原发性中枢神经系统淋巴瘤在免疫功能正常或低下患者的MRI成像特征

doi:10.19871/j.cnki.xfcrbzz.2023.02.008

摘要/Abstract

摘要： 目的探讨原发性中枢神经系统淋巴瘤（PCNSL）在不同免疫功能患者中的MRI影像表现,提高对本病的认识并为临床诊断提供参考。方法回顾性分析2012年3月至2021年4月就诊于武汉大学中南医院经病理证实的30例PCNSL患者MRI影像资料。其中男性16例,女性14例,平均年龄（60.1±11.6）岁,包括5例AIDS患者,初次诊断时误诊率达33.3%。分析PCNSL患者的影像学表现。结果共收集30例PCNSL患者,病理分型均为弥漫大B细胞淋巴瘤,其中单发20例（66.6%）,多发10例（33.3%）;病灶位于幕上26例（86.7%）,幕下4例（13.3%）。病灶形态：类圆形13例（43.3%）,不规则状11例（36.7%）,分叶状6例（20.0%）。29例病灶周围明显水肿;T₁WI稍低信号25例（83.3%）;T₂WI稍高信号23例（76.7%）;增强扫描均匀强化14例（46.7%）,不均匀强化10例（33.3%）,环形强化6例（20.0%）;20例（66.6%）可见特殊征象。结论免疫功能正常PCNSL患者的病灶多呈类圆形,T₁WI增强表现为均匀强化,具有尖角征、脐凹征等特殊征象;而免疫功能低下PCNSL患者病灶多呈分叶状、不规则形,T₁WI增强呈环形强化,且相比免疫功能正常患者病灶具有更低的表观弥散系数（ADC）值。

关键词: 原发性中枢神经系统淋巴瘤, 获得性免疫缺陷综合征, 免疫功能, 磁共振成像

Abstract: Objective This study aims to investigate the MRI features of primary central nervous system lymphoma (PCNSL) in patients with different immune statuses, in order to enhance the understandings of PCNSL and offer clinical guidance for the diagnosis of PCNSL. Method A retrospective analysis was conducted on cases of primary central nervous system lymphoma confirmed by pathology at Zhongnan Hospital of Wuhan University. The sample included 16 males and 14 females, with an average age of (60.1±11.6) years. Additionally, 5 AIDS patients were included in the study. The misdiagnosis rate was 33.3%. The aim of the study was to analyze the imaging findings of PCNSL. Result A total of 30 patients with PCNSL were included in the study, all pathologically classified as diffuse large B-cell lymphoma. Of these patients, 20 cases (66.6%) presented as solitary lesions and 10 cases (33.3%) as multiple lesions, with 26 cases (86.7%) located in the supratentorial area and 4 cases (13.3%) in the infratentorial area. The lesions were found to be round in shape in 13 cases (43.3%), irregular in 11 cases (36.7%), and lobulated in 6 cases (20.0%). Peripheral edema was observed in 29 cases. On T₁WI, the lesions showed slightly hypo-signal in 25 cases (83.3%), while on T₂WI, the signal intensity was and slightly hyper-signal in 23 cases (76.7%). 14 cases (46.7%) exhibited homogeneous enhancement, 10 cases (33.3%) showed nonhomogeneous enhancement, and 6 cases (20.0%) showed circular enhancement. In addition, 20 cases (66.6%) exhibited special features. Conclusion The lesions of PCNSL in immunocompetent patients are mostly round in shape and typically exhibit a well-defined, markedly homogeneous enhancement with special features. In contrast, the lesions of PCNSL in immunocompromised patients are often lobulated and irregular in shape, and show ring enhancement with lower ADC values compared to those in immunocompetent patients.

Key words: Primary central nervous system lymphoma, Acquired immunodeficiency syndrome, Immunologic function, Magnetic resonance imaging

中图分类号:

R445.2

史延斌, 曾莹婷, 李逸攀, 宋璐, 鲁植艳. 原发性中枢神经系统淋巴瘤在免疫功能正常或低下患者的MRI成像特征[J]. 新发传染病电子杂志, 2023, 8(2): 39-44.

Shi Yanbin, Zeng Yingting, Li Yipan, Song Lu, Lu Zhiyan. MRI features of primary central nervous system lymphoma in patients with different immune statuses[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(2): 39-44.

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