Objective:To evaluate the feasibility of CT quantitative analysis reflecting the degree of is-chemic necrosis and glucose metabolism level of non-small cell lung cancer(NSCLC).Methods:Fifty-two cases with NSCLC were enrolled in the study,the ischemia necrosis CT quantitative value (INCTQ)for NSCLC tumor on early enhancement CT images before surgery were measured.Glucose transporter 1 (Glut 1 )and carbonic anhydrase Ⅸ (CA Ⅸ)protein expression with paraffin embedded specimen after operation were detected by immunohistochemical staining.Results:The INCTQ values of expression of Glut1 -nega-tive,grade 1 and grade 2 were 0.35 ± 0.23,0.52 ± 0.55 and 1 .55 ± 1 .20,respectively (F =1 0.633,P =0.000);the INCTQ values of the Glut 1 and CA IX non-expression group,single expression group and co-expression group were 0.32 ±0.25,0.85 ±0.83 and 1 .37 ±1 .27,respectively (F =4.449, P =0.01 7).Conclusion:The early enhancement CT could be used to appraise the ischemia necrosis de-gree,and reflect the level of glucose metabolism of NSCLC.

The purpose of this study was to retrospectively assess the features of computed tomography (CT) images and clinical characteristics of male patients with solid pseudopapillary tumours (SPTs) and compare them with those of female patients.

目的:探讨64排螺旋CT常规技术对不同部位胃癌病灶T分期以及胃癌淋巴结转移程度判断的价值.方法:185例胃癌患者术前采用64排CT进行分期,并与术后病理分期进行对照.结果:胃癌检出特异性为100％,早期胃癌检出敏感性为92.0％,进展期胃癌检出敏感性为99.4％;胃癌T、N分期准确率分别为85.4％和69.2％,T1与T3、T2与T3分期准确率差异有统计学意义,贲门癌、胃体癌、胃窦癌T分期准确率分别为86.0％、85.4％和82.4％,差异无统计学意义;N0与N1、N1与N3分期准确率差异有统计学意义.结论:64排CT胃癌术前分期准确性较高,不同部位胃癌T分期准确性差异无统计学意义,早期胃癌及N分期的准确率有待进一步提高.

Objective To evaluate the role of 64-slice spiral CT with diphase dynamic scanning in predicting the T staging of gas-tric carcinoma in different locations and assessing the sensitivity of metastasis of lymph nodes.Methods 185 patients with gastric carcinoma proved by pathology underwent diphase 64-slice CT scan and performed a TNM staging according to UICC classification. The results were compared with surgical pathological findings.Results The detection sensitivity for earlier stage gastric carcinoma was 92.0% and 99.4% for the advanced stage gastric carcinoma,While the overall accuracy rates of T and N staging were 85.4%, 69.2% respectively.Compared with the pathologic findings,the accuracy rate of CT scan for T1,T2,T3,T4 staging was 72.0%, 69.6%,90.8% and 83.3% respectively.The differences were statistically significant between T1 and T3,T2 and T3.The accuracy rate of T staging was 86.0%,84.8% respectively when the lesions were located in cardia and in antrum and this difference was not statistically significant.When the lesions were located in the body of the stomach,the differences were also not statistically signifi-cant with the accuracy rate of T staging was 89.5%,86.4% ,87.2% respectively for the lateral wall of the lesser curvature,the posterior wall of the lesser curvature and both the lesser curvature and larger curvature involved.As for the N staging,The accuracy rate of N0,N1,N2,N3 was 54.3%,87.5%,68.1% and 53.6%.The differences were significant statistically between N0 and N1, N1 and N3.Conclusion There was a high accuracy in the preoperative TNM staging of the gastric carcinoma with 64-slice spiral CT. The accuracy rate of T staging of the gastric carcinoma is not relative to the lesion’s location.

