原发性中枢神经系统淋巴瘤MRI表现

目的 探讨原发性中枢神经系统淋巴瘤的MRI征象.方法 回顾性分析我院2004-01-2005-09经神经外科手术或活检后病理证实的原发性中枢神经系统淋巴瘤44例的MRI表现,包括病灶数目、大小、分布、形态及增强前后MRI信号的表现.44例原发性中枢神经系统淋巴瘤中,男29例,女15例.年龄12～76岁,平均53岁.结果 病变部位包括脑部41例,脊髓3例.病灶可单发或多发,MRI平扫T1WI大多呈略低信号,T2WI等信号或高信号;增强后病灶大都均匀实质团块状或结节状强化,少数呈环形强化.结论 原发性中枢神经系统淋巴瘤MRI表现有一定特征性.单发或多发病灶明显实质结节状强化,尤其靠近脑脊液腔时,应考虑淋巴瘤可能.     

原发性中枢神经系统淋巴瘤的MRI表现

目的:描述原发性中枢神经系统淋巴瘤的MRI表现,探讨MRI对该病的诊断价值。材料和方法:回顾性分析10例经手术病理证实的原发性中枢神经系统淋巴瘤的MRI表现。结果:10例均为弥漫大B细胞型非霍奇金淋巴瘤。5例为单发,5例为多发,共16个病灶,其中大脑半球8个,基底节4个,右侧背侧丘脑及基底节1个,脑室内3个。10例病变均表现为局灶性肿块,6例边界较清楚,4例边界不甚清楚。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例呈明显脑回样强化,1例中等度强化,1例(放疗后)无强化。2例有侧脑室室管膜线样明显强化。9例存在占位效应。3例瘤周重度水肿,5例瘤周中度水肿,2例瘤周轻度水肿。结论:原发性中枢神经系统淋巴瘤是一种较为罕见的原发性中枢神经系统恶性肿瘤,MRI是诊断该病的重要的无创性检查方法。当男性中老年患者发现颅内,特别是幕上深部脑白质及胼胝体、基底节区实性占位性病变,呈稍长或等T1、稍长或等T2信号,瘤周水肿及占位效应较轻,增强扫描呈明显均匀强化时,应考虑原发性中枢神经系统淋巴瘤的诊断。     

颅内原发性中枢神经系统淋巴瘤的MRI研究

目的研究颅内原发性中枢神经系统淋巴瘤（PCNSL）的MRI表现特点。资料与方法回顾性分析23例颅内PCNSL的MRI表现。抽取恶性胶质瘤30例、颅内转移瘤30例,共60例归为非PCNSL组作为对照。观察肿瘤部位、分布、信号、形态,并进行统计学分析。结果颅内PCNSL好发于深部脑组织,如胼胝体、丘脑及基底节区,多发病灶多呈区域性分布;肿瘤T2WI多呈等或稍高信号,甚至低信号,扩散加权像（DWI）呈均匀高信号;增强扫描多呈均匀明显强化,肿瘤周围可见“尖突征”。与非PCNSL组之间差异有统计学意义（P〈0．01）。结论颅内PCNSL影像表现多样,但具有一定特征。     

原发性中枢神经系统淋巴瘤MRI表现分析

目的探讨原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)的MRI表现,提高诊断水平。方法回顾性分析我院经病理证实的14例PCNSL患者的MRI资料。14例患者均进行MRI平扫及增强扫描,其中3例患者行MRS。由两名资深MRI诊断医师对MRI图像进行分析,包括病灶的部位、数目、信号特点、强化方式、瘤周水肿、囊变坏死、出血及MRS等。结果1)病灶数目14例患者中单发12例,多发2例,单发病例中有2例病变跨越两个脑叶,1例病变位于左侧小脑半球-小脑蚓部;2)病灶分布右额叶5个,左额叶5个,左顶叶2个,胼胝体2个,左侧大脑脚1个,左侧基底节2个,左右颞叶各1个,左侧小脑半球2个;3)信号特点等T110个,稍长/长T19个;等T28个,稍长/长T211个;DWI稍高信号8个,高信号11个;4)强化特点不均匀强化3例,明显均匀强化11例,软脑膜强化3例,2例多发病例中所有病灶均明显均匀强化;5)瘤周水肿重度水肿2个,中度水肿3个,轻度水肿14个;6)出血及囊变出血2个,囊变2个。结论增强、弥散加权成像联合瘤周水肿对PCNSL的诊断有重要价值,MRS对鉴别诊断有一定的作用。     

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.     

