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Objective To investigate the clinical value of CT lymphangiography (CTL) combined with direct lymphangiography (DLG) in primary intestinal lymphangiectasia (PIL). Methods Sixteen patients diagnosed as PIL with intestinal enteroscopy were recruited in this retrospective study. All the patients were performed DLG and CTL one week before exploratory laparotomy. Subjective assessment in DLG included weak lymphatic fluid drainage, lymphangiectasia, lymphatic reflux, fistula and thoracic outlet reflux or obstruction. While for CTL combined with DLG, the intestinal and extra-intestinal lesions were evaluated, including lymph node, edema, lymphangiectasia and abnormal distribution, fistula, and lymphangiomatosis. All the diagnosis was compared with intestinal endoscopy results. Results For DLG, 16 weak lymphatic fluid drainages, 9 lymphangiectasia, 1 fistula with abdomen and 14 thoracic outlets weak lymphatic fluid drainage or obstruction were found. For DLG combined with CTL, 16 intestinal lumens dilatation and 14 circumferential intestinal thickening were found in intestinal lesions. While for extra-intestinal lesions, the imaging features included edematous findings (12 in mesentery, 7 ascites only, 2 hydrothorax and ascites, and 3 pericardial, thoracic and abdominal effusions), abdominal lymph nodes (6 cases), lymphangiectasia and abnormal distributions (14 cases), fistulas (lymph-intestinal luminal fistula in 4 cases, and lymph-abdominal fistula in 3 cases), lymphangiomatosis (3 cases), and thoracic duct outlet dysfunction and reflux (14 cases).The number of cases diagnosed as intestinal lymphangiectasia, intestinal luminal lymph exudation and lymph fistula were 16, 10 and 6 with intestinal endoscopy, while the number were 11, 0, and 4 with CTL combination with DLG. Conclusion Combination of CTL with DLG is valuable in the diagnosis of PIL.
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Objective To evaluate the value of imaging examinations in the treatment of lymphangioleiomyomatosis (LAM) with chylothorax by thoracic duct extremity exploration.Methods Data of 34 LAM with chylothorax confirmed by pathology and clinical diagnosis were retrospectively analyzed.All patients underwent 99Tcm-DX lymphoscintigraphy and CT lymphangiography (CTL).Thoracic duct lesion types of 99Tcm-DX lymphoscintigraphy were type Ⅰ (abnormal concentration pattern),type Ⅱ (ectopic drainage pattern),and type Ⅲ (without image or transient image pattern).The type Ⅰ and type Ⅱ were diagnosed as thoracic duct abnormalities.Thoracic duct lesion types of CTL were type Ⅰ (dilatation pattern),type Ⅱ (distal obstruction pattern),type l (truck constriction pattern),type Ⅳ (ectopic drainage pattern),and type Ⅴ (no-display pattern).Type Ⅰ-Ⅳ were diagnosed as thoracic duct abnormalities.Consistency of displaying thoracic duct abnormalities between 99Tcm-DX lymphoscintigraphy and CTL was evaluated.Results The thoracic duct abnormalities in 99Tcm-DX lymphoscintigraphy were 58.82％ (20/34;type Ⅰ in 17,type Ⅱ in 3,type Ⅲ in 14),and in CTL were 73.53％ (25/34;type Ⅰ in 15,type Ⅱ in 3,type Ⅲ in 5,type Ⅳ in 2,type Ⅴ in 9).The consistency of CTL and 99Tcm-DX lymphoscintigraphy for detecting thoracic duct abnormalities was good (Kappa=0.679).In CTL thoracic duct types,type Ⅰ and Ⅱ were operated by thoracic duct-venous anastomosis or thoracic duct extremity release operation,type Ⅲ was operated by thoracic duct adhesion or compression band release operation,operative approach and method were chosen according to the abnormal thoracic duct flow path in type Ⅳ,type Ⅴ was took conservative treatment.Conclusion CTL is superior to 99Tcm-DX lymphoscintigraphy,which can clearly display the type of thoracic duct lesion and provide imaging informations to choose operation methods in thoracic duct exploration treatment for LAM with chylothorax.
