基于增强MRI纹理分析鉴别诊断眼眶淋巴瘤和炎性假瘤

目的探讨增强MRI序列纹理分析在鉴别眼眶淋巴瘤和炎性假瘤中的诊断价值。 方法回顾性分析2013年1月至2019年4月于苏北人民医院经病理证实的眼眶淋巴瘤25例和炎性假瘤24例，术前进行MRI常规序列和脂肪抑制T1WI增强扫描，选取每例患者增强图像上肿瘤的最大层面区域，应用Mazda软件勾画肿瘤感兴趣区并计算灰度直方图纹理参数。提取出9个特征参数分别为：均值(mean)、方差(variance)、偏度(skewness)、峰度(kurtosis)和第1、10、50、90、99百分位数(Pere.1%、Pere.10%、Pere.50%、Pere.90%、Pere.99%)，分别比较淋巴瘤和炎性假瘤各个纹理参数之间的差异，其中符合正态分布的参数采用双样本t检验，不符合正态分布的参数采用秩和检验，并采用受试者工作特征曲线(receiver operaling characteristic curve，ROC)分析曲线下面积(area under curve，AUC)、敏感度、特异度。运用多变量Logistic回归分析对有统计学意义的纹理参数进行建模并绘制ROC曲线评价模型效能。 结果2种肿瘤在均值、方差、第50、90、99个百分位数参数中差异有统计学意义(P<0.05)。在偏度、峰度和第1百分位数参数中差异无统计学意义(P>0.05)。2组间纹理参数方差在阈值为113.20时具有最佳诊断效能，对应的敏感度、特异度、AUC分别是95.83%、76.00%、0.930(54.87%～90.64%)。 结论增强MRI序列纹理分析可以用于眼眶淋巴瘤和炎性假瘤的鉴别诊断，且参数方差具有最佳诊断效能。     

磁共振成像在急性脑梗死和脑转移瘤中的鉴别诊断价值

目的研究急性脑梗死(ACI)和脑转移瘤(BM)的磁共振特征,分析磁共振成像(MRI)在两者影像学诊断中的鉴别价值。方法收集76例以中枢神经系统症状发病的ACI患者和BM患者,其中ACI 46例,BM患者30例。行头磁共振平扫及增强检查,分别对病灶的部位、病灶数目、灶周血管源性水肿程度、弥散加权成像(DWI)表现、强化方式程度、病灶演变情况进行对比和观察分析。结果 BM组较ACI组的多发病灶病例数明显增多。两组新发病灶在分布部位上比较,分布没有明显差异。ACI组患者ACI病灶周围基本无水肿出现,而BM组瘤周水肿程度及病例数明显高于ACI。ACI组除有4例早期大面积脑梗死病灶有轻微强化外,其余病例均无强化;而BM组患者多数病例都有不同程度的环状或实质性强化。ACI组病例有2例符合ACI诊断标准,但DWI未显示,其余病例均在DWI上明确显示为高信号影,明显多于BM组。总之,两组在病灶数目、病灶周围血管源性水肿程度、DWI表现、强化程度及病灶演变过程方面均有显著差异,在病灶分布部位上两者不存在差异性。结论以中枢神经系统症状发病的ACI和BM在磁共振表现上存在诸多差异,通过观察分析,其特征表现助于两者的鉴别诊断。     

多b值弥散加权磁共振成像在老年原发性中枢神经系统淋巴瘤患者预后评估中的应用价值

目的 探讨多b值弥散加权磁共振成像(multi-b-value diffusion-weighted magnetic resonance imaging,eDWI-MRI)参数及临床特征在老年原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)患者预后...     

