小儿生殖细胞瘤的CT诊断

目的分析小儿生殖细胞瘤的CT表现特点，提高CT诊断的准确性。资料与方法回顾性分析38例生殖细胞瘤的CT表现，并与手术及病理结果进行对照。结果多种组织成分组成的混杂密度占位18例，囊性或以囊性为主的占位12例，软组织密度或绝大部分为软组织密度的占位8例。其中良性28例，恶性10例。良性均为成熟畸胎瘤。恶性组中内胚窦瘤合并畸胎瘤3例；末成熟畸胎瘤、无性细胞瘤、内胚窦瘤各2例；卵巢绒毛膜癌1例。结论小儿生殖细胞瘤的CT表现具有各自的特点，CT诊断准确性较高，为首选的检查方法。     

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。     

胸腺原发神经内分泌肿瘤的CT诊断与鉴别诊断

目的 探讨胸腺原发神经内分泌肿瘤的CT特点.方法 选取经组织病理学及免疫组化确诊的13例胸腺原发神经内分泌肿瘤病例的临床及影像学资料.结果 13例中男性10例,女性3例.5例不典型类癌,1例典型类癌,2例小细胞神经内分泌癌,5例神经内分泌癌未明确分型;1例伴双侧肾上腺皮质增生改变;胸腺神经内分泌肿瘤通常表现为较大肿块影...     

Basal cell adenoma of the parotid gland: characteristics of 2-phase helical computed tomography and magnetic resonance imaging

OBJECTIVE: The goal of this study was to report the radiologic characteristics of basal cell adenoma of the parotid gland, which is a relatively rare neoplasm. METHODS: A radiology and otolaryngology specialist reviewed the 2-phase helical computed tomography (CT) (n = 6) and/or magnetic resonance (MR) imaging (n = 2) scans of 7 patients with basal cell adenoma. The authors evaluated the imaging characteristics, including tumor size, location, contour and margin, internal density or signal intensity, contrast enhancement pattern, and presence of calcification. The imaging features were then analyzed and correlated with the pathologic findings. RESULTS: All the tumors presented as small (less than 3 cm), well-encapsulated, round or oval masses on CT or MR imaging. On the 2-phase CT scan, the mostly solid-looking tumors (n = 4) showed marked contrast enhancement on the early phase, and there was a subsequent decrease in attenuation on the delayed phase. These tumors were classified as the solid subtype on histologic examination. Meanwhile, the tumors with large cystic areas (n = 2) showed gradual and additional enhancement on the delayed phase and were classified as the tubular or trabecular subtype on pathologic evaluation. There were small spots of low attenuation in the tumors of the solid subtype, which were proved to be intratumoral microcysts in the pathologic correlation. Calcification was found in a tumor. CONCLUSIONS: Basal cell adenomas of the parotid gland present as small well-marginated tumors and appear as masses with central large cysts or solid masses with microcysts on CT and MR imaging scans. Basal cell adenomas of the parotid gland had at least 2 different enhancement patterns on the 2-phase helical CT scans, and the enhancement patterns and imaging architecture were related to the histologic subtype of the tumors.     

小脑蚓部肿瘤的CT诊断(附95例分析)

目的：提高小脑蚓部各肿瘤ＣＴ诊断的正确性。材料与方法：９５例经手术,病理证帝物小脑蚓部肿瘤,男性５９例,女性３６例,术前均行ＣＴ平扫及增强扫描。结果：成神经管细胞瘤４１例,ＣＴ平扫以略高、等或略低混杂密度米,增强后肿瘤可均匀或不均匀强化。星形胶质瘤２９例,ＣＴ平扫以略低、低混杂密度米,增强后可轻度、不规则强化。致这膜瘤１０例,平扫以等、混合密度为主,增强多有均匀强化,常伴脑积水。或血管细胞瘤９例,     