原发性颅内淋巴瘤的MRI表现

目的 :探讨原发性颅内淋巴瘤的MRI特征,以提高该病的诊断与鉴别诊断水平。方法 :回顾性分析15例经手术或立体定向病理活检证实的原发性颅内淋巴瘤MRI表现。结果:15例,共31个病灶,单发6例,多发9例(病灶1~4个),直径平均17.1 mm。幕上27个(大脑半球13个,丘脑8个,基底节6个),幕下4个,位于小脑半球。29个病灶T1WI、T_2WI及FLAIR呈等或等低均匀信号,DWI呈略高信号;增强扫描25个病灶呈团块状强化,6个呈环状或轻微强化。病灶周围均有脑水肿,其中重度23个,中度5个,轻度或无水肿3个。24个病灶邻近蛛网膜下腔,未见脑膜转移。幕下病例未见脑积水征象。所有病灶均未见坏死及囊变。结论:原发性颅内淋巴瘤具有特征性MRI表现:多位于幕上脑实质深部,多灶生长,邻近蛛网膜下腔、很少沿脑膜播散,多数病灶呈团块状强化,坏死囊变罕见,占位效应较轻,大部分病灶呈明显弥散受限。     

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。     

艾滋病相关原发性中枢神经系统淋巴瘤的MRI表现分析

【摘要】目的：探讨获得性免疫缺陷综合征（AIDS）相关原发性中枢神经系统淋巴瘤 （PCNSL）的MRI表现。方法：回顾性分析11例经病理证实的AIDS相关PCNSL患者的临床及MRI资料。结果：11例AIDS相关PCNSL均为弥漫性大B细胞淋巴瘤,男10例,女1例,中位年龄49岁,CD4+T淋巴细胞计数中位数为39个/μL。共14个病灶,以幕上单发为主,主要分布于中线附近,其中单发病灶9例（81.8%）,多发病灶2例（18.2%）,位于幕上8例（72.7%）,幕下3例（27.3%）。T1WI为等低信号,T2WI信号高低不均,实性区以等低信号为主;T2 FLAIR大部分病灶周围见水肿,增强扫描病灶环形强化9个（64.3%）,团状强化3个（21.4%）,结节状强化2个（14.3%）,12个（85.7%）病灶出现不同程度坏死;DWI实性区高信号9个（64.3%）,等信号3个（21.4%）,低信号2个（14.3%）。结论：AIDS相关PCNSL的MRI表现具有一定特异性,仔细分析MRI各序列信号特征,结合临床表现、CD4+T淋巴细胞计数<50个/μL,有助于PCNSL的诊断。     

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

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。     

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淋巴瘤与胶质瘤的DWI对比研究

目的:探讨DWI在原发性中枢神经系统淋巴瘤(PCNSL)与胶质瘤鉴别诊断中的价值.方法:回顾性分析24例经病理证实的PCNSL的MRI表现,另选取70例胶质瘤作对照(WHOⅠ～Ⅱ级31例为A组,Ⅲ～Ⅳ级39例为B组),观察及测量肿瘤的T1WI、T2WI、DWI信号、ADC值及强化方式等,并进行统计学分析.结果:PCNSL在T1 WI上多呈低信号(23/24),T2WI上多呈高信号(23/24),DWI上多呈明显高信号(11/15),平均AIC值为(0.57±0.14)×10 -3mm2/s,低于对侧正常脑白质;A组及B组胶质瘤在T1WI上多呈低信号(51/70),T2 WI上多呈高信号(61/70),DWI上多为低信号(29/70),平均ADC值分别为(1.63±0.48)×10-3和(1.37±0.54)×10-3mm2/s,高于对侧正常脑白质,PCNSL组与胶质瘤组在DWI信号、ADC值上差异均具统计学意义(P均＜0.05).增强后PCNSL多呈明显均匀强化(21/24),呈“裂隙样”(16/21)或“团块样”(5/21).A组胶质瘤强化多不明显,B组胶质瘤多呈不均匀明显强化,呈“花环样”.结论:DWI和ADC值对PCNSL与胶质瘤的鉴别诊断有一定价值,结合T1WI、T2 WI及增强扫描等可提高诊断符合率.     

