淋巴细胞白血病小肠系膜受累的螺旋CT表现

Helical CT Findings of Mesenteric Involvement in Lymphocytic Leukemia

目的:探讨淋巴细胞白血病小肠系膜及其淋巴结受累的螺旋CT表现。方法:回顾性分析经骨髓穿刺、骨髓活检及免疫组化证实的淋巴细胞白血病,其中急性淋巴细胞白血病(ALL)20例和慢性淋巴细胞白血病(CLL)25例。在增强螺旋CT图像上,观察受累淋巴结的大小、形态、密度及解剖分布。结果:30%ALL和72%CLL小肠系膜淋巴结受累,肿大的淋巴结呈普遍均匀强化密度。11例CLL小肠系膜根部淋巴结肿大伴融合,包埋肠系膜血管,呈"三明治征"。5例ALL脾脏增大,14例CLL脾脏增大。1例ALL骨髓侵犯。结论:急性淋巴细胞白血病(ALL)和慢性淋巴细胞白血病(CLL)小肠系膜受累在解剖分布上有差异。当小肠系膜根部受累淋巴结肿大伴融合,呈"三明治征"伴脾脏增大时,应想到CLL的可能。

Purpose： To investigate the helical CT findings of mesenteric and mesenteric lymph nodes involvement in lymphocytic leukemia. Methods： Twenty cases of acute lymphoblastic leukemia （ALL） and 25 cases of chronic lymphocytic leukemia （CLL）, which were confirmed by bone marrow puncture, bone marrow biopsy and immune staining, were retrospectively analyzed. The size, shape, density and anatomical distribution of the involved lymph nodes were observed in enhanced helical CT images. Results： Enlarged lymph nodes, which were with homogeneously enhanced density, were discovered in 30% ALL cases and 72% CLL cases. Eleven cases of CLL were with mesenteric root lymphadenopathy, and the mesenteric vessels were embedded by the fused lymph node forming the sandwich feature. Five cases of ALL and 14 cases of CLL were with splenomegaly. One case of ALL was with bone marrow involvement. Conclusion： Mesenteric involvement are different in the anatomical distribution between acute lymphoblastic leukemia （ALL） and chronic lymphocytic leukemia （CLL）. Spleen enlargement combined with sandwich featured mesenteric root lymph node enlargement may suggest the diagnosis of CLL.