原发性肝外胆管癌的超声与MRI成像比较

目的探讨超声与MRI在原发性肝外胆管癌的定性、定位诊断中的临床价值。方法 40例原发性肝外胆管癌,术前行超声和MRI检查,比较两种检查方法的定性、定位诊断的准确性。结果与MRI检查比较,肝外胆管癌超声的检出率和误诊率差异无统计学意义(P>0.05),漏诊率增高(P<0.05);两种检查方法在梗阻部位的诊断上差异无统计学意义(P>0.05)。结论超声检查可作为肝外胆管癌筛查的首选影像学方法,对于临床高度怀疑肝外胆管癌而超声检查呈阴性的病例需联合MRI诊断。     

Premalignant lesions of the anal margin

Premalignant lesions of the anal margin include Bowen's disease (intraepithelial squamous cell carcinoma) and Paget's disease (intraepithelial adenocarcinoma). Our experience includes 11 patients with perianal Paget's disease and 37 patients with perianal Bowen's disease treated from 1957 to 1986. The patients with perianal Paget's disease were older, had a higher incidence of invasive cancer, and had a worse prognosis than those with perianal Bowen's disease. The characteristic appearance of these lesions and their failure to respond to conventional therapy should lead the clinician to obtain a biopsy, which readily establishes the diagnosis. Our experience confirms that adequate evaluation followed by wide local excision is the appropriate therapy. Close follow-up is recommended to identify recurrence of the perianal disease or development of other malignancies.     

超声诊断肝外胆管癌的价值

目的分析肝外胆管癌的声像图特点,探讨早期超声诊断的临床价值。方法50例超声拟诊为肝外胆管癌患者,经临床手术、其他影像学及(或)经皮胰胆管逆行造影证实,分析其患者临床及超声影像学资料。结果肝外胆管癌超声直接征象分为乳头型、团块型、截断型和狭窄型;间接征象为肝内及肝外胆管扩张、肝内及肝门部淋巴结转移和腹水。误诊3例,其中1例为胆总管结石,2例为十二指肠憩室。结论超声显像对肝外胆管癌的诊断有重要价值。     

肝门部胆管癌的CT与MRI对照研究

目的:评估CT与MRI在肝门部胆管癌的诊断价值。材料与方法:回顾性分析16例经CT与MRI检查且为手术病理证实的肝门部胆管癌的CT与MRI表现,比较两种检查手段对病灶的显示情况及定性诊断的准确率。结果:16例肝门部胆管癌CT与MRI均表现为肝内胆管不同程度的扩张,其中14例肝门部见软组织肿块,2例MRI见胆管壁增厚呈鼠尾状改变,4例门脉受累,6例 CT发现淋巴结肿大。CT与MRI定性诊断的准确率及对病灶的显示无明显差异。结论:CT与MRI是检查肝门部胆管癌的有效手段。MRI在显示肝门部肿块的大小、范围及沿胆管壁浸润方面比CT优越,尤其对早期肝门部胆管癌诊断更具价值。     

多发性硬化脑内磁共振病灶分布及其特征

目的了解多发性硬化( multiple sclerosis, MS)的病灶特点. 方法选择确诊的缓解-复发型 MS患者 203例,每 6个月检查头颅 MRI一次. 结果① 203例 MS患者中, 172( 84.7%)例脑 MRI显示脱髓鞘病灶.其中有胼胝体病灶者 90例( 52%),有脑干病灶者 106例( 62%),有小脑病灶者 46例( 28%),有与脑室联结的病灶者 157例( 91%),有典型的卵圆形病灶者 98例( 57%),病灶长轴与侧脑室切线垂直的病灶占总病灶一半以上的 130例( 76%).② 203例 MS患者中,大脑半球内和脑内无病灶者分别为 41例 (20% )和 31例 (15% ).仅脑干有病灶者 6例( 3%),仅小脑有病灶者 2例( 1%),脑干和小脑都有病灶者 2例( 1%).③ 203例共检查 827次 MRI,有活动病灶者 77例( 41%),共有活动病灶 261个,分布在大脑、小脑和脑干者依次为 223、 10和 28个. 结论①在确诊 MS患者中,多数脑 MRI有脱髓鞘病灶.②脑内有病灶者中,小脑有病灶者,较欧美报道为低.③ T2像发现活动病灶的机率不高,多次复查能提高病灶的检出率.     

