胸腹部局灶型巨淋巴结增生症影像学表现

Imaging features of focal Castleman disease in abdomen and thorax

目的：探讨胸腹部局灶型巨淋巴结增生症（LCD）的影像学表现特征，提高诊断符合率。方法：回顾性分析经手术后病理证实的12例胸腹部LCD患者的影像学表现，其中男3例，女9例，胸、腹部各6例。结果：病理分型为透明血管型11例，浆细胞型1例。10例行CT平扫及增强扫描，胸、腹部各5例，CT平扫示病灶呈等或略低密度，2例密度均匀一致，7例病灶内见裂隙状、小片状非坏死性低密度影，4例病灶内或边缘见簇状、点状、小片状或中央放射状钙化，1例见多发囊变。胸、腹部各有1例伴有纵隔及后腹膜多发小淋巴结，且腹部病例伴有肝脾肿大。另有1例合并副肿瘤性天疱疮；胸部LCD动脉期平均强化幅度90～130HU；腹部LCD动脉期平均强化幅度50～80HU，其中1例静脉期强化程度最高，余腹部病例静脉期及延迟期强化程度呈逐渐下降趋势。2例行MRI平扫及增强扫描，胸、腹部各l例，病灶呈等或稍长T1、长T2信号，T2抑脂序列呈明显高信号，增强后病灶动脉期明显强化，静脉期及延迟期强化程度下降。结论：LCD的影像学表现具有一定的特征性，结合临床症状，可以提示该病可能，确诊依赖于手术和病理。

Objective：To analyze the imaging features of focal Castleman disease in abdomen and thorax. Methods：All 12 focal Castleman disease patients （3 males, 9 females） were performed CT and MRI scans and proved by pathology. 6 were located in thorax cavity,other 6 cases located in abdominal cavity. Results： 11 of them were hyaline vascular type and one case was plasma cell type. Ten patients underwent plain and enhancement CT scanning （five patients each in thorax and abdomen）. On plain CT the lesions showed iso or slight hypodensity. Of them 2 cases presentel homogeneous, 7 cases cracked or patchy nonneerotic low attenuation areas. 4 cases showed calcification, 1 case cystic regions. 2 cases coupled with multiple small lymph nodes, 1 case accompanied with paraneoplastie pemphigus. The thoracic lesions enhanced intensively in arterial phase and CT values increased about 90~130HU,while abdominal lesions increased about 50~80HU. One abdomi hal lesion enhanced most intensively in venous phase,while the enhancement in other abdominal lesions decreased in venous and delayed phases. Two patients underwent plain and enhancement MR scanning （one patients each in thorax and abdo men）. Iso-or low T1 and high T2 signal were observed on MRI, and the lesions enhanced intensively in arterial phase, and less and less in venous and delayed phase. Conclusion： Imaging features may be helpful for the diagnosis of focal Castleman＇s disease,while the diagnosis usually confirmed by operation and pathology.