原发性胃肠道淋巴瘤多层螺旋CT表现

目的探讨原发性胃肠道淋巴瘤的 CT 表现.资料与方法回顾性分析经手术病理证实的13例胃肠道淋巴瘤患者的多层螺旋 CT 表现及其病理特征.结果13例均为非霍奇金淋巴瘤,其中弥漫大 B 细胞淋巴瘤9例,黏膜相关边缘带 B 细胞淋巴瘤4例.胃部病变6例,其中累及全胃1例,胃窦2例,胃体1例,同时累及胃体及胃窦2例;小肠病变2例,其中空肠1例,回肠末端1例;结肠病变5例,其中回盲部2例,升结肠1例,乙状结肠1例,直肠1例.多层螺旋 CT 可见胃肠壁弥漫性增厚病灶伴管腔明显狭窄;病灶轻至中度增强;个别出现瘤样扩张征象及肠系膜和(或)腹膜后淋巴结肿大.结论多层螺旋CT 诊断原发性胃肠道淋巴瘤具有胃肠管壁弥漫性或局限性增厚;密度均匀,轻至中度均匀强化,轨道征、黏膜白线征及强化均匀等影像学特征,对胃肠道淋巴瘤具有一定的诊断价值.     

回盲部恶性淋巴瘤的CT诊断

目的　分析回盲部恶性淋巴瘤的CT表现。方法　 12例均经手术切除或剖腹探查 ,病理诊断均为非霍奇金淋巴瘤。结果　CT表现为 9例回盲部肠壁弥漫性增厚 ,其中 5例侵及回盲瓣及回肠末端而呈横“8”字征。 3例呈局限性突出的软组织肿块。增强扫描病变呈中等强化。此外 ,病灶周围和 (或 )肠系膜、腹膜后可见淋巴结肿大。结论　CT能清楚显示回盲部淋巴瘤的形态特点、范围及肿大淋巴结 ,对该病的正确诊断具有重要价值     

原发性胃肠道淋巴瘤的CT诊断

目的:探讨原发性胃肠道淋巴瘤的CT表现特点。材料和方法:回顾性分析经手术病理证实的4例原发性胃肠道非霍奇金淋巴瘤的CT平扫+增强扫描表现。结果:4例经病理证实均为非霍奇金淋巴瘤,属黏膜相关淋巴组织型结外边缘带B细胞淋巴瘤,其中胃2例、小肠1例和结肠1例;2例胃淋巴瘤胃壁分别呈弥漫性增厚及局限性增厚,1例黏膜累及并伴有溃疡,胃壁均匀轻～中度增强,1例内见小片状低密度灶,小肠淋巴瘤呈多节段管壁增厚、管腔狭窄伴肠系膜淋巴结增大,肠壁及肿大淋巴结均匀明显增强,1例回盲部结肠淋巴瘤呈偏侧性肿块伴管腔狭窄,病灶均匀轻～中度增强。结论:CT诊断原发性胃肠道淋巴瘤具有较高的价值。     

小肠恶性淋巴瘤的MSCT诊断

目的：探讨小肠恶性淋巴瘤的MSCT、诊断价值。方法：回顾性分析9例经病理证实的小肠淋巴瘤的叮表现及其特点。均行CT平扫及增强扫描（动脉期和门脉期），扫描层厚、层距均为10mm。然后行1．25mm重建。结果：9例肿瘤发生于回肠近段3例，回盲部5例，空肠1例。CT平扫表现：肠壁环形增厚7例，厚度从1．2—4．6cm，平均2．5cm；肠壁不对称性增厚2例，在系膜侧形成分叶状肿块；5例见肠腔呈动脉瘤样扩张，4例轻度狭窄；肠系膜淋巴结多发肿大3例。增强扫描：病变区在动脉期和门脉期强化均不明显，CT值上升8—13HU。肠系膜血管被肿瘤包埋2例，无受压移位。结论：肠壁环形增厚、无明显强化和“动脉瘤”样肠腔扩张征是小肠原发性淋巴瘤的3个主要CT特征。伴有肠系膜淋巴结多发肿大和肠系膜血管的单纯包裹征具有一定特异性。     

