Kimura病的CT、MRI表现

目的 探讨Kimura病的CT、MRI表现,提高该病的术前诊断水平.方法 回顾性分析11例经病理证实的Kimura病患者的临床特征、CT及MRI表现.11例Kimura病患者发生于(或累及)腮腺区7例,颌面部2例,硬腭1例,腹股沟1例(其中3例为异位复发,2例为原位复发).均表现为无痛性肿物,平均病程2年以上;嗜酸性粒细胞均明显增高.结果 CT和MRI表现:5例单发结节,6例多发结节;最小者约6 mm×3 mm,最大者约60 mm ×34 mm;较大结节边界不清楚,较小者边界清楚,邻近脂肪间隙内见条索影浸润,10例颌面部病灶均位于浅筋膜下;CT显示9例密度均匀,稍低于肌肉密度;3例在MR T2WI上呈稍高信号,在T1 WI上呈等或稍低信号;11例肿块呈中度至重度、均匀或不均匀强化;9例肿块(8例颌面部、1例腹股沟)伴有同侧(或双侧)引流区淋巴结肿大,边界清楚,无坏死,无融合,强化明显.结论 Kimura病具有一定的临床和影像特征,结合实验室检查,可以进行正确诊断.     

Kimura病的CT、MRI表现

Objective To study the imaging features of Kimura disease to improve diagnostic ability prior to surgery.Methods The clinical manifestations and CT and MR findings of 11 patients with histologically confirmed Kimura disease were retrospectively analyzed.All 11 tumors originated from (or involved)the parotid region in 7 cases, the maxillofacial region in 2 cases, the palate in one case and the groin in one case.Clinically, the lesions showed asymptomatic tumors with the mean clinical course over 2 years.The increase of cosinophilic granulocyte was found in all 11 cases.Results On CT and MRI,5 patients were single masses and others were muhi-nodular masses.The smallest lesion was 6 mm×3 mm,and the largest lesion was 60 mm × 34 mm.The lesions were almost ill-defined in the subcutaneous tissue,especially 10 locating underlying superficialfascia in head and neck.On CT,the lesions showed homogeneous hypodense to the muscle in 9 patients.The lesions appeared isointeuse signal or slightly hypointense on MR T1WI and slightly hyperinteuse on T2WI in 3 patients.All lesions revealed moderate or marked, and homogeneous or inhomngeneous enhancement.Regional lymph nodes (eight cases in the maxillofacial region and one in the groin) enlarged without necrosis and fusion, and with marked enhancement.Conclusion The clinical and imaging findings of Kimura disease have some characteristics, the diagnosis can be made combined with the laboratory examination.     

头颈部Kimura病的影像表现与临床病理分析

目的:探讨头颈部Kimura病的影像学表现及临床病理特点。方法:回顾性分析7例经病理证实、临床资料完整的Kimura病CT及MR表现。结果:7例患者临床体征均为一侧或两侧颌面部和腮腺区无痛性肿大或肿块,及局部淋巴结肿大,并伴随外周血嗜酸细胞(33%～72%)及免疫球蛋白E(1 500～6 000U/ml)明显升高。CT及MRI表现为双侧腮腺弥漫性增大,内见多发结节,CT呈等低密度,MR T1W呈低信号,T2W及SPAIR呈高信号,CT及MRI增强扫描呈较明显强化,周围脂肪间隙模糊,周围软组织轻度肿胀。颏下、双侧颌下、颈动脉鞘区可见多发肿大淋巴结。镜下可见大量淋巴组织反应性增生,有明显的淋巴滤泡形成,并有大量嗜酸粒细胞浸润形成嗜酸粒细胞性微脓肿。免疫组化示CD20(+)、CD3(+)、CD1(+)、S-100少数细胞散在(+)。结论:头颈部Kimura病的影像学表现有一定的特征性,结合临床及实验室检查,可以提出Kimura病的诊断,但最终诊断须依靠组织病理学。     

