MRI对脊柱淋巴瘤的诊断价值和疗效观察

目的:研究脊柱淋巴瘤的MRI表现,探讨MRI诊断价值,观察其疗效。方法:回顾性分析13例经手术病理证实的脊柱淋巴瘤患者MRI表现和临床资料。结果:原发性非霍奇金淋巴瘤(NHL)5例,继发性B细胞源性NHL6例、T细胞源性1例、继发性霍奇金病(HD)1例。MRI表现:椎体骨质破坏11例,呈弥漫性或斑片状稍长T1信号及稍长或长T2信号,其中多椎体病变8例(6例为相邻椎体,2例为跳跃性),单椎体病变3例;椎管内硬膜外肿块9例,肿块环绕硬膜呈新月形6例,梭形2例,结节1例,T1WI呈等信号,T2WI呈等信号或稍高信号,呈中度至重度均匀性强化;椎旁肿块7例。有复查资料7例:4例原发NHL(椎管内病变手术切除,椎旁及椎体病变行局部放疗)3~24个月内多次复查,椎管内病变未见复发,其中3例椎体和椎旁病变较治疗前明显好转,1例无明显改变;1例继发于脑膜T细胞淋巴瘤术后18个月,术后8个月复发;2例继发于纵隔和腹部B细胞性NHL,放、化疗后好转,分别于6个月和12个月复查,椎体及椎旁病变复发(2例放化疗前均无椎管内病变)。结论:MRI能清晰地显示脊柱淋巴瘤的病变,典型病例可明确诊断,非典型病例须密切结合病史;原发性脊柱淋巴瘤术后放疗后疗效较好,继发性易复发。

MRI Diagnosis of Spinal Lymphoma and Assessment of Therapeutic Effects

Objective:To study MRI manifestation of spinal lymphoma and evaluation of the therapeutic effect.Methods:The MR findings and clinical data in 13 patients with pathologically-proved spinal lymphoma were retrospectively analyzed.Results:Of all 13 patients,5 cases were primary NHL and 8 cases were secondary (7 NHL and 1 HD).Vertebral destruction was found in 11 cases (8 cases involved multiple vertebral and 3 cases involved solitary vertebral),they presented diffuse and patchy long T_1 and long T_2 signal.Mass in the extradural area was found in 9 cases and appeared iso-intense on T_1WI and iso- or hyper-intense on T_2WI,and showed moderate or intense homogenous enhancement.Paravertebral masses were found in 7 cases.Of 7 cases with follow-up,4 cases with primary NHL were re-examined many times in 3~24 months,vertebral and paravertebral lesions were improved,and intraspinal lesions were not found in 3 cases,1 case had no improvement.In one case of lymphoma secondary form meningeal T-cell lymphoma,there was recurrence after eight months after surgery;vertebral and paravertebral lesions recurred in 2 cases with mediastinum and abdomen B-cell NHL in 6~12 months.Conclusion:MRI can clearly display lesions of spinal lymphoma,and can give a correct diagnosis in typical cases,but it should be combined with clinical history in untypical cases.The primary spinal lymphomas after operation and radiotherapy have a better therapeutic effect,the secondary spinal lymphomas recur easily.[