腹腔空腔脏器穿孔的螺旋CT诊断价值

目的：在急腹症空腔脏器穿孔中探讨螺旋CT对早期定性诊断及定位诊断的意义。方法分析行CT检查并经手术确诊的腹腔空腔脏器穿孔28例患者的CT表现。结果胃、十二指肠穿孔15例,其中外伤穿孔2例,小肠及结肠穿孔13例,溃疡穿孔13例,外伤所致7例,阑尾炎所致6例。 CT显示腹腔内不同位置、形态的游离气体。结论根据游离气体分布特点,螺旋CT可及时准确的做出定性及定位诊断,空腔脏器穿孔患者早期行CT检查是必需的。     

腹盆部淋巴结少见病变CT诊断（附4例报告）

腹盆部淋巴结少见病变ＣＴ诊断（附４例报告）岳丹萍＊张忠嘉我院近１０余年ＣＴ检查发现４例少见的腹盆部淋巴结病变，均经手术及／或病理证实。现报告如下。１病例介绍例１女，２４岁。间断性右上腹胀痛１年。体检右上腹深压痛，未及包块。Ｂ超检查肝右前叶近肝门区可见...     

腹部空腔脏器创伤的CT检查技术和诊断

腹部空腔脏器的创伤不管用何种影像检查方法均较难显示其直接的创口，多凭间接征象和临床表现来判断。间接征象的显示以前多为腹部平片及B超。介绍了近期献中CT对腹部空腔脏器的诊断和应用技术要点。     

钝性腹部空腔脏器及肠系膜损伤的 CT 诊断

目的：通过对照分析腹部钝性空腔脏器及肠系膜损伤患者术中发现及术前CT征象,寻找判断空腔脏器及肠系膜损伤的特征性CT表现,以助于提高诊断率。方法回顾性分析2011～2013年我院100例钝性腹部创伤患者,其中男性82例,女性18例;年龄11个月～77岁,平均37岁。将其分为A、B两组,A组为经手术证实的有钝性肠道及肠系膜损伤患者（50例）,B组为经手术证实的只有钝性实质性脏器损伤而没有空腔脏器及肠系膜损伤患者（50例）,分析两组中与空腔脏器及肠系膜损伤相关的CT征象,采用单因素分析方法,进一步得出有助于判断是否有空腔脏器及肠系膜损伤的CT征象。结果通过分析发现具有统计学意义的征象有：腹腔或腹膜后积气（P＜0.01,敏感度50％,特异度98％）,肠管壁增厚（P＜0.01,敏感度40％,特异度98％）,系膜增厚（P＜0.01,敏感度42％,特异度88％）,系膜密度增高（P＜0.05,敏感度16％,特异度98％）,腹腔脂肪间隙密度增高模糊（P＜0.05,敏感度18％,特异度96％）,腹膜增厚（P＜0.05,敏感度26％,特异度90％）。结论通过分析发现腹腔或腹膜后积气、肠管壁增厚、系膜增厚、系膜密度增高、腹腔脂肪间隙密度增高模糊等征象有助于判断空腔脏器及肠系膜损伤。     

腹部空腔脏器破裂穿孔的螺旋CT诊断价值

目的：探讨螺旋CT在腹部空腔脏器穿孔中的诊断价值。方法：回顾性分析经手术证实的15例腹部空腔脏器穿孔病例的CT表现。结果：胃十二指肠溃疡穿孔7例,腹部外伤致空回肠穿孔4例,肠结核穿孔、异物（硬鱼骨）致乙状结肠穿孔、粪块性乙状结肠穿孔及子宫积脓自发穿孔各1例,15例腹部空腔脏器穿孔的主要CT征象为剑突下隐窝积气（13例）、肝下肝圆韧带间隙积气（9例）、网膜囊积气（4例）、穿孔脏器周围局限性积气（11例）、腹膜后间隙积气（1例）、腹腔积液（11例）以及肠壁增厚（3例）等。CT可直观地显示脏器穿孔破裂口、异物等,准确地判断腹腔游离气体的有无、部位和多少,并能为穿孔部位、病因、合并症的诊断提供较多有价值的信息。结论：螺旋CT可较准确地诊断腹部空腔脏器穿孔,可作为腹部X线平片的重要补充。     

