小儿膀胱横纹肌肉瘤的影像表现和鉴别诊断

目的:探讨小儿膀胱横纹肌肉瘤(rhabdomyosarcoma,RMS)的X线造影和CT表现特征,提高对本病的认识。方法:回顾性分析10例经手术病理证实的膀胱RMS的临床影像资料,全部病例均行静脉尿路造影和/或膀胱造影检查,其中4例行CT扫描。结果:造影显示膀胱内葡萄簇状充盈缺损8例,膀胱三角区大的分叶状充盈缺损影2例,6例膀胱壁毛糙。4例CT检查均显示膀胱腔内典型葡萄簇状低于腹壁肌肉密度软组织肿块,局部膀胱壁增厚,增强扫描病灶呈轻中度强化。结论:膀胱RMS影像表现具有一定特征,结合患儿年龄及临床特征多可做出正确诊断。     

小儿盆腔及泌尿生殖系横纹肌肉瘤的影像诊断

目的探讨儿童盆腔及泌尿生殖系横纹肌肉瘤(RMS)的尿路造影和CT表现及其诊断价值。资料与方法回顾性分析20例经手术及活检病理证实的原发于盆腔及泌尿生殖系RMS的影像学资料。其中10例经静脉肾盂造影(IVP)检查,3例经膀胱尿道造影(VCUG)检查,10例经CT检查,1例经MRI检查。结果8例膀胱RMS的IVP、CT表现为膀胱内葡萄状充盈缺损,膀胱颈部与耻骨联合间距增宽,VCUG可见肿物延伸至后尿道;4例前列腺RMS表现为后尿道肿物压迫膀胱颈部并使其抬高、环绕尿道的盆底部包块。6例盆腔RMS IVP及CT表现为盆腔包块,压迫膀胱移位、变形,膀胱壁轻度浸润不规则,输尿管下段浸润者可有轻度输尿管及肾盂积水。1例尿道RMS表现为尿道内充盈缺损,1例阴道RMS,IVP表现为膀胱颈部充盈缺损。结论IVP及VCUG能明确诊断原发于膀胱、前列腺、尿道的RMS及上尿路继发病变;CT及MR可进一步了解起自阴道、前列腺、盆腔的RMS及其与周围器官的关系。     

囊腺性膀胱炎一例

患者 男,43岁.间断性无痛性肉眼血尿11天.体检:无特殊异常.膀胱镜检:膀胱容量80 ml,膀胱镜视野全部为菜花状肿物,后尿道前列腺段黏膜上可见散在乳头状肿块,膀胱颈抬高明显.KUB平片:未见明显异常.IVP:两侧肾脏显影淡,两侧肾盂明显扩张.两侧输尿管明显迂曲、增宽.膀胱底部可见一形态不规则的充盈缺损.膀胱上抬.膀胱逆行造影:膀胱充盈形态不规则,边缘不光整,未见输尿管返流征象.膀胱右侧见一憩室样阴影(图1).CT平扫:膀胱充盈不佳.膀胱壁增厚,且厚薄不均,可见软组织样影向膀胱内突起.膀胱右侧见一憩室样阴影.增强扫描:动脉期膀胱壁未见明显强化.静脉期膀胱壁轻度强化(图2).     

十二指肠癌肉瘤上消化道造影表现分析

目的探讨十二指肠癌肉瘤上消化道造影表现并分析误诊原因。方法回顾性分析我院2010年~2014年间7例经手术病理证实的7例十二指肠癌肉瘤临床X线资料。结果病变位于十二指肠2,3段交界处附近,主要表现为起源于肠壁形成浅分叶状,多结节融合状边界尚清的充盈缺损区,局部管腔狭窄,肠管蠕动减慢,粘膜皱襞增粗紊乱。其中上消化道造影误诊为平滑肌瘤4例,平滑肌瘤肉瘤3例。结论十二指肠癌肉瘤的胃肠造影表现具有一定的特征,此项检查是诊断该病的有效方法之一。     

非上皮性膀胱肿瘤影像表现（附10例分析）

目的探讨非上皮性膀胱肿瘤的诊断.材料和方法对近8年10例经手术病理证实的非上皮性膀胱肿瘤的影像表现及临床资料进行回顾性分析.结果除横纹肌肉瘤增强明显状如葡萄、平滑肌瘤边缘清晰光滑、副神经节瘤可多发有参考作用外,大多数非上皮性膀胱肿瘤影像无特殊征象.结论多数非上皮性膀胱肿瘤单就影像表现诊断困难,需结合临床资料;有些病例术前无法诊断,要依靠膀胱镜活检病理确诊.     

