摘要
目的总结原发性中枢神经系统淋巴瘤(PCNSL)非典型MRI影像学表现,以提高对非典型PCNSL影像诊断的正确率。方法回顾性分析经穿刺或手术病理证实的25例原发性中枢神经系统淋巴瘤的MRI影像学表现,包括非典型的生长部位,非特异的MRI表现和强化方式。结果 25例中单发病灶者16例,多发病灶9例,病灶数共38个。不典型发生部位可见于鞍上、脑干、小脑半球和小脑蚓部、侧脑室、三脑室和第四脑室等等。病灶形态大小不一,表现形式多种多样,可呈类圆形、不规则形,团块状、结节状、斑片状、灶状或散在分布。1例病灶侵及邻近脑膜,出现"脑膜尾征"。20例在T1WI呈稍低或等信号,T2WI呈等或稍高信号,5例T1WI、T2WI呈混杂信号。7例呈实性均质强化,6例呈结节状强化,3例呈斑片状强化,2例呈条纹状强化,2例呈环形强化,1例呈弥漫肿胀伴轻度强化,3例多发病灶多种强化方式并存。5例DWI呈均质高信号,6例呈不均匀稍高信号,4例呈中等信号。MRS检查4例出现较明显的Lip峰。结论对于发生在非典型生长部位、影像学表现非特异性的,以及颅内多发病灶的和侵犯脑膜的中枢神经系统淋巴瘤,术前诊断较为困难,需引起高度重视。
Objective To summarize the atypical MRI manifestation of primary central nervous system lymphoma （PCNSL） in order to improve the correct diagnosis of PCNSL.Methods MRI imaging findings of 25 primary central nervous system lymphomas confirmed by puncture or surgical pathology were retrospectively analyzed,including atypical growth sites,non specific MRI findings,and enhancement patterns. Results There were 38 lesions,including solitary lesion in 16 cases and multiple lesions in 9 cases.The atypical locations included sellar,pontine,cerebellum and cerebellar vermis,lateral ventricle,third and fourth ventricle,et al.The lesions demonstrated variously in size and appearance with oval like,irregular,crumby,nodular,patchy and focal or diffuse shapes.One tumor invaded adjacent meninges with “meningeal tail sign”.The tumor showed low or iso signal on T 1WI and iso or high signal on T 2WI in 20 cases,and miscellaneous signals on T 1WI and T 2WI in 5 cases.The tumor showed homogeneous enhancement in 7 cases,nodular enhancement in 6 cases,patchy enhancement in 3 cases,stripe enhancement in 2 cases,rim enhancement in 1 case and slightly diffused enhancement in 1 case.The multiple lesions showed different enhancement patterns in 3 cases.The tumor showed homogeneous high signal on DWI in 5 cases,inhomogeneous slightly high signal on DWI in 6 cases,intermediate signal on DWI in 4 cases.There was an obvious Lip peak on MRS in 4 cases. Conclusion The preoperative diagnosis of PCNSL is difficult to make and should be paid great attention when the tumors occur in atypical locations with atypical and non specific MRI features,and multiple lesions or involved meninges.
作者
赵凯
张岚
顾志强
ZHAO Kai;ZHANG Lan;GU Zhiqiang(Department of Radiology,Anyang People＇s Hospital NO.6,AnYang 455000,China;Vice Director of MRI,the First Affiliated Hospital of Henan Medical University of TCM,Zhengzhou 450000,China;）Department of Radiology,Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)
出处
《中国实用神经疾病杂志》
2018年第19期2158-2164,共7页
Chinese Journal of Practical Nervous Diseases
关键词
原发性中枢神经系统淋巴瘤
非典型
磁共振成像
立体定向穿刺活检
鉴别诊断
Primary central nervous system lymphoma；Atypical；Magnetic resonance imaging；Stereotactic needle biopsy；Differential diagnosis
