Tuberculosis versus non-Hodgkin's lymphomas involving small bowel mesentery:Evaluation with contrast-enhanced computed tomography

AIM: To evaluate the specific computed tomography (CT) imaging criteria for differentiating tuberculosis involving the small bowel mesenteric lymph nodes from lymphomas. METHODS: We retrospectively reviewed the anatomic distribution,CT enhancement patterns of lymphoma in 18 patients with mesenteric tuberculosis and 22 with untreated non-Hodgkin’s lymphomas (NHL) involving small bowel mesentery (SBM). Of the 18 patients with tuberculosis,9 had purely mesenteric tuberculous lymphadenopathy (TL),and 9 had mesenteric TL accompanied with tuberculous mesenteritis (TLM). RESULTS: CT showed that tuberculosis and NHL mainly affected lymph nodes in the body and root of SBM. Homogeneously enhanced lymph nodes in the body and root of SBM were found more often in the NHL (P < 0.05). Homogeneously mixed peripheral enhanced lymph nodes in the body of SBM were found more often in mesenteric TL and TLM (P < 0.05). Peripheral enhanced lymph nodes in the root of SBM were found more often in mesenteric TL and TLM (P < 0.01). "Sandwich sign" in the root of SBM was observed more often in NHL (P < 0.05). CONCLUSION: Anatomic lymph node distribution,sandwich sign and specific enhancement patterns of lymphadenopathy in SBM on CT images can be used in differentiating between tuberculosis and untreated NHL involving SBM.

Primary Malignant Renal Tumors in Infancy and Childhood: CT Appearances

Objective： To investigate the imaging manifestation of primary malignant renal tumor with CT. Methods： Forty-three cases of surgically and pathologically confirmed primary malignant renal tumor were retrospectively reviewed. Un-contrast and contrast CT was performed in all 43 patients in which 15 patients received MRI examination. Results： The residual normal renal tissue of 29 cases out of 34 cases of Wilms＇ tumor was enhanced and manifested ＂crescent sign＂ or ＂ring sign＂. Four cases of malignant rabdoid tumor （RTK） manifested as large mass with notable necrosis and subcapsular fluid collection; Two cases of clear cell sarcoma （CCS） showed metastases to the skull which could indicate the diagnosis; Renal cell carcinoma （RCC） （n=3） showed calcification in 1 case. Conclusion： CT can precisely delineate the location, size, extent of involvement, imaging characteristics and metastases of renal tumor, which can provide information necessary to the clinical staging, therapy planning and prognosis of the tumors.

Tuberculous abscess in hepatoduodenal ligament: Evaluation with contrast-enhanced computed tomography

Two patients with tuberculous abscess in the hepatoduodenal ligament were studied. Both patients underwent contrast-enhanced computed tomography (CT) scan. The abscess showed a low density with an irregular thick wall in the hepatoduodenal ligament on CT images, the margin was poorly defined. Contrastenhanced CT images showed the contrast-enhanced thick wall, homogeneous and peripheral-enhanced lymph nodes. Although features of the tuberculous abscess in the hepatoduodenal ligament could be conspicuously shown with contrast-enhanced CT, further experience is needed to evaluate the potential value of CT in detecting early tuberculous abscess in relation to other entities in the hepatoduodenal ligament.

Correlation of the CT values of abdominal aorta,renal artery and renal cortex with its thickness on 64-MDCT contrast enhanced imagesCorrelation of the CT values of abdominal aorta,renal artery and renal cortex with its thickness on 64-MDCT contrast enhance

