Waldeyer环淋巴瘤的CT和MRI表现

目的研究Waldeyer环淋巴瘤的CT和MRI表现及应用价值。方法对照分析23例Waldeyer环淋巴瘤的CT和MRI表现和手术、病理结果。结果11例腭扁桃体淋巴瘤和3例舌根淋巴瘤均表现为边界清楚向咽腔内突出的软组织肿块。5例鼻咽和4例咽侧壁淋巴瘤表现为鼻咽腔或口咽腔内不规则软组织肿块，病变范围较大，向周围呈弥漫性生长，无颅底和周围结构损害。CT和MRI可见淋巴瘤的密度和信号均匀，呈轻度强化，没有发生坏死和囊变，肿块与相邻结构界限清楚。23例淋巴瘤有15例发现颈部有淋巴结转移，5例鼻咽淋巴瘤中，3例侵犯鼻腔。结论CT和MRI能清楚显示Waldeyer环淋巴瘤的部位、形态、范围，有无颈部淋巴结转移和周围组织的侵犯，对临床诊断和治疗有重要价值。     

Waldeyer环淋巴组织增生及恶性淋巴瘤的MRI和CT研究

目的 :研究Waldeyer环淋巴组织增生及恶性淋巴瘤的MRI和CT表现及应用价值。方法 :对照分析 172例Waldeyer环淋巴组织增生及 2 1例恶性淋巴瘤的MRI和CT表现和手术、病理结果。结果 :172例咽部淋巴组织增生可发生于双侧咽扁桃腺、腭扁桃腺或舌根部、软腭等 ,也可沿咽壁弥漫肥厚、增生 ,引起口咽腔狭窄 ,其中 5 5例伴有睡眠时呼吸暂停综合症 (OSAS)。CT表现为增生组织或咽部弥漫性增厚 ,边界锐利 ,平扫为均匀等、高密度 ,可轻度均匀强化。MRIT1WI表现为等信号 ,T2 WI为高信号 ,颈部无肿大淋巴结。 2 1例恶性淋巴瘤有 10例发生在腭扁桃腺 ,3例在舌根部 ,均表现为向咽腔突出的类圆形软组织肿块 ;5例鼻咽和 3例咽侧壁淋巴瘤均表现为不规则的软组织肿块 ,病变范围较大 ,向四周弥漫生长 ,但无颅底及周围结构损害。MRI和CT可见肿块的密度和信号均匀 ,可轻度强化。 2 1例恶性淋巴瘤有 13例发现颈部淋巴结受侵。结论 :MRI和CT能清楚显示Waldeyer环淋巴组织增生和恶性淋巴瘤的部位、形态、范围以及有无颈部淋巴结受侵和周围组织的侵犯 ,对临床诊断和治疗有重要价值     

腹部结外淋巴瘤:CT影像学表现与病理学的关系

淋巴瘤是一组发生于淋巴结和(或)结外淋巴组织及单核巨噬细胞系统的恶性肿瘤.腹部有着丰富的结外淋巴组织,故淋巴瘤常侵犯腹腔各脏器的结外淋巴组织,而CT表现多种多样,与腹部其他恶性肿瘤或炎症病变相似,极易混淆.本文就腹部结外淋巴瘤的CT影像学表现与病理学的关联性作一综述,以进一步提高对腹部结外淋巴瘤的认识和CT诊断的正确率.     

咽及颈部淋巴瘤的影像分析

目的：探讨咽和颈部淋巴瘤的影像学特征,提高诊断水平。方法：搜集20例经穿刺活检及手术病理证实的咽和颈部淋巴瘤的临床、病理及CT和（或）MRI资料,详细分析其影像学表现。结果：本文20例中9例表现为腭扁桃体肿大伴颈部淋巴结肿大;4例表现为咽旁间隙肿块并向四周铸型生长;5例颈部多发淋巴结肿大,其中4例向下一直延伸至上纵隔内;2例表现为颈部单发肿块。18例肿块密度、信号均匀,无明显坏死,轻度强化;2例可见少许坏死囊变,密度不均匀。结论：咽和颈部淋巴瘤CT和MR表现具有一定特征性,当出现咽淋巴环肿块、咽旁间隙内铸型生长的肿块及伴有身体其它部位（如纵隔）的淋巴结肿大,对淋巴瘤的诊断有提示作用。     

