空泡蝶鞍综合征的CT诊断及临床表现

目的：提高对空泡蝶鞍综合征的CT诊断及临床表现的认识。材料与方法：回顾分析17例空泡蝶鞍综合征的临床与CT表现。结果：17例中有15例表现为内分泌症状，主要有停经泌乳、尿崩症等，另2例表现为视力障碍。常规轴位、冠状位CT扫描征象有：鞍内低密度、鞍上池模糊、三脑室下移、“漏斗征”、垂体蒂下移、后移，垂体受压变扁平，蝶鞍扩大等；脑地造影CT可见造影剂进入鞍内。结论：作者认为本症临床表现与致病因素及病变的严重程度有关，CT是较理想的诊断手段。横断面CT可作筛选，冠状面CT一般可明确诊断，疑难者可由脑池造影CT确诊。     

腹膜后纤维化的临床及影像学表现

目的 通过分析腹膜后纤维化的临床及影像学表现，加深对此少见病的认识，提高早期诊断水平。方法 总结我院1990年1月至2004年6月间经病理证实的腹膜后纤维化（RPF）病例14例，详细分析其临床及影像学表现。其中男10例，女4例，平均年龄45.8岁。全部病例均行CT平扫，其中10例同时行增强扫描；8例行MR检查；10例行静脉肾盂造影（IVP）检查；11例行B超检查。结果 （1）临床症状主要以腰背痛、腹痛（10例）及尿路梗阻（3例）为首发症状，常伴以血沉（ESR）、免疫球蛋白G（IgG）、C反应蛋白（CRP）增高及肾功能异常。（2）影像学表现：14例中11例病变位于腹膜后，肿块型10例，弥漫型4例。CT平扫可见腹膜后密度较为均匀或不均匀的软组织肿块，增强扫描显示不同程度强化；MRI在T1WI呈低信号，而在T2WI则信号强度不等。结论 影像学检查是发现和诊断腹膜后纤维化的重要手段，通过病变CT密度及MRI信号的不同表现，并结合临床检查，可以对疾病的分期和疗效提供参考。     

艾滋病合并腹部病变的影像学表现

讨目的探艾滋病（AIDS）合并腹部病变的影像学表现。方法回顾性分析6例AIDS合并腹部病变影像学表现（包括超声、CT和MR扫描）。全部病例均做了超声和胸腹部CT扫描（其中4例做了腹部CT增强扫描），1例做了胸腹部MR增强扫描。结果6例中腹部结核4例，包括腹腔淋巴结结核3例和胰腺结核1例，皆伴有其他部位结核。腹腔淋巴结结核典型CT表现为增大的腹膜后淋巴结中央低密度改变，增强后呈环状强化；胰腺结核的CT表现为胰头低密度灶，增强后病灶周围轻度强化。播散性卡波西肉瘤1例，胸腹部CT及MR扫描表现为沿增粗的支气管血管束和肝内门静脉周围分布的肿瘤病灶。盆腔恶性肿瘤1例，CT显示盆腔内占位病灶，壁不规则增厚，中央大面积低密度液化坏死区。结论AIDS合并腹部病变可表现为机会性感染和相关的恶性肿瘤，影像表现对诊断非常有帮助。组织活检可确定诊断。     

肺黏膜相关型淋巴瘤的CT表现

目的：探讨肺黏膜相关型淋巴瘤（PMALT型淋巴瘤）的CT表现。材料和方法：回顾性分析13例PMALT型淋巴瘤的CT表现，男性9例，女性4例；平均年龄55岁；病程1．5～108个月，平均14个月；全部经气管镜、经皮胸腔镜肺胸膜活检或开胸肺活检证实；CT扫描包括平扫和增强。结果：病变表现为多发性病变，双侧多见（53．8％，7／13）；病变形态多样，实变最常见（53．8％，7／13），其次为块状影（2／13）及结节影（2／13）；致密的实变影内可见支气管充气征，其他还可有胸腔积液（4／13）。结论：PMALT型淋巴瘤CT上主要表现为双侧性的实变影，常伴支气管充气征，其他表现包括块状、结节影等，缺乏特异性。     

鞍上池的断层解剖与CT图像分析

目的：利用CT图像对蝶鞍区病变作出正确诊断。方法：将与CT扫描平面一致的颅脑断层标本和颅脑CT轴位扫描图像作对照，对104例鞍上池的形态作分析。结果：鞍上池在CT图像中，可表现为四角星形、五角星形和六角星形。结论：鞍上池的形态与CT轴位扫描时头部的体位有关。不同形态的鞍上池其毗邻关系、所含结构也各不相同。池的大小、出现的层面高度有明显的个体、年龄差异。     

