脐尿管病变的CT诊断

目的:探讨脐尿管病变的CT表现特点及诊断价值。方法:对15例经手术病理证实脐尿管病变的CT表现进行回顾分析。结果:15例病变均位于脐尿管走行区。其中脐尿管囊肿5例,4例单纯性囊肿均表现为圆形或椭圆形囊性病灶,囊壁光整,增强后无强化;1例囊肿合并感染者呈多房状,囊壁毛糙,强化明显,周围脂肪组织炎性水肿渗出。4例脐尿管肿瘤发生于脐尿管膀胱交界区,呈不规则软组织肿块,增强后肿块强化明显。6例脐尿管结石,5例位于膀胱脐尿管交界区,1例位于脐尿管近膀胱段,均表现为单发或多发的圆形或类圆形高密度影,边缘光整。结论:脐尿管囊肿、肿瘤及结石的CT表现均有各自特征性,术前CT可做出明确诊断。     

脐尿管病变的CT诊断

目的 探讨脐尿管病变的CT表现及其临床诊断价值。方法 回顾分析23例经手术病理证实的脐尿管病变的CT表现，包括病灶部位、形态、大小、增强以及Retzius间隙影像改变。结果 全部23例脐尿管病变均位于腹中线处Retzius间隙内的脐尿管走行区。1例脐尿管未闭CT显示阴性。2例单纯性脐尿管囊肿表现为椭圆形或长条状囊性病灶，囊壁光整，囊内密度均匀，增强后无强化。5例脐尿管囊肿伴感染者表现为形态类似的囊性块影，壁厚强化明显，另3例病灶呈多房状，2例呈均匀软组织块影，伴感染之10例在灶周Retzius间隙内均见多少不等的片絮状或索条状密度增高影。7例脐尿管肿瘤均位于中线位膀胱顶壁区，呈不规则软组织肿块状，增强后强化明显4例，轻度强化2例，无明显强化1例。3例膀胱脐尿管憩室伴结石表现为横贯膀胱壁内外的高密度影，另1例伴发脐下脐尿管囊肿感染。结论 由于其独特的解剖部位，术前脐尿管病变很容易为CT识别，当脐尿管囊肿合并感染呈均质软组织块时需与脐尿管肿瘤相鉴别。     

卵巢囊肿蒂扭转的CT诊断

目的:探讨卵巢囊肿蒂扭转的CT表现及诊断价值.方法:回顾性分析6例经手术病理证实的卵巢囊肿蒂扭转的临床资料和CT征象.平扫6例,增强扫描4例.结果:6例CT平扫均出现囊实性双肿块、囊壁均匀或不均匀增厚、囊肿位置变化、盆腔积液等征象.3例子宫偏向扭转侧,1例囊内出血,1例囊肿破裂.增强扫描,强化减弱或无强化.结论:卵巢囊肿蒂扭转的CT表现有一定特征性,CT作为超声检查的一种补充检查方法,对卵巢囊肿蒂扭转的诊断和鉴别诊断具有重要价值.     

Calcified renal stones and cyst calcifications in autosomal dominant polycystic kidney disease: clinical and CT study in 84 patients.

Although renal calculi and cyst calcifications occur commonly in patients with autosomal dominant polycystic kidney disease (ADPKD), their true frequency is unknown because it is difficult to distinguish between the two with excretory urography and sonography. A detailed analysis of renal calcifications in ADPKD based on CT findings has not been performed. Accordingly, we retrospectively evaluated clinical and CT findings in 84 patients with ADPKD to determine the frequency of calculi and cyst calcifications, the relationship of these abnormalities to symptoms, and possible factors in their pathogenesis. Of the 84 patients, 53 had both IV contrast-enhanced and unenhanced CT scans and 31 had unenhanced scans only. We examined unenhanced CT scans of all 84 patients for renal calcifications. However, we classified renal calcifications into stones and cyst calcifications in only the 53 patients, because it is often difficult to distinguish between the two when only unenhanced scans are available. Of 84 patients, 18 (21%) had passed renal calculi or had stones treated surgically and 42 (50%) had renal calcifications on CT. Of the 53 patients who had both enhanced and unenhanced CT scans, 19 (36%) had renal calculi on CT. Patients with stones had significantly higher frequencies of previous flank pain (68% vs 35%) and of urinary tract infections (63% vs 18%) than did those without calculi. Cyst calcifications occurred in 13 (25%) of 53 patients and were probably a consequence of cyst hemorrhage. Cyst calcifications were found significantly more often in older patients with larger kidneys and worse renal function. We conclude that renal stones have a high rate of occurrence among patients with ADPKD and are a significant cause of morbidity in this disorder. Cyst calcification is also common in patients with ADPKD, particularly those with more advanced cystic disease.     

