MRI在脊柱硬膜外淋巴瘤与白血病的诊断及鉴别分析
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摘要
目的探讨MRI在脊柱硬膜外淋巴瘤与白血病的诊断及鉴别诊断分析。方法选择2016年3月-2018年3月我院收治并确诊的脊柱硬膜外淋巴瘤(15例)和白血病(10例)患者共计25例,将其病例资料进行回顾性分析。使用磁共振成像仪扫描,观察脊柱硬膜外淋巴瘤与白血病发病部位及MRI表现情况。结果共25例患者中23例(92.00%)出现脊柱及其附件弥漫性病变,且多为脊柱硬膜外淋巴瘤,其中胸段椎管内硬膜外病变患者最多。对MRI表现部位进行分析,发现脊柱硬膜外淋巴瘤多发于椎管及椎管外,而白血病则多发于椎管内,差异有统计学意义(P<0.05);脊柱硬膜外淋巴瘤好发于胸椎,而白血病则胸椎、腰骶椎及骨盆均有发生,差异有统计学意义(P<0.05)。对MRI表现情况进行分析,发现脊柱硬膜外淋巴瘤矢状面T1WI、T2WI病变节段呈弥漫性斑点状、斑片状出现短T2信号,且横断面T1WI、T2WI硬膜外软组织呈新月、半月形等T1和等T2信号,而白血病均未出现,差异有统计学意义(P<0.05)。结论脊柱硬膜外淋巴瘤与白血病的MR表现有一定特征,MR对疾病诊断有一定参考价值。
Objective To investigate MRI diagnosis and differential diagnosis spinal epidural lymphoma and leukemia. Methods The medical records of patients with spinal epidural lymphomas(15 cases) and leukemia(10 cases) who admitted to the hospital from March2016 to March 2018 were analyzed retrospectively. All cases received MR examination and analyze the location and MRI findings of spinal epidural lymphoma and leukemia.Results Of the 25 patients, 23(92.00%) had diffuse lesions of the spine and its appendages,and most of them were spinal epidural lymphomas. Patients with thoracic segment and intraspinal epidural lesions were the most. MRI findings showed that spinal epidural lymphomas mostly occurred in the spinal canal and outside spinal canal, while leukemia mainly occurred in the spinal canal(P<0.05). Spinal epidural lymphomas mainly occurred in the thoracic vertebrae, while leukemia mainly occurred in the thoracic vertebrae,lumbosacral vertebrae and pelvis(P<0.05). MRI findings showed diffuse spotted and patchy short T2 signal on sagittal T1 WI and T2 WI of spinal epidural lymphomas, and semilunar and half-moon-shaped equal T1 and equal T2 signal on cross-sectional T1 WI and T2 WI of epidural soft tissues. However, such findings were not found in patients with leukemia(P<0.05). Conclusion MRI findings of spinal epidural lymphoma and leukemia are characteristic, which is of certain reference value for diagnosis of the disease.
Objective To investigate MRI diagnosis and differential diagnosis spinal epidural lymphoma and leukemia. Methods The medical records of patients with spinal epidural lymphomas(15 cases) and leukemia(10 cases) who admitted to the hospital from March2016 to March 2018 were analyzed retrospectively. All cases received MR examination and analyze the location and MRI findings of spinal epidural lymphoma and leukemia.Results Of the 25 patients, 23(92.00%) had diffuse lesions of the spine and its appendages,and most of them were spinal epidural lymphomas. Patients with thoracic segment and intraspinal epidural lesions were the most. MRI findings showed that spinal epidural lymphomas mostly occurred in the spinal canal and outside spinal canal, while leukemia mainly occurred in the spinal canal(P<0.05). Spinal epidural lymphomas mainly occurred in the thoracic vertebrae, while leukemia mainly occurred in the thoracic vertebrae,lumbosacral vertebrae and pelvis(P<0.05). MRI findings showed diffuse spotted and patchy short T2 signal on sagittal T1 WI and T2 WI of spinal epidural lymphomas, and semilunar and half-moon-shaped equal T1 and equal T2 signal on cross-sectional T1 WI and T2 WI of epidural soft tissues. However, such findings were not found in patients with leukemia(P<0.05). Conclusion MRI findings of spinal epidural lymphoma and leukemia are characteristic, which is of certain reference value for diagnosis of the disease.
引文
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[2]何海涛,李惠民.急性髓系白血病靶向治疗的研究进展[J].中国实验血液学杂志,2016,24(1):245-249.
[3]中华医学会影像技术分会.MRI检查技术专家共识[J].中华放射学杂志,2016,50(10):724-739.
[4]Go T,Iida Y,Aoki H,et al. A Patient with Malignant Spinal Epidural Lymphoma with Initial Rapidly Aggravating Paraplegia[J].Open Journal of Orthopedics,2017,7(3):90-97.
[5]薛文.原发性脊柱硬膜外非何杰金淋巴瘤1例报道[J].实用骨科杂志,2017,23(6):571-572.
[6]罗俊普,王志国,刘文德,等.椎管内非霍奇金淋巴瘤误诊为硬膜外血肿1例[J].临床骨科杂志,2016,19(5):640-640.
[7]Dho Y S,Kim H,Wang K C,et al.Pediatric spinal epidural lymphoma presenting with compressive myelopathy:A distinct pattern of disease presentation[J]. World Neurosurgery,2018, 114(15):689-697.
[8]杨帆,孙鹏飞,那曼丽,等.脊柱原发非霍奇金淋巴瘤的影像和病理表现特征[J].放射学实践,2018(1):68-73.
[9]徐兵,林志娟.老年急性髓性白血病的预后判断及治疗进展[J].中华肿瘤防治杂志,2016,23(17):1134-1137.
[10]周建军,陈睿,王烨菁,等.上海市卢湾区居民2004-2011年白血病发病和死亡资料分析[J].中华肿瘤防治杂志,2017,24(8):507-511.
[11]王莉红,吴铮,闰蓓,等.上海市浦东新区2002-2012年白血病流行病学分析[J].中国公共卫生,2016, 32(11):1547-1550.
[12]张永利,陈克敏,邓廉夫,等.MRI评价氟骨症患者骨髓增生的研究[J].中国医学计算机成像杂志,20 16,22(4):351-355.
[13]龚彤,牛金亮.骨髓病变的MRI研究进展[J].放射学实践,2017, 32(2):183-185.
[14]侯刚强,高德宏,沈比先,等.推管内硬膜外原发性淋巴瘤影像表现[J].中国CT和MRI杂志,2018, 16(2):140-142,148.
[15]田颖,陈淑霞,胡青竹.40例中枢神经系统白血病的影像表现研究[J].中国CT和MRI杂志,2017, 15(12):15-18.