脾的CT诊断与误诊原因分析

目的:探讨副脾的螺旋CT影像特征及其误诊原因分析.方法:对23例经手术病理或临床随访证实的副脾患者的CT典型与不典型表现及临床资料进行回顾分析.结果:23例中,单发17例,多发6例.左侧肾上腺区11例,脾周或脾区12例.1例副脾伴梗死表现为均匀囊性病灶,无强化;其余22例CT均表现为平扫呈大小不等的软组织结节,密度均匀,边界清晰,CT值均在45 HU以上;增强后均匀明显强化,增强程度均在50 HU以上.结论:副脾有典型的影像学表现及常见发生部位,多数可在术前作出明确诊断,但副脾毗邻肾上腺或有伴发病变者常致术前误诊.     

Synovial sarcomas of the head and neck: CT and MR imaging findings of eight patients

BACKGROUND AND PURPOSE: Synovial sarcomas are soft-tissue tumors that rarely occur in the head and neck. The purpose of this study was to evaluate their CT and MR imaging appearance and to show that they may have a surprisingly benign imaging appearance. METHODS: Eight patients with histologically proved synovial sarcoma underwent CT; additionally, MR imaging examinations were performed in five of the eight cases. Attenuation and signal intensity on CT scans and MR images, respectively, were studied by two radiologists. They analyzed the location, size, margins, homogeneity, presence of adenopathies and infiltrative signs, and enhancement after injection of contrast medium. RESULTS: Four tumors were located in the hypopharynx, two arose from the infratemporal fossa, one arose from the maxillary sinus, and one arose from the faucial tonsil. Tumor sizes ranged from 27 to 70 mm. On CT scans and MR images, six lesions were homogeneous and well defined, with smooth margins. The remaining tumors were heterogeneous. In two cases, adjacent tissues were invaded. Calcifications were observed in one case and adenopathy in two cases. In three cases, the lesions were isointense on T1-weighted MR images and hypointense on T2-weighted MR images, and in the other two cases in which MR imaging was performed, the lesions were both isointense and hypointense on both T1- and T2-weighted images. Only the two local recurrent lesions were multilocular. CONCLUSION: Synovial sarcomas are aggressive sarcomas that may appear "benign" in some cases. In a young man, a synovial sarcoma may be suspected when a well-demarcated, homogeneous lesion is found in the head and neck.     

CT 诊断脾脏淋巴管瘤的应用价值

目的：通过分析脾脏淋巴管瘤的C T表现特征,探讨其影像诊断价值。方法搜集15例经病理证实的脾脏淋巴管瘤的CT资料,对其CT表现进行回顾性分析。结果脾脏囊状淋巴管瘤6例,海绵状淋巴管瘤9例。单发病灶7例,多发病灶8例。3例边缘清晰,12例边缘模糊。除单发单房病灶及多发单房病灶中1个病灶无分叶状轮廓改变外,余病灶轮廓均显示形态不规则,呈分叶状改变。病灶内呈稍高密度网格状分隔（除单发单房及多发单房中一个病灶外）及低密度之液性区（除1例出现分层征象,下层为稍高密度影）。增强后动脉期、门静脉期囊壁及分隔13例轻中度强化,2例延迟期轻度强化。结论脾脏淋巴管瘤的CT表现具有一定特征性,CT是临床正确诊断的重要影像学检查方法。     

鼻咽部血管纤维瘤的影像学诊断价值

目的：探讨鼻咽部血管纤维瘤影像学的价值。方法：回顾分析经手术病理证实的血管纤维瘤的CT、MRI、DSA特征，CT检查13例，MRI4例和DSA3例，同时完成2项或3项检查分别为4例和3例。结果：13例均显示出病变的部位及范围，CT平扫示软组织块为等密度或稍高密度。MRI示肿块T1WI呈等于或略高于肌肉信号，T2WI呈高信号。肿块增强扫描明显强化，CT强化密度曲线呈速升缓降型；MRI信号增强率升高。3例DSA显示供血情况以及营养血管的特征。结论：血管纤维瘤有特征性的CT和MRI表现，CT动态扫描、MRI增强率的表达及DSA有助于诊断和鉴别诊断。     

