1 病例资料 患者,男性,43 岁,因"发现左侧腹股沟区包块2 年"入院.两年前患者无意间发现左侧腹股沟区约一鸡蛋大小包块,无压痛,未予重视,近半年来包块进行性增大,呈类圆形,约拳头大小,活动度差,局部皮肤完整,包块处轻度压痛,活动时伴牵扯痛,伴尿频尿急等不适,为求进一步诊治就诊于我院.入院查体:体温 36. 6℃,心率 70 次/分,呼吸 20 次/分,血 压 111/71 mmHg(1 mmHg≈0. 133 k P a),慢性病容,步入病房,神志清楚,查体合作,头颅五官无畸形,心肺查体无特殊,腹软,无压痛、反跳痛及肌紧张,肝脾未触及,肾区无叩痛,左侧腹股沟区触及一大小约 12 cm × 14 cm 类圆形包块,无搏动感,类圆形,局部皮肤完整,无红肿、皮肤破溃及分泌物流出,包块质韧,轻压痛并活动度差,边界尚清;双侧睾丸存在,透光实验阴性,余查体无特殊,生理反射存在,病理征未引出.

目的 探讨1.5T心脏磁共振成像(CMRI)在扩张型心肌病(DCM)中的应用价值.方法 选取DCM患者45例及健康对照者25例,均进行CMRI检查,通过LGE序列判断左心室有无心肌纤维化将DCM组患者分为LGE(+)组和LGE(-)组,测如下结构及功能参数:LVEDD、LVESD、LVEDV、LVESV、LVEF、LVSV、LVCO、LVMM、LVPER及LVPFR,其中将LVEDD、LVESD、LVEDV、LVESV、LVSV、LVCO、LVMM值除以体表面积进行标准化校正后以LVEDDI、LVESDI、LVED-VI、LVESVI、LVSVI、LVCI、LVMMI表示.评价LGE(+)组、LGE(-)组与对照组之间的结构及功能参数;分析DCM患者LGE的部位、形态特点与强化节段数;分析LGE(+)节段数与心功能分级、左心室结构及功能参数之间的关系.结果 DCM LGE(+)组、LGE(-)组与对照组LVEDDI、LVESDI、LVEF、LVEDVI、LVESVI、LVMMI、LVPER及LVPFR值之间两两比较差异均有统计学意义(P＜0.05),LGE(+)、LGE(-)组与对照组LVSVI、LVCI值之间两两比较差异无统计学意义(P ＞0.05);45例DCM患者中25例出现了左心室心肌纤维化,累及心肌总节段数为137段,占32.2％(137/425),最常累及的部位为基底段的前间壁(节段2)和后间壁(节段3).25例DCM LGE(+)患者中,最常见的强化模式是肌壁间线性强化;LGE(+)节段数与心功能分级、LVESDI、LVEDVI、LVESVI、LVMMI之间呈正相关,与LVEF、LVPER、LVPFR呈负相关,而与LVEDDI、LVSVI、LVCI无相关(P＞0.05).结论 1.5T CMRI在评估DCM患者左心室的结构、功能变化,以及定性、定量检测心肌纤维化方面具有重要价值.

目的 评价磁共振扩散加权成像(DWI)感兴趣区(ROI)的选择在评估直肠癌术前分化程度和淋巴结转移中的应用价值.方法 搜集在本院经病理组织学检查确诊为直肠癌患者56例.所有患者均使用Siemens Aera1.5T磁共振扫描仪行常规扫描序列及DWI序列检查.根据术后病理分期,将肿瘤分为高、中、低分化三组;按淋巴结是否转移分为两组.由2名不同年资影像诊断医师在直肠癌DWI图像上采用三种ROI法(小ROI、面积ROI、容积ROI)独立测量病灶的表观扩散系数(ADC)值.不同组间定量资料采用方差分析或t检验;运用受试者工作特征曲线(ROC)将存在显著差异的参数进行分析,获得相应的最佳临界值、曲线下面积(AUC)和诊断效能.结果 三种ROI法获得的ADC值差异有统计学意义(P＜0.05),其中容积ROI法测得的ADC值更高、重复性最好.三种ROI法测得的ADC值在直肠癌病理分化、有无淋巴结转移中差异有统计学意义(P＜0.05).绘制ROC曲线,高、中分化组容积ROI法AUC =0.901,最佳临界值为1.125×10-3mm2/s;中、低分化组容积ROI法AUC=0.848,最佳临界值为0.965×10-3mm2/s;淋巴结转移阳性与阴性组容积ROI法AUC=0.915,最佳临界值为0.975×10-3mm2/s.结论 三种ROI法中容积ROI法测得直肠癌的ADC值可重复性最好.ADC值可用于区分高、中分化和中、低分化以及淋巴结转移阳性与阴性的直肠癌,而容积ROI法测得的ADC值预测价值最好.

