颅内原发性淋巴瘤MRI诊断价值分析
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摘要
目的分析颅内原发淋巴瘤的MRI征像特点,旨在提高对该病的诊断正确率,降低误诊率。方法回顾性分析苏州大学附属第一医院在2013年～2017年期间收治并经手术病理确诊的32例颅内原发性淋巴瘤患者的MRI资料,并对颅内原发性淋巴瘤患者的病变发生部位、大小、信号等MRI表现进行综合分析。结果本组共检出病灶60个,病灶单发20例,多发12例,以单发为主。病灶分布具有幕上为主,幕下相对少见的特征,其中额顶叶18例,颞叶11例,枕叶2例,小脑半球1例,基底节区4例,丘脑1例,胼胝体5例。多发病灶具有"卫星样"分布的特征。肿瘤周围水肿形态可呈斑片状,指套状。MRI平扫瘤体T_1WI呈等或稍低信号,T_2WI及FLAIR呈等或稍高信号。DWI多表现为高或稍高信号,增强扫描明显强化,多呈握拳样、团块状或开环样强化,"脐凹征""尖角征"及"蝶翼征"也是颅内淋巴瘤较为特异性的影像学表现。颅内原发淋巴瘤的MRS表现为胆碱(Cho)峰升高,N-乙酰天门冬氨酸(NAA)峰降低,脂质(Lip)峰高耸。结论颅内原发淋巴瘤具有特定的MRI征像,对这些征像的综合细致观察分析,有助于提高诊断正确率。
Objective To analyze the MRI features of primary intracranial lymphoma, so as to enhance diagnostic accuracy and to lower misdiagnosis rate. Methods We retrospectively analyzed MRI data of 32 patients with primary intracranial lymphoma proved by operation and pathology in the hospital from January, 2013 to July, 2017. And comprehensive analysis of location, lesion size and signal were made. Results 60 lesions were detected in 32 cases, there are 20 cases with solitary lesion, 12 cases with multiple lesions, and the focal distribution was mainly single. The distribution of the lesions was mainly supratentorial, and the lesions under tentorium were relatively rare. Site of lesion was fronto-parietal lobe(18 cases), temporal lobe(11 cases), occipital lobe(2 cases), cerebellum(1 case), basal ganglia(4 cases), thalamus(1 case) and corpus callosum(5 cases). Multiple lesions had the characteristics of "satellite like" distribution. And the edema around the tumor was found to be patchy or finger shaped. Among all the cases, T_1WI showed isointense or slightly hypointense signal, T_2WI and FLAIR showed isointense or slightly hypointense signal, and DWI showed hyperintense signa1. After contrast scanning, all the cases were markedly enhanced and the main enhanced shape was characterized by typical fist sign, lump sign or open-loop sign. Additionally, "umbilicus sign" "spike sign" and "butterfly sign" were also the specific imaging manifestations of primary intracranial lymphoma. MR spectroscopy demonstrated the increased Cho, decreased NAA, and high Lip. Conclusion Primary intracranial lymphoma has characteristic MRI findings, comprehensive and careful analysis of MRI features contribute to the improvement of diagnostic accuracy.
Objective To analyze the MRI features of primary intracranial lymphoma, so as to enhance diagnostic accuracy and to lower misdiagnosis rate. Methods We retrospectively analyzed MRI data of 32 patients with primary intracranial lymphoma proved by operation and pathology in the hospital from January, 2013 to July, 2017. And comprehensive analysis of location, lesion size and signal were made. Results 60 lesions were detected in 32 cases, there are 20 cases with solitary lesion, 12 cases with multiple lesions, and the focal distribution was mainly single. The distribution of the lesions was mainly supratentorial, and the lesions under tentorium were relatively rare. Site of lesion was fronto-parietal lobe(18 cases), temporal lobe(11 cases), occipital lobe(2 cases), cerebellum(1 case), basal ganglia(4 cases), thalamus(1 case) and corpus callosum(5 cases). Multiple lesions had the characteristics of "satellite like" distribution. And the edema around the tumor was found to be patchy or finger shaped. Among all the cases, T_1WI showed isointense or slightly hypointense signal, T_2WI and FLAIR showed isointense or slightly hypointense signal, and DWI showed hyperintense signa1. After contrast scanning, all the cases were markedly enhanced and the main enhanced shape was characterized by typical fist sign, lump sign or open-loop sign. Additionally, "umbilicus sign" "spike sign" and "butterfly sign" were also the specific imaging manifestations of primary intracranial lymphoma. MR spectroscopy demonstrated the increased Cho, decreased NAA, and high Lip. Conclusion Primary intracranial lymphoma has characteristic MRI findings, comprehensive and careful analysis of MRI features contribute to the improvement of diagnostic accuracy.
