原发性中枢神经系统淋巴瘤GCB分型与非GCB分型的磁共振影像学特征分析

MRI characteristics of PCNSL GCB subtype and non-GCB subtype

目的探讨原发性中枢神经系统淋巴瘤(PCNSL)生发中心B细胞型(GCB)和非生发中心B细胞型(非GCB)的MRI征象特征与病理学基础。方法选取经手术病理证实的PCNSL 84例患者的MR图像及病理资料。结果发现两种不同病理类型的PCNSL之间存在一些显著差异。在DWI中,GCB型病例均表现为弥散受限,而在81.36%的非GBM病例中观察到弥散受限(P<0.05)。1级水肿在GCB型病例中较为常见(52.00%),在非GCB型病例中较为罕见(27.12%)(P<0.05)。3级水肿在GCB型病例中较为罕见(8.00%),在非GCB型病例中较为常见(49.15%)(P<0.001)。62.71%的男性患者病理类型为非GCB型,37.29%的女性患者病理类型为非GCB型(P<0.05)。结论在多数情况下,常规MRI能够区分GCB型和非GCB型病变。PCNSL GCB型常见于女性,肿瘤周围常出现轻度水肿且均表现为明显弥散受限;而非GCB型常见于男性,肿瘤周围常出现重度水肿且可以出现弥散不受限的情况。可提高对疾病病理类型的鉴别能力,帮助临床医师采取针对性治疗措施。

Objective To investigate the characteristics and pathological basis of MRI in germinal center B cell(GCB)and non-germinal center B cell(non-GCB)in primary central nervous system lymphoma(PCNSL).Methods The MRI images and pathological data of 84 patients with PCNSL confirmed by surgical pathology were collected.Results This study found some significant differences between PCNSL of two different pathological types.The GCB cases all showed diffusion restriction,which was observed in 81.36%of the non-GBM cases(P<0.05).Grade 1 oedema was more common in GCB cases(52.00%)and more rare in non-GCB cases(27.12%)(P<0.05).Grade 3 oedema was relatively rare in GCB cases(8.00%)and more common in non-GCB cases(49.15%)(P<0.001).62.71%male patients were non-GCB and 37.29%female patients were non-GCB(P<0.05).Conclusion In most cases,conventional MRI could differentiate GCB and non-GCB subtype.PCNSL GCB subtype was more common in women,and mild edema often occurred around tumors and all showed diffusion restriction;while non-GCB subtype was more common in men,and severe edema often occurred around tumors.To some extent what we found could improve the differentiation ability of disease pathological types,provide support for clinical diagnosis,and help clinicians to adopt timely appropriate therapy.