脾脏炎性假瘤的影像学表现（附三例报告）

目的 报道3例脾脏炎性假瘤的影像学表现,以提高对本病的认识。方法 复习3例脾脏炎性假瘤的超声、CT扫描和1例MRI表现,并与病理表现进行对照。结果 B超表现为单发球形病变,回声不均匀、边界清楚,其中1例见环状强回声伴后方声影。3例CT平扫见脾内边界清楚的低密度肿块,1例见周边蛋壳样环状钙化;2例作增强扫描,1例静脉期略有增强,另1例延迟扫描病变强化程度与脾实质接近;1例又作MR平扫,T1、T2WI均以低信号为主。结论 脾脏炎性假瘤应列入脾单发肿物的鉴别诊断,其影像表现与肿块内纤维组织和炎性肉芽组织的多少有关。超声表现为边界清楚、回声不均的肿块;CT增强扫描以病变延迟强化为特点;MRT2WI常以低信号为主。     

腹膜后炎性假瘤的CT诊断和鉴别诊断

分析经手术病理证实的腹膜后炎性假瘤的ＣＴ增强前后表现，为进一步认识腹膜后炎性假瘤的ＣＴ特征。材料和方法：搜集１９９０年１０月至１９９７年９月经手术病理证实且资料完整的１１例腹膜后炎性假瘤，全部病例均在ＣＴ平扫发现病变后，又静脉团注１００ｍｌ碘海醇（欧乃派克）行增强ＣＴ扫描。结果：１１例ＣＴ增强前、后成像均显示边缘形态不规则的肿块，直径大小为３．５￣５．０ｃｍ；其中８例前缘和侧缘有长短各异（５￣２０     

CT and MR imaging findings of xanthogranulomatous cholecystitis: correlation with pathologic findings

The aim of this study was to evaluate CT and MRI findings in xanthogranulomatous cholecystitis (XGC) and to correlate the imaging findings with various pathologic parameters. The study included 13 patients with histopathologically confirmed XGC. The CT (n=13) and MRI (n=5) obtained in these patients were evaluated retrospectively. On CT, low-attenuation areas in the wall of XGC correlated with foam and inflammatory cells or necrosis and/or abscess in XGC. Areas of iso- to slightly high signal intensity on T2-weighted images, showing slight enhancement at early phase and strong enhancement at last phase on dynamic study, corresponded with areas of abundant xanthogranulomas. Areas with very high signal intensity on T2-weighted images without enhancement corresponded with necrosis and/or abscesses. Luminal surface enhancement (LSE) of gallbladder wall represented preservation of the epithelial layer. The early-enhanced areas of the liver bed on dynamic CT and MR images corresponded with accumulation of inflammatory cells and abundant fibrosis. Our results indicate that CT and MRI findings correlate well with the histopathologic findings of XGC.     

Metastatic liver tumor from cystic ovarian carcinomas: CT and MRI appearance.

OBJECTIVE: The initial and follow-up CT and MRI images of ten patients with hepatic metastases from ovarian tumors were retrospectively analyzed to establish their features and sequential changes in appearance. MATERIALS AND METHODS: Ten patients with hepatic metastasis from ovarian tumors received initial and follow-up CT and MRI examinations. Six patients were followed up every two to three weeks before surgical tumor resection. Both CT and MR images were analyzed by two radiologists. RESULTS: A total of fourteen lesions were detected by CT and MRI in 10 patients. All 14 lesions were demonstrated as areas of marked hyperintensity on T2-weighted MRI. Eleven cyst-like tumors were demonstrated as round or oval low density lesions on CT and as areas of hypointensity on T1-weighted imaging. Three lesions were shown as solid masses with slightly low attenuation at the initial CT examination and slightly low or iso-intensity areas on T1-weighted imaging, and these lesions showed early peripheral globular enhancement and delayed enhancement on contrast-enhanced CT and MR imaging. Cystic formation was observed two to three weeks later after initial study in all the 3 solid lesions. Rapid subcapsular effusion, which showed obvious enhancement on delayed Gd-DTPA enhanced MR imaging, was observed in two patients. CONCLUSION: The hepatic metastatic tumor from cystic ovarian carcinoma may manifest as a well-defined cystic lesion or as a solid mass, and the solid mass shows delayed enhancement on contrast-enhanced CT and MR imaging. Furthermore, rapid cystic formation and rapid subcapsular extension is frequently seen.     

