64层螺旋CT诊断肾上腺囊性病变

目的探讨肾上腺囊性病变的 CT 表现特点,提高其诊断准确性.资料与方法经手术病理证实31例的肾上腺囊性病变患者,术前均行64层螺旋 CT 平扫加增强扫描,层厚2.5mm,并行0.625mm 薄层重建及多平面重组,分析肾上腺囊性病变的 CT 表现.结果31例肾上腺囊性病变中,肾上腺上皮性囊肿5例,肾上腺淋巴管囊肿3例,肾上腺血肿4例,肾上腺化脓性炎性假囊肿1例,肾上腺皮质腺瘤囊性变4例,肾上腺嗜铬细胞瘤囊性变10例,肾上腺节细胞神经瘤2例,肾上腺神经鞘瘤囊性变1例,肾上腺转移瘤囊性变1例(原发肿瘤为肺癌).64层螺旋 CT 上囊性病变的形态、密度、囊壁厚度、有无壁结节、强化特点可以鉴别肿瘤性和非肿瘤性囊肿、良性和恶性肿瘤囊性变.结论肾上腺囊性病变的64层螺旋 CT 特征不同,有助于明确诊断.     

腹膜后良性神经鞘瘤:影像学特征与病理的关系

目的分析腹膜后神经鞘瘤的CT和MRI表现及其血液动力学特征,以提高其诊断准确性。资料与方法经手术病理证实的腹膜后神经鞘瘤16例,11例术前经螺旋CT或多排螺旋CT平扫、动脉期和门脉期增强扫描,对比剂注射流率采用3ml／s;5例经MR自旋回波（SE）T1WI、T2WI和扰相梯度回波（SPGR）动态增强成像。复习CT和MRI扫描结果并和手术病理作回顾性对照分析。结果16例神经鞘瘤边缘规则光整,肿瘤直径4．7～15．3cm．平均8．3cm。囊实性9例,完全实质性4例,完全囊性3例。4例实质性肿瘤中,3例密度均匀,1例密度不均匀;完全囊变者形成厚壁囊肿样改变,囊内外壁光整;9例囊实性病变中,实质成分密度较高．囊变区边缘规则光滑。T1WI呈低到中等信号,T2WI呈中等到高信号。所有肿瘤呈进行性延迟强化,其中,8例肿瘤强化显著,5例中等程度强化．3例轻度强化。结论腹膜后神经鞘瘤体积大,完全实质性和完全囊性比例高,血液动力学多样,容易误诊。囊变区和Antoni B区的识别有助于提高诊断准确率。     

肾上腺囊肿的CT、MRI诊断

目的:探讨肾上腺囊肿的CT、MRI表现,以提高诊断的准确率。方法:回顾性分析手术病理证实的9例肾上腺囊肿的CT、MRI表现。结果:9例肾上腺囊肿,5例行CT检查:1例呈圆形,2例呈椭圆形,2例呈分叶状。平扫囊肿密度均匀,CT值15~35HU,3例囊壁有钙化;增强扫描囊内均无强化,2例囊壁呈环形强化,3例囊壁无强化。4例行MR平扫:均呈长T1长T2异常信号,并且囊内可见分隔,分隔与液体相比呈短T1短T2异常信号,厚薄均匀,边缘光滑。结论:CT、MRI是肾上腺囊肿定位、定性诊断较为可靠和准确的方法。     

颅内表皮样囊肿的非典型CT和MRI表现

目的 探讨颅内表皮样囊肿的非典型CT和MRI表现,提高对本病的认识.方法 收集经手术病理证实的8例表皮样囊肿,术前均行MRI平扫,其中2例行扩散加权成像(difussion weighted imaging,DWI)检查,CT检查5例.MRI增强扫描4例.结果 8例表皮样囊肿发生于桥小脑角2例,大脑纵裂2例,脑实质2例,颅骨2例.CT显示囊肿表现为均匀高密度2例;混杂密度1例;囊壁及囊内钙化2例.MRI平扫2例T1WI呈均匀高信号,T2WI呈稍高、高信号;3例T1WI和T2WI呈混杂信号;3例T1WI呈不均匀低信号,T2WI呈高信号;其中1例DWI表现为高信号.4例MRI增强扫描显示囊壁显著环形强化和囊内不均匀强化2例,囊壁轻度强化2例.结论 颅内表皮样囊肿的CT和MRI非典型表现主要包括CT呈高密度、混杂密度、囊壁和囊内钙化,MRI T1 WI、T2WI呈高信号、混杂信号,增强扫描显著环形强化,在诊断时应充分结合DWI检查,以提高术前诊断准确性.     

