螺旋CT与高频超声诊断甲状腺癌价值的对比研究

目的: 分析甲状腺癌的螺旋CT (spiral CT, SCT)与高频超声(high-frequency ultrasound, US)表现,评价两者对甲状腺癌的诊断价值.材料和方法: 回顾性分析49例同期螺旋CT与高频US检查的甲状腺癌的表现,主要对原发病灶和颈部转移淋巴结进行对比分析,并与手术及病理结果对照.结果: 49例甲状腺癌,共58个原发病灶,螺旋CT与高频US均显示肿瘤病灶,形状不规则、密度/回声不均匀和边缘不清楚,两者无显著性差异(P>0.05). 螺旋CT显示16个瘤周"半岛状"瘤结节,11个瘤周"残圈"征.螺旋CT检出13个病灶微钙化,高频US检出22个病灶微钙化,两者无显著性差异(P>0.05).对颈部转移淋巴结,螺旋CT显示率84%(31/37),高频US显示率86%(32/37).结论: 高频超声应作为甲状腺癌的首选和重要检查方法,螺旋CT在评价甲状腺癌的原发灶、颈部转移淋巴结方面有一定特征性,两者结合起来,可提高甲状腺癌术前评估和诊断的准确性.     

螺旋CT三期增强扫描在小胰岛细胞瘤(直径≤2 cm)诊断中的价值

目的探讨三期螺旋CT扫描在小胰岛细胞瘤(直径≤2cm)诊断中的价值。资料与方法回顾性分析经病理证实的12例小胰岛细胞瘤患者的螺旋CT平扫及三期螺旋CT检查表现。结果12例患者共发现13个胰岛细胞瘤,其中胃泌素瘤1个,胰岛素瘤11个,无功能胰岛细胞瘤1个。CT平扫仅发现少数病灶(1/13),三期螺旋CT检查发现绝大多数病灶(12/13)。7个病灶强化峰值出现在动脉期,6个病灶强化峰值出现在实质期。病灶CT值动脉期为(118.0±31.6)HU,实质期为(131.2±26.6)HU,门静脉期为(104.5±16.3)HU,实质期与门静脉期之间有统计学意义(P<0.05),动脉期与门静脉期之间无统计学意义(P>0.05)。所有的病灶在三期增强CT上均表现为中等度或明显强化。11个病灶表现为明显均匀强化,2个病灶表现为环形强化。1个非功能性胰岛细胞瘤螺旋CT表现与其余12个功能性胰岛细胞瘤无明显差别。结论小胰岛细胞瘤三期扫描均呈中等度或明显强化,大部分表现为均匀强化,动脉期和胰腺实质期能够检出绝大部分小胰岛细胞瘤;螺旋CT增强三期扫描对判断小胰岛细胞瘤是否具有功能性价值有限。     

超声内镜对胰腺癌早期诊断价值的评估

目的 评估超声内镜对胰腺癌早期诊断的价值.方法 2007年1月-2007年6月经手术病理确诊为胰腺癌的患者126例,明确诊断前半月内均接受过超声(US)、超声内镜(EUS)及螺旋CT(SCT)检查,术后证实为小胰腺癌(癌块直径≤2cm)28例,癌块直径:2cm者98例.比较术前接受US、SCT和EUS检查的影像学异常发现率、诊断准确率及间接征象准确率等,探讨超声内镜对胰腺癌早期诊断的价值.结果 联合应用EUS及SCT检查,胰腺癌异常影像的发现率、诊断准确率大为提高,与单独应用US、EUS或SCF相比,有显著性差异(PO.05);对小胰腺癌的诊断,EUS诊断准确率显著高于US和SCY(p<0.05).结论 EUS在胰腺癌早期诊断中有重要价值,EUS联合SCT能提高胰腺癌的早期检出率.     

超选择血管造影CT在胰岛细胞瘤术前诊断中的价值

目的 探究超选择血管造影CT(SSCTA)在胰岛细胞瘤术前诊断中的价值.方法 2013年至2015年收治的54例术后病理确诊为胰岛细胞瘤患者,所有患者均进行SSCTA检查,对其术前不同影像学检查方法的资料进行回顾性分析,行经腹部超声(TAUS)检查42例;超声内镜(EUS)检查48例;超声造影(CEUS)检查51例;增强CT检查30例;增强MRI检查48例;血管造影(SAG)检查54例,分析各检查方法的定位灵敏度及准确率,以指导更好地选择术前诊断方法.结果 各种检查方法的诊断的定位灵敏度及准确率:经腹部超声为21.4％,14.3％;超声造影为82.4％,58.8％;EUS为87.5％,68.8％;增强CT为70.0％,60.0％;增强MRI为87.5％,81.3％;血管造影为72.2％,44.4％;SSCTA为94.4％,88.9％.SSCTA定位诊断胰岛细胞瘤的灵敏度及准确率明显高于其它诊断方法(P＜0.05),54例患者行SSCTA检查后均未出现任何严重并发症.结论 SSCTA对胰岛细胞瘤的术前诊断具有重要价值,且安全可靠.     

