原发性脊柱硬膜外淋巴瘤MRI诊断.docVIP

原发性脊柱硬膜外淋巴瘤MRI诊断 徐胜生，罗天友，欧阳羽，李咏梅，黄铀新 重庆医科大学附属第一医院放射科，重庆 400016 【摘要】目的 探讨原发性脊髓硬膜外淋巴瘤的MRI表现，以提高诊断准确性。资料和方法 回顾性分析5例经组织学确诊的原发性脊髓硬膜外淋巴瘤资料，分析病变的部位、数目、形态、信号、强化及邻近结构受累改变情况。结果 5例原发性脊髓硬膜外淋巴瘤中病变位于胸段2例、颈胸段、胸腰段及腰段各1例。病灶形态5例呈长条形、梭形，3例呈包鞘状，3例呈哑铃型。4例呈均匀中等T1、T2信号，轻中度强化。2例脊椎骨及1例椎旁肌肉受侵犯。结论 原发性脊髓硬膜外淋巴瘤有一定的特征MRI表现，MRI可准确诊断。 【关键词】淋巴瘤；磁共振成像；脊柱；硬膜外 MRI diagnosis of Primary Spinal epidural Lymphoma XU Shengsheng, LUO Tianyou, OUYANG Yu, LI Yongmei,HUANG Youxin Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing,400016,P. R. China 【Abstract】 Objective To investigate MRI manesfications of primary spinal epidural lymphoma (PSEL) in order to increase its diagnostic accuracy.Methods To study retrospectively 5 cases of primary spinal epidural lymphoma by histologically confirmed.To analyze the features about location,number,signal intensity,contrast enhancement of the lesion. Results Primary spinal epidural lymphoma located in the thoracic 2 cases,cervico-thoracic,thoracolumbar and lumbar 1case respectively. The shapes were long streak and fusiform in 5 cases,circled like sheath in 3 cases, dumbbell shaped in 3 cases.All the masses were intermediate signal intensities homogeneously on T1WI and T2WI,with mild and moderate enhancement.2 cases vertebras and 1 case paraspinal muscles were infiltrated. Conclusion PSEL had some characteristic MRI manesfications,which MRI could diagnose correctly. 【Key words】 lymphoma,Magnetic resonance imaging,spine,epidural 恶性淋巴瘤局限于硬膜外间隙少见，约占所有淋巴瘤的0.1～3.3%和脊柱硬膜外肿瘤的9%【1】，而原发性脊柱硬膜外淋巴瘤(primary spinal epidural lymphoma , PSEL) 是非常少见的结外淋巴瘤，其发病率占非何杰金淋巴瘤病人总数的0.1%～6.5%，术前误诊率高。现收集5例经确诊的PSEL资料，探讨MRI表现以提高认识及诊断准确性。 1 资料与方法 1.1 病例资料 回顾性分析5例经手术后组织病理学证实的淋巴瘤患者MRI资料，分析病变的部位、数目、形态、MR信号特点、强化方式及邻近结构改变。男3例，女2例；年龄32～58岁，平均为47.4岁；临床症状及体征有腰痛及双下肢疼痛3例，双下肢麻木或抖动3例，双下肢肌力减弱、脐或髋平面以下感觉减退4例，躯体前面胸6水平以下痛觉减退，背侧胸4水平以下痛觉减退，腱反射活跃1例等，病史长约20天～3月。所有患者均无发热、乏力、消瘦，经检查未扪及浅表淋巴结肿大、肝脾肿大，回顾复查病史资料周围血象、胸片、腹部超声等检查亦无异常发现。无人类免疫缺陷病毒感染阳性，无器官移植后免疫抑制剂使用史以及中枢神经系统以外的其他部位淋巴瘤病史。 1