纵隔囊肿的CT诊断与鉴别诊断

目的提高纵隔囊肿的诊断与鉴别诊断水平。方法收集经手术病理证实的纵隔囊肿36例,分析其CT表现。结果所有病例CT表现均为边缘清晰、囊壁菲薄、内为不强化的水样密度肿块。其中神经肠源性囊肿1例、支气管囊肿12例、食管囊肿2例、心包囊肿5例、皮样囊肿7例、淋巴管囊肿4例、胸腺囊肿4例、非特异性囊肿1例。结论根据CT平扫和增强扫描上特征性表现,可较正确地作出纵隔囊肿的诊断,并与其它囊性病变鉴别。     

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.     

CT features with pathologic correlation of acute gastrointestinal graft-versus-host disease after bone marrow transplantation in adults

OBJECTIVE: This study was conducted to describe the CT features of acute gastrointestinal graft-versus-host disease in adults and to correlate these findings with the pathologic grades of disease severity. MATERIALS AND METHODS: Patients (n = 22) with a history of allogeneic bone marrow transplantation and pathologically confirmed acute gastrointestinal graft-versus-host disease underwent contrast-enhanced (n = 13) and unenhanced (n = 9) CT. CT scans were retrospectively evaluated for intestinal and extraintestinal abnormalities by two radiologists who were unaware of the biopsy results. The CT findings were correlated with the pathologic grade of disease severity using the Pearson's correlation coefficient and the two-tailed nonparametric Spearman's rank correlation coefficient. RESULTS: CT features included small-bowel wall thickening (22/22), engorgement of the vasa recta adjacent to affected bowel segments (20/22), stranding of the mesenteric fat (16/22), large-bowel wall thickening (13/22), bowel dilatation proximal to thickened wall segments (5/22), ascites (10/22), periportal edema (8/22), mucosal enhancement (7/13), and serosal enhancement (4/13). The wall thickening had a discontinuous distribution in nine patients (41%). Bowel wall thickening was associated with high-grade graft-versus-host disease in patients in whom the distal esophagus (p = 0.015), ileum (p = 0.034), or ascending colon (p = 0.05) was involved. Increasing numbers of thickened bowel segments correlated with high-grade graft-versus-host disease (r = 0.548, p = 0.008). Increasing numbers of abnormal CT findings did not correlate with high-grade graft-versus-host disease (r = 0.117, p = 0.604). CONCLUSION: A variety of bowel abnormalities can be seen on CT in patients with acute graft-versus-host disease. CT findings associated with high-grade graft-versus-host disease are thickening of the distal esophagus, ileum, or ascending colon, as well as increasing numbers of thickened bowel wall segments.     

双能CT与MDCT多期增强扫描对肾囊肿CT值的影响

目的:对比研究双能CT和多排螺旋CT多期增强扫描肾囊肿CT值的变化,观察肾囊肿假性强化现象。方法:43例肾囊肿患者(46个肾囊肿)纳入本次研究,均采用CT多期增强扫描,所有病灶均被诊断为单纯肾囊肿(BosniakⅠ型)。患者行常规平扫后,经肘静脉团注非离子型对比剂,分别采集25s皮质期、70s皮髓质期及120s均衡期图像。23位患者的26个囊肿采用GE MDCT腹部多期扫描,20位患者的20个囊肿采用Siemens双能CT腹部多期扫描。结果:46个肾囊肿中直径最小5mm,最大57mm。双能CT检出20例肾囊肿,6例出现假性强化,MDCT检出26例肾囊肿,13例出现假性强化,双能CT和MDCT的假性强化发生率差异无统计学意义(P=0.177)。双能CT扫描增强前后囊肿的CT值最大相差(8.74±7.09)HU;MDCT扫描增强前后囊肿的CT值最大相差(11.64±7.37)HU。直径<1cm的囊肿在重建层厚5mm时假性强化的概率明显高于重建层厚1mm时假性强化的概率。结论:肾囊肿假性强化的现象是客观存在的,部分容积效应和硬射线效应是其中的两个重要因素。另外,MDCT机型、病变大小、肾脏背景浓度及肾囊肿位置都是影响囊肿CT值测量的因素。     

