西藏高原牧区肝包虫病患者CT表现分析

目的:探讨西藏高原牧区肝包虫病CT的特点,更好的指导临床诊断和治疗。方法:分析27例肝包虫病CT的特点和诊断,探讨其CT征象及价值。结果:共收集包虫病患者27例进行CT检查。单房性包虫囊肿25个,CT表现为囊性病变,囊内密度均匀,可见等密度的囊壁,囊比多均匀光滑,可有线状或环状钙化;有时合并内在性破裂,表现为内囊与外囊分离,或破碎的内囊漂浮在囊腔内。多房性包虫囊肿共2个,CT平扫可见多个子囊和程度不同的基质,囊壁可见钙化。结论:西藏高原牧区肝包虫病患者CT平扫有特定的影像特点,可以用来进行诊断     

西藏高原牧区肝包虫病患者CT表现分析

目的：探讨西藏高原牧区肝包虫病CT的特点,更好的指导临床诊断和治疗。方法：分析27例肝包虫病CT的特点和诊断,探讨其CT征象及价值。结果：共收集包虫病患者27例进行CT检查。单房性包虫囊肿25个,CT表现为囊性病变,囊内密度均匀,可见等密度的囊壁,囊比多均匀光滑,可有线状或环状钙化;有时合并内在性破裂,表现为内囊与外囊分离,或破碎的内囊漂浮在囊腔内。多房性包虫囊肿共2个,CT平扫可见多个子囊和程度不同的基质,囊壁可见钙化。结论：西藏高原牧区肝包虫病患者CT平扫有特定的影像特点,可以用来进行诊断。     

影像学对早期壶腹部腺Ca诊断价值探讨(附48例报告)

目的:综合分析壶腹部早期腺Ca48例病人各种影像学表现,找出其早期诊断的可靠方法。材料与方法;对照分析经手术病理证实的48例壶腹部小腺Ca的CT、超声、ERCP、PTC资料。其中胆总管下端Ca27例。乳头Ca21例。结果48例CT检查36例可见肝内外胆管扩张呈囊状、软藤状,16例肝外胆管扩张明显,肝内胆管轻度扩张。部分可见肿块影或胆总管下端截断狭窄。8例于腹膜后大血管周围可见多发肿大淋巴结。36例超生检查显示肝内胆管扩张,胆囊肿大明显,5例可见软组织肿块影。ERCP检查24例,8例可在内窥镜下看到肿块影。结论:肝内胆管及肝外胆管扩张是壶腹部腺Ca早期影像表现,特别以肝外胆管扩张、胆囊肿大明显为特征。CT、B超、ERCP、PCT均可显示,以CT显示最为可靠,ERCP可显示乳头部肿瘤的直接征像。综合影像检查可明显提高壶腹部小腺Ca的准确率。     

B超在肝囊型包虫病诊断中的临床价值与意义

目的：评价B超在肝囊型包虫病诊断中的价值与临床意义。方法：回顾性分析我院2000年12月至2011年12月收治的接受B超检查和手术治疗的332肝囊型包虫病例的临床资料。结果：332例肝囊型包虫病患者中,303例经过手术证实;肝囊型包虫病的B超分型可分为单发单囊型、多发单囊型、多子囊型、破裂感染型和坏死钙化型。单发单囊型患者以低年龄组多发,而高年龄组较少;破裂感染型以高年龄组多发;坏死钙化型病人共3例年龄均在60岁以上;破裂感染型占各型中病例数最多。结论：B型超声检查是肝囊型包虫病的主要检查方法,可确定包虫病的分型,了解包虫囊肿的部位、数目、大小和结构,为术前诊断、手术定位、观察治疗效果提供参考依据。     

