肝脂肪浸润的CT及US表现

作者报道了经病理证实的肝脂肪浸润(FIL)US、CT常见及罕见表现,并且把FIL不同表现归纳为均匀弥漫性浸润、地图样表现、灶性脂肪浸润、局部圆块形脂肪浸润及类似转移瘤的脂肪浸润等五种表现。弥漫性FIL的US分类标准是,轻度表现为肝实质弥漫性强回声,纤维隔及肝内血管缘显影正常;中度表现为弥漫性强回声伴有肝内血管及     

280例脂肪肝CT及B超诊断对比分析

我们收集了 2 80例经ＣＴ、Ｂ超检查诊为脂肪肝的患者 ,对其检查手段及诊断符合率进行了分析 ,旨在阐明ＣＴ、Ｂ超诊断脂肪肝的准确性及特异性 ,为脂肪肝的临床诊断和治疗提供可靠依据。1　资料和方法我院 1994年 1月～ 1999年 12月经ＣＴ、Ｂ超检查诊为脂肪肝的患者共 2 80例 ,其中男性 188例 ,女性 92例 ,年龄 2 1～6 9岁 ,平均 42 6岁。ＣＴ采用美国ＧＥ公司生产的Ｍａｘ 6 40全身ＣＴ ,取肝、脾同一层面 ,分别测量肝、脾ＣＴ值 ,并进行对比 ,以肝脏ＣＴ值低于脾脏ＣＴ值的多少为标准分为轻型、中型、重型及极重型 ,重型和极重型多伴有…     

腹腔播散性平滑肌肉瘤2例报告

腹腔平滑肌肉瘤不少见 ,然而广泛腹腔播散者不多 ,本文报告 2例。例 1 患者男 ,37岁。主诉左中腹间断性疼痛 5个月 ,Ｂ超、ＣＴ检查发现鸡卵大包块 ,肝脏多发性球形病灶 ,肝穿及肿物穿刺查到恶性肿瘤细胞入院。入院后检查 :腹部平坦 ,未见肠型及蠕动波 ,左中下腹压痛 (+) ,并触及一伴轻微触痛 ,质地较硬 ,可推动的拳头大肿物。Ｂ超示左中腹探及 8.0ｃｍ× 5 .0ｃｍ不规则低回声光团 ,边界清楚 ,内部回声不均匀 ,血运丰富 ,肝内多个圆形包块 ,部分包块中心有液性暗区 ,呈“牛眼症”。ＣＴ示肝内多个大小不等圆形低密度区 ,有的中心密度减低。…     

肝脏多发性炎性假瘤影像学误诊一例

患者男,３２岁。平时无明显不适,在体检中Ｂ超发现右肝有一枚直径２ｃｍ大小的低回声实质性团块,边界不清,Ｂ超诊断为右肝血管瘤。ＣＴ扫描：肝右叶后段见一枚直径２ｃｍ大小的边缘不规则的低密度肿块,平扫ＣＴ值３９ＨＵ,增强后扫描,该肿块大小、形态、密度无变化...     

腹腔内纱布团的影像表现

目的：探讨腹腔内纱布团的各种影像表现特征及其病理基础。材料和方法：２例患者经Ｂ超、ＣＴ及ＭＲＩ检查并经手术证实；进行了纱布团的水槽试验及１例动物试验。结果：纱布团在超声检查时表现为呈弧形强回声带后伴宽阔干净声影的肿块，在ＣＴ与ＭＲＩ平扫时表现为软组织密度与信号的肿块；位于腹腔内的纱布团当其周围有纤维结缔组织包膜形成后，超声检查尤其是高频探头探查于纱布团弧形强回声带外侧还可见薄层低回声带与其外侧的强回声带。ＣＴ及ＭＲＩ增强扫描可见包膜增强而纱布团内部无增强。结论：腹腔内遗留的纱布团在超声、ＣＴ和ＭＲＩ检查中都有一定的特征性表现，超声结合ＣＴ或ＭＲＩ的平扫及增强扫描可做出明确的诊断。     

肌肉内血管瘤的影像学分析(附11例报告)

目的：探讨肌肉内血管瘤影像学表现与诊断的价值。方法：回顾性总结１１例经手术和病理证实肌肉内血管瘤的Ｂ超、ＣＴ和ＭＲＩ表现。结果：７例Ｂ超检查见肌肉内软组织肿块,２例呈均匀低回声灶,３例呈网状低回声灶,２例呈混合性回声灶;形态规则、边界清楚４例;形态不规则、边界不清楚３例。７例ＣＧ检查见肌肉内肿块影。３例呈等密度,４例呈混合密度,２例可见斑点状钙化;边界清晰者３例,不清晰者４例;增强扫描肿块见明显强     

多发性巨大阿米巴肝脓肿的介入超声诊断及治疗一例

图１Ｂ超检查：肝右叶２个低回声块，直径分别为７．７ｃｍ及６．０ｃｍ，边界清楚，内部回声不均匀，错诊为“多发实性占位，转移瘤”图２ＣＴ扫描：肝内有２个直径７．５ｃｍ及６．０ｃｍ类圆形低密度区，密度不均，内有混浊状高密度影，ＣＴ值２０～８０ＨＵ，增强扫描...     

