泪腺Mikulicz病的影像学特征分析

Analysis of imaging features of Mikulicz's disease of lacrimal gland

目的探讨泪腺Mikulicz病的CT、MRI表现及鉴别诊断价值。方法选取2018年5月至2022年8月经手术病理证实为泪腺Mikulicz病的15例患者,分析其CT及MRI影像特点。结果15例患者均为双侧泪腺受累,部分患者起初为单侧泪腺受累,后逐渐发展为双侧对称肿大。大部分病变半包绕在眼球周围(眼球形态正常,未因受挤压而变形),沿外直肌长轴生长,部分病变表现为“燕尾征”,边缘光滑。CT表现为等密度,MRI表现为T1加权成像(T1WI)略低或等信号,T2加权成像(T2WI)略高或等信号,弥散加权成像(DWI)和表观扩散系数(ADC)为等信号。10例MRI增强呈较均匀明显强化,其中1例患者有胃淋巴瘤病史,且双侧腮腺受累,腮腺体积轻微增大,弥漫性信号异常。结论泪腺Mikulicz病是一种特发性自身免疫性疾病。眼眶CT和MRI不仅有助于判断病变的受累范围,而且对其性质的判断具有一定的提示意义。Mikulicz病的诊断需要综合考虑临床表现、影像学和血清学检查,以病理结果为最终诊断依据。

Objective To investigate the CT and MRI manifestations and differential diagnosis value of Mikulicz's disease of lacrimal gland.Methods From May 2018 to August 2022,15 patients with Mikulicz's disease of lacrimal gland confirmed by surgery and pathology were selected,and their CT and MRI imaging characteristics were analyzed.Results All 15 patients had bilateral lacrimal gland involvement.Some patients had unilateral lacrimal gland involvement at first,and then gradually developed into bilateral symmetrical enlargement.Most of the lesions were semi-enclosed around the eyeball(the eyeball was normal in shape and did not deform due to compression),and grew along the long axis of the external rectus muscle;some lesions showed"swallow tail sign"with smooth edges.CT showed equal density,MRI showed slightly lower or equal signal on T1-weighted imaging(T1WI),slightly higher or equal signal on T2-weighted imaging(T2WI),and equal signal on diffusion-weighted imaging(DWI)and apparent diffusion coefficient(ADC).MRI enhancement in 10 cases showed uniform and obvious enhancement,of which one patient had a history of gastric lymphoma and bilateral parotid gland involvement,and the volume of the parotid gland increased slightly and the diffuse signal was abnormal.Conclusion Mikulicz's disease of lacrimal gland is an idiopathic autoimmune disease.Orbital CT and MRI can not only help to determine the extent of involvement of the lesion,but also have a certain significance in judging the nature of the lesion.The diagnosis of Mikulicz's disease requires comprehensive consideration of clinical manifestations,imaging and serological examinations,with pathological results as the final diagnosis basis.