原发性肺弥漫大B细胞淋巴瘤的CT表现

CT findings of primary pulmonary diffuse large B-cell lymphoma

目的探讨原发性肺弥漫大B细胞淋巴瘤(DLBCL)的CT表现,以提高对该病的认识和诊断。方法回顾性分析2011年11月至2018年7月广州医科大学附属第一医院行CT平扫和增强检查并经病理确诊为原发性肺DLBCL患者的临床及CT影像资料。共入组14例患者。分析病灶的CT表现,包括病灶分布、大小、形态、边缘、密度与强化、支气管及病灶周围表现、胸腔内肺外表现及远处转移情况,并测量结节或肿块病灶的最大径线值及所有病灶平扫、增强动脉期和实质期的CT值。结果14例原发性肺DLBCL患者中,10例多发,4例单发。12例表现为肿块和/或结节,最大径线值为0.8~8.2 cm,中位数为5.3(2.9,7.8)cm,2例表现为单纯实变影。12例病灶边界清晰、光整,2例边界模糊。14例患者病灶CT平扫密度较均匀,CT值(35.1±1.0)HU,增强实质期轻中度均匀强化10例,不均匀强化4例,CT值(61.8±1.5)HU,动脉期CT值(50.9±1.3)HU,动脉期可见血管造影征9例。14例患者中,5例支气管通畅,4例见支气管轻度受压或狭窄,5例病灶内支气管受侵、闭塞。8例病灶周围间质轻度增厚,8例胸膜不均匀增厚、受侵。10例合并纵隔或肺门淋巴结肿大并融合,其中3例包绕或侵犯纵隔内大血管,7例呈钻缝样生长。4例合并少中量胸腔积液。8例患者经治疗后CT复查均无远处转移(7例经放疗、化疗或手术切除后病灶大部分消失,预后良好;1例化疗后瘤灶增大,病情进展),6例放弃治疗,要求出院。结论原发性肺DLBCL侵袭性强,恶性程度较高,有相对特征性的CT表现,确诊需依赖病理。

Objective To investigate characteristic CT manifestations of primary pulmonary diffuse large B-cell lymphoma(DLBCL).Methods CT images of 14 patients[10 males and 4 females,age(54±2)years old,range 32 to 91]with pathologically-proved pulmonary DLBCL lymphoma were retrospectively analyzed.Plain CT and contrast enhanced CT imaging were performed in all 14 patients.Image characteristics including lesion size,locations and distribution,morphology and margin,density and enhancement degrees,bronchia and lesion surroundings,other thoracic extra-pulmonary manifestations,as well as distant metastasis were analyzed and recorded.The maximal diameter of mass and/or nodules,pre and post-contrast CT values were measured.Among all 14 cases,8 cases were initially diagnosed as lung carcinoma,5 cases as infection,one case as lymphoma.Results Among all 14 primary lung DLBCL cases,there were 10 case with multiple lesions and 4 with single lesion.Masses and/or nodules were found in 12 cases,with the maximum diameter of the lesions as 0.8-8.2 cm,the median value as 5.3(2.9,7.8)cm.Two cases showed simple consolidation.The margins of the lesions were clear and smooth in 12 cases,and fuzzy in 2 cases.The density of the lesions on pre-contrast CT was relatively uniform,with mean CT value(35.1±1.0)HU.After contrast,10 cases displayed mild to moderate homogeneous enhancement,4 cases showed heterogenous enhancement.The mean CT value of post-contrast images was(61.8±1.5)HU.In arterial phase,the mean CT value was(50.9±1.3)HU.Angiographic sign was found in 9 cases in arterial phase.Of the 14 cases,bronchus was clear and smooth in 5 cases.In 4 cases,bronchus was found slight compressed or stenosis;and 5 cases showed intra-lesion bronchi invasion or occlusion.Interstitial tissue around the lesion was found slightly thickened in 8 cases.The pleura showed unevenly thickened and invaded in 8 cases.Mediastinal or hilar lymphadenopathy and fusion were found in 10 cases,with 3 cases involving mediastinal large blood vessels,and 7 cases displaying infiltrative growth pattern.There were 4 cases with pleural effusion.CT follow-up after treatment in 8 cases showed no distant metastasis(7 cases showed good prognosis,with lesions disappearing after radiotherapy,chemotherapy or surgical resection;1 case showed progressed with lesion increased after chemotherapy).Six patients abandoned the treatment and discharged from the hospital.Conclusions Primary DLBCL is a high invasive and malignant entity with certain CT characteristics.The confirmed diagnosis of pulmonary DLBCL depends on pathological results.