胆管囊肿的MRI诊断

胆管囊肿非常少见，其以远端胆总管囊柱状扩张为特点，以腹痛、腹部包块、黄疸为临床主症，部分或完全胆管或胰管阻塞可引起胆汁淤滞、胆管炎、急慢性胆囊炎或胰腺炎。以往对其诊断主要靠超声（US）、计算机体层摄影（CT）、内窥镜逆行胆胰管造影（ERCP）、光电子发射体层摄影（ECT）。近来随着EUS、CT胆管造影、磁共振成像（MRI）＋磁共振胆胰管造影（MRCP）的应用。发现和报告增多。我院自1990～2000年共15例先天性胆管囊肿患者，得以手术和病理证实，均经MRI＋MRCP诊断。本文重点就其MRI＋MRCP的影像学特点和胆管囊肿的形成机制加以探讨。     

先天性肺支气管囊肿51例外科治疗

目的 提高先天性肺内支气管囊肿的诊断、鉴别诊断及治疗水平。方法 回顾分析51例外科治疗的先天性肺支气管囊肿患的有关临床资料。结果 40例术后症状消失，9例轻度咳嗽、咳痰，1例1年后发生肺部感染合并充血性心衰，1例肺囊肿癌变，行术后化疗，现已存活4年。51例随访8个月至5年无复发。结论 手术可明确诊断，缓解症状，防止并发症，是治疗的最佳方法。     

成人先天性支气管囊肿的诊断及治疗

１９７４年～１９９３年间，我院手术治疗２２例（男１４例，女８例）成人先天性支气管囊肿，年龄１１～６２岁，其中纵隔支气管囊肿１３例（５９．１％），肺内支气管囊肿９例（４０．９％）。２０例（９１％）囊肿症状包括：反复肺部感染、囊肿感染和食道压迫所致的吞咽困难。纵隔型以胸痛、胸闷为主要，而肺内型以肺部感染和胸痛为主。胸片示９０．９％的囊肿为单房、圆形，偶有不规则形、多房、气液平和囊壁钙化。手术切除是治疗的最佳方法，纵隔型１００％行囊肿摘除术，肺内型７７．８％行肺叶切除术。我们认为手术可明确诊断，缓解症状，防止并发症。     

CT和MRI诊断老年多发性脑梗死的价值

目的 观察电子计算机断层扫描(CT)和磁共振成像(MRI)诊断老年多发性脑梗死(MCI)的价值.方法 回顾性分析2017年1月至2020年1月苏州大学附属第一医院和苏州市第九人民医院收治的180例老年MCI患者的CT和MRI影像学资料,统计并对比两种检查方式的梗死检出率、检出病灶数、检出病灶直径、病灶检出部位等情况.结...     

46例先天性支气管肺囊肿误诊原因分析

目的：分析４６例先天性支气管肺囊肿的误诊原因，从中找出经验和教训，提高对本病的认识，以防误诊、误治。方法：收集手术后经病理证实的先天性支气管肺囊肿病例共９１例。结合临床及胸片Ｘ线表现进行分析，从中找出误诊原因。结果：９１例先天性支气管肺囊肿病例中误诊４６例占５０．５５％。其中误诊为肺结核者３０例（６５．２１％）、肺脓肿６例（１３．０４％）、肺癌４例（８．７％）肺大疱、１毁损肺、脓胸各２例（各占４．     

先天性多发性支气管囊肿

患，男性，64岁．刺激眭干咳1年伴消瘦、乏力、盗汗。无咯血及发热史。胸片显示双下肺纹理增多．右下肺片影(图1)，胸部CT示右下肺后基底段5×4cm。圆形空计可(图2)．内有液平面．壁厚薄不匀，周边可见支气管扩张形成的囊状透亮影及模糊片影，纵隔、肺门淋巴结肿大不明显，右下胸膜增厚。CT印象：右下肺后基底段空洞考虑结核性空洞继发感染，右下支气管扩张合并感染。     