Intracranial ganglioglioma: clinicopathological and MRI findings in 16 patients

AIM: To record the clinical findings and magnetic resonance imaging (MRI) characteristics of intracranial gangliogliomas in 16 patients. MATERIALS AND METHODS: Sixteen patients were imaged using unenhanced and contrast-enhanced MRI. Eight patients underwent unenhanced CT and of these, three underwent contrast-enhanced CT. Two radiologists read the images retrospectively. The images were studied with regard to location, size, margin, signal intensity, enhancement characteristics, cystic changes, and presence of calcifications. Clinical data, such as presenting signs and symptoms, physical findings, and medical histories, were collected. Histopathological and immunohistochemical studies were performed and analysed by two pathologists. RESULTS: In 12 cases the tumours were located in one of the cerebral hemispheres; in the other cases they were located in the brainstem, cerebellum, suprasellar area or the thalamus. The tumour dimension varied from 1-7 cm, with a mean of 3.6 cm+/-1.8 cm. The MRI features of ganglioglioma in the present cohort can be divided into three patterns: cystic (n=2), cystic-solid (n=6), and solid (n=8). Solid lesions had a predilection for the temporal lobe; cystic and cystic-solid tumours had a wide anatomical distribution. Cystic lesions were significantly smaller than both cystic-solid and solid lesions (F=4.28, P<0.05). Cystic changes in the cystic-solid tumours showed one of the following patterns: those with walls showing contrast enhancement, those containing an enhancing nodule, or cysts without an obvious wall. The solid portion of cystic-solid gangliogliomas and the entire tumour in solid tumours showed homogeneous enhancement of variable degrees on T1-weighted (T1W) spin-echo (SE) images. Five tumours had mild or moderate oedema. In one patient two separate gangliogliomas were found, each lesion exhibiting different MRI features: solid and cystic-solid. One case of cortical ganglioglioma was found, causing bone erosion due to pressure. One tumour with chronic haemorrhage was found in the study. CONCLUSION: MRI features of gangliogliomas are non-specific. A ganglioglioma should be suspected when a tumour shows the following features: (1) a solid lesion located in the temporal lobes with mild or no oedema and homogeneous enhancement on SE T1W images; or (2) a small cystic lesion or cystic-solid mixed mass with a wall enhancement or a markedly enhanced nodule. We report a patient with two separate gangliogliomas and a case with bone erosion.     

High-density renal cysts in autosomal dominant polycystic kidney disease demonstrated by CT

Unenhanced abdominal CT scans of 35 patients with autosomal dominant polycystic kidney disease (ADPKD) showed multiple high-density (58-84 HU) renal cysts in 42.9% of patients, occasional high-density cysts in 25.7%, and no high-density cysts in 31.4%. These high-density cysts were usually subcapsular and were more frequent in patients with markedly enlarged kidneys and flank pain at the time of CT. Several were found to contain altered blood on pathological analysis. Follow-up CT often showed a reduction in cyst densities, although some cysts developed mural calcification and calcification of their contents. High-density cysts are probably produced by cyst hemorrhage. This may occur randomly as part of the natural history of the disease or may result from minor trauma to the enlarged kidneys. Renal carcinomas occur rarely in ADPKD and may occasionally be hyperdense. However, high-density cysts may usually be distinguished from carcinomas on CT by their smooth contours, sharp interfaces with renal parenchyma, homogeneity, and lack of contrast enhancement.     

含囊腔的周围型肺癌的 MDCT 特征分析

目的：分析含囊腔的周围型肺癌的 MDCT 特征,提高诊断准确性。方法回顾性分析经病理或临床证实的21例含囊腔的周围型肺癌患者的临床资料、病理类型、TNM 分期、MDCT 表现,部分行 PET-CT 检查的,测量 SUMmax,随访的病例,评价病灶的动态变化。结果共21例(病理诊断证实腺癌11例、鳞癌6例),囊腔为主型2例(9.52%);囊性与磨玻璃密度混合型3例(14.29%);囊性与实性密度混合型14例(66.67%);囊性与磨玻璃、实性密度混合型2例(9.52%)。有软组织结节的20例,结节位于腔外5例(23.81%);结节位于腔内1例(4.76%);多房囊腔与结节混合型14例(66.67%);囊腔壁环形增厚1例(4.76%)。MDCT 征象出现60%以上的有：圆形/类圆形14例(66.67%),分叶征17例(80.95%),腔内血管穿行16例(76.19%),胸膜凹陷征17例(80.95%);出现率90%以上的征象有：多囊19例(90.48%)、不规整19例(90.48%),囊腔内见分隔19例(90.48%)。支气管通入囊腔内8例(38.10%)。病灶 CT 净增值范围14.2~40 HU,平均(28.27±7.27)HU。PET-CT SUVmax 范围4.5~9.8,平均6.05,均呈明显摄取。2例患者随访出现囊腔增大,囊壁增厚。1例患者随访囊腔缩小,实性成分增多。结论囊腔内壁不规整、腔内分隔及血管穿行是诊断含囊腔周围型肺癌的重要征象。     

Dynamic multislice helical CT of maxillomandibular lesions: distinction of ameloblastomas from other cystic lesions.