软组织滑膜肉瘤的CT和MRI诊断

目的：探讨软组织滑膜肉瘤的影像学表现。方法：回顾性分析17例经手术病理证实的软组织滑膜肉瘤患者的临床及影像学资料,分析其影像学征象。结果：大部分滑膜肉瘤影像表现为邻近关节边界较为清楚的团块状或分叶状软组织肿块,肿瘤体积一般较大（〉5 cm,88%）。CT平扫可见肿瘤大部分密度与肌肉密度相似,其内可见范围不等的低密度区,1例见团块状钙化,2例见斑点状钙化,主要位于肿块的周边。较大的肿瘤（〉5 cm）在MR T1WI上与肌肉信号相比呈不均匀等信号或稍高信号,在T2WI上表现为以高信号或稍高信号为主的混杂信号,5例肿块内可见低信号分隔;较小的肿瘤（〈5 cm）在各序列上均表现出信号的均匀性;增强扫描大部分肿瘤呈明显不均匀强化。结论：软组织滑膜肉瘤的影像学表现具有一定的特征性,CT和MRI综合评价有助于提高滑膜肉瘤的诊断准确性。     

肺硬化性血管瘤的CT诊断

目的探讨肺硬化性血管瘤（PSH）的CT影像特点及诊断价值。方法回顾性分析经手术病理证实的10例PSH患者的胸部CT平扫及增强扫描资料。结果 10例PSH中,位于右肺6例、位于左肺4例,全部为单发结节灶。CT平扫病变呈圆形或类圆形,边界光滑锐利6个,边界不光滑4个;密度均匀8个,不均匀2个。其中空气新月征2例,瘤周磨玻璃样影3例,贴边血管征3例,邻近的右肺动脉扩张增粗1例。增强扫描病灶均匀强化7例,不均匀强化3例。结论境界清晰、密度均匀、明显强化为PSH的主要表现,综合分析其他征象有益于提高诊断准确率。     

动脉瘤样骨囊肿的影像和病理学表现

目的:分析动脉瘤样骨囊肿(aneuriysmal bone cyst,ABC)的影像学及病理学特点,以期提高ABC的诊断水平。方法:回顾性分析32例经病理证实的动脉瘤样骨囊肿的影像学表现,全部病例中行X线检查20例,行CT检查17例,行MRI检查14例,部分患者在X线检查后进行了CT或MRI检查。结果:病灶分布于四肢长骨18例,脊椎8例、骨盆4例、下颌骨1例、跟骨1例;在X线和CT表现为上ABC表现为偏心性和膨胀性骨质破坏,MRI表现为多囊性病灶,T1WI呈低信号,T2WI呈高信号;病理均表现为含血囊腔及结缔组织性的间隔。结论:动脉瘤样骨囊肿有其特征性影像学表现,普通X线检查是最基本的首选检查方法,CT和MRI在显示动脉瘤样骨囊肿病灶内部结构和鉴别诊断上具有优势,综合影像学检查能提高动脉瘤样骨囊肿诊断符合率。     

Comparative evaluation of echography, computerized tomography and magnetic resonance imaging in the diagnosis of hepatocellular carcinoma in cirrhotic patients]

The contribution of US, CT, and MR imaging was investigated in 25 cirrhotic patients with hepatocellular carcinoma. The following parameters were considered: lesion detection, site and size of the lesion, daughter nodules, location and/or infiltration of intrahepatic vessels, patency of portal vein and collateral vessels, signs of chronic liver disease, steatosis, ascitis, and lymphadenopathy. Our results confirm the value of US, which also allowed lesion biopsy in all cases. CT was as accurate as US in detecting the lesion and even superior in demonstrating daughter nodules. MR imaging, with conventional SE and IR sequences, was inferior since it missed 3 lesions due to motion artifacts; moreover, a smaller number of daughter nodules was seen than with CT. The authors conclude that, at present, MR imaging cannot replace US and CT; the latter, if combined with arteriography, using either hydrosoluble or liposoluble contrast agents, gives the best results in the detection of small hepatocellular carcinomas, and especially of daughter nodules which are important factors for planning appropriate therapy.     

67Ga-枸橼酸盐显像与CT诊断肺癌的对比研究

目的:探讨67Ga-枸橼酸盐显像和CT检查对肺癌的诊断价值。方法:经病理证实的82例肺癌及35例肺部良性病变患者,分别行67Ga显像和CT检查,并分别比较两组结果。结果:82例肺癌患者中,67Ga显像阳性66例,占80.5%,35例良性病变患者中,显像阴性27例,占77.1%;CT诊断82例肺癌患者64例符合,占78.0%,35例良性病变患者30例符合,占85.7%,两者诊断肿瘤良恶性无显著性差异(P>0.05)。对直径<2cm的肿块,CT诊断优于67Ga显像,其差异具有显著性(P<0.05,直径>5cm的肿块,67Ga显像优于CT诊断,差异具有显著性(P<0.05),直径2～5cm的肿块,两者诊断无显著性差异(P>0.05)。对鳞癌及小细胞未分化癌,67Ga显像的灵敏度最高。结论:两种检查方法结合可提高肺癌诊断的正确性。     

Imaging appearance of bulk fat within an oncocytic adrenocortical neoplasm,a rare and potentially malignant tumour

