MRI对侧脑室肿瘤的鉴别诊断

目的 提高MRI对侧脑室不同肿瘤的鉴别诊断水平.方法 搜集侧脑室不同肿瘤22例,其中脑膜瘤6例,星形细胞瘤3例,室管膜瘤2例,中枢神经细胞瘤2例,脉络丛乳头状瘤、少突胶质细胞瘤、室管膜下巨细胞型星形细胞瘤、生殖细胞瘤及肠源性囊肿各1例,转移瘤4例,回顾性分析其MRI表现及其临床特点.结果 本组中所有脑膜瘤及脉络丛乳头状瘤均发生于侧脑室三角部,全部中枢神经细胞瘤(2例)、室管膜下巨细胞型星形细胞瘤(1例)均发生于室间孔区及侧脑室前部;6例脑膜瘤及4例转移瘤均发生于30岁以上,1例脉络丛乳头状瘤7岁,2例中枢神经细胞瘤年龄分别为23岁、24岁.6例脑膜瘤增强后呈明显均匀强化,2例中枢神经细胞瘤内可见多发囊变区,其中1例可见多发流空血管影,1例少突胶质细胞瘤内可见多发钙化灶,1例(1/3)星形细胞瘤可见瘤内出血.结论 侧脑室肿瘤的MRI表现特点为其鉴别诊断的重要依据,肿瘤部位、发病年龄特征对于鉴别诊断也有一定参考价值.     

儿童侧脑室肿瘤的CT和MRI诊断

目的 分析儿童侧脑室肿瘤的CT与MRI影像学特征.方法 回顾性分析26例经手术与病理证实的儿童侧脑室肿瘤的CT与MRI表现,其中5例CT检查,7例MRI检查,14例同时做CT和MRI.结果 26例肿瘤包括脉络丛乳头状瘤10例,室管膜肿瘤7例,室管膜囊肿4例,室管膜下巨细胞星形细胞瘤2例,表皮样囊肿、脑膜瘤、恶性生殖细胞瘤各1例.儿童侧脑室肿瘤具有一定的CT、MRI特征性表现.结论 CT与MRI相结合,能为儿童侧脑室肿瘤的诊断和鉴别诊断提供更全面的信息,有助于提高术前诊断率.     

侧脑室肿瘤的MRI诊断及鉴别诊断

目的 探讨侧脑室肿瘤的MRI表现特点. 资料与方法 回顾性分析25例经手术病理证实的侧脑室肿瘤的MRI表现. 结果 25例侧脑室肿瘤中,星形细胞瘤9例,其中3例(3/9)位于侧脑室三角区,3例(3/9)位于侧脑室体部;脑膜瘤6例,其中4例(4/6)位于侧脑室三角区,6例增强扫描均呈明显均匀强化;室管膜下瘤3例,2例位于侧脑室前角和室间孔区,增强扫描不强化或轻度强化;中枢神经细胞瘤2例, 1例位于侧脑室前角,1例位于侧脑室体部;脉络丛乳头状瘤2例;室管膜瘤2例;转移瘤1例. 结论 侧脑室肿瘤MRI表现有一定特点.     

侧脑室肿瘤的CT和MRI诊断

目的：评价ＣＴ和ＭＲＩ对侧脑室肿瘤的诊断价值。材料和方法：经手术病理证实的侧脑室肿瘤共５６例，回顾性分析其ＣＴ和ＭＲＩ表现，病变按部位分为侧脑室三角区、侧脑室体部、室间孔区３个部分，按年龄分为＜１０岁、１０～３９岁、＞４０岁３个年龄组。结果：（１）大多数侧脑室肿瘤如脑膜瘤、星形胶质细胞瘤、少枝胶质瘤、脉络丛乳头状瘤等具有特征性的ＣＴ和ＭＲＩ表现；（２）部分肿瘤具有其好发部位，如脑膜瘤、脉络丛乳头状瘤、海绵状血管瘤好发于三角区，少枝胶质瘤好发于体部，室管膜下巨细胞型星形胶质瘤、室管膜下瘤好发于室间孔区；（３）某些肿瘤具有年龄学特征，如脉络丛乳头状瘤均＜１０岁，脑膜瘤３０岁以上者占８２．３５％，室管膜下瘤均超过４０岁。结论：侧脑室肿瘤的诊断主要依据其ＣＴ和ＭＲＩ表现，结合发生部位和年龄特征，可进一步提高诊断正确率。     