Objective:To investigate the correlation of abdominal aorta CT value,renal artery CT value and renal cortex thickness with renal cortex CT value on contrast enhanced 64-slice CT images.Methods:96patients(50 men and 46women;16~74years)with normal kidney function,which was confirmed by kidney function test were enrolled in this study,including bilateral kidneys of 92cases and unilateral kidney of 4cases(total of 188kidneys;92left,96right).After intravenous(IV)injection of contrast agent the kidneys of the selected patients were scanned by MDCT.The scans were performed in arterial,venous and 3min delayed phases.All statistical analyses were performed by using IBM SPSS 20.0.Graphs were generated using Graph Pad Prism 5software.Quantitative data were presented as mean±standard deviation,while qualitative data were presented as frequency(%).P<0.05was considered to be statistically significant.Results:The mean renal cortex thickness was(5.19±0.81)mm in all kidneys.In the arterial phase,a statistically significant positive correlation between renal cortex CT values and abdominal aortic CT values was showed(r=0.584;P<0.001).A statistically significant positive correlation between renal cortex CT values and renal cortex thickness was demonstrated(r=0.533,P<0.0001).Likewise,there was a positive correlation between renal cortex CT value and renal artery CT values(r=0.43,P<0.001).Conclusion:It is a promising approach to assess the individual kidney function by measuring abdominal aorta CT value,renal artery CT value,renal cortex CT value and renal cortex thickness using contrast MDCT.

Comparative study of helical CT with contrast-enhanced ultrasound of renal carcinoma

Objective: To investigate the efficiency of helical CT comparing with contrast-enhanced ultrasound, and to im- prove the diagnosis efficiency of renal cell carcinoma (RCC). Methods: Thirty RCCs confirmed pathologically were studied retrospectively. The un-enhanced CT scan and the triphasic enhanced helical CT scan were performed in all cases, the gray-scale US and angiosonography with SonoVue were performed in all cases meantime. Results: 22 cases (73.3%) were diagnosed correctly by helical CT alone before operation. 7 cases (23.3%) were suspected as RCC with helical CT. One case (3.3%) was misdiagnosed with helical CT. 25 cases (83.3%) were diagnosed correctly with contrast-enhanced ultrasound alone pre-operation. One case (3.3%) was suspected as RCC with angiosonography. Four cases (13.3%) were misdiagnosed with angiosonography alone. 29 cases (96.7%) were diagnosed correctly by helical CT combining with angiosonography before operation, one case (3.3%) was diagnosed as renal mass with both helical CT and angiosonography. Conclusion: Contrast-enhanced ultrasound is sensitive in detecting blood flow, it can detect the enhancement of the tumor which cannot be detected by helical CT. CT and angiosonography have strong complement each other in the diagnosis of RCC.

基于多期相CT图像的深度学习ResNet18和ResNet50模型诊断肾结核的效能比较

目的:探讨基于CT图像构建深度学习模型对肾结核进行鉴别诊断的可行性。方法:回顾性分析2018年9月至2020年8月经解放军总医院第八医学中心收治,并经组织病理学或临床确诊的肾结核、肾肿瘤、肾盂肾炎、正常肾脏、肾囊肿、肾积水患者。共纳入200例患者共400个肾脏的CT图像数据。将400个肾脏CT图像分为结核组(114个)和非结核组(286个),并且按8∶2的比例分为训练集(肾结核:85个;非肾结核:235个)和测试集(肾结核:29个;非肾结核:51个)。基于训练集通过ResNet18和ResNet50网络分别构建肾脏平扫期、皮髓质期、实质期和排泄期的深度学习模型;基于测试集评估所构建模型对肾结核的诊断效能,计算受试者工作特征曲线(ROC)曲线下面积(AUC)、敏感度、特异度、准确率和F1分数。结果:训练集中,结核组平均年龄为(41.27±11.75)岁,明显低于非结核组[(54.05±13.97)岁];测试集中,结核组平均年龄为(44.06±11.95)岁,明显低于非结核组[(56.12±10.73)岁],差异均有统计学意义(t值分别为5.753、3.444,P值均<0.05)。训练集中,结核组男性占66.7%(40/60),女性占33.3%(20/60);非结核组男性占60.9%(78/128),女性占39.1%(50/128);两组差异无统计学意义(χ^(2)=0.009,P=0.924)。测试集中,结核组男性占64.3%(18/28),女性占35.7%(10/28);非结核组男性占58.7%(27/46),女性占41.3%(19/46);两组差异无统计学意义(χ^(2)=0.018,P=0.894)。ResNet18模型肾脏各期相的AUC、敏感度、特异度、准确率和F1分数均高于ResNet50模型。ResNet18模型中以皮髓质期为最佳,AUC、敏感度、特异度、准确率和F1分数分别为0.925、93.1%、86.3%、88.7%和0.857;ResNet50模型皮髓质期AUC、敏感度、特异度、准确率和F1分数分别为0.858、72.4%、84.3%、80.0%和0.724。结论:基于多期相CT图像的ResNet18模型诊断肾结核的效能优于ResNet50模型,ResNet18模型中以皮髓质期诊断效能最佳,有较高的临床应用价值。

