肺硬化性血管瘤的CT表现(附10例报告)

目的：探讨肺硬化性血管瘤（PSH）的CT表现,旨在提高对该病的认识及诊断水平。方法：回顾性分析经手术病理证实的t0例PSH患者,其中男1例,女9例,年龄47～68岁,平均57．6岁。10例均行胸部CT检查,其中1例仅行CT平扫,9例行CT平扫及增强扫描。结果：病灶部位：右肺3例,其中上叶1例,中叶2例;左肺7例,其中上叶4例,下叶3例。病灶形态：10例均为圆形、类圆形肺内肿块或结节,境界清晰．分叶不明显（4例有浅分叶）、无毛刺、胸膜牵拉凹陷、卫星病灶及血管集束征等征象。病灶大小：均为单发,最大径1．7～5．1cm,其中〈3cm者6例。病灶密度：CT平扫4例密度较均匀,6例见斑片状稍低密度区,4例见点状或粗大点片状钙化;CT增强均匀强化3例,不均匀强化6例,9例中7僻呈延迟强化。特征性的征象：空气新月征1例、贴边血管征10例、尾征3例、晕征7例。结论：空气新月征、贴边血管征、尾征、晕征等CT征象具有一定的特征性。有助于PsH的术前诊断。     

儿童白血病继发肺部真菌感染的CT诊断

目的分析儿童白血病继发肺部真菌感染的CT表现,以提高其诊断和鉴别诊断水平。方法回顾性分析儿童白血病患者继发肺部真菌感染15例,其中肺曲霉菌病10例,白色念珠菌病2例,隐球菌感染3例,分析、总结其肺部病灶的CT征象,包括病灶的数目、分布、形态、动态变化等。结果儿童白血病患者继发肺部真菌感染病灶中,数目以多发常见;病灶呈多灶性,多分布在肺野中外带,隐球菌病结节可呈簇状分布;形态呈多样性,大部分病灶表现为结节或肿块,大小不一,伴有特殊征象,包括晕征80%、空气新月征46. 7%、病灶内小空洞40%,空洞内小条索影33. 3%,空洞内小气泡影33. 3%等;病灶动态变化明显,短期复查变化较大。结论 CT检查有助于儿童白血病继发肺部真菌感染诊断及鉴别诊断,具有重要的临床应用价值。     

肺毛霉菌病CT表现

目的探讨肺部毛霉菌病CT表现特征。方法搜集经手术、穿刺活检或痰培养证实的9例肺部毛霉菌患者的CT平扫和增强扫描资料,回顾性分析病变的形态、分布、密度。结果 (1)9例中"反晕征"表现3例(33.3%),"分隔征"表现5例(55.6%),"楔形实变坏死征"表现6例(66.7%),"晕征"表现4例(44.4%),"空气新月征"表现1例(11.1%),合并2种或2种以上征象6例(66.7%)。(2)9例中,有糖尿病史4例,急性淋巴细胞白血病、肺结核、慢性肾功能不全、不明原因多年肺部空洞病史、慢性肺部感染各1例。结论免疫功能不全患者,肺部CT出现"反晕征"、"分隔征"或"楔形实变坏死征"时,应注意毛霉菌病可能。     

急性白血病化疗后继发肺部真菌感染的CT诊断

目的 提高对急性白血病化疗后继发肺部真菌感染CT表现的认识. 资料与方法 回顾性分析25例急性白血病患者化疗后经病理、真菌培养及临床治疗随访证实的继发肺部真菌感染的CT表现. 结果 25例中CT表现为肺炎性浸润实变、结节型8例,炎性浸润实变、肿块型2例,炎性浸润实变、结节、肿块型4例,多发结节型6例,结节、肿块型5例;其中12例出现"晕征", 2例有"含气新月征"; 7例合并空洞,9例有楔形实变影.病灶在肺内的分布无特殊性. 结论 急性白血病化疗后继发肺部真菌感染CT表现为病变呈多灶性、多态性,真菌感染的"晕征"及楔形实变影是早期肺部真菌感染的较特征性CT表现.     

