目的 探讨后肾腺瘤的CT影像学特征,以提高对该病的认识.方法 回顾性分析8例经手术病理证实的后肾腺瘤CT影像学表现,与术后病理结果对比并复习相关文献,总结后肾腺瘤的CT影像学特征.结果 8例后肾腺瘤均为女性,年龄为34～65岁.CT平扫表现为类圆形单发肿块,直径2～6cm,5例其内密度均匀,未见囊变坏死区,3例呈混杂密度,可见囊变坏死区,2例可见斑点状或砂砾样钙化,增强扫描实性部分呈轻中度渐进性强化,3例可见假包膜征.结论 后肾腺瘤CT平扫多为等或稍高密度肿块,肿块密度比较均匀,增强扫描呈轻中度渐进性强化的特点,可伴有囊变或钙化,具有一定影像学特征,确诊需镜检及免疫组织化学检查.

Objective:To investigate the magnetic resonance imaging (MRI) features of desmoplastic small round cell tumor (DSRCT) of the abdomen and pelvis.Method:The retrospec-tive and descriptive study was conducted. The clinicopathological data of 8 patients with DSRCT of the abdomen and pelvis, including 3 cases admitted in Yueqing People's Hospital and 5 cases admitted in Wenzhou People's Hospital, from January 2008 to June 2022 were collected. There were 5 males and 3 females, aged (43±5)years. All patients underwent MRI plain and enhanced scanning. Observa-tion indicators: (1) imaging features of DSRCT of the abdomen and pelvis; (2) treatment and pathological examination characteristics of DSRCT of the abdomen and pelvis; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distri-bution were represented as M(range). Count data were described as absolute numbers. Results:(1) Imaging features of DSRCT of the abdomen and pelvis. ① Tumor location. Of the 8 patients, there were 6 cases with tumors located respectively at the lower edge of the liver in the right quarter costal region, the medial side of the ileocecal region in the right iliac region, the medial side of the caecum in the right iliac region, the gastro-pancreatic space in the left quarter costal region, the mesenteric space in the left iliac region and the right side of pelvic bladder, and 2 cases with tumors located at retroperitoneal space of left quarter rib region. ② Tumor size. There were 13 lesions in the 8 patients, and the maximum diameter of tumor was 9.1 (range, 3.5?20.0)cm. Of the 8 patients, there were 5 cases with single tumor and 3 cases with multiple tumors. ③ Tumor shape and boundary. Of the 8 patients, there were 4 cases with tumor in expansive growth and 4 cases with tumor in invasive growth. There were 5 cases with tumor of intratumoral necrosis and cystic degene-ration, 4 cases with tumor of intratumoral hemorrhage, 4 cases with tumor of intratumoral spot calcification, 3 cases with tumor of peritumoral tissue exudation. One patient may combined with multiple imaging manifestations. ④ Imaging characteristics of MRI plain scanning. Of the 8 patients, there were 4 cases with tumor of homogeneous hypointensity signal and 4 cases with tumor of hypointensity mixed with speckled hyperintensity (with hemorrhage) in T1 weighted imaging of MRI plain scanning. There were 3 cases with tumor of homogeneous hyperintensity and 5 cases with tumor of high signal at the edge, patchy and spot-shaped in the center in T2 weighted imaging of MRI plain scanning. There were 5 cases with tumor of high, equal and low confounding signals and 3 cases with tumor of high and low signals in T2 weighted imaging fat suppression sequence of MRI plain scanning. There were 3 cases with tumor of uniform high signals and 5 cases with tumor of high, equal and low mixed signals in diffusion weighted imaging of MRI plain scanning. ⑤ Imaging characteristics of MRI enhanced scanning. All 8 patients had tumor of heterogeneous enhancement in MRI enhanced scanning, including 2 cases with significant enhancement in arterial phase, continuous enhancement in portal phase, slightly reduced enhancement in delayed phase, 4 cases with moderate enhancement in arterial phase, continuous enhancement in portal phase, slowly exited enhancement in delayed phase, 2 cases with mild enhancement in arterial phase, continuous enhancement in portal phase, slowly exited enhancement in delayed phase. Of the 8 patients, there were 3 cases with tumor of annular enhancement with intratumoral strip or grid signals and 3 cases with tumor of peritumoral blood vessels increased and thickened signals. ⑥ Tumor invasion and metastasis. Of the 8 patients, there were 4 cases with tumor invaded bowel, 2 cases with tumor invaded surrounding tissues, 1 case with tumor invaded left kidney, spleen and pancreatic tail, 1 case with tumor invaded distal of left ureter. There were 5 cases with abdominal, retroperitoneal and inguinal lymph nodes enlargement, 4 cases with multiple nodular thickening of peritoneum and ascites, 2 cases with tumor liver and lung metastasis and 1 case with tumor rib, femur and sacrum metastasis. One patient may combined with multiple tumor metastasis. (2) Treatment and patholo-gical examination characteristics of DSRCT of the abdomen and pelvis. Of the 8 patients, 3 patients underwent complete resection as clear tumor boundary, 3 patients underwent tumor partial resection as tight adhesion between tumor and surrounding blood vessels, 2 cases underwent tumor tissue pathological examination as extensive metastasis of peritoneum, omentum, mesentery and surrounding intestine. All 8 patients were diagnosed as DSRCT by microscopic examination, electron microscopic examination, immunohistochemical staining and cytogenetic examination. (3) Follow-up. All 8 patients underwent postoperative follow-up and died during the follow-up.Conclusion:MRI features of abdominal and pelvic DSRCT include single or multiple lobulated masses with unclear boundaries, invading the omentum, mesentery, peritoneum and adjacent tissues in most cases, mixed signals and heterogeneous mild to moderate enhancement in enhanced scanning.

