肝脏囊性病变的CT和MR诊断

目的 探讨肝脏囊性占位性病变的CT和MR表现及其诊断价值.方法 收集78例肝脏囊性占位性病变的临床及影像学资料,其中炎症性囊性病变21例,肿瘤囊变病例30例,发育性囊肿27例.结果 肝脏囊性病变CT和MR检出率100%.对于炎症性囊性病变﹑肿瘤囊变和发育性囊肿,CT诊断准确率分别是76%、90%和93%,MR诊断准确率分别是83%、93%和100%.CT和MR表现:炎症性囊性病变中,肝脓肿和肝包虫囊肿表现为囊性占位,囊肿有张力,肝脓肿周围大片状低密度影或水样信号影,囊肿内可以形成气液平面.肝包虫囊肿出现大囊套小囊征象,增强检查见囊壁中度强化.肿瘤囊变中,转移瘤平扫表现为肝内多发的囊性病灶,增强检查表现为轻度或中度环形强化.原发肿瘤囊变平扫表现为囊变部分形态不规则,壁厚薄不均,增强检查具有原发肿瘤强化特点.发育性囊肿表现为单发或多发大小不等的低密度或水样信号囊性病灶,一般不强化.结论 CT和MR检查对肝脏囊性病变的定位和定性诊断具有很大价值.     

CT在脾脏占位性病变诊断及鉴别诊断中的价值

目的探讨CT在脾脏占位性病变鉴别诊断中的价值。方法回顾性分析27例经手术病理证实的脾脏占位性病变的CT及病理学资料,分析脾脏占位性病变的CT特征。结果 27例脾脏占位性病变,其中良性占位16例,包括脾囊肿7例,脾脓肿3例,脾血管瘤4例,脾血管淋巴管瘤1例,脾淋巴管瘤1例;恶性占位11例,包括转移瘤8例,淋巴瘤3例。结论 CT对脾脏占位性病变有较高的诊断价值,可作为首选的影像学检查方法。     

不典型肾实质内占位的高场强MRI与螺旋CT诊断价值分析

目的：评价高场强MRI与螺旋CT平扫与动态增强检查对不典型肾实质内占位的诊断价值。方法：37例肾实质内实性占位病变，包括肾癌21例，少脂肪血管平滑肌脂肪瘤6例，复杂良性囊性病变7例，肾嗜酸性细胞瘤1例，肾蔓状血管瘤伴出血1例，多房囊性肾瘤1例，均经1．5TMRI及螺旋CT平扫及多期动态增强检查，CT与MRI检查时间间隔2天至2月。所有病例均经手术病理证实。结果：高场强MRI检查对肾实质内不典型占位的诊断准确度为78．4％。高于螺旋CT检查的准确度(64．9％)。两者有显著差异性，P=0．025。MRI与CT检查相结合诊断准确度为89．2％，明显高于MRI及CT检查(P=0．003、0．001)。结论：MRI与螺旋CT检查相结合能明显提高不典型肾实质内占位的诊断准确度。     

脾脏占位性病变的CT诊断

目的：探讨脾脏占位性病变的CT诊断及鉴别诊断。方法：搜集并分析21例经病理和临床证实的脾脏占位性病变的CT资料，包括血管瘤3例、淋巴管瘤1例、神经纤维瘤1例、脾囊肿2例、脾脓肿3例、脾结核2例、恶性淋巴瘤4例、血管内皮肉瘤1例，转移瘤4例。结果：CT检查能清楚地显示脾脏占位性病变的大小、形态、密度以及周围组织及脏器的情况。CT对脾脏占位性病变的检出率为100％，定性诊断准确率为67％。结论：CT对脾脏占位性病变有较高的诊断价值，可作为首选的影像学检查方法。     