目的:探讨纵隔髓性脂肪瘤(mediastinal myelolipoma)的CT及MRI表现特点、诊断价值,以提高本病的认识及术前诊断的准确性.方法:回顾性分析经手术、病理证实的7例纵隔髓性脂肪瘤的CT及MRI表现,分析其影像学特点.结果:7例患者肿块均位于后纵隔;其中5例患者单侧单发,1例单侧两个结节,1例双侧多发.CT表现:病灶形态较规则,部分呈类圆形,呈等、低混杂密度,其内见CT值为负值的更低密度脂肪区,增强扫描呈轻度-中度不均匀性强化;MRI表现:病变T1WI及T2WI序列上均呈不均匀混杂信号,病灶内见斑点状、小片状脂肪信号,呈明显不均匀性强化.结论:CT及MRI检查可以发现纵隔髓性脂肪瘤的相关影像学特征,是术前诊断髓性脂肪瘤最重要的检查方法,能为本病的诊断及鉴别诊断提供重要依据.

心肌炎是一种心肌炎症性疾病,还是导致年轻人急性心力衰竭、猝死和扩张型心肌病的重要原因.心肌炎的临床症状及辅助检查结果与急性冠脉综合征的表现极其相似,常规检查鉴别诊断往往困难.虽然诊断心肌炎的"金标准"是心肌活检,但因有创、灵敏度差及病灶的局限性而限制其临床应用.心脏磁共振(CMR)"一站式"检查,不但能够了解及评估心脏结构和功能;还能直观地观察到心肌组织的病理改变(包括水肿、毛细血管渗出、细胞坏死及纤维化等)及心肌应变.随着影像技术的发展,路易斯湖诊断标准结合磁共振特征追踪技术诊断心肌炎特异性更高,评估病情变化及疗效更准确.故该文就磁共振路易斯湖诊断标准及特征追踪技术在心肌炎诊断中的应用进行综述.

冠状动脉疾病是目前世界范围内流行的一种疾病,尽管最近治疗和介入方法有所改善,但冠状动脉疾病仍然是全球主要的死亡原因.心脏磁共振成像(CMRI)序列提供关于左心室功能、区域灌注、血管生成、特别是心肌活力等信息对心肌梗死的诊断及其后期治疗与评价具有重要的意义.本文主要对MRI技术评价心肌梗死的应用及发展进行综述.

目的 探讨和分析CT对自身免疫性胰腺炎与胰腺癌的鉴别诊断价值.方法 回顾性分析我院18例经手术、组织学活检及激素治疗后好转证实的AIP作为观察组,18例经手术证实的胰腺癌作为对照组.对所有患者进行CT平扫及动态增强扫描,对比两组病灶的形态、密度、被膜样边缘、强化方式、胰管改变和胰腺外等方面的不同.结果 2组胰腺病变在腊肠样改变、局灶性密度减低、密度均匀度、增强后静脉期病灶强化密度、延迟强化、被膜样边缘、胰周淋巴结肿大、胆管渐进性狭窄、胆管截断与胆管壁强化方面存在显著差异(P＜0.05);2组胰管扩张、胰周血管受累情况、合并假性囊肿形成以及增强扫描动脉期病灶强化密度方面差异无统计学意义(P＞0.05).结论 CT扫描对自身免疫性胰腺炎与胰腺癌的鉴别诊断具有较高价值及可行性.

