Solid and papillary epithelial neoplasm of the pancreas: MR imaging and pathologic correlation.

Correlation of magnetic resonance (MR) imaging findings and those at pathologic evaluation was attempted in six cases of solid and papillary epithelial neoplasm of the pancreas. All patients were female, and the mean patient age was 26 years (range, 13-73 years). On T1-weighted spin-echo images, tumors were well demarcated, and areas of high signal intensity were evident within them. At macroscopic examination, these areas corresponded to solid portions with marked hemorrhagic necrosis or cystic portions filled with hemorrhagic debris. In three of four masses surrounded by macroscopically evident fibrous capsules, a rim of low intensity was revealed at T1-weighted imaging. When T1-weighted spin-echo imaging reveals obvious areas of high intensity within a sharply marginated tumor of the pancreas, especially in a young woman, solid and papillary epithelial neoplasm might be a primary diagnostic consideration.     

胰腺囊实性乳头状上皮性肿瘤的CT、MRI诊断

目的 研究胰腺囊实性乳头状上皮性肿瘤CT、MRI表现，提高对该病的认识诊断水平。方法 3例经手术病理证实的胰腺囊实性乳头状上皮性肿瘤均经CT检查，其中1例还进行MR平扫和动态增强。回顾性分析其临床特征及CT、MRI表现。结果 3例患者均为年轻女性，无黄疸。CT均表现为胰头部巨大的囊实性肿块；其中1例肿块内可见钙化；1例伴有胰管轻度扩张。所有3例肝内外胆管均未见扩张。1例MR检查的病例胰头部肿块在T1WI、T2WI上呈混杂信号。增强后，CT、MRI上肿块囊壁及实性成分均明显强化。结论 胰腺囊实性乳头状上皮性肿瘤CT、MRI表现较具特征性，结合临床特征可在术前作出诊断。     

胰腺实性-假乳头状瘤CT诊断

目的探讨胰腺实性-假乳头状瘤的临床特点及CT特征,提高CT诊断水平。方法回顾分析经手术及病理证实的2例胰腺实性-假乳头状瘤的临床及影像资料,并复习文献。结果本文2例均发生于年青女性(17岁及39岁),临床均以偶发腹部肿块就诊。2例均发生于胰头部。CT主要表现为囊实性结构,1例伴有点条状钙化。肿块均较大(7.7 cm×9.8 cm×12 cm及5.8 cm×8.2 cm×9.0 cm),邻近结构受压移位,1例伴胰管轻度扩张,1例门静脉受侵。结论发生于胰头部的实性-假乳头状瘤具有一定的特征。     

Invasive carcinomas derived from intraductal papillary mucinous neoplasms of the pancreas: a long-term follow-up assessment with CT imaging

OBJECTIVE: To describe computed tomography (CT) findings of invasive carcinoma derived from intraductal papillary mucinous neoplasms (IPMNs) of the pancreas during long-term follow-up. METHODS: Follow-up CT findings of 5 patients with IPMNs progressing to invasive carcinomas were respectively reviewed for 12 to 63 months. All patients underwent thin-section 3-phase helical and/or multislice CT. RESULTS: Invasive carcinomas were detected as hypo- (n = 3) or hyperattenuating (n = 2) solid masses in the pancreatic parenchyma on contrast-enhanced CT. Hypoattenuating masses were mostly visualized on arterial dominant phase images. In 4 branch-duct type IPMNs, the solid masses appeared with (n = 3) or without (n = 1) dilatation of the main pancreatic duct after 3 to 5 years. In the remaining combined-type IPMN, a solid mass was detected on initial CT and progressively increased during the follow-up. CONCLUSIONS: Arterial dominant phase CT is useful for detecting invasive carcinoma derived from IPMNs and is an effective follow-up method.     

