Castleman病的影像表现与病理对照

Comparison between CT expression and pathology of Castleman's disease

目的探讨Castleman病的CT及MRI影像表现,提高对其的认识。方法回顾性分析9例经手术病理证实的Castleman病的CT及MRI资料,并与病理结果对照分析。结果颈部3例,纵隔3例,腹膜后2例,肠系膜1例,临床类型为局限型8例,弥漫型1例,病理分型为透明血管型8例,浆细胞型1例。CT平扫与肌肉相比呈等密度;动态增强CT扫描透明血管型8例,肿块动脉期明显强化,强化程度接近同层面大动脉,静脉期及延迟期均表现为持续强化,5例病灶周围或(和)病灶内可见增粗迂曲血管影。浆细胞型1例表现为肠系膜多个软组织结节,伴有肝脾肿大,呈轻度强化表现。MRI检查3例均为透明血管型,T1WI病灶呈稍低信号,T2WI呈高信号,增强表现与CT近似。结论影像表现与病理分型关系密切;局限性边缘清楚的等密度结节,增强扫描动脉期明显强化,且强化延续时间长,灶周增粗迂曲血管影,分支状或斑点状钙化等为透明血管型相对影像学特点,弥漫浆细胞型无特征性影像学表现,确诊依赖组织病理学。

Objective To analyze the CT and MRI expression of Castleman＇ s disease and improve the recognition of Castleman＇ s disease. Methods A retrospective analysis of nine cases of pathologically proven Castleman＇ s disease CT and MRI data was performed and comparative analyzed with the pathological findings. Results There were 3 cases in neck, 3 cases in mediastinum, 2 cases in retroperitoneum, 1 case in mesentery. The clinical types were topical type in 8 cases, diffuse in 1 case; the pathological types were 8 cases of hyaline-vascular, plasma cell type in 1 case. CT scan showed isodense compared with muscle ; dynamic con- trast-enhanced CT scan of hyaline-vascular type in 8 cases, there was marked enhancement in tumor arterial phase, close to the same level of enhanced degree artery, venous phase and delayed phase appeared as continuing to strengthen. There was thickening shadow of tortuous vascular around the lesions or/and in the lesions in 5 cases. 1 case of plasma cell type showed multiple retroperitoneal soft tissue nodules, accompanied by hepatosplenomegaly, and the performance was slightly enhanced. MRI test showed that 3 cases were hyaline-vascular type, T1WI lesion with slightly lower signal and T2WI with high signal, the enhance performance was similar to CT. Conclusion The imaging findings and pathological types are closely related. Imaging features of transparent vascular type mainly expresses for marked enhancement in tumor arterial phase, the time of strengthening is long in isodensity nodules with clear edge, thickening shadow of tortuous vascular around the lesions and branch-like or punctate calcification. Diffuse plasma cell type showed no characteristic imaging findings, diagnosis depends on the histopathology.