目的 探究钼靶X线检查联合螺旋CT对早期诊断乳腺癌敏感性及特异度的影响.方法 选取本院2017年6月至2019年2月接收的疑诊为乳腺癌患者76例,分别进行螺旋CT检查和钼靶X线检查,以病理学检查结果为金标准,比较分析螺旋CT检查和钼靶X线检查联合螺旋CT的准确性、敏感性、特异性以及各征象的检出率.结果 钼靶X线检查联合螺旋CT在局部淋巴结转移、钙化、多形性和不均质性的检出率均高于螺旋CT,且诊断准确性、敏感性和特异性高于螺旋CT,差异均具有统计学意义(P<0.05).结论 在早期乳腺癌诊断中采用钼靶X线检查联合螺旋CT检查能够有效提高诊断准确性,其具有较高的敏感性和特异性,在临床上具有较高的诊断价值.

目的 探讨中枢神经系统孤立性纤维瘤(SFT)的影像学特征.方法 回顾性分析9例经手术及病理证实的SFT影像学资料,并与病理学结果进行对照分析.结果 ①9例SFT均为单发病灶,发生于幕上者5例,幕下1例,枕部中线跨天幕1例、伴颈椎管种植转移,颈椎管、右侧脑室体部各1例.肿瘤边界清楚,椭圆形或类圆形6例,不规则形3例;2例可见分叶征,病灶最大径15.26～78.13 mm.②4例CT平扫为略高密度,2例密度均匀,2例不均匀,1例瘤内伴灶性坏死,1例合并出血.③与脑实质对比,6例T1WI呈等信号为主的不均匀信号,2例呈均匀等信号;6例T2WI为低、等(或略高)混杂信号,2例为均匀等或略高信号.④增强扫描病变不均匀强化5例,均匀强化2例;3例可见“脑膜尾征”;2例见血管流空.⑤镜下显示肿瘤由疏密不均的梭性细胞、致密胶原纤维以及大量薄壁血管组成.结论 中枢神经系统SFT的MRI表现具有一定特征性,与临床病理有密切的内在联系,是诊断SFT有价值的检查方法.

目的:探讨颈部Castleman病(CD)的CT及MRI表现,以提高诊断的准确性.方法:回顾性分析10例经病理证实的颈部CD患者的临床与影像学资料.8例行CT检查,其中7例行增强扫描；2例行MRI平扫及增强扫描；1例同时行CT与MRI检查,将CT、MRI结果与病理结果对照分析.结果:按Friz2era标准分类:10例颈部CD患者,局灶型7例(透明血管型6例,混合型1例)；多中心型3例(浆细胞型2例,混合型1例).局灶型大多为透明血管型,CT表现为单发、类圆形软组织肿块,周围伴或不伴有子灶或卫星灶,增强扫描动脉期明显强化,强化程度与颈总动脉同步,静脉期及延迟期强化程度减弱,边缘斑点或条状小血管；MRI亦表现为单发异常信号,呈等T1稍长或长T2信号,强化方式同CT增强扫描,边缘多有索条状迂曲流空血管,2个病灶内有裂隙征,呈延迟强化.多中心型CD的影像表现为多发大小不等软组织肿块影,边界不清,早期轻度强化,晚期中度强化.结论:颈部CD的影像表现与临床、病理分型密切相关,透明血管型CD具有一定影像特征,尤其动态增强扫描对其具有重要诊断价值；浆细胞型CD则缺乏特征表现,确诊尚需免疫组织病理学检查.

<正>患者男,61岁。以反复右季肋部闷痛伴消瘦2周入院。2周前无明显诱因出现右季肋部闷痛不适,无恶心、呕吐,无黄疸,无发热,无腹泻及黑便,体重下降约10kg。入院查体:全身皮肤、黏膜无黄染,无肝掌、蜘蛛痣。全身浅表淋巴结未触及肿大。腹平软,可扪及明显包块,肝肋下未及,肝区无明显叩击痛。移动性浊音阴性。实验室检查:(1)血常规、尿常规及便常规均正

Objective: To evaluate the proton magnetic resonance spectroscopy(1H-MRS)finding of the peritumoral regions of brain glioma,and to explore the correlation between different metabolic and the degree of tumor infiltration.Methods:Twenty-five untreated cases with glioma were studied.The diagnosis was pathologically confirmed after surgery.All the cases underwent conventional MRI and contrast enhanced MRI,then multiple voxel 1H-MRS was performed on a 3.0 T MR scanner using pointed resolved spectral selection(PRESS).MRI-guided neuronavigation biopsies were performed to gain the tissue samples and the corresponding histopathological examination results.Results:The series yielded 239 tissue samples and the corresponding 1H-MRS and histopathological examination results were obtained.Spearman correlation analysis showed that Cho/nCr and NAA/Cho were appeared to correlate best with the degree of tumor infiltration.Conclusion:The preliminary results support that 1H-MRS accurately reflects the extent and degree of gliomas.This has important diagnostic and therapeutic implications for more accurately assessing the extent of neoplasm as well as for surgical planning and assessing response to therapy.

