Peripheral cholangiocarcinoma and clonorchiasis: CT findings

Sixteen patients with peripheral cholangiocarcinoma of the liver were examined with computed tomography (CT). None of the 16 patients presented with jaundice or had documented cirrhosis. On scans obtained both before and after the injection of contrast material, the tumors were depicted as low-attenuation masses in all cases, with wide variations in homogeneity. The tumor margin was irregular in 12 cases, and there was minimal contrast enhancement of the tumor in 14 cases. In 11 (69%) patients, CT demonstrated masses of markedly low attenuation, which corresponded to areas of diffuse microcystic change seen at histologic examination of resected specimens. In ten (63%) patients, the results of stool or intradermal tests for Clonorchis sinensis were positive. In all ten cases of clonorchiasis, mild, diffuse dilatation of the intrahepatic bile ducts was seen in addition to the low-attenuation masses, but there was no dilatation of the extrahepatic biliary tree. In five of the ten patients with clonorchiasis, stippled or aggregated, powderlike areas of high attenuation were seen on precontrast CT scans; at pathologic examination, those areas were found to be mucin. Extrahepatic metastases were demonstrated in ten (63%) patients. Peripheral cholangiocarcinoma should be the primary diagnostic consideration when these characteristic CT findings are detected in a noncirrhotic patient.     

药物性肝损害的多层螺旋CT影像表现

目的 探讨药物性肝损伤的MSCT表现.方法 回顾性分析2008年5月至2010年1月间经临床及病理证实的40例药物性肝损伤患者的MSCT影像及临床资料,总结其影像表现特征.结果 药物性肝损伤的MSCT影像表现主要有3种类型.(1)弥漫性肝脏损害2例:平扫肝脏密度均匀性减低,增强扫描肝实质轻度均匀强化.病理表现为肝细胞脂肪变性;混合炎性细胞浸润,点状坏死,毛细胆管淤胆.(2)灶性肝脏损害6例:肝内大片或多发小片状坏死灶5例.平扫肝脏密度不均匀,病变区为低密度改变;增强后病变区强化,特别是静脉期与平扫图像比较呈反转表现.另1例病程20 d的移植肝显示肝内弥漫的结节样再生.CT平扫可见肝内弥漫分布的稍高密度结节灶,增强后动脉期病灶强化,静脉期及延迟期近似于肝实质密度.5例患者病理表现为肝细胞片状及桥接坏死,大量混合炎性细胞浸润;1例重度淤胆,假小叶形成,肝细胞羽毛变性.(3)肝硬化表现2例:平扫肝脏表面呈结节状,肝叶比例失调,肝裂增宽.增强后肝脏强化一致,同时伴有脾大、腹水、侧支循环.病理为纤维组织增生,点状坏死和毛细胆管淤胆.结论 药物性肝损伤的MSCT影像表现具有一定的特征性,对临床诊断具有重要的参考价值.     

肝内胆管细胞型肝癌的CT表现

目的：分析肝内胆管细胞型肝癌的CT表现，加深对肝内胆管细胞癌的认识。方法：回顾分析18例胆管细胞型肝癌CT平扫和增强表现。结果：CT平扫培例均为低密度灶，病灶周围或病灶内均可见胆管扩张。增强扫描：动脉期无强化7例，轻度强化13例。延迟扫描18例均有不同程度延迟强化。结论：CT是胆管细胞型肝癌的重要检查方法。病灶周围或病灶内胆管扩张和病灶延迟强化是胆管细胞型肝癌的重要征象。     

动态多期螺旋CT扫描在肝内胆管细胞癌诊断中的价值

目的探讨螺旋CT动态增强扫描在肝内胆管细胞癌诊断中的应用价值。方法对经手术病理证实的30例肝内胆管细胞癌的CT资料进行回顾性分析。结果 30例患者中,肿瘤型18例,平扫表现为肝内单发的低密度不规则肿块,增强动脉期病灶无强化6例,外周部分呈轻度、不完全的环状强化12例,门脉期病灶进一步强化14例,延迟扫描病灶内部呈斑片状持续强化6例、网状或线状持续强化8例,病灶中央始终不强化4例;浸润型4例,平扫表现为肝内胆管壁局限性增厚、管腔狭窄,于增强后各期胆管壁缓慢持续强化;腔内生长型8例,平扫示近肝门部局限性软组织肿块并见肝管扩张增粗及狭窄,增强后近肝门肿块缓慢持续强化。结论螺旋CT动态增强扫描对提高肝内胆管细胞癌的正确诊断率具有一定价值。     

