腹部局限性透明血管型Castleman病的MDCT表现

MDCT Findings of Abdominal Localized Hyaline-Vascular Type Castleman's Disease

目的探讨腹部局限性透明血管型Castleman病(HV-CD)的MDCT特征性表现。方法回顾性分析经手术病理证实的11例腹部HV-CD患者术前CT平扫及动态增强资料。结果 11例中,9例病变位于腹膜后,2例位于肠系膜。CT平扫:11例均呈软组织密度肿块,平扫CT值为(46±4)HU,部分肿块内部可见斑片样、放射状低密度影及斑点样、树枝样钙化灶。2例局部边界不清。5例周围可见增大的淋巴结。4例周围腹膜局限性增厚。动态增强扫描:9例动脉期、门静脉期明显强化,CT值平均增加(80±14)HU,强化程度接近大动脉,延迟期强化程度退出;2例呈中度强化,且延迟期为著;1例动脉期边缘强化明显;病变内低密度区未强化;11例病变周围均可见供血及引流血管。结论腹部HV-CD的MDCT表现有一定的特征性,尤其是病变内的钙化及强化程度具有诊断价值。

Objective To discuss muhiple detector CT （MDCT） features of abdominal localized hyaline-vascular type Castleman＇s disease. Methods Both preoperative plain and enhanced CT findings of 11 patients with pathologically proved abdominal localized hyaline-vascular type Castleman＇ s disease were retrospectively analyzed. Results Of the 11 patients, the lesions were located at retroperitoneal region in 9 and at mesentery in 2. Plain CT scan showed that the lesion was manifested as a mass of soft tissue density with the CT value of （46 ＋ 4） HU ; patchy or radial low density shadow and mottled, branch-like calcification could be observed within some lesions. The lesion＇ s border was unclear in two patients. Enlarged lymph nodes around the lesion were seen in 5 patients. Localized thickening of peritoneum was found in 4 pa- tients. Dynamic enhanced CT scan revealed obvious enhancement in arterial phase, the mean CT value was increased by （80 ＋ 14） HU, with the enhancement of the lesion being as strong as the enhancement of aorta; and the washout sign ap- peared in delayed phase. Moderate enhancement was seen in two patients, which was more obvious in the delayed phase. Marginal enhancement in arterial phase was observed in one patient, while no enhancement was seen in low-density areas within the lesion. The feeding vessels and draining veins around the lesions were demonstrated in all patients. Conclusion Abdominal localized hyaline-vascular type Castleman＇ s disease has certain CT features. The calcification within the le- sion and the enhancement pattern of the lesion are especially valuable for the diagnosis.