侧脑室肿瘤的CT和MR诊断

目的：分析侧脑室肿瘤ＣＴ和ＭＲ表现，探讨其鉴别诊断。方法：４９例侧脑室肿瘤，４２例经手术病理证实，另７例转移瘤原发灶明确。按部位分为侧脑室三角区、前角、体部和室间孔区，按年龄分为＜１０岁、１１～２９岁、＞３０岁３个年龄组。结果：（１）部位对侧脑室肿瘤的鉴别很有帮助。三角区最常见的肿瘤有脑膜瘤、脉络丛乳头状瘤、海绵状血管瘤和转移瘤。室间孔区最常见的肿瘤有室管膜下巨细胞星形细胞瘤和中枢神经细胞瘤。（２）发病年龄在三角区和室间孔区肿瘤鉴别时很有价值：三角区脉络丛乳头状瘤好发于儿童，脑膜瘤好发于中年人，转移瘤常见于老年人。室间孔区室管膜下巨细胞星形细胞瘤主要见于儿童，而中枢神经细胞瘤主要见于中年人。（３）强化程度对侧脑室体部肿瘤鉴别有重要参考价值：室管膜瘤和脉络丛乳头状瘤强化最显著，星形细胞瘤和少枝胶质瘤呈中度强化，畸胎瘤强化轻或不强化。（４）部分侧脑室肿瘤有较特征性ＣＴ和ＭＲ表现。结论：肿瘤部位、发病年龄、强化程度和部分肿瘤特征性ＣＴ和ＭＲ表现是侧脑室肿瘤鉴别诊断的重要方面。     

脑室内胶质瘤的MRI诊断

目的 分析脑室内胶质瘤的MRI特点,提高诊断准确性.资料与方法 经手术病理证实的脑室内胶质瘤29例,其中20例位于侧脑室,2例位于三脑室,7例位于四脑室.29例均行MR平扫及增强扫描.结果 (1)大多数脑室内胶质瘤如室管膜瘤、星形细胞瘤、脉络丛乳头状瘤等具有特征性的MRI表现;(2)部分肿瘤具有其好发部位,如脉络丛乳头状瘤好发于侧脑室三角区,室管膜瘤好发于侧脑室体部,髓母细胞瘤好发于四脑室区;(3)某些肿瘤具有年龄和性别特征,如星形细胞瘤患者年龄均＜30岁,脉络丛乳头状瘤患者年龄均＞50岁,室管膜瘤女性占66.67%.结论 脑室内胶质瘤有比较特征性的MRI表现,结合患者临床和发病年龄、性别、部位等特点,可进一步提高其术前诊断准确性.     

大脑皮层及皮层下肿瘤的MRI表现

目的研究大脑皮层及皮层下肿瘤的MRI表现。方法回顾性分析187例大脑皮层及皮层下肿瘤患者的术前常规MR图像,总结常见大脑皮层及皮层下病变的MRl表现及鉴别要点。结果 187例大脑皮层及皮层下肿瘤中少突星形细胞瘤80例,弥漫性星形细胞瘤22例,胚胎发育不良性神经上皮瘤(DNET)17例,胶质母细胞瘤14例,节细胞胶质瘤11例,少突胶质细胞瘤11例,间变性少突星形细胞瘤6例,间变性少突胶质细胞瘤4例,多形性黄色星形细胞瘤(PXA)4例,恶性淋巴瘤4例,室管膜瘤4例,间变性室管膜瘤3例,胶质肉瘤2例,幕上原始神经外胚层肿瘤(PNET)2例,神经节细胞瘤1例,转移瘤1例,间变性星形细胞瘤1例。结论大脑皮层及皮层下肿瘤MRI特征性表现有助于诊断与鉴别诊断。     

