脾切除术后意外脾种植的影像学表现

The imaging findings of unexpected splenic autotransplantation after splenectomy

目的探讨脾切除术后意外脾种植的影像学表现，提高其诊断正确率。方法回顾性分析我院10例经手术病理或穿刺活检证实的脾种植患者的影像资料，结合文献探讨其影像特点。10例中7例行CT及MRI平扫、动态增强，其中2例还行99mTc-DRBC扫描；另外3例仅行CT平扫、动态增强。结果（1）7例患者表现为多发结节，3例表现为单发结节，其形态多为圆形、卵圆形。9例脾窝内见结节，4例胰尾部见结节，2例右肝部见结节，2例腹腔其他部位见结节。结节大小不等，94．6％结节最大直径小于3cm；（2）CT及MRI表现：均为均匀软组织密度结节，无囊变、坏死及钙化；1例胰尾结节呈稍短T1短他信号，其余呈长T1长他信号，信号均匀，轮廊均清晰光整。1例肝右后叶结节，CT动脉期可见腹主动脉发出的供血血管，结节周围有薄层低密度环，呈长T1长T2信号。CT及MRI强化特点相似，动脉期不均匀或均匀明显强化，门静脉期持续均匀强化，延迟期强化程度明显减退；（3）18F-FDGPET显像：腹腔多发结节明显放射性浓聚。结论影像学发现腹腔内多发结节，密度或信号均匀，轮廓清晰光整，强化特点与脾脏一致。结合脾外伤或脾切除的病史，应考虑到脾种植的可能。99mTc-DRBC扫描有助于明确诊断。

Objective To study the imaging findings of unexpected splenic autotransplantation after spienectomy and to improve diagnostic accuracy of splenic autotransplantation. Methods The findings of 10 pa- tients with splenic autotransplantation confirmed by histology in our hospital were retrospectively reviewed. In 7 patients CT and plain and dynamic enhanced MRI scanning were carried out, and in 2 of them 99mTc-DRBC scanning were also done. In 3 patients, plain and dynamic enhanced CT scannings were done. Results （ 1 ） Multiple lesions were detected in 7 patients and a single lesion in 3 patients. The masses were round and oval. The nodules were in the splenic fossa in 9 patients, in the pancreatic tail in 4 patients, in the right liver in 2 pa- tients and in other of parts of the abdominal cavity in 2 patients. These nodules varied in size and 94. 6% showed a maximum diameter of less than 3 cm ; （2） The findings on CT and MR ： all the nodules were homoge- neous with soft tissue density. There was no cystic degeneration, necrosis and calcification. In one patient with a nodule in the pancreatic tail, there was a slightly short T1 and short T2 signals. Other nodules showed long TI and long T2 signals. All the signals from the nodules were homogeneous and their outlines were clear. In a pa- tient with a nodule in the right liver, the blood supply came from the abdominal aorta. There was a surrounding thin layer of low-density ring which showed long T1 and long T2 signals. The enhanced features on CT and MR were similar. The nodules showed homogeneous or inhomogeneous enhancement in the arterial phase, with con- tinuous homogeneous enhancement in the portal venous phase, with an obvious decline in the delayed phase; （ 3 ） The findings of is F-FDG PET ： The nodules had obvious increase in FDG uptake. Conclusions In patients with a history of splenic trauma or splenectomy, abdominal nodules with multiple, homogeneous density or sig- nal, clear outline, enhanced features similar to spleen, splenic autotransplantation should be considered. 99mTc- DRBC scanning is helpful in the diagnosis of splenic autotransplantation.