目的分析骨样骨瘤的X线、CT及MRI影像表现。方法搜集2000年～2005年经病理证实的骨样骨瘤21例,男13例,女8例,年龄6～59岁。所有病例均行X线平片;17例行CT平扫;MRI平扫12例,增强扫描5例（动态MRI增强扫描3例）,完成三项检查10例。病灶位于股骨8例,胫骨7例,髋臼、胸椎各2例,锁骨及距骨各1例。分析X线、CT及MRI对瘤巢及其周围组织改变的显示能力。结果 X线、CT及MRI对瘤巢显示率分别为57.1%、76.5%、75.0%,X线、CT上瘤巢为一小圆形或卵圆形透亮区,中心有/无钙化和骨化,边缘有不同程度骨硬化;MRI上瘤巢为一小圆形异常信号区,T 1 WI呈低至中等信号,T 2 WI呈低至高信号,边缘为低信号骨硬化,瘤周不同程度骨髓及软组织水肿;Gd-DTPA增强扫描瘤巢明显强化,动态MRI增强瘤巢呈高灌注表现,时间-信号强度曲线为快速上升后缓慢持续下降（C型曲线）。结论 CT为诊断骨样骨瘤最佳方法 ,MRI能够增加瘤巢可见度并能敏感显示骨髓及周围软组织水肿,一定程度上反映病理组织特点,对骨样骨瘤有较高的诊断价值,可作为CT的补充检查手段。

Objective:To summarize the imaging features of 33 synovial sarcoma and discuss the diagnostic standard.Methods:33 cases imaging materials of synovial sarcoma proven pathologically were reviewed.Patients include 20 males and 13 females.The medical history from 1 month to 5 years.The main symptoms were local bump and pain.All of the 33 cases were performed X-ray films.21 cases were CT scaned and 15 cases were performed post-contrast scan.MRI were performed in 18 cases and post-contrast scan performed in 14 cases.Results:X-ray films of the 33 cases displayed local soft tissue bump,5(15.15%) revealed mottled calcification,and another 2(6.06%) manifested flaky calcification.CT of the 21 cases displayed ovate or lobulated soft tissue mass of hypointensity,6 masses showed clearly defined margins and muscles around were pushed,15 lesions showed ill defined margins,and no clear interface between lesions and muscles.The diameters of the lesions on CT was 2.10～18.60 cm.9 lesions were accompanied by osteolytic destruction of neighboring bones,with sharp margins and no sclerosis.6(28.57%) revealed mottled calcification within masses,and another 2(9.52%) manifested flaky calcification.7 lesions wraped neighboring joints.14 lesions demonstrated heterogeneous gradual enhancement after contrast media injection,12 of the 14 lesions manifested no enhanced cystic areas.18 lesions which were performed MR scan demonstrated heterogeneous low or light low density on T1WI,and heterogeneous high signal on T2WI.11(61.11%)of the 18 lesions displayed 'triple signal 'sign.The diameter of the lesions on MRI was 2.40 ～20.10 cm.8 masses showed clearly defined margins,10 lesions infringed neighboring muscles with ill defined margins and neighboring edema.4 lesions showed hemorrhagic foci.2 lesions(11.11%) showed fluid-fluid levels.15 lesions manifested heterogeneous post-contrast enhancement on MRI and 10(66.67%) of 18 showed no enhanced cystic areas.The 7 lesions wraped neighboring joints on MRI showed clear erosive bone destruction than CT pictures.Conclusion:There are some clinical and imaging characters of synovial sarcoma,but differential diagnosis should include multiform soft tissue tumors.

