直径小于4cm少脂肪血管平滑肌脂肪瘤的超声诊断价值

目的旨在提高超声对直径小于4cm少脂肪血管平滑肌脂肪瘤（RAML）的诊断准确性。方法分析12例（13个病灶）直径小于4em少脂肪RAML的声像图特点。结果13个病灶边界锐利清晰,与肾实质交界线平直,密集均匀高回声3个,中等回声6个,均匀低回声3个,高低回声相间的混合性回声1个。6个病灶能探及血流信号,其中3个见星点状及短线状血流,3个血流丰富,呈条索状分布;6个病灶均以静脉血流频谱为主,2个病灶可探及动脉样血流频谱,为低速低阻血流信号。术前超声诊断RAML9个病灶,超声诊断准确率为69．2％。结论超声检查对少脂肪RAML的诊断与鉴别诊断有重要价值。     

肝内脂肪瘤和血管平滑肌脂肪瘤的CT和MRI诊断

目的 探讨肝内脂肪瘤和血管平滑肌脂肪瘤的CT和MRI表现及其相应病理组织学基础。方法 收集经手术病理证实的肝内脂肪瘤和血管平滑肌脂肪瘤各3例和5例。其中7例作平扫和动、门双期螺旋CT增强扫描，1例只作平扫和平衡期增强CT扫描，2例同时加作MRI平扫和动态增强扫描。影像表现与病理组织学所见进行对照研究。结果 3例肝脂肪瘤CT平扫低密度，CT值-79～-92HU，边界清楚，密度均匀，增强扫描无明显强化。其中1例作MRI扫描，表现为T1、T2均呈均匀高信号；T1脂肪抑制呈低信号。光镜见肿瘤由丰富的脂肪组成。5例肝血管平滑肌脂肪瘤中，4例为单发肝内瘤灶，1例为肝内多发并双肾病灶。肝血管平滑肌脂肪瘤的CT平扫，表现为病灶存在不同程度的脂肪密度和低于肝组织密度的软组织区域，CT值由-83～ 41HU；动、门双期CT扫描，病灶非脂肪密度部分明显强化，高于周围肝组织，延迟期则等于或低于肝实质密度，其中2例见动脉期病灶周围肝静脉“早显”。脂肪密度区域则无明显强化。1例同时作MRI扫描，对应CT脂肪密度部分表现为T1、T2不均匀高信号，用脂肪抑制序列扫描T1高信号变为低信号。光镜见肿瘤由丰富的脂肪、血管和不同程度的平滑肌组织组成。结论 肝脂肪瘤和血管平滑肌脂肪瘤的CT、MRI表现具明显特征性，CT、MRI平扫及动态增强扫描能在术前对其作出准确诊断。     

四肢侵袭性纤维瘤病的MRI表现

目的探讨四肢侵袭性纤维瘤病（AF）的磁共振成像（MRI）表现。方法回顾分析11例经手术病理证实的四肢AF的MRI表现,其中7例加做增强扫描。结果肿瘤在T1WI呈等信号11例;脂肪抑制FSET2WI高信号10例,1例为混杂信号;7例静脉注射GdDTPA后脂肪抑制SE T1WI明显强化。10例在所有序列均见到低信号带。8例边界不清,1例部分边界清楚,2例边界清楚,并可见完整的包膜。3例侵犯相邻骨质,其中1例累及髓腔;3例侵犯皮下脂肪。所有病变均未见坏死出血和囊变,瘤周未见水肿。结论四肢AF有不同于其他身体部位AF的MRI特征,MRI对四肢AF的诊断、术前规划和术后监测有重要意义。     

乳腺原发性淋巴瘤的超声诊断

目的 报导5例原发乳腺淋巴瘤（PLB）超声表现以提高认识。方法 复习5例经手术病理证实的原发乳腺淋巴瘤的超声表现。结果 5例均为原发非霍奇金氏淋巴瘤。超声均表现为单发低回声不规则结节,与乳腺癌表现相仿,但未发现有钙化。3例伴后方回声增高。结论 超声检查难以鉴别原发淋巴瘤与乳腺癌,对于乳腺癌内孤立不规则结节且伴后方回声增高时,原发淋巴瘤应在鉴别诊断之列。     