CT and MRI features of pure acinar cell carcinoma of the pancreas in adults

OBJECTIVE: We sought to describe the CT and MRI features of pure acinar cell carcinoma of the pancreas in adults. MATERIALS AND METHODS: Eleven patients (six women and five men; mean age, 64 years) with acinar cell carcinoma, documented by pathologic examination of resected specimens, underwent CT (n=9) or MRI (n=2) examinations. Two radiologists evaluated imaging studies and determined, by consensus, the following data for each tumor: size, location, margination, internal density or signal intensity, and contrast enhancement pattern. In addition, they assessed the presence of calcification, pancreatic or bile duct dilation, and metastases. Imaging features were correlated with gross and microscopic pathologic features of the tumors. RESULTS: Masses were distributed throughout the pancreas (head, n=5; body, n=2; and tail, n=4). The mean largest dimensions were 6.0 x 5.3 cm (range, from 2 x 1.7 to 15 x 11 cm). Tumors were oval (n=5), round (n=4), or lobular (n=2). Ten (91%) masses were well marginated; nine (82%) were exophytic. Five (45%) masses enhanced homogeneously; the remaining tumors contained cystic areas. All masses enhanced less than the surrounding pancreas. Three (27%) masses contained calcifications. Four (80%) masses invaded the duodenum. Common bile and pancreatic duct dilatation was present in two and three patients, respectively. One patient had metastatic liver disease at presentation. CONCLUSION: Pure acinar cell carcinoma of the pancreas is usually an exophytic, oval or round, well-marginated, and hypovascular mass on CT and MRI. It typically is completely solid when small and contains cystic areas due to necrosis when large.     

Computed tomography of ovarian masses

A retrospective analysis of CT images in 138 histologically proven ovarian masses in 100 patients was undertaken to evaluate the usefulness and limitation of CT in the diagnosis of ovarian tumors. Benign masses were purely cystic in 98 (94.2%) and had solid component (including thickened walls, thickened septa, papillary projections) in five of 104 lesions (4.8%) on CT. These five masses, which are classified as benign solid tumors, could not be differentiated from malignant tumors by either the size of the solid portion or the intensity of contrast enhancement. In the malignant tumors a solid portion was detected in 32 of 34 tumors (94%). When a solid component is detected in an ovarian mass, the mass should be considered malignant although a few cases will be benign solid tumors. In Krukenberg tumors, which were all of gastric origin, the solid component was so large that it occupied more than one-half the mass. Therefore, if the solid portion of the ovarian mass is large on CT, upper gastrointestinal study should be performed to rule out Krukenberg tumor.     

胃间质瘤:螺旋CT表现与手术病理对照

目的:分析胃间质瘤的螺旋CT表现,评价螺旋CT鉴别胃间质瘤良恶性价值。方法:对29例胃间质瘤患者行螺旋CT扫描,对肿瘤的部位、大小、形态、增强特点、肿瘤与邻近器官的关系及有无转移进行回顾性分析,结果与手术病理对照。结果:良性6例,交界性5例,恶性18例。CT表现:肿物多具有壁在性、外生性特点(23例),腔内型6例。除5例良性肿物密度均匀外,其余均表现密度不均匀。6例高度恶性肿物表现边缘强化,中心大片低密度。病理所见:肿瘤实性部分为由梭形细胞和(或)上皮样细胞组成,变性、出血、囊变及坏死在CT均表现为低密度。肿物内伴斑点样钙化1例。胰腺、脾受侵各1例,胃壁受侵7例。多平面重建图像(MPR)排除横断面诊断胰岛细胞瘤和肝癌各1例。合并肝转移2例,淋巴结转移1例。结论:胃间质瘤的CT表现与其病理组织学相关。螺旋CT特别是MPR图像,在肿瘤的检出、判断肿瘤与周围器官的关系及有无转移上发挥重要作用,在判断肿瘤的良恶性上仍有困难。     

Gastric leiomyosarcoma: CT observations

The abdominal CT examinations of seven patients with gastric leiomyosarcoma (GLMS), proven by surgical or endoscopic biopsy or both in five patients and percutaneous aspiration biopsy in two, are reviewed. In the six patients studied prior to therapy, CT demonstrated that each of the primary gastric tumors was spherical or ellipsoidal, large (mean diameter 15 cm), and predominantly exogastric in location. Additional CT features of the primary tumor included necrosis in all six masses, a distinct gastric mural attachment in four, bubbles of gas or an air-fluid level or both in three, and mucosal ulceration in two. Direct tumor invasion of nearby organs was suggested by CT in four of the six patients, the spleen and pancreas representing the most frequent sites. Intraperitoneal spread of tumor was present in two patients; necrotic liver metastases accompanied three of the six primary tumors and were found in an additional patient examined 4 years after gastric resection. By accurately reflecting the biological behavior of GLMS, CT is an ideal imaging modality for studying this unusual neoplasm. Differential diagnosis and specificity of the CT findings are discussed.     

