Pulmonary lymphoma: computed tomography features with pathologic correlation

Objective: The aim of this study was to analyze the CT and pathology features of pulmonary lymphoma and to improve the understanding of this disease. Methods: The CT findings of 23 cases with pulmonary lymphoma were retrospectively analyzed and correlated with histopathology. Results: Of the 23 cases with pulmonary lymphoma, there were Hodgkin lymphoma (5 cases) and non-Hodgkin lymphoma (18 cases). Multiple lesions were assessed in 16 cases and single lesion in 7 cases. The imaging findings were classified into 3 types: lobar and segmental involvement type (9/23 cases, 39.13%), nodular or mass-like involvement type (8/23 cases, 34.78%) and mixed type (6/23 cases, 26.09%). Air bronchogram sign (14/23 cases, 60.8%), CT angiogram sign (12/23 cases, 52.17%), ground glass opacity nodules (3/23 cases, 13.04%) and lesion across pulmonary lobes (4/23,17.39%) were the characteristic features of pulmonary lymphoma. Conclusion: Relative characteristic CT features of pulmonary lymphoma could be revealed, which shows clinical significance in the diagnosis of the disease.

Utility of CT in differentiating liver metastases of well-differentiated gastroenteropancreatic neuroendocrine neoplasms from poorly-differentiated neuroendocrine neoplasms

Objective： To determine the capability of dynamic enhanced computed tomography（CT） to differentiate liver metastases（LMs） of well-differentiated from poorly-differentiated gastroenteropancreatic neuroendocrine neoplasms（GEP-NENs）.Methods： Patients with LMs of GEP-NENs who underwent dynamic enhanced CT examination in Peking University Cancer Hospital from January 2009 to October 2015 were included and data were retrospectively analyzed. We assessed the qualitative and quantitative CT features to identify the significant differentiating CT features of LMs of poorly-differentiated GEP-NENs from those of well-differentiated GEP-NENs using univariate analysis and a multivariate logistic regression model.Results： The study included 22 patients with LMs of well-differentiated GEP-NENs and 32 patients with LMs of poorly-differentiated GEP-NENs. Univariate analysis revealed statistically significant differences between the LMs of well-and poorly-differentiated GEP-NENs in terms of feeding arteries（36.4% vs. 75.0%, χ2=8.061,P=0.005）, intratumoral neovascularity（18.2% vs. 59.4%, χ2=9.047, P=0.003）, lymphadenopathy（27.3% vs. 81.2%,χ2=15.733, P〈0.001）, tumor-to-aortic ratio in the hepatic arterial and portal venous phase（T-A/AP： 0.297±0.080 vs.0.251±0.059, t=2.437, P=0.018; T-A/PVP： 0.639±0.138 vs. 0.529±0.117, t=3.163, P=0.003） and tumor-to-liver ratio in the hepatic arterial phase（T-L/AP： 1.108±0.267 vs. 0.907±0.240, t=2.882, P=0.006）. The LMs of poorlydifferentiated GEP-NENs showed more feeding arteries, more intratumoral neovascularity, more lymphadenopathy and a lower tumor-to-aortic ratio. Multivariate analysis suggested that intratumoral neovascularity [P=0.015, OR=0.108, 95% confidence interval（95% CI）, 0.018–0.646], lymphadenopathy（P=0.001,OR=0.055, 95% CI, 0.009–0.323） and T-A/PVP（P=0.004, OR=5.3 E–5, 95% CI, 0.000–0.044） were independent factors for differentiating LMs of poorly-differentiated from well-differentiated GEP-NENs.Conclusions： Dynamic enhanced CT features（intratumoral neovascularity, lymphadenopathy and T-A/PVP）are useful in the pathological classification of LMs of GEP-NENs.

