免疫功能正常原发性中枢神经系统淋巴瘤的MRI误诊分析

MRI Misdiagnosis of Primary Central Nervous System Lymphoma with Normal Immune Function

目的 探讨免疫功能正常原发性中枢神经系统淋巴瘤(PCNSL)的临床及MRI影像学特点,总结发生误诊的原因及防范措施。方法 回顾分析2019年10月—2022年1月收治的10例免疫功能正常PCNSL误诊患者临床资料。结果 10例均为急性起病,以不同程度头痛头晕、恶心、呕吐为主要症状就诊,且无发热,无免疫缺陷或长期免疫抑制剂使用史及器官移植史;血中性粒细胞百分比升高2例,淋巴细胞升高4例。10例据上述症状体征及MRI检查结果初步诊断为脑胶质瘤、脑膜瘤各5例,拟择期手术治疗。经手术病理检查确诊为PCNSL,其中弥漫性大细胞型7例、免疫母细胞型3例。误诊时间4~17 d。10例均在全麻下行颅内肿瘤切除术,并联合术后规律放化疗。术后随访半年,患者均存活,未发现复发。结论 PCNSL累及颅内部位多,临床及影像学表现复杂多样,对于影像学表现不典型及免疫功能正常者,初诊误诊率较高。加强接诊医师对PCNSL临床及影像学特点的认识,提高警惕性,拓宽诊断思维,及时行MRI、腰穿脑脊液及手术病理检查,以明确诊断并治疗。

Objective To explore the clinical and MRI imaging characteristics of primary central nervous system lymphoma(PCNSL)with normal immune function,and to summarize the causes of misdiagnosis and preventive measures.Methods Clinical data of 10 patients with misdiagnosed PCNSL with normal immune function admitted from October 2019 to January 2022 were retrospectively analyzed.Results All the 10 patients had acute onset,and presented with varying degrees of headache,dizziness,nausea and vomiting as the main symptoms,without fever,a history of immunodeficiency or long-term use of immunosuppressant,and a history of organ transplantation.The percentage of neutrophil in blood increased in 2 cases,lymphocyte increased in 4 cases.According to the above symptoms,signs and MRI examination results,the 10 cases were preliminarily diagnosed as glioma in 5 cases and meningioma in 5 cases,and all of them were recommended elective surgery.After surgical pathological examination,they were confirmed as PCNSL,including 7 cases of diffuse large cell type and 3 cases of immunoblastic type.Misdiagnosis lasted from 4 to 17 d.All the 10 cases underwent resection of intracranial tumor under general anesthesia,combined with regular postoperative chemoradiotherapy.After six months of follow-up,all patients survived and no recurrence was reported.Conclusion PCNSL involves many sites,and its clinical and imaging manifestations are complex and diverse.For those with atypical imaging manifestations and normal immune function,the misdiagnosis rate is relatively high at initial diagnosis.The understanding of clinical and imaging characteristics of PCNSL should be strengthened,the vigilance should be enhanced,the diagnostic thinking should be broadened,and timely MRI,lumbar puncture of cerebrospinal fluid and surgical pathological examination should be performed to confirm the diagnosis and treatment.