儿童朗格汉斯细胞组织细胞增生症累及肝脏影像学表现
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摘要
目的探讨儿童朗格汉斯细胞组织细胞增生症(LCH)累及肝脏的CT、MRI表现。方法回顾性分析确诊为LCH侵犯肝脏的22例患儿的CT及MRI表现。结果 22例患儿均表现肝脏肿大。20例Glisson鞘增宽及汇管区轨道征、晕征,其中16例CT呈低密度,5例CT增强扫描呈轻、中度强化,4例MRI表现为T2WI高信号,2例MRI增强后轻度强化。14例表现为肝内多发结节,直径约0.51～2.35 cm,其中10例沿门静脉分布、4例呈弥漫性分布;11例CT呈低密度,5例CT增强呈轻、中度强化,3例T1WI呈低信号、T2WI呈高信号,2例MR增强扫描轻度强化,较大结节呈环形强化。8例肝内胆管呈节段性狭窄及不同程度扩张。结论儿童LCH累及肝脏的CT、MRI表现具有一定特征性。
Objective To investigate CT and MRI manifestations of Langerhans cell histiocytosis(LCH) involving the liver in children. Methods CT and MRI findings of 22 children with LCH involving the liver were retrospectively analyzed. Results Hepatomegaly was found in all 22 children, while widening of Glisson sheath and track sign and halo sign of portal area were observed in 20 cases. CT showed low density in 16 cases, 5 cases showed mild to moderate enhancement, and MRI showed high signal intensity in 4 cases and 2 cases showed mild enhancement of T2WI. Fourteen children presented multiple nodules in the liver, with diameters of 0.51—2.35 cm, distributed along the portal vein in 10 cases and diffusely distributed in 4 cases. Among them, CT showed low densities in 11 cases and 5 cases showed mild to moderate enhancement, while T1WI showed low signal intensities and T2WI showed high signal intensities in 3 cases and 2 cases showed mild enhancement. Intrahepatic bile duct alternative stenoses/dilatation were noticed in 8 cases. Conclusion CT and MRI findings of LCH involving the liver in children have certain characteristics.
Objective To investigate CT and MRI manifestations of Langerhans cell histiocytosis(LCH) involving the liver in children. Methods CT and MRI findings of 22 children with LCH involving the liver were retrospectively analyzed. Results Hepatomegaly was found in all 22 children, while widening of Glisson sheath and track sign and halo sign of portal area were observed in 20 cases. CT showed low density in 16 cases, 5 cases showed mild to moderate enhancement, and MRI showed high signal intensity in 4 cases and 2 cases showed mild enhancement of T2WI. Fourteen children presented multiple nodules in the liver, with diameters of 0.51—2.35 cm, distributed along the portal vein in 10 cases and diffusely distributed in 4 cases. Among them, CT showed low densities in 11 cases and 5 cases showed mild to moderate enhancement, while T1WI showed low signal intensities and T2WI showed high signal intensities in 3 cases and 2 cases showed mild enhancement. Intrahepatic bile duct alternative stenoses/dilatation were noticed in 8 cases. Conclusion CT and MRI findings of LCH involving the liver in children have certain characteristics.
引文
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[3] Wong A,Ortiz-Neira CL,Reslan WA,et al.Liver involvement in Langerhans cell histiocytosis.Pediatr Radiol,2006,36(10):1105-1107.
[4] 虞峻崴,李慧民,李玉华,等.婴幼儿朗格汉斯细胞组织细胞增生症侵犯肝脏的影像表现.中国医学计算机成像,2013,19(5):434-437.
[5] 施莺燕,胡克非,胡俊,等.儿童朗格罕斯组织细胞增生症累及肝脏的影像表现.中华放射学杂志,2016,50(4):243-247.
[6] Shi YY,Qiao ZW,Xia CM,et al.Hepatic involvement of Langerhans cell histiocytosis in children-imaging fingdings of computed tomography,magnetic resonance imaging and magnetic resonance cholangiopancreatography.Pediatr Radiol,2014,44(6):713-718.
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[9] 李素荣,车莉,袁新宇.婴幼儿朗格汉斯细胞组织细胞增生症肺部HRCT表现.中国医学影像技术,2010,26(9):1708-1711.
[10] Steven H,Nancy LH,Stefano AP,et al.World Health Organization of tumors.WHO classification of tumors of haematopoietic and lymphoid tissues.Lyon:IARC Press,2008:14-367.
[11] Aricò M.Langerhans cell histiocytosis in aduls:More question than answers.Eur J Cancer,2004,40(10):1467-1473.
