颈部淋巴结病变的MRI诊断分析

MRI for evaluation of cervical lymphadenopathy

目的:探讨颈部淋巴结病变的MRI表现。方法:对68例颈部淋巴结病变的患者行MRI平扫及增强扫描,并常规用化学位移饱和法脂肪抑制成像(FatSat),分析病灶的形态学表现和信号特点并与病理对照。结果:在确诊的20例颈部淋巴结结核、33例颈部淋巴结转移癌、11例恶性淋巴瘤的MRI图像上,圆形淋巴结(长径比横径小于2,即LT<2)45例(结核性8例,转移癌28例,淋巴瘤9例),长圆形淋巴结(LT>2)19例(结核性12例,转移癌5例,淋巴瘤2例)。T1WI及T2WI出现中心淋巴结坏死灶和T1WI薄壁的环状强化35例(结核性6例,转移癌27例,淋巴瘤2例)。淋巴结边缘模糊和邻近脂肪组织受侵35例(结核性5例,转移癌28例,淋巴瘤2例)。9例恶性淋巴瘤MRI图像上均为均质表现。结论:MRI对颈部肿大淋巴结性质评估具有相当重要性,可作为诊断和鉴别诊断颈部淋巴结病变的一项重要检查方法。

Objective： To evaluate MRI features in cervical lymphadenopathy. Methods： Sixty-eight patients with cervical lymphadenopathy underwent both plain and enhanced MRI. Fat-suppression imaging was routinely performed using the chemical shift imaging（CSI） and fat saturation（FS） technique. Morphological features and signal intensity characteristics of MRI were analyzed and compared with pathological results. Results： Diagnosis was verified by pathology. Twenty cases had cervical tuberculous lymphadenitis, 33 had malignant lymph node metastasis and 11 had malignant lymphoma. MRI detected round lymph nodes （with the long axis/short axis〈2） in 45 cases（8 with tuberculosis, 28 with malignant metastasis and 9 with lymphoma）, and oval lymph nodes（with the long axis/short axis〉2） in 19 cases（12 with tuberculosis, 5 with malignant metastasis and 2 with lymphoma）. Thirty-five cases manifested with necrotic focus locating in the centre of the lymph node revealed in T1WI and T2WI and thin-walled rim enhancement revealed in T1WI （6 with tuberculosis, 27 with malignant metastasis and 9 with lymphomas）. Ⅲ defined margin of the lymph node and invasion of adjacent adipose tissue were found in 35 cases（5 with tuberculosis, 28 with malignant metastasis and 2 with lymphoma）. Nine cases with lymphoma showed homogeneous signal intensity on MRI. Conclusion： MRI is significant in the evaluation of enlarged cervical lymph nodes. It is an important examination in the diagnosis and differential diagnosis of cervical lymphoadenopathy.