套细胞淋巴瘤的多层螺旋CT影像学表现及其在分期中的应用价值

Evaluation of multidetector computed tomography in the diagnosis and staging of mantle cell lymphoma

目的探讨多层螺旋CT(multidetector computed tomography,MDCT)中套细胞淋巴瘤(mantle cell lymphoma,MCL)的影像学表现,以及在分期中的应用价值。方法回顾性分析23例MCL患者初诊及随诊MDCT图像,以病理和临床诊断作为金标准。结果 MCL患者23例,多表现为全身多区域淋巴结受侵(91.3%,21/23).各区域内肿大淋巴结可呈融合状,亦可呈孤立状,CT增强扫描呈中等、均匀强化。与金标准比较,MDCT检出区域淋巴结受侵的敏感性为82.1%,特异性为75.2%,MDCT对受侵淋巴结区域检出的一致性适中(Kappa值为0.410)。MDCT检出结外受侵10例(52.6%,10/19),包括肺受侵2例、脾受侵6例、扁桃体受侵3例、肠道受侵2例、乳腺受侵1例,其敏感性为75.4%,特异性为91.6%。与临床分期对照.23例患者中MDCT分期Ⅰ期1例(4.3%),Ⅱ期2例(8.7%),Ⅲ期13例(56.5%),Ⅳ期7例(30.5%).其分期准确率为73.9%(17/23)除4例因骨髓受侵将Ⅳ期低估为Ⅲ期外,将Ⅰ期高估为Ⅱ期1例,将Ⅲ期低估为Ⅱ期1例。结论 MDCT对MCL全身淋巴结受侵区域的检出具有较高的敏感性,分期准确率较高;除骨髓外,MDCT对结外受侵器官的检出敏感性亦较好。

Abstract： Objective To evaluate muhidetector computed tomography （MDCT） in the diagnosis and staging assess- ment of mantle cell lymphoma （MCL）. Method MDCT imaging was pefforrned in 23 patients with mantle cell lymphoma. The images were compared with clinical diagnostic criterion and pathologic results. Result Multi-regional involvements of lymph nodes were found in majority of 23 patients （91.3%, 21/23）. Regional lymph node involvement showed fused, moderate homogenous enhancement in MDCT. Compared with clinical diagnostic criterion and pathologic results, of all 575 regional lymph nodes in 23 patients, the sensitivity and specificity of MDCT for detecting lymph node involvement was 82. 1% and 75.2% , respectively. The Kappa test showed a moderate consistency with value of 0. 410. Extranodal organ involvement except hone marrow was found in 10 cases （89.5% , 10/23） by MDCT, including lung in 2 cases, spleen in 6, tonsil in 3, intestine in 2 and mammary in 1, with the sensitivity being 75.4% and specificity of 91.6%. Depending on MDCT staging, 1 case was classified in stage Ⅰ （4. 3% ）, 2 in stage Ⅱ （8. 7% ）, 13 in stage Ⅲ （56. 5% ）, 7 instage Ⅳ （30. 5 % ）. The accuracy of MDCT for MCL staging was 73.9% （ 17/23 ） compared with clinical staging. 4 cases in stage Ⅳ were underestimated as stage m because of bone marrow involvement, Ⅰcase in stage Ⅰ was overestimated as stage Ⅱ , and 1 case in stage Ⅲ was underestimated as stage Ⅱ by MDCT. Conclusion MDCT plays an important role in detecting muhi-regional involvement of lymph nodes and staging for MCL, and it is also useful for detecting the extran- odal organ involvement with high sensitivity.