小肾癌的CT诊断(附11例报告)

目的：评价ＣＴ扫描在小肾癌诊断中的应用价值。方法：回顾性分析１１例经手术病理证实为小肾癌（直径＜ ３．０ ｃｍ ）的Ｂ超和ＣＴ资料。结果：１１ 例小肾癌病人中Ｂ超诊断肾囊肿２例、肾良性肿瘤１ 例、肾实性占位８例;ＣＴ诊断畸胎瘤１例、肾脏恶性肿瘤１０例。ＣＴ表现：①ＣＴ平扫为软组织密度结节、无钙化及脂肪组织１０例;②增强扫描显著强化１０例（△ＣＴ值＞ ４０ ＨＵ）;③肿瘤—肾实质界面模糊不清６例、清晰而不锐利４例。结论：ＣＴ检出小肾癌优于Ｂ超,根据小病灶的密度、边缘及强化程度等特征性ＣＴ表现术前能诊断为小肾癌。     

肝血管瘤CT影像与B超对照

目的 评价ＣＴ与Ｂ超对照诊断血管瘤的价值。材料和方法 ５０便肝血管瘤病人经ＣＴ、Ｂ超对比检查。结果 本组５０例肝血管瘤病人Ｂ超检出率为１００％，ＣＴ与Ｂ超诊断完全符合３６例，Ｂ超发现病灶不能定性８例，Ｂ超发现１ｃｍ以下病灶而ＣＴ未能检出４例，ＣＴ不能定性２例。结论 Ｂ超以肝血管瘤病灶检出率估于ＣＴ，ＣＴ常规应用“两快一慢”增强扫描描述，依据ＣＴ诊断血管 三条标准，在病灶定性方面优于Ｂ超。二     

肝海绵状血管瘤经动脉栓塞治疗

目的 探讨经动脉栓塞治疗肿海绵状血管瘤的机理、临床疗效及并发症的防治。方法 １２例以Ｂ超、ＣＴＣＴ或ＭＲＩ及血管诮证实的肝海绵状血管，作超造反性肝动脉插管栓塞。栓塞剂为超液态碘渍、明胶海绵及弹簧圈。结果 栓塞术后病人癍状改善，所有病灶均有不同程度的缩小，其中９例缩小５０％以上，１例４年后Ｂ超检查瘤体消失。结论 经动脉栓塞治疗肝海绵状血管是一种有效方法，在碘油和明胶海绵栓塞基础上，再用弹簧圈栓寨，可     

肝门区胆管癌的CT表现与病理对照（附15例分析）

目的：探讨肝门区胆管癌的CT影像表现与诊断价值。方法：搜集15例经手术和病理证实的肝门区胆管癌,分析肝门区胆管癌CT影像特征和病理基础。结果：6例CT平扫表现为肝门区低密度软组织肿块,9例表现为肝门区胆管壁不规则增厚,动态增强后11例有延迟强化,CT值增加15～30HU。对照CT表现与手术所见,CT显示肝脏、肝门区动脉、门静脉、胆囊、肝门区淋巴结转移、腹膜后淋巴结浸润或转移;其它神经、脂肪受浸、腹膜种植在CT上均无明确显示。结论：肝门区胆管壁不规则增厚或软组织肿块伴肝内胆管扩张是肝门区胆管癌的CT基本影像表现,CT是检出和识别肝门区胆管癌的重要方法,但在判断肿瘤周围浸润的程度时仍有一定局限性。     

Hepatic vein Doppler waveform in patients with diffuse fatty infiltration of the liver

