口咽部非霍奇金淋巴瘤的CT诊断

目的 分析口咽部非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHL)的CT表现特征,探讨各种不同病理类型NHL的CT表现特点. 资料与方法 回顾性分析33例经病理证实的口咽部NHL患者的CT表现. 结果 33例中,B细胞来源18例(54.5%),T和NK细胞来源15例(45.5%).病变分布:扁桃体14例(弥漫性大B细胞淋巴瘤8例、NK/T细胞淋巴瘤5例、套细胞淋巴瘤1例);舌根10例(弥漫大B细胞淋巴瘤5例、滤泡性淋巴瘤3例、血管免疫母细胞性T细胞淋巴瘤1例、周围T细胞淋巴瘤1例);软腭2例(NK/T细胞淋巴瘤1例,结外边缘区B细胞淋巴瘤1例);累及两个以上口咽部位7例,均为NK/T细胞淋巴瘤.33例中,肿块型18例,其中13例为弥漫大B细胞淋巴瘤;弥漫型10例,其中8例为NK/T细胞淋巴瘤;无明显异常CT表现者5例. 结论 口咽NHL多发生于腭扁桃体及舌根,病理类型以弥漫大B细胞淋巴瘤和NK/T细胞淋巴瘤为主;CT对于NHL的鉴别诊断和病变范围的判断有重要价值.     

韦氏环不同病理类型非霍奇金淋巴瘤的CT和MRI表现特征研究

目的探讨不同病理类型韦氏环非霍奇金淋巴瘤(non-Hodgkin’s lymphoma,NHL)影像学特点,提高诊断及鉴别诊断的准确性。方法回顾性分析30例经病理证实的韦氏环非霍奇金淋巴瘤CT、MRI表现,结合其病理类型进行对比分析。结果 30例韦氏环NHL中,成熟B细胞淋巴瘤22例(73.3%),成熟T细胞和NK细胞淋巴瘤8例(26.7%)。病变表现肿块型15例(50.0%),弥漫型8例(26.7%),溃疡型2例(6.7%),混合型5例(16.7%)。B细胞型以肿块型多见(68.2%),易累及腭扁桃体,CT表现为局限性等密度肿块,边界清楚,增强后轻中度均匀强化。MRI检查病灶信号均匀,T_1WI呈稍低信号,T_2WI稍高信号。T和NK细胞型以弥漫型多见(75%),常累及两个或多个部位,病变呈浸润生长,范围较弥散,轮廓欠清晰,形态欠规则。22例(73.3%)合并颈部淋巴结转移,多累及颈部I~III区淋巴结,肿大淋巴结中央多无坏死。结论韦氏环B细胞型NHL与NK/T细胞型NHL的影像学表现各有一定特点,有助于鉴别诊断。     

运用组织芯片检测淋巴瘤中活化的细胞毒性细胞的意义

目的运用组织芯片及常规技术检测活化的细胞毒性细胞在各型淋巴瘤中的表达分布情况,为临床治疗和判断预后提供依据.方法运用免疫组织化学方法检测以60例淋巴瘤标本制成的淋巴瘤组织芯片中穿孔素、颗粒酶B的表达和分布情况;同时选择10例鼻NK/T细胞淋巴瘤常规标本与组织芯片进行比较研究,10例淋巴组织反应性增生作为对照.结果在60例淋巴瘤制成的组织芯片中,发生在淋巴结内者48例,淋巴结外者12例.B细胞淋巴瘤42例,T细胞淋巴瘤16例,2例霍奇金淋巴瘤.42例B细胞淋巴瘤的瘤细胞均不表达穿孔素和颗粒酶B.10例外周T细胞淋巴瘤中8例表达穿孔素和9例表达颗粒酶B,阳性表达细胞均为非肿瘤细胞.芯片中的2例和常规10例鼻NK/T细胞淋巴瘤中均见穿孔素和颗粒酶B过度表达.T、B细胞淋巴瘤与NK/T细胞淋巴瘤比较有显著性差异（P〈0.01）.结论穿孔素和颗粒酶B是鉴定活化的细胞毒性细胞的免疫标志物,可作为NK/T细胞淋巴瘤的诊断性标志物;其在T细胞淋巴瘤中的表达反映了机体存在抗肿瘤的免疫反应机制.组织芯片技术具有高信息量、简捷、高效、实验误差小、重复性好等优点,可作为研究淋巴瘤的有用工具.     