结外淋巴瘤:影像学共性特征与病理的关系

目的 分析结外淋巴瘤的影像学特征,探讨影像学对其诊断价值.资料与方法 回顾性分析57例经手术病理证实的结外淋巴瘤病例,非霍奇金病54例,霍奇金病3例,初诊时均无明确淋巴瘤病史,术前分别经常规X线、CT和MRI检查.结果 57例结外淋巴瘤中,消化道14例,骨骼9例,脑7例,肾5例,肺4例,脾4例,肾上腺4例,肝脏3例,肌肉3例,胰腺2例,睾丸1例,阴道1例.常规X线检查22例,术前诊断6例;CT检查39例,术前诊断17例;MRI检查19例,术前诊断12例.CT检查47个病灶中,41个病灶密度均匀,6个病灶有程度不等坏死.MRI检查26个病灶中,T1WI为低或等信号,25个病灶T2WI为低、等或略高信号,1个病灶为高信号;17个病灶信号均匀,9个病灶信号不均匀.动态CT和MR增强47例,除脑淋巴瘤为进行性显著持续强化外,其他部位淋巴瘤为进行性轻到中度延迟强化.结外淋巴瘤瘤内常可见脏器原有解剖结构,如血管、支气管、肾盂、肌间隙等残留.结论 结外淋巴瘤共性表现包括肿瘤密实,瘤内可见原有解剖结构残留,MR T2WI多为等或略高信号;一般轻度至中度延迟强化.掌握结外淋巴瘤的一些特征性影像学表现,有利于提高诊断准确率.     

肺原发性淋巴瘤的多层螺旋CT 诊断

目的：探讨肺原发淋巴瘤的多层螺旋CT特征,提高对本病的认识。方法回顾性分析经病理证实的肺原发淋巴瘤21例多层螺旋CT表现。结果21例患者均为非何杰金淋巴瘤,其中黏膜相关淋巴组织结外边缘区B细胞淋巴瘤16例,高度恶性弥漫性大B细胞非霍奇金淋巴瘤4例,T细胞淋巴瘤1例。结节和肿块型8例,肺炎肺泡型7例,混合型6例。病灶内可见支气管充气征14例,病灶周边可见小叶间隔增厚4例,可见病变跨叶生长2例,合并胸腔积液5例。结论肺原发淋巴瘤多层螺旋CT表现多样,沿肺间质分布的多发肿块或边缘清晰的实变伴支气管壁增厚,病变周边小叶间隔增厚,抗感染治疗无效,可以提示肺淋巴瘤的诊断。     

鼻腔NK/T细胞淋巴瘤的CT诊断

目的探讨鼻腔NK/T细胞淋巴瘤的表现特征。方法回顾性分析26例经病理证实的鼻腔NK/T细胞淋巴瘤患者的CT表现,评价其诊断意义。结果 CT表现:①21例发生于鼻腔前部;②15例出现鼻背部及面颊部软组织肿胀,皮下脂肪消失;③8例出现骨质破坏,其中7例破坏较轻微;④6例出现咽淋巴环增厚;⑤5例增强扫描表现为轻度强化。结论鼻腔NK/T细胞淋巴瘤具有相对特异性的CT表现,咽淋巴环增厚具有一定诊断价值,CT检查对本病诊断具有重要意义。     

腹部结外脏器原发性淋巴瘤的CT表现

目的探讨腹部结外脏器原发性淋巴瘤的CT表现。方法回顾性分析经病理证实的31例腹部结外脏器原发性淋巴瘤的CT表现,并与病理结果对照分析。结果 1)31例均为非霍奇金淋巴瘤,初诊时均无明确淋巴瘤病史,其中B细胞性26例(83.8%),T细胞性3例(9.7%),NK/T细胞性2例(6.5%);2)31例结外脏器淋巴瘤,其中肾脏6例,肝脏、肾上腺和直肠各4例,胃3例,脾脏、膀胱和卵巢各2例,胆囊,胰腺,输尿管和子宫各1例;3)累及空腔脏器者13例,CT表现为管壁不均匀增厚(7.8~26.4mm),其中弥漫性增厚5例,局限性增厚7例,1例累及子宫CT表现为子宫体积明显增大,子宫内软组织肿块影,增强扫描呈中度均匀强化。累及实质脏器者18例共38个病灶,呈圆形或类圆形23个,地图样或不规则形15个,病灶直径2.1~14.2cm,平均直径6.3cm。32个病灶CT平扫密度均匀,6个病灶密度不均,无出血或钙化;增强扫描轻度强化16例,中度强化21例,明显强化1例,8例可见"血管漂浮征"。结论腹部结外脏器原发性淋巴瘤的CT表现具有一定的特征性,CT对其诊断具有重要价值。     