胰腺实性-假乳头状瘤的声像图特征分析

目的 探讨超声对胰腺实性-假乳头状瘤(SPTP)的诊断价值.方法 分析20例SPTP的超声和病理特点.结果 20例女性SPTP患者,肿瘤均为单发,直径1.5～25.0 cm,平均7.9 cm;肿瘤位于胰头10例,体尾部6例,尾部3例,占据胰腺大部分1例;15例肿瘤包膜完整,边界清晰,5例肿瘤边界不清晰;11例呈实性类圆形较均匀弱回声,9例呈囊实混合性回声,其中6例以实性结构为主,3例以囊性结构为主;不伴有胆管及胰管扩张.7例肿瘤为恶性,3例肿瘤发生侵袭性生长或肝转移.结论 总结SPTP超声特征和了解病理结构有助于提高其诊断水平.     

Hepatic angiomyolipoma

The imaging and pathological appearances of a hepatic angiomyolipoma are presented. On ultrasound (US), the mass was well-defined and echogenic. On computed tomography (CT), the lesion appeared of soft tissue density with peripheral foci of lower density. The case illustrates the difficulty of detecting the fatty content of a tumor by CT when the fatty content represents only a small portion of the lesion. Fine-needle aspiration (FNA) cytology and needle biopsy did not yield diagnostic material, and the tumor was resected.An invited commentary on this article follows on pp. 552–553.     

肾血管平滑肌脂肪瘤的超声诊断分析

目的探讨肾血管平滑肌脂肪瘤的超声诊断。方法对20例经B超和CT检查,最后经手术病理证实的肾血管平滑肌脂肪瘤进行回顾,分析肿瘤内血管、平滑肌及脂肪的含量对超声声像图的影响及肿瘤内的血流分布情况。结果肾血管平滑肌脂肪瘤的声像图表现取决于血管、平滑肌及脂肪三种成份的比例。当瘤体以脂肪成份为主时,超声表现为强回声;当瘤体内脂肪及平滑肌均较多时,超声表现为中强回声;当瘤体以血管和平滑肌为主时,超声表现为低回声。CDFI:肿瘤内血流信号少,PW测及其动脉血流为低速高阻型。结论对于典型病例,二维超声即有较好的诊断价值;对于不典型病例,需结合彩色多普勒及CT增强扫描进行综合分析,并鉴别诊断。     

CT and MRI findings of multifocal hepatic steatosis mimicking malignancy

We present two rare cases of multifocal hepatic steatosis as a variant of fatty liver. Multifocal hepatic steatosis can cause misleading findings in the differential diagnosis when using ultrasound and computed tomography. This case report describes the atypical findings of focal fatty liver infiltrations, which were misdiagnosed as diffuse metastatic disease. The correct diagnosis was established with magnetic resonance imaging using T1-weighted gradient-echo and T2-weighted Turbo spin-echo sequences with spectral fat suppression. Multifocal hepatic steatosis was proven by biopsy. Received: 28 December 2001/Accepted: 30 January 2002     

肝脏血管平滑肌脂肪瘤的CT表现

目的 探讨肝脏血管平滑肌脂肪瘤(HAML)的CT特征及诊断价值,提高对其诊断的准确率.方法 回顾性分析12例经手术病理证实HAML的各期CT表现,其中8例动脉期、门脉期加做薄层CT扫描,5例加做MRP、MIP、VR等后处理技术.结果 12例中女性10例,右肝7例,左肝5例,其中2例呈外生性.CT平扫12个病灶皆为低密...     

