骨原发性淋巴瘤影像学特点分析

Analysis of imaging features of primary lymphoma of bone

目的探讨骨原发性淋巴瘤(PLB)的影像学特点,提高临床骨原发性淋巴瘤的影像诊断率。方法回顾性分析18例经临床和病理证实的骨原发性淋巴瘤的X线平片、CT及MRI特点。结果男10例,女8例,平均年龄(40.6±5)岁,单发16例,多发2例。股骨5例次,腰椎4例次,髂骨、胸椎各3例次,颅骨、胫骨各2例次,骶椎、肱骨各1例次;X线及CT表现为浸润型4例,溶骨型7例,硬化型1例,混合型5例,囊变型1例,明显骨膜反应3例,合并病理骨折5例,16例有明显软组织肿块,MRI检查:病变在T1WI多呈低或等信号,T2WI多呈等或稍高信号,呈明显均匀或不均匀强化。结论 (1)骨原发性淋巴瘤影像学上缺乏特征性表现,X线、CT及MRI综合分析,有助于明确诊断、鉴别诊断。(2)全身症状轻,骨皮质破坏的范围相对小而软组织肿块大,骨膜反应轻,MRI的T2WI信号不高,增强扫描多呈明显强化,是其相对特征性影像学特点。

Objective To analyze the imaging features of primary lymphoma of bone (PLB) on X-ray,computerized tomography (CT) and magnetic resonance imaging (MRI) .Methods Eighteen patients with PLB (10 males and 8 females,aged 9-60 years with a median age of 40.6 years) proved by surgery and pathology were enrolled.The 18 ones were all examined by X-ray,of whom 10 underwent CT and 13 underwent MRI.The imaging findings were retrospectively analyzed.Results The site of PLB focus was found in femoral bone in 5 cases,lumbar vertebrae in 4 cases,frontal bone and thoracic vertebrae in 3 cases respectively, cranial bone and tibia in 2 cases respectively,and sacral vertebrae and humeral bone in 1 case respectively.The CT and X-ray features of 4 cases were of infiltrating type,7 cases of osteolytic type,1 case of sclerotic type,5 cases of mixed-type,1 case of cystis degeneration type,3 cases of periosteous reaction,6 cases of pathological fracture,and 16 cases of soft tissue masses.MRI showed slightly hypo-intense or homogeneous signals on T1WI,s1ightly hyper-intense or homogeneous signals on T2WI, and homogeneous or inhomogeneous enhancement.Conclusion (1 ) PLB is lack of characteristic imaging features,so we should combine X-ray,CT and MRI images to observe the lesions.(2) It is very difficult to differentiate PLB from other malignant tumors of bone.But slight clinical symptoms of the whole body,small invasion or osteolysis with large soft tissue mass,slight periosteous reaction strongly imply the diagnosis of PLB.