骨恶性淋巴瘤13例影像学诊断

目的：探讨骨恶性淋巴瘤影像表现及诊断价值。材料与方法：回顾性分析13例经手术病理证实的骨恶性淋巴瘤。13例患者均行相应部位X线检查，9例行CT检查，2例行MRI检查。结果：12例原发骨恶性淋巴瘤中下颌骨、锁骨、胸椎、腰椎及尺骨各1例，胫骨及髂骨各2例，股骨3例，其中2例发生胸椎转移，4例合并病理性骨折，另1例为纵隔恶性淋巴瘤继发骨转移。X线及CT表现为溶骨型5例,浸润型4例．硬化型2例（其中1例呈象牙椎改变），混合型2例。MRI检查2例表现为T1WI呈等或稍低信号，T2WI呈等或稍高信号，脂肪抑制T2WI扫描仍为稍高信号。注入造影剂后，病灶呈轻至中度均匀或不均匀强化。结论：X线对骨恶性淋巴瘤的检查有重要作用，象牙椎、椎体多骨多灶性破坏、长骨溶骨性破坏、母子灶存在等对本病有重要诊断价值。CT对本病的骨质破坏、硬化反应、骨膜反应、软组织侵犯等观察优于X线。MRI对淋巴瘤侵犯性破坏所致的早期骨质改变，以及发现骨髓的早期侵犯优于X线和CT。

Imaging diagnosis of 13 cases of bone malignant lymphoma

Objective： To explore the imaging diagnosis of bone malignant lymphoma. Materials and Methods： Thirteen cases of bone malignant lymphoma verified by operation and pathology were analyzed retrospectively. Thirteen cases were examined by X-ray, 9 cases were also checked by CT and 2 cases examined by MRI. Results： In 12 cases of the primary bone malignant lymphoma, the lesion of 5 cases was in the mandible, clavicle, ulna and thoracic vertebrae. Two cases were in the tibia and the iliac bone, 3 cases were in the femur. Two cases had metastases in the thoracic vertebrae, 4 cases with pathological fracture, in one case primary mediastinal malignant lymphoma with bone metastases. The CT and X-ray features of 5 cases were osteolytic type, 4 cases were of infiltrating type, 2 cases were of sclerotic type （one case with ivory vertebra）, 2 cases of mixed-type. In 2 cases, MRI showed slightly hypointense or homogeneous on T1WI, slightly hyperintense or homogeneous on T2WI, slightly hyperintense on fat suppressed sequence, mild to moderate and homogeneous or inhomogeneous Gd DTPA enhancement with the contrast agent. Conclusion： X-ray examination plays an important role in the diagnosis of the bone malignant lymphoma. Its characteristics are ivory vertebra, multiple level vertebral body involvement and multifocal destruction, osteolytic multifocal destruction of long bones. Compared with X-ray, CT can more clearly discern the lesions such as destruction of bone, the sclerotic reaction, periosteal reaction, the invasion of soft tissues. Compared CT and X-ray, MRI can more clearly identify the lesions such as the early changes of bone mineral content invaded by lymphoma and the early involvement of bone marrow.