胸壁结核的超声影像表现及其临床应用价值

目的:探讨胸壁结核的影像学表现及其临床应用价值。方法:回顾分析64例胸壁结核的超声影像图。结果:胸壁结核的影像学表现主要为实性低回声型、液性暗区型、混合回声型,部分伴窦道形成,其较具特征性改变是图像呈"哑铃"形。结论:胸壁结核超声图像有其特征,超声检查可确定病变的范围、性质,是术前常规检查,对诊断及治疗均有重要的临床价值。     

彩色多普勒超声诊断葡萄胎的临床价值分析

目的探讨葡萄胎的超声影像特征及其临床诊断价值。方法对21例葡萄胎患者采用彩色多普勒超声检查和手术病理结果进行对比分析。结果本组21例患者均经手术病理确诊,超声确诊19例,其诊断符合率为90.48%;其中良性18例,恶性1例。其声像图表现特征较明显:子宫异常增大,与孕龄明显不符,明显大于停经月份,子宫腔内无正常胚胎及卵黄囊结构,其内充满蜂窝状、小圆形液性暗区,为大量大小不等,形态不规则的小囊取代;或因出血宫腔一侧出现片状、不规则液性暗区或云雾状低回声区;小囊腔边界清晰,囊壁菲薄呈高回声,有形容为落雪状回声,超声误诊2例均为不全流产。结论彩色多普勒超声诊断葡萄胎具有较高特异性,但遇到不典型的声像图往往给诊断带来困难引起误诊,需结合临床血HCG水平进行综合诊断。     

不典型肝脓肿超声诊断的应用(附32例分析)

目的:探讨不典型肝脓肿的超声表现及超声诊断技术临床应用价值。方法:回顾性分析32例不典型肝脓肿的超声表现,其中3例超声造影检查。全部病例经临床随访及穿刺活检后经病理证实。结果:不典型肝脓肿随病理过程的变化超声表现各不相同,可表现为实性低回声、等回声及偏高回声,与周围肝组织分界不清,内回声强弱不等,分布极不均匀,可见形态不规则的小片状液区。部分病灶内可见正常肝内门脉血管穿行。注射对比剂后整个过程病灶内部未见增强,均呈低回声,病灶边界较造影前清晰。结论:不典型肝脓肿声像图复杂多变,超声检查仍为可靠方法,超声造影更具诊断意义。     

超声检查对肉芽肿性小叶性乳腺炎和乳腺浸润性导管癌的鉴别诊断价值

目的 探讨超声检查在肉芽肿性小叶性乳腺炎（granulomatous lobular mastitis,GLM）和乳腺浸润性导管癌（invasive ductal carcinoma, IDC）鉴别诊断中的价值。方法 选取48例GLM与89例IDC患者的彩色多普勒超声资料，并与病理结果进行对照分析。结果 GLM组病灶的边缘毛刺或蟹足征、微小钙化、后方回声衰减的检出率低于IDC，差异有统计学意义（P<0.05），伴液性无回声和周边高回声晕的检出率高于IDC，差异有统计学意义（P<0.05）。两组病灶在伴腋窝淋巴结肿大和血流分级上差异无统计学意义（P>0.05）。结论 GLM声像图表现具有一定特征性，伴液性无回声及周边高回声晕的超声检查征象与IDC有所不同。故超声检查对GLM和IDC的鉴别诊断有价值。     

超声检查诊断肾癌的临床应用价值(附60例分析)

目的:评价超声检查肾癌的表现及声像图特征,提高超声检查对肾癌的诊断水平。方法:对60例经手术和病理证实的肾癌术前超声诊断和临床资料进行对比分析。结果:肾癌超声检查的声像图表现为多样性,60例中以不均质中低回声病灶最多见,共42例,占70%;混合性回声病灶12例,占20%;囊性病灶6例,占10%。超声诊断符合率95%。结论:超声检查对肾癌具有较高的诊断价值,超声科医生应对肾癌声像图全面掌握,以提高对肾癌术前诊断正确率,减少误诊率的发生。     

