国人非霍奇金淋巴瘤侵犯腹部和盆腔淋巴结的CT表现

目的分析国人非霍奇金淋巴瘤(NHL)侵犯腹部和盆腔淋巴结的CT表现,探讨其与病理类型的关系.方法 NHL患者经腹部和(或)盆腔CT发现淋巴结阳性者241例,其中96例符合入组条件.按照临床归类标准分为惰性淋巴瘤31例,侵袭性淋巴瘤61例,高度侵袭性淋巴瘤2例,不能归类2例.CT扫描范围包括腹部和盆腔46例,腹部47例,盆腔3例.80例行增强扫描.淋巴结按照腹膜后、肠系膜、腹腔、膈脚后、横膈、髂总、髂内、髂外、腹股沟组分区.淋巴结的大小取横断面最大淋巴结的短径.分析受侵淋巴结大小、数目、孤立与融合、密度,以及与病理类型的关系.结果(1)淋巴结大小以短径≤2 cm淋巴结为多,按部位计算在惰性和侵袭性淋巴瘤中共占60.5%(219/362处),分别占56.6%(77/136处),62.8%(142/226处)(χ2＝0.341,P=0.559).惰性与侵袭性淋巴瘤各部位受侵淋巴结的大小差异均无显著性意义(P值均>0.05).(2)淋巴结数目以肠系膜受侵淋巴结数目最多,惰性(6.5个)多于侵袭性(5个)淋巴瘤;腹膜后次之(惰性和侵袭性分别为4个),其中肾门上、下淋巴结受侵数目多于单纯肾门上或肾门下受侵者.(3)淋巴结孤立与融合以孤立和孤立为主最为常见,占77.1%(279/362处),惰性与侵袭性淋巴瘤分别为74.3%(101/136处)、78.8%(178/226处)(χ2=0.971,P=0.324).(4)增强后淋巴结密度以均匀多见,共86.0%(252/293处),惰性与侵袭性淋巴瘤分别为82.6%(100/121处)、88.4%(152/172处)(χ2=1.936,P=0.164);惰性淋巴瘤(14处)内出现坏死较侵袭性(12处)淋巴瘤略多(χ2=1.853,P=0.173).(5)淋巴结大小与密度的关系≤2 cm淋巴结以密度均匀占绝大多数(97.7%)(170/174处),惰性和侵袭性淋巴瘤相仿,分别为98.5%(67/68处)和97.2%(103/106处).淋巴结＞2 cm时,坏死几率明显增多,惰性和侵袭性淋巴瘤差异有非常显著性意义(χ2=27.311与20.807,P值均=0.000).结论惰性与侵袭性NHL侵犯腹部和盆腔淋巴结多表现为孤立或孤立为主,密度均匀,短径≤2 cm,在大小、数目、孤立抑或融合方面差异均无显著性意义.淋巴结密度不均与淋巴结大小有关,淋巴结短径>2 cm者,密度不均匀的机会明显增加.     

Urinary tract malakoplakia with extension into the retroperitoneum with secondary gastrointestinal involvement

A rare case of malakoplakia of the urinary tract with diffuse retroperitoneal extension is presented. Sonographically guided cytologic puncture revealed the pathologic diagnosis. The splenic flexure of the colon and the stomach appeared to be secondarily involved in the inflammatory retroperitoneal tumor. The relative role of the various imaging modalities in defining retroperitoneal extension of the disease is illustrated, with a special reference to computed tomography and endosonography. After antimicrobial treatment and left nephrectomy, partial regression of the retroperitoneal mass was documented.     

CT features of primary cerebral lymphoma in AIDS and non-AIDS patients

Computed tomographic study of six cases with primary cerebral non-Hodgkin lymphoma are reviewed. Three had a history of intravenous drug abuse and were diagnosed as having acquired immunodeficiency syndrome (AIDS). All cases presented with space occupying lesions in the frontal lobe with the exception of Case 4. Computed tomography demonstrated multiple lesions in AIDS cases whereas non-AIDS lesions were invariably single. The AIDS patients died within 1 year despite radiotherapy as compared with the non-AIDS patients.     

