原发性肠道淋巴瘤的影像学表现  

The imaging characteristics of primary intestinal lymphoma

作　　者：康冰 张硕 王锡明 孙丛 Kang Bing;Zhang Shuo;Wang Ximing;Sun Cong(Department of Radiology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属省立医院影像科,济南250021

出　　处：《中华放射学杂志》2024年第10期1075-1079,共5页Chinese Journal of Radiology

基　　金：山东省自然科学基金青年项目(ZR2023QH520)。

摘　　要：目的总结原发性肠道淋巴瘤(PIL)的影像学特征。方法该研究为横断面研究,回顾性分析2013年1月至2023年12月山东第一医科大学附属省立医院经病理证实的103例PIL患者的影像学资料。94例患者行腹部CT平扫和增强扫描,9例患者行MRI平扫和增强扫描。评价其影像学表现,包括肿瘤部位、肿瘤形态、肠壁和肠腔形态、腹腔淋巴结是否肿大、肿瘤的密度或信号、肿瘤的强化方式以及强化程度。结果103例患者中,最常见的发病部位为回肠(43.7%,45/103),其次为升结肠(20.4%,21/103)。累及肠道单节段的患者91例(88.3%),累及多节段的12例(11.7%)。组织病理学以弥漫性大B细胞淋巴瘤最为常见(65.0%,67/103),其次为黏膜相关淋巴组织边缘带淋巴瘤(9.7%,10/103)。影像学表现多样,主要包括肠壁节段性增厚84例(81.6%),肠壁肿块29例(28.2%),其中19例出现“动脉瘤样扩张”;19例(18.4%)肿瘤向腔外生长,3例伴有肠穿孔;28例(27.2%)出现肠系膜区及腹膜后多发淋巴结肿大。增强扫描72例(69.9%)表现为均质性强化,75例(72.8%)呈轻中度强化。9例行DWI的肿瘤均表现为明显扩散受限。结论PIL好发于回肠,影像学表现以肠壁节段性增厚为主,多呈轻中度均质性强化,DWI呈明显扩散受限。Objective To summarize the imaging characteristics of primary intestinal lymphoma(PIL).Methods As a cross-sectional study,a total of 103 consecutive patients diagnosed as PIL by pathology were retrospectively enrolled at Affiliated Shandong Provincial Hospital of Shandong First Medical University between January 2013 to December 2023.Ninety-four patients underwent CT plain and enhanced scans,and the remaining 9 patients only underwent MRI examination.Imaging features were evaluated,including the location and shape of the tumor,the shape of the intestinal wall and lumen,abdominal lymph nodes,the density or signal intensity of the tumor,and the degree and mode of enhancement after the enhancement scan.Results The most frequent location of PIL was the ileum(43.7%,45/103),followed by the ascending colon(20.4%,21/103).Ninety-one patients had a single lesion(88.3%),while the other 12 patients had multiple lesions(11.7%).Diffuse large B-cell lymphoma was the most common histopathological type of the PIL(65.0%,67/103),followed by mucosa-associated lymphoid tissue lymphoma(9.7%,10/103).Generally,PIL classically presented intestinal wall thickening(81.6%,84/103)and exophytic mass(28.2%,29/103).Aneurysmal dilatation of the lumen appeared in 19 patients.Nineteen tumors(18.4%)grew out of the lumen,and perforation was shown in 3 patients.Bulky mesenteric or retroperitoneal adenopathy occurred in 28 patients(27.2%).Seventy-two tumors(69.9%)showed homogeneous enhancement,and 75(72.8%)showed mild-to-moderate enhancement.In DWI images,all 9 tumors showed significant diffusion limitation.Conclusions The most frequent location of PIL was the ileum.The main imaging characteristics were segmental intestinal wall thickening,which showed mild-to-moderate homogeneous enhancement and restricted diffusion.

关 键 词：淋巴瘤 体层摄影术 X线计算机 磁共振成像 肠道 

分 类 号：R445[医药卫生—影像医学与核医学] R735.3[医药卫生—诊断学]