Carter Brett W, Wu Carol C, Khorashadi Leila, Godoy Myrna C B, de Groot Patricia M, Abbott Gerald F, Lichtenberger John P
The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Section of Thoracic Imaging, 1515 Holcombe Blvd., Unit 1478, Houston, TX 77030, USA.
Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02114, USA.
Eur J Radiol. 2014 Aug;83(8):1470-82. doi: 10.1016/j.ejrad.2014.05.018. Epub 2014 May 27.
Lymphoma is the most common hematologic malignancy and represents approximately 5.3% of all cancers. The World Health Organization published a revised classification scheme in 2008 that groups lymphomas by cell type and molecular, cytogenetic, and phenotypic characteristics. Most lymphomas affect the thorax at some stage during the course of the disease. Affected structures within the chest may include the lungs, mediastinum, pleura, and chest wall, and lymphomas may originate from these sites as primary malignancies or secondarily involve these structures after arising from other intrathoracic or extrathoracic sources. Pulmonary lymphomas are classified into one of four types: primary pulmonary lymphoma, secondary pulmonary lymphoma, acquired immunodeficiency syndrome-related lymphoma, and post-transplantation lymphoproliferative disorders. Although pulmonary lymphomas may produce a myriad of diverse findings within the lungs, specific individual features or combinations of features can be used, in combination with secondary manifestations of the disease such as involvement of the mediastinum, pleura, and chest wall, to narrow the differential diagnosis. While findings of thoracic lymphoma may be evident on chest radiography, computed tomography has traditionally been the imaging modality used to evaluate the disease and effectively demonstrates the extent of intrathoracic involvement and the presence and extent of extrathoracic spread. However, additional modalities such as magnetic resonance imaging of the thorax and (18)F-FDG PET/CT have emerged in recent years and are complementary to CT in the evaluation of patients with lymphoma. Thoracic MRI is useful in assessing vascular, cardiac, and chest wall involvement, and PET/CT is more accurate in the overall staging of lymphoma than CT and can be used to evaluate treatment response.
淋巴瘤是最常见的血液系统恶性肿瘤，约占所有癌症的5.3%。世界卫生组织于2008年发布了修订后的分类方案，根据细胞类型以及分子、细胞遗传学和表型特征对淋巴瘤进行分组。大多数淋巴瘤在疾病过程中的某个阶段会累及胸部。胸部内受影响的结构可能包括肺、纵隔、胸膜和胸壁，淋巴瘤可能作为原发性恶性肿瘤起源于这些部位，也可能在源自其他胸内或胸外部位后继发累及这些结构。肺淋巴瘤分为四种类型之一：原发性肺淋巴瘤、继发性肺淋巴瘤、获得性免疫缺陷综合征相关淋巴瘤和移植后淋巴组织增生性疾病。尽管肺淋巴瘤可能在肺内产生各种各样的表现，但特定的个体特征或特征组合，结合疾病的继发表现，如纵隔、胸膜和胸壁受累情况，可用于缩小鉴别诊断范围。虽然胸部淋巴瘤的表现可能在胸部X线片上很明显，但传统上计算机断层扫描一直是用于评估该疾病的成像方式，它能有效地显示胸内受累范围以及胸外扩散的存在和范围。然而，近年来出现了其他一些检查方法，如胸部磁共振成像和（18）F-FDG PET/CT，它们在淋巴瘤患者的评估中是对CT的补充。胸部MRI有助于评估血管、心脏和胸壁受累情况，PET/CT在淋巴瘤的总体分期方面比CT更准确，可用于评估治疗反应。
