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.

Thrombosed prosthetic valve in Ebstein's anomaly:Evaluation with echocardiography and 64-slice cardiac computed tomography

Ebstein's anomaly(EA) is a rare cardiac congenital malformation with displacement of septal and posterior tricuspid leaflets,resulting in atrialization of the right ventricle.We report a case of EA in which the etiology of a malfunctioning prosthetic tricuspid valve is depicted on cardiac computed tomography to be as a result of thrombus lodged in the valve.

Correspondence of CT perfusion imaging to pathological manifestations in rabbit models of hyperacute cerebral infarction

BACKGROUND： Could the infarction be diagnosed quickly and accurately at the acute stage by CT perfusion imaging （CTPI） technology？ Whether the images of CTPI will correspond with the pathological changes or not？ All the questions need to be solved by experimental and clinical studies. OBJECTIVE： To reveal the rules of perfusion map changes and guide the early diagnosis of hyperacute cerebral infarction by analyzing the correlation of CTPI with pathological manifestations for hyperacute cerebral infarction. DESIGN： A randomized controlled animal experiment. SETTING： Experimental Center of Medical Radiology, Longgang Central Hospital of Shenzhen City. MATERIALS： Forty-two adult New Zealand rabbits of （2.6±0.5） kg, either male or female, were randomly divided into experimental group （n =36） and control group （n =6）. Six rabbits in the experimental group were observed after ischemia for 0.5, 1, 2, 3, 4 and 6 hours respectively, and 1 rabbit in the control group was observed at each corresponding time point. METHODS： The experiments were carried out in the Experimental Center of Medical Radiology, Longgang Central Hospital of Shenzhen City from March 2003 to July 2004. Rabbit models of cerebral infarction were established by modified O＇Brein method. （1） The rabbits in the experimental group were scanned at 0.5, 1, 2, 3, 4 and 6 hours after ischemia respectively. The dynamic CT scan slice was 13 mm from the anterior edge of the frontal cortex, and six fake color functional images were obtained, including cerebral blood flow map （CBF map）, cerebral blood volume map （CBV map）, peak to enhancement map （PE map）, flow without vessels map, time to peak map （TP map）, time to start map （TS map）. The manifestations and changes of the functional maps in different interval were observed. （2） Bilateral symmetric ranges of interest （ROI） were drawn separately on the CBF map, CBV map, TP map and TS map. The blood flow parameters of focal and contralateral cerebral tissues could be obtained to calculate relative cerebral blood flow （rCBF, rCBF=focal CBF/contralateral CBF）, relative cerebral blood volume （rCBV, rCBV= focal CBV/contralateral CBV）, a relative time to peak （rTP, rTP= focal TP - contralateral TP）, a relative time to start （rTS, rTS= focal TP - contralateral TP）. （3） The perfusion maps were input into AutoCAD software. The percents of ischemic cores and peri-ischemic areas accounting for contralateral cerebral hemisphere were calculated. （4） The animals were anesthetized and killed, then the cerebellum and low brain stem were taken out. The brain tissues were cut on coronal plane at 14 mm from the anterior edge of the frontal cortex, a 2-mm piece anterior to the incision, and a 3-mm piece posterior to the incision. The anterior piece was fixed, stained and observed. A 1-mm slice was cut from the front of the posterior piece tissues as electron microscope sample, the remnant was fixed and then taken out, and the location and size of stained ＂white＂ areas were observed as the reference for electron microscope sample. （5） The correlation between CTPI and pathological manifestations was observed. MAIN OUTCOME MEASURES： （1） Laws of time and spatial changes of ischemic areas; （2） Pathological changes of the ischemic tissues; （3） Correspondency between CTPI and pathological manifestations. RESULTS： （1） Laws of time and spatial changes of ischemic areas： Relative ischemic-core areas were consistent in each perfusion map, increased incessantly along with the ischemic times. Relative peri-ischemic areas were inconsistent in each perfusion map, on CBF map from 1 to 6 hours after ischemia, the area of ischemic core increased from （1.503±0.523）% to （7.125± 1.054）%, the ascending trend occurred. But the peri-ischemic areas showed a descending trend on CBF map, the areas decreased from （8.960±0.719）% to （5.445 ± 0.884）% from 0.5 to 6 hours; The relative areas were the largest one on TP maps, the average value was （32.796±3.029）% at 0.5 hour after ischemia happening （60.540±1.683）% at 6 hours. The trend of ischemic areas was increased. No obvious change was observed on TS maps. （2） Pathological changes of the ischemic tissues： Under light microscope, there was no obvious change at 0.5- 2 hours after ischemia, edema at 3 hours, karyopycnosis at 4 hours and eosinophilous changes at 6 hours; Under electron microscope, there was edema in ischemic cores within 4 hours after ischemia, whereas karyopycnosis or structure vanished after 4 hours; Edema was observed in peri-ischemic areas. （3） Correlation between CTPI and pathological manifestations： On CTPI maps, the ischemic core was blue on CBF and CBV maps, black on TP and TS maps. Along with the ischemic times, the rCBF and rCBV decreased, whereas the rTP and rTS prolonged. Hemodynamic parameters were not significantly different within 2 hours of ischemia and 2 hours after ischemia. The rTP and rTS became 0 after 1 and 2 hours respectively. On CTPI maps the peri-ischemic area was red on CBF and CBV maps, red and yellow on TS maps, red on TP maps. Along with the ischemic times, the rCBF decreased, and the lowest level was always at about 20%, whereas the rTP and rTS prolonged. CONCLUSION： （1） CTPI manifestations corresponded well with pathological findings, and it is a sensitive, stable and reliable technique to diagnose hyperacute cerebral infarction. （2） TP map was more sensitive than CBF map and TS map in exhibiting the peri-ischemic areas, thus TP maps could be a good choice for observing peri-ischemic areas.