脾脏淋巴管瘤的CT表现

目的:探讨脾脏淋巴管瘤(splenic lymphangioma,SLA)的临床及CT表现特点。方法:回顾性分析经手术病理证实的11例SLA患者资料,其中9例行上腹部CT平扫及增强扫描,2例直接行上腹部CT增强扫描。观察临床特征及CT表现,并总结其影像学特点。结果:6例患者表现为脾大,其中2例有贫血、牙龈出血等脾功能亢进症状;2例表现为脾内多发病灶,9例表现为脾内单发病灶;11例均未见钙化及包膜。CT平扫均表现为脾内囊性低密度影,其中6例为单囊性病变,5例为多囊性病变;增强扫描动脉期及门静脉期病灶囊壁及分隔轻中度强化,延迟期3例病灶呈轻度强化,其中1例病灶延迟期囊内容物出现强化。结论:SLA在CT平扫上表现为囊性密度影,增强扫描有不同程度强化,并具有延迟强化的特点。     

脾脏炎性假瘤的CT诊断（附8例报告及文献复习）

目的：探讨脾脏炎性假瘤的CT表现及其诊断价值。方法：回顾性分析8例经手术和病理证实的脾脏炎性假瘤的临床和CT资料,并结合文献探讨其CT表现。结果：8例患者共9个病灶中CT平扫均表现为低密度灶,其中7个病灶边界清楚,2个病灶边缘稍模糊,较大的病灶其内密度不均匀;增强扫描动脉期2个病灶无明显强化,7个病灶仅有轻度强化,门脉期及延迟扫描8个病灶呈渐进性持续强化,较小的病灶甚至可呈等密度。结论：脾脏炎性假瘤在CT动态增强扫描时具有持续性、渐进性强化和延迟强化的特征性表现,螺旋CT对脾脏炎性假瘤的诊断和鉴别诊断具有重要价值。     

脾脏多发占位性病变的CT、MRI表现

目的探讨脾脏多发占位性病变的CT、MRI表现。方法回顾性分析17例经手术病理证实的脾脏多发占位性病变患者的临床及影像学资料。结果 17例脾脏多发性占位性病变中脾戈谢病1例,间皮囊肿1例,隐球菌病1例,脾结核5例,淋巴瘤4例,脾脉管瘤5例。14例行CT检查,1例行MRI检查,2例行CT、MRI检查。CT和MRI可以很好的显示病灶大小、形态、密度/信号、强化特点,脾脏不同多发占位病变各有一定的CT及MRI特点。结论 CT、MRI是脾脏多发占位性病变的重要检查手段,MRI对某些脾脏病变的诊断及鉴别诊断价值优于CT,可作为首选检查方法之一。     

胰尾和脾门区域占位病灶CT诊断及鉴别诊断

目的:分析14例胰尾、脾门区域占位病灶CT表现,提高对胰尾、脾门区病变的诊断能力.方法:对14例病例行CT平扫增强,并行多平面重建(MPR)后结合临床病理做探讨分析.结果:14例胰尾、脾门区占位病灶包括胰尾神经内分泌癌、副神经节瘤、胰尾实性假乳头瘤各1例,胰腺囊腺癌2例,胰腺炎假囊肿2例,脾原发淋巴瘤3例,胃恶性间质瘤...     

儿童腹部脏器外囊性占位的CT影像分析

目的探讨儿童腹部脏器外囊性占位病变的CT表现特点。方法回顾性分析经临床手术病理证实的13例儿童腹部脏器外囊性病变的CT表现。9例行平扫与增强检查,4例行平扫检查。结果肠源性囊肿3例、肠系膜淋巴管瘤2例、大网膜囊肿3例、囊性畸胎瘤3例、腹腔脓肿2例。并发系膜扭转1例、网膜扭转2例、囊肿出血2例、肠穿孔和右侧胸腔疝各1例。结论儿童腹部脏器外囊性病变主要为良性病变,不同类型囊性病变,各具有一定的CT特征。但对于少见类型囊性病变,术前定性诊断仍有一定的困难。     