Urinary tract malakoplakia with extension into the retroperitoneum with secondary gastrointestinal involvement

A rare case of malakoplakia of the urinary tract with diffuse retroperitoneal extension is presented. Sonographically guided cytologic puncture revealed the pathologic diagnosis. The splenic flexure of the colon and the stomach appeared to be secondarily involved in the inflammatory retroperitoneal tumor. The relative role of the various imaging modalities in defining retroperitoneal extension of the disease is illustrated, with a special reference to computed tomography and endosonography. After antimicrobial treatment and left nephrectomy, partial regression of the retroperitoneal mass was documented.     

Retroperitoneal neurilemoma: CT and MR findings.

OBJECTIVE. Our objective was to characterize the CT and MR imaging findings of retroperitoneal neurilemomas. MATERIALS AND METHODS. We reviewed the CT and MR imaging findings in six women with retroperitoneal neurilemomas. RESULTS. Retroperitoneal neurilemomas were round, 5-13 cm in diameter, and located in the presacral pelvic retroperitoneum in four patients and adjacent to the kidney in two patients. CT findings of the tumors were well-demarcated round masses showing prominent cystic changes and oriented in a somewhat radial fashion. Medium and heavily T2-weighted MR images showed high-intensity necrotic areas and nonnecrotic areas of various signal intensity. CONCLUSION. CT findings of a round mass with prominent cystic degeneration, along with certain MR imaging characteristics, may be helpful in the preoperative diagnosis of retroperitoneal neurilemomas.     

Retroperitoneal fibrosis: ultrasound and CT features.

The sonographic and computed tomographic (CT) findings in three cases of retroperitoneal fibrosis are illustrated. Its clinical, laboratory, and conventional radiographic findings are often nonspecific. The sonographic findings consist of an extensive retroperitoneal, extrarenal, anechoic, well marginated, and irregularly contoured mass. Computed tomography depicts a paraspinal, extrarenal, and well marginated lesion that is isodense with the surrounding muscles. Through other abnormalities present similar sonographic and CT findings, the differential diagnosis is limited so that correlation of the clinical and radiographic changes allows a preoperative diagnosis with high confidence.     

CNS involvement in AIDS: spectrum of CT and MR findings

The brain may be affected by a variety of abnormalities in association with human immunodeficiency virus (HIV) infection. Knowledge of their existence and characteristic imaging features are important to radiologists for detection, diagnosis, and initiation of an appropriate treatment. Although there is a considerable overlap in the imaging characteristics of different entities, some findings are found to be very suggestive of a particular disease. The CT and MR imaging techniques are commonly used in the diagnosis of neurological disorders in acquired immunodeficiency syndrome (AIDS) patients, to verify treatment response and to guide brain biopsy. This review attempts to describe CT and MR features of infectious and malignant brain disorders in HIV-seropositive patients. Received 1 July 1996; Revision received 21 October 1996; Accepted: 28 November 1996     

Ultrasonography of the genitourinary tract in children.

The author discusses the utility of ultrasound in investigating the genitourinary tract in neonates, infants, and children, and emphasizes the inter-dependence of ultrasonography and uroradiology.     

Lymphoma of the genitourinary tract

Lymphomatous involvement of the genitourinary tract is extremely rare when it presents as primary extranodal disease. It is more common in the advanced stage of disseminated disease. Computed tomography is the best diagnostic modality to detect the involvement of the genitourinary tract. Although the appearances are generally nonspecific, certain characteristics on computed tomography may suggest and allow for a proper approach to the diagnosis.     

Helical CT of the abdomen and pelvis: potential diagnostic pitfalls of arterial-phase imaging in the genitourinary tract

Spiral computed tomography (CT) is the state of the art today in imaging many features of the genitourinary tract. The use of dual-phase CT imaging improves our ability to detect and stage a wide range of pathologies. However, imaging in the arterial phase has several potential pitfalls that can result in either overcalling or undercalling genitourinary pathology. This paper reviews some of the common pitfalls and presents strategies on how to avoid them.     