18例肝内胆管细胞癌的CT表现分析

目的为了进一步提高对肝内周围型胆管细胞癌（IPCC）CT诊断的准确性。方法搜集2000年10月至2005年3月间在我院诊治的IPCC18例,并经手术病理证实,对其螺旋CT平扫＋增强的表现进行回顾性分析。结果研究证实,本组患者CT直接征象是平扫肝实质内见低或略低密度边缘模糊不清的类圆形、不规则形及分叶形的占位性病灶,增强早期肿瘤周边轻度强化之后为逐渐增强的向心性强化;间接征象是肝内胆管扩张,肝叶萎缩,周边肝被膜回缩,病灶周围血管改变及肝门、后腹膜淋巴结肿大等。结论肝内胆管细胞癌临床上多无肝硬化表现,AFP多阴性,肿块较大,且伴有钙化,增强早期肿瘤周边轻度强化之后为逐渐增强的向心性强化,高度提示IPCC。     

周围型肝内胆管细胞癌的CT表现

目的：探讨周围型肝内胆管细胞癌（IHPCC）的CT表现及其诊断价值。方法：收集21例经手术病理证实IHPCC的CT表现进行回顾性分析。结果：21例平扫表现为低密度病灶,多数边界不清,伴病灶周边胆管扩张15例,肝内胆管结石9例,胆总管结石2例;伴肝叶萎缩13例,病灶局部肝轮廓凹陷10例;增强扫描动脉期病灶周边环形、结节状强化19例,内部呈斑片状强化7例,线样强化5例、网格状强化4例,静脉期及延迟10~15min后扫描病灶有进一步强化、充填,呈现渐进性强化的特点。发现肝门周围和后腹膜区淋巴结肿大8例,无弥漫性肝硬化表现及门静脉癌栓形成征象。结论：IHPCC与其它肝肿瘤及非肿瘤性病变有着不同的病理和CT表现特征,螺旋CT动态多期增强扫描对IHPCC的诊断具有重要的临床应用价值。     

肺淋巴管肌瘤病多层螺旋CT诊断价值

目的:通过分析肺淋巴管肌瘤病(PLAM)多层螺旋CT(MSCT)的影像特点,旨在探讨其对肺淋巴管肌瘤病(PLAM)的影像诊断价值。方法:回顾性分析12例经病理证实的PLAM的胸部影像表现,包括常规扫描、横轴面薄层重组和冠状面、矢状面多平面重组(MPR)图像。结果:12例成年女性患者胸部MSCT典型征象为:双肺弥漫分布大小不等的类圆形囊腔影,常规层厚图像显示囊腔影的径线5～30mm,较小的囊腔影不能显示明确的薄壁。薄层重组和MPR图像可明确显示囊腔壁,壁厚<2mm,囊壁可见散在的血管断面影和血管穿插其中。气胸5例,乳糜胸3例,1例合并前纵隔淋巴结肿大。结论:MSCT薄层重组和冠状面、矢状面MPR对该病的早期诊断、鉴别诊断具有重要价值,同时也是判断病变进展及预后的有效指标。必要时需行肺活检,以明确病理诊断。     

螺旋CT多期扫描技术对胰腺癌的诊断价值

目的：探讨螺旋CT多期扫描对胰腺癌的诊断价值。方法：搜集行SCT动脉期、胰腺期、肝脏期三期扫描的胰腺肿块75例，均经手术病理证实，其中胰腺癌53例，局限性胰腺炎22例，比较肿瘤与炎症在SCT增强扫描各期中的表现。结果：本组胰腺癌53例，其中胰头癌33例，胰颈癌4例、胰体癌14例，胰尾癌2例。局限性胰腺炎22例，头、颈、体、尾分别为17例、2例、2例、1例。增强扫描，动脉期胰腺癌低密度43例，等密度10例，胰腺炎低密度2例，等密度20例；胰腺期胰腺癌低密度51例，等密度2例，胰腺炎低密度1例，等密度21例；肝脏期胰腺癌低密度42例，等密度11例；胰腺炎22例均为等密度。结论：胰腺螺旋CT动脉期、胰腺期、肝脏期三期增强扫描在胰腺癌诊断中具有非常重要的临床价值。     

Diagnosis of brain death using two-phase spiral CT.

PURPOSEThe purpose of this study was to determine the utility of spiral CT in the diagnosis of brain death.METHODSSpiral CT was evaluated prospectively in 14 brain-dead patients and in 11 healthy subjects. A two-phase protocol was used. Twenty seconds after intravenous injection of a nonionic iodinized contrast medium, the CT table was drawn through the gantry at a rate of 10 mm/s while scanning was in progress. The second scanning phase was started automatically a mean of 54 seconds later, using the same parameters. Opacification or absence of opacification of carotid, vertebral, and basilar arteries and intracerebral veins was ascertained for each image in both phases. The diagnosis of brain death was confirmed by elecroencephalography (n = 7), angiography (n = 5), or both (n = 2). Statistical analysis with the Fisher exact test enabled us to compare the brain-dead patients with the healthy control subjects.RESULTSIn brain death, the pericallosal and terminal arteries of the cortex did not opacify during the two phases of spiral CT, whereas the superficial temporal arteries were always visible. The internal cerebral veins, the great cerebral vein, and the straight sinus did not opacify, whereas the superior ophthalmic veins were visible on both sides 13 times. For each vessel type, specificity was 100% for nonvascular opacification criteria on the right and left sides.CONCLUSIONTwo-phase spiral CT can demonstrate the absence of intracerebral blood flow in brain death.     