Objective To retrospectively analyze imaging features of multi-slica computed tomography (MSCT) and clinical characteristics of male patients with pancreas solid pseudopapillary tumor (SPT) and compare with that of female patients.Methods From November 2000 to October 2012,clinical data of 18 male patients and 94 female patients underwent MSCT examination and pathological diagnosed as SPT were retrospectively analyzed.Clinical characteristics and imaging features of MSCT of male and female patients with SPT were analyzed,which included lesion location,size,shape,encapsulation,calcification,internal composition,density and enhancement pattern of tumors.Rank sum test or x2 test was performed for statistical analysis.Results The median age of male patients with SPT was significantly older than that of female patients (39.0 (15.0,67.0) years vs 27.5 (11.0,63.0) years; U=2.865,P =0.005).There were no significant differences in clinical manifestation,lesion location and composition ratio of benign and malignant tumors between male and female patients with SPT (all P＞0.05).Imaging of MSCT indicated that the median maximum tumor diameter of male patients with SPT was significantly shorter than that of female patients (5.1 (1.0,11.6) cm vs 7.9 (2.5,18.7) cm; U=3.161,P=0.002).Solid tumors were more common in male patients compared with female patients (9/18 vs 5.3％ (5/94) ; x2 =30.606,P＜0.01).Conclusions The imaging features of male patients with SPT are different with those of females.For pancreas lesion in males,if imaging of MSCT shows more solid composition,small lesion and with typical enhancement patterns of SPT,the possibility of SPT should be considered.

>患者男,62岁。因上腹部持续性胀痛1个月入院,疼痛与进食无关,休息后无减轻,近几天发现体重下降。体检:右上腹部压痛,未触及包块。影像学检查:CT平扫见胰腺尾部一不规则软组织肿块,大小约10.7 cm×8.0 cm×6.7 cm,密度不均,CT值约30～41HU;增强动脉期肿块实性部分明显强化,CT值约67 HU,坏死区无强化,门静脉期肿块实性病灶持续强化,CT值约73 HU,坏死区界限较动脉期清晰,肿

Objective To compare the differences in uptake of 2-deoxy-D-glucose (2-DG)-conjugated nanoparticles between breast carcinoma MDA-MB-231 cells with high metabolism and breast fibroblasts with normal metabolism,and investigate the feasibility of using the coated nanoparticles as a MRItargeted contrast agent for highly metabolic carcinoma cells.Methods The γ-Fe2O3@DMSA-DG was prepared.The glucose metabolism level of both cell lines was determined.The targeting efficacy of γ-Fe2O3 @DMSA-DG and γ-Fe2O3@DMSA NPs to breast carcinoma MDA-MB-231 cells and breast fibroblasts at 10 min,30 min,1 h and 2 h was measured with Prussian blue staining and UV colorimetric assay.MRI was performed to visualize the changes of T2WI signal intensity.Results Prussian blue staining showed more intracellular blue granules in the MDA-MB-231 cells of γ-Fe2O3@DMSA-DG NPs group than that in the γ-Fe2O3@DMSA NPs group,and the γ-Fe2O3@DMSA-DG uptake was greatly competed by free D-glucose.As revealed by UV colorimetric assay,MDA-MB-231 cells also showed that the cellular iron amount of γ-Fe2O3@DMSA-DG group was significantly higher than that of the γ-Fe2O3@DMSA group and γ-Fe2O3@DMSA-DG + D-glucose group,statistically with a significant difference between them.MRI showed that the signal intensity of γ-Fe2O3@DMSA-DG group was decrease significantly,the T2 signal intensity was decreased by 10.5％,37.5％,72.9％,92.0％ for 10 min,30 min,1 h and 2 h,respectively.In contrast,the signal intensity did not show obvious decrease in the γ-Fe2O3@DMSA-DG group,the T2 signal intensity was decreased by 8.5％,11.4％,32.0％,76.7％ for 10 min,30 min,1 h and 2 h,respectively.However,HUM-CELL-0056 cells did not produce apparent difference for positive staining in the γ-Fe2O3@DMSA-DG group,γ-Fe2O3@DMSA group and γ-Fe2O3@DMSA-DG + D-glucose group,and the signal intensity also did not produce apparent difference.Conclusions γ-Fe2O3@DMSA-DG has good targeting ability to highly metabolic breast carcinoma (MDA-MB-231) cells.It is feasible to serve as a specific MRI-targeted contrast agent for highly metabolic carcinoma cells,and deserves further studies in vivo.