咽淋巴环非霍奇金淋巴瘤相关病理类型的影像表现

目的探讨咽淋巴环非霍奇金淋巴瘤不同病理类型的影像学征象,以提高影像学认识。方法回顾18例经病理证实咽淋巴环非霍奇金淋巴瘤的CT、MRI表现,结合病理类型进行对比分析。结果在18例非霍奇金淋巴瘤中,病灶局限性11例(11/18),弥漫性7例(7/18),伴颈部淋巴结肿大10例。病理类型:B细胞型13例(72%),NK和T细胞型5例(28%)。B细胞型以局限性多见(10/13),扁桃体好发(8/13),密度和信号均匀(12/13),边界清晰(10/13),常伴颈部淋巴结肿大(8/13)。NK/T细胞型以弥漫性多见(4/5),易累及鼻咽部(4/5),边界不清(4/5)、密度和信号不均匀多见(3/5),其内可见气泡影(2/5),易侵犯鼻腔并铸形(3/5)和骨质侵蚀破坏(2/5)。结论咽淋巴环不同病理类型的非霍金奇淋巴瘤影像学具有一定特点,有助于鉴别诊断。     

鼻咽非霍奇金淋巴瘤的MRI表现与侵犯特点

目的 探讨鼻咽非霍奇金淋巴瘤(NHL)的MRI表现特征及鉴别诊断.方法 回顾性分析41例经病理证实的鼻咽NHL的MRI表现.评价病灶的大小、分布、侵犯范围及淋巴结累及情况.对B细胞型和T或NK/T细胞型2组NHL的侵犯生长方式比较采用Fisher确切概率法或Pearson卡方检验.结果 41例患者中,成熟B淋巴细胞肿瘤26例,成熟T淋巴细胞肿瘤2例,NK/T细胞瘤13例.病灶以鼻咽黏膜增厚或形成软组织肿块为主要表现,在T2WI上呈稍高信号,T1WI呈等信号,增强后均匀轻到中度强化.均匀累及鼻咽各壁24例,伴溃疡形成5例,超腔生长9例,累及舌或腭扁桃体共23例,邻近肌肉受侵20例,颅底骨质破坏12例.41例患者中,25例合并咽后淋巴结受侵,27例合并颈部淋巴结受侵.NK/T淋巴细胞型鼻咽NHL更易超腔生长、咽旁结构侵犯、溃疡形成(T或NK/T淋巴细胞型鼻咽NHL分别为8、11、4例,B淋巴细胞型鼻咽NHL分别为4、10、1例),B淋巴细胞型鼻咽NHL扁桃体侵犯更常见(B淋巴细胞型鼻咽NHL为18例,NK/T淋巴细胞型鼻咽NHL为5例).结论 鼻咽NHL在MRI上表现具有一些特点,鼻咽各壁均匀增厚多见,常累及鼻腔或扁桃体,当肿瘤体积较大但没有或仅有少许深度侵犯时要考虑NHL.不同病理类型鼻咽NHL其MRI表现有一定差异.