肠系膜脂膜炎MSCT影像学表现

目的 分析肠系膜脂膜炎的MSCT特点,提高CT诊断及鉴别诊断的水平.方法 回顾性分析12例肠系膜脂膜炎的临床及MSCT表现.5例CT平扫,7例CT平扫加双期增强检查,12例均按照CT诊断标准诊断为肠系膜脂膜炎（1例手术证实）.结果 12例表现为围绕肠系膜根部及走形区域边界清楚的脂肪肿块,呈云雾状密度增高影.7例增强扫描病灶未见强化,病变与腹腔内脂肪和腹膜后脂肪分界清晰.9例可见“假包膜”征,6例见“脂肪环”征.6例病变对邻近肠袢有推移征象,其中1例导致小肠梗阻,1例病变伴门静脉及肠系膜上静脉部分栓塞.3例病变内及后腹膜见小结节.12例病变肿块内均无囊性变及钙化灶.结论 肠系膜脂膜炎CT表现具有一定特征,MSCT是诊断肠系膜脂膜炎非常有效的影像手段.     

侵袭性血管黏液瘤的多层螺旋CT表现

侵袭性血管黏液瘤( aggressive angiomyxoma,AAM) 临床罕见,生物学行为独特,是一种罕见的间叶组织来源的良性肿瘤,多发生于腹部、盆腔及外阴的软组织,是局部侵袭性的富于黏液和血管的良性肿瘤[1].国内文献仅报告个例临床表现及病理学特征较多,对其多层螺旋CT(MSCT)双期表现报道较少.笔者回顾性分析4例侵袭性血管黏液瘤的完整CT资料,并复习相关文献,以提高对本病CT表现的认识.     

Hepatic venous congestion after living donor liver transplantation with right lobe graft: two-phase CT findings

PURPOSE: To describe and determine clinical importance of two-phase computed tomographic (CT) findings of hepatic venous congestion after living donor liver transplantation (LDLT) with right lobe graft. MATERIALS AND METHODS: Forty-eight patients underwent two-phase (hepatic arterial phase and portal venous phase [PVP]) CT at 1, 2, and 4 weeks after LDLT. Images were evaluated for hepatic attenuation difference in areas of hepatic venous congestion, opacification of hepatic and peripheral portal veins in those areas, and changes in findings at follow-up CT. CT findings were correlated with serum bilirubin level. Fisher exact test and mixed model were applied. Histopathologic specimens were obtained in six patients. RESULTS: Thirty patients (62%) had attenuation difference in segments V and VIII of right lobe transplant at initial CT scanning. Opacification of hepatic or peripheral portal veins was seen in 17 (63%) and 27 (100%) hyperattenuating areas of congestion during PVP and in none and three (19%) of 16 hypoattenuating areas, respectively. At 4-week follow-up CT, attenuation difference decreased in volume in 11 of 16 patients with hypoattenuation during PVP. All 14 patients with hyperattenuation showed no change in volume, but attenuation difference had decreased or disappeared. Histopathologic specimens showed evidence of hepatic venous congestion in all six patients. Hypoattenuation was seen at PVP CT in all three patients with severe hepatic venous congestion at histopathologic examination. Serum bilirubin level was significantly different between patients with hypoattenuation and those with hyperattenuation during PVP (P =.035) and between patients with hypoattenuation and those without attenuation difference (P =.009). CONCLUSION: Areas possibly related to hepatic venous congestion after LDLT have variable attenuation at CT; decreased enhancement during PVP correlates with increased postoperative serum bilirubin level, which indicates severity of hepatic venous congestion.     

多层螺旋CT在肝脏成像中的应用进展

多层螺旋CT对于肝脏疾病的诊断具有重要的作用。加快的扫描速度与薄层结合显著提高了空间和时间分辨率,从而提供了对肝脏病变,尤其是患有肝硬化的肝细胞癌患者更高的诊断敏感性。随着相关技术的发展,越来越多新的扫描和后处理方法应用于临床,以满足包括原发性和转移性肝肿瘤诊断、术前评价,肝移植供体评价等各种患者不同的需求。本文就以上各种具体情况分别进行综述。     

CT findings of cholangiocarcinoma associated with recurrent pyogenic cholangitis

OBJECTIVE: The purpose of our study was to determine the characteristic CT findings of cholangiocarcinoma associated with recurrent pyogenic cholangitis. CONCLUSION: CT findings of cholangiocarcinoma associated with recurrent pyogenic cholangitis are important in order to improve early diagnosis and proper treatment. Cholangiocarcinoma associated with recurrent pyogenic cholangitis is predominantly located in the atrophic hepatic lobes and in the hepatic lobes of biliary calculi and is associated with the narrowing or obliteration of the portal vein.