目的 探讨颅骨海绵状血管瘤的临床、病理及影像学特点.方法 回顾性分析12例经手术病理证实的颅骨海绵状血管瘤的临床及影像学资料.结果 6例位于额骨,2例位于顶骨,2例位于枕骨,2例位于颞骨,CT平扫表现为低密度的骨质破坏区,呈日光放射状或局限性溶骨性骨质破坏,颅内外板不同程度受累.MR平扫T1W表现为稍低信号,T2W表现为稍高信号,增强扫描明显不均匀强化.12例患者均行病变切除术加钛网修补术.肉眼见病变呈暗红色,突出颅骨表面;镜下见骨小梁被松散的结缔组织包围,周围见由内皮细胞排列的多个薄壁血管空间.结论 颅骨海绵状血管瘤具有一定的影像学特征,术前正确的或具有倾向性的诊断有助于制定正确的治疗方案,减少术中出血.

患者,男,43岁.因“两年前体检发现胃底部隆起物,直径约5 mm,近来剑突下胀痛10d余”.既往有“慢性胃炎”病史,家族中无相同患者.查体:腹软,中上腹深压痛,无反射痛及肌紧张,肝脾肋下未扪及,移动性浊音阴性,肠鸣正常,生理反射存在,病理反射未引出.辅助检查:胃镜提示胃底黏膜下隆起;内镜超声检查提示胃黏膜隆起物,病变截面大小约13.2 mm×7.5 mm;腹部CT:胃底部见一结节影(图1),直径约9 mm,局限性向外突起,边界清楚,与胃底部宽基地相连,CT值约为40 HU,考虑间质瘤可能性大.实验室检查无特殊异常.于全麻下行胃底隆起全层切除术,术后病理诊断:“胃底黏膜下肿块”为异位脾组织(副脾).

目的 应用心脏磁共振组织追踪(CMR-TT)技术定量分析急性心肌炎左室心肌应变.方法 收集急性心肌炎患者30例(病例组)及健康志愿者25例(正常对照组),采用西门子Aera1.5T磁共振完成心脏磁共振检查,应用磁共振组织追踪技术定量分析,比较两组心功能指标:左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESD)、左室每博输出量(LVSV)、心输出量(CO);左室心肌应变参数:左室整体径向应变(RS)、周向应变(CS)、纵向应变(LS)、左室整体径向应变率(RSR)、周向应变率(CSR)、纵向应变率(LSR).结果 病例组LVEF低于正常对照组[(50.72±11.46)％vs.(59.11±4.87)％,P=0.001].病例组LVESD高于正常对照组[(63.49±23.89)mL vs.(47.38±15.41)mL,P=0.007];两组间LVEDV、LVSV、CO差异无统计学意义(均P≥0.05).病例组整体RS、CS、LS低于正常对照组[RS:(29.99±10.16)％vs.(40.97±10.03)％,P<0.001;CS:(-15.39±2.86)％vs.(-19.39±2.49)％,P<0.001;LS:(-14.33±2.78)％vs.(-16.60±3.20)％,P=0.01].病例组的整体RSR、CSR、LSR低于正常对照组[RSR:(2.04±0.66)L/s vs.(3.05±1.04)L/s,P<0.001;CSR:(-0.92±0.21)L/s vs.(-1.19±0.25)L/s,P<0.001;LSR:(-0.84±0.22)L/s vs.(-1.08±0.29)L/s,P=0.002].病例组左室射血分数≥55％的整体CS、RSR、CSR均低于正常对照组[CS:(-17.16±1.61)％vs.(-19.39±2.49)％,P=0.003;RSR:(2.42±0.58)L/s vs.(3.05±1.04)L/s,P=0.025;CSR:(-1.00±0.10)L/s vs.(-1.19±0.25)L/s,P=0.002].结论 CMR-TT技术是一项操作简单、无创的分析左室心肌应变的方法,能定量评估急性心肌炎左室心肌应变;相比左室射血分数指标,心肌应变参数能更敏感地反映心脏早期受损.

目的 探讨自身免疫性胰腺炎(AIP)的CT、MRI影像学表现特征及其诊断价值.方法 回顾性分析南充市中心医院13例经病理及临床治疗后证实的AIP的CT及MRI特征.13例患者均行CT平扫及增强扫描,其中10例行磁共振成像(MRI)及薄层磁共振胰胆管造影.结果 CT检查发现13例患者中,8例胰腺弥漫性肿大,5例局限性肿胀,呈团块样肿改变;CT平扫为均匀一致的略低密度,有9例出现明显延迟强化,8例患者胰周显示模糊,7例出现鞘膜征.10例MRI检查者在T1WI呈等低信号,T2WI呈略高信号,薄层MRCP显示3例胆总管呈鼠尾状狭窄,且3例均被误诊为胆总管胰腺段占位;5例胰管呈节段性狭窄或轻度扩张,3例患者与周围血管分界不清.结论 自身免疫性胰腺炎的CT与MRI影像学表现具有一定的特征性,根据影像学表现可对多数患者作出正确的诊断.