多层螺旋CT联合彩色多普勒超声对小儿先天性胆总管囊肿的诊断价值分析

摘要 目的：探讨多层螺旋CT（MSCT）联合彩色多普勒超声对小儿先天性胆总管囊肿（CCC）的诊断价值。方法：选取2018年1月～2021年12月来我院治疗的78例CCC患儿为研究对象,所有患儿均接受彩色多普勒超声检查及MSCT检查,以病理诊断结果为金标准,对比两种检查方法对CCC的诊断价值。结果：所有CCC患儿中均未出现肝门部纤维斑块（TC征）阳性、肝动脉内径增宽,33例出现囊肿内胆泥沉积和肝内胆管扩张,16例出现胆囊异常;囊肿长径、宽径分别为（5.41±0.60）cm、（3.26±0.38）cm,脾脏内径为（1.56±0.17）cm。所有患者的Todani分型结果显示：Ⅰ型67例,Ⅱ型2例,Ⅲ型2例,Ⅳ型5例,Ⅴ型2例。与病理学诊断结果对比,彩色多普勒超声对CCC患儿Todani分型有一定的诊断效能,对Ⅰ型、Ⅳ型、Ⅴ型的诊断准确率分别为83.33%、93.59%、93.59%（P＜0.05）。与病理学诊断结果对比,MSCT对CCC患儿Todani分型有较好的诊断效能,对Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型、Ⅴ型的诊断准确率分别为88.46%、89.74%、93.59%、94.87%、97.43（P＜0.05）。彩色多普勒超声联合MSCT检查的诊断准确率高达96.15%,明显高于两种方法单独应用（P＜0.05）。结论：不同Todani分型的CCC患儿具有不同的超声征象,彩色多普勒超声及MSCT对CCC患儿Todani分型均有一定的的诊断价值,且两者联合应用时诊断价值较高。     

输尿管囊肿的超声诊断价值探讨

目的:探讨超声显像对输尿管囊肿的诊断价值,提高本病的诊断及鉴别诊断水平。方法:对我院例输尿管囊肿的超声检查资料进行回顾性分析。结果:全部病例均经手术病理证实,右侧11例,左侧11例,双侧2,5例合并重复肾及双输尿管,二维超声可直接显示输尿管囊肿形态、部位大小及其变化,超声诊断合率96%(25/26)。结论:超声显像诊断输尿管囊肿的符合率高,具有方便、快捷、经济、无创伤、无痛苦、重复性好、无需造影剂、可实时动态观察等优点,可迅速发现早期病变,直接观察囊肿部位、大小、形态、输尿管来源、输尿管开口位置、有无尿路出口梗阻及其多种并发症的诊断,可做为本病的常规首选检查项目。     

超声引导经皮肺肿块穿刺活检在临床诊断中的应用

应用超声引导经皮自动穿刺活检术对79例经X线及CT检查发现肺部肿块患者进行穿刺活检,分析患者穿刺活检二维声像图特征,彩色血流信息特征,病灶内造影剂增强情况,穿刺活检成功率及并发症情况,探讨超声引导经皮肺肿块穿刺活检在肺肿块病变临床诊断中的应用价值。结果发现:实验组79例患者中,周围型肿块73例,中央型肿块伴肺实变6例,恶性病变60例,良性病变19例。恶性病变病灶回声类型、病灶最大径线、Adler血量分级、病灶内造影剂均匀性与良性病变同类指标比较具有显著差异性(p0.05)。可见:超声引导经皮肺肿块穿刺活检是安全可靠,简便易行的方法,其良、恶性病变二维声像图特征,彩色血流信息特征,病灶内造影剂增强情况差异显著,在肺周围型肿块及伴实变中央型肿块患者的病理分型诊断中具有重要的应用价值。     

胆道系统探查中术中超声的应用及临床价值

目的:探讨胆管系统探查中术中超声(intraoperative ultrasound,IOUS)的应用及临床价值。方法:2007年3月至2014年8月应用术中超声对胆道系统进行探查的病例资料58例,对其术前影像学表现、手术过程、术中超声所见以及术中和术后诊断进行分析,研究术中超声对胆道探查的应用价值。结果:(1)58例应用术中超声病人中,肝内外胆管结石35例、肝门部胆管癌及胆总管癌11例,急性胆囊炎8例,胃癌1例,先天性胆总管囊肿1例,胆总管炎性狭窄1例,胰腺癌1例。术中超声确认取净结石或胆总管未见明显异常34例,定位肝内胆管残余结石6例,发现胆总管内尚有结石2例,术中超声确诊胆管癌2例;另发现胆总管先天性解剖异常2例;(2)在发现胆管结石方面,与术前MRCP无显著性差异(P=0.643);与术前CT、B超比较有显著差异(P0.05),诊断率分别为B超74.3%,MRCP 91.4%,CT 77.1%,IOUS 94.3%。结论:术中超声胆道系统的探查可以在广泛的疾病中得到应用,可以对术前影像学检查起到验证和补充的作用,且在术中引导各种介入操作中起到独特作用。     