<Emphasis Type="Italic">Foetus in foetu:</Emphasis> CT findings in two cases

Foetus in foetu is a rare abdominal mass presenting in early childhood, which shows classic radiologic appearances that make a preoperative diagnosis certain. We present two such cases in which the diagnosis was initially established on computed tomography, which showed mature skeletal structures including vertebrae and long bones in addition to fat. The diagnosis was corroborated by plain radiography and magnetic resonance imaging in one case and confirmed operatively and histopathologically in both cases.     

MR imaging of malignant mesenchymal tumors of the liver

Magnetic resonance (MR) features of five primary malignant mesenchymal neoplasms (plasmocytoma, leiomyosarcoma, undifferentiated sarcoma, epithelioid hemangioendothelioma, and angiosarcoma) of the liver were reported. All tumors were hypointense on T1-weighted images and hyperintense on T2-weighted images. No halo and intravenous extension were noted. A target appearance was revealed in epithelioid hemangioendothelioma. MR findings of angiosarcoma were essentially the same as those of cavernous hemangiomas (markedly hyperintense with hypointense linear septa on T2-weighted images). MR findings of these rare hepatic malignancies were nonspecific, although they were quite different from those of typical hepatocellular carcinomas. This study suggested that MR differentiation of primary hepatic mesenchymal tumors from other common benign and malignant neoplasms was difficult; however, the number of studied cases was limited.     

T2-weighted magnetic resonance imaging of the liver: comparison of fat-suppressed GRASE with conventional spin echo, fat-suppressed turbo spin echo, and gradient echo at 1.0 T

BACKGROUND: Fat-suppressed T2-weighted gradient and spin echo (GRASE) magnetic resonance imaging in the liver was compared with three other sequences: conventional spin echo (SE), fat-suppressed and respiratory-triggered turbo SE (TSE), and fast field echo (FFE). METHODS: All sequences were applied in 48 prospective patients. Quantitative and qualitative analyses were performed. Biopsy or clinical follow-up established the final diagnosis of the lesions. RESULTS: GRASE showed the second best contrast-to-noise ratio, the second best artifact level, the same lesion detectability as TSE, and very short acquisition time. GRASE and TSE had the highest sensitivity, specificity, and accuracy. CONCLUSION: Fat-suppressed GRASE offers a fast and accurate method for imaging the liver.     

肾血管平滑肌脂肪瘤超声诊断与分析

目的 探讨肾血管平滑肌脂肪瘤的超声诊断.方法 对20例经B超和CT检查,最后经手术病理证实的肾血管平滑肌脂肪瘤进行回顾,分析肿瘤内血管、平滑肌及脂肪的含量对超声声像图的影响及肿瘤内的血流分布情况.结果 肾血管平滑肌脂肪瘤的声像图表现取决于血管、平滑肌及脂肪三种成分的比例.当瘤体以脂肪成分为主时,超声表现为强回声;当瘤体内脂肪及平滑肌均较多时,超声表现为中强回声;当瘤体以血管和平滑肌为主时,超声表现为低回声.CDFI:肿瘤内血流信号少,PW测动脉血流为低速高阻型.结论 对于典型病例,二维超声即有较好的诊断价值;对于不典型病例,需结合彩色多普勒及CT增强扫描进行综合分析,并鉴别诊断.     

肝脏血管平滑肌脂肪瘤的CT及MRI表现

目的 分析肝脏血管平滑肌脂肪瘤的CT及MRI征象特点。方法 回顾性分析经手术病理证实的7例肝脏血管平滑肌脂肪瘤患者的CT和/或MRI表现,并与病理结果进行对照。结果 CT及MRI平扫共8个病灶,CT显示6个病灶中,5个呈稍低密度,1个病灶大部分呈低密度,其内可见小片状等密度。MR显示的4个病灶中,2个脂肪抑制T2WI呈低信号,T1WI呈较均匀低信号,1病灶未显示脂肪信号特点,病灶内未见囊变、血肿、坏死等信号。增强扫描动脉期7个病灶表现为明显不均匀强化,1个病灶呈均匀强化;3个病灶呈"快进快出"强化改变,5个病灶呈持续强化改变;3个病灶内部见粗大畸形血管,5个病灶可见引流静脉。结论 肝脏血管平滑肌脂肪瘤的影像学表现有一定特征性,影像学检查有助于诊断和鉴别诊断。     