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Objective To evaluate the value of imaging examinations in the treatment of lymphangioleiomyomatosis (LAM) with chylothorax by thoracic duct extremity exploration.Methods Data of 34 LAM with chylothorax confirmed by pathology and clinical diagnosis were retrospectively analyzed.All patients underwent 99Tcm-DX lymphoscintigraphy and CT lymphangiography (CTL).Thoracic duct lesion types of 99Tcm-DX lymphoscintigraphy were type Ⅰ (abnormal concentration pattern),type Ⅱ (ectopic drainage pattern),and type Ⅲ (without image or transient image pattern).The type Ⅰ and type Ⅱ were diagnosed as thoracic duct abnormalities.Thoracic duct lesion types of CTL were type Ⅰ (dilatation pattern),type Ⅱ (distal obstruction pattern),type l (truck constriction pattern),type Ⅳ (ectopic drainage pattern),and type Ⅴ (no-display pattern).Type Ⅰ-Ⅳ were diagnosed as thoracic duct abnormalities.Consistency of displaying thoracic duct abnormalities between 99Tcm-DX lymphoscintigraphy and CTL was evaluated.Results The thoracic duct abnormalities in 99Tcm-DX lymphoscintigraphy were 58.82％ (20/34;type Ⅰ in 17,type Ⅱ in 3,type Ⅲ in 14),and in CTL were 73.53％ (25/34;type Ⅰ in 15,type Ⅱ in 3,type Ⅲ in 5,type Ⅳ in 2,type Ⅴ in 9).The consistency of CTL and 99Tcm-DX lymphoscintigraphy for detecting thoracic duct abnormalities was good (Kappa=0.679).In CTL thoracic duct types,type Ⅰ and Ⅱ were operated by thoracic duct-venous anastomosis or thoracic duct extremity release operation,type Ⅲ was operated by thoracic duct adhesion or compression band release operation,operative approach and method were chosen according to the abnormal thoracic duct flow path in type Ⅳ,type Ⅴ was took conservative treatment.Conclusion CTL is superior to 99Tcm-DX lymphoscintigraphy,which can clearly display the type of thoracic duct lesion and provide imaging informations to choose operation methods in thoracic duct exploration treatment for LAM with chylothorax.
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Objective To investigate the diagnostic values of direct lymphangiography for the thoracic duct outlet obstruction.Methods The image data of direct lymphangiography were retrospectively analyzed in 124 patients with lymphedema,Chylothorax,chylous ascites,chyluria and intestinal lymphangiectasis,and compared with the results of neck thoracic duct surgical exploration,2 radiologists reviewed DLG DSA images in a double blind manner.The number of neck stem,subclavian stem,bronchialmediastinal stem and TD terminal into blood obstruction on the operation side showed by DLG were assessed using Kappa analysis.Results Of 124 patients,80 patients had the left cervical lymphatic stem reflux on DLG,75 patients with the left subclavian lymphatic stem reflux,30 patients with the left bronchial-mediastinal lymphatie stem reflux,118 patients showed the thoracic duct outlet barrier into the blood.The consistency rate of DLG were 89.9％ (80/89),92.6％ (75/81),90.9％ (30/33) and 95.2％ (118/124) compared with the neck thoracic duct surgical exploration.Tow radiologists had a high degree of diagnostic consistency (K =0.82,P ＜ 0.05).In addition,114 patients (91.9％) had tortuous,dilated waist lymphatic stem,only 10 patients (8.1％) were normal.The cisterna chyli reflux were found in 92 patients (74.2％),intestinal stem reflux in 16 patients (12.9％),reflux to the kidney area in 11 patients (8.9％),to the pericardium reflux in 5 patients (4.0％),vaginal lymphatic leakage in 7 patients (5.6％),retroperitoneal lymph leakage in 2 patients (1.6％),pleural lymphatic leakage in 3 patients (2.4％),tracheal lymph leakage in 1 patient (0.8％).Conclusion Direct lymphangiography has a high consistency with the cervical thoracic duct surgical exploration in displaying thoracic duct outlet obstruction.
