脾脏病变的CT及MRI诊断（附15例报告）

目的：报告１５例脾脏病变，分析其ＣＴ与ＭＲＩ表现及比较两者对脾脏病变的诊断价值。材料与方法：１５例中包括脾囊肿４例，脾血管瘤５例，脾包膜下血肿１例，脾淋巴瘤３例及脾梗塞、脾转移瘤各１例；应用ＣＴ检查９树，ＭＲＩ诊断６例。结果：分别对１５例脾脏病变从形态、ＣＴ密度或ＭＲＩ信号强度及增强情况等影像学表现进行了观察。结论：脾脏病变发生率虽不高，但种类很多，ＣＴ和ＭＲＩ对发现和明确脾脏病变的性质有重要价值。     

脾脏疾病的CT,MRI诊断

脾脏的大体及断面解剖。２ ．脾脏的先天变异（ 位置、形态及数目） 。３ ．脾感染性疾病：脾脓肿,脾结核及脾包虫病。ＣＴ、ＭＲＩ 均表现病灶中心为低密度液化坏死区,边缘可见环行强化。病灶多发及钙化有助于脾结核的诊断。４ ．脾脏的囊性病变：主要包括脾囊肿、脾内假性胰腺囊肿及脾包虫病。ＣＴ、ＭＲＩ 像呈液性密度或信号,边缘光整。鉴别诊断需结合临床病史及包虫皮试。５ ．脾良性肿瘤：主要包括脾血管瘤,脾错构瘤和淋巴管瘤。以脾血管瘤最多见,较特征性的影像学表现为ＣＴ 增强扫描病灶明显强化,ＭＲＩ Ｔ１ Ｗ 像呈低信号或等信号,Ｔ２ Ｗ 像呈高信号。６ ．脾脏恶性肿瘤：常见有恶性淋巴瘤和转移瘤。恶性淋巴瘤ＣＴ 表现为脾肿大,脾内多发或单发低密度灶,边缘不规整。脾转移瘤表现多种多样,病灶可单发或多发,实性或囊性。ＭＲＩ呈稍长Ｔ１ 、Ｔ２ 信号。７ ．脾梗塞：常见于脾血管血栓、癌栓栓塞及肿瘤组织的包埋。典型梗塞形状为尖端指向脾门、内小外大的锥形。ＣＴ 增强扫描为低密度灶。ＭＲＩ 呈稍长Ｔ１、长Ｔ２ 信号。８ ．脾外伤包括三种：ａ 完全性破裂;ｂ 脾中心破裂;ｃ 包膜下破裂。ＣＴ、ＭＲＩ 可显示脾损伤裂口,还可区分新鲜、陈旧出血及腹腔积液等。     

脾脏疾病的CT诊断

目的：提高对脾脏疾病ＣＴ诊断的认识。方法：复习２０例经手术和／或病理证实的脾脏病变的ＣＴ表现。结果：脾梗塞２例，脾囊肿４例，脾血管瘤２例，恶性淋巴瘤８例，转移瘤４例。结论：ＣＴ对脾脏病变的诊断具有较高的准确性，是发现脾脏病变的有效方法。     

急性坏死性胰腺炎的CT片象及其临床意义

目的：研究急性坏死性胰腺炎的ＣＴ表现和临床意义。材料和方法：回顾了早期（４８小时内）经ＣＴ检查并经多次ＣＴ随访的坏死性胰腺炎,临床和血尿淀粉酶均符合的５０例患者,平扫及团注法增强扫描,观察胰腺密度、体积、包膜改变,积液范围改变,特别注意了脾出血和脾血管受侵的危重征象。结果：急性坏死性胰腺炎早期ＣＴ图像均能做明确诊断。多部位胰腺坏死及积液超过２个部位以上的是产生并发症和临床预后较差的指征。结果 ：在     

