摘要
目的探讨原发性肝脏弥漫大B细胞淋巴瘤(PDLBCLL)的磁共振成像(MRI)影像特点, 提高对该病的诊断水平。方法回顾性分析2015年5月至2021年8月复旦大学附属中山医院及义乌市中心医院经穿刺或手术切除病理证实的15例PDLBCLL患者的临床资料, 其中男性8例, 女性7例, 年龄为(58.3±12.0)岁。13例患者行常规钆喷酸葡胺注射液增强MRI检查, 2例患者行肝胆特异性对比剂钆塞酸二钠注射液增强MRI检查。图像分析包括病灶的数目、部位、大小、形态、平扫信号强度、增强特征等。在表观弥散系数(ADC)图上测量病灶ADC值及周围肝实质ADC值, 采用配对样本t检验比较两者差异。结果 15例PDLBCLL患者中10例为单发, 4例为多发, 1例为弥漫, 动脉期轻度强化, 门静脉早期、门静脉晚期及平衡期缓慢下降, 肝胆特异期均为环形低信号。15例患者的ADC值为(0.826±0.379)×10^(-3)mm^(2)/s, 邻近肝实质ADC值为(1.311±0.236)×10^(-3)mm^(2)/s, 两者差异有统计学意义(P<0.05)。3例病灶信号均匀, 2例病灶内见瘢痕组织, 增强扫描病灶10例呈中度强化, 5例呈轻度强化, 6例病灶内见血管穿行而无受累, 呈"血管漂浮征", 7例见典型"靶征"改变, 7例周围见异常灌注, 2例有胆管受压, 伴病灶周边胆管扩张。结论 PDLBCLL的MRI影像表现具有一定特征性, 病灶边界清, 信号不均, 增强扫描表现为乏血供特点, 大部分伴有坏死, 其中以"血管漂浮征"及"靶征"较具特征性。
Objective To study the magnetic resonance imaging(MRI)features of primary hepatic diffuse large B-cell lymphoma(PDLBCLL)with the aim to improve the diagnosis of this disease.Methods The clinical data of 15 patients with PDLBCLL confirmed by biopsy or surgical resection specimens at Zhongshan Hospital of Fudan University and Yiwu Central Hospital from May 2015 to August 2021 were retrospectively analyzed.There were 8 males and 7 females,aged(58.3±12.0)years old.Thirteen patients underwent conventional Gd-DTPA enhanced MR examinations,and 2 patients underwent hepatobiliary specific contrast agent(Gd-EOB-DTPA)enhanced MR examinations.Image analysis included the number,location,size,shape,signal intensity and enhancement features of the lesions.Apparent diffusion coefficient(ADC)values of lesions and surrounding liver parenchyma were measured on the ADC map,and paired sample t-test was used to compare the differences between the two groups.Results In 15 patients,10 patients had a single,4 had multiple lesions.In 1 patient,there was diffuse,mild enhancement in the arterial phase,slow decrease in the early portal venous,late portal venous and equilibrium phases,and ring low signal signals were detected in the hepatobiliary specific phase.The average ADC value of the 15 patients was(0.826±0.379)×10^(-3)mm^(2)/s,and the average ADC value of the adjacent liver parenchyma was(1.311±0.236)×10^(-3)mm^(2)/s.The difference was significant(P<0.05).Uniform signals were detected in lesions in 3 patients,in the scar tissues of 2 patients,moderate enhancement scan lesions were improved in 10 patients,mild aggrandizement in 5 patients,lesions showing a"floating vessels"sign in 6 patients,lesions showing a typical"target"appearance in 7 patients,abnormal perfusion around the lesion in 7 patients,and compression of bile ducts with perifocal bile duct dilatation in 2 patients.Conclusion The MRI findings of PDLBCLL showed certain characteristics.The lesion boundary was clear and the signal was uneven.Contrast-enhanced scans showed a lack of blood supply,most of which were accompanied by necrosis,and the"vessel floating sign"and"target sign"were characteristic.
作者
陈玲芝
陈伶俐
杨丽
曾蒙苏
王明亮
Chen Lingzhi;Chen Lingli;Yang Li;Zeng Mengsu;Wang Mingliang(Department of Radiology,Yiwu Central Hospital,Yiwu 322000,China;Department of Pathology,Zhong-shan Hospital,Fudan University,Shanghai 200032,China;Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2022年第12期886-890,共5页
Chinese Journal of Hepatobiliary Surgery
基金
上海市临床重点专科项目(shslczdzk03202)。
关键词
肝肿瘤
磁共振成像
弥漫大B细胞淋巴瘤
弥散加权成像
Liver neoplasms
Magnetic resonance imaging
Diffuse large B cell lymphoma
Diffusion weighted imaging
