原发性中枢神经系统淋巴瘤的DWI、^1H-MRS表现与病理对照分析

Diffusion-weighted MRI and proton magnetic resonance spectroscopy characteristics of primary central nervous system lymphomas:comparative analysis with pathology

目的探讨原发性中枢神经系统淋巴瘤的DWI和1 H-MRS表现及其病理基础。方法对17例经病理证实的原发性中枢神经系统淋巴瘤的DWI、1 H-MRS与病理资料进行对照分析,比较瘤体与对侧正常脑白质ADC值以及瘤体与正常脑白质1 H-MRS代谢物峰高(Cho、Cr、NAA)和代谢物峰高比值(Cho/Cr、Cho/NAA)。结果原发性中枢神经系统淋巴瘤DWI图均表现为高信号。瘤体ADC值(655±57.95)低于对侧正常脑白质ADC值(755±86.10),差异有统计学意义(F=10.139,P<0.05)。1 H-MRS:①病例组Cho(28.13±6.15)高于对照组(20.87±4.21),差异有统计学意义(F=9.802,P<0.05);②病例组Cr(5.66±2.81)、NAA(8.31±3.26)分别低于对照组Cr(14.80±3.63)、NAA(24.88±7.41),差异有统计学意义(F=47.645、56.783,P<0.05);③病例组Cho/Cr(5.82±2.12)、Cho/NAA(3.74±1.67)分别高于对照组Cho/Cr(1.44±0.25)、Cho/NAA(0.87±0.14),差异有统计学意义(Z=-4.025、-4.025,P<0.05)。所有病例均见有Lac和(或)Lip峰。免疫组化:17例均为B细胞型非霍奇金氏淋巴瘤肿瘤,瘤细胞LCA、CD20表达均阳性。结论 DWI与1 H-MRS对原发性中枢神经系统淋巴瘤具有重要的诊断价值。

Objective To analyze the DWI and ^1 H-MRS performance of primary central nervous system lymphomas （PC- NSL） and its pathological basis. Methods DWI, ^1 H-MRS findings and their pathological data in 17 patients with patho logically confirmed primary central nervous system lymphoma were analyzed comparatively. We measured the ADC value of the tumor and its contralateral normal white matter, and compared with each other. We measured the metabolite （NAA： 2.02 ppm;Cr：3.03 ppm;Cho：3.2 ppm） peak height of the tumor and the control group, and also calculated the ratio of metabolite peaks （Cho/Cr, Cho/NAA）, and compared with each other. All data were statistically analyzed. Results DWI showed high and heterogeneous signal of PCNSL, and the ADC value of PCNSL （655±57.95, Meand=SD） were sig nificantly lower than that of the contralateral normal white matter （755 ± 86.10, Mean± SD）（ F = 10. 139, P 〈0.05）. ^1 H-MRS①Cho peaks height of PCNSL （28. 13 ± 6. 15, Mean d= SD） were significantly higher than the control group （20.87±4.21, Meand±SD） （ F =9. 802, P 〈0.05） ; ② Cr（5.66=k2.81, Mean±SD）, NAA（8.31±3.26, Mean±SD） were significantly lower than the control group Cr （14.80±3.63）, NAA（24.88±7.41）（ F =47. 645, 56. 783, P 〈0.05） respectively③ Cho/Cr（5.82 d= 2.12, Mean± SD）, Cho/NAA（3.74 ±1.67, Mean± SD） were significantly higher than the control group Cho/Cr （1.44±0.25, Mean± SD）, Cho/NAA（0. 87±0.14, Meand= SD）（ Z =-4. 025, -4. 025, P 〈 0. 05） respectively. Lac and （or） Lip peak were seen with all patients. Immunohistochemistry showed 17 cases were all B cell non-H0dgkin＇s lymphoma, positive expression of LCA and CD20 in all lymphoma cells. Conclusion DWI and ^1H- MRS has significant value in the diagnosis of primary central nervous system lymphoma.