侵袭性肺曲霉菌感染CT特征与预后

目的探讨侵袭性肺曲霉病(IPA)影像学特征及肺部病灶演变与预后的关系。方法搜集2010年1月至2012年3月痰培养曲霉菌阳性住院患者167例,对其中临床诊断为IPA的60例患者的胸部CT影像资料进行回顾性分析。采用PEMS 3.1医学统计软件分析数据,计数资料用χ2检验。结果肺部多发性结节为最常见病灶(81.7%,49/60),其次是空洞(61.7%,37/60),肺实变最少(11.7%,7/60),"晕轮征"发生率不低(68.3%,41/60)。"晕轮征"发生比较早(第1～2周),"新月征"发生晚(第2～3周)。血液病和非血液病肺部CT影像特征基本一致,差异无统计学意义。治疗有效肺部病灶在第3周趋于稳定,第4周病灶基本得到控制。恶化组与好转组比较,实变(第4～6周)(χ2=4.82,P=0.028;χ2=9.0,P=0.003;χ2=11.0,P=0.001)空洞(第4周)(χ2=4.81,P=0.028)病灶继续进展提示预后较差。结论 IPA的胸部CT多具有诊断性特征病变,CT随访对观察病情演变和预后有重要意义。     

侵袭型肺曲霉菌病CT影像变化初步研究

目的：探讨侵袭型肺曲霉菌病（IPA）的CT征象演变,提高对侵袭型肺曲霉菌病的认识和早期诊断。方法：回顾分析2,4例经皮肺部穿刺活检病理证实并且行一系列CT复查的侵袭型肺曲霉菌病的CT表现。结果：在IPA诊断第1天,“晕征”的出现率为82．5％;在中位天数3天、7天、14天,“晕征”出现率分别为68％、22％和19％,“新月形空气征”的出现率分别为8％、28％和63％,非特异性肺实变的出现率分别为31％、50％和18％。在IPA诊断后第1—7天（中位天数）,病灶体积和数目逐渐增大;7-14天,病灶大小维持相对恒定,而病灶数目则呈下降趋势。结论：“晕征”是IPA早期征象。“新月形空气征”是IPA的晚期征象。“晕征”持续时间较短,对高度怀疑为IPA的患者,胸部CT扫描应及早进行,理想的CT扫描时间应在IPA发病5天以内,在早期积极抗真菌治疗的同时,应注意积极恢复骨髓造血功能。     

肺炎性假瘤的HRCT诊断

目的 探讨肺炎性假瘤的CT表现.方法 21例经手术或病理证实的肺内直径小于2.0 cm炎性假瘤患者均经胸部高分辨力CT（RHCT）检查.其中,15例又经增强CT扫描.结果HRCT证实,21例病人中,浅分叶征见于6例,棘状突起5例,晕征8例,血管集束征5例.在接受增强扫描的15例中,增强后5例的病灶有轻度强化,而其余10例的病灶无明显强化,所有病例的病灶边缘均较光整.结论 HRCT对诊断肺内直径小于2.0 cm的炎性假瘤具有重要价值.而各种CT征象的综合分析有利于确诊.     

HRCT在新型冠状病毒肺炎诊断中的应用

目的探究常规CT以及HRCT对新型冠状病毒肺炎(COVID-19)检查中的影像学表现差异,分析HRCT的特异性影像学特征。方法回顾性分析经核酸检测阳性确诊的新型冠状病毒肺炎患者37例,先采用常规CT进行扫描,其中将肺部有渗出病变为CT阳性组,肺部无渗出病变患者为CT阴性组2例。然后针对CT阳性患者对病灶多平面重建和最大密度投影重建得出所有病灶HRCT图像。参照《新型冠状病毒肺炎的放射学诊断》1,推荐将CT影像分为早期、进展期、重症期和转归期,对不同期的HRCT及常规胸部CT的影像表现分别比较分析,找出影像表现差异。结果HRCT及常规CT影像学均表现为单侧肺或者双侧肺中外带肺野或胸膜下磨玻璃样病灶,分析常规CT及HRCT所有病灶中,病灶分布情况如下右肺上叶17例,右肺中叶18例,右肺下叶23例,左肺上叶19例,左肺下叶19例,其中双下肺分布25例(占71.4%),背侧分布26例(占74.3%)。形态特征磨玻璃,部分性或全实性,细网格、铺路石征,结节伴晕征,长轴与胸膜平行,空气支气管征,病灶沿支气管血管束分布,“增粗血管”征象。其中磨玻璃影、“细网格、铺路石”征象、结节伴晕征、“增粗血管”征象虽然在常规CT中可以显示,但HRCT通过薄层及三维重建能够清晰的显示出这种征象,其P值分别为0.006、0.008、0.042、0.035(P值<0.05),差异具有统计学意义。结论HRCT较常规CT扫描更能精确的显示出NCP的影像学细微特征,HRCT检查对新型冠状病毒肺炎患者的确诊具有十分重要意义。     