输尿管膀胱壁内段结石并发膀胱充盈缺损的特殊CT征象

目的分析输尿管膀胱壁内段结石并发膀胱充盈缺损(bladder filling defect,BFD)的CT征象以及两者的关系。资料与方法回顾分析52例急性肾绞痛患者伴输尿管膀胱壁内段结石的CT图像,包括结石是否伴BFD,结石的大小和梗阻情况与BFD的关系。结果52例中,32例可见BFD,其中28例为形态规则的充盈缺损,4例为形态不规则的充盈缺损。在输尿管膀胱壁内段结石伴有BFD阳性者中,69.5%出现明显的输尿管梗阻征象。输尿管膀胱壁内段结石伴有BFD阳性者结石平均直径为4.01mm,阴性者平均直径为4.55mm,结石大小与BFD征象无明显关系(P>0.05)。结论急性肾绞痛患者中,膀胱充盈缺损征阳性强烈提示膀胱输尿管口的钙化为结石。     

原发性输尿管癌的影像学诊断

目的：分析２７例输尿管癌的临床和影像学资料，提出其影橡学检查的程序和鉴别诊断。方法：男２７例，女７例；年龄２８～７０岁。２７例均有腹平片及排泄性尿路造影，其中１６例逆行尿路造影，８例ＣＴ检查。结果：９例腹平片患侧肾影增大，２０例患侧肾不显影。７例排泄性和１５例逆行尿路造影显示充盈缺损。８例ＣＴ检查显示输尿管壁不规则增厚３例，结节状２例，３例凸入膀胱形成肿块。结论：排泄性尿路造影能发现患侧肾功能异常或显示肿瘤，逆行尿路造影是诊断输尿管肿瘤的有效方法，ＣＴ扫描能显示肿瘤及与邻近结构的关系     

儿童膀胱恶性横纹肌肉瘤的CT诊断

儿童膀胱胚胎性横纹肌肉瘤是一种极为少见的恶性肿瘤，我院近５年来收治３例，均发生于尿道内口附近，病理证实为膀胱恶性横纹肌肉瘤，其中２例进行了CT检查，现报告如下。１临床资料本组患儿男１例，女１例，年龄２岁１例，４岁１例。均有血尿，有１例发生尿潴留。查体：尿潴留１例下腹饱满，有压痛，经导尿后未触及腹部肿块；另１例体检无异常。２例CT检查都有膀胱壁局限性的增厚，膀胱前壁有软组织块影突入膀胱内，CT值约３０～８０Hu，增强扫描肿块可见不同程度的增强，膀胱内充盈造影剂后可见突向膀胱腔内的大小不一颗粒状充盈缺损…     

伴有乳头溢液乳腺癌与导管内乳头状瘤的乳腺导管造影诊断

目的：总结分析伴有乳头溢液乳腺癌以及导管内乳头状瘤的乳腺导管造影X线表现,评价两者的诊断与鉴别诊断价值。方法：回顾性分析经手术和病理证实的23例乳腺癌和36例乳腺导管内乳头状瘤患者的乳腺导管造影检查影像资料。结果：乳腺癌导管造影主要表现为分支导管内不规则的充盈缺损伴导管壁破坏、导管阻塞中断、“潭湖征”等较为典型的征象;导管内乳头状瘤的导管造影主要表现为大导管内光整的充盈缺损,导管壁多无破坏,并伴有导管扩张以及导管扭曲。乳腺瘤与乳头状瘤在充盈缺损、导管壁破坏、导管完全中断、导管扩张以及“潭湖征”等x线征象上差异有统计学意义（P〈0．05）。乳腺导管造影诊断伴有乳头溢液乳腺癌和乳头状瘤的符合率分别为78．3％和80．1％。结论：不规则的充盈缺损伴导管壁破坏、导管阻塞中断、“潭湖征”等征象及发生部位上乳腺癌和乳腺导管内乳头状瘤两者各有特点,是诊断和鉴别诊断的重点。     