超声造影对肝内胆管细胞癌的诊断价值

目的探讨肝内胆管细胞癌的超声造影征象及临床应用价值.方法对3例病理证实的胆管细胞癌分别行常规超声及实时灰阶谐波超声造影检查,记录病灶的大小、回声、血流分布及分析超声造影各时相的特征.结果 3例病灶在二维声像图上没有特异性,彩色多普勒血流显像显示病灶均为少血供型,超声造影显示3例病灶均表现"快进快出"的超声造影增强模式,门脉相病灶呈低回声,周边可见高回声环.结论超声造影在本组肝内胆管细胞癌病例中表现出的共同特征,对病灶的诊断有一定帮助.     

超声造影观察腹膜病变

目的 探讨腹膜病变的超声造影(CEUS)特点. 方法 对32位拟行腹膜穿刺活检的患者行腹膜CEUS检查,定量分析时间-强度曲线各参数间的差异,以及与腹膜CDFI血流分级的相关性. 结果 结核性腹膜炎与腹膜转移癌的CDFI血流分级无显著差异,具有相似的超声造影增强模式.腹膜转移癌的造影增幅强度高于结核性腹膜炎.腹膜病变的CDFI血流分级与腹膜峰值强度及增幅强度呈显著正相关. 结论 CEUS可反映腹膜病变血管生成的状况.     

Hilar cholangiocarcinoma: MRI/MRCP in staging and treatment planning

The role of MR imaging in hilar cholangiocarcinoma is to confirm/reach a diagnosis and to assess resectability. Hilar cholangiocarcinoma shows the same signal intensity pattern of peripheral tumors both on T1- and T2-weighted images. On magnetic resonance cholangiopancreatography (MRCP) images, hilar cholangiocarcinoma appears as a moderately irregular thickening of the bile duct wall (5 mm) with symmetric upstream dilation of the intrahepatic bile ducts. The aim of preoperative investigation in Klatskin tumors typically requires the evaluation of the level of biliary obstruction, the intrahepatic tumor spread, and the vascular involvement; it also needs to show any atrophy-hypertrophy complex. Because of its intrinsic high tissue contrast and multiplanar capability, MR imaging and MRCP are able to detect and preoperatively assess patients with cholangiocarcinoma, investigating all involved structures such as bile ducts, vessels and hepatic parenchyma. The main reason for surgical/imaging discrepancy is represented by the microscopic diffusion along the mucosa and in the perineural space.     

超声诊断胆管癌的误诊分析及改进方法探讨

目的探讨造成肝外胆管癌超声诊断的误诊的具体因素。方法对超声误诊的32例肝外胆管癌的误诊因素进行回顾性分析,并与其它影像学检查对照。结果共有4例假阳性和28例假阴性病例,以下段及上段胆管癌误诊率较高。团块型及狭窄型易误诊为肝内胆管结石、胰头或壶腹部癌、胆管炎症;2例误诊为肝癌;部分因肥胖和胃肠道气体干扰而误诊。结论胆管癌的超声误诊的具体因素较多,通过结合病史、临床症状,禁食饮水排除气体干扰,多切面观察,结合其它影像学检查可降低胆管癌的误诊率。     

肝内胆管细胞癌超声造影表现

目的总结肝内胆管细胞癌的超声造影表现.方法回顾性分析2009年1月至2011年12月复旦大学附属中山医院收治的经手术及穿刺活检病理证实的56例肝内胆管细胞癌患者超声造影表现.结果56例肝内胆管细胞癌患者共70个病灶,所有病灶超声造影均表现为“快进快出”,门脉期及延迟期均呈低回声.肝内胆管细胞癌超声造影开始增强时间、达峰时间、表现为等回声时间、表现为低回声时间分别为(14.50±3.82)s、(22.29±4.97)s、(30.38±7.97)s、(43.54±16.80)s.70个病灶中,42个(60.0%,42/70)表现为动脉期病灶边缘不规则环状增强,28个(40.0%,28/70)表现为整体增强;动脉期增强过程中,49个病灶(70.0%,49/70)表现为“树枝状”由周边向中央延伸的特征性的增强方式.超声造影增强达峰值时,51个病灶(72.9%,51/70)表现为不均匀增强,19个(27.1%,19/70)表现为均匀增强.21个病灶(30.0%,21/70)常规二维超声检查病灶边界显示不清,超声造影病灶边界均清晰.所有病灶在门脉期及延迟期均表现为低回声.56个病灶(80.0%,56/70)超声造影表现为“快进快出”、环状增强和(或)树枝状增强.结论肝内胆管细胞癌的超声造影具有“快进快出”、环状增强和(或)树枝状增强等表现,对其诊断和鉴别诊断具有一定的价值.     

