脑室内原发性淋巴瘤CT和MRI表现特点

CT and MRI imaging features of primary ventricular lymphoma

目的探讨脑室内原发性淋巴瘤CT、MRI表现特点,为该病的诊断与鉴别诊断提供参考。方法回顾性分析1例脑室内原发性淋巴瘤的临床资料、影像学表现,复习相关文献进行综合分析,并与脑实质内原发性淋巴瘤进行对比。结果 CT显示左侧脑室三角区肿块呈稍高密度,形态规则,MRI显示肿块呈稍长T1稍长T2信号,中心可见小囊变,增强扫描明显强化,可见瘤周水肿,脱水治疗14 d后复查,病灶明显增大,形态不规则,囊变坏死区增大,增强扫描不均匀明显强化,瘤周水肿明显加重,出现"握拳样"表现,手术病理证实为弥漫性大B细胞淋巴瘤,全身PET-CT检查未发现其它部位淋巴瘤,临床确诊为侧脑室原发性淋巴瘤。结论脑室内原发性淋巴瘤罕见,与脑实质内原发性淋巴瘤具有相似的影像表现;对疑诊病例多种影像检查方法联合,对其诊断及鉴别诊断有一定帮助。

Objective To evaluate the CT and MRI imaging features of primary ventricular lymphoma, so as to provide a reference for the diagnosis and differential diagnosis of the disease. Methods The clinical data and imaging findings of primary ventricular lymphoma in one case was retrospectively analyzed with literature review and compared with primary lymphoma in parenchymal brain. Results Slightly high density tumor presented with regular shape in the trigone of lateral ventricles on CT findings, and slightly low signal intensity on T1 and slightly high signal intensity on T2 appeared on MRI findings with small cystic necrosis in tumour. An enhancement scan showed obviously enriched, and there was perilesional edema. After 14 day＇ s dehydration treatment, rechecked indicated that the lesions were significantly en- larged, the shape were irregula, the area of cystic necrosis was enlarged, heterogeneous enhanced scanning were enhanced, perilesional ede- ma became more heavier, and the imaging feature of ＂closed fist＂ appeared. It was proved to be diffuse large B cell lymphoma with surgical pathologic examination, and there was no lymphoma in other regions of the body with whole body PET-CT examination, which was clinically diagnosed as primary ventricular lymphoma. Conclusion Primary ventricular lymphoma is rarely reported, and it has similar imaging mani- festations with primary lymphoma in parenchymal brain. The combination of multiple imaging modalities will be helpful to diagnosis and dif- ferential diagnosis for the suspected patients.