PURPOSE: To evaluate the clinical usefulness of dynamic multislice helical CT in differentiating ameloblastoma from other cystic lesions in cases of maxillomandibular cystic lesions. MATERIALS AND METHODS: The study included 32 patients with maxillomandibular cystic lesions (ameloblastoma [n=6], myxofibroma [n=1], odontogenic keratocyst [n=3], dentigerous cyst [n=11], radicular cyst [n=11], and paradental cyst [n=2]). Dynamic study was performed before and 30 sec, and 90 sec after intravenous contrast medium administration. CT density values and percentage of density increase were calculated at 30 and 90 sec. RESULTS: In five cases of ameloblastoma, a rapidly enhancing area was detected within the cystic lesions at 30 sec, while no apparent rapid enhancement was seen in the other cystic lesions. Three cysts showed gradual enhancement in the marginal area at 90 sec. Comparing ameloblastoma and other kinds of cysts, we found significant differences in the percentage of density increase at 30 sec (p<0.01) and 90 sec (p<0.05). CONCLUSION: Dynamic multislice helical CT is useful in the diagnosis of cystic lesions of the maxillomandibular region, especially in the detection of neovascularities in ameloblastoma.     

Computed tomography of corpus luteal cysts

OBJECTIVE: To describe the computed tomography (CT) features of corpus luteal cysts. METHODS: We retrospectively identified 10 patients with a diagnosis of corpus luteal cysts established by ultrasound who had also undergone contemporaneous CT. A single attending radiologist, without knowledge of other clinical or radiologic findings, recorded the morphologic features of the cysts based on the CT images. RESULTS: The corpus luteal cyst seen at sonography was visible at CT in all 10 patients. All cysts were unilocular, with a mean density of 25 HU (range, 12 to 45). The mean maximum axial cyst diameter was 2.2 cm (range, 1.4 to 2.9). The mean cyst wall thickness was 3 mm (range, 2 to 4). All cyst walls were crenulated. Cyst wall enhancement was hyperdense in 6 cases, isodense in 3 cases, and hypodense in 1 case. Free fluid was seen in 9 of 10 patients. CONCLUSIONS: At CT, corpus luteal cysts are typically less than 3 cm in diameter and are characterized by a thick, crenulated, or hyperdense wall. Recognition of these CT findings should prevent misinterpretation or inappropriate management.     

CT与CA-125检测在盆腔子宫内膜异位囊肿诊断中的应用

目的分析盆腔子宫内膜异位囊肿的CT表现,结合CA-125检测提高CT诊断水平。方法回顾性分析经手术和病理证实的23例盆腔子宫内膜异位囊肿的CT表现,并将子宫内膜异位囊肿组与对照组CA-125检测数据进行统计学分析。结果CT发现卵巢子宫内膜异位囊肿20例23个囊肿以及右侧阔韧带异位囊肿、左侧阔韧带与子宫前壁间异位囊肿、腹壁切口子宫内膜异位囊肿各1个,共26个囊肿。病灶长径33～111mm,平均（67±24）mm：单房8个,双房1个,多房17个;囊肿壁〈3mm22个,囊壁≥3mm4个;囊肿边界模糊21个,边缘清晰5个;囊内cT值5～65Hu;增强扫描囊壁轻中度强化22个,明显强化4个,囊内均未见强化。23例盆腔子宫内膜异位囊肿CA-125检测阳性19例,平均（63±30）U／mL,与对照组比较有统计学意义（P〈0．05）。结论cT能较大程度显示盆腔子宫内膜异位囊肿的形态特征,CT结合CA-125检测可提高诊断正确率。     

囊性肾癌的CT和MRI表现

目的:分析囊性肾癌的CT和MRI表现,旨在提高术前正确诊断率。方法:回顾性分析经手术病理证实的16例囊性肾癌的CT和MRI表现。结果:囊性肾癌16例,囊壁不规则增厚12例,间隔不规则增厚8例,囊壁结节10例;囊性病变内出现异常软组织影6例,和/或囊性病变周围肾实质内出现异常软组织影4例;钙化2例;增强扫描实性部分明显增强8例,中度增强5例,轻度增强3例。结论:囊性肾癌的CT、MR表现有一定特征,表现典型者可做出诊断。     