原发性骨淋巴瘤CT及MRI诊断

目的探讨原发性骨淋巴瘤CT及MRI表现,以提高对该病的诊断水平。方法回顾性分析12例经临床病理证实的原发性骨淋巴瘤的影像学资料。结果12例原发性骨淋巴瘤中10例为B细胞源性,2例为T细胞源性。侵犯骨盆3例,椎体3例,肋骨2例,胸骨2例,颅骨2例。CT及MRI扫描中,9例原发性骨淋巴瘤单发。3例原发性骨淋巴瘤多骨发生。其中溶骨型7例,浸润型3例,混合型2例,均合并有病理性骨折。颅骨2例均部分形成软组织肿块。MRI表现为T1wI呈等或低信号,T1wI呈等或稍高信号。结论原发性骨淋巴瘤的CT和MRI表现具有一定特征性,有助于诊断和鉴别诊断。     

头颈部结外非霍奇金淋巴瘤的MRI应用价值

目的：探讨头颈部结外非霍奇金淋巴瘤（NHL）的MRI表现及其临床应用价值。方法：回顾性分析48例经病理证实的头颈部结外NHL患者的MRI资料。所有患者均行MRI常规检查,41例同时行增强检查,8例同时行扩散加权成像（DWI）检查。结果：48例中有42例MRI诊断为淋巴瘤,诊断符合率为87.5%。病变形态：弥漫肿胀型14例（29.2%）,结节肿块型20例（41.7%）,溃疡坏死型4例（8.3%）,混合型10例（20.8%）。病灶的主要MRI表现为于T1WI和T2WI呈均匀中等信号,增强扫描有中度均匀强化,DWI上呈明显高信号,平均ADC值为（0.59±0.11）×10^-3mm^2/s,病变检出率为100%。结论：MRI对头颈部结外NHL的诊断准确性较高,在其诊断和鉴别诊断方面有重要的临床应用价值。     

Lymphomas of the head and neck: CT findings at initial presentation

CT findings were reviewed in 68 patients with untreated head and neck lymphoma. More than half of the patients with either Hodgkin's disease or non-Hodgkin's lymphoma were detected in the earlier stages (stage I or II). Four types of abnormalities were identified with CT: nodal involvement alone (type 1), extranodal involvement alone (type 2), a combination of extranodal and nodal disease (type 3), and multifocal extranodal disease with or without nodal involvement (type 4). In the 18 patients with Hodgkin's disease, a subgroup of mixed cellularity was most common; type 1 was the prevailing CT presentation, and no type 2 or 4 lesions were observed. In the 50 patients with non-Hodgkin's lymphoma, diffuse large-cell lymphoma was the most common histologic subtype, and the most common CT presentation was type 2, followed by type 3. Lymphomatous nodes may be extensive and confluent, but often they are smaller than 2 cm and rarely are necrotized. The most frequent extranodal sites of head and neck lymphomas are Waldeyer's ring, paranasal sinuses, and nasal cavity. Extranodal lymphoma cannot be differentiated reliably from the more commonly occurring carcinoma, although it is less often associated with invasion and destruction of adjacent bony structures. Multiple sites of extranodal involvement, with or without neck lymphadenopathy, may suggest a diagnosis of non-Hodgkin's lymphoma.     

Non-Hodgkin's lymphoma of the head and neck: CT evaluation of nodal and extranodal sites

Forty-five patients with non-Hodgkin's lymphoma (NHL) of the extracranial head and neck who had undergone CT as part of their evaluation were reviewed to assess the impact of CT on clinical management. The sites of tumor deposition were subdivided by location: I, nodal; II, extranodal, lymphatic (Waldeyer's ring); and III, extranodal, extralymphatic (orbit, sinonasal, deep facial spaces, mandible, salivary gland, skin, and larynx). The CT appearance of NHL in each of the three locations was analyzed for characteristic CT signatures. Nodal NHL was suspected when CT showed multiple, large, homogeneous lymph nodes, often in unusual nodal chains of the head and neck. Extranodal, lymphatic NHL of Waldeyer's ring was indistinguishable from squamous cell carcinoma of this area unless synchronous tumor deposit in an extranodal, extralymphatic location was also present. When NHL was in nodes and/or Waldeyer's ring, CT-derived information was of limited clinical value since treatment was unfocused (chemotherapy and/or large-field radiotherapy). The CT appearances of extranodal, extralymphatic NHL was generally not distinguishable from other malignancies of these areas. However, CT-derived information regarding deep-tissue tumor size and extent was critical to planning the radiotherapy ports.     

