视网膜母细胞瘤的CT诊断

目的　研究视网膜母细胞瘤的CT诊断及鉴别诊断。方法　分析经手术病理证实的 2 5例视网膜母细胞瘤的CT表现。结果　所有病例均表现为玻璃体部分或全部密度增高。钙化 2 3例 ;眼球增大 8例 ;视神经受累 6例 ;异位视网膜母细胞瘤 7例。结论　CT对视网膜母细胞瘤可做出定性诊断     

CT、MRI在视网膜母细胞瘤的诊断价值

目的:探讨视网膜母细胞瘤的CT和MRI表现及其在诊断与鉴别诊断中的价值.方法:回顾性分析经病理证实的27例视网膜母细胞瘤的CT及MRI表现,所有病例均行CT检查,9例行MRI检查.结果:CT显示眼球内软组织肿块21例,其中眼球内单发肿块14例,多发肿块7例;肿块突破眼环进入球外5例,视神经增粗2例;颅内侵犯1例;视网膜脱离1例;伴钙化24例.MRI显示眼球内肿块5例;眼球内外肿块3例,视神经增粗3例;沿视神经侵犯颅内1例;伴视网膜脱离2例;钙化灶4例.结论:CT对视网膜母细胞瘤的定性诊断有重要意义,MRI对视网膜母细胞瘤的分期及显示视网膜脱离较好.     

视网膜母细胞瘤的CT诊断

目的 探讨视网膜母细胞瘤的CT特征、诊断和鉴别诊断。方法 回顾性分析31例（32只眼）资料完整经病理或临床证实的视网膜母细胞瘤临床和CT检查资料。结果 视网膜母细胞瘤的典型临床表现为白瞳、眼球突出等，CT表现为：a）眼球后部软组织肿块．b）点状、斑片状钙化，钙化率93.8％；c）眼球突出；d）视神经增粗，眼环增厚，提示球外蔓延。结论 CT对视网膜母细胞瘤的诊断及分期有重要价值，瘤体内钙化斑是视网膜母细胞瘤的特征性CT表现。     

视网膜母细胞瘤的影像学表现及其临床价值

目的　探讨视网膜母细胞瘤的CT、MRI表现及其诊断、鉴别诊断价值。方法　回顾性分析 3 2例经手术病理 (2 9例 )和临床证实 (3例 )的视网膜母细胞瘤。所有病例均行CT检查 ,11例行MRI检查。结果　具有典型CT表现者 2 8例 :①眼球壁上软组织密度块影向球内隆起 ;②斑点状或团块状钙化。 3例视神经增粗 ,其中 1例伴鞍上肿块。 4例瘤内无钙化。MRI显示 11例球内肿块同时伴有视网膜下积液、出血 2例 ,显示有低信号钙化灶 2例 ,视神经增粗 2例。CT与MRI检查对视网膜母细胞瘤敏感性相同。定性诊断准确率 :CT 90 .63 % (2 9/3 2 ) ,MRI 81.82 % (9/11)。分期准确率 :CT 93 .10 % (2 7/2 9) ,MRI 10 0 % (9/9)。结论　CT对肿瘤定性诊断具有重要意义。MRI检查对肿瘤分期较优越。对无钙化肿瘤辅以MRI检查可提高定性诊断准确率     

二维超声诊断视网膜母细胞瘤及其合并症的价值

目的 :探讨二维超声诊断视网膜母细胞瘤及其合并症的价值。材料和方法 :应用法国BVI眼科专用二维超声仪检查的 2 2例患者均经手术证实为视网膜母细胞瘤。结果 :视网膜母细胞瘤二维超声表现为玻璃体内实性肿物 19例 ,全部伴有钙化 ,其中砂粒样钙化 3例、钙化斑 7例、钙化团 9例 ;眼球壁局限性增厚 2例 ;视神经肿物 1例。超声发现视网膜母细胞瘤合并继发性青光眼 3例、视网膜脱离 2例、玻璃体混浊 2例。结论 :二维超声可以较明确诊断视网膜母细胞瘤及其合并症。     

视网膜母细胞瘤的CT诊断

目的:探讨视网膜母细胞瘤的CT表现特征。方法:回顾分析 51 例经手术病理证实的视网膜母细胞瘤。术前均采用层厚、层距为 2~3 mm的 CT轴位扫描。10 例行增强扫描,对比剂用量为 1.5 ml/kg,注射流率为 1.5 ml/s。结果:CT发现51例中单眼发病48例,双眼发病3例;48例表现为眼球内肿块伴钙化,眼球增大26例,眼环受累12 例,视网膜脱离9例。视神经增粗16例,眶内侵犯2例,眶周侵犯 2 例,颅内侵犯 3 例。病理学检查 18 例视神经受累。结论:CT是诊断视网膜母细胞瘤的重要工具。对其可做出定位和定性诊断,并可进行准确分期。     

