原发中枢神经系统淋巴瘤的颅脑MRI表现

Cranial MRI findings of primary central nervous system lymphoma

目的全面分析原发性中枢神经系统淋巴瘤颅脑MRI表现,进一步探讨MRI对该病的诊断价值,以期提高影像学对该病的诊断率。方法回顾性分析经立体定向活检或开颅手术病理证实的150例原发性中枢神经系统淋巴瘤颅脑MRI表现,男性77例、女性73例,男∶女=1.05∶1,平均年龄53.2(28~87)岁,并复习相关临床及文献资料。结果 150例原发性中枢神经系统淋巴瘤患者中,单发病灶56例(37.3%),多发病灶94例(62.7%);幕上皮质下及深部脑白质为好发部位,小脑、脑膜、室管膜也可受累。平扫大部分病灶呈稍长T1、稍长T2信号,增强扫描148例病灶可见强化。增强病灶位于脑实质的93例、可见脑室播散病灶的42例、可见硬脑膜强化的5例、累及柔脑膜的7例、累及神经的1例。结论原发性中枢神经系统淋巴瘤大多为弥漫性大B细胞淋巴瘤,多发于中老年人,多发病灶多见,MRI表现各有特点,增强扫描表现具有一定特点及规律性。全面了解并掌握MRI表现特点对原发性中枢神经系统淋巴瘤的诊断、鉴别诊断有重要价值,对临床诊治具有重要的指导作用,最终确诊仍需依赖于病理诊断。

Objective To investigate the pathological and radiological characteristics of primary central nervous system lymphoma( PCNSL) and to discuss the MRI diagnostic value in PCNSL comprehensively for better understanding of this disease. Methods Clinical,pathological and radiological data of 150 cases of PCNSL proved by pathology of stereotactic biopsy or surgery were analyzed retrospectively. There were 77 male and 73 female cases( male ∶ female = 1. 05 ∶ 1). Patients aged from 28 to 87 years. Results All cases were diffuse large-B cell non-Hodgkin’s lymphoma.Fifty-six cases had single lesion and 94 cases had multiple lesions. Lesions mainly occurred in the supratentorial region and located in the deep white matter and subcortical white matter. Enhancement lesion was seen in 148 cases,and no enhancement was seen in other 2 cases. Parenchymal enhancement was observed in 93 cases,ventricular disseminated enhancement was presented in 42 cases,dural enhancement was seen in 5 cases,leptomeningeal enhancement was found in 7 cases,and nerve enhancement was observed in 1 case. Conclusion PCNSL often prefers the elderly. Most cases have multiple lesions. The comprehensive understanding of the characteristic features of on PCNSL is very important for diagnosis,especially the contrast-enhanced MRI imaging finding. The specific features of contrastenhanced MR imaging is of great value and might help to improve the accuracy of diagnosis.