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目的分析腹、盆部局灶型Castleman病(LCD)的MRI特征及误诊原因,提高对该病的诊断水平。方法回顾性分析经手术和病理证实的9例腹、盆部LCD的MRI资料,观察病变部位、形态、边界、MRI信号特点及强化方式,分析LCD的MRI表现及误诊原因。结果 (1)术前误诊5例,2例诊断为副神经节瘤,1例诊断为神经鞘瘤,1例诊断为胰腺神经内分泌肿瘤,1例诊断为富血供肉瘤。(2)7例位于腹膜后,1例位于胰腺体尾部前下方,1例位于盆腔。透明血管型8例,其中1例合并朗格汉斯细胞组织细胞增生症,浆细胞型1例。(3)MRI平扫8例透明血管型LCD表现为境界清楚的圆形或类圆形软组织信号肿块,T_1WI呈等、稍低信号,T_2WI抑脂呈稍高信号(与同层面肌肉相比),其中盆腔1例LCD内合并散在多发粗条状钙化,T_1WI及T_2WI均呈散在多发低信号表现;1例浆细胞型LCD边界模糊,中心为稍短T_1、稍短T_2信号,周边呈稍长T_1、稍长T_2信号。DWI上5例未见弥散受限,4例弥散轻度受限,呈稍高信号。动态增强扫描,8例透明血管型LCD均表现为动脉期中度至明显强化,肿块边缘呈延迟期强化;1例浆细胞型LCD动脉期轻度强化,边缘呈延迟强化,与透明血管型一致。结论腹、盆部LCD的MRI表现具有一定的特征性,但由于相对少见,易误诊,对腹盆部境界清楚的软组织肿块、动脉期明显强化、延迟期边缘强化、弥散无受限或轻度受限者,要考虑到Castleman病的可能性,提高其术前诊断的准确性
Objective To analyze the MRI features and misdiagnosis of focal Castleman disease (LCD) in the abdomen and pelvis and to improve the diagnosis of the disease. Methods The MRI data of 9 cases of abdomen and pelvic LCD confirmed by operation and pathology were retrospectively analyzed. The lesion location, morphology, boundary, features of MRI signal and the intensifying mode were observed. The MRI manifestations and misdiagnosis reasons of LCD were analyzed. Results (1) 5 cases were misdiagnosed before operation, 2 cases were diagnosed as paraganglioma, 1 case was diagnosed as Schwannoma, 1 case was diagnosed as pancreatic neuroendocrine tumors and 1 case was diagnosed as blood rich for sarcoma. (2) Seven cases were located in the retroperitoneum, one in the anterior and posterior of the pancreas, and one in the pelvic cavity. Transparent blood vessels in 8 cases, including 1 case of Langerhans cell histiocytosis, plasma cell type in 1 case. (3) MRI plain 8 cases of clear blood vessel type LCD showed a clear circle or round soft tissue signal mass, T_1WI was equal and slightly lower signal, T_2WI fat slightly higher signal (compared with the same level of muscle) , Including 1 case of pelvic mixed with scattered coarse strip of calcification, T_1WI and T_2WI were scattered in multiple low signal performance; a plasmacytoid LCD boundary fuzzy, the center of slightly shorter T_1, slightly shorter signal T_2, the periphery was slightly longer T_1, slightly longer T_2 signal. DWI on the 5 cases of no diffusion limited, 4 cases of mild diffuse dispersion was slightly higher signal. In 8 cases of clear-vessel type LCD, the arterial phase showed moderate to significant enhancement and the margin of the tumor showed delayed enhancement. One case of plasmacytoid type LCD arteries was mildly enhanced and the margin was delayed enhanced, which was consistent with that of clear blood vessels. Conclusions The MRI findings of the abdominal and pelvic LCDs have some characteristics. However, due to the relatively rare and easily misdiagnosed features of the soft tissue mass in the abdominal pelvic area, the arterial phase is obviously strengthened, the edge of the delayed phase is enhanced, the dispersion is not limited or mild Restricted, to take into account the possibility of Castleman disease, improve the accuracy of its preoperative diagnosis