原发性肠道淋巴瘤的螺旋CT表型和征象分析

Analysis of Spiral CT Phenotypes and Features of Primary Intestinal Lymphoma

目的:探讨原发性肠道淋巴瘤(PIL)的CT表现,以提高该病的影像诊断和鉴别水平。方法:收集北京医院从2013年3月至2022年2月的21例经病理证实的PIL患者资料,分析其CT表型及特征表现。结果:21例PIL均为非霍奇金淋巴瘤(NHL);12例为弥漫大B细胞淋巴瘤(DLBCL),3例为滤泡性淋巴瘤,2例为NK/T细胞淋巴瘤,2例为T细胞性淋巴瘤,黏膜相关淋巴组织淋巴瘤(MALT)和套细胞淋巴瘤(MCL)各1例;病变位于结肠7例,回肠5例,小肠系膜4例,回盲部2例,空肠1例,直肠1例,1例累及右半结肠和回盲部。CT检查显示,肠壁环周浸润型3例,肠壁增厚型3例,肿块型4例,动脉瘤样扩张型7例,肠系膜多发结节型4例。CT增强多表现为均匀的轻中度强化;21例患者中,2例合并肠穿孔,2例合并肠梗阻。结论:PIL的特征CT表现包括肠管多节段受累、肠壁局限性或弥漫性明显增厚、肠腔动脉瘤样扩张、偏心性密度均匀的肠腔肿块以及肠系膜“夹心面包征”,认识这些征象有助于提高对原发性肠道淋巴瘤的诊断。

Objective:To investigate the CT manifestations of primary intestinal lymphoma(PIL)so as to improve the diagnosis and differential diagnosis.Methods:21 patients with PIL confirmed pathologically in our hospital from March 2013 to February 2022 were enrolled in this study,their CT phenotypes and features were analyzed.Results:All 21 cases of PIL were non-Hodgkin’s lymphoma(NHL),12 cases were diffuse large B-cell lymphoma(DLBCL),3 cases were follicular lymphoma,2 cases were NK/T-cell lymphoma,2 cases were T-cell lymphoma,mucosa-associated lymphoid tissue lymphoma(MALT)and mantle cell lymphoma(MCL)were identified 1 case each.The lesions were located in the colon in 7 cases,ileum in 5 cases,small intestine mesentery in 4 cases,ileocecum in 2 cases,jejunum in 1 case,rectum in 1 case,and both right hemicolon and ileocecum in 1 case.CT findings showed intestinal wall infiltration in 3 cases,intestinal wall thickening in 3cases,mass in 4 cases,aneurysmal dilation in 7 cases and mesenteric multiple nodules in 4 cases.CT enhancement mostly showed homogeneous mild/moderate enhancement.Among the 21 patients,2 case was complicated by by intestinal perforation,and 2 cases were complicated by intestinal obstruction.Conclusion:The characteristic imaging features of CT in PIL include multifocal involvement of the intestines,marked mural thickening in a focal or diffuse manner,aneurysmal dilatation of lumen,eccentric intestinal mass of uniform density and mesenteric"sandwich sign".Recognition of these signs is of diagnostic value for primary intestinal lymphoma.