多发性脾肿瘤的CT和MR诊断

CT and MRI Findings in Multiple Splenic Neoplasm

目的探讨多发性脾脏肿瘤的影像学表现,提高多发脾占位病变良恶性的鉴别诊断水平。方法回顾性分析经临床、手术病理证实的32例多发性脾肿瘤的CT和MR表现,原发性肿瘤13例,转移瘤19例。结果恶性肿瘤CT常表现为实质性或囊实性低密度肿块,增强后原发性肿瘤呈实质部分明显或中度以上强化,转移瘤以边缘强化为主;MR表现:淋巴瘤结节于T1、T2大多均呈等信号,有时可表现为T2低信号;增强后早期为低信号结节,延迟呈等信号。转移瘤T2W I极少数呈低信号。良性肿瘤以血管瘤和脉管瘤常见,CT多表现为低密度或囊性病变,增强后均匀强化或边缘呈晕状强化,血管瘤具特征性延迟强化。MR明显优于CT和动态增强CT,增强T2W I具有典型的"白炽灯"征。脉管瘤MR显示病变内含低信号分隔影,T1、T2均呈高信号,增强无强化或部分边缘强化。结论认识多发性脾肿瘤的CT和MR表现,有助于临床鉴别诊断良恶性肿瘤或非肿瘤性病变。

Objective To discuss the image features of multiple splenic neoplasm （ MSN ）, and to narrow the differential diagnosis of benign or malignant splenic lesions. Methods CT and MRI findings of 32 cases of MSN, confirmed by pathology and clinic, were analyzed retrospectively, Primary tumor in 13 cases, metastatic tumor in 19 cases. Results 27 cases malignant MSN were showed as solid or heterogenous hypoattenuated mass on plain scan CT. In contrast scan ,primary MSN appeared enhancement with significant or over moderate, and metastasis were contrasted by ill-defined or rim pattern. MR showed mostly isointense in T1 ;T2 weight imaging in primary lesions, and metastasis rarely were hypointense in T2 weight imaging. 5 cases benign MSN were showed as homogenous low density mass on plain scan. The typical manifestation of enhancement was delayed or halo singe. MR findings of them were prior to CT in differential diagnosis. Conclusions The radiologist should be familiar with CT and MRI features of MSN to help ensure correct diagnosis of benign or malignant tumor and distinguish from non-neoplastic lesion.