输卵管卵巢脓肿与卵巢良性肿瘤的CT鉴别诊断

目的:分析输卵管卵巢脓肿的CT特征,探讨CT对输卵管卵巢脓肿与卵巢附件良性肿瘤的鉴别诊断价值。材料和方法:回顾性分析13例输卵管卵巢脓肿和11例卵巢良性肿瘤的CT表现。结果:绝经前患者输卵管卵巢脓肿12例(12/13例),良性肿瘤组4例(4/11例)。脓肿13例(13/13例)、良性肿瘤9例(9/11例),CT表现为附件区囊实性肿块,脓肿和良性肿瘤边缘轮廓模糊不清分别为11例(11/13例)和4例(4/11例),两组显示囊壁增厚和边缘层状增强分别为10例(10/13例)和2例(2/11例)。脓肿的子宫骶骨韧带增厚和骶前直肠周围脂肪模糊分别为10/13例和9/11例,而良性肿瘤组无1例发生。结论:附件脓肿壁增厚和层状增强,子宫骶骨韧带增厚及骶前直肠周围脂肪模糊有助于鉴别输卵管卵巢脓肿和卵巢良性肿瘤。     

输卵管卵巢脓肿的低场MR诊断

目的探讨输卵管卵巢脓肿(tuboovarian abscess,TOA)的低场MRI表现及诊断价值。资料与方法回顾性分析经手术病理证实的26例TOA患者的MRI资料。结果 26例33个TOA,表现为附件区厚壁囊性或囊实性肿块,边界不清,囊内见多房分隔,肿块呈等长T1、长T2信号,信号欠均匀。其中24个脓肿伴积脓或积液扩张的输卵管管状结构,表现为弯曲长管状、腊肠状、糖葫芦状或曲颈瓶状。增强扫描脓肿实性及分隔部分明显强化,囊壁强化,壁厚2.5~20 mm。脓肿与子宫粘连21例,直肠乙状结肠粘连13例,骶前直肠周围脂肪水肿17例,单侧或双侧子宫骶骨韧带增厚15例,盆腔小肠、肠系膜、大网膜及盆壁结构广泛增厚粘连9例。正确诊断30个(90.9%),误诊卵巢癌1例,卵巢巧克力囊肿2例。结论 TOA具有特征性低场MRI表现。低场MRI是一种较理想的检查方法 ,具有较高的诊断价值。     

附件脓肿的CT诊断

目的 探讨附件脓肿的CT特征及其诊断价值.方法 回顾性分析26例经手术证实的附件脓肿,分析其CT影像表现.结果 26例附件脓肿中,单侧6例,双侧20例,共46个病灶,其中输卵管脓肿33个病灶,输卵管卵巢脓肿13个病灶.输卵管脓肿的CT征象为输卵管壁增厚,呈管状、囊状或多房囊状扩张,输卵管积脓.输卵管卵巢脓肿多表现为多房囊实性肿块,卵巢脓肿位于中心,外围由输卵管脓肿包绕,脓肿壁呈环形10例,团片状3例,增强扫描脓肿壁呈分层强化.盆腔结缔组织炎21例,表现为盆腔脂肪模糊、密度增高,宫骶韧带增厚,盆腔腹膜炎.输卵管卵巢脓肿与周围结构粘连,其中5例引起肠梗阻,3例引起输尿管积水.子宫内膜炎19例,腹水18例.结论 附件脓肿的CT表现具特征性,掌握其影像特征及其与周围结构的关系,对疾病的及时诊断与治疗非常重要.     

CT及MR在诊断输卵管卵巢脓肿中的作用

目的：分析输卵管卵巢脓肿（tubo-ovarian abscess,TOA）多层螺旋CT（MSCT）,MR征象,探讨影像技术对输卵管卵巢脓肿的诊断价值。方法：回顾性分析22例常规活检证实的输卵管卵巢脓肿患者的MSCT平扫及增强,其中7例行MR检查3例行增强MR扫描的影像学表现。结果：附件区厚壁多房囊性或囊实性混合肿块22例（100%）、附件区有增粗积液或积脓的输卵管管状结构影或腊肠样输卵管征象13例（59%）,子宫直肠脂肪间隙消失、脂肪密度增高、骶骨子宫韧带增厚、盆腔积液17例（77%）,CT及MRI增强扫描病灶囊液均未见强化效应,囊壁呈分层强化,并见水肿带,分隔均匀强化。结论：CT及MR检查在输卵管卵巢脓肿的诊断及病情评估中起了非常重要的作用。     