Abstract：

Objective To characterize the features of Nasopharyngeal non-Hodgkin's lymphoma (NHL) on MR imaging and find the main points to differentiate it from the other nasopharyngeal tumors.Methods The MR images of 41 patients with pathologically and immunohistochemically proven nasopharyngeal NHLs were reviewed retrospectively. Images were assessed by the size, invasive extent,signal intensity of primary nasopharyngeal tumor, and the distribution of cervical lymphadenopethy. The difference of regional tissues invasion and cervical lymphadenopathy distribution between the patients with B-cell NHLs and the patients with T-cell or NK/T-cell NHLs were analyzed by Pearson's Chi-Square test or Fisher's exact test Results Of the 41 patients, 26 patients had mature B-cell lymphoma, two patients with mature T-cell Iymphoma, and thirteen patients showed Nature killer/T-cell lymphoma in nasopharynx. MRI revealed that NHLs of nasopharynx can be showed as thickening of nasopharyngeal mucosa and (or) lumps in nasopharynx, which were slightly hyper-intensity on T2-weighted images, and intermediate signal intensity (similar to muscle) on T1 -weighted images, with mild or moderated enhancement following contrast medium administration. Twenty four cases had symmetrical disease of all walls of nasopharynx, and 17 cases had unsymmetrical tumor. Of all cases, 5 cases had superficial ulcerations, 9 cases had exceed nasoharynx invasion spreads superficially along the mucosa, 23 cases had invasion of lingual and (or) palatine tonsils,20 cases showed invasion of parapharygeal muscles, 12 cases suffered from skull base bone infiltration,25 cases had retropaharyngeal lymphadenopathy, and 27 cases had cervical lymhadenopathy. Patient with nasopharyngeal Nature killer/T-cell lymphoma had a higher incidence of exceed nasopharynx invasion,parapharyngeal structures invasion, and superficial ulcerations (the cases were 8, 11, 4 in patient with T-cell or N K/T-cell lymphoma, and 4, 10, 1 in patients with B-cell lymphoma, respectively). Patients with nasopharyngeal B-cell lymphoma had a higher incidence of inasion of lingual and (or) palatine tonsils.Conclusions Nasopharyngeal NHL is a homogeneous tumor that tends to diffusely involve all walls of the nasopharynx and spread in an exophytic fashion to fill the airway, rather than infiltrating into the deep tissues. Different pathological types of nasopharyngeal NHLs have some different appearance on MRI between each other. A large tumor in nasopharynx that fills the nasopharynx cavity, with no or minimal invasion into deep structures, but with invasion extend down into the lingual and(or)palatine tonsils, may suggest the diagnosis of nasopharyneal NHL.     

口咽部非霍奇金淋巴瘤的CT和MRI表现

目的探讨口咽部非霍奇金淋巴瘤(NHL)的CT和MRI表现。资料与方法回顾性分析21例病理确诊的口咽部非霍奇金淋巴瘤的影像特点。结果 21例中B细胞来源16例,外周T细胞来源3例,NK/T细胞来源2例。腭扁桃体受累最多见,见于16例。病变表现:肿块型7例,弥漫型5例,混合型9例。14例CT平扫呈稍低密度,增强后轻度均匀强化。6例MRI检查T1WI呈稍低信号,T2WI为稍高信号。10例咽旁间隙受压变窄,但MRI检查高信号的脂肪仍存在。15例累及颈部淋巴结,受累淋巴结密度、信号均匀,中心坏死少。结论口咽部非霍奇金淋巴瘤在发病部位、形态、肿瘤的信号、周围组织结构的侵犯方面都有一定的影像学特征,CT和MRI对于口咽部非霍奇金淋巴瘤的鉴别诊断有重要价值。     

鼻腔NK/T细胞淋巴瘤的CT和MRI表现

目的:分析和总结鼻腔原发NK/T细胞淋巴瘤的CT和MRI表现,探讨其影像学特征,以提高诊断的准确性.方法:回顾性分析25例经病理证实的鼻腔原发NK/T细胞淋巴瘤的CT和MRI影像资料.结果:原发肿瘤位于单侧鼻腔10例,双侧鼻腔8例,发生在鼻后孔7例.肿瘤侵犯周围结构包括鼻旁窦受累11例,鼻咽12例,鼻唇沟9例,口咽11...     

鼻腔NK/T细胞淋巴瘤的CT和MRI影像学表现

目的:探讨鼻腔NK/T细胞淋巴瘤的CT和MRI影像学特征,提高诊断水平.方法:搜集经手术病理证实的鼻腔NK/T细胞淋巴瘤19例,全部病例均有CT和/或MRI资料.结果:病变位于鼻腔左侧7例,右侧11例,双侧同时侵犯1例;局限于鼻前庭或鼻前部3例,鼻腔前中部6例,中后部2例,整个鼻腔受侵8例;肿瘤向鼻前庭生长并浸润鼻翼、鼻背及邻近面颊部皮肤11例;延伸至口咽部1例,侵犯眼眶2例,伴骨质破坏9例.CT显示肿瘤呈软组织密度充填鼻腔并沿鼻黏膜蔓延,MRI显示肿瘤T1WI呈等或稍低信号,T2WI呈不均匀稍高信号,增强后呈轻到中度不均匀强化.结论:鼻腔NK/T细胞淋巴瘤的影像学表现有一定特征性,CT扫描可清晰显示骨质破坏情况,MRI能够更清晰、准确显示病变侵犯范围.确诊须依赖病理学和免疫组化检查.     