腮腺原发恶性肿瘤的CT表现

目的：分析腮腺各类型原发恶性肿瘤的CT表现，了解其影像学特点，资料与方法。分析经手术及病理证实的腮腺原发恶性肿瘤19例，包括粘液表皮样癌8例，腺泡细胞癌及腺癌各3例，鳞状细胞癌及恶性混合瘤各2例，腺样囊性癌1例。结果：临床有面神经受累症状者7例，其中6例肿瘤侵及深，浅二叶。19例中，5例肿物呈圆形或椭圆形，14例呈不规则形；6例边缘清楚，13例边缘不清楚并伴有不同程度的周围结构受侵。17例行增强扫描，肿瘤均有不同程度的强化，其中10例明显强化。肿瘤密度均匀2例，不均匀15例，内部有不同形态的低密度区，其中4例中央有大片低密度坏死，9例合并有颈部淋巴结肿大。结论：面神经受累症状为腮腺恶性肿瘤的临床特点，如肿瘤侵及深，浅二叶时诊断更为可靠；肿物边缘不规则，边界不清楚，明显强化，内部密度不均匀以及颈部淋巴结肿大为腮腺原发恶性肿瘤的影像学特点。     

胃肠道间质瘤的CT诊断

目的：分析胃肠道间质瘤（GIST）的CT表现特点，探讨CT对该肿瘤的诊断价值。资料与方法：回顾性分析经手术病理证实的GIST21例，术前均行CT平扫和增强扫描。结果：肿瘤发生于胃部11例，十二指肠1例，空肠5例，回肠4例，病灶多呈圆形或类圆形，平扫：肿瘤呈均匀等密度者8例，肿块周边呈等密度，中间呈略低密度或低密度者12例，呈高，等，低混杂密度者1例，增强扫描：病灶中度或明显强化者10例；不均匀强化，其内可见多数小囊状坏死者5例，病灶中央坏死，液化，周边强化者6例，21例GIST中，良性7例，肿块直径多小于5cm，边界清楚，多均匀强化，恶性14例，肿块直径大于5cm,边界多不清楚，10例肿块内有坏死，5例出现转移灶。结论：CT检查对于GIST的定位准确，对肿瘤良恶性的判断亦很有价值，但CT表现无特异性，确诊仍有赖于病理学检查。     

Testicular microlithiasis: prevalence and tumor risk in a population referred for scrotal sonography

OBJECTIVE: Considerable accrued evidence points to an association between testicular microlithiasis, intratubular germ cell neoplasia, and testicular tumor. This study assesses both the prevalence of testicular microlithiasis revealed on sonography in a referred population and the concurrent tumor risk. MATERIALS AND METHODS: Over a 32-month period (April 1996 through November 1998), 4892 scrotal sonographic examinations were performed in 4819 patients at four referral centers. All patients underwent high-resolution (7- to 10-MHz) imaging. Using a computerized word search (n = 4102; testicular microlithiasis, calcification, microliths, calcific foci, tumor, neoplasm, cancer, hyperecho, hypoecho, heterogen, and carcinoma) and manual retrieval (n = 790), cases of tumor, testicular microlithiasis (>5 microliths per sonogram), and testicular microlithiasis plus tumor were pulled and retrospectively reviewed. The presence and type of tumor were confirmed at histology after orchidectomy. RESULTS: Fifty-four tumors were found among 4892 scrotal sonograms (28 seminomas, 14 teratomas, 8 mixed germ cell tumors, 2 Leydig cell tumors, and 2 non-Hodgkin's lymphomas). Testicular microlithiasis was present in 33 patients, giving a prevalence of 0.68%. Concurrent tumor and testicular microlithiasis were detected in seven patients, a relative risk of tumor in testicular microlithiasis was 21.6-fold (95% confidence limits: 10. 6-fold, 44.2-fold). In one patient with testicular microlithiasis, a previous orchidectomy for mixed germ cell tumor had been performed (not included in the relative risk calculation). CONCLUSION: In a referred population of 4819 patients the prevalence of testicular microlithiasis was 0.68% and the relative risk of concurrent tumor was 21.6-fold. Sonographic surveillance of testicular microlithiasis cases for tumor is mandatory.     

