タグ別アーカイブ: ct

Emergency radiology 第１回　 解答

投稿日: 作成者:


文献： 
急性膵炎診療ガイドライン 2010年
http://www.suizou.org/etc.htm　　よりダウンロードを。

一般情報：難病情報セン ター　ホームページへのリンク
http://www.nanbyou.or.jp/entry/271

Balthazal EJ.
Acute Pancreatitis: assessment of severity with clinical and CT evaluation.
Radiology 2002; 223:603-613

のp 608 より引用抜粋改変

CT Enhancement Values and Pitfalls
With helical or multidetector scanning with rapid acquisition of sequential images and　collimation of less than 5 mm, images can be obtained in the early portal venous phase (60.70 seconds after intravenous administration of 150 mL of iodinated contrast material at a rate of 3 mL/sec). We still use a monophasic protocol, starting at the top of the diaphragm and covering the entire abdomen and pelvis. Since unenhanced images are　not obtained, the detection of parenchymal injury is based solely on the degree and homogeneity of pancreatic enhancement. Basic pancreatic CT numbers of 40 .50 HU seen on unenhanced CT images are expected to increase to 100–150 HU throughout the entire normal gland during contrast material administration, depending on the size of the bolus, the speed of the injection, and the time of image acquisition (Fig 3). Lack of contrast enhancement or minimal contrast enhancement of less than 30 HU of a portion of the pancreas or of the entire pancreas indicates decreased blood perfusion (ischemia) and correlates with the development of necrosis (Figs 1, 4, 6). In this regard, however, several factors and potential pitfalls should be kept in mind.

 

この論文の中で壊死と浮腫をしっかり分けている。かなり具体的：p608-609 CT enhancement value
MDCT 5mm slice 厚、60-70s 3ml/s 150ml 総量
単純CT上膵実質は40-50HUを示す。上記相では、100-150HUまで上昇する
門脈相(60-70s 後)30HU未満では虚血、壊死を示唆する
しかし、いくつかの要因やピットフォールもある。例えば、元もと脂肪変性強い膵の場合、浮腫の強い場合、正常でも そう言う場合がある
もう一つ時間的要素
膵壊死は、臨床症状発症から24-48時間後に生じる。もし、CTが12時間以内に撮影される とよくわからない。はっきりと壊死として濃染しない状態と成るには2－3日かかる。従って、72時間後 の方が壊死の正診率は高まる。48-72時間後がいい

上記もととなったと考えられる膵壊死と病理の対比論文
Larvin M, Chalmers AG, McMahon MJ.
Dynamic contrast enhanced computed tomography: a precise technique for identifying and localising pancreatic necrosis.
BMJ 1990 Jun 2;300(6737):1425-8.

最近の膵壊死のない急性膵炎の予後についての論文
Lenhart DK, Balthazar EJ.
MDCT of acute mild (nonnecrotizing) pancreatitis: abdominal complications and fate of fluid collections.
AJR Am J Roentgenol. 2008 Mar;190(3):643-9.

EOB プリモビスト症例集 第7回　回答

投稿日: 作成者:

key words: high flow hemangioma, atypical hemangioma, EOB primovist MRI

イチロウ　サイト内の関連ページ
肝画像診断　症例6　の動画参照
http://medicaldirect.jp/shourei6/kaitou62.html

＜参考文献＞

High-flow hemangioma について

Kim KW, Kim AY, Kim TK, et al.
Hepatic hemangiomas with arterioportal shunt: sonographic appearances with CT and MRI correlation.
AJR Am J Roentgenol. 2006 Oct;187(4):W406-14.
http://www.ncbi.nlm.nih.gov/pubmed/16985113

 

Jang HJ, Kim TK, Lim HK, et al.
Hepatic hemangioma: atypical appearances on CT, MR imaging, and sonography.
AJR, 2003 Jan;180(1):135-41.
http://www.ncbi.nlm.nih.gov/pubmed/12490492

 

Vilgrain V, Boulos L, Vullierme MP,et al.
Imaging of atypical hemangiomas of the liver with pathologic correlation.
Radiographics. 2000 Mar-Apr;20(2):379-97.
http://www.ncbi.nlm.nih.gov/pubmed/10715338

Kato H, Kanematsu M, Matsuo M, et al.
Atypically enhancing hepatic cavernous hemangiomas: high-spatial-resolution gadolinium-enhanced triphasic dynamic gradient-recalled-echo imaging findings.
Eur Radiol. 2001;11(12):2510-5. Epub 2001 Sep 7.