MSCT增强扫描在胃肠道MALT淋巴瘤诊断中的应用价值

目的 分析MSCT增强扫描在胃肠道黏膜相关淋巴组织(MALT)淋巴瘤诊断中的应用价值.方法 回顾性分析经病理证实的11例胃肠道MALT淋巴瘤的临床和影像资料,分析病变部位、形态表现、增强表现、淋巴结肿大及其他结外器官的受累情况等.结果 (1)形态表现:弥漫性增厚型8例(72.7%),其中胃5例,肠3例;局限性肿块/结节型3例(27.3%),其中胃2例,肠1例;肿瘤导致管腔"动脉瘤样扩张"2例,均发生于肠道;另有1例回盲部局限性肿块/结节型,病灶致局部肠腔狭窄.(2)增强表现:10例(90.9%)中度或明显强化,9例(81.8%)均匀强化.(3)淋巴结及其他结外器官受累情况: 5例(45.5%)累及区域淋巴结,1例(9.1%)累及区域淋巴结及膈下远处淋巴结,1例(9.1%)同时累及膈肌两侧淋巴结;2例(18.2%)伴有其他结外器官受累.(4)临床分期:Ⅰ~Ⅱ期9例(81.8%),Ⅳ期2例(18.2%).结论 MSCT增强扫描可为胃肠道MALT淋巴瘤的诊断和分期提供可靠依据,建议将胸部和腹盆腔联合增强扫描作为常规检查项目.     

小肠淋巴瘤的螺旋CT诊断

目的评价螺旋CT在小肠恶性淋巴瘤诊断和鉴别诊断中的价值。方法对10例经手术病理证实的小肠恶性淋巴瘤的影像表现进行回顾性分析。结果 10例小肠淋巴瘤,8例位于回肠(包括回盲部),2例位于空肠。10例CT表现均有不同程度的肠壁增厚,2例呈动脉瘤样扩张,肠管明显环形增厚,肠管不狭窄且明显扩张;5例呈浸润型,小肠壁均有不同程度的增厚;息肉肿块型2例,肠腔内较大分叶状软组织肿块,致肠腔变窄,肿块密度较均匀,增强均匀强化,未见坏死。3例腹腔、肝门、脾门淋巴结肿大,表现为分叶状肿块或多个小结节相互融合。增厚的肠壁、软组织肿块及肿大淋巴结呈轻度强化8例,或无明显强化1例,其中2例内部可见血管被肿瘤包绕,1例并发穿孔。结论掌握小肠淋巴瘤的CT表现特征有助于与小肠间质瘤、小肠癌及小肠Crohn病的鉴别。     

结肠淋巴瘤与结肠癌CT征象对比分析

目的探讨结肠淋巴瘤与结肠癌的CT征象间的差异,以提高对两者鉴别的准确性。方法回顾性分析经手术病理或穿刺活检证实的结肠淋巴瘤11例及结肠癌13例的CT表现。所有病例均行CT平扫及增强扫描。运用Fisher精确检验的统计方法对两者肠壁增厚程度,CT增强扫描动脉期及静脉期强化程度、病灶周围淋巴结个数、周围最大淋巴结的短径、受累肠管的长度之间的差异进行比较分析。结果11例结肠淋巴瘤及13例结肠癌均有不同程度的管壁增厚及管腔狭窄;二者管壁增厚程度及CT强化程度的差异无统计学意义(P>0.05)。结肠淋巴瘤周围淋巴结个数较多于结肠癌,二者差异有统计学意义(P=0.001),11例结肠淋巴瘤中3例出现淋巴结的融合,13例结肠癌均未出现淋巴结融合,二者周围最大淋巴结的短径差异有统计学意义(P=0.015)。结肠淋巴瘤累及肠管的长度较长于结肠癌,二者累及肠管长度的差异有统计学意义(P=0.008)。结论CT能较准确地显示发病部位,肠管的浸润及与周围结构的关系,病灶周围淋巴结的个数、最大淋巴结的短径及受累肠管的长度对鉴别结肠淋巴瘤与结肠癌有帮助意义。     

