Carcinoma of the ampulla of Vater: Sonographic and CT diagnosis

Twenty patients with carcinoma of the ampulla of Vater were studied with sonography (N = 9) or both sonography and CT (N = 11). The tumor was shown by sonography in 16 patients (80%) as a small, round or oval, fairly well delineated mass in between the dilated distal common bile duct and duodenum which was delineated owing to luminal fluid or gas (N = 13); or as a polypoid mass within the dilated distal common bile duct resulting in abrupt obstruction (N = 3). In the remaining four patients, the mass was not delineated. Bile ducts were dilated down to the level of mass or ampullary region in all cases (100%), while the pancreatic duct was dilated in five cases (45%). We believe that sonography is the technique of initial choice in the diagnosis of carcinoma of the ampulla of Vater by identifying the mass at the distal end of the dilated common bile duct and/or pancreatic duct.     

Biliary cystic intraductal papillary mucinous tumor and cystadenoma/cystadenocarcinoma: differentiation by CT

Purpose To identify differential findings of biliary cystic intraductal papillary mucinous tumor (IPMT) and biliary cystadenoma/cystadenocarcinoma on CT images. Materials and methods Records of 7 patients with biliary cystic IPMT and 17 patients with biliary cystadenoma/cystadenocarcinoma were accessed. A pathologist reviewed gross morphologic and microscopic findings and confirmed the diagnosis. Two radiologists who were blind to the pathologic diagnosis reviewed CT images regarding size of cystic mass, mural nodule, septa, calcification, dilatation of the proximal, and distal bile ducts to the tumor, and the results were analyzed using multivariate analysis. Results Mural nodule and dilatation of the bile ducts distal to the cystic tumor were more commonly seen in patients with cystic IPMT than in patients with biliary cystadenoma/cystadenocarcinoma and these are statistically significant, the P values being 0.029 and 0.016, respectively. Size of the cystic tumor, presence of septa, calcification, and dilatation of the bile duct proximal to the cystic tumor were not statistically different. Conclusion Biliary cystic IPMT could be differentiated from biliary cystadenoma/cystadenocarcinoma on CT images based on the presence of mural nodules and dilatation of the bile ducts distal to the cystic tumor.     

超声造影对壶腹部周围癌诊断和鉴别诊断价值的初步研究

目的 探讨超声造影对壶腹部周围癌诊断和鉴别诊断的临床价值.方法 回顾分析22例壶腹部周围癌超声造影表现,全部病例均经手术病理证实,其中胆总管下段癌9例,壶腹癌5例,乳头癌3例,胰头癌5例.观测指标包括病灶大小及造影前后病灶的清晰显示率、增强开始时间和消退时间、增强水平及增强形态.结果 造影后病灶清晰显示率从造影前55%(12/22)提高到95%(21/22);病灶增强开始时间、消退时间和增强水平差异无统计学意义(P＞0.05),而增强形态和最大直径则明显不同:胰头癌多呈不均匀增强,管腔内均未显示突出物及"半月征",病灶直径显著大于胆总管下段癌、壶腹癌及乳头癌(P＜0.05),后三者病变多呈均匀增强,管腔内均显示突出物和(或)"半月征".结论 超声造影可显著提高壶腹部周围癌的清晰显示率,有助于病灶的定性诊断;病灶大小和增强形态对壶腹部周围癌的鉴别诊断具有重要的实用价值.     

多排螺旋CT双期扫描对腮腺良性肿瘤的诊断价值

目的探讨腮腺良性肿瘤的CT表现,提高对腮腺肿瘤的诊断水平。方法回顾性分析经手术病理证实的85例腮腺良性肿瘤患者的多排螺旋CT双期增强扫描表现。结果10例腮腺基底细胞腺瘤患者中,2个病灶密度相对均匀,8个病灶密度不均匀。43例腮腺淋巴瘤患者中,43个病灶密度较均匀,18个病灶密度不均匀。31例腮腺多形性腺瘤患者中,16个病灶密度均匀,15个病灶密度欠均匀,CT增强扫描6例明显强化,余25例轻度强化。1例鳃裂囊肿表现为类圆形的低密度结节,CT值19 HU,边缘清楚光滑,密度均匀,增强检查囊内容物不强化,囊壁可轻度增强。增强扫描动脉期,CT值增加幅度由大到小依次为基底细胞腺瘤、腺淋巴瘤、多形性腺瘤、鳃裂囊肿。基底细胞腺瘤双期CT增强幅度大于其他种类疾病(P<0.05)。结论多排螺旋CT能对腮腺肿瘤进行有效定位,双期增强扫描对诊断及鉴别诊断良性肿瘤有一定的价值。     