儿童急性白血病并发侵袭性肺曲霉菌病的CT表现

目的 探讨儿童急性白血病并发侵袭性肺曲霉菌病(IPA)的CT特征.方法 回顾性分析经临床和痰培养证实的13例IPA患儿的临床、CT资料,13例均行胸部CT扫描,并进行了4～10次随访CT扫描.结果 首次CT表现:单发结节2例,多发结节影10例,结节伴晕征9例,胸膜下楔形实变影5例,其中4例胸膜下楔形实变影与肺部多发结节影并存.随访CT扫描结节病灶和楔形病灶内出现空洞或"空气新月征"11例,7例结节病灶和2例空洞病灶周围出现晕征.结论 IPA的CT表现具有一定的特征性,CT对观察该病的发展、演变及估计预后有重要的价值.     

肺真菌感染CT征象分析

目的:分析肺真菌感染的CT 征象,以提高对该病的诊断水平.方法:对18例经临床病理组织学检查或真菌培养证实为肺部真菌感染患者的影像学资料进行回顾性分析.结果:18例患者CT征象:8例表现为双肺多发病灶,4例表现为单个肺段多发病灶,6例表现为单发病灶;病灶形态方面:8例表现为肺炎型,6例表现为肿块型,4例表现为曲霉菌球;18例患者中,8例出现"晕征".结论:肺部真菌感染影像学表现具有多样性.出现典型曲菌球者可明确肺曲菌病的诊断,若出现弥漫混合病变(渗出、实变与结节或肿块并存) 、绕有晕征的结节以及楔形实变影时,应考虑是否有真菌感染可能.     

The value of computed tomography and ultrasound in cases of inflammatory aneurysms of the abdominal aorta

In a retrospective study 344 CT examinations of patients with suspected aneurysms of the abdominal aorta were evaluated with respect to the inflammatory character of the aneurysm. In 207 cases surgical therapy was conducted. In 144 of those 207 cases preoperative ultrasound examination results were also available. Frequency of inflammatory aneurysms, as classified by CT, was 10.2% (35/344) and in the subgroup of surgically treated aneurysms, 14.0% (29/207). Sensitivity and specifity of CT to realise the inflammatory type of aneurysm was 86.2% and 97.2%. The respective figures for ultrasound examinations on the basis of 144 surgically treated aneurysms were 26.1% and 100%. We conclude that even in cases of sonographically unequivocal abdominal aneurysms CT should be performed because ultrasound is not sufficiently sensitive to realise an inflammatory character of the aneurysm, which can have great impact on surgical strategy. Correspondence to: E. Rinast     

Automated calculation of the centerline of the human colon on CT images

RATIONALE AND OBJECTIVES: This article presents an evaluation of an automated technique for determining the colon centerline with computed tomographic (CT) data sets. MATERIALS AND METHODS: The technique proceeds as follows. After indication of a voxel in the rectum, voxels corresponding to air were segmented. Points along the colon centerline were estimated on the basis of centers of mass of grown voxels. A second segmentation and centerline calculation was initiated at the cecum. These two centerlines were then averaged. The resulting average was refined by using lumen data obtained perpendicular to the average centerline. The accuracy of the technique was investigated with simulation phantoms. The technique was also evaluated for 40 clinical colon cases. Calculated centerline points were compared with those indicated by radiologists for a randomly selected clinical case. RESULTS: In the simulation studies, the calculated centerline points were, on average, within 2.5 mm of the true centerlines but differed by up to 4 mm in regions of deep folds or sharp turns. In the clinical colon study, 40% of the centerlines were computed with a single seed point and 25% with two seed points. Average centerlines were computed in 1 minute. The root mean square difference between the computed centerline points and those indicated by the radiologists was 4-5 mm (comparable to interobserver variations). CONCLUSION: Accurate centerlines can be determined from colon CT data with this automated technique.     

