【摘要】 目的 探讨原发性中枢神经系统淋巴瘤(PCNSL)的CT及MRI表现特征,以提高术前对该病的影像诊断能力。方法 分析2008年1月—2009年8月华西医院16例经病理证实PCNSL患者的CT、MRI资料及病理资料。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。16例PCNSL 29个病灶,单发11例(69%)，多发5例(31%)18个病灶。病灶好发部位依次是大脑半球临近蛛网膜下腔12个(41.4%)、脑室周围深部白质7个(24.1%)、胼胝体3个(10.3%)。有5例病变CT平扫表现为等或略高于脑实质密度影,无出血和钙化；MRI平扫75.9%(19/25)的病灶T1WI呈等低信号,T2WI等稍低信号,类似“脑膜瘤”样信号,均未见血管流空；增强后病灶大都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 CT对PCNSL的定性诊断作用有限,MRI具有一定特征性表现者,多可作出正确的诊断,但确诊有赖于病理。
ObjectiveTo investigate the value of MRI in the diagnosis of central nervous system lymphoma (CNSL). MethodsWe retrospectively analyzed the clinical data of 20 cases of primary CNSL (PCNSL) and 13 cases of secondary CNSL (SCNSL) from the Second People's Hospital of Chengdu and Chengdu 363 Hospital from January to December 2013, and analyzed their clinical data and MRI image data. We observed the tumor location, tumor size and signal, and carried out the statistical analysis. ResultsTwenty patients had PCNSL in the brain, including single lesion in 9 (45.0%), and multiple in 11 (55.0%). Among the 48 lesions, there were 23 (47.9%) nodular lesions, 21 (43.8%) crumb lesions, and 4 (8.3%) dot patch lesions; MRI showed slightly low T1 signal and slightly high T2 signal in most lesions, and showed significant even enhancing, and mild to moderate edema around the tumor. SCNSL lesions were mainly meningeal disseminated with 3 cases (23.1%) of single lesions and 10 cases (76.9%) of multiple ones, and there were a total of 30 lesions. MRI manifested that T1 and T2 mainly showed equal signals, and showed an obviously even enhancing status, and mild to moderate edema around the tumor. ConclusionThe central nervous system lymphoma has a certain characteristic MRI image, and MRI images of the primary and secondary central nervous system lymphoma were similar.