膝关节周围囊肿的超声诊断

目的评价超声检查对膝关节周围囊肿的诊断价值。方法对186例经活检或手术证实为膝关节周围囊肿的超声表现进行了回顾性分析。结果超声显示多数囊肿呈不规则形状,少数囊肿为圆形及椭圆形。囊肿的大小介于0.8cm×0.5cm×0.4cm~18.0cm×4.0cm×0.25cm之间。在声像图上,143例（76.9%）为无回声液性暗区,31例（16.7%）为液性暗区,内有低回声或中等回声结构,8例（4.3%）为不均质低回声区,4例（2.1%）为均匀的低回声区。囊肿的部位包括窝囊肿118例（63.4%）,半月板囊肿24例（12.9%）,髌下滑囊囊肿8例（4.3%）,膝关节内侧滑囊囊肿25例（13.4%）,以及膝关节外侧滑囊囊肿11例（5.9%）。本组患者超声诊断膝关节周围囊肿的准确率为100%。结论超声检查能清晰显示膝关节周围囊肿的形状、大小、部位、以及声像特征,因而能为临床确诊和正确治疗提供可靠依据。     

乳腺导管原位癌及其微浸润的磁共振成像评价

目的与X线片、超声检查比较，评价MPd对乳腺导管原位癌及其微浸润诊断的正确率和界定病灶范围的准确性。方法经手术病理证实、术前行乳腺MR检查的乳腺导管原位癌及导管原位癌伴微浸润连续病例17例，其中13例同时行X线检查、16例行超声检查。以病理资料作为金标准，作对照分析。结果（1）MR检查14例病灶有强化，11例表现为非块状强化，其中6例呈段样强化，2例呈区域性强化，导管样强化、多灶性局灶性强化、双乳大致对称的弥漫性强化各1例。这11例中有2例伴病变侧增强前的乳头后大导管扩张，其中1例增强后大导管强化，这2例均以乳头滴血为临床症状。2例块样强化表现为信号均匀、形态不规则的肿块。混合有肿块和非块样强化的1例，为信号均匀、边缘光整的卵圆形肿块伴肿块周围线样强化。（2）13例行X线检查，2例阴性；单纯钙化表现6例；钙化伴其他征象2例；非钙化病灶3例。8例含钙化的病灶中，恶性钙化5例，交界性钙化3例；钙化簇状分布5例，区域性分布2例，弥漫分布1例。（3）16例行超声检查，4例阴性，1例诊为良性病变，其余11例作出了正确的术前诊断，表现为不规则的低回声区内伴有点状的强回声改变。（4）以病理检查测量的大小作为金标准，对病灶范围界定方面MRI符合13例（13／17），高估2例；X线诊断符合7例（7／13），高估3例，低估1例；超声符合7例（7／16），高估2例，低估3例。差异无统计学意义（P=0．161）。结论乳腺导管原位癌及原位癌伴微浸润MRI表现具有特征性，联合X线和MR检查能提高其正确诊断。     

腮腺基底细胞腺瘤的CT和超声表现

目的：探讨腮腺基底细胞腺瘤的临床与CT、超声表现特点。方法回顾性分析18例经手术病理学证实的腮腺基底细胞腺瘤患者。全部病例均行CT平扫,8例进一步行增强扫描;14例行超声检查。分析患者性别、年龄、病程、临床表现及病灶数目、部位、大小、形态、密度与增强特征（CT）、内部回声与血流分布情况（超声）。结果18例患者,共19个病灶,其中仅1例单侧2个病灶;病灶大小约6-31mm,平均为（19．1±6．5）mm。18个病灶位于腮腺浅叶,其中表浅区与深部各9个,最大径平均值分别为（17．2±5．2）mm、（23．0±5．4）mm;1个病灶位于深叶,最大径26mm;6个病灶强化显著,3个病灶轻度强化。13个病灶声像图上见后方回声增强,各6个病灶内见液性暗区与血流信号。结论基底细胞腺瘤的CT与声像图有一定特征性,结合临床特点对于肿瘤的定性诊断有很大帮助;超声较CT平扫更能显示病灶的轮廓及内部囊变区。     