咽淋巴环非霍奇金淋巴瘤的CT、MRI诊断

目的探讨咽淋巴环非霍奇金淋巴瘤(NHL)的影像学特点,以提高诊断及鉴别诊断的准确性。资料与方法回顾性分析149例临床病理资料完整、原发于咽淋巴环NHL的CT和MRI表现。结果149例中,B细胞来源98例(65.8%),外周T和NK/T细胞51例(34.2%)。单发于扁桃体者最多见(56例,37.6%),其次为鼻咽、扁桃体等多部位受累(43例,28.9%)。肿块型81例,浸润型36例,溃疡型7例,混合型25例,以肿块型多见(54.4%)。肿块型轮廓境界光整,密度和信号均匀,以B细胞NHL多见;浸润型病变范围较弥漫,境界欠清晰,部分密度信号不均匀,以NK/T细胞多见;溃疡型少见,均为NK/T细胞NHL。各型病变多局限于咽黏膜间隙内,咽旁等深部间隙及颅底骨质侵犯少,仅12例(8%)。78例伴有颈淋巴结受累,受累率约52.3%,其中在B细胞NHL中为65.3%(64/98),在外周T和NK/T细胞NHL中为27.5%(14/51),两者有显著性差异(χ2=19.14,P<0.01)。结论多部位多中心起源、大肿块或咽壁弥漫浸润性增厚、颅底及深层结构侵犯少是咽淋巴环NHL典型的影像学表现,不同的免疫表型又有各自的特点,这些特征有助与该部位常见的鳞状上皮癌的鉴别。     

基线和中期18F-FDG-PET/CT应用于淋巴瘤预后评估的研究进展

<正>目前各种类型淋巴瘤预后评估指标不一,如结外NK/T细胞淋巴瘤(ENKTL),应用国际预后指数(IPI)和韩国预后指数(KPI)预测预后;弥漫性大B细胞淋巴瘤(DLBCL)应用IPI评分、aaIPI评分;套细胞淋巴瘤 (MCL) 应用MIPI以及Ki67等指标评估预后;滤泡型淋巴瘤(FL)应用FLIPI和FLIPI-2评分评估疾病预后;外周T细胞淋巴瘤(PTCL)应用PIT和m-PIT评估预后;     

咽及颈部淋巴瘤的影像分析

目的：探讨咽和颈部淋巴瘤的影像学特征,提高诊断水平。方法：搜集20例经穿刺活检及手术病理证实的咽和颈部淋巴瘤的临床、病理及CT和（或）MRI资料,详细分析其影像学表现。结果：本文20例中9例表现为腭扁桃体肿大伴颈部淋巴结肿大;4例表现为咽旁间隙肿块并向四周铸型生长;5例颈部多发淋巴结肿大,其中4例向下一直延伸至上纵隔内;2例表现为颈部单发肿块。18例肿块密度、信号均匀,无明显坏死,轻度强化;2例可见少许坏死囊变,密度不均匀。结论：咽和颈部淋巴瘤CT和MR表现具有一定特征性,当出现咽淋巴环肿块、咽旁间隙内铸型生长的肿块及伴有身体其它部位（如纵隔）的淋巴结肿大,对淋巴瘤的诊断有提示作用。     

