结外淋巴瘤:影像学共性特征与病理的关系

The Correlation of General Imaging Features with the Pathology in Extranodal Lymphoma

目的分析结外淋巴瘤的影像学特征,探讨影像学对其诊断价值。资料与方法回顾性分析57例经手术病理证实的结外淋巴瘤病例,非霍奇金病54例,霍奇金病3例,初诊时均无明确淋巴瘤病史,术前分别经常规X线、CT和MRI检查。结果57例结外淋巴瘤中,消化道14例,骨骼9例,脑7例,肾5例,肺4例,脾4例,肾上腺4例,肝脏3例,肌肉3例,胰腺2例,睾丸1例,阴道1例。常规X线检查22例,术前诊断6例;CT检查39例,术前诊断17例;MRI检查19例,术前诊断12例。CT检查47个病灶中,41个病灶密度均匀,6个病灶有程度不等坏死。MRI检查26个病灶中,T1WI为低或等信号,25个病灶T2WI为低、等或略高信号,1个病灶为高信号;17个病灶信号均匀,9个病灶信号不均匀。动态CT和MR增强47例,除脑淋巴瘤为进行性显著持续强化外,其他部位淋巴瘤为进行性轻到中度延迟强化。结外淋巴瘤瘤内常可见脏器原有解剖结构,如血管、支气管、肾盂、肌间隙等残留。结论结外淋巴瘤共性表现包括肿瘤密实,瘤内可见原有解剖结构残留,MRT2WI多为等或略高信号;一般轻度至中度延迟强化。掌握结外淋巴瘤的一些特征性影像学表现,有利于提高诊断准确率。

Objective To explore the imaging features of extranodal lymphoma and evaluate its diagnostic value. Materials and Methods 54 extranodal non-Hodgldn＇s and 3 extranodal Hodgkin＇s lymphoma of 57 patients confirmed by surgery and pathology without the history of intranodal lymphoma before surgery had the examination of conventional radiography, CT scan and MR imaging, The acquired images data were reviewed and analyzed retrospectively in comparison with surgical and pathological results. Results The locations of 57 extranodal lymphomas included digestive canal（14）, bone（9）, kidney（5）, brain（7）, lung（4）, spleen（4）, adrenal gland（4）, liver（3）, muscle（3）, pancreas（2）, testis（1）, vagina（1）, respectively. 6 of 22 cases underwent routine radiography, 17 of 39 cases underwent CT scan and 12 of 19 cases underwent MR scan were diagnosed correctly, 41 of 47 lesions underwent CT scan were homogeneous density and 6 of which presented heterogeneous density, 17 of 26 lesion underwent MR appeared uniform hypo or isointensity signal. 47 cases except brain lymphoma presented low to middle degree dynamic delayed enhanced. Extranodal lymphoma usually remained intrinsic anatomic structures. Conclusion General imaging features of extranodal lymphoma include well-circumscribed solid masses with slightly hyperintensity signal on MR T2-weighted images and low to middle degree dynamic delayed enhanced in which intrinsic anatomic structures are remained. It is important for the radiologist to recognize the typical appearance of extranodal lymphoma to improve diagnostic accuracy.