目的 探讨脾原发淋巴瘤的MRI表现。方法 回顾性分析2010-01至2019-06解放军总医院第一医学中心符合入选标准的经病理证实为脾原发淋巴瘤患者的临床资料和MRI表现。观察肿瘤信号、坏死、出血、囊变、假包膜、动态增强特点以及周围结构受侵情况。根据病灶单发或多发分为两组,比较两组间的临床资料和病灶MRI影像特征。结果 共收集13例脾原发淋巴瘤患者,脾单发8例,多发5例,共34个病灶。肿瘤T₂WI呈等高信号14个(41.2%),低信号20个(58.8%);T₁WI呈等低信号30个(88.2%),呈高信号4个(11.8%);扩散加权成像(DWI)呈高信号15个(44.1%),其中不均匀高信号6个(40.0%),等低信号19个(55.9%);肿瘤出现坏死11个(32.4%),出血6个(17.7%),无病灶出现囊变;20个病灶可见假包膜(58.8%),其中11个病灶假包膜不完整(55.0%)。MRI动态增强扫描病灶全部呈动脉期轻度强化并逐渐增强。1例(7.7%)伴有胰腺受侵,1例(7.7%)伴有结肠脾曲受侵。其中病灶大小、T₂WI信号特点、DWI信号特点以及有无假包膜在两组中有统计学差异(P＜0.05)。结论 脾原发淋巴瘤,单发病灶直径较大,T₂WI和DWI多呈等高信号,假包膜多见,而多发病灶时T₂WI和DWI多呈低信号,两组病灶在T₁WI多呈等低信号,都可以发生出血和坏死,增强扫描呈轻度渐进性强化。

Objective To analyze the magnetic resonance (MR) imaging features of primary splenic lymphoma.Methods The clinical data and MR imaging features of patients with pathologically-proved primary splenic lymphoma were retrospectively analyzed from January 2010 to June 2019. The following MRI features of the lesions were analyzed: signal intensity, necrosis, hemorrhage, cystic change, pseudo-capsule, enhancement features and invasion of surrounding structures. Divided into two groups according to single or multiple lesions, the clinical data and MRI features of the lesions were compared.Results A total of 13 patients with primary splenic lymphoma were collected (8 cases were single and 5 cases were multiple with a total of 34 lesions). Fourteen lesions (41.2%) showed iso- and hyperintense and 20 lesions (5.82.2%) showed hypointense on T₂WI; 30 lesions (88.2%) showed iso- and hypointense and 4 lesions (11.8%) showed hyperintense on T₁WI; 15 lesions (44.1%) showed hyperintense on diffusion-weighted imaging (DWI), including 6 heterogeneous hyperintense lesions (40.0%) and 19 lesions (55.88%) showed iso- and hypointense; tumor necrosis occurred in 11 lesions (32.4%), hemorrhage occurred in 6 lesions (17.7%), and no lesions had cystic change; 20 lesions (58.8%) had pseudo-capsule, of which 11 lesions (55.0%) had incomplete pseudo-capsule. All the lesions on dynamic contrast-enhanced MRI showed mild enhancement in the arterial phase and gradually enhanced. One patient (7.7%) had invasion of the pancreas, and one patient (7.7%) had invasion of the splenic flexure of colon. The size of the lesion, T₂WI and DWI signal characteristics, and the presence or absence of pseudo-capsule were statistically different between the two groups (P＜0.05).Conclusions The single lesion of primary splenic lymphoma is larger in diameter, T₂WI and DWI show iso- and hyperintense, and pseudo-capsule is more common, while the multiple lesions show mostly hypointense on T₂WI and DWI. The lesions in the two groups mostly show iso- and hypointense on T₁WI, bleeding and necrosis can occur, and the dynamic contrast-enhanced scan shows mild progressive enhancement.