Investigation of lacrimal sac space-occupying lesions using color doppler ultrasound, computed tomography, and computed tomography dacryocystography

AIM:To observe the imaging features of color Doppler ultrasound(CDU)and computed tomography(CT)or computed tomography dacryocystography(CT-DCG)in different types of lacrimal sac space-occupying lesions(SOLs).METHODS:This retrospective case series study included 21 patients with lacrimal sac SOLs who underwent lacrimal sac surgery between January 2018 and March 2022.The imaging features of CDU and CT or CT-DCG in these patients were extracted from the examination cloud system.The images were observed and analyzed.RESULTS:The detection rate of lacrimal SOLs between CDU(21/21,100%)and CT or CT-DCG(20/21,95.2%)had no statistically significant difference(P=1.0).CDU could detect the blood flow signals in all SOLs except mucocele and mucopeptide concretion.Among them,polyps had characteristic imaging changes on CDU and CT-DCG.The mucoceles and mucopeptide concretions had characteristic imaging changes on CDU,which could provide more information for differential diagnosis.CONCLUSION:The morphology and internal blood flow signals of lacrimal sac SOLs can be observed using CDU.CT or CT-DCG has advantages in observing structural damage around the lacrimal sac mass.Therefore,CDU may be used as a routine examination to exclude lacrimal sac SOLs before dacryocystorhinostomy in the absence of preoperative CT or CT-DCG.

Effect of contrast-enhanced ultrasound on differential diagnosis of intrahepatic cholangiocarcinoma and arterial phase enhanced hepatic inflammatory lesions

Objective: To investigate differential diagnosis between intrahepatic cholangiocarcinoma (ICC) and arterial phase enhanced hepatic inflammatory lesions in patients without liver cirrhosis using contrast-enhanced ultrasound (CEUS). Methods: ICC and hepatic inflammatory lesions cases with CEUS and pathological diagnosis between Sep 2013 and Oct 2016 were investigated retrospectively. Imaging features of conventional ultrasound and CEUS were analyzed. The parameters of time intensity curve (TIC), including the arrival time, peak intensity (PI) in the lesions, the starting time for washout, and the intensity difference at 3 min (Delta I-3) after contrast agent infection between the lesion and the liver parenchyma, were compared between ICC and hepatic inflammatory lesions. Results: Twenty-five ICC and fifteen inflammatory patients were included in this study. Seventeen ICC (68.0%) and two inflammatory cases (13.3%) showed bile duct dilatation on conventional ultrasound. Using CEUS, three ICC cases (12.0%) were misdiagnosed as inflammatory lesions and three inflammatory lesions (20.0%) as ICC; two ICC (8.0%) and one inflammatory case (6.7%) could not be made definite diagnosis. Washout started at 34.5 +/- 3.5 s and 61.5 +/- 12.9 s for ICC and inflammatory lesions respectively (P < 0.001). The intensity difference between lesion and liver parenchyma at 3 min after contrast agent injection was 10.8 +/- 3.1 dB in ICC and 4.2 +/- 2.3 dB in inflammatory group (P < 0.001). The sensitivity and specificity differentiating ICC and inflammatory lesions were 76% and 87% if the cut-off value of the intensity difference was 7.7 dB. Conclusions: Combined with TIC analysis, and particularly with the characteristic of the early-starting and obvious washout in ICC, CEUS can be useful in differential diagnosis between hepatic inflammatory lesions and ICC.

