Spectral Computed Tomography for the Diagnosis of Secondary Skeletal Muscle Follicular Lymphoma: A Case Analysis
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摘要:
滤泡性淋巴瘤是非霍奇金淋巴瘤的常见类型之一，继发性骨骼肌滤泡性淋巴瘤属于结外淋巴瘤，临床少见，诊断较困难，能谱增强CT成像可帮助进行影像学诊断。2021年，1名52岁的男性因发现左侧腹股沟区肿物2月就诊，经肿物穿刺活检术、颈部淋巴结清扫术及骨髓穿刺活检术后病理明确诊断为滤泡性淋巴瘤Ⅰ级、累及骨髓。后患者腰痛进行性加重2月，行腰椎能谱增强CT提示右侧腰大肌与腹膜后肿大淋巴结为同源性病灶，考虑右侧腰大肌淋巴瘤浸润可能性大。能谱增强CT成像是一种无创、便捷、准确的影像学诊断方法，通过重建、比较不同组织的能谱曲线确定肿块性质，可以帮助诊断结外淋巴瘤，对判断病变范围、指导临床治疗方案具有重要价值。
Abstract:Follicular lymphoma (FL) is one of the frequent varieties of non-Hodgkin's lymphoma (NHL). Secondary skeletal muscle FL is an uncommon extra-nodal lymphoma that is more challenging to identify. Spectral CT imaging can aid in the diagnosis of it. A 52-year-old man who had a bulge in his left inguinal area for two months in 2021. Following a mass aspiration biopsy, cervical lymph node dissection and a bone marrow aspiration biopsy, the patient was diagnosed as follicular lymphoma grade I with bone marrow involvement. Later, the patient had progressive worsening of low back pain for 2 month and underwent a lumbar spectral enhanced-CT scan, which demonstrated the right psoas major muscle and the retroperitoneal swollen lymph nodes were discovered to be homologous lesions, indicating the lymphoma infiltration of the right psoas major muscle. Spectral enhanced-CT is a non-invasive, practical, and reliable alternative technique. By reconstructing and comparing the energy spectrum curves of different tissues to shed light on the nature of the mass, it can aid in the diagnosis of extra-nodal lymphoma, which is of great value in determining the extent of the lesion and guiding the clinical treatment plan.
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Keywords:
- spectral CT /
- enhanced-CT /
- follicular lymphoma /
- extranodal lymphoma /
- skeletal muscle lymphoma
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图 1 上腹部CT平扫：双侧腰大肌形态、密度无明显差异；腹膜后多发肿大淋巴结；脾肿大
Figure 1. Computed tomography (CT) scan of the upper abdomen
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图 2 腰椎MRI平扫
（a）和（b）L1-L2水平右侧腰大肌见一肿块，呈T1WI低、T2WI稍高信号。
Figure 2. Lumbar spine MRI plain scan
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图 3 腰椎能谱CT增强图像
（a）动脉晚期 ROI对应能谱曲线（蓝线代表右侧肿大腰大肌，绿线代表左侧正常腰大肌，紫线代表腹膜后肿大淋巴结）。（b）腰椎 CT平扫：腹膜后多发肿大淋巴结；右侧腰大肌较对侧明显肿胀。（c）和（d）腰椎能谱增强 CT动脉晚期轴位图像：双侧腰大肌及腹膜后肿大淋巴结ROI对应的CT值；右侧肿大腰大肌增强后强化程度略高于左侧正常腰大肌，密度均匀。
Figure 3. Lumbar spine spectral computed tomography (CT) image
表 1 能谱增强CT扫描方式及参数
Table 1 Spectral computed tomography (CT) scan modes and parameters
扫描方式及参数名 具体扫描方式及参数值 扫描方式及参数名 具体扫描方式及参数值 采集体位 仰卧位，头先进 层间距 0.625 mm 扫描方向、范围 自胸椎下缘向下扫描至骶椎 管电压 GSI模式（瞬时切换80 kVp、140 kVp） 探测器宽度 64×0.625 mm 管电流 自动毫安模式（200～650 mA，NI：9） 扫描方法 经验法 矩阵 512×512 层厚 0.625 mm 机架旋转时间 0.6 s/r 
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表 2 双侧腰大肌及腹膜后肿大淋巴结的KVP40-70、KVP40-100及KVP40-140
Table 2 KVP40-70, KVP40-100 and KVP40-140 of the bilateral psoas major muscle and enlarged retroperitoneal lymph nodes
项目 KVP40-70 KVP40-100 KVP40-140 右侧肿大腰大肌 2.38 1.50 0.99 左侧正常腰大肌 1.41 0.89 0.60 后腹膜肿大淋巴结 2.76 1.76 1.14
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