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1、原发性中枢神经系统淋巴瘤的MRI表现【摘要】目的探讨原发性中枢神经系统淋巴瘤(PrimaryCentralNervousSystemLymphoma,PCNSL)的MRI表现特征。方法回顾性分析26例术前行MRI检查并经病理证实的原发性中枢神经系统淋巴瘤资料,主要研究PCNSL的发生部位、信号特征、强化方式、瘤周水肿、室管膜播散以及胼胝体累及情况。结果26例中7例为单发,19例为多发;其中基底节、脑室旁、胼胝体区16例,半球周边白质区7例,同时伴室管膜下结节13例;仅发生于脑室内者3例。累及胼胝体时,均可见典型“蝶翼征”。常规平扫实性部分表现为T1WI低信
2、号,T2WI等稍高信号。增强实性部分表现为明显均匀强化24例,2例表现为边缘环形中度强化。脑室内病灶或室管膜下播散结节,均未见坏死区,增强呈明显均匀强化。瘤周水肿因部位而异,基底节、脑室旁、胼胝体区病灶水肿多轻度到中度,以轻度为主;半球周边病灶水肿多较明显,呈中度到重度。结论绝大多数PCNSL表现较具特征性,MRI检查有助于提高正确诊断率。【关键词】淋巴瘤原发性中枢神经系统磁共振成像[Abstract]ObjectiveToevaluatetheMRIfeaturesofPrimaryCentralNervousSystemLymphoma(PCNSL).
3、MethodsMRIfindingsof26caseswithpathologically-provedPCNSLwereanalyzedretrospectivelyandthestudyemphasizedonthe9location,signalfeature,contrast-enhancedtype,perilesionaledema,ependymalseeding,andinfiltrationofcorpuscallosum.ResultsOnthe26cases(7ofthemweresolitary,theothersmultiple)
4、,16ofthemwerelocatedinthecorpuscallosum,basalgangliaandperiventriculeregion,7casesencephalicsurfaceandwhite-graymatterjunctionregion,3casesintraventricule,.13casesofthemassociatedwithependymalseedinglesions.Typical“butterflysign”wasfoundinthecorpuscallosumcases.Plainscandisplayedh
5、ypointensityonT1WIandiso-tohyperintensityonT2WI.Aftertheinfusionofparamagneticcontrastmaterial,24ofthemdemonstratedhomogeneousenhancementinthesolidportion,whiletherewasringenhancementin2cases.Intraventricularandependymalseedinglesionsallshowedashomogeneousmassesandintensivehomogen
6、eousenhancement.Perilesionaledemadifferentedwiththelocations.Therewasmildtomoderateedemainthecorpuscallosum,basalgangliaandperiventriculeregionlesions,whilemoderatetohighintheencephalicsurfaceandwhite-graymatterjunctionregionlesions.ConclusionMostPCNSLhavetypicalMRIcharacteristics
7、,whichishelpfulforthecorrectdiagnosisofPCNSLpreoperatively.9[Keywords]lymphoma;primary;centralnervoussystem;magneticresonanceimage原发性中枢神经系统淋巴瘤(PrimaryCentralNervousSystemLymphoma,PCNSL)是指原发于中枢神经系统内的淋巴瘤,既往报道发病率较低。近年来资料显示,PCNSL发病率呈持续上升趋势[1]。临床上,PCNSL病程较短,而全脑放疗和化疗的时机与疗效及预后密切相关,因此,早期诊
8、断是很重要的。笔者回顾性分析26例经病理证实的PCNSLMRI资料