[12] Jaffe R.Liver involvement in the histiocytic disorders of childhood.Pediatr Dev Pathol,2004,7(3):214-225.
[13] Kilborn TN,Teh J,Goodman TR.Paediatric manifestations of Langerhans cell histiocytosis:A review of the clinical and radiological findings.Clin Radiol,2003,58(4):269-278.
[14] Caruso S,Miraglia R,Maruzzelli L,et al.Biliary wall calcification in Langerhans cell histiocytosis:Report of two cases.Pediatr Radiol,2008,38(7):791-794.
[15] Chaudhary A,Debnath J,Thulkar S,et al.Imaging findings in hepatic Langerhans' cell histiocytosis.Indian J Pediatr,2006,73(11):1036-1038.
[16] 李欣,杨志勇,贾万英.儿童朗格汉斯细胞组织细胞增生症的CT表现(附13例分析) .中华放射学杂志,2001,35(1):67-69.
[17] Schmidt S,Eich G,Hanquinet S,et al.Extra-osseous involvement of Langerhans' cell histiocytosis in children.Pediatr Radiol,2004,34(4):313-321.
[18] Girard M,Franchi-Abella S,Lacaille F,et al.Specificities of sclerosing cholangitis in childhood.Clin Res Hepatol Gastroenterol,2012,36(6):530-535.
[2] 胡涛,刘嵘,李君惠,等.克拉屈滨治疗儿童难治性高危朗格汉斯组织细胞增生症:13例报告并文献复习.中华血液学杂志,2014,35(11):985-989.
[3] Wong A,Ortiz-Neira CL,Reslan WA,et al.Liver involvement in Langerhans cell histiocytosis.Pediatr Radiol,2006,36(10):1105-1107.
[4] 虞峻崴,李慧民,李玉华,等.婴幼儿朗格汉斯细胞组织细胞增生症侵犯肝脏的影像表现.中国医学计算机成像,2013,19(5):434-437.
[5] 施莺燕,胡克非,胡俊,等.儿童朗格罕斯组织细胞增生症累及肝脏的影像表现.中华放射学杂志,2016,50(4):243-247.
[6] Shi YY,Qiao ZW,Xia CM,et al.Hepatic involvement of Langerhans cell histiocytosis in children-imaging fingdings of computed tomography,magnetic resonance imaging and magnetic resonance cholangiopancreatography.Pediatr Radiol,2014,44(6):713-718.
[7] 周伟,孙怀珍.朗格罕斯组织细胞增生症临床诊治的新进展.中华儿科学杂志,1998,36(1):50-51.
[8] 高凯波,吴坚,胡罗健,等.CT诊断肺朗格汉斯细胞组织细胞增生症.中国医学影像技术,2016,32(5):741-744.
[9] 李素荣,车莉,袁新宇.婴幼儿朗格汉斯细胞组织细胞增生症肺部HRCT表现.中国医学影像技术,2010,26(9):1708-1711.
[10] Steven H,Nancy LH,Stefano AP,et al.World Health Organization of tumors.WHO classification of tumors of haematopoietic and lymphoid tissues.Lyon:IARC Press,2008:14-367.
[11] Aricò M.Langerhans cell histiocytosis in aduls:More question than answers.Eur J Cancer,2004,40(10):1467-1473.
[12] Jaffe R.Liver involvement in the histiocytic disorders of childhood.Pediatr Dev Pathol,2004,7(3):214-225.
[13] Kilborn TN,Teh J,Goodman TR.Paediatric manifestations of Langerhans cell histiocytosis:A review of the clinical and radiological findings.Clin Radiol,2003,58(4):269-278.
[14] Caruso S,Miraglia R,Maruzzelli L,et al.Biliary wall calcification in Langerhans cell histiocytosis:Report of two cases.Pediatr Radiol,2008,38(7):791-794.
[15] Chaudhary A,Debnath J,Thulkar S,et al.Imaging findings in hepatic Langerhans' cell histiocytosis.Indian J Pediatr,2006,73(11):1036-1038.
[16] 李欣,杨志勇,贾万英.儿童朗格汉斯细胞组织细胞增生症的CT表现(附13例分析) .中华放射学杂志,2001,35(1):67-69.
[17] Schmidt S,Eich G,Hanquinet S,et al.Extra-osseous involvement of Langerhans' cell histiocytosis in children.Pediatr Radiol,2004,34(4):313-321.
[18] Girard M,Franchi-Abella S,Lacaille F,et al.Specificities of sclerosing cholangitis in childhood.Clin Res Hepatol Gastroenterol,2012,36(6):530-535.