引文
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[9] Barajas RF Jr, Rubenstein JL, Chang JS, et al. Difusion-weighted MR imaging derived apparent diffusion coefficient is predictive of clinical outcome in primary central nervous system lymphoma [J].AJNR, 2010, 31(1): 60-66.
[10] Wieduwih MJ, Valles F, Issa S, et al. Immunochemotherapy with intensive consolidation for primary CNS lymphoma):a pilot study and prognostic assessment by diffusion-weighted MRI [J]. Clin Cancer Res, 2012, 18(4): 1146-1155.
[11] Geng CJ, ChenJK, Lu GM, et al. Comparative study among CT, MR imaging and pathological findings in primary central nervous system lymphoma [J]. Chin J Radiol, 2003, 37(3): 246-250.
[12] 李玮,杜滂,秦越,等.颅内原发淋巴瘤MRI表现(附8例分析)[J].医学影像学杂志,2010,20(9):1373-1376.
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[15] Bizzi A, Movsas B, Tedeschi G, et al. Response of non-Hodgkin lymphoma to radiation therapy: early and long-term assessment with 1H-MR spectroscopic imaging [J]. Radiology, 1995, 194(1): 271-276.
[2] Jenkins CNT, Cologhon IR. Characterization of primary intracranial lymphoma by CT: an analysis of the literature with particular reference of calcification hemorrhage and cyst formation [J]. Clin Radiol, 1998, 53(6): 428-434.
[3] 张建,李晶.磁共振成像在原发性中枢神经系统淋巴瘤诊断中的应用价值[J].新疆医学,2016,46(10):1287-1290.
[4] 廖伟华,王小宜,黄军,等.颅内原发性B细胞淋巴瘤MRI表现[J].中国医学影像技术,2008 , 23(4):499-503.
[5] Yap KK, Sutherland T, Liew E, et al. Magnetic resonance features of primary cen- tral nervous system lymphoma in the immunocompetent patient): a pictorial essay [J]. J Med Imaging Radiat Oncol, 2012, 56(2): 179-186.
[6] 孙照莲,曹芬,孙其中.原发性中枢神经系统淋巴瘤的影像学表现[J].医学影像学杂志,2014,24(10):1684-1687.
[7] Bhagavathi S, Wilson JD. Primary central nervous system lymphoma [J]. Arch Pathol Lab Med, 2008, 132 (11): 1830-1834.
[8] 景治涛,刘佳,班允超,等.原发性中枢神经系统淋巴瘤35例临床分析[J].中华神经外科疾病研究杂志,2015,14(1):48-52.
[9] Barajas RF Jr, Rubenstein JL, Chang JS, et al. Difusion-weighted MR imaging derived apparent diffusion coefficient is predictive of clinical outcome in primary central nervous system lymphoma [J].AJNR, 2010, 31(1): 60-66.
[10] Wieduwih MJ, Valles F, Issa S, et al. Immunochemotherapy with intensive consolidation for primary CNS lymphoma):a pilot study and prognostic assessment by diffusion-weighted MRI [J]. Clin Cancer Res, 2012, 18(4): 1146-1155.
[11] Geng CJ, ChenJK, Lu GM, et al. Comparative study among CT, MR imaging and pathological findings in primary central nervous system lymphoma [J]. Chin J Radiol, 2003, 37(3): 246-250.
[12] 李玮,杜滂,秦越,等.颅内原发淋巴瘤MRI表现(附8例分析)[J].医学影像学杂志,2010,20(9):1373-1376.
[13] 李松年,唐光健. 现代全身CT诊断学[M].第2版.北京:北京中国医药科技出版,2007.190.
[14] 赖旭峰,韩志江,史佩芝,等.颅内单发原发性恶性淋巴瘤的MRI、CT诊断和鉴别诊断[J].肿瘤学杂志,2013,19(4):309-311.
[15] Bizzi A, Movsas B, Tedeschi G, et al. Response of non-Hodgkin lymphoma to radiation therapy: early and long-term assessment with 1H-MR spectroscopic imaging [J]. Radiology, 1995, 194(1): 271-276.