CT diagnosis of ureteral fibroepithelial polyps

We report a case of fibroepithelial polyp of the ureter with serial CT examinations. Progressive growth of the fibroepithelial polyp was documented by CT within a period of 62 months. Excretory phase contrast-enhanced CT images accurately contributed to the diagnosis of ureteral fibroepithelial polyp and allowed limited surgical resection. Accurate imaging assessment of ureteral fibroepithelial polyps is essential for a conservative surgical approach and/or observation alone.     

Case report: A case of polypoid endometriosis: MR pathological correlation

We report a case of polypoid endometriosis and correlate the MRI findings with the pathological findings. The polypoid endometriosis appeared as multiple polypoid masses protruding into the adjacent pelvic organs, including the uterus and rectum. The masses were found to show hyperintensity on T(2) weighted images, which was similar to the signal intensity of the uterine endometrium, reflecting the presence of abundant endometrial-type glands. The masses were also surrounded by hypointense rim-like structures on T(2) weighted images. These structures were confirmed by pathology to correspond with fibrous tissues arising from endometriosis. These features, together with an intense enhancement similar to the adjacent uterus, may be a diagnostic clue to this rare entity.     

原发性气管肿瘤及肿瘤样病变的多层螺旋CT诊断研究（附29例分析）

目的：探讨原发性气管肿瘤及肿瘤样变的MSCT特征及评价图像后处理技术的应用价值。方法：回顾性总结29例经病理证实的气管肿瘤及肿瘤样变的MSCT表现,并结合多种图像后处理技术,如多平面重建（MPR）、容积再现技术（VR）、CT仿真支气管镜（VB）图像进行分析诊断。结果：根据病灶的MSCT表现分为四种类型：①管腔内窄基底息肉样结节型;②管腔内广基底结节或肿块型;③单纯沿管壁浸润增厚型;④管腔内外肿块型。29例中,良性肿瘤4例CT表现为管腔内圆形或类圆形结节影,轮廓光滑,呈窄基底与管壁相连,局部管壁不增厚。低度恶性肿瘤17例表现为广基底结节或肿块或沿管壁浸润增厚为主。恶性肿瘤5例CT表现为管腔内外肿块,形态不规则,呈分叶状。此外2例炎性假瘤和1例气管硬结病患者亦具有良性病变的CT特征。结论：MSCT薄层横轴位及MPR、VR、VB图像重建技术能很好地显示气管病变的形态特征,定位准确,根据病变不同CT表现亦有助于定性诊断及肿瘤良恶性的鉴别,为临床治疗提供重要及可靠的影像学信息。MSCT是一种诊断准确性高,实用性较强的影像学检查方法。     

输尿管癌与输尿管子宫内膜异位症的MSCT鉴别

目的 探讨MSCT在输尿管癌与输尿管子宫内膜异位症的鉴别诊断中的应用价值.资料与方法 回顾性分析经病理证实的5例输尿管子宫内膜异位症和12例输尿管癌患者的CT资料.结果 5例输尿管子宫内膜异位症CT表现为腔外软组织肿块4例、腔内充盈缺损1例,合并附件囊性灶3例.12例输尿管癌CT表现为管壁增厚3例、腔内充盈缺损5例和腔外肿块4例,合并后腹膜淋巴结肿大3例.结论 MSCT在鉴别输尿管癌与输尿管子宫内膜异位症方面具有一定的临床应用价值.     

