常规MRI征象及3D多平面重建增强在原发性中枢神经系统淋巴瘤诊断中的价值分析
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摘要
目的分析常规磁共振成像(MRI)征象及3D多平面重建增强在原发性中枢神经系统淋巴瘤(PCNSL)诊断中的价值。方法 2014年4月-2018年4月期间本院经病理证实的57例PCNSL患者术前均接受常规MRI检查,并行常规增强扫描,其中35例进行3D多平面重建增强成像。观察病变的一般MRI征象、T_1WI、T_2WI上的信号强度、强化形态及强化特征等。结果 57例PCNSL患者共检出79个病灶,多位于幕上脑实质,其次为幕下,多为类圆形、结节状或斑片状浸润病灶,最大径2-7.5cm。MR平扫病灶信号多均匀,T_1WI呈等信号或稍低信号,T_2WI呈稍高信号或等信号,DWI上呈高信号,且ADC值为(0.75±0.15)×10~(-3)mm~2/s,与对侧半球正常脑白质的ADC值(0.91±0.19)×10~(-3)mm~2/s对比,差异有统计学意义(P<0.05)。常规增强扫描显示病灶多呈团块状、结节状、片状、环形明显强化或轻中度强化,少数病灶内可见明显的坏死、囊变区。接受3D增强后重建的患者在清晰显示PCNSL病灶或病灶周围的"马蹄征"、"软脑膜强化征"、"室管膜强化征"、"病灶内血管包绕征"、"病灶旁血管包绕征"及"蝴蝶征"方面效果明显优于常规增强扫描(P<0.05)。结论 PCNSL的常规MRI征象如病灶位置、大小、信号强度等具有一定特征,3D多平面重建增强后可丰富强化信息,继而可作为PCNSL的诊断依据,提高诊断率。
Objective To analyze the value of conventional magnetic resonance imaging(MRI) and 3D multi-planar reconstruction and enhancement in the diagnosis of primary central nervous system lymphoma(PCNSL). Methods Fifty-seven patients with PCNSL confirmed by pathology during the period from April 2014 to April 2018 were examined by conventional MRI before surgery, and MRI conventional enhanced scan was also performed. Among them, 35 cases underwent 3 D multi-planar reconstruction and enhanced imaging. The general MRI findings, the signal intensity, enhancement morphology and enhancement sign on T_1WI and T_2WI were observed. Results A total of 79 lesions were detected in 57 patients with PCNSL, mostly in the supratentorial brain parenchyma, followed by the subcolumn. Most of them were round, nodular or patchy infiltrative lesions with a maximum diameter of 2 to 7.5 cm. MR plain scan showed that most lesions were homogeneous, with equal or slightly lower signal on T_1WI, slightly higher or equal signal on T_2WI, high signal on DWI and an ADC value of(0.75±0.15)×10~(-3) mm~2/s. Compared with the ADC value of normal white matter in the contra lateral hemisphere(0.91±0.19)×10~(-3) mm~2/s, there was significantly different(P<0.05). The conventional enhanced scan found that most lesions showed clumpy,nodular, flaky and ring-like enhancement or mild to moderate enhancement, and a few lesions showed necrosis and cystic lesion. The effect of 3D enhanced reconstruction after enhancement is significantly better than that of conventional enhanced scan in displaying the "Horseshoe sign", "Soft meningeal enhancement sign", "Ependymal enhancement sign", "Vessel encapsulation sign in the lesion", "Vessel encapsulation sign beside the lesion" and "Butterfly sign" of the lesion(P<0.05). Conclusion The conventional MRI findings of PCNSL, such as lesion location, size and signal intensity are characteristic. The 3D multiplanar reconstruction and enhancement can enrich the enhancement information which can be used as a diagnostic basis for PCNSL to improve the diagnostic rate.
Objective To analyze the value of conventional magnetic resonance imaging(MRI) and 3D multi-planar reconstruction and enhancement in the diagnosis of primary central nervous system lymphoma(PCNSL). Methods Fifty-seven patients with PCNSL confirmed by pathology during the period from April 2014 to April 2018 were examined by conventional MRI before surgery, and MRI conventional enhanced scan was also performed. Among them, 35 cases underwent 3 D multi-planar reconstruction and enhanced imaging. The general MRI findings, the signal intensity, enhancement morphology and enhancement sign on T_1WI and T_2WI were observed. Results A total of 79 lesions were detected in 57 patients with PCNSL, mostly in the supratentorial brain parenchyma, followed by the subcolumn. Most of them were round, nodular or patchy infiltrative lesions with a maximum diameter of 2 to 7.5 cm. MR plain scan showed that most lesions were homogeneous, with equal or slightly lower signal on T_1WI, slightly higher or equal signal on T_2WI, high signal on DWI and an ADC value of(0.75±0.15)×10~(-3) mm~2/s. Compared with the ADC value of normal white matter in the contra lateral hemisphere(0.91±0.19)×10~(-3) mm~2/s, there was significantly different(P<0.05). The conventional enhanced scan found that most lesions showed clumpy,nodular, flaky and ring-like enhancement or mild to moderate enhancement, and a few lesions showed necrosis and cystic lesion. The effect of 3D enhanced reconstruction after enhancement is significantly better than that of conventional enhanced scan in displaying the "Horseshoe sign", "Soft meningeal enhancement sign", "Ependymal enhancement sign", "Vessel encapsulation sign in the lesion", "Vessel encapsulation sign beside the lesion" and "Butterfly sign" of the lesion(P<0.05). Conclusion The conventional MRI findings of PCNSL, such as lesion location, size and signal intensity are characteristic. The 3D multiplanar reconstruction and enhancement can enrich the enhancement information which can be used as a diagnostic basis for PCNSL to improve the diagnostic rate.