Preventive effects of autologous bone marrow mononuclear cell implantation on intrahepatic ischemic-type biliary lesion in rabbits

BACKGROUND: The ischemic-type biliary lesion (ITBL) is one of the most serious biliary complications of liver transplantation. This study aimed to investigate the effects of autologous bone marrow mononuclear cell (BM-MNC) implantation on neovascularization and the prevention of intrahepatic ITBL in a rabbit model. METHODS: The rabbits were divided into control, experimental model, and cell implantation groups, with 10 in each group. The model of intrahepatic ITBL was established by clamping the hepatic artery and common bile duct. Autologous BM-MNCs were isolated from the tibial plateau by density gradient centrifugation and were implanted through the common hepatic artery. Changes in such biochemical markers as aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyltranspeptidase, total bilirubin and direct bilirubin were measured. Four weeks after operation, cholangiography, histopathological manifestations, differentiation of BM-MNCs, microvessel density and the expression of vascular endothelial growth factor were assessed. RESULTS: Compared with the experimental model group, the BM-MNC implantation group showed superiority in the time to recover normal biochemistry. The microvessel density and vascular endothelial growth factor expression of the implantation group were significantly higher than those of the control and experimental model groups. The ITBL in the experimental model group was more severe than that in the implantation group and fewer new capillary blood vessels occurred around it. CONCLUSIONS: Implanted autologous BM-MNCs can differentiate into vascular endothelial cells, promote neovascularization and improve the blood supply to the ischemic bile duct, and this provides a new way to diminish or prevent intrahepatic ITBL after liver transplantation. (Hepatobiliary Pancreat Dis Int 2010; 9:593-599)

Assessment of optic nerve and optic tract alterations in patients with orbital space-occupying lesions using probabilistic diffusion tractography

AIM: To investigate the diffusion changes in both the optic nerve and optic tract in orbital space-occupying lesion patients with decreased visual acuity, and its clinical significance using probabilistic diffusion tractography(PDT). METHODS: Twenty patients with orbital space-occupying lesions and 25 age-and gender-matched healthy persons were included. All patients and controls underwent routine orbital magnetic resonance imaging and diffusion tensor imaging(DTI), using a 3.0 T magnetic resonance scanner(Trio Tim Siemens). After the image data were preprocessed, each DTI parameters of the optic nerve and optic tract was obtained by PDT, including fractional anisotropy(FA), mean diffusivity(MD), axial diffusivity(AD) and radial diffusivity(RD). The asymmetry index(AI) of each parameter was calculated. Compared the parameters of the affected side optic nerve and ipsilateral optic tract with the contralateral side by paired sample t-test;compared AI of parameters of optic nerve and optic tract between the patient group and the control group by independent sample t-test. Patients were divided into threesubgroups according to the low vision grade standard of WHO, compared the FA and AI of FA between the three subgroups by single factor variance analysis. RESULTS: The affected side optic nerve presented significantly decreased FA, increased MD, AD, and RD values compared to the unaffected side(P<0.05). The AI of FA, MD, AD, and RD of optic nerve in the patients was significantly higher than that of the controls(P<0.05). The comparison results of the optic tract showed that there was no significant difference between the patient group and control group in terms of the bilateral optic tracts in patients(P>0.05). The AIs of the FA value of the optic nerve in the eyesight <0.1 subgroup was significantly higher than that in the other groups(P<0.05). CONCLUSION: FA, MD, AD, and RD of the affected side optic nerve of the orbital space-occupying lesions have significantly changed, the FA value is the most sensitive. The PDT could be a useful tool to provide valid quantitative markers of optic nerve injuries and evaluate the severity of orbital diseases, which other examinations cannot be acquired.