Objective:To explore the imaging features of hyperostosis frontalis interna (HFI).Methods:One hundred patients with clinically diagnosed HFI were enrolled from Department of Radiology, Yueqing People's Hospital and Department of Imaging, Wenzhou People's Hospital from January 2011 to December 2022. MRI alone was performed in 45 patients; MRI+DR was performed in 14, and MRI+CT was performed in 41. The imaging features of these patients were analyzed retrospectively.Results:In these 100 patients, 20 were with external hyperplasia, 51 with internal hyperplasia, and 29 with intermediate hyperplasia. External hyperplasia manifested as proliferating towards the diploe, enjoying clear boundary, uniform high signals of the hyperplastic inner plate and diploe on T1WI and T2WI, and high density of the hyperplastic inner plate and diploe on CT and DR. Internal hyperplasia manifested as proliferating towards the cranial cavity, enjoying wavy or nodular inner edges, non-uniform low signals of hyperplastic inner plate on T1WI and T2WI, and high density of the hyperplastic inner plate on CT and DR. Intermediate hyperplasia manifested as proliferating simultaneously towards the cranial cavity and diploe, enjoying thin and blurred diploe, uniform or non-uniform high signals of the hyperplastic inner plate and diploe on T1WI and T2WI, and non-uniform high density of the hyperplastic inner plate and diploe on CT and DR. Compressed and displaced brain parenchyma, reduced anterior cranial fossa volume, and narrowed subarachnoid space were noted in these 100 patients, including 47 patients with obvious frontal lobe brain tissue compression (depth of 3.0-17 mm, averaged [8.6±5.9] mm), 35 with lacunar cerebral infarction, 33 with subcortical arteriosclerotic encephalopathy, and 32 with varied degrees of cerebral atrophy.Conclusion:HFI is characterized by thickening and hardening of the bilateral frontal bone inner plates, with wavy, nodular or spindle-shaped inner edges, compressed brain tissues, and reduced anterior cranial fossa; these imaging features can help the definite diagnosis of HFI.

目的:探讨骨棕色瘤的影像表现特点.方法:回顾性分析2005年1月至2020年12月收集的16例骨棕色瘤患者的病例资料.男7例,女9例.年龄19～72岁,中位数48岁.病程4个月至13年,中位数30个月.均行X线、CT、MRI检查者4例,均行CT、MRI检查者5例,均行X线、CT检查者3例,仅行CT检查者4例.观察骨棕色瘤的部位、大小和X线、CT、MRI表现.结果:①骨棕色瘤部位及大小.肿瘤累及34块骨,其中颅骨2块、锁骨3块、肩胛骨2块、肋骨5块、胸椎2块、肱骨2块、掌骨4块、指骨5块、股骨4块、胫骨3块、腓骨2块.肿瘤直径≤3.0 cm者16块骨、3.1～5.0 cm者6块骨、5.1～7.0 cm者3块骨、≥7.1 cm者9块骨.②骨棕色瘤X线表现.7例行X线检查,共累及17块骨.17块骨均有不同程度的骨质疏松.骨质呈囊状破坏10块、膨胀性破坏3块、溶骨性破坏2块、混合性破坏2块.发生病理性骨折1块.骨皮质完整12块,骨皮质缺失或不完整5块.骨质破坏区内见骨嵴3块、见斑点状钙化5块,骨质破坏区边缘硬化2块.有骨膜反应4块.肿瘤周围软组织肿胀3块、软组织肿块2块.③骨棕色瘤CT表现.16例行CT检查,共累及34块骨.34块骨均有不同程度的骨质疏松.骨质呈囊状破坏12块、膨胀性破坏6块、溶骨性破坏5块、混合性破坏11块.发生病理性骨折2块.骨皮质完整19块,骨皮质缺失或不完整15块.骨质破坏区内见骨嵴8块、见斑点状钙化9块,骨质破坏区边缘硬化4块.有骨膜反应5块.肿瘤周围软组织肿胀7块、软组织肿块5块.④骨棕色瘤MRI表现.9例行MRI检查,共累及15块骨.T1WI呈均匀低信号5块,呈低、极低混杂信号4块,呈低、高混杂信号4块,呈极低、高混杂信号2块.T2 WI呈均匀高信号3块,呈高、极低混杂信号5块,呈低、极低混杂信号5块,呈等、高混杂信号2块.短时反转恢复序列呈不均匀高信号12块、均匀高信号3块.肿瘤相邻骨质水肿5块、相邻软组织水肿5块.结论:骨棕色瘤多见于四肢管状骨,其在X线和CT片上多表现为不同程度的骨质疏松,骨质呈囊状破坏、膨胀性破坏、溶骨性破坏、混合性破坏,骨质破坏区内可见骨嵴或斑点状钙化,少数病例有骨膜反应及病理性骨折;其在MRI T1WI上主要表现为均匀低信号,在MRI T2WI上主要表现为高、极低混杂信号和低、极低混杂信号,短时反转恢复序列主要表现为不均匀高信号.

