CT鉴别异位寂静型嗜铬细胞瘤与局限性巨大淋巴结增生症的价值

CT value of differential diagnosis of ecotopic silent pheochromocytoma from localized Castleman’s disease

目的:探讨腹部异位寂静型嗜铬细胞瘤(PHEO)与局限性巨大淋巴结增生症(LCD)的CT特征及鉴别诊断。方法:回顾性分析经病理证实的20例腹部异位寂静型PHEO和17例LCD患者的CT资料,比较2组的CT特征。结果:2组均腹膜后多见,多为圆形或卵圆形。PHEO组病灶内部囊变/坏死较LCD组多见(P=0.001);2组病灶内部均偶尔可见钙化和血管影,差异均无统计学意义(均P>0.05);PHEO组边界清楚,LCD边界常不清楚,差异有统计学意义(P=0.040);PHEO组病灶外部扩张迂曲血管影及周围子灶均较LCD组少见(均P<0.05)。2名医师测量的最大径、平扫CT值、3期增强扫描CT值的一致性良好(ICC>0.75)。2组最大径差异无统计学意义(P=0.054)。2组病灶的平扫、动脉期、静脉期、延迟期及最高绝对强化CT值差异均无统计学意义(均P>0.05)。2组病灶均常表现为明显强化,差异无统计学意义(P=0.460);PHEO组强化常不均匀,LCD组强化均匀,差异有统计学意义(P=0.003);PHEO组的强化模式为速升缓降型,LCD组为速升平稳型。结论:LCD病灶平扫密度均匀,少囊变/坏死,边界欠清楚,强化均匀,病灶外部有时可见扩张的迂曲血管、子灶,有助于与腹部异位寂静型PHEO鉴别。

Objective:To evaluate CT features and differential diagnosis of abdominal ectopic silent pheochromocytoma(PHEO)and localized giant lymph node hyperplasia(LCD).Methods:Imaging data of 20 cases of abdominal ectopic silent PHEO and 17 cases of LCD were analyzed retrospectively,and the CT features of the two groups were compared.Results:In the two groups,the lesions were mostly found in retroperitoneum and were mostly round and oval.Cystic degeneration/necrosis was more common in PHEO group than that in LCD group(P=0.001).Calcification and vessels were occasionally seen in two groups(P>0.05).The lesion boundary in PHEO group was clear,while that in LCD group was not,and there was a statistical difference(P=0.040).Satellite nodules and enhanced vessels around masses in LCD group were more common than those in PHEO group(P<0.05).The maximum diameter,non-contrast CT value,three-phase enhanced CT value between the two groups were in good agreement with the two radiologists(ICC>0.75).The maximum diameter,CT value in plain scan,aterial,venous and delayed phase and the maximum enhanced CT value had no significant differences between the two groups(all P>0.05).The enhancement in the two groups were obvious with no statistically difference(P=0.460),while that in PHEO group was often heterogeneous and in LCD group was homogeneous,the difference between the two groups was statistically significant(P=0.003).The enhancement pattern in PHEO group was“fast wash-in and slow wash-out”,in LCD group was“fast wash and gradually persistent enhancement”.Conclusions:LCD lesions have uniform density,less cystic degeneration or necrosis,unclear boundary,uniform enhancement in CT images,small satellite nodules and enhanced vessels surrounding lesions around may be helpful for the differential diagnosis.The most suggestive imaging findings of LCD include.Meanwhile the enhancement pattern of“fast wash-in and slow wash-out”in PHEO is different from the fast wash and gradually persistent enhancement in LCD.