Lymphoma of the head and neck

Lymphoma is the second most common neoplasm of the head and neck region and should be considered in the differential diagnosis of any lesion in this region, especially if the typical factors for squamous cell carcinoma are not present. The head and neck is the second most common site for extranodal lymphoma. It can involve virtually any region, including the orbit, paranasal sinuses, Waldeyer's ring, salivary glands, or thyroid. Communication with the surgeon and pathologist is essential to prevent an incorrect or delayed diagnosis. One should consider the diagnosis of lymphoma especially when multiple, large, nonnecrotic lymph nodes are present or multiple sites of disease are identified in extranodal tissue.     

Imaging of extranodal lymphoma with PET/CT

Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL) represent a spectrum of malignant neoplasms arising from the lymphoid system with an incidence of around 8% of all malignancies. Although they are generally known as tumors of lymph nodes, 25% to 40% of HD/NHL tumors, especially NHL, arise at extranodal sites along the gastrointestinal tract, head and neck, orbit, central and peripheral nervous system, thorax, bone, skin, breast, testis, thyroid, and genitourinary tract. Extranodal involvement is an important pretreatment prognostic factor for patients with lymphoma and its incidence has increased in the past 2 decades. Imaging plays an important role in the noninvasive pretreatment assessment of patients with extranodal lymphoma. This involvement can be subtle and may be overlooked during computed tomography (CT). Positron emission tomography/CT (PET/CT) has evolved into an important imaging tool for evaluation of lymphomas, facilitating the detection of affected extranodal sites even when CT shows subtle or no obvious lesions. Familiarity with extranodal manifestations and suggestive PET/CT features in different sites is important for accurate evaluation of lymphoma. This article reviews the extranodal PET/CT imaging findings regarding HD and NHL.     

FDG PET can replace bone scintigraphy in primary staging of malignant lymphoma.

Recent studies indicated that 18F-fluorodeoxyglucose (FDG) PET may be more accurate than CT in staging nodal and extranodal malignant lymphoma. The objective of this study was to compare conventional bone scintigraphy as an established skeletal staging procedure with PET using FDG in the detection of osseous involvement in malignant lymphoma. METHODS: Whole-body PET-based staging studies of 56 consecutive patients with proven Hodgkin's disease (n = 34) or non-Hodgkin's lymphoma (n = 22) were compared with the results of bone scintigraphy. Positive PET or bone scintigraphic findings were confirmed, if possible, by biopsy, MRI, CT or radiographic investigations. RESULTS: Of the 56 patients studied, 12 were found to have skeletal involvement on both studies (PET, 30 regions; bone scintigraphy, 20 regions). Findings were confirmed in all 12 patients. FDG PET detected an additional 12 involved regions in 5 patients. This was subsequently verified in 3 patients, although the other 2 cases remained unresolved. Conversely, bone scintigraphy revealed five abnormalities compatible with lymphoma in 5 patients. Three of these lesions were found to be erroneous; final evaluation of the remaining two findings was not possible. CONCLUSION: FDG PET is suitable for identifying osseous involvement in malignant lymphoma with a high positive predictive value and is thereby more sensitive and specific than bone scintigraphy.     

Radiological assessment of extranodal lymphoma: spectrum of disease

Summary Primary extranodal lymphoma manifestation in the narrow sense is the term used to define the primary organ manifestation of a malignant lymphoma, excluding the thymus, spleen, Waldeyer's tonsillar ring, the appendix and Peyer's patches. However, in the clinical routine the term is also used for the secondary organ manifestation of underlying lymphoproliferative disease. Primary extranodal lymphomas are mainly non-Hodgkin lymphomas; there is primary extranodal manifestation of Hodgkin's disease in only about 1 % of the cases. Among the extranodal NHL, the highly malignant forms predominate. A major exception is MALT lymphomas, which mainly show low slow growth. In the past, they were considered to be pseudolymphomas because of their slow and localized tumor growth. They were included as an entity of their own for the first time in the Revised European American Lymphoma (REAL) classification of 1994. The incidence data vary between < 10 % and 25 % for primary extranodal manifestation. The major reason for this is the difference in extranodal regions because of classification. Secondary organ involvment of an NHL occurs in up to 40 % of the cases in the long-term course of the disease in primary nodal lymphomas. Secondary organ involvment is frequently diagnosed in AIDS patients who develop an AIDS-related lymphoma (85 % of cases). The following contribution reports on the radiological imaging of extranodal lymphoma manifestation in the thoracoabdominal region. Eingegangen am 2. Dezember 1996 Angenommen am 10. Dezember 1996     

Results of radiotherapy in stage I to II extranodal non-Hodgkin's lymphoma of the head and neck