急性胰腺炎致脾与脾周受累螺旋CT表现与临床的相关性

目的探讨急性胰腺炎(acute pancreatitis,AP)对脾和脾周受累的螺旋CT(Spiral CT,SCT)表现以及这些并发症与重症胰腺炎的临床相关性方法收集我院AP病人205例,观察AP对脾周积液、脾梗死、脾包膜下积液和脾血管受累SCT表现结果(1)脾周积液145例,其中重症AP65例;脾梗死7例,脾包膜下积液6例,脾静脉狭窄或受压23例,脾静脉栓塞4例;(2)无脾内假性囊肿或脓肿以及脾动脉瘤形成结论(1)重症AP常累及脾和脾周结构产生并发症,这些并发症与重症AP之间有临床相关性(P<0.05);(2)SCT可作为脾和脾周并发症的随访检查手段     

CT导引下介入治疗胰腺炎

目的：探讨ＣＴ导引下对急性坏死性胰腺炎并发的胰周积液,脓肿或假性囊肿行穿刺、抽吸及注入抗生素治疗的价值。方法：９例急性坏死性胰腺炎均在ＣＴ导引下行胰周积液（４例）、脓肿（３例）、假性囊肿（２例）穿刺、抽吸及注入抗生素治疗,最少治疗２次,最多４次。结果：８例获得较好疗效,１例因这肿与有肠道相通,经４次ＣＴ导引下介入治疗,病情稳定后转外科手术。随访６例,随访时间３￣１８个月,无１例复发。结论：ＣＴ导引     

脾脏良性病变CT诊断分析

脾脏良性病变ＣＴ诊断分析汤春发，姚茹国，王志华一、临床资料：本组１４例包括脾脏血管瘤７例；脾脏结核３例；脾脏囊肿并钙化１例；脾脏梗塞２例；脾脏出血机化１例。男６例，女８例，年龄２０～５６岁，平均４２．６岁。病程２０天至５年。主要表现为畏寒、间歇性发热...     

脾脏多发血管瘤影像学表现

例１男,４９岁。左上腹不适２月余,超声示脾内多发强回声病变。查体和实验室检查无阳性发现。ＭＲＩ检查：脾脏轻度增大,广泛分布２～５ ｍｍ左右病灶,无明显占位征,Ｔ１加权病灶与脾脏等信号,质子和Ｔ２加权为界线清晰的明亮高信号。切除脾脏示质软,表面光滑,色泽暗红,剖面见较多小的紫红色病灶,切开有出血。镜下示病灶由血池、血湖构成。病理诊断：脾脏血管瘤（弥漫性）。 例２男,４５。体检Ｂ超示脾脏占位就诊。ＣＴ检查：脾脏稍大,形态尚可,平扫见十余枚２０～４０ｍｍ大小的结节影,边缘欠清,质地较均,无钙化。增强扫描…     

胰腺炎脾脏并发症的研究进展

胰腺炎脾脏并发症最早由Ｍａｌｌｏｒｙ等[1] 报道 ,此后国内、外文献多为零星报道。综合国内外文献 ,胰腺炎脾脏并发症仅占胰腺炎的 1%～ 5% [2 ] 。虽然胰腺炎并发脾脏病变少见 ,但由于其多发生于重症胰腺炎病情加重或胰腺炎反复发作过程中 ,常常是胰腺炎病情严重危及生命及预后不良的征象之一[3] 。因此 ,正确认识这一并发症的特点和演变过程 ,对胰腺炎患者治疗的选择及预后的评估有着重要的价值。据Ｆｉｓｈｍａｎ[2 ] 和Ｒｙｐｅｎｓ等[3] 报道 ,胰腺炎脾脏并发症以脾梗死和脾包膜下积液多见 ,有时可见脾脏假性囊肿、脾脓肿、脾出血、…     

脾脏肿瘤的CT诊断

目的：探讨脾脏肿瘤的ＣＴ表现。材料与方法：搜集３０例经病理和临床证实的脾脏肿瘤的ＣＴ资料,包括脾原发恶性淋巴瘤４例,恶性淋巴瘤浸润３例,脾血管肉瘤１例,脾转移瘤１５例,脾淋巴管瘤３例,脾血管瘤３例,脾错构瘤１例。均作ＣＴ平扫及增强检查。结果：ＣＴ对脾脏肿瘤的发现率极高,对病变的大小、形态、密度及周围组织脏器的显示较其他影像学检查更准确。结论：ＣＴ对脾脏肿瘤有较高的诊断价值。     

