获得性免疫缺陷综合征相关脑淋巴瘤的影像学诊断标准

Imaging diagnosis criteria of acquired immunodeficiency syndrome associated PCNSL

获得性免疫缺陷综合症(acquired immune deficiency syndrome,AIDS)相关原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)具有较独特的影像学表现,本标准基于总结文献检索病例统计及当前最新研究证据,形成了最新的影像学诊断推荐意见:将MRI平扫及增强扫描作为艾滋病相关PCNSL强推荐检查方法;影像学征象归纳为:三高,肿瘤实体部分扩散加权成像(diffusion weighted imaging,DWI)信号增高、计算机断层扫描(computed tomography,CT)平扫等、高密度且基本均匀的明显强化;二低,肿瘤实体部分ADC图明显低信号、T1WI和T2WI等低信号;三常见,多位于大脑中线结构区、常表现为多发、囊变;特征性MR增强表现为“缺口征”“尖角征”“握雪团征”和“锯齿状或棘突状”等。对于临床疑似病例,如影像学检查结果符合以上影像学表现,可作为诊断艾滋病相关PCNSL的影像学诊断标准,以期为临床提供丰富、准确的诊断信息及较明确的诊断依据,有效提升艾滋病相关PCNSL早期诊断水平,以期形成最佳决策方案,并达到早治疗及精准治疗的目的。

Acquired immune deficiency syndrome(AIDS)related primary central nervous system lymphoma(PCNSL)has unique imaging manifestations.Based on the summary of literature case statistics and the latest research evidence,we formed the updated imaging diagnostic recommendation:MRI without and with contrast scanning is the strongly recommended examination methods for AIDS-related PCNSL.Imaging signs or findings summarized as follows:THREE HIGH,increased diffusion weighted imaging(DWI)signal in solid parts of the tumor,high density of CT without contrast,and basically uniform enhancement.TWO LOW,hypo-intensity of ADC maps,iso-or hypo-intensity of T1WI without contrast and T2WI.THREE COMMON,mostly located in the midline structural area of the brain,often manifested as multiple,cystic changes.The special MRI enhancement was characterized by"Notch sign""Sharp Angle sign""Snow-holding sign"and"Jagged or Spinous shape".For clinical suspected cases,such as imaging examination in accordance with the above findings,can be used as the imaging diagnostic criteria of AIDS related PCNSL,so as to provide a rich,accurate diagnostic information for clinical with a definite diagnosis,effectively to improve the ability of AIDS related PCNSL early diagnosis,in order to easily form the optimal decision scheme,and to achieve truly early and precise treatment.