 

Yan FH, Zeng MS, Zhou KR
Role and pitfalls of hepatic helical multi-phase CT scanning in differential diagnosis of small hemangioma and small hepatocellular carcinoma.
World J Gastroenterol 1998 Aug;4(4):343-347.

 

Yu JS, Kim KW, Park MS, Yoon SW.
Hepatic cavernous hemangioma in cirrhotic liver: imaging findings.
Korean J Radiol. 2000 Oct-Dec;1(4):185-90.

EOB プリモビスト症例集 第5回　回答

投稿日: 作成者:

参考文献

＊dysplastic nodules 文献

Earls JP, et al.

Dysplastic nodules and hepatocellular carcinoma: thin-section MR imaging of explanted cirrhotic livers with pathologic correlation.

Radiology 1996 Oct;201(1):207-14.

http://www.ncbi.nlm.nih.gov/pubmed/8816545

Early hepatocelluar carcinoma: MR imaging

Muramatsu Y, et al.

Radiology. 1991 Oct;181(1):209-13.

http://www.ncbi.nlm.nih.gov/pubmed/1653443

Matsui O, et al.

Adenmatous hperplastic nodules in the cirrhotic liver: differentiation from hepatocellular carcinoma with MR imaging.

Radiology. 1989 Oct;173(1):123-6.

http://www.ncbi.nlm.nih.gov/pubmed/2550995

＊最新の論文： T1WI　高信号を呈する結節のEOB primovist診断

Chou CT, et al. Characterization of hyperintense nodules on precontrast T1-weighted MRI: utility of gadoxetic acid-enhanced hepatocyte-phase imag

J Magn Reson Imaging. 2011 Mar;33(3):625-32.

http://www.ncbi.nlm.nih.gov/pubmed/21563246

＊結節の分化度と肝細胞相での信号強度の相関性を検討した論文

Kogita S, Imai Y, Okada M, et al. Gd-EOB-DTPA-enhanced magnetic resonance images of hepatocellular carcinoma: correlation with histological grading and portal blood flow.

Eur Radiol. 2010 Oct;20(10):2405-13. Epub 2010 May 19.

http://www.ncbi.nlm.nih.gov/pubmed?term=Kogita%20S%2C%20Imai%20Y%2C%20Okada%20M%2C%20et%20al.%20%20Gd-EOB-DTPA-enhanced%20magnetic%20resonance%20images%20of%20hepatocellular%20carcinoma%3A%20correlation%20with%20histological%20grading%20and%20portal%20blood%20flow.

エキスパートはこう考える第6回　回答

投稿日: 作成者:

iphone movie

<Key words>

肺胞上皮癌、bronchioloalveolarCarcinoma、bronchoalveolar cell carcinoma、BAC、粘液産生、

CT angiogram sign,大葉性肺炎、大葉性陰影、陰影消長、悪性リンパ腫、malignant lymphoma

<文献リスト>

Trigaux JP, Gevenois PA, Goncette L, et al.
Bronchioloalveolar carcinoma: computed tomography findings.
Eur Respir J. 1996 Jan;9(1):11-6.
http://erj.ersjournals.com/cgi/reprint/9/1/11

Lee KS, Kim Y, Han J, et al.
Bronchioloalveolar carcinoma: clinical, histopathologic, and radiologic findings.
Radiographics. 1997 Nov-Dec;17(6):1345-57.
http://radiographics.rsna.org/content/17/6/1345.long

Aquino SL, Chiles C, Halford P.
Distinction of consolidative bronchioloalveolar carcinoma from pneumonia: do CT criteria work? 
AJR Am J Roentgenol. 1998 Aug;171(2):359-63.
http://www.ajronline.org/cgi/reprint/171/2/359

Akira M, Atagi S, Kawahara M, Iuchi K, Johkoh T.
High-resolution CT findings of diffuse bronchioloalveolar carcinoma in 38 patients. 
AJR Am J Roentgenol. 1999 Dec;173(6):1623-9.
http://www.ajronline.org/cgi/reprint/173/6/1623

Kim TH, Kim SJ, Ryu YH, et al.
Differential CT features of infectious pneumonia versus bronchioloalveolar carcinoma (BAC) mimicking pneumonia. 
Eur Radiol. 2006 Aug;16(8):1763-8. Epub 2006 Jan 18.