原发性中枢神经系统淋巴瘤在免疫功能正常或低下患者的MRI成像特征

目的 探讨原发性中枢神经系统淋巴瘤(PCNSL)在不同免疫功能患者中的MRI影像表现,提高对本病的认识并为临床诊断提供参考。方法 回顾性分析2012年3月至2021年4月就诊于武汉大学中南医院经病理证实的30例PCNSL患者MRI影像资料。其中男性16例,女性14例,平均年龄(60.1±11.6)岁,包括5例AIDS患者,初次诊断时误诊率达33.3%。分析PCNSL患者的影像学表现。结果 共收集30例PCNSL患者,病理分型均为弥漫大B细胞淋巴瘤,其中单发20例(66.6%),多发10例(33.3%);病灶位于幕上26例(86.7%),幕下4例(13.3%)。病灶形态：类圆形13例(43.3%),不规则状11例(36.7%),分叶状6例(20.0%)。29例病灶周围明显水肿;T₁WI稍低信号25例(83.3%);T₂WI稍高信号23例(76.7%);增强扫描均匀强化14例(46.7%),不均匀强化10例(33.3%),环形强化6例(20.0%);20例(66.6%)可见特殊征象。结论 免疫功能正常PCNSL患者的病灶多呈类圆形,T_1...     

原发颅内淋巴瘤的磁共振成像诊断价值

目的分析原发性颅内淋巴瘤的磁共振成像(MRI)信号及部位表现,提高对此病的认识。方法对23例经手术病理证实的颅内原发性淋巴瘤患者的MRI影像表现进行分析。结果病灶单发或多发,肿瘤常位于脑表面或中线附近。MRIT1呈稍低或等信号,T2呈等或稍高信号。肿瘤占位效应轻,增强多呈"团块状"强化。结论原发性颅内淋巴瘤的MRI表现有一定的特点,但无典型的MRI表现,发病部位相对较深,肿瘤大小与占位效应不成比例,增强时病灶实质均匀性强化,最后确诊依赖于病理的免疫组化检查。     

基于多模态MRI原发性中枢神经系统淋巴瘤老年患者的诊断、疗效监测和预后评估

<正>原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma, PCNSL)在2021年版世界卫生组织(world health organization, WHO)造血和淋巴组织肿瘤分类标准中定义为：病变局限于中枢神经系统(central nervous system, CNS),包括脑实质、软脑(脊)膜、脊髓和眼部,无全身其他部位累及的淋巴瘤^[1-4]。     

21例免疫功能正常的原发性中枢神经系统淋巴瘤MRI分析

目的 探讨免疫功能正常的原发性中枢神经系统淋巴瘤(PCNSL)的MRI表现特点.方法 回顾性分析21例免疫功能正常的PCNSL患者临床资料.结果 免疫功能正常的PCNSL以单发病灶为主,T1W I均呈低信号,T2W I多呈等或稍高信号;存在程度不等的占位效应;MRI增强扫描,病灶均明显强化.结论 免疫功能正常的PCNSL的MRI表现有一定的特点,MRI在PCNSL的诊断中有一定价值.     

原发性中枢神经系统淋巴瘤的CT影像特征分析

目的:分析原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma, PCNSL)的CT影像学特征,为基层医院对PCNSL的初步诊断及鉴别诊断提供参考。方法:收集郑州大学第一附属医院经病理证实的70例初诊PCNSL患者的CT资料,分析其病灶密度特征、发生部位、占位效应、病灶形态、数目、大小、瘤周水肿程度等CT影像学特征。结果:70例PCNSL患者中女34例(48.6%),男36例(51.4%),发病年龄30～82岁,肿瘤的发病部位多在基底节区(34.3%)、额叶(31.4%)、颞叶(28.6%),其中病灶累及多部位的患者39例;CT表现边缘多清晰(94.3%),多呈稍高密度(84.3%),病灶多呈团块状(92.9%),大多数肿瘤病灶周围可见不同程度的水肿(95.7%)及不同程度的占位效应(61.4%),CT平扫图像可见特殊征象(如脐凹征、握拳征、蝶翼征、勒痕征、尖角征);病灶直径为(37.3±1.7) mm; CT值中位数为39.2(36.4,42.3) Hu; CT增强扫描则均表现为明显强化。结论:PCNSL患者CT影像学多表现为边缘清...     