乳腺神经内分泌肿瘤的超声表现与病理对照分析

目的 探讨乳腺神经内分泌肿瘤(NEN)的超声检查声像图表现，并与病理结果对照分析，以提高其认识和诊断符合率。方法 选取本院经超声检查与病理证实为NEN患者25例，分析其术前超声图像、病理及临床资料，对照病理表现总结其超声图像特征。结果 25例患者病灶中，右侧乳腺16例，左侧乳腺9例，单发病灶20例，一侧多发病灶5例。超声表现形态不规则22例，圆形或椭圆形3例；边界不清14例，边界清晰11例；边缘呈分叶状16例，毛刺蟹足样6例，规整3例；内部呈混合回声13例，低回声12例；后方回声无变化16例，后方回声增强8例，后方回声衰减1例；肿瘤内部可见钙化4例；术前提示腋窝淋巴结肿大10例，病理证实为淋巴结转移9例(1例术前同时伴有肋骨、肺、颅内转移),1例病理阴性，另有1例超声检查未发现转移淋巴结，病理诊断腋窝淋巴结存在微转移；CDFI显示病灶内0～Ⅰ级血流16例，Ⅱ～Ⅲ级9例。结论 乳腺NEN多表现为混合回声或实性低回声团块，形态多不规则，边界清晰或不清，边缘不规整，CDFI可见有血流显示。超声检查结合临床资料及病理对照分析，可以提高其诊断率，为临床确定治疗方案提供参考价值。     

急性睾丸疾病的超声诊断与鉴别诊断

目的:探讨超声诊断和鉴别诊断急性睾丸疾病的价值.材料和方法:回顾性分析78例急性睾丸疾病患者的睾丸超声表现,并与临床、手术及病理结果进行对照分析. 结果:12例睾丸肿瘤瘤体较大,内部回声杂乱不均匀,病灶区血管走行不规则或呈"树枝状"分布,5例伴有钙化灶;26例睾丸外伤阴囊壁水肿增厚,病变部位回声减弱并与液性暗区混杂分布,彩色血流减少,周围组织彩色血流增强;21例急性睾丸炎患侧睾丸肿大,实质血流分布异常丰富呈五彩镶嵌的"彩球样"; 18例睾丸扭转患侧睾丸血流明显少于健侧或血流消失;1例睾丸结核病侧睾丸回声极不均匀,多种回声混杂分布. 结论:超声能够对各种急性睾丸疾病做出快速、准确的诊断和鉴别诊断.     

胆囊十二指肠瘘的超声诊断

目的评价超声对胆囊十二指肠瘘的诊断价值。方法5例经手术证实为胆囊十二指肠瘘患者均经腹部超声检查。回顾性分析了全部病例的超声表现。结果超声显示5例的胆囊壁结构模糊,体积缩小,胆总管与肝内胆管内有不稳定闪烁状强回声反射。超声显示胆囊结石大小为1.0～7.0cm,其中,3例胆囊区见弧形强回声反射后伴声影,另2例胆囊内小结石声像图不典型。上消化道梗阻及胃潴留见于4例。结论超声诊断胆囊十二指肠瘘安全,无创,且有高的敏感性,可用于术前评价。     

Multifocal musculoskeletal tuberculosis in children: appearances on computed tomography