Recurrent orbital space-occupying lesions:a clinicopathologic study of 253 cases

Objective：To analyze the clinical features,histopathologic classification and frequencies of various types of recurrent orbital space-occupying lesions.Methods：A retrospective study was carried out in 253 consecutive patients with recurrent orbital spaceoccupying lesions treated by surgical excision in the Institute of Orbital Diseases,the General Hospital of the Armed Police Force from January 2009 to December 2010.Results：The patients included 123 males and 130 females aged 2 to 78 years（mean,36.2 years）,and the last recurrence interval after operation ranged from 1 month to 40 years（median,4.75 years）.Of all the cases,159（62.8%）,65（25.7%）,20（7.9%）,8（3.2%） and 1（0.4%） had previously experienced once,twice,three,four and six times of surgeries,respectively.Among them,29（11.5%） cases had recurred 3 times or over,and 37（14.6%） cases got recurrence in 10 or more years postoperatively.Most of the patients with local recurrence presented with various clinical manifestations,while 31（12.3%） cases were symptom-free.Two hundred and thirty-one（91.3%） cases underwent surgical removal of the recurrent orbital lesions,and another 22（8.7%） cases had to receive the exenteration of orbit.Categories of these recurrent orbital lesions after operation were as follows：lacrimal gland tumors,65（25.7%） cases;vasogenic diseases,54（21.3%） cases;neurogenic tumors,42（16.6%） cases;secondary tumors,24（9.5%） cases;orbital inflammation,21（8.3%） cases;myogenic tumors,14（5.5%） cases;fibrous and adipose tumors,12（4.7%） cases;lympho-hematopoietic tumors,7（2.8%） cases;bone or cartilage tumors,7（2.8%） cases;orbital cysts,6（2.4%） cases;and indefinitely differentiated tumor,1（0.4%） case.The 10 top histopathologic diagnoses were lacrimal gland pleomorphic adenoma,hemangiolymphangioma,lacrimal gland adenoid cystic carcinoma,meningioma,inflammatory pseudotumor,neurofibroma,sebaceous gland carcinoma,vascular malformation,rhabdomyosarcoma and hemangioma.Conclusions：The variety of recurrent orbital lesions after operation includes mainly of tumors except for vascular malformation and orbital inflammatory lesions.The lacrimal gland epithelial tumor is most prone to relapse after resection,and early and longer-term postoperative follow-up is needed.

Application of endoscopic submucosal dissection in duodenal space-occupying lesions

BACKGROUNDEndoscopic submucosal dissection (ESD) has been advocated by digestiveendoscopists because of its comparable therapeutic effect to surgery, reducedtrauma, faster recovery, and fewer complications. However, ESD for lesions of theduodenum is more challenging than those occurring at other levels of thegastrointestinal tract due to the thin intestinal wall of the duodenum, narrowintestinal space, rich peripheral blood flow, proximity to vital organs, and highrisks of critical adverse events including intraoperative and delayed bleeding andperforation. Because of the low prevalence of the disease and the high risks ofsevere adverse events, successful ESD for lesions of the duodenum has rarelybeen reported in recent years.AIM To investigate the efficacy and safety of ESD in the treatment of duodenal spaceoccupyinglesions.METHODS Clinical data of 24 cases of duodenal lesions treated by ESD at the DigestiveEndoscopy Center of the Affiliated Hospital of Qingdao University from January2016 to December 2019 were retrospectively analyzed.RESULTS All of the 24 cases from 23 patients underwent ESD treatment for duodenal spaceoccupyinglesions under general anesthesia, including 15 male and 8 femalepatients, with a mean age of 58.5 (32.0-74.0) years. There were 12 lesions (50%) inthe duodenal bulb, 9 (37.5%) in the descending part, and 3 (12.5%) in the ball descending junction. The mean diameter of the lesion was 12.75 (range, 11-22)mm. Thirteen lesions originated from the mucosa, of which 4 were low-gradeintraepithelial neoplasia, 3 were hyperplastic polyps, 2 were chronic mucositis, 2were adenomatous hyperplasia, 1 was high-grade intraepithelial neoplasia, and 1was tubular adenoma. Eleven lesions were in the submucosa, including 5neuroendocrine neoplasms, 2 cases of ectopic pancreas, 1 stromal tumor, 1leiomyoma, 1 submucosal duodenal adenoma, and 1 case of submucosal lymphfollicular hyperplasia. The intraoperative perforation rate was 20.8% (5/24),including 4 submucosal protuberant lesions and 1 depressed lesion. The meanlength of hospital stay was 5.7 (range, 3-10) d, and the average follow-up time was25.8 (range, 3.0–50.0) mo. No residual disease or recurrence was found in allpatients, and no complications, such as infection and stenosis, were found duringthe follow-up period.CONCLUSION ESD is safe and effective in the treatment of duodenal lesions;however, theendoscopists should pay more attention to the preoperative preparation,intraoperative skills, and postoperative treatment.