多模态MRI对原发性颅脑淋巴瘤的诊断价值分析

目的 探讨多模态磁共振成像(MRI)对原发性颅脑淋巴瘤的诊断价值。方法 回顾性分析2018年9月—2020年9月收治的经病理证实的30例原发性颅脑淋巴瘤病人的3.0T常规磁共振成像技术(MRI)平扫、扩散加权成像(DWI)、动态磁敏感对比增强灌注成像(DSC-PWI)及氢质子磁共振波谱(1H-MRS)等多模态影像资料,分析各序列图像上病灶主要征象及参数值,评价多模态MRI对原发性颅脑淋巴瘤的诊断效能。结果 30例病人共检出45个病灶,其中单发22例,多发8例,主要分布于深部近中线脑白质处。MRI平扫病灶在T1加权像(T1WI)上呈低或稍低信号,在T2加权像(T2WI)上28个病灶呈稍高信号,10个呈等信号,7个呈混杂稍高信号。DWI上6例扩散受限呈高信号,23例扩散稍受限呈稍高信号,1例扩散不受限呈等信号,肿瘤实质表观扩散系数(ADC)值为(0.612±0.085)×10^-3 mm²/s,显著低于正常脑实质(0.706±0.041)×10^-3 mm²/s(P<0.001)。15例病人共26个病...     

颅内转移瘤及胶质母细胞瘤术后骨瓣复位的作用(附43例报告)

对67例颅内转移瘤及胶质母细胞瘤患者进行手术治疗。其中43例行肿瘤全切除 骨瓣复位术者，2例出现伤口少量积液；24例行肿瘤全切除 去骨瓣减压术者，9例有伤口积液或脑组织膨出。认为对颅内转移瘤及胶质母细胞瘤肿瘤施行全切除 术中骨瓣复位手术优于肿瘤切除 去骨瓣减压术。     

Central nervous system disease in primary Sjogrens syndrome: the role of magnetic resonance imaging

OBJECTIVES: To examine the frequency of central nervous system (CNS) disease in primary Sjogrens syndrome (pSS) and indicate ways in which cerebral magnetic resonance imaging (MRI) may help determine the significance of CNS involvement. METHODS: The current review was based on a Medline (Pubmed) literature search through May 2003, focused on Sjogrens syndrome, other vasculitides, multiple sclerosis (MS), specific MRI techniques, and MRI findings with regard to the above-mentioned diseases. Additional literature was identified in the reference sections of articles listed in Medline. RESULTS: Severe CNS manifestations reminiscent of MS have been described in pSS patients. Moreover, the prevalence of nonfocal neuropsychological abnormalities has been found to be elevated in some pSS patient populations. MRI studies suggest discrete cerebral tissue damage even in neurologically asymptomatic patients. However, small white matter lesions are nonspecific and may be related to age or cerebrovascular risk factors such as hypertension. A large controlled study, complementing established T2-weighted MRI with fluid-attenuated inversion recovery (FLAIR) to achieve high sensitivity in lesion detection, could indicate the disease specificity of white matter lesions in pSS. Newer MR techniques, such as spectroscopy and magnetization transfer imaging, applied, for example, in MS and systemic lupus erythematosus (SLE) to evaluate CNS tissue injury, could help determine the extent and mechanisms of macroscopic and microscopic CNS lesions in pSS. CONCLUSIONS: Future controlled studies will be necessary to more precisely estimate the prevalence of CNS lesions in pSS, specifically of discrete white matter abnormalities. Newer MRI techniques have the potential to provide information on the severity and pathophysiological mechanisms of CNS tissue damage.     

中枢神经系统表面铁沉积症的临床与磁共振成像特点

目的探讨中枢神经系统表面铁沉积症（SSCNS）的临床和磁振共振成像（MRI）特点。方法回顾性总结并结合文献分析2例SSCNS病例的临床及MRI资料。结果病例1出现进行性感应神经性耳聋、小脑性共济失调及脊髓病变,MRI见中脑、桥脑、小脑蚓部、小脑半球、双侧岛叶、颞叶及脊髓表面线状短T2低信号影;病例2出现痴呆合并进行性记忆力减退,MR检查见双侧额、顶叶线状T2低信号影。结论SSCNS是一种少见的综合征,磁共振T2WI（尤其是梯度回波序列）有利于显示病变,加深对其临床及影像学表现的认识有助于早期诊断、指导临床治疗并一定程度上改善预后。     

