骨原发性非霍奇金淋巴瘤的影像学表现特点

The imaging features of primary bone non-Hodgkin's lymphoma

目的:分析骨原发性非霍奇金淋巴瘤的影像学表现特点。方法:回顾性分析25例经病理证实为骨原发性非霍奇金淋巴瘤的X线、CT和MR影像资料。25例均有完整的X线资料,21例同时作了CT检查,17例同时作了MR检查。结果:X线表现为溶骨性骨质破坏的占21例,溶骨性骨质破坏和不规则硬化相混杂者3例,X线片未见明显异常者1例,出现骨膜反应者2例,出现软组织肿块者15例。21例CT扫描中,溶骨性骨质破坏者18例,溶骨性骨质破坏与不规则硬化相混杂者3例,出现骨膜反应者6例,出现软组织肿块者17例,CT图像上软组织肿块最大长径为3.0～12.5cm,平均6.7cm,相应层面骨皮质连续性中断的总长度为1.5～4.0cm,平均2.6cm。17例MR扫描中,T1WI为中等信号者13例,中、低信号混杂者4例;T2WI为中等信号者8例,高信号者2例,中高信号混杂者7例。MR图像所示的软组织肿块的最大长径为3.0～15.0cm,平均7.0cm。结论:骨原发性淋巴瘤在X线和CT上以溶骨性骨质破坏为主,并以骨皮质中断的长度小而软组织肿块相对较大,骨膜反应少而轻为特征,在MR的T2WI上以中等信号和不均匀信号为主,具有一定的特征性,有助于肿瘤的诊断和鉴别诊断。

Objective： To describe the imaging features of primary bone non-Hodgkin＇s lymphoma. Methods： Twenty-five cases with primary bone non-Hodgkin＇s lymphoma confirmed by pathology were included in the study. The plain radiographs,CT and MR images of all the patients were retrospectively reviewed, plain radiographs were available in all cases, CT scans were available for 21 cases, MRI studies were available for 17 cases. The average age of 25 cases was 32 years（range, 12-77 years）, and the male-to-female ratio was 2.6：1. Results： The bones involved were vertebrae （7 cases）, ilium （6 cases）, femur（ 3 cases）, tibia（3 cases）, acetabulum（2 cases）, pubis（2 cases）, fibula（1 case） and sternum（1 case）. In the plain radiographs, 21 cases were lyric; 3 cases were lyric mixed with irregular sclerotic and 1 case was normal; 2 cases demonstrated periosteal reaction; 15 cases had soft tissue mass. In the 21 cases with images of CT, 18 cases were lyric; 3 cases were lyric mixed with irregular sclerotic; 6 cases demonstrated periosteal reaction; 17 cases had soft tissue mass; the maximal length of the soft tissue mass ranged from 3cm to 12.5cm, with a mean length of 6.7cm, the total length of cortical discontinue in the correspond images ranged from 1.Scm to 4.0cm, with a mean length of 2.6cm. In 17 cases on TIWI, 13 cases were isointenslty; 4 cases were hypointensity mixed with isointensity. On T2WI, 8 cases were isointense; 2 cases were hyperintense; 7 cases were heterogeneous; the soft tissue mass ranged from 3cm to 15cm, with a mean of 7.0cm. ConcIusion： In radiographs and CT scans,most cases of primary bone lymphoma were lyric and characterized by minimal cortical changes despite a large accompanying soft tissue mass, with no significant periosteal reaction; the predominant tumoral intensity in MR T2WI was isointense or heterogeneous in MR images.