17例孤立性浆细胞瘤的影像学分析  

Analysis of imaging presentation of solitary plasmacytoma in 17 cases

作　　者：宋英儒[1] 李国[1] 张小波[1] 黄仲奎[1] 龙莉玲[1] 

机构地区：[1]广西医科大学第一附属医院放射科,广西530027

出　　处：《重庆医科大学学报》2008年第10期1218-1222,共5页Journal of Chongqing Medical University

摘　　要：目的:总结孤立性浆细胞瘤(Solitary plasmacytoma,SP)的影像学表现特点,提高影像诊断能力。方法:对17例手术或活检病理证实为SP的临床特点和各种影像学表现进行分析和总结。结果:所有病例仅发现单发病灶,脊柱5例、扁骨5例、长管状骨2例,平片及CT呈膨胀溶骨性破坏边界较清晰,骨皮质变薄和断裂,软组织肿胀较明显,磁共振成像(Magnetic resonance imaging,MRI)稍长T1稍长T2信号,明显均匀强化。椎体可见压缩性骨折,附件受累,位于硬膜外并相应的脊髓受压;骨外5例,平片表现为软组织肿块,CT平扫肿块密度与肌肉相似,增强扫描呈中等度均匀强化,MRI平扫肿块呈稍长T1稍长T2信号改变,增强扫描呈中等度均匀强化。全身骨ECT扫描病灶区呈中度-高度核素浓聚。PET/CT呈中度-高度不均匀葡萄糖代谢增高,SUV值6.3～8.6。治疗约一个月后,软组织往往明显消肿,骨质破坏区逐渐成骨,PET/CT复查,骨破坏区及周围软组织的葡萄糖代谢明显减低,SUV值降低到2.0以下。结论:SP常发生于男性,发病年龄比多发性骨髓瘤小,全身症状不明显,病变部位不同则表现也各不相同,但病变边界均清楚。CT和MRI能更清楚地显示病灶,MRI还可无创性评估骨髓侵润,发现X线平片和CT所不能显示的脊髓受压。PET/CT用于追踪治疗效果比较适宜。Objective：To improve diagnostic ability by the evaluation of imaging appearances of solitary plasmacytoma.Methods：Seventeen patients with solitary plasmacytoma confirmed by biopsy or operation were included in our study,whose clinical features and diagnostic imaging appearances were included.Results：Single lesion was found in all cases;Lesions of vertebra in 5 cases,flat bone in 5 cases,pipe bone in 2 cases and outside the bone in 5 cases.The Lesions in bone showed expansive osteolytic with clear border,soft tissue mass nearby,and thin and broken cortical.Vertebra lesions showed lytic destruction and compressed fracture.MRI showed slightly hypointense in T1WI and hyperintense in T2WI with markedly homogeneous enhancement.Lesions outside the bone appeared soft tissue mass with similar density to muscle in CT and X ray,and isointensity in T1WI and T2WI with markedly homogeneous enhancement.Lesions in ECT showed medium-to-high nuclide concentration,and in PET/CT showed the increase of glucose metabolize,with SUV 6.3～8.6.About one month after effective chemical therapy,soft tissue mass shrank obviously and new bone appeared,with the decrease of glucose metabolize,and SUV under 2.0.Conclusion：Solitary plasmacytoma often occurs in male,and in younger age and lacks symptoms in the whole body compared with multiple myeloma.Lesions in different regions show different manifestations,but all borders are well defined.CT and MRI can depict the extent of solitary plasmacytoma of bone clearly,but MRI was better in showing bone marrow infiltration range,and showing compression of spinal cord.PET/CT are more suitable in follow-up therapy.

关 键 词：孤立性浆细胞瘤 计算机体层摄影术 X线 磁共振成像 

分 类 号：R733.3[医药卫生—肿瘤] R563.1[医药卫生—临床医学]