Low-grade primary central nervous system lymphoma in immunocompetent patients

Primary central nervous system lymphomas (PCNSL) are usually diffuse large B-cell non-Hodgkin's lymphomas (NHL). Here we characterize the clinical presentation, course and outcome of patients with low-grade PCNSL. Records of 332 patients screened for inclusion in three multicentre prospective trials were reviewed. Ten patients (3%) with a median age of 59 years and a median Karnofsky performance status of 70% were identified. Seven patients had B-cell and three had T-cell lymphoma. The median growth fraction was 4%. The radiological morphology was unusual for PCNSL in eight patients. Three patients underwent complete tumour resection, combined with chemotherapy in one patient and with chemotherapy plus local radiotherapy in another. Four patients received chemotherapy and three received chemotherapy plus whole-brain irradiation, resulting in four complete remissions, two no-change situations and one progressive disease. Patients had an overall survival (OAS) of 2-58+ months with a 2-year OAS of 67%. Low-grade PCNSL may differ from classical high-grade PCNSL in its clinical features and radiological morphology. The clinical course may be variable and frequently more indolent than in classical PCNSL.     

骨原发性淋巴瘤继发中枢神经系统浸润1例病例报告及文献复习

目的:探讨骨原发性淋巴瘤(primary bone lymphoma,PBL)继发中枢神经系统(CNS)浸润的主要临床特点、诊断及治疗。方法:分析我科收治的1例弥漫大B细胞性PBL继发CNS浸润患者的临床表现及相关检查结果,治疗方法,并复习相关文献。结果:本例患者为老年男性,主要临床表现为骨痛,经PET/CT、骨髓象、骨组织活检、免疫组化及流式细胞学等检查确诊为弥漫大B细胞性PBL。行R-CHOP化疗方案治疗,化疗后症状缓解,但出现CNS浸润。先后给予6次鞘内注射(Ara-C、MTX、DEX),并同时2次大剂量的甲氨蝶呤(HD-MTX)系统性化疗,10次腰骶部放疗后,症状缓解,但3个月后因肺部感染死亡。结论:本例患者以骨痛为首发表现,PET/CT结合MRI示多发骨损害,经骨髓象及活检、免疫组化染色,流式细胞学检查明确诊断,对PBL应重视CNS侵犯及预防。     

Isolated central nervous system involvement in adult T-cell lymphoma/leukaemia

Central nervous system (CNS) presentation of adult T-cell lymphoma/leukaemia is rare, and almost invariably associated with systemic disease. We report an unusual manifestation of adult T-cell lymphoma/leukaemia, with isolated CNS involvement and unusual imaging findings. We also describe objective response to antiviral therapy. To our knowledge, this is the first report of such presentation and response.     

Evolving role of magnetic resonance techniques in primary sclerosing cholangitis

Development of non-invasive methods to risk-stratify patients and predict clinical endpoints have been identified as one of the key research priorities in primary sclerosing cholangitis(PSC). In addition to serum and histological biomarkers, there has been much recent interest in developing imaging biomarkers that can predict disease course and clinical outcomes in PSC.Magnetic resonance imaging/magnetic resonance cholangiopancreatography(MRI/MRCP) continue to play a central role in the diagnosis and follow-up of PSC patients. Magnetic resonance(MR) techniques have undergone significant advancement over the last three decades both in MR data acquisition and interpretation. The progression from a qualitative to quantitative approach in MR acquisition techniques and data interpretation, offers the opportunity for the development of objective and reproducible imaging biomarkers that can potentially be incorporated as an additional endpoint in clinical trials. This review article will discuss how the role of MR techniques have evolved over the last three decades from emerging as an alternative diagnostic tool to endoscopic retrograde cholangiopancreatography, to being instrumental in the ongoing search for imaging biomarker of disease stage, progression and prognosis in PSC.     

