18F-FDG PET/CT在胸段食管鳞癌淋巴结转移中的诊断价值

目的 探讨18F-FDG PET/CT在胸段食管鳞癌淋巴结转移中的诊断价值,并与增强CT及术后病理结果进行对比。 方法 胸段食管鳞癌患者54例,术前一周内行18F-FDG PET/CT和增强CT扫描,术后以病理学诊断为“金标准”,比较两种显像方法对胸段食管鳞癌淋巴结转移的灵敏度、特异度、准确率及不同短径范围的诊断准确率。应用SPSS13.0软件进行四格表χ2检验。 结果 手术共切取肿大淋巴结186枚,均经病理证实,其中淋巴结转移77枚,18F-FDG PET/CT诊断淋巴结转移的灵敏度、特异度及准确率分别为77.9%（60/77）、95.4%（104/109）和88.2%（164/186）,增强CT分别为40.3%（31/77）、75.2%（82/109）和60.8%（113/186）,二者诊断效能差异有统计学意义（χ2=24.04、15.77和36.77,P均 < 0.01）。对于短径>5 mm（5~10 mm及≥10 mm）的淋巴结,18F-FDG PET/CT诊断的准确率高于增强CT,且差异有统计学意义（χ2=26.03和26.47,P均 < 0.01）;对于短径≤5 mm的淋巴结,二者间诊断的准确率差异无统计学意义（χ2=0.24,P>0.05）。 结论 18F-FDG PET/CT在胸段食管鳞癌淋巴结转移中具有较高的诊断价值,对于短径>5 mm的淋巴结优势明显。     

胃原发性非霍奇金淋巴瘤与进展期胃癌的CT鉴别诊断

目的：探讨CT在胃原发性非霍奇金淋巴瘤与进展期胃癌鉴别诊断中的价值。方法：回顾性分析经手术病理证实的15例胃原发性非霍奇金淋巴瘤和22例进展期胃癌患者的病例资料,观察病变部位、形态、胃周径浸润范围、病灶最大厚度、坏死形态、病变强化程度及强化方式、浆膜面浸润、其它脏器浸润及腹部淋巴结转移情况等并进行对比分析。结果：胃原发性非霍奇金淋巴瘤胃壁厚度1.0～4.3cm（平均2.0cm）,增强后动静脉期较平扫CT值分别提高10和20HU;胃壁完整10例,胃壁环周浸润3例,周围淋巴结肿大（直径〉1.0cm）3例,腹腔少量积液2例。进展期胃癌胃壁厚度0.7～3.7cm（平均1.8cm）,增强后动静脉期分别较平扫CT值提高20和40HU;胃壁溃疡17例,胃壁环周浸润3例,周围淋巴结肿大8例,其中2例伴钙化,腹腔大量积液3例、少量积液2例,腹腔脏器转移4例。两组病例均可出现胃周、肾门下腹膜后区淋巴结肿大。结论：CT在胃原发性非霍奇金淋巴瘤与进展期胃癌的鉴别诊断中有重要的价值。胃壁僵硬伴明显强化、浆膜外脂肪浸润、淋巴结肿大钙化、大量腹水及脏器转移等常提示胃癌的诊断;而胃壁增厚但柔软,伴轻度～中度均匀强化有助于胃原发性非霍奇金淋巴瘤的诊断。     

直肠周围间隙淋巴结转移的术前MSCT评估

目的:分析直肠周围间隙淋巴结转移的多层CT(MSCT)表现,探讨CT诊断直肠癌淋巴结转移(N分期)的价值.方法:术前行盆腔MSCT检查的154例直肠癌病例,均行全直肠系膜切除术,对直肠周围间隙淋巴结进行病理检查,采用双盲法,记录每枚淋巴结的CT表现,包括淋巴结短轴直径、边缘、密度、分布方式.结果:以手术病理为标准.直肠周围间隙淋巴结CT检出率为86.3%(471/546),病理共检出直肠周围间隙淋巴结546枚,CT检出481枚,其中471枚(阳性172枚,阴性299枚)淋巴结与病理相匹配.CT诊断直肠周围间隙淋巴结转移的各种判断标准(淋巴结大小、边缘、密度、分布方式)的敏感性分别为83.1%、72.2%、70.1%、73.5%,特异性分别为80.5%、85.1%、82.4%、75.1%.CT显示的淋巴结大小、边缘、密度、分布方式的差异与阳性率有显著相关性,P<0.005.结论:直肠周围间隙淋巴结有良性和恶性淋巴结,综合分析淋巴结大小、形态、密度及分布对诊断直肠周围间隙淋巴结转移有很大帮助.     

