原发性脑淋巴瘤的病理表现及C T、MRI诊断研究

Diagnosis study of pathological findings,CT and MRI in primary centralnervous system lymphoma

目的：探讨原发性脑淋巴瘤（PCNSL）的病理表现及CT、MRI的诊断价值，以提高该病的诊断水平。方法回顾性分析32例PCNSL患者的CT和MRI影像学表现，并与手术或病理结果进行比较。结果32例中单发病灶29例，多发病灶4例，共有病灶41个。病灶常分布于脑表面或近中线部位。CT表现为边缘清楚的高或略高密度，MRI显示T1 WI低信号，T2 WI不均匀高信号；增强后多数病灶均明显均匀强化。联合诊断的符合率为93．8％，显著高于单独应用CT、MRI 符合率的71．9％、75．0％，差异均有统计学意义（χ^2=7.2346，P＝0．0032；χ^2=6．9538，P＝0．0037）。结论 PCNSL的CT、MRI表现具有一定特征性，临床上根据CT、MRI表现、好发部位、占位效应，并结合病理检查，可提高PCNSL诊断的敏感性和准确性。

Objective To investigate the pathological findings and diagnosis value of CT and MRI in detec-tion of primary centralnervous system lymphoma （PCNSL）so as to improve diagnostic accuracy of the condition. Methods The results of CT and MRI for 32 patients with PCNSL were analyzed retrospectively,and the results were compared with the finally obtained surgical-pathological examination.Results Of 32 cases,the foci were single in 29 cases and multiple in 4 cases,and there were 41 foci in total.Most foci were located near the surface or middle line of brain.On CT scan appearances,most foci were hyperdensity or slightly hyperdensity masses with the well definite margin,on MRI,it showed low signal of T1 -weighted imaging （T1 WI）and slightly increased non-uniform signal of T2 -weighted imaging （T2 WI）.All the foci were equally and markedly enhanced after enhancement.The diagnostic coincident rate of combination diagnosis （93.8%）was significantly higher than that of CT （71.9%）and MRI （75.0%）（χ^2 =7.234 6,P=0.003 2;χ^2 =6.953 8,P=0.003 7）.Conclusion CT,MRI have characteristic mani-festation for PCNSL,and according to the manifestation of CT,MRI,predilection site,mass effect,and combined with pathological examination,which can effectively improve the sensitivity and accuracy of diagnosis.