甲状腺滤泡型乳头状癌的超声表现与病理对照研究

目的：探讨甲状腺滤泡型乳头状癌（FVPTC）的超声表现及其与病理改变的关系。方法回顾性分析38例经手术和病理证实的FVPTC 患者的超声表现,并进行病理对照研究。结果38例FVPTC的超声表现可分为3种类型：（1）Ⅰ型8例（21%）,具备甲状腺乳头状癌的典型超声表现,结节形态不规则,边界不清,内部可呈极低回声,可见微小钙化;（2）Ⅱ型15例（39.5%）,表现为边界较清晰的等回声或低回声结节,其形态不规则,边缘可见成角或分叶,微小钙化较少见;（3）Ⅲ型15例（39.5%）,声像图表现形似腺瘤,结节边界清晰且边缘光整,内部为均匀中等回声。结合38例FVPTC的超声表现,其镜下结构特征也可相应分为3类：（1）Ⅰ型8例,病灶无明显包膜,形态不规则,呈浸润性生长;（2）Ⅱ型15例,病灶有包膜,形态不规则,病灶对包膜侵犯明显,局部突破包膜,周边可见卫星病灶;（3）Ⅲ型15例,病灶有较为完整的包膜,形态规则,病灶对包膜无明显侵犯或累及程度和范围很小。依据病灶有无包膜情况,病理诊断Ⅰ型为非包膜内型FVPTC（8/38,21%）,Ⅱ、Ⅲ型为包膜内型FVPTC（30/38,79%）,以上两者的形态、边界、声晕、纵横比、内部回声、微小钙化等超声特征的显示率不同,差异有统计学意义（P＜0.05）,而肿瘤大小、淋巴结累及等超声特征,差异没有统计学意义（P＞0.05）。结论 FVPTC 的超声表现兼具滤泡性肿瘤和普通乳头状癌的特点,其超声表现的不同与其病理亚型密切相关。     

Angiomyolipoma of the liver with least amount of fat component: imaging features of CT, MR, and angiography

We report two cases of angiomyolipoma of the liver, where small amounts of fat on computed tomography, magnetic resonance imaging, and angiography made distinguishing this tumor from other hypervascular tumors difficult. Recognizing the imaging features of no capsule, hypervascularity of the tumor including the fat component, and early venous drainage may be helpful for correctly diagnosing angiomyolipoma of the liver. Received: 20 June 2001/Accepted: 1 August 2001     

MR findings of hepatic cavernous hemangioma after intraarterial infusion of iodized oil

Magnetic resonance (MR) imaging was performed on five tumors of three patients who had hepatic hemangiomas. Four tumors were given an intraarterial infusion of 3–8 ml of iodized oil, while one tumor was not. MR images were obtained at 2.0 or 0.5 T. A single spin echo sequence with TE of 30 ms and TR of 500 ms and a double echo sequence with TEs of 60 and 150 ms and TR of 2000 ms, were used to produce relatively T1-, T2-weighted, and heavily T2-weighted images, respectively. Follow-up MR imaging was done 1–5 months after infusion of iodized oil. On relatively T1 weighted images, hemangiomas showed iso or hypointensity. On T2-weighted images, all tumors showed hyperintensity. However, on heavily T2-weighted images, tumors with iodized oil showed heterogeneous, slight hyperintensity, while tumors without iodized oil showed characteristic appearance of marked hyperintensity in hemangiomas. In hepatic cavernous hemangiomas with intraarterial infusion of iodized oil, familiarity with this unusual MR intensity of tumors on heavily T2-weighted images is useful to avoid the incorrect diagnosis and to reduce the frequency of inappropriate hepatic resection.     

