目的 分析原发前纵隔淋巴瘤的影像学特征,并与侵袭性胸腺瘤对比,以提高该病的早期诊断准确率.方法 回顾性分析20例经病理证实且影像学误诊的原发前纵隔淋巴瘤患者的影像学资料,并与23例侵袭性胸腺瘤比较,总结该病的影像学特点,包括:病变形态、分布、密度、周围淋巴结情况、与邻近血管关系、周围结构侵犯、强化幅度等.结果 淋巴瘤呈多结节融合状15例(75.00％),均匀对称分布11例(55.00％),坏死、囊变边界清晰15例(75.00％),明显推压纵隔大血管15例(75.00％),侵蚀上腔、头臂静脉10例(50.00％),侵犯肺内10例(50.00％),胸壁软组织肿块6例(30.00％),周围淋巴结肿大12例(60.00％),强化幅度<30 Hu 14例(70.00％),以上表现与侵袭性胸腺瘤比较,差异均有统计学意义(P<0.05).两者出现心包、胸腔积液情况差异无统计学意义(P>0.05).结论 前纵隔淋巴瘤虽然较为少见,但仍有一定的特征性影像学表现,多呈结节融合状,对称分布,坏死、囊变边界清晰,明显推移大血管,易侵蚀上腔及头臂静脉,易侵犯肺内,可形成胸壁软组织肿块,少见胸膜转移.结合CT引导下穿刺活检能够获得更多的诊断信息.
Imaging analysis of primary anterior mediastinal lymphoma prone to misdiagnosed
Objective To analyze the imaging features of primary anterior mediastinal lymphoma and compare them with invasive thymoma to improve the accuracy of early diagnosis. Methods The imaging data of 20 patients with primary anterior mediastinal lymphoma confirmed by pathology and misdiagnosed by imaging were retrospectively analyzed and compared with 23 cases of invasive thymoma. The imaging features of the disease were summarized,including lesion morphology,distribution,density,peripheral lymph node involvement,relationship with adjacent vessels,invasion of surrounding structures,and enhancement patterns. Results The lymphoma presented as multiple fused nodules in 15 cases (75.00％) and had symmetrical distribution in 11 cases (55.00％). There were 15 cases (75.00％) with necrosis,cystic changes and clear boundaries,15 cases (75.00％) with obvious pressure on major mediastinal vessels,10 cases (50.00％) with invasion of superior vena cava and brachiocephalic veins,10 cases (50.00％) with intrapulmonary invasion,6 cases (30.00％) with soft tissue mass of chest wall,and 12 cases (60.00％) with enlarged adjacent lymph nodes. The contrast enhancement was less than 30 Hu in 14 cases (70.00％);compared with invasive thymoma,the differences were statistically significant (P<0.05). There was no statistically significant difference between the two groups regarding the presence of pericardial or pleural effusion (P>0.05). Conclusion Although primary anterior mediastinal lymphoma is relatively rare,it has distinct imaging features,including multiple fused nodules,uniform and symmetrical distribution,necrosis and internal cystic degeneration with clear boundaries,surrounding enlarged lymph nodes,significant displacement of major mediastinal blood vessels,erosion of superior vena cava and brachiocephalic veins,lung invasion,and potential formation of soft tissue masses in the chest wall. Pleural invasion is uncommon. Combining CT-guided needle biopsy can provide additional diagnostic information.
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