甲状旁腺腺瘤MSCT和MRI影像诊断

目的探讨甲状旁腺腺瘤多层螺旋CT(MSCT)和MRI表现,并评估两种检查方法对甲状旁腺腺瘤诊断的价值。资料与方法回顾性分析经手术病理证实的48例甲状旁腺腺瘤的影像学资料,其中30例行CT平扫及增强检查,14例仅行CT平扫,5例行MRI平扫及CT平扫和(或)强化检查,4例仅行MRI平扫检查。结果 48例均为单发病灶,其中42例(87.5%)位于甲状腺下极气管-食管旁沟;6例(12.5%)为异位腺瘤。CT平扫,28例腺瘤呈均匀软组织密度,16例腺瘤密度不均匀,其内见低密度坏死区。MRI平扫,6例腺瘤呈均匀软组织信号,3例腺瘤内见长T2信号区。CT增强早期,30例腺瘤实体部分明显强化,但强化程度低于颈部大血管,晚期强化程度减低,但大血管强化程度的下降更为明显,两者之间的密度差逐渐减小。结论 MSCT可以清晰显示肿瘤的部位、大小、形态和质地。     

99 Tcm-MIBI显像定位诊断功能亢进性异位甲状旁腺

目的：探讨99Tc^m-甲氧基异丁基异腈（MIBI）显像对于异位甲状旁腺所致原发性甲状旁腺功能亢进（简称甲旁亢）的显像特点，提高甲状旁腺术前定位的准确性。方法：61例原发性甲旁患者采用99Tcm-MIBI显像（减影法6例，双时相法55例），其中52例有B超（US），15例有CT检查，全部病例均经手术和病理检查证实。结果：61例中发现异位甲状帝腺16例（26．2％），位置分别为：颈动脉鞘内3例，下颈部处伸至胸骨后6例，纵隔内7例，99Tcm-MIBI显像全部检出（100％），与手术部位一致，US检查15例，检出8例（53．3％），均位于颈部，纵隔内6例及颈动脉鞘内1例未检出。CT检查7例，纵隔内6例检出2例（28．6％），病理检查诊断：腺瘤14例，增生2例，病灶最小1g，最大＞60d,99Tcm-MIBI显像示病灶小者为放射性均匀浓聚，大者常有囊性变，甚至完全为囊肿样。位于甲状腺影像外者，双时相法的初始相即可显示，但位于纵隔深部病变的解剖关系不能精确表达，结论：99Tcm-MIBI显像是最有效的探测异位甲状旁腺的方法，缺点是对于纵隔深部病灶的解剖定位不够清楚，应加断显像或加做CT检查。     

深在性囊性胃炎影像学表现

目的 探讨深在性囊性胃炎(GCP)的影像学表现.方法 回顾性分析经手术病理证实的6例GCP的术前影像学资料.6例病例中,4例行CT平扫及增强检查,1例行CT平扫及MRI增强检查,1例行CT平扫及PET/CT检查.结果 4例病灶位于胃窦部,1例位于胃底,1例位于胃小弯.5例表现为胃壁增厚或肿块,其中4例病灶内见单发小囊,...     

原发性甲状旁腺肿瘤的影像诊断

目的:分析原发性甲状旁腺肿瘤的US、CT、ECT表现,评估各种检查方法对原发性甲状旁腺肿瘤的诊断价值.方法:回顾性分析经手术病理证实的9例原发性甲状旁腺肿瘤患者的术前影像资料.结果:病变位于甲状腺区域5例,异位4例;B超检查9例发现病变8例,均表现为边界清晰之低回声肿块;CT检查5例发现4例,表现为软组织密度结节,有明显强化;ECT检查3例发现3例,均表现为病变区域结节状核素浓聚影.结论:US、CT、ECT对大部分原发性甲状旁腺肿瘤均能作出准确的定位定性诊断,多种检查方法联合应用可提高病变的检出率.     

