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useonly;allrightsreservedAbdominalImaging•PictorialEssayLeeetal.AbdominalManifestationsofLymphomaAbdominalImagingPictorialEssayAbdominalManifestationsofExtranodalLymphoma:SpectrumofImagingFindingsCopyrightARRS.ForpersonalWai-KitLee1EddieW.F.Lau2VinayA.Duddalwar3AnthonyJ.Stanley4YvonneY.Ho4LeeWK,LauEWF,DuddalwarVA,StanleyAJ,HoYYOBJECTIVE.Thepurposeofthisarticleistoillustratethespectrumofappearancesofextranodallymphomaintheabdomenusingcross-sectionalimagingtechniques.CONCLUSION.Extranodallymphomaintheabdomencanmimicotherneoplasticorinflammatoryconditions.Althoughadefinitivediagnosisispossibleonlywithbiopsy,itisimportanttoconsiderextranodallymphomainthepresenceofcertainimagingappearancesintheappropriateclinicalsettingforthecorrectdiagnosis,accuratestaging,andoptimalmanagement.Downloadedfrom:abdomen,CT,extranodallymphoma,PET/CT,sonographyDOI:10.2214/AJR.07.3146ReceivedSeptember12,2007;acceptedafterrevisionJanuary27,2008.1DepartmentofMedicalImaging,St.Vincent’sHospital,UniversityofMelbourne,41VictoriaParade,Fitzroy,Victoria3065,Australia.AddresscorrespondencetoW.K.Lee(leewk33@hotmail.com).2DepartmentofRadiology,CentreforMolecularImaging,PeterMacCallumCancerCentre,UniversityofMelbourne,EastMelbourne,Victoria3002,Australia.3DepartmentofRadiology,NorrisComprehensiveCancerCenter,UniversityofSouthernCalifornia,LosAngeles,CA.4DepartmentofDiagnosticImaging,TheNationalUniversityHospitalofSingapore,NationalUniversityofSingapore,Singapore.CMEThisarticleisavailableforCMEcredit.See:198–2060361–803X/08/1911–198©AmericanRoentgenRaySocietyxtranodallymphomaoccursinEabout40%ofpatientswithlymphomaandhasbeendescribedinvirtuallyeveryorganandtissue[1].Indecreasingorderoffrequency,thespleen,liver,gastrointestinaltract,pancreas,abdominalwall,genitourinarytract,adrenal,peritonealcavity,andbiliarytractareinvolved[2–5].Extranodaldiseaseismorecommonwithnon-Hodgkin’slymphoma(NHL)thanwithHodgkin’slymphomaandisoftenintermediate-tohigh-grade[2,3].AIDS-relatedlymphomaandposttransplantationlymphoproliferativedisorder(PTLD)aremorelikelytoaffectextranodalsitesandareofhighergrade[2,4,5].DiffuselargeB-celllymphomaandfollicularlymphomaarethedominanthistologicsubtypesinextranodallymphoma.Mantlecelllymphoma,lymphoblasticlymphoma,Burkitt’slymphoma,andmucosa-associatedlymphoidtissue(MALT)lymphoma,however,aremorelikelytoaffectextranodalsites[2].MALTlymphomaisalow-grademarginalzoneB-celllymphomathatismostcommonlyfoundinthestomach.Itiscloselyassociatedwithchronicinflammation,suchasHelicobacterpylorigastritis,andhasaclinicallyindolentcourse.Secondaryinvolvementofextranodaltissuesaspartofgeneralizedlymphomaissignificantlymorecommonthanprimaryextranodaldisease,inwhichthereisadominantextranodalcomponentwithnoorminornodalinvolvement.Splenic,hepatic,ordiffuseinvolvementofoneormoreextranodalorgansindicatesamoreadvancedstageofdisease.Extranodalinvolvementisingeneralapoorprognosticfactor.Theproteanimagingappearancesofex-tranodallymphomaintheabdomencanmimicotherneoplasticorinflammatoryconditions.Misinterpretationoftheimagingfindingscanleadtodelayeddiagnosisandtreatment,andincorrectstagingmayresultininappropriatetreatment.Inthisarticle,weillustratetheappearancesofextranodallym-phomaintheabdomenofimmunocompetentandimmunocompromisedpatientswithcur-rentcross-sectionalimagingtechniques.ImagingTechniquesMDCTistheprincipalimagingtechniqueusedfortheevaluationofpatientswithlymphoma.However,evidenceindicatesthatPET/CTissuperiortoCTindetectingextranodaldiseaseintheabdomen,especiallyinthespleenandliver[1,6].TheroleofPET/CTinlow-gradelymphomasuchasMALTlymphomaiscontroversial.Fortheroutineevaluationofabdominallymphoma,nodataareavailableatpresentontheeffectivenessofMRI,andsonographyhasnorole.PatientsunsuitableforCTcanbeassessedwithMRI.SonographyandMRIcanbeusedfortargetedcharacterizationofindeterminatelesionsidentifiedatCT.Atourinstitution,routineabdominopelvicCTfortheevaluationoflymphomaisusuallyperformedafterthepatienthasdrunk900mLof2.5%dilutedsodiumamidotrizoateandmeglumineamidotrizoate(Gastrografin,BayerHealthCare)45–60minutesbeforethe198AJR:191,July2008AbdominalManifestationsofLymphomaDownloadedfrom(Ultravist370,BayerHealthCare)isadministeredIVatarateof2.5mL/s.CTisperformedaftera75-seconddelay.For16-and64-MDCTscanners,0.75-and0.6-mmdetectorsareused,respectively,with120kVpand150–180mAs.Insuspectedgastricorentericinvolvement,CTisperformedafterthepatienthasdrunk1,000–1,500mLofwateror2%sorbitol.Insuspectedcolonicinvolvement,CTisperformedaftertheadministrationof500–1,000mLofwateror2.5%dilutedsodiumamidotrizoateandmeglumineamidotrizoate(Gastrografin)asrectalcontrastmedium.RoutinePET/CTfortheevaluationoflymphomaisperformedafteranIVinjectionof370MBqof18F-FDGthatisadm
本文标题:adominalmanifestationofextronodallymphomapdf
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