胃肠道平滑肌肉瘤的X线及CT诊断

探讨胃肠道平滑肌肉瘤的Ｘ线和ＣＴ表现,以提高对该病的诊断能力。方法：分析经手术病理证实的２０例胃肠道平滑肌肉的Ｘ线表现及其中１１例胃平滑肌肉瘤的ＣＴ表现。结果均为单发病例,Ｘ线片上腔内型４例,表现为圆形、半圆形充盈缺损或软组织肿块,肿瘤中心出现不规则的龛影。     

Detection of pancreatic fluid and urine leakage after pancreas transplantation: value of CT and cystography

Leakage from the urinary bladder or duodenal stump after pancreas transplantation with urinary bladder drainage of the graft is difficult to diagnose clinically. We retrospectively reviewed our experience with fluoroscopic cystography and CT to determine their relative merit in the diagnosis of pancreatic fluid and urine leakage as documented by surgical exploration in pancreas transplant recipients. Thirteen leaks were diagnosed by fluoroscopic cystography or by CT in 11 patients after pancreas transplantation with urinary bladder drainage of pancreatic fluid. Conventional retrograde fluoroscopic cystography showed 11 leaks; CT with retrograde bladder opacification showed three leaks. Of the five CT studies that did not show a leak and that also were done within 7 days of a cystogram with abnormal findings, failure to use retrograde bladder opacification accounted for the majority (three cases) of missed diagnoses. Focal or free peritoneal abdominal fluid was seen in all CT examinations, with extravasation of contrast material seen into both walled-off collections and free ascites. Our experience suggests that retrograde bladder and duodenal stump opacification should be a routine part of the CT evaluation performed to detect leakage from the urinary bladder or duodenal stump after pancreas transplantation.     

脊髓动静脉畸形的CT诊断（附6例报告）

本文报告6例脊髓动静脉畸形的CT表现，其中4例经手术证实，典型的CT表现为：在异常血管区域的异常对比增强；脊髓表面扩大的动脉或静脉在椎管造影CT中表现为蛛网膜下腔内异常的充盈缺损，静脉增强CT中表现为异常的强化结构，本文讨论了CT的诊断，检查技术有评价问题。     

Non-Hodgkin's lymphoma of the bladder--CT and MRI appearances.

Computed tomography (CT) appearances of two patients with primary bladder non-Hodgkin's lymphoma are presented with magnetic resonance imaging (MRI) correlation in one. The differences between primary and secondary bladder lymphoma with respect to their clinical presentation, course and prognosis are described. Bladder lymphoma is a rare tumour which often presents as a large multilobular submucosal mass, and such an appearance may suggest the diagnosis. Bladder lymphoma, however, cannot be differentiated from the more common transitional cell carcinoma on the basis of CT attenuation values or enhancement patterns, or MRI signal characteristics. The diagnosis must, therefore, be made by histology. Other differential diagnoses and the role of various imaging techniques in the diagnosis and management of bladder lymphoma are considered.     

Transcystic biopsy: a new approach to posterior pelvic lesions

Six patients with masses located posterior to the bladder were biopsied using an anterior transcystic approach. Conventional biopsy needles were introduced through the bladder with both sonographic (five) and CT guidance (one). Clinically important diagnoses of recurrent carcinoma (four) or cytology-negative fluid (two) were made in all patients. One patient had a transient episode of minimal hematuria immediately after the biopsy. Otherwise, there were no complications. Transcystic biopsy appears to be a safe and effective technique for biopsy or aspiration of posterior pelvic masses.     