Preliminary Application of Perfusion Imaging in Neoplasm in the Brain and Body with Multi-slice Helical CT

Objective： To evaluate the clinical value of perfusion imaging in neoplasm in the brain and body with Multi-slice helical CT. Methods： Twenty-eight patients with neoplasm were subjected to perfusion imaging with multi-slice helical CT, including 22 patients with brain neoplasm and 6 patients with body neoplasm. At first, CT routine scan was preformed to localize central slices of neoplasm. Then perfusion imaging of 4 and identical slices in central slices of neoplasm was performed by using CT cine scan. Scanning images were transferred into ADW3.1 work-station to create and analyze perfusion images and parameters. Results： Perfusion parameters of cerebral neoplasm had a remarkable increase. But, CBF value of different cerebral neoplasms had partial overlap; CBV value was increased slightly; MTT value had no apparently clinical value; PS value was increased significantly, pituitary neoplasm〉meningoma〉cerebral glioma≈cerebral metastasis. PS value could reveal the characters of cerebral neoplasm and had apparently clinical value. Perfusion parameters of body neoplasms have a remarkable increase too. Body tumors were liable to be interfered by breath movement. Perfusion parameters were helpful to differentiation diagnosis of neoplasm in the brain and body. PS images of neoplasm in the brain and body were helpful to defining tumor outline and finding small tumor. Conclusion： MSCT perfusion imaging provided a precise and relative simple method to quantitatively estimate blood perfusion status in tumors in the brain and body. The technique can be easily implemented on clinical scanners.

Clinical study of stomach neoplasm CT perfusion imaging

Objection:The purpose of this study is preliminarily to discuss stomach perfusion imaging technique with Multi-slice CT and its clinical application value in stomach neoplasm.Methods:Fifteen patients with known stomach neoplasm performed perfusion imaging with 4 or 16 slice CT.Performing perfusion imaging in central slice of neoplasm,using CT cine scan,slice thick 10 mm/2i;with high pressure syringe,injecting quickly from right elbow-front vein,dosage 45-50 mL,injec-tion rate 3.5-4.0 mL/s,scanning delay time 5 s,scanning total time 45 s.We performed perfusion CT post-processing using pancreatic mode of perfusion CT software.Blood flow(BF),blood volume(BV),mean transit time(MTT),and permeability surface(PS) of gastric wall and tumor were computed for every case.Results:BF,BV,MTT and PS of gastric tumor were 116.68 ± 90.09 mL/(min·100 g),9.57 ± 8.12 mL/100 g,10.07 ± 7.74 s,20.78 ± 19.68 mL/(min·100g),respectively.The P values for each CT perfusion parameters between gastric tumor and normal gastric wall were 0.001,0.021,0.155 and 0.031,respectively.Conclusion:Perfusion CT can provide hemodynamics of gastric tumors and play a key role in the diagnosis of gastric tumors.It's clinical application prospect will be fully broad.

Solitary extramedullary plasmacytoma in retroperitoneum:A case report and review of the literature

Extramedullary plasmacytoma(EPM) is a plasma cell tumor arising outside of the bone marrow.Solitary EMP is an uncommon neoplasm and rarely occurs in the retroperitoneum and lacks distinctive clinical manifestations.We report a 26-year-old man with a solitary EMP in the retroperitoneum and discuss its clinical features,diagnosis and treatment.

Progression of hepatic hyperperfusion disorders revealed during follow-up CT scan of digestive system neoplasm

Objective： The aim of this study was to investigate progression of hepatic hyperperfusion disorders revealed during follow-up contrast material-enhanced multi-slice spiral computed tomography （MSCT） scan of digestive system neoplasm. Methods： Three-phase contrast material-enhanced MSCT were performed during the follow-up in patients with digestive system malignant tumor confirmed histologically. The progression of hepatic hyperperfusion disorders revealed on contrast material-enhanced CT image were investigated at the 2 years follow-up with approximately 6 months interval. Results： The hepatic hyperperfusion disorders were showed in 39 patients on follow-up contrast material-enhanced MSCT scans. Among the 39 patients, initial hyperperfusion disorders were revealed in 6 （15.38%）, 26 （66.67%）, and 7 （17.95%） patients in 6, 12, and 18 months during follow-up respectively. The initial hyperperfusion disorders revealed in 12 months were more frequent than those revealed in 6 months （X2 = 14.82, P 〈 0.05） and 18 months （X2 = 15.02, P 〈 0.05）. Among the 39 patients, the hyperperfusion disorders progressed into liver metastasis based on typical CT findings in 37 （94.87%） patients, and were not obvious changes in 2 （5.13%） patients. Among the 37 patients, the hyperperfusion disorders progressed into metastasis in 10 （25.64%） patients in 6 months after the hyperperfusion disorders were revealed, and in 27（69.23%） patients in 12 months. The hyperperfusion disorders developing into metastasis were more in 12 months than those in 6 months （X2= 14.98, P 〈 0.05）. Conclusion： Most hepatic hyperperfusion disorders revealed at the follow-up of digestive system neoplasm may be early manifestations of liver metastasis. The careful follow-up of hepatic hyperperfusion disorders is necessary.