PURPOSE AND PATIENTS: The incidence of skeletal tuberculosis (TB), which once accounted for a majority of cases of extrapulmonary tuberculosis, has fallen significantly in recent years with the advent of effective drug therapy. Disseminated bone involvement in TB is very uncommon but it may still occur in countries where TB is endemic. We present the imaging findings of four children ranging in age from 2 to13 years, each of whom had multiple osseous stigmata of tuberculous infection. They presented to us over a period of 9 months. RESULTS AND CONCLUSION: Three of four children had calvarial lesions, with involvement of the bony orbit in one, and large abscesses were present in the chest wall and the mediastinum of another. Lesions along the dorsal spine were demonstrated in three cases, two of which showed epidural extensions. Bone lesions in the thoracic cage accompanying those in the spine were also seen in two children, one of whom had a solitary destructive focus in a rib distant from the site of vertebral involvement. Bone lesions involving the first metacarpal in one case and the scapular wing in two others are also described. The diagnosis in each of the cases was confirmed by the identification of epitheloid giant cells and caseous necrosis or tubercle bacilli in fine needle aspirates or on tissue culture studies.     

胸壁病变的计算机X线摄影和CT检查

目的：探讨胸壁病变的计算机Ｘ线摄影（ＣＲ）和ＣＴ表现及其诊断价值,提高对胸壁病变的认识。材料和方法：回顾分析经手术病理、穿刺细胞学检查或临床随访资料证实的３９例ＣＲ和ＣＴ资料。结果：感染组１２例中（包括化脓性感染４例,胸壁结核８例）,ＣＲ准确诊断４例,ＣＴ诊断１１例;软组织肿瘤组１６例中（包括脂肪瘤７例,纤维肉瘤４例,血管瘤、神经纤维瘤、恶性纤维组织细胞瘤、侵袭性纤维瘤病和脂肪肉瘤各１例）,ＣＲ准确诊断３例,ＣＴ诊断１４例;骨肿瘤和肿瘤样病变组１１例中（包括骨纤维异常增殖症７例,软骨瘤２例,多发性骨髓瘤和骨嗜酸性肉芽肿各１例）,ＣＲ准确诊断８例,ＣＴ诊断１０例。结论：ＣＲ简便,能诊断大多数胸壁骨性病变。ＣＴ对各种胸壁病变尤其是软组织病变的诊断较ＣＲ明显优越,对鉴别胸壁肿瘤的良恶性有肯定作用,但仍有一定限制。     

获得性免疫缺陷综合征相关消化道病变的影像学表现

目的：初步探讨艾滋病（AIDs）相关消化道病变的影像学表现。方法：回顾性分析11例AIDS相关消化道病变的影像学表现。行胸部平片检查11例,胸部CT扫描4例,腹部CT扫描9例,盆腔CT扫描2例,盆腔MRI检查1例,消化道内窥镜检查9例。结果：11例中消化道穿孔3例（食管穿孔2例,胃穿孔1例）、肠结核2例、巨细胞性肠炎1例、淋巴瘤4例、胃腺癌1例。食管穿孔的主要影像表现为食管一纵隔瘘伴纵隔淋巴结结核及双肺结核;胃穿孔主要表现为胃瘘伴肝左叶及肝胃间隙脓肿;肠结核主要表现为回盲部肠壁增厚;巨细胞性肠炎主要表现为乙状结肠末段及直肠管壁向心性增厚;淋巴瘤主要表现为受累消化道管壁肿块状增厚,肠腔狭窄或扩张,多伴溃疡及病变周围淋巴结增大;胃腺癌主要表现为胃壁增厚、僵硬及明显强化。结论：AIDS相关消化道病变可表现为多种机会性感染和恶性肿瘤,影像学检查对这些病变的诊断具有重要作用。     

气管-支气管结核的胸部X线与CT诊断

目的 了解气管-支气管结核的胸部X线与CT征象及其诊断价值。方法 36例气管-支气管结核患，其中临床证实16例，手术病理证实20例，均经胸部X线与CT检查，对全部患的胸部X线与CT表现进行了回顾性分析。结果 36例患中，胸部X线显示肺段叶及全肺不张12例，两肺结核性病灶18例，其中有陈旧性结核灶，粟粒播散灶，浸润灶及肺门淋巴结肿大。病变支气管表现有完全性支气管阻塞10例，支气管肺内结节状突起5例；胸部CT扫描显示支气管管腔变窄伴管壁增厚25例，管腔表面凹凸不平5例。管腔内有结节状突起6例，纵隔淋巴结肿大及钙化15例。结论 对气管-支气管结核的胸部X线与CT表现进行综合分析。大大有助于提高其诊断准确性。     