WB-DWI在恶性肿瘤淋巴结转移中的应用

目的:探讨磁共振全身弥散加权成像(whole body diffusion-weighted imaging,WB-DWI)在恶性肿瘤淋巴结转移瘤中的应用价值。方法:对110例疑似恶性肿瘤淋巴结转移患者行WB-DWI检查,并于扫描后1周内对可疑骨转移部位及原发恶性肿瘤部位行常规MRI/CT检查。根据MRI/CT及临床综合诊断结果,将所有患者分为淋巴结转移组及非淋巴结转移组,对资料进行统计学分析,比较单独应用WB-DWI、MRI/CT及二者联合应用(WB-DWI+MRI/CT)在恶性肿瘤淋巴结转移中的诊断价值。分别测定淋巴结转移组及非淋巴结转移组的ADC值,比较其在良恶性病变鉴别诊断中的价值。结果:①将淋巴结按长径大小分为<2cm,2～3cm,>3cm,WB-DWI、MRI/CT及WB-DWI+MRI/CT对长径<2cm淋巴结转移的检出差异具有统计学意义。进一步两两比较,单独应用MRI/CT与WB-DWI+MRI/CT的差异具有统计学意义(χ2=6.519,P=0.011)。②ROC分析结果显示,WB-DWI+MRI/CT诊断恶性肿瘤淋巴结转移的特异度、诊断准确性、阳性预测值及阴性预测值诊断最高。③淋巴结转移组ADC值明显低于良性淋巴结病变组,在良恶性淋巴结转移鉴别诊断中具有一定作用。结论:WB-DWI是常规MRI、CT的有益补充,与MRI/CT的联合应用可以提高恶性肿瘤淋巴结转移的诊断率,结合ADC值测定,在恶性肿瘤淋巴结转移诊断和鉴别方面具有一定价值。     

颈部肿大淋巴结的影像分析

目的探讨颈部肿大淋巴结影像表现特点,提高诊断的准确性。方法66例经临床和病理证实的颈部肿大淋巴结患者,均进行CT和/或MR I检查,对比分析他们的影像学表现。结果多发的转移性淋巴结与多发的结核性淋巴结在位置分布上有显著性差异(P=0.006)。转移性淋巴结环形强化20例,其薄壁环形强化19例,占95%,而淋巴结结核环形强化5例均为厚壁环形强化,两者具有显著差异性(P=0.000)。转移性淋巴结中心坏死占78%,而淋巴瘤仅占36%,两者有显著性差异(P=0.018)。结论根据颈部肿大淋巴结位置分布和影像表现特点,大部分可做出正确诊断。     

Challenges in dynamic contrast-enhanced MRI imaging of cervical lymph nodes to detect metastatic disease

PURPOSE: To identify and overcome challenges in using dynamic contrast-enhanced magnetic resonance imaging (MRI) to distinguish tumor from nontumor in the cervical lymph nodes of patients with squamous cell carcinoma of the head and neck. MATERIALS AND METHODS: Signal-to-noise ratio (S/N), motion, node heterogeneity, and tissue normalizations were examined. Twenty-one patients with squamous cell carcinoma of the head and neck were scanned before a neck dissection (two-dimensional fast spoiled gradient-echo: 10 locations/13 seconds). Peak time, peak enhancement, maximum upslope, and washout slope were measured in pathologically confirmed tumor and nontumor nodes and in the submandibular gland and the sternocleidomastoid muscle. RESULTS: Surface coil arrays provided high coverage and high S/N. Motion averaged 1.1 pixels and was corrected. Large tumor nodes were heterogeneous in their contrast enhancement, while the nontumor nodes were homogeneous. The contrast enhancement parameters were significantly different for all regions except for the submandibular gland compared to the nontumor nodes. CONCLUSION: Challenges of dynamic imaging of cervical lymph nodes were overcome and significant differences were found between the tumor and nontumor nodes, indicating that dynamic imaging is feasible and may aid this patient population.     

FDG PET/CT appearance of multicentric Castleman's disease mimicking lymphoma

We report a case of a multicentric form of Castleman's disease with multiple lymph nodes showing intense FDG uptake on whole body scan mimicking non-Hodgkin's lymphoma. In this report, the patient had multiple cervical, mediastinal, hilar, retroperitoneal and abnormal lymph nodes in the groin. (18)F-fluorodeoxyglucose positron emission tomography/computed tomography was performed before tissue sampling. (18)F-FDG/PET demonstrated multiple areas of increased uptake in cervical, mediastinal, hilar, retroperitoneal and groin lymph nodes, suggesting a generalized disease of the lymphatic system including non-Hodgkin's lymphoma. The final diagnosis is based on the histopathological findings of the material obtained from the cervical lymphadenectomy. The histological diagnosis was multicentric plasma cell variant of Castleman's disease. (18)F fluorodeoxyglucose positron emission tomography/computed tomography scan helped to identify the lymph nodes involved throughout the whole body, but did not help to differentiate non-Hodgkin's lymphoma. The clinical conclusions and PET/CT findings are described in this report.     

