巨大淋巴结增生症

本文报告5例巨大淋巴结增生症的临床和X线表现,本病好发于纵隔、肺门部以及腹膜后。肿块一般较大,呈圆形或明显分叶状,具有淋巴结肿大堆积融合成团的特点,密度均匀或病灶中心有放射状、片状钙化。肿块常压迫邻近气管、食管等器官使之移位,须与纵隔肿瘤鉴别。并简要叙述了本病的发病机理、病理分型和临床特点,手术切除预后良好。     

Lymph node metastases: CT and MRI

Imaging is playing a major role in the assessment of cervical lymphadenopathy. In head and neck malignancies, imaging can be helpful for staging, and sometimes in differentiating different types of metastases, such as squamous cell carcinomas, non-hodgkins disease and thyroid carcinomas. This article on imaging of cervical lymph node metastases will describe both radiological and clinical aspects. Computed tomography (CT) and magnetic resonance (MR) are widely used for primary tumor and nodal imaging. However, very seldom these modalities have clinical consequences for the management of the neck, such as a wait-and-see policy if no nodes are depicted. This is caused by the limited accuracy of both modalities caused by the fallibility of radiologic criteria for metastases. Ultrasound (US) is hampered by similar morphologic criteria, and only US-guided fine needle aspiration cytology (FNAC) can offer additional cytologic criteria which are more reliable.     

Pilomatrix Carcinoma with Lymph Node and Pulmonary Metastases

CASE REPORT: A 72-year-old male patient developed a locally recurrent pilomatrix carcinoma (PC) of the right upper shank. Within a 2-year period he also developed bilateral pulmonary as well as inguinal, cervical and paraaortic lymph node metastases. After external-beam radiation therapy (EBRT) alone, sole interstitial high-dose-rate (HDR) brachytherapy (BRT) or postoperative EBRT with interstitial HDR-BRT boost, the patient demonstrated regressive or stable disease at the lymphatic sites. Systemic chemotherapy with intravenous paclitaxel failed to assure a substantial pulmonary response. In the course of the disease after 28 months pulmonary progression has led to continuing clinical deterioration. CONCLUSION: In accordance with literature data the hitherto course of this case corroborates that radiation therapy (RT) modalities can play an important role in the treatment of PC.     

早期乳腺癌前哨淋巴结活检替代腋窝清扫的临床应用

目的：探讨腋窝前哨淋巴结活检术在早期乳腺癌中替代腋窝淋巴清扫术的意义。方法：选择15例早期（T1-2N0M0）乳腺癌患者,用1%亚甲蓝溶液行腋窝前哨淋巴结活检,淋巴结阴性,不行腋窝清扫。结果：15例患者随访1～3年,术后无一例出现患侧上肢肿胀、患侧上肢感觉麻木、运动障碍等并发症。所有患者未发现有局部复发及腋窝肿大淋巴结。结论：对于早期乳腺癌患者,腋窝前哨淋巴结活检阴性可替代腋窝清扫术。     

颈淋巴结结核的CT诊断

提高对颈淋巴结结核的认识和CT诊断的正确性。材料和方法：经CT检查的颈淋巴结结核33例，与同期颈肿块（除颈器官肿瘤外）49例作CT对照研究，均经病理及临床证实。结果：（1）结核发病中位年龄29．2岁，明显年轻于恶性肿瘤组（556岁）。（2）结核淋巴结坏死率和包膜高度强化率均高达81．82％，结内坏死面积（≥1／2）者达7576％。（3）本文依颈淋巴结结核的CT形态分布提出分型：单纯型（Ⅰ－Ⅳ）、混合型：单纯型又可分为Ⅰ型（单个淋巴结，直径＜20mm）、Ⅱ型（串珠型）、Ⅲ型（多房型）、Ⅳ型（融合呈大单房或单个直径≥20mm）。其中Ⅱ型具诊断特异性。结论：CT对颈淋巴结结核有诊断价值。     