Primary central nervous system immunocytoma: MRI and spectroscopy

We report on a young woman with a primary cerebral immunocytoma. Most primary cerebral nervous system lymphomas (PCNSL) are highly malignant undifferentiated B-cell tumours, there are few data on the clinical course, MRI and spectroscopy findings of this rare PCNSL subtype. MRI revealed a radially enhancing tumour with mild perifocal oedema. MR spectroscopy indicated low cell turnover. Slow clinical progression, no significant changes with treatment, and imaging findings were consistent with a low-grade malignant tumour. Received: 21 January 2000/Accepted: 15 February 2000     

White-matter abnormalities in unirradiated patients cured of primary central nervous system lymphoma

On MRI, primary brain tumors are commonly seen as contrast-enhancing masses surrounded by areas of abnormal signal on T2-weighted images. Following successful treatment tumors may no longer show contrast enhancement. The residual abnormalities are assumed to be represent “edema” and infiltrating tumor cells. We report nine patients with primary lymphoma of the central nervous system who had complete responses to intravenous methotrexate, but did not receive intrathecal chemotherapy or cranial irradiation. After complete resolution of contrast-enhancing lesions, persistent abnormalities on T2-weighted images in the region of prior tumor were initially assumed to reflect residual viable tumor. As they remained unchanged for years, however, this may not hold true in the cases in which primary central nervous system lymphoma responds to chemotherapy alone. Received: 14 August 1998 Accepted: 11 August 1999     

成人白血病中枢神经系统并发症的CT与MRI表现

目的 探讨成人白血病中枢神经系统并发症(CNSCL)的CT和MRI表现及其诊断价值.方法 回顾性分析18例经临床及手术病理证实的成人CNSCL的CT和MRI表现,其中急性淋巴细胞白血病7例,急性非淋巴细胞白血病10例,慢性粒单细胞白血病1例.CT平扫11例,其中增强1例;MR平扫16例,其中增强11例.结果 颅内受累14例:(1)颅内出血7例,其中脑内血肿4例,脑内血肿合并微出血1例,微出血2例.脑内血肿均为多发病灶.CT表现为团状高密度影;MRI表现为T1WI低信号或高低混杂信号,T2WI高信号或等高信号伴环状低信号环,病灶呈环形强化或无明显强化.脑微出血在磁敏感加权成像(SWI)上表现为多发斑点状及小条状低信号,其病灶检出率明显优于CT及MRI其他常规序列检查;7例中,伴脑梗死及蛛网膜下腔出血各1例.(2)颅内肿块5例:其中左额部内板下梭形病灶或跨颅板肿块2例,T1WI呈低信号,T2WI呈高低混杂信号,并有明显均匀强化,均见脑膜尾征;鞍区肿块1例,CT示鞍区高密度影,MRI示鞍区T1WI稍低信号,T2WI高信号,有不均匀强化;右侧脑室体旁肿块1例,T1WI、T2WI均呈等信号,有明显均匀强化.左额顶叶壁厚囊性肿块1例,呈环形强化.(3)梗阻性脑积水1例,表现为中脑导水管以上脑室系统扩张.(4)脑膜病变1例,MRI表现为广泛脑膜增厚伴明显均匀强化.椎管内病变4例:其中胸腰椎左侧椎旁软组织肿块2例,侵犯椎管内,伴邻近肋骨骨质破坏1例;椎管内肿块1例,表现为胸椎管后方梭形T1WI等高信号,T2WI等低信号灶,无明显强化;胸髓信号异常1例,表现为胸髓条状T2WI及液体衰减反转恢复(FLAIR)序列高信号影.结论 成人CNSCL影像表现多种多样,CT与MRI对该病的诊断价值相辅相成;白血病患者疑脑内病变者,建议常规使用SWI检查,以尽早发现脑微出血,降低脑内血肿发生的风险.

