目的:分析腮腺腺淋巴瘤临床表现及CT影像,探讨CT对其的诊断及鉴别诊断价值.方法:回顾性分析2014～2017年我院手术病理证实的15例腮腺腺淋巴瘤患者的临床表现及CT影像.结果:15个病例共30个瘤灶,单发瘤灶8例(53.33％),多发瘤灶7例(46.67％);瘤灶主体位于浅叶13例(86.67％),位于深叶2例(13.33％);有囊性变6例(40.00％),无囊性变9例(60.00％);所有瘤灶均无钙化;11例(73.33％)有长期吸烟史.肿瘤实性部分平扫CT值36～52(45±10) Hu,动脉期CT值72～127(105±18) Hu,延迟期CT值70～93(81±9)Hu,强化程度减退＜20 Hu者6例,20～40 Hu者7例,＞40 Hu者2例,平均减退(23±13) Hu.结论:根据腮腺腺淋巴瘤临床表现及CT影像,可以为术者提供可靠的参考依据.

目的:探究磁共振磁敏感加权成像(MRI-SWI)对脑干海绵状血管瘤的诊断价值.方法:以中国人民解放军中部战区总医院2015年1月—2018年1月经手术病理证实的120例脑干海绵状血管瘤患者为研究对象,均行常规MRI及SWI检查,观察各自影像学表现,并比较常规MRI与SWI对脑干海绵状血管瘤的检出率、病灶大小.结果:T1WI呈现高信号68例,占56.67％;T2WI呈现高信号70例,占58.33％.增强扫描显示强化83例,占69.17％.SWI显示完全低信号51例,占42.50％,部分病灶呈现"蝌蚪"征;混杂信号69例,占57.50％,病灶内部信号不均,表现出"爆米花"或"桑葚"征;病灶中央高信号,周围绕以低信号的"铁环"征;相位图混杂信号,呈现"光环"征.共检出病灶232个,SWI病灶检出率100.00％,显著高于T1WI、T2WI的44.83％、53.02％;SWI检出最大瘤体直径显著大于T1WI、T2WI检查(P<0.05).结论:SWI相比常规MRI能更好地显示脑干海绵状血管瘤病灶,有明确的影像学征象,可作为脑干海绵状血管瘤诊断的重要手段.

目的 探讨基于肿瘤全域的ADC直方图对于胶质瘤分级的价值.方法 回顾性分析16例经病理证实为胶质瘤且术前接受过常规MRI、DWI患者的影像资料,其中低级别胶质瘤7例(Ⅱ级7例),高级别胶质瘤9例(Ⅲ级3例、Ⅳ级6例),记录胶质瘤的ADC直方图参数,并采用独立样本t检验(正态分布)或Mann-Whitney U检验(偏态分布),利用ROC曲线评价ADC直方图参数鉴别诊断高、低级别胶质瘤的效能.结果 低级别胶质瘤以负偏态分布为主,高级别胶质瘤以正偏态分布为主.高、低级别胶质瘤第25百分位数ADC(ADC_25th)值、第50百分位数ADC(ADC_50th)值、ADC平均(ADCmean)值及偏度值差异有统计学意义(P均＜0.05).ADC_25th、偏度值鉴别高、低级别胶质瘤的效能最高,AUC为均为0.905.结论 基于肿瘤全域的ADC直方图分析有助于胶质瘤的分级,ADC_25th、偏度值具有良好的诊断效能.

[Objective] To analyze the features of multi-slice CT images in patients with thin-wall cavity lung cancer during clinical follow-up.[Methods]Nine patients(male/female,6/3 ;age range,53～77 years)who were confirmed as thin-wall-cavity typed lung cancer by post-operative pathology were collected into this study.Their CT images in the course of clinical follow-up were reviewed retrospectively.[Results]At first CT examination,the maximum diameter of lesions in 9 cases of cavity type lung cancer was 1.5～4.5(2.9 ± 0.96)mm,and the wall thickness was 1.5～4.5(2.9 ± 0.96)mm.Mural nodules were found in 9 cases,and the mean diameter of the mural nodules was 1.59 ± 24.2mm(11.4 ± 6.75)mm.Typical CT features of 9 cases of cavity lung cancer include :there were 6 cases with irregular contour(66.7％),4 cases with burr on the edge of the lesion(44.4％),4 cases with pleural line sign(44.4％),9 cases with luminal wall nodule(100％),5 cases with intraluminal septum(55.6％).In 4 cases of cavity lung cancer,lesions and wall nodules gradually in-creased and irregular thickening was found during clinical follow-up.[Conclusion] Cavity type lung cancer is characterized by irregular thin-walled cavity with wall nodule or/and intraluminal stripe separation.The clini-cal follow-up of cavity type lung cancer showed progressive thickening of cavity wall and enlargement of wall nodule.

