肝脏淋巴瘤的超声影像分析

Ultrasound imaging features of hepatic lymphoma

目的探讨肝脏淋巴瘤超声及超声造影图像特征。方法对18例手术及穿刺活检病理证实为肝脏淋巴瘤患者的超声及超声造影图像特征进行回顾性分析。结果 18例肝脏淋巴瘤患者常规超声及超声造影表现:(1)结节型病变6例,常规超声显示肝内单发或多发低回声病灶,边界清晰(2例病灶内出现纤维条索样高回声),2例病灶内可见条状血流信号,4例未见血流信号;3例(5个病灶)超声造影表现为动脉期不同程度快速增强,门脉期快速廓清,延迟期呈低回声;术前超声及超声造影诊断恶性或可疑恶性病变5例;无定性诊断1例,病理均诊断为非霍奇金淋巴瘤。(2)弥漫型病变11例,常规超声显示肝脏弥漫性增大,其中8例回声均匀,3例回声欠均匀;8例肝内血流走行及分布未见异常,3例出现静脉变细或栓塞;术前超声诊断恶性或可疑恶性7例,无定性诊断4例;病理诊断霍奇金淋巴瘤1例,非霍奇金淋巴瘤10例。(3)混合型病变1例,常规超声显示肝脏增大,回声不均,其内见多个片状低回声区,边界模糊,肝内血流走行及分布未见异常,术前超声诊断为恶性或可疑恶性病变,病理诊断为非霍奇金淋巴瘤。(4)肝脾及淋巴结肿大:常规超声显示18例患者中11例肝脾肿大、腹腔及腹膜后淋巴结肿大。结论肝脏淋巴瘤超声声像图有一定特征,结合超声造影表现,可为肝脏淋巴瘤的诊断及鉴别诊断提供重要信息。

Objective To explore the sonographic characteristics and to evaluate its diagnostic value of hepatic lymphoma （HL）. Methods The clinical data and abdominal sonographic ifndings of 18 consecutive patients with histological proven diagnosis of lymphoma with liver involvement were reviewed, including contrast-enhanced ultrasound （CEUS） images. Results The liver sonographic features of 18 HL were differentiated as three types including nodular, diffuse and mixed type. Nodular type showed well-deifned hypoecho lesions in 6 cases with penetrating vascular lfow signals in 2 cases and no vascular lfow signals in 6 cases by color Doppler imaging. In 3 cases by CEUS, all the hepatic focal nodulars showed variable arterial enhancement but wash-out in the portal venous and late phases. For diffuse type cases, hepatomegaly without nodule was showed in 11 cases. Vasular in liver showed normal in 8 cases and abnormal in 3 cases. For mixed type cases, hepatomegaly and multiple ill-deifned hypoechoic lesions with normal vascular in liver were showed in 1 case. Hepatosplenomegaly and abdominal lymphoadenopathies were identiifed in 11 cases. Conclusions The characteristics and the types of sonographic ifndings may be helpful in differentiating HL from other liver lesions.