42例先天性胆总管囊肿的诊治体会

先天性胆总管囊肿为常见的先天性胆管畸形,该病又称为胆管扩张症。胰胆管连接异常为本病的主要病因。由于胚胎期胆总管与主胰管未能正常分离,胰胆管共同管道过长,达2～4cm,并且胆总管以直角进入胰管,因而胰液返流人胆道系统,产生反复慢性炎症,破坏胆管黏膜及弹力纤维,使管壁失去张力,导致胆管扩张。随着我院的发展,各种检查手段的日益完善,我院从1990～2000年共收治先天性胆总管囊肿患者42例,现将诊治体会报告如下。     

单用超声、CT及联合应用诊断甲状腺肿块的效果分析

目的:探讨超声、CT检查及两者联合应用对甲状腺肿块的诊断,以提高甲状腺肿块的诊断准确率.方法:回顾性搜集213例甲状腺肿块患者的临床、超声资料,及其中的127例患者CT资料,并分析各自的临床、超声和CT表现特点,并将相关的超声、CT与手术病理对照比较.结果:超声、CT在诊断良、恶性肿块在结节数目差异无统计学意义(P＞0.05);在钙化、包膜侵犯、边界、病灶形态等差异具有显著性(P＜0.05).甲状腺肿块的超声诊断符合率与CT比较,差异无统计学意义(P＞0.05);联合诊断符合率明显高于超声、CT单项诊断符合率(P＜0.05).联合诊断肿块的定性能力优于超声、CT单项检查(P＜0.05).结论:超声和CT均能较好的诊断甲状腺肿块病变,两者联合应用,可提高甲状腺肿块的诊断准确率.     

Surgical and Molecular Evaluation of Pediatric Hydatid Cyst Cases in Eastern Turkey

Cystic echinococcosis (CE) caused by Echinococcus granulosus is a major public health problem worldwide, including Turkey. The aim of the current study was to identify the strains and to estimate the potential risk factors of E. granulosus in operated pediatric cases in eastern Turkey. Ten pediatric patients (7 boys and 3 girls) living in rural areas, with ages ranging from 3 to 15 years old and various clinical histories, were included in this study. Eight patients had only liver hydatid cyst, while 1 patient had liver and lung hydatid cyst and the other liver, lung, and spleen, together. There were 2 ruptured liver cysts. After surgery, during follow-up, no increase was observed in hemagglutination levels, there were no mortalities, and there was no evidence of recurrence at 2 years post operation in all patients. Molecular analysis was performed on hydatid cyst samples obtained from the 10 pediatric cases. According to mt-12S rRNA PCR results, all cases were found to be G1/G3 cluster of E. granulosus sensu stricto.     

Long-term Sonographic and Serological Follow-up of Inactive Echinococcal Cysts of the Liver: Hints for a “Watch-and-Wait” Approach