The Use of Multislice Spiral CT to Predict the Resectability of Central Lung Cancer： Correlation with Pathologic and Surgical Findings

OBJECTIVE To assess the accuracy of multi-slice spiral CT （MSCT） with imaging reconstruction in judging central pulmonary vascular involvement from central lung cancer, and to explore its ability to predict the resectability of lung cancer. METHODS MSCTs were conducted on 48 patients who were diagnosed preoperatively with central lung cancer. Images of pulmonary arteries and veins that might affect Iobectomy or pneumonectomy were reconstructed by means of imaging processing techniques. Then the relationship of the tumor to the vessels was assessed prospectively on both axial CT images and axial CT images plus reconstructed images（CT-RI） in comparison to subsequent pathologic and surgical findings. RESULTS MSCTs were obtained on all 48 patients whom 42 underwent thoracotomy, Iobectomy or pneumonectomy. Compared with the axial CT images, CT-RI was more accurate in judging the relationship of the central pulmonary vessels to the tumor based on subsequent pathologic 78 vessels studied and surgical findings （186 vessels studied）（0.01 〈P〈0.05）. The sensitivity and positive predictive value of unresectability of the vessels were all remarkably higher with CT-RI （P〈0.01）. CONCLUSION MSCT with imaging reconstruction can improve the recognition of neoplastic invasion of central pulmonary vessels. It can be used to predict preoperatively the resectability of central lung cancer and to plan surgery.

Cavitary Pulmonary Metastases: CT Features and Their Correlation with the Pathology of the Primary Malignancy

Objective: To study CT features of cavitary pulmonary metastases and to investigate the pos- sible relationship between CT features and the pathology of the primary lesions. Methods: CT ?ndings of 131 cavitary metastatic nodules in 40 patients with pathologically-proved pulmonary metastases were retrospectively analyzed. A comparison between CT signs and the pathologic types of the primary tumors was made. Results: Cavitary metastases and multiple solid nodules coexisted in all patients. Cavitary metastases presented as bubble (n=41), irregular (n=33), cystic (n=26) or small circular (n=31) cavities, with even (n=61) or uneven (n=70) thickness of the cavity wall. Of 131 cavitary nodules, diameter less than 15 mm was seen in 44, between 15–25 mm in 66, 25–40 mm in 17 and larger than 40 mm in 4 respectively. And the wall thickness of the cavity below 4 mm, between 4–15 mm and over 15 mm was respectively seen in 69, 44 and 18 metastatic nodules. Cavitary pulmonary metastases mainly occurred in patients whose primary malignancy was squamous cell carcinoma (n=13) or adenocarcinoma (n=22). Both squamous cell carcinoma and adenocarcinoma had its own CT characteristics. The occurrence of cavity bore no relationship to its site in the lung. Conclusion: Cavitary pulmonary metastases carries certain CT features and its occurrence is related to the pathologic type of the primary malignancy.