输卵管卵巢脓肿影像学表现及误诊分析

目的：总结输卵管卵巢脓肿的影像学表现,探讨该病影像学诊断价值并分析误诊原因。方法回顾性分析13例术后病理确诊或临床确诊输卵管卵巢脓肿影像学资料,4例行 CT 平扫,9例行 MRI 平扫及增强(其中5例同时行超声检查),并与病理结果对照。结果10例表现为附件区腊肠样病变(其中1例超声误诊为肠梗阻),CT 平扫呈均匀低密度影,MRI 平扫呈长/短 T1长T2信号、部分可见液-液平面形成,增强扫描脓肿壁轻度增厚并明显均匀强化,所有患者表现不同程度腹腔、盆腔积液及周围筋膜增厚;3例表现为单侧附件区厚壁多房囊实性包块(其中2例术前误诊为卵巢肿瘤性病变),增强扫描表现为厚壁及分隔明显强化。结论CT 及 MRI 对腊肠样表现的输卵管卵巢脓肿诊断的特异性及敏感性较高,多能做出定性诊断,对囊实性病灶能清楚显示,但定性诊断困难,误诊率较高。     

31例输卵管炎症的CT分析

目的 :分析输卵管炎症的CT影像表现,探讨CT对输卵管炎症的诊断价值。方法 :回顾性分析31例经手术证实的输卵管炎症患者的盆腔CT增强扫描资料。结果:31例共41个病灶均显示附件区囊性或囊实性肿块,肿块外缘多模糊,增强扫描见囊壁、分隔及实质成分呈明显持续强化,多可见腊肠样、串珠样、C形改变及不全分隔等特征性征象。其他伴随征像有周围组织粘连、子宫骶骨韧带增厚、盆腔脂肪密度增高模糊。血管迂曲扩张及盆腔积液。结论:CT检查能较好地显示输卵管炎症引起的形态结构改变并可观察盆腔器官组织的受累及粘连情况,可对输卵管炎症做出准确诊断,对附件区包块的鉴别诊断有重要价值。     

多层螺旋CT对输卵管卵巢脓肿及输卵管积水的诊断价值

目的探讨输卵管卵巢脓肿及输卵管积水的多层螺旋CT表现,为提高临床医师对该类疾病的认识提供依据。资料与方法回顾性分析经手术病理证实的19例输卵管卵巢脓肿及17例输卵管积水患者的多层螺旋CT特征。结果 36例患者共53侧输卵管病变,CT多平面重组可以很好地显示附件区肿块,管状型39侧,多囊型7侧,单囊型7侧,腔内不全分隔及肿块边缘呈"3"字形切迹为其特征性征象。输卵管卵巢脓肿肿块壁常增厚[(4.5±1.7)mm],增强后明显强化,并可见分层;继发征象包括脓肿周围脂肪密度增高及条索影、与子宫体分界不清,7例子宫圆韧带受压前移,11例骶子宫韧带增厚,5例累及直肠系膜,8例邻近乙状结肠、小肠壁受累增厚,13例子宫直肠陷凹积水。输卵管积水肿块壁薄[(1.4±0.2)mm],增强后强化不明显,1例合并输尿管扩张。结论输卵管卵巢脓肿及输卵管积水具有特征性的CT表现,多层螺旋CT是输卵管卵巢脓肿及输卵管积水较好的检查方法。     

关于输卵管卵巢脓肿CT诊断特点的探讨研究

目的:总结分析输卵管卵巢脓肿(TOA)的CT表现,着重探讨和剖析其CT特点,以寻求诊断和鉴别诊断的依据。方法:收集12例CT检查后经手术病理或临床证实的TOA。综合临床及手术所见仔细分析CT图像中脓肿本身及继发改变。结果:CT均表现为附件区囊性或囊实性肿块及周围明显渗出水肿,4例呈管状、"腊肠形"或"葫芦状"囊状影,5例囊壁呈分层强化并可见水肿带,全部脓肿与盆腔结构广泛紧密粘连,部分侵及邻近组织器官,1例并结肠低位梗阻,1例合并急性化脓性阑尾炎。CT确诊9例,3例误诊为卵巢癌。结论:附件区"腊肠样形囊性影"、"囊壁明显环状强化并见水肿分层"等为TOA较具特征性的CT表现。综合临床资料及其CT特点能够正确诊断本病,同时对诊断不清的可疑妇科感染有鉴别价值。     

卵巢肿瘤蒂扭转的CT诊断价值探讨(附12例报告)