松果体区生殖细胞瘤的CT、MRI诊断

目的　探讨CT、MRI对松果体区生殖细胞瘤的诊断价值。方法　 11例经手术和病理证实的松果体区生殖细胞瘤患者 ,对其CT、MRI表现进行分析。结果　 11例CT平扫多呈高密度肿块 ,增强扫描呈明显均一强化 ;其MRI表现为 :(1)T1 WI等或稍低信号 ,T2 WI等或稍高信号 ,肿瘤无水肿 ;(2 )Gd -DTPA增强扫描肿瘤呈不均匀或均匀明显强化。结论　CT和MRI的多轴位成像及Gd-DTPA应用有助于松果体区生殖细胞瘤的诊断与鉴别诊断 ;病人性别和肿瘤部位具有一定特点     

儿童脑神经母细胞瘤的CT、MRI和病理分析

目的 :探讨儿童脑神经母细胞瘤的CT、MRI表现及和病理的关系。方法 :对 9例经组织病理学证实的脑神经母细胞瘤进行回顾性分析 ,研究肿瘤的CT及MRI影像学特征。结果 :9例神经母细胞瘤中 ,4例肿瘤位于右侧额叶 ,1例位于左侧额叶 ,3例位于右侧颞叶并累及同侧额叶 ,1例位于左侧顶叶。 9例肿瘤均呈囊实性肿块 ,边界清楚 ,5例有钙化。肿瘤实质性部分CT平扫呈略高密度 ,MRT1WI呈等或稍低信号 ,T2 WI呈等或稍高信号 ,增强后肿瘤实性部分和囊性部分的壁明显强化。结论 :神经母细胞瘤是儿童期少见的恶性肿瘤 ,常发生钙化、囊变、坏死。肿瘤实性部分CT平扫密度通常高于脑灰质 ,MRT1WI呈等或稍低信号 ,T2 WI呈等或稍高信号。     

肝脏局灶性结节增生的螺旋CT和MRI诊断

目的 :分析肝脏局灶性结节增生 (FNH)平扫和动态增强的螺旋CT、MRI表现 ,提高FNH诊断符合率。方法 :对 13例经手术病理证实的FNH影像学表现进行回顾性分析。螺旋CT检查 8例 ,MRI检查 6例 ,其中 1例同时做CT和MRI检查。结果 :8例CT平扫病灶均呈低密度 ,均匀或不均匀。增强动脉期扫描除中心疤痕外 ,所有病灶均有明显均匀强化 ,其中 4例还可见到病灶中心或周边增粗、扭曲的动脉。门脉期和延迟期扫描 4例呈略高密度、4例病灶呈等密度或略低密度 ,4例伴有中心疤痕者均有延迟强化。MRI检查 6例 ,病灶均呈不均匀略长或等T1及T2 信号 ,增强动脉期呈明显强化 ,门脉期及延迟期呈等或略高强化 ,4例MRI平扫显示中央瘢痕者有延迟强化。结论 :平扫和动态增强螺旋CT、MRI能较全面显示FNH的病理特征和血供特点 ,明显地提高与其它富血管恶性肿瘤的鉴别诊断能力     

