胸腹部局限性Castleman病的CT特征分析

CT characteristics of thoracoabdominal localized Castleman disease

目的 回顾性分析55例胸腹部局限性Castleman病（LCD）的CT特征,并与病理学改变进行对照,研究对LCD有诊断价值的影像特点.方法 搜集20年间胸腹部LCD患者55例,其中胸部25例,腹部30例.55例均经手术切除和组织病理学证实.所有患者均行CT平扫和增强扫描,影像征象由2名放射学医师同时分析.结果 54例透明血管型（50例）和混合型（4例）Castleman病CT表现主要包括孤立性肿物（90.7%,49例）、边缘不规则或分叶或浸润（83.3%,45例）、中央性钙化（38.9%,21例）和显著强化（100%,54例）,72.2%（39例）的病灶内可见局灶性非坏死性低密度影,70.4%（38例）和96.3%（52例）的病灶周围可见肿大的淋巴结和扩张的滋养血管.1例浆细胞型Castleman病表现为边缘不规则伴中央缺血坏死的轻度强化的单发肿块影.其CT分型包括边缘光整的单发肿块（4例）、边缘不规则或分叶状单发肿块（30例）、边缘模糊呈浸润性或磨玻璃样肿块（16例）及多发融合肿块（5例）.结论 胸腹部LCD的CT表现与发生部位和病理类型密切相关,透明血管型和混合型的CT表现具有特征性,而浆细胞型LCD的CT表现则缺乏特征性.

Objective To assess the CT characteristics of thoracoabdominal localized Castleman disease （LCD） in 55 cases and correlate with histopathologic features. Methods Fifty-five patients with LCD proved histopathologically in thorax （ n = 25 ） and abdomen （ n = 30 ） were collected during past 20 years. The unenhanced and contrast-enhanced CT were performed in all patients. Two radiologists reviewed CT images and the CT findings were analyzed simultaneously. Results In 54 patients with hyaline-vascular type （ n = 50 ） and mixed type （ n = 4 ） localized CD, the lesion typically presented as solitary mass （90. 7% , 49 cases）, with irregular or lobular or infiltrative margin （ 83.3% , 45 cases）,central calcification （38. 9%, 21 cases）, marked enhancement （100% , 54 cases）, focal non-necrosis low attenuation areas （72. 2%, 39 cases）, lymphadenopathy （70.4%, 38 cases） and dilated feeding vessels adjacent to the mass （96.3%, 52 cases）. One lesion with plasma cell type localized CD presented as a mass with irregular margin, mild enhancement and central necrosis. Four morphologic patterns wereclassified on CT, including solitary mass with well-circumscribed margin （n =4）, irregular or lobular margin （ n = 30）, infiltrative or halo-like margin （ n = 16 ）, and multiple coalescent maasses （ n = 5 ）. Conclusion CT features of thoracoabdominal localized CD are closely related to the location and pathological type. LCD with hyaline-vascular and mixed type has typical CT characteristics, while LCD with plasma cell type has no typical CT findings.