Research progresses of dual-layer spectral detector CT for preoperative evaluation on colorectal cancer

Dual-layer spectral detector CT is a new spectrum CT imaging technology based on detector being able to obtain both images similar to true plain and spectral images in one time scanning.The reconstructed multi-parameter spectral images can not only improve image quality,enhance tissue contrast,increase the visualization and detection ability of occult lesions,but also provide qualitative and quantitative analysis of the lesions,so as to provide more imaging information and multi-dimensional diagnostic basis.The research progresses of dual-layer spectral detector CT for preoperative evaluation on colorectal cancer were reviewed in this article.

Contrast-enhanced ultrasound and contrast-enhanced computed tomography for differentiating mass-forming pancreatitis from pancreatic ductal adenocarcinoma:a meta-analysis

Background:Patients with mass-forming pancreatitis(MFP)or pancreatic ductal adenocarcinoma(PDAC)presented similar clinical symptoms,but required different treatment approaches and had different survival outcomes.This meta-analysis aimed to compare the diagnostic performance of contrast-enhanced ultrasound(CEUS)and contrast-enhanced computed tomography(CECT)in differentiating MFP from PDAC.Methods:A literature search was performed in the PubMed,EMBASE(Ovid),Cochrane Library(CENTRAL),China National Knowledge Infrastructure(CNKI),Weipu(VIP),and WanFang databases to identify original studies published from inception to August 20,2021.Studies reporting the diagnostic performances of CEUS and CECT for differentiating MFP from PDAC were included.The meta-analysis was performed with Stata 15.0 software.The outcomes included the pooled sensitivity,specificity,positive likelihood ratio(+LR),negative likelihood ratio(-LR),diagnostic odds ratio(DOR),and summary receiver operating characteristic(SROC)curves of CEUS and CECT.Meta-regression was conducted to investigate heterogeneity.Bayesian network meta-analysis was conducted to indirectly compare the overall diagnostic performance.Results:Twenty-six studies with 2115 pancreatic masses were included.The pooled sensitivity and specificity of CEUS for MFP were 82%(95%confidence interval[CI],73%-88%;I^(2)=0.00%)and 95%(95%CI,90%-97%;I^(2)=63.44%),respectively;the overall+LR,-LR,and DOR values were 15.12(95%CI,7.61-30.01),0.19(95%CI,0.13-0.29),and 78.91(95%CI,30.94-201.27),respectively;and the area under the SROC curve(AUC)was 0.90(95%CI,0.87-92).However,the overall sensitivity and specificity of CECT were 81%(95%CI,75-85%;I^(2)=66.37%)and 94%(95%CI,90-96%;I^(2)=74.87%);the overall+LR,-LR,and DOR values were 12.91(95%CI,7.86-21.20),0.21(95%CI,0.16-0.27),and 62.53(95%CI,34.45-113.51),respectively;and,the SROC AUC was 0.92(95%CI,0.90-0.94).The overall diagnostic accuracy of CEUS was comparable to that of CECT for the differential diagnosis of MFP and PDAC(relative DOR 1.26,95%CI[0.42-3.83],P>0.05).Conclusions:CEUS and CECT have comparable diagnostic performance for differentiating MFP from PDAC,and should be considered as mutually complementary diagnostic tools for suspected focal pancreatic lesions.