食管旁支气管囊肿3例

例1 ,男,34岁,主诉胸骨后及左上腹不适3年,多与进食硬食有关,无呕吐,查体无重要阳性体征。X线钡餐见:食道下1 / 3左后侧壁卵圆形充盈缺损,5 2 mm×4 6 mm ,边缘光滑,缺损上缘与食道呈锐角,钡流向右偏流继而包绕肿块呈半环形,局部黏膜平展,皱襞消失,病变以上食管无扩张。X线诊断食道下段黏膜下良性肿瘤,平滑肌瘤可能性大,开胸探查发现食管壁左后侧触及5 5 mm×5 2 mm类圆形肿物,质软,无粘连,切开食管壁外层见肿物包膜完整,直达黏膜下层。肿块完整剥离。切开肿物内有多个不规则的囊腔,内有黄色粘稠液体。病理镜检囊壁内层为假复柱状纤毛上皮,…     

异位支气管囊肿的诊断和外科治疗

目的探讨异位支气管囊肿的临床病理特征和诊断,提高外科治疗水平。方法回顾分析我院1990年1月至2008年10月收治的4例异位支气管囊肿的相关临床资料,并进行文献复习。结果4例异位支气管囊肿中1例为腹膜后支气管囊肿伴慢性炎症,右额叶支气管囊肿1例,前胸壁皮下支气管囊肿1例和1例椎管内支气管囊肿,术前全部误诊,4例通过手术完整切除,病理检查确诊为支气管囊肿,术后无复发。结论异位支气管囊肿临床罕见,诊断主要依据影像学检查和病理检查,治疗首选外科手术切除,完整切除后无复发。     

肺内不典型支气管肺囊肿影像表现及CT增强在其诊断中的作用

目的 评价不典型支气管肺囊肿影像学表现。方法 搜集21例影像学表现不典型支气管肺囊肿进行回顾性分析。不典型支气管肺囊肿的影像学主要表现分为炎性浸润阴影(5例)、不规则团块影(3例)、实性球形影(8例)及分支管状阴影(5例)，对18例支气管肺囊肿进行了增强扫描。结果 炎性浸润性肺囊肿影像学无特征性，以病灶实质无强化，临床上反复感染为特点；不规则团块影、实性球形影及分支管状阴影性支气管囊肿以实质无强化，病灶周围肺野肺气肿及有或无片絮索条为主要表现；分支管状肺囊肿以沿支气管走行分布区一致为特征。结论 当反复发生的感染灶、病灶周围有肺气肿及有或无片絮状索条状影、病灶实质无强化或沿支气管走行分布区一致的管状病灶时应考虑支气管肺囊肿。     

先天性支气管囊肿的临床及病理分析

目的 探讨先天性支气管囊肿的临床及病理特点。方法 回顾性分析我院1997年1月至2002年1月经手术切除病理证实的30例先天性支气管囊肿患的临床及病理资料。结果 根据x线胸片、胸部CT检查结果,本组患病灶肺内型23例、纵隔型5例、异位型2例。其中液囊肿18例、气囊肿7例、多发肺囊肿5例。肺内型多以并发感染就诊,其中19例表现为咳嗽、咳痰,2例伴发热,11例表现为咯血或痰中带血,11例有不同程度的胸痛;CT特征为囊腔大、周围软组织少的“块中囊”,或薄壁的空腔、多发性蜂窝状、囊腔状环行透光影。纵隔型2例于体检时偶然发现,2例因囊肿压迫气管而出现胸闷、呼吸困难,1例压迫食管而出现吞咽梗塞感;CT特点为边界清楚、密度一致的孤立性圆形或卵圆形阴影,与周围器官组织相互挤压变形。异位型2例均于体表扪及囊性包块就诊。病理检查：镜下均可见假复层纤毛柱状上皮、腺体、软骨、弹力纤维和少量平滑肌。结论 先天性支气管囊肿以肺内型为多,临床表现主要为咳嗽、咳痰及咯血,cT检查以块中囊为其特征性表现;组织病理学检查均具备呼吸上皮、腺体、软骨和平滑肌。手术切除是治疗的最佳方案。     