胃肠道非霍奇金淋巴瘤的分布与CT诊断

目的探讨胃肠道非霍奇金淋巴瘤的CT表现及分型。方法搜集经内镜活检和手术病理证实的胃肠道非霍奇金淋巴瘤23例,其中来源于胃11例,小肠6例,小肠及盲肠、结肠同时受累3例,结肠3例。所有病例均行CT平扫,部分行强化CT扫描、胃肠钡餐造影及内镜检查。结果 11例胃非霍奇金淋巴瘤中原发性9例,继发性2例。胃非霍奇金淋巴瘤CT表现分两类:1弥漫性胃壁增厚型7例;2局限性胃腔内肿块型4例。肠道非霍奇金淋巴瘤共12例,原发性10例,继发性2例。肠道非霍奇金淋巴瘤CT表现分3类:1弥漫性肠壁增厚型8例;2肿块型3例;3肠系膜受累伴腔外肿块型1例。结论 CT检查胃肠道非霍奇金淋巴瘤可提供病变部位、范围和类型,有无周围侵犯及淋巴结转移等信息,并可对病变进行准确分期,在指导临床治疗和预后判断中有不可替代的作用。     

回盲部病变的MSCT鉴别诊断

目的:探讨回盲部病变的CT表现特点及鉴别诊断,提高其诊断准确性。方法:回顾性分析40例临床拟诊为回盲部病变患者的临床和影像资料,结合病理结果探讨不同病变的CT表现特征。结果:40例中,26例恶性肿瘤(腺癌20例,间质瘤3例,淋巴瘤2例,神经内分泌癌1例),其中2例淋巴瘤合并肠套叠;14例炎症,一般感染性炎症8例(阑尾炎7例,急性重症胰腺炎并肠壁弥漫性增厚1例),肉芽肿性炎6例(包括肠结核2例,克罗恩病4例)。MSCT可显示回盲部病变的范围、肠壁增厚的方式、程度及强化特点,周围脂肪密度变化、淋巴结肿大及其他脏器转移。结论:回盲部不同病变的CT表现特点不同,有助于明确诊断。     

原发性甲状腺淋巴瘤的CT表现及其病理相关性

目的探讨原发甲状腺淋巴瘤CT表现与其病理的相关性,以提高术前确诊率。方法回顾性分析13例经病理证实的B细胞来源的非霍奇金甲状腺淋巴瘤CT图像进行观察,对其病变的位置分布、形态、边缘、密度、强化及周围侵犯的情况进行统计并探讨与其病理类型的相关性。结果弥漫性大B细胞淋巴瘤表现为:双侧叶弥漫性肿大3例、单侧叶弥漫性肿大型2例、局灶结节型2例;密度均匀减低4例、不均匀减低3例;界不清6例、界清1例;7例均强化不明显或轻微强化;颈部淋巴结受累4例、累及颈部周围软组织1例。粘膜相关淋巴组织B细胞淋巴瘤表现为:甲状腺弥漫肿大1例、局灶结节3例;界清与界不清各2例;4例密度均匀、强化不明显且均未见颈部淋巴结或周围软组织受侵。粘膜相关淋巴组织B细胞淋巴瘤大细胞转化型表现为:双侧叶、单侧叶各1例均呈弥漫性肿大,界不清;密度均匀减低1例、不均匀减低1例;1例颈部淋巴结受累,2例强化均不明显,未累及周围软组织。结论甲状腺淋巴瘤的CT表现常表现为甲状腺弥漫性肿大、界清、平扫呈稍低密度、强化不明显、颈部淋巴结受累等,不同病理类型的甲状腺淋巴瘤CT表现有一定差异。     