腹膜后脂肪肉瘤:螺旋CT动态增强的表现

目的:分析腹膜后脂肪肉瘤的CT表现及其血液动力学特征,以提高其诊断准确性.方法:经手术病理证实的腹膜后脂肪肉瘤13例,术前经螺旋CT或多排螺旋CT平扫、动脉期和门脉期扫描,注射流率3ml/s.复习CT扫描结果并和手术病理作回顾性对照分析.结果:13例脂肪肉瘤中脂肪瘤样脂肪肉瘤5例,硬化型2例,黏液型3例,去分化型2例,混合型1例.肿瘤形态不规则9例,规则4例.直径11.3～29.7cm,平均14.9cm.不同类型肿瘤和同一肿瘤不同区域密度多样.肿瘤实质成分动脉期轻度至中度强化,内可见肿瘤血管;门脉期强化程度有所增加,不同类型肿瘤和同一肿瘤不同区域强化程度和强化方式多样.结论:腹膜后脂肪肉瘤境界不清,跨腹膜后器官间隙生长,成分复杂,动态增强为进行性延迟强化.认识脂肪肉瘤的各种表现有助于提高诊断率.     

卵巢生殖细胞肿瘤的CT诊断

目的探讨卵巢生殖细胞肿瘤的CT表现特点.方法回顾性分析经手术病理证实的37例46个卵巢生殖细胞肿瘤的CT资料,结合病理讨论其CT表现特点.结果本组卵巢生殖细胞肿瘤中,畸胎瘤43个,内胚窦瘤2个,混合性生殖细胞瘤1个.对卵巢畸胎瘤,CT和B超的敏感性均为100%,特异性分别为93.02%和58.14%.30例38个成熟囊性畸胎瘤,CT明确诊断27例35个,均含有脂肪密度区,5个见脂液平面,11个有浮球征,16个有钙化或牙齿状影.5个未成熟畸胎瘤呈囊性或实性为主肿块,肿块内均见多发斑点状钙化和少许小片状脂肪密度影,其中1例实性成分内见盘曲的带状略低密度影.内胚窦瘤呈囊性1例,呈实性为主1例,实性肿块内见较大的不规则低密度坏死区.混合性生殖细胞瘤呈实质性,不规则形.结论卵巢畸胎瘤和内胚窦瘤的CT表现具有各自的特点,尤其是畸胎瘤,具有特征性表现,与B超相比,CT是更好的检查方法.     

Computed tomography in primary non-seminomatous germ cell tumors of the mediastinum

Germ cell tumor exists as a primary entity in the anterior mediastinum. In a CT study of two males and one female with primary non-seminomatous germ cell tumors all masses were large and lobulated with a mixed density. The fat planes were for the most part obliterated. A high attenuating border was present around parts of the tumor in all three cases, and the pleura-lung interfaces were irregular. One patient had pericardial and left pleural effusions as well as tumor invasion of the anterior chest wall. An extragonadal germ cell tumor should be considered when CT of the thorax reveals a large mass in the anterior mediastinum of a young adult.     

原发性前纵隔肿瘤73例CT分析

目的 探讨原发性前纵隔肿瘤的CT特征性表现及鉴别诊断.方法 回顾性分析73例经病理证实的常见前纵隔肿瘤(37例胸腺瘤,17例生殖细胞肿瘤,19例淋巴瘤)的患者CT表现,包括肿瘤有无脂肪密度、囊变、钙化、强化、纵隔侵犯和淋巴结肿大.结果 58.8％ (10/17)的生殖细胞瘤发现脂肪密度,出现率显著高于其他前纵隔肿瘤(P＜0.001).73.7％(14/19)淋巴瘤发现纵隔肿大淋巴结,显著高于其他前纵隔肿瘤(P＜0.001).其他CT征像在这些前纵隔肿瘤中无显著性差异(P＞0.05).结论 前纵隔肿瘤CT扫描发现脂肪密度和纵隔淋巴结肿大为特异性征像,脂肪密度的出现高度提示生殖细胞肿瘤,而前纵隔肿瘤伴有淋巴结肿大高度提示淋巴瘤.     