Establishment of an animal model of ischemic type intrahepatic biliary lesion in rabbits

AIM:To explore a method to establish an animal model of ischemic type intrahepatic biliary lesion in rabbits. METHODS:Forty Japanese white rabbits of clean grade were divided randomly into four groups(10 rabbits per group)including sham operation(SO) group,and artery-bile obstruction(ABO)-1 h group, ABO-2 h group and ABO-3 h group.All the rabbits in this study underwent the same initial surgical procedure in which the liver was prepared as for graft removal during liver transplantation.Subsequently in the SO group,no additional vascular intervention was performed,while in groups ABO-1 h,ABO-2 h and ABO-3 h,the animals underwent combined clamping of the hepatic artery and common bile duct with microvascular clips for 1,2 and 3 h,respectively.After the scheduled occlusion time,the clip was removed to recover blood supply.The animals were killed 4 wk after operation.The survival rate,liver function, cholangiography and histopathological manifestation of the rabbits in each group were observed. RESULTS:The survival rate was 100%in groups SO,ABO-1 h and ABO-2 h,while it was 60%in group ABO-3 h.At each observation time,the change degree of the indexes of liver function was proportional to the clamping time(ABO-3 h>ABO-2 h>ABO-1 h> SO,P<0.05).Cholangiographical and histopathologic manifestations both showed that intrahepatic biliary lesion aggravated proportionally with the increase of the clamping time. CONCLUSION:An animal model of ischemic type intrahepatic biliary lesion in rabbits is successfully established,which may provide a reliable technique for basic and clinical research into the etiology, development and prophylaxis of ischemic type intrahepatic biliary lesion after liver transplantation.

Association between the fMRI manifestations of activated brain areas and muscle strength in patients with space-occupying lesions in motor cortex

