原发性骨淋巴瘤的影像诊断

[摘要] 目的 分析原发性骨淋巴瘤的影像表现，以提高对该病的诊断水平。方法 回顾性分析14例经病理证实的原发性骨淋巴瘤的影像资料，其中CT检查9例，5例行增强扫描；MRI检查12例，7例行增强扫描。结果 14例原发性骨淋巴瘤中12例为B细胞源性，2例为T细胞源性。11例侵犯单一骨，3例侵犯多骨，共侵犯19处骨骼。其中骨盆8例次，椎体5例次，股骨4例次，颅骨2例次。行CT扫描的9例中，6例表现为溶骨性破坏，呈虫蚀样、筛孔样，2例呈浸润性骨质破坏，1例呈混合型骨质破坏，2例出现骨膜反应。行MRI扫描的12例均可见骨髓侵犯，伴周围软组织肿块。T1WI呈等或低信号，T2WI呈等或高信号，增强扫描病灶呈明显不均匀强化。T2WI脂肪抑制序列显示骨髓腔侵犯更为清楚，可见病变区骨髓腔信号明显增高。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。

The imaging diagnosis of primary bone lymphoma

Object To analyze the imaging appearances of primary bone lymphoma and to improve the diagnostic accuracy. Methods 14 cases of primary bone lymphoma confirmed by pathology were included in the study. CT and MR imaging were reviewed retrospectively, CT scans were available for 9 cases with enhancement of 5; MR imaging were available for 12 cases with enhancement of 7. Result There was B-cell origin in 12 cases and T-cell origin in 2 cases. The lesions involved single bone in 11 and multiple bone in 3(pelvis 8 , vertebra 5, femur 4 and skull 2). In 9 cases with CT scans, 6 were osteolytic; displayed as moth-eaten or permeative pattern of destruction, 2 were invasion destruction, and 1 was mixed type destruction. 2 cases demonstrated periosteal reaction. In 12 cases of MR studies, bone marrow was infiltrated and both lesions can be seen around soft-tissue mass in all cases.T1WI were isointensity or hypointensity, T2WI were isointensity or hyperintensity. T2WI fat-suppression showed lesions more clearly, hyperintensity in bone marrow were seen in all cases. Conclusion In CT scans，most cases of primary bone lymphoma were osteolytic and characterized by minimal cortical destruction despite a large accompanying soft-tissue mass, without significant periosteal reaction. The scope of MRI showed lesions more clearly than the CT scan, mainly associated with bone marrow involvement and soft tissue mass, T2WI fat-suppression were hyperintensity in bone marrow of the lesions.