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目的探讨中老年重症肌无力患者淋巴样滤泡性胸腺增生的发生情况和CT表现。方法对39例经手术病理确诊为淋巴样滤泡性胸腺增生的中老年重症肌无力患者作了影像学分析,并与健康中老年人、青年重症肌无力患者淋巴样滤泡性胸腺增生作对比分析。凡无胸腺区形态正常的软组织影、无胸腺区脂肪内边缘清楚的肿块(>3 cm)或结节(<3 cm)和边缘模糊的斑片影者视为不典型淋巴样滤泡性胸腺增生。结果31例(79.5%)呈不典型表现,全部表现为胸腺区脂肪内夹杂<5 mm的斑点和细索条影;与健康中老年人和青年重症肌无力患者比较差异均有统计学意义(分别为χ2=4.135,P<0.05;χ2=9.584,P<0.01)。其中1级7例,2级14例,3级8例,4级2例,1~3级与健康中老年人比较,差异有统计学意义(P<0.01)。仅8例(20.5%)呈典型表现,包括胸腺区结节2例、胸腺软组织影2例和胸腺区边缘模糊的斑片致密影4例。结论大多数中老年重症肌无力患者淋巴样滤泡性胸腺增生的CT表现不典型,以男性多见,容易漏诊。
Objective To investigate the incidence of lymphoid follicular thymus hyperplasia and CT findings in middle-aged and elderly patients with myasthenia gravis. Methods Thirty-nine middle-aged and elderly patients with myasthenia gravis diagnosed with lymphoid follicular thymus hyperplasia were studied by imaging analysis and compared with lymphoid follicular thymus hyperplasia in healthy middle-aged and young patients with myasthenia gravis analysis. Where there is no morphologically normal soft tissue in the thymus, a clear lump (> 3 cm) or nodules (<3 cm) in the athymic zone and an edge-blurred patch are considered as atypical lymphoid follicular thymus Hyperplasia. Results There were 31 cases (79.5%) with atypical manifestations, all of them showed less than 5 mm speckle and sling in the thymus adipose tissue. The difference was statistically significant compared with healthy middle-aged and young patients with myasthenia gravis Respectively χ2 = 4.135, P <0.05; χ2 = 9.584, P <0.01). There were 7 cases of grade 1, 14 cases of grade 2, 8 cases of grade 3, 2 cases of grade 4, and the levels of grade 1 to 3 were significantly different from those of healthy middle-aged and elderly (P <0.01). Only 8 cases (20.5%) showed typical features, including 2 cases of thymus nodules, 2 cases of thymus soft tissue and thickened edge of the thymus. Conclusions CT findings of lymphoid follicular thymus hyperplasia in most myasthenia gravis patients are not typical, which is more common in men and is easily missed.