子宫内膜良、恶性息肉样病变的MR表现与临床病理对照分析

目的 探讨常规MR及动态增强扫描在子宫内膜息肉样病变中的诊断价值及病理基础.方法 回顾性分析经病理证实的子宫内膜息肉样病变48例,其中恶性肿瘤26例(23例I期子宫内膜癌和3例子宫内膜肉瘤),良性息肉样病变22例(子宫内膜息肉12例和子宫黏膜下肌瘤10例),分析其MR平扫及增强图像病灶特征,并与病理结果 进行对照.采用Fisher精确概率法对纤维核、囊变区及完整结合带在不同子宫内膜息肉样病变中的出现概率进行分析比较.结果 26例子宫内膜恶性息肉病变,其中23例子宫内膜癌在MR T2WI上均表现为子官内膜均匀等或稍高信号肿块(23/23),增强后相对于肌层均呈低信号(23/23),并伴结合带中断或模糊(20/23);子宫内膜含间质成分恶性肿瘤3例,2例为腺肉瘤,1例为癌肉瘤,MR T2WI均为混杂信号,早期局部明显强化,至后期仍明显持续强化;26例子宫内膜恶性息肉病变在MRI上子宫结合带中断或模糊征象出现的概率(23/26)均较子宫内膜息肉(1/11)及子宫黏膜下肌瘤(1/9)高,差异具有统计学意义(P值均<0.05).肿块内小囊变影及不定形纤维核影见于子宫内膜息肉(分别为8/12及5/12),2种征象在子宫内膜息肉中的出现概率均较子宫内膜恶性息肉样病变(3/26及2/26)及子宫黏膜下肌瘤(0及2/10)高,差异具有统计学意义(P值均<0.05);10例子宫黏膜下平滑肌瘤MRI均表现为境界清晰,T2WI呈等或稍低信号肿块,且出现子宫黏膜推移征象(10/10).MR平扫及增强扫描对所有48例子宫内膜息肉样病变的定性诊断敏感度为92.3%(24/26),特异度为83.3%(20/24),准确度为95.8%(46/48).结论 MRI平扫及增强扫描能反映子宫内膜良、恶性息肉样病变的特征,具有很高的诊断价值.     

肠道恶性淋巴瘤的影像诊断

目的　探讨肠道恶性淋巴瘤的影像特点。方法　复习经手术及病理证实的肠道恶性淋巴瘤 3 2例 ,其中X线钡餐 2 0例 ,双对比灌肠 12例 ,CT扫描 10例 ,B超 19例。结果　钡剂造影发现小肠或回盲受累 2 0例 ,包括小肠局部扩大 6例 ,腔内多发息肉状增生 7例 ,肠壁浸润 4例 ,腔内增生伴溃疡 3例。病灶局限于大肠者 12例 ,分别是腔内肿块 6例 ,肠腔狭窄 5例和粘膜粗大 1例。 10例CT中见肠壁不规则增厚 5例 ,腔内偏侧肿块 2例 ,肠扩大伴壁厚 3例。B超发现异常 13例 ,其中肠壁增厚的条状低回声 5例 ,假肾征 6例 ,团状低回声 2例。结论　肠道淋巴瘤的X线、CT、超声表现各有特点 ,X线钡剂造影与CT或超声结合可提高诊断准确率     

Magnetic resonance imaging findings of fibroepithelial polyp of the vulva: radiological-pathological correlation

We describe the magnetic resonance (MR) imaging findings in a 20-year-old woman with a fibroepithelial polyp of the vulva. Within the lesion, abundant fibrous tissue was visualized as stratiform hypointense areas on T2-weighted magnetic resonance imaging (MRI) scans. At the center of the attachment site, clustered fatty tissue was revealed as linear hyperintense areas on T1-weighted MRI. A mild degree of edematous stroma including less fibrosis and cellularity was demonstrated as hyperintense areas on T2-weighted MRI and hypointense areas on T1-weighted MRI. Although the MRI findings of fibroepithelial polyps of the vulva are often similar to those of aggressive angiomyxoma, angiomyofibroblastoma, and cellular angiofibroma, a fibroepithelial polyp should be considered when radiological images demonstrate the following features: stratiform hypointense areas surrounded by patchy hyperintense areas on T2-weighted MRI and hyperintense areas on T1-weighted MRI.     

