肝脏孤立性髓外浆细胞瘤的影像学特征  

Imaging features of solitary extramedullary plasmacytoma of liver

作　　者：李晓明[1] 陈伟[1] 蔡萍[1] 阎晓初[2] 王健[1] 

机构地区：[1]第三军医大学西南医院放射科,重庆400038 [2]第三军医大学西南医院病理科,重庆400038

出　　处：《中华消化外科杂志》2016年第1期85-90,共6页Chinese Journal of Digestive Surgery

摘　　要：目的总结肝脏孤立性髓外浆细胞瘤（SEP）的超声、CT及钆塞酸二钠动态增强MRI（Gd-EOB-DTPAMRI）影像学检查特征，探讨其诊断及鉴别诊断要点。方法回顾性分析2015年5月7日第三军医大学西南医院收治的1例肝脏SEP患者的临床资料，患者行超声造影、CT平扫及增强扫描、钆塞酸二钠动态增强MRI检查。完善术前相关检查后行手术治疗，术后行病理学检查和免疫组织化学染色检测。术后患者门诊行彩色多普勒超声检查，随访时间截至2015年11月12日。影像学检查记录肿瘤的部位、大小、形态、回声、密度或信号、强化特征、继发表现。记录手术治疗情况、病理学检查、免疫组织化学染色检测结果，术后恢复情况，随访期间肿瘤复发情况。结果超声造影检查示右半肝s7段探及范围约24mm×19mm的低回声包块，边界清晰，内部可见点状血流信号；动脉相迅速增强。腹部CT检查：平扫期右半肝团块状稍低密度影，CT值为34-64HU，边界清楚，邻近肝脏包膜无明显外凸。CT增强检查动脉期示包块明显均匀强化，其内可见肝右动脉后上段分支走行；门静脉期包块持续强化，强化程度稍低于正常肝实质，CT值为77-102HU；平衡期包块强化程度减低，cT值为41-98HU。动脉期最大密度投影图像示包块内可见增粗血管影走行；门静脉期最大密度投影图像示包块与肝右静脉、下腔静脉毗邻，邻近肝右静脉受压移位改变。Gd-EOB-DTPAMRI检查：右半肝稍长T。、稍长T2信号影，边界清楚，信号均匀，其内未见明显脂质成分及出血、钙化。动脉期明显强化；门静脉期持续均匀强化，强化程度高于正常肝实质；平衡期强化减低；肝胆期呈低信号，包块与下腔静脉、肝右静脉毗邻，肝右静脉呈受压移位表现，肝脏未见明显肝硬化结节表现。完善检查后，患者行腹腔镜右半肝占位性病变切除术，�Objective To summarize the imaging features of ultrasound, computed tomography （CT） and gadolinium-ethoxybenzyl-diethylenetriamine pentoacetic acid （Gd-EOB-DTPA） enhanced magnetic resonance imaging （MRI） of solitary extramedullary plasmacytoma （SEP） of liver, and investigate the key points of identifi- cation and diagnosis. Methods The clinical data of 1 patient with SEP of the liver who was admitted to the South- west Hospital of the Third Military Medical University at 7 May, 2015 were retrospectively analyzed. The patient received contrast-enhanced ultrasound （CEUS） , plain and enhanced scan of CT and Gd-EOB-DTPA enhanced MRI. The patient underwent treatment after preoperative examinations. Pathological examination and immunohisto- chemical staining were clone after operation. The patient was followed up by outpatient examination of color Doppler ultrasonography till 12 November, 2015. The location, size, shape, echo, density or signal, enhancement pattern, secondary performance were recorded by imageological examinations. Surgical treatment, results of pathological examination, immunohistochemical staining, postoperative recovery and recurrence of tumor were recorded.Results CEUS examination demonstrated a hypoeehoie hepatic lesion at S7 segment of the right liver measuring 24 mm × 19 mm with clear boundary and dotted blood flow signal in the mass. In the arterial phase, the lesion was enhanced rapidly. Abdominal CT scan showed that the mass at the right liver lobe had slightly low density with clear boundary, the CT value of 34-64 HU, and liver capsule having no significant outer convex. On enhanced CT, the lesion presented a homogeneous enhancement and shape of posterior upper tributaries of right hepatic artery in the arterial phase, the lesion presented continuous enhancement which was slightly lower than that of liver parenchyma in the portal venous phase with the CT value of 77- 102 HU, the lesion presented decreased enhancement with the CT value of 41-98 HU in the equilibrium phase

关 键 词：肝脏肿瘤 髓外浆细胞瘤 断层成像 x线计算机 磁共振成像 钆塞酸二钠 

分 类 号：R735.7[医药卫生—肿瘤] R730.44[医药卫生—临床医学]