原发性中枢神经系统淋巴瘤的影像学研究进展

原发性中枢神经系统淋巴瘤（PCNSL）是一种罕见且侵袭性极强的结外非霍奇金淋巴瘤,其占所有结外淋巴瘤的4%~6%,原发性中枢神经系统肿瘤的4%。近年来,PCNSL发病率呈逐年上升趋势,其确诊主要依靠组织病理学检查,包括立体定向活体组织病理学检查和（或）手术期间的组织病理学检查,然而这2种方法均风险较高且并发症较多。因此,寻找能准确评估PCNSL的无创性影像学方法就显得尤为重要。目前,临床常用于评价PCNSL的影像学检查方法主要有CT、 MRI、 PET/CT和PET/MRI。笔者主要对近年来PCNSL的影像学研究进展进行综述。     

原发性中枢神经系统淋巴瘤的影像学表现

目的:探讨原发性中枢神经系统淋巴瘤的影像学表现,以提高该病的诊断水平。方法:回顾性分析20例经手术及病理证实的原发性中枢神经系统淋巴瘤患者的影像学资料,分析肿瘤的影像学表现。结果:20例患者共28个病灶。单发病灶14例,多发病灶6例。病灶多位于脑深部白质、基底核、胼胝体及丘脑等近中线部位,以及额叶、顶叶等脑实质表面。CT检查5例,共10个病灶,9个表现为等或稍高密度影,1个为稍低密度影;增强扫描9个病灶明显强化,1个病灶轻度强化。MRI检查15例,共18个病灶,其中平扫11个T1WI呈稍低信号、T2WI呈稍高信号,3个T1WI、T2WI均呈等信号,4个T1WI、T2WI呈混杂信号;增强扫描14个病灶明显强化,3个呈不均匀强化,1个呈环形强化。4例累及脑膜,引起脑膜增厚,见"脑膜尾征"。2例室管膜呈线样强化。28个病灶中可见"缺口征"2个、"尖角征"3个、"握拳征"2个。5例行MRI动态增强扫描,时间-信号强度曲线示4例为缓升型,1例为平台型。2例行MRS检查,见明显的脂质峰。结论:原发性中枢神经系统淋巴瘤的CT、MRI表现具有一定特征性,结合MRI动态增强扫描和MRS检查,能提高诊断准确率,确诊仍依赖病理。     

原发性中枢神经系统淋巴瘤的影像学表现

目的：探讨原发性中枢神经系统淋巴瘤的影像学表现,以提高影像诊断水平。方法回顾性分析25例经病理证实的原发性中枢神经系统淋巴瘤的CT、MRI等影像学资料。结果单发16例,多发9例,共有39个病灶,幕上35个病灶,幕下4个病灶。单发病灶多位于脑白质深部,多发病灶常位于脑实质中线部位及大脑凸面。肿瘤在CT表现呈稍高密度,病灶T1WI多呈等或稍低信号,T2WI多呈等或稍高信号,DWI多呈高信号。增强扫描多呈明显均匀强化,少数呈斑片状强化;瘤周可见不同程度的水肿。结论原发性中枢神经系统淋巴瘤的CT、MRI表现具有一定特征性,结合临床并综合其影像学表现,可提高其诊断准确率。     

原发性中枢神经系统血管炎的影像学诊断

目的:探讨原发性中枢神经系统血管炎的临床和影像学表现,以期明确诊断要点.材料和方法:病理或临床证实的中枢神经系统血管炎25例,其中男性14例,女性11例.年龄从5～66不等,平均年龄30.8岁.全部行MRI检查,其中增强16例;11例行CT检查,其中增强6例;3例行CTA检查,9例行MRA检查,其中2例同时行DSA检查.分析所有病例的临床资料和CT、MR、DSA片.结果:25例PACNS中,6例经手术或活检证实,9例经CTA、MRA或(和)DSA证实,10例经临床随访证实.23例位于幕上,以额叶多见,其中7例为双侧多发;幕下2例位于小脑半球,左颞静脉畸形.影像学上,多数病灶边界模糊,与相应血管分布区一致,累及灰质和白质,但以白质为主,可有水肿,增强后有不同程度增强,呈斑片样或脑回样,甚至呈结节样,类似肿瘤.血管成像可以发现血管炎的征象.结论:原发性中枢神经系统血管炎的临床和影像学表现多样,CT和M RI具有一定价值,MRA和DSA对诊断帮助较大,确诊需要活检病理证实.     