肝脏炎性假瘤的CT及MRI征象

目的:探讨肝脏炎性假瘤的CT和MRI表现。方法:8例经手术病理证实的肝脏炎性假瘤。男5例,女3例,年龄35~65岁,平均53岁。8例均作CT平扫及增强扫描,其中3例行MR对比检查。结果:CT表现为1 个病灶6 例,2个病灶2例,共发现病灶10个。平扫9个病灶表现为低密度,1 个病灶表现为稍高密度。动态增强扫描2 个病灶动脉期显著强化,门脉期及延迟期中度强化;8个病灶动脉期无明显强化,门脉期及延迟期有不同方式的强化,主要表现为周边完整或不完整的环形或结节状强化,中心核心样强化及线状或不规则分隔样强化。MRI表现为2 例病灶T1WI呈低信号,T2WI呈稍高信号,1例病灶T1WI及T2WI均为等信号,动态增强扫描与CT相仿。结论:肝脏炎性假瘤的CT及MRI表现因其病理阶段不同而表现各异,诊断需结合临床,确诊尚依靠病理检查。     

肝脏孤立性坏死结节的CT及MRI表现

目的:探讨肝脏孤立性坏死结节(SNN)的螺旋CT及高场强MRI表现,提高对SNN的诊断准确性。方法:回顾性分析30例(34个)经手术病理证实的SNN患者的影像学表现。其中10例行螺旋CT平扫和3期动态增强检查,20例行MRI平扫及增强检查。结果:CT发现11个病灶,MRI发现23个病灶。CT平扫示病灶均呈低或稍低密度,6例中央可见星芒状更低密度区,增强扫描动脉期病灶均无明显强化,延迟期4个病灶有边缘强化。MRT1WI示23个病灶均为低或稍低信号,10个病灶中心见点状、星状更低信号;T2WI示5个病灶呈稍低信号、18个为稍高信号;增强扫描动脉期所有病灶均未见明显强化,8个病灶门脉期及延迟期边缘强化。16个病灶中心更低密度/信号区均未见强化。结论:CT平扫和动态增强及MRI能较好地反映SNN的影像学特点,提高了对SNN的诊断准确性。.     

椎管内表皮样囊肿的MRI表现

目的:探讨椎管内表皮样囊肿的MR表现。方法:回顾性分析16例经手术病理证实的椎管内表皮样囊肿的 MRI表现。常规行SE T1WI、TSE T2WI和STIR扫描,14例行Gd-DTPA增强扫描。结果:16例中12例病灶位于髓外硬膜下,4例位于脊髓内,合并其它先天畸形6例。MR表现为T1WI上呈低信号8例,等、低混杂信号6例,等、低、高混杂信号2例;T2WI上呈高信号10例,等、高混杂信号5例、等、低混杂信号1例;3例肿瘤内有脂肪信号。11例患者行增强扫描,肿瘤内部均无强化,肿瘤边缘轻度强化2例。结论:椎管内表皮样囊肿的MRI表现有一定特征性,除与皮样囊肿鉴别困难外,与其它椎管内肿瘤容易鉴别。     

肝局灶性结节性增生的影像诊断及病理对照研究

目的探讨肝局灶性结节性增生(focal nodu lar hyperp lasia,FNH)的影像学表现特点。方法经手术切除病理证实为肝局灶性结节性增生17例病例,术前均行螺旋CT平扫及动态增强扫描,其中10例又行MR平扫及动态增强扫描,分别进行影像学及病理学对照分析。结果17例FNH病灶均呈孤立结节或分叶状肿块,多数直径2~5 cm。平扫呈等或略低密度及信号,T2W I为略高信号。动态增强扫描,动脉期病灶均为明显的均质的强化,静脉期及延迟期12例仍略高于肝实质,6例略低于或等于肝实质。11例病灶内显示瘢痕,其中8例呈延迟强化。4例静脉期出现包膜样强化。病理观察:17例FNH均无包膜,增生的肝细胞形成肝板被纤维间隔分割呈结节状,瘢痕区域由纤维结缔组织及厚壁畸形血管组成。结论典型的FNH影像学可明确诊断,不典型的FNH应与肝细胞腺瘤、肝细胞癌、肝血管瘤相鉴别。     