视网膜母细胞瘤和Coat’s病CT征象的研究

目的：本文旨在探讨视网膜母细胞瘤与Coat’s病的不同CT表现，提高诊断和鉴别诊断能力。材料和方法：12例视网膜母细胞瘤和5例Coat’s病经手术病理证实，均在术前接受CT检查。CT为2毫米层厚连续扫描，并给予团注法增强检查。结果：两者均有软组织肿块和玻璃体密度增高．但视网膜母细胞瘤除绝大多数有钙化外．还有眼球增大，晶状体密度减低和移位的表现。结论：多数情况下．根据有无钙化可将两者区别开来．少数无钙化视网膜母细胞瘤还需根据眼球大小和晶体状改变加以区别。     

视网膜母细胞瘤的多层螺旋CT诊断

目的:探讨多层螺旋CT(MSCT)在视网膜母细胞瘤(Rb)诊断中的价值.方法:回顾性分析10例视网膜母细胞瘤的MSCT表现特点.结果:视网膜母细胞瘤MSCT表现为眼球后半部实质性肿块10例,肿块内有钙化9例,玻璃体密度增高3例,视神经增粗3例,颅内侵犯和转移1例.结论:视网膜母细胞瘤的MSCT表现具有特征性,增强检查对未钙化病例具有诊断意义.     

视网膜母细胞瘤的CT诊断

目的:探讨视网膜母细胞瘤CT表现及其特征。材料和方法:回顾性分析11例经临床和手术病理证实的视网膜母细胞瘤的CT表现。结果:视网膜母细胞瘤CT表现为眼球后壁软组织肿块11例,其中肿块内有钙化9例,玻璃体密度增高8例,突眼6例,视神经增粗4例,颅内侵犯和转移2例。术前定性准确率为81．8％,分期准确率为73％。结论:视网膜母细胞瘤的CT表现具有特征性,CT检查对本病具有重要价值。     

眼球内肿瘤的CT表现

目的：探讨常见眼球内肿瘤的CT表现及其在诊断与鉴别诊断中的价值。方法：分析经手术病理证实的47例眼球内肿瘤的CT表现,其中平扫47例、平扫加增强扫描37例。结果：视网膜母细胞瘤29例,CT表现自眼环生长的软组织肿块并钙化为本病特征表现,葡萄膜黑色素瘤13例,脉络膜血管瘤1例,脉络膜转移瘤2例,CT均表现起自眼环的软组织肿块,无钙化;脉络膜骨瘤2例,CT表现眼环类圆形骨密度肿瘤。结论：CT可确定眼球内肿瘤的位置并提示肿瘤的性质,对视网膜母细胞瘤进行确切的诊断及分期,为临床制定治疗方案提供依据。     

Detection of Calcifications in Retinoblastoma Using Gradient-Echo MR Imaging Sequences: Comparative Study between In Vivo MR Imaging and Ex Vivo High-Resolution CT

BACKGROUND AND PURPOSE:Intratumoral calcifications are very important in the diagnosis of retinoblastoma. Although CT is considered superior in detecting calcification, its ionizing radiation, especially in patients with hereditary retinoblastoma, should be avoided. The purpose of our study was to validate T2*WI for the detection of calcification in retinoblastoma with ex vivo CT as the criterion standard.MATERIALS AND METHODS:Twenty-two consecutive patients with retinoblastoma (mean age, 21 months; range, 1–71 months) with enucleation as primary treatment were imaged at 1.5T by using a dedicated surface coil. Signal-intensity voids indicating calcification on T2*WI were compared with ex vivo high-resolution CT, and correlation was scored by 2 independent observers as poor, good, or excellent. Other parameters included the shape and location of the signal-intensity voids. In 5 tumors, susceptibility-weighted images were evaluated.RESULTS:All calcifications visible on high-resolution CT could be matched with signal-intensity voids on T2*WI, and correlation was scored as excellent in 17 (77%) and good in 5 (23%) eyes. In total, 93% (25/27) of the signal-intensity voids inside the tumor correlated with calcifications compared with none (0/8) of the signal-intensity voids outside the tumor. Areas of nodular signal-intensity voids correlated with calcifications in 92% (24/26), and linear signal-intensity voids correlated with hemorrhage in 67% (6/9) of cases. The correlation of signal-intensity voids on SWI was better in 4 of 5 tumors compared with T2*WI.CONCLUSIONS:Signal-intensity voids on in vivo T2*WI correlate well with calcifications on ex vivo high-resolution CT in retinoblastoma. Gradient-echo sequences may be helpful in the differential diagnosis of retinoblastoma. The combination of funduscopy, sonography, and high-resolution MR imaging with gradient-echo sequences should become the standard diagnostic approach for retinoblastoma.

