腹腔、腹膜后淋巴结结核与淋巴瘤的多层螺旋CT鉴别诊断

目的明确结核与淋巴瘤累及腹腔、腹膜后淋巴结的多层螺旋CT强化特征及其优势解剖分布.方法淋巴结结核20例和淋巴瘤35例累及腹腔、腹膜后淋巴结,观察受累淋巴结的大小、形态、密度、强化类型和优势解剖分布.结果 95%结核性淋巴结增大呈环状强化,而环状强化在淋巴瘤仅占17.2%.70%结核性淋巴结增大形成"多房样"征象,仅8.6%淋巴瘤增大淋巴结有"多房样"征象.82.9%淋巴瘤呈均匀强化,而均匀强化在结核仅占5%.结核和淋巴瘤更多累及肠系膜、门腔间隙、肝十二指肠韧带、肝胃韧带和腹主动脉周围上部淋巴结.环状强化特征对诊断结核的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为95%、82.9%、87.3%、76%%和96.7%;结合均匀强化和腹主动脉周围下部淋巴结受累指标对诊断淋巴瘤的敏感性、特异性、准确性、阳性预测值和阴性预测值,分别为82.9%、95%、87.3%、96.7%和76%.结论结核与淋巴瘤累及腹腔、腹膜后淋巴结的多层螺旋CT强化类型及优势解剖分布有差异,据此可鉴别两者.

Differentiation between tuberculosis and lymphoma in abdominal lymph nodes: evaluation with contrast-enhanced multi-slice spiral CT

Objective To determine the specific imaging criteria for differentiating tuberculosis from lymphoma in abdominal lymph nodes on contrast-enhanced multi-slice spiral CT. Methods Contrast-enhanced multi-slice spiral CT features in 55 patients with tuberculosis (n=20) and lymphoma (n=35) in abdominal lymph nodes were retrospectively assessed for the size, morphology, density, enhancement pattern and location. Results Ninety-five percent (19/20) of the tuberculosis showed peripheral enhancement, as compared with 17.2% (6/35) of lymphoma. Seventy percent (14/20) of the tuberculosis had a mass of multi-locular appearance compared with 8.6% (3/35) of lymphoma. Homogeneous attenuation was more commonly seen in lymphoma (29/35, 82.9%) than in tuberculosis (1/20, 5%). Tuberculosis and lymphoma often involved lesser omental, mesenteric, anterior pararenal, and upper paraaortic lymph nodes. In the determination of tuberculosis, sensitivity (95%), specificity (82.9%), accuracy (87.3%), positive predictive value (76%) and negative predictive value ((96.7%)) were obtained with peripheral enhancement. The specificity was increasing to 91.4% with multilocular appearance. In the determination of lymphoma using a combination of homogeneous attenuation and lower paraaortic lymph nodes, the outcome was sensitivity (82.9%), specificity (95%), accuracy (87.3%), positive predictive value (96.7%) and negative predictive value (76%). Conclusion The contrast-enhanced pattern and anatomic distribution of lymphadenopathy shown on contrast-enhanced multi-slice spiral CT can be useful in differentiating tuberculosis from lymphoma of abdominal lymph nodes.