Mesenteric neoplasms: CT appearances of primary and secondary tumors and differential diagnosis.

Computed tomography (CT) remains the optimal imaging modality for diagnosing tumors in the mesentery. Although primary neoplasms arising from the mesenchymal tissues of the mesentery are rare, the small bowel mesentery is a major avenue for the dissemination of tumor within the peritoneal cavity. Tumors spread to the mesentery by four major routes: (a) direct extension, commonly seen with carcinoid tumor of the small intestine as well as intraabdominal cancers such as pancreatic and colon cancer; (b) lymphatic dissemination of lymphoma and some epithelial malignancies; (c) hematogenic spread resulting in embolic metastases to the small intestinal wall, usually seen in melanoma and breast cancer; and (d) seeding through the peritoneum from ovarian and gastrointestinal malignancies as well as some lymphomas. Although percutaneous imaging-guided or surgical biopsy is often necessary to guide management, analysis of CT features along with the clinical history may be useful in differentiating mesenteric tumors from infectious, inflammatory, or vascular processes affecting the mesentery. The article presents the characteristic appearances of primary and secondary mesenteric neoplasms at CT and offers a rational approach to the differential diagnosis of mesenteric masses depicted at CT.     

Lung involvement in patients with secondary immunodeficiency states

The period of last years was marked by an increasing number of patients with secondary immunodeficiencies who have also got a diagnosis of various lung pathology (bacterial pneumonia is more frequent, however protozoan, fungal, viral, tuberculous and malignant affections of lungs also are not unusual). Diagnostics and treatment of such affections require a considerable improvement. These were the goals of clinic data analysis and pathologicoanatomic studies. The article gives the systematization of lung affections and stresses the peculiarities in diagnostics and treatment of patients with lung affections on the background of secondary immunodeficiencies.     

Bone involvement in patients with lymphoma: the role of FDG-PET/CT

Purpose To evaluate the diagnostic impact and clinical significance of FDG-avid bone lesions detected by FDG-PET/CT in patients with lymphoma. Methods The study population comprised 50 consecutive patients (mean age 41.7±15.5 years; 27 female, 23 male; 41 staging, 9 restaging) with Hodgkin’s disease (n=22) or aggressive non-Hodgkin’s lymphoma (n=28) in whom FDG-avid bone lesions were detected by FDG-PET/CT. All patients had either direct biopsy of the FDG-avid bone lesion (n=18), standard bone marrow biopsy at the iliac crest (BMB; n=43) or both procedures (n=11). In 15 patients, additional MRI of the bone lesions was performed. All patients underwent FDG-PET/CT after the end of treatment. All CT images of FDG-PET/CT scans were analysed independently regarding morphological osseous changes and compared with FDG-PET results. Results In the 50 patients, 193 FDG-avid lesions were found by PET/CT. The mean standardised uptake value was 6.26 (±3.22). All direct bone biopsies (n=18) of the FDG-avid lesions proved the presence of lymphomatous infiltration. BMB (n=43) was positive in 12 patients (27.9%). In CT, 32 of 193 (16.6%) lesions were detected without the PET information. No additional morphological bone infiltration was detected on CT compared with FDG-PET. All morphological bone alterations on CT scans persisted after the end of therapy. Additional PET/CT information regarding uni- or multifocal bone involvement resulted in lymphoma upstaging in 21 (42%) patients compared with the combined information provided by CT and BMB. Conclusion In patients with FDG-avid bone lesions, FDG-PET is superior to CT alone or in combination with unilateral BMB in detecting bone marrow involvement, leading to upstaging in a relevant proportion of patients.     

CT demonstration of pelvic wall spread in primary colonic linitis plastica.

