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骨原发性淋巴瘤的CT、MRI表现及病理分析

作者:郑红伟1 杨 瑞1 刘继伟1 胡道予2 王仁发2 李小明2

所属单位:1.河南省胸科医院影像科 (河南 郑州 450000) 2.华中科技大学同济医学院附属同 济医院放射科(湖北 武汉 430030)

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摘要

目的探讨骨原发性淋巴瘤的 CT、MRI 表现。方法 回顾性分析19例骨 原发性淋巴瘤的CT、MRI影像资料,并结 合文献及病理分析。结果 19例均为单骨 发病,脊柱10例,骨盆6例,股骨3例。骨 质均呈侵润性破坏,CT呈斑片状、虫蚀状 溶骨性破坏,MRI呈稍长T1、T2信号(抑 脂序列),内可伴更长T2信号,周围均伴 软组织病灶且范围多大于骨内病灶。CT增 强3例中软组织病灶明显均匀强化1例、轻 度均匀强化2例。MRI增强15例中骨内病灶 明显强化12例,其中呈“镶边征”10例, 轻度强化3例;周围软组织病灶明显强化 9例,伴坏死2例,轻度至中度均匀强化6 例。病理上均为B细胞源性,且多为弥漫 性大B细胞淋巴瘤。结论 骨原发性淋巴瘤 的CT、MRI表现有一定的特征性,MRI对 PLB定性诊断有较高的诊断价值,结合好 发部位及年龄,应考虑到PLB的可能性。

Objective To study CT and MRI features of primary bone of the lymphoma. Methods Imaging of 19 PLB with pathologically confirmed were retrospectively reviewed. Results All lesions affected single bone, backbone 10, pelvis 6, femur 3. All bone lesions were infiltrative destruction with soft-tissue masses, CT scans displayed areas of different sizes of osteolytic cortical and marrow cavity destruction with large soft tissue masses or focus around the lesion. All of the lesions showed hypo-intense signal on T1WI and slightly hyperintense signal on T2WI. 1 soft-tissue lesion obviously uniform enhanced and 2 lesions slightly uniform enhanced after contrast-enhanced scans on CT; 12 lesion in bone obviously enhanced and 10 of 12 lesions with "lace-like sign", 3 lesions in bone slightly enhanced after contrast-enhanced scans on MRI; 9 lesions of soft-tissue masses obviously enhanced on MRI, only 2 lesion with necrosis, other 6 soft-tissue lesions slightly-moderate enhanced. Histological examination all identified B-cell lymphoma, 16 of them were diffuse larger B-cell lymphoma. Conclusion CT, MRI imaging of PBL has some characteristics, MRI has higher diagnostic value of PLB. associated with predilection site and age should be considered PBL possible.

【关键词】骨原发性淋巴瘤;体层摄影术,X线计算机;磁共振成像

【中图分类号】R557+.4

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2015.09.005

前言

骨原发恶性淋巴瘤(primary lymphoma of bone PLB)一种少见的 恶性肿瘤,占结外恶性淋巴瘤的4.7%~6.4%,占所有原发骨肿瘤的3% [1,2]。临床上误诊率高,易与其它骨原发和继发恶性肿瘤相混淆,但在 治疗方案和预后上明显不同,因此,影像学的准确诊断对于临床确定 治疗方案和评估预后具有重要的意义[2]。现回顾性分析19例PLB患者的 临床及影像资料,并结合文献及病理分析, 总结其影像学特征,提高 诊断符合率。