原发性中枢神经系统淋巴瘤常规和功能磁共振成像的特点及诊断价值分析

Characteristics and Diagnostic Value of Conventional and Functional Magnetic Resonance Imaging(fMRI) in Primary Central Nervous System Lymphoma

目的分析原发性中枢神经系统淋巴瘤(PCNSL)常规磁共振与功能磁共振成像和影像学特点和诊断价值。方法回顾我院2015年1月-2017年10月收治的19例PCNSL患者的临床检查资料,对患者行常规MRI、增强MRI、FLAIR、DWI、1H-MRS、PWI扫描,分析扫描图像。结果 19例患者共发现35个病灶,其中14例单发,5例多发,主要位于脑室旁深部脑白质区。病灶均呈T1等或者稍低信号,T2等或者稍高信号。瘤周水肿以轻、中度为主。35个病灶实性部分DWI均为稍高信号或高信号,ADC信号较对侧正常脑实质区域信号低。26个病灶呈低灌注,9个病灶为等灌注,时间-信号曲线有缓慢增强的趋势,并逐渐到达峰值。1H-MRS波谱表明病灶实性区域NAA(N-乙酰天门冬氨酸)峰降低,Cr(肌酸)峰有轻度降低,Cho(胆碱)峰升高,并出现异常高耸宽大的Lip(脂质)峰,另有4个病灶出现倒置Lac(乳酸)峰。结论常规与功能磁共振成像能够为PCNSL患者的病灶分析与病情诊断提供更为丰富的信息,有助于提高诊断准确率。

Objective To analyze the characteristics and diagnostic value of conventional magnetic resonance imaging(MRI)and functional magnetic resonance imaging(fMRI)and imaging in primary central nervous system lymphoma(PCNSL).Methods The clinical data of 19 patients with PCNSL admitted to our hospital from January 2015 to October-2017 were retrospectively reviewed.The routine MRI,enhanced MRI,FLAIR,DWI,1 H-MRS and PWI scan were performed to analyze the scanned images.Results 35 lesions were found in 19 cases,of which 14 cases were single,5 cases were multiple,mainly located in the deep brain white matter in the paraventricular area.The lesions were all T1 or slightly low signal,T2 or slightly high signal.The peritumoral edema was light and moderate.The real parts of the 35 lesions were slightly high signal or high signal,and the signal of ADC was lower than that of the contralateral normal parenchyma.26 lesions were low perfusion,9 lesions were equal perfusion,the time signal curve had a slow enhancement,and gradually reached the peak.1 H-MRS spectroscopy showed that the NAA(N-acetyl aspartate)peak decreased,Cr(creatine)peak decreased slightly,Cho(choline)peak increased,and the abnormal tall and broad Lip(lipid)peak appeared,and another 4 lesions appeared inverted Lac(lactic acid)peak.Conclusion Routine and functional magnetic resonance imaging can provide more abundant information for lesion analysis and disease diagnosis of PCNSL patients,and help to improve the accuracy of diagnosis.