摘要
目的探讨原发性中枢神经系统淋巴瘤(PCNSL)的MRI表现,旨在提高对该病诊断的准确性。方法回顾性分析及总结18例经穿刺或者手术病理证实为PCNSL患者的MRI影像表现。结果 18例中单发7例,共7个病灶,多发11例,共25个病灶。32个病灶均以局灶性生长为主,17个病灶分布于中线周围脑室旁深部白质,11个病灶分布于脑表浅灰质,4个病灶范围较大,同时分布于脑白质和脑灰质。21个白质病灶中7个病灶累及胼胝体,15个灰质病灶中有6个病灶紧贴软脑膜,另8个病灶距离脑膜小于5mm。所有病灶MRI平扫信号大致均匀,T1WI多呈低信号或等、低信号,T2WI多呈等信号或等、高信号,病灶周围多呈轻、中度水肿信号。病灶实性部分DWI多呈明显高信号,ADC呈明显低信号。MRI增强病灶实性部分明显强化,其中12个病灶内可见散在小范围坏死信号影,1个病灶中央出现较大范围的坏死信号影,出现脐凹征(19/32)、缺边征(16/32)、劈裂征(7/32)、握拳征(3/32)、马蹄征(5/32)、尖角征(26/32)、蝶翼征(7/32)、卫星征(5/32)等多种强化方式,9例患者同时可见软脑膜和(或)室管膜强化。病理学证实,18例均为弥漫性大B细胞淋巴瘤。结论 PCNSL在MRI表现具有一定特征性,MRI可帮助其诊断与鉴别诊断。
Objective To explore the MRI imaging features of primary central nervous system lvmphoma(PCNSL)so as to improve the knowledge and diagnostic accuracy of this disease.Methods The MRI imagings and clinical data of 18 patients with PCNSL,who had been confirmed by surgery and pathology,were retrospectively reviewed.Results 18 patients included 7 cases with a single lesion and 11 cases with multiple lesions,11 cases included 25 lesions totally.32 lesions of PCNSLs all growed focally,17 lesions were located in the deep brain areas near the central line structure,11 lesions were located in the shallow brain region,4 large lesions were both located in the deep brain areas near the central line structure and in the shallow brain region.Corpus callosum were involved by 7 lesions,6 lesions were followed by leptomeningeal and the distance between lesion and leptomeningeal was less than 5 mm of 8 lesions.On MRI images,all lesions were almost hypointense slightly or isointense on T 1-weighted MRI and isointense or hypointense slightly on T 2-weighted MRI images.All lesions presented as hyperintense on DWI and hypointense on ADC obviously.Contrast-enhanced MRI images showed obvious homogenous enhancement with various shapes such as notch sign(19 cases),indentation sign(16 cases),crack sign(7 cases),and fist sign(3 cases),horseshoe sign(5 cases),corner sign(26 cases),butterfly sign(7 cases),and satellite sign(5 cases).Pathological studies confirmed all cases were diffuse large B-cell lymphoma.Conclusion PCNSL has certain characteristic MRI imaging findings,MRI is helpful to diagnose PCNSL.
作者
陆方晓
刘璐璐
杨建涛
LU Fangxiao;LIU Lulu;YANG Jiantao(Department of Radiology,Zhejiang Cancer Hospital,Hangzhou 310022,P.R.China)
出处
《医学影像学杂志》
2019年第1期15-19,共5页
Journal of Medical Imaging
基金
浙江省卫计委面上项目(编号:2018ky314)
浙江省卫计委科研基金项目(编号:2017ky258)
关键词
淋巴瘤
中枢神经系统
磁共振成像
Lymphoma
Central nervous system
Magnetic resonance imaging