Utility of routine trauma CT in the detection of bladder rupture

RATIONALE AND OBJECTIVES: The purpose of this study was to determine the frequency with which routine computed tomography (CT) fails to depict bladder rupture, the potential utility of delayed CT scans, and whether these findings might be useful in determining which patients may require subsequent cystography. MATERIALS AND METHODS: Cystograms and abdominal and pelvic CT scans of 54 patients with blunt trauma and in whom bladder rupture was clinically suspected were retrospectively reviewed. Blind readings of CT scans were performed by two genitourinary radiologists. Cystograms were used as the standard. RESULTS: Cystograms depicted bladder rupture in 10 patients. On CT scans, extravesical fluid was depicted in all three patients with intraperitoneal bladder rupture (although only a small amount of pelvic intraperitoneal fluid was present in two of these patients), in all seven patients with extraperitoneal bladder rupture, and in 32 of the 44 patients without bladder injury. Contrast material had been excreted into the bladder at the time of the initial or delayed CT in eight patients with bladder rupture; however, extravasation was identified in only four of the eight. In two of the four patients without extravasation, the bladder was distended at the time of CT. No bladder injuries were found in the 12 patients in whom pelvic fluid was not identified on CT scans. CONCLUSION: The absence of pelvic fluid on a trauma CT scan indicates that bladder rupture is unlikely. Even when a partially opacified bladder is passively distended, bladder injury may be present despite the absence of contrast material extravasation.     

膀胱癌的CT分期与病理对照

目的 分析膀胱癌的CT表现，并与手术病理对照，提高膀胱癌的术前分期诊断水平。方法分析13例膀胱癌的CT表现及术前分期，并与手术病理结果对照。结果膀胱癌主要表现为膀胱壁局限性或弥漫性增厚，形成菜花样肿物向腔内突出，可向壁外生长侵犯盆腔组织器官及淋巴结转移，膀胱周围脂肪间隙模糊。膀胱癌的术前CT分期正确率为69．3％。结论螺旋CT扫描能显示膀胱癌的CT特征及向膀胱壁内、外生长情况，对术前分期有意义。     

多层螺旋CT对膀胱癌的术前分期价值

目的评价多层螺旋CT检查对膀胱癌的术前分期价值。方法对经手术病理证实的膀胱癌患者48例,男34例,女14例,均行术前多层螺旋CT检查,将肿瘤CT征象与手术病理分期结果进行对照分析。结果 CT检查对膀胱癌的总准确率为76.79%。对于膀胱壁内癌灶(≤T2b期)分期的准确率为79.49%,对于膀胱癌侵犯壁外结构的癌灶(≥T3期)分期准确率为70.59%。结论螺旋CT检查对膀胱癌具有较高的诊断价值,可作为膀胱癌术前常规和主要的检查项目。     

Effect of contrast-enhanced computed tomography on diagnosis and management of acute abdomen in adults

AIM: To determine the impact of computed tomography (CT) on the diagnosis and treatment plan in patients with acute abdominal pain. MATERIALS AND METHODS: A prospective study was undertaken in 125 adult patients presenting with acute abdominal pain (74 men and 51 women; 40.2 +/- 19.3 years; range, 18-92). Changes in diagnosis, gain in percentage diagnostic certainty and changes of treatment plan of the surgeons in the emergency department before and after CT were evaluated. Pre- and post-CT diagnoses were compared with the final diagnoses. RESULTS: CT findings changed the initial diagnosis in 40 (32.0%) patients. The diagnostic certainty was 58.3 +/- 22.9% before CT, and its gain after CT was 21.9 +/- 18.5 points (P < 0.0001). Post-CT diagnoses were consistent with the final diagnosis in 116 patients (92.8%), while pre-CT diagnoses were correct in 89 patients (71.2%; P < 0.0001). Initial treatment plans were changed in 31 (24.8%) patients after CT. In 57 (45.6%) patients, CT information changed diagnoses and/or treatment plans. No significant differences were observed in the diagnosis, diagnostic certainty and treatment plan among four surgeons. CONCLUSION: Contrast-enhanced CT frequently changed the clinical diagnoses with increased diagnostic certainty and the initial treatment plans.