腹膜后淋巴结结核的CT及MRI诊断价值的探讨

Evaluation of CT and MRI in diagnosing tuberculosis of retroperitoneal lymph nodes

目的探讨腹膜后淋巴结结核的CT、MRI表现及其诊断价值。方法经组织学检查或临床追踪证实的腹膜后淋巴结结核11例,均作螺旋CT平扫及增强扫描,3例行MRI平扫及增强扫描。回顾性分析其CT及MRI表现,并与病理检查结果对照。结果11例CT平扫中4例表现为腹膜后软组织密度的淋巴结肿大;5例表现为腹膜后软组织肿块影;2例表现为淋巴结钙化。增强扫描4例腹膜后的淋巴结肿大呈环形强化,5例平扫示腹膜后病灶为多个淋巴结彼此融合而成,环形强化的淋巴结形成多房样征象;2例淋巴结钙化的病灶表现为无强化。3例MRI平扫示腹膜后软组织肿块影,T1WI呈稍低信号,T2WI上呈稍高信号,增强扫描时呈多房样强化。8例合并腹内脏器结核,8例合并肺结核。结论平扫呈软组织密度的淋巴结肿大或淋巴结钙化,增强扫描病灶呈环形强化或多房样强化是腹膜后淋巴结结核的最常见的征象,影像学表现比较有特异性。

Objective To study the manifestations and diagnostic value of CT and MRI in the tuberculosis of retroperitoneal lymph nodes. Methods 11 cases of retroperitoneal tuberculous lymphadenitis were collected. All cases were confirmed by histological examination and followed-up. Both plain and enhanced spiral CT scaning were performed in these cases. MRI was performed in 3 cases. The CT and MRI features were retrospectively analyzed and correlated with the pathologic findings. Results retroperitoneal lymph node which displayed on CT as soft tissue density shadow were enlarged in 4 cases. CT scan revealed a mass in the retroperitoneal region in 5 cases, calcifications of lymph nodes in 2cases. Enhanced CT findings： ring-like enhancement of hypertrophied lymph nodes was found at the retroperitoneal area in 4 cases. The lesion composed of several lymph nodes with honeycomb enhancement was located at the retroperitoneal area in 5 cases, no enhancement in 2 cases with calcifications. MRI showed soft tissue mass shadow in 3 patients. Lesions are slightly hypointensity on T1-weightes. images, slightly hyperintensity on T2-weighted images. Enhanced MRI demonstrated multilocular enhancement. 8 cases companied with abdominal organ tuberculosis and 8 patients suffered from lung tuberculosis. Conclusions CT and MRI findings of most tuberculosis of retroperitoneal lymph nodes have characteristic features. Ring-like enhancement, multilocular sign and calcification of lymph nodes may suggest the diagnosis.