Splenic and perisplenic involvement in acute pancreatitis: determination of prevalence and morphologic helical CT features

PURPOSE: The purpose of this work was to determine the prevalence and morphologic helical CT features of splenic and perisplenic involvement in patients with acute pancreatic inflammatory disease in correlation with the severity of the pancreatitis. METHOD: One hundred fifty-nine contrast-enhanced helical CT scans of 100 consecutive patients with acute pancreatitis were reviewed retrospectively and independently by three observers. CT scans were scored using the CT severity index (CTSI): Pancreatitis was graded as mild (0-2 points), moderate (3-6 points), and severe (7-10 points). Interobserver agreement for both the CTSI and the presence of splenic and perisplenic involvement was calculated (K statistic). Correlation between the prevalence of complications and the degree of pancreatitis was estimated using the Fisher exact test. RESULTS: The severity of pancreatitis was graded as mild (n = 59 scans), moderate (n = 82 scans), and severe (n = 18 scans). Splenic and perisplenic abnormalities detected included perisplenic inflammatory fluid collections (95 scans, 58 patients), narrowing of the splenic vein (35 scans, 25 patients), splenic vein thrombosis (31 scans, 19 patients), splenic infarction (10 scans, 7 patients), and subcapsular hemorrhage (2 scans, 2 patients). No cases of splenic artery pseudoaneurysm formation, intrasplenic venous thrombosis, intrasplenic pseudocysts, or abscesses were detected. The interobserver agreement range for scoring the degree of pancreatitis and the overall presence of abnormalities was 75.5-79.2 and 71.7-100%, respectively. A statistically significant difference between the presence of abnormalities and the severity of pancreatitis was observed (p < 0.001). CONCLUSION: Splenic vein thrombosis (19%) and splenic infarction (7%) are relatively common CT findings in association with acute pancreatitis. The CTSI proves to be accurate in predicting these complications as there is a statistically significant correlation between the prevalence of these complications and the severity of pancreatitis.     

Reversed discrepancy between CT and diffusion-weighted MR imaging in acute ischemic stroke

PURPOSE: We sought to determine whether an early CT ischemic lesion showing parenchymal hypoattenuation might be undetectable on diffusion-weighted imaging (DWI) in acute cerebral ischemia. MATERIALS AND METHODS: We retrospectively evaluated CT and MR images of 70 consecutive patients with acute middle cerebral artery (MCA) infarction. All patients underwent CT and MR imaging within 6 hours of symptom onset. We determined the presence of reversed discrepancy (RD), defined as an early ischemic lesion showing parenchymal hypoattenuation on CT but no hyperintensity on DWI. CT Hounsfield units (HU), apparent diffusion coefficients (ADCs), and perfusion parameters were calculated for RD lesions. RESULTS: RD was found in 9 (12.9%) patients and at basal ganglia (89%). The mean HU of RD lesion was lower than that of normal tissue (DeltaHU, 2.33 +/- 0.74, P < .001). RD lesions showed no significant decrease of ADC (ADC ratio, 0.97 +/- 0.07, P = .059) and cerebral blood flow (relative CBF, 0.87 +/- 0.20, P > 0.05). Delayed DWI hyperintensity occurred in 8 (88.8%) RD lesions, and all lesions progressed to infarction. In 6 (66%) of 9 patients with RD, Alberto Stroke Program Early CT scores of ischemic lesions were lower on CT than those on DWI. CONCLUSION: RD was uncommonly found mainly in basal ganglia, and all RD lesions progressed to infarction at follow-up. Early CT ischemic lesion showing parenchymal hypoattenuation may be undetectable on DWI, and DWI may underestimate extent of severe ischemic tissue in patients with acute MCA infarction.     