Objective:To investigate the CT and MRI features of meningiomas of the skull.Methods:A retrospective analysis was performed; the CT and MRI findings of 20 patients with meningiomas of the skull confirmed by pathology after surgery in our hospital from January 2008 to December 2020 were collected.Results:Fourteen patients had skull osteolytic destruction, 4 had osteogenic destruction, and 2 had mixed destruction. There were 12 patients with soft tissue masses and 11 with radial spicules. In 16 patients accepted CT examination, uniform density was noted in 10 and uneven density in 6; 8 had high density, 5 had equal density, and 3 had low density; 5 patients were with calcification. In 17 patients accepted MRI examination, 11 had uniform signal and 6 had un-uniform signal; T1WI had slightly low signal in 12 patients and equal signal in 5 patients; T2WI had slightly high signal in 12 patients and slightly low signal in 5 patients; diffusion weighted imaging (DWI) had high signal in 12 patients and slightly high signal in 5 patients. Totally, enhanced homogeneous enhancement was noted in 12 patients and inhomogeneous enhancement was noted in 8 patients; and there were 13 patients with "meningeal tail sign" and 11 with peritumoral edema.Conclusion:Bone in patients with meningiomas of the skull is characterized by osteolytic or osteogenic destruction with soft tissue masses and radial spicules; CT shows uniform or un-uniform tumor density, MRI shows uniform or un-uniform signals, and enhanced "meningeal tail sign" is characterized.

The patient, a 61-year-old female, was admitted to the hospital for 15 days of frequent urination, urgency, painful urination and hematuria. B-ultrasound showed irregular hypoechoic masses on the anterior wall of the bladder. CT showed that the right anterior wall of the bladder protruded into the cavity of the soft tissue mass, which was lobulated, and the edge of the mass showed arc-shaped calcification; enhancement shows that the mass continues to enhance. Cystoscopy showed a lobulated soft tissue mass protruding into the cavity on the right anterior wall of the bladder, and cystoscopy showed tumor-like lesions. The preoperative clinical and imaging diagnosis was a malignant tumor of the bladder. Open partial resection of the right anterior wall of the bladder under general anesthesia, and pathological diagnosis of bladder leiomyosarcoma after surgery. Adjuvant chemotherapy (gemcitabine 1.6 g + epirubicin 80 mg + cisplatin 30 mg) was started 2 months after the operation. The chemotherapy was discontinued after a year, and the patient had no obvious adverse reactions. There were no signs of recurrence and metastasis after a 2-year follow-up.

目的 探讨成人肾母细胞瘤的CT表现特征.方法 回顾性分析经手术、病理确诊的6例成人肾母细胞瘤CT表现.结果 肿块位于右肾3例,左肾3例;肿块呈圆形3例,椭圆形3例;肿块最大直径3.7～13.0 cm,平均(7.4±7.6) cm.肿块呈低密度2例,等密度2例,高密度1例,高低密度1例,平扫CT值平均(48.2±4.5) HU;密度均匀4例,密度不均匀2例;肿块界限清楚4例,界限不清楚2例;肿块内不规则或裂隙状和条片状高密度4例,瘤内见小片状钙化2例.增强后动脉期肿块呈轻度-显著不均匀强化,CT值平均(87.8±6.8) HU,其中2例肿块周边呈小片状强化,2例肿块中心呈斑片状或絮状强化;门静脉期肿块呈轻度至中度不均匀,CT值平均(76.2 ±5.4) HU,其中3例肿块中心及周边小片状、结节状和网格样强化;残留的肾实质强化呈"新月形"或"环形".结论 成人肾母细胞瘤CT主要表现为低密度或等密度,肿块内见不规则或裂隙状低密度坏死囊变区.增强后动脉期呈轻度·显著不均匀强化,门静脉期呈轻至中度强化,残留的肾实质强化呈"新月形"或"环形".