心源性脑梗塞合并早期天幕疝的CT诊断

目的：探讨心源性脑梗塞合并早期天幕疝的CT表现。材料与方法：作者回顾性分析20例心源性脑梗塞合并单侧颅内压增高病人的平行OM线扫描CT图像，全部病人均经斜坡垂线CT扫描法证实存在早期天幕疝。结果：脑疝组中，病变侧脑室受压变形、中线结构向对侧移位20例，中线移位程度大于1.5cm时14例，病变侧脑沟明显受压消失20例，中间帆腔变窄20例，四叠体池及大脑静脉池变形或闭塞20例，外侧裂池及鞍上池闭塞11例，大脑大静脉池内见与海马回相连的软组织块9例。结论：平行OM线CT扫描图像仅能对部分早期天幕疝的病人做出诊断；平行OM线CT扫描图像上，大脑大静脉地内见与海马回相连的软组织块为天幕疝的特征性CT表现。     

脑血吸虫性肉芽肿CT和MRI表现与分型探讨

目的 探讨脑血吸虫性肉芽肿的CT和MRI的表现特征和影像学分型。方法 回顾性分析经手术病理及临床证实的脑血吸虫性肉芽肿30例。采用GE MAX640 CT机及GE Signa 0．2 T开放式永磁型MRI仪，分别进行平扫及增强扫描。结果 幕上大脑27例，幕下小脑3例。CT平扫病变呈等或稍高密度，MR平扫T1WI大多呈等或稍低信号，T2WI呈高信号但低于脑脊液信号，液体衰减反转恢复序列呈稍高信号。CT与MRI增强表现为：脑皮层或皮层下区多发或单发大小不等强化结节。根据结节的形态大小及增强特征分为4型：(1)多发小结节型5例；(2)单发大结节型8例；(3)混合结节型14例；(4)环状强化结节型3例。结论 脑血吸虫性肉芽肿有较典型的CT、MRI表现；影像学分型有利于诊断和鉴别诊断，并可为治疗提供有价值的参考。     

胃肠道间质肿瘤的影像表现

目的：探讨钡餐造影和CT对胃肠间质肿瘤（GIST）的诊断价值。方法：13例经手术病理证实的GIST均行胃肠钡餐造影检查，其中11列行CT检查，对其影像学表现进行分析。结果：13例中发病部位位于空肠者6例；良性间质肿瘤5例，恶性间质肿瘤8例；4例伴肠系膜淋巴结转移。钡餐造影表现为黏膜皱襞变平或破坏12／（12／13）例，肠腔偏侧性狭窄7（7／13）例，肿块内出现钡斑或窦道样改变4（4／13)例，CT表现为腔外不规则或分叶状肿块10（10／11）例，肿块内出现明显的多灶性低密度坏死区6（6／11）例，增强扫描有明显的不均匀性强化。结论：钡餐造影和CT是定位诊断的主要影像学方法，沿小肠长轴发展的偏侧性肠腔狭窄、伴有多发性溃疡或（和）不规则腔外肿块内有多处低密度征象对定性诊断有较大价值。     

颅内蛛网膜囊肿的CT表现:平扫和脑池造影CT扫描的对照研究

蛛网膜囊肿是颅内少见病变，占颅内占位性病变的１％～３％［１］。有关其ＣＴ平扫和脑池造影的ＣＴ表现特征国内报告并不多见。本文回顾性分析了３４例病例的ＣＴ平扫和脑池造影ＣＴ扫描的资料，就有关问题讨论如下：１资料和方法３４例中，男性３２例，女性２例；年龄２...     

肝脏包囊虫病的CT诊断

目的 探讨肝脏包囊虫病的临床特点及CT诊断价值。方法 对49例（女32例，男17例；年龄11岁～74岁，平均40．5岁）经临床和病理组织学证实的肝脏包囊虫病的CT征象进行了回顾性分析。全部病例行腹部CT平扫，5例又接受了CT增强扫描。结果 49例中，细粒棘球蚴见于48例，泡状棘球蚴见于1例。病变部位以肝右叶最多（49％），其次是肝左叶（31％）以及肝左、右叶或尾叶并发（20％）。细粒棘球蚴的cT表现有5种类型，诸如单纯型，母子囊型，多囊型，混合型，以及钙化型。包虫囊肿感染的CT表现为内外囊分离，囊壁增厚，囊内小气泡影及囊内彩带征。泡状棘球蚴的CT平扫与增强扫描均无特征，诊断较困难。结论 CT扫描对肝脏包囊虫病具有很高的诊断准确率，甚至CT平扫即可做出准确的定位诊断，对感染的肝包虫囊肿的诊断颇有价值。     

Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography.

