原发性肝脏淋巴瘤CT表现特征

CT features of primary hepatic lymphoma

目的探讨原发性肝脏淋巴瘤CT表现特点,以提高诊断的准确性。方法回顾性分析2008年9月至2018年9月温州医科大学附属乐清医院、浙江省温州市人民医院和温州医科大学附属第一医院经手术及病理学检查证实的11例原发性肝脏淋巴瘤患者的临床、CT和病理学表现。结果11例患者中,肿瘤位于肝右叶7例,肝左叶2例,肝左右叶2例;共有27个肿瘤,瘤体最大直径1.7~12.6 cm;肿瘤呈类圆形3例,椭圆形5例,不规则形3例;肿瘤界限清楚8例,不清楚3例。CT平扫为低密度6例,稍低密度3例,等密度2例;密度均匀7例,不均匀4例;CT值26~47(38±5)HU;脾脏转移2例,肋骨转移1例,腹腔和腹膜后淋巴结肿大1例。CT增强扫描病灶无明显强化1例;动脉期见病灶轻中度强化10例,其中门静脉期和延迟期病灶边缘持续环状强化8例,结节状强化2例;动脉期CT值30~68(53.8±11.6)HU,门静脉期CT值52~69(64.3±9.3)HU,延迟期CT值43~64(56.4±6.0)HU。手术完全切除8例,术后复发6例,生存3年5例,生存5年2例;手术未完全切除3例,术后均复发,其中生存3年1例,无生存5年患者。病理诊断:弥漫性大B细胞淋巴瘤10例,T细胞淋巴瘤1例。结论原发性肝脏淋巴瘤的CT检查对肿瘤的定位、定性及辅助临床诊断具有重要的价值。

Objective To investigate the CT features of primary hepatic lymphoma in order to improve the accuracy of diagnosis.Methods The clinical data,CT and pathological findings of 11 patients with primary hepatic lymphoma confirmed by surgery and pathology in Wenzhou Medical University Affiliated Yueqing Hospital,Wenzhou People′s Hospital of Zhejiang Province and the First Affiliated Hospital of Wenzhou Medical College from September 2008 to September 2018 were retrospectively analyzed.Results Among the 11 patients,the tumors were located in the right liver in 7 cases,in the left liver in 2 cases,and in the left and right lobe of the liver in 2 cases;there were 27 tumors with the largest diameter of 1.7 to 12.6 cm;the tumors were round in 3 cases,oval in 5 cases and irregular in 3 cases;the tumor boundary was clear in 8 cases and unclear in 3 cases.CT scan showed low density in 6 cases,slightly low density in 3 cases and equal density in 2 cases;the density was uniform in 7 cases and inhomogeneous in 4 cases;CT value was 26 to 47(38±5)HU;there were 2 cases of splenic metastasis,1 case of rib metastasis and 1 case of abdominal and retroperitoneal lymph node enlargement.CT enhanced scan showed no obvious enhancement in 1 case;in arterial phase,mild to moderate enhancement was seen in 10 cases,including 8 cases of continuous circular enhancement at the edge of the lesions in portal venous phase and delayed phase,and 2 cases with nodular enhancement;the CT value of arterial phase was 30 to 68(53.8±11.6)HU,that of portal venous phase was 52 to 69(64.3±9.3)HU,and that of delayed phase was 43 to 64(56.4±6.0)HU.Eight cases were completely resected,and 6 cases recurred after operation.Five cases survived for 3 years and 2 cases survived for 5 years;3 cases were not completely resected,and all of them recurred after operation.One case survived for 3 years and no patient survived for 5 years.Among them,.Pathological diagnosis was diffuse large B-cell lymphoma in 10 cases and T-cell lymphoma in 1 case.Conclusions CT examination of primary hepatic lymphoma has important value in the localization,qualitative and auxiliary clinical diagnosis of the tumor.