CT和MRI应用于诊断脾种植的临床分析与表现

Clinical Analysis and Findings of CT and MRI in the Diagnosis of Spleen Implantation

目的分析脾种植的CT、MRI影像学特点。方法回顾性分析我院收治的20例腹部脾种植患者的临床资料,患者均接受CT与MRI检查,总结其CT、MRI表现,与病理结果对照。结果 20例脾种植患者,4例位于腹膜后侧,10例位于脾脏,3例位于脾区、胰腺尾部,2例多发脾种植中,14个病灶位于上腹部肠系膜、大网膜区,10个病灶位于肝脏,呈圆形或类圆形,最大直径1.0cm-5.0cm,边缘清晰;CT平扫见稍低密度灶,边缘清晰,增强扫描强化均匀;MRI平扫T1WI序列正相位呈等或稍低信号,反相位信号降低或无变化,T2WI序列均呈等信号、高信号,肝脏脾种植区可见带状等信号,增强扫描动脉期、静脉期均可见非均匀稍高信号,延迟期呈低信号,包膜延迟期呈高信号,肝脏内带状影呈高信号,肠系膜、大网膜三期扫描均呈中等高信号。结论 CT、MRI影像学可作为脾种植诊断的辅助手段,其影像学变化与脾种植病理特点有较强的联系,但对部分影像学无特异性征象的脾种植者,则可配合穿刺活检、核素检查。

Objective To analyze the imaging features of CT and MRI in spleen implantation.Methods The clinical data of 20 patients who underwent abdominal spleen implantation in our hospital were analyzed retrospectively. All patients underwent CT and MRI examination. The CT and MRI findings were summarized and compared with the pathological findings.Results Among the 20 patients with spleen implantation, 4 cases were located in the posterior part of peritoneum, 10 in spleen, 3 cases in spleen and pancreatic tail and 2 cases in multiple spleen implantation. 14 lesions were located in upper abdominal mesenterium and greater omentum area, 10 lesions in the liver, round or quasi-circular and the largest diameter was 1.0cm-5.0cm. The edges were clear; CT plain scan showed slightly low density lesions, compared with normal spleen tissues and the edges were clear. The enhancement at the three phases was homogeneous; MRI scan showed equal or slightly low signal on T1WI sequence positive phase and the antiphase signal decreased or did not change. There were equal signal and high signal on T2WI sequence and banding equal signal in spleen implantation region. Enhanced scan showed inhomogeneous slightly high signal in arterial phase and venous phase, low signal in delayed phase, high signal in envelop delayed phase, high signal in banding shadow in liver. Three-phase scan showed middle high signal in mesenterium and greater omentum. Conclusion CT and MRI imaging can be used as a supplementary means for diagnosis of spleen implantation. The imaging changes and pathological findings of spleen implantation are significantly associated but for some patients whose imaging findings are not specific, biopsy and nuclein examination can be adopted.