CT在原发性腹膜后肿瘤诊断中的价值评估

目的 :评估CT在原发性腹膜后肿瘤诊断中的价值。材料和方法 :回顾性分析经手术和病理证实的30例原发性腹膜后肿瘤的CT平扫和增强表现 ,并与手术病理结果对照。结果 :腹膜后肿瘤的主要定位征象为腹膜后器官和血管受压前移或侧移 ,肿瘤与相邻后腹壁或盆壁肌肉、脂肪间隙不清晰或消失 ,肿瘤与腹腔内脏器间隔的完整 ,术前CT定位诊断准确率为86.7 % (26/30) ;对良恶性判断的准确率为83.3 % (25/30) ;神经源性肿瘤表现为水样密度或软组织密度 ,脂肪肉瘤呈现为囊实性或软组织密度肿块 ,嗜铬细胞瘤以囊变和明显强化为主要表现 ,畸胎瘤、脂肪瘤各有特征性表现 ,术前病理组织类型判断准确率为33.3 % (10/30)。结论 :CT对原发性腹膜后肿瘤定位诊断可靠 ,对肿瘤良恶性预测具有帮助作用 。

多层螺旋CT在喉癌及喉咽癌术前T分级中的作用

喉癌及喉咽癌是头颈部常见恶性肿瘤，手术方式多种多样，其宗旨是彻底切除肿瘤的前提下，尽量保留或重建喉功能，有效改善患者的生活质量，因此术前明确肿瘤侵犯的范围和分期对临床治疗方案的选择有重要价值。笔者应用16层螺旋CT对喉癌及喉咽癌进行术前分析，评价其在术前T分级中的临床应用价值。

腹膜后平滑肌肉瘤:多排螺旋CT动态增强表现及其病理基础

目的分析腹膜后平滑肌肉瘤的CT表现及其与病理的关系,以提高诊断准确性。方法回顾性分析经手术病理证实的腹膜后平滑肌肉瘤9例,术前经多排螺旋CT平扫和动态增强扫描,复习CT扫描结果并和手术病理进行对照分析。结果 9例腹膜后平滑肌肉瘤中,肿瘤呈椭圆形7例,不规则形2例;5例边缘毛糙,4例边缘较光整;肿瘤直径4.7-14.6 cm,平均8.3 cm。肿瘤平扫密度不均匀,9例均见片状低密度坏死区,范围大小不一,3例可见钙化。动态增强肿瘤实质成分呈进行性持续强化,强化较明显,坏死区无强化,4例瘤内可见血管影,肿瘤血管形态欠规则,1例肿瘤周围可见丰富滋养血管,2例肿瘤与髂总动脉境界不清。镜下肿瘤细胞丰富,呈梭形,细胞明显异型,可见凝固性坏死灶,核分裂数约12-16个/10 HPF。免疫组织化学结果为SMA（＋）、Des（＋）、Vim（＋）、EMA（-）或少量阳性、CEA（-）。结论腹膜后平滑肌肉瘤的CT表现具有一定的特征性,CT对其诊断具有较大价值。

外生性肾血管平滑肌脂肪瘤与腹膜后脂肪肉瘤的CT征象分析

目的探讨CT征象能否准确诊断与鉴别外生性肾血管平滑肌脂肪瘤与腹膜后脂肪肉瘤。方法回顾性分析17例外生性肾血管平滑肌脂肪瘤和7例腹膜后脂肪肉瘤的MDCT图像,使用Fisher确切概率法对CT征象与两种肿瘤之间的关系进行比较。结果肿块与肾脏交界面的肾皮质缺损、肿块内粗大血管、肾动脉分支供血及肿块内血管穿过肾实质走行仅或主要见于外生性肾血管平滑肌脂肪瘤(P均<0.01);肾脏向前移位和肿块内非脂肪成分强化结节灶仅或主要见于腹膜后脂肪肉瘤(P均<0.01)。钙化、肿块内和(或)周围出血及合并的其他血管平滑肌脂肪瘤在外生性肾血管平滑肌脂肪瘤和腹膜后脂肪肉瘤中的差异并无统计学意义(P均>0.05)。结论 CT征象能有效鉴别外生性肾血管平滑肌脂肪瘤与腹膜后脂肪肉瘤。