基于CT深度学习鉴别胸腺瘤组织学分型的临床应用价值

目的研究基于CT深度学习鉴别胸腺瘤组织学分型的临床应用价值。方法回顾性分析2014年1月—2023年3月于本院经术后病理证实的179例胸腺瘤患者的临床资料,按7︰3比列将研究对象分为训练集(n=125)和验证集(n=54)。本研究采用ResNet50作为卷积神经网络模型,提取深度学习特征,并运用主成分分析(PCA)、相关性分析和最小绝对收缩和选择算子(LASSO)算法筛选出最优深度学习特征,建立鉴别胸腺瘤组织学分型的深度学习模型(DTL Signature)。利用Logistic回归构建临床模型、深度学习模型和联合模型。绘制受试者工作特征曲线(ROC),并计算曲线下面积(AUC),评估3种模型鉴别胸腺瘤组织学分型的临床效能。结果筛选出11个CT平扫深度学习特征,并建立深度学习模型,在训练集和验证集中,其受试者工作曲线(ROC)下面积(AUC)分别为0.877、0.795,均高于临床模型的AUC,但差异均无统计学意义(Z=1.903、1.033,P均>0.05)。在训练集和验证集中,临床模型与深度学习模型构建联合模型,其ROC的AUC分别为0.890、0.841,均高于临床模型,且差异有统计学意义(Z=2.647、3.041,P均<0.05)。结论基于CT平扫的深度学习联合模型有利于鉴别胸腺瘤组织学分型,临床获益较高,值得临床推广应用。

Development and validation of a CT-based radiomics nomogram for preoperative prediction of tumor histologic grade in gastric adenocarcinoma

Objectives:To develop and validate a radiomics nomogram for preoperative prediction of tumor histologic grade in gastric adenocarcinoma(GA).Methods:This retrospective study enrolled 592 patients with clinicopathologically confirmed GA(low-grade:n=154;high-grade:n=438)from January 2008 to March 2018 who were divided into training(n=450)and validation(n=142)sets according to the time of computed tomography(CT)examination.Radiomic features were extracted from the portal venous phase CT images.The Mann-Whitney U test and the least absolute shrinkage and selection operator(LASSO)regression model were used for feature selection,data dimension reduction and radiomics signature construction.Multivariable logistic regression analysis was applied to develop the prediction model.The radiomics signature and independent clinicopathologic risk factors were incorporated and presented as a radiomics nomogram.The performance of the nomogram was assessed with respect to its calibration and discrimination.Results:A radiomics signature containing 12 selected features was significantly associated with the histologic grade of GA(P<0.001 for both training and validation sets).A nomogram including the radiomics signature and tumor location as predictors was developed.The model showed both good calibration and good discrimination,in which C-index in the training set,0.752[95%confidence interval(95%CI):0.701-0.803];C-index in the validation set,0.793(95%CI:0.711-0.874).Conclusions:This study developed a radiomics nomogram that incorporates tumor location and radiomics signatures,which can be useful in facilitating preoperative individualized prediction of histologic grade of GA.

