自体颗粒脂肪移植丰乳术后乳腺X线征象

目的探讨自体脂肪移植丰乳术后乳腺的X线征象。方法对15例自体脂肪移植丰乳术后患者行全数字化乳腺摄影,观察其X线征象。结果 15例患者30例次乳房X线摄片中,3例次乳房无明显异常征象(非同一患者),27例次乳房后间隙及腺体后部散在类圆形低密度区,其内密度同脂肪密度,27例次中,4例次腺体后缘与脂肪交界处移行不自然。23例次腺体后缘受压前移,显示"占位"效应,其中16例次乳房后间隙内见1～3个大小不等油脂性囊肿形成,并有2例次(同一患者)乳房后间隙内散在颗粒状钙化,11例次乳房内多发等密度结节影,边界清晰。结论自体颗粒脂肪移植术后,乳腺X线表现有其特征性,尤其是液化坏死后形成油脂性囊肿并伴有钙化是其特征性表现,可完全与乳腺癌钙化征象鉴别,乳腺X线摄影表现也可评价丰乳效果。     

乳腺脂肪坏死的X线表现及病理对照研究

目的 探讨乳腺脂肪坏死的X线表现及病理基础，提高对脂肪坏死的认识。方法 回顾性分析经手术、病理证实的91例（其中2例为双侧乳腺脂肪坏死，共93个病变。）脂肪坏死X线表现，并与病理结果对照。结果 主要X线表现：（1）无任何异常X线发现14例（15．4％）；（2）脂性囊肿6例（6．6％）；（3）表现为肿物20例（22．0％），其中1例为双侧乳腺脂肪坏死；（4）表现为小结节13例（14．3％）；（5）脂肪层内星芒影、斑片影、索条影混杂出现28例（30．8％），其中1例为双侧乳腺脂肪坏死；（6）脂肪层内索条影交织呈网状5例（5．5％）；（7）结构不良者5例（5．5％）。分布部位：（1）位于脂肪层内55例；（2）向脂肪层突出或位于脂肪层与腺体交界处13例，常规位摄片位于脂肪层与腺体交界处的脂肪坏死，切线位投照有利于将病变显示于脂肪层内；（3）位于腺体之间9例；（4）乳腺平片未见异常发现14例。病理表现：（1）脂性囊肿是病变早期的特征性X线表现。（2）脂肪层内不均匀密度肿物影或小结节影为病变中期的特征性表现，反应了纤维组织逐渐替代了液化坏死的脂肪组织。（3）脂肪层内或浅层腺体内局限星芒状致密影以及不规则的网状影最常见，是病变后期的特征性表现。反应了坏死脂肪组织被吸收，周围残留部分纤维组织。通常不同病理时期的X线表现常同时出现。结论 乳腺X线摄影对于脂肪坏死具有重要诊断价值。     

乳腺脂肪坏死的X线表现与鉴别诊断

目的:探讨乳腺脂肪坏死的X线诊断及其鉴别诊断,提高脂肪坏死的认识,减少误诊。方法:回顾性分析58例经病理证实的乳腺脂肪坏死的X线表现。结果:乳腺脂肪坏死根据其病因及时期X线表现多种多样:①无任何阳性X线表现9例;②脂性囊肿5例;③肿物11例;④结节2例;⑤不对称致密4例;⑥斑片影5例;⑦脂肪层内星芒状、索条状、网状影18例;⑧结构扭曲2例;⑨颗粒状、片状不规则钙化、多形性钙化2例。在多种多样的X线表现中,腺体内的脂性囊肿及皮下脂肪层内的局限星芒状、索条状、不规则网状影为脂肪坏死的特征性表现。结论:乳腺X线检查对脂肪坏死具有重要的诊断价值。认真询问病史(如外伤、手术及炎症史等),对本病有重要帮助。     

乳腺分泌性疾病的X线诊断(附24例报道)