The role of computed tomography in assessing subphrenic abscesses after posttraumatic splenectomy

INTRODUCTION: We studied subphrenic inflammatory abscesses and splenic fluid collections after splenectomy for trauma. These complications may appear early or late postoperatively; they are easily demonstrated with CT, which permits accurate spatial assessment of the lesions and appropriate treatment with percutaneous drainage. We investigated the diagnostic accuracy of CT in subphrenic inflammatory conditions after emergency splenectomy for traumatic spleen rupture and found that CT is a precious tool for rapid and easy diagnosis and follow-up of subphrenic abscesses treated with percutaneous drainage. MATERIAL AND METHODS: Thirteen patients with left subphrenic inflammatory abscesses after splenectomy for trauma were examined from 1994 to 1998. They were 9 men and 4 women ranging in age 16-67 years (mean: 32). CT demonstrated abscesses early postoperatively in 9 patients and late postoperatively (mean: 3 months) in 4 patients. Abscesses were diagnosed with CT on admission for an abdominal emergency in 3 cases; one abscess was found at outpatient US performed for persisting left abdominal pain. CT-guided percutaneous drainage was performed in all patients with the Trocar technique. RESULTS: A large inflammatory liquid collection with the typical "liquid pseudospleen" appearance and characterized by tomodensitometric coefficients of corpusculated fluid was seen in 3 cases. Multiple confluent lesions with septa were found in 3 cases. Contrastography of the abscess cavity with the injection of a water-soluble iodinated contrast agent was performed in 2 cases to detect fistulas connecting to the intestinal loops. Subphrenic abscesses had the same CT patterns both early and late postoperatively, with the collection organizing into thick and corpusculated phlogistic material and exhibiting enhanced capsulofibrous differentiation. Air bubbles and water-air levels within the collection were found in 7 cases and considered a pathognomonic sign of inflammatory abscesses. A periabscessual reaction involving intestinal loops and adjacent organs was seen in 4 cases. DISCUSSION AND CONCLUSIONS: Splenectomy causes depressed phagocytosis and decreases serum levels of IgM and antigen response. This calls for careful selection of the patients absolutely requiring splenectomy, such as those with decompensated circulation and multiple parenchymal ruptures or spleen detachment from its stalk. Subphrenic abscesses after splenectomy account for 2.5% of postoperative complications and those after splenectomy for trauma are rarer still, with 1.3%. CT is the imaging method of choice in detecting inflammatory abscesses in the residual splenic cavity and assessing their extent. CT-guided drainage is the first-line treatment, while surgery is reserved to later stages, when drainage fails or other complications occur. Finally, CT permits accurate positioning of the catheter inserted with the Trocar technique and its immediate monitoring, which permits to assess treatment efficacy.     

Real-time contrast-enhanced ultrasound of the spleen: examination technique and preliminary clinical experience