The Comparison of the Manifestation of the Clinical Imageology and Pathology between the Brucellar Spondylitis and the Spine Turberculosis

Objective: To improve the clinical differential diagnosis level, the clinical manifestation of the brucellar spondylitis and the spine turberculosis were discussed in this paper. Method: The study was completed in the No. 1 Affiliated Hospital of Hebei North University in Zhangjiakou City, Hebei Province, China, from January 2001 to December 2013 by Analyzing the X-ray, CT scanning and MRI of 257 cases of the brucellar spondylitis retrospectively and comparing with the clinical imageology and pathology 332 cases of turberculosis of the spine diagnosed finally. Results: The brucellar spondylitis: The focuses usually locate in the lumbar vertebra and L4, 5 has the highest occurrence rate. The focuses are often small but multiple, and limited to the edge of the vertebra. Hyperostosis and osteoscterosis are usually found in the tissuses around the focuses. There are often new focuses in the newborn bones, and the destruction of intervertebral discs is usually slight. Hyperostosis and osteoscterosis might be found in the surfaces of the joints. The densites of the bones close to the focuses become high. There were less or no paravertebral abscesses but inflammational granuloma can be found frequently. Turberculosis of the spine: The focuses are usually located in the thoracic and lumbar vertebra, and are characterized by the destruction of the vertebra and the intervertebral discs, accompanied by the appearance of dead bones. In most cases, paravertebral abscesses and osteoporosis might be found. Conclusions: The specific manifestation of the clinical imageology can help to differentiate the brucelar spondylitis from the turberculosis of the spine.

Correlation between Calcified Liver Metastases and Histopathology of Primary Colorectal Carcinoma in Chinese

The study examined the association between calcified liver metastases and the histopathology of the primary colorectal carcinoma in Chinese.The clinical,pathological and CT data were retrospectively analyzed in 210 patients (mean age:54.2 years) with liver metastases from colorectal carcinoma.Plain CT scanning and contrast-enhanced scanning were performed in all the patients.For the contrast-enhanced examination,iohexol was injected by using a high pressure syringe at a flow rate of 2.5-3.0 mL/s.The arterial phase lasted approximately 25 s and the portal venous phase about 60 s.All patients had no history of chronic liver diseases and had never received interventional treatments.χ 2-test was used to analyze the rate of calcification in the liver metastasis from colorectal cancer of different differentiation degrees.Among the 210 cases of liver metastases,22 patients (10.5%) were found to have calcified liver metastases on CT scan.Two patients with calcified liver metastasis received lumpectomy and developed calcification in recurrent tumors.Another two patients had calcification in newly developed tumor masses.And the calcification in the newly developed masses was similar to that of their primary counterparts in terms of morphology and distribution.On the enhanced CT scan,the tumors exhibited no enhancement during hepatic arterial phase and showed slight rim enhancement during portal venous scan in the 22 cases.The calcification became obscure on contrast-enhanced scans.Histopathologically,the primary tumors were well-differentiated adenocarcinoma in 6 cases,moderately-differentiated adenocarcinoma in 10,poorly-differentiated adenocarcinoma in 4 and mucinous adenocarcinoma in 2 among the 22 cases.No statistical correlation was noted between the incidence of calcified liver metastasis and the pathological subtypes and differentiation degrees of the primary colorectal carcinoma.It was concluded that calcified liver metastases may result from colorectal adenocarcinomata of different differentiation degrees or mucinous adenocarcinomata in Chinese population.There is no correlation between calcification of liver metastases and the pathological subtype of the primary colorectal carcinoma in Chinese,which is different from the findings that calcified metastases were associated with colorectal mucinous adenocarcinoma in other ethnic groups.

Logistic回归联合ROC曲线评价CT增强定量值在术前预测胸腺瘤危险度中的诊断价值

目的探讨临床资料、CT定性特征及定量值在术前预测胸腺瘤危险度中的价值。方法回顾性分析经手术病理证实的81例胸腺瘤患者的临床和CT资料,依据病理结果将患者分为低危组和高危组。对两组患者临床资料、CT定性特征和定量值进行组间比较;采用Logistic单因素和多因素回归分析,寻找预测胸腺瘤危险度的相关因素;对胸腺瘤危险度有预测意义的因素绘制受试者工作特征曲线(ROC曲线)评估其预测效能。结果低危组62例,高危组19例,两组的最大增强CT值和增强前后CT最大差值差异有统计学意义(P<0.001)。Logistic回归分析显示,最大增强CT值(OR=0.88,95%CI:0.83~0.94)和增强前后CT最大差值(OR=0.92,95%CI:0.88~0.97)为胸腺瘤危险度的独立预测因子(P<0.001)。最大增强CT值的ROC曲线下面积(AUC)为0.884,敏感性为68.4%,特异性为96.8%;增强前后CT最大差值的AUC为0.833,敏感性为89.5%,特异性为72.6%。结论基于增强CT的定量参数有助于术前预测胸腺瘤不同风险分层,最大增强CT值预测效能优于增强前后CT最大差值。

