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目的探讨原发性中枢神经系统弥漫大B细胞淋巴瘤(PCNS-DLBCL)磁共振及功能成像特点,提高其诊断准确率。方法回顾性分析51例经手术或活检病理证实的PCNS-DLBCL MRI资料。51例患者中,行平扫+增强+DWI共42例,单行平扫1例,直接增强6例,行1H-MRS共11例,PWI 4例。结果 51例患者中,单纯发生于幕上45例(88%),单累及幕下3例(6%),幕上、幕下均累及3例(6%);30例单发(58.8%),21例多发(41.2%)。平扫共43例,病灶T1WI、T2WI均呈等或稍长信号;发生囊变5例(11.6%);出血2例(4.7%);周围重度水肿13例(30.2%),中度水肿21例(48.8%),轻度水肿7例(16.3%),无明显水肿2例(4.7%)。增强扫描48例,呈不规则强化14例(29.2%),团块、结节状强化26例(54.2%),环形强化15例(31.3%),强化病灶均可见深浅不一之凹陷征或缺口征(100%),出现角征23例(47.9%),开环样强化10例(20.8%),偏心性结节或肿块样强化8例(16.7%),厚环样强化3例(6.3%),并于其内见低信号裂隙征。DWI均可见不同程度高信号;1H-MRS均有Cho峰明显升高,NAA峰明显降低,Cho/NAA=2.11~28.37,均出现高耸脂质(Lip)峰;PWI示病灶强化区呈低灌注。结论充分认识磁共振及功能成像表现特征,可明显提高PCNS-DLBCL的诊断准确率。
Objective To explore the features of magnetic resonance imaging and functional imaging of primary central nervous system diffuse large B cell lymphoma (PCNS-DLBCL) and to improve its diagnostic accuracy. Methods Retrospective analysis of 51 cases of PCNS-DLBCL MRI confirmed by surgery or biopsy. Forty-one patients underwent plain scan and contrast-enhanced DWI. One patient underwent plain scan in one patient and six patients were directly evaluated. Eleven patients had 1H-MRS and 4 patients had PWI. Results Of the 51 patients, 45 cases (88%) were single on the screen, 3 cases (6%) were involved in the single screen and 3 cases (6%) were on the screen, and 30 cases were single (58.8%), 21 cases were multiple (41.2%). A total of 43 cases were examined by plain scanning. The T1WI and T2WI images showed equal or slightly longer signals. 5 cases (11.6%) had cystic change, 2 cases (4.7%) had hemorrhage, 13 cases (30.2%) had peripheral edema, Cases (48.8%), mild edema in 7 cases (16.3%), no obvious edema in 2 cases (4.7%). Forty-eight cases showed enhanced enhancement in 14 cases (29.2%) with irregular enhancement, 26 cases (54.2%) with nodular enhancement, and 15 cases (31.3%) with ring enhancement. Notch sign (100%), 23 cases (47.9%) showed signs of angiography, 10 cases (20.8%) of open-loop-like enhancement, 8 cases (16.7%) of eccentric nodules or mass-like enhancement, 6.3%), and see in it a low signal fissure sign. DWI showed high signal of different extents; Cho peak of 1H-MRS increased significantly, NAA peak decreased significantly, Cho / NAA = 2.11 ~ 28.37, both showed peak Lip height; . Conclusion Fully understand the magnetic resonance imaging and imaging features, can significantly improve the diagnostic accuracy of PCNS-DLBCL.