摘要
目的：总结腹腔脏器外淋巴管瘤的CT、MRI及18氟氟代脱氧葡萄糖（^18F-FDG）PET/CT检查影像学特征。方法：采用回顾性横断面研究方法。收集2009年1月至2015年12月宁波大学医学院附属医院收治的11例和第二军医大学附属长海医院收治的5例腹腔脏器外淋巴管瘤患者的临床资料。患者行CT、MRI、^18F-FDG PET/CT检查。观察指标：（1）影像学检查情况。（2）CT和MRI检查影像学特征。（3）^ 18F-FDG PET/CT检查影像学特征。（4）治疗及随访情况。全组患者完善术前相关检查后，遵循患者及家属意愿行手术治疗，术后行病理学检查。采用门诊和电话方式进行随访，术后每6～12个月随访1次。随访内容为淋巴管瘤复发情况。随访时间截至2016年7月。结果：（1）影像学检查情况：16例患者中，行CT平扫＋增强扫描检查12例；MRI平扫＋增强扫描检查5例，MRI平扫2例；^18F-FDG PET/CT扫描检查 1例。其中1例同时行CT、MRI和PET/CT检查，2例同时行CT和MRI检查。（2）CT和MRI检查影像学特征：16例患者中，①淋巴管瘤的分型：单房型淋巴管瘤 6例，多房型淋巴管瘤 9例，淋巴管瘤病1例。②淋巴管瘤的部位： 9例淋巴管瘤位于一个区域内（单房型淋巴管瘤6例、多房型淋巴管瘤 3例），7例淋巴管瘤累及2个及以上区域（多房型淋巴管瘤6例、淋巴管瘤病1例）。③淋巴管瘤的直径：16例患者病变直径为4～25 cm，平均直径为12 cm，其中9例淋巴管瘤直径〉10 cm。④淋巴管瘤的形状： 3例淋巴管瘤形态规则，呈类圆形改变；13例淋巴管瘤形态不规则，具有“塑形” 性改变。⑤淋巴管瘤的内部结构：内容物： 12例行CT平扫检查，病变呈液性低密度，密度均匀一致，CT值为-10～19 HU；7例行MRI检查T1加权成像（T1WI）呈低信号、T2加权成像（T2WI）呈高亮信号，信号基本均匀一致。16例患者腹腔脏器外淋巴管瘤内均未见出血。1例淋巴管瘤病患者肝脏病变内因出血呈“液液平面”表现。囊壁及间隔：15例患者淋巴管瘤的囊壁厚度〈2 mm；1例多房型淋巴管瘤囊壁及间隔较厚，部分厚度〉3 mm，呈等密度，T1WI、T2WI等信号。16例患者淋巴管瘤均未见壁结节、钙化。⑥淋巴管瘤的边界：15例患者淋巴管瘤边缘光整，与毗邻组织边界清晰；1例患者多房型淋巴管瘤与毗邻的十二指肠、胰头部及升结肠边界不清晰。⑦淋巴管瘤的毗邻器官关系： 10例患者淋巴管瘤被反挤压而局部内凹，呈弧形压迹、“脐凹”样表现；4例患者淋巴管瘤包绕血管；2例患者淋巴管瘤内部见脂肪密度或信号。16例患者淋巴管瘤均未见包绕肠管，周围均未见肿大淋巴结。⑧淋巴管瘤的强化模式：14例行增强扫描患者中，13例淋巴管瘤囊壁及间隔轻度强化， 1例中度强化；淋巴管瘤内容物均无强化。（3）^18-FDG PET/CT检查影像学表现：1例多房型淋巴管瘤呈^18-FDG不均匀摄取增加，代谢活性略高于肝脏，最大标准摄取值=3.71。（4）治疗及随访情况： 14例患者行单纯淋巴管瘤切除术（6例单房型、8例多房型）；1例多房型淋巴管瘤患者行淋巴管瘤＋十二指肠降部＋胰头部＋升结肠切除术；1例淋巴管瘤病患者因腹腔脏器外病变较小，仅行脾脏切除术。16例患者术后病理学检查结果均确诊为淋巴管瘤。16例淋巴管瘤患者中，13例获得随访，随访时间为6～31个月，中位随访时间为15个月。随访期间，12例患者未复发，疗效满意；1例淋巴管瘤病患者，因复发多次行右肩部腋下、颈胸部淋巴管瘤切除术及硬化治疗。结论：腹腔脏器外淋巴管瘤的影像学表现具有一定特征性，常 表现为多房、“塑形”、液性密度或信号、囊壁及间隔菲薄、边界清晰的较大病变，多房型淋巴管瘤可以摄取^18F-FDG。
Objective：To summarize the computed tomography （CT）, magnetic resonance imaging （MRI） and fluorine18 fluorodeoxy glucose （ ^18F-FDG） positron emission tomography （PET）/CT features of abdominal nonorgani lymphangioma. Methods： The retrospective crosssectional study was conducted. The clinical data of 16 patients with abdominal nonorgani lymphangioma who were admitted to the Affiliated Hospital of Ningbo University （11 patients） and the Changhai Hospital Affiliated to the Second Military Medical University （5 patients） between January 2009 and December 2015 were collected. All the patients received CT, MRI and ^18F-FDG PET/CT examinations. Observation indicators： （1） imaging examinations; （2） imaging features of CT and MRI; （3） imaging features of PET/CT; （4） treatment and followup. Operations were applied to patients based on agreements of patients and families after finishing preoperative examinations, and postoperative pathological examinations were also performed. Followup using outpatient examination and telephone interview was performed once every 6-12 months postoperatively up to July 2016. Results：（1） Imaging examinations： of 16 patients, 12 underwent plan and contrastenhanced CT scans, 5 underwent plan and contrastenhanced MRI scans, 2 underwent plan MRI scans and 1 underwent ^18F-FDG PET/CT scan. One patient underwent simultaneously CT, MRI and ^18F-FDG PET/CT examinations and 2 patients underwent simultaneously CT and MRI examinations. （2） Imaging features of CT and MRI： ① Classification of lymphangioma： unilocular cyst, plurilocular cyst and lymphangiomatosis were detected in 6, 9 and 1 patients, respectively. ② Lymphangioma location： 9 of lymphangioma located in the single regions （6 with unilocular cyst and 3 with plurilocular cyst）, 7 of lymphangioma involved multiple regions （6 with unilocular cyst and 1 with lymphangiomatosis）. ③ Lymphangioma diameter： lesion diameter was 4-25 cm, with an average of 12 cm, and diameter in 9 of lymphangioma was more than 10 cm. ④ Lymphangioma shape： 3 lymphangiomas were regularshaped, showing roundlike changes, and 13 lymphangiomas were irregularshaped, showing ‘moulding’like changes. ⑤ Internal structure of lymphangioma： internal structures in 12 patients undergoing plain CT scans presented as liquid low density, with homogeneous density and -10-19 HU of CT value. MRI scans in 7 patients showed low signal on T1WI and high signal on T2WI, with homogeneous signals. No bleeding was found inside the abdominal nonorgani lymphangiomas of 16 patients. The “fluidfluid level” was detected in 1 patient with lymphangioma due to bleeding in pathological changes of liver. The septa and wall thickness was less than 2 mm in 15 patients with lymphangiomas, and was more than 3 mm in 1 plurilocular cyst lymphangioma, showing a equal density and isointensities on T1WI and T2WI. There was no nodule and calcification in 16 patients. ⑥ Lymphangioma boundary： 15 patients had clear boundary of lymphangioma and 1 had an unclear boundary of lymphangioma. ⑦ Extrusion of adjacent organs： lymphangiomas in 10 patients were local concave, showing arcshaped impression and “hilar depression”, lymphangiomas in 4 patients showed surrounding blood vessels, and fat density or signal inside lymphangioma was found in 2 patients. There were no surrounding intestine and lymph node enlargement in 16 patients. ⑧ Lymphangioma reinforcement： of 14 patients with contrastenhanced scans, septa and wall of lymphangiomas demostrated slight enhancement in 13 patients and moderate enhancement in 1 patient, and all contents showed no enhancement. （3） Imaging features of ^18F-FDG PET/CT： inhomogeneous uptake of FDG was manifested in 1 plurilocular cyst lymphangioma, metabolic activity of the lesion was slightly higher than liver, SUVmax=3.71. （4） Treatment and followup： 14 patients underwent single resection of lymphangioma （6 with unilocular cyst and 8 with plurilocular cyst）; 1 patient with plurilocular cyst lymphangioma underwent resection of lymphangioma, descending part of duodenum, pancreatic head and ascending colon; 1 patient with lymphangioma underwent splenectomy due to smaller lesion. Sixteen patients were confirmed with lymphangioma by postoperative pathological examinations. Of 16 patients, 13 were followed up for 6-31 months, with a median time of 15 months. During the followup, 12 patients had no recurrence, with satisfactory outcomes, and 1 with recurrence of lymphangioma underwent multiple cervical and thoracic resections under right arm and sclerotherapy. Conclusion： Abdominal nonorgani lymphangioma has some imaging characteristics, it usually manifests as a larger mass with plurilocular cyst, “moulding”, liquid density/signal, thin septa and wall and clearly boundary. Plurilocular cyst lymphangioma has uptake of ^18F-FDG.
作者
王小平
张建
王玉涛
丁前江
汪建华
Wang Xiaoping Zhang Jian Wang Yutao Ding Qianjiang Wang Jianhua(Department of Radiology, the Second People＇s Hospital of Beilun, Ningbo 315809, Zhejiang Province, China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2017年第7期752-758,共7页
Chinese Journal of Digestive Surgery
基金
浙江省医药卫生科技计划项目（2014KYB238）
宁波市自然科学基金资助项目（2015 A610201）
浙江省自然科学基金资助项目（LY13H070008）
