原发中枢神经系统淋巴瘤的不典型MRI表现  

Atypical MRI presentation of primary central nervous system non-hodgkin lymphoma

作　　者：李新瑜[1] 孙聚葆[1] 杨静[1] 熊伟[2] 鲁果果 陈殿森[1] Li Xinyu;Sun Jubao;Yang Jing;Xiong Wei;Lu Guoguo;Chen Diansen(Imaging Center, the First Affiliated Hospital and College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471003, China)

机构地区：[1]河南科技大学第一附属医院影像中心 河南科技大学临床医学院,洛阳471003 [2]南方医科大学附属南方医院影像中心

出　　处：《中华放射学杂志》2018年第2期81-85,共5页Chinese Journal of Radiology

摘　　要：目的探讨原发中枢神经系统淋巴瘤（PCNSL）的不典型MRI表现。方法回顾性分析河南科技大学第一附属医院2011年5月至2016年12月及南方医科大学附属南方医院2003年9月至2009年5月间经病理证实的影像表现不典型的17例PCNSL患者的临床资料及首诊MRI资料。所有病例均行MRI平扫及增强扫描。由2名资深放射医师对MRI资料进行评价，包括瘤灶数目、生长部位、大小、形态、信号特点及强化方式等。结果17例中8例单发，9例多发。不典型MRI表现主要包括病变部位不典型和信号特点不典型。（1）部位不典型共9例。7例单发，位于脑干3例、大脑半球浅表部位2例、小脑半球1例、鞍区1例；2例多发，均表现为单纯室管膜下多发结节不伴脑实质异常。6例单发及2例多发病灶均呈结节样T1WI等或稍低信号，T2WI等或稍高信号，增强扫描显著均匀强化。（2）信号特点不典型共10例。①散在斑片状T1WI稍低、T2WI稍高信号，增强扫描不同程度补丁样或线样强化，共6例，1例单发于脑干、5例多发以幕上白质为主；②弥漫白质T1WI稍低、T2WI稍高信号，无具体瘤灶，增强无强化，共2例；③结节样病变，内部信号欠均、可见钙化1例，明显囊变坏死1例（增强扫描呈花环状强化）。结论非典型生长部位和信号特点的PCNSL易被误诊或诊断延迟，了解其影像表现并结合临床特点，可提高诊断和鉴别诊断水平。ObjectiveTo investigate the atypical MRI manifestations in patients with primary central nervous system lymphoma（PCNSL）.MethodsThe clinical and MRI manifestations of 17 patients with pathologically confirmed atypical PCNSL in the First Affiliated Hospital of Henan University of Science and Technology （from May 2011 to Dec 2016） and Nanfang Hospital （from Sep 2003 to May 2009） were analyzed retrospectively in this study. Both conventional and contrast-enhanced MR images were acquired for each patient. The MRI manifestations including the number, location, size, shape, signal intensity, enhancement patterns of lesions were evaluated by two senior radiologists.ResultsOf the 17 cases, 8 were solitary and 9 were multiple. Two types of atypical MR findings were found： （1） Atypical location： For the 9 patients showed atypical location, 7 patients had solitary masses which were located in the brainstem （n=3） , the supratentorial superficial parts （n=2） , the cerebellum （n=1） and the sella （n=1） . Two patients had multiple lesions, showing multiple subependymal nodules and no abnormalities in the brain parenchyma. Six of the 7 solitary lesions and the 2 multiple cases showed isointense or hypointense on T1-weighted scans and isointense or hyperintense on T2-weighted scans as well as significant homogenous enhancement on contrast-enhanced T1-weighted scans. （2） Atypical signal features： Ten cases were found with atypical signal features including： ①Patchy lesions were observed in 6 patients（one patient with single lesion, and five patients with multiple lesions）, appearing as hyperintense spots on T2-weighted image and subtle hypointense on T1-Weighted image. Corresponding contrast-enhanced T1-weighted MR image showed multiple patchy/linear enhancement. ②Two cases showed diffuse supratentorial periventricular and infra-tentorial white matter T2 hyperintensity and absence of contrast enhancement. ③Nodular lesions with inhomogeneous internal signals were found in 2 cases

关 键 词：淋巴瘤 中枢神经系统 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.4[医药卫生—诊断学]