Patsios D, Roberts HC, Paul NS, et al.
Pictorial review of the many faces of bronchioloalveolar cell carcinoma. 
Br J Radiol. 2007 Dec;80(960):1015-23. Epub 2007 Oct 16.
http://bjr.birjournals.org/cgi/reprint/80/960/1015

Sawada E, Nambu A, Motosugi U, et al.
Localized mucinous bronchioloalveolar carcinoma of the lung: thin-section computed tomography and fluorodeoxyglucose positron emission tomography findings. 
Jpn J Radiol. 2010 May;28(4):251-8. Epub 2010 May 29.

CT angiogram sign 関連

Im JG, Han MC, Yu EJ, et al.
Lobar bronchioloalveolar carcinoma: “angiogram sign” on CT scans. 
Radiology. 1990 Sep;176(3):749-53.

Vincent JM, Ng YY, Norton AJ, Armstrong P.
CT “angiogram sign” in primary pulmonary lymphoma.
J Comput Assist Tomogr. 1992 Sep-Oct;16(5):829-31.

Murayama S, Onitsuka H, Murakami J, et al.
“CT angiogram sign” in obstructive pneumonitis and pneumonia. 
J Comput Assist Tomogr. 1993 Jul-Aug;17(4):609-12.

Shah RM, Friedman AC.
CT angiogram sign: incidence and significance in lobar consolidations evaluated by contrast-enhanced CT. 
AJR Am J Roentgenol. 1998 Mar;170(3):719-21.
http://www.ajronline.org/cgi/reprint/170/3/719

Maldonado RL.
The CT angiogram sign.
Radiology. 1999 Feb;210(2):323-4.

リンパ腫
Ooi GC, Chim CS, Lie AK, Tsang KW
Computed tomography features of primary pulmonary non-Hodgkin’s lymphoma. 
Clin Radiol. 1999 Jul;54(7):438-43. 

King LJ, Padley SP, Wotherspoon AC, Nicholson AG.
Pulmonary MALT lymphoma: imaging findings in 24 cases. 
Eur Radiol. 2000;10(12):1932-8.

Lee DK, Im JG, Lee KS, Lee JS, Seo JB, Goo JM, Kim TS, Lee JW.
B-cell lymphoma of bronchus-associated lymphoid tissue (BALT): CT features in 10 patients.
J Comput Assist Tomogr. 2000 Jan-Feb;24(1):30-4.

<キー画像＞

1 年前正常時胸部単純写真 10 ヶ月前肺炎発症時
今回の胸部単純写真正面像 今回の胸部単純写真側面像
肺炎改善後 造影 CT 縦隔条件
造影 CT 肺野条件

エキスパートはこう考える第５回　回答

投稿日: 作成者:

iphone movie

<key words>

びまん性汎細気管支炎、diffuse panbronchiolitis, DPB, 小葉中心性、分枝状 影、Y字、V字、細気管支炎, adult T-cell leukemia, lymphoma、非定型抗酸菌症、びまん性誤嚥性細気管支炎

<参考文献＞

・DPBの論文

Akira M, Kitatani F, Lee YS, et al.

Diffuse panbronchiolitis: evaluation with high-resolution CT.

Radiology 1988 ;168:433-488.

Nishimura K, Kitaichi M, Izumi T, et al.

Diffuse panbronchiolitis: correlation of high-resolution CT and pathologic findings.

Radiology. 1992;184:779-785.

Akira M, Higashihara T, Sakatani M, et al.

Diffuse panbronchiolitis: follow-up CT examination.

Radiology. 1993 ;189:559-62.

Hansell DM.

Small airways diseases: detection and insights with computed tomography.

Eur Respir J. 2001 ;17:1294-313.

Xie GS, Li LY, Liu HR, et al.

Diffuse panbronchiolitis with histopathological confirmation among Chinese.

Chin Med J (Engl). 2004 ;117:1299-303.

・ATL関連の論文

Okada F, Ando Y, Kondo Y, et al.

Thoracic CT findings of adult T-cell leukemia or lymphoma.

AJR Am J Roentgenol. 2004 ;182:761-767.

Okada F, Ando Y, Yoshitake S, et al.

Pulmonary CT findings in 320 carriers of human T-lymphotropic virus type 1.

