肺硬化性血管瘤CT表现与临床病理对照分析

目的:分析肺硬化性血管瘤(SHL)的CT表现特点,以及与临床病理之间的关系,提高术前诊断水平。方法:回顾性分析经手术病理证实的7例SHL患者的CT图像资料,并与手术病理相对照,探讨该病的CT诊断特点。结果:6例CT表现为肺内孤立性软组织肿块或结节、密度均匀,病变轮廓清楚、边缘光滑者4例,边缘浅分叶2例;1例表现为双肺内多个类圆形结节;1例可见小的钙化。CT增强扫描病灶明显强化,4例均匀强化,3例不均匀强化。CT表现与病理的关系是增强扫描后病灶强化明显与不明显的区域分别对应于其血管瘤成分与实性区。结论:SHL的临床症状和CT平扫无明确特征表现,CT增强扫描对病变的诊断和鉴别诊断具有重要的价值。     

CT findings of cholangiocarcinoma associated with recurrent pyogenic cholangitis

OBJECTIVE: The purpose of our study was to determine the characteristic CT findings of cholangiocarcinoma associated with recurrent pyogenic cholangitis. CONCLUSION: CT findings of cholangiocarcinoma associated with recurrent pyogenic cholangitis are important in order to improve early diagnosis and proper treatment. Cholangiocarcinoma associated with recurrent pyogenic cholangitis is predominantly located in the atrophic hepatic lobes and in the hepatic lobes of biliary calculi and is associated with the narrowing or obliteration of the portal vein.     

Sclerosing cholangitis: cholescintigraphy with Tc-99m-labeled DISIDA

Four patients with primary sclerosing cholangitis (PSC) were examined with the hepatobiliary agent Tc-99m-labeled DISIDA (diisopropylphenylcarbamoyl iminodiacetic acid), and the results correlated with those of invasive cholangiography. Three of the four patients exhibited a typical pattern of multiple, persistent focal "hot spots" in the duct system, representing stasis within the segmental ductal dilatations (beading), also seen on cholangiography. Cholescintigraphy is superior to cholangiography in cases of suspected PSC where there is nonfilling of biliary radicals due to high-grade stenosis. The finding of delayed hepatic parenchymal clearance can allow estimation of the degree of obstruction of the various branches of the major bile ducts. Cholescintigraphy offers a noninvasive method of investigating patients with suspected sclerosing cholangitis, leading to earlier diagnosis. Confirmation with invasive cholangiographic procedures is recommended.     

End-stage primary sclerosing cholangitis: CT findings of hepatic morphology in 36 patients

PURPOSE: To determine if there is a significant difference in the hepatic morphology depicted on computed tomographic (CT) scans in patients with end-stage cirrhosis caused by primary sclerosing cholangitis versus that in patients with end-stage cirrhosis caused by other factors. MATERIALS AND METHODS: The frequency of five morphologic findings of the liver parenchyma and two intrahepatic biliary findings identified on CT scans in 36 patients with end-stage cirrhosis caused by primary sclerosing cholangitis were compared with the frequency of the same findings in 472 patients with end-stage cirrhosis caused by other factors. The morphologic findings were lobulation of the liver contour, atrophy of the lateral or posterior hepatic segments, hypertrophy of the caudate lobe, and pseudotumor of the caudate lobe. Lobulation, atrophy, and hypertrophy were subclassified as mild-moderate or severe. The biliary findings were ductal dilatation and calculi. RESULTS: Each of the 11 findings occurred more frequently (P < .05) in patients with primary sclerosing cholangitis than in the other 472 patients. Six findings occurred more frequently (P < .05) in patients with primary sclerosing cholangitis than in patients with cirrhosis caused by any other single agent. CONCLUSION: There is a significant difference in the hepatic morphology observed in patients with primary sclerosing cholangitis-induced end-stage cirrhosis versus that in patients with end-stage cirrhosis of other causes.     

Sclerosing cholangitis associated with hepatic arterial FUDR chemotherapy: radiographic-histologic correlation

During a 2-year period, cholangiography was performed on 17 patients with clinical evidence of cholestasis who were receiving hepatic intraarterial floxuridine (IA-FUDR) infusions for treatment of metastatic colorectal adenocarcinoma. The development of cholestasis was associated with persistently elevated alkaline phosphatase, but serial CT examinations of the liver showed no progression of the tumor. All patients had cholangiographic abnormalities (by endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, or operative cholangiography) of the biliary ductal system similar to those in idiopathic sclerosing cholangitis. Certain features, however, appear specific to IA-FUDR-induced cholestasis. All patients studied had segmental involvement at the common hepatic duct bifurcation. The cystic duct and gallbladder were often involved, but the distal common bile duct was spared. Histologic features of periportal and periductal fibrosis were present in specimens obtained from percutaneous liver biopsy in three patients, cholecystectomy in four patients, and autopsy in two patients. When clinical signs of hepatic dysfunction occur in the absence of tumor progression, biliary sclerosis must be suspected.     

