40例中枢神经系统白血病的影像表现研究  

Imaging Findings of Central Nervous System Leukemia: A Report of 40 Cases

作　　者：田颖[1] 陈淑霞[1] 胡青竹[1] TIAN Yin;CHEN Shu-xia;HU Qing-zhu(Department of Hematology,Shangqiu First People's Hospital,Shangqiu 476100,Henan Province,China)

机构地区：[1]河南省商丘市第一人民医院血液内科,河南商丘476100

出　　处：《中国CT和MRI杂志》2017年第12期15-18,共4页Chinese Journal of CT and MRI

摘　　要：目的分析中枢神经系统白血病的影像表现及CT、MRI的诊断效能。方法选取2016年7月至2017年7月我院收治的40例中枢神经系统白血病(CNSL)患者为研究对象,均行CT、MRI平扫与增强扫描检查,分析其影响学表现,观察病变部位信号特点,对比不同类型白血病患者中枢神经系统浸润部位,以脑脊液检查(CSF)结果为金标准,分析CT与MRI诊断CNSL的灵敏度、特异度、准确度。结果本组病例中,(1)白血病浸润软脑膜3例,CT可见脑沟、脑池消失,内见条状低密度灶,MRI表现为T1WI低信号,T2WI/FLAIR呈高信号,脑回肿胀,DWI稍高信号,增强后明显强化,(2)脑实质浸润6例,均为多发肿块,MRI呈T1WI低信号、T2WI/FLAIR高信号、DWI高信号,无明显占位效应,增强后强化,其中3例合并出血,(3)硬脑膜受累19例,累及额部板障,CT见软组织密度灶,MRI见软组织信号灶,增强后明显强化,余下12例为上述类型的混合型,包括软脑膜浸润、脑实质浸润、硬脑膜受累等同时存在,病灶见混杂短/等T1WI信号及短/长T2WI信号;不同类型白血病患者各浸润部位对比差异无统计学意义(P>0.05);MRI诊断CNSL的特异度83.33%、准确度87.50%高于CT 16.67%、67.50%(P<0.05),而灵敏度(76.47%vs 88.24%)对比差异无统计学意义(P>0.05)。结论中枢神经系统白血病CT与MRI检查时影像学表现有一定特征性,尤其是MRI增强检查有助于提高诊断效能,值得在临床推广应用。Objective To analyze the imaging manifestations of central nervous system leukemia and the diagnostic efficiency of CT and MRI.Methods A total of 40 cases of patients with central nervous system leukemia(CNSL)treated in our hospital from July 2016 to July 2017 were selected for the study and treated with CT and MRI plain scan and contrast enhanced scan.The imaging manifestations were analyzed,and the lesions sites and the signal characteristics were mainly observed,and the CNS infiltration sites were compared between different types of leukemia patients.And the sensitivity,specificity and accuracy of CNSL by CT and MRI diagnosis were analyzed by taking the examination results of cerebrospinal fluid(CSF)as the gold standard.Results In this group of patients.①there were 3 cases of leptomeningeal leukemic infiltration,and the disappearance of sulcus and brain cistern and the stripy low density lesions were seen in the CT,and the low signal in T1WI,high signal in T2WI/FLAIR,gyrus swelling,slightly high and then significantly enhanced signal in the DWI were shown in the MRI.②there were 6 cases of brain parenchyma infiltration with multiple tumors,and the low signal in T1WI,high signal in T2WI/FLAIR and high signal in DWI,with no obvious occupying effect,enhanced enhancement and 3 cases complicated with hemorrhage were shown by MRI.③there were19 cases of dural involvement involving the forehead barrier,and the soft tissue density lesions were seen in the CT,and the soft tissue signal lesions significantly enhanced after enhancement were seen in the MRI.The remaining 12 cases were mixed type of above types,including soft meninges infiltration,parenchymal infiltration,dural involvement,and the short/equal T1WI signal and short/long T2WI signal were seen in the mixed lesions.There was no significant difference in the infiltration sites between different types of leukemia(P>0.05).The specificity and accuracy of CNSL by MRI diagnosis were higher than those by CT diagnosis(83.33%vs.16.67%and 87.50%vs.67.50%)(P<0.05),bu

关 键 词：中枢神经系统白血病 CNSL CT MRI 影像表现 

分 类 号：R814.42[医药卫生—影像医学与核医学] R445.2[医药卫生—放射医学]