甲状腺癌的B超与CT检查表现及意义

目的:探讨B超及CT检查对甲状腺癌的诊断价值。方法:回顾性分析189例甲状腺癌患者的B超及CT检查,了解甲状腺癌在B超及CT检查中的表现,并比较两者的优缺点。结果:B超及CT检查对甲状腺肿快的检出率为100%,B超诊断TC的符合率为50.7%,CT为81.6%,CT诊断颈部淋巴结转移的符合率为51.4%,B超为74.0%。结论:CT对甲状腺癌定性诊断正确率高于B超检查,B超发现颈部淋巴结转移要优于CT,B超应作为检查颈部肿块的首选办法。     

甲状腺癌的CT诊断研究

目的评价甲状腺癌的CT诊断价值。方法回顾性分析46例甲状腺癌患者术前CT检查及术后病理检查结果。结果所有病例CT扫描均可见肿块,其边缘均不清楚,呈浸润性生长。36例肿瘤为实性,患侧甲状腺体积增大,失去正常解剖形态,其密度不均匀,均可见不同程度的低密度区,无明确分界;增强扫描肿瘤呈不均匀强化。10例为囊性,伴高密度乳头状结节,囊壁厚薄不均,囊壁及结节有钙化。气管受侵12例,颈鞘血管受侵8例,食管受侵4例。颈部淋巴结转移22例,同侧转移14例,双侧转移9例。结论甲状腺癌的CT表现具有一定特征性,可作为判断甲状腺癌有无侵犯颈鞘血管和气管的依据,为选择临床治疗方法提供参考依据。     

乳腺癌的CT表现与病理对照研究

目的 联系病理学变化,分析乳腺癌的CT表现和特征,评价CT扫描在乳癌及内乳和腋窝淋巴结转移诊断中的价值。方法 应用CT检查36例乳癌病人,其中浸润性导管癌15例,浸润性小叶癌1例,髓样癌5例,单纯癌8例,硬癌2例,腺癌4例,Paget氏病1例。结果 (1)乳腺癌CT表现为:圆形、椭圆形和不规则形肿块,成簇排列细小钙化点,边缘毛刺,皮肤增厚和周围脂肪间隙变形等。(2)CT有较高的密度分辨率,能检出直径<1cm的癌灶。(3)大多数乳癌血供丰富,增强扫描癌灶 有显著强化,增强前后CT值之差(△CT)>50HU。(4)CT增强后肿瘤供血血管的显示(占38.9％)对乳癌诊断有帮助价值。(5)CT有助于乳腺癌内乳和腋窝淋巴结转移的诊断。结论 CT扫描对乳腺癌的早期发现和定性诊断以及评价内乳和腋窝淋巴结有无转移都有很大的诊断价值。     

肝细胞癌边缘部的CT征象与病理改变的关系

目的：探讨肝细胞癌的大小与边缘部ＣＴ征象及有关病理基础的关系。方法：收集４５例经手术、病理证实的肝细胞癌,观察其大小与边缘部的ＣＴ表现及有关的病理改变。结果：肝细胞癌的大小与其ＣＴ边缘部的形态改变及瘤旁小门静脉癌栓的发生率无关,病理上瘤旁周围肝组织内癌细胞的浸润程度与肝细胞癌边缘部的形态有关,而与它的大小无关。结论：肝细胞癌本身的膨胀性或浸润性生长方式,是测定肿瘤边缘部形态的主要因素;在分析肝细胞     

甲状腺癌术前原发灶CT分期38例分析

[目的]探讨甲状腺癌术前CT分期的价值。[方法]对38例甲状腺癌病人行术前CT扫描及增强扫描。全部病例均经手术病理证实，其中乳头癌24例，未分化癌5例，髓样癌4例，德泡状癌4例，恶性淋巴瘤1例。分析所有病例CT图像，按照TNM分期法进行甲状腺原发灶CT分期。[结果]CT分期T_12例，准确率40％（to），T_23例，准确率100％（3／3），T_34例，准确率80％（4／5），T_425例，准确96．15％（25／26）。CT分期与病理对照总体符合率为89．47％。T分类诊断过低1例，误诊3例。[结论]CT对甲状腺癌术前原发灶分期有一定的准确性，对T_2、T_3、T_4准确性较高，但对小病灶的定性诊断有一定限制。     