Sclerosing mesenteritis: imaging findings in 17 patients

OBJECTIVE: The purpose of this study was to evaluate the radiologic findings of sclerosing mesenteritis and to describe certain signs that suggest the diagnosis. CONCLUSION: Sclerosing mesenteritis represents a single disease with two radiologically different variants. In an appropriate clinical setting, radiologic features can suggest the diagnosis, delineate the extent of the process, and prescribe or limit surgical procedures. The "fat ring" sign and the presence of a tumoral pseudocapsule are important findings for the diagnosis of the disease.     

Sclerosing stromal tumor of the ovary: radiologic findings

Sclerosing stromal tumor is a rare ovarian neoplasm. We describe the radiologic findings of sclerosing stromal tumor in two patients. In both patients, MR and CT images showed a large mass in the left adnexal region. On dynamic contrast-enhanced images, the tumors showed early peripheral enhancement with centripetal progression. Received: 10 August 1998; Revision received: 3 November 1998; Accepted: 9 December 1998     

AIDS-related cholangitis: radiographic findings in nine patients

Acalculous inflammation of the biliary tract is a recently reported complication of the acquired immunodeficiency syndrome (AIDS). In a 33-month period, nine men with AIDS were evaluated because of right upper quadrant and/or epigastric pain, jaundice, or abnormal liver function test results. Each patient underwent ultrasonography and endoscopic retrograde cholangiopancreatography; seven also underwent computed tomography. In eight of nine patients the imaging studies disclosed intrahepatic and extrahepatic bile duct changes identical to those seen in sclerosing cholangitis (strictures, focal dilatation, thickened duct walls). Isolated papillary stenosis and ductal dilatation were present in one patient, while eight patients had some stricturing of the distal common duct. The combination of papillary stenosis and intrahepatic ductal strictures appears unique to AIDS-related cholangitis. Endoscopic papillotomy provided variable relief to symptoms and biochemical abnormalities. Cholangitis caused by cytomegalovirus and/or Cryptosporidium infection is the proposed pathophysiologic mechanism.     

肺硬化性血管瘤的CT表现

目的:探讨CT诊断肺硬化性血管瘤(pu lmonary sc lerosing hem angiom a,PSH)的价值。材料和方法:回顾性分析11例经病理证实的PSH的CT平扫及增强扫描表现。结果:CT平扫示PSH呈类圆形,边缘清楚的结节/肿块影;增强扫描显示病灶明显均匀增强,最大平均增强值为68.9±7.3Hu。结论:CT增强检查对PSH的诊断和鉴别诊断具有重要价值。     

肺硬化性血管瘤的CT诊断

目的　分析肺硬化性血管瘤 (PSH)的CT表现 ,提高诊断的准确性。方法　回顾性分析 5例经手术或穿刺活检病理证实的PSHCT表现。结果　 5例CT表现均为肺内孤立结节 ,边缘清楚。 4例密度均匀、边缘光整 ,1例结节内有空洞形成 ,边界欠光整。增强后均有均匀强化 ,且强化程度与周围血管相仿。病灶与周围血管关系密切。结论　CT增强扫描对该病诊断有较强的参考价值     

化脓性胆管炎的CT诊断

目的:分析化脓性胆管炎的CT表现特点及其诊断价值,旨在提高对该病的认识。方法:对56例经手术和临床证实的化脓性胆管炎进行CT回顾性分析。结果:①肝内胆管扩张56例(100%)弥漫性24例(42.86%);局限性32例(57.14%),主要局限于肝左叶;肝外胆管扩张38例(67.86%);②“中央箭头”征37例(66.07%);③胆管聚集25例(44·64%);④胆管内积气21例(37.50%),积脓27例(48.21%);⑤胆管结石48例(85.71%)表现为肝内胆管多发结石,局限于肝左叶22例(39.29%),伴肝外胆管结石37例(77.08%),胆总管下段结石26例(54.17%);⑥胆管壁弥漫性偏心性增厚26例(46.43%);⑦合并肝脓肿34例(60.71%);⑧并发腹腔积液15例(26.78%),胰腺炎13例(23.21%)。结论:化脓性胆管炎具有相对特征性CT表现,CT检查能反映化脓性胆管炎各种病理指征,是一种有效而理想的诊断方法。     

CT appearance of sclerosing cholangitis

Six patients with laryngoceles, two internal and four of the mixed type, were studied with CT. Uncomplicated laryngoceles appear on CT as air-filled structures lying in the paralaryngeal space (internal), lateral neck (external), or in both locations (mixed). Obstruction of the neck of the laryngocele by either tumor or chronic inflammation can result in a fluid-filled structure, producing on CT a well circumscribed mass of either near water or soft-tissue density, depending on its composition. CT proved useful in establishing the definitive diagnosis of a laryngocele and mapping its total extent for treatment planning.     

MRCP findings in recurrent pyogenic cholangitis

OBJECTIVE: In this essay, we present the spectrum of intrahepatic and extrahepatic bile duct abnormalities seen on MRCP in patients with recurrent pyogenic cholangitis. CONCLUSION: MRCP is a promising, noninvasive alternative to more invasive direct cholangiography for evaluating the intrahepatic and extrahepatic bile ducts in patients with recurrent pyogenic cholangitis.