鼻腔鼻窦淋巴瘤的CT和MRI诊断

目的 探讨鼻腔鼻窦淋巴瘤的CT和MRI表现，旨在提高其诊断准确性。资料与方法 回顾性分析46例经手术或活检证实的鼻腔鼻窦淋巴瘤患者的影像资料。结果 原发于鼻腔30例，鼻窦7例，鼻腔、鼻窦同时发病或累及邻近结构9例。CT表现：淋巴瘤位于鼻腔前部28例，后部2例，向前浸润鼻前庭、鼻翼、鼻背及邻近面部皮肤22例；病灶密度均匀8例，不均匀22例，增强后轻度强化7例，中度强化6例，鼻中隔、中下鼻甲浸润性破坏7例。鼻窦淋巴瘤表现为窦腔内充以软组织影，窦壁骨质浸润性改变5例，明显破坏2例，4例上颌窦周软组织浸润，增强后中度强化3例。弥漫型淋巴瘤表现为鼻腔中线区不同程度的骨质破坏，鼻腔及邻近鼻窦伴软组织肿块，6例并累及邻近面部软组织、眼眶、鼻咽部、口咽、颞下窝、翼腭窝，4例浸润颅底骨髓，2例破坏硬腭。MRI表现：T1WI低信号12例（与肌肉比较。以下同）。等信号8例；T2WI高信号11例，等信号9例；病变轻度强化6例，中度强化10例。4例沿翼腭窝神经周扩散。结论 多数鼻腔淋巴瘤及弥漫型鼻腔鼻窦淋巴瘤有特异影像学征象，可提示诊断；鼻窦淋巴瘤则缺乏特异影像学征象。CT是本病诊断的主要影像检查方法，MRI能更清楚显示病变的范围。帮助临床准确地分期。

CT and MRI Diagnosis of Lymphoma in Sinonasal Cavity

Objective To investigate the CT and MRI findings of lymphoma in sinonasal cavity so as to promote the diagnostic accuracy. Materials and Methods CT and MRI findings of 46 cases with lymphoma verified by pathology were analyzed retrospectively.Results The lesions occurred in nasal cavity in 30 cases,7 cases in paranasal sinus and 9 in sinonasal cavity and (or) surrounding structures. On CT, lymphoma were located in the anterior portion of nasal cavity in 28 cases and in posterior portion in 2 cases. Lymphoma anteriorly invaded nasal vestibule, naslala, nasal dorsum and adjacent cutaneous tissues in 22 cases. The lesions were showed as homogeneous density in 8 cases and heterogeneous density in 22 cases. There were mild enhancement in 7 cases and moderate enhancement in 6 cases on post contrast CT. Nasal septum,middle and inferior turbinates infiltrative bony destruction was found in 7 cases. The affected paranasal sinuses were filled with soft tissues in lymphoma. Sinus walls demonstrated bony infiltration in 5 cases and marked bony destruction in 2 cases, moderate enhancement was found in 3 cases. Periantral soft tissues infiltration were found in 4 cases. Diffuse lymphoma were revealed variable bony destruction in the midline of nasal cavity, accompanying with bulky soft tissues. 6 cases involved adjacent facial soft tissues, orbit, nasopharynx, oropharynx, infratemporal fossa and pterygopalatine fossa. 4 cases infiltrated bony marrow of skull base. 2 cases invaded hard palate. On MR T_1WI, sinonasal lymphomas were showed hypointensity compared to muscle in 12 cases and isointensity in 8 cases. On T_2WI, the lesions were showed hyperintensity in 11 cases and isointensity in 9 cases. Mild enhancement in 6 cases and moderate enhancement in 10 cases were found on post contrast MR. Perineural spread along pterygopalatine fossa was found in 4 cases.Conclusion Most localized nasal and diffuse sinonasal lymphoma have specific imaging appearnances, the typical imaging findings can suggest the diagnosis of lymphoma. No typical imaging characteristics were found in lymphoma occurred in paransal sinus. CT is first choice in diagnosis of lymphoma in sinonasal cavity. MRI can demonstrate optimally the invading extent and provide more accurate informations for clinical staging.