Interstitial MR lymphography with MS-325: characterization of normal and tumor-invaded lymph nodes in a rabbit model

OBJECTIVE: The aim of our study was to evaluate the performance of a new blood-pool contrast agent, MS-325, in depicting regional lymph nodes when injected interstitially and in allowing the subsequent classification of the lymph nodes as normal or tumor-bearing (VX2 tumor). MATERIALS AND METHODS: Six New Zealand white rabbits underwent adapted fast three-dimensional (3D) MR imaging before implantation of VX2 tumor cells in the flank and again 3 weeks after the implantation. For each imaging session, 0.5 mL of undiluted MS-325 was injected subcutaneously into both dorsal foot pads. For more than 120 min, the rabbits underwent repeated 3D MR imaging. The size of the individual lymph nodes and the amount of contrast agent uptake in the nodes were measured 5, 10, 15, 30, 60, and 120 min after the injection. After the rabbits had been sacrificed, their lymph nodes were removed and histopathologically analyzed. RESULTS. In normal as well as tumor-bearing hindlegs, the subcutaneous administration of MS-325 resulted in rapid delineation of popliteal, inguinal, iliac, and paraaortal lymph nodes. Tumor invasion into lymph nodes presented as circumscribed signal voids in the areas infiltrated by tumor, whereas the surrounding residual lymphatic tissue showed enhancement identical to that of normal nodes. CONCLUSION: In addition to providing a safe means of displaying the normal lymphatic system, MS-325-enhanced 3D MR lymphography depicts direct tumor invasion in lymph nodes.     

颈外侧部肿块的影像学诊断与鉴别诊断

目的 分析各种颈外侧部肿块增强扫描前后的CT、MRI表现.资料与方法 回顾性分析45例经病理证实的颈外侧部肿块增强扫描前后的CT、MRI表现,包括病灶的部位、大小、形态、边缘、密度、信号、强化特点及其与邻近血管和间隙的关系.结果 45例颈外侧部肿块中,鳃裂囊肿6例,淋巴管瘤6例,淋巴结结核6例,淋巴结转移瘤8例,颈动脉体瘤3例,淋巴瘤2例,淋巴结炎4例,神经鞘瘤5例,颈部脓肿、巨大淋巴结增生、神经纤维瘤,原始神经外胚层肿瘤、海绵状血管瘤各1例.鳃裂囊肿、淋巴管瘤表现为囊性无强化;颈部脓肿表现为环形强化;淋巴结结核、淋巴结转移瘤表现为结节状轻中度强化与环形强化共存;淋巴瘤、淋巴结炎、巨大淋巴结增生、神经纤维瘤、神经鞘瘤、原始神经外胚层肿瘤呈轻中度强化;海绵状血管瘤、颈动脉体瘤呈高度强化.结论 颈外侧部肿块增强前后CT、MRI表现有特征性改变,可作出较为准确的诊断.     

颈部淋巴结结核的CT诊断和鉴别诊断

目的:分析颈部淋巴结核的CT表现,探讨CT诊断价值及鉴别诊断。方法:对22例颈部肿块行CT平扫及增强扫描。全部病例均经病理证实。其中15例为颈部淋巴结结核,女9例,男6例,年龄20～38岁。4例为颈部淋巴结转移瘤;3例为颈部淋巴瘤。结果:颈部淋巴结结核病变好发部位为颈静脉链下、中组及颈后三角淋巴结与淋巴性肿瘤有区别。根据颈部淋巴结核CT扫描的形态,密度及周围脂肪间隙的情况,可反映颈部淋巴结结核的病理改变。结论:CT在颈部淋巴结结核的诊断方面有着重要的价值,不仅可以明确病变的部位、数目、大小、形态特征及周围情况,尚可以反映其病理改变。