目的：探讨腹盆部结外淋巴瘤的CT、MRI、18F-FDG PET-CT多模态成像特点。方法：回顾性分析经手术病理证实的97例腹盆部结外淋巴瘤的临床资料及CT、MRI、18F-FDG PET-CT影像学特点。结果：97例腹盆部结外淋巴瘤患者，发病部位分别为胃肠道、肝脏、胰腺、脾、肾及肾上腺、膀胱等，非霍奇金淋巴瘤（NHL）较霍奇金淋巴瘤（HD）多见，最常见的组织学亚型为大B细胞型淋巴瘤和滤泡型淋巴瘤，T细胞淋巴瘤亦较为常见，CT检查为软组织密度或稍低密度肿块影；MRI T1WI为等或略低信号，T2WI上为等或稍高信号；增强检查呈轻度均质进行性强化，并可见血管分支自然穿行在病变中；18F-FDG PET-CT除上述CT图像特征外，同时表现为病灶摄取18F-FDG明显增高，呈结节样或团块样放射性浓聚，坏死区未见浓聚影。结论：腹盆部结外淋巴瘤影像表现具有一定特征性，CT、MRI、18F-FDG PET-CT多模态检查能够有效提高诊断正确率，最后确诊需依赖于病理。
Abstract
Objective: To explore the multimodal imaging features of extranodal lymphoma of the abdomen and pelvic and evaluate the diagnostic value． Methods: The clinical data and imaging features of CT, MRI and PET-CT of 97 cases with extranodal lymphoma confirmed by surgery and pathology were analyzed retrospectively. Results: The locations of 97 patients with extranodal lymphoma of the abdomen and pelvic included gastrointestinal tract, liver, pancreas, spleen, kidney and adrenal gland and bladder. Non-hodgkin lymphoma(NHL) was more common than Hodgkin’s lymphoma(HD). The most common histological subtypes were large b-cell lymphoma and follicular lymphoma. T-cell lymphoma was also more common. CT examination showed homogeneous density, MRI examination appeared uniform hypo or isointensity signal. Most showed low to middle degree dynamic delayed enhanced. Extranodal lymphoma of the abdomen and pelvic usually remained intrinsic anatomic structures. The lesion uptake of 18F-FDG was significantly higher, which showed nodular or mass sample radioactive concentration． When the necrosis was found in extranodal involvements, necrosis would form a circular-like 18F-FDG uptake increased foci． Conclusion: The CT, MRI combined with 18F-FDG PET-CT imaging features of extranodal lymphoma of the abdomen and pelvic have typical characteristic. It is important to recognize the imaging appearance of extranodal lymphoma to improve diagnostic accuracy. The final diagnosis depends on the pathology.
关键词
淋巴瘤 /
体层摄影术 /
螺旋计算机 /
磁共振成像 /
正电子发射断层显像术
Key words
Lymphoma /
Tomography, spiral computed /
Magnetic resonance imaging /
Positron-emission tomography
中图分类号：
Ｒ733.4
Ｒ814.42
R445.2
R817.4
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Lee WK, Lau EWF, Duddalwar VA, et al． Abdominal manifestations of extranodal lymphoma: spectrum of imaging findings[J]． AJR, 2008, 191(1): 198-206.
[2]Scutellari PN, Borgatti L, Spanedda R. Non-hodgkin’s lymphomas of extranodal localization. Strategies for imaging diagnosis[J]. Radiol Med(Torino), 2000, 100（4）: 262-272.
[3]Weber AL, Rahemtullah A, Ferry JA． Hodgkin and non-Hodgkin lymphoma of the head and neck: clinical, pathologic, and imaging evaluation[J]． Neuroimaging Clin N Am, 2003, 13(3): 371-392.
[4]Kumar V, Abbas AK, Fausto N, et al． Robbins and Cotran Pathopathlogic Bases of Disese[M]． 8th ed． Philadelphia: Elsevier, 2009: 589-632．
[5]Lu CL, Tang Y, Yang QP, et al． Hepatosplenic T－cell lymphoma: a clinicopathological, immunophenotypic and molecular characterization of 17 chinese patients[J]． Hum Pathol, 2011, 42(12): 1965-1978．
[6]刘萌，廖栩鹤，王荣福，等． 18F-FDG PET/CT在弥漫大B细胞淋巴瘤免疫亚型诊断中的应用[J]． 中国医学影像技术，2016，32（1）：75-78．
[7]Mylam KJ, El-Galaly TC, Hutchings M, et al． Prognostic impact of clinician-based interpretation of 18F-fluorodeoxy glucose positron emission tomography/computed tomography reports obtained in patients with newly diagnosed diffuse large B-cell lymphoma[J]． Leuk Lymphoma, 2014, 55(7): 1563-1569．
[8]Coleman M, Lammers PE, Ciceri F, et al． Ｒole of rituximab and rituximab biosimilars in diffuse large B-cell lymphoma[J]． Clin Lymphoma Myeloma Leuk, 2016, 16(4): 175-181．
[9]兰晓莉，张永学，谭旭波，等． 18F-FDG PET/CT在恶性淋巴瘤诊断与疗效评估中的作用[J]． 中国医学影像技术，2009，25（2）：305-308．
[10]Maksimovic O, Bethge WA, Pintoffl JP, et al． Marginal zone B-cell non-Hodgkin’s lymphoma of mucosa-associated lymphoid tissue type: imaging findings[J]． AJR, 2008, 191(3): 921-930.
[11]卢春燕． 原发性胃肠道淋巴瘤的CT诊断[J]． 国外医学：临床放射学分册，2003，26（2）：96-99．
基金
武汉市卫健委科研项目（立项编号：WX18Q32）资助；分子影像湖北省重点实验室项目资助（编号：02.03.2018-105）。
