胰腺囊腺瘤与囊腺癌的CT诊断价值

目的：探讨胰腺浆液性囊腺瘤、黏液性囊腺瘤或囊腺癌具有鉴别诊断意义的CT征象。方法：回顾性分析经手术及病理证实的17例胰腺浆液性囊腺瘤、黏液性囊腺瘤或囊腺癌的CT表现,总结其特征性表现。结果：17例中浆液性囊腺瘤7例,黏液性囊腺瘤8例,黏液性囊腺癌2例。浆液性囊腺瘤呈分叶状轮廓者占85.7%（6/7）,均为多囊状结构,其中最大囊直径小于2cm者占71.4%（5/7）,出现病灶中心钙化者1例;黏液性囊腺瘤或囊腺癌位于胰体尾部者占90%（9/10）,无分叶状轮廓,单囊者占80%（8/10）,最大囊直径大于2cm者占90%（9/10）。囊内乳头状突起,囊壁厚薄不均,病灶内实性成分增多,多提示恶性。结论：胰腺浆液性囊腺瘤与黏液性囊腺瘤或囊腺癌的CT表现明显不同,多可做出诊断与鉴别诊断,但对于不典型表现的诊断存在困难。     

胰腺巨囊型浆液性囊腺瘤的MSCT表现及其诊断

目的：探讨胰腺巨囊型浆液性囊腺瘤的MSCT特点,提高诊断准确性。方法：13例经手术病理证实为胰腺巨囊型浆液性囊腺瘤的患者,术前行上腹部MSCT平扫及双期增强扫描。结果：13个病灶均为类圆形囊性灶,呈均匀薄壁,轮廓清、欠规则,大部分未见壁结节(12例),其中2例呈外生性生长,最大径2.0～6.5 cm,平均3.3 cm。...     

Computed tomography of benign ovarian masses

Although ultrasound is the primary imaging modality for evaluating benign gynecologic pelvic masses, CT may provide diagnostic information regarding ovarian masses that are discovered fortuitously. The relatively infrequent use of CT in evaluating the adnexa has resulted in a paucity of literature regarding the CT characteristics of benign ovarian masses. The CT appearances of 24 benign ovarian masses are presented. Pathologic diagnoses were ovarian cyst (nine), endometrioma (five), teratoma (three), serous cystadenoma (two), mucinous cystadenoma (two), thecoma (one), cystadenofibroma (one), and Brenner tumor (one). Benign ovarian cysts have characteristic homogeneous water density and smooth walls on CT. Single internal septations and slight wall irregularity are also common features, but soft-tissue mural or septal nodules are uncommon. Computed tomography can be diagnostic in evaluating cystic teratomas. Other benign ovarian masses exhibit a spectrum of CT appearances that is often nonspecific, and surgical or biopsy proof may be necessary to exclude malignancy.     

卵巢囊腺瘤和囊腺癌的螺旋CT多期增强扫描及MPR重建诊断价值

目的:探讨螺旋CT多期增强扫描对卵巢囊腺瘤和囊腺癌的诊断价值。方法:对经手术、病理证实的34例卵巢囊腺瘤(癌)的CT表现及三维重建结果进行回顾性分析。结果:34例囊腺肿瘤,浆液性囊腺瘤6例,粘液性囊腺瘤4例,浆液性囊腺癌15例,粘液性囊腺癌9例。CT表现为囊肿型(Ⅰ型)10例,囊实型(Ⅱ型)22例,实质型(Ⅲ型)2例。囊实型(Ⅱ型)又分为以囊性为主型(Ⅱa型)7例,囊实混合型(Ⅱb型)9例,以实性为主型(Ⅱc型)6例。增强后扫描,囊肿型(Ⅰ型),囊壁无强化,囊内局限性增厚分隔静脉期中等度强化;囊实型(Ⅱ型)囊壁结节状增厚、乳头状突起、不规则分隔及实性部分动脉期明显强化;实质型(Ⅲ型)动脉期明显强化。矢状位、冠状位、轴位多层面多角度观察肿瘤与周围脏器的关系。结论:卵巢囊腺瘤以Ⅰ型常见,卵巢囊腺癌以Ⅱ型为主。螺旋CT多期增强扫描能够很好地显示病灶的特点,增强后MPR三维重建可清楚地显示肿瘤与周围脏器的关系,血管重建可清楚显示肿瘤的血管构建形态,对于鉴别卵巢囊腺肿瘤的良恶性和定位诊断具有一定价值。     