引文
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[13]方向,黄周,孟倩,等.原发性中枢神经系统淋巴瘤MRI表现[J].中国介入影像与治疗学,2016,13(1):37-41.
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[15]Doskaliyev A,Yamasaki F,Ohtaki M,et al.Lymphomas and glioblastomas:differences in the apparent diffusion coefficient evaluated with high b-value diffusion-weighted magnetic resonance imaging at 3T[J].European Journal of Radiology,2012,81(2):339-344.
[16]Yamashita K,Yoshiura T,Hiwatashi A,et al.Arterial spin labeling of hemangioblastoma:differentiation from metastatic brain tumors based on quantitative blood flow measurement[J].Neuroradiology,2012,54(8):809-813.
[17]文剑波,李郁欣,黄薇园,等.原发性中枢神经系统淋巴瘤的MR征象分析及3D增强多平面重建的价值研究[J].中国CT和MRI杂志,2014,12(9):104-108.
[2]Weller M.The vanishing role of whole brain radiotherapy for primary central nervous system lymphoma[J].Neuro Oncol,2014,16(8):1035-1036.
[3]宋丹丹,刘建国,戚晓昆.原发性中枢神经系统淋巴瘤的临床诊治现状[J].中华神经科杂志,2017,50(8):636-640.
[4]曹勇,曹斌.基于1.5T MRI动态增强扫描和灌注成像技术对比性分析原发性中枢神经系统淋巴瘤和胶质母细胞瘤的影像表现[J].中国CT和MRI杂志,2017,15(9):15-17.
[5]Patrick L B,Mohile N A.Advances in Primary Central Nervous System Lymphoma[J].Current Oncology Reports,2015,17(12):60-65.
[6]陈其钻,王守森,刘峥,等.原发性中枢神经系统淋巴瘤的影像学研究[J].中华神经外科杂志,2017,33(2):173-177.
[7]王莹,张波,骆继业,等.原发性中枢神经系统淋巴瘤常规及功能磁共振成像特点[J].中国介入影像与治疗学,2017,14(10):618-622.
[8]刘运培,潘先文.原发性中枢神经系统淋巴瘤的诊断、治疗及预后分析[J].国际神经病学神经外科学杂志,2016,43(6):595-597.
[9]王亮亮,王敏,王德杭.多模态MRI对原发性中枢神经系统淋巴瘤的诊断价值[J].医学影像学杂志,2016,26(8):1379-1383.
[10]王秀玲,汪轩,张宗军,等.颅内原发性中枢神经系统淋巴瘤的磁共振诊断[J].医学影像学杂志,2017,27(2):199-203.
[11]Gadda D,Mazzoni L N,Pasquini L,et al.Relationship between Apparent Diffusion Coefficients and MR Spectroscopy Findings in High-Grade Gliomas[J].Journal of Neuroimaging,2016,27(1):128-134.
[12]耿磊,孙毅,孙志先,等.MRI鉴别诊断原发性中枢神经系统淋巴瘤与高级别胶质瘤深部病灶[J].中国介入影像与治疗学,2018,15(2):95-99.
[13]方向,黄周,孟倩,等.原发性中枢神经系统淋巴瘤MRI表现[J].中国介入影像与治疗学,2016,13(1):37-41.
[14]李昊,高培毅.脑室内原发性中枢神经系统淋巴瘤的MR诊断及文献回顾[J].影像诊断与介入放射学,2017,26(3):210-214.
[15]Doskaliyev A,Yamasaki F,Ohtaki M,et al.Lymphomas and glioblastomas:differences in the apparent diffusion coefficient evaluated with high b-value diffusion-weighted magnetic resonance imaging at 3T[J].European Journal of Radiology,2012,81(2):339-344.
[16]Yamashita K,Yoshiura T,Hiwatashi A,et al.Arterial spin labeling of hemangioblastoma:differentiation from metastatic brain tumors based on quantitative blood flow measurement[J].Neuroradiology,2012,54(8):809-813.
[17]文剑波,李郁欣,黄薇园,等.原发性中枢神经系统淋巴瘤的MR征象分析及3D增强多平面重建的价值研究[J].中国CT和MRI杂志,2014,12(9):104-108.