腹、盆部巨大淋巴结增生的影像学表现

目的 分析腹、盆部巨大淋巴结增生的影像学表现特点，以期提高对这种少见病的认识。方法 回顾性分析10例经病理证实的腹、盆部巨大淋巴结增生的临床及影像学特点。本组患者年龄18～56岁，平均40岁。其中男7例，女3例。9例位于腹部，1例位于盆腔。4例既有CT也有MRI检查，4例仅有CT检查，2例仅有MRI检查。将影像学结果与临床和病理结果进行对照。结果 10例中局限性9例，弥漫性1例。局限型9例病理诊断均为透明血管型，表现为单发肿块6例，单个较大肿块周围伴有小的子灶3例。CT平扫与肌肉相比呈等密度；动态增强多数病变（5／7例）在动脉期和延迟扫描均持续高度强化，强化程度接近大动脉。MRI平扫与肌肉相比T1WI表现为低信号或等信号，T2WI呈高信号，动态增强扫描病灶的强化方式与CT一致。4例肿块（直径〉5cm）增强扫描内部见裂隙状和放射状的CT低密度区和MRI低信号区，病理证实为较多纤维成分。弥漫型1例为浆细胞型，表现为腹膜后多个软组织结节，轮廓光整，明显强化。结论 腹、盆部Castleman病的影像学表现与病理类型密切相关。局限透明血管型巨大淋巴结增生的特点是单发肿块或单发较大肿块周围伴有小的子灶，强化密度与信号接近大动脉，较大肿块内部增强后可出现裂隙状或放射状CT低密度和MRI低信号区。

Imaging findings of Castleman disease of the abdomen and pelvis

Objective The purpose of this work was to analysis the most suggestive imaging findings of Castleman disease in the abdomen and pelvis and to improve the recognition of this rare disease.(Methods Ten patients) with pathologically proved Castleman disease in the abdomen(n=9) and pelvis((n=1)) were included in this study.Patients were 18-56 yeas old(mean = 40);7 were men and(3 women.) Imaging findings(CT&MRI,n=4;only CT,n=4;only MRI,n=2) were retrospectively reviewed and correlated with clinical and pathologic findings.Results The lesions were divided into localized(n=9) and disseminated(n=1) group.The pathologic subtypes of all 9 cases of localized disease were hyaline vascular type.Imaging findings showed a single large mass in six and a single dominant mass with small satellite nodules in three.On plain CT images,the lesions manifested as homogeneous soft masses,which is isoattenuating to muscle.After intravenous injection of contrast media,most of the masses enhanced sharply(5/7) with the attenuation similar to large arteries at arterial phase and delay scans.On MR imaging,the lesions also were homogenous and had isointense or slightly low signal intensity compared with that of muscle on T_1 weighted images and high signal intensity on T2 weighted images,and showed contrast enhancement in a similar pattern to contrast enhanced CT.After intravenous injection of contrast media,areas of central lower radial attenuation in the mass were noted in 4 cases of large masses(>5 cm) and proved to be fibrotic component pathologically.The pathologic subtypes of 1 cases of disseminated disease was plasma cell type.Imaging findings showed several well-defined nodules lied in the retroperitoneal zone that enhanced sharply with the attenuation similar to large arteries after intravenous injection of contrast media.(Conclusion Imaging) findings of Castleman disease in the abdomen and pelvis are closely associated with its pathology.The most suggestive imaging findings of localized & hyaline vascular type of Castleman disease include a single large mass or a single dominant mass with small satellite nodules,enhanced sharply with the attenuation similar to large arteries and areas of central lower radial attenuation in the large tumor after intravenous injection of contrast media.