以多发结节、肿块为特征的腮腺嗜酸性淋巴肉芽肿的多层螺旋CT诊断

Diagnosis of Parotid Eosinophilic Lymphogranuloma Characterized by Multiple Nodules and Masses by Using Multi-slice Spiral CT

目的探讨结节、肿块型腮腺嗜酸性淋巴肉芽肿的临床及多层螺旋CT(MSCT)特征,以提高对本病的认知。资料与方法回顾性分析2007年6月-2016年3月于重庆市九龙坡区中医院经手术病理证实的6例结节、肿块型嗜酸性淋巴肉芽肿患者的临床及影像学资料,并选取32例同期经手术病理证实的Warthin瘤患者。所有患者均行MSCT平扫+增强扫描,比较两组患者的临床及MSCT特征。结果嗜酸性淋巴肉芽肿患者年龄均≤50岁。与Warthin瘤患者比较,嗜酸性淋巴肉芽肿患者外周血嗜酸性粒细胞绝对值及比例和血清IgE水平均增高,差异有统计学意义(P<0.01)。与Warthin瘤患者比较,嗜酸性淋巴肉芽肿患者常伴随同侧腮腺肿大、颈深筋膜增厚、边缘模糊、病灶囊变少及颈部淋巴结肿大。嗜酸性淋巴肉芽肿患者增强扫描呈延迟强化,静脉期及延迟期强化明显;Warthin瘤患者动脉期明显强化,延迟期排空。结论结节、肿块型嗜酸性淋巴肉芽肿患者MSCT表现具有炎性病变特征,肿块密度相对均匀,且呈延迟强化改变。结合临床及实验室检查有助于与Warthin瘤鉴别。

Purpose To explore the clinical features and multi-slice spiral CT（MSCT） imaging characteristics of nodule-type and mass-type parotid eosinophilic lymphogranuloma, in order to improve the understanding of the disease. Materials and Methods The clinical and imaging data of 6 patients with nodule-type or mass-type parotid eosinophilic lymphogranuloma confirmed by surgery pathology in Chongqing Jiulongpo Chinese Medicine Hospital from June 2007 to March 2016（experimental group） were retrospectively analyzed. Another 32 synchronous patients with Warthin tumor confirmed by surgery pathology were enrolled as the control group. MSCT conventional and enhanced scanning were performed on all these patients, and the clinical features and MSCT characteristics were compared between the two groups. Results Compared with patients with Warthin tumor, the value and percentage of peripheral eosinophil and serum IgE level increased in all the 6 patients（age ≤ 50） with eosinophilic lymphogranuloma, and the difference was statistically significant（P0.01）. Compared with Warthin tumor, eosinophilic lymphogranuloma was often accompanied by ipsilateral parotid enlargement, neck deep fascia thickening and edge blurring, lesions reducing, and neck lymph node enlargement. The enhanced scanning of eosinophilic lymphogranuloma showed delayed enhancement, and the enhancement in venous phase and delayed-phase was significant; while Warthin tumor showed significant enhancement in arterial phase and contrast clearing features in delayed-phase. Conclusion The MSCT findings of eosinophilic lymphogranuloma characterized by nodules or masses shows features of inflammatory lesions, in which mass density is relatively uniform and presents delayed enhancement. Combining clinical manifestation with laboratory tests will contribute to distinguish eosinophilic lymphogranuloma and Warthin tumor.