肾结核的CT诊断——与肾盂造影及病理结果对照研究

目的 研究肾结核的CT特征。材料与方法 搜集经手术病理证实的肾结核 3 0例 ,分析其CT及肾盂造影表现 ,与病理结果对照。结果 对于肾结核的诊断率 ,CT明显高于肾盂造影 (P <0 .0 1)。肾结核CT特征表现为 :断面上聚集成“花瓣”状的多发低密度区。结论 CT扫描对肾结核的诊断具有重要价值。

肾结核的影像学表现及临床应用价值

目的:探讨B超、静脉肾盂造影与CT的肾结核表现及其对肾结核诊断的临床应用价值。方法:54例肾结核患者行B超、静脉肾盂造影与CT检查,分别从肾脏形态改变、肾实质、肾盂肾盏、输尿管、肾功能、有无钙化等方面对肾结核做出诊断;其中21例经手术治疗的中晚期肾结核患者,分别用3种影像学方法对其显示的典型肾结核特点(包括空洞、肾盂输尿管壁增厚和不规则钙化)结果进行分析。结果:B超、静脉肾盂造影及CT诊断肾结核的准确率分别为53.3%,62.8%和90.7%。CT对中晚期肾结核空洞、肾盂输尿管壁增厚和不规则钙化的显示明显优于B超和静脉肾盂造影。结论:CT能够对肾结核病变范围、程度、定位做出正确判断,可作为肾结核治疗前进行评价并制定治疗方案的最有效的影像学检查方法。

肾结核的CT征象和病理关系

目的:探讨肾结核的CT征象和病理之间的关系。方法:肾结核26例,分别经手术(16例)和尿培养(10例)证实,综合其CT征象、手术和病理结果,结合文献资料予以分析。结果:26例肾结核,22例呈大小数量不一的囊状低密度区;2例呈实质性肿块;2例以肾盂肾盏壁增厚伴肾功能下降为主。16例有钙化,2例平扫呈均匀的囊状高密度影。共20例有肾盂和输尿管壁增厚,其中2例部分膀胱壁增厚。结论:肾结核是肾脏的慢性炎症性病变,各期的CT表现差异较大,但仍有相对的特征性,CT能客观地显示各期肾结核的病理特征,是目前肾结核最佳的影像诊断方法之一。

肾结核的CT诊断及病理对照研究

目的探讨肾结核的CT征象及病理基础。方法收集经手术病理及临床相关检查、追踪证实的36例肾结核,回顾分析其在CT(部分予以三维重建技术处理)扫描中的特征。结果36例肾结核中,21例肾盂、输尿管壁增厚并伴有不同程度变形,且2例膀胱侧壁增厚。23例肾功能减退。25例肾皮质变薄。29例呈多发囊状低密度区且围绕肾盂排列,貌似"梅花瓣"状,1例为单发,10例增强延迟扫描见造影剂进入囊腔。18例各式钙化,其中肾自截1例。结论CT在肾结核的诊断中具有一定的特性,并能客观的反映不同时期的病理基础,对临床治疗提供可靠的指导作用。

肾结核的多层螺旋CT动态增强影像特征

目的分析肾结核多层螺旋CT动态增强的影像表现,并提高其诊断水平。方法 20例肾结核(累及双肾10例)患者均经多层螺旋CT平扫及3期增强扫描(皮质期、实质期、肾盂期)。结果在20例的30个病肾中,肾实质密度不均匀29个肾,不同形态钙化15个肾,集合系统不成比例扩张积液14个肾,呈"花瓣"状排列10个肾,合并输尿管上段管壁增厚5个肾,对侧肾积水3个肾,肾脏形态改变28个肾,肾皮质变薄26个肾。3期动态增强扫描显示皮质期及实质期强化程度减低密度不均匀15个肾,肾盂、肾盏、脓腔壁环状强化10个肾。肾盂期,9个肾无造影剂进入集合系统及脓腔,6个肾造影剂进入肾盂、肾盏、脓腔。结论肾结核多层螺旋CT的影像表现多种多样,多层螺旋CT能很好地显示结核病变部位、范围及双肾功能情况,可为临床准确诊断提供重要依据。