CT findings of clear cell carcinoma of the ovary

PURPOSE: The purpose of this article was to retrospectively evaluate computed tomographic (CT) findings in patients with pathologically proved clear cell carcinoma of the ovary. METHODS: CT scans of seven patients (age range, 28-79 years; mean age, 46 years) with nine lesions of histologically proved primary ovarian clear cell carcinoma of the ovary were retrospectively evaluated by two radiologists in consensus. Scans were evaluated for the laterality, size, mass characteristic, margin, attenuation of the cystic portion, internal architecture, and presence of lumen protruding mass. RESULTS: Tumors were unilateral in five patients. The average size of the tumors was 8.6 cm (range, 2.6-12.1 cm). All the masses showed mainly cystic appearance. All nine masses had smooth margin. Average attenuation of the cystic portion of the masses was 24.2 HU (Hounsfield unit) (range, 13-34 HU). Tumors usually appeared as unilocular cystic mass (n=6). Lumen protruding masses appeared in seven tumors. CONCLUSION: On CT scans, primary ovarian clear cell carcinomas appeared as large unilocular, mainly cystic, smooth marginated mass with lumen protruding solid portion and high-attenuated cystic portion.     

16层螺旋CT多期扫描在胰腺实性假乳头状瘤诊断中的应用

目的分析胰腺实性假乳头状瘤螺旋CT的影像学表现,探讨其在该病临床诊断中的应用价值。方法回顾性分析6例经手术病理证实胰腺实性假乳头状瘤的螺旋CT表现,并总结影像特点。结果 6例中5例为年轻女性,1例为男性,肿瘤边界清楚,体积较大,表现为囊实性肿块。平扫呈等低密度,增强后,动脉期肿瘤的实性部分轻度强化,门脉期和延迟期持续强化但强化程度低于胰腺实质。结论胰腺实性假乳头状瘤多见于年轻女性,螺旋CT有一定特征性表现,有较高临床诊断价值。     

胰腺实性假乳头状瘤的多层螺旋CT表现

目的探讨胰腺实性假乳头状瘤的多层螺旋CT特征性表现。方法回顾性分析经手术病理证实的5例胰腺实性假乳头状瘤的螺旋CT平扫和增强扫描影像资料。本组5例均于静脉注射造影剂后25s和55s分别获得动脉期和胰腺实质期CT扫描图像。结果患者中1例为19岁男性,其余为年轻女性,无黄疸。肿瘤呈囊实性肿块,实质与囊性部分呈相间分布,1例有病灶内钙化。肿瘤最长径4～12cm,平均8cm。CT增强扫描动脉期肿块轻度强化,门静脉期肿瘤强化略高于动脉期,但其强化程度均低于正常胰腺组织。结论胰腺实性假乳头状瘤的螺旋CT表现虽有一定特征,但在术前作出正确诊断仍较难,应行胰腺活检确诊。     

儿童肾脏恶性肿瘤的CT诊断和鉴别诊断

目的 探讨儿童肾脏恶性肿瘤的CT表现及特点。材料与方法 回顾性分析53例经临床病理证实的小儿肾脏恶性肿瘤,其中Wilms瘤45例,肾透明细胞肉瘤3例,肾细胞癌3例,肾恶性横纹肌样瘤、肾胚胎性横纹肌肉瘤各1例。结果 45例Wilms瘤中76%呈实质性肿块,4%为囊性,20%为囊实性;增强后肿瘤实质部分、囊壁及间隔有强化;9%见斑点或斑片状钙化。肾脏恶性非Wilms瘤在CT上边界清晰或模糊的类球形、密度欠均匀的实质性肿块,增强后轻～中等度强化,8例中5例（63%）见斑点或斑片状钙化。肾恶性横纹肌样瘤见实质内点状及条索状强化血管影。肾胚胎性横纹肌肉瘤表现为肾实质及肾盂内分叶状实质性肿块,侵犯肾门及输尿管上段,肾周见新月形低密度的包膜下积液。结论 CT对儿童肾脏恶性肿瘤的术前诊断及提出随访方案上有一定帮助。     

