脾脏炎性假瘤CT和MRI表现与病理对照分析

Splenic Inflammatory Pseudotumor:CT and MRI Correlated with Pathologic Findings

目的:探讨脾脏炎性假瘤的CT、MRI表现,提高CT、MRI对该病的认识和诊断水平。方法:回顾性分析经临床手术病理证实的6例患者的临床、CT、MRI资料,6例均行CT、MRI平扫及增强扫描,分析其CT、MRI表现特征并与病理结果对照。结果:脾脏炎性假瘤的MRI表现:T1WI序列表现为低或等信号,T2WI序列为低信号,信号特点与纤维组织增生、灶性出血、凝固性坏死、含铁血黄素沉着等有关。CT表现:CT平扫表现为等密度或稍低密度、边界清晰的肿块,其内可见散在点状高密度出血灶、小片状低密度坏死区。CT、MRI动态增强后各期强化不明显。CT、MRI可见病灶周围有不完整包膜。本组炎性假瘤病理以大量纤维组织增生为特征,间以淋巴细胞、浆细胞、组织细胞以及单核细胞等慢性炎性细胞浸润,伴以灶性出血、凝固性坏死、含铁血黄素沉着等。本组脾脏炎性假瘤CD68(巨噬或单核细胞标记物)均为阳性。结论:脾脏炎性假瘤具有特征性CT、MRI表现,CT、MRI对脾脏炎性假瘤的诊断及鉴别诊断具有重要价值。

Objective：To study the CT and MRI features of splenic inflammatory pseudotumor,and correlated with pathology,in order to improve the diagnostic accuracy and the understanding of the disease. Methods：The CT and MRI features of splenic inflammatory pseudotumor proved by surgery and pathology in 6 patients were reviewed retrospectively. All patients had pre-and post-contrast CT and MRI scanning,the CT and MRI features were analyzed and correlated with pathology. Results：The MRI features of splenic inflammatory pseudotumor were as follows：hypo-or iso-intense on T1 WI and hypo-intense on T2 WI, which were correlated with fibrous tissue, focal hemorrhage, coagulation necrosis and hemosiderosis on pathology. Pre-contrast CT scan showed well-defined iso-attenuated or hypo-attenuated mass with scattered punctate hyperdense hemorrhagic loci and small pieces of low density necrosis. No obvious enhancement can be seen in all phases of dynamic enhanced CT or MRI. Incomplete capsulation of the mass can also be revealed on CT or MRI. Fibrosis was the distinct pathology feature,accompanied with chronic inflammatory cell （lymphocytes, monocytes, plasma cells and histiocytes） infiltration, focal hemorrhage,hemosiderosis and coagulated necrosis. CD68 （marker for macrophage or monocyte） was positive. Conclusion：CT and MRI manifestations are valuable in the diagnosis and differential diagnosis of splenic inflammatory pseudotumor.