脾脏多发性结节病变的影像鉴别诊断  

Imaging differential diagnosis of multiple nodular lesions in spleen

作　　者：马全美 辛军[1] 侯阳[1] MA Quanmei;XIN Jun;HOU Yang(Department of Radiology,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院放射科,辽宁沈阳110004

出　　处：《实用放射学杂志》2020年第12期1961-1964,共4页Journal of Practical Radiology

摘　　要：目的探讨脾脏多发结节性病变的鉴别诊断.方法25例患者纳入研究,包括脾脏窦岸细胞血管瘤(LCA)7例,脾脏结节病3例,脾转移瘤6例,淋巴瘤8例,白血病脾浸润1例.由2名有经验医师回顾性分析经临床随访及手术病理证实的脾脏多发结节性病变的CT及MRI影像特征.结果LCA表现为脾内多发T1 WI低信号结节,T2 WI以高信号为主,部分点状低信号,增强呈缓慢向心性强化.脾脏结节病表现为脾内多发T1 WI低信号结节,T2 WI呈低信号改变,增强一致性轻中度强化.脾脏转移瘤主要表现为脾内多发T1 WI低信号结节,T2 WI呈稍高信号改变,增强边缘强化.脾脏淋巴瘤典型表现为脾内多发T1 WI均匀低信号改变,T2 WI呈均匀稍高信号改变,增强呈轻度均匀强化.脾内多发结节CT表现为脾内低密度或稍低密度结节影,强化方式同MR.结论脾脏内多发结节性病变种类繁多,不同病变具有一定的影像特征,CT、MRI平扫及动态增强扫描能明确显示病变的形态、大小、强化特点.Objective To investigate the differential diagnosis of multiple nodular lesions in spleen.Methods A total of 25 patients were included in the study,including 7 cases of littoral cell angioma(LCA),3 cases of spleen sarcoidosis,6 cases of spleen metastases,8 cases of lymphoma and 1 case of spleen infiltration by leukemia.Two experienced physicians retrospectively analyzed the CT and MRI features of the splenic multiple nodular lesions confirmed by clinical follow up and surgical pathology.Results Splenic LCA showed multiple T1WI low signal nodules in spleen,with high signal and some punctate low signal on T2 WI.The contrast-enhanced scan showed slowly centripetal enhancement.Spleen sarcoidosis manifested as multiple T3WI low-signal nodules in spleen,low signal change on T2 WI,and mild to moderate consistent enhancement.The spleen metastases mainly showed multiple T1WI low-signal nodules in spleen,a slightly high signal change on T2 WI and edge enhancement on contrast-enhanced scan.Splenic lymphoma was characterized by multiple T1WI uniform low signal in spleen.T2 WI showed uniform and slightly high signal,and the contrast enhanced scan showed mildly uniform enhancement.Splenic multiple nodules mentioned above showed low-density or slightly low-density lesions in spleen on CT,and the enhancement patterns were the same as MR.Conclusion There are many kinds of multiple nodular lesions in spleen,and both have certain imaging features.CT,MRI non-contrast and dynamic contrast-enhanced scan can clearly show the shape,size and enhancement characteristics of the lesions.

关 键 词：脾 转移瘤 结节病 窦岸细胞血管瘤 计算机体层成像 磁共振成像 

分 类 号：R733.2[医药卫生—肿瘤] R551.1[医药卫生—临床医学]