Solitary pulmonary nodules： comparison of multi-slice computed tomography perfusion study with vascular endothelial growth factor and microvessel density

Background The solitary pulmonary nodule （SPN） is one of the most common findings on chest radiographs. The objectives of clinical practice are to differentiate malignant nodules from benign nodules in the least invasive way and to make a specific diagnosis. This study was aimed to evaluate the correlation between perfusion imaging features and microvessel density （MVD） and vascular endothelial growth factors （VEGF） in SPNs using multi-slice computed tomography （MSCT）; and to provide the theoretical basis for SPN blood flow pattern and blood flow quantitative features. Also, the study called for the discussion of the method＇s clinical application value in the differential diagnosis of benign and malignant SPNs.Methods Sixty-eight patients with SPN underwent multi-location dynamic contrast enhanced （nonionic contrast material was administrated via the antecubital vein at a rate of 4 ml/s） MSCT. Precontrast and postcontrast attenuations on every scan was studied. Perfusion, peak height, and the ratio of the peak height of the SPN to that of the aorta were analyzed. Perfusion was calculated using the maximum gradient of the time-density curves （TDC） and the peak height of the aorta. The quantitative parameters （perfusion, peak height, ratio of peak height of the SPN to that of the aorta） of the blood flow pattern were compared with MVD and the VEGF expression of immunohistochemistry. Results The perfusion peak heights of malignant （（96.15±11.55） HU） and inflammatory （（101.15±8.41） HU） SPNs were significantly higher than those of benign （（47.24±9.15） HU） SPNs （P 〈0.05, P 〈0.05）. Ratios of SPN-to-aorta of malignant and inflammatory SPNs were significantly higher than those of benign SPNs （P 〈0.05, P 〈0.05）. No significant differences were found between the peak height and SPN-to-aorta ratio of malignant SPNs and inflammatory SPNs （P 〉0.05, P 〉0.05）. The precontrast densities of inflammatory SPNs were lower than those of malignant SPNs （P 〈0.05）. Perfusion values of malignant and inflammatory SPNs were significantly higher than those of the benign SPNs （P 〈0.05, P 〈0.05）. The VEGF positive expressions appeared in 32 patients with malignant SPNs and 2 patients with benign SPNs, and the average value of the MVD was higher in patients with malignant SPNs （36.88±6.76） than in patients with either benign （4.51±0.60） or inflammatory （26.11±5.43） SPNs （P 〈0.05, P 〈0.05）. There were statistically significant correlations between the CT perfusion feature and the MVD. The highest correlation was between the peak height of SPN and the MVD （r=0.657, P 〈0.05）.Conclusions Tumor microvessel density and VEGF expression facilitate the exploration of the pathophysiological basis of CT perfusion in SPNs. Multi-slice CT perfusion has shown strong positive correlations with angiogenesis in SPNs.

联合临床信息及CT特征的胸腺瘤组织学分型预测模型的研究

目的结合临床资料及CT影像特征,术前预测胸腺瘤(TETs)高、低危组织学类型。方法回顾性分析2018年1月—2023年1月行TETs切除术患者114例,以病理学分型分为低危组(33例)和高危组(81例),并从病灶最大直径、平扫及增强扫描动脉期CT值、强化幅度、增强均匀性、形状、轮廓、钙化等方面评估其影像学特征。基于患者的临床信息(性别、年龄、吸烟史、是否伴随重症肌无力)与上述影像学特征,采用多因素Logistics筛选相关因素构建预测模型,创建列线图。通过受试者工作特征曲线、校准曲线和临床决策曲线来评估预测模型性能。结果经统计学分析,动脉期CT值(P=0.002)、强化幅度(P=0.002)、增强均匀性(P=0.049)、年龄(P=0.038)是TETs高、低危分型的独立预测因素(P<0.05)。其余特征均无统计学差异。模型的训练集(AUC=0.779)和验证集(AUC=0.810)都表现出良好诊断效能。结论临床资料及CT影像学特征对鉴别TETs高、低危分型有重要价值,构建的列线图预测模型显示出良好的诊断性能。