原发性中枢神经系统淋巴瘤的影像诊断

原发性中枢神经系统淋巴瘤（primary central nervous system lymphorna,PCNSL）是一种局限于巾枢神经系统内的结节型淋巴瘤。发生于中枢神经系统的淋巴瘤中93％为原发性。淋巴瘤可分为霍奇金淋巴瘤和非霍奇金淋巴瘤两型,以原发性结节为主要表现者占5％。在原发性淋巴瘤中,98％为B细胞淋巴瘤,其余少见的为T细胞淋巴瘤、Burkitt淋巴瘤和间变性大细胞淋巴瘤。     

原发性中枢神经系统淋巴瘤的MRI诊断

目的 研究原发性中枢神经系统淋巴瘤(PCNSL)的MRI表现特点,提高对该病的诊断与鉴别诊断率.方法 回顾分析了12例经病理证实的原发性中枢神经系统淋巴瘤的MRI表现.结果 病灶T1WI多呈略低或等信号,T2WI呈等或略高信号;增强扫描多呈明显均匀强化,极少数呈环形强化,肿瘤坏死囊变少见,未见出血、钙化;瘤周水肿相对较轻,占位效应轻.结论 原发性中枢神经系统淋巴瘤MRI表现具有一定特征性,可做出较准确的诊断.     

原发性中枢神经系统非何杰金淋巴瘤影像学特征

本文报告了１５例原发性中枢神经系统非何杰金淋巴瘤并讨论该病的神经病理，影像学特征及其临床疗效，１５例患者中６例为多发病灶。肿瘤的ＣＴ表现多呈边界清晰，明显强化的分叶状病灶，并沿脑室广泛浸润。在本组经病理确诊的原发生中枢神经系统非何杰金淋巴瘤中，８例经免疫组化染色为Ｂ细胞型，肿瘤的ＰＣＮＡ－ＰＣ１０染色显示淋巴瘤的增殖速率大于２４．８％，但临床上对放疗和化疗高度敏感，１５例患者中经首次放疗和化疗后有     

多发原发性中枢神经系统淋巴瘤MRI诊断

目的 探讨多发原发性中枢神经系统淋巴瘤(MPCNSLs)的MRI特征及鉴别诊断要点.方法 回顾性分析7例经病理证实的MPCNSLs的MRI表现,其中男4例,女3例,平均年龄44岁.结果 7例共21个病灶(每例发现2～5个病灶),病灶平均大小为(2.99±1.25) cm;T1WI上几乎均呈低信号(20个病灶);T2WI上表现为高信号或混杂等高信号;液体衰减反转恢复序列上表现为高、等信号;增强扫描仅有1例(1个病灶)无强化,其余均可见不同程度及不同方式强化.结论 MPCNSLs常规MRI平扫与增强影像表现有一定的特征性,结合脑内多发特点可以做出较准确的诊断,为临床治疗提供帮助.     

骨原发性淋巴瘤的影像学诊断

目的 分析骨原发性淋巴瘤的影像学特征,探讨本病的影像学诊断价值.方法 回顾性分析19例经临床病理证实骨原发性淋巴瘤的影像学资料,包括X线16例、CT 15例及MRI 17例.结果 单骨受累16例,多骨受累3例.X线及CT表现为溶骨样改变14例,混合性溶骨-硬化改变4例,3例轻度骨膜反应,CT检查15例均见不同程度软组织影.MRI检查,病变在T1WI上呈等信号13例,低信号4例;T2WI上呈等信号2例,稍高信号10例,高信号5例;信号均匀或大致均匀11例,信号不均匀6例.结论 骨原发性淋巴瘤具有一定的影像学特征,但确诊依靠病理.     