颈部淋巴结病变CT灌注成像

目的探讨CT灌注在区分颈部淋巴结病变中的临床价值。资料与方法对51例颈部淋巴结病变患者行CT灌注成像,包括淋巴瘤9例,甲状腺癌转移9例,甲状腺癌外的其他头颈鳞癌转移22例,淋巴结炎8例,结核3例。分析和比较不同病理类型淋巴结病变曲线和灌注参数特点。结果不同病理类型淋巴结病变CT灌注曲线(TDC)走势不同,淋巴结转移瘤以"速升速降"型为主,淋巴瘤TDC曲线低平,而慢性淋巴结炎以低平和缓升型为主。甲状腺癌转移淋巴结高灌注(PF)(127.04±65.78)ml.100g-1.min-1,淋巴瘤为低灌注(PF)(32.1±20.9)ml.100g-1.min-1,与淋巴结炎、其他头颈鳞癌转移瘤之间(PF)差异有统计学意义。结论不同病理类型的恶性淋巴结的TDC走势和灌注特点不同,利用CT灌注结合CT形态学表现可以帮助区分不同病理类型的淋巴结。     

淋巴结反应性增生的CT诊断

目的分析淋巴结反应性增生的CT表现及CT的诊断价值。方法回顾性分析13例经手术及病理证实的淋巴结反应性增生的CT表现。结果13例淋巴结反应性增生中,单独侵犯颈外侧淋巴结7例,同时侵犯颈外侧区及面淋巴结、颏下淋巴结各2例,1例侵犯腋窝及腹股沟淋巴结,1例为颈、腋、纵隔、腹膜后区和腹股沟淋巴结同时肿大。肿大淋巴结短径最小0.6 cm,最大2.6 cm,平均1.6 cm。肿大淋巴结孤立存在12例,仅1例有融合。1例因相互融合而密度不均,12例密度均匀并有明显强化,增强后CT值增加19.1~113.2 HU,平均59.1 HU。结论淋巴结反应性增生的CT表现有一定的特征性,CT检查对该病的定性诊断与鉴别诊断具有重要价值。     

Lymph node imaging: basic principles

Lymph nodes are involved in a wide variety of diseases, particularly in cancer. In the latter, precise nodal staging is essential to guide therapeutic options and to determine prognosis. For long, imaging of the lymphatic system has been limited to lymph vessel,especially via the exclusive use of conventional lymphography, at the expense of invasive procedures and patient's discomfort. Three main technical advances, however, have recently completed the clinical armamentarium for lymph node imaging: first, the refinement of cross sectional imaging, i.e. CT and MRI, combined or not with dedicated contrast agents, has progressively replaced conventional lymphography in oncology situations; second, the development of intra-operative sentinel node mapping has profoundly modified the diagnostic and therapeutic procedures in several cancer situations, mostly melanoma and breast cancer; finally, the increased availability of functional imaging, especially through the use of FDG-PET, has greatly contributed to the accuracy improvement of nodal metastases identification. The aim of this review will thus be to briefly review the anatomy and physiology of the lymphatic systems and to overview the basic principles of up-to-date lymph node imaging.     

颈部良恶性淋巴结的磁共振扩散加权成像研究

目的 评价磁共振平面回波扩散加权成像在鉴别颈部良、恶性淋巴结肿大的诊断价值,探讨表观弥散系数(ADC)值与转移性淋巴结分级之间的关系.方法 34例颈部淋巴结增大病人的52个淋巴结(>10 mm),经颈部淋巴结清扫(25个)或穿刺活检(14个)及影像学随访(13个)证实.SSEPI-DWI序列(b=0 mm2/s和1 000 mm2/s),重建出ADC图并测量ADC值.统计学分析包括方差分析及Sidak t或Tamhane's T2检验、受试者操作特征(ROC)曲线分析.P<0.05认为具有统计学意义.结果 喉鳞癌性转移淋巴结(25个)、淋巴瘤性淋巴结(11个)、良性淋巴 结(16个)的平均ADC值分别为(0.78±0.09)×10-3mm2/s、( 0.64±0.09)× 10-3mm2/s、(1.22±0.16)×10-3mm2/s.转移淋巴结组,高分化组ADC值高于低分化组(P<0.05).低分化组转移性淋巴结与淋巴瘤性淋巴结ADC值无显著差异(P>0.05).恶性淋巴结的ADC值明显低于良性淋巴结(P<0.05),鉴别良恶性淋巴结ADC值的最佳临界点值为0.94×10-3mm2/s.结论 在原发性喉鳞癌转移性淋巴结中,其ADC值与淋巴结分级有关.应用SSEPI-DWI可以可靠地鉴别喉鳞癌颈部转移性淋巴结和良性淋巴结,但是无法区分低分化型喉鳞癌转移性淋巴结与淋巴瘤性淋巴结.     