肝脾滤泡树突状细胞肉瘤6例影像及病理表现并文献复习

目的 分析肝脾滤泡树突状细胞肉瘤(FDCS)的影像表现,并与病理对照分析.方法 回顾性分析2008年1月至2019年12月广州市第一人民医院和广州市红十字会医院的6例经手术病理证实肝脾FDCS患者的临床、影像及病理资料;其中3例行CT检查,2例行MRI检查,1例行CT和MRI检查.结果 2例病灶位于肝脏,4例位于脾;肿...     

原发性甲状腺淋巴瘤影像表现及误诊分析

目的探讨原发性甲状腺淋巴瘤(PTL)的影像表现,以期进一步提高PTL的诊断准确率。方法回顾性分析经手术病理证实的6例PTL患者的影像表现,其中5例行CT平扫及增强扫描,1例同时行MRI平扫及全身~(18)F-FDG PET/CT检查。结果 6例患者均以发现颈部肿物就诊,病理证实均为非霍奇金淋巴瘤,其中3例合并有桥本甲状腺炎。病灶侵及甲状腺一侧叶4例,侵及甲状腺双侧叶及峡部1例,侵及甲状腺单侧叶及峡部1例。CT表现为单发结节型2例,多发结节型1例,弥漫肿大型3例。CT平扫6例病灶均呈稍低密度,5例密度大致均匀,1例病灶内可见钙化。增强扫描5例病灶呈均匀、轻中度强化。2例出现颈部淋巴结转移。MRI病灶T_1WI呈等信号,T_2WI呈稍高信号,DWI呈高信号。PET/CT病灶表现为高代谢。6例患者术前全部误诊。结论 PTL容易误诊,其影像表现具有一定特征性,结合临床资料,有助于提高诊断准确性,其最终确诊仍需依靠病理学检查。     

单中心型Castleman病CT影像特征

【摘要】目的:结合病理结果,分析单中心型Castleman 病(UCD)的CT影像特征,提高影像学对该病的诊断准确率。方法:回顾性分析经手术病理证实的11例单中心型CD患者的影像及病理资料。结果:11 例单中心型CD中1例位于气管,3例位于纵隔,1例位于颈部,1例位于肺门,3例位于腹膜后,1例位于附件区,1例位于大腿根部,11例均行CT检查,其中6例行CT平扫+增强检查,4例行CT增强检查,1例行CT平扫检查。11例病灶均呈单发软组织肿块灶,其中5例病例出现不同程度的钙化,增强检查8例均匀或不均匀明显强化,动脉期及静脉期呈持续性、渐进性强化。结论:单中心型Castleman病在影像学上存在一定的特征性,提高该病在影像学上的认识有助于我们术前提高对该病诊断的准确性。     

局灶性透明血管型Castleman病的影像学表现与病理特点

目的分析局灶性透明血管型Castleman病(HV-LCD)的影像特征和病理特点,提高诊断准确率。方法回顾性分析经手术病理证实的11例局灶性HV-CD患者的影像及病理资料。结果 11例局灶性HV-CD中,4例位于颈部,4例位于腹膜后,2例位于肠系膜,1例位于纵隔。10例行CT检查,2例行MRI检查,5例行多普勒超声检查。所有病例病灶均呈软组织肿块灶,10例为单发,1例多发位于双侧颈部,所有病灶未见明显钙化灶。MRI平扫呈均匀等T1,长T2信号; 5例多普勒超声检查表现为圆形,椭圆形低回声光团,4例其内可见丰富血流信号显示。CT及MRI增强扫描:动脉期6例明显强化,5例静脉期及延时期强化范围扩大。9例病灶分布在大血管旁,周围小血管增多,6例周围可见增大的淋巴结。结论对于局灶性HV-CD,多种影像学检查与病理相互印证,对于本病的诊断具有重要价值。     

原发性腹膜后黏液性囊腺瘤的CT、MRI表现

目的:分析原发性腹膜后黏液性囊腺瘤的CT、MRI表现,以提高对该病的认识.方法:收集经手术病理证实的4例原发性腹膜后黏液性囊腺瘤,分析其CT、MRI表现、临床特点和病理特征.结果:3例行CT平扫,其中2例加行增强扫描,平扫示病灶呈单房、囊性表现,增强扫描囊壁未见明显强化,1例囊壁见结节状钙化;1例行MRI检查,MRI示...     