Objective To summarize the imaging features of intra-pancreatic accessory spleen (IPAS)with multidetector computed tomography (MDCT) and improve the awareness and correct diagnosis of IPAS.Methods MDCT images of seven consecutive patients with surgically and pathologically confirmed IPAS were reviewed retrospectively.The investigated features included the location,size,shape,margin,density,and enhancement of the lesions.Results Four patients were male and three were female with a mean age of 49 years old.All the lesions were located at the dorsal side of parenchyma under the capsule of pancreatic tail.Three lesions were in round-like shape,and 4 in oval shape and all were well-defined.All the lesions were mass-like without necrosis and calcification.The maximum diameter of lesion ranged from 0.9 ～ 1.8 cm with a mean value of 1.4 cm.Compared with pancreatic parenchyma,the density of lesions were homogeneous on unenhanced CT,in arterial phase,slightly increased heterogeneous density was observed in 3 patients,slightly increased homogeneous density was observed in 4 patients.All the lesions appeared as slightly increased homogeneous density in portal phase.The CT value in unenhanced phase ranged from 50 ～ 61 Hu with a mean number of 55 Hu; and it ranged from 80 ～ 110 Hu with a mean number of 97 Hu in arterial phase; and the corresponding value was from 99 ～ 120 Hu with a mean number of 102 Hu in portal phase.Among the three patients underwent MDCT angiography,neither artery nor vein was compressed or invaded,and there was no vessel connected with lesions.Conclusions IPAS has some MDCT characteristics.For small solid mass in pancreatic tail,if the density and enhancement pattern is similar to that of spleen,the diagnosis of IPAS should be considered.

目的:分析多排螺旋CT在绞窄性肠梗阻诊断中的临床应用价值。方法:回顾分析58例经手术证实为绞窄性肠梗阻患者的临床资料和腹部多排螺旋CT影像资料,总结绞窄性肠梗阻的直接征象和间接征象。结果:绞窄性肠梗阻的直接征象:9例肠系膜上动脉或上静脉充盈缺损均得到正确诊断。间接征象:肠腔扩张积液41例(70.7%);靶征:肠壁水肿增厚12例(20.7%),其中有8例肠壁出现分层改变(13.8%),4例肠壁未见强化(6.9%);腹腔积液25例(43.1%);缆绳征:肠系膜水肿及渗出38例(65.5%);漩涡征:肠系膜血管增粗、扭曲及旋转4例(6.9%);鸟嘴征:扩张的肠袢在梗阻部位逐渐变尖,向某点集中2例(3.4%);肠壁积气2例(3.4%)。肠系膜静脉积气1例、门静脉积气1例。结论:多排螺旋CT能较好显示绞窄性肠梗阻的直接和间接征象,为绞窄性肠梗阻术前重要的诊断方法。

>患者男,54岁。左侧面神经麻痹4年,左腮腺区肿块伴疼痛1周。于2012年7月25日入院。1周前无意中发现左侧耳下一"鸡蛋"大小肿块,伴疼痛,生长较快,于外院对症抗炎治疗,效果不佳而转我院就诊。体检:左腮腺扪及一肿块,大小约4 cm×3 cm×3cm质偏硬,界尚清,相对固定,

Objective: The objective of this study was to investigate the correlation between the degree of necrosis displayed in computed tomography (CT) image and the expression of hypoxic and angiogenesis biomarkers of breast cancer.Methods: Forty-four breast cancer cases were examined with CT before surgery. Tumor specimen expressions of glucose transporter 1 (Glut1), hypoxia-inducible factor 1 alpha (HIF-1 alpha), carbonic anhydrase IX (CA IX), vascular endothelial growth factor (VEGF), and CD34 (as a marker of vascular endothelial cells) were detected by immunohistochemistry.Results: The expressions of Glut1 and CA IX were localized primarily to the edges of necrotic areas or intraduct surface; there was a strong correlation between HIF-1 alpha-positive expression and CA IX-positive expression (P < 0.001), and higher Glut1 or CA IX expression grade was associated with lower microvessel density (MVD) value. In CT enhanced images, lower relative CT (rCT) values were associated with more significant necrosis in the tumor; rCT value correlated positively with MVD significantly (r = 0.319, P = 0.035), and higher Glut1 or CA IX expression grade correlated with lower rCT values (P = 0.001 and 0.003, respectively). Although high VEGF expression was significantly correlated with high HIF-1 alpha expression (P G 0.001), there were no correlations between VEGF and MVD, and HIF-1 alpha and MVD (P = 0.559 and 0.710, respectively), and the difference of the mean rCT value between high VEGF or HIF-1 alpha expression group and low VEGF or HIF-1 alpha expression group was not significant.Conclusions: In breast cancer tissues, Glut1 and CA IX are key hypoxia biomarkers. Importantly, detection of necrosis in breast cancer tissue via CT enhanced imaging may prognosticate hypoxia and angiogenesis status and help to determine treatment plan of advanced breast cancer.