Utility of CT scan for the diagnosis of chest wall tuberculosis

The objective of this study was to determine the utility of CT scan findings for the diagnosis of chest wall tuberculosis, excluding the spine. We reviewed 15 patients (13 Africans and 2 Indians) with chest wall tuberculosis, retrospectively. The radiologic examination consisted of a plain X-ray and a CT scan of the chest for each patient. The site of disease was the rib in 13 patients or the body of the sternum in 2 patients. One rib was involved in 11 patients, 2 contiguous ribs (one site) in 2 patients, and bilateral disease (two sites) was observed in the remaining patient. The 14 rib sites involved the posterior arc or costovertebral joint in 11 cases, the anterior arc in 2 cases, and the anterior and middle arc in 1 case. The CT scan findings were an abscess (n = 14) or a soft tissue mass (n = 2), osteolytic lesions (n = 13), periosteal reaction (n = 10), and sequestrum (n = 14). Bone sclerosis was observed only in 3 cases of rib involvement. The association of a soft tissue abscess, an osteolytic lesion, and sequestrum, especially in immigrants to France, suggests chest wall tuberculosis on CT scan. Received: 22 October 1998; Revision received: 11 January 1999; Accepted: 8 February 1999     

Ultrasound in the diagnosis of the juxta-pleural lesion

Any opacity on a chest radiograph has a wide differential diagnosis. Plain radiography and computed tomography may help to differentiate whether bone, intercostal soft tissue or mediastinum are involved. Bronchoscopy is often negative with peripheral lesions. This leaves the physician with a diagnostic problem. We examined ultrasonically 30 patients with juxta-pleural lesions and performed cutting biopsy in 27. Twenty-four of these produced positive histology (90%). The three that were not biopsied were anechoic and had pulsatile lesions due to vascular abnormalities. There were four benign lesions all with hypoechoic appearances and the 20 malignant cases showed a wide spectrum of echogenicity. Of the malignant lesions, 90% showed pleural line disruption with reduced respiratory movement suggesting chest wall invasion. There were no complications, despite using cutting biopsy.     

Benign fibrous mesothelioma of the pleura: MR study and pathologic correlation

Benign fibrous mesothelioma of the pleura is a rare tumor of mesodermal origin. We describe the MR findings in three pathologically proven cases. All three tumors were imaged by MR as well-circumscribed lesions with smooth margins in contact with the pleura, but without chest wall invasion. Their low signal intensity on T1-and T2-weighted sequences reflect their fibrous nature. In one case a pedicle connecting the tumor to the chest wall was visualized on a sagittal MR scan. In two cases gadolinium-enhanced T1-weighted gradient echo sequences revealed intense contrast uptake by the tumor correlated with the intratumoral hypervascularization noted by histologic examination. Although the number of cases presented is small, MR seems to be the most accurate imaging modality in the assessment of the diagnosis. Correspondence to: B. Padovani     

Soft tissue tumours and mass-like lesions of the chest wall: a pictorial review of CT and MR findings

Soft tissue tumours and tumour-like lesions of the chest wall are uncommon. The purpose of this pictorial essay is to describe the imaging findings of chest wall soft tissue tumours and tumour-like lesions. We searched the radiological and pathological archive at our institution retrospectively and reviewed the literature on soft tissue tumours of the chest wall. Common chest wall soft tissue tumours and mass-like lesions include peripheral nerve tumours, lipomas, liposarcomas, haemangiomas, elastofibromas, metastases, lymphoma and abscesses. Other lesions encountered include desmoid tumours and malignant fibrous histiocytoma. Many have distinctive radiological findings or occur in specific locations, allowing a specific radiological diagnosis to be suggested.