螺旋CT对腹部空腔脏器穿孔的诊断价值

目的探讨螺旋CT在腹部空腔脏器穿孔中的诊断价值。方法回顾性分析18例腹部空腔脏器穿孔的CT表现,所有病例经临床及手术证实。结果胃、十二指肠穿孔6例,空回肠穿孔6例,结肠穿孔4例,子宫积脓自发穿孔1例,膀胱自发性破裂1例。主要CT征象有：肝上间隙积气（14例）、肝下间隙积气（8例）、肝圆韧带裂隙积气（4例）、穿孔脏器局部积气（17例）、腹腔积液（13例）、肠壁局限性增厚（9例）。结论 CT可直观地显示腹膜腔、腹膜后腔游离气体,为临床提供及时准确的诊断,并可为明确穿孔部位、病因、合并症提供较多有价值的诊断信息。     

腹盆部促纤维组织增生性小圆细胞瘤的CT表现

目的探讨腹盆部促纤维组织增生性小圆细胞瘤(desmoplastic small round cell tumor,DSRCT)的影像表现,以提高对该肿瘤的认识及诊断水平。方法对6例经手术、活检病理证实的腹盆部DSRCT的影像表现进行回顾性分析。结果 6例CT表现为单个或多个较大肿瘤内可见坏死、囊变区,6例均可见多少不等钙化灶;增强扫描3例肿瘤实质部分呈轻至中度强化,3例明显强化,可见多发条状明显强化血管影。结论腹盆部DSRCT的CT表现有一定特征性,当青少年患者腹盆部出现多发大小不等肿块,内密度多不均匀,增强扫描肿瘤呈轻至中度强化,可提示DSRCT的诊断,确诊仍需进行病理及免疫组织化学检查。     

乳头型壶腹癌螺旋CT双期增强的表现

目的 了解螺旋CT双期增强扫描显示乳头型壶腹癌的CT表现。方法 回顾性分析15例手术病理证实的乳头型壶腹癌的CT表现,螺旋CT采用薄层双期（动脉和门脉）增强扫描,动脉期扫描采用层厚5mm,螺距1．0;门脉期扫描层厚和间隔均为5mm。结果 螺旋CT动脉和门脉增强扫描,15例均清晰显示十二指肠乳头部局限性强化的充盈缺损块影,肿瘤瘤径为1－5cm,平均2．3cm。所有病例均可见虢人胆管扩张、胆囊增大、胆总管扩张和胰腺管的扩张,仅有1例伴胰体尾部的明显萎缩。结论 螺旋CT双期增强扫描不仅能准确确定梗阻的平面,还能显示十一指肠乳头部过来腹癌强化的肿块影,这对诊断乳头型壶腹癌是关键的CT征像。     

肾综合征出血热多脏器损害的螺旋CT诊断

目的:探讨肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)伴发肾脏、肺、肝及心脏病变的螺旋CT表现,提高其诊断准确性.材料和方法:回顾性分析97例经临床确诊的HFRS合并肾脏、肺、肝及心脏病变的螺旋CT表现,其中轻型9例、中型48例、重型22例、危重型7例和非典型型11例.结果:56例表现为双肾肿胀、肾破裂出血9例、肾周炎性改变51例、肺部感染45例、肺泡内出血7例和肺水肿3例,胸腔积液63例,心包积液10例,脂肪肝9例.结论:HFRS伴多脏器损害的CT表现较具特征性,CT检查为有效的影像筛查方法.     

Comparison of MR imaging after barium administration with CT in pelvic disease.

The use of magnetic resonance (MR) imaging for evaluating the abdomen and pelvis has been limited by the lack of a suitable contrast agent. The purpose of this study was to compare axial MR imaging after rectal barium administration with computed tomography (CT) for delineation of normal anatomy and lesions of the pelvis. MR images and CT scans of 11 patients were studied retrospectively and independently by four radiologists. No substantial differences in the visualization of normal bowel, iliac vessels, lymph nodes, bladder, prostate, seminal vesicles, uterus, and cervix and in detection of abnormalities were seen between CT scans and axial MR images obtained after barium administration. This preliminary study suggests that axial MR imaging with rectal barium is a useful alternative to CT in evaluating pelvic disease.     

