成人纵隔淋巴结结核性肉芽肿的影像学表现(附4例报告并复习文献)  

The Imaging Appearance of Mediastinal Tuberculous Lymphadenitis in Adults(4 Cases Report and Literature Review)

作　　者：邱大胜[1] 李杰[1] 朱佳[1] 彭辽河[1] 周静[1] 丁九荣[1] 陈宪[2] 

机构地区：[1]湖北省肿瘤医院PET/CT中心,420079 [2]湖北省肿瘤医院放射科,420079

出　　处：《临床放射学杂志》2011年第6期906-908,共3页Journal of Clinical Radiology

摘　　要：目的探讨成人纵隔淋巴结结核性肉芽肿的CT及正电子发射体层摄影术(PET)表现。资料与方法搜集4例经病理证实的成人纵隔淋巴结结核性肉芽肿的影像学资料,均行CT平扫及增强扫描,其中1例并行PET/CT检查,1例并行腹部MR平扫。结果 4例可见两侧纵隔(2R,2L,4R,4L,5,7区)淋巴结增大,1例合并血性胸腔积液、右侧锁骨上及回盲部淋巴结增大;1例合并肝门淋巴结增大,CT平扫呈均匀软组织密度,CT值约45HU,未见钙化、液化、坏死;增强扫描病灶强化明显且均匀,CT值约100 HU;1例PET显像右侧锁骨上、右侧纵隔及回盲部增大淋巴结均呈放射性浓聚影,右侧纵隔病灶最大标准摄取值(SUVmax)为10.5,延迟120 min SUVmax为13.6;1例腹部MRI示肝门增大淋巴结信号均匀,呈稍长T1、稍长T2信号,边界清晰。结论成人纵隔淋巴结结核性肉芽肿影像学表现不典型,PET显像提供的信息对鉴别诊断价值不大,确诊依靠病理活检。Objective To discuss the PET and CT findings of mediastinal tuberculous lymphadenitis in adults.Materials and Methods The imaging data of 4 female patients confirmed mediastinal tuberculous lymphadenitis by pathology were collected.Enhanced CT scans were performed in all 4 cases.Whole body PET/CT was performed in 1 case and abdomen MRI was performed in another case.Results Mediastinal lymphadenectasis（region 2R,2L,4R,4L,5,7） were showed clearly.Hemic hydrothorax,lymphadenectasis above the right clavicle and in ileocecal junction could also be showed in 1 case.In another case,CT showed lymphadenectasis in hepatic hilum,which demonstrated homogeneous soft tissue density（CT attenuation was about 45 HU）without calcification and necrosis.The lesions were obviously enhanced（CT attenuation was about 100 HU）.Abdomen MRI showed lymph node enlargement in hepatic hilum with slightly lower signal on T1WI and higher signal on T2WI.One lesion showed strong radioactivity above the right clavicle,in the right mediastinum and ileocecal junction on PET.The SUVmax measured in the right mediastinum was 10.5,and delayed SUVmax（120 min） was 13.6.Conclusion The imaging findings of mediastinal tuberculous lymphadenitis in adults was atypical.PET was helpless in the diagnosis.The final diagnosis depend on biopsy and pathology.

关 键 词：纵隔 肉芽肿 淋巴结 体层摄影术 X线计算机 

分 类 号：R522[医药卫生—内科学]