肺黏膜相关淋巴组织淋巴瘤的CT、PET/CT表现及预后随访

Pulmonary mucosa-associated lymphoid tissue lymphoma: CT and PET/CT imaging findings and follow-up

目的:探讨肺黏膜相关淋巴组织(MALT)淋巴瘤的CT、PET/CT表现的多样性及病理学基础,提高对该病的认识。材料与方法:回顾分析27例经病理证实的肺MALT淋巴瘤患者的CT、PET/CT表现及病理资料,其中3例分别合并矽肺、干燥综合征及结核,4例同时有肺外受累。24例行胸部CT平扫及增强,2例行CT平扫,10例同时行PET/CT检查,1例仅行PET/CT扫描。结果:27例肺MALT淋巴瘤,单发3例,多发24例。27例CT均表现为肺实变,沿胸膜下或支气管血管束节段性分布,其中跨叶16例,不跨叶11例,其中24例见扩张型充气支气管,病灶边缘伴磨玻璃影或结节;同时其余肺叶伴有沿支气管血管束分布多发磨玻璃影或结节18例。病灶密度均匀,4例见少许钙化。轻度均匀强化7例,中度均匀强化17例,18例见血管造影征。肺门及纵隔淋巴结肿大4例。胸腔积液7例,胸膜增厚5例。11例病灶SUV范围2.5~14.4,平均为5.6±2.7;肺门及纵隔淋巴结放射性浓聚7例,SUV范围1.5~6.6,其中3例分别并泪腺、肝脏或股骨放射性浓聚,SUV范围3.4~6.8。21例随访,病情稳定或完全缓解18例,进展3例。免疫组化CD20及CD79a均阳性,CyclinD1均阴性,Ki-67阳性表达<20%。结论:肺MALT淋巴瘤的影像特征性表现为多发的结节及实变影,密度均匀,内有扩张充气支气管,18F-FDG高代谢,但确诊需靠病理学。

Objective： To investigate and improve the CT and PET/CT findings of pulmonary mucosa-associated lymphoid tissue （MALT） lymphoma. Methods： The findings and pathologic data of 27 patients with pathologically confirmed pulmonary MALT lymphoma were retrospectively analyzed on the CT and PET/CT image. Of all cases, 3 cases were with silicosis, Sjogren＇s syndrome and tuberculosis, and 4 cases invaded the lung. Twenty four cases had chest CT non enhanced and enhanced scan, 2 cases were of CT scan, 10 cases were underwent PET/CT and CT examination, 1 case was only with PET/CT scan. Results： Twenty four cases with muhiple lesions and three cases with solitary lesion were founded in all pulmonary MALT lymphoma cases （twenty seven cases）. Twenty seven cases of CT were manifested as pulmonary consolidation, along the subpleural or bronchial vascular bundle and segmental distribution, which crossed the lobes in 16 cases, not in 11 cases, of which 24 cases （24/27, 89%） had expansion of inflamed bronchus, the edge of the lesion with the frosted glass or nodules; while the rest of the lungs associated with multiple ground glass or nodules along bronchial vascular bundles in 18 cases. Lesion density was uniformity, and 4 cases had a little calcification. Mild degree enhancement were in 7 cases, and moderate degree enhancement was in 17 cases, 18 cases were with angiographic signs. Hilar and mediastinal lymphadenopathy was in 4 cases. Pleural effusion was in 7 cases, pleural thickening was in 5 cases. The SUV of 11 cases were 2.5±14.4, with an average of 5.6＋2.7. Mediastinal or hilar lymphadenectasis were concentrated was in 7 cases. The SUV ranged from 1.5 to 6.6, among which 3 cases were treated with lacrimal gland, liver or femur radioactivity, SUV ranged from 3.4 to 6.8. Twenty one cases were followed up, stable or complete remission was in 18 cases, progress was in 3 cases. CD20 and CD79a were all positive, CyclinD1 was all negative, Ki-67 positive expression was more than 20%. Conclusion： Pulmonary MALT lymphoma usually appears as multiple nodules and consolidations with air bronehogram and uniform density on CT, and heterogeneous high FDG uptake on PET/CT, and the final diagnosis depends on pathology.