卵巢硬化性间质瘤的CT诊断

目的 总结卵巢硬化性间质瘤（SST）的CT表现,以提高对其在CT影像学上的认识,掌握其诊断要点及主要鉴别诊断,降低误诊率.方法 分析3例经手术和病理证实的卵巢硬化性间质瘤CT表现及其特点.结果 3例均为单发,病灶与卵巢关系密切,病灶边界清晰,不侵犯周围临近器官,病灶密度多不均匀,多呈囊实性改变,动态增强病灶实性部分动脉期强化明显,静脉期继续强化,呈＂海绵状血管瘤样＂渐进性强化,囊性部分不强化,肿瘤壁多呈厚薄不均、结节状改变.结论 卵巢硬化性间质瘤在CT动态增强扫描时具有延迟强化特征性表现,肿瘤壁有结节样强化特点,在动态增强上具有一定的特征.     

肿瘤标志物联检对恶性胸腔积液的诊断价值

目的 探讨联合检测血清、胸水中的多项肿瘤标志物来鉴定胸水的性质.方法 应用MEIA和比色法分别同步检测血清、胸水中的CEA、CA199、CA125、β2-MG、TSGF并计算胸水/血清（P/S）的比值.结果 恶性组血清、胸水中的TSGF、CEA、CA199的值均显著高于结核组、良性组.且P/S＞1.2.CA125和β 2-MG在恶性组和结核组中均有较高的敏感性.结论 联检血清、胸水中的五种肿瘤标志物并计算其P/S,对胸水的鉴别具有重要的临床价值.     

Utility of multidetector CT in the diagnosis of gastric bare area invasion by proximal gastric carcinoma

Purpose To investigate the utility of multidetector CT (MDCT) in the diagnosis of gastric bare area (GBA) invasion by proximal gastric carcinoma (PGC). Methods Sixty-eight consecutive patients with biopsy-proven PGC underwent MDCT scan prior to gastrectomy. We evaluated the CT images separately for the site, size, depth, lymph node, and enhancement characteristic of each case. Each postsurgical stomach specimen was axially sectioned and comparison was made to determine the correlation between the CT findings and the pathological examination of each tumor bearing slice. Results The sensitivity for detecting GBA involvement in patients with PGC was 84%. MDCT correctly identified 32 of 38 patients with GBA invasion and 10/13 (77%) tumors with metastatic lymph node greater than 5 mm in GBA or subphrenic retroperitoneal space. 33/36 (92%) patients with tumor extension within the edge of the gastric wall and 28/32 (88%) patients with tumor infiltration into subphrenic fat were correctly identified. MDCT correctly predicted the infiltration of tumor into the diaphragm in all 14 patients and identified 6/11 (55%) patients with gastrophrenic ligament invasion. Conclusion MDCT may be of value in assessing the important radiological characteristics of GBA invasion in patients with PGC.     

肿瘤康复者对恶性肿瘤患者心理支持干预及效果

目的探讨肿瘤康复者对恶性肿瘤患者的心理支持干预及效果。方法 2008年10月起,我们招募与培训肿瘤康复志愿者,通过他们对在我院住院的恶性肿瘤患者进行心理支持干预,在干预前后采用生活质量综合评定问卷（GQOLI-74）进行调查。结果在肿瘤康复者支持干预前后,恶性肿瘤患者的生活质量总体评价前后比较差异有统计学意义（P〈0.05）;躯体功能、心理功能、物质生活状态维度前后比较差异有统计学意义（P〈0.05）。结论肿瘤康复者根据自身康复的经验与体会对恶性肿瘤患者的各方面进行针对性的干预,能有效改善患者的心理状态,从而明显提高了患者的生活质量。     

64排CT增强扫描诊断卵巢良恶性浆液性肿瘤的探讨

目的通过64排CT来判断卵巢浆液性肿瘤的良恶性。方法经手术和病理证实的卵巢浆液性肿瘤58例,其中良、恶性肿瘤各25例,交界性肿瘤8例。全部行CT平扫和增强扫描,重点分析肿瘤强化特征和内部结构等。结果良性瘤灶以单房囊为主,囊壁及囊内未见强化或囊壁轻度强化（21／25例,84％）,囊壁出现中度强化4例;恶性肿瘤呈囊实性,边界不清,形态不规则,分隔厚薄不均匀,可见壁结节,增强后实性部分明显强化（22／25例,88％）,3例无明显强化。交界性肿瘤8例仅1例无强化,其余7例出现程度不等的强化。结论浆液性囊腺瘤多见于单囊且囊壁强化不明显,提示瘤灶缺乏血供或血供甚微;浆液性囊腺癌以混杂的囊实性为主,具有较明显的强化表现;交界性肿瘤强化程度略低于恶性瘤灶而但高于良性瘤灶。运用64排CT扫描有助于判断卵巢浆液性肿瘤的性质。     

