腹部局限型Castleman病的超声表现分析

Analysis of ultrasound characteristics of abdominal localized Castleman’s disease

目的:分析腹部局限型Castleman病(Castleman’s disease,CD)的超声声像图特征,以期提高对该病的认识及术前诊断准确率。方法:选择2011年7月-2019年11月于复旦大学附属中山医院行超声检查并经病理学检查确诊为腹部局限型CD的25例患者,其中有3例患者行超声造影(contrast-enhanced ultrasound,CEUS),分析总结其常规灰阶超声及CEUS声像图表现。结果:本组共有25例患者,其中透明血管型17例,浆细胞型7例,混合型1例。病灶为低回声19例,边界清晰23例,形态规则17例,回声欠均匀或不均匀20例。病灶内部有点状及细线状高回声11例,内部有钙化灶13例,其中6例为粗大线状钙化灶,内部有点状、细线状高回声及钙化灶有4例;16例有丰富彩色血流,其中有5例测及淋巴门样血流。3例病灶CEUS相同点为增强早期造影剂均快速进入肿块内部,3例病灶达峰值时表现各不相同,延迟期有2例病灶呈低回声,1例呈稍高回声伴中央小片状始终未增强区。结论:腹部局限型CD常规灰阶超声多表现为回声欠均匀或不均匀、低回声、血供丰富的肿块,肿块内出现点状、细线状高回声或钙化灶,尤其为粗大线状钙化灶和淋巴门样血供为相对特异的超声声像图特征。

Objective:To analyze the ultrasound images characteristics of the abdominal localized Castleman’s disease and improve the recognition and preoperative diagnosis accuracy of this disease.Methods:From Jul.2011 to Nov.2019,the ultrasonic images of 25 patients with abdominal localized Castleman’s disease confirmed by pathological diagnosis,including 3 cases with contrast-enhanced ultrasound(CEUS)were retrospectively evaluated.Tumor characteristics on both gray-scale ultrasound and CEUS were further summarized.Results:There are 25 patients in this group,including 17 cases of clear blood vessel type,7 cases of plasma cell type and 1 case of mixed type.There were 19 cases with low echo,23 cases with clear boundary,17 cases with regular shape,and 20 cases with heterogeneous echo on gray-scale ultrasound.There were 11 cases with point and thin line hyperechoic,13 cases with calcification which including 6 of them were thick line calcification,and 4 cases with both point,thin line hyperechoic and calcification.On color doppler flow imaging(CDFI),rich blood flow was detected in 16 lesions,among which 5 lesions with lymph node portal-like blood supply.On CEUS,all 3 cases showed a fast wash-in pattern in arterial phase.Tumor enhancement degree at peak time was varied.Two lesions in the delay period showed hypoechoic,while the other one showed slightly hyperechoic with a small unenhanced area in the center.Conclusion:The gray-scale ultrasound features of abdominal localized Castleman disease are of heterogeneous hypoecho and abundant blood supply.Point or thin linear hyperechoic septa,calcification especially thick linear calci-fication and lymph node portal-like blood supply are relatively specific ultrasonic features of this disease.