本研究回顾性分析了10例原发性脾血管肉瘤(PSA)的CT表现。原发性脾血管肉瘤CT平扫为不均匀低或等密度，增强后肿瘤边缘或实质部分持续不均匀强化，中央坏死囊变明显，界限清楚，具有一定特征性。故当CT检查提示脾脏单个或多个稍低密度灶，密度不均匀，边缘模糊，增强扫描以边缘强化为主，"快进慢出"、渐进性强化，伴有或不伴有远处转移及腹腔积液等征象时，应考虑到PSA的可能性。

目的:探讨指(趾)骨外伤性植入性表皮样囊肿X线表现特征。方法:回顾性分析2010年1月至2020年6月术后病理确诊的25例指(趾)骨外伤性植入性表皮样囊肿患者的X线表现。其中缝纫工针头刺伤19例，采石工铁锤致伤4例，搬运工重物压伤2例。病程5～96个月，平均(42±5.2)个月。结果:术后随访时间为5～24个月，平均(15.0±3.5)个月。囊肿位于左手18例，右手5例，其中小指末节9例，中指末节8例，环指末节6例；右足部2例，其中第3趾趾末节1例，小趾末节1例；囊肿最大直径0.8～2.5 cm，平均(1.7±1.2) cm，其中7例<1.0 cm，16例1.1～2.0 cm，2例>2.1cm。25例骨质均呈囊状吸收，圆形15例，椭圆形10例。10例中心性囊肿，骨壁吸收变薄，囊壁完整；15例偏心性囊肿，压迫骨壁吸收，囊壁不完整。骨质破坏、缺损的边缘锐利，未见骨膜反应，破坏缺损区内无钙化，15例骨质破坏边缘轻度硬化，10例破坏边缘无明显硬化。本组中18例软组织有不同程度肿胀。结论:指(趾)骨外伤性植入性表皮样囊肿多为单房囊肿；X线显示骨质囊状破坏，边缘锐利，无骨膜反应；中心性病灶囊壁吸收变薄而完整，偏心性病灶囊壁吸收缺损而囊壁不完整。

Objective:To investigate the computed tomography (CT) features of primary hepatic fibrosarcoma (PHF).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 8 patients with PHF who were admitted to 2 medical centers from January 2010 to December 2019, including 3 cases of Yueqing People's Hospital of Zhejiang and 5 cases of Wenzhou People's Hospital of Zhejiang were collected. There were 5 males and 3 females, aged 50 years(range, 39?60 years). All patients underwent abdominal CT plain and enhanced examination, and surgical procedures were selected based on patients' will and individual situations. Surgical tumor specimens were given pathological examination and immunohistochemical staining. Observation indicators: (1) imaging features of CT examination; (2) treatment and pathological examinations; (3) follow-up. Follow-up was performed by outpatient examination or hospitalization to detect survival of patients and tumor recurrence up to December 2020. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Imaging features of CT examination: 8 patients received preoperative CT examinations, 3 cases of which were diagnosed as malignancies, 3 cases were diagnosed as hepatic space-occupying lesions, 2 cases were diagnosed as intrahepatic cholangiocarcinoma. ① Tumor location and general status: 8 patients had single tumor, of which 6 cases had tumor located in the right lobe of the liver and 2 cases had tumor located in the left lobe of the liver. The tumor was in oval shape in 5 patients and in circular in 3 patients. The maximum diameter of tumor in 8 patients was 9.3 cm(range, 4.0?15.0 cm). There were 1 case with tumor maximum diameter ≤5.0 cm, 4 cases with tumor maximum diameter as 5.1?10.0 cm, 3 cases with tumor maximum diameter >10.0 cm. ② CT plain scan showed uniform low density in 2 cases and uneven low density in 6 cases and the CT value of 8 cases was 40 HU(range, 29?43 HU). The tumor showed expansive growth with clear boundary in 6 cases, and invasive growth with unclear boundary in 2 cases. Five cases had intratumoral necrosis and cystic transformation, 2 cases had intratumoral strip hemorrhage, and 1 case of intratumoral calcification. There was 1 case with hilar lymph node metastasis. ③ Enhanced CT scan showed 8 cases with uneven enhancement in arterial phase, 8 cases with uneven tumor density in portal vein phase, 8 cases with intratumoral enhancement slowly withdrew in delayed phase and the density lower than liver parenchyma. (2) Treatment and pathological examinations: ① 8 patients under-went surgical resection, without intrahepatic or hilar metastasis. ② The results of postoperative pathological examination showed 2 cases with grade Ⅰ tumor differentiation (low potential malignancy), 5 cases with grade Ⅱ and Ⅲ tumor differentiation (moderate potential malignancy), 1 case with grade Ⅳ tumor differentiation (high potential malignancy). ③ Immuno-histochemical staining showed that 8 cases were positive for vimentin, CD10, p53 and negative for smooth muscle actin, keratin19, epithelial membrane antigen, endotheliocyte 34. All 8 patients were diagnosed as PHF. (3) Follow-up: all 8 patients were followed up for 7 to 128 months, with a median follow-up time of 53 months. The overall survival time of 8 patients was 15 to 122 months, and the median overall survival time was 45 months. One patient died of tumor recurrence and distant metastasis at 17 months after surgery, and the survival time of 7 patients was >28 months.Conclusions:CT plain scan of PHF showed uneven low-density masses. After enhancement, the arterial phase shows the tumor ring or peripheral nodular uneven enhancement, the intratumoral strip-shaped enhanced blood vessels. The portal vein phase shows the tumor-like small patches or grid-like continuous enhancement. The delayed phase is characterized by the slow withdrawal of intratumoral enhancement.

