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纵膈内淋巴瘤的CT诊断与鉴别研究

作者:黄潭玉 崔 冰

所属单位:广东省惠州市第三人民医院影像科(广东 惠州 516000)

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摘要

目的 研究纵膈内淋巴瘤CT诊断 与鉴别价值。方法 回顾性分析经病理 证实30例纵膈内淋巴瘤患者的CT影像学 资料,观察总结纵膈内淋巴瘤位置、大 小、形态、密度等CT表现,并与病理结 果比较。结果 与病理结果比较,CT诊 断纵膈内淋巴瘤准确率90.0%(27/30), 另3例均误诊为纵膈胸腺瘤。均淋巴结 肿大,且以多发淋巴结肿大为主;肿大 淋巴结全部融合占26.7%,表现出分叶 状或波浪状不规则软组织肿块;CT平扫 多为均匀密度,增强扫描以均匀增强为 主,占90.0%;血管移位21例(70.0%); 胸骨、肋骨前段骨质破坏、胸壁软组织 包块与心包积液、胸腔积液各8例。结 论 多层螺旋CT诊断纵膈内淋巴瘤准确率 高,可作为纵膈内淋巴瘤诊断、鉴别的 重要手段之一。

Objective To study the value of CT in diagnosis and identification of mediastinal lymphoma. Methods CT imaging data of 30 patients with mediastinal lymphoma confirmed by pathology were retrospectively analyzed. The CT findings such as the location, size, shape and density of the mediastinal lymphoma were observed and compared with pathological findings. Results Compared with the pathological findings, the accurate rate of CT in diagnosis of mediastinal lymphoma was 90.0% (27/30). Another 3 cases were misdiagnosed as mediastinal thymoma. All were lymphadenectasis and mainly were multiple lymphadenectasis; All swelling lymph nodes fusion accounted for 26.7%, showing lobulated or wavy irregular soft tissue masses. CT plain scan mainly showed homogeneous density and enhancement scan mainly was homogeneous enhancement, accounting for 90.0%. 21 cases (70.0%) were with vascular displacement. There were anterior segment of bone destruction of sternum and rib, chest wall soft tissue masses and pericardial effusion and pleural effusion in respctively 8 cases. Conclusion The accurate rate of multi-slice spiral CT in the diagnosis of mediastinal lymphoma is high. It can be used as an important method for diagnosis and identification of mediastinal lymphoma.

【关键词】纵膈内淋巴瘤;CT表现;诊断

【中图分类号】R733.4

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2017.04.022

前言

淋巴瘤指的是于淋巴结或结外淋巴组织出现的原发恶性病变,在 组织病理学上包括霍奇金病与非霍奇金淋巴瘤,典型特征为淋巴结肿 大[1]。纵膈内淋巴结主要表现为纵膈肿块,早期表现不典型,病情加 重后呈现胸闷等症状,病情进展快,预后相对差[2],为此早期及时发 现并诊断出纵膈内淋巴瘤具有十分重要的意义。近年来多层螺旋CT在 临床上应用较多,对纵膈受累淋巴结位置、大小、形态、肺及胸膜侵 犯等情况可清晰显示,在纵膈内淋巴瘤诊断中有重要作用[3]。本研究 通过回归性分析我院2013年2月~2015年2月经病理证实30例纵膈内淋 巴瘤患者多层螺旋CT影像学表现资料,以探讨其对纵膈淋巴瘤的诊断 意义。报告如下。