立体定向活检诊断原发性中枢神经系统淋巴瘤(118例临床及影像学特征)

Stereotactic biopsy in the diagnosis of primary central nervous system lymphoma(clinical and imaging features of 118 cases)

目的总结原发性中枢神经系统淋巴瘤(PCNSL)的临床、影像学特征,提高PCNSL诊治水平。方法回顾性分析经立体定向活检病理证实的118例PCNSL的临床和影像学资料。结果 118例PCNSL患者的病理类型均为B细胞性,其中男性73例,女性45例,男:女=1.62∶1,患者年龄11～83岁(平均53.4±15.9岁)。首发症状到确诊的时间为7d～3年(3.47±6.65个月),病程在3个月以内的占78.75%,其中57.5%的患者病程在1个月以内。本组病例最常见的症状包括高颅压症状(51.1%)和肢体功能障碍(47.7%)。单发病灶63例(53.4%),多发病灶55例(46.6%),基底节区和丘脑是最常见的受累部位。CT检查病灶多为稍高密度影,MRI检查病灶多为长T1、等或长T2信号影,多数病灶增强扫描为片状均匀强化。结论 PCNSL多发于中老年人,男性多见,病程短,单发病灶多见,但多发病灶的比例也较高,影像学检查病灶多均匀强化,病灶边界不清,但缺乏特异性,确诊需依赖于立体定向活检病理诊断。

Objective To analyze the clinical and imaging features promote the diagnosis of primary central nervous system lymphoma（PCNSL）.Methods Clinical and imaging data of 118 cases of pathologically confirmed PCNSL by stereotactic biopsy were retrospectively analyzed.Results All cases were type B-cell non-hodgkin lymphoma.There were 73 male cases and 45 female cases（male：female = 1.62∶1）.Patients aged from 11 to 83 years（average 53.4 ± 15.9 years）.The time from the onset of symptoms to diagnosis was from 7 days to 3 years（3.47 ± 6.65 months）,among which 78.75% and 57.5% cases was within 3 months and 1 month respectively.The most common symptoms included symptoms of high intracranial pressure（51.1%） and limb dysfunction（47.7%）.There were solitary lesion in 63 cases（53.4%） and multiple lesions in 55 cases（46.6%）.Basal ganglia and thalamus were the sites most commonly involved.The typical features of PCNSL on CT were lesions with slightly higher density.Hypointense T1 signal,isointense or hyperintense T1 signal were typical features of PCNSL on MRI.The majority of lesions showed uniform contrast enhancement.Conclusion PCNSL always involves the elderly and the male.It is with short course.Most cases are with solitary lesion,and the cases that with multiple lesions are also common.The typical imaging features of the lesion are uniform contrast enhancement with unclear border,but lack specificity.Stereotactic biopsy can confirm the diagnosis.