Human cystic echinococcosis is a chronic, complex and neglected infection. Its clinical management has evolved over decades without adequate evaluation of efficacy. Recent expert opinion recommends that uncomplicated inactive cysts of the liver should be left untreated and solely monitored over time (“watch-and-wait” approach). However, clinical data supporting this approach are still scant and published mostly as conference proceedings. In this study, we report our experience with long-term sonographic and serological follow-up of inactive cysts of the liver. From March 1994 to October 2013, 38 patients with 47 liver cysts, diagnosed as inactive without any previous treatment history, were followed with ultrasound and serology at 6–12 months intervals for a period of at least 24 months (median follow-up 51.95 months) in our outpatient clinic. In 97.4% of patients, the cysts remained inactive over time and in only one case was reactivation of the cyst detected. No complications occurred during the time of monitoring. During follow-up, serology tests for CE were negative at diagnosis or became negative in 74.1% and were positive or became positive in 25.9% of cases. Patients with inactive cysts on ultrasound but positive serological tests were also investigated by CT scan (chest and abdomen) to rule out extra-hepatic cyst localization. This study confirms the importance of a stage-specific approach to the management of cystic echinococcosis and supports the use of a monitoring-only approach to inactive, uncomplicated cysts of the liver. It also confirms that serology plays only an ancillary role in the clinical management of these patients, compared to ultrasound and other imaging techniques. The implications of these findings for clinical management and natural history of cystic echinococcosis are discussed.     

Perioperative Challenges and Surgical Treatment of Large Simple,and Infectious Liver Cyst - A 12-Year Experience

Background

Cystic lesions of the liver consist of a heterogeneous group of disorders that can present diagnostic and therapeutic challenges.

Methods

A retrospective review of all medical records of adult patients diagnosed with large (>7 cm) cystic lesions of the liver between January 2000 and December 2011, at Kurume University Hospital. Cases with polycystic disease were excluded.

Results

Twenty three patients were identified. The mean size was 13.9 cm (range, 7-22cm). The majority of simple cysts were found in women (females: males, 2: 21). In 19 patients, the cyst was removed surgically by wide deroofing (laparoscopically in 16 cases, combined with ethanol sclerotherapy in 13 cases). Infection of the liver cyst occurred in one patient, who later underwent central bi-segmentectomy.

Conclusion

Simple large cysts of the liver can be successfully treated by laparoscopic deroofing and alcohol sclerotherapy. Large hepatic cyst considered to need drainage should be removed surgically to avoid possible infection.     

Cystic echinococcosis in humans: our clinic experience

Echinococcosis in humans is a zoonotic infection caused by larval stages of cestode species of the Echinococcus genus. In cystic echinococcosis (CE), caused by Echinococcus granulosus, the liver is the first and the more frequent involved organ, followed by the lung. Heart, spleen, kidney and brain are usually less involved. The finding of a cyst in course of echinococcosis is usually fortuitous, during ultrasound examination, X-ray or CT. The Authors report 4 cases of human CE admitted to the Department of Infectious Diseases University of Naples "Federico II". Each case is peculiar both for the organ involved by the cysts and for the symptomatolgy. The abdominal pain, in case 1 caused by gallstones, allowed, by the ultrasound examination, to find several hydatid cysts in the liver, never symptomatic until then. The woman, in case 2, was operated for cysts in the lung, without receiving pharmacological prophylaxis. The same occurred in case 4, in which the lack of prophylaxis caused very serious relapses. In case 3, the young woman underwent an ultrasound examination because of an abdominal pain. A unique large cyst extended only in the spleen. The specific serology for immunoglobulin anti-E. granulosus resulted positive 1:61 (n.v. < 50). The Albendazole therapy caused the disappareance of pain, quickly. Later, the patient was splenectomized. It's not clear why only the spleen was involved and why the anti-E. granulosus serum levels of were increased only a little. The man, in case 4, was admitted with chest pain and electrocardiographic findings of myocardial anterior ischemia. He underwent surgical treatment of three hepatic cysts by E. granulosus, during the previous year. Two-dimensional echocardiography, transesophageal echocardiography, and cardiac magnetic resonance revealed a round cystic mass, 6 x 6 mm, located in the middle interventricular septum. The cardiac isoenzymes were in the normal ranges, but the anti-E. granulosus immunoglobulins were positive 1:5120 (n.v. < 64). The patient was treated with Albendazole. This caused the almost simultaneous disappearance of the circular cystic and clinical and electrocardiographic findings of myocardial ischemia. A cardiac hydatid cyst is an uncommon lesion, occurring in about 0.4-2% of patients with echinococcosis. In conclusion, Cystic echinococcosis is a problem in Mediterranean regions because of the high population of stray dogs, favourable conditions created by man and, above all, the illegal slaughtering.     

