SWI-ILSS及DWI在鉴别艾滋病相关中枢神经系统淋巴瘤与环形强化感染性病变的对比研究

A Comparative Study of SWI-ILSS and DWI in Differentiating AIDS-Related Central Nervous System Lymphoma from Ring-Enhanced Infectious Disease

目的探讨磁敏感加权成像(SWI)序列及扩散加权成像(DWI)序列在鉴别艾滋病相关中枢神经系统淋巴瘤(AR-PCNSL)与环形强化感染性病变的应用。方法分析13例AR-PCNSL与8例艾滋病合并中枢神经系统环形强化的感染性病变的常规MRI影像特征及SWI上病变内磁敏感信号(SWI-ILSS)、DWI及ADC影像特征。结果常规MRI两组间影像表现,只有在病变累及胼胝体时更提示AR-PCNSL的诊断,P值为0.046。DWI序列,AR-PCNSL壁DWI/对侧正常脑组织呈高信号(P=0.032),ADC/对侧呈低信号(P=0.024),两组间差异有统计学意义;而感染组病变中心DWI/对侧呈高信号(P=0.018),ADC/对侧值减低(P=0.047),两组间差异有统计学意义。SWI-ILSS序列,AR-PCNSL多为ILSS 2~3级,感染组ILSS 0~1级P值为0.018,两组间差异有统计学意义。结论常规MRI对AR-PCNSL与环形强化感染性病变诊断价值有限,DWI、ADC及SWI-ILSS序列能提供更多诊断及鉴别诊断信息,鉴别困难时应加扫DWI及SWI序列。

Objective To compare SWI-ILSS sequence and DWI sequence in the differential diagnosis of AIDS related central nervous system lymphoma(AR-PCNSL) and ring enhanced infectious lesions. Methods 13 cases of AR-PCNSL and 8 cases of ring enhancement infections were analyzed. Results On conventional MR when the corpus callosum was involved, the diagnosis of AR-PCNSL was suggested(P=0.046).On DWI sequence, the wall of AR-PCNSL showed high signal on DWI(P=0.032),and ADC value decreased(P=0.024).Ring-enhancement infection group lesions center showed high signal on DWI(P=0.018),ADC value decreased(P=0.047).On SWI-ILSS sequence, AR-PCNSL showed ILSS 2-3,and ILSS 0-1 in infection group(P=0.018). Conclusion Conventional MR is difficult in diagnosis of AR-PCNSL and annular enhanced infectious lesions.DWI,ADC and SWI-ILSS sequences could provide more information for differential diagnosis.DWI and SWI sequences should be added when it is difficult to differentiate these lesions.