目的 探讨核磁共振成像(magnetic resonance imaging,MRI) T2-IDEAL序列对视路病变的诊断价值.方法 回顾性分析81例罹患视路病变的患者行视路T2-IDEAL序列MRI检查,结合临床表现、眼科学检查及手术病理结果分析各类视路病变T2-IDEAL序列MRI表现.结果 81例患者中61例(75％)T2-IDEAL磁共振检查结果阳性,其中包括视路肿瘤1例(视神经胶质瘤)、鞍区肿瘤21例(垂体大腺瘤14例,颅咽管瘤7例)、视路血管病变3例(动脉粥样硬化2例,椎基底动脉延长综合症1例)、视神经病变19例(急慢性视神经炎6例,视神经损伤7例,视神经萎缩6例)以及视皮层脑病17例(右侧枕叶挫裂伤2例,缺血性白质脑病8例,脑梗死7例).结论 T2-IDEAL序列可以清晰显示视路解剖细节及视路相关病变,对各种类型视路病变病因诊断具有较高的临床价值.

目的:运用DCE-MRI定量参数评估乳腺癌新辅助化疗疗效,并分析该参数与相关生物学预后因子的相关性.方法:81例女性乳腺癌患者行新辅助化疗后根据RECIST标准分为治疗有效和无效两组,比较两组化疗前、2个疗程后、化疗结束时Ktrans、Kep和Ve值.采用免疫组化染色法检测乳腺癌组织ER、PR、HER-2、Ki-67表达情况.比较ER、PR、HER-2不同表达状态时DCE-MRI定量参数大小,分析该参数与Ki-67表达之间的相关性.结果:治疗有效组Ktrans、Kep在2个NAC疗程后及NAC化疗结束时较NAC治疗前均明显降低(P＜0.05);ER阴性组的Kep值高于ER阳性组,差异有统计学意义(P＜0.05).PR阴性组的Kep值高于PR阳性组,差异有统计学意义(P＜0.05);Ki-67表达分别与Ktrans值、Kep值呈正相关(r=0.654,P＜0.001;r=0.364,P=0.001),Ki-67表达与Ve值无相关性(P=0.177).结论:Ktrans、Kep等动态增强磁共振定量参数可用来评估乳腺癌新辅助化疗疗效,还可反映乳腺癌的生物学行为,从而间接评估乳腺癌患者预后.

Objective The purpose of the current study was to evaluate the 18 F-FDG PET/CT features in detection of multiple myeloma ( MM) lesions, and to elevate its recognition and diagnostic accuracy. Methods 18 F-FDG PET/CT imaging findings were retrospectively analyzed in patients with MM proved by bone marrow biopsy from January 2010 to January 2016. The imaging features of both bone lesions and extramedullary lesions were analyzed, and the metabolic situation was described by semiquantita-tive method (SUVmax). Results 1)The distribution of bone lesions: The following sites were most commonly affected: verte-brae in 29 cases (87. 9%), pelvis in 27 cases (81. 8%) and ribs in 26 cases (78. 8%);2)18F-FDG PET/CT imaging findings in bone lesions:dissovent bone destructions were most commonly and were detected in 30 cases (90. 9%), the SUVmax was 2. 3~12. 7 (mean value 6. 75 ± 4. 21). Medullary or parosteal soft tissue masses were found in 17 cases (51. 5%), the SUVmax was 3. 2~11. 6 (mean value 7. 12 ± 4. 84);3) Imaging findings in extramedullary lesions:extramedullary lesions were detected in 5 cases (15. 1%), 3 of which affected retroperitoneal or lesser omentum sac lymph nodes, the SUVmax was 4. 6~9. 7 (mean value 7. 1 ± 3. 14). Conclusion 18 F-FDG PET/CT has high application value in diagnosis of MM, which can detect, theseby providing the distribution and the metabolic situation of bone lesions, as well as find what of extramedullary lesions by one exami-nation, theseby providing the basis for clinical follow-up treatment.