肺癌淋巴结转移的CT表现与细胞核仁组成区关系

目的：探讨肺癌淋巴结转移CT表现与细胞核仁组成区的关系，以及CT扫描和AgNOR技术联合诊断肺癌纵隔淋巴结转移的可行性。材料与方法：应用CT扫描和AgNOR技术对38例肺癌淋巴结转移情况进行分析。结果：CT扫描淋巴结短径≥8mm的10例肺癌中淋巴结转移7例，此7例肺癌细胞的AgNOR／核均数为8.97±0．72。且AgNOR颗粒均表现为聚集型。伴淋巴结转移肺癌的AgNOR／核均数显著高于无淋巴结转移肺癌（P＜0．05）。结论：提示以CT扫描淋巴结短径≥8mm，肺癌细胞核内AgNOR颗粒为聚集型，AgNOR／核均数≥8作为标准诊断肺癌淋巴结转移有较高的特异性及敏感性。AgNOR技术及CT扫描联合诊断肺癌淋巴结转移有较好的临床应用前景。     

食管癌淋巴结转移的术前MSCT评价

目的:评价食管癌淋巴结转移的术前MSCT表现,探讨其对术中淋巴结清扫的应用价值。方法:回顾性分析126例食管癌的术前MSCT检查资料及术后临床资料,分析淋巴结转移的MSCT表现。结果:将术前MSCT图像中淋巴结短径≥5mm或<5mm,同时伴强化视为异常淋巴结标准。MSCT共检出异常淋巴结282枚,分别为左右气管旁46枚,隆突下45枚,主肺动脉窗64枚,食管旁68枚,左下肺韧带周围13枚,锁骨上及膈下46枚。126例手术共摘除阳性转移淋巴结303枚,MSCT漏诊30枚,误诊9枚。MSCT检出的282枚异常淋巴结中,术后病理证实转移的227枚,检出率为80.5%。其中,短径<5mm的阳性淋巴结7枚,短径5¹0mm淋巴结42枚,短径>10mm淋巴结178枚,阳性转移率分别为22.6%(7/31)、64.6%(42/65)、95.7%(178/186)。阳性转移的227枚淋巴结中,静脉期CT值<60 HU的淋巴结52枚,>60 HU的175枚,分别占阳性转移淋巴结的22.9%、77.1%。结论:食管癌淋巴结转移术前MSCT检查具有很高的应用价值,对临床治疗具有重要的指导意义。     

64排螺旋CT对两种胃癌淋巴结分期的评估

目的评估64排螺旋CT在两种胃癌淋巴结分期中的价值。资料与方法搜集术前作64排螺旋CT检查且经住院手术证实的资料齐全的56例连续性胃癌病例。设定胃周和胃外淋巴结短轴径≥5mm为肿大淋巴结,由两位高年资医师独立对CT图像进行评估,对淋巴结进行计数,并分别按国际抗癌联盟（UICC）分期和日本胃癌规约（GRGCS）分期方法进行分期。评价在不同分期条件下,64排螺旋CT术前对胃癌肿大淋巴结的诊断准确性的差异。结果56例胃癌,手术共清除淋巴结322枚,短轴径≥5mm的淋巴结共计256枚,其中转移为阳性的淋巴结210枚;64排螺旋CT扫描对全部短轴径≥5mm的淋巴结的显示率为94%（240/256）,检测出的阳性淋巴结百分率为95%（200/210）。对于胃壁旁组和血管旁组的肿大淋巴结,CT显示率和准确率较高。N分期的总体准确性,采用GRGCS方法为80%,UICC方法为77%。其中过高分期在GRGCS方法中的发生率为14%（8/56）,在UICC方法中的发生率为9%（5/56）;过低分期在GRGCS方法中的发生率为6%（3/56）,在UICC方法中的发生率为14%（8/56）。两种N分期方法之间差异无统计学意义（P〉0.05）。结论64排螺旋CT能够较为全面和准确地观察胃癌淋巴结的位置、形态和大小,对于N分期的总体准确性较高,采用GRGCS和UICC分期并无差异。     

