国人非霍奇金淋巴瘤侵犯腹部和盆腔淋巴结的CT表现

Abdominal and pelvic lymph node involvement in non-Hodgkin lymphoma:CT manifestations in Chinese patients

目的 分析国人非霍奇金淋巴瘤 (NHL)侵犯腹部和盆腔淋巴结的CT表现 ,探讨其与病理类型的关系。方法 NHL患者经腹部和 (或 )盆腔CT发现淋巴结阳性者 2 41例 ,其中 96例符合入组条件。按照临床归类标准分为惰性淋巴瘤 3 1例 ,侵袭性淋巴瘤 61例 ,高度侵袭性淋巴瘤 2例 ,不能归类 2例。CT扫描范围包括腹部和盆腔 46例 ,腹部 47例 ,盆腔 3例。 80例行增强扫描。淋巴结按照腹膜后、肠系膜、腹腔、膈脚后、横膈、髂总、髂内、髂外、腹股沟组分区。淋巴结的大小取横断面最大淋巴结的短径。分析受侵淋巴结大小、数目、孤立与融合、密度 ,以及与病理类型的关系。结果 (1)淋巴结大小 :以短径≤ 2cm淋巴结为多 ,按部位计算在惰性和侵袭性淋巴瘤中共占 60 5% (2 19/ 3 62处 ) ,分别占 56 6% (77/ 13 6处 ) ,62 8% (14 2 / 2 2 6处 ) (χ2 =0 3 4 1,P =0 559)。惰性与侵袭性淋巴瘤各部位受侵淋巴结的大小差异均无显著性意义 (P值均 >0 0 5)。 (2 )淋巴结数目 :以肠系膜受侵淋巴结数目最多 ,惰性 (6 5个 )多于侵袭性 (5个 )淋巴瘤 ;腹膜后次之 (惰性和侵袭性分别为 4个 ) ,其中肾门上、下淋巴结受侵数目多于单纯肾门上或肾门下受侵者。 (3 )淋巴结孤立与融合 :以孤立和孤立为主最为常见 ,占 77 1% (2 79/ 3 62?

Objective To study the CT m anifestations of abdominal and pelvic lymph nodes in non-Hodgkin lymphoma (NHL) of Chinese patients,and to investigate their correlation with pathology subtypes Methods The CT images of 241 patients with enlargement of abdominal and pelvic lymph nodes involved by NHL were reviewed Of them,96 patients whose clinical and imaging data fulfilled the requirement for analysis were included According to the Clinical Schema for the Lymphoid System,patients were divided into 3 subtypes,indolent lymphoma (IL; n =31),aggressive lymphoma (AL; n =61),very aggressive lymphoma (VAL; n =2),and unclassified lymphoma (UCL; n =2),respectively Abdominal and pelvic CT scans were undertaken in 46 patients,abdominal CT only in 47 cases,and pelvic CT only in 3 cases CT with iv contrast administration was obtained in 80 patients Anatomic sites involved were nominated as retroperitoneal (i e paraaortic),abdominal (including paracardiac,gastrohepatic,hepatic hilar,and mesenteric etc),retrocrural,diaphragmatic,common iliac,internal iliac,external iliac,and inguinal nodes,respectively Size,number,discreteness,and density of the nodal lesions were analyzed,and correlated with pathology subtypes The minimal dimension of the largest node was measured Results (1) Size: Most of the nodes were ≤ 2 cm in size,60 5% (219/362 sites) in IL and AL,56 6% (77/136 sites) in IL,and 62 8%(142/226 sites) in AL,respectively There was no statistical significant difference of the nodal size between IL and AL in each location (χ 2=0 341, P =0 559) (2) Number: Mesentery had the largest number of node involvement (6 5 vs 5 nodes on an median,IL vs AL),with retroperitoneum placed second (4 vs 4 nodes, IL vs AL) (3) Discreteness: Most of the nodes were discreted with an incidence o f 77 1% (279/362 sites,IL and AL),and 74 3% (101/136 sites) in IL,78 8% (178/226 sites) in AL,respectively No statistical significant discrepancy was found between the two pathological patterns (χ 2=0 971, P =0 324) (4) Density : Homogeneous enhancement was the most common finding after iv contrast administration,with an incidence of 86 0% (252/293 sites IL and AL),82 6% (100/121 sites) in IL,and 88 4% (152/172 sites) in AL,respectively,no statistical significance were found (χ 2=1 936, P =0 164) Central necrosis was slightly prevalent in IL compared with AL (14 vs 12 sites),yet,there was no statistical significance (χ 2=1 853, P = 0 173) (5) Relationship of size and density: Nodes≤2 0 cm were hom ogeneous in 97 7% (170/174 sites in IL and AL),98 5% (67/68 sites) in IL and 97 2% (103/106 sites) in AL For the nodes larger than 2 cm,central necrosis in IL and AL was significantly increased (χ 2=27 311 and 20 807, P =0 000 and 0 000) Conclusions (1) In NHL,abdominal and pelvic lymph node lesions were mainly homogeneously en hanced,discrete,and ≤2 cm in size No statistical significant difference between IL lymph node and AL was demonstrated in their size,number,and discreteness (2) The incidence of heterogeneity was obviously increased when a node was larg er than 2 cm