Abstract：

Objective To evaluate the CT and MRI findings and their diagnostic value of central nervous system complications of leukemia (CNSCL). Methods The CT and MRI findings of 18 adult patients with CNSCL proved by clinical features or pathology were retrospectively analyzed. Among 18 cases,7 were acute lymphocytic leukemia, 10 acute non-lymphocytic leukemia and 1 chronic myelomonocytic leukemia. Eleven cases underwent plain CT scan with one of them also receiving contrast-enhanced CT scan enhancement, 16 cases underwent plain MR scan with 11 of them receiving contrast-enhanced MR scan.Results Intracranial lesions in 14 cases: (1)intracranial hemorrhage was found in 7 cases, including intracerebral hematoma in 4 cases, micro-haemorrhage in 2 cases, and intracerebral hematoma accompanying by multiple intracerebral micro-haemorrhage foci in 1 case. All cases with intracerebral hematoma showed multiple lesions, which demonstrated high-density on CT images, and low or mixed signal on T1 WI, high- or intermediate signal with low-signal rim on T2 WI and ring enhancement or no evident enhancement. Microhaemorrhage manifested as multiple mini-mottling and strip hypointense foci on susceptibility weighted imaging, on which the detection rate of micro-haemorrhage foci was much higher than that on CT and other sequences of MRI. Among the 7 cases, one also had cerebral infarction and one subarachnoid hemorrhage.(2) Intracranial mass was found in 5 cases, among which two appeared as masses under or bestride cranium in the left frontal region with hypointensity on T1 WI, mixed signal on T2WI, strong homogeneous enhancement and dural tail sign;one showed a mass in saddle area, with high density on CT, slightly low signal on T1WI, high signal on T2WI and heterogeneous enhancement; one case displayed a mass near lateral ventricle with iso-intensity on T1 WI and T2WI and strong homogeneous enhancement; and one case manifested as cystic mass in the left fronto-apical lobe, with thick wall and ring enhancement (3)Obstructive hydrocephalus was found in 1 case, manifesting dilation of ventricles above the aquaeductus mesencephali. (4) Meningopathy was found in 1 case, manifesting diffuse thickening of meninges with strong homogeneous enhancement on MRI. Pathological changes of spinal canal was found in 4 cases among which two showed para-spinal mass involving vertebral canal and causing bone destruction of adjacent ribs; one case showed fusiform mass posterior to vertebral canal with high and intermediate signal on T1 WI and low and iso-signal on T2WI without enhancement; one showed zonale leison in thoracic cord with high signal on T2WI and fluid attenuated inversion recovery. Conclusion The radiologic manifestations of adult CNSCL are various and the role of CT and MRI for the diagnosis of CNSCL may complement each other. SWI is suggested as routine examination for patients of leukemia, in whom intracerebral lesions were suspected in order to find micro-haemorrhage as early as possible and reduce the risk of intracerebral hematoma occurrence.     

中枢神经系统肠源性囊肿的MRI表现

目的:探讨中枢神经系统肠源性囊肿的MRI表现.方法:搜集经手术及病理最终确诊的23例肠源性囊肿患者并分析其MRI表现,所有患者均经MRI平扫,其中10例行MRI增强扫描,4例行DWI扫描.结果:23例肠源性囊肿患者中,3例发生在颅内,其中2例发生在左侧中颅窝,1例发生在桥前池,其余20例发生在椎管并且全部位于髓外硬膜下,其中颈段10例,胸段8例,腰段2例.MRI平扫大部分病灶T1WI呈等低信号,T2 WI呈高信号,部分病灶信号混杂;9例增强扫描囊液及囊壁均未见明确强化,1例见边缘强化;部分病例可见特征性“脊髓嵌入征”表现;DWI均未见明显扩散受限;2例伴脊椎发育异常.结论:肠源性囊肿的形态及MRI信号特点具有一定特征,结合临床症状、伴发体征有助于早期诊断.     

中枢神经系统血管周细胞瘤的MRI诊断

目的：探讨MRI诊断中枢神经系统血管周细胞瘤（HPC）的价值,提高对本病的认识。方法：分析7例经手术病理证实为HPC的MRI表现。所有患者均行MRI平扫及增强扫描。结果：6例位于颅内,1例位于颈段椎管内。T1WI示肿瘤呈等信号或稍高信号,T2WI呈等信号或稍高信号,增强扫描肿瘤实体部分强化明显。在颅内病例中,4例病灶内有斑片状囊变或坏死区;4例显示有血管流空或强化血管影;5例有瘤周水肿;2例病灶部分跨过天幕。结论：中枢神经系统HPC的MRI表现有一定的特征,有一定的提示诊断,但需与脑膜瘤鉴别,要注意分析其恶性征象,以提高术前诊断的正确率。