腹腔异位脾种植的影像学特征及误诊分析  

Imaging features and misdiagnosis analysis of abdominal ectopic splenic implantation

作　　者：郑星 阮志兵 段庆红[3] 胡雨 卜碧玉 谢芹芹 ZHENG Xing;RUAN Zhi-bing;DUAN Qing-hong;HU Yu;BU Bi-yu;XIE Qin-qin(Department of Radiology,The Affiliated Hospital of Guizhou Medical University,Guizhou 550004,China)

机构地区：[1]贵州医科大学,贵州贵阳550025 [2]贵州医科大学附属医院影像科,贵州贵阳550004 [3]贵州省肿瘤医院影像科,贵州贵阳550001

出　　处：《影像诊断与介入放射学》2021年第2期117-123,共7页Diagnostic Imaging & Interventional Radiology

摘　　要：目的探讨腹腔异位脾种植的临床、影像学特点及误诊原因,以提高对本病的认识及诊断。方法回顾性收集经手术病理证实或临床及影像随诊为腹腔异位脾种植患者27例(共53个脾种植灶),分析其CT和/或MRI图像及临床资料。结果27例中24例因外伤致脾破裂行急诊脾切除术,3例分别因脾功能亢进、脾肿物、脾淋巴瘤行脾切除。腹腔异位脾种植灶53个,脾区20个,胃底部12个,胰尾部6个,盆腔6个,左肾上腺区3个,右肾上腺区2个,肝S4、肝S6下缘、右膈肌及腹膜后间隙各1个;病灶最大径0.6~6.3 cm。CT平扫病灶密度均匀,边界清晰,1例胃底部脾种植与胃壁粘连致边界欠清;增强扫描动脉期直径小于3 cm的病灶多呈均匀强化,直径不超过3 cm的病灶多呈不均匀强化,门脉期及延迟期扫描同脾脏的持续性均匀强化;MRI平扫T_(1)WI序列呈稍低信号,T_(2)WI序列均呈稍高信号;1例脾区脾种植病灶T_(1)WI序列呈等低信号,T_(2)WI序列呈低信号;增强与CT强化方式相同。腹腔异位脾种植病灶诊断为肝肿瘤、胃肠道间质瘤、嗜铬细胞瘤、腺瘤、肿大淋巴结及性质待定病变共13例。结论腹腔异位脾种植的临床和影像表现具有一定的特征性,结合患者脾破裂或脾切除史、腹盆腔单发或多发软组织肿块的密度/信号及强化特点,可做出明确诊断。Objective To investigate the clinical and imaging features of ectopic splenic implantation in abdominal cavity and the causes of misdiagnosis.Methods The clinical records,CT and/or MRI of 27 patients with 53 abdominal ectopic splenic implantations confirmed by pathology or clinical and imaging follow-up were retrospectively analyzed.Results Splenectomy was performed in 27 patients because of traumatic splenic rupture(24),hypersplenism(1),splenic mass(1)or lymphoma(1).The 53 ectopic splenic implantations were in the splenic fossa(20),gastric fundus(12),pancreatic tail(6),pelvic cavity(6),left(3)or right(2)adrenal region,lower margin of hepatic S4(1)or S6 segment(1),right diaphragm(1),retroperitoneal space(1).The maximum diameter of the lesions ranged from 0.6 cm to 6.3 cm.On CT,the lesions were homogeneous with clear boundary in all except for one implant that adhered to the inferior gastric wall.Lesions<3 cm showed homogeneous contrast enhancement in the arterial phase whereas lesions≥3 cm enhanced heterogeneously in the portal and delayed phases.On MRI,52/53 lesions were slightly T_(1) hypointense and slightly T_(2) hyperintense with contrast enhancement characteristics similar to CT.One lesion showed iso-low T_(1) and low T_(2) signal intensities.13/53 lesions were misdiagnosed as liver tumor,gastrointestinal stromal tumor,pheochromocytoma,adenoma,enlarged lymph nodes,or undetermined lesions.Conclusion With the history of splenic rupture or splenectomy,ectopic splenic implantation may be suspected in single or multiple abdominal and/or pelvic soft tissue masses with characteristic CT/MRI features.

关 键 词：异位脾种植 影像表现 临床特点 误诊分析 

分 类 号：R657.6[医药卫生—外科学]