PURPOSE: To report our preliminary experience in the evaluation of the spleen using a real-time contrast-specific ultrasound module in combination with a second-generation contrast agent. MATERIALS AND METHODS: In a 7-month period, 55 patients (34 males and 21 females, aged 5-77 years) with spleen disorders were evaluated by means of contrast-enhanced ultrasound. Two patients were studied because of baseline evidence of an accessory spleen and both underwent ultrasound follow-up. Twenty-five patients were studied for abdominal trauma and results were correlated with those of helical CT. Three patients were examined for suspected splenic infarction and for all CT correlation was obtained. Finally, twenty-five subjects were examined for focal diseases, such as lymphomas (17 cases) and focal lesions (8 cases); contrast-enhanced US results were correlated with those of CT (8 cases), MRI (2 cases), ultrasound follow-up (8 cases), biopsy (2 cases) or splenectomy (1 case). After an initial baseline study, the contrast-enhanced examinations were carried out using a dedicated unit equipped with a continuous contrast-specific module at low acoustic pressure. The examination started immediately after rapid contrast injection and lasted approximately 4 minutes. In the comparison between baseline and contrast-enhanced ultrasound, the following aspects were considered: detection rate of parenchymal changes, lesion extent (equal to CT, under- or overestimated), and lesion conspicuity (lesion-to-parenchyma gradient, from 0 = absent to 3 = high). RESULTS: In the 2 patients with accessory spleen, an enhancement very similar to that of the adjacent parenchyma was present and a small vascular pedicle was noted. Among the trauma patients, 18 had a direct splenic injury and one showed splenic contraction and hypoperfusion due to shock. In 74% of cases, a peritoneal effusion was demonstrated both with baseline and contrast-enhanced ultrasound; perisplenic blood collections (58% of cases) were identified in 42% of patients by both baseline and contrast-enhanced ultrasound; post-traumatic infarction was always revealed by contrast-enhanced ultrasound (11% of cases) but never by baseline ultrasound; parenchymal injuries were detected with a sensitivity of 63% by baseline ultrasound and a sensitivity of 89% by contrast-enhanced ultrasound. Moreover, contrast-enhanced ultrasound revealed findings undetectable on conventional ultrasound: global splenic hypoperfusion in 2 cases (due to shock in one and pedicle avulsion in the other), intraparenchymal contrast collections in 21% of positive cases (as confirmed by CT), extrasplenic contrast leakage in 1 of 2 cases demonstrated by CT. Of the 3 cases of splenic infarction, baseline sonography only only identified two, whereas the contrast-enhanced examination clearly identified three. Contrast-enhanced ultrasound revealed 35 of 39 focal lesions in patients studied for Hodgkin's disease and splenic focal lesions. Baseline ultrasound had a lower sensitivity (23 lesions). Lesion extension shown by contrast-enhanced sonography was equivalent to that provided by standard methods in 88% of cases (underestimated in 9% and overestimated in 3%); baseline US correctly estimated lesion size in 52% of cases, under- and overestimating them in 35% and 13% of cases, respectively. Lesion conspicuity was graded as 1 (low) in 16%, 2 (moderate) in 67%, and 3 (high) in 17% of the cases identified by enhanced sonography. Baseline ultrasound was less effective: conspicuity was graded as 1 in 42%, 2 in 39%, and 3 in 19% of cases. CONCLUSIONS: The spleen is the ideal organ to be studied with second-generation contrast media due to its superficial location, high vascularity, small size and homogeneous texture. Contrast-enhanced ultrasound is a simple, poorly-invasive and accurate tool for the evaluation of splenic disorders. If our data are confirmed, it will be possible to reduce the use of more complex technologies such as CT and MRI.     

急性胰腺炎CT、B超、手术及临床对照研究

笔者分析了２４例急性胰腺炎的ＣＴ所见，并同Ｂ超、临床化验和剖腹探查结果进行了对照研究。表明：（１）急性胰腺炎的ＣＴ诊断优于Ｂ超，对胆源性胰腺炎Ｂ超对诊断有明确帮助。（２）急性胰腺炎时，ＣＴ表现与血淀粉酶浓度不一定成正比。（３）急性胰腺炎可累及门脉系统引起血管并发症。     

Hemorrhagic aneurysm of the celiac trunk. Diagnosis by ultrasound, CT and angiography