Duodenal carcinoids: imaging features with clinical-pathologic comparison

PURPOSE: To retrospectively evaluate the imaging features of duodenal carcinoids with clinical-pathologic comparison. MATERIALS AND METHODS: The institutional review board approved this study; informed consent was not required. The study was HIPAA compliant. The authors retrospectively reviewed the barium studies (n = 20), computed tomographic (CT) scans (n = 16), magnetic resonance (MR) images (n = 2), pathology reports (n = 33), gross pathology photographs (n = 15), and clinical data (n = 33) from 33 patients (16 men and 17 women; age range, 19-90 years; mean age, 52.6 years) with a confirmed diagnosis of duodenal carcinoid admitted into our institution during a 52-year period. The imaging studies were evaluated by consensus of two abdominal radiologists for the number of masses and their location and morphologic characteristics (polypoid or mural). The CT and MR images were also assessed for contrast enhancement characteristics. RESULTS: Most carcinoids were located in the proximal duodenum (10 in the bulb, 19 in the second portion, two in the third portion, and two in the fourth portion). Seventeen patients (52%) had focal intraluminal polypoid masses and 13 (39%) had mural masses; in three patients (9%), the tumor was not visualized at CT. Five of the 33 patients (15%) had multiple carcinoids. CT showed heterogeneous contrast enhancement in all patients who received intravenous contrast material in the arterial or portal venous phases of enhancement. Nonenhancing masses were present in patients who underwent CT during the equilibrium phase. Two patients had Zollinger-Ellison syndrome. Five patients (15%) had neurofibromatosis type 1 (NF-1); four of the five patients (80%) were women, and four patients were African American. In all five patients with NF-1, the carcinoids were located in the periampullary region. CONCLUSION: Duodenal carcinoids are uncommon tumors with a wide clinical-pathologic spectrum. They occur most commonly in the proximal duodenum and manifest as an intraluminal polyp or a mural mass.     

输尿管梗阻IVU不全时MSCTU初步评价

目的:探讨MSCT对输尿管梗阻性病变在IVU显影不佳时的诊断价值。方法:回顾性分析18例经手术病理证实的输尿管梗阻性疾病,包括10例结石共12枚(其中8例伴管壁增生,1例合并炎性息肉,1例合并炎性息肉及对侧双肾盂、输尿管重复畸形),2例炎性息肉狭窄,2例输尿管周围子宫内膜异位症,2例输尿管纤维上皮性息肉,2例乳头状上皮癌。在IVU显影不佳时,30min松压即刻采用MSCT行尿路成像(multi-slice spiral CT urography,MSCTU),在工作站(AW42)上对原始图像进行MPR、CPR、VRT、MIP等多种后处理。结果:18例均为单侧输尿管阻塞性病变,MSCTU均获得高质量图像显示梗阻部位,并揭示梗阻原因。结论:IVU显影不佳即刻行MSCTU是可行的,并有助于对输尿管梗阻性疾病定位、定性,是对不足IVU的一个成本-效益比较高的补偿手段。     

原发性十二指肠腺癌影像诊断及手术切除相关影像征象的探讨

目的：探讨原发性十二指肠腺癌的影像表现及与手术切除相关征象。方法：对照手术回顾性分析17例经病理证实的十二指肠腺癌低张十二指肠造影(hypotonic duodenography，HD)和CT的表现。结果：HD显示息肉型9例，溃疡型7例，浸润型1例。CT均示腔内不规则肿块或肠壁增厚，3例示溃疡，胆系扩张10例，胰头浸润14例，血管浸润7例，淋巴结转移3例，肝转移2例。7例行根治术，10例行姑息术。结论：HD与CT结合可充分显示腔内病变，腔外浸润及转移。癌肿局限于腔内或仅侵犯胰头时可行根治术；侵犯周围重要血管，发生淋巴结、肠系膜及肝脏等转移时一般只能行姑息术。     

Kaposi's sarcoma involving a transplanted kidney, ureter and urinary bladder: ultrasound and CT findings

We report the imaging findings in a case of Kaposi's sarcoma involving a transplanted kidney, ureter and urinary bladder. Ultrasound and CT demonstrated multiple nodular masses in the pelvis of the transplanted kidney, ureter and bladder. The masses enhanced well on CT following i.v. contrast medium.     