本文回顾分析了24例乳腺分泌性疾病,其中积乳囊肿9例、浆细胞性乳腺炎10例、脂肪坏死5例。积乳囊肿分成四型:浸润型、致密型、透亮型及混合型。对浆细胞性乳腺炎及脂肪坏死的X线表现重点进行了描述,认为浆细胞性乳腺炎及脂肪坏死临床虽类似癌肿,但X线像上仍具有一定的特征。本组有约50％的病人术前获得诊断。     

乳腺错构瘤的X线诊断

目的 评价乳腺错构瘤的X线征象及其病理学基础。资料与方法 回顾性分析9例经手术病理证实的乳腺错构瘤的X线片。结果 主要X线征象：多发小囊肿2例；肿块以致密影为主、其间夹杂小透亮区3例；肿块以透亮区为主，其间见致密小岛、条索状影4例。结论 乳腺错构瘤的表现因其病灶内纤维组织、腺体、脂肪组织的比例不同而不同，部分表现为肿块内多发积乳囊肿。瘤体内密度不均匀是本病的特征性X线表现。     

乳腺导管原位癌的全数字化钼靶X线诊断

目的探讨乳腺导管原位癌（BDCIS）的全数字化乳腺钼靶X线征象。方法回顾分析30例经手术及病理检查证实为BDCIS的全数字化乳腺钼靶X线表现。常规摄影双侧乳腺轴位（CC位）及侧斜位（MLO位）摄片。结果 30例中26例有病灶内钙化,其中单纯钙化18例,肿块伴钙化3例,结构扭曲伴钙化5例;3例为单纯肿块,其中,边缘光滑、密度均匀的圆形肿块2例,边缘有毛刺、密度不均匀的类圆型肿块1例;1例为单纯结构扭曲。结论 BDCIS全数字化乳腺钼靶X线表现以钙化为主,还应重视肿块、结构扭曲以及局部非对称致密影等征象。     

乳腺脂肪坏死的X线和超声诊断

目的探讨乳腺脂肪坏死的X线及B超表现，提高对本病影像诊断的认识。资料与方法回顾性分析25例经手术、病理证实的乳腺脂肪坏死X线平片及超声声像图表现。结果X线片表现：(1)双侧乳腺结构、密度不对称10例；(2)淡薄片影3例；(3)有毛刺的结节5例；(4)X线片无阳性发现5例。超声声像图表现：(1)16例(16／17，94．1％)非医源性脂肪坏死病灶位于皮下脂肪层；(2)结节回声高低不一(高、低、无)；(3)彩色Doppler超声病灶无血流信号8例。结论乳腺脂肪坏死根据其病因和时期，其影像表现多种多样。X线与B超检查结合，本组有65％可排除乳腺癌的诊断。位于乳腺脂肪层内的网状片影或有毛刺的结节首先考虑脂肪坏死的可能，紧密结合临床病史，可提高本病诊断准确性。     

乳腺导管原位癌及其微浸润的磁共振成像评价

目的与X线片、超声检查比较，评价MPd对乳腺导管原位癌及其微浸润诊断的正确率和界定病灶范围的准确性。方法经手术病理证实、术前行乳腺MR检查的乳腺导管原位癌及导管原位癌伴微浸润连续病例17例，其中13例同时行X线检查、16例行超声检查。以病理资料作为金标准，作对照分析。结果（1）MR检查14例病灶有强化，11例表现为非块状强化，其中6例呈段样强化，2例呈区域性强化，导管样强化、多灶性局灶性强化、双乳大致对称的弥漫性强化各1例。这11例中有2例伴病变侧增强前的乳头后大导管扩张，其中1例增强后大导管强化，这2例均以乳头滴血为临床症状。2例块样强化表现为信号均匀、形态不规则的肿块。混合有肿块和非块样强化的1例，为信号均匀、边缘光整的卵圆形肿块伴肿块周围线样强化。（2）13例行X线检查，2例阴性；单纯钙化表现6例；钙化伴其他征象2例；非钙化病灶3例。8例含钙化的病灶中，恶性钙化5例，交界性钙化3例；钙化簇状分布5例，区域性分布2例，弥漫分布1例。（3）16例行超声检查，4例阴性，1例诊为良性病变，其余11例作出了正确的术前诊断，表现为不规则的低回声区内伴有点状的强回声改变。（4）以病理检查测量的大小作为金标准，对病灶范围界定方面MRI符合13例（13／17），高估2例；X线诊断符合7例（7／13），高估3例，低估1例；超声符合7例（7／16），高估2例，低估3例。差异无统计学意义（P=0．161）。结论乳腺导管原位癌及原位癌伴微浸润MRI表现具有特征性，联合X线和MR检查能提高其正确诊断。     