Focal liver lesions: evaluation with contrast-enhanced ultrasonography

The development of contrast agents for ultrasound has significantly extended its clinical applications, particularly in the detection and characterization of focal liver lesions. Real-time evaluation of the vascular phase currently can be achieved by combining new microbubble-specific methods with second-generation contrast agents. The enhancement pattern in the vascular phase combined with the behavior in the liver-specific late phase allows characterization of the most frequent focal liver lesions, with an accuracy similar to those of dynamic computed tomography and magnetic resonance imaging.     

三维超声对肝门胆管癌分型诊断的临床初步应用

目的 初步探讨三维超声在肝门胆管癌分型诊断中的应用价值.方法 对20例临床确诊的肝门胆管癌患者,分别运用二维和三维超声进行分型,使用表面光滑模式和最小回声模式对肝门部肿瘤及肝内胆道树三维重建.以手术及磁共振胰胆管造影(MRCP)确定的分型结果作为金标准,比较三维和二维超声对肝门胆管癌分型诊断的准确率.结果 本组20例患者中11例经手术证实,包括Ⅰ型、Ⅱ型各1例,Ⅲa、Ⅲb型各2例,Ⅳ型5例,9例经MRCP证实,均为Ⅳ型.20例均成功重建出肝门部肿瘤及邻近胆道树的空间结构.二维超声分型诊断正确13例,诊断错误7例,其中手术证实4例,MRCP证实3例,包括1例Ⅱ型误诊为Ⅰ型,1例Ⅲa型及1例Ⅲb型误诊为Ⅳ型,3例Ⅳ型误诊为Ⅲa型,1例Ⅳ型误诊为Ⅲb型.三维超声分型诊断正确19例,1例Ⅲb型经手术证实误诊为Ⅳ型.三维和二维超声对肝门胆管癌分型诊断的准确率分别为95.0%(19/20)、65.0%(13/20),三维超声对肝门胆管癌分型诊断准确率高于二维超声(χ2 =3.91,P＜0.05).结论 三维超声成像能够提供更加丰富的信息,对了解肝门胆管癌与胆道树的空间位置关系、明确肝门胆管癌的分型具有一定价值.     

Transvaginal ultrasonography of nongynecologic pelvic lesions

Transvaginal ultrasonography (TVUS) is one of the preferred imaging modalities in patients with gynecologic problems because of its high diagnostic accuracy, noninvasiveness, and wide availability. In endovaginal scanning, the problem of sonic attenuation is much less significant than with the transabdominal approach in the evaluation of the viscera in the true pelvis. Placement of high-frequency, high-resolution probes within the vagina allows accurate assessment of all anatomic structures of the female reproductive tract within the pelvis, and, incidentally, a variety of pathologic conditions affecting the intestinal tract, the urinary system, the pelvic walls, vessels, lymph nodes, and peritoneum can be assessed by this technique. In this article, we show the appearances of nongynecologic lesions of the female pelvis as imaged with TVUS and discuss the clinical indications to this kind of study and the role of TVUS in guiding interventional maneuvers through the vaginal vault. All endovaginal scans were taken with transducers at frequencies of 5.0-7.5 MHz.     

彩色多普勒超声对肝门部胆管癌的诊断价值

目的 评价彩色多普勒超声对肝门部胆管癌的诊断价值。方法 对４２例经手术病理证实的肝门部胆管癌患者进行彩色多普勒超声检查,观察肿瘤内供血特点及肿瘤与门静脉之间的关系,并对误诊病例进行分析。结果 肝门部胆管癌的彩色血流显示率为６４．３％,彩色血流显示率、门静脉受侵率与肿瘤大小无统计学相关性,本组病例超声诊断符合率为７１．４％。肝门部胆管癌需与原发性硬化性胆管炎、Ｍｉｒｉｚｚｉ综合征、胆囊癌侵犯肝门部胆     

肝门部胆管癌MRI诊断价值分析(附64例报告)

