Castleman病的影像学表现与手术、病理对照分析

Contrast analysis on imageology features of Castleman disease with its surgical and pathological findings

目的探讨Castleman病的CT、MR及血管造影的影像学特征,以期在术前做出正确诊断。方法回顾性分析经手术、病理证实的16例Castleman病患者的临床、影像、手术及病理资料。结果 16例患者按病理分型:透明血管型12例,浆细胞型1例,混合型3例。按临床分型:为局灶型13例,多中心型3例。影像学表现:CT扫描15例,平扫表现病灶为直径1.3～20 cm[平均(6.21±4.75)cm]大小的单发、多发结节或软组织肿块,其中1例盆腔病变内可见簇状钙化;增强扫描病灶动脉期显著强化且与动脉几乎同步强化;浆细胞型病灶呈轻-中度强化。MR检查4例,MRI 2例,1例考虑盆腔海绵状血管瘤可能,1例后纵隔囊性占位,MRI+MRA 1例,诊断Castleman病,MRA 1例诊断为颈动脉体瘤,此例同时做数字减影血管造影,诊断为甲状腺实质性肿瘤。结论透明血管型Castleman病的影像表现与病理类型密切相关,CT及MRI增强表现有其特征,具有重要的诊断价值。而浆细胞型Castleman病影像表现不典型,术前诊断困难。

Objective To investigate the imageology features of CT,MR and angiography of Castleman disease in order to make the correct preoperative diagnosis. Methods The clinical,imaging,surgical and pathological data were retrospectively analyzed in 16 patients with Castleman disease confirmed by surgery and pathology. Results The pathological types of 16 cases included hyaline vascular type（n=12）,plasma cell type（n=1） and mixed type（n=3）.Clinical classification of 16 cases included focal type（n=13） and multi-center type（n=3）.Imageology findings： CT examination was performed in 15 patients.The diameter range from 1.3 to 20cm [mean（6.21±4.75）cm].The lesions appeared as single or multiple nodules or masses.The clustered calcification was seen in the pelvic lesion in one patient.The lesions were significantly enhanced almost simultaneously with the arterial enhancement on enhanced CT.The lesions of plasma cell type were mild-moderate enhancement.MR examination was performed in 4 patients.In 2 patients with routine MRI,1 patient was diagnosed as pelvic consider possible cavernous angioma,and another patient as cystic mass in the posterior mediastinum.One patient with routine MRI and MRA was diagnosed as castleman disease.Another patient with MRA was diagnosed as carotid body tumors,and the patient was diagnosed as substantial thyroid tumor on digital subtraction angiography. Conclusion The imageology features of hyaline vascular type in Castleman disease are closely correlated with the pathological types,and the features of CT and MRI enhancement are characteristic,which has important diagnostic value.The imageology features of the plasma cell type in Castleman disease are not typical,and preoperative diagnosis is difficult.