双能量CT多定量参数联合常规CT征象鉴别卵巢原发上皮性肿瘤良恶性的价值

目的  探究双能量CT多定量参数联合常规CT征象鉴别卵巢原发上皮性肿瘤良恶性的临床应用价值。方法  回顾性连续收集2021年1月~2023年6月盐城市第一人民医院166例经手术证实的卵巢原发上皮性肿瘤病例,所有患者术前2周内均行能谱CT增强扫描,根据术后病理分为良性组（n=74）和恶性组（n=92）。记录患者的一般临床特点及常规CT特征。由2位观察者分别独立测量病灶相关双能量CT定量参数：动脉期、静脉期碘浓度,计算标准化碘浓度,测量40、50、60、70、80、90 keV单能量CT值,计算动脉期、静脉期能谱曲线斜率（K_{40-90 keV}）。采用组内相关系数检测2位测量者测量参数之间的一致性。比较两组之间各参数的差异,筛选出P < 0.1的变量作为输入变量,逐步建立基于常规CT征象、双能量CT定量参数及两者联合的二元Logistic回归模型。采用ROC曲线比较3个模型鉴别卵巢上皮性肿瘤良恶性的诊断效能。采用DeLong检验比较各曲线下面积的差异。结果  2位测量者对动脉期、静脉期两组间测得的各参数一致性较好,组内相关系数均大于0.75。良性组与恶性组的一般临床特点（年龄、临床症状）、8个常规CT征象（肿瘤位置、肿瘤形态、肿瘤边界、肿瘤密度、腹水、是否伴腹膜/网膜转移、膈上淋巴结、其他脏器转移）与双能量CT各定量参数（动脉期及静脉期CT_{40 keV}、CT_{50 keV}、CT_{60 keV}、CT_{70 keV}、CT_{80 keV}、CT_{90 keV}、K_{40-90 keV}、碘浓度、标准化碘浓度）差异有统计学意义（P < 0.05）。基于常规CT征象、双能量CT定量参数及两者联合的二元Logistic回归模型的曲线下面积依次为0.760、0.764、0.883。经DeLong检验,基于常规CT征象的模型和基于双能量CT定量参数模型之间曲线下面积的差异无统计学意义（Z=-0.659, P=0.510）,基于常规CT征象的模型和基于两者联合的模型之间曲线下面积的差异有统计学意义（Z=-4.007, P < 0.001）,基于双能量CT定量参数模型和基于两者联合的模型之间曲线下面积的差异有统计学意义（Z=-3.870, P= 0.001）。结论  相较于常规CT征象或双能量CT多定量参数,两者联合对鉴别卵巢原发上皮性肿瘤良恶性的诊断效能更高。     

腮腺Warthin瘤的CT诊断及误诊分析

目的 总结腮腺Warthin瘤的CT影像特征及其与腮腺混合瘤的鉴别要点,以提高影像定性诊断与病理符合率.方法 收集有完整手术或穿刺病理记录的17例患者的资料,其中14例为腮腺Warthin瘤,3例影像报告Warthin瘤但病理证实为混合瘤病例.患者均采用常规平扫加多期动态增强扫描,观察病灶数目、形态特征、密度、强化特征...     

18F-FDG PET/CT鉴别诊断心包良、恶性病变

目的 探讨~(18)F-FDG PET/CT鉴别诊断心包良、恶性病变的可行性及诊断价值.方法 收集16例心包病变患者的~(18)F-FDG PET/CT资料,其中恶性9例,良性7例.测得病灶SUV_(max)值,并观察病灶内部密度及与周围组织关系.对病变或心包穿刺液行病理学检查,确定良恶性.结果 恶性病变及良性病变SUV_(max)分别为10.1±6.0、3.0±2.1(P<0.01).以病灶SUV_(max)值3.5～4.5作为鉴别心包病变良恶性的阈值,判断心包病变的灵敏度为100%、特异度为85.71%、准确率为93.75%、阳性预测值为90.00%、阴性预测值为100%.结论 ~(18)F-FDG PET/CT可较准确地鉴别诊断心包病变的良、恶性.     