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。     

婴幼儿甲状舌管囊肿的CT诊断（附23例分析）

目的：探讨婴幼儿甲状舌管囊肿的CT表现。方法：对23例手术和病理证实的婴儿甲状舌管囊肿进行回顾分析。结果：CT表现为颈前正中圆形或椭圆形囊肿18例,偏一侧者5例;6例与舌骨直接关联;17例与甲状腺直接关联。CT平扫囊肿呈低密度15例,等密度8例。14例增强扫描囊内均无强化,其中11例囊壁有强化。全部病例未见钙化、瘘管及囊肿向喉内延伸。结论：婴幼儿甲状舌管囊肿的CT表现具有特征性,可为临床提供明确诊断。     

卵巢颗粒细胞瘤的临床特点和CT诊断分析

目的分析卵巢颗粒细胞瘤的临床资料及CT资料,提高对该疾病的诊断能力。方法回顾性分析13例经手术病理证实的卵巢颗粒细胞瘤的临床及CT资料。结果13例患者中11例初发,且均为单个病灶,左侧卵巢5例,右侧卵巢6例,呈圆形或椭圆形。2例患者为复发,1例单发病灶,呈不规则形,1例3个病灶,呈圆形或椭圆形。CT表现初发病例与复发病例相似,多数肿块边缘光滑,与周围组织分界清楚,11个病灶表现为囊实性肿块,2个病灶以实性为主肿块,2个病灶以囊性为主肿块。增强扫描实性部分、囊壁及分隔不同程度强化,3例呈轻度强化,8例呈中度强化,2例呈明显强化。8例患者伴有不同程度子宫体积增大、子宫内膜增厚,3例患者伴有子宫肌瘤,6例患者伴有腹水。结论卵巢颗粒细胞瘤的临床特点及CT表现具有一定的特征性,但缺乏特异性,综合分析有助于提高该疾病的正确诊断率。     

卵巢良性囊性病变的CT、MRI表现

目的 分析卵巢良性囊性病变(BOCL)的CT和MRI表现,提高对其的影像诊断与鉴别诊断水平.方法 回顾分析48例经手术病理证实的BOCL的CT和MRI表现.35例行CT平扫,其中20例行CT增强检查;8例行MRI平扫,其中3例行MRI增强检查及扩散加权成像(DWI)检查;5例同时行CT、MRI检查.结果 囊肿11例(单纯性囊肿3例、黄体囊肿3例、子宫内膜异位囊肿5例),浆液性囊腺瘤10例13个病灶,黏液性囊腺瘤8例,囊性成熟型畸胎瘤9例10个病灶,卵巢甲状腺肿10例.BOCL的大小、形态、囊壁(厚度、有无壁结节)、密度或信号、强化程度和方式等特征有助于其诊断与鉴别诊断.结论 部分BOCL的CT、MRI表现具有一定特点,术前可做出正确诊断,为临床治疗方案的选择及预后判断提供一定的理论依据.     

多层螺旋CT对胰腺囊腺瘤与囊腺癌的诊断价值

目的：探讨胰腺囊腺瘤和囊腺癌的多层螺旋CT表现及其诊断价值。方法：回顾性分析21例经手术病理证实的胰腺囊腺瘤和囊腺癌的多层螺旋CT表现。所有患者均行CT平扫及增强扫描,并采用多平面重组（MPR）和最大密度投影（MIP）等方法对图像进行后处理。结果：21例中胰腺浆液性囊腺瘤7例,其特征性的CT表现有蜂窝样囊性病灶（6例）且单个小囊最大直径≤2cm、分叶状（4例）、囊壁及囊内间隔增强后呈轻度强化（7例）、囊壁光整（7例）。黏液性囊腺瘤4例,主要CT表现为多房囊性病灶（4／4）、绝大多数小囊的最大直径〉2cm、囊壁较厚且厚薄不均（4例）、2例可见壁结节,增强扫描示囊壁、分隔及壁结节有轻度一中度强化。胰腺囊腺癌10例,CT平扫示肿瘤呈囊状低密度影,有壁结节及分隔;增强扫描示囊壁、壁结节及分隔呈中度一明显强化。结论：胰腺黏液性和浆液性囊腺瘤及囊腺癌的MSCT表现有一定特征性,MSCT对本病的诊断及鉴别诊断具有重要的临床价值。