Detection of flat colorectal polyps at screening CT colonography in comparison with conventional polypoid lesions

Background Although the screening of small, flat polyps is clinically important, the role of CT colonography (CTC) screening in their detection has not been thoroughly investigated. Purpose To evaluate the detection capability and usefulness of CTC in the screening of flat and polypoid lesions by comparing CTC with optic colonoscopy findings as the gold standard. Material and Methods We evaluated the CTC detection capability for flat colorectal polyps with a flat surface and a height not exceeding 3 mm (n = 42) by comparing to conventional polypoid lesions (n = 418) according to the polyp diameter. Four types of reconstruction images including multiplanar reconstruction, volume rendering, virtual gross pathology, and virtual endoscopic images were used for visual analysis. We compared the abilities of the four reconstructions for polyp visualization. Results Detection sensitivity for flat polyps was 31.3%, 44.4%, and 87.5% for lesions measuring 2-3 mm, 4-5 mm, and ≥6 mm, respectively; the corresponding sensitivity for polypoid lesions was 47.6%, 79.0%, and 91.7%. The overall sensitivity for flat lesions (47.6%) was significantly lower than polypoid lesions (64.1%). Virtual endoscopic imaging showed best visualization among the four reconstructions. Colon cancers were detected in eight patients by optic colonoscopy, and CTC detected colon cancers in all eight patients. Conclusion CTC using 64-row multidetector CT is useful for colon cancer screening to detect colorectal polyps while the detection of small, flat lesions is still challenging.     

Detectability of small and flat polyps in MDCT colonography using 2D and 3D imaging tools: results from a phantom study

OBJECTIVE: The objective of this phantom study was to determine the performance of MDCT colonography for the detection of small polyps under ideal imaging conditions and to determine the added value of 3D imaging when used as an adjunct to 2D imaging. MATERIALS AND METHODS: Thirty-six polypoid and 39 flat polyps (44 lesions, 2-5 mm; 31 lesions, 6-8 mm) were placed in three explanted segments of a thoroughly cleaned porcine colon (overall length, 4.5 m) that was distended with air and submerged in a water phantom. MDCT data sets with 4 x 1 mm collimation and 6-mm table feed were reconstructed every 0.7 mm with 1.25-mm effective slice width. The data were reviewed by three radiologists using 2D images in all three projections and with 3D volume-rendered images available as an adjunct to the 2D images. RESULTS: Additional 3D as a problem-solving tool significantly increased the overall sensitivity (96% vs 90%), decreased the total number of false-positive calls (n = 9 vs n = 5), and increased the diagnostic confidence level (p < 0.03) compared with 2D images alone. Small polyps less than or equal to 5 mm (89% vs 95%, p = 0.004) and flat polyps (82% vs 94%, p = 0.001) especially benefited from 3D. Sensitivity was generally higher for polypoid than for flat polyps (99% vs 94%, p = 0.041). CONCLUSION: Under phantom conditions, simulating an ideal clinical setup, MDCT colonography is not limited by spatial resolution and detects polyps less than or equal to 5 mm in size with high sensitivity and specificity. Additional 3D image tools improve diagnostic accuracy and reviewer confidence, especially for the detection of flat and small polyps.     

Subcutaneous abdominal wall masses: radiological reasoning

OBJECTIVE: A 36-year-old woman presented to her primary care physician with right lower abdominal pain. Her physician subsequently requested a CT to rule out appendicitis. Contrast-enhanced CT was performed and revealed no evidence of appendicitis but showed two subcutaneous ovoid soft-tissue masses anterior to the rectus sheath in the upper pelvis. Pelvic MRI confirmed the two masses, which showed mild enhancement. The objective of this article is to discuss a diagnostic approach to subcutaneous soft-tissue masses in the abdominal wall. Diagnosis was endometriosis of the abdominal wall. CONCLUSION: Integrating salient imaging findings with clinical history is crucial when approaching the diagnosis of subcutaneous soft-tissue masses. The diagnosis of endometriosis should be entertained when soft-tissue masses are seen in the distribution of a cesarean section scar in a woman of reproductive age. Pain, particularly with a cyclic pattern, is highly suggestive of endometriosis. If endometriosis is suspected on CT or ultrasound, MRI can be performed for further evaluation. Definitive diagnosis is made with biopsy. Because subcutaneous nodules are so amenable percutaneous biopsy, imaging features, although of interest, are somewhat ancillary to the diagnostic workup.     

