透明血管型局限性Castleman病CT、MRI特征及误诊分析  

CT,MRI features and misdiagnosis of hyaline vascular type localized Castleman disease

作　　者：葛明 涂丹丹 刘振宇 王荣春 张德华 苑翠红 张华明 钮建武 GE Ming;TU Dandan;LIU Zhenyu;WANG Rongchun;ZHANG Dehua;YUAN Cuihong;ZHANG Huaming;NIU Jianwu(Department of Radiology,Shanghai Zhongye Hospital,Shanghai 200941,China;Imaging Center,Maanshan People's Hospital,Maanshan, Anhui Province 243000,China;Department of Pathology,Shanghai Zhongye Hospital,Shanghai 200941,China)

机构地区：[1]上海中冶医院放射科,上海200941 [2]马鞍山市人民医院影像中心,安徽马鞍山243000 [3]上海中冶医院病理科,上海200941

出　　处：《实用放射学杂志》2019年第10期1644-1647,共4页Journal of Practical Radiology

摘　　要：目的总结透明血管型局限性Castleman病(LCD)的CT、MRI特点,分析误诊原因,提高术前诊断率。方法回顾分析7例经手术和病理证实为透明血管型LCD患者临床及影像资料。结果(1)术前误诊6例,1例误诊为胰腺神经内分泌肿瘤,1例误诊为胸腺瘤,1例误诊为神经源性肿瘤,1例误诊为嗜铬细胞瘤,1例误诊为肾透明细胞癌,1例误诊为小肠系膜间质瘤。(2)1例位于右侧颈部,1例位于前上纵隔,1例位于胰腺颈部,1例位于左肾上部,2例位于腹膜后,1例位于中下腹。(3)3例患者行增强MRI检查,3例行增强CT检查,1例行CT平扫及增强MRI检查。5例呈类圆形,2例为椭圆形;边界清晰4例,3例有浅分叶、边界局部欠清晰且周围有子灶;2例CT内有斑点或条状钙化;4例MRI T1WI呈等、稍低信号,T2WI抑脂呈稍高信号,DWI为稍高及高信号;所有病灶增强后动脉期均明显强化,门静脉期及延迟后持续强化,强化方式与大血管相似,5例中间和(或)周围见迂曲扩张血管影;3例动脉期病灶内见条片状、轮辐状低密度区或低信号区,延迟后部分充填。结论透明血管型LCD的CT及MRI多表现为富血供病变,增强持续强化,周边血管迂曲、内部短条状钙化及DWI高信号等具有一定的特征性,对术前诊断有一定的帮助。Objective To summarize CT and MRI features of hyaline vascular type localized Castleman disease! LCD) and analyze the causes of misdiagnosis,to improve the preoperative diagnosis rate. Methods The clinical and imaging data of 7 patients with hyaline vascular type LCD confirmed by operation and pathology were analyzed retrospectively.Results (1)6 cases were misdiagnosed before operation, 1 case was misdiagnosed as pancreatic neuroendocrine tumor, 1 case as thymoma, 1 case as neurogenic tumor, 1 case as pheochromocytoma, 1 case as clear cell renal cell carcinoma and 1 case as small mesenteric stromal tumor.(2) 1 case was located in the right neck,l case in the anterior superior mediastinum,! case in the neck of the pancreas, 1 case in the upper part of the left kidney,2 cases in the retroperitoneum and 1 case in the lower abdomen.(3) 3 cases were scaned by dynamic enhanced MRI,3 cases were scaned by dynamic enhanced CT, and 1 case was checked by plain CT and enhanced MRI.CT and MR! showed that 7 cases had a round or elliptical soft tissue mass, and 4 cases with well defined margin,3 cases were not clear in edge,2 cases with spot or strip calcification on CT images,4 cases had slightly longer Tj and longer TV signal,4 cases were restricted of diffusion and had higher signal on DWI.A11 the lesions were enhanced in arterial phase,and went on in the delayed phase.There were 5 cases with distorted vascular shadow in the middle and/or around of the mass, 3 cases with strips,spoke-like low-density areas or low-signal areas,and some lesions were filled in delayed phase.Conclusion CT and MRI features of hyaline vascular type IT'D have certain characteristics such as rich blood supply,enhancement in jjersistent,tortuosity of peripheral vascular,with some short strip calcification and high signal on DWI,which may be helpful for preoperative diagnosis.

关 键 词：CASTLEMAN病 计算机体层成像 磁共振成像 误诊 

分 类 号：R551.3[医药卫生—血液循环系统疾病] R814.42[医药卫生—内科学]