<正>恶性纤维组织细胞瘤(malignant fibrous histiocytoma,MFH)多原发于软组织,原发于骨的相对少见,术前诊断多较困难。本文分析经手术及病理证实的31例骨原发性MFH患者的影像学表现。1资料与方法1.1一般资料收集本院2004—2010年经病理及免

患者男,19岁.以"左髋不适2年半,加重2周"就诊.平素体健.血、尿常规、生化系列及肿瘤标志物阴性.查体:双侧腹股沟区及会阴部软组织肿胀,左侧可触及大小约3.00 cm×2.00 cm×0.50 cm肿物,质稍韧、固定、边界不清、轻压痛.影像学检查:X线示骨盆多发骨质溶解、消失,右侧骨质残端变细、变尖,形似"笔尖",无骨膜增生及新生骨形成(图1).CT示双侧髋臼多发骨质溶解,左侧骨质残端变薄、变细,周围软组织明显肿胀(图2).术中见耻骨联合处有软组织覆盖,其上被覆淡红色纡曲血管,左侧耻骨大部分溶解、消失.病理镜下见骨小梁稀疏、萎缩,髓腔扩大,增生血管呈分支状贯穿于纤维结缔组织中(图3).诊断:大块骨溶解症.

Objective To investigate the value of large-scale diffusion weighted imaging (DWI) in distinguishing benign and malignant vertebral lesions. Methods Totally 75 patients underwent conventional MR plain scan and large-scale DWI,and the data were retrospectively analyzed. Forty-two patients had benign lesions (benign group),including simple fractures (n=24),hemangioma (n=12) and tuberculosis (n=6). Thirty-three patients had malignant lesions (malignant group),including metastatic tumors (n=19),multiple myeloma (n=8),osteosarcoma (n=3),lymphoma (n=2) and leukemia (n=1). Signal characteristics on large-scale DWI were analyzed,while apparent diffusion coefficient (ADC) values of normal (control group) and abnormal vertebral bodies were calculated and compared. Results ADC values of benign group,malignant group and control group were (1.58±0.54)×10-3 mm2/s,(0.98±0.35)×10-3 mm2/s and (0.37±0.16)×10-3 mm2/s,respectively. ADC values of abnormal vertebral bodies were higher (all P0.001),and in benign group were higher than those in malignant group (P0.001). Conclusion The large-scale DWI can display the comprehensive scope and extent of vertebral body lesions. Quantitative analysis of ADC has some value in differentiating benign and malignant lesions of the spine. Large-scale DWI can be used as a routine sequence of vertebral body lesions.

Objective:Images of 26 cases of malignant fibrohistiosarcoma(MFH) of soft tissue were retrospectively analyzed to explore the clinical imaging diagnosis of MFH.Methods:26 cases imagings of MFH proven pathologically and immunohistochemically were reviewed.Patients included 15 males and 11 females,80.77% of the patients were more than 40 years old.The medical history was from 3 months to 5 years.7 of the 26 cases were performed X-ray films,17 cases CT pre-contrast scanned,and 8 cases post contrast scanned.MRI pre-contrast scan was performed in 14 cases,8 of which were performed post-contrast scan.Most of the lesions located in thigh,calf,forearm and buttocks.23 lesions located in deep tissue,3 lesions were superficial.Results:21(80.77%) lesions shaped irregular oval,or irregular banding soft tissue masses with diameter more than 5.0 cm.X-ray films of 3 cases displayed local soft tissue bump,accompanied by invasive destruction of neighboring bone.2 of the 3 lesions displayed periosteal reaction.Most lesions demonstrated iso-or hypodensity on CT plain films,only one displayed hyperdensity.CT post contrast scans of 8 lesions demonstrated heterogeneous enhancement after contrast media injection.Masses showed ill defined margin,and muscles nearby were eroded on CT.Arcuate calcification was found in two lesions that diameter was over 5.0 cm.CT films of 13 masses demonstrated destruction of neighboring bone or periosteal reaction.Most lesions on MR T1WI showed iso-or hypodesity and hyper-or heterogeneous density on T2WI,4 lesions accompanied by hemorrhage displayed on T1WI and 8 lesions demonstrated heterogeneous enhancement after contrast media injection.2 masses showed clearly defined margins on MRI,but 12 lesions infringed neighboring muscles with ill defined margins and neighboring edema.6 lesions were found to invade neighboring bone on MRI.Conclusion:Large round or oval,or irregular banding soft tissue masses in deep lower limb or forearm occurred in elderly,no clear boundary,accompanied by neighboring bone destruction or periosteal reaction as well as post contrast inhomogeneous enhancement,should be considered as MFH first.

1 病例资料 例1:女,38岁,发现左臀部肿物3年.体检:左臀部肿胀,可触及一包块,质硬,移动度差.MR:左臀大肌深部见一类圆形,T1WI呈不均匀稍高信号,内有少许斑片状低信号,界清,约9.0 cm×6.0 cm×5.8 cm;