小儿腹部Burkitt淋巴瘤结外侵犯的MSCT表现

目的：探讨儿童腹部Burkitt淋巴瘤结外侵犯的MSCT表现及其诊断价值。方法：回顾性分析本院22例经病理证实的Burkitt淋巴瘤的腹部MSCT资料,对其结外病变进行分类和影像学表现分析。结果：Burkitt淋巴瘤可侵犯腹盆腔的多个结外脏器,包括腹部实质脏器（8/22）和胃肠道（21/22）。病变多表现为轻度强化的密度均匀的实性肿物,出血、坏死少见,钙化罕见;常伴肠系膜及腹膜后多个肿大淋巴结、大网膜广泛增厚或腹腔积液,以回肠远端浸润型和胰腺多发结节型最多见。结论：Burkitt淋巴瘤常同时侵犯腹盆腔多个结外脏器,儿童Burkitt淋巴瘤腹部结外侵犯的MSCT表现有一定特征性。     

Infections and infestations of the gastrointestinal tract. Part 1: bacterial, viral and fungal infections

The purpose of this article is to review the imaging findings of various infections affecting the gastrointestinal tract. Barium examinations, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography all play an important role in the diagnostic workup of gastrointestinal tract infections. Knowledge of differential diagnosis, sites of involvement, and typical imaging features of different infections can help in accurate diagnosis and guide treatment.     

CT findings in peripheral T-cell lymphoma involving the gastrointestinal tract

PURPOSE: To evaluate whether computed tomography (CT) accurately depicted gastrointestinal tract involvement in peripheral T-cell lymphoma (PTCL). MATERIALS AND METHODS: CT scans were retrospectively reviewed in 14 patients with pathologically proved PTCLs of the gastrointestinal tract for the following considerations: sites, patterns of involvement (ie, morphologic features, bowel wall thickness or mass size, and contrast enhancement pattern), and ancillary findings at other sites (ie, lymphadenopathy, bowel perforation, and involvement of other organs). RESULTS: PTCL involved the stomach in three patients, the small intestine in eight, both the stomach and the small intestine in one, and the sigmoid colon in two; multifocal involvement was seen in three (21%) patients. CT failed to demonstrate the bowel lesions in three of 14 patients. At CT, 11 patients had gastric or bowel wall thickening (n = 10) and a polypoid mass (n = 1). In 10 patients, the gastric or bowel wall thickening was mild (<1 cm) in six, moderate (1-2 cm) in three, and severe (>2 cm) in one. Lymphadenopathy was noted in nine (64%) patients, with the nonbulky type in eight and the bulky type in one. Bowel perforation occurred in four (29%) patients. Other organs were involved in eight (57%) patients. CONCLUSION: CT can depict PTCL involving the gastrointestinal tract if it is not confined to the mucosa. There is a tendency toward preferential jejunal or duodenal involvement, as well as bowel perforation.     

CT of the gastrointestinal tract: principles and interpretation

The experience accumulated in daily abdominal CT scanning and CT evaluation of gastrointestinal lesions has generated helpful technical guidelines and some reliable principles of interpretation. These general principles are briefly discussed in this review, and the importance of performing a CT examination that is adequate for the detection and evaluation of gastrointestinal lesions is stressed. CT features useful in differentiating benign from malignant lesions, limitations and pitfalls in CT interpretation, overlap in the CT appearance, and classical CT features leading to specific diagnoses are described and illustrated. Although CT is established as one of the most important techniques for imaging the gastrointestinal tract, it should be used selectively and only in the context of appropriate clinical and conventional radiologic examination. CT should not be regarded as competing with, but as complementing, barium examination of the gastrointestinal tract.     

胃肠道平滑肌瘤和平滑肌肉瘤的CT表现

目的：探讨CT在胃肠道平滑肌瘤和平滑肌肉瘤诊断中的应用价值。方法：本文收集了12例（男8例,女4例,平均年龄56．1岁）经手术病理证实的胃肠道平滑肌瘤（5例）和平滑肌肉瘤（7例）。12例均作CT检查,其中3例作了胃镜检查,6例作了胃肠道钡餐造影检查。结果：胃是胃肠道平滑肌瘤和平滑肌肉瘤最好发部位,除直接浸润和远处转移提示为恶性外,肿瘤大、分叶状、不均匀强化及溃疡形成均提示平滑瘤可能性大。结论：CT在胃肠道平滑肌瘤和平滑肌肉瘤的诊断与鉴别诊断中优于胃镜和胃肠道钡餐造影检查。     

Abdominopelvic actinomycosis involving the gastrointestinal tract: CT features.