Macrocystic serous adenoma of the pancreas: radiologic-pathologic correlation

OBJECTIVE: Macrocystic serous adenoma is a rare benign pancreatic neoplasm, recently described in the pathology literature. We describe the CT and MR imaging features in a series of five consecutive pathologically proven cases. MATERIALS AND METHODS: Of seven cases fulfilling the pathology criteria for macrocystic serous adenoma over an 11-year period, five patients underwent preoperative CT and MR imaging at our institution. In addition to the clinical presentation and pathologic features of the tumor, the following CT and MR imaging features were reviewed: size and location; wall thickness; internal septations; and presence of mural nodules, papillary projections, or calcifications. RESULTS: All patients but one were women (age range, 36-78 years; mean age, 48.6 years). The sizes of the tumors ranged from 1.5 to 5.0 cm (mean, 3.1 cm). Three (60%) of five tumors were located in the pancreatic head. The wall measured less than 2 mm in four lesions and 4 mm in one. No mural nodules, papillary projections, or calcifications were present. Lesions were unilocular (n = 3) or bilocular (n = 2). Excellent correlation of imaging features with gross pathology was observed. CONCLUSION: On CT and MR imaging, the macrocystic variant of serous adenoma typically appears as a small (< 5 cm), uni- or bilocular cyst with a thin (< 2 mm) wall that lacks mural nodules or calcifications. The imaging appearance of macrocystic serous adenoma is distinctly different from that of microcystic serous cystadenoma, but the imaging appearance of macrocystic serous adenoma is indistinguishable from mucinous cystadenoma and cystadenocarcinoma of the pancreas.     

Discrimination of unilocular macrocystic serous cystadenoma from pancreatic pseudocyst and mucinous cystadenoma with CT: initial observations

PURPOSE: To compare the computed tomographic (CT) appearance of pancreatic unilocular macrocystic serous cystadenoma, mucinous cystadenoma, and pseudocyst to determine if there are findings that assist in the differential diagnosis. MATERIALS AND METHODS: CT findings in 33 patients (24 women, nine men; age range, 18-84 years; mean age, 41 years) with unilocular pancreatic lesions (macrocystic serous cystadenoma, n = 12; mucinous cystadenoma, n = 11; pseudocyst, n = 10) were retrospectively and jointly reviewed by two blinded observers. Twenty-three patients underwent helical CT, which included pancreatic and portal venous phase imaging with delays of 40 seconds and 65 seconds, respectively, after contrast material injection. Ten patients underwent conventional (nonhelical) CT. The number, size, location, and contour of lesions were reviewed, along with wall thickness and enhancement and other signs of pancreatic and peripancreatic involvement. Diagnosis was based on lesion resection (n = 22) or on a combination of cytologic findings, biochemical markers, and tumor markers (n = 11). The Fisher exact test was used to analyze the results. RESULTS: Three of four CT findings were independently specific for macrocystic serous cystadenoma: location in the pancreatic head, lobulated contour, and absence of wall enhancement. When two of these four criteria were used in combination, 83% (10 of 12) of patients with unilocular macrocystic serous cystadenoma were identified. When three or four of these criteria were used, a specificity of 100% was achieved. Location in the pancreatic head (P <.05), lobulated contour (P <.005), and lack of wall enhancement (P <.005) were specific for macrocystic serous cystadenoma in comparison with mucinous cystic tumor. Lobulated contours (P <.005) were specific for macrocystic serous cystadenoma in comparison with pseudocyst. Other CT findings were not helpful in distinguishing between the three types of lesions. CONCLUSION: A combination of CT findings is helpful in making the diagnosis of pancreatic unilocular macrocystic serous cystadenoma.     