BACKGROUND ： Functional magnetic resonance imaging （fMRI） studies have disclosed the changes of the motor function in the motor cortex of ipsilateral and contralateral hemispheres of tumor, which have special significance for making the surgical planning and most greatly minimizing the postoperative functional damages. OBJECTIVE： To analyze the association between the manifestation characteristics of hand functional area and motor dysfunction using fMRI in patients with space-occupying lesions of tumor in motor cortex. DESIGN ： A case-controlled observation SETTING： Department of Radiology, Second Affiliated Hospital, Shantou University Medical College .PARTICIPANTS： Twenty-three patients （13 males and 10 females） with space-occupying lesions of central sulcus area, aged 21-53 years with a mean age of （47±1） years were selected from the Second Affiliated Hospital of Shantou University Medical College. All the patients were diagnosed by MR scanning as space-occupying lesions of motor area, and pathologically confirmed that the lesions involved central sulcus and central Iobule; Lesions occurred in left and right hemispheres in 13 and 10 cases respectively. The tumor types were astrocytoma （n =8）, metastatic tumours （n =7）, meningiomas （n =5） and oligodendroglioma （n =3）. The muscle strength was normal in 11 cases （grade 5） and obviously decreased in 12 cases （grade 2-3 in 3 cases and grade 4 in 9 cases）; muscle strengths of both upper and lower limbs were decreased in 7 cases, and only that of upper limbs was decreased in 5 cases. Informed consents were obtained from all the subjects. Meanwhile, 9 healthy physical examinees （5 males and 4 females） of 20-56 years old with an average of （34±1） years were taken as controls. All the patients and healthy subjects were right-handed. METHODS： All the enrolled subjects were examined with MR scanning and functional imaging. Twenty cases whose clinical symptoms were mild in the patient group and 9 healthy volunteers adopted simple active finger-tapping movements, and for the 3 cases whose clinical symptoms were severe in the patient group, the simple passive finger-tapping movements were used. The manifestations in the activated brain areas were analyzed in the patients with brain tumor of different muscle strength and the controls. The motor deficit and activation of contralateral primary motor cortex （M1） in simple finger-tapping movements were observed in the patient group. MAIN OUTCOME MEASURES： （1） Brain areas activated by finger-tapping movements in each group： （2） Activated volumes in hemisphere by finger-tapping movements between groups. RESULTS： The contralateral M1 area could not be activated in 1 case in the patient group,, all the other 22 patients and 9 healthy subjects were involved in the analysis of results. （1） In the control group, unilateral finger tapping movement activated the contralateral primary motor cortex （M1）, bilateral SMA and bilateral PMC. The activation volume was the largest in contralateral primary motor cortex （M1）, smaller in the SMA, and the smallest in PMC. The finger tapping movement in healthy subjects could activate contralateral primary motor cortex （M1）, bilateral SMA and bilateral PMC, which had no obvious differences from the manifestations of brain functional area activated by active finger tapping. There was no significant difference in the volume of activated functional areas between right and left hands. In the patient group, the central sulcos around the tumor in the activated M1 area displaced towards dorsal or ventral side, also extended. The distance of displacement in the functional area was determined as compared with the contralateral central sulcus, and the results suggested the M1 displacement, including that there were 10 cases with the M1 displacement larger than 10 mm in the patients with motor deficit, which were obviously more than in those without motor deficit （n =1, P 〈 0.01）, and the activated volume in contralateral M1 area was obvious smaller in the patients with motor deficit than in those without motor deficit （P 〈 0.01）. （2） The M1 activation and changes were observed in contralateral hemisphere in the patient group, and the activated volume was obviously larger than that in the control group （P 〈 0.01）. The activated volumes of M1 and PMC in ipsilateral hemisphere were obviously larger than those in the control group （P 〈 0.05）, but that of SMA had no obvious difference between the two groups （P 〉 0.05）. CONCLUSION： fMRI can be used to observe the activation of the brain motor functional areas of patient with space-occupying lesions in motor area, and evaluate the state of their motor function. The larger the distance of displacement of M1 compressed by tumor, the more obviously the muscle strength decreases in the patients.

Cystic Degeneration of Peripheral Intrahepatic Cholangiocarcinoma: An Atypical Presentation

Cholangiocarcinomas are primary malignant tumors of the liver that arises from the epithelium lining the small intra and extrahepatic bile ducts, and has numerous histologic types and growth patterns. At computed tomography (CT) and magnetic ressonance (MR), it has various appearences which motivated the present study;we present a case within an atypical presentation. The objective is to show the variety of differential diagnoses before an atypical aspect and the importance of the imaging methods for the diagnosis. Cholangiocarcinoma is still an uncommon neoplasm, and CT and MR are crucial for accurate diagnosis and for differentiation from other hepatic tumorous and nontumorous lesions.

