原发性中枢神经系统淋巴瘤影像与病理学关系

Study of Relationship between Imaging Findings and Pathology in Primary Central Nervous System Lymphomas

目的对比研究原发性中枢神经恶性淋巴瘤(PCNSL)的影像、病理学表现,以加深对本病影像表现的认识和理解,提高本病的影像诊断水平。方法以CT、MRI对原发于中枢神经系统肿瘤进行术前平扫及增强扫描,通过穿刺活检或手术所取肿瘤组织进行病理HE和免疫组化染色检测。结果23例经临床及病理证实为原发性中枢神经系统淋巴瘤,CT、MRI共示31个病灶,肿瘤“瘤体部分”CT扫描大多表现为等或稍高均匀密度肿块,T1WI低信号,T2WI等或稍高信号,增强扫描病灶多呈明显均匀强化;“水肿区”CT平扫为低密度,MRI平扫为长T1长T2信号,无强化表现。光镜下大多出现“袖套样”结构、血供不丰富。6例穿刺标本显示肿瘤“瘤体部分”为瘤细胞密集、富有“袖套样”结构区域,血供不丰富,“水肿区”均有肿瘤细胞浸润。结论PCNSL肿瘤“瘤体部分”、“水肿区”及肿瘤强化表现与相应的病理学基础相关。

Objective To heighten the level of image diagnostics of primary central nervous system lymphoma（PC- NSL）. Methods CT and MRI plain scaning and enhanced scaning were performed before the operation in the 23 patients with PCNSL. After the operation, the pathological changes in PCNSL were observed by HE and immunohistochemistry staning. Results There were 31 lesions observed by CT and MRI in 23 patients with PCNSL proved by pathological examination. Most of the ＂tumour bodies＂ manifested iso-density or high density masses on the plain scaning imagings, and hypointense signals on T1WI and iso-intnse or slightly hyperintense ones on T2WI, and showed homogenous significantly enhancement. The edema zone of the lesions manifested low-density on the plain scaning imagings, hypointense sigals on T1WI and hypointense ones on T2WI, and showed enhancement. In the most lesions, histologically the tumor cells were spreaded around the vessels, and the so-called cuff-like structure and low vascularity were observed. There were the intensive tumor cells, lots of cuff-like structure and low vascularity in the tumor bodies of 6 biopsy samples and the edema zone of the lesion was infiltrated by the tumourous cells. Conclusion The imaging findings of the tumor body and edema zone of PCNSL and the enhancement features are associated with the changes in its pathology.