Pancreatic serous cystadenoma associated with islet cell tumour

We report the case of a 29-year-old female patient with a diffuse type of serous cystadenoma involving the entire pancreas except for part of the head, which was replaced by islet cell tumour. Ultrasound and CT showed multiple cysts in the entire pancreas and a solid mass with calcification in the head. MRI characterized the fluid content of the cysts and the extent of disease.     

原发性卵巢恶性肿瘤的CT诊断

目的:探讨原发性卵巢恶性肿瘤的CT表现。方法:回顾经CT检查并手术病理证实的原发性卵巢恶性肿瘤20例的资料,分析其CT特征表现。结果:浆液性囊腺癌11例,交界性浆液性囊腺瘤1例,粘液性囊腺癌2例,交界性粘液性囊腺瘤2例,颗粒细胞瘤2例,恶性畸胎瘤2例。结论:CT可显示肿瘤的内部特征,对原发性卵巢恶性肿瘤的病理类型有一定的诊断价值。     

胰腺囊性病变的CT诊断价值

目的 探讨CT对胰腺囊性病变的诊断价值。资料与方法 分析54例胰腺囊性病变的CT表现，其中假性囊肿41例，真性囊肿2例，浆液性囊腺瘤3例，黏液性囊腺瘤2例，囊腺癌3例，无功能性胰岛细胞瘤3例。结果 41例假性囊肿CT共检出44个囊性病灶，其中41个病灶为单房囊肿，3个病灶囊内见分隔。40个病灶为低密度，4个病灶为略高密度，增强后均无强化。另见。肾前筋膜增厚(32例)、胰周脂肪层模糊(14例)和胰管扩张(6例)。真性囊肿表现为单发或多发无强化囊性病灶，确诊主要依赖特殊临床资料和组织病理学检查。5例囊腺瘤表现为多房分隔囊性肿块，3例浆液囊腺瘤中2例中央见星芒状钙化，增强后分隔有强化。3例囊腺癌表现为多房分隔囊性病灶，其中2例有肝内多发转移。3例无功能胰岛细胞瘤，2例表现为单房囊性病灶，1例表现为多房分隔及囊内出血。结合病变本身及胰腺和胰周改变(包括肝脏)，CT对假性囊肿诊断的准确性为98．1％，对囊性病变诊断的准确性为90．7％。结论 CT能显示病变本身和胰腺及胰周(包括肝脏)形态学改变，有助于胰腺囊性病变的诊断与鉴别诊断。     

肝胆管囊腺瘤的影像学表现

目的：探讨分析肝胆管囊腺瘤的CT、MRCP及超声的影像学特点及其诊断价值。方法：回顾性分析5例手术病理证实的肝胆管囊腺瘤的CT、MRCP及超声表现。结果：5例肝胆管囊腺瘤,CT显示5例均为肝内囊实性病灶,边界清楚,增强扫描动脉期实质部分及囊壁轻度强化,门脉期进一步强化与肝实质接近;MRCP显示4例病灶为多分隔、分叶状,1例无明显分叶,囊性病灶表现为云絮状稍高信号;超声显示4例病灶为多发分隔、壁厚,1例囊壁可见多发高回声团。5例在三种影像学检查中均显示肝内胆管扩张,病灶与肝内胆管相通。结论：多种影像学检查方法联合应用有利于肝胆管囊腺瘤的诊断。     

卵巢囊腺瘤与囊腺癌的CT诊断

目的探讨CT对卵巢囊腺瘤与囊腺癌的诊断价值。方法对32例经手术病理证实的卵巢良恶性肿瘤患者包括良性卵巢囊腺瘤10例,交界性卵巢囊腺瘤4例以及恶性卵巢囊腺癌18例均经腹部CT扫描,对所有患者的CT表现进行回顾性分析。结果10例11个卵巢囊腺瘤中浆液性囊腺瘤7个,其中,单房5个,密度均匀;黏液性囊腺瘤4个,多房为主,密度不均,内见大小不等的子囊。交界性（4个）和恶性（28个）卵巢肿瘤32个,囊壁及分隔厚薄不均,不同程度强化,多有壁结节或肿块成分。结论卵巢囊腺瘤常表现为I型,囊腺癌以Ⅱ型常见。CT能很好显示卵巢肿瘤的形态特征,在鉴别卵巢囊腺肿瘤良恶性方面有一定价值。     