>患者女,25岁,孕20周。因咳嗽、咳痰伴发热、肢体酸痛、咽痛1周于2013年4月5日入院。体温39.9℃,双肺呼吸音稍粗,未闻及干湿啰音,发病第8天(住院第2天)咳嗽频繁,出现胸闷、气急。体检:口唇发绀,两肺散在湿啰音。实验室检查:白细胞(WBC)7.1×10～9/L,中性粒细胞(N)0.92,淋巴细胞(L)0.07;血生化:谷氨酸转氨酶54 U/L,肌酸激酶271 U/L,乳酸脱氢酶344 U/L。血气分析提示I型呼吸衰竭。

Background: A schwannoma arising from the pleura is rare. The computer tomography (CT) features, however, have seldom been disclosed in the English literature.Purpose: To retrospectively assess the role of CT in the diagnosis of pleural schwannomas.Material and Methods: Eleven patients with pathologically confirmed pleural schwannomas were included in the study. CT images and clinical data were analyzed. The CT features emphasized included the location of the neoplasm, as well as its diameter, origin, margin, shape, attenuation, enhancement pattern, and extent and invasion into adjacent structures, all of which were observed and recorded.Results: Seven patients were men, while four were women; patients were aged 21-60 years, with a mean age of 45 years. Most cases were incidentally detected. Seven cases involved neoplasms located in the right hemithorax whereas four cases involved neoplasms in the left hemithorax. The mean tumor diameter was 4.4 cm (range, 2.3-6.4 cm). All of the tumors were solitary and well-defined ovoid (n = 7) or round (n =4) in shape. The schwannomas showed isoattenuation (four cases) or mild hypoattenuation (seven cases) to the chest wall muscle on unenhanced CT. All cases showed minimal enhancement on contrast-medium-enhanced CT. Two bony erosions of the rib were also observed.Conclusion: CT findings may suggest the diagnosis of pleural schwannoma preoperatively. Pleural schwannoma should be included in the differential diagnosis of solid, solitary, and well-defined pleural tumors.

目的 探讨原发性小肠神经内分泌肿瘤的CT表现.方法 回顾性分析经病理证实的11例原发性小肠神经内分泌肿瘤的临床及CT表现.结果 病变位于十二指肠6例,空肠2例,回肠3例.病变表现为肠壁或肠腔内结节或肿块6例、肠管壁局限性增厚3例、肿块伴局部肠管壁增厚2例;最大径1.3~7.1 cm,平均2.8 cm.CT平扫8例为均匀软组织密度,3例为软组织密度伴小片稍低密度,均未见钙化;动脉期明显强化者8例,中等强化者3例,强化不均者7例,强化均匀者4例;门脉期较动脉期强化减低8例,强化增高3例.腹膜后或腹腔淋巴结转移2例;肝内、外胆管及胰管扩张2例.结论 小肠神经内分泌肿瘤具有一定的CT特征,CT表现有一定的诊断及鉴别诊断价值.

Objective:To evaluate the value of CT in diagnosing and differentiating primary malignant duodenal tumor(PMDT).Methods:A retrospective analysis of CT examinations was performed in 36 patients with PMDTs.The imaging features of each tumor were documented and compared with pathological findings.Results:Of the 36 patients with PMDTs,30 had adenocarcinomas,3 had malignant gastrointestinal stromal tumors(GISTs),1 had lymphoma,and 2 had neuroendocrine cell carcinomas.Duodenal adenocarcinoma manifested as a soft tissue mass accompanied with abnormal intestinal stricture.Malignant GIST exhibited a massive mass and marked enhancement.Most lymphoma exhibited extensive duodenal wall thickening and mild to moderate enhancement.Symptoms of intestinal obstruction were not readily apparent to the patients with duodenal lymphoma.Neuroendocrine carcinoma showed soft tissue density mass or nodule and intense enhancement.Conclusion:CT scan is of great value in diagnosing and differentiating primary malignant duodenal tumor.