多层螺旋CT与内镜超声对胰岛素瘤术前定位诊断的比较研究

目的: 比较多层螺旋CT与内镜超声对于胰岛素瘤术前定位诊断的临床价值.材料和方法: 15个月内低血糖症患者共35名(男:女=19:16, 平均年龄46.9岁),在2～7天内先后接受多层螺旋CT及内镜超声检查.两名放射科医师共同阅片做出CT诊断,两名消化内科医师共同做出内镜超声诊断.符合手术适应症的患者最终接受手术治疗并获得病理结果.将多层螺旋CT及内镜超声的诊断结果与病理结果进行对照分析.结果: 35名患者中共25名患者经术前评估行手术切除治疗,24名患者经病理确诊为胰岛素瘤(胰头钩突部8处,颈体部7处,尾部9处);术前多层螺旋CT检查共发现肿瘤24处(胰头钩突部9处,颈体部6处,尾部9处),术前内镜超声共发现肿瘤30处(胰头钩突部12处,颈体部9处,尾部9处).以病理诊断为金标准、部位为统计单位,多层螺旋CT术前诊断胰岛素瘤的敏感度、特异度、阳性预测值、阴性预测值及准确度分别为95.8%(23/24)、100%(51/51)、100%(23/23)、98.1%(51/52)及98.7%(74/75),内镜超声的上述数值分别是79.2%(19/24)、86.3%(44/51)、73.1%(19/26)、89.8%(44/49)及84.0%(63/75);以临床诊断为金标准、病灶为统计单位,多层螺旋CT术前诊断胰岛素瘤的敏感度、特异度、阳性预测值、阴性预测值及准确度分别为95.8%(23/24)、98.8%(80/81)、95.8%(23/24)、98.8%(80/81)及98.1%(103/105),内镜超声分别是79.2%(19/24)、86.4%(70/81)、63.3%(19/30)、93.3%(70/75)及84.8%(89/105).结论: 与内镜超声相比,多层螺旋CT有着更好的胰岛素瘤术前定位诊断价值.     

胰岛细胞瘤的螺旋CT诊断(附8例报告)

目的:探讨螺旋CT检查在胰岛细胞瘤诊断中的价值。方法:回顾性对照病理分析8例胰岛细胞瘤平扫加增强扫描的螺旋CT表现。结果:胰岛素瘤7例,直径为1.0~2.0 cm。CT平扫加增强扫描未发现肿瘤1例;6例CT平扫为等密度,增强扫描动脉期为高密度,门静脉期为略高密度。无功能性胰岛细胞瘤1例,直径为7.7 cm,CT平扫为略低密度,双期增强扫描呈周边明显强化,肿瘤内部不均匀略强化。结论:螺旋CT双期增强扫描在胰岛细胞瘤诊断中有较大价值。     

胰岛细胞肿瘤的CT检查

术前胰岛细胞瘤定位有重要意义、由于90%胰岛素瘤小于2cm、多包埋在胰腺内、且质地与胰腺组织类似,因此手术探查难以触及。准确术前定位不但能切除肿瘤、避免了盲目的胰次全切除,且缩短了手术时间,降低了手术并发症及死亡率。胰岛细胞瘤术前定位是影像学的一个重要研究题目,其中包括超声、CT、选择性动脉造影、胰静脉及胰静脉插管取样并激素水平测定。最近一些文献相继报告了胰岛细胞瘤的CT检查,论述了检查方法、诊断价值及其限度,本文就此内容加以综述。一、检查方法宜用快速高分辨力CT扫描机,如GE8800或9800扫描机。常规口服稀释造影剂显     

早期肾透明细胞癌的超声、CT和MRI诊断

目的: 研究早期肾透明细胞癌的超声、螺旋CT、MRI表现,提高其诊断水平.材料和方法: 回顾性分析经手术病理证实的13例早期肾透明细胞癌的超声、螺旋CT和9例MRI表现.结果: 13例早期肾透明细胞癌中,超声显示无回声肿块7例,厚壁型囊性肿块5例,多房囊状、分隔厚薄不一肿块1例.13例螺旋CT均显示肿块为低密度病灶,CT增强扫描示病灶均呈不均匀增强.9例MRI示肿块信号强度不均,T1WI为低信号,T2WI为不均匀性高信号,4例增强扫描均呈不均匀增强.术前超声诊断为5/13,CT为7/13,MRI为7/9,超声结合CT为13/13,超声结合CT和MRI为9/9.结论: 仅用超声或螺旋CT检查诊断早期肾透明细胞癌较困难.超声结合螺旋CT或MRI,综合影像检查能提高其诊断水平.     

