椎管内硬膜外原发性淋巴瘤影像表现

The Image Manifestations of Primary Extradural Spinal Lymphoma

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.