Successful treatment of primary central nervous system lymphoma in an elderly patient

The successful treatment of an elderly patient with primary central nervous system lymphoma is described. A 74-year-old Japanese man with left hemiplegia and consciousness disturbance presented in December 2001. His performance status was Grade 4. Computed tomography of the brain revealed a tumor in the right paraventricle. A biopsy of the brain confirmed the diagnosis of non-Hodgkin lymphoma (diffuse large, B cell type). Radiographic examinations did not detect any other lesions outside the brain. Primary central nervous system lymphoma was diagnosed. Chemotherapy was initiated in January 2002 using intravenous administration of methotrexate (600 mg/m², 6-h infusion, day 1) combined with etoposide (25 mg/m², continuous infusion, day 2–5), doxorubicin (5 mg/m², continuous infusion, day 2–5), vincristine (0.2 mg/m², continuous infusion, day 2–5), cyclophosphamide (350 mg/m², 2-h infusion, day 6) and dexamethazone (6 mg/body, 1-h infusion, day 1–6), with intrathecal administration of methotrexate (15 mg/body, day 8) and prednisolone (10 mg/body, day 8). Four courses of chemotherapy were completed without severe toxicities, followed by whole-brain radiotherapy (25 Gy). Complete remission was achieved, and the patient became alert with normalized movement of the left extremities. Despite poor prognostic factors (old age, low performance status), the patient was successfully treated as such and was still in remission without neurotoxicity in May 2004. The combination of methotrexate-based chemotherapy and radiotherapy with appropriate dose modification may improve the outcome in elderly patients with this disease since supportive therapy; CHOP, a combination of cyclophosphamide, doxorubicin, vincristine and prednisolone; and solo radiotherapy are usually not effective.     

Vascular involvement of the central nervous system and systemic diseases: etiologies and MRI findings

The objective of this study was to review magnetic resonance imaging (MRI) findings in patients with vascular involvement of the central nervous system (CNS) associated with systemic diseases. We reviewed the MRI findings in clinically suspected cases of vascular involvement of the CNS associated with systemic diseases. Vascular CNS involvement was considered in the presence of characteristic clinical, MRI and/or MR angiography findings. In order to be included in the study, patients needed to have a complete clinical and laboratory investigation and a follow-up of a minimum of 6 months. Twenty-four patients (17 women and 7 men), with mean age of 29.5 years had diagnosis of CNS vasculitis and were included. The clinical presentation was variable, but the most common complaints were headache in 18, focal deficits in 9, disturbances of consciousness in 9, and seizures in 8 patients. Underlying causes for CNS vasculitis were identified in all patients and included systemic lupus erythematosus in eight, tuberculosis in three, bacterial meningitis in three, Takayasu arteritis in two, polyarteritis nodosa in two, syphilis in two, drug abuse in two, yellow fever in one and varicella in one patient. Nonspecific high intensity T2WI/FLAIR lesions in white matter were the most common finding, present in ten patients. Eight patients had infarctions in large cerebral arteries territory, associated or not with high intensity T2WI/FLAIR small foci. Vascular involvement of the CNS can be found in a great variety of systemic diseases, including rheumatologic, infectious and drug abuse. Clinical findings are unspecific and MRI/MRA may help to establish the correct diagnosis.     

广州管圆线虫病患者中枢神经系统MRI的影像学表现

目的分析广州管圆线虫病患者中枢神经系统磁共振（MRI）的影像学特征。方法回顾性分析云南省第一人民医院1997年5月至2011年7月收治的25例广州管圆线虫病患者的中枢神经系统的MRI影像学表现。结果 25例患者中磁共振未见异常者8例,脑膜炎7例,脑实质病变8例,脊髓脊膜炎1例,脑室扩张1例。病变呈弥漫性或散在分布,在T₁加权图像（T₁WI）上呈低或等信号,在T₂加权图像（T₂WI）和对应层面液体衰减反转恢复序列（FLAIR）图像上呈高信号,注射扎喷替酸葡甲胺（Gd-DTPA）后病变中央可见圆形或卵圆形强化病灶。脑脊膜受累者可见软脑膜或室管膜呈线条形或结节状强化。结论广州管圆线虫病患者中枢神经系统的MRI表现多样,脑脊髓内呈多发长条形或结节状强化和软脑膜强化是该病主要的MRI表现,但多数MRI表现缺乏特异性。