腹盆部局灶型Castleman病的MRI特征及误诊分析  

Localized Castleman's Disease in Abdomen and Pelvis:Analysis of MRI Features and Misdiagnosis

作　　者：曾道兵 赵新湘[1] 常婵 朱黎[1] 宋林声 

机构地区：[1]云南昆明医科大学第二附属医院放射科,650101 [2]华中科技大学同济医学院附属协和医院肿瘤中心,武汉430022

出　　处：《临床放射学杂志》2017年第10期1446-1450,共5页Journal of Clinical Radiology

摘　　要：目的分析腹、盆部局灶型Castleman病(LCD)的MRI特征及误诊原因,提高对该病的诊断水平。方法回顾性分析经手术和病理证实的9例腹、盆部LCD的MRI资料,观察病变部位、形态、边界、MRI信号特点及强化方式,分析LCD的MRI表现及误诊原因。结果 (1)术前误诊5例,2例诊断为副神经节瘤,1例诊断为神经鞘瘤,1例诊断为胰腺神经内分泌肿瘤,1例诊断为富血供肉瘤。(2)7例位于腹膜后,1例位于胰腺体尾部前下方,1例位于盆腔。透明血管型8例,其中1例合并朗格汉斯细胞组织细胞增生症,浆细胞型1例。(3)MRI平扫8例透明血管型LCD表现为境界清楚的圆形或类圆形软组织信号肿块,T_1WI呈等、稍低信号,T_2WI抑脂呈稍高信号(与同层面肌肉相比),其中盆腔1例LCD内合并散在多发粗条状钙化,T_1WI及T_2WI均呈散在多发低信号表现;1例浆细胞型LCD边界模糊,中心为稍短T_1、稍短T_2信号,周边呈稍长T_1、稍长T_2信号。DWI上5例未见弥散受限,4例弥散轻度受限,呈稍高信号。动态增强扫描,8例透明血管型LCD均表现为动脉期中度至明显强化,肿块边缘呈延迟期强化;1例浆细胞型LCD动脉期轻度强化,边缘呈延迟强化,与透明血管型一致。结论腹、盆部LCD的MRI表现具有一定的特征性,但由于相对少见,易误诊,对腹盆部境界清楚的软组织肿块、动脉期明显强化、延迟期边缘强化、弥散无受限或轻度受限者,要考虑到Castleman病的可能性。Objective To analyse MRI features and misdiagnosis of Localized Castleman＆#39;s Disease （LCD）in the abdomen and pelvis,and improve our diagnosis of the disease.Methods Techniques of MRI were analyzed retrospectively for 9 patients who had confirmed LCD in the abdomen and pelvis by operation or pathology,and the lesion＆#39;s location,shape,border,MRI signal characteristics and enhancement mode were observed for MRI features and misdiagnosis of LCD.Results （1） 5 cases were misdiagnosed before operation,including 2 cases diagnosed as paraganglioma,1 case neurolemmoma,1 case pancreatic neuroendocrine tumor,and 1 case hypervascular sarcoma.（2） 7 cases were located in the retroperitoneum,1 case in the anterior inferior part of the pancreatic body and tail,and 1 case in the pelvis.8 cases were hyaline-vascular type （of which 1 case had Langerhans cell histiocytosis）,and 1 case was plasma-cell type.（3） MRI scan showed that 8 hyaline-vascular type LCD patients had a well defined and round or oval soft tissue mass,which showed equal,slightly lower signal on T1WI,and a slightly higher signal on T2WI fat-sequence （compared with the same level of muscle）,including 1 case of pelvic masses with multiple and scattered amorphous calcification showed scattered and multiple low signal on T1WI and T2WI.The boundaries were indistinct in 1 case of plasma-cell type,which showed a slightly shorter T1 and T2 in the center of the masses,and a slightly longer T1 and T2 in the margins.DWI showed that 5 cases were not restricted of diffusion,and 4 cases had slightly limited diffusion and slightly higher signal.On dynamic enhanced MRI scan,8 cases of hyaline-vascular type showed moderate to obvious enhancement in the arterial phase,and intense enhancement of the edge in delayed phase.1 case of plasma-cell type LCD,consistent with hyaline-vascular type,showed slight enhancement in the arterial phase,and delayed enhancement of the edge.Conclusion Abdominal and pelvic LCD has characteristic MRI features.Due to the rel

关 键 词：CASTLEMAN病 磁共振成像 误诊 

分 类 号：R445.2[医药卫生—影像医学与核医学] R597[医药卫生—诊断学]