肾占位性病变的CT鉴别诊断

目的：分析肾占位性病变的CT表现，探讨CT对该类疾病的鉴别诊断价值。方法：对手术／病例证实的28例肾占位性病变进行回顾性分析，所有病例均行平扫和增强扫描。结果：肾恶性肿瘤21例(75％)，其中肾癌(RCC)16例，CT表现为肾实质内形态不规则的低密度软组织肿块，增强后不强化或轻度强化；肾盂癌2例，CT表现为肾盂内软组织肿块影，增强后不强化或轻度强化。肾母细胞瘤(Wilms瘤)3例，CT表现为较大不规则的分叶肿块，增强后不强化；肾良性肿瘤3例(11％)，均为肾血管平滑肌脂肪瘤(ALL)，2两例CT表现为多种不同成分的混杂密度肿块，1例表现为均匀等密度肿块，增强后软组织部分强化，而脂肪成分不强化。其它4例(14％)，3例肾囊肿，CT表现为典型的边界清楚的囊性病灶，增强后未见强化：1例肾脓肿，CT表现为实质性与囊性混杂密度的肿块，增强后实质性部分有轻度强化，囊性部分不强化。结论：CT平扫及增强扫描，以及诊断过程中密切结合病史，对肾占位性病变有重要的鉴别诊断价值。     

脾脏病变的CT诊断(附33例分析)

目的探讨CT检查对脾脏病变的诊断价值。方法回顾性分析经手术病理或穿刺活检证实33例脾脏病变的CT表现。33例均行CT平扫,28例行双期CT增强扫描,6例做了延迟扫描。结果33例中,非肿瘤性病变6例(结核2例,血肿3例,炎性假瘤伴局灶性血管瘤1例),良性肿瘤13例(囊肿5例,血管瘤4例,淋巴管瘤1例,脉管瘤3例),恶性肿瘤14例(淋巴瘤8例,转移瘤4例,恶性肌纤维母细胞瘤1例,血管内皮肉瘤1例)。结论CT对脾脏病变有较高的诊断价值。     

脾脏淋巴瘤的CT诊断价值

目的:探讨脾脏淋巴瘤的CT特征性表现,提高影像学诊断水平.方法:回顾性分析了经病理学证实的19例脾脏淋巴瘤的CT形态学的表现和强化方式.结果:19例患者脾脏体积测量为415.32～4196.15cm3,平均(1615±709.7) cm3.脾脏肿大17例(17/19,89.5％).肿块型病灶直径＞3cm2例(2/19,10.5％);结节型病灶直径＜3cm单发性4例(4/19,21.1％),多发性11例(11/19,57.9％);弥漫型病灶直径＜5mm 2例(2/19,10.5％).CT平扫时病灶中心区CT值约为(40.43±9.44) HU;增强后动脉期病灶中心区CT值约为(51.46±13.42) HU,静脉期病灶中心区CT值约为(66.36±21.71) HU,CT平扫时病灶中心区与增强后的动、静脉期病灶密度差异有统计学意义(P＜0.001).结论:CT能很好地显示脾脏淋巴瘤的病灶形态学改变和CT强化特点,可明显提高脾脏淋巴瘤诊断的准确性.     

CT在肝脏炎性假瘤诊断中的价值

目的：探讨ＣＴ在肝脏炎性假瘤诊断中的价值。方法：１６例经手术或病理证实的肝脏炎性假瘤均作平扫及增强扫描,１０例采用动态增强扫描,６例为螺旋ＣＴ多期扫描。结果：ＣＴ平扫表现均为低密度灶,边界不清,增强动脉期扫描病灶无强化,门脉期和延迟期扫描１３ 例可见到周边环形强化;２ 例为整个病灶轻度到中度不均匀强化;１例为病灶中心结节状强化。另外１６ 例中有９例可见到病灶内纤维分隔形成。结论：ＣＴ动态增强扫描和螺旋ＣＴ多期扫描可充分反映病灶的血供特点和病理特征,在肝脏炎性假瘤的诊断和鉴别诊断中具有很大价值。     