颈颌面部Kimura病的CT表现

目的探讨颈颌面部Kimura病(Kimura’s disease,KD)的CT表现,提高对该病的诊断水平。资料与方法回顾性分析7例经病理证实的颈颌面部KD的临床及CT表现。7例患者均为男性,平均年龄30.8岁,病程较长。临床表现为颈颌面部无痛性肿块,所有患者血嗜酸性粒细胞均明显增多。结果 CT上有三种表现:(1)多发结节型3例,位于涎腺或颈部间隙内,表现为多发结节,边界清晰,增强扫描呈明显均匀强化;(2)弥漫肿块型3例,常位于颌面部皮下脂肪间隙内,表现为皮下弥漫性肿块,边界模糊,邻近皮肤增厚,增强扫描呈轻中度不均匀强化;(3)混合型1例,同时具有结节及肿块特点。多数患者(6/7)伴有颈部淋巴结肿大。结论 KD有一定的临床和CT特点,结合实验室检查,可提高对其的诊断准确率。     

颌面部木村病的CT、MRI表现

目的:探讨头颈部木村病的影像表现,以提高对该病的认识及诊断能力。方法:对11例经手术或活检病理证实的头颈部木村病的影像表现进行回顾性分析。结果:本组病例中以中青年患者多见,病史较长,绝大部分伴有嗜酸性粒细胞的升高。10例影像表现为腮腺、耳周或颊面部结节状肿块,病灶清或不清。边界清晰常呈明显强化,边界不清者常呈中度不均匀强化。多伴有颌下及颈部淋巴结肿大,可伴病侧局部皮下脂肪层萎缩。另有1例仅表现颈部多发淋巴结的肿大。结论:头颈部木村病的影像表现有一定特征性,仔细分析其征象并密切结合临床表现,可提示该病的诊断。     

布鲁氏菌性脊柱炎的CT、MRI表现

目的 :探讨布鲁氏菌性脊柱炎的CT及MRI表现,以提高对该病的影像学诊断水平。方法 :收集15例经临床、实验室检查或病理证实的布鲁氏菌性脊柱炎,分析其CT及MRI表现。结果:15例共31个椎体受累,2个椎体病变11例,单个椎体受累2例,多个椎体受累2例,L4椎体受累最多见;CT示病变椎体骨质破坏,主要发生在椎体边缘,表现为小类圆形或斑片状低密度区,慢性期骨破坏区周围可见骨质增生硬化,7例增生的骨质出现部分"虫蚀样"破坏,椎体边缘呈"花边状";11例伴相邻椎间盘破坏,椎间隙变窄;9例出现椎旁脓肿。MRI示椎体破坏区T1WI呈低信号,T2WI及T2WI压脂呈高信号,骨质破坏区由于肉芽组织增生增强扫描呈轻中度强化;周围骨质硬化区T1WI、T2WI均呈低信号。结论 :布鲁氏菌性脊柱炎的CT及MRI表现具有一定特征性,结合流行病学特点及实验室检查能明确诊断。     

不典型脑膜瘤的CT、MRI表现

目的:探讨不典型脑膜瘤的CT、MRI表现,以提高其诊断正确率。方法:经病理证实的15例不典型脑膜瘤,男8例,女7例,年龄11⁷3岁。15例均行CT平扫,11例加行增强扫描;13例行MRI检查,10例行增强扫描。结果:本组15例位于典型部位14例,1例位于脑室内;14例为大、中等肿瘤,1例为小肿瘤;类圆形5例,不规则形6例,分叶状4例;边缘清晰例6例,边缘模糊9例;4例为重度水肿,6例为中度水肿,5例为轻度水肿;5例颅骨骨板增厚、硬化,7例颅骨不同程度骨质破坏,另3例颅板无变化;3例瘤体内密度均匀,12例不均匀,10例CT增强扫描中9例不均匀强化。13例行MRI扫描,其中10例信号不均匀,10例增强扫描中9例不均匀强化;大部分"脑膜尾征"短粗、不规则。结论:不典型脑膜瘤的影像学表现有一定的特征性,根据其CT、MRI的表现,结合临床症状,可提高该病诊断的准确性。     

