纵隔内霍奇金淋巴瘤的多层螺旋CT诊断与鉴别分析

Multislice CT diagnosis and differential analysis of mediastinal Hodgkin’s lymphoma

目的探讨多层螺旋CT对纵隔内霍奇金淋巴瘤的诊断与鉴别价值。方法回顾性分析26例经穿刺活检或手术病理证实为淋巴瘤、组织病理学检测证实为霍奇金淋巴瘤患者的临床资料,对患者进行多层螺旋CT(MSCT)扫描并分析影像学资料,观察淋巴瘤位置、大小、形态和密度等,与病理学结果进行比较。结果6例(23.08%,6/26)患者为单发淋巴结肿大,其中分布在血管前间隙5例,位于气管旁1例;20例(76.92%,20/26)患者为多发淋巴结肿大,在血管前间隙和气管旁均有分布,并且有7例患者病变延伸至气管隆突及两侧肺门处。7例(26.92%,7/26)患者的肿大淋巴结全部融合,其余患者的淋巴结边缘形态多为圆形或椭圆形;多发淋巴结肿大融合患者14例(53.85%,14/26),多层螺旋CT图像中表现为分叶状或波浪状不规则软组织肿块特点,各淋巴结之间的界限部分清楚。淋巴结密度比较均匀,其中软组织和病灶处的造影密度略低,没有发现明显的坏死病灶和钙化;增强扫描结果显示,23例(88.46%,23/26)患者有轻度均匀强化,2例(7.69%,2/26)患者出现中心坏死区,1例(3.85%,1/26)患者出现环形强化。20例(76.92%,20/26)患者出现血管、器官移位,气管旁尤其是血管前间隙可见明显增大的淋巴结,且气管、食管后移,脂肪间隙消失;其余6例(23.08%,6/26)患者血管未移位,血管残留在肿瘤内,并且增强后的图像显示血管被包绕。4例(15.38%,4/26)患者出现胸骨和肋骨前段骨质破坏,5例(19.23%,5/26)患者出现胸壁软组织包块,3例(11.54%,3/26)患者出现心包积液。多层螺旋CT诊断纵隔内霍奇金淋巴瘤的准确率为88.46%(23/26),3例(11.54%,3/26)患者被误诊为纵隔内胸腺瘤。结论多层螺旋CT扫描在纵隔内霍奇金淋巴瘤的诊断中准确率较高,能有效避免误诊和漏诊,可作为纵隔内霍奇金淋巴瘤诊断、鉴别的重要手段,值得在临床推广。

Objective To discuss the diagnosis and differential value of multislice CT for mediastinal Hodgkin’s lymphoma.Methods The clinical data of 26 patients with lymphoma confirmed by puncture biopsy or surgical pathology,and Hodgkin’s lymphoma confirmed by histopathological examination.The patients were scanned with multislice CT(MSCT)and the imaging data were analyzed.The location,size,morphology and density of lymphoma were observed and compared with pathological results.Results 6 patients(23.08%,6/26)had a single lymphadenopathy,of which 5 cases were located in the anterior space of the blood vessel and 1 case was located near the trachea;20 patients(76.92%,20/26)had multiple lymphadenopathy,which was distributed in the anterior vascular space and around the trachea,and the lesions extended to the trachea and the hilars on both sides in 7 patients.The enlarged lymph nodes in 7 patients(26.92%,7/26)were all fused,and the lymph node edges in the remaining patients were mostly round or oval.There were 14 patients(53.85%,14/26)with multiple lymphadenopathy and fusion.The multi-slice spiral CT images showed irregular soft tissue masses with lobulated or wavy features,and the boundary between the lymph nodes was clear.The density of lymph nodes is relatively uniform.The contrast density of soft tissues and lesions is slightly lower,and no obvious necrotic lesions and calcifications are found.The results of enhanced scanning showed that 23 patients(88.46%,23/26)had mild homogeneous enhancement,2 patients(7.69%,2/26)had central necrosis area,and 1 patient(3.85%,1/26)had circular enhancement.Vascular and organ displacement occurred in 20 patients(76.92%,20/26).Significantly increased lymph nodes were observed near the trachea,especially in the anterior space of the blood vessel,and the trachea and esophagus moved backward,and the fat gap disappeared.The blood vessels were not displaced in the other 6 cases(23.08%,6/26),with blood vessels remained in the tumor,and the enhanced image showed that the blood vessels were surrounded.Bone destruction of the sternum and anterior ribs occurred in 4 cases(15.38%,4/26),thoracic wall soft tissue mass in 5 cases(19.23%,5/26),and pericardium effusion in 3 cases(11.54%,3/26).The accuracy of multislice CT in the diagnosis of mediastinal Hodgkin’s lymphoma was 88.46%(23/26),and 3 patients(11.54%,3/26)were misdiagnosed as mediastinal thymoma.Conclusion Multislice CT has a high accuracy in the diagnosis of mediastinal Hodgkin’s lymphoma,which can effectively avoid misdiagnosis and missed diagnosis.It can be used as an important means of diagnosis and differentiation of mediastinal Hodgkin’s lymphoma,and it is worth popularizing in clinical practice.