目的分析影响64层螺旋CT行头颈部数字动脉减影成像中的影响因素并探讨其对策。方法对78例临床怀疑有头颈部疾患的患者进行CT数字减影动脉成像。先行定位像确定扫描范围,后利用相同扫描条件对扫描范围行平扫及CTA扫描。CTA扫描采用智能阈值触发模式;将平扫与增强扫描原始数据重建成0.6mm横断面图像并进行减影处理,然后传送至工作站进行多模式重建,观察血管显示情况,分析相关影响因素。结果 78例血管减影图像中质量为优55例,良l6例,差5例,另有2例减影失败而采用常规法CTA进行后处理。对图像质量的影响因素包括:患者制动及配合,扫描参数的一致性,优化的造影剂注射方案,正确的触发点的选择,恰当的重建参数。结论通过患者的配合、制定合理的扫描程序及优化图像重建参数,CT数字减影动脉成像相比常规法有更高的工作效率及更优良的图像质量。

患者男,60岁.因突发胸痛4h,于2012年1月21日来我院就诊.就诊前有腹泻病史,既往有高血压史.体检:血压120/78 mm Hg(1 mm Hg=0.133 kPa),实验室检查:血白细胞11.4×109/L,血糖10.17 mmol/L,肌酸激酶125 U/L,肌酸激酶同工酶17 U/L.心脏超声:左心房、室不大,左心室壁明显增厚,静息状态下左心室后壁收缩活动明显减弱。

Objective:To investigate the CT findings of submandibular gland pleomorphic adenoma.Methods:Clinical data and CT findings of 18 patients with pathologically confirmed submandibular gland pleomorphic adenoma were retrospectively analyzed.Results:All cases had unilateral solitary lesion.The lesion appeared as an internal mass in 16 cases and as an exophytic mass in 2 cases.The mass was round or elliptic in 13 cases and lobulated in 5 cases.On plain CT scan images,9 lesions manifested hypo-density compared to the surrounding glandular tissue,4 isodensity,2 hyperdensity and 3 isodensity or hypodensity mixed with cystic area.The lesion was ill-defined in 12 cases while well-defined in 6 cases.No calcification was found in all the lesions.On contrast enhanced CT,all tumors manifested mild to moderate homogenous enhancement and showed a clear border delineated by the strongly enhanced glandular tissue.3 lesions that underwent two-phase enhancement had a glandular enhancement tendency.The tumor diameter ranged from 1.3 to 4.6 cm with a mean value of 2.9 cm.Conclusion:CT findings of submandibular gland pleomorphic adenoma are relatively specific,Contrast-enhanced CT has important diagnotic and differential diagnotic values in submandibular gland pleomorphic adenoma.

<正>多层螺旋CT血管成像(multislice spiral CT angiography,MSCTA)被临床医师作为诊断主动脉夹层(aortic dissection,AD)的首选影像学检查,国内外文献多有报道。然而,相比较对于CT增强表现的详细描述,AD的CT平扫表现往往一带而过。现收集我院2006—2011年收治的AD患者77例,分析其CT平扫表现及诊断价值,报告如下。

目的探讨急性肠系膜血管梗塞的CT诊断价值。方法回顾性分析14例经临床证实的病例,分析肠系膜血管梗塞的直接和间接征象。结果 14例中肠系膜动脉栓塞6例,静脉栓塞8例。直接征象:平扫5例表现为管径增粗,6例表现为管腔内密度增高,增强后表现为管腔内充盈缺损。间接征象:肠壁呈靶样增厚5例,肠系膜水肿4例,合并腹腔积液10例,增强后肠壁无强化3例,1例并发脾脏和肾脏梗死。结论急性肠系膜血管梗塞影像表现有一定的特征,CT有较高诊断价值,对于不明原因的腹痛应及时进行CT检查。