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6例肝脏结节/肿块型淋巴瘤患者的CT诊断及鉴别
CT diagnosis and differentiation of nodular/mass-type hepatic lymphoma
文章发布日期:2017年07月07日  来源:  作者:杜晓峰,马周鹏,林观生,等  点击次数:394次  下载次数:40次

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【摘要】:目的 分析肝脏结节/肿块型淋巴瘤的CT表现,以期提高其诊断水平。方法 回顾性分析2008年12月-2016年4月上海市金山区中西医结合医院和温州医科大学附属慈溪医院诊治的6例经病理或临床治疗证实的肝脏结节/肿块型淋巴瘤患者的CT资料。主要观察病灶的部位、数目、形态、大小、边界及平扫密度特点,动态增强的强化特征,内部及周边结构的改变,体表、腹腔/腹膜后有无积液及肿大淋巴结等。结果 6例患者中,2例肝脏原发性淋巴瘤均表现为肝内单发结节;4例继发性淋巴瘤中1例表现为单发结节,3例表现为多个大小不等的结节及肿块。共15个病灶,病灶最大直径为17~108 mm。5例病灶边界较清晰,1例病灶边界较模糊。CT平扫示4例病灶呈较均匀较低密度(平均CT值为29.8~41.4 Hu),其余2例病灶密度不均匀,外周为较低密度(平均CT值为26.7~39.6 Hu),中央见片状低密度区(平均CT值为16.5~27.8 Hu)。CT增强扫描动脉期及门静脉期6例均呈轻-中度持续强化,弱于正常肝脏组织呈较低密度,以门静脉期强化相对明显(平均CT值为45.6~63.9 Hu);延迟期强化均减弱,呈较低密度。4例病灶呈较均匀强化,2例平扫密度不均匀者呈周边强化,中央见斑片未强化区域。5例患者肿瘤内可见“血管漂浮征”。所有患者肿瘤均未见钙化。2例见病灶上游胆管局限稍增宽,4例见浅表及腹腔/腹膜后肿大淋巴结,1例继发性淋巴瘤见脾脏浸润。结论 肝脏结节/肿块型淋巴瘤虽然罕见,但其表现有一定特征,CT对其诊断及鉴别具有较大价值。
【Abstract】:Objective To investigate the CT findings of nodular/mass-type hepatic lymphoma, and to improve its diagnostic level. Methods A retrospective analysis was performed for the CT findings of 6 patients with nodular/mass-type hepatic lymphoma confirmed by pathology or clinical treatment who were diagnosed and treated in Integrated Traditional Chinese and Western Medical Hospital of Jinshan District and Cixi Hospital Affiliated to Wenzhou Medical University from December 2008 to April 2016. The CT findings were closely observed in terms of tumor location, number, morphology, size, boundary, and features of density, features of dynamic enhancement, changes in internal and surrounding structures, and the presence or absence of dropsy and lymph node enlargement in the body surface, the abdominal cavity, or the retroperitoneal part. Results Of all patients, 2 had primary lymphoma manifesting as a solitary nodule in the liver and 4 had secondary lymphoma, among whom 1 had a solitary nodule and 3 had multiple nodules and masses with different sizes. There were 15 lesions in total, and the maximum diameter ranged from 17 to 108 mm. Five lesions had clear boundaries and 1 had obscure boundary. CT scan showed that 4 patients had homogeneous low-density lesions (mean CT value=29.8-41.4 Hu), and 2 had inhomogeneous low-density lesions, with low density in the peripheral region (mean CT value=26.7-39.6 Hu) and patchy low-density areas in the central region (mean CT value=16.5-27.8 Hu). Contrast-enhanced CT scan in arterial phase and portal venous phase showed that all 6 patients had mild-to-moderate continuous enhancement, which was weaker than normal liver tissues, with relatively obvious enhancement in portal venous phase (mean CT value=45.6-63.9 Hu). There was a reduction in enhancement in delay phase with low density. Of all patients, 4 had homogeneous enhancement, and 2 had inhomogeneous-density lesions on plain CT scan, with peripheral enhancement and patchy non-enhanced areas in the central region. Five patients had “vessel floating sign” inside the tumor. Calcification was not seen in any patient. Of all patients, 2 had slight local broadening of the upstream bile duct, 4 had superficial and abdominal cavity/retroperitoneal lymph node enlargement, and 1 had secondary lymphoma with spleen invasion. Conclusion Although nodular/mass-type hepatic lymphoma is rare, it has its own features. CT has a high value in the diagnosis and differentiation of this disease.
【关键字】:肝肿瘤; 淋巴瘤;体层摄影术,X线计算机;诊断,鉴别
【Key words】:liver neoplasms; lymphoma; tomography, X-ray computed; diagnosis, differential
【引证本文】:杜晓峰, 马周鹏, 林观生, 等. 6例肝脏结节/肿块型淋巴瘤患者的CT诊断及鉴别[J]. 临床肝胆病杂志, 2017, 33(8): 1492-1496.

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