叶内型肺隔离症的双层螺旋CT诊断

目的 :总结叶内型肺隔离症的多层螺旋CT表现 ,探讨多层螺旋CT在肺隔离症诊断中的价值及扫描方法。方法 :6例肺隔离症患者行多层螺旋CT双期扫描。对比剂注射流率 2 .5ml/s ,扫描延时 2 5s ,层厚 3mm ,螺距 1.0。原始图像经 1.5mm薄层重建后再交工作站行三维图像后处理。结果 :本组中全部病灶均位于左肺下叶后基底段 ,表现为局部不规则肿块 ,其中 3例边缘光整 ,1例边缘不清 ,2例病灶周围血管纹理增粗。 6例均见异常供血动脉 ,发自降主动脉 4例 ,胸主动脉 2例。 6例中仅 4例显示引流静脉。其中多层螺旋CT三维图像后处理能清楚显示异常供血动脉和引流静脉 ,与术中所见完全一致。结论 :多层螺旋CT是肺隔离症定性诊断最为理想的非创伤性检查方法 ,其各种图像后处理技术能较好地显示肺隔离症的异常供血动脉和引流静脉 ,有利于确诊此病和制订手术治疗方案     

Splenic lesions: sonographic patterns, follow-up, differential diagnosis

This report concerns 172 patients with sonographically diagnosed benign and malignant splenic lesions. A variety of echopatterns was observed, but a differential diagnosis was often impossible without contributory clinical data. Thirteen patients underwent ultrasound-guided fine-needle biopsy for histological confirmation or therapy. In 14 cases splenectomy was performed for treatment or final diagnosis. Twenty-three patients had malignant space-occupying lesions of the spleen. 26 cases presented with normal splenic size, 47 showed splenomegaly of different extent. Lymphoma was the main basic illness in 60 patients. Thirteen cases presented with splenic metastases from other neoplasms. 71 malignant splenic lesions were hypoechoic when compared with normal splenic echotexture. Only two patients exhibited hyperechoic metastases. In three cases a 'halo' sign was seen. In 99 patients benign focal lesions of the spleen were diagnosed. These included splenic infarction (n = 36), dysontogenetic cysts (n = 23), splenic abscesses (n = 7), splenic calcification (n = 13), and hyperechoic lesions (n = 17) most probably representing splenic hemangioma.     

CT脊髓造影诊断椎管内占位病变的意义

The value of omnipaque myelography and CT myelography in 77 cases of intraspinal space-occupying lesions (51 extramedullary and 26 intramedullary confirmed by operation) was reviewed. In 69 cases the preoperative diagnosis was accurate, but not in the other 8 cases. It is not advisable according to the authors' experience to have both myelography and postmyelography CT scan done for all intraspinal space-occupying lesions. For most of the extramedullary tumors, myelography alone proved to be adequate. For intramedullary lesions the information obtained from myelography was inconclusive and postmyelography CT scan as a supplementary procedure was necessary.     

肝脏局灶性结节增生的螺旋CT和MRI诊断

目的 :分析肝脏局灶性结节增生 (FNH)平扫和动态增强的螺旋CT、MRI表现 ,提高FNH诊断符合率。方法 :对 13例经手术病理证实的FNH影像学表现进行回顾性分析。螺旋CT检查 8例 ,MRI检查 6例 ,其中 1例同时做CT和MRI检查。结果 :8例CT平扫病灶均呈低密度 ,均匀或不均匀。增强动脉期扫描除中心疤痕外 ,所有病灶均有明显均匀强化 ,其中 4例还可见到病灶中心或周边增粗、扭曲的动脉。门脉期和延迟期扫描 4例呈略高密度、4例病灶呈等密度或略低密度 ,4例伴有中心疤痕者均有延迟强化。MRI检查 6例 ,病灶均呈不均匀略长或等T1及T2 信号 ,增强动脉期呈明显强化 ,门脉期及延迟期呈等或略高强化 ,4例MRI平扫显示中央瘢痕者有延迟强化。结论 :平扫和动态增强螺旋CT、MRI能较全面显示FNH的病理特征和血供特点 ,明显地提高与其它富血管恶性肿瘤的鉴别诊断能力     