卵巢囊腺瘤的CT诊断

目的:提高对卵巢囊腺瘤CT诊断及鉴别诊断能力。方法:回顾性分析手术病理证实的27例卵巢囊腺瘤的CT表现。结果:浆液性囊腺瘤5例,单房4例,多房1例,密度均匀,囊壁可薄可厚或厚薄不均。粘液性囊腺瘤9例,单房3例,密度均匀,囊壁厚,多房6例,密度不均匀,内见多发大小不等子囊。交界性(6例)和恶性变(7例)13例,其中浆液性3例,粘液性10例,12例为多房改变,囊壁及分隔增厚且边缘模糊,部分呈囊实性及壁结节改变,2例恶性变者伴有大量腹水。结论:单房浆液性囊腺瘤及多房粘液性囊腺瘤具有较典型CT表现,CT易于诊断及鉴别诊断,当病变呈囊实性改变,出现壁结节,或囊壁分隔不规则增厚模糊时,提示交界性或恶性变。     

胰腺浆液性囊腺瘤的MRI特征

目的探讨胰腺浆液性囊腺瘤的MRI表现特征。方法回顾性分析10例胰腺浆液性囊腺瘤的MRI表现,包括肿瘤位置、瘤体直径、最大囊直径、分隔和中央瘢痕情况及胰胆管情况等影像学征象。结果 7例微囊型浆液性囊腺瘤:5例位于胰头部,2例位于胰体尾部。瘤体直径2.9～8.1cm,平均为5.1cm;最大囊直径0.9～6.8cm,其中5例小于2cm,平均为2.5cm,7例均可见分隔,6例可见中央瘢痕。增强扫描分隔均见强化,部分瘢痕强化,囊性成分均无强化。1例胰管轻度扩张,胆管无受累。3例少囊型浆液性囊腺瘤:2例位于胰头部,1例位于胰尾部。瘤体直径2.2～3.5cm,平均为2.8;最大囊直径2.2～3.0cm,平均为2.7cm,2例单囊,1例非单囊,无中央瘢痕。增强扫描分隔有强化,囊性成分无强化。3例胰管均无扩张,胆管无受累。结论典型的胰腺浆液性囊腺瘤MRI表现可以大致做出诊断,对于疾病的治疗,有一定的参考价值,但是最终诊断及分型还有赖于病理检查。     

卵巢囊腺瘤与囊腺癌的CT诊断

目的探讨CT在卵巢囊腺瘤和囊腺癌中的诊断价值。资料与方法回顾性复习经手术和病理证实的13例卵巢囊性肿瘤,总结其CT表现和特征。结果13例中浆液性囊腺瘤7例,黏液性囊腺瘤4例;浆液性乳头状囊腺癌Ⅰ例（Ⅱa型）,黏液性囊腺癌Ⅰ例（Ⅱb型）。囊腺瘤表现为薄壁的单房或多房囊肿,无壁结节;囊腺癌表现为不规则厚壁,间隔增厚,并有壁结节,软组织成分多。术前CT诊断正确Ⅱ例（84．6％）,误诊2例（15、4％）。结论CT能很好显示卵巢囊腺瘤、囊腺癌的特征,在鉴别良、恶性卵巢囊腺性肿瘤上有价值。     

Case report: Extra-hepatic biliary cystadenoma in association with adenomyomatosis of the gall-bladder

Biliary cystadenoma is a rare cystic tumour of biliary origin. We report on the ultrasound, CT and angiographic appearances of an extra-hepatic biliary cystadenoma arising from the left main hepatic duct with compression of the quadrate lobe. We also describe the histological finding of adenomyomatosis of the gall-bladder in association with the cystadenoma, an association not previously reported.     