患肾功能受损与患肾无功能的肾结核患肾切除者临床表现与影像学表现对比

目的对比患肾功能受损与患肾无功能的肾结核患肾切除者临床表现与影像学表现。方法回顾性收集2012年1月至2018年12月于郑州大学第一附属医院行患肾切除病理证实为肾结核患者的临床资料,共101例。根据患侧肾动态扫描所测肾小球滤过率(GFR)将其分为患肾功能受损组(患肾GFR>20 mL/min)和患肾无功能组(患肾GFR≤20 mL/min)。分析两组患者的临床症状、实验室检查及影像学检查的特点。结果肾结核切除患者病程为0.1-108个月,两组患者LUTS症状、腰痛、肉眼血尿、发热、非发热全身症状比较,差异无统计学意义(均P>0.05)。实验室检查中尿常规异常者86(85.1%)例,其中以镜下血尿为主80(79.2%)例,结核特异性检查中T-SPOT阳性率最高(88.9%),结明三项次之(77.1%);两组患者实验室检查结果比较,差异无统计学意义(均P>0.05)。患肾功能受损组的肾皮质CT增强差值和肾皮质厚度高于患肾无功能组,且动脉期两组患肾CT增强值低于各自对侧肾(均P<0.001)。多数中晚期肾结核患者肾实质结核空洞形成与肾功能受损常同时存在。结论肾结核行患肾切除者,患肾功能受损程度与患肾皮质厚度、CT动脉期患肾增强程度成正相关,而与临床症状严重程度,尿常规、结明三项、T-SPOT等实验室检查指标严重程度,以及泌尿生殖系肾外器官受累程度无关。肾结核CT动脉期与对侧健肾相比,增强程度越低,其肾功能损害越严重。

肾结核病人影像学检查方法评价

目的 :分析肾结核病人的影像学表现 ,评价各种检查方法的优缺点 ,选择敏感的检查手段。方法 :收集经手术病理证实的肾结核病人 2 4例 ,分析其腹部平片 (KUB)、静脉尿路造影 (IVP)、肾逆行造影 (AP)及CT表现 ,并进行比较。结果 :对于肾结核的诊断率 ,KUB +IVP为 4 1 7% (10 2 4 ) ,AP 6 2 5 % (5 8) ,CT 10 0 0 % (2 4 2 4 )。CT :断面上聚集成“花瓣”状的多发低密度灶。结论

慢性肾脏病并发结核病患者行CT和MRI增强检查的安全性研究进展

近年来，慢性肾脏病并发结核病（或疑似结核病）和肺癌患者越来越多，在接受CT或MRI增强检查时会出现一些特殊的不良反应，需要临床医生引起重视。CT增强检查需要使用含碘对比剂，最严重的不良反应是对比剂肾病，对比剂肾病可防可治，选择合适的对比剂品种和剂量，停用肾毒性药物并在增强检查前后进行水化治疗可最大程度地减少慢性肾脏病等高危人群的对比剂肾病发生率。MRI增强检查需使用钆对比剂，最严重的不良反应是肾原性系统性纤维化，肾原性系统性纤维化可防难治；对于慢性肾脏病处于4、5期的患者、急性肾损伤或正在进行透析治疗的患者应避免使用钆对比剂。

肾结核的CT诊断

目的 提高对肾结核CT影像的认识及诊断水平。方法 收集经手术病理证实的肾结核24例,分析其CT表现。结果 肾结核的CT表现有(1)肾髓质多发空洞或脓腔形成(83.3％),呈囊状低密度影围绕相对狭小肾盂呈“花瓣”状排列;(2)肾皮质变薄(75.0％);(3)肾盂及输尿管壁增厚(66.7％),管腔狭窄与扩张并存;(4)结核性空洞洞壁、肾实质钙化及肾自截(58.0％);(5)肾盏轻度扩张,肾盏杯口面侵蚀破坏,相应肾髓质多发小脓腔(16.7％)。而肾体积及外形改变、肾积水或积脓、肾功能不全为继发常见改变。结论 肾结核CT特征表现为:断面上聚集成“花瓣”状多发低密度区,CT扫描对肾结核的诊断具有重要价值。

