中枢神经系统白血病MR及CT影像学分析

Magnetic Resonance and Computed Tomography Imaging Analysis of Central Nervous System Leukemia

目的 分析中枢神经系统白血病(CNSL)的头颅MR及CT影像学表现。方法 回顾性分析2010年1月至2021年10月诊断CNSL且行头MR增强扫描患者的MR及CT影像学资料。结果 共41例患者。MR有32例(78.0%)阳性,其中27例(65.9%)为颅内浸润灶,包括颅神经增粗14例(34.1%),脑膜强化或占位13例(31.7%),脑实质占位4例(9.8%)及脑室内占位1例(2.4%)。颅神经增粗者中有6例(14.6%)伴颅神经走行区占位;脑膜强化或占位者中有7例(17.1%)软脑膜强化,2例(4.9%)硬脑膜强化,5例(12.2%)硬脑膜占位。同期行头颅CT者20例(48.8%),其中9例阳性(45%),其中7例为颅内浸润灶,均为占位性病变,呈均质稍高密度影。颅内浸润灶MR平扫漏诊9例(33.3%),CT漏诊7例(50.0%)。结论 CNSL的影像表现有颅神经浸润、脑膜浸润、脑实质及脑室内浸润等。增强MR对诊断有重要价值,CT平扫仅对占位性病变检出率较高。

Objective To analyze the MR and CT imaging manifestations of central nervous system leukemia(CNSL). Methods The MR and CT imaging data of patients with CNSL between January 2010 and October 2021 were analyzed retrospectively, who underwent head enhanced MR scanning. Results There were 41 patients.MR was positive in 32 cases(78.0%),of which 27 cases(65.9%) were intracranial infiltration, including 14 cases(34.1%) of cranial nerve thickening, 13 cases(31.7%) of meningeal enhancement or space occupying, 4 cases(9.8%) of brain parenchyma occupation and 1 case(2.4%) of intracerebral ventricular occupation.6 cases(14.6%) of cranial nerve thickening were accompanied by space occupying in areas of cranial nerves. Among the patients with meningeal enhancement or space occupying, there were 7 cases(17.1%) with leptomeningeal enhancement, 2 cases(4.9%) with dural enhancement, and 5 cases(12.2%) with dural space occupying. Head CT was performed in 20 cases(48.8%) in the same period, and 9 cases were positive(45%).Among them, 7 cases showed intracranial infiltrative lesions, all of which were space occupying lesions with homogeneous slightly high-density shadows. There were 9 cases(33.3%) of missed diagnosis of intracranial infiltrating lesions on MR plain scanning and 7 cases(50.0%) of missed diagnosis on CT. Conclusion The imaging manifestations of CNSL include cranial nerve infiltration, meningeal infiltration, brain parenchyma and intraventricular infiltration and so on. Enhanced MR is of great value in diagnosis, and plain CT has a high detection rate only for space occupying lesions.