双侧肾上腺非霍杰金淋巴瘤CT、MRI动态增强诊断价值

目的:探讨双侧肾上腺淋巴瘤CT、MRI动态增强影像特征。方法:回顾性分析经手术病理证实的双侧肾上腺非霍杰金淋巴瘤6例。其中继发性非霍杰金淋巴瘤5例,原发性非霍杰金淋巴瘤1例。男4人,女2。年龄35～75岁,平均63岁。全部病例均行CT平扫和动态增强检查。1例行MR平扫和增强检查。所有病例影像资料均经2名高年医师在不知道病理结果的情况下分析阅片,分别确定病变大小、形态、边缘、密度以及强化程度,以及是否伴腹膜后淋巴结肿大。结果:12个病灶中,6个病灶呈椭圆形,肿块形4个,2个病灶呈肾上腺增生改变。肿瘤直径3.9～8.0cm。10个病灶CT平扫密度均匀,2个病灶密度不均匀,其中一个病灶内可见坏死。平扫CT值为24.1～35.2HU,平均25.5HU;CT动态增强动脉期病灶轻度强化,10个病灶均匀强化,2个病灶不均匀强化,其内可见条状、网格状强化。动脉期CT值28.3～44.7HU,平均31.6HU。门静脉期继续强化,门静脉期CT值36.4～64.6HU,平均48.7HU。MR扫描T1WI信号为均匀稍低信号,T2WI扫描信号为稍高信号,增强扫描可见动脉期轻度强化,静脉期持续强化。3例伴腹膜后淋巴结肿大。2名医师诊断正确4例,2例误诊。结论:双侧肾上腺非霍杰金淋巴瘤密度相对均匀,坏死少见或范围较小,CT、MR动态增强呈轻～中等程度进行性延迟强化,强化较均匀。肾上腺淋巴瘤具有一定的影像学特点,术前CT、MR动态增强扫描有利于确诊。

The value of diagnosis of bilateral adrenal non-Hodgkin lymphoma with CT and MR dynamic enhancement

Objective:The purpose of this study was to analyze CT and MR dynamic enhancement imaging characteristic of bilateral adrenal non-Hodgkin’s lymphoma.Methods:6 patients(4 men and 2 women;with mean age of 63 years) confirmed by pathology were retrospectively analyzed.5 cases were secondary adrenal non-Hodgkin lymphoma,1 patient was primary non-Hodgkin lymphoma.All patients underwent CT plain scan and dynamic enhancement.In 1 patient,additional conventional MR scan and dynamic enhancement examination was performed.Two radiologists who were blinded to the surgieal and pathological results interpreted imaging.They determined imaging findings that consisted of lesion size,morphology,edge,density,enhanced-degree,and retroperitoneal lymph node enlargement.Results:In all 12 lesions,6 were oval shape,4 were mass and 2 adrenal hyperplasia,diameter of lesions was 3.9～8.0 cm.10 lesions manifested as isodensity,2 were heterogeneous density on unenhanced CT images,necrosis was found in one lesion.The CT value was 24.1～35.2 HU(with a mean value of 25.5 HU) on plain scan.10 lesions presented with homogeneous density characterization in dynamic enhancement,2 lesions were heterogeneous,the grid shape and strip were seen within lesions.The CT values were 28.3～44.7 HU(with a mean value of 31.6 HU),36.4～64.6 HU(with a mean value of 48.7 HU) on arterial and portal venous phases enhancement respectively.2 lesions appeared as uniform hypo-or isointensity signal on T1 weighted images and slightly hyperintensity signal on T2 weighted images.Dynamic enhancement manifested as slight enhancement on arterial phase,and delayed enhanced on portal venous phases.3 cases were retroperitoneum lymph node enlargement.4 cases were corrected diagnosis,2 were misdiagnosed.Conclusion:Density or intensity of bilateral adrenal non-Hodgkin lymphoma was homogeneous.Necrosis was rare or area small.Features of enhanced-degree were mild to moderate dynamic delayed enhanced,the density was homogeneous.Adrenal lymphoma had certain imaging characteristics.CT or MR dynamic enhancement was a valuable tool in preoperative diagnosis of adrenal lymphoma.