成人白血病中枢神经系统并发症的CT与MRI表现  

CT and MRI findings of central nervous system complications of leukemia

作　　者：徐秀芳[1] 陈英[2] 余日胜[2] 黄凯[1] 陈益红[1] 刘蕊[1] 

机构地区：[1]浙江医学高等专科学校影像教研室,杭州310053 [2]浙江大学医学院附属第二医院放射科

出　　处：《中华放射学杂志》2011年第1期37-41,共5页Chinese Journal of Radiology

摘　　要：目的 探讨成人白血病中枢神经系统并发症（CNSCL）的CT和MRI表现及其诊断价值。方法回顾性分析18例经临床及手术病理证实的成人CNSCL的CT和MRI表现，其中急性淋巴细胞白血病7例，急性非淋巴细胞白血病10例，慢性粒单细胞白血病1例。CT平扫11例，其中增强1例；MR平扫16例，其中增强11例。结果颅内受累14例：（1）颅内出血7例，其中脑内血肿4例，脑内血肿合并微出血1例，微出血2例。脑内血肿均为多发病灶。CT表现为团状高密度影；MRI表现为T1WI低信号或高低混杂信号，T2W1高信号或等高信号伴环状低信号环，病灶呈环形强化或无明显强化。脑微出血在磁敏感加权成像（SWI）上表现为多发斑点状及小条状低信号，其病灶检出率明显优于CT及MRI其他常规序列检查；7例中，伴脑梗死及蛛网膜下腔出血各1例。（2）颅内肿块5例：其中左额部内板下梭形病灶或跨颅板肿块2例，T1WI呈低信号，T2wI呈高低混杂信号，并有明显均匀强化，均见脑膜尾征；鞍区肿块1例，CT示鞍区高密度影，MRI示鞍区T1WI稍低信号，T2WI高信号，有不均匀强化；右侧脑室体旁肿块1例，T1WI、T2WI均呈等信号，有明显均匀强化。左额顶叶壁厚囊性肿块1例，呈环形强化。（3）梗阻性脑积水1例，表现为中脑导水管以上脑室系统扩张。（4）脑膜病变1例，MRI表现为广泛脑膜增厚伴明显均匀强化。椎管内病变4例：其中胸腰椎左侧椎旁软组织肿块2例，侵犯椎管内，伴邻近肋骨骨质破坏1例；椎管内肿块1例，表现为胸椎管后方梭形T，WI等高信号，T2WI等低信号灶，无明显强化；胸髓信号异常1例，表现为胸髓条状T2WI及液体衰减反转恢复（FLAIR）序列高信号影。结论成人CNSCL影像表现多种多样，CT与MRI对该病的诊断价值相辅相成；白血病患者疑脑内病变者，建议常规使用SWI检查，以尽早发现脑�Objective To evaluate the CT and MRI findings and their diagnostic value of central nervous system complications of leukemia （CNSCL）. Methods The CT and MRI findings of 18 adult patients with CNSCL proved by clinical features or pathology were retrospectively analyzed. Among t8 cases, 7 were acute lymphocytic leukemia, 10 acute non-lymphocytic leukemia and 1 chronic myelomonocytic leukemia. Eleven cases underwent plain CT scan with one of them also receiving contrast-enhanced CT scan enhancement, 16 cases underwent plain MR scan with 11 of them receiving contrast-enhanced MR scan. Results Intracranial lesions in 14 cases： （ 1 ） intracranial hemorrhage was found in 7 cases, including intracerebral hematoma in 4 cases, micro-haemorrhage in 2 cases, and intracerebral hematoma accompanying by multiple intracerebral micro-haemorrhage foci in 1 case. All cases with intracerebral hematoma showed multiple lesions, which demonstrated high-density on CT images, and low or mixed signal on T1WI, high- or intermediate signal with low-signal rim on T2WI and ring enhancement or no evident enhancement. Microhaemorrhage manifested as multiple mini-mottling and strip hypointense loci on susceptibility weighted imaging, on which the detection rate of micro-haemorrhage foci was much higher than that on CT and othersequences of MRI Among the 7 cases, one also had cerebral infarction and one subarachnoid hemorrhage. （2） Intracranial mass was found in 5 cases, among which two appeared as masses under or bestride cranium in the left frontal region with hypointensity on T1WI, mixed signal on T2WI, strong homogeneous enhancement and dural tail sign;one showed a mass in saddle area, with high density on CT, slightly low signal on T1WI, high signal on T2WI and heterogeneous enhancement; one case displayed a mass near lateral ventricle with iso-intensity on T1WI and T2WI and strong homogeneous enhancement; and one case manifested as cystic mass in the left fronto-apical lobe, with thick wall and ring enhancement. （3） Obstru

关 键 词：成人 白血病 中枢神经系统 磁共振成像 体层摄影术 X线计算机 

分 类 号：R445.2[医药卫生—影像医学与核医学]