原发性骨恶性纤维组织细胞瘤的CT和MRI诊断

目的:探讨原发性骨恶性纤维组织细胞瘤(BMFH)的CT和MRI表现,以提高影像诊断水平。方法:收集经手术病理证实的原发性BMFH 13例,9例行CT检查,其中行增强扫描3例;6例行MRI检查,其中行增强扫描2例;2例同时行CT和MRI检查。分析原发性BMFH的CT和MRI表现,并与组织病理学表现相对照。结果:13例中,长骨骨端11例,长骨骨干1例,髂骨1例。骨质表现为溶骨性破坏,其中6例病灶边缘有轻度骨硬化,7例骨质破坏区间夹杂粗细不等的骨嵴,骨膜反应1例;MRI表现为T1WI等低信号,T2WI混杂高信号。13例均见超过骨破坏范围的软组织肿块,钙化1例;T1WI表现为等或等低信号,T2WI为等高或混杂高信号。CT、MRI增强扫描病变不均匀强化。结论:原发性BMFH的CT、MRI表现有一定的特征,能较好地反映病变的病理特点,对术前明确诊断具有重要意义。     

Radiologic assessment of metastases to the thyroid gland

PURPOSE: We reviewed the radiologic and clinical data in patients with metastatic disease to the thyroid gland and assessed the role of radiologic techniques in this disorder. METHOD: The findings on US (n = 11), CT (n = 7), MRI (n = 6), palpation or US-guided fine needle aspiration (FNA) biopsy, and clinical records were reviewed in 11 cases of pathologically verified metastatic tumors of the thyroid gland. RESULTS: Five patients had palpable thyroid nodules and six had nonpalpable nodules discovered incidentally with imaging procedures. Three patients had no known malignancies at the time of diagnosis of thyroid tumors. Correct diagnosis was obtained in 10 of the 11 cases with FNA biopsy. Thyroid metastases were detected in all of the cases with US and MRI and six of the seven cases with CT. Thyroid metastases were solitary (n = 5) or multiple (n = 6), and about half of them measured <2 cm in diameter. These tumors typically had well defined margins and no calcification and sometimes had cystic portions. Multiple nodules within the same patient were radiologically quite similar to each other. On US, metastases appeared as hypoechoic or markedly hypoechoic areas without halo, on CT as low density areas, and on MRI as areas of varying signal intensities. Half of the metastases showed hypointensity on either T2-weighted images or gadolinium-enhanced T1-weighted images. The tumors involved lymph nodes in 10 cases and other remote organs in 5. Level I or II or parotid nodes were involved in six cases. CONCLUSION: These radiologic features may alert clinicians to a possibility of metastatic thyroid cancer. US combined with US-guided FNA biopsy is suitable for early diagnosis of metastases to the thyroid gland.     

早期肾透明细胞癌的超声、CT和MRI诊断

目的: 研究早期肾透明细胞癌的超声、螺旋CT、MRI表现,提高其诊断水平.材料和方法: 回顾性分析经手术病理证实的13例早期肾透明细胞癌的超声、螺旋CT和9例MRI表现.结果: 13例早期肾透明细胞癌中,超声显示无回声肿块7例,厚壁型囊性肿块5例,多房囊状、分隔厚薄不一肿块1例.13例螺旋CT均显示肿块为低密度病灶,CT增强扫描示病灶均呈不均匀增强.9例MRI示肿块信号强度不均,T1WI为低信号,T2WI为不均匀性高信号,4例增强扫描均呈不均匀增强.术前超声诊断为5/13,CT为7/13,MRI为7/9,超声结合CT为13/13,超声结合CT和MRI为9/9.结论: 仅用超声或螺旋CT检查诊断早期肾透明细胞癌较困难.超声结合螺旋CT或MRI,综合影像检查能提高其诊断水平.     