胃肠道间质瘤的CT诊断价值

目的分析胃肠道间质瘤(GIST)的CT表现特点,探讨CT对该肿瘤的诊断价值。方法回顾性分析经手术病理证实的GIST32例,术前均行CT平扫和增强扫描,15例行胃肠道气钡双重造影检查。结果肿瘤发生于胃18例,空肠4例,回肠3例,食管和肠系膜各2例,升结肠、直肠和大网膜各1例。32例CIST中,良性12例,肿瘤直径≤5.0cm,边界清楚,密度均匀;恶性20例,肿块直径≥7cm,肿瘤边缘有分叶,肿块内有坏死,肿瘤的溃疡大而深,周围组织侵犯或远处转移。本组CT定位准确度为96.9%(31/32),CT判断恶性准确度为93.8%(30/32)。结论CT对GIST具有较高的诊断价值,可弥补X线钡餐造影的局限性,对临床早期诊断和治疗以及评价预后具有重要价值。     

儿童眶部肿物的CT诊断

目的探讨儿童眶部肿物的CT表现特点。资料与方法回顾性分析39例经手术病理和l临床随访证实的眶部肿物的CT表现。结果肌锥内肿物7例，其中2例视神经胶质瘤、1例视神经鞘脑膜瘤和3例视网膜母细胞瘤累及视神经，1例表皮样囊肿位于眼外肌和视神经之间。肌锥外肿物29例，其中良性肿物2l例，包括蜂窝织炎3．例，脓肿1例，炎性假瘤3例，皮样囊肿7例，毛细血管瘤2例，淋巴管瘤、横纹肌瘤、神经鞘瘤、骨化性纤维瘤和泪腺混合瘤各1例；恶性肿物8例，其中横纹肌肉瘤5例，转移性成神经细胞瘤2例，泪腺腺样囊性癌1例。多间隙肿物3例，其中神经纤维瘤病I型1例，毛细血管瘤2例。结论儿童眶部肿物的CT表现各有其特点，结合l临床，多数可做出定性诊断。     

胃肠道间质瘤的螺旋CT诊断

目的:探讨胃肠道间质瘤(GIST)的螺旋CT表现及诊断价值.方法:回顾性分析经手术和病理证实的胃肠道间质瘤患者18例,术前均行螺旋CT扫描,7例行双期增强扫描.结果:肿瘤位于胃部8例,食管1例,十二指肠2例,小肠4例,回肠末端小肠系膜、横结肠系膜各1例,未确定原发部位者1例.无论良、恶性,CT表现17例边界清楚;瘤体内多发坏死、囊变10例,无囊变者密度均匀,为软组织密度;肿瘤边缘分叶12例;病变腔内侧面溃疡7例,气体及对比剂进入其中;钙化1例,转移2例,未见淋巴结转移;增强扫描,肿瘤中度到明显强化;螺旋CT定位准确度为77.8%,判定良、恶性准确度为50%.结论:螺旋CT对于胃肠道间质瘤的定位和提示诊断都具有非常高的价值,对肿瘤良恶性的判断有一定限度,确诊有赖于病理学检查.     

脊柱原发性骨肿瘤CT和MRI观察

目的：了解脊柱肿瘤的CT和MRI表现特征。资料与方法：分析49例脊柱肿瘤的CT和MRI表现，包括成骨细胞瘤、骨髓瘤和骨肉瘤各2例，动脉瘤样骨囊肿（ABC）3例，血管瘤和淋巴瘤各5例，骨巨细胞瘤多位于椎体，呈溶骨性破坏；成骨细胞瘤和骨肉瘤CT呈骨性密度，MRI信号较低，后者伴软组织肿块；22例脊索瘤伴骶前包块，11／16例CT上出现钙化，9例在T2WI有条状低信号纤维结构和高信号粘液基质。骨髓瘤（1例）、淋巴瘤在T1WI和T2WI分别呈略低信号和较高信号，1例骨髓瘤在T2WI呈高信号。结论；CT和MRI可清楚地显示肿瘤的部位和范围，两者结合，多数肿瘤可以定性。     