CT在胃原发非霍奇金淋巴瘤与胃低分化腺癌鉴别诊断中的应用价值

目的：探讨CT在胃原发非霍奇金淋巴瘤与胃癌的鉴别诊断中的应用价值。资料与方法：经手术病理诊断且有CT扫描的胃原发非霍奇金淋巴瘤19例，胃低分化腺癌48例，结合病理诊断对比分析二者胃壁病变厚度、密度、范围、轮廓、与周围脏器的关系及腹腔腹膜后淋巴结肿大的情况。结果：胃淋巴瘤壁厚度0．4－6．5cm，平均2．07cm；胃癌胃壁厚度0．5－4．0cm，平均1．74cm（P＝0．2932)。胃淋巴瘤淋巴结受侵10例（52．63％），CT显示淋巴结肿大6例（31．57％），真阳性3例（15．8％），其中腹膜后淋巴结肿大1例（5．26％）；胃癌淋巴结转移38例（90．48％），CT显示淋巴结肿大20例（47．6％），真阳性19例（39．6％），其中伴腹膜后淋巴结肿大4例（9．52％）。胃淋巴瘤侵犯胃壁近似全周4例（22．2％），≥胃周径50％4例（22．2％），胃癌侵犯近拟全周7例（14．6％），≥胃周径50％6例（12．5％）；胃淋巴瘤外侵5例（26．32％），CT阳性3例（15．8％），胃癌外侵42例（87．5％），CT阳性31例（64．58％）。结论：CT扫描可以显示胃壁病变的厚度、密度、范围、与周围组织的关系以及腹腔腹膜后淋巴结肿大的情况。胃癌与胃淋巴瘤在密度、厚度上均无显著差异，当病变外侵和／或有腹腔淋巴结肿大时，胃癌可能性较淋巴瘤大；而当病变厚度和侵犯周径较大时，淋巴瘤可能性较胃癌大。是否有腹膜后淋巴结肿大不能提示病变性质，应参考其他阳性征象进行诊断。     

胰腺癌胰周淋巴结转移分布特征的螺旋CT表现

目的:胰腺癌胰周淋巴结转移的分布特征及螺旋CT影像表现。方法:搜集经手术病理诊断为原发性胰腺癌45例,所有病例均经手术病理或影像标准诊断有胰周淋巴结转移。根据本组45例病例CT所反映的肿大淋巴结的分布情况,将胰周淋巴结分为8组。设定淋巴结的短径≥1.0cm为淋巴结转移阳性的影像表现。统计阳性淋巴结的出现率,重点观察淋巴结转移的部位、大小、数目、形态、密度、强化情况。结果:本组45例胰腺癌中,共计89个部位观察到淋巴结转移胰周转移淋巴结以腹腔动脉干组46.7%(21例),肠系膜根部组46.7%(21例),腹主动脉周围组35.6%(16例)为最多,胃周11.1%(5例)及脾动脉-脾门组13.3%(6例)最少。结论:胰腺癌转移所致肿大淋巴结主要分布在腹腔干、肠系膜根部以及腹主动脉周围。螺旋CT扫描检查可以较准确显示胰腺癌胰周淋巴结的转移情况。     

CT评估黏液胃癌及非黏液胃癌淋巴结转移

目的：探讨黏液胃癌（MGC）及非黏液胃癌（NGC）淋巴结大小与转移的关系及CT征象。方法：分析我院及浙江省肿瘤医院38例经手术病理证实的黏液胃癌病人的CT资料,同时将从520例非黏液胃癌中按年龄、性别配对的38例作为对照组,重点分析两组病例淋巴结大小及阳性转移率的异同,采用χ^2进行统计学处理,P〈0．05差异有统计学意义。复习文献并讨论MGC的术前CT诊断价值。结果：MGC组淋巴结检出数量及阳性率均较NGC组高,分别是53％、38％,P〈0．01,差异有统计学意义。1～5mm、6—9mm大小淋巴结的阳性转移率：MGC与NGC两组分别为29％、57％与11％、32％,P〈0．01,两组差异有统计学意义。≥10mm淋巴结检出率及阳性转移率MGC亦较NGC组略高,但差异无统计学意义。两组平均肿瘤体积MGC较NGC大;CT增强MGC以内层明显强化,中外层以低密度为主,NGC以均匀强化为主,结论：〈10mm的淋巴结MGC较NGC更易发生阳性转移,对术前趋向于MGC的淋巴结观察要十分仔细,不能忽略≤10mm的淋巴结阳性转移率。肿瘤大小、大体病理类型、强化方式等CT征象有助于MGC的术前诊断。     