Mesenteric venous collateral vessels mimicking cystic pancreatic neoplasm

We report an unusual case of intrapancreatic mesenteric venous collateral vessels following partial pancreatic surgical resection resembling pancreatic neoplasm upon greyscale sonographic and unenhanced CT examinations.Cystic lesions of the pancreas can be divided into three broad categories: lesions without an epithelial lining (pseudocyst), lesions with an epithelial lining (mucinous and serous cystadenoma and cystadenocarcinoma) and degenerative or necrotic change within a solid neoplasm (solid pseudopapillary neoplasm and cystic degeneration of ductal adenocarcinoma or neuroendocrine tumour). Here we report an unusual aetiology for a cyst-like pancreatic lesion: intrapancreatic mesenteric venous collateral vessels developing after a previous partial pancreatic resection. Failure to recognise this condition, particularly during image-guided intervention such as biopsy, endoscopic retrograde cholangiopancreatography (ERCP) or during surgery, could result in a disastrous outcome.     

卵巢囊性肿瘤的多层螺旋CT分析

目的探讨卵巢囊性肿瘤的CT表现和诊断价值。方法回顾性分析28例共30个经手术病理确诊的卵巢囊性肿瘤的CT表现。CT平扫28例,同时增强扫描26例。结果 28例卵巢囊性肿瘤中,囊腺瘤10例(浆液性囊腺瘤7例、黏液性囊腺瘤3例),囊性畸胎瘤3例,囊腺癌8例(浆液性囊腺癌3例、黏液性囊腺癌5例),卵黄囊瘤4例,kruken-berg瘤1例,透明细胞癌2例。各种肿瘤因其性质(良、恶性)不同而具有相应特征性CT表现,与手术病理对照,准确地定性诊断24例(85.7%),误诊4例(14.3%),准确定位27例(96.4%),错误定位1例(3.5%)。结论卵巢囊性肿瘤的CT表现有一定特征性,CT对卵巢囊性肿瘤的诊断及鉴别诊断具有一定帮助。     

肝胆管囊腺瘤的CT表现

目的：探讨肝胆管囊腺瘤（HBC）的螺旋CT影像特征,提高肝胆管囊腺瘤的诊断准确率。方法：回顾性分析12例经病理证实的肝胆管囊腺瘤的CT表现,并复习文献。结果：12例肝胆管囊腺瘤的CT均表现为多房囊性病变,囊内有分隔,囊壁较薄,光滑,部分囊壁均匀增厚,增强后囊壁及分隔轻度强化,延迟期呈等密度。结论：平扫加动态增强CT能较好反应HBC的影像学特点,提高了和其它肝脏肿瘤的鉴别诊断能力。     

卵巢囊腺瘤的CT诊断(附22例报告)

目的 确定CT对卵巢囊腺瘤的诊断价值。方法 对超声诊断不满意的21例卵巢囊腺瘤的CT表现进行回顾性分析，并与手术病理所见进行了对照。结果 22例卵巢囊腺瘤患中，浆液性囊腺瘤见于15例，粘液性囊腺瘤5例，交界性粘液性囊腺瘤2例。与术后病理结果对照，CT正确诊断了22例中的21例(95％)。CT探测单侧单发性卵巢囊腺瘤病变的准确率为100％(n=22／22)。结论 CT在卵巢囊腺瘤的诊断中，能清晰显示其内部特征及其病变与周围组织的关系，因而，它是一神可靠、有效的诊断方法。但是，CT对交界性卵巢囊腺瘤和卵巢囊腺瘤的恶变难以做出准确的定性诊断，多数情况下需经手术病理证实。     

The CT appearance of cystic masses of the liver

The authors here discuss twelve discrete pathologic entities that they found, in a review of over 500 abdominal CT scans, caused the appearance of a cystic lesion in the liver. The CT characteristics of the various lesions are illustrated, differential points in the patients' histories are noted, and gross and microscopic pathology specimens are correlated with the CT appearances to explain the CT findings. Lesions considered include: simple (bile duct) cyst, adult polycystic kidney disease, Caroli disease, pyogenic abscess, echinococcal cyst, amebic abscess, metastasis, biliary cystadenoma and cystadenocarcinoma, hepatocellular carcinoma, cholangiocarcinoma, biloma, and extrapancreatic pseudocyst.