卵巢表皮样囊肿的影像学表现(附2例报告并文献复习)

目的 探讨卵巢表皮样囊肿的影像学表现.资料与方法 回顾性分析2例经病理证实的卵巢表皮样囊肿的CT、MRI表现.结果 卵巢表皮样囊肿CT表现为囊性占位,囊液大部分均匀,水样密度,囊壁光整.MRI表现为囊液T1WI低信号,T2WI高信号,囊内见不定形团块状、云絮状及结节状无强化角化物,囊壁可强化,囊液无强化.CT及MRI均显示囊壁有局部增厚.结论 卵巢表皮样囊肿的影像学表现有一定的特征性,认识其表现有助于对该病的诊断.     

儿童不典型肾上腺肿瘤的影像学分析

目的 分析7例儿童不典型的肾上腺肿瘤的CT和MRI表现,以提高对儿童肾上腺肿瘤的鉴别诊断水平. 资料与方法回顾性分析经手术和病理证实的儿童肾上腺肿瘤7例,复习其CT和MRI表现并与手术病理对照分析.结果 Ⅰ级神经母细胞瘤1例,CT表现为均匀稍低密度肿块;单纯肾上腺囊肿1例,表现为均匀低密度囊性肿块,无强化;囊肿伴出血1例,囊壁嗜铬母细胞增生,表现为T1WI及T2WI高信号,增强后囊壁环形强化;肾上腺髓外造血1例,表现为均匀低密度肿块,轻度强化;皮质腺瘤1例,表现为均匀软组织密度肿块,增强后动脉期明显强化,静脉期强化减弱;肾上腺皮质癌2例,1例密度不均匀,增强后肿瘤实性成分强化持续时间较长,另1例MRI表现为轻度均匀强化.结论 除单纯囊肿外,儿童肾上腺肿瘤影像学表现缺乏特异性,确诊需与临床及病理结合.     

毛细胞型星形细胞瘤的CT、MRI表现

目的 探讨毛细胞型星形细胞瘤的CT、MRI特征.资料与方法 回顾性分析16例经手术病理证实的毛细胞型星形细胞瘤的CT及MRI表现.结果 毛细胞型星形细胞瘤影像学表现有以下特点:(1)青少年易发病,20岁以下多见;(2)病变好发于小脑;(3)肿瘤呈类圆形,伴有不同程度囊变,根据囊变程度可分为囊肿型、囊肿结节型和肿块型,以囊肿结节型最多见;(4)肿瘤囊性部分CT平扫呈低密度,MR T1WI呈明显低信号,T2WI呈明显高信号;肿瘤实性部分、囊壁及壁结节CT呈等或稍低密度,MR T1WI呈等或稍低信号, T2WI呈稍高信号.增强后肿瘤囊壁不强化或轻度强化,壁结节及实性部分明显强化,囊性部分不强化;(5)肿瘤边界清楚,瘤周无水肿;(6)肿瘤出血与钙化少见.结论 毛细胞型星形细胞瘤在CT、MRI上表现有一定特征,有助于术前与其他肿瘤的鉴别.     

