脊柱原发非霍奇金淋巴瘤的影像和病理表现特征

Imaging and pathology manifestations of primary non-Hodgkin lymphoma of spine

目的:探讨脊柱原发非霍奇金淋巴瘤的影像和病理表现特征。方法:回顾性分析12例经病理确诊的脊柱原发非霍奇金淋巴瘤的影像学表现,12例均行CT平扫,其中9例行CT增强检查,11例行MRI平扫,其中10例行MRI增强检查。10例经穿刺活检证实,2例行手术切除并经病理学检查证实。结果:单椎体病变7例(其中颈椎1例,胸椎4例,腰椎2例),多椎体病变5例,2例呈跳跃性改变,4例呈连续椎体受累(其中1例合并跳跃性改变);6例伴病理性骨折,4例椎体压缩;CT表现为溶骨性骨质破坏伴软组织肿块9例,其中7例为虫蚀型,2例为浸润型;同时合并溶骨性骨质破坏和骨质硬化1例。MRI示软组织肿块包绕脊椎生长,骨质破坏区及周围软组织肿块在T1WI上呈等、略低信号,T2WI上呈略高信号,且MRI可显示骨质破坏不明显时髓腔内的早期浸润灶,增强扫描呈轻-中度强化。12例病理结果均为非霍奇金淋巴瘤(NHL),以弥漫大B细胞为主(10/12)。结论:脊柱原发非霍奇金淋巴瘤多表现为单椎体或连续椎体侵犯,以溶骨性骨质破坏为主(单纯虫蚀型、浸润型或合并骨质硬化),伴周围软组织肿块形成,软组织肿块位于硬膜外且包绕病变椎体生长,椎间隙正常,无明显骨膜反应改变,无钙化灶;穿刺活检是早期确诊脊柱原发非霍奇金淋巴瘤的重要手段。

Objective： To study the imaging and pathology manifestations of primary non- Hodgkin lymphoma （NHL） of spine. Methods： The imaging materials of twelve patients with pathology confirmed primary NHL of spine were retrospectively analyzed. All of the twelve patients had plain CT,of them,9 patients had contrast-enhanced CT. Eleven patients had plain MRI,ten cases with con trast-enhancement. Pathology diagnosis was obtained in 2 patients with surgical resection and 10 patients with needle biopsy. Results： Of the twelve patients, seven cases had solitary vertebral involvement,ineluding cervical spine （one case）, thoracic spine （four cases） and lumbar spine （two cases）. Five patients had multiple vertebral involvement, with skipped lesions in two cases and contiguous lesions in four cases （one ease one ease had also skipped lesions）. Associated pathology fracture of vertebrae were found in six cases;four cases had collapsed vertebra. CT showed osteolytie lesion with soft tissue mass in nine cases, including seven cases with moth-eaten appearance and two cases with infiltrative bone destruction;mixed osteolytie and osteosclerosis in one case. On MRI, soft tissue mass surrounding vertebrae destruction could be revealed, appearing as low signal on TIWI, high signal on T2WI. The soft tissue mass showed mild-to-moderate enhancement after contrast administration on CT and MRI. The pathology diagnosis was NHL in these 12 patients,with ten cases as diffuse larger B-cell lymphomas （10/12）. Conclusion：The imaging findings of primary NHL of the spine mainly manifested as a single or multiple contiguous vertebral body with osteolytic destruction （moth-eaten, infiltrative destruction or associated with osteosclerosis）, extra-dural soft tissue mass surrounding the vertebral lesion,normal intervertebral space, yet without periosteal reaction or calcification. Needle biopsy is an important approach for the early diagnosis of primary NHL.