OBJECTIVE: To determine the incidence of abnormal hepatic vein Doppler waveform in patients with diffuse fatty infiltration of the liver (FIL). MATERIALS AND METHODS: In this prospective study, 40 patients with diffuse FIL and 50 normal healthy adults who served as control group underwent hepatic vein (HV) Doppler ultrasonography. The patients with the diagnosis of FIL were 23 men (57.5%) and 17 women aged 30-62 years (mean age +/- S.D., 42 +/- 12 years). Subjects in the control group were 27 men (54%) and 23 women aged 34-65 years (mean age +/- S.D., 45 +/- 14 years). The diagnosis of FIL was confirmed with computed tomography density measurements. The waveforms of HV were classified into three groups: regular triphasic waveform, biphasic waveform without a reverse flow, and monophasic or flat waveform. Etiological factors for FIL were diabetes mellitus (DM), hyperlipidemia and obesity (body mass index > 25). Serum lipid profile was obtained from all the patients with FIL. RESULTS: Seventeen of the 40 patients (43%) with FIL had an abnormal HV Doppler waveform, whereas only one of the 50 (2%) healthy subjects had an abnormal waveform. The difference in the distribution of normal Doppler waveform pattern between the patients and the control group was significant (P < 0.001). No differences were found in the behaviour of the hepatic vein Doppler waveform in relation to the different etiologic factors for FIL (P > 0.05). There was not any correlation between the degree of fat infiltration and the hepatic vein waveform pattern (P = 0.60). CONCLUSION: Patients with fatty liver has a high rate of an abnormal hepatic vein Doppler waveform pattern which can be biphasic or monophasic. We could not find a relation between the etiological factors for FIL and the occurrence of an abnormal HV Doppler waveform.     

原发性肝脏恶性纤维组织细胞瘤的CT诊断及鉴别

目的：探讨原发性肝脏恶性纤维组织细胞瘤的CT诊断及鉴别诊断。方法：回顾性分析5例经手术或活检病理证实的原发性肝脏恶性纤维组织细胞瘤的CT表现。结果：3例肿瘤位于肝右叶,2例位于肝左叶,4例肿瘤边界清楚,1例与周围肝实质分界不清。CT平扫5例肿瘤均表现为不均匀低密度,增强扫描肿瘤强化方式多样,5例肿瘤中,3例车辐状多形性型肝MFH增强扫描动脉期肿瘤实性成分轻中度不均匀强化,另外2例炎症型肝MFH动脉期明显强化,门脉期进一步强化,延迟扫描5例肿瘤均呈低密度,但肿瘤内部实性成分显示更为清晰。5例肿瘤中有4例可见粗大的供血动脉进入肿块内部。结论：肝脏恶性纤维组织细胞瘤CT表现多样,掌握不同病理类型肝MFH的CT表现,可提高其诊断的准确性。     

Computed tomographic and ultrasound appearances of focal spared areas in fatty infiltration of the liver

Computed tomography (CT) and ultrasound (US) appearances of diffuse and focal fatty infiltration of the liver (FIL) are well recognized. We have recently seen 10 cases with "fat spared" areas in FIL presenting as pseudo tumours of the liver. Characteristic appearances of fat free areas in FIL which help differentiate these areas from other focal liver lesions include (i) location in the medial segment of the left lobe of the liver, (ii) absence of mass effect on surrounding vessels and liver tissue, and (iii) presence of typical changes of FIL elsewhere in the liver on CT or US examination.     

CT在脂肪肝定量诊断中的应用

目的：探讨CT定量诊断脂肪肝的临床价值。方法：对128例临床明确诊断的非酒精性脂肪肝病例作肝脏CT平扫,测量肝脏、脾脏CT值,用CT阈值和肝内血管相对密度及肝／脾CT值比值分别进行定量分析。结果：88例轻度脂肪肝肝脏平均CT值47HU（36-56HU）;80例表现为肝血管湮没,5例表现为肝血管反转显示。29例中度脂肪肝肝脏平均CT值31HU（27～38HU）;26例表现为肝血管反转显示,3例表现为肝血管湮没。11例重度脂肪肝肝脏平均CT值16HU（-30～25HU）;均表现为肝血管明显反转显示。用CT值阈值定量诊断的正确率是62．7％;用肝血管相对密度指标定量诊断正确率为93．8％,用肝／脾CT值比值诊断脂肪率为97．7％前者与后两者间差异有显著性意义（Х^2=7．133,P〈0．01）。结论：用CT值阈值进行定量诊断的准确性较差,肝内血管相对密度法和肝脾CT值比值法结合应用在脂肪肝的定量诊断中具有较高的价值。     

Staging of advanced ovarian cancer: comparison of imaging modalities--report from the Radiological Diagnostic Oncology Group

PURPOSE: To compare ultrasonography (US), magnetic resonance (MR) imaging, and computed tomography (CT) for diagnosing and staging advanced ovarian cancer. MATERIALS AND METHODS: US, CT, and MR imaging were performed in 280 patients. Images were read by three radiologists from each of the five hospitals. Image analysis included determination of malignancy within the peritoneum (11 sites), lymph nodes (10 sites), and hepatic parenchyma. The standard of reference was based on surgical and histopathologic findings. Statistical methods used were receiver operating characteristic (ROC) curve analysis, pairwise comparison of areas under the ROC curves (A(z)), analysis of sensitivity and specificity pairs, and assessment of agreement between the degree of suspicion and standard of reference. RESULTS: There were 118 patients with malignant tumors; 73 (62%) had stage III or IV disease. Metastases were found in the peritoneum in 70 (59%), nodes in 20 (17%), and liver in seven (6%) cases. In the peritoneum, MR imaging and CT (A(z) = 0.96 for both) were more accurate than US (A(z) = 0.86), especially in the subdiaphragmatic spaces and hepatic surfaces. MR imaging and CT were more sensitive than US (95%, 92%, and 69%, respectively) for peritoneal metastases. MR imaging was more accurate than CT for detection of lymph node metastases (A(z) = 0.76 vs 0.57, P =.04). In the liver, the A(z) values for the three modalities were 0.77-0.94. CONCLUSION: CT and MR imaging are equally accurate, and either modality can be used to stage advanced ovarian cancer.     