Rathke囊肿的病理与临床、影像对照分析

目的 探讨Rathke囊肿病理与临床和CT、MRI表现的相关性.方法 回顾分析经手术病理证实的Rathke囊肿43例的病理和CT、MRI表现及临床特征.结果 27例位于鞍内和鞍上,16例位于鞍内.CT平扫囊肿多呈边界清晰的"类圆形"或"哑铃"状肿物,其中9例低密度,9例高密度,8例等或稍高混杂密度,1例囊壁钙化;CT增强扫描有6例囊壁呈环形或边缘强化,其余无强化.MR检查18例T1WI呈低或等信号,T2WI呈高信号,6例T1WI和T2WI均显示高信号,4例T1WI高信号,T2WI呈混杂信号.4例囊肿内结节,T1WI呈高信号,T2WI呈低或混杂信号.MR增强检查有9例囊壁的外缘增强.术中见肿物呈囊状,10例囊液呈脑脊液样清亮液体,15例为胶冻状咖啡色黏液,12例呈豆渣样黏稠液,6例为深褐色油状黏液.组织学分析显示部分囊液中含有脂肪结晶和脱落皮屑样物,11例HE染色可见胆固醇裂隙、凝血及肉芽组织,16例PAS染色阳性,囊液内含有黏多糖和蛋白质类物质.结论 典型的Rathke囊肿术前可以明确诊断,非典型Rathke囊肿的CT、MRI表现缺乏特异性.随着囊液组织成分的变化,影像学表现有一定的变化规律.     

肾上腺囊肿的螺旋CT诊断

目的：探讨螺旋CT诊断和鉴别诊断对肾上腺囊肿的价值。材料和方法：回顾性分析2003-05—2006-12经手术病理证实的肾上腺囊肿22例的CT表现。结果：22例中，肾上腺假性囊肿8例、肾上腺内皮囊肿2例、肾上腺皮质腺瘤并囊变3例、肾上腺嗜铬细胞瘤并囊变5例和肾上腺转移瘤并囊变4例，均为单侧发病。CT表现：肾上腺区低密度影，圆形5例、椭圆形17例，病灶大小约1．5～18cm，平均9．75cm。边界清楚。囊肿单房21例、多房1例，囊壁薄而滑，其囊内CT值10—52Hu，平均31Hu。单纯性肾上腺囊肿增强扫描未见增强，而肿瘤囊变的肾上腺囊肿其囊壁较厚有不同程度的增强。结论：螺旋CT检查对肾上腺囊肿的诊断较有特征性，增强前后CT扫描的对比分析是诊断肾上腺囊肿的有效手段。     

卵巢甲状腺肿的CT和MRI表现

【摘要】目的：卵巢甲状腺肿（SO）临床罕见，且无典型症状和体征，术前容易误诊。本研究分析SO的CT及MR表现，以提高影像诊断水平。方法：回顾性分析10例经手术和病理证实的SO患者的影像学资料，其中7例行CT平扫及增强扫描，3 例行MR平扫及增强扫描。结果：10例SO均为单侧发病，右侧6例，左侧4例；其中囊实性7例，囊性2例，实性1例；肿瘤最大径1.4~15.6cm，平均（7.7±3.9）cm。 ①CT表现：7例CT检查病变均表现包膜完整，2例伴钙化。5例囊实性病变实性部分明显强化，CT值79~145HU；1例囊性病变内含圆形高密度区，CT值65~98HU，增强后无强化；1例实性病变明显强化，CT值128HU。②MR表现：3例MR检查病变中，2例囊实性病变实性部分T1WI等信号，T2WI稍高信号，增强后明显强化，囊性部分T1WI呈低信号，T2WI呈高信号，增强未见强化；1例囊性病变T1WI呈低信号，T2WI呈高信号，病变内见类圆形极低信号区。结论:卵巢甲状腺肿的MRI、CT 表现具有一定特征性，有助于诊断及鉴别诊断。     

颈部囊性病变的多排螺旋CT和MRI影像学特征分析

目的：分析颈部囊性病变的多排螺旋CT和MRI影像学特征。方法回顾性分析41例经病理证实的颈部囊性病变的解剖部位及多排螺旋CT和MRI影像学征象。结果颈部囊性病变多形状规则,边界清晰。20例甲状舌管囊肿位于正中线舌骨水平或略偏,与甲状软骨关系密切,MRI征象为长 T1长 T2信号,信号均匀,增强扫描囊壁轻度强化;11例第二腮裂囊肿位多于胸锁乳突肌前内侧,MRI为囊性长T1长T2信号,信号均匀,囊肿内CT值为水样密度,增强扫描囊壁轻度强化;2例表皮样囊肿位于颈中线舌骨水平、颈后部,CT扫描密度均匀,增强未见明显强化;4例会厌囊肿位于会厌前间隙内,MRI影像为囊性长T1长T2信号肿块,信号均匀,CT影像为囊性薄壁低密度肿块,密度均匀;4例淋巴管瘤主要位于颈后三角区,MRI肿块呈等T1长T2信号,内部可见分隔,囊腔大小不等,增强扫描其分隔可见强化。结论颈部不同囊性病变的解剖位置和影像学征象有一定的特点,经过综合分析,可以做出正确诊断。     

