原发性结肠恶性淋巴瘤X线及CT诊断【摘要】目的：探讨结肠恶性淋巴瘤的临床X线和CT表现，以提高其诊断能力。方法：回顾性分析30例经病理证实的结肠淋巴瘤的X线领灌肠及CT表现，顿灌肠观察病变发生部位、范围、黏膜破坏及肠管有无扩张或狭窄，CT观察结肠受累的部位病灶大体形态、侵犯范围、肠壁厚度、浆膜及周围脂肪间隙受累情况、增强后强化程度、有无坏死、有无其他器官受累、肠旁及其他腹部淋巴结情况。结果：X线表现为多结节状充盈缺损伴肠管狭窄7例，肠管移位伴肠管边缘不整2例，肠管狭窄伴肠套叠2例，肠管狭窄伴不全梗阻2例，管状狭窄伴充盈缺损5例。CT表现为局灶性肿块型4例，节段环形浸润型10例，弥漫浸润型3例。结论:原发性结肠恶性淋巴瘤的X线及CT表现有一定特征性。【关键词】结肠；淋巴瘤；X线钦餐造影:1009-5519(2007)22-3344-03:R81文献标识码：AX-rayandCTdiagnosisofprimarycolicmalignantlymphomaLILi-qun,HUANGShui~he,YAOHui-fang,etal.(DepartmentofRadiology,TheNinthPeople，sHospitalofChengdu,Sichuan610015,China)[Abstract]Objective：ToanalysetheclinicalmanifestationsofX~rayandCTofprimarycolicmalignantlymphoma,soastoimprovethediagnosticability・Methods：TheclinicalmanifestationsofX-raybariumenemaandCTin30patientswithprimarycolicmalignantlymphomaconfirmedbypathologywereanalysedretrospectively.Thebariumenemawasusedtoobservethesiteandsphereofpathologicchangeandtheconditionofmucosaldestructionaswellastheintestinalcanalwasdilatedornarrowedornot,whileCTwasusedtoobservetheinvolvedsiteofthecolon,grossappearanceofthefoci,aggressivesphere,intestinalwallthickness,thepotentiateddegreeafterenhancement,theinvolvedconditionofserousmembranceandperipheralfattyspaceandtheconditionofperientericandotherabdominallymphnodesaswellastherewasnecrosisorotherorganinvolvementornot.Results：X-rayandCTdisplayedthedifferentimagingfeaturesinprimarycolicmalignantlymphoma.Inthisgroup,10caseswereregionalannularinfiltrativetype,7caseswerepolynodularfillingdefectwithintestinalstenosis,5tubularstenosiswithfallingdefect,4focallumptype,3diffuseinfiltrativetypeand2eachforintestinaldisplacementwithintestinalmarginalirregularity,intestinalstenosiswithintussusceptionandintestinalstenosiswithincompleteobstruction.Conclusion：MasteringtheX-rayandCTimagingfeaturesofprimarycolicmalignantlymphomamayimprovethedifferentialdiagnosiswhichisusefulinclinicaldecision.[Keywords]Colon；Lymphoma；X-raybariummealcontrastexamination胃肠道淋巴瘤在结外淋巴瘤中居第一位，包括原发性和继发性。起源于胃肠道的淋巴瘤为原发性胃肠道淋巴瘤。原发性胃肠道淋巴瘤常侵及胃及小肠，原发于大肠的淋巴瘤少见，因临床及影像表现缺乏特异性，多误诊为结肠癌。本文回顾性分析结肠淋巴瘤的X线及CT表现，以期提高对该病的认识，有助于早期诊治。1资料与方法1.1一般资料：收集自1999年3月"2006年9月在我院就诊的30例原发结肠淋巴瘤初诊病人的CT及X线资料。原发性大肠恶性淋巴瘤以Dawson等⑴提出诊断肠道恶性淋巴瘤的5项标准为依据。30例中，男18例，女12例，年龄5~68岁，中位年龄39岁。临床表现为腹痛或腹痛伴腹泻12例；腹部包块18例，肿块一般较硬，边界清楚，光滑或不规则，有压痛，固定或可活动；便血8例，消瘦及食欲不振6例；呈全腹隐痛，阵发性加剧伴呕吐6例。所有病人均由病理（手术或肠镜活检）证实。1.2检查方法：13例行领灌肠检查，12例行CT平扫及增强，另有5例同时行钗剂灌肠和CT扫描，两种检查方法间隔时间小于10天。所用设备：GETX-III胃肠机和ELSCINTCT-TWIN扫描仪。CT扫描层厚5〜10mm,螺距1.5：1,扫描范围从膈顶至耻骨联合。先平扫，后增强扫描，增强扫描采用高压注射器经肘静脉以2.5〜3ml/s的速率注射非离子型碘对比剂1.5ml/kg,注药后45s开始进行扫描。1.3影像学的评价：由两位有经验...