腹部恶性淋巴瘤螺旋CT表现特征

Helical CT Features of Abdominal Malignant Lymphoma

目的 明确腹部恶性淋巴瘤的螺旋CT强化特征,提高影像诊断水平。资料与方法 搜集经手术或病理证实的腹部恶性淋巴瘤41例。其中霍奇金病(HD)12例,非霍奇金淋巴瘤(NHL)29例。全部采用Siemens Somatom Plus 4螺旋CT机行增强扫描。在CT图像上,观察受累淋巴结的大小、形态、密度以及淋巴结增大的解剖优势分布。结果 累及腹部淋巴结的39例中,75％HD和74％NHL淋巴结增大呈普遍均匀强化密度,25％HD和26％NHL呈均匀强化合并坏死密度。HD和NHL均优势地累及小网膜(38％)、肠系膜(36％)、胰腺周围(41％)、腹主动脉周围上部(79％)及下部(74％)淋巴结。5例胃肠恶性淋巴瘤均示胃肠壁不规则增厚,3例伴淋巴结增大。脾HD中,7例呈均匀密度增大,3例有占位征象,脾NHL中,5例呈均匀密度增大,4例有占位征象。结论 螺旋CT显示的腹部恶性淋巴瘤淋巴结及结外器官病理改变,有利于临床肿瘤的分期及疗效的判定。

Objective To study enhanced helical CT features of abdominal malignant lymphoma, and to improve its imaging diagnosis. Materials and Methods Forty-one cases of pathologically proved abdominal malignant lymphoma were collected, of which Hodgkin's disease (HD) was seen in 12 and non-Hodgkin's lymphoma (NHL) in 29. Enhanced helical CT scanning was performed in all patients on a Siemens scanner (Somatom plus 4). The observation of CT signs was focused on the size, shape, density and distribution of the lymph nodes. Results Involvement of the abdominal lymph nodes was found in 39 cases. Diffuse and homogeneous enhancement of the enlarged lymph nodes was seen in 75% HD and 74% NHL, while homogeneous enhancement of the enlarged lymph nodes with necrosis was seen in 25% HD and 26% NHL. Both HD and NHL were apt to affect the lymph nodes in the lesser omentum (38% ), mesentery (36% ), peri-pancreatic area (41% ), and both upper (79% ) and lower (74% ) para-aortic regions. Irregular thickened gastrointestinal wall was seen in all 5 patients with gastrointestinal lymphoma, with lymphadenopathy in 3 . In patients with HD of spleen, splenomegaly with homogeneous density was seen in 7, and space-occupying effect was displayed in 3 . In patients with NHL of spleen, splenomegaly with homogeneous density was seen in 5, and space-occupying effect was displayed in 4. Conclusion Helical CT scan can easily demonstrate the involvement of both lymph nodes and abdominal organs, which is very useful for staging the tumor and evaluating the therapeutic effect.