静脉应用毒品致胸部病变的影像学表现

目的：探讨经静脉应用毒品致胸部病变的影像学表现,提高其认识和诊断水平。方法：回顾性分析2000年～2008年间28例临床收治证实的经静脉应用毒品致胸部病变的临床资料及影像学表现。结果：两肺纹理增粗、多模糊5例,浸润性斑片状、片状模糊阴影X线胸片12例、CT14例,结节影X线胸片16例、CT17例,空洞影X线胸片10例、CT13例,肺气囊X线胸片17例、CT19例,心脏增大6例,胸腔积液X线胸片6例、CT12例,液气胸3例,6例CTPA显示肺动脉充盈缺损2例（2/6）。多种形态病灶并存。本组除5例仅1种改变外,余23例均出现两种以上病变,病灶分布肺外周或胸膜下,主要在中下肺野。结论：影像学检查是静脉应用毒品致胸部病变重要的检查方法,多发周边或胸膜下的气囊、结节伴或不伴空洞是较为特征性的表现。     

Cardiovascular applications of magnetic resonance flow and velocity measurements

With recent developments of MR techniques for blood flow measurements, qualitative and quantitative information on both flow volume and flow velocity in the major vessels can be obtained. MR flow quantitation uses the phase, rather than the amplitude of the MR signal, to reconstruct the images. Previous validation studies have demonstrated the accuracy of the phase shift techniques for measuring flow velocities. This technique is now being applied successfully in the cardiovascular system to quantify global and regional ventricular function, valvular heart disease, pulmonary artery disease, thoracic aortic disease, congenital heart disease, and ischemic heart disease.     

Nodular sarcoidosis of the liver and spleen: Appearance on MR images

Small nodular lesions in the liver and spleen have been reported as an infrequent manifestation of sarcoidosis. Five patients with this appearance on either dynamic contrast material—enhanced computed tomographic (CT) or ultrasound scans underwent magnetic resonance (MR) imaging with and without dynamic gadolinium enhancement. The lesions were relatively uniform in size, ranging from 0.5 to 1.5 cm. On CT scans, they were hypoattenuating relative to surrounding parenchyma. On MR images, the lesions were hypointense relative to background parenchyma with all sequences. No substantial enhancement was observed in the lesions, although lesion conspicuity decreased over time on serial postcontrast images. Lesion conspicuity was greatest on either T2-weighted fat-suppressed (T2FS) images or early-phase dynamic contrast-enhanced images. Abdominal adenopathy was seen in three of the five patients and was hyperintense relative to liver on T2FS images in two and intermediate in intensity in one patient.     

乳腺疾病的病种构成和峰值年龄比较分析

目的 探讨乳腺疾病病理资料中病种构成、发生率和年龄分布的结构特征。方法 统计分析东北地区14所医院病理档案资料，O～69岁的患者按每10岁为一个年龄组，〉70岁者为一个年龄组，按SPSS10．0软件的要求建立数据库，分别统计乳腺疾病种类，计算发生率，绘制疾病年龄曲线，作不同类型医院同种疾病组成和年龄分布曲线比较分析。结果 共46种乳腺疾病35948例，常见疾病为纤维腺瘤、乳腺癌、腺病、男性乳腺发育、囊性增生病、副乳腺，分别占全部乳腺疾病的37．99％、21．49％、20．60％、4．54％、3．60％和2．80％，此6种乳腺疾病的患者数占全部46种乳腺病的91．02％。结论 乳腺疾病的病例数与医院的规模呈正比；不同的疾病有各自的峰值年龄；各种疾病中肿瘤性疾病23167例，占全部病例数的64．45％，其中良性、交界性和恶性肿瘤分别占66．13％、0．13％和33．74％；良性肿瘤以纤维腺瘤多见，占89．14％，恶性肿瘤以乳腺癌多见，占98．82％，二者在各医院病理资料中的发生曲线几乎相同，均呈正态分布；不同地区相同类型的医院间，乳腺疾病发生的峰值年龄没有显著性差异；非肿瘤性疾病12781例，占全部病例数的35．55％；各医院病理资料中关于乳腺腺病和囊性增生病的发生曲线极不规则，缺乏可比性，提示各医院掌握的诊断分类标准存在原则差异，有必要在这方面进行深入研究。     