The authors report their experience in the study of bleeding aneurysms of the celiac arteries. Eleven patients were examined with US, CT, and angiography (8 hepatic artery aneurysms and 3 splenic artery aneurysms). Clinical findings included digestive bleeding, upper abdominal pain, palpable pulsating masses, and jaundice. Patient history included blunt abdominal trauma, penetrating trauma due to gunshot, acute pancreatitis, recent hepatic biopsy. In all cases US showed an abdominal mass ranging in size from 2 to 10 cm. US findings included cyst-like lesions (8 cases), a lobulated solid-like lesion, and complex lesions (2 cases). Continuity of the lesion with adjacent arterial vessels was noted in 5/11 cases, and pulsing activity in 3/11 cases. US patterns, although not specific, play an important role in the diagnosis when associated to other elements such as arterial continuity, mass pulsatility, patient history, and gastrointestinal bleeding. They suggest the need for more specific imaging exams, i.e. CT and angiography, and help avoid dangerous diagnostic biopsies. CT was performed to confirm US findings in 5 cases, and detected either hypodense cystic masses, or inhomogeneous masses with arterial enhancement after bolus injection of cm. CT was used to better demonstrate the lumen, patency of the vessel, the walls of the vessel, and the parietal thrombotic component. The typical arterial enhancement was the decisive finding for the diagnosis, even though a total continuity with arterial vessels was never observed. Angiography was the method of choice for the preoperative demonstration of hepatic artery aneurysms (10 cases) and for occlusive treatment with Gianturco coils (3 cases).     

儿童急性胰腺炎的CT表现

目的：探讨儿童急性胰腺炎的CT特征及其CT检查价值。材料和方法：回顾性分析58例临床确诊的急性胰腺炎病例的临床和CT资料。结果：单纯水肿型胰腺炎43例（占74．1％），出血坏死型胰腺炎15例（占25．9％）。儿童胰腺炎CT表现包括：①胰腺本身改变：胰腺局部或弥漫性增大46例（占79．3％），密度改变18例（占31％），胰腺断裂2例（占3．4％），胰腺包膜掀起6例（占10．3％）。②胰外改变：主要为胰外积液，共38例占（65．5％）。胰外积液中以肾旁前间隙积液最多，有30例（占51．7％），小网膜囊积液次之，为26例（占44．8％）。③并发症：包括假性囊肿14例（占24．1％）、脓肿1例（占1．7％）等。结论：儿童胰腺炎胰腺坏死的发生率低，并发假性囊肿、脓肿较少，但胰外积液的发生率高。CT对儿童胰腺炎的诊断、病情监测、治疗评估等都有很大意义。     

CT在脾脏占位性病变诊断及鉴别诊断中的价值

目的:探讨CT在脾脏占位性病变鉴别诊断中的价值.方法:回顾性分析25例经手术病理证实的脾脏占位性病变的CT及病理学资料,分析脾脏占位性病变的CT特征.结果:良性占位性病变中90.9%脾脏为正常至轻度肿大,而恶性57.1%为重度脾脏肿大.良性占位性病变多为单发病灶,边界清晰,钙化多见,呈蛋壳样钙化,淋巴结少见肿大;恶性病变常为多发病灶,边界欠清,钙化少见,呈砂粒样或结节样,淋巴结肿大及腹水多见.结论:脾脏占位性病变CT表现具有一定的特征性,结合临床病史多可正确诊断.     

Computerized tomography in pulmonary infarction]

We performed a retrospective study of CT findings in 14 patients with 61 lesions of pulmonary infarction diagnosed clinically and radiographically. All cases except one had multiple pleural-based parenchymal lesions, and in five cases the lesions were bilateral. The site of pulmonary infarction was the right lower lobe in 24 lesions, left lower lobe in 19 lesions, right upper lobe and left upper lobe in seven lesions each, and right middle lobe in four lesions. Fifty-nine infarctions (excluding two segmental lesions) were divided into two groups according to the size of the lesions: a group of lesions 2 cm or more in size and a group less than 2 cm. Nineteen lesions in eight patients were in the larger group and 40 lesions in 12 patients in the smaller group. The typical CT findings of larger infarctions were pleural based parenchymal density with truncated apex, centrally directed linear shadow and inside low attenuation area indicating viable lung. Pleural thickening and effusion were frequently seen. No air bronchograms were seen in these subsegmental lesions. Smaller lesions were believed to indicate infarction of a single secondary pulmonary lobule, considering their size and shape. CT scan was able to detect these small lesions (single lobular infarctions) more frequently than chest radiography. One segmental lesion with air bronchogram was thought to represent atelectasis and the other one to represent pulmonary hemorrhage and edema. CT examination is useful for the detection and diagnosis of pulmonary infarction.