BACKGROUND AND PURPOSE: Radiologic evaluation of CSF leaks is a diagnostic challenge that often involves multiple imaging studies with the associated expense and patient discomfort. We evaluated the use of screening noncontrast high-resolution CT in identifying the presence and site of CSF rhinorrhea and otorrhea and compared it with contrast-enhanced CT cisternography and radionuclide cisternography. METHODS: We retrospectively reviewed the imaging studies and medical records of all patients who were evaluated for CSF leak during a 7-year period. Forty-two patients with rhinorrhea and/or otorrhea underwent high-resolution CT of the face or temporal bone and then had CT cisternography and radionuclide cisternography via lumbar puncture. The results of the three studies were compared and correlated with the surgical findings in 21 patients. RESULTS: High-resolution CT showed bone defects in 30 of 42 patients (71%) with CSF leak. High-resolution, radionuclide cisternography and CT cisternography did not show bone defects or CSF leak for 12 patients (29%) who had clinical evidence of CSF leak. Among the 30 patients with bone defects, 20 (66%) had positive results of their radionuclide cisternography and/or CT cisternography. For the 21 patients who underwent surgical exploration and repair, intraoperative findings correlated with the defects revealed by high-resolution CT in all cases. High-resolution CT identified significantly more patients with CSF leak than did radionuclide cisternography and CT cisternography, with a moderate degree of agreement. CONCLUSION: Noncontrast high-resolution CT showed a defect in 70% of the patients with CSF leak. No radionuclide cisternography or CT cisternography study produced positive results without previous visualization of a defect on high-resolution CT. CT cisternography and radionuclide cisternography may be reserved for patients in whom initial high-resolution CT does not identify a bone defect or for patients with multiple fractures or postoperative defects.     

Acoustic neuromas: evaluation by magnetic resonance imaging

Proton magnetic resonance imaging (MRI) examinations were performed in six patients with seven acoustic neuromas, and the results were compared with conventional tomography of the internal auditory canals, contrast-enhanced computed tomography (CT), and air CT cisternography. All tumors were identified with MRI. The three largest tumors (greater than 1 cm diameter) looked similar to the tumors seen on CT scans, although the extent of the tumor was better seen with MRI in two cases. The four small (less than or equal to 1 cm diameter) cerebellopontine angle and intracanalicular tumors were well seen with MRI, with appearances corresponding to those seen with air CT cisternography. No side effects were encountered with the MRI examinations. MRI is an accurate, noninvasive alternative to contrast-enhanced CT and air CT cisternography in the diagnosis of acoustic neuromas.     

MR cisternography: a new method for the diagnosis of CSF fistulae

The aim of this study was to compare a new MRI method for detecting the existence of cerebrospinal fluid (CSF) fistulae, i. e. MR cisternography, with CT cisternography. In a prospective study, 30 patients with post-traumatic CSF fistulae were examined. The MR examinations were performed with a 1.0-T whole-body MR system, using two T2^*-weighted sequences, a 3D PSIF (time-inversed fast imaging with steady-state precession, FISP) and a 3D constructive interference steady-state (CISS) sequence. The results of MRI and CT cisternography were compared with the surgical findings. The sensitivity in detecting CSF fistulae with MR cisternography (PSIF: 89.9 %; CISS: 93.6 %) was higher than with CT cisternography (72.3 %). The sensitivity of CT cisternography at detecting CSF fistulae in patients with a size of dural lesion less than 2 mm or in patients with multiple dural lesions is significantly lower compared with the MR method. Although the localization of CSF fistulae always proved possible with MR cisternography, this could only be accomplished wih CT in 70 % of cases. The MR cisternography technique is a new examination method with a higher sensitivity for the detection of CSF fistulae than CT cisternography. The CISS technique is superior compared with PSIF and should be used in patients with high-flow CSF fistulas. Received 15 July 1996; Revision received 15 January 1997; Accepted 25 February 1997     

脑部脉络膜裂囊肿的CT、MRI影像分析

目的:探讨脉络膜裂囊肿的影像学表现。方法:回顾分析11例脑脉络膜裂囊肿的MRI表现,其中7例行CT检查,9例行MR扫描。结果:脉络膜裂囊肿表现为圆形或类圆形、边界光滑锐利的脑脊液样低密度影或信号,增强扫描无强化。结论:脉络膜裂囊肿的CT、MRI表现较为典型,但单纯CT轴位扫描定位困难,CT多层面重建(MPR)及MRI多方位扫描有助于对其做出正确诊断。     