Radiology. 2006 Aug;240(2):559-64

<キー画像＞

胸部単純半年前正面

 

今回のエピソードの 3 ヶ月後胸部単純正面

今回のエピソード胸部単純正面

今回のエピソード トラムライン 拡大

 

 

 

今回のエピソード胸部単純側面像

 

 

 

CT1

CT2

 

 

 

CT3

CT4(一ヵ月後のCT）

副鼻腔CT

エキスパートはこう考える第1回 回答

投稿日: 作成者:

↓iphone用の動画

＜キーワード＞

びまん性肺疾患、HRCT、volume loss, 容量減少、左右対称性陰影、bronchovascular bandle、気管支血管束、薬剤性肺障害、好酸球性肺炎、薬剤性好酸球性肺炎,traction bronchiectasis, 牽引性気管支拡張

＜key画像＞

2005 年 3 月正常時の単純写真

呼吸困難時、 2005 年末の胸部単純写真

呼吸困難時の胸部 CT1

呼吸困難時の胸部 CT2
＜参考文献＞Souza CA, et al.
Drug-induced eosinophilic pneumonia: high-resolution CT findings in 14 patients.AJR. 2006 ;186:368-73.
http://www.ajronline.org/cgi/reprint/186/2/368Akira M, et al.
Drug-induced pneumonitis: thin-section CT finding in 60 patients. Radiology. 2002;224 :852-860
http://radiology.rsna.org/content/224/3/852.full.pdf+htmlEllis, SJ, et al.
Drug-induced lung disease: high-resolution CT findings. AJR. 2000;175 :1019-1024
http://www.ajronline.org/cgi/reprint/175/4/1019Cleverley JR, et al.
Drug-induced lung disease: high-resolution CT and histological findings.Clin Radiol. 2002;57:292-9.
Johkoh T, et al.
Eosinophilic lung diseases: diagnostic accuracy of thin-section CT in 111 patients.Radiology. 2000;216 :773-80.
http://radiology.rsna.org/content/216/3/773.full.pdf+html*パナルジンが原因の間質性肺炎の症例報告論文
Oon PC, et al.
Diffuse alveolar damage associated with ticlopidine use: a case report.J Formos Med Assoc. 2003;102 :262-5.Nakamura R, et al.
Interstitial pneumonia induced by ticlopidine.Circ J. 2002;66 :773-776.
http://www.jstage.jst.go.jp/article/circj/66/8/773/_pdfWatanebe M, et al.
Multiple pulmonary nodules due to ticlopidine-induced pneumonitis Nihon Kokyuki Gakkai Zasshi. 1999;37 :841-5Alonso-Martinez JL, et al.
Bronchiolitis obliterans-organizing pneumonia caused by ticlopidine.Ann Intern Med. 1998;129 :71-2
http://www.annals.org/content/129/1/71.3.full.pdf+html

エキスパートはこう考える第3回 回答

投稿日: 作成者:


＜iphone用動画＞

<key word>

急性好酸球性肺炎、acute eosinophilic pneumonia, eosinophilic lung diseases、カーリーライン、Kerley line, Kerley B line、広義間質、bronchovascular bundle, septal line, 小葉間隔壁、non cardiogenic edema、薬剤性肺障害

 

＜key画像＞

正常時

発症時

 

<参考文献＞

 

急性好酸球性肺炎文献集

Jeong YJ, Kim KI, Seo IJ, Lee CH, Lee KN, Kim KN, Kim JS, Kwon WJ.

Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview.

Radiographics. 2007 May-Jun;27(3):617-37; discussion 637-9.

http://radiographics.rsna.org/content/27/3/617.full.pdf+html

 

AEP症例報告 Abe K, Yanagi S, Imadsu Y, Sano A, Iiboshi H, Mukae H, Matsukura S.

Acute eosinophilic pneumonia with fine nodular shadows.

Intern Med. 2003 Jan;42(1):88-91.

 

Shiota Y, Kawai T, Matsumoto H, Hiyama J, Tokuda Y, Marukawa M, Ono T, Mashiba H.

Acute eosinophilic pneumonia following cigarette smoking.

Intern Med. 2000 Oct;39(10):830-3.

症例報告の直截リンクは張れませんが、Freeで取れます。画像は決してよいと言えません。

 

画像はpoorだが、臨床的なこと知りたい場合

Philit F, Etienne-Mastroianni B, Parrot A, Guerin C, Robert D, Cordier JF.

Idiopathic acute eosinophilic pneumonia: a study of 22 patients.