无功能胰岛细胞瘤的CT和MRI诊断

目的:探讨无功能胰岛细胞瘤的CT和MRI诊断.方法:回顾性分析30例经病理证实的无功能胰岛细胞瘤的影像资料,良性24例,恶性6例;经CT扫描27例,MRI 9例,其中6例同时行CT及MRI检查.结果:本组肿瘤直径2～20 cm,平均8 cm,≥8 cm者16例(占53.3%).16例(占53.3%)肿瘤呈囊性或囊实性,12例(40%)肿瘤内有较小变性坏死区,2例呈实性.12例(40%)肿瘤内有出血区,9例(30%)CT扫描见钙化影.24例CT和9例MRI增强扫描显示肿瘤内的实性部分明显强化.9例MRI的T1WI呈较低信号,T2WI呈明显高信号.结论:肿瘤体积较大、边缘规整伴变性坏死,增强扫描肿瘤实性部分明显强化以及出血、钙化是无功能胰岛细胞瘤较有特征的影像学表现.     

非功能性胰岛细胞瘤的多层CT表现

目的:探讨CT诊断非功能性胰岛细胞瘤的多排CT表现。方法:对12例病理证实的非功能胰岛细胞瘤的CT平扫及增强图像进行分析。结果:12例患者检出13个病灶。11个为实性病灶,2例为囊性,动脉期,7个病灶明显强化,3例轻度强化,1例与正常胰腺强化程度相似。门静脉期,4例为明显强化,7例位轻度强化。2例病灶始终为低密度。结论:多排CT对于非功能性胰岛细胞瘤的病灶检出及分期有很要得价值,可为手术提供重要的信息。     

MRI in insulinomas: preliminary findings.

After establishing the diagnosis of an insulinoma, most surgeons prefer preoperative localization. Selective arteriography is usually considered the gold standard for this purpose. Recently, computed tomography (CT) and preoperative US have contended the role to angiography. MRI has been used in few cases of endocrine pancreatic tumors, and its role in this particular field has to be defined. Between November 1988 and September 1990 we evaluated 7 adult patients who had had surgery in our Surgical Department. Eight tumors were resected in 6 patients who were cured; in an 18-year-old woman surgical treatment was unsuccessful. Arteriography, CT, preoperative US, MRI and intraoperative US detected 2, 6, 6, 5 and 6 tumors, respectively. Two insulinomas (0.2 and 0.7 cm) were found at histologic examination in resected specimen. The ability of intraoperative US and careful surgical exploration to resolve more than 90% of cases makes the preoperative use of arteriography and CT of questionable value. If further experience confirms these findings, US and MRI may suffice.     

Role of the intra-arterial calcium stimulation test in the preoperative localization of insulinomas

The aim of this study was determination of the significance of the arterial stimulation test with venous sampling (ASVS) in the preoperative localization of insulinoma. Eleven patients with endogenous hyperinsulinism underwent preoperative transabdominal US, spiral computer tomography (spiral CT), MRI, endoscopic ultrasound (EUS) as well as angiography (DSA) combined with ASVS. The results were compared with intraoperative findings, intraoperative ultrasound (IOUS) and histopathology. There were no complications related to the ASVS test. In 11 patients the tumor could be localized with the various modalities as follows: US 1 of 11 (9 %), MRI 3 of 10 (30 %), spiral CT 4 of 11 (36 %), EUS 5 of 10 (50 %), DSA 8 of 11 (73 %), and ASVS 10 of 11 (91 %). In 2 patients the tumors were intraoperatively neither palpable nor detectable by IOUS, and consequently the intraoperative management was governed by information provided by DSA combined with the ASVS test. Ten patients had solitary benign insulinomas and 1 patient with multiple endocrine neoplasia I had two tumors adjacent to each other in the pancreatic tail. Arterial stimulation test with venous sampling was the most sensitive preoperative test for regionalizing the insulinoma in our set of patients. It can be performed safely in the course of a regular DSA examination and may affect intra-operative management in patients in whom the tumors are not detectable by palpation or IOUS. Received: 23 June 1999; Revised: 13 January 2000; Accepted: 29 February 2000     