腮腺基底细胞腺瘤的CT与MRI表现

目的:探讨腮腺基底细胞腺瘤(BCA)的CT和MRI表现。方法:回顾性分析10例腮腺BCA的CT和MRI表现。10例中男3例,女7例;右侧腮腺4例,左侧6例。结果:10例肿瘤均为单发,肿瘤最长径平均为2.4cm。10例肿瘤中不规则形或深分叶状2例,圆形或类圆形8例;边缘均光滑清楚。MRI检查2例,表现为长T1、短T2信号实性肿块,伴稍低信号包膜,增强扫描后病灶呈均匀明显强化。CT检查8例:6例呈实性,2例呈囊实性、内有大片液化囊变,实性部分明显强化。结论:腮腺BCA的CT和MRI表现有一定特征,结合临床,有助于本病的诊断和鉴别诊断。     

脊柱嗜酸性肉芽肿的影像学诊断

目的:探讨脊柱嗜酸性肉芽肿的影像学表现及鉴别诊断.方法:回顾性分析21例经病理证实的脊柱嗜酸性肉芽肿的X线、CT和MRI表现.结果:21例中发生在颈椎5例,胸椎10例,腰椎6例;X线检查示17例(17/21)椎体呈楔形改变或椎体变扁,3例呈囊状破坏,4例显示软组织肿块,3例椎间隙变窄.7例患者行CT检查,CT主要表现为椎体不规则破坏和椎旁软组织肿块.8例行MRI检查,显示椎体破坏、信号异常和椎旁软组织肿块,3例软组织肿块在冠状面和矢状面呈套袖状,相邻椎间盘信号无明显改变.结论:脊柱嗜酸性肉芽肿的影像学表现具有一定的特征性,X线平片是其诊断基础,同时结合CT尤其是MRI检查,能够提高诊断和鉴别诊断能力,但该疾病的正确诊断有赖于临床、病理和影像表现相结合.     

99Tcm-MIBI SPECT/CT融合断层显像在甲状旁腺功能亢进症中的应用价值

目的评价99Tcm-MIBI SPECT/CT双时相融合断层显像在原发性甲状旁腺功能亢进症（PHPT）与继发性甲状旁腺功能亢进症（SHPT）中的应用价值。方法回顾性分析97例（PHPT 28例,SHPT 69例）HPT患者的99Tcm-MIBI SPECT/CT显像图像特征、症状、血清甲状旁腺激素（PTH）、血钙、磷及碱性磷酸酶（AKP）等结果。分析比较PHPT和SHPT两组患者的显像特点、手术病理、实验室检查以及诊断的灵敏度、特异度与临床指标之间的相关性。结果（1）99Tcm-MIBI SPECT/CT显像对PHPT的术前诊断灵敏度为96.55%,特异度为98.78%;对SHPT的术前诊断灵敏度为68.77%,特异度为79.17%。（2）PHPT多表现为单发病灶,而SHPT多表现为多个亢进的甲状旁腺病灶,病灶平均直径较小（Z=-2.591,P=0.010）,且容易合并钙化（χ2=9.588,P < 0.01）,差异均有统计学意义。（3）PHPT中无特殊不适主诉的患者比例明显高于SHPT中的比例（χ2=11.713,P < 0.001）,PHPT出现结石的比例高于SHPT（χ2=6.075,P < 0.001）,SHPT出现骨痛的比例高于PHPT（χ2=24.382,P < 0.01）,差异均有统计学意义;SHPT患者血清PTH和AKP水平均明显高于PHPT,差异有统计学意义（Z=-6.663、-4.326,均P < 0.001）,PHPT具有高钙低磷的特点,SHPT患者血钙正常或轻度升高,血磷明显升高。结论99Tcm-MIBI SPECT/CT双时相显像在PHPT患者的术前定位中有重要价值,特别是在PHPT中有极高的准确率。与PHPT相比,SHPT血清PTH、AKP水平升高更明显,多表现为多个病灶,病灶小,易合并钙化。     

