胆囊癌的影像学检查

早期胆囊癌无特异症状,有明显症状时(腹痛、上腹部包块、黄疸)多属晚期。因此,影像学检查对胆囊癌的早期诊断非常重要。     

平山病MRI特征分析

比较12例无颈椎病史的正常人(对照组)和6例平山病患者(观察组),颈椎中立位及过屈位MRI资料.结果观察组患者C6水平颈髓正中前后径中立位(Dn)及过屈位(Df)分别为(0.562±0.066)cm、(0.408±0.077)cm,对照组分别为(0.650±0.043)cm、(0.565±0.057)cm,两组相比,P均<0.01.观察组患者过屈位颈髓前后径较正常人变小更为明显,且以一侧变扁为著.认为平山病患者屈颈位MRI有下颈髓及其硬膜囊的异常表现,可作为诊断平山病的重要依据.     

强直性脊柱炎活动期CT与MRI影像学特征分析

目的 分析强直性脊柱炎(ankylosing spondylitis,AS)活动期CT与MRI的影像学表现特征以及对临床诊疗的指导意义。方法 回顾性分析2015-06～2018-12经该院风湿科确诊的48例AS脊柱受累患者的资料,均临床确诊AS多年,近期腰部疼痛加重,在出现症状后2周之内进行MRI及CT检查,并对两种方法的诊断特点进行评价。结果 48例AS患者CT检查中28例椎体边缘骨质增生,25例椎体呈“方椎”,8例脊柱呈“竹节椎”,21例椎小关节炎,其中5例椎小关节骨性连接,11例椎间隙变窄,密度增高。MRI检查中胸椎11例,腰椎39例。其中18例显示椎体终板前上、后上角T1WI低信号,T2WI及压脂高信号改变,30例显示整个及部分椎体T1WI低信号,T2WI及压脂高信号,11例椎间盘T2WI显示髓核结构不均一,信号减低,椎间盘高度降低,21例椎小关节局部骨质及周围滑膜T1WI低信号,T2WI及压脂高信号。结论 AS活动期的MRI及CT检查都具有一定的特点,但MRI检查对AS活动期显示更具特征性,应优选MRI检查。     

胆石病的影像学诊断

一、胆囊结石、急性胆囊炎的影像学诊断 1.CT:CT诊断胆囊结石的敏感性不及B超,仅为75％。胆石显影的清晰度与胆石的成分相关:高胆固醇含量的结石,由于与周围胆汁密度相近而较难显示;结石的含钙量越高,显影越清晰。急性胆囊炎时,CT并不是常规选用的检查方法。但是,对于疑难的急腹症患者和有严重并发症者,CT检查有一定意义。胆囊结石和急性胆囊炎常见的CT表现包括:①胆囊颈部或胆囊管结石嵌顿;②胆囊积液;③胆汁密度增加;④胆囊积脓时,腔内CT值可高达30 Hu以上;⑤胆囊周围积液;⑥胆囊壁增厚,     

超声造影诊断胆囊癌的表现特征分析

目的 分析超声造影（CEUS）检查诊断胆囊癌的价值。方法 采用CEUS检查18例经术后组织病理学检查诊断的胆囊癌和35例胆囊良性病变患者,分析其CEUS表现特征。结果 18例胆囊癌主要表现为局限性不规则病变11例,弥漫型不规则病变7例;胆囊壁厚度为（27.2±13.1） mm,显著厚于胆囊良性病变【（15.5±1.6）mm,P<0.01】;在增强初期,胆囊癌表现为高增强或等增强,在注射造影剂35s后转为低增强,发生病变处的胆囊壁完整性被破坏;胆囊壁呈不均匀性强化者为83.3%,显著高于良性病变患者的17.1%（P<0.01）;本组病例经CEUS检查,术前诊断为胆囊癌17例（94.4%）,准确判定良性病变33例（94.3%）。结论 CEUS检查能明确诊断胆囊癌,并与良性病变区别良好,有很好的临床应用价值。     