CT对卵巢原发性恶性肿瘤的诊断价值

目的 提高CT对卵巢原发性恶性肿瘤的诊断正确性。方法 回顾性分析49例80个经手术和病理证实有完整资料的卵巢原发性恶性肿瘤的CT表现特点。结果 49例80个肿瘤中75个瘤体边缘不规则或呈分叶状，5个轮廓较光整。肿瘤以囊性为主者14个，混合性35个，以实性为主者31个。11例瘤体内见粒状、斑片状或环状钙化。7例可见扭曲增粗的肿瘤血管。除2例瘤体较小者外，47例均可见周围脏器受压移位或直接受侵征象。腹水11例，胸腔积液6例，17例腹腔种植，1例肝转移。结论 卵巢原发性恶性肿瘤的CT主要表现为囊实性肿块，CT可对卵巢肿瘤准确定位并作出良恶性定性诊断。     

Intraductal papillary mucinous neoplasms of the pancreas: CT patterns of recurrence and multiobserver performance in detecting recurrent neoplasm after surgical resection

OBJECTIVE: The purposes of our study were to describe the CT appearance of recurrent intraductal papillary mucinous neoplasms of the pancreas after surgical resection and estimate the performance of CT in detecting recurrent neoplasms. MATERIALS AND METHODS: A single unblinded reviewer characterized the presence and appearance of recurrent intraductal papillary mucinous neoplasms on 66 CT scans of 17 patients with proven recurrence, noting location and appearance of recurrent neoplasm. These results, described in this article, were summarized in tabular format and shown to three blinded observer. The observers then evaluated one postoperative CT examination from every patient at our institution who underwent surgical removal of intraductal papillary mucinous neoplasms (n = 45) for the presence or absence of local or distant recurrence. RESULTS: The unblinded reviewer found 11 cases of local recurrence. Extrapancreatic local recurrences tend to have solid components (5/6), tend to be located adjacent to the resection margin (5/6), and may exhibit vascular invasion (2/6). Intrapancreatic neoplasms are usually cystic (4/5). Nine patients had distant metastases. Prospective sensitivity for recurrent tumor ranged from 76% (13/17) to 94% (16/17). Sensitivity for local recurrence ranged from 55% (6/11) to 82% (9/11). Specificity ranged from 79% (22/28) to 96% (27/28). Interobserver agreement for predicting recurrence was moderate to substantial (kappa = 0.51-0.65). CONCLUSION: Locally recurrent intraductal papillary mucinous neoplasms of the pancreas tend to be either extrapancreatic and solid at the resection margin or intrapancreatic and cystic. CT can detect most recurrent intraductal papillary mucinous neoplasms of the pancreas with moderate to substantial interobserver agreement.     

胰腺实性假乳头状瘤的CT和MRI诊断

目的:探讨胰腺实性假乳头状瘤的CT、MRI表现特征。方法:回顾性分析10例经手术病理证实的胰腺实性假乳头状瘤的临床特征及CT、MRI表现。结果:10例患者中,1例为15岁男性,其余多为年轻女性,无黄疸。10例CT均表现为胰腺巨大的囊实性肿块,其中2例肿块内可见钙化;5例肿块在T1WI、T2WI上呈高低混杂信号,增强后肿块实性成分均明显强化,囊变坏死区无强化。结论:胰腺实性假乳头状瘤的CT、MRI表现较具特征性,结合临床资料可在术前作出诊断。     

腹膜后肾上腺外副神经节瘤的CT诊断

目的 探讨腹膜后肾上腺外副神经节瘤(PGL)的CT特点.方法 回顾性分析经手术病理证实的腹膜后肾上腺外PGL 11例,并复习相关文献.所有患者均行腹盆部CT平扫及增强扫描.结果 11例肿瘤均发生于腹膜后大血管周围,其中功能性肿瘤2例,非功能性肿瘤9例;良性肿瘤8例,呈圆形或类圆形,边缘光滑,与周围结构分界清晰,3例恶性肿瘤边缘欠光滑,与周围结构分界不清,其中2例肿瘤侵犯、包绕邻近肾动脉、肾静脉及胰腺.CT平扫肿瘤多呈密度不均匀的软组织肿块,瘤内常可见范围大小不等的坏死、囊变区域(9例),部分肿瘤内合并出血(3例)及钙化(2例);2例较小的肿瘤(平均直径<4 cm)密度均匀.增强扫描肿瘤实性成分呈持续性显著增强,8例肿瘤周围或实性成分内可见迂曲增粗的肿瘤血管.结论 腹膜后肾上腺外PGL的CT表现具有一定特征性,增强CT表现结合临床症状有助于术前准确诊断.     

