目的 探讨脾脏病变的影像表现及鉴别诊断.方法 回顾性分析经手术病理证实的81例脾脏病变的CT和MRI影像征象,包括良性病变63例,恶性病变18例.结果 血管瘤13例,均无早期边缘结节状强化特点,延时3~6 min均匀强化8例,4例于常规2 min三期扫描均误诊.MRI T2trufi序列上血管瘤呈类似肝内血管的较高信号,囊肿呈水样高信号,实性病灶呈稍高信号.1例为窦岸细胞血管瘤呈延时强化,MRI上T2高信号内伴少许斑点状低信号.淋巴瘤9例,呈稍低软组织密度筛孔样轻度强化.淋巴管瘤5例中4例为多房囊状分叶,4例假性囊肿壁钙化,2例真性囊肿无壁.血管肉瘤4例实性成分明显强化,2例伴肝转移.脾脓肿8例,均具有腹痛及发热病史.脾结核4例,脾外结核灶有助于鉴别.脾动脉瘤4例,2例假性动脉瘤见瘤周血肿.13例外伤、梗死及先天异常需注意少见表现.结论 CT增强延时及MRI平扫T2信号对脾脏病变鉴别诊断具有重要意义.%Objective To study imaging signs and differential diagnosis of the splenic lesions. Methods CT and MR imaging characteristics of splenic lesions(benign in 63 and malignant in 18) proved by pathology in 81 cases were analyzed retrospectively. Results There were 13 cases with hemangiomas,the lesions had no nodular enhancement at the edges of the lesions in early phase, but homogeneous enhancement in 8 cases delayed 3 - 6 minutes, the other 4 cases were misdiagnosed with delayed two minutes after intravenous administration of contrast medium. On MRI T2 trufi sequence, hemangiomas were hyperintense which were similar to that of the intrahepatic vessels, cysts were watery-like high signal but the solid parts were slightly high signal. 1 case of littoral cell angioma was delayed enhancement and high signal intensity with a little patch of low signal on T2 WI. Lymphomas in 9 cases, the lesions were slightly lower soft tissue-like dense and sieve-like enhanced. Lymphangiomas in 5 cases, the lesions were multilocular cystic and lobulated in 4 cases, calcification in the false cyst walls in 4 cases and true cyst walls in 2 cases was seen. Angiosarcomas in 4 cases were significantly enhanced in solid ingredients and 2 cases with liver metastasis. Splenic abscesses in 8 cases, all cases had history of abdominal pain and fever. Splenic tuberculosis in 4 cases, extra-splenic tuberculosis was helpful in differentiating diagnosis. Splenic aneurysm in 4 cases, of which 2 cases were false aneurysm with peritumoral hematomas. There were splenic trauma, infarction and congenital abnormalities in 13 cases. Conclusion For splenic lesions, delayed-enhanced CT scan and MRI T2 signal are important in differentiating diagnosis.
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