上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (9): 1182-1189.doi: 10.3969/j.issn.1674-8115.2024.09.013

• 论著 · 临床研究 • 上一篇    

头颈部木村病的影像学特征研究

罗瑞1(), 杨功鑫1, 石慧敏1, 韩永顺1, 何一宁2, 田臻3, 吴颖为1()   

  1. 1.上海交通大学医学院附属第九人民医院放射科，上海 200011
    2.上海交通大学医学院附属第九人民医院统计教研室，上海 200011
    3.上海交通大学医学院附属第九人民医院病理科，上海 200011
  • 收稿日期:2024-03-06 接受日期:2024-04-19 出版日期:2024-09-28 发布日期:2024-10-09
  • 通讯作者: 吴颖为 E-mail:965871436@qq.com;wuyw0103@hotmail.com
  • 作者简介:罗　瑞（1994—），男，硕士生；电子信箱： 965871436@qq.com。
  • 基金资助:
    国家自然科学基金(82373114);上海交通大学医学院“双百人”项目(20191815);上海交通大学医学院附属第九人民医院交叉研究基金(JYJC202107)

Study of imaging characteristics of Kimura disease in the head and neck

LUO Rui1(), YANG Gongxin1, SHI Huimin1, HAN Yongshun1, HE Yining2, TIAN Zhen3, WU Yingwei1()   

  1. 1.Department of Radiology, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
    2.Department of Statistics, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
    3.Department of Pathology, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
  • Received:2024-03-06 Accepted:2024-04-19 Online:2024-09-28 Published:2024-10-09
  • Contact: WU Yingwei E-mail:965871436@qq.com;wuyw0103@hotmail.com
  • Supported by:
    National Natural Science Foundation of China(82373114);“Two-Hundred Talents” Program of Shanghai Jiao Tong University School of Medicine(20191815);Cross-Disciplinary Research Fund of Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine(JYJC202107)

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摘要：

目的·探究头颈部木村病患者计算机断层扫描（computed tomography，CT）和磁共振成像（magnetic resonance imaging，MRI）的影像学特征。方法·回顾性收集2009—2023年上海交通大学医学院附属第九人民医院经病理学确诊的头颈部木村病患者64例，所有患者均在术前完成CT和/或MRI增强成像。收集、记录及分析患者临床及影像学特征，其中包括年龄，性别，外周血嗜酸性粒细胞比例，血清IgE水平，病变位置、形态、大小、CT密度及强化程度、MRI信号及强化程度、表观扩散系数（apparent diffusion coefficient，ADC）、时间-信号强度曲线（time-signal intensity curve，TIC）类型、灌注速率及达峰时间（time to peak，TTP）。结果·64例木村病患者平均年龄（40±19）岁，男性占92.2%；73.5%患者嗜酸性粒细胞比例升高，所有检测血清IgE的患者（10例）IgE水平均升高。CT和MRI共发现结外病变（皮下和腺体病变）82个、淋巴结病变144个；结外病变中，80.5%表现为皮下或腺体内边界不清的斑片状病变，其他为边界清晰的结节状病变。所有病变在CT上均呈等密度影，在MRI上均表现为T1加权成像（T1-weighted imaging，T1WI）等信号，T2加权成像（T2-weighted imaging，T2WI）高信号。结外病变增强后多呈不均匀强化，而淋巴结病变增强后多呈均匀强化。结外病变和淋巴结病变的ADC中位数分别为1.04×10 -3 mm 2/s和0.67×10 -3 mm 2/s，差异具有统计学意义（ P=0.000）。动态增强磁共振成像结果显示，结外病变的TIC类型主要为Ⅰ型和Ⅱ型，分别占57.5%和42.5%；而淋巴结病变TIC类型主要为Ⅱ型（96.6%）。结外病变和淋巴结病变的TTP和灌注速率，差异均具有统计学意义（均 P=0.000）。结论·木村病结外病变及淋巴结病变在CT上呈等密度影，在MRI上表现为T1WI等信号、T2WI高信号。结外病变ADC较高，TIC类型为Ⅰ或Ⅱ型，增强后多呈不均匀强化；淋巴结病变ADC较低，TIC类型多为Ⅱ型，增强后多呈均匀强化。

关键词: 木村病, 计算机断层扫描, 磁共振成像, 扩散加权成像, 动态增强磁共振成像

Abstract:

Objective ·To investigate the imaging features of computed tomography (CT) and magnetic resonance imaging (MRI) in the patients with Kimura disease (KD) in the head and neck. Methods ·Sixty-four cases of KD in the head and neck comfirmed by histopathology were retrospectively collected from 2009 to 2023 in Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine. All patients completed CT and/or MRI enhancement imaging before surgery. Clinical and imaging characteristics were collected, recorded and analyzed, including age, gender, peripheral blood eosinophilic ratio, serum IgE level, the lesion location, shape, size, CT density and degree of enhancement, MRI signal intensity and degree of enhancement, apparent diffusion coefficient (ADC), time-signal intensity curve (TIC) patterns, wash-in rate, and time to peak (TTP). Results ·The average age of the 64 KD patients was (40±19) years, and 92.2% were males. A total of 73.5% of the patients showed an elevated ratio of peripheral blood eosinophil, and all 10 tested patients exhibited increased serum IgE levels. There were 82 extranodal (subcutaneous and glandular) lesions and 144 lymph node lesions detected by CT and MRI. Among the extranodal lesions, 80.5% were subcutaneous or glandular patchy lesions with unclear boundaries, and the rest were nodular lesions with clear boundaries. All lesions exhibited isodensity on CT scans and showed isointensity on T1-weighted imaging (T1WI) and hyperintensity on T2-weighted imaging (T2WI) in MRI. Most extranodal lesions tended to show heterogeneous enhancement, while most lymph node lesions showed homogeneous enhancement. The median ADCs of the extranodal lesions and the lymph node lesions were 1.04×10 -3 mm 2/s and 0.67×10 -3 mm 2/s, respectively, which were significantly different ( P=0.000). The dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) results showed that the TIC patterns of extranodal lesions were predominantly type Ⅰ and Ⅱ, accounting for 57.5% and 42.5%, respectively; while the TIC patterns of lymph node lesions were predominantly type Ⅱ (96.6%). The difference in the TTP and the wash-in rate between the extranodal lesions and the lymph node lesions were both statistically significant ( P=0.000). Conclusion ·Extranodal lesions and lymph node lesions of KD both show isodensity on CT, and isointensity on T1WI and hyperintensity on T2WI in MRI. Extranodal lesions often show high ADC, TIC type Ⅰ or Ⅱ, and mostly heterogeneous enhancement; lymph node lesions often show low ADC, TIC type Ⅱ, and mostly homogenous enhancement.

Key words: Kimura disease, computed tomography (CT), magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), dynamic enhanced magnetic resonance imaging (DCE-MRI)

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