超声造影肝脏影像报告-数据系统与欧洲超声造影指南对肝脏结节良恶性鉴别的诊断效能对比

目的对比超声造影肝脏影像报告-数据系统(contrast-enhanced ultrasound liver imaging reporting and data system,CEUS LI-RADS)与欧洲超声造影指南对肝细胞癌(hepatocellular carcinoma,HCC)高危人群肿瘤良恶性鉴别的诊断效能。方法筛选2020年8月至2022年1月在深圳市第三人民医院就诊的89例疑似HCC病例的影像学资料,其中男性74例,女性15例,年龄22~77(50.8±11.3)岁。以病理诊断为金标准,采用受试者工作曲线(receiver operating characteristic curve,ROC)分析并计算CEUS LI-RADS和欧洲CEUS指南的ROC曲线下面积(area under the subject curve,AUC)值。计算CEUS LR-5+LR-M与欧洲CEUS指南诊断肝脏恶性肿瘤的敏感性、特异性、阳性预测值、阴性预测值及准确性。结果92个病灶中77个病灶经CEUS归类为LR-5+LR-M,77个病灶经欧洲CEUS指南诊断为恶性肿瘤,75个病灶经病理证实为肝脏恶性肿瘤。CEUS LI-RADS和欧洲CEUS指南的AUC值分别为0.875、0.797,差异无统计学意义(Z=1.71,P=0.088)。以LR-5、LR-M类病灶为阳性结果,CEUS LR-5+LR-M与欧洲CEUS指南诊断肝脏恶性肿瘤的敏感性为97.3%(95%CI:90.7%~99.7%)、94.7%(95%CI:86.9%~98.5%)(χ_(2)=8.12,P=0.004),特异性为76.5%(95%CI:50.1%~93.2%)、64.7%(95%CI:38.3%~85.8%),阳性预测值为94.8%、92.2%,阴性预测值为86.7%、73.3%,准确性为93.5%(95%CI:86.3%~97.6%)、89.1%(95%CI:80.9%~94.7%)(χ_(2)=20.63,P<0.001)。结论CEUS LI-RADS与欧洲CEUS指南对HCC高危人群肿瘤良恶性鉴别的诊断效能相当,CEUS LI-RADS的敏感性和准确性更高。

超声造影在肝内占位病变鉴别诊断中的应用价值

目的探究超声造影(CEUS)在肝内占位病变鉴别诊断中的应用价值。方法回顾性分析2019年5月至2021年8月于萍乡市人民医院检查的84例肝内占位病变患者的临床资料,所有患者均实施彩色多普勒超声、CEUS和术后病理检查,以术后病理检查结果为金标准,分析彩色多普勒超声、CEUS鉴别诊断价值,计算并比较彩色多普勒超声、CEUS鉴别诊断肝内占位病变的灵敏度、特异度、准确度。结果彩色多普勒超声诊断肝内占位病变的灵敏度为86.89%(53/61),特异度为82.61%(19/23),准确度为85.71%(72/84),阳性预测值为92.98%(53/57),阴性预测值为90.37%(19/27),Kappa值为0.659;CEUS诊断肝内占位病变灵敏度为98.36%(60/61),特异度为91.30%(21/23),准确度为96.43%(81/84),阳性预测值为96.77%(60/62),阴性预测值为95.45%(21/22),Kappa值为0.909;CEUS诊断灵敏度、准确度均高于彩色多普勒超声,差异有统计学意义(P<0.05);CEUS和彩色多普勒超声诊断特异度比较差异无统计学意义。结论CEUS鉴别诊断肝内占位病变的灵敏度、准确度均明显高于彩色多普勒超声,可为临床诊断提供依据。

DIFFERENTIAL ULTRASONIC DIAGNOSES OF PULMONARY BENIGN AND MALIGNANT SPACE-OCCUPIED LESIONS OF THE PERIPHERAL TYPE

87 patients with pulmonary space-occupied lesions of the peripheral type which were either adhesive of close to pleura were examined using ultuasonography.Of them,64 cases of lung cancers and 23 of bening lesions were then confirmed by

超声造影对肝硬化小结节的诊断价值探讨

目的探讨超声造影对肝硬化小结节的诊断价值。方法 2012年2月~2016年2月我院收治的130例肝硬化患者,分别进行增强CT扫描和超声造影检查。结果在130例肝硬化患者肝内169个小结节中,经手术或肝活检组织病理学检查确诊为肝癌92例(70.8%),包括115个病灶;增强CT扫描发现符合肝癌表现者62例,其Kappa值为0.250,诊断的准确率为65.4%(85/130),敏感性为67.4%(62/92),特异性为60.5%(23/38);超声造影发现符合肝癌表现者87例,其Kappa值为0.871,诊断准确率为94.6%(123/130),敏感性为94.6%(87/92),特异性为94.7%(36/38),两者相比,差异显著(P<0.05);增强CT扫描和超声造影诊断的AUC分别为0.630和0.935,后者明显大于前者(P<0.05)。结论超声造影能显著提高对肝硬化小结节的定性诊断,值得临床进一步研究。