Small hepatocellular carcinoma: differentiation from adenomatous hyperplasia with color Doppler US and dynamic Gd-DTPA-enhanced MR imaging

Background: To investigate the usefulness of color Doppler ultrasound (US) and dynamic Gd-DTPA-enhanced magnetic resonance (MR) imaging in the differentiation of small hepatocellular carcinoma (HCC) and adenomatous hyperplasia (AH). Methods: Thirty-eight small (3 cm or less) nodular lesions (in 38 cirrhotic patients) with US features consistent with HCC underwent evaluation with color Doppler US and MR imaging. Breath-hold T1-weighted rapid acquisition spin echo MR sequence after bolus injection of 0.1 mmol/kg gadopentetate dimeglumine was used to evaluate dynamic enhancement. US-guided tissue-core percutaneous biopsy established the diagnosis: HCC in 28 cases and AH in 10. Results: Color signals with pulsatile or continuous Doppler spectrum were demonstrated in 19 of 28 HCCs (68%) but in none of the AHs. Although there was considerable overlap in signal intensity between HCC and AH on both unenhanced T1- and T2-weighted images, early enhancement on breath-hold T1-weighted images obtained 40 s after starting contrast administration was observed in 22 of 28 HCCs (79%) but in none of the AHs. In 26 of 28 HCCs (93%), pulsatile or continuous flow at color Doppler US, early enhancement at dynamic MR imaging, or both were observed. Conclusion: Findings with color Doppler US and dynamic Gd-DTPA-enhanced MR imaging enable a reliable distinction between small HCC and AH. Received: 8 August 1994/Accepted after revision: 27 January 1995     

Unusual renal cell carcinomas: a pictorial essay

Renal cell carcinoma (RCC) is the most common solid renal neoplasm. Clear cell (conventional) carcinoma is the most common pathologic subtype of RCC. Usually RCC is a hypervascular, solid, solitary mass with contour bulging. However, RCC can manifest different features according to the pathologic tumor subtypes. Preoperative diagnosis of cyst-associated RCC is very difficult, especially in cases of RCC originating in a cyst. Multiple or bilateral presentation of RCC occurs in fewer than 5% of cases. In addition, RCCs may demonstrate unusual findings such as infiltrative growth mimicking transitional cell carcinoma, fatty component mimicking angiomyolipoma, severe perinephric infiltration, and extensive calcifications mimicking inflammation or other tumor. RCCs can be associated with hereditary diseases such as von Hippel-Lindau disease. Familiarity with these radiologic features of unusual RCCs can help ensure correct diagnosis and proper management. Award winning poster at ESUR’04, Santiago de Compostella, Spain     

Transitional cell carcinoma of the upper urinary tract: staging by MRI

Background This study evaluates the ability of MRI to stage transitional cell carcinoma of the upper urinary tract.Methods Nine patients who had transitional cell carcinoma of the upper urinary tract detected by other imaging modalities underwent MRI examination at 1.5 T. Imaging included pre- and postgadolinium-DTPA T1-weighted images (9 patients) pre- and postgadolinium chelate T1-weighted fat-suppressed spin echo (7 patients). Postcontrast images were acquired prior to the presence of gadolinium within the collecting system (<2 min postcontrast), intermediate (2.5–8 min), and late (>10 min) postcontrast. Images were prospectively interpreted and lesion staging was determined. Correlation with histopathology was obtained in all cases.Results Transitional cell cancers were demonstrated in 9/9 patients, and tumors ranged in size from 2 to 8 cm (mean = 3.8 cm) in one dimension. Correct tumor staging was performed in 8/9 patients. The staging error in one case occurred because direct tumor extension into the renal parenchyma was not detected.Conclusions The results of this preliminary study show that MRI stages transitional cell cancers relatively well; however, MRI is not able to detect superficial invasion of renal parenchyma.