侧脑室肿瘤的CT、MR诊断

目的 分析侧脑室肿瘤的CT与MRI影像学特征,提高对侧脑室各种肿瘤的诊断准确性。资料与方法 回顾性分析25例经手术与病理证实的侧脑室肿瘤的CT与MRI表现,其中CT检查5例,MRI检查7例,13例同时行CT和MRI检查。结果 25例中,脑膜瘤6例,室管膜瘤5例,星形细胞瘤4例,转移瘤3例,脉络丛乳头状瘤、中央性神经细胞瘤、室管膜囊肿各2例,室管膜下巨细胞瘤1例。CT显示肿瘤钙化较佳,MR定位准确性高,可以准确显示肿瘤的位置及邻近情况。结论 不同种类的侧脑室肿瘤与发病部位、患者年龄有一定的关系,结合发生部位和年龄特征,可提高诊断率。     

室管膜下巨细胞星形细胞瘤临床病理分析

目的探讨室管膜下巨细胞星形细胞瘤(SEGA)的临床病理特征、免疫组化表达及其鉴别诊断。方法分析两例室管膜下巨细胞星形细胞瘤的临床特点，和常规HE染色及IHc表达特点。结果SEGA好发于青年，临床表现为癫痫和侧脑室壁占位。该瘤由分化良好的巨细胞星形细胞和小胶质细胞构成。IHC显示肿瘤细胞表达GFAP、Vim、S-100、Syn。结论室管膜下巨细胞星形细胞瘤是一种较少见的良性肿瘤，诊断时应排除节细胞胶质瘤、神经节细胞瘤、肥胖细胞型星形细胞瘤和巨细胞型胶质母细胞瘤等。     

侧脑室中枢神经细胞瘤的影像分析

目的 :分析侧脑室中枢神经细胞瘤的CT和MRI表现。材料和方法 :回顾性分析经手术病理证实的中枢神经细胞瘤 5例 ,其中男 3例 ,女 2例。年龄 2 0～ 44岁 ,平均 30 4岁。CT检查 3例 ,MRI检查 4例。结果 :肿瘤位于脑室内前2 /3 ,边界清楚。CT平扫呈略高密度 ,增强扫描肿瘤增强不明显。MRI表现为略短T1,略长T2信号。本组 5例有 3例误诊为室管膜瘤 ,2例误诊为星形胶质细胞瘤。结论 :中枢神经细胞瘤影像学有特征性表现 ,CT和MRI是该病有效的检查手段。侧脑室前 2 /3处发生的肿瘤 ,鉴别诊断应考虑到中枢神经细胞瘤。     

Oral and oropharyngeal tumors

There is a large variability of tumors and tumor-like lesions, which are located in the oral cavity and oropharynx. But more than 90% of all tumors in this area are squamous cell carcinomas (SCCs). Other malignancies in this location are rare. About 10% of all oral and oropharyngeal tumors are benign. Congenital lesions, like vascular malformations, lingual thyroid or (epi-)dermoid cyst, usually become present in youth or childhood. Acquired lesions can be inflammatory (abscess) or neoplastic (pleomorphic adenoma and hemangioma). Preferred imaging in childhood are ultrasound and magnetic resonance imaging (MRI), while in adults usually computed tomography (CT) and MRI are more frequently used.     

原发性结外淋巴瘤在耳鼻及咽部的临床特点

目的 总结原发性结外淋巴瘤在耳、鼻及咽部的临床表现,以提高及时确诊率。方法 回顾性分析16例原发性结外淋巴瘤在耳、鼻及咽部的临床表现特点,特别是罕见的中耳淋巴瘤和少见的副鼻窦淋巴瘤的临床表现。结果 中耳淋巴瘤1例,以伴有疼痛的慢性分泌性中耳炎(传导性聋)、轻度面瘫为特点;扁桃体淋巴瘤7例,以咽异物感及单侧扁桃体肿大为特点;鼻及副鼻窦淋巴瘤2例,以血涕、鼻臭、下鼻甲黏膜粗糙,增厚为特点;鼻咽部淋巴瘤以血涕、头痛为特点;口咽部淋巴瘤以咽痛、发热、软腭溃疡、口臭为特点。结论 在发现耳、鼻及咽部病变时,掌握原发性结外淋巴瘤在耳、鼻及咽部的临床表现特点,及时行病理检查,是及时确诊的关键。     

