论著-头颈部
原发性肝脏淋巴瘤 的CT、MRI表现及病 理分析
作者:管 彬1 钟唐力1 刘启榆1 林 华1 何川东1 谢 刚2 谢春燕2
所属单位:1.四川省绵阳市中心医院放射科 (四川 绵阳 621000) 2.四川省绵阳市中心医院病理科 (四川 绵阳 621000)
PDF摘要
目的 探讨原发性肝脏淋巴瘤 (primary hepatic lymphoma, PHL)的CT 及MRI表现,并与病理结果对照分析,旨 在提高对该病的认识和诊断。方法 回顾 性分析经手术、CT或超声引导下穿刺后病 理证实的PHL8例,7例行CT检查,5例行 MRI检查,其中4例同时进行了CT及MRI检 查。分析PHL的CT及MRI表现。结果 PHL8 例,其中单发7例,多发1例。CT表现:平 扫所有病变均呈低密度,绝大多数密度均 匀,边界清楚;MRI表现:T1WI所有病变 均呈低信号,T2WI呈稍高/高信号,DWI呈 特征性的高信号。CT及MRI增强扫描病灶 呈无明显强化或轻-中度强化,1例出现不 规则坏死;4例显示血管穿过病灶,而血 管本身无明显狭窄、包绕等受侵表现。 单发病例中1例呈肝段分布,误诊为脂肪 肝,多发1例误诊为转移瘤。病理证实为 弥漫大B细胞淋巴瘤7例,小淋巴细胞性淋 巴瘤1例。结论 PHL呈乏血供肿瘤表现, 增强扫描病灶内有血管穿过而血管本身无 明显受侵(即血管漂浮征)可能具有一定特 征。结合临床相关资料,可提高其诊断准 确性。
Objective To analyze CT and MRI findings of primary hepatic lymphoma (PHL) and compare with the pathological results for improving its recognition and diagnostic accuracy. Methods 8 patients with PHL confirmed by pathology of operation, CT or ultrasound guided puncture were reviewed retrospectively. 7 cases were perfomed CT, 5 cases were perfomed MRI and 4 cases were perfomed CT and MRI. CT and MRI findings of PHL were analyzed. Results In all 8 PHL cases, 7 cases presented solitary lesion, 1 case presented multiple lesions. Unenhanced CT showed hypodense lesions in all cases, Most of the density were uniform and the boundary were clear; On MR T1WI imaging, all lesions were presented as hypointensity, on MR T2WI imaging, all lesions showed hyperintense, on MR DWI imaging, all lesions showed distinctive hyperintense. Enhanced CT and MRI showed no evident enhancement or slight to moderate enhancement, 1 case had irregular necrosis. Blood vessel traverse lesions and the vessels were not narrowed and encircled in 4 cases. 1 case of isolated lesions showed segmental distribution of liver and were misdiagnosed as fatty liver, the multiple lesions misdiagnosed as metastatic tumor. Pathology confirmed diffuse large B cell lymphoma in 7 cases, small lymphocytic lymphoma in 1 case. Conclusion PHL were confirmed hypo-vascular tumor. Blood vessel traversing lesions without narrowing or encircling may be a characteristic sign. Combined with clinical information, the diagnostic accuracy of PHL could be improved.
【关键词】淋巴瘤;肝脏;体层摄影术; 磁共振成像
【中图分类号】R445.2;R445.3;R735.7
【文献标识码】A
【DOI】 10.3969/j.issn.1672- 5131.2018.02.001
前言
原发性肝脏淋巴瘤(primary hepatic lymphoma,PHL)是指淋巴瘤 局限在肝脏,而脾脏、淋巴结、骨髓或全身其他淋巴组织无淋巴瘤累 及证据[1]。尽管肝脏是晚期非霍奇金淋巴瘤(NHL)病人常见的结外受累 部位,但PHL却是一种罕见疾病[2]。由于发病率低,无特异性临床表 现、实验室和影像学特点,术前容易误诊。本研究回顾性分析本院收 治的8例PHL,探讨其CT及MRI表现,以提高对该病的认识。
中国CT和MRI杂志
第16卷, 第 2 期
2018年02月
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