CT在脾脏占位性病变诊断及鉴别诊断中的价值

目的:探讨CT在脾脏占位性病变鉴别诊断中的价值.方法:回顾性分析25例经手术病理证实的脾脏占位性病变的CT及病理学资料,分析脾脏占位性病变的CT特征.结果:良性占位性病变中90.9%脾脏为正常至轻度肿大,而恶性57.1%为重度脾脏肿大.良性占位性病变多为单发病灶,边界清晰,钙化多见,呈蛋壳样钙化,淋巴结少见肿大;恶性病变常为多发病灶,边界欠清,钙化少见,呈砂粒样或结节样,淋巴结肿大及腹水多见.结论:脾脏占位性病变CT表现具有一定的特征性,结合临床病史多可正确诊断.     

Optimal post-contrast timing of breast MR image acquisition for architectural feature analysis

PURPOSE: To define a post-contrast imaging time span during which diagnostic accuracy of breast magnetic resonance (MR) architectural feature analysis is maintained. MATERIALS AND METHODS: Seventy-five patients with mammographically-visible or palpable findings underwent MR examination. Three sequential post-contrast, fat-saturated, three-dimensional gradient-echo imaging runs were acquired spanning 0-90, 90-180, and 180-270 seconds after contrast injection. Five readers independently predicted the malignant potential of the MR abnormalities. RESULTS: Receiver-operator characteristics (ROC) curves were our primary measure of diagnostic accuracy. The accuracy of four readers was unchanged over the three post-contrast runs. One reader was slightly more accurate using the second and third runs than using the first. CONCLUSION: For most readers, a single post-contrast run performed at any point during the first four minutes and 30 seconds following injection should yield an equivalent diagnostic accuracy. If any time period is less optimal, it is that of our first run, performed between 0-90 seconds after contrast injection.     

Solitary Necrotic Nodules of the Liver Mimicking Hepatic Metastasis: Report of Two Cases

We present two cases of solitary necrotic nodules of the liver which on radiologic images mimicked hepatic metastasis. Solitary necrotic nodule of the liver is a rare but benign entity which histopathologically consists of an outer fibrotic capsule with inflammatory cells and a central core of amorphous necrotic material. The lesion was seen on contrast-enhanced CT as an ovoid-shaped hypoattenuating nodule; on CT during hepatic arteriography as enhancing nodule; on intraoperative US as a target-appearing hypoechoic nodule; on T2WI as a hyperintensity nodule, and on dynamic MR as a subtle peripheral enhancing nodule. Although the radiologic features are not specific, solitary necrotic nodule of the liver should be included in the differential diagnosis of hepatic metastasis.     

脊椎干骺端发育异常的X线表现

目的探讨脊椎干骺端发育异常（SMD）的临床、X线表现及其病因。方法回顾性分析5例SMD患者资料。所有病例均行X线检查。结果男4例，女1例，年龄4-15岁。均表现为发育迟缓，身材矮小，主要是躯干短，步履蹒跚，合并脊柱侧弯2例，脊柱后凸1例，双膝外翻2例。X线所见主要为多发干骺端骨化不良和扁平椎，骨骺正常，按2001年世界卫生组织分型：Ⅰ型2例、Ⅱ型1例、Ⅲ型2例。结论当遇到发育迟缓、身材矮小的儿童，X线片显示干骺端骨化不良伴有扁平椎时，应考虑到SMD的可能。