非霍奇金淋巴瘤结外侵犯的影像学表现

Extra-lymphaden Imaging Manifestations of Non-Hodgkin's Lymphoma

目的 探讨非霍奇金淋巴瘤在淋巴结以外多系统侵犯的影像学特征。资料与方法 回顾性分析 16例经手术病理或穿刺活检证实的非霍奇金淋巴瘤的临床和影像学资料 ,并复习相关文献。结果 16例非霍奇金淋巴瘤中 ,侵犯骨骼系统 4例 ,分别累及髂骨、股骨、肱骨和脊柱 ,其中溶骨性破坏 3例 ,混合性改变 1例。侵犯软组织1例 ,MRI表现为等T1、长T2 信号的巨大肿块 ,增强后明显强化。肝脏侵犯 1例 ,CT表现为边界清楚的巨大肿块 ,伴有出血、坏死等不典型的肝肿瘤征象。脑室侵犯 3例 ,CT表现为脑室壁有多个稍高密度结节影 ,增强后结节均匀强化 ,周围的脑白质有水肿改变。鼻腔及鼻窦侵犯 3例 ,CT表现为鼻腔及鼻窦内软组织肿块和相对较轻的骨质破坏。侵犯胸部 3例 ,表现为纵隔、肺门区肿块影 ,增强扫描不强化。 1例肠系膜侵犯表现为边界清楚的不规则软组织肿块。结论 非霍奇金淋巴瘤结外多系统侵犯因其侵犯部位和生长方式的不同而具有相对特异的影像学表现 ,结合临床和相关资料 ,可使其诊断准确率提高 。

Objective To discuss imaging features of the extra-lymphaden, multi-systemic involvement in non-Hodgkin's lymphoma (NHL).Materials and Methods The clinical data and imaging findings, including plain film, CT and MRI, in 16 patients with pathologically-proved NHL were retrospectively analyzed. The related literatures were reviewed.Results Of 16 cases with NHL, skeletal involvement was found in 4, including ilium, femur, humerus and spine, respectively. Lytic bony destruction was seen in 3 cases, while osteoplastic-lytic mixed destruction in 1 case. One case showed soft-tissue involvement, presenting as a huge mass with iso-T 1 and long-T 2 signal on MRI, enhanced markedly after enhancement. Hepatic involvement occurred in one case, on CT scan the lesion displayed as a well-demarcated huge mass with atypical signs of liver neoplasm, such as hemorrhage and necrosis. Cerebral ventricle was affected in 3 cases, on CT scan the lesions were characterized by multiple nodules of high density along the ventricular wall, which could be homogeneously-enhanced, and edema was accompanied in the white matter around. In 3 cases involvement was found in nasal cavity and nasal sinuses, showing the signs of soft-tissue mass and slight bone destruction. Lesion in the thorax was seen in 3 patients, being marked by mediastinal or hilar mass and showing no enhancement after contrast administered. Mesentery was affected in one case, being manifested as a sharply marginated, irregular soft-tissue mass.Conclusion The extra-lymphaden, multi-systemic involvement in NHL has somewhat specific imaging features according to the site of involvement site and its growth pattern. Combined with the clinical and other related information, the diagnostic accuracy can be further improved, thus, providing reliable evidence very useful in guiding clinical management.