CT of unusual renal masses invading the pelvicaliceal system: potential mimics of upper tract transitional cell carcinoma

Two patients with renal cell carcinoma and one patient with metastasis to the kidney from colorectal cancer are reported because all three cases manifested at computed tomography (CT) as a renal mass invading the pelvicaliceal system and radiologically simulating transitional cell carcinoma. Recognition that the CT finding of a renal mass with invasion of the pelvicaliceal system is not always indicative of a transitional cell carcinoma broadens the differential diagnosis in this setting and might potentially alter the diagnostic and therapeutic approach.     

CT fluoroscopy-assisted puncture of thoracic and abdominal masses: a randomized trial

PURPOSE: We investigated the benefit of real-time guidance of interventional punctures by means of computed tomography fluoroscopy (CTF) compared with the conventional sequential acquisition guidance. MATERIAL AND METHODS: In a prospective randomized trial, 75 patients underwent either CTF-guided (group A, n = 50) or sequential CT-guided (group B, n = 25) punctures of thoracic (n = 29) or abdominal (n = 46) masses. CTF was performed on the CT machine (Somatom Plus 4 Power, Siemens Corp., Forchheim, Germany) equipped with the C.A.R.E. Vision application (tube voltage 120 kV, tube current 50 mA, rotational time 0.75 s, slice thickness 10 mm, 8 frames/s). RESULTS: The average procedure time showed a statistically significant difference between the two study groups (group A: 564 s, group B 795 s, P = 0.0032). The mean total mAs was 7089 mAs for the CTF and 4856 mAs for the sequential image-guided intervention, respectively. The sensitivity was 71% specificity 100% positive predictive value 100% and negative predictive value 60% for the CTF-guided puncture, and 68, 100, 100 and 50% for sequential CT, respectively. CONCLUSION: CTF guidance realizes a time-saving but increases the radiation exposure dosage.     

原发性肝、胆、胰及胃癌的周围脏器及淋巴结转移的CT诊断

目的:分析本组原发性肝、胆、胰及胃癌的上腹部淋巴结转移的CT表现,提高CT对本组原发性肝、胆、胰及胃癌的上腹部淋巴结转移诊断重要性的认识。方法:回顾性分析67例经手术、病理证实的有上腹部转移的原发性肝、胆、胰及胃癌的CT表现。结果:原发性肝、胆、胰及胃癌的上腹部淋巴结转移及周围结构侵犯的CT征象,主要有上腹部淋巴结转移,邻近脏器的侵犯,血管、腹膜、种植转移及血道转移。结论:原发性肝、胆、胰及胃癌的上腹部淋巴结转移虽有相同的CT征象,但亦有各自的特点。     

Review of atypical pelvic masses on CT and MRI: expanding the differential diagnosis

Pelvic masses are increasingly evaluated by computed tomography and magnetic resonance imaging. Existing literature predominantly addresses common bladder, prostate, or gynecologic masses, with scant radiologic literature on less common pelvic masses. This article highlights the imaging features of some uncommon pelvic masses and emphasizes findings of particular diagnostic or clinical utility. Certain imaging findings can suggest specific diagnoses or can narrow the differential diagnosis.     

囊性肾癌的超声、CT及MR影像学诊断

囊性肾癌(cysticrenal cell carcinoma,CRCC)是肾癌的一种少见类型,在病理上肿瘤细胞核分裂和肿瘤分期均较低,预后较好。其临床表现缺乏特异性,超声、CT及MR影像学表现与一般肾癌不同。目前对于囊性肾癌的术前诊断,CT和MRI扫描仍为主要检查手段。囊液密度或信号、囊壁及分隔厚薄和附壁结节、钙化、病灶与肾组织分界、假包膜及增强扫描表现等是影像诊断中观察的重点。其CT、MRI表现具有一定特征,表现典型者可做出明确诊断。     

