脾脏硬化性血管瘤样结节性转化的临床特征和CT与MRI影像学表现  

作　　者：向雪莲 刘畅 张建军[3] 

机构地区：[1]浙江中医药大学附属省立同德医院,310012 [2]浙江大学医学院附属第一医院,310006 [3]浙江医院,310007

出　　处：《浙江临床医学》2025年第2期262-265,共4页Zhejiang Clinical Medical Journal

摘　　要：目的探讨脾脏硬化性血管瘤样结节性转化(SANT)的临床特征及CT和MRI影像学表现,提高对SANT诊断的准确性。方法回顾性分析38例经病理证实的SANT患者的临床资料和CT与MRI检查结果。结果38例SANT患者中,男性20例,女性18例,年龄范围18~71岁,平均年龄42.7岁,其中34例(89.4%)为单发病灶,4例(10.5%)为多发病灶;19例(50%)在体检中发现,19例(50%)因其他检查发现。术前诊断的SANT患者11例(29%),误诊患者27例(71%)。38例患者中,15例接受了CT和MRI增强检查,7例仅接受了MRI增强检查,16例仅接受了CT增强检查。所有病灶呈类圆形,其中25例(65.8%)边界清晰,10例(26%)边界欠清,3例(7%)边界不清。31例CT检查中,5例(16%)可见钙化。22例(100%)MRI检查中,所有患者T_(2)WI显示低信号瘢痕,且瘢痕强化,15例(68%)可见含铁血黄素信号。增强后,25例(65%)出现轮辐状强化,13例(34%)出现结节样强化,16例(42.1%)可见脾动脉分支穿行。增强方式以渐进性强化为主(35/38)。结论脾脏硬化性血管瘤样结节性转化是一种罕见的脾脏原发性良性病变,原因不明,可能伴有其他部位病变。影像学上主要表现为单发、实性肿块,类圆形、边界大多清晰,CT平扫密度略低于脾脏,偶见钙化,T_(2)WI主要表现为等低信号,内含更低信号瘢痕,增强多呈渐进性强化且中央瘢痕强化,多数可见典型“轮辐征”。Objective To explore the clinical features,CT and MRI imaging manifestations of splenic sclerosing angiomatoid nodular transformation(SANT),and to improve the accuracy of diagnosing SANT.Methods A retrospective analysis of the clinical data and CT and MRI examination results of 38 pathologically confirmed SANT patients was conducted.Results Among the 38 SANT patients,there were 20 males and 18 females,with an age range of 18 to 71 years,an average age of 42.7 years,and a median age of 42.5 years.In these cases,34(89.4%)were single lesions,and 4(10.5%)were multiple lesions;19(50%)were found during physical examinations,and 19(50%)were found due to other examinations.There were 11(29%)patients with preoperative diagnosis of SANT and 27(71%)patients with misdiagnosis.Among the 38 patients,15 underwent both CT and MRI enhanced examinations,7 underwent only MRI enhanced examination,and 16 underwent only CT enhanced examination.All lesions were round in shape,with 25(65.8%)having clear boundaries,10(26%)having unclear boundaries,and 3(7%)having indistinct boundaries.In the 31 CT examinations,5(16%)showed calcification;in the 22(100%)MRI examinations,all cases showed low signal scars on T_(2)WI,with scar enhancement,and 15(68%)showed hemosiderin signals.After enhancement,25(65%)showed spoke-wheel enhancement,13(34%)showed nodular enhancement,and 16(42.1%)showed splenic artery branches passing through.The enhancement pattern was mainly progressive enhancement(35/38).Conclusion Splenic sclerosing angiomatoid nodular transformation is a rare primary benign lesion of the spleen,with unknown causes,and may be accompanied by lesions in other parts.The main imaging manifestations are single,solid masses,round in shape,mostly with clear boundaries.CT scan density is slightly lower than the spleen,with occasional calcification.T_(2)WI mainly shows isointense to hypointense signals,contains lower signal scars.Enhancement shows progressive enhancement and central scar enhancement,and most show the typical"spoke-wheel sign".

关 键 词：脾脏硬化性血管瘤样结节性转化 轮辐征 计算机断层成像 核磁共振成像 

分 类 号：R733.2[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R730.44