原发性中枢神经系统淋巴瘤的影像学研究  

An imaging features of primary central nervous system lymphoma

作　　者：陈其钻[1] 王守森[1] 刘峥[1] 张尚明[1] 

机构地区：[1]南京军区福州总医院神经外科,福建350025

出　　处：《中华神经外科杂志》2017年第2期173-177,共5页Chinese Journal of Neurosurgery

基　　金：福建省科技计划（2014J01368）

摘　　要：目的探讨原发性中枢神经系统淋巴瘤（PCNSL）的影像学表现。方法回顾性收集南京军区福州总医院神经外科2010年8月至2016年8月经病理学证实的32例PCNSL患者，分析其CT及MRI影像学特征。结果32例中，单发者18例（56％），多发者14例（44％），共50个病灶；肿瘤好发于基底节区、胼胝体等深部脑组织，为76％（38／50），浅部脑组织为24％（12／50）；瘤周水肿多为轻、中度（76％，38／50）。CT平扫显示，44个（88％）病灶呈等或稍高密度，6个病灶呈稍低密度（12％）；11例增强扫描病灶呈明显强化改变。MRIT1加权成像病灶多呈等、低信号或等信号（92％，46／50），T2加权像多呈等信号或等、高信号（92％，46／50），弥散加权像多为高信号（90％，45／50）；增强扫描表现均匀一致的“团块状”、“裂隙征”、“蝶翼状”、“卫星灶”、“握拳状”及“缺口征”等多种典型强化方式。病理学证实，30例为弥漫性大B细胞淋巴瘤，2例为T细胞淋巴瘤。结论PCNSL具有特征性影像学表现，有助于PCNSL的诊断及鉴别诊断。Objective To explore the brain imaging features of primary central nervous system lymphoma （PCNSL）. Methods A total of 32 patients with histologically confirmed PCNSL in Department of Neurosurgery, Fuzhou General Hospital of Nanjing Military Command form August 2010 to August 2016 were retrospectively analyzed for their CT and MR features. Results Fifty lesions were identified in this series of 32 patients including 18 cases （56%） with a single lesion and 14 cases （44%） with multiple lesions. PCNSLs were mostly located in the deep brain areas （76% , 38/50） such as the basal ganglia and corpus callosum, and less commonly shallow brain regions （24%, 12/50）. Mild to moderate perilesional edema was seen in 38 out of 50 （76%） cases. On CT images, 44 （88%） lesions were isointense or mildly hyperintense, 6 （12%） lesions presented as mild hypointense, and 11 cases demonstrated significant enhancement with contrast. Most lesions（92% ,46/50）varied from hypointense to isointense on Tl-weighted MRI and from isointense to hyperintense on T2-weighted images. Forty-five lesions （90%） presented as hyperintense on DWI. Contrast-enhanced MRI images showed obvious homogenous enhaneement with various shapes such as lump-like, crack-like, butterfly-like, satellite-like, fist-like and indentation sign. Pathological studies confirmed 30 cases of diffuse large B-cell lymphoma and 2 cases of T-cell lymphoma. Conclusion Certain imagingand pathological features are associated with PCNSL, which would facilitate its diagnosis and differential diagnosis.

关 键 词：淋巴瘤 中枢神经系统 磁共振成像 体层摄影术 X线计算机 疾病特征 

分 类 号：R739.4[医药卫生—肿瘤]