胸腺瘤螺旋CT表现与其WHO病理分型对照研究

目的:探讨胸腺瘤螺旋CT影像特征与其WHO病理学分型之间的相关性。方法:分析84例病理证实的胸腺瘤的CT影像特征与其WHO分型之间的相关性。结果:螺旋CT征象上表现有分叶、胸膜、心包及大血管受侵犯及尖角征/锯齿征的胸腺瘤,A型、AB型与B型、胸腺癌两大类之间有显著差异(P<0.05),而肿块大小、肿块密度均匀与否、纵隔脂肪线存在与否两者之间无显著差异(P>0.05)。结论:螺旋CT对A型、AB型与B型、胸腺癌可以做出较为正确的分类,但较难区分A型与AB型、B型与胸腺癌。

胸腺瘤多层螺旋CT影像与病理学分型的相关性研究

目的探讨胸腺瘤多层螺旋CT(MSCT)影像与病理学分型之间的相关性。资料与方法回顾性分析46例胸腺瘤患者的MSCT征象并与相应病理学分型之间进行对照研究。结果肿块最大径<5cm,轮廓光整、规则,密度均匀,肿块周围脂肪线存在并呈中等均匀强化的胸腺瘤多分布在A型和AB型中;而肿块最大径>10cm,轮廓不规则或呈分叶状,肿块内有坏死、囊变及钙化,周围组织侵犯和远处转移并呈显著强化者多分布在B型和C型胸腺瘤中。结论MSCT对A型、AB型胸腺瘤与B型、C型胸腺瘤之间的分类具有较大的临床价值。

结直肠癌MSCT表现与病理分型关系的探讨

目的探讨结直肠癌多层螺旋 CT(MSCT)表现与其病理分型的关系。方法回顾性分析92例结直肠癌 MSCT 表现和对应病例的病理组织分型、淋巴结转移和周围浸润情况。全部病例术前清洁肠道,然后用2.5%的等渗甘露醇溶液灌肠,再进行64层螺旋 CT 平扫和门静脉期增强扫描。首先按照病理高、中、低分化腺癌、黏液腺癌、印戒细胞癌对病例进行分类,对各种组织类型肿瘤的 MSCT 表现形态、平扫和增强的肿瘤实质 CT 值,淋巴结和其他脏器远处转移、周围浸润情况进行了分析。最后按照病理,将病例分成3组进行统计学分析,第1组为低分化腺癌,第2组为黏液细胞癌和印戒细胞癌,第3组为中高分化腺癌。结果中分化腺癌74例;高分化4例;低分化6例;黏液腺癌7例;印戒细胞癌1例。低分化平扫 CT 值约41.00±6.39HU,增强后 CT 值约74.83±9.48HU;黏液腺癌与印戒细胞癌的平扫 CT 值约39.00±3.46HU,增强后 CT 值约73.66±11.66HU;中高分化腺癌的平扫 CT 值约44.83±5.95HU,增强后 CT 值约85.05±10.47HU。这3组 CT 值经方差分析,平扫 P=0.028,增强 P=0.015,均有统计学意义。三组病例的淋巴结转移率,低分化组为50%,黏液腺癌组为37.5%,中高分化组为28.2%,经卡方检验,三组病例淋巴结转移率的 P=0.483,无统计学意义;三组中出现肠外浸润的百分率分别各是66.7%(4/6)、75%(6/8)和35.9%(28/78),出现不均匀强化或分层状强化的分别各是83 3%(5/6)、100%(8/8)和38.5%(30/78),P 值分别为0.043和0.001,有统计学意义;发生肝、肺等远处器官转移率分别各是0%(0/6)、12.5%(1/8)和11.5%(9/78),统计分析无明确统计学意义。因此,低分化腺癌、黏液腺癌(包括印戒细胞癌)和中高分化腺癌之间在 MSCT 表现上有较显著的差异性。结论多层螺旋 CT 平扫加增强扫描有助于判断结直肠癌的病理学类型。

