原发性椎管内硬膜外恶性淋巴瘤的MRI表现  

MRI findings of primary spinal epidural malignant lymphoma

作　　者：戴西件[1] 刘碧霞[1] 纪玉强[1] 龚洪翰[1] 

机构地区：[1]南昌大学第一附属医院影像科,江西南昌330006

出　　处：《实用放射学杂志》2013年第11期1742-1745,1761,共5页Journal of Practical Radiology

摘　　要：目的 探讨原发性椎管内硬膜外恶性淋巴瘤的MRI表现,提高本病在椎管内肿瘤的认识并评价MRI在本病中的诊断价值.方法 回顾性分析经手术病理证实的15例脊柱淋巴瘤的临床和MRI影像学资料,并复习文献.结果 20个椎管内病灶中,15个位于胸段,5个位于腰骶段,16个表现为梭形,4个为长条形及椭圆形.MRI矢状位示肿块沿脊髓长轴纵向生长,呈等T1、等或稍长T2均匀信号,可见硬膜外征及脊髓水肿带,其中5个病灶呈串珠样沿脊髓长轴纵向浸润性生长.轴位示肿块呈扁平状,其中11个肿块环绕硬膜周径1/4～1/2圈,7个环绕硬膜周径1/2～3/4圈.13个硬膜外肿块包绕脊髓呈向外生长趋势,5个经椎间孔与椎旁肿块相连,呈围椎、钻孔生长特点或哑铃状改变,相应椎体呈溶骨性破坏.6例病灶行增强扫描,其中3例呈轻度、2例呈中度均匀强化,1例呈中度稍不均匀强化.结论 椎管内淋巴瘤的MRI表现有一定特征性,结合临床能为该病的术前诊断与鉴别诊断提供强有力的影像学依据.Objective To analyze the MRI characteristics of primary spinal epidural malignant lymphoma in order to improve the understanding and diagnosis of intraspinal tumors. Methods From October 2009 to February 2013, the clinical data and MRI find ings in 15 patients with intraspinal lymphoma confirmed by surgery and pathology were retrospectively analyzed. Results In a total of 20 lesions, 15 were located in the thoracic segment and other 5 in the lumbosacral segment. 16 lesions manifested as fusiform shape and 4 elongated or oval shapes. The sagittal images showed that the lesion grew longitudinally along the spinal cord with isoin tensity on T1WI and isointensity or slight-hyperintensity on T2 WI, in which 5 lesions were bead-like with infiltration. Sometimes the epidural signs and the spinal edema ribbon were seen. The lesions on axial images were oblate, involving 1/4-1/2 of dural ring in 11 and 1/2-3/4 of the ring in 7. 13 exogenic lesions surrounded the spinal cord, and 5 were dumbbell-shape through the intervertebral foramen. In 6 lesions with contrast enhancement, slight homogeneous （ n= 3 ）, moderate homogeneou （ n=2 } and moderate inhomogeneous enhancement（ n=1） were found. Conclusion MRI findings of the primary spinal malignant lymphoma are characteristic to some extent, which may provide some proofs for the clinical diagnosis.

关 键 词：椎管 硬膜外腔 淋巴瘤 磁共振成像 

分 类 号：R738.1[医药卫生—肿瘤] R445.2[医药卫生—临床医学]