木村病MRI征象分析
|
摘要
目的:探讨不同部位木村病(KD)的临床和MRI特征。方法:回顾性分析本院14例经病理证实的木村病患者的临床及MRI资料。结果:14例患者外周血嗜酸性粒细胞数均增高,1例骨髓细胞学嗜酸性粒细胞增高,8例伴有皮肤瘙痒症状,1例伴有全身粟粒样红色丘疹。病变单双侧发病各7例,累及头颈部12例(其中累及腮腺区7例,耳后区1例,颌面部2例,眼眶2例)、腹股沟区1例、肘关节1例。病变的MRI表现可分为多发结节型(3例)或弥漫肿大型(11例)。多发结节型:边界清楚,T1WI上呈低或等信号,T2WI上呈稍高或高信号,DWI上呈高信号,增强扫描病变呈明显均匀强化;弥漫肿大型:T1WI上呈稍低或等信号,T2WI上呈混杂稍高信号,DWI上呈不均匀稍高信号,增强扫描病变呈不均匀中度强化。反应性增生的淋巴结均呈明显强化且DWI上呈高信号。结论:DWI和增强扫描在木村病的诊断中可对常规MRI提供重要的补充信息,结合患者的血常规检查和临床症状,可进一步提高诊断准确性。
Objective:To investigate the clinical and MRI features of Kimura disease(KD)at different sites.Methods:The clinical features and MR manifestations of 14 patients with Kimura disease confirmed by pathology in our hospital were analyzed retrospectively.Results:The number of eosinophils in the peripheral blood of 14 patients was increased.One case showed increased eosinophils in bone marrow cells.8 patients had symptom of pruritus,and one patient had miliary red papules.Single and bilateral lesions were found in 7 cases respectively,12 cases were found in the head and neck(7 cases in the parotid gland area,1 case in the posterior area,2 cases in the maxillofacial region,and 2 cases in the orbits),one in the groin area,and one in the elbow joints.MR manifestations of the lesions were divided into two types:multiple nodular(3 cases)and diffuse large(11 cases).The border of the former type was clear,the lesions showed low to equal signal on T1 WI,slightly higher to high signal on T2 WI,high signal on DWI,and uniform enhancement on contrast enhanced scan;diffuse large swollen swabs showed slightly lower to equal signals on T1 WI,mixed slightly higher signals or slightly higher signals on T2 WI,slightly higher signals on DWI,and uneven and moderate enhancement on contrast enhanced scan.All reactive lymph nodes presented significantly enhancement and showed high signal on DWI.Conclusion:The combination of DWI and enhanced MRI scan can effectively complement the routine MR imaging findings of Kimura disease.When combined with blood tests and clinical symptoms,it can further improve the accuracy of the diagnosis.
Objective:To investigate the clinical and MRI features of Kimura disease(KD)at different sites.Methods:The clinical features and MR manifestations of 14 patients with Kimura disease confirmed by pathology in our hospital were analyzed retrospectively.Results:The number of eosinophils in the peripheral blood of 14 patients was increased.One case showed increased eosinophils in bone marrow cells.8 patients had symptom of pruritus,and one patient had miliary red papules.Single and bilateral lesions were found in 7 cases respectively,12 cases were found in the head and neck(7 cases in the parotid gland area,1 case in the posterior area,2 cases in the maxillofacial region,and 2 cases in the orbits),one in the groin area,and one in the elbow joints.MR manifestations of the lesions were divided into two types:multiple nodular(3 cases)and diffuse large(11 cases).The border of the former type was clear,the lesions showed low to equal signal on T1 WI,slightly higher to high signal on T2 WI,high signal on DWI,and uniform enhancement on contrast enhanced scan;diffuse large swollen swabs showed slightly lower to equal signals on T1 WI,mixed slightly higher signals or slightly higher signals on T2 WI,slightly higher signals on DWI,and uneven and moderate enhancement on contrast enhanced scan.All reactive lymph nodes presented significantly enhancement and showed high signal on DWI.Conclusion:The combination of DWI and enhanced MRI scan can effectively complement the routine MR imaging findings of Kimura disease.When combined with blood tests and clinical symptoms,it can further improve the accuracy of the diagnosis.
引文
[1]Abbas S,Jerjes W,Upile T,et al.Treatment of Kimura disease with photodynamic therapy:a case study[J].Photodiagnosis Photodyn Ther,2011,9(1):83-86.
[2]金显宅,张天泽,李树玲,等.嗜伊红细胞增生性淋巴肉芽肿的进一步观察[J].中华外科杂志,1957,5(11):877-879.
[3]Kimura T,Yoshimura S,Ishikawa E.Unusual granulation combined with hyperplastic changes of lymphatic tissue[J].Trans Soc Pathol Jpn,1948,37:179-180.
[4]Park SW,Kim HJ,Sung KJ,et al.Kimura disease:CT and MR imaging findings[J].AJNR,2012,33(4):784-788.
[5]Reed RJ,Terazakis N.Subcutaneous angioblastic lymphoid hyperplasia with eosinophilia(Kimura's disease)[J].Cancer,1972,29(2):489-497.