PURPOSE: To assess the computed tomographic (CT) features of abdominopelvic actinomycosis involving the gastrointestinal tract. MATERIALS AND METHODS: CT scans were analyzed in 18 patients with pathologically proved abdominopelvic actinomycosis involving the gastrointestinal tract. Eight patients had a history of using intrauterine contraceptive devices. Bowel site, wall thickness, length, bowel involvement patterns, inflammatory infiltration, and features of peritoneal or pelvic mass, if present, were evaluated at CT. RESULTS: Of the gastrointestinal tract, the sigmoid colon was most commonly involved (50%). All patients showed concentric (n = 15) or eccentric (n = 3) bowel wall thickening, with a mean thickness of 1.2 cm and a mean length of 8.3 cm. The thickened bowel enhanced homogeneously in nine patients and heterogeneously in the other nine. Inflammatory infiltration was mostly diffuse and severe. In 17 patients, a peritoneal or pelvic mass (mean maximum diameter, 3.2 cm) was seen adjacent to the involved bowel and appeared to be heterogeneously enhanced in most cases; infiltration into the abdominal wall was seen in four patients. CONCLUSION: Actinomycosis should be included in the differential diagnosis when CT scans show bowel wall thickening and regional pelvic or peritoneal mass with extensive infiltration, especially in patients with abdominal pain, fever, leukocytosis, or long-term use of intrauterine contraceptive devices.     

Imaging of abdominal tuberculosis

The concept of "abdominal tuberculosis" in this review refers to peritoneum and its reflections, gastrointestinal tract, abdominal lymphatic system, and solid visceral organs, as they are subject to varying degrees of involvement alone or in combination. Some features, including free or loculated ascites with thin-mobile septa, smooth peritoneal thickening and enhancement, misty mesentery with large lymph nodes, smudged omental involvement, and advanced ileocecal changes demonstrated by US, CT, or gastrointestinal series are deemed suggestive radiological findings. The diagnosis still requires a high index of suspicion, once the suggestive features have been demonstrated by imaging modalities.     

Imaging of extranodal lymphoma with PET/CT

Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL) represent a spectrum of malignant neoplasms arising from the lymphoid system with an incidence of around 8% of all malignancies. Although they are generally known as tumors of lymph nodes, 25% to 40% of HD/NHL tumors, especially NHL, arise at extranodal sites along the gastrointestinal tract, head and neck, orbit, central and peripheral nervous system, thorax, bone, skin, breast, testis, thyroid, and genitourinary tract. Extranodal involvement is an important pretreatment prognostic factor for patients with lymphoma and its incidence has increased in the past 2 decades. Imaging plays an important role in the noninvasive pretreatment assessment of patients with extranodal lymphoma. This involvement can be subtle and may be overlooked during computed tomography (CT). Positron emission tomography/CT (PET/CT) has evolved into an important imaging tool for evaluation of lymphomas, facilitating the detection of affected extranodal sites even when CT shows subtle or no obvious lesions. Familiarity with extranodal manifestations and suggestive PET/CT features in different sites is important for accurate evaluation of lymphoma. This article reviews the extranodal PET/CT imaging findings regarding HD and NHL.     

Wegener granulomatosis of the colon: CT and histologic correlation

Wegener granulomatosis is a systemic vasculitis with distinct clinical and histologic features often characterized with involvement of the upper airway, lung, and kidneys. The reported incidence of gastrointestinal involvement is relatively rare, with histologic confirmation often lacking. We report a case in which gastrointestinal involvement was the principal feature, with CT and histologic correlation.     

Bloodborne metastatic tumors to the gastrointestinal tract: CT findings with clinicopathologic correlation

OBJECTIVE: In this essay, we illustrate the CT features of bloodborne metastases to the gastrointestinal tract from various malignancies with an emphasis on clinicopathologic correlation. CONCLUSION: Familiarity with CT findings of bloodborne metastases to the gastrointestinal tract and an understanding of the disease spread pattern in common primary cancers will be helpful not only in detecting metastatic disease but also in minimizing the possibility of mistaking metastasis for another metachronous malignancy.