Retinoblastoma is generally treated on the basis of funduscopic, sonography, and imaging findings without prior histopathologic confirmation of diagnosis. The prevalence of calcifications is approximately 85%¹ and is considered the key finding in differentiating retinoblastoma from simulating lesions (Coats disease, persistent hyperplastic primary vitreous, or toxocara endophthalmitis) in young children.² Very rare lesions such as medulloepithelioma and retinocytoma may also have calcifications and hence occasionally cause difficulty with clinical and radiologic differentiation.³Sonography is the most commonly used imaging technique for the evaluation of intraocular tumors. The combination of funduscopy and sonography allows the identification of calcifications in 91%–95% of all patients with newly diagnosed retinoblastoma.⁴ Sensitivity to small calcifications decreases, however, in the presence of massive retinal detachment, vitreous hemorrhage, and subretinal fluid, potentially hampering the confirmation of the diagnosis. In these complicated eyes, CT is generally the method of choice for studying intraocular calcifications, with reported sensitivities of 81%–96%.⁵ Its diagnostic performance in staging retinoblastoma disease extent is limited, however, and the theoretic increased risk of radiation-induced cataracts and fatal cancers in children who are exposed to ionizing radiation should be considered.⁶ Patients with hereditary retinoblastoma in particular are at an even higher risk of developing radiation-induced tumors compared with healthy children.MR imaging is the noninvasive technique of choice for the evaluation of retinoblastoma. The combination of sonography and MR imaging is considered first-line diagnostic imaging in the evaluation of children with suspected retinoblastoma, surpassing CT.⁷ However, MR imaging does not allow reliable identification of tumoral calcifications on routinely used clinical sequences. The lack of spatial resolution with standard clinical sequences provides an additional challenge for the visualization of small punctate tumoral calcifications. Scarce data on high-resolution ocular MR imaging by using surface coils do, however, suggest that calcifications can be detected with reasonable diagnostic accuracy.⁸Gradient-echo T2*-weighted imaging sequences are sensitive to susceptibility differences among tissues that cause magnetic field inhomogeneity leading to signal loss, and T2*WI is used to depict blood products, deoxygenated venous blood in dilated vessels (venous congestion), and calcifications.^9,10 Previous work by Galluzzi et al¹¹ showed that T2*WI can be a feasible technique for detecting intraocular calcifications because calcified areas in retinoblastoma emerged as hypointense foci of signal-intensity voids (SIVs) within the soft-tissue mass. Most of the SIVs on T2*WI correlated with spots of intratumoral calcifications on CT. Whether the shape and spatial arrangement of the intraocular SIVs on MR imaging could be matched with calcifications on CT was not investigated.The purpose of our study was to assess the performance of gradient-echo T2*WI in the visualization and morphologic evaluation of retinoblastoma calcifications and to compare T2*WI with ex vivo CT scans of the enucleated eyes as the criterion standard.     

肺结核的CT诊断

目的探讨CT对肺结核的诊断价值。方法回顾性分析56例具有完整临床资料的肺结核病人的CT表现,所有病例均经病理证实或经临床随访证实。结果56例肺结核中,主要CT表现为结核灶钙化22例,支气管播散灶17例,卫星灶21例,纵隔淋巴结肿大9例,其中环状强化8例,纵隔淋巴结钙化14例,多呈点状、环状及簇状。结论CT对诊断肺结核具有较高的价值,全面分析其CT征象,有助于肺结核的诊断。     

MSCT在视网膜母细胞瘤经眼动脉化疗前分期的应用

目的:探讨多层螺旋CT在视网膜母细胞瘤经眼动脉化疗前分期的应用价值。方法:回顾性分析30例婴幼儿视网膜母细胞瘤的CT表现,并根据CT分期进行评估,选择病例进行眼动脉灌注化疗。结果:30例38眼表现为眼球内单发肿块34眼,眼内多发肿块3眼,眼内肿块及视神经管累及鞍上1眼。本组病例全部发现单发或多发钙化灶,钙化率为100%。斑点样钙化5眼,斑片状钙化22眼,混合性11眼。Danziger分期Ⅰ期31眼,Ⅱ期6眼,Ⅲ期1眼。Ⅰ期、Ⅱ期病例行眼动脉灌注化疗,Ⅲ期放弃治疗。结论:多层螺旋CT在婴幼儿视网膜母细胞瘤经眼动脉灌注化疗前的定性诊断、肿瘤分期、评价肿瘤侵犯范围及病例选择具有重要价值。     