Am J Respir Crit Care Med. 2002 Nov 1;166(9):1235-9.

http://ajrccm.atsjournals.org/cgi/reprint/166/9/1235

 

参考として 薬剤性肺炎の論文

Rossi SE, Erasmus JJ, McAdams HP, Sporn TA, Goodman PC.

Pulmonary drug toxicity: radiologic and pathologic manifestations.

Radiographics. 2000 Sep-Oct;20(5):1245-59. Review.

http://radiographics.rsna.org/content/20/5/1245.full.pdf+html

 

エキスパートはこう考える第4回 回答

投稿日: 作成者:

iphone movie

key words

夏型過敏性肺臓炎、過敏性肺臓炎、hypersensitivity pneumonitis, summer-type hypersensitivity pneumonitis, びまん性スリガラス陰影、小葉中心性、粒状陰影、広範囲、スリガラス陰影、吸引抗原、ニューモシスチス肺炎、縦隔気腫

文献

過敏性肺臓炎
Silva CI, Churg A, Muller NL.
Hypersensitivity pneumonitis: spectrum of high-resolution CT and pathologic findings.
AJR Am J Roentgenol. 2007 ;188:334-44.
http://www.ajronline.org/cgi/reprint/188/2/334

Hansell DM, Wells AU, Padley SP, Muller NL.
Hypersensitivity pneumonitis: correlation of individual CT patterns with functional abnormalities.
Radiology. 1996; 199:123-128.
http://radiology.rsna.org/content/199/1/123.long

Glazer CS, Rose CS, Lynch DA.
Clinical and radiologic manifestations of hypersensitivity pneumonitis.
J Thorac Imaging. 2002 ;17:261-272.

Patel RA, Sellami D, Gotway MB, et al.
Hypersensitivity pneumonitis: patterns on high-resolution CT.
J Comput Assist Tomogr. 2000 ;24:965-970.

Lynch DA, Newell JD, Logan PM, et al.
Can CT distinguish hypersensitivity pneumonitis from idiopathic pulmonary fibrosis?
AJR Am J Roentgenol. 1995 ;165):807-811.
http://www.ajronline.org/cgi/reprint/165/4/807

Lynch DA, Rose CS, Way D, King TE Jr.
Hypersensitivity pneumonitis: sensitivity of high-resolution CT in a population-based study.
AJR Am J Roentgenol. 1992 ;159:469-472.
http://www.ajronline.org/cgi/reprint/159/3/469

Akira M, Kita N, Higashihara T, et al.
Summer-type hypersensitivity pneumonitis: comparison of high-resolution CT and plain radiographic findings.
AJR Am J Roentgenol. 1992 ;158:1223-8.
http://www.ajronline.org/cgi/reprint/158/6/1223

Silver SF, Muller NL, Miller RR, et al.
Hypersensitivity pneumonitis: evaluation with CT. Radiology 1989; 173:441-445
http://radiology.rsna.org/content/173/2/441.long

慢性過敏性肺臓炎
Silva CI, Muller NL, Lynch DA, et al.
Chronic hypersensitivity pneumonitis: differentiation from idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia by using thin-section CT.
Radiology. 2008 ;246:288-297.
http://radiology.rsna.org/content/246/1/288.full.pdf+html

Sahin H, Brown KK, Curran-Everett D, et al.
Chronic hypersensitivity pneumonitis: CT features comparison with pathologic evidence of fibrosis and survival.
Radiology. 2007 ;244:591-598.
http://radiology.rsna.org/content/244/2/591.full.pdf+html

Adler BD,Padley SP,Muller NL,et al.
Chronic hypersensitivity pneumonitis: high-resolution CT and radiographic features in 16 patients.
Radiology. 1992 ;185:91-95.
http://radiology.rsna.org/content/185/1/91.long

Buschman DL,Gamsu G,Waldron JA Jr,et al.
Chronic hypersensitivity pneumonitis: use of CT in diagnosis.
AJR Am J Roentgenol. 1992 ;159:957-960.
http://www.ajronline.org/cgi/reprint/159/5/957

2次小葉についての論文
Webb WR.
Thin-section CT of the secondary pulmonary lobule: anatomy and the image–the 2004 Fleischner lecture.
Radiology. 2006 ;239:322-38. Epub 2006 Mar 16.
http://radiology.rsna.org/content/239/2/322.full.pdf+html

key画像