胆囊炎与厚壁型胆囊癌的彩色多普勒超声鉴别诊断

回顾性分析23例胆囊炎与16例胆囊癌患者的彩色多普勒超声检查结果。认为胆囊壁增厚形态、胆囊黏膜线完整性、胆囊与邻近结构的关系、病灶内血供特征、动脉频谱Vmax及RI值为胆囊癌与胆囊炎的鉴别要点;彩色多普勒超声在胆囊炎与厚壁型胆囊癌的鉴别诊断中具有较大价值。     

胆囊癌与胆囊良性病变的关系

已经证明,许多良性病变与胆囊癌的发病有关,而胆囊癌患者中50％以上合并胆囊良性病变,具体有胆囊结石、胆囊息肉、胆囊腺瘤、慢性胆囊炎。     

22例60岁以下原发性胆囊癌患者临床分析

本文报道1988年1月至1994年7月收治的经手术证实的用发性胆囊癌54例,其中年龄小于60岁的22例(40.7 %).现将 22例原发性胆囊癌作一临床分析.1临床资料1.1一般资料:22例中,男7例,女15例,男:女为     

胸膜结核瘤的MRI表现特征分析

目的 探讨胸膜结核瘤的MRI表现特征,以提高其诊断水平。方法 收集湖南省胸科医院2018年1月至2019年12月经病理学和(或)病原学证实或临床诊断(依据临床症状体征、免疫学检查结果,以及诊断性抗结核药品治疗有效进行综合诊断)的87例胸膜结核瘤患者。将其中资料完整的60例患者作为研究对象,男41例,女19例;年龄13~78岁,中位年龄27岁。其中8例胸膜病变经手术后病理检查确诊,43例经胸膜活检病理检查确诊,9例为临床诊断患者。所有患者均进行了结核病相关实验室检查、胸部CT平扫、MRI平扫及增强扫描检查,分析评价患者的临床及胸部MRI表现特征。结果 60例患者MRI表现为单发病灶47例(78.3%),多发病灶13例(21.7%)。共74个病灶,其中右下肺37个(50.0%)病灶,34个病灶(45.9%)呈类圆形;51个病灶(68.9%)与胸膜呈宽基底相贴,边缘光滑,病灶基底部胸膜有移行性增厚。60例患者中,13例(21.7%)为未成熟结核瘤,T₁WI呈等或稍低信号,T₂WI、表现弥散系数(ADC)图像呈稍高信号,弥散加权成像(DWI)呈等信号,弥散不受限;增强检查呈斑点状强化或结节状均匀强化。29例(48.3%)为中心凝固性坏死结核瘤,T₁WI呈等或稍低信号,T₂WI、ADC 图像呈混杂高信号,DWI呈等信号,弥散不受限,增强检查呈不均匀结节状强化或环形强化;18例(30.0%)为中心液性坏死结核瘤,T₁WI呈低信号,T₂WI、ADC图像呈高信号, DWI呈混杂高信号,弥散受限,增强检查呈环形强化。2例(3.3%)可见多个结核瘤灶融合,形成脓肿,破溃至胸膜外脂肪间隙和(或)胸壁,ADC图像呈低信号,DWI呈高信号,弥散受限,增强检查呈环形和分隔样强化。结论 胸膜结核瘤具有一定的MRI表现特征,MRI在判断胸膜结核瘤累及范围及其所处病理阶段有优势。     