40例脊柱肿瘤CT表现

目的：探讨CT对脊柱肿瘤的诊断及鉴别诊断价值。方法：回顾性分析了行CT检查并经临床或手术病理证实40例脊柱肿瘤患者的临床资料。结果：22例转移瘤共累及32个脊柱,CT表现为骨质破坏的占25／32,成骨型占4／32,混合型占3／32,在溶骨型转移中,18个病灶位于椎体后2／3,18个病灶同时累及椎弓及附件,16例伴周围软组织肿块（12例为局限性）,4例骨巨细胞瘤和1例动脉瘤样骨囊肿均表现多房膨胀性骨质破坏。3例血管瘤显示为网眼状影像中夹杂低密度脂肪。3例神经纤维瘤均显示骶孔扩大,2例骨髓瘤表现为椎体及附件膨胀性溶骨破坏,骨皮质完整或破坏,脊索瘤,骨软骨瘤,畸胎瘤,软骨肉瘤及恶性纤维组织细胞瘤各1例,在CT上也各人特点,结论：CT在明确病灶部位和范围及定性方面具有很大价值。     

基于食管癌病理标本长度推算的实际长度与CT长度的比较研究

目的 探讨CT扫描在确定食管癌病变长度方面与实际长度上的差异及其符合程度.方法 采用病理大切片技术对52例食管癌行肿瘤组织标本固定后收缩比研究,得出换算实际长度的收缩比.137例患者术前行螺旋CT扫描并在CT图像上行食管癌靶区勾画和长度测量,术后测量食管癌标本固定后长度,根据收缩比回推实际长度,比较两者差异和符合率.结果 食管癌平均收缩为术中长度的90%±10%.食管癌实际长度为(4.1±1.8)cm,CT长度为(5.8±2.4)am,两者差异有统计学意义(t=9.68,P=0.000).CT长度与实际长度相符者56例,仅占40.9%(56/137).结论 食管癌CT长度与实际长度相比存在一定差距,确定合理的食管癌病变长度要参考食管钡餐造影、食管镜等检查结果来综合判断.     

甲状腺癌CT、B超诊断与病理诊断对照分析研究

目的探讨CT、B超检查对甲状腺癌的诊断意义。方法回顾性分析286例甲状腺癌的螺旋CT、彩色B超的影像学资料,与病理诊断作对照分析。结果对于病灶直径≤1.0 cm的82例甲状腺微小癌B超诊断符合率为76.8%（63/82）,CT的诊断符合率为31.7%（26/82）,两者比较差异有统计学意义（P〈0.005）,而对于病灶直径≥1.0 cm的204例甲状腺癌B超诊断符合率为79.4%（162/204）,CT的诊断符合率为84.8%（173/204）,两者比较差异无统计学意义（P〉0.05）。结论彩色B超是目前诊断甲状腺微小癌最有效的检查方法 ,对于病灶≥1.0 cm的甲状腺癌,B超和CT检查均是阳性诊断率高的检查方法 。     

40例脊柱肿瘤CT表现

目的 :探讨CT对脊柱肿瘤的诊断及鉴别诊断价值。方法 :回顾性分析了行CT检查并经临床或手术病理证实 4 0例脊柱肿瘤患者的临床资料。结果 :2 2例转移瘤共累及 32个脊椎 ,CT表现为骨质破坏的占 2 5 /32 ,成骨型占 4 /32 ,混合型占 3/32。在溶骨型转移中 ,18个病灶位于椎体后 2 /3,18个病灶同时累及椎弓及附件。 16例伴周围软组织肿块 (12例为局限性 )。 4例骨巨细胞瘤和 1例动脉瘤样骨囊肿均表现多房膨胀性骨质破坏。 3例血管瘤显示为网眼状影像中夹杂低密度脂肪。 3例神经纤维瘤均显示骶孔扩大。 2例骨髓瘤表现为椎体及附件膨胀性溶骨破坏 ,骨皮质完整或破坏。脊索瘤、骨软骨瘤、畸胎瘤、软骨肉瘤及恶性纤维组织细胞瘤各 1例。在CT上也各有特点。结论 :CT在明确病灶部位和范围及定性方面具有很大价值     

CT在甲状腺癌诊断中的价值

目的 探讨CT在甲状腺癌的诊断及鉴别诊断中的价值.方法 回顾性分析25例甲状腺癌的CT资料.所有病例均行CT平扫,19例行增强扫描.结果 CT平扫显示,23例(92%)表现为低密度;20例(80%)密度不均匀;23例(92%)边缘模糊不规则;16例(64%)出现钙化,其中细颗粒钙化10例,混合性钙化6例.19例增强扫描显示,10例表现为不同程度的均匀强化,4例肿瘤边缘呈半岛状瘤结节强化,5例可见强化残圈征.14例(56%)肿瘤侵犯周围器官组织,11例(44%)颈部淋巴结转移.结论 CT在甲状腺癌的诊断及鉴别诊断中有较高的价值.     

Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma

Aims

Adequate evaluation and surgical management of cervical lymph node metastasis is very important in papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the impact of preoperative ultrasonography (US) and computed tomography (CT) on the surgical management of cervical lymph node metastases in PTC.

Methods

Medical records and imaging findings were retrospectively analyzed for 252 patients with PTC who underwent thyroidectomy with neck dissection.

Results

The sensitivity of both imaging techniques was lower in the central neck (US 23%, CT 41%) than in the lateral neck (US 70%, CT 82%). The specificities of US and CT were 97% and 90% in the central neck, and 84% and 64% in the lateral neck, respectively. Our surgical plans for therapeutic neck dissection were based on imaging findings in 59% of patients who underwent lateral compartment neck dissection and in 32.1% of patients who underwent central compartment neck dissection, respectively.

Conclusions

The roles of preoperative US and CT in surgical planning for central compartment neck dissection in PTC are limited because of their low sensitivity in the central neck, but US and CT may be useful in cases with non-palpable lateral neck nodes.     

Chest computed tomography (CT) in patients with micronodular lung metastases of differentiated thyroid carcinoma

Forty thoracic CT scans have been performed on 27 patients with micronodular lung metastases of differentiated thyroid carcinoma. Lung nodules were visualized in 14 out of 19 patients (78%) with functioning lung metastases, although their chest X rays were normal. However, only a small number of peripheral micronodules can be visualized by CT scan since the central micronodules remain undistinguishable from adjacent vessel structures. A close relationship has been found between the number of micronodules and the thyroglobulin (Tg) serum level. In patients previously treated by 131I for proven lung metastases and who had no uptake for several years, but in whom Tg remained detectable in the serum, CT scans have shown micronodules in 7 of the 13 patients with normal chest X rays. The present data suggest that these nodules are mainly a result of fibrosis. CT scanning appears to be an important complementary tool with regard to 131I whole body scintigraphies in the radiologic diagnosis of lung nodules and in the assessment of radioiodine therapy.     

兔VX2鼻咽移植癌的PET-CT与病理结果对照研究

目的:观察VX2兔鼻咽癌生长特点,并与所获病理和MRI结果比较,探讨18F-FDGPET-CT在鼻咽肿物检测中的作用。方法:建立VX2兔鼻咽癌模型后,完成18F-FDGPET-CT和MRI扫描并解剖;在肉眼所见肿瘤周围不同的距离取标本并完整取出斜坡作病理诊断;测量鼻咽肿物最大标准摄取值(SUV),在PET-CT和MRI图像上勾画鼻咽肿物体积。结果:VX2兔鼻咽癌可向周围组织呈广泛浸润性生长;30只兔中经病理确诊有9只兔斜坡受癌细胞侵犯,PET-CT发现6例(66.7%),MRI发现5例(55.6%),CT发现1例(11.1%);兔VX2鼻咽癌的最大SUV值与鼻咽肿物的体积呈负相关,r=-0.426,P=0.03;30只兔在18F-FDGPET-CT图像上所勾画的鼻咽肿物体积较在MRI图像上勾画体积小,差异无统计学意义,P=0.17。结论:18F-FDGPET-CT能对鼻咽癌病灶范围的确定、放疗靶区的准确勾画提供有用的信息。     

Conversion of T-stages of nasopharyngeal carcinoma by computed tomography

Thirty-six patients with nasopharyngeal carcinoma (NPC) were examined with computed tomography (CT) before definitive radiation therapy. CT clearly delineated the extent of the primary tumors. CT frequently showed subtle destruction of the paranasal sinuses and pterygoid plate, which was not usually detected by conventional X ray examinations. T-staging was made according to the UICC TNM classification system (1978) or another system, depending on clinical findings and the conventional X ray examinations (non-CT T-stage). Then, the non-CT T-stage of each patient was compared with T-stage diagnosed with CT findings alone (CT T-stage). CT upstaged non-CT T-stage in 14 of the 36 patients according to either system. Only one patient was downstaged by CT; this patient had cranial nerve palsy but no detectable bone destruction as shown by CI. We conclude that CT is the single, most reliable imaging method for primary tumors of NPC patients. Since CT detects subtle bone destruction, however, a large number of patients will be classified as having advanced tumors. Further modification of the TNM system may be needed for NPC patients in this era of CT.     