肝内胆管细胞癌与炎性病灶超声造影鉴别诊断价值

目的探讨无肝硬化背景的肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICCC)与肝脏炎性病灶超声造影(contrast enhanced Ultrasound,CEUS)鉴别诊断要点。方法无肝炎病史及肝硬化背景、已行超声造影且经病理证实的25例肝内胆管细胞癌患者(男15例,女10例)及13例肝脏炎性病灶患者(男7例,女6例)为本研究对象,病灶中位大小4.9cm(范围1.8~11.4cm)。两组临床资料未见统计学差异。分析两组病例常规超声图像及CEUS灌注特征,探讨两种病变的鉴别诊断特征。结果病理确诊的ICCC病例中,超声造影后有2例(8%)误诊为炎性病灶,3例(12%)未能得出明确诊断;病理确诊的炎性病灶中,有1例(7.7%)误诊为肝内胆管细胞癌,1例(7.7%)未能得出明确诊断;动脉期ICCC表现为周边不规则环状高增强(48%,12/25)或片状强化(52%,13/25),炎性病灶多表现片状强化(84.6%,11/13),二者在动脉期均呈边界不清,形态不规则;开始廓清时间ICCC为(34.5±3.5)秒,炎性病灶为(62.7±12.6)秒(P=0.001)。利用时间-强度曲线,注射造影剂3分钟时肝实质强度与病灶强度差ICCC为10.5±4.7,炎性病灶为3.1±1.8(P=0.001),具有统计学差异。常规超声17例(68%)ICCC显示病灶周围胆管扩张,炎性病灶为1例(7.7%)。结论无肝硬化背景的肝内炎性病灶与ICCC的鉴别诊断需联合联合常规超声及CEUS信息,尤其需重视开始廓清时间及廓清程度。

64层螺旋CT、MRCP和ERCP在肝内胆管占位中的临床应用对比分析

目的探讨64层螺旋CT、MRCP和ERCP在肝内胆管占位中的临床诊断应用价值。方法52例均经B超检查提示有肝内胆管占位的患者，行64层螺旋CT增强扫描后，对原始数据采用多平面重建（MPR）及胆管三维容积重建（SCTC）处理，对胆管占位原因进行定位、定性诊断，其中有12例患者还进行了MRCP和ERCP检查，并与手术病理进行对照和随访观察。结果64层螺旋CT对肝内胆管占位病变定位及定性的准确率分别为100％及94％，MRCP和ERCP对肝内胆管占位病变定位及定性的准确率分别为100％、100％及78％、80％。结论64层螺旋CT具有强大的后处理功能，可无创、清晰、立体显示胆管结构，提高术前对疾病的定性、定位诊断率，对肝内胆管占位诊断有重要价值，并可进一步指导临床手术治疗，是一种很好的无创性检查方法，ERCP和MRCP对64层螺旋CT很难作出定性诊断的病例起到一个辅助诊断的方法。

原发性肝癌体外化学药物敏感性试验及结果分析

目的测定肝细胞性肝癌组织对常用化疗药的敏感性,探讨肝癌组织多药耐药患者的临床病理特征。方法对2010年3月至2011年3月间在中山大学肿瘤防治中心肝胆科行肝癌切除术的100例患者标本进行体外药物敏感性实验,测定目前常用8种化疗药的抑瘤率,包括紫杉醇、开普拓、卡铂、丝裂霉素C、氟脲苷、亚砷酸、表阿霉素和吉西他滨;将患者分为2组:多药耐药组(敏感药物<4种)与非多药耐药组(敏感药物≥4种),分析患者的临床病理特征;分析肝内多病灶数与癌组织耐药数的相关性。结果化疗药物对肝癌组织的抑瘤率从高到低为紫杉醇、开普拓、卡铂、丝裂霉素C、氟脲苷、亚砷酸、表阿霉素和吉西他滨,分别为60%,44%,41%,39%,37%,29%,24%及13%,差异有统计学意义(P<0.05);两组患者的肝内多病灶情况存在显著差异;肝内多病灶数与癌组织耐药数正相关。结论常用化疗药物对肝细胞性肝癌组织的敏感度最高为紫杉醇。肝内多病灶的患者更易发生耐药,而且病灶数目越多耐药数目就越多。