胰腺实性假乳头状瘤的CT诊断

目的分析胰腺实性假乳头状瘤的CT诊断价值,以提高对该病的认识及诊断水平。方法回顾性分析6例经手术及病理证实的胰腺实性假乳头状瘤的临床资料及CT表现。结果胰腺实性假乳头状瘤好发于13～45岁年轻女性。6例肿瘤,位于胰头2例,胰尾4例,肿瘤体积较大,6例瘤体均为囊、实混合性,实性为主4例,囊性为主2例,2例肿瘤见线条状及斑点状钙化,增强扫描实性成分呈中度强化,囊性成分无强化,瘤体包膜较完整,边缘清楚。不伴有胆总管及胰管扩张。结论胰腺实性假乳头状瘤具有特征性的CT表现及临床表现。     

胰腺实性假乳头状瘤的CT诊断与鉴别诊断

目的：探讨胰腺实性假乳头状瘤的CT表现,提高对该病的诊断水平。方法：回顾性分析了5例经手术病理证实的胰腺实性假乳头状瘤患者的CT资料,均行CT平扫及增强。结果：5例患者中4例为年轻女性,男性1例,均无黄疸。位于胰头2例、胰尾2例,胰体尾均受累1例。CT平扫表现为圆形、类圆形低密度或混杂密度团块影,体积较大,增强后肿瘤实性部分及包膜可见逐渐强化,囊性部分无强化。4例病灶内见点状钙化。结论：胰腺实性假乳头状瘤影像学表现有一定特征性,结合临床资料可在术前做出诊断。     

Primary serous papillary carcinoma of the peritoneum: CT findings

AIM: To describe the computed tomography (CT) findings of primary serous papillary carcinoma of the peritoneum. MATERIAL AND METHODS: The clinical data and imaging studies of 36 women aged 37-85 years with primary papillary serous carcinoma of the peritoneum were retrospectively evaluated. Twenty-seven patients presented with general abdominal complaints; all had elevated levels of CA-125. Thirty-two women were post-menopausal, four had had bilateral salpingo-oophorectomy. RESULTS: The most common findings on pre-operative abdominal CT, performed in 30 patients, were a variable amount of ascites (n = 29), omental involvement (n = 28), irregular parietal peritoneum thickening (n = 22) and mural thickening of the sigmoid colon (n = 10). Thoracic findings included enlarged cardiophrenic nodes (n = 15) and pleural effusion (n = 11). Six patients had unilateral or bilateral adnexal masses of soft tissue density, which proved to be surface serous papillary carcinoma. CONCLUSION: Diffuse peritoneal disease on CT in patients with normal-sized ovaries or following bilateral salpingo-oophorectomy, with elevated level of serum CA-125, but without an identifiable primary tumour, should suggest the diagnosis of primary serous papillary carcinoma of the peritoneum. Associated adnexal masses or focal bowel wall thickening may be seen, representing surface involvement by this tumour.     

CT evaluation of glucagonomas

Seven patients with clinical features of the glucagonoma syndrome, including the characteristic rash, diabetes mellitus, and weight loss, were examined by CT. Computed tomography demonstrated a primary pancreatic tumor in all patients, and, in four, hepatic metastases were identified. The primary tumors, relatively large and solid in nature, varied in size from 2.5 to 6 cm in maximum diameter. The tumor was found in the tail of the pancreas in three patients and in the head of the pancreas in four. No obliteration of adjacent perivascular or peripancreatic fat planes was observed in any patient. Calcification was present in the primary tumor in three patients and in the hepatic metastases in one. All tumors that were studied angiographically were found to be hypervascular. In contrast to insulinomas, which are frequently quite small when clinically diagnosed, glucagonomas appear to attain considerable size prior to being clinically apparent. Thus, we conclude that CT ought to become the mainstay in the identification, localization, and staging of these tumors.