原发性骨骼淋巴瘤的影像学诊断

The imaging diagnosis of primary lymphoma of bone

目的:分析13例骨骼淋巴瘤的影像学特征以探讨其影像学的诊断价值。材料和方法:13例经手术病理证实的骨骼淋巴瘤病例,术前均经平片检查,其中CT检查10例,MR检查9例。结果:4例何杰金淋巴瘤和9例非何杰金淋巴瘤分别累及脊柱6例,长管状骨5例,骨盆2例,病变主要累及脊柱的椎体和长管状骨的骨干,骨质改变为溶骨型9例(69%)和混合型4例(31%),骨质破坏以浸润性虫噬状骨质破坏为主;骨皮质破坏11例,但皮质破坏的程度总是很轻微;骨膜成骨3例(23%),软组织肿块形成7例(54%)。软组织肿块CT表现为低密度或等密度,境界清楚;骨骼MRIT1WI低信号9例,T2WI显示为略低信号2例,等信号2例,高信号5例;软组织肿块的MR信号变化少,T1WI略低于肌肉,T2WI总是略高于肌肉,MR动态增强扫描为轻～中等程度强化。结论:骨骼淋巴瘤影像学特征:①明显的浸润性虫噬状骨质破坏,而骨皮质破坏轻微,骨膜反应少见;②软组织肿块T2WI信号略高,且信号相对均匀。平片、CT和MRI等影像学检查可以作出诊断。

Objective： Exploring the imaging features of lympboma of bone and evaluating their clinical value. Materials and Methods： Thirteen patients of lymphoma confirmed by surgery and pathology underwent conventional radiography, in whom 10 underwent CT scan, and 9 underwent MR imaging. The acquired images were reviewed and analysed retrospectively and correlated with surgical and pathological results. Results： Nine non-Hodgkin＇s and 4 Hodgkin＇s lymphoma affected spine （46%）, acetabulum（15%） and long bones（39%） respectively. Common locations were the vertebral body of spine and diaphysis of a major long bone. Common appearances were a lytic（69%） and mixed-density（31%） lesion with most cases showing an infiltrative or moth-eaten pattern. Cortical destruction was seen in 11 patients（85%） but usually without extensive cortical destruction. Periosteal reaction was seen in 3 patients（23%）. Soft-tissue masses were present in 7 patients（54%）. Lymphomas are hypo--dense or isodense to muscle on CT with circumscribed or distinct margins. Lymphomas appear low in signal intensity on T1-weighted images and low to high in signal intensity on T2-weighted images. Soft-tissue masses appear low in signal intensity on T1-weighted images and slightly high in signal intensity on T2-weighted images without much variable and with usually mild, enhancement following Gadolinium-DTPA（Gd-DTPA） contrast material injection. Conclusion： Lymphoma of bone has an infthrative or moth-eaten pattern lyric bone destruction associated with soft-tissue mass. Radiography, CT and MR imaging can suggest the diagnosis, particularly when slightly high in signal intensity on T2-weighted images of a soft-tissue mass without extensive cortical destruction.