骨纤维源性肿瘤的影像学定性诊断

目的:探讨骨的非骨化性纤维瘤、硬纤维瘤和纤维肉瘤的影像鉴别诊断。方法:分析43例骨的非骨化性纤维瘤、硬纤维瘤、纤维肉瘤患者的影像表现。结果:X线和CT检查显示,14例非骨化性纤维瘤,可见骨囊状膨胀破坏,8例可见纤细骨嵴;12例硬纤维瘤,4例囊状膨胀破坏,8例溶骨破坏,2例可见纤细骨嵴,6例可见粗大骨嵴;16例纤维肉瘤,5例囊状破坏,边缘不规则,11例溶骨破坏。MRI检查显示,9例非骨化性纤维瘤,9例硬纤维瘤,11例纤维肉瘤,T1WI均呈等信号和低信号,T2WI均呈较高信号和低混杂信号;T1WI和T2WI低信号的非骨化性纤维瘤和纤维肉瘤呈局灶状,硬纤维瘤呈大片状。3例纤维肉瘤T2WI可见高信号。结论:影像学能反映骨的非骨化性纤维瘤、硬纤维瘤和纤维肉瘤的特征,对其鉴别诊断有重要价值。     

Metastatic liver tumor from cystic ovarian carcinomas: CT and MRI appearance.

OBJECTIVE: The initial and follow-up CT and MRI images of ten patients with hepatic metastases from ovarian tumors were retrospectively analyzed to establish their features and sequential changes in appearance. MATERIALS AND METHODS: Ten patients with hepatic metastasis from ovarian tumors received initial and follow-up CT and MRI examinations. Six patients were followed up every two to three weeks before surgical tumor resection. Both CT and MR images were analyzed by two radiologists. RESULTS: A total of fourteen lesions were detected by CT and MRI in 10 patients. All 14 lesions were demonstrated as areas of marked hyperintensity on T2-weighted MRI. Eleven cyst-like tumors were demonstrated as round or oval low density lesions on CT and as areas of hypointensity on T1-weighted imaging. Three lesions were shown as solid masses with slightly low attenuation at the initial CT examination and slightly low or iso-intensity areas on T1-weighted imaging, and these lesions showed early peripheral globular enhancement and delayed enhancement on contrast-enhanced CT and MR imaging. Cystic formation was observed two to three weeks later after initial study in all the 3 solid lesions. Rapid subcapsular effusion, which showed obvious enhancement on delayed Gd-DTPA enhanced MR imaging, was observed in two patients. CONCLUSION: The hepatic metastatic tumor from cystic ovarian carcinoma may manifest as a well-defined cystic lesion or as a solid mass, and the solid mass shows delayed enhancement on contrast-enhanced CT and MR imaging. Furthermore, rapid cystic formation and rapid subcapsular extension is frequently seen.     

