戴　超　李高峰　茅爱平　任莉莉新疆兵团第二师库尔勒医院放射科，新疆巴音郭楞　841000

原发性脊柱恶性淋巴瘤的影像学表现分析

戴超李高峰茅爱平任莉莉
新疆兵团第二师库尔勒医院放射科，新疆巴音郭楞841000

目的 观察分析原发性脊柱恶性淋巴瘤的影像学表现，分析X线平片、CT、MRI的诊断价值。方法 选取我院2010年6月～2015年6月收治的7例原发性脊柱恶性淋巴瘤患者，均经穿刺或手术病理确诊，均接受X线平片、CT、MRI检查。结果 本组7例患者均为非霍奇金淋巴瘤，累及18个椎体，其中胸椎4例，腰椎1例，胸腰椎1例，颈椎1例；3例伴有附件受累，5例软组织肿块，3例椎管内、硬膜外肿块；X线平片影像学表现为椎体骨质破坏，椎体压缩性骨质，无椎弓根影；CT平扫肿瘤为中等密度，增强后强化均匀，无坏死；MRI T1WI肿瘤为低等信号，T2WI为低、等、高信号，增强扫描后中度强化。结论 （1）原发性脊柱恶性淋巴瘤以非霍奇金淋巴瘤较为常见；（2）肿瘤侵犯相邻椎体，软组织肿块较大且极少坏死，增强扫描肿瘤为中度强化；（3）X线平片诊断作用有限，MRI显示骨内病灶敏感性高于CT。

原发性脊柱恶性淋巴瘤；X线平片；CT；MRI；影像学表现

［Abstract］Objective To analyze the image manifestations of primary spinal malignant lymphoma and the diagnostic value of X-ray plain film，CT and MRI.Methods 7 patients with primary spinal malignant lymphoma who had received treatment in our hospital from June 2010 to June 2015 were selected as the research objects.All of the patients were confirmed by puncture or surgical pathology for diagnosis，which were given X-ray plain film，CT and MRI for examination.Results The 7 cases were all diagnosed with non-Hodgkin's lymphoma，involving 18 centrum，which included 4 cases thoracic vertebra，1 case lumbar vertebra，1 case thoracolumbar vertebra and 1 case cervical vertebra；3 cases with affected adnexa，5 cases with soft tissue mass，3 cases intraspinal or epidural masses.The imaging of X-ray plain film was manifested with destruction of vertebral bodies，compression osteoporosis，without vertebral pedicle artifact；the tumor was detected by CT plain scan to be of moderate density，homogenous post-enhancement，without necrosis；MRI and T1WI reported low intensity of tumor，yet the T2WI reported both low and high density，and the post-enhancement was moderate.Conclusion（1）Non-Hodgkin's lymphoma is one of the common primary spinal malignant lymphoma；（2）Tumors will involve adjacent centrum，produce larger soft tissue mass and less necrosis，and the post-enhancement result is moderate；（3）X-ray plain film is with limited roles and the sensitivity to bone lesion of MRI is higher than that of CT.

［Key words］Primary spinal malignant lymphoma；X-Ray plain film；CT；MRI；Image manifestations

骨恶性淋巴瘤是少见的恶性肿瘤，是淋巴瘤晚期全身散播的表现，区分难度较大，骨恶性淋巴瘤包括原发性和继发性［1，2］，原发性脊柱淋巴癌症状不明显，多为单一骨侵犯，预后良好；继发性脊柱淋巴癌指骨外淋巴组织恶性淋巴瘤侵入骨骼，病情严重，预后较差。脊柱淋巴瘤在临床更为罕见，国内外病例数极少［3］，了解其影像学表现，有利于提高诊断准确率，减少误诊和漏诊事件，为疾病诊断、治疗及预后提供专业参考。……