肝炎性肌纤维母细胞瘤的影像学特征

目的：探讨肝炎性肌纤维母细胞瘤（hepatic inflammatory myofibroblastic tumor ,HIM T ）的影像表现特征,提高对该病的认识和诊断准确性。方法回顾性分析经病理证实的7例 HIM T的影像表现,其中4例行CT 扫描,3例行MR检查。结果7例7个病灶,位于肝右叶5例,位于肝左叶2例;CT 平扫呈低或稍低密度,T1WI为稍低信号,T2WI呈等或稍高信号;CT 及MR增强动脉期明显强化2例,轻中度强化4例,不强化1例;门脉期及延迟期持续明显强化6例,边缘强化1例。结论 HIM T影像表现多样,T2 WI呈等或稍高信号、动态增强门脉期及延迟期持续强化有一定特征,但本病少见,确诊尚需组织病理学及免疫组化检查。     

颅内多发性脑膜瘤的影像学诊断

目的 探讨颅内多发性脑膜瘤的CT和MRI特征.资料与方法 对23例经手术病理证实的多发性脑膜瘤的CT和MRI资料进行回顾性分析.结果 多发性脑膜瘤双发16例,多发7例(平均4.7个),共61个肿瘤.CT平扫为颅内多发的等或略高密度病灶,MRI T1WI病灶呈等或略低信号,T2WI呈等或稍高信号,增强扫描明显均匀强化.结论 CT和MRI对颅内多发性脑膜瘤有重要诊断价值.     

肝脏孤立性坏死结节的影像和病理对照

目的认识肝脏孤立性坏死结节的影像及病理学表现，提高诊断准确率。方法１６例中１２例经手术病理证实，４例根据ＭＲＩ表现随访半年以上证实。对照病理，分析１６例超声、ＣＴ及ＭＲＩ表现。结果组织病理显示全部为凝固坏死结节，６个病灶含有小片液化坏死，平均直径２．３ｃｍ，外周的薄层纤维包膜中有淋巴细胞、浆细胞、嗜酸性细胞及少数中性白细胞浸润。超声为内部回声欠均匀的低回声结节。ＣＴ表现为边缘清楚、无强化的低密度病灶。在ＭＲＩ的Ｔ１及Ｔ２ＷＩ上分别呈低信号及等低信号，４个病灶内间以点片状更低信号及高信号，增强后病灶内部无强化，４４％（７／１６）有细环状轻度延迟强化的包膜。结论平扫加动态增强ＭＲＩ能良好反映孤立性坏死结节的病理特征，其表现具高度的诊断特异性，明显优于超声和ＣＴ。     

胸膜外孤立性纤维瘤的影像表现与病理对照研究

目的:分析总结胸膜外孤立性纤维瘤的影像表现及病理基础,提高诊断准确性.方法:回顾性分析30例经病理证实的胸膜外孤立性纤维瘤的CT、MRI表现.5例患者仅进行了CT检查,19例患者仅进行了MR检查,6例同时行CT和MR检查.结果:30例患者均为单发病灶,其中13例位于中枢神经系统,7例位于头颈部、6例位于腹盆腔、1例位于...     

肝脏局灶性结节增生的CT和MRI表现与病理对照分析

目的:探讨肝脏局灶性结节增生(FNH)的CT和MRI表现及病理基础。方法:回顾性分析18例20个经手术或穿刺活检病理证实FNH的CT和MRI表现特点,并与病理对照(CT检查12例,MRI检查10例,4例同时行CT和MRI检查)。结果:病灶大小1.8～13.5cm;CT检出11个病灶,CT平扫病灶均呈低密度,均匀或不均匀;增强扫描动脉期示除中心疤痕灶外,所有病灶均明显增强,6个病灶周边见增粗、扭曲的动脉;门脉期示病灶呈稍高密度,延时期示6个病灶呈稍高或等密度,5个病灶呈稍低密度;5个病灶的中央疤痕均延时增强。MRI检出12个病灶,病灶均呈稍长或等T1及T2信号;增强动脉期示病灶明显增强,门脉期及延时期呈稍高或等信号,7个病灶的中央疤痕延时增强。结论:CT和MRI能够显示FNH的血供特点及病理特征,动态增强扫描是诊断FNH最有效的影像学手段,在诊断和鉴别诊断中具有很大价值。     