目的 探讨MSCT动态增强在乏脂肪RAML与嫌色细胞肾癌的鉴别诊断价值.方法 选取经临床病理证实的并有完整临床和CT资料的21例乏脂肪RAML与14例嫌色细胞肾癌,回顾性分析其MSCT表现,测量病灶的各期CT值,并测量病灶相同层面皮质的CT值,并计算病灶CT值与其邻近皮质CT值的比值,统计分析各期CT值及其比值的统计学差异.结果 乏脂肪RAML 21例,嫌色细胞肾癌14例,乏脂肪RAML呈等高密度影16例,嫌色细胞肾癌呈等高密度10例;乏脂肪RAML与嫌色细胞肾癌在平扫、皮质期、髓质期及分泌期CT值以及平扫、髓质期病灶与相近皮质比值均差异有明显统计学意义(P＜0.05),皮质期及分泌期病灶与邻近皮质比值差异无统计学意义(P＞0.05),皮质期ROC曲线下面积最大(0.871),当皮质期CT值选择为106 HU时,鉴别RAML和ThRCC的敏感度为74％,特异性为91％,Youden指数为0.66.结论 MSCT动态增强在乏脂肪RAML与嫌色细胞肾癌鉴别中具有一定的价值,特别是皮质期的病灶CT值具有良好的鉴别诊断价值.

Objective:To analyze the CT and MRI features of primary hepatic sarcomatoid carcinoma.Methods:A retrospective study was conducted on 16 patients with primary hepatic sarcomatoid carcinoma who presented to Wenzhou People's Hospital of Zhejiang Province and the Second Affiliated Hospital of Wenzhou Medical University from January 2009 to June 2019. There were 8 males and 8 females, with age ranging from 35 to 71 years (average 56.8 years). The site, size, shape, margin, density of signal, adjacent tissue changes and degree enhancement of tumor were analyzed.Results:Tumors in the liver in the 16 patients were all solitary, with 11 in the right and 5 in the left liver. The maximum diameter of tumor ranged from 3 to 16cm (average 8.5cm). On plain CT scanning ( n=16), the tumors were round or oval in 6, and lobulated or irregular in 10 patients. The margins of the tumors were clear in 10 and unclear in 6 patients. All tumors showed low density, with 15 tumors showing uneven density, with necrosis and liquefaction of different sizes in the center, while 1 tumor showing uniform density. On plain MRI scanning ( n=4), four tumors had clear margins, with necrosis and liquefaction seen in the center of the tumors. The solid part showed a slightly lower signal on T 1 weighted imaging and a slightly higher signal on T 2 weighted imaging. The liquefaction focus of central necrosis showed higher signal intensity on T 2 weighted imaging. Enhanced scanning ( n=12 on CT enhancement and n=4 on MRI enhancement), the margins of the tumors were enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 7 patients. Strip septate and margin enhancement in the tumor were enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 7 patients. Inhomogeneous strengthening in the tumor was enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 1 patient. Inhomogeneous strengthening in the tumor was enhanced in the arterial phase. The enhancement was continued into the portal venous phase. In the delayed phase, enhancement in the tumor decreased, but there was continuous enhancement of the margin and interval of the tumor in 1 patient. Conclusions:Hepatic sarcomatoid carcinoma showed dual imaging characteristics of sarcoma and cancer. The imaging features of hepatic sarcomatoid carcinoma depended on the proportion of sarcomatoid components. Large intrahepatic tumors showed necrotic cystic degeneration, moderate or significant persistent enhancement in striped septum and margin of tumor.