The value of ultrasonography alone in screening surveys of cystic echinococcosis in children in Turkey

A total of 1205 primary school children were examined for cystic echinococcosis in five villages of Manisa, Turkey, to evaluate the efficacy of diagnostic methods of this infection in community-based screening surveys. Six hundred and thirty children from three villages, examined by a portable ultrasound scanner, chest microfilm and serological methods (ELISA, indirect hemagglutination) in our previous study, were designated as Study Group 1; and 575 children, from two adjacent villages, examined by ultrasonography alone in the present study, were designated as Study Group 2. In Study Group 1, hepatic cystic echinococcosis was detected in two cases (0.3%) by ultrasonography, while 43 (8.9%) and 49 (10.1%) cases were found to be positive for cystic echinococcosis by ELISA and indirect hemagglutination, respectively. Three of 575 children (0.5%) were diagnosed with cystic echinococcosis (two hepatic and one renal involvement) by ultrasonography alone in Study Group 2; and lung lesions were later detected in both cases with liver involvement by chest radiography.

Our results suggested that serological tests may be beneficial in suspected cases for confirmation and differential diagnosis, but have some drawbacks, such as discrepancy in results and high false seropositivity rates. Chest microfilm is not easy in field studies and exposure to X-ray is undesirable. As a reliable, simple, inexpensive and rapid technique, ultrasonography alone is recommended to be used in community-based screening surveys for cystic echinococcosis with confirmatory tests for suspected cases found during the screening program.     

超声造影在肝癌射频消融治疗前后的临床价值研究

目的:探讨实时超声造影(contrast-enhanced ultrasonography,CEUS)在原发性肝癌射频消融(radiofrequency ablation,RFA)微创介入前后治疗临床应用价值的研究。方法:通过分析139例肝癌患者175个病灶在超声引导下射频消融(RFA)治疗,对病灶数量、大小、边界、内部回声、造影剂灌注情况进行对比分析,及治疗后与增强CT结果进行对照。结果:射频消融前,超声造影显示82个病灶表现为动脉早期抱球状、弥漫或轻度增强;治疗1-3个月后超声造影判定89.1%(156/175)的病灶达到完全消融,10.9%(19/175)的病灶消融不完全;增强CT判定84.6%(148/175)的病灶达到完全消融,15.4%(27/175)的病灶消融不完全,治疗后超声造影检查结果与CT增强检查结果一致,两者在病灶残留复发的敏感性、特异性、准确性等方面比较无显著性差异,P>0.01。结论:实时超声造影(CEUS)能准确判断RFA对肿瘤消融的范围及程度,是一种指导治疗,判定治疗后疗效的新方法,在原发性肝癌(RFA)微创介入治疗中具有很高的临床应用价值。     

肺结核合并下呼吸道感染患者CT影像特点及IL-23R水平表达的临床意义

摘要 目的：探讨肺结核合并下呼吸道感染患者CT影像特点及IL-23R水平表达的临床意义。方法：选取2015年1月-2018年8月于我院就诊的123例肺结核患者,将所选取的患者按是否合并下呼吸道感染分为单纯肺结核组73例和肺结核合并下呼吸道感染组50例。分析两组组患者临床表现、CT影像学图片、CT影像学表现、血清IL-23R的表达水平的差异。结果：单纯肺结核组患者出现14例低热、11例胸闷、17例消瘦、14例气短、18例痰中带血、14例颈部淋巴结肿大、23例咳嗽、21例胸痛。肺结核合并下呼吸道感染组患者出现16例低热、13例胸闷、21例消瘦、19例气短、20例痰中带血、15例颈部淋巴结肿大、26例咳嗽、23例胸痛,两组患者临床表现差异均无统计学意义（P＞0.05）。单纯肺结核组CT影像学图片显示可见结节影或包块影,呈明显分叶征、短毛刺征、空泡征并发肺不张、棘状突起,边缘较清晰,增强扫描后明显强化。肺结核合并下呼吸道感染组CT影像学图片显示有分叶、毛刺,同时肺内肿物周边存在晕征、血管聚集征、卫星灶征、胸膜凹陷等表现,此外伴纵膈及肺门淋巴结明显肿大,胸壁侵犯。肺结核合并下呼吸道感染组CT影像中毛刺状结节、胸膜凹陷、空洞、分叶征、肿块、条索影比例均高于单纯肺结核组,差异有统计学意义（P＜0.05）。肺结核合并下呼吸道感染组患者IL-23R水平明显高于单纯肺结核组,差异有统计学意义（P＜0.05）。结论：与单纯肺结核患者相比较,肺结核合并下呼吸道感染患者临床表现更为严重,CT影像学特点更为明显,患者血清中IL-23R表达水平明显升高,临床可通过CT影像学结合血清IL-23R检测,以提高肺结核合并下呼吸道感染患者的临床诊断。     