能谱CT成像对侵袭性胸腺瘤与纵隔淋巴瘤的鉴别诊断价值

目的侵袭性胸腺瘤和纵隔淋巴瘤均为前纵隔常见肿瘤,两者临床表现相似,临床治疗方法截然不同,且影像学鉴别困难。本研究拟评价能谱CT成像对侵袭性胸腺瘤与纵隔淋巴瘤的鉴别诊断价值,以指导临床。资料与方法回顾性分析经病理证实的14例侵袭性胸腺瘤和10例纵隔淋巴瘤患者,术前均行平扫和双期能谱CT增强扫描,应用能谱分析软件,获得不同单能量下的CT值和碘(水)浓度,并定性分析其形态学表现。结果侵袭性胸腺瘤动脉期和静脉期40~80 keV单能量CT值及碘浓度均高于淋巴瘤,水浓度低于淋巴瘤,差异有统计学意义(P<0.05);以静脉期碘浓度9.11(100μg/cm^3)为阈值,诊断侵袭性胸腺瘤的敏感度、特异度均达100%。侵袭性胸腺瘤多呈明显分叶状,密度不均匀,囊变坏死、钙化常见,邻近淋巴结肿大少见,容易浸润纵隔血管间隙,增强扫描表现为中度-显著强化。纵隔淋巴瘤多呈多个结节融合状,病变密度不均匀,囊变坏死多见,但钙化少见,多伴有邻近淋巴结肿大,邻近血管常呈推压移位,增强扫描呈轻-中度强化,除两者囊变坏死率差异无统计学意义(P>0.05)外,其余表现差异均有统计学意义(P<0.05)。结论能谱CT成像对侵袭性胸腺瘤和纵隔淋巴瘤有一定的鉴别诊断价值。

能谱CT参数对不同分型胸腺瘤及胸腺癌的鉴别诊断

目的探讨能谱CT参数中,单能量CT值、碘浓度及能谱曲线斜率对低危型与高危型胸腺瘤、胸腺癌分型的鉴别价值。资料与方法收集胸腺上皮性肿瘤(TETs)患者35例,其中低危型胸腺瘤(A、AB、B1)17例,高危型胸腺瘤(B2、B3)11例,胸腺癌(C)7例。所有患者均行平扫及双期增强能谱CT扫描,分别获得40~140 keV单能量CT值和碘(水)基物质浓度,计算能谱曲线斜率及标准化碘浓度。分析40~100 keV单能量、能谱曲线斜率及标准化碘浓度能谱CT参数对不同分型胸腺瘤及胸腺癌的鉴别诊断价值。结果动脉期及静脉期低危型、高危型胸腺瘤及胸腺癌40~100 keV单能量CT值差异均有统计学意义(P<0.05)。动脉期40~100 keV单能量CT值在低危型胸腺瘤与胸腺癌间差异有统计学意义(P<0.05),90~100 keV单能量CT在高危型胸腺瘤和胸腺癌间差异有统计学意义(P<0.05);静脉期40~70 keV单能量CT值在低危型胸腺瘤和胸腺癌间差异有统计学意义(P<0.05),60~100 keV单能量CT值在高危型胸腺瘤和胸腺癌间差异有统计学意义(P<0.05)。动脉期及静脉期低危型、高危型胸腺瘤及胸腺癌标准化碘浓度(NIC)差异均有统计学意义(P<0.05)。动脉期低危型胸腺瘤NIC分别与高危型胸腺瘤、胸腺癌比较,差异均有统计学意义(P<0.05);静脉期低危型胸腺瘤NIC与胸腺癌比较,差异有统计学意义(P=0.002)。动脉期及静脉期低危型、高危型胸腺瘤及胸腺癌能谱曲线斜率差异均有统计学意义(P<0.05)。动脉期低危型胸腺瘤能谱曲线斜率分别与高危型胸腺瘤、胸腺癌比较,差异均有统计学意义(P<0.05);静脉期低危型胸腺瘤能谱曲线斜率与胸腺癌比较,差异有统计学意义(P=0.003)。结论能谱CT参数40~100 keV单能量、能谱曲线斜率、碘基值对TETs术前具有评估价值,可用于术前不同分型胸腺瘤及胸腺癌的鉴别诊断。