Polypoid epithelial malignancies of the esophagus

Polypoid epithelial malignancies of the esophagus are rare tumors. One hundred fifty cases of epithelial malignancy of the esophagus accessioned to the Registry of Radiologic Pathology at the Armed Forces Institute of Pathology were reviewed with respect to morphologic and pathologic characteristics. Only large intraluminal polypoid epithelial masses were analyzed. Criteria used to select cases were: (1) size greater than 4 cm, (2) expansion of the esophageal lumen by the bulky tumor, and (3) absence of constriction or wall infiltration. Twenty-two lesions met these criteria (15 spindle cell carcinomas, two carcinosarcomas, three squamous cell carcinomas, and two oat cell carcinomas). When an esophageal neoplasm is polypoid and bulky, creates a "cupola" effect, has scalloped edges, expands the lumen of the esophagus, and is pedunculated, one must consider spindle cell carcinoma as the primary diagnosis.     

Secondary non-Hodgkin's lymphoma of the small intestine. Double-contrast radiological study using oral enema

The small bowel double contrast enema was performed in 44 patients with diffuse non-Hodgkin lymphoma. "Secondary" involvement of small bowel is detected in 14 subjects (31.8%), but radiographic features are not specific for the disease. Really, lymphoma and regional enteritis may demonstrate strikingly similar patterns. The signs we have considered are: intraluminal involvement, with narrowing or dilated segments; diffuse or localized polypoid lesions; large extraluminal masses. The roentgenographic pattern of the mucosal folds consists of thick, straight or tortuous folds, with "cogwheel" appearance and moderate dilatation of the lumen.     

Upper airway obstruction in infants and children: evaluation with ultrafast CT

The diagnostic accuracy of ultrafast computed tomography (CT) was evaluated prospectively in 25 infants and children with suspected airway obstruction. All examinations were conducted in spontaneously breathing, nonsedated children. Scan acquisition times were 0.05 or 0.1 second. CT examinations, completed in an average of 10 minutes, routinely included localizing, contiguous sections through the trachea followed by serial images obtained at a rate of 17 per second through regions of interest. Imaging results were correct in 24 of 25 examinations as judged from clinical and surgical data. Ultrafast CT data permitted diagnosis of dynamic changes in airway caliber, small intraluminal polyps, focal tracheal atresia, compressive mediastinal masses, and foreign body obstructions of the major bronchi. Dose measurements showed a maximum skin exposure of 245 mR (0.06 mC/kg) per 0.05-second image. Ultrafast CT provides an accurate, minimally invasive method for dynamic imaging of the airway in nonsedated children.     

鼻息肉的CT表现与诊断价值

目的：总结分析鼻息肉的CT表现特点,评价CT扫描对鼻息肉的诊断价值。方法：97例均行轴位及冠状位扫描,其中轴位24例,冠状位73例,全部病例经鼻内窥镜手术及病理证实。结果：97例中双侧发病72例,单侧发病25例。鼻息肉主要发生在筛窦及中鼻道,部分累及上颌窦及下鼻道,在CT断面上表现为鼻腔内息肉样肿块,均合并不同程度的鼻窦炎,冠状位CT扫描比轴位显示清楚。结论：鼻息肉在CT断面上有比较特征性的表现,诊断明确,冠状位能提供与功能鼻内窥镜手术方位一致的解剖层面,能清楚显示鼻道解剖结构和病变特点,对指导纤维内窥镜手术进路及防止并发症有重要指导意义。     

Giant hyperplastic polyps in the stomach: radiographic findings in seven patients

OBJECTIVE: We reassessed the radiographic findings of giant hyperplastic polyps in the stomach on double-contrast upper gastrointestinal examinations in seven patients. CONCLUSION: Giant hyperplastic polyps in the stomach may be manifested by distinctive findings on double-contrast barium studies, appearing as polypoid lesions with multiple lobulated components that form a conglomerate mass. Nevertheless, endoscopy and biopsy are required to rule out a polypoid carcinoma as the cause of these findings.     

MR colonography: development of optimized method with ex vivo and in vivo systems

An ex vivo magnetic resonance (MR) colonographic system with a bovine colon with polyps of predetermined dimensions was developed for evaluation and optimization of different combinations of imaging sequences and intraluminal contrast agents. Findings were then applied during in vivo testing in human subjects. The results show that optimized contrast and lesion conspicuity and minimized motion artifacts can be obtained with true fast imaging with steady-state precession combined with water as an intraluminal contrast agent.