Objective To investigate the characteristics of 18F-FDG PET/CT imaging in pulmonary sclerosis pneumocytoma (PSP).Methods The clinical and PET/CT data of 16 patients with pathologically proved PSP were retrospectively analyzed.The location,shape,size,internal and external edge of the lesion,as well as the metabolism of the lesions were observed.The mean retention index (RI) was calculated in 6 patients with 18F-FDG PET/CT dual phase imaging.The difference of SUVmax between early and delayed phase were compared.And the correlation between the diameter of lesions and SUVmax were analyzed.Results There were 16 lesions in all 16 patients,including 7 cases located at right lung and 9 located at left lung.The lesions were round with the diameter of (1.97-4-0.61)cm.The uniform density were observed with the CT value of (29.87±4.71)HU.And there was no cystic degeneration and necrosis.Calcification was found in 5 lesions.The edge of 14 lesions was smooth,and the edge of another 2 lesions showed short spicular sign.Two lesions showed visible edges of ground glass opacity.There were 12 lesions with "vascular welt sign" and 3 lesions with "air crescent sign".The SUVmax value of PSP was 2.71 ± 2.13.There was no significant difference between the early SUVmax (2.44±1.57) and delayed SUVmax (2.74±1.83) in patients with dual phase imaging (t=2.09,P＞0.05).RI was (7.23±10.29)％.There was no correlation between PSH diameter and SUVmax(r=0.188,P＞0.05).Conclusion Most of PSP showed solitary pulmonary nodules in PET/CT imaging.The radioactive distribution was mild and moderate increase.The "vascular welt sign","air crescent sign" and the surrounding ground glass opacity are the references findings of PSP.

Objective: To evaluate value of dynamic volume CT(DVCT) using "a one-stop protocol for stroke" in the di-agnosis of vertebrobasilar dolichoectasia (VBD). Methods: Twenty two patients (male/female=16/6, aged 39~79 years old) with DVCT-confirmed VBD were included into this study. For each patient with VBD, the location score and height score of basi-lar artery (BA) were determined and the BA diameter were measured in a post-processing workstation, as well perfusion status of the posterior circulation area were evaluated using a whole-brain perfusion analysis software. Results: Of 22 patients, the BA diameter was (6.12±1.73) mm on average (range 3.9~10.1 mm), the averaged BA height and location score were 2.32±0.48 and 2.32 ±0.78 (range 1 to 3) respectively. Posterior-circulation abnormal perfusion were detected in 11 patients with VBD (50%), which was characterized by inordinately increased TTP, and increased rCBF and contracted MTT and presence of brain infarct lesions in serious cases. Between normal perfusion in posterior-circulation area and abnormal perfusion groups, there have significant difference both the BA position score and BA diameter (Mann-Whitney U test, P<0.05). Conclusion: For pa-tients with VBD, DVCT examination could well demonstrate the morphologic abnormality in vertebrobasilar arteries and abnor-mal perfusion in posterior circulation.