腹膜后良性神经鞘瘤的影像学特征

目的分析腹膜后良性神经鞘瘤的CT和MRI表现,总结其影像学特征。资料与方法经手术病理证实的27例腹膜后良性神经鞘瘤患者中,21例行多层螺旋CT检查,9例行MRI检查。观察CT、MRI平扫和增强时肿瘤的特征性改变。结果 27例腹膜后良性神经鞘瘤边缘规则光整,直径多在5～10cm之间,CT平扫肿瘤呈实性或囊实性。CT增强后动脉期轻至中度强化10例,主要呈云絮状、索条状强化;动脉期9例可见纤细血管显影。门脉期及延迟扫描轻度渐进性强化13例。MRI平扫呈不均匀长T1长T2影,DWI呈高信号,4例可见靶征改变,增强后门脉期及延迟呈渐进性强化。无一例发生淋巴结转移。结论腹膜后良性神经鞘瘤影像学表现具有一定特异性,CT结合MRI检查及多期增强扫描对其诊断有一定价值。

腹膜后原发肿瘤的CT表现

目的 探讨腹膜后原发肿瘤的特征性CT表现。材料与方法 对 2 5例经穿刺活检或手术后病理证实的腹膜后原发肿瘤的CT表现进行回顾性分析。结果 CT显示腹膜后原发肿瘤的敏感性为 10 0 % ,定位诊断正确率为 84.0 % ,良、恶性定性诊断率为6 8.0 %。肿瘤径线较大 ,腹膜后器官和相邻的血管受压移位 ,肿瘤与邻近腹腔内器官间的脂肪间隙中断或消失 ,以及与邻近盆壁和/或腹后壁间界限不清均为肿瘤定位、定性特征性CT表现。结论 CT对腹膜后原发肿瘤定位。

儿童腹膜后副神经节瘤CT影像学特点分析

目的：分析儿童腹膜后副神经节瘤的CT影像学特点,结合其病理特征,提高临床医生对本病的诊治水平。方法：对病理诊断为腹膜后副神经节瘤的4例（男2例,女2例）患儿的CT资料进行回顾性分析,其中1例行CT平扫＋增强＋三维扫描,其他3例行平扫＋增强扫描。结果：CT平扫显示腹膜后软组织密度影,肿瘤实体CT值为26-40 HU,密度不均,肿物直径4-9.5 cm。CT增强扫描显示肿物呈不均匀强化,内部可见星芒状无强化液性坏死区,其内及周边均有多发血管影,1例三维重建提示周边可见囊性变肿块与邻近血管结构分界不清。结论：儿童腹膜后副神经节瘤为少见肿瘤,CT检查可以清楚显示腹膜后副神经节瘤的大小、边界、密度、血运及肿瘤内物质组成。血运异常丰富的腹膜后肿瘤应高度怀疑副神经节瘤,并结合临床表现、病理组织检查对病变做出较准确的诊断及治疗。

原发性腹膜后肿瘤CT诊断(附50例分析)

目的：分析原发性腹膜后肿瘤的CT表现，探讨CT对其鉴别诊断要点。材料和方法：50例经手术和病理证实的原发性腹膜后肿瘤，其中良性15例，恶性35例，均行CT平扫及增强检查。结果；CT定位诊断正确46例，占92％。定性诊断正确36例，占72％。结论：CT对原发性腹膜后肿瘤的鉴别诊断有重要意义。

原发性腹膜后脂肪肉瘤CT表现与病理对照分析

目的：探讨原发性腹膜后脂肪肉瘤（PRI。）的CT表现及与病理组织学的关系。方法：搜集经术后病理证实的12例PRI。，回顾性分析其CT表现及与病理类型的关系。结果：肿瘤最大径为8～27cm，1例圆细胞型及1例多形性型呈椭圆形，其余10例均呈显著不规则分叶状或铸型生长。CT平扫表现：8例可见脂肪组织，分别为分化型3例、去分化型2例、混合型3例；4例未见明显脂肪组织，其中2例黏液型以液性密度为主，1例圆细胞型及1例多形性型v；t软组织密度为主；2例混合型肿块内伴有大块致密钙化。CT增强扫描表现：8例行增强扫描，其中2例脂肪瘤型可见软组织密度结节及条索影轻度强化；1例硬化型软组织团块呈轻度强化；2例黏液型可见索条分隔样轻度强化及整体云絮样轻度强化；1例去分化型中的去分化瘤体区域、1例多形性型及l例伴有钙化的混合型中的多形性瘤体区域均可见明显不均匀强化。结论：PRI。病理组织学的多样性决定了其CT表现的多样性，不同亚型CT表现具有各自特点，并能反映各自病理类型的特征。

