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。

The exploration of MRI presentation of primary central nervous system lymphoma

Objective Explore MR presentation of primary central nervous system lymphoma,decrease the rate of diagnostic error.Methods MRI manifestations of 14 patients with pathologically confirmed PCNSL in the affiliated hospital of jining medical college(from Apr 2009 to Agu 2018)were analyzed retrospectively.Both conventional and contrast-enhanced MR images were acquired for each patient,MRS in 3 of them.The MRI manifestations including location,number,signal intensity,enhancement patterns,edema of peritumor,necrosis,hemorrhage were evaluated by two senior radiologists.Results 1)number of lesions of 14 cases,12 were solitary and 2 were multiple,in solitary cases 2 lesions involved 2 lobes,1 lesion involved left cerebellum and vermis;2)distribution of lesions right frontal lobe(5),left frontal lobe(5),left parietal lobe(2),corpus callosum(2),left cerebral peduncle(1),left basal ganglia(2),left temporal lobe(1),right temporal lobe(1),left cerebellum(2);3)signal intensity isointensity in T1WI in 10 lesions,hypointensity in T1WI in 9 lesions;isointensity in T2WI in 8 lesions,hyperintensity in T2WI in 11 lesions;slight hyperintensity in DWI in 8 lesions,hyperintensity in DWI in 11 lesion;4)enhancement strong homogenous enhancement in 3 cases;strong heterogenous enhancement in 11 cases,strong homogenous enhancement in all lesions of 2 multiple cases,Meningeal enhancement in 3 cases;5)edema of peritumor marked edema in 2,moderate in 3,mild in 14;6)hemorrhage and necrosis hemorrhage in 2,necrosis in 2.Conclusion Enhancement and DWI combine with edema of peritumor are crucial for the diagnosis of PCNSL,and MRS is helpful for differential diagnosis.