CT征象及能谱定量参数Nomogram模型鉴别直肠癌肠周脂肪癌性浸润与炎性浸润

【摘要】目的：联合CT征象及能谱定量参数建立基于Logistic回归的Nomogram预测模型鉴别有浸润征象的直肠癌肠周脂肪是癌性浸润还是炎性浸润。方法：搜集能谱增强CT检查肠周脂肪具有浸润征象的直肠癌患者62例,根据病理结果分为癌性浸润组32例,炎性浸润组30例。比较两组CT征象及能谱参数的差异,筛选鉴别诊断意义较大的特征建立Logistic回归模型,绘制Nomogram、ROC曲线图及校准曲线图。结果：鉴别意义较大的特征为肠周淋巴结增大（短径≥5mm）、动脉期水浓度差（Water差）和有效原子序数（Effective-Z）、静脉期Water差和碘浓度差（Iodine差）、延迟期Water差和标准化碘浓度差（NIC差）。上述七个特征纳入多因素Logistic回归模型绘制Nomogram,模型符合率为95.2%,ROC曲线下面积（AUC）为0.986,预测能力校准曲线示预测浸润和实际浸润一致性较高。结论：基于CT征象及能谱CT定量参数建立Nomogram预测模型在鉴别有浸润征象的直肠癌肠周脂肪是否伴随癌性浸润有重要价值。     

Computed tomography and ultrasonography of metastatic cervical lymph nodes in oral squamous cell carcinoma

OBJECTIVES: To define criteria for CT and US in differentiating cervical lymph node metastases in oral squamous cell carcinoma (SCC). MATERIALS AND METHODS: CT and/or US of 230 metastatic lymph nodes and 228 benign lymph nodes in 147 patients with oral SCC were retrospectively evaluated. The CT and US findings of each lymph node were compared with the histopathological findings. A metastasis was defined on CT as a lymph node with rim or heterogeneous enhancement, or measuring 10 mm or more in the short axis, regardless of enhancement pattern, and on US as having definite internal echoes, regardless of size, or without definite internal or hilar echoes, but measuring 10 mm or more in the short axis. A lymph node with hilar echoes or a ratio of the long to short axis (L/S ratio) of 3.5 or more was considered benign. A lymph node failing to comform to any of these categories was termed questionable. RESULTS: The positive predictive value (PPV) for CT was 90.8% and the negative predictive value (NPV) was 70.4%. However, 65.7% of all lymph nodes could not be classified as either metastastic or benign. PPV for US was 96.5% and NPV was 88.1%. 25.5% of all lymph nodes could not be classified as either metastatic or benign. CONCLUSIONS: Despite limitations in detecting metastases, by including a third category 'questionable' our criteria appear clinically more useful than other current methods based on two groups only.     

直肠癌术前CT扫描的价值

目的：评估直肠癌术前ＣＴ扫描的价值。材料与方法：１０４例直肠癌（Ｔ２期１１例、Ｔ３期９０例、Ｔ４期３例）的ＣＴ扫描与手术病理这缘改变、浸润周径、淋巴结大小对Ｔ、Ｎ分期的价值。结果：以肿瘤石头居齿状和结节改变作为Ｔ３的诊断指标,其准确率分别为９４．０％、９０．４％、８８．４％;Ｔ分期的准确率是８９．４％,Ｔ３的准确率是９４．０％。将肿瘤侵犯肠管周径〉１／２与≤１／２作为Ｔ３期的诊断指标,有显著统计学     

Preoperative locoregional staging of rectal carcinoma: comparison of MR, TRUS and Multislice CT. Personal experience

PURPOSE: The aim of this study was to measure the sensitivity and clinical indications of Magnetic Resonance (MR) as compared to Transrectal Ultrasonography (TRUS) and spiral Computed Tomography (CT) in the preoperative staging and evaluation of rectal carcinoma. MATERIALS AND METHODS: Twenty patients with histologically proven rectal carcinoma were examined with phased-array coil MRI. We used T1 and T2, spin-echo, turbo-spin-echo, flash2D sequences with and without fat suppression; FOV 180-280; 4-6 mm slice thickness; i.v. Gadolinium. The MR images were compared with TRUS, spiral CT and with the final histological diagnosis. RESULTS: MR showed a 92.3% sensitivity for rectal wall infiltration vs. 100% of TRUS and 75% of CT. The sensitivity for lymph node metastases was 76.4% vs. 72.2% for TRUS and 88% for CT. CONCLUSIONS: Locoregional staging of rectal cancer by MRI shows a high sensitivity and is also feasible in stenosing or proximal rectal lesions. TRUS, despite its limitations, is still the most sensitive method for the evaluation of wall infiltration. CT was less sensitive than the other two METHODS: The sensitivity of MR and CT for lymph node metastases is comparable, but the former is more specific.     