The diagnostic value of Western blot method in patients with cystic echinococcosis

Cystic echinococcosis (CE) is the larval cystic stage (called echinococcal cysts) of a small taeniid-type tapeworm (Echinococcus granulosus). Carnivores such as dogs are usually definitive hosts. Intermediate hosts are typically herbivores such as sheep and cattle. CE can be detected using various imaging techniques such as ultrasonography or radiology. Moreover the primary diagnosis has to be confirmed by serological tests since the clinical signs of the disease are non-specific. This study examined the antigenic band patterns useful for serologic diagnosis of hydatidosis. We also report on the post-operative evolution of patients treated for this disease and also determined the diagnostic performance of Western blot IgG kit. Twenty-five (16 females and 9 males) non-operated patients with hydatid cysts (NOP) and 33 (21 females and 12 males) operated patients with hydatid cysts (OP) were included as study group and 22 healthy individuals (14 females and 8 males) with no known chronic diseases were included as a control group. The ages of the patients and control group individuals were between 16-83 years. Patient and control groups were matched for age and sex. Cyst hydatid IgG antibodies were detected in the sera from all patient groups but no antibodies were found in the sera from the control group using ELISA IgG method. Twenty-three (92%) non-operated patients and 18 (54.5%) operated patients exhibited positive results when Western blot IgG kit was used. The P7 band pattern was detected in the sera from all operated and non-operated patients. Twenty-seven of these positive cases had p7 and (p7+p16/18), (p7+p24/26) or (p7+p16/18+p24/26). No antibodies against p7, p16/18 ve p24/26 band patterns were seen in sera from the control group A statistically significant difference was detected between operated and nonoperated patients for Western blot positivity.(p<0.01). p: 0.018- X2=5,604- OR: 0.176- 95% CI: 0.037- 0.841. The sensitivity, specificity, positive prediction and negative prediction values of Echinococcus granulosus Western blot kit for 25 cases with CE and 22 healthy controls were calculated as 92%, 100%, 100% and 91.7%, respectively. In conclusion, we suggest that monitoring p7 in all non-operated patients may be useful to determine the efficiacy of medical treatment and that monitoring p7 antibodies using serological and Western blot methods in operated patients may be useful for the screening of post-operative evolution in patients with hydatid cyst.     

An Imported Case of Echinococcosis of the Liver in a Korean Who Traveled to Western and Central Europe

Echinococcus granulosus, an intestinal tapeworm of dogs and other canids, infects humans in its larval stage and causes human echinococcosis or hydatid disease. In the Republic of Korea, 31 parasite-proven human echinococcosis cases have been reported, most of which were imported from the Middle East. We recently examined a 61-year-old Korean man who had a large cystic mass in his liver. ELISA was negative for tissue parasitic infections, including echinococcosis, cysticercosis, paragonimiasis, and sparganosis. The patient underwent surgery to remove the cyst, and the resected cyst was processed histopathologically for microscopic examinations. In sectioned cyst tissue, necrotizing protoscolices with disintegrated hooklets of E. granulosus were found. In some areas, only freed, fragmented hooklets were detected. The patient had traveled to western and central Europe in 1996, and had no other history of overseas travel. We report our patient as a hepatic echinococcosis case which was probably imported from Europe.