腹膜后神经源性肿瘤的CT诊断

目的:分析腹膜后神经源性肿瘤的CT表现,提高对良、恶性腹膜后神经源性肿瘤的鉴别诊断能力。方法:对23例经手术病理证实的腹膜后神经源性肿瘤的CT征象进行回顾性分析。结果:良性13例、恶性10例。13例良性神经源肿瘤CT大多表现为圆形、类圆形软组织肿块,密度均匀,轮廓光滑,其中神经鞘瘤和节细胞神经瘤可见斑点状钙化。10例恶性神经源性肿瘤,CT显示瘤体大而不规则,混杂密度,边缘不光滑,肿瘤可液化坏死、融合或侵蚀周围组织。CT增强扫描肿瘤表现为均匀或不均匀强化。CT对其良、恶性的诊断符合率为78%,组织类型诊断符合率为60.9%。结论:腹膜后神经源性肿瘤的好发部位有一定特征性,结合CT表现有助于良、恶性的鉴别,但对病理组织类型诊断有局限。

腹膜后副神经节瘤CT诊断

目的:探讨腹膜后副神经节瘤的CT表现特征。方法:回顾性分析10例经手术病理证实的原发性腹膜后副神经节瘤CT资料,并与病理结果进行对照分析。结果:病灶均为单发,6例发生于腹主动脉左侧,4例发生于腹主动脉右侧,肿块直径均大于4cm,其内密度不均,中间均可见不规则低密度坏死区,其中4例可见斑片、点状及线状高密度钙化灶,8例增强扫描瘤体实质部分明显强化,3例可见瘤体内明显强化的纡曲扩张血管,坏死区不强化。8例病灶与周围组织边界清楚,2例侵犯周围组织。结论:原发性腹膜后副神经节瘤的CT表现具有一定特征性,CT检查有助于原发性腹膜后副神经节瘤的定位定性及明确肿瘤与周围组织结构的关系。

腹膜后去分化脂肪肉瘤的CT表现及术后一年内复发的预后分析

目的:探讨腹膜后去分化脂肪肉瘤(DDL)的CT影像分型及其术后1年内的复发情况,初步探索二者间可能存在的联系。方法:选取2010年11月-2020年12月经手术病理证实的腹膜后去分化脂肪肉瘤病例31例,回顾性分析其CT影像表现及其术后一年内的复发情况,探究肿瘤术后1年内的预后影响因素并评估基于CT影像表现的分型在提示肿瘤术后复发方面的应用价值。结果:①年龄、性别、肿瘤瘤体长径、肿块是否多灶、肿瘤类型(原发/继发)等指标均与腹膜后DDL术后1年内复发情况无关(P>0.05)。CT上肿瘤脂肪成分占比、肿瘤内是否有偏囊性低密度区、肿瘤内不同密度成分相互移行是否模糊等指标为腹膜后DDL术后1年内复发的危险因素(P<0.05)。②Kaplan-Meier法单因素生存分析结果显示:影像分型Ⅰ型组(10.583月)患者肿瘤术后1年内平均复发间隔时间长于Ⅲ型组(7.616月),差异有统计学意义(P=0.021),而Ⅱ型与Ⅰ型、Ⅱ型与Ⅲ型之间呈现出的平均复发间隔时间之间的差异均无统计学差异(P值分别为0.423、0.417)。结论:腹膜后去分化脂肪肉瘤因肿瘤组织成分及分布不同其CT影像表现形式多种多样,成熟脂肪成分越少或实性成分越混杂(内伴或不伴有脂肪成分)的肿瘤术后1年内复发率更高,基于CT影像表现的分型在对DDL的术前诊断、术后随访及预后提示等方面具有一定的指导意义。