颌骨造釉细胞瘤的影像学研究

目的研究颌骨造釉细胞瘤的影像学特征,探讨CT、MRI对颌骨造釉细胞瘤的诊断及鉴别诊断价值.方法回顾分析20例经手术病理证实的颌骨造釉细胞瘤的CT（20例）、MRI（10例）表现.观察病变的部位、形态、内部结构、邻近结构侵犯及囊内容物密度和（或）信号特征等.结果20例中,14例位于下颌磨牙与升支区,其他部位少见.CT表现：20例中,病变呈多房型13例,单房型7例;肿瘤造成邻近骨质缺损18例,其中9例缺损范围超过囊壁周长的1/2,5例肿瘤穿破邻近骨皮质,形成局部软组织肿块;9例牙根吸收,呈截断状;18例造成邻近重要结构（下颌管、上颌窦、鼻腔等）的侵犯;囊变区CT值范围为9.5～31.4 HU,平均21.2 HU.MRI表现：10例中,5例呈囊实性,实性部分均呈等T1、等T2信号;另5例呈纯囊性,其中4例呈不规则厚壁,1例囊壁见乳头状突起;囊内容物呈均一长T1、长T2信号7例,呈不均匀混杂信号3例.增强检查6例中,4例实体部分呈明显均一强化,2例囊壁呈明显不规则强化.结论造釉细胞瘤在发生部位、形态、内部结构及邻近结构侵犯等方面均具有一定的特征性.高分辨螺旋CT配合二维曲面牙科软件技术可显示病变的形态、周围骨质破坏、牙根吸收及邻近重要结构改变;MRI对于软组织成分的显示优于CT,二者联合应用对于提高造釉细胞瘤的术前诊断正确率有重要价值.     

Computed tomography and magnetic resonance imaging findings in cerebral hydatid disease

Purpose: The purpose of this study was to describe the discriminative computed tomography (CT) and magnetic resonance imaging (MRI) features of cerebral hydatid disease.Methods: The CT and MRI findings of four cases of surgically proven cerebral hydatid cysts were retrospectively reviewed. Results: CT demonstrated well-defined cystic lesions with no perilesional oedema and no contrast enhancement in all cases except one recurrent disease that showed both peripheral oedema and rim enhancement. MR images revealed well-defined cystic lesions with a quite clear rim that showed relative hypointensity limited to some aspects of the cyst walls on T2-weighted images. The cysts were spherical and obvious mass effect was observed on both CT and MR examinations. Conclusions: Although the cystic nature of intracranial hydatid disease could be equally well demonstrated on CT and MR examinations, CT is superior in detecting calcification of the cyst wall or septa, when present, and MR is better in demonstrating cyst capsule, detecting multiplicity and defining the anatomic relationship of the lesion with the adjacent structures and helps in surgical planning.     

Improved detection of intraventricular cysticercal cysts with the use of three-dimensional constructive interference in steady state MR sequences

BACKGROUND AND PURPOSE: Before the advent of MR imaging, intraventricular cysts were difficult to diagnose noninvasively. Among the invasive procedures used were contrast ventriculography and CT ventriculography. MR imaging, with its multiplanar imaging capabilities, excellent depiction of tissue contrast, and versatile parameters, is an important tool in the assessment of intraventricular cystic lesions. We investigated the role of three-dimensional constructive interference in steady state (3D-CISS) MR sequences in the evaluation of intraventricular cysticercal cysts. METHODS: The study group comprised 11 patients with intraventricular cysticercal cysts. MR studies included spin-echo (SE) T1-weighted, turbo-SE T2-weighted, and 3D-CISS sequences. All images were obtained on a superconducting 1.5-T MR unit. The routine and 3D-CISS sequences were reviewed and interpreted separately by two neuroradiologists. RESULTS: All patients underwent surgery for excision of intraventricular cysticercal cysts. Eight patients had cysts in the fourth ventricle, two in the lateral ventricle, and one in the third ventricle. SE T1-weighted images showed the cystic wall in nine cases, the scolex in four, and the cystic fluid in two. Turbo-SE T2-weighted images showed the cystic wall and scolex in three and four cases, respectively. The routine sequences did not show the scolex, cystic wall, or cystic fluid together in any of the 11 patients. 3D-CISS images showed the scolex in all 11 patients and the cystic wall and cystic fluid in eight patients each. In seven of the 11 patients, 3D-CISS images showed the scolex, cystic wall, and fluid together. CONCLUSION: The 3D-CISS sequence is more sensitive and specific than routine SE sequences in the diagnosis of intraventricular cysticercal cysts.     

