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椎管内硬膜外原发 性 淋 巴 瘤 影 像 表 现*

作者:侯刚强1 高德宏1 沈比先1 熊 伟2 褚千琨1 张大波1

所属单位:1.深圳市南山区人民医院 (广东 深圳 510515) 2.南方医科大学南方医院影像中心 (广东 广州 518052)

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摘要

目的 探讨椎管内硬膜外原发性 淋巴瘤影像表现,提高诊断及鉴别诊断 水平。方法 回顾分析经手术病理证实的 7例椎管内硬膜外原发性淋巴瘤影像及临 床资料,分析其影像表现。1例行CT平扫 检查;余6例行MR平扫、增强检查。结果 病灶发生部位均位于胸段。7例病变均表 现为椎管内硬膜外肿块,其中6例矢状位 呈梭形或长条形。1例跨椎间孔呈“哑铃 样”生长;3例单侧椎间孔扩大。横断位 4例病灶半环状包绕硬脊膜。硬脊膜、脊 髓受压变扁,但密度或信号正常。3例椎 体、附件可见骨质破坏。病灶CT表现为 等密度;T1WI等信号5例,低信号1例, T2WI略高信号2例,等信号4例,病灶密 度、信号均匀。MR增强扫描3例轻度强 化,2例中度强化,1例显著强化。未见 明确液化坏死灶。结论 原发性椎管内淋 巴瘤在发病部位、病变形态及影像表现 具有一定特征,把握这些特点有助于提 高诊断率。

Objective To investigate the imaging manifestations of intraspinal extradural lymphoma and improve the diagnosis and differentiation of this disease. Methods This study retrospectively analyzes theimages, pathological and clinical data of 7 cases of primary spinal epidural lymphoma, which were later confirmed by the operation and pathology. 1 case was subjected to CT scan. The remaining 6 cases were subjected to MR scan and enhanced examination. Results All the lesions were located in thoracic region. 7 cases of lesions showed spinal epidural lumps, of which 6 cases were spindle-shaped or elongatedsagittal shaped. In 1 case lesions were found in the intervertebral foramen and showed "dumbbell-shaped" growth. In 3 cases the unilateral intervertebral foramen were enlarged. In 4 cases lesions were found in the transversal position and showed a semi-circular shape, surrounding the dura mater. The spinal cords were compressed flat by the tumors, but the density or signals were normal. In 3 cases the adjacent vertebral bone and adnexal parts destruction were visible. The lesions showed isodensity on CT image.The other lesions had slightly low-(n=1) or iso-(n=5) intensity on T1WI, andiso(n=4)or slightly hyper- (n=2) intensity on T2WI. The mass showed mild (n=3), moderate (n=2) and significant (n=1) homogeneous enhancement on MR. There were no necrosis or cyst in the masses. Conclusion There are certain characteristics in pathogenesis, lesion morphology and image manifestations of the primary spinal canal lymphoma. The understanding of these features will be helpful to improve the diagnostic accuracy.

【关键词】椎管;淋巴瘤;磁共振成 像;体层摄影术;X线计算机

【中图分类号】R733.4;R445.2 ;R445.3

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2018.02.042

前言

椎管内淋巴瘤是一种较为罕见的淋巴结外型淋巴瘤,仅占整个中 枢神经系统淋巴瘤的4.8%,误诊率较高,与其他椎管内病变鉴别诊断 较为困难[1]。为提高对该疾病的认识及术前诊断率,本文回顾分析7例 经手术病理证实,且有完整临床及影像资料的椎管内原发性淋巴瘤, 探讨其影像特征。