复杂性肛瘘的CT、MRI表现

目的 :探讨CT、MRI在复杂性肛瘘诊断中的优劣互补性,以为手术提供更详细、准确的资料,避免肛瘘的复发。方法 :对30例无其他肛肠疾病的成年人行MRI和MSCT。结果:30例肛瘘内口在CT和MRI图像上能完全显示;5例微小的瘘管、2例隐藏的小囊肿在CT上完全显现,而MRI未显示;4例在CT图像上能清晰区别瘘管腔和瘘管壁,MRI图像上无法区别;6例MRI清晰显示了肉芽组织的扩张范围,但显示较模糊;3例阻塞的瘘管在MRI图像上显示出来,CT未显示。结论:CT与MRI对复杂性肛瘘的诊断各有优势,两者结合能取长补短,为制订手术方案、一次性根治肛瘘提供更详尽信息。     

软组织滑膜肉瘤的CT、MRI表现

目的：探讨软组织滑膜肉瘤的CT、MRI表现,提高对该病的诊断水平。方法：回顾性分析经手术病理证实18例滑膜肉瘤的临床、影像学资料,其中12例行CT检查,6例行MRI检查,分析其病变大小、部位、密度、强化方式等。结果：18例肿瘤体积均较大,其中下肢15例,上肢2例,胸壁1例。13例较深,11例呈分叶状。CT多表现为等或稍低密度,2例瘤周伴钙化,呈渐进性强化。4例T₁WI呈等或稍低信号,5例T₂WI均以稍高或高信号为主,4例病变内见T₁WI高信号,6例瘤体内见分隔征;3例T₂WI表现为"三重信号"信号,7例均为不均匀明显强化。结论：滑膜肉瘤的影像表现具有一定的特征性,特别是MRI表现,有助于滑膜肉瘤的诊断及鉴别诊断。     

白血病髓外浸润的CT、MRI表现

目的:对比分析白血病髓外浸润的CT、MRI表现,探讨CT、MRI对本病的诊断价值。方法:回顾性分析我院2011年3月至2013年10月16例经病理确诊白血病髓外浸润患者的临床和影像资料,探讨CT、MRI表现特点。结果:16例中,脑内及眼眶浸润4例,脑内病变累及颞叶、额叶、顶叶;单纯肺部浸润2例,累及上叶、下叶;肝脾同时浸润6例,均为肝、脾内多灶性病变;肺肝同时浸润2例;骶椎管内外受累2例。肺部病变为多样性,肝脏病变为弥漫性结节性,骶椎管内外受累病变为骨质破坏并软组织肿块。结论:CT、MRI可充分显示白血病髓外浸润所累及器官,但缺乏特征性,诊断仍需结合临床表现、病史、组织学、免疫生化检查等。     

腹膜后纤维化的CT、MRI表现

目的：研究腹膜后纤维化的ＣＴ、ＭＲＩ表现。方法：本组经临床病理证实病例８例,其中男５例、女３例,平均年龄４８．０岁。特发性６例,非特发性２例。８例全部进行了ＣＴ扫描,其中２例作了强化扫描,１例进行了ＭＲＩ扫描。结果：８例中病变呈弥漫性３例,肿块性５例。ＣＴ平扫可呈低密度、不均匀密度或等密度,增强扫描显示不同程度强化。ＭＲＩ、Ｔ１ＷＩ、Ｔ２ＷＩ呈低信号强度。结论：本病为一种ＣＴ扫描表现多变的少见疾病,如腹膜后出现弥漫或肿块样病变合并肾及输尿管积水时应考虑到本病诊断。     

Kimura's disease: the CT and MRI characteristics in fifteen cases

Objective

To summarize the CT and MRI features in a series of fifteen cases of Kimura's disease.

Materials and methods

The clinical data, CT and MRI findings of 15 patients with histologically proved Kimura's disease were retrospectively reviewed. All imaging data were consensually evaluated by two radiologists to determine the lesion location, number, morphology, margin, signal intensity or CT density, lesion texture, contrast enhancement pattern and involvement of adjacent structures.