SPECT对肝内占位性病变诊断价值的评价

本文应用单光子发射计算机断层,SPECT 技术对84例肝内占位性病变的诊断进行研究。84例均同时进行了 B 超检查,还检查了 CT 32例,SAG26例,手术24例。结果分析指出 SPECT 诊断准确率为90.4%。本文还介绍了不同占位性病变的 SPECT 显像特点,并就 SPECT 对原发性肝癌、转移性肝癌、肝血管瘤、肝囊肿及脓肿的鉴别诊断提出讨论。

超声造影在慢乙肝肝内中小型局灶性病变的诊断价值

目的:探讨慢性乙型病毒性肝炎患者肝内中、小型局灶性病变在超声造影表现典型与否对临床处理的指导意义。方法:对85例慢性乙型病毒性肝炎患者肝内单个占位性病变(≤5.0 cm)进行超声造影,根据病灶是否为典型增强模式而行不同的临床处理。结果:85例病灶中,72例行手术或随访追踪,13例行穿刺活检。运用此法诊断各种病灶的灵敏度、特异性、阳性预测值和阴性预测值平均值分别是90.8%、99.2%、98.0%和95.3%。结论:慢性乙型病毒性肝炎患者肝内中、小局灶性病变的超声造影增强模式典型与否对指导临床处理具有重要价值。

磁共振LAVA增强及DWI在肝结节性病变与小肝癌诊断的对比研究

目的:探讨磁共振动态增强检查和水分子扩散加权成像(DWI)在肝结节性病变与小肝癌诊断及鉴别诊断的价值及局限性,对比研究两种检查方法对肝脏占位性病变的检出效能。方法:收集125例肝脏占位性病变患者共172个病灶,常规MRI平扫、LAVA增强及DWI检查(b值分别为0和500 s/mm2),对比分析LAVA三期扫描(A组)、DWI(B组)及这两种方法联合应用(C组)在肝结节病及小肝癌检出和定性的诊断价值。结果:在结节检出方面:A组检出146个结节,B组检出138个,C组检出172个,三组组间比较差异有统计学意义(χ2=35.756,P<0.01)。在结节的定性诊断方面:在取得临床或病理证实的116个病例中,A组诊断正确82例(70.7%),B组诊断正确76例(65.5%),C组为108例(93.1%),三组组间比较差异有统计学意义(A组与C组对比χ2=19.653,P<0.01;B组与C组对比χ2=21.274,P<0.01)。结论:动态增强扫描联合DWI有助于提高肝脏结节性病变的检出率,增加诊断信息,提高诊断正确率。

Surgical treatment of a patient with peliosis hepatis: A case report

This report describes a case of a space-occupying lesion in the right liver in a 38-year-old man who was found to have peliosis hepatis. Clinical data of this patient were presented, including medical history, laboratory test and imaging results, and postoperative pathological findings (hematoxylin and eosin staining). Review of his medical history showed that the patient had been bitten by a dog three years earlier. B-mode ultrasonography revealed an uneven echo mass in the right hemiliver, and magnetic resonance imaging scans also showed a mass in the anterior segment of the right liver. Upon surgical removal, the mass was found to be 4.0 cm × 3.8 cm × 3.8 cm in size and located in segment Ⅵ. The mass had a dark and soft appearance, with an irregular edge on intraoperative ultrasonography. Postoperative pathological findings revealed many small capsules filled with blood cells. The patient was diagnosed with peliosis hepatis based on his medical history of having been bitten by a dog, presence of mild anemia, and lack of characteristic symptoms, including fever of unknown origin, abdominal pain, and hepatosplenomegaly, combined with intraoperative and postoperative pathologic findings. The operation was successful, and after being treated with anti-infection agents, the patient had a good recovery.