颅内淋巴瘤影像诊断课件

颅内淋巴瘤影像诊断课件

ID:19882750

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时间:2018-10-07

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1、CASEDISCUSSIONWANGLIJUN2008-7-14Case1:Female,66yCase1:PLAINMRICase1:POST-CONTRASTMRICase2:F66YCase2:POST-CONTRASTMRICASE3:M58Y,NHLwasdiagnosed2.5yearsago,nowfeelheadache(2008-1-25)-C+C2008-1-302008-5-15LYMPHOMAPrimarycentralnervoussystemlymphoma(PCNSL)isarareformoflymp

2、haticcancerarisinginthebrain,eye,nerves,spinalfluidsurroundingthebrainandspinalcord,andthecoveringofthebrain,calledduraSecondary:metastasestothenervoussysteminlymphomaaffectingotherorgansPCNSL:EpidemiologyOncerare(~1%),nowbecomingincreasinglymorecommonIncidencehasrisen

3、dramaticallyinpastfewdecades,asPCNSLnowaccountsfor4-7%(16%)ofallnewlydiagnosedprimarybraintumorsIncidencehasrisenintheimmunocompromisedandalsoimmunocompetentpopulationPCNSL:EpidemiologyImmunocompromisedCongenitalcausesofimmunodeficiency1.Wiskott-Aldrichsyndrome2.IgAdef

4、iciency3.X-linkedlymphoproliferativesyndromeacquiredcauses1.HIVinfectionandAIDS2.immunosuppressiveregimenafterorgantransplantationPCNSL:EpidemiologyMedianageofonset55yearsinimmunocompetent,incidenceriseswithageGreatestrisehasoccurredamongtheelderlyMaleismorecommonlysee

5、ncomparetofemale(2:1)DiagnosisHistoryFocalneurologicdeficit(i.e.hemiparesis,aphasia)presentin>50%ofallpatientswithPCNSLAlteredmentalstatus(memoryloss,confusion,etc.)foundin~33%-maybeinsidiousonsetHeadache,nausea(fromincreasedICP)in~33%Maypresentwithnew-onsetseizurein<1

6、0%BlurredvisionifocularlymphomaispresentRadiologicimagingHeadCTdetectsmostlesions(~90%)BrainMRImaydetectlesionsmissedonCTDiagnosisPrimaryCNSlymphomamayarisefromdifferentpartsofthebraindeephemisphericperiventricularwhitematterbeingthemostcommoncorpuscallosum,cerebellum,

7、orbits,andcranialnervesmayalsoharborthetumorHistology:intermediate-tohigh-gradeextranodalnon-Hodgkin'slymphomaofB-celloriginRadiologicImagingTypicalAppearanceinImmunocompetentPatientsUsuallysolitary,non-hemorrhagiclesionindeepwhitematter,nearventriclesLesionisisodenset

8、ohyperdense(70%)surroundingvasogenicedemahomogeneouslyenhancingmassSurroundingedemaistypicallylessprofoundthaninmetas

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