Zhang Shuai, Chen Min, Li Chun-Mei, Song Guo-Dong, Liu Ying
Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730; Graduate School, Peking Union Medical College, Beijing 100005, China.
Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China.
Chin Med J (Engl). 2017 Mar 20;130(6):691-697. doi: 10.4103/0366-6999.201606.
Retroperitoneal fibrosis (RPF) and lymphoma presenting as retroperitoneal mass may closely resemble each other and misdiagnosis may occur. This study investigated the differential imaging features of RPF and lymphoma which presented as a retroperitoneal soft tissue using multidetector-row computed tomography (MDCT).
The 42 consecutive patients were included in this retrospective review, including 19 RPF patients (45.2%; including 13 males and 6 females; mean age: 56.7 ± 6.2 years) and 23 patients with lymphoma (54.8%; including 14 males and 9 females; mean age: 57.4 ± 12.3 years). An array of qualitative computed tomography (CT) features of lesions in 42 consecutive patients with newly diagnosed untreated RPF and lymphoma were retrospectively analyzed. The quantitative size of the lesion at the para-aortic region and attenuation in the precontrast, arterial, and portal phases were calculated in regions of interest and compared between the patients with newly diagnosed untreated RPF and with lymphoma. Receiver operating characteristic curve analysis was used to assess the potential diagnostic value of each quantitative parameter. Inter-reader concordance was also calculated.
Mean ages between patients with RPF and lymphoma were not significantly different (56.7 ± 6.2 years vs. 57.4 ± 12.3 years P = 0.595). Compared to those in patients with lymphoma, homogeneous enhancement (65.2% vs. 94.7%, P = 0.027) and pelvic extension (52.2% vs. 89.5%, P = 0.017) were significantly more common while the involvement of additional nodes (78.3% vs. 5.3%, P < 0.001), suprarenal extension (60.9% vs. 15.8%, P = 0.004), and aortic displacement (43.5% vs. 5.3%, P = 0.006) were significantly less common in patients with RPF. Lesion size at the para-aorta was significantly greater in patients with lymphoma, compared with RPF patients (3.9 ± 1.2 cm vs. 1.8 ± 0.6 cm; P < 0.001). The attenuation values in three phases were not significantly different between patients with RPF and lymphoma. Inter-reader concordance for subjective features ranged from very good to excellent (range: 85.7-100.0%).
This study showed that MDCT can help differentiate between untreated RPF and lymphoma on the basis of qualitative CT features and lesion sizes. Differentiating RPF from lymphoma on the basis of attenuation values in the precontrast, arterial, and portal phases was difficult to accomplish.
表现为腹膜后肿块的腹膜后纤维化（RPF）和淋巴瘤可能极为相似，容易发生误诊。本研究利用多排螺旋计算机断层扫描（MDCT）探讨表现为腹膜后软组织的RPF和淋巴瘤的鉴别影像学特征。
本回顾性研究纳入了42例连续患者，其中19例为RPF患者（45.2%；包括13例男性和6例女性；平均年龄：56.7±6.2岁），23例为淋巴瘤患者（54.8%；包括14例男性和9例女性；平均年龄：57.4±12.3岁）。回顾性分析42例新诊断未治疗的RPF和淋巴瘤连续患者病变的一系列定性计算机断层扫描（CT）特征。在感兴趣区域计算腹主动脉旁区域病变的定量大小以及平扫、动脉期和门静脉期的衰减值，并在新诊断未治疗的RPF患者和淋巴瘤患者之间进行比较。采用受试者工作特征曲线分析评估各定量参数的潜在诊断价值。还计算了阅片者间的一致性。
RPF患者和淋巴瘤患者的平均年龄无显著差异（56.7±6.2岁对57.4±12.3岁，P = 0.595）。与淋巴瘤患者相比，RPF患者中均匀强化（65.2%对94.7%，P = 0.027）和盆腔延伸（52.2%对89.5%，P = 0.017）更为常见，而额外淋巴结受累（78.3%对5.3%，P < 0.001）、肾上腺延伸（60.9%对15.8%，P = 0.004）和主动脉移位（43.5%对5.3%，P = 0.006）则明显较少见。淋巴瘤患者腹主动脉旁的病变大小显著大于RPF患者（3.9±1.2 cm对1.8±0.6 cm；P < 0.001）。RPF患者和淋巴瘤患者在三个时期的衰减值无显著差异。主观特征的阅片者间一致性从非常好到优秀（范围：85.7 - 100.0%）。
本研究表明，MDCT可根据定性CT特征和病变大小帮助鉴别未治疗的RPF和淋巴瘤。根据平扫、动脉期和门静脉期的衰减值区分RPF和淋巴瘤很难实现。