29 patients with previously untreated clinical stage I and II extranodal non-Hodgkin's lymphoma of the head and neck received involved or extended field radiotherapy at the Northern Israel Oncology Center during the years 1968 to 1979. Complete initial locoregional control was achieved in all patients; however, 18 patients (62%) relapsed. Two of the relapsing patients (11%) had "in field" failure, and one (6%) had "marginal" failure, with no evidence of disease elsewhere. 13 of the relapsing patients (72%) failed at distant sites, and two of these (11%) both locally and systemically. 13 of 15 patients (87%) with lymphoma of Waldeyer's ring relapsed, most commonly in the abdominal cavity. Only one of seven patients (14%) with lymphoma of the paranasal sinuses recurred. The five- and ten-year actuarial survival of all patients was 50% and 46%, respectively. While patients with lymphoma of the paranasal sinuses had a survival probability of 86% at ten years, patients with disease originating in Waldeyer's ring had an actuarial ten-year survival of 18% only. The prognosis of younger patients was better than the prognosis of patients older than 65. Although this series is too small and heterogeneous to derive definite treatment recommendations, it is suggested that radiotherapy to doses of 4000 to 6000 cGy can control most local disease. The overall results of radiation therapy alone have been unsatisfactory in our patients with lymphoma of Waldeyer's ring and the parotid gland due to failure outside the locally treated area, frequently in the abdominal cavity. Precise staging procedures are needed to detect sites of occult disease which require the use of systemic chemotherapy. It is felt that adequately staged, localized, small size non-Hodgkin's lymphoma of the paranasal sinuses can be treated by radiotherapy alone without loss of curability.     

MRI of neck nodes in non-Hodgkin's lymphoma of the head and neck

The aim of this study is to describe the imaging features of neck nodes in non-Hodgkin's lymphoma (NHL). The MR scans of 61 patients undergoing staging of a primary extranodal NHL of the head and neck were reviewed retrospectively. Those MR images with nodal disease were assessed for (a) the pattern of nodal disease, (b) presence of nodal necrosis and (c) presence of extracapsular neoplastic spread (ENS) and nodal matting. The features of the nodal disease were analysed in relationship to the sites of the primary NHL (palatine tonsil (PT) n=23, nasal cavity (NC) n=24, nasopharynx (NP) n=6, other extralymphatic sites (OES) n=8), and histology (natural killer/T-cell (NK/T) n=26, diffuse large cell (DLC) n=24, other subtypes (OS) n=11). Nodal disease was present in 26 patients (43%) and occurred in NHL of the PT n=16 (70%), NP n=3 (50%), NC n=5 (21%) and OES n=2 (25%) and in DLC n=15 (63%), NK/T n=6 (23%) and OS n=5 (45%). Nodal disease was significantly more frequent in DLC than NK/T lymphomas (p=0.0053). Nodal disease spread in a contiguous fashion in 25 (96%) patients with nodes. Necrosis was present in 7 of 26 (27%) being present in DLC of the PT in 5, NK/T of the NP in one and NK/T of the NC in one. ENS and matting were present in 19 (73%) and 13 (50%) patients with nodes, respectively. ENS was found in DLC, NK/T, OS, NC, NP, PT, OES (11, 4, 4,1, 2, 14, 2, respectively) and matting was found in DLC, NK/T, OS, NC, NP, PT, OES (9, 3, 1, 0, 2, 10, 1, respectively). Nodal NHL spreads in a contiguous fashion and is most commonly associated with DLC lymphoma of the NP and PT in Waldeyer's ring. Extracapsular nodal spread is frequent and found in most histological subtypes especially those arising from Waldeyer's ring. Necrosis is more common than previously believed.     

Accuracy of CT in detecting squamous carcinoma metastases in cervical lymph nodes

The accuracy of computed tomography (CT) in the assessment of nodal metastases was correlated retrospectively with the pathological examination in 28 patients with known head and neck squamous cell carcinoma, who underwent neck dissections. Three patients had bilateral neck dissections resulting in a total of 31 dissections. CT scanning correctly staged 28 of 31 neck dissections providing an accuracy of 90%, a sensitivity of 87.5% and a specificity of 100% in the detection of nodal metastases. Of the 21 true positives, underestimation of the extent of nodal disease occurred in seven cases. Regarding extracapsular nodal spread, CT resulted in an accuracy of 62%, a sensitivity of 62.5% and a specificity of 60%. All three false negatives for nodal metastases occurred in metastatic spread to the submandibular nodes. The existing criteria for assessment of nodal metastases with CT are sensitive and specific, but in the assessment of extranodal spread CT may not detect 37.5% of cases.