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Objective Toinvestigatethevalueofimagingdiagnosisofthe lymphangioleiomyomatosis( LAM ).MethodsFifteen patients with LAM confirmed by pathological assessment were analyzed retrospectively for radiologic findings.They had chest radiograph, chest highresolution CT (HRCT),abdominal CT, direct lymphangiography(DLG), chest CT and abdominal CT after DLG.Results Chest radiograph findings included normal (1),increasing of lung markings (3),disseminated honeycomb or reticular pattern ( 11 ), pneumothorax ( 2 ), and pleural effusion ( 14 ). Chest conventional CT and HRCT showed typical imaging manifestation of PLAM in all cases, including sporadic or disseminated cysts in bilateral lungs. According to the grading standard of pulmonary disease made by Avila et at, there were 3 cases in grade Ⅰ , 5 cases in grade Ⅱ and 7 cases in grade Ⅲ . Fourteen of 15 patients with LAM had positive abdominal CT findings in retroperitoneum and pelvic cavity. Common abdominal CT findings included cystic lymphangioma in 9 of 14 patients, lymphangiomyoma in 13 and both coexisting in 7.One of the14patients alsohadhepaticlipomaandangiomyolipomas.Onepatienthadrenal angiomyolipomas; and one patient had hysteromyoma. All 15 cases underwent DLG, 1 cases had lymphatic obstruction in the lumbar 3 level, the remaining 14 cases had varying degrees of thoracic duct stenosis, or obstruction. Neck trunk, subclavian trunk and bronchial trunk showed lymphatic reflux. On post-DLG CT,thoracic duet outlet obstruction was not demonstrated in 3 cases, the remaining 12 cases showed thoracic outlet obstruction, consistent with the DLG findings.Conclusion HRCT is a useful diagnostic method showing characteristic findings of PLAM. MSCT can help to detect abdominal LAM. DLG and MSCT after DLG have value in displaying obstruction site of thoracic duct or lymphatic trunks and provide guidance for operative treatment.
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Objective To evaluate the role of CT imaging in staging of hypopharyngeal and laryngeal carcinoma.Methods 85 patients with hypopharyngeal or laryngeal carcinoma proved by operation were examined contrast-enhanced CT scan.The CT images were analysed by two experienced radiologists who were unknown pathologic results,in combination with the clinical data,the TNM staging of tumors were evaluated,then the results were compared with that of pathology,and Wilcoxon rank sum test was used for statistical analysis.P value less than 0.05 was considered statistically significant.Results The accuracy of the staging of lesions was 70.1% based on clinical data alone,while the clinical informations in combination with CT,the accuracy reached 87.1%,that was of significant statistically(P=0.001).Conclusion CT imaging is useful in staging of hypopharyngeal and laryngeal carcinoma,especially when it is combined with clinical data.
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Objective To eveluate the value of magnetic resonance (MRI) in diagnosis of the intracranial ganglioglioma.Methods To retrospectively analyze the clinical and the imaging materials of 4 cases intracranial ganglioglioma proved by operation and pathology. Four patients including 2 males and 2 females , aged 14～47 years, mean 27years were studied.Results 4 cases intracranial ganglioglioma were located in right temporal lobe(2 cases), left frontal lobe(1 cases) and the cerebellum lobe(1 cases). 3 cases were cyst-solid mass and one cases were predominantly cystic. There were no evidently edema around the tumor .The cystic place of the tumor was hypointense and the rampart-nodule of the tumor was slightly hypointense. Gd-DTPA enhanced scan showed surround enhancement and nodular areas of contrast enhancement along their margins. On the T 2-WI, all lesions were hyperintense.Conclusion Ganglioglioma is rarely tumor in central nervous system and it lacked peculiar findings of imaging . It may be the ganglioglioma when the patient's aged is a young man or woman, the tumor locate temporal lobe or the cerebellum, the tumor is cystic or cyst-mass neoplasm and it is demonstrated laminar or nodular areas of contrast enhancement along their margins.