Diffuse Large B-cell Lymphoma and Mucosa-Associated Lymphoid Tissue Lymphoma: A CT Comparison Study

目的 探讨胃淋巴瘤两种主要类型:弥漫性大B细胞淋巴瘤(Diffuse large B-cell lymphoma,DLBCL)和黏膜相关淋巴组织淋巴瘤(Mucosa-associated lymphoid tissue lymphoma,MALToma)CT征象的异同,为胃淋巴瘤的生物学行为评价和影像学鉴别诊断提供依据.方法 回顾分析我院规范CT检查胃淋巴瘤病例42例,均经胃镜或手术病理证实.根据病理结果将全部病例分为DLBCL和MALToma.分析两种类型淋巴瘤CT影像学征象特征,包括病变所处胃的分部、范围、形态、厚度、强化、黏膜及浆膜面情况、淋巴结转移、腹腔大血管及脏器侵犯情况、腹腔转移及有无腹水等.统计学分析比较两种类型淋巴瘤的CT征象差异.结果 DLBCL多累及胃的多个部分,且以近端胃受累为主,MALToma以胃的单一部分受累更为多见,且以胃远端分布为主,差异有显著性.DLBCL癌肿平均厚度(2.75±1.52)cm,大于MALToma癌肿平均厚度(1.23±0.64)cm,差异存在显著性(P<0.01).DLBCL胃壁以弥漫性、不均匀增厚为主,MALToma以局限性、均匀增厚为主;DLBCL较MALToma更易侵犯浆膜,淋巴结转移率较MALToma高,转移淋巴结体积大、分布更为广泛,侵犯腹腔干分支大血管及腹腔脏器的比例均高于MALToma.DLBCL静脉期强化CT值(69.09±13.49)HU,低于 MALToma静脉期强化CT值(81.79±25.82)HU.MALToma黏膜面"白线征"显示率高于 DLBCL;DLBCL浆膜侧"血管穿行征"显示率高于MALToma.结论 CT影像学征象可反映DLBCL和MALToma的生物学行为,显示两种胃淋巴瘤侵袭性的差异,可作为两者鉴别的重要手段.MALToma黏膜面"白线征"、DLBCL浆膜侧"血管穿行征"丰富了胃淋巴瘤的CT征象,为鉴别诊断及生物学行为评价提供了新的指标.Objective To explore the differences of CT signs in two kinds of gastric lymphomas, diffuse large B-cell lymphoma, DLBCL and mucosa-associated lymphoid tissue lymphoma, MALToma, to provide the evidence for the evaluation of biological behavior and imaging differential diagnosis. Methods Retrospectively analyzed 42 cases of gastric lymphoma performed with CT in our hospital, which were confirmed by endoscopy or operation pathology. Subdivided the patients to DLBCL and MALToma group. The CT signs in two kinds of gastric lymphomas were analyzed, which included the location, extension, shape, thickness, enhancement, mucosa and serosa, lymph node metastasis, invasion of great vessels of abdomen and organs, peritoneal cavity metastasis, and ascites. The differences of CT signs in two kinds of lymphomas were compared statistically. Results DLBCL usually invaded multi-location of stomach, which were mainly at the upper parts. MALToma usually invaded mono-location of stomach, which were mainly at the lower parts. The distribution feature was statistically difference. The mean thickness of DLBCL was (2.75±52) cm, which was larger than MALToma (1.23±64) cm, with statistical significance (P<0.01). The pattern of DLBCL thickening mainly as diffused and nonuniform, yet MALToma as circumscribed and uniform. DLBCL was more prone to serosa invasion than MALToma. The lymph node metastasis rate of DLBCL was higher than MALToma, and the metastatic LNs were larger and more extensive than MALToma. The rate of invasion of great vessels and organs in abdomen in DLBCL was higher than that of MALToma. The enhanced CT values of DLBCL (69.09±3.49) HU were lower than that of MALToma (81.79±5.82) HU. The demonstration rate of "white-line sign"in mucosa was higher in MALToma than DLBCL. The demonstration rate of "artery-penetration sign"was higher in DLBCL than MALToma. Conclusion CT signs can reflect the biological behavior of DLBCL and MALToma, distinguish the invasion ability of two kinds of lymphoma, and play an important role in differential diagnosis. The "White-line sign"and "artery-penetration sign"enrich the CT signs of gastric lymphoma, which provided new indicators for the differential diagnosis and biological behavior evaluation.国家重点基础研究发展规划(973计划); 北京市自然科学基金01449-541