广州管圆线虫病患者中枢神经系统MRI的影像学表现

目的分析广州管圆线虫病患者中枢神经系统磁共振（MRI）的影像学特征。方法回顾性分析云南省第一人民医院1997年5月至2011年7月收治的25例广州管圆线虫病患者的中枢神经系统的MRI影像学表现。结果 25例患者中磁共振未见异常者8例,脑膜炎7例,脑实质病变8例,脊髓脊膜炎1例,脑室扩张1例。病变呈弥漫性或散在分布,在T₁加权图像（T₁WI）上呈低或等信号,在T₂加权图像（T₂WI）和对应层面液体衰减反转恢复序列（FLAIR）图像上呈高信号,注射扎喷替酸葡甲胺（Gd-DTPA）后病变中央可见圆形或卵圆形强化病灶。脑脊膜受累者可见软脑膜或室管膜呈线条形或结节状强化。结论广州管圆线虫病患者中枢神经系统的MRI表现多样,脑脊髓内呈多发长条形或结节状强化和软脑膜强化是该病主要的MRI表现,但多数MRI表现缺乏特异性。     

CT检查对诊断胆囊腺肌症的效能分析*

目的 总结胆囊腺肌症与胆囊癌患者多层螺旋CT(MSCT)表现特征。方法 2015年9月～2020年9月我院诊治的胆囊腺肌症患者113例和胆囊癌患者78例,均接受MSCT和超声检查,外科手术治疗后行组织病理学检查。结果 MSCT检查结果与术后组织病理学检查结果的一致性(Kappa=0.749)显著高于超声检查(Kappa=0.577);MSCT诊断胆囊腺肌症的准确度为88.0%,显著高于超声检查的79.6%(P<0.05);MSCT对局限型胆囊腺肌症的检出率为97.1%,显著高于超声检查的82.9%(P<0.05);在CT检查上,胆囊腺肌症表现为胆囊壁光滑、RAS窦和肝胆交界清楚显示率分别为36.3%、36.3%和69.0%,显著高于胆囊癌组的9.0%、6.4%和38.5%(P<0.05)。结论 MSCT检查诊断胆囊腺肌症有较高的正确率,其特征有助于与胆囊癌鉴别。     

Distinguishing xanthogranulomatous cholecystitis from the wall-thickening type of early-stage gallbladder cancer

Background/Aims

Xanthogranulomatous cholecystitis (XGC) mimics early-stage gallbladder (GB) cancer with wall thickening on computed tomography (CT), both clinically and radiologically. Preoperative differentiation of XGC from early-stage GB cancer is important for selecting the most appropriate surgical management. Therefore, we evaluated the clinical features and multidetector CT (MDCT) findings of XGC to determine whether it can be distinguished from early-stage GB cancer.

Methods

We retrospectively evaluated 25 patients with XGC and 56 patients with the wall-thickening type of T1- and T2-stage GB cancer, where all of the diagnoses were pathologically confirmed by surgical treatment. All of the patients underwent preoperative MDCT. The clinical symptoms, laboratory findings, and CT findings were compared.

Results

Abdominal pain, fever, and jaundice were noted more frequently in the patients with XGC. Serum aspartate aminotransferase and alanine aminotransferase levels were more elevated in patients with XGC, whereas carbohydrate antigen (CA 19-9) was higher in the patients with GB cancer. When the T-category cancer staging of XGC and early-stage GB cancer were compared, diffuse GB wall thickening, intramural hypoattenuated nodule, gallstone, and pericholecystic infiltration were consistent significant findings associated with XGC, regardless of the cancer staging.

Conclusions

MDCT findings such as diffuse GB wall thickening, intramural hypoattenuated nodule, gallstone, and pericholecystic infiltration together with the clinical symptoms, can provide clues for physicians to differentiate XGC from early-stage GB cancer with wall thickening on CT.     