巨大浆膜下子宫肌瘤的CT与MRI诊断

目的:探讨巨大浆膜下子宫肌瘤(giant subserous hysteromyoma,GSH)的CT与MRI表现,以期提高诊断水平。方法:回顾性分析15例GSH的CT平扫、增强扫描及14例MRI平扫1、0例增强扫描表现并与手术病理结果对照。结果:5例CT表现呈非均匀实性的GSH在增强后内部呈多个大小不等的结节状改变,其间可见分隔结构,4例呈非均匀实性的GSH增强后呈"漩涡状"混杂密度,3例GSH瘤体边缘见低密度带。MRI T1WI所有肌瘤表现为等、低信号,T2WI表现为低或混杂信号,5例瘤体内部为结节状改变,其间可见高信号分隔结构,7例瘤体边缘见低信号带。结论:GSH的CT与MRI表现有一定的特征性,具有较高的诊断价值。     

纵隔生殖细胞肿瘤的CT特征

笔者分析研究了１１例经手术病理证实的纵隔生殖细胞肿瘤的ＣＴ特征。７例良性肿块中，６例囊性（其中５例为厚壁囊性），１例混合性；肿块内出现脂肪４例，脂肪／液体平面１例，钙化４例。４例恶性肿块中，３例实质性，１例混合性；钙化１例，未见脂肪。笔者认为：ＣＴ能肯定良性肿块（畸胎瘤）的诊断，对恶性生殖细胞肿瘤和其他常见病变如恶性胸腺瘤、淋巴瘤的鉴别，则有一定限度。     

头颈部孤立性纤维瘤的影像学表现

目的：探讨头颈部孤立性纤维瘤(SFT)的影像特征,提高对该病的认识。方法回顾性分析10例经手术病理证实的头颈部 SFT 患者的 CT 和 MR 表现。10例均行 CT 平扫及双期增强扫描、2例行 MR 检查。结果10例病灶均表现为孤立的肿块,最大径20~115 mm,中位最大径约35.5 mm。肿瘤发生于眼眶2例、鼻腔鼻窦4例,腮腺、面颊、锁骨上区及枕部各1例。病变边界清楚8例、模糊2例,呈椭圆形7例,分叶状3例。CT 平扫呈等或稍低密度,其中4例密度均匀,6例密度不均匀(2例见多发囊变区,1例见结节状钙化灶)。增强后9例呈明显均匀(n=3)或不均匀(n=6)强化,1例呈轻度均匀强化。CT 双期增强强化模式包括快速强化缓慢廓清8例、快速强化快速廓清1例和延迟强化1例。与脑实质相比,T1 WI 呈均匀等信号1例,等、低混杂信号1例;T2 WI 呈均匀等信号1例,等、高混杂信号(多发囊变)1例;增强后分别呈均匀和不均匀显著强化。结论头颈部不均匀的富血供肿瘤要考虑到 SFT 的可能。瘤体 T2 WI 与脑实质相比呈等或稍低信号,CT 增强扫描明显强化,双期增强呈快速强化缓慢廓清的强化模式可能是有诊断价值的影像特点。     

Germ cell tumors of the central nervous system originating from non-pineal regions: CT and MR features.

CT and MR findings were retrospectively reviewed in 12 patients with germ cell tumors originating from the non-pineal regions. Cystic or necrotic components were seen in 6 patients. Of 4 germinomas, 2 showed mixed density on the CT. The MR signal intensity of the tumor was non-specific. Of 8 germinomas, 4 were inhomogeneously enhanced on postcontrast CT and T1-weighted MR images. CT and MR features of germinomas originating from non-pineal regions frequently differ from those of germinomas originating from the pineal region. The mass of the tumor often appeared cystic and inhomogeneously enhanced following contrast infusion.