CT鉴别诊断原发性与继发性肺淋巴瘤

CT differential diagnosis of primary and secondary pulmonary lymphoma

目的观察CT鉴别诊断原发性肺淋巴瘤(PPL)与继发性肺淋巴瘤(SPL)的价值。方法回顾性分析接受胸部CT平扫的28例PPL(PPL组)及27例SPL(SPL组)患者,其中18例PPL及16例SPL接受增强扫描,观察病变CT表现;采用单因素分析及多因素logistic回归分析其CT平扫相关征象,筛选鉴别PPL与SPL的独立预测因素,并绘制受试者工作特征(ROC)曲线,评估各指标单独及联合鉴别诊断效能。结果PPL及SPL均可表现为肺结节、肿块或实变。PPL多为分布于肺外周的单发病变,可见支气管充气征伴扩张;SPL常为多发病变,多伴纵隔/肺门淋巴结肿大及胸腔积液(P均<0.05)。接受增强CT的18例PPL与16例SPL之间,病变强化方式差异有统计学意义(P=0.04),强化程度及是否存在血管造影征差异均无统计学意义(P均>0.05)。病变数目、充气支气管征伴扩张及胸腔积液是鉴别PPL与SPL的独立预测因素,其鉴别PPL与SPL的曲线下面积(AUC)分别为0.74、0.68、0.69,三者联合诊断的AUC为0.91。结论CT所见病变数目、充气支气管征伴扩张及胸腔积液有助于鉴别PPL及SPL。

Objective To explore the value of CT for differential diagnosis of primary pulmonary lymphoma(PPL)and secondary pulmonary lymphoma(SPL).Methods Totally 28 patients with PPL(PPL group)and 27 with SPL(SPL group)who underwent plain chest CT scanning were enrolled,among them 18 patients with PPL and 16 with SPL underwent enhanced chest CT.CT manifestations of PPL and SPL were observed.Univariate analysis and multivariate logistic regression analysis were used to explore the correlated plain CT signs of PPL and SPL,so as to screen the independent predictors for differentiating PPL and SPL.Receiver operating characteristic(ROC)curves were drawn to evaluate the efficacy of each index alone and in combination for differential diagnosis of PPL and SPL.Results Both PPL and SPL might present as pulmonary nodules,masses or consolidations.In PPL group,single lesion in the periphery of the lung accompanied by ectasis air-bronchogram sign was common,while in SPL group,multiple lesions accompanied by mediastinal/hilar lymphadenopathy and pleural effusion were often observed(all P<0.05).There was significant difference of the enhancement modes(P=0.04),while there was no significant difference of the enhancement degree and presence of angiographic signs between PPL(n=18)and SPL(n=16)(both P>0.05).The number of lesions,ectasis air-bronchogram sign and pleural effusion were all independent predictors for differentiating PPL and SPL,and the area under the curve(AUC)of each index alone for differentiating PPL and SPL was 0.74,0.68 and 0.69,respectively,of combined diagnosis was 0.91.Conclusion The number of lesions and the presence of ectasis air-bronchogram sign and pleural effusion showed on CT were helpful for differentiating PPL and SPL.