骨原发性淋巴瘤影像分析

Analysis of image findings in forty-one patients with primary lymphoma of the bone

目的分析原发性骨淋巴瘤（PLB）及“浮冰征”的影像表现和病理基础。方法回顾性分析经病理证实且临床资料齐全的41例PLB患者的临床与影像特征。41例全部行x线检查，20例行CT检查，12例行MR检查（3例同时行增强扫描）。结果41例PLB中位于扁骨12例，脊柱8例，长骨17例，其他不规则骨4例。发病最多的部位是股骨（10例，24．4％），其次为髂骨（8例，19．5％）。长骨病变位于骨干干骺处者11例。41例中无骨膜反应者37例（90．2％）。CT显示骨质破坏轻微而出现软组织肿块者12例，伴有明显软组织肿块者9例，出现“浮冰征”者4例。12例MR检查结果中，10例显示软组织肿块，MRI显示病变范围全部大于CT所显示病变范围，其中1例MRI显示大范围骨质异常，但平片及CT显示骨质破坏不明显。结论（1）骨质破坏轻而软组织肿块明显，或MRI显示骨质异常范围明显超过平片及CT所见，或MRI显示骨质异常而平片及CT显示骨质破坏较轻或未见明显骨质破坏者提示PLB。（2）“浮冰征”是PLB较为特殊的一种征象，其出现对淋巴瘤的诊断具有一定提示意义。

Objective To analyze the imaging features of primary lymphoma of the bone, and discuss the special feature of the ＂floating ice sign＂. Methods Forty-one cases of primary lymphoma of the bone in our unit from 1963.1-2009.6 were retrospectively studied. All 41 patients underwent X-ray examination, and 20 patients underwent CT examination, 12 patients underwent MR examination （3 cases simultaneously with enhancement）. Results Involvement of the flat bone was seen in 12 cases. Vertebral column was affected in 8 cases, and 17 cases showed lesions in long bones and irregular bones were involved in 4 cases. The most common location was the femur（ 10, 24. 4% ） , followed by the ilium（8, 19. 5% ）. Lesions were found in the metaphyses of the long bone in 11 cases （64.7%）. ＂Floating ice sign＂ was showed in the calcaneus of 2 patients and in the lumbar vertebra of 2 cases respectively, accounted for 9. 8% of all cases.＇ Slight bone destruction with soft tissue mass on CT image could be found in 12 cases, while obvious soft tissue mass was found in 9 cases. No periosteal reaction was found in 37 cases （90. 2% ）. MRI examinations of 12 patients revealed soft tissue mass in 10 patients, and the extent of the lesion was larger in MR than CT. One case showed extensive bone destruction on MR but inconspicuous bone destruction on X-ray plain film and CT scan. Conclusion Slight bone destruction with conspicuous soft tissue mass, conspicuous bone destruction on MR but slight or inconspicuous bone destruction on X-ray film and CT, could strongly imply the diagnosis of primary lymphoma of the bone. ＂Floating ice sign＂ was a special imaging feature of primary lymphoma of the bone, which could be used as a clue for the diagnosis of lymphoma.