Pancreatitis in patients with pancreas divisum:Imaging features at MRI and MRCP

AIM:To determine the magnetic resonance cholangiopancreatography(MRCP)and magnetic resonance imaging(MRI)features of pancreatitis with pancreas divisum(PD)and the differences vs pancreatitis without divisum.METHODS:Institutional review board approval was obtained and the informed consent requirement was waived for this HIPAA-compliant study.During one year period,1439 consecutive patients underwent successful MRCP without injection of secretin and abdominal MRI studies for a variety of clinical indications using a 1.5 T magnetic resonance scanner.Two experienced radiologists retrospectively reviewed all the studies in consensus.Disputes were resolved via consultation with a third experienced radiologist.The assessment included presence and the imaging findings of PD,pancreatitis,and distribution of abnormalities.The pancreatitis with divisum constituted the study group while the pancreatitis without divisum served as the control group.MRCP and MRI findings were correlated with final diagnosis.Fisher exact tests and Pearson × 2 tests were performed.RESULTS:Pancreatitis was demonstrated at MRCP and MRI in 173 cases(38 cases with and 135 cases without divisum)among the 1439 consecutive cases.The recurrent acute pancreatitis accounted for 55.26%(21 of 38)in pancreatitis patients associated with PD,which was higher than 6.67%(9 of 135)in the control group,whereas the chronic pancreatitis was a dominant type in the control group(85.19%,115 of 135)when compared to the study group(42.11%,16 of 38)(χ 2 = 40.494,P < 0.0001).In cases of pancreatitis with PD,the dorsal pancreatitis accounted for a much higher percentage than that in pancreatitis without PD(17 of 38,44.74% vs 30 of 135,22.22%)(χ 2 = 7.257,P < 0.05).CONCLUSION:MRCP and MRI can depict the features of pancreatitis associated with divisum.Recurrent acute pancreatitis and isolated dorsal involvement are more common in patients with divisum.     

Extended surgical resection for xanthogranulomatous cholecystitis mimicking advanced gallbladder carcinoma： A case report and review of literature

Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder, rarely involving adjacent organs and mimicking an advanced gallbladder carcinoma. The diagnosis is usually possible only after pathological examination. A 46 year-old woman was referred to our center for suspected gallbladder cancer involving the liver hilum, right liver lobe, right colonic flexure, and duodenum. Brushing cytology obtained by endoscopic retrograde cholangiography (ERC) showed high-grade dysplasia. The patient underwent an en-bloc resection of the mass, consisting of right lobectomy, right hemicolectomy, and a partial duodenal resection. Pathological examination unexpectedly revealed an XGC. Only six cases of extended surgical resections for XGC with direct involvement of adjacent organs have been reported so far. In these cases, given the possible coexistence of XGC with carcinoma, malignancy cannot be excluded, even after cytology and intraoperative frozen section investigation. In conclusion, due to the poor prognosis of gallbladder carcinoma on one side and possible complications deriving from highly aggressive inflammatory invasion of surrounding organs on the other side, it seems these cases should be treated as malignant tumors until proven otherwise. Clinicians should include XGC among the possible differential diagnoses of masses in liver hilum.     

胆囊癌诊断进展

原发性胆囊癌恶性程度高,临床症状出现迟,早期诊断困难,患者就诊时多属晚期,根治机会少,预后极差。因此,早期诊断是提高胆囊癌疗效的关键。     

MSCT与MRI动态增强扫描对高血供肝内胆管癌与肝细胞癌的诊断价值分析

目的 探讨多层螺旋计算机断层扫描(MSCT)与磁共振成像(MRI)动态增强扫描对高血供肝内胆管癌(ICC)和肝细胞癌(HCC)的诊断价值。方法 2018年1月～2019年6月我科诊治的70例原发性肝癌患者,均接受MSCT和MRI动态增强扫描。以手术后组织病理学检查诊断作为金标准,评估两种检查方法的诊断效能。结果 经手术后组织病理学检查,在70例原发性肝癌患者中,诊断ICC 12例,HCC 58例;MSCT检查显示HCC病灶动脉期强化、静脉期强化减退,延迟期持续强化减退;MRI多期扫描检查显示39例HCC患者病灶呈快进快出型强化,17例患者病灶呈快进慢出型强化,2例患者病灶呈慢进慢出型强化。MRI多期扫描发现9例ICC患者病灶呈慢进慢出型,3例患者病灶在动脉期和门脉期未出现明显强化,延迟期逐渐呈均匀性强化;MRI诊断HCC患者56例(96.6%),与CT诊断的53例(91.4%)比,无显著性差异(P>0.05),而诊断ICC患者9例(75.0%),显著高于CT诊断的7例(58.3%,P<0.05)。结论 在富血供的PLC患者,ICC和HCC的影像学表现有所差异,应用MRI增强扫描有利于提高对ICC的诊断检出率,值得临床积累经验和应用。     

Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: An analysis of 42 cases

AIM: To review and evaluate the diagnostic dilemma of xanthogranulomatous cholecystitis (XGC) clinically.METHODS: From July 2008 to June 2014, a total of 142 cases of pathologically diagnosed XGC were reviewed at our hospital, among which 42 were misdiagnosed as gallbladder carcinoma (GBC) based on preoperative radiographs and/or intra-operative findings. The clinical characteristics, preoperative imaging, intra-operative findings, frozen section (FS) analysis and surgical procedure data of these patients were collected and analyzed.RESULTS: The most common clinical syndrome in these 42 patients was chronic cholecystitis, followed by acute cholecystitis. Seven (17%) cases presented with mild jaundice without choledocholithiasis. Thirty-five (83%) cases presented with heterogeneous enhancement within thickened gallbladder walls on imaging, and 29 (69%) cases presented with abnormal enhancement in hepatic parenchyma neighboring the gallbladder, which indicated hepatic infiltration. Intra-operatively, adhesions to adjacent organs were observed in 40 (95.2%) cases, including the duodenum, colon and stomach. Thirty cases underwent FS analysis and the remainder did not. The accuracy rate of FS was 93%, and that of surgeon’s macroscopic diagnosis was 50%. Six cases were misidentified as GBC by surgeon’s macroscopic examination and underwent aggressive surgical treatment. No statistical difference was encountered in the incidence of postoperative complications between total cholecystectomy and subtotal cholecystectomy groups (21% vs 20%, P > 0.05).CONCLUSION: Neither clinical manifestations and laboratory tests nor radiological methods provide a practical and effective standard in the differential diagnosis between XGC and GBC.     

MRI联合应用DWI和DCE扫描序列在发现肝癌切除术后肝内复发微小癌灶的价值分析

目的 探讨MRI弥散加权成像（DWI）与动态增强扫描（DCE）序列联合应用在肝细胞癌（HCC）患者手术切除术后检出复发微小肝癌（mHCC）的诊断价值。方法 在43例肝细胞癌患者手术切除术后行MRI、DWI和DCE扫描序列,以早期发现复发癌灶。结果 在术后1年,43例HCC患者中发现54个复发病灶;DWI联合DCE对复发的mHCC判断的敏感性、特异性和准确性分别为89.5%、97.1%和94.4%,DCE单独诊断的敏感性为63.2%,特异性为88.6%,准确性为79.6%,而DCE单独诊断复发mHCC的敏感性,特异性和准确性最低,分别是60.0%,67.7%和64.8%（P＜0.05）。结论 在MRI检查中应用DWI和DCE扫描序列联合检测能显著提高对复发的mHCC的发现率。     

CT与MRI诊断鼻咽癌的对比研究

目的 探讨鼻咽癌向周围邻近结构侵犯的CT和MRI表现。并比较其诊断价值。方法 分析经病理证实的2l例NPC患者CT和MRI资料。结果 鼻咽癌瘤体T1WI等信号14例(66,7％),T2WI高信号18例(85．7％),增强T1WI高信号9例(100％)。CT、MRI显示鼻咽癌以下结构的浸润率有显著性差异：完全茎突后间隙、颅骨和海绵窦(P值分别为0．015,0.000和0．017)。副鼻窦检出率分别为14．3％和4．8％,但P值为0．143。其余结构两者检出无统计学差异。结论 以MRI为鼻咽癌患者首选影像学检查,可更准确了解肿瘤侵犯范围。