乳腺癌术后肝转移癌的声像图特点

本文回顾性分析了１９８７－１１～１９９４－１１乳腺癌术后肝内占位性病变１２０例，其中９８例为转移癌，２２例为非均匀性脂肪肝、肝囊肿或血管瘤。采用针吸活检、诊断性化疗、综合影像学诊断及超声随访方法证实。乳腺癌术后出现脂肪肝的比例较高（４７％），肝转移伴脂肪肝者３５例（３６％），其声像图特点为内部呈低回声（６６％）及周围无低回声晕（６９％）；而不伴脂肪肝者６３例（６４％），其内部多呈等回声（５９％），常伴低回声晕（７６％）。脂肪肝的存在使肝脏回声衰减，可能导致占位显示不清而漏诊；脂肪肝的存在又往往使得一些占位病变表现不典型而误诊。当声像图不典型、鉴别诊断困难时，应做超声引导下穿刺活检予定性诊断。     

FDG PET/CT and Mediastinal Nodal Metastasis Detection in Stage T1 Non-Small Cell Lung Cancer: Prognostic Implications

Objective

We aimed to compare the prognoses of patients with pathologically true negative (P-TN) N2 and PET/CT false negative (FN) results in stage T1 non-small cell lung cancer (NSCLC).

Materials and Methods

Our institutional review board approved this retrospective study with a waiver of informed consent. The study included 184 patients (124 men and 60 women; mean age, 59 years) with stage T1 NSCLC who underwent an integrated PET/CT and surgery. After estimating the efficacy of PET/CT for detecting N2 disease, we determined and compared disease-free survival (DFS) rates in three groups (P-TN [n = 161], PET/CT FN [n = 12], and PET/CT true positive [TP, n = 11]) using the Kaplan-Meier analysis and log-rank test.

Results

Pathologic N2 disease was observed in 23 (12%) patients. PET/CT had an N2 disease detection sensitivity of 48% (11 of 23 patients), a specificity of 95% (153 of 161), and an accuracy of 89% (164 of 184). The 3-year DFS rate in the PET/CT FN group (31%, 95% confidence interval [CI]; 13.6-48.0%) was similar to that of the TP group (16%, 95% CI; 1.7-29.5%) (p = 0.649), but both groups had significantly shorter DFS rates than the P-TN group (77%, 95% CI; 72.0-81.2%) (p < 0.001).

Conclusion

The PET/CT shows a high specificity, but low sensitivity for detecting N2 disease in stage T1 NSCLC. Patients with PET/CT FN N2 disease have survival rates similar to PET/CT TP N2 disease patients, which are both substantially shorter than the survival rate of P-TN patients.     

Lung metastases

The lungs are among the most prominent target organs for metastatic disease. Most frequently, lung metastases originate from cancers of the head and neck, breast, stomach, pancreas, kidney, bladder, the male and female genitourinary tract, and sarcomas. Plain chest radiography is typically the modality used for detection and therapeutic monitoring; however, the use of CT for these purposes is becoming more frequent. Currently, spiral CT appears to be the most sensitive imaging technique in the identification of metastases, because it detects a higher number of pulmonary nodules compared to other techniques. Pulmonary metastatic disease manifests itself by the presence of pulmonary nodules, lymphangitic carcinomatosis, endobronchial tumors, and pleural involvement. Nevertheless, the differential diagnosis is an important consideration, particularly in patients with solitary pulmonary nodules, systemic disorders, and signs or symptoms indicative of infection. The role of the radiologist involves the identification of metastatic disease, monitoring of response to therapy, and the use of invasive procedures when the differential diagnosis indicates the need for biopsy and histopathologic proof. The radiologist must be aware of the impact of his diagnosis on patient management and should be familiar with oncologic strategies as well as the terminology used to characterize tumor response. In future, the role of imaging may further expand due to the increased sensitivity in lesion detection, increased specificity in lesion (tissue) characterization using MR imaging, and reduced radiation exposure. Correspondence to: Christian J. Herold     

Follow-up Results After Negative Findings on Unenhanced Hepatic MR Imaging for Hepatic Metastasis from Rectal Cancer

Objective

To assess the follow-up results after negative findings on unenhanced hepatic MR imaging in rectal cancer patients who have undergone locally curative surgery.

