CT联合MRI对原发性中枢神经系统淋巴瘤的诊断价值

CT and MRI in the Diagnosis of Primary Central Nervous System Lymphoma

目的探讨原发性中枢神经系统淋巴瘤患者采用CT与MRI联合诊断的临床价值。方法收集2017年8月—2019年7月我院收治的60例原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)患者作为观察对象,分别行CT与MRI诊断,总结PCNSL的影像学特点。结果MRI对PCNSL的诊出率为100%,其中26例单发病灶、34例多发;CT诊出病症44例,诊出率73.3%,其中24例单发病灶,20例多发,差异具有统计学意义(P<0.05)。对60例患者进行进一步观察,得到:幕上病灶46例、幕上和幕下同时受累14例。不规则的团块状病灶30例、卵圆形病灶28个、蝶翼形病灶18例。病灶平均直径(4.83±0.19)cm。CT平扫显示,16例患者的病灶为均匀的高密度影、10例为不均匀的高密度影、10例为均匀的等密度影。靠近颅骨骨质浸润、未见钙化的病灶有12个。MRI平扫显示:22例T1WI等信号、30例稍低信号;T2WI表现为等信号或者稍低信号,稍高信号16例、14例信号欠均匀,中心发现囊性病变。DWI均表现为高信号或者稍高信号。结论无论是CT还是MRI诊断原发性中枢神经系统淋巴瘤,均具有显著的临床优势和独有的征象,为了进一步提高临床诊断的准确率,更加推荐二者联合诊断。

Objective To explore the clinical value of combined diagnosis of CT and MRI in patients with primary central nervous system lymphoma.Methods Sixty cases of Primary central nervous system lymphoma(PCNSL)admitted to our hospital from August 2017 to July 2019 were collected as objects of observation,diagnosed by CT and MRI respectively,and the imaging characteristics of PCNSL were summarized.Results The detection rate of PCNSL by MRI was 100%,including 26 cases with single lesion and 34 cases with multiple lesions.Among the 44 cases diagnosed by CT,the diagnosis rate was 73.3%,including 24 cases with single lesion and 20 cases with multiple lesions,with statistically significant difference(P<0.05).Further observation of 60 patients showed that:46 cases of supratentorial lesions,14 cases of supratentorial lesions and 14 cases of supratentorial lesions.There were 30 irregular lumpy lesions,28 ovoid lesions and 18 sphenoid lesions.The mean diameter of the lesion was(4.83±0.19)cm.Plain CT scan showed that the lesions of 16 patients were of uniform high-density shadow,10 were of non-uniform high-density shadow,and 10 were of uniform isodensity shadow.There were 12 lesions close to the bone infiltration of the skull without calcification.MRI plain scan showed:22 T1WI isosignal,30 lower signal;T2WI showed equal signal or slightly lower signal,slightly higher signal in 16 cases,and slightly less uniform signal in 14 cases.Cystic lesions were found in the center.DWI is high signal or slightly high signal.Conclusion Whether CT or MRI is used to diagnose primary central nervous system lymphoma,both have significant clinical advantages and unique signs.In order to further improve the accuracy of clinical diagnosis,a combined diagnosis of the two is more recommended.