目的:评价CT对卵巢肿瘤蒂扭转的诊断,探讨囊壁局限性增厚对卵巢肿瘤蒂扭转的诊断价值。方法:对12例卵巢肿瘤蒂扭转的CT征象作回顾性分析,对卵巢肿瘤蒂扭转囊壁局限性增厚CT表现与文献报道的B超特征性表现双肿块声像图作对照分析。结果:本组12例病例中11例为卵巢囊性或者囊实性肿瘤,其中6例有局限性囊壁增厚,除此之外卵巢肿瘤蒂扭转还有其它许多CT征象,如卵巢肿瘤囊肿壁及囊肿内出血,附件输卵管增粗、显示,盆腔内积液,子宫位置偏位。结论:只要我们能密切结合临床,CT能对大多数卵巢肿瘤蒂扭转作出正确诊断。     

输卵管卵巢脓肿的CT、MR表现与病理对照分析

目的 探讨输卵管卵巢脓肿的CT、MR影像表现,以提高对该病的影像诊断水平.方法 回顾性分析32例经手术、病理确诊的输卵管卵巢脓肿的CT、MRI表现,29例行CT平扫,其中21例行增强扫描,22例行MRI检查,其中10例先行平扫后增强,并与病理结果相对照,重点观察病变的位置、形态、边缘、密度/信号特点及强化特征.结果 32例主要表现为位于附件区囊性或囊实性包块,形态各异,病变呈腊肠样改变10例,多房状、蜂窝状改变13例,串珠状改变9例;CT平扫为水样密度,MR表现为T1WI呈等或低信号,T2 WI呈高信号,DWI呈高信号,增强后囊壁呈厚壁强化,囊内见不全分隔影,分隔均匀强化.囊内出现液-液分层8例.病变周围模糊,可见炎性渗出、粘连及盆腔积液等征象.病理:输卵管迂曲、扩张,并与周围组织粘连,管壁充血、水肿,内见炎性细胞浸润;卵巢肿胀,间质内见大量炎性细胞浸润.结论 CT、MR可以较为精确的显示输卵管卵巢脓肿的形态、边界、范围及与邻近组织的关系,对该病的诊断及鉴别诊断具有重要价值.     

Adnexal masses: MR imaging observations at 1.5 T, with US and CT correlation

To assess the role of 1.5-T magnetic resonance (MR) imaging in evaluation of the adnexa, 43 consecutive examinations that revealed 61 adnexal masses were retrospectively reviewed. T1- and T2-weighted images in coronal, axial, and/or sagittal planes were included. Available ultrasound (US) (n = 30) and/or computed tomographic (CT) (n = 9) scans were then correlated with the MR images. On T2-weighted images at least part of all adnexal masses was of higher signal intensity than surrounding muscle and adipose tissue, and therefore the adnexal masses were best seen with these sequences. T1-weighted imaging improved tissue characterization by revealing signal characteristics of fat in teratomas and characteristics of blood in endometriomas or hemorrhagic cysts, pelvic inflammatory disease, ovarian carcinomas, serous cystadenomas, and teratomas. MR imaging provided additional information or increased diagnostic confidence in 25 of 30 patients who underwent US or CT. MR imaging is a promising problem-solving modality after US in the study of adnexal abnormalities.     

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.     

Actinomycosis: CT findings in six patients

Actinomycosis is an uncommon disease with clinical and radiographic findings that overlap those of other inflammatory and neoplastic conditions. A retrospective review of CT scans in six proved cases revealed a spectrum of findings, including soft-tissue mass with various degrees of infiltration and abscess formation. Administration of IV contrast material was helpful in defining the loculations of the abscess in two cases. Areas of involvement included the neck (two cases), liver (one case), abdominal wall (one case), thorax (one case) and kidney and retroperitoneum (one case). CT findings of a soft-tissue mass in the neck, lungs, or abdomen, with or without a draining sinus or fistula, raise the possibility of actinomycosis in patients with clinical findings that suggest a subacute or chronic inflammatory process.     

Adnexal masses in female pediatric patients

OBJECTIVE: This article reviews the range of adnexal masses that present in pediatric females. The preferred imaging modalities, the appearance of the normal ovaries, and the epidemiology of ovarian diseases and abnormalities are discussed. The illustrated abnormalities include simple and complex ovarian and paraovarian cysts, neoplasms, ovarian torsion, ectopic pregnancy, and tuboovarian abscess, with attention to the imaging features and vascular flow patterns that help distinguish surgical from nonsurgical cases, malignant from benign lesions, and ovarian abnormalities from mimickers. CONCLUSION: The critical clinical questions to the radiologist in the setting of adnexal lesions are the site of origin, benign versus malignant features, and presence of infection or abscess. Pairing clinical presentation and imaging findings will direct appropriate management, whether it is reassurance, follow-up imaging, or surgery.     