CT与MRI诊断鼻咽癌的对比研究

目的 探讨鼻咽癌向周围邻近结构侵犯的CT和MRI表现。并比较其诊断价值。方法 分析经病理证实的2l例NPC患者CT和MRI资料。结果 鼻咽癌瘤体T1WI等信号14例(66,7％),T2WI高信号18例(85．7％),增强T1WI高信号9例(100％)。CT、MRI显示鼻咽癌以下结构的浸润率有显著性差异：完全茎突后间隙、颅骨和海绵窦(P值分别为0．015,0.000和0．017)。副鼻窦检出率分别为14．3％和4．8％,但P值为0．143。其余结构两者检出无统计学差异。结论 以MRI为鼻咽癌患者首选影像学检查,可更准确了解肿瘤侵犯范围。     

螺旋CT 和MRI 对肝内周围型胆管癌诊断价值分析

目的探讨螺旋计算机断层成像（CT）和磁共振成像（MRI）技术对肝内周围型胆管癌（IHPCC）的诊断价值。方法经病理学检查证实的80例IHPCC患者,均行螺旋CT和MRI平扫、增强和延迟扫描检查,比较影像学检查诊断的正确率。结果影像学上病灶为1.3 cm×2.0 cm~7.3 cm×9.0 cm （平均4.6 cm×6.4 cm）;位于肝左叶58例,肝右叶22例;呈肿块型46例（57.50%）、浸润狭窄型17例（21.25%）、腔内生长型10例（12.50%）、肿块不明确7例（8.75%）;CT平扫病灶呈略低密度,增强扫描时病灶分别呈轻中度的边缘强化50例、中央轻度条状或片状强化12例和无强化18例,延迟扫描时呈不均匀性片状或分隔状强化47例、均匀强化5例和无强化28例;MRI平扫较CT显示病灶更为清晰,延迟后73例病灶逐渐强化;MRI诊断正确率为91.3%,CT诊断正确率为80.0%,两者比较差异无统计学意义（P>0.05）。结论增强延迟扫描可提高螺旋CT和MRI诊断IHPCC的准确性,诊断IHPCC时可优先考虑行MRI检查。     

CT能谱成像鉴别肝癌和肝脏局灶性结节增生的临床价值

目的探讨CT能谱成像在鉴别肝癌和肝局灶性结节增生（FNH）中的应用价值。方法回顾性分析46例肝脏占位性病变患者（肝癌32例,FNH14例）行64层CT双期能谱扫描结果。测量病灶、正常肝组织和腹主动脉的能谱参数,对比分析两种占位性病变间不同能量水平下病灶-肝脏对比噪声比（CNR）、标准化碘浓度（NIC）、病灶与正常肝组织碘浓度比值（LNR）及病灶动脉期和门静脉期碘浓度的差异（ICD）等。结果除部分能量点外,肝癌和FNH在不同能量水平下的CNR随着单光子能量的增加而减小。肝癌和FNH的动脉期最佳CNR分别为3.6±1.1和8.3±2.7,门静脉期最佳CNR分别为1.8±0.3和1.1±0.2;肝癌和FNH动脉期NIC分别为0.3±0.1和0.4±0.1,门静脉期NIC分别为0.5±0.1和0.9±0.2;动脉期LNR分别为3.0±0.5和6.2±1.0,门静脉期LNR分别为1.0±0.1和1.2±0.3;动脉期和门静脉期ICD值分别为0.4±0.1g/L和1.2±0.3g/L。肝癌动脉期和门静脉期的NIC、LNR和ICD值均低于FNH,差异均有统计学意义（NIC比较,t值分别为-3.196、-6.518;LNR比较,t值分别为-12.911、-3.260;ICD比较,t值为-2.754,P均＜0.05）。动脉期LNR鉴别肝癌和FNH的敏感度和特异度最高,均为100%。结论 CT能谱成像分析对肝癌和FNH的检出和鉴别诊断有一定的价值,能提高检出效能和诊断准确性。     

Non-adherence to Recommendations for Further Testing after Outpatient CT and MRI

Background

Nearly 1 in every 5 outpatient visits ends with a request for a diagnostic imaging test, and imaging reports often contain recommendations for further testing. Little is known about adherence to recommendations for further testing after outpatient computed tomography (CT) and magnetic resonance imaging (MRI).