目的探讨MRI对肝门部胆管癌的诊断价值。方法对经手术病理证实的肝门部胆管癌64例,采用MRI平扫、MRCP及动态增强扫描。结果 64例肝门部胆管癌均表现为肝内胆管不同程度"软藤样扩张"(MRCP),肝门区胆管狭窄、中断或腔内充盈缺损;42例MRI肝门区可见稍长T_1、稍长T_2的肿块影,22例未发现明确肿块;增强扫描42例可见肿块延迟期缓慢持续强化,22例表现为管壁增厚强化,管腔狭窄。结论增强前后MRI可以显示肝门胆管癌的特征性改变,如联合应用MRCP则有助于提高其定位、定性诊断准确率。     

Characterization of adrenal lesions on chemical shift MRI: comparison of 1.5 T and 3 T MRI

Purpose

To compare three chemical shift MRI techniques [two-dimensional (2D) dual gradient echo (dGRE), 3D VIBE, and 3D VIBE-Dixon] at 3 T and 2D dGRE technique at 1.5 T to assess their ability of detecting microscopic fat in adrenal adenomas and differentiating between adenomas and non-adenomas.

Methods

Seventy-eight patients with 97 lesions (78 adenomas, 19 non-adenomas) underwent both 1.5 T and 3 T chemical shift MRI. The Wilcoxon signed-ranked test was used to determine if there was significant difference between the signal intensity index (SII) values of each technique to assess their ability to detect microscopic fat in adrenal adenomas. ROC analysis was performed for the SII values of each technique, the adrenal-to-spleen SI ratio of 2D dGRE technique at 3 T, and the fat fraction values of the 3D VIBE-Dixon technique to identify the optimal threshold for differentiation of adrenal adenomas from non-adenomas.

Results

For detection of microscopic fat, the mean SII value of 2D dGRE technique at 1.5 T was significantly higher than that of the chemical shift imaging techniques at 3 T (p = 0.001). For discrimination of adenomas from non-adenomas, the area under the curve (AUC) and 95% confidence interval values of 2D dGRE technique at 1.5 T and 2D dGRE, 3D VIBE, 3D VIBE-Dixon techniques at 3 T were calculated as 1.00 (1.00–1.00), 0.991 (0.978–1.00), 0.999 (0.995–1.00), 0.993 (0.979–1.00), respectively, for the SII.

Conclusion

Chemical shift MRI at 1.5 T using the 2D dGRE technique provided the most accurate differentiation between adenomas and non-adenomas. However, there was no statistically significant difference between chemical shift imaging techniques at 1.5 T and 3 T.

     

超声造影诊断输尿管占位的初步探讨

目的 探讨超声造影诊断输尿管占位的可行性及声像表现.方法 对19例19个经手术病理证实为输尿管占位性病变的常规超声及超声造影声像图进行回顾性分析.常规超声观察输尿管占位大小、回声、边界、有无彩色血流信号.超声造影观察病灶的增强方式和增强时相,包括起始时间、达峰值时间、消退时间及病灶内部结构的增强表现.结果 本组19个肿块最大长径范围2.1～7.7 cm,常规超声显示低回声肿块7个,等回声肿块10个,高回声肿块1个,显示欠清1个;8个病灶内发现彩色血流信号,6个仅周边见彩色血流信号,5个未显示彩色血流信号.超声造影19例病灶早期均见增强,同步增强8个,缓慢增强11个;达峰值时呈稍高回声11个,稍低回声3个,等回声5个;增强晚期快速消退16个,同步消退1个,稍慢消退1个,不能比较1个.常规超声的病灶血供检出率、边界清晰显示率和输尿管癌的诊断敏感性分别为74%(14/19)、16%(3/19)和50%(8/16),超声造影的病灶血供检出率、边界清晰显示率和输尿管癌的诊断敏感性分别为100%(19/19)、58%(11/19)和94%(15/16),两组差异有统计学意义.结论 超声造影可改善输尿管占位的血供和边界显示,提高诊断敏感性.     

超声造影诊断输尿管占位的初步探讨

目的 探讨超声造影诊断输尿管占位的可行性及声像表现.方法 对19例19个经手术病理证实为输尿管占位性病变的常规超声及超声造影声像图进行回顾性分析.常规超声观察输尿管占位大小、回声、边界、有无彩色血流信号.超声造影观察病灶的增强方式和增强时相,包括起始时间、达峰值时间、消退时间及病灶内部结构的增强表现.结果 本组19个肿...