骨巨细胞瘤影像学诊断及鉴别诊断研究

目的分析骨巨细胞瘤、骨囊肿、动脉瘤样骨囊肿、骨纤维结构不良X线平片、CT及MRI征象，结合病理总结骨巨细胞瘤的X线平片、CT、MRI特点及鉴别诊断要点。方法收集经X线平片诊断为骨巨细胞瘤23例患者X线平片、CT片、MRI片，并与病理结果结合分析。结果平片简便易行，能提供病变部位整体信息。CT和MRI能够提供更详细信息。结论综合运用X线平片、CT及MRI方法，与临床表现、病人一般状况相结合将提高骨巨细胞瘤诊断及鉴别诊断的准确性。     

增强CT定量分析联合肿瘤标志物检测对肝细胞肝癌与局灶性结节增生的鉴别诊断意义

目的探讨增强CT定量分析联合肿瘤标志物检测对肝细胞肝癌(HCC)与局灶性结节增生(FNH)的鉴别诊断价值。方法选择2016年1月至2018年12月90例肝脏占位病变患者(HCC52例、FNH38例)进行回顾性分析,所有患者均接受增强CT检查和进行肿瘤标志物甲胎蛋白检测,观察两组患者的平扫CT值、动静脉期强化CT值、病灶动静脉期CT值与同期肝实质CT值的比值、甲胎蛋白水平。结果HCC组平扫CT值、静脉期CT值、动脉期CT值、静脉期强化CT差值、动脉期强化CT差值均显著低于FNH组,差异有统计学意义(P<0.05);HCC组静、动脉期与肝实质的比值均显著低于FNH组,差异有统计学意义(P<0.05);HCC组AFP水平显著高于FNH组,差异有统计学意义(P<0.05);增强CT定量联合AFP检测肝细胞肝癌的灵敏度和特异度(88.00%、60.34%)均高于单独增强CT定量分析(75.00%、81.57%)及AFP检测(69.23%、65.79%)。结论增强CT定量分析联合肿瘤标志物检测对HCC和FNH鉴别具有较高价值,可提高诊断准确性。     

兔肝VX2肿瘤超声造影时相划分:与多排螺旋CT增强扫描对照实验研究

目的 探讨灰阶实时超声造影(CEUS)和多排螺旋CT(MDCT)增强扫描兔肝VX2肿瘤的增强显像特征及兔肝超声造影时相的划分标准.方法 运用超声造影剂SonoVue对33只荷肝VX2瘤兔行CEUS和64排螺旋CT增强扫描,以团注造影剂后肝动脉开始增强作为动脉期的起始时间,以VX2肿瘤增强达峰时间作为门脉期的起始时间,以肝实质增强达峰值强度时间作为实质期的起始时间,观察其增强特征,比较CEUS中肿瘤和瘤周同水平肝实质的时间强度曲线和MDCT中腹主动脉、门静脉、肝实质和肿瘤的时间密度曲线形态特征,制定划分各期时相的标准.结果 CEUS和MDCT对VX2肿瘤动脉期、门脉期、实质期起始时间的划定分别为(6.82±1.36)s、(11.64±2.03)s、(20.24±4.17)s和(9.43±2.23)s、(13.77±2.01)s、(22.71±4.58)s,CEUS较MDCT各相起始时间均提早(P<0.01),二者对兔肝VX2肿瘤增强显像特征一致,均表现为"快进快退".结论 CEUS可以对兔肝VX2肿瘤的灌注情况进行实时高分辨率显像,CEUS和MDCT时相标准可为相关的影像学评估研究提供基本的理论依据.     

肾包虫病的CT诊断(附8例报告)

本文报告经手术病理证实的8例肾包虫，其中单纯肾包虫5例，破入肾盂肾盏继发感染3例，对其临床特点及CT表现作了初步分析，简要探讨了CT和B超在诊断中的价值和限度。     

Differentiation of benign periablational enhancement from residual tumor following radio-frequency ablation using contrast-enhanced ultrasonography in a rat subcutaneous colon cancer model

