脾脏肿瘤的CT诊断及鉴别诊断(1)
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[摘要] 目的 分析脾脏肿瘤的CT诊断及鉴别诊断。 方法 回顾性分析23例经手术病理证实的脾脏肿瘤的CT表现，探讨脾脏肿瘤的CT特征。 结果 恶性肿瘤15例(淋巴瘤9例，转移瘤5例，血管肉瘤1例)，表现为脾脏明显肿大，结节多为多发不规则低密度影，边界不清，钙化少见，淋巴结肿大多见。良性肿瘤8例(淋巴管瘤2例，海绵状血管瘤4例，炎性假瘤2例)，病灶多为单发，偶为多发，边界清晰，脾脏肿大多不明显。 结论 对于脾脏肿瘤，CT检查结合临床病史大多可作出定性诊断。
[关键词] 脾脏肿瘤；体层摄影术；X线计算机
[中图分类号] R445.3 [文献标识码] B [文章编号] 1673-9701(2012)06-0098-03
Value of CT in diagnosis and differential diagnosis of splentic tumor
HE Liu1 GAO Yuying2
1.Department of Radiology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110032, China; 2.Department of Radiology, Affiliated Shengjing Hospital of China Medical University, Shenyang 110004, China
[Abstract] Objective To analyze the value of CT in the diagnosis and differential diagnosis of the splentic tumors. Methods All of 23 cases of splentic tumors proved by surgery and pathology were retrospectively studied, CT characteristics of splentic tumors were discussed. Results There were 15 m alignant tumors and 8 benign tumors. Among the m alignant, splenomegaly was showed. Multiple ill-defined lesions with low density and rare calcification and enlargement of lymph nodes were found in m alignant lesions. However, rare splenomegaly was seen in the benign lesions. Well-defined solitary or Multiple lesion with calcifications and with no lymph nodes were showed in benign masses. Conclusion Qualitative diagnosis could be obtained mostly when the CT findings were correlated with the clinical data.
[Key words] Splentic tumor; Tomography; X-ray computed
脾脏肿瘤在临床上比较少见。肿瘤治疗前的方案选择主要依赖于CT检查，本文搜集23例脾脏肿瘤进行回顾性分析，探讨CT对于脾脏肿瘤的诊断价值。
1 资料与方法
1.1 一般资料
收集2006年1月～2010年7月就诊的23例脾脏肿瘤，病例全部经手术病理证实，其中男15例，女8例，年龄24～77岁(平均56岁)，淋巴瘤9例，血管肉瘤1例，转移瘤5例，海绵状血管瘤4例，淋巴管瘤2例，炎性假瘤2例。
1.2 检查方法
所有病例均行CT平扫及增强扫描。CT扫描机为Philips Sensation 64，扫描层厚3 mm，扫描范围为膈顶至肾下极，增强扫描造影剂为欧乃派克80～100 mL(注射流率2.5 mL/s)，开始注射后分别于25 s、60 s及180 s行动脉期、门脉期及延迟期扫描。
2 结果
2.1 脾脏恶性肿瘤
2.1.1 淋巴瘤 9例，年龄51～72岁，男女比例为7/2，平扫可见8例脾脏明显增大，形态不整(封三图4)，另1例脾脏未见明显增大，仅局部轮廓轻度外凸；8例均可见脾脏内单发或多发低密度影，边界不清，1例未见明显异常密度改变，增强扫描可见脾脏内未强化影；4例可见腹膜后或脾门旁淋巴结肿大，1例病变内可见索条状钙化影，左肾动脉受侵1例，肝脏内多发小结节状低密度影1例。临床表现为偶然发现上腹部肿块，上腹部不适，进行性消瘦伴低热，腋下及颈部淋巴结肿大。
2.1.2 血管肉瘤 1例，脾脏增大，可见多发大小不等类圆形低密度影，增强扫描可见病灶强化方式各异(封三图5)。
2.1.3 转移瘤 共5例，平扫脾脏增大，可见多发低密度影，形态规则或不整，边缘模糊，增强扫描1例不均匀强化，2例中心可见更低密度影 ......
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