泡状棘球蚴病肝外转移灶的CT表现

目的 分析肝外泡状棘球蚴病的ＣＴ表现评价ＣＴ检查在诊断中的应用价值。方法 １２例经手术病理证实为肝泡状棘球蚴病的患者因新的临床症状,经ＣＴ检查发现肝外多脏器合并泡状棘球蚴病。结果 脑泡状棘球蚴病７例,增强后表现为内部有多发蜂窝状低密度的肿块或显示为“靶征”样的强化结节;包状棘球蚴病３例,表现为以肺野外带居多,内部有“小空泡征”或“偏心空洞”的结节灶;     

儿童腹膜后成神经细胞瘤侵犯肾脏与肾母细胞瘤的鉴别诊断

目的评价儿童腹膜后成神经细胞瘤侵犯肾脏与肾母细胞瘤的CT表现鉴别要点。方法分析经手术证实的有明确肾脏侵犯13例腹膜后成神经细胞瘤的CT征象，并与同期经手术证实的15例肾母细胞瘤进行对照。结果13例成神经细胞瘤中12例表现为不规则肿块，11例边界不清，10例包含钙化，9例腹膜后血管受侵犯，12例有腹膜后和膈脚后淋巴结转移；15例肾母细胞瘤中，12例呈圆形肿块，2例边界不清，2例有钙化，2例腹膜后血管受侵犯，3例有腹膜后淋巴结转移；无膈脚后淋巴结转移表现。其中神经母细胞瘤的肿瘤分叶征、钙化、腹膜后和膈脚后淋巴结转移、腹主动脉和下腔静脉包埋均较肾母细胞瘤常见。其中膈脚后淋巴结转移和腹膜后血管包埋对于诊断神经母细胞瘤具有较高价值。结论膈脚后淋巴结转移和腹膜后血管包埋是成神经细胞瘤的特征性表现，对于鉴别腹膜后成神经细胞瘤与肾母细胞瘤具有重要的意义。     

肺泡微石症的CT诊断

目的探讨肺泡微石症的ＣＴ表现及诊断价值。方法回顾性分析９例经活检病理证实或临床综合确诊的肺泡微石症ＣＴ表现。结果常规ＣＴ表现：肺窗示肺实质内有无数细小散在的粟粒结节，以中下肺的外周部密集，其ＣＴ值为２００～４００ＨＵ，多合并不同程度的肺气肿及间质纤维化；纵隔窗示细结节影最密集区常呈沿胸膜的线带状或散在的点簇状钙化，形成“火焰征”及“白描征”。高分辨率ＣＴ（ＨＲＣＴ）表现：肺野似磨玻璃样，结节大小稍有区别，沿支气管血管束分布偏多及小叶间隔增厚。结论ＣＴ尤其ＨＲＣＴ能更准确地反映本病的综合病理特点及病程，在诊断及鉴别诊断中起决定性作用。     

增强CT扫描在甲状腺肿瘤鉴别诊断中的价值

目的探讨增强CT扫描在甲状腺肿瘤鉴别诊断中的价值及重要性.方法回顾性分析经手术及病理证实的27例甲状腺肿瘤的术前CT增强前后表现,其中甲状腺腺瘤18例,甲状腺乳头状癌9例.结果增强扫描18例腺瘤中,12例囊性腺瘤有完整性强化环,6例实体腺瘤瘤内岛形强化结节.9例乳头状癌中均无完整强化环,其中4例瘤壁强化结节.9例乳头状癌中7例瘤内有钙化(呈斑点状、细颗粒状或二者混合状),4例甲状腺周围器官侵犯.结论甲状腺肿瘤必须强调增强扫描才能显示甲状腺肿瘤的病理特征,对鉴别诊断具有重要价值.甲状腺周围器官侵犯是诊断甲状腺癌的肯定征象.瘤壁乳头状强化结节和瘤内斑点状、颗粒状钙化是甲状腺乳头状癌的可靠诊断征象.瘤周完整性强化环、瘤壁光滑锐利是良性腺瘤的征象.