2017年海南省维持性血液透析患者肺结核流行情况及其影响因素分析

背景慢性肾脏病(CKD)患者进入尿毒症期前常因肾脏原发病接受免疫抑制剂治疗,而进入尿毒症期后多种原因可致其细胞免疫和体液免疫低下,是肺结核侵犯的主要人群。海南省属于中国肺结核高发地区,血液透析患者肺结核患病率数据长期缺如。目的调查2017年海南省维持性血液透析(MHD)患者肺结核流行病学现状,并分析其影响因素,以寻找下一步结核病防控突破点。方法选取2017-01-01至2017-12-30在海南省33家二级以上医院血液净化中心/室行MHD的患者2385例为调查对象。由海南省血液净化质量控制中心统一制定调查表后发放给各医院血液净化中心/室的医疗质控员进行调查与数据资料登记。调查表包含患者一般资料、临床资料、影像学检查结果。按照患者胸部CT检查结果将其分为胸部CT正常患者、非活动性肺结核患者、疑似肺结核患者、肺结核患者。采用多因素Logistic回归分析探究MHD患者出现非活动性肺结核、疑似肺结核、肺结核的影响因素。结果共发放问卷2385份,回收有效问卷1917份,有效回收率为80.37%。1917例MHD患者中,胸部CT正常457例(23.84%),非活动性肺结核336例(17.53%),疑似肺结核1045例(54.51%),肺结核79例(4.12%)。不同性别、年龄、医保类型、肾脏原发病、区域分布的MHD患者胸部CT检查结果比较,差异有统计学意义(P<0.05)。其中≤44岁MHD患者胸部CT检查结果与45~59、60~74、75~89岁患者比较,差异有统计学意义(P<0.05);45~59岁MHD患者胸部CT检查结果与75~89岁患者比较,差异有统计学意义(P<0.05)。海南省城镇居民医疗保险MHD患者胸部CT检查结果与海南省从业人员医疗保险患者比较,差异有统计学意义(P<0.05)。以原发性肾小球疾病(PGN)为原发病的MHD患者胸部CT检查结果与以糖尿病肾病(DN)为原发病患者比较,差异有统计学意义(P<0.05)。北部区域MHD患者胸部CT检查结果与东部、南部、中部区域患者比较,差异有统计学意义(P<0.05)。东部区域MHD患者胸部CT检查结果与南部、西部区域患者比较,差异有统计学意义(P<0.05)。南部区域MHD患者胸部CT检查结果与中部区域患者比较,差异有统计学意义(P<0.05)。西部区域MHD患者胸部CT检查结果与中部区域患者比较,差异有统计学意义(P<0.05)。年龄〔OR=1.492,95%CI(1.303,1.709)〕、区域分布〔北部:OR=5.299,95%CI(3.493,8.038);南部:OR=2.320,95%CI(1.469,3.663);西部:OR=3.817,95%CI(2.454,5.937)〕是MHD患者出现疑似肺结核的影响因素(P<0.05)。年龄〔OR=1.373,95%CI(1.160,1.625)〕、区域分布〔北部:OR=3.739,95%CI(2.219,3.299);南部:OR=1.929,95%CI(1.079,3.448);西部:OR=2.332,95%CI(1.327,4.100)〕是MHD患者出现非活动性肺结核的影响因素(P<0.05)。性别〔OR=2.073,95%CI(1.172,3.665)〕、年龄〔OR=1.944,95%CI(1.466,2.578)〕、区域分布〔北部:OR=5.103,95%CI(1.710,15.224);南部:OR=4.650,95%CI(1.458,14.828);西部:OR=3.260,95%CI(1.004,10.579)〕是MHD患者出现肺结核的影响因素(P<0.05)。结论2017年海南省MHD患者CT检查结果示肺结核患病率为4.12%,将CT检查结果中疑似肺结核和肺结核进行汇总,总的临床肺结核患病率为56.83%;且肺结核患病率在老年、男性、有居民医疗保险的MHD患者中较高,同时在不同原发病患者中,DN患者结核患病率显著高于PGN;海南省中部区域MHD患者肺结核、疑似肺结核患病率均为全省最低。年龄、区域分布是MHD患者出现疑似肺结核、非活动性肺结核、肺结核的影响因素,性别是MHD患者出现肺结核的影响因素,需引起重视。

