摘要
目的分析原发性脑内淋巴瘤MRI影像表现与病理的关系,提高对本病术前影像诊断的准确性。方法回顾性分析2009年4月-2015年8月我院经手术及病理确诊为原发性脑内淋巴瘤39例的MRI影像学表现,分析其与病理的关系。结果 39例中23例单发,16例多发,共发现79个病灶,其中幕上68个,幕下11个,幕上病灶多位于脑实质深部或中线区域,其中额、顶、颞、枕叶脑白质深部共33个,基底节区15个,胼胝体8个,大脑半球灰白质交界区7个,丘脑5个。MRI平扫于T1WI序列,呈等信号病灶47个,稍低信号32个;T2WI序列呈等信号病灶54个,稍高信号25个;T2 flair序列以等信号为主。MRI增强扫描,均匀或较均匀团状强化病灶25个,不均匀团状强化8个,结节状强化29个,不规则片状或斑片状强化9个,病变位于胼胝体呈蝶翼状强化8个。其中15个病灶出现"握拳状"强化征象,26个见"尖角征",28个病灶出现"缺口征"或"脐凹征",3个病灶可见邻近脑膜强化。33个病灶瘤周轻度水肿,29个瘤周中度水肿,17个瘤周重度水肿。结论原发性脑内淋巴瘤MRI多表现为与灰质相近的等信号,其病理基础为肿瘤细胞排列紧密、核浆比例较高、细胞间隙含水少,肿瘤围绕血管周围间隙浸润生长、破坏血脑屏障,且由于囊变坏死少见,故多呈明显均匀强化。
Objective To analyze the relationship between MRI imaging manifestations and pathological results of patients with primary brain lymphoma,and improve the accuracy of preoperative imaging diagnosis of this disease.Methods MRI imaging findings of 39 lesions confirmed by surgery and pathology in our hospital were retrospectively analyzed,and its relationship with pathology was also analyzed.Results There were 23 patients with single lesion and 16 patients with multiple lesions.A total of 79 lesions were found with 68 lesions located at supratentorial region and 11 lesions located at infratentorial region,33 lesions were seen located in the deep alba,15 lesions located in the basal ganglion,8 lesions located in the callosum corpus,7 lesions located in the gray matter,and 5 cased located in the thalamus.Of the 79 lesions,47 lesions showed isointensity signal,32 lesions showed slightly hypointensity signal on T1 WI.On T2 WI,54 lesions showed isointensity signal and 25 lesions showed hyperintensity signal.After Gd-DTPA injection,the lesions showed homogeneous enhancement mass in 25 lesions,heterogeneous enhancement mass in 8 lesions,nodular enhancement in 29 lesions,irregular enhancement in 9 lesions,and enhancement like butterfly wing in 8 lesions.Clench fist sign were found in 15 lesions,angular sign in 26 lesions,incision sign in 28 lesions,and 3 lesions had adjacent dural enhancement.Slight para-tumorous edema was found in 33 lesions,moderate edema in 29 lesions and marked edema in 17 lesions.Conclusion On MRI,primary brain lymphoma demonstrates similar signals with gray matter.Its pathological basis are closely packed tumor cells,high nucleoplasm ratio,little water in intercellular space,and tumor infiltrative growth surrounding blood vessels which damages blood-brain barrier,and it shows obvious homogeneous enhancement because of rare cystic necrosis.
出处
《解放军医学院学报》
CAS
2016年第7期761-765,共5页
Academic Journal of Chinese PLA Medical School
关键词
原发性脑内淋巴瘤
磁共振成像
诊断
primary brain lymphoma
magnetic resonance imaging
diagnosis
