摘要
目的探讨多发性脑胶质瘤(MCG)与原发性中枢神经系统淋巴瘤(PCNSL)之间最有鉴别价值的MRI信号特点。方法收集经手术病理证实的MCG病人20例和PCNSL病人18例,病人均行MRI平扫及增强扫描检查。对比分析MCG和PCNSL的影像学表现特点。结果在20例MCG病人共计病灶60个,其中14个(23.33%)病灶位于海马和海马旁回,额叶、顶叶、颞叶和岛叶病灶数共计31个(51.67%);18例PCNSL病人共计病灶50个,其中39个(78.00%)病灶位于中线旁深部脑白质。MRI信号特点:MRI平扫MCG多表现为团块状、斑片状病灶,信号多不均匀,呈长T1WI、长T2WI信号,占位效应较显著;PCNSL多表现为结节状和团块状实性病灶,呈等或稍长T1WI、等或稍长T2WI信号,DWI像呈较均匀高信号,水肿和占位效应相对较轻。MRI增强扫描MCG病灶内部及病灶间的强化程度多不一致,以"环状"、"花环状"强化方式多见;PCNSL病灶多表现为均匀、一致的结节状、团块状明显强化,其中"握拳状"和"尖角状"强化方式为其典型特征。MCG病灶伴坏死、囊变、出血者多见,而PCNSL病灶伴坏死、囊变、出血者少见。结论 MCG和PCNSL的发病部位、信号特点和强化方式有各自的特异性,尤其是二者病灶的强化特点的不同可作为MCG和PCNSL之间较为准确、可靠的影像鉴别依据。
Objective To assess the most valuable signal characteristics of MRI in differential diagnosis of multiple cerebral gliomas （MCG） and primary central nervous system lymphoma （PCNSL）. Methods Twenty patients with MCG and 18 with PCNSL confirmed by surgery and pathology were enrolled in this study. A plain and enhanced scan was done in all of them. The features of MRI manifestations in MCG and PCNSL were compared and analyzed. Results In 20 cases of MCG, a total of 60 lesions were recorded, of which,14 （23.33%） were located at hippocampns and hippocampal gyrus, 31 （51.67%） at frontal, parietal, temporal and insular lobe; In 18 cases of PCNSL, 50 lesions were detected, of which, 39 （78.00%） were located at deep white matter near median line. Signal features on MRI： plain MRI revealed most of the MCG manifested as masses or patches, ha ving a hetero-long T1WI and T2WI signal, with an obvious mass effect; most of the PCNSL manifested as nodules or masses, having an iso-or-slightly long T1WI and T2WI signal, iso-high signal on DWI image, and having a relatively slight edema and mass effect. Enhanced MRI showed MCG having a hetero-enhancement inside or among the lesions, appearing as a ＇ring＇ or ＇flower shape＇ enhancement; while PCNSL having an obvious iso-enhancement, presenting a nodule or mass shape enhancement, of which, the ＇ fist sign＇ and ＇ angular sign＇ were its typical features. The lesions accompanied with necrosis, cystic degeneration and hemorrhage were much commonly seen in MCG than in PCNSL. Conclusion The diseased parts, signal characteristics and pattern of enhancement of MCG and PCNSL have their respective specificity, the difference of the features of enhancement, in particular, can be used as a reliable imaging prove in the differential diagnosis of MCG and PCNSL.
出处
《齐鲁医学杂志》
2015年第1期15-18,共4页
Medical Journal of Qilu
关键词
神经胶质瘤
中枢神经系统
淋巴瘤
磁共振成像
诊断
鉴别
glioma
central nervous system
lymphoma
magnetic resonance imaging
diagnosis, differential