MRI对原发性中枢神经系统淋巴瘤的诊断

目的 探讨原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)的MRI特点,提高对PCNSL的认识和诊断水平.方法 回顾性分析21例经手术病理或穿刺活检证实的PCNSL的MR表现,并结合文献研究MRI特征.结果 单发7例,多发7例,弥漫性生长7例,共33个肿瘤,其中额叶12个,脑室旁8个,颞叶、顶叶、透明隔、小脑蚓部各2个,枕叶、基底节区、丘脑、脑干、小脑各1个; 4例肿瘤累及胼胝体.肿瘤实质MR T1WI呈等或稍低信号,T2WI呈等或稍高信号,信号较均匀;18例肿瘤实质强化明显,信号均匀,可呈现"尖角征"和"脐凹征"及具有特征性的"蝴蝶征",3例出现环形强化.结论 PCNSL MR检查具有特征性表现,MRI检查对PCNSL具有独特的诊断价值.     

Imaging of primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) comprises 5% of all primary brain tumours. PCNSL demonstrates a variety of well-documented imaging findings, which can vary depending on immune status and histological type. Imaging features of PCNSL may overlap with other tumours and infection making definitive diagnosis challenging. In addition, several rare variants of PCNSL have been described, each with their own imaging characteristics. Advanced imaging techniques including 2-[(18)F]-fluoro-2-deoxy-d-glucose ((18)FDG) and (11)C?positron-emission tomography (PET), (201)Tl single-photon emission computed tomography (SPECT), (1)H-magnetic resonance spectroscopy (MRS), and MR perfusion, have been used to aid differentiation of PCNSL from other tumours. Ultimately, no imaging method can definitively diagnose PCNSL, and histology is required.     

Nonenhancing primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) is rare, although its frequency has increased in recent years. Radiographically, almost all PCNSL enhance on CT and/or MRI, and nonenhancing PCNSL has been thought to be extremely rare. We present PCNSL showing multiple nonenhancing lesions on MRI in an immunocompetent patient.     

Nonenhancing primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) is rare, although its frequency has increased in recent years. Radiographically, almost all PCNSL enhance on CT and/or MRI, and nonenhancing PCNSL has been thought to be extremely rare. We present PCNSL showing multiple nonenhancing lesions on MRI in an immunocompetent patient.     

123I-IMP SPET in the diagnosis of primary central nervous system lymphoma

We reviewed N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) single-photon emission tomography (SPET) images of brain tumours and assessed the usefulness of 123I-IMP SPET for the diagnosis of primary central nervous system (CNS) lymphoma. We analysed 52 tumours that showed enhancement on magnetic resonance imaging: 11 malignant lymphomas, 3 anaplastic astrocytomas, 17 glioblastomas, 12 meningiomas, 4 metastatic brain tumours and 5 other brain tumours. 123I-IMP uptake in the tumours on early (15-min) and delayed (4-h) scans was visually classified as high, moderate or low as compared with the contralateral brain cortex. Early and delayed 123I-IMP uptake ratios comparing tumours with contralateral brain cortex (T/N ratio) were also calculated. In malignant lymphomas, the visual uptake of 123I-IMP was moderate to high on the delayed scans. The delayed T/N ratios were significantly higher than the early ratios (P<0.05) and all lymphomas, with the exception of one small one, had delayed ratios greater than 0.9. In non-lymphomatous tumours, the visual uptake of 123I-IMP was low on the delayed scans. The delayed T/N ratios were significantly lower than the early ratios (P<0.01) and all non-lymphomatous tumours had delayed ratios of less than 0.8. The T/N ratios of lymphomas were significantly higher than those of non-lymphomatous tumours on both early and delayed scans (P<0.0001). These results suggest that 123I-IMP SPET may be a useful tool in the differential diagnosis of primary CNS lymphoma.     