Benign periablational enhancement (BPE) response to thermal injury is a barrier to early detection of residual tumor in contrast enhanced imaging after radio-frequency (RF) ablation. The objective of this study was to evaluate the role of quantitative of contrast-enhanced ultrasound (CEUS) in early differentiation of BPE from residual tumor in a BD-IX rat subcutaneous colon cancer model. A phantom study was first performed to test the validity of the perfusion parameters in predicting blood flow of two US contrast imaging modes-contrast harmonic imaging (CHI) and microflow imaging (MFI). To create a simple model of BPE, a peripheral portion of the tumor was ablated along with surrounding normal tissue, leaving part of the tumor untreated. First-pass dynamic enhancement (FPDE) and MFI scans of CEUS were performed before ablation and immediately, 1, 4 and 7 days after ablation. Time-intensity-curves in regions of BPE and residual tumor were fitted to the function y = A(1-exp[-β{t-t0}])+C, in which A, β, t0 and C represent blood volume, flow speed, time to start and baseline intensity, respectively. In the phantom study, positive linear correlations were noted between A, β, Aβ and contrast concentration, speed and flow rate, respectively, in both CHI and MFI. On CEUS images of the in vivo study, the unenhanced ablated zone was surrounded by BPE and irregular peripheral enhancement consistent with residual tumor. On days 0, 4 and 7, blood volume (A) in BPE was significantly higher than that in residual tumor in both FPDE imaging and MFI. Significantly greater blood flow (Aβ) was seen in BPE compared with residual tumor tissue in FPDE on day 7 and in MFI on day 4. The results of this study demonstrate that qualitative CEUS can be potentially used for early detection of viable tumor in post-ablation assessment.     

基于CT测量的肿瘤体积对非小细胞肺癌患者新辅助化疗疗效的评估价值

目的  分析基于CT测量的肿瘤体积对非小细胞肺癌患者新辅助化疗疗效的评估价值。方法  选取2019年5月~2020年5月在我院接受新辅助化疗的74例非小细胞肺癌患者,化疗后以病理结果为标准其分为有效组（n=51）和无效组（n=23）,通过CT测量所有患者的肿瘤体积,并采用单因素和Logistic多因素回归分析其影响因素。结果  化疗后,两组患者肿瘤体积小于化疗前（P < 0.05）,有效组患者肿瘤体积小于无效前（P < 0.05）。两组患者化疗后6月生存率的差异无统计学意义（P > 0.05）;化疗后1年,有效组患者生存率高于无效组（P < 0.05）。单因素分析结果显示：临床分期、分化程度以及化疗周期可能是肿瘤体积的影响因素（P < 0.05）。Logistic回归分析结果显示：临床分期、分化程度及化疗周期是非小细胞肺癌患者肿瘤体积的影响因素（P < 0.05）。ROC曲线分析结果表明肿瘤体积对非小细胞肺癌患者新辅助化疗疗效的预测价值,敏感度为0.732,特异性为0.800。结论  基于CT测量的肿瘤体积对非小细胞肺癌患者新辅助化疗的疗效有一定的评估价值。     

Automated anatomical labeling of abdominal arteries and hepatic portal system extracted from abdominal CT volumes

This paper proposes a method for automated anatomical labeling of abdominal arteries and a hepatic portal system. In abdominal surgeries, understanding blood vessel structure is critical since it is very complicated. The input of the proposed method is the blood vessel region extracted from the CT volume. The blood vessel region is expressed as a tree structure by applying a thinning process to it and compute the mapping from the branches in the tree structure to the anatomical names. First, several characteristic anatomical names are assigned by rule-based pre-processing. The branches assigned to these names are used as references. The remaining blood vessel names are assigned using a likelihood function trained by a machine-learning technique. Simple rule-based postprocessing can correct several blood vessel names. The output of the proposed method is a tree structure with anatomical names. In an experiment using 50 blood vessel regions manually extracted from abdominal CT volumes, the recall and precision rates of the abdominal arteries were 86.2% and 85.3%, and they were 86.5% and 79.5% for the hepatic portal system.     

经直肠CDFI检测前列腺癌局部血流特征与肿瘤血管生长因子表达的相关性研究

目的 探讨经直肠彩色多普勒超声检测前列腺癌局部血流及其与肿瘤血管生成间的关系。方法 回顾分析了经直肠前列腺活检证实的前列腺癌患者11例,观察前列腺癌病灶局部的CDFI、PDI血流信号的变化及其分布特征,采用免疫组织化学技术检测病灶局部血管内皮生长因子（VEGF）的表达,并对血流信号和VEGF表达的阳性细胞半定量分级。结果 11例患者中经直肠灰阶超声共检出病灶14个,其中单发病灶6个,3例为双侧分布各两个弥漫性病灶,2例未检出病灶。灰阶超声对前列腺癌的诊断符合率为81．8％。CDH和PDI检查病灶局部血流信号增多,半定量分级多为2级和3级。VEGF表达阳性细胞弥漫分布于癌巢中,在癌巢的中心部位表达强于癌巢边缘,VEGF的表达与CDH和PDI都较明显的相关。结论 彩色多普勒超声对病灶血流信号的分析可在一定程度上反映肿瘤病灶的血管生成特征。