Oncocytic adrenocortical neoplasm is a rare adrenal tumour that usually follows a benign clinical course. In some cases, however, these tumours have exhibited malignant behaviour. Here, we present the first published case showing bulk fat within an oncocytic adrenocortical neoplasm on CT and MRI, a finding that mimics fat within an adrenal myelolipoma. The distinction between these entities is important, as the current suggested management of an oncocytic adrenocortical neoplasm is resection with subsequent imaging surveillance.Incidental adrenal lesions are common and are estimated to occur in about 4% of abdominal CT examinations [1]. The presence of even a small amount of fat within an adrenal lesion is often deemed a specific finding for establishing a diagnosis of a benign myelolipoma [2, 3]. In this report we present the CT and MRI findings of an incidentally discovered adrenal lesion containing bulk fat that proved to be an oncocytic adrenocortical neoplasm. The biological behaviour of these rare lesions is not yet fully understood and resection and imaging surveillance are recommended. To our knowledge, the imaging appearance of an oncocytic adrenocortical neoplasm containing fat has not been previously demonstrated.     

骨化性肌炎的多模态影像学表现

目的:探讨骨化性肌炎的X线、CT、MRI、SPECT/CT的特征性表现。方法:回顾性分析56例经病理或随访证实为骨化性肌炎患者的影像学资料,总结其影像学特征,探讨该病的鉴别要点及诊断价值。结果:56例中,位于髋关节23例,肘关节18例,其他部位15例。早期病变12例,CT或MRI表现为软组织水肿、肿胀,无明显骨化成分,可合并邻近骨骼的骨膜反应;中期病变23例,表现为软组织内分层状肿块,病灶中心呈软组织密度或信号,病灶周围呈蛋壳样、絮状骨化影,SPECT/CT表现为病灶整体显像剂异常摄取;晚期病变21例,表现为边界清楚的骨化团块,SPECT/CT显像15例,其中3例未见显像剂摄取,6例病灶中央显像剂摄取,6例病灶周围显像剂不均匀摄取。结论:骨化性肌炎早期缺乏影像学特征,中期蛋壳样骨化是其特征表现,晚期的骨化团块可表现为不同形式的显像剂摄取,多模态影像学的综合应用可提高其临床诊断价值。     

巨淋巴结增生症的多层螺旋CT表现

目的探讨巨淋巴结增生症(giant lymph node hyperplasia,GLNH)的多层螺旋CT(MSCT)表现,旨在提高对本病的认识。资料与方法回顾性分析经病理证实的7例GLNH患者的MSCT表现,其中平扫+增强5例,2例仅行平扫。结果 7例中,1例弥漫型病变表现为肺内间质性炎症和肺门、纵隔淋巴结肿大;6例局灶型病变中,腹膜后和肺门各1例,纵隔和颈动脉鞘区各2例,平扫均表现为边界清晰的孤立软组织密度影,其中腹膜后1例密度不均匀,增强扫描呈"网格"样强化,余病灶密度均匀,增强扫描呈动脉期中度均匀强化,门静脉期、延迟期持续强化。2例纵隔病变内可见"分支"状、"斑点"状钙化;3例周边可见大血管分支,4例周围可见大小不等的淋巴结。结论局灶型GLNH的MSCT表现有一定的特征性,多可以确诊;弥漫型GLNH的MSCT表现无显著特征,需要结合临床资料综合考虑。     

不典型子宫肌瘤的CT与超声表现

目的：总结13例不典型子宫肌瘤的CT与超声表现，以期提高其诊断与鉴别诊断的准确性。资料与方法：选择经超声、CT检查（增强扫描10例，平扫3例）表现不典型，由手术、病理诊断的子宫平滑肌肿瘤13例，回顾分析其影像学与手术、病理表现。病变包括良性子宫平滑肌瘤11例，恶性2例。发病部位包括阔韧带5例、浆膜下3例、子宫颈1例、肌壁间和术后复发各2例。结果；CT扫描显示肿瘤边界清楚，肿物向上可延伸至髂嵴水平以上，向后下生长位于骶前。CT增强扫描肿瘤密度明显高于或接近腰肌者7例，病理显示肿瘤内均无显著变性；CT扫描肿瘤密度不均匀，超声显示肿瘤囊实性者6例，病理证实肿瘤内粘液样变性4例，液化坏死性囊性变2例。结论：子宫平滑肌瘤的不典型影像表现主要由于肿瘤起源特殊（子宫颈、阔韧带）、肿瘤巨大以及变性所致，CT扫描可表现为边界清楚的巨大盆腹腔或腹膜后肿物；当肿瘤有变性时，肿瘤可呈不均匀强化或很少强化，二维超声可表现为不均匀回声甚至囊实性肿物。