目的:探讨婴幼儿骨皮质增生症的X线表现特征.方法:对2009年1月至2019年12月收集的10例婴幼儿骨皮质增生症患儿的X线资料进行分析.男女各5例;年龄2 d至10岁,<6个月7例、12个月2例、10岁1例;均有发热、易激惹、患肢弯曲及局部软组织肿胀表现;病变部位为双上肢2例、下颌骨和双下肢2例、双下肢3例、双上肢和双下肢3例.总结10例患儿病变部位的X线表现特征.结果:本组10例患儿,病变共累及28块骨,其中股骨8块、胫骨7块、腓骨2块、尺骨4块、桡骨4块、肩胛骨1块、下颌骨2块.病变累及2块骨3例、累及3块骨3例、累及5块骨1例、累及8块骨1例.X线表现为骨皮质广泛增厚、硬化19块,骨干向心性变细、髓腔变窄16块,骨皮质及骨膜增厚呈现"套管征"2块,骨膜呈广泛层状、丘状和花边状增生22块,骨质膨胀性改变12块,骨干弯曲变形24块,髓腔增宽、骨皮质变薄11块,骨皮质变薄且局部疏松、模糊8块.长骨病变仅限于骨干,均未累及干骺端.结论:婴幼儿骨皮质增生症的X线表现主要为各种形态的骨膜增生与骨皮质增厚,以四肢长骨多见;长骨病变仅限于骨干,不累及干骺端,病骨骨干可出现向心性变细、髓腔变窄;骨皮质广泛增厚、硬化,可出现病骨变粗、弯曲变形;骨膜增生多表现为层状、丘状、花边状,增生的骨膜可环绕整个病骨呈现"套管征";部分骨皮质可出现疏松、模糊或与增生骨膜相融合.

目的:探讨胰腺浆液性囊腺瘤MSCT表现和病理特征。方法:回顾性分析经手术及病理证实的43例胰腺浆液性囊腺瘤的MSCT表现,观察病灶部位、大小、囊腔类型、中央瘢痕、钙化及强化特点等。结果:43例胰腺浆液性囊腺瘤中,浆液性微囊型囊腺瘤34例,浆液性寡囊型囊腺瘤9例。34例浆液性微囊型囊腺瘤的囊直径平均为（4.2±0.5） cm,其中多囊蜂窝型29例,囊内见多发厚薄不均的蜂窝状分隔,其囊隔厚度为0.03～0.2 cm;多囊海绵型5例,瘤内呈海绵状囊实混杂密度,囊隔显示不清。34例微囊型囊腺瘤内有中央星芒状纤维瘢痕14例,放射状或砂砾状和囊壁上斑点状钙化14例,上游胰管扩张4例。9例浆液性寡囊型囊腺瘤中单囊型4例,呈圆形或卵圆形,囊直径平均为（3.1±3） cm;多囊型5例,边缘呈分叶状,由数个小囊构成,囊壁薄而光滑、均匀,其囊壁厚度＜0.1 cm。增强扫描表现:微囊型囊腺瘤中囊内分隔、中央星芒状纤维瘢痕及实性成分多呈轻中度强化,囊内分隔及实性成分越多,强化越明显,中央纤维瘢痕多呈延迟强化;寡囊型囊腺瘤囊内无强化,仅囊壁、囊隔呈轻度强化。结论:胰腺浆液性囊腺瘤CT表现具有一定特征性。微囊型囊腺瘤CT平扫呈蜂窝状或海绵状,瘤中央见星芒状纤维瘢痕及放射状钙化,增强扫描见囊壁、分隔及实性部分呈轻中度或显著强化,中央纤维瘢痕呈延迟强化;寡囊型囊腺瘤由单个或数个大囊组成,无中央纤维瘢痕及钙化,增强扫描见囊壁、囊隔呈轻度强化。

Objective:To summarize the imaging and pathological features of primary central nervous system lymphoma in special sites, and analyze some misdiagnosed cases to provide help for clinical diagnosis.Methods:Thirty-nine patients with primary central nervous system lymphoma diagnosed by pathology from 2000 to 2019 in Wenzhou People′s Hospital and the Second Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. The imaging and pathological features of primary central nervous system lymphoma in special sites were summarized, and the misdiagnosed cases in these special sites were analyzed.Results:Primary central nervous system lymphoma in special sites included one case of primary dural lymphoma, with thickening of dura mater and obvious enhancement; two cases with lesions in lateral ventricle, with homogeneous enhancement, involving ependyma and spreading to medulla oblongata; two cases with lesions in middle cerebellar peduncle, with patchy abnormal signals and no specific masses, mild to moderate enhancement after enhancement, and one misdiagnosed as demyelinating lesions; one case with lesions in the sellar region which obviously enhanced with a typical “dent sign”, misdiagnosed as invasive pituitary tumor. All the pathological findings indicated diffuse large B cell lymphoma.Conclusions:It is difficult to diagnose primary central nervous system lymphoma in special sites, which is easy to cause misdiagnosis. Understanding its imaging characteristics and pathology can help to diagnose the disease.