Methods

We performed a retrospective cohort study linking provincial administrative data to a cross-sectional audit of 23,691 outpatient CT and MRI scans performed in 2005 in Ontario, Canada. After excluding patients who died (n = 1031), were hospitalized (n = 3030), or visited an emergency department (n = 3660) within 180 days of the index CT/MRI scan, 15,970 CT/MRI scans were included. The primary outcome was adherence to recommendations for further testing within 180 days of an index CT/MRI scan.

Results

Further testing was recommended in 2027 of 15,970 (12.7%) index CT/MRI scan reports and was recommended most frequently after CT chest scans (593 of 2276 [26.1%]). From the 2027 scans in which further testing was recommended, we identified 2102 individual recommendations for a specific type of follow-up test and found that just over one third (37.6%) of these recommendations were followed at 180 days. Adherence was lower (32.3%) when patients had a visit to the referring physician within 180 days of the index CT/MRI scan, compared with when they had no such visit (50.5%; P <.001).

Conclusions

Radiologists commonly recommend further testing after outpatient CT and MRI scanning. However, nearly two thirds of these recommendations are not followed. This suggests that substantial opportunities exist to improve the exchange of information between clinicians and radiologists and to advance the quality of outpatient care.     

Comparison of CT and MRI for presurgical characterization of paraaortic lymph nodes in patients with pancreatico-biliary carcinoma

AIM：To determine the accuracy of computed tomography （CT） and magnetic resonance （MR） for presurgical characterization of paraaortic lymph nodes in patients with pancreatico-biliary carcinoma. METHODS：Two radiologists independently evaluated CT and MR imaging of 31 patients who had undergone lymphadenectomy （9 metastatic and 22 non-metastatic paraaortic nodes）. Receiver operating characteristic （ROC） curve analysis was performed using a five point scale to compare CT with MRI. To re-define the morphologic features of metastatic nodes, we evaluated CT scans from 70 patients with 23 metastatic paraaortic nodes and 47 non-metastatic ones. The short axis diameter, ratio of the short to long axis, shape, and presence of necrosis were compared between metastatic and non-metastatic nodes by independent samples t-test and Fisher＇s exact test. P 〈 0.05 was considered statistically significant. RESULTS：The mean area under the ROC curve for CT （0.732 and 0.646, respectively） was slightly higher than that for MRI （0.725 and 0.598, respectively） without statistical significance （P = 0.940 and 0.716,respectively）. The short axis diameter of the metastatic lymph nodes （mean = 9.2 mm） was significantly larger than that of non-metastatic ones （mean = 5.17 mm, P 〈 0.05）. Metastatic nodes had more irregular margins （44.4%） and central necrosis （22.2%） than non-metastatic ones （9% and 0%, respectively）, with statistical significance （P 〈 0.05）. CONCLUSION：The accuracy of CT scan for the characterization of paraaortic nodes is not different from that of MRI. A short axis-diameter （〉 5.3 mm）, irregular margin, and presence of central necrosis are the suggestive morphologic features of metastatic paraaortic nodes.     

