咽淋巴环非霍奇金淋巴瘤的CT、MRI诊断

CT and MRI Diagnosis of Waldeyer′s Ring in Non-Hondgkin′s Lymphoma (NHL): Analysis of 149 Cases

目的探讨咽淋巴环非霍奇金淋巴瘤(NHL)的影像学特点,以提高诊断及鉴别诊断的准确性。资料与方法回顾性分析149例临床病理资料完整、原发于咽淋巴环NHL的CT和MRI表现。结果149例中,B细胞来源98例(65.8%),外周T和NK/T细胞51例(34.2%)。单发于扁桃体者最多见(56例,37.6%),其次为鼻咽、扁桃体等多部位受累(43例,28.9%)。肿块型81例,浸润型36例,溃疡型7例,混合型25例,以肿块型多见(54.4%)。肿块型轮廓境界光整,密度和信号均匀,以B细胞NHL多见;浸润型病变范围较弥漫,境界欠清晰,部分密度信号不均匀,以NK/T细胞多见;溃疡型少见,均为NK/T细胞NHL。各型病变多局限于咽黏膜间隙内,咽旁等深部间隙及颅底骨质侵犯少,仅12例(8%)。78例伴有颈淋巴结受累,受累率约52.3%,其中在B细胞NHL中为65.3%(64/98),在外周T和NK/T细胞NHL中为27.5%(14/51),两者有显著性差异(χ2=19.14,P<0.01)。结论多部位多中心起源、大肿块或咽壁弥漫浸润性增厚、颅底及深层结构侵犯少是咽淋巴环NHL典型的影像学表现,不同的免疫表型又有各自的特点,这些特征有助与该部位常见的鳞状上皮癌的鉴别。

Objective To study the imaging features of Waldeyer′s ring in non-Hondgkin′s lymphoma (NHL) to improve the diagnosis of NHL. Materials and Methods CT and MRI appearances of 149 patients with pathologically-proved Waldeyer′s ring-NHL were retrospectively analyzed. Results Of 149 cases, 98 cases of Waldeyer′s ring-NHL were originated from B-cell (65.8%), and 51 cases from T and NK/T-cell (34.2%). The tonsil was the most vulnerable site (n=56,37.6%) followed by the multiple sites in nasopharynx, tonsil and other locations (n=43,28.9%). There were four types in appearances of lesions which were nodules or masses (n=81, 54.4%) characterized with distinct margin, homogeneous density or intensity and commonly in B-cell NHL, diffuse infiltration growth (n=36) characterized with vague margin and partly inhomogeneous density or intensity and commonly in NK/T-cell NHL, pure ulcer (n=7) all found in NK/T-cell NHL, mixed (n=25). The lesions of all types were usually localized in between pharynx-mucosa space, but rarely in deep facial space such as the space beside pharynx and in skull-base, only 12 cases were involved (8%). 52.3%(78/149) cervical lymph nodes were involved, including B-cell NHL (65.3%), T and NK/T-cell (27.5%), the former of which was significantly differeance than that of latter (χ2=19.14, P<0.01).Conclusion Multiple positions and centers origin, huge masses or diffuse infiltration growth without skull-base and deep facial space involvement are typical imaging features of Waldeyer′s ring-NHL, which are related to its immunotype, understanding of the imaging features of Waldeyer′s ring-NHL can help to differentiate it from squamous epithelial cell carcinoma.