恶性淋巴瘤受累淋巴结的全身螺旋计算机层析成像表现

Whole body CT features of lymph nodes involved in malignant lymphoma

目的探讨恶性淋巴瘤累及淋巴结的全身螺旋计算机层析成像（CT）表现及其解剖分布。方法回顾性分析89例诊治的淋巴瘤患者，其中霍奇金淋巴瘤（HL）12例，非霍奇金淋巴瘤（NHL）77例。所有患者均行颈部、胸部及全腹部CT直接增强扫描，记录所有病例肿大淋巴结分布、大小、密度及强化程度。结果HL组患者中普遍均匀强化9例（75．0％），均匀强化伴坏死3例（25．0％）；NHL组中普遍均匀强化64例（83．1％），均匀强化伴坏死13例（16．9％），两组均匀强化情况比较差异无统计学意义（Fisher精确概率法，P=0．4461）。HL组中淋巴结呈融合状6例（50．0％），不融合6例（50．0％）；NHL组中淋巴结呈融合状8例（10．4％），不融合69例（89．6％），两组比较差异有统计学意义（Fisher精确概率法，P=0．0028）。HL组患者常优势累及颈部及纵隔淋巴结，NHL组患者常优势累及颈部、纵隔及腹腔淋巴结，两组全身淋巴结累及优势分布差异无统计学意义（Fisher精确概率法，P=0．110）。结论全身螺旋CT扫描能很好的显示淋巴瘤患者全身淋巴结肿大的形态、部位及分布。

Objective To investigate CT feature after contrast-enhanced and anatomic distribute of the whole body lymph nodes involved by lymphoma. Methods The whole body CT findings in 89 cases （HL 12 cases, NHL 77 cases） of malignant lymphoma were retrospectively analyzed. The contrast-enhanced CT features （size, density and the digree of contrast enhancement） and anatomic distribution of the whole body lymph nodes involved by lymphoma were clarified. Results In the HL group, Diffuse and homogeneous enhancement of the enlarged lymph nodes was found in 9 cases （75.0 %）, while homogeneous enhancement of the enlarged lymph nodes with some little necrosis was found in 3 cases （25.0 %）. In the NHL group, diffuse and homogeneous enhancement of the enlarged lymph nodes was found in 64 cases （83.1%）, while homogeneous enhancement of the enlarged lymph nodes with some little necrosis was found in 13 cases （16.9 %）. There was not statistically significant （Fisher exact probability, P = 0.4461） between the two groups. In the HL group, the enlarged lymph nodes were mixed together in 6 cases （50.0 %）, while the enlarged lymph nodes were separate in 6 cases （50.0 %）. In the NHL group, the enlarged lymph nodes were mixed together in 8 cases （10.4 %）, while the enlarged lymph nodes were separate in 69 cases （89.6 %）, there was statistically significant （Fisher exact probability, P = 0.0028）. The dominant anatomic distributions of the lymph nodes involved by HL group were neck and mediastinum. The dominant anatomic distributions of the lymph nodes involved by NHL group were neck, mediastinum and abdomen, there was not statistically significant between the anatomic distributions （Fisher exact probability, P =0.110）. Conclusion CT can easily demonstrate the involvement and extension of malignant involving the whole body, but CT can not differentiate HL and NHL except for the confluence state.