原发颈部成人神经母细胞瘤一例

病例资料患者,男．39岁。因右锁骨上窝肿块术后1年半、再发8个月入院。患者1年半前于无意中发现右锁骨上一核桃大小包块,无发热、触痛等其它不适,于外院手术切除,具体不详。8个月前右锁骨上再次出现无痛性肿块,进行性增大,且患者出现右上肢内侧麻木、乏力。     

内镜治疗食管胃静脉曲张前后门体侧支循环的变化

Objective To investigate the hemodynamic changes of protosystemic collaterals before and after endoscopic treatment in patients with gastroesophageal varices using 64-row multidetector computed tomograghy portal venography (MDCTPV) so as to evaluate the efficacy of endoscopic treatment in patients with or without para-esoghageal varices and with or without nonvarices portosystemic collaterals before treatment. Methods Twenty-six patients with gastroesophageal varices, who underwent endoscopic variceal ligation (EVL) for esophageal varices and endoscopic N-butyl-2-cyanoacrylate injection (EBC) for gastric varices between Jan.2007 and Dec. 2009, were enrolled. Sixty four-row MDCT was used to examine the changes of portosystemic collaterals 1 week before and 12 months after endoscopic treatment. The reconstructed images of portosystemic collaterals before and after endoscopic treatment were evaluated. Results Excellent quality of portosystemic collateral vessels on CTPV were obtained in all patients. The mean diameter of left gastric vein decreased from (6.7±1.9) mm to (5.0±1.9) mm after endoscopic treatment,with significant difference (P＜ 0.05). There was no significant difference in outcomes between patients with or without para-esoghageal varices (80% vs 72.7%, P＞0.05) and patients with or without non-varices portosystemic collaterals (82.4% vs 66.7% ,P＞0.05). Conclusions Sixty fourrow MDCTPV may provide important information for option of endoscopic treatment and prognosis.     

巨大原发良性腹膜后无功能副神经节瘤一例

腹膜后巨大良性无功能性副神经节瘤属于罕见病，误诊率极高，我院曾收治1例，现报道如下。     

64层螺旋CT血管成像对TACE治疗原发性肝癌的临床价值

目的:探讨64层螺旋CT血管成像对于肝癌(HCC)供血动脉的显示价值。方法:100例HCC患者在肝动脉化疗栓塞术(TACE)前后行MSCT扫描和血管成像。结果:100例患者的HCC供血血管被充分显示;TACE治疗效果与HCC供血动脉有密切关系,规则性供血类型与变异性血管类型差异有统计学意义(P=0.034)。结论:64层螺旋CT血管成像是一种评价HCC供血动脉的重要方法,为术式的选择及预后提供了重要信息。     

髂骨软骨黏液样纤维瘤合并病理性骨折误诊1例分析并文献复习

目的 探讨软骨黏液样纤维瘤的影像诊断及临床特征.方法 左髂骨软骨黏液样纤维瘤合并病理性骨折l例,复习相关文献并分析临床、影像学及病理,探讨其诊断治疗及预后.结果 髂骨软骨黏液样纤维瘤比较少见,合并病理性骨折更是罕见,缺乏特征性影像学表现,术前诊断困难,需与骨巨细胞瘤、骨囊肿等疾病相鉴别,外科治疗为首选.结论 软骨黏液样纤维瘤影像诊断存在一定难度,外科治疗预后较好,但是术后复发率较高.     

64层螺旋CT血管造影对肝移植术前的评估

充分了解患者血管情况,据此制订合适的术式,是肝移植是否能够成功的关键之一。64层螺旋CT血管造影（Mulfislice CT Angiography,MSCTA）是一种无创性的血管成像技术,将扫描图像利用多种后处理方式如最大密度投影（MIP）、容积再现技术（VR）等对图像进行三维重建,能清晰显示肝脏多级血管的形态、走行及变异,对肝动脉、门静脉及肝静脉进行分型及评估,从而采取适合于患者的术式及治疗,这些对肝移植术前有着重要意义。     

原发性软组织骨肉瘤1例

<正>女,62岁,因"发现左大腿无痛性渐增性肿物13年"入院治疗,13年前无意中发现左大腿下段前内侧有一"蚕豆"大小的肿物,触之无压痛。近年来肿块逐渐增大,伴有行走跛行,足趾麻木。入院查体:左侧大腿前内侧可触及一大小约34cm×22cm肿块,质韧,表面光滑无破溃,可见扩张静脉,皮肤温度较健侧偏高,边界清楚,无明显压痛,活动度良好,与表面皮肤无明显粘连。触压肿块时,感左下肢麻木。     