患者男,45岁,因“无明显诱因反复胸背部疼痛、胸前区牵扯痛3个月”就诊.25年前患者曾于当地医院接受脾脏切除术.查体:腹部左侧见约15 cm手术瘢痕,右上腹局部无肌紧张、压痛及反跳痛.腹部CT:肝左内叶见大小约为5.0 cm×4.9 cm的等密度团块,突出于肝脏包膜之外,形态欠规则,CT值约58 HU(图1A),增强动脉期(图1B)及门静脉期(图1C)肿块密度与肝实质一致,其内似见线样未强化低密度影,考虑为肝左叶占位性病变.

1 病历资料 患者,女性,30岁,因体检发现"右肾占位1月余"入院. 无血尿、蛋白尿,尿常规及肝、肾功能未见明显异常. 查体:双侧肾区无叩击痛,输尿管走行区无明显压痛. 影像学检查:B超可见右肾中上份实质内见大小约3.6 cm ×3.2 cm的等回声团,边界清晰,形态规则,未见明显血流信号,余肾实质回声均匀,皮、髓质分界清晰,集合系统不分离,未见确切强回声团. 超声造影提示肿瘤占位性病变,癌可能性大. CT(平扫+增强扫描)可见右肾体积增大,见一直径约4.3 cm的囊实性团块影,其内可见斑片状钙化灶及小片状液性密度区,增强扫描显示肿块实质性成分呈轻度强化,液性区域无强化,病灶突破肾脏轮廓,紧贴肝右后叶,诊断意见:考虑肿瘤占位性病变可能大(见图1). 手术及病理:全麻下行后腹腔镜右肾肿瘤根治性切除术,术中见右肾形态失常,中上极可见一大小约5 cm ×4 cm ×4 cm的实质性包块,向肾外突出,质韧,边界欠清,中心部分呈鱼肉样改变.镜下:肿瘤以上皮性成分为主,多为早期上皮性分化,未分化的胚芽成分较少见,未见明显间质性改变,瘤细胞体积小、核深染、呈梭形,输尿管断端、肾门血管及肾周脂肪无肿瘤浸润(见图2). 病理学诊断:成人型肾母细胞瘤(上皮型).

Objective To analyze the CT features,clinical diagnostic value,and the causes of misdiagnosis for xanthogranulomatous cholecytitis (XGC) and improve its diagnostic accuracy.Methods The CT features of 20 patients of XGC confirmed by operation and pathology were retrospectively analyzed,and the imaging features of XGC were analyzed.Abdomen CT scans with and without contrast enhancement were performed in all patients.Results Only 4 cases was correctly diagnosed before surgery in all patients.CT features of XGC were included gallbladder enlargement in varying degrees (4 cases),gallbladder shrinking (9 cases) and gallbladder wall thickening (20 cases) by CT common scan.CT enhanced scan findings included hypodense nodules in the thickened walls (7 cases),continuous mucosal line (12 cases),fuzzy gallbladder and liver (4 cases),local infiltration of liver (4 cases),and "hypodense band" sign (4 cases).12 patients were complicated with calculus of gallbladder.1 patient was complicated with calculus of common bile duct.Conclusion The relevant imaging features of XGC can be found by CT scans.After contrast administration,hypoattenuated areas presented in thickened gallbladder wall,"hypodense band" sign,and continuous mucosal line on contrast-enhanced CT are very important for the diagnosis and differential diagnosis of XGC.

Objective To investigate the characteristics of coronary artery disease in different gender patients with type 2 diabetes (T2DM).Methods Patients undergoing coronary angiography of dual source CT in our hospital from April 2015 to March 2016 were selected.A total of 261 patients (63 with T2DM and 198 without T2DM) were examined.All images were comprehensively assessed by two radiologists who had experienced in cardiovascular diagnosis.Results The incidence of obstructive coronary artery disease with T2DM was higher than patients without diabetes regardless men or women (P ＜ 0.05).However,the incidence of obstructive coronary artery disease without diabetes in men was higher than women (P ＜ 0.05).Condusion The incidence of obstructive coronary artery disease in patients with T2DM is relatively high.It should attract attention of clinicians.

