肺血管内大B细胞淋巴瘤的影像诊断  

Imaging diagnosis of pulmonary intravascular large B-cell lymphoma

作　　者：梁锐洪 易炜[2] 李娴[2] LIANG Ruihong;YI Wei;LI Xian(Department of Radiology,First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China.)

机构地区：[1]南方医科大学南方医院放射科,广东广州510515 [2]广州医科大学附属第一医院放射科,广东广州510120

出　　处：《中国中西医结合影像学杂志》2023年第2期154-158,共5页Chinese Imaging Journal of Integrated Traditional and Western Medicine

摘　　要：目的:探讨肺血管内大B细胞淋巴瘤(IVLBCL)的CT和PET/CT表现。方法:回顾性分析10例经病理活检确诊肺IVLBCL患者的CT和PET/CT表现及临床资料。10例均行胸部CT平扫,其中4例同时行PET/CT检查。结果:10例胸部CT显示,肺IVLBCL均为两肺多发病变,表现为两肺透亮度减低和弥漫多发斑片及片状磨玻璃稍高密度影,5例沿胸膜下分布,5例随机分布。10例中,8例伴实性和/或磨玻璃样微小结节,微小结节均随机分布;6例合并实变影,包括左上肺下舌段及左下肺后基底段实变影2例,两下肺前内基底段条片样实变影2例,右上肺胸膜下楔形实变影2例;2例合并两上肺小叶间隔增厚。3例合并脾大,2例合并肝大及肾上腺增粗,所有患者均无两侧肺门及纵隔淋巴结肿大。4例同时行PET/CT检查,均显示两肺病灶呈轻中度不均匀弥漫性放射性浓聚,肺内病变最大标准化摄取值(SUV_(max))范围为2.3~8.0,平均4.2±2.6。10例中,3例合并脾脏及骨髓受累,1例合并肝脏及肾上腺受累,1例合并全身肌肉受累,肺外器官SUV_(max)范围2.7~6.4。结论:IVLBCL的影像特征主要为两肺弥漫多发磨玻璃影和随机分布的微小结节影,可合并实变影和小叶间隔间质增厚,病灶在PET/CT上表现为高代谢改变。Objective:To investigate the CT and PET/CT features of pulmonary intravascular large B-cell lymphoma(IVLBCL).Methods:The CT and PET/CT features and clinical data of ten patients with pulmonary IVLBCL were analyzed.Chest CT was performed in 10 cases,and PET/CT was performed in 4 cases.Results:CT images showed IVLBCLs were multiple lesions of both lungs with decreased brightness,diffuse multiple spots and flake ground glass with slightly high density;5 lesions were distributed under the pleura,and 5 were randomly distributed.In the ten cases,8 cases had solid and/or ground-glass micronodules,which were randomly distributed.Consolidation was shown in 6 cases,whose distribution included 2 cases of left superior and left inferior basal segments,2 cases of inferior basal segments in both lungs,and 2 cases of subpleural lesions in the right superior lung.In addition,2 cases had interlobular septa thicknesses in both upper lungs.Moreover,3 cases had splenomegaly,and 2 cases had hepatomegaly and adrenal enlargement.Enlarged lymph nodes were not observed in the hilum and mediastinum in all 10 cases.PET/CT scanning was also performed in 4 cases.The lesions in both lungs showed slightly or moderately inhomogeneous radioactive concentrations.The maximum standardized uptake value(SUV_(max))ranged from 2.3 to 8.0,with an average value of 4.2±2.6.The involvement of the spleen and bone marrow(3 cases),liver and adrenal(1 case),and systemic muscle(1 case)were complicated,with SUV_(max) ranging from 2.7 to 6.4.Conclusions:The imaging features of pulmonary IVLBCL include multiple ground-glass opacities,randomly distributed micronodules,consolidation,and thickness of the interlobular interstitium.These lesions are hypermetabolic on PET/CT.

关 键 词：淋巴瘤 B细胞 肺 正电子发射断层显像术 体层摄影术 X线计算机 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]