Balthazar E J, Noordhoorn M, Megibow A J, Gordon R B
Radiology Department, New York University-Tisch Medical Center, NY 10016, USA.
AJR Am J Roentgenol. 1997 Mar;168(3):675-80. doi: 10.2214/ajr.168.3.9057513.
The purpose of this study was to describe and analyze the CT features of small-bowel lymphoma, compare those features with the radiographic presentation in immunocompetent patients and patients with AIDS, and discuss the role of CT in the initial detection and evaluation of this disease.
Abdominal CT examinations of 42 consecutive patients with proven small-bowel lymphoma were retrospectively reviewed. In 19 patients, small-bowel examinations were also available for review. The 42-patient study group was divided into two subgroups: 22 patients with AIDS and 20 immunocompetent patients.
Primary small-bowel lymphoma was present in 37% of patients and was equally distributed between the two subgroups. The histologic types included non-Hodgkin's lymphoma in 33 patients, Burkitt's lymphoma in seven patients, Hodgkin's lymphoma in one patient, and mucosa-associated lymphoid tissue-type lymphoma in one patient. Solid organ involvement (liver, splee, kidney, or adrenal glands) was detected in 22% of patients with AIDS and in 10% of the immunocompetent patients. We saw two main patterns of CT appearance. In the first pattern, single or multiple segments had circumferential wall thickening, homogeneous in attenuation, that ranged from 1.5 cm to 7 cm (mean, 2.6 cm) in 33 patients. In the second pattern, single or multiple cavitary lesions were revealed as nodular and grossly enlarged intestinal lumen with bowel wall thickening in 13 patients. A polypoid mass that was entirely intraluminal was seen in one patient. Heterogeneous areas of low attenuation were revealed in two intestinal tumors of HIV-positive patients. Mesenteric or retroperitoneal lymphadenopathy was seen in 45% of patients with AIDS and 60% of the immunocompetent patients. The gross morphologic features, distribution. pattern of CT presentation, degree of wall thickening, and length of involvement were all similar in the two subgroups.
More than half (52%) of the individuals with small-bowel lymphoma diagnosed at our institution in the last 4 years were patients with AIDS. The features revealed by CT scans were characteristic or highly suggestive of small-bowel lymphoma. We saw no significant differences in the radiographic features of patients with AIDS and immunocompetent patients.
本研究旨在描述和分析小肠淋巴瘤的CT特征，将这些特征与免疫功能正常患者及艾滋病患者的影像学表现进行比较，并探讨CT在该疾病的初始检测和评估中的作用。
对42例经证实的小肠淋巴瘤患者的腹部CT检查进行回顾性分析。其中19例患者还可进行小肠检查。42例患者的研究组分为两个亚组：22例艾滋病患者和20例免疫功能正常患者。
37%的患者存在原发性小肠淋巴瘤，且在两个亚组中分布均匀。组织学类型包括33例非霍奇金淋巴瘤、7例伯基特淋巴瘤、1例霍奇金淋巴瘤和1例黏膜相关淋巴组织型淋巴瘤。22%的艾滋病患者和10%的免疫功能正常患者检测到实体器官受累（肝脏、脾脏、肾脏或肾上腺）。我们观察到两种主要的CT表现模式。第一种模式，33例患者中单个或多个节段出现环形壁增厚，密度均匀，厚度为1.5厘米至7厘米（平均2.6厘米）。第二种模式，13例患者中单个或多个空洞性病变表现为结节状且肠腔明显扩大，伴有肠壁增厚。1例患者可见完全位于腔内的息肉样肿块。2例HIV阳性患者的肠道肿瘤中发现低密度不均匀区域。45%的艾滋病患者和60%的免疫功能正常患者可见肠系膜或腹膜后淋巴结肿大。两个亚组的大体形态特征、分布、CT表现模式、壁增厚程度和受累长度均相似。
在过去4年于我院诊断的小肠淋巴瘤患者中，超过一半（52%）为艾滋病患者。CT扫描显示的特征具有小肠淋巴瘤的特征性或高度提示性。我们未发现艾滋病患者和免疫功能正常患者的影像学特征有显著差异。