肾结核的CT诊断

目的 :探讨肾结核的CT表现及其鉴别诊断。方法 :回顾性分析 2 6例经手术病理或其它辅助检查及临床追踪证实的肾结核的CT表现。结果 :2 6例肾结核全部是临床型肾结核 ,肾结核的CT表现随病理的变化而变化。围绕肾盂呈“花瓣样”聚集的多发囊样低密度影是肾结核的特征性表现。肾结核的表现还有 :肾皮质局部或普遍性萎缩变薄 ,肾盂及输尿管壁普遍增厚 ,管腔狭窄或扩张 ,肾实质肿块或钙化 ,肾的体积增大或缩小以及肾功能损害等。肾功能丧失、自截肾是肾结核的晚期表现。结论 :CT扫描对肾结核的诊断具有重要的价值 ,是目前肾结核的最佳的诊断方法。肾结核CT表现不典型时 ,密切结合临床及其它检查是正确诊断的关键。

多排螺旋CT(MSCT)对肾结核的诊断价值

目的探讨MSCT及泌尿成像技术(CTU)、后处理技术对肾结核诊断的应用价值。方法回顾性分析经手术病理及临床证实的30例肾结核CT平扫、增强及CTU扫描表现,应用多平面重建(MPR)、曲面重建(CPR),最大密度投影(MIP)及容积重组(VR)等后处理技术,分析不同时期肾结核的影像特征。结果不同时期肾结核CT表现各具有其特征性,早期典型表现为多发低密度病灶呈花瓣状排列、钙化、肾脏外形的改变,晚期表现为肾积水、肾功能损伤、自截肾及肾周侵润等。结论肾结核在MSCT扫描尤其是CTU检查中有其特征性表现,对肾结核的诊断具有特殊的价值。

多层螺旋CT尿路造影对肾结核的诊断价值

目的分析多层螺旋CT尿路造影(CTU)对肾结核的诊断价值。方法回顾性分析2016年1月至2020年6月78例泌尿系感染患者的CTU成像资料。以手术病理结果诊断肾结核为金标准,采用受试者工作特征曲线(ROC)评估CTU成像在肾结核疾病中的诊断价值。采用Kappa值评价CTU成像诊断结果与病理结果的一致性。结果78例患者中共有42例肾结核。肾结核组患者的CTU特征主要表现为肾体积缩小、肾脓肿、肾盏或肾盂壁增厚、输尿管壁增厚、膀胱壁增厚、肾实质钙化、肾结石、肾积水等。CTU成像鉴别诊断肾结核的诊断价值高达97%,敏感度、特异度分别93%,89%,鉴别诊断结果与病理结果具有较好的一致性(Kappa值为0.793),差异有统计学意义(P<0.01)。结论CTU检查对肾结核疾病的诊断价值较高,可以在泌尿系疾患中推广使用。

Neoplasm-like abdominal nonhematogenous disseminated tuberculous lymphadenopathy: CT evaluation of 12 cases and literature review

AIM: To assess the diagnostic value of computed tomography (CT) imaging in screening for abdominal nonhematogenous disseminated tuberculous lymphadenopathy (TL). METHODS: The CT scans of 12 patients with abdominal nonhematogenous disseminated TL suggestive of neoplasm were retrospectively analyzed in this review. The final diagnoses were confirmed by lymph node pathology for seven patients and by laparoscopic surgery for five patients. All of the patients were treated at our institution between April 1995 and August 2009. RESULTS: The sites of involvement were the periportal (n = 6), peripancreatic (n = 3), periaortic (n = 3), and mesenteric (n = 2) regions. On the plain CT scan, the lymphadenopathy showed a heterogeneous isodensity or hypodensity in 11 patients and a low density in one patient. Peripheral enhancement was observed on the dynamic contrast-enhanced CT scans for all patients. In two cases, scans were more revealing during the portal venous and delayed phases. CONCLUSION: Abdominal lymphadenopathy with predominant peripheral rim-like enhancement on the dynamic contrast-enhanced CT scan may suggest a diagnosis of TL.