Results

There were 14 male and 1 female, with peripheral blood eosinophilia in all 14 patients. 13 patients were presented with a painless mass. 13 patients had lesions located in the head and neck related to the major salivary glands. 1 patient had lesion in groin. Subcutaneous fat diffuse atrophy around the tumor site was found in 11 patients. 9 patients had solitary mass and 6 patients had multiple masses. Most masses were ill-defined, but no specific density or signal patterns were found. Most patients exhibited enlarged or obviously enhanced abnormal lymph nodes but without necrosis.

Conclusion

The characteristic distribution, morphology with enlarged draining lymphadenopathy, combined with the clinical features and laboratory examination enables a confident preoperative diagnosis of Kimura's disease.     

颌面区Kimura病CT和MR诊断

目的探讨CT和MRI对颌面区Kimura病的诊断价值,旨在提高对Kimura病的认识。资料与方法回顾性分析6例经病理证实的腮腺区Kimura病的临床、CT和MRI表现。结果6例Kimura病病程长（平均5．5年）,表现为面部和腮腺区无痛性肿大或肿块（其中1例双侧肿大）,皮肤瘙痒。所有患者血常规嗜酸性粒细胞均明显增多（平均超出正常值约5～6倍）。CT和MRI表现为：（1）单侧或双侧腮腺浅叶弥漫性增大,常有多个结节;（2）累及并侵犯面部皮下组织,邻近皮肤增厚;（3）腮腺周围、颌下周围和颈深上淋巴结增大,增大的淋巴结密度或信号均匀,边界清楚光滑,无坏死、囊变,几乎不融合。结论Kimura病有一定的临床和影像特点,结合实验室检查,术前可以正确诊断。     

颅内血管外皮细胞瘤的MRI／CT影像学表现

目的：探讨颅内血管外皮细胞瘤（hemangiopericytoma,HPC）的影像特征。方法回顾性分析经病理及免疫组织化学证实的16例HPC患者的CT及MRI表现。所有患者均行MR扫描,6例行CT扫描。结果所有病变均为单发病灶,均位于颅内脑外,均为分叶状肿块,15例位于幕上,1例位于幕下。6例CT平扫均呈稍高密度、间杂低密度,均未见钙化,1例邻近颅底骨质呈侵蚀破坏,5例增强扫描均呈明显不均匀强化,并可见明显增粗的血管影,4例可见明显的瘤周水肿带。T1WI以等、低信号、T2WI以低、高混杂信号为主,2例信号均匀、14例信号不均,13例周围有水肿。增强扫描中15例病灶均明显不均匀强化,1例中度强化。2例病灶与硬膜呈宽基底相连,14例为窄基底相连。16例病灶均未出现“脑膜尾征”。DWI中,7例肿瘤呈等低混杂信号为主。MRS中,4例Cho峰明显升高;2例NAA峰及Cr峰降低。结论HPC影像表现具有一定特点,当脑外肿瘤呈分叶状,内部密度不均匀,有囊变坏死,周围骨质无增生硬化,甚至有破坏吸收改变,水肿较严重,肿瘤内未见钙化,侵犯周围脑组织或并发颅外转移时,提示HPC可能性大。     

木村病的影像表现及文献复习

目的 探讨不同部位木村病的CT及MRI表现.方法 收集本院经病理证实19例木村病患者的CT和MRI行回顾性分析,并结合文献讨论.结果 19例木村病中累及头颈部16例、肺内1例、胸壁1例、肝脾受累1例.头颈部木村病CT表现为结节、团块及弥漫性密度异常,平扫与肌肉密度相似,T1WI呈等或稍低信号,T2WI呈高信号,CT和MRI增强扫描多为中度或明显强化.肺内及胸壁木村病表现为软组织肿块,增强扫描肺内病灶呈中度强化,胸壁病灶呈环形强化.肝脾同时受累木村病病灶呈散在结节状轻度强化灶.结论 木村病影像学表现缺乏特征性,需结合实验室检查及病理综合判断.     

