原发性骨淋巴瘤影像学表现与病理特征

Pathological Features and Imaging Analysis of Primary Bone Lymphoma

目的:探讨总结原发性骨淋巴瘤的影像学表现及病理特征,以提高其诊断准确性。方法:回顾性分析2012年1月至2017年12月经病理证实的21例原发性骨淋巴瘤患者的X线片,CT,MRI及SPECT的影像学资料,仔细复习其影像学征象并与病理特征作参照。结果:21例患者,单发18例,多发3例。单发18例中,椎骨6例,股骨4例,肱骨及髂骨各2例,肋骨、腓骨、尺骨、肩胛骨各1例。多发3例中,多节段椎骨1例,累及椎骨、髂骨1例,累及下颌骨、股骨、胫骨、左腕骨及双足跗骨1例。X线和CT显示溶骨型19例,混合型2例,病理骨折11例,有明显的软组织肿块11例。MRI检查9例,信号均匀7例,信号不均匀2例;病灶T1WI呈等信号或稍低信号,T2WI呈稍高信号2例、高信号7例。MRI增强扫描7例,肿瘤不均匀强化3例,均匀强化4例。SPECT显像8例,病灶均表现为核素异常浓聚。病理类型均为弥漫性非霍奇金淋巴瘤,其中B细胞19例,T细胞2例。结论:原发性骨淋巴瘤可发生于全身骨骼各个部位,有一定影像学特征,综合应用多种影像学检查可增加病变显示的信息量,但最终确诊仍需要病理学检查。

Objective:To summarize the imaging and pathological features of primary bone lymphoma(PBL),in order to improve its diagnostic accuracy.Methods:The imaging data of 21 cases with PBL confirmed by pathology were retrospectively analyzed and compared with corresponding pathological results.Results:Of these 21 cases,single bone involved in 18 cases and multiple bones involved in 3 cases.Of these 18 cases,6 cases involved in vertebrae,4 cases of femurs,2 cases of humerus and iliums respectively,1 case of ulnar,rib,tibia and scapular respectively.Of these 3 cases,1 cases involved in vertebrae,1 case vertebrae and ilium,1 case mandible,femur,tibia,left carpal bone and bilateral tarsal.X-ray and CT showed osteolytic destruction type in 19 cases,mixed destruction type in 2 cases,pathological fracture in 11 cases,obvious soft tissue mass in 11 cases.MRI examination in 9 cases showed homogeneous signal in 7 cases,heterogeneous signal in 2 cases,isointense signal on T1 WI in 2 cases,high signal on T2 WI in 7 cases.Enhanced scanning in 7 cases,3 cases of tumor showed nonuniform enhanced,4 cases uniform enhanced.SPECT imaging in 8 cases,the cases showed abnormal concentration of nuclides.Pathological types were diffuse non-Hodgkin’s lymphoma,including 19 cases of B cells,2 cases of T cells.Conclusion:PBL can occur in all parts of the body skeleton,imaging features have some characteristics,comprehensive application of a variety of imaging can fully display the disease,but the final diagnosis still requires pathological examination.