乳腺单纯性囊肿的钼靶X线影像分析

目的提高乳腺X线摄影对乳腺单纯性囊肿诊断的认识。方法回顾2000-03～2004-0339例经手术、病理证实为乳腺单纯性囊肿的钼靶X线征象。结果39例56个乳腺单纯性囊肿患者:X线正确诊断为单纯性囊肿的23例,诊断为纤维腺瘤的10例,乳腺癌2例,肿块待查4例。正确率59.0%,误诊率41.0%。囊肿X线表现:呈圆形12个,卵圆形38个,轻度分叶状4个,慧星尾状肿块2个。囊肿边界清楚、锐利26个,部分清楚、部分模糊27个,全部模糊3个。囊肿密度均匀54个,伴有钙化2个。其中囊肿长轴垂直于胸壁20个,指向乳头方向18个。囊肿加压后变形4个。结论仔细分析乳腺单纯性囊肿的X线征象有助于提高对本病诊断的准确性。     

原发性乳腺脂肪坏死的病理及X线诊断

乳腺脂肪坏死的X线表现多种多样,不少病例酷似肿瘤,甚至误诊为乳癌。Adair报告110例原发及继发性乳腺脂肪坏死,多数在术后方明确诊断。本文报告了29例,年龄从14到87岁。临床表现:10例有外伤史,1例有乳头溢血,26例乳房有结节扪及,大多位于乳晕后或乳房上部,结节表浅,直径从1厘米到数厘米,3例呈多发性,1例为双侧性,14例结节质坚,边缘清楚,无皮肤粘连。另外15例结节的境界不清,并有表浅或深部粘连,临床征象甚似乳癌。5例主诉疼痛,8例腋下淋巴结肿大。 X线表现:典型的X线征象为透明的皂泡状阴影,周围有密度增高的线状阴影或弧形钙化包绕。     