1 病例资料 患者,女性,40岁,因右膝关节疼痛4年伴肢体活动受限1年入院.患者4年前无明显诱因出现右膝关节疼痛,近1年来自觉疼痛加重并肢体活动受限,可行走、呈跛行步态,休息后可稍缓解,未行相关治疗.专科查体:右膝关节明显肿胀并皮温升高,髌骨上方可触及1个可活动肿物,大小约3.0 cm,质韧、压之可伴疼痛,浮髌试验阳性,关节伸曲活动稍受限,其他体格检查无异常.

Diffusion-weighted imaging (DWI)is the only noninvasive method to detect the diffusion motion of wa-ter molecular in living tissue.It has been widely used in the study of brain tumors and its response to therapy,because apparent diffusion coefficient (ADC)has a certain correlation with the tumor cell structure and the classification of the tumor.The potential and applicability of ADC value for the diagnosis of the disease were determined.Intracranial germ cell tumors (IGCTs),as a rare intracranial tumor,is lack of characteristic clinical manifestations and specifici-ty.This paper reviewed the relevant literature on the application of ADC in IGCTs and explored its relationship and application value.

Objective To discuss the width of ischiofemoral space (IFS) in asymptomatic adults and the related influence of physiological parameters (including age,sex,height,body weight,intertuberous distance,femoral offset,lesser trochanter height,etc).Methods Pelvic MSCT data of 61 adults without hip pain symptom were analyzed retrospectively.The indexes were measured,including the width of IFS,intertuberous distance,femoral offset,lesser trochanter height,femoral neck long axis,femoral neck angle and ischial angle.The correlation between the width of IFS and the physiological parameters was analyzed.Results The height,body weight,width of IFS,femoral offset,lesser trochanter height and femoral neck long axis of male subjects were larger than those of female subjects (all P＜0.05),while the intertuberous distance and ischial angle of male subjects were smaller than those of female subjects (both P＜0.001).There was positive correlation between the width of IFS and femoral neck long axis (P＜0.001).Negative correlation was found between the width of IFS and the age,intertuberous distance,femoral neck angle,ischial angle,respectively (all P＜0.001).No correlation between IFS and the height,body weight,femoral offset,lesser trochanter height was found (all P＞0.05).Conclusion MSCT can be applied for measurement and evaluation of relative anatomy images of ischiofemoral impingement.The structure of pelvis is different between male and female,and this may be the reason of why female patients are more likely to suffer from ischiofemoral impingement.

Objective To explore the CT characteristics and clinical features of nonfunctioning pancreatic neuroendocrine neo-plasm ( P-NENs) .Methods The image of CT scan and enhanced features of 17 P-NENs patients treated and confirmed in our hospital were analyzed.Results There were total 19 lesions in these 17 patients.There were 3 cases with G1 (pathological grading),9 with G2 and 5 with G3.CT features analysis showed that most of the lesions demonstrated low-density with clear boundary.Enhanced signal in all the lesions was detected in the delayed phase except two cases which had peri-lesional enhancing rim.All of the main pancreatic ducts were not invented.All cases had lymph node metastasis regardless of pathological grading.Conclusion P-NENs is prone to lymph node metastasis.Combination of CT findings with clinical features can be used as preoperative diagnosis.

目的 探讨卡氏肺孢子菌肺炎的高分辨CT (HRCT)表现及临床意义.方法 分析12例卡氏肺孢子菌肺炎患者的HRCT表现.结果 卡氏肺孢子菌肺炎HRCT表现为实变、磨玻璃影、小叶间隔增厚、支气管血管束周围间质增厚、小叶内间质增厚、胸膜下间质增厚、牵引性支气管扩张、马赛克表现、碎石路征、肺气囊、纵隔淋巴结增大等征像.结论 免疫力低下患者近期出现肺部感染性病变,HRCT扫描可见前述间质性改变、对称性磨玻璃影、新发肺气囊及马赛克表现应高度警惕卡氏肺孢子菌肺炎.