123I-IMP SPET in the diagnosis of primary central nervous system lymphoma

We reviewed N-isopropyl-p-[¹²³I]iodoamphetamine (¹²³I-IMP) single-photon emission tomography (SPET) images of brain tumours and assessed the usefulness of ¹²³I-IMP SPET for the diagnosis of primary central nervous system (CNS) lymphoma. We analysed 52 tumours that showed enhancement on magnetic resonance imaging: 11 malignant lymphomas, 3 anaplastic astrocytomas, 17 glioblastomas, 12 meningiomas, 4 metastatic brain tumours and 5 other brain tumours. ¹²³I-IMP uptake in the tumours on early (15-min) and delayed (4-h) scans was visually classified as high, moderate or low as compared with the contralateral brain cortex. Early and delayed ¹²³I-IMP uptake ratios comparing tumours with contralateral brain cortex (T/N ratio) were also calculated. In malignant lymphomas, the visual uptake of ¹²³I-IMP was moderate to high on the delayed scans. The delayed T/N ratios were significantly higher than the early ratios (P<0.05) and all lymphomas, with the exception of one small one, had delayed ratios greater than 0.9. In non-lymphomatous tumours, the visual uptake of ¹²³I-IMP was low on the delayed scans. The delayed T/N ratios were significantly lower than the early ratios (P<0.01) and all non-lymphomatous tumours had delayed ratios of less than 0.8. The T/N ratios of lymphomas were significantly higher than those of non-lymphomatous tumours on both early and delayed scans (P<0.0001). These results suggest that ¹²³I-IMP SPET may be a useful tool in the differential diagnosis of primary CNS lymphoma.     

原发性中枢神经系统淋巴瘤的磁共振成像表现

目的探讨原发性中枢神经系统淋巴瘤（PCNSL）的磁共振成像（MRI）特征及鉴别诊断。方法回顾性分析15例经手术病理证实的PCNSL的MRI表现。结果病理检查均为B细胞来源的弥漫性大B细胞性淋巴瘤。15例PCNSL19个病灶,单发13例（87％）,多发2例（13％）共6个病灶。病灶常位于脑表浅部位和近中线部位,T1wI呈等或稍低信号,T2WI及液体衰减反转恢复序列（FLAIR）呈等或稍高信号,弥散加权成像（DWI）呈高信号。所有病灶均明显强化,增强后病灶大多呈均匀实质团块状或结节状强化,典型的可出现“尖角征”、“握拳征”,3例可见小囊变,呈“硬环征”。结论PCNSL的MRI表现具有一定的特征性,术前MRI检查有助于诊断及鉴别诊断,结合患者影像学及临床资料,术前可作出明确诊断。     

原发中枢神经系统淋巴瘤的颅脑MRI表现

目的:全面分析原发性中枢神经系统淋巴瘤颅脑MRI表现,进一步探讨MRI对该病的诊断价值,以期提高影像学对该病的诊断率。方法:回顾性分析经立体定向活检或开颅手术病理证实的150例原发性中枢神经系统淋巴瘤颅脑MRI表现,男性77例、女性73例,男∶女=1.05∶1,平均年龄53.2（28～87）岁,并复习相关临床及文献资料。结果:150例原发性中枢神经系统淋巴瘤患者中,单发病灶56例（37.3％）,多发病灶94例（62.7％）;幕上皮质下及深部脑白质为好发部位,小脑、脑膜、室管膜也可受累。平扫大部分病灶呈稍长T1、稍长T2信号,增强扫描148例病灶可见强化。增强病灶位于脑实质的93例、可见脑室播散病灶的42例、可见硬脑膜强化的5例、累及柔脑膜的7例、累及神经的1例。结论:原发性中枢神经系统淋巴瘤大多为弥漫性大B细胞淋巴瘤,多发于中老年人,多发病灶多见,MRI表现各有特点,增强扫描表现具有一定特点及规律性。全面了解并掌握MRI表现特点对原发性中枢神经系统淋巴瘤的诊断、鉴别诊断有重要价值,对临床诊治具有重要的指导作用,最终确诊仍需依赖于病理诊断。     

颅内原发性中枢神经系统淋巴瘤的MRI表现

目的研究颅内原发性中枢神经系统淋巴瘤（PCNSL）的MR／表现特点。方法回顾性分析8例经手术病理证实的原发性中枢神经系统淋巴瘤的MR／表现。结果8例均为弥漫大B细胞型非霍奇金淋巴瘤。3例为单发,5例为多发,共13个病灶,其中大脑半球8个,基底节区4个,右侧背侧丘脑及基底节区1个。8例病变均表现为局灶性肿块,T1WI呈稍低或等信号;T2WI呈等或稍高信号。增强扫描7例呈明显均匀强化,1例轻度强化。6例瘤周重度水肿,2例瘤周中度水肿。结论原发性中枢神经系统淋巴瘤较为罕见,MRI是诊断该病的重要的无创性检查方法。颅内PCNSL影像学表现多样,但具有一定特征。