Clinical role of 99mTcO4/MIBI scan, ultrasound and intra-operative gamma probe in the performance of unilateral and minimally invasive surgery in primary hyperparathyroidism

The main purposes of this study were: (a) to investigate the efficacy of an imaging protocol based on the combination of 99mTcO4/MIBI scintigraphy and neck ultrasound (US) in selecting patients with primary hyperparathyroidism (HPT) for unilateral neck exploration, and (b) to help define the role of the intraoperative MIBI gamma probe (IMGP) technique in the performance of minimally invasive radio-guided surgery (MIRS). One hundred and forty-three consecutive patients with primary HPT were enrolled in the study. We used a modified 99mTcO4/MIBI scintigraphic procedure which included the oral administration of potassium perchlorate to cause rapid 99mTcO4 washout from the thyroid tissue, thereby permitting the acquisition of high-quality early MIBI images. A single-photon emission tomography (SPET) acquisition was also obtained in 21 patients, of whom seven had an enlarged parathyroid gland (EPG) in the mediastinum at planar scintigraphy and 14 had discordant scan/US findings for the presence of a cervical EPG. Neck US was performed in the same session as scintigraphy using a small-parts, high-resolution 10-MHz transducer. All patients were then operated on by the same surgical team. Quick PTH assay (QPTH) was used to measure PTH intraoperatively to confirm successful parathyroidectomy. In patients with scan/US evidence of a solitary EPG and with a normal thyroid gland, limited, unilateral neck surgery or, more recently, MIRS was planned (n=91). In patients with scan/US evidence of multiglandular disease (MGD) (n=21) or concomitant nodular goitre (n=24) or in patients with a negative scan/US evaluation (n=7), extensive bilateral neck exploration was planned (n=52). In 87 of the 91 patients (95.6%) in whom preoperative imaging indicated the presence of a solitary EPG and a normal thyroid gland, a single parathyroid adenoma was found at surgery, and these patients were treated by unilateral neck exploration or MIRS. In the remaining four patients of this group, conversion to bilateral neck exploration was required because parathyroid carcinoma (n=3) or MGD (n=1) was diagnosed at operation. In some cases SPET was helpful in better localising the EPG. In particular, in 5 of the 21 patients evaluated, SPET localised an EPG deep in the neck or mediastinum and at surgery a parathyroid adenoma was found in the paratracheal or para-oesophageal space. In 43 of the 46 patients (93.5%) who were candidates for MIRS, the IMGP technique allowed parathyroidectomy to be performed through a small, 2- to 2.5-cm skin incision with a short duration of intervention (mean 34 min). We conclude that: (a) The integrated scan/US imaging protocol that we used appears to be accurate in selecting patients with primary HPT for unilateral neck exploration. (b) In our series the most prevalent cause of bilateral neck exploration was the co-existence of a nodular goitre; thus accurate preoperative evaluation of the thyroid gland by dual-tracer scintigraphy and US imaging is strongly recommended in all patients with HPT. (c) SPET can provide the surgeon with useful information when an EPG is located deep in the neck or mediastinum. (d) IMGP appears to be a useful intraoperative device in HPT patients with solitary parathyroid adenomas and a normal thyroid gland, since it permits minimally invasive and time-saving surgery.     