Radiography,abdominal CT and MRI compared with sacroiliac joint CT in diagnosis of structural sacroiliitis

ObjectiveTo assess the performance of pelvic plain radiograph (radiography), abdominal CT and sacroiliac joint MRI (MRI) compared with sacroiliac joints CT (SI joint CT) for the diagnosis of structural sacroiliitis in a population suffering from spondyloarthritis (SpA) meeting the New York or ASAS criteria.MethodsAll SpA patients eligible for biologic treatment who received a pre-therapeutic check-up including the four imaging techniques in the same year were selected from 2005 to 2012. An assessment of sacroiliitis was based independently by a rheumatologist and a radiologist on radiography according to the modified New York criteria and on abdominal CT, MRI and SI Joint CT depending on the presence of erosion on at least two consecutive slices. A final diagnosis was established for conflicting exams.ResultsOf the 58 selected patients, sacroiliitis was diagnosed on radiography, abdominal CT, MRI and SI Joint CT in 32, 26, 34 and 35 patients, respectively. Inter-reader agreements for the grade of sacroiliitis were substantial with a weighted Kappa that varied between 0.60 and 0.76 and they were moderate for the diagnosis of sacroiliitis with a Kappa that varied between 0.45 and 0.55 for the four imaging modalities. The sensitivities of radiography, abdominal CT and MRI were 82.8%, 71.4% and 85.7% respectively and the specificities were 86.9%, 100% and 82.6% respectively with excellent accuracy and positive predictive value and good negative predictive value.ConclusionThis study demonstrates the relevance of MRI and abdominal CT for the diagnosis of structural sacroiliitis with good sensitivities and excellent specificities. These imaging modalities may also contribute for the diagnosis of structural sacroiliitis.     

Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries Part 2: Gastrointestinal tract and retroperitoneal organs

Computed tomography plays an important role in the detection and management of blunt visceral injuries in adults. Current standard examination techniques enable detection of the majority of perforating or devascularizing bowel injuries, although diagnostic findings are often subtle and meticulous inspection is required. Computed tomography may demonstrate pancreatic contusions and lacerations and help in distinguishing minor traumatic lesions without involvement of the pancreatic duct (organ injury scale, grades I and II) from deep lacerations with ductal involvement (grades III and V). Computed tomography enables distinguishing renal contusions and minor cortical lacerations that can usually be managed conservatively (injuries of grades I–III) from corticomedullary lacerations and injuries of the major renal vessels (grades IV and V) that have a less favorable prognosis and more commonly require surgical repair. In addition, CT is well suited for the detection of active renal hemorrhage and guidance of transcatheter embolization treatment and delineation of preexisting benign or malignant pathologies that may predispose to posttraumatic hemorrhage. The radiologist's awareness of the diagnostic CT findings of abdominal visceral injuries as well as their clinical and surgical implications are important prerequisites for optimal patient management. Received 22 July 1997; Revision received 16 October 1997; Accepted 23 October 1997     

妇科恶性肿瘤术后盆腔淋巴囊肿的CT、MRI诊断

目的 研究盆腔淋巴囊肿的影像特征.方法 回顾性分析经穿刺化验及临床随访证实的51例共68个淋巴囊肿的CT及MRI临床及影像资料.结果 68个囊肿均位于盆腹膜外髂血管旁,其中95.6％(65/68)位于髂外血管周围.位于髂外血管前缘或后缘及髂内血管前缘的囊肿98.0％(51/52)呈卵圆形,且位于髂外血管前缘者33.3％(13/39)见“桃尖征”.骑跨髂外血管内侧缘或外侧缘的多呈葫芦形、哑铃形、肾形、U形联通管状.囊肿边缘光滑清晰,囊液为水样密度或信号.CT增强囊壁轻度强化,囊壁显示欠清;MRI增强囊壁及囊内分隔呈中等度强化,囊壁均匀光滑,囊内容物无强化.结论 CT及MRI能清晰显示盆腔淋巴囊肿分布特点、形态学特征、典型的密度、信号及强化表现,结合妇科恶性肿瘤手术病史可对盆腔淋巴囊肿做出正确诊断.