甲状腺癌的再手术(附108例分析)

 目的　探讨甲状腺癌的再手术的原因和并发症情况。方法　回顾性总结 10 8例甲状腺癌再手术的的原因和并发症情况。结果　本组接受再次手术 112次 ,并发症发生率 2 2 % ,随访期 2～ 13年 ,5年及 10年生存率分别为 75 .0 % (81/ 10 8)和 37% (4 0 / 10 8)。结论　及时诊断、选择合理的术式是避免甲状腺癌患者再手术的主要措施 ,术中漏诊及快速冷冻切片的误诊亦不容忽视 ,术中保护喉返神经及甲状旁腺的关键是熟悉解剖和仔细操作。     

Thoracic metastasis in advanced ovarian cancer: comparison between computed tomography and video-assisted thoracic surgery

Objective

To determine which computed tomography (CT) imaging features predict pleural malignancy in patients with advanced epithelial ovarian carcinoma (EOC) using video-assisted thoracic surgery (VATS), pathology, and cytology findings as the reference standard.

Methods

This retrospective study included 44 patients with International Federation of Obstetrics and Gynecology (FIGO) stage III or IV primary or recurrent EOC who had chest CT ≤30 days before VATS. Two radiologists independently reviewed the CT studies and recorded the presence and size of pleural effusions and of ascites; pleural nodules, thickening, enhancement, subdiaphragmatic tumour deposits and supradiaphragmatic, mediastinal, hilar, and retroperitoneal adenopathy; and peritoneal seeding. VATS, pathology, and cytology findings constituted the reference standard.

Results

In 26/44 (59%) patients, pleural biopsies were malignant. Only the size of left-sided pleural effusion (reader 1: rho=-0.39, p=0.01; reader 2: rho=-0.37, p=0.01) and presence of ascites (reader 1: rho=-0.33, p=0.03; reader 2: rho=-0.35, p=0.03) were significantly associated with solid pleural metastasis. Pleural fluid cytology was malignant in 26/35 (74%) patients. Only the presence (p=0.03 for both readers) and size (reader 1: rho=0.34, p=0.04; reader 2: rho=0.33, p=0.06) of right-sided pleural effusion were associated with malignant pleural effusion. Interobserver agreement was substantial (kappa=0.78) for effusion size and moderate (kappa=0.46) for presence of solid pleural disease. No other CT features were associated with malignancy at biopsy or cytology.

Conclusion

In patients with advanced EOC, ascites and left-sided pleural effusion size were associated with solid pleural metastasis, while the presence and size of right-sided effusion were associated with malignant pleural effusion. No other CT features evaluated were associated with pleural malignancy.     

KAI1基因异常表达与甲状腺乳头状癌发生、发展的关系

目的:探讨KAI1基因表达与甲状腺乳头状癌发生、发展的关系。方法:采用逆转录-聚合酶链反应(RT-PCR)和免疫组织化学(EnvisionTM)法,检测59例甲状腺良、恶性病变组织标本中KAI1 mRNA和蛋白的表达,并与临床病理资料进行比较分析。结果:甲状腺乳头状癌中KAI1 mRAN表达水平为3.59±1.57,蛋白表达阳性24例(66.67%),两者均高于甲状腺腺瘤(P<0.01,P<0.05)、结节性甲状腺肿(P<0.01,P<0.01)和正常甲状腺组织(P<0.01,P<0.01);KAI1 mRNA和蛋白表达与甲状腺乳头状癌淋巴结转移、患者肿瘤大小相关(P<0.05);KAI1 mRNA和蛋白的表达呈显著正相关(r=0.486,P<0.01)。结论:KAI1 mRNA和蛋白异常表达与甲状腺乳头状癌的发生、发展有关,可为肿瘤淋巴结转移、预后的判断提供依据。     

甲状腺癌淋巴管生成因子表达与淋巴结转移关系的研究

目的研究淋巴管生成因子(VEGF-C)在甲状腺癌中的表达及其与淋巴结转移的关系.方法应用免疫组化S-P法检测44例甲状腺癌中VEGF-C的表达情况,并以17例癌旁正常甲状腺组织作对照.结果 VEGF-C在甲状腺癌中有高水平表达(81.8%),其中乳头状癌阳性表达(88.9%)高于其他类型,有淋巴结转移组VEGF-C阳性率(92.0%)明显高于无淋巴结转移组(68.4%,P＜0.05).9例死亡病例中7例为阳性表达.结论 VEGF-C表达与甲状腺癌病理分型及预后可能有一定关系,与甲状腺癌淋巴结转移密切相关.