Rathke囊肿:CT、MRI表现与病理对照研究

目的：探讨Rathke囊肿的影像学表现与病理组织学之间的关系。材料和方法：病理证实的Rathke囊肿20例，男12例，女8例。年龄11—70岁，平均44岁。18例行CT检查，其中7例增强；12例行MRI检查，其中7例增强；20例中CT和MRI检查均进行有10例。分析所有CT、MRI片，并与手术病理对照。结果：10例Rathke囊肿位于鞍内，9例位于鞍内伴鞍上延伸，1例位于鞍上。Rathke囊肿因其囊液成分不同而有不同的影像学表现。少数伴出血。一般无强化，少数可见囊壁的强化。结论：Rathke囊肿影像学表现多样，CT和MRI有一定的价值，确诊需结合病理分析。     

脑室脑膜瘤的影像诊断

目的　探讨脑室脑膜瘤的影像学表现,以提高对脑室脑膜瘤的认识和诊断正确率。方法　经手术病理证实的脑室脑膜瘤 22例,其中男 8例,女 14例,年龄 17~72岁(平均 45岁 )。行MRI检查 21例,其中增强 17例;行CT检查 11例,其中增强 4例;同时行CT和MRI检查 10例,结合手术和病理结果进行分析。结果　脑室脑膜瘤以纤维型多见,主要位于侧脑室三角区,多数表现为实质性肿块,边界清晰,明显强化。可见钙化,出血及囊变少见。结论　脑室脑膜瘤有特殊的影像学表现,CT和MRI在诊断中具有一定的价值,尤其是MRI。     

骨样骨瘤的X线、CT和MRI表现和诊断价值

目的分析骨样骨瘤的X线、CT和MRI表现,评价它们的诊断价值。方法经手术病理证实,同时有X线、CT和MRI检查的骨样骨瘤22例,其中男19例,女3例。分析X线、CT和MRI对瘤巢和瘤巢周围改变的显示能力。结果X线、CT和MRI分别有17、22和20例表现为有一圆形或卵圆形小于2cm的瘤巢,瘤巢周围可有程度不一的骨质硬化、骨膜反应、软组织及骨髓腔水肿或相邻关节的肿胀。X线诊断的准确率为77.3%（17/22）;CT诊断的准确率为100%（22/22）;MR诊断的准确率为90.9%（20/22）。结论大多数的骨样骨瘤具有较典型的影像学表现,易于诊断,其中以CT对瘤巢的定位最为准确,单凭X线或MR的表现可因未能显示瘤巢而误、漏诊。     

输卵管卵巢脓肿影像学表现及误诊分析

目的：总结输卵管卵巢脓肿的影像学表现,探讨该病影像学诊断价值并分析误诊原因。方法回顾性分析13例术后病理确诊或临床确诊输卵管卵巢脓肿影像学资料,4例行 CT 平扫,9例行 MRI 平扫及增强(其中5例同时行超声检查),并与病理结果对照。结果10例表现为附件区腊肠样病变(其中1例超声误诊为肠梗阻),CT 平扫呈均匀低密度影,MRI 平扫呈长/短 T1长T2信号、部分可见液-液平面形成,增强扫描脓肿壁轻度增厚并明显均匀强化,所有患者表现不同程度腹腔、盆腔积液及周围筋膜增厚;3例表现为单侧附件区厚壁多房囊实性包块(其中2例术前误诊为卵巢肿瘤性病变),增强扫描表现为厚壁及分隔明显强化。结论CT 及 MRI 对腊肠样表现的输卵管卵巢脓肿诊断的特异性及敏感性较高,多能做出定性诊断,对囊实性病灶能清楚显示,但定性诊断困难,误诊率较高。     

Spinal intradural hydatid cyst. A case report

The authors report the case of a 13-year-old girl in whom the diagnosis of intradural hydatid cyst was suspected on CT scan and MRI and confirmed at surgery. The interest of this case is related to the extremely rare location and its severe prognostic. CT scan and MRI can easily make an anatomic and topographic diagnosis of the intradural hydatid cyst.     

椎动脉型颈椎病的CT和MR成像

目的:探讨多层螺旋CT和磁共振成像对椎动脉型颈椎病的诊断价值。方法:随机抽取CT检查和MRI检查显示异常患者各30例,30例全部行颈部MRI和MRA检查;30例行CTA检查。结果:MRA及CTA均显示椎动脉变细、扭曲、局限性狭窄、闭塞或走行失常等改变;但显示骨质结构CT优于MRI检查;MRI无射线损伤。结论:MRA与MRI联合应用及多层螺旋CTA检查均是诊断椎动脉型颈椎病较为理想的检查手段。