脾脏肿瘤的CT诊断

目的：探讨脾脏肿瘤的ＣＴ表现。材料与方法：搜集３０例经病理和临床证实的脾脏肿瘤的ＣＴ资料,包括脾原发恶性淋巴瘤４例,恶性淋巴瘤浸润３例,脾血管肉瘤１例,脾转移瘤１５例,脾淋巴管瘤３例,脾血管瘤３例,脾错构瘤１例。均作ＣＴ平扫及增强检查。结果：ＣＴ对脾脏肿瘤的发现率极高,对病变的大小、形态、密度及周围组织脏器的显示较其他影像学检查更准确。结论：ＣＴ对脾脏肿瘤有较高的诊断价值。     

Helical CT screening for hepatocellular carcinoma in patients with cirrhosis: frequency and causes of false-positive interpretation

OBJECTIVE: The purpose of our study was to determine the specificity of helical CT for depiction of hepatocellular carcinoma in a population of patients with cirrhosis. SUBJECTS AND METHODS: Single-detector helical CT screening was undertaken in 1329 patients with cirrhosis who were referred for transplantation. The patients underwent one or more helical CT examinations over 30 months and were followed up for an additional 19 months or until transplantation. We predominantly used unenhanced and biphasic contrast-enhanced techniques with infusions of 2.5-5.0 mL/sec. Four hundred thirty patients underwent transplantation within this period. Liver specimens were sectioned at 1-cm intervals, with direct comparison of imaging and pathologic findings and histologic confirmations of all lesions. Prospective preoperative helical CT reports were used for the primary data analysis. A retrospective unblinded review was undertaken to determine characteristics of false-positive lesions diagnosed as hepatocellular carcinoma. RESULTS: Thirty-five patients (8%) had false-positive diagnoses for hepatocellular carcinoma based on helical CT. Twenty of these patients (5%) showed hypoattenuating lesions seen during one of the three helical CT examination phases. Fifteen patients (3%) had hyperattenuating lesions seen during the arterial phase. Among the 15 hyperattenuating lesions, CT revealed the causes to be transient benign hepatic enhancement (n = 3), hemangiomas (n = 2), fibrosis (n = 2), peliosis (n = 1), volume averaging (n = 1), low-grade dysplastic nodule (n = 1), or undetermined (n = 5). Of the 20 hypoattenuating lesions, the causes were shown to be fibrosis (n = 8), focal fat (n = 4), infarcted regenerative nodules (n = 2), regenerative nodules (n = 1), fluid trapped at the dome of the liver (n = 1), hemangioma (n = 1), or undetermined (n = 3). Follow-up helical CT in 13 (72%) of 18 patients allowed a change in the diagnosis of hepatocellular carcinoma to a finding of no cancer present. CONCLUSION: Helical CT screening for hepatocellular carcinoma in patients with cirrhosis has a substantial false-positive detection rate. Although most of lesions were hypoattenuating, a few hyperenhancing arterial phase lesions were proven not to be hepatocellular carcinoma. An awareness of imaging characteristics and follow-up imaging can help radiologists avoid a mistaken diagnosis in many patients.     

口服法螺旋CT胆管造影临床应用价值探讨

目的探讨口服法螺旋CT胆管造影对胆系疾病的诊断价值和对胆系手术的指导价值。方法可疑胆系病变患者18例。服用碘番酸后12~14h行CT扫描,并行2D、3DMIP重建。据碘番酸剂量分大剂量组(6.0g)5例,中剂量组(3.0g)10例和小剂量组(1.0g)3例。显影程度分未显影、轻度显影、良好显影和过度显影4级。造影结果与病理和/或临床结果对照。结果(1)胆管显影与碘番酸剂量有关。观察肝内胆管用量不应<6.0g,观察肝总管和胆总管3.0g基本满足要求。(2)口服法螺旋CT胆管造影可显示肝内外胆管特别是肝外胆管的解剖结构,反映胆系功能和其通畅情况以及病变与胆管之间的关系,对胆囊阴性结石和胆囊息肉诊断的敏感度为80%,对胆总管阴性结石诊断的敏感度为88.89%,特异度为100%。(3)2D和3DMIP重建空间感好,是原始图像的重要补充。结论口服法螺旋CT胆管造影简便、无创,是显示肝内外胆管解剖结构和诊断胆系病变的一种较好方法,对胆系手术有指导作用。