Nonfunctional mediastinal parathyroid cyst: imaging findings in two cases

The authors describe the computed tomography (CT) and magnetic resonance (MR) imaging findings of a 69-year-old woman and a 69-year-old man with a nonfunctional mediastinal parathyroid cyst. In the described cases, unenhanced CT showed homogeneous areas of water density, and unenhanced MRI showed homogeneous areas that were isointense to cerebrospinal fluid, reflecting their serous fluid contents. Both cysts were located posterior to the left lower pole of the thyroid gland with an extension to the superior mediastinum, either anterior or posterior to the left brachiocephalic vein. CT and MR imaging findings of parathyroid cysts are nonspecific, and they are often difficult to differentiate from other cystic lesions located in the lower neck or in the superior mediastinum. However, a parathyroid cyst should be considered when radiologic images demonstrate its characteristic location, posterior to the thyroid gland, with an extension to the superior mediastinum.     

甲状腺癌淋巴结转移的CT表现

目的：评价甲状腺癌淋巴结转移的CT特点。方法：回顾性分析经手术及病理诊断的108例甲状腺癌淋巴结转移的CT表现。结果：108例中，颈上中深组淋巴结转移76例，颈下深组及锁骨上窝86例，气管食管沟52例，纵隔17例。84例乳头状癌中，16例淋巴结密度与正常甲状腺相似，24例有囊性变，其中18例淋巴结囊内有明显强化的乳头状结节，11例有细颗粒状钙化，24例滤泡癌，髓样癌，透明细胞癌中，17例淋巴结明显强化，17例与甲状腺原发或复发肿瘤密度一致，密度均匀或不均匀。结论：甲状腺癌转移淋巴结好发部位为颈静脉链周围，气管食管沟及纵隔；淋巴结明显强化，与正常甲状腺密度一致，囊性变，囊壁内明显强化的乳头状结节及细颗粒状钙化为甲状腺乳头状癌的特征性改变，淋巴结明显强化，与甲状腺肿瘤密度一致为滤泡癌，髓样癌，透明细胞癌转移淋巴结的特点。     

滑膜血管瘤的影像学诊断

目的:分析滑膜血管瘤的影像学表现及诊断价值。材料和方法:回顾性分析已确诊12例滑膜血管瘤(男性7例,女性5例),其中膝关节5例、肘关节2例、腕关节2例、髋关节2例、肩关节1例。X线检查8例,CT检查平扫2例,MRI检查5例其中增强4例,血管造影1例。结果:X线平片可以出现静脉石、软组织肿胀、骨质侵蚀、继发骨关节炎表现。CT表现为软组织肿胀及骨质侵蚀,血管造影仅发现膝周少许异常染色血管影。MRI发现局限型(2例)和弥漫型(3例),局限型表现为髌上囊区局限肿块影,T1WI上等低信号影,于T2WI序列表现为高信号;弥漫型2例表现为弥漫性生长可突破关节囊,病灶大部分呈T1WI上等低信号影,T2WI上高信号影,其内含有更低信号细条索影及高信号分隔影。1例含有大量含铁血黄素则T1WI及T2WI上均表现为低信号。结论:X线平片、CT及血管造影对滑膜血管瘤诊断有一定帮助,MRI可明确显示血管瘤特征性脉管及纤维脂肪成分,提高该病术前诊断率。     

原发性肛管直肠恶性黑色素瘤影像学诊断(5例报告及文献复习)

目的探讨原发性肛管直肠恶性黑色素瘤(AMM)的CT和MRI诊断价值。方法回顾性分析经组织病理学证实的AMM5例,其中男2例,女3例。4例行CT检查,1例行MRI检查。结果AMM表现明显蕈伞型肿块充满肠腔不伴肠梗阻(n=4),肠壁明显增厚(n=1);2例伴肠周脂肪浸润,其中1例延伸至骶前间隙;4例伴淋巴结转移,其中1例淋巴结直径>3cm。CT平扫示肿块呈稍低密度影,轻度强化1例、中度强化3例;AMM及其转移灶在MRIT1WI均呈高信号,T2WI为低信号。抑脂T1WI能更好地显示病灶范围及转移灶。结论肛门直肠部AMM可表现为腔内较大蕈伞型肿块,虽充满肠腔,但不伴肠梗阻,同时具较大淋巴结转移及明显肠周脂肪浸润。MRI对鉴别黑色素性AMM有提示价值。