脾脏淋巴瘤的CT/MRI诊断

目的分析脾脏淋巴瘤的CT及MRI表现,以期提高诊断准确性。方法回顾性分析经组织病理学证实的脾脏淋巴瘤6例,其中4例患者接受多层螺旋CT动态增强扫描,2例患者行MRIT1WI、T2WI、扩散加权成像(DWI)及动态增强扫描。6例均经手术病理证实,与病理组织学结果对照,分析此6例患者的CT及MRI表现。结果 6例患者脾脏不同程度增大,CT平扫时多为低密度灶,MRI为T1WI双回波序列低信号,T2WI压脂序列稍高信号,DWI呈明显高信号,增强动脉期病灶轻度均匀/不均匀强化,静脉期及延迟期稍减退,各期的强化均低于同层面的脾脏实质的强化程度,不均匀强化者病灶内见片状无强化区。其中脾脏淋巴瘤累及肝脏3例,累及胃2例,累及淋巴结5例。脾脏小B细胞淋巴瘤多形成弥漫浸润型或栗粒结节型,弥漫大B细胞淋巴瘤多形成单发巨块型。结论 CT及MRI影像学方法,在病理诊断之前,对鉴别脾脏占位病变的良恶性及高度提示脾脏淋巴瘤的诊断具有重要价值。

Objective To improve the diagnostic accuracy of splenic lymphoma by studying the CT/MRI imaging features. Methods CT/MRI findings of 6 cases of splenic lymphoma proved histopathologically were retrospectively analyzed. Of 6 cases of splenic lymphoma, 4 cases performed dynamic contrast enhanced spiral CT scan, 2 cases performed MRI T1 WI, T2 WI, diffusion weighted imaging（DWI） and dynamic contrast-enhanced scan. 6 cases were pathologically confirmed, analysis of the CT/MRI findings with pathologic correlation. Results 6 patients with varying degrees of spleen enlargement. CT scan showed as homogenous hypodense. MRI T1 WI dual-echo sequence showed low signal. T2 WI fat suppression sequences was slightly hperintense. DWI showed the lesion was significantly higher signal. Enhanced arterial phase lesions showed slightly even /uneven enhancement. Venous and delayed phase was slightly diminished. The degree of enhancement was less than the spleen of the same level.3 cases Splenic lymphoma involved the liver, 2 cases involved the stomach, 5 cases involved the lymph nodes. Splenic small B-cell lymphoma was more likely to show as the diffuse infiltrative or military nodules. Diffuse large B-cell lymphoma is more likely to show as a single massive. Conclusion CT/MRI is helpful for identifying benign and malignant splenic lesions and is highly suggestive of the diagnosis of splenic lymphoma.