摘要
目的对于原发性中枢神经系统淋巴瘤(PCNSL)的特征性临床表现及影响预后相关因素进行探讨。方法回顾性总结并详细分析宁夏医科大学总医院神经外科2008年6月—2019年12月期间36例经病理检查明确为PCNSL患者的临床资料。包括患者的一般资料(性别、年龄、病程)、肿瘤状况(数量、水肿)、治疗方案(手术、术后放化疗)对患者生存期的影响。结果本组患者中男21例,女15例;年龄16~77岁,其中>60岁22例、≤60岁14例;病程≤3个月者29例,>3个月者7例。临床表现无特异性,脑脊液检查未发现肿瘤细胞。影像学检查示,肿瘤位于幕上者31例、幕下者2例、幕上及幕下均累及者3例;单发者27例,多发者9例。CT平扫示病灶中密度呈稍高者26例、略等者9例、明显增高者仅1例。MRI平扫示病灶中T1WI低信号、T2WI高信号;增强扫描示病灶中强化呈显著均匀者25例、强化呈不均匀者7例、强化呈环形伴囊变或坏死者4例,14例患者病灶呈现"脐凹征""尖角征""蝶翼征"等PCNSL的影像学特征表现。DWI示病灶周围水肿轻度者31例、中度者4例,重度者仅1例。MRS示19例患者出现Lip峰、6例患者出现Lip/Lac复合峰。手术方法中23例进行开颅肿瘤切除术、13例仅行活检术;术后行联合放疗+化疗者17例、单纯放疗者9例、单纯化疗者8例、未行任何后续治疗者2例。病理检查示Ki-67>70%者15例,Ki-67≤70%者21例。术后平均随访23.7个月,死亡27例,总体中位生存期为18.7个月。结论MRI增强扫描、DWI、MRS检查可以为PCNSL的早期诊断及鉴别诊断提供参考价值。患者的年龄、病灶的数量、治疗方案的选择及Ki-67增殖指数的高低是影响其预后的相关因素。
Objective To explore the characteristic clinical manifestations and prognostic factors of primary central nervous system lymphoma(PCNSL).Methods The clinical data of 36 patients with PCNSL confirmed by pathology in the Department of Neurosurgery,General Hospital of Ningxia Medical University from June 2008 to December 2019,were retrospectively summarized and analyzed in detail.It included the impact of the patient’-s general data(gender,age,course of disease),tumor status(quantity,edema),treatment plan(operation,postoperative radiotherapy and chemotherapy)on the patient’-s survival.Results There were 21 males and 15 females in this group.The age ranged from 16 to 77 years old,including 22 cases>60 years old and 14 cases≤60 years old.The course of disease was≤3 months in 29 cases and>3 months in 7 cases.The clinical manifestations were nonspecific,and no tumor cells were found in cerebrospinal fluid examination.Imaging examination showed that the tumors were located in 31 cases above the tentorium,2 cases below the tentorium,and 3 cases involved both above and below the tentorium;There were 27 single cases and 9 multiple cases.Plain CT scan showed slightly higher density in 26 cases,slightly equal in 9 cases and significantly increased in only 1 case.Plain MRI showed low signal on T1WI and high signal on T2WI.Contrast enhanced scanning showed that 25 cases had densely homogenious enhancement,7 had uneven enhancement,4 had ring enhancement with cystic change or necrosis,and 14 had the imaging features of PCNSL such as“umbilical concave sign”,“sharp angle sign”and“butterfly sign”.DWI showed that there were 31 cases of mild perifocal edema,4 of moderate edema and only 1 of severe edema.MRS showed that 19 patients had lip peak and 6 had Lip/Lac complex peak.Among the surgical methods,23 cases underwent craniotomy and 13 underwent biopsy only.17 cases received combined radiotherapy and chemotherapy,9 received radiotherapy alone,8 received chemotherapy alone,and 2 did not receive any subsequent treat
作者
刘诤
张鹏帅
宋子木
刘阳
刘帅
LIU Zheng;ZHANG Peng-shuai;SONG Zi-mu(Department of Neurosurgery,General Hospital of Ningxia Medical University,Yinchuan 750004,China)
出处
《临床神经外科杂志》
2021年第4期419-423,共5页
Journal of Clinical Neurosurgery
基金
宁夏医科大学优势学科群建设科研项目(XY201603)
宁夏高等学校科学研究项目(NGY2020036)。
关键词
原发性中枢神经系统淋巴瘤
MRI
弥散加权成像
KI-67
预后影响因素
primary central nervous system lymphoma
magnetic resonance imaging(MRI)
diffusion-weighted imaging
Ki-67
prognostic factor