胚胎发育不良性神经上皮瘤的影像学与临床病理特征

目的探讨胚胎发育不良性神经上皮瘤（DNT）的MRI、CT表现及临床病理特征。方法回顾性分析经组织病理学证实的12例DNT的MRI、CT表现与临床病理特点。结果男6例，女6例，年龄12～68岁（平均36．7岁）。大多数病例以癫痫小发作为主，神经系统检查无阳性体征。MR检查病变均位于幕上结构，累及皮层，额叶（4例）及颞叶（3例）为主；最大径2-5cm不等，形态呈类圆形、分叶状或不规则状；2例累及白质，7例伴囊性变。病变在MRI均呈T1WI低信号，T2WI高信号，无病变周围水肿及占位效应；囊性病变在T1WI信号均匀，等于或略高于脑脊液。6例CT扫描病变均呈低密度改变，其中2例呈囊性分叶状，1例呈局灶性钙化；4例增强后病变无强化，1例病变内呈轻度不均匀强化。病理组织学DNT分为3型：单纯型（4例）、复杂型（6例）及非特异型（2例）。结论DNT是一种良性病变，MRI较CT更具特征性表现。     

卵巢囊性腺纤维瘤CT及MRI表现

目的：探讨卵巢囊性腺纤维瘤的CT及MRI表现特点,提高对该病的诊断水平。方法：回顾性分析11例经手术病理证实的卵巢囊性腺纤维瘤患者的CT及MRI资料,其中9例行CT平扫及增强扫描,2例行MRI平扫。结果：本组11例中6例呈囊性,5例呈囊实性。囊性病灶与卵巢囊腺瘤的影像表现无法鉴别。3例囊实性病灶在CT增强后于实性区内可见多发小囊样无强化区,呈＂筛孔样＂改变。2例囊实性病灶于MRI T2加权呈低信号的实性部分内可见多发小囊样、索条状高信号,形成＂黑色海绵征＂。结论：＂筛孔征＂及＂黑色海绵征＂是卵巢囊性腺纤维瘤的影像特征,有助于其诊断与鉴别诊断。     

毛细胞星形细胞瘤的CT、MRI诊断分析

目的探讨毛细胞型星形细胞瘤的CT、MRI特征。方法回顾性分析8例经手术病理证实的毛细胞型星形细胞瘤的CT及MRI表现。结果（1）病变好发于小脑,8例毛细胞星形细胞瘤中,起源于幕下者5例。幕上者3例。（2）肿瘤呈类圆形,伴不同程度囊变,根据囊变程度可分为囊肿型、囊肿结节型和肿块型,以囊肿结节型最多见;（3）肿瘤囊性部分CT平扫呈低密度,MR平扫T1WI呈明显低信号,T2W1呈明显高信号;肿瘤实性部分、囊壁及壁结节CT呈等或稍低密度,MRT1W1呈等或稍低信号,T2WI呈稍高信号。增强后肿瘤囊壁不强化或轻度强化,壁结节及实性部分明显强化,囊性部分不强化;（4）肿瘤边界清楚,瘤周无水肿;（5）肿瘤出血与钙化少见。结论毛细胞型星形细胞瘤在CT、MRI表现具有一定特征性,可为临床术前提供信息。     

泪腺腺样囊性癌的CT和MRI诊断

目的研究泪腺腺样囊性癌的CT和MRI表现。资料与方法回顾性分析32例经组织学证实的泪腺腺样囊性癌患者的影像学资料。结果32例均为单侧发病,其中位于左侧19例,右侧13例。CT表现：病变呈长圆形11例,不规则形8例,扁平形7例,卵圆形4例,分叶状2例;24例边界清楚,10例轮廓呈锯齿状;11例密度不均匀,内见低密度区和／或钙化,增强后中到高度强化;24例包绕并压迫眼球,16例沿眶外壁向眶尖区生长,与外直肌分界不清,其中4例浸润视神经;邻近眶壁骨质虫蚀样破坏24例,明显溶骨性破坏3例。MRI表现：与正常眼外肌比较,T1WI呈低信号14例,等信号12例,T2WI呈高信号22例,等信号4例,其中22例信号不均匀,中到高度强化。病变可蔓延到颅内、颞窝、颞下窝、翼腭窝等邻近结构,也可沿神经周扩散。结论泪腺腺样囊性癌有特异影像学征象,可提示诊断;CT是诊断本病的主要影像检查方法,MRI能更清楚地显示病变的范围,CT联合MRI可对诊断、治疗提供重要信息。