Materials and Methods

From all pertinent imaging reports and medical records, we selected 255 patients who had negative results on unenhanced hepatic MR imaging. When selecting patients who had undergone curative resection, the following patients were excluded from the study: 1) patients in whom extrahepatic metastases were detected on preoperative staging work-ups, 2) patients in whom the surgery was judged to be non-curative due to peritoneal seeding or local aggressiveness. Cases with follow-up periods of less than 18 months were also excluded, as these cases were considered insufficient to confirm the negative outcomes. Thus, a total of 149 patients were ultimately enrolled in our study. The follow-up results of unenhanced MR imagings were assessed according to the assumption that the newly developed hepatic metastases had been false-negative lesions on preoperative MR image.

Results

During a median follow-up period of 29.3 months, 25 hepatic metastases were detected in 13 patients (8.7%), which indicated a negative predictive value of 91.3%.

Conclusion

Unenhanced hepatic MR imaging provides a high negative predictive value with regard to the detection of hepatic metastasis in the preoperative evaluation of rectal cancer.     

Carcinosarcoma of the Liver: A Case Report

Primary hepatic carcinosarcoma is a rare tumor comprised of a mixture of carcinomatous and sarcomatous elements. Less than 20 adequately documented cases have been reported, however the imaging features of two cases were briefly described. We present here a case of carcinosarcoma of the liver in a 46-year-old woman, which was confirmed based on pathology. Imaging showed a large mass with large necrotic portions, small cystic portions, calcifications and bone formations.     

高场MRI对喉及下咽癌术前分期价值的评价

目的评价高场MRI（1.5T）在喉、下咽癌术前分期中的价值。方法对36例喉、下咽癌患者的MRI资料进行回顾性分期，并与临床分期及手术病理分期相对照。结果MRI对各期喉、下咽癌的准确率分别是T192%，T286%，T386%，T4100%。临床分期准确率分别是T1100%，T286%，T357%，T422%。MRI和临床分期总准确率分别是92%，69%。二者之间有显著性差异。结论高场MRI通过不同加权像的对比和从多角度准确显示肿瘤的部位形态及浸润范围，因而显著性提高喉、下咽癌术前分期的准确性。     

腹腔镜手术治疗子宫恶性肿瘤的应用价值

目的 研究腹腔镜下广泛全子宫切除术、盆腔淋巴结切除术治疗早期子宫恶性肿瘤的应用价值.方法 回顾性分析34例经腹腔镜和30例开腹手术治疗的临床Ⅰ～Ⅱ期子宫恶性肿瘤患者的临床资料,比较两组的手术时间、术中出血量、并发症、术后恢复情况及淋巴结切除数目等.结果 两组的手术时间、并发症发生率无显著性差异.腹腔镜组的术中出血量为247.13±127.62ml,明显少于同期开腹手术者(904.51±428.37ml,P＜0.01).腹腔镜组淋巴结切除数为23.2±5.8个,多于开腹组淋巴结切除数(16.5±3.8,P＜0.01).术后胃肠功能恢复时间,腹腔镜组为26.4±8.3h,开腹组为54.6±13.5h,两组间有显著性差异(P＜0.01).术后随访11个月两组均未见复发病例.结论 腹腔镜下广泛全子宫切除术、盆腔淋巴结切除术获得满意的效果,近期疗效肯定,远期疗效尚需进一步随访分析.     

MR Imaging of papillary renal neoplasms: potential application for characterization of small renal masses

The purpose of our study was to evaluate the role of MRI in demonstrating the precise nature of papillary renal tumors (P RCC) and its potential application to select patients for partial surgery. Ninety-seven tumors less than or equal to 3 cm in size [55 papillary renal cell carcinoma - 42 clear cell renal carcinoma (CC RCC)] were preoperatively evaluated by MRI. Imaging findings were assessed with a special focus on the aspect of the tumoral process. Correlations were performed with pathologic staging after surgery. At pathology, 92 tumors were established to be staged p T1 and 5 were p T3 ( 3 cases of CC RCC and 2 cases of P RCC). Ninety-four percent of papillary tumors exhibited low signal intensity with homogeneous pattern on T2-weighted images. All clear cell carcinoma were hyperintense and heterogeneous on T2-weighted sequence. Enhancement was lower and delayed in the papillary type in comparison with the clear cell type. MRI is accurate enough to predict the ‘histologic‘ nature of papillary renal carcinoma. It is an additional argument to propose that the tumor can be removed by partial surgery.