目的 探讨卵巢硬化性间质瘤的CT、MRI表现及其病理特征.方法 选取经手术和病理证实的卵巢硬化性间质瘤9例患者临床资料,观察肿瘤的大小、形状、边缘、密度或信号及强化表现.结果 9例均为单发,肿瘤最大直径3.5～12.0 cm,平均(6.6 ±2.9)cm.肿瘤呈卵圆形5例,圆形3例,分叶状1例.CT平扫显示肿瘤界限均清楚,其中实性肿块1例,密度均匀,界限清楚,密度与子宫相近,CT值41 HU;囊实性肿块4例,内部密度不均匀,CT值16～39 HU.MRI平扫显示肿瘤均呈囊实性,其中3例肿瘤内部信号混杂,T1WI呈等信号,T2WI呈高及等信号,瘤内见"湖岛征";1例肿瘤在T1WI呈等信号,实质部分呈短T2、囊性部分呈长T2信号,内壁见结节、乳头状影,局部呈"毛刷"、"梳征"样改变.包膜在T1WI及T2WI均呈低信号.增强动脉期见肿瘤外周呈花环样、乳头状或梳齿状强化,静脉期、延迟期肿瘤实性部分渐进性、向心性强化,呈"快进慢出"为特征.病理检查9例均可见假小叶结构、印戒细胞、致密胶原纤维、疏松水肿结缔组织及丰富血管.结论 CT和MRI检查对术前诊断卵巢硬化性间质瘤具有较高临床价值.

目的 探讨肝上皮样血管内皮瘤的MRI表现特征.方法 回顾性分析经病理证实的肝上皮样血管内皮瘤26例患者的MRI表现.结果 26例中共473个结节,结节大小为0.5～12.0cm,其中直径＞5.0cm的16个结节,平均直径(2.2±0.2)cm.单发结节型1例,表现为T1WI低信号,T2WI稍高信号,无明显特征性征象,增强后动脉期片絮状强化,门静脉期及延迟期呈向心逐渐强化;多发结节型17例,在T1WI均呈低信号,其中6例病灶内见出血灶,呈斑片状高信号;7例见包膜“皱缩征”;12例在T2WI见“靶征”;多数病灶在DWI呈中心低信号、外周环形高信号,ADC图呈中心高信号、外周环形低信号;增强后12例呈环形渐进性向心强化,4例呈持续环形强化,1例伴肝小静脉阻塞综合征动脉期明显强化,但门静脉期及延迟期病灶显示不清;17例中“棒棒糖征”8例,“瘤内血管征”5例;融合型8例,除包含多发结节型病灶特点外,病灶可相互融合,融合病灶增强后7例呈云絮状渐进性强化,1例呈环形渐进性向心强化;8例均有“靶征”、“棒棒糖征”和局部包膜“皱缩”,其中5例见“瘤内血管征”.结论 肝上皮样血管内皮瘤的MRI有一定特征性,局部包膜形态“皱缩”,T2WI见“靶征”,增强后出现双环征,门静脉期见“棒棒糖征”及“瘤内血管征”对诊断有重要帮助,同时发现病灶近包膜分布,并且出现病灶相互融合时,更有助于诊断.

回顾性分析经手术、病理证实的成年人先天性胃重复畸形11例CT表现及相关的临床资料。11例患者均有间断性呕吐，其中6例患者上腹部反复疼痛，3例上腹部可扪及质软的包块；病程10～15个月，平均12个月；囊肿位于胃底6例，胃窦4例，胃体1例；囊肿最大径3.3～12.0 cm，平均(6.2±5.8)cm；囊肿型7例，管状型2例，不规则形2例；囊肿界限清，囊内无分隔，囊壁厚度均匀，囊壁紧贴胃壁，与胃腔不相通。CT增强检查提示重复畸形囊壁与胃壁呈一致性均匀强化，其中显著强化7例，中度强化4例。成年先天性胃重复畸形的CT表现具有一定特征性，对胃重复畸形的术前诊断具有重要的价值。