Objective To investigate the imaging features of 18F-fluorodeoxyglucose (18F-FDG) positron-emission tomography/computed tomography (PET/CT) in autoimmune pancreatitis (AIP).Methods A total of 14 AIP patients' 18F-FDG PET/CT data in authors' hospital were retrospectively analyzed,the metabolic activity characteristics of the local pancreatic and extrapancreatic organs were analyzed,and average retention index (RI) of pancreatic lesions,early maximum standardized uptake value (SUVmax),delayed SUVmax were calculated and compared.Results Among 14 patients (5 males and 9 females),the average age was 49 years (ranged,31-67 years),11 patients with diffuse enlargement of pancreas,3 patients with local enlargement of the head of pancreas,the metabolic activity of the lesion site were increased.The main pancreatic duct in 10 patients showed diffuse stenosis,3 patients were localized and multifocal stenosis,1 patients was localized pancreatic duct stricture with proximal pancreatic obiliary dilatation,5 patients with peripancreatic sheath syndrome,3 patients with pancreatic leakage around.There were statistically significant difference in early SUVmax and the delayed SUVmax of 14 AIP patients(t=-6.63,P<0.05),and had no statistical difference between early SUVmax and delay SUVmax of 3 local pancreatic growth patients (t=-4.5,P=0.05).The difference among the early SUVmax,delayed SUVmax and RI were not statistically significant of patients with diffuse enlargement in pancreas (P>0.05).In 14 AIP patients,the changes of pancreatic external organs were found.The diagnostic accuracy of PET/CT was 71.40% (10/14),among which 3 patients was misdiagnosed as pancreatic head carcinoma,and 1 patient were misdiagnosed as acute pancreatitis.Conclusion 18F-FDG PET/CT AIP imaging has certain characteristics,and it is helpful to improve the correct rate and the accuracy of the disease.

Objective To analyze the 16-silce CT-pathologic correlation of cavernous lung squamous cell carcinoma(SCC)and lung adenocarcinoma.Methods Twenty-two cases of cavernous lung cancer diagnosed by lung biopsy,bronchoscopy biopsy or postoperative pathology were collected since June 2013,including 12 lung SCC cases and 10 lung adenocarcinoma cases.The CT images were restrospectively analyzed,and the characteristics of cavernous lung cancer between two different pathological types were compared.Results Cavernous SCC possessed the characteristic of quasi-circular thick-walled cavity [tumor diameter,(42±27)mm;thickness,(8.6±3.4)mm].Among 12 lung SCC cases,cavity fluid presented in 5 cases,wall nodule in 2 cases,and cavernous septa in 2 cases.No pleural line or spiculation were found in cavity of all patients.Among 10 cavernous adenocarcinoma [tumor diameter,(35±14)mm;thickness,(5.4±2.7)mm],spicule sign appeared in 8 cases,wall nodule in 7 cases,and no liquid loading were found in all cavities.Compared with cavernous lung SCC,lesions in cavernous lung adenocarcinoma were smaller with thinner wall(P<0.05).The probabilities of wall nodule and spicule sign in cavernous lung adenocarcinoma were more than these in cavernous lung SCC(P<0.05).Conclusion The CT manifestations of cavernous lung SCC and adenocarcinoma show some characteristics.Generally,cavernous lung SCC always presents as quasi-circular thick-walled cavity,and cavernous adenocarcinoma is irregular in shape,thin-walled with spicule sign and mural nodules.

Objective To assess the correlation between prognostic relevant factors of breast cancer and its apparent diffusion coefficient (ADC) value.Methods Forty breast cancer patients with invasive ductal carcinoma (IDC) were included in the study,in total 44 lesions.The preoperative diffusion-weighted imagings of IDC patients were retrospected,and ADC values of breast IDC lesions were measured.Compared with postoperative pathology results,the correlation between ADC values of lesions and prognostic relevant factors,including lesion size,status of lymph node metastasis,nuclear grade,expressions of estrogen receptor (ER),progesterone receptor (PgR) and human epidermal factor receptor 2 (HER-2) were analyzed.The lesions of breast cancer were divided into groups by maximum diameter＜2 cm or ≥2 cm.According to the Ki-67 labeling index,mitotic activities of IDC lesions were defined as grade Ⅰ (≤15％),grade Ⅱ (16％-30％) and grade Ⅲ (≥30％).It was considered as positive when the staining cells of ER and PgR were over 10％ of tumor cells,and marker ratio of HER-2 staining cells in excess of 25％ of tumor cells was HER-2 over expression.Results There were significantly different in ADC values arong different grade groups of mitotic activities of IDC (P =0.014),ER-positive group had a greater ADC value than negative group (P =0.005),and ADC value of PgR-positive group was higher than that of negative group (P =0.048).There was significantly correlation between ADC values and mitosis activities of IDC lesions (R =-0.424,P =0.04) as well as ER expression status (R =-0.12,P =0.26).Conclusion Quantitative analysis of ADC values contributes to the prognostic assessment of breast cancer.The mitotic activities and ER expressions status of prognostic relevant factors relate to ADC values of IDC.