Fat necrosis of the breast: clinical, mammographic and sonographic features

OBJECTIVE: the purpose of this study was to describe and quantitate the clinical, mammographic and sonographic (US) features and to evaluate the evolution of fat necrosis in the breast. MATERIALS AND METHODS: a retrospective review of the clinical, mammographic and US findings of 126 fat necrosis lesions in 94 patients, diagnosed between 1989 and 1999, was done. All the cases included in the study had at least 3 years follow-up mammograms. In addition, 48 patients with a total of 62 fat necrosis lesions, also had an US follow-up. Fat necrosis was diagnosed on the basis of histologic (n=25) and initial or follow-up imaging (n=69) findings. RESULTS: the predominant mammographic features of the 114 lesions apparent on mammograms were radiolucent oil cyst (n=34, 26.9%), round opacity (n=16, 12.6%), asymmetrical opacity or heterogenicity of the subcutaneous tissues (n=20, 15.8%), dystrophic calcifications (n=34, 26.9%), clustered pleomorphic microcalcifications (n=5, 3.9%), and suspicious speculated mass (n=5, 3.9%). In five patients with 12 (9.5%) palpable masses, mammograms were normal. The predominant US features of the 112 lesions apparent on sonograms were solid (n=18, 14.2%), anechoic with posterior acoustic enhancement (n=21, 16.6%), anechoic with posterior acoustic shadowing (n=20, 15.8%), cystic with internal echoes (n=14, 11.1%), cystic with mural nodule (n=5, 3.9%) and increased echogenicity of the subcutaneous tissues (n=34, 26.9%). In five patients with 14 (11.1%) lesions, sonographic examination was normal. Mammographic follow-up showed that five of the radiolucent oil cysts developed curvilinear calcifications, six of the round opacities decreased in size and density, and another two disappeared. Eleven of the dystrophic calcifications became even more coarse. Six of the asymmetrical opacities became vague and one developed an oil cyst and coarse calcifications. The only nonoperated speculated mass developed a typical small radiolucent oil cyst in the centre. US follow-up showed that 18 of the 29 increased subcutaneous tissue echogenicity turned back to normal, while in the remaining 11 small cysts formed. In 19 solid appearing masses, 15 showed decrease in size, while four remained stable (biopsy disclosed fat necrosis). The four complex masses in two patients showed increase in size and appeared more cystic (FNAB was consistent with fat necrosis). CONCLUSION: a spectrum of imaging findings is associated with fat necrosis. Knowledge of the mammographic and US appearance and evolution of these patterns may enable imaging follow-up of these lesions, reducing the number of unnecessary biopsies.     

早期乳腺癌的X线表现（附40例报告）

目的 提高对早期乳腺癌X线征象的认识。材料与方法 将40例早期乳腺癌X线征象作回顾性分析。结果 早期乳腺癌X线征象有：泥沙样微细钙化30例（75％）,X线未见肿块或结节而钙化灶为唯一恶性征象者18例（45％）,与对侧乳房比较呈不对称局限性密度增高15例（37．5％）,致密小结节影14例（35％）,乳腺结构局部扭曲紊乱4例（10％）,条索状导管增粗5例（12．5％）,血管影迂曲、增多、增粗1例,无异常X线征显示1例。结论 （1）泥沙样微细钙化仍是早期乳腺癌非常重要的诊断依据,甚至是唯一恶性征象。（2）非对称性局限性密度增高,乳腺结构局部扭曲紊乱,在排除乳腺炎和手术穿刺活检病史后,应考虑早期乳腺癌可能。（3）在串珠型结节样乳腺中混杂着的恶性致密小结节影,易被忽视,须与健侧乳腺仔细对照观察,以发现小癌或微小癌。（4）对临床疑为小纤维腺瘤,如果X线征有边缘模糊或小角状突起时,应予高度重视,进行活检。     

静脉注射海洛因所致胸部病变的影像学表现

目的 探讨静脉注射海洛因所致胸部感染性病变的影像学方法。方法 回顾性分析25例静脉注射海洛因继发胸部感染性病变患者的临床与影像学资料。尿海洛因试验均阳性，均摄有高kV胸片，6例做了胸部CT扫描，6例做了超声心动图检查。结果 胸部X线平片及CT上表现为肺纹理增多5例，小片状模糊影15例，肺气囊16例，小空洞16例，小结节7例，胸腔积液8例，气胸2例，液气胸6例，肺水肿2例；心影增大11例，多种形态病灶并存20例。6例超声心动图检查者，见三尖瓣赘生物4例，三尖瓣关闭不全4例。结论 静脉注射海洛因的胸部感染性病灶影像表现多种多样，其中“多发小空洞和肺气囊征”对青壮年静脉注射海洛因所致肺部感染的诊断有一定的价值。     