Value of various imaging modalities for diagnostic work-up of tumors of the adrenal gland

OBJECTIVE: This paper describes the value of various imaging modalities for diagnostic work-up of tumors of the adrenal gland. METHODS: Results of the literature are reviewed. An optimized examination protocol for computed tomography (CT) and magnetic resonance imaging (MRI) is shown for assessment and differentiation of unclear lesions of the adrenal gland. RESULTS: Measurements of attenuation in the native examination as well as delayed enhancement are the cornerstones in the CT diagnostics of tumors of the adrenal gland. In MRI, chemical-shift imaging and evaluation of signal characteristics in T1- and T2-weighted images are most important for characterization even in unclear cases. CONCLUSION: CT and MRI play the major role in imaging of adrenal gland tumors.Whereas CT is less expensive and widely available,MRI provides advantages in unclear cases because of the excellent tissue contrast and the superior characterization.     

原发性中枢神经系统淋巴瘤的影像学表现

目的：探讨原发性中枢神经系统淋巴瘤的影像学表现,以提高影像诊断水平。方法回顾性分析25例经病理证实的原发性中枢神经系统淋巴瘤的CT、MRI等影像学资料。结果单发16例,多发9例,共有39个病灶,幕上35个病灶,幕下4个病灶。单发病灶多位于脑白质深部,多发病灶常位于脑实质中线部位及大脑凸面。肿瘤在CT表现呈稍高密度,病灶T1WI多呈等或稍低信号,T2WI多呈等或稍高信号,DWI多呈高信号。增强扫描多呈明显均匀强化,少数呈斑片状强化;瘤周可见不同程度的水肿。结论原发性中枢神经系统淋巴瘤的CT、MRI表现具有一定特征性,结合临床并综合其影像学表现,可提高其诊断准确率。     

眼部淋巴瘤CT和MRI诊断

目的:分析眼部恶性淋巴瘤的CT和MRI表现特点,探讨二者诊断淋巴瘤的价值。方法:13例眼部淋巴瘤,CT检查12例,MRI检查5例。结果:所有病例经病理证实,其中10例为单侧,3例为双侧,均累及隔前眶周组织,8例以眼眶的上象限为主,5例以下象限为主,境界不清。5例呈局限性块影;8例呈弥漫软组织影,沿肌锥外向眶内浸润生长,同时累及泪腺和邻近眼外肌,并沿肌锥外向眶内生长呈铸形样改变;3例大部分眼环被肿瘤组织环绕,呈光芒样改变,并累及球后。CT平扫肿瘤组织呈境界欠清的中等密度软组织块影,MRI呈较低或略高信号强度,增强扫描肿块均呈较明显的均匀强化。结论:眼部恶性淋巴瘤的CT和MRI表现具有一些特征,影像学检查对本病的诊断具有重要价值。     

动态增强MRI对肝脏良恶性肿瘤的鉴别诊断

目的:通过分析动态增强磁共振成像法对肝细胞癌、肝转移瘤及海绵状血管瘤的诊断准确性,评价其在肝脏良恶性肿瘤鉴别诊断中的价值。方法:动态增强法采用快速梯度回波(FLASH序列),以病灶为中心取矢状位或斜位成像;每次5-8层,采集时间约10-20秒,用同一序列共重复扫描9次。结果:在动态增强MRI成像中,15例肝细胞癌表现为注射造影剂后15-45秒后呈迅速、中度不均匀强化,75秒后强化迅速消退;另2例未见明显早期强化,后期仍呈低信号。肝转移瘤表现为轻度、逐渐周边强化,延时期仍呈轻度环形强化。海绵状血管瘤表现为逐渐增强的、由周边向中心扩展的显著强化,延时期仍不消退,呈显著高信号。结论:动态增强MRI能有效地显示肝脏肿瘤内的血液动力学变化,能为鉴别诊断提供可靠的依据,对肝脏肿瘤的准确诊断有极其重要的价值。