Madelung综合征的CT与MRI表现

目的 探讨Madelung综合征的CT与MRI表现特征.方法 搜集5例Madelung综合征患者,5例中Ⅰ型3例,Ⅱ型2例.5例患者均行CT检查,1例行CT增强扫描,2例行MR平扫.分析其临床特点及影像表现.结果 3例Ⅰ型Madelung综合征表现为躯干上部浅层皮下脂肪及颈深层脂肪增多,肿物弥漫分布于颈部、上胸及肩部,呈现"马颈圈"、"牛颈"样特征性表现;2例Ⅱ型表现为四肢近端、前胸壁皮下脂肪明显增厚,呈"大力水手"的特殊外观;5例患者均有腹直肌前方、腹股沟皮下脂肪增厚及阴囊内脂肪堆积.CT显示病变部位浅层皮下脂肪增多,CT值为-30～-70 HU;MR T1WI、T2WI及T2WI脂肪抑制序列均能显示增厚的脂肪组织,呈典型的短T1、长T2信号,在脂肪抑制序列上呈低信号,脂肪组织间有纤维组织分隔.结论 结合长期大量酗酒史,CT与MR检查对Madelung综合征可明确诊断,并明确病变范围及周围组织分界,对手术治疗方案提供有价值的信息.

Abstract：

Objective To determine the CT and MR findings of Madelung syndrome. MethodsFive cases of Madelung syndrome were collected in our hospital from February 2006 to June 2009, including 3 cases of typeⅠMadelung syndrome and 2 cases of typeⅡ Madelung syndrome. The 5 cases were all examined by CT, meanwhile 1 case by CT enhancement scanning and 2 cases by MR. The clinical characteristics and imaging manifestations were analyzed. Results CT and MR images in 3 patients of typeⅠMadelung syndrome displayed fat accumulation within the subcutaneous tissue of the upper trunk and deep layer tissue of neck. The diffuse masses were located around the neck, upper chest and shoulders, which were called "horse collar"and " buffalo humps". The other 2 cases of type Ⅱ Madelung syndrome displayed fat thickening within the subcutaneous tissue of the proximal extremities, anterior chest wall, showing special appearance of "vigorous sailor". All the 5 patients showed fat deposit within the subcutaneous tissue of the anterior rectus abdominis, inguina and fat accumulation within the scrotum. CT showed proliferated fat at the subcutaneous tissue of the involved regions. The CT value of proliferated fat were between -30 and -70 HU. The proliferated fat tissue all could be displayed on MR T1WI,T2WI and T2WI fat suppression sequence, with typical hypointensity on T1WI and hyperintensity on T2WI, hypointensity on fat-suppression sequence and fibrous septation presenting among fat tissue. Conclusion Combination with the history of long-term alcohol abuse, the Madelung syndrome could be diagnosed by CT and MR, which had great value in the surgical planning for identifying the extent of disease.     

原发性肝类癌的CT及MRI表现

目的 探讨原发性肝类癌的CT及MRI表现.方法 回顾性分析2003年12月至2008年11月间11例经手术病理证实的原发性肝类癌患者资料.4例行CT检查,8例行MRI检查,分析其影像表现特征.结果 11例中肿瘤多发2例,表现为2个或2个以上的结节状病灶,其余9例均为单发.CT检查4例患者病灶均表现为平扫边界清楚低密度,中心可见不规则更低密度区;增强后动脉期病灶实质部分不均匀强化,中心更低密度区无强化,门静脉期及延迟期病灶边缘仍轻度强化,强化程度较动脉期减低,中心坏死区始终无强化.MRI 8例患者中7例T_1WI表现为边界清楚的不均匀低信号,T_2WI病灶呈高信号,中心可见不规则低信号;增强后动脉期病灶边缘不均匀强化,病灶中心可见不规则无强化低信号区,门静脉期及延迟期病灶边缘仍轻度强化,边缘显示不清,病灶中心无强化低信号区范围较动脉期缩小.1例患者T_1WI表现为边界清楚的囊状低信号影,囊内可见高信号,T_2WI病灶呈高信号;增强后动脉期病灶边缘不均匀强化,门静脉期及延迟期呈低信号.结论 平扫和动态增强CT扫描及MRI能反映原发性肝类癌的影像特点,具有一定特征性.