Primary linitis plastica of the colon is a rare entity, and its radiographic and CT findings have been described in previously published literature. We present the CT demonstration of the pelvic wall spread in this unusual disease, and briefly review its radiologic and pathologic features.     

Lesions of the head and neck in patients with AIDS: CT and MR findings

The CT and/or MR findings were reviewed in 43 patients with head and neck disease; 27 had AIDS, 14 had AIDS-related complex, and two had positive human immunodeficiency virus serologies. Fourteen patients had infections, 15 had tumors, and 15 had benign lymphoid hyperplasia. Deep cervical infections were caused by bacterial and mycobacterial organisms, including Mycobacterium avium-intracellulare. Bacterial infections were clinically more virulent than they would be in immunocompetent patients. Neoplasms included Kaposi sarcoma, lymphoma, and squamous cell carcinoma. Benign lymphoid hyperplasia demonstrated enlargement of the cervical lymph nodes, adenoids, and tonsils. Although there was considerable overlap in the imaging characteristics of the various diseases seen, several distinguishing features were noted. Cellulitis, with infiltration and thickening of the subcutaneous fat, was typical of bacterial infections, but was uncommon with tumors or mycobacterial infections. Lymph nodes with necrotic centers were seen with Kaposi sarcoma, squamous cell carcinoma, and mycobacterial infection, but not with lymphoma or benign lymphoid hyperplasia. Benign adenoidal enlargement is usually symmetric with a flat anterior border, but bulky lesions indistinguishable from tumor were seen in two patients. It is important for radiologists to be aware of the spectrum of head and neck disease in patients with human immunodeficiency virus. The CT and MR assessment can guide biopsy and assist in planning therapy.     

Diagnostic sonography of the fetal genitourinary tract

Fetal diagnosis has vastly improved over the last decade. Ultrasound has become the imaging modality of choice. As real-time equipment has improved technologically, the ability to deduce subtle abnormalities has greatly increased. The fetal genitourinary tract may be evaluated for renal dysplasias, anomalies, or obstruction. Points of obstruction and, at times, the exact cause of obstruction may be deduced. Abnormalities of the ureter, bladder, urethra, scrotum, or reproductive system can be detected.     

Diagnostic sonography of the fetal genitourinary tract

Fetal diagnosis has vastly improved over the last decade. Ultrasound has become the imaging modality of choice. As real-time equipment has improved technologically, the ability to deduce subtle abnormalities has greatly increased. The fetal genitourinary tract may be evaluated for renal dysplasias, anomalies, or obstruction. Points of obstruction and, at times, the exact cause of obstruction may be deduced. Abnormalities of the ureter, bladder, urethra, scrotum, or reproductive system can be detected. Early diagnosis allows for proper individual or family counseling for hereditable disorders and chromosomal abnormalities. The perinatology team can be alerted to an abnormality that may require early neonatal surgical or medical intervention. Early treatment can prevent significant deterioration of renal function. The possibilities of prenatal intervention may be considered.     

Mediastinal neuroblastoma and ganglioneuroma. The differentiation between primary and secondary involvement on the chest roentgenogram.

The roentgenologic diagnosis and differentiation of mediastinal neurogenic tumors are possible on the chest roentgenogram as a rule. The soft tissue mass may be ill-defined and the tumor "ghost-like" in the case of primary neuroblastoma, but it is usually obvious in ganglioneuroma and metastatic disease. The presence of calcifications differentiates neurogenic tumors from other posterior mediastinal tumors of childhood. They are common in primary and rare in secondary disease. Rib erosions and displacement are striking in neuroblastoma (after a few months of age), more subtle in ganglioneuroma, and absent with secondary involvement. In 3 out of 7 posterior mediastinal neuroblastomas the diagnosis and treatment were delayed, as the adjacent rib changes were not appreciated for some time. "Dumbbell" shaped tumors are usually associated with vertebral changes and myelography is indicated even in the absence of neurologic deficit. Thoracic deformity and disability subsequent to laminectomy, radiation therapy, or both, are present in all survivors.