宝石CT在原发性肝淋巴瘤中的诊断价值

The value of gemstong CT in the diagnosis of primary liver lymphome

目的:总结原发性肝淋巴瘤CT平扫及三期增强的特点,提高对其影像表现的认识及诊断。方法:回顾性分析经手术或肝脏穿刺活检后病理证实的5例原发性肝淋巴瘤的CT表现。男性4例,女性1例,平均年龄50岁。术前均行CT平扫及三期增强扫描,分析病灶形态、大小、密度、位置及增强特点。结果:平扫5例病灶均为稍低或低密度影,边界清晰3例,边界模糊2例,密度均匀4例,密度不均匀1例,病灶内可见不规则更低密度影,未见钙化及出血灶。增强扫描动脉期4例病灶强化不明显,1例病灶呈轻度强化,门脉期及平衡期4例病灶呈轻至中度强化,强化较均匀,1例强化不明显,1例病灶周边肝实质可见较薄的边缘强化,2例单发肿块内可见肝固有血管穿行,1例单发肿块沿血管浸润,但血管形态相对正常,形成所谓"血管漂浮征"。结论:原发性肝淋巴瘤术前容易误诊,但结合CT平扫、三期增强扫描及临床相关检查,可以提示诊断。

Objective To conclued the plain CT and the three-phase contrast enhancement CT characteristics of primary liver lymphome for improving the realization and diagnosis of CT characteristics. Methods We retrospectively analysed the CT mainfestation of 5 patients(4 male,1 female,with medium age 50 years)with surgery or biopsy proved of primary liver lymphome.All patients were examined with plain CT scaning and contrast-enhanced CT scaning,then analyzed the shape..size、density、place and enhancement characteristics of lesion.Results Unenhanced CT showed slightly low density or low density lesions,clear borders in 3 cases,blur borders in 2 cases,uniform density in 4 cases,uneven density in 1 case.The center can be seen with a lower density shadow,no calcification or bleeding.Enhanced CT showed no evident enhancement(1 case)on the arterial plase,then showed mild-middle enhancement and uniform(4 cases) on portal venous and delayed phase scan, no evident enhancement(1 case),the peripheral liver parenchyma could be seen with thinner edge reinforcement in1 case,hepatic inherent blood vessel could be seen through into two single lesions,a single lesion was infiltrated along the blood vessel so-called 'blood vessel floadting sign'.Conclusion Early diagnose primary liver lymphome before operation is difficult,but it is useful for the diesease diagnosing combined with plain CT scans、three-phase enhancement of CT and clinical informatons.