Primary clear cell carcinoma in the liver: CT and MRI findings

AIM: To retrospectively analyze the computed tomography (CT) and magnetic resonance imaging (MRI) appearances of primary clear cell carcinoma of the liver (PCCCL) and compare the imaging appearances of PCCCL and common type hepatocellular carcinoma (CHCC) to determine whether any differences exist between the two groups. METHODS: Twenty cases with pathologically proven PCCCL and 127 cases with CHCC in the Second Affiliated Hospital of Sun Yat-sen University were included in this study. CT or MRI images from these patients were retrospectively analyzed. The following imaging findings were reviewed: the presence of liver cirrhosis, tumor size, the enhancement pattern on dynamic contrast scanning, the presence of pseudo capsules, tumor rupture, portal vein thrombosis and lymph node metastasis. RESULTS: Both PCCCL and CHCC were prone to occur in patients with liver cirrhosis, the association rate of liver cirrhosis was 80.0% and 78.7%, respectively (P > 0.05). The mean sizes of PCCCL and CHCC tumors were (7.28 ± 4.25) cm and (6.96 ± 3.98) cm, respectively. Small HCCs were found in 25.0% (5/20) of PCCCL and 19.7% (25/127) of CHCC cases. No significant differences in mean size and ratio of small HCCs were found between the two groups (P = 0.658 and 0.803, respectively). Compared with CHCC patients, PCCCL patients were more prone to form pseudo capsules (49.6% vs 75.0%, P = 0.034). Tumor rupture, typical HCC enhancement patterns and portal vein tumor thrombosis were detected in 15.0% (3/20), 72.2% (13/18) and 20.0% (4/20) of patients with PCCCL and 3.1% (4/127), 83.6% (97/116) and 17.3% (22/127) of patients with CHCC, respectively. There were no significant differences between the two groups (all P > 0.05). No patients with PCCCL and 2.4% (3/127) of patients with CHCC showed signs of lymph node metastasis (P > 0.05). CONCLUSION: The imaging characteristics of PCCCL are similar to those of CHCC and could be useful for differentiating these from other liver tumors (such as hemangioma and hepatic metastases). PCCCLs are more prone than CHCCs to form pseudo capsules.

Ischemic colitis masquerading as colonic tumor:Case report with review of literature

Ischemic colitis can mimic a carcinoma on computed tomographic (CT) imaging or endoscopic examination. A coexisting colonic carcinoma or another potentially obstructing lesion has also been described in 20% of the cases of ischemic colitis. CT scan can differentiate it from colon cancer in 75% of cases. However, colonoscopy is the preferred method for diagnosing ischemic colitis as it allows for direct visualization with tissue sampling. Varied presentations of ischemic colitis have been described as an ulcerated or submucosal mass or as a narrowed segment of colon with ulcerated mucosa on colonoscopy. Awareness and early recognition of such varied presentations of a common condition is necessary to differentiate from a colonic carcinoma, and to avoid unnecessary surgery and related complications.

原发性胸腺透明细胞癌1例

患者男,36岁,因＂体检发现左前纵隔肿物2月余,左上肢酸胀2周＂入院。查体：左颈根部可触及3cm×4cm肿物,质硬,不易推动,无触痛;左颈根部及左胸背部、左上肢皮肤均可见浅表静脉曲张,左上肢轻度浮肿。实验室检查无异常。胸部CT：左上纵隔见约9.9cm×7.3cm×7.1cm肿块影,