扁胸综合症临床X线征像分析

目的：参考文献并依据本文资料分析、总结扁胸综合症的x线征象特点，对其命名与导致胸廓变扁的不同类型提出我们的看法。方法：随机搜集1临床资料完整的扁胸综合症患者24例，每位患者均接受体检、听诊与心电图检查，均摄有标准的胸部正侧位片，22例患者接受了心脏超声检查，2例行心导管检查。结果：24例扁胸综合症中，胸部脊柱反曲但胸骨曲度正常者2例；脊柱曲度消失变直(既直背)6例，但其中4例胸骨曲度尚可，另2例胸骨平直并局限性内陷；胸椎曲度变小并胸骨平直或稍内陷4例；12例胸部脊柱曲度尚好，但有4例胸骨平直，有8例存在程度不同胸骨内陷。结论：造成扁胸综合症的直接原因可为单纯脊柱因素或单纯胸骨因素，亦可为脊柱与胸骨的综合因素。所以，称其为“扁胸综合症”较“直背综合症”更为确切。     

Nonpalpable breast cancer: mammographic appearance as predictor of histologic type.

PURPOSE: To investigate the association between mammographic appearance and histologic diagnosis of nonpalpable breast cancers. MATERIALS AND METHODS: Mammographic characteristics of 317 consecutive clinically nonpalpable breast cancers in patients treated with breast-conserving surgery were reviewed. Malignant lesions were categorized as spiculated masses, other lesions, calcifications, and combined findings. Calcifications were characterized as amorphous, pleomorphic, or fine linear and branching. Logistic regression was used for the evaluation. Odds ratios (ORs) represent the magnitude of the association between a histologic diagnosis and a mammographic finding. RESULTS: Spiculated mass without calcifications (n = 150) and calcifications alone (n = 79) accounted for three of four cancers. A spiculated mass without calcifications was strongly associated with invasive cancers (OR = 12). Calcifications alone were strongly associated with ductal carcinoma in situ (DCIS) (OR = 19). In a decreasing order, the following invasive cancers were each associated with spiculated lesions without calcifications: ductal carcinoma grade 1 (OR = 28), ductal carcinoma grade 2 (OR = 17), lobular carcinoma (OR = 11), and ductal carcinoma grade 3 (OR = 4.6). Fine linear and branching calcifications alone were associated with not only DCIS nuclear grades 3 (OR = 17) and 2 (OR = 9.7) but also with invasive ductal carcinoma grade 3 (OR = 13). CONCLUSION: Mammographic appearance can be a predictor of histologic diagnosis in three of four nonpalpable breast cancers.     

Breast cancer: reliability of mammographic appearance as a predictor of hormone receptor status.

The association of mammographic appearance with hormone receptor status was investigated in 397 patients with primary breast cancers. The mammographic appearance was classified as type 1, spiculated (n = 159); type 2, structural changes (density) (n = 102); type 3, calcifications (n = 30); type 4, circumscribed opacity (n = 65); and type 5, not visible on mammogram (n = 41). Univariate analysis showed a significant association with estrogen receptor (ER) status for age (less than 50 vs greater than or equal to 50 years), tumor TNM category (those in category 1 vs those in higher categories), and mammographic appearance; with progesterone receptor status, the association was significant only for age. Multivariate analysis adjusted for potential confounders confirmed a significant association between ER status and mammographic appearance (ER status was more likely with type 1 than with the other mammographic types), but the strength of the association was limited. The mammographic appearance of breast cancer is not a reliable method to predict hormone receptor status for clinical purposes.     

消化道多原发癌的X线病理诊断(附11例报告)

目的：探讨消化道多原发癌的X线病理诊断，提高诊断能力，方法：11例有消化道症状的患者均经X线钡剂造影检查，其中8例内镜检查活检，4例手术，最终均经病理确诊为多在发癌，结果：同时多原发癌10例，其中1例食管二处癌肿，贲门一处癌肿；6例食管、胃各一处癌肿；1例胃二处癌肿；2例结肠2－3处癌肿。异时多原发癌1例，先为胃窦癌，术后一年又患贲门癌。结论：诊断消化道多原发癌，病理组织学检查是根据，X线检查为首选的重要方法，内镜活检是必要的手段，两者联合应用检出率和诊断正确率最高。