Localization of pancreatic insulinoma: comparison of pre- and intraoperative US with CT and angiography

Methods of preoperative radiologic localization of insulinoma were compared in 52 patients, 44 of whom had solitary tumors. Examinations performed in these 44 patients were preoperative ultrasonography (US) in 28, angiography in 26, and computed tomography in 23. Prospective sensitivities were 61%, 54%, and 30%, respectively. Imaging sensitivities were lower for the eight patients with multiple insulinomas. In 28 of the 44 patients, intraoperative US was performed without the examiner being aware of the surgical findings. The sensitivity was 84%. Four insulinomas were not palpable but were visualized sonographically. The combined sensitivity of intraoperative US and surgical palpation for detecting solitary insulinomas was 100%. High-frequency intraoperative US is valuable for detecting occult solitary insulinomas and considerably useful for determining the proximity of insulinomas to the pancreatic and bile ducts.     

Comparison of hydro-US and spiral CT in the staging of gastric cancer.

The purpose of this study was to compare the diagnostic accuracy of hydro-ultrasonography (US) and spiral computed tomography (CT) in the staging of gastric cancer. Forty-three patients with gastric cancers confirmed at surgery underwent hydro-US and spiral CT on the same day prospectively. Hydro-US and spiral CT were done after ingestion of water. US and CT images were independently analyzed. After surgery, pathological findings according to TNM classification were compared with US and CT findings. The detection rate for T1 tumors was 75% (12/16), and all T2-T4 tumors were detected (27/27). In the T class, good correlation with pathology occurred in 55.8% of cases for US and 58.1% for CT, and there was no difference in staging accuracy between US and CT (P=.7667). Overstaging occurred in 14% for US and CT. Understaging occurred in 30.2% for US and 27.9% for CT. In the N class, good correlation with pathology occurred in 60.5% for US and 55.8% for CT, and there was no difference in staging accuracy between US and CT (P=.0949). Overstaging occurred in 4.7% for US and 18.6% for CT, and understaging occurred in 34.9% and 25.6%, respectively. The diagnostic accuracy of hydro-US and spiral CT in the staging of gastric cancer was between 55.8% and 60.5%, and there was no significant difference in staging accuracy between hydro-US and spiral CT, except for a tendency to overstaging by CT and understaging by US in the N class (P<.05).     

Invasive Diagnostik bei Insulinomen des Pankreas

Insulinomas are the most common cause for hypoglycemia with endogenous hyperinsulinism. Insulinomas are the most frequent endocrine tumor of the pancreas and 10% occur as multiple tumors (e.g. multiple endocrine neoplasia type I) or in rare cases as islet cell hyperplasia. A further 10–15% of insulinomas are malignant. Non-invasive imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US) and somatoreceptor scintigraphy (SRN) show a lower sensitivity for detection and localization of tumors, because in many cases insulinomas are smaller than 2 cm in size. Invasive pre-operative diagnostic procedures, such as transhepatic peripancreatic venous blood sampling (TPVB) and the intra-arterial calcium stimulation test (ASVS) are much more time-intensive compared to CT, MRI and US with an examination time of 2-3 h but achieve a more exact pre-operative detection and localization with sensitivities mostly greater than 95% and are therefore the diagnostic methods of choice.     

The usefulness of spiral Computed Tomography and colour-Doppler ultrasonography to predict portal-mesenteric trunk involvement in pancreatic cancer

PURPOSE: The aim of this study was to determine the clinical utility of spiral computed tomography (CT) and colour Doppler ultrasonography (US) in the evaluation of portal-mesenteric trunk (PMT) involvement in pancreatic cancer. MATERIALS AND METHODS: Ninety-five patients with pancreatic cancer underwent preoperative assessment of the PMT with spiral CT and colour Doppler US. Five stages of vascular involvement were established. During surgery intraoperative US was performed to confirm the preoperative findings. RESULTS: Of the 95 patients observed, 82 (86.3%) underwent surgery. The sensitivity of spiral CT was 98%, specificity 79%, overall accuracy 80.2%. The positive predictive value was 87.5%; the negative predictive value 96%. The results of colour Doppler US were 92.3%, 72,7%, 72.8%, 79.5% and 88.8%, respectively. CONCLUSIONS: The results indicate that spiral CT is the gold standard in detecting PMT involvement in pancreatic cancer. Colour Doppler US is useful, but adds nothing to CT. Both of these techniques improve the possibility of predicting the resectability of pancreatic cancer.     

