原发性中枢神经系统淋巴瘤多模态MRI不典型表现及其病理学基础的探讨  

An Investigation into the Atypical Imaging Manifestations and Pathological Basis of Primary Central Nervous System Lymphoma using Multi⁃Modal MRI

作　　者：张隐笛 张伟[1] 王曼 周小玲 ZHANG Yindi;ZHANG Wei;WANG Man;ZHOU Xiaoling(Department of Radiology,Hunan Brain Hospital(Hunan No.2 Hospital))

机构地区：[1]湖南省脑科医院(湖南省第二人民医院)

出　　处：《中国医学计算机成像杂志》2024年第1期11-16,共6页Chinese Computed Medical Imaging

基　　金：湖南省卫生健康委科研计划项目(D202309017859)。

摘　　要：目的:探讨免疫功能正常的原发中枢神经系统淋巴瘤(PCNSL)患者不典型MRI表现及其相关病理学基础,以利于PCNSL的正确诊断。方法:回顾性分析2017年8月至2022年8月在我院经组织病理学诊断的PCNSL患者资料。所有患者在治疗前均接受MRI检查,实验室检查显示均无免疫功能缺陷,排除复发性中枢神经系统淋巴瘤及继发性淋巴瘤。由2名医师分别对MRI图像进行判读。结果:31例中枢神经系统淋巴瘤中19例符合入选标准,其中男性11例,女性8例,年龄为(63±9)岁。所有病例均经组织学病理诊断为B细胞淋巴瘤,15例为弥漫性大B细胞淋巴瘤。病灶单发7例,病灶2个4例,病灶3个及以上8例。不典型发病部位包括侧脑室、脑干、小脑半球。不典型影像表现包括:病灶信号不均匀,合并出血及坏死;增强无强化,多发片状、线状强化;呈高灌注;无明显弥散受限。结论:PCNSL表现不典型时容易误诊,多发病灶中更容易出现不典型表现,采用多模态MRI尤其是结合病变表观弥散系数值及磁共振波谱有利于疾病诊断。Purpose:To explore the atypical MRI manifestations and related pathological basis of primary central nervous system lymphoma(PCNSL)in immunocompetent patients,aiming to facilitate the accurate diagnosis of PCNSL.Methods:A retrospective analysis was conducted on patients with histopathologically confirmed PCNSL in our hospital from August 2017 to August 2022.All patients underwent MRI examination before treatment,and laboratory tests showed no immunodeficiency.Recurrent central nervous system lymphoma and secondary lymphoma were excluded.Two physicians independently interpreted the MRI images.Results:Among 31 cases of central nervous system lymphoma,19 met the inclusion criteria,including 11 males and 8 females,with an average age of(63±9)years.All cases were histopathologically diagnosed as B-cell lymphoma,with 15 cases being diffuse large B-cell lymphoma.Single lesion was found in 7 cases,two lesions in 4 cases,and three or more lesions in 8 cases.Atypical sites included lateral ventricles,brainstem,and cerebellar hemisphere.Atypical imaging features included heterogeneous lesion signals,accompanied by hemorrhage and necrosis;no enhancement after contrast administration,multiple patchy or linear enhancements;high perfusion;no obvious diffusion restriction.Conclusions:When presenting with unusual signs,PCNSL is often misinterpreted,and abnormal features are more frequently seen in numerous lesions.For the diagnosis of disease,multimodal MRI is useful,especially when combined with magnetic resonance spectroscopy and apparent diffusion coefficient measurements.

关 键 词：原发中枢神经系统淋巴瘤 磁共振成像 

分 类 号：R733.4[医药卫生—肿瘤] R814.43[医药卫生—临床医学]