Magnetic resonance imaging in the evaluation of abscesses

Ten patients with percutaneous biopsy or surgically proven abscesses were evaluated with magnetic resonance imaging (MRI) to describe the appearance of abscesses, define the capability of MRI to localize abscesses, and compare the capabilities of MRI and CT for the diagnosis and determination of the extent of an abscess. Comparative CT scans were available in six cases. The most common MRI finding was an abnormal area of low signal intensity, either homogeneous or heterogeneous, on the short repetition rate (500 msec TR) images with a relative increase in signal intensity on the longer repetition rate (1500 or 2000 msec TR) images. MRI demonstrated a more clear delineation of the extent of inflammatory changes than did CT, and MRI demonstrated the abscess as a collection distinct from surrounding structures on at least one repetition rate. Intravenous contrast medium was unnecessary with MRI to evaluate vasculature or to define the capsule around an abscess. With CT, unless an abscess contained air or was of low attenuation, it often blended with the surrounding structures and was difficult to differentiate from them. Surgical clips in the postoperative patient with an abscess did not degrade the MR images as often occurred with CT. This study describes the MRI appearance of abscess and indicates a potential value of the use of MRI to evaluate abscess outside the central nervous system and spine.     

Neck infection associated with pyriform sinus fistula: imaging findings

BACKGROUND AND PURPOSE: Acute suppurative neck infections associated with branchial fistulas are frequently recurrent. In this study, we describe the imaging findings of acute suppurative infection of the neck caused by a third or fourth branchial fistula (pyriform sinus fistula). METHODS: Imaging findings were reviewed in 17 patients (11 female and six male patients, 2 to 49 years old) with neck infection associated with pyriform sinus fistula. Surgery or laryngoscopic examination confirmed the diagnoses. Fourteen patients had a history of recurrent neck infection and seven had cutaneous openings on the anterior portion of the neck (all lesions were on the left side). Imaging studies included barium esophagography (n = 16), CT (n = 14), MR imaging (n = 2), and sonography (n = 3). RESULTS: A sinus or fistulous tract was identified in eight of 16 patients on barium esophagograms. In 14 patients, CT studies showed the inflammatory infiltration and/or abscess formation along the course of the sinus or fistulous tract from the pyriform fossa to the thyroid gland. In nine patients, CT scans showed the entire course or a part of the sinus or fistulous tract as a tiny spot containing air. MR images showed a sinus or fistulous tract in two patients, whereas sonograms could not depict a sinus or fistulous tract in three patients. All 17 patients were treated with antibiotics. In one patient, the sinus tract was surgically excised, while 15 patients underwent chemocauterization of the sinus or fistulous tract with good outcome. Follow-up was possible for 16 of the 17 patients. CONCLUSION: When an inflammatory infiltration or abscess is present between the pyriform fossa and the thyroid bed in the lower left part of the neck, an infected third or fourth branchial fistula should be strongly suspected.     

Psoas muscle disorders: MR imaging

Nineteen patients with evidence of psoas and iliopsoas abnormalities on computed tomographic (CT) scans (12 with metastases, three with lymphoma, two with hematoma, and two with abscess) were examined with magnetic resonance (MR) imaging. The abnormal psoas could be identified on both T1- and T2-weighted spin-echo images, although T2-weighted sequences provided better contrast. The psoas muscle can be affected by one of three mechanisms: total replacement, lateral displacement, or medial displacement. In four patients in whom the CT study showed apparent enlargement of a psoas muscle, subsequent MR imaging examinations demonstrated that the psoas muscle was compressed and displaced laterally by a paraspinal mass. MR images provided better contrast between the normal and abnormal psoas than CT scans in nine cases; MR images were inferior to CT scans in two cases because calcifications (one case) and air bubbles within an abscess (one case) were not detectable.     

Adnexal and cul-de-sac abnormalities: transvaginal sonography

Sixty-seven patients selectively chosen from 354 undergoing conventional transabdominal (TA) sonography for evaluation of a clinically suspected adnexal mass subsequently underwent transvaginal (TV) sonography either because the TA sonograms were technically suboptimal or because it was not possible to characterize with certainty an abnormality identified with TA sonography. TV sonography added diagnostically useful information in 25 of 28 patients with cystic pathologic changes in the adnexa uteri. Eight of 12 patients with tuboovarian abscess and nonspecific adnexal masses visualized with TA sonography had tube-shaped fluid collections characteristic of pyosalpinx identified with TV sonography. TV sonography added diagnostically useful information in all seven patients with diseases of the cul-de-sac (rectouterine fossa) and allowed differentiation of adnexal from primary uterine disease in three patients with TA sonograms on which findings were equivocal. It also expedited the diagnosis of a tubal pregnancy in ten of 14 patients and was useful in the detection of adhesions and perforated intrauterine devices. These results indicate that adjunctive TV sonography can provide important diagnostic information.