肝脏局灶性结节增生CT、MRI征象和病理特点的综合分析

目的探讨肝脏局灶性结节增生（FNH）的CT、MRI征象和病理特点。方法回顾性分析经手术切除病理证实为FNH病例15例,其中7例术前行多层螺旋CT平扫及多期增强扫描,另8例行MR平扫及多期增强扫描。结果15例病灶多呈类圆形、椭圆形,少数呈分叶状;病灶直径3．0～8．0cm;病灶的边界在平扫时显示模糊,增强后显示清楚;CT平扫病灶多呈稍低或等密度,中心部分瘢痕结构呈更低密度,增强后动脉期病灶实质部分多明显均匀强化,瘢痕结构未见强化,门静脉期和延迟期实质部分强化程度下降呈稍低或等密度,瘢痕结构延迟强化,其中4例瘢痕结构可见;MRI平扫病灶呈稍长或等T1WI及T2WI信号,瘢痕结构于T2WI上呈特征性高信号,增强后三期信号变化特点类似CT三期增强特点,其中5例瘢痕结构可见;9例增强后病灶内或周围可见增粗、扭曲的动脉,在T2WI上表现为血管流空。结论熟悉FNH多种影像征象,可提高FNH术前诊断率。CT和MRI能够反映FNH病理特点及血供血管情况,可为临床选择手术方案提供重要参考。     

三种影像学方法诊断肝外胆管结石比较研究

目的 探讨采用超声、腹部CT和磁共振胆管成像(MRCP)诊断肝外胆管结石的效能.方法 2017年3月～2019年2月在我院治疗的肝外胆道梗阻性病变患者107例,术前行腹部超声、CT和MRCP检查,以术后病理学检查为金标准,采用ROC曲线分析腹部超声、CT和MRCP诊断肝外胆管结石的效能.结果 本组病例经手术后病理学检查...     

CT and MR imaging in Hodgkin's disease – present and future

Abstract:  Initial staging of Hodgkin's disease is crucial to determine the location and extent of disease, and is the hallmark for the choice of treatment. At present, the established radiological technique for staging Hodgkin's disease is computed tomography (CT). Modern multidetector row CT scanners allow fast imaging from the scull base to the groins during a single breath hold with a spatial resolution of approximately 1 mm. Both, nodal and extranodal involvement of Hodgkin's disease can be diagnosed with CT. Magnetic resonance (MR) imaging is another useful cross-sectional imaging modality for staging Hodgkin's disease. The development of fast MR imaging techniques has considerably reduced imaging time without compromising the quality of MR images. As a consequence, MR imaging is now considered to be as diagnostic as CT for staging Hodgkin's disease. The excellent soft-tissue contrast and the lack of exposure to ionizing radiation are the main advantages of MR imaging. For the detection of extranodal Hodgkin's disease, MR imaging is superior to assess involvement of the brain, the spinal cord and bone marrow; while CT allows excellent evaluation of lung disease. Common major problems in staging Hodgkin's disease are still the detection of nodal involvement in normal sized lymph nodes and residual tumor masses after therapy. In the future, newly developed lymphotropic contrast agents for MR imaging might be helpful to answer these questions.     

心脏CT检查对肥厚型心肌病合并冠心病患者的诊断价值

目的:评估心脏CT检查在诊断肥厚性心肌病(hypertrophic cardiomyopathy,HCM)可疑合并冠心病患者中的价值。方法:60例患者入组本研究。心脏CT检查包括冠状动脉CT血管造影(CT angiography,CCTA)和延迟强化检查。以冠状动脉造影(coronary angiography,CA)和心脏磁共振检查(cardiovascular magnetic resonance,CMR)作为参考标准,分别检测CCTA和延迟强化检查在评估冠状动脉狭窄程度、左心室舒张末期室壁厚度、心功能和心肌纤维化的诊断准确性。结果:与CA比较,CCTA在检测冠状动脉狭窄程度方面的敏感性、特异性、阳性预测值及阴性预测值分别为100%、94.4%、92.3%及100%。在检测左心室舒张末期室壁厚度、心功能指标方面,CT与CMR有较好的相关性,但CT略低估以上指标。CMR延迟强化图像的对比噪声比优于CT(P0.01);CT测量的局灶性心肌纤维化范围与CMR结果相关性较好(P0.01)。结论:心脏CT一站式检查能够提供冠状动脉狭窄程度、心室形态、心功能及心肌活性方面的信息,有助于肥厚性心肌病可疑合并冠心病患者的鉴别诊断。