原发性纵隔淋巴瘤：CT上各种组织学亚型的特征

Primary mediastinal lymphoma: characteristic features of the various histological subtypes on CT.

作者信息

Tateishi Ukihide, Müller Nestor L, Johkoh Takeshi, Onishi Yasushi, Arai Yasuaki, Satake Mitsuo, Matsuno Yoshihiro, Tobinai Kensei

机构信息

Division of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.

出版信息

J Comput Assist Tomogr. 2004 Nov-Dec;28(6):782-9. doi: 10.1097/00004728-200411000-00009.

DOI:10.1097/00004728-200411000-00009

PMID:15538151

Abstract

OBJECTIVE

To assess the characteristic features of the primary mediastinal lymphoma (PML) on CT and to test the relationship between CT findings and the likelihood of the 3 most common subtypes (Hodgkin lymphoma [HL], mediastinal diffuse large B-cell lymphoma [Med-DLBCL], and precursor T-cell lymphoblastic lymphoma [T-LBL]).

METHODS

Sixty-six consecutive patients with pathologically proven PML including 29 patients with HL, 21 with Med-DLBCL, and 16 with T-LBL underwent CT prior to therapy. CT scans were independently reviewed by 2 radiologists who were blinded to the pathologic diagnosis for the following considerations: pattern of involvement (i.e., morphologic features, mass size, and contrast enhancement pattern), and ancillary findings at other sites including neck, abdomen, and pelvis. Interobserver agreement was measured by Kappa statistics, and independent predictors were calculated using multiple logistic regression analysis for determining the likelihood of the subtypes based on CT.

RESULTS

Characteristic features of HL included irregular contour of the anterior mediastinal mass (20 of 29, 69%) and high prevalence of associated mediastinal lymphadenopathy (28 of 29, 97%). Characteristic features of Med-DLBCL included regular contour (14 of 21, 67%) and absence of cervical and abdominal lymphadenopathy (0 of 21). Characteristic features of T-LBL included regular contour (12 of 16, 75%) and high prevalence of cervical (9 of 16, 56%) and abdominal (6 of 16, 38%) lymphadenopathy and splenomegaly (11 of 16, 69%). CT findings independently associated with increased likelihood of HL were surface lobulation (P <0.01), the absence of vascular involvement (P <0.01), or pleural effusion (P <0.05). The presence of vascular involvement was associated with increased likelihood of Med-DLBCL (P <0.001). Furthermore, CT findings including the presence of cervical lymph nodes or inguinal lymph nodes (P <0.001), the presence of pericardial effusion (P <0.05), and the absence of surface lobulation (P <0.05) were significantly associated with the likelihood of T-LBL.

CONCLUSION

The various histologic subtypes of PML have characteristic manifestations in the neck, chest, and abdomen, which allow their distinction on CT.

摘要

目的

评估原发性纵隔淋巴瘤（PML）的CT特征，并检验CT表现与3种最常见亚型（霍奇金淋巴瘤[HL]、纵隔弥漫性大B细胞淋巴瘤[Med-DLBCL]和前体T细胞淋巴母细胞淋巴瘤[T-LBL]）可能性之间的关系。

方法

66例经病理证实的PML患者，包括29例HL患者、21例Med-DLBCL患者和16例T-LBL患者，在治疗前接受了CT检查。2名放射科医生在不知病理诊断的情况下独立阅片，考虑以下因素：受累模式（即形态学特征、肿块大小和强化模式），以及颈部、腹部和骨盆等其他部位的伴随表现。观察者间一致性用Kappa统计量测量，使用多元逻辑回归分析计算独立预测因子，以根据CT确定亚型的可能性。

结果

HL的特征包括前纵隔肿块轮廓不规则（29例中的20例，69%）以及相关纵隔淋巴结肿大的高发生率（29例中的28例，97%）。Med-DLBCL的特征包括轮廓规则（21例中的14例，67%）以及无颈部和腹部淋巴结肿大（21例中的0例）。T-LBL的特征包括轮廓规则（16例中的12例，75%）以及颈部（16例中的9例，56%）和腹部（16例中的6例，38%）淋巴结肿大及脾肿大的高发生率（16例中的11例，69%）。与HL可能性增加独立相关的CT表现为表面分叶（P<0.01）、无血管受累（P<0.01）或胸腔积液（P<0.05）。血管受累与Med-DLBCL可能性增加相关（P<0.001）。此外，包括存在颈部淋巴结或腹股沟淋巴结（P<0.001）、存在心包积液（P<0.05）以及无表面分叶（P<0.05）等CT表现与T-LBL的可能性显著相关。