颈部肿大淋巴结的影像分析

目的探讨颈部肿大淋巴结影像表现特点,提高诊断的准确性。方法66例经临床和病理证实的颈部肿大淋巴结患者,均进行CT和/或MR I检查,对比分析他们的影像学表现。结果多发的转移性淋巴结与多发的结核性淋巴结在位置分布上有显著性差异(P=0.006)。转移性淋巴结环形强化20例,其薄壁环形强化19例,占95%,而淋巴结结核环形强化5例均为厚壁环形强化,两者具有显著差异性(P=0.000)。转移性淋巴结中心坏死占78%,而淋巴瘤仅占36%,两者有显著性差异(P=0.018)。结论根据颈部肿大淋巴结位置分布和影像表现特点,大部分可做出正确诊断。     

腹部淋巴结结核的CT诊断

目的：研究腹部淋巴结结核的CT表现,提高该疾病的诊断及鉴别诊断水平。方法：搜集14例经病理证实的腹部淋巴结结核,观察受累淋巴结的解剖分布、形态及强化方式特征。结果：肠系膜淋巴结受累8例,胰周小网膜10例,脾门1例,腰3平面以上腹膜后间隙6例,脾肿大10例。多房环形强化10例,均匀强化3例,环形强化1例。结论：腹部淋巴结结核CT表现具有一定的特征性,有助于该疾病的诊断及鉴别诊断。     

纵隔巨大淋巴结增生的CT诊断（附四例报告）

巨大淋巴结增生是一种少见的淋巴结特发性增大的良性疾病，多发生在纵隔，常误诊为纵隔肿瘤。本研究的目的是提出本病的ＣＴ征象，以及纵隔肿瘤鉴别。经手术、病理证实的纵隔巨大淋巴结增生４例。ＣＴ平后用６０％泛影葡胺１００ｍｌ团注法行增强扫描。纵隔窗观察，窗宽３５０ＨＵ，窗位３５ＨＵ。本病平扫时显示为软组织肿块，呈圆形或椭圆形，边缘光整，密度均匀，钙化发生率低。     

直肠周围间隙淋巴结转移的术前MSCT评估

目的:分析直肠周围间隙淋巴结转移的多层CT(MSCT)表现,探讨CT诊断直肠癌淋巴结转移(N分期)的价值.方法:术前行盆腔MSCT检查的154例直肠癌病例,均行全直肠系膜切除术,对直肠周围间隙淋巴结进行病理检查,采用双盲法,记录每枚淋巴结的CT表现,包括淋巴结短轴直径、边缘、密度、分布方式.结果:以手术病理为标准.直肠周围间隙淋巴结CT检出率为86.3%(471/546),病理共检出直肠周围间隙淋巴结546枚,CT检出481枚,其中471枚(阳性172枚,阴性299枚)淋巴结与病理相匹配.CT诊断直肠周围间隙淋巴结转移的各种判断标准(淋巴结大小、边缘、密度、分布方式)的敏感性分别为83.1%、72.2%、70.1%、73.5%,特异性分别为80.5%、85.1%、82.4%、75.1%.CT显示的淋巴结大小、边缘、密度、分布方式的差异与阳性率有显著相关性,P<0.005.结论:直肠周围间隙淋巴结有良性和恶性淋巴结,综合分析淋巴结大小、形态、密度及分布对诊断直肠周围间隙淋巴结转移有很大帮助.