肝脏继发淋巴瘤CT表现与病理的对照分析

Correlation of CT findings of secondary hepatic lymphoma with pathology

目的评价CT动态增强扫描在肝脏继发淋巴瘤中的诊断价值，以提高诊断准确性。方法回顾性分析9例经病理证实的肝脏继发淋巴瘤病例，7例为非霍奇金淋巴瘤，2例为霍奇金淋巴瘤，所有病例术前经CT平扫、动脉期和门静脉期扫描，复习CT扫描结果并和病理作回顾性对照分析。结果9例肝脏继发淋巴瘤共发现23个病灶，位于肝脏左叶9个，右叶6个，肝门区5个，尾状叶3例；16个病灶位于门静脉左右支周围，7个位于肝脏周边。病灶呈类圆形17个，地图形6个。病灶密实，密度均匀，坏死少见或坏死范围很小。病灶直径2．7～16．5cm，平均5．9cm。动态增强呈进行性延迟强化，多数肿瘤强化轻微，少数呈轻至中度强化。各期扫描CT值分别为平扫20．7～31．5HU（平均25．3HU），动脉期CT值23．8～48．5HU（平均31．9HU），门静脉期35．3～60．2HU（平均47．8HU），6个病灶内可见形态正常的肝脏固有血管。肝门病灶表现为肝门门静脉周围血管套样软组织影，包绕但不压迫门静脉。结论认识动态增强CT特征有助于提高诊断的准确性。

Objective To correlate CT findings of secondary hepatic lymphoma with pathology and to evaluate it＇s clinical value. Methods Nine patients with secondary hepatic lymphoma confirmed by pathology underwent spiral CT scanning and dual-phase dynamic contrast-enhancement scanning before operation, the CT data were reviewed and analysed retrospectively in comparison with surgical and pathological results. Results Twenty-three lesions of secondary hepatic lymphoma in 9 patients were located in the left lobe （9 lesions）, the right lobe （6 lesions ） , the porta of the liver （5 lesions） and the caudate lobe （3 lesions）, respectively. Sixteen of these 23 lesions were distributed over an area near the portal vein, 7 were scattered in the exterior of liver. 17 lesions had an ellipsoid contour and 6 showed irregular contour. The diameter of the lesions ranged from 2.7 to 16. 5 cm,with a mean diameter of 5.9 era. The tumor demonstrated mild homogeneous dynamic delayed contrasted-enhancement and the CT value of the noncontrast scans, AP phases and PVP phases were 20. 7 to 31.5 HU（with a mean value of 25.3 HU）, 23.8 to 48.5 HU（with a mean value of 31.9 HU） and 35.3 to 60.2 HU（with a mean value of 47.8 HU） respectively. Intrinsic hepatic vessels could be discerned in 6 lesions. The lesions situated in the porta of the liver encased the portal vessels, but there was no vessel compression or occlusion. Conclusion Recognition of the dynamic CT features of hepatic lymphoma could enhance its diagnostic accuracy.