肝脏上皮样血管平滑肌脂肪瘤的影像学表现

目的:探讨肝脏上皮样血管平滑肌脂肪瘤(epithelioid angiomyolipoma,E-AML)的影像学表现,提高诊断准确率。方法:收集并回顾性分析经手术后病理证实的20例肝脏E-AML患者的资料。20例患者中,4例同时行CT平扫及双期增强扫描、MRI平扫及动态增强扫描,1例行CT平扫及双期增强扫描,14例行MRI平扫及动态增强扫描,1例行CT血管成像(CT angiography,CTA)检查。对病灶的部位、数目、大小(最大径)、形态,病灶平扫密度或信号特点,病灶内有无脂肪成分,病灶内有无血管影及周边血管情况,有无假包膜及其强化表现,病灶动态增强特征,以及周围肝实质背景等进行记录和分析。结果:肝E-AML单发17例、多发3例;共24枚病灶,其中,尾状叶4枚、右叶9枚、左叶11枚;病灶大小1.0~25.0 cm;24枚病灶均为椭圆形或圆形;7枚病灶均为低密度,22枚病灶T1WI呈低信号、T2WI呈高信号、扩散加权成像(diffusion weighted imaging,DWI)呈高信号及表观扩散系数(apparent diffusion coefficient,ADC)均降低;动态增强10枚表现为"快进快出"型,14枚表现为"快进慢出"型;7枚含有脂肪成分;23枚病灶内及周边可见点条状血管影;14枚见"强化逐渐减退"的假包膜;1例CTA显示肝动脉供血、肝静脉引流入下腔静脉。结论:单发富血供肿块、瘤体内和周围见点条状血管影及早显引流静脉、动脉期出现强化假包膜是肝E-AML具有一定特征性的影像学表现。     

内镜治疗食管胃静脉曲张前后门体侧支循环的变化

目的 比较肝硬化胃食管静脉曲张(GEV)患者内镜治疗前后门体侧支循环的变化,评价内镜治疗前伴或不伴食管旁静脉曲张(Para-EV)及非静脉曲张门体分流与内镜治疗疗效的关系.方法 2007年1月至2009年12月期间在内镜中心行食管静脉曲张套扎(EVL)+胃静脉曲张组织胶注射(EBC)治疗的肝硬化食管胃静脉曲张患者26例.在治疗前1周及治疗后1年内进行64排螺旋CT门脉成像检查,观察门脉系统侧支血管在内镜治疗前后的变化情况.结果 胃左静脉平均直径在内镜治疗后显著减小[(6.7±1.9)mm比(5.0±1.9)mm,P＜0.05].治疗前GEV伴Para-EV与不伴ParaEV的内镜治疗有效率差异无统计学意义(80.0%比72.7%,P＞0.05).治疗前GEV伴非静脉曲张门体分流与不伴非静脉曲张门体分流的内镜治疗有效率差异无统计学意义(82.4%比66.7%,P＞0.05).结论 多排螺旋CT门脉成像可以为GEV的治疗方案选择及评价预后提供重要信息.     

内镜治疗食管胃静脉曲张前后门体侧支循环的变化

Objective To investigate the hemodynamic changes of protosystemic collaterals before and after endoscopic treatment in patients with gastroesophageal varices using 64-row multidetector computed tomograghy portal venography (MDCTPV) so as to evaluate the efficacy of endoscopic treatment in patients with or without para-esoghageal varices and with or without nonvarices portosystemic collaterals before treatment. Methods Twenty-six patients with gastroesophageal varices, who underwent endoscopic variceal ligation (EVL) for esophageal varices and endoscopic N-butyl-2-cyanoacrylate injection (EBC) for gastric varices between Jan.2007 and Dec. 2009, were enrolled. Sixty four-row MDCT was used to examine the changes of portosystemic collaterals 1 week before and 12 months after endoscopic treatment. The reconstructed images of portosystemic collaterals before and after endoscopic treatment were evaluated. Results Excellent quality of portosystemic collateral vessels on CTPV were obtained in all patients. The mean diameter of left gastric vein decreased from (6.7±1.9) mm to (5.0±1.9) mm after endoscopic treatment,with significant difference (P＜ 0.05). There was no significant difference in outcomes between patients with or without para-esoghageal varices (80% vs 72.7%, P＞0.05) and patients with or without non-varices portosystemic collaterals (82.4% vs 66.7% ,P＞0.05). Conclusions Sixty fourrow MDCTPV may provide important information for option of endoscopic treatment and prognosis.