患者男,69岁,自述撞伤致左小腿疼痛3个月,加重伴发热3天就诊.2012年8月于中国人民解放军武汉总医院就诊住院,体格检查:体温39.1℃,左小腿稍肿胀,皮温稍高,内侧局部压痛(+),表面皮肤无异常,全身浅表淋巴结未触及.实验室检查:白细胞计数12.6×109/L,中性细胞百分率93.5％,中性细胞绝对数11.81×109/L,C反应蛋白218 mg/L,血沉54 mm/h.

Objective To explore major factors which caused blood stagnation in vertebrobasilar artery and cerebral infarction in posterior-circulation region of vertebrobasilar dolichoectasia (VBD) through magnetic resonance imaging (MRI) analysis.Methods A total of 22 patients confirmed with VBD were included into this study,there were 16 males and 6 females,the average age was (61.7±10.8) years (rang,39-79 years).The basilar artery (BA) maximum diameter was measured on MRI images,BA height scores,BA location scores and BA total scores were recorded.The relationship between BA indexes and cerebral infarction were evaluated respectively by Mann-Whitney U test.Results Among 22 patients,20 cases had a history of hypertension,8 cases occurred old or acute infarction in the posterior circulation area,2 case were BA fusiform aneurysm,11 cases presented "bright-blood-vessel sign" of vertebrobasilar artery on fluid attenuation inversion recovery (FLAIR),T1-weighted imaging (T1WI).Between bright-blood-vessel sign positive group and negative group,there were statistically different in BA maximum diameter and BA location scores (P<0.05),and significantly different in BA total scores (P<0.01).Between posterior circulation cerebral infarction positive group and negative group,there were significantly different in BA location scores and BA total scores (P<0.05).Conclusion For patients with VBD,BA position offset probably contribute to the posterior circulation cerebral infarction.

目的 探讨18F-FDG PET/CT显像对引起胆道梗阻的恶性肿瘤的诊断价值.方法 搜集并回顾性分析39例经病理证实因恶性肿瘤引起梗阻性黄疸患者的18F-FDG PET/CT显像资料;通过半定量法测定的最大标准摄取值(SUVmax)对图像进行分析,定性以局部区域放射性浓聚为依据,以SUVmax≥2.5作为诊断恶性肿瘤的依据.结果 18F-FDG PET/CT诊断恶性胆道梗阻性疾病的定性符合率为97.4％ (38/39),定位符合率为92.3％(36/39).本组38例PET-CT显像的引起胆道梗阻的恶性肿瘤大小为(3.08±1.32)cm,SUVmax为5.12±1.74,两者Pearson相关系数为0.511,P=0.001.对肝内胆管细胞癌(14例)、肝外胆管癌(10例)、胰头癌(8例)、胆囊癌(6例)的病灶大小及SUVmax分别进行单因素方差分析,各组大小比较F=4.401,P=0.01;SUVmax比较F=1.519,P=0.227.结论 18F-FDG PET/CT显像对引起胆道梗阻的恶性肿瘤的定性及定位诊断有较高的准确率,SUVmax与病灶大小呈正相关,与病理类型无关.

Objective To investigate the value of 99Tcm-DTPA renal dynamic imaging in patients with gouts.Methods A total of 157 gouts patients（153 male;age range 1888 years） underwent conventional 99Tcm-DTPA renal dynamic imaging from June 2011 to October 2014.After bolus injection of 111185 MBq tracer,a series of images were obtained.DTPA renograms were generated by the application of computer technology ROIs.GFR were calculated using Gates and C20 were gained also.The GFR detected by 99Tcm-DTPA was compared with BUN,SCr and UA.Furthermore,unilateral renal GFR and C20 was analysed.Results BUN and SCr still maintain a normal level when the GFR measurement by renal dynamic imaging decreased slightly.GFR was low as 60 ml/min or less,BUN and SCr increased significantly.The GFR changed earlier than BUN and SCr in gouts patients with renal damage.Excluding the impact of factors such as urinary tract obstruction,19.7%of patients showed unilateral renal GFR decline.Reducing C20 was observed in 22.3%kidneys with normal GFR.UA levels were not changed significantly with worsening renal function.Conclusions Radionuclide renal dynamic imaging is an effective method to assess the renal function in patients with gout.