目的:探讨髂骨血友病性假肿瘤(hemophilic pseudotumor,HP)的影像特征.方法:收集8例经临床、实验室确诊的髂骨A型HP的病例资料.均为男性;年龄19～43岁,中位数27岁;均有明确外伤史,临床主要表现为局部软组织肿胀和血肿,其中皮肤表面张力增高5例、关节功能障碍4例、不能行走3例;血浆凝血因子Ⅷ活性均低于正常值,活化部分凝血活酶时间延长.1例患者仅行X线检查、2例仅行CT检查、1例仅行MRI检查、2例同时行X线和CT检查、2例同时行CT和MRI检查,其中2例行CT增强扫描、1例行MRI增强扫描.分析病变的影像特征.结果:①病变部位与大小.左侧髂骨病变4例,右侧髂骨病变2例,双侧髂骨病变2例;病变位于髂骨体4例,髂骨翼4例,其中髂前上棘2例、髂后上棘1例、髂前下棘1例;病变最大径5～60 cm,中位数18 cm.骨内型5例,骨膜下型2例,肌间型1例.②X线表现.3例行X线检查,病变位于左侧髂骨2例、双侧髂骨1例.2例骨质呈多囊状破坏伴轻度膨胀改变,破坏边缘骨质轻度硬化,周围软组织肿胀不明显.1例骨质呈明显膨胀性破坏,破坏边缘硬化,部分囊壁缺失,伴周围软组织肿胀与肿块.③CT表现.6例行CT检查,病变位于左侧髂骨3例、右侧髂骨2例、双侧髂骨1例.骨质呈囊状破坏1例,侵蚀性破坏2例,膨胀性破坏3例.骨皮质部分吸收消失2例,大部分吸收消失2例,骨皮质完整2例.破坏边缘的骨质硬化3例.6例均有界限清楚的软组织肿块,密度高于肌肉组织,CT值45～68 HU;其中1例软组织肿块最大径>10 cm,密度低于周围正常肌肉组织,密度不均匀,CT值21～25 HU.2例CT增强扫描,肿块均未见强化.④MRI表现.3例行MRI检查,病变位于左侧髂骨1例、右侧髂骨1例、双侧髂骨1例.骨质呈溶骨性破坏1例,侵蚀性破坏1例,膨胀性破坏1例.骨皮质部分吸收消失2例,大部吸收消失1例.3例MRI信号于T2WI、T1WI、短时间反转恢复序列和扩散加权成像均呈高低混杂信号,其中2例病变区可见分隔.3例均有软组织肿块,边界清楚,其中1例软组织肿块最大径>10 cm;软组织肿块信号在T1 WI、T2 WI、短时间反转恢复序列和扩散加权成像上均呈高低混杂信号.1例增强扫描未见强化.⑤病理表现.8例患者病变组织肉眼见囊内为退化性血凝块或陈旧性出血,显微镜下可见囊壁为正常组织或纤维组织,无炎症性变化和新生物;肿胀软组织为反复出血而形成的血肿,血肿内密度较高,其中1例可见细小的钙化.结论:髂骨HP分为肌间型、骨膜下型和骨内型,病变部位骨质呈囊状、膨胀性、溶骨性或侵蚀性破坏,骨皮质菲薄,部分伴有骨皮质缺损及软组织血肿,CT密度不均、MRI信号混杂,结合临床表现和实验室检查可明确诊断.

目的 对比研究不同Rel.CM值对应的VNCa图对踝关节骨挫伤的诊断效能,优选最佳的Rel.CM值参数.在最优化Rel.CM值的基础上,分析双能量CT虚拟去骨技术对踝关节骨挫伤的应用价值.方法 收集2018年5月至2019年5月间临床怀疑踝关节骨挫伤患者60例,均行DECT和MRI检查.以MRI为参考标准,比较Rel.CM值分别为1.25、1.45、1.60、1.75的VNCa图对踝关节骨挫伤诊断的敏感度、特异度、准确度、阳性预测值、阴性预测值及约登指数,优选出最佳Rel.CM值参数.2位医生分别在最优Rel.CM值对应的VNCa图上测量骨挫伤区域与正常骨髓区域(对照组)的CT值,结果取2位医生测量的平均值,采用t检验比较两者CT值的差异是否有统计学意义.结果 60个踝关节被划分成600个区.MRI显示189个区(胫骨下段67个,腓骨下段98个,距骨24个)表现为斑片状、斑点状T1WI低信号,T2WI脂肪抑制序列高信号.Rel.CM值为1.25、1.45、1.60、1.75的VNCa图诊断踝关节骨挫伤的约登指数分别为0.13、0.41、0.79、0.70,Rel.CM=1.60的VNCa图诊断准确性最高,其灵敏度和特异度分别为82.54％和96.35％.在最优Rel.CM参数(1.60)的VNCa图上,骨挫伤区域和正常骨髓区域(对照组)的CT值分别为-97.0(-55.5～-120.6)HU和-149.1(-128.2～-168.5)HU,95％的置信区间为(50.1～54.1),差异有统计学意义(t=27.766,P<0.05).结论 DECT的VNCa图对踝关节骨挫伤具有较高的灵敏度和特异度,Rel.CM值设置为1.60的VNCa图对踝关节骨挫伤的诊断效能最优.