腹膜假性黏液瘤的影像学表现

目的探讨腹膜假性黏液瘤(PMP)的影像诊断。资料与方法经手术病理证实的PMP2例,术前均行超声、CT和MRI检查,其中1例行多层螺旋CT血管造影(MSCTA)检查。结果2例PMP超声表现为腹腔内多囊性肿块,内部回声不均;CT表现为网膜、肝脾周围、肠间多发低密度影,内部可见分隔,肝边呈“扇贝样”;1例可见病灶内点状及线状钙化,并见病灶沿胸腹腔间隙向后纵隔生长,MSCTA示肝外段门脉主干受侵变窄,MRI示病灶呈长T1、长T2改变。结论PMP在CT和MRI上病变部位和病变形态有其特殊影像学表现,术前影像学的评价有利于手术方案的制定。     

腹部急性肝脾创伤的CT诊断

目的探讨闭合性及开放性肝脾创伤的CT表现及诊断价值。材料与方法回顾性分析了48例经手术和临床证实的肝脾创伤的CT表现。结果撕裂伤肝4例,脾19例;实质内血肿肝5例,脾6例;包膜血肿肝6例,脾9例;断裂或碎裂伤3例;腹腔内积血肝周7例,脾周5例,肝肾隐窝1例,肝脾复合伤4例。结论肝脾创伤CT表现类型相似,CT能明确创伤病变的部位、性质、程度,敏感性和特异性高,为临床治疗提供重要信息,为腹部创伤最重要的检查方法之一。     

Computed tomography of benign hepatic tumors

Computed tomography (CT) was performed on five patients with focal benign liver lesions: two cases of focal nodular hyperplasia (FNH) and three cases of hepatic adenoma (HA). All five patients had low density lesions seen best on noncontrast scans. Focal nodular hyperplasia often presents as an asymptomatic, well circumscribed lesion with a central, stellate, fibrous scar. Hepatic adenoma, which is associated with the use of oral contraceptives, is a smooth bordered mass that exhibited foci of hemorrhage in two of our three cases. Both of these benign liver lesions enhance to a variable degree of following intravenous contrast medium administration. It is concluded that a specific diagnosis of FNH or HA may be suggested when appropriate CT findings are detected.     

Peripheral anatomic evaluation using 3D CT hepatic venography in donors: significance of peripheral venous visualization in living-donor liver transplantation

OBJECTIVE: The purpose of this study was to determine clinical roles for 3D CT hepatic venography in the evaluation of peripheral hepatic venous anatomy during living-donor liver transplantation. MATERIALS AND METHODS: Subjects comprised 54 donors (age range, 20-60 years) who had undergone surgery to donate a liver for transplantation. Visualization of each hepatic venous branch and total visualization using 3D CT hepatic venography were evaluated. Maximum venous branch order visualized was graded as nil, first branch, second branch, or third branch or more. The distance between the hepatic surface and the tip of each hepatic venous branch was classified as 0-5 mm, 6-10 mm, 11-15 mm, 16-20 mm, or 21-25 mm. Quality of total 3D CT hepatic venography was evaluated subjectively as poor, good, fair, or excellent. Dominance of large hepatic veins in the right lobe, peripheral branching pattern of the middle hepatic vein, and branching pattern of the vein draining segment IVb were also assessed. RESULTS: Most hepatic venous branches (96.2% [275/286]) were visualized up to at least the second-order branches, and 93.7% (268/286) of branches were within 10 mm of the hepatic surface. As for total visualization, 98% (53/54) of cases were regarded as excellent. The dominant vein in the right lobe was the right hepatic vein in 27 cases, inferior hepatic vein in 25, and middle hepatic vein in one. The branching pattern of the middle hepatic vein was type 1 in 36 cases, type 2 in nine, and type 3 in eight. Segment IVb vein branched from the middle hepatic vein in 20 patients, and from the left hepatic vein in 34. CONCLUSION: Because 3D CT hepatic venography visualizes peripheral hepatic venous branches in detail, the technique is useful for determining operative indications in living-donor liver transplantation.