血液病免疫抑制治疗后播散性白色念珠菌感染的CT表现

CT findings of disseminated candida infection after immunosuppressive therapy for hematological diseases

目的探讨血液病免疫抑制治疗后的播散性白色念珠菌感染的CT表现。方法分析5例经临床和病理活检证实的免疫抑制治疗后播散性白色念珠菌感染的患者并进行文献复习。结果5例均发现肝多发结节病灶,其中2例伴肺部多发结节病灶,1例伴有脾脏及双肾、后腹膜区多发结节病灶。肝脏CT平扫均表现为多发类圆形等或略低密度结节影。增强动脉期表现为结节中心低密度无强化区、周边为高密度强化环,即呈“牛眼征”2例;结节均匀强化2例;结节中心小结节样强化、周边低密度环、外周环状强化1例。所有活动期病灶周围肝实质动脉期均伴有一过性高密度灌注区。门脉期及延迟期病灶边缘仍可见环形强化,强化范围较动脉期缩小2例、呈花环样强化2例、外周强化环消退1例。脾脏和肾脏病灶表现与肝脏类似;肺部结节表现为实性结节或伴空洞。结论血液病免疫抑制治疗后播散性白色念珠菌感染的CT表现有一定特征性,该特征性有助于早期诊断和疗效监测。

Objective To explore the CT findings of disseminated candida infection after immunosuppressive therapy for hematological diseases.Methods Retrospective analysis of 5 patients with liver candida infection after immunosuppressive therapy confirmed by clinical and pathological biopsy and review the literature.Results Multiple nodular lesions in liver are found in 5 cases,2 cases with multiple nodules in the lung,1 case with multiple nodules in the spleen and kidneys.CT scans are characterized by multiple round or similar low-density nodules.The enhancement of arterial phase showed a low-density non-enhancement zone in the center of the nodule,and a high-density enhancement ring in the periphery,which was 2 cases of"bull eye sign";nodular uniform enhancement in 2 cases;1 case has small nodular enhancement of the nodule center,low density around and peripheral ring enhancement.High-density perfusion area has been represented in all hepatic parenchymal arteries around all active lesions.Circular reinforcement can still be seen at the edge of the lesion during the portal and delayed phases,2 cases of enhancement range is smaller than arterial phase,garland-like reinforcement in is found in 2 cases,1 case is decreased.The spleen and kidney lesions behave similarly to the liver,and the lung nodules appear as solid nodules or with cavities.Conclusion Disseminated candida infection after immunosuppressive therapy for hematological diseases has certain pattern on CT imaging,which is helpful for early diagnosis and efficacy monitoring.