纵隔巨淋巴细胞增生症的多层螺旋CT诊断

Multi slice CT diagnosis of giant cell hyperplasia in mediastinum

目的探讨纵隔巨淋巴细胞增生症的多层螺旋C T表现及病理基础,以期能提高对此类病变的诊断认识.方法回顾性分析2003至2013年江苏省苏北人民医院经手术病理证实的20例纵隔巨淋巴细胞增生症的CT表现.主要观察病变的大小、包膜、密度、强化等特点.结果本组2 0 例纵隔巨淋巴细胞增生,病变直径（长径）大小2. 9-5. 2 cm,其中3 例病灶直径〉5 cm.病灶均呈实性,未见坏死、囊变、出血密度;1 0 例可见点状、沙粒状小钙化; 瘤体均有包膜, 呈膨胀性生长,压迫邻近血管、心脏及肺组织结构,但未见浸润、破坏及转移征象.增强扫描1 6 例瘤体呈明显血管样均匀强化,4 例呈中度强化,动脉期C T 值83 - 151 （126. 0 ± 9. 9） HU,静脉期持续强化,C T 值101 - 183（146.0 ±11. 3）H U .结论纵隔巨淋巴细胞增生CT表现为实性肿块,有完整薄膜, 坏死囊变罕见,可见沙粒状小钙化,增强扫描血管样强化具有一定的特点,可为临床诊断提供帮助.

Objective To investigate the multi slice CT( MSCT) findings and pathological basis of giant cell hyperplasia in mediastinum,in order to improving the diagnosis of the disease. Methods The CT findings of 20 patients with giant cell hyperplasia in mediastinum confirmed by surgery and pathology from2003 to 2013 in Northern Jiangsu People' s Hospital were retrospectively analyzed. Tumor size,capsule,density and enhancement pattern were assessed. Results The tumor diameters of the 20 cases of giant cell hyperplasia in mediastinum were 2. 9 to 5. 2 cm( length) and 3 cases diameters were > 5 cm. All lesions were solid,with no necrosis,cystic degeneration and hemorrhage. Ten cases had punctuate and tophaceous calcification. All lesions had a clear boundary( capsule sign),showing expansive growth,compression of adjacent vessels,heart and lung structures,but had no invasion,destruction and transfer. On enhanced CT scan,16 cases showed obvious homogeneous vascular enhancement,and 4 cases showed moderate enhancement. The CT values in arterial phase were 83-151( 126. 0 ± 9. 9) HU,and 101-183( 146. 0 ± 11. 3)HU in venous phase. Conclusions Mediastinal giant lymphoproliferation tends to be a solid mass,rare cystic necrosis and hemorrhage,had intact capsule and visible sand granular small calcification. After enhancement,vascular enhancement is the certain characteristic. These findings can help improve clinical diagnosis.