原发性颅内恶性淋巴瘤的临床特点及影像学诊断

Diagnosis of primary intracranial malignant lymphoma by clinical and imaging characteristics

目的探讨原发性颅内恶性淋巴瘤的临床、影像学特征。方法对25例经手术及病理证实的原发性颅内恶性淋巴瘤的临床、影像学表现及治疗进行了回顾性分析。结果本病以中老年人多见,病程短,病情进展快,颅压高症状出现早,多位于幕上,可单发或多发,可侵及室管膜和软脑膜并沿之播散;CT扫描多表现为等密度肿块,MRI显示T1加权像多呈低信号,T2加权像多呈高信号,CT和MRI增强扫描病灶多呈均匀明显强化;对放疗、化疗敏感。结论原发性颅内恶性淋巴瘤的临床、影像学表现与某些中枢神经系统病变有类似之处,鉴别比较困难,确诊主要依靠病理检查。最佳治疗方案是手术加放疗、化疗的联合治疗。

Objective To investigate the clinical and imaging characteristics of primary intracranial malignant lymphoma (PIML). Methods Twenty five cases affirmatively diagnozed as PIML through surgery and pathologic tests were retrospectively analyzed in regard to their clinical presentations, radiological findings and treatments. Results There were many characters of this disease such as short courses, frequent occurrence in middle-old age, speedy progress, earlier intracranial pressure, frequent supratentorial location, solitary or multiple in number and possible invasion into ependyma and leptomeninges or even along them. CT scanning showed the tumor had the same density as the brain. MRI indicated hypo-signal in T1WI and hyper-signal in T2WI. Enhanced scanning showed the lesion was contrasted evenly and obviously. It was sensitive to radiotherapy and chemotherapy. Conclusion It is difficult to distinguish PILM from other central nervous system tumors only depending on their clinical manifestations and radiological findings. The final diagnosis can be determined by pathological examination. The combination of operation with radiotherapy and chemotherapy is the best therapeutic method.