原发性中枢神经系统血管内淋巴瘤的影像表现:附4例报道并文献复习  

Imaging findings of intravascular lymphoma of central nervous system:Report of 4 cases and literature review

作　　者：张金彩 时传迎 李明利[2] 有慧[2] 冯逢[2] ZHANG Jincai;SHI Chuanying;LI Mingli;YOU Hui;FENG Feng(Department of Radiology,Central Hospital of Linyi,Linyi 276400,China;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Radiology,Liaocheng People’s Hospital,Liaocheng 252000,China)

机构地区：[1]临沂市中心医院影像科,临沂276400 [2]中国医学科学院北京协和医学院北京协和医院放射科,北京100730 [3]聊城市人民医院影像科,聊城252000

出　　处：《磁共振成像》2020年第10期900-903,共4页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的分析血管内(弥漫大B细胞)淋巴瘤患者脑MRI表现,提高对血管内淋巴瘤的认识。材料与方法回顾性分析4例经病理学活检证实的血管内淋巴瘤的脑MRI表现,总结MRI诊断要点。结果本组病例临床上3例以快速进展性痴呆为特征,1例以高热为特征。4例MRI均表现为脑内多发梗死灶,扩散加权成像(diffusion-weighted imaging,DWI)上呈高信号,ADC图上呈略低信号。病灶分布不符合血管分布区,以双侧脑白质分布为主。对应T2WI上可见病灶范围更大,病灶更多。3例活检前多次MRI检查,均可见新发DWI高信号病变出现。结论脑内多发DWI高信号,不符合血管分布区,ADC值减低不明显,而T2WI上范围更大、病变更多时,如果同时临床上有发热或快速的认知功能下降,要高度怀疑血管内淋巴瘤的可能。Objective:To summarize the brain MRI manifestations of intravascular(diffuse large B-cell)lymphoma,improving the understanding of intravascular lymphoma.Materials and Methods:The brain MRI findings of 4 cases of intravascular lymphoma confirmed by skin and brain biopsy were analyzed retrospectively.Combined with the clinical manifestations,laboratory examination,the key features of MRI for diagnosis of intravascular lymphoma were summarized.Results:The clinical manifestations were haemophilus syndrome in 1 case and rapid cognitive decline/progressive dementia in 3 cases.Abnormal brain MRI were displayed in all 4 cases,which showed as multiple lesions with high signal on T2WI,high signal on DWI with slight ADC reduced.The lesions were mainly located in the white matter of bilateral cerebral hemisphere and did not in accordance with the vascular distribution area.In 3 cases,short-term follow-up MRI before biopsy showed that there are always new DWI high signal lesions.Conclusions:When a patient have fever or rapid cognitive decline,and with abnormal brain MR imaging findings,which showed multiple DWI hyperintensity lesions located in brain white matter bilaterally,did not in accordance with the vascular distribution area,with or without ADC reduced,the possibility of intravascular B-cell lymphoma should be highly suspected.

关 键 词：血管内淋巴瘤 弥漫大B细胞淋巴瘤 磁共振成像 扩散加权成像 表观扩散系数 

分 类 号：R445.2[医药卫生—影像医学与核医学] R733.4[医药卫生—诊断学]