骨原发性淋巴瘤的影像学诊断与鉴别诊断

摘要

Objective To explore the CT and MRI findings of the primary bone lymphoma (PBL) and its differential diagnosis. Methods Clinical data and imaging findings in 21 patients with PBL confirmed by operation and pathologic examination were ret-rospectively analysed. The size,shape,density,signal,boundary,strengthen and the changes of the adjacent structure of the mass wereobserved. Results Total of the 17 cases infringed the single bone,and other 4 cases infringed the multiple bones. PBL mainly showed an ill-defined soluble bone destruction which looks like platelike or worm-eaten. The bone cortex of some cases were dis-continuous or interrupted,together with platelet residual bone on its edge. However,the residual bone didn't exceed the region of the interrupted bone cortex. Some cases had periosteal reaction and pathological fracture. PBL showed low or mild low density on CT images,and showed equal T1 and long or equal T2 signal on MRI. The signal were mainly uniform. The tumor mainly showed u-niform and slightly lower density moderate enhancement after the administration of Gd-DTPA. Conclusion The PBL has certain imaging characteristics,and the early diagnostic is helpful for the preoperative localization and evaluating the postoperative extent.%目的 探讨骨原发性淋巴瘤(Primary bone lymphoma,PBL)的影像学表现及其鉴别诊断.方法 回顾性分析我院经病理证实的21例骨原发性淋巴瘤(男13例,女8例)的临床及影像学资料,分析病变的大小、形态、密度、信号、边界、强化方式及邻近结构的改变.结果 单骨发病者17例,多骨发病者4例.PBL主要表现为边界不清的虫噬样或大片状溶骨性骨质破坏,可见骨皮质中断或不连续,其边缘可见小片状残骨,但残骨均不超过骨皮质中断范围.部分可合并骨膜反应及病理性骨折.CT以低或稍低密度为主,MRI上T1WI以等T1、T2WI上以等或稍长T2信号为主,信号多均匀.增强扫描以中度均匀强化为主.结论 PBL具有一定的影像学特征,早期确诊对其术前定位及术后预后评估具有重要的临床价值.