Castleman病的影像学诊断

目的探讨Castleman病（CD）的CT及MRI影像表现,提高对其的认识。方法回顾性分析8例经手术及穿刺病理证实CD患者的CT及MRI资料,并与病理结果对照分析。结果 8例CD患者中,6例为局灶型,其中5例为透明血管型、1例为浆细胞型;2例为多中心型,均为浆细胞型。CT检查8例,平扫5例病灶表现为密度均匀的软组织肿块,与肌肉相比呈等密度;3例病灶内有小斑片状低密度。3例伴点、条状钙化。CT增强扫描5例透明血管型动脉期显著强化,强化程度接近同层面血管,门静脉期及延迟期持续强化。其中3例平扫斑片状低密度区,增强后2例呈相对低密度改变,1例呈更高密度。3例浆细胞型中等均匀强化。MRI检查4例,均为透明血管型,T1WI病灶呈稍低信号,T2WI呈高信号。其中1例T2WI中央斑片状亮高信号,增强扫描强化方式与CT一致。结论 CD的影像学表现与临床及病理分型密切相关,局灶型病例多为透明血管型,影像学表现具有一定特征;多中心型病理多为浆细胞型,影像学表现无明显特征,确诊依赖组织病理学。

Imaging diagnosis of Castleman disease

Objective To study the CT and MRI manifestations of Castleman disease, and to improve the cognition. Methods The CT and MRI data of 8 cases of Castleman disease proved by operation and pathology were retrospectively analyzed, and the results were compared with pathological findings.Results Among 8 cases, there were 6 cases with focal type Castleman disease, 5 of hyaline vascular type and 1 of plasma cell type. There were 2 cases with multicentric type Castleman disease and they were both plasma cell type. CT examination was performed in 8 cases. The plain scan in 5 cases showed soft tissue masses with homogeneous density, and isodense compared with muscle. The lesions showed small patchy low density in 3 cases. And there were 3 cases with dot and strip calcification. A significant enhancement was shown in 5 cases of hyaline vascular type in arterial phase, with nearly same enhancement level compared with vessels. In portal venous phase and delayed phase the enhancement continued. Among 3 cases with plain patchy low density area, 2 cases showed relatively lower density, and 1 case showed higher density after enhancement. 3 cases of plasma cell type showed moderately homogeneous enhancement. MRI examination was performed in 4 cases of hyaline vascular type. On T1WI the lesions showed slightly low signal intensity, and on T2WI showed high signal intensity. Among them, 1 case showed central bright high patchy signal intensity, and the enhanced pattern was similar with CT.Conclusion The imaging findings of Castleman disease are closely related to its clinical and pathological type. Most of focal type cases are hyaline vascular type, with certain image characteristics. While most of multicentric type cases are plasma cell type without obvious image characteristics, and the diagnosis depends on histopathological findings.