111In-pentetreotide scintigraphy in the detection of insulinomas: importance of SPECT imaging.

The aim of this study was to determine whether the systematic use of SPECT can increase the reported low sensitivity of somatostatin receptor scintigraphy (SRS) in detecting insulinomas. METHODS: Fourteen patients were evaluated. After 111In-pentetreotide injection (approximately 250 MBq intravenously), abdominal SPECT images were obtained at 4 h and multiple planar images were obtained at 4 and 24 h. MRI and CT were performed within 1 mo of SRS. Sixteen tumors were histologically verified after surgery in 14 patients. RESULTS: SPECT revealed 14 lesions in 12 patients (sensitivity, 87.5%), both planar SRS and MRI revealed 7 tumors in 7 patients (sensitivity, 43.8%), and CT revealed only 5 lesions in 4 patients (sensitivity, 31.3%). Moreover, in 4 patients SPECT was the only examination with positive findings. CONCLUSION: SPECT at 4 h is mandatory for preoperative detection of insulinomas using SRS because the images are more sensitive than planar images and are superior to images from other conventional methods.     

胰岛素瘤的影像学评价(附28例报告)

目的：探讨多种影像学方法在胰岛素瘤术前定位诊断中的价值。资料与方法：28例经手术病理证实的胰岛素瘤患者于术前做B超和DSA检查，22例行胰腺CT扫描，10例行MRI检查。结果：4种影像学方法对胰岛素瘤术前定位诊断准确率分别为：DSA 82％（23／28），超声57％（16／28），CT 41％（9／22），MRI90％（9／10）。DSA与超声。MRI相结合使本组术前定位诊断准确率达93％（26／28）。结论：MRI和DSA是胰岛素瘤术前定位诊断准确率高而有效的方法。对临床有Whipple三联征患者，应首先选用超声和MRI或螺旋CT检查，特别是MRI或螺旋CT薄层快速动态增强扫描。当上述无创检查方法仍不能明确诊断时，可进一步行胰血管造影，多种影像技术联合应用可以提高本病的诊断准确率。     

Assessment of contrast-enhanced ultrasonography in diagnosis and preoperative localization of insulinoma

ObjectiveThis study was to evaluate the value of contrast-enhanced ultrasonography (CEUS) in the diagnosis and preoperative localization of insulinoma and explore the enhancement patterns of the tumors.MethodsUnenhanced and contrast-enhanced ultrasonographic examinations of 31 patients who underwent resection of insulinomas were retrospectively reviewed. The diagnosis sensitivity and localization specificity of CEUS for insulinomas were determined. Results of unenhanced ultrasonography and CEUS were compared by Chi-square test.ResultsUnenhanced ultrasonography could display 9 of 37 (24.3%) surgically verified insulinomas in 31 patients, while the diagnosis sensitivity and localization specificity of preoperative CEUS was 33 (89.2%) and 32 (86.5%) of the 37 tumors, respectively. In contrast to the unenhanced ultrasonography, the improvement of CEUS in the diagnosis and preoperative localization of insulinomas was significant (p < 0.0001). The enhancement pattern of insulinoma on CEUS was fast wash-in and slow wash-out. All the tumors were homogeneous hypervascularity in the earlier arterial phase, while the tumors still displayed hyperenhancing pattern in the late phase.ConclusionOur study demonstrates the great potential of CEUS in the diagnosis and preoperative localization of insulinomas. Since CEUS is a convenient, inexpensive, effective and non-invasive modality, the study supports the use of CEUS as a primary tool in the evaluation of patients with insulinomas.     

胰腺实性假乳头状瘤的多层螺旋CT表现

目的探讨胰腺实性假乳头状瘤的多层螺旋CT特征性表现。方法回顾性分析经手术病理证实的5例胰腺实性假乳头状瘤的螺旋CT平扫和增强扫描影像资料。本组5例均于静脉注射造影剂后25s和55s分别获得动脉期和胰腺实质期CT扫描图像。结果患者中1例为19岁男性,其余为年轻女性,无黄疸。肿瘤呈囊实性肿块,实质与囊性部分呈相间分布,1例有病灶内钙化。肿瘤最长径4～12cm,平均8cm。CT增强扫描动脉期肿块轻度强化,门静脉期肿瘤强化略高于动脉期,但其强化程度均低于正常胰腺组织。结论胰腺实性假乳头状瘤的螺旋CT表现虽有一定特征,但在术前作出正确诊断仍较难,应行胰腺活检确诊。