目的探讨18F-FDG PET/CT显像对引起胆道梗阻的恶性肿瘤的诊断价值。方法搜集并回顾性分析39例经病理证实因恶性肿瘤引起梗阻性黄疸患者的18F-FDG PET/CT显像资料;通过半定量法测定的最大标准摄取值（SUVmax）对图像进行分析,定性以局部区域放射性浓聚为依据,以SUVmax≥2.5作为诊断恶性肿瘤的依据。结果18F-FDG PET/CT诊断恶性胆道梗阻性疾病的定性符合率为97.4%（38/39）,定位符合率为92.3%（36/39）。本组38例PET-CT显像的引起胆道梗阻的恶性肿瘤大小为（3.08±1.32）cm,SUVmax为5.12±1.74,两者Pearson相关系数为0.511,P=0.001。对肝内胆管细胞癌（14例）、肝外胆管癌（10例）、胰头癌（8例）、胆囊癌（6例）的病灶大小及SUVmax分别进行单因素方差分析,各组大小比较F=4.401,P=0.01;SUVmax比较F=1.519,P=0.227。结论18F-FDG PET/CT显像对引起胆道梗阻的恶性肿瘤的定性及定位诊断有较高的准确率,SUVmax与病灶大小呈正相关,与病理类型无关。

目的 探讨骨淋巴瘤18F-FDG PET/CT显像的影像学特点.方法 搜集经病理组织学证实的骨淋巴瘤患者35例,其中原发性骨淋巴瘤4例,继发性骨淋巴瘤31例,分析其18 F-FDG PET/CT表现.结果 4例原发性骨淋巴瘤均为非霍奇金淋巴瘤,单骨发病,表现为骨质破坏伴软组织肿块,放射性摄取增高,SUVmax 7.9～17.9.31例继发性骨淋巴瘤,霍奇金淋巴瘤5例,非霍奇金淋巴瘤26例,单骨发病2例,多骨发病29例,骨质密度异常表现多样,具体分为:(1)骨质破坏型20例,表现为不同程度溶骨性骨质破坏,邻近可伴或不伴有软组织肿块,放射性摄取不同程度增高,SUVmax 2.5～15.0; (2)骨质硬化型3例,以骨质硬化为主,病变区域骨质密度高于正常骨骼,不伴有邻近的软组织肿块影;放射性摄取无异常增高或轻度增高,SUVmax 1.0～ 5.6;(3)骨髓浸润型8例,全身骨髓弥漫性放射性摄取增高,SUVmax 1.7～ 9.8,无骨质密度异常.结论 骨淋巴瘤18F-FDG PET/CT影像学表现有一定的特征性,分析其表现,对原发性和继发性骨淋巴瘤的诊断、鉴别诊断有重要的临床价值.

Objective To explore the value of elevated urinary microalbumin in patients with type 2 diabetes mellitus(T2DM)and the influential factors.Methods Urinary microalbumin of 79 T2DM patients were detected.The association of urinary microalbumin with serum creatinine(Scr),hyperuricemia and clinical signs were analysed.Results Elevated urinary microalbumin occurred before the increasing of Scr,and its increase was companied with the deterioration of the kidney function.Hyperuricemia,hypertension and uncontrolled blood glucose could worsen the kidney function.Conclusion Urinary microalbumin is a sensitive markers for early renal function damage in T2DM patients whose occurrence and development is affected by multiple factors.

Objective To investigate variation of serum homocysteine in middle-aged and elderly population.Methods The serum Hcy were detected in 446 middle-aged and elderly persons and analyzed by gender and ages. The changes of serum Hcy in persons with hypertension,coronary heart disease( CHD) and cerebral apoplexy were studied. Results The mean value of serum homocysteine was 16. 60 ± 7. 58μmol /L. A higher homocysteine in male and persons more than 80 years were observed. The serum homocysteine in persons with cardio-cerebral vascular disease were higher than that of normal control. Conclusion There are gender and age difference in serum homocysteine. The hyperhomocysteinemia( HHcy) is a risk factor for cardiac-cerebral vascular disease.