[6]李安琪,徐坚民.头颈部木村病的CT诊断[J].放射学实践,2014,29(2):159-161.
[7]Chen H,Thompson LD,Aguilera NS,et al.Kimura disease:a clinicopathologic study of 21cases[J].Am J Surg Pathol,2004,28(4):505-513.
[8]Hiroshi Iwai MP,Kaoru Nakae MD,Koshi Ikeda MP,et al.Kimura disease:diagnosis and prognostic factors[J].Otolaryngology Head and Neck Surgery,2007,137(2):306-311.
[9]Park JS,Jin W,Ryu KN,et al.Bilateral asymmetric superficial soft tissue masses with extensive involvement of both upper extremities:demonstration of Kimura's disease by US and MRI[J].Eur Radiol,2009,19(3):781-786.
[10]Gopinathan A,Tan TY.Kimura's disease:imaging patterns on computed tomography[J].Clin Radiol,2009,64(10):994-999.
[11]Takeishi M,Makino Y,Nishioka H,et al.Kimura disease:diagnostic imaging findings and surgical treatment[J].J Craniofac Surg,2007,18(5):1062-1067.
[12]Oguz KK,Ozturk A,Clia A.Magnetic resonance imaging findings in Kimura's disease[J].Neuroradiology,2004,46(10):855-858.
[13]Horikoshi T,Motoori K,Ueda T,et al.Head and neck MRI of Kimura disease[J].Br J Radiol,2011,84(1005):800-804.
[14]Kar IB,Sethi AK.Kimura's disease:report of a case &review of literature[J].Maxillofac Oral Surg,2013,12(1):109-112.
[15]Wang J,Tang Z,Feng X,et al.Preliminary study of diffusionweighted imaging and magnetic resonance spectroscopy imaging in Kimura disease[J].J Craniofac Surg,2014,25(6):2147-2151.
[16]Chung Y,Jee W,Kang Y,et al.Kimura's disease involving a long bone[J].Skeletal Radiol,2010,39(5):495-500.
[17]郭鹏德,燕飞,张青,等.眼眶淋巴瘤累及眼外肌的MRI分析[J].放射学实践,2015,30(3):232-235.
[2]金显宅,张天泽,李树玲,等.嗜伊红细胞增生性淋巴肉芽肿的进一步观察[J].中华外科杂志,1957,5(11):877-879.
[3]Kimura T,Yoshimura S,Ishikawa E.Unusual granulation combined with hyperplastic changes of lymphatic tissue[J].Trans Soc Pathol Jpn,1948,37:179-180.
[4]Park SW,Kim HJ,Sung KJ,et al.Kimura disease:CT and MR imaging findings[J].AJNR,2012,33(4):784-788.
[5]Reed RJ,Terazakis N.Subcutaneous angioblastic lymphoid hyperplasia with eosinophilia(Kimura's disease)[J].Cancer,1972,29(2):489-497.
[6]李安琪,徐坚民.头颈部木村病的CT诊断[J].放射学实践,2014,29(2):159-161.
[7]Chen H,Thompson LD,Aguilera NS,et al.Kimura disease:a clinicopathologic study of 21cases[J].Am J Surg Pathol,2004,28(4):505-513.
[8]Hiroshi Iwai MP,Kaoru Nakae MD,Koshi Ikeda MP,et al.Kimura disease:diagnosis and prognostic factors[J].Otolaryngology Head and Neck Surgery,2007,137(2):306-311.
[9]Park JS,Jin W,Ryu KN,et al.Bilateral asymmetric superficial soft tissue masses with extensive involvement of both upper extremities:demonstration of Kimura's disease by US and MRI[J].Eur Radiol,2009,19(3):781-786.
[10]Gopinathan A,Tan TY.Kimura's disease:imaging patterns on computed tomography[J].Clin Radiol,2009,64(10):994-999.
[11]Takeishi M,Makino Y,Nishioka H,et al.Kimura disease:diagnostic imaging findings and surgical treatment[J].J Craniofac Surg,2007,18(5):1062-1067.
[12]Oguz KK,Ozturk A,Clia A.Magnetic resonance imaging findings in Kimura's disease[J].Neuroradiology,2004,46(10):855-858.
[13]Horikoshi T,Motoori K,Ueda T,et al.Head and neck MRI of Kimura disease[J].Br J Radiol,2011,84(1005):800-804.
[14]Kar IB,Sethi AK.Kimura's disease:report of a case &review of literature[J].Maxillofac Oral Surg,2013,12(1):109-112.
[15]Wang J,Tang Z,Feng X,et al.Preliminary study of diffusionweighted imaging and magnetic resonance spectroscopy imaging in Kimura disease[J].J Craniofac Surg,2014,25(6):2147-2151.
[16]Chung Y,Jee W,Kang Y,et al.Kimura's disease involving a long bone[J].Skeletal Radiol,2010,39(5):495-500.
[17]郭鹏德,燕飞,张青,等.眼眶淋巴瘤累及眼外肌的MRI分析[J].放射学实践,2015,30(3):232-235.