CT三期增强扫描对胃癌淋巴结转移的诊断价值

目的:评价螺旋CT三期增强扫描对胃癌淋巴结转移的诊断价值,探讨转移淋巴结的CT三期增强扫描特征。方法:对73例进展期胃癌患者行CT平扫及三期动态增强扫描,并与手术病理结果对照。结果:转移淋巴结的主要CT征象:较小转移淋巴结以实性为主,随直径增大呈环状、囊状改变者增加;强化类型分为实性均匀强化,环带样强化和囊状不强化;强化峰值时间不同,以动脉期达强化峰值者多见。CT三期增强扫描诊断胃癌淋巴结转移的诊断符合率为86.3%,敏感度为86.2%,特异度为86.7%。CT三期增强扫描对转移淋巴结的检出率及诊断准确性高于CT平扫,二者间差异有显著性意义(P<0.05)。结论:CT三期增强扫描可进一步提高对胃癌淋巴结转移的诊断准确性,对术前全面评价淋巴结转移状况有重要临床价值。     

Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma

OBJECTIVE: This study compares dynamic helical CT with dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. SUBJECTS AND METHODS: Women with biopsy-proven cervical carcinoma prospectively underwent dynamic helical CT and MR imaging before surgery. A metastatic node on CT and MR imaging was defined as a rounded soft-tissue structure greater than 10 mm in maximal axial diameter or a node with central necrosis. Imaging results were compared with pathology, and receiver operating characteristic curves for size and shape were plotted on a hemipelvis basis. Nodal density and signal intensity on CT and MR images, respectively, were reviewed for differences between benign and malignant disease. RESULTS: A total of 949 lymph nodes were found at pathology in 76 hemipelves in 43 women, of which 69 lymph nodes (7%) in 17 hemipelves (22%) were metastatic. Sensitivity, specificity, positive and negative predictive values, and accuracy of helical CT and MR imaging in the diagnosis of lymph node metastasis on a hemipelvis basis was 64.7%, 96.6%, 84.6%, 90.5%, and 89.5% and 70.6%, 89.8%, 66. 7%, 91.4%, and 85.5%, respectively. Receiver operating characteristic curves for helical CT and MR imaging gave cutoff values of 9 and 12 mm in maximal axial diameter, respectively, in the prediction of metastasis. Central necrosis had a positive predictive value of 100% in the diagnosis of metastasis. Signal intensity on MR imaging and density-enhancement pattern on CT in patients with metastatic nodes did not differ from those in patients with negative nodes. CONCLUSION: Helical CT and MR imaging show similar accuracy in the evaluation of pelvic lymph nodes in patients with cervical carcinoma. Central necrosis is useful in the diagnosis of metastasis in pelvic lymph nodes in cervical cancer.     

直肠癌CT诊断与分期

目的:评价CT在诊断和直肠癌分期的价值。材料和方法:回顾性分析150例经手术病理证实的直肠癌的CT表现,评价其CT诊断和分期的价值。结果:直肠癌CT的主要表现包括肠壁增厚50例、软组织肿块61例和肠腔狭窄49例;与手术病理对照,CT显示病灶、周围组织侵犯和淋巴结转移的准确性分别为96.7%(145/150)、88.4%(84/95)和51.7%(15/29);CT分期与Dukes分期的总符合率为83.3%。结论:直肠癌的CT诊断和分期与手术病理分期有很好的一致性,CT是直肠癌术前诊断的重要影像检查方法。     

直肠癌的CT表现及其对术前分期的意义

目的分析直肠癌的CT特征,并评价其诊断意义。方法回顾性分析经手术、病理证实的18例直肠癌病例的临床与CT资料,并依据CT表现对18例直肠癌病变进行了术前CT分期。结果直肠癌的CT表现主要为肠壁增厚,肠腔内肿块,肠腔狭窄,肠周浸润,淋巴结转移。术前CT正确分期15例（83.3%）。结论直肠癌术前CT检查对病变的严重程度的判断,设计合理的治疗和手术计划以及预后的估计具有很高的临床应用价值。     

The role of CT in the staging and radiotherapy planning of prostatic tumours

Fifty patients with proven carcinoma of the prostate have been evaluated with CT. The CT studies were carried out for staging and radiotherapy planning and the findings compared with rectal examination and lymphography. CT provided useful additional information to that obtained by rectal examination in 40% of patients and these findings had important implications for radiotherapy planning. There was good correlation between CT and lymphography in the assessment of pelvic lymph node involvement.